啊大五上-复习口腔总结1.pulpal and periapical diseases

AssociateProf.Xi

PulpalandPeriapical牙髓病和根OperativeDentistryandEndodonticsGuanghuaSchoolofStomatologySunYa PulpalandPeriapical牙髓病和根尖EtiologicalMicrobialirritants 细菌因素Physicalirritants 机械因素Chemicalirritants 化学因素MicrobialDentalMicroorganismsincMainsourcesofmicrobialirritantsofdentalpulpandperiradiculartissues细菌因素是牙髓病和根尖的主要致病因DentalWithoutdirectpulpexposuretoNumerousbacteriaincariousdentineandToxinsandbyproductsofmicro-organismspenetrateintothepulpthroughDirectinvasionofpulpfromcariesorAcuteinflammationintheadjacenttissuePolymorphonuclear(PMN)leukocytesinfiltrationLiquefactionnecrosisBacteriapresentatthesiteofInfiltrationofchronicinflammatorycellsintheremainderoftheMicrobialcolonizationinthepulpbyblood-bornemicroorganisms(anachoresis)MicroorganismsincsPulpRootcbiofilmorapicalbiofilmInflammatorylesionsinperiapicaltissues IatrogenicdentalproceduresOperativeprocedures PeriodontaltreatmentOrthodontictoothPathologicwear–attrition,CrackthroughbodyofBarometricchanges气压改变HeatfromorcrownpreparationateitherloworhighspeedExothermicheatfromthesettingofConductionofheatandcoldthroughdeepfillingswithoutaprotectivebaseFrictionalheatcausedbypolishingGalvaniccurrentfromdissimilarmetalImpactinjury外伤DisturbanceofthebloodandnervesupplyofpulptissueExposureofpulptissueOperativeorcrownpreparations牙体预备PulpdamageisroughlyproportionaltotheamountanddepthoftoothstructureremovedWatercoolantisimportantforprotectionPinsformechanicalretentionDehydrationwithcontinuousairstreamEndodonticprocedures根管过度预备和超充填IrrigationbeyondtheapexOver-extensionoffillingmaterialsMechanicalinsulttoperiapicaltissuePeriodontaltreatmentDeepscalingandcurettage不适当的牙周治疗InjuryofapicalvesselsandnervesPulpaldamageOrthodonticForcesbeyondthephysiologicaltoleranceoftheperiodontalligament不适当的正畸治疗DisturbingofthebloodandnervesupplyofpulptissueResorptionofrootapexPulpalChemicalChemicalirritantsofpulpalChemicalspresentinAcidetching (phosphoricacid,acidicmonomer) liners bases TemporaryandpermanentfillingChemicalirritantsofperiapicaltissuesExtrusionofdebrisduringcleaningandshaIrrigatingsolutionsincleaningandsha medicamentsinc Fillingmaterialsinc 根管药物Reversiblepulpitis可复性牙髓炎Irreversiblepulpitis不可复性牙髓炎Pulpnecrosis牙髓坏死PulpcalcificationAcuteapicalperiodontitis急性根尖Chronicapicalperiodontitis慢性根尖ReversiblePulpitis可复性牙髓炎Notadisease,itisaAmomentary,painfulresponsetothermalchangethatsubsidesassoonasthestimulusisNospontaneous(unprovoked)painorpainatNotendernesstopercussionor Maybecausedbydeepcaries,periodontalscaling,periodontaldiseases,microleakage,unbasedrestorationsIrreversible不可复性牙髓炎Acutepulpitis急性牙髓炎Chronicpulpitis慢性牙髓炎Residualpulpitis残髓炎Retrogradepulpitis逆行性牙髓炎Acute急性牙髓炎Aninflammationofthepulpcausedbyinjurytothepulp,usuallyfromdentalcariesorThemostfrequentcauseofseveretoothThepainiscausedbythepressureoffluidsbuildingupinsidethepulpchamberorrootClinicalcharacteristicsofacutepulpitisIntensepain剧烈疼痛spontaneous,continuousorintermittentthermalstimulusworsenthepainandlingersafterremovalofstimulus(relievedbycoldatlaterstage)worsenatnight, erorwhenlyingdowndifficulttoidentifytheoffendingtooth(referredpainiscommon) Probing探诊:severepainDiagnosisofacutepulpitisFracturedtoothMissingrestorationDeepperiodontalpocketHyperocclusion(咬合)ThermaltestPainfulresponsethatlingersafterthestimulusisThermal温度测试PulpvitalityChronic慢性牙髓炎ChronicpulpitiswithaclosedpulpChroniculceredpulpitisChronichyperplasticpulpitis(PulpClinicalcharacteristicsofchronicPaincanbeAprevioushistoryofspontaneouspaininthesamelocation(moderatetoAlargecariouslesion,afracturedtoothormissingrestoration,deepperiodontalpocketPulpvitalitytests牙髓测试noresponseordelayedresponsePercussion叩诊notendernesstopercussionRadiograph:Thickenedperiodontalligament残髓Treatedtoothwithmissedc andresidualpulpTendertoverticalpercussionThermaltests:delayedRadiograph:“thickened”periodontalligamentspaceDiagnosis:painfulwhenscoutingthec withafileRetrograde逆行性牙髓炎LonghistoryofNotoothdecayorotherdetectabletoothdefectClinicalfeaturesofpulpitisClinicalfeaturesofDeepperiodontalpocketLossofattaTendertolateralRadiograph:verticalorhorizontalboneloss,radiolucencyaroundtherootandPulp牙髓坏死MaybepulpalinoriginAsymptomatic无自觉症状Coronaldiscoloration牙冠变色Pulpvitalitytests:noresponseTendertoverticalpercussionIntra-oralorextra-oralsinusmaybepresentnoperiapicalradiolucencyPulp牙髓钙化Manifestedaspulpstonesdenticles髓石ordiffusecalcifications弥漫性钙化RadiographprovidesimportantdiagnosticTraumahistoryorprevioustreatmentwithcalciumAcuteapical急性根尖MildtosevereinflammationorcloselyassociatedwiththeapexofatoothComplications:osteomyelitis骨髓炎cellulitisAcuteperiapical急性根尖周脓肿SwellingpresentRaisedtemperatureandTendertobothpalpationandIfanacuteexacerbationofachronicsituation,thereisawell-definedradiolucentarea,otherwisewideningofperiodontalligamentDiagnosisofacuteapicalConstantthrobbingpainonbiting咬合痛，跳Severetendernesstopercussionand叩诊与扪诊疼痛RegionallymphadenitisandfevermaybepresentPulpvitalitytests:noresponsePasthistoryofpulpitis,traumaorendodonticChronicapical慢性根尖Resultedfromprolongedinflammationthathasinvolvedcorticalplatemakingtheperiapicallesionvisibleon Periapicalgranuloma根尖周肉芽肿Periapicalabscess根尖周脓肿Periapicalcystradicularcyst)根尖周囊Periradicularcondensingosteoitis根尖周致密性骨炎ClinicalcharacteristicsofTeethfeel“differentor“hollow”onpercussionPresenceofsinustract瘘管orswellingPresenceofaperiapicalradiolucencyPulpvitalitytestsconfirmpulpnecrosisPeriradicularcondensingosteoitis根尖周致密性骨炎慢性根尖周脓肿Aswellingwithintra-oralorextra-oralsinuswithpusdrainageToothistendertopercussionPeriodontalpocketwithpusdischargeTreatment:RCTorextractionTreatmentPulpalandPeriapicalDiseasesEmergencytreatmentVitalpulpRootctherapyEmergency应急处理Accesstopulpchamberanddrainage(drainagethroughtherootc)开髓Drainagebyincisingafluctuantswelling(IncisionanddrainageI&D)切开排脓Occlusalreduction降低咬合Antibiotictherapy消OralgesicsVitalPulp活髓治疗Indirectpulpcap间接盖髓Directpulpcap直接盖髓Pulpotomy活髓切断术IndirectpulpDeepcariousNohistoryofpulpalNosignsofirreversibleNopulpexposureafterexcavationofcariousdentineNoperiapicalchangesonradiographRemoveallsoftened,mushyorleatheryCa(OH)2placedontheremainingdentintokillorsuppressbacteriaTemporaryorpermanentDirectpulpAccidentalormechanicalpulpexposure(normalpulp)preparationPlacementofpinsMainlyforimmaturepermanentteethwithrecent(<24hr)traumaticpulpexposureormechanicalexposureduringpreparationPulpCapMaterialsCalciumhydroxide氢氧化钙Themostcommonly-usedpulp-capmaterialWater-basedcalciumhydroxidee.g.Dycal,ImmaturepermanentteethwithpulpexposurebycariesRemovalofallcariousdentinandpulptissuetotheleveloftheradicularpulpVitalpulpstumpcappedwithCa(OH)2Symptomatic:endodontictreatmentRoot 根管治疗术RootCTreatment/Therapy(RCT)isneededwhenthepulpisinfectedasaresultoftoothdecayorinjury

RemoveallinfectionfromtherootcShapeandcleanthecObturatetherootctopreventanyfurtherinfectionCoronalrestorationRootcpreparation根管预备Intracmedicaments根管Rootcobturation根管充填Coronalrestoration牙体修复RootcpreparationAccesspreparation开Cnegotiation定位和疏通根管Determineworkinglength测量工作长度Shapeandcleantherootc根管清理成形AccesspreparationAdministrationoflocalanesthesiaifrequiredToothisolationrubberdam,cottonrolls,salivaAccesspreparationAccessPreparationswith