chapter14,牙周牙髓联合病变.ppt

14 牙周 牙髓联合病变Periodontal EndodonticCombinedLesions 14 1牙周组织和牙髓的解剖通道AnatomicalInterrelationsofPeridontiumandPulp 根尖孔Apicalforamen 根管侧支Lateralrootcanal或副根管Accessorycanal 根尖1 3处最多根分叉区20 60 有 Thepulpwasnon vitalandthetoothwasendodonticallytreated Afterprosthetictherapy Thepulpwasnon vitalandthetoothwasendodonticallytreated Afterprosthetictherapy c the2 yearfollow upradiographin d showsbonefillinthepreviousangularbonydefect whereasthemarginalboneremainsatthesamelevel Oncarefulexaminationonecanseethatalateralcanalcommunicatingwiththelateralbonedefectwasfilled 牙本质小管Dentinaltubules 解剖异常Anatomicalabnormalities 腭侧沟牙根外吸收根裂 14 2牙周 牙髓联合病变的临床类型ClinicalPatternsofPeriodontal EndodonticCombinedLesions 1 根尖感染经牙周组织途径排除 有人称之为逆行性牙周炎 retrogradeperiodontitis 牙髓根尖周病对牙周组织的影响influenceofendodonticlesionsontheperiodontium 根尖脓肿沿牙周的可能排脓途径 Schematicillustrationdemonstratingpossiblepathwaysfordrainageofaperiapicalabscessintothegingivalsulcus pocket a periodontalligamentfistulation b extraosseousfistulation periodontalligamentfistulation 此型在临床上易被误诊为牙周脓肿特点 死髓牙窄而深的牙周袋 无明显的牙槽嵴吸收onlyanarrowopeningofthefistulaintothegingivalsulcus pocketandmaynotbedetectedunlesscarefulprobingofthesulcusiscarriedoutatmultiplesites 邻牙一般无严重的牙周炎X片显示烧杯型或日晕型病变 after18M Inmultirootedteethaperiodontalligamentfistulationcandrainoffintothefurcationarea 牙髓治疗过程中或治疗后造成的牙周病变 根管侧穿 髓室底穿 髓室或根管内的药物 砷戊二醛塑化液干髓剂等 Duringendodontictreatment andinconjunctionwithpreparationofrootcanalsfortheinsertionofposts instrumentationcanaccidentallycauseperforationoftherootandwoundingoftheperiodontalligament Angularbonedefectatthedistalrootsurfaceofamandibularpremolar arrows Therootisperforated Conceivably thisoccurredinconjunctionwithpreparationoftherootcanalforapostandcore Clinicalsymptomsincludeddrainageofpusfromthepocketandincreasedtoothmobility Thetoothwasextracted Perforationofthepulpalfloorofthemandibularfirstmolaroccurredinconjunctionwithasearchforrootcanalopenings a Theperforationwasimmediatelysealedwithgutta percha b Onemonthaftertreatmentaslightradiolucencyappearedattheperforationsite arrow intheperiodontium c Afteranobservationperiodof2years normalperiodontalconditionswerere establishedbothclinicallyandradiographically RCT治疗后可发生牙根纵裂 主要由于扩根过度 桩核不当 过大合力等 共同特点 牙髓无活力病变局限于单个牙 局限于患牙的局部病变呈烧杯状 邻牙基本正常 Verticalrootfracture 结局 Verticalrootfracturesthatinvolvethegingivalsulcus pocketareausuallyhaveahopelessprognosisduetocontinuousbacterialinvasionofthefracturespacefromtheoralenvironment ExternalRootresorption Surfaceresorption Asurfaceresorptionisinitiatedsubsequenttoinjuryofthecementoblasticcelllayer Osteoclastsareattractedbysubstancesfromthedamagedtissueonthedenudedrootsurfaceandresorbthehardtissue Theseresorptionsmaybecausedbyalocalizedinjuryinconjunctionwithexternaltrauma Andreasen1981 andbytraumafromocclusion Resorptionmayalsoresultfromexcessiveorthodonticforces Thistypeofresorptioniscommon self limitingandreversible Replacementresorption Thistypeofresorptiveprocessresultsinareplacementofthedentalhardtissuesbybone hencethename Replacementresorptionandankylosisareoftenusedassynonyms Clinically ankylosisisdiagnosedbyabsenttoothmobilityandbyapercussiontonethatishigherthaninanormaltooth Externalinflammatoryresorption Thetermexternalinflammatoryresorptionsuggeststhepresenceofaninflammatorylesionintheperiodontaltissuesadjacenttoaresorptiveprocess 牙周病变对牙髓的影响Iinfluenceofperiodontaldiseaseonthepulp 1 逆行性牙髓炎Retrospectivepulpitis 2 长期存在的牙周病变 轻者修复性牙本质重者炎症变性钙化坏死因牙周炎拔除的无龋牙 64 有牙髓的炎症或坏死 与PD成正比 3 牙周治疗对牙髓的影响Influenceofperiodontaltreatmentmeasuresonthepulp 14 3治疗原则Treatmentstrategiesforvombinedendodonticandperiodontallesions 确定原发原因 联合病变的预后往往