{"id":27829,"date":"2023-04-24T12:39:24","date_gmt":"2023-04-24T05:39:24","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27829"},"modified":"2023-05-02T09:30:31","modified_gmt":"2023-05-02T02:30:31","slug":"van-de-xac-dinh-chieu-dai-lam-viec-trong-dieu-tri-noi-nha","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/24\/van-de-xac-dinh-chieu-dai-lam-viec-trong-dieu-tri-noi-nha\/","title":{"rendered":"V\u1ea5n \u0111\u1ec1 x\u00e1c \u0111\u1ecbnh chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c (WL) trong \u0111i\u1ec1u tr\u1ecb N\u1ed9i nha."},"content":{"rendered":"

V\u1edbi ki\u1ebfn th\u1ee9c v\u1ec1 gi\u1ea3i ph\u1eabu \u1ed1ng t\u1ee7y, \u0111\u1ecbnh v\u1ecb v\u00e0 \u0111\u1ecbnh l\u01b0\u1ee3ng t\u1ea5t c\u1ea3 c\u00e1c \u1ed1ng t\u1ee7y, thi\u1ebft l\u1eadp v\u00e0 duy tr\u00ec chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c th\u00edch h\u1ee3p trong su\u1ed1t qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha, c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng ho\u00e0n to\u00e0n c\u00f3 th\u1ec3 mong \u0111\u1ee3i k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed1t nh\u1ea5t cho b\u1ec7nh nh\u00e2n. B\u00e0i vi\u1ebft n\u00e0y \u0111\u1ec1 c\u1eadp m\u1ed9t c\u00e1ch t\u1ed5ng quan vi\u1ec7c x\u00e1c \u0111\u1ecbnh chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha, nh\u1eb1m gi\u1ea3m thi\u1ec3u, h\u1ea1n ch\u1ebf nh\u1eefng v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n. C\u00f9ng t\u00ecm hi\u1ec3u.<\/strong><\/p>\n

1. T\u1ed5ng quan v\u1ec1 chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb N\u1ed9i nha<\/h2>\n

Chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c (working length \u2013 WL) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 kho\u1ea3ng c\u00e1ch t\u1eeb m\u1ed9t \u0111i\u1ec3m tham chi\u1ebfu \u1edf th\u00e2n r\u0103ng \u0111\u1ebfn \u0111i\u1ec3m t\u1eadn c\u00f9ng m\u00e0 vi\u1ec7c s\u1eeda so\u1ea1n v\u00e0 tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y k\u1ebft th\u00fac t\u1ea1i \u0111\u00f3. L\u00fd t\u01b0\u1edfng nh\u1ea5t l\u00e0 vi\u1ec7c s\u1eeda so\u1ea1n v\u00e0 tr\u00e1m b\u00edt n\u00ean gi\u1edbi h\u1ea1n \u1edf v\u1ecb tr\u00ed sinh l\u00fd th\u00edch h\u1ee3p trong l\u00f2ng \u1ed1ng t\u1ee7y \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t. \u0110i\u1ec1u th\u00fa v\u1ecb l\u00e0 v\u1ecb tr\u00ed ch\u00ednh x\u00e1c c\u1ee7a \u0111i\u1ec3m k\u1ebft th\u00fac vi\u1ec7c s\u1eeda so\u1ea1n v\u00e0 tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y v\u1eabn c\u00f2n \u0111\u01b0\u1ee3c tranh lu\u1eadn qua h\u00e0ng th\u1eadp k\u1ef7. Tuy nhi\u00ean, n\u1ebfu \u0111i\u1ec3m k\u1ebft th\u00fac c\u1ee7a v\u1eadt li\u1ec7u tr\u00e1m b\u00edt qu\u00e1 ng\u1eafn ho\u1eb7c qu\u00e1 d\u00e0i so v\u1edbi ch\u00f3p r\u0103ng tr\u00ean phim X quang th\u00ec k\u1ebft qu\u1ea3 kh\u00f4ng kh\u1ea3 quan. Nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u1ed3ng \u00fd r\u1eb1ng \u0111\u1ed1i v\u1edbi r\u0103ng t\u1ee7y s\u1ed1ng, \u0111i\u1ec3m d\u1eebng c\u1ee7a d\u1ee5ng c\u1ee5 v\u00e0 ch\u1ea5t tr\u00e1m b\u00edt n\u00ean ng\u1eafn h\u01a1n l\u1ed7 ch\u00f3p. \u0110\u1ed1i v\u1edbi nh\u1eefng r\u0103ng ho\u1ea1i t\u1eed t\u1ee7y k\u00e8m vi\u00eam quanh ch\u00f3p, gi\u1edbi h\u1ea1n ph\u00eda ch\u00f3p \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 g\u1ea7n ch\u00f3p r\u0103ng tr\u00ean phim. Th\u1ef1c t\u1ebf cho th\u1ea5y, m\u1ea5t m\u1ed7i mm chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c (t\u00ednh t\u1eeb ch\u00f3p r\u0103ng tr\u00ean phim) th\u00ec t\u1ef7 l\u1ec7 th\u1ea5t b\u1ea1i t\u0103ng l\u00ean kho\u1ea3ng 14% ho\u1eb7c 12%.<\/p>\n

2. V\u1ea5n \u0111\u1ec1 x\u00e1c \u0111\u1ecbnh chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c trong \u0111i\u1ec1u tr\u1ecb N\u1ed9i nha<\/h2>\n

Tr\u01b0\u1edbc \u0111\u00e2y, \u0111i\u1ec3m th\u1eaft ch\u00f3p (foramen nh\u1ecf) d\u01b0\u1eddng nh\u01b0 l\u00e0 m\u1ed9t v\u1ecb tr\u00ed th\u00edch h\u1ee3p \u0111\u1ec3 k\u1ebft th\u00fac vi\u1ec7c s\u1eeda so\u1ea1n v\u00e0 tr\u00e1m b\u00edt \u1ed1ng t\u1ee7y. N\u00f3 \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 ph\u1ea7n h\u1eb9p nh\u1ea5t c\u1ee7a \u1ed1ng t\u1ee7y v\u00e0 n\u1eb1m \u1edf v\u1ecb tr\u00ed ng\u1eafn h\u01a1n foramen l\u1edbn. Tuy nhi\u00ean, \u0111i\u1ec3m th\u1eaft ch\u00f3p n\u00e0y ch\u1ec9 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c trong \u00edt h\u01a1n 50% s\u1ed1 r\u0103ng nghi\u00ean c\u1ee9u, v\u00e0 ph\u1ea7n \u1ed1ng t\u1ee7y \u0111o\u1ea1n ch\u00f3p song song th\u00ec th\u1ea5y th\u01b0\u1eddng xuy\u00ean h\u01a1n. Nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y s\u1eed d\u1ee5ng ph\u00e2n t\u00edch micro \u2013 CT \u0111o\u1ea1n th\u1eaft ch\u00f3p (\u0111\u01b0\u1eddng n\u1ed1i ng\u00e0 \u2013 cement) (apical constriction \u2014 AC) tr\u00ean nh\u1eefng r\u0103ng c\u1ed1i l\u1edbn \u0111\u00e3 nh\u1ed5 nh\u1eadn th\u1ea5y:<\/p>\n

    \n
  1. T\u1ea5t c\u1ea3 c\u00e1c \u1ed1ng t\u1ee7y \u0111\u01b0\u1ee3c ki\u1ec3m tra \u0111\u1ec1u th\u1ea5y m\u1ed9t AC.<\/li>\n
  2. H\u00ecnh d\u1ea1ng ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a AC \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y l\u00e0 song song.<\/li>\n
  3. AC r\u1ea5t g\u1ea7n v\u1edbi l\u1ed7 ch\u00f3p (apical foramen \u2013 AF) (0.2 mm).<\/li>\n
  4. K\u00edch th\u01b0\u1edbc c\u1ee7a AC \u1edf c\u00e1c r\u0103ng c\u1ed1i l\u1edbn t\u01b0\u01a1ng \u1ee9ng tr\u00e2m s\u1ed1 30. B\u1ec7nh nh\u00e2n tr\u1ebb c\u00f3 AC l\u1edbn h\u01a1n \u0111\u00e1ng k\u1ec3.<\/li>\n
  5. V\u1ecb tr\u00ed c\u1ee7a AF ng\u1eafn h\u01a1n so v\u1edbi ch\u00f3p r\u0103ng tr\u00ean phim trong 88% c\u00e1c \u1ed1ng t\u1ee7y; AF ng\u1eafn h\u01a1n 2 mm so v\u1edbi ch\u00f3p r\u0103ng gi\u1ea3i ph\u1eabu trong 5% c\u00e1c \u1ed1ng t\u1ee7y.<\/li>\n
  6. Kho\u1ea3ng c\u00e1ch trung b\u00ecnh c\u1ee7a AC so v\u1edbi ch\u00f3p r\u0103ng tr\u00ean phim l\u00e0 0,9 mm.<\/li>\n
  7. Trong 68% c\u00e1c \u1ed1ng t\u1ee7y, khi kho\u1ea3ng c\u00e1ch c\u1ee7a AC so v\u1edbi ch\u00f3p r\u0103ng tr\u00ean phim ng\u1eafn h\u01a1n ho\u1eb7c d\u00e0i h\u01a1n 0,5 mm so v\u1edbi kho\u1ea3ng c\u00e1ch trung b\u00ecnh (nh\u01b0 \u0111\u00e3 n\u00eau trong m\u1ee5c s\u1ed1 6), th\u00ec cho th\u1ea5y vi\u1ec7c x\u00e1c \u0111\u1ecbnh \u0111i\u1ec3m th\u1eaft ch\u00f3p b\u1eb1ng phim X quang c\u00f3 th\u1ec3 ch\u00ednh x\u00e1c ch\u1ec9 trong 32% c\u00e1c \u1ed1ng t\u1ee7y.<\/li>\n<\/ol>\n

    Ngo\u00e0i ra, l\u1ed7 foramen l\u1edbn, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a nh\u01b0 l\u00e0 ph\u1ea7n ch\u00f3p m\u1edf r\u1ed9ng nh\u1ea5t c\u1ee7a ch\u00e2n r\u0103ng, th\u00ec th\u1ea5y n\u00f3 kh\u00f4ng n\u1eb1m \u1edf v\u1ecb tr\u00ed ch\u00f3p r\u0103ng gi\u1ea3i ph\u1eabu trong kho\u1ea3ng 60- 80% r\u0103ng \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u v\u00e0 n\u00f3 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y \u1edf c\u00e1ch ch\u00f3p r\u0103ng gi\u1ea3i ph\u1eabu trong kho\u1ea3ng t\u1eeb 0 \u0111\u1ebfn 3 mm.<\/p>\n

    C\u00e1c nghi\u00ean c\u1ee9u k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha \u0111\u00e1nh gi\u00e1 chi\u1ec1u d\u00e0i tr\u00e1m b\u00edt trong m\u1ed1i t\u01b0\u01a1ng quan v\u1edbi ch\u00f3p r\u0103ng tr\u00ean phim, kh\u00f4ng nh\u1ea5t thi\u1ebft t\u01b0\u01a1ng \u1ee9ng v\u1edbi l\u1ed7 ch\u00f3p l\u1edbn. Tuy nhi\u00ean, d\u01b0\u1eddng nh\u01b0 t\u1ea5t c\u1ea3 c\u00e1c k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u, kh\u00f4ng c\u00f3 ngo\u1ea1i l\u1ec7, \u0111\u1ec1u \u0111\u1ed3ng \u00fd r\u1eb1ng s\u1ef1 qu\u00e1 m\u1ee9c c\u1ee7a v\u1eadt li\u1ec7u tr\u00e1m b\u00edt s\u1ebd g\u00e2y \u1ea3nh h\u01b0\u1edfng x\u1ea5u \u0111\u1ebfn k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

    R\u00f5 r\u00e0ng vi\u1ec7c x\u00e1c \u0111\u1ecbnh chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c th\u00edch h\u1ee3p v\u00e0 duy tr\u00ec n\u00f3 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t. Do chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c tr\u00ean phim kh\u00f4ng ch\u00ednh x\u00e1c trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed c\u1ee7a \u0111i\u1ec3m th\u1eaft ch\u00f3p hay l\u1ed7 ch\u00f3p (foramen), n\u00ean c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c, ch\u1eb3ng h\u1ea1n nh\u01b0 m\u00e1y \u0111\u1ecbnh v\u1ecb ch\u00f3p \u0111i\u1ec7n t\u1eed (electronic apex locator \u2013 EAL) v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111o l\u01b0\u1eddng b\u1eb1ng cone gi\u1ea5y (paper point measurement \u2013 PPT) ng\u00e0y c\u00e0ng tr\u1edf n\u00ean quan tr\u1ecdng trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng.<\/p>\n

    \"xac-dinh-chieu-dai\"
    H\u00ecnh \u1ea3nh s\u00e0n t\u1ee7y c\u1ee7a r\u0103ng c\u1ed1i l\u1edbn minh h\u1ecda b\u1ea3n \u0111\u1ed3 m\u00e0u s\u1eafc. C\u00f3 3 l\u1ed7 t\u1ee7y g\u1ea7n ngo\u00e0i ri\u00eang bi\u1ec7t. C\u00e1c mi\u1ec7ng \u1ed1ng t\u1ee7y \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y t\u1ea1i ch\u1ed7 n\u1ed1i c\u1ee7a s\u00e0n t\u1ee7y t\u1ed1i m\u00e0u v\u00e0 c\u00e1c th\u00e0nh bu\u1ed3ng t\u1ee7y c\u00f3 m\u00e0u s\u00e1ng h\u01a1n.<\/figcaption><\/figure>\n

    M\u1ed9t nghi\u00ean c\u1ee9u in vivo g\u1ea7n \u0111\u00e2y \u0111\u00e3 so s\u00e1nh \u0111\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a vi\u1ec7c x\u00e1c \u0111\u1ecbnh chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c gi\u1eefa EAL v\u1edbi phim X quang, tr\u00ean 482 \u1ed1ng t\u1ee7y \u1edf 160 r\u0103ng \u1edf h\u00e0m tr\u00ean v\u00e0 h\u00e0m d\u01b0\u1edbi. Sau khi nh\u1ed5, v\u1ecb tr\u00ed ch\u00ednh x\u00e1c c\u1ee7a \u0111i\u1ec3m th\u1eaft ch\u00f3p \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng c\u00e1ch quan s\u00e1t tr\u1ef1c ti\u1ebfp. K\u1ebft qu\u1ea3 cho th\u1ea5y r\u1eb1ng khi \u0111o chi\u1ec1u d\u00e0i b\u1eb1ng m\u00e1y \u0111\u1ecbnh v\u1ecb ch\u00f3p th\u00ec sai l\u1ec7ch kho\u1ea3ng \u00b1 0,5 mm so v\u1edbi l\u1ed7 ch\u00f3p nh\u1ecf (\u0111i\u1ec3m th\u1eaft ch\u00f3p) \u1edf 100% tr\u01b0\u1eddng h\u1ee3p, trong khi \u0111\u1ed1i v\u1edbi phim X quang, k\u1ebft qu\u1ea3 \u0111o n\u1eb1m trong kho\u1ea3ng n\u00e0y ch\u1ec9 trong 15% tr\u01b0\u1eddng h\u1ee3p. \u0110i\u1ec1u n\u00e0y cho th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u00fang m\u00e1y \u0111\u1ecbnh v\u1ecb ch\u00f3p s\u1ebd cho ph\u00e9p x\u00e1c \u0111\u1ecbnh chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c ch\u00ednh x\u00e1c h\u01a1n so v\u1edbi phim c\u1eadn ch\u00f3p.<\/p>\n

    Ngu\u1ed3n: Clinical Guide for Optimal Treatment Outcome – Springer International Publishing Switzerland 2017<\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

    V\u1edbi ki\u1ebfn th\u1ee9c v\u1ec1 gi\u1ea3i ph\u1eabu \u1ed1ng t\u1ee7y, \u0111\u1ecbnh v\u1ecb v\u00e0 \u0111\u1ecbnh l\u01b0\u1ee3ng t\u1ea5t c\u1ea3 c\u00e1c \u1ed1ng t\u1ee7y, thi\u1ebft l\u1eadp v\u00e0 duy tr\u00ec chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c th\u00edch h\u1ee3p trong su\u1ed1t qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha, c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng ho\u00e0n to\u00e0n c\u00f3 th\u1ec3 mong \u0111\u1ee3i k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed1t nh\u1ea5t cho […]<\/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":[],"yoast_head":"\nV\u1ea5n \u0111\u1ec1 x\u00e1c \u0111\u1ecbnh chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c (WL) trong \u0111i\u1ec1u tr\u1ecb N\u1ed9i nha.<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft \u0111\u1ec1 c\u1eadp t\u1ed5ng quan x\u00e1c \u0111\u1ecbnh chi\u1ec1u d\u00e0i l\u00e0m vi\u1ec7c trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha, nh\u1eb1m h\u1ea1n ch\u1ebf v\u1ea5n \u0111\u1ec1 v\u1ec1 sau. 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