Ⅲ/Ⅳ期牙周炎的临床诊治决策进展

doi:10.13591/j.cnki.kqyx.2025.01.003

Abstract

Abstract:

In 2018, a consensus on the new international classification of periodontal diseases and peri-implant diseases was jointly published by the American Academy of Periodontology (AAP) and European Federation of Periodontology (EFP), which divided periodontitis into stagesⅠ-Ⅳ. The diagnosis and treatment of stage Ⅲ/Ⅳ periodontitis are the focus and difficulty in clinical practice. Developing standardized clinical decision-making for the diagnosis and treatment of stage Ⅲ/Ⅳ periodontitis can help patients with this condition achieve better plaque control, maintain healthy periodontal status and restore chewing function and aesthetics. Based on the EFP S3 level clinical guidelines for the treatment of stage Ⅰ-Ⅲ and stage Ⅳ periodontitis, combined with the new international classification of periodontal diseases and peri-implant diseases in 2018 and the Chinese expert consensus on the diagnosis of severe periodontitis in 2017, this article elaborates clinical diagnosis and treatment decisions for stage Ⅲ/Ⅳ periodontitis, aiming to provide reference for clinical application practice.

Key words: stage Ⅲ/Ⅳ periodontitis, severe periodontitis, diagnosis and treatment decisions

CLC Number:

R781.4

CHEN Xu, LI Lu, WANG Xiaoqian, WANG Tianyao, XU Yan. Progress of diagnosis and treatment decisions in stage Ⅲ/Ⅳ periodontitis[J]. Stomatology, 2025, 45(1): 13-17.

Figures/Tables 4

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References 24

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分期	严重程度			复杂程度	范围和分布
分期	邻面最严重 CAL/mm	牙槽骨吸收	因牙周炎失牙数	复杂程度	范围和分布
Ⅰ期	1~2	牙根冠方1/3(<15%)	0	最大PD≤4 mm;主要为水平型骨丧失	①局限型(<30%牙位受波及); ②广泛型(≥30%牙位受波及)
Ⅱ期	3~4	牙根冠方1/3(15%~33%)	0	最大PD≤5 mm;主要为水平型骨丧失
Ⅲ期	≥5	延伸至根中1/2~根尖1/3	≤4	在Ⅱ期基础上,还伴有PD≥6 mm;垂直骨丧失≥3 mm;Ⅱ~Ⅲ度根分叉病变;中度牙槽骨破坏
Ⅳ期	≥5	延伸至根中1/2~根尖1/3	≥5	在Ⅲ期基础上,还伴有以下任一情况:咀嚼功能异常、继发性牙合创伤(牙齿松动度≥2度)、重度牙槽骨破坏、咬合错乱(移位或扭转)、余留牙齿少于20颗(10组对牙合牙)

项目	2017年《重度牙周炎诊断标准及特殊人群牙周病治疗原则的中国专家共识》^*	2018牙周病和植体周病国际新分类
项目	重度牙周炎	Ⅲ期	Ⅳ期
探诊深度	>6 mm	≥6 mm	≥6 mm
附着丧失	≥5 mm	邻面最重位点≥5 mm	邻面最重位点≥5 mm
牙槽骨吸收	>根长的1/2	≥根中1/3	≥根中1/3
牙齿松动/缺失	牙齿松动	因牙周炎缺失牙≤4颗	因牙周炎缺失牙≥5颗
其他临床特征	炎症较明显,可伴有牙周脓肿; 后牙存在Ⅱ度或Ⅲ度根分叉病变	在Ⅱ期基础上,还可伴:PD≥6 mm;垂直骨丧失≥3 mm;Ⅱ~Ⅲ度根分叉病变;中度牙槽骨破坏	在Ⅲ期基础上,还伴有以下任一情况:咀嚼功能异常;继发性牙合创伤(牙齿松动度≥2度);重度牙槽骨破坏;咬合错乱(移位或扭转);余留牙齿少于20颗(10组对牙合牙)

Progress of diagnosis and treatment decisions in stage Ⅲ/Ⅳ periodontitis

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