温医牙周基础治疗ppt课件

Chapter 14Initial TherapyChapter14Phasetherapyisthefirststepinthechronologicsequenceofproceduresthatconstituteperiodontaltreatment.TheobjectiveofPhasetherapyistoalteroreliminatethemicrobialetiologyandcontributingfactorsforgingivalandperiodontaldiseases.Theresultisthearrestingoftheprogressionofdiseaseandpreservationofthedentitioninastateofhealth,comfort,andfunctionwithappropriateesthetics.PhasetherapyisthefirststScetion 1 Plaque ControlPlaque control is the removal of dental plaque on aregularbasisandthepreventionofitsaccumulationontheteethandadjacentgingivalsurfaces.Itisacriticalcomponent of dental practice,permitting long-termsuccessofperiodontalanddentalcare.Plaquecontrolisthemosteffectivemeansofpreventingaccumulationofmicrobial dental deposits,thereby interfering with theinitiation,development,or progression of periodontaldisease.Scetion1PlaqueControlPlaqPatient Evaluation and EducationPhasemicroscopeDisclosingsolutionDisclosingtabletPatientEvaluationandEducati温医牙周基础治疗ppt课件温医牙周基础治疗ppt课件温医牙周基础治疗ppt课件Plaque IndexPlaque Control RecordPlaqueIndexPlaqueControlRecMethods:1.ToothbrushingBassmethodRollingmethodChartersmethodMethods:ToothbrushingTheBassmethodisapreferredmethodofbrushing.Itinvolvesplacingthetoothbrushheadata45degreeanglealongthegumline,pointingdownwardsonthebottomteethandupwardsonthetopteeth.Thetipsofthetoothbrushbristlesshouldgounderneaththegumline.Thetoothbrushisgentlyvibrated,notscrubbed,alongthegumlinespendingabout3secondsoneachtooth.Theentireprocessofbrushingshouldlast3-4minutes(aboutthelengthofonesongontheradio!)ToothbrushingTheBassmethoBassmethod.A,Placethetoothbrushsothatthebristlesareangledapproximatelyat45degreesfromthetoothsurfaces.B,Startatthemostdistaltoothinthearchanduseavibrating,back-and-forthmotiontobrush.ABBassmethod.A,PlacethetootABBassmethod.A,Properpositionofthebrushinthemouthaimsthebristletipstowardthegingivalmargin.B,Diagramsshowstheidealplacement,whichcouldpermitslightsubgingivalpenetrationofthebristletips.ABBassmethod.A,ProperpositBassmethod.Thecorrectpalatalpositiononmolarsandpremolarsiswiththebristletipsatthegingivalmarginasshowninthediagram,notontheocclusalsurfaces.Bassmethod.ThecorrectpalatBassmethod.Palatalpositionofthesofttoothbrushonthemolarsandpremolarspermitsbristletippenetrationintotheinterproximalareasandpossiblyslightlysubgingivally.Bassmethod.PalatalpositionBassmethod.Adjustingthepalatalpositionofthetoothbrushonincisors,asshowninthediagram,mayprovidebetteraccessforplaqueremoval.Bassmethod.AdjustingthepalBassmethod.Placementofthebristlesonthepalatalsurfacesoftheincisorteethcanbedifficultandoftenrequiresthismodifiedapproach.Bassmethod.PlacementoftheThisbrushpositiononocclusalsurfacesoftheteethisusedwithanytechnique,includingtheBass,Stillman,orChartersmethod.ThisbrushpositiononocclusaPlace bristles along the gumline at a 45-degree angle.Bristles should contact both the tooth surface and the gumline.Gently brush the outer tooth surfaces of 2-3 teeth using a vibrating back&forth rolling motion.Move brush to the next group of 2-3teeth and repeat.Maintain a 45-degree angle with bristles contacting the tooth surface and gumline.Gently brush using back,forth,and rolling motion along all of the inner tooth surfacesPlacebristlesalongthegumliTilt brush vertically behind the front teeth.Make several up&down strokes using the front half of the brush.Place the brush against the biting surface of the teeth&use a gentle back&forth scrubbing motion.Brush the tongue from back to front to remove odor-producing bacteria.Tiltbrushverticallybehindt2.Dental flossWrapmostoftheflossonthemiddlefingeroftherighthandandtherestaroundthemiddlefingerofthelefthand.Asyouareflossing,takeuptheflossontheotherfingerlikeascrollto provide fresh floss.Use indexfingers and thumbs as guides forflossing the upper teeth and indexfingersforthelowerteeth.Holdtheflosstightlyandworkitgentlybetweentheteeth.Beverycarefulnottosnaptheflossbetweenteethandundergumsbecausethiscanharmthedelicatetissue.2.DentalflossWrapmostofthCurvetheflossaroundthetoothandcarefullyworkitapically.Worktheflossintothesulcus.CurvetheflossaroundthetooHoldingtheflosstightlyagainstthetooth,scrapetowardthepointwherethetoothtouchesitsneighbor.Repeatthisstepontheadjacenttooth.Setapatternforflossing,andfollowthesamepatterneverytimesothatalltheteethareflossed.HoldingtheflosstightlyagaiWind 20cm of floss around middle fingers of each hand.Pinch floss between thumbs and index fingers,leaving a 11.5cm length in between.Use thumbs to direct floss between upper teeth.Keep a 11.5cm length of floss taut between fingers.Use index fingers to guide floss between contacts of the lower teethWind20cmofflossaroundmiddGently guide floss between the teeth by using a zig-zag motion.DO NOT SNAP FLOSS BETWEEN YOUR TEETH.Contour floss around the side of the tooth.Slide floss up and down against the tooth surface and under the gumline.Floss each tooth thoroughly with a clean section of flossGentlyguideflossbetweentheTriangulartoothpicksInterproximalbrushesYarnGauzestripsWaterirrigationdevicesElectrictoothbrushOther aids:TriangulartoothpicksOtheraidCleaningofconcaveorirregularproximaltoothsurfaces.Dentalfloss(A)maybelesseffectivethananinterdentalbrush(B)onlongrootsurfaceswithconcavities.CleaningofconcaveorirregulInterproximalembrasurespacesvarygreatlyinpatientswithperiodontaldisease.Ingeneral,embrasureswithnogingivalrecessionareadequatelycleanedusingdentalfloss(A);largerspaceswithexposedrootsurfacesrequiretheofaninterproximalbrush(B);andsingle-tuftedbrushescleanefficientlyininterproximalspaceswithnopapillae(C).Interproximalembrasurespaces3.Chemical Plaque ControlAdministration:1.Mouthwashes2.Dentifrices3.Chewinggums4.Syringesforpocketirrigation3.ChemicalPlaqueControlAdmiAgents:Tensioactiveagents(fluoride,1.64%SnF,siliconesetc)Antibiotics(tetracyclines,kanamycin,spiramycin,metronidazoleetc)Antiseptics(chloramineT,chlorhexidinesalts)Enzymes(dextranases,trypsin,lipase)DietarysubstancesAgents:Stainfollowingtwoweeksrinsingwith0.12%chlorhexidine.StainfollowingtwoweeksrinsDependingonthelocationofthecalculus,scalingisdividedintoeithersupragingivalorsubgingivalinstrumentation.Theobjectiveofsupragingivalscalingistheremovalofdepositsfromtheclinicalcrownsoftheteeth.Subgingivalscalingistheremovalofdepositsbelowthegingivalmargin.Section 3 Scaling and Root PlaningDependingonthelocationoft Definition:Scalingandrootplaningaretechniquesofinstrumentationappliedtotherootsurfacetoremoveplaque,calculus,andalteredorroughenedcementum.Whenthoroughlyperformed,thesetechniqueesleaveasmooth,clean,hard,andpolishedrootsurface.Definition:Goals:Thepurposeofscalingandrootplaningistoeliminatetheetiologicagentscausinginflammation,bacterialplaque,anditsproductsonandinthetooth,andcalculus.Goals:ThepurposeofscalingaRationale for root planning:Therationaleforplaningrootsurfacesistoremovecalculusandcementumcontainingendotoxinandtosmooththerootsurfaces.Rationaleforrootplanning:Applicability:1.Edematousandfibroticgingivae2.Phase1therapy3.Maintenancetherapy4.Preparationofprosthetic,orthodonticandoperativetherapyApplicability:EdematousandfiInstruments and instrumentationInstrumentsusedforscalingandrootplaningareclassifiedas:Handinstruments(curettes,sickles,hoes)Ultrasonicandsonicinstruments(ultrasonicscalers)InstrumentsandinstrumentatioSupragingival ScalingvSicklesvHoesSupragingivalScalingSicklesSubgingival ScalingvUniversalCurettesvGraceycurettesvHoesvFilesSubgingivalScalingUniversalGraceyCuretteUniversalCurettesAreaofuseSetofmanycurettesdesignedforspecificareasandsurfacesOnecurettedesignedforallareasandsurfacesCuttingEdgeUseOnecuttingedgeused;workwithouteredgeonlyBothcuttingedgesused;workwitheitherouterorinneredgeCurvatureCurvedintwoplanes:bladecurvesupandtothesideCurvedinoneplane:bladecurvesup,nottosideBladeangleOffsetblade:faceofbladebeveledat70degreestoshankNotoffset:faceofbladebeveledat90degreestoshankGraceyCuretteUniversalCurettGracey5/6:Foranteriorteeth;havelong,straightshanksGracey7/8:ForfacialandlingualsurfacesofposteriorteethGracey11/12:FormesialsurfacesofposteriorteethGracey13/14:FordistalsurfacesofposteriorteethGracey5/6:ForanteriorteetGracey#5-6curetteadaptedtoananteriortooth.Gracey#5-6curetteadaptedtoGracey#7-8curetteadaptedtothefacialsurfaceofaposteriortooth.Gracey#7-8curetteadaptedtoGracey#11-12curetteadaptedtothemesialsurfaceofaposteriortooth.Gracey#11-12curetteadaptedGracey#1314curetteadaptedtothedistalsurfaceofaposteriortooth.Gracey#1314curetteadaptedPrimer on InstrumentationGraspModified pen graspPalm graspFulcrumsWorking StrokeHand Position Patient/operator Position PrimeronInstrumentationGrasModifiedpengrasp.Thepadofthemiddlefingerrestsontheshank.Standardpengrasp.Thesideofthemiddlefingerrestsontheshank.Modifiedpengrasp.ThepadofPalm and thumb grasp,used for stabilizing instruments during sharpening.Palmandthumbgrasp,usedforThefulcrumisthestabilizingandpivotalpointfromwhichtheworkingstrokeusedinscalingandrootplaningcanoccur.ThefulcrumisthestabilizingBuilt-upfulcrumBuilt-upfulcrumSplitfulcrumSplitfulcrumIntraoralconventionalfingerrest.Thefourthfingerrestsontheocclusalsurfacesofadjacentteeth.Intraoralcross-archfingerrest.Thefourthfingerrestsontheincisalsurfacesofteethontheoppositesideofthesamearch.IntraoralconventionalfingerIntraoralopposite-archfingerrest.Thefourthfingerrestsonthemandibularteethwhilethemaxillaryposteriorteethareinstrumented.Intraoralfinger-on-fingerrest.Thefourthfingerrestsontheindexfingerofthenonoperatinghand.Intraoralopposite-archfingerExtraoralpalm-upfulcrum.Thebacksofthefingersrestontherightlateralaspectofthemandiblewhilethemaxillaryrightposteriorteethareinstrumented.Extraoralpalm-downfulcrum.Thefrontsurfacesofthefingersrestontheleftlateralaspectofthemandiblewhilethemaxillaryleftposteriorteethareinstrumented.Extraoralpalm-upfulcrum.TheIndexfinger-reinforcedrest.Theindexfingerisplacedontheshankforpressureandcontrolinthemaxillaryleftposteriorlingualregion.Thumb-reinforcedrest.Thethumbisplacedonthehandleforcontrolinthemaxillaryrightposteriorlingualregion.Indexfinger-reinforcedrest.Thecuretteblade.Thebackthirdisthatpartnearesttheshankoftheinstrument.Thetoethirdextendsfromtheroundedtipofthebladetoapproximatelyone-thirdthedistanceofthelengthoftheblade.Thecuretteblade.ThebackthBladeadaptation.A,Bladeinpropercontact.Thetoethirdofthebladeisused.B,Impropercontactofbackthirdofbladewithtooth,leadingtotissuelacerationbytoeofblade.C,Figureofthetipofthebladeadaptedtothetoothsurface,leadingtotissuedistentionandtoothgouging.Bladeadaptation.A,BladeinRootplaningstrokesaremultidirectional.RootplaningstrokesaremultiPatient-operator positioning Patient-operatorpositioningThepatientpositionissupineforaccesstothemaxillaryarch.Thebackofthepatientschairisraisedtoa30to40degreeangletothefloortoaccessthemandibulararch.ThepatientpositionissupineSubgingivalscalingprocedure.A,Curetteinsertedwiththefaceofthebladeflushagainstthetooth.B,Workingangulation(45to90degrees)isestablishedatthebaseofthepocket.C,Lateralpressureisapplied,andthescalingstrokeisactivatedinthecoronaldirection.Subgingivalscalingprocedure.Maxillary right posteriorsextant:facialaspectOperatorposition:Sideposition.Illumination:Direct.Visibility:Direct(indirectfordistalsurfacesofmolars).Retraction:Mirrororindexfingerofthenonoperatinghand.Fingerrest:Extraoral,palm up.Backsofthemiddleandfourthfingersonthelateralaspectofthemandibleontherightsideoftheface.MaxillaryrightposteriorsextMaxillary right posteriorsextant,premolarregiononly:facialaspectOperatorposition:Sideorbackposition.Illumination:Direct.Visibility:Direct.Retraction:Mirrororindexfingerofthenonoperatinghand.Fingerrest:Intraoral,palm up.Fourthfingerontheocclusalsurfacesoftheadjacentmaxillaryposteriorteeth.MaxillaryrightposteriorsextMaxillary right posteriorsextant:lingualaspectOperatorposition:Sideorfrontposition.Illumination:Directandindirect.Visibility:Directorindirect.Retraction:None.Fingerrest:Extraoral,palm up.Backsofthemiddleandfourthfingersonthelateralaspectofthemandibleontherightsideoftheface.MaxillaryrightposteriorsextMaxillary right posteriorsextant:lingualaspectOperatorposition:Frontposition.Illumination:Direct.Visibility:Direct.Retraction:None.Fingerrest:Intraoral,palm up,finger on finger.Indexfingerofthenonoperatinghandontheocclusalsurfacesofthemaxillaryrightposteriorteeth;fourthfingeroftheoperatinghandontheindexfingerofthenonoperatinghand.MaxillaryrightposteriorsextMaxillary anteriorsextant:facialaspect,surfaces away from the operatorOperatorposition:Backposition.Illumination:Direct.Visibility:Direct.Retraction:Indexfingerofthenonoperatinghand.Fingerrest:Intraoral,palm up.Fourthfingerontheincisaledgesorocclusalsurfacesofadjacentmaxillaryteeth.Maxillaryanteriorsextant:faMaxillary anteriorsextant:facialaspect,surfaces toward the operatorOperatorposition:Frontposition.Illumination:Direct.Visibility:Direct.Retraction:Indexfingerofthenonoperatinghand.Fingerrest:Intraoral,palm down.Fourthfingerontheincisaledgesortheocclusalorfacialsurfacesofadjacentmaxillaryteeth.Maxillaryanteriorsextant:faMaxillary anteriorsextant:lingualaspect,surfaces away fromtheoperator(surfacestowardtheoperatorarescaledfromafrontposition)Operatorposition:Backposition.Illumination:Indirect.Visibility:Indirect.Retraction:None.Fingerrest:Intraoral,palm up.Fourthfingerontheincisaledgesortheocclusalsurfacesofadjacentmaxillaryteeth.Maxillaryanteriorsextant:liMaxillary left posteriorsextant:facialaspectOperatorposition:Sideorbackposition.Illumination:Directorindirect.Visibility:Directorindirect.Retraction:Mirror.Fingerrest:Extraoral,palm down.Frontsurfacesofthemiddleandfourthfingersonthelateralaspectofthemandibleontheleftsideoftheface.MaxillaryleftposteriorsextaMaxillary left posteriorsextant:facialaspectOperatorposition:Backorsideposition.Illumination:Directorindirect.Visibility:Directorindirect.Retraction:Mirror.Fingerrest:Intraoral,palm up.Fourthfingerontheincisaledgesortheocclusalsurfacesofadjacentmaxillaryteeth.MaxillaryleftposteriorsextaMaxillary left posteriorsextant:lingualaspectOperatorposition:Frontposition.Illumination:Direct.Visibility:Direct.Retraction:None.Fingerrest:Intraoral,palm down,opposite arch,reinforced.Fourthfingerontheincisaledgesofthemandibularanteriorteethorthefacialsurfacesofthemandibularpremolars,reinforcedwiththeindexfingerofthenonoperatinghand.MaxillaryleftposteriorsextaMaxillary left posteriorsextant:lingualaspectOperatorposition:Front position.Illumination:Directandindirect.Visibility:Directandindirect.Retraction:None.Fingerrest:Extraoral,palm down.Frontsurfacesofthemiddleandfourthfingersonthelateralaspectofthemandibleontheleftsideoftheface.Thenonoperatinghandholdsthemirrorforindirectillumination.MaxillaryleftposteriorsextaMaxillary left posteriorsextant:lingualaspectOperatorposition:Sideorfrontposition.Illumination:Direct.Visibility:Direct.Retraction:None.Fingerrest:Intraoral,palm up.Fourthfingerontheocclusalsurfacesofadjacentmaxillaryteeth.MaxillaryleftposteriorsextaMandibular left posteriorsextant:facialaspectOperatorposition:Sideorbackposition.Illumination:Direct.Visibility:Directorindirect.Retraction:Indexfingerormirrorofthenonoperatinghand.Fingerrest:Intraoral,palm down.Fourthfingerontheincisaledgesortheocclusalorfacialsurfacesofadjacentmandibularteeth.MandibularleftposteriorsextMandibular left posteriorsextant:lingualaspectOperatorposition:Frontorsideposition.Illumination:Directandindirect.Visibility:Direct.Retraction:Mirror retracts tongue.Fingerrest:Intraoral,palm down.Fourthfingerontheincisaledgesortheocclusalsurfacesofadjacentmandibularteeth.MandibularleftposteriorsextMandibular anteriorsextant:facialaspect,surfaces towardtheoperatorOperatorposition:Front position.Illumination:Direct.Visibility:Direct.Retraction:Indexfingerofthenonoperatinghand.Fingerrest:Intraoral,palm down.Fourthfingerontheincisaledgesortheocclusalsurfacesofadjacentmandibularteeth.Mandibularanteriorsextant:fMandibular anteriorsextant:facialaspect,surfaces awayfromtheoperatorOperatorposition:Back position.Illumination:Direct.Visibility:Direct.Retraction:Indexfingerorthumbofthenonoperatinghand.Fingerrest:Intraoral,palm down.Fourthfingerontheincisaledgesortheocclusalsurfacesofadjacentmandibularteeth.Mandibularanteriorsextant:fMandibular anteriorsextant:lingualaspect,surfaces awayfromtheoperatorOperatorposition:Back position.Illumination:Directandindirect.Visibility:Directandindirect.Retraction:Mirror retracts tongue.Fingerrest:Intraoral,palm down.Fourthfingerontheincisaledgesortheocclusalsurfacesofadjacentmandibularteeth.Mandibularanteriorsextant:lMandibular anteriorsextant:lingualaspect,surfaces towardtheoperatorOperatorposition:Front position.Illumination:Directandindirect.Visibility:Directandindirect.Retraction:Mirror retracts tongue.Fingerrest:Intraoral,palm down.Fourthfingerontheincisaledgesortheocclusalsurfacesofadjacentmandibularteeth.Mandibularanteriorsextant:lMandibular right posteriorsextant:facialaspectOperatorposition:Sideorfrontposition.Illumination:Direct.Visibility:Direct.Retraction:Mirrororindexfingerofthenonoperatinghand.Fingerrest:Intraoral,palm down.Fourthfingerontheincisaledgesortheocclusalsurfacesofadjacentmandibularteeth.MandibularrightposteriorsexMandibular right posteriorsextant:lingualaspectOperatorposition:Frontposition.Illumination:Directandindirect.Visibility:Directandindirect.Retraction:Mirror retracts tongue.Fingerrest:Intraoral,palm down.Fourthfingerontheincisaledgesortheocclusalsurfacesofadjacentmandibularteeth.MandibularrightposteriorsexSonic and Ultrasonic InstrumentationSonicandUltrasonicInstrumenIndicationsandcontraindicationsforsonicandultrasonicscalingdonotsubstantiallydifferfromthosegivenfortheuseofhandinstrumentsininitialandsupportiveperiodontaltherapy.Sonicandultrasonicscalersshouldnotbeusedwhentreatingpatientswithtransmissiblediseases.Patientandoperatorpositioningforsonicandultrasonicinstrumentationfollowthesameprinciplesasforhandinstrumentation.IndicationsandcontraindicatSection 4.Results and ReevaluationPlaquecontrolSupragingivalScalingSubgingivalScalingSection4.ResultsandReevalHeavycalculusdepositsandseveregingivalinflammation.Threeweeksaftereliminationofirritants,gingivalhealinghasresulted.HeavycalculusdepositsandsePatientbeforephase1therapy.Clinicalpreoperativeview.Clinicalpostoperativeviewafterphase1therapyandmaintenancevisits.Patientbeforephase1therapyRadiographtakenbeforephase1therapy.Radiographtaken1.5yearsafterphase1therapy.RadiographtakenbeforephaseTherapyofocclusaltraumacanbeaccomplishedinthefollowingways:1.Occlusaladjustmentbygrinding2.Orthodontictreatment3.Splinting4.Prostheticreconstruction5.Constructionofbiteguards6.ExtractionofextrudedteethSection5OcclusaltherapyTherapyofocclusaltraumacanSelectivegrindingforprematurecontacts:Prematurecontactsexistincentricocclusalpositiononly:grindthefossae(deepenthefossae)Prematurecontactsexistineccentricocclusalpositiononly:grindtheslopesPrematurecontactsexistinbothcentricocclusalpositionandeccentricocclusalposition:grindthecusps(reshapethecusps)SelectivegrindingforpremSelectivegrindingforocclusaldisharmonies:vProtrusiveocclusalpositions:grindthedistalinclinesofthemaxillarylingualcuspsandthemesialinclinesofthemandibularbuccalcuspsvLateralocclusalpositions:grindtheocclusalinclinesofthemaxillarylingualcuspsandthemandibularbuccalcuspsSelectivegrindingforocclusaA,Buccolingualnarrowing.Areatobegroundisoutlined.B,Buccolingualnarrowingascompleted.A,Buccolingualnarrowing.AreA,Thetoothisworn,obliteratingtheocclusalanatomyandmakingtheocclusalsurfacebroad.B,Reshapingnarrowstheocclusaltableandrestorestheanatomy.A,Thetoothisworn,obliteraAnextrudedtoothhasbeenshortened(shadedarea)tocreateanormalocclusalplane.AnextrudedtoothhasbeenshoA,Theelongateddistobuccalcuspofthemaxillarymolarwedgesthelowermolarsandforcesthemapart.Foodimpactionoccursduringmastication.B,Thedistobuccalcuspofthemaxillarymolarisrounded,andbothwedgingandfoodinpactionareeliminated.A,TheelongateddistobuccalcGrindingmethods1.Selectproperinstruments2.Grindtheprematurecontactsexistincentricocclusalpositionfirstly3.Minimizethegrindingscale,increasethegrindingtimes4.Paym