JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY
Danh gia muc do lech lac xirong ham bSng phim X-quang thuong quy va phim c^t \&p chiim tia hinh non trong cSy ghep implant
Evaluation of maxillofacial skeletal deformities in dental implants by conventional radiography and cone beam computed tomography
TrSn Cao Binh, Dam Van Vift Benh vien Rdng Hdm Mat Trung ucmg Hd Npi
Muc tieu: D^nh gia mUc dp lech lac xuong ham bang phim X-quang thudng quy (phim 2D) va phim CT. Cone Beam hay phim 3D tren cae benh nhan cay ghep implant nha khoa. Doi tugng vd phuang phdp:
Mo t l cat ngang 30 benh nhan mat 49 rang den kham va eay ghep implant nha khoa tai Benh vien Rang Ham Mat Trung UOng Ha Npi Xd t h i n g 3/2012 den thang 12/2015. Kit qud: Chieu cao xUOng cd ich >
18mm: 59,2%; so vj tri xuong ham cd chieu cao nhd hpn 15mm: 8,2% tren phim 2D va 3D. Cac vi tri xUong ham cd do day dUcrt 7mm: 73,4% xac djnh bang phan mem 3D. Khim lam sang va ket hpp phim 2D ehi xac djnh chfnh xac 26,60%. D6 nhay va do dac hieu cua CT. Cone Beam la 100% tren lat c^t ngang. ©6 nhay la 91,6% va dp dac hieu CT. Cone Beam la 97,4% trong viec xac ^ n h tdn thuong mat ngoai xUong ham vung cay ghep tren lat c i t dUng dpc. Kit ludn: Kham lam sang va chup phim 3D cd do nhay va dd dac hieu cao tren 90% de xac djnh chinh xac khoi lupng xUong ham vung mat rang va lap ke hoach cay ghep implant nha khoa.
Tdkhoa: Phim 3D, cay ghep implant.
Summary
Objective: To evaluate the maxillofacial skeletal deformities in dental implants by projection radiography (2D) and cone beam computed tomography. Subject and method: Cross-sectional study, this study was conducted on 30 patients with 49 missing teeth. These patients were examined and placed dental implants at National Hospital of Odonto - Stomatology, Hanoi from March, 2012 to December, 2015. Resu/t; Residual bone height > 18mm: 59.2%; residual bone height < 15mm: 8.2% (2D and 3D film).
Residual bone width < 7mm (73.4%) {3D film). Clinical examination and 2D film gave only 26.60% accuracy.
The sensitivity and the specificity of cone beam computed tomography were 100% in axial direction.
The sensitivity was 91.6% and the specificity was 97.4% in sagittal direction. Conclusion: The sensitivity and the specificity of clinical examination and 3D film were over 90%.
Keywords: Dental implant, 3D film.
Ngdy nhdn hdr 04/8/2017. ngdy chap nhdn ddng: 17/8/2017
Nguaiphdn hdi- Tran Cao Binh. Email: dr.binhnhos@gmailcom - Benh vi4n Rdng Hdm Mat Trung ucmg HdNoi
TAPCHlY DL;0C LAM SANG 108 Tap 12-568/2017 I . D a t v a n d e
Trong eay ghep Implant nha khoa ngoai kham lam sang, hlnh I n h y hoe gdp phan quan trpng de lap ke hoach dieu tri.
Hinh I n h y hpc thudng quy ehi hien thj dupe hai ehieu (2D) cau true xUdng ham theo dp cao, dp rdng, khdng xac djnh dupe ehieu trong ngoai (dp day), mat khae kfeh thUde khdng trung thUe so vdi thuc te eua ngUdi benh vl hlnh I n h phdng dai k h o i n g 20 - 30%. Do vay ket hpp glQa lam sang va phim 2D chi cd the giSi lap ke hoach dieu tri d mdc 60 - 70% so benh nhan mat rang den de eay ghep Implant.
Phan mem 3D khdng nhCfng hien thj eac cau true xUdng ham tren nhieu mat phang, kich thudc dung nhu cau cau giai phau thuc te eua ngudi benh, ma cdn cd eae ehde nang khae nhU do dp dai, do gdc, do ty trong, ve cac cau true giai phau nhU xoang ham, dng than kinh rang dUdi, x l e dinh d u n g khdi lupng xUdng ham, danh gia mat dp xUdng hSm va cho biet hUdng dU djnh dat Implant eho phep phau thuat vien lap dupe ke hoach cay ghep Implant nha khoa phu hpp nhat.
Tren thd gidi da cd nhQng nghien cdu dng dung p h l n mem 3D trong cay ghep Implant nha khoa nhung tai Viet Nam cd rat it nhufng nghien cdu dng dung phan mem 3D trong eay ghep Implant nha khoa. Chinh vl vay, chung tdi tien hanh de tai nay vdi cac muc tidu sau: Ddnh gid mdc do lich Igc xuong vung hdm mat tren phim 2D vd 3D trong cdy ghip Implant nha khoa.
2. Ddi tUtfng va phiTcfng phap 2.1. Ddi tugng
CIc benh nhan mat rang den k h i m va cay ghep Implant nha khoa tai Benh vien Rang Ham Mat Trung Udng Ha Ndi tCf thang 3/2012 den t h i n g 12/2014.
Tiiu chudn chon Tudi: T d i 8 tudi t r d ldn.
K h i m l l m sang vung mat rang cd du chd de dat va phuc hinh tren Implant.
Chup phim 2D va phim 3D.
Tiiu chudn logi trd Bdnh nhan khdng phdi hop.
Khdng thao bd dUpc nhUng kim loai vung can chup nhU: Cau rang gia, nep kim loai...
Khdng cd dCi cho de dat va phue hlnh tren Implant.
T u d i : N h d h d n I B t u d i . 2.2.P/ii/tfngphdp:Tien cufu, m d t a . C/ipn cdmdu; 30 benh nhan 49 rang mat.
Cdc bddc tien hdnh nghiin cdu
Budc 1. Kham lam sang, chup phim 2D lUa chpn benh nhan.
BUde 2. Chup phim CT. Cone Beam (CTCB).
Budc 3. Phan tieh phim CTCB tren phan mem 3D.
Xdc dinh tinh trgng xdOng hdm
Kich thudc xuong ham vung dd djnh dat Implant (IP) theo 3 chieu:
Theo chieu ddng.
Theo chieu trong ngoai.
Theo chieu ganxa.
Xlc dinh mat dp xUdng ham:
xuong loai 1 (Dl): Tren 1250 don vj Hounsfield.
xuong loai 2 (D2): Td 850 den dUdi 1250 ddn vj Hounsfield.
xuong loai 3 {D3): TU 350 den dUdi 850 ddn vi Hounsfield.
xuong loai 4 (D4): TU 150 den dUdi 350 dOn vi Hounsfield.
Xac djnh eae yeu t d giai phau lien quan:
Chan rang lan can.
6 n g than kinh rang dudi.
Day xoang ham va xoang ham.
Lo khau cai trUdc.
Ld cSm va cac thanh phan lien quan.
Dpng maeh xoang, vIeh xoang, tinh trang mang xoang...
TrUdng hpp thieu khdi lUpng xUdng, can xac dinh:
T i n g khdi luong xUOng theo chieu dUng.
Tang khdi lUpng xUong theo chieu ngang.
Phuong p h i p tang khdi lupng xUdng:
Ghep bdt xUdng nhan tao va mang.
Ghep xUdng khdi, vdng tU than.
GhepxUdng n h i n tao vdi mang titan, lUdi...
Trudng hpp can nang xoang, can x l c djnh:
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JOURNAL OF 108 - CLINICAL IWEDICINE AND PHARMACY
Nang xoang kin.
Nang xoang hd.
Budc 4: Lap ke hoach dat IP phuc hdi mat rang.
Budc 5: Thao t i e dat IP, eham sde va theo doi sau dat IP.
Budc 6: Phue hlnh rang.
Dp nhay va dp dac hieu:
Dd nhay dupc xae dinh bang ty le sd trUdng hop p h l t hien tdn thUdng d mat ngoai XHT tai vj trf cay ghep tren sd tdn thUOng that sU dupe p h l t hien khi lat vat de cay ghep implant.
Dp dac hieu dUpc xac dinh bang ty Id sd trudng hpp khdng p h l t hien thay tdn thuong d mat ngoai XUdng ham khi l i t vat de cay ghep implant tren ele trudng hpp dUOc d i n h gia la khong cd tdn thuong tren phim CTCB.
2.3. Thu thap va xdly so liiu
Cac so lieu thu thap duoc x d ly theo phuong phap thdng ke y hpc vdi chuang trinh EPI- INFO 6.04 va SPSS.
Tfnh trung blnh, so sanh 2 gia tri trung blnh dung test T student.
Tfnh ty le %, so s i n h cac ty le dung test X^
2.4. Dgo ddc trong nghien cdu
De eUdng nghien cdu dupe Hdi ddng khoa hpe cap CO sd va cap Nha nude cap chap thuan.
Nghien cUu dUpc thUe hien tren nhUng benh nhan hoan toan t u nguyen va khdng phan biet ddi xd tren cac benh nhan khdng t u nguyen nghien cdu.
Cac ky thuat thu t h l p thdng tin, theo ddi dieu trj va phan tich sd lieu khach quan de d i m b l o tinh trung thuc trong nghien eUu.
3. Ket qua
Dgc diem xdong hdm tren phim 2D vd 3D de chdn dodn vd dieu tri cdy ghep implant nha khoa
Bang 1. Chieu cao xUtfng phau thuat
Nhdn xet: Chieu eao xUong phau thuat d cac vj trf ed ehieu cao xUdng > 18mm chlem tdi 59,2%, 15mm ehi chiem 8,2%.
Bdng 2 . Dd rdng xUtfng phau thudt
chieu cao
< 15mm 15-<18mm
> 18mm Tdng
SolUtfng 4 16 29 49
Ti\e%
8,2 32,6 59,2 100
Do rong
< 7 m m
^ 7 m m Tdng
So IUtfng 36 13 49
T 9 l e % 73,4 26,6 100
Nhdn xet: Doi vdi vung rang cda, xUdng ham co do rdng > 7mm chiem 36,6%, ehu yeu la dUdi 7mni {chiem 73,4%).
Bang 3. Dd nhay cOa phan mem 3D trong phat hien tdn thi/tfng mat ngoai xiftfng ham
CaclatcSt
Tren l i t cat ngang Tren lat c i t ddng dpc
Sdtrtfcrng htfp ton thUtfng phat
hi^n tren phim CBCT
12 n
Sd trtfo^g htfp ton thucmg phat
hien tren lam sang 12 12
Od nhay
(%)
100 91,6 Nhdn xit: Tren l i t cat ngang, dp nhay la 100%
trong khi tren lat c^t dpc, X)/ le nay d mdc thap hfln vdi dp nhay la 91,6%.
Bang 4. Do dac hieu cOa phan mem 3D trong xac dinh khdng co ton thUtfng mat ngoai xUtfng ham
Caclat cSt
Tren l i t e l t ngang Tren l i t e l t dUng doe
Sd trudng htfp khong ton thUtfng tren
lam sang 37
37
Sd trUtfng htfp khong ton thUtfng tren CBCT
37
38 Do dac hieu {%} 100
97,4
Nhdn xet: Tren l i t cat ngang dp dac hieu la 100% trong khi tren l i t cat doe dp dac hieu la 97,4%.
TAP CH( Y DUOC LAM SANG 108 Tap 12-S6 8/2017
4. Ban luan
Trong nghien cdu cda chung tdi chieu cao xUong phau thuat cda cac benh nhan deu rat tdt, trong do chieu cao > 18 mm chiem tdi 59,2%. Sd vj tri xUong ham ed chieu cao nhd hdn 15mm ehi chiem 8,2%. Dieu do ndi len ehieu cao xUOng cd ich vung rang cda khdng bao gid la mdt van de khi cay ghep Implant.
Chieu rdng xuong phau thuat: Phan mem 3D eho phep do dd rdng xUong rat ehinh x l e (vdi dp chfnh xac tdi 0,1mm). Dieu nay cd y nghTa rat quan trong khi d vung rang cda, chieu cao xUdng cd fch khdng la van de thl chieu rdng xUOng cd ich ludn la mdi ban tam rat ldn cda cac nha lam sang khi cay ghep Implant. Cac vj trf xUdng ham cd dp day dUdi 7mm chiem tdi 73,4% va hau het cac trudng hpp nay deu phai ghep xUong khi tien hanh cay ghep.
Oay la mdt van di can dac biet lUu y khi cay ghep Implant d vung nay, chi khi nao cac nha lam sang lam chu ky thuat ghep xUong thl mdi nen tien hanh cay ghep Implant d vung nay.
Kit qud diiu tri
Khi nang khdi phuc sdc nhai cua benh nhan:
Sau khi lap phue hinh 12 t h i n g , X^ le khdi phuc sde nhai tdt chiem tdi 83,7%, ty' le k h i ehiem 16,3%.
Khdng cd mdc kem.
Kha nang khdi phuc sdc nhai dn djnh theo thdi gian.
Kha nang khdi phuc tham my cCia benh nhan.
Kha nang khdi phuc tham my cua phuc hlnh Implant la rat tdt. Sau khi lap phuc hinh 12 thang mUc tdt la 87,8%.
Khi nang khdi phuc tham my cua phue hinh Implant g i l m di theo thdi gian. Sau khi lap phuc hlnh 12 thang da ed mpt trUdng hpp phuc hlnh ed tham my kem (chiem 2%).
Ty ii thdnh cdng
Ty le thanh edng cua ly thuat eay ghep Implant trong nghien cdu nay la 98%, tUdng dUdng vdi c l e tac g i l k h i c trong nude va tren the gidi.
Do nhgy vd do ddc hiiu
Tren lat cat ngang, dp nhay va dp d i e hieu la 100% trong khi tren lat cat dpc, ty' le nay d mdc thap hon vdi dp nhay la 91,6% va dd d i e hieu la 97,4%.
Ket q u i nay cung tUOng t u nhu nghien cdu cua Gaia BF va cs nam 2011 vdi ket q u i dp nhay cua phim CBCT trong phat hien tdn thUdng tren lat cat ngang la 98% cdn do dac hieu la 97,4%. Tren lat eat ddng dpc cacty le nay tuong dng la 86,3 va 98,1% [10].
Cae budc thuc hien dng dung phan mem 3D trong chl'n doan phue vu eay ghep Implant nha khoa da thUe hien deu cd dp nhay va dp dac hieu la tren 95%.
5. Ket luan
Danh gia mUc dp leeh lae xUdng ham tren phim 2D va 3D trong chan doan va dieu trj cay ghep implant nha khoa.
Chieu cao xUong phau thuat > 18mm chiem tdi 59,2%. Sd vi trf xUdng ham ed ehieu cao nhd hdn 15mm chi ehiem 8,2% tren phim 2D va 3D.
Chieu rdng xuong p h l u thuat: CIc vj trf xUdng ham cd dp day dUdi 7mm (73,4%) dUde x l e djnh bang phan mem 3D va hau het cac trUdng hop nay deu p h l i ghep xuong khi tien hanh eay ghep.
K h i m lam sang va ket hop phim 2D chf xac djnh chfnh xac 26,60%.
Kham lam sang va chup phim 3D de lap ke hoach eay ghep Implant nha khoa. Phim 3D cd dp nhay va dp dac hieu la 100% tren l i t cat ngang; dp nhay la 91,6% va do d i e hieu la 97,4% trong viec xae dinh tdn thUdng mat ngoai xUong ham vijng eay ghep tren l i t eat ddng dpc.
Tai lieu tham khao
1. Pham Thanh Ha (2007) Nghiin cdu dng dung ky thudt Implant nha khoa de idm phuc hinh rdng cd dinh. Luan van Thac sy y hpc. TrUdng Dai hpc Rang Ham Mat, Ha Ndi, tr. 35-36.
2. Ta Anh Tuan va CS (2007) Nghiin cdu dng dung ky thudt Implant de ndng cao hiiu qud phuc hinh nha khoa. De tai nghien cUu khoa hpc cap bp. Bd Qudc phdng, tr. 59-72.
3. Albrektsson T, Zarb G, Worthington P & Ericsson R (1986) The long-term efficacy of currently used dental Implants: A review and proposed criteria of success. Int J Oral Maxillofac Implants 1:11-25.
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Bragger U, Aeschlimann S, Biirgln W et al (2001) Biological and technical complications and failures with fixed partial dentures (FPD) on implants and teeth after four to five years of function. Clin Oral ImpI Res 12: 26-34.
Roos-Jansaker AM, Lindahl C, Renvert H, Renvert S (2006) Nine- to fourteen-year follow-up of Implant treatment Part 11: Presence of peri-Implant lesions. J Clin Periodontol 33: 290-295.
Bragger U, Aeschlimann S, Burgin W et al (2001) Biological and technical complications and failures with fixed partial dentures (FPD) on Implants and
teeth after four to five years of function. Clin Oral ImpI Res 12:26-34.
Pjetursson BE, Tan K, Lang NP et al (2004) A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clin Oral ImpI Res 15:625-642.
Gaia BF et al (2011) Comporison between cone- beam and multislice computed tomography for identification of simulated bone lesions. Braz Oral Res 25(4): 362-368.
