侵袭性牙周炎一例.ppt

诊断 45慢性根尖炎（外院开髓后） 侵袭性牙周炎 鉴别诊断 1.non-contributory medical history2.rapid attachment loss and bone destruction3.familial aggregation of cases 温医07口腔 倪秀凤 病例报告 医生，我想补牙 女 ， 27 牙又疼了，这会儿还肿起来了，不能出去见人了，555…… 来，跟我说 说怎么了 医生，是这样 这样……的 恩，你这个牙 要做根管治疗， 要来好几次…… 不行不行 我马上要 回家过年了 那只能先给你开髓 先缓解症状了， 过年回来接着看 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，BI 2-3 临床检查 46冠完整，近中PD10mm X片表现：近中牙槽骨角形吸收 16、26、36 PD7-8mm， 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 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 Primary features Generally present 1.Amounts of microbial deposits inconsistent with the severity of periodontal destruction 2.Elevated proportions of Actinobacillus actinomy-cetemcomitans and, in some Far East populations,porphyromonas gingitvalis3.Phagocyte abnormalities4.Hyper-responsive macrophage phenotype, includeing elevated production of PGE2 and IL-1β in response to bacterial endotoxins5.Progression of attachment loss and bone loss may be self-arresting —Lang et al.1999 Circumpubertal onset Localized first molar/incisor presentation with interproximal attachment loss on at least two permanent teeth ,one of which is a first molar, and involving no more than two teeth other than first molars and incisors Robust serum antibody response to infecting agents Usually affecting persons under 30 years of age,but patients may be older Generalized interproximal attachment loss affecting at least three permanent teeth other than first molars and incisors Pronounced episodic nature of the destrucion of attachment and alveolar bone Poor serum antibody response to infecting agents Generalized aggressive periodontitis(GAP) Locatized aggressive periodontitis(LAP) 治疗设计 45 完成RCT 牙周系统治疗：1：OHI 2：龈上洁治（手工）