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Nghin cu Y hc

Y Hc TP. H Ch Minh * Tp 11 * Ph Bn S 2 * 2007

33 - NH GI KT QU PHU THUT IU TR SANG THNG QUANH CHP RNG T THNG 9/1999 N THNG 9/2001
Hunh Kim Dim*, Phm Th Hng Loan*, L c Lnh*

TM TT
Mc tiu: Nhm nh gi kt qu phu thut iu tr sang thng quanh chp rng, thc hin hi cu trn 24 bnh nhn (34 rng). Phng php: Bnh nhn c ti khm v nh gi dc trn cc tiu chun v lm sng v X quang, Kt qu cho thy hu ht cc trng hp u c lnh thng hon ton trn xng (70%), kt qu tt trn lm sng (80%). Kt lun: Cc trng hp lnh thng xng khng hon ton u lin quan n tnh trng ni nha khng t v thi gian t lc ni nha n lc phu thut di.

ABSTRACT
APICAL RESECTION: AN EVALUATION OF TREATMENT RESULTS (1999 TO 2001) Hunh Kim Dim*, Phm Th Hng Loan*, L c L{nh* * Y Hoc TP. Ho Chi Minh * Vol. 11 Supplement of No 2 - 2007: 240 247 Objective: In order to evaluate the results of apicoectomy, a retrospective study was carried out on 24 cases. Method: Patients were re-examined and apical lesion evaluated using radiographic and clinical criteria. Conclusion: Most cases with incomplete bone repair were related to unacceptable endodontic treatment and/or delayed surgery following eudodontic treatment. ho|n to|n nhng m bnh,< v| quan trng l| T VN s c lp c h thng ng ty vi mi Mc tiu chung ca iu tr ni nha l| bo trng xung quanh. Mt s nh| l}m s|ng cho tn rng, hu ht c{c rng cn iu tr tu u rng vic tr{m ngc cho php c lp h {p ng tt vi phng ph{p iu tr khng thng ng ty mt c{ch hiu qu v| l| mt phu thut. Tuy nhin khi iu tr ni nha yu t v cng quan trng trong s th|nh thng thng gp kh khn, khng th thc cng ca phu thut ct chp. {nh gi{ s hin, hoc mt phc hnh khng th th{o th|nh cng ca phu thut ct chp, c{c t{c g,< hay mt sang thng c kch thc qu{ gi u cho rng ngo|i vic {nh gi{ v vi ln (m| nu ch iu tr ni nha thng thng sinh hc, cn da v|o phim tia X v| mt s s khng th em li s l|nh thng ho|n tiu chun l}m s|ng sau thi gian phu thut. ho) th phng ph{p iu tr bng phu Ti b mn Nh Rng-Tiu Phu Thut, thut s c ch nh nhm mc ch loi b Khoa Rng H|m Mt, i Hc Y Dc nhng nguyn nh}n g}y bnh vng chp v| TP.HCM chng ti thc hin vic iu tr bo tn rng. c{c sang thng quanh chp bng phng Phu thut ct chp ch}n rng nhm loi ph{p phu thut ct chp v| c hay khng c b m bnh vng chp v| c hoc khng c tr{m ngc cho nhiu trng hp l}m s|ng. km tr{m ngc; th|nh cng ca phu thut Nhm {nh gi{ kt qu iu tr v| gp phn ph thuc v|o nhiu yu t, nh mc v x}y dng s liu l thuyt ging dy ca B trng ca qu{ trnh phu thut, s loi b
* Khoa RHM i Hc Y Dc TP. HCM.

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mn, chng ti thc hin nghin cu hi cu {nh gi{ kt qu ca phu thut ct chp iu tr sang thng quanh chp rng t th{ng 09/1999 n th{ng 09/2001, vi mc tiu sau:

Nghin cu Y hc

thut: rng mang phc hnh, ng ty b calci ho{ v| yu t kt hp. Thi gian t lc iu tr ni nha n lc phu thut: tc th sau mt ng|y tr{m bt ng ty (mt ng|y sau khi iu tr ni nha, bnh nh}n c chuyn sang phu thut chp), di s{u th{ng hay t s{u th{ng tr ln. Phim X quang: trn phim quanh chp ghi nhn tnh trng v| kch thc sang thng (u ht, nang), kch thc <1cm hay 1 cm. Tnh trng ni nha: quan s{t vin 1 (ThS. inh Th Kh{nh V}n, B mn Cha Rng) {nh gi{ tnh trng ni nha trn phim quanh chp theo tiu chun sau: Tt: vt liu tr{m bt cn quang ng nht v| c{ch chp ch}n rng t 0,5 n 1mm, khng c khong thu quang gia vt liu tr{m v| th|nh ng ty. Khng tt: khi ng ty thiu d|y c, c ch trng cha c tr{m bt, c khong trng gia vt liu tr{m bt v| th|nh ng ty, c ng ty cha c tr{m (i vi rng nhiu ng ty), ng ty b m rng qu{ mc hay thiu chun b c v chiu d|i v| chiu rng. Khng thy vt liu tr{m bt ng ty (VLTBOT). Ghi nhn lc phu thut: c tr{m ngc hay khng c tr{m ngc. Sau phu thut: Mi bnh nh}n tr li {nh gi{ trn l}m sng v X quang. Phng vn trc tip bnh nh}n c hay khng c triu chng lin quan n rng nguyn nh}n iu tr, bao gm: au sau phu thut, cm gi{c kh chu,< {nh gi{ kt qu l}m s|ng (quan st vin 2). Tt: bnh nh}n ho|n to|n khng c triu chng au nhc ti rng nguyn nh}n. M nha chu bnh thng, nim mc {y h|nh lang vng rng tng ng khng ph n, sung huyt, khng c l d.

Mc tiu tng qut


{nh gi{ kt qu iu tr sang thng quanh chp bng phu thut ct no chp

Mc tiu chuyn bit


- Kho s{t c im dch t hc ca sang thng quanh chp. - {nh gi{ s l|nh thng trn l}m s|ng v| trn phim tia X ca bnh nh}n sau phu thut ct no chp.

I TNG PHNG PHP NGHIN CU i tng nghin cu


Bao gm tt c c{c bnh nh}n c phu thut ct chp c v| khng c tr{m ngc, khng s dng m ghp trn vng sang thng ti B mn Nh Rng Tiu Phu Thut khoa Rng H|m Mt trng i hc Y Dc TP H Ch Minh t th{ng 09/1999 n thng 09/2001.

Phng php nghin cu


Thit k nghin cu Nghin cu hi cu. Qui trnh nghin cu Thu thp s liu trn cc h s bnh n
Tng kt bnh {n ca nhng bnh nh}n c phu thut ct chp rng ti B mn Nh Rng-Tiu Phu Thut t th{ng 09/1999 n thng 09/2001 theo tiu chun chn mu trn. Ghi nhn c{c thng tin t bnh {n D liu v bnh nh}n: tn, tui, gii tnh, s bnh {n. L do n kh{m. V tr sang thng: h|m trn, h|m di, loi rng. Tnh trng bnh nh}n lc n phu thut: yu t sinh hc: sng, au, l d, c hoc khng c sang thng quanh chp; yu t k

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Y Hc TP. H Ch Minh * Tp 11 * Ph Bn S 2 * 2007


nh gi tnh trng trm ngc: Tt: vt liu tr{m ngc (amalgam) nm gn trong xoang tr{m, khng c mnh vn amalgam trong vng phu thut. Khng tt: ming tr{m cn trong hoc nm ngo|i xoang tr{m ngc v| cn st mnh vn amalgam trong vng phu thut, km vi hnh nh thu quang vng chp rng, i khi bnh nh}n c au nh ko d|i.

Trung bnh: bnh nh}n vn cn cm gi{c au nhc m h, khng r r|ng ti rng nguyn nh}n. M nha chu, nim mc {y h|nh lang bnh thng. Xu: bnh nh}n vn cn au ti rng nguyn nh}n, nim mc {y hnh lang ph n, sung huyt, c hoc khng c l d. ng thi ghi nhn c hay khng c i m|u nu ti v tr tr{m ngc. {nh gi{ kt qu trn X quang: l|nh thng trn xng v| tnh trng tr{m ngc (nu c) So s{nh phim trc v| sau phu thut {nh gi{ s l|nh thng trn xng(Quan s{t vin 3). - Lnh thng hon ton: khi c s thu hp hoc mt ho|n to|n sang thng, c hnh th|nh c{c th xng trong vng sang thng vi mt cn quang tng ng vi xng lnh xung quanh. - Lnh thng khng hon ton: kch thc sang thng thu hp so vi ban u, c hnh th|nh xng trong vng sang thng nhng mt cn quang km hn xng l|nh xung quanh. - Khng lnh thng: khi sang thng khng gim kch thc hay ph{t trin ln hn (hnh nh thu quang lan rng), khng c s t{i to xng trong vng sang thng. o kin nh trong vic {nh gi{ s l|nh thng trn X quang, sau ln {nh gi{ u tin 15 ng|y chng ti chn ngu nhin 12 phim c li, ghi nhn kt qu v| so s{nh vi kt qu c ln mt. Kt qu cho thy khng c s khc bit c ngha gia hai ln c phim (p > 0,05).

KT QU
C 24 bnh nh}n (BN) vi 34 rng (R) tha c{c tiu chun chn mu trn; s liu thu thp gm c{c s liu trc phu thut v| sau phu thut. Thu thp trc phu thut (ghi nhn t h s bnh {n)

Cc s liu tng qut


Bng 1. Tng s bnh nhn phn b theo tui, phi
n = 24 BN S lng BN S lng R Tui trung bnh Nam 11 (45,8%) 17 (50%) 30,82,7 N 13 (54,2%) 17 (50%) 26,92,3 Hm di Trc Sau 04 03 11,8% 8,8% 20,6% iu tr d phng Nha s Gy dng chuyn c 04 01

Bng 2. Phn loi rng phu thut


n = 34R S lng R Ti l % Tng cng Hm trn Trc Sau 26 01 76,5% 2,9% 79,4%

Bng 3. Tng s bnh nhn theo l do n khm


C triu chng n = 24 BN Sng, L d au S lng 12 07 BN T l % 50% 29,2% Tng s 79,2%

16,7% 4,1% 20,8%

Cc s liu t khm lm sng


Bng 4. Yu t nh hng n ch nh phu thut
n = 34 S lng R Tng s Yu t sinh hc 24 70,6% Yu t k thut 02 5,9% Yu t kt hp 08 24,5%

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Y Hc TP. H Ch Minh * Tp 11 * Ph Bn S 2 * 2007 Cc s liu ghi nhn t phim X quang


Bng 5. Phn loi tnh trng NN trc PT
NN Khng thy Tng khng VLTBOT cng tt S lng R 34R 13 20 01 (2,9%) 34 (38,3%) (58,8%) (100%) R c phc 09R 0 (0%) 08 01 (11,1%) 09 hnh (88,9%) (100%) R khng 25R 13 12 (48%) 0 (0%) 25 phc hnh (52%) (100%) n NN tt

Nghin cu Y hc

BN LUN V ch nh ca phu thut


Tng kt bnh {n ca 24 bnh nh}n c phu thut ct chp trong nghin cu ghi nhn c 11 nam (45,8%),13 n (44,2%), vi s lng rng phu thut nh nhau (bng1). Rng h|m trn c phu thut ct chp nhiu nht (79,4%) (bng 2), tng t nghin cu Stockdale v| Chandler. a s c{c t{c gi cho rng nhng tht bi ni nha ch yu lin quan n vic iu tr ni nha khng tt hoc do rng c mang phc hnh. Phn ln c{c trng hp tht bi n|y u {p ng tt vi vic iu tr ni nha li theo ng phng ph{p. AAE (Hip hi c{c nh| ni nha Hoa K) cho rng nn thc hin phu thut khi vic iu tr ni nha tht bi hay khng th thc hin c. C{c ch nh n|y bao gm: Nhm 1: lin quan n c{c yu t k thut nh gy dng c 1/3 chp, ng ty b calci ha, d dng, rng mang phc hnh v.v< Nhm 2: lin quan n c{c yu t sinh hc nh cn tn ti dai dng ca c{c triu chng l}m s|ng, hin din ca sang thng quanh chp, hoc kt hp va triu chng va sang thng quanh chp. Nhm 3: kt hp c hai yu t sinh hc v| k thut. Trong nghin cu n|y, ch nh lin quan yu t sinh hc chim 70,6%, yu t k thut 5,9%, v| nhm kt hp 24,5% (bng 4). a s nhng rng c phu thut u c sang thng quanh chp: 94,1% v| tnh trng ni nha khng tt (58,8%). Theo Geoffrey (1995), m ht quanh chp chnh l phn ng t v ca c th gii hn s lan rng ca c cht do vi khun, nu h thng ng ty c l|m sch, to hnh v| tr{m bt tt th phn ng t nhin ca c th s gip l|nh thng v| loi tr c{c sang thng quanh chp. Do , vi c{c rng n|y, sau khi

nh gi sau phu thut


Bng 6. nh gi X quang sau phu thut
n = 34 R Lnh Lnh thng Khng lnh thng khng hon thng hon ton ton 25 09 0 73,4% 26,6% 0% Khng Tng lnh cng thng 0 (0%) 13 (100%) 0 (0%) 20 (100%) 0 (0%) 01 (100%)

S lng R T l %

Bng 7. Lnh thng trn xng theo tnh trng NN


Lnh Lnh thng thng hon khng ton hon ton Rng NN tt 13R 11 02 (15,4%) (84,6%) Rng NN 20R 14 (70%) 06 (30%) khng tt Khng thy 01 0 (0%) 01 (100%) VLTBOT n

Bng 8: nh gi tnh trng trm ngc v i mu nu


C trm ngc Khng trm ngc Tt Khng tt S lng R 10 (29,4%) 04 (11,8%) 20 (58,8%) i mu nu 01 05 0 n = 34 R

Bng 9: nh gi lm sng sau PT


n = 34R S lng R T l % Tt 27 79,4% Trung bnh 03 8,8% Xu 04 11,8%

Bng 10: Lnh thng trn lm sng theo tnh trng ni nha
Tt Khng tt Khng thy VLTBOT Trung Xu Tng bnh cng 13R 11 02 0 (0%) 13 (84,6%) (15,4%) (100%) 20R 16 (80%) 01 (5%) 03 20 (15%) (100%) 01R 0 (0%) 0 (0%) 01 01 (100%) (100%) n Tt

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Y Hc TP. H Ch Minh * Tp 11 * Ph Bn S 2 * 2007


rng khng c triu chng l}m s|ng v| tham gia chc nng, khng cn hin tng vim nhim do qu{ trnh phu thut, ng thi trn phim X quang phi c s l|nh thng ca xng, m quanh rng vn cn v| tr li bnh thng sau mt thi gian phu thut. Bensoussan (1997) cho rng s to xng sau phu thut ct chp ch c th {nh gi{ chc chn bng phim tia X sau mt nm v c nhng trng hp th|nh cng trong thi gian ngn nhng sau vn th|nh lp sang thng mi do cn tn ti nhng kch thch vng chp. Trong nghin cu nay chng ti, mc thi gian {nh gi{ kt qu sau phu thut ti thiu l| mt nm ri v| ti a l| ba nm ri-thi gian n|y s l|nh thng trn xng (nu c) din ra ho|n chnh. Bc u {nh gi{ s l|nh thng trn xng cho thy kt qu l|nh thng ho|n to|n chim t l tng i cao: 73,4% (bng 6), c bit, khng c trng hp n|o {nh gi{ l| khng l|nh thng. Bensoussan (1997) cho rng th|nh cng ca phu thut ty thuc rt nhiu v|o vic sa son v| tr{m bt h thng ng ty. Tuy nhin trong nghin cu ca chng ti vn c s l|nh thng sau phu thut i vi c{c rng khng c tr{m bt ng ty tt (70%) (bng 7), c{c rng n|y ch yu l| tr{m bt cha ti chp (c{ch chp 2mm), iu n|y c th gii thch do phu thut loi b ho|n to|n phn chp ch}n rng khng tr{m tt v| c tr{m ngc c{ch ly gia h thng ng ty vi m quanh chp. i vi c{c rng c mang phc hnh, t l l|nh thng khng ho|n to|n trn xng tng i cao: 55,6% (bng 9), to|n b c{c rng n|y u c tnh trng ni nha khng t (100%), thi gian t lc ni nha n lc phu thut d|i trn 6 th{ng v| g}y bin chng trn l}m s|ng; 44,4% (4 rng) l|nh thng ho|n to|n trn xng cng c tnh trng ni nha khng t nhng 1 rng khng c du chng l}m s|ng v| c phu thut d phng; 3 rng cn li c kch thc sang

thc hin vic iu tr ni nha ng tiu chun cn phi c mt khong thi gian theo di s l|nh thng (ti thiu 06 th{ng), nu sau sang thng vn khng gim kch thc hay cn tn ti c{c triu chng l}m s|ng th lc by gi mi c quyt nh phu thut. Mt s t{c gi kh{c cho rng nn phu thut ngay sau khi iu tr ni nha nu tn thng tiu xng qu{ ln hoc c lin quan n nhiu rng, kch thc 1cm l| kch thc tiu chun cho vic ch nh phu thut. Donald v| Dimitroulis cn ch nh phu thut ct chp kt hp vi xt nghim gii phu bnh nu sang thng quanh chp khng lin h r r|ng vi rng nguyn nh}n hoc nghi ng vi c{c chn o{n kh{c. Ngo|i ra, mt s t{c gi cng a ra c{ch iu tr gii quyt tc thi i vi nhng bnh nh}n khng c iu kin nh khng c thi gian, bnh nh}n xa< Trong nghin cu ca chng ti loi ch nh tc thi chim mt ti l {ng k: 41,7%. Ch nh kh{c phu thut cn c {p dng trn nhng rng mang phc hnh c tnh trng ni nha khng tt hoc cha ni nha nhng khng th th{o phc hnh ra iu tr li theo phng ph{p thng thng, c{c rng n|y ang g}y bin chng hoc tnh c c ph{t hin c sang thng quanh chp. Theo mt s t{c gi, s th|nh cng ca phu thut trong nhng trng hp n|y khng cao v t bn th}n ming tr{m ngc khng th m bo s kht s{t ho|n to|n b mt ct ca chp rng khi phn cn li ca ng ty ch}n rng khng c m bo v trng. Trong nghin cu, loi ch nh n|y chim 26,5% (9 rng) v| to|n b c{c rng n|y u c tnh trng ni nha khng tt (bng 5) trong 88,9% (8 rng) c triu chng l}m s|ng, 11,1% (1 rng) c ch nh iu tr d phng do tnh c ph{t hin c sang thng quanh chp >1cm.

nh gi sau phu thut


Theo El-Swiah (1996), phu thut ct chp c cho l| th|nh cng khi sau phu thut c{c

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thng <1cm nn th|nh cng sau phu thut tt hn. iu n|y cho thy i vi c{c rng c mang phc hnh m| iu tr ni nha cha tt th th|nh cng thp v| ngh nn th{o g phc hnh, iu tr ni nha li trc khi chuyn phu thut ct chp. i vi c{c rng c tr{m ngc chng ti ghi nhn 57,1% l|nh thng ho|n to|n trn xng (bng 9). Trong s 09 rng l|nh thng khng ho|n to|n th 04 rng c tr{m ngc v| u tr{m ngc khng tt vi s st amalgam trong vng phu thut, chng ti ngh c th nhng mnh vn amalgam n|y g}y cn tr s l|nh thng. Vn n|y nn chng cn c nghin cu thm trn l}m s|ng. Vi 5 rng cn li u c tnh trng ni nha khng tt, c l cng chnh v th m| s l|nh thng din ra khng ho|n to|n. {nh gi{ trn l}m s|ng, tng t vi X quang, ghi nhn t l l|nh thng tt kh{ cao: 79,4% (bng 9). Tuy nhin c 04 rng cho kt qu l}m s|ng xu, c 4 rng u c mang phc hnh v| c tnh trng ni nha khng t, {nh gi{ kt qu l|nh thng trn phim X quang ghi nhn 2 rng l|nh thng ho|n to|n v| 2 rng khng ho|n to|n. Chng ti quyt nh phu thut li v| ph{t hin 1 rng b nt dc bnh nh}n c 3 rng }y c th l| nguyn nh}n g}y tht bi trn l}m s|ng, bnh nh}n cn li c kch thc sang thng ln chng ti tin h|nh no li. Mc d c gng khc phc tnh trng i m|u nu bng c{ch ct v{t chp tng i t v| gi nguyn c{c th|nh xoang tr{m nhng trong s 14 rng c tr{m ngc vn ghi nhn 6 rng c i m|u nu v| c{c rng n|y c {nh gi{ c tnh trng tr{m ngc khng tt. iu n|y c th gii thch chnh s st li c{c mnh vn amalgam trong vng quanh chp l|m amalgam ph}n t{n v|o m mm g}y ra s tip xc trc tip ca amalgam vi m nu l|m nu b nhim m|u. Nh vy, vn cn lu trong phu thut ct chp c tr{m

Nghin cu Y hc

ngc l| phi gim thiu ti a s st amalgam sau khi trm.

Hnh 1: i mu nu ti v tr trm ngc Bc u {nh gi{ cho phep ghi nhn: a s c{c rng c l|nh thng xng v| kt qu l}m s|ng tt u c thi gian t lc ni nha n lc phu thut ngn (phu thut tc th v| phu thut sau ni nha 6 th{ng). Phi chng thi gian theo di sau ni nha 6 th{ng l| thi im sau cng quyt nh thc hin phu thut ct chp hay khng, vn n|y c tip tc nghin cu.

KT LUN
Hi cu h s bnh {n ca 24 bnh nh}n vi 34 rng c phu thut ct chp (c v khng c tr{m ngc) ti B mn Nh Rng Tiu Phu Thut t th{ng 09/1999 n th{ng 09/2001, cho phep rt ra mt s kt lun sau:

V c im dch t
a s c{c rng phu thut ct chp l| rng hm trn (79,4%). Bnh nh}n thng n kh{m do c triu chng trn l}m s|ng (79,2%). Ch nh phu thut ct chp ch yu lin quan n yu t sinh hc (70,6%). 61,7% rng chuyn phu thut ct chp l| c tnh trng ni nha khng t, trong s c{c rng n|y c 85,7% c triu chng trn l}m s|ng.

Chuyn Rng Hm Mt

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3. Berrone S., Aimetti M. (1989), Apicoectomy: Comparison between two case series, Minerva Stomatol, vol. 38, N02, pp.291294. Bi Qu Dng (1999), Phu thut ni nha, B|i ging Ni Nha, Khoa Rng H|m Mt Trng H.Y Dc TP.HCM Danin J., Linder LE., Lundqvist G., Ohlsson L., Ramskold LO., Stromberg T. (1999), Outcomes of periradicular surgery in cases with apical pathosis and untreated canals, Oral Surg Oral Med Oral Pathol Oral Radiol Endod, vol. 87, N02, pp.227-232. Dimitroulis G (1997), A synopsis of Minor oral surgery, Wright, First edition, Oxford, pp.87-90. Donald E., Arens., Surgycal Endodontics, pp.574-598. Doornbusch H., Broersma L., Boering G., Wesselink PR. (2002), Radiographic evalution of cases referred for surgical endodonties, Int. Endod J., vol. 35, N05, pp.472477. El-Swiah JM., Walker RT. (1996), Reasons for apicoectomies. A retrospective study, Endod Dent. Traumatol, vol. 12, N04, pp.185-191. Garrett K., Kerr M., Hartwel G., OSullivan S., Mayer P. (2002), The effect of a bioresorbable matrix barrier in endodontic surgery on the rate of periapical healing: An in vivo study, J. Endod, vol. 28, N07, pp.503-506. Goeffrey LH (1995), Surgical aids to endodontics, Minor oral surgery; pp.315-327. Goldberg F., Torres MD., Bottero C. (1990), Thermoplasticized gutta-percha in endodontic surgical procedures, Endod Dent. Traumatol, vol. 6, N03, pp.109113. Langlais RP., Langland OE., Nortj CJ. (1995), Radiologic diagnosis of pulpal and periapical disease, Diagnosis imaging of the jaws, pp.199-202. L c L{nh (1997), Nhn xt v s l|nh thng trong s dng m ghp ng loi cho 30 bnh nh}n thiu hng m xng h|m, K yu cc cng trnh nghin cu khoa hc Rng Hm Mt 1997, pp.67-72. L c L{nh (2000), Phu thut ct chp rng, Gi{o trnh Nh Rng Tiu Phu Thut, Khoa Rng H|m Mt Trng H.Y Dc TP.HCM. Martineau C (1989), La chirugie periapicale, Linformation Dentaire, No25, pp.21912200. Nguyn Th Bch L, L c L{nh, Phm Th Hng Loan, Trn Quang n, Phm N Minh Ngc (2000), Mt s kinh nghim v| kt qu iu tr bo tn rng bng phng ph{p phu thut ct chp tr{m ngc, Cc cng trnh nghin cu khoa hc Rng Hm Mt 2002, pp.159 166. Testori T., Capelli M., Milani S., Weinstein RL. (1999), Success and failure in periradicular surgery: a longitudinal retrospective analysis, Oral Surg. Oral Med. Oral Pathol Oral Radiol Endod, vol. 87, N04, pp.493-498. Zuolo ML., Ferreira MO., Gutmann JL. (2000), Prognosis in periradicular surgery: a clinical prospective study, Int. Endod Jp., vol. 33, N02, pp.91-98.

Phu thut ct chp mang li s thnh cng cao cho hu ht cc trng hp


70% l|nh thng ho|n to|n trn xng v| 80% cho kt qu tt trn l}m s|ng. L|nh thng khng ho|n to|n trn xng (26,6%) hay l|nh thng trung bnh trn m mm (8,8%) u ch yu lin quan vi tnh trng ni nha khng t v| thi gian t lc ni nha n lc phu thut d|i. Do vy nn theo di l|nh thng sau iu tri ni nha trong khong thi gian 6 th{ng quyt nh phu thut hay khng. S l|nh thng sau phu thut c {nh gi{ qua kh{m nh k trn l}m s|ng v| phim tia X cho thy thi gian l|nh thng ho|n to|n ti thiu t mt nm tr ln, sang thng c|ng ln thi gian s l|nh thng ho|n to|n din ra c|ng ko d|i (theo Langlais(17) c th n 2,5 nm). Vic iu tr ty nn c thc hin mt c{ch cn thn nhm mang li kt qu tt cho bnh nh}n v| tr{nh vic phu thut khng cn thit. i vi c{c rng c phc hnh nn iu tr ni nha tt v| gii quyt tnh trng sang thng nu c trc khi l|m phc hnh. Phu thut ct chp c hoc khng c trm ngc l| cn thit cho vic iu tr c{c sang thng quanh chp bo tn rng, c bit i vi c{c sang thng c kch thc ln. Mt kh{c, nghin cu n|y mt ln na khng nh th|nh cng ca phu thut chp i vi c{c rng c sang thng quanh chp v| c{c rng iu tr ni nha tht bi (theo ng ch nh) nhng vic phu thut phi thc hin theo ng k thut nhm tr{nh to c{c kch thch mi cn tr s l|nh thng.

4.

5.

6. 7. 8.

9.

10.

11. 12.

13.

14.

15.

16. 17.

18.

TI LIU THAM KHO


1. Abramovitz I., Better H., Shacham A., Shlomi B., Metzger Z. (2002), Case selection for apical surgery: a retrospective evaluation of associated factors and rational, J. Endod, vol. 28, N07, pp.527-530. Bensoussan DC. (1997), L,endodontie chirurgical: apport de nouvelles technologies, Revue d,Odonto-Stomalogie, pp.427-435. 19.

2.

246

Chuyn Rng Hm Mt

Y Hc TP. H Ch Minh * Tp 11 * Ph Bn S 2 * 2007

Nghin cu Y hc

Chuyn Rng Hm Mt

247

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