牙髓病和根尖周病治疗概述（p189）课件

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1、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CaseAnaly

2、sis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Sa

3、livaevacuatorSalivaejectorsPainControl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

4、.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IndirectPulpCap

5、ping（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!Thesecal

6、ciumionspresentinthedentinbridgecomefromthesystemiccirculation,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MineralTrioxideAgg

7、regate(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现的患牙DirectPulpCappingFor

8、adirectpulpcappingprocedure,acalciumhydroxideliningmaterialisplacedontheexposedpulpaltissueandasmallamountofsurroundingdentin.Asealinglinerand/orasealingrestorationisthenplacedtosealoutbacteriaandtheirby-products.Factorsthataffectoutcomeofpulpcapping