牙周牙髓联合病变-同济口腔医学课件.ppt

* 14 牙周－牙髓联合病变　Periodontal-Endodontic Combined Lesions 14-1 牙周组织和牙髓的解剖通道　Anatomical Interrelations of Peridontium and Pulp 根尖孔 Apical foramen 根管侧支　Lateral root canal　或副根管　Accessory canal 根尖1/3处最多 根分叉区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 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. 牙本质小管 Dentinal tubules 解剖异常 Anatomical abnormalities 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 Clinical Patterns of Periodontal-Endodontic Combined Lesions 1，根尖感染经牙周组织途径排除，有人称之为逆行性牙周炎 (retrograde periodontitis) 牙髓根尖周病对牙周组织的影响 influence of endodontic lesions on the periodontium 根尖脓肿沿牙周的可能排脓途径 Schematic illustration demonstrating possible pathways for drainage of a periapical abscess into the gingival sulcus/pocket. (a) periodontal ligament fistulation. (b) extraosseous fistulation periodontal ligament fistulation. 此型在临床上易被误诊为牙周脓肿 特点： 　　　死髓牙 窄而深的牙周袋，无明显的牙槽嵴吸收 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 multiple sites. 　　　邻牙一般无严重的牙周炎 X片显示烧杯型或日晕型病变 after 18 M In multirooted teeth a periodontal ligament fistulation can drain off into the furcation area ２，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）　 During endodontic treatment, and in conjunction with preparation of root canals for the insertion of posts, instrumentation can accidentally cause perforation of the root and wounding of the periodontal ligament Angular bone defect at the distal root surface of a mandibular premolar (arrows). The root is per forated. Conceivably, this occurred in conjunction with preparation of t