侵襲性牙周炎一例

1、局限性侵襲性牙周炎一例,溫醫(yī)07口腔倪秀鳳,病例報(bào)告,那天……,醫(yī)生，我想補(bǔ)牙,牙又疼了，這會(huì)兒還腫起來(lái)了，不能出去見人了，555……,半月前……,現(xiàn)病史：4年來(lái)右下后牙反復(fù)腫痛，牙齦排膿后可緩解，平時(shí)偶有刷牙出血癥狀，有輕度口腔異味及后牙食物嵌塞史。否認(rèn)明顯牙齒松動(dòng)、移位癥狀 ，兩周前右下后牙復(fù)又腫起伴咬合痛及右側(cè)面部腫大癥狀，至當(dāng)?shù)蒯t(yī)院就診，予開髓急性處理，消炎藥?kù)o脈滴注（具體用藥不詳）。目前疼痛緩解，今為進(jìn)一步治療，到我科就診。

2、刷牙習(xí)慣：每日2次，豎刷牙，無(wú)牙線使用習(xí)慣。,主訴：右下后牙反復(fù)腫痛4年余，加重兩周,,,臨床檢查,45已開髓，牙合面見暫封物，叩（＋），松（-）根尖片示：45根尖區(qū)見不規(guī)則低密度影,口腔衛(wèi)生狀況差，牙石（ ＋＋＋），色素（＋ ＋ ），中等菌斑軟垢,全口牙齦輕度紅腫，伴舌側(cè)輕度牙齦萎縮，BI 2-3,臨床檢查,46冠完整，近中PD10mm X片表現(xiàn)：近中牙槽骨角形吸收,16、26、36 PD7-8mm，余牙PD3-5mm詳見大表

3、,,,,,,,,,,,,,,全身情況：,HBsAg陽(yáng)性,余無(wú)殊,家族史：父母親早失牙,既往史：無(wú)牙科治療史,診斷,45慢性根尖炎（外院開髓后）侵襲性牙周炎,鑒別診斷,慢性牙周炎與侵襲性牙周炎,局限性侵襲性牙周炎與廣泛性侵襲性牙周炎,1.non-contributory medical history2.rapid attachment loss and bone destruction3.familial aggregatio

4、n of cases,,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 E

5、ast populations,porphyromonas gingitvalis3.Phagocyte abnormalities4.Hyper-responsive macrophage phenotype, includeing elevated production of PGE2 and IL-1β in response to bacterial endotoxins5.Progression of attachmen

6、t loss and bone loss may be self-arresting,—Lang et al.1999,Circumpubertal onsetLocalized first molar/incisor presentation with interproximal attachment loss on at least two permanent teeth ,one of which is a first mol

7、ar, and involving no more than two teeth other than first molars and incisorsRobust serum antibody response to infecting agents,Usually affecting persons under 30 years of age,but patients may be olderGeneralized inter

8、proximal attachment loss affecting at least three permanent teeth other than first molars and incisorsPronounced episodic nature of the destrucion of attachment and alveolar bonePoor serum antibody response to infectin

9、g agents,Generalized aggressive periodontitis(GAP),Locatized aggressive periodontitis(LAP),治療設(shè)計(jì),45 完成RCT牙周系統(tǒng)治療：1：OHI 2：齦上潔治（手工） 3：齦下刮治+根面平整