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Periodontal Pocket

Oleh:
Rosita Nurdiani

FIGURE 20-1Illustration of pocket formation that


indicates expansion in two directions(arrows)from
the normal gingival sulcus(left)to the periodontal
pocket(right).

FIGURE 20-2Different types of periodontal pockets.A,Gingival


pocket. There is no destruction of the supporting periodontal
tissues.B,Suprabony pocket. The base of the pocket is coronal
to the level of the underlying bone. Bone loss is
horizontal.C,Intrabony pocket. The base of the pocket is apical
to the level of the adjacent bone. Bone loss is vertical.

FIGURE 20-3Classification of pockets


according to involved tooth
surfaces.A,Simple pocket.B,Compound
pocket.C,Complex pocket.

FIGURE
20-3Classification
of
pockets
according to involved tooth surfaces.A,Simple
pocket.B,Compound
pocket.C,Complex
pocket.

PATOGENESIS

FIGURE 20-5Interdental papilla with suprabony pockets on


proximal tooth surfaces. Note the densely inflamed connective
tissue, with the infiltrate extending between the collagen fibers
and the proliferating and ulcerated pocket epithelium.

FIGURE 20-6Low-power view of the base of the periodontal


pocket and apical area. Note the dense inflammatory
infiltrate on the area of destroyed collagen fibers and the
thin, fingerlike extension of epithelium covering the
cementum, which has been denuded of fibers.

FIGURE 20-6Low-power view of the base of the


periodontal pocket and apical area. Note the dense
inflammatory infiltrate on the area of destroyed collagen
fibers and the thin, fingerlike extension of epithelium
covering the cementum, which has been denuded of fibers.

HISTOPATOLOGI

FIGURE 20-8A,Lateral wall of a periodontal pocket showing


epithelial proliferative and atrophic changes as well as
marked inflammatory infiltrate and the destruction of
collagen fibers.B,Slightly apical view of the same patient
showing the shortened junctional epithelium.

FIGURE 20-9Base of periodontal pocket showing


extensive proliferation of lateral epithelium next to atrophic
areas, dense inflammatory infiltrate, remnants of destroyed
collagen fibers, and the junctional epithelium, which is
apparently in a less altered state than the lateral pocket
epithelium.

Bacterial Invasion

FIGURE 20-10Scanning electron micrograph of a section of pocket wall in


advanced periodontitis in a human specimen showing bacterial penetration
into the epithelium and connective tissue. Scanning electron microscope view
of the surface of the pocket wall(A),sectioned epithelium(B),and sectioned
connective tissue(C).Curved arrows point to areas of bacterial penetration into
the epithelium. Thick white arrows point to bacterial penetration into the
connective tissue through a break in the continuity of the basal
lamina.CF,Connective tissue fibers;D,accumulation of bacteria (rods, cocci,
and filaments) on the basal lamina;F,filamentous organism on the surface of
the epithelium. The asterisk points to coccobacillus in the connective tissue.

FIGURE 20-11Transmission electron micrograph of the


epithelium in the periodontal pocket wall showing bacteria in the
intercellular spaces.B,Bacteria;EC,epithelial cell;IS,intercellular
space;L,leukocyte about to engulf bacteria. (8000.)

Microtopography of
Gingival Wall

FIGURE 20-12Scanning electron frontal micrograph of the


periodontal pocket wall. Different areas can be seen in the
pocket wall surface.A,Area of quiescence;B,bacterial
accumulation;C,bacterialleukocyte interaction;D,intense
cellular desquamation. Arrows point to emerging leukocytes
and holes left by leukocytes in the pocket wall. (800.)