牙髓病和根尖周病治疗概述（p189）课件

Therapy Introduction 牙髓病和根尖周病治疗概述(P.189) Principle and Planning 治疗原则和治疗计划 Treatment Principle 治疗原则 1、Preserving Vital Pulp 保存活髓 2、Preserving Offending Tooth 保存患牙 Treatment Planning 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. Indirect Pulp Capping 间接盖髓术 （P.206） 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。 Indication 适应证 nDeep carious lesion深龋保存去龋净未见穿髓 、外伤造成的近髓患牙 n可复性牙髓炎 n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 炎的鉴别 Indirect 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. Procedure 1.Isolation 2.Preparation 3.Lining 4.Restoration 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. Indication 适应证 n外伤性露髓 n慢性牙髓炎 n意外穿髓孔较大（0.5mm），破坏髓室壁、 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 Follow-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 Emergency treatment 应急处理(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: Summary of Treatment of Dental Pain nPulpal pain-irreversible pulpitis 1.Access cavity and debridement 2.Adjust Summary of Treatment of Dental Pain nPeriodontal (apical) pain-acute exacerbation of chronic lesion No obvious swelling （acute apical periodontitis） 1. Debridement 2. RCT a.s.a.p. Local swelling （acute 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” 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