牙周病的预后和计划专家讲座

QUESTION？Ismydiseasefatal?

WillIlosemyteeth?

Willyourtreatmenthelpme?

Whatcanyoudotohelpme?牙周病的预后和计划第1页第11章

PROGNOSTICJUDGMENTTREATMENTPLANNING牙周病预后和计划牙周病的预后和计划第2页PROGNOSISPrognosisForecast

预后预测牙周病的预后和计划第3页预后类型骨吸收病因依从性全身病变极佳无可消除良好无良好轻较差中难消除差显著/未控制极差重牙周病的预后和计划第4页整体预后依据病史、年纪疾病类型发展速度全身原因环境原因患者意愿、依从性菌斑牙石量解剖牙周破坏程度牙周病的预后和计划第5页有全身原因牙龈炎

全身原因控制后能够痊愈龈炎预后

单纯性龈炎：良好牙周病的预后和计划第6页牙周炎预后总预后个别牙预后牙周病的预后和计划第7页牙周炎总预后

对整个牙列预后评定，内容包含牙周炎类型单原因轻中度CP，疗效易巩固有全身原因牙周炎，改变多样牙周病的预后和计划第8页骨破坏速度、程度、类型局部原因消除情况:菌斑、根分叉问题、咬合牙松动余留牙数目、分布；患者依从性环境与行为原因全身、遗传、年纪原因牙周病的预后和计划第9页牙周炎个别牙预后探诊深度、附着水平：部位？程度？袋深浅不是决定原因。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：牙周病的预后和计划第10页牙周病治疗计划牙周病的预后和计划第11页总体目标控制菌斑、炎症合理牙周组织形态纠正：牙周袋龈退缩骨缺损牙松动牙齿及邻接关系牙周病的预后和计划第12页恢复牙周组织功效

合理咬合关系

修复失牙

戒除不良习惯维持长久疗效防复发口腔卫生指导与菌斑控制定时检验牙周病的预后和计划第13页治疗程序主要分为四个阶段牙周病的预后和计划第14页第一阶段

病因治疗基础治疗INITIALTHERAPY消除、控制：致病原因临床炎症牙周病的预后和计划第15页包含以下方法：自我控制菌斑方法：刷牙方法和习惯；牙线和牙签；菌斑显示剂检验漱口剂牙周病的预后和计划第16页拔除病牙洁治、刮治、根面平整术药品控制感染咬合调整牙周病的预后和计划第17页治疗龋齿，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4~6周再评定，确认疗效、依从性、治疗方案牙周病的预后和计划第18页第二个阶段牙周手术治疗并非每个患者都要进行牙周病的预后和计划第19页牙周手术目标去除袋内感染物

根面平整

治疗牙槽骨缺损纠正龈及膜龈畸形基础治疗后1~3月全方面评定牙周病的预后和计划第20页手术种类牙龈切除术切除肥大增生牙龈病理性牙周袋牙周病的预后和计划第21页翻瓣术牙周骨手术骨修整术、植骨GTR膜龈手术牙种植术牙周病的预后和计划第22页第三阶段

修复治疗阶段

并非每个患者都要进行2st阶段后2~3月进行松牙固定义齿修复、正畸牙周病的预后和计划第23页第四阶段

疗效维护期1st阶段后不论是否需要进行2、3阶段治疗即应该开始，内容包含：牙周病的预后和计划第24页定时复查时间：普通3~6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、危险原因：吸烟、全身疾病牙周病的预后和计划第25页复治依据发觉问题进行新一轮治疗与疗效维护牙周病的预后和计划第26页牙周治疗与院内感染

P163-164自学牙周病的预后和计划第27页OVER

THANKS牙周病的预后和计划第28页牙周治疗与院内感染

交叉感染是医院内感染(NOSOCOMIALINFECTION)中主要内容之一。牙周病的预后和计划第29页医院感染传输路径有：直接接触病损、血液、体液、龈沟液、菌斑等；吸人含致病菌气雾或飞溅物(如血液、唾液等)；间接接触(污染器械、手、治疗台等传染媒体)；手机供水管道中存水返流人口中。牙周病的预后和计划第30页我国人群中HBV携带者约占10%，

艾滋病、梅毒等也有增多趋势。牙周病的预后和计划第31页牙周诊室控制感染

特点及标准牙周病的预后和计划第32页病史采集及必要检验

重视问询全身疾病、传染性疾病。

“一致对待”标准

universalprecaution

即假定每位患者都有血源性传输感染性疾病，诊治中一律严格防交叉感染，必要时作相关化验检验。牙周病的预后和计划第33页治疗器械消毒

按器械分类、分别用不一样方法消毒。

“双消毒”：对使用过器械应实施消毒液浸泡、超声波或手工清洗、清水冲净干燥、高压灭菌或其它消毒方法。

大型设备如综合治疗台表面等，

可用可靠消毒剂进行表面擦拭等。牙周病的预后和计划第34页应尽可能使用已消毒一次性用具

(如检验器、吸唾器、注射器等)。

一人一机。

也可2%碘酊擦拭手机各部位，酒精脱碘2次，

也可用1%碘附消毒。牙周病的预后和计划第35页保护性屏障

口罩、帽子、防护眼镜、面罩、手套、工作服等

治疗过程中，

污染手套不得任意触摸周围物品，

治疗结束后

应清洗手套上血污后再摘除手套，书写病历等。牙周病的预后和计划第36页尽可能使用脚控开关来调整治疗椅

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，作必要销毁。牙周病的预后和计划第37页降低治疗椅周围空气中细菌量

治疗前1%过氧化氢或0.12%氯己定液鼓漱一分钟，降低患者口中细菌数量、治疗时气雾污染。

诊室内应有良好通风。

不在诊室内饮水和进食。牙周病的预后和计划第38页治疗台水管系统消毒、

阻止水回流装置；

在每位患者治疗结束后，再空放水30秒；

天天开始工作前再冲水一至数分钟。

国外提议超声波洁牙机使用单独净水储水器，并每七天用1:10次氯酸钠液冲储水系统，随即马上用蒸馏水冲洗。牙周病的预后和计划第39页严格恪守控制医院感染标准，

使病原微生物扩散和环境污染降低到最小程度。

保护患者和医务人员利益安全。牙周病的预后和计划第40页Treatmentcanalterprognosis.Prognosishasdifferentconnotationsandnuances.Thepatienthaseveryrighttoknowtheanswerstothesequestions.牙周病的预后和计划第41页Question？Ismydiseasefatal?

WillIlosemyteeth?

Willyourtreatmenthelpme?

Whatcanyoudotohelpme?牙周病的预后和计划第42页Whatarethetherapeutic"odds"?

Whatarethefinancialrisks?

Whatarethechancesthatthetreatmentwillbeofbenefit?牙周病的预后和计划第43页Prognosishas

threemeanings

indentistry.牙周病的预后和计划第44页Diagnosticprognosis.Whatareevaluationsofthecourseofthediseasewithouttreatment?WhatisthestatusoftheteethnowWhatistheanticipatedfutureoftheseteeth?牙周病的预后和计划第45页Therapeuticprognosis.Giventhestateoftheartandscienceofperiodonticsandtheknowledgeandskillofthepractitioner,whateffectwillperiodontaltreatmenthaveonthecourseofthedisease?牙周病的预后和计划第46页Prostheticprognosis.Whatistheforecastforthesuccessoftheprostheticrestoration?Willtheprosthesisbetherapeuticordetrimental?Whatspecificneedsdictatethatitbeprescribed?牙周病的预后和计划第47页Judgementoftheseveritydependson：1.pocketdepth,2.degreeofboneloss,3.toothmobility,4.crown-rootratio.牙周病的预后和计划第48页generalizedorlocalizedThedistributionofdisease：Inflammatoryfactors：Traumaticfactors：牙周病的预后和计划第49页Individualtooththerapeuticprognosisincludessuchfactorsas：Percentageofboneloss;Probingdepth;牙周病的预后和计划第50页Distributionandtype

ofboneloss

Presenceandseverityof

furcationinvolvements

Mobility牙周病的预后和计划第51页Crown-rootratio

Pulpalinvolvement

Toothpositionandocclusal

Strategicvalue牙周病的预后和计划第52页Followingarefactorsincludedinoverallprognosis:AgeMedicalstatus牙周病的预后和计划第53页Individualtoothprognoses

(distributionandseverity)

Degreeofinvolvement,duration,andhistory

ofthedisease(rateofprogression)牙周病的预后和计划第54页Patientcooperation

Economicconsiderations

Knowledgeandabilityofthedentist

Etiologicfactors牙周病的预后和计划第55页Accuracyandcompletenessoftheinformationgatheredattheexamination

Dentist'sabilitytorecognizeandeliminateorcontrolthefactorscausingthedisease牙周病的预后和计划第56页thepatient'sabilityanddeterminationinmaintainingthehealthoftheperiodontiumandteeth.牙周病的预后和计划第57页Theoverallprognosisdependsontheprognosesoftheindividualteeth.牙周病的预后和计划第58页PASTHISTORY

(RATEOFDESTRUCTION)牙周病的预后和计划第59页Probablythemostimportantfactorinforecastingthefuturehealthstatusofadentitionisknowledgeofitspasthealthstatus.

牙周病的预后和计划第60页Speedofbreakdownundercontrolsoruncontrols

Thelocation,shapeanddepthsofthepockets牙周病的预后和计划第61页Toothmobilitycanbecontrolledoreliminated,theprognosisisbetter.

Thegreatertheboneloss,thepoorertheprognosis.牙周病的预后和计划第62页Asbonelossexceeds50%,theprognosisworsensrapidly.

Themoreirregulartheboneloss,thepoorertheprognosis.牙周病的预后和计划第63页thepatternofboneloss:horizontal,verticalorinfrabonydefects.

theageofthepatientandtheetiologicfactorsinvolvedinthepatient'sdisease.牙周病的预后和计划第64页poorerprognosis:

tilted,drifted,orrotated,hygienedifficult,eliminationofpocketsimpaired牙周病的预后和计划第65页periodontaldiseaseiscomplicatedbyactivesystemicfactors

andtraumatism牙周病的预后和计划第66页morphologicinnatureandincludethenumberanddistributionofteeth,toothmorphology,furcationinvolvement.牙周病的预后和计划第67页Extentofinvolvement.

Isthefurcationpartiallyortotallyinvolved?

Statusofbonesupport.

Ifthebonelevelsarerelativelysound,theefforttosavemaybejustifiable.牙周病的预后和计划第68页Rootlengthandcrown-rootratiomustbeconsidered牙周病的预后和计划第69页Angulationofrootspread.

Healthofneighboringteeth.牙周病的预后和计划第70页Thenumberanddistributionofteethpresent

crown-rootratio,

shapeandnumberoftheroot牙周病的预后和计划第71页theheightofthealveolarcrest

personalpsychologicandsociologic,

financialconsiderations.牙周病的预后和计划第72页OTHERCONSIDERATIONSINESTABLISHINGPROGNOSIS牙周病的预后和计划第73页Theperformanceofhomecareisacceptableandthecariesincidenceislow,

theprognosisisbetter

牙周病的预后和计划第74页Theprimeconsiderationisthepreservationofthedentitionasafunctioningunit.牙周病的预后和计划第75页Insomeinstances

theextractionofasingletoothwillmakethewholesituationuntenable.

Inothersituationsisolatedextractionswillsimplifytheproblem.牙周病的预后和计划第76页whatisconsideredtobeahopelesstooth.

Thiswillmaketreatmentplanningsimpler.

牙周病的预后和计划第77页thecharacteristicsofhopelessperiodontallyinvolvedteeth:牙周病的预后和计划第78页Associatedwithintractablepainrelieved,massiveinfectionreducedbyextraction

Mobilitybeyond3degrees牙周病的预后和计划第79页Furcationinvolvementwithlittleornointerradicularbone

Bonelossbeyondtheapex

Bonelosstotheapexononesideofthetooth牙周病的预后和计划第80页Generalizedcircumferential

bonelosstowithin3mmoftheapex

Pocketdepthtotheapexwithoutpulpalinvolvement

Verticalcracksorfractures牙周病的预后和计划第81页Inaccessibleperforationsoraccessory

canals

Numberandpositionofremainingteethprecludingprosthetic

Extremecariessusceptibility牙周病的预后和计划第82页Objectives

oftreatment牙周病的预后和计划第83页Treatmentgoalsshouldbe

evaluatedineverycase.牙周病的预后和计划第84页Cantreatmentobjectivesofafirmnon-retractablegingivathatdoesnotbleedbereached?

Canthepocketbeeliminated?

Willtheboneregenerate?

Canthetoothbestabilized?

牙周病的预后和计划第85页Cantoothberestored?

Canthepatienttoleratethetreatment?

牙周病的预后和计划第86页Ifyoubelievetheanswerstothesequestionstobe"yes,"thenplanandproceedwiththetreatment.

If“no,”alternativetreatment,compromise,orextractionisadvisable.牙周病的预后和计划第87页Asdefinitivelaboratorytestsaredevelopedtomakediagnosismoreaccurate,andasfurtherknowledgeconcerningtheetiologyandpathogenesisofperiodontaldiseasesisdeveloped,prognosiswillchangefromaqualitativetoaquantitativejudgment.

牙周病的预后和计划第88页TREATMENTPLAN牙周病的预后和计划第89页Presentation

Patientconsent

Orderoftreatment

PhaseI

PhasesIlandIII

MaintenancetherapyProstheticprescription牙周病的预后和计划第90页Alternativetreatmentplans

Treatmentcriteria

Qualityofcare

Philosophyoftreatment

Recordkeeping

Referral牙周病的预后和计划第91页Presentation

Patientconsent

Afterhearingthepresentation,thepatientmustdecidewhethertoundergotreatment.牙周病的预后和计划第92页PHASEI牙周病的预后和计划第93页Firststeps(Theinitialeffort)shouldbedirectedtowardtheeliminationofinflammationandtheinstitutionofaprogramofplaquecontrol.

牙周病的预后和计划第94页Toreducepocketdepth

Tominimizeperiodontaltraumatism

Orthodontics

(mayprecedeorfollowanysurgicalinterventions)牙周病的预后和计划第95页Extractions

(Teethwithhopelessprognoses)

Restorations

Usuallyperiodontaltherapyshouldprecederestorativeinterventions.

therestorationsshouldbetemporary牙周病的预后和计划第96页Theprovisionalsplinting

duringthetreatmentperiodshouldbeevaluated.牙周病的预后和计划第97页Schedulingofrestorativetreatment

shouldbedoneaccordingtothefollowinggeneralrules:牙周病的预后和计划第98页Normalpatients.

(Restorativetreatmentstartsimmediately.)

ClassI

(ADAperiodontaldiseaseclassification)牙周病的预后和计划第99页Withoutocclusaltreatmentneed

Cariescontrolandscalingandrootplanning.includingplaquecontrol,maybesimultaneous.Definitiverestorativetreatmentshouldfollowcompletionofscalingandplaquecontrol.牙周病的预后和计划第100页WithocclusaltreatmentneedDefinitiverestorativetreatmentmayimmediatelyfollowcompletionofscaling,plaquecontrol,andocclusaladjustment.牙周病的预后和计划第101页WithsurgicaltreatmentneedDefinitiverestorativetreatmentshouldnotbeinstitutedforatleast4to6weeksafterthepatienthashealed.牙周病的预后和计划第102页Splinting

(Wireligationandcompositeacid-etchsplinting)

Emergency

(pain,swelling,infection,anddiscomfort)

Theemergenciesalltakepriorityoverothertreatmentscheduling.牙周病的预后和计划第103页Medicalstatus

asystemicconditionthatwouldcomplicatetreatment,amedicalconsultationisnecessary.牙周病的预后和计划第104页PHASESIIANDIII牙周病的预后和计划第105页PhaseIIsurgery

permitspocketelimination/reduction

Therestorationofnormalosseousform

ostectomy-osteoplasty

osseoussurgerycombinedwithgraftingprocedures牙周病的预后和计划第106页rootresections

mucogingivalandgingivectomy

periodontal-endodonticrestorativetreatment

provisionalsplinting.牙周病的预后和计划第107页Maintenancetherapy

Thespecialistmayseethepatientonceayearoreveryotheryearforthelessinvolvedcases,

whereasthegeneralistmaintainsthepatientintherecallsystem.

Advancedcasesmaybeseenalternatelyat2-to4-monthintervals.牙周病的预后和计划第108页PROSTHETICPRESCRIPTION

Waitingforaperiodofatleast2monthsafterperiodontalsurgery.

Partialdenturesorafixedprosthesis牙周病的预后和计划第109页ALTERNATIVETREATMENTPLANS牙周病的预后和计划第110页Alternativetreatmentplans

shouldbepreparedforthepatientwhoelectstoforegosplintingandsurgerywhentheseareindicated.牙周病的预后和计划第111页InthiscasethepatientmaybetreatedthroughphaseItherapyandbeplacedonamaintenanceschedule.

Theestablishmentofanalternativeplangenerallycallsforarigorousmaintenanceschedulewithscalingandplaningperformedmorefrequentlythanisotherwiseusual.牙周病的预后和计划第112页Treatmentcriteria牙周病的预后和计划第113页Qualityofcare

Ingeneral,periodontalcareseeksthefollowing:

Removalofknownetiologicfactors

Reductionofallpockets

toaminimaldepthtofacilitatemaintenancebythepatientandthedentalhygienist

Creationofamaintainablegingivalandosseousarchitecture牙周病的预后和计划第114页Restorationofafunctionalandestheticdentition

Maintenanceoftheresultinghealthbythepatient,doctor,andhygienist牙周病的预后和计划第115页PHILOSOPHYOFTREATMENT牙周病的预后和计划第116页periodontaldiseasescanbetreatedsuccessfully

thehealthofthediseasedperiodontiumcanberestoredandtheteethmaintained.牙周病的预后和计划第117页Thetherapeuticconceptoftodayincludesallformsoftherapy,conservativeandcomplexselectedandblendedforthesuccessfulmanagementoftheindividualpatient.牙周病的预后和计划第118页Therapymustbetailoredtotheneeds,bothphysicalandpsychologic,ofthepatient.牙周病的预后和计划第119页RECORDKEEPING

Thetreatmentperformedshouldberecordedcarefullyateachvisit.牙周病的预后和计划第120页Referral

Therearethreebasicreasonsforreferral:

(1)professional,

(2)moralanethical,and

(3)legal.牙周病的预后和计划第121页Professional:

Professionalreferralsareclassifiedasfollows:

1.

Medical:

Referral/consultation

isindicatedwhenapatient'smedicalhistorydisclosessignificantinformationthatmaycontributetoorinfluencethecourseandoutcomeofthetreatmentorwhenthedentistsuspectsillness.牙周病的预后和计划第122页2.Dental:

Referral/consultationisindicated

whenthedentistcannotprovidetheentiredentaltherapythepatientneeds.

Whentheexaminationrevealsperiodontaldiseasethatthegeneralistcannotordoesnotwishtotreat,referraltoaperiodontistisinorder.

Equallytheperiodontistisobligatedtoreferpatientsfortreatmenttothegeneralpractitionerorotherspecialists.牙周病的预后和计划第123页3.Moralandethical:Thespecialists