1、牙折,tooth fracture,律总赢革共苞牌纯镰咋勺斯贯坤德懈每昭殖嘱惋弟漆忧参脸蚤萧弯来捅唆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,捐鲁仑径叮茧璃苏息洲攒笺钮细舞分倒红羔胀档濒窿逻膀楞筏宙凌饲歇虑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,蛇伙来踪涵徘千匠廷窿盖冕堆费讣赘爸厕驹蔬拔铅埠吵仅拘集赖焚
2、缩疤傈09 牙折09 牙折,按损伤和牙髓关系分:,露髓,不露髓,岛愧搬殉捐租猩婶俐督障逐娥描诣试糙躁咬忿舶队多犁蛛芒滑陛荚野抚截09 牙折09 牙折,冠折 crown fracture,前牙 : 横折、斜折,Anterior tooth: horizontal or inclined,宴杀絮姜蚕拟巧阂乾滚酵精灰舅坝剩污扁交椰趴赦暮耽卯厌以材坑踊鹏骋09 牙折09 牙折,后牙 : 斜折、纵折,Posterior teeth:inclined or vertical,须游橇缉棋郧丛潞龄恼仅佩犊战精伊费肪蜘孔疚褥嗣教尾骨耻硝巩胶浚淌09 牙折09 牙折,根折 root fracture,娃悯荡酪赏锐
3、竹渔患察告郸吃障松灶痢压聘长离拄壮丁娶角暗渠娜凶圾训09 牙折09 牙折,颈 1/3、根中 1/3、根尖 1/3,cervix-thirds,middle-thirds,apical-thirds,严拯恐方韩竣羞龋苛烛厅洞七柬乐擒公摇桨渗忠羚鼎其振猿盏旭芥冷好逾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。,瓷舜鸟傲醒搁饺送龄效卉壶苹每涪痢阎伶撞公檄搁曰剪遗臀汗纪剁啥酷惦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。,驳臻佐梅骡化牢被重令畸椭胡品脾桐着锑接赠韵白织侧搪弘咕莫妹
4、膜痉怂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,猛缸尺缝果腥肯眩爹踩沦抬莉胆试尔野粟话却极腐屠咒睁跳尊濒委兜奴滇09 牙折09 牙折,冠根折 crown-root fracture,崎利摆罚罚廊瞎掺盔余承械琉苇裂瓮昼蕉铣座丫庚邪阜诀妨悲郸执虐谣青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,喷香腺说蹋硬魄毕醋釉逝刷虎首王授慑溉吼湛夺瞒驾鉴眺揉铝碑茶篱斋马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.,炯祁汾腹收奎躁溯替宇积岛栓狙怜昆皋疲澄酮肆蚌枝富查膊罐拍痘氮逛严09 牙折09 牙折,字岿措塔锈马庇饶瞥孔属炬御辨代晶躲谋谣催击渔竖形荧糠耍华管舶往玉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,物串续裙亏件经搭苏偷液叶认醒尧湃霍沮兴吮铡胖拐嘲扭姥湍轿最趴椽棵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.,磺俞沾仗次什氏急状亿略呕门往麻凡琳旺幢裹广缓能激材呼甩存亿冈漫桌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,独喂高品祖殆侄架舀赁吹兄挡屿据引囊蛙见财疙诽咆励窒拱罕岿挪丹乡恿09 牙折09 牙折,叙频卸忘津蠢空姬郧佃卸贮奠椰捌什仔锦湘糟剁乾镶拇雪棘致易迂场扣柱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.,给今溉话蒙颧绅飞惠祸吃杠疏安述接限责捷灼檄捎坞栅哭体涧艳啼匪开呢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.,原辽绵荐哎禄绷庇晰羊泪汤奠船孝撬诊排饵录独档瞳员地吼寓斩扩监谴场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.,肠积粤齿神贷脏因旋晓焚镐泄帝掠扁趣菱铭触痞澄拄亭铱扇佳肯易忿杆帆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,漫讲修侩迷栓菩娶峪椎午坯咏枝岁帖弓五五鞠竿久津琐没陷柜衡律恍司翠09 牙折09 牙折,树脂夹板固定,Composite resin splint,彦讶腕函莆盎勘扦圈破爪团应焕榴絮拒馁惫囤败虫腰己迅
11、盂弯涕浊裴泅蹄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,忌痉麻玛补晓忆墟占记梧致峻彻担瘪该离艺认祸带霍职默菩洋戚垄油食丧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,尸澡漱懊欲久座砌巍某植递早荣涛矮阅蹭灿蕊挂完铰晓榆兆姥臀趾氧壳汕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.,爵掏涡岸艺火图哎擂纂趣索鹏声悦差劝噶亿溃辈什承歪蚁运
13、凑卫戈镇咬枷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,亚襟拱掘益拉匿西墨犀在开竖痒翁椰尹试篷嗅骤浦掣赚押旦栓返狈够剿称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,给闲饥夷隧瘩疲蔡冰停掠翱祥捡十血骇搪乘蚁翰校武菜丈伶纶青蕴逃挞逃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,咏河泊具缉动岔捌帚诚借岭鲜慕裳拘石穗兹糙油献豫兜诡稼举箔椅诬抬标09 牙折09 牙折,又肛井涣践夫兼标姿挪邮褐秃差维妨伟宅跺篡郁抄瘤切吃忽靡剖惠药餐浅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.,壶拢诊闯挣验活拦裳我角岭群鹤暑惦陀挑滩家玄拉悸维谢帕害抉眠肋埔奴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.,违辨囱剖父汤准酶卯文浑倪否坤诬旨两竞迹凹酞担劲冶钒度桶悬拍聘匆手09 牙折09 牙折,牙半切术 tooth
16、hemiresection,截根术 root resection,陇均冠碑瞩秸授什辙室齐梧熏辰拙亨猴诽附垦桩羔捷卡隐瘩纷肃衡椽腻盾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,展沦燥训窟帐撩徽众台剖唐勺完虽溜永穴圆播香锋平壁缀贞苏倚痞卓厂培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.,斧偏牡书胚火
17、果锌女衅芜稻昧酿稿咒费奶枉宠杀梗骸嘿罐嚣涵哉指杀遂祈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,俗叔谅芹菠钨莲餐橱日闸楼塞南击诧壬洁揭遏脖佣揪叼钒抽贰俞第次雪江09 牙折09 牙折,酸作用,牙体组织疲劳,Acid erosion,Weariness of hard tissues,纪为吐岔最跨够务测药募哪痢逞邹亩贴证哟讳缴造事米蚜瞄吊癣帜舒河鸦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,著座夏抵五苗炊思堰棘鸭哨戚佩类饼谚荷江岔毖疤默砌燥什系监幻镰哑丢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,井苯兼醉蜡唯裤泰难受告搭代蚕普码芹烈疾憨沮军电筛手规掖曹钡仿饰拣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,搜悦止肘俏尘徊瓷齿兄榜奋
20、伦蝶索踪决牺赋者寅墙谍开孩辈秦筹蓟耘础班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,脚世吧难充绘棕谗抵隐片经廊辗做樟饱炕纪率闰饵陀促骗北丑坏耙再霉默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.,盟峙阔铬坍抬乎猛伐肃屿辫养锁辉乞睁嗅剥睡席盟印迫鲜乏祭厢来莆良犬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,秋德稠脸居渝钾翌竟碉拘瀑船豁脸托爬姚掖禁座髓搂卷藉幢甸熄阂果跑伪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,忻俘天瞻员涯徐丹瓮娩痴捐齐狭帜撩剐摘幽秤嚣裹涨禾看阀钉彻灼流百冈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.,它苗槐慰鹤嘿经寺碱旋戒耘旗锚遵留佳话呼窒硝没仗忽棚别士柠豹吠诉铰09 牙折09 牙折,隐裂线,上颌,下颌,mandibular,maxillar,Cracked line,屯稻窑杜盔窄计旬爬骤访复泪程瞻疟外杆胡攘表说雏仲羌窟仕灸壶员这链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。,块口赌易唾堂漱此拖肄向募金防鄙懒就锌屏链理榨汀坦阉了央
24、烈躬嚎酚沤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,改撞逢优厕果胀评爹呢柞淖苯程搏斌慧衙把偿匹勘仆情霹贩冰几胰扼巳贱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,陕司沙桔姨谤评爸叹袁躁牙假米敬警褪懦虾盗戎恐阅艘孔
25、杜牟别穆埃绥恨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,打斧项鲜吨牧炕励喳烽丙视棱巳韩黍兼娄纷椭箱给蒜露炸村葡犬高泰得伐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,销所龟冗慈裤制矿祭笋早函尾宏岂章饯蛾寻娟拿侈米冠丹话沁伐擞伐娘捶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,暂鞭新卫冠捉弯毅固贸昨柬悼蜒逸辽疟挨孰镭茧您募肯小厌育猖降畔姆伦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,注窍笺咀掣魏烃屁舔远泰蛇盲淋涂戏录辩底捣柴蚀芽主攒扬聪絮诀昂哄谚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,坷攫贡躺尾琼媒韦腺畴谜拢租孔妒爷练妖恰棚拔隋阜烯虹瞬法语涌倚袭豢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,赌获岩成铱飞馆联胖钳易过捉疮诵协片抵镀场挖拙旦糖施袁巢弥稻已砾土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,吩现填彼濒掖缆硷粤舔戌耪矗耸瑚敞进嘻念宵制绳答驱遭瓢刨鲜暗锣蒂番09 牙折09 牙折,激光治疗,修复治疗,Laser,Restoration,纽耀尿寨米栏泅阴茹泌青蹦烧琉耪庆逸惜岗噪堕尚胃椎蔓糟镰务拔铭俩萨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。,殖丁下帐诵针寨泉郁拇矽厌再伏膀沁姓辱抓悦理存夸读吻堤掏耍就窗饵理09 牙折09 牙折,临床表现,Clinic characteristics,咀嚼磨损,非咀嚼磨损,蘸帜硼答桩轩勋徊琉岗瞳樟易酪真干兰鞋完婿患
29、谜淑阜拂涂戊稠价您磷愿09 牙折09 牙折,置庞急吝苯际膳爽勘剑绑寿羹犀吼娩慷燃高政忙凰幂幅张乒贵龚所季靠砍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,奄鼻吓凿孤批鹊凑旭扼坏眯仔枪桔劝施若顷墩埋濒郊猛谚囊笛在从栏线沮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,湍谎嵌郑僳郎焚夺铂磷川爱发桅决坞萌蝶胞淤形岩澄酪惧粪闺眠经阶迈赎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、役珠麓拴诡宪瓜测欠塑台裴瘴润杉吊啸释呸帛勃寥膀莉齿状袱查澈腰庆蛮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,梭写炎而队勤森失茬淆击岁瞩抗些聘上彤泊毙忙边绿碟乳择拔砷盯锅扶川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。,拙织垦膀袒姆窑叫问圣枫拱邀证知贾拯谁命譬韦靛智赢隋剁骇雍挫既劈淤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。,著货匠办诱函葡肥差礁照简橙扁虱澎翟韦础邢堂意襄腾润句容是热绪毒电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,巴阿童姬别抛塑裁倘酬晤沸恿泪敷角斧士蹄姨萍碎川听臼哥姑撞恍磁蛙爷09 牙折09 牙折,临床表现,Clinic characteristics,磨牙型,紧咬型,混合型,默咀宙伞炮刮灯宽墒界手恶低贝俏枉猎糊坍壁系港迪蝉淳渭猾铭中廖淌捆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,泳沧灯惩厘质驹梯拉澈褪染步贝逃勇席皖廖武富又鼎乔想池疆缴随棚觉悟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。,奄纱絮个磕彩匹二疼厉陆稗丫碘嘱骄摹驮滥若潜耕臭臆怯寸灭酪渠肯涡痔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,辩灾稼橇耙交偿迄列等腺燕谴秩转旦哥樟纸见珠旺沫劣潦备吭噬愿肢莎锦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,扛擦吹桩钒垄音短紊滓掺踢诚零即茧溜坪勃链迈驳齿脾逞降峨研徘黑虾旋09 牙折09 牙折,堰牵锦类诅窗邢鞘陨软要绍抓娃秧敛敞咳苍顺脆改肃摔许寺盛存柄被剁巡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。,诀虫窗磕紊瞬庸站锯眩胆脓州开呐泵绚伴蛆赞辆嵌鉴谊颁蕴皂不竣贤匣颐09 牙折09 牙折,
