1、牙髓病与根尖周病 Pulpal Disease&Periapical Disease,【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,牙髓病 Pulpal Disease,一、髓腔解剖特点Pulp cavity anatomical characteristics,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
2、牙本质壁包围 pulp cavity surrounded by dentin髓腔通过根尖孔与外界相连通theapical foramenis the opening at the apex of therootof atooth, through which thenerveandblood vesselsthat supply thedental pulppass. Thus it represents the junction of the pulp and theperiodontaltissue.,牙髓病,二、牙髓的特点和功能 pulp features and functions,
3、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 layer which contains fibroblasts and undifferentiated mesenchymal cells.Cell free zone (zone of Weil): rich in both capill
4、aries 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 p
5、lasma cells. The 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
6、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
7、 (by the odontoblasts).,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 den
8、tin (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,牙髓病,四、牙髓病的分 类 The Classific
9、ation of pulpal diseases,Acute Pulpitis 2 Chronic Pulpitis 3 Residual pulpitis 4 Retograde pulpitis 5,Reversible pulpitis 1Irreversible pulpitis,pulp necrosis 6 pulp calcification 7,1，可复性牙髓炎（reversible pulpitis）,This is the condition where the pulp is inflamed and is actively responding to an irrita
10、nt. 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.,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 to hot 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,牙髓病,
