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An isolated periodontal pocket is a perplexing clinical entity that usually poses a diagnostic challenge to the oral health professional. Although periodontal pockets are easy to detect, they can be easily missed during a routine clinical examination. The broad range of aetiological factors that can result in an isolated periodontal pocket makes identifying the cause difficult. The aetiology can be as simple as an overhanging restoration or food impaction due to open interproximal contacts, to more complex and uncommonly occurring presentations, such a palato-radicular groove or cemental tears. Although previous classifications proposed by the American Academy of Periodontology and European Federation of Periodontology have discussed this topic under different headings, an explicit classification on isolated periodontal pockets based on aetiology is currently missing. Isolated periodontal pockets are easily undiagnosed, with associated cases presenting with substantial destruction necessitating complex multidisciplinary treatment. This article highlights the various causes of an isolated periodontal pocket, and provides a systematic and easy clinical aetiology-based classification. The proposed classification categorizes isolated periodontal pockets into those occurring due to: (1) developmental anomalies of the teeth; (2) iatrogenic causes; and (3) pathological conditions. Further studies are essential to validate this classification.
CPD/Clinical Relevance: Early detection of easily missed isolated periodontal pockets is of clinical value during initial screening to avoid delayed diagnosis and treatment.
Article
A comprehensive periodontal examination, with assessment of the risk factors, helps in identifying the extent of periodontitis (localized or generalized) and in determining the stage and grade of periodontitis.1 Measurement of pocket depth and clinical attachment loss using periodontal probes are the most important means to diagnose periodontitis.2 Periodontal pockets are easily detected in generalized periodontitis cases; however, in a few situations, periodontal pockets are associated only with an isolated tooth or a particular location on a tooth's surface. The detection of isolated periodontal pockets may be easily missed during initial screening or dismissed as having minimal diagnostic value, both by general dental practitioners and specialists.3 The aetiology of an isolated periodontal pocket can be restorative, endodontic, prosthodontic, periodontic or a combination of these, resulting in delayed diagnosis and treatment.3 Numerous individual case reports4 and short communications/letters to editors5 are published where the diagnostic significance of isolated periodontal pockets are discussed. Previous classifications proposed by the American Academy of Periodontology and the European Federation of Periodontology have broadly discussed this topic under different headings.6 Additionally, previous reviews have stressed prosthodontic considerations and the potential of the dental prosthesis with subgingival margins causing gingivitis and periodontitis.3,7 However, an explicit classification for isolated periodontal pockets is needed. The authors define an isolated periodontal pocket as a pathologically deepened gingival sulcus, or a periodontal pocket of more than 4 mm in depth with bleeding on probing in a localized area or site, with an aetiology unique to that site. This narrative review summarizes the relevant literature regarding isolated periodontal pockets, including their causes, commonly involved sites, and treatment. The review also proposes an aetiology-based classification for isolated periodontal pockets.
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