Article reprinted with permission of DVM360 –October 17,
2018. DVM360 MAGAZINE is a copyrighted publication of
Advanstar Communications inc. All rights reserved
DENTISTRY
The ABCs of Veterinary Dentistry
‘P’ is for
Periodontal Pockets
Do you know how to help patients with pockets? Get the lowdown on subgingival
cleaning, laser gingivectomy and locally applied antimicrobials and sealants.
By Jan Bellows, DVM, DAVDC, DABVP, FAVD
The gingival sulcus is a normal shallow space between
the marginal gingiva and the tooth. Its depth is
generally 0.5 to 1 mm in cats and 1 to 5 mm in dogs,
depending on the specific tooth and the size of the
patient.
A pocket is a pathologically deepened gingival sulcus
that occurs secondary to coronal movement of the
gingival margin (pseudopocket), apical movement
of the gingival attachment (periodontal pocket) or a
combination of both. The clinical or absolute pocket
depth is the distance from the gingival margin to the
base of a pocket (measured in millimeters).
Gingival recession refers to the displacement of the
gingival margin apical to the cementoenamel junction.
Periodontal pockets and pseudopockets can occur
together with gingival recession.
In this article, I will help you diagnose pockets and
determine the optimal treatment.
Suprabony and infrabony pockets
Suprabony pockets, also referred to as supra-alveolar
and supracrestal pockets, occur above the crest
of alveolar bone (Figure 1). The lateral wall of the
suprabony pocket consists of epithelial tissue. When
the suprabony pocket is less than 5 mm in a medium
or large dog, representing stage 2 periodontal
disease, treatment includes the removal of supra-
and subgingival plaque and calculus and closed root
planing. If the 5-mm pocket represents stage 3 or 4
periodontal disease, consider extraction. Treatment
may also include locally applied antibiotics. For
suprabony pockets greater than 5 mm without gingival
recession, coronal repositioned flap surgery can be
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performed by a practitioner with advanced training in
periodontal surgery.
Infrabony pockets, also referred to as intra-alveolar
pockets, occur when the pocket floor (epithelial
attachment) is apical to the alveolar bone (Figure 1).
The lateral wall will consist of epithelial tissue and
bone. Radiographically, infrabony pockets appear as
vertical bone loss along the root surface. However,
Normal
Gingival
enlargement
Sulcus
Tooth
Attached
gingiva
Alveolar
bone
Suprabony
pocket
Infrabony
pocket
Figure 1: Illustrations of normal and abnormal gingival
conditions. (Illustration by Roxy Townsend)