Y HOC VIET NAM THANG 4 - SO 2^014 CONG TRINH NGHIEN CCfU |
K H A O S A T G O C BENNETT, DOC QUI DAO LOI CAU VA MOT SO THONG SO K H A C BANG BO GHITRUC QUICK-AXIS
6- SINH VIEN VIEN D A O TAO RANG HAM MAT 1 8 - 2 5 TUOI V6 Trirffng Nhir Ngoc*, Nguyin Thi Thu Phirong*, Hoang Bao Duy*
TOM TAT
MiJC tieu nghien cu\i: Xac djnh cac gia tri trung binh cua: dp sau, do dai ciia du'dng van dong ha mieng toi da, do dai cua du'dng van dong ra tru'dc toi da va van dong sang ben toi da, goc Bennett, goc quy dao loi cau, van dong sang ben lap tCrc. Phu'tfng phap nghien culi: mo ta cat ngang tren 30 sinh vien tuoi tu" 18-25, CO kh6p can Angle I, ghi cac bien so nghien culi bang may ghi true do Quick-Axis. Ket qua: goc quy dao loi cau: phal: 30,55 ± 14,67, trai;
34,10±14,0; goc Bennett: phai: 5,65 ± 1,70, trai: 5,32
± 1,25. Ket luan: Cac du'dng ghi trung nhau trong nhffng mm dau t e n ciia van dong. Dan ve cuoi van dpng, cac du'dng ghi du'dc tach nhau ra va khac nhau ve dp dai va dp cong. Du'dng ghi trong van dpng ha - lui sau toi da la du'dng ghi dai nhat.
Titkhoa: Quick-axis, goc Bennette, doc loi cau,,,
S U M M A R Y
DETERMINATION OF BENNETT ANGLE, CONDYLAR SLOPE T H O N G A N D OTHER VALUE OF CONDYLAR MOUVEMENT W I T H
THE Q U I C K - A X I S OF FAG I N O D O N T O - STOMATOLOGY STUDENT AGED 1 8 - 2 5
Research objectives: Determinate mean value:
depht, lenght of maximal opening path, lenght of maximal protrusion path va maximal lateral displacement, angle of Bennett, condylar slope angle, immediate lateral displacement. Subjects and methodology: Cross-sectional descripble on 30 students aged 18-25 with a normocclusion in class I of Angle, enregistrement the variable with Quick-Axis FAG. Results: condylar slope: right: 30,65 ± 14,67, left: 34,10±14,0; angle of Bennett: right: 5,65 ± 1,70, left: 5,32 ± 1,25... Conclusions: duplicate records in some of first mm of movement. Towards the end of mouvement, the record line is far away and different in length and curvature degree. The record line of maximal retrusion-opening is longest.
Keywords: Quick-axis, angle of Bennette, condylar slope,..
I. OAT V X N O E
Len rang tren cang nhai, lam mang nhai dieu trj roi loan chCTc nang khdp thai du'dng ham la mot cong viec thu'dng gap. £)e len du'dc sap can trung tarn len cang nhai va phan tich chuyen dong cua xUdng ham du'di, goc Bennet va doc loi cau la hai thong so can phai xac djnh [1],[2].
Thong thu'dng, chung ta c6 the sir dung cac hop loi cau da c6 cac gia trj trung binh, tuy nhlen, de chinh xac hdn chung ta can phai xac djnh goc Bennet va doc loi cau tren bp ghi true cho tutig ca nhan tru'dc khi len cang nhai [3],[4],[5],[61. 0 Viet Nam, hien nay con c6 rat ft de tai nghien CLTU ve van de nay, chinh vi v$y chung to! da tlen hanh nghien CLTU de tai nay vdi muc tieu sau: Xac djnh cac gia trj trung binh ciia: dp sau, dp dai CLia du'dng van dpng ha mieng toi da, do dai cua du'dng van dpng ra tru'dc to! da va van dpng sang ben toi da, goc Bennett, goc quy dao loi rau, van dpng sang ben lap tuTc
Tong quan tai li$u
Van dpng sang ben la van dpng vong tron cua ham rang quay theo chieu ngang. Trong van dong tir phai sang trai, thi ben trai la ben lam viec va ben phai la ben khong lam viec. Loi cau ben khong lam viec du^ ra tru'dc, xuong du'di va vao trong. Loi cau ben lam viec di chuyen nhe nhang ve phfa sau, ra ngoai va len tren. Goc tao bdi quy dao loi cau ben khong lam viec vdi m3t phang dpc gpi la goc Bennett. Goc nay c6 the ghi du'dc tren do hinh hoac ti'nh toan theo cong thifc Hanau: Goc Bennett = 06 nghieng quT dao loi cau/8 + 12 [5].
* Vien Dao Tao RSng Ham Mat
Phan bien khoa hgc: PGS.ts Mai Oinh Hu>ig
Y HOC VltT NAM THANG 4 - SO 2^014
De xac djnh gia trj goc Bennett, chung ta c6 the SLf dung bp ghi true, ngay nay mot trong nhutig bp ghi true hay du'dc sir dung do la Bp ghi tjuc Quick-Axis cua F.A.G.Dentaire- France. Bp ghi true Quick- Axis dUa tren nguyen tac true ban le va mat phang tham chieu Franfort; Cho phep ghi lai mot each nhanh chong cac thong so can thiet cua chuyen dpng ham du'di de chu'dng trinh hoa cho tat ea cac loai cang nhai ban thich u'ng.
Bang each sii' dung thia khoa, eo the chuyen mau ham tren len cang nhai Quick-Master. Giup ho trd chan doan benh khdp thai du'dng ham. Giup ho trd chan doan benh ly khdp can.
II. Odi TUPNG VA PHU'aNG PHAP NGHIEN CLTU 2.1. Than gian vS dja diem nghien cufu:
Nghien CIJHJ du'dc thi/e hien tai Vien Oao tao Rang Ham Mat - Tru'dng Oai hoc Y Ha Npi, tCr thang 12 nSm 2010 den thang 4 nam 2011.
2.2. O^ tu'dng nghien cu'u
Nghien culj du'dc thi/e hien tren sinh vien Vien Oao tao Rang Ham Mat lu^ tuoi tiT 18 den 25. Ti£u chuan li/a chon: Khong c6 trieu chirng cua rcH loan van dpng khdp thai du'dng ham, khong eo tien SLT chan thu'dng vCing ham mat, dii 28 rSng (khong tinh rang khon), chu^ dieu trj chinh nha, khdp can loai I theo Angle (danh gia d ca rSng nanh va rang ham Idn thLT nhat), hong cd rSng mpc lech khoi cung ham. Tieu cliuan lo^i tru": CO di tat vung ham mat, tien su" chan thu'dng ham mat, da du'dc dieu trj chinh hinh
rSng mat, da du'dc dieu trj phuc hinh rang, d tien SLT roi loan van dpng khdp thai du'dng ham.
2.3. Thiet ke nghien cu'u: mo ta cat ngang.
_ 2.4. C3 mau nghien cu'u va each chon mlu: Chpn mau thuan tien. Oe so lieu di dp tin cay, chung toi tien hanh kham sang Ipc, chpn 30 sinh vien du dieu kien theo tieu chuan chpn mau nghien cu'u.
2.5. Cac bu'de nghien cu'u: Lap danh sach sinh vien, kham sang Ipc, lap danh sach doi tu'dng nghien cu\j, tien hanh ghi true ky tren lam sang, do dac va ghi nhan cac bien so nghien ciTu theo hu'dng dan cua nha san xuat. De khac phye sai so chung toi tien hanh tap huan ky cho nhdm ky nang kham sang Ipc va ghi true do.
Cac bien so can do:
- Dp sau cua du'dng van dpng ha mieng toi da, dp dai cua du'dng van dpng ha mieng toi da, dp dai cua du'dng van dpng ra tru'dc, dp dai cua du'dng van dpng sang ben.
- Goc quy dao loi cau du'dc ghi nhan la goc du'dc tao bdi true hoanh vdi doan thang di tu* diem goc toa dp qua giao diem vd^ du'dng ghi ha-lui sau toi da d vong trdn each goc tpa do 5mm.
- Goc Bennett; Khi hu'dng dan benh nhan dUa ham ve ben lam viec, kim cua Micrometre vii^
Cham cung tron ban kinh 3mm tren ban ghi, doan djch chuyen tren than Micrometre du'dc ghi nhan va quy doi theo bang chuyen doi cua nha san xuat.
GiS tri ghi nhan (mm) 0,20 -> 0,40 0,50 ->0,70 0,80-> 1,00 l,10-> 1,30 1,40 •» 1,70 1,70-> 1,90
Goc Bennett tifcjnq u'ng (do) 5"
10°
15"
20"
25°
30° 1 Ghi nh$n van dpng sang ben lap tire: Dung ban
tay ph^l dd ham du'di, ngdn cai dat d canh len xu'dng ham du'di, tay trai giu' dau benh nhan, th^c hl^n mpt ap ii/c sang ben doi vdi ham du'di song song vdi true ban le. Doan djch chuyen eiia
than Micrometre tu'dng litig vdi so mm can chuyen vao gia khdp theo bang 2.2. Gia trj nay du'dc xac djnh khi SLT dung gia khdp thich u'ng (nhu j i a khdp Denar) vdi gia trj Bennett du'dc cho san la 10°.
B^ng2. Bang chuyen doi qia tri van donq sanq i3en lap Gld trj ghi nh9n(mm)
0,1 -> 0,5 0,6 -> 1,0 1,1 •> 1,5
Gia tri chuyen vao gia I(h6p 0,5 1,0 1,5
tiJc
Goc Bennett diTOc x^c dinh 10"
10°
10"
Y HOC VIET NAM THANG 4 - SO 2/2014 1,6 -> 2,0
2,1 -> 2,5
2,0 2,5
10"
10°
10°
2.6. Oao du'c nghien cu'u: Nghien cu'u cd sU dong y tu" nguyen ciia cac doi tu'dng nghien cull. Cac thong tin ca nhan cua doi tu'dng se du'dc dam bao glQ' bi mat. Nghien cu'u nay chl nham muc dich nang cao cong tac cham soc site khoe rang mieng. Ngoai ra khong con muc dfch nao khac.
2.7. Phu'dng phap xiY ly so lieu:
Ma hoa va nhap so lieu, xu* ly so lieu bang phan mem SPSS 16.0 va mpt so thuat toan thong ke y hoc khae.
III. KET QUA
Dudng ghi tren true do trong van dpng ha -lui sau ciia ham du'di (mau do) la mot du'dng cong lien tuc, xuat phat tii" goc toa dp di xuong du'di va ra tru'dc. Bat dau bang mpt doan ngan, doc xuong
va tiep tdi mot doan ngang hdn. Du'dng ghi d nam va nifcd hinh dang gidng nhau.
Du'dng ghi tren true do trong van dpng ra tru'dc toi da (mau den) cung xuat phat tiTvi tn goc toa dp di xuong du'di va ra tru'dc. Du'dng ghi nay triing vdi du'dng ghi cua van dpng ha mieng toi da trong khoang 5mm dau tien cua van dpng. Sau do, du'dng ghi du'dc tach ra va xuong dUdi'hdn so vdi du'dng ghi ciia van dpng ha mieng tdi da.
Du'dng ghi tren true do trong van dpng sang ben (mau xanh) cung xuat phat tir goc toa dp di xuong du'di va ra tru'dc, Du'dng ghi nay triing vdi du'dng ghi ciia van dpng ha mieng toi da va van dpng ra tru'dc trong vai mm dau tien ciia van dpng, sau do tach ra.
Hinh dang dudng ghi d nam va nu" gidng nhau.
Mfnfi 3.1. Cac du'dng ghi d nam
Hinh 3.2. Cac du'dng ghi d nU
Y HOC VI&T NAM T H A N G 4 - SO 2^014
Bang 3. Gia trj trung binh ( A ' ) va dp lech chuan (SD) ciia cac du'dng ghi tren true ^ d hai gidi nam va nu'.
Du'dng ghi
Dp sau du'dng ha mieng toi da (mm)
Do dai du'dng ha mieng toi da (mm)
Dp dai du'dng du:a ham ra tru'dc (mm)
Op dai du'dng du^a ham sang ben
(mm)
Gidi tinh
Nam
m
Nam va ni?
Nam NO- Nam & NO'
Nam Ni?
Nam va Nff Nam
NO' Nam & Ni?
Khdp Phai Trai Phai Trai Phai Trai Phai Trai Phai Trai Phai Trai Phai Trai Phai Trai Phai Trai Piiai Trai Phai Trai Phai Trai
X 3,05 3,37 2,65 2,65 2,83 2,97 12,54 12,94 11,92 12,02 12,20 12,43 8,69 9,54 Ifil 7,46 8,13 8,40 11,96 11,77 11,26 11,03 11,57 11,36
a 0,75 0,94 0,71 0,80 0,74 0,93 2,45 3,16 2,51 2,35 2,47 2,74 1,61 1,78 1,31 1,56 1,52 1,95 2,47 3,48 2,63 2,08 2,55 2,77
P Phai
>0,05
>0,05
>0,05
>0,05 Trai
<0,05
>0,05
<0,05
>0,05
Sif khac biet giu^ nam va nit c6 y nghia thong ke d do dai du'dng ha lui sau toi da khdp trai va do dai du&ng du^ ham ra truik khdp trai cua cac du'dng ghi.
Bang 4. Gia tri trung binh goc Bennett, quT dao toi cau va van dong U c thSng so loi
cau
Goc quy dao ioi cau
m
Goc Bennett (dp)
Gidi tinh
Nam Ni?
Nam va ni?
Nam NC?
Nam & Ni?
Khdp Phai Trai Phai Trai Phai Trai Phai Trai Phai Trai Phai Trai
X 33,57 39,43 28,24 29,71 30,65 34,10 5,71 5,36 5,59 5,29 5,65 5,32
SD 13,0 13,01 15,90 13,73 14,67 14,07 1,81 1,34 1,66 1,21 1,70 1,25
sang ben ngay iap ti?c P Phai
>0,05
>0,0S Trai
>0,05
>0,05
Y HOC VIET NAM THANG 4 - SO 2/2014
Van dpng sang ben lap tire (mm)
0,50
0,52 0,12 0,09
>0,05
Sif khac biet giu'a nam va nu' khong c6 y nghia thong ke d bat ky gia trj nao cua thong soldi cau.
IV. BAN LUAN
Bp ghi true Quick-Axis cua F.A.G.Dentaire- France ghi van dpng loi cau Ian lu'dt ben phai roi ben trai, he thong nay khong eo sir ho trd hay giiip dS cua may mde, do vay trong qua trinh ghi nhan cac thong s6 vdi bp ghi true Quick -Axis cd the gap cac sai so do nhieu nguyen nhan khac nhau. Nhan thirc du'dc dieu nay nen trong qua trinh nghien ciTu chiing toi da cd cac bien phap han che, khac phuc cac sai so mpt each toi da, tranh du'dc nhutig sai sot gay sai lech ket qua nghien cufu.
Tren true do, eae du'dng ghi trong mat phang dirng doe trung nhau trong khoang 5mm dau tien ciia van dpng. Ve phia cuoi van dpng chiing khac nhau ve mire do va hinh dang. Du'dng ghi trong van dpng ha- lui sau toi da la du'dng ghi dai nhat.
Nghien eCru da xac djnh du'dc gia trj trung binh va dp lech chuan cua cac du'dng ghi van dpng loi cau cua ngu'di Viet binh thu'dng: Dp dai du'dng ha mieng tdi da 12,20 ± 2,47 mm (P) va 12,43 ±2,74mm(T); dp sau du'dng ha mieng tdi da 2,83±0,74mm(P) va 2,97±a,93mm(T); dp dai du'dng du'a ham sang ben 11,57 ± 2,55mm(P) va 11,36 ± 2,77mm(T); dp dai du'dng du'a ham ra tru'dc 8,13± l,52mm(P) va 8,40 ± l,95mm(T).
Neu lay gia trj trung binh ciia cac du'dng ghi tren true do ciia nam va nU lam chuan cd the thay cd si/ khac biet giu'a gia tn trung binh cua nam nu" vdi gia tri trung binh ciia tirng gidi d khdp phai va trai.
Nghien ciru cung da xac dinh du'dc gia trj trung binh va dp lech chuan cua cac thong loi cau cua ngu'di Viet binh thu'dng: goc Bennet 5,65°±1,70°(P), 5,32°±1,25''(T); goc quy dao loi cau 30,65°±14,67°(P), 34,10°±14,07°(T);
van dpng sang ben lap tire 0,53±0,12mm(P), 0,52 ± 0,09mm(T).
V. KET LUAN
Cac du'dng ghi tren true do la nhulig du'dng cong lien tyc, xuat phat tir goc toa dp di xuong du'di va ra tru'dc. Cac du'dng ghi triing nhau trong nhUng mm dau tien ciia van dong. Dan ve cuoi van dpng, cac du'dng ghi du'dc tach nhau ra va khac nhau ve dp dai va dp cong, Du'dng ghi trong van dpng ha -lui sau tdi da la du'dng ghi dai nhat.
Viec ghi van dpng loi cau vdi bp ghi taic cho phep danh gia dac diem du'dng ghi ciia phirt hdp loi cau - dla khdp, cung cap nhiJng thong so chinh xac ciia khdp thai du'dng ham de chuyen mau ham sang gia khdp. Sau khi thiTc hien de tai, chiing toi nhan thay day la mpt phu'dng phap tuOng doi ddn gian, eo the sir dung trong thi/e hanh lam sang de chan doan va irng dung trong viec len gia khdp de thi/c hien cac phye hoi va dieu tri cac roi loan chiTc nang khdp thai du'dng ham.
TAI LIEU THAM KHAO
1. Hoang Tu" Hung, 2005, Can khdp hpc, NXB Y hoc, TP Ho Chf Minh.
2. Tran Thien LOG, 2005, Phuc hinh thao iSp toan ham, NXB Y hoc, TP Ho Chi Minh.
3. ROZENCWElb D., 1994, Algies et dysfonctionnements de I'apparell mastlcateur, CDP, Paris.
^. GOULET JP ET AL, 2000, Functional Occlusion From TMJ to Smile Design, chapter 7, pp58 5. Jagger R., 2005, Occlusion and Clinical Practice,
section 2, Chapter 6, Licensing Agency, UK, pp 60.
6. Boulos P3, Adib SM, Naltchayan U . The Bennett angle. Clinical comparison of different reconjing methods, N Y State Dent J. 2008 Mar;74(2):34-8..
