牙體牙髓學(xué)齲病的治療

1、Operative Dentistry,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.,enamel,,pu

2、lpodentinal complex,,,cementum,Periodontal,,牙體修復(fù)原則,去凈齲壞牙體組織保守治療的原則抗力形和固位形,充填材料的選擇,性能要求 物理和機(jī)械，化學(xué)，生物學(xué)選擇要點 牙齒部位，窩洞部位和咬合力，病人情況，其他因素,,Cavity Preparation,The mechanical alteration of a defective , injured, or disea

3、sed 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.,Classification of cavit

4、y,Cavities may be classified according to the location where the carious lesion beginsClass ⅠClass ⅡClass ⅢClass ⅣClass ⅤClass Ⅵ,—G.V.Black in 1908,Class I,All pit and fissure cavities are Class I. Cavities on oc

5、clusal surface; Cavities on occlusal two-thirds of the facial and lingual surfaces of molars;Cavities on lingual surface of maxillary incisor.,,,Class II,A cavity occurring on the proximal surface of posterior

6、teeth are Class II.MO mesial and occlusal DO distal and occlusal MOD mesial, occlusal and dista,,,Class III,Cavities on the proximal surfaces of anterior teeth that do not involve the incisal angles are Class III.,

7、,Class IV,Cavities on the proximal surfaces of anterior teeth that do involve the incisal angles are Class IV.,,Class V,Cavities on the gingival third of the facial or lingual surfaces of all teeth ( not pit and fis

8、sure cavities ) are Class V.,Class VI,Cavities on the incisal edge of anterior teeth or the occlusal cusp heights of posterior teeth are Class VI.,Cavity,Simple cavity: only one tooth surface is involved.,Compound

9、 cavity: two surfaces are involved.,Complex cavity: three or more surfaces are involved.,Cavity Structure,walls angles cavity,Walls,Internal walls: a prepared cavity surface that does not extend to the external toot

10、h 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 pul

11、p.,a side or surface of the cavity preparation that aids in enclosing the restorative material.,Walls,External walls: a prepared cavity surface that extend to the external tooth surface. The external walls takes the nam

12、e ofthe tooth surface that the wall is toward.,,,,.,Angles,Line angle: the junction of the two planal surfaces of different orientation along a line.,Angles,Point angle: the junction of three planal surfaces of dif

13、ferent orientation.,Angles,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

14、margin.,Resistance Form,定義洞深：盒狀洞形階梯結(jié)構(gòu)窩洞外形去除無機(jī)釉薄壁弱尖的處理,,,Retention form,Lateral retentionundercutdovetailtrapeziaadhesive,,,,,,深齲的治療,原則：正確判斷牙髓狀況,治療方法,墊底充填,,安撫治療,,間接蓋髓術(shù),治療方案,根面齲,,,保守治療,,充填治療,,,窩洞預(yù)備的基本原則,Remo

15、val of Remaining CariesWhen the dentin has a firm feel with the explorer, removal of the tooth structure should cease, even if stained dentin remains.只需去除感染牙本質(zhì)（崩解層和透入層）根據(jù)硬度和著色兩個標(biāo)準(zhǔn)來判斷,,,二、保護(hù)牙髓組織 間斷操作，鋒利器械，冷卻 不

16、向髓腔加壓 了解解剖結(jié)構(gòu)、增齡變化,,三、盡量保留健康牙體組織 最小程度擴(kuò)展洞形 齦緣位置 盡量不做預(yù)防性擴(kuò)展 釉質(zhì)成形術(shù) enameloplasty,,,注意患者全身狀況,窩洞預(yù)備基本步驟,The design of the cavity preparation for either a tooth with initial caries or replacement restoration i

17、s 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.,,一、預(yù)備洞形1、開闊洞口及進(jìn)入病變區(qū)：不同窩洞進(jìn)入通道的選擇,,,2、設(shè)計預(yù)備洞的外形 以病變?yōu)榛A(chǔ)

18、 擴(kuò)展 避開承受咬合力的部位 圓滑曲線The 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 outl

19、ine 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.,鄰面的頰舌洞緣位置,在規(guī)定的深度擴(kuò)展洞形,,3、抗力形和固位形,,4、Finishing the Enamel Walls and Mar

20、gins This 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,

21、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.,,5、無痛制洞法 鋒

22、利器械，正確手法 局部麻醉 anesthesia 化學(xué)機(jī)械去齲,,二、術(shù)區(qū)隔離 棉卷隔離,Reasons for use of rubber dam,Protectionaspiration or swallowing of instruments or irrigantsSoft tissue injury caused by instruments EfficiencyImprove visibility (

23、dry field and reduced mirror fogging)Minimize patient conversationMinimize the need for frequent rinsingReduced risk of cross-contamination Legal considerations,Four-handed dentistryClose support四手操作,選擇性輔助隔離法：

24、 refraction cord,mouth prop,,三、窩洞消毒,,CAVITY LINERS AND BASES are used primarily to protect the pulp and to aid the pulp in recovering from irritation resulting from cavity preparation. 1、窩洞封閉：洞漆、樹脂粘結(jié)劑 2、襯洞：隔絕化學(xué)和溫度

25、刺激 常用洞襯劑 3、墊底：隔絕溫度、化學(xué)、電流及機(jī)械刺激。常用材料,,根據(jù)余留牙本質(zhì)的厚度和修復(fù)材料的種類選用不同的封閉劑、洞襯劑和（或）墊底材料墊底的部位,,,銀汞合金修復(fù)術(shù),,適應(yīng)癥,Ⅰ、Ⅱ類洞后牙Ⅴ類洞美觀要求不高，尖牙遠(yuǎn)中鄰面洞配合附加固位釘冠修復(fù)前的牙體充填,,窩洞預(yù)備,洞形要求,,,,Ⅰ、Ⅱ、Ⅲ、Ⅴ類洞不同洞形的制備要求,銀汞合金充填,護(hù)髓成形片和楔子,,,,,填充材料：