TAP CHi Y DU'Q'C LAM S A N G 108 Tap 8 - S o 2/2013
Danh gia triln vong cua he thSng ch6t soi trong phue hinh than rang co t6n I^huygt Ion
The Assessment and Progress of Fiber Posts System for the Restoration of Large Area Defect Teeth
Le Thu Ila ' Klioa Rdng.BC-nh vien Trung uang Qudn ddi 108
Ngo \'an Manh" "Bo mdn Rang Hdm Mdt. Dai hoc Y Thdi BinhPhuang phap cam chdt phue hinh la mdt trong nhdng phuang phap dieu trj quan trong sau khi tien hanh dieu tri ndi nha. Vai chuc nam trd lai day he thdng chdt due kim loai thanh pham da trd thanh phuong phap chinh de phue hinh trong nhdng trudng hop rang bj tdn thuang, nhung do ban than chiing cdn ton tai nhieu khuyet diem nen da han che sU sU dung rdng rai cua chung tren lam sang. TU nhUng nam 90 trd lai day khi chdt soi caebon da ra ddi, do chinh Uu diem cua chdt soi nen he thdng nay da da dat dUOc su tin nhiem cua cic bac si lam sang, tiep sau dd la sU ra ddi cua chdt spi thijy tinh, chdt soi thach anh va chdt polyethilen. Hien tai viec sU dung chdt thuy tinh da trd thanh ohuong phap chinh trong phue hinh rang tdn thuong, tuy nhien nd cung boc 16 nhieu khuyet diem Dieu nay thuc day cic nghien cUu mdi ra ddi nhu chdt thach anh. Bai b i o nay danh g i i q u i trinh phat tnen - sU phan loai - nhUng uu diem cCia he thdng chdt soi mdi nhat, ddng thai cd nhUng luu y ve nhUng van de tren lam sang va ve vat lieu, tinh chat cua cac loai chdt nay.
TUkhda: Gay chan rang, chdt sOi, tinh can quang(can tia X)
Summary
Post and core restoration is one of the main methods to restore tooth contour after root canal treatment (RCT). Although metal carted posts and core restoration have been the main trends to fix the defective teeth for decades, there are many shortcomings which have limited their clinical applications.
For 60 years of the last century carbon fiber posts have appeared and been accepted by dentists. And from then on, glass fiber post quartz fiber post and polyethylene fibre caused resin post turn up. Now, the glass fiber post restoration is the main trend in fiber restoration, however, it has its own limitations.
So reseachers have studied the new generation quartz fiber post. This message has reviewed the fiber post history, the merits and shortcomings of every kind of fiber post the basic physical and chemical properties, and the merits of the newest generation fiber post And it also summarized the material and instruments, clinical steps and the problems which should be paid attention to in clinical practice.
Keywords: Root fracture Fiber posts X-ray hinder
Plian bien khoa hoc: PGS.TS NGUYEN TAI SON
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol8-N°2/2013
1 . D a t vain de
Rang sau khi duac dieu trj ndi nha, than rang t h u d n g bi tdn t h u o n g phan ldn t d chdc, vi vay de tang cudng su dn djnh va vUng c h k cua chup rang ngUdi ta t h u d n g tien hanh c^m chdt phue hinh.
TrUde day c i c chdt due va cui kim loai ludn chiem vj the chu yeu tren lam sang, nhUng b i n than chung cdn tdn tai nhUng khuyet diem sau'
1. "Module dan hdi" (Modulus of Elasticity) ldn hon "Module dan hdi" cua nga rang, vi the de s i n sinh Ung luc tap trung trong dng tuy gay gay chan r a n g ' "
2. Tinh chat c i n quang cua kim loai trong phue hinh rang sU khdng kim loai i n h hudng den dp t r o n g suot cua rang. Dieu nay cung i n h h u d n g nghiem trpng den t h i ' m m l cua phue hinh rang sU khdng kim loai.
3. Kim loai trong mieng de bj oxy hda va cd the gay ddc tinh eho eae te bao.
4. Ngay nay chup cpng hudng tU MRI tren l i m sang duac sU dung rdng rai nhUng chdt kim loai ed the gay hien tuong hinh anh gia, tU do anh hudng den c h i t luang chan doan hinh anh cua cong hudng tU.
5. Sau khi gan chdt kim loai neu mudn thay the bang mdt chdt khac la m o t van de rat khd (viec rut chdt kim loai ra khdi dng tuy rat phUe tap).
Vi vay trong nhdng nam gan d i y do tinh chat tuong thich sinh hoc t d t cua chdt sai, tinh khdng bi oxy hda, do ben vat li cao ddng thdi dap Ung duoc yeu cau cua phue hinh rang sd khdng kim loai nen chdt soi rat nhanh dUdc sU d u n g rdng rai.
1.1. Phan loai chdt sai 1.1.1. Chdt sai Carbon
Trong he thong chdt soi, dUpc sU d u n g sdm nhi't chinh la chdt sai Carbon, nam 1990 Durret...'^' gidi thieu nguyen li Ung d u n g va kl thuat che t i e de tang eudng dp eUng cua chdt soi Carbon. Sau dd ki thuat nay duoc s d d u n g rdng rai d thi t r u d n g Au - MI, Do tinh chat dan hdi tdt, de rut khdi dng tuy, cd the d u n g trong phue hinh tham m l ma chdt soi Carbon d i t r d thanh mdt trong nhdng v i t lieu quan t r p n g
t r o n g phue hinh nhiJng rang cd t o n thuang ldn.
Durret lan dau tien dUa ra c h d t soi Carbon nang cao d p CLfng cua he t h d n g cui compocite, module dan hdi cua nd v^ nga rang t u a n g d u o n g nhau nen c6 the phan tan Ung l u c v a han che LTnglUc tap trung.
Nam 1990. Fredriksson gidi thieu " ' mdt loai soi Carbon de tang cUdng d d cdng cCia cui rang va vat lieu nay da t r d t h a n h c h d t sOi Carbon sdm nhat Chdt soi Carbon dupe tao t h a n h bdi vd so sd Carbon keo dai theo cung m d t p h u o n g hudng s3p xep va duac lien ket bdi nhua Epoxy, giUa soi Carbon va cac phan t d nhua Epoxy la m p t mdi lien ket hUu ca.
Hien nay tren thj t r u d n g , chdt soi Carbon chu yeu cd s i n p h a m C-POST^" cua cdng ty Bisco (IVly) va he t h d n g Carbopost cua c d n g ty Carbotech (Phap).
Chdt sai Carbon cd m o d u l e dan hoi thap va co kha nang c h d n g lao hda cao c u n g t i n h tUOng thich sinh hpc tdt, vi vay dat d u a c su tin d u n g cua cac bac si phue hinh. N h u n g d o mau sac cua loai chdt nay la mau den khdng cung vdi m a u sSc rang va khong t h i ' u quang nen khong thich h a p dung trong rang sU khdng kim loai va khdng t h e lam hai Idng eae yeu cau cua nha khoa t h a m ml. Cung vdi su phat trien cua khoa hpc, hien nay m a u sac cua chdt dupc cai tien thanh mau t r i n g hoac trang sCfa, chi cd mpt cot mau den rat n h d d tam chdt.
l.l.2.Ch6t sai thuy tinh
Hien nay tren l i m sang san pham chdt sol thuy t i n h duac sU d u n g chu yeu ed Luscent Anchors, Parapost Fiber, Fiber Kor... Thanh phan chu yeu cua chdt soi thuy t i n h la SiO^, t d n tai dUdi hinh thde phi tinh the. Do t i n h chat d i n hdi tdt, d d cdng thap va t u o n g d u o n g vdi d p c d n g cua nga rang nen chotsoi t h u y t i n h khdng gay Ung luc tap trung trong ong tuy. Cdn chdt kim loai t r o n g qua trinh phue hinh dng lUc chu yeu t i p t r u n g d phan chdp chan rang nen de gay gay chdp chan rang "'. Tuy nhien chdt sol thiiy t i n h con ed nhieu khuyet d i e m sau: t h d nhat, nhiJng s i n pham chdt soi dau tien khdng can quang khi chup X-quang, dac d i e m nay gay t r d ngai tren lam sang va khd k h i n c h o qua t r i n h kiem tra chat lUdng dieu trj c u n g n h u k h d khan t r o n g viec riit chdt sOi t r o n g t r u d n g h o p phue hinh that bai. Hien nay cung 100
TAP CHi Y DU'O'C L A M S A N G 108 Tap 8 - 3 6 2/2013
vdi sU p h i t trien cOa khoa hoc kl thuat, mdt sd s i n pham chdt sal thiJy tinh da cd tinh can quang. ThU hai, difdi t i e dung cua lUc c i n , sU bien dang cua chdt soi thuy tinh lam c i c ch^t gSn ket phai chju luc keo va luc cat, tU do i n h hudng den dp kbit giUa thanh dng tuy va chdt soi, iam g i i m chat luang dieu tri.
1.1.3. Chdt sai thach anh
Cung n h u chdt sol Carbon, chot sol thach anh duoc tao thanh khi thay the sai Carbon b i n g soi thach anh. Loai chdt soi nay ve b i n chat t u a n g d d n g vdi chdt sai thuy tinh, thanh phan chu yeu la SiOj, nhu'ng su khac biet giUa chung la chdt sai thuy tinh 6 dang SIO, phi t i n h the con chdt thach anh dudi dang SiO^ t i n h the. Module dan hdi cua thach anh nam trong khoang t d 15 ~ 7 GPa va tUong dUOng vdi module dan hdi cua c h d t soi thuy tinh. Thach anh la mdt loai vat lieu it dan n d do nhiet dd v i cic spi thach anh cd t i n h nang ca hpc (tinh gan ket) tdt va tinh t h i ' m m l cao, vi the nd la m o t loai vat lieu tuang ddi li t u d n g t r o n g phue hinh bang chdt soi- Neu dem so sanh vdi mau den cua chdt sdi Carbon thi mau trang cua chdt soi thach anh ed t i n h thi'u quang tdt han, do vay chung duae ua ehudng hon trong phue hinh nha khoa tham ml, NhUng the he chdt thach anh m d i nhat chu yeu cd d d n g san pham D.T.Light Post va he t h d n g Aesthetic Plus cua edng ty Bisco (MI) va he t h d n g FRC Post Plus cua cong ty Ivoelar. Trong thanh phan cua chdt thach anh cua hai cdng ty tren cd pha nguyen t d n h o m , vi the tdn tai tinh c i n quang nhi't dinh. Neu so s i n h vdi nhu'ng loai chdt soi ed tinh can quang tha'p thi chdt soi thach anh tren l i m sang de kiem tra ket q u i va phan tl'ch han, ddng t h d i chdt sai thach anh cd tinh thi'u quang tdt. vi the t r o n g t r u d n g hap gan ket b i n g nhUa composite cho hinh i n h quang t r u n g tdt hon.
NhUng dos Santos Alves Morgan LP ...'^' tien hanh thi nghiem vdi t i n h tha'u quang cua chdt soi phat hien ra d dp sau cang Idn thi eudng dp i n h sang cang nhd, d i e biet la 1/3 chdp thi hieu q u i quang triing khdng dat dupe. Trong t r u d n g h o p nay, chdt sai thach anh ed uu diem hon c i c loai chot soi khic, nhUng day van la m o t van de chUa dupc giai quyet triet de. V\ the tren lam sang ngudi ta cd the sd dung
nhUng phUOng phap g i n ket (Dual - cure) ket hap gida p h u a n g phap quang trung hap va hda hoc, hoac p h u o n g p h i p g i n ket hda hpc de phat huy hieu q u i gan ket tot hon, Akkayan '''' tien hanh thi nghiem vdi k h i n i n g chdng dUt gay cua chdt hap kim titan, chdt thach anh, chdt thuy t i n h va chdt zirconia. Ket qua cho thay chdt sai thach anh cd kha n i n g chdng dut gay tdt nhat vi gia tri module d i n hdi cua nd tuong duong vdi module dan hdi cua n g i rang, thi nghiem cung chi ra rang sU dUt gay cua chdt x i y ra trUdc khi c h i n r i n g bj gay. Chdt hop kim titan de dUt gay nhat vt g i i trj module dan hdi cua nd tuong ddi ldn, trong thi nghiem dUt gay thi than r i n g gay trUde khi chdt sai titan gay. Dieu nay chi ra r i n g chdt sdi thach anh cd tinh chat b i o ve t d t ddi vdi c h i n rang trong nhUng trudng hap da dieu tn tuy, neu cd m o t lUe rat ldn t i c ddng, chdt thach anh se gay trUdc khi chan rang bj gay, vi the p h i t huy duoc kha nang bao ve r i n g cua chdt thach anh.
1.1.4. Chot sgi polyetylen
Chdt sai polyetylen b i n chi't la nhua compocite duoc gia cd b i n g c i c sai ribbon polyetylen de tang cudng do cUng, tinh ben va k h i n i n g chdng lao hda.
Khic vdi nhUng loai chdt sai khic, loai chdt nay tren lam sang duoc true tiep tao thanh b i n g each dd nhua composite luu ddng vao dng tCiy da dUOc sUa soan hoan tat. Sau dd dung m o t hay nhieu soi polyetylen d i tham s i n nhUa composite cung cdng cu chuyen dung de c i m vao dng tuy da sUa soan tren, cudi cung dung anh s i n g cCia den halogen de quang trung '". Neu so sanh vdi chdt sal thuy tinh thi he t h d n g chdt soi polyetylen kbit hon nhung kem dan hdi hon, San pham tren thj trudng dUpc biet den la he t h d n g Ribbond cua Mi.
1.2. Tddng quan vatlieu 1.2.1. Vat liiu gan kit chot sgi
Neu so sanh giUa vat lieu g i n ket truyen t h d n g la cement, kem carboxylate va glassionomer cement thi dung nhua compocite de g i n ket eho hieu q u i tdt hon. Theo Sahma.,.'^' dung eae vat lieu g i n ket khac nhau de gan ket chdt sai thi nhua composite cho hieu qua t d t hon so vdi glassionomer cement
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol 8 - N°2 /2013
d i n g ke. Ba - chich.i'^' tien hanh t h i n g h i e m vdi chdt hdp kim va chdt soi Carbon, phan biet d u n g cac c h i t g i n ket khac nhau n h u kem phosphat, xi mang thuy tinh va nhUa composite. Thi nghiem cho thay nhUa composite cd ket q u i tdt hon rd ret va khdng phu thudc vao b i n chat cua vat lieu cau thanh chdt spi.
1.2.2. Vat lieu tao cui
Vat lieu tao cui cd hai loai: mdt loai chinh la chi't g i n ket giUa chdt sai va nga rang, va khi g i n ket d d n g thdi ta tao hinh cui rang bSng chinh vnt lieu i'y, n h u Paracore (Colent), Clearfil DC core (Kuruary), Smart Mix (OMG)... Cdn loai thU hai l i sau khi g i n xong chdt soi vao dng tuy, diing mdt loai vat lieu k h i c de tao ciii, n h u Unicem Rylex (3M), Calibra (Densply)
1.2 3. Dung cu lao hinh ong tuy
Dung cu tao hinh dng tuy g o m mui khoan G (Gates Gliden Drills) va mui khoan P (Peesoreamer), khoan G de lam sach v i lay di m o t phan nhung vat chat cua qua trinh dieu tri ndi nha n h u gutta, cortisomon.,, Sau do diing mui khoan P de tao xoang dat chdt soi. Phan ldn c i c hang deu cd mui khoan di kem vdi s i n pham cua minh nhU: he t h d n g D.T.Light Post cua edng ti Bisco, dUdng kinh cua cac mui khoan tao hinh phan biet l i 1,25mm; 1,5mm;
1,8mm; 2,2mm.
7.5. Van de xd li be mat cua chdt sai va phuang phap cat
1.3.1. Xdiibe mdt
XU li be mat la m o t trong nhung p h u o n g p h i p lam t i n g dien tich gan ket, giup chdt soi cd dinh t d t hon t r o n g dng tuy va tang dp g i n ket giua chdt sai V3 vat lieu g i n ket. Cac bien phap xCr li be mat hay d i i n g g d m : phun xU li be m i t , bdi silane coupliny agent va x d li be mat b^ng acid n h u hydroluoric acid hoac acid p h o s p h o r i c " " " l
1.3.2. Phuang phdp cat chot sgi
Khi cat bo phan thda cua chdt spi t h u d n g d i i n g mui khoan kim cuong, neu d i i n g keo hoac kim cat dUt se Iam hong ket cau cua sgi. Grandini"^' tien hanh thi nghiem diing mui khoan kim cUong.dla cat
kim CUdng va thCr n g h i e m tren s i u loai chdt soi khac nhau. Sau d d kiem tra be m a t e i t d u d i ki'nh hien vi dien tU, ket q u i cho tha'y d u n g m u i khoan kim cuang b^ mat Ccit t o a n ven, d i i n g dia cat kim cuong thiet dien t u a n g ddi t o a n ven, cdn t r u d n g hop diing keo thiet dien c i t ed dUdng gay va d u d n g gay dddi sau vao than chdt.
Ket luan
SU ra d d i cua c h d t sai 6a k h i c phue dUcfc nhieu han che cua chdt kim loai truyen t h d n g , nd cd nhieu uu diem nhU:
1. K h i n i n g chdng lao hda 2. Chdng i n m d n
3. Cd the rut ra trong trudng hap dieu tri that bai 4. Op t u a n g thich sinh hoc t o t
5. Tinh c h i t co hoc t u o n g dUOng vdi td chij'c rang '''^"""
6. Khong anh h u d n g d e n chup cpng hudng tir (MRI) N h u n g t r o n g he t h d n g chdt sai hien nay cung con t d n tai m p t sd khuyet d i e m nhU:
1. Dudi t i c d u n g cua luc can, su bien dang ciia chdt soi thuy t i n h lam cac chat gan ket ehiu luc keo v i luc eat tU do i n h h u d n g den dp kbit giCfa thanh dng tuy va chdt soi.
2. V i n de anh hUdng cua su thi'u quang va sU dan truyen anh sang tdi qua trinh quang triing can duoc nghien cdu sau h o n .
Tai lieu t h a m khao
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TAP CHi Y DU'O'C L A M S A N G 108 Tap 8 - S o 2/2013
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