dd牙髓病和根尖周病治疗概述(P189)精品.pptVIP

Systemic Factors  全身因素 干扰牙髓组织的修复 Prognosis and Conversion预后和转归 牙髓组织的转归分为成功和失败两个方面 穿髓孔下修复性牙本质形成，封闭穿髓点——成功（术后2个月左右） 牙髓组织慢性炎症，出现疼痛症状；牙髓钙化或内吸收——失败 Prognosis and Conversion预后和转归 Reported prognosis is in the range of 80% 年轻恒牙直接盖髓术后冠髓感染可试行活髓切断术 Follow-up 定期复查判断疗效 Electric pulp testing, thermal testing, palpation tests, and percussion tests should be carried out at 3 weeks;3,6, and 12 months; and yearly thereafter. Indirect Pulp Capping 间接盖髓术 （P.206） 原 理 窝洞中遗留的少量细菌被盖髓剂覆盖，及细菌产酸所需的底物被隔绝而大幅度下降，Ca(OH)2可维持局部的碱性环境，有利于修复性牙本质的形成。 Indication 适应证 Deep carious lesion深龋保存去龋净未见穿髓、外伤造成的近髓患牙 可复性牙髓炎 诊断性治疗：has no history of spontaneous pain and respond normally to vitality tests无明显自发痛的慢性牙髓炎和可复性牙髓炎的鉴别 Indirect Pulp Capping In an indirect pulp capping procedure, demineralized dentin is removed in the periphery of the preparation, but a small amount of demineralized dentin is left immediately over the area of the pulp. A calcium hydroxide lining material is placed to cover the remaining demineralized dentin. A sealing liner and/or a sealing restoration is then placed to seal out bacteria and their by-products. Procedure 1.Isolation 2.Preparation 3.Lining 4.Restoration Pulpotomy 活髓切断术 (P.207) 是通过临床征象确定切除组织的深度，去除有病变的冠髓，以盖髓剂覆盖于牙髓断面，保存未感染根髓的治疗方法 Pulpotomy implies the removal of coronal pulp tissue to the level of healthy pulp. Indication 适应证 外伤性露髓 慢性牙髓炎 意外穿髓孔较大（0.5mm），破坏髓室壁、髓室顶者 根尖孔发育未完成的年轻恒牙 Follow-up 定期复查判断疗效 术后2～4年内定期复查 牙髓坏死、钙化、内吸收是直接盖髓术、牙髓切断术后潜在的并发症，影响日后的桩钉固位修复，故一旦根尖孔发育完成，即行常规根管治疗术 Emergency treatment 应急处理(P.213) Establish proper access to all canals. Irrigate thoroughly with NaOCl. Debride pulp chamber. Debride the coronal and middle portions of the root canal with k-files, Hedstrom files, or broaches, and use copious NaOCl irrigation, making sure not to penetrate the apical 2 to 3 mm of the canal. Temporarily seal the access opening. Use analgesics as necessary. This plan of action may be un