{"id":31270,"date":"2023-05-03T19:08:04","date_gmt":"2023-05-03T12:08:04","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31270"},"modified":"2023-05-03T21:44:28","modified_gmt":"2023-05-03T14:44:28","slug":"chuan-bi-vi-tri-cay-ghep-doi-voi-tai-tao-xuong-co-huong-dan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/03\/chuan-bi-vi-tri-cay-ghep-doi-voi-tai-tao-xuong-co-huong-dan\/","title":{"rendered":"Chu\u1ea9n b\u1ecb v\u1ecb tr\u00ed c\u1ea5y gh\u00e9p \u0111\u1ed1i v\u1edbi t\u00e1i t\u1ea1o x\u01b0\u01a1ng c\u00f3 h\u01b0\u1edbng d\u1eabn."},"content":{"rendered":"<p><strong>X\u01b0\u01a1ng l\u00e0nh m\u1ea1nh v\u00e0 \u0111\u1ea7y \u0111\u1ee7 l\u00e0 \u0111i\u1ec1u ki\u1ec7n c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1eb7t implant \u0111\u1ea1t ch\u1ee9c n\u0103ng v\u00e0 th\u1ea9m m\u1ef9. N\u1ebfu kh\u00f4ng th\u1ecfa m\u00e3n \u0111i\u1ec1u ki\u1ec7n n\u00e0y, c\u1ea7n ch\u1ec9 \u0111\u1ecbnh gh\u00e9p x\u01b0\u01a1ng tr\u01b0\u1edbc khi \u0111\u1eb7t implant. Th\u1ee7 thu\u1eadt gh\u00e9p s\u1ebd ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 ph\u1ee9c t\u1ea1p c\u1ee7a thi\u1ebfu h\u1ed5ng. B\u00e0i vi\u1ebft n\u00e0y ch\u1ee7 y\u1ebfu \u0111\u1ec1 c\u1eadp \u0111\u1ebfn v\u1ea5n \u0111\u1ec1 chu\u1ea9n b\u1ecb v\u1ecb tr\u00ed c\u1ea5y gh\u00e9p \u0111\u1ed1i v\u1edbi t\u00e1i t\u1ea1o x\u01b0\u01a1ng c\u00f3 h\u01b0\u1edbng d\u1eabn, \u0111\u1ed3ng th\u1eddi s\u01a1 l\u01b0\u1ee3c v\u1ec1 c\u00e1c lo\u1ea1i m\u00e0ng s\u1eed d\u1ee5ng trong qu\u00e1 tr\u00ecnh n\u00e0y. C\u00f9ng t\u00ecm hi\u1ec3u.<\/strong><\/p>\n<h2>1. Kh\u00e1i ni\u1ec7m v\u1ec1 chu\u1ea9n b\u1ecb v\u1ecb tr\u00ed c\u1ea5y gh\u00e9p<\/h2>\n<p>M\u00f4 c\u1ee9ng v\u00e0 m\u00f4 m\u1ec1m th\u01b0\u1eddng c\u1ea7n \u0111\u01b0\u1ee3c &#8220;chu\u1ea9n b\u1ecb\u201d (t\u00e1i t\u1ea1o\/ph\u1ee5c h\u1ed3i) \u0111\u1ec3 cho ph\u00e9p \u0111\u1eb7t implant v\u00e0o v\u1ecb tr\u00ed l\u00fd t\u01b0\u1edfng v\u1ec1 ch\u1ee9c n\u0103ng l\u1eabn th\u1ea9m m\u1ef9 v\u1edbi \u0111\u1ee7 x\u01b0\u01a1ng \u0111\u1ee7 n\u00e2ng \u0111\u1ee1 [4]. C\u00f3 nhi\u1ec1u lo\u1ea1i khi\u1ebfm khuy\u1ebft m\u00f4 c\u1ee9ng, v\u1edbi m\u1ee9c \u0111\u1ed9 ph\u1ee9c t\u1ea1p kh\u00e1c nhau, bao g\u1ed3m thi\u1ebfu h\u1ed3ng x\u01b0\u01a1ng theo chi\u1ec1u ngang ho\u1eb7c chi\u1ec1u \u0111\u1ee9ng ho\u1eb7c c\u1ea3 hai [1]. Quy tr\u00ecnh gh\u00e9p \u0111\u1ec3 chu\u1ea9n b\u1ecb v\u1ecb tr\u00ed c\u1ea5y gh\u00e9p th\u01b0\u1eddng thay \u0111\u1ed5i t\u00f9y theo m\u1ee9c \u0111\u1ed9 ph\u1ee9c t\u1ea1p c\u1ee7a thi\u1ebfu h\u1ed5ng. C\u00f3 nhi\u1ec1u lo\u1ea1i v\u1eadt li\u1ec7u gh\u00e9p kh\u00e1c nhau v\u1edbi nh\u1eefng t\u00ednh ch\u1ea5t sinh h\u1ecdc kh\u00e1c nhau. Nh\u1eefng t\u00ednh ch\u1ea5t n\u00e0y c\u00f9ng v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 to\u00e0n th\u00e2n v\u00e0 y\u1ebfu t\u1ed1 m\u00f4i tr\u01b0\u1eddng t\u1ea1i ch\u1ed7 c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 gh\u00e9p [4]. Khi\u1ebfm khuy\u1ebft m\u00f4 m\u1ec1m l\u1edbn \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t d\u1ec5 d\u00e0ng tr\u01b0\u1edbc khi \u0111\u1eb7t implant, c\u00f2n nh\u1eefng khi\u1ebfm khuy\u1ebft nh\u1ecf c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft v\u00e0o th\u1eddi \u0111i\u1ec3m \u0111\u1eb7t implant [4].<\/p>\n<p>X\u01b0\u01a1ng l\u00e0nh m\u1ea1nh v\u00e0 \u0111\u1ea7y \u0111\u1ee7 l\u00e0 \u0111i\u1ec1u ki\u1ec7n c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1eb7t implant \u0111\u1ea1t ch\u1ee9c n\u0103ng v\u00e0 th\u1ea9m m\u1ef9. N\u1ebfu kh\u00f4ng th\u1ecfa m\u00e3n \u0111i\u1ec1u ki\u1ec7n n\u00e0y, c\u1ea7n ch\u1ec9 \u0111\u1ecbnh gh\u00e9p x\u01b0\u01a1ng tr\u01b0\u1edbc khi \u0111\u1eb7t implant [4]. Th\u1ee7 thu\u1eadt gh\u00e9p s\u1ebd ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 ph\u1ee9c t\u1ea1p c\u1ee7a thi\u1ebfu h\u1ed5ng. T\u00e1i t\u1ea1o x\u01b0\u01a1ng c\u00f3 h\u01b0\u1edbng d\u1eabn GBR l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt ph\u1ed5 bi\u1ebfn, trong \u0111\u00f3 s\u1eed d\u1ee5ng m\u00e0ng ng\u0103n \u0111\u1ec3 ng\u0103n c\u00e1ch v\u1ecb tr\u00ed gh\u00e9p kh\u1ecfi m\u00f4 m\u1ec1m ph\u00eda tr\u00ean. K\u00e9o gi\u00e3n x\u01b0\u01a1ng (distraction osteogenesis) v\u00e0 n\u00e2ng xoang c\u0169ng l\u1ea7n l\u01b0\u1ee3t \u0111\u01b0\u1ee3c S\u1eec d\u1ee5ng \u0111\u1ec3 c\u1ea3i thi\u1ec7n chi\u1ec1u r\u1ed9ng v\u00e0 chi\u1ec1u cao c\u1ee7a s\u1ed1ng h\u00e0m b\u1ecb khi\u1ebfm khuy\u1ebft [4].<\/p>\n<h2>2. T\u1ed5ng quan v\u1ec1 c\u00e1c lo\u1ea1i m\u00e0ng ng\u0103n s\u1eed d\u1ee5ng trong qu\u00e1 tr\u00ecnh t\u00e1i t\u1ea1o x\u01b0\u01a1ng c\u00f3 h\u01b0\u1edbng d\u1eabn (GBR)<\/h2>\n<p>T\u00e1i t\u1ea1o x\u01b0\u01a1ng c\u00f3 h\u01b0\u1edbng d\u1eabn GBR v\u00e0 k\u1ef9 thu\u1eadt gh\u00e9p ban \u0111\u1ea7u s\u1eed d\u1ee5ng m\u00e0ng l\u1ecdc (gi\u1ea5y) Millipore kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi th\u1ef1c t\u1ebf [5]. M\u00e0ng polytetrafluoroethylene l\u1ea7n \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u00e0o n\u0103m 1984 v\u00e0 \u0111\u01b0\u1ee3c xem l\u00e0 ti\u00eau chu\u1ea9n cho GBR [6] v\u1edbi k\u1ebft qu\u1ea3 tuy\u1ec7t v\u1eddi. Lo\u1ea1i m\u00e0ng kh\u00f4ng ti\u00eau n\u00e0y ph\u1ea3i \u0111\u01b0\u1ee3c l\u1ea5y ra v\u00e0o l\u1ea7n ph\u1eabu thu\u1eadt th\u1ee9 hai v\u00e0o th\u1eddi \u0111i\u1ec3m 4-6 tu\u1ea7n sau l\u1ea7n ph\u1eabu thu\u1eadt th\u1ee9 nh\u1ea5t. Th\u00f4ng th\u01b0\u1eddng, m\u00e0ng kh\u00f4ng ti\u00eau c\u00f3 th\u1ec3 b\u1ecb l\u1ed9 trong th\u1eddi gian l\u00e0nh th\u01b0\u01a1ng v\u00e0 b\u1ecb nhi\u1ec5m, d\u1eabn \u0111\u1ebfn ph\u1ea3i l\u1ea5y ra s\u1edbm, t\u1eeb \u0111\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 t\u00e1i t\u1ea1o. M\u00e0ng ti\u00eau \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n \u0111\u1ec3 kh\u1eafc ph\u1ee5c c\u00e1c h\u1ea1n ch\u1ebf n\u00e0y [5]. Nh\u1eefng m\u00e0ng n\u00e0y c\u00f3 th\u1ec3 c\u00f3 ngu\u1ed3n g\u1ed1c \u0111\u1ed9ng v\u1eadt ho\u1eb7c polymer t\u1ed5ng h\u1ee3p. Ch\u00fang d\u1ea7n d\u1ea7n b\u1ecb th\u1ee7y ph\u00e2n ho\u1eb7c b\u1ecb enzyme ph\u00e2n h\u1ee7y [7], v\u00e0 do \u0111\u00f3, kh\u00f4ng c\u1ea7n ph\u1eabu thu\u1eadt th\u00ec hai \u0111\u1ec3 l\u1ea5y m\u00e0ng ra. Ngu\u1ed3n g\u1ed1c c\u1ee7a ch\u00fang r\u1ea5t \u0111a d\u1ea1ng, trong giai \u0111o\u1ea1n \u0111\u1ea7u l\u00e0 collagen b\u00f2, polylactic acid, polyglycolide, Vicryl, da nh\u00e2n t\u1ea1o, v\u00e0 m\u00e0ng c\u1ee9ng \u0111\u00f4ng kh\u00f4. M\u00e0ng t\u1ed5ng h\u1ee3p \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n g\u1ea7n \u0111\u00e2y th\u01b0\u1eddng k\u1ebft h\u1ee3p nhi\u1ec1u lo\u1ea1i v\u1eadt li\u1ec7u [8].<\/p>\n<p>M\u00e0ng collagen th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong GBR, v\u00e0 l\u00e0 collagen lo\u1ea1i I ho\u1eb7c II c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb b\u00f2 ho\u1eb7c l\u1ee3n. Ch\u00fang th\u01b0\u1eddng li\u00ean k\u1ebft ch\u00e9o v\u00e0 ti\u00eau sau 4 \u0111\u1ebfn 40 tu\u1ea7n t\u00f9y lo\u1ea1i. M\u00e0ng ti\u00eau collagen kh\u00f4ng c\u1ea7n ph\u1eabu thu\u1eadt \u0111\u1ec3 l\u1ea5y ra. Nh\u1eefng m\u00e0ng n\u00e0y ng\u0103n c\u1ea3n s\u1ef1 di chuy\u1ec3n t\u0103ng sinh c\u1ee7a t\u1ebf b\u00e0o bi\u1ec3u m\u00f4, \u1ed5n \u0111\u1ecbnh v\u1eadt li\u1ec7u gh\u00e9p h\u1ea1t, v\u00e0 ng\u0103n ng\u1eeba m\u1ea5t m\u00e1u b\u1eb1ng c\u00e1ch k\u00edch th\u00edch s\u1ef1 k\u1ebft d\u00ednh ti\u1ec3u c\u1ea7u \u0111\u1ec3 h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u \u0111\u00f4ng s\u1edbm v\u00e0 \u1ed5n \u0111\u1ecbnh v\u1ebft th\u01b0\u01a1ng [5, 6]. Nh\u1eefng m\u00e0ng n\u00e0y c\u00f2n c\u00f3 th\u1ec3 t\u1ea1o thu\u1eadn l\u1ee3i cho s\u1ef1 \u0111\u00f3ng k\u00edn v\u1ebft th\u01b0\u01a1ng ban \u0111\u1ea7u nh\u1edd t\u00ednh ch\u1ea5t h\u00f3a h\u01b0\u1edbng \u0111\u1ed9ng nguy\u00ean b\u00e0o s\u1ee3i [6].<\/p>\n<figure id=\"attachment_31288\" aria-describedby=\"caption-attachment-31288\" style=\"width: 708px\" class=\"wp-caption alignnone\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-31288 size-full\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/3-Figure3-1.png\" alt=\"tai-tao-xuong-1\" width=\"708\" height=\"856\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/3-Figure3-1.png 708w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/3-Figure3-1-248x300.png 248w\" sizes=\"(max-width: 708px) 100vw, 708px\" \/><figcaption id=\"caption-attachment-31288\" class=\"wp-caption-text\">M\u00e0ng ti\u00eau collagen ng\u0103n c\u1ea3n s\u1ef1 di chuy\u1ec3n t\u0103ng sinh c\u1ee7a t\u1ebf b\u00e0o bi\u1ec3u m\u00f4, \u1ed5n \u0111\u1ecbnh v\u1eadt li\u1ec7u gh\u00e9p h\u1ea1t, v\u00e0 ng\u0103n ng\u1eeba m\u1ea5t m\u00e1u b\u1eb1ng c\u00e1ch k\u00edch th\u00edch s\u1ef1 k\u1ebft d\u00ednh ti\u1ec3u c\u1ea7u \u0111\u1ec3 h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u \u0111\u00f4ng s\u1edbm v\u00e0 \u1ed5n \u0111\u1ecbnh v\u1ebft th\u01b0\u01a1ng<\/figcaption><\/figure>\n<p>M\u1ed9t v\u1ea5n \u0111\u1ec1 c\u1ea7n xem x\u00e9t sau khi chu\u1ea9n b\u1ecb v\u1ecb tr\u00ed c\u1ea5y gh\u00e9p l\u00e0 c\u1ea7n th\u1eddi gian l\u00e0nh th\u01b0\u01a1ng bao l\u00e2u tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh \u0111\u1eb7t implant. K\u1ebft h\u1ee3p v\u1eadt li\u1ec7u gh\u00e9p v\u00e0o v\u1ecb tr\u00ed nh\u1eadn v\u00e0 s\u1ef1 t\u1ea1o x\u01b0\u01a1ng s\u1ed1ng t\u1ea1i v\u1ecb tr\u00ed n\u00e0y c\u1ea7n kho\u1ea3ng th\u1eddi gian kh\u00e1c nhau. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho r\u1eb1ng n\u00ean ch\u1edd 4-6 th\u00e1ng tr\u01b0\u1edbc khi \u0111\u1eb7t implant. Tuy nhi\u00ean, th\u1eddi gian l\u00e0nh th\u01b0\u01a1ng sau khi chu\u1ea9n b\u1ecb tr\u00ed c\u1ea5y gh\u00e9p c\u00f2n thay \u0111\u1ed5i ph\u1ee5 thu\u1ed9c nhi\u1ec1u y\u1ebfu t\u1ed1, ch\u1eb3ng h\u1ea1n nh\u01b0 y\u1ebfu t\u1ed1 b\u1ec7nh nh\u00e2n (th\u00f3i quen, t\u00ecnh tr\u1ea1ng to\u00e0n th\u00e2n), v\u1eadt li\u1ec7u gh\u00e9p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, v\u00e0 k\u00edch th\u01b0\u1edbc c\u1ee7a v\u1ecb tr\u00ed gh\u00e9p [9, 10]. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u kh\u00e1c cho th\u1ea5y implant c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u1eb7t c\u00f9ng l\u00fac gh\u00e9p (ph\u1eabu thu\u1eadt m\u1ed9t th\u00ec) n\u1ebfu c\u00f3 \u0111\u1ee7 x\u01b0\u01a1ng \u0111\u1ec3 t\u1ea1o ra \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh implant s\u01a1 kh\u1edfi.<\/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<p><em>1. Lindhe JKT. Clinical Periodontology and Implant Dentistry, 4th edn. Hoboken, NJ: Wiley-Blackwell; 2003.<\/em><br \/>\n<em>2. Seibert JS, Salama H. Alveolar ridge preservation and<\/em><br \/>\n<em>reconstruction. Periodontol 2000 1996;11:69-84. 3. Miller Jr PD. Periodontal plastic surgery. Curr Opin Periodontol 1993:136-143.<\/em><br \/>\n<em>4. American Academy of Periodontology. Guidelines for management of patients with periodontal disease. J Mich Dent Assoc 2006;88(10):24.<\/em><br \/>\n<em>5. Miller N, Penaud J, Foliguet B, et al. Resorption rates of 2 commercially available bioresorbable membranes. A histomorphometric study in a rabbit model. J Clin Periodontol 1996;23(12):1051\u20131059.<\/em><br \/>\n<em>6. Juodzbalys G, Raustia AM, Kubilius R. A 5-year follow- up study on one-stage implants inserted concomitantly with localized alveolar ridge augmentation. J Oral Rehabil 2007;34(10):781-789.<\/em><br \/>\n<em>7. Duskova M, Leamerova E, Sosna B, Gojis O. Guided tissue regeneration, barrier membranes and reconstruction of the cleft maxillary alveolus. J Craniofac Surg 2006;17(6):1153-1160.<\/em><br \/>\n<em>8. Wang HL, Boyapati L. &#8220;PASS&#8221; principles for predictable bone regeneration. Implant Dent 2006;15(1):8-17.<\/em><br \/>\n<em>9. Chen ST, Wilson Jr TG, H\u00e4mmerle CH. Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes. Int J Oral Maxillofac Implants 2004;19(Suppl):12-25.<\/em><br \/>\n<em>10. Bell RB, Blakey GH, White RP, et al. Staged reconstruction of the severely atrophic mandible with autogenous bone graft and endosteal implants. J Oral Maxillofac Surg 2002;60(10):1135-1141.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>X\u01b0\u01a1ng l\u00e0nh m\u1ea1nh v\u00e0 \u0111\u1ea7y \u0111\u1ee7 l\u00e0 \u0111i\u1ec1u ki\u1ec7n c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1eb7t implant \u0111\u1ea1t ch\u1ee9c n\u0103ng v\u00e0 th\u1ea9m m\u1ef9. N\u1ebfu kh\u00f4ng th\u1ecfa m\u00e3n \u0111i\u1ec1u ki\u1ec7n n\u00e0y, c\u1ea7n ch\u1ec9 \u0111\u1ecbnh gh\u00e9p x\u01b0\u01a1ng tr\u01b0\u1edbc khi \u0111\u1eb7t implant. Th\u1ee7 thu\u1eadt gh\u00e9p s\u1ebd ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 ph\u1ee9c t\u1ea1p c\u1ee7a thi\u1ebfu h\u1ed5ng. 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