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gingival recession

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‫ركود‬ ‫اللثة‬ ‫مصنوع‬ ‫بواسطة‬ : ‫د‬ . ‫محمد‬ ‫عبدهللا‬ ‫المسوري‬ ‫مترجم‬ ‫من‬ ‫اإلنجليزية‬ ‫إلى‬ ‫العربية‬ - www.onlinedoctranslator.com
‫مقدمة‬ • ‫انحسار‬ ‫اللثة‬ ‫في‬ ‫شكله‬ ‫الموضعي‬ ‫أو‬ ‫المعمم‬ ‫لح‬ ‫الة‬ ‫غير‬ ‫مرغوب‬ ‫فيها‬ ‫تؤدي‬ ‫إلى‬ ‫انكشاف‬ ‫الجذر‬ ‫حيث‬ ‫يحدث‬ ‫تحول‬ ‫قمي‬ ‫في‬ ‫موضع‬ ‫هامش‬ ‫اللثة‬ ‫من‬ CEJ ‫ا‬ً‫ي‬‫تدريج‬ . * ‫وذكرت‬ ‫الدراسات‬ ‫االستقصائية‬ ‫األخيرة‬ ‫أن‬ 88 ٪ ‫من‬ 65 ‫سنة‬ ‫قديم‬ ‫و‬ 50 ٪ ‫من‬ ‫الناس‬ ‫بين‬ ‫من‬ 18 ‫إلى‬ 64 ‫سنة‬ ‫القديمة‬ ‫لديها‬ ‫واحد‬ ‫أو‬ ‫أكثر‬ ‫من‬ ‫المواقع‬ ‫مع‬ ‫الركود‬ . ( ‫جمعية‬ ‫طب‬ ‫األسنان‬ ‫األمريكية‬ 2003)
‫األعراض‬ ‫والمشاكل‬
‫العوامل‬ ‫المحددة‬ • ‫لوحة‬ ‫بكتيرية‬  ‫وجد‬ ‫أوليري‬ ‫وآخرون‬ ‫عالقة‬ ‫مباشرة‬ ‫بين‬ ‫زيادة‬ ‫مؤشر‬ ‫البالك‬ ‫وزيادة‬ ‫ركود‬ ‫األنسجة‬ ‫الهامشية‬ • ‫الصدمة‬ ‫الناتجة‬ ‫عن‬ ‫تنظيف‬ ‫األسنان‬  ‫تقنية‬ ‫غير‬ ‫الئقة‬  ‫فرشاة‬ ‫أسنان‬ ‫خاطئة‬ • ‫العوامل‬ ‫العالجية‬  ‫الملغم‬ ‫أو‬ ‫البروز‬ ‫االصطناعي‬  ‫المشابك‬  ‫أجهزة‬ ‫تقويم‬ ‫األسنان‬ • ‫العادات‬  ‫األظافر‬ ‫أو‬ ‫أي‬ ‫جسم‬ ‫غريب‬
• ‫سوء‬ ‫وضع‬ ‫األسنان‬  ‫أسنان‬ ‫منزاحة‬ ‫من‬ ‫الشدق‬ ‫أو‬ ‫أسنان‬ ‫مدورة‬ ‫بسب‬ ‫ب‬ ‫تغير‬ ‫العالقة‬ ‫بين‬ ‫األسنان‬ ‫والعظام‬ • ‫التشريح‬ ‫غير‬ ‫المواتي‬  ‫ارتفاع‬ ‫لجام‬ ‫اإلدراج‬  ‫الطية‬ ‫الشدقية‬ ‫الضحلة‬ ‫التي‬ ‫تنتج‬ ‫التوت‬ ‫ر‬ ‫على‬ ‫اللثة‬ ‫الهامشية‬ • ‫الحركات‬ ‫التقويمية‬
• ‫صدمة‬
• ‫العوامل‬ ‫عالجية‬ ‫المنشأ‬ • ‫منتجات‬ ‫التدخين‬ ‫والتبغ‬
• ‫شيخوخة‬ ‫وكان‬ ‫يعتقد‬ ‫ا‬ً‫ض‬‫أي‬ ‫أنه‬ ‫يسبب‬ ‫ركود‬ ‫اللثة‬ . ‫ومع‬ ‫ذلك‬ ، ‫تم‬ ‫تجاهل‬ ‫هذه‬ ‫الفكرة‬ ‫بسبب‬ ‫عدم‬ ‫وجود‬ ‫أدلة‬ ‫مقنعة‬ ‫على‬ ‫أن‬ ‫الشيخوخة‬ ‫تسبب‬ ً ً‫ل‬‫تحو‬ ‫في‬ ‫الرتباط‬ ‫اللثوي‬ . • ‫التغيرات‬ ‫الهرمونية‬ ‫التغيرات‬ ‫الهرمونية‬ ‫لدى‬ ‫النساء‬ ‫أثناء‬ ‫الحمل‬ ‫والحيض‬ ‫والرضاعة‬ ‫يمكن‬ ‫أن‬ ‫تج‬ ‫عل‬ ‫اللثة‬ ‫أكثر‬ ‫حساسية‬ ‫وتصبح‬ ‫أكثر‬ ‫عرضة‬ ‫للركود‬ .
• ‫النمط‬ ‫الحيوي‬ ‫اللثوي‬ .
:
‫تصنيف‬
`
 ‫ضحلة‬ ‫ضيقة‬  ‫ضيق‬ ‫عميق‬  ‫واسعة‬ ‫ضحلة‬  ‫عميق‬ ‫واسع‬
‫عالج‬ ‫غير‬ ‫جراحية‬ ‫الجراحية‬ 1- ‫زراعة‬ ‫األنسجة‬ ‫الرخوة‬ ‫الحرة‬ ‫أ‬ - ‫الكسب‬ ‫غير‬ ‫المشروع‬ ‫الظهارية‬ ‫ب‬ - ‫تحت‬ ‫الظهارة‬ ‫الكسب‬ ‫غير‬ ‫المشروع‬ CT 2- ‫رفرف‬ ‫األنسجة‬ ‫الرخوة‬ ‫عنيق‬ ‫أ‬ - ‫رفرف‬ ‫الدوران‬ ‫ب‬ - ‫رفرف‬ ‫التقدم‬ .1 ‫الرصد‬ ‫والوقاية‬ 2. ‫استخدام‬ ‫إزالة‬ ‫التحسس‬ ‫وكالء‬ ، ‫الورنيش‬ 3. ‫الترميم‬ ‫المركب‬ 4. ‫قشور‬ ‫اللثة‬ ‫القابلة‬ ‫لإلزالة‬ 5. ‫تقويم‬ ‫األسنان‬
‫الرصد‬ ‫والوقاية‬ ‫إذا‬ ‫كان‬ ‫الركود‬ ‫هو‬ ‫ل‬ ‫تتقدم‬ ‫ول‬ ‫يثير‬ ‫حساسية‬ ‫األسنان‬ ‫أو‬ ‫فقيرة‬ ‫جماليات‬ ، ‫فإن‬ ‫تعليمات‬ ‫تنظيف‬ ‫األسنان‬ ‫والمراقبة‬ ‫المنتظمة‬ ‫من‬ ‫خالل‬ ‫برنامج‬ ‫ص‬ ‫يانة‬ ‫صارم‬ ‫ستكون‬ ‫العالج‬ ‫األمثل‬ .
‫إزالة‬ ‫التحسس‬ ‫وكالء‬ ، ‫الورنيش‬ • ‫يعتمد‬ ‫عالج‬ ‫فرط‬ ‫الحساسية‬ ‫لعاج‬ ‫األسنان‬ ‫على‬ ‫سد‬ ‫األنابيب‬ ‫العاج‬ ‫ية‬ ‫ومنع‬ ‫تحفيز‬ ‫األعصاب‬ . ‫طليعة‬ - ‫ارجين‬ ™ ‫تحتوي‬ ‫التكنولوجيا‬ ‫أرجينين‬ ‫ه‬ ‫وهو‬ ‫حمض‬ ‫أميني‬ ‫موجود‬ ‫بشكل‬ ‫طبيعي‬ ‫في‬ ‫اللعاب‬ ‫كربونات‬ ‫الكالسيوم‬ .
‫الترميمات‬ ‫المركبة‬ ‫استخدام‬ ‫الراتنج‬ ‫المركب‬ ‫إلخفاء‬ ‫عيوب‬ ‫الركود‬ ‫والقضاء‬ ‫على‬ ‫المث‬ ‫لثات‬ ‫السوداء‬ ‫الناتجة‬ ‫عن‬ ‫الركود‬ . ‫رأب‬ ‫المينا‬ ‫تم‬ ‫تنفيذه‬ ‫حتى‬ ‫القاطع‬ ‫الطائرة‬ ‫في‬ ‫هذه‬ ‫الحالة‬
‫قشور‬ ‫اللثة‬ ‫القابلة‬ ‫لإلزالة‬
‫تقويم‬ ‫األسنان‬ • ‫في‬ ‫بعض‬ ‫الحالت‬ ‫قد‬ ‫يساعد‬ ‫التدخل‬ ‫الجراحي‬ ‫والترقيع‬ ‫في‬ ‫عالج‬ ‫عيب‬ ‫الرك‬ ‫ود؛‬ ‫ومع‬ ‫ذلك‬ ، ‫إذا‬ ‫كان‬ ‫عالج‬ ‫تقويم‬ ‫األسنان‬ ‫ا‬ً‫خيار‬ ‫يرغب‬ ‫المريض‬ ‫في‬ ‫أخذه‬ ‫بعين‬ ‫العت‬ ‫بار‬ ، ‫فيجب‬ ‫تأجيل‬ ‫أي‬ ‫تدخل‬ ‫جراحي‬ ‫إلى‬ ‫ما‬ ‫بعد‬ ‫اكتمال‬ ‫حركة‬ ‫تقويم‬ ‫األسنان‬ .
‫مؤشرات‬ ‫للتدخل‬ ‫الجراحي‬ ‫الحاجة‬ ‫إلى‬ ‫تحسين‬ ‫جماليات‬ ‫األنسجة‬ ‫الرخوة‬ ‫تقليل‬ ‫فرط‬ ‫الحساسية‬ ‫تحسين‬ ‫التحكم‬ ‫في‬ ‫البالك‬ ‫منع‬ ‫المزيد‬ ‫من‬ ‫تطور‬ ‫خلل‬ ‫الركود‬
‫العوامل‬ ‫المؤثرة‬ ‫على‬ ‫نتائج‬ ‫جراحة‬ ‫اللثة‬ ‫التجميلية‬ • ‫حالة‬ ‫سطح‬ ‫الجذر‬ - ‫وجود‬ ‫حساب‬ ‫التفاضل‬ ‫والتكامل‬ ، ‫تسوس‬ ، ‫ملوث‬ ‫المالط‬ ‫أو‬ ‫الترمي‬ ‫مات‬ ‫على‬ ‫سطح‬ ‫الجذر‬ • ‫بارز‬ fraenal ‫المرفقات‬ • ‫عمق‬ ‫الدهليز‬ • ‫نوع‬ ‫األنسجة‬ ( ‫سمك‬ ‫اللوحات‬ ‫ذات‬ ‫السماكة‬ ‫المنقسمة‬ ‫المرفوعة‬ ) • ‫حجم‬ ‫عيب‬ ‫الركود‬ ‫ومواد‬ ‫الكسب‬ ‫غير‬ ‫المشروع‬ • ‫التدخين‬ • ‫نظافة‬ ‫فم‬ ‫المريض‬ .
‫الكسب‬ ‫غير‬ ‫المشروع‬ ‫اللثة‬ ‫الحرة‬ 1- ‫ال‬ ‫ظهاري‬ ‫طعم‬ ‫لثوي‬ ‫مجاني‬ ‫يمكن‬ ‫استخدامه‬ ‫إما‬ ‫في‬ ‫مرحلة‬ ‫واحدة‬ ‫أو‬ ‫على‬ ‫مرحلتين‬ ‫لتغطية‬ ‫س‬ ‫طح‬ ‫الجذر‬ ‫المكشوف‬ • ‫يجب‬ ‫أن‬ ‫يكون‬ ‫هناك‬ ‫تداخل‬ ‫مناسب‬ ‫بين‬ ‫أنسجة‬ ‫الكسب‬ ‫غير‬ ‫المشروع‬ ‫واألنسجة‬ ‫الرخوة‬ ‫حول‬ ‫عيب‬ ‫الركود‬ ‫في‬ ‫الموقع‬ ‫المت‬ ‫لقي‬ . • ‫الشلل‬ ‫من‬ ‫الكسب‬ ‫غير‬ ‫المشروع‬ ‫في‬ ‫الموقع‬ ‫المتلقي‬ ‫أمر‬ ‫ض‬ ‫روري‬ ‫أيضا‬ ‫العيب‬ : ‫ال‬ ‫ظهاري‬ ‫الكسب‬ ‫غير‬ ‫المشروع‬ ‫اللثوي‬ ‫الحر‬ ‫هو‬ ‫أنه‬ ‫يحتفظ‬ ‫باألس‬ ‫نان‬ ‫لون‬ ‫من‬ ‫األنسجة‬ ‫المانحة‬
‫الكسب‬ ‫غير‬ ‫المشروع‬ ‫اللثة‬ ‫الحرة‬ 2- ‫تحت‬ ‫الظهارة‬ ‫زرع‬ ‫األنسجة‬ ‫الضامة‬
‫رفرف‬ ‫عنيق‬ ‫رفرفة‬ ‫التقدم‬
‫رفرف‬ ‫عنيق‬ ‫جانبي‬
‫رفرف‬ ‫عنيق‬ ‫تحويلي‬ ‫رفرف‬ ‫بواسطة‬ PENNEL ET EL
‫رفرف‬ ‫عنيق‬ ‫رفرف‬ ‫حليمة‬ ‫مزدوجة‬
‫تجديد‬ ‫األنسجة‬ ‫الموجهة‬ • ‫تبين‬ ‫أن‬ ‫متوسط‬ ‫تغطية‬ ‫الجذر‬ ‫التي‬ ‫تم‬ ‫تحقيقها‬ ‫من‬ ‫خالل‬ ‫تجديد‬ ‫األنسجة‬ ‫الم‬ ‫وجه‬ ‫يتراوح‬ ‫بين‬ 48-94%.
‫استخدام‬ ‫الطعوم‬ ‫و‬ ‫طعم‬ ‫أجنبي‬ ‫في‬ ‫إدارة‬ ‫تراجع‬ ‫اللثة‬ • ‫خلصت‬ ‫مراجعة‬ ‫منهجية‬ ‫حديثة‬ ‫إلى‬ ‫أن‬ ‫هذه‬ ‫الطعوم‬ ‫قد‬ ‫تكون‬ ‫مفيدة‬ ‫في‬ ‫الحالت‬ ‫التي‬ ‫يكون‬ ‫فيها‬ 1- ‫خلل‬ ‫ركودي‬ ‫كبير‬ ‫يحتاج‬ ‫إلى‬ ‫عالج‬ . 2- ‫األنسجة‬ ‫المطعومة‬ ‫المأخوذة‬ ‫من‬ ‫الحنك‬ ‫من‬ ‫شأنها‬ ‫أن‬ ‫توفر‬ ‫ا‬ً‫م‬‫حج‬ ‫غير‬ ٍ ‫كاف‬ ‫من‬ ‫األنسجة‬ .
‫التكهن‬ • ‫ال‬ ‫تحت‬ ‫الظهارة‬ ‫لقد‬ ‫ثبت‬ ‫أن‬ ‫طعم‬ ‫النسيج‬ ‫الضام‬ ‫يوفر‬ ‫نسبة‬ ‫تغطية‬ ‫جذرية‬ ‫أكب‬ ‫ر‬ ‫من‬ ‫طعم‬ ‫النسيج‬ ‫الضام‬ ‫ظهاري‬ ‫طعم‬ ‫لثوي‬ ‫مجاني‬ • ‫تحت‬ ‫الظهارة‬ ‫ترقيع‬ ‫األنسجة‬ ‫الضامة‬ ‫مع‬ ‫أ‬ ‫تاجيا‬ ‫رفرفة‬ ‫متقدمة‬ ‫ثبت‬ ‫أنه‬ ‫يوفر‬ ‫ت‬ ‫غطية‬ ‫جذرية‬ ‫أفضل‬ ‫من‬ ‫تلك‬ ‫الموجودة‬ ‫في‬ ‫تاجيا‬ ‫رفرف‬ ‫متقدم‬ ‫وحده‬ ‫على‬ ‫مدى‬ ‫فترة‬ ‫متاب‬ ‫عة‬ ‫مدتها‬ ‫خمس‬ ‫سنوات‬ • ‫عندما‬ ‫تحت‬ ‫الظهارة‬ ‫تتم‬ ‫مقارنة‬ ‫طعم‬ ‫النسيج‬ ‫الضام‬ ‫مع‬ ‫تجديد‬ ‫األنسجة‬ ‫الموجه‬ ‫تح‬ ‫ت‬ ‫الظهارة‬ ‫أظهر‬ ‫الكسب‬ ‫غير‬ ‫المشروع‬ ٍ ً‫ال‬‫دلي‬ ‫على‬ ‫تحقيق‬ ‫تغطية‬ ‫أكبر‬ ‫للجذور‬
‫معايير‬ ‫التغطية‬ ‫الجذرية‬ ‫الناجحة‬
• ‫كان‬ ‫شاب‬ ‫يبلغ‬ ‫من‬ ‫العمر‬ 21 ‫ا‬ً‫م‬‫عا‬ ‫المشار‬ ‫إليها‬ ‫اللثة‬ ‫القسم‬ ، ‫من‬ ‫قبل‬ ‫طبيب‬ ‫تقويم‬ ‫األسنان‬ ‫بسبب‬ ‫التهاب‬ ‫اللثة‬ ‫الشديد‬ ‫ركود‬ ‫القواطع‬ ‫المركزية‬ ‫الفكية‬ .
‫سويقة‬ ‫فرعية‬ ‫تم‬ ‫اختيار‬ ‫طعم‬ ‫النسيج‬ ‫الضام‬
‫االستنتاجات‬ • ‫عالج‬ ‫ركود‬ ‫اللثة‬ ‫سوف‬ ‫يعتمد‬ ‫على‬ ‫شكوى‬ ‫المريض‬ ‫في‬ ‫المقام‬ ‫األول‬ . • ‫ال‬ ‫تحت‬ ‫الظهارة‬ ‫طعم‬ ‫النسيج‬ ‫الضام‬ ‫مع‬ ‫أ‬ ‫قرنويا‬ ‫السديلة‬ ‫المتقدمة‬ ‫هي‬ ‫إج‬ ‫راء‬ ‫التطعيم‬ ‫القياسي‬ ‫الذهبي‬ . • ‫يعتمد‬ ‫التشخيص‬ ( ‫كمية‬ ‫تغطية‬ ‫الجذر‬ ‫التي‬ ‫تم‬ ‫تحقيقها‬ ) ‫على‬ ‫شدة‬ ( ‫حجم‬ ) ‫الركود‬ .
‫شكر‬ ‫أنت‬

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Lecture 8 (gingival recession).en.ar.pptx

Editor's Notes

  1. كيف برو-ارجين™ التكنولوجيا تسد الأنابيب تشير أحدث الأبحاث إلى أنه عند درجة الحموضة الفسيولوجية،أرجينينوتتفاعل كربونات الكالسيوم وترتبط بسطح العاج المشحون سالبًا لتشكل طبقة غنية بالكالسيوم على سطح العاج وفي الأنابيب العاجية لتوصيلها وإغلاقها.
  2. لون القرنفلبورس جيدلونمباراة التحكم في الرطوبة التأكد من عدم وجود حواف لأنها قد تجعل نظافة الفم صعبة مما يؤدي إلى مزيد من الركود عادي أو مركب
  3. ويرتبط تضيق الأوعية الدموية اللثوية في كثير من الأحيان يسبب نخر الأنسجة الرخوة. • عدم الالتزام بالخلايا الليفية11؛ و • تغير في الاستجابة المناعية
  4. الهدف من هذا العلاج هو منع تشكيل فترة طويلةتقاطعيظهارة ولكن بدلاً من ذلك تسمح بربط النسيج الضام الطبيعي بسطح الجذر المكشوف
  5. بعد إزالة التحبيبهذا-سواء، لا توجد لوحة ميكروبية أو كالوري يمكن اكتشافها سريريًاالتفاضل والتكاملتم العثور عليه على أسطح الجذور، ولكن تم الكشف بشكل غير متوقع عن شريط مطاطي تقويمي حول قمم القواطع المركزية