外力直接撞击外力直接撞击, ,咀嚼咬到沙石、咀嚼咬到沙石、碎骨等硬物。碎骨等硬物。be impacted by force,biting be impacted by force,biting hard food.hard food. EtiologyEtiologyClinic characteristicsClinic characteristics按部位分:冠折 Crown fracture根折Root fracture冠根联合折 Crown-root fracture按损伤和牙髓关系分: :露髓不露髓冠折冠折 crown fracture 前牙前牙 : : 横折、斜折横折、斜折Anterior tooth: horizontal or inclined后牙后牙 : : 斜折、纵折斜折、纵折Posterior teeth:inclined or vertical根折根折 root fracture颈颈 1/3、根中、根中 1/3、根尖、根尖 1/3cervix-thirds,middle-thirds,apical-thirds根折可有牙齿松动、叩痛、龈沟根折可有牙齿松动、叩痛、龈沟出血、粘膜触痛等。出血、粘膜触痛等。有的早期无明显症状，数日后出现。有的早期无明显症状，数日后出现。无根折外伤恒牙牙髓坏死率为 3859根折牙牙髓坏死率为2024，断端间隙利于炎症引流。X片是诊断根折的重要依据片是诊断根折的重要依据Diagnosis can be carried out by radiographic examination冠根折冠根折 crown-root fracture以斜行多见，以斜行多见，牙髓常暴露。牙髓常暴露。The fracture will often be inclined with pulp exposure治疗治疗TreatmentTreatment缺损少牙本质未暴露，磨光锐边。缺损少牙本质未暴露，磨光锐边。冠折冠折 crown fractureWithout dentin exposure,selective grinding of the incisal edge is sufficient.牙本质暴露敏感者，盖髓树脂修复。牙本质暴露敏感者，盖髓树脂修复。Cover with Ca(OH)2 and composite resin restoration if dentin is expose and sensitive牙髓暴露，牙根发育完成者行活髓摘除术，牙根发育未完成者行活髓切断术。In case of a pulp exposure,pulpectomy is indicated if the root apical is developed,pulpotomy is sufficient if the root apical is developing. 根折根折 root fracture根中1/3折，根尖1/3折middle-thirds,apical-thirds用夹板固定三个月，如牙冠端有错位，在固定前应复位。Reposition the coronal fragment and use splinting for 3 months在治疗后1、3、6、12个月定期复查牙髓的活力状况，一旦发现牙髓有炎症或坏死趋势，则应作根管治疗术。Check for pulpal complications after 1 month,3 months,6 months and 12 months.If pulp necrosis occurs,root canal therapy should be done.颈颈1/3折断：均先行根管治疗折断：均先行根管治疗断端在龈上，根管治疗后桩核冠修复断端在龈上，根管治疗后桩核冠修复Cervix-thirds fracture:root canal therapy should be doneIf fracture surface above gingival level,a post-retained full crown is fabricated after RCT.断端在龈下牙槽骨上，龈切暴断端在龈下牙槽骨上，龈切暴露断面桩核冠修复。露断面桩核冠修复。Fracture surface between gingival and alveolar:a post-retained crown is fabricated after gingivectomy expose the fracture surface.断端在牙槽骨下断端在牙槽骨下4mm4mm，牙根较长，可牙根较长，可手术或正畸方法牵引后，桩核冠修复。手术或正畸方法牵引后，桩核冠修复。If fracture surface is 4mm below the alveolar and the root length is enough ,surgical or orthodontic extrusion of the root ,to move the fracture surface to amore optimal location for final restoration树脂夹板固定树脂夹板固定Composite resin splint根折的转归钙化性愈合结缔组织性愈合骨、结缔组织联合愈合断端被慢性炎症组织分开Connective tissue healingThe fragment is separated by chronic inflammation tissue Calcified healingHard-connective tissue union healingHealing of root fracture冠根联合折冠根联合折crown-root fracture：可作根管治疗，具备桩核冠修复可作根管治疗，具备桩核冠修复的冠根联合折，应保留。的冠根联合折，应保留。The tooth with crown-root fracture which can be restored by a post retained full crown should be saved to receive RCT 发生在牙根的纵裂,未波及牙冠者。Vertical root fracture, not involving the crown.慢性持续性的创伤合力牙根发育缺陷无髓牙EtiologyEtiologyChronic durative traumatic occlusal force Defect of root developmentPulpless tooth无髓牙Pulpless tooth内因：牙本质脱水，失去弹性，牙变 脆，致使牙抗折力降低。外因：侧方加压充填根管桩或桩核修复其他X线检查对诊断牙根纵裂有重要意义Diagnosis can be carried out by radiographic examinationClinic characteristics 松动明显，牙周破坏严重或单根牙的牙根纵裂，均应拔除。The tooth should be extracted if it is very loose or of severe periodontal lesion or vertical root fracture in single rooted tooth. 牙周病损局限且牙稳固的磨牙，可在根管治疗后行牙半切术或截根术。Tooth hemiresection or root resection is performed after RCT if the molar is steady and of limited periodontal lesion.牙半切术tooth hemiresection截根术root resection楔状缺损是牙齿唇、颊颈部硬组织缓慢楔状缺损是牙齿唇、颊颈部硬组织缓慢磨耗所致，因该缺损常呈楔状而得名。磨耗所致，因该缺损常呈楔状而得名。Wedge-shaped defect is caused by tardy abrasion of buccal cervix hard tissues.刷牙不当刷牙不当牙颈部结构牙颈部结构Structure of tooth cervixImproper teeth brushingEtiologyEtiology酸作用酸作用牙体组织疲劳牙体组织疲劳Acid erosionWeariness of hard tissues由由23个平面组成，坚硬光滑，为牙本色。个平面组成，坚硬光滑，为牙本色。Usually have 2 or 3 surfaces,hard and smooth,tooth-like color。 Clinic characteristicsClinic characteristics根据缺损程度分浅型、深型和穿髓根据缺损程度分浅型、深型和穿髓3型型前磨牙好发，常左右对称，有牙龈退缩前磨牙好发，常左右对称，有牙龈退缩随年龄增长，楔状缺损有增加趋势随年龄增长，楔状缺损有增加趋势Be classified with shallow,deep and pulp exposure according to the depth of the lesionMost commonly occur on the buccal surface of bicuspids symmetrically and accompany with gingival recessionThe sizes of abrasions increase with age 改正刷牙方法改正刷牙方法牙体缺损少无牙本质过敏，不需处理。牙体缺损少无牙本质过敏，不需处理。Correct tooth brushingTreatment and preventionTreatment and preventionCareful observation if there is no tooth sensitivity and the lesions are small有牙本质过敏，可用药物、激光等脱敏。有牙本质过敏，可用药物、激光等脱敏。牙体缺损多，可充填修复。牙体缺损多，可充填修复。Fillings if the lesions are extensionDesensitization with medicine or laser if there is dentin hypersensitive 牙髓感染或根尖病变时，作髓牙髓感染或根尖病变时，作髓病或根管治疗。病或根管治疗。缺损导致牙齿横折时，根据情缺损导致牙齿横折时，根据情况作根管治疗或拔除。况作根管治疗或拔除。Root canal therapy is performed if there is pulpitis or periapical periodontitis.Root canal therapy or extraction are performed if tooth fracture is occurred.又称不全牙裂或牙微裂，指牙冠又称不全牙裂或牙微裂，指牙冠表面非生理性细小裂纹。表面非生理性细小裂纹。Fine non-physiological crack on the surface of the crown牙齿结构薄弱环节牙齿结构薄弱环节牙尖斜度大牙尖斜度大创伤合力创伤合力Weak tache of tooth structureBig cuspid pitchTraumatic occlusal forceEtiologyEtiology隐裂牙发生于上颌磨牙最多，其次是隐裂牙发生于上颌磨牙最多，其次是下颌磨牙，第一磨牙多于第二磨牙。下颌磨牙，第一磨牙多于第二磨牙。Clinic characteristicsClinic characteristicsMost commonly occur on maxillary molar, and secondly on mandibular molar.The crack occurs on first molar is more than that on second molar. 隐裂线隐裂线上颌上颌下颌下颌mandibularmaxillarCracked line表浅者无症状，较深时，遇冷热表浅者无症状，较深时，遇冷热刺激敏感或咬合不适。刺激敏感或咬合不适。深隐裂有牙髓炎症状和定点咀嚼痛。深隐裂有牙髓炎症状和定点咀嚼痛。隐裂线隐裂线碘酊等可渗入隐裂处碘酊等可渗入隐裂处探针撬动隐裂处有疼探针撬动隐裂处有疼痛感，棉签置可疑牙痛感，棉签置可疑牙尖上咬合，有撕裂样尖上咬合，有撕裂样疼痛。疼痛。调合调合113均衡合力均衡合力处理隐裂牙处理隐裂牙TreatmentTreatmentOcclusal adjustmentBalance occlusal forceTreat the cracked tooth牙本质过敏症牙本质过敏症（dentine hypersensitivity）又又称称过敏性牙本质过敏性牙本质（hypersensitive dentine），），是牙齿受到外界刺激，引起的酸痛症状。是牙齿受到外界刺激，引起的酸痛症状。不是一种独立疾病，是各种牙病共有症状。不是一种独立疾病，是各种牙病共有症状。115病因病因病因病因使牙本质暴露的各种原因使牙本质暴露的各种原因与牙本质暴露的时间、修复性牙本与牙本质暴露的时间、修复性牙本质形成快慢有关。质形成快慢有关。不是所有牙本质暴露的牙齿都有症状不是所有牙本质暴露的牙齿都有症状牙本质暴露还不能解释所有临床表现牙本质暴露还不能解释所有临床表现EtiologyEtiology发病机理发病机理发病机理发病机理 PathogenesisPathogenesisPathogenesisPathogenesis1.神经学说：牙本质中存在牙髓神经末梢，感觉神经学说：牙本质中存在牙髓神经末梢，感觉可由牙本质表层传导入牙髓可由牙本质表层传导入牙髓前期牙本质前期牙本质管间牙本质管间牙本质管周牙本质管周牙本质2.牙本质纤维传导学说：成牙本质细胞原浆突牙本质纤维传导学说：成牙本质细胞原浆突中含有乙酰胆碱酶，它在受刺激后引起神经传中含有乙酰胆碱酶，它在受刺激后引起神经传导，产生疼痛导，产生疼痛3.流体动力学：外界刺激使牙本质小管内液体移动流体动力学：外界刺激使牙本质小管内液体移动搅动了牙髓内容物，间接兴奋游离神经末稍，传入搅动了牙髓内容物，间接兴奋游离神经末稍，传入冲动产生痛觉冲动产生痛觉临床表现和诊断临床表现和诊断临床表现和诊断临床表现和诊断温度试验温度试验探诊探诊Clinic characteristics and diagnosisClinic characteristics and diagnosisExplorationTemperature test石川修三的评定标准石川修三的评定标准0 0度度：冷刺激和机械刺激无疼痛冷刺激和机械刺激无疼痛1 1度：可诱发疼痛，但疼痛较轻微度：可诱发疼痛，但疼痛较轻微2 2度：可诱发可以忍受的疼痛度：可诱发可以忍受的疼痛3 3度：可诱发难以忍受的疼痛度：可诱发难以忍受的疼痛主观评价主观评价Subjective evaluation疼痛疼痛3级评判法级评判法数字化疼痛评判法数字化疼痛评判法Verbal rating scale,VRSVisual analogue scale,VAS治疗治疗封闭牙本质小管，减少或避免封闭牙本质小管，减少或避免牙本质内液体流动。牙本质内液体流动。TreatmentTreatmentSeal the dentinal tubule to decrease or avoid the flowing of the liquid inside dentin 氟化物氟化物氯化锶氯化锶氟化氨银氟化氨银碘化银碘化银其他药物其他药物药物治疗药物治疗medicationmedication树脂类脱敏剂树脂类脱敏剂激光治疗激光治疗修复治疗修复治疗LaserRestoration由于单纯机械摩擦作用而造成的牙体硬组织慢性磨耗称为磨损。Clinic characteristicsClinic characteristics咀嚼磨损非咀嚼磨损 磨损牙本质暴露修复性牙本质牙髓腔体积缩小Pathological changePathological change均匀适宜的磨损对牙周组织的健康有重要意义Physiological meaningPhysiological meaning牙本质过敏症食物嵌塞牙髓和根尖周病颞下颌关节紊乱病创伤合创伤性溃疡SyndromeSyndrome生理性磨损，如无症状无需处理。去除和改正引起病理性磨损的原因有牙本质过敏者，作脱敏处理。TreatmentTreatment不均匀磨损需调合。导致牙髓和根尖周病时，按常规进行牙髓病、根尖周病治疗。有食物嵌塞者，应恢复点接触和重建合面溢出沟。并发颞下颌关节紊乱病,应作覆盖义齿修复。睡眠时有习惯性磨牙或白昼也有无意识磨牙习惯者，称为磨牙症。心理因素合不协调全身因素职业EtiologyEtiologyClinic characteristicsClinic characteristics磨牙型紧咬型混合型去除致病因素合板的应用调磨咬合修复治疗肌电反馈治疗治疗各种并发症TreatmentTreatmentErosionErosion酸雾或酸酐作用与牙而造成的牙硬组织损害称为酸蚀症。主要由无机酸，如盐酸、硝酸等所致，其中以盐酸的危害最大。EtiologyEtiology最初仅有感觉过敏，进而产生实质缺损。多发生于前牙唇面。酸蚀的形式因酸而异。Clinic characteristicsClinic characteristicsTreatment and preventionTreatment and prevention改善劳动条件局部药物脱敏缺损严重者可充填法、修复法处理。并发牙髓病变者，应先作牙髓病治疗。