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1、TherapyIntroduction牙髓病和根尖周病治療概述(P.189)PrincipleandPlanning治療原則和治療計(jì)劃TreatmentPrinciple治療原則1、PreservingVitalPulp保存活髓2、PreservingOffendingTooth保存患牙TreatmentPlanning治療計(jì)劃EmergencyEndodonticTreatment緩解疼痛，控制急性癥狀Examination&RoutineTreatment全面檢查，常規(guī)治療CaseAnalysis病例選擇BasisforSucc
2、essfulEndodonticMedicalHistory患者狀態(tài)適用于任何年齡，無絕對的全身禁忌證DentalHistory患牙狀態(tài)盡可能保存患牙InfectionControl感染的控制（AsepticTechnique無菌技術(shù)）IsolatingtheOperativeField術(shù)區(qū)隔離SterilizingtheInstrument手機(jī)滅菌、器械消毒和滅菌Absorbents隔濕CottonrollsRubberDam橡皮障Suction吸唾器SalivaevacuatorSalivaejectorsPainControl
3、無痛技術(shù)LocalAnesthesia局部麻醉法2％Lidocaine＋EpinephrineLocalAnesthesiaTechniquesLocalinfiltrationanesthesia局部浸潤麻醉（常用）Blockanesthesia阻滯麻醉（常用）Intraligamentaryanesthesia牙周膜內(nèi)注射Intrapulpalanesthesia牙髓內(nèi)注射TreatmentMethods治療方法(P.203)保存活髓保存全部生活牙髓－PulpCapping（蓋髓術(shù)）保存根部生活牙髓－Pulpotomy（牙髓切斷
4、術(shù)）蓋髓術(shù)PulpCappingPulpcappingisdefinedas“endodontictreatmentdesignedtomaintainthevitalityoftheendodontium”.覆蓋使牙髓病變轉(zhuǎn)歸的制劑以保護(hù)牙髓，消除病變，保存活髓蓋髓術(shù)PulpCappingDirectPulpCapping（直接蓋髓術(shù)）覆蓋已暴露的牙髓IndirectPulpCapping（間接蓋髓術(shù)）覆蓋接近牙髓的牙本質(zhì)DrugsinPulpCappingandPulpotomy常用蓋髓劑CalciumHydroxide氫氧化鈣
5、(highlyalkaline強(qiáng)堿性)最具療效的蓋髓劑之一Dycal:可硬性氫氧化鈣制劑，可作為次基材料Calvital:為非可硬性氫氧化鈣制劑Antibacterialactivity中和炎癥所產(chǎn)生的酸性產(chǎn)物ActivateAKP,promotedentinformation激活堿性磷酸酶，促進(jìn)修復(fù)性牙本質(zhì)形成Remember!Thesecalciumionspresentinthedentinbridgecomefromthesystemiccirculation,notfromthecalciumhydroxideyouuse
6、d.修復(fù)過程中形成的牙本質(zhì)橋中的鈣離子是來自體循環(huán)OtherDrugs其它蓋髓劑ZincOxide-eugenol氧化鋅丁香油糊劑（多用于間接蓋髓）Glucocoticoids&Antibiotics糖皮質(zhì)激素及抗生素Hydroxyapatite羥基磷灰石、BMP骨形成蛋白MineralTrioxideAggregate(MTA)DirectPulpCapping直接蓋髓術(shù)Pulpcappingimpliesplacingthedressingdirectlyontothepulpexposure.原理用蓋髓劑覆蓋在露髓創(chuàng)面上，消除
7、炎癥和感染，保護(hù)牙髓組織，使其恢復(fù)健康。Indications適應(yīng)證考慮病人年齡年輕恒牙根尖孔尚未形成考慮病變程度恒牙牙髓有無感染、牙髓病變早期階段Contraindication禁忌證有牙痛史的恒牙有慢性牙髓炎或根尖周炎表現(xiàn)的患牙DirectPulpCappingForadirectpulpcappingprocedure,acalciumhydroxideliningmaterialisplacedontheexposedpulpaltissueandasmallamountofsurroundingdentin.Asealin
8、glinerand/orasealingrestorationisthenplacedtosealoutbacteriaandtheirby-products.Factorsthataffectoutcomeofpulpcapping
