{"id":28942,"date":"2023-04-27T22:17:08","date_gmt":"2023-04-27T15:17:08","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28942"},"modified":"2023-05-01T23:40:01","modified_gmt":"2023-05-01T16:40:01","slug":"benh-ly-toan-than-thuoc-tac-dong-den-cay-ghep-implant","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/27\/benh-ly-toan-than-thuoc-tac-dong-den-cay-ghep-implant\/","title":{"rendered":"B\u1ec7nh l\u00fd to\u00e0n th\u00e2n\/thu\u1ed1c t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn c\u1ea5y gh\u00e9p Implant."},"content":{"rendered":"

\u0110\u1ed1i v\u1edbi Nha s\u0129, vi\u1ec7c n\u1eafm v\u1eefng v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng Y khoa t\u1edbi c\u1ea5y gh\u00e9p Implant r\u1ea5t quan tr\u1ecdng, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u00e1c \u0111\u1ed9ng c\u1ee7a b\u1ec7nh l\u00fd to\u00e0n th\u00e2n\/thu\u1ed1c t\u1edbi qu\u00e1 tr\u00ecnh c\u1ea5y gh\u00e9p Implant. C\u00f9ng t\u00ecm hi\u1ec3u c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan n\u00e0y b\u1eb1ng c\u00e1c c\u00e2u h\u1ecfi th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng, gi\u00fap \u00edch \u0111\u01b0\u1ee3c r\u1ea5t nhi\u1ec1u trong qu\u00e1 tr\u00ecnh ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/strong><\/p>\n

\"benh-ly-toan-than-\"<\/p>\n

1. C\u00e1c b\u1ec7nh l\u00fd to\u00e0n th\u00e2n v\u00e0\/ho\u1eb7c c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd to\u00e0n th\u00e2n c\u00f3 t\u00e1c \u0111\u1ed9ng nh\u01b0 th\u1ebf n\u00e0o l\u00ean s\u1ef1 th\u00e0nh c\u00f4ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p?<\/strong><\/p>\n

\u1ea2nh h\u01b0\u1edfng c\u1ee7a c\u00e1c nguy c\u01a1 s\u1ee9c kh\u1ecfe l\u00ean k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng b\u1edfi v\u00ec ch\u1ec9 c\u00f3 m\u1ed9t v\u00e0i th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng 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. V\u1ec1 nguy\u00ean t\u1eafc, ch\u1ec9 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng th\u1ec3 ch\u1ea5t \u0111\u1ed9 I (P1: b\u1ec7nh nh\u00e2n kh\u1ecfe m\u1ea1nh b\u00ecnh th\u01b0\u1eddng) ho\u1eb7c \u0111\u1ed9 II (P2: b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd to\u00e0n th\u00e2n nh\u1eb9) theo Hi\u1ec7p h\u1ed9i G\u00e2y m\u00ea Hoa K\u1ef3 (ASA) m\u1edbi \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt, ch\u1eb3ng h\u1ea1n nh\u01b0 c\u1ea5y gh\u00e9p nha khoa, v\u00e0 nguy c\u01a1 ph\u1eabu thu\u1eadt c\u1ee7a b\u1ec7nh nh\u00e2n ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc so v\u1edbi l\u1ee3i \u00edch m\u00e0 c\u1ea5y gh\u00e9p nha khoa c\u00f3 th\u1ec3 \u0111em l\u1ea1i cho h\u1ecd [1, 14-16]. \u0110\u1ed1i v\u1edbi c\u00e1c v\u1ea5n \u0111\u1ec1 y khoa c\u1ea5p t\u00ednh v\u00e0 nghi\u00eam tr\u1ecdng (t\u00ecnh tr\u1ea1ng th\u1ec3 ch\u1ea5t ASA x\u1ebfp lo\u1ea1i P3 \u0111\u1ebfn P6), vi\u1ec7c t\u00ednh to\u00e1n nguy c\u01a1 th\u1ea5t b\u1ea1i d\u01b0\u1eddng nh\u01b0 l\u00e0 b\u1ea5t kh\u1ea3 thi b\u1edfi v\u00ec nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng nh\u01b0 v\u1eady h\u1ea7u nh\u01b0 kh\u00f4ng bao gi\u1edd \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p. M\u1ed9t \u1ea5n ph\u1ea9m g\u1ea7n \u0111\u00e2y n\u00f3i r\u1eb1ng \u0111i\u1ec1u tr\u1ecb nha khoa cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c x\u1ebfp lo\u1ea1i P4 ho\u1eb7c cao h\u01a1n n\u00ean \u0111\u01b0\u1ee3c tr\u00ec ho\u00e3n cho \u0111\u1ebfn khi t\u00ecnh tr\u1ea1ng y khoa c\u1ee7a b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh v\u00e0 c\u1ea3i thi\u1ec7n t\u1ed1i thi\u1ec3u \u0111\u1ebfn P3 [17]. C\u00e1c b\u1ec7nh l\u00fd to\u00e0n th\u00e2n c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u00f4 trong mi\u1ec7ng b\u1eb1ng c\u00e1ch t\u0103ng t\u00ednh nh\u1ea1y c\u1ea3m v\u1edbi nh\u1eefng b\u1ec7nh l\u00fd kh\u00e1c ho\u1eb7c c\u1ea3n tr\u1edf s\u1ef1 l\u00e0nh th\u01b0\u01a1ng.<\/p>\n

Ngo\u00e0i ra, c\u00e1c t\u00ecnh tr\u1ea1ng to\u00e0n th\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ho\u1eb7c nh\u1eefng li\u1ec7u ph\u00e1p kh\u00e1c, t\u1eeb \u0111\u00f3 c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn implant v\u00e0 m\u00f4 xung quanh [3]. C\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u kh\u00e1c nhau, ch\u1ee7 y\u1ebfu l\u00e0 nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u, \u0111\u00e1nh gi\u00e1 t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 y khoa\/to\u00e0n th\u00e2n v\u00e0\/ho\u1eb7c thu\u1ed1c l\u00ean k\u1ebft qu\u1ea3 t\u00edch h\u1ee3p x\u01b0\u01a1ng c\u1ee7a implant, nh\u01b0ng c\u1ea7n th\u1eadn tr\u1ecdng khi ngo\u1ea1i suy t\u1eeb nh\u1eefng k\u1ebft qu\u1ea3 n\u00e0y, b\u1edfi v\u00ec kh\u00f4ng th\u1ec3 thu \u0111\u01b0\u1ee3c qu\u00e1 nhi\u1ec1u th\u00f4ng tin t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u nh\u01b0 v\u1eady n\u1ebfu thi\u1ebfu s\u1ef1 hi\u1ec3u bi\u1ebft v\u1ec1 bi\u1ec3u hi\u1ec7n v\u00e0 b\u1ea3n ch\u1ea5t c\u1ee7a b\u1ec7nh l\u00fd to\u00e0n th\u00e2n li\u00ean quan [18, 19]. M\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 c\u00f2n x\u00e1c \u0111\u1ecbnh nh\u1eefng b\u1ec7nh l\u00fd kh\u00f4ng n\u00ean \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p, ho\u1eb7c c\u1ea7n ph\u1ea3i d\u00e8 d\u1eb7t, nh\u01b0ng v\u1eabn ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng cho \u0111i\u1ec1u n\u00e0y [20-23]. Do \u0111\u00f3, li\u1ec7u m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 to\u00e0n th\u00e2n\/thu\u1ed1c c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn s\u1ef1 t\u00edch h\u1ee3p x\u01b0\u01a1ng l\u00ean giao di\u1ec7n implant hay kh\u00f4ng v\u00e0 \u1ea3nh h\u01b0\u1edfng c\u1ee7a ch\u00fang trong giai \u0111o\u1ea1n l\u00e0nh th\u01b0\u01a1ng l\u00e0 nh\u01b0 th\u1ebf n\u00e0o v\u1eabn l\u00e0 c\u00e2u h\u1ecfi \u0111ang g\u00e2y tranh c\u00e3i.<\/p>\n

2. V\u1ea5n \u0111\u1ec1 t\u00edch h\u1ee3p x\u01b0\u01a1ng<\/strong><\/p>\n

T\u00edch h\u1ee3p x\u01b0\u01a1ng l\u00e0 m\u1ed9t kh\u00e1i ni\u1ec7m sinh h\u1ecdc \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng trong c\u1ea5y gh\u00e9p nha khoa [3]. S\u1ef1 duy tr\u00ec x\u01b0\u01a1ng l\u00e2u d\u00e0i quanh m\u1ed9t implant \u0111\u00e3 t\u00edch h\u1ee3p x\u01b0\u01a1ng l\u00e0 \u0111i\u1ec1u t\u1ed1i quan tr\u1ecdng cho s\u1ef1 th\u00e0nh c\u00f4ng l\u00e2m s\u00e0ng, v\u00e0 s\u1ef1 t\u00e1i t\u1ea1o x\u01b0\u01a1ng quanh implant c\u0169ng r\u1ea5t quan tr\u1ecdng cho t\u1ef7 l\u1ec7 t\u1ed3n t\u1ea1i l\u00e2u d\u00e0i c\u1ee7a implant [4]. Ng\u01b0\u1eddi ta tin r\u1eb1ng c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 ti\u00eau x\u01b0\u01a1ng quanh implant: y\u1ebfu t\u1ed1 t\u1ea1i ch\u1ed7, y\u1ebfu t\u1ed1 c\u1ea5y gh\u00e9p, y\u1ebfu t\u1ed1 ph\u1ee5c h\u00ecnh, v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 li\u00ean quan \u0111\u1ebfn b\u1ec7nh nh\u00e2n, bao g\u1ed3m b\u1ec7nh l\u00fd to\u00e0n th\u00e2n, thu\u1ed1c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd to\u00e0n th\u00e2n, \u0111\u1eb7c \u0111i\u1ec3m di truy\u1ec1n, s\u1eed d\u1ee5ng thu\u1ed1c ho\u1eb7c r\u01b0\u1ee3u trong th\u1eddi gian d\u00e0i, v\u00e0 h\u00fat thu\u1ed1c l\u00e1 [4]. S\u1ef1 h\u00ecnh th\u00e0nh kho\u1ea3ng sinh h\u1ecdc quanh implant l\u00e0 l\u00fd thuy\u1ebft \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn r\u1ed9ng r\u00e3i v\u1ec1 s\u1ef1 ti\u00eau x\u01b0\u01a1ng sinh l\u00fd v\u00e0 n\u00ean \u0111\u01b0\u1ee3c hi\u1ec3u l\u00e0 m\u1ed9t hi\u1ec7n t\u01b0\u1ee3ng sinh l\u00fd. N\u00f3 \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh do s\u1ef1 ti\u00eau x\u01b0\u01a1ng \u0111\u1ec3 ph\u00f9 h\u1ee3p v\u1edbi c\u1ea5u tr\u00fac m\u00f4 m\u1ec1m, v\u1edbi s\u1ed1 \u0111o trung b\u00ecnh theo chi\u1ec1u \u0111\u1ee9ng l\u00e0 1.5-2 mm [5-9]. S\u1ef1 ti\u00eau x\u01b0\u01a1ng \u0111i\u1ec3n h\u00ecnh ti\u1ebfp theo s\u1ebd l\u00e0 ti\u00eau g\u1edd x\u01b0\u01a1ng d\u1ea7n d\u1ea7n sau khi \u0111\u00e3 t\u00edch h\u1ee3p x\u01b0\u01a1ng.<\/p>\n

C\u00e1c m\u1ee9c \u0111\u1ed9 ti\u00eau x\u01b0\u01a1ng kh\u00e1c nhau ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c [10]. M\u1ed9t nghi\u00ean c\u1ee9u b\u00e1o c\u00e1o r\u1eb1ng ti\u00eau x\u01b0\u01a1ng d\u1ea7n d\u1ea7n 0.2 mm sau n\u0103m \u0111\u1ea7u ti\u00ean th\u1ef1c hi\u1ec7n ch\u1ee9c n\u0103ng v\u00e0 \u2264 0.2 mm m\u1ed7i n\u0103m trong nh\u1eefng n\u0103m ti\u1ebfp theo c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem l\u00e0 th\u00e0nh c\u00f4ng [11]. M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c l\u1ea1i ch\u1ea5p nh\u1eadn ti\u00eau x\u01b0\u01a1ng 2 mm sau 5 n\u0103m k\u1ec3 t\u1eeb th\u1eddi \u0111i\u1ec3m \u0111\u1eb7t implant [12]. Tuy nhi\u00ean, m\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c g\u1ea7n \u0111\u00e2y \u0111\u00e3 b\u00e1o c\u00e1o v\u1ec1 vi\u1ec7c ti\u00eau x\u01b0\u01a1ng 3 mm v\u1ec1 ph\u00eda giao di\u1ec7n abutment-implant sau 5-20 n\u0103m th\u1ef1c hi\u1ec7n ch\u1ee9c n\u0103ng [13]. M\u1eb7c d\u00f9 nh\u1eefng nghi\u00ean c\u1ee9u tr\u00ean [11-13] \u0111\u1ec1u ch\u1ea5p nh\u1eadn ti\u00eau x\u01b0\u01a1ng l\u00ean \u0111\u1ebfn 2 mm sau nhi\u1ec1u n\u0103m, nh\u01b0ng v\u1eabn ch\u01b0a c\u00f3 s\u1ef1 \u0111\u1ed3ng thu\u1eadn v\u1ec1 v\u1ea5n \u0111\u1ec1 n\u00e0y. Kh\u00f4ng nh\u1eefng v\u1eady, t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 t\u1ea1i ch\u1ed7 v\u00e0 to\u00e0n th\u00e2n l\u00ean ti\u1ebfn tr\u00ecnh ti\u00eau x\u01b0\u01a1ng quanh implant \u0111\u00e3 t\u00edch h\u1ee3p x\u01b0\u01a1ng c\u0169ng c\u00f2n g\u00e2y tranh c\u00e3i [10].<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o:<\/p>\n

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

3. Bornstein MM, Cionca N, Mombelli A. Systemic conditions and treatments as risks for implant therapy. Int J Oral Maxillofac Implants 2009;24(Suppl): 12-27.<\/p>\n

4. Clementini M, Rossetti PHO, Penarrocha D, et al. Systemic risk factors for peri-implant bone loss: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2014;43:323-334.<\/p>\n

5. Berglundh T, Lindhe J, Ericsson I, et al. The soft tissue barrier at implants and teeth. Clin Oral Implants Res 1991;2:81-90.<\/p>\n

6. Sanz M, Alendaz J, Lazaro P, et al. Histopathologic characteristics of peri-implant soft tissues in Br\u00e5nemark implants with 2 distinct clinical and radiographic patterns. Clin Oral Implants Res 1991;2:128-134.<\/p>\n

7. Quirynen M, Van Steenberghe D. Bacterial colonization of the internal part of two stage implants: an in vivo study. Clin Oral Implants Res 1993;4:158-161.<\/p>\n

8. Hermann JS, Cochran DL, Nummicoski PV, et al. Crestal bone changes around titanium implants: a radiographic evaluation of unloaded nonsubmerged and submerged implants in the canine mandible. J Periodontol 1997;68:1117-1130.<\/p>\n

9. Jansen VK, Conrads G, Richter EJ. Microbial leakage and marginal fit of the implant abutment interface. Int J Oral Maxillofac Implants 1997;12:527-540.<\/p>\n

10. De Souza JGO, Pereira Neto ARL, et al. Impact of local and systemic factors on additional peri-implant bone loss. Quintessence Int 2013;44:415-424.<\/p>\n

11. Albrektsson T, Isidor F. Consensus report of session IV. In: Lang NP, Karring, T (eds), Proceedings of the 1st European Workshop on Periodontology. London: Quintessence; 1994, pp 365-369.<\/p>\n

12. Wennstr\u00f6m J, Palmer R. Consensus report session 3: clinical trials. In: Lang NP, Karring T, Lindhe J (eds), Proceedings of the 3rd European Workshop on Periodontology. Implant Dentistry. Berlin: Quintessence; 1999, pp 255-259.<\/p>\n

13. Fransson C, Lekholm U, Jemt T, Berglundh T. Prevalence of subjects with progressive bone loss at implants. Clin Oral Implants Res 2005;16:440-446.<\/p>\n

14. Meijer GJ, Cune MS. Surgical dilemmas. Medical restrictions and risk factors. Ned Tijdschr Tandheelkd 2008;115:643-651 (in Dutch).<\/p>\n

15. Bornstein MM, Cionca N, Mombelli A. Systemic conditions and treatments as risks for implant therapy. Int J Oral Maxillofac Implants 2009;24(Suppl): 12-27.<\/p>\n

16. American Society of Anesthesiologists. New classification of physical status. Anesthesiology 1963;24:111.<\/p>\n

17. Maloney WJ Weinberg MA. Implementation of the American Society of Anesthesiologists physical status classification system in periodontal practice. J Periodontol 2008;79:1124-1126.<\/p>\n

18. Smith RA, Berger R, Dodson TB. Risk factors associated with dental implants in healthy and medically compromised patients. Int J Oral Maxillofac Implants 1992;7:367-372.<\/p>\n

19. Van Steenberghe D, Quirinen M, Molly L, Jacobs R. Impact of systemic diseases and medication on osseointegration. Periodontol 2000 2003;33:163-171.<\/p>\n

20. Blanchaert RH. Implants in the medically challenged patient. Dent Clin North Am 1998;42:35-45.<\/p>\n

21. Sugerman PB, Barber MT. Patient selection for endosseous dental implants: oral and systemic considerations. Int J Oral Maxillofac Implants 2002;17:191-201.<\/p>\n

22. Hwang D, Wang HL. Medical contraindications to implant therapy: part I: absolute contraindications. Implant Dent 2006;15:353-360.<\/p>\n

23. Hwang D, Wang HL. Medical contraindications to implant therapy: part II: relative contraindications. Implant Dent 2007;16:13-23.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u0110\u1ed1i v\u1edbi Nha s\u0129, vi\u1ec7c n\u1eafm v\u1eefng v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng Y khoa t\u1edbi c\u1ea5y gh\u00e9p Implant r\u1ea5t quan tr\u1ecdng, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u00e1c \u0111\u1ed9ng c\u1ee7a b\u1ec7nh l\u00fd to\u00e0n th\u00e2n\/thu\u1ed1c t\u1edbi qu\u00e1 tr\u00ecnh c\u1ea5y gh\u00e9p Implant. 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