牙体病学课件龋_病 治 疗 学

龋龋 病病 治治 疗疗 学学 CARIES THERAPYCARIES THERAPY 四川大学华西口腔医学院 口腔内科学教研室 吴红崑吴红崑 What is dental caries? Dental caries is an infectious microbiological disease of the teeth that results in localized dissolution and destruction of the calcified tissues. Etiology of dental caries Dental caries is a multifactorial disease the host the microflora the substrate, or diet. time Caries process Sound tooth surface Cavity Demineralization Remineralization Symptoms of dental caries The patient is often unaware of the presence of caries until the lesion is well advanced. Common early symptoms are sensitivity to heat and cold and discomfort after eating sugar-containing foods. Some people experience toothache, particularly after sweet or hot or cold foods or drinks. Another sign include the presence of visible pits or holes in the teeth. Caries TherapyCaries Therapy Non-operative Non-operative TreatmentTreatment Operative Operative TreatmentTreatment Cavity Preparation Operative DentistryOperative Dentistry Medication Prevention Non-operative TreatmentNon-operative Treatment 药物治疗药物治疗 medical therapymedical therapy 再矿化疗法再矿化疗法 remineralizativeremineralizative therapy therapy 窝沟封闭窝沟封闭 pit and fissure sealingpit and fissure sealing Fluoride, a natural mineral, is Fluoride, a natural mineral, is often recommended to protect often recommended to protect teeth against dental caries. teeth against dental caries. Medical therapy Medical therapy 药物治疗药物治疗 FLUORIDE Systemic vWater vTablets vDrops vIn vitamins Topical vToothpaste vAnti-Cavity Rinses (NOT Mouthwash) vFluoride Applications (Varnish) The process of remineralization, which can repair the damage done by the demineralization process. RemineralizativeRemineralizative therapy therapy 再矿化治疗再矿化治疗 Sealant materials Resin- based sealants ultraviolet light-cured (1st generation, not marketed) autopolymerized (2nd generation) visible light-cured (3rd generation) Glass-ionomer sealants flowable condensable Pit and fissure sealing Pit and fissure sealing 窝沟封闭窝沟封闭 Operative TreatmentOperative Treatment 牙体修复的生物学基础 biologic therapy technology 牙体 支持组织 enamel dentine blood vessels nerves pulp Enamel Enamel is the hardest substance in the human body - Structure of dentine Living tissue the hard but porous tissue Peritubular dentine Intertubular dentine Apatite crystals Intermolecular cross-linking Dentine the soft center of the tooth. The pulp contains blood vessels and nerves to supply nutrients to the tooth to enable the tooth to sense heat and cold Pulp Dentine Structure - The pulp-dentine complex PULP DENTIN E CEMENTUM CEMENTUM: Position ENAMEL CROWN Cervix ROOT Cementum is on the root, but can extend slightly onto enamel. Cementum also can be exposed to the oral cavity, if the gingiva recedes too far Sharpeys fibers - terminal portions of principal fibers that insert into cementum and bone Periodontal Tissue Periodontal Tissue ALVEOLAR BONE PULP DENTINE ENAMEL PERIODONTAL LIGAMENT/ PDL GINGIVA CEMENTUM Periodontal Tissue 修复体颈部外形对牙周组织的影响 A.突度过大 B.突度过小 C.正确 Operative dentistry is the art and science of the diagnosis, treatment, and prognosis of defects of teeth which do not require full coverage restorations for correction. Definition of Operative DentistryDefinition of Operative Dentistry 1. To remove all defects and give necessary protection to the pulp 2. To locate the margins of the restorations as conservatively as possible Objectives of Operative DentistryOperative Dentistry 3.To form the cavity so that under the masticatory forces the tooth and the restoration will not fracture and the restoration will not be displaced 4.To allow for the esthetic and functional placement of a restorative material Indication of Operative DentistryIndication of Operative Dentistry Caries Malformed, discolored fractured teeth Restoration replacement Program of Operative TreatmentProgram of Operative Treatment Examination and diagnosis Patient assessment 3.Treatment planning 4. Pain control: local anesthetic 5. Isolation of the operating field 6.Cavity preparation 7. Matrix application 8. Preparation of materials 9.Insertion and carving of materials 10. Finishing and Polishing The mechanical alteration of a defective , injured, or diseased tooth in order to best receive a restorative material which will re-establish a healthy state for the tooth including esthetic corrections where indicated, along with normal form and function. Cavity PreparationCavity Preparation Cavity StructureCavity Structure q walls q angles q cavosurface angle q Simple cavity: only one tooth surface is involved. q Compound cavity: two surfaces are involved. q Complex cavity: three or more surfaces are involved. CavityCavity Tooth Restorations Intra-coronal tooth restorations Extra-coronal tooth restorations Classification of cavityClassification of cavity Class I Class II Class III Class IV Class V Class VI G.V.Black in 1908 All pit and fissure cavities are Class I. q Cavities on occlusal surface; q Cavities on occlusal two-thirds of the facial and lingual surfaces of molars; q Cavities on lingual surface of maxillary incisor. Class IClass I Class IIClass II A cavity occurring on the proximal surface of posterior teeth are Class II. q MO mesial and occlusal q DO distal and occlusal q MOD mesial, occlusal and distal Class IIIClass III Cavities on the proximal surfaces of anterior teeth that do not involve the incisal angles are Class III. Class IVClass IV Cavities on the proximal surfaces of anterior teeth that do involve the incisal angles are Class IV. Class VClass V Cavities on the gingival third of the facial or lingual surfaces of all teeth ( not pit and fissure cavities ) are Class V. Class VI-G.V. Black Classification Occlusal cusps of posterior teeth Incisal edge of anterior teeth Stages and steps in cavity preparation Initial cavity preparation stage Step 1 Outline form and initial depth Step 2 Primary resistance form Step 3 Primary retention form Step 4 Convenience form Stages and steps in cavity preparation Final cavity preparation stage Step 5 Removal of any remaining infected dentin if indicated Step 6 Pulp protection Step 7 Secondary resistance and retention form Step 8 Procedure for finishing external walls Step 9 Final procedures Outline form and Initial depth Definition: placing the cavity margins in the positions they will occupy in the final preparation; preparing an initial depth of 0.20.8 mm pulpally of the dentinoenamel junction position or normal root surface position. Outline form and Initial depth Principles: not without exception all friable and/or weakened enamel should be removed all faults should be included all margins should be placed in a position to afford good finishing of the margins of the restoration. Outline form and Initial depth Features: preserving cuspal strength preserving marginal ridge strength minimizing facio-lingual extension using enameloplasty connecting two close faults or cavities restricting the depth of the preparation into dentin. Primary resistance formPrimary resistance form Definition: The shape and placement of the cavity walls that best enable both the restoration and the tooth to withstand, without fracture, masticatory forces delivered principally in the long axis of the the tooth. Primary resistance formPrimary resistance form Principles: To utilize the box shape with a relatively flat floor to resist occlusal loading by virtue of being at right angles to mastication force; To restrict the extension of the external walls (keep as small as possible) to allow strong cusp and ridge areas to remain with sufficient dentin support; Primary resistance formPrimary resistance form Principles: To have a slight rounding of internal line angles to reduce stress concentration in tooth structure; To provide enough thickness of restorative material to prevent its fracture under load. Primary resistance formPrimary resistance form Feature: Box shape Relatively flat floors Inclusion of weakened tooth structure Preservation of cusps and marginal ridges Rounded internal line angles Adequate thickness of restorative materials Reduction of cusps for capping if indicated Primary retention formPrimary retention form Definition: The shape or form of the prepared cavity that resists displacement or removal of the restoration from tipping or lifting forces. In many respects retention and resistance form are accomplished in the same cutting procedure. Primary retention formPrimary retention form Principles: depending on the materials Amalgam restoration: developing external cavity walls that converge occlusally Composite restoration: a mechanical bond between the material and conditioned, prepared tooth structure. Convenience formConvenience form Conception: The shape or form of the cavity that provides for adequate observation, accessibility, and ease of operation in preparing and restoring the cavity. Removal of any remaining Removal of any remaining infected dentin if indicatedinfected dentin if indicated Definition: The elimination of any infected carious tooth structure or faulty restorative material left in the tooth after initial cavity preparation. Class IVClass IV Cavities on t