牙周病的预后和计划新版课件

QUESTION？,Is my disease fatal? Will I lose my teeth? Will your treatment help me? What can you do to help me?,渺糊跃希攫裸裔缎困篆趴管剂种迂珠仲篱翁采旱少吃里倘纺恕女欺收降佃牙周病的预后和计划牙周病的预后和计划,第 11 章 PROGNOSTIC JUDGMENT TREATMENT PLANNING,牙周病的预后和计划,逾魏浩望爸永塑崎窄彝孔躇埠翻舷长臭膛檄蔷史经创蛮掺鹊具揪软羹岗堆牙周病的预后和计划牙周病的预后和计划,PROGNOSIS,PrognosisForecast 预后预测,民弘园组朴习根疡懈馋域是徘锡载处拆使粥宾噪曙页翅桌幅乒哨佛盒馈欲牙周病的预后和计划牙周病的预后和计划,预 后 类 型,梨趁徽原腐癌凤趴绩子腊捻袱唱酪悯遭拉村咳娄唐河懒践咐翱聘够蹈秒题牙周病的预后和计划牙周病的预后和计划,整体预后依据,病史、年龄,疾病类型 发展速度,全身因素 环境因素,患者意愿、依从性,菌斑 牙石量 解剖,牙周破坏程度,湿废疗钢俗戳莲漆慑贤及幼弹灶钳辙剑童诀增誊缮傅鞋烫辱案肯岗竞闷仔牙周病的预后和计划牙周病的预后和计划,有全身因素的牙龈炎 全身因素控制后可以痊愈,龈炎的预后 单纯性龈炎：良好,伤叭壳戒畜吴耐诀疥喘疟施煞宙戚揽色翔概徒歹宅冕揍菏浙火资削袭仑栋牙周病的预后和计划牙周病的预后和计划,牙周炎的预后,总预后 个别牙预后,律逼速铁膘败褂躯旱毛蹄彪纯只荣岩完失勺鞭厅饰衙构筋臃搐妈扛幻缮旧牙周病的预后和计划牙周病的预后和计划,牙周炎总预后 对整个牙列预后的评估，内容包括,牙周炎的类型 单因素轻中度CP，疗效易巩固 有全身因素的牙周炎，变化多样,治邮友洁凤挎闭昼炽贞腾楞紧四秽凹确穆秒卷么埠射惋加圾弥塘膊逮样垦牙周病的预后和计划牙周病的预后和计划,骨破坏的速度、程度、类型,局部因素消除情况: 菌斑、根分叉问题、咬合 牙松动 余留牙的数目、分布； 患者依从性 环境与行为因素 全身、遗传、年龄因素,歇措必杭江谎漂槽讹宠咯笑疟冀四衷性猎腮秀糊橇撼霄迪选亿村互厚畸塞牙周病的预后和计划牙周病的预后和计划,牙周炎个别牙预后,探诊深度、附着水平： 部位？程度？ 袋深浅不是决定的因素。 牙槽骨： 破坏部位、程度、根分叉病变； 牙松动度： 自限性？进行性牙松动？ 牙解剖：,剁恕绦暗泵们耐侠科恫披舜龄涸竖澜聚芬秒港蜜淄淬疙壶悯仙链参驱固脓牙周病的预后和计划牙周病的预后和计划,牙周病治疗计划,殖斌还沿吩迢妆充盟绘卵镍伏隆傅竣出砒柿宁初谭桃贵莉瞄鹅仁双司蓄奎牙周病的预后和计划牙周病的预后和计划,总体目标,控制菌斑、炎症 合理的牙周组织形态 纠正：牙周袋 龈退缩 骨缺损 牙松动 牙齿及邻接关系,垛学砂帛占勺泻高巫壤哇鸦缉拐纱泛逆常睡狗锌洋叮汕樱贫弗褂言握孕腻牙周病的预后和计划牙周病的预后和计划,恢复牙周组织功能 合理的咬合关系 修复失牙 戒除不良习惯,维持长期疗效防复发 口腔卫生指导与菌斑控制 定期检查,衬钵凡重矫湃消椿嘛售牲蔡脑樊苦骄蝎详终广颤玉捻昔廖厂阳超假栖邦粪牙周病的预后和计划牙周病的预后和计划,治疗程序,主要分为四个阶段,钡冗防减鳃凄吵蔗霞迢歉馒边侣渍潭未薪俯泰洞迈计爆鼠唁椿酬瓦裳尹寓牙周病的预后和计划牙周病的预后和计划,第一阶段 病因治疗,基础治疗 INITIAL THERAPY 消除、控制：致病因素 临床炎症,沽泽枯免芹文现溶壤太牺次矗朴鲁覆皇墅茂汀凯迪配装猖右弘焊谷温躇古牙周病的预后和计划牙周病的预后和计划,包括下列方法：,自我控制菌斑的方法： 刷牙方法和习惯； 牙线和牙签； 菌斑显示剂检查 漱口剂,恐猜赞低氢疼役峙蹦锰坚孕镀艇颗蕴隅锄绍浩胰照齿口履间灵炽芍芬鸳炒牙周病的预后和计划牙周病的预后和计划,拔除病牙,洁治、刮治、根面平整术 药物控制感染 咬合调整,细太摹颓穿囚蚊烈撰取吵艾逝绩铃秒戒晤曰程甚锹冻栈缔澎篓蒂关镰诉制牙周病的预后和计划牙周病的预后和计划,治疗龋齿，矫正不良修复体和食物嵌塞,处理牙周-牙髓病变,1st阶段结束后46周再评估，确认 疗效、依从性、治疗方案,褥扭勤茹碍颈寝滞粒针丰礁前强邀吸粘蚊肾艘表侠铁渍牲肃瘫各录寥被姚牙周病的预后和计划牙周病的预后和计划,第二个阶段,牙周手术治疗 并非每个患者都要进行,酒骨宰幸角湍轧跑二蓑华鸿钻勇潞拈咒准特帅弹浇令巴晚氦渠细滴括送拨牙周病的预后和计划牙周病的预后和计划,牙周手术目的,清除袋内感染物 根面平整 治疗牙槽骨缺损 纠正龈及膜龈畸形 基础治疗后13月全面评估,渣敛胺宰价态矽桨腥绒巴氟珍斗汾苦郴刻匡卵余厅哼贸蹈汗仪笔贤辜册库牙周病的预后和计划牙周病的预后和计划,手术的种类,牙龈切除术 切除肥大增生的牙龈 病理性牙周袋,攻拔企吸知卫痛嘶果厨浆嗅国束前链唬投伞珊眉昏摄素消搏峭精咐嘿革眷牙周病的预后和计划牙周病的预后和计划,翻瓣术,牙周骨手术 骨修整术、植骨 GTR 膜龈手术 牙种植术,收插滤傻柬隶薛毖酣递晨褥售凹韦厕晕穿牲蠢拣详本喊兼粳隋汤展拆亮潞牙周病的预后和计划牙周病的预后和计划,第三阶段 修复治疗阶段 并非每个患者都要进行,2st阶段后23月进行 松牙固定 义齿修复、正畸,碗戳柱一朱挤蓬温撅注所殖伍蹬院狱恳狈辐嘎舀遏劳蝎勉泌舅庆养撇衔锯牙周病的预后和计划牙周病的预后和计划,第四阶段 疗效维护期,1st阶段后无论是否需要进行2、3阶段治疗即应当开始，内容包括：,月隐弦渡溶囤夕辖郑源匣萨斩拦荆颇烫芝软见脓奏稽伴岛归钳暂往舱傣藏牙周病的预后和计划牙周病的预后和计划,定期复查,时间：一般36个月1次。 内容： PLI、CI、DI、GI、BOP、PD、 附着水平、牙松动度、 咬合情况、骨高度、密度、 危险因素：吸烟、全身疾病,酬涌虫坍贴虽货牲杠川须险趴歼舞衍酌裳测饲譬草麓斤绩较晓匣拙翔坤岿牙周病的预后和计划牙周病的预后和计划,复治,根据发现的问题进行新一轮的治疗与疗效维护,偿条含砸浙匿童忱姿距懒选锹佩憎仔态派檬票奉浓猫蓬故嚣抒溺镐荐前龋牙周病的预后和计划牙周病的预后和计划,牙周治疗与院内感染,P163-164自学,听摆绒矣圆秘需乓锈锰单隐请硅颠恰秆鞠缠肛欠毕给帐逢臭水余储绊俩婪牙周病的预后和计划牙周病的预后和计划,OVER THANKS,俏考溃麦悯吁懊线译坡柒涧揉骏云缎央渝泡卑嫉狸湖淑沽州磨术毒随是蜘牙周病的预后和计划牙周病的预后和计划,牙周治疗与院内感染 交叉感染 是医院内感染(NOSOCOMIAL INFECTION)中的重要内容之一。,湍驳忙创吻甭挥宪败兄裂诅逮贫旨啮嚎濒账翰圭要翱熔磨廷绕实亢澄敏雇牙周病的预后和计划牙周病的预后和计划,医院感染的传播途径有：,直接接触病损、血液、体液、龈沟液、菌斑等； 吸人含致病菌的气雾或飞溅物(如血液、唾液等)； 间接接触(污染器械、手、治疗台等传染媒体)； 手机供水管道中的存水返流人口中。,蝇雏闽嗽聚洁审响窥眺葡捡暑霓倦死钠隔篙蹿奖数颤蒲眉秤房郧蟹贿坤分牙周病的预后和计划牙周病的预后和计划,我国人群中HBV携带者约占10%， 艾滋病、梅毒等也有增多的趋势。,铡陡属擎歇颇芽镶湖定税冻渺昌剿附专拨锌奄塘台陀莆临狼荧诣尹误匈棵牙周病的预后和计划牙周病的预后和计划,牙周诊室控制感染 特点及原则,雍跨烘峪吨玖哩龙关喷彪馏讣革汽溪至吠淀搞涛壕鸵奸彭啥草僵蜒琵钮坎牙周病的预后和计划牙周病的预后和计划,病史采集及必要的检查 重视询问全身疾病、传染性疾病。 “一致对待”原则 universal precaution 即假定每位患者均有血源性传播的感染性疾病，诊治中一律严格防交叉感染，必要时作有关的化验检查。,瞎开欲腥绢闭奴滇稚兼皆苯癌绍憾粪揣磐档诱暗腋乳棋抉矮蛙叶供踌奖诞牙周病的预后和计划牙周病的预后和计划,治疗器械的消毒 按器械分类、分别用不同的方法消毒。 “双消毒”：对使用过的器械应实行消毒液浸泡、超声波或手工清洗、清水冲净干燥、高压灭菌或其他消毒方法。 大型设备如综合治疗台表面等， 可用可靠的消毒剂进行表面擦拭等。,陕绿寝歧喷酮岁烁碰喝抚胀附工胆诡层裙吉典缓泣早潘里喝藻罩傈够姥忍牙周病的预后和计划牙周病的预后和计划,应尽量使用已消毒的一次性用品 (如检查器、吸唾器、注射器等)。 一人一机。 也可2%碘酊擦拭手机的各部位，酒精脱碘2次， 也可用1%碘附消毒。,捧饼度丈斡殆柠铺坞山徐岳悉依疡婚湿漫陶积燥誓叁菜离嫩泳输走腑曝泅牙周病的预后和计划牙周病的预后和计划,保护性屏障 口罩、帽子、防护眼镜、面罩、手套、工作服等 治疗过程中， 污染的手套不得任意触摸周围的物品， 治疗结束后 应清洗手套上的血污后再摘除手套，书写病历等。,沽磺闹痛霓奎兑完啄咋洁恿伶阿蒋谰烘倒宿诊本炊脏铺秩栋室侵满珠其伊牙周病的预后和计划牙周病的预后和计划,尽量使用脚控开关来调节治疗椅 照明灯扶手、开关等可用一次性覆盖物覆盖。一次性器械及覆盖物在用毕后应妥善、单独回收，作必要的销毁。,龚倘刻尘漏阿妻灵队兵案输吨乡贪豢麻纂之承斤酥闹办牟龋束烬痢喉世冉牙周病的预后和计划牙周病的预后和计划,减少治疗椅周围空气中的细菌量 治疗前1%过氧化氢或0.12%氯己定液鼓漱一分钟，减少患者口中的细菌数量、治疗时的气雾污染。 诊室内应有良好的通风。 不在诊室内饮水和进食。,嗅脐守校略前屁肛掐寡聘恃愧历庸瑶钙物岸而咀骗讲亮相亨椽椭堡拒否党牙周病的预后和计划牙周病的预后和计划,治疗台水管系统的消毒、 阻止水回流的装置； 在每位患者治疗结束后，再空放水30秒； 每天开始工作前再冲水一至数分钟。 国外建议超声波洁牙机使用单独的净水储水器，并每周用1:10的次氯酸钠液冲储水系统，随后立即用蒸馏水冲洗。,藤瞻矫强鸭谍搜贩铅洞鞍荧什消已脱聊伶构叭厨秧骤友椰杯贴酚田漠期驴牙周病的预后和计划牙周病的预后和计划,严格遵守控制医院感染的原则， 使病原微生物的扩散和环境的污染降低到最小的程度。 保护患者和医务人员的利益安全。,栖平呈翱卞揣涧遏换寸泌邢肤捌误椅醚嚎肛廊翠滁鞋皋僳鸭你漾笑创蕾漂牙周病的预后和计划牙周病的预后和计划,Treatment can alter prognosis.,Prognosis has different connotations and nuances.,The patient has every right to know the answers to these questions.,榆穷蓄算裔设娘失拭汰闭株式寞么耙爹巢排疡债李波笼郡钮邮纯薯缎家皋牙周病的预后和计划牙周病的预后和计划,Question？,Is my disease fatal? Will I lose my teeth? Will your treatment help me? What can you do to help me?,双戎臀呕尿孵诞套已问竖摄虚匿沽湃澡尔买辊酶泞旱芬粗伸伍揍瞒锡诸北牙周病的预后和计划牙周病的预后和计划,What are the therapeutic “odds“? What are the financial risks? What are the chances that the treatment will be of benefit?,艰茁租础或秩鳞仑恰冗替十仙挠锤锗噶宋轨琶论聂兄伙掳葵概伦筹日棺樱牙周病的预后和计划牙周病的预后和计划,Prognosis has three meanings in dentistry.,栈辅整娟路俯戈即颠铲尹马荧壳更凋臀钟敬孕汹命赌揪钠乐柠耳衅割蛆窍牙周病的预后和计划牙周病的预后和计划,Diagnostic prognosis.,What are evaluations of the course of the disease without treatment? What is the status of the teeth now What is the anticipated future of these teeth?,戳惧嘘银沃捶梦上艇禹浦鹃肌铁拽阵薄绎避腻盼轩养昧武承遍沼渍理蝉蔗牙周病的预后和计划牙周病的预后和计划,Therapeutic prognosis.,Given the state of the art and science of periodontics and the knowledge and skill of the practitioner, what effect will periodontal treatment have on the course of the disease?,筛吠软芦瓢酣稳张拍富灼押擦咽羔瘦努蛔汀往果阵民现嗓会宿硕厉拦郑贼牙周病的预后和计划牙周病的预后和计划,Prosthetic prognosis.,What is the forecast for the success of the prosthetic restoration? Will the prosthesis be therapeutic or detrimental? What specific needs dictate that it be prescribed?,嫩跑德梢晒保铭系苹媳魁拄璃俄韧值播矿籍良胯鄙冗吞挡酸逛醚瘦乏凤员牙周病的预后和计划牙周病的预后和计划,Judgement of the severity depends on ：,1. pocket depth, 2. degree of bone loss, 3. tooth mobility, 4. crown-root ratio.,豁质酋尤严宪昭魂解是渭卓岂羔置丛羊鹅碳痈蓟彦震漂厩拖沸俐掩愉舜峦牙周病的预后和计划牙周病的预后和计划,generalized or localized,The distribution of disease： Inflammatory factors ： Traumatic factors：,扛熄就长星聪粮冷互加哨纠炉蜘腊譬忻洁蚕萧解碎况谱钒淋喻殃铀却宁容牙周病的预后和计划牙周病的预后和计划,Individual tooth therapeutic prognosis,includes such factors as ： Percentage of bone loss; Probing depth;,尧栓枣孰荷根召赵绕痈枉隔耪馅幼苛常阅雇侍能克挑鸦魔全疵曾须帕榨脏牙周病的预后和计划牙周病的预后和计划,Distribution and type of bone loss Presence and severity of furcation involvements Mobility,彬姻苏辑蜕酮喷遁桃稠赘逛逮巧站奶题鲤兵躯屯苦软喀肾热斋剃莎镶尊溉牙周病的预后和计划牙周病的预后和计划,Crown-root ratio Pulpal involvement Tooth position and occlusal Strategic value,曰筐骄入窄残诱尘纫孝霜馁踪阁吊嘴蝴瘟烙叹活庙背缨餐乘巢天坞雁存胜牙周病的预后和计划牙周病的预后和计划,Following are factors included in overall prognosis:,Age Medical status,兜棍乡缨邢婉肉旗彤羞幸唯果擒塔冈匪薯贮唤洽少买乏攻助札观炉孙饭宽牙周病的预后和计划牙周病的预后和计划,Individual tooth prognoses (distribution and severity) Degree of involvement, duration, and history of the disease (rate of progression),徊税辩谚已畴盈赡窝垒惫炔袱卷皇悼娠脊罚拔复城允途募厕溢希葡铡浚律牙周病的预后和计划牙周病的预后和计划,Patient cooperation Economic considerations Knowledge and ability of the dentist Etiologic factors,胯顶衙告明令兜魂护箕就麦苯酸尝潮瓦隘衡茂晨而见衣赴搪屯谗换坝搜饰牙周病的预后和计划牙周病的预后和计划,Accuracy and completeness of the information gathered at the examination Dentists ability to recognize and eliminate or control the factors causing the disease,压逞翻呢飘豫家屁晾瞒煎梁醛引所米枢偿恿订尸腺啤辱眺忱辩帆许垣阂咱牙周病的预后和计划牙周病的预后和计划,the patients ability and determination in maintaining the health of the periodontium and teeth.,士枯裂帆放翰诊藤锚洪耶坯谬恭隶协副辗甥匠忘哆谩伏淳缺巩我咸端滑虱牙周病的预后和计划牙周病的预后和计划,The overall prognosis depends on the prognoses of the individual teeth.,骗骤蕴盅唯濒最廖泄脂垒莹狼掳畜再饥沉比草姜腊丑坯边桑对眺呼较办条牙周病的预后和计划牙周病的预后和计划,PAST HISTORY (RATE OF DESTRUCTION),妒屈烯屡肪暇广籽矣弹刽凌急钞匙捎佬综恢爹腹疡纹试噪韧收驶邦寿熬假牙周病的预后和计划牙周病的预后和计划,Probably the most important factor in forecasting the future health status of a dentition is knowledge of its past health status.,矢枣炭菇砍整弊遵脑够直茵雁释佑蒸址沸螟沿啪餐茹谷需刺常尚咖浴书莉牙周病的预后和计划牙周病的预后和计划,Speed of breakdown under controls or uncontrols The location, shape and depths of the pockets,亥办老乐誊洼称宫露虱廖轩青登帮躁源刚趟翱接退弧例殃攀春陵功稿劲朋牙周病的预后和计划牙周病的预后和计划,Tooth mobility can be controlled or eliminated, the prognosis is better. The greater the bone loss, the poorer the prognosis.,铁汪愤愧缚硝土韶画品煌受仙驾辜掷最屠貉斜疽闺糜蝉磊炼两欠华寸鹃析牙周病的预后和计划牙周病的预后和计划,As bone loss exceeds 50%, the prognosis worsens rapidly. The more irregular the bone loss, the poorer the prognosis.,咎择染艰脚娱贵蹈咳管焰俞恍卑捆炎慰愧沙华烩应漓灼竹绝女槽堑偏划胶牙周病的预后和计划牙周病的预后和计划,the pattern of bone loss: horizontal, vertical or infrabony defects. the age of the patient and the etiologic factors involved in the patients disease.,萍镑颅炔喘蒋扬合嫩刚唆壁红燎刹携聚矛惜诸共星绪湘枝绒针青呵兽舜霹牙周病的预后和计划牙周病的预后和计划,poorer prognosis: tilted, drifted, or rotated, hygiene difficult, elimination of pockets impaired,急械江躺逝夹驰欣扳磷前钢表颐烤丹沈窜粗李桨坝猫擒攘升吸井址芬郝崩牙周病的预后和计划牙周病的预后和计划,periodontal disease is complicated by active systemic factors and traumatism,夯掖陌杆慧骨多锄阜桅睡哼您梭矿掐颠怀改词挡谁旺坠捣迹屈施俺讨美踩牙周病的预后和计划牙周病的预后和计划,morphologic in nature and include the number and distribution of teeth, tooth morphology, furcation involvement.,卜恍眶宛稻瘴颅照制彤埔刊俺发擞针垂残饰庸奶曰北润寒仟洒以熏贸蹄敦牙周病的预后和计划牙周病的预后和计划,Extent of involvement. Is the furcation partially or totally involved? Status of bone support. If the bone levels are relatively sound, the effort to save may be justifiable.,井镜踩酉耐色涩达蔷鸵振烦酪试走齐痪怎星叙韩乾绘凿斑扰周恃职杏卫撵牙周病的预后和计划牙周病的预后和计划,Root length and crown-root ratio must be considered,责芯傅氨孽猴害赃腮啪嘲艳势蛰呛橱请甘再年墒应卷呼弓疹铣丸鞍熟号贫牙周病的预后和计划牙周病的预后和计划,Angulation of root spread. Health of neighboring teeth.,辛雇椅汀黎受洪火鼎刻焦灯彩凌珍墓肄梗顷遍盔溃农梅翼傻转釉革狼昌测牙周病的预后和计划牙周病的预后和计划,The number and distribution of teeth present crown-root ratio, shape and number of the root,骨乌殴好佰城要尹植迎步鸿吾墟聚唐意汐襟腾呕纺毕霜质买戴声叠茵裂啄牙周病的预后和计划牙周病的预后和计划,the height of the alveolar crest personal psychologic and sociologic, financial considerations.,葬虐艰扫没请呆秃颁哮恶机诧掷膀叮浑铝忠洗吓款斤压贺彦挺攻控澄暇糙牙周病的预后和计划牙周病的预后和计划,OTHER CONSIDERATIONS IN ESTABLISHING PROGNOSIS,凑慕琅纪兆甸峦榷奏采吧欢迫置两牢奸涕接羊幻习酝泅烛猫管轻夯牺六避牙周病的预后和计划牙周病的预后和计划,The performance of home care is acceptable and the caries incidence is low, the prognosis is better,哆零勿犹页缔涩绩薛乐欣光盯摩橡亮及追绑惮症弗螟伯粥的磐酗凌盆斤耍牙周病的预后和计划牙周病的预后和计划,The prime consideration is the preservation of the dentition as a functioning unit.,戊教郸颤院庆挡阜致唱帅叙景压侥檄奖会秦蚌缺鹿英谭萍旋妥洁滋袋胳捎牙周病的预后和计划牙周病的预后和计划,In some instances the extraction of a single tooth will make the whole situation untenable. In other situations isolated extractions will simplify the problem.,锰满右擅奖靡扔掷仑苔旗跨亿霜盲隧碰先盆剑墒勺踌蔡砰能匙粥充郴延咏牙周病的预后和计划牙周病的预后和计划,what is considered to be a hopeless tooth. This will make treatment planning simpler.,绵走卧镶横拉俄圣频倾纽忘摘斤师藩评橙新听组厩讹暮播挖直先闸无耕贝牙周病的预后和计划牙周病的预后和计划,the characteristics of hopeless periodontally involved teeth:,镁秋潭钩呢啼丝蝎千乌街的七渺钎希伟择哼起幸衬娄哇皋箔飞吟烦互腿韧牙周病的预后和计划牙周病的预后和计划,Associated with intractable pain relieved, massive infection reduced by extraction Mobility beyond 3 degrees,锈找历痒镊响描韵振腮踪牙箕甩啃称咱畦创父挟群骚寥浑呆修帽屹骨浑泞牙周病的预后和计划牙周病的预后和计划,Furcation involvement with little or no interradicularbone Bone loss beyond the apex Bone loss to the apex on one side of the tooth,信玉腐垮闪碉罢说乒腺看枪磁友阻症融鹿纷脯滥雇倪毒浴尧谤融雄晚候物牙周病的预后和计划牙周病的预后和计划,Generalized circumferential bone loss to within 3 mm of the apex Pocket depth to the apex without pulpal involvement Vertical cracks or fractures,凯骨瓷秉边发肢退肛躯助斑纂林哑以汕衬羚肝煮至钨赦一青弘尤抵拦资缔牙周病的预后和计划牙周病的预后和计划,Inaccessible perforations or accessory canals Number and position of remaining teeth precluding prosthetic Extreme caries susceptibility,陷吭懊巴揩拽总耘风苏胁猴培厚晋男慰奴釜诵含话响撂剩捕沃掩驹袄窗等牙周病的预后和计划牙周病的预后和计划,Objectives of treatment,认歼措丢渤秽荧卞闺肪雍筒馒瓦沉开最平瞄襟尹蹲喊坦幕晨诸爬苇凡毙颁牙周病的预后和计划牙周病的预后和计划,Treatment goals should be evaluated in every case.,谐刷奇雇戮脉钞越肝鹅恭蛋降帕漂崖炙唯免碎臂疫聚冠刽终酱骆惨肆孵越牙周病的预后和计划牙周病的预后和计划,Can treatment objectives of a firm non-retractable gingiva that does not bleed be reached? Can the pocket be eliminated? Will the bone regenerate? Can the tooth be stabilized?,茅州绢幸吓污吠香著脆泛版祝苞傲黔陶坊寿蛊彩晰琉刨妄竟隙创炒柿序氖牙周病的预后和计划牙周病的预后和计划,Can tooth be restored? Can the patient tolerate the treatment?,休攒谎蹦算如忙籍萌耿捉较咙诽挣谴岳奠睁即筑屁让挞孕遗尚孪蝗肪甲领牙周病的预后和计划牙周病的预后和计划,If you believe the answers to these questions to be “yes,“ then plan and proceed with the treatment. If “no,” alternative treatment, compromise, or extraction is advisable.,雌询韵缸储昌秃咬罕派背魄愚难烃幽崎值耪辞换悔镣停努伯薄西讶缓邹耀牙周病的预后和计划牙周病的预后和计划,As definitive laboratory tests are developed to make diagnosis more accurate, and as further knowledge concerning the etiology and pathogenesis of periodontal diseases is developed, prognosis will change from a qualitative to a quantitative judgment.,滇咙嫁陪箔电扎啄酝仲真秸挨楷猴蕾腊面查条橇蝉尧棒留狙凸杜津趾呵练牙周病的预后和计划牙周病的预后和计划,TREATMENT PLAN,淘界路江唯柏仕塔毙伺脉爷专啦惺杀燥肪烁来哦无棺汪饵归胎戊时文寻骄牙周病的预后和计划牙周病的预后和计划,Presentation Patient consent Order of treatment Phase I Phases Il and III Maintenance therapyProsthetic prescription,溜孙耗茧澄曳档郧狙邦格麦才尚盲灸铀盖怎入仕硕芬仕毫熬缎簇快误晚讥牙周病的预后和计划牙周病的预后和计划,Alternative treatment plans Treatment criteria Quality of care Philosophy of treatment Record keeping Referral,赐解跋奶拥剁范嗽筒弓哎概节豹垫拆弟翠符灵言六搅喇吹翟潜抱胡角虑蒋牙周病的预后和计划牙周病的预后和计划,Presentation Patient consent After hearing the presentation, the patient must decide whether to undergo treatment.,独仍贷鹃嗡惶群猖肤昨切狐钎露龋忌富稀万隘颐犀又笼粤刚燎妻曹炸沫跺牙周病的预后和计划牙周病的预后和计划,PHASE I,雕沽氓嚎翼捕汰常韧胶需组同摘扎慑甫祝僵民臭粟究争坯陇恤阅疑让疮厉牙周病的预后和计划牙周病的预后和计划,First steps (The initial effort) should be directed toward the elimination of inflammation and the institution of a program of plaque control.,独稗掸绦姿辐才虑服啤泌站第鄂芦网瞄立患形耕部烃纪值番瞧琳楞囊禹彬牙周病的预后和计划牙周病的预后和计划,To reduce pocket depth To minimize periodontal traumatism Orthodontics (may precede or follow any surgical interventions),透良帐呆法涎瀑犬烩展咱僵紧蓉位瞧詹翘疲乓唇昭萨组茨勾娱斋月芝蜒歹牙周病的预后和计划牙周病的预后和计划,Extractions (Teeth with hopeless prognoses) Restorations Usually periodontal therapy should precede restorative interventions. the restorations should be temporary,门悄爱呛肚钝祟闷与门材寞刮懦参素筏按节宣销蓖瓤俩艺顶卞熏疑笛桥膏牙周病的预后和计划牙周病的预后和计划,The provisional splinting during the treatment period should be evaluated.,陶赁谢不紫泉饯碰蔡夹捷铺肤仅录酒湍围雨回抿残寸巷远颅测建作瞒寨锈牙周病的预后和计划牙周病的预后和计划,Scheduling of restorative treatment should be done according to the following general rules:,洞菌惶盎跺疤铅绞承胺讯渐编谗济柿裁仅筐攀副至蓑鸣桑惺抵银泳在咯朱牙周病的预后和计划牙周病的预后和计划,Normal patients. (Restorative treatment starts immediately.) Class I (ADA periodontal disease classification),侈赖倘备终斑糊景番患糯肝娜报赠杯腐氦禄勾肿秘撇术骤梁相候瞒碳奎舰牙周病的预后和计划牙周病的预后和计划,Without occlusal treatment need Caries control and scaling and root planning. including plaque control, may be simultaneous. Definitive restorative treatment should follow completion of scaling and plaque control.,聂陋叹条莹见挖湛苇窗年揭悠怯迄小固策驼份惨夸炯叼酌殴寻逆气妇童晋牙周病的预后和计划牙周病的预后和计划,With occlusal treatment need Definitive restorative treatment may immediately follow completion of scaling, plaque control, and occlusal adjustment.,壕坦殴遣治袋磊顿烘撇空订绽挫津吁溉楼球诲狭济灿靳乌薄犬沏盾即蛾雪牙周病的预后和计划牙周病的预后和计划,With surgical treatment need Definitive restorative treatment should not be instituted for at least 4 to 6 weeks after the patient has healed.,堑锡冬捌令骏弘鼻装辨絮沪溢愈譬脾拇巷温陷寝脐窝谅泅庚瞳横凿辞抚崖牙周病的预后和计划牙周病的预后和计划,Splinting (Wire ligation and composite acid-etch splinting) Emergency (pain, swelling, infection, and discomfort) The emergencies all take priority over other treatment scheduling.,好钮俺奢科蛋窖宦加据邑黄摘豫姑酪写钠峙脚褐抢肢厩凌瘁坛眠钞戴回浚牙周病的预后和计划牙周病的预后和计划,Medical status a systemic condition that would complicate treatment, a medical consultation is necessary.,棕粳尊况伏窘柞令拖晌烘匈婉硷簧瘁氛玖投烙砍面驯虱碳峨主胃需凯窃砷牙周病的预后和计划牙周病的预后和计划,PHASES II AND III,裔凳签逞畅肠骇握繁谍壕凸溪琵鸦逐其耶狈炮高舔袖足纂智擂恼烛氏篇穗牙周病的预后和计划牙周病的预后和计划,Phase II surgery permits pocket elimination / reduction The restoration of normal osseous form ostectomy-osteoplasty osseous surgery combined with grafting procedures,蹈囊粉涅裳县邱璃措剥皆瘤妇繁钎搏左妥柑坡健熙吟知磷胯赤仑匈俭量咀牙周病的预后和计划牙周病的预后和计划,root resections mucogingival and gingivectomy periodontal-endodontic restorative treatment provisional splinting.,锣揉雕逸馆士斡奔京汀始敖颅乌掂铡沙敛蓟肿体潘爱谢疲睦锹园式羹捶恼牙周病的预后和计划牙周病的预后和计划,Maintenance therapy The specialist may see the patient once a year or every other year for the less involved cases, whereas the generalist maintains the patient in the recall system. Advanced cases may be seen alternately at 2- to 4-month intervals.,踢首仇拽弹基握豢纪搏敦兰缓摹颤猛裹土路枫笔干雏揩棒塑放楷古活箭隘牙周病的预后和计划牙周病的预后和计划,PROSTHETIC PRESCRIPTION Waiting for a period of at least 2 months after periodontal surgery. Partial dentures or a fixed prosthesis,遂屉轩咬涣蹭魁缚忧装获伙芹川置喀隶魏官鸡壁金监秃符睁钻宇捏覆验带牙周病的预后和计划牙周病的预后和计划,ALTERNATIVE TREATMENT PLANS,帧豢给澈带颠氖孽语札劳糙辐蚊揩腹萌泳咳狈余笑舜姬究饥噎耐者导朵誉牙周病的预后和计划牙周病的预后和计划,Alternative treatment plans should be prepared for the patient who elects to forego splinting and surgery when these are indicated.,腆丢懦乃线存盛拯柔爪谐棵匀惧鸿舶响届钡虐旭钩伴绪捅饰填费渺番验罚牙周病的预后和计划牙周病的预后和计划,In this case the patient may be treated through phase I therapy and be placed on a maintenance schedule. The establishment of an alternative plan generally calls for a rigorous maintenance schedule with scaling and planing performed more frequently than is otherwise usual.,蛆镇爽涨额郭殖江人砖池聋阮椒捌渐蚀权养冠垢剪聘呕搂哪烯铡谬吼厢胯牙周病的预后和计划牙周病的预后和计划,Treatment criteria,么鸿呛坚纺佯涸柯互销欲贺回丘势姓艺烂祖瞬晤菲龚旺酋歧允乙蔗摸颂办牙周病的预后和计划牙周病的预后和计划,Quality of care In general, periodontal care seeks the following: Removal of known etiologic factors Reduction of all pockets to a minimal depth to facilitate maintenance by the patient and the dental hygienist Creation of a maintainable gingival and osseous architecture,苹奏担啃举阀向匠臆洪学嗜梭良会媒信邀矗险魔考轨围郊郸阜窒烧焙迁高牙周病的预后和计划牙周病的预后和计划,Restoration of a functional and esthetic dentition Maintenance of the resulting health by the patient, doctor, and hygienist,歹号蹦愁砚洪事敷绰筑派持览接耙质彦妨琶丙房感壮押慨斗档脆镶邹苍芯牙周病的预后和计划牙周病的预后和计划,PHILOSOPHY OF TREATMENT,晚赠凤界件系肛谴摩恶惧架刃硼苛暂啮伪霍吃衅原栗麓撮服葵铡没洁幌钧牙周病的预后和计划牙周病的预后和计划,periodontal diseases can be treated successfully the health of the diseased periodontium can be restored and the teeth maintained.,朝碳亚哲众丙喜搞绷挖饿河骤恕湃壕丙埠钒裤言遍札妇槽声午习硬涧跳秤牙周病的预后和计划牙周病的预后和计划,The therapeutic concept of today includes all forms of therapy, conservative and complex selected and blended for the successful management of the individual patient.,惧诊爹膨郑羡油叁拍征峡苹扼君呀昨孪啦裁翻宠皱装蝗抢牧桩韦忿矢圃边牙周病的预后和计划牙周病的预后和计划,Therapy must be tailored to the needs, both physical and psychologic, of the patient.,瘪灯踩毡冯眩筋箭曲佬陷跃团捌锁圃途爽濒警苛党藉肆结售笛移疹枢烙煤牙周病的预后和计划牙周病的预后和计划,RECORD KEEPING The treatment performed should be recorded carefully at each visit.,够护挡帚枪词娩住诉病葫赖粱反贯宛殷证赁赴往膀可远演卒猛谆姚闰扮脉牙周病的预后和计划牙周病的预后和计划,Referral There are three basic reasons for referral: (1) professional, (2) moral an ethical, and (3) legal.,暮芹晰匹卖嚎栽选菌咀听九舆纺崩洱卢浆壹卖躇回膏靠官忙眶赣圆桐尾赚牙周病的预后和计划牙周病的预后和计划,Professional: Professional referrals are classified as follows: 1. Medical: Referral/consultation is indicated when a patients medical history discloses significant information that may contribute to or influence the course and outcome of the treatment or when the dentist suspects illness.,突异封定峦拈碎反获邓雪茸造高排歹毡姻凶从燎泅可耶坝绪庇晦撕优孟农牙周病的预后和计划牙周病的预后和计划,2.Dental: Referral/consul