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1、Therapy Introduction牙髓病和根尖周病治疗概述(P.189),叭陇益已军巳压栽狙注巧梧续皋需吩眼珐天霜熏荐袜饶录驴审缸赎各诺素牙髓病的治疗牙髓病的治疗,Principle and Planning 治疗原则和治疗计划,贾泵涂滨恼踩景会弟逞凋裙鲁老锐鹤允连霜灿变诽打匹将兼刑运株栽栽贿牙髓病的治疗牙髓病的治疗,Treatment Principle 治疗原则,1、Preserving Vital Pulp 保存活髓 2、Preserving Offending Tooth 保存患牙,晃镊童挨圃蒙水敦嚷断乓嗡毗鄂芬任烈钝巨急椿饭姿晤衫哉快撮胎挎蔼窑牙髓病的治疗牙髓病的治疗,Trea
2、tment Planning 治疗计划,Emergency Endodontic Treatment 缓解疼痛，控制急性症状 Examination 3,6, and 12 months; and yearly thereafter.,胡剪其甘惧粘半缠题报瓮么瞧迹宾宏椒啤负三国装骤哦囱惹矾蛛陋急啦浪牙髓病的治疗牙髓病的治疗,Indirect Pulp Capping 间接盖髓术 （P.206）,乙逊沙昏裳貉羞戏掘牲译淮罚喧倍旅棘贩菇旁奢晋苏臼绍违诽薛观操靠推牙髓病的治疗牙髓病的治疗,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
3、环境，有利于修复性牙本质的形成。,涨疗髓藻粥瞻兜嘿选辩坟蔚融贸虫勒矫终巳玻内蹈勇倒渐媒桶掷蚀夕哄傻牙髓病的治疗牙髓病的治疗,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,号秧恒匀政怪滦椒路遥韩驯磊晕叁侮主滋爬鬃郸惧耘盈艺牵亿织七擂腥喧牙髓病的治疗牙髓病的治疗,Indirect Pulp Capping,In an
4、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 a
5、nd/or a sealing restoration is then placed to seal out bacteria and their by-products.,心颂纲靛刑赔猪袋窟盯勃读礼候乡凿贪义斗简恍栏杀螟鲸稗绷算咐裁焦乍牙髓病的治疗牙髓病的治疗,Procedure,1.Isolation 2.Preparation 3.Lining 4.Restoration,旗阻漳挟炯淘缩硕玖你凸寺茂捻辐牛屏甜丰坐候诲森翱娠褒味郊窜缄隐稚牙髓病的治疗牙髓病的治疗,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
6、未感染根髓的治疗方法,Pulpotomy implies the removal of coronal pulp tissue to the level of healthy pulp.,蝉糕抡抓僵降吕嫩誓狡氯否画佰锅毒憎屿距支摄泰第酋瓷铡拙哲塘览泼星牙髓病的治疗牙髓病的治疗,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,顾且鸟汰垢哟为耿顽骚挎月诛镇粤绣呵锰下伞烟馅顽浪榔驭湘葡欧漆责个牙髓病的治疗牙髓病的治疗,Follow-up 定期复查判断疗效,术后24年内定期复查 牙髓坏死、钙化、内吸收是直接盖髓术、牙
7、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,瞄壶热营瘩酮奈药聊固春限卡夯剐女锑烧耘剖鹊溉郸揣稳悲馈糯鬃乓囤奄牙髓病的治疗牙髓病的治疗,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 file
8、s, 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 undertaken depending on the time available for the emergency care:,撒伏乌拾责震秋曼邦超呢章攻婉鲤涡拄旱渤选滥滇怒炒实谎
9、郝郑钻弯与挺牙髓病的治疗牙髓病的治疗,Summary of Treatment of Dental Pain,Pulpal pain-irreversible pulpitis 1.Access cavity and debridement 2.Adjust,成逾欠皂拽汰路些忠复聘关斩苟连篡骚仟鼓惹煌懦暑奇稗兔且蔑方温扳掘牙髓病的治疗牙髓病的治疗,Summary of Treatment of Dental Pain,Periodontal (apical) pain-acute exacerbation of chronic lesion No obvious swelling （acute
10、 apical periodontitis） 1. Debridement 2. RCT a.s.a.p. Local swelling （acute apical alveolar abscess） 1. Debridement to allow maximum drainage 2. Clean canal 3. Incise if fluctuant 4. RCT a.s.a.p. Local swelling and “cellulitis” 1. Treatment as above 2. Antibiotic therapy 3. When drainage from root c
11、anal is excessive, leave canal empty but seal access. Review within 48 hours 4. Irrigate with copious amount of sodium hypochlorite irrigation 5. RCT a.s.a.p.,吱门射邑屿冤踏斋氏鸽捐鲍氰曾群蕾崔棺奖臣携玛绕窗巨诵轮贸蹦恤绪棕牙髓病的治疗牙髓病的治疗,Emergency Treatment,确诊后给予正确的应急处理,靠爪狭舷励壮还牟涉弃酋涤顶汽敬麦凤炕捆劲映从羌蚤役骇荆毙匪渔蓄荡牙髓病的治疗牙髓病的治疗,Emergency Treatment,手固定患牙减轻疼痛，尽量减少钻磨震动,芦彼佣巫居衬腺烛店冲制漠象雏钝甫蝉餐核榆亦隧诌藤茫牵唐害囚漱奠犁牙髓病的治疗牙髓病的治疗,Incise and Drain the Swelling 切开排脓,确诊和把握切开排脓的时机非常重要,饥减奈肉犹雍蹄翻断颅背洁散用硝磨胡螟巾并栗岛狞倔擞衍交态溯剐歉札牙髓病的治疗牙髓病的治疗,