{"id":24250,"date":"2023-04-19T10:01:48","date_gmt":"2023-04-19T03:01:48","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24250"},"modified":"2023-05-02T11:38:43","modified_gmt":"2023-05-02T04:38:43","slug":"lay-xuong-tu-than-tai-sinh-xuong-co-huong-dan-trong-mieng","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/lay-xuong-tu-than-tai-sinh-xuong-co-huong-dan-trong-mieng\/","title":{"rendered":"K\u1ef9 thu\u1eadt l\u1ea5y x\u01b0\u01a1ng t\u1ef1 th\u00e2n v\u00e0 gh\u00e9p x\u01b0\u01a1ng trong ph\u1eabu thu\u1eadt mi\u1ec7ng."},"content":{"rendered":"

B\u00e0i vi\u1ebft n\u00e0y n\u00f3i v\u1ec1 k\u1ef9 thu\u1eadt l\u1ea5y x\u01b0\u01a1ng v\u00e0 gh\u00e9p x\u01b0\u01a1ng t\u1ef1 th\u00e2n trong ph\u1eabu thu\u1eadt mi\u1ec7ng, \u0111\u1eb7c bi\u1ec7t s\u1eed d\u1ee5ng trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu x\u01b0\u01a1ng \u0111\u1ec3 t\u1ea1o d\u1ef1ng ph\u1ee5c h\u00ecnh Implant. K\u1ef9 thu\u1eadt n\u00e0y l\u00e0 d\u1ea1ng k\u1ef9 thu\u1eadt kh\u00f3, \u0111\u00f2i h\u1ecfi ph\u1eabu thu\u1eadt vi\u00ean c\u00f3 tay ngh\u1ec1 cao, luy\u1ec7n t\u1eadp th\u00e0nh th\u1ea1o v\u00e0 \u0111\u1ea3m b\u1ea3o quy tr\u00ecnh k\u00e8m theo. C\u00f9ng t\u00ecm hi\u1ec3u.<\/strong><\/p>\n

1. K\u1ef9 thu\u1eadt l\u1ea5y x\u01b0\u01a1ng t\u1ef1 th\u00e2n<\/h2>\n

Gh\u00e9p x\u01b0\u01a1ng t\u1ef1 th\u00e2n c\u00f3 th\u1ec3 l\u00e0 m\u1eabu x\u01b0\u01a1ng trephine ho\u1eb7c kh\u1ed1i x\u01b0\u01a1ng l\u1ea5y t\u1eeb c\u00e1c v\u00f9ng trong v\u00e0 ngo\u00e0i mi\u1ec7ng. M\u00f4 gh\u00e9p l\u1edbn c\u00f3 th\u1ec3 l\u1ea5y t\u1eeb c\u00e1c khu v\u1ef1c gi\u1eefa 2 l\u1ed7 c\u1eb1m d\u01b0\u1edbi g\u00e2y t\u00ea t\u1ea1i ch\u1ed7. Vi\u1ec7c ch\u0103m s\u00f3c t\u1ed1t r\u1ea5t c\u1ea7n thi\u1ebft \u0111\u1ec3 tr\u00e1nh \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn vi\u1ec7c cung c\u1ea5p th\u1ea7n kinh \/ m\u1ea1ch m\u00e1u \u0111\u1ebfn c\u00e1c r\u0103ng tr\u01b0\u1edbc. \u0110\u00e1nh gi\u00e1 Xquang c\u1ea9n th\u1eadn tr\u01b0\u1edbc ph\u1eabu thu\u1eadt \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh l\u01b0\u1ee3ng x\u01b0\u01a1ng c\u00f3 s\u1eb5n. M\u1ed9t khi v\u1ea1t ni\u00eam m\u1ea1c \u0111\u00e3 \u0111\u01b0\u1ee3c l\u1eadt l\u00ean th\u00f4ng qua m\u1ed9t \u0111\u01b0\u1eddng r\u1ea1ch \u0111\u1ec3 b\u1ed9c l\u1ed9 h\u00e0m d\u01b0\u1edbi, \u0111\u00e1nh d\u1ea5u \u0111\u01b0\u1eddng vi\u1ec1n m\u1ea3nh gh\u00e9p c\u00e1ch ch\u00f3p r\u0103ng c\u1eeda \u00edt nh\u1ea5t 5 mm x\u01b0\u01a1ng.<\/p>\n

\"lay-xuong-tu-than-1\"
B\u1eb1ng c\u00e1ch t\u1ea1o m\u1ed9t v\u1ea1t r\u1ed9ng g\u1ea7n \u0111\u01b0\u1eddng ti\u1ebfp n\u1ed1i n\u01b0\u1edbu-ni\u00eam m\u1ea1c, m\u1ed9t ph\u1ea7n l\u1edbn c\u1ee7a h\u00e0m d\u01b0\u1edbi ph\u00eda tr\u01b0\u1edbc \u0111\u01b0\u1ee3c b\u1ed9c l\u1ed9. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y v\u00ec phi\u1ebfn x\u01b0\u01a1ng ph\u00eda m\u00f4i d\u00e0y n\u00ean ch\u00e2n r\u0103ng c\u1eeda d\u01b0\u1edbi kh\u00f4ng nh\u00ecn th\u1ea5y \u0111\u01b0\u1ee3c. Ph\u1ea3i ch\u0103m s\u00f3c t\u1ed1t \u0111\u1ec3 tr\u00e1nh \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c s\u1ed1ng c\u1ee7a r\u0103ng.<\/figcaption><\/figure>\n

Nh\u1eefng nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y \u0111\u00e3 \u0111\u1ec1 ngh\u1ecb m\u1ed9t m\u1ee9c an to\u00e0n l\u00e0 8 mm d\u01b0\u1edbi ch\u00f3p r\u0103ng c\u1eeda v\u00e0 kh\u00f4ng s\u00e2u qu\u00e1 4 mm \u0111\u1ec3 tr\u00e1nh \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c s\u1ed1ng c\u1ee7a r\u0103ng. \u0110\u01b0\u1eddng n\u00e9t ch\u00e2n r\u0103ng v\u00e0 ch\u00f3p th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ea5y tr\u1ef1c ti\u1ebfp khi x\u01b0\u01a1ng b\u1ed9c l\u1ed9 v\u00e0 tham kh\u1ea3o c\u1ea9n th\u1eadn X quang l\u00e0 b\u1eaft bu\u1ed9c. \u0110\u1ed1i v\u1edbi vi\u1ec7c l\u1ea5y x\u01b0\u01a1ng kh\u1ed1i, c\u00e1c b\u00e1c s\u0129 ph\u1eabu thu\u1eadt c\u00f3 m\u1ed9t s\u1ed1 l\u1ef1a ch\u1ecdn:
\n1. M\u0169i khoan tr\u1ee5 (fissure bur)
\n2. C\u01b0a dao \u0111\u1ed9ng (oscillating saw)
\n3. \u0110\u0129a quay
\n4. Ph\u1eabu thu\u1eadt piezo
\n5. M\u0169i Trephines<\/p>\n

Vi\u1ec7c s\u1eed d\u1ee5ng m\u0169i khoan v\u00e0 tay khoan th\u1eb3ng c\u00f3 th\u1ec3 l\u00e0 k\u1ef9 thu\u1eadt m\u00e0 nhi\u1ec1u ph\u1eabu thu\u1eadt vi\u00ean l\u1ef1a ch\u1ecdn do h\u1ecd quen thu\u1ed9c v\u1edbi c\u00e1c c\u00f4ng c\u1ee5 n\u00e0y. Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c \u0111\u0129a kim c\u01b0\u01a1ng high-speed \u1edf tay khoan th\u1eb3ng ho\u1eb7c khu\u1ef7u \u0111\u1ec3 l\u1ea5y kh\u1ed1i x\u01b0\u01a1ng l\u1edbn c\u00f3 l\u1ee3i th\u1ebf l\u00e0 h\u1ea1n ch\u1ebf \u0111\u1ed9 s\u00e2u ch\u1ec9 2-3 mm c\u0169ng nh\u01b0 ng\u0103n ng\u1eeba t\u1ed1t vi\u1ec7c ch\u1ea5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m.<\/p>\n

\"lay-xuong-tu-than-2\"
(A, B) Tay khoan th\u1eb3ng v\u00e0 khu\u1ef7u \u0111\u1ec3 d\u00f9ng cho c\u00e1c \u0111\u0129a kim c\u01b0\u01a1ng cho x\u01b0\u01a1ng gh\u00e9p (FRIOS Microsaws, FRIATEC, Mannheim, \u0110\u1ee9c). Nh\u1edd s\u1ef1 b\u1ea3o v\u1ec7, ch\u00fang c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong kh\u00f4ng gian kh\u00e1 h\u1ea1n ch\u1ebf m\u00e0 kh\u00f4ng ch\u1ea5n th\u01b0\u01a1ng c\u00e1c m\u00f4 m\u1ec1m xung quanh.<\/figcaption><\/figure>\n

Ph\u1eabu thu\u1eadt piezo c\u00f3 l\u1ee3i th\u1ebf l\u00e0 d\u1ec5 d\u00e0ng \u0111i v\u00e0o v\u1edbi c\u00e1c \u0111\u1ea7u kh\u00e1c nhau c\u00f3 s\u1eb5n, l\u00e0m gi\u1ea3m s\u1ef1 kh\u00f3 ch\u1ecbu cho b\u1ec7nh nh\u00e2n. Kh\u00f3 kh\u0103n t\u01b0\u01a1ng \u0111\u1ed1i c\u1ee7a vi\u1ec7c c\u1eaft x\u01b0\u01a1ng d\u00e0y v\u1edbi m\u1ed9t ph\u1eabu thu\u1eadt piezo l\u00e0 c\u00f3 th\u1ec3 l\u00e0m h\u1ea1n ch\u1ebf vi\u1ec7c s\u1eed d\u1ee5ng n\u00f3 trong nh\u1eefng t\u00ecnh hu\u1ed1ng nh\u1ea5t \u0111\u1ecbnh (l\u00e0m m\u00f2n l\u01b0\u1ee1i c\u1eaft – ng\u01b0\u1eddi d\u1ecbch di\u1ec5n gi\u1ea3i). B\u1ea5t k\u1ef3 th\u1ee7 thu\u1eadt l\u1ea5y x\u01b0\u01a1ng n\u00e0o c\u0169ng \u0111\u00f2i h\u1ecfi b\u01a1m nhi\u1ec1u n\u01b0\u1edbc mu\u1ed1i v\u00e0 \u0111i\u1ec1u n\u00e0y d\u1ec5 d\u00e0ng \u0111\u1ea1t \u0111\u01b0\u1ee3c v\u1edbi ph\u1eabu thu\u1eadt piezo. \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i c\u1eaft xuy\u00ean qua ho\u00e0n to\u00e0n x\u01b0\u01a1ng v\u1ecf \u1edf ph\u00eda m\u00f4i \u0111\u1ec3 m\u1ea3nh gh\u00e9p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u1eaft ra t\u1eeb x\u01b0\u01a1ng x\u1ed1p b\u00ean d\u01b0\u1edbi.<\/p>\n

\"lay-xuong-tu-than-3\"
\u0110\u0129a kim c\u01b0\u01a1ng c\u1eaft r\u1ea5t m\u1ecbn \u1edf \u0111\u1ed9 s\u00e2u ki\u1ec3m so\u00e1t, gi\u1ea3m thi\u1ec3u nguy c\u01a1 ch\u1ea5n th\u01b0\u01a1ng cho c\u00e1c c\u1ea5u tr\u00fac l\u00e2n c\u1eadn. \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 \u0111\u1ea3m b\u1ea3o r\u1eb1ng c\u00e1c \u0111\u01b0\u1eddng c\u1eaft g\u1eb7p nhau \u1edf m\u1ed7i g\u00f3c \u0111\u1ec3 cho ph\u00e9p n\u1ea1y kh\u1ed1i x\u01b0\u01a1ng l\u00ean. Ch\u1ea3y m\u00e1u t\u1eeb s\u00e2u trong m\u1ed7i l\u1ea7n c\u1eaft cho th\u1ea5y r\u1eb1ng vi\u1ec7c c\u1eaft ho\u00e0n to\u00e0n xuy\u00ean qua x\u01b0\u01a1ng v\u1ecf v\u00e0 v\u00e0o x\u01b0\u01a1ng x\u1ed1p.<\/figcaption><\/figure>\n

Trong m\u1ed9t s\u1ed1 khu v\u1ef1c c\u1eaft ban \u0111\u1ea7u c\u00f3 th\u1ec3 ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u00e0o s\u00e2u b\u1eb1ng m\u0169i khoan tr\u1ee5 (fissure) ti\u00eau chu\u1ea9n \u0111\u1ebfn \u0111\u1ed9 s\u00e2u mong mu\u1ed1n. C\u1ea7n ph\u1ea3i c\u1ea9n th\u1eadn \u0111\u1ec3 h\u1ea1n ch\u1ebf c\u1eaft b\u00ean trong h\u00e0m d\u01b0\u1edbi v\u00ec th\u1ee7ng m\u1eb7t trong c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn xu\u1ea5t huy\u1ebft t\u1eeb c\u00e1c m\u00f4 m\u1ec1m m\u1eb7t trong, c\u00f3 th\u1ec3 kh\u00f3 kh\u0103n \u0111\u1ec3 c\u1ea7m m\u00e1u. Sau khi c\u1eaft gi\u1ea3m ph\u00e1c th\u1ea3o \u0111\u00e3 xong, m\u1ea3nh gh\u00e9p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c n\u00e2ng l\u00ean b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng osteotomes ho\u1eb7c c\u00e1i \u0111\u1ee5c cong thi\u1ebft k\u1ebf \u0111\u1eb7c bi\u1ec7t cho m\u1ee5c \u0111\u00edch \u0111\u00f3. C\u1ed1 g\u1eafng \u0111\u1ec3 n\u1ea1y kh\u1ed1i trong khi v\u1ecf x\u01b0\u01a1ng c\u00f2n nguy\u00ean v\u1eb9n s\u1ebd g\u00e2y ra g\u00e3y m\u1ea3nh x\u01b0\u01a1ng gh\u00e9p. M\u1ed9t block l\u1edbn k\u00e9o d\u00e0i qua \u0111\u01b0\u1eddng gi\u1eefa c\u00f3 th\u1ec3 kh\u00f3 kh\u0103n \u0111\u1ec3 n\u1ea1y v\u00e0 c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i chia th\u00e0nh hai ph\u1ea7n.<\/p>\n

\"\"
\u0110\u1ec3 l\u1ea5y m\u1ea3nh gh\u00e9p l\u1edbn t\u1eeb h\u00e0m d\u01b0\u1edbi ph\u00eda tr\u01b0\u1edbc, c\u00e1c kh\u1ed1i \u0111\u01b0\u1ee3c chia l\u00e0m hai ph\u1ea7n, gi\u1ea3m l\u1ef1c c\u1ea7n thi\u1ebft \u0111\u1ec3 n\u1ea1y c\u00e1c kh\u1ed1i v\u00e0 gi\u1ea3m thi\u1ec3u nguy c\u01a1 g\u00e3y ch\u00fang. L\u01b0u \u00fd \u0111\u1ed9 s\u00e2u c\u1ee7a v\u00f9ng cho, \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e0o s\u00e2u do l\u1ea5y x\u01b0\u01a1ng d\u01b0\u1edbi x\u01b0\u01a1ng x\u1ed1p.<\/figcaption><\/figure>\n

M\u1eabu Trephine c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ea5y t\u1eeb c\u1eb1m v\u00e0 c\u00f3 nhi\u1ec1u k\u00edch c\u1ee1 kh\u00e1c nhau c\u1ee7a trephine c\u00f3 s\u1eb5n cho m\u1ee5c \u0111\u00edch n\u00e0y.<\/p>\n

\"lay-xuong-tu-than-4\"
C\u00e1c k\u00edch c\u1ee1 kh\u00e1c nhau c\u1ee7a trephines \u0111\u01b0\u1ee3c l\u00e0m s\u1eb5n cho c\u00e1c k\u00edch c\u1ee1 kh\u00e1c nhau c\u1ee7a m\u00f4 gh\u00e9p v\u00e0 cho ph\u00e9p \u0111i v\u00e0o c\u00e1c v\u00f9ng h\u1ea1n ch\u1ebf. N\u00f3 r\u1ea5t h\u1eefu \u00edch v\u00ec c\u00f3 c\u00e1c v\u1ea1ch ngang ch\u1ec9 \u0111\u1ed9 s\u00e2u \u1edf m\u1eb7t ngo\u00e0i v\u00e0 cho ph\u00e9p gi\u00e1m s\u00e1t \u0111\u1ed9 s\u00e2u khi c\u1eaft.<\/figcaption><\/figure>\n

\u0110i v\u00e0o khu v\u1ef1c n\u00e0y v\u1edbi tay khoan kh\u00e1 c\u1ed3ng k\u1ec1nh v\u00e0 trephines l\u1edbn c\u00f3 th\u1ec3 l\u00e0m cho th\u1ee7 thu\u1eadt kh\u00f3 kh\u0103n h\u01a1n so v\u1edbi vi\u1ec7c l\u1ea5y m\u1ed9t kh\u1ed1i, tr\u1eeb khi m\u00f4 m\u1ec1m \u0111\u01b0\u1ee3c l\u1eadt r\u1ed9ng ra. M\u1ed9t khi kh\u1ed1i x\u01b0\u01a1ng v\u1ecf v\u00e0 x\u1ed1p \u0111\u01b0\u1ee3c l\u1ea5y ra, ph\u1ea7n x\u01b0\u01a1ng x\u1ed1p \u0111\u1eb7t v\u1ec1 ph\u00eda v\u00f9ng gh\u00e9p c\u00f2n x\u01b0\u01a1ng v\u1ecf quay v\u1ec1 ph\u00eda tr\u00ean. Ki\u1ec3m so\u00e1t s\u1ef1 ch\u1ea3y m\u00e1u c\u1ee7a x\u01b0\u01a1ng r\u1ea5t quan tr\u1ecdng tr\u01b0\u1edbc khi \u0111\u00f3ng m\u00f4 m\u1ec1m, v\u00e0 do v\u1eady nhi\u1ec1u t\u00e1c gi\u1ea3 th\u00edch l\u01b0\u1edbi carboxymethylcellulose \u0111\u01b0\u1ee3c nh\u00e9t v\u00e0o v\u00f9ng cho, m\u1eb7c d\u00f9 s\u00e1p x\u01b0\u01a1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u01b0a th\u00edch b\u1edfi m\u1ed9t s\u1ed1 ph\u1eabu thu\u1eadt vi\u00ean. M\u1ed9t s\u1ed1 ng\u01b0\u1eddi kh\u00e1c \u1ee7ng h\u1ed9 vi\u1ec7c nh\u00e9t v\u00e0o v\u00f9ng cho c\u00e1c s\u1ea3n ph\u1ea9m thay th\u1ebf x\u01b0\u01a1ng \u0111\u01b0\u1ee3c gi\u1eef l\u1ea1i v\u1edbi m\u00e0ng ch\u1eafn \u0111\u1ec3 gi\u1ea3m thi\u1ec3u s\u1ef1 thay \u0111\u1ed5i profile x\u01b0\u01a1ng. Vi\u1ec7c \u0111\u00f3ng k\u00edn m\u00f4 m\u1ec1m t\u1ed1t t\u1ea1i v\u00f9ng cho r\u1ea5t quan tr\u1ecdng v\u00ec xu h\u01b0\u1edbng th\u1ee7ng v\u1ebft th\u01b0\u01a1ng kh\u00e1 cao v\u00e0 vi\u1ec7c \u0111\u00f3ng k\u00edn v\u1ebft th\u01b0\u01a1ng n\u00ean \u0111\u01b0\u1ee3c nh\u1eafm v\u00e0o.<\/p>\n

C\u00e1c v\u00f9ng l\u1ea5y x\u01b0\u01a1ng kh\u00e1c trong mi\u1ec7ng c\u0169ng c\u00f3 nh\u01b0ng h\u1ea1n ch\u1ebf l\u01b0\u1ee3ng x\u01b0\u01a1ng c\u00f3 s\u1eb5n h\u01a1n. X\u01b0\u01a1ng m\u1eabu Trephine l\u1ea5y t\u1eeb v\u00f9ng sau r\u0103ng c\u1ed1i h\u00e0m d\u01b0\u1edbi c\u00f3 th\u1ec3 cung c\u1ea5p m\u1ed9t m\u1ea3nh gh\u00e9p m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng cao \u0111\u1ee7 k\u00edch th\u01b0\u1edbc.<\/p>\n

\"lay-xuong-tu-than-5\"
(A, B) L\u1ea5y x\u01b0\u01a1ng b\u1eb1ng m\u0169i trephine \u1edf v\u00f9ng sau r\u0103ng c\u1ed1i h\u00e0m d\u01b0\u1edbi. V\u00f9ng n\u00e0y c\u00f3 th\u1ec3 cho x\u01b0\u01a1ng gh\u00e9p ch\u1ea5t l\u01b0\u1ee3ng t\u1ed1t nh\u01b0ng k\u00edch th\u01b0\u1edbc c\u1ee7a c\u00e1c m\u1ea3nh gh\u00e9p c\u00f3 th\u1ec3 b\u1ecb gi\u1edbi h\u1ea1n. B\u1eb1ng c\u00e1ch t\u0103ng k\u00edch th\u01b0\u1edbc c\u1ee7a v\u1ea1t, c\u00e0nh \u0111\u1ee9ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0m v\u00f9ng cho. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c \u0111\u0129a kim c\u01b0\u01a1ng ho\u1eb7c d\u1ee5ng c\u1ee5 piezo c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng h\u01a1n v\u00e0 k\u00edch th\u01b0\u1edbc c\u1ee7a m\u1ea3nh gh\u00e9p l\u1edbn h\u01a1n.<\/figcaption><\/figure>\n
\"lay-xuong-tu-than-6\"
(A) M\u1ed9t tr\u01b0\u1eddng h\u1ee3p cho th\u1ea5y m\u1ea5t x\u01b0\u01a1ng \u0111\u00e1ng k\u1ec3 v\u1ec1 chi\u1ec1u cao v\u00e0 chi\u1ec1u ngo\u00e0i trong. (B) M\u1ee9c \u0111\u1ed9 khuy\u1ebft h\u1ed5ng x\u01b0\u01a1ng sau khi l\u1eadt v\u1ea1t m\u1eb7t ngo\u00e0i v\u00e0 m\u1eb7t trong. (C) Khoan l\u1ed7 \u1edf v\u00f9ng nh\u1eadn. (D) M\u1ed9t m\u1eabu x\u01b0\u01a1ng trephine \u0111\u01b0\u1ee3c g\u1eafn ch\u1eb7t v\u1edbi x\u01b0\u01a1ng b\u00ean d\u01b0\u1edbi v\u1edbi m\u1ed9t v\u00edt titan \u0111\u01b0\u1eddng k\u00ednh 1,2 mm (Mondeal Medical Systems GmbH, Am Gewerbering 7, 78570 Muhlheim a.d. Donau, \u0110\u1ee9c). (E) M\u1ed9t b\u01b0\u1edbc n\u1eefa, b\u1ea5t k\u1ef3 kho\u1ea3ng tr\u1ed1ng n\u00e0o c\u0169ng \u0111\u01b0\u1ee3c nh\u00e9t v\u00e0o h\u1ed7n h\u1ee3p v\u1ee5n x\u01b0\u01a1ng v\u00e0 m\u00e1u (osseous coagulum) ho\u1eb7c m\u1ea3nh x\u01b0\u01a1ng. (F) M\u1ed9t m\u00f4 li\u00ean k\u1ebft l\u1ea5y t\u1eeb kh\u1ea9u c\u00e1i \u0111\u1ea3m b\u1ea3o vi\u1ec7c kh\u00e2u k\u00edn t\u1ed1t v\u00e0 l\u00e0m cho profile m\u00f4 m\u1ec1m d\u00e0y h\u01a1n. (G) V\u00f9ng gh\u00e9p l\u00e0nh th\u01b0\u01a1ng 3 th\u00e1ng sau khi gh\u00e9p. (H) X\u01b0\u01a1ng gh\u00e9p duy tr\u00ec k\u00edch th\u01b0\u1edbc trong pha l\u00e0nh th\u01b0\u01a1ng- \u0111\u00e2y l\u00e0 do m\u1ed9t ph\u1ea7n m\u1ea3nh gh\u00e9p l\u00e0 v\u1ecf x\u01b0\u01a1ng d\u00e0y \u0111\u1eb7c. (I) \u0110\u1eb7t implant v\u00e0o m\u00f4 gh\u00e9p cho th\u1ea5y s\u1ef1 bao ph\u1ee7 implant t\u1ed1t v\u00e0 h\u01b0\u1edbng implant l\u00fd t\u01b0\u1edfng.<\/figcaption><\/figure>\n

C\u00e1c l\u1ed3i c\u1ee7 h\u00e0m tr\u00ean c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0ng m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng \u1edf \u0111\u00e2y c\u00f3 th\u1ec3 kh\u00f4ng t\u1ed1t. Kh\u1ed1i l\u1edbn h\u01a1n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ea5y t\u1eeb c\u00e0nh \u0111\u1ee9ng, m\u1ecfm v\u1eb9t, b\u1edd ch\u00e9o ngo\u00e0i v\u00e0 m\u1eb7t ngo\u00e0i x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng m\u0169i khoan ho\u1eb7c piezo. V\u00f9ng n\u00e0y \u0111\u01b0\u1ee3c nhi\u1ec1u ph\u1eabu thu\u1eadt vi\u00ean \u01b0a th\u00edch h\u01a1n c\u1eb1m.<\/p>\n

\"\"
M\u1ed9t lo\u1ea1t h\u00ecnh \u1ea3nh cho th\u1ea5y vi\u1ec7c l\u1ea5y x\u01b0\u01a1ng kh\u1ed1i t\u1eeb m\u1eb7t ngo\u00e0i x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi \u0111\u1ec3 gh\u00e9p v\u00e0o r\u0103ng c\u1eeda gi\u1eefa h\u00e0m tr\u00ean. (A) M\u1ed9t v\u1ea1t ni\u00eam m\u1ea1c m\u00e0ng x\u01b0\u01a1ng \u0111\u01b0\u1ee3c l\u1eadt l\u00ean v\u00e0 \u0111\u1ee5c l\u1ed7 tr\u00ean m\u00e0o x\u01b0\u01a1ng v\u1edbi m\u0169i khoan ph\u1eabu thu\u1eadt. C\u1eaft ph\u00eda g\u1ea7n v\u00e0 ph\u00eda xa \u0111\u1ec3 ki\u1ec3m so\u00e1t k\u00edch th\u01b0\u1edbc c\u1ee7a m\u1ea3nh gh\u00e9p. C\u1eaft xuy\u00ean qua x\u01b0\u01a1ng v\u1ecf xu\u1ed1ng ph\u00eda d\u01b0\u1edbi \u0111\u1ec3 gi\u00fap kh\u1ed1i x\u01b0\u01a1ng g\u00e3y \u1edf m\u1ee9c \u0111\u1ed9 th\u00edch h\u1ee3p. (B) M\u1ea3nh gh\u00e9p \u0111\u01b0\u1ee3c l\u1ea5y ra v\u1edbi m\u1ed9t c\u1ea3i \u0111\u1ee5c x\u01b0\u01a1ng v\u00e0 sau \u0111\u00f3 nay ra. (C) M\u1ea3nh gh\u00e9p \u0111\u00e3 \u0111\u01b0\u1ee3c l\u1ea5y ra, m\u1ee9c \u0111\u1ed9 g\u00e3y x\u01b0\u01a1ng kh\u00f3 c\u00f3 th\u1ec3 h\u1ea1n ch\u1ebf h\u01a1n n\u1eefa. (D) sau \u0111\u00f3 m\u1ea3nh gh\u00e9p \u0111\u01b0\u1ee3c c\u1eaft b\u1eb1ng m\u0169i khoan v\u00e0 b\u01a1m n\u01b0\u1edbc mu\u1ed1i ho\u1eb7c b\u1eb1ng k\u1eb9p c\u1eaft \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c profile x\u01b0\u01a1ng \u1ed5 ch\u00ednh x\u00e1c v\u00e0 cho ph\u00e9p m\u1ea5t x\u01b0\u01a1ng m\u1ed9t \u00edt trong giai \u0111o\u1ea1n l\u00e0nh th\u01b0\u01a1ng. Sau khi \u0111\u1ee5c l\u1ed7 \u1edf v\u00f9ng nh\u1eadn, m\u1ea3nh gh\u00e9p \u0111\u01b0\u1ee3c g\u1eafn v\u00e0o v\u1edbi m\u1ed9t v\u00edt v\u1eb7n nh\u1ecf. (E) Kh\u00e2u \u0111\u00f3ng k\u00edn \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch d\u00f9ng c\u00e1c v\u1ea1t m\u1eb7t ngo\u00e0i, bao g\u1ed3m gi\u1ea3m c\u0103ng m\u00e0ng x\u01b0\u01a1ng.<\/figcaption><\/figure>\n

L\u01b0\u1ee3ng x\u01b0\u01a1ng l\u1ea5y t\u1eeb b\u1ea5t k\u1ef3 v\u00f9ng n\u00e0o trong khi d\u00f9ng d\u1ee5ng c\u1ee5 c\u1eaft c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u0103ng l\u00ean b\u1eb1ng c\u00e1ch d\u00f9ng c\u00e1i r\u00e2y trong b\u1ed9 m\u00e1y h\u00fat.<\/p>\n

\"\"
(A) M\u1ed9t c\u00e1i ch\u1eb7n x\u01b0\u01a1ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 thu c\u00e1c v\u1ee5n x\u01b0\u01a1ng v\u00e0 m\u1ea3nh x\u01b0\u01a1ng nh\u1ecf trong qu\u00e1 tr\u00ecnh s\u1eeda so\u1ea1n v\u1edbi d\u1ee5ng c\u1ee5 quay. C\u00e1c b\u1ed9 l\u1ecdc nh\u1ef1a tr\u1eafng d\u00f9ng m\u1ed9t l\u1ea7n \u0111\u1ec3 l\u1ea5y x\u01b0\u01a1ng. L\u01b0\u1ee3ng x\u01b0\u01a1ng l\u1edbn c\u00f3 th\u1ec3 thu \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1ch n\u00e0y, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi s\u1eed d\u1ee5ng d\u1ee5ng c\u1ee5 c\u1eaft th\u00f4 nh\u01b0 khoan xo\u1eafn v\u00e0 c\u00e1c v\u00f9ng x\u01b0\u01a1ng c\u00f3 m\u1eadt \u0111\u1ed9 cao. (B) M\u1ed9t Bone Trap TM (AstraTech, Th\u1ee5y \u0110i\u1ec3n). \u0110\u00e2y l\u00e0 m\u1ed9t c\u00e1i ch\u1eb7n x\u01b0\u01a1ng d\u00f9ng m\u1ed9t l\u1ea7n, cho ph\u00e9p t\u1ef1 \u0111em x\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp \u0111\u1ebfn v\u00f9ng gh\u00e9p, h\u1ea1n ch\u1ebf t\u1ed1i \u0111a vi\u1ec7c x\u1eed l\u00fd m\u00f4 gh\u00e9p v\u00e0 gi\u1ea3m t\u1ed5n th\u1ea5t v\u1eadt li\u1ec7u. (C) X\u01b0\u01a1ng c\u1eaft \u0111\u01b0\u1ee3c \u0111\u1ea9y ra t\u1eeb BoneTrap.<\/figcaption><\/figure>\n

Nh\u1eefng c\u1ee5c x\u01b0\u01a1ng l\u1ea5y \u0111\u01b0\u1ee3c trong qu\u00e1 tr\u00ecnh khoan, \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 ti\u1ec1m n\u0103ng k\u00edch d\u1eabn x\u01b0\u01a1ng t\u1ed1t.<\/p>\n

Do b\u01a1m r\u1eeda trong qu\u00e1 tr\u00ecnh c\u1eaft, l\u01b0\u1ee3ng x\u01b0\u01a1ng v\u1ee5n thu \u0111\u01b0\u1ee3c c\u00f3 th\u1ec3 \u0111\u00e1ng k\u1ec3, \u0111\u1eb7c bi\u1ec7t n\u1ebfu d\u00f9ng lo\u1ea1i d\u1ee5ng c\u1ee5 quay th\u00f4. C\u00e1c nh\u00e0 l\u00e2m s\u00e0ng mong mu\u1ed1n s\u1eed d\u1ee5ng m\u1ed9t \u0111\u01b0\u1eddng \u1ed1ng h\u00fat chuy\u00ean d\u1ee5ng \u0111\u1ec3 gi\u1eef l\u1ea1i x\u01b0\u01a1ng \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 nhi\u1ec5m khu\u1ea9n \u0111\u1eb7c bi\u1ec7t v\u1edbi n\u01b0\u1edbc b\u1ecdt, vv. Khi kh\u00f4ng s\u1eed d\u1ee5ng, c\u00e1i ch\u1eb7n x\u01b0\u01a1ng n\u00ean \u0111\u01b0\u1ee3c l\u1ea5y ra \u0111\u1ec3 x\u01b0\u01a1ng kh\u00f4ng b\u1ecb kh\u00f4. C\u00e1c v\u1ee5n x\u01b0\u01a1ng t\u1ea1o th\u00e0nh m\u1ed9t ch\u1ea5t b\u1ed9t nh\u00e3o, nh\u01b0 th\u1ebf l\u00e0 d\u1ec5 d\u00e0ng thao t\u00e1c v\u00e0 c\u00f3 th\u1ec3 \u0111\u1eb7t \u1edf b\u1ea5t k\u1ef3 kho\u1ea3ng tr\u1ed1ng n\u00e0o c\u00f2n l\u1ea1i gi\u1eefa m\u1ea3nh gh\u00e9p v\u00e0 n\u1ec1n gh\u00e9p. Tr\u01b0\u1eddng h\u1ee3p c\u1ea7n ph\u1ea3i thay \u0111\u1ed5i profile x\u01b0\u01a1ng \u1ed5, h\u1ea1t gh\u00e9p c\u1ea7n \u0111\u01b0\u1ee3c b\u1ea3o v\u1ec7 b\u1eb1ng m\u1ed9t l\u1edbp m\u00e0ng t\u1ea1o ra kho\u1ea3ng tr\u1ed1ng (a space- creating membrane) ho\u1eb7c l\u01b0\u1edbi (mesh).<\/p>\n

M\u1ed9t c\u00e1ch kh\u00e1c \u0111\u1ec3 gh\u00e9p x\u01b0\u01a1ng cho c\u00e1c khuy\u1ebft h\u1ed5ng nh\u1ecf, n\u01a1i m\u00e0 x\u01b0\u01a1ng c\u1ee5c kh\u00f4ng th\u1ec3 cung c\u1ea5p \u0111\u1ee7 nguy\u00ean li\u1ec7u c\u00f3 ch\u1ea5t l\u01b0\u1ee3ng t\u1ed1t l\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng n\u1ea1o x\u01b0\u01a1ng nh\u01b0 Safescraper 1 TWIST v\u00e0 Micross (Meta, Reggio Emilia, Italy).<\/p>\n

\"\"
(A) Safescraper 1 Twist l\u00e0 m\u1ed9t v\u00ed d\u1ee5 c\u1ee7a m\u1ed9t c\u00e2y n\u1ea1o x\u01b0\u01a1ng d\u00f9ng m\u1ed9t l\u1ea7n v\u00e0 c\u00f3 lo\u1ea1i th\u1eb3ng v\u00e0 cong \u0111\u1ec3 \u0111i v\u00e0o d\u1ec5 d\u00e0ng. Khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u00ean x\u01b0\u01a1ng v\u1ecf, \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u00f9ng sau r\u0103ng c\u1ed1i \/ m\u1eb7t ngo\u00e0i x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi, l\u01b0\u1ee3ng x\u01b0\u01a1ng \u0111\u00e1ng k\u1ec3 c\u00f3 ch\u1ea5t l\u01b0\u1ee3ng t\u1ed1t c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ea5y th\u00f4ng qua m\u1ed9t v\u1ea1t nh\u1ecf \/ v\u1ebft r\u1ea1ch. (B) X\u01b0\u01a1ng l\u1ea5y t\u1eeb v\u00f9ng sau r\u0103ng c\u1ed1i ch\u1ee9a \u0111\u1ea7y trong c\u00e2y n\u1ea1o.<\/figcaption><\/figure>\n

\u0110i\u1ec1u n\u00e0y cho ph\u00e9p \u0111i v\u00e0o c\u00e1c v\u00f9ng b\u1ecb gi\u1edbi h\u1ea1n th\u00f4ng qua m\u1ed9t v\u1eadt nh\u1ecf \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u00f9ng sau r\u0103ng c\u1ed1i. C\u00e1c v\u1ee5n x\u01b0\u01a1ng thu \u0111\u01b0\u1ee3c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 nh\u00e9t v\u00e0o c\u00e1c kho\u1ea3ng tr\u1ed1ng xung quanh m\u1ea3nh gh\u00e9p ho\u1eb7c l\u00e0m nguy\u00ean li\u1ec7u gh\u00e9p trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ea7n b\u1ea3o to\u00e0n th\u1ec3 t\u00edch, v\u00ed d\u1ee5, th\u1ee7 thu\u1eadt n\u00e2ng xoang \/ b\u1ea3o t\u1ed3n \u1ed5 r\u0103ng ho\u1eb7c d\u01b0\u1edbi m\u00e0ng.<\/p>\n

L\u1ea5y x\u01b0\u01a1ng trong mi\u1ec7ng \u0111\u00e3 tr\u1edf n\u00ean ph\u1ed5 bi\u1ebfn h\u01a1n v\u1edbi s\u1ef1 ra \u0111\u1eddi c\u1ee7a m\u1ed9t s\u1ed1 c\u00e1c k\u1ef9 thu\u1eadt n\u00f3i tr\u00ean v\u00e0 \u0111\u1eb7c bi\u1ec7t h\u1ea5p d\u1eabn v\u00ec b\u00e1c s\u0129 ph\u1eabu thu\u1eadt nha khoa \u0111ang l\u00e0m vi\u1ec7c trong m\u1ed9t m\u00f4i tr\u01b0\u1eddng quen thu\u1ed9c. Th\u1ef1c t\u1ebf l\u00e0 c\u00e1c th\u1ee7 thu\u1eadt n\u00e0y c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n d\u01b0\u1edbi g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 v\u1edbi t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng t\u01b0\u01a1ng ; \u0111\u1ed1i th\u1ea5p c\u0169ng l\u00e0m cho ph\u1eabu thu\u1eadt vi\u00ean l\u1ef1a ch\u1ecdn cho m\u00f4 gh\u00e9p nh\u1ecf. Tuy nhi\u00ean, n\u1ebfu c\u1ea7n c\u00e1c kh\u1ed1i x\u01b0\u01a1ng l\u1edbn h\u01a1n, v\u00f9ng cho ngo\u00e0i mi\u1ec7ng \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn. Trong l\u1ecbch s\u1eed, v\u00f9ng \u0111\u01b0\u1ee3c ch\u1ecdn l\u00e0 m\u00e0o x\u01b0\u01a1ng ch\u1eadu v\u1edbi l\u01b0\u1ee3ng x\u01b0\u01a1ng c\u00f3 s\u1eb5n l\u1edbn.<\/p>\n

\"lay-xuong-tu-than-7\"
(A) C\u00e1c v\u00f9ng ngo\u00e0i mi\u1ec7ng th\u00edch h\u1ee3p cho vi\u1ec7c l\u1ea5y x\u01b0\u01a1ng v\u1eabn l\u00e0 m\u00e0o ch\u1eadu, n\u01a1i c\u00f3 x\u01b0\u01a1ng kh\u1ed1i v\u00e0 m\u1ed9t l\u01b0\u1ee3ng \u0111\u00e1ng k\u1ec3 v\u1ee5n x\u01b0\u01a1ng x\u1ed1p c\u00f3 th\u1ec3 l\u1ea5y \u0111\u01b0\u1ee3c. (B) M\u1ed9t c\u00e1i nghi\u1ec1n x\u01b0\u01a1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n m\u1ea3nh c\u00e1c x\u01b0\u01a1ng l\u1edbn t\u1ea1o ra c\u00e1c x\u01b0\u01a1ng gh\u00e9p d\u1ea1ng h\u1ea1t d\u1ec5 d\u00e0ng nh\u00e9t v\u00e0o c\u00e1c kho\u1ea3ng tr\u1ed1ng v\u00e0 kh\u00f4ng gian b\u1ecb gi\u1edbi h\u1ea1n. M\u00f4 gh\u00e9p nh\u01b0 v\u1eady c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong th\u1ee7 thu\u1eadt n\u00e2ng xoang.<\/figcaption><\/figure>\n

Tuy nhi\u00ean, \u0111i\u1ec1u n\u00e0y \u0111\u00f2i h\u1ecfi m\u1ed9t b\u00e1c s\u0129 ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o m\u1ed9t c\u00e1ch th\u00edch h\u1ee3p, g\u00e2y m\u00ea to\u00e0n th\u00e2n (tr\u1eeb khi m\u1eabu trephine \u0111\u01b0\u1ee3c coi l\u00e0 \u0111\u1ee7), v\u00e0 c\u00e1c th\u1ee7 thu\u1eadt c\u00f3 li\u00ean quan \u0111\u1ebfn bi\u1ebfn ch\u1ee9ng \u0111\u00e1ng k\u1ec3.<\/p>\n

2. Qu\u00e1 tr\u00ecnh gh\u00e9p x\u01b0\u01a1ng v\u00e0o v\u00f9ng c\u1ea7n thi\u1ebft<\/h2>\n

M\u1ed9t khi \u0111\u00e3 l\u1ea5y \u0111\u01b0\u1ee3c v\u1eadt li\u1ec7u gh\u00e9p, n\u00f3 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u1ea1o h\u00ecnh \u0111\u1ec3 l\u1ea5p \u0111\u1ea7y khuy\u1ebft h\u1ed5ng v\u1edbi m\u0169i khoan t\u01b0\u1edbi n\u01b0\u1edbc ho\u1eb7c d\u1ee5ng c\u1ee5 c\u1ea7m tay nh\u01b0 k\u1eb9p c\u1eaft v\u00e0 \u0111\u1ee5c. L\u00fd t\u01b0\u1edfng nh\u1ea5t l\u00e0 m\u00f4 gh\u00e9p n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh \u0111\u1ec3 v\u1eeba kh\u1edbp v\u1edbi v\u00f9ng nh\u1eadn, nh\u1eefng ch\u1ed7 thi\u1ebfu \u0111\u01b0\u1ee3c l\u1ea5p \u0111\u1ea7y v\u1edbi x\u01b0\u01a1ng v\u1ee5n v\u00e0 m\u1ea3nh x\u01b0\u01a1ng. V\u00f9ng nh\u1eadn ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u1ee5c l\u1ed7 v\u1edbi m\u0169i khoan ph\u1eabu thu\u1eadt \u0111\u1ec3 th\u00fac \u0111\u1ea9y ch\u1ea3y m\u00e1u t\u1eeb x\u01b0\u01a1ng x\u1ed1p, k\u00edch th\u00edch h\u00ecnh th\u00e0nh m\u1ea1ch m\u00e1u v\u00e0 k\u1ebft n\u1ed1i v\u1edbi m\u1ea3nh gh\u00e9p.<\/p>\n

S\u1ef1 th\u00e0nh c\u00f4ng c\u1ee7a m\u00f4 gh\u00e9p, t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u1ee7a implant, n\u00f3 ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 \u1ed5n \u0111\u1ecbnh c\u1ee7a m\u00f4 gh\u00e9p v\u00e0 li\u00ean quan \u0111\u1ebfn c\u1ee5c m\u00e1u \u0111\u00f4ng. Do \u0111\u00f3 m\u00f4 gh\u00e9p n\u00ean \u0111\u01b0\u1ee3c gi\u1eef v\u1eefng b\u1eb1ng v\u00edt titan.<\/p>\n

\"\"
(A) H\u00e0m tr\u00ean cho th\u1ea5y khu v\u1ef1c r\u0103ng nanh b\u00ean tr\u00e1i c\u1ea7n gh\u00e9p tr\u01b0\u1edbc khi \u0111\u1eb7t implant. Profile m\u00e0o s\u1ed1ng h\u00e0m c\u00f3 k\u00edch th\u01b0\u1edbc \u0111\u1ea7y \u0111\u1ee7 \u1edf b\u00ean ph\u1ea3i nh\u01b0ng c\u00f3 m\u1ed9t l\u00f5m m\u1eb7t ngo\u00e0i \u0111\u00e1ng k\u1ec3 \u1edf b\u00ean tr\u00e1i. (B) Hai kh\u1ed1i g\u1ed3m x\u01b0\u01a1ng v\u1ecf v\u00e0 x\u01b0\u01a1ng x\u1ed1p \u0111\u00e3 \u0111\u01b0\u1ee3c t\u1ec9a th\u00e0nh h\u00ecnh v\u00e0 g\u1eafn ch\u1eb7t v\u00e0o b\u1eb1ng v\u00edt titan nh\u1ecf \u0111\u01b0\u1eddng k\u00ednh 2.0 mm \u0103n kh\u1edbp v\u1edbi s\u1ed1ng h\u00e0m. Tr\u01b0\u1edbc \u0111\u00f3, \u0111\u1ee5c l\u1ed7 x\u01b0\u01a1ng v\u1ecf c\u1ee7a v\u00f9ng nh\u1eadn v\u1edbi m\u0169i khoan ph\u1eabu thu\u1eadt nh\u1ecf. C\u00e1c m\u1ea3nh gh\u00e9p l\u1edbn h\u01a1n profile s\u1ed1ng h\u00e0m \u0111\u1ec3 cho ph\u00e9p ti\u00eau \u0111i m\u1ed9t \u00edt trong qu\u00e1 tr\u00ecnh l\u00e0nh th\u01b0\u01a1ng. B\u1ea5t k\u1ef3 kho\u1ea3ng tr\u1ed1ng n\u00e0o gi\u1eefa c\u00e1c m\u1ea3nh gh\u00e9p v\u00e0 v\u00f9ng nh\u1eadn \u0111\u01b0\u1ee3c nh\u00e9t \u0111\u1ea7y v\u1edbi m\u1ea3nh x\u01b0\u01a1ng x\u1ed1p v\u00e0 h\u1ed7n h\u1ee3p v\u1ee5n x\u01b0\u01a1ng. H\u01a1n n\u1eefa v\u1ee5n x\u01b0\u01a1ng (osseous coagulum) \u0111\u01b0\u1ee3c nh\u00e9t gi\u1eefa v\u00e0 tr\u00ean m\u1ea3nh gh\u00e9p \u0111\u1ec3 t\u1ea1o m\u1ed9t profile tr\u01a1n l\u00e1ng t\u1edbi v\u00f9ng gh\u00e9p. (C) Ba th\u00e1ng sau m\u00f4 gh\u00e9p \u0111\u00e3 ti\u00eau \u0111i m\u1ed9t \u00edt, \u0111i\u1ec1u n\u00e0y nh\u1ea5n m\u1ea1nh t\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c \u0111\u1eb7t m\u1ed9t m\u00f4 gh\u00e9p l\u1edbn h\u01a1n th\u1ec3 t\u00edch c\u1ea7n thi\u1ebft. B\u1ea3o v\u1ec7 m\u00f4 gh\u00e9p v\u1edbi m\u00e0ng ho\u1eb7c l\u01b0\u1edbi titan c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m s\u1ef1 ti\u00eau \u0111i nh\u01b0ng c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m tr\u00f9ng v\u00e0 m\u1ea5t ho\u00e0n to\u00e0n v\u1eadt li\u1ec7u gh\u00e9p. (D) M\u1ed9t tr\u1ee5 ch\u1ec9 h\u01b0\u1edbng (direction indicator) \u0111\u01b0\u1ee3c \u0111\u1eb7t v\u00e0o sau khi khoan v\u1edbi v\u1edbi m\u0169i 2.5mm \u0111\u1ec3 ch\u1ec9 ra h\u01b0\u1edbng c\u1ee7a implant v\u00e0 s\u1ef1 \u0111\u1ea7y \u0111\u1ee7 c\u1ee7a x\u01b0\u01a1ng m\u1eb7t ngo\u00e0i. (E) \u0110\u1eb7t implant v\u1edbi m\u1ed9t h\u01b0\u1edbng l\u00fd t\u01b0\u1edfng m\u00e0 kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 s\u1ef1 n\u1ee9t g\u00e3y ho\u1eb7c th\u1ee7ng n\u00e0o nh\u1edd vi\u1ec7c s\u1eed d\u1ee5ng m\u00f4 gh\u00e9p.<\/figcaption><\/figure>\n

S\u1ef1 \u1ed5n \u0111\u1ecbnh v\u00e0 b\u1ea3o v\u1ec7 m\u00f4 gh\u00e9p h\u01a1n n\u1eefa c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng l\u01b0\u1edbi titan ho\u1eb7c m\u00e0ng ch\u1eafn \u0111\u1ec3 che ph\u1ee7 m\u00f4 gh\u00e9p Nh\u1eefng c\u00e1i n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1eef v\u1eefng b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng v\u00edt nh\u1ecf ho\u1eb7c \u0111inh. \u0110\u1eb7c bi\u1ec7t vi\u1ec7c s\u1eed d\u1ee5ng m\u00e0ng ch\u1eafn \u0111\u01b0\u1ee3c \u1ee7ng h\u1ed9 \u0111\u1ec3 l\u00e0m gi\u1ea3m l\u01b0\u1ee3ng s\u1ef1 ti\u00eau c\u1ee7a m\u1ea3nh gh\u00e9p x\u1ea3y ra trong giai \u0111o\u1ea1n l\u00e0nh th\u01b0\u01a1ng, c\u00f3 th\u1ec3 kho\u1ea3ng 50% trong s\u00e1u th\u00e1ng. Tuy nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng m\u00e0ng c\u0169ng \u0111\u1eb7t ra m\u1ed9t nguy c\u01a1 cao b\u1ecb nhi\u1ec5m tr\u00f9ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 n\u1ebfu m\u00e0ng b\u1ecb l\u1ed9. C\u00e1c t\u00e1c gi\u1ea3 hi\u1ec7n nay kh\u00f4ng \u1ee7ng h\u1ed9 vi\u1ec7c s\u1eed d\u1ee5ng v\u1edbi kh\u1ed1i gh\u00e9p nh\u01b0ng ch\u1ea5p nh\u1eadn r\u1eb1ng c\u1ea7n thi\u1ebft s\u1eed d\u1ee5ng m\u00f4 gh\u00e9p d\u1ea1ng h\u1ea1t ho\u1eb7c d\u1ea1ng \u0111\u01b0\u1ee3c nghi\u1ec1n.<\/p>\n

Kh\u00e2u \u0111\u00f3ng v\u1ebft th\u01b0\u01a1ng t\u1ea1i ch\u1ed7 gh\u00e9p ph\u1ea3i \u0111\u01b0\u1ee3c ho\u00e0n th\u00e0nh, v\u00e0 c\u1ea7n ph\u1ea3i \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ed9t v\u1ebft kh\u00e2u k\u00edn v\u1edbi m\u00f4 m\u1ec1m c\u00e0ng \u00edt c\u0103ng c\u00e0ng t\u1ed1t. \u0110i\u1ec1u n\u00e0y kh\u00f3 \u0111\u1ea1t \u0111\u01b0\u1ee3c v\u1edbi nh\u1eefng thay \u0111\u1ed5i l\u1edbn trong profile x\u01b0\u01a1ng v\u00e0 c\u00f3 th\u1ec3 \u0111\u00f2i h\u1ecfi ph\u1ea3i l\u1eadt m\u00f4 m\u1ec1m nhi\u1ec1u h\u01a1n n\u1eefa v\u00e0 gi\u1ea3m c\u0103ng m\u00e0ng x\u01b0\u01a1ng \u0111\u1ec3 k\u00e9o m\u00f4 m\u1ec1m xu\u1ed1ng nhi\u1ec1u h\u01a1n. C\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 kh\u00e2u \u0111\u00f3ng n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t tr\u01b0\u1edbc ph\u1eabu thu\u1eadt, \u0111\u1eb7c bi\u1ec7t n\u01a1i r\u1ea1ch c\u00e1c \u0111\u01b0\u1eddng gi\u1ea3m c\u0103ng n\u00ean c\u00e1ch xa v\u00f9ng gh\u00e9p khi b\u1eaft \u0111\u1ea7u ph\u1eabu thu\u1eadt. Kh\u1ea3 n\u0103ng h\u1edf v\u1ebft th\u01b0\u01a1ng tr\u00ean v\u00f9ng gh\u00e9p l\u00e0 vao h\u01a1n v\u00e0 mang l\u1ea1i nhi\u1ec1u bi\u1ebfn ch\u1ee9ng.<\/p>\n

B\u1ec7nh nh\u00e2n s\u1ebd nh\u1eadn \u0111\u01b0\u1ee3c kh\u00e1ng sinh th\u00edch h\u1ee3p tr\u01b0\u1edbc v\u00e0 sau ph\u1eabu thu\u1eadt \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 nhi\u1ec5m tr\u00f9ng. Kho\u1ea3ng th\u1eddi gian gi\u1eefa gh\u00e9p v\u00e0 \u0111\u1eb7t implant l\u00e0 ch\u1ee7 \u0111\u1ec1 c\u1ee7a nhi\u1ec1u tranh c\u00e3i. Khi s\u1eed d\u1ee5ng gh\u00e9p onlay, nhi\u1ec1u t\u00e1c gi\u1ea3 mu\u1ed1n kho\u1ea3ng th\u1eddi gian 3-4 th\u00e1ng. V\u00edt v\u00e0 \u0111inh c\u1ed1 \u0111\u1ecbnh m\u00e0ng \u0111\u01b0\u1ee3c l\u1ea5y ra t\u1ea1i th\u1eddi \u0111i\u1ec3m c\u1ea5y gh\u00e9p nh\u01b0ng lo\u1ea1i b\u1ecf ho\u00e0n to\u00e0n c\u00e1c m\u00e0ng PTFE c\u00f3 th\u1ec3 r\u1ea5t kh\u00f3 kh\u0103n. Khi \u0111\u1eb7t implant \u1edf v\u00f9ng g\u1ea7n \u0111\u00e2y v\u1eeba \u0111\u01b0\u1ee3c gh\u00e9p onlay, tuy\u1ec7t \u0111\u1ed1i c\u1ea9n th\u1eadn kh\u00f4ng \u0111\u1ec3 t\u00e1ch x\u01b0\u01a1ng gh\u00e9p ra kh\u1ecfi x\u01b0\u01a1ng b\u00ean d\u01b0\u1edbi trong qu\u00e1 tr\u00ecnh \u0111\u1eb7t implant. Do \u0111\u00f3 th\u1ee7 thu\u1eadt khoan l\u1ed7 l\u1edbn d\u1ea7n v\u00e0 l\u1ef1c nh\u1ecf l\u00e0 b\u1eaft bu\u1ed9c khi chu\u1ea9n b\u1ecb c\u00e1c v\u00f9ng c\u1ea5y gh\u00e9p cho implant.<\/p>\n

Ngu\u1ed3n: Implant trong th\u1ef1c h\u00e0nh Nha khoa – Richard D.Palmer\/Nh\u00f3m d\u1ecbch Saigon Young Dentists Vi\u1ec7t Nam<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

B\u00e0i vi\u1ebft n\u00e0y n\u00f3i v\u1ec1 k\u1ef9 thu\u1eadt l\u1ea5y x\u01b0\u01a1ng v\u00e0 gh\u00e9p x\u01b0\u01a1ng t\u1ef1 th\u00e2n trong ph\u1eabu thu\u1eadt mi\u1ec7ng, \u0111\u1eb7c bi\u1ec7t s\u1eed d\u1ee5ng trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu x\u01b0\u01a1ng \u0111\u1ec3 t\u1ea1o d\u1ef1ng ph\u1ee5c h\u00ecnh Implant. K\u1ef9 thu\u1eadt n\u00e0y l\u00e0 d\u1ea1ng k\u1ef9 thu\u1eadt kh\u00f3, \u0111\u00f2i h\u1ecfi ph\u1eabu thu\u1eadt vi\u00ean c\u00f3 tay ngh\u1ec1 cao, luy\u1ec7n t\u1eadp th\u00e0nh th\u1ea1o […]<\/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":"\nK\u1ef9 thu\u1eadt l\u1ea5y x\u01b0\u01a1ng t\u1ef1 th\u00e2n v\u00e0 gh\u00e9p x\u01b0\u01a1ng trong ph\u1eabu thu\u1eadt mi\u1ec7ng.<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft v\u1ec1 k\u1ef9 thu\u1eadt l\u1ea5y x\u01b0\u01a1ng v\u00e0 gh\u00e9p x\u01b0\u01a1ng t\u1ef1 th\u00e2n trong ph\u1eabu thu\u1eadt mi\u1ec7ng, \u0111\u00f2i h\u1ecfi ph\u1eabu thu\u1eadt vi\u00ean th\u00e0nh th\u1ea1o, \u0111\u1ea3m b\u1ea3o quy tr\u00ecnh k\u00e8m theo.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, 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