1、Dep. of Operative Dentistry & Endodontics School of Stomatology Fourth Military Medical University,Cariology,Wang Hanguo,Contents,Self-introduction Caries Biological basis of Operative Dentistry Cavity Preparation Research papers,Self-introduction,prefix,dent- , denta- 牙,齿dent-al 牙的dent-al caries 龋d
2、ent-al materials 牙科材料dent-alloy 牙合金,denti- , dento - 牙, 齿dentist 牙科医生dentistry 牙科学 dentition 牙列Operative Dentistry 牙体修复(手术)学,odonto-, odont- 牙, 齿Odonto-logy 牙科学endo-, end- 内,在内,内部end-odontics 牙髓病学peri- 周围,邻近peri-odonto-logy 牙周病学ped(o) - 与儿童有关的ped-odontics 儿童牙科学,Conservative Dentistry Operative Denti
3、stry & Endodontics Periodontology & Oral Medicine Pedodontics Department of Conservative Dentistry Operative Dentistry & Endodonics,stomato-, stomat- 口、 口腔stomatic 口腔的Stomato-logy 口腔(医)学School of Stomatology 口腔医学院stomatological 口腔医学的stomat-itis 口腔炎,oral 口的 cavity 口腔 microflora 口腔菌丛 hygiene 口腔卫生oralo
4、gy 口腔学,in vitro 离体 (在活体外)in vivo 在体 (在活体内)in situ 原位,Permanent dentition,Caries,Clinical Appearance,Characteristics,Process of caries,Demineralization of apatitesDecomposition of organic substanceDiscolorationDisintegration of tooth structureCavitation,Definition,Dental caries, or tooth decay, is a
5、pathological process of localized destruction of tooth tissue by microorganisms. It is an irreversible, slowly progressive decay of the hard tissues of individual teeth characterized by demineralization of apatites and decomposition of organic substance which leads to a disintegration of tooth struc
6、tures and cavitation.,Susceptible sites,Susceptible teeth,molar premolar incisor canine,Classification,Developmental stage,SuperficialModerateDeep,Symptom?,Irritating/stimulating pain Spontaneous pain,Caries Pulpitis Periapical desease,Developmental speed,Chronic caries Acute caries rampant caries A
7、rrested caries,Treated or not,primary caries secondary caries,Etiology,Multi-factorial disease Host: teeth & saliva Microflora Substrate Time,Four factors must be acting concurrently Conditions within each of these factors must be favorable : bacteria cariogenic substrate suitable host susceptible t
8、ime sufficient,Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet. 2007 Jan 6;369(9555):51-9.,Biological basis of Operative Dentistry,Dentinogenesis,Primary dentinogenesis Secondary dentinogenesis Tertiary dentinogenesis Reactionary dentinogenesis Reparative dentinogenesis,Dentinogenesis,Primary
9、 dentinogenesis before completion of root formation Secondary dentinogenesis after completion of root formation Tertiary dentinogenesis at specific foci in the tooth in response to various stimuli,Dentine matrix secreted by surviving odontoblasts in response to an appropriate stimulus.,Reactionary d
10、entinogenesis,Dentine matrix secreted by a new generation of odontoblast-like cells in response to an appropriate stimulus, after the death of the original odontoblasts.,Reparative dentinogenesis,Operative Dentistry,Cavity Classification,I: Beginning in pits and fissures. II: Beginning in the proxim
11、al surfaces of the premolars and molars. III: Beginning in the proximal surfaces of the incisors and canines. IV: Beginning in the proximal surfaces of the incisors and canines and involving the incisal angle. V: Beginning in the gingival third of the labial, buccal or lingual surfaces.,Fundamental
12、Principles,Removal of the caries lesion clearlyConservation of the health dentine APACProtection of the dental pulp APAC,Cavity preparation,Procedures 1. Gain access and obtain outline form 2. Obtain the required resistance form 3. Obtain the required retention form 4. Obtain the required convenienc
13、e form 5. Remove any remaining caries dentine 6. Finish the enamel walls and margins 7. Perform cavity cleansing and medication,Biological and conservative approach rather than simple physical and mechanical one.,A synthetic enamel for rapid tooth repair,Seamless fixing of an early caries lesion can
14、 be achieved without prior excavation.,Yamagishi K, Onuma K, Suzuki T, Okada F, Tagami J, Otsuki M, Senawangse P,Nature. 2005 Feb 24;433(7028):819,Paste = H2O2 + H3PO4 +fluorized apatite,Original 3min later 15min later,acidic phosphate fluoride (NaF),Paste,SEM photograph of longitudinal section of p
15、aste-treated tooth after 10,000 times of brushing. Loss of re-grown layer by brushing is less than 10 .,Self-assembling peptide scaffolds promote enamel remineralization,J Dent Res. 2007 May;86(5):426-30,Kirkham J, Firth A, Vernals D, Boden N, Robinson CShore RC, Brookes SJ, Aggeli A,COOH-Gln-Gln-Arg-Phe-Glu-Trp-Glu-Phe-Glu-Gln-Gln-NH2,
