chapter15­16章牙周炎的伴发病变和牙周医学.pptVIP

15 牙周炎的其他伴发病变 Other Secondary Lesions of Periodontitis 15-1牙周脓肿 Periodontal Abscesses 牙周炎中\晚期出现深牙周袋后的一个常见的伴发症状, 是位于牙周袋壁或深部牙周组织的局限性化脓性炎症,可引起周围胶原纤维和骨质的破坏 1, 深牙周袋或复杂性牙周袋，内壁的化脓性炎症向深部结缔组织扩展, 无引流通道This abscess formation is usually due to the marginal closure of a deep periodontal pocket and lack of proper drainage. 发病因素 Causal factor 2，不规范的洁治或刮治术后，损伤大，或袋内术后感染物堆积，加上引流不畅Post-scaling periodontal abscess. When these lesionsoccur immediately after scaling or after a routine professional prophylaxis, they are usually related to the presence of small fragments of remaining calculus that obstruct the pocket entrance once the edema in the gingiva has disappeared 临床表现 Clinical feature Acute Periodontal Abscess 发病突然，唇颊或舌腭侧形成半球形突起，炎症早期，张力大，疼痛剧烈，患牙有浮动感，松动明显 Periodontal abscess (arrows) associated with a lower right first molar. Observe the association between the abscess formation and the furcation lesion in this molar. Chronic Periodontal Abscess 急性期治疗不彻底，反复发作所致，一般无症状，可见窦道（fistula) Periodontal abscess associated with a lower left canine. Observe the fistulous tract opening demonstrated with a gutta-percha point. Radiological image of the lower canine The differential diagnosis with a periapical abscess was done by the positive tooth vitality sign and absence of caries or restoration in the tooth, and the presence of a deep periodontal pocket in tooth. 鉴别诊断 Differential diagnosis 与牙龈脓肿gingival abscess 的鉴别 局限于龈乳头或龈缘，无牙周袋，无附着丧失，无牙周炎症状和体征 与尖周脓肿periapical abscess的鉴别 感染来源 牙周袋 牙体龋坏和不良修复体 牙髓活力 脓肿部位 松动度 扣痛 X片 等 治疗原则 Treatment principle The treatment of the periodontal abscess usually includes two stages: the management of the acute lesion the appropriate treatment of the original and/or residual lesion, once the emergency situation has been controlled. For the treatment of the acute lesion, alternatives were proposed, such as: (1) incision and drainage (2) scaling and root planing (3) periodontal surgery (4) the use of different systemically administere