{"id":24511,"date":"2023-04-19T10:37:33","date_gmt":"2023-04-19T03:37:33","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24511"},"modified":"2023-05-02T11:31:00","modified_gmt":"2023-05-02T04:31:00","slug":"nong-che-xuong-doi-loai-bo-than-kinh-trong-phau-thuat-mieng","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/nong-che-xuong-doi-loai-bo-than-kinh-trong-phau-thuat-mieng\/","title":{"rendered":"Nong-ch\u1ebb x\u01b0\u01a1ng, d\u1eddi-lo\u1ea1i b\u1ecf th\u1ea7n kinh trong ph\u1eabu thu\u1eadt mi\u1ec7ng."},"content":{"rendered":"

B\u00e0i vi\u1ebft n\u00e0y \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u00edt ph\u1ed5 bi\u1ebfn h\u01a1n trong ph\u1eabu thu\u1eadt mi\u1ec7ng – Implant, nh\u1eb1m ki\u1ec3m so\u00e1t v\u00f9ng nh\u1ed5 r\u0103ng, nh\u01b0 nong-ch\u1ebb x\u01b0\u01a1ng, d\u1eddi-lo\u1ea1i b\u1ecf d\u00e2y th\u1ea7n kinh, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n t\u1ed1t nh\u1ea5t cho qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00e0 b\u1ec7nh nh\u00e2n. C\u00f9ng t\u00ecm hi\u1ec3u th\u00eam.<\/strong><\/p>\n

1. Ki\u1ec3m so\u00e1t v\u00f9ng nh\u1ed5 r\u0103ng<\/h2>\n

R\u0103ng c\u1ea7n thi\u1ebft ph\u1ea3i nh\u1ed5 v\u00e0 vi\u1ec7c \u0111\u1eb7t implant sau \u0111\u00f3 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft b\u1eb1ng nhi\u1ec1u c\u00e1ch. Ch\u00fang ta n\u00ean nh\u1edb r\u1eb1ng ph\u1ea7n l\u1edbn \u1ed5 r\u0103ng l\u00e0nh th\u01b0\u01a1ng m\u1ed9t c\u00e1ch b\u00ecnh th\u01b0\u1eddng v\u1edbi \u0111\u1ea7y x\u01b0\u01a1ng trong \u1ed5 r\u0103ng, \u0111\u1eb7c bi\u1ec7t khi ch\u1ec9 c\u00f3 m\u1ed9t r\u0103ng c\u00f3 li\u00ean quan v\u00e0 c\u00f3 r\u0103ng \u0111\u1ee9ng li\u1ec1n k\u1ec1.<\/p>\n

B\u1ea3o qu\u1ea3n c\u00e1c \u1ed5 r\u0103ng l\u00e0 \u0111i\u1ec1u ki\u1ec7n ti\u00ean quy\u1ebft cho vi\u1ec7c l\u1ea5p \u0111\u1ea7y x\u01b0\u01a1ng v\u00e0 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111i\u1ec1u n\u00e0y t\u1ed1t nh\u1ea5t b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p nh\u1ed5 r\u0103ng kh\u00f4ng sang ch\u1ea5n, \u0111\u1eb7c bi\u1ec7t l\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c Periotome (Friedrichsfeld GmbH, Mannheim, \u0110\u1ee9c) ho\u1eb7c c\u00e1c luxator.<\/p>\n

Nh\u1ed5 c\u00e1c r\u0103ng kh\u00f3 h\u1ecfi ph\u1ea3i m\u00e0i x\u01b0\u01a1ng v\u00e0 c\u1eaft m\u00f4 m\u1ec1m xung quanh, kh\u00e2u k\u00edn t\u1ed1t c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 trong vi\u1ec7c l\u00e0m l\u00e0nh v\u1ebft th\u01b0\u01a1ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n m\u00f4 m\u1ec1m l\u00e0m \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn vi\u1ec7c l\u00e0nh th\u01b0\u01a1ng nguy\u00ean ph\u00e1t. \u0110\u1eb7t v\u1eadt li\u1ec7u gh\u00e9p v\u00e0o \u1ed5 r\u0103ng v\u00e0 s\u1eed d\u1ee5ng c\u00e1c m\u00e0ng h\u00fat (occlusive membranes) \u0111\u00e3 \u0111\u01b0\u1ee3c \u1ee7ng h\u1ed9 \u0111\u1ec3 c\u1ea3i thi\u1ec7n l\u01b0\u1ee3ng x\u01b0\u01a1ng t\u1ea1o ra. Tuy nhi\u00ean v\u1ea5n \u0111\u1ec1 c\u00f3 th\u1ec3 ph\u00e1t sinh n\u1ebfu \u1ed5 r\u0103ng v\u00e0 m\u00f4 gh\u00e9p \/ m\u00e0ng b\u1ecb nhi\u1ec5m tr\u00f9ng, d\u1eabn \u0111\u1ebfn m\u1ea5t x\u01b0\u01a1ng nhi\u1ec1u h\u01a1n so v\u1edbi vi\u1ec7c kh\u00f4ng c\u1ea7n gh\u00e9p g\u00ec c\u1ea3.<\/p>\n

2. N\u1ee9t x\u01b0\u01a1ng v\u00e0 c\u1eeda s\u1ed5 x\u01b0\u01a1ng trong ph\u1eabu thu\u1eadt mi\u1ec7ng<\/h2>\n

Khi\u1ebfm khuy\u1ebft nh\u1ecf t\u1ea1o ra t\u1ea1i th\u1eddi \u0111i\u1ec3m \u0111\u1eb7t implant nh\u01b0 v\u1ebft n\u1ee9t x\u01b0\u01a1ng t\u1ea1i vi\u1ec1n ho\u1eb7c c\u1eeda s\u1ed5 x\u01b0\u01a1ng c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i gh\u00e9p, ph\u1ee5 thu\u1ed9c v\u00e0o profile, k\u00edch th\u01b0\u1edbc v\u00e0 v\u1ecb tr\u00ed.<\/p>\n

\"phau-thuat-mieng-1\"
(A) Khi \u0111\u1eb7t implant th\u01b0\u1eddng g\u00e2y ra nh\u1eefng c\u1eeda s\u1ed5 x\u01b0\u01a1ng nh\u1ecf nh\u01b0 th\u1ebf n\u00e0y. C\u00f3 c\u1ea7n thi\u1ebft ph\u1ea3i gh\u00e9p khuy\u1ebft h\u1ed5ng n\u00e0y ho\u1eb7c s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt GBR l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c \u0111\u1eb7t ra. Implant c\u00f3 s\u1ef1 \u1ed5n \u0111\u1ecbnh t\u1ed1t v\u00e0 ph\u1ea7n l\u1edbn c\u1ee7a n\u00f3 n\u1eb1m trong x\u01b0\u01a1ng t\u1ed1t; vi\u1ec7c \u0111\u1eb7t m\u00e0ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng v\u00e0 m\u1ea5t x\u01b0\u01a1ng. (B) V\u1ebft n\u1ee9t x\u01b0\u01a1ng l\u1edbn nh\u01b0 tr\u00ean implant h\u00e0m d\u01b0\u1edbi b\u00ean tr\u00e1i c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i gh\u00e9p \u0111\u1ec3 k\u00edch th\u00edch x\u01b0\u01a1ng che ph\u1ee7 c\u00e1c ren b\u1ecb l\u1ed9 . V\u00ec ren \u1edf b\u00ean ngo\u00e0i x\u01b0\u01a1ng v\u1ecf, cho n\u00ean m\u00e0ng s\u1ebd c\u00f3 xu h\u01b0\u1edbng s\u1ee5p v\u00e0o c\u00e1c ren, l\u00e0m gi\u1ea3m l\u01b0\u1ee3ng x\u01b0\u01a1ng \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh. Do \u0111\u00f3 n\u00e2ng \u0111\u1ee1 m\u00e0ng \u0111\u1ec3 duy tr\u00ec th\u1ec3 t\u00edch n\u00ean c\u1ed1 g\u1eafng \u0111\u1ea1t \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng m\u1ed9t m\u00e0ng gia c\u1ed1 titan ho\u1eb7c t\u1ed1t h\u01a1n l\u00e0 s\u1eed d\u1ee5ng c\u00e1c v\u1ee5n x\u01b0\u01a1ng d\u01b0\u1edbi m\u00e0ng. T\u00ean vi\u1ebft t\u1eaft: GBR, t\u00e1i t\u1ea1o x\u01b0\u01a1ng c\u00f3 h\u01b0\u1edbng d\u1eabn.<\/figcaption><\/figure>\n
\"phau-thuat-mieng-2\"
M\u1ed9t lo\u1ea1t h\u00ecnh \u1ea3nh l\u00e2m s\u00e0ng cho th\u1ea5y vi\u1ec7c ki\u1ec3m so\u00e1t m\u1ed9t v\u1ebft n\u1ee9t nh\u1ecf. \u0110i\u1ec1u n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 c\u1ea3i thi\u1ec7n profile s\u1ed1ng h\u00e0m v\u00e0 gi\u1ea3m thi\u1ec3u kh\u1ea3 n\u0103ng implant b\u1ecb th\u1ea5y xuy\u00ean qua l\u1edbp n\u01b0\u1edbu m\u1ecfng. (A) V\u00f9ng r\u0103ng nanh tr\u00ean b\u00ean tr\u00e1i m\u1ea5t x\u01b0\u01a1ng \u0111\u00e1ng k\u1ec3 chi\u1ec1u cao m\u00e0o x\u01b0\u01a1ng v\u00e0 chi\u1ec1u r\u1ed9ng ngo\u00e0i trong. (B) V\u00f9ng \u0111\u00e3 \u0111\u01b0\u1ee3c chu\u1ea9n b\u1ecb cho m\u1ed9t implant Astra Tech 4,5 ST ch\u1ea5p nh\u1eadn l\u1ed9 b\u1ec1 m\u1eb7t implant \u1edf v\u00f9ng c\u1ed5. (C) X\u01b0\u01a1ng xung quanh \u0111\u01b0\u1ee3c \u0111\u1ee5c l\u1ed7 v\u1edbi m\u0169i khoan tr\u00f2n. (D) Implant b\u1ecb l\u1ed9 b\u1ec1 m\u1eb7t. M\u1ed9t m\u00e0ng t\u1ef1 ti\u00eau Resolut (WL Gore & Associates Inc.) \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1eaft \u0111\u1ec3 che kho\u1ea3ng tr\u1ed1ng ngo\u00e0i v\u00e0 trong. (E) V\u1ee5n x\u01b0\u01a1ng thu \u0111\u01b0\u1ee3c t\u1eeb v\u00f9ng khoan x\u01b0\u01a1ng \u0111\u01b0\u1ee3c \u00e9p ch\u1eb7t tr\u00ean v\u00f9ng implant b\u1ecb l\u1ed9. (F) M\u00e0ng \u0111\u01b0\u1ee3c t\u1ea1o h\u00ecnh tr\u00ean s\u1ed1ng h\u00e0m \u0111\u1ec3 duy tr\u00ec profile s\u1ed1ng h\u00e0m mong mu\u1ed1n- m\u00e0ng \u0111\u01b0\u1ee3c n\u00e2ng \u0111\u1ee1 \u1edf ngo\u1ea1i vi b\u1edfi x\u01b0\u01a1ng kh\u1ecfe m\u1ea1nh v\u00e0 \u1edf b\u00ean d\u01b0\u1edbi nh\u1edd implant v\u00e0 v\u1ee5n x\u01b0\u01a1ng. (G) Kh\u00e2u k\u00edn v\u1edbi ch\u1ec9 t\u1ef1 ti\u00eau.<\/figcaption><\/figure>\n

Tuy nhi\u00ean l\u00fd do h\u1ee3p l\u00fd cho c\u00e1c th\u1ee7 thu\u1eadt \u0111\u00f3 ph\u1ea3i \u0111\u01b0\u1ee3c xem x\u00e9t k\u1ef9 v\u00ed d\u1ee5 nh\u01b0 m\u00f4 gh\u00e9p \u0111\u1eb7t trong c\u00e1c khi\u1ebfm khuy\u1ebft nh\u01b0 v\u1eady c\u0169ng nh\u01b0 x\u01b0\u01a1ng t\u1ea1o ra b\u1eb1ng k\u1ef9 thu\u1eadt GBR kh\u00f4ng th\u1ec3 g\u00f3p ph\u1ea7n v\u00e0o s\u1ef1 \u1ed5n \u0111\u1ecbnh implant ban \u0111\u1ea7u v\u00e0 x\u01b0\u01a1ng c\u00f3 th\u1ec3 kh\u00f4ng bao gi\u1edd t\u00edch h\u1ee3p v\u00e0o b\u1ec1 m\u1eb7t c\u1ee7a implant. S\u1eeda ch\u1eefa c\u00e1c khi\u1ebfm khuy\u1ebft nh\u01b0 v\u1eady c\u00f3 th\u1ec3 h\u1eefu \u00edch trong tr\u01b0\u1eddng h\u1ee3p ni\u00eam m\u1ea1c n\u1eb1m ph\u00eda tr\u00ean m\u1ecfng v\u00e0 c\u00f3 nguy c\u01a1 nh\u00ecn th\u1ea5y implant xuy\u00ean qua n\u01b0\u1edbu.<\/p>\n

3. Nong v\u00e0 ch\u1ebb x\u01b0\u01a1ng<\/h2>\n

\u0110\u1eb7t m\u1ed9t implant v\u00e0o s\u1ed1ng h\u00e0m m\u00e0 h\u1eb9p h\u01a1n \u0111\u01b0\u1eddng k\u00ednh implant m\u1ed9t ch\u00fat c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1ch t\u0103ng chi\u1ec1u r\u1ed9ng m\u00e0o x\u01b0\u01a1ng s\u1eed d\u1ee5ng m\u1ed9t trong hai k\u1ef9 thu\u1eadt. Nong v\u00f9ng c\u1ea5y gh\u00e9p m\u1ed9t c\u00e1ch \u0111\u01a1n gi\u1ea3n nh\u1ea5t b\u1eb1ng c\u00e1ch cho ph\u00e9p implant m\u1edf r\u1ed9ng s\u1ed1ng h\u00e0m khi n\u00f3 ch\u00e8n v\u00e0o. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c khi x\u01b0\u01a1ng m\u1ecfng v\u00e0 \u0111\u1ee7 m\u1ec1m \u0111\u1ec3 cho ph\u00e9p nong; c\u0169ng c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng nong b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng implant thu\u00f4n h\u00ecnh n\u00f3n (tapered implant). Vi\u1ec7c nong x\u01b0\u01a1ng th\u01b0\u1eddng quy \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng c\u00e1c osteotome, nh\u01b0 osteotomes Summers ho\u1eb7c nh\u1eefng h\u1ec7 th\u1ed1ng c\u1ee5 th\u1ec3 kh\u00e1c.<\/p>\n

\"\"
Osteotome c\u1ee7a Astra Tech cho vi\u1ec7c nong x\u01b0\u01a1ng t\u1ea1i c\u00e1c v\u00f9ng implant ri\u00eang bi\u1ec7t. C\u00e1c d\u1ea3i t\u01b0\u01a1ng \u1ee9ng v\u1edbi \u0111\u1ed9 d\u00e0i implant c\u00f3 s\u1eb5n trong h\u1ec7 th\u1ed1ng n\u00e0y. Khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng t\u1ea1i nhi\u1ec1u v\u00f9ng ch\u00fang c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ti\u1ebfp t\u1ee5c m\u1edf r\u1ed9ng v\u00e0 ch\u1ebb s\u1ed1ng h\u00e0m \u1edf ph\u00eda g\u1ea7n v\u00e0 ph\u00eda xa. Tuy\u1ec7t \u0111\u1ed1i c\u1ea9n th\u1eadn khi s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt n\u00e0y v\u00e0 s\u1ef1 l\u1ef1a ch\u1ecdn t\u1eebng tr\u01b0\u1eddng h\u1ee3p l\u00e0 r\u1ea5t quan tr\u1ecdng.<\/figcaption><\/figure>\n
\"\"
M\u1ed9t lo\u1ea1t c\u00e1c h\u00ecnh \u1ea3nh l\u00e2m s\u00e0ng cho th\u1ea5y s\u1eed d\u1ee5ng osteotome Astra Tech \u0111\u1ec3 nong r\u1ed9ng s\u1ed1ng h\u00e0m tr\u00ean \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n thi\u1ebfu r\u0103ng b\u1ea9m sinh d\u1eabn \u0111\u1ebfn profile s\u1ed1ng h\u00e0m r\u1ea5t h\u1eb9p. (A) V\u00f9ng \u0111\u1eb7t implant ban \u0111\u1ea7u \u0111\u01b0\u1ee3c s\u1eeda so\u1ea1n xuy\u00ean qua x\u01b0\u01a1ng v\u1ecf v\u1edbi m\u0169i khoan h\u01b0\u1edbng d\u1eabn v\u00e0 m\u0169i khoan xo\u1eafn 2mm. (B) Osteotome \u0111\u01b0\u1eddng k\u00ednh 2mm \u0111\u01b0\u1ee3c d\u00f9ng v\u00e0 nh\u1eb9 nh\u00e0ng v\u1eb7n v\u00e0o v\u00e0\/ho\u1eb7c xoay v\u1ec1 ph\u00eda ch\u00f3p \u0111\u1ec3 m\u1edf r\u1ed9ng x\u01b0\u01a1ng. (C) C\u00e1c osteotome \u0111\u01b0\u1ee3c ch\u1ebf t\u00e1c v\u1edbi chi\u1ec1u d\u00e0i implant mong mu\u1ed1n. L\u01b0u \u00fd osteotome \u0111\u00e3 ti\u1ebfn v\u1ec1 ph\u00eda ch\u00f3p bao xa. (D) Sau \u0111\u00f3 m\u1ed9t osteotome \u0111\u01b0\u1eddng k\u00ednh 2.0 \/ 3.2-mm \u0111\u01b0\u1ee3c d\u00f9ng \u1edf m\u1ee9c m\u00e0o x\u01b0\u01a1ng theo sau l\u00e0 m\u1ed9t osteotome 3,2 mm m\u1ed9t l\u1ea7n n\u1eefa nh\u1eb9 nh\u00e0ng ti\u1ebfn v\u1ec1 ph\u00eda ch\u00f3p. (E) V\u00f9ng \u0111\u1eb7t implant ph\u00eda xa \u0111\u01b0\u1ee3c s\u1eeda so\u1ea1n gi\u1ed1ng nh\u01b0 v\u1eady. L\u01b0u \u00fd osteotome trong v\u00f9ng n\u00e0y c\u00f3 emergence v\u1ec1 ph\u00eda ngo\u00e0i h\u01a1n nh\u1edd prifile x\u01b0\u01a1ng \u1ed5 c\u00f3 s\u1eb5n . (F) C\u00e1c osteotome \u0111\u01b0\u1eddng k\u00ednh 3,2 mm \u0111\u00e3 \u0111i \u0111\u1ebfn 13 mm. (G) Ho\u00e0n th\u00e0nh v\u00f9ng khoan x\u01b0\u01a1ng. L\u01b0u \u00fd x\u01b0\u01a1ng v\u1ecf ph\u00eda ngo\u00e0i 2 r\u0103ng c\u1eeda \u0111\u00e3 c\u00f3 s\u1ef1 n\u1ee9t nh\u1eb9. \u0110\u00e2y l\u00e0 \u0111i\u1ec1u b\u00ecnh th\u01b0\u1eddng v\u00ec x\u01b0\u01a1ng v\u00f9ng kh\u1ea9u c\u00e1i c\u00f3 ch\u1eafc h\u01a1n so v\u1edbi x\u01b0\u01a1ng ph\u00eda ngo\u00e0i v\u00e0 \u00edt b\u1ecb n\u1ee9t v\u1ee1 h\u01a1n. (H) C\u00e1c implant cho th\u1ea5y kh\u00f4ng b\u1ecb b\u1ed9c l\u1ed9 b\u1ec1 m\u1eb7t implant. S\u1ef1 \u1ed5n \u0111\u1ecbnh t\u1ed1t ban \u0111\u1ea7u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c mong \u0111\u1ee3i v\u1edbi vi\u1ec7c l\u1eadp k\u1ebf ho\u1ea1ch c\u1ea9n th\u1eadn v\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt nh\u1eb9 nh\u00e0ng.<\/figcaption><\/figure>\n

K\u1ef9 thu\u1eadt n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0o vi\u1ec7c c\u00f3 \u0111\u1ee7 x\u01b0\u01a1ng x\u1ed1p gi\u1eefa c\u00e1c phi\u1ebfn x\u01b0\u01a1ng v\u1ecf \u0111\u1ec3 cho ph\u00e9p m\u1edf r\u1ed9ng v\u00f9ng c\u1ea5y gh\u00e9p l\u00fac \u0111\u1ea7u v\u1edbi m\u0169i khoan ph\u1eabu thu\u1eadt mi\u1ec7ng. B\u1eb1ng thao t\u00e1c nh\u1eb9 nh\u00e0ng v\u00e0 s\u1eed d\u1ee5ng c\u00e1c osteotome v\u1edbi \u0111\u01b0\u1eddng k\u00ednh t\u0103ng kh\u00f4ng \u0111\u00e1ng k\u1ec3, vi\u1ec7c n\u1edbi r\u1ed9ng h\u1ee3p l\u00fd c\u1ee7a s\u1ed1ng h\u00e0m c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c v\u00e0 cho ph\u00e9p \u0111\u1eb7t implant.<\/p>\n

M\u1edf r\u1ed9ng to\u00e0n b\u1ed9 s\u1ed1ng h\u00e0m trong ph\u1eabu thu\u1eadt mi\u1ec7ng c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng osteotome d\u1eb9p ho\u1eb7c b\u1ed9 d\u1ee5ng c\u1ee5 ch\u1ebb s\u1ed1ng h\u00e0m. M\u1ed9t l\u1ea7n n\u1eefa, ph\u1ea3i c\u00f3 m\u1ed9t s\u1ed1 m\u1eb7t x\u01b0\u01a1ng x\u1ed1p trong s\u1ed1ng h\u00e0m \u0111\u1ec3 cho ph\u00e9p m\u1ed9t m\u1eb7t tinh th\u1ec3 t\u1ef1 nhi\u00ean c\u1ee7a vi\u1ec7c ch\u1ebb x\u01b0\u01a1ng (a natural plane of cleavage). Ph\u1ea3i c\u1ea9n th\u1eadn \u0111\u1ec3 h\u1ea1n ch\u1ebf v\u00f9ng m\u1edf r\u1ed9ng b\u1eb1ng c\u00e1ch c\u1eaft t\u1ed1i thi\u1ec3u \u1edf m\u1ed7i \u0111\u1ea7u c\u1ee7a s\u1ed1ng h\u00e0m. S\u1ef1 nguy hi\u1ec3m c\u1ee7a vi\u1ec7c g\u00e3y m\u1ed9t t\u1ea5m x\u01b0\u01a1ng v\u1ecf kh\u00f4ng n\u00ean b\u1ecf qua v\u00e0 c\u1ea7n ph\u1ea3i th\u1ef1c t\u1eadp k\u1ef9 \u0111\u1ec3 l\u00e0m ch\u1ee7 k\u1ef9 thu\u1eadt n\u00e0y. C\u1ea7n th\u1eadn tr\u1ecdng trong v\u00f9ng x\u01b0\u01a1ng gi\u00f2n, \u0111\u1eb7c bi\u1ec7t \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i v\u00e0 h\u00fat thu\u1ed1c l\u00e1. M\u1ed9t s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a vi\u1ec7c ch\u1ebb s\u1ed1ng h\u00e0m v\u00e0 vi\u1ec7c nong x\u01b0\u01a1ng t\u1ea1i v\u00f9ng ri\u00eang l\u1ebb c\u00f3 th\u1ec3 t\u1ea1o ra nh\u1eefng thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 cho profile s\u1ed1ng h\u00e0m. M\u1ed9t khi c\u00e1c s\u1ed1ng h\u00e0m \u0111\u00e3 \u0111\u01b0\u1ee3c m\u1edf r\u1ed9ng, implant, gh\u00e9p x\u01b0\u01a1ng, ho\u1eb7c k\u1ebft h\u1ee3p c\u1ea3 hai c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u1eb7t trong kho\u1ea3ng tr\u1ed1ng. Ngay l\u1eadp t\u1ee9c \u0111\u1eb7t implant v\u00e0o v\u00f9ng v\u1eeba \u0111\u01b0\u1ee3c ch\u1ebb s\u1ed1ng h\u00e0m c\u00f3 th\u1ec3 ph\u1ee9c t\u1ea1p b\u1edfi implant kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 \u1ed5n \u0111\u1ecbnh ban \u0111\u1ea7u. M\u1ed9t y\u1ebfu t\u1ed1 h\u1ea1n ch\u1ebf cho nh\u1eefng k\u1ef9 thu\u1eadt n\u00e0y l\u00e0 ch\u00fang kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e9p thay \u0111\u1ed5i trong chi\u1ec1u h\u01b0\u1edbng c\u1ee7a s\u1ed1ng h\u00e0m v\u00e0 do \u0111\u00f3 implant c\u0169ng v\u1eady. \u1ede nh\u1eefng n\u01a1i g\u00f3c \u0111\u1ed9 c\u1ee7a implant l\u00e0 c\u1ea7n thi\u1ebft v\u00e0 s\u1ed1ng h\u00e0m kh\u00f4ng cho ph\u00e9p chi\u1ec1u h\u01b0\u1edbng nh\u01b0 v\u1eady th\u00ec c\u00e1c k\u1ef9 thu\u1eadt kh\u00e1c \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u \u0111\u1ec3 m\u1edf r\u1ed9ng x\u01b0\u01a1ng t\u1ea1i v\u1ecb tr\u00ed mong mu\u1ed1n.<\/p>\n

4. S\u1ef1 t\u1ea1o x\u01b0\u01a1ng trong kho\u1ea3ng h\u1edf trong ph\u1eabu thu\u1eadt mi\u1ec7ng<\/h2>\n

Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c phi\u1ebfn x\u01b0\u01a1ng gi\u1eef ch\u1eb7t hai b\u00ean m\u1ed9t \u0111\u01b0\u1eddng g\u00e3y t\u1ea1o ra do ph\u1eabu thu\u1eadt mi\u1ec7ng, m\u00e0 sau \u0111\u00f3 \u0111\u01b0\u1ee3c t\u00e1ch ra b\u1eb1ng l\u1ef1c c\u01a1 h\u1ecdc, \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh v\u00e0 ph\u1eabu thu\u1eadt h\u00e0m m\u1eb7t \u0111\u1ec3 t\u0103ng chi\u1ec1u cao x\u01b0\u01a1ng. X\u01b0\u01a1ng trong kho\u1ea3ng h\u1edf s\u1ebd ph\u00e1t tri\u1ec3n \u0111\u1ec3 cho ph\u00e9p gia t\u0103ng chi\u1ec1u cao s\u1ed1ng h\u00e0m v\u00e0 sau \u0111\u00f3 \u0111\u1eb7t implant.<\/p>\n

5. D\u1eddi\/ lo\u1ea1i b\u1ecf d\u00e2y th\u1ea7n kinh<\/h2>\n

M\u1ea5t chi\u1ec1u cao x\u01b0\u01a1ng \u1ed5 r\u0103ng \u1edf ph\u00eda sau h\u00e0m d\u01b0\u1edbi s\u1ebd \u1ea3nh h\u01b0\u1edfng vi\u1ec7c \u0111\u1eb7t implant tr\u1eeb khi h\u00e0m d\u01b0\u1edbi r\u1ed9ng chi\u1ec1u ngo\u00e0i trong v\u00e0 c\u00f3 kh\u00f4ng gian \u0111\u1ec3 \u0111\u1eb7t implant n\u1eb1m c\u1ea1nh d\u00e2y th\u1ea7n kinh. Trong \u0111a s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, \u0111i\u1ec1u n\u00e0y l\u00e0 kh\u00f4ng th\u1ec3 v\u00e0 c\u00e1c b\u00e1c s\u1ef9 th\u01b0\u1eddng ngh\u0129 t\u1edbi m\u1ed9t s\u1ed1 l\u1ef1a ch\u1ecdn kh\u00e1c. \u0110\u1eb7t nhi\u1ec1u implant ng\u1eafn c\u00f3 th\u1ec3 cung c\u1ea5p \u0111\u1ee7 s\u1ef1 n\u00e2ng \u0111\u1ee1 m\u00e0 kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn sinh c\u01a1 h\u1ecdc c\u1ee7a ph\u1ee5c h\u00ecnh. \u0110\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 \u1ed5n \u0111\u1ecbnh c\u1ee7a implant c\u00f3 th\u1ec3 kh\u00f3 kh\u0103n v\u00ec x\u01b0\u01a1ng x\u1ed1p trong v\u00f9ng n\u00e0y th\u01b0\u1eddng l\u00e0 th\u01b0a th\u1edbt.<\/p>\n

\"phau-thuat-mieng-3\"
V\u1edbi chi\u1ec1u cao x\u01b0\u01a1ng h\u1ea1n ch\u1ebf tr\u00ean k\u00eanh r\u0103ng d\u01b0\u1edbi, vi\u1ec7c s\u1eed d\u1ee5ng nhi\u1ec1u implant ng\u1eafn c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u1ee7ng h\u1ed9. \u0110\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 v\u1eefng \u1ed5n implant ban \u0111\u1ea7u trong t\u00ecnh tr\u1ea1ng nh\u01b0 v\u1eady c\u00f3 th\u1ec3 kh\u00f3 kh\u0103n b\u1edfi v\u00ec th\u01b0\u1eddng c\u00f3 \u00edt x\u01b0\u01a1ng x\u1ed1p v\u00e0 ch\u00f3p c\u1ee7a implant kh\u00f4ng th\u1ec3 g\u00e0i trong x\u01b0\u01a1ng v\u1ecf. C\u1ea7n ph\u1ea3i ch\u1eeba l\u1ea1i m\u1ed9t bi\u00ean \u0111\u1ed9 an to\u00e0n c\u00e1ch k\u00eanh r\u0103ng d\u01b0\u1edbi 3mm do sai s\u1ed1 c\u1ee7a \u0111\u1ed9 d\u00e0i c\u1ee7a m\u0169i khoan, tr\u00e1i ng\u01b0\u1ee3c v\u1edbi implant ph\u00eda xa trong h\u00ecnh.<\/figcaption><\/figure>\n

\u0110\u1eb7t implant \u1edf ph\u00eda tr\u01b0\u1edbc l\u1ed7 c\u1eb1m v\u00e0 v\u00f3i ra ph\u00eda xa \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u1edbi nhi\u1ec1u th\u00e0nh c\u00f4ng l\u1edbn, th\u00edch h\u1ee3p trong ca m\u00e0 implant \u0111\u1ee7 chi\u1ec1u d\u00e0i v\u00e0 kh\u1edbp c\u1eafn thu\u1eadn l\u1ee3i. Gh\u00e9p onlay c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y b\u1eb1ng c\u00e1ch gi\u1ea3m chi\u1ec1u cao c\u1ee7a ph\u1ee5c h\u00ecnh.<\/p>\n

\"\"
Vi\u1ec7c s\u1eed d\u1ee5ng m\u1ed9t mi\u1ebfng gh\u00e9p onlay cho ph\u00e9p \u0111\u1eb7t c\u00e1c implant d\u00e0i h\u01a1n v\u00e0 l\u00e0m gi\u1ea3m chi\u1ec1u cao c\u1ee7a ph\u1ee5c h\u00ecnh. Implant g\u00e0i v\u00e0o x\u01b0\u01a1ng v\u1ecf ph\u00eda tr\u00ean c\u1ee7a h\u00e0m d\u01b0\u1edbi gi\u00fap implant \u1ed5n \u0111\u1ecbnh t\u1ea1i th\u1eddi \u0111i\u1ec3m \u0111\u1eb7t.<\/figcaption><\/figure>\n

M\u1ed9t c\u00e1ch kh\u00e1c l\u00e0 ph\u1eabu thu\u1eadt mi\u1ec7ng b\u1ed9c l\u1ed9 b\u00f3 th\u1ea7n kinh r\u0103ng d\u01b0\u1edbi v\u00e0 d\u1eddi n\u00f3 ra ph\u00eda ngo\u00e0i \u0111\u1ec3 cho ph\u00e9p \u0111\u1eb7t implant xuy\u00ean qua ph\u1ea7n l\u1edbn x\u01b0\u01a1ng h\u00e0m d\u01b0\u1edbi v\u00e0 do \u0111\u00f3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u1ed5n \u0111\u1ecbnh trong x\u01b0\u01a1ng v\u1ecf. \u0110\u00e2y l\u00e0 m\u1ed9t th\u1ee7 thu\u1eadt kh\u00f3 kh\u0103n v\u00e0 nhi\u1ec1u nguy c\u01a1, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u1ea3m gi\u00e1c t\u00ea ho\u1eb7c d\u1ecb c\u1ea3m \u1edf d\u00e2y th\u1ea7n kinh c\u1eb1m, c\u1ea7n \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch \u0111\u1ea7y \u0111\u1ee7 cho b\u1ec7nh nh\u00e2n. C\u1ea7n ph\u1ea3i b\u1ed9c l\u1ed9 t\u1ed1t h\u00e0m d\u01b0\u1edbi, b\u00f3c t\u00e1ch ho\u00e0n to\u00e0n th\u1ea7n kinh c\u1eb1m ra kh\u1ecfi h\u00e0m d\u01b0\u1edbi. Sau \u0111\u00f3 nh\u1eb9 nh\u00e0ng khoan ph\u00eda m\u1eb7t ngo\u00e0i v\u1edbi m\u0169i tr\u00f2n v\u00e0 n\u01b0\u1edbc mu\u1ed1i \u0111\u1ec3 d\u1ec5 d\u00e0ng di chuy\u1ec3n d\u00e2y th\u1ea7n kinh h\u01b0\u1edbng ra ngo\u00e0i v\u01b0\u1ee3t qu\u00e1 kho\u1ea3ng c\u00e1ch c\u1ea7n thi\u1ebft. Implant \u0111\u01b0\u1ee3c \u0111\u1eb7t v\u00e0o v\u00e0 c\u00e1c d\u00e2y th\u1ea7n kinh \u0111\u01b0\u1ee3c \u0111\u1eb7t tr\u1edf l\u1ea1i g\u1ea7n v\u1edbi implant. Nh\u1eefng b\u00f3 th\u1ea7n kinh m\u1ea1ch m\u00e1u kh\u00e1c th\u01b0\u1eddng t\u1ed5n th\u01b0\u01a1ng khi \u0111\u1eb7t implant l\u00e0 c\u00e1c d\u00e2y th\u1ea7n kinh r\u0103ng c\u1eeda \u1edf h\u00e0m tr\u00ean. B\u00f3 n\u00e0y c\u00f3 th\u1ec3 r\u1ea5t l\u1edbn v\u00e0 c\u00f3 th\u1ec3 l\u00e0m h\u1ea1n ch\u1ebf vi\u1ec7c \u0111\u1eb7t implant l\u00fd t\u01b0\u1edfng \u1edf v\u00f9ng r\u0103ng c\u1eeda gi\u1eefa. Lo\u1ea1i b\u1ecf c\u00e1c b\u00f3 n\u00e0y v\u00e0 gh\u00e9p x\u01b0\u01a1ng c\u00f3 th\u1ec3 ho\u00e0n tr\u1ea3 l\u1ea1i v\u00f9ng n\u00e0y \u0111\u1ec3 \u0111\u1eb7t implant sau ba th\u00e1ng l\u00e0nh th\u01b0\u01a1ng.<\/p>\n

\"phau-thuat-mieng-3\"
V\u1edbi chi\u1ec1u cao x\u01b0\u01a1ng h\u1ea1n ch\u1ebf tr\u00ean k\u00eanh r\u0103ng d\u01b0\u1edbi, vi\u1ec7c s\u1eed d\u1ee5ng nhi\u1ec1u implant ng\u1eafn c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u1ee7ng h\u1ed9. \u0110\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 v\u1eefng \u1ed5n implant ban \u0111\u1ea7u trong t\u00ecnh tr\u1ea1ng nh\u01b0 v\u1eady c\u00f3 th\u1ec3 kh\u00f3 kh\u0103n b\u1edfi v\u00ec th\u01b0\u1eddng c\u00f3 \u00edt x\u01b0\u01a1ng x\u1ed1p v\u00e0 ch\u00f3p c\u1ee7a implant kh\u00f4ng th\u1ec3 g\u00e0i trong x\u01b0\u01a1ng v\u1ecf. C\u1ea7n ph\u1ea3i ch\u1eeba l\u1ea1i m\u1ed9t bi\u00ean \u0111\u1ed9 an to\u00e0n c\u00e1ch k\u00eanh r\u0103ng d\u01b0\u1edbi 3mm do sai s\u1ed1 c\u1ee7a \u0111\u1ed9 d\u00e0i c\u1ee7a m\u0169i khoan, tr\u00e1i ng\u01b0\u1ee3c v\u1edbi implant ph\u00eda xa trong h\u00ecnh.<\/figcaption><\/figure>\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 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u00edt ph\u1ed5 bi\u1ebfn h\u01a1n trong ph\u1eabu thu\u1eadt mi\u1ec7ng – Implant, nh\u1eb1m ki\u1ec3m so\u00e1t v\u00f9ng nh\u1ed5 r\u0103ng, nh\u01b0 nong-ch\u1ebb x\u01b0\u01a1ng, d\u1eddi-lo\u1ea1i b\u1ecf d\u00e2y th\u1ea7n kinh, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n t\u1ed1t nh\u1ea5t cho qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00e0 b\u1ec7nh nh\u00e2n. C\u00f9ng t\u00ecm hi\u1ec3u th\u00eam. 1. Ki\u1ec3m so\u00e1t v\u00f9ng nh\u1ed5 […]<\/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":"\nNong-ch\u1ebb x\u01b0\u01a1ng, d\u1eddi-lo\u1ea1i b\u1ecf th\u1ea7n kinh trong ph\u1eabu thu\u1eadt mi\u1ec7ng.<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft n\u00f3i \u0111\u1ebfn c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u00edt ph\u1ed5 bi\u1ebfn h\u01a1n trong ph\u1eabu thu\u1eadt mi\u1ec7ng - Implant: nong-ch\u1ebb x\u01b0\u01a1ng, d\u1eddi-lo\u1ea1i b\u1ecf d\u00e2y th\u1ea7n kinh. 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