{"id":28921,"date":"2023-04-27T21:59:10","date_gmt":"2023-04-27T14:59:10","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28921"},"modified":"2023-05-01T23:40:56","modified_gmt":"2023-05-01T16:40:56","slug":"ca-lam-sang-02-cac-van-de-y-khoa-den-phau-thuat-implant","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/ca-lam-sang-02-cac-van-de-y-khoa-den-phau-thuat-implant\/","title":{"rendered":"Ca l\u00e2m s\u00e0ng 02: C\u00e1c v\u1ea5n \u0111\u1ec1 Y khoa \u0111\u1ebfn ph\u1eabu thu\u1eadt Implant."},"content":{"rendered":"

M\u1ee5c ti\u00eau c\u1ee7a ca l\u00e2m s\u00e0ng n\u00e0y: Hi\u1ec3u \u0111\u01b0\u1ee3c nh\u1eefng b\u1ec7nh l\u00fd y khoa c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 th\u1ea5t b\u1ea1i ho\u1eb7c bi\u1ebfn ch\u1ee9ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p, \u1ea3nh h\u01b0\u1edfng c\u1ee7a thu\u1ed1c l\u00ean \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p, c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh y khoa tuy\u1ec7t \u0111\u1ed1i c\u1ee7a \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p nha khoa v\u00e0 vi\u1ec7c ki\u1ec3m so\u00e1t v\u1ea5n \u0111\u1ec1 y khoa c\u00e1 nh\u00e2n tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p. C\u00f9ng t\u00ecm hi\u1ec3u.<\/strong><\/p>\n

1. T\u00ecnh hu\u1ed1ng ca l\u00e2m s\u00e0ng<\/strong><\/p>\n

B\u1ec7nh nh\u00e2n nam, ng\u01b0\u1eddi da tr\u1eafng, 70 tu\u1ed5i, v\u1edbi than phi\u1ec1n ch\u00ednh l\u00e0 “T\u00f4i b\u1ecb m\u1ea5t c\u00e1c r\u0103ng sau v\u00e0 kh\u00f3 \u0103n nhai\u201d. B\u1ec7nh nh\u00e2n b\u1ecb m\u1ea5t c\u00e1c r\u0103ng #17-#14, #24- #27, #37, #36, #42, v\u00e0 #44-#47 c\u00e1ch \u0111\u00e2y v\u00e0i n\u0103m do b\u1ec7nh nha chu tr\u1ea7m tr\u1ecdng. C\u00e1c r\u0103ng c\u1ed1i l\u1edbn th\u1ee9 ba m\u1ecdc ng\u1ea7m v\u00e0 \u0111\u00e3 nh\u1ed5 khi b\u1ec7nh nh\u00e2n c\u00f2n tr\u1ebb. B\u1ec7nh nh\u00e2n c\u00f3 ph\u1ee5c h\u00ecnh th\u00e1o l\u1eafp chuy\u1ec3n ti\u1ebfp \u1edf h\u00e0m tr\u00ean v\u00e0 h\u00e0m d\u01b0\u1edbi tr\u01b0\u1edbc khi ti\u1ebfp t\u1ee5c l\u00e0m ph\u1ee5c h\u00ecnh c\u1ed1 \u0111\u1ecbnh, nh\u01b0ng b\u1ec7nh nh\u00e2n kh\u00f4ng mang \u0111\u1ec1u \u0111\u1eb7n.<\/p>\n

\"case-lam-sang-2-1\"
T\u00ecnh tr\u1ea1ng tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb (Ch\u1ee5p m\u1eb7t ngo\u00e0i)<\/figcaption><\/figure>\n
\"case-lam-sang-2-2\"
T\u00ecnh tr\u1ea1ng tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb (Ch\u1ee5p m\u1eb7t nhai)<\/figcaption><\/figure>\n

B\u1ec7nh nh\u00e2n kh\u00e1m nha s\u0129 \u0111\u1ecbnh k\u1ef3 \u0111\u1ec3 ch\u0103m s\u00f3c r\u0103ng mi\u1ec7ng nh\u1eb1m gi\u1eef c\u00e1c r\u0103ng c\u00f2n l\u1ea1i \u0111\u1ed3ng th\u1eddi cho bi\u1ebft b\u1ec7nh nh\u00e2n ch\u1ea3i r\u0103ng 2 l\u1ea7n\/ng\u00e0y v\u00e0 d\u00f9ng ch\u1ec9 nha khoa \u00edt nh\u1ea5t 1 l\u1ea7n\/ng\u00e0y. B\u1ec7nh nh\u00e2n c\u00f3 mi\u1ebfng tr\u00e1m composite xoang V \u1edf m\u1eb7t ngo\u00e0i r\u0103ng #35 v\u00e0 #34, v\u00e0 mi\u1ebfng tr\u00e1m composite \u1edf c\u1ea1nh c\u1eafn r\u0103ng #11.<\/p>\n

2. \u0110\u00e1nh gi\u00e1 ca l\u00e2m s\u00e0ng<\/strong><\/p>\n

    \n
  • Ti\u1ec1n s\u1eed y khoa: T\u1ea1i th\u1eddi \u0111i\u1ec3m \u0111i\u1ec1u tr\u1ecb, b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng lo\u1ea1i II, \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1eb1ng thu\u1ed1c (metformin). N\u1ed3ng \u0111\u1ed9 glycated hemoglobin (HbA1c) l\u1ea7n cu\u1ed1i l\u00e0 6.7%, \u0111\u01b0\u1ee3c \u0111o c\u00e1ch \u0111\u00e2y v\u00e0i tu\u1ea7n. \u0110\u01b0\u1eddng huy\u1ebft l\u00fac \u0111\u00f3i l\u00e0 120 mg\/dL trong l\u1ea7n kh\u00e1m s\u1ee9c kh\u1ecfe cu\u1ed1i c\u00f9ng. B\u1ec7nh nh\u00e2n c\u0169ng b\u1ecb cao huy\u1ebft \u00e1p, \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1eb1ng thu\u1ed1c (hydroclorothiazide, doxazosin methylate, benazepril). Ngo\u00e0i ra, b\u1ec7nh nh\u00e2n c\u00f2n b\u1ecb t\u0103ng cholesterol m\u00e1u nh\u01b0ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1eb1ng thu\u1ed1c (simvastatin). Cu\u1ed1i c\u00f9ng, b\u1ec7nh nh\u00e2n b\u1ecb ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u g\u1ed1i c\u00e1ch \u0111\u00e2y 4 n\u0103m, d\u1eabn t\u1edbi h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u \u0111\u00f4ng v\u00e0 \u0111\u00e3 di chuy\u1ec3n \u0111\u1ebfn ph\u1ed5i. B\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt \u0111\u1ea7u g\u1ed1i v\u00e0 u\u1ed1ng Coumadin k\u1ec3 t\u1eeb \u0111\u00f3. T\u1ef7 s\u1ed1 b\u00ecnh th\u01b0\u1eddng chu\u1ea9n h\u00f3a (INR) cu\u1ed1i c\u00f9ng c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0 2.3. Ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3 c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0 33.9, \u0111\u01b0\u1ee3c x\u1ebfp lo\u1ea1i b\u00e9o ph\u00ec. B\u1ec7nh nh\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c ghi nh\u1eadn d\u1ecb \u1ee9ng thu\u1ed1c.<\/li>\n
  • \u0110\u00e1nh gi\u00e1 to\u00e0n th\u00e2n\n
      \n
    • D\u1ea5u hi\u1ec7u sinh t\u1ed3n\n
        \n
      • Huy\u1ebft \u00e1p: 135\/70 mmHg<\/li>\n
      • Nh\u1ecbp tim: 85 l\u1ea7n\/ph\u00fat (b\u00ecnh th\u01b0\u1eddng)<\/li>\n
      • Nh\u1ecbp th\u1edf: 16 l\u1ea7n\/ph\u00fat<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n
      • Th\u00f3i quen c\u00e1 nh\u00e2n: B\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed h\u00fat thu\u1ed1c l\u00e1 v\u00e0 u\u1ed1ng r\u01b0\u1ee3u t\u1ea1i th\u1eddi \u0111i\u1ec3m \u0111i\u1ec1u tr\u1ecb.<\/li>\n
      • Kh\u00e1m ngo\u00e0i m\u1eb7t\n
          \n
        • Kh\u00f4ng ghi nh\u1eadn b\u1ec7nh l\u00fd l\u00e2m s\u00e0ng khi kh\u00e1m ngo\u00e0i m\u1eb7t.<\/li>\n
        • B\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 kh\u1ed1i u ho\u1eb7c s\u01b0ng.<\/li>\n
        • Kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m \u1ed5n \u0111\u1ecbnh, th\u1ef1c hi\u1ec7n ch\u1ee9c n\u0103ng, v\u00e0 tho\u1ea3i m\u00e1i.<\/li>\n
        • M\u1eb7t c\u00e2n x\u1ee9ng, v\u00e0 s\u1edd h\u1ea1ch b\u1ea1ch huy\u1ebft b\u00ecnh th\u01b0\u1eddng.<\/li>\n<\/ul>\n<\/li>\n
        • Kh\u00e1m trong mi\u1ec7ng\n
            \n
          • T\u1ea7m so\u00e1t ung th\u01b0 h\u1ed1c mi\u1ec7ng \u00e2m t\u00ednh.<\/li>\n
          • Kh\u00e1m m\u00f4 m\u1ec1m, bao g\u1ed3m c\u1ea3 l\u01b0\u1ee1i v\u00e0 s\u00e0n mi\u1ec7ng v\u00e0 h\u1ea7u h\u1ecdng, kh\u00f4ng ghi nh\u1eadn b\u1ec7nh l\u00fd l\u00e2m s\u00e0ng.<\/li>\n
          • Kh\u00e1m m\u00f4 nha chu cho th\u1ea5y \u0111\u1ed9 s\u00e2u t\u00fai n\u1eb1m trong kho\u1ea3ng 1-3 mm.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
            \"case-lam-sang-2-3\"
            S\u01a1 \u0111\u1ed3 nha chu. \u0110o \u0111\u1ed9 s\u00e2u t\u00fai trong bu\u1ed5i kh\u00e1m \u0111\u1ea7u ti\u00ean<\/figcaption><\/figure>\n
              \n
            • \n
                \n
              • Vi\u00eam n\u01b0\u1edbu khu tr\u00fa nh\u1eb9.<\/li>\n
              • M\u00e0u s\u1eafc, k\u00edch th\u01b0\u1edbc, h\u00ecnh d\u1ea1ng, v\u00e0 m\u1eadt \u0111\u1ed9 n\u01b0\u1edbu b\u00ecnh th\u01b0\u1eddng.<\/li>\n
              • M\u00f4 s\u1eebng h\u00f3a s\u0103n ch\u1eafc v\u00e0 l\u1ed1m \u0111\u1ed1m.<\/li>\n
              • M\u1ea5t b\u00e1m d\u00ednh to\u00e0n th\u1ec3 m\u1ee9c \u0111\u1ed9 trung b\u00ecnh v\u00e0 tr\u1ea7m tr\u1ecdng t\u1ea1i m\u1ed9t s\u1ed1 v\u1ecb tr\u00ed, t\u1ee5t n\u01b0\u1edbu to\u00e0n b\u1ed9.<\/li>\n
              • M\u1ed9t th\u1eafng m\u00f4i h\u00e0m tr\u00ean l\u1ea1c ch\u1ed7 v\u00e0 hai th\u1eafng m\u00e1 h\u00e0m d\u01b0\u1edbi \u1edf 2 b\u00ean, k\u00e9o d\u00e0i \u0111\u1ebfn v\u00f9ng m\u1ea5t r\u0103ng ph\u00eda sau.<\/li>\n
              • M\u1ea3ng b\u00e1m xung quanh m\u1ed9t s\u1ed1 r\u0103ng, n\u00ean ch\u1ec9 s\u1ed1 kh\u00f4ng m\u1ea3ng b\u00e1m ch\u1ec9 \u0111\u1ea1t 90%.<\/li>\n
              • \u0110\u00e1nh gi\u00e1 s\u1ed1ng h\u00e0m v\u00f9ng m\u1ea5t r\u0103ng cho th\u1ea5y ti\u00eau x\u01b0\u01a1ng theo chi\u1ec1u ngang v\u00e0 chi\u1ec1u \u0111\u1ee9ng (Seibert lo\u1ea1i III).<\/li>\n
              • Mi\u1ebfng tr\u00e1m xoang V \u1edf m\u1eb7t ngo\u00e0i r\u0103ng #35 v\u00e0 #34, v\u00e0 mi\u1ebfng tr\u00e1m composite \u1edf c\u1ea1nh c\u1eafn r\u0103ng #11.<\/li>\n<\/ul>\n<\/li>\n
              • Kh\u1edbp c\u1eafn: C\u1eafn ch\u00eca 3.5 mm v\u00e0 c\u1eafn ph\u1ee7 4 mm. Kh\u00f4ng th\u1ec3 ph\u00e2n lo\u1ea1i Angle theo r\u0103ng c\u1ed1i l\u1edbn do b\u1ec7nh nh\u00e2n \u0111\u00e3 m\u1ea5t c\u00e1c r\u0103ng n\u00e0y. Ph\u00e2n lo\u1ea1i theo r\u0103ng nanh ch\u1ec9 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c b\u00ean tr\u00e1i l\u00e0 h\u1ea1ng II. C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng kh\u1edbp c\u1eafn th\u1ee9 ph\u00e1t (m\u00f2n r\u0103ng, r\u0103ng lung lay, s\u1edd rung) c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn. Ph\u00e2n t\u00edch ch\u1ee9c n\u0103ng kh\u1edbp c\u1eafn cho th\u1ea5y c\u00f3 h\u01b0\u1edbng d\u1eabn tr\u01b0\u1edbc trong v\u1eadn \u0111\u1ed9ng tr\u01b0\u1ee3t ra tr\u01b0\u1edbc v\u00e0 h\u01b0\u1edbng d\u1eabn r\u0103ng nanh trong v\u1eadn \u0111\u1ed9ng tr\u01b0\u1ee3t sang b\u00ean.<\/li>\n
              • Phim X-quang: Phim to\u00e0n c\u1ea3nh v\u00e0 phim full-mouth \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh.<\/li>\n<\/ul>\n

                 <\/p>\n

                \"\"<\/p>\n

                \"\"<\/p>\n

                 <\/p>\n

                  \n
                • \n
                    \n
                  • Phim X-quang cho th\u1ea5y c\u00f3 ti\u00eau x\u01b0\u01a1ng theo chi\u1ec1u ngang to\u00e0n th\u1ec3 m\u1ee9c \u0111\u1ed9 trung b\u00ecnh. Ti\u00eau x\u01b0\u01a1ng theo chi\u1ec1u \u0111\u1ee9ng c\u0169ng \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf c\u00e1c v\u00f9ng m\u1ea5t r\u0103ng. Ch\u1ee5p c\u1eaft l\u1edbp \u0111i\u1ec7n to\u00e1n ch\u00f9m tia h\u00ecnh n\u00f3n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 k\u1ef9 h\u01a1n nh\u1eefng v\u00f9ng m\u1ea5t r\u0103ng. Chi\u1ec1u cao x\u01b0\u01a1ng gi\u1eefa m\u00e0o x\u01b0\u01a1ng v\u1edbi xoang h\u00e0m b\u00ean ph\u1ea3i, t\u1ea1i v\u1ecb tr\u00ed c\u1ea5y gh\u00e9p d\u1ef1 ki\u1ebfn, \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng stent X-quang, l\u00e0 4.95 mm, v\u00e0 v\u1edbi xoang h\u00e0m b\u00ean tr\u00e1i l\u00e0 8 mm. Chi\u1ec1u cao x\u01b0\u01a1ng gi\u1eefa m\u00e0o x\u01b0\u01a1ng v\u1edbi \u1ed1ng th\u1ea7n kinh x\u01b0\u01a1ng \u1ed5 d\u01b0\u1edbi l\u00e0 12 mm \u1edf c\u1ea3 2 b\u00ean. Kho\u1ea3ng c\u00e1ch \u0111\u1ebfn l\u1ed7 c\u1eb1m b\u00ean ph\u1ea3i l\u00e0 10 mm. \u0110\u1ee7 chi\u1ec1u r\u1ed9ng ngo\u00e0i-trong \u1edf t\u1ea5t c\u1ea3 c\u00e1c v\u1ecb tr\u00ed \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1eb7t implant.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                    3. Ch\u1ea9n \u0111o\u00e1n, k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb v\u1ec1 ca l\u00e2m s\u00e0ng n\u00e0y<\/strong><\/p>\n

                      \n
                    • Ch\u1ea9n \u0111o\u00e1n ca l\u00e2m s\u00e0ng: Ch\u1ea9n \u0111o\u00e1n vi\u00eam nha chu m\u1ea1n d\u1ea1ng to\u00e0n th\u1ec3 m\u1ee9c \u0111\u1ed9 trung b\u00ecnh v\u00e0 tr\u1ea7m tr\u1ecdng t\u1ea1i m\u1ed9t s\u1ed1 v\u1ecb tr\u00ed, bi\u1ebfn d\u1ea1ng v\u00e0 b\u1ec7nh l\u00fd ni\u00eam m\u1ea1c n\u01b0\u1edbu \u1edf r\u0103ng th\u1eadt (t\u1ee5t n\u01b0\u1edbu m\u1eb7t ngo\u00e0i, m\u1eb7t trong, v\u00e0 m\u1eb7t b\u00ean, th\u1eafng l\u1ea1c ch\u1ed7), bi\u1ebfn d\u1ea1ng v\u00e0 b\u1ec7nh l\u00fd ni\u00eam m\u1ea1c n\u01b0\u1edbu t\u1ea1i s\u1ed1ng h\u00e0m m\u1ea5t r\u0103ng (thi\u1ebfu h\u1ed5ng chi\u1ec1u ngang v\u00e0 chi\u1ec1u \u0111\u1ee9ng \u1edf t\u1ea5t c\u1ea3 c\u00e1c v\u00f9ng m\u1ea5t r\u0103ng, v\u00e0 th\u1eafng l\u1ea1c ch\u1ed7), v\u00e0 ch\u1ea5n th\u01b0\u01a1ng kh\u1edbp c\u1eafn (th\u1ee9 ph\u00e1t) \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp. Ch\u1ea9n \u0111o\u00e1n m\u1ea5t r\u0103ng b\u00e1n ph\u1ea7n v\u1edbi lo\u1ea1i I Kennedy \u1edf h\u00e0m tr\u00ean v\u00e0 lo\u1ea1i I (bi\u1ebfn th\u1ec3 2) Kennedy \u1edf h\u00e0m d\u01b0\u1edbi \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp th\u00eam.<\/li>\n
                    • K\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb ca l\u00e2m s\u00e0ng: H\u1ed9i ch\u1ea9n li\u00ean chuy\u00ean khoa c\u00f9ng v\u1edbi m\u1eabu h\u00e0m ch\u1ea9n \u0111o\u00e1n v\u00e0 m\u1eabu s\u00e1p \u0111\u00e3 \u0111\u01b0a ra nhi\u1ec1u ph\u01b0\u01a1ng \u00e1n \u0111i\u1ec1u tr\u1ecb kh\u00e1c nhau. H\u1ea1n ch\u1ebf v\u1ec1 m\u1eb7t t\u00e0i ch\u00ednh c\u0169ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn quy\u1ebft \u0111\u1ecbnh sau c\u00f9ng. K\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n n\u00e0y bao g\u1ed3m \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u l\u00e0 c\u1ea1o v\u00f4i r\u0103ng v\u00e0 h\u01b0\u1edbng d\u1eabn v\u1ec7 sinh r\u0103ng mi\u1ec7ng \u0111\u1ec3 gi\u1ea3i quy\u1ebft vi\u00eam n\u01b0\u1edbu. Ti\u1ebfp theo l\u00e0 \u0111\u1eb7t c\u00e1c implant t\u1ea1i v\u1ecb tr\u00ed #16 v\u00e0 #14 k\u1ebft h\u1ee3p v\u1edbi n\u00e2ng xoang h\u1edf, c\u00e1c implant t\u1ea1i v\u1ecb tr\u00ed #24 v\u00e0 #26 k\u1ebft h\u1ee3p v\u1edbi n\u00e2ng xoang k\u00edn, v\u00e0 c\u00e1c implant t\u1ea1i c\u00e1c v\u1ecb tr\u00ed #36, #42 v\u00e0 #46. Sau th\u1eddi gian t\u00edch h\u1ee3p x\u01b0\u01a1ng \u0111\u1ea7y \u0111\u1ee7 (6-8 th\u00e1ng \u1edf h\u00e0m tr\u00ean, 4 th\u00e1ng \u1edf h\u00e0m d\u01b0\u1edbi), ti\u1ebfn h\u00e0nh l\u00e0m ph\u1ee5c h\u00ecnh tr\u00ean implant.<\/li>\n
                    • \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 ca l\u00e2m s\u00e0ng:\n
                        \n
                      • Tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb, c\u1ea7n tham v\u1ea5n b\u00e1c s\u0129 t\u1ed5ng qu\u00e1t v\u00e0 b\u00e1c s\u0129 fai-m\u0169i-h\u1ecdng. B\u00e1c s\u0129 t\u1ed5ng qu\u00e1t \u0111\u1ec1 ngh\u1ecb b\u1ec7nh nh\u00e2n ng\u01b0ng u\u1ed1ng warfarin 5 ng\u00e0y tr\u01b0\u1edbc ph\u1eabu thu\u1eadt v\u00e0 b\u1eaft \u0111\u1ea7u u\u1ed1ng Lovenox (heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p) \u0111\u1ebfn 24 gi\u1edd tr\u01b0\u1edbc ph\u1eabu thu\u1eadt. B\u1ec7nh nh\u00e2n n\u00ean u\u1ed1ng l\u1ea1i warfarin v\u00e0 Lovenox 24 gi\u1edd sau ph\u1eabu thu\u1eadt cho \u0111\u1ebfn khi INR 2 2.0, sau \u0111\u00f3 ng\u01b0ng u\u1ed1ng Lovenox.<\/li>\n
                      • B\u00e1o c\u00e1o tai-m\u0169i-h\u1ecdng cho th\u1ea5y b\u1ec7nh nh\u00e2n c\u00f3 nang nh\u1ea7y ni\u00eam m\u1ea1c l\u00e0nh t\u00ednh \u1edf xoang h\u00e0m b\u00ean ph\u1ea3i v\u00e0 d\u00e0y m\u00e0ng xoang \u1edf xoang h\u00e0m b\u00ean tr\u00e1i. C\u1ea3 hai t\u00ecnh tr\u1ea1ng \u0111\u1ec1u kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ph\u1eabu thu\u1eadt implant ho\u1eb7c th\u1ee7 thu\u1eadt n\u00e2ng xoang. Tuy nhi\u00ean, trong tr\u01b0\u1eddng h\u1ee3p th\u1ee7ng m\u00e0ng xoang, c\u1ea7n ph\u1ea3i d\u1eebng ph\u1eabu thu\u1eadt, kh\u00f4ng \u0111\u1eb7t implant hay gh\u00e9p x\u01b0\u01a1ng, v\u00e0 chuy\u1ec3n b\u1ec7nh nh\u00e2n \u0111\u1ebfn b\u00e1c s\u0129 tai-m\u0169i-h\u1ecdng \u0111\u1ec3 l\u1ea5y nang v\u00e0 \u0111i\u1ec1u tr\u1ecb xoang.<\/li>\n
                      • Sau \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1eb7t implant. Vi\u1ec7c \u0111\u1eb7t implant di\u1ec5n ra trong 3 bu\u1ed5i h\u1eb9n.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                        \"\"<\/p>\n

                          \n
                        • B\u00e0n lu\u1eadn v\u1ec1 ca l\u00e2m s\u00e0ng:\n
                            \n
                          • Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, v\u1ea5n \u0111\u1ec1 ch\u00ednh l\u00e0 ti\u1ec1n s\u1eed y khoa c\u1ee7a b\u1ec7nh nh\u00e2n. B\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 b\u1ec7nh to\u00e0n th\u00e2n b\u1eb1ng thu\u1ed1c. Nh\u1eefng y\u1ebfu t\u1ed1 n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb implant nh\u1eb1m gi\u1ea3m thi\u1ec3u nguy c\u01a1 bi\u1ebfn ch\u1ee9ng v\u00e0 t\u1ed1i \u01b0u h\u00f3a k\u1ebft qu\u1ea3 c\u1ea5y gh\u00e9p. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n kh\u1ecfe m\u1ea1nh, t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng c\u1ee7a m\u1ed9t s\u1ed1 h\u1ec7 th\u1ed1ng implant \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o n\u1eb1m trong kho\u1ea3ng 90-95% sau 10 n\u0103m. Tuy nhi\u00ean, c\u1ea5y gh\u00e9p c\u00f3 th\u1ec3 th\u1ea5t b\u1ea1i, do kh\u00f4ng t\u00edch h\u1ee3p x\u01b0\u01a1ng trong giai \u0111o\u1ea1n l\u00e0nh th\u01b0\u01a1ng ban \u0111\u1ea7u, ho\u1eb7c implant kh\u00f4ng \u0111\u1ea1t ch\u1ee9c n\u0103ng do ph\u00e1 h\u1ee7y ho\u1eb7c nhi\u1ec5m tr\u00f9ng m\u00f4 quanh implant d\u1eabn t\u1edbi m\u1ea5t n\u00e2ng \u0111\u1ee1 implant. K\u1ebft qu\u1ea3 l\u00e2u d\u00e0i c\u1ee7a \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi c\u00e1c y\u1ebfu t\u1ed1 t\u1ea1i ch\u1ed7 ho\u1eb7c nh\u1eefng b\u1ec7nh l\u00fd to\u00e0n th\u00e2n ho\u1eb7c c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c. Tr\u00ean th\u1ef1c t\u1ebf, ng\u01b0\u1eddi ta cho r\u1eb1ng m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 t\u1ea1i ch\u1ed7 v\u00e0 to\u00e0n th\u00e2n c\u00f3 th\u1ec3 l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p [1, 2]. T\u00e1c \u0111\u1ed9ng t\u1eeb c\u00e1c nguy c\u01a1 s\u1ee9c kho\u1ebb l\u00ean k\u1ebft qu\u1ea3 c\u1ea5y gh\u00e9p l\u00e0 kh\u00f4ng r\u00f5 r\u00e0ng b\u1edfi v\u00ec c\u00f3 r\u1ea5t \u00edt th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean c\u00f3 nh\u00f3m ch\u1ee9ng \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe nh\u01b0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 [1]. M\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd, ch\u1eb3ng h\u1ea1n nh\u01b0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng kh\u00f4ng ki\u1ec3m so\u00e1t, r\u1ed1i lo\u1ea1n ch\u1ea3y m\u00e1u, suy gi\u1ea3m\/\u1ee9c ch\u1ebf h\u1ec7 mi\u1ec5n d\u1ecbch, ho\u1eb7c v\u1ea5n \u0111\u1ec1 t\u00e2m th\u1ea7n, c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn vi\u1ec7c ch\u0103m s\u00f3c h\u1eadu ph\u1eabu, t\u1eeb \u0111\u00f3 l\u00e0m t\u0103ng nguy c\u01a1 th\u1ea5t b\u1ea1i c\u1ee7a implant. Tuy nhi\u00ean, v\u1eabn ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng m\u1ea1nh m\u1ebd x\u00e1c th\u1ef1c c\u00e1c m\u1ed1i li\u00ean quan n\u00e0y [1, 2]. Do \u0111\u00f3, l\u1ef1a ch\u1ecdn b\u1ec7nh nh\u00e2n l\u00e0 r\u1ea5t quan tr\u1ecdng nh\u1eb1m t\u0103ng kh\u1ea3 n\u0103ng th\u00e0nh c\u00f4ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p.<\/li>\n
                          • C\u1ea7n ph\u1ea3i hi\u1ec3u r\u1eb1ng m\u1ee9c \u0111\u1ed9 ki\u1ec3m so\u00e1t b\u1ec7nh quan tr\u1ecdng h\u01a1n nhi\u1ec1u so v\u1edbi b\u1ea3n ch\u1ea5t c\u1ee7a b\u1ec7nh l\u00fd \u0111\u00f3, v\u00e0 ki\u1ec3m so\u00e1t y khoa c\u00e1 nh\u00e2n ph\u1ea3i \u0111\u1ea1t \u0111\u01b0\u1ee3c tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p, b\u1edfi v\u00ec \u0111\u1ed1i v\u1edbi nhi\u1ec1u b\u1ec7nh nh\u00e2n, ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng v\u00e0 nh\u1eefng l\u1ee3i \u00edch t\u1eeb implant c\u00f3 th\u1ec3 cao h\u01a1n so v\u1edbi r\u1ee7i ro [1]. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd to\u00e0n th\u00e2n, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i c\u00e2n nh\u1eafc gi\u1eefa chi ph\u00ed v\u1edbi ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng v\u00e0 tu\u1ed5i th\u1ecd c\u1ee7a b\u1ec7nh nh\u00e2n, \u0111\u1ed3ng th\u1eddi th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt c\u1ea5y gh\u00e9p d\u01b0\u1edbi s\u1ef1 v\u00f4 khu\u1ea9n nghi\u00eam ng\u1eb7t, ch\u1ea5n th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u, tr\u00e1nh c\u0103ng th\u1eb3ng v\u00e0 xu\u1ea5t huy\u1ebft n\u1eb7ng c\u0169ng r\u1ea5t quan tr\u1ecdng. M\u1ed9t \u0111i\u1ec1u quan tr\u1ecdng kh\u00f4ng k\u00e9m \u1edf c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y l\u00e0 ph\u1ea3i \u0111\u1ea3m b\u1ea3o \u0111i\u1ec1u tr\u1ecb duy tr\u00ec v\u1edbi v\u1ec7 sinh r\u0103ng mi\u1ec7ng t\u1ed1i \u01b0u, kh\u00f4ng h\u00fat thu\u1ed1c l\u00e1, v\u00e0 tr\u00e1nh c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 c\u1ea5y gh\u00e9p [1, 2].<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                            Ngu\u1ed3n t\u00e0i li\u1ec7u: Clinical Cases in Implant Dentistry, First Edition – Published 2017 by John Wiley & Sons, Inc.<\/em><\/p>\n

                            1. Diz P, Scully C, Sanz M. Dental implants in the medically compromised patient. J Dent 2013;41:195\u2013206.<\/em><\/p>\n

                            2. G\u00f3mez-de Diego R, Mang-de la Rosa M, Romero-P\u00e9rez MJ, et al. Indications and contraindications of dental implants in medically compromised patients: update. Med Oral Patol Oral Cir Bucal 2014;19(5):e483-e489.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

                            M\u1ee5c ti\u00eau c\u1ee7a ca l\u00e2m s\u00e0ng n\u00e0y: Hi\u1ec3u \u0111\u01b0\u1ee3c nh\u1eefng b\u1ec7nh l\u00fd y khoa c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 th\u1ea5t b\u1ea1i ho\u1eb7c bi\u1ebfn ch\u1ee9ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p, \u1ea3nh h\u01b0\u1edfng c\u1ee7a thu\u1ed1c l\u00ean \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p, c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh y khoa tuy\u1ec7t \u0111\u1ed1i c\u1ee7a \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p nha khoa v\u00e0 […]<\/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":"\nCa l\u00e2m s\u00e0ng 02: C\u00e1c v\u1ea5n \u0111\u1ec1 Y khoa \u0111\u1ebfn ph\u1eabu thu\u1eadt Implant.<\/title>\n<meta name=\"description\" content=\"Ca l\u00e2m s\u00e0ng n\u00e0y ch\u1ee7 y\u1ebfu n\u00f3i v\u1ec1 c\u00e1c v\u1ea5n \u0111\u1ec1 Y khoa \u0111\u1ebfn ph\u1eabu thu\u1eadt Implant. 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