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TAP CHi Y HOC VIET NAM TAP 459 - THANG 10 - S 6 2 - 2017

GIA TRI CUA PHIM TOAN CANH PANORAMARAMA VA PHIM CAT Lap CHUM TIA HINH NON TRONG PHAU THUAT

RANG H A M LaN THU BA H A M DUai

Tran Cao Binh*. Pham Tran Anh Khoa**

T O M TAT

Muc tieu: So sanh gia tri mot so kich thu'dc va hinh thai ciia rang khon ham du'di (RKHD) sau phlu thuat glCia lam sang va phim Panorama, phim CT.

Cone Beam (CTCB). D61 tu'dng nghien cu'u: la c^c benh nhan co RKHD kham va dieu tri tai khoa Phau thuat trong mieng tai Benh vien Rang Ham Mat Trung u'dng Ha Noi, tu" 8/ 2014 den 8/ 2015. Ket qua: Chieu dai chan rang 8 do du'dc tren phim Panorama la 9,5 ± 1,9, tren phim CTCB la 10,2 ± 1,1. Sd chenh lech so vdi lam sang do duoc ciia phim Panorama la: -1,0 ± 2,1, CTCB la: -0,5 ± 1,5. Chieu dai toan bg rang 8 chiing t6i do du'dc tren lam sang la 17,7 ± 1,1. Tren phim Panorama fa 16,5 ± 2,5, tren phim CTCB la 16,8

± 1,3. 06 chenh ve chieu dai toan bo rang 8 g\da lam sang v6i phim Panorama la -0,6 ± 2,1 va CTCB la -0,6 ± 1.0. Co sd khac biet ve so lu'dng chan rang §ttjta f^norama so vcfl sau FT; Khong co su' khac biet ve so ludng chan rang giite phim CTCB so vdi sau FT. Dp rong nhat ciia chan rang 8 tren lam sang la 8,7 ± 2,0, tren phim Panorama la 9,3 ± 8,9, tren phim CTCB la 8,6 ± 1.1. 06 chenh ve do rong nhat ciia chan rang 8 giij^ lam sang vdi phim Panorama la 1,8± 13,8 va CTCB la -0,1

±1,5. Co sd chenh kha Idn giiJa 2 phim vdi lam sang va b thay phim CVCS co do chinh xac cao hOn. Ket luan:

Tl le chan RKHD chum chiem da so 78.49%, chan phan ky' it g3p 21.51%. hinh dang chan RKHD thu'dng gap la chan thing 53.44%, cao gap 1.8 tan chan cong (35.48%). Chan diii trong rat hiem 1,08%. Ti le gay bien chiihg cija cac tu" the RKHD: lech ngoai: 85,11%; lech gan: 66,67%; thing true la: 55,55%; lech xa: 33.33%.

Ti le gay bien 'diuhg ciia cac vi tri la:; Vi tri A: 65,52%;

Vi tri B: 85,19%; Vi tri C: 62,5%.

TCr khoa: Rang khon ham du'di, cat Idp chiim ba hinh non

SUMMARY

THE VALUE OF PANORAMIC RADIOGRAPH AND CONE BEAM COMPUTED TOMOGRAPHY

I N MANDIBULAR THIRD MOLAR Objective: Compare some tooth sizes and shapes of mandibular third molar between clinical examination and X-ray films (paronamic signs and cone beam computed tomography - CBCT findings). Subjects:

Patients who had mandibular third molar were examed and treated at Department of Oral Surgery, National Hospital of Odonto - Stomatology, Hanoi from August, 2014 to August, 2015. Results:

*Benh vi$n Rang Ham MSt Tif Ha Noi

*Hru'dng Dai hoc YHa Ngl Chju frach nhierh chinh: Tran Cao Binh Email: dr.binhnhos@gmail.com Ngay nhan bai: 1/7/2017 Ngay phan bien khoa hoc; 31/7/2017 Ngay duyet bai: 18/9/2017

1. Ihe mean root length i he deviation compare to clinical examination I. 1 he mean tooth lenath fl7.7 ± 1,1) 1 he deviation compare to clinical examination S. 1 He max root width

(8,7 ± 2,0) 1 he deviation compare to clinical examination

'\. Ihe number or roots compare to clinical examination

Overall

Panoramic radioqraph 9,5 ± 1,9 -1,0 ± 2,1 16,5 ± 2,5 -0,6 ± 2,1 9,3 ± 8,9 1,8± 13,8 Still had deviation

Cone beamCT 10,2 ± 1,1 -0,5 ± 1,5 16,8 ± 1,3 -0,6 ± 1,0 8,6 ± 1,1 -0,1 ±1,5 deviation No

Higher accuracy Conclusions: Root contact: 78.49%, root separation: 21.51%. Straight shaped root: 63.44%, curved shaped raot: 35.48%. Clubbed shaped naot still occurred in one case (1.08%). The rate of complications:

Classification according to Archer 1975, Kruger 1 984:

Buccoangular (85,11%), Mesioangular (65,67%), Vertical (55,56%), Distaangular (33.33%). Classification according to Peli and Gregory 1933: Oass A (65,52%), Class B (85,19%), Class C (52,5%).

Keyword: Mandibular third molar. Cone beam computed tomography

I. OjBkT VAN OE

Rang ham Icfn thu' ba (rang 8) ham du'di (RKHD) gay nhieu bien chimg bien phire tap tai cho, toan than doi khi rat nang ne cho ngu'di benh. Hinh thai va vi tri mpe RKHD co lien quan chat che tdi ty le gay bien chu'ng ciia no. Kham lam sang va chup phim X quang de ho trd va lap ke hoach dieu t n .

Nhu'ng phim hay sii' dung de phuc vu cho phau thuat la phim toan canh (Panoramarama) va phim CTCB Cone Beam (CTCB). Phim toan canh cung cap thong tin nhat dinh cho chan doan va dieu tri RKHD, nhu'ng khong danh gia chi'nh xac vi tri, hinh dang, hu'dng ciia than rang, sd lu'dng va hinh dang chan rang. Phim CTCB khac phuc nhu'ng ban che cua phim Panorama ma cdn cho phep ta danh gia chinh xac cac cau trite giai phau lien quan nhu' vach xu'dng mat xa rang so 7 va lien quan ong than kinh rang du'di.

Chung toi tien hanh nghien cu'u de tai nay vdi muc tieu; So sanh gia tn mot so kich thu'dc ba hinh thai cua RKHD sau phau thuat gitici lam sang va phim Panorama, CTCB d nhom benh nhan tren.

VIETNAM MEDICAL JOURNAL N°2 - OCTOBER - 2017

11.061 TU'DNG VA PHU'ONG PHAP NGHIEN CUU 2.1.061 tu'dng nghien citu: La cac benh nhan cd RKHD kham va dieu fri Benh vien Rang Ham Mat Trung u'dng Ha Npi, tir 8/ 2014 den 8/ 2015.

*rieu chuan Ida chpn:

• Nhu'ng benh nhan RKHD

- Khong cd benh man tinh toan than nhU: di dng, tim mach, tieu du'dng, benh ve mau.

- Cd nguyen vpng nho RKHD

- Dong y chup phim toan canh Panoramarama va phim CTCB

*Tieu chuan logi trOr:

- Cd cac benh toan than dang tien trien - Khong cd nguyen vpng nho RKHD.

- Benh nhan khong hdp tac...

- Khong chup phim Panoramarama hoac/ va phim CTCB

ZZPhiAAig phap nghien culi: Mo tE cat ngang

*C& mau:

- Sir dung cong thii'c tinh cd mau ciia nghien cijlj md ta cat ngang, tinh du'dc cd mau la n=58:

- Trong cong trinh nay, chiing toi tien hanh nghien ciru tren 60 benh nhan.

2.3. Cic bu'dc tien hanh nghiSn cihi Bing 3.1: Chieu dai than ring 8

- Buikl: KMm lam sang: de thu timp thongs - Bu'dc 2: Danh gia trong mieng -I- Danh gia vi t r i rang

+ Oanh gia true rang 8 so vdi rang 7 -I- Diing compa de do khoang each tir mat nhai R7 den diem cao nhat R8 va khoang each tir diem gan nhat cua mat nhai R8 den bd Icii canh len XHD.

+ Danh gia cac dau hieu lam sang nhu" suhg, dau hay khit ham hay khong.

- Bddc 3: Chup phim Panorama, CTCB va danh gia tren phim 2 phim:

- Bu'dc 4: Nho RKHD va doi chieu tren phim.

- Bu'dc 5; y.d ly so lieu

2.4 So lieu du'dc nhap va phan tich bin phan mem SPSS 16.0

+ Diing Test de so sanh cac ty le, hoac Test Fisher exa CTCB trong tru'dng hdp tan so ly thuyet < 5.

+ Gia bi p< 0,05 du'dc coi la cd y nghTa thong ke III. KET QUA V A BAN LU^N

So sanh ghep cap phim Panorama-phim CTCB vdi lam sang sau phau thuat

3 . 1 . Chieu dai than rang R8

Chieu dai Ulan rang 8

Phim Panorama

So

lu'dng

Kich thu'dc lu'dng

Lam sang So lu'dng Kich thu'dc

7,3 ± 0,9 6,7 ± 0,9

34

6,9 ± 0,6

26

7,3 ± 1,1

26 6,5 ± 0,7

26

7,3 ± 0,7 >0,05

Chung

7,3 ± 1,0

60

6,6 ± 0,8 60

7,0 '± 0,6 >0,05

Bing 3.2: dp chenh ve chieu dai than rang R8 giu'a phim Panorama, CTCB vdi lim sang Chieu dai

than rang R8

Chenh giu'a phim Panorama vdi lam sang So lu'dng

Chenh giu'a phim CTCB vdi lam sang So lu'dng Kich thu'dc "

p (Wilcoxon signed-rank test

ghep cap)

34

0,4 ± 1,1

34

-0,1 ± 0,9

<0,05

R48

26 0,2 ± 1,5 26 -0,3 ± 0,6

<0,05

Chung

60 0,3 ± 1,3 60

Chieu dai do du'dc tren phim Panorama la; 7,3 ± lech so vdi lam sang do du'dc ciia phim Panorama la: 0, cho thay phim CTCB cd dp ehi'nh xac hdn. Sd khac biet

3.2. Khoang each gan xa than RS Bing 3.3. Khoing cich gin xa thin R8

-0,2 ± 0,9

<a,05 1,0, tren phim CTCB la: 6,6 ± 0,8. Su" chenh ,3 ± 1,3, CTCB la: -0,2 ± 0,9. Si/ khac biet nay nay cd y nghla thong ke vdi P < 0.05.

Khoang each gan xa than Rt

R38 R48 Chung Bang 3.4; B

Phim Panorama So lifdnq

34 26 60 p chenh i

Kich thu'dc 11,2 ± 1,8 11,6 ± 1,2 11,3 ± 1,6 e khoang ca

Phim CTCB So lUcJnq

34 26 60 ch gan xa

Kich thu'dc 11,4 ± 1,0 11,2 ± 1,2 11,3 ± 1,0 than RS gi

Lam sanq So lyonq

34 26 60 O'a phim

Kich thu'dc 11,6 ± 1 , 1 12,2 ± 1,3 11,8 ±1,2 Panorama^

P

>0,05

> 5 / S l

>0,05 TTCB vdi am sang

Khoang each gan xa than RS

R38

Chenh giu'a phim Panorama vdi lam sang Sd lu'dng

34

Kich thu'dc -0,7 ± 2,4

Chenh giu'a phim CTCB vdi lam sang Sd lu'dng

34

Kich thu'dc -0,4 ± 0,7

P

>0,05

1 R48 1 Chunq

TAP CHi Y HOC Viei NAM TAP 459 26

60

•0,6 ±1,2 -0,7 ± 0,2

-THANG 10-562-2017 26 60

-0,6 ± 0,4 -0,4 ± 0,6

>0,05 1

> 0,05 I Khoang cach gan xa rang 8 do du'dc tren phim Panorama la: 11,3 ± 1,6, tren phim CTCB la: 11,3

± 1,0. Su" chenh lech so vdi lam sang do du'dc cua phim Panorama la: -0,7 ± 0,2, CTCB la: -0,4 ± 0,6. Sir khac biet nay cho thay phim CTCB cd dp chi'nh xac hdn. Tuy nhien su' khac biet nay khong cd y nghTa thong ke vdi P > 0.05.

3.4. Chieu dai chan R8 Bang 3.5: Chieu dai chan ring 8 chieu dai

Chan RS R38 R48 Chung

Phim Panorama So lUdnq

34 26 60

Kich thu'dc 9,5 ± 2,2 9,5 ± 1,3 9,5 ± 1,9

Phim CTCB So iUdnq

34 26 60

Kich thu'dc 10,1 ± 1,2 10,4 ± 1,1 10,2 ± 1,1

Lam sang Sd lUdriq

34 26 60

Kich thu'dc 11,1 ± 0,9 9,9 ± 1,6 10,7 ±1,3

P

<0,05

<0,05

<0,05 Bing 3.6: Do chenh ve chieu dai chin rang 8 giCta phim Panorama, CTCB vdi lam sang

^hanh nii".',. nhii.. ^V.nv.\. ni.",,^ n U I n ."Tf-WI ..Jj'. I^—. I

Chieu dai chan R8

Chenh giu'a phim Panorama vdi iam sang So iudnq

Chenh giCa phim CTCB voi lam sang

So lUdnq

34

-1,2 ± 2,5

34

-0,9 ± 1,5

R48 -0,5 ± 0,8

26 0,4 ± 0,6

Chunq

-1,0 ± 2,1 -0,5 ± 1,5

Chieu dai chan rang 8 do du'dc tren phim Panorama Ia9,5 ± 1,9, tren phim CTCB la: 10,2 ± 1,1. Su' chenh lech so vdi lam sang do du'dc cua phim Panorama la; -1,0 ± 2,1, CTCB la: -0,5 ± 1,5. SU khac biet nay cho thay phim CTCB cd do chinh xac hdn. SLT khac biet nay cc y nghla thong ke vdi P < 0.05

3.5. Chieu dai toan bp R8 Bang 3.7. Chieu dai toan bo R8 dai toan

boRS

Phim Panorama

lUdnq Kich thudc Sd lUdnq

Phim CTCB

^ 5 0 lUdnq

Lam sang Kich thudc

R48

26 16,4 ± 2,6 16,8 ± 1,2 18,0 ± 0,9 <0,05

Chunq

16,8 ± 1,4 17,1 ± 1,1

< 0,05,

16,5 ± 2,5 16,8 ± 1,3 17,7 ± 1,1

Bang 3.8: Bo chenh ve chieu dai toan be RS giu'a phim Panorama, CTCB vdi lam sang Chieu dai

toan bo R8

Chenh giu'a p h i j n Panorama veli sau p h l u thuat SolUdnq

Chenh giu'a ghim CTCB vdi sau phau thuat So lUdnq Kich thu'dc

34 34

-0,9 ± 1,1

>0,05

R48

26

-0,7 ± 2,2

26 -0,07 ± 0,5

>0,05

Chunq

60 -0,6 ± 2,1 60 -0,6 ± 1,0 •0,05

Chieu dai toan bo rang 8 chung tdi dd dUdc tren lam sang la 17,7 ± 1,1. Tren phim Panorama la 16,5 ± 2,5, tren phim CTCB la 16,8 ± 1,3. Do chenh ve chieu dai toan bo rang 8 giu'a lam sang vdi phim Panorama la -0,6 ± 2,1 va CTCB la -0,6 ± 1,0. Oieu nay cho thay phim CTCB chinh xac hdn.

Tuy nhien su" khac biet nay khong co y nghTa thong ke vdi P >0,05.

3.6. So lu'dng ch3n rang Bang 3.9: So lifting chan rang So lu'dng

chan rang R38 R48 Chung

Phim Panorama So

lUdnq 34 26 60

So lu'dng chan rang 1,9± 0,3 2,0 ± 0,0 2,0 ± 0,2

Sau phau thuat SolUdng

34 26 60

Kich thu'dc 2,0 ± 0,2 2,1 ± 1,3 2,1 ± 0,3

Phim CTCB So ludnq

34 26 60

Kich thu'dc 1,9 ± 0,2 2,0 ± 0,2 2,0 ± 0,2

P

Bing 3.10:

phau thuit

Dp chenh ve sd lu'dng chan rang 3 giii'a phim Panorama va CTCB vdi sau

So lu'dng chan rang R38

Chenh giCa phim Panorama vdi sau phau thuat So lu'dng

34

Kich thu'dc -0,2 ± 0,4

Chenh giu'a ^him CTCB vdi sau phau thuat Sd lu'dng

34

Kich thudc -0,1 ± 0,3

P

< 0 , 0 5

VIETNAM MEDICAL JOURNAL N°2 - OCTOBER • 2017 R48

1 Chung 26 60

-0,1 ± 0,3 -0,2 ± 0,4

26 60

0,0 ±0,0 1 < 0,05 1 -0,1 ±0,3 1 < 0,05 1 Cd su' khac biet ve so lu'dng chan rang giiJa Panorama so vdi sau P I . Khdng cc sU khac biet ve so lu'dng Chan rang giu'a phim CTCB sc vdi sau PT

3.7. Do rong nhat cua Chan rang 8 Bang 3.11: Bo rong nhat cua chan rang 8 S o rong

nhat cua c h i n rang

R38 R48 Chung

Phim Panorama Sd lu'dng

34 26 60 Bang 3.12: Bg che Panorama va CTCB

Do rong nhatcua chan rang R38 R48 Chunq

Kich thu'dc 8,2 ± 1,4 10,6 ± 13,3

9,3 ± 8,9

Phim CTCB So lu'dng

34 26 60

Kich thl/dc 8,6 ± 0,9 8,5 ± 1,2 8,6 ± 1,1

Lam sang So lu'dng

34 26 60

Kich thu'dc 9,1 ± 1,2 7,6 ± 2,9

P

<0,05

<0,0S 8,7 ± 2,0 < 0,05 nh ve do rdng nhat cua chan rang 8 giii'a lam sang vdi phim Chenh giu'a phim ^

Panorama vdi sau phau thuat So lu'dng

34 26 60

Kich thUdc -1,1 ± 1,0 0,9 ± 1,1 1,8± 13,8

Chenh giu'a ghim CTCB vdi sau phau thuat So lu'dng

34 26 60

Kich thu'dc -0,4 ± 0,5

0,7 ± 2,7 -0,1 ±1,5

P

<0,05

<0,05

<0,05 Do rong nhat cua Chan rang 8 tren lam sang la 8,7 ± 2,0, tren phim Panorama la 9,3 ± 8,9, tren phim CTCB la 8,6 ± 1,1. 06 chenh ve dp rong nhat cua chan rang 8 giu^a lam sang vdi phim Panorama la 1,8± 13,8 va CTCB la -0,1 ±1,5. Co si/ chenh kha Idn giu'a 2 phim vdi lam sang va ta thay phim CTCB co dp chinh xac cao hdn. Si; khac biet nay cc y nghTa thong ke vdi P < 0,05

3.8. Hinh dang chan rang Bang 3.13: Hinh dang chan rang Hinh dang chan

rang Chum Thanq Conq Roanq rdnq Bang 3.14: Bo che Hinh dang chan

ring Gidnq nhau

Khac nhau Cdng

Lam sang n 10 19 12 0

%

Tren phim Panorama n

26 30 11 0

»/o

Tren phim CTCB n

28 30 17 0

«/o

nh ve hinh dang Chan rang 8 giiya lam sang vdi phim Panorama va CTCB Panorama so vdi

sau PT n 16 15 31

51.6

%

48.4 100

CTCB so vdi sau PT n

23 8 31

74.2

%

25.8 100 IV. KET LUJC^N

4.1. Ti le chan RKHD chum chiem da sd 78.49%, chan phan ky it gap 2 i . 5 1 % . Hinh dang chan RKHD thang thu'dng gap 63.44%, chan cong (35.48%); Chan diii trong rat hiem 1.08%.

4.2. Mdi lien quan giu'a hinh thai mpe ciia RKHD vdi bien chu'ng: Ti le gay bien chirng cua cac tu' the RKHD: lech ngoai: 85,11%; lech gan:

66,67%; thang true: 55,56%; lech xa: 33.33%;

Ti le gay bien chdng cua cac vi tri la:Vi tri B:

85,19%; Vj tri A: 65,52%; Vi tri C: 62,5%.

TAI LIEU THAM KHAO

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Evolution des techniques d'imagerie dans te diagnosbc pre-chirurgicale, RadioproteCTCBlon.

These Chirurgien Dentair, Nancy.

4. Ericson S, Kurol J. (1986). Radiographic assessment of maxillary canine eruption in children with clinical signs of eruption disturbance. Eur. J.

Orthod. 8,133 -140.

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6. Scarfe WC, Farman AG, Sukovic P (2006).

Clinical applications of cone-beam computed tomography in dental praCTCBice. J Can Dent Assoc. 72(1). 75 - 80.

/ . Cavezian R., Pasquet G. (2011). Cone BeaiTi:

Imagene Diagnostique en Odontostomatologfe Principes, resultats et perspeCTCBlves. E^Wer. 14-16.