Y HOC Vl|T NAM THANG 8 - SO 2/2014
DANH GIA KET QUA DIEU TRI HOI CHU'NG NUT VOf RANG 6" NHOM RANG H A M
T O M TAT
Nghien ciiu thi/c hien tren 38 benh nhan v6i 55 rang ham co hpi chiitig nut v9 rang. 45 rSng di/cfc bao tSn va theo doi sau 2 nSm di@u tri. Ket qua danh gia Chung, 38 ring dat tot chiem 84,44%, 4 rang dat loat kha (8,89%) va 3 r^ng loai kem (6,67%).
Titlchda: hoi chutig nut vd rang.
SUMMARY
EVALUATE THE EFFECTIVENESS OF THE TREATMENT OF CRACKED TOOTH SYNDROME I N MOLAR TOOTH GROUP
Research carried out on 38 patients w/ith 55 teeth of cracked tooth syndromes. 45 teeth is preserved and monitored after 2 years of treatment.
The results show that, 38 teeth reached the good level of 84,44%, 4 teeth reached fair level of 8,89% and 3 teeth reached weak level of 6,67%, respectively.
Keywords: cracked tooth syndrome
I.OiSlTVANeE
Hpi chilYig nut v 8 rang CIS (cracked tooth syndrome) la mot trong nhu'ng chan doan kho trong Nha khoa. Benh nhan thu'dng mo ta trieu chutig dau choi khi nhai H mot nhom rang ma khong xac djnh duWc chi'nh xac rang nguyen nhan.
NhJJtig trieu chtifng tam sang va X-quang thdi ky dau rat mb nhat. Chan doan chfnh xac va dieu trj scfm CO the cham dut tinh trang kho chju keo dai khong can thiet doi vcfi benh nhan va tranh du'dc nhuTig phu'dng phap dieu trj phtfc tap.
Qua 3 nSm theo doi nhu'ng benh nhan den kham chuyen khoa tai Khoa A l l chung toi ghi nh$n duUc 38 b§nh nhan vdi 55 rang bj nut v3.
Bai Viet nay du^a ra mot cai nhin tong quan ve trieu chiing lam sSng, chan doan va each yi.\i ly chung cho cac trudng hdp nut v3 rang ham (rang sau) vdi muc tieu cu the la:
Phalli Thj Thu H5ng*, Le Thi Thu Ha*
1. Mo ta trieu ch'&ng iam sang va phan ioai cac dudng nut tren mo rang d nhom rang ham (rang sau).
2. Danh gia ket qua deu tri sau hai nam theo ddi.
IL DOI TU'DNG VA PHUCyNG PHAP NGHIEN COU 2 . 1 . fiol tu'dng nghien cu'u:
NhuYig benh nhan du'dc dieu trj chuyen khoa Rang tai khoa A l l t\i thang 1 nam 2010 den thang 1 nam 2012.
2.2. Phu'dng phap nghien cu'u:
Thiet ici' nghien cui/: Nghien ciTu can thiep, tien cu'u theo doi dpc.
Thdl glan nghien cui/: Thdi gian theo doi de danh gia ket qua tren lam sang la 2 nam.
Qua trinh nghien cdu:
+ Li/a chpn benh nhan: Kham lam sang, chpn benh nhan co chan doan niit v3 mo rang tru'dc va sau dieu trj.
+ Mo ta cac trieu chu'ng thu'dng gap.
+ Phan loai du'dng nut: theo 5 loai dk neu tren.
+ Xu" tri ton thu'dng: Tuy tru'dng hdp ma co chi djnh dieu trj npi nha hay bao ton tuy, lay manh v3 hay khong, nao lo dd hoac trIch abces (trong tru'dng hop du'dng niit di du'di Idi), nho rang, lam chup bao ve.
+ Phuc hoi mo rang; lam chup su" bao ve trong tru'dng hpp du'dng niit thupc phan loai 1,2,3 tren lam sang. Tru'dng hdp mo rang ton thu'dng it - tram composite phuc hoi to chii'c cuTig bi m a t
Theo doi sau 2 nam dieu trj ve trieu chiilig lam sang, hinh anh X-quang can chdp va chat lu'dng phuc hinh.
Phu'dng phap danh gia kit qua:
Tong hdp cac chi sd ve trieu chu'ng 16m sang, hinh anh X-quang va chat lu'dng phuc hinh, ket qua danh gia se phan thanh 3 mdc dp: tot, kha, kem d thdi diem 2 nam.
* BSnh vien TW QO 108 Chiu trSdi nhlim chinh: l& Thj Thu Ha Ernail: [email protected] Dt: 0912043160 Phan bi^n khoa hpc: GS.TS Le Gia Vinh Ngay nhSn bai: 21/6/2014
YHOC VIET NAM THANG 8 - S6 2/2014
STT
1
2
3 Tieu
chi danh
gia Trieu chu'ng lam sang
Hinh anhX- quang
Chat lu'dng phuc hinh Danh gia
chung
Kem
Van con dau, e nhiTc tal rang nguyen nhan. Niem mac day hanh lang phu ne, xung huyet, co the co 16 do.
- V6i rang da dieu trj tuy: chat han ong tuy thieu dp day dac, co cho trong chua du'dc tram bit, c6 khoang trong giiia vat iieu tram bit va thanh ong tuy.
Co hinh anh ton thu'dng cuong rang.
- V6I rang bao ton tu'/: thay hinh anh u hat hoac nang quanh cuSng.
- Vdi chup sit: niit v3 sit I<h6ng sua chiia difdc. Hd diTing hoan tat gay rat thu'c an. Bong phuc hinh.
- Vdi mieng tram composite: bong, v3 mienq tram composite.
0/3; 1/3 tot Kem
Tot
Benh nhan hoan toan ichong co tneu chu'ng dau nhu-c, e buot tai rang nguyen nhan. Mo nha chu binh thu'dng, niem mac day hanji lang vung rang tu'dng uTig I<h6ng phu ne, xunq huyet. Khonq co lo do.
- Vdi rang da dieu tr| tuy: vat iieu han ong tuy can quang dong nhat, each chop rang tit 0,5-lmm. Khong cd i<hoang thau quang glua vat iieu tram va thanh ong tuy.
Khong co hinh anh ton thu'dng cuong rang.
- Vdi rang bao ton tuy: lihong co hinh anh u hat hoac nanq quanh cuonq rang.
- Vdi chup SLT: viJng chac, Ithong co hien tu'dng nut v9 sir, du'dng lioan tat i<hit sat vdi mo rang.
- Vdi mieng tram composite: khong bong v8, CO nqdt. Khft sat vdi mo rang.
2/3 tot Kha
3/3 tot Tot PhWOng phap xiyiy so lieu
Cac thong tin, so iieu ciia benh nhan du'dc IUu giil trong may tinh va xir ly bang phSn mem Epi info 6.04. Su' dung thuat toan thong ke tinh t / ie, so sanh bang thuat toan x^.
III. KET QUA VA BAN LUAN
Nghien cffu thu'c hien tren 38 benh nhan vdi 55 rang, qua trinh theo doi trong 2 nam da thu du'dc nhutig ket qua sau:
Bang 1. So iieu benh nhan (n = 38) Gidi tinh
Nif Nam
So lu'dng 5 33 38
Ty le % 62,86%
37,14%
100%
Tuoi (trung binh+do lech chuan) 44,688 ± 10,460 55,307 + 10,398 51,471 ± 11,202
Nghien cdu cho thay so iddng benh nhan nam trong nghien cud cao han so vai benh nhan nu'.
Tudi trung binh_ cua hai gidi khac biet co y nghia thong ke vdi T= 4,99 > 2,7 = t (36; 0,01/2) Do dac diem benh nhan trong khoa nen sd benh nhan nam va nd' chenh iech nhau ro ret. Khoa tiep nhan phan idii benh nhan nam, cao tudi do do tudi trung binh hai gidi cung co su'khac biet.
Bang 2. Cac trieu chiiinq thudnq qap.
NhO'ng trieu chu'ng lam sang thu'dng gap Oau Choi khi nhal cham phai
Dau khi an nonq, lanh, chua, nqot Ou'dnq ran tren than rang ntiin thay du'dc Lo do, abces vung Idi tffdnq u'nq Manh rang lung lay Sirt, v8 mat mot phan than rang Cd diem hd tuy tren than rang v3
n 39 27 35 9 12 26 19
70,90%
%
49,09%
63,63%
16,36%
21,81%
47,27%
34,55%
Y HOC VigT NAM THANG 8 • SO 2/2014
Trieu chiitig du'dc nhieu benh nhan nhan biet nhat la dau choi khi nhai cham phai. Mpt so it benh nhan den mupn vdi lo dd hoac abces chu'ng to ton thu'dng da co tu'dng doi lau va bj bo qua.
Vdi nhiJng rang do cd lo do va abces, hau het co
chi dinh nho bd. Khuyen cao benh nhan, khi co nhiJng dau hieu bat thu'dng nho nhat d rang nen den kham de XLT ly kip thdi. Trieu chuTng cang nang thi kha nang nho' bd rang cang Idn.
Bang 3. So rang cd CTS tren moi bgnh nhan Strang CTS/1 bn
So benh nhan So rang
1 rang 25
2 rang 9 25 1 18
3 rang 4 12
Tong 38 55
Trong nghien cdu nay, benh nhan mang nhieu rang co hoi chu'ng CTS nhat la 3 rang. Phan idn benh nhan cd 1 rang bi CTS. NhOhg binh nhan co nhieu rang CTS, thudng co van de sang chan khdp can, mun mat nhai, hoac co sd tdn thddng can ddi 2 ben.
Bang 4. Phan loai du'dng nut tren md rang va phu'dng phap dieu trj.
^ — ^ P d i i e u tri PhSn loaF^"-^^
Loai 1 Loai 2 Loai 3 Loai 4 Loai 5 ToNG
Tram composite
4
4
Chup rang bao ton tuy
5
5
Chup rang, dfeu tri tuy
22 13 1
36
Nho rang
4 3 2 9
Tong 31(56,36%) 14(25,46%) (Ibn bo dtri)
5(9,09%) 3(5,45%) 2(3,63%) 55 l^pt benh nhan cd rang nut theo phan loai 2
khong quay Iai tiep tuc dieu trj. Vdi phan loai 3, chan rang gay du'dc nho bd, phan cdn Iai khong lay hoac lay dp 1, dp 2 cd the bao tdn lam chup bao ve. 9 rang da nho va 1 rang khong dieu tri se khong cd danh gia sau 2 n3m dieu trj. Tru'dc day, thu'dng quan niem cac rang dd dieu tri tuy mdi a n phai lam chup bao ve. Theo quan diem
cua chiing toi, cac rang dd cu CTS deu cd nhihig du'dng niit khd kiem soat, do li/c nhai cd the nhii'ng du'dng niit se Idn hdn, gay anh hu'dng den tuy rang va lam mat ttiem to chii'c cii'ng cua rang. Chinh vi vay chiing toi chi djnh lam chup bao ve rpng rdi cho ca cdc rang chuci bj ton thu'dng tuy.
Bangs. Phan ioai theo nhdm rang.
Ham tren Ham du'di Tong
Rang ham nho n S 4 12
»/o 14.55%
7,27%
21,82%
Ran n 24 19 43
g ham Idn 43,63%
%
34,54%
78,17%
Tong n 32 23 55
58,18%
%
41,81%
100%
Sif phan bo theo nhom rang cua cac rang bl CTS glOa ham tren va ham dwell twang dwang nhau co y nghia thong ke vcllQ= 0,451 < q (1;0,0S) = 3,841. (do tin cay 95%), P>0,OS(P=0,5)
Oinh giS ket qua diHu tri Tieu chi danh giS LSmsang Tot
Kem
sau 2 n^m theo doi. (n=45) Bao ti5n tuy
+ chup sii' 5
Chifa tuy + chup su'
32 4
Tram composite 4
Tong 41
4
Y HOC VI$T NAM THANG 8 - SO 2/2014
x-quang Phuc hinh
Tong Tot Kem Ta Kem
5 5 5
30 6 35
1 36
4 3 1 4
39 6 43
2 45
STT 1 2 3
Tieu chi danh gia Trieu chirnq iam sang
Hinh anh X-quang Chat iUdng phuc hinh Dcinh gia chung
Kem 4 6 2 3 (6,67%)
Kem
Tot 41 39 43 4 (8,89%)
Kha 38 (84,44%)
Tot
Tong
45 Trong tdng so 45 rang dddc theo doi trong 2 nam, co 38 rang dat dddc ca 3 tieu chf dinh gia li tot nen kit qua danh gia chung dat tot 4 rang dat 2 tieu chi tot, danh gia chung ia kha, 3 ring cdn Iai chi dddc danh gia la kem.
IV. Kir LUAIVl
Nghien ciiH thu'c hien tren 38 benh nhan vdi 55 rang du'dc chan doan cd hpi chu'ng niit v3 rang, sau khi dieu trj theo doi 2 nam ve trieu chu'ng lam sang, hinh anh X-quang va chat lu'dng phuc hinh sii", ket qua thu du'dc cho phep du^ ra mpt so ket luan sau:
4.1. Mo ta trieu chu'ng lam sang va phSn loai cac du'dng nut tren mo rang 6 nhom rang ham (rang sau)
Trieu chutig sdm va hay gap nhat d 38 benh nhan la dau chdi khi an nhai (70,9%), tiep theo la du'dng ran tren mo rang phat hien du'dc khi tham kham (63,63%) va it gap nhat la abces, lo do d vdng Idi tuWng u'ng chan rang (16,36%)
Phan loai 1 chiem ty le cao nhat va la td'n thu'dng nhe nhat, do dd phat hien sdm d phan Ioai nay kha nang bao tdn rang va can thiep toi thieu se cao hdn. Phan Ioai 4 va 5 cd ty le nho bd la 100%.
4.2. Danh gia ket qua dieu trj sau hai nam theo doi.
Sau 2 nam theo dui ket qua dieu trj d 45 rang du'dc bao ton, cd 38 rang (84,44%) ket qua dieu trj chung dat Ioal tot, 4 rang (8,89%) dat loai kha va 3 rang (6,57%) la Ioal kem.
TAI LIEU THAM KHAO 1. Gabrial R. Zukerman.
2. Rang nut: m$t tinh trang chuyen tiep trong mdt quo trdnh dien bien dan" (Tai lieu djch).
Cap nhat Nha khoa. Tap 5- S6 2/2000 (tr.67-72) 3. Cameron CE. "The cracked tooth syndrome." J
Am Dent Assoc 1964;68;405-11.
4. Louis H. Berman and Sergio Kuttler, DDS.
"Fracture Necrosis: Diagnosis, Prognosis Assessment, and Treatment Recommendations.'' JOE - Volume 36, Number 3, March 2010.
5. Niek J.M. Opdam. "Seven-year Clinical Evaluation of Painful Cracked Teeth Restored with a Direct Composite Restoration." JOE - Volume 34, Number 7, July 2008.
6. William Kahfer. "The cracked tooth conundnjm:
Terminology, classification, diagnosis, and management", Am J Dent 2008;21:275-282.
