{"id":17904,"date":"2023-04-13T16:21:27","date_gmt":"2023-04-13T09:21:27","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=17904"},"modified":"2023-05-02T16:35:00","modified_gmt":"2023-05-02T09:35:00","slug":"implant-nha-khoa-chi-dinh-va-chong-chi-dinh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/implant-nha-khoa-chi-dinh-va-chong-chi-dinh\/","title":{"rendered":"Implant nha khoa – Ch\u1ec9 \u0111\u1ecbnh v\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh."},"content":{"rendered":"

B\u00e0i vi\u1ebft n\u00e0y s\u1ebd n\u00f3i v\u1ec1 c\u00e1c ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee5 th\u1ec3 c\u1ee7a quy tr\u00ecnh ph\u1eabu thu\u1eadt c\u1eafm Implant Nha khoa. B\u00e0i vi\u1ebft cung c\u1ea5p cho Nha s\u0129 g\u00f3c nh\u00ecn s\u00e2u s\u1eafc khi \u0111\u1ee9ng tr\u01b0\u1edbc m\u1ed9t b\u1ec7nh nh\u00e2n v\u00e0 chu\u1ea9n b\u1ecb ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng th\u1ee7 thu\u1eadt n\u00e0y. C\u00f9ng t\u00ecm hi\u1ec3u s\u00e2u h\u01a1n.<\/strong><\/p>\n

\"implant-nha-khoa-1\"
Implant – thay \u0111\u1ed5i c\u00e1ch m\u1ea1ng c\u1ee7a ng\u00e0nh Nha khoa<\/figcaption><\/figure>\n

1. Ch\u1ec9 \u0111\u1ecbnh<\/h2>\n

1.1. Ch\u1ec9 \u0111\u1ecbnh to\u00e0n th\u00e2n c\u1ee7a implant nha khoa<\/h3>\n

Trong hai th\u1eadp k\u1ef7 g\u1ea7n \u0111\u00e2y, vi\u1ec7c thay th\u1ebf r\u0103ng b\u1ecb m\u1ea5t t\u1eebng ph\u1ea7n (ho\u1eb7c to\u00e0n b\u1ed9) b\u1eb1ng implant trong x\u01b0\u01a1ng (endosseous) \u0111\u00e3 tr\u1edf th\u00e0nh m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c quan t\u00e2m nhi\u1ec1u nh\u1ea5t. Th\u00e0nh c\u00f4ng c\u1ee7a vi\u1ec7c c\u1eafm gh\u00e9p implant n\u00e0y d\u1ef1a tr\u00ean s\u1ef1 t\u00edch h\u1ee3p x\u01b0\u01a1ng (osseointegration), \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u1ea7n \u0111\u1ea7u ti\u00ean b\u1edfi hai nh\u00f3m nghi\u00ean c\u1ee9u c\u1ee7a Br\u00e5nemark v\u00e0 Schroeder. C\u00e1c nghi\u00ean c\u1ee9u c\u01a1 b\u1ea3n th\u1eed nghi\u1ec7m c\u1ee7a h\u1ecd \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng, v\u1eadt li\u1ec7u c\u1ea5y gh\u00e9p b\u1eb1ng titan c\u00f3 kh\u1ea3 n\u0103ng g\u1eafn li\u1ec1n v\u00e0 ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp v\u1edbi x\u01b0\u01a1ng, qu\u00e1 tr\u00ecnh \u0111\u00f3 g\u1ecdi l\u00e0 osseointegration (t\u00edch h\u1ee3p x\u01b0\u01a1ng) ho\u1eb7c d\u00ednh kh\u1edbp (ankylosis) ch\u1ee9c n\u0103ng. \u0110\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c ch\u00eca kho\u00e1 th\u00e0nh c\u00f4ng, t\u1ee9c l\u00e0 duy tr\u00ec \u0111\u01b0\u1ee3c s\u1ef1 t\u00edch h\u1ee3p x\u01b0\u01a1ng c\u1ea7n ph\u1ea3i c\u00f3 ch\u1ec9 \u0111\u1ecbnh v\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u0111\u00fang, l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c b\u1ec7nh nh\u00e2n ph\u00f9 h\u1ee3p, \u0111\u1ed3ng th\u1eddi ph\u1ea3i l\u1eadp k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb \u0111\u00fang.<\/p>\n

Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1eafm gh\u00e9p c\u00f3 th\u1ec3 do y\u1ebfu t\u1ed1 t\u1ea1i ch\u1ed7 ho\u1eb7c to\u00e0n th\u00e2n, trong \u0111\u00f3 nha s\u0129 l\u1ea1i th\u01b0\u1eddng r\u1ea5t hay b\u1ecf qua y\u1ebfu t\u1ed1 b\u1ec7nh to\u00e0n th\u00e2n. B\u1ec7nh to\u00e0n th\u00e2n c\u00f3 th\u1ec3 l\u00e0m m\u00f4 v\u00f9ng mi\u1ec7ng t\u0103ng s\u1ef1 nh\u1ea1y c\u1ea3m v\u1edbi c\u00e1c b\u1ec7nh kh\u00e1c ho\u1eb7c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn qu\u00e1 tr\u00ecnh l\u00e0nh th\u01b0\u01a1ng. Ngo\u00e0i ra, thu\u1ed1c ho\u1eb7c li\u1ec7u ph\u00e1p d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh to\u00e0n th\u00e2n c\u0169ng c\u00f3 kh\u1ea3 n\u0103ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn implant nha khoa v\u00e0 m\u00f4 m\u1ec1m xung quanh, g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 c\u1eafm gh\u00e9p, th\u1eadm ch\u00ed \u1ea3nh h\u01b0\u1edfng c\u1ea3 \u0111\u1ebfn t\u00ednh m\u1ea1ng b\u1ec7nh nh\u00e2n. V\u00ec v\u1eady, vi\u1ec7c \u0111\u00e1nh gi\u00e1 s\u1ee9c kh\u1ecfe to\u00e0n th\u00e2n \u1edf b\u1ec7nh nh\u00e2n c\u1ea5y gh\u00e9p nha khoa c\u0169ng nh\u01b0 b\u1ea5t c\u1ee9 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c can thi\u1ec7p ph\u1eabu thu\u1eadt n\u00e0o kh\u00e1c l\u00e0 vi\u1ec7c l\u00e0m b\u1eaft bu\u1ed9c. \u0110\u00e1nh gi\u00e1 tr\u01b0\u1edbc ph\u1eabu thu\u1eadt l\u00e0 xem x\u00e9t t\u1ea5t c\u1ea3 c\u00e1c y\u1ebfu t\u1ed1 c\u00f3 kh\u1ea3 n\u0103ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebf ho\u1ea1ch ph\u1eabu thu\u1eadt v\u00e0 v\u00f4 c\u1ea3m. Ng\u01b0\u1eddi ph\u1eabu thu\u1eadt vi\u00ean ph\u1ea3i bi\u1ebft v\u1eadn d\u1ee5ng c\u00e1c ki\u1ebfn th\u1ee9c c\u1ee7a m\u00ecnh v\u1ec1 di\u1ec5n bi\u1ebfn c\u1ee7a qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt v\u1edbi c\u00e1c th\u00f4ng tin thu \u0111\u01b0\u1ee3c t\u1eeb vi\u1ec7c kh\u00e1m, \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb. N\u1ebfu t\u00ecnh tr\u1ea1ng s\u1ee9c kho\u1ebb b\u1ec7nh nh\u00e2n cho ph\u00e9p qua th\u0103m kh\u00e1m v\u00e0 h\u1ed9i ch\u1ea9n khi \u0111\u00f3 m\u1edbi \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt. T\u1eeb k\u1ebft qu\u1ea3 \u0111\u00e1nh gi\u00e1 m\u1edbi c\u00f3 th\u1ec3 \u0111\u1eb7t k\u1ebf ho\u1ea1ch ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt nh\u01b0 th\u1eddi gian, ph\u01b0\u01a1ng ph\u00e1p v\u00f4 c\u1ea3m, ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt v\u00e0 ti\u00ean l\u01b0\u1ee3ng nh\u1eefng v\u1ea5n \u0111\u1ec1 \u0111\u1eb7c bi\u1ec7t c\u00f3 th\u1ec3 x\u1ea3y ra trong ph\u1eabu thu\u1eadt.<\/p>\n

T\u1ea1i h\u1ed9i ngh\u1ecb \u0111\u1ed3ng thu\u1eadn ITI (International Team of Oral Implantology), Buser v\u00e0 c\u1ed9ng s\u1ef1 (2000) \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t chia c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 to\u00e0n th\u00e2n th\u00e0nh hai nh\u00f3m:<\/p>\n

– Nh\u00f3m 1 (nguy c\u01a1 cao): B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh to\u00e0n th\u00e2n n\u1eb7ng (kh\u1edbp, vi\u00eam kh\u1edbp, lo\u00e3ng x\u01b0\u01a1ng, b\u1ec7nh x\u01b0\u01a1ng d\u1ec5 g\u00e3y), suy gi\u1ea3m mi\u1ec5n d\u1ecbch (HIV, \u0111ang d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch), ng\u01b0\u1eddi nghi\u1ec7n ma tu\u00fd (r\u01b0\u1ee3u), b\u1ec7nh nh\u00e2n kh\u00f4ng tu\u00e2n th\u1ee7 (r\u1ed1i lo\u1ea1n t\u00e2m l\u00fd v\u00e0 tinh th\u1ea7n).<\/p>\n

– Nh\u00f3m 2 (nguy c\u01a1 \u0111\u00e1ng k\u1ec3): B\u1ec7nh nh\u00e2n b\u1ecb chi\u1ebfu x\u1ea1 x\u01b0\u01a1ng (x\u1ea1 tr\u1ecb), \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng n\u1eb7ng (\u0111\u1eb7c bi\u1ec7t l\u00e0 typ 1), r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u (xu\u1ea5t huy\u1ebft t\u1ea1ng, d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng), nghi\u1ec7n thu\u1ed1c l\u00e1 n\u1eb7ng.<\/p>\n

Theo h\u1ec7 th\u1ed1ng ph\u00e2n lo\u1ea1i c\u1ee7a Hi\u1ec7p h\u1ed9i G\u00e2y m\u00ea M\u1ef9 (ASA) ph\u00e2n ra 6 lo\u1ea1i:<\/p>\n

– Pl: B\u1ec7nh nh\u00e2n kh\u1ecfe m\u1ea1nh b\u00ecnh th\u01b0\u1eddng.
\n– P2: B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh to\u00e0n th\u00e2n nh\u1eb9.
\n– P3: B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh to\u00e0n th\u00e2n n\u1eb7ng.
\n– P4: B\u1ec7nh nh\u00e2n b\u1ec7nh n\u1eb7ng \u0111ang \u0111e d\u1ecda cu\u1ed9c s\u1ed1ng.
\n– P5: B\u1ec7nh nh\u00e2n h\u1ea5p h\u1ed1i.
\n– P6: B\u1ec7nh nh\u00e2n ch\u1ebft n\u00e3o, hi\u1ebfn t\u1ea1ng.<\/p>\n

B\u1ec7nh nh\u00e2n c\u00f3 ch\u1ec9 \u0111\u1ecbnh c\u1ea5y gh\u00e9p nha khoa th\u01b0\u1eddng n\u1eb1m trong hai lo\u1ea1i \u0111\u1ea7u. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111ang b\u1ec7nh n\u1eb7ng v\u00e0 c\u1ea5p t\u00ednh, nguy c\u01a1 th\u1ea5t b\u1ea1i cao v\u00e0 h\u1ea7u nh\u01b0 kh\u00f4ng bao gi\u1edd c\u00f3 ch\u1ec9 \u0111\u1ecbnh c\u1ea5y gh\u00e9p (l\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ASA x\u1ebfp lo\u1ea1i t\u00ecnh tr\u1ea1ng th\u1ec3 ch\u1ea5t t\u1eeb P3 \u0111\u1ebfn P6).<\/p>\n

Tuy nhi\u00ean, c\u00f3 c\u00f4ng b\u1ed1 m\u1edbi \u0111\u00e2y cho r\u1eb1ng, vi\u1ec7c c\u1eafm gh\u00e9p c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n tr\u00ean b\u1ec7nh nh\u00e2n c\u1ecf ph\u00e2n lo\u1ea1i \u0111\u1ebfn P4 ho\u1eb7c cao h\u01a1n khi t\u1ec9nh tr\u1ea1ng s\u1ee9c kho\u1ebb b\u1ec7nh nh\u00e2n \u0111\u00e3 \u1ed5n \u0111\u1ecbnh v\u00e0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u1ea3i thi\u1ec7n v\u1ec1 \u00edt nh\u1ea5t m\u1ee9c P3.<\/p>\n

M\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 \u0111\u00e3 x\u00e1c \u0111\u1ecbnh, m\u1ed9t v\u00e0i b\u1ec7nh to\u00e0n th\u00e2n m\u00e0 c\u1ea5y gh\u00e9p nha khoa kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o, ho\u1eb7c \u00edt nh\u1ea5t l\u00e0 c\u00f3 v\u1ea5n \u0111\u1ec1 n\u1ebfu c\u1ea5y gh\u00e9p. Tuy nhi\u00ean, c\u00e1c b\u00e1o c\u00e1o v\u1eabn ch\u01b0a \u0111\u01b0a ra \u0111\u01b0\u1ee3c b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng.
\nC\u00e1c b\u1ec7nh to\u00e0n th\u00e2n c\u00f3 t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c \u0111\u1ebfn s\u1ef1 th\u00e0nh c\u00f4ng c\u1ee7a qu\u00e1 tr\u00ecnh t\u00edch h\u1ee3p x\u01b0\u01a1ng:<\/p>\n

– T\u00ecnh tr\u1ea1ng b\u1ec7nh to\u00e0n th\u00e2n n\u1eb7ng v\u00e0 c\u1ea5p t\u00ednh (nhi\u1ec5m tr\u00f9ng c\u1ea5p t\u00ednh, vi\u00eam ph\u1ebf qu\u1ea3n n\u1eb7ng. b\u1ec7nh kh\u00ed ph\u1ebf th\u0169ng, thi\u1ebfu m\u00e1u n\u1eb7ng, b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t, t\u0103ng huy\u1ebft \u00e1p kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t, ch\u1ee9c n\u0103ng gan b\u1ea5t th\u01b0\u1eddng, vi\u00eam th\u1eadn, b\u1ec7nh t\u00e2m th\u1ea7n n\u1eb7ng, t\u00ecnh tr\u1ea1ng c\u00f3 nguy c\u01a1 xu\u1ea5t huy\u1ebft n\u1eb7ng, vi\u00eam m\u00e0ng trong tim ho\u1eb7c nh\u1ed3i m\u00e1u c\u01a1 tim).<\/p>\n

13 b\u1ec7nh to\u00e0n th\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c b\u1ed5 sung th\u00eam (Mombelli v\u00e0 Cionca, 2006) l\u00e0:
\n1. X\u01a1 c\u1ee9ng b\u00ec.
\n2. H\u1ed9i ch\u1ee9ng Sj\u00f6gren.
\n3. R\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n v\u00e0 ho\u1eb7c b\u1ec7nh parkinson.
\n4. Liken ph\u1eb3ng mi\u1ec7ng.
\n5. Nhi\u1ec5m HIV.
\n6. Lo\u1ea1n s\u1ea3n ngo\u1ea1i bi.
\n7. Suy gi\u1ea3m mi\u1ec5n d\u1ecbch l\u00e2u d\u00e0i sau khi c\u1ea5y gh\u00e9p n\u1ed9i t\u1ea1ng.
\n8. B\u1ec7nh tim m\u1ea1ch.
\n9. B\u1ec7nh crohn
\n10. B\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.
\n11. Lo\u00e3ng x\u01b0\u01a1ng.
\n12. \u0110ang d\u00f9ng thu\u1ed1c bisphosphonates.
\n13. B\u1ec7nh nh\u00e2n \u0111ang x\u1ea1 tr\u1ecb.<\/p>\n

Trong khu\u00f4n kh\u1ed5 b\u00e0i n\u00e0y, \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ee9c kh\u1ecfe to\u00e0n th\u00e2n, ch\u00fang ta s\u1ebd ch\u00fa tr\u1ecdng nh\u1eefng v\u1ea5n \u0111\u1ec1 ch\u00ednh nh\u01b0: t\u00ecnh tr\u1ea1ng tim m\u1ea1ch, huy\u1ebft \u00e1p, b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, t\u00ecnh tr\u1ea1ng nghi\u1ec7n r\u01b0\u1ee3u, h\u00fat thu\u1ed1c l\u00e1, b\u1ec7nh nh\u00e2n tia x\u1ea1, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u00e1c lo\u1ea1i thu\u1ed1c corticoid, thu\u1ed1c bisphosphonate, tu\u1ed5i t\u00e1c b\u1ec7nh nh\u00e2n. T\u1eeb \u0111\u00f3 c\u00f3 ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt ch\u00ednh x\u00e1c, c\u00f3 ti\u00ean l\u01b0\u1ee3ng v\u1ec1 k\u1ebft qu\u1ea3 sau ph\u1eabu thu\u1eadt.<\/p>\n

1.2. M\u1ed9t s\u1ed1 b\u1ec7nh to\u00e0n th\u00e2n \u1ea3nh h\u01b0\u1edfng t\u1edbi\u00a0implant nha khoa<\/h3>\n

1.2.1. \u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng tim m\u1ea1ch<\/h4>\n

1.2.1.1. B\u1ec7nh l\u00fd v\u1ec1 tim<\/h5>\n
\"implant-nha-khoa-2\"
B\u1ec7nh l\u00fd tim \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ec9 \u0111\u1ecbnh Implant tr\u00ean b\u1ec7nh nh\u00e2n<\/figcaption><\/figure>\n

V\u1ea5n \u0111\u1ec1 quan t\u00e2m \u0111\u1ea7u ti\u00ean l\u00e0 t\u00ecnh tr\u1ea1ng tim m\u1ea1ch c\u1ee7a b\u1ec7nh nh\u00e2n b\u1edfi s\u1ef1 ph\u1ee9c t\u1ea1p v\u00e0 nguy hi\u1ec3m c\u00f3 th\u1ec3 x\u1ea3y ra khi b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c b\u1ec7nh v\u1ec1 tim m\u1ea1ch. M\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n hay g\u1eb7p nh\u1ea5t g\u00e2y t\u1eed vong trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt l\u00e0 nh\u1ed3i m\u00e1u c\u01a1 tim. C\u00e1c b\u1ec7nh tim m\u1ea1ch kh\u00e1c nh\u01b0 cao huy\u1ebft \u00e1p, lo\u1ea1n nh\u1ecbp tim, b\u1ec7nh van tim, block nh\u0129 th\u1ea5t c\u0169ng g\u00e2y \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u t\u1edbi qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt v\u00e0 s\u1ef1 th\u00e0nh c\u00f4ng c\u1ee7a cu\u1ed9c ph\u1eabu thu\u1eadt. M\u1ed9t v\u1ea5n \u0111\u1ec1 \u0111\u1eb7t ra l\u00e0 l\u00e0m th\u1ebf n\u00e0o \u0111\u1ec3 ng\u01b0\u1eddi ph\u1eabu thu\u1eadt vi\u00ean c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c nh\u1eefng nguy c\u01a1 ti\u1ec1m \u1ea9n n\u00e0y v\u00e0 ph\u1ea3i l\u00e0m x\u00e9t nghi\u1ec7m g\u00ec \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt c\u1ea5y gh\u00e9p nha khoa.<\/p>\n

Ph\u00e1t hi\u1ec7n b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed nh\u1ed3i m\u00e1u c\u01a1 tim l\u00e0 \u0111i\u1ec1u r\u1ea5t quan tr\u1ecdng. \u1ede c\u1ed9ng \u0111\u1ed3ng n\u00f3i chung, khi can thi\u1ec7p ph\u1eabu thu\u1eadt, nguy c\u01a1 b\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim th\u1ea5p d\u01b0\u1edbi 1%. N\u1ebfu ph\u1ea3i ph\u1eabu thu\u1eadt cho b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed nh\u1ed3i m\u00e1u c\u01a1 tim tr\u01b0\u1edbc \u0111\u00f3 3 th\u00e1ng th\u00ec nguy c\u01a1 nh\u1ed3i m\u00e1u c\u01a1 tim xu\u1ea5t hi\u1ec7n tr\u1edf l\u1ea1i l\u00e0 30% v\u00e0 15% \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 ti\u1ec1n s\u1eed nh\u1ed3i m\u00e1u c\u01a1 tim tr\u01b0\u1edbc \u0111\u00f3 4 \u2013 6 th\u00e1ng. N\u1ebfu tr\u00ec ho\u00e3n ph\u1eabu thu\u1eadt \u00edt nh\u1ea5t 6 th\u00e1ng sau khi b\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim s\u1ebd l\u00e0m gi\u1ea3m nguy c\u01a1 m\u1eafc b\u1ec7nh l\u1ea1i xu\u1ed1ng c\u00f2n 5 \u2013 6% v\u00e0 t\u1ef7 l\u1ec7 n\u00e0y duy tr\u00ec t\u01b0\u01a1ng \u0111\u1ed1i h\u1eb1ng \u0111\u1ecbnh su\u1ed1t c\u00e1c th\u1eddi gian v\u1ec1 sau.<\/p>\n

B\u1ec7nh nh\u00e2n b\u1ecb \u0111au th\u1eaft ng\u1ef1c c\u1ea7n ph\u1ea3i kh\u00e1m k\u1ef9 l\u01b0\u1ee1ng, n\u1ebfu \u0111au th\u1eaft ng\u1ef1c \u0111\u01a1n thu\u1ea7n th\u01b0\u1eddng \u00edt nguy hi\u1ec3m. Tr\u01b0\u1eddng h\u1ee3p \u0111au th\u1eaft ng\u1ef1c xu\u1ea5t hi\u1ec7n sau nh\u1ed3i m\u00e1u c\u01a1 tim th\u00ec c\u00e0ng t\u0103ng y\u1ebfu t\u1ed5 nguy c\u01a1 nh\u1ed3i m\u00e1u t\u00e1i ph\u00e1t khi ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt. N\u1ebfu b\u1ec7nh nh\u00e2n ch\u1ec9 \u0111au th\u1eaft ng\u1ef1c trong th\u1eddi gian ho\u1ea1t \u0111\u1ed9ng m\u1ea1nh v\u00e0 \u0111\u00e1p \u1ee9ng nhanh v\u1edbi nitroglycerin \u0111\u1eb7t \u1edf mi\u1ec7ng th\u00ec c\u00f3 th\u1ec3 ph\u1eabu thu\u1eadt ngo\u1ea1i tr\u00fa. Nh\u1eefng b\u1ec7nh nh\u00e2n \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh, k\u00edch th\u00edch nh\u1eb9 c\u0169ng \u0111au ho\u1eb7c \u0111au c\u1ea3 khi ngh\u1ec9 ng\u01a1i th\u00ec c\u1ea7n kh\u00e1m v\u00e0 c\u00e2n nh\u1eafc k\u1ef9 tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt.<\/p>\n

Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u1ed1i gh\u00e9p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh ng\u01b0\u1eddi ta th\u1ea5y nguy c\u01a1 b\u1ecb thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim r\u1ea5t th\u1ea5p.
\n\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh v\u1ec1 m\u1ea1ch v\u00e0nh, ph\u1eabu thu\u1eadt vi\u00ean c\u1ea7n c\u00f3 k\u1ebf ho\u1ea1ch ph\u00f2ng ng\u1eeba kh\u1ea3 n\u0103ng xu\u1ea5t hi\u1ec7n c\u01a1n \u0111au th\u1eaft ng\u1ef1c b\u1eb1ng c\u00e1ch t\u0103ng oxy trong khi ph\u1eabu thu\u1eadt l\u00e0 c\u00e1ch t\u1ed1t nh\u1ea5t v\u00e0 l\u00e0m gi\u1ea3m lo l\u1eafng cho b\u1ec7nh nh\u00e2n. Tr\u01b0\u1edbc ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 cho b\u1ec7nh nh\u00e2n d\u00f9ng nitroglycerin v\u00e0 d\u00f9ng thu\u1ed1c t\u00ea t\u1ea1i ch\u1ed7 \u0111\u1ec3 ph\u1eabu thu\u1eadt ti\u1ebfn h\u00e0nh t\u1ed1t h\u01a1n.<\/p>\n

\u0110\u1ea7u ti\u00ean c\u1ea7n khai th\u00e1c k\u1ef9 t\u00ecnh tr\u1ea1ng s\u1ee9c kho\u1ebb hi\u1ec7n t\u1ea1i v\u00e0 ti\u1ec1n s\u1eed b\u1ec7nh t\u1eadt c\u1ee7a b\u1ec7nh nh\u00e2n, ti\u1ec1n s\u1eed m\u1eafc hay bi\u1ec3u hi\u1ec7n d\u1ecb \u1ee9ng \u0111\u00e3 x\u1ea3y ra, ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c (t\u00ean thu\u1ed1c, li\u1ec1u l\u01b0\u1ee3ng, t\u1ea1i sao ph\u1ea3i d\u00f9ng thu\u1ed1c v\u00e0 d\u00f9ng bao l\u00e2u…), t\u00ecnh tr\u1ea1ng h\u00fat thu\u1ed1c l\u00e1, nghi\u1ec7n r\u01b0\u1ee3u, bia, ma tu\u00fd, nguy c\u01a1 b\u1ecb HIV…<\/p>\n

Ti\u1ec1n s\u1eed nh\u1ed3i m\u00e1u c\u01a1 tim, c\u00f3 b\u1ec7nh v\u1ec1 van tim hay kh\u00f4ng, \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb bao l\u00e2u, thu\u1ed1c d\u00f9ng. Khi c\u00f3 nghi ng\u1edd hay qua khai th\u00e1c th\u1ea5y c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 tim m\u1ea1ch ph\u1ea3i g\u1eedi b\u1ec7nh nh\u00e2n \u0111i kh\u00e1m h\u1ed9i ch\u1ea9n v\u1edbi b\u00e1c s\u0129 chuy\u00ean khoa v\u1ec1 tim m\u1ea1ch \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh c\u00f3 cho ph\u00e9p ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt hay kh\u00f4ng.<\/p>\n

1.2.1.2. Huy\u1ebft \u00e1p<\/h5>\n

\u0110\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n cao huy\u1ebft \u00e1p, t\u1eadp trung ph\u00e1t hi\u1ec7n c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 k\u1ebft h\u1ee3p v\u1edbi b\u1ec7nh tim m\u1ea1ch trong ti\u1ec1n s\u1eed qua khai th\u00e1c. H\u1ecfi b\u1ec7nh nh\u00e2n v\u1ec1 b\u1ec7nh cao huy\u1ebft \u00e1p \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nh\u01b0 th\u1ebf n\u00e0o v\u00e0 hi\u1ec7u qu\u1ea3 ra sao, k\u1ebft h\u1ee3p v\u1edbi \u0111o huy\u1ebft \u00e1p, \u0111\u1ebfm m\u1ea1ch hi\u1ec7n t\u1ea1i c\u1ee7a b\u1ec7nh nh\u00e2n. Trong m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u ng\u01b0\u1eddi ta th\u1ea5y huy\u1ebft \u00e1p b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 t\u0103ng l\u00ean trong nh\u1eefng ng\u00e0y ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt b\u1edfi s\u1ef1 lo l\u1eafng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh chi\u1ebfm kho\u1ea3ng 25% tr\u01b0\u1eddng h\u1ee3p. V\u00ec v\u1eady, nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u1ea7n cho thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p tr\u01b0\u1edbc v\u00e0 sau khi ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt.<\/p>\n

B\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng cao hay c\u00f3 d\u1ea5u hi\u1ec7u m\u1ed9t b\u1ed9 ph\u1eadn n\u00e0o \u0111\u00f3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng m\u1ea5t ch\u1ee9c n\u0103ng do cao huy\u1ebft \u00e1p th\u00ec c\u1ea7n c\u00e2n nh\u1eafc k\u1ef9 l\u01b0\u1ee1ng tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u1ea7n c\u00f3 h\u1ed9i ch\u1ea9n v\u1edbi b\u00e1c s\u0129 chuy\u00ean khoa tim m\u1ea1ch. Trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n b\u1ecb cao huy\u1ebft \u00e1p ho\u1eb7c b\u1ec7nh tim m\u1ea1ch \u1edf m\u1ee9c \u0111\u1ed9 cho ph\u00e9p v\u1eabn ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c th\u00ec vi\u1ec7c d\u00f9ng thu\u1ed1c t\u00ea c\u00f3 epinephrine c\u0169ng th\u1ea5p c\u00e0ng t\u1ed1t. N\u1ebfu s\u1eed d\u1ee5ng thu\u1ed1c t\u00ea mepivacain 3% m\u00e0 kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 g\u00e2y t\u00ea c\u00f3 th\u1ec3 d\u00f9ng thu\u1ed1c t\u00ea c\u00f3 ch\u1ee9a epinephrine n\u1ed3ng \u0111\u1ed9 1 : 200.000. Li\u1ec1u t\u1ed1i \u0111a epinephrine d\u00f9ng tr\u00ean b\u1ec7nh nh\u00e2n tim m\u1ea1ch hay cao huy\u1ebft \u00e1p l\u00e0 kh\u00f4ng qu\u00e1 0,04mg. T\u00e1c d\u1ee5ng g\u00e2y t\u00ea kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 c\u00f3 th\u1ec3 do thu\u1ed1c thi\u1ebfu kh\u1ea3 n\u0103ng g\u00e2y co m\u1ea1ch c\u0169ng c\u00f3 th\u1ec3 do t\u00e1c d\u1ee5ng l\u00e0m t\u0103ng huy\u1ebft \u00e1p m\u1ea1nh h\u01a1n t\u00e1c d\u1ee5ng g\u00e2y co m\u1ea1ch.<\/p>\n

1.2.2. B\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/h4>\n

B\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng l\u00e0 m\u1ed9t b\u1ec7nh h\u1ec7 th\u1ed1ng c\u00f3 kh\u1ea3 n\u0103ng \u1ea3nh h\u01b0\u1edfng t\u1edbi s\u1ef1 l\u00e0nh th\u01b0\u01a1ng do b\u1ecb gi\u1ea3m neutrophil chemotaxis v\u00e0 ho\u1ea1t \u0111\u1ed9ng th\u1ef1c b\u1ea3o c\u0169ng gi\u1ea3m, l\u00e0m cho d\u1ec5 b\u1ecb nhi\u1ec5m tr\u00f9ng. Tuy nhi\u00ean, b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng kh\u00f4ng ph\u1ea3i l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i trong c\u1ea5y gh\u00e9p nha khoa nh\u01b0ng c\u0169ng l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 c\u00e2n nh\u1eafc khi ti\u1ebfn h\u00e0nh c\u1ea5y gh\u00e9p. Ch\u1ec9 \u0111\u1ecbnh c\u1ea5y gh\u00e9p ch\u1ec9 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n khi b\u1ec7nh \u1ed5n \u0111\u1ecbnh hay ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh v\u00e0 c\u00f3 k\u1ebf ho\u1ea1ch ch\u0103m s\u00f3c tr\u01b0\u1edbc, sau ph\u1eabu thu\u1eadt t\u1ed1t.<\/p>\n

1.2.3. C\u00e1c b\u1ec7nh v\u1ec1 m\u00e1u<\/h4>\n

Tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh v\u1ec1 m\u00e1u nh\u01b0: b\u1ec7nh \u01b0a ch\u1ea3y m\u00e1u, suy tu\u1ef7, b\u1ec7nh nh\u00e2n thi\u1ebfu y\u1ebfu t\u1ed1 VIII… khi c\u1ea5y gh\u00e9p d\u1ec5 b\u1ecb ch\u1ea3y m\u00e1u k\u00e9o d\u00e0i v\u00e0 l\u00e0m v\u1ebft th\u01b0\u01a1ng ch\u1eadm li\u1ec1n, d\u1ec5 nhi\u1ec5m tr\u00f9ng. V\u00ec v\u1eady, c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u00e0 kh\u00e1m h\u1ed9i ch\u1ea9n chuy\u00ean khoa tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt n\u1ebfu \u0111i\u1ec1u ki\u1ec7n cho ph\u00e9p. B\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng c\u1ea7n ph\u1ea3i d\u1eebng s\u1eed d\u1ee5ng \u00edt nh\u1ea5t tr\u01b0\u1edbc 1 tu\u1ea7n.<\/p>\n

1.2.4. B\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c ch\u1ed1ng vi\u00eam corticosteroid<\/h4>\n

Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c corticosteroid k\u00e9o d\u00e0i v\u1edbi li\u1ec1u l\u01b0\u1ee3ng l\u1edbn s\u1ebd \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u t\u1edbi qu\u00e1 tr\u00ecnh l\u00e0nh th\u01b0\u01a1ng c\u1ee7a implant nha khoa sau c\u1ea5y gh\u00e9p. S\u1eed d\u1ee5ng corticosteroid k\u00e9o d\u00e0i l\u00e0m ch\u1eadm qu\u00e1 tr\u00ecnh bi\u1ec7t ho\u00e1 c\u1ee7a c\u00e1c t\u1ebf b\u00e0o trung m\u00f4, ng\u0103n c\u1ea3n s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c bi\u1ec3u m\u00f4, s\u1ef1 t\u1ed5ng h\u1ee3p collagen, ng\u0103n c\u1ea3n s\u1ef1 di chuy\u1ec3n c\u1ee7a c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o v\u00e0 s\u1ef1 t\u0103ng tr\u01b0\u1edfng c\u1ee7a t\u1ebf b\u00e0o s\u1ee3i, ng\u0103n c\u1ea3n ho\u00e1 \u1ee9ng \u0111\u1ed9ng c\u1ee7a b\u1ea1ch c\u1ea7u, th\u1ef1c b\u00e0o v\u00e0 ti\u00eau n\u1ed9i b\u1ea3o. N\u1ebfu ch\u1ec9 d\u00f9ng m\u1ed9t li\u1ec1u duy nh\u1ea5t th\u00ec kh\u00f4ng \u1ea3nh h\u01b0\u1edfng t\u1edbi qu\u00e1 tr\u00ecnh l\u00e0nh th\u01b0\u01a1ng.<\/p>\n

1.2.5. B\u1ec7nh nh\u00e2n lo\u00e3ng x\u01b0\u01a1ng d\u00f9ng c\u00e1c thu\u1ed1c c\u00f3 ch\u1ee9a bisphosphonate<\/h4>\n

Lo\u00e3ng x\u01b0\u01a1ng l\u00e0 t\u00ecnh tr\u1ea1ng gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng x\u01b0\u01a1ng trong c\u01a1 th\u1ec3, l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a nhi\u1ec1u nguy\u00ean nh\u00e2n g\u00e2y ra nh\u01b0: b\u1ec7nh n\u1ed9i ti\u1ebft, b\u1ec7nh th\u1eadn n\u1eb7ng th\u1ea3i m\u1ea5t qu\u00e1 nhi\u1ec1u canxi, h\u1eadu qu\u1ea3 c\u1ee7a vi\u1ec7c d\u00f9ng thu\u1ed1c corticoid k\u00e9o d\u00e0i. Trong \u0111\u00f3, lo\u00e3ng x\u01b0\u01a1ng c\u1ee7a ph\u1ee5 n\u1eef tu\u1ed5i m\u00e3n kinh chi\u1ebfm t\u1ef7 l\u1ec7 l\u1edbn c\u00e1c tr\u01b0\u1edfng h\u1ee3p, nguy\u00ean nh\u00e2n l\u00e0 do thi\u1ebfu h\u1ee5t n\u1ed9i ti\u1ebft t\u1ed1 estrogen n\u00ean ch\u1ee9c n\u0103ng \u0111i\u1ec1u ho\u00e0 h\u1ea5p th\u1ee5 canxi v\u00e0o x\u01b0\u01a1ng b\u1ecb suy gi\u1ea3m.<\/p>\n

Bisphosphonate l\u00e0 thu\u1ed1c ch\u1ed1ng lo\u00e3ng x\u01b0\u01a1ng. \u0110\u00e2y l\u00e0 m\u1ed9t thu\u1ed1c kh\u00e1 c\u00f4ng hi\u1ec7u v\u00e0 \u0111\u01b0\u1ee3c d\u00f9ng r\u1ed9ng r\u00e3i trong l\u00e2m s\u00e0ng \u0111\u1ec3 kh\u1ed1ng ch\u1ebf c\u0103n b\u1ec7nh c\u1ee7a h\u1ea7u nh\u01b0 m\u1ecdi ph\u1ee5 n\u1eef sau m\u00e3n kinh v\u00e0 nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng \u0111\u1ee7 canxi trong kh\u1ea9u ph\u1ea7n \u0103n.<\/p>\n

Trong x\u01b0\u01a1ng c\u00f3 hai lo\u1ea1i t\u1ebf b\u00e0o ch\u00ednh l\u00e0 t\u1ea1o c\u1ed1t b\u00e0o (t\u1ebf b\u00e0o t\u1ea1o ra x\u01b0\u01a1ng) v\u00e0 h\u1ee7y c\u1ed1t b\u00e0o (t\u1ebf b\u00e0o ti\u00eau x\u01b0\u01a1ng). C\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 g\u00e2y ra lo\u00e3ng x\u01b0\u01a1ng nh\u01b0ng m\u1ed9t trong nh\u1eefng y\u1ebfu t\u1ed1 \u0111\u00f3 l\u00e0 s\u1ef1 ho\u1ea1t \u0111\u1ed9ng qu\u00e1 m\u1ea1nh c\u1ee7a t\u1ebf b\u1ea3o ti\u00eau x\u01b0\u01a1ng v\u00e0 gi\u1ea3m ch\u1ee9c n\u0103ng t\u1ebf b\u00e0o t\u1ea1o x\u01b0\u01a1ng.Bisphosphonate l\u00e0 thu\u1ed1c gi\u00fap g\u1eafn ch\u1eb7t canxi tr\u00ean b\u1ec1 m\u1eb7t x\u01b0\u01a1ng, l\u00e0m gia t\u0103ng s\u1ef1 t\u00edch lu\u1ef9 canxi c\u1ee7a c\u01a1 th\u1ec3 l\u00ean x\u01b0\u01a1ng n\u00ean c\u00f3 t\u00e1c d\u1ee5ng ng\u0103n ch\u1eb7n hay l\u00e0m ch\u1eadm qu\u00e1 tr\u00ecnh hu\u1ef7 x\u01b0\u01a1ng. M\u1eb7t kh\u00e1c, n\u00f3 l\u1ea1i k\u00edch th\u00edch t\u1ebf b\u00e0o t\u1ea1o x\u01b0\u01a1ng v\u00e0 do \u0111\u00f3, gi\u00fap c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng lo\u00e3ng x\u01b0\u01a1ng. Tuy nhi\u00ean, \u1edf li\u1ec1u cao ho\u1eb7c d\u00f9ng d\u00e0i ng\u00e0y c\u00e1c thu\u1ed1c n\u00e0y l\u1ea1i g\u1eafn ch\u1eb7t v\u1edbi tinh th\u1ec3 Ca3PO4 (canxi photphat) trong m\u1eabu l\u00e0m gi\u1ea3m s\u1ef1 canxi ho\u00e1 trong x\u01b0\u01a1ng, d\u1eabn t\u1edbi l\u00e0m x\u01b0\u01a1ng kh\u00f4ng th\u1ec3 ch\u1eafc \u0111\u01b0\u1ee3c. \u0110\u00e2y l\u00e0 tr\u1edf ng\u1ea1i s\u1ebd g\u00e2y ra nh\u1eefng t\u00e1c h\u1ea1i kh\u00f4ng mong mu\u1ed1n c\u1ee7a thu\u1ed1c. So v\u1edbi nh\u1eefng ph\u1ee5 n\u1eef m\u00e3n kinh ch\u1ec9 u\u1ed1ng thu\u1ed1c t\u1ed1i \u0111a 3 th\u00e1ng li\u00ean t\u1ee5c th\u00ec nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng \u1edf nh\u1eefng ph\u1ee5 n\u1eef u\u1ed1ng li\u00ean t\u1ee5c tr\u00ean 5 n\u0103m cao h\u01a1n 2,74 l\u1ea7n. T\u1ea1i bi\u1ec3n n\u00e0y l\u00e0 tai bi\u1ebfn c\u1ea7n ch\u00fa \u00fd nh\u1ea5t v\u1edbi c\u1ea3 ng\u01b0\u1eddi b\u1ec7nh v\u00e0 b\u00e1c s\u0129,<\/p>\n

M\u1ed1i quan h\u1ec7 gi\u1eefa bisphosphonates (BP) v\u00e0 th\u1ea5t b\u1ea1i c\u1ee7a c\u1ea5y gh\u00e9p nha khoa ch\u01b0a \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch m\u1ed9t c\u00e1ch \u0111\u1ea7y \u0111\u1ee7. T\u1ef7 l\u1ec7 th\u1ea5t b\u1ea1i c\u1ee7a implant nha khoa \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n d\u00f9ng bisphosphonate \u0111\u01b0\u1eddng u\u1ed1ng c\u0169ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 tr\u00ean m\u1ed9t b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t. C\u00e1c t\u00e1c gi\u1ea3 \u0111\u00e3 k\u1ebft lu\u1eadn r\u1eb1ng, bisphosphonate d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y ho\u1ea1i t\u1eed x\u01b0\u01a1ng sau ph\u1eabu thu\u1eadt c\u1ea5y gh\u00e9p. Tuy nhi\u00ean, \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng bisphosphonate \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u00e0 s\u1eed d\u1ee5ng k\u00e9o d\u00e0i (tr\u00ean 3 n\u0103m), t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng g\u00e2y ho\u1ea1i t\u1eed x\u01b0\u01a1ng h\u00e0m \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o. V\u00ec v\u1eady, c\u1ea7n th\u1eadn tr\u1ecdng \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n n\u1eef tu\u1ed5i m\u00e3n kinh, n\u00ean h\u1ecfi k\u1ef9 ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c c\u00f3 bisphosphonate nh\u1eb1m h\u1ea1n ch\u1ebf th\u1ea5t b\u1ea1i sau c\u1eafm implant nha khoa.<\/p>\n

1.2.6. Tia x\u1ea1<\/h4>\n

Trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n sau tia x\u1ea1 c\u1ea7n t\u00e1i t\u1ea1o khi\u1ebfm khuy\u1ebft h\u00e0m m\u1eb7t do c\u1eaft b\u1ecf c\u00e1c kh\u1ed1i u \u00e1c t\u00ednh b\u1eb1ng c\u1eafm gh\u00e9p nha khoa hay nh\u1ed5 r\u0103ng… c\u1ea7n ph\u1ea3i c\u00e2n nh\u1eafc k\u1ef9, b\u1edfi sau ph\u1eabu thu\u1eadt r\u1ea5t ch\u1eadm li\u1ec1n th\u01b0\u01a1ng, th\u1eadm ch\u00ed x\u01b0\u01a1ng v\u00f9ng can thi\u1ec7p b\u1ecb ho\u1ea1i t\u1eed. Ng\u01b0\u1eddi ta th\u1ea5y r\u1eb1ng, kh\u1ea3 n\u0103ng t\u00edch h\u1ee3p x\u01b0\u01a1ng t\u1ed1t h\u01a1n tr\u00ean b\u1ec7nh nh\u00e2n sau ch\u1ea1y tia x\u1ea1 khi \u0111\u01b0\u1ee3c \u0111\u01b0\u1ee3c b\u1ed9i \u00e1p oxy (Hyperbaric oxygen \u2013 HBO) tr\u01b0\u1edbc khi c\u1ea5y gh\u00e9p. Do v\u1eady, ch\u00fang ta n\u00ean tr\u00ec ho\u00e3n vi\u1ec7c c\u1ea5y gh\u00e9p nha khoa sau m\u1ed9t th\u1eddi gian t\u1ed1i thi\u1ec3u tr\u00ean 12 th\u00e1ng v\u00e0 n\u00ean cho b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb m\u1ed9t \u0111\u1ee3t HBO tr\u01b0\u1edbc khi c\u1ea5y gh\u00e9p. Khi can thi\u1ec7p ph\u1eabu thu\u1eadt v\u00e0o c\u00e1c m\u00f4 \u0111\u00e3 b\u1ecb tia x\u1ea1, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i \u00e1p d\u1ee5ng k\u1ef9 thu\u1eadt kh\u00f4ng sang ch\u1ea5n, b\u1edfi c\u00e1c m\u00f4 v\u00f9ng ch\u1ea1y tia x\u1ea1 s\u1ebd ch\u1eadm l\u00e0nh th\u01b0\u01a1ng sau nh\u1eefng thao t\u00e1c ph\u1eabu thu\u1eadt v\u00e0 k\u1ebft qu\u1ea3 d\u1ec5 th\u1ea5t b\u1ea1i sau c\u1ea5y gh\u00e9p, c\u00f3 th\u1ec3 d\u1eabn t\u1edbi ho\u1ea1i t\u1eed x\u01b0\u01a1ng.<\/p>\n

1.2.7. Tu\u1ed5i<\/h4>\n

Tu\u1ed5i b\u1ec7nh nh\u00e2n th\u01b0\u1eddng sau 18 tu\u1ed5i \u1edf n\u1eef gi\u1edbi v\u00e0 20 tu\u1ed5i \u1edf nam gi\u1edbi khi s\u1ef1 ph\u00e1t tri\u1ec3n x\u01b0\u01a1ng h\u00e0m t\u01b0\u01a1ng \u0111\u1ed1i \u1ed5n \u0111\u1ecbnh. Kh\u00f4ng c\u00f3 tu\u1ed5i t\u1ed1i \u0111a, mi\u1ec5n l\u00e0 s\u1ee9c kho\u1ebb to\u00e0n th\u00e2n \u0111\u1ea3m b\u1ea3o. Tuy nhi\u00ean khi tu\u1ed5i cao, h\u1ec7 th\u1ed1ng x\u01b0\u01a1ng kh\u1edbp c\u00f3 s\u1ef1 thay \u0111\u1ed5i v\u1ec1 th\u00e0nh ph\u1ea7n mu\u1ed1i kho\u1ea3ng khung t\u1ef1a h\u1eefu c\u01a1 v\u00e0 c\u00e1c th\u00e0nh ph\u1ea7n t\u1ebf b\u00e0o. Ch\u1ee9ng lo\u00e3ng x\u01b0\u01a1ng l\u00e0 m\u1ed9t t\u1ec9nh tr\u1ea1ng hay g\u1eb7p, trong \u0111\u00f3 ch\u1ee7 y\u1ebfu l\u00e0 t\u00ecnh tr\u1ea1ng gi\u1ea3m c\u00e1c th\u00e0nh ph\u1ea7n mu\u1ed1i kho\u00e1ng c\u1ee7a x\u01b0\u01a1ng. T\u1ea7n su\u1ea5t trao \u0111\u1ed5i canxi gi\u1eefa m\u00f4 x\u01b0\u01a1ng v\u00e0 huy\u1ebft thanh gi\u1ea3m d\u1ea7n theo tu\u1ed5i. T\u1ed1c \u0111\u1ed9 li\u1ec1n x\u01b0\u01a1ng khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u0169ng gi\u1ea3m d\u1ea7n. Ng\u01b0\u1eddi ta th\u1ea5y r\u1eb1ng, t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng khi c\u1eafm implant c\u0169ng gi\u1ea3m khi tu\u1ed5i c\u00e0ng cao v\u00ec nh\u1eefng thay \u0111\u1ed5i sinh l\u00fd n\u00eau tr\u00ean. V\u00ec v\u1eady, sau khi c\u1ea5y gh\u00e9p c\u1ea7n c\u00f3 s\u1ef1 c\u00e2n nh\u1eafc k\u1ef9 v\u1ec1 th\u1eddi gian tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh ph\u1ee5c h\u00ecnh r\u0103ng tr\u00ean implant, th\u00f4ng th\u01b0\u1eddng th\u00ec th\u1eddi gian l\u00e0nh th\u01b0\u01a1ng \u1edf ng\u01b0\u1eddi cao tu\u1ed5i k\u00e9o d\u00e0i h\u01a1n \u1edf ng\u01b0\u1eddi tr\u1ebb.<\/p>\n

1.2.8. T\u00ecnh tr\u1ea1ng h\u00fat thu\u1ed1c l\u00e1<\/h4>\n

Qua nh\u1eefng nghi\u00ean c\u1ee9u ng\u01b0\u1eddi ta nh\u1eadn th\u1ea5y ng\u01b0\u1eddi h\u00fat thu\u1ed1c l\u00e1, kh\u00f3i thu\u1ed1c l\u00e0 m\u1ed9t ch\u1ea5t \u0111\u1ed9c \u0111\u1ed1i v\u1edbi h\u1ec7 h\u00f4 h\u1ea5p v\u00e0 tu\u1ea7n ho\u00e0n. \u0110\u1eb7c bi\u1ec7t l\u00e0 nicotin c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 l\u00e0nh th\u01b0\u01a1ng. Khi nicotin b\u1ecb h\u00fat v\u00e0o hay ti\u00eam v\u00e0o trong c\u01a1 th\u1ec3 g\u00e2y n\u00ean hi\u1ec7n t\u01b0\u1ee3ng co m\u1ea1ch th\u00f4ng qua c\u01a1 ch\u1ebf tr\u1ef1c ti\u1ebfp ho\u1eb7c qua gi\u1ea3i ph\u00f3ng catecholamin, c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u1eddng tr\u1ef1c ti\u1ebfp \u0111\u1ebfn nguy\u00ean b\u1ea3o s\u1ee3i. \u1ea2nh h\u01b0\u1edfng co m\u1ea1ch c\u1ee7a nicotin s\u1ebd d\u1eabn \u0111\u1ebfn h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u \u0111\u00f4ng \u1edf m\u1ea1ch m\u00e1u nh\u1ecf g\u00e2y t\u1eafc m\u1ea1ch v\u00e0 t\u1ea1o ra hi\u1ec7n t\u01b0\u1ee3ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9.
\nTr\u00ean \u0111\u1ed9ng v\u1eadt, nicotin \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 l\u00e0m cho v\u1ebft th\u01b0\u01a1ng l\u00e2u l\u00e0nh. M\u1ed9t nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ee9ng minh kh\u1ecfi thu\u1ed1c l\u00e1 l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh ho\u1ea1i t\u1eed da \u1edf b\u1ec7nh nh\u00e2n c\u0169ng da m\u1eb7t g\u1ea5p 12,5 l\u1ea7n so v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng h\u00fat thu\u1ed1c l\u00e1.
\nH\u00fat thu\u1ed1c c\u00f3 \u1ea3nh h\u01b0\u1edfng kh\u00f4ng t\u1ed1t \u0111\u1ebfn vi\u1ec7c gh\u00e9p x\u01b0\u01a1ng, s\u1ef1 t\u00edch h\u1ee3p x\u01b0\u01a1ng c\u1ee7a implant, s\u1ef1 l\u00e0nh m\u1ea1nh c\u1ee7a m\u00f4 quanh implant v\u1ec1 l\u00e2u d\u00e0i (Buser v\u00e0 c\u1ed9ng s\u1ef1, 2004). M\u1ed9t v\u00e0i nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng cho th\u1ea5y h\u00fat thu\u1ed1c c\u00f3 \u1ea3nh h\u01b0\u1edfng kh\u00f4ng t\u1ed1t \u0111\u1ebfn s\u1ef1 t\u00edch h\u1ee3p x\u01b0\u01a1ng c\u1ee7a implant c\u1ea3 ng\u1eafn h\u1ea1n l\u1eabn d\u00e0i h\u1ea1n (Bain v\u00e0 Moy, 1990; De-Bruyn v\u00e0 Collaert, 1990; Lambert v\u00e0 c\u1ed9ng s\u1ef1, 2000; Wallace, 2000).
\nDo nh\u1eefng t\u00e1c d\u1ee5ng tr\u00ean c\u1ee7a nicotin n\u00ean tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh c\u1ea5y gh\u00e9p nha khoa c\u1ea7n c\u00f3 c\u00e2n nh\u1eafc. B\u1ec7nh nh\u00e2n h\u00fat thu\u1ed1c n\u00ean \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn cai thu\u1ed1c tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb. B\u1ec7nh nh\u00e2n h\u00fat thu\u1ed1c tr\u00ean 10 \u0111i\u1ebfu m\u1ed9t ng\u00e0y \u0111\u01b0\u1ee3c xem thu\u1ed9c nh\u00f3m nguy c\u01a1 cao. Tuy ch\u01b0a c\u00f3 k\u1ebft lu\u1eadn n\u00e0o v\u1ec1 th\u1eddi gian ph\u1ea3i ki\u00eang thu\u1ed1c l\u00e1 khi ph\u1eabu thu\u1eadt nh\u01b0ng nhi\u1ec1u ph\u1eabu thu\u1eadt vi\u00ean khuy\u00ean b\u1ec7nh nh\u00e2n kh\u00f4ng n\u00ean h\u00fat thu\u1ed1c l\u00e1 trong 10 ng\u00e0y tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt v\u00e0 4 \u2013 6 tu\u1ea7n sau khi ph\u1eabu thu\u1eadt.<\/p>\n

1.2.9. Nghi\u1ec7n r\u01b0\u1ee3u<\/h4>\n

Nghi\u1ec7n r\u01b0\u1ee3u c\u0169ng l\u00e0 v\u1ea5n \u0111\u1ec1 ch\u00fang ta c\u1ea7n quan t\u00e2m, v\u00ec nghi\u1ec7n r\u01b0\u1ee3u th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn suy gi\u1ea3m ch\u1ee9c n\u0103ng gan, r\u1ed1i lo\u1ea1n y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u, ch\u1ee9c n\u0103ng b\u1ea5t th\u01b0\u1eddng b\u1ea1ch c\u1ea7u, thi\u1ebfu m\u00e1u, r\u1ed1i lo\u1ea1n nh\u1ecbp tim, r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n v\u00e0 r\u1ed1i lo\u1ea1n khi cai r\u01b0\u1ee3u. V\u00ec v\u1eady, \u0111i\u1ec1u c\u1ea7n thi\u1ebft l\u00e0 khi kh\u00e1m c\u1ea7n khai th\u00e1c c\u1ea9n th\u1eadn \u0111\u1ec3 ph\u00e1t hi\u1ec7n kh\u1ea3 n\u0103ng nghi\u1ec7n r\u01b0\u1ee3u c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ec3 ti\u1ebfn h\u00e0nh c\u00e1c x\u00e9t nghi\u1ec7m li\u00ean quan \u0111\u1ebfn c\u00e1c ch\u1ee9c n\u0103ng tr\u00ean c\u00f3 b\u1ecb \u1ea3nh h\u01b0\u1edfng hay kh\u00f4ng tr\u01b0\u1edbc khi quy\u1ebft \u0111\u1ecbnh ph\u1eabu thu\u1eadt hay kh\u00f4ng ph\u1eabu thu\u1eadt.
\nNh\u01b0 v\u1eady, \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o th\u00e0nh c\u00f4ng cho implant nha khoa c\u1ea7n c\u00f3 c\u00e1c ch\u1ec9 \u0111\u1ecbnh v\u1ec1 to\u00e0n th\u00e2n nh\u01b0 sau:
\nB\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe to\u00e0n th\u00e2n t\u1ed1t, kh\u00f4ng m\u1eafc c\u00e1c b\u1ec7nh c\u1ea5p t\u00ednh hay m\u1ea1n t\u00ednh \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 implant. – C\u00f3 b\u1ec7nh to\u00e0n th\u00e2n nh\u01b0ng \u0111\u00e3 \u1ed5n \u0111\u1ecbnh hay \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t.
\n– C\u00e1c th\u00f3i quen x\u1ea5u \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u1ed5n \u0111\u1ecbnh ho\u1eb7c ki\u1ec3m so\u00e1t nh\u01b0 nghi\u1ebfn r\u0103ng, nghi\u1ec7n r\u01b0\u1ee3u, ma tu\u00fd, h\u00fat thu\u1ed1c l\u00e1, v\u1ec7 sinh r\u0103ng mi\u1ec7ng.
\nVi\u1ec7c kh\u00e1m \u0111\u00e1nh gi\u00e1 s\u1ee9c kh\u1ecfe to\u00e0n th\u00e2n c\u1ee7a b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi c\u1eafm gh\u00e9p nha khoa l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft, \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng cho th\u00e0nh c\u00f4ng hay th\u1ea5t b\u1ea1i c\u1ee7a vi\u1ec7c c\u1eafm gh\u00e9p nha khoa. \u0110\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c m\u1ed9t \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c c\u1ea7n ph\u1ea3i kh\u00e1m t\u1ec9 m\u1ec9, ph\u00e1t hi\u1ec7n nh\u1eefng nghi ng\u1edd, ch\u1ec9 \u0111\u1ecbnh c\u00e1c x\u00e9t nghi\u1ec7m c\u1ea7n thi\u1ebft \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng s\u1ee9c kho\u1ebb c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh v\u00e0 chu\u1ea9n b\u1ecb chu \u0111\u00e1o cho cu\u1ed9c ph\u1eabu thu\u1eadt.<\/p>\n

1.3. Ch\u1ec9 \u0111\u1ecbnh t\u1ea1i ch\u1ed7 c\u1ee7a implant nha khoa<\/h3>\n

– C\u1ea5u tr\u00fac x\u01b0\u01a1ng b\u00ecnh th\u01b0\u1eddng, kh\u1ed1i l\u01b0\u1ee3ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng x\u01b0\u01a1ng ph\u00f9 h\u1ee3p, l\u00fd t\u01b0\u1edfng l\u00e0 x\u01b0\u01a1ng c\u00f3 m\u1eadt \u0111\u1ed9 t\u1eeb 1 \u2013 III.<\/p>\n

– M\u00f4 m\u1ec1m l\u00e0nh m\u1ea1nh, kh\u00f4ng vi\u00eam nhi\u1ec5m. C\u00e1c nhi\u1ec5m tr\u00f9ng t\u1ea1i ch\u1ed7 c\u00f3 th\u1ec3 tr\u1ef1c ti\u1ebfp l\u00e0m gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng l\u1eabn ch\u1ea5t l\u01b0\u1ee3ng m\u00f4 c\u1ee9ng v\u00e0 m\u00f4 m\u1ec1m \u1edf v\u00f9ng c\u1ea7n c\u1ea5y gh\u00e9p v\u00e0 v\u00f9ng l\u00e2n c\u1eadn. Tinh ch\u1ea5t nhi\u1ec5m tr\u00f9ng c\u1ea5p t\u00ednh hay m\u1ea1n t\u00ednh s\u1ebd quy\u1ebft \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng sau khi \u0111i\u1ec1u tr\u1ecb ki\u1ec3m so\u00e1t nhi\u1ec5m tr\u00f9ng. Trong nhi\u1ec5m tr\u00f9ng t\u1ea1i ch\u1ed7 nguy c\u01a1 cao nh\u1ea5t khi vi\u00eam nhi\u1ec5m c\u1ea5p t\u00ednh v\u1edbi bi\u1ec3u hi\u1ec7n t\u1ea1o m\u1ee7 v\u00e0 s\u01b0ng t\u1ea1i ch\u1ed7. Vi\u00eam m\u1ea1n t\u00ednh nh\u01b0 vi\u00eam quanh ch\u00f3p \u1edf r\u0103ng c\u1ea7n ph\u1ee5c h\u1ed3i b\u1eb1ng implant c\u00f3 nguy c\u01a1 bi\u1ebfn ch\u1ee9ng trung b\u00ecnh n\u1ebfu ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc khi \u0111\u1eb7t implant.<\/p>\n

– Tr\u1ee5c r\u0103ng l\u00e2n c\u1eadn th\u1eb3ng ho\u1eb7c nghi\u00eang \u00edt. N\u1ebfu nghi\u00eang nhi\u1ec1u ph\u1ea3i m\u1ea3i ch\u1ec9nh, d\u1ef1ng tr\u1ee5c, ch\u1eefa tu\u1ef7 ho\u1eb7c nh\u1ed5 b\u1ecf n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

– Kho\u1ea3ng ph\u1ee5c h\u00ecnh \u0111\u1ee7 \u0111\u1ec3 th\u1ef1c hi\u1ec7n ph\u1ee5c h\u00ecnh tr\u00ean implant nha khoa.<\/p>\n

2. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h2>\n

2.1. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i c\u1ee7a implant nha khoa<\/h3>\n

2.1.1. To\u00e0n th\u00e2n<\/h4>\n

– \u0110ang b\u1ecb c\u00e1c b\u1ec7nh c\u1ea5p t\u1ec9nh.<\/p>\n

– \u0110ang b\u1ecb b\u1ec7nh l\u00fd m\u1ea1n t\u00ednh to\u00e0n th\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t. – Ng\u01b0\u1eddi m\u1eafc b\u1ec7nh l\u00fd th\u1ea7n kinh kh\u00f4ng \u1ed5n \u0111\u1ecbnh.<\/p>\n

– Ph\u1ee5 n\u1eef mang thai: Tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n implant nha khoa b\u1eaft bu\u1ed9c ph\u1ea3i ch\u1ee5p phim \u0111\u1ec3 ki\u1ec3m tra c\u1ea5u tr\u00fac v\u00e0 th\u1ec3 t\u00edch x\u01b0\u01a1ng, g\u00e2y t\u00ea v\u00e0 th\u01b0\u1eddng ph\u1ea3i s\u1eed d\u1ee5ng m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c kh\u00e1ng sinh, ch\u1ed1ng vi\u00eam. \u0110i\u1ec1u n\u00e0y kh\u00f4ng h\u1ec1 t\u1ed1t \u0111\u1ed1i v\u1edbi s\u1ee9c kh\u1ecfe c\u1ee7a b\u00e0 m\u1eb9 v\u00e0 thai nhi.<\/p>\n

– B\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng c\u1ea7n \u0111\u01b0a INR d\u01b0\u1edbi 2 (b\u00ecnh th\u01b0\u1eddng l\u00e0 1,2), corticoid d\u1eebng tr\u01b0\u1edbc 10 ng\u00e0y.<\/p>\n

2.1.2. T\u1ea1i ch\u1ed7<\/h4>\n

– B\u1ec7nh nh\u00e2n \u0111ang c\u00f3 vi\u00eam nhi\u1ec5m c\u1ea5p t\u00ednh t\u1ea1i khoang mi\u1ec7ng nh\u01b0 vi\u00eam l\u1ee3i c\u1ea5p t\u1ec9nh, vi\u00eam h\u1ecdng c\u1ea5p, vi\u00eam xoang h\u00e0m c\u1ea5p…<\/p>\n

– B\u1ec7nh nh\u00e2n \u0111ang m\u1eafc c\u00e1c b\u1ec7nh l\u00fd r\u0103ng mi\u1ec7ng nh\u01b0 vi\u00eam quanh r\u0103ng, vi\u00eam l\u1ee3i m\u1ea1n t\u00ednh… c\u1ea7n \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n implant.<\/p>\n

– B\u1ec7nh nh\u00e2n \u0111ang c\u00f3 vi\u00eam nhi\u1ec5m ti\u1ebfn tri\u1ec3n t\u1ea1i v\u00f9ng d\u1ef1 \u0111\u1ecbnh \u0111\u1eb7t implant.<\/p>\n

– V\u00f9ng c\u1eafm implant thi\u1ebfu ni\u00eam m\u1ea1c s\u1eedng hoa c\u1ea7n gh\u00e9p,<\/p>\n

– B\u1ec7nh nh\u00e2n d\u1ecb d\u1ea1ng x\u01b0\u01a1ng h\u00e0m nghi\u00eam tr\u1ecdng kh\u00f4ng th\u1ec3 ph\u1ee5c h\u1ed3i.<\/p>\n

– B\u1ec7nh nh\u00e2n \u0111ang ho\u1eb7c \u0111\u00e3 ch\u1ea1y tia x\u1ea1 d\u01b0\u1edbi 12 th\u00e1ng, n\u1ebfu ti\u1ebfn h\u00e0nh c\u00f3 nguy c\u01a1 th\u1ea5t b\u1ea1i v\u00ec x\u01b0\u01a1ng d\u1ec5 b\u1ecb ho\u1ea1i t\u1eed.<\/p>\n

– B\u1ec7nh nh\u00e2n c\u00f3 th\u00f3i quen ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nhi\u00eau nghi\u1ebfn r\u0103ng.<\/p>\n

2.2. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i c\u1ee7a implant nha khoa<\/h3>\n

– B\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh to\u00e0n th\u00e2n giai \u0111o\u1ea1n cu\u1ed1i.<\/p>\n

– B\u1ec7nh nh\u00e2n gi\u1ea3, y\u1ebfu kh\u00f4ng \u0111\u1ee7 s\u1ee9c kho\u1ebb \u0111\u1ec3 ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt.<\/p>\n

– B\u1ec7nh nh\u00e2n v\u1ec7 sinh r\u0103ng mi\u1ec7ng k\u00e9m, kh\u00f4ng c\u00f3 \u00fd th\u1ee9c h\u1ee3p t\u00e1c v\u1edbi b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

Ngu\u1ed3n: Implant Nha khoa 1 – NXB Gi\u00e1o d\u1ee5c Vi\u1ec7t Nam<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

B\u00e0i vi\u1ebft n\u00e0y s\u1ebd n\u00f3i v\u1ec1 c\u00e1c ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee5 th\u1ec3 c\u1ee7a quy tr\u00ecnh ph\u1eabu thu\u1eadt c\u1eafm Implant Nha khoa. B\u00e0i vi\u1ebft cung c\u1ea5p cho Nha s\u0129 g\u00f3c nh\u00ecn s\u00e2u s\u1eafc khi \u0111\u1ee9ng tr\u01b0\u1edbc m\u1ed9t b\u1ec7nh nh\u00e2n v\u00e0 chu\u1ea9n b\u1ecb ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng th\u1ee7 thu\u1eadt n\u00e0y. C\u00f9ng t\u00ecm hi\u1ec3u s\u00e2u […]<\/p>\n","protected":false},"author":21,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[28,33],"tags":[3],"yoast_head":"\nImplant nha khoa - Ch\u1ec9 \u0111\u1ecbnh v\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft n\u00e0y \u0111\u1ec1 c\u1eadp \u0111\u1ebfn ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee5 th\u1ec3 c\u1ee7a quy tr\u00ecnh ph\u1eabu thu\u1eadt c\u1eafm Implant Nha khoa, cung c\u1ea5p g\u00f3c nh\u00ecn s\u00e2u s\u1eafc khi \u0111i\u1ec1u tr\u1ecb\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Implant nha khoa - Ch\u1ec9 \u0111\u1ecbnh v\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. - 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