y HOC VIET NAM T H A H G 6 - SO 1/2014
DANH GIA KET QUA DIEU TRI NOI NHA B A N G PHU'aNG P H A P SIJA SOAN ONG TUY VQI T R A M XOAY NI-TI PROTAPER
Le Thi Thu Ha*
T6M TAT
Nghien culi du'dc thi/c hien dieu tri noi nha bang phutfng phap sute soan ong tu^' tren 184 rang bang he thong tram xoay Ni-Tl Protaper du'dc chia lam 3 nhom:
Nhom 1: 62 ring du'i;fc sii^ soan ong tuy bang he thong trSm xoay may ftotaper. Nhom 2: 61 rang duWc ^ dung h§ thong tram tay Protaper (su" dung ky thuat stte soan ong tuy butit xuong Crown - Down). Nhom 3: 61 ring d u ^ su^ soan m g tuy bang trSm tay thong thu&ng.
Ddnh gia hieu qua 5u^ soan ong tuy cua he thong tram xoay NI-TI Protaper
So v6i he thong tram xoay thong thudng sau 6 thang vei sau 1 nam k ^ qua la: Viem tuy l<hdng hoi phyc diiem 78,8%, day ia benh ly thu'dng gap tren lam Scing. Trong dieu tri npi nha rdng so 6 hay gap nhat (chlS'm 48,3%). Hieu qua sijte soan vdi tram xoay Protaper may va tay ^ t hdn tram xoay thong thu'dng ket qu^ sau 12 thang hieu qua su^ soan ong tuy tot chi€m t/1? 90,3%, t ^ m xoay tay tot chilm ty le 86,8%
vS tram xoay thong thu'dng la 52,4%, tram xoay NI-TI Protaper giff nguyen vj tri to cuong rang va hinh dang ong tuy ban dau so vdi tram xoay thong thu'dng.
Tiy khoi: Npi nha, trSm xoay Protaper.
SUMMARY
THE ASSESSMENT OF THE RESULTS OF ENDODONTIC BY THE CANAL PREPARATION METHOD U S I N G NIKEL -
H T A N I U M ROTARY PROTAPER The study treatment (root canal) by meduliary tubes compose method with rotating brooch Ni-n protaper on 184 teeth. Is divided into three groups.
Groupl: 62 teeth root canal tubes preparedby protaper rotary brooch by the method step sow (Crow down).
Group2: 61 teeth root canal prepared by protaper rotary brooch. Group 3: 61 teeth was composed by marrow pipesaw brooch handles normal in oeder to evanluate the effectiveness of tubes prepared brooch rotation Ni- Tl protaper after care, after 6 months and after 1 year. The result: Inflammation of the spinal cord do not regenerate accounted for 78,8%.
Pathological met many on clinical, dental treatment in the teeth of 6 is the most common accounting for 48,3%. Effectlveway of pipe turning machine and run bnxxrh rotate hand protaper system better than brooch hand normal: Results afte 12 months saw a slew of good protaper accounted for 90,3%
rotaredbrooch hand protaper good accounting for 86,6%. And brooch handles normal acxuunted for
* Khoa f^ng BVTWQD108
Phin bi$n khoa A(«r;GS.TS Le Gia Vinh
62,4%. Brooch Ni-Tl rotary protaper effectively and maintain position of the tooth shape and foramen teeth at first compared to conventional rotating brooch.
Keywords: Endodontic, Ni-Ti Rotary protaper.
\. OAT V A N £>E
Npi nha la mot chuyen nganh nha khoa ma doi tu'dng la nhij'ng van de lien quan den hinh thai, sinh ly hoc, benh hoc tuy rang. Trong dieu trj npi nha mpt trong nhu'ng glai doan quan trpng nhat la giai doan s u ^ soan va tao hinh ong tuy.
Viec lam sach va tao hinh ong tuy phai co dung cu chuyen biet. Ljch s\i ve dung cu noi nha dirdc ke den tu" nam 1852, Arthur da sir dung mot d i y tram nho de lam rgng ong tuy rang cho tdi nam 1974 tieu chuan ve dung cu npi nha mdi du'dc quy chuan. Muc tieu toi uli cua dieu trj noi nha la tram bit ong tuy theo ba chieu trong khong gian van de nay can hieu ro rang viec tap dang ong tuy phai dat du'dc dp thuon toi thieu la 6 % va g i i j nguyen cau true giai phau hinh dang ong tuy.
1990 lan dau tien Ni-Ti du'dc du'a vao sir' dung trong npi nha de khac phuc nhu'ng han che cua dung cu bang thep khong gi theo tieu chuan ISO va giup cho viec sift soan ong tuy cong du'dc de dang, cac nha san xuat da d u ^ ra dung cu tram du'dc che tao bang hdp kim Ni-Ti vdi 2 dac tinh u'u Viet la deo dai va co kha n^ng phuc hoi lai hinh dang ban dau. Dung cu nay du'dc cac bac sT nha khoa ap dung trong nhChig thap nien qua va da nhan ra \iu nhu'dc diem cua no. li! nam 2005 he thong tram xoay Protaper ra ddi va du'dc u'ng dung dieu tri npi nha tai Viet Nam, tu" nani 2008 den nay khoa l?ang BVTWQO 108 da utig dung bo tram xoay Protaper trong dieu tx\ npi nha. Oe danh gia hieu qua ciia he thong tram nay chung toi da tien hanh nghien ciilj de tai nay vcfi muc tieu: Oanh gia hieu qua su^ soan ong tuy cua he thdng tram xoay Ni-Ti Protaper so vdi he thdng tram xoay thong thudng.
II. VAT L l i u O g N G e g VA P H L r a N G P H A P NGHIEN CO'U
2 . 1 . DiJng cu Protaper: Oay la tram NI-TI xoay mdi nhat, thiet ke dac biet cai thien qua trinh chuan bj ong tuy dac biet nhutig tru'dng hdp ong tuy kho, bj canxi hoa va cong nhieu.
2.2. Ooi tu'dng nghien cu'u:
Y HOC VIET NAM T H A N G 6 - S01/2014
- Cac benh nhan ro rang bj viem tuy khong hoi phuc hoac cac ton thu'cfng benh ly tuy l<hac nhu'ng c6 chl dmh dieu tn npi nha khong phau thuat tuoi tCr 16 den 60 tuoi.
- Tieu chuan loai trCr: - NhuTig rang viem quanh cuong man tfnh co chl dinh dieu tri npi nha va phau thuat.
- Rang chu^ dong kin cuong do sang chan hoac rang chu^ tru'dng thanh,
- Vung quanh rang tieu xu'dng qua 1/2 chieu dai chan rang.
2.3. PhiTdng phap nghien cij'u.
184 rang du'dc chia lam 3 nhom.
Nhom 1. (62 rang) chuan bj ong tuy bang tram xoay may Protaper theo hu'dng dan cua nha san xuat su'dung bu'dc xupng (Crpwn- Down).
Nhom 2. (61 rang) chuan bj ong tuy blng tram xoay Protaper xoay tay sii dung theo hu'dng din cua nha san xuat. SlJ dung bu'dc xuong Crown - Down
Nhom 3. (61rang) chuan bj bang tram xoay tay thong thu'dng K va H bang phu'dng phap bu'dc lai (Hybrid- Technique).
2.4'. Tieu chi danh gia l<et qua Danh gia ket qua su^ soan ong tuy duS tren 5 nguyen tac cd hpc cua Schilder de danh gia kha nang siia soan ong tuy cua hai loai tram xoay Protaper va tram xoay thong thu'dng tren tlTng ong tU'/ bang hinh anh XQKTS.
2.5. Phu'dng phap xiy ly so lifu Toan bo so lieu du'dc xu' Iy bang chu'dng trinh Epi-Infb 6.04 cua WHO.
KET QUA N G H I E N CO'U
3.1. M$t so dac diem cua doi tu'dng nghien cihi ^ Chung toi dSu trj chg 172 benh nhan'trong dd cd 52 nam va 120 nff, luS tuoi tir 16 den 60 (184 rang)
Bing 3.1. Phan bo benh nhan theo tuoi ya qidi.
Sd lu'dng
Ty le %Sd lu'png
TyleSSo lu'dng long so
Tv 11%
34
65,38 92 76,66 12673,25
9,61 10
8,33
158,72
25,01 15,01 18,03
^ Tong so I S2 I 30,24 I 120 I 69,76 I 172 I . 1 0 0 , . , Nhgn xet: Bang 3.1 cho thay benh nhan, trong nhbm tudi 15-34 cd ty e cao nhat trong nhom nghien' ciJu (73,25%) n\l nhieu hOn nam (nff 69,76%, nam 30,24%)
Bing 3.2. Phan bd cac the benh theo nhdm nghien cifu.
Nhom
Chan doiin Tuy hoai tiT"
Protaper xoay N = 62 may
Protaper
xoay N = 6 1Tram xoay tay thong thu'dng
n = 6 1
Tong so Tyle
(%)
16
Viem tuy khong hoi phuc 52 78,80
Viem quanh cuong cap
Viem quanh cuong man _5,45_
'Tong so
Nh$n x^t: Bang 3.2 cho thay ton thu'dng viem tuy khdng hoi phuc chiem ty le nhieu nhat 145/18^
rSng (78,80%).
Bing
^ - ^ ^ a n g Nh6ifr^~^
Protaper xoay mau Protaper xoay tay Tram tay thong thu'dnq Tong so Ty le (%) Nh|n xit:
chiem tyle
3.3. Phan bo nhdm nghien cffu theo nhdm
Ham tren
R l 0 0 0
R2 1 0 0 0 1 0 1 0,3 Bin cao
g3.3 ihat(
R3 2 0 1 3 1,63 Cho 30,4i>i
R4 3 5 3 11 5,97 thayt i)sau
R5 1 4 2 7 3,80 rong c dddi
R6 9 12 12 33 17,9 ic nho n ring
R7 8 7 9 24 13,04 m ngh 6 ham
rang
Ham difdi R l
1 0 2 3 1,63 en a trin
R2 1 0 1 2 1,08 'nj cua '17,91
R3 1 3 0 4 2,17
chu
•} va 1
R4
2 3 1 6 3,26 ig tdi ang s
RS 3 2 1 6 3,26 rang 77ha
R6 20 17 19 56 30,4 him s
•ndub R7 10 8 10 78 1.5,2 0 6 he 1(15,.
Tong
so
62
61
61
1 8 «
mdiK vm '%)
Y HQC VIET HAM T H A M G 6 • SO 1/2014
3.2. D i n h gia ket qua si^a soan ong tuy Bang 3.4. Ket qua su:a soan onq tuv Danh gid
Tot Trunq binh
Tong so
Proterpes may So Iffdnq
56 6 62
Tyle 90,3 9,7 100
Proterpes tay So Iffdnq
53 8 61
Tyle 86,8 13,2 100
Tram tay thong thirdng Sd IffOnq
32 29 61
Tyle 52,4 47,6 100
Tong so S/ lu'dnq
141 43 184
Tyle 76,6 23,4 100 Nhan x6t; Bang 3.4 Cho thay ket qua su^ soan dng tuy d nhom Proterpes may cho ket qua tot cao la (90,3%). Nhom Proterpes tay la 86,8% trong khi nhom tram tay thong thu'dng chf la 52,4%.
3.3. Ddnh gia ket qua dieu tri tiTng nhom 3.3.1. i>inti gia kit gua dieu ft/ Protaper may Bing 3.5. Danh gia ket qua dieu tn nhom Proteper may
\ N h 6 m rhdk a l a n \ Proteper miy sau dieu tri n=62 Proteper
n=60 Proteper may sau 12 thing n=60
Lam sang TC
55
59 TL 88,7
»8,33
58 »6,66 NN
6
1
2 TL 9,67
1,66
3,33 TB
1
0
0 TL 1,61
0
0
X Quang TC
56
59
58 TL 90,32
98,32
96,66 NN
5
1
2 TL S,66
1,66
3,33 TB
1
0
0 TL 1,61
0
0
Danh gia chung TC
55
59
58 TL 88,7
98,33
96,66 NN
6
1
2 TL 9,67
1,66
3,33 TB
1
0
0 TL 1,61
0
0 Nh$nxit:
• Sau d i u tr| ty le thinh cong l i 88,7% (55/62 ring) nghl ngd 9,67% (6/62 rang) that bai 1/61%
(1/62 ring).
- Sau dieu tri 6 thing ty I? thanh cdng 98,33% (59/60 rang) nghi ngd 1,66% (1/60 ring) that bai 0.
- Sau ailu trj 12 thing t^ 1$ thanh cong 96,66 (58/60 rang) nghi ngd la 3,33% (2/60 ring).
3.3.2. Binh gii kit gui dieu tif Proteper tay Bing 3.6. Oanh gia ket qua dieu tri Proteper tay
\ N h 6 m hMgfen, Proteper may sau
dieu tri n=61 Proteper niy sau 6
thing n=60 Proteper miy sau 12 thing n=60
LSm sing TC
55
58
58
(%) TL
96,16
98,30
98,30 NN
6
1
1
(%) TL
9,83
1,69
1,69 TB
0
0
0
(%) TL
0
0
0
X Quang TC
51
54
57 TL f%) 83,60
91,52
96,61 NN 10
5
2
(%) TL
16,9
8,47
2,38 TB
0
0
0
(%) TL
0
0
0
Dinh g i i chung TC
49
54
57 U 80,32
91,52
96,61 NN 12
5
2 U 19,68
8,47
3,38 TB
D
0
0 TL
0
0
0 Nh$nxit:
- Sau dISu tr| ty I? thinh cdng l i 80,32% (49/61 ring) nghi ngd la 19,68 % (12/61 ring) - Sau dieu tri 6 thing ty le thanh cdng la 91,52% (54/59 rang) nghi ngd la 8,97% (5/89 ring).
- Sau 12 thing ty le thanh cong la 96,61 % (57/59 rang) nghi ngd la 3,38% (2/59 ring).
Y HOC VIET NAM THANG 6 - SO irzoi*
3.3.3. Binh gia ket qui dieu tri vdi trim tay thong thu-dng Bing 3.7. Danh qia ket qua dieu tri ong tuy vdi tram thdng thffdnq.
~^ Nhom Thdi glari
Nhdm tram tay thdng thffdnq n=61 Nhdm tram tay thong
thffdng sau 6 thing Nhdm tram tay thdng thffdnq sau 12 thanq
Lam sang
rc
51 54 55
TL 83,60 91,52 93,22
NN 10 5 4
TL 16,90
8,48 6,78
TB 0 0 0
TL 0 0 0
X Quang TC
33 39 50
TL 54,09 66,10 84,74
NN 28 20 9
TL 45,90 33,89 15,26
TB 0 0 0
TL 0 0 0
Danh gia chung TC
28 45 52
TL 45,90 76,27 88,13
NN 33 14 7
TL 54,09 23,73 11,87
TB 0 0 0
TL 0 0 0 Nhin xet;
- Sau dieu tri ty le thanh cong l i 45,90% (28/61 rang) nghi ngd la 54,09% (33/61'rang).
- Sau dieu tri 6 thing ty le thanh cdng la 76,27% (45/59 rang) nghi ngd la 23,73% (14/59 rang).
- Sau dieu tri 12 thing ty le thanh cong la 88,13% (52/59 rang) nghi ngd la 11,87% (7/89 rang).
IV. BAN LUAN
Qua nghien culi 184 rang dffdc chia ngau nhien thanh 3 nhdm.
Nhdm 1: Dffdc su^ soan dng tuy vdi tram xoay miy Ni-Tl Protaper miy.
Nhdm 2: Dffdc sffa soan ong tu'/ vdi tram xoay tay NI- Ti Protaper tay.
Nhdm 3; Sffa soan ong tuy vdi tram xoay thdng thffdng.
4.1. Trong ket qui phan bd the theo benh theo nhdm nghien cull benh ly viem tuy khong hoi phuc la cao nhat 145/184 rang (78,80%) v i Iffa tuoi hay gap nhat la 15->34 chiem 73,25%.
T'/1$ nay phan nao da ndi len benh ly tuy la mdt trong nhifng cap culi nha khoa hay gap. Chan doin xac djnh va phan biet dinh benh ly tuy yeu cau phii chinh xac duS tren trieu chffng lam sang die b i t la trieu chiing cd nang ket hdp tham khim can than rang ton thffdng, ket hdp thff nghiem tuy va X-Q la tieu chuan bat biipc de chan doin xie dinh va cd ke hoach dieu tri, Qua bing 3.3 cho thay rang ham sd 6 cd ty le trong nhien cffu Idn hdn cac rang khac. Ket qua nay phan nao danh gii sd bp ve ton thffdng benh ly tuy ciia rang ham so 6 la thffdng gap tren lam sing, vi nd la rang vinh vien mpc len tO" luc 6 tupi.
4.2. Hieu qua ciJa tram xoay may, xoay tay Ni-Ti trong viec giii' nguyen hinh dang ban dau ciia ong tuy.
Hieu qua cua tram xoay miy, tay Ni -Ti trong viec giif nguyen hinh dang ban dau ciia ong tuy.
Qua ket qua bang 3.4 cho thay sffa soan ong tuy tieu chuan tot Proterpes may la 56 chim 90,3%, Proterpes tay la 53 chiem 86,8% trong khi do trim tay thdng thffdng la 32 chiem 52,4% da chffng minh dffdc hieu qua ciia tram xoay Ni-Ti
ludn ludn tpn trpng hinh dang ban dau ciia dng tu'i' sau khi siia span png tuy. Dd la tieu chuan 1^
tffdng ciia be mat cd hpc phii hdp vdi 1 sp tic gii tren the gidi (HussI Mann M; 2005, BahaRa RA 17] la tram xoay Ni-Ti cd tic dung giff nguy&i ciia png tuy tdt hdn hinh dang ban dau cua tram xoay thdng thffdng.
4.3. Ket qua diSu trj noi nha bang nhdm tram xoay Ni-Ti may co 1/62 rang (1,61%) thait bai do gay dyng cu trong khi sii'a so^n ong tuy.
Ket qua dinh gia ve mat lam sang sau dieu trt: Cic benh nhan cd trieu chutig dau nhutig khdng cd bieu hien viem quanh cudng cap dul^
danh gii la nghi ngd (thep doi) vi neu la danh gii la that bai thi chffa cd cd sd. Sau 6 thing ty % thanh cdng l i 98,33%. Day la nhifng benh nhin t i i khim vdi trieu chffng khdng dau d giai doan nay. Sau 6 thing ty Ie thanh cdng la 98,33%
nhffng chi tffdng ddi chinh xie va thieu 2 benh nhan khdng t i i khim. Sau 12 thing ty le thanii cong thap hdn 96,61% khi dd ty le nghi ngd la 2/60 (3.33%). Trong 2 trffdng hdp nay nghi ng*
1 trffdng hdp rang cd tdn thffdng vd dpc, chung tdi khong dinh gia that bai do dieu tri ndi nha ma do khdng chi dinh lam chup bio ve ring. KS qua danh gia sau 12 thing ty le thinh cdng la 96,61% dffpc dinh gia dffa tren X-Quang la ySi to chinh de danh gii vi hinh anh XQ td chilt quanh chdp rang cd dau hieu linh thffdng.
- Ket qua dieu tri npi nha ciia nhdm ring vdi tram Prptaper xoay tay: Qua theo dol kSt qri dieu tri ndi nha sau dieu tri, sau 6 thing v i SBO 12 thing ty le thinh cdng ve lam sing ting (fin:
sau dieu tri 90,16% sau 6 thing l i 98,30% ^ sau 12 thing la 96,30%, ty le thanh cdng sau 1!
Y HQC VIET NAM T H A H G 6 - SO 1/2014
thang du^c danh gia bang XQ la (57/59) chiem 9 6 , 6 1 % danh gia ve lam sang la 98,30% nhuTig l<hi danh gia ket qua d i u n g chung toi lay cSn cu*
la XQ la cd sd danh gia chinh vi tai thdi diem danh gia tai Icham trieu chuYig lam sang la trieu ChuTng chii quan cua benh nhan khong dau nhuYig hinh anh ton thu'dng quanh chop rang khong co dau hieu lanh thu'dng.
- Ket qua dieu tri npi nha bang tram xoay thong thu'dng
Nhom du'dc dieu tri bang tram xoay thong thudng ket qua du'dc danh gia ve mat lam sang va XQ, danligia chung c6 t y le thanh cong la 88,13% It hdn cac nhom du'dc chuan bj bang trSm Ni-Ti (Protaper may la 96,66%; Protaper tay la 96,16%)
Ket qua lam sang chung toi ghi nh$n du'dc sau dieu tH benh nhan xuat hien trieu chuYig dau (nhu^g d mii'c dp nhe) khong cd bieu hien viem quanh cudng cap sau co chi djnh diJng thuoc khang sinh chong viem do dieu trf bSr^ tram xoay tay thong thu'dng gay djch chuyen Io cuong rSng day cac to chu'c hoai tu' ra ngoai cudng rang g§y nSn tri^u chu'ng dau. Sau 12 thang ty le thanh cong cua lam sang la 55/59 rang (chidm 93.22%) nghi ngd la 4/59 (chiem 6,78%). jTrong 4 tru'dng hdp danh gia la nghi ngd khi kiem tra XQ diung toi tiiay co hinh anh tdn thudng quanh chdp d mu'c dp t6n thu'dng va kham lam sang cSn thSn phat hi?n co lo rd vung Idi tu'dng ulig vdi chan r3ng tdn thu'dng. Bay la mot nhu'dc dllfm cua tram xoay thong thu'dng ft co kdt qua ve mSt sinh hpc trong khi siia soan dng tuy.
- So sanh vc^ mot so tac gia: ket qua dieu trj npi nha cua chOng toi dude danh gia la thanh cong trong cac nhdm nghien CU\J
Protaper xoay may: 96,66%
Protaper xoay tay : 9 6 , 6 1 % Protaper xoay thong ttiu'dng: 88,13%
o So s^nh cac nhdm tram xoay Ni-Ti may va tay ket qua khdng co khac biet. Nhutig co sir khac bi^t ro glUa tr^m xoay may, tay Ni -Ti vdi tram xoay thong thu'dng.
- C^c tAc gia trong nu'dc:
Tran Tlii Lan Anh [1] dieu trj Protaper may c6 tf-1^ thanh cong XQ la 9 4 % lam sang la 95%.
Trjnh TTial Ha [3] nghlfin cuU 43 trudng hdp thSy KQ-sau 12 thang ty 1$ thanh cong la 91,9%.
t e Hutig [ 4 ] nghien ciJu 30 trudng hdp co ty I? th^nh cong 93,3%.
Nguyen Manh Ha [2] cd ty le thanh cong 9 8 % sau 12 thang theo doi. Ket qua cua chiing 1»i phij hdp vdi cac tac gia tren.
- Cac tac gia nu'dc ngoai: Qvist [5] d u ^ ra mpt sd ket qua nghien ciili cua tru'dng dai hpc Temple (My) ve ty le tiianh cong dieu trj noi nha la 95,2% sau 12 thang.
- Theo Hession [ 7 ] la mpt nha npi nha lic da cong bo ty le thanh cong la 98,7%.
Ket qua ctia chiing toi phu hdp vdi ket qua ciia cac tac gia tren.
V. K ^ LUAN
Qua nghien ciilJ 184 dng tuy dude sii^ soan bang tram xoay Protaper may, Protaper tay va tram xoay thong thu'dng chiing t6i n i t ra mpt sd ket luan sau:
- M6t sd d | c diem benh nhan nghien ciitJ.
Viem tuy khong hoi phuc chiem ty 1$ 78,8% dSy la benh ly thudng gap trong not nha.
Trong dieu tri noi nha rSng so 6 hay gap nhSt (48,3%).
- Hieu qua sii^ soan dng tuy vdi tram xoay Protaper may va tay va tram xoay tJi6ng thudnq.
- Hieu qua siila soan dng tuy: tram xoay may Protaper tdt 56/62 chiem 90,3%, tiim xoay tay Protaper tdt 53/61 chiem 86,8% va ti-am xoay thong thudng tdt 32/61 chiem 52,4%
=>Tram xoay Ni-Ti co hieu qua tot gui nguyen vj tri lo cudng rang va hinh dang ong tuy ban dau hdn tram xoay tay thong thudng.
- Hieu qua dieu tri npi nha ciia tram xoay m^_y sau 12 thang tdt clilem 96,66% tram xoay tay tot la 9 6 , 6 1 % va tram xoay tay tii6ng thudng la 88,13%. Nhu" vay tram xoay Protaper may va tay hieu qua hdn trSm xoay tay thong thu'dng.
l A i Li^U T H A M K H A O
1. Tran t h j Lan Anh (2005): Dclnh gia hl^u quS sii^
soan ong tuy cua tram xoay mSy Protaper, luan van thac sy y hoc Trudng E)?i hoc Y H^ N^i.
2. Nguyin Manh Ha (2005) Nghien oitJ dfic d l ^ lam sang va dieu tn vjgm quanh cuong rSng man tfnh bSng phu'dng phap noi nha, Luan an tien si y hoc, trudng dai hoc Y H^ Noi.
3. Trinh Thai Kd (1995): Danh gia ket qua sd bp dieu trj ....sau 1 nSm. Lu$n vSn Thac si Y hpc, Trudng Oat hoc Y Ha Npi.
4. Le Hulig (2003): Nghien ciiU hinh thai va h§
thong ong tuy ring so 4 v& s6 6 iihg dyng trong dieu tri noi nha. Luan an Tl^n Si Y hpc, 16-17.
5. Qvist V, Stoltzeic' (2004) "Amultivariath a nalef sis of the out come of endodoutic tredt ment"
Ever loraLSa 112, PP: 224-230.
6. Huai smaun M, Gambal A, Baher (2002). A An evahua tion of roat canal pre perration With the automated Excalubua endodoutic handpiece Chu- Oral lukest, 35, PP, 514-521.