NHAN XET DAC DIEM LAM S A N G V A XQUANG RANG VINH V I £ N CHITA DONG CUONG CO CHI DINH DIEU TRI NOI NHA Dao Thi H^ng Nga*, \gu>ln Manh Ha*, Tran Ngoc Thanh* Nguyen Thi Thu Phircng*, V
Trang 1NHAN XET DAC DIEM LAM S A N G V A XQUANG RANG VINH V I £ N
CHITA DONG CUONG CO CHI DINH DIEU TRI NOI NHA
Dao Thi H^ng Nga*, \gu>ln Manh Ha*, Tran Ngoc Thanh*
Nguyen Thi Thu Phircng*, Vo Truong Nhir Ngoc*, Tran Thj My Hanh*, Luong Minh Hang*
T O M TAT
Oat van de: Nghien cffu nham mo ta dac diem
lam sang va x-quang cac rang vinh vien chi/a ddng
cuong CO chi dinh di'eu trj npi nha Do! tu'dng va
phu'dng phap: 32 benh nhan v6i 38 rang vinh vien
chua dong kin cuong trddc dieu trj npi nha tai Benh
vien Rang Ham Mat Trung LTpng Ha Npi va trung tam
nha khoa 225 Trddng Chinh ty thang 1 nam 2012 den
thang 6 nam 2013 Ket qua: Nguyen nhan hay gap la
thu'dng 75% gap d nam va 100% d rang cffa, viem
quanh cuong la 86,85%, Tren phim x-quang, 53.16%
tn/dng hdp chan rang cJ giai doan I I I , 86.85% co hinh
anh thau quang quanh cuong Ket luan: Hinh thai lam
sang rang chUa dong cuong dffdc dieu tri npi nha co
ton thuong tai cho da dang nhi/ng thUdng gap la
benh viem quanh cuong
Tff khoa: dong cudng, mineral thoxide
aggregate, calcium hydroxide
S U M M A R Y
I M M A T U R E PERMANENT TEETH;
CAUSE, LESION CHARACTERS
A N D R A D I O G R A P H Y
Introduction: The aims of this study were to
describe the cause, lesion characters and radiography
of immature permanent teeth Materials and
Method: From Jan 2012 to June 2013, we had treated
38 open apices teeth of 32 patients in Hanoi Nabonal
Odonto-Stomatology Hospital and Dental Health Care
225 Truong Chinh Results: The mam causes were
(75% in male and 100% in incisors) Apical
periodontitis was mam disease (86,85%) On
radiography, roots were at stgae I I I in 63.16% of the
cases and 86,85% with periapical lesion Conclusion:
Lesion characters of patents with open apices teeth
were very variety and apical penodontitis was quite
more common
Keywords: open apices, apexification, mineral
trioxide aggregate, calcium hydroxide
* Vien Dao Tao RSng Ham Mat, Tnfdng Oai Hpc YHa Not
I D A T V A N OE Trong ITnh vffc dieu t n npi nha, cac trffdng hdp rang vinh vien chffa dong cuong khong qua hiem gap, ehiem b/ le khoang 5 % den 15% va thffdng do eae nguyen nhan chan thffdng, bat thffdng cau true rang (niim phu), sau rang [1], [2], [ 3 ] Tuy nhien, do tiiy rang bj ton thffdng sdm tff giai doan chan rang chffa hoan thien nen cac trieu chffng khong dien hinh, it khi dydc phat hien kjp thdi Tren phim x-quang can chop thffdng thay hinh anh mot chan rang ngan, budng ong tiiy rpng, lo cudng rpng hoac loe, tieu xffdng quanh eudng Do d d , viec dieu tri gap nhieu khd khan Oe dieu tri thong thffdng phai diing cae vat lieu khae nhau nhff Calcium hydroxide va hien nay la Mineral Trioxide Aggregate (MTA) vdi nhieu dac tfnh tdi ffu, lam lanh thffdng va kfch thfch hinh thanh hang rao
mo effng giup cho viec tram bft ong tuy de dang hdn, dffa den ty le thanh cdng eao [2]
Van de dat ra la: co phai tat ca cac rang bi ton thffdng tiiy va chffa ddng cudng deu dieu trj npi nha dffdc khdng va ket qua nhff the nao Vi vay, chiing tdi tien hanh nghien cffu nay nham muc tieu; Nhan xet dac diem lam sang va X -quang 6 nhffng rang vinh vien chffa ddng cuong trffdc dieu trj npi nha
II o 6 l T U O N G VA PHU'aNG PHAP NGHIEN COU 2.1 Ddi tu'dng nghien cu'u
32 benh nhan vdi 38 rang vinh vien chuci ddng kfn cudng cd ehf djnh dieu t n npi nha du'dc dieu tri tai Benh vien Rang Ham Mat trung t/dng
Ha Npi va trung tam nha khoa 225 Trffdng Chinh tff thang 1 nam 2012 den thang 8 nam 2013
Tieu ehuan Iffa chpn; Benh nhan co cac rSng vTnh vien chffa ddng kfn cuong cd ehi djnh dieu
t n npi nha, rang ed kha nang phyc hoi lai than rang, benh nhan t y nguyen tham gia nghien cffu
Tieu ehuan loai trff: Rang bj viem quanh rang, chan rang bj nut, gay Benh nhan cd cac benh tim mach (hep hd van 2 la, suy tim), tieu
Trang 2dffdng, benh viem than hoac benh toan than
khac chuci on djnh Benh nhan khong hpp tac
2.2 Phu'dng phap nghien cu'u: nghien
cffu du'dc thiet ke theo phu'dng phap mo ta
cSt ngang
2j2.1 Cac bien sd nghien c&u:
-^Tuoi, gidi, vj tri rang ton thu'dng, nguyen nhan
ton thffdng, dac diem lam sang ciia rang ton
thu'dng
- X- quang can chdp:
-t- Xae dmh giai doan hinh thanh ehan rang: 5
giai doan [3] I: Lo cuong rang phan ky, chieu
dai chan rang ngan hdn Vz ehan rang hoan thien;
II: lo cuong phan ky, chieu dai chan rang bang
Vl chan rang hoan thien ; III: lo cuong phan ky,
chieu dai chan rang bang 2/3 chan rang hoan
thien; IV: lo cudng rong, chieu dai gan bang ehan rang hoan thien; V: rang da ddng cudng, su' phat trien chan rang hoan thien
+ Xac dinh mffe dd ton thu'dng (hinh anh thau quang) viing eudng tru'dc dieu trj: co hay khdng, neu cd thi do kich thu'dc td'n thu'dng (du'dng kfnh Idn nhat)
2.2.2 Thu thap va xdiysdlieu: Phan mem
SPSS 13.0 va cac thuat toan thdng ke khac
2,3 £>ao dffc nghien cu'u
Benh nhan ddng y tff nguyen tham gia nghien cffu va ed quyen rut khdi nghien cyu bat
ky liic nao Cac thdng tin ea nhan ciia ddi tUpng
nghien cyu se 6if(ic dam bao giff bf mat tuyet ddi Nghien cffu 6iS6c sff chap thuan ciia cac dja
diem nghien cffu
III K ^ QUA
Bang 1: Dac diem chung ciia nhdm benh nhan
'~"~''~ ~„,^^ Tuoi
Gidi ^ " ^ ^ - - ^
Nam
Nff
Tong so
6
-n
15
12
11
15
%
46,88 37,5 84,38
>
n
3
2
5
15
%
9,38 6,24 15,62
Tong so
N
18
14
32
%
56,25 43,75
100
filhan xit: Tmng so 32 benh nhan, co 56.25% benh nhan nam va 43.75% benh nhan nif Tuoi gap
nhieu nhat la nhom di/cli 15 tuoi (84.38%)
Bang 2: Phan bo rang b
' - - — _ _ N h 6 m tuoi
Nguyen nliin '—^^
Sau rang
Chan thu'ong
Num phu
Tong 50
ton thu'ong theo nquyen nhan va nhom tuoi
6-15
n
5
14
10
29
%
13.15 36.84 26.32 76.31
> 1 5
n
0
2
7
9
%
0 5.26 18.43 23.69
Tong so
N
5
16
17
38
%
13.15 42.10 44.75
100
Nh$n xet: Jrong so 38 rang, co 13.15% do sau rang, 42.10% do chan thirong, co 44.75% do num phu
Bang 3: Phan bo rang ton thu'ong
Nguyen nhin
Sau rSng
Chan thu'dng
Num phu
Mau nghien CLTU
n
5
16
17
38
theo nguyen n
Gidi
Nam (%)
60
75 47.06 60.53
Nff(%)
40
25 52.94 39.47
han va gidi, v tri
Vi tri
RC (%)
0
100 5.88 44.74
RHN {%)
20
0 94.12 44.74
RHL {%)
80
0
0 10.52
Nh$nx4t: Do sau rSng g3p 80% 6 RHL, do chan thffdng gap 75% d benh nhan nam va 100% d rang
::ffa, do num phu g3p 94,12% d RHN Tnsng so cae rang nghien cffu viem tuy ed 2 trffdng hpp (5,26%),
Trang 3Bang 4: Dau t ieu lam sang tai vi tri rang td'n thffdng
Bien sd nghien cu'u
Co nang
Td'n thffdng
hoac bat
thffdng td
chffe cffng
Thu'c the
Khdng
Dau do kfch thfch Khdng
Cd
Ld sau/tram cu Nut vdthan Niim phu Khdng
Co
Doi mau Sffng ne loi
Ld rd Lunq lay
Gd doe dau
n (%)
2 (6.25)
26 (81.25) 4(12.5)
30 (93.75)
0 5(13.16)
20 (52.63) 17(34.21)
38 (100)
2 (5.26)
25 (65.79)
7 (18.42) _^
15 (39.47)
16 (42.11)
31 (81.58)
N
32 benh nhan
38 rang
38 ranq
38 ranq
38 ranq
38 ranq
38 rang
38 ranq
Nhan xet: Co 93.75% benh nhan c6 trieu chu'ng dau, 52.63% so rang co niit v8 than, cac trieu
chu'ng thi/c the hay gap: go dau 81.58%, doi mau 65.79%, lung lay 42.11%, io ro 39.47%
Bang 5: Qac die m X-quang tai vi tri rang ton thu'dng
Bien so ngliien cu'u
Giai doan
chan rang
Ton thu'dng quanh
cuong
I
II III
IV Khonq
Cd
< 5mm
5 - 10mm
>10mm
n { % )
0
3 (7.89) 24(63.16)
11 (28.95) 5(13.15) 9(23.68)
21 (55.26)
3 (7.90)
33 (86.85)
N(%)
38(100)
38 (100)
Nhan xet: Trong sd 38 rang, cd 63.16% rang cd chan rang dang d giai doan III, cd 86.85% trffdng
hdp cd td'n thffdng quanh cudng
IV BAN LUJC^N
Trong thdi gian 1.5 nam, chiing tdi da tien
hanh dieu tri npi nha cho 32 benh nhan vdi 38
rang chffa ddng kfn cudng, trong dd sd benh
nhan nam gap nhieu hdn (18/32 benh nhan), ti
le nammff = 1,29/1 Nhdm tudi hay gap la tff 6
den 15 tud'i (84.38%); day la Iffa tud'i ma bd rang
vTnh vien bat dau mpc nhffng ehan rang chffa
hoan thien, cac nguyen nhan gay anh hffdng den
tiiy rang deu cd the lam cho rang khdng tiep tuc
ddng cudng dffdc
4.1 Nguyen nhan va dac diem lam sang
cua rang ton thffdng
Trong sd 38 rang ^if^ic dieu trj, ehung tdi
gap 5/38 (13,15%) trffdng hdp la do sau rang,
16/38 (42,10%) trffdng hdp la do chan thffdng,
chii yeu gap d Iffa tudi dffdi 15, tre hieu ddng
phu (mdt loai bat thffdng td chffe cffng ciia rang, trong niim phu thffdng cd sff keo dai ciia tiiy rang, do vay tiiy rang de bi hoai ty tff tff khi rang can khdp vdi rang ddi dien), thffdng gap d tre dffdi 15 tuoi, vi Iffa tuoi nay cac rang ham nho mdi bat dau mpc va chffa kip ddng eudng neu bi ton thffdng tiiy rang [4]
Trong nhdm nguyen nhan do sau rang chiing tdi ehi gap d cac rang ham (rang ham nhd va rang ham Idn), khdng gap trffdng hdp nao d rang cffa Trong nhdm nguyen nhan do chan thffdng, chiing tdi chi gap d eac rang cffa, khdng g3p
trffdng hdp nao d rang ham va gap chu yeu tren
benh nhan nam
Trong nhdm nguyen nhan do sang chan man tinh do niim phu, chung tdi gap chii yeu d rang ham nhd: 94.12% trffdng hdp, 6 rang cffa la
Trang 4Ket qua nay cung phii hdp vdi ket qua eiia Marc
va cdng sff [ 6 ] , dieu nay phii hpp vdi dac diem
lam sang hay gSp num phu nhd len d giffa 2 mui
rang cua rang ham nhd, thu'dng gap d ngffdi
chau A, gay sang chan tiiy man tfnh tff sdm va
rang dd chffa kjp dong kin cudng
4.2 Trieu chu'ng l a m s a n g t a i vj t r i r a n g
ton thffdng
Trong cac trffdng hop rang du'Oc dieu tri, tat
ca cac trffdng hdp deu thay cd ton thu'ong td
chffe cffng ciia rang hoae ed bat thffdng to chffe
ciTng nhff niim phu Day la bang chffng cho thay
tuy rang da bj ton thffdng trffc tiep do vi khuan
xam nhap hoac gian tiep do sang chan Nhffng
trffdng hdp nut vd hoac sau mat t d chffe cffng
Idn doi hdi sff phuc hoi than chan rang sdm mdi
cd the bao tdn rang lau dai
Phan Idn cac rang deu cd cac trieu chffng ciia
tinh trang hoai tff tiiy (rang dd'i mau) va vi khuan
da gay ton thffdng ra viing quanh cuong cap nhff
dau, sffng ne ldi hay viem quanh eudng man nhff
CO lo dd, go dpc dau Oieu nay phii hdp vdi phan
bo benh ly ciia cac rang dffdc dieu trj: 7/38
(18.42%) rang viem quanh cudng cap, 26/38
(58,43%) rang vfem quanh cuong man tfnh Ket
qua nay cung cho thay da sd benh nhan khdng
dffdc kham phat hien kjp thdi num phu ngay tff
khi rang mdi mpc va khong Cifdc theo ddi day du
sau chan thffdng, thffdng den khi cd bien chffng
mdi di kham
4.3 Dac diem X - q u a n g t a i vj t r i rang ton
thffdng
Trong 58 rang dffdc dieu trj, cd 3/38
(7.89%) trffdng hdp ehan rang d giai doan I I va
tdi 24/38 (63.16%) chan rang dang d giai doan
I I I , nghia la cudng rang cdn md rpng va loe ra,
chan rSng mdi 6if<ic thanh lap ngan Day thffe sff
la mpt thach thyc Idn khi tram bft viing cudng, vi
phai dam bao yeu cau vffa tram kfn khft va
khong duS vat lieu tram di qua cuong rang [ 1 ] ,
[7] Khdng g§p trffdng hdp nao chan rang dang
d giai doan I (chan rang mdi dffdc thanh lap,
chieu dai chan rSng ffdc tfnh ngan hdn mot nffa
so vdi chan rang hoan thien), vi giai doan nay rang chu'a mpc vao khoang mieng hoac neu ed moc thi do qua ngan, to chffe nang dd quanh rang yeu, dac biet neu ed viem nhiem td chffe quanh rang cang lam eho rang de mat sdm,
V KET LUAN Nhdm tud'i hay gap la 6 - 15 tudi Nguyen nhan tdn thu'Png hay gap la do niim phu, ehan thffdng, ft gap do sau rang, Trong nhdm nguyen nhan do niim phu gap chii yeu d rang ham nhd,
do chan thu'Png gap chii yeu d nam va nhom rang cffa Benh ly hay gap la viem quanh cuong vdi eac trieu chffng ehinh la go dau, dd'i mau rang, lung lay rang, lo rd, sffng ne Tren phim x-quang, hay gap chan rang dang phat trien d giai doan I I I sd rang cd hinh anh thau quang quanh eudng TAI LIEU T H A M KHAO
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apices Endodontic Topics, 23, 105 - 130
2 El-Meligy OA, Avery DR (2006) Compansion
of apexification with mineral trioxide aggregate
and calcium hydroxide, Pediatr Dent, 28(3), 248
- 2 5 3
3 Mathew B.P, Hegde M.N (2008) Management
of nonvital immature teeth - case reports and
review Endodontology, 15 (3),18 - 21
4 Deery C, Toumba K J (2005) Diagnosis and
prevention of dental caries Pediatnc Dentistry, 3"^
edition, Oxford, 108 - 129
5 Michael P Powers and Faisal A.Q.(1997) Diagnosis and Management of Dentoalveolar
injuries, Oral and Maxillofacial Trauma, The second
edition by W.B.Saunders company, 359- 390
6 Marc E Levitan, Van T Himel (2006) Dens Evaginatus: Literature Review, Pathophysiology,
and Comprehensive Treatment Regimen, J Endod,
Jan, 32(1), 1 - 9
7 Shabahang S and M Torabinejad (2000) Treatment of teeth with open apices using mineral
trioxide aggregate Practical Periodontics and Aesthetic Dentistry, 12{3), 315-320