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1、,tooth fracture,http:/,外力直接撞击,咀嚼咬到沙石、碎骨等硬物。be impacted by force,biting hard food.,Etiology,http:/,Clinic characteristics,按部位分:,冠折,Crown fracture,根折,Root fracture,冠根联合折,Crown-root fracture,http:/,按损伤和牙髓关系分:,露髓,不露髓,http:/,冠折 crown fracture,前牙:横折、斜折,Anterior tooth:horizontal or inclined,http:/,后牙:斜折、纵折
2、,Posterior teeth:inclined or vertical,http:/,根折 root fracture,http:/,颈 1/3、根中 1/3、根尖 1/3,cervix-thirds,middle-thirds,apical-thirds,http:/,根折可有牙齿松动、叩痛、龈沟出血、粘膜触痛等。,有的早期无明显症状，数日后出现。,http:/,无根折外伤恒牙牙髓坏死率为 3859,根折牙牙髓坏死率为2024，断端间隙利于炎症引流。,http:/,X片是诊断根折的重要依据,Diagnosis can be carried out by radiographic exam
3、ination,http:/,冠根折 crown-root fracture,http:/,以斜行多见，牙髓常暴露。,The fracture will often be inclined with pulp exposure,http:/,治疗Treatment,缺损少牙本质未暴露，磨光锐边。,冠折 crown fracture,Without dentin exposure,selective grinding of the incisal edge is sufficient.,http:/,http:/,牙本质暴露敏感者，盖髓树脂修复。,Cover with Ca(OH)2 and c
4、omposite resin restoration if dentin is expose and sensitive,http:/,牙髓暴露，牙根发育完成者行活髓摘除术，牙根发育未完成者行活髓切断术。,In case of a pulp exposure,pulpectomy is indicated if the root apical is developed,pulpotomy is sufficient if the root apical is developing.,http:/,根折 root fracture,根中1/3折，根尖1/3折middle-thirds,apica
5、l-thirds,用夹板固定三个月，如牙冠端有错位，在固定前应复位。,Reposition the coronal fragment and use splinting for 3 months,http:/,http:/,在治疗后1、3、6、12个月定期复查牙髓的活力状况，一旦发现牙髓有炎症或坏死趋势，则应作根管治疗术。,Check for pulpal complications after 1 month,3 months,6 months and 12 months.If pulp necrosis occurs,root canal therapy should be done.,h
6、ttp:/,颈1/3折断：均先行根管治疗,断端在龈上，根管治疗后桩核冠修复,Cervix-thirds fracture:root canal therapy should be done,If fracture surface above gingival level,a post-retained full crown is fabricated after RCT.,http:/,断端在龈下牙槽骨上，龈切暴露断面桩核冠修复。,Fracture surface between gingival and alveolar:a post-retained crown is fabricated
7、 after gingivectomy expose the fracture surface.,http:/,断端在牙槽骨下4mm，牙根较长，可手术或正畸方法牵引后，桩核冠修复。,If fracture surface is 4mm below the alveolar and the root length is enough,surgical or orthodontic extrusion of the root,to move the fracture surface to amore optimal location for final restoration,http:/,树脂夹
8、板固定,Composite resin splint,http:/,根折的转归,钙化性愈合,结缔组织性愈合,骨、结缔组织联合愈合,断端被慢性炎症组织分开,Connective tissue healing,The fragment is separated by chronic inflammation tissue,Calcified healing,Hard-connective tissue union healing,Healing of root fracture,http:/,冠根联合折crown-root fracture：,可作根管治疗，具备桩核冠修复的冠根联合折，应保留。,T
9、he tooth with crown-root fracture which can be restored by a post retained full crown should be saved to receive RCT,http:/,牙根纵裂,vertical root fracture,发生在牙根的纵裂,未波及牙冠者。,Vertical root fracture,not involving the crown.,http:/,病因,慢性持续性的创伤合力,牙根发育缺陷,无髓牙,Etiology,Chronic durative traumatic occlusal force,
10、Defect of root development,Pulpless tooth,http:/,无髓牙,Pulpless tooth,内因：牙本质脱水，失去弹性，牙变 脆，致使牙抗折力降低。,外因：,侧方加压充填根管,桩或桩核修复,其他,http:/,临床表现,X线检查对诊断牙根纵裂有重要意义,Diagnosis can be carried out by radiographic examination,Clinic characteristics,http:/,http:/,治疗,Treatment,松动明显，牙周破坏严重或单根牙的牙根纵裂，均应拔除。,The tooth should
11、be extracted if it is very loose or of severe periodontal lesion or vertical root fracture in single rooted tooth.,http:/,牙周病损局限且牙稳固的磨牙，可在根管治疗后行牙半切术或截根术。,Tooth hemiresection or root resection is performed after RCT if the molar is steady and of limited periodontal lesion.,http:/,牙半切术tooth hemiresect
12、ion,截根术root resection,http:/,慢性损伤,磨损,楔状缺损,磨牙症,牙隐裂,酸蚀症,第七章 牙体慢性损伤,http:/,_ _ _,楔状缺损是牙齿唇、颊颈部硬组织缓慢磨耗所致，因该缺损常呈楔状而得名。,Wedge-shaped defect is caused by tardy abrasion of buccal cervix hard tissues.,http:/,刷牙不当,牙颈部结构,Structure of tooth cervix,Improper teeth brushing,Etiology,http:/,酸作用,牙体组织疲劳,Acid erosion,
13、Weariness of hard tissues,http:/,由23个平面组成，坚硬光滑，为牙本色。,Usually have 2 or 3 surfaces,hard and smooth,tooth-like color。,Clinic characteristics,http:/,根据缺损程度分浅型、深型和穿髓3型,前磨牙好发，常左右对称，有牙龈退缩,随年龄增长，楔状缺损有增加趋势,Be classified with shallow,deep and pulp exposure according to the depth of the lesion,Most commonly o
14、ccur on the buccal surface of bicuspids symmetrically and accompany with gingival recession,The sizes of abrasions increase with age,http:/,改正刷牙方法,牙体缺损少无牙本质过敏，不需处理。,Correct tooth brushing,Treatment and prevention,Careful observation if there is no tooth sensitivity and the lesions are small,http:/,有
15、牙本质过敏，可用药物、激光等脱敏。,牙体缺损多，可充填修复。,Fillings if the lesions are extension,Desensitization with medicine or laser if there is dentin hypersensitive,http:/,牙髓感染或根尖病变时，作髓病或根管治疗。,缺损导致牙齿横折时，根据情况作根管治疗或拔除。,Root canal therapy is performed if there is pulpitis or periapical periodontitis.,Root canal therapy or ex
16、traction are performed if tooth fracture is occurred.,http:/,牙隐裂,cracked tooth,又称不全牙裂或牙微裂，指牙冠表面非生理性细小裂纹。,Fine non-physiological crack on the surface of the crown,http:/,病因,牙齿结构薄弱环节,牙尖斜度大,创伤合力,Weak tache of tooth structure,Big cuspid pitch,Traumatic occlusal force,Etiology,http:/,临床表现,隐裂牙发生于上颌磨牙最多，其次
17、是下颌磨牙，第一磨牙多于第二磨牙。,Clinic characteristics,Most commonly occur on maxillary molar,and secondly on mandibular molar.The crack occurs on first molar is more than that on second molar.,http:/,隐裂线,上颌,下颌,mandibular,maxillar,Cracked line,http:/,表浅者无症状，较深时，遇冷热刺激敏感或咬合不适。,深隐裂有牙髓炎症状和定点咀嚼痛。,隐裂线,碘酊等可渗入隐裂处,探针撬动隐裂处
18、有疼痛感，棉签置可疑牙尖上咬合，有撕裂样疼痛。,http:/,治疗,调合,113,均衡合力,处理隐裂牙,Treatment,Occlusal adjustment,Balance occlusal force,Treat the cracked tooth,http:/,第八章牙本质过敏症,牙本质过敏症（dentine hypersensitivity）又称过敏性牙本质（hypersensitive dentine），是牙齿受到外界刺激，引起的酸痛症状。,不是一种独立疾病，是各种牙病共有症状。,115,http:/,病因,使牙本质暴露的各种原因,与牙本质暴露的时间、修复性牙本质形成快慢有关。,
19、不是所有牙本质暴露的牙齿都有症状,牙本质暴露还不能解释所有临床表现,Etiology,http:/,发病机理 Pathogenesis,1.神经学说：牙本质中存在牙髓神经末梢，感觉可由牙本质表层传导入牙髓,前期牙本质,管间牙本质,管周牙本质,2.牙本质纤维传导学说：成牙本质细胞原浆突中含有乙酰胆碱酶，它在受刺激后引起神经传导，产生疼痛,3.流体动力学：外界刺激使牙本质小管内液体移动搅动了牙髓内容物，间接兴奋游离神经末稍，传入冲动产生痛觉,http:/,临床表现和诊断,温度试验,探诊,Clinic characteristics and diagnosis,Exploration,Tempera
20、ture test,http:/,石川修三的评定标准,0度：冷刺激和机械刺激无疼痛,1度：可诱发疼痛，但疼痛较轻微,2度：可诱发可以忍受的疼痛,3度：可诱发难以忍受的疼痛,http:/,主观评价,Subjective evaluation,疼痛3级评判法,数字化疼痛评判法,Verbal rating scale,VRS,Visual analogue scale,VAS,http:/,治疗,封闭牙本质小管，减少或避免牙本质内液体流动。,Treatment,Seal the dentinal tubule to decrease or avoid the flowing of the liqui
21、d inside dentin,http:/,氟化物,氯化锶,氟化氨银,碘化银,其他药物,药物治疗,medication,树脂类脱敏剂,http:/,激光治疗,修复治疗,Laser,Restoration,http:/,磨 损,Abrasion,由于单纯机械摩擦作用而造成的牙体硬组织慢性磨耗称为磨损。,http:/,临床表现,Clinic characteristics,咀嚼磨损,非咀嚼磨损,http:/,http:/,病理变化,磨损,牙本质暴露,修复性牙本质,牙髓腔体积缩小,Pathological change,http:/,生理意义,均匀适宜的磨损对牙周组织的健康有重要意义,Physio
22、logical meaning,http:/,并发症,牙本质过敏症,食物嵌塞,牙髓和根尖周病,颞下颌关节紊乱病,创伤合,创伤性溃疡,Syndrome,http:/,治疗,生理性磨损，如无症状无需处理。,去除和改正引起病理性磨损的原因,有牙本质过敏者，作脱敏处理。,Treatment,http:/,不均匀磨损需调合。,导致牙髓和根尖周病时，按常规进行牙髓病、根尖周病治疗。,有食物嵌塞者，应恢复点接触和重建合面溢出沟。并发颞下颌关节紊乱病,应作覆盖义齿修复。,http:/,磨 牙 症,Bruxism,睡眠时有习惯性磨牙或白昼也有无意识磨牙习惯者，称为磨牙症。,http:/,发病因素,心理因素,合不
23、协调,全身因素,职业,Etiology,http:/,临床表现,Clinic characteristics,磨牙型,紧咬型,混合型,http:/,治疗,去除致病因素,合板的应用,调磨咬合,修复治疗,肌电反馈治疗,治疗各种并发症,Treatment,http:/,酸 蚀 症,Erosion,酸雾或酸酐作用与牙而造成的牙硬组织损害称为酸蚀症。,http:/,病 因,主要由无机酸，如盐酸、硝酸等所致，其中以盐酸的危害最大。,Etiology,http:/,临床表现,最初仅有感觉过敏，进而产生实质缺损。,多发生于前牙唇面。,酸蚀的形式因酸而异。,Clinic characteristics,http:/,http:/,治疗和预防,Treatment and prevention,改善劳动条件,局部药物脱敏,缺损严重者可充填法、修复法处理。,并发牙髓病变者，应先作牙髓病治疗。,http:/,
