啊大五上-復(fù)習(xí)口腔總結(jié)1.pulpal and periapical diseases

AssociateProf.Xi

PulpalandPeriapical牙髓病和根OperativeDentistryandEndodonticsGuanghuaSchoolofStomatologySunYa PulpalandPeriapical牙髓病和根尖EtiologicalMicrobialirritants 細(xì)菌因素Physicalirritants 機(jī)械因素Chemicalirritants 化學(xué)因素MicrobialDentalMicroorganismsincMainsourcesofmicrobialirritantsofdentalpulpandperiradiculartissues細(xì)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氣壓改變HeatfromorcrownpreparationateitherloworhighspeedExothermicheatfromthesettingofConductionofheatandcoldthroughdeepfillingswithoutaprotectivebaseFrictionalheatcausedbypolishingGalvaniccurrentfromdissimilarmetalImpactinjury外傷DisturbanceofthebloodandnervesupplyofpulptissueExposureofpulptissueOperativeorcrownpreparations牙體預(yù)備PulpdamageisroughlyproportionaltotheamountanddepthoftoothstructureremovedWatercoolantisimportantforprotectionPinsformechanicalretentionDehydrationwithcontinuousairstreamEndodonticprocedures根管過(guò)度預(yù)備和超充填I(lǐng)rrigationbeyondtheapexOver-extensionoffillingmaterialsMechanicalinsulttoperiapicaltissuePeriodontaltreatmentDeepscalingandcurettage不適當(dāng)?shù)难乐苤委烮njuryofapicalvesselsandnervesPulpaldamageOrthodonticForcesbeyondthephysiologicaltoleranceoftheperiodontalligament不適當(dāng)?shù)恼委烡isturbingofthebloodandnervesupplyofpulptissueResorptionofrootapexPulpalChemicalChemicalirritantsofpulpalChemicalspresentinAcidetching (phosphoricacid,acidicmonomer) liners bases TemporaryandpermanentfillingChemicalirritantsofperiapicaltissuesExtrusionofdebrisduringcleaningandshaIrrigatingsolutionsincleaningandsha medicamentsinc Fillingmaterialsinc 根管藥物Reversiblepulpitis可復(fù)性牙髓炎Irreversiblepulpitis不可復(fù)性牙髓炎Pulpnecrosis牙髓壞死PulpcalcificationAcuteapicalperiodontitis急性根尖Chronicapicalperiodontitis慢性根尖ReversiblePulpitis可復(fù)性牙髓炎Notadisease,itisaAmomentary,painfulresponsetothermalchangethatsubsidesassoonasthestimulusisNospontaneous(unprovoked)painorpainatNotendernesstopercussionor Maybecausedbydeepcaries,periodontalscaling,periodontaldiseases,microleakage,unbasedrestorationsIrreversible不可復(fù)性牙髓炎Acutepulpitis急性牙髓炎Chronicpulpitis慢性牙髓炎R(shí)esidualpulpitis殘髓炎R(shí)etrogradepulpitis逆行性牙髓炎Acute急性牙髓炎Aninflammationofthepulpcausedbyinjurytothepulp,usuallyfromdentalcariesorThemostfrequentcauseofseveretoothThepainiscausedbythepressureoffluidsbuildingupinsidethepulpchamberorrootClinicalcharacteristicsofacutepulpitisIntensepain劇烈疼痛spontaneous,continuousorintermittentthermalstimulusworsenthepainandlingersafterremovalofstimulus(relievedbycoldatlaterstage)worsenatnight, erorwhenlyingdowndifficulttoidentifytheoffendingtooth(referredpainiscommon) Probing探診:severepainDiagnosisofacutepulpitisFracturedtoothMissingrestorationDeepperiodontalpocketHyperocclusion(咬合)ThermaltestPainfulresponsethatlingersafterthestimulusisThermal溫度測(cè)試PulpvitalityChronic慢性牙髓炎ChronicpulpitiswithaclosedpulpChroniculceredpulpitisChronichyperplasticpulpitis(PulpClinicalcharacteristicsofchronicPaincanbeAprevioushistoryofspontaneouspaininthesamelocation(moderatetoAlargecariouslesion,afracturedtoothormissingrestoration,deepperiodontalpocketPulpvitalitytests牙髓測(cè)試noresponseordelayedresponsePercussion叩診notendernesstopercussionRadiograph:Thickenedperiodontalligament殘髓Treatedtoothwithmissedc andresidualpulpTendertoverticalpercussionThermaltests:delayedRadiograph:“thickened”periodontalligamentspaceDiagnosis:painfulwhenscoutingthec withafileRetrograde逆行性牙髓炎LonghistoryofNotoothdecayorotherdetectabletoothdefectClinicalfeaturesofpulpitisClinicalfeaturesofDeepperiodontalpocketLossofattaTendertolateralRadiograph:verticalorhorizontalboneloss,radiolucencyaroundtherootandPulp牙髓壞死MaybepulpalinoriginAsymptomatic無(wú)自覺(jué)癥狀Coronaldiscoloration牙冠變色Pulpvitalitytests:noresponseTendertoverticalpercussionIntra-oralorextra-oralsinusmaybepresentnoperiapicalradiolucencyPulp牙髓鈣化Manifestedaspulpstonesdenticles髓石ordiffusecalcifications彌漫性鈣化RadiographprovidesimportantdiagnosticTraumahistoryorprevioustreatmentwithcalciumAcuteapical急性根尖MildtosevereinflammationorcloselyassociatedwiththeapexofatoothComplications:osteomyelitis骨髓炎cellulitisAcuteperiapical急性根尖周膿腫SwellingpresentRaisedtemperatureandTendertobothpalpationandIfanacuteexacerbationofachronicsituation,thereisawell-definedradiolucentarea,otherwisewideningofperiodontalligamentDiagnosisofacuteapicalConstantthrobbingpainonbiting咬合痛，跳Severetendernesstopercussionand叩診與捫診疼痛RegionallymphadenitisandfevermaybepresentPulpvitalitytests:noresponsePasthistoryofpulpitis,traumaorendodonticChronicapical慢性根尖Resultedfromprolongedinflammationthathasinvolvedcorticalplatemakingtheperiapicallesionvisibleon Periapicalgranuloma根尖周肉芽腫Periapicalabscess根尖周膿腫Periapicalcystradicularcyst)根尖周囊Periradicularcondensingosteoitis根尖周致密性骨炎ClinicalcharacteristicsofTeethfeel“differentor“hollow”onpercussionPresenceofsinustract瘺管orswellingPresenceofaperiapicalradiolucencyPulpvitalitytestsconfirmpulpnecrosisPeriradicularcondensingosteoitis根尖周致密性骨炎慢性根尖周膿腫Aswellingwithintra-oralorextra-oralsinuswithpusdrainageToothistendertopercussionPeriodontalpocketwithpusdischargeTreatment:RCTorextractionTreatmentPulpalandPeriapicalDiseasesEmergencytreatmentVitalpulpRootctherapyEmergency應(yīng)急處理Accesstopulpchamberanddrainage(drainagethroughtherootc)開(kāi)髓Drainagebyincisingafluctuantswelling(IncisionanddrainageI&D)切開(kāi)排膿Occlusalreduction降低咬合Antibiotictherapy消OralgesicsVitalPulp活髓治療Indirectpulpcap間接蓋髓Directpulpcap直接蓋髓Pulpotomy活髓切斷術(shù)IndirectpulpDeepcariousNohistoryofpulpalNosignsofirreversibleNopulpexposureafterexcavationofcariousdentineNoperiapicalchangesonradiographRemoveallsoftened,mushyorleatheryCa(OH)2placedontheremainingdentintokillorsuppressbacteriaTemporaryorpermanentDirectpulpAccidentalormechanicalpulpexposure(normalpulp)preparationPlacementofpinsMainlyforimmaturepermanentteethwithrecent(<24hr)traumaticpulpexposureormechanicalexposureduringpreparationPulpCapMaterialsCalciumhydroxide氫氧化鈣Themostcommonly-usedpulp-capmaterialWater-basedcalciumhydroxidee.g.Dycal,ImmaturepermanentteethwithpulpexposurebycariesRemovalofallcariousdentinandpulptissuetotheleveloftheradicularpulpVitalpulpstumpcappedwithCa(OH)2Symptomatic:endodontictreatmentRoot 根管治療術(shù)RootCTreatment/Therapy(RCT)isneededwhenthepulpisinfectedasaresultoftoothdecayorinjury

RemoveallinfectionfromtherootcShapeandcleanthecObturatetherootctopreventanyfurtherinfectionCoronalrestorationRootcpreparation根管預(yù)備Intracmedicaments根管Rootcobturation根管充填Coronalrestoration牙體修復(fù)RootcpreparationAccesspreparation開(kāi)Cnegotiation定位和疏通根管Determineworkinglength測(cè)量工作長(zhǎng)度Shapeandcleantherootc根管清理成形AccesspreparationAdministrationoflocalanesthesiaifrequiredToothisolationrubberdam,cottonrolls,salivaAccesspreparationAccessPreparationswith