牙周病的主要症状和临床病理课件

牙周病的主要症状和临床病理牙周病的主要症状和临床病理 牙周病的主要症状和临床病理（一）临床病理一、牙龈炎症和出血一、牙龈炎症和出血 1.初期病损（initial lesion）2.早期病损（early lesion)3.确立期病损（established lesion)4.晚期病损（advanced lesion)（一）临床病理一、牙龈炎症和出血 1.初期病损（in1.牙龈出血（二）临床表现1.牙龈出血（二）临床表现2.色、形、质的改变2.色、形、质的改变牙周病的主要症状和临床病理课件3.龈沟深度及附着水平附着丧失（attachment loss,AL）当结合上皮与牙面的附着关系被破坏时，称为附着丧失。测量方法：从CEJ到袋底的距离 意义：代表了牙周支持组织的破坏程度。3.龈沟深度及附着水平附着丧失（attachment lo龈袋（假性牙周袋）：龈沟的加深是由于牙龈的肿胀或增生使龈缘位置向冠方移动，而结合上皮的位置并未向根方迁移，此为假性牙周袋，或称为龈袋。4 龈沟液（GCF）龈袋（假性牙周袋）：二 牙周袋形成1.结合上皮增殖、炎性浸润（一）牙周袋形成的机理2.牙龈纤维破坏，结合上皮向根方增殖。3.随着牙周袋的形成，更有利于菌斑的堆积，形成恶性循环。二 牙周袋形成1.结合上皮增殖、炎性浸润（一）牙周袋形成的1.软组织壁（二）牙周袋的病理2.根面壁 结构的改变：化学的改变3.袋内容物1.软组织壁（二）牙周袋的病理2.根面壁3.袋内容物1.根据牙周袋底与牙槽嵴顶的位置关系分 骨上袋（suprabony pocket）骨下袋（infrabony pocket）（三）牙周袋的类型2.根据累及的牙面数，牙周袋可分为：简单袋（simple pocket)复合袋（compound pocket)复杂袋（complex pocket)1.根据牙周袋底与牙槽嵴顶的位置关系分（三）牙周袋的类型2.牙周病的主要症状和临床病理课件牙周病的主要症状和临床病理课件三、牙槽骨吸收三、牙槽骨吸收（一）牙槽骨吸收的临床病理 1.炎 症 2.牙合创伤（二）牙槽骨吸收的机制（一）牙槽骨吸收的临床病理（二）牙槽骨吸收的机制1.水平型吸收（horizontal resorption）2.垂直型吸收（vertical resorption）一壁骨袋、二壁骨袋、三壁骨袋、四壁骨袋、混合壁袋3.凹坑状吸收4.其它形式的骨变化（三）牙槽骨吸收的形式1.水平型吸收（horizontal resorption）牙周病的主要症状和临床病理课件牙周病的主要症状和临床病理课件牙周病的主要症状和临床病理课件牙周病的主要症状和临床病理课件牙周病的主要症状和临床病理课件牙周病的主要症状和临床病理课件I度：牙槽骨吸收在牙根的颈1/3以内（四）牙槽骨吸收的临床表现II度：牙槽骨吸收超过根长1/3，但在2/3以内III度：牙槽骨吸收占根长2/3以上I度：牙槽骨吸收在牙根的颈1/3以内（四）牙槽骨吸收的临床表四四 牙齿松动和移位牙齿松动和移位1.牙槽骨吸收（一）牙齿松动2.牙合创伤3.牙周膜的急性炎症 4.牙周手术后5.女性激素水平改变四 牙齿松动和移位1.牙槽骨吸收（一）牙齿松动2.牙合创伤1.牙周支持组织的破坏（二）牙齿病理性移位 2.牙合力的改变1.牙周支持组织的破坏（二）牙齿病理性移位 2.牙合力的改变 牙周病的分类1.-why 世界临床牙周病学专题讨论会（1989年）1999年AAP新分类 牙周病的分类1.-whyWhy?legal ramifications affects treatment plan and prognosis for communication with patients Why?legal ramificationsHistory:Last classification system was devised at the 1989 World Workshop in Clinical Periodontology Improved understanding of etiology of periodontal diseases Inclusion of gingival diseasesHistory:Last classification The Periodontium:supporting apparatus of the tooth and its associated components alveolar bone periodontal ligament cementum gingival attachment The Periodontium:supporting aGingival Diseases:Can occur on a periodontium with no attachment loss,or on a periodontium with attachment loss that is not progressingDental plaque inducedNon-plaque inducedGingival Diseases:Can occur onGingivitis:general informationDEFN:inflammation of the givgivaubiquitousocclusion analysismajor cause:accumulation of plaqueother causestx:removal of the causedoesnt inevitably lead to periodontitisGingivitis:general informatioGingivitis:pathology4 stages:initial,early,established,advanced lesion Summary:PMNs,exudate,collagen breakdown,plasma cells,proliferation of epitheliumMajor cause:accumulation of plaqueGingivitis:pathology4 stages:Dental plaque-induced gingival diseasesI.Gingivitis associated with dental plaque only a.without other local contributing factors b.with local contributing factors Dental plaque-induced gingivalDental plaque-induced gingival diseasesII.Gingival diseases modified by systemic factors a.associated with the endocrine system 1.puberty-associated gingivtis 2.menstrual cycle-associated gingivitis 3.Pregnancy-associated 4.diabetes mellitus-associated gingivitisDental plaque-induced gingivalPeriodontitis-Definition:Inflammation involving the gingival unit(gingiva and alveolar mucosa)and extending to the periodontal ligament,alveolar bone,and cementum.Periodontitis involves the loss of clinical attachment and radiographic evidence of bone loss.Periodontitis-Definition:InfPeriodontitis-evidence of loss of periodontal attachment previously classified by age now classified by“nature”of diseases:progression,clinical presentation,associated systemic diseases Periodontitis-evidence of losPeriodontitis:classification overview chronic periodontitisaggressive periodontitisperiodontitis as a manifestation of systemic diseaseanecrotizing periodontal diseasesabscesses of the periodontiumperiodontitis associated with endodontic lesionsdevelopmental or acquired deformaties and conditionsPeriodontitis:classification Chronic Periodontitisformerly“adult”periodontitiscan be:localized or generalizedusually slowly progressive diseasemay have short periods of rapid progressionChronic Periodontitisformerly Aggressive Periodontitisformerly“early onset”periodontitiscan be:localized or generalizedhighly destructive forms of periodontitisnot age dependment-diagnosis of“chronic”or“aggressive”depends on many criteriaAggressive PeriodontitisformerPeriodontitis as a Manifestation of Systemic Diseases1.Associated with haematological disorders2.Associated with genetic disorders3.Not otherwise specifiedPeriodontitis as a ManifestatiNecrotizing Periodontal Diseases1.Necrotizing ulcerative gingivitis(NUG)2.Necrotizing ulcerative periodontitis(NUP)Necrotizing Periodontal DiseasAbscesses of the Periodontium1.Gingival abscess2.Periodontal abscess3.Pericoronal abscessAbscesses of the Periodontium1Periodontitis associated with Endodontic lesions-combined periodontic-endodontic lesionsPeriodontitis associated with Developmental or Acquired Deformaties and ConditionsA.Localized tooth-related factors 1.Tooth anatomic factors 2.Dental restorations/appliances 3.Root fractures 4.Cervical root resorption and cemental tearsDevelopmental or Acquired DefoDevelopmental or Acquired Deformaties and ConditionsB.Mucogingival deformaties,conditions 1.Gingival/soft tissue recession 2.Lack of keratinized gingiva 3.Decreased vestibular depth 4.Frenum/muscle position 5.Gingival excess 6.Abnormal colourDevelopmental or Acquired DefoDevelopmental or Acquired Deformaties and ConditionsC.Mucogingival deformaties and conditions on edentulous ridgesD.Occlusal traumaDevelopmental or Acquired Defo