牙周牙髓联合病变PPT课件

During endodontic treatment, and in conjunction with preparation of root canals for the insertion of posts, instrumentation can accidentally cause perforation of the root and wounding of the periodontal ligament
After an observation period of 2 years, normal periodontal conditions were re-
established both clinically and radiographically
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Perforation of the pulpal floor of the mandibular first molar occurred in
conjunction with a search for root canal openings (a). The perforation was
根管侧穿，髓室底穿，髓室或根管内的药物（砷 戊 二醛 塑化液 干髓剂等）
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Angular bone defect at the distal root surface of a mandibular premolar (arrows). The root is per forated. Conceivably, this occurred in conjunction with preparation of the root canal for a post and core. Clinical symptoms included drainage of pus from the pocket and increased tooth mobility. The tooth was extracted.
根尖1/3处最多 根分叉区20-60%有
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The pulp was non-vital and the tooth was endodontically treated. After prosthetic therapy
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The pulp was non-vital and the tooth was endodontically
(a) periodontal ligament fistulation.
(b) extraosseous fistulation
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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.
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)
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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.
same level. On careful examination one can see that a
lateral canal communicating with the lateral bone
牙本质小管 Dentinal tubules 解剖异常 Anatomical abnormalities
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
邻牙一般无严重的牙周炎
X片显示烧杯型或日晕型病变
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after 18 M
In multirooted teeth a periodontal ligament fistulation can drain off into the furcation area
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２，牙髓治疗过程中或治疗后造成的牙周病变
immediately sealed with gutta-percha (b). One month after treatment a slight
radiolucency appeared at the perforation site (arrow) in the periodontium (c).
腭侧沟 牙根外吸收 根裂
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14-2 牙周-牙髓联合病变的临床类型 Clinical Patterns of Periodontal-Endodontic Combined Lesions
牙髓根尖周病对牙周组织的影响 influence of endodontic lesions on the periodontium
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
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根管侧支 Lateral root canal 或副根管 Accessory canal