牙髓病和根尖周病治疗概述（p189）_2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CaseAnalysis病例选择BasisforSuccessfulE

2、ndodonticMedicalHistory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LocalAnest

3、hesia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PulpCappingPulpc

4、appingisdefinedas“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

5、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

6、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

7、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DirectPulpCappingForadirectpulpcappingprocedure,acalciumhydroxideliningmaterialisplacedontheexposedpulpaltissueandasmallamountofsurroundingdentin.Asealinglinerand/orasealingrestorationisthenplacedtoseal

8、outbacteriaandtheirby-products.Factorsthataffectoutcomeofpulpcapping