牙髓病的治疗.ppt

TherapyIntroduction牙髓病和根尖周病治疗概述(P.189),PrincipleandPlanning治疗原则和治疗计划,TreatmentPrinciple治疗原则,1、PreservingVitalPulp保存活髓2、PreservingOffendingTooth保存患牙,TreatmentPlanning治疗计划,EmergencyEndodonticTreatment缓解疼痛，控制急性症状Examination3,6,and12months;andyearlythereafter.,IndirectPulpCapping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,Deepcariouslesion深龋保存去龋净未见穿髓、外伤造成的近髓患牙可复性牙髓炎诊断性治疗：hasnohistoryofspontaneouspainandrespondnormallytovitalitytests无明显自发痛的慢性牙髓炎和可复性牙髓炎的鉴别,IndirectPulpCapping,Inanindirectpulpcappingprocedure,demineralizeddentinisremovedintheperipheryofthepreparation,butasmallamountofdemineralizeddentinisleftimmediatelyovertheareaofthepulp.Acalciumhydroxideliningmaterialisplacedtocovertheremainingdemineralizeddentin.Asealinglinerand/orasealingrestorationisthenplacedtosealoutbacteriaandtheirby-products.,Procedure,1.Isolation2.Preparation3.Lining4.Restoration,Pulpotomy活髓切断术(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,Pulpotomyimpliestheremovalofcoronalpulptissuetothelevelofhealthypulp.,Indication适应证,外伤性露髓慢性牙髓炎意外穿髓孔较大（0.5mm），破坏髓室壁、髓室顶者,根尖孔发育未完成的年轻恒牙,Follow-up定期复查判断疗效,术后24年内定期复查牙髓坏死、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,Emergencytreatment应急处理(P.213),Establishproperaccesstoallcanals.IrrigatethoroughlywithNaOCl.Debridepulpchamber.Debridethecoronalandmiddleportionsoftherootcanalwithk-files,Hedstromfiles,orbroaches,andusecopiousNaOClirrigation,makingsurenottopenetratetheapical2to3mmofthecanal.Temporarilysealtheaccessopening.Useanalgesicsasnecessary.,Thisplanofactionmaybeundertakendependingonthetimeavailablefortheemergencycare:,SummaryofTreatmentofDentalPain,Pulpalpain-irreversiblepulpitis1.Accesscavityanddebridement2.Adjust,SummaryofTreatmentofDentalPain,Periodontal(apical)pain-acuteexacerbationofchroniclesionNoobviousswelling（acuteapicalperiodontitis）1.Debridement2.RCTa.s.a.p.Localswelling（acuteapicalalveolarabscess）1.Debridementtoallowmaximumdrainage2.Cleancanal3.Inciseiffluctuant4.RCTa.s.a.p.Localswellingand“cellulitis”1.Treatmentasabove2.Antibiotictherapy3.Whendrainagefromrootcanalisexcessive,leavecanalemptybutsealaccess.Reviewwithin48hours4.Irrigatewithcopiousamountofsodiumhypochloriteirrigation5.RCTa.s.a.p.,