149 Questions
What is the periodontal pocket?
A deepened gingival sulcus due to apical displacement of the gingival attachment
What are the learning outcomes related to the periodontal pocket?
Describing the association of periodontal pocket histopathology with the clinic
How do the types of periodontitis differ?
In their natural history and progression
What causes deepening of the gingival sulcus?
Coronal movement of the gingival margin
What is the histopathology of the periodontal pocket associated with?
The clinic
What distinguishes attachment loss clinically?
Apical displacement of the gingival attachment
How can one define periodontal disease activity?
By assessing gingival bleeding upon probing
What is the importance of periodontal pocket in periodontal diseases?
It is a consequence of periodontal diseases.
What is the pathogenesis of the periodontal pocket?
Bacterial plaque accumulation at the gumline
What are the clinical features of an edematous pocket wall?
Bluish-red, soft, and spongy
What does the presence of pus in a periodontal pocket indicate?
Active inflammation
What is the principal component of the debris in periodontal pockets?
Microorganisms and their products
What is observed in the root surface wall of periodontal pockets with light and electron microscopy?
Areas of increased mineralization
What is the result of exposure to oral fluid and bacterial plaque on the cementum of root surfaces?
Remineralization
What characterizes active root caries lesions?
Yellowish or light-brown areas
What zone of a periodontal pocket is covered by attached plaque?
Semidestroyed connective tissue fibers
What characterizes periods of quiescence in periodontal disease activity?
Reduced inflammatory response and little or no loss of bone and connective tissue attachment
What does site specificity refer to in periodontal disease?
Destruction occurring on a few teeth or some aspects of some teeth at any given time
What is the effect of diseased root fragments when placed in tissue culture?
Prevent the attachment of human gingival fibroblasts in vitro
Which of the following is true about the relationship between attachment loss and pocket depth?
Different degrees of attachment loss depend solely on the location of the base of the pocket on the root surface
What is the characteristic type of bone loss in suprabony pockets?
Horizontal
How does periodontal abscess formation occur when trauma to the tooth or perforation of the lateral wall of the root in endodontic therapy happens?
The gingival wall shrinks, occluding the pocket orifice, resulting in a periodontal abscess in the sealed-off portion of the pocket
What is a periodontal abscess classified as when it occurs in the soft-tissue wall of a deep periodontal pocket?
Gingival abscess
What type of microorganisms have been reported to primarily colonize the periodontal abscess?
Gram-negative anaerobic rods
What causes pathologic changes in the pulp associated with periodontal pockets?
Spread of infection from periodontal pockets
In which type of pockets does the base lie coronal to the crest of the alveolar bone?
Suprabony pockets
What is meant by 'lateral periodontal cyst' as mentioned in the text?
A cyst that causes localized destruction of the periodontal tissues along a lateral root surface
What is found normally between the apical end of junctional epithelium and alveolar bone?
A relatively constant distance
What is generally but not always correlated with pocket depth?
Severity of bone loss
Which type of pocket occurs when the bottom of the pocket is coronal to the underlying alveolar bone?
Suprabony pocket
What clinical signs suggest the presence of periodontal pockets?
Gingival bleeding and suppuration
What has been described in human chronic periodontitis as invading the apical and lateral areas of the pocket wall?
Bacteria with predominant gram-negative cell walls
What microorganisms are mostly associated with healthy gingiva?
Few microorganisms, mostly coccoid cells and straight rods
What type of lesion are periodontal pockets?
Chronic inflammatory lesions
What do the clinical signs of periodontal pockets include?
Localized pain or pain “deep in the bone”
What is true about suprabony (supracrestal or supraalveolar) pockets?
The bottom of the pocket is coronal to the underlying alveolar bone
What is the initial lesion in the development of periodontitis?
Inflammation of the gingiva in response to a bacterial challenge
What is associated with healthy gingiva?
Increased numbers of coccoid cells and straight rods
What has been found in intercellular spaces of the epithelium in human chronic periodontitis?
Filaments, rods, and coccoid organisms with predominant gram-negative cell walls
Define the periodontal pocket.
Pathologically deepened gingival sulcus
What is the importance of periodontal pocket in periodontal diseases?
One of the most important clinical features
List the types of periodontal pockets.
Gingival, periodontal, suprabony, infrabony
How is periodontal pocket measured and how is it clinically distinguished from gingival pockets?
Measured with a periodontal probe; distinguished by the position of the base relative to the alveolar bone
List the histopathology of the periodontal pocket and its association with the clinic.
Associated with tissue destruction; pathogenesis explained
Define attachment loss and how it is clinically distinguished.
Loss of attachment between tooth and surrounding tissues; clinically distinguished by attachment level
Define periodontal disease activity and how it is clinically distinguished.
Activity of tissue destruction; distinguished by clinical signs of inflammation
What is the pathogenesis of the periodontal pocket?
Mechanisms of tissue destruction and healing
What is meant by site specificity in periodontal disease?
Different responses to therapy based on location
How do the types of periodontitis differ?
Differ in etiology, natural history, progression, and response to therapy
What are the two types of periodontal pockets?
Suprabony and Intrabony
What are the clinical signs that suggest the presence of periodontal pockets?
Bluish-red thickened marginal gingiva, bluish-red vertical zone from the gingival margin to the alveolar mucosa, gingival bleeding and suppuration, tooth mobility, diastema formation, and localized pain or pain 'deep in the bone.'
What types of microorganisms are associated with diseased gingiva?
Increased numbers of spirochetes and motile rods.
What has been described in human chronic periodontitis as invading the apical and lateral areas of the pocket wall?
Filaments, rods, and coccoid organisms with predominant gram-negative cell walls.
What are the areas noted in the soft-tissue wall of the periodontal pocket?
Areas of relative quiescence, areas of bacterial accumulation, areas of emergence of leukocytes, areas of leukocyte-bacteria interaction, areas of intense epithelial desquamation, areas of ulceration, and areas of hemorrhage.
What are the clinical features that suggest the presence of periodontal pockets?
Bluish-red thickened marginal gingiva, bluish-red vertical zone from the gingival margin to the alveolar mucosa, gingival bleeding and suppuration, tooth mobility, diastema formation, and localized pain or pain 'deep in the bone.'
What is the initial lesion in the development of periodontitis?
Inflammation of the gingiva in response to a bacterial challenge.
What are the mechanisms of tissue destruction triggered by bacterial plaque?
Host's cells produce proteinases, cytokines, and prostaglandins that can damage or destroy the tissues.
What has scanning electron microscopy permitted the description of in the soft-tissue wall of the periodontal pocket?
Areas of relative quiescence, areas of bacterial accumulation, areas of emergence of leukocytes, areas of leukocyte-bacteria interaction, areas of intense epithelial desquamation, areas of ulceration, and areas of hemorrhage.
What is the significance of periodontal pockets as healing lesions?
They are constantly undergoing repair, but complete healing does not occur due to the persistence of the bacterial attack.
What are the pathologic changes that may occur in the pulp due to the spread of infection from periodontal pockets?
Atrophic and inflammatory pulpal changes
What is the mean length of the distance between the apical extent of calculus and the alveolar crest in human periodontal pockets?
1.97 mm (±33.16%)
In what type of pockets does the base lie between the tooth and the bone, with bone loss being mostly vertical?
Infrabony pockets
What is the classification of a periodontal abscess that occurs in the soft-tissue wall of a deep periodontal pocket?
Abscess in the soft-tissue wall of a deep periodontal pocket
What are the microorganisms that have been reported to primarily colonize the periodontal abscess?
Primarily gram-negative anaerobic rods
What is the characteristic type of bone loss in suprabony pockets?
Horizontal bone loss
What is the term used to describe the localized destruction of periodontal tissues along a lateral root surface, most often in the mandibular canine–premolar area?
Lateral periodontal cyst
What is the result of incomplete removal of calculus during treatment of a periodontal pocket?
Formation of a periodontal abscess in the sealed-off portion of the pocket
What is the term used to describe the severity of attachment loss in pocket formation, which is generally but not always correlated with the depth of the pocket?
Attachment loss
What may cause painful symptoms or affect the response of the pulp to restorative procedures in the context of periodontal pockets?
Pathologic changes in the pulp
What are the clinical features of a fibrotic pocket wall?
More firm and pink
What is the principal component of the debris in periodontal pockets?
Microorganisms and their products
What are the zones found in the bottom of a periodontal pocket?
Cementum covered by calculus, attached plaque, unattached plaque, attachment of the junctional epithelium, and semidestroyed connective tissue fibers
What is the effect of diseased root fragments when placed in tissue culture?
Induce irreversible morphologic changes in the cells of the culture
What is the characteristic type of bone loss in suprabony pockets?
Horizontal
What causes pathologic changes in the pulp associated with periodontal pockets?
Bacterial products (e.g., endotoxins)
What characterizes active root caries lesions?
Well-defined yellowish or light-brown areas, frequently covered by plaque, and softened or leathery consistency on probing
What does site specificity refer to in periodontal disease?
Periodontal destruction does not occur in all parts of the mouth at the same time; rather, it occurs on a few teeth at a time or even only on some aspects of some teeth at any given time
What is the condition of the pocket wall when inflammatory fluid and cellular exudate predominate?
Bluish-red, soft, spongy, and friable, with a smooth, shiny surface
What are the components of purulent exudate in the periodontal pocket?
Living, degenerated, and necrotic leukocytes; living and dead bacteria; serum; and a scant amount of fibrin
The periodontal pocket is defined as a pathologically deepened gingival ______.
sulcus
Deepening of the gingival sulcus may occur as a result of coronal movement of the gingival margin, apical displacement of the gingival attachment, or a combination of the two ______.
processes
The periodontal pocket is one of the most important clinical features of ______ disease.
periodontal
The different types of periodontitis differ with regard to their etiology, natural history, progression, and response to ______.
therapy
The deepening of the gingival sulcus may occur as a result of coronal movement of the gingival margin, apical displacement of the gingival attachment, or a combination of the two ______.
processes
The periodontal pocket is one of the most important clinical features of ______ disease.
periodontal
The different types of periodontitis differ with regard to their etiology, natural history, progression, and response to ______.
therapy
The periodontal pocket, which is defined as a pathologically deepened gingival sulcus, is one of the most important clinical features of ______ disease.
periodontal
The periodontal pocket, which is defined as a pathologically deepened gingival sulcus, is one of the most important clinical features of periodontal ______.
disease
The periodontal pocket is defined as a pathologically deepened gingival ______.
sulcus
Sites of periodontal destruction are often found next to sites with little or no destruction. Therefore, the severity of periodontitis increases with the development of new disease sites and with the increased breakdown of existing sites. Pulp Changes Associated With Periodontal Pockets The spread of infection from periodontal pockets may cause pathologic changes in the ______.
pulp
Relationship of Attachment Loss and Bone Loss to Pocket Depth The severity of the attachment loss in pocket formation is generally but not always correlated with the depth of the pocket. This is because the degree of attachment loss depends on the location of the base of the pocket on the root surface, whereas pocket depth is the distance between the base of the pocket and the crest of the gingival margin. Pockets of the same depth may be associated with different degrees of attachment loss, and pockets of different depths may be associated with the same amount of ______ loss.
attachment
Area Between Base of Pocket and Alveolar Bone Normally, the distance between the apical end of the junctional epithelium and the alveolar bone is relatively constant. The distance between the apical extent of calculus and the alveolar crest in human periodontal pockets is most constant, having a mean length of 1.97 mm (±33.16%).The distance from attached plaque to bone is never less than 0.5 mm and never more than 2.7 mm. These findings suggest that the bone-resorbing activity induced by the bacteria is exerted within these distances. However, the finding of isolated bacteria or clumps of bacteria in the connective tissue and on the bone surface may modify these considerations. Relationship of ______ to Bone In infrabony pockets, the base of the pocket is apical to the crest of the alveolar bone, and the pocket wall lies between the tooth and the bone.
Periodontal Abscess A periodontal abscess is a localized purulent inflammation in the periodontal tissues. It is also known as a lateral abscess or a ______ abscess. Abscesses that are localized in the gingiva, that are caused by injury to the outer surface of the gingiva, and that do not involve the supporting structures are called gingival abscesses. Gingival abscesses may occur in the presence or absence of a periodontal ______.
What has been described in human chronic periodontitis as invading the apical and lateral areas of the pocket ______?
wall
What is observed in the root surface wall of periodontal pockets with light and electron ______?
microscopy
What is found normally between the apical end of junctional epithelium and ______ bone?
alveolar
What are the mechanisms of tissue destruction triggered by bacterial ______?
plaque
What are the clinical features of a fibrotic pocket ______?
wall
What characterizes active root caries ______?
lesions
In periodontal pockets, if the inflammatory fluid and cellular exudate predominate, the pocket wall is bluish-red, soft, spongy, and friable, with a smooth, shiny surface; at the clinical level, this is generally referred to as an ______ pocket wall.
edematous
If there is a relative predominance of newly formed connective tissue cells and fibers, the pocket wall is more firm and pink and clinically referred to as a ______ pocket wall.
fibrotic
Purulent exudate, if present in the patient, consists of living, degenerated, and necrotic leukocytes; living and dead bacteria; serum; and a scant amount of ______.
fibrin
The root surface wall of periodontal pockets often undergoes changes that are significant because they may perpetuate the periodontal infection, cause pain, and complicate periodontal treatment. Pathologic granules have been observed with light and electron microscopy, and they may represent areas of collagen degeneration or areas in which collagen fibrils have not been fully ______ initially.
mineralized
When root fragments from teeth with periodontal disease are placed in tissue culture, they induce irreversible morphologic changes in the cells of the culture. Such changes are not produced by normal roots. Diseased root fragments also prevent the in vitro attachment of human gingival fibroblasts, whereas normal root surfaces allow the cells to attach ______.
freely
Areas of increased ______ are probably a result of an exchange of minerals and organic components at the cementum saliva interface after exposure to the oral cavity.
mineralization
Exposure to oral fluid and bacterial plaque results in proteolysis of the embedded remnants of Sharpey fibers; the cementum may be softened, and it may undergo fragmentation and ______.
cavitation
Unlike enamel caries, root surface caries tend to progress around rather than into the tooth. Active root caries lesions appear as well-defined yellowish or light-brown areas; they are frequently covered by plaque, and they have a softened or ______ consistency on probing.
leathery
Periodontal pockets go through periods of exacerbation and quiescence as a result of episodic bursts of activity followed by periods of ______.
remission
Periods of quiescence are characterized by a reduced inflammatory response and little or no loss of bone and connective tissue ______.
attachment
Pockets can be classified as follows: Gingival pocket is formed by gingival enlargement without destruction of the underlying ______ tissues. The sulcus is deepened because of the increased bulk of the gingiva. Periodontal pocket produces destruction of the supporting ______ tissues, thereby leading to the loosening and exfoliation of the teeth. The remainder of this chapter refers to this type of pocket. Two types of ______ pockets exist, as follows: Suprabony (supracrestal or supraalveolar) occurs when the bottom of the pocket is coronal to the underlying alveolar bone. Intrabony (infrabony, subcrestal, or intraalveolar) occurs when the bottom of the pocket is apical to the level of the adjacent alveolar bone. With this second type, the lateral pocket wall lies between the tooth surface and the alveolar bone. Pockets can involve one, two, or more tooth surfaces, and they can be of different depths and types on different surfaces of the same tooth and on approximal surfaces of the same interdental space. Pockets can also be spiral (i.e., originating on one tooth surface and twisting around the tooth to involve one or more additional surfaces)These types of pockets are most common in furcation areas. Clinical Features Clinical signs that suggest the presence of ______ pockets include a bluish-red thickened marginal gingiva; a bluish-red vertical zone from the gingival margin to the alveolar mucosa; gingival bleeding and suppuration; tooth mobility; diastema formation; and symptoms such as localized pain or pain “deep in the bone.” The only reliable method of locating ______ pockets and determining their extent is careful probing of the gingival margin along each tooth surface. Pathogenesis The initial lesion in the development of periodontitis is the inflammation of the gingiva in response to a bacterial challenge. Changes involved in the transition from the normal gingival sulcus to the pathologic ______ pocket are associated with different proportions of bacterial cells in dental plaque. Healthy gingiva is associated with few microorganisms, mostly coccoid cells and straight rods. Diseased gingiva is associated with increased numbers of spirochetes and motile rods. However, the microbiota of diseased sites cannot be used as a predictor of future attachment or bone loss, because their presence alone is not sufficient for disease to start or progress. Bacterial Invasion Bacterial invasion of the apical and lateral areas of the pocket wall has been described in human chronic periodontitis. Filaments, rods, and coccoid organisms with predominant gram-negative cell walls have been found in intercellular spaces of the epithelium. Hillmann and colleagues have reported the presence of Porphyromonas gingivalis and Prevotella intermedia in the gingiva of aggressive periodontitis cases. Actinobacillus actinomycetemcomitans has also been found in the tissues.Bacteria may invade the intercellular space under exfoliating epithelial cells, but they are also found between deeper epithelial cells as well as accumulating on the basement lamina. Some bacteria traverse the basement lamina and invade the subepithelial connective tissue. Mechanisms of Tissue Destruction The inflammatory response triggered by bacterial plaque unleashes a complex cascade of events aimed at destroying and removing bacteria, necrotic cells, and deleterious agents. However, this process is nonspecific; in an attempt to restore health, the host’s cells (e.g., neutrophils, macrophages, fibroblasts, epithelial cells) produce proteinases, cytokines, and prostaglandins that can damage or destroy the tissues. Microtopography of the Gingival Wall Scanning electron microscopy has permitted the description of several areas in the soft-tissue (gingival) wall of the ______ pocket in which different types of activity take place. These areas are irregularly oval or elongated and adjacent to one another, and they measure about 50 to 200 μm. These findings suggest that the pocket wall is constantly changing as a result of the interaction between the host and the bacteria. The following areas have been noted: 1. Areas of relative quiescence, showing a relatively flat surface with minor depressions and mounds and occasional shedding of cells. 2. Areas of bacterial accumulation, which appear as depressions on the epithelial surface, with abundant debris and bacterial clumps penetrating into the enlarged intercellular spaces. These bacteria are mainly cocci, rods, and filaments, with a few spirochetes. 3. Areas of emergence of leukocytes, in which leukocytes appear in the pocket wall through holes located in the intercellular spaces. 4. Areas of leukocyte–bacteria interaction, in which numerous leukocytes are present and covered with bacteria in an apparent process of phagocytosis. Bacterial plaque associated with the epithelium is seen either as an organized matrix covered by a fibrinlike material in contact with the surface of cells or as bacteria penetrating into the intercellular spaces 5. Areas of intense epithelial desquamation, which consist of semiattached and folded epithelial squames, which are sometimes partially covered with bacteria 6. Areas of ulceration, with exposed connective tissue 7. Areas of hemorrhage, with numerous erythrocytes. The transition from one area to another could result from bacteria accumulating in previously quiescent areas and triggering the emergence of leukocytes and the leukocyte–bacteria interaction. Periodontal Pockets as Healing Lesions Periodontal pockets are chronic inflammatory lesions and thus are constantly undergoing repair. Complete healing does not occur because of the persistence of the bacterial attack, which continues to stimulate an inflammatory response, thereby causing degeneration of the new tissue elements formed during the continuous effort at repair.
periodontal
Pockets can be classified as follows: Gingival pocket is formed by gingival enlargement without destruction of the underlying periodontal tissues. The sulcus is deepened because of the increased bulk of the gingiva. ______ pocket produces destruction of the supporting periodontal tissues, thereby leading to the loosening and exfoliation of the teeth. The remainder of this chapter refers to this type of pocket.
Periodontal
Two types of ______ pockets exist, as follows: Suprabony (supracrestal or supraalveolar) occurs when the bottom of the pocket is coronal to the underlying alveolar bone. Intrabony (infrabony, subcrestal, or intraalveolar) occurs when the bottom of the pocket is apical to the level of the adjacent alveolar bone. With this second type, the lateral pocket wall lies between the tooth surface and the alveolar bone.
periodontal
Clinical signs that suggest the presence of ______ pockets include a bluish-red thickened marginal gingiva; a bluish-red vertical zone from the gingival margin to the alveolar mucosa; gingival bleeding and suppuration; tooth mobility; diastema formation; and symptoms such as localized pain or pain “deep in the bone.”
periodontal
The initial lesion in the development of ______ is the inflammation of the gingiva in response to a bacterial challenge. Changes involved in the transition from the normal gingival sulcus to the pathologic ______ pocket are associated with different proportions of bacterial cells in dental plaque.
periodontitis
Bacterial invasion of the apical and lateral areas of the pocket wall has been described in human chronic ______. Filaments, rods, and coccoid organisms with predominant gram-negative cell walls have been found in intercellular spaces of the epithelium.
periodontitis
The inflammatory response triggered by bacterial plaque unleashes a complex cascade of events aimed at destroying and removing bacteria, necrotic cells, and deleterious agents. However, this process is nonspecific; in an attempt to restore health, the host’s cells (e.g., neutrophils, macrophages, fibroblasts, epithelial cells) produce proteinases, cytokines, and prostaglandins that can damage or destroy the tissues. Mechanisms of Tissue Destruction
periodontal
Scanning electron microscopy has permitted the description of several areas in the soft-tissue (gingival) wall of the ______ pocket in which different types of activity take place.
periodontal
Periodontal pockets are chronic inflammatory lesions and thus are constantly undergoing ______. Complete healing does not occur because of the persistence of the bacterial attack, which continues to stimulate an inflammatory response, thereby causing degeneration of the new tissue elements formed during the continuous effort at repair.
repair
The periodontal pocket is defined as a pathologically deepened gingival ______.
sulcus
In which type of pockets does the base lie coronal to the crest of the alveolar bone?
suprabony
What characterizes active root caries ______?
lesions
What are the mechanisms of tissue destruction triggered by bacterial ______?
plaque
The periodontal pocket is one of the most important clinical features of ______ disease.
periodontal
What is the characteristic type of bone loss in suprabony pockets?
vertical
What characterizes periods of quiescence in periodontal disease activity?
inactivity
What are the clinical features of an edematous pocket wall?
swelling
What is found normally between the apical end of junctional epithelium and ______ bone?
alveolar
What causes deepening of the gingival sulcus?
movement
The condition of the soft-tissue wall of the periodontal pocket results from the interplay of the destructive and constructive tissue changes. Their balance determines clinical features such as color, consistency, and surface texture of the pocket wall. If the inflammatory fluid and cellular exudate predominate, the pocket wall is bluish-red, soft, spongy, and friable, with a smooth, shiny surface; at the clinical level, this is generally referred to as an edematous pocket wall. If there is a relative predominance of newly formed connective tissue cells and fibers, the pocket wall is more firm and pink and clinically referred to as a ______ pocket wall.
fibrotic
Purulent exudate, if present in the patient, consists of living, degenerated, and necrotic leukocytes; living and dead bacteria; serum; and a scant amount of ______.
fibrin
The periodontal pocket is defined as a pathologically deepened gingival ______.
sulcus
The root surface wall of periodontal pockets often undergoes changes that are significant because they may perpetuate the periodontal infection, cause pain, and complicate periodontal treatment. Pathologic granules have been observed with light and electron microscopy, and they may represent areas of collagen degeneration or areas in which collagen fibrils have not been fully ______ initially.
mineralized
Scanning electron microscopy has permitted the description of several areas in the soft-tissue (gingival) wall of the ______ pocket in which different types of activity take place.
periodontal
Periodontal pockets go through periods of exacerbation and quiescence as a result of episodic bursts of activity followed by periods of ______.
remission
Pathologic granules have been observed with light and electron microscopy, and they may represent areas of collagen degeneration or areas in which collagen fibrils have not been fully ______ initially.
mineralized
The periodontal pocket, which is defined as a pathologically deepened gingival sulcus, is one of the most important clinical features of periodontal ______ disease.
periodontal
Pus is a common feature of periodontal disease, but it is only a secondary sign. The presence of pus or the ease with which it can be expressed from the pocket merely reflects the nature of the ______ changes in the pocket wall.
inflammatory
Sites of periodontal destruction are often found next to sites with little or no destruction. Therefore, the severity of periodontitis increases with the development of new disease sites and with the increased breakdown of existing sites. Pulp Changes Associated With Periodontal Pockets The spread of infection from periodontal pockets may cause pathologic changes in the ______.
pulp
Sites of periodontal destruction are often found next to sites with little or no destruction. Therefore, the severity of periodontitis increases with the development of new disease sites and with the increased breakdown of existing sites. Pulp Changes Associated With Periodontal Pockets The spread of infection from periodontal pockets may cause pathologic changes in the pulp. Such changes may give rise to painful symptoms, or they may adversely affect the response of the pulp to restorative procedures. Involvement of the pulp in periodontal disease occurs through either the apical foramen or the lateral pulp canals after pocket infection reaches them. Atrophic and inflammatory pulpal changes occur in such cases (see Chapters 52 and 63). Relationship of Attachment Loss and Bone Loss to Pocket Depth The severity of the ______ loss in pocket formation is generally but not always correlated with the depth of the pocket. This is because the degree of ______ loss depends on the location of the base of the pocket on the root surface, whereas pocket depth is the distance between the base of the pocket and the crest of the gingival margin. Pockets of the same depth may be associated with different degrees of ______ loss, and pockets of different depths may be associated with the same amount of ______ loss. The severity of bone loss is generally but not always correlated with pocket depth. Extensive ______ and bone loss may be associated with shallow pockets if the ______ loss is accompanied by recession of the gingival margin, and slight bone loss can occur with deep pockets. Area Between Base of Pocket and Alveolar Bone Normally, the distance between the apical end of the junctional epithelium and the alveolar bone is relatively constant. The distance between the apical extent of calculus and the alveolar crest in human periodontal pockets is most constant, having a mean length of 1.97 mm (±33.16%).The distance from attached plaque to bone is never less than 0.5 mm and never more than 2.7 mm. These findings suggest that the bone-resorbing activity induced by the bacteria is exerted within these distances. However, the finding of isolated bacteria or clumps of bacteria in the connective tissue and on the bone surface may modify these considerations. However, the finding of isolated bacteria or clumps of bacteria in the connective tissue and on the bone surface may modify these considerations. Relationship of Pocket to Bone In infrabony pockets, the base of the pocket is apical to the crest of the alveolar bone, and the pocket wall lies between the tooth and the bone.
attachment
The severity of ______ loss is generally but not always correlated with pocket depth. Extensive attachment and ______ loss may be associated with shallow pockets if the attachment loss is accompanied by recession of the gingival margin, and slight ______ loss can occur with deep pockets.
bone
Infrabony ______, the base of the pocket is apical to the crest of the alveolar bone, and the pocket wall lies between the tooth and the bone.
pockets
Atrophic and inflammatory ______al changes occur in such cases (see Chapters 52 and 63).
pulp
The transition from the normal gingival sulcus to the pathologic ______ pocket are associated with different proportions of bacterial cells in dental plaque.
periodontal
The ______ between the apical extent of calculus and the alveolar crest in human periodontal pockets is most constant, having a mean length of 1.97 mm (±33.16%).
distance
In ______ pockets, the base is coronal to the crest of the alveolar bone, and the pocket wall lies coronal to the bone.
suprabony
The distance from attached ______ to bone is never less than 0.5 mm and never more than 2.7 mm.
plaque
In suprabony pockets, the alveolar crest gradually attains a more apical position in relation to the tooth, but it retains its general ______ and architecture.
morphology
Abscesses that are localized in the gingiva, that are caused by injury to the outer surface of the gingiva, and that do not involve the supporting structures are called ______ abscesses.
gingival
Pockets can be classified as follows: ______
Gingival pocket is formed by gingival enlargement without destruction of the underlying periodontal tissues. The sulcus is deepened because of the increased bulk of the gingiva. Periodontal pocket produces destruction of the supporting periodontal tissues, thereby leading to the loosening and exfoliation of the teeth. The remainder of this chapter refers to this type of pocket. Two types of periodontal pockets exist, as follows: Suprabony (supracrestal or supraalveolar) occurs when the bottom of the pocket is coronal to the underlying alveolar bone. Intrabony (infrabony, subcrestal, or intraalveolar) occurs when the bottom of the pocket is apical to the level of the adjacent alveolar bone. With this second type, the lateral pocket wall lies between the tooth surface and the alveolar bone. Pockets can involve one, two, or more tooth surfaces, and they can be of different depths and types on different surfaces of the same tooth and on approximal surfaces of the same interdental space. Pockets can also be spiral (i.e., originating on one tooth surface and twisting around the tooth to involve one or more additional surfaces)These types of pockets are most common in furcation areas. Clinical Features Clinical signs that suggest the presence of periodontal pockets include a bluish-red thickened marginal gingiva; a bluish-red vertical zone from the gingival margin to the alveolar mucosa; gingival bleeding and suppuration; tooth mobility; diastema formation; and symptoms such as localized pain or pain “deep in the bone.” The only reliable method of locating periodontal pockets and determining their extent is careful probing of the gingival margin along each tooth surface.
Test your knowledge of the soft-tissue wall conditions in the periodontal pocket and how they affect clinical features such as color, consistency, and texture. Understand the interplay of destructive and constructive tissue changes and their impact on pocket wall characteristics.
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