牙体牙髓学龋病的治疗课件.ppt

1、牙体牙髓学龋病的治疗Operative dentistry is the art and science of the diagnosis,treatment,and prognosis of defects of teeth which do not require full coverage restorations for correction.enamel pulpodentinal complex 避开承受咬合力的部位Black in 1908surfaces of different orientation.尽量不做预防性扩展Periodontal间断操作，锋利器械，冷却Cavit

2、ies on occlusal surface;Cavities on the incisal edge of anterior teeth or the occlusal cusp heights of posterior teeth are Class VI.refraction cordAll pit and fissure cavities are Class I.牙齿部位，窝洞部位和咬合力，病人情况，其他因素Cavosurface angle:the angle of toothcementumPeriodontal 牙体修复原则n去净龋坏牙体组织n保守治疗的原则n抗力形和固位形充填

3、材料的选择n性能要求n 物理和机械，化学，生物学n选择要点n 牙齿部位，窝洞部位和咬合力，病人情况，其他因素 The mechanical alteration of a defective,injured,or diseased tooth in order to best receive a restorative material which will re-establish a healthy state for the tooth including esthetic corrections where indicated,along with normal form and fu

4、nction.nCavities may be classified according to the location where the carious lesion beginsnClass nClass nClass nClass nClass nClass G.V.Black in 1908 All pit and fissure cavities are Class I.Cavities on occlusal surface;Cavities on occlusal two-thirds of the facial and lingual surfaces of molars;C

5、avities on lingual surface of maxillary incisor.A cavity occurring on the proximal surface of posterior teeth are Class II.MO mesial and occlusal DO distal and occlusal MOD mesial,occlusal and dista nCavities on the proximal surfaces of anterior teeth that do not involve the incisal angles are Class

6、 III.圆滑曲线只需去除感染牙本质（崩解层和透入层）Cavosurface angle:the angle of tooth以病变为基础Soft tissue injury caused by instruments三、尽量保留健康牙体组织structure formed by the junction ofMOD mesial,occlusal and distaThe outline form is determined by the size and shape of the carious lesion and by the need for a suitable design th

7、at will hold a restoration firmly in place.surfaces of different orientation along a line.Compound cavity:two surfaces are只需去除感染牙本质（崩解层和透入层）Line angle:the junction of the two planalCavities on the incisal edge of anterior teeth or the occlusal cusp heights of posterior teeth are Class VI.All pit and

8、 fissure cavities are Class I.Periodontal釉质成形术 enameloplastynCavities on the proximal surfaces of anterior teeth that do involve the incisal angles are Class IV.nCavities on the gingival third of the facial or lingual surfaces of all teeth (not pit and fissure cavities)are Class V.nCavities on the i

9、ncisal edge of anterior teeth or the occlusal cusp heights of posterior teeth are Class VI.Simple cavity:only one tooth surface is involved.Compound cavity:two surfaces are involved.Complex cavity:three or more surfaces are involved.nwalls nangles ncavity Internal walls:a prepared cavity surface tha

10、t does not extend to the external tooth surface.Axial walls:an internal wall parallel with the long axis of the tooth and occlusal of the tooth.Pulpal walls:an internal wall that is both perpendicular to the long axis of the tooth and occlusal of the pulp.a side or surface of the cavity preparation

11、that aids in enclosing the restorative material.External walls:a prepared cavity surface that extend to the external tooth surface.The external walls takes the name ofthe tooth surface that the wall is toward.Line angle:the junction of the two planal surfaces of different orientation along a line.Po

12、int angle:the junction of three planal surfaces of different orientation.Cavosurface angle:the angle of tooth structure formed by the junction of a prepared cavity wall and the external surface of the tooth.Also referred to as the cavity margin or cavosurface margin.Resistance Formn定义n洞深：n盒状洞形n阶梯结构n

13、窝洞外形n去除无机釉n薄壁弱尖的处理Retention formnLateral retentionnundercutndovetailntrapezianadhesive深龋的治疗n原则：n正确判断牙髓状况治疗方法n垫底充填n安抚治疗间接盖髓术治疗方案龋病类型龋病类型软龋能否去净软龋能否去净牙髓状况牙髓状况治疗方案治疗方案根面龋n保守治疗n充填治疗窝洞预备的基本原则nRemoval of Remaining CariesnWhen the dentin has a firm feel with the explorer,removal of the tooth structure shoul

14、d cease,even if stained dentin remains.n只需去除感染牙本质（崩解层和透入层）n根据硬度和着色两个标准来判断n二、保护牙髓组织n 间断操作，锋利器械，冷却n 不向髓腔加压n 了解解剖结构、增龄变化n三、尽量保留健康牙体组织n 最小程度扩展洞形n 龈缘位置n 尽量不做预防性扩展n 釉质成形术 enameloplasty n注意患者全身状况窝洞预备基本步骤nThe design of the cavity preparation for either a tooth with initial caries or replacement restoration

15、is based on the location of the caries,the amount and extent of the caries,the amount of lost tooth structure,and the restorative material to be used.n一、预备洞形n1、开阔洞口及进入病变区：不同窝洞进入通道的选择n2、设计预备洞的外形n 以病变为基础n 扩展n 避开承受咬合力的部位n 圆滑曲线nThe dentist must establish an outline form,which determines the overall shap

16、e of the preparation along the cavity margins of the restoration and the tooth surfaces.The outline form is determined by the size and shape of the carious lesion and by the need for a suitable design that will hold a restoration firmly in place.邻面的颊舌洞缘位置在规定的深度扩展洞形n3、抗力形和固位形n4、Finishing the Enamel W

17、alls and Margins nThis is a process of angling,beveling,and smoothing the walls of the cavity preparation to achieve the best marginal seal possible between the restorative material and tooth structure.The dentist may use burs,diamond stones,or hand-cutting instruments(chisels,hoes,hatchets,and ging

18、ival margin trimmers)to complete the walls by removing loose or unsupported enamel to create the strongest possible enamel wall.n5、无痛制洞法n 锋利器械，正确手法n 局部麻醉 anesthesian 化学机械去龋 n二、术区隔离n 棉卷隔离Reasons for use of rubber damnProtection aspiration or swallowing of instruments or irrigants Soft tissue injury c

19、aused by instruments nEfficiency Improve visibility(dry field and reduced mirror fogging)Minimize patient conversation Minimize the need for frequent rinsingnReduced risk of cross-contamination nLegal considerations选择性辅助隔离法：refraction cordmouth prop n三、窝洞消毒n CAVITY LINERS AND BASES are used primaril

20、y to protect the pulp and to aid the pulp in recovering from irritation resulting from cavity preparation.n 1、窝洞封闭：洞漆、树脂粘结剂n 2、衬洞：隔绝化学和温度刺激n 常用洞衬剂n 3、垫底：隔绝温度、化学、电流及机械刺激。常用材料n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n垫底的部位银汞合金修复术适应症n、类洞n后牙类洞n美观要求不高，尖牙远中邻面洞n配合附加固位钉n冠修复前的牙体充填窝洞预备n洞形要求n、类洞不同洞形的制备要求银汞合金充填n护髓n成形片和楔子n填充材料：少量分次，层层加压n雕刻成形n调整咬合n打磨抛光：24小时完全硬固并发症n意外穿髓n疼痛n 牙髓性n 牙周性n充填体折断谢谢观看谢谢观看谢谢观看谢谢观看