牙周牙髓联合病变ppt课件

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1、14牙周－牙髓联合病变Periodontal-EndodonticCombinedLesions14-1牙周组织和牙髓的解剖通道AnatomicalInterrelationsofPeridontiumandPulp根尖孔Apicalforamen根管侧支Lateralrootcanal或副根管Accessorycanal根尖1/3处最多根分叉区20-60%有Thepulpwasnon-vitalandthetoothwasendodonticallytreated.Afterprostheticther

2、apyThepulpwasnon-vitalandthetoothwasendodonticallytreated.Afterprosthetictherapy(c),the2-yearfollow-upradiographin(d)showsbonefillinthepreviousangularbonydefect,whereasthemarginalboneremainsatthesamelevel.Oncarefulexaminationonecanseethatalateralcanalcomm

3、unicatingwiththelateralbonedefectwasfilled.牙本质小管Dentinaltubules解剖异常Anatomicalabnormalities腭侧沟牙根外吸收根裂14-2牙周-牙髓联合病变的临床类型ClinicalPatternsofPeriodontal-EndodonticCombinedLesions1，根尖感染经牙周组织途径排除，有人称之为逆行性牙周炎(retrogradeperiodontitis)牙髓根尖周病对牙周组织的影响influenceofendod

4、onticlesionsontheperiodontium根尖脓肿沿牙周的可能排脓途径Schematicillustrationdemonstratingpossiblepathwaysfordrainageofaperiapicalabscessintothegingivalsulcus/pocket.(a)periodontalligamentfistulation.(b)extraosseousfistulationperiodontalligamentfistulation.此型在临床上易被误诊为

5、牙周脓肿特点：死髓牙窄而深的牙周袋，无明显的牙槽嵴吸收onlyanarrowopeningofthefistulaintothegingivalsulcus/pocketandmaynotbedetectedunlesscarefulprobingofthesulcusiscarriedoutatmultiplesites.邻牙一般无严重的牙周炎X片显示烧杯型或日晕型病变after18MInmultirootedteethaperiodontalligamentfistulationcandrainoff

6、intothefurcationarea２，牙髓治疗过程中或治疗后造成的牙周病变根管侧穿，髓室底穿，髓室或根管内的药物（砷　戊二醛　塑化液　干髓剂等）Duringendodontictreatment,andinconjunctionwithpreparationofrootcanalsfortheinsertionofposts,instrumentationcanaccidentallycauseperforationoftherootandwoundingoftheperiodontalligame

7、ntAngularbonedefectatthedistalrootsurfaceofamandibularpremolar(arrows).Therootisperforated.Conceivably,thisoccurredinconjunctionwithpreparationoftherootcanalforapostandcore.Clinicalsymptomsincludeddrainageofpusfromthepocketandincreasedtoothmobility.Thetoo

8、thwasextracted.Perforationofthepulpalfloorofthemandibularfirstmolaroccurredinconjunctionwithasearchforrootcanalopenings(a).Theperforationwasimmediatelysealedwithgutta-percha(b).Onemonthaftertreatmentaslightradioluce