牙周病的预后和计划培训ppt课件

牙周病的预后和计划牙周病的预后和计划牙周病的预后和计划1第第第第 11 11 章章章章 PROGNOSTIC JUDGMENT PROGNOSTIC JUDGMENT TREATMENT PLANNINGTREATMENT PLANNING牙周病的预后和计划牙周病的预后和计划牙周病的预后和计划牙周病的预后和计划牙周病的预后和计划2第 11 章 PROGNOSTIC JUDGMENT TRPROGNOSISPROGNOSISPrognosisPrognosisForecastForecast预后预后预后预后预测预测预测预测牙周病的预后和计划3PROGNOSISPrognosisForecast预预预预预 后后后后 类类类类 型型型型骨吸收骨吸收 病病 因因 依从性依从性 全身病变全身病变极佳极佳无无可消除可消除良好良好无无良好良好轻轻较差较差中中难消除难消除差差明显明显/未控制未控制极差极差重重牙周病的预后和计划4预 后 类 型骨吸收病 因依从性全身病变极佳无可消除良好无整体预后依据整体预后依据病史、年龄病史、年龄疾病类型疾病类型 发展速度发展速度全身因素全身因素 环境因素环境因素患者意愿、依从性患者意愿、依从性菌斑菌斑 牙石量牙石量 解剖解剖牙周破坏程度牙周破坏程度牙周病的预后和计划5整体预后依据病史、年龄疾病类型 发展速度全身因素 环境因素有全身因素的牙龈炎有全身因素的牙龈炎有全身因素的牙龈炎有全身因素的牙龈炎全身因素控制后可以痊愈全身因素控制后可以痊愈全身因素控制后可以痊愈全身因素控制后可以痊愈龈炎的预后龈炎的预后龈炎的预后龈炎的预后单纯性龈炎：良好单纯性龈炎：良好单纯性龈炎：良好单纯性龈炎：良好牙周病的预后和计划6有全身因素的牙龈炎全身因素控制后可以痊愈龈炎的预后单纯性牙周炎的预后牙周炎的预后牙周炎的预后牙周炎的预后总预后总预后总预后总预后个别牙预后个别牙预后个别牙预后个别牙预后牙周病的预后和计划7牙周炎的预后总预后牙周病的预后和计划7牙周炎总预后牙周炎总预后牙周炎总预后牙周炎总预后对整个牙列预后的评估，内容包括对整个牙列预后的评估，内容包括对整个牙列预后的评估，内容包括对整个牙列预后的评估，内容包括1.1.牙周炎的类型牙周炎的类型牙周炎的类型牙周炎的类型单因素轻中度单因素轻中度单因素轻中度单因素轻中度CPCP，疗效易巩固疗效易巩固疗效易巩固疗效易巩固有全身因素的牙周炎，变化多样有全身因素的牙周炎，变化多样有全身因素的牙周炎，变化多样有全身因素的牙周炎，变化多样牙周病的预后和计划8牙周炎总预后对整个牙列预后的评估，内容包括 牙周炎的类型2.2.骨破坏的速度、程度、类型骨破坏的速度、程度、类型骨破坏的速度、程度、类型骨破坏的速度、程度、类型 3.3.局部因素消除情况局部因素消除情况局部因素消除情况局部因素消除情况:菌斑、根分叉问题、咬合菌斑、根分叉问题、咬合菌斑、根分叉问题、咬合菌斑、根分叉问题、咬合3.3.牙松动牙松动牙松动牙松动4.4.余留牙的数目、分布；余留牙的数目、分布；余留牙的数目、分布；余留牙的数目、分布；5.5.患者依从性患者依从性患者依从性患者依从性6.6.环境与行为因素环境与行为因素环境与行为因素环境与行为因素7.7.全身、遗传、年龄因素全身、遗传、年龄因素全身、遗传、年龄因素全身、遗传、年龄因素牙周病的预后和计划9骨破坏的速度、程度、类型 局部因素消除情况:牙周病的预后和计牙周炎个别牙预后牙周炎个别牙预后牙周炎个别牙预后牙周炎个别牙预后1.1.探诊深度、附着水平：探诊深度、附着水平：探诊深度、附着水平：探诊深度、附着水平：部位？程度？部位？程度？部位？程度？部位？程度？袋深浅不是决定的因素。袋深浅不是决定的因素。袋深浅不是决定的因素。袋深浅不是决定的因素。2.2.牙槽骨：牙槽骨：牙槽骨：牙槽骨：破坏部位、程度、根分叉病变；破坏部位、程度、根分叉病变；破坏部位、程度、根分叉病变；破坏部位、程度、根分叉病变；3.3.牙松动度：牙松动度：牙松动度：牙松动度：自限性？进行性牙松动？自限性？进行性牙松动？自限性？进行性牙松动？自限性？进行性牙松动？4.4.牙解剖：牙解剖：牙解剖：牙解剖：牙周病的预后和计划10牙周炎个别牙预后探诊深度、附着水平：牙周病的预后和计划10牙周病治疗计划牙周病治疗计划牙周病治疗计划牙周病治疗计划牙周病的预后和计划11牙周病治疗计划牙周病的预后和计划11总体目标总体目标总体目标总体目标1.1.控制菌斑、炎症控制菌斑、炎症控制菌斑、炎症控制菌斑、炎症2.2.合理的牙周组织形态合理的牙周组织形态合理的牙周组织形态合理的牙周组织形态纠正：牙周袋纠正：牙周袋纠正：牙周袋纠正：牙周袋 龈退缩龈退缩龈退缩龈退缩骨缺损骨缺损骨缺损骨缺损 牙松动牙松动牙松动牙松动牙齿及邻接关系牙齿及邻接关系牙齿及邻接关系牙齿及邻接关系牙周病的预后和计划12总体目标控制菌斑、炎症牙周病的预后和计划123.3.恢复牙周组织功能恢复牙周组织功能恢复牙周组织功能恢复牙周组织功能合理的咬合关系合理的咬合关系合理的咬合关系合理的咬合关系修复失牙修复失牙修复失牙修复失牙戒除不良习惯戒除不良习惯戒除不良习惯戒除不良习惯4.4.维持长期疗效防复发维持长期疗效防复发维持长期疗效防复发维持长期疗效防复发口腔卫生指导与菌斑控制口腔卫生指导与菌斑控制口腔卫生指导与菌斑控制口腔卫生指导与菌斑控制定期检查定期检查定期检查定期检查牙周病的预后和计划13恢复牙周组织功能合理的咬合关系修复失牙戒除不良习惯维持治疗程序治疗程序治疗程序治疗程序主要分为四个阶段主要分为四个阶段主要分为四个阶段主要分为四个阶段牙周病的预后和计划14治疗程序主要分为四个阶段牙周病的预后和计划14第一阶段第一阶段第一阶段第一阶段病因治疗病因治疗病因治疗病因治疗基础治疗基础治疗基础治疗基础治疗INITIAL THERAPYINITIAL THERAPY消除、控制：消除、控制：消除、控制：消除、控制：致病因素致病因素致病因素致病因素临床炎症临床炎症临床炎症临床炎症牙周病的预后和计划15第一阶段病因治疗基础治疗牙周病的预后和计划15包括下列方法：包括下列方法：包括下列方法：包括下列方法：1.1.自我控制菌斑的方法：自我控制菌斑的方法：自我控制菌斑的方法：自我控制菌斑的方法：刷牙方法和习惯；刷牙方法和习惯；刷牙方法和习惯；刷牙方法和习惯；牙线和牙签；牙线和牙签；牙线和牙签；牙线和牙签；菌斑显示剂检查菌斑显示剂检查菌斑显示剂检查菌斑显示剂检查漱口剂漱口剂漱口剂漱口剂牙周病的预后和计划16包括下列方法：自我控制菌斑的方法：牙周病的预后和计划162.2.拔除病牙拔除病牙拔除病牙拔除病牙3.3.洁治、刮治、根面平洁治、刮治、根面平洁治、刮治、根面平洁治、刮治、根面平整术整术整术整术4.4.药物控制感染药物控制感染药物控制感染药物控制感染5.5.咬合调整咬合调整咬合调整咬合调整牙周病的预后和计划17拔除病牙洁治、刮治、根面平整术牙周病的预后和计划176.6.治疗龋齿，矫正不良治疗龋齿，矫正不良治疗龋齿，矫正不良治疗龋齿，矫正不良修复体和食物嵌塞修复体和食物嵌塞修复体和食物嵌塞修复体和食物嵌塞7.7.处理牙周处理牙周处理牙周处理牙周-牙髓病变牙髓病变牙髓病变牙髓病变1 1stst阶段结束后阶段结束后阶段结束后阶段结束后4646周再评估，确认周再评估，确认周再评估，确认周再评估，确认疗效、依从性、治疗方案疗效、依从性、治疗方案疗效、依从性、治疗方案疗效、依从性、治疗方案牙周病的预后和计划18治疗龋齿，矫正不良修复体和食物嵌塞处理牙周-牙髓病变1st阶第二个阶段第二个阶段第二个阶段第二个阶段牙周手术治疗牙周手术治疗牙周手术治疗牙周手术治疗并非每个患者都要进行并非每个患者都要进行并非每个患者都要进行并非每个患者都要进行牙周病的预后和计划19第二个阶段牙周手术治疗牙周病的预后和计划19牙周手术目的牙周手术目的牙周手术目的牙周手术目的清除袋内感染物清除袋内感染物清除袋内感染物清除袋内感染物根面平整根面平整根面平整根面平整治疗牙槽骨缺损治疗牙槽骨缺损治疗牙槽骨缺损治疗牙槽骨缺损纠正龈及膜龈畸形纠正龈及膜龈畸形纠正龈及膜龈畸形纠正龈及膜龈畸形基础治疗后基础治疗后基础治疗后基础治疗后1313月全面评估月全面评估月全面评估月全面评估牙周病的预后和计划20牙周手术目的清除袋内感染物根面平整治疗牙槽骨缺损牙周病的手术的种类手术的种类手术的种类手术的种类1.1.牙龈切除术牙龈切除术牙龈切除术牙龈切除术切除肥大增生的牙龈切除肥大增生的牙龈病理性牙周袋病理性牙周袋牙周病的预后和计划21手术的种类牙龈切除术牙周病的预后和计划212.2.翻瓣术翻瓣术翻瓣术翻瓣术3.3.牙周骨手术牙周骨手术牙周骨手术牙周骨手术骨修整术、植骨骨修整术、植骨4.4.GTRGTR5.5.膜龈手术膜龈手术膜龈手术膜龈手术6.6.牙种植术牙种植术牙种植术牙种植术牙周病的预后和计划22翻瓣术牙周骨手术牙周病的预后和计划22第三阶段第三阶段第三阶段第三阶段修复治疗阶段修复治疗阶段修复治疗阶段修复治疗阶段并非每个患者都要进行并非每个患者都要进行2 2stst阶段后阶段后阶段后阶段后2323月进行月进行月进行月进行松牙固定松牙固定松牙固定松牙固定义齿修复、正畸义齿修复、正畸义齿修复、正畸义齿修复、正畸牙周病的预后和计划23第三阶段修复治疗阶段并非每个患者都要进行2st阶段后2第四阶段第四阶段第四阶段第四阶段疗效维护期疗效维护期疗效维护期疗效维护期1 1stst阶段后无论是否需要进行阶段后无论是否需要进行阶段后无论是否需要进行阶段后无论是否需要进行2 2、3 3阶段治疗即应当开始，内阶段治疗即应当开始，内阶段治疗即应当开始，内阶段治疗即应当开始，内容包括：容包括：容包括：容包括：牙周病的预后和计划24第四阶段疗效维护期1st阶段后无论是否需要进行2、3阶段治1.1.定期复查定期复查定期复查定期复查1.1.时间：一般时间：一般时间：一般时间：一般3636个月个月个月个月1 1次。次。次。次。2.2.内容：内容：内容：内容：PLIPLI、CICI、DIDI、GIGI、BOPBOP、PDPD、附着水平、牙松动度、附着水平、牙松动度、附着水平、牙松动度、附着水平、牙松动度、咬合情况、骨高度、密度、咬合情况、骨高度、密度、咬合情况、骨高度、密度、咬合情况、骨高度、密度、危险因素：危险因素：危险因素：危险因素：吸烟、全身疾病吸烟、全身疾病吸烟、全身疾病吸烟、全身疾病牙周病的预后和计划25定期复查 时间：一般36个月1次。牙周病的预后和计划252.2.复治复治复治复治根据发现的问题进行新根据发现的问题进行新根据发现的问题进行新根据发现的问题进行新一轮的治疗与疗效维护一轮的治疗与疗效维护一轮的治疗与疗效维护一轮的治疗与疗效维护牙周病的预后和计划26复治根据发现的问题进行新一轮的治疗与疗效维护牙周病的预后和计牙周治疗与院内感染牙周治疗与院内感染牙周治疗与院内感染牙周治疗与院内感染P P163-164163-164自学自学自学自学牙周病的预后和计划27牙周治疗与院内感染P163-164自学牙周病的预后和计划2OVEROVERTHANKSTHANKS牙周病的预后和计划28OVERTHANKS牙周病的预后和计划28牙周治疗与院内感染牙周治疗与院内感染牙周治疗与院内感染牙周治疗与院内感染交叉感染交叉感染交叉感染交叉感染 是医院内感染是医院内感染是医院内感染是医院内感染(NOSOCOMIAL(NOSOCOMIAL INFECTION)INFECTION)中的重要内容之一。中的重要内容之一。中的重要内容之一。中的重要内容之一。牙周病的预后和计划29牙周治疗与院内感染交叉感染 是医院内感染(NOSOCO医院感染的传播途径有：医院感染的传播途径有：医院感染的传播途径有：医院感染的传播途径有：直接接触直接接触直接接触直接接触病损、血液、体液、龈沟液、菌斑等；病损、血液、体液、龈沟液、菌斑等；病损、血液、体液、龈沟液、菌斑等；病损、血液、体液、龈沟液、菌斑等；吸人吸人吸人吸人含致病菌的气雾或飞溅物含致病菌的气雾或飞溅物含致病菌的气雾或飞溅物含致病菌的气雾或飞溅物(如血液、唾液等如血液、唾液等如血液、唾液等如血液、唾液等)；间接接触间接接触间接接触间接接触(污染器械、手、治疗台等传染媒体污染器械、手、治疗台等传染媒体污染器械、手、治疗台等传染媒体污染器械、手、治疗台等传染媒体)；手机手机手机手机供水管道中的存水返流人口中。供水管道中的存水返流人口中。供水管道中的存水返流人口中。供水管道中的存水返流人口中。牙周病的预后和计划30医院感染的传播途径有：直接接触病损、血液、体液、龈沟液、菌斑我国人群中我国人群中我国人群中我国人群中HBVHBV携带者约占携带者约占携带者约占携带者约占10%10%，艾滋病、梅毒等也有增多的趋势。艾滋病、梅毒等也有增多的趋势。艾滋病、梅毒等也有增多的趋势。艾滋病、梅毒等也有增多的趋势。牙周病的预后和计划31我国人群中HBV携带者约占10%，艾滋病、梅毒等也有增多的牙周诊室控制感染牙周诊室控制感染牙周诊室控制感染牙周诊室控制感染特点及原则特点及原则特点及原则特点及原则牙周病的预后和计划32牙周诊室控制感染特点及原则牙周病的预后和计划32病史采集及必要的检查病史采集及必要的检查病史采集及必要的检查病史采集及必要的检查重视询问全身疾病、传染性疾病。重视询问全身疾病、传染性疾病。重视询问全身疾病、传染性疾病。重视询问全身疾病、传染性疾病。“一致对待一致对待一致对待一致对待”原则原则原则原则universal precautionuniversal precaution即假定每位患者均有血源性传播的感染性疾病，即假定每位患者均有血源性传播的感染性疾病，即假定每位患者均有血源性传播的感染性疾病，即假定每位患者均有血源性传播的感染性疾病，诊治中一律严格防交叉感染，必要时作有关的诊治中一律严格防交叉感染，必要时作有关的诊治中一律严格防交叉感染，必要时作有关的诊治中一律严格防交叉感染，必要时作有关的化验检查。化验检查。化验检查。化验检查。牙周病的预后和计划33病史采集及必要的检查重视询问全身疾病、传染性疾病。“一 治疗器械的消毒治疗器械的消毒治疗器械的消毒治疗器械的消毒 按器械分类、分别用不同的方法消毒。按器械分类、分别用不同的方法消毒。按器械分类、分别用不同的方法消毒。按器械分类、分别用不同的方法消毒。“双消毒双消毒双消毒双消毒”：对使用过的器械应实行消毒液：对使用过的器械应实行消毒液：对使用过的器械应实行消毒液：对使用过的器械应实行消毒液浸泡、超声波或手工清洗、清水冲净干燥、高压灭浸泡、超声波或手工清洗、清水冲净干燥、高压灭浸泡、超声波或手工清洗、清水冲净干燥、高压灭浸泡、超声波或手工清洗、清水冲净干燥、高压灭菌或其他消毒方法。菌或其他消毒方法。菌或其他消毒方法。菌或其他消毒方法。大型设备大型设备大型设备大型设备如综合治疗台表面等，如综合治疗台表面等，如综合治疗台表面等，如综合治疗台表面等，可用可靠的消毒剂进行表面擦拭等。可用可靠的消毒剂进行表面擦拭等。可用可靠的消毒剂进行表面擦拭等。可用可靠的消毒剂进行表面擦拭等。牙周病的预后和计划34 治疗器械的消毒 按器械分类、分别用不同的方法消毒。应尽量使用已消毒的一次性用品应尽量使用已消毒的一次性用品应尽量使用已消毒的一次性用品应尽量使用已消毒的一次性用品(如检查器、吸唾器、注射器等如检查器、吸唾器、注射器等如检查器、吸唾器、注射器等如检查器、吸唾器、注射器等)。一人一机。一人一机。一人一机。一人一机。也可也可也可也可2%2%碘酊擦拭手机的各部位，酒精脱碘碘酊擦拭手机的各部位，酒精脱碘碘酊擦拭手机的各部位，酒精脱碘碘酊擦拭手机的各部位，酒精脱碘2 2次，次，次，次，也可用也可用也可用也可用1%1%碘附消毒。碘附消毒。碘附消毒。碘附消毒。牙周病的预后和计划35应尽量使用已消毒的一次性用品(如检查器、吸唾器、注射器等)保护性屏障保护性屏障保护性屏障保护性屏障口罩、帽子、防护眼镜、面罩、手套、工作服等口罩、帽子、防护眼镜、面罩、手套、工作服等口罩、帽子、防护眼镜、面罩、手套、工作服等口罩、帽子、防护眼镜、面罩、手套、工作服等治疗过程中，治疗过程中，治疗过程中，治疗过程中，污染的手套不得任意触摸周围的物品，污染的手套不得任意触摸周围的物品，污染的手套不得任意触摸周围的物品，污染的手套不得任意触摸周围的物品，治疗结束后治疗结束后治疗结束后治疗结束后应清洗手套上的血污后再摘除手套，书写病历等。应清洗手套上的血污后再摘除手套，书写病历等。应清洗手套上的血污后再摘除手套，书写病历等。应清洗手套上的血污后再摘除手套，书写病历等。牙周病的预后和计划36保护性屏障口罩、帽子、防护眼镜、面罩、手套、工作服等治疗尽量使用尽量使用尽量使用尽量使用脚控开关来调节治疗椅脚控开关来调节治疗椅脚控开关来调节治疗椅脚控开关来调节治疗椅照明灯扶手、开关等可用一次性照明灯扶手、开关等可用一次性照明灯扶手、开关等可用一次性照明灯扶手、开关等可用一次性覆盖物覆盖。覆盖物覆盖。覆盖物覆盖。覆盖物覆盖。一次性器械及覆盖一次性器械及覆盖一次性器械及覆盖一次性器械及覆盖物在用毕后应妥善、单独回收，物在用毕后应妥善、单独回收，物在用毕后应妥善、单独回收，物在用毕后应妥善、单独回收，作必要的销毁。作必要的销毁。作必要的销毁。作必要的销毁。牙周病的预后和计划37尽量使用脚控开关来调节治疗椅照明灯扶手、开关等可用一次性覆减少治疗椅周围空气中的细菌量减少治疗椅周围空气中的细菌量减少治疗椅周围空气中的细菌量减少治疗椅周围空气中的细菌量治疗前治疗前治疗前治疗前1%1%过氧化氢或过氧化氢或过氧化氢或过氧化氢或0.12%0.12%氯己定液鼓漱一氯己定液鼓漱一氯己定液鼓漱一氯己定液鼓漱一分钟，减少患者口中的细菌数量、治疗时的气分钟，减少患者口中的细菌数量、治疗时的气分钟，减少患者口中的细菌数量、治疗时的气分钟，减少患者口中的细菌数量、治疗时的气雾污染。雾污染。雾污染。雾污染。诊室内应有良好的诊室内应有良好的诊室内应有良好的诊室内应有良好的通风通风通风通风。不在诊室内饮水和进食。不在诊室内饮水和进食。不在诊室内饮水和进食。不在诊室内饮水和进食。牙周病的预后和计划38减少治疗椅周围空气中的细菌量治疗前1%过氧化氢或0.12%治疗台水管系统的消毒、治疗台水管系统的消毒、治疗台水管系统的消毒、治疗台水管系统的消毒、阻止水回流的装置；阻止水回流的装置；阻止水回流的装置；阻止水回流的装置；在每位患者治疗结束后，再空放水在每位患者治疗结束后，再空放水在每位患者治疗结束后，再空放水在每位患者治疗结束后，再空放水3030秒；秒；秒；秒；每天开始工作前再冲水一至数分钟。每天开始工作前再冲水一至数分钟。每天开始工作前再冲水一至数分钟。每天开始工作前再冲水一至数分钟。国外建议超声波洁牙机使用单独的净水储国外建议超声波洁牙机使用单独的净水储国外建议超声波洁牙机使用单独的净水储国外建议超声波洁牙机使用单独的净水储水器，并每周用水器，并每周用水器，并每周用水器，并每周用1:101:10的次氯酸钠液冲储水的次氯酸钠液冲储水的次氯酸钠液冲储水的次氯酸钠液冲储水系统，随后立即用蒸馏水冲洗。系统，随后立即用蒸馏水冲洗。系统，随后立即用蒸馏水冲洗。系统，随后立即用蒸馏水冲洗。牙周病的预后和计划39治疗台水管系统的消毒、阻止水回流的装置；在每位患者治疗结严格遵守控制医院感染的原则严格遵守控制医院感染的原则严格遵守控制医院感染的原则严格遵守控制医院感染的原则，使病原微生物的扩散和环境的污染使病原微生物的扩散和环境的污染使病原微生物的扩散和环境的污染使病原微生物的扩散和环境的污染降低到最小的程度。降低到最小的程度。降低到最小的程度。降低到最小的程度。保护患者和医务人员的利益安全。保护患者和医务人员的利益安全。保护患者和医务人员的利益安全。保护患者和医务人员的利益安全。牙周病的预后和计划40严格遵守控制医院感染的原则，使病原微生物的扩散和环境的污染Treatment can alter Treatment can alter prognosis.prognosis.Prognosis has different Prognosis has different connotations and nuances.connotations and nuances.The The patient has every rightpatient has every right to to know the answers to these know the answers to these questions.questions.牙周病的预后和计划41Treatment can alter prognosis.QuestionQuestion？Is my disease Is my disease fatalfatal?Will I Will I loselose my teeth?my teeth?Will your treatment Will your treatment helphelp me?me?What can you doWhat can you do to help me?to help me?牙周病的预后和计划42Question？Is my disease fatal?What are the What are the therapeutictherapeutic odds?odds?What are the What are the financialfinancial risks?risks?What are the What are the chanceschances that the that the treatment will be of treatment will be of benefitbenefit?牙周病的预后和计划43What are the therapeutic oddsPrognosis has Prognosis has three meaningsthree meanings in dentistry.in dentistry.牙周病的预后和计划44Prognosis has three meaningsDiagnostic prognosis.Diagnostic prognosis.What are evaluations of the course What are evaluations of the course of the disease of the disease without treatmentwithout treatment?What is the What is the status of the teeth nowstatus of the teeth nowWhat is the anticipated What is the anticipated future of future of these these teethteeth?牙周病的预后和计划45Diagnostic prognosis.What areTherapeutic prognosis.Therapeutic prognosis.Given Given the state of the artthe state of the art and and science of periodontics and the science of periodontics and the knowledge and skillknowledge and skill of the of the practitioner,what practitioner,what effecteffect will will periodontal treatment have on the periodontal treatment have on the course of the disease?course of the disease?牙周病的预后和计划46Therapeutic prognosis.Given tProsthetic prognosis.Prosthetic prognosis.What is the What is the forecastforecast for the for the success of the prosthetic success of the prosthetic restoration?restoration?Will the prosthesis be Will the prosthesis be therapeutic therapeutic or detrimentalor detrimental?What What specific needs dictatespecific needs dictate that it that it be prescribed?be prescribed?牙周病的预后和计划47Prosthetic prognosis.What is Judgement of the severity Judgement of the severity depends on depends on：1.pocket depth,1.pocket depth,2.degree of bone loss,2.degree of bone loss,3.tooth mobility,3.tooth mobility,4.crown-root ratio.4.crown-root ratio.牙周病的预后和计划48Judgement of the severity depegeneralized or localizedgeneralized or localizedThe distribution of diseaseThe distribution of disease：Inflammatory factors Inflammatory factors：Traumatic factorsTraumatic factors：牙周病的预后和计划49generalized or localizedThe diIndividual tooth Individual tooth therapeutic prognosistherapeutic prognosisincludes such factors as includes such factors as：PercentagePercentage of bone loss;of bone loss;Probing Probing depthdepth;牙周病的预后和计划50Individual tooth therapeutic pDistribution and typeDistribution and type of of bone lossbone lossPresence and severity ofPresence and severity of furcation involvementsfurcation involvementsMobilityMobility牙周病的预后和计划51Distribution and type of bone Crown-root ratioCrown-root ratioPulpal involvementPulpal involvementTooth position and occlusalTooth position and occlusalStrategic valueStrategic value牙周病的预后和计划52Crown-root ratioPulpal involvFollowing areFollowing are factors factors included in included in overall prognosis:overall prognosis:AgeAgeMedical statusMedical status牙周病的预后和计划53Following are factors includedIndividual tooth prognosesIndividual tooth prognoses (distribution and severity)(distribution and severity)Degree of involvementDegree of involvement,duration,duration,andand history history of the of the disease(rate of progression)disease(rate of progression)牙周病的预后和计划54Individual tooth prognoses (Patient cooperationPatient cooperationEconomic considerationsEconomic considerationsKnowledge and ability Knowledge and ability of the of the dentistdentistEtiologic factorsEtiologic factors牙周病的预后和计划55Patient cooperationEconomic cAccuracy and completeness Accuracy and completeness of the of the information gatheredinformation gathered at the examinationat the examinationDentists abilityDentists ability to recognize to recognize and eliminate or control the and eliminate or control the factors causing the diseasefactors causing the disease牙周病的预后和计划56Accuracy and completeness of tthe the patients abilitypatients ability and and determination in determination in maintaining the health of maintaining the health of the periodontium and teeth.the periodontium and teeth.牙周病的预后和计划57the patients ability and deteThe overall prognosis The overall prognosis depends on the prognoses depends on the prognoses of the individual teeth.of the individual teeth.牙周病的预后和计划58The overall prognosis depends PAST HISTORYPAST HISTORY (RATE OF DESTRUCTION)(RATE OF DESTRUCTION)牙周病的预后和计划59PAST HISTORY(RATE OF DESTRUCProbably the most Probably the most important factor in important factor in forecasting the future health forecasting the future health status of a dentition is status of a dentition is knowledge of its past health knowledge of its past health status.status.牙周病的预后和计划60Probably the most important faSpeedSpeed of breakdown under of breakdown under controls or uncontrols controls or uncontrols The The locationlocation,shapeshape and and depthsdepths of the pockets of the pockets牙周病的预后和计划61Speed of breakdown under contrTooth mobility can be Tooth mobility can be controlled or eliminated,the controlled or eliminated,the prognosis is better.prognosis is better.The greater the bone loss,The greater the bone loss,the poorer the prognosis.the poorer the prognosis.牙周病的预后和计划62Tooth mobility can be controllAs bone loss exceeds 50%,As bone loss exceeds 50%,the prognosis worsens the prognosis worsens rapidly.rapidly.The more irregular the The more irregular the bone loss,the poorer the bone loss,the poorer the prognosis.prognosis.牙周病的预后和计划63As bone loss exceeds 50%,the the pattern of bone lossthe pattern of bone loss:horizontal,vertical or horizontal,vertical or infrabony defects.infrabony defects.the age of the patient and the age of the patient and the etiologic factors involved the etiologic factors involved in the patients disease.in the patients disease.牙周病的预后和计划64the pattern of bone loss:horipoorer prognosis:poorer prognosis:tilted,drifted,or rotated,tilted,drifted,or rotated,hygiene difficult,elimination hygiene difficult,elimination of pockets impairedof pockets impaired牙周病的预后和计划65poorer prognosis:tilted,driperiodontal disease is periodontal disease is complicated by active complicated by active systemic factors systemic factors and traumatismand traumatism牙周病的预后和计划66periodontal disease is complicmorphologicmorphologic in nature and in nature and include the include the numbernumber and and distributiondistribution of teeth,tooth of teeth,tooth morphology,morphology,furcationfurcation involvement.involvement.牙周病的预后和计划67morphologic in nature and inclExtent of involvement.Extent of involvement.Is the furcation partially or Is the furcation partially or totally involved?totally involved?Status of bone support.Status of bone support.If the bone levels are If the bone levels are relatively sound,the effort to relatively sound,the effort to save may be justifiable.save may be justifiable.牙周病的预后和计划68Extent of involvement.Is theRoot length and crown-root Root length and crown-root ratio must be consideredratio must be considered牙周病的预后和计划69Root length and crown-root ratAngulation of root Angulation of root spread.spread.Health of Health of neighboring teeth.neighboring teeth.牙周病的预后和计划70Angulation of root spread.HeThe number and distribution The number and distribution of teeth presentof teeth presentcrown-root ratio,crown-root ratio,shape and number of the shape and number of the root root 牙周病的预后和计划71The number and distribution ofthe height of the alveolar the height of the alveolar crestcrestpersonal psychologic personal psychologic and sociologic,and sociologic,financial considerations.financial considerations.牙周病的预后和计划72the height of the alveolar creOTHER OTHER CONSIDERATIONS IN CONSIDERATIONS IN ESTABLISHING ESTABLISHING PROGNOSISPROGNOSIS牙周病的预后和计划73OTHER CONSIDERATIONS IN ESTABLThe performance of The performance of home home carecare is acceptable and the is acceptable and the cariescaries incidence is low,incidence is low,the prognosis is betterthe prognosis is better 牙周病的预后和计划74The performance of home care iThe prime consideration is The prime consideration is the the preservation of the preservation of the dentitiondentition as a functioning as a functioning unit.unit.牙周病的预后和计划75The prime consideration is theIn some instancesIn some instancesthe extraction of a single tooth the extraction of a single tooth will make the whole situation will make the whole situation untenable.untenable.In other situationsIn other situations isolated extractions will simplify isolated extractions will simplify the problem.the problem.牙周病的预后和计划76In some instancesthe extractiwhat is considered to be a what is considered to be a hopeless tooth.hopeless tooth.This will make treatment This will make treatment planning simpler.planning simpler.牙周病的预后和计划77what is considered to be a hopthe the characteristics characteristics of hopelessof hopeless periodontally involved teeth:periodontally involved teeth:牙周病的预后和计划78the characteristics of hopelesAssociated with intractable Associated with intractable painpain relieved,massive relieved,massive infection reduced by infection reduced by extractionextractionMobility beyond 3Mobility beyond 3 degrees degrees牙周病的预后和计划79Associated with intractable paFurcationFurcation involvement with involvement with little or no little or no interradicularboneinterradicularboneBone loss Bone loss beyond the apexbeyond the apexBone loss to the apex on Bone loss to the apex on one sideone side of the tooth of the tooth牙周病的预后和计划80Furcation involvement with litGeneralized Generalized circumferentialcircumferential bone lossbone loss to within 3 mm of to within 3 mm of the apexthe apexPocket depth to the apex Pocket depth to the apex without pulpal involvementwithout pulpal involvementVertical cracks or fracturesVertical cracks or fractures牙周病的预后和计划81Generalized circumferential boInaccessible Inaccessible perforationsperforations or or accessoryaccessory canalscanalsNumber and position of Number and position of remaining teeth precluding remaining teeth precluding prostheticprostheticExtreme Extreme cariescaries susceptibility susceptibility牙周病的预后和计划82Inaccessible perforations or aObjectivesObjectivesof treatmentof treatment牙周病的预后和计划83Objectivesof treatment牙周病的预后和Treatment goals should beTreatment goals should be evaluated in evaluated in every case.every case.牙周病的预后和计划84Treatment goals should be evalCan treatment objectives of a Can treatment objectives of a firm non-retractable gingiva firm non-retractable gingiva that that does not bleed be does not bleed be reached?reached?Can Can the pocket be the pocket be eliminated?eliminated?Will the Will the bone regenerate?bone regenerate?Can the Can the tooth be stabilized?tooth be stabilized?牙周病的预后和计划85Can treatment objectives of a Can Can tooth be restored?tooth be restored?Can the Can the patient tolerate the patient tolerate the treatment?treatment?牙周病的预后和计划86Can tooth be restored?Can theIf you believe the answers to If you believe the answers to these questions to be these questions to be yes,yes,then then plan and proceed with plan and proceed with the treatment.the treatment.If If“no,”“no,”alternative alternative treatment,compromise,or treatment,compromise,or extraction is advisable.extraction is advisable.牙周病的预后和