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

（一）临床病理一、牙龈炎症和出血1.初期病损（initiallesion）

2.早期病损（earlylesion)3.确立期病损（establishedlesion)4.晚期病损（advancedlesion)1.牙龈出血（二）临床表现2.色、形、质的改变3.龈沟深度及附着水平•附着丧失（attachmentloss,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。

•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）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。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.根据牙周袋底与牙槽嵴顶的位置关系分骨上袋（suprabonypocket）骨下袋（infrabonypocket）

（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（simplepocket)

复合袋（compoundpocket)

复杂袋（complexpocket)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1.水平型吸收（horizontalresorption）2.垂直型吸收（verticalresorption）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以上四牙齿松动和移位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Why?•legalramifications•affectstreatmentplanandprognosis•forcommunicationwithpatients

History:•Lastclassificationsystemwasdevisedatthe1989WorldWorkshopinClinicalPeriodontology•Improvedunderstandingofetiologyofperiodontaldiseases•InclusionofgingivaldiseasesThe

Periodontium:supportingapparatusofthetoothanditsassociatedcomponents•alveolarbone•periodontalligament•cementum

•gingivalattachment

GingivalDiseases:Canoccuronaperiodontiumwithnoattachmentloss,oronaperiodontiumwithattachmentlossthatisnotprogressingDentalplaqueinducedNon-plaqueinducedGingivitis:

general

informationDEF’N:inflammationofthegivgivaubiquitousocclusionanalysismajorcause:accumulationofplaqueothercausestx:removalofthecausedoesn’tinevitablyleadtoperiodontitisGingivitis:pathology4stages:initial,early,established,advancedlesionSummary:PMNs,exudate,collagenbreakdown,plasmacells,proliferationofepitheliumMajorcause:accumulationofplaqueDentalplaque-inducedgingivaldiseasesI.Gingivitisassociatedwithdentalplaqueonlya.withoutotherlocalcontributingfactorsb.withlocalcontributingfactors

Dentalplaque-inducedgingivaldiseasesII.Gingivaldiseasesmodifiedbysystemicfactorsa.associatedwiththeendocrinesystem1.puberty-associatedgingivtis2.menstrualcycle-associatedgingivitis3.Pregnancy-associated4.diabetesmellitus-associatedgingivitisPeriodontitis-Definition:Inflammationinvolvingthegingivalunit(gingivaandalveolarmucosa)andextendingtotheperiodontalligament,alveolarbone,andcementum.Periodontitisinvolvesthelossofclinicalattachmentandradiographicevidenceofboneloss.Periodontitis-evidenceoflossofperiodontalattachmentpreviouslyclassifiedbyagenowclassifiedby“nature”ofdiseases:progression,clinicalpresentation,associatedsystemicdiseasesPeriodontitis:

classificationoverview

chronicperiodontitisaggressiveperiodontitisperiodontitisasamanifestationofsystemicdiseaseanecrotizingperiodontaldiseasesabscessesoftheperiodontiumperiodontitisassociatedwithendodonticlesionsdevelopmentaloracquireddeformatiesandconditionsChronicPeriodontitisformerly“adult”periodontitiscanbe:localizedorgeneralizedusuallyslowlyprogressivediseasemayhaveshortperiodsofrapidprogressionAggressivePeriodontitisformerly“earlyonset”periodontitiscanbe:localizedorgeneralizedhighlydestructiveformsofperiodontitisnotagedependment-diagnosisof“chronic”or“aggressive”dependsonmanycriteriaPeriodontitisasaManifestationofSystemicDiseasesAssociatedwithhaematologicaldisordersAssociatedwithgeneticdisordersNototherwisespecifiedNecrotizingPeriodontalDiseases1.Necrotizingulcerativegingivitis(NUG)2.Necrotizingulcerativeperiodontitis(NUP)AbscessesofthePeriodontium1.Gingivalabscess2.Periodontalabscess3.PericoronalabscessPeriodontitisassociatedwithEndodonticlesions-combinedperiodontic-endodonticlesionsDevelopmentalorAcquiredDeformatiesandConditionsA.Localizedtooth-relatedfactors1.Toothanatomicfactors2.Dentalrestorations/appliances3.Rootfractures4.CervicalrootresorptionandcementaltearsDevelopmentalorAcquiredDeformatiesandConditionsB.Mucogingivaldeformaties,conditions1.Gingival/softtissuerecession2.Lackofkeratinizedgingiva