The pathological periodontal pocket 1.The remaining tooth associated epithelium has been transformed to a pocket epithelium which is characterized by proliferations of sc rete peg formations and by an increased permeability for cells and fluid. In some areas the connective tissue is devoid of epithelium and there may be a direct contact between the pocket environment and the connective tissue. Lateral to the pocket epithelium in the connective tissue there is a dense accumulation of immune cells of various types.
Plasma cells predominate the immune infiltrates.
The collagen in the connective tissue close to the pocket epithelium is dissolved and there are relatively fewer fibroblasts compared to healthy periodontal conditions. The mechanisms behind the tissue damage appear to associate with the release of metalloproteinases from accumulated leukocytes and substances from the local immune process in the gingiva. The actual attachment loss is believed to be caused by the dissolution of collagen fibers which allow the epithelium to proliferate over the tooth surface. The progression rate of periodontal attachment loss varies. In some periods the destruction of the attachment is rapid in others more slow.