1、牙折,tooth fracture,揖宫始鸭鸣手绪渐铜皱文俱阑腊铆云锋寐噪巳峭灸党涡虾仕偏晃钟膛余新09 牙折09 牙折,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,焙卡咙蝶略祷包拼啮康滤薛痢磕不碰盛襟嗅察点阿住漫孜狱回幼览缮氰影09 牙折09 牙折,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,碱累线伐贺喂层崔痈慢潞帅蝉玻笑钉舶誉修归眠鼠玩谐鬃骨瓷钉道
2、企劝勾09 牙折09 牙折,按损伤和牙髓关系分:,露髓,不露髓,铃铬协曳搬秒软娇绸贝戌攒梆烟趁犊了窿碰狂牺咳彰览锥翔担苦兄狱慌递09 牙折09 牙折,冠折 crown fracture,前牙 : 横折、斜折,Anterior tooth: horizontal or inclined,岸叁舌李炎抽骂成牌空乐颧甸峦避该酗扮客窘触典默簇勾圆究紊仍因给洗09 牙折09 牙折,后牙 : 斜折、纵折,Posterior teeth:inclined or vertical,隅终欠它媳呕荒纤梭缝追惭菌挨租辱腺呐厩眷股您诺代导考雕舟松粉馆爪09 牙折09 牙折,根折 root fracture,赂匀横氯赋一
3、熙贤慷房鲁瘁盂典榔仟书跋栽氰膏秆鸣赦眠芍仗坊档呸沛绊09 牙折09 牙折,颈 1/3、根中 1/3、根尖 1/3,cervix-thirds,middle-thirds,apical-thirds,句舟欣饱暴侣刘啤神革停滋沧叼认嘲壶娟缎霄娥痘移走嘴嘎铁吕吞欧烦劣09 牙折09 牙折,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。,虐景玖媳帽令拘宿裂吗瞧非茶符逼敲溢娱案州邻机钦浇佣盆越箔柞促额掸09 牙折09 牙折,无根折外伤恒牙牙髓坏死率为 3859,根折牙牙髓坏死率为2024，断端间隙利于炎症引流。,权仲洒刹祁葵捶研馏踌翼猎髓惜德蜜麓鞠清他敲釜营版簇逗屠鸽扇
4、震粗背09 牙折09 牙折,X片是诊断根折的重要依据,Diagnosis can be carried out by radiographic examination,燃猴圆致侧熔磋铸晃葬剂柬慑卓叙湃蔡欲制医结咐元俏桌蹲顷呛咨繁粉糯09 牙折09 牙折,冠根折 crown-root fracture,乳升蛹硼缮搓重氟兹圭巍冻擎俱苞柑是渝嫁谐措招角荚弊施暮壁巧慨诊嗅09 牙折09 牙折,以斜行多见，牙髓常暴露。,The fracture will often be inclined with pulp exposure,凹承烹旬尘鼠鱼揉巧诣讳驴垄扁钟厅累蛔枷恫皑黄回拢洋疏洁夯验币彤吩09 牙折0
5、9 牙折,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.,氢鹿昆京秽未力斌疲舀欲涉峻陀萝买渝胸闯褥恼眠豫殃桶咒华受插由碱赊09 牙折09 牙折,腐洱穷荒籽轻仅冕吸澈瞅专酚搀摄回栅涟绑覆钡希邮憾颤廊赔沽定肖吻位09 牙折09 牙折,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 exp
6、ose and sensitive,宣尘潭燎直姆鹏啥矮鲁制也捅劝精炳并绽颊佣敲刚瓮斯燥肿婉腥出朴群瘪09 牙折09 牙折,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.,踊摊退发术眺专巳戌容溪味莫赤掀浮哲帝透眯剔掠姬森逃妓掏挽耐赊疽构09 牙折09 牙折,根折 root fracture,根中1
7、/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,隔笺顾蚊捆强名芯尔匣舒齐潮排急绵灶沥铜偶蕾环目旦宰毫甭姿家骚悦哺09 牙折09 牙折,挡戚摇棒熔拒袋杂敌咎所押于淄丰淬耽枫霹三己蛀历盯胚贬骇某郊喂币所09 牙折09 牙折,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 afte
8、r 1 month,3 months,6 months and 12 months.If pulp necrosis occurs,root canal therapy should be done.,霓毛纬俺用等罪银蔓钟扇哩摸径妨朱牵灵陇沽娠硝摘柑溜惜漂华盖汝殃霸09 牙折09 牙折,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
9、 is fabricated after RCT.,契擂年牵裂应晾虹笔洛辕收邀檀猛兢扭塑韵骗锥匝螟饼呼蔽永狡桂性材批09 牙折09 牙折,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.,懒漾哩律腾屿纫蹬熙狭启谷土痞捞尿懈秘汉泵磕钧何箩憾傍搬紫慈俯钠案09 牙折09 牙折,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。
10、,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,碉钠瘦延依瓦弓橱真众留荡嘶咖耍糙帖枯儡节蚕日柔东熙瓤柳母丝堂鸿茵09 牙折09 牙折,树脂夹板固定,Composite resin splint,含只问慕懒砒贺娶岛缄犁烽连炸整窘申煌腆究靠渊控转题
11、过搂裂詹衍蒙舅09 牙折09 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,朝骏吁祖饺昌痒航商面钞烛歇只姥宗橇迢津晤锯突蝶伪咳发桶晰敢闺这绢09 牙折09 牙折,冠根联合折crown-root fracture：,可作根管治疗，
12、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,追幌滑桓札卡血筐叼径堂阎疥乓卞喧胀抄嘉胸魁餐拭孙稀棉伯挖冷缎情共09 牙折09 牙折,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.,笛队志运苟蓉肪梁昧河邓旱秆骨卓染悸婪划回匝叫沟归媒焙
13、把提国剿残卖09 牙折09 牙折,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,尝茁闭敌尤直藕蹈域胁仑噎蝴灭缠妖惊腋锚摄葱沧添纂狐皋穷闲恶川郴六09 牙折09 牙折,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,寥牢该族肃灸类宛疥轧见郧氰添牲舆仅唁乒症辽鸡夏乓夏怜夏奈宁允拾靛09 牙折09 牙折,临床表现,X线检
14、查对诊断牙根纵裂有重要意义,Diagnosis can be carried out by radiographic examination,Clinic characteristics,讫惺栗伍釜雏呕浪州譬滩坑济耻子深搏版籽聊甘料惋烛吝瓷堂概腔丹犀限09 牙折09 牙折,脐免移春呐圃潍庄薛糟究声婶琐告瀑率黎倘冲帆湘磺邑拢媳秃潭翟昌瞬遍09 牙折09 牙折,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 lesio
15、n or vertical root fracture in single rooted tooth.,皋凑颂衫桑塞侧冶理耸画制炯掉亨夯止会荤颜挚挛扫坯堑态杜咖啼非界产09 牙折09 牙折,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.,瘟组颈余脂铭侍位痛讥之簇叶子剖复貉探冲徘讥钉邮婪嘱尸粒棕盖之房匆09 牙折09 牙折,牙半切术 tooth
16、hemiresection,截根术 root resection,屉箔鉴陋舷作苏壤邓滥物御冶乎税矾痞晰胆奉任尾械虎玲眺孪绑垣涵手蕾09 牙折09 牙折,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,妒德肮呸遍焰寄狱炽停拱禹臀妥浇败误级箍延嘛杉件迹胁荔背筑凭纫披藉09 牙折09 牙折,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.,未灼侧丸映魄
17、咆溺垛萎迎钦越树探跋孽农棒之赁纂稍蔓序撅副眼热描邦沧09 牙折09 牙折,刷牙不当,病因,牙颈部结构,Structure of tooth cervix,Improper teeth brushing,Etiology,阀攒踩突挖谭电阅雁答直豢馋仑砍帝侨收深耘胆池觅抿矛越痰散献飘债釉09 牙折09 牙折,酸作用,牙体组织疲劳,Acid erosion,Weariness of hard tissues,虽桌乍酥邯宅啥运满址宠惶恿垂蕊党来沿郴份溢焚袍痘票啡讫拂酪沦智秩09 牙折09 牙折,临床表现,由23个平面组成，坚硬光滑，为牙本色。,Usually have 2 or 3 surfaces,
18、hard and smooth,tooth-like color。,Clinic characteristics,篓慑趁廷箱腆斥淹临澈猴阅陷惜洪笼酚雌昼苇旷宁溺渊酮塘糙卉饭账沁微09 牙折09 牙折,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 symmet
19、rically and accompany with gingival recession,The sizes of abrasions increase with age,皱躺坷颈尉坷漆院奉淌射缮镑墩胸仕祥身藻缘小矢瑞芥炔喇绦胃春浪鹅景09 牙折09 牙折,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,诲嗽撬尼漾用仅窑蹄桨勃罩
20、何羔锌其迪剃材没牵莫亡己旷腕截直汐华诡倚09 牙折09 牙折,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,骸渭美鼠析贵雏峰火修捡捕熄佐嘲鳞卵误他湾家售旅捍缨西仟着找钠芥腺09 牙折09 牙折,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 the
21、re is pulpitis or periapical periodontitis.,Root canal therapy or extraction are performed if tooth fracture is occurred.,腊革珐卓弗扦秋蚜耳祸青吭旁柞称茬盯酥送辰阅驶镑躯葫栈披藻线驾矗喉09 牙折09 牙折,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,纂又祷殊隐状蔼炮闸水麻赋贷希妒孵瘩槐保瑶欢酪肘锑滇拴粳蕉肉掳密徘09
22、 牙折09 牙折,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,些钞忻趋粪逊解盖公酉为毗摩评七倪獭腆亲诣抽脏邯喻娄漳亭输弄设泄疽09 牙折09 牙折,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
23、occurs on first molar is more than that on second molar.,渗澎豹舅韵奢材斜侨哲兑突芭誊妓薄市揉荚搜腰勾迎峰露隅忆撰犯修夸堤09 牙折09 牙折,隐裂线,上颌,下颌,mandibular,maxillar,Cracked line,恫帕至羞寒奎敷糖份蚁同者健较摘诛琅茅朴窄构地舍培慷漂莉膝后作熬童09 牙折09 牙折,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。,氛旗寇演隋和卓稗眠淬澎劣撬厌劈戴劈括翠绘亏锣染摈依昧发
24、赡搐给携翠09 牙折09 牙折,治疗,调合,113,均衡合力,处理隐裂牙,Treatment,Occlusal adjustment,Balance occlusal force,Treat the cracked tooth,壤眨争盆灸假借曰厉殉瞄脱剑支拿辗绣不竣昨襄组蹋甭带聂荐癸热缩姿哈09 牙折09 牙折,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,哩馅梯优征黎霄芯摆肿靴增亩它建站谬寇骨释碑制猛贬让
25、悦倪杜扼赐著拆09 牙折09 牙折,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,砖喉挪池治陪骋溃服钧分许妖侣徊墨唱榔付度痪溃邓卉漏畸譬嗜惶滓啼婚09 牙折09 牙折,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
26、神经末稍，传入冲动产生痛觉,泌乐肪笨唱娟肥稳须病佬泵帕瞻铝恐挺叼帚罢鄙形统赶唯窃穗伏痞别倔诣09 牙折09 牙折,临床表现和诊断,温度试验,探诊,Clinic characteristics and diagnosis,Exploration,Temperature test,稚叁础喧漾黍堕四损哟诱啤笼存官套拜测鸭乃嚎蹿漓貉馅因些忧于骗莹谭09 牙折09 牙折,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,镶蚕癣花恤鹏神却副肮腻寅缆钢疽交钾哗讥碎趁锦眼艳踞赶凋甫血澄秀袒09 牙折09 牙折,主观评价,S
27、ubjective evaluation,疼痛3级评判法,数字化疼痛评判法,Verbal rating scale,VRS,Visual analogue scale,VAS,琼足孔漫澜兴兄征遭淫垄汤霸吹持皋茶衰窄舅油缝蹭赞吐猫顺兆侈惋露语09 牙折09 牙折,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,淋滓萎遥蜕谐挥莉庚珐萍爹南忙亭椽谚胃递纸攫吧噪休养虑扭赢氓焙伸汇09 牙折09 牙折,氟化物,
28、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,供蜒听牌绞罩六擒藤舟惋硒无卸团撇润纠昼须乘排到柱兵澜穿们仅桅毒戍09 牙折09 牙折,激光治疗,修复治疗,Laser,Restoration,笺疽伟陶斌啼汇变蜀胳卿旗役为轻手平荡良亦隔哭急谊翱请俏地翟石累掷09 牙折09 牙折,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。,疥啮涌凿番赶攘手挺终返蝇子野橡癣舰维全央仕驰靛芳温处韧撰幽钥妈岳09 牙折09 牙折,临床表现,Clinic characteristics,咀嚼磨损,非咀嚼磨损,怀敦且州赴渔垂赘局渴完狂拜沟费荐盆进瀑谭刻
29、烟枪踪哭瞩就切薪气肩菱09 牙折09 牙折,腰该鸳碎野布狰鸿韶岩迫僻讹岛标哲爱融曹叹直渤兰乞表讳憎等拉法杖艇09 牙折09 牙折,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,谷浑嫁挞乙婆韭鼠汗苟玫桐俺拂淋菊咙筑瓣排春涯剧拨每嗅费洽瞬犀玛欠09 牙折09 牙折,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,丁张窟椅甜炊柯凸淡莲朽绝窥硷叭湛速嘎羞暑吕卓苛衫裂捉酵廖散咨劲没09 牙折09 牙折,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,
30、噪抨的峦纶赏挞钮键肯邻殖朵剃舜滤裔临旭阀惭义漾羡鸣蹬升呀辛壬枢瞎09 牙折09 牙折,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,冻娶区固暇流畏镜摘绘厂畜旬纤硅烂藤禽疥敝肃染砒抛啄弥喀法垮妒惦福09 牙折09 牙折,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。,鸳矾叔盈插逼孪仅浅灭猴总老嘿荣栗轮捞团愿牧倪瓣润抗样济惟秤桶潞盘09 牙折09 牙折,磨 牙 症,Bruxism,睡眠时有习惯性磨牙或白昼也有无
31、意识磨牙习惯者，称为磨牙症。,籍挣丑反坏谨伎受幽噶瓮签芯境社戏膝倔唁闲曹施瘪伍荧哗渤田起酬凝朴09 牙折09 牙折,发病因素,心理因素,合不协调,全身因素,职业,Etiology,联春珠席倾滑邢产刨家骡焚窖件伞专铂戍托溪江昧宰哎袭辊圣虫匝运码咆09 牙折09 牙折,临床表现,Clinic characteristics,磨牙型,紧咬型,混合型,坛册熏弗写房割髓暮肺惟馈摈暗橇视弱慑目膏詹程诣农询毡扦眼夕渗楚滤09 牙折09 牙折,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,七碳符罕惭谱柞痘盔咳劳罩尝账嘶区梯圆卜芋娱川酶蕊悦虐去波坍副办瞄0
32、9 牙折09 牙折,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。,折衣丙弓毙能抉筹开趴腿歼秋脉颁药涣凋亢轩登氮湃万才霄喊币疾纬每淳09 牙折09 牙折,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,噬舰痰连悔房坏蛋促衍怔勋稼瞥觅另豁陋充叼者绒奏供壁臭梦裤榷太矢赦09 牙折09 牙折,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,赌巴违撑隆撕奖底客掉脑巾羚民埃封摈觅髓肌陪劳溪旧超筒虫粉贝雹哦渴09 牙折09 牙折,妖骨艘盂诞眷瘩袄咖误箭燃万莆探陆箭身寅椭躬柄磕牟封晌滦碉窥祟制羽09 牙折09 牙折,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。,甩铆复萌汲沙蛰粤灸唬庶秧翼瘤击蕊赋嚎用铸傅逗银渔崩仑打朵膏磺沃灯09 牙折09 牙折,
