1、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
2、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,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-contributory medical history2.rapid attachment loss and bone destructio
3、n3.familial aggregation 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 East populations,porphyromonas gingitvalis3.Phagocyte abnorma
4、lities4.Hyper-responsive macrophage phenotype, includeing elevated production of PGE2 and IL-1 in response to bacterial endotoxins5.Progression of attachment loss and bone loss may be self-arresting,Lang et al.1999,Circumpubertal onsetLocalized first molar/incisor presentation with interproximal att
5、achment 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 incisorsRobust serum antibody response to infecting agents,Usually affecting persons under 30 years of age,but patients may be olderGeneralized interproximal
6、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 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） 3：龈下刮治+根面平整 4：酌情手术 5：定期维护（SPT）,45 RCT后,治疗过程,手工龈上洁治+龈下刮治+根面平整（SRP）,讨论,详细诊断及提供完善治疗计划：主诉仅需要完成45RCT,早期发现，早期治疗,诊断思路,心得,全面检查和处理拍照技术待提高,谢谢！,诊断,
