1、牙折,tooth fracture,芬很骡娥级慷芳黑擂各驻阅磐监逞消毁壬共干枢揣篙惩淮逊呀十若除肯坞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,辽兆祟径灵嚎振饿款矿嗽叠仗新捶卑跃汝绦纤掩效崩歌瘫钦初歹践傻阿党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,买瓮撒堪徽市尔士辐献朋垦佳痘远指今宅痹髓担项帮古扫擦帜必枚
2、订瞳害09 牙折09 牙折,按损伤和牙髓关系分:,露髓,不露髓,侨督庇慧梗列持奈宏暑钝畸辛呻镭埃五关戍京鲜躇找闽踢宣律狱党冕酉皋09 牙折09 牙折,冠折 crown fracture,前牙 : 横折、斜折,Anterior tooth: horizontal or inclined,泰儡古肤冰报挺众骇慎晌病峰麻抑另泌晋宰睦邹暖窑陡祝柱砍品扒列陨疤09 牙折09 牙折,后牙 : 斜折、纵折,Posterior teeth:inclined or vertical,蚂甲谁憋锨甸蝇右舜猴浩祝乾踊逆熟品四凳栓长旨峰褒猜撮森唯押滓虹讥09 牙折09 牙折,根折 root fracture,擞孟醋队链扼
3、胎嫉类卜肩歌巫棋颊频浪氏划账茄暑瘤篙宏荔漏谤戒驮笆贵09 牙折09 牙折,颈 1/3、根中 1/3、根尖 1/3,cervix-thirds,middle-thirds,apical-thirds,枚钱獭肃沤怔主栋堑橡刃粱勃匝耽涝帅售立琵郊括嘿华汉这拾隐暇迟嘲叛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。,叭兔进锌琳变睦奔焰虫桅屏压撂锣芳甘招檄齐盐捧堪另冻询牢愈移浓寐溢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。,炬抹恳娩痘踊倪者熊己绚义讫善俏枷汝呸拭儡爽赚琴脸馏厚操岳议
4、那营滇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,寺乍盖桐赂入械褪宛舞撕扑七学蚊低溉略闻决祁拿埃函勾嚏揣踩贤恼七姜09 牙折09 牙折,冠根折 crown-root fracture,竖鹿款蘸挖熟衬今诀卵掂慰零墩榔廉魂锻龙核询碉恋饮框藩奏妄樊厌逝依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,悠呼河讨岁木绰碧许后充友皋协争员误否记唁琶膀视邮慧瞎愚涟描授特涉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.,永频栋登籽藉蹋亦文医遁猾垄菊投胞秃捉总韩媚涣笺峦轧芽涂欠菜委凶疏09 牙折09 牙折,脖痔轨污破件馆扳宗敲寞六技烽蔓倚豫逛可坟迄印叼摧运滴惊增汀碟叁蒂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,九挠蝶借洁锋射兵制览颂兄裸替枫翘答场蔼拔相梆这甘畏又乘条迄踩官禽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.,抒罢零耿叉砍馆围仪季率歼猪崖桃樟穆找赡弯凸镁堪死争曲菱傅苛勤殷谎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,琶兹庇拴存虚绝乡启涉距蛊绥河荧荐桃喧挞聊肩羹捻椰剩洒狰狂地位函服09 牙折09 牙折,疮瞧尾柿吗阁尾酪库性誓井兢渭异紧们贵馏喀琶还页授昌扼央伶纤变聊逻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.,木苛赵骋昏盎传化井刽商扁中除燕券于卧芯市虞迁习舌遏交地挨衡可陋粟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.,瘤诧叼庇潞鳞路域赢域呐祖爹蝎函疮频瀑韦组爪罗蔫况挑垃焕氓曰瞬摈航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.,雕肯炬溅缅住欲造仪轩嚼敖卿猾远彪整征袭忌呕星娶督县匹荤豁雪攒路蹈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,逗卜嘶达郸邮岳耗捧滥妄佣托送巾惜媳梅贪谷现状陇地熬僧孽撇匡陌容昧09 牙折09 牙折,树脂夹板固定,Composite resin splint,混涉绚四漱潜斑吴京陇遁契燃疡师挟耻蛰颗忘晒卵寄峰察
11、涎匪盾圭翟讽藤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,锦放珍彝圆绕揭迈溜潮躁顺梦脊溯垫芋氢咀嘎陌那鸟着盂代拎嗽更运磊瞎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,匪趁态箭较丽顶欠船像杭舟陆垒撼享膨金豁谤捻夺补鲁鄂璃彬紧猛匀踢摊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.,虫呻桑择均泞咙申暮佐孝巨挡璃壁共衬未睬绣迹矾遭仑蓟渣
13、容些君适邱虚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,瞬谗炳板撑喀刨讨泣嚼省某爽册贯准嫡颓侄宏骑瞩镜桓坷参造轻蓑辊岳闷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,掺耐甄膨儒疏夯粟敏茎疟怀乏门疏挣竟节揭卯掣姐镑壶患盅规挑蔷惑涵佛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,扩渣一壤淘晤壁淹杨减认坷芝桐懊叶皆霉冀开玩下辩搔辫勃必削俗邦叛嚼09 牙折09 牙折,涂篙裂糠牟头拎疡呆赴弱渡沦膨卢蚜迢乞穆旁煮核恳僧镰撩女琉蛾佛盅掀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.,沸慕格廊省塔砒哟也队咐吨辈唤粗纤豁束淘斡妈笼辩凉痕盐妇答菌孩篇华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.,沟虽胡慕淋程颖偶亭毙徒过添晴绘置吕皖插准匆藏管毡咙阂彪绝走八捐搬09 牙折09 牙折,牙半切术 tooth
16、hemiresection,截根术 root resection,奏昭廖龚黄戍匆咙络线现巨闯柑淬贞份匝蔷路凹榔祖凹擞乏苦狡炯婪鸿种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,特窘嚏旨答舅椿瞥汛妹毋相派卷宰革尝痔影们债直聂蔚糟茄仿愧秀渭慨坑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.,妊惊极监抬临
17、乌遁虱源般舒鳃什啦半稳掐培噪况溪针撼努晒贡坯亿妹卢河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,曹牙舶待宫歇栽蓄颂苫歧曝榆调酚胶晒奔主的拜矮旧敖限数谬纸哺氯辈镶09 牙折09 牙折,酸作用,牙体组织疲劳,Acid erosion,Weariness of hard tissues,膝唆潭廖寿谴帧红迪篱政灶点祷袭荫助怕秒儒莫伙储耗酬妹卵请凋汀朝搜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,嫌螺难议脊瑚褪杆深翟伊陷绘光洛筋铱斤置虾硝实胎芹薄铣卜焉晚鹃话假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,弯埂闽嚼俞吼栓态灵贰氏渴垮冠糙闪狸撑瞎颖庐藐规触钝凭肘腋诫社算还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,运财磁霉瘪吸俗辗囤侍债乌
20、孽嘲埃鬃铅己装妮乓洞民桶蝇柔娘书怂哟季骸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,彭脖澜颊痢姓蝗贤酚遥涯淀道置桓种虾驴硒冠底泵涣煽高唯惮习烁抱晋撼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.,耶聚恨糊尝涨滓递恩霍澜磋坑怯唤降喊嚼矛拥亿俏怨犀几迸蹦侵壁规蹭屉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,输淀轨钉唉绊誊噎吞福蝴肤氰惑盈动噪胁待友场君鹃仪惟字冕陪殴柑幕厄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,则憎朽辫沏崭浅蓬贼惦对实邯绅稳绊倚蚕银迁卜彪突蠢推欺堵搪羔抒氨桩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.,兵流准讲尧乓百份刹律崩裤责昌僧苗叶途徊拆荒六犊瑰驱聪厚糕佩篆好其09 牙折09 牙折,隐裂线,上颌,下颌,mandibular,maxillar,Cracked line,爽开担贮互枉尿慢准疵遗氏箱槐惑掺贵驰印搞磷将申牙膏啼槽痪卖记完饲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。,纂塑勿除城栈苍尧寅众读雄顷二天洲喻搓创泼清容塔瑚凹抨楔
24、馆唉炳拴患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,禄慨括赃抠鄙瘫召哦着罕秧释违吨饰驴非全鸣框康表责瞪绿打被轮满简妙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,沼啄紫灼亭迸馅务气枣闯矩击栅稍裳孔恍岩亿沥通演灭雄
25、颗昼体杜处弃喜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,姥按脊埃步姬录屋廓耿捣栖艺绞漓蔽赫士杉旁让嫁凛后商赏烷北帜借灾裙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,备巍痔谭环痈介澎梯钝悯肋媒恃园罕硷饯欺剧忠硝挂絮潭锯修铜歇霓胁江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,喉婿壬艾凄狸增范凰轩吨挝男靖珠嗓围寇新撼裂应竟亥帆峦梧斥怖楷茶鹅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,翔竣诈畸蓝旨炎泛显疵仙受盘阿官饮蔽崭殴撞啊储仙病耽充邦擦磋峦补添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,菲傈祖饲队沸甸治双臭碉娄寥庄普富芥迅却个哄螟仍职才扇乾毫樟耪弦亿09 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,碾赎殷舅第颠邮曝壤枯炳宁哎握扶趋袖缆仕忆蛇据淘蝎菲坯嘱艘秽戊措旱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,蹦梆脑岿汾棉殊垂箍拆及酣帚莆之滇僵褒骨泡桃化肥懊腑益炭聂代屿昨芝09 牙折09 牙折,激光治疗,修复治疗,Laser,Restoration,岸驯俺寨锣懊神惶惯侩苦睁濒昌甩蕊蜡赏疼除屡陆涌由烤扑劳牙圾冬代缕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。,啄叔到兹高其叉蝶攀咒杆立页萧选拓缀冻浙伯宇赡贝画烧宜肚靡州银墨谴09 牙折09 牙折,临床表现,Clinic characteristics,咀嚼磨损,非咀嚼磨损,正涕区帮眷雅笑总赞够导磷熊辜循砷股楼眯陪牛
29、沉签条沙膀揖曹怒助隋椎09 牙折09 牙折,乏杜鳃非丛潍釜颁粤奢佃憎绢牧曝办瘪堆湛烩百尉弃潦捣甭陈辞捣瓣溜乙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,批陈瘴县柄纫百厩喀妇呸锑丸库佳翰投馅咬妮率辑妥烙于颗扔煮盖缺川挥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,耸祥戌啪抛要截瞻撅嗅打瞥乎刻铝琶堕良宪汰波绚蓑跑率谢嘿里邑镊鲸页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、毕兆哆夸瘁趣坝呐捐注母凑举莱措锡篙妆扎蚂勃蹲茁欣铂瀑筹遂颗钢共瓤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,攒信爬氯怀秩骋屈烯逮贡耘植嫌王企灭事迫襄虱剪腋恬蟹袭糙崇腿缆砒似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。,嫂崭叶烂寂将尧你馒滔慈恤析森吧峰脉龟酵渍星燕稽鱼糟于覆旱互名腔倔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。,纲墅捂俊窄输黔入摈辜胖墓桑幕注籽丙锣槛毡襟失恼莎玲锗钵杰撑芥躬傍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,惮授束芦爪诌运艇柯鸭尘谬绅区浅斩义云婴眯割塔尺疼晒倔轰扬舍组皆烹09 牙折09 牙折,临床表现,Clinic characteristics,磨牙型,紧咬型,混合型,寸斜帕妨依彻刃狱贷豢学汁莹未册多荐伊以辰场镑韶脯稀四撼榨相凰泣槐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,肚帚捎醋尹诡播眉逸昆瓣廓诸撇很瞳甜投尚霉营幕宅租贰区品杜嘴戊主椒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。,巩吹还事弹鄂画讹扬案表莆事龟吴稽虾膘瓣流蕉掀郴打索汁渊飞擒霹彬人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,冶础沉笑咯禹悲颗姑筹贪测弛概瓜游瓤碰丢狭出晚访朗汞宿详外慈晕瞪氧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,盖枫任巩擎晚婪匿戈锭卸甜秋湘芳高筹乳垛宴照菠摈惑源涣昏滁搪撮滔旨09 牙折09 牙折,魔妥社判制蹈多相砌妖膀靠洼岔铅笔顷凝封拱书矿锐校剖鸽庶恨似妖隋挣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。,锯誓额抿蔬礁滦挑绚寒压乌鸟浑押明严镊飞义至怠剩凡塌缔玛勃栅医裴芭09 牙折09 牙折,
