根尖周病PPT文档格式.ppt

1、Disease of Periapical Tissues,根 尖 周 病,Definition,periodontal membrane牙周膜cementum牙骨质 alveolar bone牙槽骨,pulp tissues 牙髓apical foramen 根尖孔 periapical tissues 根尖 周组织,Blood vessels nervelymphatic vesselspulpitis 牙髓炎,infection,injury deep periodontal pocket 深牙周袋,Classification,periapical periodontitis根尖周炎a

2、cute急性chronic慢性chronic periapical abscess慢性根尖脓肿periapical granuloma根尖肉芽肿 periapical cyst根尖囊肿,Periapical periodontitis,inflammatory lesion 炎性病变in periodontal membrane 牙周膜 of root apex 根尖resorption of cementum and alveolar bone,Periapical periodontitis,Etiology bacterial effects 感染因素 most of them deri

3、ved from pulpitis牙髓炎 a defensive reaction,cariesPulpitis（Acute or chronic）pulpal Necrosis牙髓坏死Periapical inflammation 炎症,Periapical periodontitis,Etiology bacterial effects 感染因素 derived from severe periodontitis重度牙周炎 deep periodontal pocket牙周袋 almost reach to the root apex periapical diseases,Periapi

4、cal periodontitis,Etiology Mechanical damage 机械损伤traumatic accidents意外损伤occlusal trauma咬合创伤iatrogenic damage医源性损伤 from dental procedures For example:#in the root canal therapy根管治疗 the instrument or the filling materials were extruded the apical foramen,Etiology Chemical irritation化学刺激Most of them ar

5、e iatrogenicarise from the procedure of root canal therapy 根管治疗For example:#irritative filling material,Periapical periodontitis,Periapical periodontitis,Classification according to the duration of disease 病程acute periapical periodontitis急性根尖周炎chronic periapical periodontitis 慢性根尖周炎,Acute periapical

6、 periodontitis,acute inflammation around apex secondary to the caries and pulpitis pulpal Necrosis decomposed products of pulp and the toxin inflammation of periapical tissue association with a nonvital tooth 死髓牙,bacteria,Acute periapical periodontitis,secondary to trauma外伤high occlusal contacts咬合创伤

7、wedging by a foreign object异物嵌塞a vital tooth活髓牙 an acute exacerbation 急性发作of chronic periapical periodontitis,Acute periapical periodontitis,Classificationacute serous periapical periodontitis 急性浆液性根尖周炎acute purulent（suppurative）periapical periodontitis 急性化脓性根尖周炎 acute periapical abscess or acute al

8、veolar abscess 急性根尖脓肿或急性牙槽脓肿,Acute periapical periodontitis,Clinical features临床表现symptomatic as the inflamed exudates炎性渗出物 accumulates within the periapical tissues initial stagetenderness of the affected tooth患牙疼痛 relieved by direct application of pressure咬合压力下缓解sera squeezed out of the dilation扩张

9、blood vessels,Acute periapical periodontitis,Clinical featuresProgressionpain more intenseextreme sensitivity to chewing咀嚼the affected tooth extrude from its socket患牙伸长 the pain is spontaneous自发,persistent持续 but is circumscribed局限indicate the affected toothacute serous inflammatory stage,Acute peria

10、pical periodontitis,Clinical features acute serous inflammatory stage acute serous periapical periodontitis purulent stage acute purulent periapical periodontitis,short,Acute periapical periodontitis,Clinical features The neutrophils degenerate and die and form the pus pus accumulate and form the ab

11、scess 脓肿（acute purulent periapical periodontitis or acute alveolar abscess）the pain violent剧烈 and persistent持续extreme sensitivity to percussion叩诊extrusion of the tooth evidentlyswelling of the tissues,中性白细胞,脓液,Acute periapical periodontitis,Clinical featuresheadache,malaise,fever and chills may be p

12、resent spread along the path of least resistance through the medullary spaces osteomyelitis 骨髓腔 骨髓炎perforate the cortex cellulites 骨皮质 蜂窝织炎,Acute periapical periodontitis,Clinical features abscess in the soft tissue cellulites channelize through the overlying soft tissue channelize through the skin

13、intraoral sinus口内窦道 cutaneous sinus皮肤窦道 drain the purulent material,Acute periapical periodontitis,Radiographic features X线表现a thickening of the apical periodontal ligament牙周韧带no appreciable alternations,Acute periapical periodontitis,Histopathologic features 组织学表现a central area of disintegrating ne

14、utrophils surrounded by leukocytes白细胞 and lymphocytesdilatation of the blood vessels in the adjacent tissuesmarrow spaces shows an inflammatory cell infiltrate around the area of suppuration contains a serous exudates 浆液渗出,Chronic periapical periodontitis,no symptom mild pain or unfit when biting or

15、 chewing on solid food acute exacerbation急性发作when the resistance of immunity system decreasingimportant histopathologic feature the formation of the inflamed granulation tissue 炎性肉芽组织 the absorption of the alveolar bone牙槽骨吸收,Chronic periapical periodontitis,Classificationchronic periapical abscess 慢

16、性根尖脓肿periapical granuloma 根尖肉芽肿,Chronic periapical abscess,chronic suppurative periapical periodontitis 慢性化脓性根尖周炎chronic alveolar abscess 慢性牙槽脓肿chronic suppurative inflammation of periapical tissues results from acute periapical abscess or periapical granuloma,Chronic periapical abscess,Clinical featuresasymptomatic sensitivity to percussion mild pain occasioned when biting or chewing on solid food formation of fistulous瘘管形成 if the lesion undergoes an acute exacerbationtwo types nonvital tooth,Chr