{"id":19099,"date":"2023-04-12T16:49:55","date_gmt":"2023-04-12T09:49:55","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19099"},"modified":"2023-04-17T14:42:42","modified_gmt":"2023-04-17T07:42:42","slug":"lay-tuy-toan-bo-phuong-phap-dieu-tri-noi-nha","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/lay-tuy-toan-bo-phuong-phap-dieu-tri-noi-nha\/","title":{"rendered":"L\u1ea5y tu\u1ef7 to\u00e0n b\u1ed9 – Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha."},"content":{"rendered":"

L\u1ea5y tu\u1ef7 to\u00e0n b\u1ed9 l\u00e0 ph\u01b0\u01a1ng ph\u00e1p lo\u1ea1i tr\u1eeb to\u00e0n b\u1ed9 c\u00e1c t\u1ed5 ch\u1ee9c ho\u1ea1i t\u1eed, vi khu\u1ea9n. \u0111\u1ed9c t\u1ed1, c\u00e1c ch\u1ea5t k\u00edch th\u00edch trong bu\u1ed3ng tu\u1ef7 v\u00e0 \u1ed1ng tu\u1ef7 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n b\u1ea3o t\u1ed3n c\u00e1c r\u1eb1ng b\u1ec7nh l\u00fd, ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng \u0103n nhai c\u0169ng nh\u01b0 ch\u1ee9c n\u0103ng th\u1ea9m m\u1ef9 c\u1ee7a r\u0103ng. B\u00e0i vi\u1ebft s\u1ebd \u0111\u1ec1 c\u1eadp \u0111\u1ebfn ph\u01b0\u01a1ng ph\u00e1p l\u1ea5y tu\u1ef7 to\u00e0n b\u1ed9 trong \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha, c\u0169ng nh\u01b0 ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p tr\u00ean l\u00e2m s\u00e0ng.<\/strong><\/p>\n

1. Ch\u1ec9 \u0111\u1ecbnh l\u1ea5y tu\u1ef7 to\u00e0n b\u1ed9<\/h2>\n
\"phuong-phap-lay-tuy-toan-bo-1\"
L\u1ea5y tu\u1ef7 to\u00e0n b\u1ed9 l\u00e0 m\u1ed9t quy tr\u00ecnh trong \u0111i\u1ec1u tr\u1ecb N\u1ed9i nha<\/figcaption><\/figure>\n

\u2013 Vi\u00eam tu\u1ef7 kh\u00f4ng h\u1ed3i ph\u1ee5c.<\/p>\n

\u2013 Tu\u1ef7 ho\u1ea1i t\u1eed.<\/p>\n

\u2013 C\u00e1c b\u1ec7nh l\u00fd cu\u1ed1ng r\u0103ng.<\/p>\n

2. Nguy\u00ean t\u1eafc c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p l\u1ea5y tu\u1ef7 to\u00e0n b\u1ed9<\/h2>\n
\"Phuong-phap-lay-tuy-toan-bo-2\"
H\u1ec7 th\u1ed1ng \u1ed1ng tu\u1ef7 l\u00e0 m\u1ed9t c\u1ea5u tr\u00fac r\u1ea5t ph\u1ee9c t\u1ea1p, v\u00ec th\u1ebf vi\u1ec7c l\u00e0m s\u1ea1ch, t\u1ea1o h\u00ecnh v\u00e0 h\u00e0n k\u00edn kh\u00edt l\u00e0 th\u1eed th\u00e1ch \u0111\u1ed1i v\u1edbi nhi\u1ec1u Nha s\u0129<\/figcaption><\/figure>\n

Cho \u0111\u1ebfn nay, nguy\u00ean t\u1eafc c\u01a1 b\u1ea3n c\u1ee7a \u0111i\u1ec1u tr\u1ecb tu\u1ef7 v\u1eabn kh\u00f4ng thay \u0111\u1ed5i so v\u1edbi 40 n\u0103m tr\u01b0\u1edbc. Nguy\u00ean t\u1eafc \u0111\u00f3 g\u1ecdi l\u00e0 “tam th\u1ee9c n\u1ed9i nha”. Nguy\u00ean t\u1eafc n\u00e0y \u0111\u01b0\u1ee3c Schilder ho\u00e0n thi\u1ec7n b\u1edfi thu\u1eadt ng\u1eef \u201cba chi\u1ec1u kh\u00f4ng gian”, bao g\u1ed3m:<\/p>\n

\u2013 V\u00f4 tr\u00f9ng.<\/p>\n

\u2013 L\u00e0m s\u1ea1ch v\u00e0 t\u1ea1o h\u00ecnh \u1ed1ng tu\u1ef7.<\/p>\n

\u2013 Tr\u00e1m b\u00edt h\u1ec7 th\u1ed1ng \u1ed1ng tu\u1ef7 k\u00edn kh\u00edt theo ba chi\u1ec1u kh\u00f4ng gian.<\/p>\n

2.1. V\u00f4 tr\u00f9ng<\/h3>\n

L\u00e0 t\u1ea1o ra h\u00e0ng r\u00e0o b\u1ea3o v\u1ec7 tr\u00e1nh l\u00e2y nhi\u1ec5m ch\u00e9o theo nguy\u00ean t\u1eafc chung c\u1ee7a \u0111i\u1ec1u tr\u1ecb y h\u1ecdc, bao g\u1ed3m:<\/p>\n

– V\u00f4 tr\u00f9ng tuy\u1ec7t \u0111\u1ed1i c\u00e1c d\u1ee5ng c\u1ee5 n\u1ed9i tu\u1ef7.<\/p>\n

– C\u00f4 l\u1eadp r\u1eb1ng: Th\u01b0\u1eddng s\u1eed d\u1ee5ng \u0111am cao su:<\/p>\n

+ B\u1ea3o v\u1ec7 b\u1ec7nh nh\u00e2n kh\u1ecfi c\u00e1c d\u1ee5ng c\u1ee5, c\u00e1c m\u1ea3nh v\u1ecf c\u01a1 v\u00e0 h\u1eefu c\u01a1 t\u1eeb m\u00f4 tu\u1ef7 b\u1ec7nh, c\u00e1c dung d\u1ecbch s\u00e1t khu\u1ea9n \u1ed1ng tu\u1ef7.<\/p>\n

+ C\u00e1ch ly c\u00e1c h\u1ec7 th\u1ed1ng \u1ed1ng tu\u1ef7 v\u1edbi n\u01b0\u1edbc b\u1ecdt, m\u00e1u v\u00e0 d\u1ecbch m\u00f4 t\u1eeb m\u00f4i tr\u01b0\u1eddng mi\u1ec7ng, kh\u1ed1ng ch\u1ebf nhi\u1ec5m khu\u1ea9n ch\u00e9o gi\u1eefa h\u1ec7 th\u1ed1ng \u1ed1ng tu\u1ef7 v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 trong m\u00f4i tr\u01b0\u1eddng mi\u1ec7ng.<\/p>\n

+ B\u1ea3o v\u1ec7 m\u00f4 m\u1ec1m.<\/p>\n

+ Thu\u1eadn l\u1ee3i cho c\u00e1c nha s\u0129 nh\u00ecn r\u00f5 mi\u1ec7ng \u1ed1ng tu\u1ef7 khi th\u1ef1c hi\u1ec7n c\u00e1c thao t\u00e1c l\u00e2m s\u00e0ng.<\/p>\n

\u2013 S\u1eed d\u1ee5ng c\u00e1c dung d\u1ecbch s\u00e1t khu\u1ea9n \u1ed1ng tu\u1ef7.<\/p>\n

2.2. L\u00e0m s\u1ea1ch v\u00e0 t\u1ea1o h\u00ecnh \u1ed1ng tu\u1ef7 trong \u0111i\u1ec1u tr\u1ecb tu\u1ef7 to\u00e0n b\u1ed9<\/h3>\n

2.2.1. Nguy\u00ean t\u1eafc c\u01a1 h\u1ecdc trong \u0111i\u1ec1u tr\u1ecb tu\u1ef7 to\u00e0n b\u1ed9<\/h4>\n

N\u0103m 1974, Schiller \u0111\u00e3 n\u00eau ra 5 nguy\u00ean t\u1eafc c\u01a1 h\u1ecdc cho t\u1ea1o h\u00ecnh h\u1ec7 th\u1ed1ng \u1ed1ng tu\u1ef7 theo ba chi\u1ec1u kh\u00f4ng gian:<\/p>\n

\u2013 T\u1ea1o h\u00ecnh \u1ed1ng tu\u1ef7 d\u1ea1ng thu\u00f4n li\u00ean t\u1ee5c v\u1ec1 ph\u00eda cu\u1ed1ng r\u0103ng \u0111\u1ec3:<\/p>\n

+ T\u0103ng kh\u1ea3 n\u0103ng l\u00e0m s\u1ea1ch c\u1ee7a dung d\u1ecbch s\u00e1t khu\u1ea9n.<\/p>\n

+ T\u1ea1o s\u00f3ng chu\u1ea9n \u0111\u1ed9ng cho guttapercha theo nguy\u00ean l\u00fd thu\u1ef7 l\u1ef1c h\u1ecdc.<\/p>\n

\u2013 \u0110\u01b0\u1eddng k\u00ednh nh\u1ecf nh\u1ea5t t\u1ea1i l\u1ed7 cu\u1ed1ng r\u0103ng c\u00f3 m\u1ed1c tham chi\u1ebfu l\u00e0 \u0111\u01b0\u1eddng ranh gi\u1edbi cement \u2013 ng\u00e0 tr\u00ean phim Xquang. Nguy\u00ean t\u1eafc n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng khi \u1ed1ng tu\u1ef7 c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng n\u1ed9i ti\u00eau t\u1ea1o ra c\u00e1c \u0111o\u1ea1n ph\u00ecnh b\u1ea5t th\u01b0\u1eddng. H\u00ecnh th\u1ec3 khoang tu\u1ef7 c\u1ea7n ph\u00f9 h\u1ee3p v\u1edbi \u0111\u1eb7c t\u00ednh c\u01a1 nhi\u1ec7t h\u1ecdc c\u1ee7a guttapercha \u0111\u1ec3 tr\u00e1m b\u00edt k\u00edn c\u00e1c l\u1ed7 \u1ed1ng tu\u1ef7.<\/p>\n

\u2013 T\u1ea1o th\u00e0nh \u1ed1ng tu\u1ef7 c\u00f3 d\u1ea1ng thu\u00f4n, th\u00e0nh tr\u01a1n nh\u1eabn v\u00e0 ph\u1ea3i gi\u1eef \u0111\u01b0\u1ee3c h\u00ecnh d\u1ea1ng ban \u0111\u1ea7u c\u1ee7a \u1ed1ng tu\u1ef7 theo ba chi\u1ec1u kh\u00f4ng gian. T\u1ea1o h\u00ecnh tr\u00ean nhi\u1ec1u m\u1eb7t ph\u1eb3ng cho \u201cd\u00f2ng ch\u1ea3y\u201d c\u1ee7a ch\u1ea5t h\u00e0n b\u00e1n c\u1ee9ng ch\u1ecbu t\u00e1c \u0111\u1ed9ng c\u1ee7a l\u1ef1c kh\u00e1ng tr\u1edf nh\u1ecf nh\u1ea5t. D\u1ea1ng thu\u00f4n li\u00ean t\u1ee5c cho khoang tu\u1ef7 ph\u1ea3i \u0111\u01b0\u1ee3c t\u1ea1o h\u00ecnh theo \u0111\u00fang \u0111\u01b0\u1eddng cong t\u1ef1 nhi\u00ean c\u1ee7a \u1ed1ng tu\u1ef7. C\u00e1c nghi\u00ean c\u1ee9u in vitro v\u00e0 in vivo cho th\u1ea5y h\u1ec7 th\u1ed1ng \u1ed1ng tu\u1ef7 kh\u00f4ng theo m\u1ed9t h\u01b0\u1edbng \u0111\u01a1n gi\u1ea3n nh\u01b0 tr\u00ean Xquang m\u00e0 cong theo c\u00e1c h\u01b0\u1edbng kh\u00e1c nhau trong kh\u00f4ng gian. Do v\u1eady, m\u1edf r\u1ed9ng \u0111o\u1ea1n th\u00e2n \u1ed1ng tu\u1ef7 v\u00e0 khoang tu\u1ef7 th\u1eb3ng tr\u1ee5c l\u00e0 y\u1ebfu t\u1ed1 quan tr\u1ecdng \u0111\u1ec3 d\u1ee5ng c\u1ee5 t\u1ea1o h\u00ecnh tr\u01b0\u1ee3t theo \u0111\u01b0\u1eddng cong c\u1ee7a \u1ed1ng tu\u1ef7.<\/p>\n

\u2013 Gi\u1eef \u0111\u00fang v\u1ecb tr\u00ed nguy\u00ean thu\u1ef7 c\u1ee7a l\u1ed7 cu\u1ed1ng r\u0103ng. Theo c\u00e1c nghi\u00ean c\u1ee9u m\u00f4 h\u1ecdc, v\u1ecb tr\u00ed l\u1ed7 cu\u1ed1ng r\u0103ng th\u01b0\u1eddng n\u1eb1m l\u1ec7ch v\u1ec1 m\u1ed9t ph\u00eda \u0111\u1ec9nh ch\u00f3p ch\u00e2n r\u0103ng. Vi\u1ec7c t\u1ea1o h\u00ecnh \u1ed1ng tu\u1ef7 ph\u1ea3i \u0111\u1ea3m b\u1ea3o g\u00f3c t\u1edbi, tr\u00e1nh di chuy\u1ec3n l\u1ed7 cu\u1ed1ng r\u0103ng, t\u0103ng kh\u1ea3 n\u0103ng l\u00e0m s\u1ea1ch v\u00e0 tr\u00e1m b\u00edt k\u00edn t\u1edbi cu\u1ed1ng.<\/p>\n

\u2013 Gi\u1eef \u0111\u00fang k\u00edch th\u01b0\u1edbc nguy\u00ean thu\u1ef7 c\u1ee7a l\u1ed7 cu\u1ed1ng r\u0103ng. Tr\u00ean ph\u01b0\u01a1ng di\u1ec7n m\u00f4 h\u1ecdc v\u00e0 mi\u1ec5n d\u1ecbch h\u1ecdc, \u0111\u01b0\u1eddng k\u00ednh c\u1ee7a l\u1ed7 cu\u1ed1ng r\u0103ng \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng \u0111\u1ebfn tu\u1ed5i th\u1ecd c\u1ee7a r\u0103ng sau \u0111i\u1ec1u tr\u1ecb. Vi\u1ec7c b\u1ea3o t\u1ed3n ranh gi\u1edbi cement \u2013 ng\u00e0 c\u00f3 t\u00e1c d\u1ee5ng c\u00e1ch ly ph\u1ea7n m\u00f4 ng\u00e0 \u201cch\u1ebft\u201d (do r\u0103ng kh\u00f4ng c\u00f2n tu\u1ef7) v\u1edbi l\u00e1 c\u1ee9ng, l\u00e0m cho r\u0103ng t\u1ed3n t\u1ea1i tr\u00ean cung h\u00e0m nh\u01b0 m\u1ed9t \u0111\u01a1n v\u1ecb s\u1ed1ng, kh\u00f4ng b\u1ecb \u0111\u00e0o th\u1ea3i b\u1edfi \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch.<\/p>\n

2.2.2. Nguy\u00ean t\u1eafc sinh h\u1ecdc trong \u0111i\u1ec1u tr\u1ecb tu\u1ef7 to\u00e0n b\u1ed9<\/h4>\n

\u2013 Ph\u1ea7n t\u00e1c \u0111\u1ed9ng hi\u1ec7u l\u1ef1c c\u1ee7a d\u1ee5ng c\u1ee5 n\u1ed9i tu\u1ef7 ch\u1ec9 \u0111\u01b0\u1ee3c gi\u1edbi h\u1ea1n trong l\u00f2ng h\u1ec7 th\u1ed1ng \u1ed1ng tu\u1ef7, tr\u00e1nh g\u00e2y t\u1ed5n th\u01b0\u01a1ng m\u00f4 cu\u1ed1ng.<\/p>\n

\u2013 Tr\u00e1nh \u0111\u1ea9y c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 vi khu\u1ea9n, m\u00f4 tu\u1ef7 ho\u1ea1i t\u1eed v\u00e0 m\u00f9n ng\u00e0 xu\u1ed1ng m\u00f4 cu\u1ed1ng.<\/p>\n

\u2013 L\u1ea5y s\u1ea1ch to\u00e0n b\u1ed9 c\u00e1c th\u00e0nh ph\u1ea7n nhi\u1ec5m khu\u1ea9n trong khoang tu\u1ef7, t\u00e1i l\u1eadp l\u1ea1i c\u00e2n b\u1eb1ng sinh th\u00e1i ho\u00e1 h\u1ecdc cho m\u00f4 cu\u1ed1ng.<\/p>\n

\u2013 Ho\u00e0n t\u1ea5t vi\u1ec7c l\u00e0m s\u1ea1ch, t\u1ea1o h\u00ecnh cho m\u1ed7i \u1ed1ng tu\u1ef7 trong m\u1ed7i l\u1ea7n \u0111i\u1ec1u tr\u1ecb.<\/p>\n

– T\u1ea1o khoang tu\u1ef7 \u0111\u1ee7 r\u1ed9ng cho vi\u1ec7c \u0111\u1eb7t thu\u1ed1c n\u1ed9i tu\u1ef7, \u0111\u1ed3ng th\u1eddi h\u00fat ph\u1ea7n d\u1ecbch r\u1ec9 vi\u00eam t\u1eeb m\u00f4 cu\u1ed1ng.<\/p>\n

2.3. Tr\u00e1m b\u00edt k\u00edn kh\u00edt h\u1ec7 th\u1ed1ng \u1ed1ng tu\u1ef7 theo ba chi\u1ec1u kh\u00f4ng gian<\/h3>\n

M\u1ee5c \u0111\u00edch c\u1ee7a vi\u1ec7c tr\u00e1m b\u00edt kh\u00edt h\u1ec7 th\u1ed1ng \u1ed1ng tu\u1ef7:<\/p>\n

\u2013 Tr\u00e1nh s\u1ef1 th\u1ea9m th\u1ea5u, r\u00f2 vi k\u1ebd d\u1ecbch r\u00ec vi\u00eam t\u1eeb m\u1ecf cu\u1ed1ng r\u0103ng v\u00e0o l\u00f2ng khoang tu\u1ef7.<\/p>\n

\u2013 Tr\u00e1nh t\u00e1i nhi\u1ec5m v\u00e0 x\u00e2m nh\u1eadp vi khu\u1ea9n v\u00e0o m\u00f4 cu\u1ed1ng r\u0103ng.<\/p>\n

\u2013 T\u1ea1o m\u00f4i tr\u01b0\u1eddng sinh ho\u00e1 th\u00edch h\u1ee3p cho s\u1ef1 ph\u1ee5c h\u1ed3i c\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u00f3 ngu\u1ed3n g\u1ed1c tu\u1ef7 r\u0103ng.<\/p>\n

V\u1eadt li\u1ec7u h\u00e0n tu\u1ef7: y\u00eau c\u1ea7u c\u1ee7a ch\u1ea5t h\u00e0n \u1ed1ng tu\u1ef7 (Grossman):<\/p>\n

\u2013 Sinh h\u1ecdc: kh\u00f4ng \u0111\u1ed9c v\u1edbi v\u00f9ng quanh cu\u1ed1ng, s\u00e1t tr\u00f9ng, ng\u0103n c\u1ea3n s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a vi khu\u1ea9n, kh\u00f4ng k\u00edch th\u00edch cu\u1ed1ng r\u0103ng.<\/p>\n

\u2013 L\u00fd h\u1ecdc:<\/p>\n

+ C\u1ea3n quang.<\/p>\n

+ Tr\u01b0\u1edbc m\u1ec1m, sau c\u1ee9ng.<\/p>\n

+ Kh\u00f4ng thay \u0111\u1ed5i th\u1ec3 t\u00edch.<\/p>\n

+ B\u1ecbt k\u00edn cu\u1ed1ng r\u0103ng.<\/p>\n

+ D\u00ednh v\u00e0o th\u00e0nh \u1ed1ng tu\u1ef7.<\/p>\n

+ Ng\u1ea5m v\u00e0o \u1ed1ng ng\u00e0, \u1ed1ng tu\u1ef7 ph\u1ee5.<\/p>\n

\u2013 Ho\u00e1 h\u1ecdc:<\/p>\n

+ Kh\u00f4ng tan trong dung m\u00f4i h\u1eefu c\u01a1 c\u1ee7a c\u01a1 th\u1ec3.<\/p>\n

+ Kh\u00f4ng thay \u0111\u1ed5i ho\u00e1 t\u00ednh.<\/p>\n

+ Kh\u00f4ng thay \u0111\u1ed5i m\u00e0u r\u0103ng.<\/p>\n

\u2013 Th\u1ef1c h\u00e0nh:<\/p>\n

+ D\u1ec5 b\u1ea3o qu\u1ea3n v\u00e0 s\u1eed d\u1ee5ng.<\/p>\n

+ D\u1ec5 \u0111\u01b0a v\u00e0o, l\u1ea5y ra.<\/p>\n

Ngu\u1ed3n: Ch\u1eefa r\u0103ng v\u00e0 n\u1ed9i nha t\u1eadp 2 – NXB Gi\u00e1o d\u1ee5c Vi\u1ec7t Nam<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

L\u1ea5y tu\u1ef7 to\u00e0n b\u1ed9 l\u00e0 ph\u01b0\u01a1ng ph\u00e1p lo\u1ea1i tr\u1eeb to\u00e0n b\u1ed9 c\u00e1c t\u1ed5 ch\u1ee9c ho\u1ea1i t\u1eed, vi khu\u1ea9n. \u0111\u1ed9c t\u1ed1, c\u00e1c ch\u1ea5t k\u00edch th\u00edch trong bu\u1ed3ng tu\u1ef7 v\u00e0 \u1ed1ng tu\u1ef7 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n b\u1ea3o t\u1ed3n c\u00e1c r\u1eb1ng b\u1ec7nh l\u00fd, ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng \u0103n nhai c\u0169ng nh\u01b0 ch\u1ee9c n\u0103ng th\u1ea9m m\u1ef9 c\u1ee7a r\u0103ng. 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