《牙髓病的治疗》PPT课件 (2)

TherapyIntroduction牙髓病和根尖周病治疗概述(P.189)PrincipleandPlanning治疗原则和治疗 计划 项目进度计划表范例计划下载计划下载计划下载课程教学计划下载 TreatmentPrinciple治疗原则1、PreservingVitalPulp保存活髓2、PreservingOffendingTooth保存患牙TreatmentPlanning治疗计划EmergencyEndodonticTreatment缓解疼痛，控制急性症状Examination&RoutineTreatment全面检查，常规治疗CaseAnalysis病例选择BasisforSuccessfulEndodonticMedicalHistory患者状态适用于任何年龄，无绝对的全身禁忌证DentalHistory患牙状态尽可能保存患牙InfectionControl感染的控制（AsepticTechnique无菌技术）IsolatingtheOperativeField术区隔离SterilizingtheInstrument手机灭菌、器械消毒和灭菌Absorbents隔湿CottonrollsRubberDam橡皮障Suction吸唾器SalivaevacuatorSalivaejectorsPainControl无痛技术LocalAnesthesia局部麻醉法2％Lidocaine＋EpinephrineLocalAnesthesiaTechniquesLocalinfiltrationanesthesia局部浸润麻醉（常用）Blockanesthesia阻滞麻醉（常用）Intraligamentaryanesthesia牙周膜内注射Intrapulpalanesthesia牙髓内注射TreatmentMethods治疗方法(P.203)保存活髓保存全部生活牙髓－PulpCapping（盖髓术）保存根部生活牙髓－Pulpotomy（牙髓切断术）盖髓术PulpCappingPulpcappingisdefinedas“endodontictreatmentdesignedtomaintainthevitalityoftheendodontium”.覆盖使牙髓病变转归的制剂以保护牙髓，消除病变，保存活髓盖髓术PulpCappingDirectPulpCapping（直接盖髓术）覆盖已暴露的牙髓IndirectPulpCapping（间接盖髓术）覆盖接近牙髓的牙本质DrugsinPulpCappingandPulpotomy常用盖髓剂CalciumHydroxide氢氧化钙(highlyalkaline强碱性)最具疗效的盖髓剂之一Dycal:可硬性氢氧化钙制剂，可作为次基材料Calvital:为非可硬性氢氧化钙制剂Antibacterialactivity中和炎症所产生的酸性产物ActivateAKP,promotedentinformation激活碱性磷酸酶，促进修复性牙本质形成Remember!Thesecalciumionspresentinthedentinbridgecomefromthesystemiccirculation,notfromthecalciumhydroxideyouused.修复过程中形成的牙本质桥中的钙离子是来自体循环OtherDrugs其它盖髓剂ZincOxide-eugenol氧化锌丁香油糊剂（多用于间接盖髓）Glucocoticoids&Antibiotics糖皮质激素及抗生素Hydroxyapatite羟基磷灰石、BMP骨形成蛋白MineralTrioxideAggregate(MTA)DirectPulpCapping直接盖髓术Pulpcappingimpliesplacingthedressingdirectlyontothepulpexposure.原理用盖髓剂覆盖在露髓创面上，消除炎症和感染，保护牙髓组织，使其恢复健康。Indications适应证考虑病人年龄年轻恒牙根尖孔尚未形成考虑病变程度恒牙牙髓有无感染、牙髓病变早期阶段Contraindication禁忌证有牙痛史的恒牙有慢性牙髓炎或根尖周炎 表 关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf 现的患牙DirectPulpCappingForadirectpulpcappingprocedure,acalciumhydroxideliningmaterialisplacedontheexposedpulpaltissueandasmallamountofsurroundingdentin.Asealinglinerand/orasealingrestorationisthenplacedtosealoutbacteriaandtheirby-products.Factorsthataffectoutcomeofpulpcappingorpulpotomy决定预后的因素Localfactors局部因素Systemicfactors全身因素AgesandStatusofthePulp年龄与牙髓的状态LocalFactors局部因素1）Thesizeoftheexposure露髓孔大小——直径大于1mm行活髓切断术保存活髓LocalFactors局部因素2）Locationoftheexposure露髓孔的位置——颈部龋预后差（轴壁牙本质钙化桥阻断冠髓血供）LocalFactors局部因素3）Periodsofexposure牙髓暴露的时间越长，牙髓发生炎症的可能性越大LocalFactors局部因素4）Discouragedforcariouspulpexposures牙髓暴露的类型——因龋病露髓的牙齿由于细菌感染不提倡盖髓外伤性露髓炎症多局限在距牙髓表面2mm的范围内LocalFactors局部因素5）Marginalleakage边缘渗漏，牙髓炎症将持续存在，不能修复LocalFactors局部因素6）Periodontallyinvolvedteeth牙周疾患的牙齿盖髓效果差LocalFactors局部因素7）Crownandbridge冠桥修复的基牙为禁忌症SystemicFactors全身因素干扰牙髓组织的修复PrognosisandConversion预后和转归牙髓组织的转归分为成功和失败两个方面穿髓孔下修复性牙本质形成，封闭穿髓点——成功（术后2个月左右）牙髓组织慢性炎症，出现疼痛症状；牙髓钙化或内吸收——失败PrognosisandConversion预后和转归Reportedprognosisisintherangeof80%年轻恒牙直接盖髓术后冠髓感染可试行活髓切断术Follow-up定期复查判断疗效Electricpulptesting,thermaltesting,palpationtests,andpercussiontestsshouldbecarriedoutat3weeks;3,6,and12months;andyearlythereafter.IndirectPulpCapping间接盖髓术（P.206）原理窝洞中遗留的少量细菌被盖髓剂覆盖，及细菌产酸所需的底物被隔绝而大幅度下降，Ca(OH)2可维持局部的碱性环境，有利于修复性牙本质的形成。Indication适应证Deepcariouslesion深龋保存去龋净未见穿髓、外伤造成的近髓患牙可复性牙髓炎诊断性治疗：hasnohistoryofspontaneouspainandrespondnormallytovitalitytests无明显自发痛的慢性牙髓炎和可复性牙髓炎的鉴别IndirectPulpCappingInanindirectpulpcappingprocedure,demineralizeddentinisremovedintheperipheryofthepreparation,butasmallamountofdemineralizeddentinisleftimmediatelyovertheareaofthepulp.Acalciumhydroxideliningmaterialisplacedtocovertheremainingdemineralizeddentin.Asealinglinerand/orasealingrestorationisthenplacedtosealoutbacteriaandtheirby-products.Procedure1.Isolation2.Preparation3.Lining4.RestorationPulpotomy活髓切断术(P.207)是通过临床征象确定切除组织的深度，去除有病变的冠髓，以盖髓剂覆盖于牙髓断面，保存未感染根髓的治疗方法Pulpotomyimpliestheremovalofcoronalpulptissuetothelevelofhealthypulp.Indication适应证外伤性露髓慢性牙髓炎意外穿髓孔较大（0.5mm），破坏髓室壁、髓室顶者根尖孔发育未完成的年轻恒牙Follow-up定期复查判断疗效术后2～4年内定期复查牙髓坏死、钙化、内吸收是直接盖髓术、牙髓切断术后潜在的并发症，影响日后的桩钉固位修复，故一旦根尖孔发育完成，即行常规根管治疗术Emergencytreatment应急处理(P.213)Establishproperaccesstoallcanals.IrrigatethoroughlywithNaOCl.Debridepulpchamber.Debridethecoronalandmiddleportionsoftherootcanalwithk-files,Hedstromfiles,orbroaches,andusecopiousNaOClirrigation,makingsurenottopenetratetheapical2to3mmofthecanal.Temporarilysealtheaccessopening.Useanalgesicsasnecessary.Thisplanofactionmaybeundertakendependingonthetimeavailablefortheemergencycare:SummaryofTreatmentofDentalPainPulpalpain-irreversiblepulpitis1.Accesscavityanddebridement2.AdjustSummaryofTreatmentofDentalPainPeriodontal(apical)pain-acuteexacerbationofchroniclesionNoobviousswelling（acuteapicalperiodontitis）1.Debridement2.RCTa.s.a.p.Localswelling（acuteapicalalveolarabscess）1.Debridementtoallowmaximumdrainage2.Cleancanal3.Inciseiffluctuant4.RCTa.s.a.p.Localswellingand“cellulitis”1.Treatmentasabove2.Antibiotictherapy3.Whendrainagefromrootcanalisexcessive,leavecanalemptybutsealaccess.Reviewwithin48hours4.Irrigatewithcopiousamountofsodiumhypochloriteirrigation5.RCTa.s.a.p.EmergencyTreatment确诊后给予正确的应急处理EmergencyTreatment手固定患牙减轻疼痛，尽量减少钻磨震动InciseandDraintheSwelling切开排脓确诊和把握切开排脓的时机非常重要