(口腔科学课件)5.2Toothextraction英语局麻拔牙12

ToothExtraction（牙拔除术）重庆医科大学附属第一医院口腔頜面外科硕士研究生导师李雅冬labialpalatalDental

elevator（牙挺）Desmotomes（牙龈分离器）Desmotomesareusedtoseverthesofttissueattachment.Curette（刮匙）Themainuseofcuretteistheremovalofgranulationtissueorsmallcystsinsocket.Periostealelevator

（骨膜分离器）

MalletandChisel（骨锤和骨凿）Section2

INDICATIONSFORREMOVALOFTOOTH（拔牙的适应症）（一）INDICATIONS(适应症)SevereCaries（严重龋病）SeverePeriodontalDisease（严重牙周病）PulpalNecrosis（牙髓坏死）FullbonyimpactedTooth（埋伏牙）、SupernumeraryTooth（多生牙）、ectopictooth(错位牙)PartialbonyimpactedTooth，softtissueimpactedTooth（阻生牙）CrackedTooth(牙外伤)Retaineddeciduous(滞留乳牙)Theneedfortreatment治疗需要（preorthodontic正畸前、Preprosthetic修复前、preradiotherapy放疗前）Endo-periolesiontooth(病灶牙)SevereCaries（严重龋病）SeverePeriodontalDisease（严重牙周病）endodontictreatment（根管治疗）PulpalNecrosis（牙髓坏死）FullbonyimpactedTooth（埋伏牙）SupernumeraryTooth（多生牙）ectopictooth(错位牙)PartialbonyimpactedTooth（阻生牙）softtissueimpactedTooth（阻生牙）CrackedTooth(牙外伤)Retaineddeciduous(滞留乳牙)

Theneedfortreatment治疗需要preorthodontic正畸前PatientwillundergoorthodonticbecauseofcrowdeddentitionPreprosthetic修复前、preradiotherapy放疗前Thetoothinterferewiththedesignofprostheticorradiotherapypreorthodontic

Preprosthetic

Endo-periolesiontooth(病灶牙)

（二）contraindications禁忌症Haematologicaldisorders血液系统疾病Cardiovasculardiseases心血管系统疾病Diabetesmellitus糖尿病Thyrotoxicosis甲亢Renaldiseases肾脏、liverdiseases肝脏疾病Menstrualperiod月经pregnancy妊娠期Acuteinfection急性炎症期Malignanttumor恶性肿瘤Haematologicaldisorders血液系统疾病thepatienthasthetendencytobleedeasilyortakesomedrugsthatmakehimbleedeasilyStopdrug,receivetreatmentafterthediseaseisbroughtundercontrolextracttoothCardiovasculardiseases心血管系统疾病

ThepatientissufferingfromanyheartdiseasesConsultwithacardiologistbeforetoothextrationDiabetesmellitus糖尿病ThebloodglucoselevelishighDecreasebloodglucoseleveltonormalThyrotoxicosis甲亢

ThethyrodglandishyperactiveHeartrateandbloodpressureshouldbenormalRenaldiseases肾脏疾病、

liverdiseases肝脏疾病ExtractionisdeferreduntilthesediseasescanbebroughtundercontrolMenstrualperiod月经Extractionbringexcessivebleedingpregnancy妊娠期ItisbetterextractionisdeferreduntilafterthechildhasbeendeliveredAcuteinfection急性炎症期

ThepatientcannotopenmouthenoughwideMalignanttumor恶性肿瘤ToothislocatedinmalignanttumorExtractionhastenthemetastasicprocessRemovetumouratthesametimeremovethetoothSection3

thestepsoftoothextraction(牙拔除术的步骤)

一、severperiodontalligament(分离牙龈)

fingerrest(要有支点)二、usedentalelevator(牙挺使用)Fulcrum(支点)：

buccalplateofbone(颊侧牙槽骨)neveruseadjacenttoothasfulcrum(邻牙不能作为支点)2.Threekindsofforce:wedge,lever,wheelandaxle(三种力学楔入、撬动、转动)3.thumbandforefingerprotectadjacenttissue(左手保护)4.Controlforce(用力控制)三、usedentalforceps(安放牙钳)Choosetheproperforceps(选择器械)Thebeaksparalleltothetooth(钳喙与牙体长轴平行)thumbandforefingerprotectadjacenttissue(左手保护)Amplitudefrequency(幅度频率)四、extractthediseasedtooth(拔除患牙)Threekindsofforce:Shank,rotation,traction(３种力：摇动、扭转、牵引)Thetechniqueforextraction(各类牙拔除方法)

maxillarycentralincisor,lateralincisor(上颌前牙)Maxillarycanine(上颌尖牙)Maxillaryfirstpremolar,secondpremolar(上颌双尖牙)Maxillaryfirstmolar(上颌第一磨牙)Maxillarysecondmolar(上颌第二磨牙)Mandibularcentralincisor,lateralincisor(下颌前牙)Mandibularcanine(下颌尖牙)Mandibularfirstpremolar,secondpremolar(下颌双尖牙)Mandibularfirstmolar(下颌第一磨牙)Mandibularsecondmolar(下颌第二磨牙)牙根拔除术Extractionofroots

Rootforcepsextraction(根钳取根法)Rootextractionbyelevator(牙挺取根)Roottipextraction(根尖取根法)Toothdivision(分根取根法)Surgicalextraction(翻瓣去骨取根法)五、postextractionmanagement(拔牙创处理)Clearthesocketcompressthelingualandbuccalplatesbitefirmlyongauzeplacedoverthewound

bitegauzefor30min(咬纱团30min)havefoodafter2h(2h后进食)

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