{"id":29268,"date":"2023-04-29T11:02:44","date_gmt":"2023-04-29T04:02:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29268"},"modified":"2023-05-01T23:27:58","modified_gmt":"2023-05-01T16:27:58","slug":"thuoc-anh-huong-den-su-tich-hop-xuong-cua-implant","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/thuoc-anh-huong-den-su-tich-hop-xuong-cua-implant\/","title":{"rendered":"Thu\u1ed1c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 t\u00edch h\u1ee3p x\u01b0\u01a1ng c\u1ee7a Implant."},"content":{"rendered":"<p><strong>M\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y ra bi\u1ebfn ch\u1ee9ng trong ho\u1eb7c sau ph\u1eabu thu\u1eadt c\u1ea5y gh\u00e9p, ho\u1eb7c c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng l\u00ean s\u1ef1 l\u00e0nh th\u01b0\u01a1ng, s\u1ef1 t\u00edch h\u1ee3p x\u01b0\u01a1ng s\u1edbm v\u00e0 mu\u1ed9n, v\u00e0 c\u00f3 th\u1ec3 d\u1eabn t\u1edbi c\u1ea5y gh\u00e9p th\u1ea5t b\u1ea1i. C\u00f9ng t\u00ecm hi\u1ec3u m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn qu\u00e1 tr\u00ecnh n\u00e0y.\u00a0<\/strong><\/p>\n<h2>1. Thu\u1ed1c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn qu\u00e1 tri\u1ec3n n\u01b0\u1edbu.<\/h2>\n<ul>\n<li>Thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh (phenyltoin). Phenyltoin l\u00e0 thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh v\u00e0 \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e0 g\u00e2y ph\u00ec \u0111\u1ea1i n\u01b0\u1edbu khi c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a m\u1ea3ng b\u00e1m. Qu\u00e1 tri\u1ec3n n\u01b0\u1edbu c\u00f2n x\u1ea3y ra xung quanh abutment xuy\u00ean n\u01b0\u1edbu\/ni\u00eam m\u1ea1c n\u1ebfu c\u00f3 s\u1ef1 t\u00edch t\u1ee5 m\u1ea3ng b\u00e1m. Lo\u1ea1i b\u1ecf ph\u1ea7n m\u00f4 m\u1ec1m ph\u00ec \u0111\u1ea1i b\u1eb1ng ph\u1eabu thu\u1eadt c\u1eaft n\u01b0\u1edbu (trong tr\u01b0\u1eddng h\u1ee3p qu\u00e1 tri\u1ec3n \u00edt) ho\u1eb7c ph\u1eabu thu\u1eadt l\u1eadt v\u1ea1t (khi kh\u1ed1i l\u01b0\u1ee3ng m\u00f4 l\u1edbn h\u01a1n). Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u v\u1ec1 implant nha khoa \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng phenyltoin.<\/li>\n<li>Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb cao huy\u1ebft \u00e1p (thu\u1ed1c kh\u00f3a k\u00eanh calcium). C\u00e1c thu\u1ed1c kh\u00f3a k\u00eanh dihydropyridine calcium \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb cao huy\u1ebft \u00e1p g\u00e2y qu\u00e1 tri\u1ec3n n\u01b0\u1edbu l\u00e0 m\u1ed9t t\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p. Ch\u01b0a c\u00f3 d\u1eef li\u1ec7u v\u1ec1 nguy c\u01a1 qu\u00e1 tri\u1ec3n n\u01b0\u1edbu \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y khi \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p.<\/li>\n<li>Thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch (cyclosporin). Cyclosporin v\u00e0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u00ea cho b\u1ec7nh nh\u00e2n gh\u00e9p t\u1ea1ng, c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ph\u00ec \u0111\u1ea1i n\u01b0\u1edbu nh\u01b0 m\u1ed9t t\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p. Qu\u00e1 tri\u1ec3n n\u01b0\u1edbu d\u01b0\u1eddng nh\u01b0 kh\u00f4ng li\u00ean quan \u0111\u1ebfn m\u1ea3ng b\u00e1m. Cyclosporin \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u l\u00ean c\u00e1c implant \u0111\u00e3 t\u00edch h\u1ee3p x\u01b0\u01a1ng, c\u1ee5 th\u1ec3 l\u00e0 n\u00f3 \u1ea3nh h\u01b0\u1edfng l\u00ean s\u1ef1 chu chuy\u1ec3n x\u01b0\u01a1ng v\u00e0 l\u00e0m m\u1ea5t c\u00e2n b\u1eb1ng x\u01b0\u01a1ng.<\/li>\n<\/ul>\n<h2>2. Thu\u1ed1c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn qu\u00e1 tr\u00ecnh \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu serotonin ch\u1ecdn l\u1ecdc (SSRIs)<\/h2>\n<p>\u0110\u00e2y l\u00e0 thu\u1ed1c th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u1ea5t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tr\u1ea7m c\u1ea3m, \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 chuy\u1ec3n h\u00f3a x\u01b0\u01a1ng v\u00e0 t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp l\u00ean s\u1ef1 t\u1ea1o x\u01b0\u01a1ng b\u1eb1ng c\u00e1ch t\u0103ng s\u1ef1 bi\u1ec7t h\u00f3a h\u1ee7y c\u1ed1t b\u00e0o. K\u1ebft qu\u1ea3 l\u00e0 ch\u00fang l\u00e0m gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng x\u01b0\u01a1ng v\u00e0 m\u1eadt \u0111\u1ed9 kho\u00e1ng x\u01b0\u01a1ng, \u0111\u1ed3ng th\u1eddi l\u00e0m t\u0103ng nguy c\u01a1 lo\u00e3ng x\u01b0\u01a1ng v\u00e0 g\u00e3y x\u01b0\u01a1ng. Trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 g\u1ea7n \u0111\u00e2y, c\u00e1c t\u00e1c gi\u1ea3 nh\u1eadn th\u1ea5y \u0111i\u1ec1u tr\u1ecb b\u1eb1ng SSRIs c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c t\u0103ng nguy c\u01a1 th\u1ea5t b\u1ea1i c\u1ee7a c\u00e1c implant \u0111\u00e3 t\u00edch h\u1ee3p x\u01b0\u01a1ng, do \u0111\u00f3 c\u1ea7n l\u1eadp k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt c\u1ea9n th\u1eadn \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng SSRI.<\/p>\n<h2>3. Nh\u00f3m thu\u1ed1c Bisphosphonate<\/h2>\n<p>Bisphosphonate l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn s\u1ef1 ti\u00eau x\u01b0\u01a1ng (lo\u00e3ng x\u01b0\u01a1ng ho\u1eb7c b\u1ec7nh Paget), ung th\u01b0 x\u01b0\u01a1ng di c\u0103n, h\u1ed9i ch\u1ee9ng c\u1eadn ung th\u01b0, v\u00e0 \u0111a u t\u1ee7y. Ch\u00fang c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng qua \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch. Nguy c\u01a1 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng bisphosphonate \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn, \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 nguy c\u01a1 ho\u1ea1i t\u1eed x\u01b0\u01a1ng h\u00e0m do bisphosphonate (BRONJ). Lo\u1ea1t b\u1ec7nh nh\u00e2n ph\u00e1t tri\u1ec3n BRONJ sau c\u1ea5y gh\u00e9p nha khoa \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 nhi\u1ec1u nh\u1ea5t cho \u0111\u1ebfn hi\u1ec7n nay l\u00e0 27 b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng bisphosphonate, c\u1ea3 \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch (alendronate, zoledronic acid, v\u00e0 pamidronate). Th\u1eddi gian trung b\u00ecnh t\u1eeb l\u00fac \u0111\u1eb7t implant \u0111\u1ebfn l\u00fac xu\u1ea5t hi\u1ec7n BRONJ l\u00e0 16 th\u00e1ng. Trong m\u1ed9t b\u00e1o c\u00e1o lo\u1ea1i case kh\u00e1c v\u1ec1 BRONJ sau c\u1ea5y gh\u00e9p nha khoa, m\u1ed9t l\u1ea7n n\u1eefa \u1edf c\u1ea3 nh\u1eefng b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng bisphosphonate \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch, \u0111\u00e3 cho th\u1ea5y \u0111\u1eb7t implant \u1edf v\u00f9ng r\u0103ng sau d\u01b0\u1eddng nh\u01b0 c\u00f3 nguy c\u01a1 ph\u00e1t tri\u1ec3n BRONJ cao h\u01a1n. BRONJ th\u1ef1c s\u1ef1 l\u00e0 v\u1ea5n \u0111\u1ec1 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb bisphosphonate ti\u00eam t\u0129nh m\u1ea1ch, nh\u01b0ng t\u1ea7n s\u1ed1 BRONJ \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng bisphosphonate \u0111\u01b0\u1eddng u\u1ed1ng l\u1ea1i r\u1ea5t \u00edt. Vi\u1ec7c s\u1eed d\u1ee5ng bisphosphonate \u0111\u01b0\u1eddng u\u1ed1ng t\u1ea1i th\u1eddi \u0111i\u1ec3m \u0111\u1eb7t implant v\u00e0 trong su\u1ed1t giai \u0111o\u1ea1n l\u00e0nh th\u01b0\u1eddng d\u01b0\u1eddng nh\u01b0 kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 th\u00e0nh c\u00f4ng s\u1edbm c\u1ee7a implant. V\u00e0o n\u0103m 2007, Hi\u1ec7p h\u1ed9i B\u00e1c s\u0129 ph\u1eabu thu\u1eadt h\u00e0m m\u1eb7t Hoa K\u1ef3 \u0111\u00e3 \u0111\u01b0a ra h\u01b0\u1edbng d\u1eabn d\u00e0nh cho b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng bisphosphonate \u0111\u01b0\u1eddng u\u1ed1ng, d\u1ef1a tr\u00ean t\u00ecnh hu\u1ed1ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 th\u1eddi gian u\u1ed1ng thu\u1ed1c, cho r\u1eb1ng n\u00ean th\u1eadn tr\u1ecdng h\u01a1n tr\u01b0\u1edbc v\u00e0 sau ph\u1eabu thu\u1eadt trong v\u00f2ng 3 n\u0103m sau khi ng\u01b0ng \u0111i\u1ec1u tr\u1ecb bisphosphonate. Hai t\u1ed5ng quan h\u1ec7 th\u1ed1ng cho th\u1ea5y \u0111\u1eb7t implant \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n u\u1ed1ng bisphosphonate l\u00e2u ng\u00e0y kh\u00f4ng d\u1eabn \u0111\u1ebfn BRONJ v\u00e0 kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u1ef7 l\u1ec7 t\u1ed3n t\u1ea1i ng\u1eafn h\u1ea1n c\u1ee7a implant. C\u00e1c t\u00e1c gi\u1ea3 k\u1ebft lu\u1eadn r\u1eb1ng c\u1ea5y gh\u00e9p nha khoa c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t th\u1ee7 thu\u1eadt an to\u00e0n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n u\u1ed1ng bisphosphonate trong v\u00f2ng &lt; 5 n\u0103m, v\u00e0 implant nha khoa c\u00f3 th\u1ec3 t\u00edch h\u1ee3p x\u01b0\u01a1ng v\u00e0 duy tr\u00ec \u1ed5n \u0111\u1ecbnh ch\u1ee9c n\u0103ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng bisphosphonate. T\u00f3m l\u1ea1i, c\u00f3 s\u1ef1 nh\u1ea5t tr\u00ed v\u1ec1 vi\u1ec7c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ea5y gh\u00e9p \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng bisphosphonate ti\u00eam t\u0129nh m\u1ea1ch. Trong khi \u0111\u00f3, nh\u1eefng b\u1ec7nh nh\u00e2n lo\u00e3ng x\u01b0\u01a1ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi bisphosphonate n\u00ean \u0111\u01b0\u1ee3c th\u00f4ng b\u00e1o v\u1ec1 nguy c\u01a1 c\u1ea5y gh\u00e9p th\u1ea5t b\u1ea1i c\u0169ng nh\u01b0 nguy c\u01a1 ho\u1ea1i t\u1eed x\u01b0\u01a1ng v\u00e0 k\u1ebft qu\u1ea3 n\u00e2ng xoang k\u00e9m, v\u00e0 do \u0111\u00f3, c\u1ea7n ph\u1ea3i \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 \u0111\u1ed3ng thu\u1eadn t\u1eeb b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt c\u1ea5y gh\u00e9p nha khoa.<\/p>\n<h2>4. \u0110i\u1ec1u tr\u1ecb corticosteroid<\/h2>\n<p>Nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a corticosteroid g\u1ed3m c\u00f3 gi\u1ea3m m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng, l\u00e0m m\u1ecfng bi\u1ec3u m\u00f4, v\u00e0 \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch. Do \u0111\u00f3, vi\u1ec7c s\u1eed d\u1ee5ng glucocorticoid to\u00e0n th\u00e2n c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 t\u00edch h\u1ee3p x\u01b0\u01a1ng c\u1ee7a implant v\u00e0 s\u1ef1 l\u00e0nh th\u01b0\u01a1ng quanh implant. Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb corticosteroid l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a c\u1ea5y gh\u00e9p nha khoa, nh\u01b0ng c\u1ea7n l\u01b0u \u00fd r\u1eb1ng corticosteroid to\u00e0n th\u00e2n c\u00f3 th\u1ec3 g\u00e2y \u1ee9c ch\u1ebf tr\u1ee5c h\u1ea1 \u0111\u1ed3i-tuy\u1ebfn y\u00ean-th\u01b0\u1ee3ng th\u1eadn, v\u00e0 do \u0111\u00f3 c\u1ea7n tu\u00e2n th\u1ee7 nh\u1eefng khuy\u1ebfn c\u00e1o ti\u00eau chu\u1ea9n khi ph\u1eabu thu\u1eadt mi\u1ec7ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb steroid. C\u01a1 quan ki\u1ec3m so\u00e1t thu\u1ed1c v\u1eabn khuy\u00ean r\u1eb1ng b\u1ec7nh nh\u00e2n \u0111\u00e3 k\u1ebft th\u00fac \u0111\u1ee3t \u0111i\u1ec1u tr\u1ecb corticosteroid to\u00e0n th\u00e2n d\u01b0\u1edbi 3 tu\u1ea7n nh\u01b0ng c\u00f3 th\u1ec3 \u0111ang trong t\u00ecnh tr\u1ea1ng c\u0103ng th\u1eb3ng, ch\u1eb3ng h\u1ea1n nh\u01b0 ch\u1ea5n th\u01b0\u01a1ng, ph\u1eabu thu\u1eadt, ho\u1eb7c nhi\u1ec5m tr\u00f9ng, v\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 suy gi\u1ea3m tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn, th\u00ec n\u00ean \u0111i\u1ec1u tr\u1ecb bao ph\u1ee7 corticosteroid to\u00e0n th\u00e2n trong giai \u0111o\u1ea1n n\u00e0y.<\/p>\n<p><em>Ngu\u1ed3n t\u00e0i li\u1ec7u: Clinical Cases in Implant Dentistry, First Edition &#8211; Published 2017 by John Wiley &amp; Sons, Inc.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>M\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y ra bi\u1ebfn ch\u1ee9ng trong ho\u1eb7c sau ph\u1eabu thu\u1eadt c\u1ea5y gh\u00e9p, ho\u1eb7c c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng l\u00ean s\u1ef1 l\u00e0nh th\u01b0\u01a1ng, s\u1ef1 t\u00edch h\u1ee3p x\u01b0\u01a1ng s\u1edbm v\u00e0 mu\u1ed9n, v\u00e0 c\u00f3 th\u1ec3 d\u1eabn t\u1edbi c\u1ea5y gh\u00e9p th\u1ea5t b\u1ea1i. C\u00f9ng t\u00ecm hi\u1ec3u m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn qu\u00e1 tr\u00ecnh [&hellip;]<\/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":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Thu\u1ed1c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 t\u00edch h\u1ee3p x\u01b0\u01a1ng c\u1ee7a Implant. - Vinmec<\/title>\n<meta name=\"description\" content=\"M\u1ed9t s\u1ed1 thu\u1ed1c \u1ea3nh h\u01b0\u1edfng l\u00e0nh th\u01b0\u01a1ng, t\u00edch h\u1ee3p x\u01b0\u01a1ng s\u1edbm v\u00e0 mu\u1ed9n, d\u1eabn t\u1edbi c\u1ea5y gh\u00e9p th\u1ea5t b\u1ea1i. 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