牙体牙髓病学 新疆医科大学口腔系口腔内科教研室 赵 今

Management (Therapy) of Dental Caries 龋病治疗 Management (Therapy) of Dental Caries

教学目的及内容 掌握：龋病治疗的目的及原则；各种洞型的分类及备洞基本原则；牙体修复原则，深龋的治疗原则和治疗方法。 熟悉：各种充填材料的性能及应用范围。

ClassІ Class Ⅱ ClassШ ClassⅤ Class Ⅳ

WHAT ARE THE RESULTS IF THE CAVITES ARE NOT PROPERLY TREATED?

PULPITIS 牙髓炎 UNTREATED CARIES 龋坏 FICIAL CELLULITIS 面部蜂窝织炎 PERIAPICAL ABSCESS 根尖周病 SYSTEMIC SPREAD 系统扩散

Decay has penetrated into pulp and has caused an abscess

FICIAL CELLULITIS

治疗的目的： 终止病变 保护牙髓 恢复牙的形态、功能及美观 维持与临近软硬组织的正常解剖关系 治疗原则： 针对不同的龋损，采用不同的治疗方法

MANAGEMENT 治疗方法 预防治疗阶段（Preventive management strategies） 非手术治疗（Causal, Noninvasive treatment） 修复治疗法（Restorative treatment）

Preventive management strategies 口腔卫生习惯（Use of oral hygiene ） 氟防龋（Use of fluoride：water supply, toothpaste, tablet and drops, etc.) 饮食习惯（Diet counseling）

Causal, Noninvasive treatment 药物治疗(Chemical therapy） 再矿化治疗(Remineralizative therapy) 窝沟封闭(Pit and fissure sealing)

药物治疗 （Drugs） Applications Fluoride Methodology Early (initial) enamel lesions Early (initial) dentine lesions of deciduous teeth that are in period of replacement Arrest caries Fluoride Sodium fluoride varnish APF gel Stannous fluoride gel Toothpastes Mouth rinses Methodology Apply the sodium fluoride varnish on dry teeth with a brush APF gel should be used with a precaution since it would be very toxic if swallowing sufficient quantity fluoride. Stannous fluoride gel should be applied with toothbrush by the patient following normal tooth-brushing at night.

隔湿、干燥

涂氨化硝酸银

涂还原剂

再矿化治疗 Remineralizative therapy 概念：用人工的方法使已经脱矿、变软的牙釉质发生再矿化，恢复硬度，使早期釉质龋终止或消除的方法称再矿化治疗 interferes with the demineralisation/ remineralisation process be being incorporated into the enamel/dentine crystals and reducing the pH at which they go into solution

适应症（Applications）： 光滑面早期釉质龋 龋病易感者 （Initial enamel lesions without decay） 龋病易感者 （Susceptible population for prevention ：such as patient with radiation therapy)

窝沟封闭 Pit and fissure sealing 原理（Introduction and rationale） 临床适应症（Clinical indication） 材料的选择（Choice of sealant material） 临床操作（Clinical techniques）

原理：封闭剂作为一种屏障，使窝沟与口腔环境隔绝，阻止细菌、食物残渣及其酸性产物等致龋因子进入窝沟。 Pits and fissures provide a sheltered environment in which dental plaque can develop so that these areas are particularly susceptible to dental decay. Fissure sealants are materials designed to prevent pit and fissure caries.

适应症： 窝沟可疑龋坏 咬合面窝沟发育不良 年轻恒磨牙 They are applied, mainly to the occlusal surfaces of the teeth, to obliterate the occlusal fissures, thus removing the sheltered environment which favours caries progression.

材料的选择 普通封闭材料 含氟封闭材料

临床操作（Clinical techniques） Isolation of teeth Cleaning the teeth Etching Washing Drying Mixing the resin Sealant application Checking occlusion

PIT AND FISSURE SEALANTS

修复治疗 Restorative Teatment 主要修复原则： 去除感染牙体组织 Remove infected tooth structure 预备窝洞 Cavity preparation 充填修复材料 Filling restorative materials Amalgam Composite resin Glass ionomer cement

窝洞预备的基本原则 Basic Principles of Cavity Making 去净龋坏组织（Remove all the infected tooth structure） 保护牙髓（Protect the vital pulp） 尽量保留健康的牙体组织（Preserve the heath tooth structure as much as possible） 预备一定的抗力与固位形 Prepare resistance form and retention form

Nomenclatures (专门名词) I (incisal) 切 缘 B (buccal) 颊 面 facial La (labial) 切 缘 B (buccal) 颊 面 facial La (labial) 唇 面 L (lingual) 舌 面 P (palatal) 腭 面 M (mesial) 近 中 D (distal) 远 中 O (occlusal) 牙合 面

龋病的治疗 窝洞预备（制洞） cavity preparation 用手术去除龋洞龋坏组织并按要求备成一定形状的洞形，以容纳和支持充填材料，所备成的洞称窝洞。典型的窝洞为盒状洞。 充填 filling 采用适当的材料充填窝洞，以恢复牙体的正常外形和生理功能。

Classification of decay cavity It will be easier to describe the technical procedures if cavities are classified and different parts of the cavity given standard descriptions. Although cavities (preparation) have been classified in many ways, the most widely accepted classification is the one devised by G.V. Black (1908), who now is known as the father of operative dentistry.

G.V.Black分类 按龋损部位分类 点隙裂沟 Ⅰ Ⅱ 后牙邻面 Ⅲ 前牙邻面未损伤切角 Ⅳ 前牙邻面损伤切角 Ⅴ 颊唇面、舌腭面颈1/3 Ⅵ 尖、嵴

Class Ⅰ Restoration All pit-and-fissure restoration are Class Ⅰ, and they are assigned to three groups: On occlusal surface of premolars and molars On two thirds of the facial and lingual surface of molars On lingual surface of maxillary incisors

Class Ⅱ Restoration Restorations on the proximal surfaces of posterior teeth are Class Ⅱ

Class Ⅲ Restoration Restorations on the proximal surfaces of anterior teeth that do not involve the incisal angle are Class Ⅲ

Class Ⅳ Restoration Restorations on the proximal surfaces of anterior teeth that do involve the incisal edge are Class Ⅳ

Class Ⅴ Restoration Restorations on the gingival third of the facial or lingual surfaces of all teeth are Class Ⅴ

Class Ⅵ Restoration Restorations on the incisal edge of anterior teeth or the occlusal cusp heights of posterior teeth are Class Ⅵ

按累及牙面数分类 单面洞 双面洞 复杂洞

窝洞的结构 洞 缘 侧 壁 洞 壁 髓 壁 洞 底 轴 壁 线 角 洞角 点 角

窝洞的抗力形与固位形 抗力形 resistance form 例： 使充填体和余留牙结构能够承受正常咬合力而不折裂的特定形状。 洞 深 盒状洞 阶梯 洞缘

固位形 retention form 侧壁固位 倒凹固位 鸠尾固位 梯形固位 能使充填体能保留于洞内，承受咬合力后不移位、不脱落的、洞的特定形状。 侧壁固位 倒凹固位 鸠尾固位 梯形固位

备洞步骤 Steps in cavity preparation 外形设计（Establishing outline form） 抗力与固位设计（Obtaining resistance and retention form） 便利形设计（Obtaining convenience form） 去净龋坏（Removal of remaining caries） 修正釉壁及洞面边缘（Correction of enamel walls and cavosurface margins） 清洁窝洞(cavity toilet)

术区隔离 Isolation of the working field 目的：防止唾液进入窝洞，避免唾液中的细菌污染洞壁，水分和蛋白质等成分影响充填材料的性能和与洞壁的密合。 It is necessary to isolate teeth in order to keep them free from saliva. The procedures for isolation may be either a few minutes or as long as hours.

方法 (Methods of isolating teeth): 橡皮障隔离（Rubber dam） 棉卷隔离（ Cotton Products）

Sterilization Of Cavity 窝洞消毒 Sterilization Of Cavity

Cavity liners and bases 洞衬及垫底 Cavity liners and bases

可分为窝洞封闭、洞衬及垫底（Categories of cavity sealers, bases, and liners） 常用材料： 氧化锌丁香油酚（Zinc Oxide-Eugenol） 磷酸性粘固粉(Phosphate Cement) 氢氧化钙(Calcium Hydroxide) 玻璃离子粘固粉(Glass-Ionomer Cement) 树脂(Adhensive Liners )

临床常用垫底方法（Methods of bases）: 单层垫底（Single layer basement） 双层垫底（Double layers basement） 双层垫底

Cavity liners and bases

修复材料的选择 The selection of restorative materials 牙齿的部位 (The location of the tooth) 窝洞的位置及所受的咬合压力 (The location of the cavity on tooth and the occlusal stress) 患者的情况 (patient) 其它 (others)

汞合金充填技术 Amalgam technique

Amalgam has been proven a superior material 耐磨（Durability） 稳定长久（Longevity） 抗压强度大（Ability to withstand the pressures of chewing） 易操作（Ease of placement） 价廉（Cost effectiveness）

汞合金修复步骤 Steps Summary Of The Amalgam Restoration 进入病变区 设计和预备洞的外形 建立固位形与抗力形 去尽龋坏组织 预备辅助固位形与抗力形 修整洞缘 清理窝洞 隔湿 护髓 充填 雕刻外形、调牙合 打磨、抛光

牙色材料 TOOTH COLORED MATERIALS 复合树脂（Composite resin） 玻璃离子粘固粉（Glass ionomer cement） 三明治技术 (The sandwich technique) Match the tooth color well

复习思考题 制备洞形的原则。 垫底的目的，材料的选择和 垫底的方法。 银汞合金的性能和临床意义。

Thank you for your attention!