DAC DIEM MOI H A N COMPOSITE TIT DAN DINH DYAD FLOV\rr" KERR TREN KINH HIEN VI DIEN TCT QUET
T O M TAT
Muc tieu: Nhan xet dac diem ciia moi han composite tU dan dinh Dyad Flow™ Kerr tren kinh hien VI dien tff quet. Do'i tffdng va phffdng phap nghien cuti: Doi tffdng nghien cffu la 10 chiec rang ham nho vmh vien dffdc nho do chi dinh chinh nha. fioi rang dffdc khoan tao lo han kich thffdc 2x3mm, sau 1 mm d vung co rang mat ngoai, Thffc hien han bang composite Dyad Flow. Cac mau rang dUdc xff If be m|t va soi tren kinh hien vi dien tff quet (SEI^) tai thdi ddiem 1 tuan va 3 thang sau han. Ket qua: Do rong trung binh khoang hd moi han composite Dyad va mo rang sau 1 tuan theo chieu ngang la 3,67±l,80|jm, theo cfiieu dpc la 3,68±l,97pm. Dp rpng trung binh khoang hd moi han composite Dyad va mo rang sau 3 thang theo chieu ngang la 5,56±3,54|jm, theo chieu doc la 3,78d=l,67pm. Ket luan: Composite Dyad lien kSt vdi mo rang kem trong do lien ket v6i mo nga tot hdn so vdi mo men,
SUMMERY
CHARACTERISnCS OF THE FILUNGS BY SELF-ADHESIVE COMPOSITE DYAD FLOW™
KERR ON SCANNING ELECTRON MICROSCOPE Objective: Reviews characteristics of the fillings by self-adhesive composite Dyad Flow^'^Kerr on scanning electron microscope. Subjects and Methods Study: 10 premolars are put out by specifying orthodontic. Each tooth is is created 1 hole size 2x3mm, depth.1 mm in cervical tooth. Perform filling by Dyad Flow composite. The sample is treated tooth surface and observe on scanning eledxon microscope (SEM) at 1 week and 3 month after filling.
Results: The average of distance between the composite Dyad and dental tissue after 1 week is 3.67
± 1.80 micron horizontally, is 3.68 ± 1.97 micron vertically. The average of distance between the composite Dyad and dental tissue after 3 months is 5.56 ± 3.54 micron horizontally, is 3.78 ± 1.67 micron vertically. Conclusion: Composite Dyad stick is adhesive poorly to the dental tissue , including, its adhesion to dentin better enamel.
I. DAT VAN DE
Composite nha khoa ngay cang dffde ffng dung vao dieu tn, bdi nhffng ffu diem vffdt trpi eiia minh. Tuy nhien, composite ciJng ed nhffng
*Vien Dao tao Rang Ham Mat, trudng Dai hgc Y Hn
**i/ien Rang Ham Mat Trung ddng Ha Noi Chiu trach nhiem chfnh: Pham Tht Tuyet Nga Email: [email protected] Ngay nhan bai: 6.01.2017 Ngay phan bien khoa hgc: 17.4.2017 Ngay duyet b^i: 25.4.2017
Pham Thi Tuyet Nga*, Pham Thi Thu Hien**
han che nhff gay qua earn nga, anh hffdng B tiiy rang... ngoai ra thao tae edn phffc tap nhlu bffdc vdi yeu cau ehat ehe. Nam vffng nhij'ng irti nhffdc diem nay, eae nha nghien effu da tap trung phat trien loai vat lieu tiem nang nay|hanti eac loai composite eai thien hoan hao hdn [^.
Nam 2009, xuat hien loai composite t6rf^^|3p tat ea eae thanh phan lam mot, ffu viet hdn, TOO tac trd nen de dang hdn rat nhieu, tian che gay nhay cam nga ma van giff dffde tinh tham,0, do bam dfnh cao von cd. Hien nay loai composite tff dan dinh_nay da dffdc sff dung tai Viet Nam, tuy nhien, v l n chffa cd nhieu nghien cuff lam ro hieu qua ciia loai vat lieu nay. Vi vay chiing tai tien hanh nghien ciiu de tai vdi mue tieu; Nf\m xet dac dii'm cua mdi han composite tii dan dink Dyad Flov/'^Kerr trin kinh hien vi diin t&quet II. D 6 I TU'{prJG VA PHU'OTMG PHAP NGHIEN CIJU
1 . Doi tu'dng nghien cu'u: Doi tu'dng nghien cufu la 10 ehiee rang ham nhd vinh viin difdc nhd do chi dinh chinh nha trong do tuoi 18 - 25 difdc lffa chpn theo nhffng tieu chuan sau.
-Rang khde manh, khong bi chan thu'dng trffdc dd.
- Rang khdng od bi benh ly tiiy hay benh ly cumg.
-Rang khong mang phue hinh.
-Rang khdng dj dang, ed bat thffdng trong qua trinh phat trien rang.
2. Phu'dng phap nghien cu'u: Nghien cuti thffe nghiem in vitro.
• Ph&dngjihap th&c Men: Cae rang du'^c khoan tao 1 id han tai viing co rang kfch tiiu'dc 2x3mm, sau 1mm. Dung composite Dyad Flow han kin lo han vffa tao. Sau dd, eae rang d # chia ngau nhien vao liai nhom dpc ket_qua^ci Irai thdi diem: sau 1 tuan va sau 3 thang. 0^mo[Si^
diem, eac rang difdc tien hanh xff ly be mat va soi tren kfnh hien vi dien tff quet nham danh gia sff kin khft giffa mo rang va vat lieu.
' • Thu thap so'lieu: Omd\ nhdm csic^etf\v&
thu dffdc tai'2 thdi diem: sau khi ban 1 tuan va sau han 3 thang.
a moi thdi diem mau dffdc danh_^gia qua / tieu chi: Chieu ngang: Md ta dae diem be rrg vet han (dinh tinh). (be mat) €)o khoang hd m md rang va vat lieu {dinh Iffdng). Chieu dpc: Mo ta (dinh tinh) va do khoang hd (djnh Iffdng). (laf cat doc) giD^ md rang va vat lieu tai eac thanh va
Ti°iP CHI Y HOC VIET NAM TAP 454 - THANG 5 - SO 2 - 2017 fay l6 han. Moi mau dffcfc ehup 5 anh tai 5 vi tri
M n g nhat, moi anh tien hanh do 3 kieh thffdc.
III. KET a U A NGHIEN CLTU
1. Dac dii'm be mat moi han Composite
& tho9 diem 1 tuan va 3 thing - 6 thdi diem 1 tuan, vdi cae dp phdng dai 30 i^a 500 lan quan sat dffdc be mat Composite tho.
cd the quan sat thay cac tmh the Composite 1 each ro rang.
- a thdi diem 3 thang, d dp phong dai 30 va 500 lan be mat Composite hau nhff khong thay doi so vdi mau 1 tuan, tuy nhien be mat trd nen thd, go ghe hdn vdi hinh anh cac khdi Oamposite kfch thffde khong dong deu.
Hinhl. Hinh anh mau Composite Dyad 1 tuan d mffe phdng dai: a) 30 lan; b) 500 lan 2; Dac diem lien ket giO'a mo rang va Composite Dyad d thdi diem 1 tuan va 3 thang - 0 tJidi diem 1 tuan, hinh anh phong dai 30 lan cho thay be mat Composite tffdng ddi dong nhat, hjy nhien cd the nhin thay mpt so dffdng niit d vung ria mieng tram.
-O thdi diem 3 thang, hinh anh be mat Composite van tffdng ddi dong deu. Vdi dp phong dai 30 lan cac dffdng nut dffdc nhin thay mpt each kha rd rang, keo dai dpc theo vien moi tram Composite.
Hinh 2. Hmh anh mau Composite Dyad 3 thang d mffc phdng dai 30 lan 3. Kich thu'dc khoang hd giCa mo rang va vat lieu sau 1 tuanva 3 thang
Bang 3.1. Kich th&dc khoang hdgi&a mo rang va vat lieu sau 1 tuan theo chiiu ngang va chiiu doc
Vitrf
Ngang Docn
125 125Trung binh ( p m ) 3,67 3,68
fid lech ( i i m ) 1,80 1,97
P 0,98>0,01
Min ( p m ) 1,21 0,58
Max ( u m ) 10,6 11,8 -Dp rpng trung binh khoang hd moi han Composite Dyad va mo rang sau 1 tuan theo ehieu ngang la 3,67±i,80pm, kieh thffdc Idn nhat la 10,6pm.
-Dd rdng trung binh khoang hd moi han Composite Dyad va md rang sau 1 tuan theo chieu doc la 3,68±i,97pm, kieh thffdc Idn nhat dat tdi l l , 8 i j m .
-Op rpng khoang hd giffa md rang va vat lieu theo chieu ngang va dpc khdng cd sff khac biet ed b'nh thong ke (p>0,01).
Bang 3.2. Kich th&dc khoang hd giita mo rang va vat lieu sau 3 thang theo chieu ngang va ctiieu dpc
V i t r i Nqanq Doc
n 125 125
Trung binii ( p m ) 5,56 3,78
Do lech ( p m ) 3,54 1,67
P 0,00<0,01
Min ( p m ) 0,77 0,97
Max ( p m ) 14,3 9,91 -Dp rpng trung binh khoang hd moi han Composite Dyad va md rang sau 3 thang theo chieu ngang ia 5,56±3,54pm, vdi kieh thffdc Idn nhat len den 14,3|jm.
VIETNAM MEDICAL JOURNAL N°2 - MAY - 2017
-Do rdng trung binh khoang hd moi han Composite Dyad va md rang sau 3 thang theo chieu doc la 3,78±i,67Mm, vdi kieh thffdc Idn nhat la 9,9lMm.
-Dp rpng khoang hd theo ehieu dpc vdi khoang hd theo chieu ngang cd sff khae biet cd y ngfiia thdng ke( p<0,01), khoang hd ehieu doc nhd hdn so vdi khoang hd chieu ngang.
Bang 3.3. So sanh khoang hdgl&a mo rang va vat lieu sau 1 tuan va 3 thang theo dilSu ngang va chieu dgc
chieu Doc ngang
So sanh cap Trung binh(pm)
0,10 1,88
Std.D 2,57 3,62
Std. E 0,23 0,32
Can du'di(ym) -0,35
1,24
Can trenfuml 0,56 2,52
t 0,461 5,810
df 124 124
P 0,646 Khoang hd dpc sau 3 thang va 1 tuan eiia moi han composite Dyad vdi md rang khdng ed sffldiac
AW
bi^t thong ke vdi sff chenh lech nhd (p>0,01). Khoang hd ngang sau 3 thang va 1 tuan ciia mSi han Composite Dyad vdi md rang cd sff khac biet thong ke vdi sff chenh lech tffdng ddi Idn (p<0,01).
IV. BAN LUJjkN Iffc, giam dp cang va cai thien mdi lien ket viing Hinh anh composite Dyad d thdi diem 1 tuan ""ia moi han [ 1 ] . Trong nghien cffu eua chiing toi khdng quan sat thay nhu'ng dai lien ket tff Idp sff dung composite Dyad ed module dan hoitliip composite dl vao long ong nga. Dieu nay ed the "^^^"^ ^ai thien tdi da sff toan ven viing ria ciia la do d Composite Dyad sff dung acid yeu, nen "^o' ^^a"' ^"y "h'^n lai dem tdi sff co ngot niiieu Idp md rang dffdc etching mdng, khien thanh
phan Ijonding ciia composite ft di sau vao mo ring, Iffc Iffu giff it hdn. Khi sff eo ngdt eiia composite dien ra, lam co keo, tao khoang hd giffa mo rang va composite.
Theo ket qua bang 3.1 cho thay kfch thffde trung binh khoang hd nay la 3,67±l,80pm theo chieu ngang va 3,68±l,97pm theo ehieu dpc. So sanh vdi ket qua dat dffdc trong nghien eiTu eua Stefen Dacic va cdng sff [1] thi khoang each nay v l n nam trong mffc trung binh tot, ket qua nay trong nghien cffueiia ehiing tdi eung hdp li vdi ket luan rang kha nang gan dinh eiia composite the he dan dinh thff 5 tot hdn so vdi composite the he dan dinh thff 7 [2].
Sau 3 thang, kfch thffde khoang hd giu^
composite va md rang nhd nhat do dffde la 0,77 pm tuy nhien ed nhtiYig vj tri len tdi 14,3pm. Kfch tiiffde trung binh eua khoang hd len tdi 5,56±3,54pm theo chieu ngang, Idn hdn so vdi d thdi d i i m 1 tuan. Nguyen nhan ehii yeu ciia cac khoang trdng giu^ md rang va composite la sff CO ngdt lai ciia composite sau khi trimg hdp, tao n§n ap Iffe eo tren cac thanh dffdc bonding vdi md rang. Lffe eo keo nay eung rat Idn khi trong nghien cffu chiing tdi sff dung lo han loai 5, cd C - factor [3] Idn (lo han loai V cd C-faetor la 5, 5 la Idn nhat). Ap iffc nay anh hffdng bdi nhieu yeu to, chang han nhff khoi Iffdng composite dffde triing hdp, kT thuat phuc hoi, dae tinh Idng eiia composite va cau true hinh hpc,hda hpc ciia md rang [4]. Ngffdi ta cho rang, vdi composite long, do dae tinh module dan hoi thap, cd tae dung nhff mpt bp dem dan hoi, hap thu mdt phan ap
hdn so vdi composite hat dpn Idn hdn. Vf du ntitf trong nghien effu ciia Stefan Dacic va cong si/
[1] sff dung Composite Filtek Z250 ia hat ijonlai va Filtek Supreme XT Flowable la hat dpn nho, ket qua cho thay kfch thffdc khoang hd ciia moi han Composite hat dpn lai 1,6 ± 0,8pm nho htin so vdi hafddn nhd la 5,1±1,6 \sm [1],
Tren lat cat doe eiia mau vat, khoang hd giu^
mo rang va composite xuat hien ro rang, tjy nhien kfch thffde nhd hdn so vdi khoang hdchiSu ngang. Trong nghien effu eiia chung toi, kich thffde trung binh khoang hd d lat eat dpc la 3,78±l,67Mm. Kich thffdc nay khdng tang nhieu so vdi ket qua cua mau 1 tuan
Tuy nhien ket qua thu dffdc tff mau composite Dyad cho thay mffc do dong deu l(idi thffdc khoang hd theo ehieu ngang va dpc d mau 1 tuan, nhffng d mau 3 thang, kieh thffdc khoang hd theo chieu ngang lai tang vpt, gap 1,5 lan so vdi kieh thffde mau 1 tuan, dong thdi kfch thu'dc khoang hd theo chieu ngang cung Idn hdn soviii khoang hd chieu doc (p>0,01). Oieu nay cho thay dp ben vffng ciia lien ket vdi mo nga ciiajhe thong dan dfnh trong composite Dyad tot hdnso vdi lien ket vdi men rang.
Ket qua nay ciia ehiing toi la phii hdp vi3l kit qua dat dffdc trong nghien cffu ciia C. A. Munffi- Viveros va cong sff [5] cung nhff trong ngtiien cull ciia H. Bui va cdng sff [6].
V. K^TLUAN
Qua ket qua nghien cuXi dae diem moi lian Composite tff dan dfnh g tren thffe nghiemf nhdm rang liam nhd vinh vien, chiing tdi riitta nhuYig ket luan sau:
TAP CHl Y HOC VIET NAM TAP 454 - THANG 5 - SO 2 - 2017 Tren hinh anh phdng to xuat hien khoang hd
giffa md rang va vat lieu 1 each rd rang, keo dai xuyen suot vien moi han dieu nay the hien dp lien ket kem eiia Composite Dyad vdi md rang.
Kieh thffdc khoang hd theo chieu ngang tang nhanh sau 3 thang trong khi kich thffde theo chieu dpc lai kha dn dinh, eho thay kha nang lien ket md nga tot hdn so vdi md men.
TAI LIEU T H A M KHAO
1, Stefan Dacic et al. (2011). Marginal GAP and Alteration of Enamel Around Adhesive Restorations of Teeth (in vitro SEM investigaton). J.Faculty of
Medicine in Nis, 28(2), 109-118.
2. Nazarian, A., (2011). The progression of dental adhesives, ADA CERP 1,1-10.
3. N. Hie et al. (2007). Low-shrinkage cximposite for dental application. 3. Dental Matenals, 26,149-155 t . M.Hannig et al. (2001). Comparative In Vivo and In Vitro Investigation of Interfacial Bond Variability. J.Operative Dentistry, 26, 3-11, 5. C. A. Munoz-Viveros and M. Campillo-Funollet
et al. (2010). Shear Bond Strength of Dyad Flow to Dentin and Enamel Substrates. AADR 6. H. Bui, T. D. Nguyen, X. Qian and D. Tobia et at.
(2009). Bond Strength of a New Self-Adhering Composite. lADR, Abstract 1804.
DANH GIA HIEU QUA BAN DAU CUA PHU'aNG PHAP DAT STENT DUaNG MAT QUA NOI SOI MAT TUY NGU'DC DONG
TRONG DIEU TRI TAG MAT DO UNG THU
TOM TAT
MIIC deu: Danh gia ket qua sdm cua phu'Ong phap dat stent du'dng mat qua NSMTND trong dieu tn ac mat cd hoc do ung thu'. Bdi tu'dng va phu'dng phap. 32 benh nhan tuoi trung binh 63,4 -i- 12,9; bi tac dudng mat chinh ^do ung thu' giai doan mupn khong con chi dinh phau thuat triet can da dddc dat stent du'dng mat tai Khoa Noi tieu hoa, Benh vien TLfOD 108, thdi gian tff tharig 10/2014 den thang 12/2015. Ketqua. Ty le thanh eong ky thuat la 25/32 Bi^ (78,1%). Theo doi sau 01 thang nong do bilirubin trong huyet thanh giam > 50% d 24/25 BN(967o), da so benh nhan cd cai thien ve tinh trang larn sang va chat Iu'dng song. Bien ehffng chii yeu la nhiem khuan dudng mat chiem ty le 5/32 (15,6%), khong co tru'dng hdp nao tff vong lien quan den 1^ thuat. Ket luan.
phUdng phap dat stent dUdng mat qua NSI^TND c6 hieu qua dan luU cao trong dieu tn t i c mat cd hpc do un'^ thU, tuy nhien day la ky thuat kho, ty le bien chuhg klia cao.
T& khoa: Tzc mat do ung thU, ERCP, dat stent du'dng mat
SUMMARY
EVALUATE THE SHORT TERM RESULTS OF ERCP BOIARY SrermNG F O R PATIErfTS SUFFERING R O M MALIGNANT BILIARY OBSTRUCTION Aims, to evaluate the short term results of ERCP biliary stentlng for patients suffenng from malignant biliary obstruction. Patients and Methods. 32 unresectable patients with biliary obstruction due to
*Benh vien Tt/QD 108
Chiu trach nhiem chinh: Dffdng Minh Thang Email: [email protected] l>lgay nhan bin: 7.01.2017 l^gay phan bien khoa hpc: 10.4.2017 Ngay duyet bai: 24.4.2017
DiroTig Minh Thang*, Do Quang Ut*
advanced cancers, mean age 63,4 + 12,9; were undergone ERCP biliary stenting at the Gastroenterology Department, 108 Hospital from October 2014 to December 2015. Results. The technique was succeed in 25/32 patients(78,l%).
After one month follow up, the serum total bilirubin level decreased > 50% in 24/25(96%) patients.
Clinical and quality of life improvement was clearly seen in most of patients. The mam complication rate was cholangitis accounting for 5/32(15,6%), There was no case of procedure-related death. Conclusion:
ERCP biliary stenting was very effective for biliary drainage in patients with malignant biliary obstruction, however it is' not an easy tectinique with high complication rate.
Key words: biliary malignant obstruction, ERCP, biliary stenting.
I. OAT VAN DE
Da so cae trffdng hdp tac mat xay ra khi ung thff dffdc phat hien mupn khdng cdn kha nang dieu tri phau thuat hoac la sff tien trien, xam lan di can ciia benh ung thff da dffdc phat hien tff trffdc. Muc tieu dieu tri ehinh d nhdm benh nhan nay la dieu tri giam nhe, cai thien tinh trang lam sang va ehat Iffdng song, keo dai thdi gian song them. Ngay nay vdi nhieu tien bo ve ndi sol mat tuy ngffde ddng (NSMTND), eae dung cu ndi soi dae biet la stent kim loai tff gian nd, dat stent dan Iffu dffdng mat qua NSMTND da ngay cang ehffng td la mot phffdng phap xam lan tdi thieu, cd hieu qua eao so vdi phffdng phap dan lffu dffdng mat qua da hoac phau thuat. 6 nffdc ta ky thuat dat stent dffdng mat qua ndi NSMTND trong tae mat do ung thff da va dang difdc ffng dung ngay cang nhieu d eae benh vien Idn, tuy
