Nhận xét đặc điểm lâm sàng và x quang răng vĩnh viễn chưa đóng cuống có chỉ định điều trị nội nha

Y HOC VIET NAM THANG 2 - SO
2/2014
__^
NHAN XET DAC DIEM LAM
SANG VA
XQUANG RANG VINH
VI£N
CHITA DONG CUONG CO CHI DINH DIEU TRI NOI NHA
Dao Thi
H^ng
Nga*,
\gu>ln
Manh Ha*, Tran Ngoc Thanh*
Nguyen Thi Thu
Phircng*,
Vo Truong
Nhir
Ngoc*,
Tran Thj My Hanh*, Luong Minh Hang*
TOM TAT
Oat van de: Nghien cffu nham mo ta dac
diem
lam sang va x-quang cac rang
vinh vien
chi/a
ddng
cuong
CO
chi dinh di'eu trj npi nha.
Do!
tu'dng va

phu'dng phap: 32 benh nhan v6i 38 rang
vinh vien
chua dong kin cuong trddc dieu trj npi nha
tai
Benh
vien Rang Ham Mat Trung
LTpng
Ha Npi va trung tam
nha khoa 225 Trddng Chinh
ty
thang 1 nam 2012 den
thang 6 nam 2013. Ket qua: Nguyen nhan hay gap la
do
niim
phu 94.12% gap d rang ham nho, do chan
thu'dng 75% gap d nam va 100% d rang cffa, viem
quanh cuong la
86,85%,
Tren phim x-quang, 53.16%
tn/dng hdp chan rang
cJ
giai doan III, 86.85% co hinh
anh thau quang quanh cuong. Ket
luan:
Hinh
thai
lam
sang rang chUa dong cuong dffdc dieu tri npi nha co
ton thuong
tai

cho da dang
nhi/ng
thUdng gap la
benh
viem
quanh cuong.
Tff khoa: dong cudng, mineral
thoxide
aggregate, calcium hydroxide.
SUMMARY
IMMATURE PERMANENT TEETH;
CAUSE,
LESION CHARACTERS
AND RADIOGRAPHY
Introduction: The
aims
of this study were to
describe the cause, lesion characters and radiography
of immature permanent teeth. Materials and
Method:
From Jan 2012 to June 2013, we had treated
38 open apices teeth of 32 patients in Hanoi
Nabonal
Odonto-Stomatology Hospital and Dental Health Care
225 Truong Chinh. Results: The mam causes were
dens evaginatus
(94,12%
in premolars) and traumas
(75%
in male and 100% in incisors). Apical

periodontitis was mam disease (86,85%). On
radiography, roots were at stgae III in 63.16% of the
cases and 86,85% with periapical lesion. Conclusion:
Lesion characters of patents with open apices teeth
were very variety and apical
penodontitis
was quite
more common.
Keywords: open apices,
apexification,
mineral
trioxide
aggregate, calcium hydroxide
*
Vien
Dao
Tao
RSng
Ham
Mat,
Tnfdng
Oai Hpc
YHa
Not
Phdn
bien khoa hpc: PGS.TS Mai Dinh Hu'ng
I.
DAT VAN OE
Trong ITnh vffc
dieu

tn npi nha, cac trffdng
hdp rang
vinh
vien chffa dong cuong khong qua
hiem gap, ehiem
b/
le khoang 5% den 15% va
thffdng do eae nguyen nhan chan thffdng, bat
thffdng cau true rang
(niim
phu), sau rang [1],
[2],
[3]. Tuy nhien, do
tiiy
rang bj ton thffdng
sdm tff giai doan chan rang chffa hoan thien nen
cac trieu chffng khong dien
hinh,
it
khi dydc phat
hien kjp
thdi.
Tren phim x-quang can chop
thffdng thay hinh anh mot chan rang ngan,
budng ong
tiiy
rpng, lo cudng rpng hoac
loe,
tieu
xffdng quanh eudng. Do dd, viec dieu tri gap

nhieu khd khan. Oe dieu tri thong thffdng phai
diing cae vat lieu khae nhau nhff Calcium
hydroxide va hien nay la Mineral Trioxide
Aggregate
(MTA)
vdi nhieu dac tfnh tdi ffu, lam
lanh thffdng va kfch thfch hinh thanh hang rao
mo effng giup cho viec tram bft ong tuy de dang
hdn,
dffa den ty le thanh cdng eao [2].
Van de dat ra la: co phai tat ca cac rang bi
ton thffdng
tiiy
va chffa ddng cudng deu
dieu
trj
npi nha dffdc khdng va ket qua nhff the nao. Vi
vay, chiing tdi tien hanh nghien cffu nay nham
muc
tieu;
Nhan xet dac diem lam sang va X -
quang
6
nhffng rang
vinh vien
chffa ddng cuong
trffdc
dieu
trj npi nha.
II.

o6l TUONG VA PHU'aNG PHAP
NGHIEN
COU
2.1.
Ddi
tu'dng nghien cu'u
32 benh nhan vdi
38
rang
vinh
vien
chuci
ddng kfn cudng cd ehf djnh dieu tn npi nha du'dc
dieu tri tai Benh vien Rang Ham Mat trung
t/dng
Ha Npi va trung tam nha khoa 225 Trffdng Chinh
tff thang 1 nam 2012 den thang 8 nam 2013.
Tieu ehuan Iffa chpn; Benh nhan co cac
rSng
vTnh vien chffa ddng kfn cuong cd ehi djnh dieu
tn npi nha, rang ed kha nang phyc hoi lai than
rang,
benh nhan ty nguyen tham gia nghien
cffu.
Tieu
ehuan loai
trff:
Rang bj viem quanh
rang,
chan rang bj nut, gay.

Benh
nhan cd cac
benh tim mach (hep hd van 2 la, suy tim), tieu
Y
HQC
VigT
NAM
THANG
2 - SO
2/2014
dffdng,
benh viem
than
hoac benh toan than
khac
chuci
on
djnh.
Benh nhan khong hpp tac.
2.2.
Phu'dng phap nghien cu'u: nghien
cffu du'dc thiet ke theo phu'dng phap mo ta
cSt
ngang
2j2.1.
Cac
bien
sd
nghien c&u:
-^Tuoi,

gidi,
vj tri rang ton thu'dng, nguyen nhan
ton thffdng, dac diem lam sang
ciia
rang ton
thu'dng.
- X- quang can chdp:
-t-
Xae
dmh giai doan hinh thanh ehan rang: 5
giai doan [3]. I: Lo cuong rang phan ky, chieu
dai chan rang ngan hdn
Vz
ehan rang hoan thien;
II:
lo cuong phan ky, chieu dai chan rang bang
Vl
chan rang hoan thien ; III: lo cuong phan ky,
chieu dai chan rang bang 2/3 chan rang hoan
thien;
IV: lo cudng rong, chieu dai gan bang
ehan rang hoan thien; V: rang da ddng
cudng,
su'
phat trien chan rang hoan thien.
+ Xac dinh mffe dd ton thu'dng (hinh anh
thau quang) viing eudng tru'dc dieu trj: co hay
khdng,
neu cd thi do kich thu'dc td'n thu'dng
(du'dng kfnh Idn nhat)

2.2.2.
Thu
thap
va
xdiysdlieu:
Phan
mem
SPSS
13.0
va
cac thuat toan thdng ke khac
2,3.
£>ao dffc
nghien cu'u
Benh nhan ddng y tff nguyen tham gia
nghien cffu va ed quyen rut
khdi
nghien
cyu
bat
ky
liic
nao. Cac thdng
tin
ea nhan
ciia
ddi
tUpng
nghien
cyu

se
6if(ic
dam bao
giff
bf mat tuyet
ddi.
Nghien cffu
6iS6c
sff chap thuan
ciia
cac dja
diem nghien
cffu.
III.
K^
QUA
Bang
1:
Dac
diem chung
ciia
nhdm benh nhan
'~"~''~ ~„,^^
Tuoi
Gidi
^"^^ ^
Nam
Nff
Tong so
6-

n
15
12
11
15
%
46,88
37,5
84,38
>
n
3
2
5
15
%
9,38
6,24
15,62
Tong so
N
18
14
32
%
56,25
43,75
100
filhan
xit:

Tmng
so 32 benh nhan, co 56.25% benh nhan nam va 43.75% benh nhan nif. Tuoi gap
nhieu nhat la nhom
di/cli
15 tuoi (84.38%).
Bang
2:
Phan
bo rang b
' —__Nh6m
tuoi
Nguyen
nliin '—^^
Sau rang
Chan thu'ong
Num
phu
Tong 50
ton thu'ong theo nquyen nhan va nhom tuoi
6-15
n
5
14
10
29
%
13.15
36.84
26.32
76.31

>15
n
0
2
7
9
%
0
5.26
18.43
23.69
Tong so
N
5
16
17
38
%
13.15
42.10
44.75
100
Nh$n
xet:
Jrong
so 38
rang,
co 13.15% do
sau
rang,

42.10%
do
chan
thirong, co 44.75% do num phu.
Bang
3:
Phan
bo rang ton thu'ong
Nguyen
nhin
Sau
rSng
Chan thu'dng
Num phu
Mau nghien
CLTU
n
5
16
17
38
theo nguyen n
Gidi
Nam
(%)
60
75
47.06
60.53
Nff(%)

40
25
52.94
39.47
han va
gidi,
v tri
Vi
tri
RC (%)
0
100
5.88
44.74
RHN
{%)
20
0
94.12
44.74
RHL {%)
80
0
0
10.52
Nh$nx4t:
Do sau
rSng g3p
80%
6

RHL, do chan thffdng gap
75%
d benh nhan nam va 100% d rang
::ffa,
do num phu
g3p
94,12%
d
RHN.
Tnsng
so cae rang nghien cffu viem tuy ed 2 trffdng hpp (5,26%),
:uy ho?i
tff
3
(7,89%),
viem quanh cuong cap 7 (18,42%), viem quanh cudng man 26 (68,43%)
Y
HOC
VIET
NAM
THANG
2 - SO
2/2014
Bang 4:
Dau t
ieu lam sang tai vi tri rang td'n thffdng
Bien
sd
nghien cu'u
Co nang

Td'n thffdng
hoac bat
thffdng td
chffe cffng
Thu'c the
Khdng
Cd
Bau tff nhien
Dau do kfch thfch
Khdng
Cd
Ld sau/tram cu
Nut
vdthan
Niim
phu
Khdng
Co
Doi
mau
Sffng
ne loi
Ld
rd
Lunq lay
Gd
doe dau
n
(%)
2 (6.25)

26 (81.25)
4(12.5)
30
(93.75)
0
5(13.16)
20 (52.63)
17(34.21)
38
(100)
2 (5.26)
25
(65.79)
7 (18.42)
_^
15 (39.47)
16 (42.11)
31 (81.58)
N
32
benh nhan
38 rang
38 ranq
38 ranq
38 ranq
38 ranq
38 rang
38 ranq
Nhan xet: Co 93.75% benh nhan c6 trieu chu'ng dau, 52.63% so rang co
niit

v8
than,
cac trieu
chu'ng
thi/c
the hay gap: go dau 81.58%, doi mau 65.79%, lung lay
42.11%,
io ro 39.47%.
Bang
5:
Qac
die m X-quang tai vi tri rang ton thu'dng
Bien so ngliien cu'u
Giai doan
chan rang
Ton thu'dng quanh
cuong
I
II
III
IV
Khonq
Cd
< 5mm
5 -
10mm
>10mm
n
{%)
0

3 (7.89)
24(63.16)
11 (28.95)
5(13.15)
9(23.68)
21 (55.26)
3 (7.90)
33 (86.85)
N(%)
38(100)
38
(100)
Nhan xet: Trong sd 38 rang, cd 63.16% rang cd chan rang dang d
giai
doan III, cd 86.85% trffdng
hdp cd td'n thffdng quanh cudng.
IV. BAN
LUJC^N
Trong thdi gian 1.5 nam, chiing tdi da tien
hanh dieu tri npi nha cho 32 benh nhan vdi 38
rang chffa ddng kfn cudng, trong dd sd benh
nhan nam gap nhieu hdn (18/32 benh nhan), ti
le
nammff
=
1,29/1.
Nhdm tudi hay gap la tff 6
den 15 tud'i (84.38%); day la Iffa tud'i ma bd rang
vTnh vien bat dau mpc nhffng ehan rang chffa
hoan thien, cac nguyen nhan gay anh hffdng den

tiiy
rang deu cd the lam cho rang khdng tiep tuc
ddng cudng dffdc.
4.1.
Nguyen nhan va dac diem lam sang
cua rang ton thffdng
Trong sd 38 rang
^if^ic
dieu trj, ehung tdi
gap 5/38 (13,15%) trffdng hdp la do sau rang,
16/38 (42,10%) trffdng hdp la do chan thffdng,
chii
yeu gap d Iffa tudi dffdi 15, tre hieu ddng
nhieu,
17/38 (44,75%) trffdng hdp la do num
phu (mdt loai bat thffdng td
chffe
cffng
ciia
rang,
trong
niim
phu thffdng cd sff keo dai
ciia tiiy
rang,
do vay
tiiy
rang de bi
hoai ty
tff tff khi rang

can khdp vdi rang
ddi
dien), thffdng gap
d
tre
dffdi 15
tuoi,
vi Iffa tuoi nay cac rang ham nho
mdi bat dau mpc va chffa kip ddng eudng neu bi
ton thffdng
tiiy
rang [4] .
Trong nhdm nguyen nhan do sau rang chiing
tdi ehi gap d cac rang ham (rang ham nhd va
rang ham Idn), khdng gap trffdng hdp nao d rang
cffa.
Trong nhdm nguyen nhan do chan thffdng,
chiing tdi chi gap d eac rang cffa, khdng
g3p
trffdng hdp nao d rang ham va gap chu yeu tren
benh nhan nam.
Trong nhdm nguyen nhan do sang chan man
tinh
do
niim
phu, chung tdi gap
chii
yeu d rang
ham nhd: 94.12% trffdng hdp,
6

rang cffa la
5,88%,
khdng gap trffdng hdp nao d rang ham.
Y HOC VIET NAM THANG 2 - SO 2/2014
Ket qua nay cung
phii
hdp vdi ket qua
eiia
Marc
va cdng sff [6], dieu nay
phii
hpp vdi dac diem
lam sang hay
gSp
num phu nhd len d giffa 2 mui
rang cua rang ham nhd, thu'dng gap d ngffdi
chau A, gay sang chan
tiiy
man tfnh tff sdm va
rang dd chffa kjp dong kin cudng.
4.2.
Trieu chu'ng lam sang tai vj tri rang
ton thffdng
Trong cac trffdng hop rang du'Oc dieu tri, tat
ca cac trffdng hdp deu thay cd ton thu'ong td
chffe cffng
ciia
rang hoae ed bat thffdng to
chffe
ciTng

nhff
niim
phu. Day la bang chffng cho thay
tuy rang da bj ton thffdng trffc tiep do vi khuan
xam nhap hoac gian tiep do sang chan. Nhffng
trffdng hdp nut vd hoac sau mat td
chffe
cffng
Idn doi hdi sff phuc hoi than chan rang sdm mdi
cd the bao tdn rang lau dai.
Phan Idn cac rang deu cd cac trieu chffng
ciia
tinh trang hoai tff
tiiy
(rang dd'i mau) va vi khuan
da gay ton thffdng ra viing quanh cuong cap nhff
dau,
sffng ne ldi hay viem quanh eudng man nhff
CO
lo dd, go dpc dau. Oieu nay
phii
hdp vdi phan
bo benh ly
ciia
cac rang dffdc dieu trj: 7/38
(18.42%) rang viem quanh cudng cap, 26/38
(58,43%) rang vfem quanh cuong man
tfnh.
Ket
qua nay cung cho thay da sd benh nhan khdng

dffdc kham phat hien kjp thdi num phu ngay tff
khi rang mdi mpc va khong
Cifdc
theo ddi day du
sau chan thffdng, thffdng den khi cd bien chffng
mdi di kham.
4.3.
Dac diem X-quang tai vj tri rang ton
thffdng
Trong 58 rang dffdc dieu trj, cd 3/38
(7.89%) trffdng hdp ehan rang d giai doan II va
tdi 24/38 (63.16%) chan rang dang d giai doan
III,
nghia la cudng rang cdn md rpng va loe ra,
chan
rSng
mdi
6if<ic
thanh lap ngan. Day thffe sff
la mpt thach
thyc
Idn khi tram bft viing cudng, vi
phai dam bao yeu cau vffa tram kfn khft va
khong
duS
vat lieu tram di qua cuong rang [1],
[7].
Khdng
g§p
trffdng hdp nao chan rang dang

d
giai doan I (chan rang mdi dffdc thanh lap,
chieu dai chan
rSng
ffdc tfnh ngan hdn mot nffa
so
vdi
chan rang hoan thien), vi giai doan nay
rang chu'a mpc vao khoang mieng hoac neu ed
moc thi do qua ngan, to chffe nang dd quanh
rang yeu, dac biet neu ed
viem
nhiem td
chffe
quanh rang cang lam eho rang de mat sdm,
V. KET LUAN
Nhdm tud'i hay gap la 6 - 15 tudi . Nguyen
nhan tdn thu'Png hay gap la do
niim
phu, ehan
thffdng,
ft gap do sau rang, Trong nhdm nguyen
nhan do
niim
phu gap
chii
yeu d rang ham nhd,
do chan thu'Png gap
chii
yeu d nam va nhom rang

cffa.
Benh ly hay gap la viem quanh cuong vdi eac
trieu chffng ehinh la go dau, dd'i mau rang, lung
lay rang, lo rd, sffng ne. Tren phim x-quang, hay
gap chan rang dang phat trien d giai doan III sd
rang cd hinh anh thau quang quanh eudng.
TAI LIEU THAM
KHAO
1.
Torabinejad
M, Ibrahim AT (2012).
Management of teeth
with
necrotic pulps open
apices. Endodontic
Topics,
23,
105
- 130.
2.
El-Meligy
OA, Avery DR (2006).
Compansion
of apexification with mineral trioxide aggregate
and calcium hydroxide, Pediatr Dent, 28(3), 248
-253.
3.
Mathew
B.P, Hegde M.N (2008). Management
of

nonvital
immature teeth - case reports and
review. Endodontology, 15 (3),18 - 21.
4.
Deery C,
Toumba
K.
J.
(2005).
Diagnosis and
prevention of dental caries.
Pediatnc
Dentistry,
3"^
edition,
Oxford, 108 - 129
5. Michael P. Powers and Faisal
A.Q.(1997).
Diagnosis and Management of Dentoalveolar
injuries, Oral and
Maxillofacial
Trauma,
The second
edition by W.B.Saunders company, 359- 390
6. Marc E. Levitan, Van T.
Himel
(2006). Dens
Evaginatus: Literature Review, Pathophysiology,
and Comprehensive Treatment Regimen, J
Endod,

Jan,
32(1), 1-9
7. Shabahang S. and M Torabinejad (2000).
Treatment of teeth
with
open apices using mineral
trioxide
aggregate.
Practical Periodontics and
Aesthetic
Dentistry,
12{3), 315-320.