【口腔医学】牙折的病因及治疗方法ppt课件

1、外力直接撞击外力直接撞击,咀嚼咬到沙石、咀嚼咬到沙石、碎骨等硬物。碎骨等硬物。be impacted by force,biting hard food. EtiologyEtiologyClinic characteristicsClinic characteristics按部位分:冠折 Crown fracture根折Root fracture冠根结合折 Crown-root fracture按损伤和牙髓关系分:露髓不露髓前牙前牙 : 横折、斜折横折、斜折Anterior tooth: horizontal or inclined后牙后牙 : 斜折、纵折斜折、纵折Posterior tee

2、th:inclined or vertical颈颈 1/3、根中、根中 1/3、根尖、根尖 1/3cervix-thirds,middle-thirds,apical-thirds根折可有牙齿松动、叩痛、龈沟根折可有牙齿松动、叩痛、龈沟出血、粘膜触痛等。出血、粘膜触痛等。有的早期无明显病症，数日后出现。有的早期无明显病症，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根据片是诊断根折的重要根据Diagnosis can be carried out by radiographic examination以斜行多见，牙髓常暴

3、露。以斜行多见，牙髓常暴露。The fracture will often be inclined with pulp exposure缺损少牙本质未暴露，磨光锐边。缺损少牙本质未暴露，磨光锐边。Without dentin exposure,selective grinding of the incisal edge is sufficient.牙本质暴露敏感者，盖髓树脂修复。牙本质暴露敏感者，盖髓树脂修复。Cover with Ca(OH)2 and composite resin restoration if dentin is expose and sensitive牙髓暴露，牙根发育

4、完成者行活髓摘除术，牙根发育未完成者行活髓切断术。In case of a pulp exposure,pulpectomy is indicated if the root apical is developed,pulpotomy is sufficient if the root apical is developing. 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。Reposition the coronal fragment and use splinting for 3 months在治疗后1、3

5、、6、12个月定期复查牙髓的活力情况，一旦发现牙髓有炎症或坏死趋势，那么应作根管治疗术。Check for pulpal complications after 1 month,3 months,6 months and 12 months.If pulp necrosis occurs,root canal therapy should be done.颈颈1/31/3折断：均先行根管治疗折断：均先行根管治疗断端在龈上，根管治疗后桩核冠修复断端在龈上，根管治疗后桩核冠修复Cervix-thirds fracture:root canal therapy should be doneIf fr

6、acture surface above gingival level,a post-retained full crown is fabricated after RCT.断端在龈下牙槽骨上，龈切暴断端在龈下牙槽骨上，龈切暴露断面桩核冠修复。露断面桩核冠修复。Fracture surface between gingival and alveolar:a post-retained crown is fabricated after gingivectomy expose the fracture surface.断端在牙槽骨下断端在牙槽骨下4mm，牙根较长，牙根较长，可手术或正畸方法牵引后

7、，桩核冠修可手术或正畸方法牵引后，桩核冠修复。复。If fracture surface is 4mm below the alveolar and the root length is enough ,surgical or orthodontic extrusion of the root ,to move the fracture surface to amore optimal location for final restoration树脂夹板固定树脂夹板固定Composite resin splint根折的转归钙化性愈合结缔组织性愈合骨、结缔组织结合愈合断端被慢性炎症组织分开Con

8、nective tissue healingThe fragment is separated by chronic inflammation tissue Calcified healingHard-connective tissue union healingHealing of root fracture可作根管治疗，具备桩核冠修复可作根管治疗，具备桩核冠修复的冠根结合折，应保管。的冠根结合折，应保管。The tooth with crown-root fracture which can be restored by a post retained full crown should

9、be saved to receive RCT 发生在牙根的纵裂,未涉及牙冠者。Vertical root fracture, not involving the crown.慢性继续性的创伤合力牙根发育缺陷无髓牙EtiologyEtiologyChronic durative traumatic occlusal force Defect of root developmentPulpless tooth无髓牙Pulpless tooth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X线检查对诊断牙根纵裂有重要意义Diagnosis can b

10、e carried out by radiographic examinationClinic characteristics 松动明显，牙周破坏严重或单根牙的牙根纵裂，均应拔除。The tooth should be extracted if it is very loose or of severe periodontal lesion or vertical root fracture in single rooted tooth. 牙周病损局限且牙稳定的磨牙，可在根管治疗后行牙半切术或截根术。Tooth hemiresection or root resection is perfor

11、med after RCT if the molar is steady and of limited periodontal lesion.牙半切术tooth hemiresection截根术root resection慢性损伤慢性损伤磨损磨损楔状缺损楔状缺损磨牙症磨牙症牙隐裂牙隐裂酸蚀症酸蚀症楔状缺损是牙齿唇、颊颈部硬组织缓慢楔状缺损是牙齿唇、颊颈部硬组织缓慢磨耗所致，因该缺损常呈楔状而得名。磨耗所致，因该缺损常呈楔状而得名。Wedge-shaped defect is caused by tardy abrasion of buccal cervix hard tissues.刷牙不当刷

12、牙不当牙颈部构造牙颈部构造Structure of tooth cervixImproper teeth brushingEtiologyEtiology酸作用酸作用牙体组织疲劳牙体组织疲劳Acid erosionWeariness of hard tissues由由23个平面组成，巩固光滑，为牙本性。个平面组成，巩固光滑，为牙本性。Usually have 2 or 3 surfaces,hard and smooth,tooth-like color。 Clinic characteristicsClinic characteristics根据缺损程度分浅型、深型和穿髓根据缺损程度分浅型、

13、深型和穿髓3型型前磨牙好发，常左右对称，有牙龈退缩前磨牙好发，常左右对称，有牙龈退缩随年龄增长，楔状缺损有添加趋势随年龄增长，楔状缺损有添加趋势Be classified with shallow,deep and pulp exposure according to the depth of the lesionMost commonly occur on the buccal surface of bicuspids symmetrically and accompany with gingival recessionThe sizes of abrasions increase with

14、 age 矫正刷牙方法矫正刷牙方法牙体缺损少无牙本质过敏，不需处牙体缺损少无牙本质过敏，不需处置。置。Correct tooth brushingTreatment and preventionTreatment and preventionCareful observation if there is no tooth sensitivity and the lesions are small有牙本质过敏，可用药物、激光等脱敏。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。牙体缺损多，可充填修复。Fillings if the lesions are extensionDese

15、nsitization with medicine or laser if there is dentin hypersensitive 牙髓感染或根尖病变时，作髓牙髓感染或根尖病变时，作髓病或根管治疗。病或根管治疗。缺损导致牙齿横折时，根据情缺损导致牙齿横折时，根据情况作根管治疗或拔除。况作根管治疗或拔除。Root canal therapy is performed if there is pulpitis or periapical periodontitis.Root canal therapy or extraction are performed if tooth fracture

16、 is occurred.又称不全牙裂或牙微裂，指牙冠又称不全牙裂或牙微裂，指牙冠外表非生理性细小裂纹。外表非生理性细小裂纹。Fine non-physiological crack on the surface of the crown牙齿构造薄弱环节牙齿构造薄弱环节牙尖斜度大牙尖斜度大创伤合力创伤合力Weak tache of tooth structureBig cuspid pitchTraumatic occlusal forceEtiologyEtiology隐裂牙发生于上颌磨牙最多，其次是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。下颌磨牙，第一磨牙多于第二磨

17、牙。Clinic characteristicsClinic characteristicsMost commonly occur on maxillary molar, and secondly on mandibular molar.The crack occurs on first molar is more than that on second molar. 隐裂线隐裂线上颌上颌下颌下颌mandibularmaxillarCracked line表浅者无病症，较深时，遇冷热表浅者无病症，较深时，遇冷热刺激敏感或咬合不适。刺激敏感或咬合不适。深隐裂有牙髓炎病症和定点咀嚼痛。深隐裂有牙髓

18、炎病症和定点咀嚼痛。隐裂线隐裂线碘酊等可渗入隐裂处碘酊等可渗入隐裂处探针撬动隐裂处有疼探针撬动隐裂处有疼痛感，棉签置可疑牙痛感，棉签置可疑牙尖上咬合，有撕裂样尖上咬合，有撕裂样疼痛。疼痛。调合调合113平衡合力平衡合力处置隐裂牙处置隐裂牙TreatmentTreatmentOcclusal adjustmentBalance occlusal forceTreat the cracked tooth牙本质过敏症牙本质过敏症dentine hypersensitivity又称过敏性牙本质又称过敏性牙本质hypersensitive dentine，是牙齿遭到外界刺激，引起，是牙齿遭到外界刺激，引

19、起的酸痛病症。的酸痛病症。不是一种独立疾病，是各种牙病共有病症。不是一种独立疾病，是各种牙病共有病症。115使牙本质暴露的各种缘由使牙本质暴露的各种缘由与牙本质暴露的时间、修复性牙本与牙本质暴露的时间、修复性牙本质构成快慢有关。质构成快慢有关。不是一切牙本质暴露的牙齿都有病不是一切牙本质暴露的牙齿都有病症症牙本质暴露还不能解释一切临床表牙本质暴露还不能解释一切临床表现现EtiologyEtiology1.神经学说：牙本质中存在牙髓神经末梢，觉得神经学说：牙本质中存在牙髓神经末梢，觉得可由牙本质表层传导入牙髓可由牙本质表层传导入牙髓前期牙本质前期牙本质管间牙本质管间牙本质管周牙本质管周牙本质2.

20、牙本质纤维传导学说：成牙本质细胞原浆突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中含有乙酰胆碱酶，它在受刺激后引起神经传导，产生疼痛导，产生疼痛3.流体动力学：外界刺激使牙本质小管内液体挪动流体动力学：外界刺激使牙本质小管内液体挪动搅动了牙髓内容物，间接兴奋游离神经末稍，传入搅动了牙髓内容物，间接兴奋游离神经末稍，传入激动产生痛觉激动产生痛觉温度实验温度实验探诊探诊Clinic characteristics and diagnosisClinic characteristics and diagnosisExplorationTemperature tes

21、t石川修三的评定规范石川修三的评定规范0 0度：冷刺激和机械刺激无疼痛度：冷刺激和机械刺激无疼痛1 1度：可诱发疼痛，但疼痛较细微度：可诱发疼痛，但疼痛较细微2 2度：可诱发可以忍受的疼痛度：可诱发可以忍受的疼痛3 3度：可诱发难以忍受的疼痛度：可诱发难以忍受的疼痛客观评价客观评价Subjective evaluation疼痛疼痛3级评判法级评判法数字化疼痛评判法数字化疼痛评判法Verbal rating scale,VRSVisual analogue scale,VAS治疗治疗封锁牙本质小管，减少或防止封锁牙本质小管，减少或防止牙本质内液体流动。牙本质内液体流动。TreatmentTreatmentSeal the dentinal tubule to decrease or avoid the flowing of the liquid inside dentin 氟化氟化物物氯化氯化锶锶氟化氨银氟化氨银碘化碘化银银其他药物其他药物药物治疗药物治疗medicationmedication树脂类脱敏剂树脂类脱敏剂激光治疗激光治疗修复治疗修复治疗LaserRestoration由于单纯机械摩擦作用而呵斥的牙体硬组织慢性磨耗称为磨损。Clinic characteristicsClinic characteristics咀嚼磨损非咀嚼磨