Peridontics : 6/periodontal Pocket And Patterns Of Alveolar Bone Loss/ First Semester

Front 1

Pathogenesis-the periodontal pocket

Back 1

•Inflammatory change in gingival sulcus connective tissue wall.

•Destruction of collagen fibers apical to JE.

•Proliferation of apical cells of the JE along the root.

•Detachment of the coronal portion of JE from the root, due to increased PMN

Front 2

What are the two types of peridontal pockets ?

Back 2

•Gingival pocket
•Periodontal pocket

Front 3

Gingival Pocket

Back 3

•Gingival pocket—a deepening of the gingival sulcus as a result of inflammation

•There is NO apical migration of the JE.

•However, the coronal portion of the JE detaches from the tooth resulting in a slight increase in probing depth.

•In many cases, swelling of the gingival tissue also contributes to an increased probing depth.

Front 4

Healthy gingival suclus

Back 4

•In health, the JE attaches along its entire length to the enamel of the tooth.

Front 5

gingival pocket

Back 5

•In gingivitis, the coronal portion of the JE detaches from the tooth resulting in a slight increase in probing depth.

•In gingivitis, there usually is tissue swelling that also results in an increase in probing depth.

Front 6

Characteristics of Gingival Pockets

Back 6

There is no apical migration of JE.

•The JE remains coronal to the CEJ.

•Gingival pockets are also called pseudopockets (false)  No destruction of PDL fibers or alveolar bone.

Front 7

Periodontal pocket

Back 7

Periodontal pocket—a pathologic deepening of the gingival sulcus as a result of
–Apical migration of the junctional epithelium
–Destruction of periodontal ligament fibers
–Destruction of alveolar bone

Front 8

List the two types of peridontlal pockets

Back 8

•Suprabony periodontal pocket
•Infrabony periodontal pocket

Front 9

Suprabony Pocket

Back 9

•(supracrestal, supraalveolar)

•It occurs when there is horizontal bone loss.

•JE is located coronal to the crest of the alveolar bone (above the crest of bone).

Front 10

Infrabony Pocket

Back 10

•It occurs when there is vertical bone loss.
•JE is located apical to the crest of the alveolar bone (below the crest of bone).
•Base of the pocket is located within the cratered-out area of bone alongside the root surface.

Front 11

Attachment Loss

Back 11

•Attachment loss is the destruction of the fibers and alveolar bone that support the teeth.
•The base of a pocket may exhibit a very irregular pattern of tissue destruction.

Front 12

Disease Site

Back 12

•A disease site is an area of tissue destruction.

•A disease site may involve only one surface of the tooth, such as the distal surface, or several surfaces, or all four surfaces of the tooth.

Front 13

Active Disease Site

Back 13

•Active disease site—a disease site that shows continued apical migration of the junctional epithelium over time

•Example:
The deepest reading on the Distal surface of the mandibular right first molar:
3 months ago -->5 mm.
Today--> 6 mm

Front 14

Inactive Disease Site

Back 14

Inactive disease site—a disease site that is stable, with the attachment level of the JE remaining at the same level for a period of time

•For example, the deepest reading on the distal surface of the mandibular right first molar has remained at 5 mm for 12 months.

•Example, the deepest reading on the distal surface of the mandibular right first molar has remained at 5 mm for 12 months.

Front 15

Assessing Disease Sites

Back 15

•Disease activity should be assessed with a periodontal probe at regular intervals and recorded in the patient chart or computerized record.

Front 16

Characteristics of Periodontal Pockets

Back 16

•A periodontal pocket reflects the history of the disease.
•The presence of a periodontal pocket does not indicate necessarily that there is active disease at the site.

Front 17

Changes in Alveolar Bone

Back 17

Balance between bone formation and resorption.
(osteoblast and osteoclast)
•Regulated by local and systemic factors.
•Periodontal disease results in an imbalance between formation and destruction.

Front 18

Pathogenesis-bone resorption

Back 18

•Inflammatory infiltrate extends from gingiva to bone along the course of blood vessels.
•Less frequently, inflammation extends directly into PDL to the interdental septum.
•Facially and lingually, inflammation spreads along the outer periosteal surface of the bone and penetrates the marrow spaces.

Front 19

Rate of Bone Loss

Back 19

Loe et al. (1986): Srilankan tea workers, no oral hygiene, no treatment:
•Average rate of bone loss: 0.2mm/year (facially), 0.3mm/year (interproximally).
•Varies depending on the type of disease present. 3 groups:
1. rapid progression (8%):CAL 0.1-1.0mm/year.
2. moderate progression (81%):CAL 0.05-0.5mm/year.
3. minimal or no progression (11%):CAL 0.05-0.09mm/year

Front 20

alveolar bone loss in health

Back 20

In health, the crest of the alveolar bone is located approximately 2 (1.97) mm apical to (below) the CEJs.

Front 21

alveolar bone loss in gingivitis

Back 21

•In gingivitis, the crest of the alveolar bone is located approximately 2 mm apical to (below) the CEJs.
•JE is at its normal level

Front 22

alveolar bone loss in periodontitis

Back 22

•In periodontitis, bone destruction may be severe and progressive .

Front 23

Patterns of Bone Loss

Back 23

Two Patterns of Bone Loss :
•Horizontal bone loss
•Vertical bone loss

Front 24

Horizontal Pattern of Bone Loss

Back 24

•Is the most common pattern of bone loss
•Results in a fairly even, overall reduction in the height of bone

Results in a practically even overall reduction in bone height

Front 25

Vertical Pattern of Bone Loss

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•Is the less common pattern of bone loss
•Results in an uneven reduction in bone height
•Results in more rapid progression of bone loss next to the root surface

•Results in a trenchlike area of missing bone alongside the root

Front 26

Pathways of Inflammation into the Bone

Back 26

Pathway in Horizontal Bone Loss :

•Into the gingival connective tissue
•Into the alveolar bone
•Into the periodontal ligament

pathway of infalmmation in vertical bone loss :
•Occurs when the crestal periodontal ligament fibers are weakened and no longer act as an effective barrier to inflammation , so :
•Into the gingival connective tissue
•Directly into the PDL space
•Into the alveolar bone

Front 27

Bone Defects in Periodontitis

Back 27

Infrabony defects are classified on the basis of the number of osseous (bony) walls.

One-Wall Intrabony Defect

Two-Wall Intrabony Defect

Three-Wall Intrabony Defect

Interproximal Osseous Crater

Front 28

Assessment of furcation involvement

Back 28

Using a blunt probe inserted in a horizontal direction.
Assessment of buccolingual extension of the probe into the furcation area.
Naber’s probe: specially designed for assessment of furcation involvement.

Front 29

Furcation Involvement

Back 29

•Furcation involvement occurs on a multirooted tooth when the periodontal infection invades the area between and around the roots.
•This results in a loss of alveolar bone between the roots of the tooth.

Keep in mind that furcation involvement may be related to the presence of:
1.Enamel pearls.
2.Presence of accessory canals in furcaion area.