If the T Cell is unable to effectively deal with the infection and it becomes chronic, a more robust immune response may be required. There is, however, a persistence of the manifestations of acute inflammation. The inflammatory infiltrate in the Established Lesion occupies a greater area within the connective tissue, with more destruction of collagen matrix. Again, the junctional epithelium will attempt to occupy the space and wall-off the infection by migrating laterally and apically, resulting in early pocket formation. Another significant change from earlier stages of disease is the predominance of Ig producing Plasma Cells within the inflammatory infiltrate. Thus, an increase in extravascular immunoglobulins (antibodies) can now be detected within the connective tissue and junctional epithelium. These changes may be linked to one or more immune system events.
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