牙體牙髓學(xué)-齲病的治療

OperativeDentistry

鄭沛精選課件OperativeDentistryOperativedentistryistheartandscienceofthediagnosis,treatment,andprognosisofdefectsofteethwhichdonotrequirefullcoveragerestorationsforcorrection.精選課件enamel精選課件pulpodentinalcomplex精選課件

精選課件cementum精選課件Periodontal精選課件牙體修復(fù)原則去凈齲壞牙體組織保守治療的原則抗力形和固位形精選課件充填材料的選擇性能要求

物理和機(jī)械，化學(xué)，生物學(xué)選擇要點(diǎn)

牙齒部位，窩洞部位和咬合力，病人情況，其他因素精選課件精選課件CavityPreparation

Themechanicalalterationofadefective,injured,ordiseasedtoothinordertobestreceivearestorativematerialwhichwillre-establishahealthystateforthetoothincludingestheticcorrectionswhereindicated,alongwithnormalformandfunction.精選課件

Classificationofcavity

CavitiesmaybeclassifiedaccordingtothelocationwherethecariouslesionbeginsClassⅠClassⅡClassⅢClassⅣClassⅤClassⅥ—G.V.Blackin1908精選課件ClassI

AllpitandfissurecavitiesareClassI.

Cavitiesonocclusalsurface;Cavitiesonocclusaltwo-thirdsofthefacialandlingualsurfacesofmolars;Cavitiesonlingualsurfaceofmaxillaryincisor.精選課件精選課件ClassII

AcavityoccurringontheproximalsurfaceofposteriorteethareClassII.MOmesialandocclusal

DOdistalandocclusalMODmesial,occlusalanddista

精選課件精選課件精選課件ClassIIICavitiesontheproximalsurfacesofanteriorteeththatdo

notinvolvetheincisalanglesareClassIII.精選課件精選課件ClassIV

Cavitiesontheproximalsurfacesofanteriorteeththatdo

involvetheincisalanglesareClassIV.精選課件精選課件ClassVCavitiesonthegingivalthirdofthefacialorlingualsurfacesofallteeth(notpitandfissurecavities)areClassV.精選課件精選課件ClassVICavitiesontheincisaledgeofanteriorteethortheocclusalcuspheightsofposteriorteethareClassVI.精選課件精選課件

Cavity

Simplecavity:onlyonetoothsurfaceisinvolved.

Compoundcavity:twosurfacesareinvolved.

Complexcavity:threeormoresurfacesareinvolved.

精選課件精選課件CavityStructure

wallsanglescavity精選課件Walls

Internalwalls:apreparedcavitysurfacethatdoesnotextendtotheexternaltoothsurface.

Axialwalls:aninternalwallparallelwiththelongaxisofthetoothandocclusalofthetooth.Pulpalwalls:aninternalwallthatisbothperpendiculartothelongaxisofthetoothandocclusalofthepulp.asideorsurfaceofthecavitypreparationthataidsinenclosingtherestorativematerial.精選課件WallsExternalwalls:apreparedcavitysurfacethatextendtotheexternaltoothsurface.Theexternalwallstakesthenameofthetoothsurfacethatthewallistoward.

.精選課件精選課件Angles

Lineangle:thejunctionofthetwoplanalsurfacesofdifferentorientationalongaline.

精選課件Angles

Pointangle:thejunctionofthreeplanalsurfacesofdifferentorientation.

精選課件精選課件Angles

Cavosurfaceangle:theangleoftoothstructureformedbythejunctionofapreparedcavitywallandtheexternalsurfaceofthetooth.

Alsoreferredtoasthecavitymarginorcavosurfacemargin.

精選課件精選課件ResistanceForm定義洞深：盒狀洞形階梯結(jié)構(gòu)窩洞外形去除無機(jī)釉薄壁弱尖的處理精選課件精選課件RetentionformLateralretentionundercutdovetailtrapeziaadhesive精選課件精選課件精選課件精選課件精選課件深齲的治療原則：正確判斷牙髓狀況精選課件精選課件精選課件治療方法墊底充填精選課件安撫治療精選課件間接蓋髓術(shù)精選課件治療方案齲病類型軟齲能否去凈牙髓狀況治療方案精選課件根面齲精選課件精選課件保守治療精選課件充填治療精選課件精選課件精選課件窩洞預(yù)備的基本原則RemovalofRemainingCariesWhenthedentinhasafirmfeelwiththeexplorer,removalofthetoothstructureshouldcease,evenifstaineddentinremains.只需去除感染牙本質(zhì)（崩解層和透入層）根據(jù)硬度和著色兩個(gè)標(biāo)準(zhǔn)來判斷精選課件精選課件二、保護(hù)牙髓組織間斷操作，鋒利器械，冷卻不向髓腔加壓了解解剖結(jié)構(gòu)、增齡變化精選課件三、盡量保留健康牙體組織最小程度擴(kuò)展洞形齦緣位置盡量不做預(yù)防性擴(kuò)展

釉質(zhì)成形術(shù)enameloplasty

精選課件精選課件注意患者全身狀況精選課件窩洞預(yù)備基本步驟Thedesignofthecavitypreparationforeitheratoothwithinitialcariesorreplacementrestorationisbasedonthelocationofthecaries,theamountandextentofthecaries,theamountoflosttoothstructure,andtherestorativematerialtobeused.精選課件一、預(yù)備洞形1、開闊洞口及進(jìn)入病變區(qū)：不同窩洞進(jìn)入通道的選擇精選課件精選課件2、設(shè)計(jì)預(yù)備洞的外形以病變?yōu)榛A(chǔ)擴(kuò)展避開承受咬合力的部位圓滑曲線Thedentistmustestablishanoutlineform,whichdeterminestheoverallshapeofthepreparationalongthecavitymarginsoftherestorationandthetoothsurfaces.Theoutlineformisdeterminedbythesizeandshapeofthecariouslesionandbytheneedforasuitabledesignthatwillholdarestorationfirmlyinplace.精選課件鄰面的頰舌洞緣位置精選課件在規(guī)定的深度擴(kuò)展洞形精選課件3、抗力形和固位形精選課件4、FinishingtheEnamelWallsandMargins

Thisisaprocessofangling,beveling,andsmoothingthewallsofthecavitypreparationtoachievethebestmarginalsealpossiblebetweentherestorativematerialandtoothstructure.Thedentistmayuseburs,diamondstones,orhand-cuttinginstruments(chisels,hoes,hatchets,andgingivalmargintrimmers)tocompletethewallsbyremovinglooseorunsupportedenameltocreatethestrongestpossibleenamelwall.精選課件5、無痛制洞法鋒利器械，正確手法局部麻醉anesthesia化學(xué)機(jī)械去齲

精選課件二、術(shù)區(qū)隔離棉卷隔離精選課件ReasonsforuseofrubberdamProtectionaspirationorswallowingofinstrumentsorirrigantsSofttissueinjurycausedbyinstrumentsEfficiencyImprovevisibility(dryfieldandreducedmirrorfogging)MinimizepatientconversationMinimizetheneedforfrequentrinsingReducedriskofcross-contaminationLegalconsiderations精選課件精選課件精選課件Four-handeddentistryClosesupport四手操作精選課件選擇性輔助隔離法：refractioncord精選課件mouthprop

精選課件三、窩洞消毒精選課件

CAVITYLINERSANDBASESareusedprimaril