多种全身性疾病和状况可影响牙周炎的病程或对牙周附着器具产生负面影响。牙龈凹陷非常普遍,通常与超敏反应有关,龋齿和非龋齿宫颈病变的发展在暴露的根表面和受损的美学。咬合力可导致牙齿和牙周附着器具的损伤。与牙齿或假体相关的几种发育或获得性疾病可能易患牙周病。该工作组的目的是审查和更新1999年关于这些疾病和病症的分类,并制定病例定义和诊断注意事项。
通过对以下四个方面的评论进行了讨论:1)全身性疾病和状况的牙周表现;2)天然牙齿周围的粘膜牙龈状况;3)创伤性咬合力和咬合创伤;4)假牙和牙齿相关因素。这份共识报告基于这些审查的结果和与会者的专家意见。
主要发现包括以下内容:1)主要是罕见的全身性疾病(例如Papillon-Lefevre综合征,白细胞粘附缺陷,和其他)对牙周炎的病程和更常见的疾病(如糖尿病)有重大影响,以及影响牙周设备的条件独立于牙菌斑生物膜引起的炎症(如肿瘤疾病);2)糖尿病相关的牙周炎不应被视为一个独特的诊断,但是糖尿病应该被认为是一个重要的修饰因子,并作为描述符包括在牙周炎的临床诊断中;3)同样,吸烟-现在被认为是对尼古丁的依赖性和对牙周支持组织具有重大不利影响的慢性复发性医学疾病-是牙周炎临床诊断中作为描述符的重要修饰;4)牙龈表型的重要性,包括牙龈厚度和宽度在粘膜牙龈条件的情况下,是公认的,并介绍了牙龈凹陷的新分类;5)没有证据表明创伤性咬合力导致牙周附着丧失,非龋齿宫颈病变,或牙龈凹陷;6)创伤性咬合力导致正常支撑的牙齿适应性活动,而它们导致牙齿逐渐移动,支撑减少,通常需要夹板;7)术语“生物宽度”被由交界上皮和上结缔组织组成的上组织附着代替;8)上结缔组织附着内的修复边缘的侵犯与炎症和/或牙周支持组织的丢失有关。然而,目前尚不清楚对牙周组织的负面影响是否是由牙菌斑生物膜引起的,创伤,牙齿材料的毒性或这些因素的组合;9)牙齿解剖因素与牙菌斑生物膜引起的牙龈炎症和牙周支持组织的损失有关。
对影响牙周炎病程和牙周附着器的牙周表现和状况进行了最新分类,以及发育和后天的条件,是介绍的。还介绍了病例定义和诊断注意事项。
A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations.
Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This
consensus report is based on the results of these reviews and on expert opinion of the participants.
Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues.
An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.