上交大牙体牙髓病学教案06牙发育异常和牙震荡、牙脱位

PAGEPAGE5上海交通大学口腔医学院教案课程名称牙体牙髓病学第6、7次课2007年教师姓名孙喆职称副教授教研室口腔内科教学时数3授课题目牙发育异常和牙震荡、牙脱位教学对象口腔04级七年制授课地点教室教学方式大课本课的重点、难点：本课的重点难点及对策重点：氟牙症、四环素牙、畸形中央尖的病因、症状、诊断和防治难点：釉质发育不全的发病机理，氟牙症的治疗，畸形中央尖的临床表现及治疗，牙震荡和牙脱位的临床表现及治疗对策：用多媒体图片显示釉质发育不全的发病机理简图，配合各疾病的典型病例的临床表现和治疗方法，加以详细讲解。本次课应用的教具：本次课应用的教材教具参考书教材:《牙体牙髓病学》（第二版）樊明文主编人民卫生出版社2000年教具：电脑、多媒体投影仪、电子教棒。参考书：《口腔科手册》(第二版)刘正主编上海科学技术出版社1997年《BLEACHINGTECHNIQUESINRESTORATIVEDENTISTRY》EditedbyLindaGreenwallMartinDunitzLtd,amemberoftheTaylor＆Francisgroup

主要教学内容：（可另附页）主要教学内容及时间安排介绍牙齿发育异常及部分牙外伤的内容：釉质发育不全、氟牙症、畸形中央尖、牙震荡、牙脱位（introducethesummaryofdisordersofdevelopmentandinjuryofteeth,includingenamelhypoplasia,dentalfluorosis,abnormalcentralcusp,concussionanddislocationoftheteeth）（2分钟）介绍牙齿发育异常的内容：结构、形态、数目和萌出异常，结合钟状期造釉器图，复习牙釉质、牙本质的发育过程(introducethesummaryofdisordersofdevelopmentofteeth,includinghistodifferentiation,morphodifferentiation,disturbanceinnumberandgermination,andreviewtheformationofenamelanddentinewiththefigureofenamelorganinbellstage)（3分钟）釉质发育不全(enamelhypoplasia)病因(aetiology)：营养障碍，内分泌失调，婴儿、母体疾病，局部因素。(nutritiondeficiency,incretiondisorder,infant&maternaldiseaseandlocalagent)临床表现(clinicalfeature)：轻症、重症，发病时间和临床表现的关系。(Mildandseveretype,indicatingtherelationshipbetweentheaffecttimeandclinicalfeature)防治(preventionandcure)：无法预防(impossibletoprevent)；复合树脂修复(compositeresin)（10分钟）氟牙症(dentalfluorosis)病因(aetiology)：饮水含氟量过高，正常饮水含氟量为1ppm(ingestionexcessivefluorineindrinkingwater,and1partpermillionoffluorideinnormaldrinkingwater)。发病机理(mechanism):氟浓度增高，抑制碱性磷酸酶活力，造成釉质矿化不良，色素沉积。多媒体显示发病机理图。(Owingtoexcessivefluoride,inhibitionofalkalinephosphataseresultsinenamelhypormineralizationandpigmendeposition)临床表现(clinicalfeature)：轻、中、重(mild,middleandseveretype)。预防(prevention)：重选水源，去除水中过量氟(reselectwatersource,orgetridofexcessivefluoride)。治疗(therapy)：脱色法，复合树脂修复(discolorationorcompositeresin)(10分钟)四环素牙(tetracyclinestainedteeth)发病机理(mechanism)：牙齿发育矿化期服用大量四环素牙着色四环素牙，(多媒体显示发病机理图)。(duringtheformationoftheteeth,sufficienttetracyclineadministrateleadstoteethstainedandtetracyclinestainedteeth)临床表现(clinicalfeature)：颜色改变，病理磨片荧光染色。(colouralteration,andfluorescencestainingroundsection)预防(prevention)：孕妇和8岁以下儿童少用四环素(pregnantfemalesandchildrenunderageof8avoidtheusageoftetracycline)。处理(treatment)：内脱色，外脱色，树脂修复(intracoronalbleaching,bleachingandcompositeresin)(10分钟)乳光牙(hereditarydentinogenesisimperfecta)病因(aetiology)：常染色体显性遗传(autosomaldominantinheritance)。病理变化(pathology)：(1)杂乱牙本质充满牙髓腔，髓腔闭锁(pulpchamberfullofirregulardentine,andatresiaofpulpchamber)；(2)髓腔内为大量牙髓，髓腔增大(pulpchamberwithlargeamountofpulp,augmentationofpulpchamber)。临床特点(clinicalfeatures)：乳光微黄半透明色(translucent,opalescentamber-likeappearance)。治疗(therapy)：义齿修复(denturerestoration)(5分钟)先天性梅毒牙(congenitalsyphiliticteeth)病因(c)：牙胚发育期，梅毒侵害，成釉细胞受害，牙本质矿化障碍。(Duringteethformation,withspirochaeteinfection,ameloblastinjured,anddentinemineralizariondisturbanceoccurred)病理变化(pathology)：釉质明显减少和缺失，牙本质生长线明显。(Significantlylackorlossofenamel,dentineincrementallinesareeasytodetect)临床表现(clinicalfeatures)：半月形切牙，蕾状磨牙(Hutchinsonteeth,moonteeth)预防(prevention)：妊娠早期治疗梅毒(treatmentofsyphilisduringearlytrimesterofpregnancy)。（5分钟）畸形中央尖(abnormalcentralcusp)病因(aetiology)：牙齿发育期，牙乳头向造釉器突起。(duringteethformation,dentalpapillaprotrudeintoenamelorgan)临床表现和诊断(clinicalfeaturesanddiagnosis)：合面中央窝半圆形突起，可有牙髓伸入。(hemicycleprotuberanceincentralfossaofocclusalsurface,withofwithoutdentalpulp)治疗(therapy)：多次磨除脱敏，磨除后盖髓治疗，根尖成行术．(grind&desensitizationtimeaftertime,pulpcappingaftergrind,apexification)(20分钟)牙内陷(densinvaginatus)病因(aetiology)：牙发育期，造釉器过度增殖深入牙乳头中。(duringteethformation,over-proliferatedenamelorganprotrudeintodentalpapilla)临床表现和诊断(clinicalfeaturesanddiagnosis)：畸形舌侧窝，畸形根面沟、畸形舌侧尖，牙中牙。(lingualfossadeformity,lingualfurrowdeformity,lingualcuspdeformity,densindents)治疗(therapy)：充填，手术(filling,operation)(15分钟)牙震荡(concussionofteeth病因(aetiology)：较轻外力(minorimpact)临床表现(clinicalfeatures)：伸长不适感、轻微松动和叩痛，龈缘可有渗血。(senseofstretchanddiscomfort,slightmobility,tendertopercussionandmastication)治疗(therapy)：患牙休息、调合、固定。(occlusalrelief,fixation)（5分钟）牙脱位(dislocationofteeth)病因(aetiology)：撞击(violentimpact)。临床表现及诊断(clinicalfeaturesanddiagnosis)：(1)部分脱位(luxation&intrusion)：嵌入、伸长、唇舌向移位(intrusion,elongationandlabialorlingualdisplacement)。(2)完全脱位(dislocationofteeth)：牙槽窝空虚，牙齿脱落或少许软组织相连(emptyalveolarsocketwithoutteeth,orwithteethlinkedtoabitsofttissue)。各种并发症(complication)：牙髓坏死、髓腔变窄或消失、牙根外吸收、边缘性牙槽骨吸收。(pulpnecrosis,lossofpulpchamber,rootexternalabsorptionandalveolarprocessabsorption)治疗原则(therapeuticprinciple)——保存患牙(conservation)。(1)部分脱位(luxation&intrusion)：复位，结扎固定(relocation,deligationandfixation)。(2)完全脱位(dislocationofteeth)：牙齿重植——方法(replantation)。牙再植后愈合方式(healingmod)：牙周膜愈合，骨性粘连，炎性吸收(periodontalligamentrecover,dentalankylosisandinflamma