{"id":28580,"date":"2023-04-26T12:22:50","date_gmt":"2023-04-26T05:22:50","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28580"},"modified":"2023-05-02T08:25:16","modified_gmt":"2023-05-02T01:25:16","slug":"nhuoc-diem-va-khac-phuc-trong-danh-gia-dieu-tri-noi-nha","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/26\/nhuoc-diem-va-khac-phuc-trong-danh-gia-dieu-tri-noi-nha\/","title":{"rendered":"Nh\u01b0\u1ee3c \u0111i\u1ec3m v\u00e0 kh\u1eafc ph\u1ee5c trong \u0111\u00e1nh gi\u00e1 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha."},"content":{"rendered":"

\u0110\u1ed1i v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng phim Xquang truy\u1ec1n th\u1ed1ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb N\u1ed9i nha th\u00e0nh c\u00f4ng hay kh\u00f4ng c\u00f2n nhi\u1ec1u nh\u01b0\u1ee3c \u0111i\u1ec3m, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u00ednh th\u1ed1ng nh\u1ea5t c\u1ee7a h\u00ecnh \u1ea3nh v\u00e0 c\u1ea5u tr\u00fac kh\u00f4ng r\u00f5 r\u00e0ng. V\u00ec th\u1ebf, ng\u00e0y nay \u0111\u00e3 c\u00f3 nhi\u1ec1u c\u00e1ch \u0111\u1ec3 kh\u1eafc ph\u1ee5c v\u1ea5n \u0111\u1ec1 k\u1ec3 tr\u00ean, \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y.<\/strong><\/p>\n

\"danh-gia-dieu-tri\"<\/p>\n

1. Nh\u01b0\u1ee3c \u0111i\u1ec3m c\u00f2n hi\u1ec7n h\u1eefu – tr\u00ean phim th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c th\u1ed1ng nh\u1ea5t<\/h2>\n

S\u1ef1 m\u1ea5t \u0111i tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 th\u1ea5u quang quanh ch\u00f3p hi\u1ec7n nay l\u00e0 th\u01b0\u1edbc \u0111o ch\u00ednh cho th\u1ea5y \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha th\u00e0nh c\u00f4ng. Tuy nhi\u00ean, vi\u1ec7c \u0111\u00e1nh gi\u00e1 tr\u00ean phim c\u00f2n nhi\u1ec1u h\u1ea1n ch\u1ebf. Phim X quang cung c\u1ea5p h\u00ecnh \u1ea3nh t\u0129nh, th\u1ec3 hi\u1ec7n m\u1ee9c \u0111\u1ed9 kho\u00e1ng h\u00f3a c\u1ee7a r\u0103ng v\u00e0 c\u00e1c c\u1ea5u tr\u00fac quanh ch\u00f3p. Tuy nhi\u00ean \u0111\u1ec3 th\u1ea5y \u0111\u01b0\u1ee3c s\u1ef1 thay \u0111\u1ed5i x\u01b0\u01a1ng r\u00f5 r\u00e0ng tr\u00ean phim th\u00ec \u0111\u00f2i h\u1ecfi sang th\u01b0\u01a1ng ph\u1ea3i c\u00f3 m\u1ee9c \u0111\u1ed9 h\u1ee7y kho\u00e1ng ho\u1eb7c t\u00e1i kho\u00e1ng nh\u1ea5t \u0111\u1ecbnh.<\/p>\n

M\u1ed9t nghi\u00ean c\u1ee9u c\u01a1 b\u1ea3n \u0111\u1ec3 ki\u1ec3m tra \u0111\u1ed9 nh\u1ea1y c\u1ee7a phim X quang truy\u1ec1n th\u1ed1ng trong vi\u1ec7c ph\u00e1t hi\u1ec7n sang th\u01b0\u01a1ng \u1edf x\u01b0\u01a1ng cho th\u1ea5y sang th\u01b0\u01a1ng quanh ch\u00f3p gi\u1edbi h\u1ea1n trong x\u01b0\u01a1ng x\u1ed1p th\u00ec kh\u00f4ng th\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c. H\u01a1n n\u1eefa \u0111\u00e1nh gi\u00e1 tr\u00ean phim X quang th\u01b0\u1eddng mang t\u00ednh ch\u1ee7 quan v\u00e0 b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi ng\u01b0\u1eddi \u0111\u1ecdc. Th\u1eadt v\u1eady, nhi\u1ec1u nh\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u00e3 xem l\u1ea1i c\u00f9ng phim nh\u01b0 nhau nh\u01b0ng s\u1ef1 gi\u1ea3i th\u00edch\/cho \u0111i\u1ec3m c\u1ee7a h\u1ecd l\u1ea1i kh\u00e1c nhau. Quan tr\u1ecdng h\u01a1n, vi\u1ec7c \u0111\u00e1nh gi\u00e1 phim X quang c\u0169ng c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n l\u1ea1i \u2013 khi c\u00f9ng m\u1ed9t phim \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 6 \u2013 8 th\u00e1ng sau \u0111\u00f3 th\u00ec t\u1ec9 l\u1ec7 th\u1ed1ng nh\u1ea5t gi\u1eefa c\u00e1c nh\u00e0 \u0111\u00e1nh gi\u00e1 n\u1eb1m trong kho\u1ea3ng 72% \u0111\u1ebfn 88% t\u00f9y thu\u1ed9c v\u00e0o \u0111\u1eb7c \u0111i\u1ec3m X quang \u0111\u01b0\u1ee3c ki\u1ec3m tra. S\u1ef1 kh\u00e1c nhau n\u00e0y gi\u1eefa c\u00e1c nh\u00e0 \u0111\u00e1nh gi\u00e1, v\u00e0 ngay c\u1ea3 \u1edf c\u00f9ng m\u1ed9t nh\u00e0 \u0111\u00e1nh gi\u00e1, c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch cho s\u1ef1 thay \u0111\u1ed5i l\u1edbn t\u1ec9 l\u1ec7 k\u1ebft qu\u1ea3 c\u1ee7a nh\u1eefng nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng v\u00e0 X quang. Nh\u1eefng s\u1ed1 li\u1ec7u n\u00e0y nh\u1ea5n m\u1ea1nh s\u1ef1 c\u1ea7n thi\u1ebft ph\u1ea3i hi\u1ec7u ch\u1ec9nh c\u00e1c nh\u00e0 \u0111\u00e1nh gi\u00e1 v\u00e0 gi\u1ea3m thi\u1ec3u s\u1ef1 b\u1ea5t \u0111\u1ed3ng trong \u0111\u1ecdc phim X quang khi thi\u1ebft k\u1ebf nghi\u00ean c\u1ee9u k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha. \u0110i\u1ec1u quan tr\u1ecdng l\u00e0, s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ed1n c\u00f3 gi\u1eefa c\u00e1c nh\u00e0 quan s\u00e1t khi ph\u00e2n t\u00edch h\u00ecnh \u1ea3nh X quang nh\u1ea5n m\u1ea1nh s\u1ef1 c\u1ea7n thi\u1ebft ph\u1ea3i l\u1ef1a ch\u1ecdn nh\u1eefng bi\u1ec7n ph\u00e1p \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 phim thi\u1ebft th\u1ef1c nh\u1ea5t \u0111\u1ec3 s\u1eed d\u1ee5ng trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng.<\/p>\n

2. H\u1ec7 th\u1ed1ng \u0111\u00e1nh gi\u00e1 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ch\u1ec9 s\u1ed1 quanh ch\u00f3p (Periapical Index \u2013 PAI)<\/h2>\n

Trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, \u0111i\u1ec3m k\u1ebft th\u00fac ch\u00ednh \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha l\u00e0 th\u0103m kh\u00e1m l\u00e2m s\u00e0ng v\u00e0 t\u00ecnh tr\u1ea1ng m\u00f4 quanh ch\u00f3p d\u1ef1a tr\u00ean X quang c\u1eadn ch\u00f3p. \u0110\u00e1nh gi\u00e1 tr\u00ean phim X quang l\u00e0 nh\u1eefng \u00fd ki\u1ebfn ch\u1ee7 quan d\u1ef1a v\u00e0o s\u1ef1 thay \u0111\u1ed5i m\u1ee9c \u0111\u1ed9 c\u1ea3n quang c\u1ee7a t\u1ed5n th\u01b0\u01a1ng quanh ch\u00f3p c\u00f9ng v\u1edbi s\u1ef1 l\u00e0nh th\u01b0\u01a1ng x\u01b0\u01a1ng v\u00e0 s\u1ef1 t\u00e1i l\u1eadp c\u1ea5u tr\u00fac quanh ch\u00f3p. Hi\u1ec7n nay ti\u00eau chu\u1ea9n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha l\u00e0 ti\u00eau chu\u1ea9n Strindberg v\u00e0 ph\u00e2n lo\u1ea1i c\u1ee7a Hi\u1ec7p h\u1ed9i n\u1ed9i nha M\u1ef9 (AAE), c\u1ea3 2 \u0111\u1ec1u y\u00eau c\u1ea7u \u0111i\u1ec3m k\u1ebft th\u00fac ch\u00ednh \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 l\u00e0 d\u1ef1a tr\u00ean phim X quang.<\/p>\n

\u0110\u1ec3 \u00e1p d\u1ee5ng r\u1ed9ng r\u00e3i c\u00e1c ti\u00eau chu\u1ea9n n\u00e0y, nh\u00e0 l\u00e2m s\u00e0ng c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a m\u00f4 quanh ch\u00f3p tr\u00ean phim X quang. V\u00e0 \u0111i\u1ec1u quan tr\u1ecdng kh\u00f4ng k\u00e9m l\u00e0 c\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha n\u00ean s\u1eed d\u1ee5ng c\u00e1c ti\u00eau chu\u1ea9n \u0111\u00e1ng tin c\u1eady \u0111\u1ec3 \u0111\u1ecbnh ngh\u0129a th\u1ebf n\u00e0o l\u00e0 th\u00e0nh c\u00f4ng v\u00e0 th\u1ea5t b\u1ea1i. \u0110\u1ec3 gi\u1ea3i quy\u1ebft v\u1ea5n \u0111\u1ec1 n\u00e0y, m\u1ed9t h\u1ec7 th\u1ed1ng ch\u1ea5m \u0111i\u1ec3m m\u00f4 quanh ch\u00f3p, d\u1ef1a v\u00e0o h\u00ecnh \u1ea3nh X quang m\u00f4 quanh ch\u00f3p 2 chi\u1ec1u \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e2y d\u1ef1ng. Thang \u0111i\u1ec3m n\u00e0y tr\u1edf th\u00e0nh c\u00f4ng c\u1ee5 h\u1ee3p l\u00fd v\u00e0 \u0111\u00e1ng tin c\u1eady cho c\u00e1c nh\u00e0 l\u00e2m s\u00e0ng v\u00e0 nh\u00e0 nghi\u00ean c\u1ee9u khi \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha, ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c th\u00e0nh c\u00f4ng v\u00e0 th\u1ea5t b\u1ea1i.<\/p>\n

Ch\u1ec9 s\u1ed1 quanh ch\u00f3p (periapical index) l\u00e0 m\u1ed9t h\u1ec7 th\u1ed1ng cho \u0111i\u1ec3m \u0111\u1ec3 ph\u00e2n lo\u1ea1i c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m vi\u00eam quanh ch\u00f3p tr\u00ean X quang. N\u00f3 d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y \u0111\u01b0\u1ee3c c\u1ee7a vi\u00eam quanh ch\u00f3p, v\u00e0 \u0111\u01b0\u1ee3c x\u00e2y d\u1ef1ng t\u1eeb m\u1ed9t nghi\u00ean c\u1ee9u c\u1ed5 \u0111i\u1ec3n v\u1ec1 m\u1ed1i t\u01b0\u01a1ng quan gi\u1eefa m\u00f4 h\u1ecdc \u2212 X quang. N\u00f3 l\u00e0 m\u1ed9t thang g\u1ed3m 5 \u0111i\u1ec3m \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea sau \u0111\u00e2y:<\/p>\n

    \n
  1. C\u1ea5u tr\u00fac m\u00f4 quanh ch\u00f3p b\u00ecnh th\u01b0\u1eddng.<\/li>\n
  2. Nh\u1eefng thay \u0111\u1ed5i nh\u1ecf trong c\u1ea5u tr\u00fac x\u01b0\u01a1ng m\u00e0 kh\u00f4ng c\u00f3 s\u1ef1 h\u1ee7y kho\u00e1ng.<\/li>\n
  3. Nh\u1eefng thay \u0111\u1ed5i nh\u1ecf trong c\u1ea5u tr\u00fac x\u01b0\u01a1ng v\u00e0 c\u00f3 m\u1ed9t v\u00e0i v\u1ecb tr\u00ed h\u1ee7y kho\u00e1ng.<\/li>\n
  4. Vi\u00eam quanh ch\u00f3p v\u1edbi v\u00f9ng th\u1ea5u quang r\u00f5.<\/li>\n
  5. Vi\u00eam quanh ch\u00f3p m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng.<\/li>\n<\/ol>\n

    PAI cung c\u1ea5p c\u00e1c ti\u00eau chu\u1ea9n kh\u00e1ch quan khi \u0111\u00e1nh gi\u00e1 m\u00f4 quanh ch\u00f3p tr\u00ean phim X quang \u1edf nh\u1eefng r\u0103ng \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha. Do v\u1eady, r\u1ea5t nhi\u1ec1u nghi\u00ean c\u1ee9u k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb s\u1eed d\u1ee5ng n\u00f3 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng m\u00f4 quanh ch\u00f3p.<\/p>\n

    G\u1ea7n \u0111\u00e2y, cone beam CT (CBCT) \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 h\u1eefu \u00edch \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 l\u1eadp k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb n\u1ed9i nha. CBCT-PAI (CBCT periapical index) \u0111\u01b0\u1ee3c x\u00e2y d\u1ef1ng \u0111\u1ec3 \u00e1p d\u1ee5ng s\u1ef1 chu\u1ea9n h\u00f3a c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a vi\u00eam quanh ch\u00f3p d\u1ef1a v\u00e0o CBCT. Ch\u1ec9 s\u1ed1 n\u00e0y l\u00e0 m\u1ed9t thang 6 m\u1ee9c \u0111\u1ed9 bao g\u1ed3m \u0111i\u1ec3m s\u1ed1 (t\u1eeb 0 \u2013 5) v\u00e0 2 bi\u1ebfn s\u1ed1 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 m\u1edf r\u1ed9ng v\u00e0 s\u1ef1 ph\u00e1 h\u1ee7y c\u1ee7a v\u1ecf x\u01b0\u01a1ng. Thang \u0111i\u1ec3m CBCT-PAI bao g\u1ed3m: 0: C\u1ea5u tr\u00fac x\u01b0\u01a1ng quanh ch\u00f3p c\u00f2n nguy\u00ean v\u1eb9n.<\/p>\n

      \n
    1. \u0110\u01b0\u1eddng k\u00ednh v\u00f9ng th\u1ea5u quang quanh ch\u00f3p t\u1eeb 0.5 \u2013 1 mm.<\/em><\/li>\n
    2. \u0110\u01b0\u1eddng k\u00ednh v\u00f9ng th\u1ea5u quang quanh ch\u00f3p t\u1eeb 1 \u2013 2 mm.<\/em><\/li>\n
    3. \u0110\u01b0\u1eddng k\u00ednh v\u00f9ng th\u1ea5u quang quanh ch\u00f3p t\u1eeb 2 \u2013 4 mm.<\/em><\/li>\n
    4. \u0110\u01b0\u1eddng k\u00ednh v\u00f9ng th\u1ea5u quang quanh ch\u00f3p t\u1eeb 4 \u2013 8 mm.<\/em><\/li>\n
    5. \u0110\u01b0\u1eddng k\u00ednh v\u00f9ng th\u1ea5u quang quanh ch\u00f3p 8 mm.<\/em><\/li>\n<\/ol>\n
        \n
      • E – \u0110\u1ed9 r\u1ed9ng c\u1ee7a v\u1ecf x\u01b0\u01a1ng.<\/em><\/li>\n
      • D – S\u1ef1 ph\u00e1 h\u1ee7y c\u1ee7a v\u1ecf x\u01b0\u01a1ng.<\/em><\/li>\n<\/ul>\n

        CBCT nh\u1ea1y h\u01a1n phim c\u1eadn ch\u00f3p c\u1ed5 \u0111i\u1ec3n khi ph\u00e1t hi\u1ec7n th\u1ea5u quang quanh ch\u00f3p. Do v\u1eady ng\u01b0\u1eddi ta hy v\u1ecdng l\u00e0 CBCT-PAI s\u1ebd l\u00e0m gi\u1ea3m nh\u1eefng ch\u1ea9n \u0111o\u00e1n sai l\u1ec7ch tr\u00ean phim c\u1eadn ch\u00f3p. Tuy nhi\u00ean, m\u1ed9t nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t l\u1edbn v\u1ec1 h\u00ecnh th\u00e1i kho\u1ea3ng d\u00e2y ch\u1eb3ng nha chu \u1edf nh\u1eefng r\u0103ng l\u00e0nh m\u1ea1nh tr\u00ean l\u00e2m s\u00e0ng. \u0110i\u1ec1u n\u00e0y nh\u1ea5n m\u1ea1nh s\u1ef1 c\u1ea7n thi\u1ebft ph\u1ea3i \u0111\u00e1nh gi\u00e1 t\u1ed1t h\u01a1n v\u00e0 x\u00e1c \u0111\u1ecbnh r\u00f5 r\u00e0ng h\u01a1n c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m b\u00ecnh th\u01b0\u1eddng v\u00e0 b\u1ea5t th\u01b0\u1eddng tr\u00ean h\u00ecnh \u1ea3nh CBCT, tr\u01b0\u1edbc khi x\u00e9t \u0111\u1ebfn vi\u1ec7c \u1ee9ng d\u1ee5ng h\u1ec7 th\u1ed1ng c\u00f4ng ngh\u1ec7 m\u1edbi n\u00e0y v\u00e0o \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3.<\/p>\n

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

        \u0110\u1ed1i v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng phim Xquang truy\u1ec1n th\u1ed1ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb N\u1ed9i nha th\u00e0nh c\u00f4ng hay kh\u00f4ng c\u00f2n nhi\u1ec1u nh\u01b0\u1ee3c \u0111i\u1ec3m, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u00ednh th\u1ed1ng nh\u1ea5t c\u1ee7a h\u00ecnh \u1ea3nh v\u00e0 c\u1ea5u tr\u00fac kh\u00f4ng r\u00f5 r\u00e0ng. 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