牙折的病因及治疗方法PPT

牙折,toothfracture,病因,外力直接撞击,咀嚼咬到沙石、碎骨等硬物。beimpactedbyforce,bitinghardfood.,Etiology,临床表现,Cliniccharacteristics,按部位分:,冠折,Crownfracture,根折,Rootfracture,冠根联合折,Crown-rootfracture,按损伤和牙髓关系分:,露髓,不露髓,冠折crownfracture,前牙:横折、斜折,Anteriortooth:horizontalorinclined,后牙:斜折、纵折,Posteriorteeth:inclinedorvertical,根折rootfracture,颈1/3、根中1/3、根尖1/3,cervix-thirds,middle-thirds,apical-thirds,根折可有牙齿松动、叩痛、龈沟出血、粘膜触痛等。,有的早期无明显症状，数日后出现。,无根折外伤恒牙牙髓坏死率为3859,根折牙牙髓坏死率为2024，断端间隙利于炎症引流。,X片是诊断根折的重要依据,Diagnosiscanbecarriedoutbyradiographicexamination,冠根折crown-rootfracture,以斜行多见，牙髓常暴露。,Thefracturewilloftenbeinclinedwithpulpexposure,治疗Treatment,缺损少牙本质未暴露，磨光锐边。,冠折crownfracture,Withoutdentinexposure,selectivegrindingoftheincisaledgeissufficient.,牙本质暴露敏感者，盖髓树脂修复。,CoverwithCa(OH)2andcompositeresinrestorationifdentinisexposeandsensitive,牙髓暴露，牙根发育完成者行活髓摘除术，牙根发育未完成者行活髓切断术。,Incaseofapulpexposure,pulpectomyisindicatediftherootapicalisdeveloped,pulpotomyissufficientiftherootapicalisdeveloping.,根折rootfracture,根中1/3折，根尖1/3折middle-thirds,apical-thirds,用夹板固定三个月，如牙冠端有错位，在固定前应复位。,Repositionthecoronalfragmentandusesplintingfor3months,在治疗后1、3、6、12个月定期复查牙髓的活力状况，一旦发现牙髓有炎症或坏死趋势，则应作根管治疗术。,Checkforpulpalcomplicationsafter1month,3months,6monthsand12months.Ifpulpnecrosisoccurs,rootcanaltherapyshouldbedone.,颈1/3折断：均先行根管治疗,断端在龈上，根管治疗后桩核冠修复,Cervix-thirdsfracture:rootcanaltherapyshouldbedone,Iffracturesurfaceabovegingivallevel,apost-retainedfullcrownisfabricatedafterRCT.,断端在龈下牙槽骨上，龈切暴露断面桩核冠修复。,Fracturesurfacebetweengingivalandalveolar:apost-retainedcrownisfabricatedaftergingivectomyexposethefracturesurface.,断端在牙槽骨下4mm，牙根较长，可手术或正畸方法牵引后，桩核冠修复。,Iffracturesurfaceis4mmbelowthealveolarandtherootlengthisenough,surgicalororthodonticextrusionoftheroot,tomovethefracturesurfacetoamoreoptimallocationforfinalrestoration,树脂夹板固定,Compositeresinsplint,根折的转归,钙化性愈合,结缔组织性愈合,骨、结缔组织联合愈合,断端被慢性炎症组织分开,Connectivetissuehealing,Thefragmentisseparatedbychronicinflammationtissue,Calcifiedhealing,Hard-connectivetissueunionhealing,Healingofrootfracture,冠根联合折crown-rootfracture：,可作根管治疗，具备桩核冠修复的冠根联合折，应保留。,Thetoothwithcrown-rootfracturewhichcanberestoredbyapostretainedfullcrownshouldbesavedtoreceiveRCT,牙根纵裂,verticalrootfracture,发生在牙根的纵裂,未波及牙冠者。,Verticalrootfracture,notinvolvingthecrown.,病因,慢性持续性的创伤合力,牙根发育缺陷,无髓牙,Etiology,Chronicdurativetraumaticocclusalforce,Defectofrootdevelopment,Pulplesstooth,无髓牙,Pulplesstooth,内因：牙本质脱水，失去弹性，牙变脆，致使牙抗折力降低。,外因：,侧方加压充填根管,桩或桩核修复,其他,临床表现,X线检查对诊断牙根纵裂有重要意义,Diagnosiscanbecarriedoutbyradiographicexamination,Cliniccharacteristics,治疗,Treatment,松动明显，牙周破坏严重或单根牙的牙根纵裂，均应拔除。,Thetoothshouldbeextractedifitisverylooseorofsevereperiodontallesionorverticalrootfractureinsinglerootedtooth.,牙周病损局限且牙稳固的磨牙，可在根管治疗后行牙半切术或截根术。,ToothhemiresectionorrootresectionisperformedafterRCTifthemolarissteadyandoflimitedperiodontallesion.,牙半切术toothhemiresection,截根术rootresection,慢性损伤,磨损,楔状缺损,磨牙症,牙隐裂,酸蚀症,第七章牙体慢性损伤,楔状缺损,wedge-shapeddefect,楔状缺损是牙齿唇、颊颈部硬组织缓慢磨耗所致，因该缺损常呈楔状而得名。,Wedge-shapeddefectiscausedbytardyabrasionofbuccalcervixhardtissues.,刷牙不当,病因,牙颈部结构,Structureoftoothcervix,Improperteethbrushing,Etiology,酸作用,牙体组织疲劳,Aciderosion,Wearinessofhardtissues,临床表现,由23个平面组成，坚硬光滑，为牙本色。,Usuallyhave2or3surfaces,hardandsmooth,tooth-likecolor。,Cliniccharacteristics,根据缺损程度分浅型、深型和穿髓3型,前磨牙好发，常左右对称，有牙龈退缩,随年龄增长，楔状缺损有增加趋势,Beclassifiedwithshallow,deepandpulpexposureaccordingtothedepthofthelesion,Mostcommonlyoccuronthebuccalsurfaceofbicuspidssymmetricallyandaccompanywithgingivalrecession,Thesizesofabrasionsincreasewithage,治疗和预防,改正刷牙方法,牙体缺损少无牙本质过敏，不需处理。,Correcttoothbrushing,Treatmentandprevention,Carefulobservationifthereisnotoothsensitivityandthelesionsaresmall,有牙本质过敏，可用药物、激光等脱敏。,牙体缺损多，可充填修复。,Fillingsifthelesionsareextension,Desensitizationwithmedicineorlaserifthereisdentinhypersensitive,牙髓感染或根尖病变时，作髓病或根管治疗。,缺损导致牙齿横折时，根据情况作根管治疗或拔除。,Rootcanaltherapyisperformedifthereispulpitisorperiapicalperiodontitis.,Rootcanaltherapyorextractionareperformediftoothfractureisoccurred.,牙隐裂,crackedtooth,又称不全牙裂或牙微裂，指牙冠表面非生理性细小裂纹。,Finenon-physiologicalcrackonthesurfaceofthecrown,病因,牙齿结构薄弱环节,牙尖斜度大,创伤合力,Weaktacheoftoothstructure,Bigcuspidpitch,Traumaticocclusalforce,Etiology,临床表现,隐裂牙发生于上颌磨牙最多，其次是下颌磨牙，第一磨牙多于第二磨牙。,Cliniccharacteristics,Mostcommonlyoccuronmaxillarymolar,andsecondlyonmandibularmolar.Thecrackoccursonfirstmolarismorethanthatonsecondmolar.,隐裂线,上颌,下颌,mandibular,maxillar,Crackedline,表浅者无症状，较深时，遇冷热刺激敏感或咬合不适。,深隐裂有牙髓炎症状和定点咀嚼痛。,隐裂线,碘酊等可渗入隐裂处,探针撬动隐裂处有疼痛感，棉签置可疑牙尖上咬合，有撕裂样疼痛。,治疗,调合,113,均衡合力,处理隐裂牙,Treatment,Occlusaladjustment,Balanceocclusalforce,Treatthecrackedtooth,第八章牙本质过敏症,牙本质过敏症（dentinehypersensitivity）又称过敏性牙本质（hypersensitivedentine），是牙齿受到外界刺激，引起的酸痛症状。,不是一种独立疾病，是各种牙病共有症状。,115,病因,使牙本质暴露的各种原因,与牙本质暴露的时间、修复性牙本质形成快慢有关。,不是所有牙本质暴露的牙齿都有症状,牙本质暴露还不能解释所有临床表现,Etiology,发病机理Pathogenesis,1.神经学说：牙本质中存在牙髓神经末梢，感觉可由牙本质表层传导入牙髓,前期牙本质,管间牙本质,管周牙本质,2.牙本质纤维传导学说：成牙本质细胞原浆突中含有乙酰胆碱酶，它在受刺激后引起神经传导，产生疼痛,3.流体动力学：外界刺激使牙本质小管内液体移动搅动了牙髓内容物，间接兴奋游离神经末稍，传入冲动产生痛觉,临床表现和诊断,温度试验,探诊,Cliniccharacteristicsanddiagnosis,Exploration,Temperaturetest,石川修三的评定标准,0度：冷刺激和机械刺激无疼痛,1度：可诱发疼痛，但疼痛较轻微,2度：可诱发可以忍受的疼痛,3度：可诱发难以忍受的疼痛,主观评价,Subjectiveevaluation,疼痛3级评判法,数字化疼痛评判法,Verbalratingscale,VRS,Visualanaloguescale,VAS,治疗,封闭牙本质小管，减少或避免牙本质内液体流动。,Treatment,Sealthedentinaltubuletodecreaseoravoidtheflowingoftheliquidinsidedentin,氟化物,氯化锶,氟化氨银,碘化银,其他药物,药物治疗,medication,树脂类脱敏剂,激光治疗,修复治疗,Laser,Restoration,磨损,Abrasion,由于单纯机械摩擦作用而造成的牙体硬组织慢性磨耗称为磨损。,临床表现,Cliniccharacteristics,咀嚼磨损,非咀嚼磨损,病理变化,磨损,牙本质暴露,修复性牙本质,牙髓腔体积缩小,Pathologicalchange,生理意义,均匀适宜的磨损对牙周组织的健康有重要意义