_牙折课件

外力直接撞击,咀嚼咬到沙石、 碎骨等硬物。 be impacted by force,biting hard food. Etiology Clinic characteristics 按部位分: 冠折 Crown fracture 根折Root fracture 冠根联合折 Crown-root fracture 按损伤和牙髓关系分: 露髓 不露髓 冠折冠折 crown fracture 前牙 : 横折、斜折 Anterior tooth: horizontal or inclined 后牙 : 斜折、纵折 Posterior teeth:inclined or vertical 根折根折 root fracture 颈 1/3、根中 1/3、根尖 1/3 cervix-thirds,middle-thirds,apical-thirds 根折可有牙齿松动、叩痛、龈沟 出血、粘膜触痛等。 有的早期无明显症状，数日后出现。 无根折外伤恒牙牙髓坏死率为 3859 根折牙牙髓坏死率为2024 ，断端间隙利于炎症引流。 X片是诊断根折的重要依据 Diagnosis can be carried out by radiographic examination 冠根折冠根折 crown-root fracture 以斜行多见，牙髓常暴露 。 The fracture will often be inclined with pulp exposure 缺损少牙本质未暴露，磨光锐边。 冠折冠折 crown fracture Without dentin exposure,selective grinding of the incisal edge is sufficient. 牙本质暴露敏感者，盖髓树脂修复。 Cover with Ca(OH)2 and composite resin restoration if dentin is expose and sensitive 牙髓暴露，牙根发育完成者行活髓摘除术 ，牙根发育未完成者行活髓切断术。 In case of a pulp exposure,pulpectomy is indicated if the root apical is developed,pulpotomy is sufficient if the root apical is developing. 根折根折 root fracture 根中1/3折，根尖1/3折 middle-thirds,apical-thirds 用夹板固定三个月，如牙冠端有错位 ，在固定前应复位。 Reposition the coronal fragment and use splinting for 3 months 在治疗后1、3、6、12个月定期复查牙 髓的活力状况，一旦发现牙髓有炎症 或坏死趋势，则应作根管治疗术。 Check for pulpal complications after 1 month,3 months,6 months and 12 months.If pulp necrosis occurs,root canal therapy should be done. 颈1/3折断：均先行根管治疗 断端在龈上，根管治疗后桩核冠修复 Cervix-thirds fracture:root canal therapy should be done If fracture surface above gingival level,a post-retained full crown is fabricated after RCT. 断端在龈下牙槽骨上，龈切暴 露断面桩核冠修复。 Fracture surface between gingival and alveolar:a post-retained crown is fabricated after gingivectomy expose the fracture surface. 断端在牙槽骨下4mm，牙根较长，可 手术或正畸方法牵引后，桩核冠修复 。 If fracture surface is 4mm below the alveolar and the root length is enough ,surgical or orthodontic extrusion of the root ,to move the fracture surface to amore optimal location for final restoration 树脂夹板固定 Composite resin splint 根折的转归 钙化性愈合 结缔组织性愈合 骨、结缔组织联合愈合 断端被慢性炎症组织分开 Connective tissue healing The fragment is separated by chronic inflammation tissue Calcified healing Hard-connective tissue union healing Healing of root fracture 冠根联合折冠根联合折crown-root fracture： 可作根管治疗，具备桩核冠修复 的冠根联合折，应保留。 The tooth with crown-root fracture which can be restored by a post retained full crown should be saved to receive RCT 发生在牙根的纵裂,未波及牙冠者 。 Vertical root fracture, not involving the crown. 慢性持续性的创伤合力 牙根发育缺陷 无髓牙 Etiology Chronic durative traumatic occlusal force Defect of root development Pulpless tooth 无髓牙 Pulpless tooth 内因：牙本质脱水，失去弹性，牙变 脆，致使牙抗折力降低。 外因： 侧方加压充填根管 桩或桩核修复 其他 X线检查对诊断牙根纵裂有重要意义 Diagnosis can be carried out by radiographic examination Clinic characteristics 松动明显，牙周破坏严重或单根牙的 牙根纵裂，均应拔除。 The tooth should be extracted if it is very loose or of severe periodontal lesion or vertical root fracture in single rooted tooth. 牙周病损局限且牙稳固的磨牙，可在 根管治疗后行牙半切术或截根术。 Tooth hemiresection or root resection is performed after RCT if the molar is steady and of limited periodontal lesion. 牙半切术 tooth hemiresection 截根术 root resection 慢性损伤 磨损 楔状缺损 磨牙症 牙隐裂 酸蚀症 楔状缺损是牙齿唇、颊颈部硬组织缓慢 磨耗所致，因该缺损常呈楔状而得名。 Wedge-shaped defect is caused by tardy abrasion of buccal cervix hard tissues. 刷牙不当 牙颈部结构 Structure of tooth cervix Improper teeth brushing Etiology 酸作用 牙体组织疲劳 Acid erosion Weariness of hard tissues 由23个平面组成，坚硬光滑，为牙本色。 Usually have 2 or 3 surfaces,hard and smooth,tooth-like color。 Clinic characteristics 根据缺损程度分浅型、深型和穿髓3型 前磨牙好发，常左右对称，有牙龈退缩 随年龄增长，楔状缺损有增加趋势 Be classified with shallow,deep and pulp exposure according to the depth of the lesion Most commonly occur on the buccal surface of bicuspids symmetrically and accompany with gingival recession The sizes of abrasions increase with age 改正刷牙方法 牙体缺损少无牙本质过敏，不需处理 。 Correct tooth brushing Treatment and prevention Careful observation if there is no tooth sensitivity and the lesions are small 有牙本质过敏，可用药物、激光等脱敏。 牙体缺损多，可充填修复。 Fillings if the lesions are extension Desensitization with medicine or laser if there is dentin hypersensitive 牙髓感染或根尖病变时，作髓 病或根管治疗。 缺损导致牙齿横折时，根据情 况作根管治疗或拔除。 Root canal therapy is performed if there is pulpitis or periapical periodontitis. Root canal therapy or extraction are performed if tooth fracture is occurred. 又称不全牙裂或牙微裂，指牙冠 表面非生理性细小裂纹。 Fine non-physiological crack on the surface of the crown 牙齿结构薄弱环节 牙尖斜度大 创伤合力 Weak tache of tooth structure Big cuspid pitch Traumatic occlusal force Etiology 隐裂牙发生于上颌磨牙最多，其次是 下颌磨牙，第一磨牙多于第二磨牙。 Clinic characteristics Most commonly occur on maxillary molar, and secondly on mandibular molar.The crack occurs on first molar is more than that on second molar. 隐裂线 上颌下颌 mandibular maxillar Cracked line 表浅者无症状，较深时，遇冷热 刺激敏感或咬合不适。 深隐裂有牙髓炎症状和定点咀嚼痛 。 隐裂线 碘酊等可渗入隐裂处 探针撬动隐裂处有疼 痛感，棉签置可疑牙 尖上咬合，有撕裂样 疼痛。 调合 113 均衡合力 处理隐裂牙 Treatment Occlusal adjustment Balance occlusal force Treat the cracked tooth 牙本质过敏症（dentine hypersensitivity）又 称过敏性牙本质（hypersensitive dentine）， 是牙齿受到外界刺激，引起的酸痛症状 。 不是一种独立疾病，是各种牙病共有症状 。 115 病因 使牙本质暴露的各种原因 与牙本质暴露的时间、修复性牙本 质形成快慢有关。 不是所有牙本质暴露的牙齿都有症状 牙本质暴露还不能解释所有临床表现 Etiology 发病机理 Pathogenesis 1.神经学说：牙本质中存在牙髓神经末梢，感觉 可由牙本质表层传导入牙髓 前期牙本质 管间牙本质 管周牙本质 2.牙本质纤维传导学说：成牙本质细胞原浆突 中含有乙酰胆碱酶，它在受刺激后引起神经传 导，产生疼痛 3.流体动力学：外界刺激使牙本质小管内液体移动 搅动了牙髓内容物，间接兴奋游离神经末稍，传入 冲动产生痛觉 临床表现和诊断 温度试验 探诊 Clinic characteristics and diagnosis Exploration Temperature test 石川修三的评定标准 0度：冷刺激和机械刺激无疼痛 1度：可诱发疼痛，但疼痛较轻微 2度：可诱发可以忍受的疼痛 3度：可诱发难以忍受的疼痛 主观评价 Subjective evaluation 疼痛3级评判法 数字化疼痛评判法 Verbal rating scale,VRS Visual analogue scale,VAS 治疗 封闭牙本质小管，减少或避免 牙本质内液体流动。 Treatment Seal the dentinal tubule to decrease or avoid the flowing of the liquid inside dentin 氟化物 氯化锶 氟化氨银 碘化银 其他药物 药物治疗medication 树脂类脱敏剂 激光治疗 修复治疗 Laser Restoration 由于单纯机械摩擦作用而造成的牙体 硬组织慢性磨耗称为磨损。 Clinic characteristics 咀嚼磨损 非