龋临床特征和诊断ppt课件

Chapter 3 Clinical Manifestations and Diagnosis of Dental Caries龋临床特征和诊断Chapter3ClinicalManifest1Histophathology of CariesEnamel Caries龋临床特征和诊断HistophathologyofCariesEname2The early enamel lesion consists of four zones of alternating levels of mineralisation.It illustrates the dynamic nature of the caries process.The surface zone blocks the passage of calcium ions into the body of the lesion and may have to be removed to allow the lesion to become arrested(After Kidd&Joyston-Bechal,1987).龋临床特征和诊断Theearlyenamellesionconsis3Dentinal Caries龋临床特征和诊断DentinalCaries龋临床特征和诊断4Dentine caries comprises two main layers.In the outer layer,the dentine is heavily infected with bacteria.Both organic matrix and mineral have been lost and the dentine is beyond repair.In the deeper layer,the dentine has been affected by plaque acids and demineralised.The number of colony forming units(CFU)of bacteria decreases(about 100 times)as cavity preparation proceeds into affected dentine.The damage in this layer is reversible if bacterial metabolism can be halted.A barrier of translucent(well mineralised)dentine may be formed ahead of the advancing lesion.Reactionary(secondary)dentine forms to protect the pulp from acid irritation(After Kidd&Joyston-Bechal,1987龋临床特征和诊断Dentinecariescomprisestwo5龋临床特征和诊断龋临床特征和诊断6Root caries lesionsEarly:Appears as radiolucent zone in the root cementum 龋临床特征和诊断RootcarieslesionsEarly:Ap7Steps in the formation of an arrested lesion in dentinea)high concentration of dissolved mineral salts.b)If bcterial acidproduction is reduced,and the pH increases,the salts precipitate into large crystals of tricalcium phosphate which temporally block the tubule.c)If further bacterial activity is suppressed,the odontoblast secretes collagen and calcium salts.Crystals of hydroxyapatite then form and block the tubule more effectively(After Daculsi et al,1987)龋临床特征和诊断Stepsintheformationofana8The Process of Demineralization and RemineralizationCaries is a dynamic process.Teeth are subjected to an ongoing cycle of demineralization and remineralization determined by the balance of factors.龋临床特征和诊断TheProcessofDemineralizatio9DemineralizationDemineralization is the process of removing minerals,in the form of mineral ions,from dental enamel.A substantial number of mineral ions can be removed from hydroxyapatite latticework without destroying its structural integrity 龋临床特征和诊断DemineralizationDemineralizati10RemineralizationRemineralization is the process of restoring minerals-again,in the form of mineral ions-to the hydroxyapatites latticework structure.龋临床特征和诊断RemineralizationRemineralizati11促进再矿化阻止龋病发展龋损的形成是脱矿与再矿化的连续性动力过程。龋临床特征和诊断促进再矿化阻止龋病发展龋损的形成是脱矿与再矿化的连续性动力121、除去致龋底物：木糖醇取代蔗糖，减少碳水化合物摄入频率 Diet counseling :To identify the sources of sucrose and acidic foodstuffs in the diet To reduce the frequency of ingestion of both To use xylitol as sugar substitute.龋临床特征和诊断1、除去致龋底物：木糖醇取代蔗糖，龋临床特征和诊断132、仔细刷牙，牙面不形成厚的牙菌斑Oral hygiene :Plaque free tooth surface do not decay.Dental flossingTooth brushing Rinsing 龋临床特征和诊断2、仔细刷牙，牙面不形成厚的牙菌斑龋临床特征和诊断143、在牙齿发育的再矿化期间，结合氟离子，可形成更具抗龋能力的釉质Use of fluoride龋临床特征和诊断3、在牙齿发育的再矿化期间，结合氟龋临床特征和诊断15Clinicalclassificationofcaries龋临床特征和诊断Clinicalclassificationofcar16Classification according to progression rate Acute caries:progress fast,often in children and teenagers,light colored cavity.龋临床特征和诊断Classificationaccordingtopr17Rampantcaries,manytoothinvolvedatsametimeacutecariesfeatureoftenaccompaniedbysystematicdisorder.Suchassjogrensyndromeorsalivareductionafterradiation.Cariesinapatientwithimpairedsalivaryfunctionasresultofradiationtherapy(courtesyofDrsJansmaandVissink,RUG,theNetherlands).龋临床特征和诊断Rampantcaries,manytoothinv18龋临床特征和诊断龋临床特征和诊断19Chronic caries progress slowly,black or brown colored cavity hard remaining dentine Arrested caries caries stop progressing because of the local etiological change龋临床特征和诊断Chroniccariesprogress20Secondary caries(recurrent caries)caries recurred after treatment.Often at the margin the filling materials restoration or beneath The shadow located on the mesiolingual cusp adjacent to the larger occlusal amalgam restoration on the maxillary right first molar indicates the presence of carious dentin 龋临床特征和诊断Secondarycaries(recurrentca21龋临床特征和诊断龋临床特征和诊断22Classification according to the involving site Occlusal caries Root caries Smooth surface caries 龋临床特征和诊断Classificationaccordingtoth23Classification according to the deepness Superfacial caries(浅龋)white spot lesions,visibly frosted surface brown spot Dentin caries(中龋)cavitated lesion involving the up part of dentin Deep caries(深龋)cavitated lesion involving the pupal third of dentin龋临床特征和诊断Classificationaccordingtoth24Diagnosis Visual change Probing:rough surface or trapping point pain upon probing Temperature test X-ray examination Transillumination龋临床特征和诊断DiagnosisVisualchange龋临床特征和25Visual changeMatte,white,activecervicallesions龋临床特征和诊断VisualchangeMatte,white,ac26龋临床特征和诊断龋临床特征和诊断27Probing:roughsurfaceortrappingpointpainuponprobingTheexplorertipcaneasilydamagewhitespotlesions龋临床特征和诊断Probing:roughsurfaceortrap28龋临床特征和诊断龋临床特征和诊断29龋临床特征和诊断龋临床特征和诊断30Temperature test龋临床特征和诊断Temperaturetest龋临床特征和诊断31X-ray examination龋临床特征和诊断X-rayexamination龋临床特征和诊断32Transillumination（FOTL,FOTL,光纤透照法光纤透照法）：Proximalcarieslesionisdetectedinananteriortoothwiththeuseoftransillumination龋临床特征和诊断TransilluminationProximalcari33LAF（激光荧光法（激光荧光法)龋临床特征和诊断LAF（激光荧光法)龋临床特征和诊断34The hardware of the intra-oral system includes a measurement probe,a control unit,and a computer fitted with a framegrabber.The control unit consists of an illumination device and imaging electronics.The light source is a special arc-lamp based on Xenon氙氙 technology.The light from this lamp is filtered by a blue-transmitting filter.A liquid light guide transports the blue light to the teeth in the mouth.Quantitative Light-induced Fluorescence龋临床特征和诊断Thehardwareoftheintra-oral35QLF technical specifications龋临床特征和诊断QLFtechnicalspecifications龋36QLF theoryThe QLF method is based on the auto-fluorescence荧光荧光 of teeth.When teeth are illuminated with high intensity blue light they will start to emit light in the green part of the spectrum.The fluorescence of the dental material has a direct relation with the mineral content of the enamel.Quantitative Light-induced Fluorescence 龋临床特征和诊断QLFtheoryTheQLFmethodis37DIAGNOdent pen(龋齿探测笔)DIAGNOdenthttp:/龋临床特征和诊断DIAGNOdentpen(龋齿探测笔)龋临床特征和诊38DIAGNOdent pen龋临床特征和诊断DIAGNOdentpen龋临床特征和诊断39DIAGNOdent龋临床特征和诊断DIAGNOdent龋临床特征和诊断40Standardofdiagnosis龋临床特征和诊断Standardofdiagnosis龋临床特征和诊断41Superfacial caries(浅龋)White spot or brown,dark lesion,rough upon probing No complaint,no hypersensitivity龋临床特征和诊断Superfacialcaries(浅龋)Whites42Dentin caries(中龋)Cavity,hypersensitivity upon probing,hot or cold stimulus.龋临床特征和诊断Dentincaries(中龋)Cavity,hyp43Deep caries(深龋)Deep cavity,very sensitive and some pain upon stimulus,however the pain disappear as soon as the stimulus is taken away.龋临床特征和诊断Deepcaries(深龋)Deepcavity,44TreatmentStrategy龋临床特征和诊断TreatmentStrategy龋临床特征和诊断45Treatment StrategyPreventive(casual,noninvasive)treatmentRestorative(operative,invasive)treatment 龋临床特征和诊断TreatmentStrategyPreventive(c46Preventive treatmentchemical therapy:use of fluoride with a regular daily administration or professional applied.pit and fissure sealing 龋临床特征和诊断Preventivetreatmentchemicalt47一、一、chemical therapy（化学疗法化学疗法）1药物治疗药物治疗适应证适应证（1）恒牙早期釉质龋未形成龋洞者，自洁作用较好的区域；（2）一年内将被替换的乳牙大面积浅龋；（3）静止龋。药物药物 氟化物 硝酸银龋临床特征和诊断一、chemicaltherapy（化学疗法）龋临48药物治疗氟化物氟化物(fluorence)75氟化钠甘油糊剂 8氟化亚锡溶液 酸性磷酸氟化钠（APF）溶液 含氟凝胶（1.5APF凝胶）含氟涂料 原理：氟与HA作用，形成氟磷灰石；沉积氟化物，促进再矿化。氟化物对软组织无腐蚀性，不使牙变色，安全有效，前后牙均可使用。龋临床特征和诊断药物治疗氟化物(fluorence)龋临床特征和诊断49药物治疗硝酸银硝酸银 10硝酸银 氨硝酸银 原理:蛋白银沉淀 还原银或碘化银渗入牙釉质牙 本质，杀灭细菌，封闭病变区 对软组织有强的腐蚀性，不可用于牙颈部龋，并使牙变黑，只用于乳牙和后牙。龋临床特征和诊断药物治疗硝酸银10硝酸银氨硝酸银龋临床特征和诊断50应用方法应用方法：用石尖磨除牙表面浅龋，暴露病变部位清洁牙面隔湿吹干涂布药物龋临床特征和诊断应用方法：用石尖磨除牙表面浅龋，暴露病变部位龋临床特征和诊断512Remineralization(再矿化疗法)再矿化液：主要为含有不同比例的钙、磷和氟。适应症平滑面早期釉质龋龋易感者预防应用方法应用方法：漱口液每日含漱 局部应用龋临床特征和诊断2Remineralization(再矿化疗法)龋临床52pit and fissure sealing（窝沟封闭)适适应应证证：窝沟可疑龋；与充填窝洞相邻的牙合面无龋深沟裂，应应用用方方法法：清洁牙面、隔湿、酸蚀、涂布及固化封闭剂。龋临床特征和诊断pitandfissuresealing（窝沟封闭)53Definition of Operative Dentistry Operative 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.龋临床特征和诊断DefinitionofOperativeDentis54Such treatment should result in the restoration of proper tooth form,function,and esthetics while maintaining the physiological integrity of the teeth in harmonious relationship withthe adjacent hard and soft tissues;all of which enhance the general health and welfare of the patient.龋临床特征和诊断Suchtreatmentshouldresulti55Indication of Operative Dentistry Caries Malformed,discolored,or fractured teethRestoration replacement 龋临床特征和诊断IndicationofOperativeDentis56Program of Operative Treatment Patient assessment Examination and diagnosis Treatment planning 龋临床特征和诊断ProgramofOperativeTreatment57Cavity 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.龋临床特征和诊断CavityPreparationThemechani58龋临床特征和诊断龋临床特征和诊断59龋临床特征和诊断龋临床特征和诊断60 Classification of cavity Class Class Class Class Class Class G.V.Black in 1908龋临床特征和诊断ClassificationofcavityCla61Class 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.龋临床特征和诊断ClassIAllpitandfissure62Class 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 龋临床特征和诊断ClassIIAcavityoc63Class IIICavities on the proximal surfaces of anterior teeth that do not involve the incisal angles are Class III.龋临床特征和诊断ClassIIICavitiesontheproxi64Class IVCavities on the proximal surfaces of anterior teeth that do involve the incisal angles are Class IV.龋临床特征和诊断ClassIVCavitiesontheproxi65Class VCavities on the gingival third of the facial or lingual surfaces of all teeth (not pit and fissure cavities)are Class V.龋临床特征和诊断ClassVCavitiesonthegingiva66Class VICavities on the incisal edge of anterior teeth or the occlusal cusp heights of posterior teeth are Class VI.龋临床特征和诊断ClassVICavitiesontheincisa67洞型分类一类洞：根据发生于所有牙齿的发育窝，沟内的一类洞：根据发生于所有牙齿的发育窝，沟内的龋损所制备的洞型。龋损所制备的洞型。二类洞：后牙邻面的龋损所制备的洞型。二类洞：后牙邻面的龋损所制备的洞型。三类洞：前牙邻面未损及切角的龋损所制备的洞三类洞：前牙邻面未损及切角的龋损所制备的洞型。型。四类洞：前牙邻面损及切角的龋损所制备的洞型。四类洞：前牙邻面损及切角的龋损所制备的洞型。五类洞：所有牙齿颊（唇），舌（腭）面龈五类洞：所有牙齿颊（唇），舌（腭）面龈1/3牙面的龋损制备的洞型。牙面的龋损制备的洞型。六类洞：所有牙齿牙尖，牙脊或冠轴交界的轴角六类洞：所有牙齿牙尖，牙脊或冠轴交界的轴角区的龋损所制备的洞型。区的龋损所制备的洞型。龋临床特征和诊断洞型分类一类洞：根据发生于所有牙齿的发育窝，沟内的龋临床特征68Cavity Structure walls angles cavity 龋临床特征和诊断CavityStructurewalls龋临床特征和诊69龋临床特征和诊断龋临床特征和诊断70WallsInternal walls:a prepared cavity surface that does not extend to the external tooth surface.Axialwalls:aninternalwallparallelwiththelongaxisofthetoothandocclusalofthetooth.Pulpalwalls:aninternalwallthatisbothperpendiculartothelongaxisofthetoothandocclusalofthepulp.龋临床特征和诊断WallsInternalwalls:aprepar71WallsExternal walls:a prepared cavity surface that extend to the external tooth surface.Theexternalwallstakesthenameofthetoothsurfacethatthewallistoward.龋临床特征和诊断WallsExternalwalls:aprepare72龋临床特征和诊断龋临床特征和诊断73AnglesLine angle:the junction of the two planal surfaces of different orientation along a line.龋临床特征和诊断AnglesLineangle:thejunc74龋临床特征和诊断龋临床特征和诊断75AnglesPoint angle:the junction of three planal surfaces of different orientation.龋临床特征和诊断AnglesPointangle:thejuncti76龋临床特征和诊断龋临床特征和诊断77AnglesCavosurface 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.龋临床特征和诊断AnglesCavosurfaceangle:the783洞型结构洞壁洞壁：窝洞的壁，分侧壁和髓壁(pulpal walls)pulpal walls)侧壁与牙面垂直的壁(颊壁,龈壁)髓壁与洞侧壁垂直，位于洞底覆盖牙髓的洞壁。轴壁与牙长轴平行的髓壁洞角洞角点角三壁相交构成 颊轴龈点角线角两壁相交构成 颊髓线角洞缘角洞缘角洞侧壁与牙面相交形成的线角 洞缘 窝洞侧壁与牙面相交构成洞的边缘龋临床特征和诊断3洞型结构龋临床特征和诊断79龋临床特征和诊断龋临床特征和诊断80 CavitySimple cavity:only one tooth surface is involved.Compound cavity:two surfaces are involved.Complex cavity:three or more surfaces are involved.龋临床特征和诊断CavitySimplecavity:onlyon81龋临床特征和诊断龋临床特征和诊断82