PERIODONTAL PATHOLOGY

MSC.DDS. TRẦN THỊ PHƯƠNG THẢO

• The Periodontal Pocket

Túi nha chu

• Bone Loss and Patterns of Bone Destruction

Mất xương và các dạng hình thái phá huỷ xương contents
• Periodontal Response to External Forces

Đáp ứng nha chu với ngoại lực

• Masticatory System Disorders That Influence the

Periodontium

Rối loạn hệ thống nhai ảnh hưởng mô nha chu

• Periodontitis

Viêm nha chu

• Necrotizing Ulcerative Periodontitis

Viêm nha chu lở loét hoại tử

THE PERIODONTAL POCKET
A pathologic counterpart of sulcus.

The shallow fissure between the circumferential

gingiva and the tooth surface

deepens sulcus elongation without

periodontal tissue
destruction
 cementoenamel junction base of the pocket

A- Normal B- Suprabony pocket C- Infrabony pocket

Suprabony pockets, resulting from horizontal loss of bone Infrabony pockets, resul3ng from ver3cal, angular bone loss.
 Simple: Involving one tooth
surface
Compound: involving two and more
tooth surface
Spiral/ complex: Originates on
one tooth surface and twists
around the tooth to involve one
or more additional tooth
surfaces*

Simple pocket: One walled

Simple pocket: Two walled
Compound pocketSpiral pocket/complex pocket
 NATURE OF THE SOFT TISSUE WALL OF
THE POCKET:

EDEMATOUS POCKET: Inflammatory

fluid and cellular exudate
predominates, pocket wall is
bluish red, soft, spongy and
friable, with a smooth shiny
surface.

FIBROTIC POCKET: Relative

predominance of newly formed
connective tissue cells and
fibers. Pocket wall is firm and
pink

Periodontal Pockets as Healing Lesions

 The distance mesured from the gingival
Periodontal depth
margin to the base of the pocket

Clinical attachment The distance mesured from the CEJ to

loss (CAL) the base of the pocket
Pathogenesis of
periodontal pocket
• Formation of bacterial colony

• Infammatory process

• Migration of neutrophils

• Tissue destruction

• Activation of Neutrophils

• Pocket formation
Pathogenesis
of periodontal
pocket
 Normal Initial Precoce Established Advanced
lesion lesion lesion lesion

Parodontologie et dentisterie d’implantaire- Volume 1, Philippe Bouchard

 debris that consists principally of
microorganisms and their products
(enzymes, endotoxins, and other metabolic
products), gingival fluid, food remnants,
Tooth/Root salivary mucin, desquamated epithelial
cells, and leukocytes
surface wall

Gingival wall

Apical wall
Clinical Appearance of a
Periodontal Pocket
Correlations exist between some clinical and histopathologic features of the
Bluish-red discoloration
Gingival flaccidity
Smooth, shiny surface
Pitting on pressure
Pink and firm gingival walls
Bleeding on probing
Pain on probing
Pus discharge on digital
(finger) pressure
periodontal pocket
circulatory stagnation
destruction of gingival fibers and surrounding tissues.
atrophy of the epithelium and edema.
edema and degeneration of connective tissue fibers.
fibrotic changes that predominate over exudation and
degeneration
increased vascularity, the thinning and degeneration of the
epithelium, and the proximity of engorged vessels to the
inner surface.
the ulceration of the inner aspect of the pocket wall
suppurative inflammation of the inner wall.
 Periodontal abscess
• Localized purulent inflammation in the
periodontal tissues

Gingival abscess Periodontal abscess

Lateral Formation in
Extension of Incomplete After trauma
extension of a
infection removal of & endodontic
inflammation pocket+tortuo
from pocket calculus therapy
us course

Abscess in the soft-

Abscess in the supporting
tissue wall of a deep
periodontal tissues along the
periodontal pocket.
lateral aspect of the root.
Bone loss and bone loss pattern
Periodontitis Tooth loss

Destruction of
alveolar bone

systemic influences
local influences

Bone Bone
height Resorption >>>> Formation density
FACTORS CAUSING DESTRUCTION OF BONE

Trauma from occlusion (TFO)

vary according to the concomitant absence or presence of periodontal inflammation.

Systemic disorders

Osteoporosis and osteopenia,

Hyperparathyroidism
Leukemia
Langerhans cell histiocytosis
Immune deficiencies

Extension of gingival inflammation

(most common*)
 immune
response

Resistance
of the host width of the
Inflammation attached
gingiva

reactive
fibrogenesis
and
osteogenesis
A. Interproximal pathways:
1. From gingiva into bone;
2. From bone into
periodontal ligament;
3. From gingiva directly
into periodontal ligament.

B. Facial and lingual

pathways:
1. From gingiva along the
outer periosteum;

2. From periosteum into

bone;
3. From gingiva into the
periodontal ligament.
Bone Loss Patterns in Periodontal Disease.

1. Horizontal bone loss

2. Vertical or angular bone loss Anatomic Features

3. Bulbous bone contours Trauma from Occlusion
4. Reversed architecture Food Impaction

5. Ledges

6. Osseous crater

7. Furcation defects
 Bone Loss Patterns in Periodontal Disease.
1. Horizontal bone loss
 Bone Loss Patterns in
Periodontal Disease

1. Horizontal bone loss

2. Vertical or angular bone loss

Bone Loss Patterns in
Periodontal Disease.

1. Horizontal bone loss

2. Vertical or angular bone

loss

3. Bulbous bone contours

Bone Loss Patterns in
Periodontal Disease.

1. Horizontal bone loss

2. Vertical or angular bone loss

3. Bulbous bone contours

4. Reversed architecture
Bone Loss Patterns in
Periodontal Disease.

1. Horizontal bone loss

2. Vertical or angular bone loss

3. Bulbous bone contours

4. Reversed architecture

5. Ledges
Bone Loss Patterns in Periodontal Disease.

1. Horizontal bone loss

2. Vertical or angular bone loss

3. Bulbous bone contours

4. Reversed architecture

5. Ledges

6. Osseous crater
Bone Loss Patterns in Periodontal Disease.

1. Horizontal bone loss

2. Vertical or angular bone loss

3. Bulbous bone contours

4. Reversed architecture

5. Ledges

6. Osseous crater

7. Furcation defects
 Clinical case
• A 53-year-old male patient presented with the chief
complaint: “My gums constantly bleed when I brush and
I want a healthy mouth.” His last dental exam had
been 6 months earlier. Prior to that, he had
infrequent care for 5 years. Around 5 years ago, he
was diagnosed with hypertension and hyperlipidemia.
Oral hygiene was poor, with a plaque and bleeding
index of 70%. Generalized heavy plaque with moderate
to heavy supragingival and subgingival calculus was
noted.
 Question

The bone loss pattern observed on the maxillary left bicuspid mesial surface is:
a. Angular. b. Horizontal. c. Normal.

To assess furcation involvement for #26, what will be the ideal method?
a. Radiographic evaluation.
b. Clinical evaluation with a Nabers probe.
C. Surgical exposure and examination.
Based on the clinical and radiographic presentation, which furcation is most probably affected for
tooth #26?
a. Distal. b. Mesial. c. Buccal. d. Palatal