齲臨床特征和診斷課件

Chapter3

ClinicalManifestationsandDiagnosisofDentalCariesChapter3

ClinicalManifestHistophathologyofCariesEnamelCariesHistophathologyofCariesEnameTheearlyenamellesionconsistsoffourzonesofalternatinglevelsofmineralisation.Itillustratesthedynamicnatureofthecariesprocess.Thesurfacezoneblocksthepassageofcalciumionsintothebodyofthelesionandmayhavetoberemovedtoallowthelesiontobecomearrested(AfterKidd&Joyston-Bechal,1987).TheearlyenamellesionconsisDentinalCariesDentinalCariesDentinecariescomprisestwo

mainlayers.Intheouterlayer,thedentineisheavilyinfectedwithbacteria.Bothorganicmatrixandmineralhavebeenlostandthedentineisbeyondrepair.Inthedeeperlayer,thedentinehasbeenaffectedbyplaqueacidsanddemineralised.Thenumberofcolonyformingunits(CFU)ofbacteriadecreases(about100times)ascavitypreparationproceedsintoaffecteddentine.Thedamageinthislayerisreversibleifbacterialmetabolismcanbehalted.Abarrieroftranslucent(wellmineralised)dentinemaybeformedaheadoftheadvancinglesion.Reactionary(secondary)dentineformstoprotectthepulpfromacidirritation(AfterKidd&Joyston-Bechal,1987Dentinecariescomprisestwo

齲臨床特征和診斷課件RootcarieslesionsEarly:AppearsasradiolucentzoneintherootcementumRootcarieslesionsEarly:ApStepsintheformationofanarrestedlesionindentinea)highconcentrationofdissolvedmineralsalts.b)Ifbcterialacidproductionisreduced,andthepHincreases,thesaltsprecipitateintolargecrystalsoftricalciumphosphatewhichtemporallyblockthetubule.c)Iffurtherbacterialactivityissuppressed,theodontoblastsecretescollagenandcalciumsalts.Crystalsofhydroxyapatitethenformandblockthetubulemoreeffectively(AfterDaculsietal,1987)

StepsintheformationofanaTheProcessofDemineralizationandRemineralizationCariesisadynamicprocess.Teetharesubjectedtoanongoingcycleofdemineralizationandremineralizationdeterminedbythebalanceoffactors.TheProcessofDemineralizatioDemineralizationDemineralizationistheprocessofremovingminerals,intheformofmineralions,fromdentalenamel.AsubstantialnumberofmineralionscanberemovedfromhydroxyapatitelatticeworkwithoutdestroyingitsstructuralintegrityDemineralizationDemineralizatiRemineralizationRemineralizationistheprocessofrestoringminerals-again,intheformofmineralions-tothehydroxyapatite'slatticeworkstructure.RemineralizationRemineralizati促進再礦化阻止齲病發(fā)展齲損的形成是脫礦與再礦化的連續(xù)性動力過程。促進再礦化阻止齲病發(fā)展齲損的形成是脫礦與再礦化的連續(xù)性動力1、除去致齲底物：木糖醇取代蔗糖，減少碳水化合物攝入頻率Dietcounseling:ToidentifythesourcesofsucroseandacidicfoodstuffsinthedietToreducethefrequencyofingestionofbothTousexylitolassugarsubstitute.1、除去致齲底物：木糖醇取代蔗糖，2、仔細刷牙，牙面不形成厚的牙菌斑Oralhygiene:Plaquefreetoothsurfacedonotdecay.DentalflossingToothbrushingRinsing2、仔細刷牙，牙面不形成厚的牙菌斑3、在牙齒發(fā)育的再礦化期間，結(jié)合氟離子，可形成更具抗齲能力的釉質(zhì)Useoffluoride3、在牙齒發(fā)育的再礦化期間，結(jié)合氟齲臨床特征和診斷課件Clinicalclassificationofcaries

ClinicalclassificationofcarClassificationaccordingtoprogressionrateAcutecaries:progressfast,ofteninchildrenandteenagers,lightcoloredcavity.ClassificationaccordingtoprRampantcaries,manytoothinvolvedatsametimeacutecariesfeatureoftenaccompaniedbysystematicdisorder.Suchassjogrensyndromeorsalivareductionafterradiation.

Cariesinapatientwithimpairedsalivaryfunctionasresultofradiationtherapy(courtesyofDrsJansmaandVissink,RUG,theNetherlands).

Rampantcaries,manytoothinv

Chroniccaries

progressslowly,blackorbrowncoloredcavityhardremainingdentine

Arrestedcaries

cariesstopprogressingbecauseof

thelocaletiologicalchangeChroniccariesprogressSecondarycaries(recurrentcaries)cariesrecurredaftertreatment.Oftenatthemarginthefillingmaterialsrestorationorbeneath

Theshadowlocatedonthemesiolingualcuspadjacenttothelargerocclusalamalgamrestorationonthemaxillaryrightfirstmolarindicatesthepresenceofcariousdentin

Secondarycaries(recurrentca齲臨床特征和診斷課件ClassificationaccordingtotheinvolvingsiteOcclusalcaries

RootcariesSmoothsurfacecariesClassificationaccordingtothClassificationaccordingtothedeepnessSuperfacialcaries(淺齲)whitespotlesions,visiblyfrostedsurfacebrownspotDentincaries(中齲)cavitatedlesioninvolvingtheuppartofdentinDeepcaries(深齲)cavitatedlesioninvolvingthepupalthirdofdentinClassificationaccordingtothDiagnosisVisualchangeProbing:roughsurfaceortrappingpointpainuponprobingTemperaturetestX-rayexaminationTransilluminationDiagnosisVisualchangeVisualchange

Matte,white,activecervicallesionsVisualchangeMatte,white,ac齲臨床特征和診斷課件Probing:roughsurfaceortrappingpointpainuponprobing

TheexplorertipcaneasilydamagewhitespotlesionsProbing:roughsurfaceortrap齲臨床特征和診斷課件齲臨床特征和診斷課件Temperaturetest

TemperaturetestX-rayexamination

X-rayexaminationTransillumination（FOTL,光纖透照法）：

ProximalcarieslesionisdetectedinananteriortoothwiththeuseoftransilluminationTransilluminationProximalcariLAF（激光熒光法)

LAF（激光熒光法)

Thehardwareoftheintra-oralsystemincludesameasurementprobe,acontrolunit,andacomputerfittedwithaframegrabber.Thecontrolunitconsistsofanilluminationdeviceandimagingelectronics.Thelightsourceisaspecialarc-lampbasedonXenon氙technology.Thelightfromthislampisfilteredbyablue-transmittingfilter.Aliquidlightguidetransportsthebluelighttotheteethinthemouth.

QuantitativeLight-inducedFluorescenceThehardwareoftheintra-oralQLF?technicalspecificationsQLF?technicalspecificationsQLF?theoryTheQLF?methodisbasedontheauto-fluorescence熒光ofteeth.Whenteethareilluminatedwithhighintensitybluelighttheywillstarttoemitlightinthegreenpartofthespectrum.Thefluorescenceofthedentalmaterialhasadirectrelationwiththemineralcontentoftheenamel.QuantitativeLight-inducedFluorescence

QLF?theoryTheQLF?methodisDIAGNOdentpen(齲齒探測筆)DIAGNOdenthttp:///products/handpieces_accessories/special_instruments/diagnodent/tutorial.asp?navid=500019&lan=Us&znavid=311000DIAGNOdentpen(齲齒探測筆)DIAGNOdentpenDIAGNOdentpenDIAGNOdentDIAGNOdent齲臨床特征和診斷課件StandardofdiagnosisStandardofdiagnosisSuperfacialcaries(淺齲)Whitespotorbrown,darklesion,roughuponprobingNocomplaint,nohypersensitivitySuperfacialcaries(淺齲)WhitesDentincaries(中齲)Cavity,hypersensitivityuponprobing,hotorcoldstimulus.Dentincaries(中齲)Cavity,hypDeepcaries(深齲)Deepcavity,verysensitiveandsomepainuponstimulus,howeverthepaindisappearassoonasthestimulusistakenaway.Deepcaries(深齲)Deepcavity,TreatmentStrategyTreatmentStrategyTreatmentStrategyPreventive(casual,noninvasive)treatmentRestorative(operative,invasive)treatment

TreatmentStrategyPreventive(cPreventivetreatmentchemicaltherapy:

useoffluoridewitharegulardailyadministrationorprofessionalapplied.

pitandfissuresealingPreventivetreatmentchemicalt一、chemicaltherapy

（化學(xué)療法

）

1．藥物治療適應(yīng)證（1）恒牙早期釉質(zhì)齲未形成齲洞者，自潔作用較好的區(qū)域；（2）一年內(nèi)將被替換的乳牙大面積淺齲；（3）靜止齲。藥物氟化物硝酸銀一、chemicaltherapy

（化學(xué)療法）藥物治療氟化物(fluorence)

75％氟化鈉甘油糊劑8％氟化亞錫溶液酸性磷酸氟化鈉（APF）溶液含氟凝膠（1.5％APF凝膠）含氟涂料原理：氟與HA作用，形成氟磷灰石；沉積氟化物，促進再礦化。氟化物對軟組織無腐蝕性，不使牙變色，安全有效，前后牙均可使用。藥物治療氟化物(fluorence)藥物治療硝酸銀10％硝酸銀氨硝酸銀原理:蛋白銀沉淀

還原銀或碘化銀滲入牙釉質(zhì)牙本質(zhì)，殺滅細菌，封閉病變區(qū)

對軟組織有強的腐蝕性，不可用于牙頸部齲，并使牙變黑，只用于乳牙和后牙。藥物治療硝酸銀10％硝酸銀氨硝酸銀應(yīng)用方法：用石尖磨除牙表面淺齲，暴露病變部位清潔牙面隔濕吹干涂布藥物應(yīng)用方法：用石尖磨除牙表面淺齲，暴露病變部位2．Remineralization(再礦化療法)

再礦化液：主要為含有不同比例的鈣、磷和氟。適應(yīng)癥平滑面早期釉質(zhì)齲齲易感者預(yù)防應(yīng)用方法：漱口液每日含漱局部應(yīng)用

2．Remineralization(再礦化療法)pitandfissuresealing

（窩溝封閉)

適應(yīng)證：窩溝可疑齲；與充填窩洞相鄰的牙合面無齲深溝裂，應(yīng)用方法：清潔牙面、隔濕、酸蝕、涂布及固化封閉劑。

pitandfissuresealing

（窩溝封閉)DefinitionofOperativeDentistry

Operativedentistryistheartandscienceofthediagnosis,treatment,andprognosisofdefectsofteethwhichdonotrequirefullcoveragerestorationsforcorrection.

DefinitionofOperativeDentisSuchtreatmentshouldresultintherestorationofpropertoothform,function,andestheticswhilemaintainingthephysiologicalintegrityoftheteethinharmoniousrelationshipwiththeadjacenthardandsofttissues;allofwhichenhancethegeneralhealthandwelfareofthepatient.SuchtreatmentshouldresultiIndicationofOperativeDentistry

Caries

Malformed,discolored,orfracturedteethRestorationreplacement

IndicationofOperativeDentisProgramofOperativeTreatment

PatientassessmentExaminationanddiagnosisTreatmentplanningProgramofOperativeTreatmentCavityPreparation

Themechanicalalterationofadefective,injured,ordiseasedtoothinordertobestreceivearestorativematerialwhichwillre-establishahealthystateforthetoothincludingestheticcorrectionswhereindicated,alongwithnormalformandfunction.

CavityPreparationThemechani齲臨床特征和診斷課件齲臨床特征和診斷課件

Classificationofcavity

ClassⅠClassⅡClassⅢClassⅣClassⅤClassⅥ—G.V.Blackin1908

ClassificationofcavityClaClassI

AllpitandfissurecavitiesareClassI.

Cavitiesonocclusalsurface;Cavitiesonocclusaltwo-thirdsofthefacialandlingualsurfacesofmolars;Cavitiesonlingualsurfaceofmaxillaryincisor.ClassIAllpitandfissureClassII

AcavityoccurringontheproximalsurfaceofposteriorteethareClassII.MOmesialandocclusal

DOdistalandocclusalMODmesial,occlusalanddista

ClassIIAcavityocClassIIICavitiesontheproximalsurfacesofanteriorteeththatdo

notinvolvetheincisalanglesareClassIII.ClassIIICavitiesontheproxiClassIV

Cavitiesontheproximalsurfacesofanteriorteeththatdo

involvetheincisalanglesareClassIV.ClassIV

CavitiesontheproxiClassVCavitiesonthegingivalthirdofthefacialorlingualsurfacesofallteeth(notpitandfissurecavities)areClassV.ClassVCavitiesonthegingiva齲臨床特征和診斷課件ClassVICavitiesontheincisaledgeofanteriorteethortheocclusalcuspheightsofposteriorteethareClassVI.ClassVICavitiesontheincisa齲臨床特征和診斷課件洞型分類一類洞：根據(jù)發(fā)生于所有牙齒的發(fā)育窩，溝內(nèi)的齲損所制備的洞型。二類洞：后牙鄰面的齲損所制備的洞型。三類洞：前牙鄰面未損及切角的齲損所制備的洞型。四類洞：前牙鄰面損及切角的齲損所制備的洞型。五類洞：所有牙齒頰（唇），舌（腭）面齦1/3牙面的齲損制備的洞型。六類洞：所有牙齒牙尖，牙脊或冠軸交界的軸角區(qū)的齲損所制備的洞型。洞型分類一類洞：根據(jù)發(fā)生于所有牙齒的發(fā)育窩，溝內(nèi)的齲臨床特征和診斷課件CavityStructure

wallsanglescavityCavityStructurewalls齲臨床特征和診斷課件Walls

Internalwalls:apreparedcavitysurfacethatdoesnotextendtotheexternaltoothsurface.

Axialwalls:aninternalwallparallelwiththelongaxisofthetoothandocclusalofthetooth.Pulpalwalls:aninternalwallthatisbothperpendiculartothelongaxisofthetoothandocclusalofthepulp.WallsInternalwalls:apreparWallsExternalwalls:apreparedcavitysurfacethatextendtotheexternaltoothsurface.

.Theexternalwallstakesthenameofthetoothsurfacethatthewallistoward.

WallsExternalwalls:aprepare齲臨床特征和診斷課件Angles

Lineangle:thejunctionofthetwoplanalsurfacesofdifferentorientationalongaline.

AnglesLineangle:thejunc齲臨床特征和診斷課件Angles

Pointangle:thejunctionofthreeplanalsurfacesofdifferentorientation.

AnglesPointangle:thejuncti齲臨床特征和診斷課件Angles

Cavosurfaceangle:theangleoftoothstructureformedbythejunctionofapreparedcavitywallandtheexternalsurfaceofthetooth.

Alsoreferredtoasthecavitymarginorcavosurfacemargin.

AnglesCavosurfaceangle:the3．洞型結(jié)構(gòu)●

洞壁：窩洞的壁，分側(cè)壁和髓壁(pulpalwalls)

△

側(cè)壁與牙面垂直的壁(頰壁,齦壁)△

髓壁與洞側(cè)壁垂直，位于洞底覆蓋牙髓的洞壁?！?/p>

軸壁與牙長軸平行的髓壁●

洞角△

點角三壁相交構(gòu)成頰軸齦點角△

線角兩壁相交構(gòu)成頰髓線角●

洞緣角

洞側(cè)壁與牙面相交形成的線角

△洞緣窩洞側(cè)壁與牙面相交構(gòu)成洞的邊緣3．洞型結(jié)構(gòu)齲臨床特征和診斷課件

Cavity

Simplecavity:onlyonetoothsurfaceisinvolved.

Compoundcavity:twosurfacesareinvolved.

Complexcavity:threeormoresurfacesareinvolved.

CavitySimplecavity:onlyon齲臨床特征和診斷課件齲臨床特征和診斷課件Chapter3

ClinicalManifestationsandDiagnosisofDentalCariesChapter3

ClinicalManifestHistophathologyofCariesEnamelCariesHistophathologyofCariesEnameTheearlyenamellesionconsistsoffourzonesofalternatinglevelsofmineralisation.Itillustratesthedynamicnatureofthecariesprocess.Thesurfacezoneblocksthepassageofcalciumionsintothebodyofthelesionandmayhavetoberemovedtoallowthelesiontobecomearrested(AfterKidd&Joyston-Bechal,1987).TheearlyenamellesionconsisDentinalCariesDentinalCariesDentinecariescomprisestwo

mainlayers.Intheouterlayer,thedentineisheavilyinfectedwithbacteria.Bothorganicmatrixandmineralhavebeenlostandthedentineisbeyondrepair.Inthedeeperlayer,thedentinehasbeenaffectedbyplaqueacidsanddemineralised.Thenumberofcolonyformingunits(CFU)ofbacteriadecreases(about100times)ascavitypreparationproceedsintoaffecteddentine.Thedamageinthislayerisreversibleifbacterialmetabolismcanbehalted.Abarrieroftranslucent(wellmineralised)dentinemaybeformedaheadoftheadvancinglesion.Reactionary(secondary)dentineformstoprotectthepulpfromacidirritation(AfterKidd&Joyston-Bechal,1987Dentinecariescomprisestwo

齲臨床特征和診斷課件RootcarieslesionsEarly:AppearsasradiolucentzoneintherootcementumRootcarieslesionsEarly:ApStepsintheformationofanarrestedlesionindentinea)highconcentrationofdissolvedmineralsalts.b)Ifbcterialacidproductionisreduced,andthepHincreases,thesaltsprecipitateintolargecrystalsoftricalciumphosphatewhichtemporallyblockthetubule.c)Iffurtherbacterialactivityissuppressed,theodontoblastsecretescollagenandcalciumsalts.Crystalsofhydroxyapatitethenformandblockthetubulemoreeffectively(AfterDaculsietal,1987)

StepsintheformationofanaTheProcessofDemineralizationandRemineralizationCariesisadynamicprocess.Teetharesubjectedtoanongoingcycleofdemineralizationandremineralizationdeterminedbythebalanceoffactors.TheProcessofDemineralizatioDemineralizationDemineralizationistheprocessofremovingminerals,intheformofmineralions,fromdentalenamel.AsubstantialnumberofmineralionscanberemovedfromhydroxyapatitelatticeworkwithoutdestroyingitsstructuralintegrityDemineralizationDemineralizatiRemineralizationRemineralizationistheprocessofrestoringminerals-again,intheformofmineralions-tothehydroxyapatite'slatticeworkstructure.RemineralizationRemineralizati促進再礦化阻止齲病發(fā)展齲損的形成是脫礦與再礦化的連續(xù)性動力過程。促進再礦化阻止齲病發(fā)展齲損的形成是脫礦與再礦化的連續(xù)性動力1、除去致齲底物：木糖醇取代蔗糖，減少碳水化合物攝入頻率Dietcounseling:ToidentifythesourcesofsucroseandacidicfoodstuffsinthedietToreducethefrequencyofingestionofbothTousexylitolassugarsubstitute.1、除去致齲底物：木糖醇取代蔗糖，2、仔細刷牙，牙面不形成厚的牙菌斑Oralhygiene:Plaquefreetoothsurfacedonotdecay.DentalflossingToothbrushingRinsing2、仔細刷牙，牙面不形成厚的牙菌斑3、在牙齒發(fā)育的再礦化期間，結(jié)合氟離子，可形成更具抗齲能力的釉質(zhì)Useoffluoride3、在牙齒發(fā)育的再礦化期間，結(jié)合氟齲臨床特征和診斷課件Clinicalclassificationofcaries

ClinicalclassificationofcarClassificationaccordingtoprogressionrateAcutecaries:progressfast,ofteninchildrenandteenagers,lightcoloredcavity.ClassificationaccordingtoprRampantcaries,manytoothinvolvedatsametimeacutecariesfeatureoftenaccompaniedbysystematicdisorder.Suchassjogrensyndromeorsalivareductionafterradiation.

Cariesinapatientwithimpairedsalivaryfunctionasresultofradiationtherapy(courtesyofDrsJansmaandVissink,RUG,theNetherlands).

Rampantcaries,manytoothinv

Chroniccaries

progressslowly,blackorbrowncoloredcavityhardremainingdentine

Arrestedcaries

cariesstopprogressingbecauseof

thelocaletiologicalchangeChroniccariesprogressSecondarycaries(recurrentcaries)cariesrecurredaftertreatment.Oftenatthemarginthefillingmaterialsrestorationorbeneath

Theshadowlocatedonthemesiolingualcuspadjacenttothelargerocclusalamalgamrestorationonthemaxillaryrightfirstmolarindicatesthepresenceofcariousdentin

Secondarycaries(recurrentca齲臨床特征和診斷課件ClassificationaccordingtotheinvolvingsiteOcclusalcaries

RootcariesSmoothsurfacecariesClassificationaccordingtothClassificationaccordingtothedeepnessSuperfacialcaries(淺齲)whitespotlesions,visiblyfrostedsurfacebrownspotDentincaries(中齲)cavitatedlesioninvolvingtheuppartofdentinDeepcaries(深齲)cavitatedlesioninvolvingthepupalthirdofdentinClassificationaccordingtothDiagnosisVisualchangeProbing:roughsurfaceortrappingpointpainuponprobingTemperaturetestX-rayexaminationTransilluminationDiagnosisVisualchangeVisualchange

Matte,white,activecervicallesionsVisualchangeMatte,white,ac齲臨床特征和診斷課件Probing:roughsurfaceortrappingpointpainuponprobing

TheexplorertipcaneasilydamagewhitespotlesionsProbing:roughsurfaceortrap齲臨床特征和診斷課件齲臨床特征和診斷課件Temperaturetest

TemperaturetestX-rayexamination

X-rayexaminationTransillumination（FOTL,光纖透照法）：

ProximalcarieslesionisdetectedinananteriortoothwiththeuseoftransilluminationTransilluminationProximalcariLAF（激光熒光法)

LAF（激光熒光法)

Thehardwareoftheintra-oralsystemincludesameasurementprobe,acontrolunit,andacomputerfittedwithaframegrabber.Thecontrolunitconsistsofanilluminationdeviceandimagingelectronics.Thelightsourceisaspecialarc-lampbasedonXenon氙technology.Thelightfromthislampisfilteredbyablue-transmittingfilter.Aliquidlightguidetransportsthebluelighttotheteethinthemouth.

QuantitativeLight-inducedFluorescenceThehardwareoftheintra-oralQLF?technicalspecificationsQLF?technicalspecificationsQLF?theoryTheQLF?methodisbasedontheauto-fluorescence熒光ofteeth.Whenteethareilluminatedwithhighintensitybluelighttheywillstarttoemitlightinthegreenpartofthespectrum.Thefluorescenceofthedentalmaterialhasadirectrelationwiththemineralcontentoftheenamel.QuantitativeLight-inducedFluorescence

QLF?theoryTheQLF?methodisDIAGNOdentpen(齲齒探測筆)DIAGNOdenthttp:///products/handpieces_accessories/special_instruments/diagnodent/tutorial.asp?navid=500019&lan=Us&znavid=311000DIAGNOdentpen(齲齒探測筆)DIAGNOdentpenDIAGNOdentpenDIAGNOdentDIAGNOdent齲臨床特征和診斷課件StandardofdiagnosisStandardofdiagnosisSuperfacialcaries(淺齲)Whitespotorbrown,darklesion,roughuponprobingNocomplaint,nohypersensitivitySuperfacialcaries(淺齲)WhitesDentincaries(中齲)Cavity,hypersensitivityuponprobing,hotorcoldstimulus.Dentincaries(中齲)Cavity,hypDeepcaries(深齲)Deepcavity,verysensitiveandsomepainuponstimulus,howeverthepaindisappearassoonasthestimulusistakenaway.Deepcaries(深齲)Deepcavity,TreatmentStrategyTreatmentStrategyTreatmentStrategyPreventive(casual,noninvasive)treatmentRestorative(operative,invasive)treatment

TreatmentStrategyPreventive(cPreventivetreatmentchemicaltherapy:

useoffluoridewitharegulardailyadministrationorprofessionalapplied.

pitandfissuresealingPreventivetreatmentchemicalt一、chemicaltherapy

（化學(xué)療法

）

1．藥物治療適應(yīng)證（1）恒牙早期釉質(zhì)齲未形成齲洞者，自潔作用較好的區(qū)域；（2）一年內(nèi)將被替換的乳牙大面積淺齲；（3）靜止齲。藥物氟化物硝酸銀一、chemicaltherapy

（化學(xué)療法）藥物治療氟化物(fluorence)

75％氟化鈉甘油糊劑8％氟化亞錫溶液酸性磷酸氟化鈉（APF）溶液含氟凝膠（1.5％APF凝膠）含氟涂料原理：氟與HA作用，形成氟磷灰石；沉積氟化物，促進再礦化。氟化物對軟組織無腐蝕性，不使牙變色，安全有效，前后牙均可使用。藥物治療氟化物(fluorence)藥物治療硝酸銀10％硝酸銀氨硝酸銀原理:蛋白銀沉淀

還原銀或碘化銀滲入牙釉質(zhì)牙本質(zhì)，殺滅細菌，封閉病變區(qū)

對軟組織有強的腐蝕性，不可用于牙頸部齲，并使牙變黑，只用于乳牙和后牙。藥物治療硝酸銀10％硝酸銀氨硝酸銀應(yīng)用方法：用石尖磨除牙表面淺齲，暴露病變部位清潔牙面隔濕吹干涂布藥物應(yīng)用方法：用石尖磨除牙表面淺齲，暴露病變部位2．Remineralization(再礦化療法)

再礦化液：主要為含有不同比例的鈣、磷和氟。適應(yīng)癥平滑面早期釉質(zhì)齲齲易感者預(yù)防應(yīng)用方法：漱口液每日含漱局部應(yīng)用

2．Remineralization(再礦化療法)pitandfissuresealing

（窩溝封閉)

適應(yīng)證：窩溝可疑齲；與充填窩洞相鄰的牙合面無齲深溝裂，應(yīng)用方法：清潔牙面、隔濕、酸蝕、涂布及固化封閉劑。

pitandfissuresealing

（窩溝封閉)DefinitionofOperativeDentistry

Operativedentistryistheartandscienceofthediagnosis,treatment,andprognosisofdefectsofteethwhichdonotrequirefullcoveragerestorationsforcorrection.

DefinitionofOperativeDentisSuchtreatmentshouldresultintherestorationofpropertoothform,function,andestheticswhilemaintainingthephysiologicalintegrityoftheteethinharmoniousrelationshipwiththeadjacenthardandsofttissues;allofwhichenhancethegeneralhealthandwelfareofthepatient.SuchtreatmentshouldresultiIndicationofOperativeDentistry

Caries

Malformed,discolored,orfracturedteethRestorationreplacement

IndicationofOperativeDentisProgramofOperativeTreatment

PatientassessmentExaminationanddiagnosisTreatmentplanningProgramofOperativeTreatmentCavityPreparation

Themechanicalalterationofadefective,injured,ordiseasedtoothinordertobestreceivearestorativematerialwhichwillre-establishahealthystateforthetoothincludingestheticcorrectionswhereindicated,alongwithnormalformandfunction.

CavityPreparationThemechani齲臨床特征和診斷課件齲臨床特征和診斷課件

Classificationofcavity

ClassⅠClassⅡClassⅢClassⅣClassⅤClassⅥ—G.V.Blackin1908

ClassificationofcavityClaClassI

AllpitandfissurecavitiesareClassI.

Cavitiesonocclusalsurface;Cavitiesonocclusaltwo-thirdsofthefacialandlingualsurfacesofmolars;Cavitiesonlingualsurfaceofmaxillaryincisor.ClassIAllpitandfissureClassII

AcavityoccurringontheproximalsurfaceofposteriorteethareClassII.MOmesialandocclusal

DOdistalandocclusalMODmesial,occlusalanddista

ClassIIAcavityocClassIIICavit