具体描述
“口腔临床要点快速掌握系列”是国际著名的Quintessence出版集团近期出版的介绍口腔各科基本技术和最新医学理论的专业丛书。该丛书自2∞2年起陆续出版发行,我社第时间引进.以便国内学者同步了解国际口腔技术发展的新进展。本书用7章的篇幅详细地论述了龋病的诊断、治疗材料的选择失败修复体的处理以及非龋性疾病的诊治。本书由国际知名口腔医学专家编写.一切从临床实践出发,通过大量实例和图片使内容浅显易懂。本书采用了中英对照的编排方式,对提高读者的专业英语水平大有裨益。本书适合临床口腔科医师、技师和口腔医学生阅读。
牙体修复的临床决策(中英文对照) 前言 牙体修复学是口腔医学领域中至关重要的一环,其核心在于通过精密的诊断、周全的评估以及科学的治疗,恢复牙齿的形态、功能、美观,并最终维护口腔健康。在日新月异的牙科技术和日趋严谨的临床实践中,牙医面临的挑战也日益复杂。每一次的牙体修复,都是一次精密的临床决策过程。这个过程要求牙医不仅要掌握扎实的理论基础,更要具备敏锐的临床观察能力、丰富的实践经验以及对各种治疗方案优劣势的深刻理解。 本书的诞生,正是源于对当前牙体修复临床实践中“决策”这一核心环节的深入思考。我们观察到,尽管牙科教育体系不断完善,但如何将理论知识转化为临床实践中的精准判断,如何在一个个复杂的病例面前做出最适合患者的选择,仍然是许多牙医,尤其是年轻牙医面临的瓶颈。特别是当面对不同材料、不同技术、不同修复方式的选择时,如何权衡利弊,如何预见并发症,如何制定长期有效的治疗计划,都离不开一个清晰、系统化的决策框架。 本书以“临床决策”为切入点,旨在为读者提供一个条理清晰、逻辑严谨的思考路径。我们并非简单罗列各种修复技术或材料,而是着重于引导读者理解“为什么”要选择某种方案,以及“如何”在不同的临床情境下做出最优选择。我们相信,只有理解了决策背后的逻辑和依据,才能真正做到举一反三,应对各种未知和复杂的情况。 本书最大的特色在于采用了中英文对照的形式。我们深知,口腔医学是一个高度国际化的学科,最新的研究进展、最前沿的技术理念,往往首先以外文形式出现。通过中英文对照,我们希望为读者提供一个便捷的学习平台,既能深入理解中文语境下的临床实践,又能与国际前沿的学术思想接轨。这有助于拓宽读者的视野,提升其在全球口腔医学领域的竞争力。 本书结构与内容概述 本书并非一本简单的技术手册,而是一部关于临床思维与实践决策的深度探索。我们将从牙体修复的基石——诊断与评估出发,逐步深入到各种具体修复方法的决策考量,并最终探讨长期维护与预后评估。 第一部分:牙体修复的诊断与评估 在任何修复治疗之前,准确的诊断和全面的评估是制定合理治疗计划的基石。本部分将系统梳理牙体修复的诊断流程,包括: 病史采集与主诉分析: 深入探讨如何通过细致的询问,了解患者的既往史、用药史、生活习惯、就医目的,以及准确把握患者的主诉,这直接关系到治疗方向的确定。 临床检查: 详细阐述牙体、牙周、黏膜、颌骨等口腔组织的系统检查方法,包括视诊、触诊、叩诊、牙周探诊、咬合分析等。强调不同检查手段在诊断中的价值和局限性。 影像学诊断: 重点讲解各种影像学检查(如X线片、CBCT)在牙体修复诊断中的应用,如何解读影像学图像,识别潜在的病灶,评估骨组织情况,以及其在制定治疗计划中的指导意义。 实验室检查: 阐述必要的实验室检查(如唾液检查、微生物学检查)在特定情况下的作用,例如评估唾液分泌功能对修复材料选择的影响,或在根管治疗相关的感染性疾病诊断中的应用。 诊断模型的建立: 引导读者如何整合病史、临床检查和影像学检查结果,建立一个全面、准确的患者口腔健康状况模型。 第二部分:椅旁决策:直接修复的智慧 直接修复,即在患者口内一步完成的修复,因其便捷性和相对较低的成本,在临床上应用广泛。本部分将深入探讨直接修复的决策过程: 龋病的诊断与分型: 详细介绍不同程度龋病的诊断标准,以及如何根据龋损的范围、深度、位置及患者的全身状况,决定是否需要进行充填治疗,以及充填的范围。 充填材料的选择: 深入分析各种常用充填材料(如树脂、玻璃离子水门汀、银汞合金)的性能特点、适应症、禁忌症、优缺点,以及在不同临床场景下的选择依据。例如,如何权衡树脂的粘接强度、美观性与玻璃离子的防龋性、低强度。 窝洞预备的原则与决策: 讲解不同窝洞预备的经典原则和现代理念,如何根据龋损情况、材料特性及受力方向,制定最优的窝洞预备方案,以确保充填体的固位、抗力及长期稳定性。 粘接技术与决策: 详细阐述不同粘接系统的原理、操作要点及选择依据,强调粘接在直接修复中的关键作用,以及如何应对粘接过程中的挑战。 美学区直接修复的决策: 重点探讨前牙区直接修复的挑战,包括颜色匹配、形态恢复、边缘封闭等,以及如何通过精细的操作和材料选择,达到理想的美学效果。 第三部分:椅旁决策:间接修复的精艺 间接修复,如全冠、部分冠、贴面、嵌体等,因其能提供更优异的力学性能和美学效果,在复杂病例中扮演着重要角色。本部分将聚焦间接修复的决策艺术: 间接修复的适应症与禁忌症: 详细分析哪些情况适合进行间接修复,哪些情况应谨慎或避免,以及如何根据患者的咬合关系、牙体组织缺损程度、牙周状况、经济能力等因素进行综合判断。 全冠修复的决策: 适应症的细化: 针对根管治疗后牙齿、严重磨损牙、畸形牙、桩核冠修复后牙齿等不同情况,分析全冠修复的必要性。 材料选择的考量: 深入比较金属烤瓷冠、全瓷冠(如氧化锆、铸瓷)、全金属冠等材料的生物相容性、力学强度、美观性、边缘密合性、对牙龈颜色的影响等,并给出不同情况下的选择建议。 牙体预备的原则与技术: 讲解不同类型全冠(全冠、披肩冠、三四冠)的预备原则,如何确保足够的固位形、抗力形,以及对牙龈缘的精细处理。 印模与比色: 强调准确印模和精确比色对最终修复体制作的重要性。 部分冠(贴面、嵌体)修复的决策: 贴面修复: 详细介绍直接法和间接法贴面的适应症、材料选择(瓷贴面、树脂贴面)、牙体预备的最小化原则,以及在美学修复中的特殊应用。 嵌体修复: 重点分析嵌体(高嵌体、低嵌体)相较于直接充填的优势,其适应症(中度以上缺损、咬合力较大等),以及与全冠修复的界限。材料选择(陶瓷、金属、树脂)的权衡。 临时修复的策略与意义: 探讨临时修复在间接修复过程中的重要性,如何根据修复类型、修复时间,选择合适的临时修复材料和方法,以保护牙体、维持咬合、防止牙移位。 第四部分:特定临床情境下的决策挑战 牙体修复的实践并非一成不变,许多复杂情境需要特殊的考量和决策。本部分将聚焦于这些挑战: 牙周病患者的牙体修复决策: 重点分析牙周病对牙体修复的影响,如何评估牙周健康状况,如何选择对牙周组织刺激最小的修复方案,以及如何与牙周治疗协同进行。 咬合力学在修复决策中的考量: 深入探讨咬合力的评估方法,不同咬合异常(如磨牙症、牙齿排列不齐)对修复体寿命的影响,以及如何通过调整咬合、选择合适的材料,来应对复杂的咬合力学问题。 根管治疗后牙齿的修复决策: 详细分析根管治疗后牙齿的生物力学改变,如何评估残余牙体组织的强度,如何选择合适的桩核和牙冠,以预防牙齿折裂。 颌面部创伤后的牙体修复决策: 探讨牙齿折断、脱位等创伤情况下的紧急处理原则,以及如何根据损伤类型、程度,制定长期的修复计划,包括即刻修复、早期修复和后期修复的策略。 种植修复与牙体修复的联合决策: 在缺失牙伴存有残根、残冠的情况下,如何权衡拔除残根、行种植修复,还是尽可能保留残根、进行桩核冠修复,以及两者联合应用的决策逻辑。 生物材料与新技术的应用决策: 介绍当前发展迅速的生物陶瓷、 CAD/CAM 技术、数字化印模技术等在牙体修复中的应用,以及如何评估新技术的临床有效性和适用性。 第五部分:长期维护与预后评估 成功的牙体修复不仅仅是完成椅旁治疗,更在于其长期的稳定性和患者的口腔健康。本部分将着重于: 修复体长期失效的常见原因分析: 深入剖析修复体脱落、折裂、继发龋、牙周病变、继发性咬合创伤等常见失效原因,并从设计、材料、操作、患者依从性等多个维度进行分析。 定期复查与维护的策略: 强调定期复查在牙体修复中的重要性,如何制定个性化的复查计划,以及在复查中如何发现并处理潜在问题。 患者教育与依从性: 探讨如何通过有效的医患沟通,提高患者对口腔卫生维护、修复体保养的认知和依从性,这是保证修复体长期成功的关键。 基于证据的决策与终身学习: 鼓励读者关注最新的科研进展,学习新的技术和理念,并将循证医学的原则融入日常临床决策,实现终身学习和持续改进。 结语 本书致力于为读者构建一个系统化的牙体修复临床决策框架。我们希望通过对诊断、评估、材料选择、技术应用、特定情境处理等各个环节的深入剖析,帮助读者提升临床思维能力,做出更科学、更精准、更符合患者利益的治疗决策。牙体修复是一门艺术,更是一门科学。愿本书成为您临床实践中值得信赖的伙伴,共同追求口腔健康的卓越。 Foreword Restorative dentistry stands as a cornerstone of dental medicine, with its essence lying in restoring the form, function, and aesthetics of teeth, and ultimately safeguarding oral health, through precise diagnostics, thorough assessments, and scientific treatments. In the rapidly evolving landscape of dental technology and increasingly rigorous clinical practices, dentists face ever more complex challenges. Every dental restoration is, in essence, a intricate clinical decision-making process. This process demands that dentists possess not only a solid theoretical foundation but also keen clinical observation skills, extensive practical experience, and a profound understanding of the advantages and disadvantages of various treatment options. The genesis of this book stems from a deep reflection on the "decision-making" aspect, the core element of current clinical practice in restorative dentistry. We have observed that despite continuous improvements in dental education systems, translating theoretical knowledge into precise judgments in clinical practice, and making the optimal choices for patients when faced with diverse and complex cases, remains a bottleneck for many dentists, especially those early in their careers. Particularly when confronted with choices among different materials, techniques, and restorative modalities, weighing pros and cons, anticipating complications, and formulating long-term, effective treatment plans all hinge on a clear, systematic decision-making framework. This book, using "clinical decision-making" as its focal point, aims to provide readers with a well-organized and logically coherent thought process. We do not simply enumerate various restorative techniques or materials; instead, we focus on guiding readers to understand why a particular option is chosen and how to make the optimal choice in different clinical scenarios. We believe that only by understanding the logic and rationale behind decisions can one truly generalize and cope with various unknown and complex situations. The most significant feature of this book is its bilingual format, presenting both Chinese and English content. We are acutely aware that dentistry is a highly international discipline, and the latest research advancements and cutting-edge technical concepts often first emerge in foreign languages. Through this bilingual presentation, we hope to provide a convenient learning platform for readers, enabling them to gain a deep understanding of clinical practice within the Chinese context while also connecting with international academic frontiers. This will help broaden readers' horizons and enhance their competitiveness in the global field of dentistry. Structure and Content Overview of the Book This book is not merely a technical manual but an in-depth exploration of clinical thinking and practical decision-making. We will begin with the cornerstone of restorative dentistry – diagnosis and assessment – and gradually delve into the decision-making considerations for various specific restorative methods, ultimately addressing long-term maintenance and prognosis evaluation. Part I: Diagnosis and Assessment in Dental Restoration Accurate diagnosis and comprehensive assessment are the bedrock for formulating rational treatment plans in any restorative procedure. This section systematically outlines the diagnostic process for dental restoration, including: Medical History Taking and Chief Complaint Analysis: A detailed exploration of how to elicit past medical history, medication history, lifestyle habits, and treatment goals through meticulous questioning, and how to accurately grasp the patient's chief complaint, which directly influences the determination of the treatment direction. Clinical Examination: A thorough explanation of systematic examination methods for the teeth, periodontium, oral mucosa, jawbones, and other oral tissues, including visual inspection, palpation, percussion, periodontal probing, and occlusion analysis. The value and limitations of different examination techniques in diagnosis are emphasized. Radiographic Diagnosis: A focused discussion on the application of various radiographic examinations (e.g., X-rays, CBCT) in the diagnosis of dental restoration, how to interpret radiographic images, identify potential lesions, assess bone tissue status, and their guiding significance in treatment planning. Laboratory Examinations: Elucidation of the role of necessary laboratory tests (e.g., salivary tests, microbiological examinations) in specific situations, such as assessing the impact of salivary secretion function on restorative material selection, or in the diagnosis of infectious diseases related to root canal treatment. Establishment of a Diagnostic Model: Guiding readers on how to integrate medical history, clinical examination, and radiographic findings to establish a comprehensive and accurate model of the patient's oral health status. Part II: Chairside Decision-Making: The Art of Direct Restoration Direct restoration, completed in a single visit in the patient's mouth, is widely used in clinical practice due to its convenience and relatively low cost. This section delves into the decision-making process for direct restorations: Diagnosis and Classification of Dental Caries: A detailed presentation of diagnostic criteria for different degrees of caries, and how to determine whether restorative treatment is necessary, and its extent, based on the scope, depth, and location of the carious lesion, as well as the patient's systemic condition. Selection of Filling Materials: An in-depth analysis of the performance characteristics, indications, contraindications, advantages, and disadvantages of commonly used filling materials (e.g., composite resin, glass ionomer cement, amalgam), and the rationale for selection in different clinical scenarios. For instance, how to weigh the bonding strength and aesthetics of composite resin against the caries-preventive properties and lower strength of glass ionomer. Principles and Decisions in Cavity Preparation: A discussion of classic principles and modern concepts of various cavity preparations, how to devise the optimal cavity preparation plan based on the carious lesion, material properties, and stress direction, to ensure the retention, resistance, and long-term stability of the filling. Bonding Techniques and Decisions: A detailed explanation of the principles, operational key points, and selection rationale for different bonding systems, emphasizing the crucial role of bonding in direct restoration and how to address challenges encountered during the bonding process. Decision-Making for Direct Restoration in the Aesthetic Zone: A focus on the challenges of direct restoration in the anterior region, including color matching, form restoration, and marginal sealing, and how to achieve ideal aesthetic outcomes through precise operations and material selection. Part III: Chairside Decision-Making: The Craftsmanship of Indirect Restoration Indirect restorations, such as full crowns, partial crowns, veneers, and inlays, play a significant role in complex cases due to their superior mechanical properties and aesthetic results. This section focuses on the art of decision-making for indirect restorations: Indications and Contraindications for Indirect Restoration: A detailed analysis of which situations are suitable for indirect restoration, which should be approached with caution or avoided, and how to make a comprehensive judgment based on the patient's occlusion, degree of tooth structure loss, periodontal status, economic capacity, and other factors. Decision-Making for Full Crown Restoration: Refinement of Indications: Analysis of the necessity of full crown restoration for various conditions, such as post-endodontic teeth, severely worn teeth, malformed teeth, and teeth with post-and-core restorations. Considerations for Material Selection: An in-depth comparison of the biocompatibility, mechanical strength, aesthetics, marginal fit, and impact on gingival color of various materials (e.g., porcelain-fused-to-metal crowns, all-ceramic crowns like zirconia and lithium disilicate, all-metal crowns), with recommendations for different situations. Principles and Techniques of Tooth Preparation: A discussion of the preparation principles for different types of full crowns (full veneer crowns, partial veneer crowns, three-quarter crowns), how to ensure sufficient retention and resistance form, and the meticulous management of the gingival margin. Importance of Impression Taking and Shade Selection: Emphasis on the critical importance of accurate impressions and precise shade selection for the fabrication of the final restoration. Decision-Making for Partial Crown (Veneer, Inlay) Restoration: Veneer Restoration: A detailed introduction to the indications, material selection (ceramic veneers, resin veneers), the principle of minimal tooth preparation for both direct and indirect veneers, and their special applications in aesthetic restoration. Inlay Restoration: A focus on the advantages of inlays (macro-inlays, micro-inlays) compared to direct fillings, their indications (moderate to severe defects, significant occlusal forces, etc.), and the boundary with full crown restoration. Consideration of material selection (ceramic, metal, resin). Strategies and Significance of Provisional Restoration: A discussion on the importance of provisional restorations in the indirect restorative process, how to select appropriate provisional restorative materials and methods based on the type of restoration and treatment duration, to protect the tooth and maintain occlusion and prevent tooth displacement. Part IV: Decision-Making Challenges in Specific Clinical Scenarios Dental restorative practice is not static, and many complex situations require special considerations and decisions. This section focuses on these challenges: Decision-Making for Dental Restoration in Periodontally Compromised Patients: A focus on the impact of periodontal disease on dental restoration, how to assess periodontal health status, how to select restorative options that minimize irritation to periodontal tissues, and how to coordinate with periodontal treatment. Consideration of Occlusal Mechanics in Restorative Decision-Making: An in-depth discussion of occlusal force assessment methods, the impact of different occlusal abnormalities (e.g., bruxism, malocclusion) on the longevity of restorations, and how to address complex occlusal mechanics by adjusting occlusion and selecting appropriate materials. Decision-Making for Restoration of Endodontically Treated Teeth: A detailed analysis of the biomechanical changes in endodontically treated teeth, how to assess the strength of residual tooth structure, and how to select appropriate posts and crowns to prevent tooth fracture. Decision-Making for Dental Restoration Following Maxillofacial Trauma: A discussion of emergency management principles for tooth fractures, luxations, and other traumatic injuries, and how to formulate a long-term restorative plan based on the type and severity of the injury, including strategies for immediate, early, and late restoration. Combined Decision-Making for Implant Restoration and Dental Restoration: In cases where missing teeth coexist with residual roots or stumps, how to weigh the decision of extracting residual roots and performing implant restoration versus preserving residual roots as much as possible and performing post-and-core crown restoration, and the decision logic for their combined application. Decision-Making on the Application of Biomaterials and New Technologies: An introduction to the application of rapidly developing biomaterials such as bioceramics, CAD/CAM technology, and digital impression techniques in dental restoration, and how to evaluate the clinical effectiveness and applicability of new technologies. Part V: Long-Term Maintenance and Prognosis Evaluation Successful dental restoration goes beyond completing chairside treatment; it lies in its long-term stability and the patient's oral health. This section focuses on: Analysis of Common Causes of Long-Term Failure of Restorations: An in-depth analysis of common failure causes such as restoration debonding, fracture, secondary caries, periodontal disease, and secondary occlusal trauma, and an analysis from multiple dimensions including design, materials, operation, and patient compliance. Strategies for Regular Follow-up and Maintenance: Emphasizing the importance of regular follow-up in dental restoration, how to formulate personalized follow-up plans, and how to detect and address potential problems during follow-up. Patient Education and Compliance: Discussing how to improve patient awareness and compliance with oral hygiene maintenance and restoration care through effective doctor-patient communication, which is key to ensuring the long-term success of restorations. Evidence-Based Decision-Making and Lifelong Learning: Encouraging readers to stay updated with the latest scientific research, learn new techniques and concepts, and integrate the principles of evidence-based medicine into daily clinical decision-making, thereby achieving lifelong learning and continuous improvement. Conclusion This book is dedicated to constructing a systematic framework for clinical decision-making in dental restoration for readers. We aim to enhance clinical thinking skills and enable readers to make more scientific, precise, and patient-beneficial treatment decisions by delving into all aspects, including diagnosis, assessment, material selection, technique application, and handling of specific scenarios. Dental restoration is both an art and a science. May this book serve as a trusted companion in your clinical practice, as we collectively strive for excellence in oral health.