TAP CHI Y HOC VlgT NAM TAP 459 - THANG 10 - SO 2 - 2017
DANH GIA KET QUA CAY GHEP IMPLANT NHA KHOA TAI BENH VIEN RANG H A M MAT TRUNG UONG H A NOI
T O M TAT^
Hue tieu: Danh gia ket qua dieu tn phuc hinh rang bang phu'dng phap cay ghep Implant nha khoa vdi su" ho trO ciia phan mem 3D. Do! tu'dnp va phiTtf'ng phap: mo ta ten cu'u 30 benh nhan tren 18 tuoi di/Oc cay ghep 49 Implant thanh conq. Ket qua:
Ty le thanh cong 98%. Sau khi lap phuc hinh 6 thang su'c nhai cua phuc hinh tren Implant tot: 83,7% va trung binh: 16,3%. Ty le nay tu'Ong liYig la 85,7% va 14,3% sau 12 thang con sau 18 thang lu'dng iTng la 83,7 va 16,3%. Sau khi lap phuc hinh 6 thang tham my du'dc khoi phuc tot: 91,8% va trung binh: 8,2%.
Ty le nay tu'dng uhg la 89,8% va 10,2% sau 12 thang con sau 18 thang mii'c tot la 87,8%, mii'c kha la 10,2% va mire kern la 2%. Ket Iuan: ty le thanh cong trong cay ghep Implant c6 lihg dung phan mem 3D_la 98%, kha nang khoi phuc chdc nang an nhai va tham my rat tot. Cac bien chutig^xay ra chiem t / le rat nho va deu trong pham vi c6 the sda chu'a du'dc.
Ti/'/fAda.'Implant, phan mem 3D.
SUMMARY
EVALUATION OF THE RESULTS OF DENTAL IMPLANTS AT NATIONAL HOSPITAL OF
ODONTO - STOMATOLOGY, HANOI Objectives: This study was to evaluate prosthetic outcomes of 49 dental implants using 3D software.
Subjects and methods: prospective study, this shjdy was conducted on 30 patients with 49 missing teeth. These patients were examined and placed dental implants at National Hospital of Odonto - Stomatology, Hanoi. Results: The success rate of dental implants was 98%. 6 months after functional loading,83.7% of implants had good masticatory function and 16.3% of implants had moderate masticatory function. 12 months after functional loading, the rates were 85.7% and 14.3%, respectively and those after 18 months was 83.7%
and 16.3%, respectively. While 91.8% of implant had good esthetes and 8.2% of implants had moderate estJietics results 6 months after loading. 12 months after functional loading, the rates were 89.8% and 10.2%, respectively. 18 months after loading, 87.8%
of implants had good esthetics, 8.2% of implants had moderate results and only 2% of implants had bad esthetics. Conclusions: Planning of dental implants using 3D software is predictable with high success and low complicational rate.
Keywords: Implant, 3D software.
Benh vien Rang Ham Mat Trung ddng Ha Noi Chju trach nhiem chinh: Tran Cao Binh Email: [email protected] Ngay nhan bai: ^I^IJQY?
Ngay phan bien khoa hoc:: 31/8/2017 Ngay duyet bai: 18/9/2017
Tran Cao Binh*, Pham Thanh Ha*
I. BAT VAN OE
Cay ghep Implant nha khoa de lam phuc hinh rang gia cho benh nhan la mot ky thuat phuc hinh tien tien, mang lai nhieu Idi ich cho ngu'di benh. Rat nhieu cac bien phap nham giam thieu bien chu'ng da du'dc dda ra va viec LTng dung phim CT Cone Beam (CTCB) trong viec lap ke hoach dieu trj cay ghep Implant nha khoa c6 y nghTa rat quan trong doi vdi muc dich nay.
Chup phim CTCB de lap ke hoach cay implant do vj tri cua Implant du'dc xac dinh trong khong glan 3 chieu giup cho Implant du'dc dat d vj tri thuan Idi nhat va khi do ty le bien chu'ng trong va sau khi phlu thuat se du'dc giam thieu.
Nghien cu'u cua chung toi c6 cac muc tieu: Oanh gia ket qua va cac bien chu'ng trong cay ghep nhiJng benh nhan tren.
II. o d i TLTONG VA PHLTOfNG PHAP NGHIEN CUXJ 2 . 1 . Dol tu'dng nghien cu'u: La cac benh nhan mat rang den cay ghep implant nha khoa tai Benh vien Rang Ham Mat Trung u'dng Ha Noi 2012-2014
Tieu chuan Ilia chon:
- Benh nhan da mat rang tren 6 thang hoac da du'dc ghep xu'dng tren 6 thang
- Co chieu cao xu'dng c6 I'ch toi thieu 8 mm, dp day xu'dng toi thieu 6 mm, khoang trong doi vdi 2 rang ke ben toi thieu 6 mm.
- Khong bj cac benh tim mach, tieu du'dng va cac benh he thong.
- id nguyen dong y tham gia nghien cu'u.
Tieu chuan loai trit: NhCi'ng benh nhan khong cd du tieu chuan su'c khde de cay ghep Implant cijng nhu' khong cd nguyen vong du'dc dieu tri phuc hinh bang phu'dng phap nay.
- Benh nhan mat rang toan ham.
- Benh nhan da bi xa tri vung dau mat co.
- Benh nhan cd tinh trang viem nhiem trong khoang mieng.
- Benh nhan cd tat nghien rang.
- Benh nhan song d nddc ngoai khong c6 dieu kien den kham dinh ky de theo doi.
2.2. Phu'dng phap nghien cu'u: Nghien cu'u thu' nghiem lam sang md khong doi chu'ng.
C3 mau: 30 benh nhan mat 49 rang Thdi gian nghien cu'u: Td 03/2012 den 12/2014.
2.3. Cac bUdc tien hanh nghien cu'u
VIETNAM MEDICAL JOURNAL N°2 - OCTOBER - 2017 - Kham, chyp phim cd li'ng dung phan mem
3D, chan doan va lap ke hoach dieu trj.
- Cay ghep Implant.
- Lam rang gia tren Implant. ^ - Hen benh nhan tai kham de theo doi.
2.4. Phu'dng phap thu thap va xuT ly so lieu: Cac so lieu du'dc ghi vao Phieu theo doi benh nhan va du'dc xd ly bang phan mem thong ki y hoc SPSS 16.0.
111. KET QUA NGHIEN CirU
Ba/^ 1: Phan toaib&ih nhin theo nhom tu&
1 Nh6m tuoi [So benh nhan | Ti le ( % ) ! Bing 3: Kha nang khoi phuc sifc nhai cua benh nhan
<40
41-59
> 6 0 Tong so
21 8 1 3 0
70 26,7
3,3 100 Bang 2: Nguyen nhan mat tang
Nguyen nhSn Bien chutlg cua b$nh ly
tuy rang Bien chu'ng cua benh
Viem guanh rang Chan thu'dng
Tong sd
So benh nh3n
35 8 6 49
T h e
71,4 16,3 12,3 100
So lu'dng
Tot
Ty le (%) " So lu'dng ~Ty le (%) Trung binh
So Itfdnq I Ty le (%) Sau 6 thang
41
Sau 12 thang 42
14,3
Sau 18 thang
16,3
Bang 4; Kha nang khoi phuc tham my cua benh nhan
Sau 6 thang Sau 12 thang Sau 18 thang
Tot So lu'dng
45 44 43
Ty le (%) 91,8 89,8 87,8
Trung binh So li/dng
4 5 5
Ty le (%) 8,2 10,2 10,2
Kem Sd lu'dng
0 0 1
Ty le (%1 0 0 2 Bing 5: Ty le thinh cong
Thanh cdng That bai Tong cong
So Implant 49
1 50
TV le ( % ) 98
2 100 Bang 6; Bien chu'ng phau thuat
Loai bien chu'ng Chay mau Wis vet thu'dng
Si/no ne Dau iced dai
Sdca 1 3 2 1
Tv le { % ) 2 6,1 4,1 2 Bang 7: Bien chu'ng phuc hinh
Loai bi'en chi^ng
vastr
Long vit lien ket AbutmentHd tiep xuc
Sau 6 thanq Sdca
1 0 1
Ty le (%1
Sau 12 thang Sd ca
2 0 3
Ty le (%)
Sau 18 thang Soca
4 2 6
Ty le (%) 8,2 4,1 12,2 Bang 8: Bien chu'ng cua to chu'c xung quanh Implant
Loai bien chu'ng Viem mo mem guanh Implant
Viem quanh Implant
Sau 6 thang Soca
2 0
Ty le (%) 4,1
0
Sau 1 2 thang Soca
4 1
Ty le (%) 8,2
2
Sau 18 thang Soca
7 2
Tv le (%) 14,3
4,1 IV. BAN I U A N
4 . 1 . f)ac diem lam sang: Trong nghien cu'u cua chung toi benh nhan tre nhat la 19 tuoi va gia nhat la 65 tu6i, trung binh la 33,9 ± 13,5 tuoi. Nhom benh nhan tu" 40 tuoi trd xuong chiem tdi 70%. LiTa tuoi cua benh nhan trong nghien cdu cua chiing toi nhd hdn trong cac
nghien cu'u ciia cac tac gia khac nhu' nghien CLTU cua Bragger va cs tren nhom benh nhan tii" 23 - 83 tuoi (trung binh la 55,7 tuoi) [1]. Dieu nay c6 the ly giai la nghien cu'u du'dc tien hanh tren nhom rang cCra va benh nhan tre tuoi neu mat rang thuoc nhom nay thi se cd nhu cau phuc hinh cao hdn.
TAP CHi Y HOC VIJT NAM T^P 459 - THANG 10-502 - 2017 Nguyen nhan chi'nh ciia mat rang la bien
chiJtig cua benh ly tuy rang (76,7%), so lieu nay phu hdp vdi ket qua dieu tra ciia Vien Rang Ham Mat Ha Noi va thanh pho Ho Chi Minh vdi sd giup dS ciia To chdc Y te the gidi vdi ket Iuan sau rang la nguyen nhan chmh gay mat rang vdi ti le 57-72% tuy theo liTa tuoi. Nguyen nhan tiep theo la viem quanh rang (16,3%), cuoi cung la do chan thu'dng (12,3%). Trong nghien cu'u cua chiing toi ti le benh nhan bj mat rang do viem quanh rang thap cd the dddc giai thich la do lira tuoi cua cac benh nhan trong nghien cifu nay la tu'dng doi tre nen ho cDng it mac benh viem quanh rang hdn. Mat rang do viem quanh rang thu'dng c6 su'c khoe toan than kem do tuoi tac nen ho khong lu^ chon phu'dng phap phuc hinh rang gia bang each cay ghep Implant.
4.2. Ket qua dieu trj
4.2.i. Kha nang khoi phuc su'c nhai cua benh nhan: Sau khi lap phuc hinh 18 thang, ty le khoi phuc su'c nhai tot chiem tdi 83,7%, \^ le kha chiem 16,3%. Khong c6 mu'c kem. Kha nang khoi phuc su'c nhai on dinh theo thdi gian.
4.2.2. Kha nang khoi phuc thi'm my cua benh nhan: Kha nang khoi phuc tham my ciia phuc hinh Implant la rat tot. Sau khi lap phuc hinh 18 thang mu'c tot ia 87,8%. Kha nang khoi phuc tham my ciia phuc hinh Implant giam di theo thdi gian. Sau khi lap phuc hinh 18 thang da CO mot tru'dng hdp phuc liinh cd tham my kem (chiem 2%). Ket qua ciia nghien cu'u nay
\ nay cung tu'dng t i / whd nghien cu'u ciia Pham Thanh Ha (2007) vdi ti le khoi phuc tham my tot
\
la90,9%
va kha la9,1% [2],
^ 4.2.3. Ty le thanh cong: Ty le thanh cong CLia ky thuat cay ghep Implant trong nghien cu'u
" nay la 98%, tu'dng du'dng vdi cac tac gia khac trong nu'dc va tren the gidi. Ket qua nay cung I tu'dng td vdi nghien culi tong quan he thong va
^ phan tfch meta ciia Moraschini va cong sd khi
^ cay ghep Implant vdi sd hu'dng dan ciia phan , mem 3D [3].
4.3. Bien chutig
% 4.3.1. Cic bien chd'ng sau qua trinh '•i. phau thuat: Trong nghien cu'u ciia chung toi, I chi c6 1 tru'dng hdp bj chay mau 1 ngay sau i phau thuat nhu'ng chi c6 hien tu'dng ri mau chOr
^ khong chay thanh dong. Chiing toi da sd dung
^1 Viscostat tai cho ket hdp vdi can gac va mau da
^ cam ngay sau do. Co 03 tru'dng hdp hd vet
^' thu'dng, tat ca cac tru'dng hdp _^deu du'dc phat
•, hien muon khi benh nhan den cat chi. Trong so '. nay 02 tru'dng hdp da du'dc lam sach mep vat va khau lai, tn/dng hdp con lai do mep vat hd nhieu
chiing toi da quyet djnh thao nap day Implant va lap tru lien thu'dng.
Chiing toi theo doi du'dc 2 tru'dng hdp bj su'ng ne 2 ngay sau khi phau thuat. NhiJng tru'dng hdp nay chiing toi cho dung them khang sinh, khang viem va tang cu'dng ve sinh rang mieng. Sau khi dieu trj 5 ngay cac trieu chirtig sutig ne da giam dan va het han. Do phSu thuat Implant du'dc thUc hien tnDng khoang mieng la mot moi tru'dng nhiem khuan nen ty le nay la d mii'c binh thu'dng.
Mot tru'dng hdp benh nhan sau khi phau thuat 3 ngay van bi dau nhieu mac du khong bj suVig ne hoac nhiem triing. Benh nhan du'dc dung thuoc giam dau lieu cao va trieu chu'ng dau da het sau khi phau thuat 1 tuan. Khi benh nhan den kham iai mot thang sau khi dat Implant chiing toi thay Implant khong c6 sd tich hdp xu'dng. Mac dii chi la mot tru'dng hdp ddn le nhu'ng cijng c6 the dat nghi ngd ve moi lien quan giiJa dau sau khi p h l u thuat va si/ khong tich hdp xu'dng.
4.3.3. Cac bien chu'ng lien quan den phuc hinh: T\nh trang hd tiep xuc ben chiem ti le Idn nhat vdi 12,2% sau 18 thang theo doi.
Tiep XUC ben chii yeu bi hd d phi'a gan ciia phuc hinh Implant do Implant luon bat dong trong xu'dng trong khi rang that luon cd xu hu'dng djch chuyen ve phia tru'dc gay nen tinh trang hd tiep xuc. Tinh trang nay cang tang len tren benh nhan c6 to chCrc quanh rang that khong tot hay benh nhan c6 mot hoac vai rang that phia tru'dc Implant khong nam trong cung rang dan den cung rang de bj x6 lech hdn. Chinh vi the nen doi vdi nhij'ng benh nhan thuoc cac nhom nguy cd tren chiing t6i_ khuyen cao nen lam phuc hinh bat vit de cd the de dang thao ra sda chiJa khi can thiet.
Tinh trang khac long vit lien ket abutment trong nghien cdu nay la 4 , 1 % , thap hdn mot chiit so vdi nghien cu'u ciia Bragger U va cs trong do ti le long vit lien ket abutment [4].
Nghien cu'u ciia chiing toi cDng cho ket qua ti le vS sir la 8,2%, thap hdn ti le vd sir 10,7% trong nghien ciru cua tac gia neu tren. Dieu nay cd the ly giai la thdi gian theo ddi ciia chiing toi chi la 18 thang, trong khi do thdi gian theo doi ciia nghien ciru neu tren la 5 nam.
4.3.4. Cic bien chu'ng lien quan den to chu'c xung quanh Implant:Sau 18 thang theo doi, ty le viem mo mem xung quanh Implant la 14,3% va ty le viem quanh Implant la 4 , 1 % .
Cac ket qua khac nhau theo cac nghien cu'u khac nhau cd the ly giai d sir khac biet giCa cac he thong Implant, cac phu'dng phap cham soc
VIETNAM MEDICAL JOURNAL N°2 - OCTOBER - 2017 benh nhan sau phuc hinh khac nhau d cac tac
gia khac nhau ty nhiien nhin chung day la mot ty le tu'dng doi cao va cac nha lam sang can het sdc quan tam tdi van de nay.
V. KET LUAN
Ty le thanh cong ciia nghien ciru la 98%.
Chiirc nang: Sau phuc hinh tren Implant 6 thang sire nhai du'dc khoi phuc tot 83,7% va trung binh 16,3%. Sau 12 thang t / le tu'dng irng la 85,7% va 14,3% Sau 18 thang tu'dng liYig la 83,7 va 16,3%.
Tham my: Sau phuc hinh 6 thang tham my dUdc khoi phuc tot 91,8% va trung binh 8,2%.
Ty le nay tu'dng uTng la 89,8% va 10,2% sau 12 thang con sau 18 thang mii'c tot la 87,8%, mu'c kha la 10,2% va mire kem la 2%.
Cac bien chu'ng: trong va ngay sau khi phau thuat cd 1 tru'dng hdp bj chay mau (2%) va 3 tru'dng hdp bj hd vet thu'dng (6,1%), 2 tru'dng hdp suTig ne (4,1%) va 1 tru'dng hdp dau keo dai (2%). Sau khi phuc hinh 18 thang c6 2 tru'dng hdp bi long 6c lien ket abutment (4,1%), 4 tru'dng hdp bj vd sir (8,2%) va 6 tru'dng hdp bi hd tiep xiic vdi rang ke ben (12,2%). Sau 18 thang ke tir khi phuc hinh, ty le viem mo mem
quanh Implant la 14,3% va ty le viem quanh Implant la 4 , 1 % .
TAI LIEU T H A M KHAO
1. Pham Thanh Ha (2007), Nghien ciTu dng dung ky thuat Implant nha khoa de lam phuc hinh rang CO dinh, Luan van Thac sy y hoc, Tru'dng Dai hoc Rang Ham Mat, Ha Noi, tr. 35-36.
2. Ta Anh Tuan va cs ^2007], Nghien CIJIJ iTng dung ky thuat Implant de nang cao hieu qua phuc hinh nha khoa, De tai nghien cuTj khoa hoc cap b6, Bo Quoc phong. Tr. 59-72.
3. 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, pp. 26-34.
4. Roos-JansSker AM, Lindahl C, Renvert H, Renvert S (2006), Nine- to fourteen-year follow- up of Implant treatment. Part I I : presence of peri- Implant lesions,J Clin Periodontol, 33, pp. 290-295.
s. 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, pp. 625-642.
6. Gaia BF et al, Companson between cone-beam and multislice computed tomography for identification of simulated bone lesions. Braz Oral Res. 2011 Jul-Aug;25(4):362-8.
NGHIEN CtfU DAC DIEM LAM SANG GIAI DOAN TRAM CAM a BENH N H A N R O I L O A N KHI SAC CO H A N H VI PHAM TOI
T O M TAT
Muc tieu: Nghien cdu dac diem lam sang ^iai doan "doan tram cam d benh nhan roi loan khf sac - giai doan tram cam, cd hanh vi pham toi. 061 tUtfng va phu'dng phap nghien cu'u; Nghien ciTu 69 benh nhan roi loan khi sac pham toi, liien tai c6 giai doan tram cam, tai vien giam dinh phap y Tarn than Trung u'dng Bien Hoa. Nghien ciru tien ciru cat ngang, c6 mo ta tdng tru'dng hdp cu the. Ket c|ua: Cac trieu chirng chinh ciia tram cam hay gap nhat la khi sac tram vdi 98,55%, mat cam giac ngon mieng chiem 94,20%.
Cac tneu chirng roi loan cam xiic hay gap nhat la buon chan chiem 92,75% va giam hirng thii va sd thich vdi 75,36%, TLT duy cham chap chiem ty le cao nhat vdi
*Vien Phap y Tam than Tif Bien Hoa.
** Benh yien Quan y 103, HVQY Chiu trach nhiem chinh: BiJi Quang Huy Email: bshuy2003@yahoo,com Ngay nhan bai: 2/8/2017 Ngay phan bien khoa hoc: 24/8/2017 Ngay duyet bii: 11/9/2017
Nguyen Thanh Quang*, Bui Quang Huy**
Ngo Nggc Tan**, Cao Tien Diic**
94,20%, tiep den la it noi, it giao tiep chiem 92,75%.
Van dong cham chap chiem ty le 91(30%, giam hoat dong 84,06%. Cac trieu chiTng cO the hay gap nhat la chan an, siit can chiem ty le 94,20%, dau Sau 73,91%. Mat ngu dau giac chieni 62,31%, ngii khong sau chiem 52,54%.
Tit khoa: Giai doan tram cam SUMMARY
STUDYING CUNICAL AND CHARACTERISTICS DEPRESSIVE EPISODE I N PATIErfTS WITH
MOOD DISORDER HAVE CRIMINAL ACTS Objective: To study the clinical charactenstics of the depressive episode in patients with mood disorders - stage depression, with offenses. Subjects and Methods: cross-sectional prospective study, which describes each specific case on 69 patients with mood disorder (depressive episode), who have committed crimes. Results: The main symptoms of depressive symptoms were depression of 98.55%, loss of appetite of 94.20%. Sadness accounted for 92.75%, loss of interest accounted for 75.36%. Slow thinking accounted for 94.20%, less communication
