{"id":31533,"date":"2023-05-04T06:56:45","date_gmt":"2023-05-03T23:56:45","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31533"},"modified":"2023-05-04T21:17:14","modified_gmt":"2023-05-04T14:17:14","slug":"yeu-to-tang-truong-xuong-trong-tai-tao-xuong-co-huong-dan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/yeu-to-tang-truong-xuong-trong-tai-tao-xuong-co-huong-dan\/","title":{"rendered":"Y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng x\u01b0\u01a1ng trong t\u00e1i t\u1ea1o x\u01b0\u01a1ng c\u00f3 h\u01b0\u1edbng d\u1eabn."},"content":{"rendered":"

B\u00e0i vi\u1ebft n\u00e0y t\u1ed5ng quan v\u1ec1 c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng x\u01b0\u01a1ng trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt t\u00e1i t\u1ea1i x\u01b0\u01a1ng c\u00f3 h\u01b0\u1edbng d\u1eabn, cung c\u1ea5p cho nha s\u0129 g\u00f3c nh\u00ecn \u0111a chi\u1ec1u v\u1ec1 lo\u1ea1i y\u1ebfu t\u1ed1 n\u00e0y trong ph\u1eabu thu\u1eadt t\u00e1i t\u1ea1o kh\u00e1c nhau. C\u00f9ng t\u00ecm hi\u1ec3u chi ti\u1ebft h\u01a1n trong b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y.<\/strong><\/p>\n

1. T\u1ed5ng quan h\u1ec7 th\u1ed1ng v\u1eadn chuy\u1ec3n c\u1ee7a y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng<\/h2>\n

N\u00f3i chung, c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng c\u1ea7n c\u00f3 h\u1ec7 th\u1ed1ng v\u1eadn chuy\u1ec3n, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 carrier, \u0111\u1ec3 ph\u00e2n ph\u1ed1i \u0111\u1ebfn v\u1ecb tr\u00ed \u0111\u00edch v\u00e0 t\u1ed1i \u0111a h\u00f3a hi\u1ec7u qu\u1ea3 c\u1ee7a ch\u00fang l\u00ean m\u00f4 xung quanh. M\u1ed9t h\u1ec7 th\u1ed1ng v\u1eadn chuy\u1ec3n l\u00fd t\u01b0\u1edfng c\u1ea7n c\u00f3 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m sau: (1) an to\u00e0n v\u00e0 kh\u00f4ng g\u00e2y \u0111\u1ed9c cho c\u01a1 th\u1ec3 ch\u1ee7, (2) kh\u00f4ng g\u00e2y mi\u1ec5n d\u1ecbch, (3) t\u01b0\u01a1ng h\u1ee3p sinh h\u1ecdc v\u1edbi c\u01a1 th\u1ec3 ch\u1ee7, (4) t\u1ed1c \u0111\u1ed9 ti\u00eau sinh h\u1ecdc ph\u00f9 h\u1ee3p m\u00e0 kh\u00f4ng c\u1ea3n tr\u1edf s\u1ef1 t\u00e1i t\u1ea1o m\u00f4, (5) \u0111\u1ed9ng h\u1ecdc t\u1ed1i \u01b0u \u0111\u1ec3 ph\u00f3ng th\u00edch y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng d\u1ea7n d\u1ea7n theo th\u1eddi gian, (6) c\u1ea5u tr\u00fac nguy\u00ean v\u1eb9n \u0111\u1ec3 duy tr\u00ec kho\u1ea3ng t\u1ea1i v\u1ecb tr\u00ed gh\u00e9p, (7) gi\u00e1 th\u1ec3 cho t\u1ebf b\u00e0o di c\u01b0, t\u0103ng sinh, v\u00e0 bi\u1ec7t h\u00f3a, v\u00e0 (8) thao t\u00e1c d\u1ec5 d\u00e0ng.<\/p>\n

Cho \u0111\u1ebfn nay, \u03b2<\/em>-fricalcium phosphate (\u03b2<\/em>-TCP) l\u00e0 h\u1ec7 th\u1ed1ng v\u1eadn chuy\u1ec3n cho rhPDGF-BB duy nh\u1ea5t \u0111\u01b0\u1ee3c FDA Hoa K\u1ef3 c\u00f4ng nh\u1eadn. \u03b2<\/em>-TCP l\u00e0 m\u1ed9t v\u1eadt li\u1ec7u t\u1ed5ng h\u1ee3p \u0111\u01b0\u1ee3c l\u00e0m t\u1eeb mu\u1ed1i calcium v\u00e0 acid phosphoric. Nh\u1eefng v\u1eadt li\u1ec7u \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 carrier cho rhPDGF bao g\u1ed3m FDBA h\u1ea1t, FDBA h\u1ea1t kh\u1eed kho\u00e1ng, v\u00e0 x\u01b0\u01a1ng gh\u00e9p h\u1ea1t d\u1ecb lo\u1ea1i.<\/p>\n

H\u1ec7 th\u1ed1ng v\u1eadn chuy\u1ec3n rhBMP-2 duy nh\u1ea5t \u0111\u01b0\u1ee3c FDA Hoa K\u1ef3 c\u00f4ng nh\u1eadn l\u00e0 mi\u1ebfng x\u1ed1p collagen ti\u00eau (ACS) c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb collagen lo\u1ea1i I trong g\u00e2n b\u00f2. C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ee9ng minh \u0111\u01b0\u1ee3c t\u00ednh an to\u00e0n, t\u00ednh kh\u1ea3 thi, v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng ACS l\u00e0m carrier cho rhBMP-2 trong ph\u1eabu thu\u1eadt gh\u00e9p x\u01b0\u01a1ng. M\u1eb7c d\u00f9 ACS c\u00f3 nhi\u1ec1u \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a m\u1ed9t carrier l\u00fd t\u01b0\u1edfng, nh\u01b0ng n\u00f3 kh\u00f4ng c\u00f3 s\u1ef1 to\u00e0n v\u1eb9n c\u1ea5u tr\u00fac v\u00e0 b\u1ecb h\u1ea5p thu b\u1edfi c\u01a1 th\u1ec3 ch\u1ee7 trong m\u1ed9t th\u1eddi gian t\u01b0\u01a1ng \u0111\u1ed1i ng\u1eafn. V\u00ec nh\u1eefng nh\u01b0\u1ee3c \u0111i\u1ec3m n\u00e0y, n\u00ean c\u00e1c v\u1eadt li\u1ec7u kh\u00e1c, ch\u1eb3ng h\u1ea1n nh\u01b0 x\u01b0\u01a1ng gh\u00e9p d\u1ecb lo\u1ea1i v\u00e0 x\u01b0\u01a1ng gh\u00e9p \u0111\u1ed3ng lo\u1ea1i, \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi rhBMP-2 v\u00e0 ACS.<\/p>\n

rhPDGF-BB (khu\u00f4n t\u0103ng c\u01b0\u1eddng y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng Gem 21S, Osteohealth) \u0111\u01b0\u1ee3c cung c\u1ea5p d\u01b0\u1edbi d\u1ea1ng ch\u1ea5t l\u1ecfng (0.5 mL) trong m\u1ed9t \u1ed1ng b\u01a1m \u1edf n\u1ed3ng \u0111\u1ed9 0.3 mg\/mL. Carrier, ch\u1eb3ng h\u1ea1n nh\u01b0 FDBA h\u1ea1t, \u0111\u01b0\u1ee3c h\u00f2a v\u1edbi rhPDGF-BB trong kho\u1ea3ng 15 ph\u00fat b\u1eb1ng k\u1ef9 thu\u1eadt v\u00f4 khu\u1ea9n \u0111\u00fang, \u0111\u1ec3 cho ph\u00e9p rhPDGF b\u00e1m d\u00ednh v\u00e0o carrier. Sau \u0111\u00f3, FDBA h\u1ea1t \u0111\u00e3 ho\u00e0 v\u1edbi thPDGF \u0111\u01b0\u1ee3c cho v\u00e0o v\u1ecb tr\u00ed thi\u1ebfu h\u1ed3ng x\u01b0\u01a1ng v\u00e0 nh\u1ed3i d\u01b0\u1edbi \u00e1p l\u1ef1c v\u1eeba ph\u1ea3i. Ch\u1ea3y m\u00e1u nhi\u1ec1u ph\u1ea3i \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t tr\u01b0\u1edbc khi \u0111\u1eb7t rhPDGF-BB \u0111\u1ec3 gi\u1ea3m s\u1ef1 r\u1eeda tr\u00f4i rhPDGF do m\u00e1u. Carrier \u0111\u00e3 h\u00f2a v\u1edbi rhPDGF sau \u0111\u00f3 \u0111\u01b0\u1ee3c ph\u1ee7 b\u1eb1ng m\u00e0ng ng\u0103n, v\u00e0 v\u1ea1t ni\u00eam m\u1ea1c m\u00e0ng x\u01b0\u01a1ng ph\u00eda tr\u00ean \u0111\u01b0\u1ee3c kh\u00e2u l\u1ea1i \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 \u0111\u00f3ng k\u00edn ban \u0111\u1ea7u m\u00e0 kh\u00f4ng g\u00e2y c\u0103ng. rhBMP-2 (x\u01b0\u01a1ng gh\u00e9p INFUSE, BioHorizon) c\u00f3 n\u1ed3ng \u0111\u1ed9 1.5 mg\/mL v\u1edbi li\u1ec1u l\u01b0\u1ee3ng dao \u0111\u1ed9ng t\u1eeb 1.05 \u0111\u1ebfn 12.0 mg. rhBMP-2 \u0111\u01b0\u1ee3c cung c\u1ea5p d\u01b0\u1edbi d\u1ea1ng b\u1ed9t \u0111\u00f4ng kh\u00f4 n\u00ean n\u00f3 ph\u1ea3i \u0111\u01b0\u1ee3c h\u00f2a v\u1edbi n\u01b0\u1edbc c\u1ea5t trong 15 ph\u00fat. Dung d\u1ecbch rhBMP-2 sau \u0111\u00f3 \u0111\u01b0\u1ee3c cho l\u00ean ACS trong khu v\u1ef1c v\u00f4 khu\u1ea9n. Kho\u1ea3ng th\u1eddi gian 15 ph\u00fat s\u1ebd cho ph\u00e9p protein rhBMP-2 li\u00ean k\u1ebft v\u1edbi mi\u1ebfng x\u1ed1p collagen. rhBMP-2\/ACS ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c cho v\u00e0o v\u00f9ng thi\u1ebfu h\u1ed5ng v\u1edbi \u00e1p l\u1ef1c nh\u1eb9. V\u1ea1t ni\u00eam m\u1ea1c m\u00e0ng x\u01b0\u01a1ng ph\u00eda tr\u00ean rhBMP-2\/ACS \u0111\u01b0\u1ee3c kh\u00e2u l\u1ea1i \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 \u0111\u00f3ng k\u00edn ban \u0111\u1ea7u.<\/p>\n

2. S\u1eed d\u1ee5ng y\u1ebfu t\u1ed1 n\u00e0y trong t\u00e1i t\u1ea1o x\u01b0\u01a1ng c\u00f3 h\u01b0\u1edbng d\u1eabn c\u00f3 th\u1ef1c s\u1ef1 l\u00e0m t\u0103ng kh\u1ed1i l\u01b0\u1ee3ng x\u01b0\u01a1ng hay kh\u00f4ng?<\/h2>\n

Jung v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 l\u00e2m s\u00e0ng, m\u00f4 h\u1ecdc, v\u00e0 X-quang c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng PDGF-BB ho\u1eb7c BMP-2 trong ph\u1eabu thu\u1eadt GBR trong t\u1ed5ng quan h\u1ec7 th\u1ed1ng c\u1ee7a m\u00ecnh [1, 2]. Do s\u1ed1 l\u01b0\u1ee3ng nghi\u00ean c\u1ee9u h\u1ea1n ch\u1ebf v\u00e0 m\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng kh\u00e1c nhau n\u00ean v\u1eabn ch\u01b0a th\u1ec3 r\u00fat ra k\u1ebft lu\u1eadn cho v\u1ea5n \u0111\u1ec1 n\u00e0y. Tuy nhi\u00ean, c\u00e1c t\u00e1c gi\u1ea3 nh\u1eadn th\u1ea5y, nh\u00ecn chung, vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng n\u00e0y trong ph\u1eabu thu\u1eadt GBR c\u00f3 th\u1ec3 mang l\u1ea1i l\u1ee3i \u00edch. C\u1ea7n c\u00f3 th\u00eam nh\u1eefng th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean c\u00f3 nh\u00f3m ch\u1ee9ng \u0111\u1ec3 tr\u1ea3 l\u1eddi c\u00e2u h\u1ecfi n\u00e0y.<\/p>\n

C\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng nh\u01b0 PDGF v\u00e0 BMP-2 hi\u1ec7n di\u1ec7n trong c\u01a1 th\u1ec3 \u1edf n\u1ed3ng \u0111\u1ed9 sinh l\u00fd \u0111\u1ee7 \u0111\u1ec3 g\u00e2y ra t\u00e1c \u0111\u1ed9ng sinh h\u1ecdc. Do nhu c\u1ea7u s\u1eed d\u1ee5ng rhPDGF-BB v\u00e0 rhBMP-2 \u1edf n\u1ed3ng \u0111\u1ed9 cao \u0111\u1ec3 \u0111em l\u1ea1i k\u1ebft qu\u1ea3 mong mu\u1ed1n, n\u00ean m\u1ed9t m\u1ed1i lo ng\u1ea1i khi s\u1eed d\u1ee5ng nh\u1eefng y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng t\u00e1i t\u1ed5 h\u1ee3p c\u1ee7a ng\u01b0\u1eddi n\u00e0y l\u00e0 kh\u1ea3 n\u0103ng g\u00e2y ung th\u01b0 v\u00e0 c\u00e1c s\u1ef1 ki\u1ec7n mi\u1ec5n d\u1ecbch \u1edf c\u01a1 th\u1ec3 ch\u1ee7. S\u1ef1 t\u1ea1o x\u01b0\u01a1ng th\u1eeba t\u1ea1i nh\u1eefng v\u1ecb tr\u00ed ngo\u00e0i \u00fd mu\u1ed1n c\u0169ng l\u00e0 m\u1ed9t m\u1ed1i lo ng\u1ea1i kh\u00e1c. FDA Hoa K\u1ef3 y\u00eau c\u1ea7u kh\u00f4ng s\u1eed d\u1ee5ng c\u1ea3 rhPDGF -BB v\u00e0 rhBMP-2 \u1edf ph\u1ee5 n\u1eef mang thai, b\u1edfi v\u00ec nh\u1eefng t\u00e1c \u0111\u1ed9ng ti\u1ec1m \u1ea9n c\u1ee7a c\u00e1c ph\u00e2n t\u1eed profein n\u00e0y l\u00ean b\u00e0o thai \u0111ang ph\u00e1t tri\u1ec3n v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u0111\u1ea7y \u0111\u1ee7.<\/p>\n

M\u1eb7c d\u00f9 c\u00f3 m\u1ed9t v\u00e0i b\u00e1o c\u00e1o v\u1ec1 t\u00e1c d\u1ee5ng ph\u1ee5 trong nha khoa li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng rhPDGF-BB v\u00e0 rhBMP-2, nh\u01b0ng \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i hi\u1ec3u \u0111\u01b0\u1ee3c nguy c\u01a1 c\u1ee7a ch\u00fang. V\u00ed d\u1ee5, rhBMP-2 c\u00f3 th\u1ec3 g\u00e2y vi\u00eam xoang khi s\u1eed d\u1ee5ng trong n\u00e2ng xoang gh\u00e9p x\u01b0\u01a1ng, ho\u1eb7c ph\u00f9 do vi\u00eam g\u00e2y ra b\u1edfi rhBMP-2 c\u00f3 th\u1ec3 l\u00e0m s\u01b0ng m\u1eb7t v\u00e0 th\u1eadm ch\u00ed l\u00e0 m\u1ea5t c\u1ea3m gi\u00e1c n\u1ebfu kh\u1ed1i s\u01b0ng t\u1ea1o \u00e1p l\u1ef1c \u0111\u00e8 l\u00ean d\u00e2y th\u1ea7n kinh.<\/p>\n

3. T\u1ed5ng quan v\u1ec1 PRP<\/h2>\n

PRP l\u00e0 huy\u1ebft t\u01b0\u01a1ng ch\u1ee9a ti\u1ec3u c\u1ea7u \u0111\u1eadm \u0111\u1eb7c thu t\u1eeb m\u00e1u t\u1ef1 th\u00e2n. PRP ch\u1ee9a c\u1ea3 ba \u0111\u1ed3ng ph\u00e2n PDGF (PDGF-AA, PDGF-AB, v\u00e0 PDGF-BB), VEGF, y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng chuy\u1ec3n d\u1ea1ng \u00df-1 v\u00e0 \u00df-2, EGF, v\u00e0 c\u00e1c ph\u00e2n t\u1eed b\u00e1m d\u00ednh t\u1ebf b\u00e0o nh\u01b0 vitronectin, fibrin, v\u00e0 fibronectin thi\u1ebft y\u1ebfu cho s\u1ef1 l\u00e0nh th\u01b0\u01a1ng.<\/p>\n

PRP \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c th\u00fac \u0111\u1ea9y s\u1ef1 t\u00e1i t\u1ea1o x\u01b0\u01a1ng trong c\u00e1c \u1ee9ng d\u1ee5ng nha khoa. Tuy nhi\u00ean, nh\u1eefng b\u00e1o c\u00e1o kh\u00e1c c\u0169ng \u0111\u1eb7t ra c\u00e2u h\u1ecfi v\u1ec1 l\u1ee3i \u00edch to\u00e0n b\u1ed9 c\u1ee7a PRP trong s\u1ef1 t\u1ea1o x\u01b0\u01a1ng. S\u1ef1 m\u00e2u thu\u1eabn n\u00e0y d\u01b0\u1eddng nh\u01b0 xu\u1ea5t ph\u00e1t t\u1eeb vi\u1ec7c thu th\u1eadp v\u00e0 chu\u1ea9n b\u1ecb PRP. V\u00ed d\u1ee5, ly t\u00e2m m\u00e1u ph\u1ea3i ch\u00ednh x\u00e1c \u0111\u1ec3 t\u00e1ch ti\u1ec3u c\u1ea7u kh\u1ecfi h\u1ed3ng c\u1ea7u nh\u1eb1m thu \u0111\u01b0\u1ee3c ti\u1ec3u c\u1ea7u n\u1ed3ng \u0111\u1ed9 cao m\u00e0 kh\u00f4ng l\u00e0m ph\u00e1 h\u1ee7y ho\u1eb7c ly gi\u1ea3i ti\u1ec3u c\u1ea7u, n\u1ebfu kh\u00f4ng, nh\u1eefng ti\u1ec3u c\u1ea7u n\u00e0y s\u1ebd kh\u00f4ng th\u1ec3 ti\u1ebft ra c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng c\u00f3 ho\u1ea1t t\u00ednh sinh h\u1ecdc. Ngo\u00e0i ra, b\u1eaft bu\u1ed9c ph\u1ea3i s\u1eed d\u1ee5ng PRP \u1edf d\u1ea1ng \u0111\u00f4ng t\u1ee5 cho v\u1ecb tr\u00ed ph\u1eabu thu\u1eadt, b\u1edfi v\u00ec PRP \u0111\u00f4ng t\u1ee5 s\u1ebd cho ph\u00e9p c\u00e1c h\u1ea1t trong ti\u1ec3u c\u1ea7u h\u00f2a v\u00e0o m\u00e0ng t\u1ebf b\u00e0o, t\u1eeb \u0111\u00f3 cho ph\u00e9p ch\u00fang ph\u00f3ng th\u00edch c\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng.<\/p>\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. Jung RE, Thoma DS, Hammerle CH. Assessment of the potential of growth factors for localized alveolar ridge augmentation: a systematic review. J Clin Periodontol 2008;35(8 Suppl):255-281.<\/p>\n

2. Jung RE, Windisch SI, Eggenschwiler AM, et al. A randomized-controlled clinical trial evaluating clinical and radiological outcomes after 3 and 5 years of dental implants placed in bone regenerated by means of GBR techniques with or without the addition of BMP-2. Clin Oral Implants Res 2009;20:660-666.<\/p>\n","protected":false},"excerpt":{"rendered":"

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