Y HOC VIET NAM THANG - SO 2/2014 __^ 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*, 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 nam 2012 den thang nam 2013. Ket qua: Nguyen nhan hay gap la niim phu 94.12% gap d rang ham nho, chan 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. SUMMARY I M M A T U R E PERMANENT TEETH; CAUSE, LESION CHARACTERS A N D RADIOGRAPHY 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 dens evaginatus (94,12% in premolars) and traumas (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 Phdn bien khoa hpc: PGS.TS Mai Dinh Hu'ng I. D A T V A N OE Trong ITnh vffc dieu tn npi nha, cac trffdng hdp rang vinh vien chffa dong cuong khong qua hiem gap, ehiem b/ le khoang 5% den 15% va thffdng eae nguyen nhan chan thffdng, bat thffdng cau true rang (niim phu), sau rang [1], [2], [ ] . Tuy nhien, tiiy rang bj ton thffdng sdm tff giai doan chan rang chffa hoan thien nen cac trieu chffng khong dien hinh, it 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 dd, viec dieu tri gap nhieu khd khan. Oe dieu tri thong thffdng phai diing cae vat lieu khae nhff Calcium hydroxide va hien la Mineral Trioxide Aggregate (MTA) vdi nhieu dac tfnh tdi ffu, lam lanh thffdng va kfch thfch hinh hang rao mo effng giup cho viec tram bft ong de dang hdn, dffa den ty le cdng eao [2]. Van de dat 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 nham muc tieu; Nhan xet dac diem lam sang va X quang nhffng rang vinh vien chffa ddng cuong trffdc dieu trj npi nha. II. o l TUONG 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 tn 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 nam 2012 den thang nam 2013. Tieu ehuan Iffa chpn; Benh nhan co cac rSng vTnh vien chffa ddng kfn cuong cd ehi djnh dieu tn 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 la, suy tim), tieu Y HQC VigT NAM THANG - SO 2/2014 dffdng, 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 ehan rang: 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 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 - 15 15 Tong so Gidi ^ " ^ ^ - - ^ n n N Nam 15 46,88 9,38 18 56,25 Nff 12 37,5 6,24 43,75 14 Tong so 11 84,38 15,62 32 100 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 ton thu'ong theo nquyen nhan va nhom tuoi ' --—__Nh6m tuoi 6-15 >15 Tong so Nguyen nliin '—^^ n n N Sau rang 13.15 0 13.15 Chan thu'ong 14 36.84 5.26 16 42.10 Num phu 26.32 10 18.43 17 44.75 Tong 50 76.31 29 23.69 38 100 Nh$n xet: Jrong so 38 rang, co 13.15% sau rang, 42.10% chan thirong, co 44.75% num phu. % % % Bang 3: Phan bo rang ton thu'ong theo nguyen n han va gidi, v tri Gidi Vi tri n Nam (%) Nff(%) RC (%) RHN {%) RHL {%) Sau rSng 60 40 20 80 Chan thu'dng 16 75 25 100 0 17 52.94 Num phu 47.06 5.88 94.12 Mau nghien CLTU 38 60.53 39.47 44.74 44.74 10.52 Nh$nx4t: Do sau rSng g3p 80% RHL, chan thffdng gap 75% d benh nhan nam va 100% d rang ::ffa, num phu g3p 94,12% d RHN. Tnsng so cae rang nghien cffu viem ed trffdng hpp (5,26%), :uy ho?i tff (7,89%), viem quanh cuong cap (18,42%), viem quanh cudng man 26 (68,43%) Nguyen nhin Y HOC VIET NAM THANG - SO 2/2014 Bang 4: Dau t ieu lam sang tai vi tri rang td'n thffdng N n (%) Bien sd nghien cu'u (6.25) Khdng 32 30 26 (81.25) Co nang Bau tff nhien benh nhan Cd (93.75) 4(12.5) Dau kfch thfch Khdng Td'n thffdng 5(13.16) hoac bat Ld sau/tram cu 38 rang 38 thffdng td 20 (52.63) Cd Nut vdthan (100) chffe cffng 17(34.21) Niim phu 38 ranq (5.26) Khdng 38 ranq Doi mau 25 (65.79) 38 ranq (18.42) _^ Sffng ne loi Thu'c the 38 ranq Co 15 (39.47) Ld rd 16 (42.11) 38 rang Lunq lay 38 ranq 31 (81.58) Gd doe dau 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 n {%) N(%) I Giai doan II (7.89) 38(100) chan rang III 24(63.16) IV 11 (28.95) 5(13.15) Khonq Ton thu'dng quanh 9(23.68) < 5mm 38 (100) cuong Cd - 10mm 33 (86.85) 21 (55.26) >10mm (7.90) 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, dd sd benh nhan nam gap nhieu hdn (18/32 benh nhan), ti le nammff = 1,29/1. Nhdm tudi hay gap la tff 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 sau rang, 16/38 (42,10%) trffdng hdp la chan thffdng, chii yeu gap d Iffa tudi dffdi 15, tre hieu ddng nhieu, 17/38 (44,75%) trffdng hdp la num phu (mdt loai bat thffdng td chffe cffng ciia rang, niim phu thffdng cd sff keo dai ciia tiiy rang, vay tiiy rang de bi hoai ty tff tff rang can khdp vdi rang ddi dien), thffdng gap d tre dffdi 15 tuoi, vi Iffa tuoi cac rang ham nho mdi bat dau mpc va chffa kip ddng eudng neu bi ton thffdng tiiy rang [4] . Trong nhdm nguyen nhan 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 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 sang chan man tinh niim phu, chung tdi gap chii yeu d rang ham nhd: 94.12% trffdng hdp, rang cffa la 5,88%, khdng gap trffdng hdp nao d rang ham. Y HOC VIET NAM THANG - SO 2/2014 Ket qua cung phii hdp vdi ket qua eiia Marc va cdng sff [ ] , dieu phii hpp vdi dac diem lam sang hay gSp num phu nhd len d giffa 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 rang da bj ton thffdng trffc tiep vi khuan xam nhap hoac gian tiep sang chan. Nhffng trffdng hdp nut vd hoac sau mat td 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 viing quanh cuong cap nhff dau, sffng ne ldi hay viem quanh eudng man nhff CO lo dd, go dpc dau. Oieu 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 cung cho thay da sd benh nhan khdng dffdc kham phat hien kjp thdi num phu tff rang mdi mpc va khong Cifdc theo ddi day du sau chan thffdng, thffdng den cd bien chffng mdi di kham. 4.3. Dac diem X - q u a n g tai 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 III, nghia la cudng rang cdn md rpng va loe ra, chan rSng mdi 6if . 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. 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. 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