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Introduction
Pathologically deepened gingival sulcus
Periodontal pocket formation & alveolar bone destruction
Neutrophils constantly release granules containing acid hydrolases and neutral proteases (elastase & collagenase) These degrade collagen, proteoglycans & fibrinogen
Classification
Gingival Pocket Periodontal Pocket
Suprabony: (supracrestal/supra alveolar):
the bottom of the pocket is coronal to the underlying alveolar bone the bottom of the pocket is apical to the level of the adjacent alveolar bone. The lateral pocket wall lies between the tooth surface and the alveolar bone
Intrabony (infrabony):
Suprabony
Intrabony
On the facial and lingual surfaces, the periodontal ligament fibres beneath the pocket follow their normal horizontal-oblique course between the tooth and the bone
Clinical Features
Bluish-red, thickened marginal gingiva
Suppuration
Tooth mobility Diastema formation Localized pain
Pathogenesis
Inflammation in CT of gingival sulcus Degradation of CT Apical to JE collagen is destroyed, so area is occupied by inflammatory cells and edema Collagen loss occurs due to:
Collagenases and other enzymes (matrix metalloproteinases) produced by different cells Fibroblasts phagocytize collagen fibers
Pathogenesis
Therefore, apical cells of JE proliferate along the root & the coronal portion of JE detach from the root More PMNs invade the coronal portion of JE Sulcus deepening
Bacterial Invasion
Some bacteria have been shown to be able to invade the periodontal tissues: Porphyromonas gingivalis Aggrigatibacter actinomycetemcomitans Prevotella Intermedia
7. Areas of hemorrhage
Healing Pockets
Intact CT
Bone is a dynamic tissue The height and density of alveolar bone are maintained by an equilibrium, regulated by local and systemic influences, between:
Factors responsible for the conversion of gingivitis to periodontitis are not known at this time
Systemic disorders.
Combination.
The cellular composition of the infiltrated connective tissue also changes with increasing severity of the lesion. Fibroblasts and lymphocytes predominate in stage I gingivitis, whereas the number of plasma cells and blast cells increases gradually as the disease progresses. contained gingivitis: T lymphocytes are preponderant. As the lesion becomes a B-lymphocyte lesion, it becomes progressively destructive.
Spread of Inflammation from the Gingiva into the Supporting Periodontal Tissues: A- Interproximally;
* (1) From the gingiva into the bone * (2) From the bone into the periodontal ligament * (3) From the gingiva into the periodontal ligament
Periods of Destruction
Periodontal destruction occurs in an episodic, intermittent manner, with periods of inactivity or quiescence
The destructive periods result in loss of collagen and alveolar bone with deepening of the periodontal pocket
These include
o prostaglandins and their precursors o interleukins (ILl and IL-1) o tumor necrosis factor alpha (TNF- )
o prostaglandin E2 (PGE2)
In the absence o f inflammation, the changes caused by trauma from occlusion vary from;
Increased compression and tension of the periodontal ligament and increased osteoclasis of alveolar bone To necrosis of the periodontal ligament and bone and resorption of bone and tooth structure These changes are reversible and can be repaired if the offending forces are removed
A, Lower incisor with thin labial bone - bone loss can become vertical only when it reaches thicker bone in apical areas B, Upper molars with thin facial bone, where only horizontal bone loss can occur C, Upper molar with a thick facial bone, allowing for vertical bone loss
Exostoses
Exostoses are outgrowths of bon of varied sizes and shapes Palatal exostoses have been found in 40 % of human skulls
They can occur as small nodules, large nodules, sharp ridges, spike-like projections, or any combination of these
Different types of bone deformities can result from periodontal disease Their presence may be seen on radiographs
However, careful probing and surgical exposure of the areas is required to determine their exact conformation and dimensions
Osseous Craters
Osseous craters are concavities in the crest of the interdental bone confined within the facial and lingual walls
Reversed Architecture
Produced by loss of interdental bone, including the facial plates, lingual plates, or both, without concomitant loss of radicular bone, thereby reversing the normal architecture (- ve architecture) More common in the maxilla
Ledges