1、（一）临床病理（二）临床表现二 牙周袋形成1.结合上皮增殖、炎性浸润1.软组织壁1.根据牙周袋底与牙槽嵴顶的位置关系分 骨上袋（suprabony pocket）骨下袋（infrabony pocket）（一）牙槽骨吸收的临床病理 1.炎 症 2.牙合创伤I度：牙槽骨吸收在牙根的颈1/3以内四四 牙齿松动和移位牙齿松动和移位1.牙槽骨吸收1.牙周支持组织的破坏Why?legal ramifications affects treatment plan and prognosis for communication with patients History:Last classificatio
2、n system was devised at the 1989 World Workshop in Clinical Periodontology Improved understanding of etiology of periodontal diseases Inclusion of gingival diseasesThe Periodontium:supporting apparatus of the tooth and its associated components alveolar boneGingival Diseases:-Can occur on a periodon
3、tium with no attachment loss,or on a periodontium with attachment loss that is not progressing-Dental plaque induced-Non-plaque inducedGingivitis:general information-DEFN:inflammation of the givgiva-ubiquitous-occlusion analysis-major cause:accumulation of plaque-other causes-tx:removal of the cause
4、-doesnt inevitably lead to periodontitisGingivitis:pathology-4 stages:initial,early,established,advanced lesion -Summary:PMNs,exudate,collagen breakdown,plasma cells,proliferation of epithelium-Major cause:accumulation of plaqueDental plaque-induced gingival diseasesI.Gingivitis associated with dent
5、al plaque only a.without other local contributing factors b.with local contributing factors Dental plaque-induced gingival diseasesII.Gingival diseases modified by systemic factors a.associated with the endocrine system 1.puberty-associated gingivtis 2.menstrual cycle-associated gingivitis 3.Pregnan
6、cy-associated 4.diabetes mellitus-associated gingivitisPeriodontitis-Definition:Inflammation involving the gingival unit(gingiva and alveolar mucosa)and extending to the periodontal ligament,alveolar bone,and cementum.Periodontitis involves the loss of clinical attachment and radiographic evidence o
7、f bone loss.Periodontitis-evidence of loss of periodontal attachment-previously classified by age-now classified by“nature”of diseases:progression,clinical presentation,associated systemic diseases Periodontitis:classification overview-chronic periodontitis-aggressive periodontitis-periodontitis as
8、a manifestation of systemic diseasea-necrotizing periodontal diseases-abscesses of the periodontium-periodontitis associated with endodontic lesions-developmental or acquired deformaties and conditionsChronic Periodontitis-formerly“adult”periodontitis-can be:localized or generalized-usually slowly p
9、rogressive disease-may have short periods of rapid progressionAggressive Periodontitis-formerly“early onset”periodontitis-can be:localized or generalized-highly destructive forms of periodontitis-not age dependment-diagnosis of“chronic”or“aggressive”depends on many criteriaPeriodontitis as a Manifes
10、tation of Systemic Diseases1.Associated with haematological disorders2.Associated with genetic disorders3.Not otherwise specifiedNecrotizing Periodontal Diseases1.Necrotizing ulcerative gingivitis(NUG)2.Necrotizing ulcerative periodontitis(NUP)Abscesses of the Periodontium1.Gingival abscess2.Periodo
11、ntal abscess3.Pericoronal abscessPeriodontitis associated with Endodontic lesions-combined periodontic-endodontic lesionsDevelopmental or Acquired Deformaties and ConditionsA.Localized tooth-related factors 1.Tooth anatomic factors 2.Dental restorations/appliances 3.Root fractures 4.Cervical root re
12、sorption and cemental tearsDevelopmental or Acquired Deformaties and ConditionsB.Mucogingival deformaties,conditions 1.Gingival/soft tissue recession 2.Lack of keratinized gingiva 3.Decreased vestibular depth 4.Frenum/muscle position 5.Gingival excess 6.Abnormal colourDevelopmental or Acquired Deformaties and ConditionsC.Mucogingival deformaties and conditions on edentulous ridgesD.Occlusal trauma
