Y HQC VlgT NAM THANG 3 - S6 1/2013 2010. Vol 32, No.4; Trang 172-174.
Oong Thien Bao. So bo nghien ciTu mo hlnh dai thao dudng typ 2 th^ am hu nhiet thinh tren d6ng v^t thiic nghigm. Tap chi nghien cffu noi khoa tmng y thuc dung, 2009, Vol 123, No.6;
Trang 3^33.
Chu Ho Ho, Ton Kien Tan va Cs. Nghien cffu mo hinh gay DTD typ II tren ddng v$t thuc nghiem bang che do an giau nSng IUdng va
STZ. Tap chi trung y Tan CUOng. 2009, Vol 39;
Trang 55-57.
Muc Timg Nguu, Khang Lo Muoi va Cs. Thiet lap mo hinh chuot cong DTD typ II. Bao Hoc vien y hoc Giang Tay, 2009, Vol 49, No.8, Trang 16-19.
Quach Le va Cs. Thiel lap mo hinh chupt cong OTD bang STZ. Tap chi ket hop Nghien cffu va lam sang y hoc Trung Quoc, 2006. Vol 4, No 5, Trang 4-5.
NGHIEN Cliu DAC DIEM LAM SANG, X QUANG RANG XOAY TRUC VA ANH H U ^ G DEN KHOTP CAN OT MOT NHOM BENH NHAN DANG DIEU TRj NAN CHINH RANG
TAI BENH VIEN VIET NAM CUBA NAM 2012
Nguyen Thj Thu Phffdng^
Pham Hong Ngoc*
* , Vd Tru'dng Nhff N g o c * *
SUMMARY
STUDY CLINICAL, RADIOGRAPHY CHARACTERISnCS OF ROTATED TEETH AND INFLUENCE ON OCCLUSION I N A GROUP OF PATIENTS UNDER ORTHODONTIC TREATMENT
IN VIETNAM - CUBA HOSPITAL 2012 Methodology: Sample of study compnses 30 patients under orthodontic treatment. All patients were examined, impressed and taken panoramic and cephalometric radiography, Method of study is cross sectioned descnption. Goal of study is to describe clinical, radiography characteristics and the influence on ocdusion of rotated teeth. Result: Percentages of patients, whose arches have 3 rotated teeth and 1 rotated tooth, are 43% and 23,3% respectively.
80,3% of rotated teeth rotate 10° - 45°, 17,1% of rotated teeth rotate > 45°-90°... Conclusion: Ratio of female patients is higher than that of male patients.
The main reason lead to rotabon is space insufficience and supernumerary teeth. Rotated teeth can be seen in all class of disocclusion. Rotated teeth, which rotate less 45°, are the most common.
Keyword: rotated teeth, supernumerary teeth, orthodontic treatment..
I.
DAT VANo f
Cac van de bat thffdng cua ham rang nhu chen chuc, lech lac, vau rang...luon la mdi ban tam cua benh nhan va cac nha sT, hp da khong ngffng tim each de cai thien chung. Ngay nay ty le lech lac rang d tre em va ngffdi ldn tffdng ddi
* BVViet Nam Cuba, ** Vien DT Ring Him Mat Phin bifn khoa hpc: PGS.TS. D6 Quang Trung
cao, trong sd dd rang bi xoay true rat hay gap [5]. Rang xoay true gay anh hUdng nhieu den tham my va chffc nang. Benh nhan thUdng hay bi viem ldi, viem quanh rang va sau rang do ve sinh rang mieng khd, sU lam sach tU nhien giam, cac diem sang chan hay gap nen thudng dan den mat rang. Tuy nhien, hien nay cac de tai nghien cffu ve rang xoay true chUa co nhieu, vl vay chiing toi tien hanh de tai "Nghien cffu dac diem lam sang, X- quang ciia rang xoay true d mot nhom benh nhan dang dieu tri nan chinh rang tai Benh vien Viet Nam - Cu Ba nam 2012 " vdi muc tieu: Mo ta die diem lam sing, X Quang rang xoay true va anh hu'dng den cung rang, khdp can.
I. T 6 N G QUAN TAI LIEU
Rang xoay true la rang van moc d tren eung, nhung khong diing ve mat rang so vdi mat phang ngang, Rang xoay tren true dffng ciia rang. Cd the gap rang xoay true d mpi rang.
Theo Saurabh K. Gupta [6] ty le rang xoay true la 10,24%, rang xoay tff 45°- 90° la hay gap nhat, ehiem 58,26%, rang xoay < 45° chiem 31,31%, rang xoay > 90° ehiem 10,43%.
Co nhieu nguyen nhan ed the gay rang xoay true nhU: thieu cho mpe tren cung rang, co rang ngam, cd rang thffa, rang sffa ton tai lau tren eung ham...Khi ed rang xoay true ed the bieu hien tren lam sang cac van de nhU: Cung rang
Y HQC VlgT NAM THANG 3 - Sd 1/2013 khong deu, cac rang khong thang hang. Tren
cung rang cd mpt hoac nhieu rSng xoay true.
Benh nhan co the co khdp can loal I, loal I I (rSng hoac xffdng), loai I I I (r§ng hoac xffdng). Cd the CO rSng thffa, r§ng ngam, r5ng sffa ton tal lau tren cung ham. RSng ke can cd the cd hien tffdng bj sau: Khi r5ng bi xoay true, sU tiep xiic vdl r3ng ben eanh bj thay doi tao nen- mdt vung Iffu giff thffc an giffa r5ng do va rSng ben canh dan den sau rang va ldi bj ton thffdng. To chffc nha ehu bj tdn t h f f d n g ; R^ng xoay true tao nen vung Iffu giff thffc ^n giQa rSng dd va rang ben eanh, sff ve sing rang mieng kem, hau qua la Idi bj viem, tui nha chu hinh thanh, tieu xffdng d rSng va mat rang sdm. Cung rSng cd hien tffdng thieu khoang: mffc do nhe: <4mm, mffc dp trung binh:
5-9mm, mffc do nSng: > 10mm. X quang; Phim Panorama: ed the cd r5ng ngam.
II. 0 6 1 TUpNG VA PHUONG PHAP NGHIEN COU 2 . 1 . O o i t u ' d n g n g h i e n c f f u ; Tat ca nhffng benh nhan den kham va dieu tri ehinh nha cd rang xoay true tai benh vien Viet Nam - Cu Ba Ha Noi tff thang 6/2011 - 9/2012.
Tieu chuan Iffa chpn benh nhan: Benh nhan cd mpt hoac nhleu rang tff rang ham nho vinh vien den rang cffa vtnh vien bj xoay true. Benh nhan chffa dieu trj chinh hinh rang mat
Tieu chuan loal trff; Benh nhan khong hdp tac, benh nhan cd benh viem quanh rSng, benh nhan cd rdi loan tam than.
2 . 2 . Phu'cfng p h a p n g h i e n cu'u Nghien cffu dffdc thiet ke theo phffdng phap md ta cat ngang. Theo cdng thffc tinh cd mau cho nghien cffu xac dinh ty le mac benh trong mdt quan the ehiing tdi ti'nh d\idc c3 mau toi thieu la 30 benh nhan. Tat ca benh nhan dffdc kham, thdng tin thu dUdc ghi vao mau benh an thdng nhat. Lay khudn hai ham va do mau thach cao, phan tich mau: Xac djnh dd xoay ciia rang theo chieu gan xa, xae dinh khoang can co va hien co, Oo sau dffdng cong spee. Chup phim X quang: Phim panorama, phim sp nghieng tff xa.
Sd lieu dffdc nhap va xff ly theo phffdng phap thong ke y hpc vdi phan mem SPSS 16.0.
2.3. T h d i g i a n v a d j a d i e m n g h i e n cffu:
nghien cffu dffdc thuc hien tai Khoa Rang mieng benh vien Viet Nam - Cu Ba: 37 Hai Ba Trulig - Ha Noi, tff thang 6/2011 den thang 9/2012.
III. KET QUA NGHIEN CUU VA BAN LUAN
Qua nghien effu 30 benh nhan cd rang xoay true dffdc dieu tri tai khoa Rang Mieng benh vien Viet Nam - Cu Ba Ha Npi tff 6/2011- 9/2012 ehiing tdi cd mdt so ket qua va nhan xet sau ve tinh trang rang xoay true.
3 . 1 . P h a n b d b e n h n h a n t h e o t u d l va g l d i Bang 3 . 1 : Phan bd benh nhan theo nhdm tudi
<12 tuoi
> 12 tuoi
Rang hon htfp n 4 1 5
»/o 13,33
3.33 16,7
Rang vTnh vien N 1 24 25
»/o 3,33 8,0 83,3
Tong N 5 25 30
16,7
%
83,33 100
Trung binh
16,7 Oolech
chuan 6,01
Nhan xet: Nhom nghien cffu gom 9 benh nhan nam (30%), 21 benh nhan nff (70%). Ti le benh nhan nff den dieu trj nan chinh rang nhieu hdn ti le benh nhan nam. Tudi trung binh 16,7%
vdi dp lech chuan la 6,01. Tuoi benh nhan thap nhat la 8, cao nhat la 37. Sd benh nhan d nhdm tudi > 12 ehiem ti le 83,3%, gap 5 lan sd benh nhan d nhom tuoi < 12 tuoi. Cd mot benh nhan CO ham rang hon hdp d Iffa tuoi >12 tuoi. Tudi cd ham rang hon hdp eao nhat la 12 tud'i.
Ti le nff den dieu trj cao hdn nam gidi cd le do nhu eau tham mi d nff eao hdn nam va tam li eiia cac bae phu huynh thffdng quan tam nhieu
den tham m l cho be gal cao hdn cac be trai. Co sff khac biet giffa hai nhdm tudi la do: d nhom tud'i CO ham rang hdn hdp rang xoay true gap chil yeu d viing rang trffdc va chi dieu tri nhiftig trffdng hdp rang xoay true nang anh hffdng den cac rang ben canh va rang ddi dien.
3 . 2 . Ly d o d e n k h a m v a n g u y e n nhan g a y x o a y t r u e : Ly do benh nhan den kham chinh nha la sff khap khenh chen chiic vung rang cffa (66,7%). Vau ham tren (13,3%) va rang thffa (13,3%) la ly do thff hai. Chi cd 2 benh nhan (6,7%) den kham vi khdp can ngffdc
Y HQC VlgT NAM THANG 3 • sd 1/2013 Nguyen nhan chii yeu la thieu cho mpc tren
cung rang (cd 24 trffdng hdp chiem chiem 80%), CO rang thffa chiem ti le 13,3% (4 trffdng hdp), con chan rang sD^ chiem ti le 3,3% (mot trffdng hdp) va phanh mdi bam thap cung chiem ti le 3,3% (mpt trffdng hdp).
Sff bat tffdng xffng giffa rang va ham co the do rang qua to hoae xffdng ham qua nhd hoae ca hai da dan den tinh trang thieu khoang tren eung ham, khdng dii cho cho rang moc dan den tinh
trang rang bi xoay true. Theo Le Thj Nhan [2] ti le thieu cho chiem 6 0 % d tre em tdi dieu tn tai khoa nan chinh rang Vien Rang ham mat trung u'dng. Cd sff khac biet giffa ti le eiia ehung tdi vdi ti le nay co le la do sff khae nhau ve ddi tupng nghien cffu. Rang thffa can trd sff moc ciia mdt hoac ca hai rang ben canh do dan den tinh trang cae rang nay bi xoay true hoac gay ra tinh trang thieu cho, rang lan can eung cd the bi xoay tryc.
Do dd can dffdc phat hien va nhd sdm.
3.3. Phan loai khdp can theo Angle Bamj3.2:Phan loai khdp can theo Angle
11 1
C L I CL2 CL3 Tong so
Rdnq ham phai C L I
20 66,7%
1 3,3%
2 6,7%
23 76,7%
CL2 1 3,3%
4 1 3 , 3 %
0 0%
5 16,7%
CL3 0 0%
0 0%
2 6 , 7 %
2 6,7%
Tong so 21 70%
5 16,7%
4 13,3%
30 1 0 0 % Nhan xet: Ti le rang xoay tryc tren benh
nhan sai khdp can toai I cd ti le cao nhat, chiem 66,7%, tiep den la sai khdp ean loai I I , sai khdp can loai I I I chiem ti le thap nhat 6,7%. Cd 13,7%
sai khdp can phdi hdp. Theo Ddng Khac Tham va Hoang Tff Hiing [1],[4] ti le gap sal khdp can Angle I gap nhieu nhat chiem 71,3%, Angle I I chiem 7%, Angle I I I ehiem 21,7%.
3.4. T i n h t r a n g r a n g x o a y t r u e Ty le gap rang xoay true tren ea hai ham la eao nhat 46,6%, ty le gap rang xoay true chi d ham tren hoae ham dudi ngang nhau la 26,7%.
Rang cffa giffa bj xoay true hay gap nhat (30,3%), tiep den la rang ham nhd thff hai (21%). Ti le gap rang xoay true d rang nanh la
19,7%. Ti le gap rang xoay true d rang cffa ben, rang ham nhd thff nhat la 1 4 , 5 % .
Ket qua ciia chiing toi khac vdi nghien effu eua Saurabh K. Gupta [6]. Trong nghien effu eiia Gupta [6] ti le gap rang xoay true d rang ham nho thff hai la cao nhat (33,1%), tiep den la rang ham nho thff nhat (27,8%) va sau do la rang cffa giffa (27%), ti le rang xoay true gap d nhom rang ham nho la 6,24 % tren ti le gap rang xoay tryc tren cung ham la 10,24%, chiem hdn 50%
trUdng hpp gap rang xoay true.
Tren eung ham benh nhan ed ba rang xoay true hay gap nhat (43%), tiep den la mgt rang (23,3%). Gap bdn hoac nam rang xoay true tren eung ham benh nhan ehiem ti le thap 6,7% cho moi trUdng hop.
Bang 3,3: I^LTC do xoay true
10-45°
>45-90»
> 9 0 » Tong
Nhom R tru'dc N 27 6 1 34
35,5
%
7,9 1,3 44,7
cua ranq heo nhom ranq Nhom rang nanh
N 13 2 0 15
17,1
%
2,6 0,0 19,7
Nhom rang ham nho N
21 5 1 27
27,7
%
6,6 1,3 35,6
Tong N 61 13 2 76
80,3
%
17,1 2,6 100 Nh$nxet: Phan I6n cac rang bi xoay true cao nhat chiem 4 4 , 7 % , tiep den la nhom rang tir 10"- 450; 80,3%, rang bi xoay true >45°-96° ham nho ( 3 5 , 6 % ) . Rang nanh bj xoay true co chiem 1 7 , 1 % , rang bi xoay >90 it gap nhat: ti le thap nhat 19,7%. Khong co sir khae biet co 2,6%, nhom rang tru'dc co t i le rang xoay true
Y HQC VlgT NAM THANG 3 - SO 1/2013 y nghia thong ke ve ti le phan bd dp xoay ciia
rSng giffa cac nhdm rang vdl dp tin cay 9 5 % . Ket qua ciia chiing toi tffdnci ddi phii hdp vdl ket qua nghien cffu ciia Nguyen Thu Phffdng.
Trong nghien cffu cua Nguyen Thu Phffdng [3]
rang xoay true tff lQ-45o eung hay gSp nhat vdi ti le 71,8%, va ti le gap rang xoay >90o la 2 , 1 % . Theo Le Thi Nhani2] sd dp xoay thffdng la dffdi 45°, it khi tdi 90°, lai eang hiem gSp ldn hdn 90°, tuy nhien tac gia khong cho biet ti le la bao nhieu. Khac vdl ehiing toi, trong nghien effu ciia Saurabh K. Gupta[6] rang xoay tff 45°- 90° hay gap nhat 67/115 trffdng hdp (58,3%), tiep den la tir 10-45 o vdl 36/ 115 trffdng hdp (31,3%) va cd 12/115 trffdng hdp rang xoay >90o (10,4%).
Hau q u a c u a r a n g x o a y t r u e Rang xoay true gay viem lpi ehiem ti le cao nhat: 70% (21/30). Hien tUdng mdn mat nhai rang ddi dien it gap hdn: 16,7% (5/30). Tieu xUdng 0 rang la bien chffng sau viem ldi va mon mat nhai rang ddi dien. Bieu hien cd loan nang khdp thai dffdng ham ehi gap d mpt benh nhan ehiem 3,3%. Viem ldi la dau hieu thffdng thay d benh nhan ed sai khdp ean noi chung va rang xoay tryc noi rieng. SU hien dien eiia rang xoay tryc tren cung ham tao nen sU luu giff thffc an giffa rang do va rang ke can, sff khd khan trong ve sinh rang mieng va hau qua la ldi bi viem.
IV. KET LU&N
Tl le benh nhan nff cd rang xoay tnjc den dieu trj chinh nha cao hdn nam gidi. Luia tudl cd ham r3ng vTnh vien nhieu hdn Ida tudi c6 ham rang hon hdp. Nguyen nhan chii yeu gay rang xoay true la ttiieu khoang tren cung ham va cd rSng thu^.
RSng xoay true gap d ca sai khdp can lo^l I, sai khdp eSn loai I I (rang hoac xffdng), sal khdp can loai I I I (rang hoSc xffdng.). Rang xoay true gap nhleu d rang cffa giffa va rang ham nhd thff hai.
Rang xoay < 4 5 ° hay gap nhat.
T A I L I E U T H A M KHAO
1, Hoang Tff Hiing (2005), C3n khep hoc, mt xuSt ban Y hpc thanh pho Ho Chi Minh, pp 10-30
2 LS Thj NhAn (1977), 'Lech lac h$ thong ring"- Rang ham rriat tap 1, Nha xuat ban Y hpc, trang 490.
3 Nguyin Thj Thu Phu'dng (1996), Su-dung Idilqi CO dinh vdl mic dl din trut tiep tren ring dedieu tn ring trutk moc ngam- sal ch5- lech true, Lu§n an thac sT y hpc.Dai hoc Y Ha npi
4. Oong Kh^cThSm - Pham Thj XuSn U n (2004), "U/t vi ip dung lut twng chinh hinh rang mif- Oiinh hinh ring mSt, Nha xuat tan Y hpc, trang 45-55.
3. Amita Sharma and Varun Pratap Singh (2012,), Supernumerary Teeth in Indian Children: A Sun/ey ol 300 Cases, International Joumai of Dentistry, Article ID 745265, pp: 10-20.
6. Saurabh K., Gupta, Payal, Sandhya Jain & Deshraj Jain (2011), Prevalence ard distnbubon of seledecd devei^ymental dental anomalies In an Inden poptJ^on, Journal of oral Sdence, 53 (2), pp 231-238.
OANH GIA MOT SO THANH TUU CUA NGANH NHAN KHOA
TOM T A T
Muc tieu: nham danh gia thue trang mpt so tien bp cua nganh Nhan khoa ciia the gidi va Viet nam trong cha'n doan va dieu tn. PhUdng phap nghien cffu la phu'ong phap chuyen gia, phUdng phap dien giai. Ket qua nghien cffu: Nhifng tien bg Idn trong cac ky thuat cha'n doan giiip cho cac bac si c6 Chan doan chinh xac cao phuc vu cho cong tac dieu tn nhU ky thuat sir' dung he thong lang kinh loi, he thong chan doan hinh anh OCT (Optical Coherence Topography), OCT phan trUdc, OCT phan sau, mach ky huynh quang vdi Indocyanin (ICG), sieu am UBM (ultrsoul
* ' Benh vien Mat TW
Phan bien khoa hpc: PGS.TS. Pham Van T§n
Biomicosopy). .Nhffng tien bg trong ky thuat dieu tn giilp ciiXi eho nhieu ngUdi tranh dUdc mil 16a, n§ng cao chat iupng cham soc va chat lUdng thi Iffc: sff dyng thudc ffc ehe tan mach trong dieu trj benh, vi phau thuat noi nhan phau thuat khdng khau trong c3t dich kinli (23 -27 G), phako vdi vet mo 1,8mm, dung the thiiy tinh nhan tao da tieu cU, dieu tiet, dieu chlnh loan thj, FemtoLaser, Laser excimer mo the thiiy tinh, inig dyng te bao goc trong dieu tri, ghep ngi mo giac mac, eSt dich kinh bdm dau silicon dieu tr[ viem mil ngi nhan, cat dich kinh dieu tn benh vong mac tre de non giai doan 4,5... Ket lugn: nhffng tien b6 ciia nganh Nhan khoa The gidl cQng nhU d Viet nam trong
