牙髓病與根尖周病-復旦大學精品課程網站

1、牙髓病與根尖周病 Pulpal Disease&Periapical Disease,【病因Causes 】,細菌因素Bacterial factors物理因素Physical factors化學因素Chemical factors免疫因素Immune factors,牙髓病 Pulpal Disease,一、髓腔解剖特點Pulp cavity anatomical characteristics,牙髓病,髓腔解

2、剖與牙髓病和根尖周病的癥狀和治療關系緊密。 Pulp cavity anatomy is related to pulpal and periapical disease.髓腔由堅硬的牙本質壁包圍 pulp cavity surrounded by dentin髓腔通過根尖孔與外界相連通the apical foramen is the opening at the apex of the

3、 root of a tooth, through which the nerveand blood vessels that supply the dental pulp pass. Thus it represents the junction of the pulp and theperiodontal tissue.,牙髓病,二、牙髓的特點

4、和功能 pulp features and functions,牙髓病,Structural features The central region : large nerve trunks and blood vessels. three layers (from innermost to outermost)1. Cell rich zone (zone of Rinaggio): innermost pulp

5、layer which contains fibroblasts and undifferentiated mesenchymal cells.Cell free zone (zone of Weil): rich in both capillaries and nerve networks.Odontoblastic layer: outermost layer which contains odontoblasts and li

6、es next to the predentin and mature dentin Cells found in the dental pulp include fibroblasts (the principal cell), odontoblasts, defence cells like histiocytes, macrophage, granulocytes, mast cells and plasma cells. Th

7、e nerve plexus of Raschkow is located central to the cell-free zone.,牙髓的功能：The primary function of the dental pulp 形成功能——成牙本質細胞形成牙本質 to form dentin (by the odontoblasts)Formative:cells of the pulp organ produce denti

8、n which surrounds and protects the pulpal tissue.營養(yǎng)功能——血管系統(tǒng)向牙髓牙本質復合體提供營養(yǎng)成分Nutritive: the pulp keeps the organic components of the surrounding mineralized tissue supplied with moisture and nutrients;感覺功能——疼痛Sensory: e

9、xtremes in temperature, pressure, or trauma to the dentin or pulp are perceived as pain;防御功能——修復性牙本質形成Protective: the formation of reparative or secondary dentin (by the odontoblasts).,三、臨床病理,牙髓的防御機制 1）牙本質硬化 Dent

10、in sclerosis 2）第三期牙本質形成 The formation of reparative dentin 第一期牙本質 Primary dentin: The most prominent dentin in the tooth, lies between the enamel and the pulp chamber. The outer layer closest to e

11、namel is known as mantle dentin. 第二期牙本質 Secondary dentin (Regular Secondary Dentin): Formed after root formation is complete, normally after the tooth has erupted and is functional. 第三期牙本質

12、 Tertiary dentin （reparative dentin） ： Formed as a reaction to external stimulation such as cavities. 3）牙髓炎癥反應 Pulp Inflammatory response,牙髓病,四、牙髓病的分 類 The Classification of pulpal diseases,Acute Pulpit

13、is 2 Chronic Pulpitis 3 Residual pulpitis 4 Retograde pulpitis 5,Reversible pulpitis

14、 1Irreversible pulpitis,pulp necrosis 6 pulp calcification 7,1，可復性牙髓炎（reversible pulpitis）,This is the condition where the pulp is inflamed and is actively respondin

15、g to an irritant. The pulp is still considered to be vital. This means that once the irritant is eliminated, usually by removal of decay and the placement of a filling, that the pulp will return to its normal, healthy

16、state.,牙髓病,【病因Causes 】,齲病、窩洞或牙體制備dental caries, cavity or tooth preparation,【臨床表現(xiàn) Symptoms】,溫度刺激后短暫瞬間疼痛, 刺激去除后疼痛立即消失, 無自發(fā)痛。  No spontaneous pain, transient pain to hot and cold, pain immediately disappear