chapter,牙周牙髓联合病变文件材料.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 (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 RCT治疗后可发生牙根纵裂: 主要由于扩根过度,桩核不当, 过大合力等 共同特点: 牙髓无活力 病变局限于单个牙，局限于患牙的局部 病变呈烧杯状， 邻牙基本正常 Vertical root fracture 结局: Vertical root fractures that involve the gingival sulcus/pocket area usually have a hopeless prognosis due to continuous bacterial invasion of the fracture space from the oral environment.