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minibabyqq 2007-1-26 02:19

[color=Magenta][size=5][b]內分泌瘤形成的管理Management of Endocrine Neoplasia  [/b][/size][/color]

處理共同的內分泌腫瘤構成重大努力在伴侶動物實踐。pituitary 、甲狀腺和腎上腺腫瘤診斷在狗和貓經常是直接的。治療, 然而, 介入複雜或有爭議的決定和廣泛的post-treatment 監視。
腦下垂體的瘤形成
腦下垂體依賴hyperadrenocorticism (PDH) 佔80.85% 臨床hyperadrenocorticism (HAC) 在狗和貓和歸結於微或macroadenoma 。腎上腺依賴hyperadrenocorticism (啊) 歸結於腎上腺皮質激素的一個主要腫瘤和下面被談論。hypophyseal 腦下垂體腎上腺軸是系統地連接的長的並且短的反饋機制和因此HAC 的臨床, 診斷, 和治療管理複雜地同樣連接在這些內分泌器官之間。
PDH 的臨床介紹、診斷, 和分化從啊周到地被選派了在最近回顧並且伴侶動物的臨床評估與HAC 成為了獸醫一個共同的技巧。主要特點在兩隻狗和貓包括polyuria/polydipsia 、脫髮症、polyphagia, 和慵倦和鍛煉不寬容的未指明的標誌。多數貓是還hyperglycemic 和處理為胰島素抗性糖尿病mellitus 。在HAC 的有效的管理以後, 胰島素要求經常decline 並且貓的少數以糖尿病也許不再需要胰島素。貓沒有一致糖尿病mellitus 仍然提出與polyuria/polydipsia 。貓也許有dermatologic 介入包括易碎的皮膚、週期性膿皮病, 和seborrhea 。
HAC 的診斷和分化是直接的當臨床標誌、胃腸ultrasonographic 資料, 試鏡頭, 和誘惑內分泌測試一起被考慮。關心應該被使用在hyperadrenocorticism 診斷, 然而, 在一致地不陳列hyperadrenocorticism 的經典標誌的動物中, 因為非腎上腺病症也許極大影響腦下垂體腎上腺軸的內分泌評估。HAC 的管理必須被投入在上下文以狗也許有的所有其它醫療課題。少量狗與HAC 要求+化皮質酮水平的迫切更正並且在一些情況情況的直接治療不能是符合患者的利益。其它混亂的管理也許採取優先權。但是, HAC 最後控制在狗是需要的當更加迫切的情況被控制了, 為了防止hypercortisolemia 的分解代謝和免疫抑制的作用進一步致衰弱一致疾病的患者或妥協的成功的治療。
PDH 常規療法在狗介入o,p 的管理 ' DDD 。Bioavailablity 是窮的並且管理以飯食被推薦。磨成粉片劑應該被避免為了使這種致癌物質的物質降低潛在的曝光到所有者。療法的目標與 o,p ' - 雙對氯苯基二氯乙烷將導致小結腎上腺病勢漸退這樣崗位促腎上腺皮質激素刺激+化皮質酮價值是< 5 ug/dl 。標準協議介入裝貨藥量間隔時間被一個維護藥量的期間跟隨。30.50 mg/kg PO 最初的藥量每天10 天被建議。中等或大大小狗也許要求劃分藥量為了減少嘔吐。所有者把強體松或prednisolone 供給(0.15.0.25 mg/kg/d) 應該是標準協議從裝貨階段治療也許導致一次腎上腺皮質的危機。促腎上腺皮質激素刺激測試應該被使用監測反應如果腎上腺皮質的鎮壓的臨床標誌被觀察或從事10 天 o,p ' - 雙對氯苯基二氯乙烷裝貨。大約50% 狗將復發在第一年之內。再加工以o,p 的裝貨期間 ' - 雙對氯苯基二氯乙烷在藥量上面和在維護藥量的增量根據50% 被推薦。
其它治療選擇為狗存在與PDH 如果 o,p ' - 雙對氯苯基二氯乙烷不是有效的或如果狗不能容忍藥物。Ketoconozole 迅速地減少+化皮質酮水平但是相對地昂貴的和要求連續每日藥量。腦下垂體的輻照區域導致CNS 的重大減少臨床簽到狗與腦下垂體的macroadenomas 。腫瘤神經學標誌大小、嚴肅, 和對放射治療的內分泌活動影響反應在狗與腦下垂體的macroadenomas 。中間進步自由生存隨後而來的輻照區域是20 個月在狗以有利臨床參量(即, 奪取並且/或者溫和的神經學標誌唯一, 功能macroadenoma 和小相對腫瘤大小) 。狗以更加嚴厲的神經學標誌由於大, nonfunctional 腫瘤有一種更加粗劣的預測。結論關於內分泌作用隨後而來的輻照區域的正常化不能使由於一致 o,p ' - 雙對氯苯基二氯乙烷治療在一些狗。但是, hyperadrenocorticism 的二年控制率是32% 在12 條狗沒被對待與 o,p ' - 雙對氯苯基二氯乙烷跟隨輻照區域。另外的預期研究被擔保擴大這些觀察在對放射治療的用途為PDH 。放射治療的好處為狗與PDH 沒有神經學標誌是未知的。Trans sphenoidal 垂體切除術被描述了。
甲狀腺瘤形成
似犬甲狀腺瘤形成
似犬甲狀腺的腫瘤構成1.2.4% 所有腫瘤在狗。中間年齡在診斷是九到十年並且沒有一致的性別素質。拳擊手是事先安排好的對良性腺瘤和惡性甲狀腺腫瘤。另外, 小獵犬和金黃獵犬作為養殖被辨認了在甲狀腺癌增加的風險。甲狀腺癌原因論在狗是未知的雖然甲狀腺腫瘤在所有種類也許導致跟隨充足的輻射暴露。多數狗以甲狀腺癌euthyroid 當20% 也許是hyperfunctional 有或沒有伴隨甲狀腺機能亢進的標誌。甲狀腺機能不足也許並且收效由於正常甲狀腺組織的腫瘤破壞。大約33% 狗以甲狀腺癌很可能提供了轉移在診斷之時顯然在肺柔膜組織或在地方淋巴結。淋巴排水設備是頭蓋骨往submandibular 和retropharyngeal 淋巴結在這個區域甲狀腺的在狗。在疾病的自然路線期間在狗, 大約65.90% 狗以未經治療的甲狀腺癌將患轉移對各種各樣的組織。宮外的甲狀腺組織也許提升癌沒有甲狀腺的介入和也許被分佈沿腹脖子的vestigial 根瘤和入縱隔。
甲狀腺癌定期分級法在狗介入胸部的勘測射線照相為肺轉移、一般健康評估通過血液學掩護, 和輔助腫瘤站點或可疑變形的站點的另外的評估。超聲波評估或計算tomographic 掃瞄以脖子的對比改進有價值當大, 固定的大量是存在。掃瞄可能確定外科切除程度軟組織入侵和可能, 將是有用的為放射治療計劃。
似犬甲狀腺癌的治療由大量的大小, hyperthyroid 疾病程度入侵, 症狀在其它器官, 和可利用的治療選擇口授。甲狀腺根瘤的手術提供最佳的結果以最少病態當腫瘤自由地是可移動物沒有深刻的組織入侵。流動性最好被確定當狗被麻醉因為深刻的結構的附件經常不被讚賞當狗是醒的。外科方法是通過midline 切開。它是可能單邊地犧牲頸部的靜脈、頸動脈和vagosympathetic 樹幹以可接受的病態(單邊的Horner.s 綜合症狀) 。雙邊切除術也許導致laryngeal 痲痺和可能megaesophagus 。狗與固定和雙邊損害是可憐的有效的候選人。手術潛在地複雜歸結於地方組織入侵和過份出血或地方凝固反常性成為的系統coagulopathies 跟隨外科操作。這樣複雜化應該被期望在切除之前。
外在射線放射治療當前被評估在狗以unresectable 甲狀腺大量。初步資料建議輻射也許被用於為主要療法或downstage 大, 蔓延性甲狀腺腫瘤。殘餘的腫瘤負擔隨後而來的輻照區域的外科撤除也許提供進一步好處因為主要腫瘤再現佔重大必死。被照耀的組織的外科切除術在這個區域應該被完成以理解, 長期纖維變性和攣縮也許導致重要地方呼吸結構的收縮。
狗的Thirty-fifty 百分之對待了與或者doxorubicin 或cisplatin 也許展示一個部份反應(> 對容量的50% 減少) 。這樣甲狀腺癌的反應速度對化療建議一個角色為化療在甲狀腺腫瘤的管理雖然增加的生存時間為大多數狗以甲狀腺癌被對待以化療未被證實。
也許幫助確定治療決定在狗以甲狀腺癌的幾個預斷因素被辨認了。依照早先被提及, 大量的附件或入侵入周圍的組織是一個不讚同的因素。當評估自由地流動大量, 根瘤的大小看來是轉移的一個預斷預報因子在狗以甲狀腺癌。
似貓的甲狀腺瘤形成
甲狀腺機能亢進是最共同的內分泌混亂在貓和廣泛地被回顧了。這樣一個重大健康問題原因論和發病原理在貓仍然不為人所知。雖然似貓的甲狀腺機能亢進主要人口統計的特點顯著未改變在之前的15 年, 混亂的臨床顯示改變了。多數貓以甲狀腺機能亢進現在提出以溫和而不是嚴厲減重、一個可觸知的甲狀腺根瘤, 和心臟私語。Polyuria/polydipsia 和polyphagia 被減少在發生與10.15 年比較前。
甲狀腺機能亢進診斷定期地根據被舉起的清液T4 價值雖然清液甲狀腺激素的波動現在被認可並且貓以' 隱密' 甲狀腺機能亢進也許有T4 價值在正常參考範圍的上半方之內。
從事甲狀腺機能亢進診斷其它系統的一個詳盡的評估應該被舉辦。心動過速和被舉起R 揮動在ECG 保留最頻繁的心臟病反常性在hyperthyroid 貓。胸部射線照相和一個心臟病ultrasonographic 評估是前提對療法。Azotemia 或公開腎衰竭是重大sequelae 跟隨甲狀腺機能亢進控制。甲狀腺激素生產過剩增加glomerular 濾清率(GFR) 並且也許掩沒部下的腎臟病。它是不明的怎麼確定哪隻貓也許是在危險中開發腎臟複雜化沒有GFR 的準確決心, 雖然被集中的尿比重在治療之前也許是有用的。
放射性核素想像以technetium pertechnetate 被表明證實解剖程度功能甲狀腺組織。大約70.80% 貓以甲狀腺機能亢進有雙邊耳垂介入並且根瘤不能單獨地經常是可識別的在體檢。只10% 這些貓有雙邊對稱根瘤。經常, 一耳垂是大的並且其他小也許做診斷雙邊疾病混淆。偶爾地, 功能甲狀腺根瘤存在與功能宮外的甲狀腺組織的組合在縱隔並且貓也許很少有宮外的功能甲狀腺組織在縱隔之內沒有一個可觸知的甲狀腺根瘤。沒有這個另外的組織具體知識, 甲狀腺根瘤的外科撤除不導致疾病的決議。甲狀腺組織的地點明顯地確定型並且程度療法和因此甲狀腺掃描被推薦如果可利用。它特別重要如果甲狀腺nodule(s) 的外科切除術是選擇的治療。放射性核素掃瞄找出潛在的宮外的甲狀腺組織更需不是如果放射同位素或醫療管理將被考慮。
似貓的甲狀腺機能亢進的治療
試驗治療期間以methimazole 逐漸增長的藥量被推薦在明確的治療之前確定程度隱密腎臟病。如果腎臟病是溫和的, 少量但可接受的甲狀腺機能亢進也許被維護以methimazole, 或明確的治療也許被完成和甲狀腺激素補充被執行增加GFR 和減少azotemia 。所有者必須是消息靈通對甲狀腺替換的需要在明確的療法之前。長時期的methimazole 療法定期地不被推薦因為它同厭食聯繫在一起, 嘔吐, 和骨髓dyscrasias 在大約20% 貓中。但是, 在一些情況和以充分監視, methimazole 也許被容忍長時間(> 2.3 月) 。
明確的療法當前包括或者甲狀腺組織的外科切除或甲狀腺的收音機碘化物燒蝕以 131I. Surgical 切除一般被考慮當貓被診斷以單邊的甲狀腺病由放射性核素想像。 131I 放射同位素是選擇的治療當雙邊甲狀腺病存在或當宮外的甲狀腺組織被辨認, 因為少量複雜化發生比隨後而來的手術和post-treatment 激素補充經常被避免。 131我也許並且被使用對待貓與甲狀腺carcinoma.(50) 大劑量也許是必要有效地腐蝕腫瘤在這些情況
最近, 甲狀腺根瘤的對氨基苯甲酸二射入在超聲波教導下被報告了。四隻貓與單邊的甲狀腺根瘤接受了一射入。臨床標誌的決議發生了在一個星期之內。毒力不是顯然的除了溫和的聲音變化在二隻貓上。六隻貓與雙邊甲狀腺根瘤並且被注射了。對氨基苯甲酸二的射入入兩耳垂導致第一貓的死亡並且殘餘的五隻貓有只一個甲狀腺根瘤被注射。復發發生了在一隻貓以對氨基苯甲酸二的隨後安全射入在對側根瘤。瞬變週期性laryngeal 神經激怒發生了在二喪失五隻貓造成聲音變動, Horner.s 綜合症狀(vagosympathetic 神經), 和堵嘴。另外的資料從貓對待了以對氨基苯甲酸二射入熱切地將被期望。
腎上腺封墊瘤形成
一般考慮
腎上腺損害的最近編輯從幾個病理性和臨床資料庫提供良性和惡性腎上腺封墊腫瘤的流行的有用的估計在狗和貓。大約35-40% 老年醫學的小獵犬從研究殖民地有節狀增生的histopathologic 證據跟隨完全屍體檢驗。主要腎上腺腫瘤(表皮和髓心) 被報告了在5.19% 這些狗中。驚奇, 33% histopathologic 腎上腺損害在研究小獵犬是轉移從其它惡性腫瘤站點。最共同的腫瘤被辨認以腎上腺轉移是淋巴瘤、hemangiosarcoma 和黑瘤。相反, 主要腎上腺腫瘤被報告了在大約0.17.0.76% 愛犬(所有似犬腫瘤1.2 %) 並且0.03% 貓中(0.2% 似貓的腫瘤) 從獸醫醫療資料庫。它是有趣, 只似犬腎上腺損害3.5 % 在這個資料庫是轉移。這資料, 總結不同的終點, 建議腎上腺封墊比臨床被讚賞經常影響以瘤形成。明顯差誤在腎上腺封墊瘤形成之間的臨床和histologic 證據可能歸結於: 1) 厚臉皮方法辨認和非侵入性地描繪腎上腺損害antemortem; 2) 困難獲得組織為切片檢查法由於腎上腺封墊的大小、vascularity 和地點; 並且3) 一些腎上腺腫瘤也許保留assymptomatic 或隱密。
對胃腸ultrasonography 的增加的用途提高了我們的能力辨認臨床和臨床症狀不顯的腎上腺反常性。意想不到的腎上腺大量被辨認在大約1% 胃腸超聲波評估中。但是, 在腎上腺損害的發現上增加在狗接受一個完全胃腸超聲波評估為未指明的病症。例如, 在最近回顧展回顧, 20 40 條狗以後被證實有嗜鉻細胞瘤有嫌疑的腎上腺損害儘管缺乏臨床標誌具體地與那混亂有關。那些嗜鉻細胞瘤沒被辨認在超聲波是< 直徑1 cm 。因而, 對腎上腺封墊的增加的注意在超聲波考試期間應該增加在腎上腺具體損害的發現上。
腎上腺想像更加敏感的方法並且將援助在損害的描述特性。在人, 癌比腺瘤一般大的, 侵略入周圍的結構, 和有不同的想像質量在CT 或嗜鉻細胞瘤先生同樣有不同的想像特徵。初步證據在狗支持這發現。腎上腺封墊的腺瘤一般是< 2 cm 直徑並且癌是任一大小, 經常> 2 cm 。石灰化不看來是有預測性的為或腺瘤或癌雖然嗜鉻細胞瘤不鈣化。對想像形式的膨脹的用途譬如CT 和先生在狗和貓可能將提供另外的資料在具體腎上腺損害的特徵用於診斷和治療計劃。
偶然發生的腎上腺損害應該臨床被調查如果他們被診斷。非造形術腎上腺損害譬如囊腫或肉芽腫是非常罕見的在狗或貓和變形的損害的高發生辯解一個詳盡的endocrinologic 掩護和評估為非腎上腺瘤。偶然發生的腎上腺大量也許看來是nonfunctional 在診斷之時雖然它可能似乎他們臨床症狀不顯地實際上是工作。功能腎上腺腫瘤的診斷和管理被談論下面但nonfunctional, 偶然發生的腎上腺大量的證明創造管理困境。診斷也許進取地被追求以一個外科切片檢查法或也許更加保守地被處理(頻繁想像, 內分泌測試, 血壓掩護, 等) 。但是, 瘤形成的管理在它臨床變得明顯之前清楚地是最佳的時候干預。
腎上腺皮質激素
臨床標誌和診斷:
大約15% 狗被診斷以hyperadrenocorticism (HAC) 是hypercortisolemic 由於一個主要腎上腺表皮腫瘤(啊) 。大多數腎上腺皮質的腫瘤在狗藏匿glucocorticoids 並且臨床標誌一致與hypercortisolemia 是腎上腺皮質激素的功能腫瘤標記。除+化皮質酮之外, 礦物類皮質激素和腎上腺雄激素也許被腎上腺皮質的腫瘤不適當地發布。醛甾酮藏匿腎上腺腫瘤沒有一致hypercortisolemia 被報告了在貓和狗。
腎上腺腫瘤發生在老年醫學(平均年齡= 11 年。) 狗。大養殖(長捲毛狗、德國牧羊人、獵犬和狗) 並且女性看上去在代表在腎上腺腫瘤臨床回顧。腎上腺腫瘤在貓是罕見的並且不足的資訊存在描繪這種疾病。
臨床標誌聯繫了hyperadrenocorticism, 是否由於腎上腺大量或腦下垂體的大量相似和周到地被回顧了在最近文學。簡要地, hyperadrenocorticism 診斷根據適當的標誌、實驗室endocrinologic 試鏡頭的反常性一致與hypercortisolemia, 和結果譬如內在促腎上腺皮質激素、促腎上腺皮質激素刺激測試、低藥量dexamethasone 鎮壓(LDDS) 測試、高藥量dexamethasone 鎮壓(HDDS) 測試、24 小時尿+化皮質酮排泄, 或尿+化皮質酮: 肌氨酸酐比率。ultrasonographic 特點一個最近總結從狗以hyperadrenocorticism 結束了腎上腺許多損害, 通常單邊, 是可識別的在狗與啊和狗以PDH 很少被生產的謹慎腎上腺根瘤或大量。
腎上腺表皮腫瘤的治療
腎上腺腫瘤的管理要求臨床狀態的患者, 程度腫瘤入侵入周圍的結構和能力的考慮手術後地支持患者。理想的外科候選人與sequelae 不妥協由於hypercortisolemia 和有非侵入性, 非變形的腎上腺表皮腺瘤。多數狗, 然而, 由hypercortisolemia 醫療上妥協並且腎上腺腫瘤是惡性在近似狗的一半。定期地生存做法和進展通過手術後管理為賠償hypoadrenalcorticism 的狗有一個市場對好預測。一和二年生存在狗腎上腺腫瘤的生存切除術是大約80.90% 。手術後管理需要對電解質glucocorticoids 的平衡和管理的密切的關注。Dexamethasone 一般被執行在和在手術之後之前。促腎上腺皮質激素刺激測試手術後地是成功的24.48 小時在之後, 強體松也許用dexamethasone 被替代和被維護以適當的監視二個到三個月。
o,p ' - 雙對氯苯基二氯乙烷或ketoconazole 是有效的在減少+化皮質酮分泌物從腎上腺腫瘤, 應該被推薦為不是外科候選人或為標誌的前有效的改良的狗。o,p 大劑量 ' - 雙對氯苯基二氯乙烷長期是需要的為狗與腎上腺腫瘤與狗比較與PDH (50.75 mg/kg/day 14 天是被推薦的開始的藥量) 。對腎上腺作用的定期評估如所描述為PDH 是需要的但持續的歸納藥量也許是必要的或藥量的逐步升級(在50 mg/kg/day 增加每14 天間隔時間) 也許必需。一旦控制, 被壓制的+化皮質酮生產維護也許被完成與50.75 mg/kg/week 雖然復發發生在大約50% 狗中。被調整的維護藥量也許臨時地解決這些復發。 o,p ' - 雙對氯苯基二氯乙烷也許並且被創始在有公開轉移為減輕症狀的狗。Ketoconazole 在定期藥量(10 mg/kg PO q12h) 導致被減少的+化皮質酮集中和變稀的臨床症狀在大約50% 狗中以腎上腺腫瘤。它經常被推薦四個到八個星期作為一個前奏對腎上腺大量的外科切除術正常化也許影響麻醉或外科手術的一致+化皮質酮導致的疾病。

Managing common endocrine tumors constitutes significant effort in companion animal practice. The diagnosis of pituitary, thyroid and adrenal tumors in dogs and cats is often straightforward. Treatment, however, involves complex or controversial decisions and extensive post-treatment monitoring.
Pituitary Neoplasia
Pituitary-dependent hyperadrenocorticism (PDH) accounts for 80?5% of clinical hyperadrenocorticism (HAC) in dogs and cats and is due to a micro- or macroadenoma. Adrenal-dependent hyperadrenocorticism (AH) is due to a primary tumor of the adrenal cortex and is discussed below. The hypophyseal-pituitary-adrenal axis is systemically linked by long and short feedback mechanisms and therefore clinical, diagnostic, and therapeutic management of HAC is likewise intricately linked between these endocrine organs.
The clinical presentation, diagnosis, and differentiation of PDH from AH has been thoroughly detailed in recent reviews and the clinical evaluation of companion animals with HAC has become a common skill of veterinarians. The predominant features in both dogs and cats include polyuria/polydipsia, alopecia, polyphagia, and nonspecific signs of lethargy and exercise intolerance. Most cats are also hyperglycemic and managed for insulin-resistant diabetes mellitus. Following effective management of HAC, insulin requirements often decline and a minority of cats with diabetes may no longer require insulin. Cats without concurrent diabetes mellitus still present with polyuria/polydipsia. Cats may have dermatologic involvement including fragile skin, recurrent pyoderma, and seborrhea.
The diagnosis and differentiation of HAC is straightforward when clinical signs, abdominal ultrasonographic data, screening tests, and provocative endocrine testing are considered together. Care should be used in the diagnosis of hyperadrenocorticism, however, in animals that do not concurrently exhibit classic signs of hyperadrenocorticism, since non-adrenal illness may significantly affect endocrine evaluation of the pituitary-adrenal axis. Management of HAC must be put in context with any other medical problems the dog may have. Few dogs with HAC require urgent correction of cortisol levels and in some situations immediate treatment of the condition may not be in the best interest of the patient. Management of other disorders may take priority. However, ultimate control of HAC in dogs is needed when more urgent conditions have been controlled, in order to prevent the catabolic and immunosuppressive effects of hypercortisolemia from further debilitating the patient or compromising successful treatment of concurrent disease.
Conventional therapy of PDH in dogs involves administration of o,p' 靝DD. Bioavailablity is poor and administration with meals is recommended. Pulverizing tablets should be avoided in order to reduce potential exposure of this carcinogenic substance to the owners. The goal of therapy with o,p' -DDD is to induce sub-total adrenal lysis such that the post ACTH stimulation cortisol value is < 5 ug/dl. The standard protocol involves a loading dose interval followed by a maintenance-dosing period. An initial dose of 30?0 mg/kg PO per day for 10 days is suggested. Medium or large size dogs may require dividing the dose in order to reduce vomiting. Supplying the owners with prednisone or prednisolone (0.15?.25 mg/kg/d) should be standard protocol as well since the loading phase of treatment may induce an adrenocortical crisis. ACTH stimulation tests should be used to monitor response if clinical signs of adreno-cortical suppression are observed or following the 10 days of o,p' -DDD loading. Approximately 50% of dogs will relapse within the first year. Re-treatment with a loading period of o,p' -DDD at the doses above and an increase in the maintenance dose by 50% is recommended.
Other treatment options exist for dogs with PDH if o,p' -DDD is not effective or if the dog is not able to tolerate the drug. Ketoconozole reduces cortisol levels rapidly but is relatively expensive and requires continuous daily dosing. Irradiation of the pituitary gland has resulted in significant reduction of CNS clinical signs in dogs with pituitary macroadenomas. Tumor size, severity of neurologic signs, and endocrine activity influence response to radiation therapy in dogs with pituitary macroadenomas. The median progression free survival following irradiation was 20 months in dogs with favorable clinical parameters (i.e., seizures and/or mild neurologic signs only, functional macroadenoma and small relative tumor size). Dogs with more severe neurologic signs due to large, nonfunctional tumors had a poorer prognosis. No conclusions regarding normalization of endocrine function following irradiation could be made due to concurrent o,p' -DDD treatment in some dogs. However, the two year control rate of hyperadrenocorticism was 32% in the 12 dogs not treated with o,p' -DDD following irradiation. Additional prospective studies are warranted to extend these observations on the use of radiation therapy for PDH. The benefit of radiation therapy for dogs with PDH without neurologic signs is unknown. Trans-sphenoidal hypophysectomy has been described.

minibabyqq 2007-1-26 02:20

[color=Magenta][size=5][b]介紹畸齒矯正術Introduction to Orthodontics  [/b][/size][/color]


叮咬瑕疵是共同在小一般實踐。多數人經常找到在狗但兔子和, 較少, 貓還出席以咬合不良。診斷叮咬瑕疵和擬定治療計劃, 獸醫需要能認可正常位置。方法咬住評估因此需要是有條不紊和邏輯的。
正常咬合樣式被命名orthognathism 。問題共同地存在在狗, 主要由於在頭骨類型上巨大變化在種類之內。
有三種基本的頭骨類型:
Dolicocephalic: 長, 狹窄的面孔, 即, 粗礪的大牧羊犬、俄國獵狼犬或靈獅。
Mesocephalic: normal. 類型面孔, 即, 德國牧羊人, 西伯利亞愛斯基摩。
Brachycephalic: 短, 寬廣的面孔, 即, 拳擊手、牛頭犬, 和Pug 。
所有成人狗通常有42 顆成人牙。清楚對面部外形的長度的減少在小, 突然面對的養殖將導致擁擠牙至少, 與更加痛苦和難看瑕疵在例外情況。
正常叮咬評估
正常點尋找在估計狗叮咬是如下:
門牙應該是scissor 叮咬。上部門牙應該重疊更低的門牙。更低的門牙的切開邊緣應該遮沒在或者靠近瓣環土坎在上部門牙的palatal 表面。
更低的犬應該整潔地適合入diastema 空間在上部犬和壁角門牙之間當嘴是閉合的。理想地, 更低的犬不應該接觸上部牙。
前臼齒應該形成shear 嘴藉以下頷骨前臼齒的冠的要訣應該指向直接地入interproximal 空間在前臼齒之間在上部下頜和反之亦然。上部第四顆前臼齒(carnassial) 應該是lateral/buccal 對更低的第一槽牙。
頭骨應該是對稱的在瀘頂骨矢狀合縫的飛機。
任一偏差從上述標準是偏差從法線。一些課本主張包括更多標準的系統。這些是有用的在更加複雜的案件, 主要四個標準將允許對多數的一個迅速和準確評估案件被看見。
叮咬分類
類0 或Orthoclusion
這是正常叮咬為狗正如每標準被列出以上。

類一個Malocclusion/Neutroclusion
整體關係是正確相對上部和更低的下頜但鎖柱線不正確歸結於一個或更多牙是在對準線外面, 被轉動, 或被更換在某個方面, 即, 被保留的落葉牙、先前cross-bite 、後部cross-bite 、舌被偏移的下頷骨犬齒、缺掉牙、被衝擊的牙, 超編人員的牙, 被轉動的和擁擠牙。
類二Malocclusion/Distoclusion/.Overshot 。
一些或所有下頷骨牙是末端的在他們的與上頷骨牙的關係。實際上, 這提到一塊短的下顎骨和一塊相對地長的上顎骨。經常指一個 被超越的下頜。這不是normal 。在任一養殖但被看見在各種各樣的狗。它被報告有繼承一個被證明的autosomal 隱性方式longhaired Dachshunds 和德國Shorthaired 尖。其它養殖並且一定顯示類2 咬合不良在相對地高數字。有鬍子的大牧羊犬、德國牧羊人、西部高地, 和Weimeraner 是所有共同的養殖在英國以這個問題。
類三Malocclusion/Mesioclusion/.Undershot 。
一些或所有下頷骨牙是mesial (rostral) 在他們的與他們的上頷骨相對物的關係。提到一塊長的下顎骨和一塊相對地短的上顎骨。養殖譬如波士頓狗、拳擊手和英國牛頭犬顯示這個 下前牙突出的下頜 作為normal. 解剖特點。這些養殖經常過度擁擠了牙由於缺乏空間, 特別在上顎骨, 和開發早期牙周疾病。
咬合不良的臨床重要性
對獸醫的主要責任面對咬合不良是痛苦的解除或難受。第二責任建議關於情況的可能的繼承。一否則酣然, 很好喜歡齒列也許顯示不對稱的磨蝕或損耗。問題也許發生以咀嚼和TMJ 作用。軟的組織精神創傷是一個共同的續集malpositioned 牙並且, 終於, 牙過早的損失也許由一個增加的責任造成對periodontitis 。
咬合不良原因論和概念
主要問題面對獸醫關於原因論將決定是否問題被繼承或被獲取。如果它是可能確定這(由標準協助被列出以上), 它將允許治療計劃以合理和道德方式。有一種治療可利用為所有一情況和它重要的頻繁地超過動物不返回到基因庫以做他們的用途的被對待的被繼承的正牙學情況當螺柱尾隨更加中意。許多養殖在英國一致地運行以高水平共同的咬合不良。這些phenotypically 是臨床和清晰地可看見的。一些也許是少量地重要在臨床水平, 即, 不要造成功能問題對動物, 但是在一個基因型水平上仍然是重大的對養殖整體上。這些個體可能經常被辨認使用標準上面和從育種的水池被去除。不採取行動此時可能導致重大問題的水平在以下世代。
Interceptive 畸齒矯正術 提到及早需要行動, 經常在臨時齒列之時, 以後避免問題。四個下頜象限全部獨立地增長。在一迅速地生長動物這能共同地導致臨時咬合不良。最共同是下顎骨比上頷骨象限慢慢地增長可能導致情況臨時更低的犬齒變得被捉住的末端和舌對他們的正常位置, 在坑在堅硬上顎組織的類2 咬合不良。下顎骨的正常rostral 成長然後被防止因此下頷骨身體腹上趨向對弓而不是rostrally 增長。更低的臨時犬的適當和仔細的提取此時的可能解除牙齒保險設備和防止長期弓法並且解除一個痛苦的問題。其它例子經常會是一顆混雜的dentition.temporary 和永久teeth.most 門牙的出現。臨時牙的提取清楚地是中意解除擁擠。它是明智射線照相區域首先作為一顆永久牙的疏忽提取此時可能錯誤地導致一個非常怏怏不樂的客戶。
共同的臨床咬合不良
先前Crossbite
這是瑕疵, 可能被繼承或被獲取。可能的aetiology.s 尾部是被保留的臨時門牙, 擁擠上部或更低的門牙曲拱或精神創傷推擠的一個或更多上部永久門牙。正牙學操作通過一個丙烯酸酯的括號與擴展螺絲或由一archbar 與按鈕和橡皮筋是合理地成功的在改正這個問題 只要曲拱不擁擠。這不應該執行直到頭骨發展是完全頭骨成長也許否則趕過牙運動。在開始這型畸齒矯正術之前記住, 設備被使用也許湧出必須是存在為12 個星期或更多。另外獸醫應該仔細地審查道德位置。這一般不是一個不正常的情況, 也許歸結於擁擠門牙曲拱和因為這樣的治療不能是符合動物或養殖的利益。
扭曲的嘴
在這個情況一個下顎骨並且/或者上顎骨的邊比其他長的。它導致非對稱在saggital 飛機。它認為被繼承。其它叮咬反常性同時頻繁地將是存在。
後部Crossbite
下頷骨carnassial (槽牙1 或409/309) 是被找出的頰的對上頷骨carnassial (前臼齒4 或108/208) 。經常結果在結石和區域的更加迅速的儲積變得有傾向對牙周疾病。治療範圍從努力homecare 對更加老練的牙周疾病治療。Odontoplasty 也許必需如果主要尖頂導致精神創傷對軟的組織在相反曲拱。其它叮咬反常性同時頻繁地將是存在。
基本的狹窄Canines/Lingually 被偏移的下頷骨犬
可能正牙學提及的最共同的原因由於痛苦和明顯的軟的組織損傷介入了。更低的犬噴發在一個背部方向而不是bucally 和不發現他們的正常位置在diastema 在上部犬和門牙3 之間。這通常傷害反對的堅硬上顎的軟的組織。獨自它會被分類作為類一個咬合不良但它與下頷骨brachygnathism 和因此率在許多情況下被結合作為混雜的類Two/Class 一個咬合不良。這個情況被證明是由於一個autosomal 隱性變化在至少一養殖(GSH 尖, ref 。Byrne 和Byrne 。獸醫紀錄(1992): 130, 375-376) 。治療是根本在許多情況下允許嘴關閉沒有痛苦。這可能採取正牙學外科地打翻以叮咬飛機或變短更低的似犬冠和執行一部份冠狀pulpectomy 的形式在被暴露的黏漿狀物質。另外, 閹割動物應該強烈被勸告。下頷骨犬的提取將被避免如果可能由於根對symphyseal 區域貢獻的力量。
叮咬總結
鑰匙的鎖柱或的類型叮咬看主要在上顎骨的關係下顎骨在前臼齒牙雖然四個不同標準應該, 至少, 被審查為叮咬評估。
1 。 門牙應該陳列scissor 叮咬。
2 。 下頷骨犬應該整潔地適合diastema 在上部壁角門牙和上頷骨似犬之間, 應該接觸兩者都不。另外它應該被漁在一個舌頰方向。
3 。 上部PM1 排隊在一個槽孔在更低的PM1 和PM2 之間。上部PM2 排隊在一個槽孔在更低的PM2 和PM3 之間等等提供pinking 剪作用。
4 。 頭骨應該是對稱的在瀘頂骨矢狀合縫的飛機
保障道德位置和防止不是符合養殖的利益的治療執行, 所有者應該請求簽署一個正牙學發行形式。

Bite defects are common in small general practice. The majority is found in dogs but rabbits and, less often, cats also present with malocclusions. To diagnose bite defects and formulate treatment plans, the veterinarian needs to be able to recognize the normal position. The approach to bite assessment therefore needs to be methodical and logical.
The normal occlusal pattern is termed orthognathism.Problems exist commonly in dogs, mainly due to great variation in skull type within the species.
There are three basic skull types:
Dolicocephalic: long, narrow faces, e.g., Rough Collie, Borzoi or Greyhound.
Mesocephalic: 䒟ormal?type face, e.g., German Shepherd, Siberian Husky.
Brachycephalic: short, broad faces, e.g., Boxer, Bulldog, and Pug.
All adult dogs normally have 42 adult teeth. Clearly the reduction in length of the facial profile in small, short faced breeds will lead to crowding of teeth at the very least, with more painful and disfiguring defects in more extreme cases.
NORMAL BITE ASSESSMENT
The normal points to look for in assessing a dog bite are as follows:
The incisors should be in scissor bite. The upper incisors should overlap the lower incisors. The incisal edges of the lower incisors should occlude at or near the cingulum ridge on the palatal surface of the upper incisors.
The lower canines should fit neatly into the diastema space between the upper canines and corner incisors when the mouth is closed. Ideally, the lower canines should touch neither upper tooth.
The premolars should form 𦽳hear mouth?whereby the tips of the crowns of the mandibular premolars should point directly into the interproximal spaces between the premolars on the upper jaw and vice versa. The upper fourth premolar (carnassial) should be lateral/buccal to the lower first molar.
The skull should be symmetrical in the sagittal plane.
Any deviation from the above criteria is a deviation from the normal. Some textbooks advocate systems that include more criteria. Whilst these are useful in more complex cases, the main four criteria will allow a rapid and accurate assessment of the majority of cases seen.
BITE CLASSIFICATION
Class 0 or Orthoclusion
This is a normal bite for a dog as per the criteria listed above.

Class One Malocclusion/Neutroclusion
The overall relationship is correct relative to upper and lower jaws but the line of occlusion is incorrect due to one or more teeth being out of alignment, rotated, or changed in some way, e.g., retained deciduous teeth, anterior cross-bite, posterior cross-bite, lingually displaced mandibular canine teeth, missing teeth, impacted teeth, supernumerary teeth, rotated and crowded teeth.
Class Two Malocclusion/Distoclusion/洤vershot?/p> Some or all of the mandibular teeth are distal in their relationship with the maxillary teeth. In effect, this refers to a short mandible and a relatively long maxilla. Often referred to as an overshot jaw. This is not 忛ormal?in any breed but is seen in a variety of dogs. It is reported to have a proven autosomal recessive mode of inheritance in longhaired Dachshunds and German Shorthaired Pointers. Other breeds certainly display class 2 malocclusions in relatively high numbers also. The Bearded Collie, German Shepherd, West Highland, and Weimeraner are all common breeds in the UK with this problem.
Class Three Malocclusion/Mesioclusion/牐ndershot?/p> Some or all of the mandibular teeth are mesial (rostral) in their relationship with their maxillary counterparts.Refers to a long mandible and a relatively short maxilla. Breeds such as Boston Terriers, Boxers and English Bulldogs show this undershot jaw as a 忛ormal?anatomical feature. These breeds often have overcrowded teeth due to lack of space, particularly in the maxilla, and develop early periodontal disease.
CLINICAL IMPORTANCE OF MALOCCLUSION
The primary responsibility for the veterinarian faced with a malocclusion is the relief of pain or discomfort. The second responsibility is counseling as regards the possible inheritance of the condition. An otherwise sound, well cared for dentition may show asymmetric abrasion or attrition. Problems may occur with mastication and TMJ function. Soft tissue trauma is a common sequel of malpositioned teeth and, finally, premature loss of teeth may be caused by an increased liability to periodontitis.
AETIOLOGY AND ETHICS OF MALOCCLUSION
The primary problem facing the veterinarian as regards aetiology is to decide whether the problem is inherited or acquired. If it is possible to determine this (assisted by the criteria listed above), it will allow the planning of treatment in a rational and ethical manner. Frequently there is more than one treatment available for any one condition and it is critical that animals are not returned to the gene pool with treated inherited orthodontic conditions that make their use as stud dogs more desirable. Many breeds in the UK consistently run with high levels of common malocclusions. Some of these are clinical and clearly visible phenotypically. Some may be marginally important at the clinical level, i.e., cause no functional problems to the animals, but on a genotypic level still be significant to the breed as a whole. These individuals can often be identified using the criteria above and removed from the breeding pool. Failing to take action at this time can lead to levels of significant problems in following generations.
Interceptive orthodontics refers to taking action early, often at the time of temporary dentition, to avoid problems later. The four jaw quadrants all grow independently. In a rapidly growing animal this can commonly lead to temporary malocclusions. The most common is a class 2 malocclusion where the mandibles grow more slowly than the maxillary quadrants leading to a situation where the temporary lower canine teeth become caught distal and lingual to their normal position, possibly in pits in the hard palate tissue. Normal rostral growth of the mandibles is then prevented so the mandibular bodies tend to bow ventrally rather than grow rostrally. Appropriate and careful extraction of the lower temporary canines at this time can relieve the dental interlock and prevent the long term bowing as well as relieving a painful problem. Another example would be the presence of a mixed dentition鍟emporary and permanent teeth𤧥ost often incisors. Clearly extraction of the temporary teeth is desirable to relieve crowding. It is wise to radiograph the area first as inadvertent extraction of a permanent tooth by mistake at this time can result in a very unhappy client.
COMMON CLINICAL MALOCCLUSIONS
Anterior Crossbite
This is a defect, which can be inherited or acquired. Possible aetiology𠏋 are retained temporary incisors, crowding of the upper or lower incisor arches or trauma pushing one or more of the upper permanent incisors caudally. Orthodontic manipulation by means of an acrylic brace with an expansion screw or by an archbar with buttons and elastic bands has been reasonably successful in correcting this problem as long as the arch is not crowded. This should not be performed until the skull development is complete otherwise skull growth may outpace the tooth movement. Before embarking on orthodontics of this type bear in mind that the device employed may well have to be present for 12 weeks or more. In addition the veterinarian should carefully examine the ethical position. This is generally not a dysfunctional condition and may be due to crowding of the incisor arch and as such treatment may not be in the best interest of the animal or the breed.
Wry Mouth
In this condition one side of the mandible and/or maxilla is longer than the other. It leads to an asymmetry in the saggital plane. It is considered to be inherited. Frequently other bite abnormalities will be present simultaneously.
Posterior Crossbite
Mandibular carnassial (Molar 1 or 409/309) is located buccal to maxillary carnassial (Premolar 4 or 108/208). Often results in more rapid accumulation of calculus and the area becomes more prone to periodontal disease. Treatments range from diligent homecare to more sophisticated periodontal disease treatments. Odontoplasty may be required if the main cusp causes trauma to soft tissue on the opposite arch. Frequently other bite abnormalities will be present simultaneously.
Base Narrow Canines/Lingually Displaced Mandibular Canines
Probably the most common reason for orthodontic referral due to the pain and obvious soft tissue damage involved. The lower canines erupt in a dorsal direction rather than bucally and fail to find their normal position in the diastema between the upper canine and incisor 3. This usually injures the soft tissue of the opposing hard palate. On its own it would be classified as a Class One malocclusion but in many cases it is combined with mandibular brachygnathism and therefore rates as a mixed Class Two/Class One malocclusion. This condition has been proven to be due to an autosomal recessive mutation in at least one breed (GSH Pointer, ref. Byrne and Byrne. Veterinary Record (1992): 130, 375-376). Treatment is essential in most cases to allow the mouth to close without pain. This can take the form of orthodontic tipping with a bite plane or shortening the lower canine crowns surgically and performing a partial coronal pulpectomy on the exposed pulps. In addition, neutering of the animal should be strongly advised. Extraction of the mandibular canines is to be avoided if possible due to the strength the roots contribute to the symphyseal area.
BITE SUMMARY
The key to occlusion or to the type of bite is seen primarily in the relationship of the maxilla to the mandible in the premolar teeth although four separate criteria, at the very least, should be examined for a bite appraisal.
1. The incisors should exhibit scissor bite.
2. The mandibular canine should fit neatly in the diastema between the upper corner incisor and maxillary canine and should touch neither. In addition it should be angled in a lingual buccal direction.
3. The upper PM1 lines up in a slot between the lower PM1 and PM2. The upper PM2 lines up in a slot between the lower PM2 and PM3 and so forth to provide a 𢖯inking shear?effect.
4. The skull should be symmetrical in the sagittal plane
To safeguard the ethical position and to prevent treatments being performed that are not in the best interest of the breed, owners should be asked to sign an orthodontic release form.

minibabyqq 2007-1-26 02:21

[color=Magenta][size=5][b]一種可移動的正牙學器具為狗  [/b][/size][/color]


舌deviated/displaced 下頷骨犬是一個相對地共同的正牙學問題在狗(1-6) 。這咬合不良也許歸結於牙齒反常性、骨骼反常性或兩個的組合(7,8) 。這個情況是更多比一個審美問題。由於下頷骨似犬冠的palatal 聯絡打翻, 這個情況導致難受和痛苦, 頻繁地可以導致黏膜潰瘍、傳染, 和甚而oronasal fistulation (7-10) 。治療形式為maloccluding 的牙的運動也許被承擔使用固定的器具: 斜面(直接或間接) (11-14), 擠撞斜面(15), 和活躍設備(擴展螺絲、W 導線, 修改過的方形字體螺旋) (2,8,16) 。其它治療選擇包括外科改變位置(17-19), 外科冠減少, 和提取(8,10,19,20) 。
所有這些技術有某些好處和不利, 廣泛地被回顧了(4,6,21) 。所有要求麻醉在至少一個場合, 用一些要求它在多個場合。
技術被描述這裡舌是deviated/displaced 下頷骨犬的更正的一個非常簡單, 低廉, 動物友好的技術當其它嚴厲咬合不良不是存在(22) 。它可能被描述作為行為修改技術運用一個可移動的正牙學設備。
技術描述
技術包括刺激狗演奏, 越經常越好, 與正確的大小和形狀的具體橡膠玩具。玩具應該是圓或卵形和做硬橡膠以光滑的表面避免犬齒的磨蝕。玩具的正確大小之間坐和在犬齒之後, 太大以至於不能實際上適合, 主要地適用於側向壓力牙當狗演奏。為小狗這通常意味橡膠球4 cm 直徑, 大養殖需要一個與6-8 cm 直徑。
咬合不良的正確診斷是大的重要為這個技術的成功。主要下頜差誤不應該是存在。diastema 在上頷骨第三隻門牙和犬之間應該將足夠寬容納下頷骨犬齒。想法在技術之後是, 行動演奏和嚼在一個適當的對象也許強迫牙在一個更加適當的位置。
所有者被勸告演奏與狗越經常越好, 和拿走所有其它玩具。承擔1 個星期的學習的階段在治療開始有效之前, 二個進一步星期將是需要的在從治療的任一個好處可能被看見之前。所以鎖柱被檢查在三個星期以後, 另外在進一步月度間隔時間當有必要。如果運動不看在三個星期以後, 其它治療方法應該被考慮。

結果
50 個案件被跟隨了在二個星期和二年之間。多數狗是非常年輕(少於七個月年齡) 。復發未被報告跟隨對這個技術的用途。看起來似乎結束更正(labioversion) 少許風險, 因為它從未發生了在任何狗被對待。技術運作在多數論點, 經常採取不再比幾個星期為更正。結果將被提出重點在咬合不良的正確診斷。技術的失敗的主要理由是鎖柱問題不同於下頷骨犬齒的舌位移。

技術的好處
技術與橡膠玩具避免麻醉必要。和以任一個正牙學技術, 它會是適當充分獲得前和post-treatment 印象, 但為可理解的原因所有者不要他們的狗被麻醉為那。作為妥協, 堅硬蠟叮咬薄酥餅可能被使用記錄冠要訣位置在多數神志清楚的狗。照片應該被拍攝記錄程度咬合不良和作為記錄咬合不良一個進一步手段和治療的成功或失敗。
技術與橡膠球有幾其它主要好處當與工作比較與常用的器具。好口頭衛生學不是必須的為成果當使用橡膠球技術雖然它應該被勸告為牙周疾病的預防。口頭軟的組織精神創傷從壓力, 炎症, 和潰瘍是不太可能的以這個技術並且下頜成長像被看見與一些固定的器具不會被禁止。

Lingually deviated/displaced mandibular canines are a relatively common orthodontic problem in the dog (1-6). This malocclusion may be due to a dental abnormality, a skeletal abnormality or a combination of both (7,8). This condition is more than just an esthetic problem. Due to the palatal contact of the mandibular canine crown tips, this condition frequently causes discomfort and pain and may lead to mucosal ulceration, infection, and even oronasal fistulation (7-10). Treatment modalities for movement of the maloccluding teeth may be undertaken using fixed appliances: inclined plane (direct or indirect) (11-14), telescoping inclined plane (15), and active devices (expansion screw, W-wire, modified quad helix) (2,8,16). Other treatment options include surgical repositioning (17-19), surgical crown reduction, and extraction (8,10,19,20).
All of these techniques have certain advantages and disadvantages, which have been reviewed extensively (4,6,21). All of them require anesthesia on at least one occasion, with some requiring it on multiple occasions.
The technique described here is a very simple, inexpensive, animal-friendly technique for correction of lingually deviated/displaced mandibular canines when no other severe malocclusion is present (22). It can be described as a behaviour modification technique utilizing a removable orthodontic device.
TECHNIQUE DESCRIPTION
The technique consists of stimulating the dog to play, as often as possible, with specific rubber toys of the right size and shape. The toy should be round or oval and made of hard rubber with a smooth surface to avoid abrasion of the canine teeth. The correct size of toy sits in between and just behind the canine teeth, too large to actually fit, principally applying lateral pressure to the teeth while the dog plays. For small dogs this usually means a rubber ball of 4 cm in diameter, large breeds need one with 6-8 cm in diameter.
Correct diagnosis of the malocclusion is of major importance for success of this technique. No major jaw discrepancy should be present. The diastema between the maxillary third incisor and canine should be wide enough to accommodate the mandibular canine tooth. The idea behind the technique is that the act of playing and chewing on a suitable object might force the teeth in a more appropriate position.
The owner is advised to play with the dog as often as possible, and to take away all the other toys. Assuming a one-week learning phase before the treatment becomes effective, two further weeks will be needed before any benefit from the treatment is likely to be seen. Therefore the occlusion is checked after three weeks, then again at further monthly intervals as necessary. If no movement is seen after three weeks, other treatment methods should be considered.

RESULTS
Over 50 cases were followed for between two weeks and two years. Most dogs were very young (less than seven months of age). No relapses were reported following use of this technique. There seems to be little risk of over correction (labioversion), since it never happened in any of the dogs treated. The technique worked in the majority of cases, often taking no longer than a few weeks for correction. Results will be presented with emphasis on correct diagnosis of the malocclusion. The major reasons for failure of the technique were occlusion problems other than lingual displacement of the mandibular canine teeth.

ADVANTAGES OF THE TECHNIQUE
The technique with the rubber toy avoids the necessity of anesthesia. As with any orthodontic technique, it would be advisable to obtain full pre- and post-treatment impressions, but for understandable reasons owners do not want their dogs to be anesthetised just for that. As a compromise, hard wax bite wafers can be used to record crown tip positions in most conscious dogs. Photographs should be taken to record the degree of malocclusion and as a further means of recording malocclusion and success or failure of treatment.
The technique with the rubber ball has several other major advantages when compared to working with the commonly used appliances. Good oral hygiene is not mandatory for successful outcome when using the rubber ball technique although it should be advised for prevention of periodontal disease. Oral soft tissue trauma from pressure, inflammation, and ulceration are unlikely with this technique and jaw growth will not be inhibited as is seen with some of the fixed appliances.

minibabyqq 2007-1-26 02:21

[color=Magenta][size=5][b]口頭射線照相和影片解釋Extra Oral Radiographs and Film Interpretation [/b][/size][/color]

[size=12px]嘴的造影和伴生的結構可能偶爾地挫敗, 但一旦技術被掌握, 質量診斷射線照相應該是在實習者的伸手可及的距離之內。Oral/Dental 造影是一個嚴重未充分利用的技術在許多實踐。在許多規程, 診斷射線照相對治療計劃是根本的, 並且在其他人, 治療也許contraindicated 沒有他們。口腔要求內部口頭和額外口頭技術。雖然牙多數射線照相執行使用內部口頭技術(當射線照相位於在嘴裡面), 額外口頭技術(影片位於在嘴之外) 的地方經常被使用為某些牙(即, 尾部上頷骨牙或下頷骨前臼齒1 和2) 和為不能適合小牙齒影片的大區域或損害。不能庫存特別牙齒影片的初學者獸醫牙醫, 它也許考慮到程度診斷能力為口腔結構。
EXTRA-ORAL 標準看法
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]左正確的側向或正確左側面。 [/b]患者是在側向recumbency 並且頭的rostral 方面被上升創造一個平行的關係與影片。經常使用為定期勘測但打開嘴看法防止下顎骨的coronoid 過程的覆蓋物。診斷能力由結構的疊加限制。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]Ventro 背部頭骨。[/b] 患者是在背部recumbency 與堅硬上顎平行與影片。如果可能, 氣管內管應該被去除在曝光之前。診斷能力由結構的疊加限制。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]Dorso-ventral 頭骨。 [/b]至於VD 與患者在sternal recumbency 。
EXTRA-ORAL 補充看法
各種各樣的傾斜看法是有用減少疊加
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]打開嘴45[/b][b]. 側向傾斜為下顎骨和上顎骨。[/b] 患者是在側向recumbency 和嘴充分地張與非收音機不透明的堵嘴(泡沫楔子或注射器盒) 。目標區域是最近的影片並且瀘頂骨矢狀合縫的飛機是被轉動的45. 與楔子。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]瀘頂骨矢狀合縫傾斜[/b] 為temperomandibular 聯接: 參見下面。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]額外口頭近的平行的技術。[/b] 為牙齒射線照相, 這個技術是一個選擇對平分角度為上頷骨面頰牙。它有用特殊在zygomatic 曲拱疊加結束標準內部口頭平分的角度圖的貓。患者是在側向recumbency 與目標牙近桌。目標牙的長的軸是作為在平行附近對影片儘可能和射線有角度的在90. 對影片和目標。嘴張以支柱指揮射線影片在90. 沒有疊加頂面面頰牙在底下面頰牙。準確性依靠能力保留牙作為在平行附近對影片儘可能。
TMJ 想像
temperomandibular 聯接的想像可能是困難的。主要問題是那些安置為想像和一再並且再生產的圖像。另外, 總值射線照相可能是困難解釋。
徵兆為TMJ 想像
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Pain/reluctance 關閉嘴。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 牙咬合不良。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 勉強/Inability 對masticate 。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 對TMJ 介入的評估在下頷骨破裂和其它地方精神創傷。 [table][tr][td=1,1,289][/td][td=1,1,289][align=center][color=white][/color][color=white][b]TMJ 的條件[/b][/color][/align][/td][td=1,1,290][/td][/tr][tr][td=1,1,289][align=center][b][u]發展
[/u][/b]TMJ 發育異常
Craniomandibular Osteopathy (CMO 或Westie.s 疾病)[/align][/td][td=1,1,289][align=center][b][u]獲取
[/u][/b]Luxation
下頷骨髁破裂
Zygomatic 過程破裂[/align][/td][td=1,1,290][align=center][b][u]混雜
[/u][/b]能使腐敗的關節炎
退化聯接疾病
瘤形成
Masticatory Myopathy[/align][/td][/tr][/table]看法為TMJ
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]瀘頂骨矢狀合縫傾斜為temperomandibular 聯合空間。[/b] 患者是在側向recumbency 與聯接被審查最近桌。頭的rostral 方面被上升以便瀘頂骨矢狀合縫的飛機由25. rostro-caudally 上升 為brachycephalic 養殖, 15 。 為mesocephalics 和10. 為dolicocephalics 。嘴張以泡沫塊。中央射線是有角度的聯接被審查對影片排列下頷骨髁垂線的長的軸為聯合空間的更好的形象化。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]側向傾斜看法[/b]
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  [b][i]狗:[/i][/b] Dorso 45. 側向傾斜。患者在在側向recumbency 與目標聯接下來。瀘頂骨矢狀合縫的飛機被轉動45. 從側面與泡沫楔子並且射線被指揮通過更低的TMJ 。
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  [b][i]貓:[/i][/b] Ventro 20. 側向dorsolateral 傾斜 [table][tr][td=1,1,184][table][tr][td][table][tr][td][img=174,180]http://www.vin.com/ImageDBPub/IM05000/IMC02841.gif[/img]
[/td][/tr][/table][/td][/tr][/table][/td][td=1,1,5][/td][/tr][/table]由於zygomatic 曲拱的突起在貓, 一個輕微地另外看法被使用。患者被安置在側向recumbency 與目標聯接從桌。頭被打翻20. 從側面並且射線垂直地被指揮通過上部TMJ 。
TMJ 想像總結
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 技術上要求。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 傾斜看法是困難安置。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 傾斜看法是困難再生產。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 傾斜看法是困難解釋。
牙齒射線照相的解釋
任一射線照相的解釋要求時刻、設備和一種邏輯方法防止錯過損害。
設備
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 放大鏡或塊是非常有用的, 特別為小損害。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 影片質量取決於許多可變物: 曝光、影片速度, 發展質量, 安置, 等。它也許幫助削減keyhole 。在卡片和觀看射線照相通過匙孔以背景室光。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 熱的光在觀察者之內可能幫助, 因為好對比存在在口腔的密集的組織和空氣之間。
解釋過程
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 評估圖像質量: 圖像太光或黑暗? 對比? 適當地處理? 圖像變形了或疊加了?
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 具體地辨認種類、地點和結構。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 審查整體射線照相從左到右。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 牙: 檢查各顆牙為:
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  變化在等高並且/或者密度牙質上。
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  變化在骨頭水平上在根附近(特殊furcation 和interproximal) 。
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  變化在黏漿狀物質分庭或牙周空間上。
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  變化在骨頭密度上在lamina dura 附近根和正直。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 下頜: 審查損害在下頜:
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  站點: 地點, 程度, 孤零零, multi-focal 或推斷。
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  大小和形狀: 測量和描述。要求一個或更多看法。
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  對稱: 審查對側站點。雙邊對稱暗示正常變形。
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  疆界: 硬化, 吸回, 缺乏連續性。
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  內容: lucent 或不透明。同源或變化的密度。
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  協會以其它結構。牙被偏移或resorbing 。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 試圖一個診斷或估計對進一步測試的需要。
共同的徵兆和研究結果為口頭射線照相
精神創傷和Exodontia
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 診斷和破碎的牙治療計劃或骨頭和周圍的組織。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 冠破裂: 複雜(如果黏漿狀物質被暴露) 或不複雜。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 根破裂要求射線照相被採取以主要射線平行與起點的破裂為真實的表示法和形象化破裂線的角度和末端。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 提取射線照相前保證做法可能適當地計劃和發展反常性或resorptive 損害並且/或者ankylosis 不會使操作員驚奇。崗位提取射線照相保證, 所有根片段被去除並且抵押損傷未被造成。
牙周疾病
附件損失是關鍵的在牙周疾病治療計劃。重大特點尋找是:
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 後退骨頭高度相對cemento 搪瓷連接點(CEJ) 。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 骨頭損失在interproximal 空間或在furcation 。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 加寬的牙周空間是高度重大的。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] lamina dura 正直損失。lamina dura 是一條稀薄的白色線在根附近和代表密集的表皮骨頭, 不是結構因本身之能力。一完全lamina dura 是暗示的好牙周健康。lamina dura 被分離從牙由牙周韌帶, 相對地radiolucent 。jawbone 是trabecular 在樣式和變化在密度以年齡和地點。缺乏可看見的空間在PL 的區域也許表明根的ankylosis 。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 頂端稀薄或光暈。暗示牙周病理學導致endodontic 病理學(類1 聯合的損害), endodontic 病理學導致牙周病理學(類2) 或配齊聯合的perio/endo 損害(類3) 。
在牙密度上瑕疵和變化
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 齲通常影響狗的槽牙牙。正常等高和密度損失只將是可看見的在射線照相如果病理學被推進。估計是否黏漿狀物質運河由牙質損失影響。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 似貓的Odontoclastic Resorptive 損害。這些損害治療計劃必須介入造影。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 內部或外在根吸回。經常次要對牙周或endodontic 疾病。
發展瑕疵和反常現象
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 錯過永久牙的偵查。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 超編人員的牙。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 牙以發展問題。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 牙有爆發問題: 衝擊或延遲。
脹大、囊腫和瘤
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 囊腫當前被標定的和膨脹的細胞溶解的損害。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 瘤也許提出作為增加的或被減少的密度。他們經常是不規則和窮地標定以骨頭病勢漸退。損害的周圍的周密的調查將幫助, 和這經常地震多發地帶在一個病理性過程中。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Craniomandibular osteopathy (CMO) 通常是下頷骨身體的損害, 偶爾地基地頭蓋骨或TMJ.s, 和導致proliferative periosteal 反應。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 骨髓炎經常將提出以proliferative 反應在周圍以被減少的密度在損害的中心。
新陳代謝的疾病
影響鈣新陳代謝, 譬如hyperparathyroidism, 禮物的疾病如同被減少的骨頭密度。牙經常被引述作為floating. 當推進。


Radiography of the mouth and associated structures can occasionally be frustrating, but once the techniques are mastered, quality diagnostic radiographs should be well within the reach of the practitioner. Oral/Dental radiography is a seriously under-used technique in many practices. In many procedures, diagnostic radiographs are essential to the treatment plan, and in others, treatment may be contraindicated without them. The oral cavity requires both intra-oral and extra-oral techniques. Although most radiographs of teeth are performed using intra-oral techniques (when the radiograph is located inside the mouth), extra-oral techniques (where the film is located outside the mouth) are often used for certain teeth (e.g., caudal maxillary teeth or mandibular premolars 1 and 2) and for large areas or lesions that may not fit onto small dental films. For neophyte veterinary dentists who may not stock special dental films, it may allow a degree of diagnostic ability for the oral cavity structures.
EXTRA-ORAL STANDARD VIEWS
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]Left-Right Lateral or Right-Left Lateral. [/b]Patient is in lateral recumbency and the rostral aspect of the head is raised to create a parallel relationship with the film. Often used for routine surveys but open-mouth view prevents overlay of the coronoid processes of the mandibles. Diagnostic ability is limited by superimposition of structures.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]Ventro-dorsal Skull.[/b] The patient is in dorsal recumbency with the hard palate parallel to the film. If possible, the endotracheal tube should be removed before exposure. Diagnostic ability is limited by superimposition of structures.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]Dorso-ventral Skull. [/b]As for VD with patient in sternal recumbency.
EXTRA-ORAL SUPPLEMENTAL VIEWS
Various oblique views are helpful to reduce superimposition
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]Open Mouth 45[/b][b]° Lateral Oblique for both mandible and maxilla.[/b] The patient is in lateral recumbency and the mouth fully opened with a non radio-opaque gag (foam wedge or syringe case). The target area is nearest the film and the sagittal plane is rotated 45° with a wedge.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]Sagittal Oblique[/b] for the temperomandibular joints: see below.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]Extra-oral Near Parallel Technique.[/b] For dental radiographs, this technique is an alternative to bisecting angle for the maxillary cheek teeth. It is of particular use in cats where the zygomatic arch superimposes over standard intra-oral bisecting angle views. The patient is in lateral recumbency with the target teeth nearest the table. The long axis of the target teeth is as near parallel to the film as possible and the beam is angled at 90° to the film and the target. The mouth is opened with a prop to direct the beam onto the film at 90° without superimposing the top cheek teeth on the bottom cheek teeth. Accuracy is dependent on ability to keep teeth as near parallel to the film as possible.
TMJ IMAGING
Imaging of the temperomandibular joints can be difficult. The main problems are those of positioning for imaging and also reproducing images repeatedly. In addition, the resultant radiographs can be hard to interpret.
Indications for TMJ Imaging
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Pain/reluctance to close mouth.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Malocclusion of teeth.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Reluctance /Inability to masticate.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Assessment of TMJ involvement in mandibular fracture and other regional trauma. [table][tr][td=1,1,289][/td][td=1,1,289][align=center][color=white][b]Conditions of the TMJ[/b][/color][/align][/td][td=1,1,290][/td][/tr][tr][td=1,1,289][align=center][b][u]Developmental
[/u][/b]TMJ Dysplasia
Craniomandibular Osteopathy (CMO or Westie𠏋 Disease)[/align][/td][td=1,1,289][align=center][b][u]Acquired
[/u][/b]Luxation
Mandibular Condyle Fracture
Zygomatic Process Fracture[/align][/td][td=1,1,290][align=center][b][u]Miscellaneous
[/u][/b]Septic Arthritis
Degenerative Joint Disease
Neoplasia
Masticatory Myopathy[/align][/td][/tr][/table]Views for TMJ
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]Sagittal Oblique for the temperomandibular joint space.[/b] The patient is in lateral recumbency with the joint to be examined nearest the table. The rostral aspect of the head is raised so that the sagittal plane is raised rostro-caudally by 25° for brachycephalic breeds, 15?sup> for mesocephalics and 10° for dolicocephalics. The mouth is opened with a foam block. The central beam is angled onto the joint to be examined to align the long axis of the mandibular condyle perpendicular to the film for better visualisation of the joint space.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] [b]Lateral Oblique Views[/b]
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  [b][i]Dog:[/i][/b] Dorso 45° lateral oblique. Patient lies in lateral recumbency with target joint down. Sagittal plane is rotated 45?from lateral with foam wedge and beam is directed through lower TMJ.
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  [b][i]Cat:[/i][/b] Ventro 20° lateral-dorsolateral oblique [table][tr][td=1,1,184][table][tr][td][table][tr][td][img=174,180]http://www.vin.com/ImageDBPub/IM05000/IMC02841.gif[/img]
[/td][/tr][/table][/td][/tr][/table][/td][td=1,1,5][/td][/tr][/table]Due to the prominence of the zygomatic arch in the cat, a slightly different view is employed. The patient is placed in lateral recumbency with the target joint away from the table. The head is tipped up 20° from the lateral and the beam is directed perpendicularly through the upper TMJ.
Summary of TMJ Imaging
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Technically demanding.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Oblique views are hard to position.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Oblique views are hard to reproduce.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Oblique views are hard to interpret.
INTERPRETATION OF DENTAL RADIOGRAPHS
The interpretation of any radiograph requires time, equipment and a logical approach to prevent missing lesions.
EQUIPMENT
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Magnifying glass or block is very useful, particularly for small lesions.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Film quality depends on many variables: exposure, film speed, development quality, positioning, etc. It may help to cut a 恾eyhole?in a card and view the radiograph through the keyhole with the background room lights off.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] A hot light within the viewer can help, as good contrast exists between the dense tissues of the oral cavity and air.
INTERPRETATION PROCESS
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Evaluate the image quality: image too light or dark? Contrast? Processed properly? Image distorted or superimposed?
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Specifically identify the species, location and structures.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Examine whole radiograph from left to right.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Teeth: check each tooth for:
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  Changes in contour and/or density of dentine.
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  Changes in bone level around roots (particularly furcation and interproximal).
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  Changes in pulp chamber or periodontal space.
[img=8,8]http://www.vin.com/Images/Icons/Bullet2.gif[/img]  Changes in bone density around root and integrity of lamina dura.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Jaw: examine lesion in jaw:[/size]

minibabyqq 2007-1-26 02:22

[color=Magenta][size=5][b]牙齒預防Performing a Complete Prophylaxis  [/b][/size][/color]


一完全牙齒預防有: 1) 臨床考試和繪製; 2) intraoral 造影; 3) 牙周療法; 4) 其它矯正療法依照被表明; 5) homecare 。這些, 獸醫執行第一四當所有者在家執行為時。
優選的治療依靠一好診斷工作。口頭診斷根據臨床考試和造影的結果以教導從個案歷史。另外的診斷測試被使用當表明。它是好實踐記錄案件細節用一個系統的方式。一個永久紀錄應該由相關的醫療和牙齒歷史、診斷所有治療做成資料和細節執行。
臨床考試和繪製
神志清楚的動物
一個神志清楚的動物的考試以嫌疑的口腔疾病介入估計不僅口腔適當, 而且面孔(面部骨頭和zygomatic 曲拱), temporomandibular 聯接、唾液封墊(mandibular/sublingual 和parotids 通常是只可觸知的如果擴大), 和淋巴結(下頷骨, 子宮頸的觸診鏈子) 。
鎖柱應該被檢查在麻醉之前。多數動物允許至少口腔的粗略檢查在麻醉之前並且這應該執行。口腔的黏膜應該被審查以及牙。
被麻醉的動物
口腔的正常解剖特點需要被辨認和被檢查。刷新您的記憶在這些特點從解剖學課本高度被推薦。是只以法線的知識, 反常性可能被辨認。
各顆牙periodontium 需要被估計。研究結果應該被記錄在圖。以下索引和標準應該被評估為各顆牙: 1) 流動性; 2) 齒齦炎; 3) 齒齦後退; 4) 牙周探查的深度; 5) furcation 介入。在動物中以牙齒儲蓄的大儲積(匾和結石) 在牙, 它也許是必要去除這些準確地估計齒齦後退、牙周探查的深度和furcation 介入。
INTRAORAL 造影
病理性幅射線照相的變動通常分離並且因此清晰和細節是根本的。使牙齒射線照相被使用為診斷目的, 這應該是牙的大小和形狀的一個準確表示法沒有毗鄰結構的疊加。Intraoral 幅射線照相的技術因而必需。充分的嘴(勘測) 射線照相被推薦為所有患者。
優選的oral/dental 治療不是可能的沒有一好診斷工作。口頭診斷取決於臨床和幅射線照相的考試。齲、resorptive 損害、牙周疾病、endodontic 病理學、破裂、骨頭病理學, 和造形術損害全部要求造影為一個更加完全的診斷。許多牙齒規程可能只被執行在幅射線照相的控制之下。檢查規程治療的充足和成功沉重依靠造影。簡而言之, 造影的重要性和放射學在獸醫牙科方面無法被過分強調。
牙周療法
專業牙周療法包括在上和次級齒齦結垢去除牙齒儲蓄, 和擦亮和根計劃恢復牙表面對平滑性。被視為unsalvageable 的牙由periodontitis 嚴厲地影響但, 應該被提取。
牙周手術從未是最重要的治療為periodontitis 。保守的管理包括的詳盡的在上和次級齒齦結垢, rootplaning, 擦亮, 灌溉, 與每日縝密家庭關心的組合, 是第一步。牙周手術應該只做所有者顯示了能力保持牙乾淨的地方。如果客戶無法維護好牙齒衛生學測量為他們的寵物, 然後在動物的福利的興趣, 那裡是沒有徵兆為手術。
其它矯正療法
病理性情況被辨認應該被對待或受影響的牙應該被提取。
HOMECARE
牙掠過為人所知是取消匾唯一最有效的手段。研究顯示了那在狗以實驗性地導致的齒齦炎並且在自然發生的齒齦炎, 每日牙掠過是有效的在退回齒齬對health.(1,2) 在4 年的研究中使用小獵犬, (3) 它被顯示了, 沒有口頭衛生學匾迅速地被積累沿齒齦邊際以齒齦炎顯現出在幾個星期之內。被餵養相同飲食在相同情況下但的狗未被服從對每日牙掠過開發了齒齦炎或periodontitis 的臨床標誌。在沒有接受每日牙掠過的小組, 齒齦炎進步了對periodontitis 在多數個體。
當匾機械撤除通過牙掠過是人的牙齒衛生學中流砥柱, 多數狗所有者通常不刷狗牙。結果, 機械上減少匾儲積通過飲食紋理成為預防牙齒關心的一重要部份在狗和貓。牙周疾病與飲食的方面連接了。幾項研究調查了飲食的地方齒齦炎的作用在匾形成和發展在狗。粗糙的飲食也許減少匾儲積在一些牙和在某一牙surfaces.(4) A 研究被進行在六個月期間調查口頭洗滌通過飲食手段, 表示, 狗消耗測試飲食(a) 比控制同樣極大有較少匾、結石, 和齒齦炎症group.(5), 對牙齒衛生學嚼(b) 的每日用途被顯示減少牙齒儲蓄的儲積並且減少齒齦炎在兩短期與長期studies.(6-10) 牙齒衛生學嚼的效力與橡皮而不是堅硬紋理(c) 並且是demonstrated.(11)
有沒有魔術的子彈, 我們能餵養我們的寵物防止齒齦炎。每日牙掠過依然是恢復被激起的齒齬唯一最有效的手段對健康和臨床然後維護健康齒齬。但是, 牙齒儲蓄的儲積的機械減少(匾和結石), 如此減少齒齦炎嚴肅通過飲食手段, 是一個有用的附屬措施, 應該高度被推薦寵愛所有者。
家庭關心並且是對待的periodontitis 的一個最重要的方面。在專業療法以後, 所有者必須每天防止或取消匾的儲積。實際上, 它經常是有用牽連每日牙掠過在專業療法之前。多數動物需要三個到四個星期habituation 期間在他們將接受安排所有牙被刷在你坐之前。有並且不會接受牙掠過的動物並且專業治療的這樣案件將需要是更加根本的。對一個典型反匾代理的附屬用途, 理想地chlorhexidine digluconate, 經常必需。牙齒飲食或牙齒衛生學的作用嚼在periodontitis 未被調查。它是不太可能的, 這樣產品是有效的在對待的periodontitis 。實際上, 他們也許甚而contra-indicated 因為我們知道那在個體以嚴厲periodontitis 咀嚼結果在一瞬變bacteraemia 。

A complete dental prophylaxis includes: 1) clinical examination and charting; 2) intraoral radiography; 3) periodontal therapy; 4) other remedial therapy as indicated; 5) homecare. Of these, the veterinarian performs the first four while the owner carries out the last at home.
Optimal treatment relies on a good diagnostic work-up. Oral diagnosis is based on the results of clinical examination and radiography with guidance from the case history. Additional diagnostic tests are used when indicated. It is good practice to record case details in a systematic way. A permanent record should be made of relevant medical and dental history, diagnostic data and details of all treatment performed.
CLINICAL EXAMINATION AND CHARTING
Conscious Animal
The examination of a conscious animal with suspect oral cavity disease involves assessing not only the oral cavity proper, but also palpation of the face (facial bones and zygomatic arch), temporomandibular joint, salivary glands (mandibular/sublingual and the parotids are usually only palpable if enlarged), and lymph nodes (mandibular, cervical chain).
The occlusion should be checked prior to anaesthesia. Most animals allow at least a cursory inspection of the oral cavity prior to anaesthesia and this should be performed. The mucous membranes of the oral cavity should be examined as well as the teeth.
Anaesthetised Animal
Normal anatomical features of the oral cavity need to be identified and inspected. Refreshing your memory on these features from an anatomy textbook is highly recommended. It is only with knowledge of the normal that abnormalities can be identified.
The periodontium of each tooth needs to be assessed. The findings should be recorded on a chart. The following indices and criteria should be evaluated for each tooth: 1) mobility; 2) gingivitis; 3) gingival recession; 4) periodontal probing depth; 5) furcation involvement. In animals with large accumulations of dental deposits (plaque and calculus) on the teeth, it may be necessary to remove these to assess gingival recession, periodontal probing depth and furcation involvement accurately.
INTRAORAL RADIOGRAPHY
Pathological radiographic changes are usually discrete and therefore clarity and detail are essential. For a dental radiograph to be used for diagnostic purposes, it should be an accurate representation of the size and shape of the tooth without superimposition of adjacent structures. Intraoral radiographic techniques are thus required. Full mouth (survey) radiographs are recommended for all patients.
Optimal oral/dental treatment is not possible without a good diagnostic work-up. Oral diagnosis depends on clinical and radiographic examination. Caries, resorptive lesions, periodontal disease, endodontic pathology, fractures, bone pathology, and neoplastic lesions all require radiography for a more complete diagnosis. Many dental procedures can only be carried out under radiographic control. Checking adequacy of procedures and success of treatment relies heavily on radiography. In short, the importance of radiography and radiology in veterinary dentistry cannot be over-emphasized.
PERIODONTAL THERAPY
Professional periodontal therapy consists of supra- and sub-gingival scaling to remove dental deposits, and polishing and root planning to restore the tooth surfaces to smoothness. Teeth severely affected by periodontitis but which are deemed unsalvageable, should be extracted.
Periodontal surgery is never first-line treatment for periodontitis. Conservative management consisting of thorough supra- and sub-gingival scaling, rootplaning, polishing, irrigation, in combination with daily meticulous home care, is the first step. Periodontal surgery should only be performed where the owner has shown the ability to keep the teeth clean. If a client cannot maintain good dental hygiene measures for their pet, then in the interest of the well being of the animal, there is no indication for surgery.
OTHER REMEDIAL THERAPY
Pathological conditions identified should be treated or the affected teeth should be extracted.
HOMECARE
Tooth brushing is known to be the single most effective means of removing plaque. Studies have shown that in dogs with experimentally induced gingivitis as well as in naturally occurring gingivitis, daily tooth brushing is effective in returning the gingivae to health.(1,2) In a four-year study using the Beagle, (3) it was shown that, with no oral hygiene plaque accumulated rapidly along the gingival margin with gingivitis developing within a few weeks. Dogs that were fed an identical diet under identical conditions but were subjected to daily tooth brushing developed no clinical signs of gingivitis or periodontitis. In the group that was not receiving daily tooth brushing, gingivitis progressed to periodontitis in most individuals.
While mechanical removal of plaque by means of tooth brushing is the mainstay of human dental hygiene, most dog owners do not regularly brush their dogs?teeth. Consequently, mechanically reducing plaque accumulation by means of dietary texture becomes an important part of preventive dental care in the dog and cat. Periodontal disease has been linked with aspects of diet. Several studies have investigated the local effect of diet on plaque formation and development of gingivitis in the dog. A coarse diet may reduce plaque accumulation on some teeth and on some tooth surfaces.(4) A study performed over a six-month period investigating oral cleansing by dietary means, showed that dogs consuming a test diet (a) had significantly less plaque, calculus, and gingival inflammation than the controlgroup.(5) Similarly, the daily use of a dental hygiene chew (b) has been shown to reduce accumulation of dental deposits and reduce gingivitis in both short and long-term studies.(6-10) The efficacy of a dental hygiene chew with a rubbery rather than hard texture (c) has also been demonstrated.(11)
There is as yet no magic bullet that we can feed our pets to prevent gingivitis. Daily tooth brushing remains the single most effective means of restoring inflamed gingivae to health and of then maintaining clinically healthy gingivae. However, mechanical reduction of accumulation of dental deposits (plaque and calculus), thus reducing the severity of gingivitis by dietary means, is a useful adjunctive measure and should be highly recommended to pet owners.
Home care is also a most important aspect of treating periodontitis. Following professional therapy, the owner must prevent or remove the accumulation of plaque on a daily basis. In fact, it is often useful to implicate daily tooth brushing prior to the professional therapy. Most animals require a three to four week habituation period before they will accept having all teeth brushed in one sitting. There are also animals that will not accept tooth brushing and the professional treatment of such cases will need to be more radical. Adjunctive use of a topical anti-plaque agent, ideally chlorhexidine digluconate, is often required. The effect of dental diets or dental hygiene chews on periodontitis has not been investigated. It is unlikely that such products are effective in treating periodontitis. In fact, they may even be contra-indicated since we know that in an individual with severe periodontitis mastication results in a transient bacteraemia.

minibabyqq 2007-1-26 02:23

[color=Magenta][size=5][b]牙周疾病的治療Periodontal Decision Making and Treatment Planning  [/b][/size][/color]


這次演講對adult 起始牙周疾病被限制在貓, 狗(和人們) 。牙周疾病的治療簡單地不審閱一牙齒預防的階段在as 和當依據。牙周疾病必須幾乎被處理以關心節目從誕生直到死亡。關心適當的治療和供應需要為專門製作單獨動物的要求。這些要求將改變與時間如同個體感受性對牙周疾病變得明顯並且早先關心作為失敗它的通行費。
牙周疾病AETIOPATHOGENESIS
牙周疾病原因論和發病原理的運作的知識對瞭解怎麼是根本的做預防和治療情況有效。根本起因是牙齒匾但它的作用被許多因素很大地修改。
individual.s 主人反應是一個關鍵系數在牙周疾病創立和進步。它有用實用能辨認更高的感受性個體對牙周疾病和因此指揮更加巨大的關心對更加貧窮。它一般被接受, 更小的體重狗是更高的風險候選人為膠疾病。貓適合在同樣等級在大致等效體重狗的位置。純淨的養殖貓和狗是更高的風險比發怒養殖。一些純淨的養殖特別有傾向。
一旦牙周疾病成為建立了當地環境變動傾向於疾病和因此進步會集動量。因此預防和早期干預是控制疾病最佳的方式。一旦牙周附件和骨頭支持失去, 它主要無法收復。
易反應對前攝
疾病的易反應的治療等疾病成立和然後對待它。這太經常是全部案件在牙周疾病, 特別在過去幾年。牙周疾病的流行是很偉大的, 所有個體應該被承擔是在危險中直到顯示否則。前攝關心是一種更加適當的方法。
牙周疾病的治療
規則口頭衛生學(家庭關心) 。
牙齒考試。
在上和次級齒齦結垢。
擦亮。
根計劃。
牙提取。
牙周手術。
上述名單主要組分在牙周疾病的治療。適當的治療不是一個簡單的事情工作在名單下。以對疾病的aetiopathogenesis 的理解, 操作員應該瞭解怎麼各個治療的方面會有益於患者。結垢, 根計劃, 和擦亮的較長期好處依靠後續家庭關心。治療努力應該被修改根據許多因素, 主要一個是家庭關心。決定可能被做出在潛在級家庭關心上可達成或在實際關心執行。
案件評估
在決定任一個治療計劃之前, 案件應該被估計。重新估價階段性地將是必要的和治療管理被修改像適當。當估計案件, 以下因素必須是堅定的:
家庭關心可達成(和現實) 。
各顆單獨牙的牙周狀態和的整體嘴。
動物的年齡。
動物的一般健康狀態。
早先牙齒歷史。
經濟限制。
家庭關心可達成
任一種治療的長期好處由獸醫實踐將取決於每日家庭關心的水平。最初地參量將是什麼所有者準備著考慮和試圖。它可能需要某個時候為家庭關心的水平建立和基礎線集合。沒有家庭關心給持續的匾控制, 其它治療形式寬鬆他們的好處。稱和擦亮的牙僅僅成為gum 從事園藝。
牙周狀態
參量看, 神志清楚:
齒齦炎。
流動性。
齒齦後退。
缺掉牙。
早先牙齒圖。
參量看, 在GA 之下:
牙周口袋深度。
殘餘的骨頭support.Radiography 。
出現或缺乏結石不是表示的牙周健康。真實的牙周狀態可能由考試只確定在一般麻醉劑之下。被估計神志清楚是唯一顯示的所有因素。它是明智通知所有者, 神志清楚的考試提供一guesstimate. 並且真正的治療要求只將為人所知在適當的考試以後在麻醉劑之下。它不是不凡為牙周狀態顯著是(更好或更壞) 與最初的評估不同。當要求治療在麻醉劑之下的問題清楚地被發現, 它給一個原因進行和允許其它牙同時被估計。有時需要對於一次適當的考試成為原因執行牙齒治療。
最準確和最重要的參量為各顆牙預測在牙周疾病是最深刻的牙周口袋深度在任一個站點在那顆牙。
動物的年齡
牙周疾病一個更加先進的階段在更加年輕比期望的年齡、手段治療和控制需要被提供在一個更高的水平。它也許表明高風險個體或其他預先處理因素。
動物的一般健康狀態
治療的好處應該勝過風險。因為所有治療要求一種一般麻醉劑, 所有方面聯繫了麻醉的需要被估計根據好實踐。有catch 22. situation.there 也許是影響麻醉的風險但同樣問題也許由持續的牙周疾病惡化的醫療課題。
減少動物的免疫狀態的疾病也許更加迅速地導致一種進步牙周疾病。那裡生長證據支持假說, 任一個牙站點與先進的periodontitis 可能有一個有害的作用在其它疾病過程和在其它身體站點。
早先牙齒歷史
早先治療的數字。
時間從前種牙齒治療。
研究結果在早先牙齒examination(s) 作為牙齒治療一部分(被記錄在牙齒圖) 。
比較隨時間。
早先牙齒歷史提供準確資訊至於牙周狀態一次從前(研究結果在早先牙齒考試) 並且為疾病過程提供時間表。
案件管理
理想地, 疾病應該由充分口頭衛生學規程的鼓動防止年輕年齡。簡單的齒齦炎可能被扭轉如果必要的口頭衛生學可能被獲得。一旦結石積累了, 家庭關心技術效力被減少在匾控制。結石撤除由結垢必需退回嘴到優選的健康。它必須記住執行專業牙周療法的好處(PPT, dental 。或dental 預防。) 是短命的如果由家庭關心規程沒接著。在嘴以早期牙周疾病, 家庭關心應該建立在PPT 之前。
膠疾病實際階段在各顆牙和在嘴一般, 可能由一次明確的牙齒考試只建立在一般麻醉劑之下。當有重大結石存在, 它變得更難估計牙周情況。它也許由一次完全考試辯解執行PPT 根據建立基礎線。它是有用知道什麼家庭關心達到或也許是可能的在開始PPT 之前。
在嘴以過份結石或先進的牙周疾病, phase 1 。PPT 應該執行當是實用的。這種治療將包括一次充分的牙的考試、提取以先進的牙周疾病, 和基本的結垢。一次dead 木頭。被清除並且嘴被清掃, 最好家庭關心可能建立。家庭關心企圖在階段1 之前會看上去徒勞對所有者並且他們無合理動機。第二種階段治療會被安排一旦最佳的家庭關心成立了。
當它知道一點點或沒有家庭關心將被給, 治療應該轉移往牙的更加進取的選擇為提取和較少時間在conservative. 措施上花費。以更高的水平家庭關心可達成, 更加偉大專業牙清潔的好處和那麼偉大的努力和時間在結垢上花費, 擦亮, 根飛行等被辯解。
在PPT 以後, 需要繼續採取的行動監測嘴和持續的口頭衛生學的條件。它知道, 所有者的高百分比滑倒在持續的嘴關心的水平當時間流逝從指示。
牙周手術
牙周手術的形式, 除齒齦增生之外簡單的撤除, 不應該被考慮直到一個持續的gold 標準。口頭衛生學被證明。趨向在人的牙周治療是保留在保守的治療區域和避免對牙周手術的用途。外科治療不會有長期好處沒有充分匾控制。它必須被問至於是否它是適當開始外科牙周規程。
極小的目標
應該被規定關心的極小的標準將提供足夠的治療, 牙不到達牙周疾病先進的階段。是在牙周疾病先進的階段, 真正的威脅造成動物的健康和福利。在先進的牙周疾病痛苦成為一種可能性, 特別是隨著牙流動性的增加。深牙周口袋和軟的組織炎症考慮到bacteraemic 陣雨的真正的可能性從組織運動。這也許加重疾病在其它站點甚至是被減少的估計壽命的一個原因。

This lecture is limited to 弌dult onset?periodontal disease in cats, dogs (and people). Treatment of periodontal disease is not simply going through the stages of a dental prophylaxis on an 弌s and when?basis. Periodontal disease has to be managed with a programme of care almost from birth until death. The appropriate treatment and provision of care needs to be tailored to the requirements of the individual animal. These requirements will change with time as the individuals?susceptibility to periodontal disease becomes apparent and the failing of previous care takes its toll.
AETIOPATHOGENESIS OF PERIODONTAL DISEASE
A working knowledge of the aetiology and pathogenesis of periodontal disease is essential to understanding how to make prevention and treatment of the condition effective. The fundamental cause is dental plaque but its effects are greatly modified by many factors.
The individual𠏋 host response is a key factor in the establishment and progression of periodontal disease. It is of practical use to be able to identify individuals of higher susceptibility to periodontal disease and so direct greater care to the more needy. It is generally accepted that dogs of smaller body weight are higher risk candidates for gum disease. A cat fits on the same scale at the position of a dog of roughly equivalent body weight. Pure breed cats and dog are higher risk than cross breeds. Some pure breeds are particularly prone.
Once periodontal disease becomes established the local environment changes in favour of the disease and so the progression gathers momentum. For this reason prevention and early intervention are the best ways of controlling the disease. Once periodontal attachment and bone support is lost, it is largely impossible to regain.
REACTIVE Vs. PROACTIVE
Reactive treatment of a disease is waiting for the disease to become established and then treating it. This is all too often the case in periodontal disease, especially in past years. The prevalence of periodontal disease is so great that all individuals should be assumed to be at risk until shown otherwise. Proactive care is a more appropriate approach.
TREATMENT OF PERIODONTAL DISEASE
Regular oral hygiene (Home care).
Dental examination.
Supra and sub gingival scaling.
Polishing.
Root planning.
Tooth extraction.
Periodontal surgery.
The above lists the main components in the treatment of periodontal disease. Proper treatment is not a simple matter of working down the list. With an understanding of the aetiopathogenesis of the disease, the operator should understand how each aspect of treatment would benefit the patient. The longer-term benefits of scaling, root planning, and polishing are dependent on follow-up home care. The treatment efforts should be modified depending on many factors, the main one being home care. Decisions can be made on potential level of home care achievable or on actual care being performed.
CASE ASSESSMENT
Before deciding on any treatment plan, the case should be assessed. Reassessment will be necessary periodically and the treatment management altered as appropriate. When assessing a case, the following factors have to be determined:
Home care achievable (and reality).
Periodontal status of each individual tooth and of the whole mouth.
Age of the animal.
General health status of the animal.
Previous dental history.
Economic constraints.
Home Care Achievable
The long-term benefits of any treatment by the veterinary practice will depend on the level of daily home care. Initially the parameter will be what the owners are prepared to consider and attempt. It can take some time for the level of home care to be established and a baseline set. Without home care to give ongoing plaque control, other treatment modalities loose their benefits. Scaling and polishing teeth becomes merely 孄um gardening.?
Periodontal Status
Parameters to look at, conscious:
Gingivitis.
Mobility.
Gingival recession.
Missing teeth.
Previous dental chart.
Parameters to look at, under GA:
Periodontal pocket depth.
Residual bone support妔adiography.
The presence or absence of calculus is not indicative of periodontal health. The true periodontal status can only be determined by examination under general anaesthetic. All the factors that are assessed whilst conscious are only indicators. It is wise to inform the owner that the conscious examination provides a 孄uesstimate?and that the real treatment requirement will only be known after proper examination under anaesthetic. It is not uncommon for the periodontal status to be dramatically different (better or worse) from the initial appraisal. When a problem that requires treatment under anaesthetic is clearly found, it gives a reason to proceed and allows the other teeth to be assessed at the same time. Sometimes the need for a proper examination becomes the reason to perform dental treatment.
The most accurate and important parameter for the prognosis of each tooth in periodontal disease is the deepest periodontal pocket depth at any site on that tooth.
Age of the Animal
A more advanced stage of periodontal disease at a younger than expected age, means the treatment and control needs to be provided at a higher level. It may indicate a high-risk individual or another predisposing factor.
General Health Status of the Animal
The benefits of treatment should outweigh risk. As all treatment requires a general anaesthetic, all aspects associated with an anaesthetic need to be assessed according to good practice. There is a 𡤧atch 22?situation鍟here may be medical problems that affect the anaesthetic risk but the same problems may be exacerbated by the ongoing periodontal disease.
Diseases that reduce the immune status of an animal may result in a more rapidly progressive periodontal disease. There is growing evidence to support the hypothesis that any tooth site with advanced periodontitis can have a harmful effect on other disease processes and at other body sites.
Previous Dental History
Number of previous treatments.
Time since last dental treatment.
Findings at previous dental examination(s) as part of dental treatment (recorded on the dental chart).
Comparison over time.
The previous dental history gives accurate information as to the periodontal status at a time in the past (findings at previous dental examination) and provides a time frame for the disease process.
CASE MANAGEMENT
Ideally, the disease should be prevented by instigation of adequate oral hygiene procedures from a young age. Simple gingivitis can be reversed if the necessary oral hygiene can be attained. Once calculus has accumulated, the efficacy of home care techniques is reduced in plaque control. Calculus removal by scaling is required to return the mouth to optimal health. It must be remembered that the benefit of performing professional periodontal therapy (PPT, a 𡞫ental?or 𡞫ental prophylaxis? is short lived if not followed up by home care procedures. In mouths with early periodontal disease, home care should be established prior to PPT.
The actual stage of gum disease at each tooth and in the mouth generally, can only be established by a definitive dental examination under general anaesthetic. When there is significant calculus present, it becomes more difficult to estimate the periodontal condition. It may be justified to perform a PPT on the basis of establishing a baseline by a complete examination. It is still useful to know what home care is being achieved or may be possible before commencing PPT.
In mouths with excessive calculus or advanced periodontal disease, a 𢖯hase 1?PPT should be performed as soon as is practical. This treatment will include a full examination, extraction of teeth with advanced periodontal disease, and a basic scaling. Once the 𡞫ead wood?is cleared and the mouth cleaned up, the best possible home care can be established. Attempts of home care before phase 1 would appear futile to the owner and they would be unmotivated. A second phase treatment would be arranged once the best home care has become established.
When it is known that little or no home care will be given, the treatment should shift towards more aggressive selection of teeth for extraction and less time spent on 𡤧onservative?measures. With higher levels of home care achievable, the greater the benefits of professional tooth cleaning and so greater effort and time spent on scaling, polishing, root planing etc is justified.
After PPT, there needs to be follow up to monitor the condition of the mouth and the ongoing oral hygiene. It is known that a high percentage of owners slip in the level of ongoing mouth care as time elapses from instruction.
Periodontal Surgery
No forms of periodontal surgery, other than simple removal of gingival hyperplasia, should be considered until an ongoing 孄old standard?of oral hygiene is proven. The trend in human periodontal treatment is to remain in the areas of conservative treatment and to avoid the use of periodontal surgery. Surgical treatment will have no long-term benefit without adequate plaque control. It has to be questioned as to whether it is appropriate to embark on surgical periodontal procedures.
Minimum Goal
The minimum standard of care that should be set is to provide enough treatment that no tooth reaches the advanced stages of periodontal disease. It is in the advanced stages of periodontal disease that a real threat is posed to the health and well being of the animal. In advanced periodontal disease pain becomes a possibility, especially with increasing tooth mobility. Deep periodontal pockets and soft tissue inflammation allow for the real possibility of bacteraemic showers from tissue movement. This may aggravate disease in other sites or even be a reason for reduced life expectancy.

minibabyqq 2007-1-26 02:24

[color=Magenta][size=5][b]基本技術在牙提取Basic Practical Techniques in Tooth Extraction  [/b][/size][/color]


牙提取可能是非常富挑戰性和很少是一個簡單的做法。成功的提取是整個牙被去除以精神創傷極小值對毗鄰, 殘餘的組織(和操作員) 。達到最佳的成功率要求:
牙根形態學知識。
技術正確選擇。
有適當的設備。
實踐和耐心。
根形態學
操作員需要通曉所有牙根的正常形狀和數量。注意, 反常性譬如額外根或反常地形狀的根(即, 勾子) 不是不凡的。為什麼的提示是正常根樣式, 參見一本牙齒課本, Dentalabels。, 牙齒圖、Visimodels, 或一塊乾燥頭骨。
SECTIONING.MULTI-ROOTED 牙
在貓和狗, 提取的定期技術將鬆開(luxate) 並且提取(海拔) 各牙根單獨。於所有案件, 冠2 和3 根源牙需要被區分導致根片斷在提取之前。多根源的牙根通常分歧和有因此撤退不同的道路。使用一個牙齒鑽子區分冠使能是準確的, 快的切口, 並且起因極小的精神創傷對毗鄰組織。
第一步將找出furcation, 一般是直接地在冠的主要cuspal 點之下。證實地點, 它能感覺以探針作為凹狀或由輕微地反射看見膠邊際與儀器或空氣注射器。牙應該被切開從furcation 在膠水平和上升通過冠使用裂痕bur 在一牙齒handpiece 。裁減也許需要然後是延長的在膠水平之下達到完全冠分裂。測試分裂由楔住一個電梯在被區分的冠之間和觀察冠零件的輕微的運動在相反方向。它也許是有用並且減少冠高度在luxation 之前。
區分3 顆根源的牙(上部carnassial 牙和上部槽牙牙在狗) 可能由使用只達到裂痕burs 在牙齒handpieces 。準確安置裁減要求牙形態學適當的知識。
通常冠由垂直的裁減區分。在大牙裡冠高度也許大於bur 長度。在這些牙裡, 最好漁裁減審閱較少高度冠的零件。這並且意味切口要求較少努力。
切開齒齦附件
作為切斷tooth.s 附件一部分, 牙的齒齦附件應該被切開在整個圓周附近。這可能由跑一把scalpel 刀片在齒齦sulcus/pocket 附近和裁減做根表面對crestal 骨頭。齒齦附件可能並且被切開使用一個鋒利的牙齒電梯在luxation 之時。如果齒齦附件不被切開有將是多餘的中斷和精神創傷對軟的組織如同牙被提取。
根LUXATION 和撤除
Luxation 是鬆懈牙在插口由進步切斷牙周韌帶纖維。適當的大小的Couplands 電梯, 或一臺相似的儀器被使用。電梯被插入在齒齬之後在一個銳角對牙根直到它擊中crestal 骨頭。儀器要訣現在被楔住在根和骨頭之間和柔和地被轉動(沒撬起) 側向地移動牙。壓力逐漸被加強和然後舉行五秒舒展和打破牙周纖維。電梯然後被調遷在不同的站點在牙和做法附近被重覆直到牙根成為寬鬆。耐心和受控部隊是需要, 不畜生力量。力量應該被應用作為低落在根下儘可能當提取牙。滑倒, 當使用電梯, 經常是因為牙行動。您應該支持下頜用您的其它手和有拇指和手指在任何一方牙被提取。使用air/water 注射器在提取期間漂洗去血液和保留它在海灣可能是非常有用的當它使根luxation 進展清楚地看。
根海拔和提取
在牙提取在狗, 牙罐頭完全地被提取使用電梯但它通常是簡單完成提取使用提取鑷子。最後的牙周纖維是殘破的由輕微地轉動根在插口。因為牙根在狗是不平直亦不圓的在橫剖面, 他們不會轉動更多比程度或二。何時根將轉動一點在兩個方向鑷子可能然後被使用拉扯牙從插口。提取鑷子的額嘴應該適合根和做4 點接觸。根儘可能應該總是被夾住的一樣低下來減少扭矩在根和破損風險。
在貓牙提取, 鑷子可能被使用及早和對更加了不起的作用對luxate 牙。一旦根行動, 鑷子可能被使用轉動牙在插口。牙根在貓傾向於是平直和通報在橫剖面和因此允許更加巨大的自轉。注意應該被採取不擊碎牙與鑷子或不允許力量側向對根的長的軸。似貓的牙根尖頂經常是球莖的。一旦根是相當寬鬆它被popping. 撤出球莖尖頂通過更加狹窄的插口上面。
外科提取或開放提取技術
一個外科提取技術被表明的所有犬齒和根片段撤除。某些人民更喜歡這種方法為多顆毗鄰牙的提取。外科提取介入培養一塊齒齦擋水板和去除一些骨頭促進提取。所有獸醫應該通曉一個外科提取做法。這個技術的描述可能被發現在小動物牙科(2 nd 編輯BSAVA指南 。) 並且其它好文本。
根ATOMISATION 。
想法是, 根操練在使用高速牙齒鑽子之外。這不是一個適當的提取技術, 應該只被使用作為前個選擇技術。根霧化頻繁地是必要的為似貓的牙根與odontoclastic resorptive 損害當根是ankylosed 或resorbed 。最好留下根要訣一個小片斷而不是鑽子和造成對毗鄰結構的損傷譬如下等齒齦音運河或上頷骨靜脈竇。有不足的繼續採取的行動有用的資料知道是否這實際上是一個可接受的做法。
插口的治療
一旦牙被提取了, 目標將促進最佳癒合插口。急劇骨多的投射和不能生存的骨頭片斷應該被去除。任一個不能生存的軟的組織應該並且被去除。插口應該柔和地是curetted 去除任一個粒化組織。有利弊為縫合齒齬。它應該被考慮是否縫合或包裝插口援助癒合和減少手術後痛苦或妨害這些因素由於額外組織操作和foreign. 材料出現。縫合被表明當有過份組織流動性。提取插口自然地癒合很好並且作者認為最小的干預是最佳。最佳的方式促進癒合和使崗位提取痛苦減到最小是靠柔和和適當的提取技術。相當數量手術後痛苦與程度精神創傷關聯與毗鄰骨頭和軟的組織在提取期間。
提取複雜化
提取也許由根反常性(譬如剩餘曲度或勾子) 或根ankylosis 使更加困難。複雜化起因於不正確技術或不足的關心在它的施行和通常有:
對毗鄰組織的醫原性損傷。
破碎的根和殘餘根要訣。
被偏移的根片段, 特別是palatal 根或上部carnassial 牙或在貓, 下頷骨前臼齒根。
Fistula, 通常oronasal fistula, 在提取上部犬齒以後在狗。
下頜破裂。
被延遲的或複雜的癒合。
乾燥插口。
乾燥插口
這個情況很好未被報告在動物中。它很好被認可在人當有在痛苦的明顯增量大約三天在提取以後。它同血塊的損失聯繫在一起從骨多的表面的插口和曝光。它被認為發生在動物中, 特別是如果過份力量使用了在提取期間。動物開始陳列痛苦和可能發熱狀態的標誌幾天在牙齒提取以後。治療是與抗生素。在人, 插口被清洗和被包裝以obtundant 和防腐選礦。
何時根片段可能被留下?
理想將避免情況由正確技術。除非破裂可觀地是在骨頭水平之下, 它也許仍然是可能去除根殘餘由對電梯或其它儀器的進一步用途。一個外科提取技術將允許根殘餘撤除深深在骨頭。根片段無法被留下如果它同傳染或病理學聯繫在一起。它可能被爭論, 潛在的複雜化從留下一個小片斷不被傳染) 的根要訣(是充足地小至於使精神創傷撤除不正當。這也許是如此但不應該被使用作為一個一般藉口。射線照相應該被採取並且animal.s 紀錄清楚地被標記表明根片段的位置。後續射線照相應該儘可能被獲得監測在顯現出的病理學的情況下。
崗位提取關心
所有者應該被勸告不哺養軟的稠黏的食物, 將包裝在插口。正常食物應該被哺養和軟綿綿地, 不稠黏, 食物只用如果需要。通常口頭衛生學應該立刻重新開始。chlorhexidine 準備的典型應用可能被使用一個短的期間如果有對牙掠過的反對。堅韌嚼玩具應該被扣壓大約一個星期當縫合被安置了
痛覺缺失應該被給在extraction(s) 和另外的繼續採取的行動痛覺缺失之前被考慮。相當數量痛苦將依靠提取的困難, 提取站點的數量和單獨患者。抗生素路線定期地不被表明在牙提取以後。抗生素應該被使用當有他們的要求的一個具體原因。
設備
理想地, 提取成套工具應該準備和消炎了準備好各個情況。許多儀器或某一儀器的特殊樣式將是根據操作員的個人特選。作者會使用:
基本的提取成套工具
1 。   充分的牙齒鑽子單位(包括3 在1 個注射器裡) 。
2 。   Luxator (s) (大小根據牙的大小) 。
3 。   電梯。為狗; Couplands 第1 和第3 。為貓; 超級亭亭玉立的電梯。
4 。   牙鑷子(樣式76.N) 。
5 。   紗拖把。
由骨頭rongeurs 和縫合成套工具可能補充。
外科提取成套工具
1 。   基本的提取成套工具。
2 。   Periosteal 電梯(Goldman 狐狸或蛻變) 。
3 。   Scalpel 把柄和第15 刀片。
4 。   組織鑷子。
5 。   針囤戶。
6 。   Resorbable 縫合材料與a swagged 在針(4/0 含鉻食道或Monocryl) 。

Tooth extraction can be very challenging and is rarely a simple procedure. A successful extraction is when the entire tooth is removed with the minimum of trauma to the adjacent, remaining tissues (and the operator). To achieve the best success rate requires:
Knowledge of tooth root morphology.
Correct choice of technique.
Having the appropriate equipment.
Practice and patience.
ROOT MORPHOLOGY
The operator needs to be familiar with the normal shape and number of roots of all the teeth. Be aware that abnormalities such as extra roots or abnormally shaped roots (e.g., hooks) are not uncommon. For a reminder of what is the normal root pattern, refer to a dental textbook, Dentalabels?/sup>, dental charts, Visimodels? or a dry skull.
SECTIONING𦳀ULTI-ROOTED TEETH
In the cat and dog, the routine technique for extraction is to loosen (luxate) and extract (elevation) each tooth root individually. In all cases, the crowns of 2 and 3 rooted teeth need to be sectioned to produce single root pieces prior to extraction. The roots of multi-rooted teeth are usually divergent and therefore have different paths of withdrawal. Using a dental drill to section the crown enables cutting that is accurate, quick, and causes minimum trauma to adjacent tissues.
The first step is to locate the furcation, which is generally directly below the main cuspal point of the crown. To confirm the location, it can be felt with a probe as a concavity or seen by slightly reflecting the gum margin with an instrument or the air syringe. The tooth should be cut from the furcation at gum level and up through the crown using a fissure bur in a dental handpiece. The cut may need to then be extended below gum level to achieve complete crown division. Test the division by wedging an elevator between the sectioned crown and observing slight movement of the crown parts in opposite directions. It may be helpful to also reduce the crown height prior to luxation.
Sectioning 3 rooted teeth (upper carnassial teeth and the upper molar teeth in dogs) can only be achieved by using fissure burs in dental handpieces. Accurate positioning of the cuts requires proper knowledge of tooth morphology.
Usually the crowns are sectioned by vertical cuts. In large teeth the crown height may be greater than the bur length. In these teeth, it is better to angle the cut to go through a part of the crown of less height. This also means the cutting requires less effort.
CUTTING THE GINGIVAL ATTACHMENT
As part of the severing of the tooth𠏋 attachment, the gingival attachment of the tooth should be cut around the entire circumference. This can be done by running a scalpel blade around the gingival sulcus/pocket and cutting down the root surface to crestal bone. The gingival attachment can also be cut using a sharp dental elevator at the time of luxation. If the gingival attachment is not cut there will be unnecessary disruption and trauma to the soft tissues as the tooth is extracted.
ROOT LUXATION AND REMOVAL
Luxation is the loosening of the tooth in the socket by progressive severing of the periodontal ligament fibres. A Couplands elevator of the appropriate size, or a similar instrument is used. The elevator is inserted behind the gingiva at an acute angle to the tooth root until it hits crestal bone. The instrument tip is now wedged between the root and bone and gently rotated (not levered) to move the tooth laterally. The pressure is built up gradually and then held for five seconds to stretch and break the periodontal fibres. The elevator is then relocated at different sites around the tooth and the procedure repeated until the tooth root becomes loose. Patience and controlled force are needed, not brute strength. The force should be applied as low down the root as possible when extracting teeth. Slipping, when using an elevator, is often because the tooth moves. You should support the jaw with your other hand and have a thumb and finger on either side of the tooth being extracted. Using the air/water syringe during extraction to rinse away blood and keep it at bay can be very helpful as it enables the progress of root luxation to be seen clearly.
ROOT ELEVATION AND EXTRACTION
In tooth extraction in dogs, the tooth can completely extracted using the elevator but usually it is simpler to finish the extraction using extraction forceps. The final periodontal fibres are broken by slightly rotating the root in the socket. As the roots of teeth in the dog are neither straight nor round in cross section, they will not rotate more than a degree or two. When the root will turn a little in both directions the forceps can then be used to pull the tooth from the socket. The beaks of the extraction forceps should fit the root and make a 4-point contact. The root should always be gripped as low down as possible to reduce the torque on the root and the risk of breakage.
In cat tooth extraction, the forceps can be employed earlier and to greater effect to luxate the tooth. Once the root is moving, the forceps can be used to rotate the tooth in the socket. Teeth roots in cats tend to be straight and circular in cross section and so allow greater rotation. Care should be taken not to crush the tooth with the forceps or to allow forces lateral to the long axis of the root. Feline tooth root apices are often bulbous. Once the root is quite loose it is withdrawn by 𢖯opping?the bulbous apex through the narrower socket above.
SURGICAL EXTRACTION OR OPEN EXTRACTION TECHNIQUE
A surgical extraction technique is indicated for removal of all canine teeth and root fragments. Some people prefer this approach for the extraction of multiple adjacent teeth. A surgical extraction involves raising a gingival flap and removing some bone to facilitate extraction. All veterinary surgeons should be familiar with a surgical extraction procedure. A description of this technique can be found in the BSAVA Manual of Small Animal Dentistry (2nd ed.) and other good texts.
ROOT 𨯗TOMISATION?/p> The idea is that the root is drilled out using high-speed dental drills. This is not a proper extraction technique and should only be employed as a technique of last choice. Root atomisation is frequently necessary for feline teeth roots with odontoclastic resorptive lesions when the root is ankylosed or resorbed. It is better to leave a small piece of root tip rather than over drill and cause damage to adjacent structures such as the inferior alveolar canal or the maxillary sinus. There is insufficient follow up information available to know whether this is actually an acceptable procedure.
TREATMENT OF THE SOCKET
Once the tooth has been extracted, the aim is to promote the best healing of the socket. Sharp bony projections and non-viable bone pieces should be removed. Any non-viable soft tissue should also be removed. The socket should be gently curetted to remove any granulation tissue. There are pros and cons for suturing the gingiva. It should be considered whether the suturing or packing of a socket aids healing and reduces postoperative pain or hinders these factors due to the extra tissue manipulation and the presence of 𡜻oreign?material. Suturing is indicated when there is excessive tissue mobility. Extraction sockets heal very well naturally and the author feels that minimal intervention is best. The best way to promote healing and minimise post extraction pain is by gentle and proper extraction techniques. The amount of postoperative pain correlates to the degree of trauma to the adjacent bone and soft tissues during extraction.
EXTRACTION COMPLICATIONS
Extraction may be made more difficult by root abnormalities (such as excess curvature or hooks) or root ankylosis. Complications usually result from incorrect technique or insufficient care in its execution and include:
Iatrogenic damage to adjacent tissues.
Fractured roots and remnant root tips.
Displaced root fragments, especially the palatal root or the upper carnassial tooth or in the cat, mandibular premolar roots.
Fistula, usually oronasal fistula, after extracting the upper canine tooth in dogs.
Jaw fracture.
Delayed or complicated healing.
Dry socket.
DRY SOCKET
This condition has not been well reported in animals. It is well recognized in people when there is a marked increase in pain about three days after extraction. It is associated with loss of the blood clot from the socket and exposure of the bony surface. It is thought to occur in animals, especially if excessive force was used during the extraction. The animal begins exhibiting signs of pain and possibly pyrexia a few days after the dental extraction. Treatment is with antibiotics. In people, the socket is cleaned and packed with an obtundant and antiseptic dressing.
WHEN CAN A ROOT FRAGMENT BE LEFT?
The ideal is to avoid the situation by correct technique. Unless the fracture is considerably below bone level, it may still be possible to remove the root remnant by further use of elevators or other instruments. A surgical extraction technique will allow the removal of root remnants deep in the bone. A root fragment cannot be left if it has associated infection or pathology. It can be argued that the potential complication from leaving a small piece of root tip (which is not infected) is sufficiently small as to make the trauma of removal unjustified. This may be so but should not be used as a general excuse. A radiograph should be taken and the animal𠏋 records clearly marked to indicate the position of the root fragment. Where possible a follow-up radiograph should be obtained to monitor in case of developing pathology.
POST EXTRACTION CARE
The owner should be advised not to feed soft sticky food, which will pack in the sockets. Normal food should be fed and soft, not sticky, food only used if necessary. Usual oral hygiene should be recommenced immediately. Topical application of chlorhexidine preparations can be used for a short period if there is an objection to tooth brushing. Tough chew toys should be withheld for about a week when sutures have been placed
Analgesia should be given prior to extraction(s) and additional follow up analgesia considered. The amount of pain will depend on the difficulty of the extraction, the number of extraction sites and the individual patient. A course of antibiotics is not routinely indicated after tooth extraction. Antibiotics should be used when there is a specific reason for their requirement.
EQUIPMENT
Ideally, extraction kits should be prepared and sterilised ready for each situation. Many of the instruments or the particular pattern of a certain instrument will be according to the personal preference of the operator. The author would use:
Basic Extraction Kit
1.   Full dental drill unit (including 3 in 1 syringe).
2.   Luxator (s) (size according to size of teeth).
3.   Elevators. For dogs; Couplands No. 1 and No. 3. For cats; Super Slim elevators.
4.   Tooth forceps (pattern 76N).
5.   Gauze swabs.
Possibly supplemented by bone rongeurs and a suture kit.
Surgical Extraction Kit
1.   Basic extraction kit.
2.   Periosteal elevator (Goldman Fox or Molt).
3.   Scalpel handle and No. 15 blade.
4.   Tissue forceps.
5.   Needle holders.
6.   Resorbable suture material with a swagged on needle ( 4/0 chromic gut or Monocryl).

minibabyqq 2007-1-26 02:25

[color=Magenta][size=5][b]牙周療法Basic Periodontal Flaps  [/b][/size][/color]


用很大數量的患者需要牙周療法, 一些將需要牙周外科干預對各種各樣的程度。經常, 這些治療將是以gingivoplasties, 各種各樣的擋水板的形式, 和在一些特殊情況, 被引導的組織再生。牙周療法的目標介入去除結石或害病的組織和使口袋深度減到最小當保存至少2 毫米附上齒齬保護齒齦音骨頭和mucosa 免受腐蝕。
如果根表面被暴露或如果口袋深度五毫米是少於, 閉合根飛行和subgingival 刮術也許執行。使用一個curette subgingivally 以重疊的衝程在水平, 垂直, 和傾斜方向, 根飛行去除結石、殘骸, 和壞死的牙骨質提供乾淨, 光滑的表面。curette 可能輕微地並且被漁參與齒齦表面為害病或微生物被滲入的組織撤除。當口袋深度超出5 毫米, 或其它病理學存在, 更加蔓延性的規程被擔保。
偶爾地, 在口袋深度的重大地方或廣義增量沒有附件損失將發生以條件譬如齒齦增生或與交往epulis 。在這些情況下, gingivectomy 去除重複齒齬減少suprabony pseudopocket 深度促進牙表面清潔當維護至少2 毫米附加的齒齬。口袋深度被測量並且一對應的靈菌觀點用探針提出在幾會合在受影響的牙附近。二面對切的切開用scalpel 刀片被做連接靈菌點, 維護一次加調料烘烤的邊緣齒齦出現和保存充分組織。
當口袋深度超出4 毫米但與最小的骨頭損失或需要撤除的害病的軟的組織, 一塊簡單的擋水板允許通入和改善的可見性為開放刮術和根飛行。插入scalpel 刀片入溝和跟隨加調料烘烤的等高切斷上皮附件。為大區域要求治療, 垂直發布切開可能被做在最初的切開的mesial 和末端末端。使用一個periosteal 電梯, 齒齬被反射暴露根表面。擦亮根表面和灌溉與稀釋chlorhexidine 跟隨詳盡根飛行和subgingival 刮術。在改變位置擋水板以後, 它interdentally 被縫合與能吸收, 被中斷的縫合。當這個做法最共同地執行在面部和舌表面, 深口袋在上頷骨cuspid 牙的palatal 方面可能被暴露使用相似的tech.nique 為治療。
當口袋是大於4 毫米以骨頭損失和重大相當數量compro.mised 口袋皮膜, 一塊反向二面對切的擋水板被使用去除受影響的齒齬和為詳盡的清潔提供通入, 只要充足的附上齒齬是存在。用scalpel 刀片被漁對齒齦音骨頭, 切開被做成齒齬留下少量的組織一個稀薄的衣領。擋水板被舉起(有時暴露齒齦音冠) 如果osteoplasty 被擔保。害病的組織衣領被去除與curette 並且根表面被清洗, 被擦亮, 和完全地被灌溉。Interdental 縫合幫助改變位置齒齬。
為深intrabony 口袋大於5.6 毫米更加包含的損害與骨頭損失和最小的附上齒齬, 開放刮術與一塊apically 被改變位置的擋水板渴望。和在簡單的擋水板技術, 相似的切開被做在上皮附件和為verti.cal 發行, 允許充足的曝光提供根飛行和刮術。經常骨頭邊際是鋒利, 不規則, 或壞死的, 和要求改造。主要目標是改變位置齒齬因此它躺在上面齒齦音骨頭以邊際coronally 擴大2 毫米。這邊際不應該說謊頂端對毗鄰mucogingival 線, 然而。
其它牙周規程也許介入pedicle 或釋放齒齦貪佔保險, 至少2 毫米附上齒齬是存在在一個特殊站點。骨頭瑕疵管理和被引導的組織再生努力退回牙周結構到一個正常狀態, 並且牙周用夾板固定允許寬鬆牙的安定鼓勵reattachment 。
被引導的組織再生(GTR) 在牙科方面通常應付重建和再生牙周組織失去的由於疾病或傷害。組織再生被展示了與齒齦音骨頭、牙骨質, 和牙周韌帶在具體情況以具體類型療法。
研究支持了牙周反應和附件類別取決於類型組織第一repopulates 根表面的理論。根據這個定理, 有基本上能repopulate 根表面的四個組織, 每個造成各種各樣的牙周作用。這些組織是齒齦皮膜、齒齦結締組織、齒齦音骨頭, 和牙周韌帶。在這種理論上, 各上述結果的多孔的型在另外附件後果。齒齦上皮細胞, 移居沿齒齦結締組織下來對根表面, 導致長的junctional 上皮附件。如果齒齦結締組織是第一對repopulate 根表面, 然後根源吸回通常發生。如果細胞對repopulate 起源於骨頭二反映的當中一個然後發生, 或根吸回或ankylosis 。但當牙周細胞是一對repopulate 根表面, 新附件收效。牙周細胞有能力再開發牙骨質在根表面並且一個健康附件也許引起。
根本性將安置一個物理障礙在被導航的根表面和齒齦擋水板之間。障礙作為威懾物從居住於排除齒齦皮膜或齒齦結締組織根結構。這個障礙為牙周韌帶並且/或者齒齦音骨頭的祖先細胞然後提供一個區域有自由存取為遷移。當牙周韌帶的軟的組織快速地顯現出比骨頭, 預期, 這遷移和成長發生在骨多的侵略之前。它一般被相信, 牙周細胞有最巨大的潛力促進新附件但骨頭並且充當signifi.cant 角色。研究建議, GTR 障礙應該在到位和原封28 到42 天為渴望的作用。
崗位有效蒼勁的家庭關心和匾控制是根本的。抗生素為三個星期崗位手術一般被推薦。
家庭關心
家庭關心是整個職員能充當一個重要角色的一個區域在。客戶教育關於適當的方法和材料為牙齒衛生學對過程是關鍵的。職員應該很好熟練的在可利用的家庭關心產品和技術因此他們能援助在demon.strations 為寵物所有者。客戶教育可能開始在非常早期由介紹新小狗和小貓所有者對掠過的概念作為一個規則修飾和衛生學節目一部分。一些寵物也許難對待並且傷害風險對所有者應該被估計在推薦的家庭關心。
即使堅硬嘎吱咬嚼的對象提供嚼可能幫助減少匾和結石儲積的鍛煉, 應該被保重以某些對象。堅硬嘎吱咬嚼的食物和款待確定地有好處但一些更加堅硬的嚼玩具可能可能造成一些損傷。真正的骨頭、岩石, 和甚而冰應該總被避免。

With the large number of patients requiring periodontal therapy, some will need periodontal surgical intervention to various degrees. Most often, these treatments will be in the form of gingivoplasties, various flaps, and in some special cases, guided tissue regeneration. The goals of periodontal therapy involve removing calculus or diseased tissue and minimizing pocket depth while preserving at least 2 mm of attached gingiva to protect alveolar bone and mucosa from eroding.
If root surfaces are exposed or if the pocket depth is less than five mm, closed root planing and subgingival curettage may be performed. Using a curette subgingivally with overlapping strokes in horizontal, vertical, and oblique directions, root planing removes calculus, debris, and necrotic cementum to provide a clean, smooth surface. The curette can also be angled slightly to engage the gingival surface for removal of diseased or microorganism-infiltrated tissues. When pocket depth exceeds 5 mm, or other pathology exists, more invasive procedures are warranted.
Occasionally, significant local or generalized increases in pocket depths without attachment loss will occur with conditions such as gingival hyperplasia or associated with an epulis. In these cases, gingivectomy removes redundant gingiva to reduce the suprabony pseudopocket depths to facilitate the cleaning of tooth surfaces while maintaining at least 2 mm of attached gingiva. Pocket depth is measured and a corresponding bleeding point is made with the probe at several junctures around the affected teeth. A beveled incision is made with a scalpel blade connecting the bleeding points, maintaining a scalloped edge gingival appearance and preserving adequate tissue.
When pocket depths exceed 4 mm but with minimal bone loss or diseased soft tissue that needs removal, a simple flap allows access and improved visibility for open curettage and root planing. Inserting the scalpel blade into the sulcus and following the scalloped contour severs the epithelial attachment. For large areas requiring treatment, vertical-releasing incisions can be made at the mesial and distal ends of the initial incision. Using a periosteal elevator, the gingiva is reflected to expose the root surfaces. A polishing of the root surfaces and irrigation with dilute chlorhexidine follows thorough root planing and subgingival curettage. After repositioning the flap, it is sutured interdentally with absorbable, interrupted sutures. While this procedure is most commonly performed on facial and lingual surfaces, deep pockets on the palatal aspect of the maxillary cuspid teeth can be exposed using a similar tech要ique for treatment.
When the pockets are greater than 4 mm with bone loss and significant amounts of compro衫ised pocket epithelium, a reverse bevel flap is employed to remove the affected gingiva and provide access for thorough cleaning, as long as sufficient attached gingiva is present. With the scalpel blade angled to the alveolar bone, the incision is made into the gingiva leaving a thin collar of marginal tissue. The flap is elevated (sometimes exposing the alveolar crest) if osteoplasty is warranted. The collar of diseased tissue is removed with a curette and the root surfaces are completely cleaned, polished, and irrigated. Interdental sutures help reposition the gingiva.
For more involved lesions of deep intrabony pockets greater than 5? mm with bone loss and minimal attached gingiva, open curettage with an apically repositioned flap is desired. As in the simple flap technique, similar incisions are made at the epithelial attachment and for verti苞al release, allowing sufficient exposure to provide for the root planing and curettage. Often bone margins are sharp, irregular, or necrotic, and require remodeling. The main goal is to reposition the gingiva so it overlies the alveolar bone with the margin extending 2 mm coronally. This margin should not lie apical to adjacent mucogingival lines, however.
Other periodontal procedures may involve pedicle or free gingival grafts to insure that at least 2 mm of attached gingiva is present at a particular site. Bone defect management and guided tissue regeneration strive to return the periodontal structures to a more normal state, and periodontal splinting allows stabilization of loose teeth to encourage reattachment.
Guided tissue regeneration (GTR) in dentistry normally deals with the reestablishment and regeneration of periodontal tissues lost due to disease or injury. Tissue regeneration has been demonstrated with alveolar bone, cementum, and the periodontal ligament in specific situation with specific types of therapy.
Research has supported the theory that the category of periodontal reaction and attachment being dependent upon the type of tissue that first repopulates the root surface. Based upon this theorem, there are basically four tissues that can repopulate the root surface, each resulting in various periodontal effects. These tissues are gingival epithelium, gingival connective tissue, alveolar bone, and periodontal ligament. In this theory, each cellular type of the above results in a different attachment consequence. Gingival epithelial cells, which migrate along the gingival connective tissues down to the root surface, result in long junctional epithelial attachments. If gingival connective tissue is first to repopulate the root surface, then root resorption usually occurs. Should the cells to repopulate originate from bone then one of two repercussions occurs, either root resorption or ankylosis. But when periodontal cells are the first to repopulate the root surface, new attachment results. The periodontal cells have the ability to redevelop cementum on the root surface and a healthy attachment may be generated.
The fundamentals are to place a physical barrier between the instrumented root surface and the gingival flap. The barrier acts as a deterrent to exclude the gingival epithelium or gingival connective tissue from populating the root structure. This barrier then provides an area for the progenitor cells of the periodontal ligament and/or alveolar bone to have free access for migration. As the soft tissues of the periodontal ligament develop faster than bone, it is hoped that this migration and growth happens prior to bony incursion. It is generally believed that periodontal cells have the greatest potential to promote new attachment but that bone also plays a signifi苞ant role. Studies have suggested that GTR barriers should be in place and intact for 28 to 42 days for desired effect.
Post operatively vigorous home care and plaque control is essential. Antibiotics for up to three weeks post-surgery are generally recommended.
HOME CARE
Home care is one area in which the entire staff can play an important role. Client education about the proper methods and materials for dental hygiene is crucial to the process. Staff members should be well versed in available home care products and techniques so they can aid in demon貞trations for the pet owner. Client education can start at a very early stage by introducing new puppy and kitten owners to the concept of brushing as part of a regular grooming and hygiene program. Some pets may be difficult to treat and the risk of injury to the owner should be assessed in recommending home care.
Even though hard crunchy objects provide chewing exercise that can help reduce plaque and calculus accumulation, care should be taken with certain objects. Hard crunchy food and treats definitely have benefits but some of the harder chew toys can possibly cause some damage. Real bones, rocks, and even ice should always be avoided.

minibabyqq 2007-1-26 02:25

[color=Magenta][size=5][b]外科提取Surgical Extractions  [/b][/size][/color]


定義
Surgical 提取。被定義作為一塊muco-periosteal 擋水板必須被上升的技術並且齒齦音骨頭被去除為了去除整體牙根。
徵兆
有經常供選擇的治療對提取。供選擇的治療被推薦為有健康牙周狀態的戰略牙(一般, 永久似犬和大後部牙) 。治療由提取, 然而, 總是更好的對留給病理學未經治療。
共同的徵兆為外科提取有:
Periodontally 酣然的上部和更低的犬, 由破裂影響或被介入在咬合不良。
由ankylosis 影響的牙。
殘餘的根片段被埋置深深在小窩之內的根殘餘。
根以異常的形態學。
沒有crestal 骨頭損失的多根源的牙。
牙的外科提取的技術
Pre-extraction 射線照相檢查根形態學和得到病理學的一張更加完全的圖片需要提取是必須的。外科提取應該執行在一個乾淨的環境。如此, 牙周療法(在上和次級齒齦結垢, 根飛行和冠擦亮) 應該執行在開始提取之前。
上部犬
上部犬齒將被使用為例為外科提取。在提取技術上的區別的其它牙將被突出。
做法:
切開上皮附件在犬附近和對2 nd 前臼齒(106/206) rostrally 擴大切開對3 rd 門牙( 103/104) 並且末端上使用第11 或第15 刀片。
削減發布的切開在最初的切開的rostral 和末端末端對正義在muco 齒齦線之外。使發布的切開輕微地分歧保證, 擋水板的基地比邊緣寬廣的。
使用一種wax 小鏟類型periosteal 電梯舉齒齬和mucosa 從骨頭躺在上面似犬根。擴大發布的切開如果需要。
去除頰骨頭板材躺在上面根, 使用適當地估量圍繞毛刺用水irrigation/cooling 。它通常不是必要去除骨頭對尖頂, 只到根長度的三分之二。大小2 或4 毛刺是最佳為貓, 大小6 為狗和估量8 為大的養殖。Water-cooling 和灌溉是必須的骨頭熱量地否則將被損壞並且sequestrum 也許以後形成。骨頭可能欣然被區分從牙; 骨頭有一種灰色顏色和流血, cementum/dentine 白色和avascular 。
使用圓的毛刺創造低谷或天溝在牙根和齒齦音骨頭之間在rostral 和末端根表面。設法去除骨頭和不是鑽子入根表面, 或牙也許破碎在海拔期間。
安置一個電梯在低谷的當中一個中和轉動電梯沿它長的軸。這次行動將轉動牙沿它長的軸。目標將劃分palatal 牙周纖維和那些根要訣, 但避免撬起根要訣入鼻洞。電梯被轉動舒展纖維, 和被拿著10.30 秒一次, 重覆各邊直到牙成為寬鬆, 和可能容易地被去除。
毛刺被使用使小窩的邊緣光滑。如果插口用殘骸被填裝, 這應該柔和地被驅趕出來在關閉之前。保證一個乾淨的凝塊形式在插口。
擋水板應該被縫合在插口, 這樣, 沒有緊張在任何縫合。如果需要, 直言地解剖擋水板次級mucosally 往嘴唇邊際為了獲取更多組織。保證, palatal mucosa 的邊緣是自由的由柔和地插入periosteal 電梯在骨頭和軟的組織之間。使用簡單的被中斷的縫合和能吸收的縫合材料與一swaged 在針。發布切開的適當的安置應該保證, 所有邊緣在修理之時由骨頭支持。如果它不是可能充分地關閉擋水板沒有緊張, 那麼留下開頭, 癒合將由粒化。
降低犬
上部犬將是牙外科地經常被提取, 但下頷骨犬, 如果periodontally 聲音, 並且將要求外科提取由於他們的寬根比較直徑在cemento 搪瓷連接點和根的曲度。酣然的下頷骨似犬根應該只被提取以真正原因從根帳戶為50% rostral 下頷骨大塊。他們的撤除, 與齒齦音骨頭一起, 可觀地減弱rostral 下頷骨ramus 並且破裂也許發生。一隻periodontally 酣然但破碎的更低的犬的Endodontic 療法和恢復是更好的對提取。
如果使用一種頰方法, 必須被保重避免對neurovascular 捆綁的損傷退出精神孔當培養擋水板。一種舌方法是可能的但給粗劣的形象化為做法。保存下頷骨力量, 去除如同少許骨頭如同possible.just 對點最大根。它是可能獲得小彎曲的luxators 跟隨根曲度和使相當數量骨頭撤除減到最小必需。
鞋幫4th 前臼齒和降低1 個st 槽牙在狗
這些牙, 如果由periodontitis 影響, 被區分和non-surgical 提取通常去除。但如果牙是periodontally 酣然的, 外科提取然後被表明。擋水板為上部4th 前臼齒(108/208) 延長從3 rd 前臼齒(107/207 的 ) 中部對1 st 槽牙(109/209 的) 末端邊緣, 與發布的切開由第一切開的末端末端被做。這避免對infraorbital 孔的損傷, 背部對3rd 前臼齒(107/207) 。擋水板為更低的1st 槽牙(309/409) 通常只需要延伸到毗鄰牙, 以發布的切開在各個末端分流當他們通過mucogingival 線。頰骨頭可能被去除暴露furcation 為了區分牙入它的組成部分root/crown 單位。齒齦音冠骨頭進一步撤除將促進電梯詞條入牙周空間沒有干涉從突出的搪瓷船腹在這些牙。如果ankylosis 是存在, 大多數頰骨頭板材將需要被去除。(用途小心當去除很多根頰骨頭作為上部4th 前臼齒mesiolateral 根說謊反對infraorbital 運河和更低的1st 槽牙根要訣是在精神運河附近。)
似貓的前臼齒
歷史上, 似貓的前臼齒是每個獸醫惡夢由於他們破碎在提取期間的舒適。這留下根, 有或沒有冠片斷附上, 必須被去除。雖然它也許誘惑留下這些根和希望他們意志resorb 或齒齬將增長在他們, 這疏忽。殘餘的牙片段也許導致很多痛苦和作為源泉的炎症, 可能造成口腔炎。
似貓的上部前臼齒可能non-surgically 通常被去除, 但如果ankylosis 是存在, 外科技術被描述上面可能被使用。在下顎骨, 一個修改過的技術瞄準保存齒齦音骨頭被推薦。這個方法可能適應最似貓的多顆根源的牙撤除。
技術將buccally 和舌培養一塊小齒齦擋水板, 被剛夠齒齦音crestal 骨頭撤除跟隨暴露furcation 。小圓的毛刺, 通常估量2, 被使用由furcation 末端上做二裁減在45 度, 一個, 和一個rostrally 。這些裁減將取消冠的大多數留下唯一一個小問題的冠在各單獨根。下個階段將使用或者大小。2 或大小。4 圓的毛刺去除cancellous 骨頭在二根之間。深度應該是相同像根長度, 和在下顎骨, 不長期足夠進入下頷骨運河。如果在疑義, 測量距離在您的射線照相。各根由骨頭只然後支持在三邊並且一個小luxator 或電梯可能被緩和入空間由毛刺創造並且根可能鬆開和被去除。
被保留的落葉上頷骨犬齒
外科提取可能被表明的這裡歸結於是有傾向破碎的長的狹窄的根如果一種non-surgical 方法被使用。如上所述跟隨技術的一顆永久牙但小心避免對永久犬的損傷。


DEFINITION
廍urgical Extraction?is defined as a technique where a muco-periosteal flap must be raised and alveolar bone removed in order to remove the whole tooth root.
INDICATIONS
There are often alternative treatments to extraction. Alternative treatment is recommended for strategic teeth (generally, permanent canine and large posterior teeth) that have a healthy periodontal status. Treatment by extraction, however, is always preferable to leaving pathology untreated.
Common indications for surgical extraction include:
Periodontally sound upper and lower canines, which are affected by fracture or involved in a malocclusion.
Teeth that are affected by ankylosis.
Root remnants where the remaining root fragments are embedded deep within the alveolus.
Roots with bizarre morphology.
Multiple-rooted tooth that has no loss of crestal bone.
TECHNIQUE FOR SURGICAL EXTRACTION OF TEETH
Pre-extraction radiographs to check root morphology and get a more complete picture of the pathology necessitating the extraction are mandatory. Surgical extraction should be performed in a clean environment. So, periodontal therapy (supra- and sub-gingival scaling, root planing and crown polishing) should be performed before starting the extraction.
Upper Canines
An upper canine tooth will be used as an example for surgical extraction. Differences in extraction technique for other teeth will be highlighted.
Procedure:
Cut the epithelial attachment around the canine and extend the incision rostrally to the 3rd incisor (103/104) and distally to the 2nd premolar (106/206) using a No. 11 or No. 15 blade.
Cut a releasing incision at the rostral and distal ends of the initial incision to just beyond the muco-gingival line. Make the releasing incisions slightly divergent to ensure that the base of the flap is broader than the edge.
Use a 𢘛ax spatula?type periosteal elevator to lift the gingiva and mucosa from the bone overlying the canine root. Extend the releasing incisions if necessary.
To remove the buccal bone plate overlying the root, use an appropriately sized round burr with water irrigation/cooling. It is usually not necessary to remove bone to the apex, only to two-thirds of the root length. A size 2 or 4 burr is best for cats, a size 6 for dogs and size 8 for giant breeds. Water-cooling and irrigation is mandatory otherwise bone will be thermally damaged and a sequestrum may later form. Bone can readily be differentiated from tooth; bone has a greyish colour and bleeds, cementum/dentine is white and avascular.
Use the round burr to create a trough or gutter between the tooth root and the alveolar bone on the rostral and distal root surfaces. Try to remove bone and not drill into the root surface, or the tooth may fracture during elevation.
Place an elevator in one of the troughs and rotate the elevator along its long axis. This action will rotate the tooth along its long axis. The aim is to break down the palatal periodontal fibres and those of the root tip, but avoid levering the root tip into the nasal cavity. The elevator is rotated to stretch the fibres, and held for 10?0 seconds at a time, repeating each side until the tooth becomes loose, and can be easily removed.
The burr is used to smooth the edges of the alveolus. If the socket is filled with debris, this should gently be flushed out prior to closure. Ensure a clean clot forms in the socket.
The flap should be sutured over the socket, such that there is no tension on any of the sutures. If necessary, bluntly dissect the flap sub-mucosally towards the lip margin in order to gain more tissue. Ensure that the edge of the palatal mucosa is free by gently inserting the periosteal elevator between the bone and soft tissue. Use simple interrupted sutures and an absorbable suture material with a swaged on needle. Proper placement of releasing incisions should ensure that all edges at the time of repair are supported by bone. If it is not possible to fully close the flap without tension, then leave an opening, which will heal by granulation.
Lower Canines
The upper canines will be the teeth most often extracted surgically, but mandibular canines, if periodontally sound, will also require surgical extraction due to their wide root compared with the diameter at the cemento-enamel junction and the curvature of the root. Sound mandibular canine roots should only be extracted with good reason since the root accounts for 50% of the rostral mandibular bulk. Their removal, together with alveolar bone, considerably weakens the rostral mandibular ramus and fractures may occur. Endodontic therapy and restoration of a periodontally sound but fractured lower canine is preferable to extraction.
If using a buccal approach, care must be taken to avoid damage to the neurovascular bundle exiting the mental foramen while raising the flap. A lingual approach is possible but gives poor visualisation for the procedure. To preserve mandibular strength, remove as little bone as possible𤩦ust to the point of maximum root. It is possible to obtain small curved luxators to follow the root curvature and minimise the amount of bone removal required.
Upper 4th Premolars And Lower 1st Molars in The Dog
These teeth, if affected by periodontitis, are usually removed by sectioning and non-surgical extraction. But if the teeth are periodontally sound, then surgical extraction is indicated. The flap for the upper 4th premolar (108/208) extends from the middle of the 3rd premolar (107/207) to the distal edge of the 1st molar (109/209), with the releasing incision made from the distal end of the first incision. This avoids damage to the infraorbital foramen, dorsal to the 3rd premolar (107/207). The flap for the lower 1st molar (309/409) usually only needs to extend to the adjacent teeth, with the releasing incisions at each end diverging as they pass through the mucogingival line. Buccal bone can be removed to expose the furcation in order to section the tooth into its constituent root/crown units. Further removal of alveolar crest bone will facilitate entry of elevators into the periodontal space without interference from the prominent enamel bulge on these teeth. If ankylosis is present, most of the buccal bone plate will need to be removed. (Use caution when removing large amounts of buccal bone as the upper 4th premolar mesiolateral root lies against the infraorbital canal and the lower 1st molar root tips are adjacent to the mental canal.)
Feline Premolars
Historically, feline premolars have been every veterinary surgeons nightmare due to the ease with which they fracture during extraction. This leaves roots, with or without pieces of crown attached, which must be removed. Although it might be tempting to leave these roots and hope they will resorb or the gingiva will grow over them, this is negligent. Remaining tooth fragments may cause a great deal of pain and act as a source of inflammation, possibly resulting in stomatitis.
Feline upper premolars can usually be removed non-surgically, but if ankylosis is present, the surgical techniques described above can be used. In the mandible, a modified technique aimed at preserving alveolar bone is recommended. This method can be adapted to the removal of most feline multiple rooted teeth.
The technique is to raise a small gingival flap, both buccally and lingually, followed by the removal of just enough alveolar crestal bone to expose the furcation. A small round burr, size 2 usually, is used to make two cuts from the furcation at 45 degrees, one distally, and one rostrally. These cuts will remove the bulk of the crown leaving only a small point of crown on each individual root. The next stage is to use either a size?2 or size?4 round burr to remove the cancellous bone between the two roots. The depth should be the same as the root length, and in the mandible, not long enough to enter the mandibular canal. If in doubt, measure the distance on your radiographs. Each root is then only supported by bone on three sides and a small luxator or elevator can be eased into the space created by the burr and the roots can be loosened and removed.
Retained Deciduous Maxillary Canine Teeth
Surgical extraction can be indicated here due to the long narrow root that is prone to fracture if a non-surgical approach is used. Follow the technique as above for a permanent tooth but use care to avoid damage to the permanent canine.

minibabyqq 2007-1-26 02:26

[color=Magenta][size=5][b]緊急Endodontics 和Pulpotomy Emergency Endodontics and Pulpotomy [/b][/size][/color]

[size=12px]介紹
牙齒傷害被分類了根據各種各樣的因素, 譬如原因論、解剖學、病理學, 或治療考慮。分類根據系統由世界衛生組織採取(世界衛生組織) 在疾病的國際分類的它的應用對牙科和口腔醫學。分類包括傷害對牙, 支撐結構, 齒齦, 和口頭mucosa 和根據解剖, 治療, 和prognosticating 考慮。這個分類可能適用於永久和主要牙。
安定、作用和美學的改善, 或重建在受損傷的牙(和他們的牙周支持) 依然是富挑戰性努力, 特別當滋補規程必須執行在緊急狀態或在一個有限的期間內跟隨精神創傷。受損傷的組織長期預測要求功能正直的恢復, 牙根吸回的生命力, 和預防。
牙齒精神創傷的分類 [table][tr][td=1,1,436]傷害對堅硬牙齒組織和黏漿狀物質
1 。 搪瓷違背。
2 。 搪瓷破裂(不複雜的冠破裂) 。
3 。 搪瓷牙質破裂(不複雜的冠破裂): 破裂以牙物質損失被限制對搪瓷和牙質, 但不介入黏漿狀物質。
4 。 複雜的冠破裂。
5 。 不複雜的冠根破裂。
6 。 複雜的冠根破裂。
7 。 根破裂。
傷害對牙周組織
1 。 震蕩。
2 。 半脫位(鬆懈) 。
3 。 Extrusive luxation (周邊脫臼, 部份撕裂) 。
4 。 側向luxation 。
5 。 闖入luxation (中央脫臼) 。
6 。 撕裂(exarticulation) 。
[/td][td=1,1,436]傷害對支持的骨頭
1 。 下頷骨或上頷骨齒齦音插口的Comminution 。
2 。 下頷骨或上頷骨齒齦音插口牆壁的破裂。
3 。 下頷骨或上頷骨齒齦音過程的破裂。
4 。 下顎骨或上顎骨破裂。
傷害對齒齬或口頭Mucosa
1 。 齒齦或口頭mucosa 的撕裂。
2 。 齒齬或口頭mucosa 挫傷。
3 。 齒齬或口頭mucosa 磨蝕。
[/td][/tr][/table][size=2]永久牙破裂和預測的治療[/size]
1 。 [b]搪瓷違背。[/b] Pulpal 敏感性由密封或結合控制殘缺不全的搪瓷破裂。預測是好的並且期望的複雜化包括黏漿狀物質壞死。
2 。 [b]搪瓷破裂(沒有牙質被暴露) 。[/b] 撤除鋒利的搪瓷邊緣和矯正研或恢復與綜合樹脂。預測是好的並且期望的複雜化是黏漿狀物質壞死、黏漿狀物質運河obliteration, 和根吸回。
3 。 [b]搪瓷牙質破裂, 沒有黏漿狀物質曝光。[/b] 直接(臨時) 治療將安置+氧化鈣劃線員被暴露的牙質和搪瓷。預測是好的並且期望的複雜化是黏漿狀物質壞死。
4 。 [b]搪瓷牙質破裂以黏漿狀物質曝光。[/b] 直接治療對被暴露的黏漿狀物質組織是由黏漿狀物質加蓋, pulpotomy, 或pulpectomy (根運河療法) 。預測被守衛對好為黏漿狀物質生命力和好為endodontically 被對待的牙。
部份花冠PULPECTOMY
黏漿狀物質加蓋暗示, pulpal 創傷由傷害造成用+氧化鈣被蓋和玻璃離子聚合物水泥或補藥。Pulpotomy 介入損壞的或被激起的組織撤除對臨床健康黏漿狀物質的水平, 隨後而來被+氧化鈣選礦和玻璃離子聚合物水泥和綜合恢復。Pulpectomy 介入整個黏漿狀物質的撤除, 清洗和塑造根運河, 和obturation 以海豹獵人和馬來樹膠點被冠恢復跟隨。Pulpotomy 只要可能是現有的被暴露的重要黏漿狀物質的治療在牙在努力保存它的生命力和允許牙加強通過持續的成長。幾個用語使用進一步定義一般用語pulpotomy 。這些包括重要pulpotomy, 部份冠狀pulpectomy, +氧化鈣pulpotomy, formocresol pulpotomy 和戊二醛pulpotomy 。Intracanal 療程必須仔細地被選擇至於不導致有害反應。
一重要pulpotomy 並且被完成在選舉冠截肢術以後。pulpotomy 最好執行當牙破碎了不再比三個到六個小時。這是選擇的治療在幼小動物只要黏漿狀物質是vital.sometimes 只要二個星期崗位欺辱。時間在傷害和考試之間直接地將影響黏漿狀物質的健康。概括來說, 比一個星期被暴露了為較少的黏漿狀物質是可接受的為pulpotomy 。預測是更窮的黏漿狀物質長期被暴露。pulpotomy 做法意欲為持續的牙質生產保存黏漿狀物質組織的生命力。期限partial 花冠pulpectomy 。是適當的用於獸醫牙科。通常, 再進入和常規根運河obturation 不執行除非有其它徵兆。
徵兆為部份冠狀Pulpectomy
1 。 剩餘冠狀結構是充足的為恢復在重要黏漿狀物質曝光在一顆發育未全的牙(殘缺不全的根發展) 。
2 。 重要黏漿狀物質曝光在一個幼小動物與一條成熟牙和大黏漿狀物質運河以剩餘充足的冠狀牙結構。
3 。 選舉冠狀減少為咬合精神創傷安心或解除武裝進取的動物。
如果有重要黏漿狀物質曝光的未知的期間以黏漿狀物質出血的活化作用和endodontic 病理學的沒有徵兆, 這顆牙也許由部份冠狀pulpectomy 然後對待。這是一個頻繁介紹在獸醫牙科方面。客戶教育必須包括將要求再進入和endodontic obturation 複雜化的可能性。pulpotomy 是一個可接受的做法當動物必須被解除武裝(冠狀減少) 。留下一條開放和被暴露的黏漿狀物質運河在解除武裝以後是邀請對傳染和訴訟。
技術
這外科手術要求不育的技術。外科準備以橡膠水壩技術, 外科裝飾, 蓋帽, 面具, 手套, 並且不育的儀器被表明。
在牙齒射線照相的評估以後, 黏漿狀物質分庭被輸入並且黏漿狀物質被取消下來對大約牙的子宮頸水平。避免黏漿狀物質的子宮頸水平, 是重要在牙質生產和對牙的力量貢獻。大約5 到10 毫米黏漿狀物質被取消使用水冷的圓的金剛石bur 在一高速handpiece 。柔和地洗滌黏漿狀物質與鹽和安置一個潮濕棉花藥丸在黏漿狀物質直到靈菌停止。然後再洗滌黏漿狀物質在安置黏漿狀物質選礦之前。+氧化鈣被介紹在黏漿狀物質組織作為粉末。被暴露的牙質應該並且被塗上。玻璃離子聚合物被安置在+氧化鈣黏漿狀物質選礦。冠恢復被完成使用直接保稅的綜合補藥。
光的安置治療了未裝滿的樹脂被安置在黏漿狀物質組織沒有+氧化鈣的安置並且被描述了, 並且二氧化碳laser 重要pulpectomy 技術。
如果黏漿狀物質靈菌不停止在五分鐘以後, 取消2 到3 毫米黏漿狀物質。如果出血繼續, 繼續進行常規endodontic pulpectomy 和obturation 技術。對成功的重要黏漿狀物質的評估用牙齒射線照相逐年被做在六個星期, 六個月和然後。一座dentinal 橋梁也許是顯然的表明一個成功的做法。但是, 成功也許看沒有一座明顯的dentinal 橋梁。週期性重新估價與射線照相是確定一個成功的做法唯一的方法。
牙破裂的Endodontic 治療
要求endodontic 治療牙的臨床標誌被概述了以各種各樣的來源。牙以牙周疾病也許進步對導致的endodontic 疾病
牙Luxations 和預測的治療
1 。 [b]震蕩和半脫位(鬆懈) 。 [/b]鎖柱安心在受傷的牙並且/或者鉗製也許被表明, 特別是在案件明顯鬆懈。否則軟的飲食14 天。檢查鎖柱和後續與射線照相和敏感性測試在六個星期和六個月。預測被守衛對好
2 。 [b]Extrusive luxation (周邊脫臼, 部份撕裂) 並且側向luxation 。 [/b]治療將改變位置牙在正常位置使用地方麻醉。在被延遲的治療的情況下, 牙應該允許自發地重新編制入正常位置或orthodontically 被移動。牙應該用夾板固定與酸銘刻樹脂藤條。用夾板固定的期間應該是, 為擠壓, 二個到三個星期; 為側向luxation, 三個星期; 並且在少量的骨頭故障的情況下, 六個到八個星期。檢查鎖柱和後續與射線照相和敏感性測試在六個星期和六個月。預測被守衛對好
3 。 [b]闖入luxation (中央脫臼) 。[/b] 牙也許自發地通常re 噴發。外科改變位置被顯示了對增量複雜化譬如少量的骨頭支持外在根吸回和損失。改變位置可能orthodontically 被執行在三個到四個星期中。齒齦撕裂應該被縫合以能吸收的縫合材料。預測被守衛的歸結於根表面吸回的高發生。
4 。 [b]撕裂(exarticulation) 。[/b] 直接治療介入柔和地清洗牙與鹽(化學製品, 不摩擦根表面) 。灌溉插口與一條柔和的小河鹽(不curette 插口) 。改種牙使用柔和的手指壓力。申請酸銘刻被保留的藤條。分與抗生素七到10 天。avulsed 牙將要求根運河療法在二個到四個星期崗位用夾板固定, 可能被結束在藤條撤除之時。檢查鎖柱和後續與射線照相和敏感性測試在六個星期和六個月。複雜化包括根表面吸回(沒有治療), 替換吸回(提取如果進步, 否則根運河療法) 並且激動吸回(根運河療法。如果有插口傷害或牙周韌帶傷害, 那麼插口被對待並且被延遲的安放是選擇的治療。牙被清洗牙周韌帶並且插口是curetted 。根運河extraorally 被填裝得。牙被安置在氟化物解答(2.4 % 鈉氟化物磷酸鹽酸化在酸鹼度5.5) 20 分鐘在安放之前。牙被漂洗, reimplanted 和用了夾板固定。氟化物減少根吸回進步將按50% 。
傷害的治療對支持的骨頭和預測
1 。 [b]下頷骨或上頷骨齒齦音插口的Comminution 。[/b] 傷害對齒齦音插口一般不要求治療。痛苦管理被表明。
2 。 [b]下頷骨或上頷骨齒齦音插口牆壁的破裂。[/b] 牙和插口牆壁被改變位置使用地方麻醉。所有寬鬆片段應該被去除。破裂減少是由數字式壓力。軟的組織的撕裂應該被縫合。牙和破裂被穩定與酸銘刻被保留的綜合藤條。
3 。 [b]下頷骨或上頷骨齒齦音過程的破裂。[/b] 治療是由減少和鉗製使用地方麻醉。在這類型破裂, 包含的牙尖頂可能由前庭骨頭板材經常鎖到位。用夾板固定由酸etch/resin 藤條或曲拱酒吧達到四個到八個星期。寬鬆牙應該被留下到位保險穩定的減少, 但也許要求提取在藤條撤除。軟的組織的撕裂應該被縫合。
4 。 [b]下顎骨或上顎骨破裂。 [/b]下頜破裂的治療是由確切的改變位置和定像。牙在下頜破裂線應該被保留並且剛性定像應該是應用的。Intraoral 用夾板固定使用一種丙烯酸酯的合成材料是理想的。板材的安置與螺絲也許被表明。必須被保重避免螺絲的安置通過牙根。鎖柱應該是正常的並且減少幅射線照相地被檢查。抗藥性療法也許被表明14 到21 天。Traumatically 損壞的牙可能被對待在藤條撤除。下頜應該被固定八個到12 個星期, 和三個到四個星期在發育未全的患者。檢查鎖柱和後續與射線照相和敏感性測試在六個星期和六個月。預測被守衛對好。
抗生素和鎮痛藥
關於endodontic 傳染的眾多的細菌學研究表示, 主要微生物是特許的並且強制嫌氣性細菌。指南至於對抗生素的使用在獸醫endodontic 患者未建立。對抗生素的合理的用途根據幾個因素: 適當的徵兆、藥物的有效率反對侵略的有機體, 和藥物的毒力對患者。預防疾病的抗藥性養生之道被表明為心臟病患者和患者以系統疾病情況。許多endodontic 傳染迅速地反應根運河療法, 不要求系統療程。如果抗菌光譜是唯一的標準, 氯林肯黴素會是選擇藥物為對待的endodontic 傳染。它是特別有效的反對 [i]Bacteroides[/i] sp. 和periapical 傳染。Penicillin.s 幾乎像有效是反對[i]Bacteroides [/i]sp. 口頭 張力 , 也許是有效的反對gram-positive 有機體。
口頭鎮痛藥有效地控制手術後endodontic 痛苦。臨床痛苦可能同不充分的運河準備、醫原性穿孔、結束儀器工作和periapical 炎症聯繫在一起。Periradicular 痛苦經常發生在獸醫患者。如果患者遭受充滿痛苦, 鎮痛藥然後被推薦。nonsteroidal 抗發炎藥物, (NSAIDs) 譬如阿斯匹靈和周邊地carprofen, 行動控制適度痛苦。opioids, 譬如butorphanol, 在中心行動得和將處理適度對嚴厲手術後痛苦。
INTRODUCTION
Dental injuries have been classified according to a variety of factors, such as etiology, anatomy, pathology, or therapeutic considerations. The classification is based on a system adopted by the World Health Organization (WHO) in its Application of International Classification of Diseases to Dentistry and Stomatology. The classification includes injuries to the teeth, supporting structures, gingival, and oral mucosa and is based on anatomical, therapeutic, and prognosticating considerations. This classification can be applied to both permanent and primary teeth.
Stabilization, improvement, or reestablishment of function and aesthetics in traumatized teeth (and their periodontal support) remains a challenging endeavor, particularly when restorative procedures must be performed in emergencies or within a limited period following the trauma. The long-term prognosis of traumatized tissues requires restoration of functional integrity, tooth vitality, and prevention of root resorption.
CLASSIFICATION OF DENTAL TRAUMA [table][tr][td=1,1,436]Injuries To Hard Dental Tissues And The Pulp
1. Enamel infraction.
2. Enamel fracture (uncomplicated crown fracture).
3. Enamel-dentin fracture (uncomplicated crown fracture): a fracture with loss of tooth substance confined to enamel and dentin, but not involving the pulp.
4. Complicated crown fracture.
5. Uncomplicated crown-root fracture.
6. Complicated crown-root fracture.
7. Root fracture.
Injuries To The Periodontal Tissues
1. Concussion.
2. Subluxation (loosening).
3. Extrusive luxation (peripheral dislocation, partial avulsion).
4. Lateral luxation.
5. Intrusive luxation (central dislocation).
6. Avulsion (exarticulation).
[/td][td=1,1,436]Injuries To The Supporting Bone
1. Comminution of the mandibular or maxillary alveolar socket.
2. Fracture of the mandibular or maxillary alveolar socket wall.
3. Fracture of the mandibular or maxillary alveolar process.
4. Fracture of mandible or maxilla.
Injuries To Gingiva Or Oral Mucosa
1. Laceration of gingival or oral mucosa.
2. Contusion of gingiva or oral mucosa.
3. Abrasion of gingiva or oral mucosa.
[/td][/tr][/table]TREATMENT OF PERMANENT TOOTH FRACTURES AND PROGNOSIS
1. [b]Enamel infraction.[/b] Pulpal sensitivity is controlled by sealing or bonding the incomplete enamel fracture. Prognosis is good and expected complications include pulp necrosis.
2. [b]Enamel fracture (no dentin exposed).[/b] Removal of sharp enamel edges and corrective grinding or restoration with composite resin. Prognosis is good and expected complications are pulp necrosis, pulp canal obliteration, and root resorption.
3. [b]Enamel-dentin fracture, no pulp exposure.[/b] Immediate (provisional) treatment is to place a calcium hydroxide liner over exposed dentin and enamel. Prognosis is good and expected complications are pulp necrosis.
4. [b]Enamel-dentin fracture with pulp exposure.[/b] Immediate treatment to the exposed pulp tissue is by pulp capping, pulpotomy, or pulpectomy (root canal therapy). The prognosis is guarded to good for pulp vitality and good for endodontically treated teeth.
PARTIAL CORONAL PULPECTOMY
Pulp capping implies that the pulpal wound caused by the injury is covered with calcium hydroxide and a glass ionomer cement or restorative. Pulpotomy involves removal of damaged or inflamed tissue to the level of clinically healthy pulp, following by calcium hydroxide dressing and glass ionomer cement and composite restoration. Pulpectomy involves removal of the entire pulp, cleaning and shaping the root canal, and obturation with a sealer and gutta percha points followed by crown restoration. Pulpotomy is the treatment of the existing exposed vital pulp in the tooth in an effort to preserve its vitality and to allow the tooth to strengthen through continued growth as long as possible. Several terms are used to further define the general term pulpotomy. These include vital pulpotomy, partial coronal pulpectomy, calcium hydroxide pulpotomy, formocresol pulpotomy and glutaraldehyde pulpotomy. Intracanal medications must be carefully selected so as not to induce adverse reactions.
A vital pulpotomy is also completed after elective crown amputation. A pulpotomy is best performed when a tooth has been fractured no longer than three to six hours. This is the treatment of choice in young animals as long as the pulp is vital珦ometimes as long as two weeks post-insult. The length of time between injury and examination will directly affect the health of the pulp. As a rule, pulps that have been exposed for less than a week are acceptable for pulpotomy. The prognosis is poorer the longer the pulp is exposed. The pulpotomy procedure is intended to preserve the vitality of the pulp tissue for continued dentin production. The term 𢖯artial coronal pulpectomy?is more appropriate for use in veterinary dentistry. Generally, reentry and conventional root canal obturation is not performed unless there are other indications.
Indications for Partial Coronal Pulpectomy
1. Remaining coronal structure is sufficient for restoration in a vital pulp exposure in an immature tooth (incomplete root development).
2. Vital pulp exposure in a young animal with a mature tooth and large pulp canal with remaining sufficient coronal tooth structure.
3. Elective coronal reduction for relief of occlusal trauma or disarming of aggressive animals.
If there is an unknown duration of vital pulp exposure with activation of pulp hemorrhage and no indications of endodontic pathology, then this tooth may be treated by partial coronal pulpectomy. This is a frequent presentation in veterinary dentistry. Client education must include the possibility of complications that will require reentry and endodontic obturation. A pulpotomy is an acceptable procedure when an animal has to be disarmed (coronal reduction). To leave an open and exposed pulp canal after disarming is an invitation to infection and litigation.
Technique
This surgical procedure requires sterile technique. Surgical preparation with rubber dam technique, surgical drapes, caps, masks, gloves, and sterile instruments is indicated.
After evaluation of dental radiographs, the pulp chamber is entered and the pulp is removed down to about the cervical level of the tooth. Avoid the cervical level of pulp, which is important in dentin production and contributes to the strength of the tooth. Approximately 5 to 10 millimeters of pulp are removed using a water-cooled round diamond bur in a high-speed handpiece. Gently wash the pulp with saline and place a moist cotton pellet on the pulp until the bleeding stops. Then wash the pulp again before placing a pulp dressing. Calcium hydroxide is introduced over the pulp tissue as a powder. Exposed dentin should be coated also. A glass ionomer is placed over the calcium hydroxide pulp dressing. A crown restoration is completed using a direct bonded composite restorative.
Placement of a light cured unfilled resin placed over the pulp tissue without placement of calcium hydroxide has also been described, as well as CO2 laser vital pulpectomy techniques.
If the pulp bleeding does not stop after five minutes, remove 2 to 3 millimeters of pulp. If hemorrhage continues, proceed with conventional endodontic pulpectomy and obturation techniques. Assessment of successful vital pulp is made with dental radiographs at six weeks, six months and then yearly. A dentinal bridge may be evident indicating a successful procedure. However, success may be seen without an obvious dentinal bridge. Periodic reassessment with radiographs is the only method of determining a successful procedure.
Endodontic Treatment Of Tooth Fractures
Clinical signs of teeth that require endodontic treatment have been outlined in various sources. Teeth with periodontal disease may progress to induced endodontic disease
Treatment of Tooth Luxations and Prognosis
1. [b]Concussion and subluxation (loosening). [/b]Relief of occlusion on the injured tooth and/or immobilization may be indicated, especially in cases of marked loosening. Otherwise a soft diet for 14 days. Check the occlusion and follow-up with radiographs and sensitivity testing at six weeks and six months. Prognosis is guarded to good
2. [b]Extrusive luxation (peripheral dislocation, partial avulsion) and lateral luxation. [/b]Treatment is to reposition the tooth in normal position using local anesthesia. In case of delayed treatment, the teeth should be allowed to realign spontaneously into normal position or be moved orthodontically. The tooth should be splinted with an acid-etch resin splint. The splinting period should be, for extrusion, two to three weeks; for lateral luxation, three weeks; and in case of marginal bone breakdown, six to eight weeks. Check the occlusion and follow-up with radiographs and sensitivity testing at six weeks and six months. Prognosis is guarded to good
3. [b]Intrusive luxation (central dislocation).[/b] The teeth may normally re-erupt spontaneously. Surgical repositioning has been showed to increase complications such as external root resorption and loss of marginal bone support. Repositioning can be carried out orthodontically over a period of three to four weeks. The gingival lacerations should be sutured with an absorbable suture material. Prognosis is guarded due to the high incidence of root surface resorption.
4. [b]Avulsion (exarticulation).[/b] Immediate treatment involves cleaning the tooth gently with saline (no chemicals, do not rub the root surface). Irrigate the socket with a gentle stream of saline (do not curette the socket). Replant the tooth using gentle finger pressure. Apply an acid-etch retained splint. Dispense antibiotics for seven to 10 days. The avulsed tooth will require root canal therapy in two to four weeks post-splinting, which can be completed at the time of splint removal. Check the occlusion and follow-up with radiographs and sensitivity testing at six weeks and six months. Complications include root surface resorption (no treatment), replacement resorption (extraction if progressive, otherwise root canal therapy) and inflammatory resorption (root canal therapy. If there is a socket injury or periodontal ligament injury, then the socket is treated and delayed implantation is the treatment of choice. The tooth is cleaned of periodontal ligament and the socket is curetted. The root canal is filled extraorally. The tooth is placed in a fluoride solution (2.4 % sodium fluoride phosphate acidulated at pH 5.5) for 20 minutes prior to implantation. The tooth is rinsed, reimplanted and splinted. The fluoride will reduce the progression of root resorption by 50%.
Treatment of Injuries To The Supporting Bone and Prognosis[/size]

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[color=Magenta][size=5][b]標準Endodontic 技術Standard Endodontic Techniques  [/b][/size][/color]


介紹
標準根運河療法更加清楚被描述作為常規endodontics 。多數現代endodontic 治療介入不可逆地損壞的黏漿狀物質的撤除被清洗和塑造根運河空間和隨後裝填跟隨, 或obturation, 與半固體材料和海豹獵人。塑造運河由或手或發動機驅動的儀器完成。清潔由灌溉完成運河系統與也許是抗菌的和有組織溶化的能力的一定數量的解答的當中一個。Obturation 達到與馬來樹膠和根運河海豹獵人。
清潔和塑造階段endodontic 治療被認為最重要。當運河是乾淨的, 它重要, 系統由微生物不再次汙染。由於根運河系統的複雜解剖學, 完全消毒作用是幾乎無法達到。它重要, 因此, 任何殘餘的微生物在dentinal tubules 防止乘以對抗菌選礦的用途被三維裝填跟隨。Recontamination 從口腔必須被避免, 並且好冠狀封印的重要性無法被過高估計。
ENDODONTIC 疾病診斷
Endodontic 治療必需當pulpal 內容接受一個不可逆的退化激動過程或是壞死的並且牙必要作為齒列的一功能部份。許多endodontically 包含的牙的標誌也許被觀察在不同時候在受影響的動物的困厄期間。地方化的面部腫鼓或變動的parulis 或gumboil 頂端對包含的牙會提出牙齒膿腫的直接懷疑。地方lymphadenopathy 也許由觸診查出。被減少的尖酸的壓力在戲劇或侵略訓練期間也許是著名, 和願是食物勉強吃或拒絕, 特別艱苦或纖維狀食物, 和動物也許有選擇性地平衡從它的飲食消滅更加堅硬的項目。解除難受在膿腫發展期間的晚標誌, 動物也許經常試圖與涼快或冷的表面和液體聯繫。熱病也許顯現出當膿腫到達一個深刻階段。幅射線照相地, periapical 膿腫或肉芽腫也許出現作為一個圓radiolucent 區域在受影響的牙的尖頂; 骨多的trabeculation 是被減少或缺席的。在膿腫形成早期, 骨多的變動幅射線照相地不是存在。因此, 仙子頂端膿腫無法從有差別的診斷被消滅單一地根據一消極幅射線照相發現。
PULPECTOMY 技術
Pulpectomy 介入黏漿狀物質分庭和運河的內容的撤除。有應該連續地被獲得為成功合理的保證獸醫endodontic 療法的三個主要目標。
1 。 最初地, 黏漿狀物質分庭的整個內容和運河應該被去除以endodontic 文件和灌溉。
2 。 使用endodontic 文件, 運河應該被洗滌和被擴大給運河輕微的漏斗形狀。
3 。 尖頂(或尖頂) 被對待的牙應該被密封並且運河被包裝以一種endodontic 填充材料。抗藥性療法被推薦與endodontic 療法一道
訪問準備
牙齒射線照相總是endodontic 療法的一重要部份。根canal(s) 的形狀、長度、寬度和方向形象化在射線照相。所有endodontic 規程從射線照相開始。犬齒的通入形式被做在冠正義花冠的mesial 或面部表面的確切的中心對齒齦邊際。通入形式總被做在所有後部牙咬合表面。下頷骨第一槽牙將有二根。起始點滲透建立一個初步概述形式是在mesial 凹線的確切的中心和末端尖頂的確切的中心。有三根在上頷骨第四顆前臼齒。起始點滲透建立初步概述形式被集中在末端根運河輕微地末端對末端發展凹線。palatal (mesio 舌) 根被擊穿在palatal 坑, 幾乎在furcation 在palatal 和mesio 頰根之間。起始點滲透對mesio 頰根圍繞在這尖頂二分之一距離在尖頂要訣和齒齦邊際之間。trans 花冠方法並且被描述了。
運河準備
Debriding Canal(s)
當通入準備被完成了並且黏漿狀物質分庭被暴露, 分庭的內容, 如果有, 被去除使用一有刺的broach 。broach 是一條逐漸變細的鋼繩, 圓在橫剖面, 成裁減被做了在運作的末端。這些裁減創造倒鉤, 飄動從導線軸在一個向外方向。這些倒鉤捲入殘餘的黏漿狀物質內容和去除它當broach 從運河被撤出。運河是debrided 和然後塑造了使用Hedstrom 並且/或者K 類型文件。
Hedstrom 文件是一條逐漸變細的鋼繩, 圓在橫剖面, 長笛由機器過程切開。因為名字暗示, 這是文件並且運作的行動因而是在撤退。K 類型文件是一條逐漸變細的鋼繩, 方形或三角在橫剖面, 被掌握了在導線要訣和被扭轉了。行動將歸檔或在撤退。這個文件可能並且被使用在一次擴大的行動由安置它在運河對第一非強迫的聯絡, 轉動一個四分之一輪順時針和然後讓步。
根運河debridement 可能被援助以對一個結為螯合物的代理的用途譬如EDTA (乙烯二胺tetraacetic 酸) 。它的作用三倍: 它幫助debride 運河開放牙質tubules, 它軟化牙質使dentinal 撤除更加容易, 並且它潤滑運河。作為一個牙質變柔和的代理, EDTA 非常慢慢地運作。EDTA 由化工束縛認為結為螯合物或去除金屬離子譬如鈣他們。
概括
在debriding 的或歸檔的過程過程中, 根運河必須被概述。一個更小的直徑文件斷斷續續地是並且最後插入對被測量的頂端長度和被包裝入尖頂的小位元殘骸被去除保險總運河debridement 。概括是必要為適當的endodontic 成功。灌溉運河被灌溉用鈉次氯酸鹽(家庭漂白的) 解答。它能潤滑, 洗滌殘骸, 溶化有機組織和毀壞幾乎所有微生物被發現在根運河系統。漂白應該被灌溉從運河以最後的鹽灌溉。當canal(s) 被灌溉了在最後的時間, 殘餘的濕氣必須被消滅在運河可能被填裝之前。這可能由一再插入做各自的吸收劑紙點入運河。成功的endodontic 療法最好被獲得與一條乾燥運河在最後的填裝的做法之前。
填裝CANAL(S)
完全根運河治療的目標是準備的根運河和黏漿狀物質空間的總三維obturation 。孔在牙的尖頂不是黏漿狀物質空間的單一通信對外在表面根。Dentinal tubules 在一微觀等級, 以及輔助部件和側向運河在一宏觀等級, 能和聯絡與外在表面根。這是因此要求密封根運河在它的準備過程中和在頂端孔。這將防止微生物進入和reinfecting 牙由滲透。達到根運河的頂端和冠狀封印最重要。
Obturation 或根運河的裝填是做法的頂點在根運河療法。治療整個養生之道對這點將建立牙在生物兼容狀態, 和塑造和促進填裝運河。失敗對充分地obturate 和密封運河將導致endodontic 失敗。材料的組合來緊挨理想和買得起一種充分根運河填充材料: 馬來樹膠和根運河海豹獵人。根運河海豹獵人馬來樹膠單獨不是能密封根運河。在對準備的運河的最精確的適應, 微觀空間將存在和將允許漏出。為了達到充分封印, 根運河海豹獵人被使用與馬來樹膠一道提供總obturation 那個措施。例子包括Kerr Sealapex, Mynol 水泥、AH-26 、ESPE Ketac Endo 和氧化鋅與丁子香酚。
海豹獵人被使用創造和維護頂端封印。根運河水泥或海豹獵人由運用安置lentulo 螺旋補白在減少齒輪角度, 與endodontic 文件, 並且/或者靠射入技術。馬來樹膠馬來樹膠是某些樹被淨化的, 被凝固的乳狀滲出液被發現在馬來亞群島。它與橡膠相關緊密地。當安置馬來樹膠, 主要錐體慢慢地被選擇和被插入入運河允許空氣和剩餘海豹獵人逃脫在錐體附近。主要錐體大小對應於最後文件被使用當導航運河。然後分佈器由安置使用它入運河在主要錐體和運河牆壁之間。側向結露使用安置壓力在一個頂端方向。分佈器的逐漸變得尖細是側向地壓縮和塗馬來樹膠的機械力量。分佈器創造空間為一個另外的輔助錐體。柔和地撤出分佈器形式根運河使用反覆轉動的運動和立刻插入一個準備的輔助錐體入最近被塑造的空間。直接安置是必要的因為馬來樹膠將反彈在分佈器被去除之後。輔助錐體應該輕微地小比分佈器。重覆側向地凝聚馬來樹膠和增加輔助錐體這個做法直到運河充分地被填裝了對子宮頸線。熱傳遞儀器被使用垂直凝聚運河的子宮頸部份和枯萎剩餘馬來樹膠在水平2 毫米頂端對子宮頸線。Glick No.1 或接觸' n ' 熱(EIE/Analytic 技術, 桔子, 加州) 也許被使用。做射線照相展示根運河裝填的完整性或殘缺不全。如果運河不是完全地obturated, 馬來樹膠將需要被去除並且做法再開始。一旦obturation 被證實, 冠狀分庭必須周到地被清洗。所有海豹獵人和馬來樹膠片段必須被去除。清洗通入海豹獵人使用酒精被浸泡的棉花藥丸。
訪問恢復
運河的隨後而來的裝填恢復可能被安置, 使用或者綜合或混合物, 密封通入開頭和破裂排行。首先, 根運河填充材料用玻璃離子聚合物或其它中間滋補材料層數報道。其次, 下面裁減洞準備被完成。如果綜合被使用, 搪瓷被銘刻, 漂洗, 並且粘合劑被應用和治療。終於, 綜合或混合物被安置, 被完成, 和被擦亮。
OBTURATION 的評估
幅射線照相的評估是對obturation 的評估唯一的直接方法。學習obturation 射線照相為radiolucencies 表明空隙或殘缺不全的obturation 。填充材料應該是一致的密度從頂端對冠狀方面以鋒利和分明邊際。材料應該延伸到工作長度, 應該反射運河的形狀, 逐漸變細從花冠對頂端。進一步評估應該預定在二個星期和六個星期, 被射線照相逐年跟隨在六個月和然後爾後。

INTRODUCTION
Standard root canal therapy is more clearly described as conventional endodontics. Most modern endodontic treatment involves removal of the irreversibly damaged pulp followed by cleaning and shaping of the root canal space and subsequent filling, or obturation, with a semisolid material and a sealer. Shaping of the canal is done by either hand or engine-driven instruments. Cleaning is done by irrigating the canal system with one of a number of solutions that may be antibacterial and have tissue-dissolving ability. Obturation is achieved with gutta-percha and a root canal sealer.
The cleaning and shaping phase of endodontic treatment is regarded as the most important. When the canal is clean, it is important that the system is not recontaminated by microorganisms. Because of the complex anatomy of the root canal system, complete disinfection is almost impossible to achieve. It is important, therefore, that any remaining microorganisms in the dentinal tubules are prevented from multiplying by the use of an antimicrobial dressing followed by three-dimensional filling. Recontamination from the oral cavity must be avoided, and the importance of a good coronal seal cannot be overestimated.
DIAGNOSIS OF ENDODONTIC DISEASE
Endodontic treatment is required when the pulpal contents are undergoing an irreversible degenerative inflammatory process or are necrotic and the tooth is needed as a functional part of the dentition. Many signs of the endodontically involved tooth may be observed at various times during the affected animal's distress. Localized facial edema or a fluctuant parulis or gumboil apical to the involved tooth would raise immediate suspicions of a dental abscess. Regional lymphadenopathy may be detected by palpation. Reduced biting pressure during play or aggression training may be noted, as may be reluctance to eat or refusal of food, especially hard or fibrous food, and the animal may even selectively eliminate harder items from its diet. To relieve discomfort during late signs of abscess development, the animal may constantly attempt to contact cool or cold surfaces and liquids. Fever may develop as the abscess reaches an acute stage. Radiographically, the periapical abscess or granuloma may appear as a circular radiolucent area at the apex of the affected tooth; bony trabeculation is reduced or absent. In the early stages of abscess formation, bony changes are not radiographically present. Because of this, peri-apical abscess cannot be eliminated from the differential diagnosis solely based on a negative radiographic finding.
PULPECTOMY TECHNIQUE
Pulpectomy involves removal of the contents of the pulp chamber and canal. There are three major goals of veterinary endodontic therapy that should be sequentially attained for reasonable assurance of success.
1. Initially, the entire contents of the pulp chamber and canal should be removed with endodontic files and irrigation.
2. Using endodontic files, the canals should be cleansed and enlarged to give the canal a slight funnel shape.
3. The apex (or apices) of the treated tooth should be sealed and the canal packed with an endodontic filling material. Antibiotic therapy is recommended in conjunction with endodontic therapy
ACCESS PREPARATION
Dental radiographs are always an important part of endodontic therapy. The shape, length, width and direction of the root canal(s) are visualized on the radiograph. All endodontic procedures begin with radiographs. Access form of the canine teeth is made in the exact center of the mesial or facial surface of the crown just coronal to the gingival margin. Access form is always made on the occlusal surface of all posterior teeth. The mandibular first molar will have two roots. The initial point of penetration to establish a preliminary outline form is in the exact center of the mesial groove and the exact center of the distal cusp. There are three roots in the maxillary fourth premolar. The initial point of penetration to establish preliminary outline form is centered over the distal root canal slightly distal to the distal developmental groove. The palatal (mesio-lingual) root is penetrated at the palatal pit, nearly over the furcation between the palatal and mesio-buccal root. The initial point of penetration to the mesio-buccal root is centered on this cusp one-half the distance between the cusp tip and the gingival margin. A trans-coronal approach has also been described.
CANAL PREPARATION
Debriding the Canal(s)
When access preparation has been completed and the pulp chamber is exposed, the contents of the chamber, if any, are removed using a barbed broach. A broach is a tapered steel wire, round in cross section, into which cuts have been made in the working end. These cuts create barbs, which flare from the shaft of the wire in an outward direction. These barbs entangle residual pulp content and remove it when the broach is withdrawn from the canal. The canal is then debrided and shaped using Hedstrom and/or K-type files.
A Hedstrom file is a tapered steel wire, round in cross section, whose flutes are cut in by a machine process. As the name implies, it is a file and thus the working action is on the withdrawal. The K-type file is a tapered steel wire, square or triangular in cross section, which has been grasped at the very tip of the wire and twisted. The action is to file or on withdrawal. This file can also be used in a reaming action by placing it in the canal to the first unforced contact, rotating a quarter turn clockwise and then withdrawing.
Root canal debridement can be aided with the use of a chelating agent such as EDTA (ethylene diamine tetraacetic acid). Its function is threefold: it helps debride the canal opening up dentin tubules, it softens the dentin making dentinal removal easier, and it lubricates the canal. As a dentin-softening agent, EDTA works very slowly. The EDTA is meant to chelate or remove metallic ions such as calcium by binding them chemically.
Recapitulation
Throughout the debriding or filing process, the root canal must be recapitulated. A smaller diameter file is intermittently and finally inserted to the measured apical length and the small bits of debris that are packed into the apex are removed to insure total canal debridement. Recapitulation is a necessity for proper endodontic success. Irrigation The canal is irrigated with a solution of sodium hypochlorite (household bleach). It is able to lubricate, wash out debris, dissolve organic tissue and destroys almost all of the microorganisms found in the root canal system. The bleach should be irrigated from the canal with a final saline irrigation. When the canal(s) have been irrigated for the final time, residual moisture must be eliminated before the canal can be filled. This can be done by repeatedly inserting individual absorbent paper points into the canal. Successful endodontic therapy is best attained with a dry canal prior to the final filling procedure.
FILLING THE CANAL(S)
The goal of complete root canal treatment is the total three-dimensional obturation of the prepared root canal and pulp spaces. The foramina at the apex of the tooth are not the sole communication of the pulp spaces to the external surface of the root. Dentinal tubules on a microscopic scale, as well as accessory and lateral canals on a macroscopic scale, can and do communicate with the external surface of the root. It is therefore a requirement to seal the root canal throughout its preparation as at the apical foramina. This will prevent microorganisms from entering and reinfecting the tooth by percolation. Achieving an apical and coronal seal of the root canal is most important.
Obturation or the filling of the root canal is the culmination of the procedure in root canal therapy. The entire regimen of treatment to this point has been to establish the tooth in a biologic compatible status, and to shape and facilitate filling the canal. Failure to fully obturate and seal the canal will lead to endodontic failure. A combination of materials comes close to the ideal and affords an adequate root canal filling material: Gutta-percha and root canal sealer. Root Canal Sealers Gutta-percha alone is not capable of sealing a root canal. Even in the most precise adaptation to the prepared canal, microscopic spaces will exist and allow leakage. In order to achieve an adequate seal, root canal sealers are used in conjunction with gutta-percha to provide that measure of total obturation. Examples include Kerr Sealapex, Mynol Cement, AH-26, ESPE Ketac-Endo and Zinc Oxide with Eugenol.
Sealers are used to create and maintain an apical seal. The root canal cement or sealer is placed by utilizing lentulo spiral fillers on a reduction gear contra angle, with endodontic files, and/or by injection techniques. Gutta-Percha Gutta-percha is a purified, coagulated milky exudate of certain trees found in the Malayan Archipelago. It is closely related to rubber. When placing the gutta-percha, the master cone is selected and is inserted slowly into the canal to allow air and excess sealer to escape around the cone. The master cone size corresponds to the last file used when instrumenting the canal. Then a spreader is used by placing it into the canal between the master cone and the canal wall. Lateral condensation is used to place pressure in an apical direction. The taper of the spreader is the mechanical force that laterally compresses and spreads the gutta-percha. The spreader is creating the space for an additional accessory cone. Gently withdraw the spreader form the root canal using a back and forth rotating movement and immediately insert a prepared accessory cone into the newly shaped space. Immediate placement is necessary since gutta-percha will rebound after the spreader is removed. The accessory cone should be slightly smaller than the spreader. Repeat this procedure of laterally condensing the gutta-percha and adding accessory cones until the canal has been fully filled to the cervical line. A heat transfer instrument is used to vertically condense the cervical portion of the canal and sear off the excess gutta-percha at a level 2 mm apical to the cervical line. A Glick No.1 or a Touch 'n' Heat (EIE/Analytic Technology, Orange, CA) may be used. Make a radiograph to demonstrate the completeness or incompleteness of the root canal filling. If the canal is not completely obturated, the gutta-percha will need to be removed and the procedure started over again. Once obturation is confirmed, the coronal chamber must be thoroughly cleaned. All sealer and gutta-percha fragments must be removed. Clean access sealer using alcohol soaked cotton pellets.
ACCESS RESTORATION
Following filling of the canal a restoration can be placed, using either composite or amalgam, to seal the access opening and fracture line. First, the root canal filling materials are covered with a layer of glass ionomer or other intermediate restorative material. Next, an under cut cavity preparation is completed. If composite is being used, the enamel is etched, rinsed, and a bonding agent applied and cured. Finally, the composite or amalgam is placed, finished, and polished.
EVALUATION OF OBTURATION
Radiographic evaluation is the only immediate method of assessment of the obturation. Study the obturation radiograph for radiolucencies indicating voids or incomplete obturation. The filling material should be of uniform density from apical to coronal aspects with sharp and distinct margins. The material should extend to the working length and should reflect the shape of the canal, tapering from coronal to apical. Further evaluations should be scheduled at two weeks and six weeks, followed by radiographs at six months and then yearly thereafter.?

minibabyqq 2007-1-26 02:28

[color=Magenta][size=5][b] 飲食的作用在牙周疾病The Effects of Diet on Periodontal Disease  [/b][/size][/color]


營養演奏在牙形成的一個重要角色和發展並且在骨頭發展和新陳代謝。它也許並且被介入在疾病過程影響牙和它的支撐結構。當有當前將防止牙周疾病的發展的沒有營養素的知道的唯一營養素或組合, 許多營養素缺乏被認為與齒齦炎和periodontitis 發展和進步連接。另外, 飲食的紋理將影響牙齒儲蓄和因而齒齦健康的儲積。
牙周疾病原因論和發病原理
齒齦炎和periodontitis 的主要起因是匾的儲積在牙表面。結石(齒垢) 是一個次要病因學因素。牙周疾病發病原理充分地絕不被闡明。匾細菌和他們的產品, 並且主人的激動和免疫反應, 對periodontium 的破壞貢獻。
致病性機制被介入在牙周疾病有:
直接傷害由匾微生物。
間接傷害由匾微生物通過炎症。
雖然許多微生物學的研究被進行了, 協會在具體periopathogens 和periodontitis 之間依然是決定性地被證明。它不是可能陳述是否microbiota 發現了在深牙周口袋裡何處支撐結構被毀壞了是起因或periodontitis 的作用。許多微生物產品有一點點或沒有直接毒性作用在主人; 反而他們擁有潛力激活non-immune 和免疫激動反應。這是實際上造成組織損傷的這些激動反應。
總之, 它不是可能整個地佔牙周疾病發病原理。狗有, 最近三十年, 被使用作為實驗性模型為人的牙周疾病。儘管這, 我們不充分地仍然瞭解機制被介入在疾病發展在或者種類。它現在是好接受, 然而, 這是對匾細菌的主人的反應而不是直接地造成組織損傷的微生物劇毒。
臨床考慮
未受干擾的匾儲積導致齒齦炎。但是, 沒有所有動物以未經治療的齒齦炎將進步對periodontitis 。健康齒齬可能由頻繁臨床維護, 通常每日, 匾撤除。在人, 取消匾唯一最有效的手段是頻繁, 更好地每日, 牙掠過。這並且被顯示適用為狗。
動物與臨床健康齒齬不會開發periodontitis 。未經治療的齒齦炎將, 在一些個體, 進展對periodontitis 。在我們的知識的當前層, 我們無法預言哪個體以齒齦炎將開發periodontitis 。
飲食紋理的作用
關係在飲食紋理和匾的齒齦炎的儲積和發展之間清楚地未被展示在人, 雖然鏈接被確定了在狗。它提議, 區別看在研究在人和狗之間也許歸結於另外牙解剖學, 即, 也許考慮到牙表面更加高效率的清潔通過嚼的狗牙是逐漸變細。當纖維狀食物也許幫助從嚼取消匾表面, 區域在齒齦邊際(重要區域附近為牙周疾病的_蒙) 由嚼高效率地不洗滌。
幾名工作者調查了未加工的蘋果或紅蘿蔔的每日加法的作用對飲食在齒齦健康在人。除顯示對齒齦炎的減少的一項研究之外, 其他人沒有顯示有利作用從這些食物的加法被獲得。幾項最近研究調查了減少牙齒儲蓄的儲積機械手段(匾和結石) 通過飲食紋理在狗。這修改過的乾燥飲食和牙齒衛生學嚼減少匾和結石的儲積和齒齦炎嚴肅。他們臨床不維護健康齒齬在沒有牙掠過時。而且, 它有被展示, 減少齒齦炎嚴肅必要將防止periodontitis 的發展。
除機械上清潔之外牙, 鼓勵嚼的食物並且將刺激唾液流程。唾液包含幫助保持嘴乾淨的抗菌代理。它並且被推測, 嚼幫助加強齒齦音骨頭和牙周韌帶如此減少開發periodontitis 風險。但是, 證據支持這種理論缺乏。
營養影響
牙周疾病的主要起因是匾的儲積在牙表面。但是, 對疾病發展和進步的可能的營養影響也許發生。營養也許影響牙周疾病的機制有:
1 。 抗菌行動。 許多營養素有抗菌活動。這些也許修改牙齒匾的數量並且/或者質量和因而同對齒齦炎症的減少聯繫在一起。
2 。 抗發炎作用。 減少對傷害的主人反應的營養素也許導致對齒齦炎periodontitis 嚴肅的減少並且/或者發展和進步。這些運作在影響酵素旁邊被介入在抗發炎化合物的生產或在修改旁邊化合物實際上導致。
3 。 免疫系統修改。 一些營養素被認為作為免疫系統修飾詞他們優選host.s 免疫反應以便防護免疫反應勝過self-destructive 部分。這能由齒齦皮膜的滲透性的改變並且完成, 如此改變對細菌產品的主人抵抗。
4 。 抗氧化作用。 營養素在抗氧化行動幫助下維護細胞正直由減少被host.s 激動和免疫反應創始對主人組織的自由基損傷。他們並且用於保護主人免受細菌損傷。
研究迄今表示, 幾營養素缺乏有一個作用在牙周疾病發展和進步。另一方面, 沒有確鑿的證據, 任一營養素的補充在和在必需的水平之外之上有一個作用在牙周疾病的發展。有趣的是, 牙周疾病的發展可能有一個深刻作用在個體的營養狀態。牙痛苦和損失可能影響個體的情感福利, 並且將影響食物選擇做出。這可能導致是更加損傷的對受影響的個體營養缺乏並且/或者嚴厲營養不良的發展。它應該被強調, 沒有可能被使用作為每日牙掠過和規則牙齒核對的一個替補的已知的營養干預。平衡的營養應該使用與一個有效的牙齒衛生學節目一道減少開發牙周疾病風險。
總之
飲食紋理被顯示了對牙齒儲蓄的影響儲積在狗, 雖然這樣鏈接未建立在人。營養缺乏主要由修改顯示影響牙周疾病對匾的主人反應, 但營養素不會防止疾病發展或進步。營養素的補充未被顯示對影響疾病, 雖然數, 包括葉酸和維生素C, 保證促進調查。很好平衡的飲食的組合、規則牙齒考試和清潔, 和一個好家庭牙齒衛生學節目將減少開發牙周疾病風險在人和動物。

Nutrition plays an important role in tooth formation and development as well as in bone development and metabolism. It may also be involved in disease processes affecting the tooth and its supporting structures. While there is currently no known single nutrient or combination of nutrients that will prevent the development of periodontal disease, deficiencies of many nutrients are thought to be linked to the development and progression of both gingivitis and periodontitis. In addition, the texture of the diet will affect accumulation of dental deposits and thus gingival health.
AETIOLOGY AND PATHOGENESIS OF PERIODONTAL DISEASE
The primary cause of gingivitis and periodontitis is accumulation of plaque on the tooth surfaces. Calculus (tartar) is a secondary etiologic factor. The pathogenesis of periodontal disease is by no means fully elucidated. The plaque bacteria and their products, as well as the inflammatory and immune reactions of the host, contribute to the destruction of the periodontium.
The pathogenic mechanisms involved in periodontal disease include:
Direct injury by plaque microorganisms.
Indirect injury by plaque microorganism via inflammation.
Although numerous microbiological studies have been performed, the association between specific periopathogens and periodontitis remains to be conclusively proven. It is not yet possible to state whether the microbiota found in deep periodontal pockets where supporting structures have been destroyed are the cause or an effect of periodontitis. Many microbial products have little or no direct toxic effect on the host; instead they possess the potential to activate non-immune and immune inflammatory reactions. It is these inflammatory reactions that actually cause the tissue damage.
In summary, it is not yet possible to entirely account for the pathogenesis of periodontal disease. The dog has, for the last thirty years, been used as the experimental model for human periodontal disease. Despite this, we still do not fully understand the mechanisms involved in disease development in either species. It is now well accepted, however, that it is the host's response to the plaque bacteria rather than microbial virulence that directly causes the tissue damage.
CLINICAL CONSIDERATIONS
Undisturbed plaque accumulation will result in gingivitis. However, not all animals with untreated gingivitis will progress to periodontitis. Clinically healthy gingivae can be maintained by frequent, usually daily, plaque removal. In man, the single most effective means of removing plaque is frequent, preferably daily, tooth brushing. This has also been shown to hold true for the dog.
Animals with clinically healthy gingivae will not develop periodontitis. Untreated gingivitis will, in some individuals, progress to periodontitis. At our current level of knowledge, we cannot predict which individuals with gingivitis will develop periodontitis.
THE EFFECT OF DIETARY TEXTURE
The relationship between dietary texture and the accumulation of plaque and development of gingivitis has not been clearly demonstrated in humans, although a link has been determined in dogs. It has been proposed that differences seen between studies in man and dogs may be due to the different tooth anatomy, i.e., dog teeth are more tapered which may allow for more efficient cleaning of the tooth surface through chewing. While fibrous foods may help to remove plaque from chewing surfaces, the area around the gingival margin (the important area for the initiation of periodontal disease) is not efficiently cleansed by chewing.
Several workers have investigated the effect of the daily addition of raw apples or carrots to the diet on gingival health in man. With the exception of one study that showed a reduction in gingivitis, others showed no beneficial effect being derived from the addition of these foods. Several recent studies have investigated mechanical means of reducing accumulation of dental deposits (plaque and calculus) via dietary texture in the dog. These modified dry diets and dental hygiene chews do reduce the accumulation of plaque and calculus and the severity of gingivitis. They do not maintain clinically healthy gingivae in the absence of tooth brushing. Moreover, it has yet to be demonstrated that reducing the severity of gingivitis will necessarily prevent the development of periodontitis.
Aside from mechanically cleaning the teeth, food that encourages chewing will also stimulate salivary flow. Saliva contains anti-bacterial agents that help keep the mouth clean. It has also been speculated that chewing helps strengthen the alveolar bone and periodontal ligament thus reducing the risk of developing periodontitis. However, the evidence to support this theory is lacking.
NUTRITIONAL INFLUENCES
The primary cause of periodontal disease is the accumulation of plaque on the tooth surfaces. However, possible nutritional influences on the development and progression of disease may occur. Mechanisms by which nutrition may affect periodontal disease include:
1. Anti-Microbial Action. Many nutrients have anti-microbial activity. These may alter the quantity and/or quality of dental plaque and thus be associated with a reduction in gingival inflammation.
2. Anti-Inflammatory Effect. Nutrients that decrease the host response to injury may result in a reduction in the severity of gingivitis and/or development and progression of periodontitis. These work by affecting the enzymes involved in the production of the anti-inflammatory compounds or by altering which compounds are actually produced.
3. Immune System Modification. Some nutrients are thought to act as immune system modifiers in that they optimise the host𠏋 immune response so that the protective immune reactions outweigh the self-destructive ones. This could also be accomplished by alteration of the permeability of the gingival epithelium, thus changing host resistance to bacterial products.
4. Anti-Oxidant Effect. Nutrients with an anti-oxidant action help maintain cell integrity by reducing the free radical damage to host tissues that is initiated by the host𠏋 inflammatory and immune reactions. They also serve to protect the host from bacterial damage.
Research to date shows that deficiencies of several nutrients have an effect on the development and progression of periodontal disease. On the other hand, there is no conclusive evidence that supplementation of any nutrient above and beyond required levels has an effect on the development of periodontal disease. Interestingly, the development of periodontal disease can have a profound effect on nutritional status of the individual. Pain and loss of teeth can affect the emotional well-being of the individual and will also affect the food choices made. This can result in the development of nutritional deficiencies and/or severe malnutrition that are even more detrimental to the affected individual. It should be emphasized that there is no known nutritional intervention that can be used as a substitute for daily tooth brushing and regular dental check-ups. Balanced nutrition should be used in conjunction with an effective dental hygiene program to reduce the risk of developing periodontal disease.
IN SUMMARY
Dietary texture has been shown to influence accumulation of dental deposits in the dog, although such a link has not been established in man. Nutritional deficiencies have been shown to affect periodontal disease primarily by altering the host response to plaque, but no nutrient will prevent disease development or progression. Supplementation of nutrients has not been shown to affect disease, although several, including folic acid and vitamin C, warrant further investigation. The combination of a well balanced diet, regular dental examinations and cleanings, and a good home dental hygiene program will reduce the risk of developing periodontal disease in man and animals.

minibabyqq 2007-1-26 02:29

[color=Magenta][size=5][b]Endodontic 解剖學和診斷Endodontic Anatomy and Diagnosis  [/b][/size][/color]


介紹
Endodontics 也許被定義作為牙齒科學分支與形式、作用、牙齒黏漿狀物質和periradicular 區域的健康, 和治療的研究有關。Endodontic 治療包括任一個做法被設計維護所有的健康, 或一部分的, 黏漿狀物質。當黏漿狀物質是害病或傷害, 治療是瞄準的維護或恢復periradicular 組織的健康, 通常由根運河治療, 但偶爾地與endodontic 手術的組合。
標準根運河療法更加清楚被描述作為常規endodontics 。多數現代endodontic 治療介入不可逆地損壞的黏漿狀物質的撤除被清洗和塑造根運河空間和隨後裝填跟隨, 或obturation, 與半固體材料和海豹獵人。 塑造運河完成用手或發動機驅動的儀器, 後者包括聲波和超音波地供給動力的文件和handpieces 以轉動, 任意地振動, 或交換行動。清潔由灌溉完成運河系統與也許是抗菌的和有組織溶化的能力的一定數量的解答的當中一個。Obturation 達到與馬來樹膠和根運河海豹獵人。
清潔和塑造階段endodontic 治療被認為最重要。當運河是乾淨的, 它重要, 微生物不再次汙染系統。由於根運河系統的複雜解剖學, 完全消毒作用是幾乎無法達到。它重要, 因此, 任何殘餘的微生物在dentinal tubules 防止乘以對抗菌選礦的用途被三維裝填跟隨。Recontamination 從口腔必須被避免並且好冠狀封印的重要性無法被過高估計。
ENDODONTIC 解剖學
牙齒黏漿狀物質
牙齒黏漿狀物質是結締組織被裝箱在一個剛性堅硬組織。它包括細胞、地面物質, 和神經系統和血管供應。黏漿狀物質, 與圍攏它的牙質一道, 指黏漿狀物質牙質複合體。牙質是專業結締組織mesenchymal 起源。它由高度被區分的和專業odontoblasts 放下和形成牙的礦化的部份的大多數
Tubules 包含長的狹窄的odontoblastic 過程。它是不定的是否這些過程到牙質的中點或充分的距離旅行到牙質搪瓷連接點。tubules 用流體被填裝並且流體交換也許發生從黏漿狀物質向外或從搪瓷往黏漿狀物質。
Peritubular 牙質排行tubules 和由odontoblast 過程放下。Peritubular 牙質被認為形成作為老化的正常後果, 也許被刺激加速譬如齲、損耗, 和磨蝕。dentinal tubules 鎖柱由這個過程和由礦物水晶叫做硬化和給年邁的牙他們的典型半透明。
主要牙質形式在牙發展期間。次要牙質形成一旦牙充分地被發展並且放下在整個pulpal 表面; 這是亦稱生理或規則次要牙質
Odontoblast 細胞身體被分離從礦化的牙質由unmineralized 層數以predentin 著名。Odontoblasts 形式每細胞層數, 但在組織學部分出現作為一個多層的結構因為他們的中堅力量是在不同的水平。Odontoblasts 是不能勝任的進一步分裂一次充分地成熟, 和如果損壞, 也許被替換從undifferentiated mesenchymal 細胞。黏漿狀物質的剩下的人包括是嵌入成纖維細胞和激動細胞和血管和神經纖維一個複雜網路的地面物質。
黏漿狀物質的作用
黏漿狀物質的主要作用是形成和防禦。防禦反應對黏漿狀物質的生存是根本的。黏漿狀物質並且被認為作為對疾病的一種知覺器官(即, 牙物質損失) 警告由得出痛苦, 但這是一個相對地粗劣的警告系統明顯地考慮黏漿狀物質成為不可逆地激起牙的數量, 沒有警告。任一牙變形起因於裝載也許由本體感受器查出在黏漿狀物質。雖然一個本體感受的機制的存在未被證明, 它為破裂提供一個解釋為pulpless 牙的感受性。
黏漿狀物質血管供應
黏漿狀物質的血管系統幫助它克服封閉的問題在剛性牙之內。小動脈從牙齒動脈(A. facialis) 進入通過頂端孔和在中心通過通過黏漿狀物質, 釋放側向分支, 劃分進一步成血絲。更小的船到達odontoblastic 層數, 在在哪裡之下他們廣泛地劃分形成結節和在odontoblastic 層數之內。多血脈性的回歸通過血絲網路收集, 團結對形式venules 追獵在黏漿狀物質下的中央部份。獨特的特點在這個安排是動靜脈分流器, 防止不能堅持的壓力積累在剛性環境裡。淋巴船確定地未被證實。總之, 以年齡, 供血減少並且它的建築學變得更加簡單。這被減少的供血也許使黏漿狀物質易受影響不可逆的損傷。
黏漿狀物質神經供應
牙齒黏漿狀物質富有地innervated 與知覺和自主神經系統的神經纖維。這些進入黏漿狀物質與血管通過頂端孔。如同神經捆綁通行證他們劃分成更小的分支和coronally 形成Raschow 密集的結節。 各自的軸突也許分支入許多終端細絲, 也許反過來進入dentinal tubules; 一軸突也許innervate 100 dentinal tubules 。一些tubules 也許包含幾神經纖維。
自主神經系統的神經供應包括有同情心的纖維, 控制microcirculation 。知覺激動包括二(可能三) 類型纖維。更加快速的舉辦的d 纖維認為負責對銳利, 地方化的dentinal 痛苦被體驗在鑽井期間, 探查, 空氣hyperosmotic 流體的乾燥、應用, 和熱化或冷卻牙質。這些刺激共同的特點是, 他們導致流體的迅速運動在dentinal tubules, 導致組織機械畸變在黏漿狀物質牙質疆界和刺激d 纖維(水力理論) 。打開的dentinal tubules 由酸蝕刻也許增加牙質敏感性。相反地, 阻攔tubules, 例如由綜合樹脂或自然地由硬化, 防止可變的流程和減低敏感牙質。
更加緩慢舉辦的刺激, unmyelinated C 纖維被認為提升更加愚鈍, 跳動, 較少地方化的痛苦。C 纖維被熱量, 機械或化工刺激激活到達黏漿狀物質的更加深刻的部份
第三類型神經, ss 纖維, myelinated 和有最迅速的傳導速度。這些纖維被認為反應原封冠的非有毒機械刺激, 也許是重要在調控的咀嚼和裝載牙, 但他們並且反應牙質的刺激。
Periradicular Tissues.Cementum.........
牙骨質蓋radicular 牙質。牙骨質是主要一個無機組織和比牙質不滲透的。多孔的牙骨質包含聯絡互相通過小管和與牙質的cementocytes 。它通常被發現在牙的頂端和furcation 地區。Sharpey.s 纖維也許被埋置在多孔的牙骨質裡。非細胞牙骨質形成牙骨質最內在的層數和是無細胞。它幾乎報道整體根表面在稀薄的透明層數。它包含嚴密被包裝的礦化的牙周纖維。中間牙骨質被發現在cementodentinal 連接點和有牙骨質和牙質的特徵。牙骨質的作用將為牙周韌帶纖維提供附件, 暫停牙從齒齦音骨頭。
Periradicular Tissues.Periodontal 韌帶
牙周韌帶是支持牙的密集的纖維狀結締組織並且附有它它的插口。它的主要成分是膠原, 被埋置在一個膠般矩陣。纖維被安排在具體小組以各自的作用。這些包括齒齦, transseptal, 齒齦音冠, 水平, 傾斜, 和頂端纖維。功能適應也許發生在寬廣的區域以中間結節著名。韌帶的主單元是成纖維細胞以偶爾的激動細胞。Hertwig 根鞘, 幫助根形成, 不是完全斷開線一旦根形成是完全的, 但退化入什麼類似一個穿孔的袋子上皮細胞, 有時描述作為剩餘Malassez 。這些細胞可能激增當由炎症刺激形成囊腫。
對牙周韌帶的供血起源於下等牙齒動脈。小動脈進入韌帶在根的尖頂附近和從齒齦音插口和分支的側向方面血絲在韌帶之內在一個polyhedric 樣式沿牙的長的軸。膠原纖維運行通過空間。血管是離骨頭較近比對牙骨質。Venules 排泄尖頂通過開口在插口的骨多的牆壁和入骨髓空間。
神經捆綁進入牙周韌帶通過許多孔在齒齦音骨頭。他們分支和結束在小被環繞的身體在牙骨質附近。神經運載痛苦、接觸, 和壓力感覺和構成masticatory 用具的反饋機制的重要部分。
牙周韌帶的作用包括本體感受的作用和作為一個黏彈性坐墊由於它的纖維和液壓機液體系統(血管和他們的與船水庫的通信在韌帶的骨髓和細胞間的流體) 。韌帶有巨大能適應的容量; 它反應功能超載由加寬解除裝載在牙。血管通信在黏漿狀物質和periodontium 之間形成路為炎症傳輸和微生物在組織之間。
Periradicular Tissues.Alveolar 骨頭
齒齦音骨頭支持牙由形成另一附件為牙周韌帶的纖維。它包括表皮骨頭二塊板材由吸水的骨頭分離。在一些區域, 齒齦音骨頭是稀薄的沒有吸水的骨頭。齒齦音骨頭和表皮板材是最厚實的在下顎骨。吸水的骨頭橫條的形狀和結構反射一個特殊站點的注重軸承要求。骨頭的無機零件的表面由osteoblasts 排行負責任對骨頭形成。成為合併在礦物組織之內的那些細胞叫做osteocytes 和保持互相聯絡通過小管; osteoclasts 負責對骨頭吸回, 也許被看見在Howship.s 空白
ENDODONTIC 疾病診斷
Endodontic 治療必需當pulpal 內容接受不可逆退化激動處理或是牙必要作為齒列的一功能部份的necrotic.and 。黏漿狀物質的死亡和壞死發生當它被侵略和被淹沒由致病性細菌並且/或者由於精神創傷。
許多endodontically 包含的牙的標誌也許被觀察在不同時候在受影響的動物的困厄期間。地方化的面部腫鼓或變動的parulis (或gumboil) 頂端對包含的牙會培養直接可疑對牙齒膿腫。地方lymphadenopathy 也許由觸診查出。被減少的尖酸的壓力在戲劇或侵略訓練期間也許是著名, 和願是食物勉強吃或拒絕, 特別艱苦或纖維狀食物; 動物也許有選擇性地平衡從它的飲食消滅更加堅硬的項目。解除難受在膿腫發展期間的晚標誌, 動物也許經常試圖與涼快或冷的表面和液體聯繫。熱病也許顯現出當膿腫到達一個深刻階段。
要求endodontic 治療牙的臨床標誌被概述了以各種各樣的來源。牙以牙周疾病也許進步對導致的endodontic 疾病。這些臨床標誌看在破碎的和原封牙(表1) 裡。
表1: 牙的臨床標誌要求Endodontic 治療
1 。   冠狀破裂以靈菌。
2 。   冠狀破裂沒有靈菌; 黏漿狀物質運河可能被探查與一位endodontic 探險家。
3 。   冠是原封的; 牙變色顯示pulpal 壞死(顏色也許變化從紅色對黑色) 。
4 。   軟的組織標誌:...
a 。   管狀的短文在muco 頰重疊犬齒的根尖頂。
b 。   在下軌道膨脹從endodontically 包含的上頷骨第4 顆前臼齒或第1 槽牙。
c 。   在下下頷骨fistula 從排泄犬齒。
牙齒想像
齒列的幅射線照相的圖像和periradicular 組織幫助定義程度endodontic 疾病。是否這些圖像導致使用數字設備或標準牙齒影片, 沒有在診斷的endodontic 疾病上的區別。幅射線照相地, periapical 膿腫或肉芽腫也許出現作為一個圓radiolucent 區域在受影響的牙的尖頂; 骨多的trabeculation 是被減少或缺席的。在膿腫形成早期, 骨多的變動幅射線照相地不是存在。因此, periapical 膿腫無法從有差別的診斷被消滅單一地根據一消極幅射線照相發現。經常, 比較同樣牙的圖像在下頜的雙方將顯露在也許表明endodontic 疾病的黏漿狀物質分庭或黏漿狀物質運河上的區別。


INTRODUCTION
Endodontics may be defined as the branch of dental science concerned with the study of form, function, health, and treatment of the dental pulp and periradicular region. Endodontic treatment includes any procedure designed to maintain the health of all, or part of, the pulp. When the pulp is diseased or injured, treatment is aimed at maintaining or restoring the health of the periradicular tissues, usually by root canal treatment, but occasionally in combination with endodontic surgery.
Standard root canal therapy is more clearly described as conventional endodontics. Most modern endodontic treatment involvesremoval of the irreversibly damaged pulp followed by cleaning and shaping of the root canal space and subsequent filling, or obturation, with a semisolid material and a sealer. Shaping of the canal is done by hand or engine-driven instruments, the latter including sonically and ultrasonically powered files and handpieces with rotating, randomly vibrating, or reciprocating actions. Cleaning is done by irrigating the canal system with one of a number of solutions that may be antibacterial and have tissue-dissolving ability. Obturation is achieved with gutta-percha and a root canal sealer.
The cleaning and shaping phase of endodontic treatment is regarded as the most important. When the canal is clean, it is important that microorganisms do not recontaminate the system. Because of the complex anatomy of the root canal system, complete disinfection is almost impossible to achieve. It is important, therefore, that any remaining microorganisms in the dentinal tubules are prevented from multiplying by the use of an antimicrobial dressing followed by three-dimensional filling. Recontamination from the oral cavity must be avoided and the importance of a good coronal seal cannot be overestimated.
ENDODONTIC ANATOMY
The Dental Pulp
The dental pulp is a connective tissue encased in a rigid hard tissue. It consists of cells, ground substance, and neural and vascular supplies. The pulp, in conjunction with the dentin that surrounds it, is referred to as the pulp-dentin complex. Dentin is a specialized connective tissue of mesenchymal origin. It is laid down by highly differentiated and specialized odontoblasts and forms the bulk of the mineralized portion of the tooth
Tubules contain the long narrow odontoblastic process. It is uncertain whether these processes travel to the midpoint of the dentin or the full distance to the dentin-enamel junction. The tubules are filled with fluid and fluid exchange may occur from the pulp outwards or from the enamel towards the pulp.
Peritubular dentin lines the tubules and is laid down by the odontoblast process. Peritubular dentin is thought to form as a normal consequence of aging and may be accelerated by stimuli such as caries, attrition, and abrasion. Occlusion of dentinal tubules by this process and by mineral crystals is called sclerosis and gives aged teeth their characteristic translucency.
Primary dentin forms during tooth development. Secondary dentin forms once the teeth are fully developed and is laid down evenly over the entire pulpal surface; it is also known as physiological or regular secondary dentin
Odontoblast cell bodies are separated from mineralized dentin by an unmineralized layer known as predentin. Odontoblasts form a single layer of cells, but in histological section appears as a multilayered structure because their nuclei are at different levels. Odontoblasts are incapable of further division once fully mature, and if damaged, may be replaced from undifferentiated mesenchymal cells. The remainder of the pulp consists of ground substance into which are embedded fibroblasts and inflammatory cells and a complex network of blood vessels and nerve fibers.
The Functions of the Pulp
The primary function of the pulp is formative and defensive. Defense reactions are essential to the survival of the pulp. The pulp has also been thought to act as a sensory organ that warns against disease (i.e.,loss of tooth substance) by eliciting pain, but this is a relatively poor warning system considering the number of teeth whose pulps become irreversibly inflamed, apparently without warning. Any tooth deformation resulting from loads may be detected by proprioceptors in the pulp. Although the existence of a proprioceptive mechanism has not been proven, it does offer an explanation for the susceptibility of pulpless teeth to fracture.
The Vascular Supply of the Pulp
The vascular system of the pulp helps it to overcome problems of encapsulation within the rigid tooth. Arterioles from the dental arteries (A. facialis) enter through the apical foramina and pass centrally through the pulp, giving off lateral branches, which divide further into capillaries. Smaller vessels reach the odontoblastic layer, where they divide extensively to form a plexus below and within the odontoblastic layer. Venous return is collected by a network of capillaries, which unite to form venules coursing down the central portion of the pulp. The unique feature in this arrangement is the arteriovenous shunt, which prevents build-up of unsustainable pressure in the rigid environment. Lymphatic vessels have not been definitely confirmed. In general, with age, the blood supply diminishes and its architecture becomes simpler. This diminished blood supply may render a pulp more susceptible to irreversible damage.
The Nerve Supply of the Pulp
The dental pulp is richly innervated with sensory and autonomic nerve fibers. These enter the pulp with the blood vessels through the apical foramina. As the nerve bundles pass coronally they divide into smaller branches and form the dense plexus of Raschow. Individual axons may branch into many terminal filaments, which in turn may enter the dentinal tubules; one axon may innervate up to 100 dentinal tubules. Some tubules may contain several nerve fibers.
The autonomic nerve supply consists of sympathetic fibers, which control the microcirculation. The sensory innervation consists of two (possibly three) types of fibers. The faster conducting A-d-fibers are thought to be responsible for sharp, localized dentinal pain experienced during drilling, probing, air drying, application of hyperosmotic fluids, and heating or cooling dentin. The common feature of these stimuli is that they cause rapid movement of fluid in the dentinal tubules, which cause mechanical distortion of tissue in the pulp-dentin border and stimulates the A-d-fibers (the hydrodynamic theory). Opening dentinal tubules by acid etching may increase sensitivity of dentin. Conversely, blocking the tubules, for example by composite resins or naturally by sclerosis, prevents fluid flow and desensitizes dentin.
Stimulation of the slower conducting, unmyelinated C-fibers are thought to give rise to the duller, throbbing, less localized pain. The C-fibers are activated by thermal, mechanical or chemical stimuli reaching the deeper parts of the pulp
A third type of nerve, the A-ß-fibers, are myelinated and have the most rapid conduction velocity. These fibers are thought to respond to non-noxious mechanical stimulation of the intact crown and may be important in regulating mastication and loading of teeth, but they also respond to stimulation of dentin.
The Periradicular Tissues䊼ementum?????
Cementum covers the radicular dentin. The cementum is primarily an inorganic tissue and is more impervious than dentin. Cellular cementum contains cementocytes which communicate with each other via canaliculi and with dentin. It is usually found in the apical and furcation regions of the tooth. Sharpey𠏋 fibers may be embedded in cellular cementum. Acellular cementum forms the innermost layer of cementum and is devoid of cells. It covers almost the whole root surface in a thin hyaline layer. It contains closely packed mineralized periodontal fibers. Intermediate cementum is found at the cementodentinal junction and has characteristics of both cementum and dentin. The function of cementum is to provide attachment for the periodontal ligament fibers, which suspend the tooth from the alveolar bone.
The Periradicular Tissues𢰦eriodontal Ligament
The periodontal ligament is a dense fibrous connective tissue that supports the tooth and attaches it to its socket. Its principal component is collagen, which is embedded in a gel-like matrix. The fibers are arranged in specific groups with individual functions. These include gingival, transseptal, alveolar crest, horizontal, oblique, and apical fibers. Functional adaptation may take place in the broad zone known as the intermediate plexus. The main cells of the ligament are fibroblasts with occasional inflammatory cells. The root sheath of Hertwig, which helps root formation, does not totally involute once root formation is complete, but degenerates into what resembles a perforated bag of epithelial cells, sometimes described as the rests of Malassez. These cells can proliferate when stimulated by inflammation to form a cyst.
The blood supply to the periodontal ligament originates from the inferior dental artery. Arterioles enter the ligament near the apex of the root and from lateral aspects of the alveolar socket and branch into capillaries within the ligament in a polyhedric pattern along the long axis of the tooth. Collagen fibers run through the spaces. The blood vessels are closer to the bone than to the cementum. Venules drain the apex through apertures in the bony wall of the socket and into the marrow spaces.
Nerve bundles enter the periodontal ligament through numerous foramina in the alveolar bone. They branch and end in small rounded bodies near the cementum. The nerves carry pain, touch, and pressure sensations and form an important part of the feedback mechanism of the masticatory apparatus.
Functions of the periodontal ligament includes proprioceptive functions and acting as a viscoelastic cushion because of its fibers and hydraulic fluid systems (blood vessels and their communication with vessel reservoirs in the bone marrow and interstitial fluid of the ligament). The ligament has great adaptive capacity; it responds to functional overload by widening to relieve the load on the tooth. Vascular communications between the pulp and periodontium form pathways for transmission of inflammation and microorganisms between the tissues.
The Periradicular Tissues嫎lveolar Bone
Alveolar bone supports the teeth by forming the other attachment for fibers of the periodontal ligament. It consists of two plates of cortical bone separated by spongy bone. In some areas, alveolar bone is thin with no spongy bone. The alveolar bone and cortical plates are thickest in the mandible. The shape and structure of the trabeculae of spongy bone reflect the stress-bearing requirements of a particular site. The surfaces of the inorganic parts of bone are lined by osteoblasts responsible for bone formation. Those cells which become incorporated within the mineral tissue are called osteocytes and maintain contact with each other via canaliculi; osteoclasts are responsible for bone resorption and may be seen in the Howship𠏋 lacunae
DIAGNOSIS OF ENDODONTIC DISEASE
Endodontic treatment is required when the pulpal contents are undergoing an irreversible degenerative inflammatory process or are necrotic㻡nd the tooth is needed as a functional part of the dentition. Death and necrosis of the pulp occur when it is invaded and overwhelmed by pathogenic bacteria and/or as a result of trauma.

minibabyqq 2007-1-26 02:29

[color=Magenta][size=5][b]打開尖頂Endodontics Open Apex Endodontics  [/b][/size][/color]


目標和原則
開放尖頂endodontics 是承認根治療無法成功地被對待以一種標準endodontic 治療的治療形式。外科endodontics 的目標是去除堅持的periapical 傳染的原因元素, 並且伴生的periapical 損害。取消periapical 傳染的起因, root(s) 的頂端末端外科地被去除並且新頂端末端three-dimensionally 被清洗, 被塑造, 和被填裝得密封運河從periapical 組織。根尖頂的外科曝光允許periapical 損害的刮術, 遞交為histopathologic 評估。
徵兆
外科endodontics 被表明為無法被對待以一種標準normograde endodontic 治療的根, 並且那些不成功地被對待了並且預測是好以一種外科治療比與再加工。但是, 多數研究表示, 長期預測是好與再加工比以外科endodontics 。有是再加工是成功的案件, 在外科endodontic 治療失敗了以後。
選擇在二個選擇, 再加工或外科endodontics 之間, 應該根據失敗的被察覺的起因。有關於儀器工作的質量的問題的案件, obturation, 或恢復是確定候選人為再加工。的確, 有毛病的通入或破裂站點恢復經常被忽略了作為endodontic 治療失敗的主要起因。垂直的根破裂應該並且被認為一種可能性以endodontic 治療失敗。在這種情況下, 治療的形式不會運作和牙, 或它的根如果根切除術被考慮, 應該被提取。
主要徵兆為外科endodontics 是損害的起因不是在運河的案件以難達到對根尖頂通過運河(pulpal 石頭, 運河obliteration), 案件(被擠壓的物質, 外國身體) 或, 儘管它的起因的排除, periapical 損害自已永存的地方(periapical 囊腫) 。醫療禁忌症候為外科endodontics 是未管制的糖尿病、結束階段腎臟病, 和免役缺陷。
牙齒禁忌症候是再加工有一種更好的預測, 根尖頂無法外科地被獲取的箱子(上部第四顆前臼齒的palatal 根), 並且牙無法被保存的地方。牙, 或它的根, can.t 被保存當它不是可恢復的, 妥協由於它的牙周狀態, 或有垂直的根破裂。
耐心準備
patient.s 醫療和牙齒歷史應該首先被回顧。patient.s 資料庫應該包括血液學評估和血液化學。任一種系統疾病應該被估計確定如果患者是一名適當的候選人為麻醉和endodontic 治療。如果需要, patient.s 健康狀態應該被穩定在做法之前。血液凝結缺乏會是一個嚴肅的問題在外科endodontic 治療期間。如果懷疑從patient.s 醫療故事的回顧, 血液凝結的作用應該被評估(靈菌時間, 被激活凝固時間) 。
技術
如果不已經做, 或如果根運河治療的質量是可疑的, normograde endodontic 治療應該完成或被再做。外科endodontics 不是適當的清潔, 塑造, 和radicular 系統的三維obturation 的一個替補。
The 牙經常被對待以外科endodontics 在獸醫牙科方面是犬齒和carnassials 。他們被認為戰略牙由於他們的重要性談到他們的大小和作用。carnassials 和上部犬齒的根接近通過一塊頰mucoperiosteal 擋水板。半月形的切開被集中在根的中部被對待。juga 幫助的觸診地方化根。切開apically 繼續在遠的線角度下顆mesial 和末端牙。它的長度應該允許頂端區域的曝光以擋水板的被動收縮在它的海拔以後與一個periosteal 電梯。
更低的犬齒的根接近通過皮膚切開被集中超過根的頂端三在下顎骨的腹方面。皮膚下組織和骨膜被舉起暴露下顎骨的腹外皮。
osteotomy 被集中超過根的頂端三。尖頂的地點可能由使用估計從牙齒射線照相或工作長度測量被做在normograde 根運河治療期間。osteotomy 執行與一個高速手片斷和圓的bur, 或更好地外科bur (Lindman) 。bur 冷卻與不育鹽。一個外科手片斷有不送被加壓的空氣好處, 因此防止皮膚下氣腫和空氣栓塞。
骨頭周圍地被去除使用蝕刻行動直到尖頂被發現。牙質是黃色和軟在紋理比骨頭。尖頂被暴露足夠考慮到它刮術、部分, retro 儀器工作和填裝。病理性組織從土窖被去除與骨頭curette 和被保存為histopathological 考試。做法的最重要的部份是被傳染的材料的撤除在根運河。根的頂端末端被切除與逐漸變細的裂痕bur 。它被推薦去除至少3 毫米, 但這必須被衡量以患者的大小。
如果運河的儀器工作將做與bur, 裁減用斜面(bucco 舌) 在45SYMBOL 176 \f "標誌" \s 被做10 附近。對牙的長的軸。斜面為更低的犬是mesio 末端的。以超音波或聲波根結束準備, 斜面可能是較少比45SYMBOL 176 \f "標誌" \s 10. 。裁減可能甚而是垂直對root.s 長的軸。有較不dentinal tubules 被暴露和少量可能性, 一條次要運河留給未經治療在根的舌方面。
apicoectomy 一次被完成, 土窖被漂洗和被保持乾燥與膠原、骨頭蠟, 或相似的產品。放大和一個好光源是根本的為根的被暴露的表面的一次詳盡的考試。它重要尋找次要根, 次要運河, 一個地峽出現在校長和需要被導航和被密封的次要運河, 和radicular 系統任一個變型之間。
顯然最佳的方式導航運河和它的分枝將做一種超音波或聲波根結束準備。好處是巨大的: 更好的debridement, 準備的牆壁是平行並且集中與運河, 不育被維護在準備期間, 沒有變薄舌牆壁和較少穿孔的機會, 和填裝的水泥的更多保留。沒有需要對於斜面當頂端部份被切除頂端部份的root.more 可能被去除與寂靜更根原封。當運河是被削減的垂線對它長的軸, 有較少接口以漏出能發生的retro 填裝的材料。在超音波或聲波根結束準備是可利用的之前, 準備完成以一個微型角度在一個低速手片斷或一個平直的手片斷。一個相反錐體bur 被使用創造保留以咬邊。
一旦準備是完全的, 根結束用不育鹽或檸檬酸被漂洗etchant 和被烘乾。它也許是必要替換物質牆壁土窖保持它乾燥在retro 裝填期間。準備被檢查它的透徹。
給最佳的結果的填充材料是超級EBA 和IRM 。這些ZOE 水泥被混合對黏土一貫性, 介紹, 並且凝聚在運河直到他們形成輕微過度充填。鍍鋅混合物, 早先標準材料, 經常被使用較少如同它導致更多漏出比超級EBA 或IRM 。MTA 是產生更好的結果比ZOE 水泥在在試管中的研究期間的新材料。如果它證明更好在長期活體內研究中, 它的用途也許改進封印的質量在根的頂端末端。
在水泥被設置之後, 它被雕刻與一臺冷的刀片儀器。根的被填裝的頂端末端可能然後使光滑以30 刀片綜合精整bur 。射線照相被採取評估裝填的質量。
物質牆壁土窖被取消並且mucoperiosteal 擋水板的外科站點和下面周到地被漂洗對明白任一殘骸。骨多的土窖用osteo 促進的材料然後被填裝(任意) 。擋水板被縫合安置了以能吸收的縫合材料在a swaged 在針使用一個簡單的不連續的縫合樣式。壓力是應用的在擋水板二分鐘以濕紗減少血塊厚度在擋水板之下, 因此傾向主要癒合。
在關心和FOLLOW-UP 以後
抗生素為七天和鎮痛藥被規定(NSAID) 四天。在第一二個星期期間, 患者被哺養唯一軟的食物和不被給什麼嚼(即, 玩具) 。在這個期間, 它被推薦漂洗嘴一兩次每日用chlorhexidine 的一種0.12% 解答。癒合mucoperiosteal 擋水板被檢查二個星期在手術以後並且規則口頭衛生學規程可能通常被恢復那時。後續射線照相手術後地被需要四個到六個月, 和爾後重覆了每12 個月。
結論
有是非常扣人心弦的改善在牙齒技術在最後十年期間。這些改善必要不意味, endodontic 治療外科地完成, 如同新技術並且改進能力non-surgically 對待根運河。新技術有一個巨大作用在牙齒工作可達成的今天的質量, 和那手段一種更好的預測為endodontic 疾病的治療在人和動物。


GOALS AND PRINCIPLES
Open apex endodontics is a treatment modality that allows treatment of roots that cannot be treated successfully with a standard endodontic treatment. The goal of surgical endodontics is to remove the causal elements of the persisting periapical infection, as well as the associated periapical lesions. To remove the cause of the periapical infection, the apical end of the root(s) is surgically removed and the new apical end is cleaned, shaped, and filled three-dimensionally to seal the canal from the periapical tissue. The surgical exposure of the root apex allows the curettage of the periapical lesions, which are submitted for histopathologic evaluation.
INDICATIONS
Surgical endodontics is indicated for roots that cannot be treated with a standard normograde endodontic treatment, and those which have been unsuccessfully treated and whose prognosis is better with a surgical treatment than with retreatment. However, most studies have shown that the long-term prognosis is better with retreatment than with surgical endodontics. There have been cases where retreatment has been successful, even after surgical endodontic treatment has failed.
The choice between the two options, retreatment or surgical endodontics, should be based on the perceived cause of the failure. Cases where there are questions about the quality of the instrumentation, obturation, or restoration are definite candidates for retreatment. Indeed, faulty access or fracture site restorations have often been overlooked as a main cause of endodontic treatment failure. Vertical root fracture should also be considered a possibility with endodontic treatment failure. In this case, neither modality of treatment would work and the tooth, or its root if a root resection is considered, should be extracted.
The main indications for surgical endodontics are cases with inaccessibility to the root apex through the canal (pulpal stones, canal obliteration), cases where the cause of the lesion is not in the canal (extruded material, foreign bodies) or where, despite elimination of its cause, a periapical lesion self-perpetuates (periapical cysts). The medical contraindications for surgical endodontics are uncontrolled diabetes, end-stage renal disease, and immunodeficiency.
The dental contraindications are the cases where a retreatment has a better prognosis, where the apex of the root cannot be accessed surgically (palatal root of an upper fourth premolar), and where the tooth cannot be saved. A tooth, or its root, can㦙 be saved when it is not restorable, is compromised because of its periodontal status, or has a vertical root fracture.
PATIENT PREPARATION
The patient𠏋 medical and dental history should first be reviewed. The patient𠏋 database should include hematological evaluation and blood chemistry. Any systemic disease should be assessed to determine if the patient is a suitable candidate for anesthesia and endodontic treatment. If needed, the patient𠏋 health status should be stabilized before the procedure. A blood clotting deficiency would be a serious problem during surgical endodontic treatment. If suspected from a review of the patient𠏋 medical story, blood-clotting functions should be evaluated (bleeding time, activated coagulation time).
TECHNIQUE
If not already done, or if the quality of the root canal treatment is questionable, a normograde endodontic treatment should be done or redone. Surgical endodontics is not a substitute for proper cleaning, shaping, and three-dimensional obturation of the radicular system.
�he teeth most often treated with surgical endodontics in veterinary dentistry are the canine teeth and the carnassials. They are considered strategic teeth because of their greater importance with respect to their size and function. The roots of the carnassials and upper canine teeth are approached via a buccal mucoperiosteal flap. The semi-lunar incision is centered over the middle of the root to be treated. Palpation of the juga helps localize the root. The incision is continued apically over the far line angle of the next mesial and distal tooth. Its length should allow exposure of the apical area with passive retraction of the flap after its elevation with a periosteal elevator.
The roots of the lower canine teeth are approached via a skin incision centered over the apical third of the root on the ventral aspect of the mandible. The subcutaneous tissue and periosteum are elevated to expose the ventral cortex of the mandible.
The osteotomy is centered over the apical third of the root. The location of the apex can be estimated from the dental radiographs or by using the working length measurement made during the normograde root canal treatment. The osteotomy is performed with a high-speed hand piece and a round bur, or preferably a surgical bur (Lindman). The bur is cooled with sterile saline. A surgical hand piece has the advantage of not sending pressurized air, thereby preventing subcutaneous emphysema and air embolism.
The bone is removed circumferentially using an etching motion until the apex is found. The dentin is more yellow and softer in texture than bone. The apex is exposed enough to allow for its curettage, section, retro-instrumentation and filling. The pathological tissue is removed from the crypt with a bone curette and saved for histopathological examination. The most important part of the procedure is the removal of the infected material in the root canal. The apical end of the root is resected with a tapered fissure bur. It is recommended to remove at least 3 mm, but this has to be weighted with the size of the patient.
If the instrumentation of the canal is to be done with a bur, the cut is made with a bevel (bucco-lingual) of around 45SYMBOL 176 \f "Symbol" \s 10?to the long axis of the tooth. The bevel for the lower canine is mesio-distal. With ultrasonic or sonic root-end preparation, the bevel can be less than 45SYMBOL 176 \f "Symbol" \s 10? The cut can even be perpendicular to the root𠏋 long axis. There are less dentinal tubules exposed and fewer possibilities that a secondary canal is left untreated on the lingual aspect of the root.
Once the apicoectomy is completed, the crypt is rinsed and kept dry with collagen, bone wax, or similar product. Magnification and a good light source are essential for a thorough examination of the exposed surface of the root. It is important to look for the presence of secondary roots, secondary canals, an isthmus between principals and secondary canals, and any aberration of the radicular system that need to be instrumented and sealed.
By far the best way to instrument the canal and its ramification is to do an ultrasonic or sonic root-end preparation. The advantages are tremendous: better debridement, the walls of the preparation are parallel and centered with the canal, sterility is maintained during the preparation, there is no thinning of the lingual wall and less chance of perforation, and more retention of the filling cement. There is no need for a bevel when the apical part is cut off the root𤧥ore of the apical part can be removed with still more of the root intact. When the canal is cut perpendicular to its long axis, there is less inter-face with the retro-filling material where leakage could occur. Before ultrasonic or sonic root-end preparation was available, preparation was done with a miniature contra-angle on a low-speed hand piece or a straight hand piece. An inverse cone bur was used to create retention with an undercut.
Once the preparation is complete, the root-end is rinsed with sterile saline or a citric acid etchant and dried. It might be necessary to replace the material walling the crypt to keep it dry during retro filling. The preparation is inspected for its thoroughness.
The filling materials that give the best results are Super EBA and IRM. These ZOE cements are mixed to a clay consistency, introduced, and condensed in the canal until they form a slight overfill. Zinc amalgam, the previous standard material, is used less often as it causes more leakage than Super EBA or IRM. MTA is a new material that yields even better results than the ZOE cements during in-vitro studies. If it proves better in long-term in-vivo studies, its use might improve the quality of the seal at the apical end of the root.
After the cement is set, it is carved with a cold blade instrument. The filled apical end of the root can then be smoothed with a 30-blade composite finishing bur. A radiograph is taken to evaluate the quality of the filling.
The material walling the crypt is removed and the surgical site and underside of the mucoperiosteal flap are rinsed thoroughly to clear any debris. The bony crypt is then filled with osteo-promotive material (optional). The flap is sutured in placed with absorbable suture material on a swaged-on needle using a simple discontinuous suture pattern. Pressure is applied on the flap for two minutes with wet gauze to reduce the blood clot thickness underneath the flap, thereby favoring primary healing.
AFTER CARE AND FOLLOW-UP
Antibiotics are prescribed for seven days and analgesics (NSAID) for four days. During the first two weeks, the patient is fed only soft food and is not given anything to chew on (e.g., toys). During this period, it is recommended to rinse the mouth once or twice daily with a 0.12% solution of chlorhexidine. The healing of the mucoperiosteal flap is checked two weeks after the surgery and the regular oral hygiene procedures can usually be resumed at that time. A follow-up r>><<reafter.
CONCLUSION
There have been very exciting improvements in dental technology during the last decade. These improvements do not mean necessarily that more endodontic treatments will be done surgically, as the new technology also improves the ability to treat root canals non-surgically. The new technology has had a tremendous effect on the quality of the dental work achievable today, and that means a better prognosis for treatment of endodontic disease in man and animal.

minibabyqq 2007-1-26 02:30

[color=Magenta][size=5][b]Dentigerous 囊腫在狗Dentigerous Cysts in Dogs  [/b][/size][/color]


Odontogenic 囊腫從口頭皮膜被獲得與相關牙齒用具的發展。在人的口頭病理學方面, 囊腫組織學上被分類, 根據細胞並且/或者組織, 入原始, dentigerous (囊泡), 牙周, 齒齦, 鈣化的odontogenic 囊腫, 或odontogenic keratocyst 的分化和發展。不幸地, 這個分類不是令人滿意的為臨床工作者。
dentigerous (囊泡) 囊腫是最共同的類型囊腫在人。這囊腫同一顆被衝擊的永久牙的冠聯繫在一起。爆發囊腫頻繁地同噴發落葉或永久牙聯繫在一起對於兒童。組織學上, 它被定義和epithelialized 洞包含可變或半固體材料, 與相關顯現出的牙齒用具。它被相信, 皮膜與相關odontogenic 囊腫可能從牙毒菌、被減少的搪瓷皮膜、上皮剩餘Malassez, Hertwig 鞘的殘餘, 牙齒lamina 的殘餘, 或可能口頭皮膜基礎層數被獲得。
在小動物牙科方面, odontogenic 囊腫很好未被提供。在狗, dentigerous 囊腫(包括爆發囊腫) 是最共同的odontogenic 囊腫。但是, 囊腫比其它腫瘤也許較不頻繁地被報告在似犬口腔因為發生是更低, 或臨床, 他們被誤診了作為缺掉牙以微妙或沒有臨床標誌。
Dentigerous 囊腫, 包括爆發囊腫, 被觀察了在12 條狗自1996 年以來。所有箱子被發現了在小養殖: 一條玩具長捲毛狗, 一馬爾祂, 一隻微型Schnauzer 、和九brachycephalic 養殖(即, Pug 、Pekingese, Shih Tzu) 或他們的雜種。dentigerous 囊腫未被發現在中間或大養殖狗, 或在任一大小dolicocephalic 養殖。大多dentigerous 囊腫聯繫了針對mal 的牙被發現了在狗經過五年紀, 並且爆發囊腫二個盒被發現了在小狗少於一年紀。許多案件被發現了在定期預防期間以微妙或沒有臨床標誌, 當一些顯示了齒齦膨脹、難受, 並且/或者厭食。恆定的靈菌從a fistulated 被爆裂的囊腫並且被中斷的脹大被觀察了。更低的第一槽牙是最共同地受影響的, 被先前落葉牙和永久犬跟隨。
所有囊腫用黏液流體, 包含被填裝了水晶, hemosiderin/hemoglobin 、血液並且/或者細胞群。相當數量囊狀流體禮物取決於程度骨頭吸回和排水設備出現。組織學研究結果包括變厚的齒齦皮膜並且2.4 層數non-keratinized 皮膜排行囊狀牆壁, 有或沒有炎症。希夫正面地下室膜被觀察了作為一個界限在上皮襯裡和結締組織之間。Brachycephalic 養殖卓越地並且變厚了齒齬。
放射學研究結果顯示冠unerupted 落葉或永久牙包含在radiolucent 區域當根停住了在齒齦音骨頭裡。嚴厲骨頭吸回unerupted 牙
經常同被衝擊的牙的mal 取向聯繫在一起。在某些情況下, radiolucent 區域延伸到精神孔的水平和末端對更低的犬。爆發囊腫聯繫了落葉齒列未同骨頭吸回聯繫在一起, 但落葉根吸回發生了。在一隻小狗, 上顎骨的不對稱的發展和下顎骨被觀察了, 造成扭曲的鎖柱。
dentigerous 囊腫由gingivoplasty, 外科正牙學治療, 和提取對待了與囊腫牆壁的debridement 。是嚴厲骨頭吸回的結果的囊狀洞用perioglass (Consil., Nutromax) 被填裝了。預測是令人滿意的。再現沒有發生。
前臼齒和門牙經常是缺掉在小養殖狗。這項研究建議, 臨床錯過的牙, 特別是第一前臼齒在小養殖狗, 應該放射學地被審查。如果任何被衝擊的牙被發現, 齒齦切除術、提取, 或正牙學更正被表明。dentigerous 囊腫的素質在brachycephalic 養殖不是清楚的從這次勘測。你能推測, 他們的下頷骨和齒齦解剖形態學也許貢獻因素。

Odontogenic cysts are derived from the oral epithelium associated with the development of the dental apparatus. In human oral pathology, cysts are histologically classified, depending on differentiation and development of cells and/or tissues, into primordial, dentigerous (follicular), periodontal, gingival, calcifying odontogenic cyst, or odontogenic keratocyst. Unfortunately, this classification has not been satisfactory for clinicians.
The dentigerous (follicular) cyst is the most common type of cyst in humans. This cyst is associated with the crown of an impacted permanent tooth. An eruption cyst is frequently associated with erupting deciduous or permanent teeth in children. Histologically, it is defined as epithelialized cavities containing fluid or semisolid material, associated with a developing dental apparatus. It is believed that the epithelium associated with odontogenic cysts can be derived from the tooth germ, the reduced enamel epithelium, the epithelial rests of Malassez, remnants of the sheath of Hertwig, remnants of the dental lamina, or possibly the basal layer of oral epithelium.
In small animal dentistry, odontogenic cysts have not been well documented. In dogs, dentigerous cysts (including eruption cysts) are the most common odontogenic cysts. However, cysts may be less frequently reported than other tumors in the canine oral cavity because the incidence is lower, or clinically, they were misdiagnosed as missing teeth with subtle or no clinical signs.
Dentigerous cysts, including eruption cysts, were observed in 12 dogs since 1996. All the cases were found in small breeds: one Toy Poodle, one Maltese, one Miniature Schnauzer, and nine brachycephalic breeds (e.g., Pug, Pekingese, Shih Tzu) or their crossbreeds. No dentigerous cysts have been found in middle or large breeds dogs, or in dolicocephalic breeds of any size. Most of the dentigerous cysts associated with mal-oriented teeth were found in dogs over five years of age, and two cases of eruption cysts were found in puppies less than one year of age. Many cases were found during routine prophylaxis with subtle or no clinical signs, while some showed gingival swelling, discomfort, and/or anorexia. Constant bleeding from a fistulated ruptured cyst and interrupted swellings were observed. The lower first molar was the most commonly affected, followed by anterior deciduous teeth and permanent canines.
All cysts were filled with mucous fluid, containing crystalline, hemosiderin/hemoglobin, blood and/or cell clusters. The amount of cystic fluid present depended on the extent of bone resorption and the presence of drainage. Histological findings include a thickened gingival epithelium and 2? layers of non-keratinized epithelium lining the cystic wall, with or without inflammation. The Schiff positive basement membrane was observed as a boundary between the epithelial lining and the connective tissue. Brachycephalic breeds also had remarkably thickened gingiva.
Radiological findings showed the crown of an unerupted deciduous or permanent teeth contained in the radiolucent area while the roots were anchored in alveolar bone. Severe bone resorption around unerupted teeth
was often associated with mal-orientation of impacted teeth. In some cases, the radiolucent area extended to the level of the mental foramen and just distal to the lower canines. Eruption cysts associated with the deciduous dentition were not associated with bone resorption, but deciduous root resorption did occur. In one puppy, asymmetric development of the maxilla and mandible was observed, resulting in a wry occlusion.
The dentigerous cysts were treated by gingivoplasty, surgical orthodontic treatment, and extraction with debridement of the cyst wall. The cystic cavities that were a result of severe bone resorption were filled with perioglass (Consil? Nutromax). The prognoses were satisfactory. Recurrence did not occur.
Premolars and incisors are often missing in small breed dogs. This study suggests that clinically missing teeth, especially the first premolar in small breed dogs, should be examined radiologically. If any impacted teeth are found, gingival resection, extraction, or orthodontic correction is indicated. Predisposition of dentigerous cysts in brachycephalic breeds is not clear from this survey. One could speculate that their mandibular and gingival anatomical morphology may be contributing factors.
REFERENCES

minibabyqq 2007-1-26 02:31

[color=Magenta][size=5][b]Odontogenic 腫瘤 [/b][/size][/color]

[size=12px]Odontogenic 腫瘤一般被認為罕見在所有種類。但是, 精確流行病學的資料不是可利用的為狗和貓。這的主要原因的當中一個是繼續的混亂關於這些損害的實質。在許多勘測所謂的 [i]epulides[/i], 是地方化的脹大在齒齦邊際並且構成各種各樣的病理性個體, 或一起被編組或被排除。最近研究結果表明, 許多epulides 是odontogenic 腫瘤。其它原因是事實許多臨床工作者定期地不遞交epulides 為histopathological 考試, 因此介紹傾斜在研究根據檔案材料。對情況的本質的一個準確評估是一個前提對於治療政策制定。它因此重要瞭解odontogenic 腫瘤生物。
分類
Odontogenic 腫瘤傳統上被分類了根據了出現或缺乏[i]歸納[/i]現象 。瞭解分類根據歸納, 它重要考慮上皮和mesenchymal 組織的相互互作用在odontogenesis 期間。上皮牙齒lamina invaginates 形成搪瓷器官。內在搪瓷器官皮膜包括pre-ameloblasts 。mesenchymal odontoblast 前體移居對地下室膜和最終聯繫聯絡以pre-ameloblasts 。pre-ameloblasts 然後導致odontoblasts 形成牙質。反過來, odontoblasts 影響ameloblasts 並且這些細胞開始藏匿搪瓷矩陣。mesenchymal stroma 被附寄在顯現出的牙齒濾泡導致承擔牙齒黏漿狀物質的特徵。當牙形成被完成, odontogenic 皮膜消失忘記上皮剩餘Malassez 在牙周韌帶。上皮細胞這些群保留他們的odontogenic 潛力, 也許用瘤形成隨後被表達。
ameloblastoma 是一個無感的腫瘤的例子。在這種腫瘤類型, 造形術細胞ameloblast 起源不導致周圍的mesenchymal 細胞。所以, 牙齒堅硬組織根本上不被形成和腫瘤遺骸的軟組織腫瘤。odontoma 是一個引人腫瘤的最佳的例子。Odontomas 是odontogenic 皮膜腫瘤以odontogenic ectomesenchyme 的歸納, 為所有牙齒堅硬和軟的組織的形成描繪, 包括搪瓷、牙質、牙骨質, 和黏漿狀物質。雖然分類根據歸納最近被摒棄了, 有優點在這個分類作為瞭解部下的過程幫助瞭解clinicopathological 交互作用。
世界衛生組織最近採取了一個分類根據造形術細胞的上皮, mesenchymal 或混雜的上皮mesenchymal 起源, 而不是一個根據引人變動。以下桌總結odontogenic 腫瘤的當前被接受的分類在人, 以各型一個例子知道發生在動物中: [table][tr][td=6,1,878]腫瘤與Odontogenic 用具有關
[/td][/tr][tr][td=3,1,438][b]良性[/b]
[/td][td=3,1,440][b]惡性[/b]
[/td][/tr][tr][td=1,1,146]Odontogenic 皮膜沒有odontogenic ectomesenchyme
[/td][td=1,1,146]Odontogenic 皮膜與odontogenic ectomesenchyme, 有或沒有牙齒堅硬組織形成
[/td][td=1,1,146]Odontogenic ectomesenchyme 有或沒有包括的odontogenic 皮膜
[/td][td=1,1,146]Odontogenic 癌
[/td][td=1,1,146]Odontogenic 肉瘤
[/td][td=1,2,148]Odontogenic carcinosarcoma
[/td][/tr][tr][td=1,1,146]即, ameloblastoma
[/td][td=1,1,146]即, odontoma
[/td][td=1,1,146]即, odontogenic fibroma
[/td][td=1,1,146]即, 主要內部osseous 癌
[/td][td=1,1,146]即, ameloblastic fibrodentino.sarcoma
[/td][/tr][/table]AMELOBLASTOMA
(中央或內部osseous) ameloblastoma 是最共同的odontogenic 腫瘤的當中一個(偶爾地不正確地指adamantinoma) 。這個腫瘤通常提出作為一個當地蔓延性瘤以osteolysis 在牙根和囊狀變動附近。ameloblastoma 的經典組織學出現是ameloblasts 和星形的蜂巢胃細胞的一個囊泡安排, 類似搪瓷器官的基本的結構。一定數量的組織學變形為人所知發生。Ameloblastoma 在狗為焦點keratinization 經常描繪。轉移未被描述。
似犬acanthomatous 或周邊ameloblastoma 和在中心被找出的ameloblastoma, 但出現是一個良性odontogenic 腫瘤以組織學特徵在下頜的牙軸承區域的齒齬和mucosa 一樣。在似犬epulides 一回顧, 多數損害, 最初被分類作為acanthomatous epulis, 被發現周邊ameloblastoma 。這些損害由成熟squamous 皮膜海島和板料組成在低落之內一膠原纖維狀結締組織stroma 減輕細胞性。這些海島和板料每個由palisading 的細胞列一定以核極化從地下室膜。濾滲在部下的骨頭是顯然的在許多情況下。周邊ameloblastoma 的放射學圖片由分離濾滲、齒齦音骨頭吸回, 和牙位移控制。雖然組織學上非常相似, ameloblastoma 這個變形與周邊ameloblastoma 不同在人因為它侵略骨頭。期限似犬acanthomatous ameloblastoma 被建議因此區分。在狗, 地方再現是非常共同的隨後而來的少量的切除並且寬或根本切除被推薦因此。
周邊ODONTOGENIC FIBROMA
腫瘤的一個大比例早先被描述作為fibromatous 和僵化的epulides 是周邊odontogenic fibromas 。這是一個生長緩慢, 良性瘤為隔絕海島或odontogenic 皮膜子線是存在纖維狀組織的擴散描繪。各種各樣骨頭, osteoid, dentinoid, 甚至牙骨質像材料也許被發現, 經常在接近的協會與odontogenic 皮膜, 建議mesenchymal 歸納。放射學特點變化根據出現和相當數量礦化的產品。周邊odontogenic fibroma 不復發如果充分地切除。在人, 周邊odontogenic fibroma 是一個罕見的情況, 但是它是共同在狗。
ODONTOMA
odontoma 是上皮和mesenchymal 細胞很好被區分造成所有牙齒組織類型的形成的腫瘤。odontoma 也許並且被認為hamartoma 而不是瘤。牙齒組織也許或不能陳列正常聯繫對互相。tooth-like 結構是存在的odontoma, 表明先進的多孔的分化和指一 [i]複合[/i] odontoma 。另一方面, 牙齒組織conglomerate 不具有相似對牙的odontoma 稱一 [i]複雜[/i] odontoma 。Odontomas 被診斷了在幼小狗和在貓。放射學出現是典型的和是或鈣化的材料尖銳被定義的大量由一條狹窄的radiolucent 帶圍攏或tooth-like 結構的一個易變的數字。odontoma 也許同聯繫在一起unerupted 牙, dentigerous 囊腫, 或也許附有一顆否則正常牙。期限ameloblastic odontoma 偶爾地遇到在獸醫文學。一ameloblastic odontoma 是一ameloblastoma 以焦點分化入odontoma 。
似貓的引人ODONTOGENIC 腫瘤
這種腫瘤類型最初被描述了在幼小貓作為引人fibro-ameloblastoma 。Ameloblastic 上皮細胞被安排在牙齒附近黏漿狀物質像stroma 描繪這個腫瘤。rostral 上顎骨是發生最共同的站點。腫瘤也許當地蔓延性, 但轉移未被記錄。
AMYLOID-PRODUCING ODONTOGENIC 腫瘤
這種腫瘤類型是罕見的, 也許臨床並且提出作為epulis 。它指在獸醫文學一個鈣化的上皮odontogenic 腫瘤, 雖然它被發現這不是人的CEOT 的似犬相對物。期限, 澱粉質食物生產odontogenic 腫瘤, 會似乎因此適當為這損害。腫瘤具有一些相似對ameloblastoma: 皮膜在一些區域展覽palisading 基礎細胞和星形的蜂巢胃也許焦點發生。最突出的特點是傾向於鈣化澱粉質食物的出現。再現在切除被報告了之後, 僅轉移不發生。


Odontogenic tumours are generally considered rare in all species. However, precise epidemiological data are not available for the dog and cat. One of the main reasons for this is the continuing confusion regarding the true nature of some of these lesions. In many surveys the so-called [i]epulides[/i], which are localized swellings on the gingival margin and which constitute a variety of pathological entities, are either grouped together or excluded. Recent findings indicate that many epulides are odontogenic tumours. Another reason is the fact that many clinicians do not routinely submit epulides for histopathological examination, thereby introducing bias in the studies based on archival material. An accurate assessment of the nature of the condition is a prerequisite for therapeutic decision-making. It is therefore important to understand the biology of odontogenic tumours.
CLASSIFICATIONS
Odontogenic tumours have traditionally been classified based on the presence or absence of the phenomenon of [i]induction[/i]. To understand the classification based on induction, it is important to consider the reciprocal interactions of epithelial and mesenchymal tissues during odontogenesis. The epithelial dental lamina invaginates to form the enamel organ. The inner enamel organ epithelium consists of the pre-ameloblasts. The mesenchymal odontoblast precursors migrate to the basement membrane and eventually make contact with the pre-ameloblasts. The pre-ameloblasts then induce the odontoblasts to form the dentin. In turn, the odontoblasts influence the ameloblasts and these cells start secreting the enamel matrix. The mesenchymal stroma enclosed in the developing dental follicle is induced to take on the characteristics of dental pulp. As tooth formation is completed, the odontogenic epithelium disappears leaving behind the epithelial rests of Malassez in the periodontal ligament. These clusters of epithelial cells retain their odontogenic potential, which may subsequently be expressed in neoplasia.
The ameloblastoma is an example of a non-inductive tumour. In this tumour-type, the neoplastic cells of ameloblast origin do not induce the surrounding mesenchymal cells. Therefore, no dental hard tissues are formed and the tumour remains essentially a soft-tissue tumour. The odontoma is the best example of an inductive tumour. Odontomas are tumours of odontogenic epithelium with induction of odontogenic ectomesenchyme, characterized by the formation of all dental hard and soft tissues, including enamel, dentin, cementum, and pulp. Although the classification based on induction has recently been abandoned, there is merit in this classification as understanding the underlying processes helps to understand the clinicopathological correlations.
The World Health Organization has recently adopted a classification based on the epithelial, mesenchymal or mixed epithelial-mesenchymal origin of the neoplastic cells, rather than one based on inductive changes. The following table summarizes the currently accepted classification of odontogenic tumours in man, with one example of each type known to occur in animals: [table][tr][td=6,1,878]Tumours Related to the Odontogenic Apparatus
[/td][/tr][tr][td=3,1,438][b]Benign[/b]
[/td][td=3,1,440][b]Malignant[/b]
[/td][/tr][tr][td=1,1,146]Odontogenic epithelium without odontogenic ectomesenchyme
[/td][td=1,1,146]Odontogenic epithelium with odontogenic ectomesenchyme, with or without dental hard tissue formation
[/td][td=1,1,146]Odontogenic ectomesenchyme with or without included odontogenic epithelium
[/td][td=1,1,146]Odontogenic carcinomas
[/td][td=1,1,146]Odontogenic sarcomas
[/td][td=1,2,148]Odontogenic carcinosarcoma
[/td][/tr][tr][td=1,1,146]e.g., ameloblastoma
[/td][td=1,1,146]e.g., odontoma
[/td][td=1,1,146]e.g., odontogenic fibroma
[/td][td=1,1,146]e.g., primary intra-osseous carcinoma
[/td][td=1,1,146]e.g., ameloblastic fibrodentino貞arcoma
[/td][/tr][/table]AMELOBLASTOMA
The (central or intra-osseous) ameloblastoma is one of the most common odontogenic tumours (occasionally incorrectly referred to as an adamantinoma). This tumour usually presents as a locally invasive neoplasm with osteolysis around the tooth roots and cystic changes. The classic histological appearance of an ameloblastoma is a follicular arrangement of ameloblasts and stellate reticulum cells, resembling the basic structure of the enamel organ. A number of histological variants are known to occur. Ameloblastoma in the dog is often characterized by focal keratinization. Metastasis has not been described.
The canine acanthomatous or peripheral ameloblastoma is a benign odontogenic tumour with the same histological characteristics as the centrally located ameloblastoma, but appearing in the gingiva and mucosa of the tooth-bearing area of the jaws. In one review of canine epulides, the majority of lesions, which were originally classified as acanthomatous epulis, were found to be peripheral ameloblastoma. These lesions are composed of islands and sheets of mature squamous epithelium within a collagenous fibrous connective tissue stroma of low to moderate cellularity. These islands and sheets are each bounded by a row of palisading cells with nuclear polarization away from the basement membrane. Infiltration in the underlying bone is evident in most cases. The radiological picture of peripheral ameloblastoma is dominated by discrete infiltration, alveolar bone resorption, and tooth displacement. Although histologically very similar, this variant of ameloblastoma differs from the peripheral ameloblastoma in man in that it invades bone. The term canine acanthomatous ameloblastoma was therefore suggested to make this distinction. In the dog, local recurrence is very common following marginal excision and wide or radical excision is therefore recommended.
PERIPHERAL ODONTOGENIC FIBROMA
A large proportion of tumours previously described as fibromatous and ossifying epulides are peripheral odontogenic fibromas. This is a slow-growing, benign neoplasm characterized by the proliferation of fibrous tissue in which isolated islands or strands of odontogenic epithelium are present. A variety of bone, osteoid, dentinoid, or even cementum-like material may be found, often in close association with the odontogenic epithelium, suggesting mesenchymal induction. Radiological features vary according to the presence and amount of mineralized products. Peripheral odontogenic fibroma does not recur if adequately excised. In man, the peripheral odontogenic fibroma is a rare condition, whereas it is common in the dog.
ODONTOMA
An odontoma is a tumour in which both the epithelial and mesenchymal cells are well differentiated resulting in the formation of all dental tissue types. An odontoma may also be considered a hamartoma rather than a neoplasm. The dental tissues may or may not exhibit a normal relation to one another. An odontoma in which tooth-like structures are present, indicates advanced cellular differentiation and is referred to as a [i]compound[/i] odontoma. On the other hand, an odontoma in which the conglomerate of dental tissues bears no resemblance to a tooth is called a [i]complex[/i] odontoma. Odontomas have been diagnosed in young dogs and in the cat. The radiological appearance is typical and is either a sharply defined mass of calcified material surrounded by a narrow radiolucent band or a variable number of tooth-like structures. An odontoma may be associated with unerupted teeth, a dentigerous cyst, or may be attached to an otherwise normal tooth. The term ameloblastic odontoma is occasionally encountered in the veterinary literature. An ameloblastic odontoma is an ameloblastoma with focal differentiation into an odontoma.
fELINE INDUCTIVE ODONTOGENIC TUMOUR
This tumour type was originally described in young cats as inductive fibro-ameloblastoma. Ameloblastic epithelial cells arranged around dental pulp-like stroma characterize this tumour. The rostral maxilla is the most common site of occurrence. The tumour may be locally invasive, but metastasis has not been recorded.
AMYLOID-PRODUCING ODONTOGENIC TUMOUR
This tumour type is rare and may also present clinically as an epulis. It has been referred to in the veterinary literature as a calcifying epithelial odontogenic tumour, although it was found that it is not the canine counterpart of the human CEOT. The term, amyloid-producing odontogenic tumour, would therefore seem more appropriate for this lesion. The tumour bears some resemblance to an ameloblastoma: the epithelium in some areas exhibits palisading of the basal cells and stellate reticulum may occur focally. The most prominent feature is the presence of amyloid that tends to calcify. Recurrence after excision has been reported, but metastasis does not take place.[/size]

minibabyqq 2007-1-26 02:31

[color=Magenta][size=5][b]牙撕裂Tooth Avulsion  [/b][/size][/color]


傷害對牙是共同在人的牙科方面。他們是主要地炫耀相關傷害和頻繁地被看見對於兒童。在獸醫方面, 傷害對牙經常當前作為破裂。但是, 撕裂和luxation 傷害發生在精神創傷期間從戰鬥和汽車事故。客戶應該被製作知道, 這些牙搶救是可能的以及時關注。撕裂傷害經常影響犬齒。工作狗的持續的價值與他們的齒列有關的作用因此牙的保存是重要的在這些個體。
在人的牙科方面, 有收效傷害的六個分類當力量適用於牙大於牙周韌帶(PL), neurovascular 供應和骨頭的物理極限:
1 。 震蕩: 反常鬆懈, 沒有幅射線照相的變動不被觀察。
2 。 半脫位: 傷害對牙支持結構以出血和鬆開沒有幅射線照相的變動
3 。 Extrusive luxation: 部份位移在插口外面以出血, neurovascular 和PL 纖維的完全中斷。牙是瘦長的並且有更寬的PL 空間在射線照相。
4 。 側向luxation: 異常位移與小窩PL 纖維破裂和破裂。有一點流動性與尖頂被鎖。增加的PL 空間被觀察在射線照相。
5 。 闖入luxation: 位移深深對齒齦音小窩的骨頭、破裂, 一顆短的牙、沒有流動性和尖頂在鼻道(犬齒在狗和貓) 。
6 。 Exarticulation (撕裂): 完成牙+/- 齒齦音fracture.(1) 的損失
影響類型位移的其它因素包括衝擊的力量和方向、對象形狀和根發展類型、階段, 牙周韌帶周圍的軟的組織的健康, 和厚度。傷害不變地是對齒齬、PL 、骨頭, 和牙骨質的複雜一介入的損傷。結果, 修理的樣式是相等地複雜的並且受撫養者在一定數量的pulpal 壞死和治療的可變物包括額外齒齦音期間和存貯, 率, treatment.(2) 一項研究類型外在支持被運用, 和分級法報告了較少成功為癒合當多撕裂發生。另外一個更高的成功率被注意了在下頷骨牙裡與上頷骨teeth.(3) 比較
有幾sequelae 對撕裂和luxation 傷害在牙。主要和多數一致的後遺症是pulpal 壞死由於供血的中斷對牙。在人牙科黏漿狀物質測試和黏漿狀物質生命力頻繁監視做在輕傷譬如震蕩。這是較不可行的在我們的患者並且傷害最頻繁地被提出是更加嚴厲的那麼那裡是一點混亂至於是否供血被打亂。一例外發生尖頂是開放的地方並且有是牙的一次級luxation 。與這些年輕牙巨大vascularity, 那裡也許是一個機會為生存。但是, 這些牙必須嚴密被監測。
表面吸回是發生在撕裂傷害以後的一個非侵入性的過程。小表面吸回洞發生在牙骨質和外面牙質之內。這是物理損傷的修理過程對鈣化的組織的由細胞的補充跟隨損壞的組織撤除由巨噬細胞。
替換吸回發生當PL 大區域丟失或被損壞。癒合發生從齒齦音邊創造聯合在牙和骨頭之間。這是根的並網入小窩的正常改造的過程以逐漸替換由bone.(4) 潛在的問題是根、傳染通過齒齦溝或冠破裂的破壞從正常懸浮損失由PL 提供。它重要注意到, avulsed 根的機械撤除或刮術導致替換吸回。
激動吸回迅速地是一個進步但可治療的過程。滾筒形的radiolucencies 擊穿牙質是顯然的在射線照相。這是dentinal tubules 聯絡的一個直接結果與壞死的黏漿狀物質。毒性產品通過tubules 對PL.(2) 最後的結果可能是內部, 外在, 或替換吸回。
PL 崗位撕裂的醫治用的樣式被審查了在猴子。在三天, 有分離線在PL 中間由血塊斡旋。在七天, 有junctional 皮膜的附件。齒齦衣領纖維團聚。PL 重建連續性與包含被混亂的成纖維細胞的結締組織。在一個月, PL 有一次正常出現但結締組織不是成熟的。在4 個月, 功能上針對的PL 是present.(4-7)
治療為concussive 牙傷在人的牙科方面介入軟的飲食二個星期以黏漿狀物質生命力接近的監視幾個月對幾年。藤條不被認為必要。治療為牙的半脫位是same.(1)
Extrusive luxation 傷害要求柔和改變位置牙與凝塊的慢擠壓。一個功能(非剛性的) 藤條是應用的二個到三個星期。Endodontics 由20 days.(1) 軟的飲食被建議的A 執行。
側向luxation 傷害要求強有力改變位置小窩的牙和壓縮。齒齦撕裂被修理。一個功能藤條是應用三個星期或更長的(六個星期) 如果齒齦音破裂是更加廣泛的。在人的牙科方面, endodontics 不可以必需, 根據牙的位移和成熟, 但是在獸醫牙科方面, 它不變地必需。
闖入傷害在一顆發育未全的牙, 如果不嚴厲, 也許允許re 爆發。在一顆成熟牙, 黏漿狀物質意志necrose 。治療要求外科改變位置和用夾板固定。畸齒矯正術也許必需如果傷害比48 hours.(1) 舊
治療exarticulated 牙要求直接replantation 在五分鐘內獲取一個有利結果。活躍持續的研究在人的牙科方面產生了幾個治療選擇但□一普遍性將避免烘乾PL 細胞在根表面。乾燥作用是PL 細胞死亡的主要起因。根大於五分鐘的乾燥時間是嚴厲地損傷的對PL 細胞survival.(4) 直接replantation 總不是可能的在患者承受了重大精神創傷處。耐心生存經常口授延遲在replantation 。在這些情況下, 我們外推從人的牙科, 不使用autologous 唾液作為暫時的支持而是設法去直接地變冷的低肥胖牛奶在4. C 直到到來在獸醫醫院。它重要不是讓牛奶溫暖對室溫在運輸期間但保持它變冷在ice.(4) 自來水將導致迅速細胞死亡和如果使用它必須是簡要的洗滌土從根。牛奶將防止細胞死亡和是只理想的近期因為它無法重新補充細胞但簡單地維護滲透的pressure.(1) 調動到一束平衡的鹽水(HBSS) 直到replantation 。目標是保存殘餘的PL 細胞clonogenic 潛力。那是PL 的能力再生。PL 意志necrose 在20 分鐘以後。最佳的支持是組織培養基譬如Eagle.s 媒介或Viaspan (8) 但他們難獲得和不太可能是可利用的在必需的時間。
在replantation 期間, 凝塊撤除是有爭議的但柔和的壓力應該被使用當不接觸根。插口的年齡是還重要的在癒合PL 。在一項最近研究中, 牙支持了在存儲介質但插口的各種各樣的年齡被使用了為replantation 。如同插口變老了, 程度癒合reduced.(9)
各種各樣的治療主張根據額外口頭時期、乾燥牙時期, 和成熟。一些治療為長時期的extraoral 時間包括檸檬酸、doxycycline 和氟化物。為大於120 分鐘的長時期的乾燥時期: 刮術、檸檬酸doxycycline 、氟化物, 和額外口頭endodontics 與CaOH.(1)
一旦牙被改種了, 一個功能藤條必須是應用的。要求有: 藤條被應用直接地在嘴, 沒有精神創傷對牙在應用期間並且撤除過程, 沒有侵入在齒齦組織, 能力允許口頭衛生學被保留, 並且分裂允許一些運動為PL healing.(10, 11) 剛性藤條促進ankylosis 。藤條必須允許通入為endodontics 。通常導線和綜合藤條運作得很好。他們應該適用於至少二顆穩定的牙在任何一方撕裂。導線不應該有記憶避免avulsed 牙的正牙學運動。輕的正牙學曲拱導線0.016.0.020 另外被使用在人dentistry.(12), 射線照相應該被採取核實被改種的位置在鎖柱被估計了以後。根據程度損傷藤條也許保留到位二個或更多星期。
附屬治療包括抗生素, 通常四圜素在人的患者。四圜素被使用因為它有抗菌和anti-resorptive 物產。它anti-resorptive 歸結於它的直接禁止在osteoclasts 並且collagenase.(13) 抗藥性療法在獸醫患者被勸告。Non-steroidal anti-inflammatories 並且被使用在撕裂傷害以後。Chlorhexidine 沖洗並且主張。破傷風並且被建議在人的患者。
一項最近研究審查了對dexamethasone 的用途在牙周癒合。更好癒合被注意了與地方dexamethasone (16 ug/ml 在Viaspan) 比與系統dexamethasone use.(14) 類固醇減少和阻攔巨噬細胞活化作用表示和減少osteoclast 數字和作用。Calcitonin 感受器官並且是enhanced.(14)
一般被接受的時期為黏漿狀物質extirpaton 和治療與CaOH 是七到14 天在人的牙科方面。一項研究建議黏漿狀物質extirpation 不是重要的如果做在少於20 days.(15) 如果pulpectomy 做在CaOH 一個乳脂狀的混合物被使用的7.10 天。如果pulpectomy 做在僵硬的CaOH 14 天或以後是used.(11) CaOH 被替換或重新包裝了每三個到六個月直到lamina dura 可能被追蹤在根尖頂附近在radiographs.(11)
一旦lamina dura 是原封的, 最後的obturation 與馬來樹膠和海豹獵人水泥執行。時間為+氧化鈣包裝最近被學習了。Trop 等, 認為, 當endodontics 被創始了在14 天, 長期或短期CaOH 沒有產生明顯的變化對醫治用的樣式在被改種的狗teeth.(16) 在其它研究中, 它結束了長期CaOH 療法比短期也許有效的在建立的激動根resorption.(17) 的治療
戰略地重要牙搶救是可能的以及時關注和詳盡的後續。客戶需要做出一個消息靈通的決定和財政和時間承諾對多被演出的規程為了達到成功。根據Andreasen if 所有avulsed 牙立刻被改種了, 醫治用的率的85.97% 能被期望的PL 。

Injuries to teeth are common in human dentistry. They are predominantly sports related injuries and frequently seen in children. In veterinary medicine, injuries to teeth most often present as fractures. However, avulsions and luxation injuries occur during trauma from fights and motor vehicle accidents. Clients should be made aware that salvage of these teeth is possible with prompt attention. Avulsion injuries often affect the canine teeth. The continued value of working dogs is related to the function of their dentition so preservation of the teeth is critical in these individuals.
In human dentistry, there are six classifications of injuries that result when the force applied to the tooth is greater than the physical limits of the periodontal ligament (PL), neurovascular supply and bone:
1. Concussion: no abnormal loosening, no radiographic changes are observed.
2. Subluxation: injury to the tooth support structure with hemorrhage and loosening-no radiographic changes
3. Extrusive luxation: partial displacement out of the socket with hemorrhage, complete disruption of the neurovascular and PL fibres. The tooth is elongated and there is a wider PL space on radiographs.
4. Lateral luxation: eccentric displacement with alveolus fracture and rupture of PL fibres. There is little mobility with the apex locked. An increased PL space is observed on radiographs.
5. Intrusive luxation: displacement deep to alveolar bone, fracture of the alveolus, a short tooth, no mobility and the apex in the nasal passages (canine teeth in the dog and cat).
6. Exarticulation (avulsion): complete loss of the tooth +/- alveolar fracture.(1)
Other factors that affect the type of displacement include force and direction of the impact, object shape and type, stage of root development, periodontal ligament health, and thickness of the surrounding soft tissue. The injury is invariably a complex one involving damage to gingiva, PL, bone, and cementum. Consequently, the pattern of repair is equally complex and dependent on a number of variables including extra-alveolar duration and storage, rate of pulpal necrosis and treatment, type of external support applied, and staging of treatment.(2) One study has reported less success for healing when multiple avulsions occur. In addition a higher success rate was noted in mandibular teeth when compared with maxillary teeth.(3)
There are several sequelae to avulsion and luxation injury in the tooth. The predominant and most consistent sequela is pulpal necrosis due to disruption of the blood supply to the tooth. In human dentistry pulp testing and frequent monitoring of pulp vitality is done in more minor injuries such as concussion. This is less feasible in our patients and the injuries most frequently presented are far more severe so there is little confusion as to whether blood supply is disrupted or not. One exception does occur where the apex is open and there has been a sub- luxation of the tooth. With the tremendous vascularity of these young teeth, there may be an opportunity for survival. However, these teeth must be monitored closely.
Surface resorption is a non-invasive process that occurs after avulsion injury. Small superficial resorption cavities occur within the cementum and the outer dentin. It is a repair process of the physical damage to calcified tissue by recruitment of cells following removal of damaged tissue by macrophages.
Replacement resorption occurs when large areas of PL are lost or damaged. Healing occurs from the alveolar side creating a union between tooth and bone. It is the incorporation of the root into the normal remodeling process of the alveolus with gradual replacement by bone.(4) The potential problem is the destruction of the root, infection via the gingival sulcus or crown fracture from loss of normal suspension provided by the PL. It is important to note that mechanical removal or curettage of the avulsed root will result in replacement resorption.
Inflammatory resorption is a rapidly progressive but treatable process. Bowl-shaped radiolucencies penetrating the dentin are evident on radiographs. It is a direct result of contact of dentinal tubules with necrotic pulp. Toxic products pass through the tubules to the PL.(2) The eventual outcome can be internal, external, or replacement resorption.
The healing pattern of the PL post avulsion has been examined in monkeys. At three days, there is a separation line in the middle of the PL mediated by the blood clot. At seven days, there is attachment of the junctional epithelium. The gingival collar fibres re-unite. The PL re-establishes continuity with connective tissue that contains disorganized fibroblasts. At one month, the PL has a normal appearance but the connective tissue is not mature. At 4 months, a functionally oriented PL was present.(4-7)
Treatment for concussive tooth injuries in human dentistry involves a soft diet for two weeks with close monitoring of pulp vitality for months to years. A splint is not considered necessary. The treatment for subluxation of a tooth is the same.(1)
Extrusive luxation injuries require gentle repositioning of the tooth with a slow extrusion of the clot. A functional (non-rigid) splint is applied for two to three weeks. Endodontics is performed by 20 days.(1) A soft diet is suggested.
Lateral luxation injuries require forceful repositioning of the tooth and compression of the alveolus. Gingival lacerations are repaired. A functional splint is applied for three weeks or longer (up to six weeks) if the alveolar fractures are more extensive. In human dentistry, endodontics may not be required, depending on the displacement and maturity of the tooth, but in veterinary dentistry, it is invariably required.
Intrusive injuries in an immature tooth, if not severe, may permit re-eruption. In a mature tooth, the pulp will necrose. Treatment requires surgical repositioning and splinting. Orthodontics may be required if the injury is older than 48 hours.(1)
Treatment of an exarticulated tooth requires immediate replantation within five minutes to gain a favorable result. Active ongoing research in human dentistry has yielded several treatment options but the one universal is to avoid drying of the PL cells on the root surface. Desiccation is the primary cause of PL cell death. Drying time of the root greater than five minutes is severely detrimental to PL cell survival.(4) Immediate replantation is not always possible in cases where the patient has sustained significant trauma. Patient survival often dictates a delay in replantation. In these cases, we extrapolate from human dentistry and do not use autologous saliva as an interim support but try to go directly to chilled low fat milk at 4° C until arrival at a veterinary hospital. It is important not to let the milk warm to room temperature during transit but to keep it chilled on ice.(4) Tap water will cause rapid cell death and if used it must be brief to lavage dirt from the root. Milk will prevent cell death and is only ideal in the short term as it cannot replenish cells but simply maintains osmotic pressure.(1) Transfer to Hanks Balanced Salt Solution (HBSS) until replantation. The goal is to preserve clonogenic potential of remaining PL cells. That is the ability of the PL to regenerate. PL will necrose after 20 minutes. The best support is tissue culture medium such as Eagle𠏋 medium or Viaspan (8) but they are difficult to obtain and unlikely to be available at the required time.
During replantation, clot removal is controversial but gentle pressure should be used while not touching the root. The age of the socket is also critical in healing of the PL. In a recent study, teeth were supported in storage media but various ages of socket were used for replantation. As the socket aged, the degree of healing reduced.(9)
Various treatments are advocated depending on extra-oral time, dry time, and maturity of tooth. Some of the treatments for prolonged extraoral time include citric acid, doxycycline and fluoride. For prolonged dry time of greater than 120 minutes: curettage, citric acid doxycycline, fluoride, and extra-oral endodontics with CaOH.(1)
Once the tooth has been replanted, a functional splint must be applied. Requirements include: the splint is applied directly in the mouth, there is no trauma to the tooth during the application and removal process, no impingement on gingival tissues, the ability to permit oral hygiene is retained, and the split allows some movement for PL healing.(10, 11) Rigid splints promote ankylosis. The splint must permit access for endodontics. Usually wire and composite splints work well. They should be applied to at least two stable teeth on either side of the avulsion. The wire should have no memory to avoid orthodontic movement of the avulsed tooth. Light orthodontic arch wire 0.016?.020 is used in human dentistry.(12) Additionally, a radiograph should be taken to verify replanted position after occlusion has been assessed. Depending on the degree of damage a splint may remain in place for two or more weeks.
Adjunct treatments include antibiotics, usually tetracycline in human patients. Tetracycline is used as it has antibacterial and anti-resorptive properties. It is anti-resorptive due to its direct inhibition on osteoclasts and collagenase.(13) Antibiotic therapy in veterinary patients is advised. Non-steroidal anti-inflammatories are also used after avulsion injuries. Chlorhexidine rinses are also advocated. Tetanus is also suggested in human patients.
A recent study examined the use of dexamethasone in periodontal healing. Better healing was noted with local dexamethasone (16 ug/ml in Viaspan) than with systemic dexamethasone use.(14) The steroid reduces and blocks expression of macrophage activation and reduces osteoclast numbers and function. Calcitonin receptors are also enhanced.(14)
The generally accepted time for pulp extirpaton and treatment with CaOH is seven to 14 days in human dentistry. One study suggests pulp extirpation is not critical if done at less than 20 days.(15) If pulpectomy is done at 7?0 days a creamy mixture of CaOH is used. If pulpectomy is done at 14 days or later a stiff CaOH is used.(11) The CaOH is replaced or repacked every three to six months until the lamina dura can be traced around the root apex on radiographs.(11)
Once the lamina dura is intact, final obturation with gutta percha and sealer cement is performed. Length of time for calcium hydroxide packing has been recently studied. Trop et al., concluded that when endodontics were initiated at 14 days, long- or short-term CaOH made no apparent difference to the healing pattern in replanted dog teeth.(16) In another study, it was concluded that long term CaOH therapy may be more effective than short term in the treatment of established inflammatory root resorption.(17)
Salvage of strategically important teeth is possible with prompt attention and thorough follow-up. The client needs to make an informed decision and financial and time commitment to multiple staged procedures in order to achieve success. According to Andreasen 𧗽f all avulsed teeth were replanted immediately, a PL healing rate of 85?7% could be expected.?/p>

minibabyqq 2007-1-26 02:32

[color=Magenta][size=5][b]牙發展干擾Developmental Disturbances of Teeth  [/b][/size][/color]


介紹
發展牙齒混亂也許歸結於反常性在牙齒lamina 和toothgerms (反常現象數量上, 大小, 形狀的) 分化或對反常性在牙齒堅硬組織(反常現象的形成在結構裡) 。在一些, 分化兩個階段是反常的。發展牙齒干擾也許是被繼承, 獲取, 或先天。沒有所有發展牙齒混亂是先天的。
1 。在牙數字上變化
1.A 。減退數量上: Anodontia 、Oligodontia 和Hypodontia
Anodontia (先天缺乏牙) 並且oligodontia (唯一幾顆牙當前) 是罕見的情況, 經常伴生以廣義混亂。Hypodontia (一顆或幾顆牙錯過) 是一個共同的情況。
遺傳性因素經常被介入在先天缺乏牙。牙可能並且是缺掉由於干擾(即, 精神創傷、傳染, 化工激怒) 在最初development.(1) 期間
Hypodontia 在永久齒列頻繁比在主要齒列。當一顆主要牙先天地錯過, 它的永久後繼者經常是缺掉, 雖然沒有necessarily.(2) 前臼齒和門牙是最頻繁地影響的牙。
一些系統混亂用hypodontia/oligodontia 被連接在永久齒列: 即ectodermal 發育異常在無毛breeds.(3)
造影是根本區分缺掉牙從被衝擊的和嵌入牙。
臨床重要性:在hypodontia 主要化妝, 分化在可能的遺傳性和被證明的創傷起因之間是重要為養殖狗。
1.B 。增量數量上: 超編人員的牙(Hyperdontia)
這可能發生在主要並且/或者永久齒列。超編人員的牙也許被繼承, 但可能由干擾並且造成在牙development.(1) 期間最超編人員的牙是門牙或前臼齒。他們能, 但不一定, 有正常形狀和大小。
臨床重要性: 超編人員的牙也許導致干擾在爆發, 牙的擁擠, 和偏差。在那個案件, 提取需要被考慮。多半時間, 我們選擇牙最偏離在大小、形狀, 或位置。再, 射線照相是必須的。當這些牙don.t 起因臨床問題, 他們不應該被提取。所有者需要被勸告混亂的可能的inheritability 。
1.C 。被衝擊的和嵌入牙
一顆被衝擊的牙結果從牙的疏忽噴發入它的正常位置由於某一物理障礙在爆發path.(4) 這通常是一個被獲取的情況但它可能基因。裝緊可能導致由精神創傷或簡單地由於tooth.s 位置在小窩以便它不是可勝任噴發入它的正常位置。嵌入牙是是unerupted, 通常由於缺乏爆發force.(4) 的牙
臨床重要性:被衝擊的和嵌入牙需要被區分從缺掉牙。射線照相被表明因此。被衝擊的牙應該經常被去除或至少被監測。被衝擊的牙也許導致毗鄰牙根的吸回。在人, 週期性痛苦由於牙裝緊被描述了。dentigerous 囊腫也許顯現出在牙附近的冠狀部份。此外, ameloblastoma 案件被報告顯現出在牆壁這樣cyst.(4)
2 。改變在大小
改變在大小是有限的臨床重要在狗和貓。比法線小的牙是microdont 。當他們大的比法線他們指macrodont 。牙當前在狗以ectodermal 發育異常經常是太小並且簡單的圓錐形shape.(5) 有時超編人員的牙比法線小。
臨床重要性: 主要化妝, 雖然macrodont 牙也許需要被提取由於干涉以舒適的鎖柱。
3 。改變在形狀
3.A 。加倍、融合和Concrescence
加倍。 加倍被定義如同企圖由一種搪瓷器官做二顆牙。這導致一個結構與二完全地或殘缺不全地被分離的冠與一條唯一根和根運河。偶爾地我們看完全卵裂或孿生(二顆牙從一種搪瓷器官) 。原因論是未知的, 但精神創傷被建議了作為可能的起因, 雖然一個familial 傾向被建議too.(5,6) 加倍看在落葉並且在永久齒列。
臨床 重要性: 造影是根本的在提取或endodontic 治療之前。
融合。 融合是加入二牙毒菌, 造成一顆唯一大牙。融合也許介入牙的整個長度, 或唯一根, 根據牙的發展階段在聯合之時。根運河可能被分享或分離。原因論是未知的, 但精神創傷和一個familial 傾向兩個被建議了當可能的cause.(5,6) 融合看在落葉並且在永久齒列。它也許難甚至不可能區分超編人員的牙的融合從加倍。
臨床重要性: 造影是根本的在提取或endodontic 治療之前。
Concrescence 。Concrescence 是毗鄰已經被形成的牙的融合由牙骨質。它也許發生在爆發前後。這是牙由牙骨質團結唯一融合的形式。它被認為出現從精神創傷或擁擠teeth.(5)
臨床重要性: 這個情況是無意義的除非你設法提取介入的牙的當中一個。再, 在做根本的任一提取之前, 造影是必須的!
3.B 。Dilaceration
Dilaceration 提到鋒利的彎或曲線或測角在牙的根或冠。起因通常是深刻機械精神創傷在牙的發展期間這樣, 牙的鈣化的部份的立場被改變並且剩下的人被形成有一個角度。曲線或彎也許發生任何地方沿牙的長度。遺傳性因素應該被介入只在很小數量cases.(4)
臨床意義: A dilacerated 冠也許是一個審美問題。提取或endodontic 治療也許是困難的在a 的情況下dilacerated 根。嚴厲地dilacerated 牙可以無法噴發。
3.C 。小室Invaginatus, 小室在Dente, Tooth 在牙之內。
這是一個不凡的牙反常現象, 唯一幾個案件被描述在獸醫literature.(7) 它代表搪瓷和牙質的套入部份往牙的黏漿狀物質。它可能是表面的(冠) 深深(冠和根) 。情況的原因論是未知的。在人溫和的形式相當是共同性(由5%).(4) 決定
臨床意義: Depends 在損害的嚴肅(變化從更高的齲感受性對pulpal 壞死和periapical 炎症) 。
3.D 。超編人員的根
輔助根能看在狗和貓。最共同地包含的是上部第三顆前臼齒在狗和上部秒鐘(9%) 內和第三顆前臼齒(10%) 在cat.(8)
臨床意義: 超編人員的根的幅射線照相的認識非常重要當包含的牙的endodontic 治療或提取是必要的。
3.E 。搪瓷珍珠, 搪瓷下落
搪瓷珍珠是搪瓷小, 焦點過份大量在牙的表面。它最頻繁地發生在牙的叉路或trifurcation 。偶爾地搪瓷珍珠由牙質支持; 黏漿狀物質墊鐵非常很少延伸到它。搪瓷珍珠被描述了在dog.(9)
臨床意義: 臨床, 他們是只重大的當位於一個periodontally 害病的區域, 因為沒有牙周附件上釉珍珠。
3.F 。其它瑕疵
其它瑕疵沒有具體名字能通常看。臨床重要性變化從無意義和主要化妝, 對極端重大和導致黏漿狀物質壞死和牙膿腫。
4 。結構瑕疵
4.A 。搪瓷
Amelogenesis imperfecta, 搪瓷瑕疵的一個遺傳性形式, 影響兩齒列。發生在狗和貓是unknown.(1) 三型被描述在人的醫學: 上釉發育不全、搪瓷hypocalcification, 和搪瓷hypomaturation 。
環境搪瓷發育不全 是一個共同的結構瑕疵看在dog.s 牙裡。搪瓷顯現出在二個階段: 一個分泌階段(矩陣生產和早期的成礦) 並且成熟性階段(在礦物含量的增量由撤退水和蛋白質) 。搪瓷可能是定量地瑕疵(正常堅硬= 搪瓷發育不全) 或定性地瑕疵的(正常數額, hypomineralized = 搪瓷hypocalcification).(5) 一些干擾影響矩陣形成和成礦。搪瓷瑕疵發生以傷害在搪瓷發展期間形成階段; 一旦搪瓷鈣化了, 這樣的瑕疵無法是produced.(4)
病因學因素也許當地或系統地發生。病因學因素例子有: 維生素缺乏(軟骨病), epitheliotropic 病毒、hypocalcemia 、過份氟化物攝取、地方傳染, 或精神創傷。有時, 明顯的起因無法被辨認(先天) 。defect(s) 的程度取決於病因學因素, factor.s 存在的期間的強度並且因素發生在牙development.(5) 期間的時間, 因為ameloblasts 是最敏感的細胞的當中一個在身體根據新陳代謝的要求, 任一嚴肅的營養缺乏或系統疾病是潛在地能導致搪瓷發育不全。
4.B 。其它結構瑕疵
少量報告非常存在在獸醫文學裡關於牙質瑕疵。被描述在人的文學裡被繼承的情況dentinogenesis imperfecta (遺傳性似蛋白石的牙質) 並且dentinal 發育異常。牙質hypocalcification 有起因和環境搪瓷瑕疵一樣, 可能由組織學examination.(4) 只查出
地方odontodysplasia 影響牙質和搪瓷。一顆或幾顆牙在一個地方化的區域是受影響的和被描述當ghost 牙(牙以反常形狀, 非常稀薄的搪瓷和牙質, 瑕疵成礦) 。起因是未知的, 雖然許多病因學因素是suggested.(5) 由於受影響的牙的質量差, 提取是選擇的治療。


INTRODUCTION
Developmental dental disorders may be due to abnormalities in the differentiation of the dental lamina and the toothgerms (anomalies in number, size, shape) or to abnormalities in the formation of the dental hard tissues (anomalies in structure). In some, both stages of differentiation are abnormal. Developmental dental disturbances may be inherited, acquired, or idiopathic. Not all developmental dental disorders are congenital.
1. VARIATIONS IN TOOTH NUMBER
1.A. Decrease in Number: Anodontia, Oligodontia and Hypodontia
Anodontia (congenital absence of teeth) and oligodontia (only a few teeth present) are rare conditions, often associated with generalised disorders. Hypodontia (one or a few teeth missing) is a common condition.
Hereditary factors are often involved in the congenital absence of teeth. Teeth can also be missing as a result of disturbances (e.g., trauma, infection, chemical irritation) during initial development.(1)
Hypodontia in the permanent dentition is more frequent than in the primary dentition. When a primary tooth is congenitally missing, its permanent successor is often missing too, though not necessarily.(2) Premolars and incisors are the most frequently affected teeth.
Some systemic disorders are connected with hypodontia/oligodontia in the permanent dentition: e.g. ectodermal dysplasia in the hairless breeds.(3)
Radiography is essential to differentiate missing teeth from impacted and embedded teeth.
Clinical importance:In hypodontia mainly cosmetic, differentiation between possible hereditary and proven traumatic causes is important for breeding dogs.
1.B. Increase in Number: Supernumerary Teeth (Hyperdontia)
This can occur in primary and/or permanent dentition. Supernumerary teeth may be inherited, but can also be caused by disturbances during tooth development.(1) Most supernumerary teeth are incisors or premolars. They can, but do not necessarily, have a normal shape and size.
Clinical importance: Supernumerary teeth may cause disturbances in eruption, crowding, and deviation of teeth. In that case, extraction needs to be considered. Most of the time, we choose the tooth most deviate in size, shape, or position. Again, radiographs are mandatory. When these teeth don㦙 cause clinical problems, they should not be extracted. The owner needs to be advised of the possible inheritability of the disorder.
1.C. Impacted and Embedded Teeth
An impacted tooth results from failure of the tooth to erupt into its normal position because of some physical barrier in the eruption path.(4) Generally this is an acquired condition but it can be genetic. Impaction can be caused by trauma or simply because of the tooth𠏋 position in the alveolus so that it is not capable to erupt into its normal position. Embedded teeth are teeth that are unerupted, usually because of a lack of eruptive force.(4)
Clinical importance:Impacted and embedded teeth need to be differentiated from missing teeth. Radiographs are therefore indicated. Impacted teeth should be removed or at least monitored on a regular basis. Impacted teeth may cause resorption of the roots of adjacent teeth. In man, periodic pain due to tooth impaction had been described. A dentigerous cyst may develop around the coronal portion of the tooth. Furthermore, cases of ameloblastoma have been reported to develop in the wall of such a cyst.(4)
2. ALTERATIONS IN SIZE
Alterations in size are of limited clinical importance in dogs and cats. Teeth that are smaller than normal are microdont. When they are larger than normal they are referred to as macrodont. Teeth present in dogs with ectodermal dysplasia often are too small and of simple conical shape.(5) Sometimes supernumerary teeth are smaller than normal.
Clinical importance: Mainly cosmetic, although a macrodont tooth may need to be extracted because of interference with comfortable occlusion.
3. ALTERATIONS IN SHAPE
3.A. Gemination, Fusion and Concrescence
Gemination. Gemination is defined as an attempt to make two teeth from one enamel organ. This results in a structure with two completely or incompletely separated crowns with a single root and root canal. Occasionally we see complete cleavage or twinning (two teeth from one enamel organ). The etiology is unknown, but trauma has been suggested as a possible cause, though a familial tendency has been suggested too.(5,6) Gemination is seen in the deciduous as well as in the permanent dentition.
Clinical importance: Radiography is essential before extraction or endodontic treatment.
Fusion. Fusion is the joining of two tooth germs, resulting in a single large tooth. Fusion may involve the entire length of the teeth, or only the roots, depending on the stage of development of the teeth at the time of the union. The root canal can be shared or separate. The etiology is unknown, but trauma and a familial tendency both have been suggested as a possible cause.(5,6) Fusion is seen in the deciduous as well as in the permanent dentition. It may be difficult or even impossible to differentiate fusion of supernumerary teeth from gemination.
Clinical importance: Radiography is essential before extraction or endodontic treatment.
Concrescence.Concrescence is the fusion of adjacent already-formed teeth by cementum. It may take place before or after eruption. It is a form of fusion where the teeth are united by cementum only. It is thought to arise from trauma or crowding of teeth.(5)
Clinical importance: This condition is insignificant unless one tries to extract one of the teeth involved. Again, before doing any extraction at all, radiography is mandatory!
3.B. Dilaceration
Dilaceration refers to a sharp bend or curve or angulation in the root or crown of a tooth. The cause is usually acute mechanical trauma during the development of the tooth such that the position of the calcified portion of the tooth is changed and the remainder is formed at an angle. The curve or bend may occur anywhere along the length of the tooth. Hereditary factors are supposed to be involved only in a small number of cases.(4)
Clinical significance: A dilacerated crown may be an esthetic problem. Extraction or endodontic treatment may be difficult in case of a dilacerated root. Severely dilacerated teeth may be unable to erupt.
3.C. Dens Invaginatus, Dens in Dente, 孏ooth within a Tooth?/p> This is an uncommon tooth anomaly, with only a few cases described in the veterinary literature.(7) It represents an invagination of enamel and dentin towards the pulp of the tooth. It can be superficial (crown) to deep (crown and root). The etiology of the condition is unknown. In humans the mild form is fairly common (up to 5%).(4)
Clinical significance: 痃epends on the severity of the lesion (varying from higher caries susceptibility to pulpal necrosis and periapical inflammation).
3.D. Supernumerary Roots
Accessory roots can be seen in dogs and cats. Most commonly involved are the upper third premolar in the dog and the upper second (9%) and third premolar (10%) in the cat.(8)
Clinical significance: Radiographic recognition of supernumerary roots is very important when endodontic treatment or extraction of the involved tooth is necessary.
3.E. Enamel Pearls, Enamel Drops
An enamel pearl is a small, focal excessive mass of enamel on the surface of the tooth. It occurs most frequently in the bifurcation or trifurcation of the tooth. Occasionally the enamel pearl is supported by dentin; very rarely a pulp horn extends into it. Enamel pearls have been described in the dog.(9)
Clinical significance: Clinically, they are only significant when located in a periodontally diseased area, since there is no periodontal attachment to enamel pearls.
3.F. Other Defects
Other defects with no specific name can be seen regularly. Clinical importance varies from insignificant and mainly cosmetic, to extremely significant and leading to pulp necrosis and tooth abscess.
4. STRUCTURAL DEFECTS
4.A. Enamel
Amelogenesis imperfecta, a hereditary form of enamel defects, affects both dentitions. The incidence in dogs and cats is unknown.(1) Three types are described in human medicine: enamel hypoplasia, enamel hypocalcification, and enamel hypomaturation.
Environmental enamel hypoplasia is a common structural defect seen in dog𠏋 teeth. Enamel develops in two stages: a secretory stage (matrix production and early mineralization) and a maturation stage (increase in mineral content by withdrawal of water and protein). The enamel can be quantitatively defective (normal hardness = enamel hypoplasia) or qualitatively defective (normal amount, hypomineralized = enamel hypocalcification).(5) Some disturbances affect both matrix formation and mineralization. Enamel defects occur with injury during the formative stage of enamel development; once the enamel has calcified, no such defect can be produced.(4)
Etiologic factors may occur locally or systemically. Examples of etiologic factors include: vitamin deficiencies (rickets), epitheliotropic viruses, hypocalcemia, excessive fluoride ingestion, local infection, or trauma. Sometimes, no apparent cause can be identified (idiopathic). The extent of the defect(s) depends on the intensity of the etiologic factor, the duration of the factor𠏋 presence and the time at which the factor occurs during tooth development.(5) , Since the ameloblasts are one of the most sensitive cells in the body in terms of metabolic requirements, any serious nutritional deficiency or systemic disease is potentially capable of producing enamel hypoplasia.
4.B. Other Structural Defects
Very few reports exist in veterinary literature regarding dentin defects. Described in human literature are the inherited conditions dentinogenesis imperfecta (hereditary opalescent dentin) and dentinal dysplasia. Dentin hypocalcification has the same causes as environmental enamel defects and can only be detected by histological examination.(4)
Regional odontodysplasia affects both dentin and enamel. One or several teeth in a localized area are affected and are described as 孄host teeth?(teeth with abnormal shape, very thin enamel and dentin, defective mineralization). The cause is unknown, though numerous etiologic factors have been suggested.(5) Because of the poor quality of affected teeth, extraction is the treatment of choice.

minibabyqq 2007-1-26 02:33

[color=Magenta][size=5][b]口頭Proliferative 損害在狗Oral Proliferative Lesions in Dogs  [/b][/size][/color]

1 。介紹
口頭proliferative 損害是相對地共同在小動物, 但幸運地, 很多這些損害是良性的。口咽是四惡性瘤形成多數共同的站點在狗並且cats.(1) 口頭敵意估計代表5.4% 所有惡性腫瘤在dogs.(2) 口頭敵意預測經常是窮的, 部分因為他們只被診斷在疾病的一個先進的階段。各種各樣的條件, 包括感染條件, 可能提出作為proliferative 損害或地方膨脹在嘴。並且, 看起來像一個感染情況的非醫治用的潰瘍也許湧出是敵意。任一損害的確切的本質可能由histopathological 考試只確定。採取切片檢查法被表明為所有proliferative 或其他可疑損害譬如非醫治用的潰瘍。
2 。考試
任一次考試應該總開始與獲得充分的歷史和做一般體格檢查。臨床標誌由所有者、損害的期間和進步觀察, 和前治療和他們的結果如果所有是著名。
第一步在臨床分級法是大量的仔細的檢查和觸診:
大小和站點。
潰瘍並且/或者壞死出現。
定像對部下的組織。
牙的任何反常流動性。
地方淋巴結應該palpated:
大小, 形狀, 一貫性。
定像對周圍的組織。
一般體格檢查也許給出遙遠的轉移的徵兆。胸部射線照相被表明在被懷疑的敵意所有病例。既使當這些證明確切並且沒有標誌的轉移, 我們需要記住, 他們一次到達4.5 毫米在diameter.(3) 的孤零零肺根瘤將靠常規幅射線照相的技術只查出
受影響的下頜的幅射線照相的考試是必須的。最佳的細節可能被獲得以非屏幕牙齒影片和一個內部口頭幅射線照相的技術在許多情況下。骨頭濾滲也許由不同程度吸回並且/或者新骨頭形成見證。骨頭的吸回只將是可看見的以標準技術當超過30.50% 骨頭是resorbed.(4) 在一些敵意, 也許並且那裡是牙根的吸回的證據。CT 掃描是敏感的為採摘骨頭的吸回。特別是在上頷骨損害, 用途CT 掃描可能提供關於大量的程度的根本額外資訊。
As 被表明以上, 損害的精確本質可能由histopathological 考試只確定。一個代表性切片檢查法(incisional 或excisional) 應該被採取。一根美好的針aspirate 通常是極限值在診斷口頭大量。一個atraumatically 被採取的切片檢查法, 屬於損害界限被切除, 沒被發現提高轉移發生。注意應該被採取避免損害的嚴厲地被激起的或壞死的部份因為這些將遮暗histopathological 診斷。
histopathological 考試的臨床研究結果和結果應該匹配: 看非常進取的損害大概是, 既使histopathological 結果告訴否則。當他們don.t 比賽, 研究結果應該與病理學家和在某些情況下另外的切片檢查法被談論將被表明。
3 。口頭腫瘤臨床分級法
口頭腫瘤可能被演出使用TNM 分類(主要腫瘤、地方淋巴結, 遙遠的轉移), 由世界衛生組織介紹了。使用這個系統, 患者可能被分類入四個臨床階段的當中一個。它被展示, 預測惡化當腫瘤階段增加從I 對IV.(5) 此外, 這個系統力量臨床工作者評估患者用一個有條不紊和全面方式。臨床分級法應該與採取切片檢查法被結合確定損害的histopathological 本質。
4 。EPULIDES
期限Epulis 。是一個臨床描寫期限提到地方化的成長在gingival.(6) 多數epulides 是良性非造形術損害或odontogenic 腫瘤, 但任一個惡性腫瘤可能提出作為epulis 。所以, 被切除的epulis 應該histopathologically 總被審查確定損害的真正的本質。在154 epulides 的一項回顧展研究中在普利托里亞大學, 它被發現43.5% 是焦點纖維狀增生, 16.9% 是周邊odontogenic fibroma, 並且17.5% 是似犬acantomathous 或周邊ameloblastoma 。另外, 一定數量的其它腫瘤(fibrosarcoma 、squamous 細胞癌、惡性黑瘤, 等。) 提出作為epulis.(7)
5 。ODONTOGENIC 腫瘤
Odontogenic 腫瘤構成一個不同的小組造形術損害起源於odontogenic 組織。這些損害可能被分類根據了他們的起源從各種各樣的毒菌層數(ectodermal, mesodermal, 混雜) 或作為引人或無感(根據是否有互作用在上皮和mesenchymal 組織之間相似與那被看見在odontogenesis).(6,8) 共同的odontogenic 瘤期間在狗是周邊odontogenic fibroma 、周邊ameloblastoma, 和中央ameloblastoma 。這些是無感的。Odontoma 是較不共同和是一個引人odontogenic 腫瘤的例子。
6 。惡性黑瘤
惡性黑瘤是最共同的口頭敵意在狗並且帳戶為所有口頭敵意的大約三分之一在這species.(2) 那裡是一種強的嗜好為男性。惡性黑瘤典型地發生在更舊的狗(平均年齡11 年) 。斗雞家Spaniels, 德國牧羊人和狗與沉重被著色的口頭mucosa 也許是predisposed.(2,9) 惡性黑瘤是不凡的在貓。惡性黑瘤也許被著色或unpigmented (amelanotic) 。Amelanotic 黑瘤也許臨床和histopathologically 是一個診斷問題, 。
惡性黑瘤經常發生在齒齬, 被頰或labial mucosa 、上顎, 和背部表面tongue.(2) 跟隨在齒齦損害, 牙齒中斷是共同並且骨頭介入經常看。轉移對地方淋巴結、肺, 和其它器官發生在早期。預測是極端窮的。選擇的治療是寬外科切除。非常小和早期的損害外科切除也許非常偶爾地是成功的, 但為更大的損害手術是沒有比palliative.(1) 放射治療也許被使用為地方控制惡性melanoma.(10)
7 。SQUAMOUS 細胞癌
SCC 是次要個共同的惡性口頭腫瘤在dog.(2,9) 在貓, 這是最共同口頭malignancy.(11)
7.1 。似犬SCC
最共同的站點為似犬SCC 是齒齬。SCC 經常發生在更舊的狗(平均8.9.7 年) 沒有性predilection.(2) 乳頭狀的SCC 被描述了在非常年輕dogs.(12,13) 主要大量經常是潰瘍的。SCC 可能提出作為慢性非醫治用的潰瘍, 沒有proliferation.(14) 牙齒中斷是共同; 骨頭入侵被發現在多數lesions.(2,9) SCC 只後做metastatise 對地方淋巴結和肺, 但在疾病過程中。寬地方切除是因此經常治病的。_ scc 是敏感對輻射, 但骨頭介入減少這反應對radiotherapy.(1,9) scc 這舌頭和扁桃腺是共同, 但還更進取比這齒齦形式(15,16) 。以tonsillar 形式, 有一種嗜好為男性。Tonsillar 損害通常是單邊的。轉移對地方淋巴結顯現出及早在疾病; 預測是poor.(16)
7.2 。似貓的SCC
SCC 是最共同的口頭敵意在貓。口頭SCC 經常發生在更舊的貓, 沒有知道的養殖或性association.(11) 它經常位於上顎骨的premolar/molar 區域, 下顎骨的前臼齒區域和舌頭(1) 。在舌頭, 損害也許提出作為非醫治用的ulcerative 損害在frenulum, 非常可比較與什麼我們看見以外國身體被困住在舌頭之下。經常腫瘤清楚地不是可看見的, 但是它可能palpated 作為牢固的大量在腹身體尾部對frenulum 。上頷骨和舌頭SCC 有一種粗劣的預測, 反應任一種therapy.(1) 下頷骨SCC 在貓很少只有一種公正的預測(治療可能以非常早期的損害和寬外科切除) 。
8 。FIBROSARCOMA
Fibrosarcoma 經常被看見在大養殖狗, 以平均年齡相對地年輕(4.5 年) 。在更小的動物, fibrosarcoma 經常提出在更舊的年齡(> 8 years).(1) Fibrosarcoma 經常被看見在上顎骨。它也許發生作為protruberant 大量在牙齒邊際和上顎。Fibrosarcoma 也許並且起源於鼻軟骨, 上顎骨的側向表面或上顎, 作為光滑的大量與原封上皮覆蓋物。Fibrosarcomas 當地蔓延性和有高再現率在外科切除以後, 並且變形的潛力在那惡性黑瘤和SCC.(2,9) 預測之間是易變的, 到大規模範圍根據腫瘤的地點和程度在診斷的時期。
9 。其它腫瘤
許多其它敵意發生在和在口腔附近(即, osteosarcoma 、hemangiosarcoma 、neurofibroma 、plasmocytoma, 等) 。當對待這些, 你應該總使用常識, 和用途文學報告關於生物行為在人或這種腫瘤類型生物行為在其它站點在身體作為指南為治療(即, 邊際為切除) 並且預測。更多資訊關於較不共同的腫瘤的行為是需要的; 當前, 有唯一其它腫瘤類型的治療逸事報告。主題是什麼被刪去應該由感興趣和老練的病理學家histopathologically 審查。長期後續需要完成和應該被報告。
10 。NON-NEOPLASTIC 損害
焦點纖維狀增生和廣義齒齦增生提出作為epulis 。當切除總似乎良性, histopathological 檢查需要做的損害, 因為這些損害也許非常臨床看同惡性損害一樣。
在貓, 損害從嗜伊紅的肉芽腫複合體提出作為proliferative 損害, 應該被區分從造形術和良性hyperplastic 損害。嗜伊紅或疏懶潰瘍、嗜伊紅的匾, 和collagenolytic 肉芽腫全部被假定是反應樣式為部下的疾病, 雖然這種部下的疾病的證明也許是difficult.(17) 嗜伊紅的潰瘍最共同地被看見在上嘴唇當一個中央粉紅黃色區域以一個被上升的邊緣。Collagenolytic 肉芽腫(嗜伊紅的肉芽腫, 線性肉芽腫) 作為被上升的, 線性, 粉紅黃色匾可能提出在口腔和咽, 也許pruritic 。治療選擇包括證明部下的疾病、glucocorticoids, 抗菌療法和外科excision

1. INTRODUCTION
Oral proliferative lesions are relatively common in small animals, but fortunately, a lot of these lesions are benign. The oropharynx is the fourth most common site of malignant neoplasia in dogs and cats.(1) Oral malignancies are estimated to represent 5.4% of all malignant tumours in dogs.(2) Prognosis of oral malignancies is often poor, partly because they are only diagnosed at an advanced stage of the disease. A variety of conditions, including infectious conditions, can present as a proliferative lesion or a local swelling in the mouth. Also, a non-healing ulcer that looks like an infectious condition may well be a malignancy. The exact nature of any lesion can only be determined by histopathological examination. The taking of a biopsy is indicated for all proliferative or other suspicious lesions such as non-healing ulcers.
2. EXAMINATION
Any examination should always start with obtaining a full history and doing a general physical examination. Clinical signs observed by the owner, duration and progression of the lesion, and former treatments and their results should all be noted.
The first step in clinical staging is careful inspection and palpation of the mass:
Size and site.
Presence of ulceration and/or necrosis.
Fixation to the underlying tissues.
Any abnormal mobility of teeth.
Regional lymph nodes should be palpated:
Size, shape, consistency.
Fixation to the surrounding tissues.
General physical examination may give indications of distant metastasis. Thoracic radiographs are indicated in all cases of suspected malignancy. Even when these prove to be clear and there are no signs yet of metastasis, we need to keep in mind that solitary pulmonary nodules will only be detected by conventional radiographic techniques once they reach 4? mm in diameter.(3)
Radiographic examination of the affected jaw is mandatory. The best detail can be obtained with non-screen dental film and an intra-oral radiographic technique in most cases. Bone infiltration may be evidenced by varying degrees of resorption and/or new bone formation. Resorption of bone will only be visible with standard technique when more than 30?0% of the bone has been resorbed.(4) In some malignancies, there may also be evidence of resorption of tooth roots. CT-scan is much more sensitive for picking up resorption of bone. Especially in maxillary lesions, the use of CT-scan can give essential extra information about the extent of the mass.
鼦s indicated above, the precise nature of the lesion can only be determined by histopathological examination. A representative biopsy (incisional or excisional) should be taken. A fine needle aspirate is usually of limited value in diagnosing oral masses. An atraumatically-taken biopsy, which falls within the boundaries of the lesion to be excised, has not been found to enhance the occurrence of metastasis. Care should be taken to avoid severely inflamed or necrotic parts of the lesion since these will obscure the histopathological diagnosis.
Clinical findings and results of the histopathological examination should match: a lesion that looks very aggressive probably is, even if the histopathological result tells otherwise. When they don㦙 match, the findings should be discussed with the pathologist and in some cases additional biopsies will be indicated.
3. CLINICAL STAGING OF ORAL TUMOURS
Oral tumours can be staged using the TNM-classification (primary tumour, regional lymph node, distant metastasis), which has been introduced by the WHO. Using this system, patients can be classified into one of four clinical stages. It has been demonstrated that prognosis worsens as the tumour stage increases from I to IV.(5) Furthermore, this system forces the clinician to evaluate the patient in a methodical and comprehensive way. Clinical staging should be combined with the taking of biopsies to determine the histopathological nature of the lesion.
4. EPULIDES
The term 𡌃pulis?is a clinically descriptive term referring to a localized growth on the gingival.(6) Most epulides are benign non-neoplastic lesions or odontogenic tumours, but any malignant tumour can present as an epulis. Therefore, an excised epulis should always be histopathologically examined to determine the real nature of the lesion. In a retrospective study of 154 epulides at the University of Pretoria, it was found that 43.5% were focal fibrous hyperplasia, 16.9% were peripheral odontogenic fibroma, and 17.5% were canine acantomathous or peripheral ameloblastoma. In addition, a number of other tumours (fibrosarcoma, squamous cell carcinoma, malignant melanoma, etc.) were presenting as an epulis.(7)
5. ODONTOGENIC TUMOURS
Odontogenic tumours constitute a diverse group of neoplastic lesions originating from odontogenic tissues. These lesions can be classified based on their origin from the various germ layers (ectodermal, mesodermal, mixed) or as inductive or non-inductive (based on whether there is an interaction between epithelial and mesenchymal tissues similar to that seen during odontogenesis).(6,8) Common odontogenic neoplasms in the dog are peripheral odontogenic fibroma, peripheral ameloblastoma, and central ameloblastoma. These are non-inductive. Odontoma is less common and is an example of an inductive odontogenic tumour.
6. MALIGNANT MELANOMA
Malignant melanoma is the most common oral malignancy in the dog and accounts for around one third of all oral malignancies in this species.(2) There is a strong predilection for the male. Malignant melanoma typically occurs in older dogs (mean age 11 years). Cocker Spaniels, German Shepherds and dogs with heavily pigmented oral mucosa may be predisposed.(2,9) Malignant melanoma is uncommon in the cat. Malignant melanoma may be pigmented or unpigmented (amelanotic). Amelanotic melanomas may be a diagnostic problem, both clinically and histopathologically.
Malignant melanoma occurs most often on the gingiva, followed by the buccal or labial mucosa, palate, and dorsal surface of the tongue.(2) In gingival lesions, dental disruption is common and bone involvement is often seen. Metastasis to the regional lymph nodes, lungs, and other organs takes place at an early stage. Prognosis is extremely poor. Treatment of choice is wide surgical excision. Surgical excision of very small and early lesions may very occasionally be successful, but for larger lesions surgery is no more than palliative.(1) Radiation therapy may be used for local control of malignant melanoma.(10)
7. SQUAMOUS CELL CARCINOMA
SCC is the second most common malignant oral tumour in the dog.(2,9) In cats, this is the most common oral malignancy.(11)
7.1. Canine SCC
The most common site for canine SCC is the gingiva. SCC most often occurs in older dogs (average 8?.7 years) with no sex predilection.(2) Papillary SCC has been described in very young dogs.(12,13) The primary mass is often ulcerated. SCC can present as a chronic non-healing ulcer, without proliferation.(14) Dental disruption is common; bone invasion is found in the majority of lesions.(2,9) SCC does metastatise to the regional lymph nodes and lungs, but only late in the disease process. Wide local excision is therefore often curative. SCC is sensitive to radiation, but bone involvement decreases the response to radiotherapy.(1,9) SCC of the tongue and tonsils is less common, but also much more aggressive than the gingival form (15,16). In the tonsillar form, there is a predilection for males. Tonsillar lesions are usually unilateral. Metastasis to the regional lymph nodes develops early in the disease; prognosis is poor.(16)
7.2. Feline SCC
SCC is the most common oral malignancy in cats. Oral SCC most often occurs in older cats, with no known breed or sex association.(11) It is most often located in the premolar/molar region of the maxilla, premolar region of the mandible and the tongue (1). In the tongue, the lesion may present as a non-healing ulcerative lesion in the frenulum, very comparable to what we see with foreign bodies trapped under the tongue. Often the tumour is not clearly visible, but it can be palpated as a firm mass in the ventral body caudal to the frenulum. Maxillary and tongue SCC have a poor prognosis, responding only rarely to any kind of therapy.(1) Mandibular SCC in the cat has a fair prognosis (cure possible with very early lesions and wide surgical excision).
8. FIBROSARCOMA
Fibrosarcoma is most often seen in large breed dogs, with a mean age relatively young (4? years). In smaller animals, fibrosarcoma most often presents at an older age (> 8 years).(1) Fibrosarcoma is seen most often in the maxilla. It may occur as a protruberant mass at the dental margins and palate. Fibrosarcoma may also originate from the nasal cartilages, the lateral surface of the maxilla or the palate, as a smooth mass with an intact epithelial covering. Fibrosarcomas are locally invasive and have a high recurrence rate after surgical excision, and a metastatic potential between that of malignant melanoma and SCC.(2,9) Prognosis is variable, to a large extent depending on both location and extent of the tumour at time of diagnosis.
9. OTHER TUMOURS
Many other malignancies occur in and around the oral cavity (e.g., osteosarcoma, hemangiosarcoma, neurofibroma, plasmocytoma, etc.). When treating these, one should always use common sense, and use literature reports on biological behaviour in humans or biological behaviour of this tumour type at other sites in the body as guidelines for treatment (e.g., margins for excision) and prognosis. More information on behaviour of the less common tumours is needed; at present, there are only anecdotal reports of treatment of other tumour types. The main issue is that whatever is cut out should be histopathologically examined by interested and experienced pathologists. Long-term follow-up needs to be done and should be reported.
10. NON-NEOPLASTIC LESIONS
Focal fibrous hyperplasia and generalised gingival hyperplasia presents as an epulis. When excising lesions that seem benign, histopathological exam always needs to be done, since clinically these lesions may look very much the same as malignant lesions.
In cats, lesions from the eosinophilic granuloma complex do present as proliferative lesions and should be differentiated from neoplastic and benign hyperplastic lesions. Eosinophilic or indolent ulcer, eosinophilic plaque, and collagenolytic granuloma are all presumed to be reaction patterns for underlying disease, though identification of this underlying disease may be difficult.(17) Eosinophilic ulcer is most commonly seen on the upper lip as a central pinkish yellow area with a raised edge. Collagenolytic granuloma (eosinophilic granuloma, linear granuloma) can present in the oral cavity and pharynx as raised, linear, pinkish yellow plaques, which may be pruritic. Treatment options includes identification of the underlying disease, glucocorticoids, antibacterial therapy and surgical excision

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骨頭增廣的成功在牙周療法推進了以加速的率在過去幾年。成功的骨頭再生在牙周口袋形成是期望的現實。
強制periodontitis 症狀是炎症、真實的牙周口袋形成和骨頭吸回。這些症狀發生在不同程度, 以不同程度骨頭損失。
口袋形成推進以牙周疾病嚴肅。口袋形成推進從口袋形成與附件損失和激增口袋皮膜以起點crestal 骨頭損失到延伸在齒齦音冠之外的垂直或水平的骨頭損失。
有基本上二類型骨頭損失看在先進的牙周疾病: 垂直和水平。垂直的骨頭損失看在infrabony 口袋形成。口袋的深度是頂端的對crestal 高度骨頭。水平的骨頭損失沒有實際上口袋形成以一一致降下crestal 骨頭。
Infrabony 口袋(在下齒齦音垂直的骨頭損失) 陳列各種各樣的形式關於被傳染的骨頭。osseous 瑕疵被分類和: 三牆壁骨多的瑕疵, 由三osseous 表面和一牙表面毗鄰; 二牆壁骨多的瑕疵, 由二osseous 牆壁和二牙表面毗鄰; 一個牆壁骨多的瑕疵, 由二牙表面和一osseous 牆壁毗鄰; 並且聯合的骨多的瑕疵(杯子), 由牙幾表面和數骨頭毗鄰。成功的骨頭積土是最偉大的與三個牆壁口袋被二牆壁和然後一個牆壁和杯子跟隨。
骨頭增廣材料被分類像osseous 導電性和osseous 引人。Osseous 引人骨頭或骨多的替補在新骨頭的形成參與, 但是osseous 導電性材料為骨多的再生提供一個絞刑臺或格子沒有參與在骨頭形成。
Osseous 引人材料從前一般是autologous 骨頭移植。那是骨頭被收穫從主人和被種入入準備的骨多的瑕疵。這導致非常成功的骨頭增廣。但是, 主人骨頭總不是可達到的, 因此對新增廣材料的用途被開發了。
多數osseous 導電性材料是陶瓷、玻璃, 或hydroxyapatite 服務的形式當腳手架機制為骨頭成長。對dematerialized, 被冰凍乾燥的, 或放熱的遲鈍和人的骨頭的用途是仍然一個廣泛被應用的osseous 導電性代理以osseous 歸納結果一些要求。
骨頭Morphogenic 蛋白質(BMPs) 是推進的當中一個在骨頭增廣。他們與dematerialized 骨頭他人代筆被結合導致增量在牙骨質和骨頭裡。BMPs 產物多個作用由作為mitogens 在undifferentiated mesenchymal 細胞和osteoblast 前體。他們導致osteoblast 表現型的表示增加鹼性磷酸鹽活動在骨頭細胞裡。
看起來似乎新osseous 導電性材料不盡的品種現在可以得到。以下產品和他們的應用和效力是一些被推薦的材料, 但不是唯一材料可利用為獸醫牙周療法:
EMDOGAIN, (BIORA 交往)
被促進了用於獸醫牙科在過去四年之內。Emdogain 是搪瓷矩陣蛋白質被收穫從豬的主要齒列。它顯示了能力增加變換因素Beta 1 和小片被獲得的成長因素的水平。
新Emdogain 膠凝體提供更好處理的質量比原始的形式。它最好被使用與其它導電性代理的組合譬如dematerialized 被冰凍乾燥的骨頭他人代筆材料。在一塊充分的厚度擋水板被上升之後, 所有granulomatous 組織從三牆壁被去除並且/或者二個牆壁口袋和根周到地浮出水面根飛行和被對待與EDTA 。Emdogain 膠凝體雞尾酒, (Emdogain 和dematerialized 被冰凍乾燥的骨頭) 嚮瑕疵被應用和緊緊被縫合。增加的和更加有效的增量在骨頭裡被獲得當混合物被安置作為一個雞尾酒在resorbable 之下, 引導組織膜。
CONSIL (NUTRIMAX 實驗室公司。)
Consil 顯然是廣泛被應用的osseous 導電性材料由獸醫。Consil 是類型玻璃珠物質相似與其它聚合物為osseous 傳導唯一。它的效力實際上是相同像其它osseous 導電性材料。
HTR-POLYMER (BIOPLANT 公司。)
一個biocompatible 聚合物以形成一個non-resorbable radiopaque 多孔矩陣腳手架為osseous 傳導的小珠形式。它被交付入一個準備的骨多的瑕疵通過一個平直的桶注射器。齒齦擋水板必須緊緊被縫合防止高溫反應器小珠的損失。像Consil, 這是有效的osseous 導電性材料。但是所有導電性材料不提供經常是需要的有效的骨多的積土。
OSTEOGRAF/N (CERTAMED 牙齒)
恢復通過細胞斡旋的自然無機遲鈍的礦物。這是xenograph 適當為人和動物osseous 傳導。它是更好的osseous 導電性材料的當中一個似乎勝過多數聚合物。
ALLGRO (CERTAMED 牙齒)
Dematerialized 被冰凍乾燥的骨頭同種異體移植, (DFDBA) 。這是定期地被檢驗為osteo 引人活動的唯一的DFDBA 。Dematerialized 被冰凍乾燥的骨頭被描繪了作為近的osteo 導電性由許多臨床工作者。但是, 這個產品似乎是更加有效的osteo 導電性聚合物由獸醫當前使用。
PEPGEN-P-15
型-1 膠原綜合以屬於顆粒的形式, 這個產品是當前的科技目前進步水平在增廣材料裡。屬於顆粒的形式可能難交付對外科站點, 然而, 油灰形式, (鈉藻酸鹽) 的PepGen- P-15 展示優秀biocompatibility 和處理物產。這個產品與無機遲鈍biomineral 造成一和唯一組織設計的骨頭替換貪佔結合一綜合性細胞約束peptide 仿造自生的骨頭生物聚合物無機和有機組分。
在multi-center 試驗, PepGen-P-15 展示了正面結果。ABM/P-15 遲鈍的被獲得的hydroxylapatite 矩陣(ABM/P-15 即, PepGen-P-15) 顯示了優越結果對dematerialized 骨頭粉末。ABM/P-15 和undifferentiated mesenchymal 細胞的最後的顯形表示的Entopic 多孔的分化入骨頭導致osteocytes 組織學上被證實了。
研究進行了在Mayo 診所的研究分裂運用十條小獵犬狗。四個站點每狗和四骨頭替補材料被使用了: 人的被冰凍乾燥的dematerialized 骨頭(H-FDDB), 狗被獲得的被冰凍乾燥的dematerialized 骨頭(D-FDDB), OsteoGraf/N-300 和OsteoGraf/N-300 與PepGen-P-15 。14 天評估顯露了瑕疵包含H-FDDB 並且D-FDDB 有一點對沒有容量在所有十條狗。瑕疵包含N-300 維護了最初的容量, 但是可觸知和機動性在所有十條狗。瑕疵包含PepGen-P-15 維護了他們的容量和顯示了僵化的可觸知的標誌。組織學評估在30 天以後顯示了瑕疵包含PepGen-P-15 被展示的多孔的分化一致與entopic osteoinduction 。
這個產品是研究的結果由Rajendra Bhatnagar, 舊金山生物工藝學大學博士舉辦。他描述另外類型的變革齒齦成纖維細胞入骨頭。這仿造對乾細胞研究的用途。CertaMed 購買了他的研究的結果。結果是運作在變換齒齦成纖維細胞旁邊成骨頭PepGen-P-15 的發展。
獸醫periodontics 受益於人的牙周療法, 但由對最常用的骨頭增廣產品的極限和作用的理解並且限制了為獸醫。
因為有限的時間經常看在臨床獸醫牙科方面, 臨床工作者應該雇用最高效率的增廣材料避免再加工、失去的時間, 和下等結果。

The success of bone augmentation in periodontal therapy has advanced at an accelerated rate in the past few years. Successful bone regeneration in periodontal pocket formation is an expected reality.
Obligate symptoms of periodontitis are inflammation, true periodontal pocket formation and bone resorption. These symptoms occur in varying degrees, with varying degrees of bone loss.
Pocket formation advances with the severity of periodontal disease. Pocket formation advances from pocket formation with attachment loss and proliferating pocket epithelium with beginning crestal bone loss to vertical or horizontal bone loss that extends beyond the alveolar crest.
There are basically two types of bone loss seen in advanced periodontal disease: vertical and horizontal. Vertical bone loss is seen in infrabony pocket formation. The depth of the pocket is apical to the crestal height of bone. Horizontal bone loss has virtually no pocket formation with a uniform lowering of crestal bone.
Infrabony pockets (infra-alveolar vertical bone loss) exhibit various forms in relation to the infected bone. The osseous defects are classified as: three wall bony defect, bordered by three osseous surfaces and one tooth surface; two wall bony defect, bordered by two osseous walls and two tooth surfaces; one wall bony defect, bordered by two tooth surfaces and one osseous wall; and combined bony defect (cup), bordered by several surfaces of tooth and several of bone. Successful bone fill is greatest with three wall pockets followed by two wall and then one wall and cup.
Bone augmentation materials are classified as osseous conductive and osseous inductive. Osseous inductive bone or bony substitutes take part in the formation of new bone, whereas osseous conductive materials provide a scaffold or trellis for bony regeneration without taking part in bone formation itself.
Osseous inductive material in the past has generally been autologous bone transplants. That is, bone harvested from the host and implanted into the prepared bony defects. This results in very successful bone augmentation. However, host bone is not always attainable, hence the use of new augmentation materials has been developed.
Most osseous conductive materials have been forms of ceramics, glass, or hydroxyapatite serving as scaffolding mechanisms for bone growth. The use of dematerialized, freeze-dried, or radiated bovine and human bone is still a widely used osseous conductive agent with some claims of osseous induction results.
Bone Morphogenic Proteins (BMPs) are one of the advancements in bone augmentation. They are combined with dematerialized bone allographs producing increases in cementum and bone. BMPs produce multiple effects by acting as mitogens on undifferentiated mesenchymal cells and osteoblast precursors. They induce the expression of the osteoblast phenotype increasing alkaline phosphatase activity in bone cells.
There seems to be an endless variety of new osseous conductive materials currently available. The following products and their application and efficacy are some of the recommended materials, but not the only material available for veterinary periodontal therapy:
EMDOGAIN, (BIORA RAPPORT)
Has been promoted for use in veterinary dentistry within the past four years. Emdogain is an enamel matrix protein harvested from porcine primary dentition. It has shown the ability to increase levels of Transforming Factor-Beta 1 and Platelet-derived Growth Factor.
The new Emdogain Gel provides better handling qualities than the original form. It is best used in combination with other conductive agents such as dematerialized freeze-dried bone allograph material. After a full thickness flap is raised, all granulomatous tissue is removed from the three wall and/or two wall pockets and the root surfaces thoroughly root planed and treated with EDTA. The Emdogain Gel cocktail, (Emdogain and dematerialized freeze dried bone) is applied to the defect and tightly sutured. Added and more effective increases in bone are obtained when the mixture is placed as a cocktail under a resorbable, guided-tissue membrane.
CONSIL (NUTRIMAX LABORATORIES INC.)
Consil is by far the most widely used osseous conductive material by veterinarians. Consil is a type of glass bead material similar to other polymers for osseous conduction only. Its efficacy is virtually the same as other osseous conductive materials.
HTR-POLYMER (BIOPLANT INC.)
A biocompatible polymer in bead form that forms a non-resorbable radiopaque porous matrix scaffolding for osseous conduction. It is delivered into a prepared bony defect through a straight barrel syringe. The gingival flap must be tightly sutured to prevent loss of the HTR beads. Like Consil, it is an effective osseous conductive material. However all conductive materials do not provide the effective bony fill that is often needed.
OSTEOGRAF/N (CERTAMED DENTAL)
A natural inorganic bovine mineral that restores through cell mediation. It is a xenograph suitable for both human and animal osseous conduction. It is one of the better osseous conductive materials that seems to outperform most polymers.
ALLGRO (CERTAMED DENTAL)
Dematerialized Freeze-dried Bone Allograft, (DFDBA). This is the only DFDBA that is routinely assayed for osteo-inductive activity. Dematerialized freeze-dried bone has been characterized as near osteo conductive by many clinicians. However, this product seems to be more effective that the osteo-conductive polymers currently used by veterinarians.
PEPGEN-P-15
A composite of Type -1 collagen in particulate form, this product is the current state of the art in augmentation materials. The particulate form can be difficult to deliver to the surgical sites, however, the putty form, (sodium alginate) of PepGen- P-15 shows excellent biocompatibility and handling properties. This product combines a synthetic cell binding peptide with inorganic bovine biomineral resulting in the first and only tissue-engineered bone replacement graft to mimic both the inorganic and organic components of autogenous bone biopolymer.
In multi-center trials, PepGen-P-15 demonstrated positive results. ABM/P-15 bovine derived hydroxylapatite matrix (ABM/P-15 i.e., PepGen-P-15) has shown superior results to dematerialized bone powder. Entopic cellular differentiation of ABM/P-15 and the eventual phenotypic expression of the undifferentiated mesenchymal cells into bone producing osteocytes was histologically confirmed.
A study was conducted at the research division of the Mayo Clinic utilizing ten Beagle dogs. Four sites per dog and four bone substitute materials were used: human freeze-dried dematerialized bone (H-FDDB), dog-derived freeze-dried dematerialized bone (D-FDDB), OsteoGraf/N-300 and OsteoGraf/N-300 with PepGen-P-15. The 14-day evaluation revealed the defects containing H-FDDB and D-FDDB had little to no volume in all ten dogs. The defects containing N-300 maintained the initial volume, but were palpable and mobile in all ten dogs. The defects containing PepGen-P-15 maintained their volume and showed palpable signs of ossification. Histological evaluation after 30 days showed the defects containing PepGen-P-15 demonstrated cellular differentiation consistent with entopic osteoinduction.
This product is the result of research conducted by Dr. Rajendra Bhatnagar, University of San Francisco bioengineering. He describes the transformation of a different type of gingival fibroblast into bone. This mimics the use of stem cell research. CertaMed purchased the results of his research. The result was the development of PepGen-P-15 that works by transforming gingival fibroblasts into bone.
Veterinary periodontics has benefited from human periodontal therapy, but has also been limited by an understanding of the limits and effects of the most commonly used bone augmentation products for veterinarians.
Since limited time is often seen in clinical veterinary dentistry, the clinician should employ the most efficient augmentation material to avoid retreatment, lost time, and inferior results

minibabyqq 2007-1-26 02:34

[color=Magenta][size=5][b]牙齒材料Dental Materials [/b][/size][/color]


我們簡要地將談論對一些的類別和用途產品最有用在獸醫牙科方面。介紹將集中於對材料的實用臨床用途和他們的臨床相關的物產和氣質。起初, 對牙齒材料的用途似乎複雜和纏擾不清, 各材料有它自己的物產和借它對某些應用的處理能力。獸醫牙科要求可能被使用恢復作為正常作用儘可能的材料。咀嚼力量被安置在動物和缺乏總控制我們有在他們牌子滋補獸醫牙科更牽涉到作用比美學。
理想的滋補材料會形成一個化學鍵上釉和牙質, 是非刺激性成漿狀和軟的組織, 是制菌作用的, 穿戴以率和牙結構一樣, 有高壓縮和抗拉強度, 不是疲勞, 有熱擴散系數和牙質一樣, 形成完善的封印在滋補材料之間和牙, 不變形在設置, 和有理想的美學。這樣材料有被發明。許多材料擁有一定數量的這些物產, 然而, 和, 每個可能被使用為某些規程。
牙齒混合物
混合物依然是最堅硬和最強的材料可利用的今天為直接銷售恢復。它容易使用, 幫助維護封印反對漏出由開發腐蝕在混合物牙接口(雖然現代混合物有效地做這較少), 和經受了時間考驗。對混合物的用途在人有成為的有爭議由於關心關於它的水銀內容和總值潛在的健康危害。和在許多爭論, 反對的看法廣泛變化和由他們的擁護者多情地爭論。一個粗劣的審美結果是一decline 的其它原因在混合物使用因為它不匹配自然牙結構和不使隨時間變暗。
在獸醫牙科方面, 混合物可能是一種好選擇為咬合桌(類I) 齲損害的治療在槽牙牙。在人, 它佩帶只5.10 . 每年。咬合表面負擔大裝載和受益因此於堅硬材料。這並且是必需的咬邊可能導致以對牙力量的少許作用的區域在。
因為混合物與牙結構不結合, 它要求一undercut 。提供舉行它到位的保留。牙質接合代理的襯裡被安置和被治療, 並且混合物被磨碎在amalgamator 和增加地然後被安置入洞。它被凝聚和被雕刻在被擦亮前。粘合劑被使用主要為密封牙反對漏出。如果自動治療或雙重治療粘合劑被使用, 混合物的一些接合對牙結構然後發生, 但這是非常微弱的債券。使用粘合劑指bonded 混合物, 。但粗劣的政券力量無法被依靠拿著裝填在place.it 仍然需要一種咬邊的洞準備。
綜合
期限綜合僅僅表明, 各種各樣的組分或成份混合在一起創造一種新物質。在本文裡, 我們考慮牙齒滋補綜合。這些塗上補白微粒給他們結合與矩陣階段) 的組成由丙烯酸酯的樹脂(矩陣階段), 補白微粒(被分散階段) 並且聯結階段(。
樹脂最共同地被使用在牙齒補藥知道作為bis GMA, 由反應生產在bisphenol A 和glycidal 異丁烯酸之間。樹脂是dimethacrylate 單體, 被自由基出現導致聚合。這些自由基可能由化學反應或外在能量的介紹引起或(熱或光) 。
化工被激活的樹脂來作為二個組分(二漿糊通常) 。一漿糊包含一個過氧化苯□創始者和其他一個叔胺活化計。當二漿糊是spatulated, 胺物起反應與過氧化苯□對創始聚化的形式自由基。
光被激活的樹脂來作為唯一漿糊在注射器或compule 。漿糊包含一個photoinitiator 分子(camphoroquinone) 並且胺物活化計。當暴露在光在400 到500 毫微米波長範圍, photoinitiator 變得激動和起反應以胺物生產自由基, 因此創始聚化過程。
化學製品治療樹脂有好處治療在他們的整個大量過程中, 但必須迅速被安置在他們set. 和可以充足地然後需要幾分鐘對治療允許完成之前。光治療樹脂唯一set. 當暴露在治療的光和如此有更久的工作時間和更加迅速地然後治療當暴露。但是, 唯一那個材料的部份暴露於充足的強度光能將治療和因此深刻的恢復經常需要被分層堆積。多數參考建議, 應該被治療綜合的最大厚度是2.0 到2.5 毫米(根據綜合的陰涼地) 。所以, 為一個4 毫米深刻的瑕疵, 您會安置2 毫米厚實的層數, 會治療它和然後會增加另外2 毫米厚實的層數和會治療它。
被分散的階段綜合由補白微粒組成譬如石英、鋰、鋁硅酸鹽、硼硅酸鹽、鋇和各種各樣的玻璃。綜合的分類和許多它的有形資產由卑鄙顆粒大小口授。
常規綜合有最大的卑鄙顆粒大小, 也許有微粒100 微米。雖然這些綜合被提供可以好處在未裝滿的樹脂(相對耐壓強度、抗拉強度、堅硬, 熱擴散), 他們沒有擦亮對光滑的表面。磨蝕傾向於去除更軟的樹脂矩陣, 留下大補白微粒被暴露。Microfilled 綜合使用更小的顆粒和是因此高度polishable 。但是, 他們比常規綜合作為不艱苦像強有樹脂矩陣的更高的百分比和因此是亦不。在人, 他們做非常好的審美恢復為先前牙, 但在獸醫患者的嘴, 他們有少許應用。小顆粒綜合是企圖達到高的polishablility microfilled 與力量的組合並且堅硬macrofilled 。雜種綜合構成更好的妥協。多數包含膠質硅土(microfiller 大小) 並且磨玻璃微粒混合物(0.6 到1.0 微米) 。這些綜合有好力量, 可能被擦亮對光滑的表面, 做他們好通用補藥。
合成材料與牙齒組織不結合, 因此, 物理聯合與牙達到使用某一排序一種牙齒粘合劑。他們不會被談論在本文裡。
綜合滋補材料的當中一個最重要的不利是聚化收縮。當樹脂矩陣聚合, 組織的聚合物分子比它的被混亂的構成單體佔領較少空間。所以, 作為綜合治療, 它收縮和因此也許拉扯從洞牆壁。化學製品被激活的綜合傾向於收縮朝中間和因此拉扯相等地從所有牆壁。光被激活的綜合傾向於收縮往光和因此將拉扯從牆壁進一步從光。這拉扯從牆壁可能導致少量的漏出和恢復的最後的失敗。牙齒接合系統幫助克服這個傾向拉扯從牆壁但不完全地總防止它。
其它方法主張為減少polymerizarion 收縮的作用將增加地安置綜合。那是地方每少量, 治療它, 和然後安置其它小增加, 重覆過程直到瑕疵被填裝。
程度收縮依靠有些補白的百分比於綜合(多數雜種是60 到65% 補白由容量) 。因為補白不收縮, 更多補白意味較少收縮。
玻璃離子聚合物水泥
玻璃離子聚合物提到使用硅酸鹽玻璃粉末和polyacrylic 酸的水溶液的一個小組材料。組分必須被測量和仔細地被混合。他們也許進來瓶以測量設備, 或在ampules 以pre-measured 相當數量液體和粉末。比率重要, 因此最可靠的形式是作為pre-measured ampules 。結合與牙質由iononic 和micromechanical 力量感覺發生兩個。安置玻璃離子聚合物恢復, 牙質和搪瓷是酸被銘刻以conditioner. (通常polyacrylic 酸), 那麼被漂洗。牙被烘乾(不十分乾燥 ) 並且材料輕微地被安置。它必須被安置當材料的表面是發光的, 或它與牙質不會結合。油漆或未裝滿的樹脂應該是應用的在安置之後保護它免受或乾燥作用或吸水率, 其中之二可能有害地影響它最後的物產。在第一階段集合是完全的(五 分鐘之後極小值), 油漆被取消並且恢復可能是形狀, 鋪沙, 和使光滑。然後油漆一件表面外套, 或更好地未裝滿的樹脂, 應該被安置, 再保護免受乾燥作用和濕氣。最後的集合結束堅硬作為24 小時。
玻璃離子聚合物有好處化工結合直接地與搪瓷和牙質。有離子債券被形成在牙的鈣和集合材料之間。因為搪瓷是富有的在鈣裡, 債券上釉比債券強的對牙質。玻璃離子聚合物政券力量比那低接合agent/composite 系統, 但在一些情況, 巨大的政券力量不是最優先考慮的事。
玻璃離子聚合物有其它中意的物產並且你是氟化物發行。因為westernized 人是易受齲, 發布氟化物和幫助防止次要齲在恢復之下的補藥是中意的。多麼重要這氟化物發行是在獸醫患者也許是開放對辯論。其它中意的特點是相對地好biocompatibility 。這允許玻璃離子聚合物被安置緊挨甚至在齒齦邊際之下以最小的反應(如果邊際被完成很好) 。
總之, 玻璃離子聚合物是微弱的在壓縮和緊張比綜合和是較少磨蝕抗性。但是, 在非咬合, 低磨蝕區域他們快和容易安置和有做了很好臨床。玻璃離子聚合物也許被加強成為cermets. (銀色或銀色混合物粉末混合了入原始的粉末或純淨的金屬銀被熔化對玻璃粉末) 為增大的強度, 更加收音機不透明和增加的磨蝕抵抗) 。
Compomers 是玻璃離子聚合物和綜合混合物。目標是提供一些物產(譬如氟化物發行, autocuring, 和牙質接合) 對合成材料, 或提供更高的力量、polishability 和美學對玻璃離子聚合物。在實施, 材料擁有物產的實用混合, 但無是一樣發出音的像同樣物產在父母材料。他們傾向於有更低的穿戴力量比綜合。

總結
獸醫牙齒恢復的目標是恢復健康和作用對妥協的牙。一個另外的目標儘可能儘可能是保存一樣許多牙在恢復期間procedure.i.e., 去除作為少許牙在瑕疵的準備期間。混合物是強的, 但要求一點額外牙撤除創造機械保留。玻璃離子聚合物與牙質結合, 允許較少牙撤除為準備, 但他們不是一樣審美的像綜合和快速地不佩帶。綜合是強的, 和可能被結合以膠黏劑避免剩餘牙撤除。以玻璃離子聚合物和保稅的綜合, 輕微的咬邊為額外機械保留可能是有用的。

We will briefly discuss the categories and uses of some of the products most useful in veterinary dentistry. The presentation will focus on the practical clinical use of the materials and their clinically relevant properties and idiosyncrasies. At first, the use of dental materials seems complicated and confusing, yet each material has its own properties and handling abilities that lend it to certain applications. Veterinary dentistry requires materials that can be used to restore as normal function as possible. The forces of mastication pl>><<h function than aesthetics.
The ideal restorative material would form a chemical bond to enamel and dentine, be non irritant to pulp and soft tissues, be bacteriostatic, wear at the same rate as tooth structure, have high compressive and tensile strength, not fatigue, have the same thermal expansion coefficient as dentine, form a perfect seal between restorative material and tooth, not distort upon setting, and have ideal aesthetics. Such a material has yet to be invented. Many materials possess a number of these properties, however, and as such, each can be used for certain procedures.
DENTAL AMALGAM
Amalgam remains the hardest and strongest material available today for direct placement restorations. It is easy to use, helps maintain a seal against leakage by developing corrosion at the amalgam-tooth interface (although modern amalgams do this much less effectively), and has withstood the test of time. Use of amalgam in humans has become controversial due to concerns regarding its mercury content and resultant potential health hazard. As in many controversies, opposing views vary widely and are argued passionately by their proponents. A poor aesthetic result is another reason for a decline in amalgam use since it does not match natural tooth structure and darkens over time.
In veterinary dentistry, amalgam can be a good selection for treatment of occlusal table (Class I) caries lesions on molar teeth. In humans, it wears only 5?0 µ per year. The occlusal surface bears large loads and therefore benefits from a hard material. It is also an area in which the required undercuts can be produced with little effect on tooth strength.
As amalgam does not bond to tooth structure, it requires an 𠀾ndercut?to provide the retention that holds it in place. A lining of a dentin-bonding agent is placed and cured, and then amalgam is triturated in an amalgamator and placed incrementally into the cavity. It is condensed and carved prior to being burnished. The bonding agent is used primarily for sealing the tooth against leakage. If an auto-cure or dual-cure bonding agent is used, then some bonding of the amalgam to tooth structure occurs, but this is a very weak bond. Using a bonding agent is referred to as 弎onded amalgam,?but the poor bond strength cannot be relied on to hold the filling in place�t still needs an undercut cavity preparation.
COMPOSITES
The term composite merely indicates that various components or ingredients have been mixed together to create a new substance. In this paper, we will be considering dental restorative composites. These are composed of an acrylic resin (matrix phase), filler particles (dispersed phase) and acoupling phase (which coats the filler particles allowing them to couple with the matrix phase).
The resin most commonly employed in dental restoratives is known as bis-GMA, which is produced by a reaction between bisphenol A and a glycidal methacrylate. The resin is a dimethacrylate monomer, which is induced to polymerize by the presence of free radicals. These free radicals can be generated either by chemical reaction or the introduction of external energy (heat or light).
Chemically activated resins come as two components (two pastes usually). One paste contains a benzoyl peroxide initiator and the other a tertiary amine activator. When the two pastes are spatulated, the amine reacts with the benzoyl peroxide to form free radicals that initiate polymerization.
Light-activated resins come as a single paste in a syringe or compule. The paste contains a photoinitiator molecule (camphoroquinone) and an amine activator. When exposed to light in the 400 to 500 nm wavelength range, the photoinitiator becomes excited and reacts with the amine to produce the free radicals, thereby initiating the polymerization process.
Chemical-cure resins have the advantage of curing throughout their entire mass, but must be placed quickly before they 𦽳et?and then may take several minutes to cure sufficiently to allow finishing. Light-cure resins only 𦽳et?when exposed to the curing light and so have a much longer working time and then cure more rapidly when exposed. However, only that portion of the material exposed to sufficient intensity of light energy will cure and so deep restorations often need to be layered. Most references suggest that the maximum thickness of composite that should be cured is 2.0 to 2.5 millimeters (depending on the shade of the composite). Therefore, for a 4 millimetre deep defect, you would place a 2 millimeter thick layer, cure it and then add another 2 millimeter thick layer and cure it.
The dispersed phase of composites is composed of filler particles such as quartz, lithium, aluminium silicate, borosilicate, barium and various other glasses. The classification of the composite and many of its physical properties are dictated by the mean particle size.
Conventional composites have the largest mean particle size and may have particles up to 100 microns. Though these composites offered may advantages over the unfilled resins (relative to compressive strength, tensile strength, hardness, thermal expansion), they did not polish to a smooth surface. Abrasion tends to remove the softer resin matrix, leaving the large filler particles exposed. Microfilled composites use much smaller particles and are therefore more highly polishable. However, they have a higher percentage of resin matrixes than conventional composites and so are as neither hard nor as strong. In humans, they make very nice esthetic restorations for anterior teeth, but in the mouths of the veterinary patient, they have little application. Small particle composites are an attempt to achieve the high polishablility of the microfilled in combination with the strength and hardness of the macrofilled. Hybrid composites constitute a better compromise. Most contain a mixture of colloidal silica (microfiller size) and ground glass particles (0.6 to 1.0 microns). These composites have good strength and can be polished to a smooth surface, making them a good general-purpose restorative.
No composite material bonds to dental tissues, therefore, physical union with the tooth is achieved using a dental bonding agent of some sort. They will not be discussed in this paper.
One of the most important disadvantages of composite restorative materials is polymerization shrinkage. As the resin matrix polymerizes, the organized polymer molecule occupies less space than its disorganized constituent monomers did. Therefore, as the composite cures, it shrinks and so may pull away from the cavity walls. Chemical-activated composites tend to shrink toward the centre and so pull away from all walls equally. Light-activated composites tend to shrink toward the light and so will pull away from the walls furthest from the light. This pulling away from the walls can lead to marginal leakage and eventual failure of the restoration. Dental bonding systems help to overcome this tendency to pull away from the walls but do not always prevent it completely.
Another method advocated for reducing the effect of polymerizarion shrinkage is to place the composite incrementally. That is place a small amount, cure it, and then place another small increment, repeating the process until the defect is filled.
The degree of shrinkage is somewhat dependent on the percentage of filler in the composite (most hybrids are 60 to 65% filler by volume). As the filler does not shrink, more filler means less shrinkage.
GLASS IONOMER CEMENTS
Glass ionomer refers to a group of materials that use silicate glass powder and an aqueous solution of polyacrylic acid. The components must be carefully measured and mixed. They may come in bottles with measuring devices, or in ampules with pre-measured amounts of liquid and powder. The ratio is important, so the most reliable form is as pre-measured ampules. Bonding to dentin is felt to occur both by iononic and micromechanical forces. To place a glass ionomer restoration, the dentin and enamel are acid etched with a 𡤧onditioner?(usually polyacrylic acid), then rinsed. The tooth is slightly dried (not bone dry) and the material placed. It must be placed while the surface of the material is still shiny, or it will not bond to the dentin. A varnish or unfilled resin should be applied immediately after placement to protect it from either desiccation or water sorption, both of which can adversely affect its final properties. After the first stage set is complete (minimum of five minutes), the varnish is removed and the restoration can be shaped, sanded, and smoothed. Then a surface coat of varnish, or preferably unfilled resin, should be placed, again to protect against desiccation and moisture. The final set to end hardness takes 24 hours.
Glass ionomers have the advantage of chemically bonding directly to enamel and dentin. There is an ionic bond formed between the calcium of the tooth and the set material. As enamel is richer in calcium, the bond to enamel is stronger than the bond to dentin. The bond strength of glass ionomer is much lower than that of bonding agent/composite systems, but in some situations, huge bond strength is not the top priority.
Glass ionomers have other desirable properties and one is fluoride release. Since westernized humans are susceptible to caries, a restorative that releases fluoride and helps to prevent secondary caries under the restoration is desirable. How important this fluoride release is in veterinary patients might be open to debate. Another desirable feature is relatively good biocompatibility. This allows glass ionomers to be placed close to or even under the gingival margin with minimal reaction (if the margins are finished well).
In general, glass ionomers are weaker in compression and tension than composites and are less abrasion resistant. However, in non-occlusal, low abrasion areas they are quick and easy to place and have done well clinically.?Glass ionomers may be reinforced to become 𡤧ermets?(silver or silver amalgam powder mixed into original powder or pure metallic silver fused to glass powder) for increased strength, more radio-opaque and increased abrasion resistance).
Compomers are mixtures of glass ionomers and composites. The goal was to provide some properties (such as fluoride release, autocuring, and dentin bonding) to composite materials, or to provide higher strength, polishability and esthetics to glass ionomers. In implementation, the materials do possess a practical mix of properties, but none are as pronounced as the same properties in the parent material. They tend to have lower wear strength than composites.
SUMMARY
The goal of veterinary dental restoration is to restore health and function to compromised teeth. An additional goal is to preserve as much of the tooth as possible during the restoration procedure�.e., to remove as little tooth as possible during preparation of the defect. Amalgam is strong, but requires a little extra tooth removal to create mechanical retention. Glass ionomers bond to dentin, allowing less tooth removal for preparation, but they are not as esthetic as composites and wear faster. Composites are strong, and can be bonded with an adhesive to avoid excess tooth removal. Even with glass ionomer and bonded composites, a slight undercut for extra mechanical retention can be helpful.

minibabyqq 2007-1-26 02:35

[color=Magenta][size=5][b]補齒術Prosthodontics  [/b][/size][/color]


補齒術是介入失去的牙或牙結構替換以一個義肢設備牙科的分支。這包括冠、橋梁和植入管。空間允許關於冠的討論唯一。介紹將接觸在橋梁和植入管。
義肢冠
有許多因素當考慮治療計劃為也許是一名候選人為一個義肢冠的牙。您的工作將看它附有對和所有者帶來問題給您的各顆候選人牙, 動物。然後決定如果冠被表明。
有冠破裂以黏漿狀物質曝光的牙通常要求總pulpectomy 和根運河obturation 。運河的存取孔和屑子的鑽井去除自然牙組織和因此減弱殘餘的冠。與黏漿狀物質去, 有不再濕氣的來源被提供給牙質從內並且這缺乏濕氣並且減弱冠(牌子它更加易碎) 。所以, 它是相當安全說, 一顆endodontically 被對待的牙比一顆原封, 重要牙微弱的。如果那導致fracture/wear 的行為繼續沒有減退在endodontic 療法以後, 那麼義肢冠也許湧出的一種防護金屬被表明。
最共同地破碎的牙在狗是犬。這些長, 圓錐形冠逐漸變細對美好的點。根據精神創傷的本質, 這通常是終止的這些稀薄的要訣。在endodontic 治療以後, 您被留下與一個更短, 更加矮胖的冠。這新形狀是機械上較不有傾向破碎並且這也許抵消減弱的作用被提及在最後部分。
下顆最共同地破碎的牙是第四顆上部前臼齒。典型地, 這是負擔尖酸的力量和失敗的小, 突出的mesial 尖頂。一旦這個要訣去, 新冠形狀允許尖酸的力量被延長更大的表面。再, 變化在機械工上起因於改變在冠形狀也許保護它免受進一步損傷。
歷史上, 牙被恢復了以由機械保留拿著到位唯一的混合物。這意味著, 洞準備必須有咬邊, 更加進一步減弱冠和帶領注重造反者在洞底部preps 。混合物做了□什麼增加來牙的力量。現在, 我們結合不要求咬邊和的綜合樹脂因此允許一種更加保守的洞準備。另外, 保稅的恢復, 雖則不幾乎一樣強像自然牙結構, 增加一些力量來牙與混合物比較, 被動地坐在孔。
為了安置金屬冠在牙, 一些自然牙結構必須通常被犧牲。金屬冠通常是至少1 毫米厚實的。所以, 一毫米組織(搪瓷和牙質) 必須從自然冠的所有表面被去除。這更加進一步減弱牙並且那與冠的目的是相反的。在有大黏漿狀物質分庭和稀薄的冠牆壁的一條幼小狗, 組織損失在冠附近的外部也許是不能接受的。
由金屬假肢蓋一定是好的被保護免受進一步損傷牙並且這的部份是安置金屬冠的原因。但是, 金屬冠不防止它不蓋牙的部份的破裂。
在人, 金屬冠經常被使用保護忍受咬合力量被指揮沿他們長的軸的槽牙。在狗犬齒裡, 力量通常是在90 度對長的軸並且金屬冠的邊際可能作為支點, 導致牙的破裂在冠的頂端邊際。
冠可能掉下並且當他們, 他們很少被發現。替換一個失去的冠要求新套印象並且那麼有一種麻醉劑清掃牙和採取新印象和至少另安置冠。所有者準備的受理是這種風險和費用嗎?
為許多客戶決定對待牙而不是提取它是一個大躍遷。在我的實踐、根運河和保守的恢復費用兩次儘量提取。如果我們增加一個金屬冠(冠prep, 印象、實驗室費、第二種用封泥密封代理的麻醉劑安置冠, 費用), 共計票據加倍再。為許多寵物所有者, 它是公正不實用的非常投入他們的獸醫預算入一顆唯一牙的治療。
義肢冠的主要目的是進一步損傷的預防對被對待的牙的。這可能由避免經常也達到行為那導致破裂首先。許多狗傷他們的後部牙嚼在所有者無心地提供對他們的骨頭和堅硬玩具。一旦消息靈通這導致的牙齒破裂, 他們通常只太愉快以至於不能擺脫觸犯的玩具。以風險因而減少了, 需要對於金屬冠緊迫。
安置冠在一顆被對待的牙可能有對殘餘的牙的負面地影響。如果所有者被說服安排冠工作被完成預防進一步損壞對於被對待的牙, 他們也許認為, 它是所有不錯允許動物繼續破壞性的行為那導致破裂首先。所以, 殘餘的牙繼續被安置在危險中。如果冠不被安置, 所有者是可能是謹慎的關於他們的pet.s 嚼習性, 造福於被對待的牙和所有其他。
從所有這, 您也許得到我從未安置冠, 但不是案件的印象。我是公正非常有選擇性的。
一些狗損壞他們的牙在他們的責任表現。警察和安全狗、ringsport 狗、shutzhund 狗, 和flyball 狗全部被介入在安置他們的牙在危險中的活動。在案件譬如這, 危險的行為無法被修改。一些狗是慢性籬笆chewers 並且情況無法被改變。在案件喜歡這, 牙的保存是重要性的地方並且牙齒惡習繼續, 我推薦塑像金屬冠。
我不做化妝冠(冠由牙色的材料製成) 。冠的目的將防止進一步損傷。無審美冠材料來緊密在耐久性到金屬合金。實際上, 有相當有傾向對切削和崩裂, 並且在人的患者, 他們共同地要求修理。在dog.s 嘴, 他們也許看相當放電, 但他們不可能阻止在長期。
交配動物者和展示類型有時請求化妝冠為他們的展示狗。但是, AKC 和CKC 會皺眉在這。對規則的我的理解是, 它是可接受執行根運河治療和填裝存取孔, 但自然冠無法在任何情況下被增添。推理是, 法官不會有方式知道什麼是在假肢之下並且什麼先天不足它也許掩蓋。所以, 安置一個美麗的陶瓷冠在展示狗的犬也許導致無資格。
指南為被熔鑄的金屬冠設計
許多以下可能被發現在更加了不起的細節在獸醫牙齒文學, 但我現在將給幾條線一些冠設計的方面。
一項忽略的原則記住是自然牙結構的保存最大化最後的結果的力量。每當牙結構必須被去除滿足設計其它標準, 它應該被去除只在程度上absolutely 必要。
牙被加冠經常是接近的聯絡與接近並且/或者遮沒成員。所以, 為了是室為材料的厚度那裡□去□常做假肢, 牙必須有它的外部維度被減少。例如, 那裡也許是少於一毫米在牙404 和牙103 和104 之間。如果牙404 接受補藥1.5 毫米厚實的夾克, 它然後太寬的以至於不能適合空間可利用。所以, 它必須被減少允許恢復的加法。為上頷骨第四顆前臼齒牙, palatal 面孔不能是被修造, 照原樣在與下頷骨第一槽牙的labial 面孔的接近的接近度當嘴是閉合的。為了計劃適當的牙減少, 操作員必須仔細地估計所有咬合介入的關係。
材料被使用在生產假肢對牙減少的要求並且將衝擊。例如, 金塑像冠應該是至少1 毫米厚實的在咬合, 切開或cuspal 表面但可能逐漸變細對非常美好的齒齦邊際。另一方面, 瓷熔化對金屬夾克incisally 或cuspally 需要是至少2 毫米厚實的, 1.5 毫米occlusally 和至少1.5 毫米厚實在齒齦cavosurface 。所以, 它重要決定什麼補藥將被使用在開始冠準備之前。它是適當與您的牙齒實驗室談論減少要求在治療之前保證, 您提供他們以空間量他們需要。
為了誕生外形(牙的形狀當它從齒齬湧現) 被恢復的冠是相似與自然牙和可接受的為牙周健康, 關心維護必須被採取在設計和準備齒齦cavosurface 。因素被考慮包括解剖學自然牙和它關係對其它口頭結構和材料被使用為恢復。有幾條少量的終點線選擇從如標準文本所述。
斜面結束有一些好處。它考慮到冠的一些微運動沒有對部下的牙邊際的損傷。它並且允許實驗室製造一個冠以堅固齒齦邊際, 比邊際較不技術上橫徵暴斂的逐漸變細對美好的點(羽毛, 隱密, 鑿子, 斜面) 。
羽毛裝飾, 隱密, 鑿子, 並且二面對切的邊際允許冠的一些微運動在重音之下, 是優良為一些材料, 可能保護部下的牙免受損傷由吸收重音。但是, 這些結束所有逐漸變得尖細對可能更難準確地打蠟和會是依於畸變在處理期間的美好的點。
為瓷和陶瓷恢復, 冠的微運動能導致少量崩裂和切削這堅硬, 但易碎, 材料。所以, 靶垛聯接一般必需。再, 與您的化驗員協商保證, 您少量的prep 是適當使材料被使用。
為牙的牙周健康, 這齒齦cavomargin 應該是地方1 到2 毫米冠狀對自由齒齦邊際。這保持牙恢復接口去從齒齬和公開它是容易接近的為家關心的地方。在人的補齒術, 邊際subgingivally 經常被安置為化妝原因; 與明智flossing 和掠過, 這可能運作很好。與狗, 由於典型地較不比有效的家關心, 作用和耐久性應該採取優先權在化妝用品; 並且保留邊際在開放改進牙周預測。
當用封泥密封的代理可利用的今天要求是難以置信地強的, 它重要設計將最大化冠的保留的冠準備。鑰匙的當中一個將最大化表面聯絡在牙和冠之間。那裡應該是至少4 毫米酣然的牙由冠報道並且6 毫米會更喜歡。
偶爾地, 破碎的牙有少於4 毫米自然冠左花冠對自由齒齦邊際。為了達到充足的保留, 某事必須完成。冠加長規程(參照下個介紹) 是暴露更多自然牙結構由改變位置牙的自由齒齦邊際的外科手術。
其它方法將增加材料來殘餘的冠。安置一個被預製的或定製的崗位入endodontic 運河並且/或者別針入牙質可能做這。這些別針和崗位然後被使用作為腳手架保留某種核心積累材料的形式。雖然這些戰略可能改進冠的保留, 他們實際上並且減弱自然牙結構。一個endodontic 崗位也許幫助拿著冠到位但力量在冠也許被傳達通過崗位給運河在根之內, 可能導致根破裂。所以, 達到保留的目標也許是在衝突以維護牙的正直的原則。
旋轉的穩定經常是關心在準備的犬齒因為準備的表面也許接近一個圓柱形錐體。防止冠的自轉, 保留凹線也許被削減牙。這些凹線必須是互相平行和自然冠的長的軸允許義肢冠適當地滑。他們應該是足夠深的提供對自轉的抵抗當避免自然牙組織過份撤除。
一旦實驗室創造了蠟樣式(為一個充分的金屬冠) 或uncured 瓷或陶瓷冠在石模型, 他們必須能去除它並且您必須能安置完成品在patient.s 牙。所以, 牙必須coronally 逐漸變細從齒齦cavosurface 因此冠可能滑斷斷續續。渴望的程度逐漸變得尖細是五到六度從平行的邊。用平行的邊, 摩擦在牙之間和冠會使坐冠困難。沒有一些出氣孔槽孔允許空氣和膠漿逃脫, 宣揚並且液壓會防止冠適當的就座。過份逐漸變得尖細減少表面可利用為保留和對冠的逐出是機械上較不有抵抗性。
任何切開下準備的牙將使它難使實驗室從模型去除樣式和使您安置冠在牙。當咬邊是難免的, 他們可能用綜合或玻璃離子聚合物被填裝在冠準備之前。
當安置金屬冠在一顆破碎的犬齒, 所有者也許構想完成品像未損壞的牙將是相同大小和形狀, 但這不被推薦。為了使牙破裂降低風險頂端到冠(在冠邊際和齒齦音冠之間) 並且改進冠的保留, 它建議, 被恢復的牙比自然冠高度的2/3 是沒有。修造冠比那更加高級做它太多像一根高效率的槓桿並且力量(垂直對牙的長的軸) 需要在要訣撞出冠很大地被減少。
犬齒有末端曲度對冠, 幫助保留犧牲者從滑出牙的掌握。當製造一個塑像冠為一顆犬齒, 它建議, 實驗室取消這末端曲度由創造一個光滑的傾斜從末端cavosurface 對冠要訣。這樣, 如果狗牢固地掌握某事和艱苦拉扯, 它是可能滑下牙而不是被捉住在它之後和傷牙或成功冠。


Prosthodontics is the branch of dentistry that involves replacement of lost teeth or tooth structure with a prosthetic device. This includes crowns, bridges and implants. Space permits discussion of crowns only. The presentation will touch on bridges and implants.
PROSTHETIC CROWNS
There are many factors when considering the treatment plan for a tooth that might be a candidate for a prosthetic crown. Your job is to look at each candidate tooth, the animal it is attached to and the owner that brought the problem to you. Then decide if a crown is indicated or not.
A tooth that has a crown fracture with pulp exposure usually requires total pulpectomy and root canal obturation. Drilling of the access holes and filing of the canals removes natural tooth tissue and so weakens the remaining crown. With the pulp gone, there is no longer a source of moisture being supplied to the dentin from within and this lack of moisture also weakens the crown (makes it more brittle). Therefore, it is quite safe to say that an endodontically treated tooth is weaker than an intact, vital tooth. If the behaviour that led to the fracture/wear is going to continue unabated after endodontic therapy, then a protective metal prosthetic crown may well be indicated.
The most commonly fractured teeth in dogs are the canines. These long, conical crowns taper to a fine point. Depending on the nature of the trauma, it is usually these thin tips that break off. After endodontic treatment, you are left with a much shorter, stockier crown. This new shape is mechanically much less prone to fracture and this may counter-balance the weakening effects mentioned in the last section.
The next most commonly fractured tooth is the fourth upper premolar. Typically, it is the small, prominent mesial cusp that bears the biting force and fails. Once this tip is gone, the new crown shape allows the biting forces to be spread over a larger surface area. Again, the change in mechanics resulting from the alteration in crown shape may protect it from further damage.
Historically, teeth were restored with amalgam that was held in place by mechanical retention only. This meant that the cavity preparation had to have undercuts, which further weakened the crown and led to stress risers in the bottom of the cavity preps. The amalgam itself did nothing to add to the strength of the tooth. Now, we have bonded composite resins that require no undercutting and so allow a more conservative cavity preparation. In addition, the bonded restoration, though not nearly as strong as natural tooth structure, does add some strength to the tooth compared to amalgam, which just sits passively in the hole.
In order to place a metal crown on a tooth, some of the natural tooth structure usually must be sacrificed. A metal crown is usually at least 1 millimeter thick. Therefore, a millimeter of tissue (enamel and dentin) must be removed from all surfaces of the natural crown. This further weakens the tooth and that is contrary to the purpose of the crown. In a young dog that has a large pulp chamber and a thin crown wall, the loss of tissue around the outside of the crown may be unacceptable.
The portion of the tooth that is covered by the metal prosthesis is certainly well protected from further damage and this is the reason for placing a metal crown. However, a metal crown does not prevent a fracture of the portions of the tooth it does not cover.
In humans, metal crowns are often used to protect molars that endure occlusal forces directed along their long axis. In dog canine teeth, the forces are usually at 90 degrees to the long axis and the margin of the metal crown can act as a fulcrum, leading to a fracture of the tooth at the apical margin of the crown.
Crowns can fall off and when they do, they are rarely found. To replace a lost crown requires a new set of impressions and so there is at least one anesthetic to clean up the tooth and take the new impressions and another to place the crown. Are the owners prepared to accept this risk and cost?
For many clients the decision to treat the tooth rather than extract it is a big jump. In my practice, root canal and conservative restoration costs about twice as much as extraction. If we add a metal crown (crown prep, impressions, lab fees, second anesthetic to place crown, cost of luting agent?, the total bill doubles yet again. For many pet owners, it is just not practical to put so much of their veterinary budget into the treatment of a single tooth.
The main purpose of the prosthetic crown is the prevention of further damage to the treated tooth. This can also often be achieved by avoiding the behaviour that led to the fracture in the first place. Many dogs break their posterior teeth chewing on bones and hard toys that the owners unwittingly provided to them. Once informed that this causes dental fractures, they are usually only too happy to get rid of the offending toys. With the risk thus reduced, the need for a metal crown is less pressing.
Placing a crown on a treated tooth can have a negative impact on the remaining teeth. If the owners are convinced to have the crown work done to prevent further damage to the treated tooth, they may feel that it is all right to allow the animal to continue the destructive behaviour that led to the fracture in the first place. Therefore, the remaining teeth continue to be placed at risk. If no crown is placed, the owners are more likely to be cautious about their pet𠏋 chewing habits, to the benefit of the treated tooth and all the others as well.
From all this, you may be getting the impression that I never place crowns, but that is not the case. I am just very selective.
Some dogs damage their teeth in the performance of their duties. Police and security dogs, ringsport dogs, shutzhund dogs, and flyball dogs are all involved in activities that place their teeth at risk. In cases such as this, the risky behaviour cannot be altered. Some dogs are chronic fence chewers and the situation cannot be changed. In cases like this, where the preservation of the teeth is a high priority and the dental abuse is going to continue, I recommend cast metal crowns.
I do not do cosmetic crowns (crowns made of tooth coloured material). The purpose of the crown is to prevent further damage. None of the esthetic crown materials comes close in durability to the metal alloys. In fact, there are quite prone to chipping and cracking, and in human patients, they commonly require repair. In a dog𠏋 mouth, they may look pretty at discharge, but they are not likely to hold up in the long term.
Breeders and show types sometimes request cosmetic crowns for their show dogs. However, the AKC and CKC would frown on this. My understanding of the rules is that it is acceptable to perform the root canal treatment and fill the access holes, but that the natural crown cannot be augmented in any way. The reasoning is that the judges would have no way of knowing what is under the prosthesis and what congenital defect it might be covering up. Therefore, placing a beautiful ceramic crown on the canine of a show dog might lead to disqualification.
GUIDELINES FOR DESIGN OF CAST METAL CROWNS
Much of the following can be found in greater detail in the veterinary dental literature, but I will give a few lines to some aspects of crown design now.
One over-riding principle to keep in mind is preservation of natural tooth structure to maximize the strength of the final result. Whenever tooth structure must be removed to satisfy other criteria of design, it should be removed only to the extent absolutely necessary.
The tooth to be crowned is often in close contact with the proximal and/or occluding members. Therefore, in order for there to be room for the thickness of material used to make the prosthesis, the tooth must have its outside dimensions reduced. For example, there may be less than one millimeter between tooth 404 and teeth 103 and 104. If tooth 404 receives a 1.5-millimeter thick jacket of restorative, it would then be too wide to fit in the space available. Therefore, it must be reduced to allow the addition of the restoration. For the maxillary fourth premolar tooth, the palatal face must not be over built, as it is in close proximity to the labial face of the mandibular first molar when the mouth is closed. In order to plan an appropriate tooth reduction, the operator must carefully assess all occlusal relationships involved.
The material to be used in the fabrication of the prosthesis will also impact on the requirements of tooth reduction. For example, a gold cast crown should be at least 1 millimeter thick on the occlusal, incisal or cuspal surface but can be tapered to a very fine gingival margin. On the other hand, a porcelain-fused-to-metal jacket needs to be at least 2 millimeters thick incisally or cuspally, 1.5 millimeters occlusally and at least 1.5 millimeters thick at the gingival cavosurface. Therefore, it is important to decide what restorative will be used before starting the crown preparation. It is advisable to discuss reduction requirements with your dental laboratory prior to treatment to ensure that you provide them with the amount of space they need.
In order for the emergence profile (shape of the tooth as it emerges from the gingiva) of the restored crown to be similar to the natural tooth and acceptable for maintenance of periodontal health, care must be taken in designing and preparing the gingival cavosurface. The factors to be considered include the anatomy of the natural tooth and it relationship to other oral structures and the material to be used for the restoration. There are several marginal finish lines to choose from as outlined in standard texts.
A chamfer finish has some advantages. It allows for some micro-movement of the crown without damage to the underlying tooth margin. It also allows the lab to fabricate a crown with a substantial gingival margin, which is less technically exacting than margins that taper to a fine point (feather, occult, chisel, bevel).
Feather, occult, chisel, and bevel margins allow some micro-movement of the crown under stress, which is fine for some materials and can protect the underlying tooth from damage by absorbing the stress. However, these finishes all taper to a fine point which can be more difficult to wax up accurately and would be subject to distortion during handling.
For porcelain and ceramic restorations, micro-movement of the crown can lead to marginal cracking and chipping of these hard, but brittle, materials. Therefore, butt joints are generally required. Again, consult with your laboratory technicians to ensure that your marginal prep is appropriate for the material to be used.
For the periodontal health of the tooth, this gingival cavomargin should be place 1 to 2 millimeters coronal to the free gingival margin. This keeps the tooth-restoration interface away from the gingiva and out in the open where it is accessible for home-care. In human prosthodontics, the margin is often placed subgingivally for cosmetic reasons; with judicious flossing and brushing, this can work well. With dogs, in view of typically less than effective home-care, function and durability should take priority over cosmetics; and keeping the margin out in the open improves the periodontal prognosis.

minibabyqq 2007-1-26 02:36

[color=Magenta][size=5][b]冠加長Crown Lengthening  [/b][/size][/color]


介紹
冠加長是相當數量牙supragingivally 被暴露增加的任一個做法。這也許orthodontically 或外科地達到。本文將談論這些徵兆並且介紹冠加長也許達到的一些方法。
牙周關係
瞭解為什麼冠加長也許是中意的, 牙周解剖學回顧是在有條有理。不幸地, 空間不允許這這裡, 因此讀者被指揮對標準獸醫和人的牙齒文本對於資訊關於主題。回顧解剖學和關係在各種各樣的牙齒和paradental 組織之間。
負擔特別提及的一個概念是 生物寬度。每個區域在牙的子宮頸區域之內有一個目的並且身體努力維護他們。生物寬度描述這個關係。在periodontally 健康人, 齒齦溝是大約1 毫米深的, junctional 上皮衣領是大約1 毫米寬, 和因此是結締組織附件區域。所以, 從自由齒齦邊際的距離到齒齦音冠是大約3 毫米。如果自由齒齬被截肢, 齒齦音冠、結締組織附件, 和junctional 皮膜全部將移居1 毫米在根下再創造一個齒齦溝和重建關係由生物寬度規定。在periodontally 健康狗, 區域在自由齒齦邊際和齒齦音冠之間也許是3 毫米各個, 根據並且牙被考慮狗的大小。
生物寬度是periodontium 的自然防禦, 將努力維護某一距離在任一恢復和齒齦音crestal 骨頭之間。在狗, 那裡應該是至少1 毫米結締組織附件根源牙骨質花冠對齒齦音冠。花冠對這應該是1 到2 毫米junctional 皮膜。花冠對這應該是1 到2 毫米一個齒齦溝深度。最後齒齦cavomargin 應該是1 毫米花冠對自由齒齦邊際。所以, 齒齦cavomargin 應該是4 到6 毫米冠狀對齒齦音冠。如果它比這接近的, 炎症將接著而來導致骨頭的吸回和齒齦附件的頂端遷移直到生物寬度被重建。雖然它是理想的有恢復完全supragingival, 它是可能安置他們subgingival 如果選擇不存在。
徵兆為冠加長
在之下噴發的牙
如果牙保留部份地只噴發, 有subgingivally 將是更多冠比法線。作為不齒齬亦不牙周韌帶附上對subgingival 搪瓷這創造一個深刻的牙周瑕疵。當這個瑕疵成為傳染與匾細菌, pericoronitis 接著而來。一個選擇將提取在之下噴發的牙。但是, 為戰略地重大牙, 冠加長做法也許解決牙周關心當保存牙。
延伸Subgingivally 的牙齒破裂
牙齒破裂是一共同發現在狗和貓。在許多情況下, 損傷supragingivally 被制約對臨床冠。在這些情況下, 瑕疵的恢復有對牙的牙周狀態的一點衝擊。但是, 許多牙齒破裂介入subgingivally 延伸和也許去在cementoenamel 連接點之外的損傷。
為所有實用目的、齒齬和牙周韌帶唯一附上對牙骨質, 他們不附有牙質或滋補材料。延伸根的任一破裂將介入部下的牙質的cemental 覆蓋物和曝光的損失。如果瑕疵不被恢復, 牙周韌帶並且/或者齒齦組織與被暴露的牙質聯繫也許被動地說謊反對牙質或也許攻擊它以odontoclasts 為再吸收牙。如果牙被恢復, 齒齬和韌帶仍然不會附有, 因此一個牙周瑕疵堅持並且那裡也許仍然是外在吸回在牙恢復接口如果恢復適當地沒被完成。
改進牙周預測為一顆牙與冠根破裂, 冠加長做法也許被使用安置瑕疵和它的恢復完全地supragingival 。
增加一個義肢冠的保留
有它是中意安置塑像金屬冠在一顆損壞的牙的各種各樣的情況。為了這條假肢停留到位, 必須那裡是充分表面為保留。為狗犬齒, 那裡應該是4 毫米極小值自然冠高度由義肢冠報道。有時牙的破裂是這樣, 有決不這相當數量臨床冠餘留。在那些案件, 冠加長做法可能被使用增加相當數量牙可利用為假肢的保留。
規程
有三類型冠加長規程。根據介入的牙, 有達到渴望的結果各種各樣的方式。
第一類型: Gingivectomy 。
類型2: Apically 被改變位置的擋水板。
類型3: 牽強的爆發以一些類型正牙學設備(沒被談論這裡) 。
第一類型: 冠加長
為牙與豐富的齒齬, 譬如上頷骨犬齒在一條大狗, 2 到3 毫米臨床冠可能由執行簡單地獲取一周圍gingivoplasty 。一根牙周探針被使用測量齒齦溝的深度並且外面齒齦皮膜被刺以針創造靈菌點, 1 到2 毫米線冠狀對溝地板。二面對切的切開用第11 scalpel 刀片然後被做, 連接小點在牙附近並且被切斷的齒齬被去除。由保持切開冠狀對齒齦溝的地板, 沒有侵犯在生物寬度和因此牙的牙周狀態不減弱。
第一類型冠加長不需要介入牙的整個圓周。如果瑕疵被暴露被隔絕對牙的一張面孔, 那麼唯一區域需要被去除的齒齬覆蓋物。肯定混合切開以周圍的齒齬避免鋒利的步和角度在自由齒齦邊際。
型2: 冠加長
具體做法依靠介入的牙。唯一根源的牙沒有furcations 最容易periodontally 處理但多根源的牙可能並且被對待這樣。各種各樣的擋水板設計是可能的, 但所有必須:
尊敬生物寬度。
維護一個充分crown/root 長度比率(根至少1.5 次長期比冠) 。
允許擋水板的安置沒有緊張在縫合線。
考慮到牙周健康維護。
上頷骨犬齒
充分的厚度, mucoperiosteal 包圍擋水板buccally 和palatally 被舉起。切開為擋水板開始在側向門牙的頰面孔和切斷齒齦附件對那顆牙。它末端上然後運行通過diastema 在門牙和犬齒之間, 在齒齦溝附近在頰邊的似犬, 通過diastema 在似犬和第一顆前臼齒之間, 在齒齦溝附近在頰邊第一前臼齒, 等等。切開作為末端上當有必要被擴大允許頰擋水板的充分反射。Palatal 擋水板被舉起在切斷包含的牙的齒齦附件以後在palatal 邊。
齒齦音骨頭從根表面被去除使用骨頭鑿子或牙齒burs 在一隻高速牙齒手編結。巨大必須被保重保存被暴露的牙骨質以便齒齦擋水板可能再依附對牙表面。骨頭塑造外形以便新齒齦音冠是至少1 毫米頂端的對瑕疵。新齒齦音冠應該被塑造對遇見牙在一個非常銳角的一個光滑和鋒利的邊緣, 很像原始的齒齦音冠在一個periodontally 健康情況。一個牙齒curette 運轉很好為這。
一旦充足的骨頭被去除一直暴露牙骨質帶(為齒齦reattachment) 在牙附近, 骨頭palatal, mesial 和末端對牙塑造外形那麼那裡是與周圍的骨頭的逐漸傾斜和轉折。然後殘骸從外科領域被取消為準備改變位置擋水板。
頰擋水板放下在牙以自由齒齦邊際被安置大約4 毫米冠狀對新齒齦音冠並且palatal 擋水板放下平展在堅硬上顎。它也許是必要整理某一重複組織從擋水板邊際允許擋水板說謊平展沒有折。擋水板interdentally 被縫合互相以美好的(5-0) 能吸收的材料譬如Monocryl. 。
患者被哺養變柔和的食物為二個星期和對堅硬玩具的denied 通入。系統抗生素和防腐口頭沖洗被表明在外科醫生的謹慎。
下頷骨犬齒
充分的厚度mucoperiosteal 頰和舌擋水板被開發至於為上頷骨犬齒。齒齬在下頷骨犬齒和第一下頷骨前臼齒牙之間是一條稀薄的帶沿interdental 骨頭的背部土坎。設法保留切開在齒齬之內這個窄帶如同齒齬握縫合更好比口頭mucosa 。
骨頭減少與那是做的有些相似被描述上面。一個區別是下頷骨側向門牙的接近度與下頷骨犬齒的mesial 面孔。為了達到適當osseous 塑造外形為犬, 它是有時必要從側向門牙牙去除可觀的齒齦音骨頭。雖然先進的牙周規程的目的將保存牙, 它也許被視為適當犧牲側向門牙傾向於改進預測為更加重大的犬齒。這將是決定根據個體的牙周狀態, 相當數量骨頭支持餘留為門牙, 和那顆牙的被察覺的重要性為患者(展示狗對家庭寵物) 。
一旦齒齦音冠被塑造並且使光滑的和周圍的骨頭被減少與新齒齦音冠逐漸混合, 區域是debrided 如上所述。頰和舌擋水板放下在牙和interdentally 被縫合得。再, 它也許是必要整理擋水板邊際去除重複組織。
頰擋水板有一個傾向乘坐在犬齒和尋找它的道路回到它原始的高度。這可能應付由安置兩三褶襉縫合。使用同樣, 美好的能吸收的材料, 安置針通過齒齬在mucogingival 連接點附近, subperiosteally 跑它到下顎骨的腹疆界, 和然後通過口頭mucosa 在labial 前庭的底部。然後栓結, 拉扯它足夠緊緊腹上畫齒齦直到自由齒齦邊際是大約4 毫米冠狀對新齒齦音冠。病後調養是至於為上頷骨犬齒。
上頷骨第四顆前臼齒牙
這些牙, 和所有多根源的牙, 形成一個額外挑戰。在狗, furcation 是緊挨cemento 搪瓷連接點。所以, 瑕疵不必須subgingivally 延伸在有嚴肅的furcation 介入之前。牙, 嘴他們被發現, 並且所有者出席患者必須所有仔細地被評估決定的患者在如果牙是可治療的或應該被提取。您必須評估損傷、animal.s 牙周狀態、對口頭衛生學的owner.s 承諾, 和您自己的技術技能的程度。
典型地, 瑕疵被處理是頰平板破裂。很少是有牙的palatal 邊的任一介入。所以, 它通常是只必要舉起一塊頰mucoperiosteal 擋水板。假使後部牙的近似值, 包圍擋水板不能是充足的; 一個或更多垂直發布切開也許是需要的。在舉起擋水板以後, 充足的齒齦音骨頭被去除暴露整個瑕疵並且至少1 毫米原封牙骨質。如果瑕疵介入只一根, 它也許是可能做這減少沒有去除骨頭從furcation 。
一旦新齒齦音冠被創造了並且外科領域debrided, 擋水板可能被縫合到位。在許多情況下, 它不是可能subgingivally 留下整個瑕疵當寂靜的覆蓋物furcation 與擋水板。在這些情況下, 瑕疵應該被恢復在擋水板的安置之前。這導致恢復的頂端邊際subgingivally 被安置, 不是中意的, 但是它比留給furcation 好被暴露。
擋水板apically 被改變位置得和被縫合對齒齬mesial 和末端對擋水板。它是重要對那自由齒齦邊際是大約2 毫米冠狀對furcation 以便齒齬可能報道和保護這periodontally 重大解剖學。
因為擋水板mesially 和末端上只被縫合和不能說謊平展反對牙沿整個頰牆壁, 一些組織膠黏劑也許被使用。在擋水板被縫合之後, 它被推擠反對齒齦音骨頭和牙強迫任一血液和流體從外科領域。然後cyanoacrylate 下落被安置在擋水板的自由齒齦邊際和被允許流動冠的搪瓷, 添加擋水板到牙。應該被保重, 膠漿不流動在它作為外國身體和會延遲擋水板reattachment 對齒齦音骨頭和被暴露的牙骨質的擋水板之下。

INTRODUCTION
Crown lengthening is any procedure by which the amount of tooth exposed supragingivally is increased. This may be achieved orthodontically or surgically. This paper will discuss some of these indications as well as introducing some of the methods by which crown lengthening may be achieved.
PERIoDONTAL RELATIONSHIPS
To understand why crown lengthening may be desirable, a review of periodontal anatomy is in order. Unfortunately, space does not permit this here, so the reader is directed to standard veterinary and human dental texts for information on the subject. Review anatomy and the relationships between the various dental and paradental tissues.
One concept that bears special mention is Biological Width. Each of the zones within the cervical area of the tooth has a purpose and the body strives to maintain them. Biological width describes this relationship. In periodontally healthy humans, the gingival sulcus is approximately 1 millimeter deep, the junctional epithelial collar is about 1 millimeter wide, and so is the zone of connective tissue attachment. Therefore, the distance from the free gingival margin to the alveolar crest is approximately 3 millimeters. If the free gingiva is amputated, the alveolar crest, connective tissue attachment, and junctional epithelium will all migrate 1 millimeter down the root to re-create a gingival sulcus and re-establish the relationship prescribed by biological width. In periodontally healthy dogs, the zones between the free gingival margin and alveolar crest may be up to 3 millimeters each, depending on the size of the dog and which tooth is being considered.
Biological width is a natural defense of the periodontium, which will strive to maintain a certain distance between any restoration and the alveolar crestal bone. In the dog, there should be at least 1 millimeter of connective tissue attachment to root cementum coronal to the alveolar crest. Coronal to this should be 1 to 2 millimeters of junctional epithelium. Coronal to this should be a gingival sulcus of 1 to 2 millimeters depth. Finally the gingival cavomargin should be 1 millimeter coronal to the free gingival margin. Therefore, the gingival cavomargin should be 4 to 6 millimeters coronal to the alveolar crest. If it is closer than this, inflammation will ensue to cause resorption of bone and apical migration of the gingival attachments until the biological width is re-established. Though it is ideal to have restorations totally supragingival, it is possible to place them subgingival if no alternative exists.
INDICATIONS FOR CROWN LENGTHENING
Under-Erupted Teeth
If a tooth remains only partially erupted, there will be more of the crown subgingivally than normal. As neither the gingiva nor periodontal ligament attach to the subgingival enamel this creates a deep periodontal defect. As this defect becomes infected with plaque bacteria, a pericoronitis ensues. One option is to extract the under-erupted tooth. However, for strategically significant teeth, a crown lengthening procedure might resolve the periodontal concerns while preserving the tooth.
Dental Fractures That Extend Subgingivally
Dental fractures are a common finding in both dogs and cats. In many cases, the damage is restricted to the clinical crown supragingivally. In these cases, restoration of the defect has little impact on the periodontal status of the tooth. However, many dental fractures involve damage that extends subgingivally and may go beyond the cementoenamel junction.
For all practical purposes, gingiva and periodontal ligament only attach to cementum, they do not attach to dentin or restorative materials. Any fracture that extends onto the root will involve loss of the cemental covering and exposure of the underlying dentin. If the defect is not restored, the periodontal ligament and/or gingival tissues in contact with the exposed dentin may just lie passively against the dentin or may attack it with odontoclasts in an attempt to reabsorb the tooth. If the tooth is restored, the gingiva and ligament will still not attach, so a periodontal defect persists and there may still be external resorption at the tooth-restoration interface if the restoration has not been finished properly.
To improve the periodontal prognosis for a tooth with a crown-root fracture, a crown lengthening procedure may be employed to place the defect and its restoration completely supragingival.
To Increase Retention Of A Prosthetic Crown
There is a variety of situations in which it is desirable to place a cast metal crown on a damaged tooth. In order for this prosthesis to stay in place, there must be adequate surface area for retention. For a dog canine tooth, there should be a minimum of 4 millimeters of natural crown height covered by the prosthetic crown. Sometimes the fracture of the tooth is such that there is less than this amount of clinical crown remaining. In those cases, a crown lengthening procedure can be used to increase the amount of tooth available for retention of the prosthesis.
PROCEDURES
There are three types of crown lengthening procedures. Depending on the tooth involved, there is a variety of ways of achieving the desired results.
Type-1: Gingivectomy.
Type-2: Apically repositioned flaps.
Type-3: Forced eruption with some type of orthodontic device (not discussed here).
Type 1: Crown Lengthening
For teeth with abundant gingiva, such as the maxillary canine teeth in a large dog, 2 to 3 millimeters of clinical crown can be gained simply by performing a circumferential gingivoplasty. A periodontal probe is used to measure the depth of the gingival sulcus and the outer gingival epithelium is pricked with a needle to create a line of bleeding points, 1 to 2 millimeters coronal to the sulcus floor. A beveled incision is then made with a No. 11 scalpel blade, connecting the dots around the tooth and the severed gingiva is removed. By keeping the incision coronal to the floor of the gingival sulcus, there is no encroachment on the biological width and so the periodontal status of the tooth is not compromised.
Type 1 crown lengthening need not involve the entire circumference of the tooth. If the defect to be exposed is isolated to one face of the tooth, then only the gingiva covering that area need be removed. Be certain to blend the incision with the surrounding gingiva to avoid sharp steps and angles in the free gingival margin.
Type 2: Crown Lengthening
The specific procedure depends on the tooth involved. Single rooted teeth with no furcations are the easiest to manage periodontally but multi-rooted teeth can also be treated in this manner. Various flap designs are possible, but all must:
Respect biological width.
Maintain an adequate crown/root length ratio (root at least 1.5 times longer than crown).
Allow placement of the flaps with no tension at the suture lines.
Allow for maintenance of periodontal health.
Maxillary Canine Tooth
Full thickness, mucoperiosteal envelop flaps are elevated buccally and palatally. The incision for the flaps starts on the buccal face of the lateral incisor and severs the gingival attachment to that tooth. It then runs distally through the diastema between the incisor and canine tooth, around the gingival sulcus on the buccal side of the canine, through the diastema between the canine and first premolar, around the gingival sulcus on the buccal side of the first premolar, and so on. The incision is extended as far distally as necessary to allow adequate reflection of the buccal flap. Palatal flap is elevated after severing gingival attachment of the involved teeth in the palatal side.
Alveolar bone is removed from the root surface using bone chisels or dental burs in a high-speed dental hand piece. Great care must be taken to preserve the exposed cementum so that the gingival flap can reattach to the tooth surface. The bone is contoured so that the new alveolar crest is at least 1 millimeter apical to the defect. The new alveolar crest should be shaped to a smooth and sharp edge that meets the tooth at a very acute angle, much like the original alveolar crest in a periodontally healthy situation. A dental curette works well for this.
Once sufficient bone has been removed to expose a band of cementum (for gingival reattachment) all the way around the tooth, the bone palatal, mesial and distal to the tooth is contoured so there are gradual slopes and transitions to the surrounding bone. Then debris is removed from the surgical field in preparation for repositioning of the flaps.
The buccal flap is laid down on the tooth with the free gingival margin placed about 4 millimeters coronal to the new alveolar crest and the palatal flap is laid down flat on the hard palate. It may be necessary to trim some redundant tissue from the flap margins to allow the flaps to lie flat without buckling. The flaps are sutured to each other interdentally with a fine (5-0) absorbable material such as Monocryl?
The patient is fed softened food for two weeks and denied access to hard toys. Systemic antibiotics and antiseptic oral rinses are indicated at the discretion of the surgeon.
Mandibular Canine Tooth
Full thickness mucoperiosteal buccal and lingual flaps are developed as for the maxillary canine tooth. The gingiva between the mandibular canine tooth and the first mandibular premolar tooth is a thin band along the dorsal ridge of the interdental bone. Try to keep the incision within this narrow band of gingiva as gingiva holds a suture better than oral mucosa.
Bone reduction is done in a manner similar to that described above. One difference is the proximity of the mandibular lateral incisor to the mesial face of the mandibular canine tooth. In order to achieve proper osseous contouring for the canine, it is sometimes necessary to remove considerable alveolar bone from the lateral incisor tooth as well. Though the purpose of advanced periodontal procedures is to preserve teeth, it may be deemed appropriate to sacrifice the lateral incisor in favor of improving the prognosis for the more significant canine tooth. This will be a decision based on the periodontal status of the individual, the amount of bone support remaining for the incisor, and the perceived importance of that tooth for the patient (show dog versus family pet).
Once the alveolar crest has been shaped and smoothed and surrounding bone reduced to blend gradually with the new alveolar crest, the area is debrided as above. The buccal and lingual flaps are laid down on the tooth and sutured interdentally. Again, it may be necessary to trim the flap margins to remove redundant tissue.
The buccal flap has a tendency to ride up on the canine tooth and find its way back to its original height. This can be dealt with by placing a couple of tuck sutures. Using the same, fine absorbable material, place the needle through the gingiva near the mucogingival junction, run it subperiosteally to the ventral border of the mandible, and then out through the oral mucosa at the bottom of the labial vestibule. Then tie the knot, pulling it tight enough to draw the gingival ventrally until the free gingival margin is about 4 millimeters coronal to the new alveolar crest. After-care is as for the maxillary canine tooth.
Maxillary Fourth Premolar Tooth

minibabyqq 2007-1-26 02:36

[color=Magenta][size=5][b]鼻和靜脈竇疾病Surgical Approach and Management of Nasal and Sinus Disease  [/b][/size][/color]


鼻TURBINATES (DORSAL).CANINE
徵兆
試探性rhinotomy 為鼻瘤形成、傳染、外國身體, 和incisional 切片檢查法。
做法的描述
1 。 似犬頭骨的側向看法顯示地方解剖學和關係在鼻洞、cribriform 板材, 和前面靜脈竇之間。cribriform 板材的rostral 方面是尾部對線平行與infraorbital 邊際(腹軌道外緣) 。
2 。 似犬頭骨的背部看法顯示地方解剖學和關係在鼻洞、cribriform 板材, 和前面靜脈竇之間。線平行與前面骨頭(背部軌道外緣的) 可觸知的zygomatic 過程表明前面靜脈竇的rostral 方面。Intraoperatively, frontomaxillary 縫合也許被觀察在前面靜脈竇和鼻洞的連接點。cribriform 板材位於中間和midline 關於可觸知的infraorbital 邊際。
3 。 患者被安置在腹recumbency 與脖子被延伸。頭是被安置的每被舉起的, 被填塞的區域(被滾動的毛巾) 並且穩定由把下顎骨錄音對經營的桌。背部midline 皮膚切開被做起點在鼻骨頭和尾部傳播的rostral 結尾到地點平行與前面骨頭的zygomatic 過程。
4 。 皮膚下組織和骨膜被切和被反射暴露鼻骨頭和nasomaxillary, frontomaxillary, 和frontonasal 縫合線, 代表鼻, 前面和上頷骨骨頭的清楚的發音。注意應該被採取保存骨膜, 是關閉的一個重要組織組分。Rhinotomy 由使用執行一個intramedullary 別針做一鼻osteotomy 在midline rostral 對一條橫向線平行與infraorbital 邊際。計劃的長方形ostectomy 站點也許對frontonasal 縫合線caudodorsally 延伸如果前面靜脈竇的探險必需。
5 。 骨頭rongeurs 使用延伸圓osteotomy 和曝光ethmoidal 外耳。總之, 一狹窄長方形ostectomy 是優選的, 寬度由有效的目標口授。
6 。 前面靜脈竇也許由caudodorsal 引伸ostectomy 形象化。前面骨頭的內在桌被去除允許前面靜脈竇ectoturbinates 和mucosa 的形象化。
關閉
骨膜apposed 使用綜合性能吸收的縫合在一個簡單的連續的樣式。皮膚下組織apposed 在第二層數被皮膚並列跟隨使用綜合性非能吸收的縫合在一個簡單的被中斷的樣式。
評論
Ostectomy 為試探性rhinotomy 也許對或正確或左鼻洞被限制為單邊的疾病。骨頭擋水板也許被使用為rhinotomy 代替長方形ostectomy 。纖維狀和periosteal 組織癒合提供一個企業, 化妝結果在患者接受ostectomy 。感染或造形術疾病過程也許介入鼻和上頷骨骨頭。因為試探性rhinotomy 經常執行獲得組織樣品為明確的診斷, 作者喜歡不替換潛在地害病的骨頭擋水板。
完成turbinectomy (或者uni- 或雙邊) 通常徊避堅持出血隨後而來rhinotomy 為turbinectomy 。棉花臍帶磁帶被安置通過nostril(s), 被包裝在鼻洞, 和被維護24 小時將提供hemostasis 。一支5 法郎哺養的管被安置通過一個鼻孔和入nasopharynx 為氧氣管理將援助在手術後複雜化的預防與低氧症有關。
對鼻TURBINATES.FELINE 的方法
徵兆
試探性rhinotomy 為鼻瘤形成、傳染、外國身體, 和incisional 切片檢查法。
做法的描述
1 。 似貓的頭骨的側向看法顯示地方解剖學和關係在鼻洞、cribriform 板材, 和前面靜脈竇之間。cribriform 板材的rostral 方面是在一條水平線在infraorbital 邊際(腹軌道外緣中間) 並且前面骨頭(背部軌道外緣的) zygomatic 過程。
2 。 似貓的頭骨的背部看法顯示地方解剖學和關係在鼻洞、cribriform 板材, 和前面靜脈竇之間。線平行與前面骨頭的可觸知的zygomatic 過程的中間曲線表明前面靜脈竇的rostral 方面。Intraoperatively, frontonasal 縫合也許是被觀察的rostral 對前面靜脈竇和鼻洞的連接點。cribriform 板材位於中間和midline 關於前面骨頭的可觸知的zygomatic 過程。
3 。 患者被安置在腹recumbency 與脖子被延伸。頭是被安置的每被舉起的, 被填塞的區域(被滾動的毛巾) 並且穩定由把下顎骨錄音對經營的桌。背部midline 皮膚切開被做起點在鼻骨頭和dorsocaudally 傳播的rostral 結尾到地點平行與前面骨頭的zygomatic 過程。
4 。 Rhinotomy 執行為鼻洞ethmoidal 外耳通入和曝光相似與做法被描述為Approach 與鼻Turbinates (Dorsal).Canine. 。總之, 一狹窄長方形ostectomy 是優選的, 寬度由有效的目標口授。frontonasal 縫合線也許被使用作為地標為caudodorsal 引伸rhinotomy 。引伸ostectomy 對線平行與前面骨頭的可觸知的zygomatic 過程的中間曲線caudodorsally 允許sinusotomy 為一或兩前面靜脈竇的探險。
關閉
骨膜apposed 使用綜合性能吸收的縫合在一個簡單的連續的樣式。皮膚下組織apposed 在第二層數被皮膚並列跟隨使用綜合性非能吸收的縫合在一個簡單的被中斷的樣式。
評論
Ostectomy 為試探性rhinotomy 也許對或正確或左鼻洞被限制為單邊的疾病。cribriform 板材是好的vascularized 和應該被避免。因為它不是好的形象化在手術期間, 外科醫生應該通曉解剖地標定義它的地點。骨頭擋水板也許被使用為rhinotomy 代替長方形ostectomy 。纖維狀和periosteal 組織癒合提供一個企業, 化妝結果在患者接受ostectomy 。感染或造形術疾病過程也許介入鼻和上頷骨骨頭。因為試探性rhinotomy 經常執行獲得組織樣品為明確的診斷, 作者喜歡不替換潛在地害病的骨頭擋水板。
對前面SINUSES.FELINE 的方法
徵兆
試探性sinusotomy 為瘤形成、傳染、lavage 和排水設備, 和incisional biopsy/microbial 文化。
做法的描述
1 。 患者被安置在腹recumbency 與脖子被延伸。頭是被安置的每被舉起的, 被填塞的區域(被滾動的毛巾) 並且穩定由把下顎骨錄音對經營的桌。背部midline 皮膚切開被做集中在平行前面骨頭的地點(背部軌道外緣) 並且結尾的zygomatic 過程rostral 對地點平行中間canthi 。
2 。 骨膜被切在midline 和被反射使用一個periosteal 電梯暴露paramidline 前面骨頭區域在前面靜脈竇。骨頭trephine 也許被使用執行sinusotomy rostral 對平行前面骨頭的zygomatic 過程的地點。sinusotomy 也許被擴大使用骨頭rongeurs 暴露尾部鼻道為靜脈竇排水設備或前面靜脈竇更加巨大的區域為靜脈竇obliteration 。
關閉
骨膜apposed 使用綜合性能吸收的縫合在一個簡單的連續的樣式。皮膚下組織apposed 在第二層數被皮膚並列跟隨使用綜合性非能吸收的縫合在一個簡單的被中斷的樣式。
評論
骨頭擋水板不是必要的。纖維狀和periosteal 組織癒合提供一個企業, 化妝結果在患者接受ostectomy 為sinusotomy 。一個intramedullary 別針也許被使用執行鼻osteotomy 代替骨頭trephine 。
對前面SINUSES.CANINE 的方法
徵兆
試探性sinusotomy 為瘤形成、傳染、lavage 和排水設備, 和incisional biopsy/microbial 文化
做法的描述
1 。 患者被安置在腹recumbency 與脖子被延伸。頭是被安置的每被舉起的, 被填塞的區域(被滾動的毛巾) 並且穩定由把下顎骨錄音對經營的桌。背部midline 皮膚切開被做集中在平行前面骨頭的地點(背部軌道外緣) 並且結尾的zygomatic 過程rostral 對中間canthi 。
2 。 骨膜被切在midline 和被反射, 使用一個periosteal 電梯對曝光paramidline 前面骨頭區域在前面靜脈竇。一個intramedullary 別針也許被使用執行sinusotomy 在平行前面骨頭的zygomatic 過程的地點。
3 。 sinusotomy 也許被擴大使用骨頭rongeurs 暴露尾部鼻道為靜脈竇排水設備或前面靜脈竇更加巨大的nasofrontal 開頭的區域為靜脈竇obliteration 或重建。
關閉
骨膜apposed 使用綜合性能吸收的縫合在一個簡單的連續的樣式。皮膚下組織apposed 在第二層數被皮膚並列跟隨使用綜合性非能吸收的縫合在一個簡單的被中斷的樣式。
評論
骨頭擋水板不是必要的。纖維狀和periosteal 組織癒合提供一個企業, 化妝結果在患者接受ostectomy 為sinusotomy 。骨頭trephine 也許被使用執行靜脈竇osteotomy 代替一個intramedullary 別針。正常排水設備從前面靜脈竇也許由管的安置重建入前面靜脈竇和通過nasofrontal 開頭的ventromedial 區域。

NASAL TURBINATES (DORSAL)䊼ANINE
Indications
Exploratory rhinotomy for nasal neoplasia, infection, foreign body, and incisional biopsy.
Description of the Procedure
1. Lateral view of the canine skull showing regional anatomy and relationship between the nasal cavity, cribriform plate, and frontal sinus. The rostral aspect of the cribriform plate is caudal to a line parallel to the infraorbital margins (ventral orbital rims).
2. Dorsal view of the canine skull showing regional anatomy and relationship between the nasal cavity, cribriform plate, and frontal sinus. A line parallel to the palpable zygomatic processes of the frontal bone (dorsal orbital rims) indicates the rostral aspect of the frontal sinus. Intraoperatively, the frontomaxillary suture may be observed at the junction of the frontal sinus and nasal cavity. The cribriform plate is located medially and on the midline in relation to the palpable infraorbital margins.
3. The patient is positioned in ventral recumbency with the neck extended. The head is positioned over an elevated, padded area (rolled towel) and stabilized by taping the mandible to the operating table. A dorsal midline skin incision is made beginning at the rostral end of the nasal bone and extending caudally to a location parallel to the zygomatic processes of the frontal bone.
4. Subcutaneous tissues and periosteum are incised and reflected to expose the nasal bone and nasomaxillary, frontomaxillary, and frontonasal suture lines, which represent the articulations of the nasal, frontal and maxillary bones. Care should be taken to preserve the periosteum, which is an important tissue component of the closure. Rhinotomy is performed by using an intramedullary pin to make a nasal osteotomy on the midline rostral to a transverse line parallel to the infraorbital margins. The planned rectangular ostectomy site may extend caudodorsally to the frontonasal suture line if exploration of the frontal sinus is required.
5. Bone rongeurs are used to extend the circular osteotomy and expose ethmoidal conchae. In general, a narrow rectangular ostectomy is optimal, the width dictated by operative goals.
6. The frontal sinus may be visualized by caudodorsal extension of the ostectomy. The inner table of the frontal bone is removed allowing visualization of the frontal sinus ectoturbinates and mucosa.
Closure
The periosteum is apposed using synthetic absorbable suture in a simple continuous pattern. Subcutaneous tissues are apposed in a second layer followed by skin apposition using synthetic non-absorbable suture in a simple interrupted pattern.
Comments
Ostectomy for exploratory rhinotomy may be limited to either right or left nasal cavities for unilateral disease. Bone flaps may be used for rhinotomy instead of rectangular ostectomy. Fibrous and periosteal tissue healing provides a firm, cosmetic result in patients receiving ostectomy. Infectious or neoplastic disease processes may involve the nasal and maxillary bones. Since exploratory rhinotomy is often performed to obtain tissue samples for definitive diagnosis, the author prefers not to replace the potentially diseased bone flap.
Complete turbinectomy (either uni- or bilateral) usually circumvents persistent hemorrhage following rhinotomy for turbinectomy. Cotton umbilical tape placed through the nostril(s), packed in the nasal cavity, and maintained for 24 hours will provide hemostasis. A 5 Fr feeding tube placed through one nostril and into the nasopharynx for oxygen administration will aid in prevention of postoperative complications related to hypoxia.
APPROACH TO THE NASAL TURBINATES䭻ELINE
Indications
Exploratory rhinotomy for nasal neoplasia, infection, foreign body, and incisional biopsy.
Description of the Procedure
1. Lateral view of the feline skull showing regional anatomy and the relationship between the nasal cavity, cribriform plate, and frontal sinus. The rostral aspect of the cribriform plate is on a horizontal line midway between the infraorbital margins (ventral orbital rims) and the zygomatic process of the frontal bone (dorsal orbital rims).
2. Dorsal view of the feline skull showing regional anatomy and the relationship between the nasal cavity, cribriform plate, and frontal sinus. A line parallel to the medial curve of the palpable zygomatic processes of the frontal bone indicates the rostral aspect of the frontal sinus. Intraoperatively, the frontonasal suture may be observed rostral to the junction of the frontal sinus and nasal cavity. The cribriform plate is located medially and on the midline in relation to the palpable zygomatic processes of the frontal bone.
3. The patient is positioned in ventral recumbency with the neck extended. The head is positioned over an elevated, padded area (rolled towel) and stabilized by taping the mandible to the operating table. A dorsal midline skin incision is made beginning at the rostral end of the nasal bone and extending dorsocaudally to a location parallel to the zygomatic processes of the frontal bone.
4. Rhinotomy is performed for nasal cavity access and exposure of ethmoidal conchae similar to the procedure described for 𨯗pproach to the Nasal Turbinates (Dorsal)䊼anine.?In general, a narrow rectangular ostectomy is optimal, the width dictated by operative goals. The frontonasal suture line may be used as a landmark for caudodorsal extension of the rhinotomy. Extension of the ostectomy caudodorsally to a line parallel to the medial curve of the palpable zygomatic processes of the frontal bone allows sinusotomy for exploration of one or both frontal sinuses.
Closure
The periosteum is apposed using synthetic absorbable suture in a simple continuous pattern. Subcutaneous tissues are apposed in a second layer followed by skin apposition using synthetic non-absorbable suture in a simple interrupted pattern.
Comments
Ostectomy for exploratory rhinotomy may be limited to either right or left nasal cavities for unilateral disease. The cribriform plate is well vascularized and should be avoided. Since it is not well visualized during surgery, the surgeon should be familiar with anatomic landmarks defining its location. Bone flaps may be used for rhinotomy instead of rectangular ostectomy. Fibrous and periosteal tissue healing provides a firm, cosmetic result in patients receiving ostectomy. Infectious or neoplastic disease processes may involve the nasal and maxillary bones. Since exploratory rhinotomy is often performed to obtain tissue samples for definitive diagnosis, the author prefers not to replace the potentially diseased bone flap.
APPROACH TO THE FRONTAL SINUSES䭻ELINE
Indications
Exploratory sinusotomy for neoplasia, infection, lavage and drainage, and incisional biopsy/microbial culture.
Description of the Procedure
1. The patient is positioned in ventral recumbency with the neck extended. The head is positioned over an elevated, padded area (rolled towel) and stabilized by taping the mandible to the operating table. A dorsal midline skin incision is made centered on a location that parallels the zygomatic processes of the frontal bone (dorsal orbital rims) and ending rostral to a location that parallels the medial canthi.
2. The periosteum is incised on the midline and reflected using a periosteal elevator to expose the paramidline frontal bone areas over the frontal sinus. A bone trephine may be used to perform the sinusotomy rostral to a location that parallels the zygomatic processes of the frontal bone. The sinusotomy may be enlarged using bone rongeurs to expose the caudal nasal passages for sinus drainage or greater areas of frontal sinus for sinus obliteration.
Closure
The periosteum is apposed using synthetic absorbable suture in a simple continuous pattern. Subcutaneous tissues are apposed in a second layer followed by skin apposition using synthetic non-absorbable suture in a simple interrupted pattern.
Comments
Bone flaps are not necessary. Fibrous and periosteal tissue healing provides a firm, cosmetic result in patients receiving ostectomy for sinusotomy. An intramedullary pin may be used to perform nasal osteotomy instead of a bone trephine.
APPROACH TO THE FRONTAL SINUSES䊼ANINE
Indications
Exploratory sinusotomy for neoplasia, infection, lavage and drainage, and incisional biopsy/microbial culture
Description of the Procedure
1. The patient is positioned in ventral recumbency with the neck extended. The head is positioned over an elevated, padded area (rolled towel) and stabilized by taping the mandible to the operating table. A dorsal midline skin incision is made centered on a location that parallels the zygomatic processes of the frontal bone (dorsal orbital rims) and ending rostral to the medial canthi.
2. The periosteum is incised on the midline and reflected, using a periosteal elevator to expose paramidline frontal bone areas over the frontal sinus. An intramedullary pin may be used to perform the sinusotomy at a location that parallels the zygomatic processes of the frontal bone.
3. The sinusotomy may be enlarged using bone rongeurs to expose the caudal nasal passages for sinus drainage or greater areas of frontal sinus for sinus obliteration or reconstruction of the nasofrontal opening.
Closure
The periosteum is apposed using synthetic absorbable suture in a simple continuous pattern. Subcutaneous tissues are apposed in a second layer followed by skin apposition using synthetic non-absorbable suture in a simple interrupted pattern.
Comments
Bone flaps are not necessary. Fibrous and periosteal tissue healing provides a firm, cosmetic result in patients receiving ostectomy for sinusotomy. A bone trephine may be used to perform sinus osteotomy instead of an intramedullary pin. Normal drainage from the frontal sinus may be re-established by placement of tubes into the frontal sinuses and through the ventromedial area of the nasofrontal opening.

minibabyqq 2007-1-26 02:37

[color=Magenta][size=5][b]口頭腫瘤手術Surgery of Oral Tumors [/b][/size][/color]

[size=12px]口腔的巨蟹星座是共同的發生在狗和是較不共同在貓。解剖區域不是有傾向對這樣各種各樣的癌症與依照變化對療法的一個反應。Preoperative 切片檢查法和準確分級法對適當的治療至關重要。多數口頭癌症被對待以手術, 雖然輻射有在輻射敏感癌症、unresectable 疾病, 或手術後殘餘的疾病的管理的一個有限但確定角色。長期寬恕的鑰匙是: 1) 診斷在早期(小容量); 並且2) 進取的外科切除術在這個狀況下, 經常是治病的。mandible/maxilla 的癌症寬撤除是可達成的以骨頭撤除。大可醫治和nonmalignant 情況存在, 需要被認出以便不適當的無痛苦的死亡或療法不發生。
健康腫瘤大楔子切片檢查法經常是必要做診斷。二個共同的切片檢查法結果問題在口腔是: 1) amelanotic 黑瘤也許被解釋作為undifferentiated 瘤形成(特別汙點也許幫助解決這些箱子); 並且2) 大養殖狗(特別是金黃獵犬的) 上顎骨的fibrosarcoma 也許組織學上看非常良性是進取的在患者和需要根本切除術竟管切片檢查法結果。
惡性癌症在或在下顎骨或上顎骨要求骨頭去除規程如果永久地方疾病控制將被期望以手術。軟的組織大量的定像對骨頭強烈建議骨頭入侵不管什麼地方射線照相展示(記得30-40% 骨頭必須被毀壞在它是顯然的在簡單的射線照相) 之前。準確preoperative 分級法由對CT 或MRI 掃瞄的用途提高, 特別是為損害尾部位於下顎骨的嘴、軌道, 或垂直的ramus 。Preoperative 切片檢查法是關鍵的但不能沾染頰mucosa 因為它將擔當創傷關閉主要手段。Mandibulectomy 規程在共同的用法包括單邊的rostral, 雙邊rostral, 分裝式, 垂直的ramus, 和總單邊的切除術。複雜化包括創傷開裂(特別是如果早先照耀或如果electrocautery 半新過份), 自發地決心) 的ranula. 形成(, 舌頭滯後、唇炎, 和殘餘的下顎骨中間漂泊。Maxillectomy 規程包括單邊的premaxilla 、雙邊premaxilla (。鼻planum), 和單邊的側向上顎骨。迄今, 一個源遠流長的方法重建雙邊尾部palatine 損害不是可利用的。關閉是以頰黏膜交叉點貪佔。主要複雜化是受傷的開裂(~ 10%), 一般欣然re 被縫合如果頰擋水板是可實行的。
注意需要給予對為正確手術專門製作正確腫瘤類型和階段。訪問對輸血, 加護病房, 並且鎮痛藥是中意的。對化妝和功能結果的所有者滿意(不總oncologic 結果) 是一致地好的。
長期結果從oncologic 透視被提出在表1 。
表1: 各種各樣的紙總結在Mandibulectomy 或Maxillectomy [table][tr][td=1,1,184][/td][td=1,1,184][/td][td=1,1,184].[b]% 本機[/b]
[/td][td=1,1,184][b]中間生存[/b]
[/td][td=1,1,184][/td][/tr][tr][td=1,1,184][/td][td=1,1,184][b]Number[/b]
[/td][td=1,1,184][b]Recurrence[/b]
[/td][td=1,1,184][b](months)[/b]
[/td][td=1,1,184][b].% 1 年[/b]
[/td][/tr][tr][td=1,1,184][/td][td=1,1,184][/td][td=1,1,184][/td][td=1,1,184][/td][td=1,1,184][/td][/tr][tr][td=1,1,184]Acanthomatous epulis
[/td][td=1,1,184]149
[/td][td=1,1,184]4
[/td][td=1,1,184]36
[/td][td=1,1,184]90
[/td][/tr][tr][td=1,1,184]Squamous 細胞癌
[/td][td=1,1,184]92
[/td][td=1,1,184]15
[/td][td=1,1,184]18
[/td][td=1,1,184]70
[/td][/tr][tr][td=1,1,184]Osteosarcoma
[/td][td=1,1,184]69
[/td][td=1,1,184]25
[/td][td=1,1,184]8
[/td][td=1,1,184]50
[/td][/tr][tr][td=1,1,184]黑瘤
[/td][td=1,1,184]126
[/td][td=1,1,184]25
[/td][td=1,1,184]8
[/td][td=1,1,184]35
[/td][/tr][tr][td=1,1,184]Fibrosarcoma
[/td][td=1,1,184]92
[/td][td=1,1,184]46
[/td][td=1,1,184]11
[/td][td=1,1,184]35
[/td][/tr][/table]Cancer of the oral cavity is a common occurrence in dogs and is less common in cats. No anatomic area is prone to such a wide variety of cancers with as varied a response to therapy. Preoperative biopsy and accurate staging are critical to proper treatment. Most oral cancers are treated with surgery, although radiation has a limited but definite role in management of radiation sensitive cancer, unresectable disease, or postoperative residual disease. The key to long-term remission is: 1) diagnosis at an early stage (small volume); and 2) aggressive surgical resection at this stage, which is often curative. Wide removal of cancer of the mandible/maxilla is achievable with bone removal. A large array of curable and nonmalignant conditions exists that needs to be recognized so that inappropriate euthanasia or therapy does not take place.
Large wedge biopsies of healthy tumor are often necessary to make a diagnosis. Two common biopsy result problems in the oral cavity are: 1) amelanotic melanoma may be interpreted as undifferentiated neoplasia (special stains may help resolve these cases); and 2) fibrosarcoma of the maxilla of large breed dogs (especially Golden Retrievers) may look very benign histologically yet is aggressive in the patient and needs radical resection in spite of the biopsy result.
Malignant cancer on or in the mandible or maxilla requires bone-removing procedures if permanent local disease control is to be expected with surgery. Fixation of a soft tissue mass to bone strongly suggests bone invasion regardless of what regional radiographs demonstrate (remember that 30-40% of the bone must be destroyed before it is obvious on plain radiographs). Accurate preoperative staging is enhanced by the use of CT or MRI scans, especially for lesions caudally located in the mouth, orbit, or vertical ramus of the mandible. Preoperative biopsies are crucial but must not contaminate the buccal mucosa since it will serve as the primary means of wound closure. Mandibulectomy procedures in common usage include unilateral rostral, bilateral rostral, segmental, vertical ramus, and total unilateral resection. Complications include wound dehiscence (especially if previously irradiated or if electrocautery is used in excess), 𩂈anula?formation (which spontaneously resolves), tongue lag, cheilitis, and medial drift of remaining mandible. Maxillectomy procedures include unilateral premaxilla, bilateral premaxilla (?nasal planum), and unilateral lateral maxilla. To date, a well-established method to reconstruct bilateral caudal palatine lesions is not available. Closure is with buccal mucosal transposition grafts. The major complication is wound dehiscence (~ 10%), which is generally readily re-sutured if the buccal flap is viable.
Attention needs to be paid to tailoring the correct surgery to the correct tumor type and stage. Access to blood transfusions, intensive care units, and analgesics is desirable. Owner satisfaction with cosmetic and functional results (not always the oncologic results) is uniformly good.
The long-term results from an oncologic perspective are presented in Table 1.
TABLE 1: Summary of Various Papers on Mandibulectomy or Maxillectomy [table][tr][td=1,1,184][/td][td=1,1,184][/td][td=1,1,184]?b>% Local
[/td][td=1,1,184][b]Median Survival[/b]
[/td][td=1,1,184][/td][/tr][tr][td=1,1,184][/td][td=1,1,184][b]賫umber[/b]
[/td][td=1,1,184][b]袠ecurrence[/b]
[/td][td=1,1,184][b]?months)[/b]
[/td][td=1,1,184][b]? 1 year[/b]
[/td][/tr][tr][td=1,1,184][/td][td=1,1,184][/td][td=1,1,184][/td][td=1,1,184][/td][td=1,1,184][/td][/tr][tr][td=1,1,184]Acanthomatous epulis
[/td][td=1,1,184]149
[/td][td=1,1,184]4
[/td][td=1,1,184]36
[/td][td=1,1,184]90
[/td][/tr][tr][td=1,1,184]Squamous cell carcinoma
[/td][td=1,1,184]92
[/td][td=1,1,184]15
[/td][td=1,1,184]18
[/td][td=1,1,184]70
[/td][/tr][tr][td=1,1,184]Osteosarcoma
[/td][td=1,1,184]69
[/td][td=1,1,184]25
[/td][td=1,1,184]8
[/td][td=1,1,184]50
[/td][/tr][tr][td=1,1,184]Melanoma
[/td][td=1,1,184]126
[/td][td=1,1,184]25
[/td][td=1,1,184]8
[/td][td=1,1,184]35
[/td][/tr][tr][td=1,1,184]Fibrosarcoma
[/td][td=1,1,184]92
[/td][td=1,1,184]46
[/td][td=1,1,184]11
[/td][td=1,1,184]35
[/td][/tr][/table][/size]

minibabyqq 2007-1-26 02:38

[color=Magenta][size=5][b]口頭腫瘤Oral Tumors and Their Biology [/b][/size][/color]

[size=12px]發生和風險因素
口頭癌症佔6% 似犬癌症和3% 所有癌症在貓。共同的口頭腫瘤的一個一般總結被發現在表1 。
病理學和自然行為
口頭fibrosarcoma 組織學上經常將看驚奇良性。如果癌症在考慮中迅速地增長, 週期性, 或侵略骨頭, 然而, 臨床工作者應該口授治療至於為惡性癌症。Fibrosarcoma 當地非常蔓延性但metastasizes 在少於20% 案件中(通常對肺) 。
惡性黑瘤可能提出一張纏擾不清的histopathologic 圖片如果腫瘤或切片檢查法部分不包含melanin (所有案件的三分之一) 。undifferentiated 肉瘤his.topathologic 診斷應該被視為以懷疑為可能的部下的黑瘤。黑瘤有一種嗜好metastasize 對地方淋巴結和然後肺。
Squamous 細胞癌通常是一個直接的histologic 診斷。骨頭的嚴厲和廣泛的介入是共同在貓。變形的率在貓是有些未知的因為那麼少量貓有他們的地方疾病被控制觀察長期metas.tatic 潛力。轉移在犬是非常site-dependent 與rostral 口腔有低變形的率和尾部舌頭和扁桃腺有高變形的潛力。
traditional. epulides 與齒齦hyper.plasia 是相似在出現上和通常被限制對一兩個站點在膠邊際。他們是緩慢生長, 變牢固, 和由原封皮膜一般蓋。這些被分類作為纖維狀epulides 或僵化的epulides 根據出現或缺乏骨頭。epulides 三等最近被命名了acanthomatous epulis 代替ada.manti.noma 的早先期限。一些病理學家互換性使用用語。這些當地蔓延性和實際上總侵略骨頭雖然他們不metastasize 。
診斷技術和WORK-UP
診斷評估為口頭癌症重要歸結於大範圍癌症行為和治療選擇可利用。很可能癌症有正面胸口射線照相在診斷之時是mela.noma 和尾部口頭和pharyngeal 區域的squamous 細胞癌。
是依附的骨頭, 除簡單的epulides 之外的癌症, 應該有地方射線照相被採取在麻醉之下。當40% 或更多外皮被毀壞, 病勢漸退也許被觀察。但是, 明顯正常射線照相不排除骨頭入侵。地方淋巴結應該仔細地palpated 為擴大或非對稱。當可觸知, 他們應該吐氣。
最後步, 在同樣麻醉之下, 是仔細的觸診和一個大incisional 切片檢查法。健康組織大樣品在損害的邊緣和中心將增加診斷出產量。切片檢查法站點應該位於這樣位置至於容易地包括在一項可能的切除術。為小損害, excisional 切片檢查法也許被承擔在最初的評估之時。為更加廣泛的疾病, 等切片檢查法結果準確地計劃治療被鼓勵。
預測
預測為acanthomatous epulis/ada.mantinoma 是優秀與surg.ery 並且/或者輻照區域以地方再現對少於5% 估計。
外型為squamous 細胞癌是非常站點和種類受撫養者。犬的癌症在rostral 嘴是可醫治的以手術或irradia.tion, 當舌頭的那些扁桃腺或基地, 高度變形和可能當地或地方復發。似貓的squamous 細胞癌地方控制是窮的以或手術或放射治療。
總之, 25% 狗以口頭惡性黑瘤將生存一年或更。狗以腫瘤少於直徑二厘米有511 天中間生存與狗相對以淋巴結介入或腫瘤大於二厘米直徑中間生存是164 天的。週期性惡性mela.noma 做非常比主要達到永久地方控制的被對待的疾病。變老, 養殖, 性, 程度染色, 微觀出現(?), 並且解剖站點不是prognos.tic 。
fibrosarcoma 地方控制是更多問題比轉移。最佳的1 年的生存以幾乎任一種治療比25-40% 沒有好。Fibro.sarcomas 一般被認為輻射抗性為可測量的疾病但控制率被改進當對待微觀手術後殘餘的疾病。
表1: 狗和貓的共同的口頭癌症總結[table=98%][tr][td=1,1,114][/td][td=1,1,135][/td][td=1,1,105].[b]似犬[/b]
[/td][td=1,1,105][/td][td=1,1,135][/td][td=1,1,120].[b]似貓[/b]
[/td][td=1,1,105][/td][/tr][tr][td=1,1,114][/td][td=1,1,135][b]Squamous 細胞癌* (SCC)[/b]
[/td][td=1,1,105][b]Fibrosarcoma(FS)[/b]
[/td][td=1,1,105][b]黑瘤(毫米)[/b]
[/td][td=1,1,135][b]牙齒[/b]
[/td][td=1,1,120][b]Squamous 細胞癌* (SCC)[/b]
[/td][td=1,1,105][b]Fibrosarcoma (FS)[/b]
[/td][/tr][tr][td=1,1,114]頻率(%)
[/td][td=1,1,135]20-30
[/td][td=1,1,105]10-20
[/td][td=1,1,105]30-40
[/td][td=1,1,135]5
[/td][td=1,1,120]70
[/td][td=1,1,105]20
[/td][/tr][tr][td=1,1,114]年齡(幾年)
[/td][td=1,1,135]10
[/td][td=1,1,105]7
[/td][td=1,1,105]12
[/td][td=1,1,135]9
[/td][td=1,1,120]10
[/td][td=1,1,105]10
[/td][/tr][tr][td=1,1,114]性嗜好
[/td][td=1,1,135]均等
[/td][td=1,1,105]M > F
[/td][td=1,1,105]M > F
[/td][td=1,1,135]F > M
[/td][td=1,1,120]無
[/td][td=1,1,105]無
[/td][/tr][tr][td=1,1,114]耐心大小
[/td][td=1,1,135]更大
[/td][td=1,1,105]更大
[/td][td=1,1,105]更小
[/td][td=1,1,135]無
[/td][td=1,1,120]--
[/td][td=1,1,105]--
[/td][/tr][tr][td=1,1,114]站點嗜好
[/td][td=1,1,135]Rostral 下顎骨
[/td][td=1,1,105]上顎
[/td][td=1,1,105]頰mucosa
[/td][td=1,1,135]Rostral 下顎骨
[/td][td=1,1,120]下顎骨或上頷骨骨頭; 舌頭
[/td][td=1,1,105]齒齬
[/td][/tr][tr][td=1,1,114]地方淋巴結轉移
[/td][td=1,1,135]罕見(除了扁桃腺和舌頭)
[/td][td=1,1,105]罕見
[/td][td=1,1,105]共同
[/td][td=1,1,135]從未
[/td][td=1,1,120]罕見
[/td][td=1,1,105]罕見
[/td][/tr][tr][td=1,1,114]遙遠的轉移
[/td][td=1,1,135]罕見(除了扁桃腺和舌頭)
[/td][td=1,1,105]偶爾
[/td][td=1,1,105]共同
[/td][td=1,1,135]從未
[/td][td=1,1,120]罕見
[/td][td=1,1,105]偶爾
[/td][/tr][tr][td=1,1,114]總出現
[/td][td=1,1,135]紅色, 花椰菜, 上升了, 潰瘍
[/td][td=1,1,105]平, 牢固, 潰瘍
[/td][td=1,1,105]2/3 著色了, 潰瘍
[/td][td=1,1,135]像SCC
[/td][td=1,1,120]Proliferative 在咽; 最小的可看見的疾病在口腔裡
[/td][td=1,1,105]企業
[/td][/tr][tr][td=1,1,114]% 骨頭介入**
[/td][td=1,1,135]易變
[/td][td=1,1,105]共同
[/td][td=1,1,105]易變
[/td][td=1,1,135]總
[/td][td=1,1,120]共同
[/td][td=1,1,105]共同
[/td][/tr][tr][td=1,1,114]輻射反應***
[/td][td=1,1,135]好
[/td][td=1,1,105]窮公正
[/td][td=1,1,105]粗劣的?****
[/td][td=1,1,135]優秀
[/td][td=1,1,120]窮
[/td][td=1,1,105]窮
[/td][/tr][tr][td=1,1,114]手術反應
[/td][td=1,1,135]好rostral; 公正尾部
[/td][td=1,1,105]Fair.good (特別是大損害)
[/td][td=1,1,105]市場對好
[/td][td=1,1,135]優秀
[/td][td=1,1,120]窮
[/td][td=1,1,105]公正好
[/td][/tr][tr][td=1,1,114]預測
[/td][td=1,1,135]Good.rostral; poor.caudal
[/td][td=1,1,105]窮公正
[/td][td=1,1,105]窮公正
[/td][td=1,1,135]優秀
[/td][td=1,1,120]非常窮
[/td][td=1,1,105]公正
[/td][/tr][tr][td=1,1,114]通常死因
[/td][td=1,1,135]遙遠的疾病
[/td][td=1,1,105]地方疾病
[/td][td=1,1,105]遙遠的疾病
[/td][td=1,1,135]腫瘤很少關係了
[/td][td=1,1,120]地方疾病
[/td][td=1,1,105]地方疾病
[/td][/tr][tr][td=1,1,114]評論
[/td][td=1,1,135]行為顯著變化從前線(好) 支持(貧寒) 口腔
[/td][td=1,1,105]經常生物看起來低年級組織學上但非常蔓延性
[/td][td=1,1,105]出現或缺乏顏料不是預斷
[/td][td=1,1,135]與SCC 組織學上被混淆
[/td][td=1,1,120]下顎骨和上顎骨許多腫瘤有一點點或沒有可看見的口頭疾病但骨頭嚴厲深刻的入侵
[/td][/tr][/table]INCIDENCE AND RISK FACTORS
Oral cancer accounts for 6% of canine cancer and 3% of all cancers in cats. A general summary of the common oral tumors is found in Table 1.
PATHOLOGY AND NATURAL BEHAVIOR
Oral fibrosarcoma will often look surprisingly benign histologically. If the cancer in question is growing rapidly, is recurrent, or is invading bone, however, the clinician should dictate treatment as for malignant cancer. Fibrosarcoma is very invasive locally but metastasizes in less than 20% of cases (usually to the lungs).
Malignant melanoma can present a confusing histopathologic picture if the tumor or the biopsy section does not contain melanin (one-third of all cases). A his負opathologic diagnosis of 𠀾ndifferentiated sarcoma?should be looked upon with suspicion for possible underlying melanoma. Melanoma has a predilection to metastasize to regional lymph nodes and then lung.
Squamous cell carcinoma is usually a straightforward histologic diagnosis. Severe and extensive involvement of bone is common in the cat. The metastatic rate in the cat is somewhat unknown since so few cats have their local disease controlled to observe the long-term metas負atic potential. Metastasis in the canine is very site-dependent with the rostral oral cavity having a low metastatic rate and the caudal tongue and tonsil having a high metastatic potential.
The 懀raditional?epulides are similar to gingival hyper計lasia in appearance and are usually confined to one or two sites at the gum margin. They are slow growing, firm, and generally covered by intact epithelium. These are classified as fibrous epulides or ossifying epulides depending on the presence or absence of bone. A third class of epulides recently has been termed acanthomatous epulis instead of the previous term of ada衫anti要oma. Some pathologists use the terms interchangeably. These are much more locally invasive and virtually always invade bone although they do not metastasize.
DIAGNOSTIC TECHNIQUES AND WORK-UP
The diagnostic evaluation for oral cancers is critical due to the wide ranges of cancer behavior and therapeutic options available. The most likely cancers to have positive chest radiographs at the time of diagnosis are mela要oma and squamous cell carcinoma of the caudal oral and pharyngeal area.
Cancers that are adherent to bone, other than simple epulides, should have regional radiographs taken under anesthesia. When 40% or more of the cortex is destroyed, lysis may be observed. However, apparently normal radiographs do not rule out bone invasion. Regional lymph nodes should be carefully palpated for enlargement or asymmetry. When palpable, they should be aspirated.
The last step, under the same anesthesia, is careful palpation and a large incisional biopsy. Large samples of healthy tissue at the edge and center of the lesion will increase the diagnostic yield. The biopsy site should be located in such a position as to be easily included in a possible resection. For small lesions, excisional biopsy may be undertaken at the time of initial evaluation. For more extensive disease, waiting for biopsy results to accurately plan treatment is encouraged.
PROGNOSIS
The prognosis for acanthomatous epulis/ada衫antinoma is excellent with surg苟ry and/or irradiation with local recurrence rates less than 5%.
The outlook for squamous cell carcinoma is very site and species dependent. Cancers of the canine in the rostral mouth are curable with surgery or irradia負ion, while those of tonsil or base of the tongue, are highly metastatic and likely to recur locally or regionally. Local control of feline squamous cell carcinoma is poor with either surgery or radiation therapy.
Overall, over 25% of dogs with oral malignant melanomas will survive one year or more. Dogs with tumors less than two centimeters in diameter have a median survival of 511 days as opposed to dogs with lymph node involvement or tumors greater than two centimeters in diameter whose median survival is 164 days. Recurrent malignant mela要oma does worse than primarily treated disease that achieves permanent local control. Age, breed, sex, degree of pigmentation, microscopic appearance (?), and anatomic site are not prognos負ic.
Local control of fibrosarcoma is more of a problem than metastasis. The best one-year survivals with almost any treatment are no better than 25-40%. Fibro貞arcomas are generally considered radiation resistant for measurable disease but control rates are improved when treating microscopic postoperative residual disease.
TABLE 1: Summary of Common Oral Cancers of the Dog and Cat[table=98%][tr][td=1,1,114][/td][td=1,1,135][/td][td=1,1,105]?b>CANINE
[/td][td=1,1,105][/td][td=1,1,135][/td][td=1,1,120]?b>FELINE
[/td][td=1,1,105][/td][/tr][tr][td=1,1,114][/td][td=1,1,135][b]Squamous cell carcinoma* (SCC)[/b]
[/td][td=1,1,105][b]Fibrosarcoma(FS)[/b]
[/td][td=1,1,105][b]Melanoma (MM)[/b]
[/td][td=1,1,135][b]Dental[/b]
[/td][td=1,1,120][b]Squamous cell carcinoma* (SCC)[/b]
[/td][td=1,1,105][b]Fibrosarcoma (FS)[/b]
[/td][/tr][tr][td=1,1,114]Frequency (%)
[/td][td=1,1,135]20-30
[/td][td=1,1,105]10-20
[/td][td=1,1,105]30-40
[/td][td=1,1,135]5
[/td][td=1,1,120]70
[/td][td=1,1,105]20
[/td][/tr][tr][td=1,1,114]Age (years)
[/td][td=1,1,135]10
[/td][td=1,1,105]7
[/td][td=1,1,105]12
[/td][td=1,1,135]9
[/td][td=1,1,120]10
[/td][td=1,1,105]10
[/td][/tr][tr][td=1,1,114]Sex predilection
[/td][td=1,1,135]Equal
[/td][td=1,1,105]M > F
[/td][td=1,1,105]M > F
[/td][td=1,1,135]F > M
[/td][td=1,1,120]None
[/td][td=1,1,105]None
[/td][/tr][tr][td=1,1,114]Patient size
[/td][td=1,1,135]Larger
[/td][td=1,1,105]Larger
[/td][td=1,1,105]Smaller
[/td][td=1,1,135]None
[/td][td=1,1,120]--
[/td][td=1,1,105]--
[/td][/tr][tr][td=1,1,114]Site predilection
[/td][td=1,1,135]Rostral mandible
[/td][td=1,1,105]Palate
[/td][td=1,1,105]Buccal mucosa
[/td][td=1,1,135]Rostral mandible
[/td][td=1,1,120]Mandible or maxillary bone; tongue
[/td][td=1,1,105]Gingiva
[/td][/tr][tr][td=1,1,114]Regional lymph node metastasis
[/td][td=1,1,135]Rare (except tonsil and tongue)
[/td][td=1,1,105]Rare
[/td][td=1,1,105]Common
[/td][td=1,1,135]Never
[/td][td=1,1,120]Rare
[/td][td=1,1,105]Rare
[/td][/tr][tr][td=1,1,114]Distant metastasis
[/td][td=1,1,135]Rare (except tonsil and tongue)
[/td][td=1,1,105]Occasional
[/td][td=1,1,105]Common
[/td][td=1,1,135]Never
[/td][td=1,1,120]Rare
[/td][td=1,1,105]Occasional
[/td][/tr][tr][td=1,1,114]Gross appearance
[/td][td=1,1,135]Red, cauliflower, raised, ulcerated
[/td][td=1,1,105]Flat, firm, ulcerated
[/td][td=1,1,105]2/3 pigmented, ulcerated
[/td][td=1,1,135]Like SCC
[/td][td=1,1,120]Proliferative in pharynx; minimal visible disease in oral cavity
[/td][td=1,1,105]Firm
[/td][/tr][tr][td=1,1,114]% Bone involvement**
[/td][td=1,1,135]Variable
[/td][td=1,1,105]Common
[/td][td=1,1,105]Variable
[/td][td=1,1,135]Always
[/td][td=1,1,120]Common
[/td][td=1,1,105]Common
[/td][/tr][tr][td=1,1,114]Radiation response***
[/td][td=1,1,135]Good
[/td][td=1,1,105]Poor-fair
[/td][td=1,1,105]Poor?****
[/td][td=1,1,135]Excellent
[/td][td=1,1,120]Poor
[/td][td=1,1,105]Poor
[/td][/tr][tr][td=1,1,114]Surgery response
[/td][td=1,1,135]Good rostral; fair caudal
[/td][td=1,1,105]Fair𤨾ood (especially large lesions)
[/td][td=1,1,105]Fair to good
[/td][td=1,1,135]Excellent
[/td][td=1,1,120]Poor
[/td][td=1,1,105]Fair-good
[/td][/tr][tr][td=1,1,114]Prognosis
[/td][td=1,1,135]Good銄ostral; poor櫘audal
[/td][td=1,1,105]Poor-fair
[/td][td=1,1,105]Poor-fair
[/td][td=1,1,135]Excellent
[/td][td=1,1,120]Very poor
[/td][td=1,1,105]Fair
[/td][/tr][tr][td=1,1,114]Usual cause of death
[/td][td=1,1,135]Distant disease
[/td][td=1,1,105]Local disease
[/td][td=1,1,105]Distant disease
[/td][td=1,1,135]Rarely tumor related
[/td][td=1,1,120]Local disease
[/td][td=1,1,105]Local disease
[/td][/tr][tr][td=1,1,114]Comments
[/td][td=1,1,135]Behavior varies dramatically from front (good) to back (poor) of oral cavity
[/td][td=1,1,105]Often looks low grade histologically but very invasive biologically
[/td][td=1,1,105]Presence or absence of pigment is not prognostic
[/td][td=1,1,135]May be confused with SCC histologically
[/td][td=1,1,120]Many tumors of mandible and maxilla have little or no visible oral disease but severe deep invasion of bone
[/td][/tr][/table][/size]

minibabyqq 2007-1-26 02:39

[color=Magenta][size=5][b]口頭破裂修理Advanced Oral Fracture Repair [/b][/size][/color]

[size=12px]解剖學
下顎骨由二個一半組成以水平的部份(身體) 支持的牙和垂直的部份(ramus) 供給表面為肌肉附件和清楚的發音頭骨。下顎骨的各個一半加入在rostral midline 形成下頷骨symphysis 。主要neurovascular structures.including 下頷骨動脈和靜脈和下等齒齦音nerve.enter 下顎骨在caudomedial 方面通過下頷骨孔。這些結構提供主要neurovascular 輸入對下顎骨和單一neurovascular 供應對下頷骨牙。下頷骨運河mesially 打開形成2.3 精神孔。對temporomandibular 聯接的下頷骨貢獻(TMJ) 包括橫向地瘦長的髁。對聯接的世俗骨頭貢獻筒形和圍攏嚴密髁。TMJ 並且有圓盤或半月板提供一個接口在骨多的組分之間。
生物力學
下頷骨破裂生物力學表明, 下顎骨的緊張邊是齒齦音疆界, 或下顎骨的牙邊。參與牙的技術鞏固緊張表面, 允許腹表面的自然壓縮。Intraoral 藤條、interdental 丙烯酸酯、interdental interdental 導線和丙烯酸酯的導線, 和組合可能嚮緊張帶表面被申請。傾斜下頷骨身體破裂可能被分類像有利或不利。破碎被安置從dorsocaudal 對ventromesial 被認為有利的線因為下顎骨的肌肉附件有主要腹插入造成破裂線的壓縮。破碎被安置從dorsomesial 對ventrocaudal 被認為不利的線因為相似的肌肉力量導致mesial 片段的分心。破裂的固有biomechanical 本質的知識也許影響政策制定關於破裂定像的技術。
定像技術
下頷骨破裂在狗發生次要對交通工具的精神創傷、秋天、解僱、槍響, 和戰鬥與其它動物。下頷骨破裂代表3-6% 所有破裂被看見在狗當15% 所有破裂在貓影響主要下頷骨symphysis 。最共同的地點為破裂在狗是在PM 1 和M 2 之間。病理性下頷骨破裂也許發生次要對牙周疾病、瘤形成, 和新陳代謝的疾病。主要宗旨為下頷骨破裂修理在小動物是回歸對正常作用。2.3 毫米的尾部malalignment 也許防止嘴的mesial 部份的關閉由一充分的厘米。所以, 它是必要維護閉塞的對準線當提供充分穩定為骨多的聯合。下頷骨破裂修理的基本原則包括鎖柱的一個穩定的定像的解剖減少和恢復, 應用中立化消極力量在破裂線, 柔和醫原性牙齒精神創傷處理軟的組織, 害病的牙的退避, 提取在破裂線之內, 使減到最小的過份軟的組織恢復迅速回歸到作用技術的海拔, 和應用。
下顎骨的破裂在狗提出幾個獨特的挑戰對獸醫因為它承受不同的力量比較weight.bearing 骨頭。下頷骨破裂將癒合在破裂空白和一些流動性面前, 只要vascularity 被保護, 血管再生被鼓勵, 和傳染被防止。定像方法應該允許作用的直接恢復; 是輕的和不笨重, 經濟, 和欣然可利用; 並且要求唯一合理的時間、專門技術, 和輔助設備為應用。精神創傷對牙根和neurovascular 結構不能導致臨床標誌; 但是, endodontic 和牙周複雜化包括齒齦音骨頭吸回、牙根介入、pulpitis, 和牙損失也許發生。下等齒齦音動脈和它的分支提供單一供血對齒齦音骨頭、牙周韌帶, 和牙。它的重要性在癒合下頷骨破裂和牙結構裡在傷害和所有隨後臨床作用以後是未知的。同樣, 痛苦的neuroma 臨床發生在對下等齒齦音神經的損傷在破裂期間未被提供在狗之後。
臨時槍口coaptation 也許是應用的在preoperative 期間支持下頷骨破裂。如果使用, 患者應該被監測保險槍口不干涉以呼吸的狀態或不導致多餘, 潛在地損傷興奮。槍口coaptation 並且是下頷骨破裂的最共同的明確的安定技術在狗。它共同的用途表明, 它是成功的在提供骨多的聯合多半時間。Post-treatment 鎖柱不能是優選的, 然而患者傾向於臨床做很好。複雜化和問題聯繫了槍口應用包括食物內容的咬合不良、志向次要對嘔吐, 極高熱從被減少的通風的作用(對氣喘的消極作用), 和潮濕皮炎。這個定像方法是低廉的, 消極地不影響破裂片段血管供應或牙根和下頷骨運河的neurovascular 結構。雖然經常成功在提供破裂片段穩定充足促進次要骨多癒合, 下頷骨癒合由於槍口應用也許同永久咬合不良聯繫在一起。其它潛在的複雜化, 也許發生在治療期間, 包括耐心不順從, 和被延遲的回歸到作用與正常咀嚼的制約有關。外在定像方法使用intrafragmentary 別針和丙烯酸酯的旁邊酒吧也許提供充分下頷骨破裂安定; 但是, 下頷骨運河的結構醫原性精神創傷是可能的根據對別針安置和下頷骨解剖學的地點的推薦。鬆懈和傳染是二個最頻繁的問題與相關對更大的外在骨骼定像別針的用途和是主要骨頭熱量壞死的結果和軟的組織。
其它潛在的複雜化與相關對外在定像方法的用途是pin.tract 傳染、器具的耐心fixator 酒吧的不寬容, 和中斷在家庭陳設品。內部定像方法譬如intramedullary 別住和板材和螺絲也許並且同牙根和neurovascular 結構聯繫在一起醫原性精神創傷。破裂片段血管供應的中斷在植入管應用期間也許使癒合複雜化。缺點對鍍層是設備的費用, 堅固時間投資必需學會技術原則, 和滲透通過或干涉以供血對下頷骨牙的根造成endodontic 疾病。方法使用interdental 定像(如果) 是臨時或主要下頷骨破裂安定一個重要組分在人。臨床報告推薦了如果為下頷骨破裂的安定在狗。interdental 定像好處為下頷骨破裂的安定包括醫原性精神創傷對牙根和neurovascular 結構下頷骨運河, 最小的中斷破裂片段血管供應, 恢復鎖柱, 和早期的回歸退避到作用。總之, 是快為癒合進行和提供充足的安定的幾個定像方法也許被使用為下頷骨破裂修理。有這些屬性的技術也許被使用為下頷骨破裂的緊急管理。
INTERDENTAL 定像
Interdental 定像方法為人的下頷骨破裂安定包括常春藤圈、壯健圈、修改過的壯健圈、丙烯酸酯的藤條, 和Erich 曲拱酒吧。能力如果方法提供下頷骨破裂安定當避免醫原性複雜化固有以其它更加常規的定像方法使這些技術特別中意。材料的低成本, 應用相對下頷骨破裂舒適, 和頻率在狗對他們潛在的用途貢獻在獸醫方面。
雖然丙烯酸酯不遵守很好金屬, 它依照冠形狀和interdigitates 總金屬建築學(金屬磁夾板曲拱酒吧) 並且變形(導線轉彎) 。搪瓷緊持物產由microporosities 的形成繁殖在棱鏡核心之內或在搪瓷附近標尺周圍使用磷酸搪瓷表面的膠凝體蝕刻。Microporosity 深度向範圍報告從20 到50 微米。牙齒丙烯酸酯的材料被顯示擊穿這些microporosities 形成, finger.like 投射, 造成強的債券在丙烯酸酯的材料和搪瓷之間。
技術運用24 測量儀不鏽鋼矯形導線和poly(methyl)methacrylate 被開發了。導線是地方在牙附近以壯健圈時尚, 牙由酸蝕刻準備, 並且牙齒丙烯酸酯與牙被結合創造interdental 定像。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 狗被安置在腹recumbency 並且嘴一般張以窺器或其它設備。這個技術嚮破裂最好被申請在前臼齒對槽牙區域。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 如果破裂是開放, debridement 和黏膜創傷關心執行。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 二十四根測量儀矯形導線被切開對將合併至少二顆牙在任何一方破裂的長度。導線被應用交錯的時尚和被拉緊對牙使用扭轉的時尚如同你會以cerclage 接線。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 一旦導線被應用了, 牙被清洗與一個超音波過秤者, 被酸蝕刻跟隨與40% 磷酸膠凝體, 然後漂洗和烘乾。蝕刻執行在第一至第三顆前臼齒和舌表面的頰和舌表面只第四前臼齒和槽牙, 考慮到上頷骨和下頷骨拱廊的scissor 叮咬。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 牙齒丙烯酸酯被混合在2:1 比率。三立方厘米(由容量) 單體粉末被安置在一個混合的容器。一和one.half 立方厘米聚合物液體增加來粉末。混合物被攪動一個短期和然後轉移到一個3 cc 注射器與針附上。柱塞部份地被插入, 注射器被倒置, 並且針被去除一旦氣泡到達了上面。柱塞充分地然後被插入入注射器, 搬空空氣從注射器。丙烯酸酯被允許對cure. 直到它到達聚化蒼白的階段。這可能由測試查明丙烯酸酯在一張紙或在您的手指之間。丙烯酸酯嚮被銘刻了牙的頰和舌表面然後被應用。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 破裂的進一步減少也許進行當丙烯酸酯硬化(丙烯酸酯可能仍然被鑄造) 。灌溉與涼快的自來水或鹽可能在這個狀況下使用減少熱由丙烯酸酯的放熱聚化引起。
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] 丙烯酸酯一次被治療, 它的形狀可能被修改與牙齒burs 和文件。另外的丙烯酸酯可能增加原始的丙烯酸酯一旦它被洗滌殘骸和被烘乾。如果器具打破在破裂之前癒合, 另外的丙烯酸酯可能直接地嚮那被應用與牙已經被結合。
最近研究各種各樣的類型力量interdental 定像包括導線、導線和曲拱酒吧、丙烯酸酯、丙烯酸酯和導線, 和丙烯酸酯與導線和曲拱酒吧比較。結果表明, 丙烯酸酯的interdental 定像被加強與金屬是最強的定像當測試在彎曲。那些的最強的interdental 設備被測試是丙烯酸酯的與導線和曲拱酒吧。相似與技術被描述, 導線和曲拱酒吧也許是應用的使用24 測量導線和正牙學曲拱酒吧。曲拱酒吧嚮下頷骨拱廊的舌方面被應用由使用各自的圈24 測量導線在各顆牙的脖子上和在曲拱酒吧的磁夾板之下在牙附近。導線被扭轉在下頷骨拱廊, 實際上cerclage 的舌方面架線曲拱酒吧對各自的牙。丙烯酸酯被應用相似如所描述早先。總之, 較少的命令對更加巨大的力量是導線< 導線和曲拱酒吧< 丙烯酸酯< 丙烯酸酯和導線< 丙烯酸酯與導線和曲拱酒吧。

ANATOMY
The mandible is composed of two halves with the horizontal portion (body) supporting teeth and the vertical portion (ramus) providing surfaces for muscle attachment and articulation with the skull. Each half of the mandible joins at the rostral midline to form the mandibular symphysis. Major neurovascular structures𡟙ncluding the mandibular artery and vein and the inferior alveolar nerve珻nter the mandible on the caudomedial aspect through the mandibular foramen. These structures provide the major neurovascular input to the mandible and sole neurovascular supply to the mandibular teeth. The mandibular canal opens mesially to form 2? mental foramina. The mandibular contribution to the temporomandibular joint (TMJ) consists of a transversely elongated condyle. The temporal bone contribution to the joint is tubular and closely surrounds the condyle. The TMJ also has a disc or meniscus providing an interface between bony components.
BIOMECHANICS
Mandibular fracture biomechanics indicates that the tension side of the mandible is the alveolar border, or tooth side of the mandible. Techniques that engage teeth secure the tension surface, allowing natural compression of the ventral surface. Intraoral splints, interdental acrylic, interdental wire, and combinations of interdental wire and acrylic can be applied to the tension band surface. Oblique mandibular body fractures can be classified as advantageous or disadvantageous. Fracture lines that are oriented from dorsocaudal to ventromesial are considered advantageous since muscular attachments to the mandible have a primarily ventral insertion causing compression of the fracture line. Fracture lines that are oriented from dorsomesial to ventrocaudal are considered disadvantageous since similar muscle forces lead to distraction of the mesial fragment. Knowledge of the inherent biomechanical nature of the fracture may affect decision-making concerning the technique for fracture fixation.
FIXATION TECHNIQUES
Mandibular fractures in the dog occur secondary to vehicular trauma, falls, kicks, gunshots, and fights with other animals. Mandibular fractures represent 3-6% of all fractures seen in the dog while 15% of all fractures in the cat affect primarily the mandibular symphysis. The most common location for fracture in dogs is between the PM 1 and M 2. Pathologic mandibular fracture may occur secondary to periodontal disease, neoplasia, and metabolic diseases. The primary objective for repair of mandibular fractures in small animals is return to normal function. Caudal malalignment of 2? mm may prevent closure of the mesial portion of the mouth by a full centimeter. Therefore, it is necessary to maintain occlusive alignment while providing adequate stability for bony union. Basic principles of mandibular fracture repair include anatomic reduction and restoration of occlusion, application of a stable fixation to neutralize negative forces on the fracture line, gentle handling of soft tissues, avoidance of iatrogenic dental trauma, extraction of diseased teeth within the fracture line, minimizing excessive soft tissue elevation, and application of techniques which restore a rapid return to function.
Fractures of the mandible in dogs present several unique challenges to the veterinarian since it withstands different forces compared with weight㼀earing bones. Mandibular fractures will heal in the presence of fracture gaps and some mobility, as long as vascularity is protected, revascularization encouraged, and infection prevented. The fixation method should allow immediate restoration of function; be light and not cumbersome, economical, and readily available; and require only a reasonable amount of time, expertise, and ancillary equipment for application. Trauma to tooth roots and neurovascular structures may not result in clinical signs; however, endodontic and periodontal complications including alveolar bone resorption, tooth root involvement, pulpitis, and tooth loss may occur. The inferior alveolar artery and its branches provide the sole blood supply to alveolar bone, periodontal ligament, and teeth. Its importance in the healing of mandibular fractures and tooth structures after injury and any subsequent clinical effects is unknown. Likewise, the clinical occurrences of painful neuroma after damage to the inferior alveolar nerve during fracture have not been documented in the dog.
Temporary muzzle coaptation may be applied during the preoperative period to support mandibular fracture. If used, the patient should be monitored to insure the muzzle does not interfere with breathing status or cause unnecessary, potentially detrimental excitement. Muzzle coaptation is also the most common definitive stabilization technique for mandibular fracture in dogs. Its common use indicates that it is successful in providing bony union most of the time. Post-treatment occlusion may not be optimal, however patients tend to do well clinically. Complications and problems associated with muzzle application include malocclusion, aspiration of food contents secondary to vomiting, hyperthermia from decreased ventilatory function (negative effect on panting), and moist dermatitis. This fixation method is inexpensive and does not negatively affect fracture fragment vascular supply or tooth roots and neurovascular structures of the mandibular canal. Although often successful in providing fracture fragment stability sufficient to promote secondary bony healing, mandibular healing because of muzzle application may be associated with permanent malocclusion. Other potential complications, which may occur during the treatment period, include patient noncompliance, and delayed return to function related to restriction of normal mastication. External fixation methods using intrafragmentary pins and acrylic side bars may provide adequate mandibular fracture stabilization; however, iatrogenic trauma of structures of the mandibular canal is possible based on recommendations for location of pin placement and mandibular anatomy. Loosening and infection are the two most frequent problems associated with the use of larger external skeletal fixation pins and are primarily a result of thermal necrosis of bone and soft tissue.
Other potential complications associated with the use of external fixation methods are pin𩣱ract infections, patient intolerance of the appliance, and disruption of the fixator bar on household furnishings. Internal fixation methods such as intramedullary pinning and plates and screws may also be associated with iatrogenic trauma of tooth roots and neurovascular structures. Disruption of fracture fragment vascular supply during implant application may complicate healing. Drawbacks to plating are the expense of the equipment, substantial time investment required to learn technical principles, and the penetration through or interference with the blood supply to the roots of the mandibular teeth resulting in endodontic disease. Methods using interdental fixation (IF) are an important component of temporary or primary mandibular fracture stabilization in humans. Clinical reports have recommended IF for stabilization of mandibular fractures in dogs. Advantages of interdental fixation for stabilization of mandibular fractures include avoidance of iatrogenic trauma to tooth roots and neurovascular structures of the mandibular canal, minimal disruption of fracture fragment vascular supply, restoration of occlusion, and early return to function. In summary, several fixation methods may be used for mandibular fracture repair that are quick to perform and provide sufficient stabilization for healing. Techniques that have these attributes may be used for emergency management of mandibular fractures.
INTERDENTAL FIXATION
Interdental fixation methods for human mandibular fracture stabilization include Ivy loop, Stout loop, modified Stout loop, acrylic splints, and Erich arch bar. The ability of IF methods to provide mandibular fracture stabilization while avoiding iatrogenic complications inherent with other more conventional fixation methods makes these techniques particularly desirable. The low cost of materials, relative ease of application, and frequency of mandibular fracture in dogs contribute to their potential uses in veterinary medicine.
Although acrylic does not adhere well to metal, it conforms to crown shape and interdigitates with gross metal architecture (metal cleats of the arch bar) and deformation (wire twists). Enamel adherence properties are propagated by formation of microporosities within prism cores or around rod peripheries of enamel using phosphoric acid gel etching of the enamel surface. Microporosity depth has been reported to range from 20 to 50 microns. Dental acrylic materials have been shown to penetrate these microporosities-forming, finger馪ike projections, resulting in a strong bond between the acrylic material and enamel.
A technique utilizing 24 gauge stainless steel orthopedic wire and poly(methyl)methacrylate has been developed. The wire is place around the teeth in Stout loop fashion, the teeth are prepared by acid etching, and dental acrylic is bonded to the teeth to create the interdental fixation.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] The dog is generally positioned in ventral recumbency and the mouth opened with a speculum or other device. This technique is best applied to fractures in the premolar to molar area.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] If the fracture is open, debridement and mucosal wound care is performed.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Twenty-four gauge orthopedic wire is cut to a length that will incorporate at least two teeth on either side of the fracture. The wire is applied in an intertwining fashion and tightened to the teeth using a twisting fashion as one would with cerclage wiring.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Once the wire has been applied, the teeth are cleaned with an ultrasonic scaler, followed by acid etching with 40% phosphoric acid gel, then rinsed and dried. The etching is performed on the buccal and lingual surfaces of the first through third premolars and lingual surface only of the fourth premolar and molars, taking into account the scissor bite of the maxillary and mandibular arcades.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] The dental acrylic is mixed in a 2:1 ratio. Three cubic centimeters (by volume) of monomer powder is placed in a mixing container. One-and-one𧬆alf cubic centimeter of polymer liquid is added to the powder. The mixture is stirred for a brief period and then transferred to a 3 cc syringe with a needle attached. The plunger is inserted partially, the syringe is inverted, and the needle is removed once the air bubble has reached the top. The plunger is then inserted fully into the syringe, evacuating the air from the syringe. The acrylic is allowed to 𡤧ure?until it reaches the doughy stage of polymerization. This can be ascertained by testing the acrylic on a piece of paper or between your fingers. The acrylic is then applied to the buccal and lingual surfaces of the teeth that have been etched.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Further reduction of the fracture may be performed while the acrylic hardens (the acrylic can still be molded). Irrigation with cool tap water or saline can be used at this stage to decrease the heat generated by the exothermic polymerization of the acrylic.
[img=8,8]http://www.vin.com/Images/Icons/Bullet1.gif[/img] Once the acrylic is cured, its shape can be modified with dental burs and files. Additional acrylic can be added right onto the original acrylic once it is cleansed of debris and dried. If the appliance breaks prior to fracture healing, additional acrylic can be applied directly to that already bonded to the teeth.[/size]

minibabyqq 2007-1-26 02:39

[color=Magenta][size=5][b]麻醉的神經塊和口頭痛覺缺失Local Anesthetic Nerve Blocks and Oral Analgesia  [/b][/size][/color]


我們取得了進展在動物痛苦的我們的治療, 特別是在最後十年之內。研究協助了延伸到獸醫許多實踐和產品早先被使用在人的領域。我們的客戶通曉這些實踐和盼望我們是嫻熟在這些規程和對他們的寵物擴大他們。客戶的自願依從我們的建議為口頭關心也許由痛苦控制的他們的悟性確定為他們的寵物。
原因使用本機塊
改進的客戶服從是一個原因執行地方麻醉的神經塊。被控制intraoperative 痛苦, 對深刻的麻醉的需要消滅。交感神經地斡旋的反射心跳緩慢風險在去除, 像更高的氣體含量的伴隨低血壓症和hypoventilation 。這翻譯對更加安全的麻醉的經驗為患者。
被防止痛苦wind-up. 現象和禁止有毒刺激發行難受的水平耐心經驗在做法期間和以後被減少。這翻譯對更加快速和較不充忙補救; 對額外療程的被減少的需要在直接手術後期間; 並且將減少手術後鎮痛藥數額、類型和頻率必要保持患者舒適。技術和配藥介入住院病人關心手段金錢儲款被減少的氣體消耗量和更低需要對實習者。
地方麻醉的代理
地方麻醉的代理輸入和佔領離子渠道在神經細胞膜, 防止去極化劑。這防止或減速痛苦衝動的傳導。地方代理的舉起被改進增加作用的玻璃酸, 和期間被增加與vasoconstrictors 。Epinephrine (腎上腺素) 並且L 降腎上腺素(levarterenol) 被使用在1:50 000 (1 mg/50 機器語言鹽) 或1:200 000 (1 mg/200 機器語言鹽) 。更低的集中是充足的為效力, 但更高的濃度抵銷epinephrine 的不穩定和改進保存性。所有地方麻醉的代理窮地運作在一個酸性環境裡譬如一個被傳染的區域。
最常用的地方麻醉的代理是mepivicaine 、lidocaine 和bupivacaine 。Mepivacaine, 有或沒有epinephrine, 在幾分鐘內需要作用, 和開始變稀在1.5.2.0 小時以後。Lidocaine 2% (與epinephrine 1:200 000) 有二到五分鐘起始, 和提供知覺封鎖二個小時。Bupivacaine, 有或沒有epinephrine, 需要大約五分鐘為起始, 但提供痛覺缺失六個小時。Mepivacaine 比lidocaine 和bupivacaine 提供一個更加巨大的安全限度, 特別是在貓較不毒性的。所有三個代理可能被購買在ampules, 包含1.8 機器語言, 或在更大, 更加經濟, multi-dose 瓶裡。
劑量
可能一次被給狗或貓mepivacaine 、lidocaine, 或bupivacaine 的總藥量是2 mg/kg 。這總藥量必須被劃分在需要被麻醉站點的數量。例如, bupivacaine 可能被購買在一種0.5% 解答和有因此5 mg/ml 。一隻5.0 公斤貓能容忍10 bupivacaine 毫克, 或能採取2 cc 的總容量解答。如果四個站點需要然後被減低敏感最大體積使用每站點是0.5 機器語言。實踐上, 0.25.0.3 機器語言地方代理每站點是充分的達到充分的減低敏感在貓和小狗。一條45 公斤狗能容忍90 mepivacaine 、lidocaine 或bupivacaine 毫克。在lidocaine 的2% 解答, 有20 mg/ml 。這條狗能接受解答的總容量是4.5 mls 。如果二個站點需要減低敏感, 2.25 mls 能然後被使用每站點。臨床, 0.75.1.0 機器語言在站點是充足達到完全痛覺缺失。一個一或三機器語言注射器與25 測量針通常是充分的為安置塊。
面部激動
大多數知覺輸入被接受通過trigeminal (第五個頭蓋骨) 神經的分支。主要知覺分支對口頭和牙齒外科醫生重要是上頷骨和下頷骨分裂。上頷骨分裂離開trigeminal 神經節和退出頭蓋骨洞通過孔rotundum, 路線通過翼狀運河, 和橫渡pterygopalatine 窩進入infraorbital 運河。在輸入infraorbital 運河的尾部極限之前, 神經送將成為主要和較小palatine 神經的分支。這些神經innervate 堅硬和軟的上顎、他們的mucosa, 和nasopharynx 。這些分支被減低敏感以上頷骨神經塊。
在上頷骨分裂進入infraorbital 運河之前, 它釋放供應上頷骨槽牙和頰齒齬和mucosa 的尾部上頷骨齒齦音神經, 並且被阻攔以尾部infraorbital 塊。在釋放尾部上頷骨齒齦音神經以後, 上頷骨神經進入infraorbital 運河, 這稱infraorbital 神經。當infraorbital 神經攀登infraorbital 運河, 它釋放從運河腹上退出的二個另外分支。中間上頷骨齒齦音神經innervates 前臼齒和聯繫的頰齒齬。rostral 上頷骨齒齦音神經供應犬、門牙, 和聯繫的頰齒齬。infraorbital 神經的殘餘的纖維然後退出infraorbital 運河的頭蓋骨程度innervate rostral 上顎骨和上嘴唇的側向和背部皮膚結構。這些中間上頷骨齒齦音、rostral 上頷骨齒齦音, 和infraorbital 神經由頭蓋骨infraorbital 神經塊阻攔。
trigeminal 神經的下頷骨分裂出現從trigeminal 神經節, 退出頭蓋骨通過孔ovale, 和劃分成並聯支路。分裂包括知覺頰神經、舌神經和下頷骨, 或下等齒齦音神經。頰神經接受刺激從面部肌組織、面頰的皮膚、mucosa 和頰齒齬沿下顎骨的後部方面。頰齒齬可能由頰塊減低敏感。舌神經供應舌頭、嘴的地板, 舌齒齬, 和submandibular 唾液封墊。下頷骨神經進入下顎骨在舌邊, 通過下頷骨孔。神經rostrally 然後追獵在骨頭之內innervate 下頷骨牙對midline 。這根神經可能被阻攔以下頷骨神經塊。在第二顆前臼齒(狗的) 水平或rostral 對第三顆前臼齒(貓), 下頷骨神經釋放精神神經分支。這些分支退出通過精神孔, 和為下巴的皮膚區域服務、嘴唇、和rostral 頰齒齬和mucosa 。這些神經被阻攔以精神神經塊。
站點提供分支神經塊
下頷骨, 中間精神, 和infraorbital 孔是多數興趣在小動物口頭規程上。infraorbital 孔可能被劃分成頭蓋骨和尾部塊。
頭蓋骨infraorbital 。 這個站點是頂端的對第三顆前臼齒的末端根ventrorostral 對消沉能感覺的zygomatic 曲拱並且神經twanged. 。塊將麻醉ipsilateral 前臼齒、犬和門牙牙和聯繫的軟的組織。
尾部infraorbital 。 如果牢固的數字式壓力被安置在infraorbital 運河的頭蓋骨末端在射入以後, 或針被推進深深入孔, 那麼神經將被麻醉在運河的軌道末端並且在尾部上頷骨齒齦音神經之前分支對槽牙齒列。這個塊將麻醉所有ipsilateral 齒列和軟的組織包括槽牙。
中間精神。 在犬, 這個站點是palpated 腹的對第二顆前臼齒的mesial 根。似貓, 它位於在嘴唇frenulum 之下等距離在第三顆前臼齒和犬之間。如果針進入孔, 塊將麻醉ipsilateral 軟的組織、犬和門牙牙。如果麻醉劑被放置在孔外面然後唯一頰軟的組織從犬今後對midline 將接受痛覺缺失。在人的解剖學方面, 有完全門牙區域的重大激動起源於兩下顎骨的左右邊。是否這並且發生在獸醫方面是不明的。如果減低敏感看來是殘缺不全的當工作在這個區域, 它也許是必要阻攔右和左精神神經。
下頷骨。 這個塊可能intraorally 或extraorally 完成。孔是消沉位於在下顎骨的ramus 的中間邊。它是近似地等距離在ramus 的rostral 和尾部疆界之間和在高度在一線路信號電平之間以齒齦音骨頭的冠和下顎骨的身體的中間高度。神經被麻醉在它進入下顎骨, 將阻攔所有軟的組織和齒列在那嘴的邊之前。intraoral 方法介入指揮注射器橫跨舌頭從嘴的反面和安置麻醉的代理在與孔的接近度。如果這種方法笨拙然後extraoral 方法也許更加容易。在這種方法, 針將被插入直角對下顎骨0.5.1.0 cm 的腹疆界頭蓋骨對有角過程的rostral 邊緣。線得出從眼睛的側向眼角對這個入口應該下落橫跨zygomatic 曲拱的中點。與手指被插入入嘴和palpating 孔針應該走下顎骨的中間邊緣和背部地被推進直到它能感覺是在與孔的接近度。這個塊將提供痛覺缺失對整體hemimandible 。
偶爾地被使用為主要規程要求完全hemimaxilla 痛覺缺失, 包括軟的組織、齒列, 和上顎的其它塊, 是上頷骨神經塊。
上頷骨。 intraoral 方法要求一個人的志向注射器與27 或30 測量針, 可能只達到在一條更大的狗由於主要palatine 孔的有限的大小。孔位於二條線的交叉點, 一哪些是得出的垂線對palatal midline 在mesiodistal 中點通過上頷骨第四顆前臼齒。第二條線與上顎的midline 是被畫的平行的等距離在齒列和palatal midline 之間。針必須是被插入的caudolaterally 指向, 最大值
30 個程度測角對上顎。針必須擊穿對深度相等與那必要到達第二槽牙的最末端的方面。在更小的患者, extraoral 技術必須被使用。針應該是被插入的垂線對頭的長的軸在rostral zygomatic 曲拱的腹疆界之下。針將需要是被指揮的輕微地背部的從水平。如果軟的組織的操作頰對下顎骨是必要的, 即, 面頰, 一個頰塊必須被安置。
頰。 針應該被安置在組織和地方麻醉劑的submucosa 被注射在第二和第三下頷骨槽牙的水平在狗, 和第三顆和第四顆前臼齒在貓。有關心, 一個孔的滲透與針也許導致精神創傷對神經。這是特別可能當試圖阻攔精神神經在一個小動物。因此, 運用齒齦音神經塊也許提供下顎骨的更好的減低敏感當避免醫原性精神創傷。同樣能是前述為intraoral 方法對上頷骨神經。
痛覺缺失
為手術後痛苦控制, 鎮痛藥應該變化根據難受的被期望的水平。比簡單的提取應該被認為有適度難受和口腔炎接受更多的任一名患者事例, 多提取, 或艱苦或軟的組織操作應該被承擔有一個高水平痛苦。
opioid 家庭是優秀為控制重大痛苦。對一opioid 的用途在premedication, 或內部有效, 將提供一種更加光滑的麻醉劑當等一個地方塊採取影響。這協同作用地並且將有效以口頭操作提供刺激由塊沒控制的一個地方塊。Butorphanol 有1.2 小時、oxymorphone 1.5.3 小時, 和嗎啡的期間2.4 小時。Buprenorphine 也許提供8.10 小時手術後痛覺缺失。Oxymorphone 可能並且被送在家為鼻內應用在0.05.0.1 mg/kg q4-6h 。
一個供選擇的產品控制重大痛苦是芬太奴補釘。這個產品也許只取得到通過一家人的醫院藥房。貓或小狗需要一個25 microgram/hr 補釘、一條中間大小的狗50 microgram/hr 補釘, 一條大狗75 microgram/hr 補釘, 和大的養殖, 100 microgram/hr 補釘。時間從一個補釘的應用對痛覺缺失起始是大約6.8 小時, 以最佳的作用在大約12 個小時。痛覺缺失意志的期間持續4.5 天以後補釘應該被去除。不要使用butorphanol 當等痛覺缺失起始從補釘, 照原樣一個競爭反對者, 將使補釘無效。補釘是優秀鎮痛藥送家與患者。安置補釘是在患者或小孩子無法訪問它的地點, 並且用繃帶蓋它。因為這是一個人的產品, 它的用途是off 標籤。Overdosing 也許導致pupillary 擴張、心動過速, 並且/或者煩躁不安。在這種情況下去除補釘並且患者將恢復正常在幾小時之內。如果補釘被咽下了鼓勵嘔吐和使用反對者, 即, naloxone 。
療程為適度難受包括non-steroidal anti-inflammatories (NSAIAs) 。acetominophen/codeine 產品可能被使用在狗在10 mg/kg 藥量為acetominophen 和一mg/kg 為可待因。為貓, 可待因糖漿可能被給在0.5.1 mg/kg q8h 。最初的藥量應該被給在醫院保證興奮不發生。可待因有令人不快的口味因此公式化可待因用風味糖漿。考慮增加額外纖維來動物接受可待因的飲食防止便秘。transdermal 可待因漿糊是適當的為小患者, 可能被安置在耳朵pinna 的裡面。
多數客戶有關心, 口頭規程將給予痛苦在他們的寵物。我們的客戶的悟性我們如同能幹和關心的專家由什麼經常確定他們在家看見在做法以後。對鎮痛藥的明智的用途將幫助您的患者, 將幫助您的客戶, 和請便。

We have come a long way in our treatment of animal pain, especially within the last decade. Research has assisted in extending to veterinary medicine many of the practices and products previously used in the human field. Our clients are familiar with these practices and expect us to be adept in these procedures and to extend them to their pets. A client's willingness to comply with our suggestions for oral care may be determined by their perception of pain control for their pet.
REASONS TO USE LOCAL BLOCKS
Enhanced client compliance is just one reason to perform local anaesthetic nerve blocks. By controlling intraoperative pain, the need for deep anesthesia is eliminated. The risk of vagally mediated reflex bradycardia in removed, as is the attendant hypotension and hypoventilation of higher gas concentrations. This translates to a safer anesthetic experience for the patient.
By preventing the 𢘛ind-up?phenomena of pain and inhibiting the release of noxious stimuli the level of discomfort the patient experiences is reduced both during the procedure and after. This translates to a faster and less eventful recovery; a reduced need for extra medication in the immediate post-operative period; and will reduce the amount, type and frequency of post-operative analgesic needed to keep the patient comfortable. Reduced gas consumption and lower need of technical and pharmaceutical involvement in patient care mean monetary savings for the practitioner.
LOCAL ANESTHETIC AGENTS
Local anesthetic agents enter and occupy ion channels in a nerve cell membrane, preventing depolarization. This prevents or retards conduction of pain impulses. Uptake of the local agent is improved with the addition of hyaluronidase, and duration of effect increased with vasoconstrictors. Epinephrine (adrenaline) and L-norepinephrine (levarterenol) are used at 1:50 000 (1 mg/50 ml saline) or 1:200 000 (1 mg/200 ml saline). The lower concentration is sufficient for efficacy, but the higher concentration offsets the instability of epinephrine and improves shelf life. All local anesthetic agents work poorly in an acidic environment such as an infected area.
The most commonly used local anaesthetic agents are mepivicaine, lidocaine and bupivacaine. Mepivacaine, with or without epinephrine, takes effect within minutes, and begins to attenuate after 1.5?.0 hours. Lidocaine 2% (with epinephrine 1:200 000) has an onset of two to five minutes, and provides sensory blockade for two hours. Bupivacaine, with or without epinephrine, requires approximately five minutes for onset, but provides analgesia for six hours. Mepivacaine is less toxic than lidocaine and bupivacaine provides a greater safety margin, especially in cats. All three agents can be purchased in ampules, which contain 1.8 ml, or in larger, more economical, multi-dose bottles.
DOSAGE
The total dose of mepivacaine, lidocaine, or bupivacaine that can be given at one time to a dog or cat is 2 mg/kg. This total dose must be divided over the number of sites that need to be anesthetised. For example, bupivacaine can be purchased in a 0.5% solution and therefore has 5 mg/ml. A 5.0 kg cat could tolerate 10 mg of bupivacaine, or could take a total volume of 2 cc of solution. If four sites need to be desensitized then the maximum volume to use per site is 0.5 ml. In practice, 0.25?.3 ml of local agent per site is adequate to achieve full desensitisation in cats and small dogs. A 45 kg dog could tolerate 90 mg of mepivacaine, lidocaine or bupivacaine. In a 2% solution of lidocaine, there is 20 mg/ml. The total volume of solution this dog could accept is 4.5 mls. If two sites needed desensitizing, then 2.25 mls could be used per site. Clinically, 0.75?.0 ml at a site is sufficient to achieve complete analgesia. A one or three ml syringe with a 25-gauge needle is usually adequate for placing the blocks.
FACIAL INNERVATION
The vast majority of sensory input is received via branches of the trigeminal (fifth cranial) nerve. The major sensory branches of concern to oral and dental surgeons are the maxillary and mandibular divisions. The maxillary division leaves the trigeminal ganglion and exits the cranial cavity through the foramen rotundum, courses through the alar canal, and crosses the pterygopalatine fossa to enter the infraorbital canal. Just before entering the caudal limit of the infraorbital canal, the nerve sends off branches that will become the major and minor palatine nerves. These nerves innervate the hard and soft palates, their mucosa, and the nasopharynx. These branches are desensitized with the maxillary nerve block.
Just before the maxillary division enters the infraorbital canal, it gives off the caudal maxillary alveolar nerve that supplies the maxillary molars and the buccal gingiva and mucosa, and is blocked with the caudal infraorbital block. After giving off the caudal maxillary alveolar nerve, the maxillary nerve enters the infraorbital canal, where it is called the infraorbital nerve. While the infraorbital nerve is traversing the infraorbital canal, it gives off two more branches that exit ventrally from the canal. The middle maxillary alveolar nerve innervates the premolars and associated buccal gingiva. The rostral maxillary alveolar nerve supplies the canine, incisors, and associated buccal gingiva. The remaining fibers of the infraorbital nerve then exit the cranial extent of the infraorbital canal to innervate the lateral and dorsal cutaneous structures of the rostral maxilla and upper lip. These middle maxillary alveolar, rostral maxillary alveolar, and the infraorbital nerve are blocked by the cranial infraorbital nerve block.
The mandibular division of the trigeminal nerve arises from the trigeminal ganglion, exits the cranium via the foramen ovale, and divides into multiple branches. The divisions include the sensory buccal nerves, the lingual nerve and the mandibular, or inferior alveolar nerve. The buccal nerves receive stimuli from the facial musculature, skin, mucosa of the cheek and buccal gingiva along the posterior aspect of the mandible. The buccal gingiva can be desensitized by the buccal block. The lingual nerve supplies the tongue, the floor of the mouth, the lingual gingiva, and the submandibular salivary gland. The mandibular nerve enters the mandible on the lingual side, via the mandibular foramen. The nerve then courses rostrally within the bone to innervate the mandibular teeth to the midline. This nerve can be blocked with the mandibular nerve block. At the level of the second premolar (dogs) or rostral to the third premolar (cats), the mandibular nerve gives off mental nerve branches. These branches exit through the mental foramina, and serve the cutaneous areas of the chin, lip, and the rostral buccal gingiva and mucosa. These nerves are blocked with the mental nerve block.
SITES TO DELIVER BRANCH NERVE BLOCKS
The mandibular, middle mental, and infraorbital foramina are of most interest in small animal oral procedures. The infraorbital foramen can be divided into cranial and caudal blocks.
Cranial infraorbital. This site is apical to the distal root of the third premolar just ventrorostral to the zygomatic arch where a depression can be felt and the nerve 懀wanged.?The block will anaesthetise the ipsilateral premolar, canine and incisor teeth and associated soft tissues.
Caudal infraorbital. If firm digital pressure is placed over the cranial end of the infraorbital canal after injection, or the needle is advanced deep into the foramen, then the nerve will be anaesthetised at the orbital end of the canal and before the caudal maxillary alveolar nerve branches off to the molar dentition. This block will anaesthetise all ipsilateral dentition and soft tissues including the molars.
Middle mental. In the canine, this site is palpated ventral to the mesial root of the second premolar. In the feline, it is located under the lip frenulum about equidistant between the third premolar and the canine. If the needle enters the foramen, the block will anaesthetise the ipsilateral soft tissues, canine and incisor teeth. If the anaesthetic is deposited outside of the foramen then only the buccal soft tissues from the canine forward to the midline will receive analgesia. In human anatomy, there is significant innervation of the complete incisor area originating from both the left and right sides of the mandible. Whether this also occurs in veterinary medicine is unclear. If desensitization appears to be incomplete when working in this area, it may be necessary to block both the right and left mental nerves.
Mandibular. This block can be done intraorally or extraorally. The foramen is a depression located on the medial side of the ramus of the mandible. It is approximately equidistant between the rostral and caudal borders of the ramus and at a height between a line level with the crest of the alveolar bone and the mid height of the body of the mandible. The nerve is anaesthetised before it enters the mandible and will block all soft tissues and dentition on that side of the mouth. The intraoral approach involves directing the syringe across the tongue from the opposite side of the mouth and placing the anaesthetic agent in proximity to the foramen. If this approach is awkward then the extraoral approach may be easier. In this approach, the needle will be inserted at right angles to the ventral border of the mandible 0.5?.0 cm cranial to the rostral edge of the angular process. A line drawn from the lateral canthus of the eye to this entry point should fall across the midpoint of the zygomatic arch. With a finger inserted into the mouth and palpating the foramen the needle should be walked off the medial edge of the mandible and advanced dorsally until it can be felt to be in proximity to the foramen. This block will provide analgesia to the whole hemimandible.
Another block that is used occasionally for major procedures requiring analgesia of the complete hemimaxilla, including soft tissues, dentition, and palate, is the maxillary nerve block.
Maxillary. The intraoral approach requires a human aspiration syringe with a 27 or 30-gauge needle and can only be achieved in a larger dog due to the limited size of the major palatine foramen. The foramen is located at the intersection of two lines, the first of which is drawn perpendicular to the palatal midline at a mesiodistal midpoint through the maxillary fourth premolars. The second line is drawn parallel to the midline of the palate equidistant between the dentition and the palatal midline. The needle must be inserted pointing caudolaterally, at a maximum

minibabyqq 2007-1-26 02:40

[color=Magenta][size=5][b]食物過敏在狗Update on Food Allergy in the Dog  [/b][/size][/color]


原因論
Food 過敏被定義作為免疫學上基於的反應對食物。在多數臨床案件, 確切的原因論不是好的被瞭解。型免疫學機制I-IV 被假設了。相反, 食物不寬容是一個一般用語描述任一有害反應對沒有一個免疫學依據的食物, 包括食物中毒(由毒素的直接行動造成) 。從一個實用依據, 行動機制不衝擊臨床工作者面對慢性食物導致的皮膚疾病潛在的事例。它被推理, 多數食物變態反應原是蛋白質。
對某人特徵的描述
性嗜好未被報告為食物過敏在狗或貓。在一些研究中, 養殖嗜好不是著名。相反, 二項研究發現某些狗養殖也許有一種風險為食物過敏的發展:
軟上漆的Wheaton 狗, Dalmatian, 西部高地白狗, 大牧羊犬, 中國Shar Pei, Llasa Apsa, 斗雞家Spaniel 、Springer Spaniel, 微型Schnauzer 、拉布拉多獵犬Dachshund 和拳擊手。養殖資料從科羅拉多州立大學表示, 獵犬比狗其它養殖也許是在更加巨大的風險開發食物過敏。當年齡在介紹作為可變物被報告了, 幾位研究員現在認為, 至少33% 他們的情況在狗是動物少於一年紀。清楚地, 當食物過敏也許任何時候發生在animal.s 生活中, 它應該總被考慮作為瘙癢差別在幼小狗
歷史和臨床標誌
食物過敏的最共同的臨床標誌是非季節性瘙癢, 通常被推斷。瘙癢也許主要並且被指揮在腳 或耳朵。非常很少, 食物過敏狗與皮膚損害但沒有瘙癢被報告了。最共同的主要dermatologic 損害是丘疹和紅斑; 共同的次要損害是表皮collarettes (通常表明膿皮病) pyotraumatic 皮炎(hot 斑點。) hyperpigmentation, 和seborrhea 。食物過敏的臨床標誌被報告了在斗雞家Spaniels 相同與先天seborrhea 與相關那養殖。食物過敏作為根本原因的先天onychodystrophy (殘廢, 分裂的爪[ 釘子]) 被報告了在二條狗。食物過敏在貓也許提出作為頭的瘙癢和面孔, milliary 皮炎, 或嗜伊紅的肉芽腫複合體的顯示的當中一個。
被報告的一致食道(GI) 標誌在狗之中以食物過敏的皮膚標誌是罕見的; 它是未知的如果這歸結於GI 標誌真實的缺乏或如果實際上改變在這些狗凳子是相對地微妙的並且/或者不是著名或由所有者志願當獲得歷史。但是, 一個最近報告提供了20 狗以瘙癢和GI 標誌特點colitis: 糞便黏液、糞便血液、裡急後重和增加的糞便頻率。皮膚和GI 簽署解決在哺養狗排除飲食。Lymphocytic plasmacytic colitis 與食物過敏連接了在貓和獵豹。
神經學標誌譬如不適 和奪取 很少被報告了。作者認為, 不適也許在之下被報告, 作為在能級的增量(acting 像小狗, 感覺更好。) 經常是著名在哺養狗飲食沒有觸犯的變態反應原; 這也許發生在瘙癢的停止之前。呼吸標誌, 譬如哮喘, 並且被報告了, 但似乎是相當罕見的。
一致hypersensitivities 被報告了在狗和包括遺傳性過敏症、蚤過敏皮炎、小腸寄生生物過敏, 和甚而過敏對遲鈍的胰島素。一致膿皮病 並且/或者 Malassezia pachydermatis 傳染並且是共同性。狗也許有膿皮病(表面或深) 作為食物過敏的唯一的臨床標誌。這些狗臨床經常是法線(即, 非pruritic) 當接受抗生素。所以, 它變得相當重要診斷和治療次要傳染, 當瘙癢堅持由於這些傳染也許迷惑臨床工作者的能力診斷部下的過敏。
診斷
診斷理想的方法是哺養排除(hypoallergenic 。) 飲食。作者的經驗和的其它研究員 是失望的在對血清學或皮內皮膚測試的用途診斷食物過敏在寵物在北美洲。
排除飲食一般包含一蛋白質和一澱粉。這些必須根據狗的早先暴露對各種各樣的糧食。重要記住是活在家庭與貓傾向於暴露於魚, 通過或貓食或貓排匯物的他們的消耗量的狗。在加州大學戴維斯分校, 我們經常開始狗用豬肉和土豆, 雖然花馬豆和土豆也許並且用。根據非曝光, 兔子、鴨子, 和金槍魚並且是選擇。我們並且用了exotic. 食物像麋當可行。除淡水之外, □什麼應該被哺養對狗在排除飲食試驗期間。這意味著, 維生素和嚼玩具必須被消滅, 並且調味的療程(譬如某些ecto/endoparasite 預防物) 應該由其他替換, 相等地有效的non-flavored 準備。蛋白質調味的牙膏應該由麥芽調味的品種替換。由於排除飲食不是一平衡一個, 狗也許丟失重量, 開發dull. haircoat 或結垢的所有者比通常應該被警告, 或餓。在貓, 我們將用基於羊羔的babyfood 為人的嬰兒。
一定, 一些所有者是無法或不願意烹調為他們的寵物為期間必要。在這些情況下, 皮膚學服務在加州大學戴維斯分校使用商業可利用的有限抗原飲食。為狗這些會包括Purina LA (salmonid); Iams FP (魚和土豆) 並且KO (袋鼠和燕麥); IVD 鴨子、鹿肉、whitefish, 或兔子加上土豆; 小山D/D (鴨子或魚和米); 或Waltham 魚和米。為貓, 這些會包括IVD 鴨子、鹿肉, 或兔子加上土豆; 小山D/D 似貓; 或Iams 羊羔和大麥。其它選擇為已經被哺養許多食物, 或飲食歷史是未知的動物, 是對被水解的蛋白質的用途節食, 蛋白質來源被水解對小分子量, 如此避免body.s immunologic 雷達。這樣食物包括Purina HA (被水解的大豆), 小山Z/D, 或DVM 排除。對商業準備的飲食的用途將給確定食物過敏的一次大約90% 機會; 但是, 無這些飲食將運作為所有動物, 並且動物的疏忽改善在這樣飲食也許擔保嘗試另外一個, 或家煮熟的飲食在其它試驗。
排除飲食的長度是有些有爭議的, 然而, 我們的觀察辯解了八個到12 個星期一次飲食試驗。一些瘙癢堅持在12 個星期入飲食試驗也許表明對繼續飲食的需要, 但也許並且表明一致hypersensitivities 出現。在抗生素被給對待次要傳染, 或口頭類皮質激素為嚴厲瘙癢處, 飲食必須繼續為二個星期極小值通過這些治療的中止, 為了適當地判斷它的效力。
在臨床標誌的決議用哺養排除飲食, 動物應該挑戰以它的規則飲食證實食物過敏的診斷。臨床標誌再現通常是著名在一個星期之內, 但也許採取只要二個星期。動物再那時被給它的排除飲食, 並且所有者也許然後決定挑戰與被懷疑的變態反應原, 各變態反應原被給一個到二個星期一次。最共同的被證明的變態反應原在狗是牛肉、雞、牛奶、蛋、玉米、麥子, 和大豆; 在貓, 魚和奶製品。對超過二變態反應原的過敏是不凡的。一旦觸犯的變態反應原被辨認, 不包含他們商業的準備的狗食也許被哺養對狗。在所有者拒絕做誘惑測試的案件, 有限抗原寵物食品的當中一個也許用作為維護飲食。

Etiology
硓ood allergy is defined as an immunologically based reaction to food. In most clinical cases, the exact etiology is not well understood. Immunologic mechanisms of types I-IV have been hypothesized. In contrast, food intolerance is a general term describing any adverse reaction to food that does not have an immunologic basis, including food poisoning (caused by the direct action of a toxin). From a practical basis, the mechanism of action does not impact the clinician faced with a potential case of chronic food-caused cutaneous disease. It is theorized that most food allergens are proteins.
Signalment
No sex predilection has been reported for food allergy in dogs or cats. In some studies, no breed predilection was noted. In contrast, two studies found that certain dog breeds may have a risk for the development of food allergy:
Soft-Coated Wheaton Terrier, Dalmatian, West-Highland White Terrier, Collie, Chinese Shar Pei, Llasa Apsa, Cocker Spaniel, Springer Spaniel, Miniature Schnauzer, Labrador Retriever Dachshund and the Boxer. Breed data from Colorado State University shows that retrievers may be at greater risk to develop food allergy than other breeds of dogs. While the age at presentation has been reported as variable, several researchers now feel that at least 33% of their cases in dogs are of animals less than one year of age. Clearly, while food allergy may occur at any time in animal𠏋 life, it should always be considered as a differential of pruritus in the young dog
History and Clinical Signs
The most common clinical sign of food allergy is non-seasonal pruritus, which is usually generalized. Pruritus may also be primarily directed at the feet or ears. Very rarely, food allergic dogs with skin lesions but without pruritus have been reported. The most common primary dermatologic lesions are papules and erythema; common secondary lesions are epidermal collarettes (usually indicating a pyoderma) pyotraumatic dermatitis (蘔ot spots? hyperpigmentation, and seborrhea. Clinical signs of food allergy have been reported in Cocker Spaniels identical to the idiopathic seborrhea associated with that breed. Food allergy as the underlying cause of idiopathic onychodystrophy (misshapen, splitting claws [nails]) has been reported in two dogs. Food allergy in cats may present as pruritus of the head and face, milliary dermatitis, or one of the manifestations of the eosinophilic granuloma complex.
Reported concurrent gastrointestinal (GI) signs among dogs with cutaneous signs of food allergy are rare; it is unknown if this is due to a true dearth of GI signs or if in fact changes in the stool of these dogs were relatively subtle and/or were not noted or volunteered by the owners while obtaining the history. However, a recent report documented 20 dogs with both pruritus and GI signs typical of colitis: fecal mucus, fecal blood, tenesmus and increased fecal frequency. Both cutaneous and GI signs resolved upon feeding the dogs an elimination diet. Lymphocytic-plasmacytic colitis has been linked to food allergy in cats and cheetahs.
Neurologic signs such as malaise and seizures rarely have been reported. The author feels that malaise may be under-reported, as an increase in energy level (弌cting like a puppy, feeling better? is often noted upon feeding the dog a diet without the offending allergen; this may occur before cessation of pruritus. Respiratory signs, such as asthma, have also been reported, but seem to be quite rare.
Concurrent hypersensitivities have been reported in dogs and include atopy, flea allergy dermatitis, intestinal parasite allergy, and even an allergy to bovine insulin. Concurrent pyoderma and/or Malassezia pachydermatis infection is also common. Dogs may have pyoderma (superficial or deep) as the only clinical sign of food allergy. These dogs are often clinically normal (i.e., non-pruritic) while receiving antibiotics. Therefore, it becomes quite important to diagnose and treat secondary infections, as persistence of pruritus due to these infections may confound the ability of the clinician to diagnose the underlying allergy.
Diagnostics
The ideal method of diagnosis is the feeding of an elimination (蘔ypoallergenic? diet. The experience of the author and of other researchers has been disappointing in the use of serologic or intradermal skin tests to diagnose food allergy in pets in North America.
The elimination diet generally contains one protein and one starch. These must be based on previous exposure of the dog to various foodstuffs. Important to remember is that dogs who live in households with cats tend to have been exposed to fish, through their consumption of either cat food or cat feces. At UC Davis, we often start dogs with pork and potatoes, although pinto beans and potatoes may also be used. Based on non-exposure, rabbit, duck, and tuna are also options. We have also used 𦦨xotic?foods like elk when feasible. Other than fresh water, nothing else should be fed to the dog during the elimination diet trial. This means that vitamins and chewing toys must be eliminated, and that flavored medications (such as certain ecto/endoparasite preventatives) should be replaced by other, equally effective non-flavored preparations. Protein-flavored toothpaste should be replaced by the malt-flavored variety. Because the elimination diet is not a balanced one, owners should be warned that the dog might lose weight, develop a 𡞫ull?haircoat or scaling, or be hungrier than usual. In cats, we will use lamb-based baby food for human infants.
Certainly, some owners are unable or unwilling to cook for their pet for the period necessary. In such cases, the dermatology service at UC Davis uses commercially available limited-antigen diets. For dogs these would include Purina LA (salmonid); Iams FP (fish and potato) and KO (kangaroo and oats); IVD duck, venison, whitefish, or rabbit plus potato; Hills D/D (duck or fish and rice); or Waltham fish and rice. For cats, these would include IVD duck, venison, or rabbit plus potato; Hills D/D feline; or Iams lamb and barley. Another option for animals who already have been fed many foods, or whose dietary history is unknown, is the use of hydrolyzed protein diets, in which the protein source is hydrolyzed to small molecular weights, thus avoiding the body𠏋 𧗽mmunologic radar.?Such foods include Purina HA (hydrolyzed soy), Hills Z/D, or DVM Exclude. Use of a commercially prepared diet will give an approximately 90% chance of determining a food allergy; however, none of these diets will work for all animals, and failure of an animal to improve on such a diet may warrant trying another one, or a home-cooked diet in another trial.
The length of the elimination diet is somewhat controversial, however, our observations have justified a dietary trial of eight to 12 weeks. Persistence of some pruritus at 12 weeks into the diet trial may indicate the need for continuing the diet, but may also indicate the presence of concurrent hypersensitivities. In cases where antibiotics are given to treat secondary infections, or oral corticosteroids for severe pruritus, the diet must be continued for a minimum of two weeks past discontinuation of these treatments, in order to properly judge its efficacy.
Upon resolution of clinical signs with the feeding of an elimination diet, the animal should be challenged with its regular diet to confirm the diagnosis of a food allergy. Recurrence of clinical signs is usually noted within one week, but may take as long as two weeks. At that point the animal is given its elimination diet again, and the owner may then elect to challenge with suspected allergens, each allergen being given one to two weeks at a time. The most common proven allergens in the dog are beef, chicken, milk, eggs, corn, wheat, and soy; in the cat, fish and milk products. Allergies to more than two allergens are uncommon. Once the offending allergens are identified, commercially prepared dog foods that do not contain them may be fed to the dog. In cases in which the owners refuse to do provocative testing, one of the limited-antigen pet foods may be used as a maintenance diet.

minibabyqq 2007-1-26 02:41

[color=Magenta][size=5][b]Sebaceous 腺炎 Sebaceous Adenitis [/b][/size][/color]


臨床介紹
看起來似乎sebaceous 腺炎的二個形式。以焦點形式, 有脫髮症、紅斑, 和過份結垢地方化的區域(標度是charac.teristically 非常依附頭髮) 。頭和肢看上去更加一致地被介入。炎症和瘙癢是易變的但也許是存在, 特別是以表面膿皮病。這個形式是共同在短上漆的養殖(即, Viszla), 和經常開始以頂頭或面部介入和尾部進步。
一個廣義形式提出以劇烈的相當數量標度在皮膚, 標度ad.herent 對頭髮(囊泡鑄件) 並且外套和剝皮經常乾燥對接觸。當疾病進步(經常尾部從面孔或頭), 有一廣義變薄外套。pinnae 的背後面, 中間方面和耳道通常是最受影響的。瘙癢是vari.able 但也許被標記, 特別是如果一個次要細菌膿皮病禮物。_ 養殖是pre.disposed 對這形式包括這標準長捲毛狗, 薩莫耶特, akita, 老英國Sheepdog, 和這拉薩Apso 。
從前, 這些問題(特別是廣義形式) 是可能的diag.no.sed 作為先天seborrheas 或endocrinopathy. 。
原因論
一個激動過程看來負責對毀壞sebaceous 封墊在受影響的區域。起因為激動過程的_蒙當前是未知的。明顯的orthokeratotic 皮膚角化過度並且被注意。這精神錯亂在keratinization 也許至少一部分是缺乏的產品sebaceous 封墊和他們的分泌物。這些患者看來是有傾向對次要細菌傳染的發展, 也許對瘙癢和掉頭發極大貢獻。
有差別的診斷
為焦點形式, 差別是: 大批出沒(Demodex), 傳染(細菌, 皮蘚菌, Malassezia), 鋅敏感皮膚病, pemphigus foliaceus; 為廣義形式: endocrinopathy, 先天seborrhea, 萊什曼原蟲病。
診斷
皮膚的切片檢查法通常是診斷的。受影響的區域顯示pyogranulomatous inflam.mation (與嗜中性和巨噬細胞) 在sebaceous 封墊附近。Seba.ceous 封墊是以各種各樣的階段被毀壞。明顯的ortho.keratotic 皮膚角化過度是存在(變厚地層corneum) 。在晚階段疾病, 炎症決心, 留下缺乏sebaceous 封墊。
治療
一定數量的養生之道被使用了並且反應是易變的。下面被列出養生之道由本作者使用, 與特選被給那□首先被列出。治療也許被使用在組合, 除用維生素A 之外以retinoids (因為他們根本上是同樣類型療程) 。次要膿皮病的治療是必要。
維生素A, 口頭: 小到中狗10,000 IU q12h; 大養殖(Akitas, 標準長捲毛狗) 20,000 IU q12h 。
脂肪酸補充(雙重力量); 晚櫻草油, 500 毫克每日兩次。
浴油的二個小時應用, 被五到七香波跟隨。月度重覆得兩次。掉頭發最初地看被頭髮再生物隨後了而來。
50%.100% 丙烯甘醇浪花申請了被anti.seborrheic 香波每三到四天最初地一次每日跟隨。最初地慢慢地使sham.poos 頻率, 和然後丙烯甘醇浪花的頻率降低到幫助控制問題的最少頻繁應用。
Isotretinoin (Accutane。) 或acitretin (Soriatane。) 1.3 mg/kg 每12 個小時直到寬恕; 然後最低, 多數少有的藥量要求控制臨床標誌。
其它種類
Sebaceous 腺炎被報告了在貓和兔子。治療協議不是源遠流長的。

Clinical presentation
There seem to be two forms of sebaceous adenitis. In the focal form, there are localized areas of alopecia, erythema, and excessive scaling (the scale is charac負eristically very adherent to hairs). The head and extremities appear to be more consistently involved. Inflammation and pruritus are variable but may be present, especially with a superficial pyoderma. This form is more common in short-coated breeds (e.g., Viszla), and often starts with head or facial involvement and progresses caudally.
A generalized form presents with dramatic amounts of scale on the skin, scale ad虐erent to hairs (follicular casting) and the coat and skin often dry to the touch. As the disease progresses (often caudally from the face or head), there is a generalized thinning of the coat. The dorsal back, medial aspect of the pinnae and the ear canals usually are the most affected. Pruritus is vari苔ble but may be marked, especially if a secondary bacterial pyoderma present. Breeds that are pre苓isposed to this form include the Standard Poodle, Samoyed, Akita, Old English Sheepdog, and the Lhasa Apso.
In the past, these problems (especially the generalized form) were likely diag要o貞ed as idiopathic seborrheas or endocrinopathy.?/p> Etiology
An inflammatory process appears to be responsible for destroying the sebaceous glands in the affected areas. The cause for initiation of the inflammatory process is unknown at present. Marked orthokeratotic hyperkeratosis is also noted. This derangement in keratinization may at least in part be a product of the lack of sebaceous glands and their secretions. These patients appear to be prone to the development of secondary bacterial infections, which may contribute significantly to pruritus and hair loss.
Differential diagnoses
For the focal form, differentials are: Infestations (Demodex), infections (bacterial, dermatophyte, Malassezia), zinc-responsive dermatosis, pemphigus foliaceus; for the generalized form: endocrinopathy, idiopathic seborrhea, Leishmaniasis.
Diagnosis
Biopsy of the skin is usually diagnostic. Affected areas show a pyogranulomatous inflam衫ation (with neutrophils and macrophages) around the sebaceous glands. Seba苞eous glands are in various stages of being destroyed. Marked ortho虺eratotic hyperkeratosis is present (thickening of stratum corneum). In late stage disease, the inflammation resolves, leaving an absence of sebaceous glands.
Treatment
A number of regimens have been used and the response has been variable. Listed below are the regimens used by this author, with preference given to the ones listed first. Treatments may be used in combination, with the exception of using the vitamin A with retinoids (because they are essentially the same type of medication). Treatment of secondary pyoderma is a necessity.
Vitamin A, oral: small to medium dogs 10,000 IU q12h; large breeds (Akitas, Standard Poodles) 20,000 IU q12h.
Fatty acid supplementation (double strength); evening primrose oil, 500 mg twice daily.
Two hour application of bath oil, followed by five to seven shampoos. Repeat twice monthly. Hair loss is seen initially followed by hair regrowth.
50%?00% propylene glycol sprays applied once daily followed by anti貞eborrheic shampoos every three to four days initially. Slowly reduce the frequency of sham計oos initially, and then the frequency of the propylene glycol sprays to the least frequent application that helps to control the problem.
Isotretinoin (Accutane?/sup>) or acitretin (Soriatane?/sup>) 1? mg/kg every 12 hours until remission; then the lowest, most infrequent dose required to control clinical signs.
Other species
Sebaceous adenitis has been reported in cats and rabbits. Treatment protocols are not well established.
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