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1、1. Basic Knowledge1. Basic Knowledgepetiodontal tissues/periodontiumoral epitheliumsucular epitheliumsucular epitheliumjunctional epitheliumjunctional epitheliumfree gingival groove(GG)free gingival groove(GG)dento-gingival junction(DGJ)dento-gingival junction(DGJ)gingivafree gingiva/marginal gingiv
2、afree gingiva/marginal gingivagingival sulcus/crevice krevisgingival sulcus/crevice krevisattached gingivaattached gingivakeratinized gingivakeratinized gingivastipplingstipplingmucogingival junctionmucogingival junctiongingival papillagingival papillagingival colgingival colbiological width(BW)biol
3、ogical width(BW)periodontal ligamentperiodontal ligamentalveolar processalveolar processcemento-enamel junction(CEJ)cemento-enamel junction(CEJ)ankylosisalveolar bone crestfenestrationfenestrationdehiscencedehiscenceabscesses of the periodontiumgingival abscessperiodontal abscesspericoronal abscessr
4、isk factordeterminantsusceptibilitysite-specificperiodontal ecosystemperiodontal ecosystemdental plaque biofilmdental plaque biofilmasquired pellicleasquired pelliclesupragingical plaquesupragingical plaquemateria albamateria albasubgingival plaquesubgingival plaqueattached subgingival plaqueattache
5、d subgingival plaqueunattached subgingival plaqueunattached subgingival plaquespecific plaque hypothesisperiodontal pathogensporphyromonas gingivalisporphyromonas gingivalis（PgPg）Tannerella forsythusTannerella forsythus牙周组织口腔龈上皮沟内上皮沟内上皮结合上皮结合上皮游离龈沟游离龈沟龈牙结合部龈牙结合部牙龈游离龈游离龈/ /边缘龈边缘龈龈沟龈沟附着龈附着龈角化龈角化龈点彩点彩膜
6、龈联合膜龈联合龈乳头龈乳头龈谷龈谷生物学宽度生物学宽度牙周膜牙周膜/ /牙周韧带牙周韧带牙槽突牙槽突釉牙骨质界釉牙骨质界牙固连牙槽嵴顶骨开窗骨开窗骨开裂骨开裂牙周组织脓肿牙龈脓肿牙周脓肿冠周脓肿危险因素决定因素易感性牙位特异性牙周生态系牙周生态系菌斑生物膜菌斑生物膜获得性薄膜获得性薄膜龈上菌斑龈上菌斑白垢白垢龈下菌斑龈下菌斑附着性龈下菌斑附着性龈下菌斑非附着性龈下菌斑非附着性龈下菌斑特异性菌斑学说牙周致病菌牙龈卟啉单胞菌牙龈卟啉单胞菌福赛拟杆菌福赛拟杆菌gingival crevicular fluid(GCF)gingival crevicular fluid(GCF)polymorphon
7、uclear leukocyte PMNregenerationregenerationrepairrepairdental calculusdental calculusroot furcationsroot furcationsplaque indexplaque indexbleeding on probing BOPbleeding on probing BOPattachment level ALattachment level ALattachment gainattachment gain2. Diseases2. Diseasesgingival diseasesdental
8、plaque-induced gingivitisdental plaque-induced gingivitisinitial factorinitial factorinitial lesioninitial lesionearly lesionearly lesionestablished lesionestablished lesionadvanced lesionadvanced lesionpapillary gingivitispapillary gingivitisattached gingivaattached gingivapseudo pocketpseudo pocke
9、tlinear gingival erythema, LGElinear gingival erythema, LGEchair-side oral hygiene instructionpuberty-associated gingivitispuberty-associated gingivitisgingival hyperplasiagingival hyperplasiapregnancy-assosiated gingivitispregnancy-assosiated gingivitisprophyleukemia-associated gingival lesionleuke
10、mia-associated gingival lesiondrug-induced gingival enlargementsdrug-induced gingival enlargementsdrug-induced gingival hyperplasiadrug-induced gingival hyperplasiahereditary gingival fibromatosishereditary gingival fibromatosisacute necrotizing ulcerative gingivitisacute necrotizing ulcerative ging
11、ivitis， ANUG ANUGnecrotizing gingivostomatitisacute multiple gingival absecessesgingival absecessplasma cell gingivitisepulis ep lispyogenic granuloma ,paiudenikchronic periodontitis, CPapical migrationapical migrationattachment lossattachment lossgingival pocketgingival pocketsulcular epitheliumsul
12、cular epithelium龈沟液龈沟液中性多形核白细胞再生再生修复修复牙石牙石根分叉根分叉菌斑指数菌斑指数探诊后出血探诊后出血附着水平附着水平附着获得附着获得牙龈病菌斑性龈炎菌斑性龈炎始动因子始动因子初期病损初期病损早期病损早期病损确立期病损确立期病损重度病损重度病损龈乳头炎龈乳头炎附着龈附着龈假性牙周袋假性牙周袋牙龈线性红斑牙龈线性红斑椅旁口腔卫生指导青春期龈炎青春期龈炎龈增生龈增生妊娠期龈炎妊娠期龈炎洁治白血病性龈病损白血病性龈病损药物性牙龈肥大药物性牙龈肥大药物性龈增生药物性龈增生遗传性牙龈纤维瘤病遗传性牙龈纤维瘤病急性坏死性溃疡性龈炎急性坏死性溃疡性龈炎坏死性龈口炎急性多发性龈脓
13、肿牙龈脓肿浆细胞龈炎牙龈瘤化脓性肉芽肿慢性牙周炎根方迁移根方迁移附着丧失附着丧失龈袋龈袋沟内上皮沟内上皮periodontal pocketperiodontal pocketalveolar bone resorptionalveolar bone resorptiontrauma from occlusion/ occlusal traumatrauma from occlusion/ occlusal traumahorizontal resorptionhorizontal resorptionvertical resorptionvertical resorptionsuprabon
14、y pocketsuprabony pocketinfrabony pocketinfrabony pocketangular resorptionangular resorptionone/two/three-walled bony defectone/two/three-walled bony defectquiescencequiescenceexacerbation ek,ssbeiexacerbation ek,ssbei n, in, i ,z-,z-simple pocketsimple pocketcompound pocketcompound pocketcomplex po
15、cketcomplex pockettooth mobilitytooth mobilitybruxismclenchingpremature contactmechanical removalalveolar ridgetooth extractionaggressive periodontitis, AgPaggressive periodontitis, AgPfurcation involvementfurcation involvementflap surgeryflap surgeryguided tissue regenerationguided tissue regenerat
16、ionroot resectionroot resectionroot separationroot separationhemisectionhemisectionperiodontal-endodontic combined lesionsperiodontal-endodontic combined lesionsretrospective pulpitisretrospective pulpitisperiodontal abscessesperiodontal abscessesgingival abscessgingival abscessgingival recessiongin
17、gival recession3.Treatment3.Treatmentinitial therapyinitial therapysurgical therapysurgical therapyrestorative and orthodontic therapyrestorative and orthodontic therapymaintenance therapymaintenance therapyoral health instructionoral health instructionsupragingival scalingsupragingival scalingsubgi
18、ngival scalingsubgingival scalingscaling and root planing, SRPscaling and root planing, SRPremoval of local irritational factorsremoval of local irritational factors牙周袋牙周袋牙槽骨吸收牙槽骨吸收（牙合）创伤（牙合）创伤水平吸收水平吸收垂直吸收垂直吸收骨上袋骨上袋骨下袋骨下袋角形吸收角形吸收一/二/三壁骨袋一/二/三壁骨袋静止期静止期活动期活动期单面袋单面袋复合袋复合袋复杂袋复杂袋牙齿松动牙齿松动夜磨牙紧咬牙早接触机械清除菌斑牙槽
19、嵴拔牙侵袭性牙周炎侵袭性牙周炎根分叉病变根分叉病变翻瓣术翻瓣术引导性再生术引导性再生术截根术截根术分根术分根术半牙切除术半牙切除术牙周牙周- -牙髓联合病变牙髓联合病变逆行性牙髓炎逆行性牙髓炎牙周脓肿牙周脓肿牙龈脓肿牙龈脓肿牙龈退缩牙龈退缩基础治疗基础治疗手术治疗手术治疗修复及正畸治疗修复及正畸治疗维护期维护期口腔卫生指导口腔卫生指导龈上洁治龈上洁治龈下刮治龈下刮治洁治、刮治和根面平整洁治、刮治和根面平整清除局部刺激因素清除局部刺激因素occlusal therapyocclusal therapyantimicrobial therapyantimicrobial therapyre-eva
20、luationre-evaluationsupportive periodontal therapy, SPTsupportive periodontal therapy, SPTplaque controlplaque controlrollingrollingabrasiveabrasivedetergentdetergentdental flossdental flosstoothpickstoothpicksinterdental brushinterdental brushchlorhexidine klchlorhexidine kl :heksidi:n / hibitane:h
21、eksidi:n / hibitanescalerscalersicklesicklehoehoecurette kjuretcurette kjuretfilefileuniversal curettesuniversal curettesarea-specific curettesarea-specific curettesthe lower shankthe lower shankrestorative overhangingrestorative overhangingattachment gainattachment gainocclusal traumaocclusal traum
22、atraumatizing occlusiontraumatizing occlusionco-destructive factorco-destructive factorfunctional mobilityfunctional mobilitytrauma from occlusion index, TOItrauma from occlusion index, TOIadaptability index, AIadaptability index, AIphysical tooth mobilityphysical tooth mobilityinitial or intra-alve
23、olar tooth mobility, ITMinitial or intra-alveolar tooth mobility, ITMsecondary tooth mobility, STMsecondary tooth mobility, STMocclusal adjustmentocclusal adjustmentsplintsplintselective grindingchemotherapychemotherapysystemic antimicrobial therapymetronidazole ,metrnaidzulamoxicillinrefractory per
24、iodontitistetracyclinemacrolideshost modulatory therapies, HMThost modulatory therapies, HMTsuturingsuturing调牙合调牙合药物辅助治疗药物辅助治疗疗效再评估疗效再评估牙周支持治疗牙周支持治疗菌斑控制菌斑控制竖转动法竖转动法摩擦剂摩擦剂洁净剂洁净剂牙线牙线牙签牙签牙间隙刷牙间隙刷氯己定氯己定/ /洗必泰洗必泰洁治器洁治器镰形洁治器镰形洁治器锄形洁治器锄形洁治器匙形刮治器匙形刮治器根面锉根面锉通用型刮治器通用型刮治器专用型刮治器专用型刮治器颈部最下端颈部最下端充填体悬突充填体悬突附着获得附着获
25、得咬合创伤咬合创伤创伤性牙合创伤性牙合协同破坏因素协同破坏因素功能性牙齿动度功能性牙齿动度牙周咬合创伤指数牙周咬合创伤指数牙周适应性指数牙周适应性指数生理性牙齿松动生理性牙齿松动初级或槽内动度初级或槽内动度次级动度次级动度咬合调整咬合调整牙周夹板牙周夹板选磨法药物治疗药物治疗全身抗微生物的治疗甲哨唑/灭滴灵阿莫西林难治性牙周炎四环素大环内酯类抗生素宿主调节治疗宿主调节治疗缝合缝合periodontal dressingperiodontal dressingresective surgeryresective surgeryreconstruction surgeryreconstructio
26、n surgeryregenerative surgeryregenerative surgeryguided tissue regenerationguided tissue regeneration，GTRGTRplastic surgeryplastic surgerybiologically acceptableperiodontal dressingperiodontal dressing 或或 periodontal pack periodontal packperiodontal surgeryperiodontal surgery： access surgery access
27、surgerygingivectomygingivectomygingivoplastygingivoplastythe modified Widman flapthe modified Widman flapundisplaced flapundisplaced flapthe apically repositioned flapthe apically repositioned flapdistal wedge proceduresdistal wedge proceduresosseous surgeryosseous surgeryexternal beveled incisionex
28、ternal beveled incisioninternal beveled incisioninternal beveled incisioncrevicular incisioncrevicular incisioninterdental incisioninterdental incisionpapilla preservation incisionpapilla preservation incisionfull thickness flapfull thickness flapmucoperiosteal flapmucoperiosteal flappartial thickne
29、ss flappartial thickness flapinterrupted interdental sutureinterrupted interdental suturesling suturesling suturemattress suturemattress sutureanchor sutureanchor suturelong junctional epitheliumlong junctional epithelium，LJELJEankylosisankylosisnew attachmentnew attachmentre-attachmentre-attachment
30、osteoplastyosteoplastypstectomypstectomyperiodontal regenerative surgeryperiodontal regenerative surgerybone graft proceduresbone graft proceduresosteoinductionosteoinductionosteoconductionosteoconductionPeriodontal Plastic SurgeryPeriodontal Plastic SurgeryCrown Lengthening SurgeryCrown Lengthening
31、 SurgeryMucogingival SurgeryMucogingival Surgeryfree gingival graftfree gingival graftLaterally Positioned FlapLaterally Positioned Flap牙周敷料牙周敷料切除性手术切除性手术重建性手术重建性手术再生性手术再生性手术引导性组织再生术引导性组织再生术牙周成形手术牙周成形手术生物相容性牙周塞治剂牙周塞治剂牙周基础性手术牙周基础性手术牙龈切除术牙龈切除术牙龈成形术牙龈成形术改良改良WidmanWidman翻瓣术翻瓣术嵴顶原位复位瓣术嵴顶原位复位瓣术根向复位瓣术根向复位瓣
32、术远中楔形瓣切除术远中楔形瓣切除术牙周骨手术牙周骨手术外斜切口外斜切口内斜切口内斜切口沟内切口沟内切口牙间切口牙间切口保留龈乳头切口保留龈乳头切口全厚瓣全厚瓣粘膜骨膜瓣粘膜骨膜瓣半厚瓣半厚瓣牙间间断缝合牙间间断缝合悬吊缝合悬吊缝合褥式缝合褥式缝合锚式缝合锚式缝合长结合上皮长结合上皮骨固连骨固连新附着新附着再附着再附着骨成形术骨成形术骨切除术骨切除术牙周再生性手术牙周再生性手术植骨术植骨术骨诱导骨诱导骨引导骨引导牙周成形手术牙周成形手术牙冠延长术牙冠延长术膜龈手术膜龈手术游离龈移植术游离龈移植术侧向转位瓣术侧向转位瓣术Double papilla flap surgerySubepithelial Connective Tissue GraftSubepithelial Connective Tissue GraftFrenotomyFrenotomyFrenectomyFrenectomy双乳头转位瓣术上皮下结缔组织移植术上皮下结缔组织移植术系带修整术系带修整术系带切除术系带切除术
