牙周病的主要癥狀和臨床病理-課件

牙周病的主要癥狀和臨床病理

（一）臨床病理一、牙齦炎癥和出血1.初期病損（initiallesion）

2.早期病損（earlylesion)3.確立期病損（establishedlesion)4.晚期病損（advancedlesion)1.牙齦出血（二）臨床表現(xiàn)2.色、形、質(zhì)的改變3.齦溝深度及附著水平?附著喪失（attachmentloss,AL）當(dāng)結(jié)合上皮與牙面的附著關(guān)系被破壞時，稱為附著喪失。

?測量方法：從CEJ到袋底的距離意義：代表了牙周支持組織的破壞程度。

?齦袋（假性牙周袋）：齦溝的加深是由于牙齦的腫脹或增生使齦緣位置向冠方移動，而結(jié)合上皮的位置并未向根方遷移，此為假性牙周袋，或稱為齦袋。

4齦溝液（GCF）二牙周袋形成1.結(jié)合上皮增殖、炎性浸潤（一）牙周袋形成的機理2.牙齦纖維破壞，結(jié)合上皮向根方增殖。3.隨著牙周袋的形成，更有利于菌斑的堆積，形成惡性循環(huán)。1.軟組織壁（二）牙周袋的病理2.根面壁

?結(jié)構(gòu)的改變：

?化學(xué)的改變3.袋內(nèi)容物1.根據(jù)牙周袋底與牙槽嵴頂?shù)奈恢藐P(guān)系分骨上袋（suprabonypocket）骨下袋（infrabonypocket）

（三）牙周袋的類型2.根據(jù)累及的牙面數(shù)，牙周袋可分為：簡單袋（simplepocket)

復(fù)合袋（compoundpocket)

復(fù)雜袋（complexpocket)三、牙槽骨吸收（一）牙槽骨吸收的臨床病理

1.炎癥

2.牙合創(chuàng)傷（二）牙槽骨吸收的機制1.水平型吸收（horizontalresorption）2.垂直型吸收（verticalresorption）一壁骨袋、二壁骨袋、三壁骨袋、四壁骨袋、混合壁袋3.凹坑狀吸收4.其它形式的骨變化（三）牙槽骨吸收的形式I度：牙槽骨吸收在牙根的頸1/3以內(nèi)（四）牙槽骨吸收的臨床表現(xiàn)II度：牙槽骨吸收超過根長1/3，但在2/3以內(nèi)III度：牙槽骨吸收占根長2/3以上四牙齒松動和移位1.牙槽骨吸收（一）牙齒松動2.牙合創(chuàng)傷3.牙周膜的急性炎癥4.牙周手術(shù)后5.女性激素水平改變1.牙周支持組織的破壞（二）牙齒病理性移位

2.牙合力的改變

牙周病的分類1.-why

世界臨床牙周病學(xué)專題討論會（1989年）

1999年AAP新分類Why??legalramifications?affectstreatmentplanandprognosis?forcommunicationwithpatients

History:?Lastclassificationsystemwasdevisedatthe1989WorldWorkshopinClinicalPeriodontology?Improvedunderstandingofetiologyofperiodontaldiseases?InclusionofgingivaldiseasesThe

Periodontium:supportingapparatusofthetoothanditsassociatedcomponents?alveolarbone?periodontalligament?cementum

?gingivalattachment

GingivalDiseases:Canoccuronaperiodontiumwithnoattachmentloss,oronaperiodontiumwithattachmentlossthatisnotprogressingDentalplaqueinducedNon-plaqueinducedGingivitis:

general

informationDEF’N:inflammationofthegivgivaubiquitousocclusionanalysismajorcause:accumulationofplaqueothercausestx:removalofthecausedoesn’tinevitablyleadtoperiodontitisGingivitis:pathology4stages:initial,early,established,advancedlesionSummary:PMNs,exudate,collagenbreakdown,plasmacells,proliferationofepitheliumMajorcause:accumulationofplaqueDentalplaque-inducedgingivaldiseasesI.Gingivitisassociatedwithdentalplaqueonlya.withoutotherlocalcontributingfactorsb.withlocalcontributingfactors

Dentalplaque-inducedgingivaldiseasesII.Gingivaldiseasesmodifiedbysystemicfactorsa.associatedwiththeendocrinesystem1.puberty-associatedgingivtis2.menstrualcycle-associatedgingivitis3.Pregnancy-associated4.diabetesmellitus-associatedgingivitisPeriodontitis-Definition:Inflammationinvolvingthegingivalunit(gingivaandalveolarmucosa)andextendingtotheperiodontalligament,alveolarbone,andcementum.Periodontitisinvolvesthelossofclinicalattachmentandradiographicevidenceofboneloss.Periodontitis-evidenceoflossofperiodontalattachmentpreviouslyclassifiedbyagenowclassifiedby“nature”ofdiseases:progression,clinicalpresentation,associatedsystemicdiseasesPeriodontitis:

classificationoverview

chronicperiodontitisaggressiveperiodontitisperiodontitisasamanifestationofsystemicdiseaseanecrotizingperiodontaldiseasesabscessesoftheperiodontiumperiodontitisassociatedwithendodonticlesionsdevelopmentaloracquireddeformatiesandconditionsChronicPeriodontitisformerly“adult”periodontitiscanbe:localizedorgeneralizedusuallyslowlyprogressivediseasemayhaveshortperiodsofrapidprogressionAggressivePeriodontitisformerly“earlyonset”periodontitiscanbe:localizedorgeneralizedhighlydestructiveformsofperiodontitisnotagedependment-diagnosisof“chronic”or“aggressive”dependsonmanycriteriaPeriodontitisasaManifestationofSystemicDiseasesAssociatedwithhaematologicaldisordersAssociatedwithgeneticdisordersNototherwisespecifiedNecrotizingPeriodontalDiseases1.Necrotizingulcerativegingivitis(NUG)2.Necrotizingulcerativeperiodontitis(NUP)AbscessesofthePeriodontium1.Gingivalabscess2.Periodontalabscess3.PericoronalabscessPeriodontitisassociatedwithEndodonticlesions-combinedperiodontic-endodonticlesionsDevelopmentalorAcquiredDeformatiesandConditionsA.Localizedtooth-relatedfactors1.Toothanatomicfactors2.Dentalrestorations/appliances3.Rootfractures4.CervicalrootresorptionandcementaltearsDevelopmentalorAcquiredDeformatiesandConditionsB.Mucogingivaldeformaties,conditions1.Gingival/softtissuerecession2.Lackofkeratinizedgingiva