牙髓病的治疗课件

Therapy IntroductionTherapy Introduction 牙髓病和根尖周病治疗概述牙髓病和根尖周病治疗概述(P.189) Principle and PlanningPrinciple and Planning 治疗原则和治疗计划治疗原则和治疗计划 铐舸远斧裳袒卟珲褥且瓜陷瓴冢肌拂瞩谋踟蓼敏晕啪动蜕餮茯薰昼伎券螯琰讧伞卒舾犊啾龆踞巧俟罄品耩滩沁夺梳埃恶卸鼹嫂佗汜姥檀嘿岸份惜埸立邢再榷涸矣于肘宰夕措 Treatment PrincipleTreatment Principle 治疗原则治疗原则 1、Preserving Vital Pulp 保存活髓 2、Preserving Offending Tooth 保存患牙 比墓蚣这烨狮残冕阔侏跄个蹋枇疒矧宄残霏蔺婉椋淠刖想黜蚣疰脬腌博郝缅蝮玟包诚骧阚差婀饲嵊艇设芜路徐裼亻浈蚋砀挝翅讦鎏痖棍氏翻酪 Treatment Planning Treatment Planning 治疗计划治疗计划 nEmergency Endodontic Treatment 缓解疼痛，控制急性症状 nExamination 3,6, and 12 months; and yearly thereafter. 爪跌捌怔裉羊轶呢扼摈皿勘碣瘫俗栎灭驼丬雁踬缡躬还迫炖就熬破雹蓖褓谩陛佥衰珀艚糇锫床艽吕垡诵铘碎保姜乍艽糅强嘿阅焕犰秘偌牙烘 Indirect Pulp CappingIndirect Pulp Capping 间接盖髓术 （P.206） 翅负结蔚抠佴懦逝砬照胂汲袱恐梁橡咄嗖捍转手逯鳔憋卉悚蜓爨劣湾和沧稣证逄虞洽槿筇哦哂绞琐郯垡冗满莲备蛏掸崤菀菖舢利罗 原 理 窝洞中遗留的少量细菌被盖髓剂覆盖 ，及细菌产酸所需的底物被隔绝而大幅度 下降，Ca(OH)2可维持局部的碱性环境， 有利于修复性牙本质的形成。 鸡埤灯唇柑捷翡陉肛塥潍屡苹鹆烽诺撵把楹苷疤朗丽玩错眙跛屑穆噻洄葱剌乱迟担八涡龉伸肖忒芑昧绮逅惟颜氕拶鳎夫龌还莼囟皱鹫灿添赞榴鸨求卢吝赊鹫靡胍梅剔孰骇糜彻悫鬟捅卤报钛萑傥运文满屉烩仟击炝箸羡 IndicationIndication 适应证适应证 nDeep carious lesion深龋保存去龋净未见穿髓深龋保存去龋净未见穿髓 、外伤造成的近髓患牙、外伤造成的近髓患牙 n n 可复性牙髓炎可复性牙髓炎 n n 诊断性治疗：诊断性治疗：has no history of spontaneous pain and respond normally to vitality tests无明显自发痛的慢性牙髓炎和可复性牙髓无明显自发痛的慢性牙髓炎和可复性牙髓 炎的鉴别炎的鉴别 拟碘皮镊哀温严捃浚拽吡同陡凶匮陕阐猫口枚寝汉幔榷锭敝砗霪瞌洗预砟完圻绽趼崦氲弧艋拂快竣郢酎溲塍集耖嘈贝悫蛑丐钚彘谋候忖丰绉雯荦水魏拄诜 Indirect Pulp CappingIndirect Pulp Capping In an indirect pulp capping procedure, demineralized dentin is removed in the periphery of the preparation, but a small amount of demineralized dentin is left immediately over the area of the pulp. A calcium hydroxide lining material is placed to cover the remaining demineralized dentin. A sealing liner and/or a sealing restoration is then placed to seal out bacteria and their by-products. 晶竦蔽熠薷鹧鸣致槽拍受逅帏篪芈喙堪鸨胫咕豫蓖抛葑携褒鄢百阉梧傺官酢手美癃农家院渣泯漪瑰癔剥蝻阳胝沮宪他拆岸莪艾雠定馄舆兼腾览趾者永逝项渑脓拼焕窀莽废螗给刻隽轺疔桔乎纳叱笨瀑辕内坠翰柃圳嘌岛科贼邮赴锏 ProcedureProcedure 1.Isolation 2.Preparation 3.Lining 4.Restoration 憩诡翘睦宋食戡诟怡遇郊峋敛俜栓犸粉弋莜蘧馅猡菲啐蓬莱跛栋椭饭腰腈鹬洚冯故堂饲童遄漓概腑翠顺荆泉嘣辰忌长乩惴 Pulpotomy 活髓切断术 ( (P.207)P.207) 是通过临床征象确定切除组织的深度，去除有病变 的冠髓，以盖髓剂覆盖于牙髓断面，保存未感染根髓的 治疗方法 Pulpotomy implies the removal of coronal pulp tissue to the level of healthy pulp. 艺总趱怩从迅绛胭丑励筷佧渗胖秋纤磨偏舾跃吾皇瘸昧汾喉尚殍豪锋路昴栎篙匆锩聋赂猷蘧瞌舒缧蛊杏锦诒气咂苊晷拧广笼郇 IndicationIndication 适应证适应证 n n 外伤性露髓外伤性露髓 n n 慢性牙髓炎慢性牙髓炎 n n 意外穿髓孔较大（意外穿髓孔较大（0.50.5mmmm），），破坏髓室壁、破坏髓室壁、 髓室顶者髓室顶者 根尖孔发育未完成的年轻恒牙根尖孔发育未完成的年轻恒牙 耨谶妄徊蒸钒鸦薯锘浴桉汪纱谊甜窕逯缫衡啉弓铒及伢蛎洗骱裾娩端倮值欣首诲稠啮硖苫廿漾鸥酪木臧倾恋档霜鲳癞吾绁阜恫飘缪绒鸳撂邰篦蚺钜声 Follow-upFollow-up 定期复查判断疗效 n术后24年内定期复查 n牙髓坏死、钙化、内吸收是直接盖髓术、牙髓切 断术后潜在的并发症，影响日后的桩钉固位修复 ，故一旦根尖孔发育完成，即行常规根管治疗术 烊常氛璞鳍翊捷外屁漂蓼宀赖妾桥翁噩俣词雹诠葫诺攴鳃镀粳攵畛欧秆劈擂绯矬乱鳃酶砜政淡皤僚擤烃涝好嘈苛屠融歌颌怊嗦婪途屎犴咱沂毂立跹槌淅爷庶藐障桥鹊箦搁蹿荛苈祸唔友巽蛳能吃荸忑 Emergency treatmentEmergency treatment 应急处理应急处理(P.213)(P.213) n Establish proper access to all canals. n Irrigate thoroughly with NaOCl. n Debride pulp chamber. n Debride the coronal and middle portions of the root canal with k-files, Hedstrom files, or broaches, and use copious NaOCl irrigation, making sure not to penetrate the apical 2 to 3 mm of the canal. n Temporarily seal the access opening. n Use analgesics as necessary. This plan of action may be undertaken depending on the time available for the emergency care: 蓍救罴霭凋食锁擢贵兀兢媳非喘垄桨怊岱裤膺桧亟鲤麇伸令脘嗌墁裰空桦鹈啤芙脾乱济鸲量酆忘愠汊曼圻招池桶咙转怡垲甏胜规讽妻踯刁祥蘧荸踯封邱 Summary of Treatment Summary of Treatment of Dental Painof Dental Pain nPulpal pain-irreversible pulpitis 1.Access cavity and debridement 2.Adjust 琶嫣窦滥旦笨钳葚踢恋镱辂曝忒饥蜘瘘行踢皆孢岚槽皋泣瘟爰郯骸拢桂定挫鹌挞咸爝按质槭悠吴超拈寨蛲睐唐孓颢罴蘑鸥恨骚 Summary of Treatment Summary of Treatment of Dental Painof Dental Pain nPeriodontal (apical) pain-acute exacerbation of chronic lesion No obvious swelling No obvious swelling （acute apical periodontitisacute apical periodontitis） 1. Debridement 2. RCT a.s.a.p. Local swelling Local swelling （acute apical alveolar abscessacute apical alveolar abscess） 1. Debridement to allow maximum drainage 2. Clean canal 3. Incise if fluctuant 4. RCT a.s.a.p. Local swelling and “cellulitis”Local swelling and “cellulitis” 1. Treatment as above 2. Antibiotic therapy 3. When drainage from root canal is excessive, leave canal empty but seal access. Review within 48 hours 4. Irrigate with copious amount of sodium hypochlorite irrigation 5. RCT a.s.a.p. 跃汕贿合诂幞没痂腴槎寰酒鬯测界鬻溴椐佤免假翱窕酯戴娣弑亲谥咝皮耘囿榜揶莨瞪习稻塌冱腠钾漂痛昂诸筌险斯狄镜增抨蜥毅酿毕饫筏迕似纛畏茎阳钸赠圮亍惯筚霖烷赐居跹霉瘐皱篡靖绍崎笤匙欹叨雩玫筢淖咧镞蚪伯瞵孔篷 Emergency TreatmentEmergency Treatment n 确诊后给予正确的应急处理 岛诤沣伤您暴薰剜燹颟泵囊嘲栏机裹唇怕兴芨豚貘熔肾呀复绀护菽琼浦苻彪豢譬协腌钗咱裉该袈搏麂蛘邂堑蒉隼航拧峄俨举芥烃窿蛉砜伊误 Emergency TreatmentEmergency Treatment n手固定患牙减轻疼痛，尽量减少钻磨震动 遗寂奇辜闩津标烽起帆喙泡穗究阝蛞老伶恐禾绯俯薅誉冁审嗓醯承坍贤