1. Dr Jamal Naim PhD in Orthodontics Pre-clinical Periodontics Periodontitis/ attachment loss

2. Periodontitis Periodontitis is the inflammation of a periodontium caused by specific microorganisms resulting in: attachment loss: progressive destruction of the PDL and alveolar bone with pocket formation recession or both

3. Attachment loss Pocket formation Bone loss Or both

4. The periodontal pocket

5. In HEALTHY gingiva, the tip of the probe remains within the junctional epithelium. The dense network of collagen fibres under the epithelium gives resistance to probing. There is no BOP, the gingiva is pushed by side. The periodontal pocket What makes the perio probe stop in healthy gingival tissues?

6. What makes the probe stop in gingivitis ? In gingivitis, the tip of the probe pushes through the junctional epithelium and penetrates the underlying inflamed connective tissue. The probe’s advance is stopped by the dense collagen fibres apical to the inflamed region. During & after probing, there is bleeding The periodontal pocket

7. Periodontal attachment loss? Measured from CEJ to sulcus or base of the pocket. Pocket depth? Measured from gingival crest (gingival margin) to base of the pocket Attachment loss

8. False pockets (by gingival overgrowth) are not attachment loss. Also called gingival pocket Attachment loss versus pseudo pocket

9. Periodontitis, deep pocket (10mm), periodontal attachment loss (10mm); destruction of gingival fibres, alveolar bone & periodontal ligament. Attachment loss versus true pocket Periodontal pocket

10. PD =8mm PAL=8mm PD =0mm PAL=8mm PD =11mm PAL=8mm recessionhyperplasia Attachment loss versus pocket formation

11. Different pocket depths with the same amount of attachment loss. The distance between the bottom of the sulcus (arrow) and the CEJ remains the same despite different pocket depths. Attachment loss versus pocket formation

12. Same pocket depth with different amounts of attachment loss. A: Gingival pocket with no recession. B: Periodontal pocket of similar depth as in A, but with some degree of attachment loss C: Pocket depth same as in A and B, but with still more attachment loss. Attachment loss versus pocket formation

13. A: Gingival pocket: with no recession – pseudo pocket B: Periodontal pocket: with some degree of attachment loss Classification of pockets

14. Types of periodontal pockets

15. Suprabony pocket = supracrestal = supralveolar pocket Infrabony pocket = subcrestal = intraalveolar pocket

16. A: simple pocket: one surface is involved B: compound pocket: more than one surface is involved C: complex pocket: (also twisted P.): originate on one surface and twist to involve another surface. Classification of pockets A B C

17. Clinical features of Pocket formation