牙体牙髓学龋病的治疗课件

牙体牙髓学龋病的治疗牙体牙髓学龋病的治疗1Operative 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.Operative DentistryOperative d2enamelenamel3 pulpodentinal complex pulpodentinal complex4 牙体牙髓学龋病的治疗课件5避开承受咬合力的部位Black in 1908surfaces of different orientation.尽量不做预防性扩展Periodontal间断操作，锋利器械，冷却Cavities on occlusal surface;Cavities on the incisal edge of anterior teeth or the occlusal cusp heights of posterior teeth are Class VI.refraction cordAll pit and fissure cavities are Class I.牙齿部位，窝洞部位和咬合力，病人情况，其他因素Cavosurface angle:the angle of toothcementum避开承受咬合力的部位cementum6Periodontal Periodontal 7牙体修复原则n去净龋坏牙体组织n保守治疗的原则n抗力形和固位形牙体修复原则去净龋坏牙体组织8充填材料的选择n性能要求n 物理和机械，化学，生物学n选择要点n 牙齿部位，窝洞部位和咬合力，病人情况，其他因素充填材料的选择性能要求9牙体牙髓学龋病的治疗课件10Cavity 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.Cavity Preparation The m11 Classification of cavity nCavities may be classified according to the location where the carious lesion beginsnClass nClass nClass nClass nClass nClass G.V.Black in 1908 Classification of cavity Cav12Class 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.Class I All pit and fissure13牙体牙髓学龋病的治疗课件14Class 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 Class II A cavity oc15牙体牙髓学龋病的治疗课件16牙体牙髓学龋病的治疗课件17Class IIInCavities on the proximal surfaces of anterior teeth that do not involve the incisal angles are Class III.Class IIICavities on the proxi18圆滑曲线只需去除感染牙本质（崩解层和透入层）Cavosurface angle:the angle of tooth以病变为基础Soft tissue injury caused by instruments三、尽量保留健康牙体组织structure formed by the junction ofMOD mesial,occlusal and distaThe 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.surfaces of different orientation along a line.Compound cavity:two surfaces are只需去除感染牙本质（崩解层和透入层）Line angle:the junction of the two planalCavities on the incisal edge of anterior teeth or the occlusal cusp heights of posterior teeth are Class VI.All pit and fissure cavities are Class I.Periodontal釉质成形术 enameloplasty圆滑曲线19Class IVnCavities on the proximal surfaces of anterior teeth that do involve the incisal angles are Class IV.Class IVCavities on the proxi20牙体牙髓学龋病的治疗课件21Class VnCavities on the gingival third of the facial or lingual surfaces of all teeth (not pit and fissure cavities)are Class V.Class VCavities on the gingiva22牙体牙髓学龋病的治疗课件23Class VInCavities on the incisal edge of anterior teeth or the occlusal cusp heights of posterior teeth are Class VI.Class VICavities on the incisa24牙体牙髓学龋病的治疗课件25 Cavity Simple cavity:only one tooth surface is involved.Compound cavity:two surfaces are involved.Complex cavity:three or more surfaces are involved.Cavity Simple cavity:only on26牙体牙髓学龋病的治疗课件27Cavity Structure nwalls nangles ncavity Cavity Structure walls 28Walls 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.Walls Internal walls:a prep29Walls 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.Walls External walls:a prepar30牙体牙髓学龋病的治疗课件31Angles Line angle:the junction of the two planal surfaces of different orientation along a line.Angles Line angle:the junc32Angles Point angle:the junction of three planal surfaces of different orientation.Angles Point angle:the juncti33牙体牙髓学龋病的治疗课件34Angles 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.Angles Cavosurface angle:the 35牙体牙髓学龋病的治疗课件36Resistance Formn定义n洞深：n盒状洞形n阶梯结构n窝洞外形n去除无机釉n薄壁弱尖的处理Resistance Form定义37牙体牙髓学龋病的治疗课件38Retention formnLateral retentionnundercutndovetailntrapezianadhesiveRetention formLateral retentio39牙体牙髓学龋病的治疗课件40牙体牙髓学龋病的治疗课件41牙体牙髓学龋病的治疗课件42牙体牙髓学龋病的治疗课件43深龋的治疗n原则：n正确判断牙髓状况深龋的治疗原则：44牙体牙髓学龋病的治疗课件45牙体牙髓学龋病的治疗课件46治疗方法n垫底充填治疗方法垫底充填47n安抚治疗安抚治疗48间接盖髓术间接盖髓术49治疗方案龋病类型龋病类型软龋能否去净软龋能否去净牙髓状况牙髓状况治疗方案治疗方案治疗方案龋病类型软龋能否去净牙髓状况治疗方案50根面龋根面龋51牙体牙髓学龋病的治疗课件52n保守治疗保守治疗53n充填治疗充填治疗54牙体牙髓学龋病的治疗课件55牙体牙髓学龋病的治疗课件56窝洞预备的基本原则nRemoval of Remaining CariesnWhen the dentin has a firm feel with the explorer,removal of the tooth structure should cease,even if stained dentin remains.n只需去除感染牙本质（崩解层和透入层）n根据硬度和着色两个标准来判断窝洞预备的基本原则Removal of Remaining 57牙体牙髓学龋病的治疗课件58n二、保护牙髓组织n 间断操作，锋利器械，冷却n 不向髓腔加压n 了解解剖结构、增龄变化二、保护牙髓组织59n三、尽量保留健康牙体组织n 最小程度扩展洞形n 龈缘位置n 尽量不做预防性扩展n 釉质成形术 enameloplasty 三、尽量保留健康牙体组织60牙体牙髓学龋病的治疗课件61n注意患者全身状况注意患者全身状况62窝洞预备基本步骤nThe 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.窝洞预备基本步骤63n一、预备洞形n1、开阔洞口及进入病变区：不同窝洞进入通道的选择一、预备洞形64牙体牙髓学龋病的治疗课件65n2、设计预备洞的外形n 以病变为基础n 扩展n 避开承受咬合力的部位n 圆滑曲线nThe 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.2、设计预备洞的外形66邻面的颊舌洞缘位置邻面的颊舌洞缘位置67在规定的深度扩展洞形在规定的深度扩展洞形68n3、抗力形和固位形3、抗力形和固位形69n4、Finishing the Enamel Walls and Margins nThis 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.4、Finishing the Enamel Walls a70n5、无痛制洞法n 锋利器械，正确手法n 局部麻醉 anesthesian 化学机械去龋 5、无痛制洞法71n二、术区隔离n 棉卷隔离二、术区隔离72Reasons for use of rubber damnProtectionaspiration or swallowing of instruments or irrigantsSoft tissue injury caused by instruments nEfficiencyImprove visibility(dry field and reduced mirror fogging)Minimize patient conversationMinimize the need for frequent rinsingnReduced risk of cross-contamination nLegal considerationsReasons for use of rubber damP73牙体牙髓学龋病的治疗课件74牙体牙髓学龋病的治疗课件75Four-handed dentistryFour-handed dentistryClose supportClose support四手操作四手操作四手操作四手操作Four-handed dentistry76选择性辅助隔离法：refraction cord选择性辅助隔离法：77mouth prop mouth prop78n三、窝洞消毒三、窝洞消毒79n CAVITY LINERS AND BASES are used primarily to protect the pulp and to aid the pulp in recovering from irritation resulting from cavity preparation.n 1、窝洞封闭：洞漆、树脂粘结剂n 2、衬洞：隔绝化学和温度刺激n 常用洞衬剂n 3、垫底：隔绝温度、化学、电流及机械刺激。常用材料 CAVITY LINERS AND BASES are u80n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n垫底的部位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81牙体牙髓学龋病的治疗课件82银汞合金修复术银汞合金修复术83适应症n、类洞n后牙类洞n美观要求不高，尖牙远中邻面洞n配合附加固位钉n冠修复前的牙体充填适应症、类洞84牙体牙髓学龋病的治疗课件85窝洞预备n洞形要求窝洞预备洞形要求86n、类洞不同洞形的制备要求、类洞不同洞形的制备要求87牙体牙髓学龋病的治疗课件88牙体牙髓学龋病的治疗课件89牙体牙髓学龋病的治疗课件90牙体牙髓学龋病的治疗课件91银汞合金充填n护髓n成形片和楔子银汞合金充填护髓92牙体牙髓学龋病的治疗课件93牙体牙髓学龋病的治疗课件94n填充材料：少量分次，层层加压填充材料：少量分次，层层加压95n雕刻成形雕刻成形96n调整咬合n打磨抛光：24小时完全硬固调整咬合97并发症n意外穿髓n疼痛n 牙髓性n 牙周性并发症意外穿髓98n充填体折断充填体折断99谢谢观看谢谢观看谢谢观看100谢谢观看谢谢观看谢谢观看101