牙体牙髓学-龋病的治疗课件

OperativeDentistryOperativeDentistryOperativedentistryistheartandscienceofthediagnosis,treatment,andprognosisofdefectsofteethwhichdonotrequirefullcoveragerestorationsforcorrection.enamel

cementumPeriodontal牙体修复原则去净龋坏牙体组织保守治疗的原则抗力形和固位形

Classificationofcavity

CavitiesmaybeclassifiedaccordingtothelocationwherethecariouslesionbeginsClassⅠClassⅡClassⅢClassⅣClassⅤClassⅥ—G.V.Blackin1908ClassII

AcavityoccurringontheproximalsurfaceofposteriorteethareClassII.MOmesialandocclusal

DOdistalandocclusalMODmesial,occlusalanddista

ClassIIICavitiesontheproximalsurfacesofanteriorteeththatdo

notinvolvetheincisalanglesareClassIII.ClassIV

Cavitiesontheproximalsurfacesofanteriorteeththatdo

involvetheincisalanglesareClassIV.

Cavity

Simplecavity:onlyonetoothsurfaceisinvolved.

Compoundcavity:twosurfacesareinvolved.

Complexcavity:threeormoresurfacesareinvolved.

CavityStructure

wallsanglescavityWallsExternalwalls:apreparedcavitysurfacethatextendtotheexternaltoothsurface.Theexternalwallstakesthenameofthetoothsurfacethatthewallistoward.

.Angles

Lineangle:thejunctionofthetwoplanalsurfacesofdifferentorientationalongaline.

Angles

Pointangle:thejunctionofthreeplanalsurfacesofdifferentorientation.

Angles

Cavosurfaceangle:theangleoftoothstructureformedbythejunctionofapreparedcavitywallandtheexternalsurfaceofthetooth.

Alsoreferredtoasthecavitymarginorcavosurfacemargin.

ResistanceForm定义洞深：盒状洞形阶梯结构窝洞外形去除无机釉薄壁弱尖的处理RetentionformLateralretentionundercutdovetailtrapeziaadhesive深龋的治疗原则：正确判断牙髓状况治疗方法垫底充填安抚治疗间接盖髓术治疗方案龋病类型软龋能否去净牙髓状况治疗方案根面龋保守治疗充填治疗窝洞预备的基本原则RemovalofRemainingCariesWhenthedentinhasafirmfeelwiththeexplorer,removalofthetoothstructureshouldcease,evenifstaineddentinremains.只需去除感染牙本质（崩解层和透入层）根据硬度和着色两个标准来判断二、保护牙髓组织间断操作，锋利器械，冷却不向髓腔加压了解解剖结构、增龄变化三、尽量保留健康牙体组织最小程度扩展洞形龈缘位置尽量不做预防性扩展

釉质成形术enameloplasty

注意患者全身状况窝洞预备基本步骤Thedesignofthecavitypreparationforeitheratoothwithinitialcariesorreplacementrestorationisbasedonthelocationofthecaries,theamountandextentofthecaries,theamountoflosttoothstructure,andtherestorativematerialtobeused.一、预备洞形1、开阔洞口及进入病变区：不同窝洞进入通道的选择2、设计预备洞的外形以病变为基础扩展避开承受咬合力的部位圆滑曲线Thedentistmustestablishanoutlineform,whichdeterminestheoverallshapeofthepreparationalongthecavitymarginsoftherestorationandthetoothsurfaces.Theoutlineformisdeterminedbythesizeandshapeofthecariouslesionandbytheneedforasuitabledesignthatwillholdarestorationfirmlyinplace.邻面的颊舌洞缘位置在规定的深度扩展洞形3、抗力形和固位形4、FinishingtheEnamelWallsandMargins

Thisisaprocessofangling,beveling,andsmoothingthewallsofthecavitypreparationtoachievethebestmarginalsealpossiblebetweentherestorativematerialandtoothstructure.Thedentistmayuseburs,diamondstones,orhand-cuttinginstruments(chisels,hoes,hatchets,andgingivalmargintrimmers)tocompletethewallsbyremovinglooseorunsupportedenameltocreatethestrongestpossibleenamelwall.5、无痛制洞法锋利器械，正确手法局部麻醉anesthesia化学机械去龋

二、术区隔离棉卷隔离ReasonsforuseofrubberdamProtectionaspirationorswallowingofinstrumentsorirrigantsSofttissueinjurycausedbyinstrumentsEfficiencyImprovevisibility(dryfieldandreducedmirrorfogging)MinimizepatientconversationMinimizetheneedforfrequentrinsingReducedriskofcross-contaminationLegalconsiderationsFour-handeddentistryClosesupport四手操作选择性辅助隔离法：refractioncordmouthprop

三、窝洞消毒

CAVITYLINERSANDBASESareusedprimarilytoprotectthepulpandtoaidthepulpinrecoveringfromirritationresultingfromcavitypreparation.1、窝洞封闭：洞漆、树脂粘结剂

2、衬洞：隔绝化学和温度刺激常用洞衬剂

3、垫底：隔绝温度、化学、电流及机械刺激。常用材料根据余留牙本质的厚度和修复材料的种类选用不同的封闭剂、洞衬剂和（或）垫底材料垫底的部位银汞合金修复术适应症Ⅰ、Ⅱ类洞后牙Ⅴ类洞美观要求不高，尖牙远中邻面洞配合附加固