牙周病課件：松動的原因及處理方法

ToothMobilityToothMobilityToothMobilityPhysiologicToothMobilityITMSTMAdaptiveToothMobilityPathologicToothMobilityPhysiologicToothMobilitylimitedtoothmovementortoothdisplacementtheresilienceofanintactandhealthyperiodontiummoderateforceisappliedtothecrownofthetooth[1]500g,bucco-lmgualcrownexcursion,0.04-0.12mm[2]ToothMobility(TM)Curve[3]Directly,butnotlinearly,relatedtothemagnitudeoftheforceapplied.Mobility-relatedFactorstheperiodontiumdoesnotactsimplyasaspring"...theinteractionsoffibers,bloodvessels,cellsandinterstitialfluidintransmittingtheforcestothealveolarbone“[4]TMQualityoftheperiodontaltissueAnatomicalcharacteristicsNumber,shape，lengthandoftherootsIntrinsicelasticityoftheToothitselfIncreasedToothMobiiityPhysiologicphenomena：tootheruption，pregnancypathologicphenomena：occlusaltrauma,periodontitis,toothtrauma,periapicallesion,bruxism,…OcclusalTraumaaphaseofprogressiveandaphaseofstabilizedenlargementoftheperiodontalligamentspaceboneresorptionVasctilaralterationsanddegenerativephenomenaareducednumberofcollagenfibersinsertingPeriodontalDisease"...wasmainlytheresultoftheapicaldisplacementofthealveolarbonemarginandofthecorrespondingapicalshiftofthefulcrumofthemovementofthecrownoftheteethinthetoothmobilitymeasurements“[5]PeriodontalDiseasequantitativeandqualitativealterationsintheperiodontalligamentandsupralveolarsofttissuesbesidesthedisplacementoftherootwithinthealveolarsocket,alsothetransmissionoftheforcestothealveolarbone[6]TreatmentPrinciplesOcclusalTrauma“…Already1weekfollowingtherapy,alltreatedteethexhibitedasignificantreductionintoothmobilitydespitethefactthatnoimprovementhadoccurredinthegingivalcondition.”[7]“…10weeksafterthetraumahadbeendiscontinued(i)normaltoothmobility,(ii)normalwidthoftheligamentspace,(iii)reorganisationoftheperiodontalfibersand(iv)regenerationofthealveolarbonehadoccurred.”[8]TreatmentPrinciplesPeriodontalDisease“…Treatmentproceduresrestrictedtosupragingivaldebridementandresolutionofgingivitisfailtoreducetoothmobihtyinperiodontitispatients”[9]AtreatmentprocedurewhicheffectivelycontrolstheinflammatoryprocessinthestibmarginalperiodontaltissuesoftenalsoresultsinareductionofapathologicallyincreasedtoothmobilityTreatmentPrinciplesTreatmentplanExtractionBasictreatmentRe-evaluationSplintMeasuresOfClinicalAssesmentMiller:Ⅰ,Ⅱ,ⅢPeriotestReference[1]Lindhe,J,,Nyman,S,&Ericsson,I,(1989)Traumafromocclusion.In:Lindhe,J.Textbookofclinicaiperiodontology,2ndedition,Copenhagen:IVIunksgaard,ch,8.[2]Muhlemann,H,R,(1960)Tenyearsoftoothmobilitymeasurements.JournalofPeriodontology31,110-122.[3]Mahlemann,H,R,&Zander,H,A,(1954)Toothmobility(III),Themechanismoftoothmobility.JournalofPeriodontology25,128-137,[4]Wills,D.J.,Picton,D.&Davies,W.(1972)Aninvestigationoftheviscoelasticpropertiesoftheperiodontitiminmonkeys.JournalofPeriodontalResearch7,42-51.[5]Lindhe,J,&Nyman,S,(1989)Occlusaltherapy,in:Lindhe,J,(ed,):Textbookofclinicalperiodontology,2ndedition,IVIunksgaard,Copenhagen,ch,21,Reference[6]Muhlemann,H,R,(1967)Toothmobihty:areviewofclinicalaspectsandresearchfindings.JournalofPeriodontology38,686-705,[7]Vollmer,W.H.&Rateilschak,K.H.(1975)Influenceofocclusaladjustmentongingivitisandmobilityoftraumatizedteeth.JournalofClinicalPeriodontohgy2,,113-125.[8]Poison,A,,Meitner,S,&Zander,H,(1976b)Traumaandprogressionofmarginalperiodonlitisinsquirrelmonkeys,(IV),Reversibilityofbonelossduetotraumaaloneandtraumasuperimposeduponperiodontitis.JournalofPeriodontalRese