牙体牙髓学龋病的治疗课件

1、牙体牙髓学龋病的治疗1 郑沛牙体牙髓学龋病的治疗2operative dentistry is the art and science of the diagnosis, treatment, and prognosis of defects of teeth which do not require full coverage restorations for correction. 牙体牙髓学龋病的治疗3enamel牙体牙髓学龋病的治疗4 pulpodentinal complex牙体牙髓学龋病的治疗5 牙体牙髓学龋病的治疗6cementum牙体牙髓学龋病的治疗7periodontal 牙

2、体牙髓学龋病的治疗8牙体修复原则n去净龋坏牙体组织n保守治疗的原则n抗力形和固位形牙体牙髓学龋病的治疗9充填材料的选择n性能要求n 物理和机械，化学，生物学n选择要点n 牙齿部位，窝洞部位和咬合力，病人情况，其他因素牙体牙髓学龋病的治疗10牙体牙髓学龋病的治疗11 the mechanical alteration of a defective , injured, or diseased tooth in order to best receive a restorative material which will re-establish a healthy state for the t

3、ooth including esthetic corrections where indicated, along with normal form and function. 牙体牙髓学龋病的治疗12 ncavities may be classified according to the location where the carious lesion beginsnclass nclass nclass nclass nclass nclass g.v.black in 1908 牙体牙髓学龋病的治疗13 all pit and fissure cavities are class

4、i. ncavities on occlusal surface; ncavities on occlusal two-thirds of the facial and lingual surfaces of molars;ncavities on lingual surface of maxillary incisor.牙体牙髓学龋病的治疗14牙体牙髓学龋病的治疗15 a cavity occurring on the proximal surface of posterior teeth are class ii.nmo mesial and occlusal ndo distal and

5、 occlusal nmod mesial, occlusal and dista 牙体牙髓学龋病的治疗16牙体牙髓学龋病的治疗17牙体牙髓学龋病的治疗18ncavities on the proximal surfaces of anterior teeth that do not involve the incisal angles are class iii.牙体牙髓学龋病的治疗19牙体牙髓学龋病的治疗20ncavities on the proximal surfaces of anterior teeth that do involve the incisal angles are

6、class iv.牙体牙髓学龋病的治疗21牙体牙髓学龋病的治疗22ncavities on the gingival third of the facial or lingual surfaces of all teeth ( not pit and fissure cavities ) are class v.牙体牙髓学龋病的治疗23牙体牙髓学龋病的治疗24ncavities on the incisal edge of anterior teeth or the occlusal cusp heights of posterior teeth are class vi.牙体牙髓学龋病的治疗

7、25牙体牙髓学龋病的治疗26 simple cavity: only one tooth surface is involved. compound cavity: two surfaces are involved. complex cavity: three or more surfaces are involved. 牙体牙髓学龋病的治疗27牙体牙髓学龋病的治疗28 nwalls nangles ncavity 牙体牙髓学龋病的治疗29 internal walls: a prepared cavity surface that does not extend to the extern

8、al tooth surface. axial walls: an internal wall parallel with the long axis of the tooth and occlusal of the tooth. pulpal walls: an internal wall that is both perpendicular to the long axis of the tooth and occlusal of the pulp.a side or surface of the cavity preparation that aids in enclosing the

9、restorative material.牙体牙髓学龋病的治疗30 external walls: a prepared cavity surface that extend to the external tooth surface. the external walls takes the name ofthe tooth surface that the wall is toward. .牙体牙髓学龋病的治疗31牙体牙髓学龋病的治疗32 line angle: the junction of the two planal surfaces of different orientation

10、 along a line. 牙体牙髓学龋病的治疗33 point angle: the junction of three planal surfaces of different orientation. 牙体牙髓学龋病的治疗34牙体牙髓学龋病的治疗35 cavosurface angle: the angle of tooth structure formed by the junction of a prepared cavity wall and the external surface of the tooth. also referred to as the cavity mar

11、gin or cavosurface margin. 牙体牙髓学龋病的治疗36牙体牙髓学龋病的治疗37resistance formn定义n洞深：n盒状洞形n阶梯结构n窝洞外形n去除无机釉n薄壁弱尖的处理牙体牙髓学龋病的治疗38牙体牙髓学龋病的治疗39retention formnlateral retentionnundercutndovetailntrapezianadhesive牙体牙髓学龋病的治疗40牙体牙髓学龋病的治疗41牙体牙髓学龋病的治疗42牙体牙髓学龋病的治疗43牙体牙髓学龋病的治疗44深龋的治疗n原则：n正确判断牙髓状况牙体牙髓学龋病的治疗45牙体牙髓学龋病的治疗46牙体牙髓

12、学龋病的治疗47治疗方法n垫底充填牙体牙髓学龋病的治疗48n安抚治疗牙体牙髓学龋病的治疗49间接盖髓术牙体牙髓学龋病的治疗50治疗方案龋病类型龋病类型软龋能否去净软龋能否去净牙髓状况牙髓状况治疗方案治疗方案牙体牙髓学龋病的治疗51根面龋牙体牙髓学龋病的治疗52牙体牙髓学龋病的治疗53n保守治疗牙体牙髓学龋病的治疗54n充填治疗牙体牙髓学龋病的治疗55牙体牙髓学龋病的治疗56牙体牙髓学龋病的治疗57窝洞预备的基本原则nremoval of remaining cariesnwhen the dentin has a firm feel with the explorer, removal of

13、the tooth structure should cease, even if stained dentin remains.n只需去除感染牙本质（崩解层和透入层）n根据硬度和着色两个标准来判断牙体牙髓学龋病的治疗58牙体牙髓学龋病的治疗59n二、保护牙髓组织n 间断操作，锋利器械，冷却n 不向髓腔加压n 了解解剖结构、增龄变化牙体牙髓学龋病的治疗60n三、尽量保留健康牙体组织n 最小程度扩展洞形n 龈缘位置n 尽量不做预防性扩展n 釉质成形术 enameloplasty 牙体牙髓学龋病的治疗61牙体牙髓学龋病的治疗62n注意患者全身状况牙体牙髓学龋病的治疗63窝洞预备基本步骤nthe d

14、esign of the cavity preparation for either a tooth with initial caries or replacement restoration is based on the location of the caries, the amount and extent of the caries, the amount of lost tooth structure, and the restorative material to be used.牙体牙髓学龋病的治疗64n一、预备洞形n1、开阔洞口及进入病变区：不同窝洞进入通道的选择牙体牙髓学

15、龋病的治疗65牙体牙髓学龋病的治疗66n2、设计预备洞的外形n 以病变为基础n 扩展n 避开承受咬合力的部位n 圆滑曲线nthe dentist must establish an outline form, which determines the overall shape of the preparation along the cavity margins of the restoration and the tooth surfaces. the outline form is determined by the size and shape of the carious lesio

16、n and by the need for a suitable design that will hold a restoration firmly in place. 牙体牙髓学龋病的治疗67邻面的颊舌洞缘位置牙体牙髓学龋病的治疗68在规定的深度扩展洞形牙体牙髓学龋病的治疗69n3、抗力形和固位形牙体牙髓学龋病的治疗70n4、finishing the enamel walls and margins nthis is a process of angling, beveling, and smoothing the walls of the cavity preparation to a

17、chieve the best marginal seal possible between the restorative material and tooth structure. the dentist may use burs, diamond stones, or hand-cutting instruments (chisels, hoes, hatchets, and gingival margin trimmers) to complete the walls by removing loose or unsupported enamel to create the stron

18、gest possible enamel wall.牙体牙髓学龋病的治疗71n5、无痛制洞法n 锋利器械，正确手法n 局部麻醉 anesthesian 化学机械去龋 牙体牙髓学龋病的治疗72n二、术区隔离n 棉卷隔离牙体牙髓学龋病的治疗73reasons for use of rubber damnprotection aspiration or swallowing of instruments or irrigants soft tissue injury caused by instruments nefficiency improve visibility (dry field and

19、 reduced mirror fogging) minimize patient conversation minimize the need for frequent rinsingnreduced risk of cross-contamination nlegal considerations牙体牙髓学龋病的治疗74牙体牙髓学龋病的治疗75牙体牙髓学龋病的治疗76牙体牙髓学龋病的治疗77选择性辅助隔离法： refraction cord牙体牙髓学龋病的治疗78mouth prop 牙体牙髓学龋病的治疗79n三、窝洞消毒牙体牙髓学龋病的治疗80n cavity liners and bases are used primarily to protect the pulp and to aid the pulp in recovering from irritation resu