Supra bony true pocket
'Supra bony' true pocket. base of pocket is above crest of alveolar bone. associated with horizontal boneless
infra bony true pocket
'Infra bony' true pocket. base of pocket below crest of alveolar bone, association with vertical boneless
deepened gingival sulcus
False gingival pocketing
A pathologically altered or enlarged gingival sulcus confined to the gingiva
redness, bleeding, swelling (oedema), loss of stippling, pain?
False pocketing outcome 1
resolution (complete return to normal), if plaque and calculus removed, inflammation subsides and false pocket decreases
False pocketing outcome 2
continued exposure long term to plaque, inflammatory response continues, increased pocket depth, healing and destruction occurring simultaneously (chronic inflammation), fibrosis may occur, may or may not progress to periodontitis
caused by long term exposure to plaque, increased gingival fibres formed to aid repair, complete resolution is difficult if inflammation is long standing.
how to measure boneloss
measured in % from 1-2 mm below CEJ to apicies
True (periodontal) Pocket
a pathologically altered gingival sulcus, the base extends apically beyond CEJ and includes destruction of alveolar bone, PDL and cementum.
Identify true pocket
Probing (BPE) if probe goes past CEJ, radiographs- assess bone levels, loss of bone, pdl, cementum
plaque by products causing direct and indirect damage to gingival tissue. Endotoxins, exotoxins, bacterial enzymes, metabolic waste products
Aetiology pocketing and boneloss
Indirect damage from plaque by products which trigger immune response which have the potential to: Protect host by phagocytosis (GOOD), (BAD) WBC can damage surrounding tissue, WBC can activate chemical mediators which trigger tissue destruction- boneloss and ligament loss- T lymphocytes realise cytokines which stimulates osteoclasts, WBC can over eat and explodes causing enzymes to spill out that then damage its self.
loss of alveolar bone support.
chronic generalised periodontitis. inflammation spreads along neurovascular bundles in cancellous bone, destroys bone first then ligament. (plaque sat in sulcus for a long time, by products migrate into tissue, travel down blood and nerve vessels destroy bone and ligaments)
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