牙周手术治疗总则和基本要点-同济口腔医学课件.ppt

术区铺单 * * 22 牙周手术治疗的总则 General Principles of Periodontal Surgery 牙周外科解剖 Anatomy in periodontal surgery It is imprtant to have a knowledge pf surgical anatomy in order to understand and to identify structures which can restrict access and visibility. Knowledge of surgical anatomy enables one to choose a accurate surgical technique for each case while avoiding anatomic hazards. 和其它手术一样，牙周术者必须了解与牙周手术有关的解剖结构，这一点是牙周手术成功的因素之一。 Anterior teeth are frequently located labially, resulting in thin alveolar bone. Window-like openings called fenestrations(arrow) are sometimes observed. So a split-thickness flap should be utilized in this case 前牙一般多位于靠于唇侧的位置，因此唇侧的牙槽骨板较薄，有时局部可出现牙槽骨缺如牙根暴露的情况，称为“开窗”（fenestration）（箭头）。 ? ? ? 上颌前部 Anterior Maxilla 上颌前部Anterior Maxilla 鼻嵴（nasal spine） Sometimes close to the alveolar bone crest. The resorption of the crest by periodontal disease may create an anatomical consideration in surgical intervention 有时与牙槽嵴相邻，因此当牙周病引起牙槽骨吸收时，局部的解剖内容将发生变化，牙周手术时因考虑到这一点。 Exostosis may be found in the anterior region, but the incidence is low compared to the molar region. 前牙牙槽骨的外生性骨疣。其发生率较后牙低 外生性骨疣 Exostosis 上颌前部 Anterior Maxilla On the palatal aspect, the nasopalatine nerve and artery emanate from the incisive foramen 鼻腭孔 其中有鼻腭神经和血管束通过，牙周手术波及此区域时，因注意保护。术后往往会出现暂时的上腭双侧尖牙区域粘膜的麻木。 In the presence of inflammation, tension from the frenum may result in retraction of the gingiva, which can cause recession and contribute to underlying periodontal destruction. This is often evident when the zone of attached gingiva is nattow or absent. Frenum attachments in the permanent dentition are classified into 4 types by attachment level: 当炎症存在时，系带的牵拉会导致牙龈的退缩，甚至可导致整个牙周组织的退缩。这些情况往往发生在附着龈窄或没有的情况下。恒牙列系带附着，可分为4种类型： 口腔系带 Oral Frenum 龈乳头穿越附着型（Papilla-penetration attachment），造成牙齿的邻接丧失和移位。发生率约为2％。 口腔系带 Oral Frenum 龈乳头附着型Papilary attachment The incidence is about 16％ 口腔系带 Oral Frenum 牙龈附着型Gingival attachment This is most common and the inciden