牙髓病与根尖周病 Pulpal Disease & Periapical Disease

1. 牙髓病与根尖周病 Pulpal Disease&Periapical Disease

2. 【病因Causes 】 • 细菌因素Bacterial factors • 物理因素Physical factors • 化学因素Chemical factors • 免疫因素Immune factors

3. 牙髓病 Pulpal Disease

4. 牙髓病 一、髓腔解剖特点 Pulp cavity anatomical characteristics

5. 牙髓病 • 髓腔解剖与牙髓病和根尖周病的症状和治疗关系紧密。 Pulp cavity anatomy is related to pulpal and periapical disease. • 髓腔由坚硬的牙本质壁包围 pulp cavity surrounded by dentin • 髓腔通过根尖孔与外界相连通 • the apical foramen is the opening at the apex of the 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.

6. 牙髓病 二、牙髓的特点和功能 pulp features and functions • 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 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 lies 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. The nerve plexus of Raschkow is located central to the cell-free zone.

7. 牙髓的功能：The primary function of the dental pulp • 形成功能——成牙本质细胞形成牙本质 to form dentin (by the odontoblasts) • Formative:cells of the pulp organ produce dentin which surrounds and protects the pulpal tissue. • 营养功能——血管系统向牙髓牙本质复合体提供营养成分 • Nutritive: the pulp keeps the organic components of the surrounding mineralized tissue supplied with moisture and nutrients; • 感觉功能——疼痛 • Sensory: extremes in temperature, pressure, or trauma to the dentin or pulp are perceived as pain; • 防御功能——修复性牙本质形成 • Protective: the formation of reparative or secondary dentin (by the odontoblasts).

8. 牙髓病 三、临床病理 • 牙髓的防御机制 1）牙本质硬化 Dentin sclerosis 2）第三期牙本质形成 The formation of reparative dentin 第一期牙本质 Primary dentin: The most prominent dentin in the tooth, lies between the enamel and the pulp chamber. The outer layer closest to enamel is known as mantle dentin. 第二期牙本质 Secondary dentin (Regular Secondary Dentin): Formed after root formation is complete, normally after the tooth has erupted and is functional. 第三期牙本质 Tertiary dentin （reparative dentin）： Formed as a reaction to external stimulation such as cavities. 3）牙髓炎症反应 Pulp Inflammatory response

9. 四、牙髓病的分 类 The Classification of pulpal diseases • Reversible pulpitis 1 • Irreversible pulpitis • Acute Pulpitis2 • Chronic Pulpitis3 • Residual pulpitis4 • Retograde pulpitis5 • pulp necrosis6 • pulp calcification7

10. 牙髓病 1，可复性牙髓炎（reversible pulpitis） • This is the condition where the pulp is inflamed and is actively responding 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 state.

11. 牙髓病 【病因Causes 】 • 龋病、窝洞或牙体制备 dental caries, cavity or tooth preparation 【临床表现 Symptoms】 • 温度刺激后短暂瞬间疼痛, 刺激去除后疼痛立即消失, 无自发痛。 • No spontaneous pain, transient pain tohot and cold, pain immediately disappear after stimulus remove. • 病损接近髓腔、牙周病、咬合创伤。 • Lesionclose to the pulp cavity, deep periodontal pocket, trauma