口腔医学牙折的病因及治疗方法课件

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1、牙折toothfracture病因外力直接撞击,咀嚼咬到沙石、碎骨等硬物。beimpactedbyforce,bitinghardfood.Etiology临床表现Cliniccharacteristics按部位分:冠折Crownfracture根折Rootfracture冠根联合折Crown-rootfracture按损伤和牙髓关系分:露髓不露髓冠折crownfracture前牙:横折、斜折Anteriortooth:horizontalorinclined后牙:斜折、纵折Posteriorteeth:inclinedorvertical根折rootfrac

2、ture颈1/3、根中1/3、根尖1/3cervix-thirds,middle-thirds,apical-thirds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。无根折外伤恒牙牙髓坏死率为38％～59％根折牙牙髓坏死率为20％～24％，断端间隙利于炎症引流。X片是诊断根折的重要依据Diagnosiscanbecarriedoutbyradiographicexamination冠根折crown-rootfracture以斜行多见，牙髓常暴露。Thefracturewilloftenbeinclinedwithpulpexp

3、osure治疗Treatment缺损少牙本质未暴露，磨光锐边。冠折crownfractureWithoutdentinexposure,selectivegrindingoftheincisaledgeissufficient.牙本质暴露敏感者，盖髓树脂修复。CoverwithCa(OH)2andcompositeresinrestorationifdentinisexposeandsensitive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。Incaseofapulpexposure,pulpectomyisindicatedifth

4、erootapicalisdeveloped,pulpotomyissufficientiftherootapicalisdeveloping.根折rootfracture根中1/3折，根尖1/3折middle-thirds,apical-thirds用夹板固定三个月，如牙冠端有错位，在固定前应复位。Repositionthecoronalfragmentandusesplintingfor3months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。Checkforpulpalcomplicationsaf

5、ter1month,3months,6monthsand12months.Ifpulpnecrosisoccurs,rootcanaltherapyshouldbedone.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-thirdsfracture:rootcanaltherapyshouldbedoneIffracturesurfaceabovegingivallevel,apost-retainedfullcrownisfabricatedafterRCT.断端在龈下牙槽骨上，龈切暴露断面桩核冠修复。Fracturesurfac

6、ebetweengingivalandalveolar:apost-retainedcrownisfabricatedaftergingivectomyexposethefracturesurface.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。Iffracturesurfaceis4mmbelowthealveolarandtherootlengthisenough,surgicalororthodonticextrusionoftheroot,tomovethefracturesurfacetoamoreoptimallocati

7、onforfinalrestoration树脂夹板固定Compositeresinsplint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ConnectivetissuehealingThefragmentisseparatedbychronicinflammationtissueCalcifiedhealingHard-connectivetissueunionhealingHealingofrootfracture冠根联合折crown-rootfracture：可作根管治疗，具备桩核冠修复的冠根联合折，应保留。Thetoot

8、hwithcrown-rootfrac