侵襲性牙周炎AggressivePeriodontitis1111-1命名的歷史背景HistoricalBackground1923年彌漫性牙周萎縮diffuseatrophyofthealveolarbone1942年牙周變性paradontosis1969年青少年牙周炎juvenileperiodontitis1990年侵襲性牙周炎aggressiveperiodontitis11-2侵襲性牙周炎的危險(xiǎn)因素RiskFactorforAggressivePeriodontitisMicrobiologyAa檢出率LJP90-100%毒性產(chǎn)物L(fēng)eukotoxin,Boneresorption–inducingtoxin,Epitheliotoxin,Cytolethaldistendingtoxin(壞死膨脹毒素),apoptosis-inducingtoxin(致凋亡毒素)等引發(fā)宿主免疫反應(yīng)血清和牙齦局部,抗Aa抗體升高牙周治療與Aa數(shù)量的關(guān)系機(jī)械與藥物治療Environmentalandbehaviorfactors與AP有關(guān)的宿主因素吞噬細(xì)胞功能缺陷對LPS的過度反應(yīng),產(chǎn)生過量的毒性因子特異性性抗體的水平和親和力不足針對Aa糖蛋白的IgG2抗體水平不足遺傳因素背景多種微生物高毒性因子易感宿主防御功能低下and/or過度炎癥反應(yīng)牙周組織破壞11-3侵襲性牙周炎的臨床特點(diǎn)ClinicalFeaturesofAPAP23yFCP48yM快速進(jìn)展的牙周組織破壞rapidperiodontaltissuedestruction年齡與性別ageandgender口腔衛(wèi)生情況oralhygiene好發(fā)牙位toothspicificity家族聚集性familyaggregation全身情況systemiccondition臨床特點(diǎn)注意排除:Malocclusion不正規(guī)的正畸治療全身疾病廣泛的局部刺激因素11-5侵襲性牙周炎的治療原則TreatmentPrincipleofAa早期治療防止復(fù)發(fā)SRP翻瓣刮治earlytreatmentandpreventionofrecurrence抗菌藥物的應(yīng)用四環(huán)素類Antimicrobialtherapy

調(diào)整機(jī)體的防御機(jī)能抑制膠原酶和PGE2Hostmodulatatorytherapy

中藥等綜合治療正畸牙移植復(fù)查Comprehensivetreatment小結(jié)感染性疾病組織破壞多因素疾病:微生物宿主環(huán)境全身多類型(CPAP),治療:去除菌斑及促進(jìn)因子,可配合多種手段長期治療(重復(fù)治療),終身維護(hù)重視預(yù)防MultiplechoicequestionsLocalisedaggressiveperiodonttitisIshighlyprevalentinadolescentsCanaffectanyteethinthepermanentdentitionIstypicallycharacterisebyActinobacillus

actinomycetemcomitansinfectionCommonlyrunsinfamiliesIsassociatedwithneutrophildefectsa.False.Prevalenceis<1%.b.False.Thereisalocalisedfirstmolarandincisorpresentationwithnomorethantwootherteethaffected(ifmoreteeththanthisareaffected,thediagnosisisgeneralisedaggressiveperiodontitis).c.True.Microbialanalysistypicallyrevealselevatedlevelsofthisorganism.d.True.Studiesshowthatlocalisedaggressiveperiodontitisisaheritabletrait.e.True.Patie