牙体牙髓学——龋病的治疗.pptx

Operative DentistryOperative 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.第1页/共102页enamel第2页/共102页 pulpodentinal complex第3页/共102页 第4页/共102页cementum第5页/共102页Periodontal 第6页/共102页牙体修复原则去净龋坏牙体组织保守治疗的原则抗力形和固位形第7页/共102页充填材料的选择性能要求 物理和机械，化学，生物学选择要点 牙齿部位，窝洞部位和咬合力，病人情况，其他因素第8页/共102页第9页/共102页Cavity Preparation 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 function.第10页/共102页 Classification of cavityClassification of cavity Cavities may be classified according to the location where the carious lesion beginsClass Class Class Class Class Class G.V.Black in 1908 第11页/共102页Class IClass I 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;Cavities on lingual surface of maxillary incisor.第12页/共102页第13页/共102页Class II Class II 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 第14页/共102页第15页/共102页第16页/共102页Class IIIClass IIICavities on the proximal surfaces of anterior teeth that do not involve the incisal angles are Class III.第17页/共102页第18页/共102页Class IVCavities on the proximal surfaces of anterior teeth that do involve the incisal angles are Class IV.第19页/共102页第20页/共102页Class VClass VCavities on the gingival third of the facial or lingual surfaces of all teeth (not pit and fissure cavities)are Class V.第21页/共102页第22页/共102页Class VIClass VICavities on the incisal edge of anterior teeth or the occlusal cusp heights of posterior teeth are Class VI.第23页/共102页第24页/共102页 Cavity Simple cavity:only one tooth surface is involved.Compound cavity:two surfaces are involved.Complex cavity:three or more surfaces are involved.第25页/共102页第26页/共102页Cavity StructureCavity Structure walls angles cavity 第27页/共102页Walls Internal walls:a prepared cavity surface that 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 that aids in enclosing the restorative material.第28页/共102页Walls 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.第29页/共102页第30页/共102页Angles Line angle:the junction of the two planal surfaces of different orientation along a line.第31页/共102页Angles Point angle:the junction of three planal surfaces of different orientation.第32页/共102页第33页/共102页Angles 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.第34页/共102页第35页/共102页Resistance Form定义洞深：盒状洞形阶梯结构窝洞外形去除无机釉薄壁弱尖的处理第36页/共102页第37页/共102页Retention formLateral retentionundercutdovetailtrapeziaadhesive第38页/共102页第39页/共102页第40页/共102页第41页/共102页第42页/共102页深龋的治疗n原则：n正确判断牙髓状况第43页/共102页第44页/共102页第45页/共102页治疗方法垫底充填第46页/共102页安抚治疗第47页/共102页间接盖髓术第48页/共102页治疗方案龋病类型软龋能否去净牙髓状况治疗方案第49页/共102页根面龋第50页/共102页第51页/共102页保守治疗第52页/共102页充填治疗第53页/共102页第54页/共102页第55页/共102页窝洞预备的基本原则Removal of Remaining CariesWhen the dentin has a firm feel with the explorer,removal of the tooth structure should cease,even if stained dentin remains.只需去除感染牙本质（崩解层和透入层）根据硬度和着色两个标准来判断第56页/共102页第57页/共102页二、保护牙髓组织 间断操作，锋利器械，冷却 不向髓腔加压 了解解剖结构、增龄变化第58页/共102页三、尽量保留健康牙体组织 最小程度扩展洞形 龈缘位置 尽量不做预防性扩展 釉质成形术 enameloplasty 第59页/共102页第60页/共102页注意患者全身状况第61页/共102页窝洞预备基本步骤The design of the cavity preparation for either a tooth with initial caries or replacement restoration 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.第62页/共102页一、预备洞形1、开阔洞口及进入病变区：不同窝洞进入通道的选择第63页/共102页第64页/共102页2、设计预备洞的外形 以病变为基础 扩展 避开承受咬合力的部位 圆滑曲线The dentist must establish an outline form,which determines the overall shape 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.第65页/共102页邻面的颊舌洞缘位置第66页/共102页在规定的深度扩展洞形第67页/共102页3、抗力形和固位形第68页/共102页4、Finishing the Enamel Walls and Margins This 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 gingival margin trimmers)to complete the walls by removing loose or unsupported enamel to create the strongest possible enamel wall.第69页/共102页5、无痛制洞法 锋利器械，正确手法 局部麻醉 anesthesia 化学机械去龋 第70页/共102页二、术区隔离 棉卷隔离第71页/共102页Reasons for use of rubber damProtectionaspiration or swallowing of instruments or irrigantsSoft tissue injury caused by instruments EfficiencyImprove visibility(dry field and reduced mirror fogging)Minimize patient conversationMinimize the need for frequent rinsingReduced risk of cross-contamination Legal considerations第72页/共102页第73页/共102页第74页/共102页Four-handed dentistryFour-handed dentistryClose supportClose support四手操作四手操作第75页/共102页选择性辅助隔离法：refraction cord第76页/共102页mouth prop 第77页/共102页三、窝洞消毒第78页/共102页 CAVITY LINERS AND BASES are used primarily to protect the pulp and to aid the pulp in recovering from irritation resulting from cavity preparation.1、窝洞封闭：洞漆、树脂粘结剂 2、衬洞：隔绝化学和温度刺激 常用洞衬剂 3、垫底：隔绝温度、化学、电流及机械刺激。常用材料第79页/共102页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）垫底材料垫底的部位第80页/共102页第81页/共102页银汞合金修复术第82页/共102页适应症、类洞后牙类洞美观要求不高，尖牙远中邻面洞配合附加固位钉冠修复前的牙体充填第83页/共102页第84页/共102页窝洞预备洞形要求第85页/共102页、类洞不同洞形的制备要求第86页/共102页第87页/共102页第88页/共102页第89页/共102页第90页/共102页银汞合金充填护髓成形片和楔子第91页/共102页第92页/共102页第93页/共102页填充材料：少量分次，层层加压第94页/共102页雕刻成形第95页/共102页调整咬合打磨抛光：24小时完全硬固第96页/共102页并发症意外穿髓疼痛 牙髓性 牙周性第97页/共102页充填体折断第98页/共102页牙齿折裂第99页/共102页继发龋第100页/共102页患者，男，2岁，主诉：右下后牙冷刺激痛2周，无自发痛体检：颌面颊沟深龋，探诊（），质较硬，冷诊（），冷刺激去除疼痛快速缓解，叩诊（）。第101页/共102页