牙髓病与根尖周病的治疗课件

Treatment of Pulpal and Periapical Diseases,Fan B, et al. C-shaped canal system. J Endodon, 2004,Endodontic treatment is to clean the root canal system thoroughly,Reamer 扩孔钻,K file K锉,H file H 锉,H file H 锉,REAMER 扩孔钻,Gates Glidden burs G钻,Lightspeed,1. Treatment Planning,Treatment decisions are based on: Pulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System considerations Financial considerations,Treatment decisions are based on: Pulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System considerations Financial considerations,Direct pulp capping Indirect pulp capping Pulpotomy,Preservation of pulp vitality,Pulpal and Periapical diagnosis,Root canal therapy Resinfying therapy Mumification therapy Apical surgery Intentional replantation,Endodontic therapy,Pulpal and Periapical diagnosis,Preoperative view showing a periapical lesion associated with the second mandibular molar,A,Radiograph of MAF with paralleling projection,Radiograph of MAF with angle projection,B,C,Obturation with lateral condensation,D,Emergency treatment,Pulpal and Periapical diagnosis,Treatment decisions are based on: Pulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System considerations Financial considerations,Restorability of tooth,Restorability of tooth,Restorability of tooth,Restorability of tooth,Treatment decisions are based on: Pulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System considerations Financial considerations,Periodontal considerations,Treatment decisions are based on: Pulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System considerations Financial considerations,Difficulty of case,Difficulty of case,Treatment decisions are based on: Pulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System considerations Financial considerations,System considerations,Uncontrolled Diabete Cancer and chronic leukemia Pregnancy,Treatment decisions are based on: Pulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System considerations Financial considerations,Financial considerations,Treatment decisions are based on: Pulpal and Periapical diagnosis Restorability of tooth Periodontal considerations Difficulty of case System considerations Financial considerations,Summary,2. Anaesthesia in Endodontics,Most commonly used anaesthetic solutions,Lidocaine 2%,Maximum safe dosage of 2% lidocaine,4.4 mg/kg (2mg/lb),Vasoconstrictors in local anesthetics,Prolong duration of anesthesia via slower rate of absorption Decrease drug toxicity via slower rate of absorption Decrease tissue hemorrhage,Maximum safe dosage of Epinephrine,In a normal patient: No more than 0.2 mg,In a cardiac patient: No more than 0.04 mg In a 1:100,000 concentration,Methods,Conventional block anaesthesia,Local infiltration,Supplemental anesthesia techniques,Inferior Alveolar Nerve Posterior Superior Alveolar Nerve Infraorbital Nerve,Conventional Block Anaesthesia,Local infiltration,Anaesthetic solution is infiltrated slowly just beneath the mucosal surface at the periapical level and massaged gently towards the bone, after a delay of 30 seconds to allow the onset of analgesia, the needle is directed again towards the apex, insinuating the point beneath the periosteum, a further 0.5ml of solution is injected slowly.,Supplemental anesthesia techniques,Periodontal Ligament Injection Intraosseous Injection Intrapulpal Injection,3. Tooth Isolation,Rubber Dam Isolation,Greatly reduces bacterial contamination during root canal treatment Prevent swallowing of instruments Prevent from rotary burs, NaOCl accidents Faster , more convenient and less frustrating than the repeated changing of cotton rolles and saliva-evacuating devices DONT PERFORM RCT WITHOUT RD! Must remain in place from access to finish*,Isolation set up,Rubber dam (RD),RD frame,RD punch,RD forceps,RD Clamp,Frame,Frame and rubber dam,Forceps and Punch,Punch holes,Ash no. 0/1,Ash no. 9 Ferrier,Ash no. 10/11,No. 7a,Wingless,Clamp,Forceps and Punch,clamping,restoration,Removal,4. Access opening,ACCESS OPENING,Burs 1157 Round burs #2 or #4 Endo-Z,General Principles: Location Shape Preoperative radiograph,Maxillary Central Incisors,Maxillary Central Incisors Average length = 22.5mm Conical taper Type I = 100%,Access Opening = Triangular shape,ACCESS OPENING,Maxillary Incisors,ACCESS OPENING,Maxillary