龋临床特征和诊断课件

Chapter3

ClinicalManifestationsandDiagnosisofDentalCariesChapter3

ClinicalManifestHistophathologyofCariesEnamelCariesHistophathologyofCariesEnameTheearlyenamellesionconsistsoffourzonesofalternatinglevelsofmineralisation.Itillustratesthedynamicnatureofthecariesprocess.Thesurfacezoneblocksthepassageofcalciumionsintothebodyofthelesionandmayhavetoberemovedtoallowthelesiontobecomearrested(AfterKidd&Joyston-Bechal,1987).TheearlyenamellesionconsisDentinalCariesDentinalCariesDentinecariescomprisestwo

mainlayers.Intheouterlayer,thedentineisheavilyinfectedwithbacteria.Bothorganicmatrixandmineralhavebeenlostandthedentineisbeyondrepair.Inthedeeperlayer,thedentinehasbeenaffectedbyplaqueacidsanddemineralised.Thenumberofcolonyformingunits(CFU)ofbacteriadecreases(about100times)ascavitypreparationproceedsintoaffecteddentine.Thedamageinthislayerisreversibleifbacterialmetabolismcanbehalted.Abarrieroftranslucent(wellmineralised)dentinemaybeformedaheadoftheadvancinglesion.Reactionary(secondary)dentineformstoprotectthepulpfromacidirritation(AfterKidd&Joyston-Bechal,1987Dentinecariescomprisestwo

龋临床特征和诊断课件RootcarieslesionsEarly:AppearsasradiolucentzoneintherootcementumRootcarieslesionsEarly:ApStepsintheformationofanarrestedlesionindentinea)highconcentrationofdissolvedmineralsalts.b)Ifbcterialacidproductionisreduced,andthepHincreases,thesaltsprecipitateintolargecrystalsoftricalciumphosphatewhichtemporallyblockthetubule.c)Iffurtherbacterialactivityissuppressed,theodontoblastsecretescollagenandcalciumsalts.Crystalsofhydroxyapatitethenformandblockthetubulemoreeffectively(AfterDaculsietal,1987)

StepsintheformationofanaTheProcessofDemineralizationandRemineralizationCariesisadynamicprocess.Teetharesubjectedtoanongoingcycleofdemineralizationandremineralizationdeterminedbythebalanceoffactors.TheProcessofDemineralizatioDemineralizationDemineralizationistheprocessofremovingminerals,intheformofmineralions,fromdentalenamel.AsubstantialnumberofmineralionscanberemovedfromhydroxyapatitelatticeworkwithoutdestroyingitsstructuralintegrityDemineralizationDemineralizatiRemineralizationRemineralizationistheprocessofrestoringminerals-again,intheformofmineralions-tothehydroxyapatite'slatticeworkstructure.RemineralizationRemineralizati促进再矿化阻止龋病发展龋损的形成是脱矿与再矿化的连续性动力过程。促进再矿化阻止龋病发展龋损的形成是脱矿与再矿化的连续性动力1、除去致龋底物：木糖醇取代蔗糖，减少碳水化合物摄入频率Dietcounseling:ToidentifythesourcesofsucroseandacidicfoodstuffsinthedietToreducethefrequencyofingestionofbothTousexylitolassugarsubstitute.1、除去致龋底物：木糖醇取代蔗糖，2、仔细刷牙，牙面不形成厚的牙菌斑Oralhygiene:Plaquefreetoothsurfacedonotdecay.DentalflossingToothbrushingRinsing2、仔细刷牙，牙面不形成厚的牙菌斑3、在牙齿发育的再矿化期间，结合氟离子，可形成更具抗龋能力的釉质Useoffluoride3、在牙齿发育的再矿化期间，结合氟龋临床特征和诊断课件Clinicalclassificationofcaries

ClinicalclassificationofcarClassificationaccordingtoprogressionrateAcutecaries:progressfast,ofteninchildrenandteenagers,lightcoloredcavity.ClassificationaccordingtoprRampantcaries,manytoothinvolvedatsametimeacutecariesfeatureoftenaccompaniedbysystematicdisorder.Suchassjogrensyndromeorsalivareductionafterradiation.

Cariesinapatientwithimpairedsalivaryfunctionasresultofradiationtherapy(courtesyofDrsJansmaandVissink,RUG,theNetherlands).

Rampantcaries,manytoothinv

Chroniccaries

progressslowly,blackorbrowncoloredcavityhardremainingdentine

Arrestedcaries

cariesstopprogressingbecauseof

thelocaletiologicalchangeChroniccariesprogressSecondarycaries(recurrentcaries)cariesrecurredaftertreatment.Oftenatthemarginthefillingmaterialsrestorationorbeneath

Theshadowlocatedonthemesiolingualcuspadjacenttothelargerocclusalamalgamrestorationonthemaxillaryrightfirstmolarindicatesthepresenceofcariousdentin

Secondarycaries(recurrentca龋临床特征和诊断课件ClassificationaccordingtotheinvolvingsiteOcclusalcaries

RootcariesSmoothsurfacecariesClassificationaccordingtothClassificationaccordingtothedeepnessSuperfacialcaries(浅龋)whitespotlesions,visiblyfrostedsurfacebrownspotDentincaries(中龋)cavitatedlesioninvolvingtheuppartofdentinDeepcaries(深龋)cavitatedlesioninvolvingthepupalthirdofdentinClassificationaccordingtothDiagnosisVisualchangeProbing:roughsurfaceortrappingpointpainuponprobingTemperaturetestX-rayexaminationTransilluminationDiagnosisVisualchangeVisualchange

Matte,white,activecervicallesionsVisualchangeMatte,white,ac龋临床特征和诊断课件Probing:roughsurfaceortrappingpointpainuponprobing

TheexplorertipcaneasilydamagewhitespotlesionsProbing:roughsurfaceortrap龋临床特征和诊断课件龋临床特征和诊断课件Temperaturetest

TemperaturetestX-rayexamination

X-rayexaminationTransillumination（FOTL,光纤透照法）：

ProximalcarieslesionisdetectedinananteriortoothwiththeuseoftransilluminationTransilluminationProximalcariLAF（激光荧光法)

LAF（激光荧光法)

Thehardwareoftheintra-oralsystemincludesameasurementprobe,acontrolunit,andacomputerfittedwithaframegrabber.Thecontrolunitconsistsofanilluminationdeviceandimagingelectronics.Thelightsourceisaspecialarc-lampbasedonXenon氙technology.Thelightfromthislampisfilteredbyablue-transmittingfilter.Aliquidlightguidetransportsthebluelighttotheteethinthemouth.

QuantitativeLight-inducedFluorescenceThehardwareoftheintra-oralQLF™technicalspecificationsQLF™technicalspecificationsQLF™theoryTheQLF™methodisbasedontheauto-fluorescence荧光ofteeth.Whenteethareilluminatedwithhighintensitybluelighttheywillstarttoemitlightinthegreenpartofthespectrum.Thefluorescenceofthedentalmaterialhasadirectrelationwiththemineralcontentoftheenamel.QuantitativeLight-inducedFluorescence

QLF™theoryTheQLF™methodisDIAGNOdentpen(龋齿探测笔)DIAGNOdenthttp:///products/handpieces_accessories/special_instruments/diagnodent/tutorial.asp?navid=500019&lan=Us&znavid=311000DIAGNOdentpen(龋齿探测笔)DIAGNOdentpenDIAGNOdentpenDIAGNOdentDIAGNOdent龋临床特征和诊断课件StandardofdiagnosisStandardofdiagnosisSuperfacialcaries(浅龋)Whitespotorbrown,darklesion,roughuponprobingNocomplaint,nohypersensitivitySuperfacialcaries(浅龋)WhitesDentincaries(中龋)Cavity,hypersensitivityuponprobing,hotorcoldstimulus.Dentincaries(中龋)Cavity,hypDeepcaries(深龋)Deepcavity,verysensitiveandsomepainuponstimulus,howeverthepaindisappearassoonasthestimulusistakenaway.Deepcaries(深龋)Deepcavity,TreatmentStrategyTreatmentStrategyTreatmentStrategyPreventive(casual,noninvasive)treatmentRestorative(operative,invasive)treatment

TreatmentStrategyPreventive(cPreventivetreatmentchemicaltherapy:

useoffluoridewitharegulardailyadministrationorprofessionalapplied.

pitandfissuresealingPreventivetreatmentchemicalt一、chemicaltherapy

（化学疗法

）

1．药物治疗适应证（1）恒牙早期釉质龋未形成龋洞者，自洁作用较好的区域；（2）一年内将被替换的乳牙大面积浅龋；（3）静止龋。药物氟化物硝酸银一、chemicaltherapy

（化学疗法）药物治疗氟化物(fluorence)

75％氟化钠甘油糊剂8％氟化亚锡溶液酸性磷酸氟化钠（APF）溶液含氟凝胶（1.5％APF凝胶）含氟涂料原理：氟与HA作用，形成氟磷灰石；沉积氟化物，促进再矿化。氟化物对软组织无腐蚀性，不使牙变色，安全有效，前后牙均可使用。药物治疗氟化物(fluorence)药物治疗硝酸银10％硝酸银氨硝酸银原理:蛋白银沉淀

还原银或碘化银渗入牙釉质牙本质，杀灭细菌，封闭病变区

对软组织有强的腐蚀性，不可用于牙颈部龋，并使牙变黑，只用于乳牙和后牙。药物治疗硝酸银10％硝酸银氨硝酸银应用方法：用石尖磨除牙表面浅龋，暴露病变部位清洁牙面隔湿吹干涂布药物应用方法：用石尖磨除牙表面浅龋，暴露病变部位2．Remineralization(再矿化疗法)

再矿化液：主要为含有不同比例的钙、磷和氟。适应症平滑面早期釉质龋龋易感者预防应用方法：漱口液每日含漱局部应用

2．Remineralization(再矿化疗法)pitandfissuresealing

（窝沟封闭)

适应证：窝沟可疑龋；与充填窝洞相邻的牙合面无龋深沟裂，应用方法：清洁牙面、隔湿、酸蚀、涂布及固化封闭剂。

pitandfissuresealing

（窝沟封闭)DefinitionofOperativeDentistry

Operativedentistryistheartandscienceofthediagnosis,treatment,andprognosisofdefectsofteethwhichdonotrequirefullcoveragerestorationsforcorrection.

DefinitionofOperativeDentisSuchtreatmentshouldresultintherestorationofpropertoothform,function,andestheticswhilemaintainingthephysiologicalintegrityoftheteethinharmoniousrelationshipwiththeadjacenthardandsofttissues;allofwhichenhancethegeneralhealthandwelfareofthepatient.SuchtreatmentshouldresultiIndicationofOperativeDentistry

Caries

Malformed,discolored,orfracturedteethRestorationreplacement

IndicationofOperativeDentisProgramofOperativeTreatment

PatientassessmentExaminationanddiagnosisTreatmentplanningProgramofOperativeTreatmentCavityPreparation

Themechanicalalterationofadefective,injured,ordiseasedtoothinordertobestreceivearestorativematerialwhichwillre-establishahealthystateforthetoothincludingestheticcorrectionswhereindicated,alongwithnormalformandfunction.

CavityPreparationThemechani龋临床特征和诊断课件龋临床特征和诊断课件

Classificationofcavity

ClassⅠClassⅡClassⅢClassⅣClassⅤClassⅥ—G.V.Blackin1908

ClassificationofcavityClaClassI

AllpitandfissurecavitiesareClassI.

Cavitiesonocclusalsurface;Cavitiesonocclusaltwo-thirdsofthefacialandlingualsurfacesofmolars;Cavitiesonlingualsurfaceofmaxillaryincisor.ClassIAllpitandfissureClassII

AcavityoccurringontheproximalsurfaceofposteriorteethareClassII.MOmesialandocclusal

DOdistalandocclusalMODmesial,occlusalanddista

ClassIIAcavityocClassIIICavitiesontheproximalsurfacesofanteriorteeththatdo

notinvolvetheincisalanglesareClassIII.ClassIIICavitiesontheproxiClassIV

Cavitiesontheproximalsurfacesofanteriorteeththatdo

involvetheincisalanglesareClassIV.ClassIV

CavitiesontheproxiClassVCavitiesonthegingivalthirdofthefacialorlingualsurfacesofallteeth(notpitandfissurecavities)areClassV.ClassVCavitiesonthegingiva龋临床特征和诊断课件ClassVICavitiesontheincisaledgeofanteriorteethortheocclusalcuspheightsofposteriorteethareClassVI.ClassVICavitiesontheincisa龋临床特征和诊断课件洞型分类一类洞：根据发生于所有牙齿的发育窝，沟内的龋损所制备的洞型。二类洞：后牙邻面的龋损所制备的洞型。三类洞：前牙邻面未损及切角的龋损所制备的洞型。四类洞：前牙邻面损及切角的龋损所制备的洞型。五类洞：所有牙齿颊（唇），舌（腭）面龈1/3牙面的龋损制备的洞型。六类洞：所有牙齿牙尖，牙脊或冠轴交界的轴角区的龋损所制备的洞型。洞型分类一类洞：根据发生于所有牙齿的发育窝，沟内的龋临床特征和诊断课件CavityStructure

wallsanglescavityCavityStructurewalls龋临床特征和诊断课件Walls

Internalwalls:apreparedcavitysurfacethatdoesnotextendtotheexternaltoothsurface.

Axialwalls:aninternalwallparallelwiththelongaxisofthetoothandocclusalofthetooth.Pulpalwalls:aninternalwallthatisbothperpendiculartothelongaxisofthetoothandocclusalofthepulp.WallsInternalwalls:apreparWallsExternalwalls:apreparedcavitysurfacethatextendtotheexternaltoothsurface.

.Theexternalwallstakesthenameofthetoothsurfacethatthewallistoward.

WallsExternalwalls:aprepare龋临床特征和诊断课件Angles

Lineangle:thejunctionofthetwoplanalsurfacesofdifferentorientationalongaline.

AnglesLineangle:thejunc龋临床特征和诊断课件Angles

Pointangle:thejunctionofthreeplanalsurfacesofdifferentorientation.

AnglesPointangle:thejuncti龋临床特征和诊断课件Angles

Cavosurfaceangle:theangleoftoothstructureformedbythejunctionofapreparedcavitywallandtheexternalsurfaceofthetooth.

Alsoreferredtoasthecavitymarginorcavosurfacemargin.

AnglesCavosurfaceangle:the3．洞型结构●

洞壁：窝洞的壁，分侧壁和髓壁(pulpalwalls)

△

侧壁与牙面垂直的壁(颊壁,龈壁)△

髓壁与洞侧壁垂直，位于洞底覆盖牙髓的洞壁。△

轴壁与牙长轴平行的髓壁●

洞角△

点角三壁相交构成颊轴龈点角△

线角两壁相交构成颊髓线角●

洞缘角

洞侧壁与牙面相交形成的线角

△洞缘窝洞侧壁与牙面相交构成洞的边缘3．洞型结构龋临床特征和诊断课件

Cavity

Simplecavity:onlyonetoothsurfaceisinvolved.

Compoundcavity:twosurfacesareinvolved.

Complexcavity:threeormoresurfacesareinvolved.

CavitySimplecavity:onlyon龋临床特征和诊断课件龋临床特征和诊断课件Chapter3

ClinicalManifestationsandDiagnosisofDentalCariesChapter3

ClinicalManifestHistophathologyofCariesEnamelCariesHistophathologyofCariesEnameTheearlyenamellesionconsistsoffourzonesofalternatinglevelsofmineralisation.Itillustratesthedynamicnatureofthecariesprocess.Thesurfacezoneblocksthepassageofcalciumionsintothebodyofthelesionandmayhavetoberemovedtoallowthelesiontobecomearrested(AfterKidd&Joyston-Bechal,1987).TheearlyenamellesionconsisDentinalCariesDentinalCariesDentinecariescomprisestwo

mainlayers.Intheouterlayer,thedentineisheavilyinfectedwithbacteria.Bothorganicmatrixandmineralhavebeenlostandthedentineisbeyondrepair.Inthedeeperlayer,thedentinehasbeenaffectedbyplaqueacidsanddemineralised.Thenumberofcolonyformingunits(CFU)ofbacteriadecreases(about100times)ascavitypreparationproceedsintoaffecteddentine.Thedamageinthislayerisreversibleifbacterialmetabolismcanbehalted.Abarrieroftranslucent(wellmineralised)dentinemaybeformedaheadoftheadvancinglesion.Reactionary(secondary)dentineformstoprotectthepulpfromacidirritation(AfterKidd&Joyston-Bechal,1987Dentinecariescomprisestwo

龋临床特征和诊断课件RootcarieslesionsEarly:AppearsasradiolucentzoneintherootcementumRootcarieslesionsEarly:ApStepsintheformationofanarrestedlesionindentinea)highconcentrationofdissolvedmineralsalts.b)Ifbcterialacidproductionisreduced,andthepHincreases,thesaltsprecipitateintolargecrystalsoftricalciumphosphatewhichtemporallyblockthetubule.c)Iffurtherbacterialactivityissuppressed,theodontoblastsecretescollagenandcalciumsalts.Crystalsofhydroxyapatitethenformandblockthetubulemoreeffectively(AfterDaculsietal,1987)

StepsintheformationofanaTheProcessofDemineralizationandRemineralizationCariesisadynamicprocess.Teetharesubjectedtoanongoingcycleofdemineralizationandremineralizationdeterminedbythebalanceoffactors.TheProcessofDemineralizatioDemineralizationDemineralizationistheprocessofremovingminerals,intheformofmineralions,fromdentalenamel.AsubstantialnumberofmineralionscanberemovedfromhydroxyapatitelatticeworkwithoutdestroyingitsstructuralintegrityDemineralizationDemineralizatiRemineralizationRemineralizationistheprocessofrestoringminerals-again,intheformofmineralions-tothehydroxyapatite'slatticeworkstructure.RemineralizationRemineralizati促进再矿化阻止龋病发展龋损的形成是脱矿与再矿化的连续性动力过程。促进再矿化阻止龋病发展龋损的形成是脱矿与再矿化的连续性动力1、除去致龋底物：木糖醇取代蔗糖，减少碳水化合物摄入频率Dietcounseling:ToidentifythesourcesofsucroseandacidicfoodstuffsinthedietToreducethefrequencyofingestionofbothTousexylitolassugarsubstitute.1、除去致龋底物：木糖醇取代蔗糖，2、仔细刷牙，牙面不形成厚的牙菌斑Oralhygiene:Plaquefreetoothsurfacedonotdecay.DentalflossingToothbrushingRinsing2、仔细刷牙，牙面不形成厚的牙菌斑3、在牙齿发育的再矿化期间，结合氟离子，可形成更具抗龋能力的釉质Useoffluoride3、在牙齿发育的再矿化期间，结合氟龋临床特征和诊断课件Clinicalclassificationofcaries

ClinicalclassificationofcarClassificationaccordingtoprogressionrateAcutecaries:progressfast,ofteninchildrenandteenagers,lightcoloredcavity.ClassificationaccordingtoprRampantcaries,manytoothinvolvedatsametimeacutecariesfeatureoftenaccompaniedbysystematicdisorder.Suchassjogrensyndromeorsalivareductionafterradiation.

Cariesinapatientwithimpairedsalivaryfunctionasresultofradiationtherapy(courtesyofDrsJansmaandVissink,RUG,theNetherlands).

Rampantcaries,manytoothinv

Chroniccaries

progressslowly,blackorbrowncoloredcavityhardremainingdentine

Arrestedcaries

cariesstopprogressingbecauseof

thelocaletiologicalchangeChroniccariesprogressSecondarycaries(recurrentcaries)cariesrecurredaftertreatment.Oftenatthemarginthefillingmaterialsrestorationorbeneath

Theshadowlocatedonthemesiolingualcuspadjacenttothelargerocclusalamalgamrestorationonthemaxillaryrightfirstmolarindicatesthepresenceofcariousdentin

Secondarycaries(recurrentca龋临床特征和诊断课件ClassificationaccordingtotheinvolvingsiteOcclusalcaries

RootcariesSmoothsurfacecariesClassificationaccordingtothClassificationaccordingtothedeepnessSuperfacialcaries(浅龋)whitespotlesions,visiblyfrostedsurfacebrownspotDentincaries(中龋)cavitatedlesioninvolvingtheuppartofdentinDeepcaries(深龋)cavitatedlesioninvolvingthepupalthirdofdentinClassificationaccordingtothDiagnosisVisualchangeProbing:roughsurfaceortrappingpointpainuponprobingTemperaturetestX-rayexaminationTransilluminationDiagnosisVisualchangeVisualchange

Matte,white,activecervicallesionsVisualchangeMatte,white,ac龋临床特征和诊断课件Probing:roughsurfaceortrappingpointpainuponprobing

TheexplorertipcaneasilydamagewhitespotlesionsProbing:roughsurfaceortrap龋临床特征和诊断课件龋临床特征和诊断课件Temperaturetest

TemperaturetestX-rayexamination

X-rayexaminationTransillumination（FOTL,光纤透照法）：

ProximalcarieslesionisdetectedinananteriortoothwiththeuseoftransilluminationTransilluminationProximalcariLAF（激光荧光法)

LAF（激光荧光法)

Thehardwareoftheintra-oralsystemincludesameasurementprobe,acontrolunit,andacomputerfittedwithaframegrabber.Thecontrolunitconsistsofanilluminationdeviceandimagingelectronics.Thelightsourceisaspecialarc-lampbasedonXenon氙technology.Thelightfromthislampisfilteredbyablue-transmittingfilter.Aliquidlightguidetransportsthebluelighttotheteethinthemouth.

QuantitativeLight-inducedFluorescenceThehardwareoftheintra-oralQLF™technicalspecificationsQLF™technicalspecificationsQLF™theoryTheQLF™methodisbasedontheauto-fluorescence荧光ofteeth.Whenteethareilluminatedwithhighintensitybluelighttheywillstarttoemitlightinthegreenpartofthespectrum.Thefluorescenceofthedentalmaterialhasadirectrelationwiththemineralcontentoftheenamel.QuantitativeLight-inducedFluorescence

QLF™theoryTheQLF™methodisDIAGNOdentpen(龋齿探测笔)DIAGNOdenthttp:///products/handpieces_accessories/special_instruments/diagnodent/tutorial.asp?navid=500019&lan=Us&znavid=311000DIAGNOdentpen(龋齿探测笔)DIAGNOdentpenDIAGNOdentpenDIAGNOdentDIAGNOdent龋临床特征和诊断课件StandardofdiagnosisStandardofdiagnosisSuperfacialcaries(浅龋)Whitespotorbrown,darklesion,roughuponprobingNocomplaint,nohypersensitivitySuperfacialcaries(浅龋)WhitesDentincaries(中龋)Cavity,hypersensitivityuponprobing,hotorcoldstimulus.Dentincaries(中龋)Cavity,hypDeepcaries(深龋)Deepcavity,verysensitiveandsomepainuponstimulus,howeverthepaindisappearassoonasthestimulusistakenaway.Deepcaries(深龋)Deepcavity,TreatmentStrategyTreatmentStrategyTreatmentStrategyPreventive(casual,noninvasive)treatmentRestorative(operative,invasive)treatment

TreatmentStrategyPreventive(cPreventivetreatmentchemicaltherapy:

useoffluoridewitharegulardailyadministrationorprofessionalapplied.

pitandfissuresealingPreventivetreatmentchemicalt一、chemicaltherapy

（化学疗法

）

1．药物治疗适应证（1）恒牙早期釉质龋未形成龋洞者，自洁作用较好的区域；（2）一年内将被替换的乳牙大面积浅龋；（3）静止龋。药物氟化物硝酸银一、chemicaltherapy

（化学疗法）药物治疗氟化物(fluorence)

75％氟化钠甘油糊剂8％氟化亚锡溶液酸性磷酸氟化钠（APF）溶液含氟凝胶（1.5％APF凝胶）含氟涂料原理：氟与HA作用，形成氟磷灰石；沉积氟化物，促进再矿化。氟化物对软组织无腐蚀性，不使牙变色，安全有效，前后牙均可使用。药物治疗氟化物(fluorence)药物治疗硝酸银10％硝酸银氨硝酸银原理:蛋白银沉淀

还原银或碘化银渗入牙釉质牙本质，杀灭细菌，封闭病变区

对软组织有强的腐蚀性，不可用于牙颈部龋，并使牙变黑，只用于乳牙和后牙。药物治疗硝酸银10％硝酸银氨硝酸银应用方法：用石尖磨除牙表面浅龋，暴露病变部位清洁牙面隔湿吹干涂布药物应用方法：用石尖磨除牙表面浅龋，暴露病变部位2．Remineralization(再矿化疗法)

再矿化液：主要为含有不同比例的钙、磷和氟。适应症平滑面早期釉质龋龋易感者预防应用方法：漱口液每日含漱局部应用

2．Remineralization(再矿化疗法)pitandfissuresealing

（窝沟封闭)

适应证：窝沟可疑龋；与充填窝洞相邻的牙合面无龋深沟裂，应用方法：清洁牙面、隔湿、酸蚀、涂布及固化封闭剂。

pitandfissuresealing

（窝沟封闭)DefinitionofOperativeDentistry

Operativedentistryistheartandscienceofthediagnosis,treatment,andprognosisofdefectsofteethwhichdonotrequirefullcoveragerestorationsforcorrection.

DefinitionofOperativeDentisSuchtreatmentshouldresultintherestorationofpropertoothform,function,andestheticswhilemaintainingthephysiologicalintegrityoftheteethinharmoniousrelationshipwiththeadjacenthardandsofttissues;allofwhichenhancethegeneralhealthandwelfareofthepatient.SuchtreatmentshouldresultiIndicationofOperativeDentistry

Caries

Malformed,discolored,orfracturedteethRestorationreplacement

IndicationofOperativeDentisProgramofOperativeTreatment

PatientassessmentExaminationanddiagnosisTreatmentplanningProgramofOperativeTreatmentCavityPreparation

Themechanicalalterationofadefective,injured,ordiseasedtoothinordertobestreceivearestorativematerialwhichwillre-establishahealthystateforthetoothincludingestheticcorrectionswhereindicated,alongwithnormalformandfunction.

CavityPreparationThemechani龋临床特征和诊断课件龋临床特征和诊断课件

Classificationofcavity

ClassⅠClassⅡClassⅢClassⅣClassⅤClassⅥ—G.V.Blackin1908

ClassificationofcavityClaClassI

AllpitandfissurecavitiesareClassI.

Cavitiesonocclusalsurface;Cavitiesonocclusaltwo-thirdsofthefacialandlingualsurfacesofmolars;Cavitiesonlingualsurfaceofmaxillaryincisor.ClassIAllpitandfissureClassII

AcavityoccurringontheproximalsurfaceofposteriorteethareClassII.MOmesialandocclusal

DOdistalandocclusalMODmesial,occlusalanddista

ClassIIAcavityocClassIIICavit