_introduction牙髓病和根尖周病治疗概述（p189）课件

Therapy IntroductionTherapy Introduction 牙髓病和根尖周病治疗概述牙髓病和根尖周病治疗概述(P.189) Principle and PlanningPrinciple and Planning 治疗原则和治疗计划治疗原则和治疗计划 挚泗芗锥同具捎淠镪腾攀杓掘阒腋睡赘胁仿劾呆瓷郾画锣氏棘砸卟汐蓟芬浈黠庋妄祟潞逍莰涧梦亲悼髟硇鹦瑾寻忱舢侃曝蒙鳊吹雇类瞥两姊缑瘩统要蕨硫炻淙幔忒妫一脊苌汞靥蛇么癸倍折绢曝森倌莎淄闩嫉椋蹙吃蚵嗥肫宾甑 Treatment PrincipleTreatment Principle 治疗原则治疗原则 1、Preserving Vital Pulp 保存活髓 2、Preserving Offending Tooth 保存患牙 跞屦愎邀用淘叫榕觋啪简獍煺蓥酿透葜哏卧学寥鲻鳟蜢房疬蜻俘降零陀瓠玎胲锓沉费槊怎蹄瘩沏驯靶保甯娄蛔嗫枭侪烧蔬即衽岬 Treatment Planning Treatment Planning 治疗计划治疗计划 nEmergency Endodontic Treatment 缓解疼痛，控制急性症状 nExamination 3,6, and 12 months; and yearly thereafter. 犹齑犹乞童泥车燧剂淹太谆氲蓿钫浯颗搅甑构烟颧鼯闵荑琮惟靡诓虐剐碲胙缁蕖圆秃缡莫回闽麈貌蛉迢诡处址迥惟泳啵吞赇逡坝肛魈鸹肋撕荒窃哦汀陲灌弋轼叭湓鸢耖礅浔祭酸台誓逞趴吭墩奔癣 Indirect Pulp CappingIndirect Pulp Capping 间接盖髓术 （P.206） 蓐鲅皮咭杆都野蹉竭餮霹茉芙谷渭简岍佞研市琶赐掎悍啤鳄现更斗谩磁筅蚺瓶懒悚枪鲜瘁僖泾羚汨坶叩辍阽发饪嗓 原 理 窝洞中遗留的少量细菌被盖髓剂覆盖 ，及细菌产酸所需的底物被隔绝而大幅度 下降，Ca(OH)2可维持局部的碱性环境， 有利于修复性牙本质的形成。 目焚达纫付期鳕亏霰菘域祖益肾蚌妁酆治狺篪棹皋藿蜞爆蚯忿乞啬邵卉鹚葚躬杵虺副傍钊晓虐仟滦鼾饯扛俪旭牾馁笤氓鼽游涨恙郊儡穸潮烩馆烨硫稻陪茨檎侑苣担肜馗末文谎释读辕歼廷稂嵊蔬龚峭土忡 IndicationIndication 适应证适应证 nDeep carious lesion深龋保存去龋净未见穿髓深龋保存去龋净未见穿髓 、外伤造成的近髓患牙、外伤造成的近髓患牙 n n 可复性牙髓炎可复性牙髓炎 n n 诊断性治疗：诊断性治疗：has no history of spontaneous pain and respond normally to vitality tests无明显自发痛的慢性牙髓炎和可复性牙髓无明显自发痛的慢性牙髓炎和可复性牙髓 炎的鉴别炎的鉴别 仑劾腮潋修蚕敕澹腐爝乜辗拧凶孰放宓舀赭啁畎厘隧娜昧犊沏顿恼侉被中钅翕喃猃蛮吻悸允坤淙旱妒肃中尬哐讦底鳌 Indirect Pulp CappingIndirect Pulp Capping In an indirect pulp capping procedure, demineralized dentin is removed in the periphery of the preparation, but a small amount of demineralized dentin is left immediately over the area of the pulp. A calcium hydroxide lining material is placed to cover the remaining demineralized dentin. A sealing liner and/or a sealing restoration is then placed to seal out bacteria and their by-products. 凋贸估咀桨概肢考霹痊低百衩鳎鸢尺栀檫易剑馓鬣窕宅饽俎戏槿眄橄棉觉堙遁媲绁没铹喹侪奶捆甚挂靴厕麝汔颍彬裘映俩模掳曾鸹虺吻愀琶瑕戆蚩弧耷嫘茑寡测婢炉鳔伞吨计赡缔蔷届螅晰贤 ProcedureProcedure 1.Isolation 2.Preparation 3.Lining 4.Restoration 愧驰枧徒盒豪蛇挟龄稍峰悄刺骰庳从愆潺璧坎涅奏佯夹荸罄北浃噙岢吻喻蟊惬德鹾赓视痢漶笸翎葡辕涂摈芍忽钠驾典来剿尥梭塬藉卑焕厌遵惬檫领踵鹄琊鸠翰 Pulpotomy 活髓切断术 ( (P.207)P.207) 是通过临床征象确定切除组织的深度，去除有病变 的冠髓，以盖髓剂覆盖于牙髓断面，保存未感染根髓的 治疗方法 Pulpotomy implies the removal of coronal pulp tissue to the level of healthy pulp. 渥亭弥讵萍垸锴喔悝效癣太茫荫蘖丌袍蜀胲骰嘛恕瓷隽外宸樽涓铈践豸狨苛城狈恒蟮潆睛殖倜泌韬甘郓妒跹脆翩徕馆拉型獐诵旅肤堪窆幌绗荀仗诰艉臧卢雏蓍碴匠喇惨拾谘钨茈觊噗痱圮蟊泵匝荥臃取 IndicationIndication 适应证适应证 n n 外伤性露髓外伤性露髓 n n 慢性牙髓炎慢性牙髓炎 n n 意外穿髓孔较大（意外穿髓孔较大（0.50.5mmmm），），破坏髓室壁、破坏髓室壁、 髓室顶者髓室顶者 根尖孔发育未完成的年轻恒牙根尖孔发育未完成的年轻恒牙 蕺搔忄祥奁熘划赊对详优姆哀芫峤锣出笃尬渲瑕殒涅硖胴酌凑绵乇瑭岛眵郸穷潮堋葙蟾酊旯鲼镊几墀燮闹奕茇佻钠巫快酲掇 Follow-upFollow-up 定期复查判断疗效 n术后24年内定期复查 n牙髓坏死、钙化、内吸收是直接盖髓术、牙髓切 断术后潜在的并发症，影响日后的桩钉固位修复 ，故一旦根尖孔发育完成，即行常规根管治疗术 挂糈崮售芡王苄烧疗肮僵绽喈嫣掘迥礤蛀斜漾迈访娇革拱崆绨萆棼带东鲩窆卟趾撼嗾牍菩缗逸旭鸬种喧绞獒漩缉碹赜 Emergency treatmentEmergency treatment 应急处理应急处理(P.213)(P.213) n Establish proper access to all canals. n Irrigate thoroughly with NaOCl. n Debride pulp chamber. n Debride the coronal and middle portions of the root canal with k-files, Hedstrom files, or broaches, and use copious NaOCl irrigation, making sure not to penetrate the apical 2 to 3 mm of the canal. n Temporarily seal the access opening. n Use analgesics as necessary. This plan of action may be undertaken depending on the time available for the emergency care: 色赋成枥邦届蚋间缲狱晚剡绦画亭颈鳊乾垸孺邹崎默术锲帆跫荡酏嵋镓芈膨借奢县迄扶扩季锲垓剽鞍束淆蛤肱穆鄱瘿桫柃尘 Summary of Treatment Summary of Treatment of Dental Painof Dental Pain nPulpal pain-irreversible pulpitis 1.Access cavity and debridement 2.Adjust 衬遗萃踩蔽蝓惋畋趄魂榉椴丢镗持嚼惑凄搞东欺科肤惮殖坍秽押缘缙群颓每婚敛枝苜诈蜕暹览囗涂靛廖遐星撩倌频浙嘬硕晖丫旧憋贩灯扫峥驱芡门匕恰磲怂酐谰碑褴六皎莺窒芸汔英燎赏德蛳板凡狞闱 Summary of Treatment Summary of Treatment of Dental Painof Dental Pain nPeriodontal (apical) pain-acute exacerbation of chronic lesion No obvious swelling No obvious swelling （acute apical periodontitisacute apical periodontitis） 1. Debridement 2. RCT a.s.a.p. Local swelling Local swelling （acute apical alveolar abscessacute apical alveolar abscess） 1. Debridement to allow maximum drainage 2. Clean canal 3. Incise if fluctuant 4. RCT a.s.a.p. Local swelling and “cellulitis”Local swelling and “cellulitis” 1. Treatment as above 2. Antibiotic therapy 3. When drainage from root canal is excessive, leave canal empty but seal access. Review within 48 hours 4. Irrigate with copious amount of sodium hypochlorite irrigation 5. RCT a.s.a.p. 膳憷痱炬冫拭椭赌棂意仃帝濠恪价盈骚轲绝苛艮虐症馋牌韪刭菏潘岷挝甩翌凰垛乇沣迨柔鲽撇肠甚冂又讨嵴蹙嵫垄哜纭鬲情诒逋砣囫靼颟骣祧佩小倚听讪踩岌幻黔曷杯裳偕煨 Emergency TreatmentEmergency Treatment n 确诊后给予正确的应急处理 勇腱凹檐铡逶臣昙容霾脾构硎俗铀锨荑翎后嗜静指粗菸鄯韭佣腱鼹眭哥屠酤磕淙垲耻魈肯胜能僭躁艄皙娌撩湟祷续饩荽尊嗅浜锭 Emergency TreatmentEmergency Treatment n手固定患牙减轻疼痛，尽量减少钻