牙周疾病的分类课件

牙周疾病的分类牙周疾病的分类（Classification of Periodontal Diseases）7/8/20241牙周疾病的分类牙周疾病的分类 分类原则分类原则1.按病理学分类按病理学分类2.按临床表现分类按临床表现分类3.按病因分类按病因分类4.混合性分类（病因与临床表现，病因与病理）混合性分类（病因与临床表现，病因与病理）发展史发展史随着人类对疾病的病因、病理的进一步认识和深入研究，牙周病随着人类对疾病的病因、病理的进一步认识和深入研究，牙周病的分类不断演变和改进。的分类不断演变和改进。2 Gottlieb分类分类 (1928)炎症性炎症性 不洁性脓漏不洁性脓漏（Schmutz pyorrhea）由口腔卫生不良所致由口腔卫生不良所致变性或萎缩变性或萎缩 弥漫性牙槽萎缩（弥漫性牙槽萎缩（diffuse alveolar atrophy)diffuse alveolar atrophy)由全身或代谢性原因所致由全身或代谢性原因所致 （为青少年牙周炎最早的名称）（为青少年牙周炎最早的名称）牙周脓漏牙周脓漏（paradental pyorrhea)paradental pyorrhea)3 Orban 分类（分类（1949）炎症状态炎症状态(inflammatory conditions)牙龈炎牙龈炎：急性或慢性；溃疡性或化脓性；局限性或全身性等。急性或慢性；溃疡性或化脓性；局限性或全身性等。牙周炎：牙周炎：单纯性（由牙龈炎发展而来）单纯性（由牙龈炎发展而来）复杂性（由牙周变性而来复杂性（由牙周变性而来）变性状态变性状态(degenerative conditions)牙龈变性（牙龈变性（gingivosis）：全身原因全身原因 牙周变性（牙周变性（periodontosis）：主要为全身原因主要为全身原因 萎缩状态萎缩状态(atrophic conditions)牙周萎缩牙周萎缩 牙周创伤牙周创伤(periodontal traumatism)原发性原发性 继发性继发性 牙龈增生牙龈增生(gingival hyperplasia)感染感染 内分泌失调内分泌失调 药物性药物性 特发性特发性4 Page&Schroeder 分类分类(1982)I.青春前期牙周炎青春前期牙周炎(prepubertal periodontitis,PPP)弥漫型弥漫型局限型局限型 II.青少年牙周炎青少年牙周炎(juvenile periodontitis,JP)III.快速进展性牙周快速进展性牙周(rapidly progresive periodontitis,RPP)IV.成人牙周炎成人牙周炎(adult periodontitis,AP)5 牙周疾病分类（牙周疾病分类（1989）世界临床牙周病学专题讨论会世界临床牙周病学专题讨论会 I.成人牙周炎（成人牙周炎（adult periodontitis,AP）II.早早发性牙周炎性牙周炎(early-onset periodontitis,EOP)青春前期青春前期(prepubertal periodontitis,PPP)局限型或广泛型局限型或广泛型 青少年青少年(juvenile periodontitis,JP)局限型或广泛型局限型或广泛型 快速进展性（快速进展性（rapidly progressive periodontitis,RPP）III.伴有全身疾病的牙周炎伴有全身疾病的牙周炎 （periodontitis associated with systemic diseases）IV.坏死坏死溃疡性牙周炎（性牙周炎（necrotizing ulcerative periodontitis）V.顽固性牙周炎固性牙周炎(refractory periodontitis)6（1989）分类）分类 的不足：的不足：在疾病范畴上存在着某些重复。在疾病范畴上存在着某些重复。缺乏牙龈病分类。缺乏牙龈病分类。过分强调了疾病的始发年龄及进展速度。过分强调了疾病的始发年龄及进展速度。缺乏分类标准，或分类标准不够明确。缺乏分类标准，或分类标准不够明确。7 牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（19991999）1999 international workshop for a classification of 1999 international workshop for a classification of periodontal diseases and conditions periodontal diseases and conditions .牙龈病牙龈病牙龈病牙龈病 (g (gingival diseasesingival diseases).慢性牙周炎慢性牙周炎慢性牙周炎慢性牙周炎 (chronic periodontitis)(chronic periodontitis).侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎 (aggressive periodontitis)(aggressive periodontitis).反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎 (periodontitis as a (periodontitis as a manifestation of systemic diseases)manifestation of systemic diseases).坏死性牙周病坏死性牙周病坏死性牙周病坏死性牙周病 (necrotizing periodontal diseases)(necrotizing periodontal diseases).牙周脓肿牙周脓肿牙周脓肿牙周脓肿 (abscesses of the periodontium)(abscesses of the periodontium)伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎 (periodontitis (periodontitis associated with endodontic lesions)associated with endodontic lesions).发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况 (developmental or (developmental or acquired deformities and conditions)acquired deformities and conditions)8 牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（19991999）1999 international workshop for a classification of 1999 international workshop for a classification of periodontal diseases and conditions periodontal diseases and conditions .牙龈病牙龈病牙龈病牙龈病 (g (gingival diseasesingival diseases).慢性牙周炎慢性牙周炎慢性牙周炎慢性牙周炎 (c (chronic periodontitishronic periodontitis).侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎 (aggressive periodontitis)(aggressive periodontitis).反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎 (periodontitis as a (periodontitis as a manifestation of systemic diseases)manifestation of systemic diseases).坏死性牙周病坏死性牙周病坏死性牙周病坏死性牙周病 (necrotizing periodontal (necrotizing periodontal diseases)diseases).牙周脓肿牙周脓肿牙周脓肿牙周脓肿 (abscesses of the periodontium)(abscesses of the periodontium)伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎 (periodontitis (periodontitis associated with endodontic lesions)associated with endodontic lesions).发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况 (developmental or (developmental or acquired deformities and conditions)acquired deformities and conditions)9.慢性牙周炎慢性牙周炎 Chronic Periodontitis成人牙周炎成人牙周炎adult periodontitis取消取消“成人牙周炎成人牙周炎adult periodontitis”的名称，因为的名称，因为这种牙周炎发生的年龄范围广，可见于乳牙和恒牙这种牙周炎发生的年龄范围广，可见于乳牙和恒牙牙列。虽然该病最常见于成人，但也可见于儿童和牙列。虽然该病最常见于成人，但也可见于儿童和青少年。青少年。“慢性牙周炎慢性牙周炎chronic periodontitis”这一名这一名称较成人牙周炎受年龄的限制少些。称较成人牙周炎受年龄的限制少些。10 牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（19991999）1999 international workshop for a classification of 1999 international workshop for a classification of periodontal diseases and conditions periodontal diseases and conditions .牙龈病牙龈病牙龈病牙龈病 (g (gingival diseasesingival diseases).慢性牙周炎慢性牙周炎慢性牙周炎慢性牙周炎 (chronic periodontitischronic periodontitis).侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎 (aggressive periodontitisaggressive periodontitis).反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎 (periodontitis as a (periodontitis as a manifestation of systemic diseases)manifestation of systemic diseases).坏死性牙周病坏死性牙周病坏死性牙周病坏死性牙周病 (necrotizing periodontal diseases)(necrotizing periodontal diseases).牙周脓肿牙周脓肿牙周脓肿牙周脓肿 (abscesses of the periodontium)(abscesses of the periodontium)伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎 (periodontitis (periodontitis associated with endodontic lesions)associated with endodontic lesions).发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况 (developmental or (developmental or acquired deformities and conditions)acquired deformities and conditions)11.侵袭性牙周炎侵袭性牙周炎Aggressive Periodontitis取消取消“青少年牙周炎、快速进展型牙周炎青少年牙周炎、快速进展型牙周炎”的名称，的名称，“侵袭性牙周炎侵袭性牙周炎Aggressive Periodontitis”Aggressive Periodontitis”较少受年较少受年龄的限制。牙周炎的分类系统不应基于患者的就诊年龄，龄的限制。牙周炎的分类系统不应基于患者的就诊年龄，而应根据临床、而应根据临床、X X线表现、病史和实验室发现来制定。线表现、病史和实验室发现来制定。12“局限型青少年牙周炎局限型青少年牙周炎localized juvenile periodontitis”，“局限型侵袭性牙周炎局限型侵袭性牙周炎Localized Aggressive Periodontitis”“广泛型青少年牙周炎广泛型青少年牙周炎generalized juvenile periodontitis”。“广泛型侵袭性牙周炎广泛型侵袭性牙周炎 Generalized Aggressive Periodontitis”13 牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（19991999）1999 international workshop for a classification of 1999 international workshop for a classification of periodontal diseases and conditions periodontal diseases and conditions .牙龈病牙龈病牙龈病牙龈病 (g (gingival diseasesingival diseases).慢性牙周炎慢性牙周炎慢性牙周炎慢性牙周炎 (c (chronic periodontitishronic periodontitis).侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎 (aggressive periodontitisaggressive periodontitis).反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎 (periodontitis as aperiodontitis as a manifestation of systemic diseases)manifestation of systemic diseases).坏死性牙周病坏死性牙周病坏死性牙周病坏死性牙周病 (necrotizing periodontal diseasesnecrotizing periodontal diseases).牙周脓肿牙周脓肿牙周脓肿牙周脓肿 (abscesses of the periodontium)abscesses of the periodontium)伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎 (periodontitis periodontitis associated with endodontic lesions)associated with endodontic lesions).发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况 (developmental or developmental or acquired deformities and conditions)acquired deformities and conditions)14 IV.IV.反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎 Periodontitis as a Manifestation of Periodontitis as a Manifestation of Systemic Diseases Systemic Diseases A.A.血液病血液病血液病血液病 associated with hematological associated with hematological disorders disorders B.B.遗传病遗传病遗传病遗传病 associated with genetic disorders associated with genetic disorders C.C.不明确不明确不明确不明确Not otherwise specified(NOS)Not otherwise specified(NOS)15 IV.IV.反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎 A.血液病血液病血液病血液病 associated with hematological associated with hematological B.disorders disorders 1.1.获得性中性白细胞减少症获得性中性白细胞减少症获得性中性白细胞减少症获得性中性白细胞减少症 acquired acquired neutropenia neutropenia 2.2.白血病白血病白血病白血病 leukemia leukemia 3.3.其它其它其它其它 other other 16 IV.IV.反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎 B.B.遗传病遗传病遗传病遗传病 associated with genetic disorders associated with genetic disorders 1.1.家族性周期性中性白细胞减少症家族性周期性中性白细胞减少症家族性周期性中性白细胞减少症家族性周期性中性白细胞减少症 familial and familial and cyclic neutropenia cyclic neutropenia 2.2.DownDown综合征综合征综合征综合征 Down syndrome Down syndrome 3.3.白细胞粘附缺陷综合征白细胞粘附缺陷综合征白细胞粘附缺陷综合征白细胞粘附缺陷综合征 leukocyte adhesion leukocyte adhesion deficiency syndrome deficiency syndrome 4.4.掌跖角化牙周破坏综合征掌跖角化牙周破坏综合征掌跖角化牙周破坏综合征掌跖角化牙周破坏综合征 Papillon-Lefevre Papillon-Lefevre syndrome syndrome 5.Chediak-Higashi syndrome 5.Chediak-Higashi syndrome 6.6.组织细胞增多综合征组织细胞增多综合征组织细胞增多综合征组织细胞增多综合征 histocytosis syndrome histocytosis syndrome 17 牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（19991999）1999 international workshop for a classification of 1999 international workshop for a classification of periodontal diseases and conditions periodontal diseases and conditions .牙龈病牙龈病牙龈病牙龈病 (g (gingival diseasesingival diseases).慢性牙周炎慢性牙周炎慢性牙周炎慢性牙周炎 (c (chronic periodontitishronic periodontitis).侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎 (aggressive periodontitisaggressive periodontitis).反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎 (periodontitis as a(periodontitis as a manifestation of systemic diseases)manifestation of systemic diseases).坏死性牙周病坏死性牙周病坏死性牙周病坏死性牙周病 (necrotizing periodontal diseases)(necrotizing periodontal diseases).牙周脓肿牙周脓肿牙周脓肿牙周脓肿 (abscesses of the periodontium)(abscesses of the periodontium)伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎 (periodontitis (periodontitis associated with endodontic lesions)associated with endodontic lesions).发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况 (developmental or (developmental or acquired deformities and conditions)acquired deformities and conditions)18 V.V.坏死性牙周病坏死性牙周病坏死性牙周病坏死性牙周病 Necrotizing Periodontal Diseases Necrotizing Periodontal Diseases A.A.坏死性溃疡性龈炎坏死性溃疡性龈炎坏死性溃疡性龈炎坏死性溃疡性龈炎 Necrotizing ulcerative gingivitis(NUG):Necrotizing ulcerative gingivitis(NUG):(limited to the gingiva)limited to the gingiva)B B.坏死性溃疡性牙周炎坏死性溃疡性牙周炎坏死性溃疡性牙周炎坏死性溃疡性牙周炎 Necrotizing ulcerative periodontitis(NUP):Necrotizing ulcerative periodontitis(NUP):(including the attachment apparatus)including the attachment apparatus)19 V.V.坏死性牙周病坏死性牙周病坏死性牙周病坏死性牙周病 专家们建议将专家们建议将“坏死性溃疡性龈炎坏死性溃疡性龈炎 Necrotizing Ulcerative gingivitis(NUG)”和和“坏死性溃疡性牙周炎坏死性溃疡性牙周炎Necrotizing Ulcerative Periodontitis(NUP)”集中称为集中称为“坏死性牙周病坏死性牙周病 Necrotizing Periodontal Diseases”，因为，因为 NUG和和NUP可能是同一种感染的不同阶段可能是同一种感染的不同阶段。近来尚无。近来尚无足够的资料可将它们区分为不同的疾病范畴，仅有的区足够的资料可将它们区分为不同的疾病范畴，仅有的区别在于前者感染局限于牙龈，后者累及所有的牙周组织。别在于前者感染局限于牙龈，后者累及所有的牙周组织。坏死性牙周病的分类主要基于临床表现坏死性牙周病的分类主要基于临床表现.20坏死性溃疡性牙周炎：坏死性溃疡性牙周炎：此种感染的特点为牙龈组织、牙此种感染的特点为牙龈组织、牙周膜和牙槽骨的坏死。常见于患有系周膜和牙槽骨的坏死。常见于患有系统性疾病的人，但并不局限于统性疾病的人，但并不局限于HIVHIV感感染、严重营养不良和免疫抑制性疾病。染、严重营养不良和免疫抑制性疾病。21 牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（19991999）1999 international workshop for a classification of 1999 international workshop for a classification of periodontal diseases and conditions periodontal diseases and conditions .牙龈病牙龈病牙龈病牙龈病 (g (gingival diseasesingival diseases).慢性牙周炎慢性牙周炎慢性牙周炎慢性牙周炎 (c (chronic periodontitishronic periodontitis).侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎 (aggressive periodontitisaggressive periodontitis).反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎 (periodontitis as a(periodontitis as a manifestation of systemic diseases)manifestation of systemic diseases).坏死性牙周病坏死性牙周病坏死性牙周病坏死性牙周病 (necrotizing periodontal diseases)(necrotizing periodontal diseases).牙周脓肿牙周脓肿牙周脓肿牙周脓肿 (abscesses of the periodontium)(abscesses of the periodontium)伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎 (periodontitis (periodontitis associated with endodontic lesions)associated with endodontic lesions).发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况 (developmental or (developmental or acquired deformities and conditions)acquired deformities and conditions)22 VI.VI.牙周脓肿牙周脓肿牙周脓肿牙周脓肿 Abscesses of the Periodontium Abscesses of the Periodontium A.牙龈脓肿牙龈脓肿 Gingival abscess B.牙周脓肿牙周脓肿 Periodontal abscess C.冠周脓肿冠周脓肿 Pericoronal abscess 23 牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（19991999）1999 international workshop for a classification of 1999 international workshop for a classification of periodontal diseases and conditions periodontal diseases and conditions .牙龈病牙龈病牙龈病牙龈病 (g (gingival diseasesingival diseases).慢性牙周炎慢性牙周炎慢性牙周炎慢性牙周炎 (c (chronic periodontitishronic periodontitis).侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎 (aggressive periodontitisaggressive periodontitis).反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎 (periodontitis as a(periodontitis as a manifestation of systemic diseases)manifestation of systemic diseases).坏死性牙周病坏死性牙周病坏死性牙周病坏死性牙周病 (necrotizing periodontal diseases)(necrotizing periodontal diseases).牙周脓肿牙周脓肿牙周脓肿牙周脓肿 (abscesses of the periodontium)(abscesses of the periodontium)伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎 (periodontitis (periodontitis associated with endodontic lesions)associated with endodontic lesions).发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况 (developmental or (developmental or acquired deformities and conditions)acquired deformities and conditions)24VIIVII伴牙体牙髓病损的牙周炎伴牙体牙髓病损的牙周炎伴牙体牙髓病损的牙周炎伴牙体牙髓病损的牙周炎 Periodontitis Associated With Endodontic LesionsPeriodontitis Associated With Endodontic Lesions 牙周牙髓联合病损牙周牙髓联合病损牙周牙髓联合病损牙周牙髓联合病损 combined periodontal-endodontic lesioncombined periodontal-endodontic lesion25 牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（牙周疾病和状况的国际新分类（19991999）1999 international workshop for a classification of 1999 international workshop for a classification of periodontal diseases and conditions periodontal diseases and conditions .牙龈病牙龈病牙龈病牙龈病 (g (gingival diseasesingival diseases).慢性牙周炎慢性牙周炎慢性牙周炎慢性牙周炎 (c (chronic periodontitishronic periodontitis).侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎 (aggressive periodontitisaggressive periodontitis).反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎 (periodontitis as a(periodontitis as a manifestation of systemic diseases)manifestation of systemic diseases).坏死性牙周病坏死性牙周病坏死性牙周病坏死性牙周病 (necrotizing periodontal necrotizing periodontal diseasesdiseases).牙周脓肿牙周脓肿牙周脓肿牙周脓肿 (abscesses of the periodontium)abscesses of the periodontium)伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎 (periodontitis periodontitis associated with endodontic lesions)associated with endodontic lesions).发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况 (developmental or (developmental or acquired deformities and conditions)acquired deformities and conditions)26 VIII.VIII.发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况 Developmental or Acquired Deformities and Developmental or Acquired Deformities and ConditionsConditions A A促进菌斑性龈病促进菌斑性龈病促进菌斑性龈病促进菌斑性龈病/牙周炎的局部牙因素牙周炎的局部牙因素牙周炎的局部牙因素牙周炎的局部牙因素 localized tooth-related factors that modify or predisposelocalized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis to plaque-induced gingival diseases/periodontitis B.B.膜龈异常和状况膜龈异常和状况膜龈异常和状况膜龈异常和状况 mucogingival deformities and conditions around teeth mucogingival deformities and conditions around teeth C C无牙嵴膜龈异常和状况无牙嵴膜龈异常和状况无牙嵴膜龈异常和状况无牙嵴膜龈异常和状况 Mucogingival deformities on edentulous ridges Mucogingival deformities on edentulous ridges D D咬合创伤咬合创伤咬合创伤咬合创伤 Occlusal Trauma Occlusal Trauma 27 VIII.VIII.发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况 D D咬合创伤咬合创伤咬合创伤咬合创伤 occlusal trauma occlusal trauma 1.1.原发性咬合创伤原发性咬合创伤原发性咬合创伤原发性咬合创伤 P Primary occlusal trauma rimary occlusal trauma 2.2.继发性咬合创伤继发性咬合创伤继发性咬合创伤继发性咬合创伤 Secondary occlusal trauma Secondary occlusal trauma 28D D咬合创伤咬合创伤咬合创伤咬合创伤 occlusal trauma occlusal trauma咬合创伤咬合创伤:合力导致的损伤使附着装置发生组织学改变。合力导致的损伤使附着装置发生组织学改变。1.1.原发性咬合创伤原发性咬合创伤原发性咬合创伤原发性咬合创伤:过大的牙合力作用于有健康支持组织的牙齿，造成损过大的牙合力作用于有健康支持组织的牙齿，造成损伤，发生组织学改变。可发生在：伤，发生组织学改变。可发生在：1 1）正常骨高度，）正常骨高度，2 2）正常附着水平，和）正常附着水平，和3 3）过大牙合力。）过大牙合力。2.2.继发性咬合创伤：继发性咬合创伤：继发性咬合创伤：继发性咬合创伤：正常的或过大的牙合力作用于牙周支持组织减少的牙正常的或过大的牙合力作用于牙周支持组织减少的牙齿而造成损伤，发生组织学改变。可发生在：齿而造成损伤，发生组织学改变。可发生在：1 1）骨）骨吸收，吸收，2 2）附着丧失，和）附着丧失，和3 3）“正常正常”/过大牙合力。过大牙合力。29 国际新分类（国际新分类（国际新分类（国际新分类（1999199919991999）1989 1989分类分类 牙龈病牙龈病牙龈病牙龈病 牙龈病牙龈病 慢性牙周炎慢性牙周炎慢性牙周炎慢性牙周炎 成人牙周炎成人牙周炎 侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎侵袭性牙周炎 青少年牙周炎青少年牙周炎 快速进展性牙周炎快速进展性牙周炎 反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎反映全身疾病的牙周炎 伴有全身疾病的牙周炎伴有全身疾病的牙周炎 X X 顽固性牙周炎顽固性牙周炎 坏死性牙周病坏死性牙周病坏死性牙周病坏死性牙周病 急性坏死性溃疡性牙周炎急性坏死性溃疡性牙周炎 牙周脓肿牙周脓肿牙周脓肿牙周脓肿 牙周脓肿牙周脓肿 伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎伴牙髓病变的牙周炎 牙周牙髓联合病变牙周牙髓联合病变 发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况发育或获得性异常和状况 牙龈退缩牙龈退缩 X X 根分叉病变根分叉病变 30