{"id":20114,"date":"2023-04-13T23:12:56","date_gmt":"2023-04-13T16:12:56","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=20114"},"modified":"2023-04-17T14:41:36","modified_gmt":"2023-04-17T07:41:36","slug":"tieu-chan-rang-phuong-phap-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/tieu-chan-rang-phuong-phap-dieu-tri\/","title":{"rendered":"Ti\u00eau ch\u00e2n r\u0103ng &#8211; Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb."},"content":{"rendered":"<p><strong>B\u00e0i vi\u1ebft sau n\u1ed9i dung n\u00f3i v\u1ec1 s\u01a1 l\u01b0\u1ee3c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u00e1c tr\u01b0\u1eddng h\u1ee3p ti\u00eau ch\u00e2n r\u0103ng tr\u00ean l\u00e2m s\u00e0ng. B\u00e0i vi\u1ebft cung c\u1ea5p c\u00e1c ph\u00e2n lo\u1ea1i ti\u00eau c\u1ed5 r\u0103ng, ti\u00eau ch\u00e2n r\u0103ng do k\u00edch th\u00edch hay do nhi\u1ec5m tr\u00f9ng, \u0111\u1ed3ng th\u1eddi k\u1ebft h\u1ee3p s\u1eed d\u1ee5ng c\u00e1c v\u1eadt li\u1ec7u ph\u1ee5c h\u1ed3i trong \u0111i\u1ec1u tr\u1ecb. C\u00f9ng t\u00ecm hi\u1ec3u th\u00eam.<\/strong><\/p>\n<figure id=\"attachment_20153\" aria-describedby=\"caption-attachment-20153\" style=\"width: 300px\" class=\"wp-caption alignnone\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-20153\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/endodontics-internal-resorption-resorption-diag-6.jpeg\" alt=\"tieu-chan-rang\" width=\"300\" height=\"421\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/endodontics-internal-resorption-resorption-diag-6.jpeg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/endodontics-internal-resorption-resorption-diag-6-214x300.jpeg 214w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-20153\" class=\"wp-caption-text\">Ti\u00eau ch\u00e2n r\u0103ng &#8211; V\u1ea5n \u0111\u1ec1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 s\u1ed1ng c\u1ee7a r\u0103ng tr\u00ean cung h\u00e0m<\/figcaption><\/figure>\n<h2>1. Ngo\u1ea1i ti\u00eau<\/h2>\n<h3>1.1. \u0110i\u1ec1u tr\u1ecb ti\u00eau c\u1ed5 r\u0103ng th\u00e2m nh\u1eadp<\/h3>\n<p>M\u1ee5c ti\u00eau l\u00e0 \u0111\u1eebng qu\u00e1 tr\u00ecnh ti\u00eau c\u1ed5 r\u0103ng th\u00e2m nh\u1eadp b\u1eb1ng c\u00e1ch lo\u1ea1i tr\u1eeb u h\u1ea1t quanh ch\u00e2n r\u0103ng. H\u1ed3i ph\u1ee5c b\u1ec1 m\u1eb7t ch\u00e2n r\u0103ng m\u00e0 c\u00e1c t\u1ebf b\u00e0o c\u00f2n s\u00f3t l\u1ea1i kh\u00f4ng th\u1ec3 x\u00e2m nh\u1eadp v\u00e0o \u0111\u01b0\u1ee3c.<\/p>\n<p>&#8211; Heithersay 1 v\u00e0 2:<\/p>\n<p>+ B\u00ean ngo\u00e0i: Lo\u1ea1i tr\u1eeb u h\u1ea1t v\u00e0 tr\u00e1m. \u0110\u1ec3 lo\u1ea1i tr\u1eeb u h\u1ea1t c\u1ea7n g\u00e2y t\u00ea b\u1ec1 m\u1eb7t v\u00e0 d\u00f9ng c\u00e2y n\u1ea1o l\u1ea5y s\u1ea1ch t\u1ed5n th\u01b0\u01a1ng. C\u1ea7m m\u00e1u b\u1eb1ng c\u00e1c lo\u1ea1i gel hay dung d\u1ecbch c\u1ea7m m\u00e1u: b\u1ed9i gel (hay dung d\u1ecbch c\u1ea7m m\u00e1u v\u00e0o t\u1ed5n th\u01b0\u01a1ng v\u00e0 cho b\u1ec7nh nh\u00e2n c\u1eafn ch\u1eb7t g\u1ea1c 3 \u2013 5 ph\u00fat. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng laser \u0111\u1ec3 c\u1ea7m m\u00e1u. Sau \u0111\u00f3 \u0111\u1eb7t ch\u1ec9 co n\u01b0\u1edbc v\u00e0o v\u00e0 tr\u00e1m k\u00edn t\u1ed5n th\u01b0\u01a1ng \u0111\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n l\u00e0nh th\u01b0\u01a1ng t\u1ed1t.<\/p>\n<p>+ B\u00ean trong: \u0111i\u1ec1u tr\u1ecb tu\u1ef7.<\/p>\n<p>&#8211; Heithersay 3:<\/p>\n<p>+ B\u00ean ngo\u00e0i: lo\u1ea1i tr\u1eeb u h\u1ea1t v\u00e0 tr\u00e1m c\u00f3 s\u1eed d\u1ee5ng c\u00e1c m\u00e0ng sinh h\u1ecdc.<\/p>\n<p>+ B\u00ean trong: \u0111i\u1ec1u tr\u1ecb tu\u1ef7.<\/p>\n<p>V\u1eadt li\u1ec7u \u0111\u1ec3 tr\u00e1m t\u1ed1t nh\u1ea5t l\u00e0 Biodentine.<\/p>\n<p>\u2013 Heithersay 4: r\u1ea5t kh\u00f3 \u0111i\u1ec1u tr\u1ecb, c\u1ea7n c\u00e2n nh\u1eafc nh\u1ed5 r\u0103ng.<\/p>\n<h3>1.2. \u0110i\u1ec1u tr\u1ecb ti\u00eau ch\u00e2n r\u0103ng do c\u00e1c k\u00edch th\u00edch trong th\u1eddi gian ng\u1eafn (th\u01b0\u1eddng do ch\u1ea5n th\u01b0\u01a1ng)<\/h3>\n<p>\u2013 Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb:<\/p>\n<p>+ Gi\u1ea3m thi\u1ec3u nguy c\u01a1 cho r\u1eb1ng b\u1ecb ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n<p>+ D\u00f9ng thu\u1ed1c gi\u1ea3m c\u00e1c ph\u1ea3n \u1ee9ng vi\u00eam.<\/p>\n<p>+ \u0110i\u1ec1u tr\u1ecb t\u1ee7y theo t\u1eebng tr\u01b0\u1eddng h\u1ee3p.<\/p>\n<p>\u2013 Ti\u00eau vi\u00eam: Tu\u1ef7 c\u1ee7a r\u0103ng \u0111\u01b0\u1ee3c c\u1eafm l\u1ea1i th\u01b0\u1eddng b\u1ecb ho\u1ea1i t\u1eed v\u00e0 s\u1ebd g\u00e2y vi\u00eam, do \u0111\u00f3 g\u00f3p th\u00eam kh\u1ea3 n\u0103ng ti\u00eau ch\u00e2n r\u0103ng do c\u01a1 h\u1ecdc s\u1eb5n c\u00f3 c\u1ee7a r\u0103ng \u0111\u01b0\u1ee3c c\u1eafm l\u1ea1i. Ch\u1ec9 c\u00f3 l\u1ea5y t\u1ee7y ho\u1ea1i t\u1eed kh\u00f4ng th\u00f4i th\u00ec kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 lo\u1ea1i tr\u1eeb nh\u1eefng d\u00e2y Tome ho\u1ea1i t\u1eed trong \u1ed1ng ng\u00e0, m\u00e0 n\u00f3 s\u1ebd l\u00e0m t\u0103ng ph\u1ea3n \u1ee9ng vi\u00eam s\u1eb5n c\u00f3 c\u1ee7a m\u00f4 quanh ch\u00e2n r\u0103ng. Qu\u00e1 tr\u00ecnh ti\u00eau ch\u00e2n r\u0103ng \u0111\u01b0\u1ee3c c\u1eafm l\u1ea1i c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u00edt nh\u1ea5t sau 1 tu\u1ea7n. V\u00ec v\u1eady, ph\u1ea3i th\u1ef1c hi\u1ec7n vi\u1ec7c l\u00e0m s\u1ea1ch t\u1ee7y v\u00e0 tr\u00e1m paste calcium hydroxide \u1ed1ng tu\u1ef7 v\u00e0o ng\u00e0y th\u1ee9 6 sau khi c\u1eafm l\u1ea1i r\u0103ng v\u00e0 c\u1ed1 \u0111\u1ecbnh. Paste calcium hydroxide tr\u00e1m \u1ed1ng t\u1ee7y s\u1ebd \u0111\u01b0\u1ee3c thay l\u1ea1i sau 6 tu\u1ea7n v\u00e0 sau \u0111\u00f3 t\u00f9y theo s\u1ef1 theo d\u00f5i t\u00ecnh h\u00ecnh ti\u00eau ch\u00e2n r\u0103ng v\u00e0 t\u00ecnh h\u00ecnh paste trong \u1ed1ng tu\u1ef7, m\u00e0 th\u1eddi gian thay paste s\u1ebd thay \u0111\u1ed5i kh\u00e1c nhau, nh\u01b0ng kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1ec3 paste calcium hydroxide trong \u1ed1ng tu\u1ef7 qu\u00e1 6 th\u00e1ng. Th\u1eddi gian theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng k\u00e9o d\u00e0i \u00edt nh\u1ea5t m\u1ed9t n\u0103m. Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 ti\u00eau ch\u00e2n r\u0103ng quan tr\u1ecdng ph\u1ea3i thay paste calcium hydroxide h\u00e0ng th\u00e1ng. C\u1ea7n tr\u00e1nh c\u00f3 s\u1ef1 th\u00f4ng gi\u1eefa t\u00fai l\u1ee3i v\u00e0 m\u00f4 d\u00e2y ch\u1eb1ng xung quanh r\u0103ng v\u00e0 v\u1eabn c\u00f2n c\u1ea7n ph\u1ea3i theo d\u00f5i ch\u1eebng n\u00e0o ch\u01b0a th\u1ea5y c\u00f3 m\u1ed9t h\u00e0ng r\u00e0o ng\u0103n c\u1ee7a m\u00f4 quanh r\u0103ng \u1ed5n \u0111\u1ecbnh.<\/p>\n<p>\u2013 Ti\u00eau thay th\u1ebf: Khi t\u1ebf b\u00e0o d\u00e2y ch\u1eb1ng ho\u1ea1i t\u1eed, t\u1ebf b\u00e0o hu\u1ef7 x\u01b0\u01a1ng kh\u00f4ng nh\u1eadn ra, c\u1ea5u tr\u00fac r\u0103ng g\u00e2y ti\u00eau ch\u00e2n r\u0103ng v\u00e0 t\u1ebf b\u00e0o t\u1ea1o x\u01b0\u01a1ng t\u1ea1o ra x\u01b0\u01a1ng d\u1ea7n d\u1ea7n thay th\u1ebf v\u00e0o. \u0110i\u1ec1u tr\u1ecb b\u1eb1ng calcium hydroxide kh\u00f4ng l\u00e0m ng\u1eebng ti\u00eau, nh\u01b0ng v\u1eabn ph\u1ea3i s\u1eed d\u1ee5ng \u0111\u1ec3 tr\u00e1nh b\u1ed9i nhi\u1ec5m.<\/p>\n<h3>1.3. \u0110i\u1ec1u tr\u1ecb ti\u00eau ch\u00e2n r\u0103ng do nhi\u1ec5m tr\u00f9ng t\u1ee7y r\u0103ng<\/h3>\n<p>\u2013 C\u00e1c tr\u01b0\u1eddng h\u1ee3p ti\u00eau ch\u00e2n r\u0103ng v\u00e0 th\u1ee7ng \u1ed1ng t\u1ee7y \u0111\u1ec1u g\u00e2y ra s\u1ef1 th\u00f4ng gi\u1eefa t\u1ee7y v\u00e0 m\u00f4 d\u00e2y ch\u1eb1ng quanh r\u0103ng l\u00e0m tr\u1edf ng\u1ea1i cho vi\u1ec7c tr\u00e1m k\u00edn \u1ed1ng t\u1ee7y.<\/p>\n<p>\u2013 \u0110\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p ti\u00eau ch\u00e2n r\u0103ng, tr\u01b0\u1edbc h\u1ebft ph\u1ea3i lo\u1ea1i b\u1ecf nguy\u00ean nh\u00e2n g\u00e2y ti\u00eau ch\u00e2n r\u0103ng v\u00e0 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho s\u1ef1 h\u00ecnh th\u00e0nh m\u00f4 calci ho\u00e1 b\u1ecbt k\u00edn ch\u1ed7 ch\u00e2n r\u0103ng b\u1ecb ti\u00eau th\u00f4ng v\u1edbi tu\u1ef7 \u0111\u1ec3 cho ph\u00e9p ch\u00fang ta c\u00f3 th\u1ec3 tr\u00e1m k\u00edn \u0111\u01b0\u1ee3c \u1ed1ng tu\u1ef7. Trong tr\u01b0\u1eddng h\u1ee3p ti\u00eau ch\u00e2n r\u0103ng do vi\u00eam, ch\u00e2n r\u0103ng c\u0169ng th\u01b0\u1eddng c\u00f3 h\u00ecnh \u1ea3nh c\u1ee7a ch\u00e2n r\u0103ng ch\u01b0a kh\u00e9p cu\u1ed1ng. V\u00ec v\u1eady, c\u1ea7n t\u1ea1o n\u00ean m\u1ed9t m\u00f4i tr\u01b0\u1eddng m\u00e0 trong \u0111\u00f3 c\u00e1c m\u00f4 c\u1ee7a \u1ed1ng t\u1ee7y v\u00e0 v\u00f9ng quanh ch\u00f3p sau khi t\u1ee7y ch\u1ebft c\u00f3 th\u1ec3 t\u1ea1o \u0111\u01b0\u1ee3c m\u1ed9t h\u00e0ng r\u00e0o v\u1edbi hoa \u1edf \u0111\u1ec9nh ch\u00f3p. H\u00e0ng r\u00e0o calci ho\u00e1 n\u00e0y c\u1ea5u t\u1ea1o b\u1edfi cement, x\u01b0\u01a1ng, m\u00f4 t\u01b0\u01a1ng t\u1ef1 x\u01b0\u01a1ng. Vi\u1ec7c t\u1ea1o ra m\u1ed7i tr\u01b0\u1eddng n\u00e0y bao g\u1ed3m vi\u1ec7c l\u00e0m s\u1ea1ch v\u00e0 t\u1ea1o th\u00e0nh h\u00ecnh \u1ed1ng t\u1ee7y \u0111\u1ec3 lo\u1ea1i b\u1ecf m\u1ea3nh v\u1ee5n v\u00e0 vi khu\u1ea9n, sau \u0111\u00f3 \u0111\u1eb7t v\u1eadt li\u1ec7u k\u00edch th\u00edch \u0111\u00f3ng ch\u00f3p v\u00e0o \u1ed1ng tu\u1ef7 \u0111\u1ebfn t\u1eadn ch\u00f3p r\u0103ng. V\u1eadt li\u1ec7u th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0 calcium hydroxide, hay v\u1eadt li\u1ec7u sinh h\u1ecdc (MTA, Biodentine&#8230;)<\/p>\n<p><strong>a) \u0110i\u1ec1u tr\u1ecb ngo\u1ea1i ti\u00eau ch\u00f3p r\u0103ng v\u1edbi calci hydroxyd (\u0111\u00f3ng ch\u00f3p)<\/strong><\/p>\n<p>Ph\u01b0\u01a1ng ph\u00e1p:<\/p>\n<p>\u2013\u00a0Chu\u1ea9n b\u1ecb \u1ed1ng t\u1ee7y: C\u1ea7n l\u01b0u \u00fd \u0111\u01b0\u1eddng v\u00e0o \u1ed1ng tu\u1ef7 c\u1ea7n chu\u1ea9n b\u1ecb t\u01b0\u01a1ng \u1ee9ng v\u1edbi chi\u1ec1u r\u1ed9ng c\u1ee7a \u1ed1ng tu\u1ef7 \u0111\u1ea7u cu\u1ed1ng r\u0103ng.<\/p>\n<p>\u2013 X\u00e1c \u0111\u1ecbnh chi\u1ec1u d\u00e0i \u1ed1ng t\u1ee7y c\u1ea7n chu\u1ea9n b\u1ecb theo ph\u01b0\u01a1ng ph\u00e1p c\u1ed5 \u0111i\u1ec3n.<\/p>\n<p>\u2013 Nong \u1ed1ng t\u1ee7y v\u00e0 l\u00e0m s\u1ea1ch \u1ed1ng t\u1ee7y l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng. Khi nong \u1ed1ng t\u1ee7y c\u1ea7n ch\u00fa \u00fd: Th\u00e0nh \u1ed1ng t\u1ee7y g\u1ea7n cu\u1ed1ng r\u1ea5t m\u1ecfng m\u1ea3nh khi n\u00f3ng d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng.<\/p>\n<p>\u2013 Vi\u1ec7c b\u01a1m r\u1eeda khi nong \u1ed1ng t\u1ee7y th\u01b0\u1eddng th\u1ef1c hi\u1ec7n b\u1eb1ng natri hypoclorit, sau \u0111\u00f3 d\u00f9ng n\u01b0\u1edbc c\u1ea5t hay n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd \u0111\u1ec3 tr\u00e1nh g\u00e2y b\u1ecfng ho\u00e1 h\u1ecdc \u1edf m\u00f4 quanh cu\u1ed1ng.<\/p>\n<p>\u2013 L\u00e0m kh\u00f4 \u1ed1ng t\u1ee7y c\u1ea9n th\u1eadn v\u00e0 tr\u00e1nh s\u1ef1 xu\u1ea5t ti\u1ebft m\u1edbi. N\u00ean d\u00f9ng c\u00f4n gi\u1ea5y l\u1edbn quay ng\u01b0\u1ee3c \u0111\u1ea7u d\u00f9ng \u0111\u1ec3 \u0111o l\u1ea1i chi\u1ec1u d\u00e0i \u1ed1ng t\u1ee7y tr\u01b0\u1edbc khi tr\u00e1m v\u00e0 \u0111\u1ec3 ki\u1ec3m tra xem c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng xu\u1ea5t ti\u1ebft kh\u00f4ng. \u1ed0ng tu\u1ef7 \u0111\u01b0\u1ee3c tr\u00e1m s\u1ebd ph\u1ea3i ho\u00e0n to\u00e0n kh\u00f4.<\/p>\n<p>\u2013 Tr\u00e1m \u1ed1ng t\u1ee7y b\u1eb1ng calci hydroxyd: M\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 ch\u1ee7 tr\u01b0\u01a1ng \u0111\u1eb7t b\u1ea5c MCPC trong \u1ed1ng tu\u1ef7 \u0111\u1ec3 s\u00e1t tr\u00f9ng \u1ed1ng t\u1ee7y, sau m\u1ed9t \u0111\u1ebfn hai tu\u1ea7n n\u1ebfu r\u0103ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng g\u00ec th\u00ec tr\u00e1m \u1ed1ng t\u1ee7y v\u1edbi calci hydroxyd. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 kh\u00e1c th\u00ec khuy\u00ean kh\u00f4ng n\u00ean d\u00f9ng MCPC v\u00ec MCPC \u0111\u1ed9c cho m\u00f4 quanh cu\u1ed1ng r\u0103ng.<\/p>\n<p>\u2013 K\u1ef9 thu\u1eadt tr\u00e1m \u1ed1ng t\u1ee7y b\u1eb1ng calci hydroxyd: + Paste tr\u00e1m \u1ed1ng t\u1ee7y ph\u1ea3i kh\u00f4 d\u1ebbo.<\/p>\n<p>+ C\u00f3 th\u1ec3 tr\u00e1m b\u1eb1ng lentulo, b\u1eb1ng \u1ed1ng b\u01a1m hay c\u00e2y mang amalgam nh\u1ecf \u0111\u1ea7u b\u1eb1ng nh\u1ef1a v\u00f4 tr\u00f9ng v\u00e0 c\u00e2y l\u00ean d\u1ecdc c\u1ee1 s\u1ed1 th\u00edch h\u1ee3p.<\/p>\n<p>+ \u0110\u01b0a v\u00e0o \u1ed1ng t\u1ee7y t\u1eebng l\u01b0\u1ee3ng nh\u1ecf v\u00e0 \u0111\u1ea9y paste calcium hydroxide s\u00e1t v\u00e0o m\u00f4 quanh cu\u1ed1ng r\u0103ng r\u1ed3i d\u1ea7n d\u1ea7n nh\u1ed3i \u0111\u1eb7t to\u00e0n b\u1ed9 \u1ed1ng t\u1ee7y. C\u00f3 t\u00e1c gi\u1ea3 ch\u1ee7 tr\u01b0\u01a1ng c\u1ed1 \u00fd nh\u1ed3i h\u01a1i qu\u00e1 cu\u1ed1ng trong l\u1ea7n \u0111\u1ea7u \u0111\u1ec3 c\u00f3 th\u1ec3 thu \u0111\u01b0\u1ee3c s\u1ef1 li\u1ec1n x\u01b0\u01a1ng t\u1ed1t h\u01a1n.<\/p>\n<p>+ Khi tr\u00e1m kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1ec3 nhi\u1ec5m n\u01b0\u1edbc b\u1ecdt, v\u00ec v\u1eady n\u00ean d\u00f9ng Rubber dam. N\u1ebfu th\u00e2n r\u0103ng v\u1ee1 l\u1edbn, c\u1ea7n t\u00e1i t\u1ea1o l\u1ea1i th\u00e2n r\u0103ng tr\u01b0\u1edbc khi tr\u00e1m \u1ed1ng t\u1ee7y. Sau khi tr\u00e1m \u1ed1ng t\u1ee7y n\u00ean tr\u00e1m t\u1ea1m b\u1eb1ng IRM.<\/p>\n<p>\u2013 Theo d\u00f5i v\u00e0 thay ch\u1ea5t tr\u00e1m calcium hydroxide: Th\u00f4ng th\u01b0\u1eddng sau khi tr\u00e1m l\u1ea7n \u0111\u1ea7u 6 tu\u1ea7n th\u00ec thay ch\u1ea5t tr\u00e1m calcium hydroxide trong \u1ed1ng t\u1ee7y. Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 ch\u1ea3y m\u00e1u hay c\u00f3 xu\u1ea5t ti\u1ebft th\u00ec sau khi tr\u00e1m l\u1ea7n \u0111\u1ea7u 3 tu\u1ea7n \u0111\u00e3 n\u00ean thay ch\u1ea5t h\u00e0n. L\u1ea7n th\u1ee9 hai th\u00ec tu\u1ef3 thu\u1ed9c t\u00ecnh tr\u1ea1ng paste calcium hydroxide \u1edf l\u1ea7n thay tr\u01b0\u1edbc. N\u1ebfu paste kh\u00f4 thay l\u1ea1i sau 3 th\u00e1ng. Tr\u01b0\u1eddng h\u1ee3p paste c\u00f2n \u01b0\u1edbt th\u00ec ph\u1ea3i thay h\u00e0ng th\u00e1ng. Ch\u00fa \u00fd kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1ec3 paste trong \u1ed1ng tu\u1ef7 qu\u00e1 6 th\u00e1ng.<\/p>\n<p>+ Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng n\u00e0o \u0111\u00f3 hay c\u00f3 r\u00f2 th\u00ec c\u1ea7n ph\u1ea3i thay l\u1ea1i ho\u00e0n to\u00e0n ch\u1ea5t tr\u00e1m c\u0169.<\/p>\n<p>+ L\u01b0u \u00fd khi tr\u00e1m \u1ed1ng t\u1ee7y b\u1eb1ng calci hydroxide t\u1eeb l\u1ea7n th\u1ee9 2 tr\u1edf \u0111i n\u00ean tr\u00e1m ng\u1eafn h\u01a1n chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c 1 \u2013 2mm \u0111\u1ec3 kh\u00f4ng l\u00e0m t\u1ed5n th\u01b0\u01a1ng m\u00f4 \u0111ang li\u1ec1n s\u1eb9o.<\/p>\n<p>\u2013 Th\u1eddi gian li\u1ec1n th\u01b0\u01a1ng: Th\u1eddi gian h\u00ecnh th\u00e0nh m\u00f4 calci ho\u00e1 v\u00f9ng cu\u1ed1ng r\u0103ng ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u1ed9 l\u1edbn c\u1ee7a t\u1ed5n th\u01b0\u01a1ng, th\u01b0\u1eddng t\u1eeb 6 \u2013 24 th\u00e1ng (trung b\u00ecnh l\u00e0 1 n\u0103m 17 th\u00e1ng). Tuy nhi\u00ean c\u00f3 tr\u01b0\u1eddng h\u1ee3p c\u1ea7n \u0111\u1ebfn 4 n\u0103m \u0111\u1ec3 l\u00e0nh th\u01b0\u01a1ng ho\u00e0n to\u00e0n.<\/p>\n<p>\u2013 Tr\u00e1m v\u0129nh vi\u1ec5n \u1ed1ng t\u1ee7y: \u1ed0ng t\u1ee7y \u0111\u01b0\u1ee3c tr\u00e1m v\u0129nh vi\u1ec5n b\u1eb1ng gutta percha hay b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p tr\u00e1m kh\u00e1c khi:<\/p>\n<p>+ R\u0103ng kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng g\u00ec.<\/p>\n<p>+ Tr\u00ean X Quang th\u1ea5y cu\u1ed1ng r\u0103ng \u0111\u00e3 kh\u00e9p v\u1edbi m\u00f4 calci ho\u00e1.<\/p>\n<p>+ Paste l\u1ea5y ra trong \u1ed1ng t\u1ee7y ph\u1ea3i kh\u00f4.<\/p>\n<p>+ Th\u0103m d\u00f2 b\u1eb1ng kim ho\u1eb7c c\u00f4n gi\u1ea5y th\u1ea5y cu\u1ed1ng r\u0103ng \u0111\u01b0\u1ee3c b\u1ecbt k\u00edn. Ch\u00fa \u00fd khi th\u0103m d\u00f2 ph\u1ea3i r\u1ea5t nh\u1eb9 nh\u00e0ng v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c \u1ea5n m\u1ea1nh.<\/p>\n<p>\u2013 Theo d\u00f5i \u0111i\u1ec1u tr\u1ecb: R\u0103ng c\u1ea7n theo d\u00f5i \u0111\u1ecbnh k\u1ef3 6 th\u00e1ng\/ 1 l\u1ea7n trong 1 \u2013 2 n\u0103m.<br \/>\n<em><span style=\"text-decoration: underline;\">*) C\u01a1 ch\u1ebf h\u00ecnh th\u00e0nh m\u00f4 calci ho\u00e1 v\u00f9ng cu\u1ed1ng c\u1ee7a calcium hydroxide:<\/span><\/em><\/p>\n<p>T\u00e1c \u0111\u1ed9ng ch\u1ee7 y\u1ebfu c\u1ee7a calcium hydroxide l\u00e0 g\u00e2y ra s\u1ef1 h\u00ecnh th\u00e0nh m\u00f4 calci ho\u00e1, th\u00eam v\u00e0o \u0111\u00f3 n\u00f3 c\u00f3 t\u00ednh ch\u1ea5t s\u00e1t tr\u00f9ng v\u00e0 c\u1ea7m m\u00e1u. Do \u0111\u1ed9 pH cao, khi calcium hydroxide ti\u1ebfp x\u00fac v\u1edbi m\u00f4 li\u00ean k\u1ebft s\u1ebd g\u00e2y ra s\u1ef1 tho\u00e1i ho\u00e1 c\u1ee7a m\u00f4 v\u00e0 do t\u00ednh ch\u1ea5t ho\u00e0 tan trong n\u01b0\u1edbc k\u00e9m n\u00ean t\u1ed5n th\u01b0\u01a1ng ch\u1ec9 gi\u1edbi h\u1ea1n \u1edf b\u1ec1 m\u1eb7t ti\u1ebfp x\u00fac. \u0110i\u1ec1u \u0111\u00f3 t\u1ea1o n\u00ean m\u1ed9t v\u00f9ng ho\u1ea1i t\u1eed b\u1ec1 m\u1eb7t 1 \u2013 1,5mm, k\u00edch th\u00edch h\u00ecnh th\u00e0nh t\u1ebf b\u00e0o t\u1ea1o x\u01b0\u01a1ng r\u0103ng v\u00e0 t\u1ebf b\u00e0o t\u1ea1o x\u01b0\u01a1ng bi\u1ec7t h\u00f3a t\u1eeb nh\u1eefng t\u1ebf b\u00e0o li\u00ean k\u1ebft trong m\u00f4 d\u00e2y ch\u1eb1ng quanh ch\u00e2n r\u0103ng. Ch\u00ednh nh\u1eefng t\u1ebf b\u00e0o n\u00e0y s\u1ebd h\u00ecnh th\u00e0nh m\u00f4 v\u00f4i ho\u00e1 d\u1ea1ng x\u01b0\u01a1ng r\u0103ng hay d\u1ea1ng x\u01b0\u01a1ng \u1edf v\u00f9ng ch\u00f3p r\u0103ng. Tuy nhi\u00ean, ng\u01b0\u1eddi ta th\u1ea5y trong ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p m\u00f4 v\u00f4i ho\u00e1 kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u v\u00e0 c\u00f3 th\u1ec3 c\u00f3 nh\u1eefng \u1ed5 m\u00f4 li\u00ean k\u1ebft. \u0110i\u1ec1u n\u00e0y th\u01b0\u1eddng b\u1ecb g\u00e2y ra b\u1edfi calcium hydroxide \u00e1p v\u00e0o m\u1ed9t m\u00f4 b\u1ecb ph\u00e1 r\u00e1ch.<\/p>\n<p>V\u1ecb tr\u00ed h\u00ecnh th\u00e0nh m\u00f4 v\u00f4i ho\u00e1 \u1edf cu\u1ed1ng r\u0103ng c\u00f3 th\u1ec3 thay \u0111\u1ed5i kh\u00f4ng \u0111o\u00e1n tr\u01b0\u1edbc \u0111\u01b0\u1ee3c. N\u00f3 c\u00f3 th\u1ec3 \u1edf xung quanh cu\u1ed1ng r\u0103ng ho\u1eb7c \u1edf l\u1ed7 cu\u1ed1ng r\u0103ng hay \u1edf trong \u1ed1ng tu\u1ef7 ngay tr\u00ean l\u1ed7 cu\u1ed1ng r\u0103ng n\u1ebfu \u0111o\u1ea1n tu\u1ef7 \u1ea5y c\u00f2n t\u1ed3n t\u1ea1i m\u00f4 tu\u1ef7 s\u1ed1ng. N\u00f3i chung v\u1ecb tr\u00ed h\u00ecnh th\u00e0nh m\u00f4 calci ho\u00e1 ph\u1ee5 thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed m\u00e0 calcium hydroxide ti\u1ebfp x\u00fac v\u1edbi m\u00f4 s\u1ed1ng.<\/p>\n<p>Ngo\u00e0i ra, calcium hydroxide c\u00f2n t\u1ea1o ra m\u00f4i tr\u01b0\u1eddng thu\u1eadn l\u1ee3i cho s\u1ef1 kho\u00e1ng h\u00f3a: trong qu\u00e1 tr\u00ecnh ti\u00eau ng\u00f3t ch\u00e2n r\u0103ng, ho\u1ea1t \u0111\u1ed9ng c\u1ee7a t\u1ebf b\u00e0o hu\u1ef7 x\u01b0\u01a1ng di\u1ec5n ra trong m\u00f4i tr\u01b0\u1eddng acid. Calcium hydroxide v\u1edbi t\u00ednh ki\u1ec1m v\u00e0 kh\u1ea3 n\u0103ng th\u1ea9m th\u1ea5u \u0111\u00e3 l\u00e0m gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng c\u1ee7a t\u1ebf b\u00e0o hu\u1ef7 x\u01b0\u01a1ng, k\u00edch th\u00edch s\u1ef1 s\u1eeda ch\u1eefa v\u00e0 g\u00e2y ra s\u1ef1 l\u1eafng \u0111\u1ecdng c\u1ee7a m\u00f4 c\u1ee9ng.<\/p>\n<p><strong>b) \u0110i\u1ec1u tr\u1ecb ngo\u1ea1i ti\u00eau ch\u00f3p r\u0103ng v\u1edbi v\u1eadt li\u1ec7u sinh h\u1ecdc: MTA, Biodentine&#8230; (t\u1ea1o n\u00fat ch\u1eb7n ch\u00f3p).<\/strong><\/p>\n<p>MTA:<\/p>\n<p>\u2013 Th\u00e0nh ph\u1ea7n:<\/p>\n<p>+ Tricalcium silicate<\/p>\n<p>+ Dicalcium silicate<\/p>\n<p>+ Tricalcium aluminate<\/p>\n<p>+ Tetracalcium aluminoferrite.<\/p>\n<p>+ Calcium sulfate<\/p>\n<p>+ Bismuth oxide<\/p>\n<p>\u2013 \u0110\u1eb7c t\u00ednh sinh h\u1ecdc:<\/p>\n<p>+ T\u01b0\u01a1ng h\u1ee3p sinh h\u1ecdc v\u1edbi m\u00f4 ch\u00f3p hi\u1ebfm khi g\u00e2y ph\u1ea3n \u1ee9ng vi\u00eam khi \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>+ Kh\u00f4ng \u0111\u1ed9c.<\/p>\n<p>+ Ti\u00eau ch\u1eadm, \u00edt tan trong n\u01b0\u1edbc.<\/p>\n<p>+ S\u00e1t kh\u00edt, ng\u0103n ch\u1eb7n s\u1ef1 th\u1ea5m d\u1ecbch, pH =12,5, \u0111\u00e2y l\u00e0 pH ki\u1ec1m gi\u00fap trung h\u00f2a acid c\u1ee7a m\u00f4 m\u1ec1m, gi\u1ea3m vi\u00eam v\u00e0 s\u00e1t khu\u1ea9n.<\/p>\n<p>+ \u0110\u00f4ng c\u1ee9ng nhanh sau 4 gi\u1edd.<\/p>\n<p>+ K\u00edch th\u00edch qu\u00e1 tr\u00ecnh t\u00e1i s\u1eeda ch\u1eefa m\u00f4 (c\u1ea3 m\u00f4 m\u1ec1m v\u00e0 c\u1ee9ng). C\u00f3 th\u1ec3 t\u1ea1o l\u1edbp cement ho\u00e0n ch\u1ec9nh t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho vi\u1ec7c t\u1ea3i b\u00e1m d\u00ednh d\u00e2y ch\u1eb1ng (li\u1ec1n th\u01b0\u01a1ng ho\u00e0n to\u00e0n).<\/p>\n<p>\u2013 Ph\u01b0\u01a1ng ph\u00e1p th\u1ef1c hi\u1ec7n:<\/p>\n<p>+ T\u1ea1o h\u00ecnh, b\u01a1m r\u1eeda \u1ed1ng t\u1ee7y gi\u1ed1ng nh\u01b0 tr\u00e1m v\u1edbi calci hydroxyd.<\/p>\n<p>+ T\u1ea1o n\u00fat ch\u1eb7n ch\u00f3p v\u1edbi MTA: \u00d4ng t\u1ee7y kh\u00f4ng c\u1ea7n ph\u1ea3i th\u1ea5m kh\u00f4 ho\u00e0n to\u00e0n v\u00ec \u0111\u1ed9 \u1ea9m s\u1ebd th\u00fac \u0111\u1ea9y ph\u1ea3n \u1ee9ng thi\u1ebft l\u1eadp.<\/p>\n<p>\u2022 Tr\u1ed9n MTA v\u1edbi n\u01b0\u1edbc c\u1ea5t \u0111\u1ec3 \u0111\u01b0\u1ee3c d\u1ea1ng gi\u1ed1ng nh\u01b0 c\u00e1t \u1ea9m.<\/p>\n<p>\u2022 D\u00f9ng d\u1ee5ng c\u1ee5 chuy\u00ean d\u1ee5ng \u0111\u01b0a MTA v\u00e0o \u1ed1ng tu\u1ef7 \u0111\u1ebfn g\u1ea7n ch\u00f3p r\u0103ng kh\u1ecfi MTA d\u00e0i 1 \u2013 2mm.<\/p>\n<p>\u2022 D\u00f9ng c\u00e2y l\u00e8n d\u1ecdc hay \u0111\u1ea7u c\u1ee9ng c\u1ee7a c\u00e2y cone gi\u1ea5y c\u1ee1 l\u1edbn \u0111\u1ea7m nh\u1eb9 nh\u00e0ng MTA \u0111\u1ebfn ch\u00f3p r\u0103ng.<\/p>\n<p>\u2022 Ch\u1ee5p phim ki\u1ec3m tra.<\/p>\n<p>+ Tr\u00e1m \u1ed1ng t\u1ee7y v\u1edbi Gutta Percha: V\u00ec MTA c\u1ea7n th\u1eddi gian \u0111\u1ec3 \u0111\u00f4ng c\u1ee9ng n\u00ean vi\u1ec7c tr\u00e1m \u1ed1ng t\u1ee7y c\u1ea7n th\u1ef1c hi\u1ec7n v\u00e0o bu\u1ed5i h\u1eb9n sau. C\u00f3 th\u1ec3 tr\u00e1m \u1ed1ng t\u1ee7y b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p l\u00ean ngang ngu\u1ed9i ho\u1eb7c l\u00ean d\u1ecdc n\u00f3ng.<br \/>\nBiodentine:<\/p>\n<p>\u2013 Th\u00e0nh ph\u1ea7n:<\/p>\n<p>+ Qu\u1eb7ng:<\/p>\n<p>\u2022 Tricalcium silicat<\/p>\n<p>\u2022 Calcium carbonate<\/p>\n<p>\u2022\u00a0Zirconium dioxide<\/p>\n<p>+ Ch\u1ea5t l\u1ecfng:<\/p>\n<p>\u2022\u00a0Calci clorua<\/p>\n<p>\u2022\u00a0Super plasticizers.<\/p>\n<p>\u2022\u00a0N\u01b0\u1edbc.<\/p>\n<p>\u2013 \u0110\u1eb7c t\u00ednh sinh h\u1ecdc:<\/p>\n<p>+ T\u01b0\u01a1ng h\u1ee3p sinh h\u1ecdc, k\u00edch th\u00edch qu\u00e1 tr\u00ecnh t\u00e1i kho\u00e1ng h\u00f3a, k\u00edch th\u00edch t\u1ea1o x\u01b0\u01a1ng.<\/p>\n<p>+ C\u00f3 th\u1ec3 t\u1ef1 thi\u1ebft l\u1eadp v\u00e0 ph\u00e1t tri\u1ec3n l\u1ef1c n\u00e9n. Th\u1eddi gian thi\u1ebft l\u1eadp kho\u1ea3ng 180 ph\u00fat v\u00e0 c\u01b0\u1eddng \u0111\u1ed9 n\u00e9n c\u00f3 th\u1ec3 \u0111\u1ea1t 20,2mpa sau 28 ng\u00e0y.<\/p>\n<p>\u2013 Ph\u01b0\u01a1ng ph\u00e1p th\u1ef1c hi\u1ec7n: Gi\u1ed1ng nh\u01b0 v\u1edbi MTA. Biodentine l\u00e0 m\u1ed9t v\u1eadt li\u1ec7u c\u00f3 th\u1ec3 thay th\u1ebf nhi\u1ec1u ch\u1ec9 \u0111\u1ecbnh c\u1ee7a MTA v\u00e0 chi ph\u00ed kh\u00f4ng qu\u00e1 cao.<\/p>\n<p>2. \u0110i\u1ec1u tr\u1ecb n\u1ed9i ti\u00eau<\/p>\n<p>S\u1eed d\u1ee5ng calcium hydroxide c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m qu\u00e1 tr\u00ecnh n\u1ed9i ti\u00eau. Sau khi \u0111\u1eb7t paste calcium hydroxide v\u00e0o nh\u1eefng v\u00f9ng b\u1ecb ti\u00eau ng\u00f3t th\u00ec \u1edf l\u1ea7n h\u1eb9n ti\u1ebfp theo calcium hydroxide l\u00e0m ho\u1ea1i t\u1eed t\u1ea5t c\u1ea3 nh\u1eefng m\u00f4 t\u1ee7y c\u00f2n s\u00f3t l\u1ea1i trong c\u00e1c khe r\u00e3nh c\u1ee7a ph\u1ea7n n\u1ed9i ti\u00eau. Ph\u1ea7n ho\u1ea1i t\u1eed s\u1ebd \u0111\u01b0\u1ee3c l\u1ea5y \u0111i b\u1eb1ng c\u00e1ch b\u01a1m r\u1eeda v\u1edbi natri hypoclorit,<\/p>\n<p>Calcium hydroxide n\u00ean \u0111\u1eb7t v\u00e0o v\u00f9ng n\u1ed9i ti\u00eau 3 th\u00e1ng\/1 l\u1ea7n cho \u0111\u1ebfn khi s\u1ef1 ti\u00eau ng\u00f3t ch\u1ea5m d\u1ee9t. Tr\u00e1m \u1ed1ng tu\u1ef7: C\u1ea7n t\u1ea1o n\u00fat ch\u1eb7n ch\u00f3p v\u00e0 b\u01a1m guttapercha l\u1ecfng v\u00e0o \u1ed1ng tu\u1ef7.<\/p>\n<p><em>Ngu\u1ed3n: Ch\u1eefa r\u0103ng v\u00e0 n\u1ed9i nha t\u1eadp 1 &#8211; NXB Gi\u00e1o d\u1ee5c Vi\u1ec7t Nam<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>B\u00e0i vi\u1ebft sau n\u1ed9i dung n\u00f3i v\u1ec1 s\u01a1 l\u01b0\u1ee3c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u00e1c tr\u01b0\u1eddng h\u1ee3p ti\u00eau ch\u00e2n r\u0103ng tr\u00ean l\u00e2m s\u00e0ng. B\u00e0i vi\u1ebft cung c\u1ea5p c\u00e1c ph\u00e2n lo\u1ea1i ti\u00eau c\u1ed5 r\u0103ng, ti\u00eau ch\u00e2n r\u0103ng do k\u00edch th\u00edch hay do nhi\u1ec5m tr\u00f9ng, \u0111\u1ed3ng th\u1eddi k\u1ebft h\u1ee3p s\u1eed d\u1ee5ng c\u00e1c v\u1eadt li\u1ec7u ph\u1ee5c h\u1ed3i trong \u0111i\u1ec1u [&hellip;]<\/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":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ti\u00eau ch\u00e2n r\u0103ng - Ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb. - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft ph\u00e2n lo\u1ea1i ti\u00eau c\u1ed5 r\u0103ng, ti\u00eau ch\u00e2n r\u0103ng, \u0111\u1ed3ng th\u1eddi h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng c\u00e1c v\u1eadt li\u1ec7u ph\u1ee5c h\u1ed3i trong \u0111i\u1ec1u tr\u1ecb. 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