牙周病学绪论和解剖生理（双语）第2版同济口腔医学课件

牙周病学绪论牙周病学绪论 1 Introduction of Introduction of PeriodontologyPeriodontology 团泊洼的秋天 秋风风象一把柔韧韧的梳子，梳理着静静的团团泊洼； 秋光如同发发亮的汗珠，飘飘扬扬飘飘扬扬 地在平滩滩上挥挥洒。 高粱好似一队队队队 的“红领红领 巾”，悄悄地把周围围的道路观观察 ； 向日葵摇头摇头 微笑着，望不尽太阳起处处的红红色天涯。 矮小而年高的垂柳，用苍绿苍绿 的叶子抚抚摸着快熟的庄稼； 密集的芦苇苇，细细心地护卫护卫 着脚下偷偷偷偷 开放的野花。 “好诗应该是这样的， 它是茁壮成长的树木， 根深深地扎在土地里； 它是有源的水，可以追 溯到源头。 赵文博诗集大地流泉 牙周组织的健康，是口腔 其他学科治疗成功的基础 所谓牙周病，顾名思义，就是发生在 牙齿支持(周围)组织的一类疾病。这些组 织叫做牙周组织 牙周组织的主要功能是将 牙齿稳固地固定在牙槽窝内， 使牙齿得以实施其咀嚼功能。 牙周病学 的英文名词有二： Periodontology 是研究牙周组织的结构、 生理和病理的学科 Periodontics 是一门临床学科。主要 研究牙周病的诊断、治疗和 预防。 Chapter One INTRUDUCTIONChapter One INTRUDUCTION 狭义的牙周病-牙周支持组织破坏 的牙周炎，不包括牙龈病。 广义的牙周病-发生于牙周组织的 各种病理情况，主要包括牙龈病和牙 周炎两大类 国内一般将牙周病作为广义名词，而 将有牙周组织破坏的一类称为牙周炎 。 Chapter One INTRUDUCTIONChapter One INTRUDUCTION 牙周病学发展简史牙周病学发展简史 The Historical Background of The Historical Background of PeriodontologyPeriodontology Chapter One INTRUDUCTIONChapter One INTRUDUCTION EARLY CIVILIZATION (早期文明时期)： Chapter One INTRUDUCTIONChapter One INTRUDUCTION 黄帝内经外台秘要等书中有牙周病的描述以及治疗方 法； 第一五九窟看到了唐代（ 公元618907年）壁画“揩牙 图”，证实早在千年前佛教中 就有刷牙的仪式。 “刷牙图”在敦煌已发现十 几处。据专家研究，刷牙习俗 始于印度，随佛教传入我国。 有关刷牙的习俗，汉译佛经中 已有记载，叫作”杨枝梳齿”， 杨枝即齿木的误译，梳齿即刷 牙，“齿木”即当时的牙刷。 The Middle Ages 中世纪 FIGURE: Illustration of AbuI- Qasims Peridontal instruments, showing scalers (sc), files (f 锉), and the wiring of losse teeth(w) Chapter One INTRUDUCTIONChapter One INTRUDUCTION RENAISSANCE ( 文艺复兴时期) Figure: The first book written in a common language (German) and specifically devoted to dental practice, entitled Artzney Buchlein or Zene Artzney, was published in Leipzig in 1530 1530年，第一本牙科书（德语） Chapter One INTRUDUCTIONChapter One INTRUDUCTION Anton van Leeuwenhoek(1683 荷兰 人)，developed the microscope and used it to discover microorganisms, cellular structure, blood cells, sperm(精 子), and various other microscopic structures, including the tubular structure of dentin. 。 Chapter One INTRUDUCTIONChapter One INTRUDUCTION Using material from his gingival tissues, van Leeuwenhoek first described oral bacterial flora, and his drawings offered a reasonably good presentation of oral spirochetes and bacilli : “I didnt clean my teeth (on purpose) for three days and then took the material that had lodged in small amounts on the gums above my front teeth I found a few living animalcules(微生物).” 用自己的牙龈作标本，首次描 述了口腔微生物： Chapter One INTRUDUCTIONChapter One INTRUDUCTION 18TH CENTURY The five types of instruments used by Fauchard for detaching tartar from the teeth Chapter One INTRUDUCTIONChapter One INTRUDUCTION John M. Riggs (1811-1885) was the leading authority on periodontal disease and its treatment in the United States, to the point that periodontitis, or alveolar pyorrhea(溢 脓), was known as “Riggs dissease” 美国第一个以专门从事牙周病治疗和研究的牙医 1,首先提出牙周病发展的4个阶段; 2,首先提出牙周治疗的4个步骤; 1947年美国牙医学会才将牙周病学指定 为牙医学中的一个专科 现代-牙周医学的提出 19TH CENTRY Chapter One INTRUDUCTIONChapter One INTRUDUCTION 19世纪,不同牙医发明的 早期洁治工具 Chapter One INTRUDUCTIONChapter One INTRUDUCTION 19TH FIG: Microscopic features of periodontal disease as presented by Znamensky (1902) 牙周组织病理学“切片” Miller(1890)提出牙 周炎是由口腔各种细菌 造成的后世的非特异 性菌斑学说 Chapter One INTRUDUCTIONChapter One INTRUDUCTION 20世纪 以后 现代牙周病学的发展 Periodontics flourished in Central Europe, with two major centers of excellence: Vienna and Berlin. lVienna：Developed the basic histopathologic concepts on which modern periodontics was built. 建立现代牙周医学的基础-组织病理学点 Major representative 代表人物 Bemhard Gottlieb(1885-1950)Balint J. Orben(1899-1960 Chapter One INTRUDUCTIONChapter One INTRUDUCTION l Berlin： The Berlin group consisted mostly of clinical scientists who developed and refined the surgical approach to periodotal therapy. 发展了临床治疗和手术方法，发展了牙周外科 Weski carried out pioneering studies correlation of radiographic and histopathologic changes in periodontal disease. He also conceptualized the periodontium as formed by cementum, gingiva, periodontal ligament, and bone and gave it the name paradentium 牙科放射和组织病理学的先锋将牙周组织归纳为牙骨 质，牙周膜，牙槽骨，牙龈，称做Parodontium（仍在欧洲 使用） Oskar Weski(1879- 1952) Chapter One INTRUDUCTIONChapter One INTRUDUCTION Robert Neumann(1882- 1958) described the principles of periodontal flap surgery, including osseous re-contouring , as it is currently known 20年代提出翻瓣手术的原则，包 括骨修整术Chapter One INTRUDUCTIONChapter One INTRUDUCTION After World War II The USA and Scandinavia took a leading role in basic and clinical periodontal research from the 1950s on, with major advances in the fields of experimental pathology, microbiology, and immunology. Animal models of periodontal disease were developed and the role of local and systemic factors studied牙周研究全面兴 起，并和其他医学一样，向深度发展（实验病理，微生物，免疫学，病因 学） Leading researcher Lrving Glickman (1914-1972) Jens Waerhaug (1907-1980) Chapter One INTRUDUCTIONChapter One INTRUDUCTION 20世纪70年代 牙周多学科发展， 厌氧微生物学，分子生物学，免疫学，分子生物 流行病学， 治疗学：基础治疗，促进组织再生技术，牙周外科，药物 根面处理：机械，化学，生物 组织再生：生长因子，骨替代物，GTR（丹麦Nyman) 组织再生细胞：细胞移植，牙周组织工程 今后 Chapter One INTRUDUCTIONChapter One INTRUDUCTION WHO（1984）健康人十项标准第8条 牙齿清洁 无洞 无疼痛 牙龈颜色正常 牙 龈不流血 牙周病学在口腔医学中的位置 80Y-20 teeth 口腔两大疾病 与正畸,修复等学科的关系密切 与全身的关系-牙周医学 目前国内外的差距, 目前中国的状况和未来 Chapter One INTRUDUCTIONChapter One INTRUDUCTION 卫生部全国流行病学调查(1985) 失牙原因的流行病学调查 第一章第一章 绪论绪论 各年龄组未治疗的龋病和牙周病患病率 12岁 15岁 18岁 35-44岁 65-74岁 龋病 42.6 42.9-51.7 48.2 47.7 59.1 牙周病 69.0 7.4 85.2 97.2 99.4 常洁治者 52.0 67.9 78.6 93.0 77.0 注:牙周病至少一个区段 数据来源于1995年全国流行病学调查资料 牙周病的地位明显突出: 1,发病率上升(相对龋齿), 失牙的主要原因 2,中晚期治疗较难 3,引起患者重视 4,牙周病教育与专门从事牙周病临床和科研的人数 国外的观念与国内的差别: 国外现在的状况就是将来我国的必然 第一章第一章 绪论绪论 牙周医学的发展和其他学科发展密不可分 。各种观点在不断的修正，更新和发展。 个人的学习与发展： 局部与整体，知识的开拓，注重基础理论 和知识，方可触类旁通，创新与发展. 牙周组织的解剖生理 The Normal Periodontium Anatomy of the Periodontium 2 牢记正常结构的解剖与功能 牢记相应的英语单词 要与临床知识相结合 The periodonium consists of the investing and supporting tissue of tooth (gingiva, periodontal ligament, cementum, alveolar boon). The cementum is considered a part of the periodontium because, along with the bone, it serves as the support for the fibers of the periodontal ligament. The periodontium is subject to morphologic and functional variations, as well as changes associated with age. This section deals with the normal features of the tissues of the periodontium, knowledge of which is necessary for an understanding of periodontal diseases. The soft and hard tissues surrounding dental implants have many features similar to and some important differences from the periodontal tissues. These features and differences are dealt with in other chapter. 牙周组织的发育 The development of the periodontal tissues The dental organ (DO) Dental papilla (DP)- dentin and the pulp Dental follicle (DF) - periodontal supporting tissues Gingival tissue（epithelium, connective tissue ） Alveolar bone Peridontal ligament Cementum The Normal The Normal PeriodontiumPeriodontium 正常牙周组织的结构正常牙周组织的结构 Chapter two Normal Periodontium 龈沟 游离龈 附着龈 膜龈结合 牙槽粘膜 牙周组织正常结构 2-1 牙龈 Gingiva Chapter two Normal Periodontium 牙龈的临床表征 Clinical Features of Gingiva 三部分组成: 游离龈, 附着龈, 龈乳头 MGJ-膜龈结合 G-牙龈 AM-牙槽黏膜 第二章第二章 牙周组织解剖生理牙周组织解剖生理 牙龈-临床大体解剖结构 MGJ-膜龈联合 AM-牙槽黏膜 F-口底 IP-切牙乳头 RR-腭皱襞 PM-硬腭黏膜 G-牙龈 Chapter two Normal Periodontium 龈 沟 游离龈 附着龈 膜龈结合 牙槽粘膜 游离龈: Marginal Gingiva The terminal edge or border of gingiva surrounding the teeth like a collar .Forming the soft tissue wall of the gingival sulcus. 较薄,紧贴牙面,领圈包饶, 与牙面间 形成龈沟,平均1.8mm, 下 前后 老轻 龈乳头Interdental Gingiva ( Gingival Papillar) The shape of the gingiva in a given interdental space depends on the contact point between the two adjoining teeth 龈乳头: 锥型,充满相邻两牙接触区根方的龈外展隙中。 侧缘，顶缘-游离龈延续； 龈谷：形状由牙以及邻接点形状决定；非角化上皮 Shape of interdental gingival papillae correlated with the shape of teeth and embrasures. A, Broad interdental papillae. B, Narrow interdental papillae 宽 窄 龈乳头的外形与 牙形状和斜面情 况 牙龈上皮 General Aspects of Gingival Epithelium Biology The main function of the gingival epithelium is to protect the deep structures while allowing a selective interchange with the oral environment, This is achieved by proliferation and differentiation of the keratinocyte . Proliferation of keratinocytes takes place by mitosis in the basal layer Differentiation involves the process of keratinization, which consists of a sequence of biochemical and morphologic events that occur in the cell as it migrates from the basal layer. The main morphologic change is a progressive flattening of the cell. 牙龈组织学 Microscopic Features of Gingiva Although the gingival epithelium constitutes a continuous lining of stratified squamous epithelium, three different areas can be defined from the morphologic and functional points of view: the oral or outer epithelium 口腔龈上皮 the sulcular epithelium 沟内上皮 the junctional epithelium 结合上皮 Gingival Epithelium： Three different areas Oral or Outer Epithelium Sulcular Epthelium Junctional Epithelium 口腔龈上皮Oral or Outer Epithelium The oral epithelium covers the crest and outer surface of the marginal gingiva and the surface of the attached gingiva. 游离龈顶端外表面到附着龈 角化和不全角化复层鳞状上 皮，角化程度与年龄和绝经( )有关，可抵抗咀嚼摩擦，起到 保护下层组织的作用 第二章第二章 牙周组织解剖生理牙周组织解剖生理 角化层(Stratum Conneum) 颗粒层(Stratum Granulosum) 棘层(Stratum Spinosum) 基底层(Stratum Basale) 角化复层鳞状上皮 Flattened on surface of the gingiva 角化细胞平展，边界清晰 X 1000 Several keratinocytes about to be exfoliated 龈缘上皮（近龈 沟）上皮剥脱 X 3000 口腔龈上皮(游离龈 附着龈) 沟内上皮 Sulcular Epithelium 1, Thin, nonkeratinized, stratified squamous epithelium 非角化复层鳞状上皮（不全角化）,缺乏角化层和颗 粒层 2, Local irritation (contact with the tooth, bacterial flora) of sulcus prevents sulcular keratinization . 有角化潜力, 龈沟内炎症的刺激，与牙面的接触, 使 之非角化,口腔上皮同样 3, Itmay act as a semipermeable membrane ; 半透膜的作用-沟内物质与组织间的互透 Sulcular Epitheliun 结合上皮 Junctional epithelium The JE consists of a collar-like band of stratified squamous nonkeratinizing epithelium. It is three to four layers thick in early life, but the number of layers increases with age to 10 or even 20; 沟内上皮根方呈领圈状附着于牙冠(釉质)或牙 根(牙骨质)的上皮, 非角化复层鳞状上皮，无钉 突。 l l The length, ranges from 0.25 to 1.35 mm 正常附着在釉牙骨质界，冠方为龈沟底，长度 0.25-1.35mm l Epithelium attachment by means of an internal basal lamina to tooth, external basal lamina to gingival connective tissue 靠内基底板和半桥粒与牙相附着,冠方可达10- 30层，根方逐渐变薄，细胞连接较疏松 Junctional epithelium Epithelium attachment by means of an internal basal lamina to tooth, external basal lamina to gingival connective tissue 细胞与根面长轴平行，细胞间连接疏松，间隙 较大，内基板（IBL）与牙面结合，外基板（ EBL）与CT结合 结合上皮具有较大的 渗透性，龈沟物质和 体液物质相互作用 结合上皮 炎症时结合上皮细胞间 隙变宽，中性粒细胞和 体液从细胞间隙向龈沟 移动 结合上皮的弱点 无角化，无钉突 细胞间隙大，连接疏松 上皮通透性大 结合上皮与牙周探诊 正常结合上皮， 及少炎性细胞 炎症时炎性细胞 侵润，血管渗出 ，胶原纤维破坏 ，组织疏松，造 成探诊时出血， 探诊过深 正常 中度炎症 重度炎症 N-中性白细胞，L-淋巴细胞， P-浆细胞，V-小静脉，CO-胶 原纤维，FI-成纤维细胞，ICT -炎性CT，NCT-正常CT 第二章 牙周组织解剖生理 龈牙结合部 Dental-gingival Unit 是指牙龈组织籍上皮与牙面连接 ，良好地封闭了软硬组织交界处； 结合上皮在牙面的附着因牙龈纤维 而得到进一步加强，牙龈纤维使游 离龈更紧密地贴附于牙面因此， 将结合上皮和牙龈纤维视为一个功 能单位 龈牙单位的解剖位置和组织学 特点决定了该部位是肌体防御系统 与外界致病因子争夺的场所, 是牙 周病的始发部位 龈牙结合部-龈牙单位Dento-gingival Junction/Dantal-gingival unit) The attachment of the junctional epithelium to the tooth is reinforced by the gingival fibers, which brace the marginal gingiva against the tooth surface. For this reason, the junctional epithelium and the gingival fibers are considered to be a functional unit, referred to as the dentogingival unit. 生物学宽度(BW)：龈沟底牙槽嵴顶 结合上皮(0.97)+结缔组织附着（1.07) = 2mm 2mm BW基本保持不变 牙冠延长术应考虑BW 牙龈上皮的更新 Renewal of Gingival Epithelium The oral epithelium undergoes continuous renewal.不断更 新 u The mitotic and renewal rate varies in different areas of the oral epithelium;不同部位的上皮更新率不同。 u With highest and lowest mitotic rate occurring in the morning and evening, respectively; 早晨最快,傍晚最慢 结合上皮一周内可重新建立，切除后口腔上皮爬入，重新形成结合上皮 牙龈结缔组织 Gingival Connective Tissue n Consists of two layers: papillary and reticular n CT has a cellular and an intercellular compartment. n Type one collagen provides tensile strength to the gingival tissue. n Type IV and elastic (弹性) fiber 网状层 乳头层 特点: 主要为固有层(乳头层和网状层) 主要成分为胶原蛋白(60%),主要为I 型胶原,少量其他胶原 (IV 和弹力纤 维 牙龈纤维 Gingival Collagen Fibers Function: 1,To brace the marginal gingiva firmly against the tooth 2, To provide the rigidity necessary to withstand the forces of mastication (咀嚼) without being deflected away from the tooth surface. 3,To unite the free marginal gingiva with the cementum of the root and the adjacent attached gingiva (将游离龈与附着龈和 牙骨质形成统一的单位) ，束紧牙龈；，保持硬度；，与周围组织相连 组牙龈纤维 Fiber 纤维 Cementum 牙骨质 Alveolar bone 牙槽骨 Circular fiber环行纤维 可显示三组纤维： 龈牙纤维 牙骨膜纤维 环行纤维 牙龈结缔组织的细胞成分 Connective Tissue Cellular Compartment The preponderant cellular clement in the gingival connective tissue is the fibroblast（成纤维细胞）. It synthesize collagen and elastic fibers, as well as the glycoproteins and glycosaminoglycans (粘多糖) of the amorphous intercellular substance. Fibroblasts also regulate collagen degradation. l Mast cells（肥大细胞） small foci of plasma cells and lymphocytes （淋巴细胞） l The inflammation cells are usually present in small amounts in clinically normal gingiva.（正常牙龈中也存在炎性细胞 ） in spite of the frequency of their occurrence, the inflammatory cells are not a normal component of the gingival tissue 主要为成纤维细胞，占细胞的，是胶原合成的主要细胞 炎型性反应细胞：靠近龈沟附近 （临床正常牙龈组织切片）严格讲不属于 正常细胞成分 ICJ -intercellular junctions 第二章 牙周组织解剖生理 牙龈结缔组织基质: 主要由成纤维细胞产生 基质的作用 基质的成分: 蛋白多糖proteoglycans 透明质酸 硫酸软骨素 hyaluronic acid 糖蛋白 glycoproteins, (mainly Fibronectin, FN) 骨粘连蛋白 第二章 牙周组织解剖生理 牙龈的血液供应 Blood Supply : An arteriole (毛细动脉) penetrating the interdental alveolar bone to supply the interdental tissue (left) and a supraperiodteal arteriole oberlying the facial alveolar bone, sending branches to the surrounding tissue (right) 1,PDL 2,牙槽骨 3,骨膜上 骨膜表面,牙槽骨间隔,牙周膜,牙槽骨内 SP-骨膜上, PDL A-结合上皮 B-牙龈上皮 血管铸形SEM The connective tissue that surrounds the root and connects it with the bone. It is continuous with the connective tissue of the gingiva and communicates with the marrow spaces through vascular channels in the bone. 牙周膜 围绕牙并连接牙根和牙槽骨的致密结缔组织 。与牙龈结缔组织相延续，与牙槽骨通过血 管通道相交通。 2-2 牙周膜(牙周韧带) Periodontal Ligament 牙周膜纤维 Periodontal Fibers n The most important elements of the periodontal ligament are the principal fibers, which are collagenous（ type), are arranged in bundles. 牙周膜最重要的成分是胶原构成的主纤维(主要是 型），呈束状排列 n Terminal portions of the principal fibers that insert into cementum and bone are termed Sharpeys fibers. 两端分别埋入牙槽骨和牙骨质内，埋入部分称为 Sharpeys纤维 Alveolar crest 牙槽嵴纤维（） Horizontal 横纤维（） Oblique 斜纤维（） Apical 根尖纤维（） Interradicular 根间纤维（） 第二章 牙周组织解剖生理 The principal fibers are arranged in five groups: (Tansseptal 纵隔纤维（书中没有） 主纤维（Pricipal fiber) 型胶原和耐酸水解纤维 （oxytalan) 组成 第二章 牙周组织解剖生理 Alveolar crest fibers Oblique Fiber 斜纤维（） Transseptal fibers (F) (银染色） The principal fibers are remodeled by the periodontal ligament cells to adapt to physiologic needs and in response to different stimulation 牙周韧带的宽度（厚度） 不断形成新的主纤维、牙 骨质和改建牙槽骨。这种 功能对牙周组织的修复十 分重要，是牙周炎治疗后 形成牙龈与牙根面之间新 附着的主要细胞来源。 其宽度是否随年龄及功 能状态而变异，尚有不同 报道,一般为0.15-0.38mm ，整个牙周韧带呈现为围 绕牙根的窄黑线。 Sharpey 纤维 SF 牙槽嵴纤维组、水平纤维组 、斜纤维组、根尖纤维组和 根间纤维组。 静止状态-波纹状-生理性动 度。 受力-拉直且略有伸长-力传 递至牙槽骨； 牙周韧带-缓冲压力-避免牙 槽骨受到过大的冲击 宽度0.15-0.38,平均0.2, 侧方压力-根中l3与根尖1 3-支点。磨牙的转动中心 则位于诸根之间的空间。 牙周膜生理要点 PDL静止下呈波浪状，使牙有微小生理动度 转动支点： 单根：根尖与 根中交界 多根：诸牙根之间的 空间 最窄处位于根中部 牙周膜的细胞成分 Cellular Elements Four types of cells have been identified in the PDL: 1, Connective tissue cells 结缔组织细胞: Fibroblasts (most common cells), Cementoblasts, Osteoblasts ( 成纤维细胞 ,成牙骨质细胞, 成骨细胞)， 2, Epithelium rest cells : Malassez 上皮剩余细胞 3, Defense cells 防御细胞： 巨噬细胞 肥大细胞 嗜酸性粒细胞 4, Neurovascular cells 神经血管相关细胞 ( 5 , 未分化间充质细胞 ) 成纤维细胞是牙周膜中最常见的细胞: 卵圆或细长,多伪足突起,合成胶 原,降解陈旧胶原,一生中参与牙周膜牙骨质和牙槽骨的不断改建 SEM 相差显微镜 Fibroblast are the common cells in the PDL, They synthesize collagen and have also been shown to possess the capacity to phagocytose “old” collagen fibers and degrade them by enzyme hydrolysis. Thus, collagen turnover to be regulated by fibroblasts. Epithelium rests 上皮剩余细胞 MALASSEZ Epithelium rests are considered to be remnants of Hertwigs sheath, which disintegrates during root development. Epithelium rests proliferation when stimulated and participate in the formation of periapical cysts and lateral root cysts Lateral root cysts CB成牙骨质细胞,OB成骨细胞,BB束骨,SF-SHARPEY NV血管神经 F成纤维细胞 Osteoblasts and cementoblasts, as well as osteoclasts and odontoclasts, are also seen in the cemental and osseous surfaces of the PDL 结缔组织细胞: 成骨细胞(破骨细胞) 成牙骨质细胞 第二章 牙周组织解剖生理 牙周膜细胞具有缤纷多彩的特性 钙化 + + - - - ALP + - - + - CAP + + - - + % 34 7 37.3 12.7 9 （单细胞克隆，株，年）（单细胞克隆，株，年） 牙周膜细胞中各亚类的状态决定于多种因素:年龄,生物学状态等 第二章 牙周组织解剖生理 牙周干细胞 Periodontal Stem Cell 自我更新 Self-Renewal 限定性传输细胞 Restricted Transit Cell 成骨、成牙骨质细胞系 Osteoblast Cememtoblast Lineages 牙周、牙龈成纤维细胞系牙周、牙龈成纤维细胞系 Periodontal Gingival Periodontal Gingival Fibroblast LineagesFibroblast Lineages 牙周膜细胞分化示意图牙周膜细胞分化示意图 未分化间充质细胞 第二章 牙周组织解剖生理 牙周膜基质 Ground Substance of PDL The DL also contain a large proportion of ground substance filling the spaces between fibers and cells. Two main components: 1, glycosaminoglycans such as hyaluronic (糖胺多糖: 透明质酸) 2, Glycoproteins such as fibronectin and lamina(糖蛋白:FN和层连蛋白) 牙周膜血管神经 1, 牙龈血管; 上下齿槽动脉的分支 2, 富含丰富的感觉神经末梢, 通过三叉神经传递感觉, 压 力感受十分敏感 第二章 牙周组织解剖生理 PDL FUNCTION 牙周膜的作用： A，物理性功能 Physical function : Resistance to impact of occlusal forces; Transmision of occlusal forces to the bone 保护血管神经免受外力；传导咬合力至牙槽骨；将牙与骨相连；保 持牙龈在牙齿的合适位置；抵抗咬合力 第二章 牙周组织解剖生理 B，形成和改建功能 Formative and Remodeling Functions : Cell of the periodontal ligament participate in the formation and resorption of cementum and bone, which occur in physiology tooth movement; in the accommodation of the periodontium to occlusal forces; and in the repair of injuries. Variations in cellular enzyme activity are correlated with the remodeling process. l 伴随牙齿的移动, 组织生成, 以适合外力的作用 l 治疗中的牙周组织再生 C ，营养功能和感觉功能 Nutritional and Sensory Function 2-3 牙骨质 （Cementum） 成分：羟磷灰石，胶原纤维（内，外），非胶原蛋白（CAP） (From Schroeder, H.E.,1991) % by weight Enamel DentinCementumBone Mineral95706145 Organic1202730 Water4101225 牙骨质的结构 There are two sources ofcollagen fibers in cementum: 牙