Vim li cas thiaj faib caries? Qhov no tsuas yog thaum xub thawj siab ib muag ib tug kab mob yooj yim paub rau txhua leej txhua tus. Rau cov kws kho hniav, muaj qhov sib txawv ntawm nws ntau hom, thiab txhua tus ntawm lawv yuav tsum muaj nws tus kheej tshwj xeeb rau kev kho mob.
Caries yuav txawv
Caries yog cov kab mob ntau tshaj plaws ntawm qhov ncauj kab noj hniav, tsim nyob rau hauv ntau qhov chaw ntawm cov hniav, daim duab kho mob ntawm cov txheej txheem kuj yuav txawv. Rau kev yooj yim hauv kev kho mob, kev xaiv kom raug ntawm kev npaj cov hniav thiab cov khoom siv rau kev txhaws, nws yog ib txwm ua raws li cov hom kab mob caries. Qhov no yog li cas cov chav kawm txawv raws li Dub, raws li qhov tob ntawm qhov txhab, raws li qib ntawm kev ua haujlwm ntawm cov txheej txheem kev puas tsuaj, raws li qhov muaj teeb meem, raws li qhov chaw kho mob thiab thaj chaw ntawm qhov txhab.
Qhov kev faib tawm rov qab rau xyoo 1986 los ntawm tus kws kho hniav Asmeskas J. Black yog qhov tshwj xeeb tshaj yog. Nws lub hom phiaj yog los ua kom lub hauv paus ntsiab lus ntawm kev kho mob rau ntau hom kab mob carious ntawm tus hniav.
chav kawm dub
Dub tau txheeb xyuas tsib chav kawm raws li qhov chaw nyob ntawm qhov chaw, uas yog, nyob ntawm qhov chaw raws nraimkab noj hniav:
- Localization nyob rau hauv fissures (kev nyuaj siab thiab crevices nyob rau hauv lub enamel ntawm lub zom zom), pits ntawm molars thiab premolars (loj thiab me molars), canines thiab incisors.
- Ob lossis ntau qhov chaw raug cuam tshuam - qhov nruab nrab thiab qhov nruab nrab (caries ntawm cov hniav pem hauv ntej) lossis occlusal (txiav thiab zom qhov chaw) ntawm cov molars thiab premolars raug ntes.
- Kev loj hlob ntawm tus kab mob ntawm qhov nruab nrab thiab qhov nruab nrab ntawm cov canines thiab incisors.
- Localization yog tib yam li Qib 3, ntxiv rau lub kaum sab xis lossis lub kaum sab xis raug ntes.
- Cov kab noj hniav nyob thaj tsam ncauj tsev menyuam ntawm txhua pab pawg hniav.
Black's chav kawm systematize tag nrho cov kev xaiv ua tau rau txoj kev loj hlob ntawm caries, rau txhua tus ntawm lawv muaj kev kho mob cais, ib txoj kev npaj ib tug kab mob thiab txhim kho ib tug txhaws.
Black First Class
Cov kab noj hniav carious nyob rau hauv txoj kev no ua rau muaj kev pheej hmoo ntawm kev tawg ntawm ntug ntawm qhov txhaws vim qhov siab siab ntawm nws thaum zom. Thaum npaj cov hniav, kev ntsuas yuav tsum tsis suav nrog qhov no. Qhov no tshwm sim los ntawm kev txo qis bevel ntawm cov enamel thiab siv cov txheej tuab ntawm cov khoom ntim. Thaum siv cov tshuaj tua kab mob sib xyaw, nws yog siv rau qhov sib npaug mus rau hauv qab ntawm cov kab noj hniav carious, vim tias shrinkage yuav raug coj mus rau lub pulp. Yog tias siv cov khoom siv kho lub teeb, nws tau muab tso rau hauv oblique txheej. Shrinkage nyob rau hauv cov ntaub ntawv no yuav raug coj mus rau lub hauv paus ntawm polymerization. Cov khaubncaws sab nraud povtseg yuav tsum dag los ntawm nruab nrab ntawm lub hauv qab mus rau ntug ntawm kab noj hniav, xav txogtshwm sim los ntawm sab phab ntsa, thiab tom qab - perpendicular mus rau zom nto. Raws li qhov tshwm sim, qhov nruj nruj ntawm qhov txhaws hauv kab noj hniav tau tiav.
thawj chav kawm kab noj hniav sau cov kauj ruam
Yuav tsum ua li no los ntawm tus kws kho hniav kom kho chav kawm 1 raws li Dub:
- mob nyem (siv tshuaj loog gel lossis lidocaine spray),
- npaj tus hniav (kev npaj yuav tsum tho qhov chaw cuam tshuam los ntawm caries tob rau hauv cov ntaub so ntswg),
- yog tias tsim nyog, thov cov khoom siv insulating (kom tiv thaiv cov khoom sib xyaw los ntawm kev cuam tshuam rau cov tawv nqaij thiab khaus nws),
- etch thiab ntxuav tawm cov kua qaub, kab noj hniav qhuav,
- cais tawm ntawm qaub ncaug,
- thov primer yog tias tsim nyog (los npaj cov hniav),
- siv cov nplaum (cov khoom sib txuas ntawm cov ntaub so ntswg thiab cov hniav los yog primer),
- txheej los ntawm txheej siv cov khoom siv, kho nws,
- kho kom zoo nkauj, tiav thiab polish,
- ua rau ci ntsa iab (zaum kawg).
Black Second Class
Class 2 raws li Dub, uas muaj nws tus kheej cov teeb meem, suav nrog ob txoj haujlwm tseem ceeb hauv nws txoj kev kho mob - los tsim kom muaj kev sib cuag ntawm cov hniav thiab xyuas kom muaj kev sib haum xeeb ntawm cov khoom sib xyaw rau ntawm ntug ntawm lub ntsiab kab noj hniav. Feem ntau cov txheej txheem filling yog qhov nyuaj los ntawm cov tsos ntawm ib tug overhanging ntug ntawm lub filling, tsis muaj kev sib cuag ntawm cov hniav los yog cov khoom uas muaj carious kab noj hniav. Txhawm rau tiv thaiv qhov no, nyias cov matrices raug siv, kev hloov pauv yog nqa tawmhniav (nyob rau hauv qhov txwv tau) siv ntoo wedges. Ib tug matrix yog qhia rau hauv qhov chaw interdental thiab tsau nrog ib tug wedge, ces moistened nrog dej. Lub npoo swells thiab thawb tus hniav rov qab. Txoj kev no thaum lub sij hawm txhaws tsis txhob overhanging ntug ntawm lub filling, uas nyob rau hauv lem yuav ua rau o ntawm cov pos hniav. Lub nruj haum ntawm cov khoom siv rau hauv cov kab noj hniav kom ntseeg tau tias kev siv cov nplaum nplaum - ib daim ntawv khi, vim tias cov khoom sib xyaw nws tus kheej tsuas yog txuas nrog cov enamel, tab sis tsis yog rau dentin.
theem ntawm cov kab noj hniav ntawm chav kawm thib ob
Black cov chav kawm hauv kev kho mob muaj cov ntsiab lus zoo sib xws, tab sis txhua tus ntawm lawv yuav tsum muaj qhov tshwj xeeb ntawm kev sau. Nov yog cov kauj ruam rau qib ob:
- mob nyem,
- kev npaj,
- yog tias tsim nyog, kho cov pos hniav,
- kev teeb tsa ntawm lub matrix nrog kev taw qhia ntawm ib tug ntoo wedge los yog tuav,
- yog tias tsim nyog thawb cov hniav sib nrug,
- siv lub ncoo insulating (yog tias tsim nyog),
- nqa cov txheej txheem ntawm etching, ntxuav tawm cov kua qaub thiab ziab kab noj hniav,
- hniav cais tawm ntawm qaub ncaug,
- thov primer thiab nplaum,
- yog tias tsim nyog - kho dua ntawm ntug enamel (yog tias tsis muaj),
- sib tov txheej,
- extracting matrix and wedge,
- kev tiv thaiv kev tiv thaiv,
- Y kho, polishing,
- tiav kev xav.
qib peb thiab plaub
Ntawm no yog lub luag haujlwm tseem ceeb yog ua los ntawmxaiv cov xim ntawm cov khoom filling, vim hais tias nyob rau hauv cov ntaub ntawv no caries yog localized nyob rau hauv pem hauv ntej cov hniav. Vim qhov sib txawv pob tshab coefficient ntawm dentin thiab enamel, nws yog ib qho tsim nyog yuav tau siv ob qho xim sib txawv thaum kho. Qhov no yog qhov tsim nyog kom cov hniav zoo li homogeneous, thiab qhov txhaws tsis zoo li ib thaj. Txhawm rau tsim cov txiaj ntsig zoo tshaj plaws, cov xim dawb ntawm cov khoom siv los xyaum dentin, thiab yuav luag pob tshab los tsim cov enamel. Ua kom qhov kev hloov pauv tsis pom, cov enamel bevel overlaps los ntawm 2-3 hli. Nws yog ib qho tseem ceeb uas tus kws kho hniav zoo koom nrog hauv kev ua haujlwm zoo, uas tuaj yeem txiav txim siab qhov pom tseeb ntawm cov hniav. Nws muaj peb theem: opaque (feem ntau yellowish, txawm lub txiav ntug yog opaque), pob tshab (daj-grey ntxoov, txiav ntug yog pob tshab), pob tshab heev (greyish tint, pob tshab ntug occupies ib feem peb ntawm cov hniav.
theem ntawm cov kab noj hniav ntawm qib 3 thiab 4
Txhawm rau sau cov chav kawm thib peb thiab plaub ntawm cov kab noj hniav dub, tus kws kho hniav yuav tsum ua cov hauv qab no:
- ntxuav qhov chaw ntawm cov quav hniav,
- txiav txim qhov ntxoov ntxoo ntawm tus hniav,
- tshuaj loog,
- npaj cov hniav, tsis muaj cov ntaub so ntswg,
- nruab cov hlua thim rov qab lossis matrices thaum xav tau (gingival margin cuam tshuam),
- siv cov ntaub thaiv npog,
- yog tias tsim nyog, rov kho cov hniav ntawm cov hniav,
- ntxuav cov kua qaub thiab qhuav cov kab noj hniav,
- cais qaub ncaug,
- thov primer (yeem) thiabnplaum,
- siv cov txheej txheem thaiv cov khoom,
- tshem tawm cov matrix thiab xov, yog tias muaj,
- kho cov npoo, muab qhov xav tau rau tus hniav,
- sib tsoo thiab polishing,
- tiav kev xav.
Black qib tsib
Hauv qhov no, kev sib raug zoo ntawm cov pos hniav thiab kab noj hniav carious yog qhov tseem ceeb. Nrog rau qhov mob sib sib zog nqus nrog kaw ntawm ntug qis ntawm cov pos hniav, nws los ntshav, tus kws kho hniav zoo yuav txiav txim siab tam sim ntawd tias yuav tsum tau kho cov gingival margin. Tom qab ua qhov tsim nyog manipulations nrog cov pos hniav, ib ntus filling yog thov rau ob peb hnub kom tshem tawm cov teeb meem ntxiv thaum txhim kho ib qho mus tas li. Chav kawm thib tsib suav nrog kev siv cov khoom sib xyaw thiab cov khoom sib xyaw (composite-ionomer compositions). Cov tom kawg yog siv rau cov kab mob ntawm lub ntsej muag nrog ib qho tseem ceeb ntawm thaj chaw hauv cheeb tsam. Nyob rau hauv cov ntaub ntawv uas qhov zoo nkauj tsos yog ib qho tseem ceeb (los yog cov kab mob cuam tshuam rau cov enamel nkaus xwb), lub teeb-kho sib xyaw ntawm ib tug tshwj xeeb xaiv ntxoov ntxoo yog siv.
Qhia ua kab noj hauv qib tsib
Yuav tsum tau ua hauv kev kho mob caries ntawm qib tsib:
- ntxuav qhov chaw ntawm cov hniav los ntawm cov quav hniav,
- dev ntxoov ntxoo,
- Yadminister anesthesia,
- ua kev npaj, tshem tawm cov ntaub so ntswg,
- kho gingival margin yog tias tsim nyog,
- ntxig rov qab xov,
- siv cov ntaub thaiv npog yog tias tsim nyog,
- ntxuav cov kua qaub, qhuav,
- cais tawm ntawm qaub ncaug,
- thov primer thiab nplaum,
- khoom tso, kev xav,
- sib tsoo thiab polishing,
- tiav kev xav.
qib 6
Tus kws kho hniav Asmeskas paub zoo, tom qab uas qhov kev faib tawm no muaj npe, tau txheeb xyuas tsib chav ntawm cov kab noj hniav carious. Tau ntev, nws qhov system tau siv los ua nws daim ntawv qub. Tab sis tom qab ntawd, ntawm qhov pib ntawm Lub Koom Haum Saib Xyuas Kev Noj Qab Haus Huv Ntiaj Teb, cov chav kawm Dub tau hloov pauv me me - qhov thib rau tau ntxiv rau lawv. Nws piav qhia txog qhov chaw ntawm caries ntawm ntug ntse ntawm incisors thiab nyob rau hauv mounds ntawm zom cov hniav.
