牙周牙髓聯(lián)合病變ppt課件

1、14,牙周－牙髓聯(lián)合病變　Periodontal-Endodontic Combined Lesions,14-1 牙周組織和牙髓的解剖通道　Anatomical Interrelations of Peridontium and Pulp,根尖孔 Apical foramen,根管側(cè)支　Lateral root canal　或副根管　Accessory canal,根尖1/3處最多根分叉區(qū)20-60%有,,The pulp was

2、 non-vital and the tooth was endodontically treated. After prosthetic therapy,The pulp was non-vital and the tooth was endodontically treated. After prosthetic therapy (c), the 2 -year follow-up radiograph in (d) shows b

3、one fill in the previous angular bony defect, whereas the marginal bone remains at the same level. On careful examination one can see that a lateral canal communicating with the lateral bone defect was filled.,牙本質(zhì)小管 Dent

4、inal tubules,解剖異常 Anatomical abnormalities,腭側(cè)溝 牙根外吸收 根裂,,14-2 牙周-牙髓聯(lián)合病變的臨床類型 Clinical Patterns of Periodontal-Endodontic Combined Lesions,1，根尖感染經(jīng)牙周組織途徑排除，有人稱之為逆行性牙周炎 (retrograde periodontitis),牙髓根尖周病對(duì)牙周組織的影響 influenc

5、e of endodontic lesions on the periodontium,根尖膿腫沿牙周的可能排膿途徑,Schematic illustration demonstrating possible pathways for drainage of a periapical abscess into the gingival sulcus/pocket. (a) periodontal ligament fistulatio

6、n. (b) extraosseous fistulation,,periodontal ligament fistulation.此型在臨床上易被誤診為牙周膿腫特點(diǎn)：　　　死髓牙 窄而深的牙周袋，無(wú)明顯的牙槽嵴吸收 only a narrow opening of the fistula into the gingival sulcus/pocket and may not be d

7、etected unless careful probing of the sulcus is carried out at multiple sites.　　　鄰牙一般無(wú)嚴(yán)重的牙周炎 X片顯示燒杯型或日暈型病變,after 18 M,In multirooted teeth a periodontal ligament fistulation can drain off into the furcation

8、area,,２，牙髓治療過(guò)程中或治療后造成的牙周病變,根管側(cè)穿，髓室底穿，髓室或根管內(nèi)的藥物（砷　戊二醛　塑化液　干髓劑等）,During endodontic treatment, and in conjunction with preparation of root canals for the insertion of posts, instrumentation can accidentally cause perforatio

9、n of the root and wounding of the periodontal ligament,Angular bone defect at the distal root surface of a mandibular premolar (arrows). The root is perforated. Conceivably, this occurred in conjunction withpreparation

10、 of the root canal for a post and core. Clinicalsymptoms included drainage of pus from the pocket and increased tooth mobility. The tooth was extracted.,Perforation of the pulpal floor of the mandibular first molar occu

11、rred in conjunction with a search for root canal openings (a). The perforation was immediately sealed with gutta-percha (b). One month after treatment a slight radiolucency appeared at the perforation site (arrow) in the

12、 periodontium (c). After an observation period of 2 years, normal periodontal conditions were re-established both clinically and radiographically,RCT治療后可發(fā)生牙根縱裂: 主要由于擴(kuò)根過(guò)度,樁核不當(dāng), 過(guò)大合力等,共同特點(diǎn):牙髓無(wú)活力病變局限于單個(gè)牙，局限于患牙的局部病變呈燒杯狀，

13、鄰牙基本正常,Vertical root fracture,結(jié)局: Vertical root fractures that involve the gingival sulcus/pocket area usually have a hopeless prognosis due to continuous bacterial invasion of the fracture space from the oral

14、environment.,External Root resorption,Surface resorption,A surface resorption is initiated subsequent to injury of the cementoblastic cell layer. Osteoclasts are attracted by substances from the damaged tissue on the den

15、uded root surface and resorb the hard tissue,These resorptions may be caused by a localizedinjury in conjunction with external trauma (Andreasen1981) and by trauma from occlusion. Resorptionmay also result from excess

16、ive orthodontic forces.,This type of resorption is common, self-limiting and reversible,Replacement resorption,This type of resorptive process results in a replacement of the dental hard tissues by bone, hence the name,R

17、eplacement resorption and ankylosis are often used as synonyms.,Clinically, ankylosis is diagnosed by absent tooth mobility and by a percussion tone that is higher than in a normal tooth,External inflammatory resorption,

18、The term external inflammatory resorption suggests the presence of an inflammatory lesion in the periodontal tissues adjacent to a resorptive process,牙周病變對(duì)牙髓的影響 Iinfluence of periodontal disease on the pulp,1, 逆行性牙髓炎 Re

19、trospective pulpitis,2，長(zhǎng)期存在的牙周病變：輕者 修復(fù)性牙本質(zhì) 重者 炎癥 變性 鈣化 壞死 因牙周炎拔除的無(wú)齲牙，64%有牙髓的炎癥或壞 死，與PD成正比,3，牙周治療對(duì)牙髓的影響 Influence of periodontal treatment measures

20、 on the pulp,14-3 治療原則 Treatment strategies for vombined endodontic and periodontal lesions,確定原發(fā)原因。 聯(lián)合病變的預(yù)后往往取決于牙周病損的預(yù)后，牙周破壞不嚴(yán)重，牙齒不松動(dòng)，預(yù)后較好,1，由牙髓根尖病變引起的牙周病變 清除感染源的牙髓－消除袋內(nèi)感染－完善RCTFirst observe the result