chapter14-牙周牙髓联合病变-课件.ppt

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1、14牙周牙髓联合病变牙周牙髓联合病变Periodontal-Endodontic Combined Lesions14-1 牙周组织和牙髓的解剖通道牙周组织和牙髓的解剖通道Anatomical Interrelations of Peridontium and Pulp根尖孔根尖孔 Apical foramen根管侧支根管侧支Lateral root canal或副根管或副根管Accessory canal根尖1/3处最多根分叉区20-60%有The pulp was non-vital and the tooth was endodontically treated.After prosth

2、etic therapy(c),the 2-year follow-up radiograph in(d)shows bone fill in the previous angular bony defect,whereas the marginal bone remains at the same level.On careful examination one can see that a lateral canal communicating with the lateral bone defect was filled.牙本质小管牙本质小管 Dentinal tubules解剖异常解剖

3、异常 Anatomical abnormalities 腭侧沟 牙根外吸收 根裂14-2 牙周牙周-牙髓联合病变的临床类型牙髓联合病变的临床类型 Clinical Patterns of Periodontal-Endodontic Combined Lesions1，根尖感染经牙周组织途径排除，有人称之为逆行性牙根尖感染经牙周组织途径排除，有人称之为逆行性牙周炎周炎(retrograde periodontitis)牙髓根尖周病对牙周组织的影响牙髓根尖周病对牙周组织的影响 influence of endodontic lesions on the periodontiumperiodont

4、al ligament fistulation.此型在临床上易被误诊为牙周脓肿特点：特点：死髓牙 窄而深的牙周袋，无明显的牙槽嵴吸收 only a narrow opening of the fistula into the gingival sulcus/pocket and may not be detected unless careful probing of the sulcus is carried out at multiple sites.邻牙一般无严重的牙周炎 X片显示烧杯型或日晕型病变 after 18 M In multirooted teeth a periodonta

5、l ligament fistulation can drain off into the furcation area，牙髓治疗过程中或治疗后造成的牙周病变，牙髓治疗过程中或治疗后造成的牙周病变根管侧穿，髓室底穿，髓室或根管内的药物（砷戊二醛塑化液干髓剂等）During endodontic treatment,and in conjunction with preparation of root canals for the insertion of posts,instrumentation can accidentally cause perforation of the root a

6、nd wounding of the periodontal ligamentPerforation of the pulpal floor of the mandibular first molar occurred in conjunction with a search for root canal openings(a).The perforation was immediately sealed with gutta-percha(b).One month after treatment a slight radiolucency appeared at the perforatio

7、n site(arrow)in the periodontium(c).After an observation period of 2 years,normal periodontal conditions were re-established both clinically and radiographicallyRCT治疗后可发生牙根纵裂治疗后可发生牙根纵裂:主要由于扩根过度主要由于扩根过度,桩核不当桩核不当,过大合力过大合力等等共同特点共同特点:牙髓无活力牙髓无活力病变局限于单个牙，局限于患牙的局部病变局限于单个牙，局限于患牙的局部病变呈烧杯状，病变呈烧杯状，邻牙基本正常邻牙基本正常

8、Vertical root fracture结局结局:Vertical root fractures that involve the gingival sulcus/pocket area usually have a hopeless prognosis due to continuous bacterial invasion of the fracture space from the oral environment.External Root resorption Replacement resorptionThis type of resorptive process result

9、s in a replacement of the dental hard tissues by bone,hence the name Replacement resorption and ankylosis are often used as synonyms.Clinically,ankylosis is diagnosed by absent tooth mobility and by a percussion tone that is higher than in a normal toothExternal inflammatory resorptionThe term exter

10、nal inflammatory resorption suggests the presence of an inflammatory lesion in the periodontal tissues adjacent to a resorptive process牙周病变对牙髓的影响牙周病变对牙髓的影响 Iinfluence of periodontal disease on the pulp1,逆行性牙髓炎 Retrospective pulpitis 2，长期存在的牙周病变：轻者 修复性牙本质 重者 炎症 变性 钙化 坏死 因牙周炎拔除的无龋牙，64%有牙髓的炎症或坏 死，与PD成正比 3，牙周治疗对牙髓的影响 Influence of periodontal treatment measures on the pulp2，逆行性牙髓炎主要看患牙能否保留牙髓初步治疗，如病变可以控制，牙髓牙周同时治疗