侵袭性牙周炎一例.ppt

局限性侵袭性牙周炎一例,温医07口腔倪秀凤,病例报告,那天,医生，我想补牙,牙又疼了，这会儿还肿起来了，不能出去见人了，555,半月前,现病史：4年来右下后牙反复肿痛，牙龈排脓后可缓解，平时偶有刷牙出血症状，有轻度口腔异味及后牙食物嵌塞史。否认明显牙齿松动、移位症状，两周前右下后牙复又肿起伴咬合痛及右侧面部肿大症状，至当地医院就诊，予开髓急性处理，消炎药静脉滴注（具体用药不详）。目前疼痛缓解，今为进一步治疗，到我科就诊。刷牙习惯：每日2次，竖刷牙，无牙线使用习惯。,主诉：右下后牙反复肿痛4年余，加重两周,临床检查,45已开髓，牙合面见暂封物，叩（），松（-）根尖片示：45根尖区见不规则低密度影,口腔卫生状况差，牙石（），色素（），中等菌斑软垢,全口牙龈轻度红肿，伴舌侧轻度牙龈萎缩，BI2-3,临床检查,46冠完整，近中PD10mmX片表现：近中牙槽骨角形吸收,16、26、36PD7-8mm，余牙PD3-5mm详见大表,全身情况：,HBsAg阳性,余无殊,家族史：父母亲早失牙,既往史：无牙科治疗史,诊断,45慢性根尖炎（外院开髓后）侵袭性牙周炎,鉴别诊断,慢性牙周炎与侵袭性牙周炎,局限性侵袭性牙周炎与广泛性侵袭性牙周炎,1.non-contributorymedicalhistory2.rapidattachmentlossandbonedestruction3.familialaggregationofcases,Primaryfeatures,Generallypresent,1.Amountsofmicrobialdepositsinconsistentwiththeseverityofperiodontaldestruction2.ElevatedproportionsofActinobacillusactinomy-cetemcomitansand,insomeFarEastpopulations,porphyromonasgingitvalis3.Phagocyteabnormalities4.Hyper-responsivemacrophagephenotype,includeingelevatedproductionofPGE2andIL-1inresponsetobacterialendotoxins5.Progressionofattachmentlossandbonelossmaybeself-arresting,Langetal.1999,CircumpubertalonsetLocalizedfirstmolar/incisorpresentationwithinterproximalattachmentlossonatleasttwopermanentteeth,oneofwhichisafirstmolar,andinvolvingnomorethantwoteethotherthanfirstmolarsandincisorsRobustserumantibodyresponsetoinfectingagents,Usuallyaffectingpersonsunder30yearsofage,butpatientsmaybeolderGeneralizedinterproximalattachmentlossaffectingatleastthreepermanentteethotherthanfirstmolarsandincisorsPronouncedepisodicnatureofthedestrucionofattachmentandalveolarbonePoorserumantibodyresponsetoinfectingagents,Generalizedaggressiveperiodontitis(GAP),Locatizedaggressiveperiodontitis(LAP),治疗设计,45完成RCT牙周系统治疗：1：OHI2：龈上洁治（手工）3：龈下刮治+根面平整4：酌情手术5：定期维护（SPT）,45RCT后,治疗过程,手工