牙折的病因及治疗方法ppt课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,牙折的病因及治疗方法,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,牙折的病因及治疗方法,*,牙折,tooth fracture,牙折的病因及治疗方法,1,牙折tooth fracture牙折的病因及治疗方法1,病因,外力直接撞击,咀嚼咬到沙石、碎骨等硬物。,be impacted by force,biting hard food.,Etiology,牙折的病因及治疗方法,2,病因外力直接撞击,咀嚼咬到沙石、碎骨等硬物。Etiology,临床表现,Clinic characteristics,按部位分,:,冠折,Crown fracture,根折,Root fracture,冠根联合折,Crown-root fracture,牙折的病因及治疗方法,3,临床表现Clinic characteristics按部位分,按损伤和牙髓关系分,:,露髓,不露髓,牙折的病因及治疗方法,4,按损伤和牙髓关系分:露髓不露髓牙折的病因及治疗方法4,冠折,crown fracture,前牙,:,横折、斜折,Anterior tooth: horizontal or inclined,牙折的病因及治疗方法,5,冠折 crown fracture 前牙 : 横折、斜折,后牙,:,斜折、纵折,Posterior teeth:inclined or vertical,牙折的病因及治疗方法,6,后牙 : 斜折、纵折Posterior teeth:incl,根折,root fracture,牙折的病因及治疗方法,7,根折 root fracture牙折的病因及治疗方法7,颈,1/3,、根中,1/3,、根尖,1/3,cervix-thirds,middle-thirds,apical-thirds,牙折的病因及治疗方法,8,颈 1/3、根中 1/3、根尖 1/3cervix-thir,根折可有牙齿松动、叩痛、龈沟出血、粘膜触痛等。,有的早期无明显症状，数日后出现。,牙折的病因及治疗方法,9,根折可有牙齿松动、叩痛、龈沟出血、粘膜触痛等。有的早期无明显,无根折外伤恒牙牙髓坏死率为,38,59,根折牙牙髓坏死率为,20,24,，断端间隙利于炎症引流。,牙折的病因及治疗方法,10,无根折外伤恒牙牙髓坏死率为 3859根折牙牙髓坏死率为,X,片是诊断根折的重要依据,Diagnosis can be carried out by radiographic examination,牙折的病因及治疗方法,11,X片是诊断根折的重要依据Diagnosis can be c,冠根折,crown-root fracture,牙折的病因及治疗方法,12,冠根折 crown-root fracture牙折的病因及治,以斜行多见，,牙髓常暴露。,The fracture will often be inclined with pulp exposure,牙折的病因及治疗方法,13,以斜行多见，牙髓常暴露。The fracture will,治疗,Treatment,缺损少牙本质未暴露，磨光锐边。,冠折,crown fracture,Without dentin exposure,selective grinding of the incisal edge is sufficient.,牙折的病因及治疗方法,14,治疗缺损少牙本质未暴露，磨光锐边。冠折 crown frac,牙折的病因及治疗方法,15,牙折的病因及治疗方法15,牙本质暴露敏感者，盖髓树脂修复。,Cover with Ca(OH),2,and composite resin restoration if dentin is expose and sensitive,牙折的病因及治疗方法,16,牙本质暴露敏感者，盖髓树脂修复。Cover with Ca(,牙髓暴露，牙根发育完成者行活髓摘除术，牙根发育未完成者行活髓切断术。,In case of a pulp exposure,pulpectomy is indicated if the root apical is developed,pulpotomy is sufficient if the root apical is developing.,牙折的病因及治疗方法,17,牙髓暴露，牙根发育完成者行活髓摘除术，牙根发育未完成者行活髓,根折,root fracture,根中,1/3,折，根尖,1/3,折,middle-thirds,apical-thirds,用夹板固定三个月，如牙冠端有错位，在固定前应复位。,Reposition the coronal fragment and use splinting for 3 months,牙折的病因及治疗方法,18,根折 root fracture根中1/3折，根尖1/3折用,牙折的病因及治疗方法,19,牙折的病因及治疗方法19,在治疗后,1,、,3,、,6,、,12,个月定期复查牙髓的活力状况，一旦发现牙髓有炎症或坏死趋势，则应作根管治疗术。,Check for pulpal complications after 1 month,3 months,6 months and 12 months.If pulp necrosis occurs,root canal therapy should be done.,牙折的病因及治疗方法,20,在治疗后1、3、6、12个月定期复查牙髓的活力状况，一旦发现,颈,1/3,折断：均先行根管治疗,断端在龈上，根管治疗后桩核冠修复,Cervix-thirds fracture:root canal therapy should be done,If fracture surface above gingival level,a post-retained full crown is fabricated after RCT.,牙折的病因及治疗方法,21,颈1/3折断：均先行根管治疗断端在龈上，根管治疗后桩核冠修复,断端在龈下牙槽骨上，龈切暴露断面桩核冠修复。,Fracture surface between gingival and alveolar:a post-retained crown is fabricated after gingivectomy expose the fracture surface.,牙折的病因及治疗方法,22,断端在龈下牙槽骨上，龈切暴露断面桩核冠修复。Fracture,断端在牙槽骨下,4mm,，,牙根较长，可手术或正畸方法牵引后，桩核冠修复。,If fracture surface is 4mm below the alveolar and the root length is enough ,surgical or orthodontic extrusion of the root ,to move the fracture surface to amore optimal location for final restoration,牙折的病因及治疗方法,23,断端在牙槽骨下4mm，牙根较长，可手术或正畸方法牵引后，桩,树脂夹板固定,Composite resin splint,牙折的病因及治疗方法,24,树脂夹板固定Composite resin splint牙折,根折的转归,钙化性愈合,结缔组织性愈合,骨、结缔组织联合愈合,断端被慢性炎症组织分开,Connective tissue healing,The fragment is separated by chronic inflammation tissue,Calcified healing,Hard-connective tissue union healing,Healing of root fracture,牙折的病因及治疗方法,25,根折的转归钙化性愈合结缔组织性愈合骨、结缔组织联合愈合断端被,冠根联合折,crown-root fracture,：,可作根管治疗，具备桩核冠修复的冠根联合折，应保留。,The tooth with crown-root fracture which can be restored by a post retained full crown should be saved to receive RCT,牙折的病因及治疗方法,26,冠根联合折crown-root fracture：可作根管治,牙根纵裂,vertical root fracture,发生在牙根的纵裂,未波及牙冠者。,Vertical root fracture, not involving the crown.,牙折的病因及治疗方法,27,牙根纵裂vertical root fracture发生在牙,病因,慢性持续性的创伤合力,牙根发育缺陷,无髓牙,Etiology,Chronic durative traumatic occlusal force,Defect of root development,Pulpless tooth,牙折的病因及治疗方法,28,病因慢性持续性的创伤合力牙根发育缺陷无髓牙EtiologyC,无髓牙,Pulpless tooth,内因：,牙本质脱水，失去弹性，牙变 脆，致使牙抗折力降低。,外因：,侧方加压充填根管,桩或桩核修复,其他,牙折的病因及治疗方法,29,无髓牙Pulpless tooth内因：牙本质脱水，失去弹性,临床表现,X,线检查对诊断牙根纵裂有重要意义,Diagnosis can be carried out by radiographic examination,Clinic,characteristics,牙折的病因及治疗方法,30,临床表现X线检查对诊断牙根纵裂有重要意义Diagnosis,牙折的病因及治疗方法,31,牙折的病因及治疗方法31,治疗,Treatment,松动明显，牙周破坏严重或单根牙的牙根纵裂，均应拔除。,The tooth should be extracted if it is very loose or of severe periodontal lesion or vertical root fracture in single rooted tooth.,牙折的病因及治疗方法,32,治疗Treatment松动明显，牙周破坏严重或单根牙的牙根纵,牙周病损局限且牙稳固的磨牙，可在根管治疗后行牙半切术或截根术。,Tooth hemiresection or root resection is performed after RCT if the molar is steady and of limited periodontal lesion.,牙折的病因及治疗方法,33,牙周病损局限且牙稳固的磨牙，可在根管治疗后行牙半切术或截根术,牙半切术,tooth hemiresection,截根术,root resection,牙折的病因及治疗方法,34,牙半切术截根术牙折的病因及治疗方法34,慢性损伤,磨损,楔状缺损,磨牙症,牙隐裂,酸蚀症,第七章 牙体慢性损伤,牙折的病因及治疗方法,35,慢性损伤磨损楔状缺损磨牙症牙隐裂酸蚀症第七章 牙体慢性损伤牙,楔状缺损,wedge-shaped defect,楔状缺损是牙齿唇、颊颈部硬组织缓慢磨耗所致，因该缺损常呈楔状而得名。,Wedge-shaped defect is caused by tardy abrasion of buccal cervix hard tissues.,牙折的病因及治疗方法,36,楔状缺损wedge-shaped defect楔状缺损是牙齿,刷牙不当,病因,牙颈部结构,Structure of tooth cervix,Improper teeth brushing,Etiology,牙折的病因及治疗方法,37,刷牙不当病因牙颈部结构Structure of tooth,酸作用,牙体组织疲劳,Acid erosion,Weariness of hard tissues,牙折的病因及治疗方法,38,酸作用牙体组织疲劳Acid erosionWeariness,临床表现,由,2,3,个平面组成，坚硬光滑，为牙本色。,Usually have 2 or 3 surfaces,hard and smooth,tooth-like color,。,Clinic characteristics,牙折的病因及治疗方法,39,临床表现由23个平面组成，坚硬光滑，为牙本色。Usuall,根据缺损程度分浅型、深型和穿髓,3,型,前磨牙好发，常左右对称，有牙龈退缩,随年龄增长，楔状缺损有增加趋势,Be classified with shallow,deep and pulp exposure according to the depth of the lesion,Most commonly occur on the buccal surface of bicuspids symmetrically and accompany with gingival recession,The sizes of abrasions increase with age,牙折的病因及治疗方法,40,根据缺损程度分浅型、深型和穿髓3型前磨牙好发，常左右对称，有,治疗和预防,改正刷牙方法,牙体缺损少无牙本质过敏，不需处理。,Correct tooth brushing,Treatment and prevention,Careful observation if there is no tooth sensitivity and the lesions are small,牙折的病因及治疗方法,41,治疗和预防改正刷牙方法牙体缺损少无牙本质过敏，不需处理。Co,有牙本质过敏，可用药物、激光等脱敏。,牙体缺损多，可充填修复。,Fillings if the lesions are extension,Desensitization with medicine or laser if there is dentin hypersensitive,牙折的病因及治疗方法,42,有牙本质过敏，可用药物、激光等脱敏。牙体缺损多，可充填修复。,牙髓感染或根尖病变时，作髓病或根管治疗。,缺损导致牙齿横折时，根据情况作根管治疗或拔除。,Root canal therapy is performed if there is pulpitis or periapical periodontitis.,Root canal therapy or extraction are performed if tooth fracture is occurred.,牙折的病因及治疗方法,43,牙髓感染或根尖病变时，作髓病或根管治疗。缺损导致牙齿横折时，,牙隐裂,cracked tooth,又称不全牙裂或牙微裂，指牙冠表面非生理性细小裂纹。,Fine non-physiological crack on the surface of the crown,牙折的病因及治疗方法,44,牙隐裂cracked tooth又称不全牙裂或牙微裂，指牙冠,病因,牙齿结构薄弱环节,牙尖斜度大,创伤合力,Weak tache of tooth structure,Big cuspid pitch,Traumatic occlusal force,Etiology,牙折的病因及治疗方法,45,病因牙齿结构薄弱环节牙尖斜度大创伤合力Weak tache,临床表现,隐裂牙发生于上颌磨牙最多，其次是下颌磨牙，第一磨牙多于第二磨牙。,Clinic characteristics,Most commonly occur on maxillary molar, and secondly on mandibular molar.The crack occurs on first molar is more than that on second molar.,牙折的病因及治疗方法,46,临床表现隐裂牙发生于上颌磨牙最多，其次是下颌磨牙，第一磨牙多,隐裂线,上颌,下颌,mandibular,maxillar,Cracked line,牙折的病因及治疗方法,47,隐裂线上颌下颌mandibularmaxillarCrack,表浅者无症状，较深时，遇冷热刺激敏感或咬合不适。,深隐裂有牙髓炎症状和定点咀嚼痛。,隐裂线,碘酊等可渗入隐裂处,探针撬动隐裂处有疼痛感，棉签置可疑牙尖上咬合，有撕裂样疼痛。,牙折的病因及治疗方法,48,表浅者无症状，较深时，遇冷热刺激敏感或咬合不适。深隐裂有牙髓,治疗,调合,113,均衡合力,处理隐裂牙,Treatment,Occlusal adjustment,Balance occlusal force,Treat the cracked tooth,牙折的病因及治疗方法,49,治疗调合113均衡合力处理隐裂牙TreatmentOcclu,第八章牙本质过敏症,牙本质过敏症,（,dentine hypersensitivity,）,又称,过敏性牙本质,（,hypersensitive dentine,），,是牙齿受到外界刺激，引起的酸痛症状。,不是一种独立疾病，是各种牙病共有症状。,115,牙折的病因及治疗方法,50,第八章牙本质过敏症牙本质过敏症（dentine hypers,病因,使牙本质暴露的各种原因,与牙本质暴露的时间、修复性牙本质形成快慢有关。,不是所有牙本质暴露的牙齿都有症状,牙本质暴露还不能解释所有临床表现,Etiology,牙折的病因及治疗方法,51,病因使牙本质暴露的各种原因与牙本质暴露的时间、修复性牙本质形,发病机理,Pathogenesis,1.神经学说：牙本质中存在牙髓神经末梢，感觉可由牙本质表层传导入牙髓,前期牙本质,管间牙本质,管周牙本质,2.牙本质纤维传导学说：成牙本质细胞原浆突中含有乙酰胆碱酶，它在受刺激后引起神经传导，产生疼痛,3.流体动力学：外界刺激使牙本质小管内液体移动搅动了牙髓内容物，间接兴奋游离神经末稍，传入冲动产生痛觉,牙折的病因及治疗方法,52,发病机理 Pathogenesis1.神经学说：牙本质中存在,临床表现和诊断,温度试验,探诊,Clinic characteristics and diagnosis,Exploration,Temperature test,牙折的病因及治疗方法,53,临床表现和诊断温度试验探诊Clinic characteri,石川修三的评定标准,0,度,：,冷刺激和机械刺激无疼痛,1,度：可诱发疼痛，但疼痛较轻微,2,度：可诱发可以忍受的疼痛,3,度：可诱发难以忍受的疼痛,牙折的病因及治疗方法,54,石川修三的评定标准0度：冷刺激和机械刺激无疼痛1度：可诱发疼,主观评价,Subjective evaluation,疼痛3级评判法,数字化疼痛评判法,Verbal rating scale,VRS,Visual analogue scale,VAS,牙折的病因及治疗方法,55,主观评价Subjective evaluation疼痛3级评,治疗,封闭牙本质小管，减少或避免牙本质内液体流动。,Treatment,Seal the dentinal tubule to decrease or avoid the flowing of the liquid inside dentin,牙折的病因及治疗方法,56,治疗封闭牙本质小管，减少或避免牙本质内液体流动。Treatm,氟化物,氯化锶,氟化氨银,碘化银,其他药物,药物治疗,medication,树脂类脱敏剂,牙折的病因及治疗方法,57,氟化物氯化锶氟化氨银碘化银其他药物药物治疗medicatio,激光治疗,修复治疗,Laser,Restoration,牙折的病因及治疗方法,58,激光治疗修复治疗LaserRestoration牙折的病因及,磨 损,Abrasion,由于单纯机械摩擦作用而造成的牙体硬组织慢性磨耗称为磨损。,牙折的病因及治疗方法,59,磨 损Abrasion由于单纯机械摩擦作用而造成的牙体硬组,临床表现,Clinic characteristics,咀嚼磨损,非咀嚼磨损,牙折的病因及治疗方法,60,临床表现Clinic characteristics咀嚼磨损,牙折的病因及治疗方法,61,牙折的病因及治疗方法61,病理变化,磨损,牙本质暴露,修复性牙本质,牙髓腔体积缩小,Pathological change,牙折的病因及治疗方法,62,病理变化磨损牙本质暴露修复性牙本质牙髓腔体积缩小Pathol,生理意义,均匀适宜的磨损对牙周组织的健康有重要意义,Physiological meaning,牙折的病因及治疗方法,63,生理意义均匀适宜的磨损对牙周组织的健康有重要意义Physio,并发症,牙本质过敏症,食物嵌塞,牙髓和根尖周病,颞下颌关节紊乱病,创伤合,创伤性溃疡,Syndrome,牙折的病因及治疗方法,64,并发症牙本质过敏症食物嵌塞牙髓和根尖周病颞下颌关节紊乱病创伤,治疗,生理性磨损，如无症状无需处理。,去除和改正引起病理性磨损的原因,有牙本质过敏者，作脱敏处理。,Treatment,牙折的病因及治疗方法,65,治疗生理性磨损，如无症状无需处理。去除和改正引起病理性磨损的,不均匀磨损需调合。,导致牙髓和根尖周病时，按常规进行,牙髓病、根尖周病治疗。,有食物嵌塞者，应恢复点接触和重建合面溢出沟。并发颞下颌关节紊乱病,应作覆盖义齿修复。,牙折的病因及治疗方法,66,不均匀磨损需调合。导致牙髓和根尖周病时，按常规进行有食物嵌塞,磨 牙 症,Bruxism,睡眠时有习惯性磨牙或白昼也有无意识磨牙习惯者，称为磨牙症。,牙折的病因及治疗方法,67,磨 牙 症Bruxism睡眠时有习惯性磨牙或白昼也有无意识磨,发病因素,心理因素,合不协调,全身因素,职业,Etiology,牙折的病因及治疗方法,68,发病因素心理因素合不协调全身因素职业Etiology牙折的病,临床表现,Clinic characteristics,磨牙型,紧咬型,混合型,牙折的病因及治疗方法,69,临床表现Clinic characteristics磨牙型紧,治疗,去除致病因素,合板的应用,调磨咬合,修复治疗,肌电反馈治疗,治疗各种并发症,Treatment,牙折的病因及治疗方法,70,治疗去除致病因素合板的应用调磨咬合修复治疗肌电反馈治疗治疗各,酸 蚀 症,Erosion,酸雾或酸酐作用与牙而造成的牙硬组织损害称为酸蚀症。,牙折的病因及治疗方法,71,酸 蚀 症Erosion酸雾或酸酐作用与牙而造成的牙硬组织损,病 因,主要由无机酸，如盐酸、硝酸等所致，其中以盐酸的危害最大。,Etiology,牙折的病因及治疗方法,72,病 因主要由无机酸，如盐酸、硝酸等所致，其中以盐酸的危害最大,临床表现,最初仅有感觉过敏，进而产生实质缺损。,多发生于前牙唇面。,酸蚀的形式因酸而异。,Clinic characteristics,牙折的病因及治疗方法,73,临床表现最初仅有感觉过敏，进而产生实质缺损。多发生于前牙唇面,牙折的病因及治疗方法,74,牙折的病因及治疗方法74,治疗和预防,Treatment and prevention,改善劳动条件,局部药物脱敏,缺损严重者可充填法、修复法处理。,并发牙髓病变者，应先作牙髓病治疗。,牙折的病因及治疗方法,75,治疗和预防Treatment and prevention改,