JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.1 l-N°5/2
Dac diem lam sang va X-quang cac rang thira viing ph tru-o-c ham tren o" benh nhan kham nan chinh rang
Clinical and radiographiccharacteristics of anterior maxilla supernumeraries in orthodontics patients
Nguyin Le Ngoc Khanh*, Vo Thi Thiiy Hdng* *Benh vien Rdng Hdm Mat Trung m
, « ^ . .r^/ „. ** **TnFcmgBgikpcYHa.
Nguyen Thi Thu Phirong** *
Tom t a t
Muc tiiu: Md t l d i e diem l i m sang va can l i m sang cCia bdnh n h i n rang thUa vdng phfa trUdc ham trdn cQa benh nhan ddn kham n i n chinh rang. Doi tugng vd phuang phdp: Ddi tUOng nghien cUu gdm 136 benh nhan ed rang thi^a hoac rang thUa n g l m dUOc tham k h i m lam sang va chup phim kiem tra 6i danh gia c i c tridu chUng lam s i n g va can lam sang. SU dung thdng kd toan hpc de phan tich sd lidu thu I thap dupc. Kit qua: T^ le rang thUa phia trUde h i m tren p h i n b d d nam nhi^u hOn nU (t^ Id nam/nU la 2,5/1). Trong dd, rang thUa hinh ndn gap nhieu n h i t (59%), It gap nhat la u rang (3,4%). Ring thUa ed the x u l t hidn don Id hoac nhieu rang tren cung. Cac bien chihig t h u d n g gap l i lech lae rang vTnh vien, khe thua rang eiTa ham trdn, g i y can t r d moc rang khien rang vTnh vien moc ngam. M d t sd ft trUdng hpp khdng cd bien ehUng, thudng gap 6 ham rang siJa. Trdn phim cat Idp chum tia hinh ndn, bac sy cd the x i e djnh kha chinh xae vj trf, hUdng moc cung nhU mdi lien he vdi e i c cau true l i n can, nhd d d xae dinh dudng vao de dang hOn khi phau t h u i t l l y bd rang thUa. Kit ludn: Ring thUa la nguydn nhan g i y lech lac khdp can, d i e bidt la cac rang thUa vCing phia trUdc ham trdn. Phat hidn sdm va ed phUOng p h i p dieu tri dung se giup t r i n h dupe e i c bldn chUng gay i n h hUdng den chile nang v i tham my eda bdnh n h i n .
TUkhda: Rang thUa, phim cat Idp chum tia hlnh ndn.
Summary "
Objective: This study is aimed at assessing t h e characteristics and X-ray examination of anterior maxillary supernumeraries. Subject and method: A sample of 136 patients with anterior maxillary supernumeraries was selected and assessed by elinieal examination and radiographs. Descriptive statistics were used t o analyze the data. Result: Males were affected more than females w i t h a sex ratio of 2.5/1. Supernumeraries appear in a variety of shapes, the most common in this study was conical, followed by turbeculate, then by supplemental and odontomatous. Supernumerary teeth may occur singly, or in multiples. In general, supernumerary teeth, particularly in the maxillary anterior region may cause clinical problems, crowding, displacement or rotation of permanent teeth, diastema, failure of eruption..., that patients need t o be cheeked and treated. Some non-syndrome cases were found, especially in deciduous dental arch. By using CBCT, d o a o r s could dertemlne accurately t h e location, morphology and the related structure. Thus, the pathway for surgical intervention may be assessed
Ngdy nhdn 30/9/2016. ngdy chdp nhdn 31/10/2016
Ngudi phdn hoi: Nguyen Le Ngoc Khanh - Benh vien Rang Hdm Mat Trung uang
TiBiP CHl Y DJOC LAM SANG 108 T?p 11-So 5/2016 easier. Conclusion: Supernumerary teeth are considered one of the most significant dental anomalies which may cause malocclusion, especially the anterior maxillary ones. Eariy diagnosis and treatment of patients w i t h supernumerary teeth are important t o prevent or minimize complications.
Keywords: Supernumerary teeth, CT conebeam.
I . D a t v I n d ^
Mdt trong cac van de giy I n h hUdng Idn den thIm my v i chUc nang cCia ham rang ta cie rang thifa, dae bidt l i rang thUa vung phfa trudc, dat ra nhidm vu cho eic bac sy rang him mat nham dUa ra ke hoach didu tn day dCi eu the, toan dien cho benh nhin. De dem lai hidu q u i dieu trj tdt n h i t cho bdnh nhan, ddi hdi cd su phdi hpp nhjp nhing cQa cle chuyen khoa khic nhau nhu chan doln hlnh anh, phau t h u i t trong mieng va nan chinh rang [1], [2].
Cac phuong phap chan doin eho phep phit hien sc^ va dieu tri du phdng ring thUa va rang thCfa ngam, bao gdm hdi tl^n sU gia dinh, khim l i m sang va danh gia tren phim X-quang [3], [4]. Trong dd, cae hlnh anh X-quang ed vai trd rit quan trong trong chan doan va dieu tri ring thUa moc ngam. CJ nude ta cho tdi nay van ehua ed nhieu edng trinh nghien eUu ve van de niy. VI vay, ehung tdi thuc hien de tai nay nham muc tidu Md td ddc diem ldm sdng vd X-quang rdng thUa vdng cUa hdm tren cua binh nhdn din khdm ndn chinh rdng.
2. Ooi t U c ^ g va phUtfng p h a p 2.1. Ddi tugng
Gdm 136 bdnh n h i n Suae lua chon t h e o tidu chuan: Cd r i n g thUa v i i n g phfa trUde ham t r e n . Loai trU nhufng bdnh nhan da hoac dang dieu trj chinh nha, benh n h i n ed tien sU chan t h u o n g v u n g h i m mat cd i n h hudng den khdp can, benh n h i n ed phue hinh vung r i n g eUa, benh n h i n ed phanh m d i bam bat t h u d n g d o 111, d p IV t h e o phan loai eua Plaeek [3], cd dj t a t bam sinh hoac chan thUPng
vung ham mat anh hUdng den khdp c l n va bdnh ^"^ "
nhin khdng hop t i c . Bieu d 6 1 . Phan bo ddi tupng nghien eUu theo gidi Nhdn xet: Trong sd 136 bdnh nhan cCia mau nghien cUu, ed 39 benh nhan nU (chiem 28,7%), 97 benh nhan nam (chiem 71,3%). Su khac biet ed y nghta t h d n g ke vdi p<0,05 (p=0,0001).
2.2. Phuang phdp
Nghien eUu tien cUu m d t l cat ngang g d m cac bude:
Budc 1: Hdi b e n h va kham l i m s i n g nhUng b e n h nhan thda man t i d u chuan lua chon ci!ia n g h i e n cUu de t h u t h a p t h d n g t i n h l n h ehfnh v l c i c ndi d u n g phieu nghien cUu.
Bude 2: Chup p h i m t o a n e i n h va p h i m CT conebeam (ddi v d i rang thUa ngam). Danh gia e l e d i e diem trdn p h i m t h e o mau phieu nghien cUu.
Bude 3: P h i n tfch eae d i e didm trdn lam sang v l trdn p h i m X-quang de dUa ra hUdng dieu t r i .
BUdcA: Nhap v i xU 1^ sd lieu.
Bude5: Tdng h p p sd lieu va vlet b i o eao.
2.3.Xi3'/yso//eu
T i t ca benh i n nghidn cUu sau khi kiem tra, cac so lidu se dUpc ma hda va nhap va phan tfch t h e o phan m e m t h d n g kd SPSS 16.0.
3. Ket q u a
3.1. Phdn bdddi tugng nghien cdu theo gidi
JOURNAL OF 108-CLINICAL MEDICINE AND PHARMACY Vol.l 1 - N°5/2
3.2. Hinh the rang thUaBangl.Hiniitlierangtiiifa
Rang thC^a Rang thifa ng^m
T6ng so
Rang iiinli non n 79 26 705
%
61,2 53,1 S9
Rang niiieu niim n 38 17 55
%
29,5 34,7 30,9
Rang giong rang vTnli vien
n 12 0 12
%
9,3
U r a n g n 0
0 1 6 6,7 1 6
%
0 12,2 3,4
Ciiung n 129
49 178
%
72,5 27,5 100
P
<0,0
Whdn xet; Trong tong sd 178 rang, cd 105 ring thUa hlnh ndn, ehidm 59%, 55 rang thCfa nhidu ni (30,9%), 12 rang thUa hinh the gidng rang vTnh vien (6,7%), 6 khdi u rang (chiem 3,4%). SU khic bidt o nghta thong ke vdi p<0,01.
3.3. Do c6n chia trin lam sang
Bang 2. Do cSn chia tren lam sang
Rang thiia Rang thCfa ngam Ca rang thCfa va rang ngam
Tong so
Binh tiiUdng
n 1' %
46 1 48,4
117 64
40,7 50,0 47,1
Tang n 45 16 6 6 7
%
47,4 59,3 42,9 49,3
Gidm n 4 0 1 S
%
4,2 0 7,1 3,7
Tdng n 95 27 14 136
%
69,9 19,9 10,2 100
0,60
W/jdn xef.-Tren 136 bdnh nhin, 67 benh nhan cd do can chia tang, chiem 49,3%, 64 bdnh nhin ed ddc chia binh thudng (47,1 %), 5 benh nhan glim do can chia (3,7%).
3.4. Vf trirdng thda ngam theo chieu tren
Nam cao hon ai6ng rSng g ^ nhat. ngay dinii san m S
Bleu do 2. Vi tri rang thUa ngam theo chidu tren dUdi so vdi cudng rang vtnh vien
gan nhit tren phim CLCTHN
W/idn xet; Trong sd 49 rang thCfa nglm, theo chieu tren - dudi, vi tri thudng gip nhat la glUa cudng r i
vdi dinh sdng him (71,4%), ehi ed 4 trudng hpp rang thCfa nglm nam eao, tiep xuc vdi nen mui (8,2%).
TAPCHlYDl/gCLAMSANG 108 Tap 11-So 5/2016 3.5. HUdng mgc cda rdng thUa ng&m
Bang 3. Hi/drng moc cOa rang thCia ngam tren phim cat ldp chum tia hinh non
Hi/dng mocBinh thudng Nam ngang Mocngucfc Tong so
Rang tilnli non n 0
e
20 26
%
0 76,9 23,1 S3,1
Rang nhieu niim n 2 10 5 77
%
66,7 33,3 34,7
Rang gidng rang vinti
viln
n 0 0 0 0
%
0 0 0 0
Tdng sd n 2 16 25 43
%
4,7 37,2 58,1 100
P
0,02*
W/idnxef:Trong sd 43 rang thCra ngam (khdng tinh cac u rang), hudng moc ngupc ehlem 58,1 %. Chi cd 2 rang ed hudng mgc binh thudng (ehlem 4,7%). SU khic biet niy cd y nghta thdng kd vdi p<0,05.
3.6. Cdc bien dtv^g thui^g gap
Ci Aig Biira v& ling nglm (n = 14]
• CtvacobtencMng •Ti&di&tiing •Sangchan • Caib^mpc • Ledi • THlukhoai^
Bieu do 3. Cic bien chdng thudng gap
W/jdn xet Trong tdng sd 136 bdnh nhin, ty^ Id bdnh nhin cd Idch lac eae rang ctjfa ham tren ehlem 72 benh nhan (52,9%), tiep den la thi^u khoing vdi 52 bdnh nhin (38,2%), 48 benh nhan cd can trd mpc rang (35,3%), 31 benh nhin chUa cd bien chdng, 10 bdnh nhin sang chin khdp can (7,4%). Khdng cd bdnh nhln bi nang ring hoae tidu chan rang.
4. Ban luan
4.1. Rang thda va gidi tinh
Trong sd 136 benh nhin eua mau nghidn eUu, ed 39 bdnh nhan nU (chiem 28,7%), 97 bdnh nhin
nam (chiem 71,3%). SU khie biet cd y nghta thdng ke vdi p<0,05 (p=0,0001). Ket q u i l i tUong ddng vdi nghien cUu md ta eda M. Isabel Leco Berroeal va edng su (2007) vdi tJ Id nam/nO la 2,5/1 (tUOng Ung vdi 71,4% va 28,6%) [4]. Ddng thdi, ket qui cung
129
JOURNAL OF 108 -CLINICAL MEDICINE AND PHARMAa Vol.11-r5/20l
t u o n g d o n g vdi m d t nghien cilu t r o n g nude cCia T o n g Minh Son vh Hoang V I t t HJI (2014) vffl t? le nam/nO xap xi 2/1 [8], N h u vay, ket q u J tUOng doi phCi h o p v i i g i i thuyet duoc m d t sd tac gia dUa ra, do la sU chl phdi cua yeu t d di truyen, tuy nhlSn khdng t u a n t h e o quy luat Menden t h d n g t h u d n g ma dl truyen lien ket gldl t l n h [5].
Tudi t r u n g binh cua mau nghien cUu la 9,49.
Benh nhan n h d t u d i nhat la 4 t u d i , Idn t u d i nhSt la 32 t u d i .
4.2. Hinh the rang thCta
Trong t d n g sd 178 rang, cd 105 rang thifa hlnh n d n , chldm 59%, 55 rang thUa n h l ^ u n u m (30,9%), 12 rang thCra htnh t h e gidng rang vTnh v i l n (6,7%), 6 khdi u rang ( c h l j m 3,4%). SU khac biet cd y nghia t h d n g ke vdi p<0,05. Ket qua nay kha t u o n g d d n g vdi nghien cUu ciia L.D. Hamdan va cdng su (2002) vdi cac t J le lan luot la 74,8%, 11,9%, 6,9% va 6,4%
[5]. So sanh vdi nghidn cUu cOa Ashtsh Shah va cdng sU (2008) cung t u o n g d d n g vdi cac t ^ le Ian luot la 7 5 % , 1 2 % , 7 % v a 6 % [ l ] .
4.3. Do can chia
Trong 136 b&nh nhan, 67 benh nhSn cd d d can chia t a n g , chiem 49,3%, 64 benh nhan cd d d can chia binh thUOng (47,1%), 5 benh nhan g l i m d d can chia (3,7%). Chung ta cd t h e thay cac rang thCra v u n g phia trudc t h u d n g gay lech lac rang va thay ddi chi so Bolton d i n ddn tang do can chia.
4.4. Vi trirdng thifa ngam theo chieu tren dU6i Trong sd 49 rang thUa n g l m , t h e o chieu tren - dudi, vi tn' t h u d n g gap nhat la giOra cudng rang vdi dinh sdng ham (71,4%), chi cd 4 t r u d n g h o p rang thUa ngam nam cao, tiep xuc vdi ndn mui (8,2%).
4.5. Hudng mgc cUa rang thita ngam Trong sd 43 rang thUa ngam (khdng t i n h cac u rang), hirdng mgc nguoc chiem 58,1 %. Chi cd 2 rang cd hudng moc binh t h u d n g (ehidm 4,7%).
4.6. Bien chiing cua rang thira ngam Odl vdi n h d m benh nhan cd rang thUa, bien chUng t h u d n g gap nhat la thieu khoang (48,4%), t i e p den la lech lac rang vTnh vien (44,8%), sang
chKn k h d p can c h i e m 7,4%. Cac benh n h l n c6 rar thira n g a m t h u d n g gay can t r d moc rang (51,9«
Cac bien c h i i n g d o rang thira gay ra chu ydu la \k lac rang v d i 52,9%, t i e p d d n la gay c i n t r d mpc rar vTnh vien 35,3%, va sang chan khdp cSn. Kdt qi nay t u o n g d d n g v d i n g h i e n c i l u cOa Tdng Minh Sc va Hoang Viet H i i (2014) v d i t r i e u chii'ng lech k rang c h i e m t ^ Id cao n h a t len t d i 75% [8]. Khdr p h a t hien t r u d n g h o p n a o bj t i d u chan rang vir v i e n hay h l n h t h i n h n a n g t h a n rang. B l e u n l y cd:
khac biet v d i nhCmg n g h i e n c i l u tren t h e gidi nl n g h i e n ctfu ciia Dl Blase va c d n g sU (1971) I I ( k h o i n g 4 - 9% cd h l n h t h a n h nang [6]. Hay Joke (1976) da bao cao 1 t r u d n g h d p t i e u c h i n r i n g ci giufa ham t r d n d o rang thUa (71. SU khac bidt n l y i t h e d o v a o t h d i ki d d , sU p h a t t r i e n cua h§ thdng q u a n g va sU q u a n t a m den h i m rang cdn chi nhieu, vi v l y rang t h i f a dUOc p h l t hien mupn '
gay ra nhCfng b i e n c h i i n g t r e n . H 5. K e t l u a n
Rang thUa v i i n g phia t r u d c ham tren I I van i gay I n h h u d n g ddn c l chifc nang va t h I m my o h i m rang. SU p h a n b d t y le rang thUa khdng deu c gldl, t r o n g d o t;^ le nam g a p 2,5 lan t ^ le nCf, chii y la cac rang thifa h i n h n d n , chiem 59%. Rang th khdng duoc p h a t hien va xif ly kip t h d i cd the g ndn n h d n g bien c h i f n g n h u lech lac rang, c i n I mpc rang, khe thUa v u n g cCfa, Idch lac khdp can N g l y nay, vdi sU ra d d i cua p h i m cat ldp chum hinh n d n , cac bac sy da cd t h e m m d t cdng cu dac I g i i i p xac d j n h chinh x l c vj t r i , hinh t h e cung n nhifng cau true l l n can x u n g q u a n h r i n g thUa m ngam. N h d d d cd t h e dua ra ke hoach dieu tri dii cung n h u xac d i n h d u p c d u d n g t i d p can r i n g th de dang hon cho cac b i c sy phau t h u a t . Tai l i e u t h a m I t i i a o
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2. Schmuckli et al (2010) Prevalence and morphok of supernumerary teeth in the population of a Su community. Short communication. Schw Monatsschr Zahnmed 120(11): 987-993.
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Plaeek Mirko, M.S Miroslav et al (1974) Significance of the labial fi-enum attachment in periodontal disease in man. Journal of periodontology 45(12): 891 -894.
M. Isabel Leco Ben-ocal, Jose F. Martin Morales et al (2007J An obser/ational study of the ^equency of supernumerary teeth in a population of 2000 patients.
Medlclna Oral, Patologla Oral y Cirugia Bucal.
Rajab LD, Hamdan M (2002) Supernumerary teeth:
Review of the literature and a survey of 152 cases. Int J Pediatric Dent 12:244-254.
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Jokela M (1976) Rapid root resorption in central incisor caused by a supernumerary tooth, a case report. Proe Finn Dent Soe 72:56-59.
Tdng Minh Son v i H o i n g Viet N i l (2014) Dgediim ldm sdng, Xquang vd dnh hUdng cOa rdng thUa. Tap cht nghien cUu khoa hpc.
