儿童及青少年牙和支持组织的外伤

1、儿童及青少年牙和支持组织的外伤口腔预防儿童科18/20/2022chi2Trauma to the Teeth and Supporting TissuesDental TraumaHow to DiagnosisTreatment to the Dental Trauma28/20/2022chi3概 论38/20/2022chi4参考书Mc Donald RE and Avery DR. Dentistry for the Child and Adolescent,6th ed. st. Louis: C.V.Mosby,Co,1994. Andreason JO and Andreaso

2、n FM. Essentials of traumatic injuries to the teeth. Denmark: Laursen A/S, Tnder, 1990. Endodontics and Dental Traumatology48/20/2022chi5The International Association of Dental Trauma (IADA)国际牙外伤协会58/20/2022chi6牙外伤(Dental Trauma or Injuries)是指牙齿受到急剧的创伤，特别是打击、撞击等所引起的牙体、牙髓和牙周组织的损伤。（急性的）68/20/2022chi7儿

3、童牙外伤的特点年龄特点：儿童及青少年的发病率高年龄高峰：乳牙 13岁 恒牙79岁发生部位：切牙尖牙磨牙 上颌 下颌性别比较：男性 女性78/20/2022chi8乳牙外伤后影响后继恒牙的发育：釉质发育不全 or 钙化不全 修复性牙本质形成 弯曲牙 部分牙根停止发育影响后继恒牙的正常萌出影响恒牙列的正常形成88/20/2022chi9恒牙外伤后牙体组织的缺失或缺损 接触点 邻牙倾斜；间隙的丧失；对颌牙的伸长（替牙期的患者影响更大）98/20/2022chi10牙外伤后外伤牙本身预后的不定性，儿童生长发育的活跃性，诊断的困难性。当时口腔局部的创伤；以后机体的生理和心理上的创伤牙医：作出快速、正确、

4、全面的诊断；作出正确的处理；减少后遗症。10牙外伤的诊断？118/20/2022chi12牙外伤的诊断病史临床检查发射性X线片的检查128/20/2022chi13病 史 年龄，性别，外伤原因，作用力的大小和方向，发生地点及环境污染情况，外伤确切的时间，对冷热的反应，是否影响咬合，就诊前脱位牙的保存情况，是否经过一段无意识期，有无恶心、呕吐，全身有无影响治疗的疾患：血友病等，以前有无牙外伤史问 查138/20/2022chi14临床检查电活力测定 两种观点新的、陌生的仪器 儿童 害怕；有效性（髓休克3个月）机会；首次电活力意义（Rock等在1974年报道1年后82有活力） 积极治疗；微不足道的

5、刺激冷热诊 常适用乳牙光透射情况 （光束由舌侧向唇侧照射）其它：松动度检查 多个牙一起动提示？叩诊检查 metallic / dull percussion tone提示？148/20/2022chi15放射性X线片检查患牙与邻牙、对侧同名牙作比较比较髓腔、根管的大小、形态以及发育情况根折的检出率：（假阴性） X线透射中心的射线与牙折线一致或平行 夹角1520 夹角1520 无法显示 若怀疑有根折，改变角度，加拍23张牙片15牙外伤的治疗？168/20/2022chi17Treatment to the Dental TraumaInjury to the Primary DentalCrow

6、n FracturesCrown-Root FracturesRoot FracturesAvulsionConcussion and SubluxationExtrusionLateral LuxationIntrusionFracture of the Alveolar Process178/20/2022chi18治疗原则乳牙外伤冠折根折冠根联合折牙完全性脱位牙震荡牙伸长牙侧向移位牙嵌入牙槽骨骨折软组织外伤188/20/2022chi19Injuries to the Primary DentitionVerify eventual collision between a displac

7、ed primary tooth and its permanent successorIf this has occurred, remove the displaced incisorIf not ,observationMonitor healing regularly with routine clinical and radiographic examination198/20/2022chi20乳 牙 外 伤儿童的牙槽骨韧性较好，临床上以外伤移位多见处理上要谨慎乳牙外伤发生移位，伤及后继恒牙胚乳牙外伤继发感染，伤及后继恒牙胚208/20/2022chi21乳 牙 外 伤冠折：治疗原

8、则同恒牙冠根联合折 ：拔牙，残留牙根（生理性吸收）根折： 固定困难，拔除侧向移位： 观察/拔除嵌入： 观察/拔除完全性脱位： 不作再植术218/20/2022chi22Crown FracturesFractures of enamel Grinding Composite restoration Fractures of enamel and dentin Composite restoration Re-attachment of the crown fragmentPulp exposures Pulp capping Pulpotomy 228/20/2022chi23冠 折Crown

9、 Fractures仅累及牙釉折层：磨改、树脂修复累及牙本质：间接盖髓后，作牙折片再粘、树脂修复累及牙髓腔：直接盖髓术或活髓切断术后，作冠修复238/20/2022chi24Pulp CappingIsolate the pulp exposureCover the pulp with a calcium hydroxide materialRestore the teeth either immediately or after 3 month period248/20/2022chi25PulpotomyIsolate the pulp exposureAmputate the pulp

10、to a level approximately 2 mm below the exposure site,or to where fresh bleeding is seenRestore the tooth either immediately or after a 3-month period 258/20/2022chi26Crown-Root fracturesRemoval of the coronal fragment with subsequent restoration above gingival levelRemoval of the coronal fragment s

11、upplemented by gingivectomy and osteotomy and subsequent restoration with a post-retained crownRemoval of the coronal fragment and surgical extrusion of the rootRemoval of the coronal fragment and subsequent orthodontic of the root268/20/2022chi27冠 根 联 合 折crown root fractures拔除冠折片，龈上冠修复拔除冠折片，龈、骨切除术，

12、冠修复拔除冠折片，外科牙根伸长法，冠修复拔除冠折片，正畸牙根伸长法，冠修复纵折：拔除278/20/2022chi28Root FracturesCheck for pulpal complications after 3 weeks,6 weeks and 3 monthsReposition the coronal fragment and use firm splinting for 3 monthsRoot : crown1/3 middle1/3 apical1/3288/20/2022chi29根 折root fractures颈1/3:拔除“牙折冠”，根管治疗后，龈切或牵引冠修复中

13、1/3:复位固定3个月尖1/3:观察或复位固定3个月298/20/2022chi30AvulsionReplantation procedure Place the avulsed tooth in saline Examine the socket area Rinse the periodontal ligament and apical foramen with saline Flush the socket with saline Replant the tooth Splint the tooth for 12 weeks Antibiotic therapy T.A.T308/20

14、/2022chi31牙完全脱位avulxion再植术复位固定12周 (无PDL者 6周）氢氧化钙糊剂作暂时性根充抗炎治疗：普鲁卡因青霉素 6080万单位 2次/日 肌肉注射TAT注射318/20/2022chi32牙完全脱位avulxion再植术治疗要点脱位牙的保存情况：牛奶、NS等脱位牙的脱位时间： 30min 2hour 牙周膜的处理：保留与否牙槽窝的处理：清除血凝块，NS冲洗328/20/2022chi33牙完全脱位avulxion再植术治疗效果取决于外伤牙的保存 湿润/干燥外伤牙的脱位时间30分钟以内：2年或更长，90无牙根内吸收2小时以外：95牙根发生内吸收338/20/2022ch

15、i34Concussion and SubluxationOcclusal relief(e.g. by selective grinding of opposing teeth) and a soft dietImmobilization of the involved teeth may be appropriate for patient comfort,2 weeks fixation 348/20/2022chi35牙震荡/亚脱臼concusion/subluxution概念牙震荡：牙周lig内出血、水肿，完整，牙一般无松动亚脱臼：牙周lig内出血、水肿，部分撕裂，牙一般有松动、伴龈

16、沟出血调合，软饮食（2周），一般不需要固定（若固定，应2周）358/20/2022chi36ExtrusionRepositioningFixation 23 weeks 368/20/2022chi37牙 伸 长extrusion（局麻）复位固定23周牙髓存活情况牙根形成的：50存活牙根未形成的：90以上存活根管治疗时机：观察期间， X线检查一旦发现根尖牙根、牙槽骨有炎性吸收378/20/2022chi38Lateral LuxationLocal anestheticRepositioningFixation 3 weeksIf radiographic examination revea

17、ls a temporary breakdown of the marginal bone,maintain fixation for up to 2 months388/20/2022chi39牙 侧 向 移 位lateral luxation（局麻下）复位固定3周根管治疗时机：观察期间，X线检查一旦发现根尖牙根、牙槽骨有炎性吸收398/20/2022chi40IntrusionImmature root formation Await spontaneous re-eruption,usually takes 24 months Monitor pulpal healing radiogr

18、aphically 3,4 and 6 weeks after injuryMature root formation Await spontaneous re-eruption or extrude orthodontically over a period of 2 3 weeksExtirpate the pulp 2 weeks after injury,using calcium hydroxide paste as an interim dressing408/20/2022chi41牙 嵌 入intrusion诊断：病史、叩诊（metallic音)、X线检查牙髓坏死率牙根未形成：

19、50 牙根已形成：100 牙根吸收牙根未形成：58% 牙根已形成：70 418/20/2022chi42牙 嵌 入intrusion牙根尚未形成：观察24月（再萌）牙根已形成：观察（10天）和/或正畸牵引（23周）OR 外科拔牙复位固定4周氢氧化钙糊剂作暂时性根充428/20/2022chi43Fracture of the Alveolar ProcessLocal anestheticRepositioning Fixation 34 weeks438/20/2022chi44牙槽骨骨折局部的牙槽骨骨折局麻下，复位固定（34周）根尖锁住（Apical Lock)448/20/2022chi45软组织外伤清创缝合TAT注射抗炎治疗458/20/2022chi46牙外伤常见的几种治疗方法468/20/2022chi47牙外伤常见的几种治疗方 法复合树脂修复技术（直接、间接）盖髓术活髓切断术根尖成行术根管治疗术（复位）固定术478/20/2022chi48活髓切断术适应证：露髓比较多，时间比较长，估计牙髓炎症局限于冠髓或根髓的冠1/3以内488/20/2022chi49根尖成形术适应证