DENTISTRY
radiographs generally cannot be used to diagnose
pockets since they are soft tissue defects.
Infrabony defects can be further classified by the
number of walls remaining around the tooth—
information that can help inform treatment decisions.
An infrabony defect is shaped like a box without a
top. The bottom of the box is the base of the pocket.
One of the box’s sides is the tooth root. The three
remaining sides of the box are the potential walls of
the defect.
There is a direct relationship between the prognosis
of the therapy and the number of intact walls.
Three-wall defects that have progressed to stage 3
periodontal disease (25% to 50% support loss) have
the best prognosis for new attachment after advanced
periodontal surgery, bone grafts and stringent
home care. Two-wall defects lag behind in terms of
treatment prognosis, and one- and no-wall defects
carry the worst prognosis. For patients with stage 2
periodontal disease (less than 25% support loss) easier
treatment options can be effective (see below).
a histopathologic term, is an increased number
of normal cells in normal arrangement. Gingival
hypertrophy is an increase in the size of individual
cells. Gingival hyperplasia and hypertrophy can be
accurately diagnosed only microscopically. When
viewed clinically without histologic confirmation,
this condition is correctly referred to as gingival
enlargement.
The specific cause of gingival enlargement is unknown,
but there may be a genetic predisposition in boxers,
rottweilers, Great Danes, collies, Doberman pinschers,
Dalmatians and golden retrievers. Cyclosporine,
phenytoin and calcium channel blocker medications,
including amlodipine, have also been implicated
(Figure 2A). Elimination of these medications, coupled
with dental scaling, polishing and removal of the
enlarged gingiva (preserving at least 2 mm of attached
gingiva), usually results in a cure in cases caused by
medication (Figure 2B).
Gingival enlargement can lead to increased pocket
depths secondary to augmented gingival height versus
Gingival enlargement and resultant
pseudopockets
Gingival enlargement is an increase in the size or
thickness of the gingiva (Figure 1). Gingival hyperplasia,
Figure 3A.: Gingival enlargement secondary to amlodipine.
Figure 2A: Gingival enlargement resulting in pseudopockets.
(All images courtesy of Dr. Jan Bellows).
Figure 2B: A gingivectomy surrounding the left maxillary
third and fourth premolars and first molar is performed,
eliminating the pseudopockets
Figure 3B: Gingival enlargement resolved after discontinuation of
medication and laser-assisted gingivectomy.
Issue 04 | AUGUST 2017 | 27