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侵袭性牙周炎 Aggressive Periodontitis

侵袭性牙周炎 Aggressive Periodontitis. 11. 11-1 命名的历史背景 Historical Background. 1923 年 弥漫性牙周萎缩 diffuse atrophy of the alveolar bone. 1942 年 牙周变性 paradontosis. 1969 年 青少年牙周炎 juvenile periodontitis. 1990 年 侵袭性牙周炎 aggressive periodontitis. 11-2 侵袭性牙周炎的危险因素

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侵袭性牙周炎 Aggressive Periodontitis

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  1. 侵袭性牙周炎 Aggressive Periodontitis 11

  2. 11-1 命名的历史背景 Historical Background 1923年 弥漫性牙周萎缩 diffuse atrophy of the alveolar bone 1942年 牙周变性 paradontosis 1969年 青少年牙周炎 juvenile periodontitis 1990年 侵袭性牙周炎 aggressive periodontitis

  3. 11-2 侵袭性牙周炎的危险因素 Risk Factor for Aggressive Periodontitis Microbiology Aa 检出率 LJP90-100% 毒性产物 Leukotoxin, Bone resorption –inducing toxin, Epitheliotoxin, Cytolethal distending toxin (坏死膨胀毒素), apoptosis-inducing toxin(致凋亡毒素) 等 引发宿主免疫反应 血清和牙龈局部, 抗Aa抗体升高 牙周治疗与Aa数量的关系 机械与药物治疗

  4. Systemic factors 白细胞功能缺陷 (defect of neutrophil functions) 产生特异性抗体　IgG2, GAgP时低 遗传背景 家族聚集现象 (family aggregation) 牙骨质发育异常 (defect in cementum formation may be responsible for LAaP

  5. Environmental and behavior factors 与AP有关的宿主因素 吞噬细胞功能缺陷 对LPS的过度反应,产生过量的毒性因子 特异性性抗体的水平和亲和力不足 针对Aa糖蛋白的IgG2抗体水平不足 遗传因素背景

  6. 多种微生物 高毒性因子 易感宿主 防御功能低下and/or过度炎症反应 牙周组织破坏

  7. 11-3侵袭性牙周炎的临床特点 Clinical Features of AP AP 23y F CP 48 y M

  8. AP X片-29岁 F 7年病史

  9. 临床特点 快速进展的牙周组织破坏 rapid periodontal tissue destruction 年龄与性别 age and gender 口腔卫生情况 oral hygiene 好发牙位 tooth spicificity 家族聚集性 family aggregation 全身情况 systemic condition

  10. 11-4 侵袭性牙周炎的诊断 Diagnosis of AP • 　年龄一般在３５岁以下，但也可超过 • 　无明显的全身疾病 • 　快速的骨吸收和附着丧失 • 　家族聚集性 • 　破坏程度与菌斑及局部刺激量不一样 • 　鉴别诊断时主要应排除ＡｇＰ

  11. 注意排除: Malocclusion 不正规的正畸治疗 全身疾病 广泛的局部刺激因素

  12. CP LAgP GAgP 成人 青春期前后 30以下 慢,中进展 快速 快速 菌斑与破坏一致 不一致 不一定 病变分布不定 局限切牙磨牙, 除切磨牙外 其它牙少于2个 其它牙大于3个 无 明显 明显 多 无/少 无/可有 年龄 进展 菌斑 分布 家族 龈下结石

  13. 11-5 侵袭性牙周炎的治疗原则Treatment Principle of Aa 早期治疗防止复发 SRP 翻瓣刮治 early treatment and prevention of recurrence 抗菌药物的应用 四环素类 Antimicrobial therapy 调整机体的防御机能 抑制胶原酶和PGE2 Host modulatatory therapy 中药等 综合治疗 正畸 牙移植 复查 Comprehensive treatment

  14. 小结 感染性疾病 组织破坏 多因素疾病: 微生物 宿主 环境 全身 多类型(CP AP), 治疗: 去除菌斑及促进因子, 可配合多种手段 长期治疗(重复治疗), 终身维护 重视预防

  15. Multiple choice questions • Localised aggressive periodonttitis • Is highly prevalent in adolescents • Can affect any teeth in the permanent dentition • Is typically characterise by Actinobacillus actinomycetemcomitans infection • Commonly runs in families • Is associated with neutrophil defects

  16. a. False. Prevalence is <1%. b. False. There is a localised first molar and incisor presentation with no more than two other teeth affected (if more teeth than this are affected, the diagnosis is generalised aggressive periodontitis). c. True. Microbial analysis typically reveals elevated levels of this organism. d. True. Studies show that localised aggressive periodontitis is a heritable trait. e. True. Patients with localised aggressive periodontitis may have abnormalities of neutrophil chemotaxis and phagocytosis.

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