chapter15,16章牙周炎的伴发病变和牙周医学NEW课件.ppt

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1、15牙周炎的其他伴发病变OtherSecondaryLesionsofPeriodontitis15-1牙周脓肿PeriodontalAbscesses牙周炎中晚期出现深牙周袋后的一个常见的伴发症状,是位于牙周袋壁或深部牙周组织的局限性化脓性炎症,可引起周围胶原纤维和骨质的破坏1,深牙周袋或复杂性牙周袋，内壁的化脓性炎症向深部结缔组织扩展,无引流通道Thisabscessformationisusuallyduetothemarginalclosureofadeepperiodontalpocketandlackofproperdrainage.发病因素Causalfac

2、tor2，不规范的洁治或刮治术后，损伤大，或袋内术后感染物堆积，加上引流不畅Post-scalingperiodontalabscess.Whentheselesionsoccurimmediatelyafterscalingorafteraroutineprofessionalprophylaxis,theyareusuallyrelatedtothepresenceofsmallfragmentsofremainingcalculusthatobstructthepocketentranceoncetheedemainthegingivahasdisappeared临床

3、表现ClinicalfeatureAcutePeriodontalAbscess发病突然，唇颊或舌腭侧形成半球形突起，炎症早期，张力大，疼痛剧烈，患牙有浮动感，松动明显Periodontalabscess(arrows)associatedwithalowerrightfirstmolar.Observetheassociationbetweentheabscessformationandthefurcationlesioninthismolar.ChronicPeriodontalAbscess急性期治疗不彻底，反复发作所致，一般无症状，可见窦道（fistula)Peri

4、odontalabscessassociatedwithalowerleftcanine.Observethefistuloustractopeningdemonstratedwithagutta-perchapoint.RadiologicalimageofthelowercanineThedifferentialdiagnosiswithaperiapicalabscesswasdonebythepositivetoothvitalitysignandabsenceofcariesorrestorationinthetooth,andthepresenceofadeep

5、periodontalpocketintooth.鉴别诊断Differentialdiagnosis与牙龈脓肿gingivalabscess的鉴别局限于龈乳头或龈缘，无牙周袋，无附着丧失，无牙周炎症状和体征与尖周脓肿periapicalabscess的鉴别感染来源牙周袋牙体龋坏和不良修复体牙髓活力脓肿部位松动度扣痛X片等治疗原则TreatmentprincipleThetreatmentoftheperiodontalabscessusuallyincludestwostages:themanagementoftheacutelesiontheappropriatetrea

6、tmentoftheoriginaland/orresiduallesion,oncetheemergencysituationhasbeencontrolled.Forthetreatmentoftheacutelesion,alternativeswereproposed,suchas:(1)incisionanddrainage(2)scalingandrootplaning(3)periodontalsurgery(4)theuseofdifferentsystemicallyadministeredantibiotics(5)toothextraction.15-

7、2牙龈退缩GingivalRecessionGingivalrecessionandPeriodontalatrophy?常见原因牙周炎治疗后解　剖因　素刷　牙不　当正畸力不当和过大咬合力不良修复体临床表现及后果Clinicalproblems1，影响美观2，牙根敏感3，食物嵌塞和根面龋治疗原则Treatmentprinciple刷牙习惯咬合力调整正畸力量根面脱敏防龋美容手术（膜龈手术）15-3牙的病理性移位PathologicalToothMigration原因：牙周支持组织的破坏牙合力的改变治疗原则：牙周彻底治