牙体病学课件牙体硬组织非龋性疾病

牙体硬组织非龋性疾病 Noncaries Teeth Disease 四川大学华西口腔医学院 口腔内科学教研室 李继遥 Disorder of development Teeth injury Teeth chronic trauma Dentin hypersensitivity NoncariesNoncaries Teeth Disease Teeth Disease abnormal structure abnormal morphology abnormal number of tooth abnormal sequence of eruption Disorder of development Enamel hypoplasiaDental fluorosis Abnormal Structure Tetracycline stained teethCongenital syphilitic teeth Hereditary dentinogenesis imperfecta Principe of treatment Enamel Enamel hypoplasiahypoplasia is a defect in tooth is a defect in tooth enamel that results in less quantity of enamel that results in less quantity of enamel than normal. enamel than normal. 1st section Enamel hypoplasia nutrition shortage endocrine disorder disease apical inflammation of deciduous tooth (Turner tooth) Etiology pits, grooves, lines or larger areas of missing enamel surface yellowish or brownish discoloration occlusal distortion, aesthetic problems, sensitivity localized or present on numerous teeth and all or part of the surfaces of each affected tooth may be involved bilateral symmetric distribution Clinical Features Caries prevention Aesthetically restoration Functionally restoration Treatment A condition of enamel hypoplasia characterized by white chalky spots or brown staining and pitting of teeth due to an increased level of fluoride affecting enamel matrix formation and calcification by impairment of ameloblastic function. Dental Dental fluorosisfluorosis Etiology Excessive fluoride contact Clinical Features white to brown pigmentation permanent tooth common deciduous tooth rare excessive wear and fracturing of the incisal and occlusal surfaces systemic symptoms MILDMODERAT SEVERE u Treatment Prevention Micro-abrasive treatment Complex resin restoration Intrinsic tooth discoloration Intrinsic tooth discoloration associated with drugs from the associated with drugs from the tetracycline family. tetracycline family. 3ed section3ed section Tetracycline stained teethTetracycline stained teeth Tetracycline incorporate into the Tetracycline incorporate into the calcification process of developing teeth, calcification process of developing teeth, affects either primary or secondary affects either primary or secondary dentition after maternal or childhood dentition after maternal or childhood ingestion respectively. ingestion respectively. u Etiology u Histologic Features Tetracyclines diffuse through dentin to the enamel interface, chelating calcium ions and incorporating into hydroxyapatite as a stable orthophosphate complex. The affected teeth first have a bright-yellow The affected teeth first have a bright-yellow bandlikebandlike appearance that fluoresces under appearance that fluoresces under ultraviolet light, the color gradually changes to ultraviolet light, the color gradually changes to gray or red-brown. gray or red-brown. u Clinical Features MILDMODERATE SEVERE u Treatment Prevention Aesthetic restoration complex resin restoration full crown restoration Professional bleaching A hereditary defect consisting of opalescent teeth composed of irregularly formed and undermineralized dentin that obliterates the coronal and root pulpal chambers 4th section Dentinogenesis imperfecta Dentinal tubules are disoriented, irregular, widely spaced Calcification defect Vascular channels Cellular inclusions uHistologic Features u Clinical Feature Autosomal dominant Opalescent teeth Dentin exposure and functional attrition Atresia of coronal and root canal pulpal chamber Dentinogenesis imperfecta u Treatment Stainless steel crown on the molar Over denture Abnormal teeth seen in congenital syphilis Congenital syphilitic teeth u Etiology Inflammation of the enamel organ u Clinical Features Permanent tooth common deciduous tooth rare Hutchinson teeth (incisor) Mulberry molar Pfluger teeth (Moon teeth) u Treatment Prevention Aesthetic restoration Composite resin restoration Full crown Microdontia Macrodontia Conic shaped teeth Fused teeth geminated teeth Concrescence of teeth Abnormal central cusp Dens invaginatus Enamel pearl Abnormal morphology 2ed section Fused teeth Two teeth united during development by the union of their tooth germs; the teeth may be joined by the enamel of their crowns, by their root dentin, or by both A developmental anomaly arising from the attempted division of one tooth bud, resulting in incomplete formation of two teeth and usually manifest as a bifid crown upon a single root Geminated teeth 2ed section Concrescence of teeth Union of the roots of two or more normal teeth caused by confluence of their cemental surfaces 在牙齿发育期内，由于牙乳头组织向造釉器突起 ，造成在牙齿在牙合面形成额外的牙尖，因多见于 下颌双尖牙合面中央窝处，故称畸形中央尖。 Abnormal central cusp Abnormal central cusp 1. 好发牙位：下颌54,一般对称出现 2. 临床表现：根据畸形中央尖磨耗程度不同，可 出现不同的症状和体征 未露髓 症状：双尖牙区牙本质过敏症状酸甜、冷 热、刺激痛、无自发痛 体征： a. 额外尖 b. 因磨耗不同，有环形褐色牙本质环 c.用探针探，病人可觉敏感，酸痛 露髓： 症状： 急性/慢性牙髓炎症状 体征：a. 额外尖 b. 因磨耗不同，有环形褐色牙本质环 c. 环中央有黑色小点为穿髓角处 d.探痛 已为根尖周炎 症状：急性/慢性根尖周炎症状 体征：d. 有的可见双尖牙区龈瘘 f . x-ray：若牙髓感染坏死发生在年轻恒牙期， 根尖孔停止发育成形，仍呈喇叭状 Chronic Apical Periodontitis 3. 治疗 未露髓：一次-刚萌出、尖而长畸形尖可在局麻和 严格消毒下，一次磨去，作直接盖髓治疗。 分次、间隔半月/一月，少量、避免折断或 过度磨耗，且可在髓角处形成足够的修复 性牙本质而不至露髓，注意每次脱敏。 露髓/尖周炎：按牙髓根尖病治疗 若患牙根尖尚未发育完成：按年轻 恒牙的治疗原则和方法治疗，如根尖发 育成形术、根尖诱导成形术 Anomaly of the tooth, found chiefly in upper lateral incisors. It is characterized by invagination of the enamel at the incisal edge Dens invaginatus u Etiology Developmental disorder u Clinical Features rare in primary teeth most often permanent maxillary lateral incisors, central incisors, premolars, canines and molars various severity （舌侧窝、根面沟、舌侧尖、 牙中牙） Restoration of the opening to prevent caries, indirect pulp capping and filling Endodontic therapy Periondontal treatment Extraction u Treatment Ectopic nodular deposits of enamel that primarily occur in the bifurcation or trifurcation areas on the roots of molars. Enamel pearl u Etiology Ectopic enamel formation u Clinical Features Upper molars Asymptomatic Higher incidence in Mongoloid and Eskimo populations u Treatment no treatment required Supernumerary tooth Congenital anodontia Abnormal number of tooth Supernumerary tooth Teeth in excess of the normal number u Clinical Features 90% in maxilla mesiodens most common fourth molars、lower premolars、 upper lateral incisors single or multiple