牙周牙髓聯(lián)合病變

1、牙周牙髓聯(lián)合病變根管側(cè)支Lateral root canal或副根管Accessory canal根尖1/3處最多根分叉區(qū)20-60%有 The pulp was non-vital and the tooth was endodontically treated. After prosthetic therapy The pulp was non-vital and the tooth was endodontically treated. After prosthetic therapy (c), the 2 -year follow-up radiograph in (d) shows

2、bone fill in the previous angular bony defect, whereas the marginal bone remains at the same level. On careful examination one can see that a lateral canal communicating with the lateral bone defect was filled. 牙本質(zhì)小管 Dentinal tubules解剖異常 Anatomical abnormalities 腭側(cè)溝 牙根外吸收 根裂14-2 牙周-牙髓聯(lián)合病變的臨床類型 Clini

3、cal Patterns of Periodontal-Endodontic Combined Lesions1，根尖感染經(jīng)牙周組織途徑排除，有人稱之為逆行性牙周炎 (retrograde periodontitis)牙髓根尖周病對牙周組織的影響 influence of endodontic lesions on the periodontium根尖膿腫沿牙周的可能排膿途徑Schematic illustration demonstrating possible pathways for drainage of a periapical abscess into the gingival s

4、ulcus/pocket. (a) periodontal ligament fistulation. (b) extraosseous fistulationperiodontal ligament fistulation.此型在臨床上易被誤診為牙周膿腫特點：死髓牙 窄而深的牙周袋，無明顯的牙槽嵴吸收 only a narrow opening of the fistula into the gingival sulcus/pocket and may not be detected unless careful probing of the sulcus is carried out at

5、 multiple sites.鄰牙一般無嚴(yán)重的牙周炎 X片顯示燒杯型或日暈型病變 after 18 M In multirooted teeth a periodontal ligament fistulation can drain off into the furcation area，牙髓治療過程中或治療后造成的牙周病變根管側(cè)穿，髓室底穿，髓室或根管內(nèi)的藥物（砷戊二醛塑化液干髓劑等）During endodontic treatment, and in conjunction with preparation of root canals for the insertion of po

6、sts, instrumentation can accidentally cause perforation of the root and wounding of the periodontal ligamentAngular bone defect at the distal root surface of a mandibular premolar (arrows). The root is perforated. Conceivably, this occurred in conjunction withpreparation of the root canal for a post

7、 and core. Clinicalsymptoms included drainage of pus from the pocket and increased tooth mobility. The tooth was extracted.Perforation of the pulpal floor of the mandibular first molar occurred in conjunction with a search for root canal openings (a). The perforation was immediately sealed with gutt

8、a-percha (b). One month after treatment a slight radiolucency appeared at the perforation site (arrow) in the periodontium (c). After an observation period of 2 years, normal periodontal conditions were re-established both clinically and radiographicallyRCT治療后可發(fā)生牙根縱裂: 主要由于擴根過度,樁核不當(dāng), 過大合力等共同特點:牙髓無活力病

9、變局限于單個牙，局限于患牙的局部病變呈燒杯狀，鄰牙基本正常Vertical root fracture結(jié)局: Vertical root fractures that involve the gingival sulcus/pocket area usually have a hopeless prognosis due to continuous bacterial invasion of the fracture space from the oral environment.External Root resorption Surface resorptionA surface reso

10、rption is initiated subsequent to injury of the cementoblastic cell layer. Osteoclasts are attracted by substances from the damaged tissue on the denuded root surface and resorb the hard tissueThese resorptions may be caused by a localizedinjury in conjunction with external trauma (Andreasen1981) an

11、d by trauma from occlusion. Resorptionmay also result from excessive orthodontic forces.This type of resorption is common, self-limiting and reversibleReplacement resorptionThis type of resorptive process results in a replacement of the dental hard tissues by bone, hence the name Replacement resorpt

12、ion and ankylosis are often used as synonyms.Clinically, ankylosis is diagnosed by absent tooth mobility and by a percussion tone that is higher than in a normal toothExternal inflammatory resorptionThe term external inflammatory resorption suggests the presence of an inflammatory lesion in the peri

13、odontal tissues adjacent to a resorptive process牙周病變對牙髓的影響 Iinfluence of periodontal disease on the pulp1, 逆行性牙髓炎 Retrospective pulpitis 2，長期存在的牙周病變：輕者 修復(fù)性牙本質(zhì) 重者 炎癥 變性 鈣化 壞死 因牙周炎拔除的無齲牙，64%有牙髓的炎癥或壞 死，與PD成正比 3，牙周治療對牙髓的影響 Influence of periodontal treatment measures on the pulp14-3 治療原則 Treatment strategies for vombined endodontic and periodontal lesions確定原發(fā)原因。