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TP.HCM, thng 03 nm 2012.

B CNG THNG TRNG I HC


CNG NGHIP TP.HCM VIN CNG NGH SINH HC
& THC PHM
MN:
CNG NGH SINH HC TRN NGI V NG
VT
TIU LUN:
VT LIU SINH HC TRONG CHN THNG

CHNH HNH, NHA KHOA
GVHD: Th.s Trn Th Phng Nhung. Nhm:
13

B CNG THNG TRNG I HC
CNG NGHIP TP.HCM VIN CNG NGH SINH HC
1. L Khnh Duy 11306331
2. Hong Th Lc 11333531
3. Phan Phc Thin 11325911
4. Nguyn Thanh Thy 11307391
5. Tng Th Thanh Thy 11261831
6. Trn Th Minh Thy 11276771
7. Nhan Minh Tr 11270841
8. Phm Dng T Trinh 11315091
9. Phan Nguyn Thanh Tuyn 11299711
TP.HCM, thng 03 nm 2012.

& THC PHM
MN:
CNG NGH SINH HC TRN NGI V NG
VT
TIU LUN:
VT LIU SINH HC TRONG CHN THNG

CHNH HNH, NHA KHOA
GVHD: Th.s Trn Th Phng Nhung. Nhm:
13
1. L Khnh Duy 11306331
2. Hong Th Lc 11333531
3. Phan Phc Thin 11325911
4. Nguyn Thanh Thy 11307391
5. Tng Th Thanh Thy 11261831
6. Trn Th Minh Thy 11276771
7. Nhan Minh Tr 11270841
8. Phm Dng T Trinh 11315091
9. Phan Nguyn Thanh Tuyn 11299711
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 1


MC LC
I M U ............................................................................................................................ 2
1. t vn .................................................................................................................. 2
1.2 Mc ch nghin cu ............................................................................................... 2
1.3 Phng php nghin cu ......................................................................................... 2
II. NI DUNG ..................................................................................................................... 2
1. Tnh tng hp ca vt liu sinh hc ....................................................................... 2
1.1 p ng min dch ca c th vi vt liu sinh hc ................................................ 2
1.2 Quy trnh nh gi tnh tng hp ca vt liu sinh hc ......................................... 4
2. Vt liu s dng trong ch to vt liu sinh hc ng dng trong chn thng
chnh hnh ...................................................................................................................... 9
2.1 Silicone .................................................................................................................... 9
2.2 Vt liu gm y sinh Hydroxyapatit (HAp) ............................................................ 11
2.3 Composite cacbon .................................................................................................. 12
2.4 INTOST- 4 ............................................................................................................. 13
2.5 Zirconia(lm rng gi) ........................................................................................... 14
3. ng dng vt liu sinh hc trong chn thng chnh hnh ..................................... 14
3.1 Xng nhn to...................................................................................................... 14
3.2 Khp nhn to ........................................................................................................ 18
4. ng dng vt liu sinh hc trong nha khoa ............................................................ 26
4.1 Cu to, c im v phn loi rng gi ................................................................ 26
4.2 Vt liu s dng trong chnh hnh nha khoa .......................................................... 35
5. Thnh tu ng dng vt liu sinh hc trong chn thng chnh hnh, nha khoa 46
5.1 Thnh tu ng dng vt liu sinh hc trong chn thng chnh hnh ................. 46
5.2 Thnh tu ng dng vt liu sinh hc trong nha khoa ........................................... 50
III. KT LUN ................................................................................................................... 53
TI LIU THAM KHO .................................................................................................. 54
I M U
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 2


1. t vn
Ngy nay dn s ngy cng ngy cng tng nhanh ko theo l cc t nn , bnh tt
v cc tai nn xy ra trong x hi. Cc tai nn thng gp trong lao ng sn xut, tai nn giao
thng ... lm cho con ngi b h hng hoc khim khuyt b phn no trn c th. Nhng
b phn b h hng hay mt i s lm cho con ngi cm thy kh khn trong sinh hot v nh
hng rt ln n sc kho ca h . Neu nh trc kia nhng bnh nhn b mt mt phn tai
chn hay b lit chn tay ... phi sng mt cm vi mi ngi xung quanh v v b ngoi ca
mnh v kh khn trong i sng sinh hot n cui i, th gi y vi s tin b ca khoa hc
k thut cng vi s h tr ca cc vt liu y sinh trong y hc gip cho cuc sng ca h
c tr li ging nh nhng ngi bnh thng khc. V vy nhm chng ti quyt nh chn
ti Vt liu y sinh trong chn thng chnh hnh , nha khoa tm hiu thm v iu k
diu ca cc vt liu y sinh ny.
I. 2 Mc ch nghin cu
Tm hiu , nghin cu v cc vt liu y sinh trong chn thng chnh hnh , nha khoa
v li ch ca cc vt liu y sinh ny trong vic tr bnh cho con ngi.
1.3 Phng php nghin cu
Vi nhiu ngun thng tin khc nhau : sch , bo , internet ... c chng ti tng hp
mt cch chn lc a ra mt cch tng qut v cc vt liu y sinh thng c s dng
trong chn thng chnh hnh , nha khoa.
II. NI DUNG
1. Tnh tng hp ca vt liu sinh hc.
1.1 p ng min dch ca c th vi yt liu sinh hc.
1.1.1 Khi nim v min dch
p ng min dch c hiu l phn ng bnh thng ca ng vt c
xng sng khi mt vt l c a vo c th. y l mt phn ng bo v gii c,
trung ha v gip loi tr vt l.
Tuy nhin, trong mt s trng hp, cc phn ng vi nhng vt khng c c th gy
hi cho c th ch nh cc phn ng d ng hoc qu mn.
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 3


Cc p ng c phn thnh bn loi: loi I, loi II, loi III, loi IV. Bn p ng
ny theo mt c ch thng thng, c kch ng do s hin din ca mt vt l l khng
nguyn (antigen). Cc t bo trnh din khng nguyn (antigen Processing cell - APC),
thng l t bo n nhn (monocyte) hoc i thc bo (macrophage) hay t bo bch tuc
(dendritic) da, bt khng nguyn, x l n (ct bng enzym) v chuyn n (trnh din) n
t bo khc l t bo lympho T h tr (T helper cell - Th). Sau , t bo Th trnh din
khng nguyn c x l cho mt t bo lympho T khc l t bo T c (T cytotoxic
cell - T
c
) hoc cho t bo lympho B (t bo B). T bo nhn (t bo T hoc B) bt u mt
p ng tc ng khng nguyn c x l, to mt phc hp hot ng. Trong trng
hp t bo nhn l t bo T th p ng min dch l loi IV hay min dch qua trung gian
t bo. Trng hp t bo nhn l t bo B, kt qu cui cng l gii phng khng th t
do, dn n p ng loi I, n, III thuc th dch. Trong p ng t bo T, cc t bo T s
tp trung vng hin din vt l. Trong khi cc t bo B vn xa (trong cc m bch
huyt), cc khng th lu thng v xut hin ti vng c vt l.

1.1.2 p ng min dch ca ngi vi mt s yt liu sinh hc.
Hin nay, hu ht cc vt liu sinh hc c lm t nha, Collagen v cc
polymer tng hp,... Ty tng loi vt liu khc nhau m c th s c phn ng min dch
khac nhau:
Nha: Vt liu nha c dng ch to gng, bao cao su... l cao su (elastomer)
trch t thc vt. D ng vi nha thng l loi I (p ng qua trung gian IgE) vi phn ng
tc th (trong vng vi pht) c th e da s sng. Tuy nhin, nha khng c s dng ch
to vt liu ghp trong thi gian di nn cc p ng thi gian di khng c ch .
Collagen: Collagen c thu nhn t cc ngun vt liu t nhin nh da, m b... y
Loi Khng th T bo lin quan Cht trung gian Kt qu
I IgE Lympho B
Histamin,cc amin
vn mch
Nga, vim mi, gin
mch
II IgG, IgM Lympho B
Histamin,cc amin
vn mch
Gin mch
III IgG, IgM Lympho B
Cc amin vn mch au, sng, nghn
mch, gin mch
IV - Lympho T Cytokin au, sng
Bng 1: Cc c im chnh ca bn loi p ng min dch.
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 4


l mt protein ngoi lai nn n c kh nng kch thch nhiu p ng min dch. Cc khng th
ca lp IgE, IgM, IgG v cc p ng min dch qua trung gian t bo c quan st. Phng
nga quan trng l loi b cng nhiu vt liu ngoi lai cng tot. Do collagen ca cc loi ng
vt c v c cu trc tng t nn c th loi b cc protein nhim v li vt liu khng sinh
d ng. X l ha hc v khu mch collagen c th lm gim tnh sinh khng nguyn. Cc sn
phm collagen cn c nh gi cn thn v kh nng khi ng cc p ng min dch.
Cc polymer tng hp: Cc vt liu ny da trn nn tng cc thnh phn carbon,
hydro, nit v oxy to nn h sinh hc. Do vic to ra cc vt liu c tnh khng nguyn l
khng th xy ra. Tuy nhin, mt s vt liu polymer c na ha hc l ng quan tm nh
polysiloxane (silicone elastomer), polyurethane, poly(methyl)methacrylate...
1.2 Quy trnh nh gi tnh tng hp ca vt liu sinh hc.
Khi vt ghp tip xc vi h sinh hc, cc phn ng sau c quan st: Trong vng vi
giy u tin, cc protein t dch c th s lng ng. Lp protein ny iu ha nhiu phn ng
ca h thng t bo. cu trc ca cc protein hp ph ph thuc vo cc c tnh b mt ca vt
ghp. Sau , m xung quanh vt ghp phn ng ging nh phn ng ca c th vi tn thng
hoc nhim trng. Do cc kch thch c hc v ho hc, vt ghp c th gy ra vim ko di.
Ket qu l m ht hnh thnh xung quanh vt ghp. Trong sut qu trnh tip xc gia vt liu
sinh hc v c th, mi trng c th s gy ra s phn hy. Cc qu trnh thy phn v oxid
ha c th lm mt tnh n nh c hc v gii phng cc sn phm phn hy.
Ket qu ca s chuyn vn cc sn phm phn hy c kh nng ha tan qua h mch v
bch huyt l phn ng ca ton c th vi vt ghp l khng th trnh khi. Ngoi ra, s nhim
khun ca vt ghp cng c xem l mt tr ngi.
1.2.1 Cc th nghim tin quyt nh gi tnh tng hp sinh hc
Cc th nghim thnh cng v c tnh invitro ca cc vt liu v cc sn phm u
tin l iu kin tin quyt nh gi tnh tng hp sinh hc. c tnh l ha (nh b mt,
din tch) v cc c tnh thch hp khc (nh c, in, vn chuyn, phn hy sinh hc nu c
th ng dng) phi c nh gi trn vt liu th. Cc d liu ny phi c so snh vi cc
kt qu ti cc thi im ch to, tit trng, ng gi, bo qun v bt k tin trnh no c th
nh hng bt li n tnh n nh ca sn phm, tnh an ton v hiu qu sau khi ghp. Cc vt
liu khng qua cc th nghim tin quyt ny th khng c nh gi tnh tng hp sinh hc.
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 5


1.2.2. Cc phng php th nghim v nh gi tnh tng hp sinh hc
nh gi tnh tng hp sinh hc ca vt liu gm nhiu th nghim: invitro (s dng
t bo v m), exvivo, m hnh ng vt v cc th nghim lm sng. Cc t chc tiu chun
quc t v quc gia c th cung cp nhng thng tin thch hp: the American Society for
Testing and Materials (ASTM), the International Organization for Standardization (ISO), FDA
v the National Institutes of Health (NIH).
1.2.2.1 Th nghim invitro
u im chnh ca phng php ny l gi c hp l, u t nh trong phng th
nghim, v quan trng nht l qu trnh thc hin nhanh vi s lng ln vt liu.
Tnh tng hp mu ca vt liu: c xc nh bng cch s dng mu chng ng
(mt hn ch khng th trnh ca cc th nghim ny) v nh gi s hnh thnh cc mu ng
trn b mt vt liu cng nh s hot ha ng huyt tng, s bm dnh v t tp tiu cu, s
tng hp v gii phng ng thi cc hp cht ha hc hot ng sinh hc (nh cc tc nhn t
tp, cc nhn t tng trng), s hot ha b th v cc bch cu khi cc thnh phn ny tng
tc vi cc vt liu tng hp. Ty thuc vo mc ch s dng cui cng ca vt liu, cc th
nghim tnh tng hp mu phi c b tr di iu kin tnh hay dng chy trong cc th
nghim cp v mn tnh. Hng cu v s gii phng hemoglobin di iu kin dng chy trong
b phn gi, s ha vi lin quan n cc b phn di chuyn c hc (cc l ca van tim) cng
phi c xc nh. Tuy nhin, khng th loi tr cc phn ng ny khi mu tip xc vi cc
vt liu tng hp. Do , kim sot v toi thiu cc phn ng ny l mc tiu trong vic thit k
cc vt liu tng hp mu.
Nhng tin b trong k thut nui cy t bo cung cp mt m hnh invitro hu ch
nh gi tnh tng hp sinh hc ca vt liu trong tin trnh lnh ha vt thng. Cc t bo
ng vt c v c s dng xc nh cc chc nng ca t bo (bm dnh, di c, tng sinh,
tng hp v lng ng cc cht nn ngoi bo...) trn vt liu. Neu mc tiu ca vic thit k v
nh gi cc vt liu mi l nhng lin kt mnh gia m xung quanh v vt liu cy ghp hoc
c s to thnh m mi th ch nhng vt liu h tr chc nng ca cc t bo c bit v ti
thiu s tng tc ca cc dng t bo cnh tranh mi c nh gi nhiu hn. V d, ch
nhng vt liu tng cng chc nng nguyn bo xng (t bo to xng) nhng gim ti
thiu chc nng ca cc nguyn bo si (t bo cnh tranh) mi tr thnh ng c vin cho cc
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 6


ng dng trong chnh hnh hoc nha khoa.
M hnh t bo ng vt invitro cng c s dng xc nh nh hng ca cc hp
cht ha hc (nh loi ion, hm lng ion c gii phng khi kim loi b xi mn, cc i
phn t v cc monomer c gii phng trong sut qu trnh phn hy ca cc polymer c th
ti hp thu sinh hc) c gii phng di cc iu kin ca mi trng sinh l. Cc vt liu b
tht bi trong th nghim c tnh cp s khng c nh gi cng nh xem xt tip tc. Ngay
c khi vt liu qua th nghim kh nng sng ca t bo th nh hng ca cc sn phm
c gii phng n hnh thi (gm s tch ly ni bo ca cc sn phm phn hy), s tng
sinh v cc chc nng khc ca t bo t u cho n kt thc s dng vt liu cng phi c
nh gi.
Cc m hnh ny rt tt kho st cc chc nng v cc c ch thch hp ca mt
dng t bo ti mt thi im nhng b hn ch trong mi trng phc tp ca c th. Do ,
cn thit s dng cc m hnh khc (nh m hnh ng vt) lm sng t cc s kin nhiu
kha cnh, tng tc v linh ng m trc tip, trung gian kim sot cc tng tc m - vt liu
bn trong c th.
I.2.2.2. Cc m hnh ng vt
Cc m hnh ng vt c s dng xc nh tnh tng hp in vi vo ca cc vt
liu. Cc kt qu m tnh (khng c kt qu) quyt nh kh nng khng chp nhn h thng
c th nghim. Tuy nhin, cc kt qu dng tnh khng nht thit chng minh tnh tng
hp ngi. Do s khc bit v loi, vic ngoi suy cc kt lun t th nghim ng vt tin
on cc p ng ca con ngi l khng chc chn v nguy him. M hnh ng vt thch hp
nht l linh trng do s tng ng ca chng vi ngi, thm ch s khan him, gi c v duy
tr... by ng vt ny.
Vic th nghim trn m hnh ng vt ch c tin hnh sau khi thc hin thnh
cng cc th nghim tin quyt v c tnh vt liu v cc th nghim invitro. Cc nh nghin
cu nn xc nh loi thch hp nht cho mc ch kho st, cn thn b tr th nghim sao cho
s lng ng vt s dng nh nht nhng thu c kt qu thng k cao v trnh lp li th
nghim khng cn thit.
Phn loi cc th nghim
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 7


Cc th nghim ng vt nh gi tnh tng hp sinh hc ca vt liu c th c
phn thnh 3 cch chnh:
s Cc th nghim khng chc nns
Trong trng hp ny, cc mu c hnh dng bt k c ghp vo m mm (di da,
trong c, trong bng) qua quy trnh tiu phu. Nghin cu ny cn khong thi gian ngn (vi
ngy n vi thng) nhng cung cp thng tin gi tr v cc tng tc m - vt liu sinh hc ti
ch v cc bin chng h thng.
s Cc th nghim ex vivo
Cc shunt ng mch - tnh mch v tnh mch - tnh mch c ly t mu ca ng
vt, qua th nghim vt liu v a tr li c th ng vt. Trong trng hp ny, cc d liu
thu nhn c xc nh tnh tng hp sinh hc mu ca vt liu l s tch ly protein, s
bm dnh t bo mu v s ng cc trn b mt vt liu.
s Cc th nghim chc nn2
Th nghim ny cn ghp mt vt liu c chc nng, v d ghp khp hng v tim
trong nhng vng t chc ca ng vt theo cch phu thut tng t ca ngi. Cc th
nghim chc nng l cc nghin cu thi gian di, cn nhng suy xt c bit (nh thit k, ch
to v th nghim b phn gi), phc tp v t tin.
Cc p ng sinh hc ti ch v h thng
S cy ghp vt liu trn ng vt cung cp cc thng tin quan trng v s tng tc
vi tnh tng hp mu, cp tnh, mn tnh, s vim ti ch v h thng, nhy cm v tin
trnh lnh ha vt thng. Cc p ng gy st, min dch, c tnh v sinh khi u ca ng vt
cy ghp vt liu cng c th c xc nh, cc phng php v quy trnh chi tit ca cc th
nghim ny c ASTM, NIH v cc t chc chuyn nghip khc cung cp.
1.2.3. Cc th nghim lm sng
s Cc quy trnh v cc quy nh
Neu cc th nghim invitro v trn ng vt thnh cng th cng khng
th tin on c tc ng ca vt liu trn ngi nu khng c cc th nghim lm sng. Cc
th nghim lm sng phi thnh cng trc khi cc b phn gi c s dng rng ri cho bnh
nhn.
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 8


Ngoi cc tiu chun khoa hc, cc nh gi lm sng phi tun theo quy nh php
lut. Cc kt qu th nghim invitro, exvivo (ng vt) phi c lu gi cn thn h tr cho
cc th nghim lm sng. Ngi nhn phi c mua bo him cho cc ri ro khi cy ghp vt
liu mi. Hn na, cc quy trnh chi tit m t vt liu, qu trnh phu thut, x l hu phu,
chm sc ngi nhn v cc nh gi khc nh so snh sc khe ca ngi nhn trc v sau
khi cy ghp, so snh ngi nhn vi ngi khe mnh cng nhm thch hp (tui, gii tnh,
mi trng sng v lm vic...) phi ph hp vi cc quy nh ca FDA, quc t nhm bo v
quyn li ca nhng ngi tham gia trong th nghim lm sng.
s S tht bi khi cy ghp, s phc hi v nh gi
Mt thng tin khc quan trng v c gi tr c th c thu nhn t vic
nh gi vt liu cng nh cc m sinh hc xung quanh l s phc hi ca b phn gi t c th
vo cui i ca ngi nhn. Mc d cc vt liu sinh hc c thit k da trn c s sinh l
ca ngi khe mnh bnh thng nhng ngi nhn cc vt liu ny li ch yu l ngi ln
tui hoc ngi bnh. Do , khng th d on ht c tc ng ca vt liu di tt c tnh
trng ngi nhn vi nhiu bnh l v n thuc khc nhau. Di nhng trng hp nh th,
cc bin chng khng d kin trc c th xy ra nh l mt chc nng, ri lon ha l... Ngoi
ra, nhng bin chng nh l au hoc gy bt tin c th kt hp vi vim nhim v cc triu
chng lm sng khc gy nguy him cho sc khe ngi nhn. Khi , s can thip ca phu
thut l khng th trnh khi.
2. Vt liu s dng trong ch to vt liu sinh hc ng dng trong chn thng chnh
hnh.
2.1 Silicone
Silicone l mt hp cht cao phn t (polymers) c tn ha hc l
dimethylpolysiloxane, vi thnh phn ch yu l silicon kt hp vi oxygen, carbon v cc gc
hu c nh ethyl, methyl, phenyl, cu trc ha hc ca n gm nhng chui lin kt silicon -
oxygen (-Si-O-Si-O-) v cc lin kt ngang vi cc nguyn t carbon. Bng cch bin i cc
kiu lin kt cu trc phn t ngi ta to c cc dng tn ti khc nhau ca silicon nh dng
lng (fluid), dng gel, dng do, dng rn. Silicone dng do kiu cao-su (Silastic) c sng
ch nm 1945.
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 9


Silicone c Hng Dow Corning (M) ch to t nm 1930. en nm 1943, Dow
Corning tp trung chuyn v silicone v tr thnh nh sn xut silicone ln nht th gii vi
7000 chng loai sn phm.
Hp chat silicone c thnh phn ch yu l silicon nhng hon ton khc v c tnh l
ha. Silicon (Si) l mt nguyn t ha hc ph bin trong t nhin, ng hng th hai sau
Oxygen, chim 27,5 % t trng v tri t. Silicon khng tn ti c lp m thng tn ti trong
t nhin di dng hp cht nh silic-dioxide (Si02)hoc silicate. Ngi ta s dng cc k thut
tch Oxygen ra khi hp cht S02 thu lay silicon. T silicon ny mi ch to ra hp chat
silicone polymer, m mt s trong nhng sn phm silicone polymers ny c s dng trong y
hc. Silicon c vai tr rt quan trong v rt ph bin trong t nhin cng nh trong i sng. N
c mt trong tt c cc loi qu t nhin. N l thnh phn c bn trong nguyn liu ca cc
ngnh cng nghip nh thy tinh, thp, vt liu cht do, in v in t V.V.. c bit trong cc
ngnh cng ngh k thut cao vai tr ca silicon l v cng quan trng. Silicon chip l b phn
linh kin c bn ca cng ngh bn dn v cng ngh ch to my tnh in t. Silicone lng
(silicone fluid) v Silicone do (Silastic) l 2 dng silicone ch yu c s dng trong thm
m nh l nhng cht liu cy n vo c th.
Silicone do (silastic):
Silicone dng ny rt quen thuc vi gii lm p v n chnh l cc loi ming ghp
cy n cho nhiu vng c th: sng mi, cm, m, bp chn, c ngc, mng v.v... gi ting anh
rt thng dng l implant. Dng silicone ny c s dng t lu v hin vn ang c s
dng ph bin trn th gii. Ngoi nhng c tnh chung ca silicone, cc loi implant ny cn
c nhiu u im thun li cho s dng nh mm mi, dai, chc, d thao tc khi phu thut, d
o gt chnh sa theo yu cu, d to hnh theo hnh dng ca c quan cn cy ghp.
Silicone lng c thit k s dng cho y hc l siliconeMDX 44011, c nht
cao gp 350 ln nht ca nc (350 centistokes so vi ca nht ca nc l 1 centistoke).
Silicone c nht cng cao th cng t b hp thu, cng gi c hnh khi, t b bin dng.
Silicone lng c nhng c tnh l ha ca silicone ni chung nhng c u im hn v nht l
d s dng. Silicon lng v cc hn hp ca n pha vi mt s cht khc nh du thc vt, acid
bo.. .c s dng bm vo lm y cc khuyt lm di da, lm tng khi lng t chc
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 10


theo mun.Thm m cha hi lng c th ly ra thay i chnh sa rt d dng.
2.2 Vt liu gm y sinh Hydroxyapatit (HAp)
Vt liu gm y sinh nh nhm, km, hydroxyapatit, tricanxi photphat v mng sinh hc
c ng dng v pht trin rt nhiu trong vn chm sc sc kho con ngi cng nh
ci thin i sng ca con ngi. l cc gm sinh hc c th thay th cc b phn xng b
chn thng trong c th con ngi m khng h c phn ng ph no, l cc dng xi mng
y sinh dng hn xng, cc dng khong cht c s dng lm thuc cha cc bnh
thoi ho xng... Ban u, gm y sinh c s dng thay th xng trong nn cng nghip
y sinh bi nhng c tnh qu bu ca chng nh kh nng hot ng sinh hc tt, t trng thp,
bn ho, kh nng khng tr cao v ring i vi canxi photphat th bi n c thnh phn rt
ging vi xng ngi v ng vt. L do ch yu ca cc loi vt liu gm c dng lm vt
liu thay th l bi chng c kh nng chu lc 'mm do v kh nng tng thch sinh hc
cao. Nm 1920, Albee cng b ng dng dc phm thnh cng u tin ca gm y sinh
canxi photphat trn c th con ngi v nm 1975, Nery v cng s cng b cc ng dng v
nha khoa ca cc loi gm ny trn ng vt. iu ny m ra mt cuc cch mng v vic
nghin cu v th nghim ng dng ca cc vt liu gm trong dc phm v trong nha khoa.
Ngy nay, cc vt liu gm c dng trong rt nhiu cc lnh vc khc nhau nh: thay
th rng, xng b ch, xng hng, gn, dy chng v cha cc bnh v tim nh thay van
tim... Trong cc dng canxi photphat th tri-canxi photphat Ca3(P04)2, TCP v hydroxyapatit
Cal0(PO4)6(OH)2, HAp l cc hp cht c hot tnh v tng thch sinh hc tt nht. Xu hng
gn y trn th gii l tng hp cc dng vt liu c kch thc micro v c bit l vt liu c
kch thc nano nhm tng din tch b mt ca vt liu t tng kh nng phn ng v tnh
tng thch ca chng.
Vic nghin cu v tng hp HAp c kch thc nano c cc nh khoa hc
nghin cu t hng chc nm nay bng nhiu phng php khc nhau v ang dn dn a cc
vt liu y sinh ny vo phu thut thay th xng cho con ngi. Hydroxyapatit,
Cal0(PO4)6(OH)2, l mui kp ca tri-canxi photphat v canxi hydroxit, trong t nhin tn ti
di dng flo-apatit CalO(PC)4)6F2. N l thnh phn v c chnh trong xng v rng ngi
v hin ang tr thnh i tng nghin cu chnh ca cc nh khoa hc nhm mc ch ci
thin cc tnh cht sinh hc, ho hc ca n. Hydroxyapatit (HAp) thng c s dng di
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 11


dng bt thay th xng hoc lm cht ph ln b mt kim loi tng kh nng tng thch
ca vt liu cy ghp.
Cc nh khoa hc ang hon thin quy trnh cng ngh nhm tm ra phng php tng
hp vt liu ti u ci thin v nng cao cht lng sng. Nh HAp dng bt lm thuc b sung
canxi trn c s micro HAp, Gm t hp HA-bTCP l vt liu y sinh chnh cho cc phu thut
ghp xng, ni xng, chnh hnh hoc sa cha xng, mng n-HA, dng composite.
2.3 Composite cacbon
Nh, d lp rp rp, bn cao... l c im ca loi chn gi bng vt liu composite
cacbon.
Chn gi bng nha composite cacbon c ch to t loi vt liu gm hai lp si
cacbon bn cho kt hp vi 4-6 lp si bazan cng mt loi nha tng hp. Nh vy chn gi
ny c ng chn nh, bn cao v chu lc tt.
C hai loi ng chn gi. Loi dnh dnh cho ngi ln c chiu di 30 cm, nng ch
c 190 gram v loi dnh cho tr em, di 25 cm, nng 135 gram. Chn gi lm bng nha
composite cacbon c bn 3 nm, c chc nng gn ging chn tht. Cu to khp gi c c
ny, vng tt hn v do c l xo nn d dng lp rp, hng b phn no thay b phn .
Trung tm Cng ngh Vt liu - Vin ng dng Cng ngh nghin cu loi chn gi
ny t nm 2000. en nm 2003, kt qu ca nghin cu trn c T chc Chnh hnh
Ngoi tuyn Hoa K (Prosthetics Outreach Foundation-POF) kim nghim v xc nhn t yu
cu k thut..
2.4 INTOST- 4
Sau nhiu nm nghin cu, cc nh khoa hc ca Trung tm cng ngh laser (B KH-
CN) ch to thnh cng INTOST- 4, loi vt liu ccbon xp ng dng trong lnh vc chn
thng, chnh hnh v phc hi chc nng...
Ccbon thay xng
Hin nay, cc nh khoa hc th gii v Vit Nam u cho rng y l vt liu ccbon
c nht v nh ng dng lm vt liu thay th xng.
S dng vt liu ny trong chn thng chnh hnh cho thy, khi trm xng, cc t
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 12


bo xng c th mc qua l xp, mao dn ca ccbon v lin xng nhanh chng. INTOST- 4
khng h thua km vt liu thay th xng dng xp tng t Hydrroapatit, Interpore- 200 (M)
v mi gc .
Ccbon xp c th s dng trm xng, ch to khp, phn lt cho a m ct sng,
trm hc mt... Ngoi ra, nhiu ngnh cng nghip khc cng s dng vt liu ny.
Mt sn phm na cng ang c trin khai nghin cu l Piro ccbon- ccbon sital.
Vt liu ny c ch to nhit cao (1.400- 1.500 C) nn mt ccbon tp trung cao,
bn rt ln (c th gp 3 - 4 ln thp) nhng li c n hi ph hp cho s kt hp vi
xng.
Nga, Anh v M l 3 quc gia hin ang sn xut v tiu th hng triu cac van tim
nhn to bng vt liu ny. Ring ngnh y hc, ngoi ng dng , vt liu ny c th thay th
mt cch tuyt vi cho inh ni ty, chm xng i, chn rng gi... Nhng sn phm u tin
t vt liu trn ca Vit Nam ra i v ang trong giai on th nghim.
2.5 Zirconia(lm rng gi)
(Zr02) l oxit ca kim loi Zirconium (Zr) c pht hin t rt lu. Do c tnh cht
c bit, Zirconia c s dng rng ri trong cc nghnh cng nghip k thut cao nh: lm v
tu v tr con thoi, thng xe hi,...Zirconia cn c s dng rng ri trong y khoa t lu do c
c tnh tng hp sinh hc tt, nh thay th khp hng, khp gi nhn to,...
Zirconia c nhng tnh cht c bit him c nhng vt liu khc nh : mu trang ,
rt cng,c kh nng chng t gy v kh nng chng mi mn cao...Zirconia c cc nh
khoa hc nghin cu v to ra loi vt liu c thnh phn c bn l Zirconia (tm gi l vt liu
Zirconia) ng dng an ton vo nha khoa thc hin ci gi, implant v implant abutments,
mc ci chnh nha v lm "khung sn" cho mo v cu rng s ...
Vt liu Zirconia dng cho phc hnh s trong nha khoa rt cng v nhit nng chy
rt cao, nn khng th dng phng php c thng thng to ra mt "khung sn" nng
cho lp s ph bn ngoi lin kt vi n (ging nh b xng ngi dng nng ton
b c th). Do to ra mt "khung sn" nh trn,vt liu Zirconia c "tin" bng h
thng my chuyn dng dng trong nha khoa theo phng php CAD/CAM (Computer-Aided
Design/ Computer- Aided Manufacturing ).Sau , "khung sn" ny c p ln nhng lp
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 13


s v em i "nung" cho ging hnh dng v mu rng tht ca tng bnh nhn. To ra mt rng
s c "khung sn" lm bng vt liu Zironia ( rng s kim loi c khung sn lm bng hp
kim) hay cn gi l rng s Zirconia .
3. ng dng yt liu sinh hc trong chn thng chnh hnh.
3.1 Xng nhn to
3.1.1 Xng nhn to t san h
San h l mt vt liu sinh hc c ngun gc t nhin. San h t nhin sau khi c x
l qua nhiu cng an lai b cc thnh phn hu c th ch cn l mt khung xng cht vi
thnh phn ch yu l carbonate calci v mt t cht khang khc u l thnh phn c trong
xng ngi, ng vt c v. Ngoi ra, san h x l khng c t bo sng cng khng c
thnh phn hu c nn kh nng sinh min dch trn nguyn tc l khng c.
Do c cu trc xp vi kch thc cc l ph hp, sau khi cy vo xng, san h kch
thch s lin xng qua c ch dn to xng, khi u bng vic xm nhp nhanh chng ca
mch mu v cc t bo u dng xng vo mnh ghp. Sau xy ra ng thi hai qu trnh
hy mnh ghp v tn to xng, din ra tng t nh khi ghp xng.
xp ca san h ph thuc vo tng loi v nh hng nhiu n tnh cht vt l ca
mnh ghp. xp thp th mnh san h cng chc hn nhng khi ghp vo xng th qu
trnh sinh xng mi v hy san h ban u ch xy ra xung quanh nn ghp, mnh ghp s tn
ti cng vi xng ch mt thi gian di mi thay th ht, tng t nh ghp xng v. Neu
xp cao th mnh san h s nhanh chng b tiu hy m khng kp to xng mi thay th.
Trong trng hp khim khuyt xng c hnh dng phc tp gy ra sau chn thng
hay phu thut, vic tm mt mnh ghp c hnh dng tng t kh khn hn. Hn na, nu
mnh ghp khng c nh cht, li nhng khang trng gia m ghp v xng ch th s
gp tr ngi l cc mnh m vn xung quanh ri vo khang trng s lm chm lin xng,
thm ch thi ghp hay gy nhim trng sau ny. Mt lai xi mng ng cng nhanh to t cc
ht san h vi Sulfat calci hay sulfate km c ngh s dng trong trng hp ny. Sau khi
x l vi p sut v nhit cao, hn hp ny trn vi nc s to thnh dng kem, c th c
khun theo hnh dng ty v t c ng cng ti a sau 60 pht.
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 14


3.1.2 Quy trnh x l san h nhm ch to xng c ng dng ti Vit Nam
Trn th gii ngi ta c khuynh hng tm ra nhng vt liu khc thay th nh vt liu
tng hp; si thu tinh; kim loi; san h. Nm 1996, c s gi ca gio s Rouvillain,
ngi Php, v vic Vit Nam c rt nhiu san h, c th nghin cu dng n ghp xng,
cc bc s v nhng nh khoa hc ti TP HCM hp ng vi Vin Hi dng hc Nha Trang
nh danh, bo qun tm v vn chuyn san h v thnh ph.
Nm 1997 cc sinh vin thc tp dng san h th ghp xng trn th v ot gii
nht khoa hc tr ton quc. Nm 1998 ghp th trn ch. Nm 1999 ti ny c a i
bo co cc nc Malaysia, Indonesia. Ti y, vi s gp ca tin s M.Strong, cc bc s
Vit Nam quyt nh chn loi san h Porites Lutea l loi ph hp nht cho ngi. T
1999 n 2001, vt liu ny bt u c nghin cu ng dng chuyn khoa mt v rng hm
mt, ct sng. Cc bc x l san h:
Thu hach san h. San h c la chn bi cc nh chuyn mn, c nh danh
khoa hc r rng (ging Porites sp. v Montastrea sp. thuc h Poriitidae). Thu hach mu san
h sng t cc vng bin khng nhim trnh cc tp cht lng ng, c nh tm trong
dung dch st trng mnh chuyn v phng th nghim.
Ca n kch thc ph hp, lai b cc phn c tp nhim thy bng mt thng.
Ph hy polyp (cc thnh phn hu c). S dng dung dch
hypochloride natri 5% ngm trong nhiu ngy.
Ra bng nc ct trn my siu m (140W, 47kHz, 55C) hoc si h p(30 - 40c
tng ng 40 - 70mmHg).
Sy kh trong my chn khng (30 - 40c, 760atm trong 24 gi).
ng gi. Dn nhn.
Kh trng gamma 25kGy.
Ra cht hu c bng my autoclave 121c, 60 pht trong dung dch NaCl 0,9%.
nh lng protein trong dch ra bng phng php lowry v biuret.
Tin hnh o t trng, xp, tc ht nc ( nhit phng v nhit si h
p).
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 15



Hnh 2: Ghp san h vo ct sng c.
3.1.3 Mt s cht thay xng thng mi hin nay
ProOsteon v ProOsteon500R (Interpore): san h bin i thnh hydroxyapatite v
carbonat hydroxyapatite. Mt cu trc dng san h xp hat ng nh l mt scaffold cho
xng mi. ng dng trong iu tr gy hnh xng i vi xng di v ni ct sng c.
Ostoglass (US Biomaterials): thy tinh c hat tnh sinh hc kt hp vi collagen v
kch thch s hnh thnh xng gia mnh ghp, cc si collagen v xng c. ng dng trong
iu tr khim khuyt quanh rng, xng mt, xng tai gia, c nh gy xng di, ni ct
sng, thay khp.
Skeletal Repair System (SRS - Norian): xi mng c th tim, c th lm khun, cng
khi vo c th to thnh carbonate apatite, ng dng lm cht ph n nh mnh gy.
BSM (ETEX Corporation); l bt calcium phosphate kch thc nano, dng tinh th,
tng hp, cng nhit c th. ng dng trong cha rng v quanh rng.
Vitoss v Crotoss (Orthovita): l cht lp y ch trng xng v da trn terpolymer
ca bisphenol-a - glycidyl dimethacrylate, bisphenol-a-ethoxy dimethacrylate v triethylene
glycol dimethacrylate, ng dng lm xi mng cha s v lm cht lp y tn khuyt xng.
Bone Source (Orthofix - Stryker - Howmedica): l mt lai xi mng gm da trn hydroxy
apatite, cht ny cng ln trong 20 - 30 pht v chuyn thnh

Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
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hydroxyapatite trong 4 gi. ng dng cha s v lm cht lp y trong cc trng hp chnh
hnh.
Ngai ra, cn mt s sn phm thng mi khc c ch to t cc nguyn liu: a-
tricalcium phosphate, cc ht hydroxyapatite-tricalcium phosphate v collagen b, cht nn
xng ca ngi c kh khang huyn ph trong glycerol, cht nn xng kh khang vi
collagen.
3.2 Khp nhn to
Khp l ni tip gip gia cc u xng, gm c khp ng, khp bn ng v khp
bt ng. Trong , khp ng tham gia v gi vai tr chnh trong cc c ng ca c th
ngi. Nhng v l do bnh l hay chn thng m cc khp ny nh thoi ha khp, vim
khp,... dn n tn thng khng hi phc ca khp nh: thoi ha khp hng, hoi t chm
xng i v khun, gy c xng i... Khi khp b tn thng khng hi phc s nh hng
n kh nng i li, sinh hot, hc tp v lao ng ca bnh nhn, gim cht lng cuc sng.
Thuc v cc phng php iu tr nhm iu tr cn nguyn, gim triu chng v ngn nga
cc di chng ca bnh. Khi cc phng php iu tr v ni khoa khng ci thin, thay khp
nhn to c thc hin nhm ci thin chc nng vn ng ca khp, ci thin cht lng cuc
sng ca bnh nhn. Cng vi tin b ca khoa hc k thut, phu thut thay khp hng ni
ring v cc phu thut thay khp ni chung c thc hin ngy cng nhiu gp phn nng
cao cht lng iu tr v cuc sng ca bnh nhn.
Thay khp nhn to l mt phu thut trong khp mc tiu ca bnh nhn c thay
th bng khp nhn to nhm gim au v to thun li cho vic sinh hot ca bnh nhn.
Mt s tnh trng bnh l hoc chn thng nh thoi ha khp, vim khp,... dn n
tn thng khng hi phc ca khp nh: thoi ha khp hng, hoi t chm xng i v
khun, gy c xng i... Khi khp b tn thng khng hi phc s nh hng n kh nng
i li, sinh hot, hc tp v lao ng ca bnh nhn, gim cht lng cuc sng. Thuc v cc
phng php iu tr nhm iu tr cn nguyn, gim triu chng v ngn nga cc di chng
ca bnh. Khi cc
phng php iu tr v ni khoa khng ci thin, thay khp nhn to c thc hin
nhm ci thin chc nng vn ng ca khp, ci thin cht lng cuc sng ca bnh
nhn. Cng vi tin b ca khoa hc k thut, phu thut thay khp hng ni ring v cc
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 17


phu thut thay khp ni chung c thc hin ngy cng nhiu gp phn nng cao
cht lng iu tr v cuc sng ca bnh nhn.
3.2.2 Vt liu dng trong to khp nhn to
Hp kim da trn kim lai ch: vt liu chnh lm nn khp hng tan phn l
mt hp kim gm sat, titan, crom, carbon, nhm, molybden, vanadium... nhng tu chung
c 3 nhm chnh l kim lai da trn st, kim lai da trn titan v kim lai da trn
cobalt.
s UHMWPE (ltraHigh Molecular Weight PolyEthylene): l vt liu chnh to
nn phn ci. L mt hp cht nha bo m cng chc. Vi thi gian hn
35 nm s dng, s dung np ca c th ngi c ghi nhn l tt v sc chu
vi lc bo mn cng c chi nhn l kh quan.
S Xi mng: l vt liu c dng gn khp nhn to vo xng. Xi mng
(polymethylmethacrylate, PMMA) l mt hn hp gia phn bt (gm PMMA
tin polymer ha v barium sulfate) v dung dch (gm dn phn
methylmethacrylate). Khi 2 phn ny tip xc vi nhau s cho ra mt hn hp st
ri cng dn cho n lc cng hn, do s gn cht cc phn khp nhn to vo
xng. Thng thng, t lc trn ln vo nhau n lc cng hn l 1 0 - 1 2 pht, c
lai nhanh hn hoc chm hn.
Xi mng rt bn vi lc p nhng d v vi lc cng v lc x.
S Gm: hin nay c s dng lm u khp thay cho kim lai. bo mn v
lc ma st t.
Vt liu dng cho khp nhn to phi m bo c 4 yu t sau:
Thch hp v mt sinh hc.
Kh nng chng mi mn tt
C cu trc ph hp c th m bo chc nng ca khp l nng c th
Vt liu tt nhng phi m bo gi thnh hp l nht.
3.2.3 Khp hng nhn to
3.2.3.1 Cu to: mi khp hng c to thnh t 2 phn:
Phn 0 ci: gm mt v kim lai bao plastic bn trong.
Phn xng i: gm mt thn kim lai vi mt u kim lai trn. Mt vi khp
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 18


c u bng gm gn vi thn.

3.2.3.2 Phn loi khp hng nhn to
Khp hng c xi mng
Khp v xng c lin kt bng xi mng xng (bn cht l polymethylmetacrylat),
pht trin cch y khang 40 nm, dng xi mng gn kim lai vi xng. Trong phc hp
xng - xi mng - khp nhn to th xi mng c coi l phn yu nht, thng b lng, v sau
5- 10 nm v khi m li, vic ly ht xi mng c ra cng khng d dng, nn c khuynh
hng s dng cc khp khng xi mng. Cc khp xi mng lm gim au v tng tnh linh ng
ca khp, t kt qu ngay sau khi gii phu nn thng c s dng cho ngi gi, t vn
ng v nhng ngi c xng yu nh lang xng.

Hnh 3: Khp hng nhn to
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
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Khp hng khng xi mng
Khp khng xi mng: pht trin cch y khang 20 nm, c mt li mn trn b mt
chm xng, ng knh l 100 - lOOOIm. Li cho php xng tng trng vo trong li v
tr thnh 1 phn ca xng. Nhc im chnh ca khp khng xi mng l thi gian hi phc
ko di (mt thi gian xng t nhin tng trng vo trong l v gn vi khp). Ngi c
thay khp khng xi mng phi hn ch hat ng trong 3 thng bo v khp mi.

i
_ .< - T .
Ceiment
/ cV-
/r*/ Bone
m
I
_ il _____

Hnh 4: Khp nhn to xi mng. Hnh 5: Khp nhn to phi xi mng.
3.2.4 Khp gi nhn to
Gii phu khp gi:
Khp gi l mt trong nhng khp ln nht c th. N gip cho chng ta c th
i ng, chy nhy v thc hin hu ht cc ng tc sinh hot hng ngy. Mt khp chnh
l ni tip xc gia u di xng i v u trn xng chy. Ngoi ra cn c mt khp
gia xng bnh ch v xng i. Khp gi c nhiu dy chng v c bm xung quanh
gip tng cng vng chc ca khp gi. Be mt mi u xng ca din khp c
bao ph mt lp sn khp rt trn lng. Lp sn ny c chc nng nh mt lp m v
gip cho khp gi c ng d dng. Phn cn li ca b mt khp gi c mt lp mng
bao bc gi l mng hot dch. Lp mng ny tit ra cht dch gip bi trn khp gi, lm
gim lc ma st khi c ng. Bnh thng cc thnh phn ny hot ng vi nhau mt
cch nhp nhng. Tuy nhin nu c chn thng hoc mt bnh l no xy ra khp
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
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gi, n s
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
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lm ph v s cn bng ny, lm cho ngi bnh c cm gic au, yu chn hoc gim
chc nng khp gi.
Sn khp ng vai tr rt quan trng trong khp gi. Chnh v vy nu lp sn
khp b tn thng, b bo mn th khp gi s b au hoc gim chc nng. Nguyn nhn
ph bin nht gy tn thng sn khp l vim khp. Vim khp c th do thoi ha, do
thp khp hoc do chn thng. Phn ng vim s lm tn thng sn khp, c th l
bong sn hoc bo mn sn khp.

a b
Hnh 6: a - Khp gi bnh thng, b -
khp gi b thoi ha.
Cc kiu khp gi nhn to
Khp nhn to c ra i vo nhng nm 1960 cng vi s xut hin ca khp
nhn to kiu bn l c dng xi mng, n ch m bo cho khp gi hot ng sinh l rt
hn ch l gp v dui. Trong mt thi gian di, do c nhiu tht bi cng nh bin chng
lm cho khp gi nhn to b mang ting xu, mi ngi k c bc s ni khoa, ngoi khoa
cng nh l bnh nhn nghi ng v kt qu ca thay khp gi. Tt c kinh nghim v tin
b cho php to nn nhng khp nhn to ngy nay. Vi nguyn tc c bn ca s thay
i l tit kim xng a ra cc mu khp nhn to, trong vic ct xng ch gii
hn b mt ca khoang khp thoi ho.
S Khp gi nhn to n
Cch y hai mi nm, MARMOR pht minh ra khp gi nhn to n bn
ngoi v bn trong: mt mm chy c che ph bi mt lp polythylne v mt li cu

Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
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che ph bi lp kim loi c hnh th gii phu nh l li cu bnh thng. Khp gi n
c s dng rng ri, t c thnh cng l v c cht lng v kt qu tt. Chnh
tng lm khp gi n lm cho ngi ta pht trin tip ch to khp xng i - bnh
ch, thay th cho thoi ho khp i - bnh ch: rnh lin li cu c che ph bi kim
loi, cn bnh ch mt sau th c ph bi mt ming polythylne thay th cho sn khp
hng. Ch nh khp nhn to n trong trng hp khoang khp i din cn cha b
thoi ho.
S Khp gi nhn to ton b
Khp gi nhn to ton b l s tha hng ca tt c nhng hiu bit v sinh l
ca gi, c bit l khi nim v chuyn ng, trt, quay ca xng chy. Khp gi c
bn l thi khng dng na thay vo l khp nhn to ton b dng trt xut hin t
nhng nm 70, khp ny tn trng gii phu ca gi c bit ca h thng dy chng.
Khp nhn to dng trt ch thay th cho sn khp hng, gn ging nh l
khp gi n, ch lm cho mt khoang khp: n bao gm hai thnh phn ring bit mm
chy v li cu. Li cu lm bng kim loi, n bao bc ly ton b u di xng i bao
gm c rnh lin li cu ca khp bnh ch, c th dng hay khng dng ming
polythylne thay th cho sn khp mt sau bnh ch. Chiu di ca ui kim loi cm vo
trong ng tu khng cn thit nh vi mm chv.
mm chy, c mt ming m nh bng polythylne chen vo gia mm chy
v li cu bng kim loi. Khi ct xng cn phi o chiu dy b mt thay th bng
ming nha ny.
xng i, ct xng theo nhng mt ct c chun b trc sao cho ph hp
vi chiu cong ca li cu v kht vi mt tip xc ca khp nhn to.
N c nhiu c khp khc nhau cho php thay i ph hp vi gii phu ca tng
ngi.
Khp nhn to dng trt ch thay th cho sn khp hng, gn ging nh l
khp gi n, ch lm cho mt khoang khp: n bao gm hai thnh phn ring bit mm
chy v li cu. Li cu lm bng kim loi, n bao bc ly ton b u di xng i bao
gm c rnh lin li cu ca khp bnh ch, c th dng hay khng dng ming
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
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polythylne thay th cho sn khp mt sau bnh ch. Chiu di ca ui kim loi cm vo
trong ng tu khng cn thit nh vi mm chv.
mm chy, c mt ming m nh bng polythylne chen vo gia mm chy
v li cu bng kim loi. Khi ct xng cn phi o chiu dy b mt thay th bng
ming nha ny.
xng i, ct xng theo nhng mt ct c chun b trc sao cho ph hp
vi chiu cong ca li cu v kht vi mt tip xc ca khp nhn to.
N c nhiu c khp khc nhau cho php thay i ph hp vi gii phu ca tng
ngi. Ngi ta bit rng vi loi khp nhn to ny, khi thay cn phi sa li gii phu
cho tht ph hp vi tng u xng, hn na phi m bo s vng chc ca h thng
dy chng : trong bt buc phi m bo s chc chn ca h thng dy chng bn, hay
ni cch khc ch khi h thng dy chng bn cn nguyn vn mi c th s dng loi
khp nhn to ny. Vai tr ca dy chng cho vn cn ang bn ci: phn ln cc phu
thut vin chnh hnh u cho rng vic ly b dy chng cho trc khng gy bt c mt
hu qu no. Nhng vi dy chng cho sau ly i hay li cn l vn cha ng ng.
Nhng khp ngy ny c ch to c hai loi bo tn hay khng bo tn dy chng cho
sau.
Khp gi dng trt tuy phc tp nhng tn trng vi nguyn tc mi nu trn.
C nh khp c th dng bng ximng, ch cn dng rt t v mt ct u xng v khp
nhn to rt kht nhau, cng c loi khng dng ximng, xng s chui vo b mt tip xc
ca khp vi xng cho php c nh tt.
Mt trong nhng khp nhn to trt ci tin l khp quay: Nm gia li cu v
mm chy bng kim loi l ming nha polythylne di ng c th quay c: c hai
kiu: dng mt phng c trc quay, hay l loi c rnh trt. ng vai tr ging nh trong
sn chm nn tip xc gia kim loi v nha s c ci thin t mn hn. Khp kiu
ny c tnh cht nh hai khp, mt l gia mt di nha vi mt mm chy, hai l gi
mt trn ca nha lm xung vi li cu i cong vng ln. v vn ng gn nh sinh l,
gim nhng hn ch do khp nhn to gy nn.
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 24


s Khp gi nhn to bn l
Cn li nhm cui cng ca khp nhn to l khp gi c bn l, n gm c hai
phn: mt xng chy, mt xng i, l hai on inh di cm vo ng tu, hai
phn c ni vi nhau bi bn l ch cho php gp dui gi. Xng i v xng chy
ni vi nhau thng qua khp nhn to, khp ny c c im l khng di ng c sang
hai bn.
Mt ci tin ca khp loi ny l khp bn l c trc quay: n gm c cc phn
c hc cho php xoay gia xng i v xng chy.
K thut thay khp
Mi mt loi khp a ra u c mt kiu thay khc nhau, cn t m v phi tun
th cc nguyn tc v gii phu cng nh sinh l:
Ct xng chnh xc rt quan trng:n cho php chng ta chnh c trc ca chi
di, khi cn phi ct thm hay bt u xng chy, hay xng i a chi v t th
bnh thng trnh cc hng khp nhn to sau ny, hn na vic ct xng chnh xc cn
gip lp khp nhn to d dng.
Trc ca chi di c bit quan trng trong thay khp n: nu thay qu dy lm
cho khoang i chy b chnh li qu mc ban u.
Ngc li trong thoi ho khp nng c th xng b mn i nhiu cn phi to
hnh li xng lm nn tt cho khp nhn to, c th dng chnh ming xng c ly
pha bn khoang khp i din, rt him khi dng xng ghp ca ngi khc (trong
trng hp thay li khp).
Tn trng cn bng dy chng l yu t c bn ca khp nhn to trt: ct xng
cn phi gi li c cng ca dy chng va cn i hai bn, n trnh c nhng
hin tng nh khp qu cht, to nn nguy c cng khp sau ny hay li qu lng c th
l nguyn nhn ca lng khp. Mt iu quan trng l phi cn i gia hai dy chng, c
ngha l tn trng cn bng gia dy chng bn trong v bn ngoi. Mi ngi u bit
rng, k thut ny rt t m, d dng thc hin hn nu c dng c thay th mu ng cho
tng loi khp v tng loi phu thut, nhng kinh nghim ca phu thut vin l mt yu
t c bn ca thnh cng trong phu thut ny.
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 25


4. ng dng vt liu sinh hc trong nha khoa.
Y hc ngy cng pht trin, ngi ta khng nhng ng dng vic cha bnh ca y
hc m cn s dng cho mc ch thm m. iu ny th hin kh r qua y khoa chn
thng chnh hnh, c bit l nha khoa. Vi cc thnh tu v y hc, sinh hc, cng ngh
vt liu, con ngi ch to ra nhng cht liu, b phn thay th trong nha khoa. C
rt nhiu cht liu c ng dng, vi cc c tnh khc nhau, v cng ngy ngi ta cng
nghin cu ra nhiu cht liu mi khc. Tuy nhin, c im chung ca nhng cht liu
ng dng trong nha khoa ny l bn, ph hp vi ngi dng v khng gy hi cho con
ngi.
4.1 Cu to, c im v phn loi rng gi
4.1.1 Cu to rng ngi
Cu trc ca rng c nhiu lp, t ngoi vo trong theo th t:
Men rng (enamel: l lp ngoi cng c dy mng ty theo mt rng, Mt nhai
ca rng hm c dy nhiu nht. Men rng khng c mu v trong sut, nn mu rng
l mu ca ng. Men rng l m xng cng nht trong c th, tuy nhin nhng do cu to
bi cc t bo hnh lng tr theo chiu ng v hng tm, c c tnh gin v d nt khi
c va chm mnh , hoc nhit trong ming thay i t ngt t nng sang lnh. Khi ta
ang n nng m ung nc lnh ngay, nhit lm men rng dn n ri li co rt
nhanh qu, men rng s b nt.
Ng rng (Dentine): Te bo ng rng c cng khng bng men, nn ng rng
rt d b axt ph hu nu men rng bn trn b hng th ng rng s d b sp nhanh
chng. Mu ca ng rng cng l mu ca rng v men rng khng c mu. Do cu to bn
trong, gia cc t bo ng c nhng ng nh cha dy thn kinh v mch mu nn ng
rng c cm gic au khi su rng tin vo su trong lp ng. Ng rng cm gic vi nng
lnh , cht chua ngt, v hi gi lnh. Cng nh men rng, ng rng mt khi b su, mt
cht b b, m s khng t ti to li c. Cch duy nht ti to ng rng b mt l
trm rng hoc lm rng gi.
Ty rns (Pulp): Gm bung ty (pulp chamber) v ng ty chn rng (root canal).
Bung ty l trung tm im ca rng, cha mch mu v dy thn kinh nui rng.
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 26


Mch mu dn t trong xng v i vo rng t di gc rng, qua l chp chn rng.
Chn rng (Root): l phn nm trong xng hm, cu to ca chn rng l ng
chn rng (cementum, hay ng gc rng) c cng nhiu hn ng vng thn rng. Chn
rng khng hn cht vi xng hm m c bao quanh bi dy chng nha chu
(periodontal ligament), nh m chn rng nm m i trong xng rng.
M nng rng: Gm nu, dy chng nha chu v xng rng.
Nu rng: l nim mc m mm bao ph nn hm v sn ming. Nu rng bao
quanh rng vng rng che ch cho chn rng bn di.
Dy chng nha chu: c tc dng nh ci m ngn cch chn rng vi xng
rng (Alveolar, socket). Dy chng nha chu cu to bi nhng si collagen c tnh
n hi, mt u gn vo xng rng, mt u bm vo ng chn rng lm cho
rng ng vng chc trong xng hm. Do rng khng phi ng yn v cng
nhc m rng c c ng, khi ta n, lc cn nhai lm rng b ln xung mt t ri
li bung tr ln l nh dy chng nha chu.
Xng 0 rng: bao quanh chn rng, bnh thng xng bao ph n c rng v
gip rng ng vng trn hm.

Hnh 7: Cu to rng

Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 27


4.1.2 c im rng gi
Da vo cu trc v cc tnh cht ca rng tht m ngi ta tm ra cch thay th,
phc hi khi rng b bnh, h hng. Cc vt liu sinh hc s c ng dng to ra cc
phn thay th cho rng tht b h. Rng gi do da vo cu trc ca rng tht, nn c
cu to kh tng ng vi rng tht. Rng gi c nhng phn tip xc vi thc n, phn
c nh rng vo hm v phn gia rng gi vi phn c nh. Tuy nhin, rng gi c
lm t nhng vt liu tng hp c bit v khng c phn mch mu nui rng.
Nh vy, c th chia cu trc rng gi lm hai phn:
Phn rng ngoi
y l phn s tip xc trc tip vi thc n, chu cc va chm trc tip khi nhai,
cn x. Cng nh rng tht, phn rng ngoi ny cn bo m bn, chu nhit v
c tnh thm m cao. Vt liu c dng phn ny thng l s trng men, mt
s cc kim loi qu nh vng, bc.
Phn c nh
C th chia phn ny ra hai phn nh l c nh rng gi vi hm v phn lin kt
vi rng gi. Cng nh m nng ca rng tht, phn c nh ny c nhim v mang
rng, nng rng v gi rng c nh trn hm. Vt liu s dng lm phn c nh ny
cn c nhng tnh cht tng t phn nng ca rng tht nh bn, khng gy d ng,
vng chc. Ngi ta thng dng cc loi nha tng hp c bit hay kim loi ng
dng lm phn c nh ny.
4.1.3 Phn loi rng gi
Rng gi c nhiu kiu loi a dng, phong ph. v vt liu cu to c rng s,
rng vng, rng hp kim.... Da vo kiu rng gi c rng hm v rng ca gi. Tuy nhin
dng phn bit, ngi ta chia rng gi lm 4 loi chnh da vo cch thc v cu
trac rng gi thay th cho rng tht trn hm.
4.1.3.1 Mo rng
Mo rng hay cn gi l chp rng l 1 phc hi nha khoa bao bc quanh rng v
c dn vo rng bng mt loi keo dn nha khoa. Mo rng c ch nh cho cc rng
su hoc rng gy v. Mo rng phc hi hnh dng bn ngoi v lm tng s vng
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 28


chc ca rng b tn thng.
Ci rng
Mo rng
Hnh 8: Mo rng ca gn vo ci rng Hnh 9: Mo rng hm
Vi nha khoa hin i ngy nay, c rt nhiu vt liu nha khoa chn la. Mt s
mo rng c lm ton b t vng, mt s khc c lm t hp kim c ph s bn
ngoi (mo s kim loi). Theo thi gian, mo s kim loi l ng en vin nu trng
khng thm m. Mo ton s l chn la tt nht c v thm m t nhin. Hin nay c
nhiu vt liu c s dng lm mo rng, mt s vt liu ph bin nh:
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 29



Hnh 10: Mo rng s
s Kim loi (hp kim).
s S bn ngoi vi sn kim loi (kim loi thng/ kim loi qu) bn trong.
s S (ton b l s). s Nha tng hp. s Nha-kim loi.



Hnh 12: Mo rng vng Hnh
13: Mo s - kim loi
Mo rng cng i hi s chm sc tng t nh rng t nhin. V sinh rng
ming k, kim tra rng nh k duy tr ch n tt cho rng, mo rng cht lng cao c
th s dng trong khong 10- 15 nm.
u v khuyt im ca cc loi mo rng:
Mo vng
u im: vic bc mo vng n gin v t gy bin chng nht v c rt t m rng
b ly i do mi v m rng lnh mnh cn li c bo tn ti a. Khng nh mo s,
mo vng khng gy tnh trng mn mt nhai cc rng i din. Mo vng cng d gn
kht vo ci rng hn. Vng l 1 cht hon ton khng gy nh hng c hi no cho m
nu.
Khuyt im: khng thm m do mu nh vng ca n.


Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 30


Mo s ton phn
u im: mo s hoc cc loi nha c gia c c xem l em li thm m cao
nht cho phc hnh v d dng p s theo mu cc rng xung quanh.
Khuyt im: dy lp s cn phi dy c th t thm m, iu ny ng
ngha vi vic phi mi b nhiu m rng trn rng cn bc mo.
Mo s - kim loi
u im: c th cho mu sc t nhin.
Khuyt im: do c 1 lp kim loi lm sn bn di nn n cn phi c che bi
lp opaque bn trn trc khi lp s c p ln. iu ny lm cho vic p s kh t
c xuyn thu nh rng t nhin.
4.1.3.2 Cu rng
Cu rng c dng thay th mt hay nhiu rng tht b mt, bng cch bc cu
gia hai rng, cu rng c nng v c dn vo cc rng t nhin k cn. Cu rng
l mt kiu rng gi, gm mt nhp cu c ni vi hai mo rng hai bn thay th rng
mt. Hai mo trn hai rng tr k bn vng mt rng c gn dnh v gi cht nhp cu
trn cc rng hai bn. cu rng, tng t mo rng, c th c lm bng s, kim loi qu
(vng), hoc kt hp ca hai loi trn.
Cu rng gm t nht 3 n v rng dnh lin nhau, cu rng gip khi phc hnh
dng cung rng v ngn chn cc rng nghing vo khong mt rng, ng thi khng cho
rng i din tri vo khong mt.
Cng nh vi mo rng, nhiu vt liu c dng to ra cu rng nh cu s -
kim loi, s qu kim, s khng kim loi.


Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 31



Hnh 14: Quy trnh thc hin cu rng C
3 loi cu rng:
Cu rng thng thng: cc rng 2 u khong mt rng s c mi lm
tr cho 1 cu. cu rng ny khng th tho ra khi ming nh hm gi tho lp.
Cu dn: cu dn c dng tm thi vng rng trc; c s dng tt nht
khi cc rng tr lnh mnh v khng c nhng ming trm ln. rng gi c dn
vo cc rng 2 bn khong mt rng bi cnh dn, cc cnh dn ny c dn vo
mt trong ca cc rng k cn. Loi cu ny khng cn phi mi nhiu m rng
trn cc rng k cn.
Cu vi: thng dng vng rng t chu lc nhai ln nh vng rng ca.
c thc hin khi ch c rng 1 u ca khong mt rng, cu vi thng ta
trn 1 hoc nhiu rng tr.
4.1.3.3 Rng cy ghp Implant
Cy ghp rng implant l thnh tu khoa hc tuyt vi nht trong lch s nha khoa
cho php phc hi li rng mt ging nh rng tht c v phng din thm m ln
chc nng, cy ghp implant ging nh to mt thn rng mi vi chic rng, cu rng hay
rng gi c trng ln thay th cho rng b mt. Implant nha

Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 32


khoa l nhng thanh kim loi/hp kim thng l titanium c cy vo xng hm lm
ch da cho rng s bn trn m khng cn mi 2 rng k bn nh lm cu rng. Implant l
gii php tt nht trong cc trng hp mt rng. Ngy nay, vi nhng u im ca
Implant, n dn dn thay th cu rng v hm gi tho lp.

Hnh 15: Rng cy ghp implant Hnh 16: Mt ct dc rng cy ghp implant
C hai loi cy ghp rng mplant:
Implant thng: mt tr nh lm bng titanium, kch thc trung bnh ng knh
t 3.5 - 5 mm, di 10 - 16 mm. Mt phn implant c vn vo xng hm ni mt
rng, ng vai tr nh mt chn rng v mt phn nh ln trn nu, trn s gn
mt mo rng bng s ging nh rng tht.
Tr Implant Mo s
Hnh 17: Cy ghp implant
Mni I mplant: l nhng tr implant c kch thc nh,
lm bng titanium. Mt phn implant c vn vo xng hm ni mt rng v
mt phn nh ln trn nu vi mt np y va kht gi l mc ci. N c t
vo trong nn ca hm gi, gip hm gi n nh khi n nhai. c dng trong
trng hp thiu th tch xng.

Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 33



Hnh 18: Mini Implant
u v khuyt im trong cy ghp rng mplant:
u im:
Khng cn mi cc rng k bn phc hi li chic rng mt do khng lm
tn hi rng tht k bn.
Cm ghp tr implant vo xng hm s to vng chc cho sc nhai tt
hn.
Hm Implant chc, bn v cht, c th tn ti sut i.
Ngn chn tnh trng tiu xng, gi cho xng hm khng b tiu i m bo
thm m cho nu.
Khuyt im:
Cn nhiu thi gian thc hin rng gi trn implant, sau khi cy ghp implant
vo xng hm phi i t 3 - 6 thng tr implant dnh cht vo xng mi c th lm
c rng gi. Khng phi bao gi cng t c implant, k thut i hi mt s iu
kin m bo thnh cng.
4.1.3.4 Hm tho lp
Phc hnh tho lp l loi hm rng gi m ngi dng c th mang vo hoc tho
ra ty . c chia lm hai loi chnh l hm tho lp bn phn v ton phn.
Hm gi bn phn: trong trng hp mt, h hng nhiu rng trn mt hm,
tuy nhin khng hng ht hm.
Hm tho lp ton phn: trng hp mt hoc h hng gn nh ton hm
rng. Da vo vt liu cu to, c 2 loi hm gi ton phn: hm gi ton phn
nha cng, c phn nn hm bng nha cng; v hm gi ton phn nha do, c
phn nn hm bng nha do Biosot.
Metal Housing

Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 34


Vt liu dng trong hm tho lp kh a dng, gm nha cng tng hp, nha
mm biosot, kim loi, s ....

Hnh 19. Hm gi tho p bn phn bng kim loi - nha tng hp
S u v khuyt im hm tho lp:
u im: hm tho lp kh bn, chc. Ci thin tnh trng mt rng, tng sc n
nhai, to s thm m cho ngi dng.
Nhc im: phi thng xuyn tho ra chi ra, v sinh, cn thi gian thch
nghi v sc nhai khng tt.
4.2 Vt liu s dng trong chnh hnh nha khoa
4.2.1 Hp kim/kim loi c
Kim loi v hp kim c s dng rng ri sn xut nhng vt phm c hnh
dng theo yu cu, c bn v chu lc tt nh tnh c th gia cng ca n.
Hu ht kim loi dng trong nha khoa l di dng hp kim. Hp kim c nhiu u
im so vi cc kim loi nguyn cht v c tnh c hc v l hc do c ch to t
n ti u t nhng kim loi thnh phn.
Hp kim c nha khoa c dng trong nha khoa lm mo (chp), cu, cc
phc hnh c nh kim loi - s, kim loi - nha, cht ng ty, hm khung...
Hp kim cn p ng c cc i hi chung nh sau:
'S Phi c tnh tng hp sinh hc, khng to ra c cht gy nguy him hoc gy d
ng i vi ngi s dng.
'S Phc hnh phi c tnh khng n mn v khng b thay i trong mi trng ming.

Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
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'S Cc c tnh l hc v c hc, nh tnh dn nhit, nhit nng chy, h s dn n
v nhit, bn... cn c p ng, tho mn cc gi tr ti thiu v thay i theo
nhng i hi khc nhau ca cc ng dng phc hnh.
'S Cc kim loi, hp kim v vt liu i km phi y , khng t qu.
s Ring i vi gia cng, hp kim cn d nu chy, d c, d hn, d nh bng, t co,
khng phn ng vi vt liu lm khun c, khng mn, khng b ln khi nung s.
4.2.1.1 Tnh cht ca kim loi
Tnh c hc
Quan trng nht l bn, do dai, cng, tnh chng mi mn. Kim loi c
th dt mng v ko si.
Tnh cht yt l
-Trng thi: nhit thng, tt c u th rn, tr thu ngn v
gallium.
- Di tc dng ca nhit, kim loi thay i mu sc.
- T trng: Thp khng r c t trng va phi (7,9), hp kim qu c t trng ln
hn. Trong nha khoa t trng cng nh cng tt.
- nng chy: ng (1083C), bc (960C), vng (1063C),nicken
(1452C), coban (1489C), crom (1820C).
- Tnh co th tch: nhit gim, kim loi c th co th tch dn n thay
i kch thc vt c, lm gim chnh xc.
Tnh cht ho hc
- L tnh chu ng ca kim loi trong mi trng acid, kim v dung dch
mui.
- Vng, Bch kim l kim loi ng u trong cc kim loi ny, n chu ng tt
trc cc phn ng ho hc trong ming.
- Trong ming c cht lu hunh lm bc b en, ng b xanh, ngoi ra acid
trong thc n v do vi khun to ra l nhng yu t lm mn kim loi.
- Nhng hp kim thng dng trong nha khoa nh: vng + bch kim, vng +
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 36


paladi, vng + ng, vng + bc, hp kim khng r gm coban, nicken, crom.
Bng 2. Phn loi hp kim nha khoa ca ADA 1984

Nm 2003, hi ng khoa hc ca ADA xem xt li s phn loi, bao gm
thm titanium nh mt mc ring trong nha khoa. Titanium l mt trong nhng kim loi c
tnh tng hp sinh hc cao nht trong cc ng dng nha khoa v c ng dng rng vi
c tnh tng t kim loi qu. Titanium ng dng ch yu trong cy ghp implant.
4.2.2 S nha khoa
S nha khoa l mt sn phm dng trong nha khoa phc hi, c bn cht l vt
liu v c khng kim loi, tri qua nung nhit cao t c c tnh mong muon
(J.M. Powers, R.L. Sakaguchi: Craigs Restorative Dental Materials, 2006).
Da vo cch pha v t l tinh th, ngi ta phn loi s nha khoa nh sau. S
gm hai pha:
S Pha thy tinh (glassy/vitreous phase)
S Pha tinh the (crystalline phase)
Ty vo bn cht v lng pha tinh th
Zirconia (Zr0
2
)
Alumina (A12 0
3
)
Feldspar (KAlSi3 0
8
)
Leucite (KAlSi2 0
6
)
Spinel (MgAl2 0
4
)
(Alloy Classification of the American Dental Association 1984)
Typ hp kim Tng lng kim loi qu trong thnh

phn (theo khi lng)
Rt qu (HN) > 40 wt% Au & > 60 wt% nguyn t kim

loi qu (Au + Ir + Os + Pd + Rh + Ru)
Qu (N) > 25 wt% nguyn t kim loi qu
Thng (PB) < 25 wt% nguyn t kim loi qu
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 37


Lithium disilicate (Li2 Si2 0
5
)
Lithium phosphate (L3 PO4 )
Fluorapatite (Ca5 (P04 )3 F)
S cho phc hnh s khng kim loi thng c lng t l tinh th cao (t 35
n 99%).
c im c hc ca s nha khoa ph thuc vo cc yu t chnh sau y:
Kch thc tinh th (ca pha tinh th).
T l v th tch ca pha tinh th.
bn ca lin kt, s chnh lch n hi, s chnh lch v dn n
nhit gia cc pha thy tinh dn. Do pha tinh th tngi rn chc,
ng nt s i theo pha thy tinh. Kch thc v lan rng dn ca
ng nt c th c gii hntrong khang cch gia cc phn t ca
pha tinh th.
4.2.2.1 Thnh phn cu to trong s nha khoa
S Cao lanh:
L mt silicate alumin ngm nc, chu nhit tt, chy lng nhit 1800c.
Trn vi nc thnh bt nho hi dnh lm cho cng vic nn d dng hn.
s b tt (Feldspath):
Khong cht thin nhin l silicate kp kali v albumin, chy lng gia nhit
1 1 0 0 - 1300c, lm cho s trong sut v chu la cao.
S Thch anh (Quartz):
Thnh phn ch yu l silic, ly t vi loi , ct, dng nh khung cho s v
ngn cho s co trong khi nung chy nhit 1700c.
s Cc cht khc:
Nh hn the, cacbonat Na, canxi lm cho s c nhit nng chy xung thp hn
1 1 0 0 c.
S Cc oxyt kim loi nhum mu:
Nh oxyt titan cho mu vng, oxyt urani cho mu vng cam, oxyt ng cho mu
ve chai,...
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 38


Cung cp di dng: bt s nhiu mu v nc ct (hoc cn 70 trn vi bt
cho dng bt do.
Cng dng: Lm mo, cn mt ngoi rng kim loi.
4.2.2.2 u im
- Dung np vi cc m mm.
- L cht cch nhit tt.
- Ben vng trong mi trng ming.
- Khng bin dng di sc nn khi nhai.
- D ra sch.
- Khng b i mu, c mu ging rng tht.
4.2.2.3 Khuyt im
- B co khi nung.
- Nghe ting vang khi n nhai.
4.2.3 Ciment gn dnh trong phc hnh c nh
L vt liu dng lp kn cc khong h gia m rng v vt liu phc hnh,
ng thi to s kt dnh vt liu phc hnh vo m rng.
S kt dnh ca 2 mt cht rn bi mt cht lng c mt c ch l ho phc
S Nng lc b mt (Energie de surface): l sc ht ca cc nguyn t b mt ca mt
tinh th cht rn, to nn sc cng b mt v to nn s kt dnh ho hc vi vt
liu khc.
S Tnh thm t (Mouillabilit, Wetting): l kh nng ca mt cht lng tri ra trn b
mt mt cht rn. Kh nng ny to ra sc cng b mt.
S S kt dnh vi m rng
Vt liu dnh vi m rng bng hai cch:
Bm vo nhng ngm nh (c hc) ca b mt.
Phn ng ho hc vi thnh phn ca m rng (ni ionique, cordinants,
chlalante, hydrognes, vandervan). c s kt dnh tt, vt liu phi c tnh phn cc
cao hn nc kt hp vi cc nhm protins i cc trong ng rng.
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 39


4.2.3.1 Tnh cht cn c ca ciment gn dnh vnh vin
S iu kin sinh hc
V trng
pH trung ho hoc acid yu
Lm du au
Che ch m rng
Khng c tnh
Km khun
Phng nga su rng.
S iu kin l ho
nht hi thp
C kh nng thm t
ng cng nhanh v ng nht
Khng ri lon bi m chung quanh
Khng to nhit
Dnh tt vi m rng v vt liu phc hnh
cng khng thay i
ho tan yu trong ung dch ming
Khng thm nc
Mu sc n nh.
S iu kin c hc
p mng thp (<25 |i)
Ht mn
D trn
Co rt yu khi chuyn trng thi.
S iu kin lm sng
Khng mi v
Sa son v gn d dng
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 40


Ly phn tha khi vt gn, rng, m mm tng i d.
4.2.3.2 Cc loi ciments gn thng dng
Ciment phosohate de zinc (1870)
Ciment Polycarboxylate (1960)
Ciment de verre ionomre (Glass ionomer lutting cement) (1970)
Cc loi ciment c bit khc: gn vnh vin cc phc hnh nh cu rng dn sn
kim loi, mt dn s, inlay, onlay s, mt composite.... Cc loi ciment ny l: ciment
rsine composite, ciment de verre ionomre hybride.
Ciment gn dnh tm thi (ciments temporaires)
4.2.4 Nha tng hp composite nha khoa
Composite l mt vt liu c cu to bng cch phi hp 2 hay nhiu vt liu
c tnh cht khc nhau v khng tan vo nhau, s phi hp ny lm cho vt liu t c
tnh cht tt hn khi dng ring r (thut ng composite cng c s dng cho cc vt
liu trong cng nghip).
Trong nha khoa composite c cha 3 phase chnh:
- Phase hu c: l khung nha cn gi l thnh phn nha c bn.
- Phase v c: l cc ht cht n phn tn u khp khi vt liu.
- Phase lin kt: l cht ni b mt ca ht cht n vo khung.
Ngoi 3 cht chnh trn cn c cc cht khc nh cht to mu, cc cht gp phn
vo s trng hp nh cc cht khi mo, cht gia tc, cht c ch.
Composite nha khoa thng dng p ln b mt rng (gi, tht) to mu sc,
bng, bn chc cho rng. Hay ph thuc vo thnh phn tng hp m nha
composite c th c dng lm khung trong hm tho lp. Ngoi ra, nha tng hp
composite cn to tnh thm m v bo v phn d tn thng pha trong.
Vt liu nha khoa composite c nhiu c im ni bt nh tnh thm m rt cao.
C rt nhiu mu khc nhau chn la cho ph hp vi cc mu rng khc nhau. Hn
na, cng, chu lc, chu mn ca composite cng kh cao. Tuy nhin, nhc im
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 41


ca composite l gi thnh t, khng ph hp vi ti tin ca tng lp bnh dn. Mt
im cn lu na l kh nng chu mn, chu p lc ca nha tng hp composite vn
cha tht s tt.
Composite nha khoa ni chung c phn loi theo thnh phn, s lng hoc
tnh cht ca ht n hoc ca phase matrix (phase hu c). Phng php phn loi thng
dng nht l da trn lng cht n (theo % th tch hoc khi lng), kch thc ca ht
n v cch thm ht n.
Composite cng c th c phn loi trn c s ca thnh phn matrix (Bis-
GMA hay UMD), hoc l phng php lm trng hp (t trng hp, quang trng hp uv,
quang trng hp vi nh sng trng thy, lng trng hp hoc trng hp theo giai
on)....
4.2.4.1 Theo kch thc ht n
Kch thc ca cc ht cht n c nh hng n dung lng cht n v do
nh hng n cc c im khc ca composite ( co do trng hp, bn c hc,
ngm nc...)
Ngi ta phn loi composite da vo kch thc ca ht, c th chia composite ra
4 loi:
Composite c in (C. traditionnel: C.T)
Cn gi l composite ht n i the (macrofilled composite) cha cc ht cht
n ln t 1 - 50 vi t l chim 76-80% trng lng vt liu nn cn gi l composite
cha ht n nng (heavy filled composite). Loi ny khng th lm nhn bng c
nhng c kh nng chng gy v cao nn thng c s dng trm cho cc rng chu
lc nhai ln, rng v ln, xoang II Black.
Composite ht nh (C. microcharge: C.M)
Cn gi l composite ht n vi th (Microfilled composite), cha cc ht n
kch thc 0,04 thng l ht silic dng keo (colloidal silica) vi t l ht n chim 50-
52% trng lng, nn cn gi l composite cha ht n nh (Light filled composite). Loi
ny sau khi nh bng s cho b mt sng bng nh men t nhin nhng kh nng chng
gy v km nn ch dng cho cc rng khng chu lc, v vy cn c tn l composite rng
trc (anterior composite).
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 42


C th cc ht nh ny di dng ng th, c phn tn ng u khp c
khi vt liu.
C th l composite ht nh khng ng th, trong khi vt liu cn cha cc
ht tin trng hp to t 1 - 2 0 0 v mt dung lng cht n cao hn.
Composite lai (C. hybrid: C.H)
Cn gi l composite ht n hn hp, cha 2 loi ht n c kch thc khc
nhau, ht n nh c kch thc 0,04 v ht ln t 1 tr ln vi t l sao cho kch thc
trung bnh ca ton th ht n bng hoc hn 1 . T l ht n thng chim 76-80%
trng lng vt liu, v vy n cng thuc loi composite cha ht n nng. Loi
composite ny c kh nng chng gy v cao khi trm cc rng chu lc nhai v c kh
nng lm nhn bng nhng khng bng composite ht n vi th.
Composite hybrid vi ht n cc nh (nanoill Composite)
c th lm nhn bng cao nh composite ht n vi th m vn gi c tnh
cht c l u vit, ngi ta sn xut loi composite gm 2 loi ht n, loi ht n silic
0,04 v ht n thy tinh s t 0,6-0, 8 . Ngoi ra trong mt vi trng hp c bit, cc ht
n cc ln (megafill) >100 , hoc cc nh 0,005-0,01 cng c s dng.
u tin l nhng composite vi nhng ht n ln, ri n nhng composite c
ht n nh c thay th cho cernent silicate trm cc rng trc, sau ngi ta nhn
thy cc ht n ln lm cho b mt composite khng nhn, khng bng (to iu kin lu
gi cc mnh vn hoc cht mu),cc ht n nh th lm qunh cao, kh s dng.
khc phc iu ny, ngi ta s dng va ht n ln va ht n nh, l loi composite
thng dng hin nay.
4.2A.2 Theo thnh phn nha khung
Thnh phn nha khung thay i s ko theo nht ca composite khc nhau,
p ng nhng yu cu a dng v lm sng, nn c phn loi gm:
Composite nn
L loi composite c c cao, s dng tng t nh amalgame, v c th nn
c nn ch yu dng trm rng sau (xoang loi I v II), c bit khi trm xoang loi II
c kh nng lm cng khun trm gip to tip im tt. Loi composite ny c khng
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 43


mi mn cao v co thp.
Composite do
L loi composite c c trung bnh, thng dng trm cc rng trc hoc
cc l trm v tr khng chu lc.
Composite lng
L loi composite c nht thp, c th chy vo cc ng ngch ca xoang trm
hoc dng mng trn b mt, nn thng c dng trm bt h rnh, lt y v b
xoang, ph lng b mt. Loi ny thng c cha trong con nhng u nh hoc trong
ng tim vi kim nh.
4.2.4.3 Theo cch trng hp
Da trn cch trng hp c cc loi composite sau:
Composite quang trng hp (light cure)
Trng hp bng nh sng thy c (photopolymerization), thng s dng n
Halogen. Loi composite ny thng di dng cht do ng trong seringue hoc trong
con nhng u ln bm trc tip vo l trm. Dng ny c li im l c th iu khc
khi nha cn do, thi gian lm vic tu cho n khi chiu nh sng trng hp, ngoi ra
cn tit kim c vt liu tha, c tnh thm m cao v c th thay i mu sc tng
lp.
Composite ho trng hp (cold / self cure): trng hp bng phn ng ho
hc (chemopolymerization)
Composite trng hp bng nhit (heat cure)
Loi composite ha trng hp hoc nhit trng hp thng di dng 2 l cht
do hoc ll bt v 1 l cht lng, khi cn dng chng ta ly 2 th (theo hng dn ca nh
sn xut) trn vi nhau to phn ng ng cng. Dng ny c bt li l thi gian lm
vic ngn, khi trn to nhiu bt.
Loi ny c cng v chu mn km, bm dnh khng tt, d lm tn thng
ty v b i mu sau mt thi gian, v vy hin nay t dng.
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 44


5. Thnh tu ng dng yt liu sinh hc trong chn thng chnh hnh, nha khoa
5.1 Thnh tu ng dng vt liu sinh hc trong chn thng chnh hnh
5.1.1 Nghin cu ng dng san h trong chn thng chnh hnh
Nghin cu ch to san h Vit Nam lm vt liu cy ghp thay xng l nghin
c u tin Vit Nam ni ring v khu vc ng Nam ni chung trong lnh vc ny.
e ti c bt u nm 1994 vi s cng tc ca vin Hi Dng hc Nha Trang
v mt s c quan khoa hc khc.
Trong nm 2003 bt u dng san h to hnh nhng phn khim khuyt
xng cho BN b tn thng xng hm, xng g m, xng hc mt... Nhng BN ny
trc y phi chp nhn mt b mp, bin dng do thiu xng hoc phi dng ximng,
titanium rt t tin v sau ghp khng t tiu c.
Trong khi ghp vt liu san h vo ngoi vic to hnh ban u, s c thay th
dn bng chnh m ca c th ngi . BS iu tr to nhng khung nh hnh trc trn
BN bng nha hoc thch cao, ri da vo s ch to mnh san h bng k thut th
cng. Khoa phu thut hm mt Vin Rng hm mt TP ghp cho su trng hp nh
vy.
Trong nhng bnh l v xng khp : gy chn p ty do hp ng sng (do thoi
ha xng hoc a m, chn p vo lng ty): phng php iu tr l m rng ng
sng, dng san h lm vt liu ghp lm rng ng sng. BV Chn thng chnh hnh
TP.HCM p dng cho 10 trng hp, khoa ngoi thn kinh BV Ch Ry thc hin cho
trn 30 ca.
Vt liu san h cha nhng bnh l ct sng s c tip tc trin khai nh: ti
to bng sng, to hnh thn sng hoc a m. sp ti b mn cng kt hp vi khoa chi
trn BV Chn thng chnh hnh TP.HCM ghp cho mt s trng hp mt xng
vng chi trn. Ngoi ra ty BS lm sng c yu cu, c th dng san h trong to hnh
nhng sn s, hp s...
Trong tng lai s ch to ximng sinh hc t san h iu tr mt s bnh l
chn thng chnh hnh nh bm vo nhng hc xng b thiu ht. km to hnh ti ch
cho nhng xng tn thng m khng cn phi phu thut m rng.
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 45


Ximng dng trong y hc hin khong 500 USD/5cc, c c im tn ti vnh
vin nhng v lu di c th lm khuyt xng. Trong khi ximng sinh hc s c thay
th dn n mt thi im no n tr thnh ca chnh c th ngi
Khng nh nhng vt liu nhn to khc, c tnh c o ca san h Porites lutea
l sau ghp mt thi gian c c th tip nhn, ng ha (san h c xng mc vo,
thay th) gn ging nh xng bnh thng.
5.1.2 Vt liu gm y sinh Hydroxyapatit (HAp)
l cc gm sinh hc c th thay th cc b phn xng b chn thng trong
c th con ngi m khng h c phn ng ph no, l cc dng xi mng y sinh dng
hn xng, cc dng khong cht c s dng lm thuc cha cc bnh thoi ho
xng... Ban u, gm y sinh c s dng thay th xng trong nn cng nghip y
sinh bi nhng c tnh qu bu ca chng nh kh nng hot ng sinh hc tt, t trng
thp, bn ho, kh nng khng tr cao v ring i vi canxi photphat th bi n c thnh
phn rt ging vi xng ngi v ng vt. L do ch yu ca cc loi vt liu gm c
dng lm vt liu thay th l bi chng c kh nng chu lc mm do v kh nng
tng thch sinh hc cao.
Ngy nay, cc vt liu gm c dng trong rt nhiu cc lnh vc khc nhau nh:
thay th rng, xng b ch, xng hng, gn, dy chng v cha cc bnh v tim nh
thay van tim... Trong cc dng canxi photphat th tri-canxi photphat Ca3(P04)2, TCP v
hydroxyapatit Cal0(PO4)6(OH)2, HAp l cc hp cht c hot tnh v tng thch sinh
hc tt nht.
5.1.3 Carbon y sinh :
Cc si carbon dng trong y hc l thnh phn ca cc cellulosa ca cy thng tri
qua qu trnh x l bng nhit nhit cao (3.0000C) cho mt vt liu carbon ng nht,
rt tinh khit (chim 99% carbon) v sch, vn gi c cu trc m. Cc t hp carbon
(carbon compozit) l s kt hp ca carbon vi mt cht kt dnh polyamit cho mt vt
liu mi, c nhiu u im m mi thnh phn cu to khng c (Miller)
Nm 2008, Trung tm Cng ngh Vt liu - Vin ng dng Cng ngh - B Khoa
hc v Cng ngh nghin cu ti: ng dng sn phm carbon y sinh trong chn
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 46


thng chnh hnh, phu thut thn kinh, cha bng v cc loi vt thng. e ti
phu thut chnh hnh, v s, cha bng v cc vt thng bng carbon cho cc bnh nhn
ti Bnh vin a khoa tnh Vnh Phc, Trung tm y t huyn Lp Thch, Yn Lc. Ket qu
c th nh sau:
Cc sn phm carbon y sinh:
- Vt liu lm bng cha bng v vt thng;
- Vt liu carbon dng khu m mm, lm dy chng;
- ng dng vt liu t hp carbon trong khoa rng - hm - mt;
- Ming ghp m xng bng compozit carbon-carbon;
- Cc mch mu nhn to v ng ni bng vt liu carbon;
- Chm xng i;
- Cc loi np kt hp xng;
- a m ct sng;
- ng ni ng mch;
- Mnh ghp thay th khuyt tt xng s;
- Cc sn phm cy ghp khc: inh ni tu v phu thut xng sng.
5.1.4 Ximang sinh hc
Gn y, Trung tm Phu thut Thm m Bnh vin Ch Ry (TTTM - CR)
dng Bone Cement - mt loi cement sinh hc - to hnh cho mt s trng hp mt m
xng thng, xa b tm l mc cm trong cuc sng.
Ximang sinh hc l vt liu to hnh c nhiu u im; khng ch dung np tt, c
cng, chu lc tt, t b di lch... m quan trng hn c l d to hnh theo mun.
Ximang sinh hc gm hai thnh phn l bt v dung mi. Khi trn chng vi nhau theo t
l qui nh s to thnh mt loi bt nho. t vo ni cn to hnh, bt nho ny s chy
vo v m st mi ngc ngch ca khuyt hng v ng cng trong khong 6 pht. Trong
khong thi gian ny, phu thut vin s tranh th to hnh mt ngoi sao cho khp vi
nhng ng nt ca xng s v mt xung quanh.
v hiu qu s dng ximang sinh hoc, mt nghin cu vo nm 1998 M v
vic dng vt liu tng hp sinh hc to hnh hc mt cho thy: Nhm s dng kim loi
c n 4,4% c bin chng v 3,3% phi tho b; Trong khi , nhm dng ximang sinh
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
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hoc ch c 0,9% c bin chng v 0,9% phi tho b. T l ny kh l tng v bone
cement qu l cu cnh thm m cho nhng trng hp khuyt hng xng vng mt.
5.1.5 Khp hng ton b
Vit Nam, thay khp hng ton b ang c nhng bc tin ban u trong cc
trung tm Chn thng - Chnh hnh. Cng ging nh cc nc trong khu vc ng Nam
, do tui th tng ln, do kh nng kinh t c ci thin... chc chn thay khp hng
ton b s tr thnh mt k thut iu tr rt ph bin nc
Ch nh thay khp hng ton b cng ngy cng c m rng, ngng tui
ngy cng c h thp nh s pht trin khng ngng ca cng ngh ch to nguyn liu.
Mt s bnh c bn ca khp hng, n mt lc no cn c cha bng thay khp
hng ton b: vim khp, thoi ha khp, hoi t chm xng i, lao khp hng, trt
hoc bn trt khp hng bm sinh,...
Ngy nay c hng trm loi khp hng nhn to ph hp cho tng loi bnh l,
tng la tui. Ch tic rng tt c cn u rt t so vi mc thu nhp bnh qun ca dn ta.
c bit qua kinh nghim ca Khoa Chn thng - Chnh hnh Bnh vin Xanh
Pn - H Ni, chng ti thy hu ht ngi bnh c thay khp hng ton b u cn rt
tr, li b hng c hai bn khp hng; ta phi bo m cho h mt cuc sng tng i
bnh thng trong 25 - 50 nm cn li ca cuc i vi s ln m li t nht c th. Vic
ch nh m, la chn loi khp, chn thi im phu thut, mi trng phu thut, tp
phc hi chc nng sau m, theo di cht ch v.v... tt c u rt quan trng cho kt qu
iu tr trc mt v lu di
5.2 Thnh tu ng dng vt liu sinh hc trong nha khoa
5.2.1 Implant_thnh tu mi ca nn nha khoa hin i
Vn chnh ca s thnh cng l vt liu cy ghp, tuy nhin t l thnh cng
li khim tn. Vic thay th rng b mt bng mt vt gn su vo xng hm khng phi
l iu mi l. Kho c hc cho thy ngi Ai cp v ngi Nam M c xa thay th
nhng rng tht mt bng ng voi, v s hoc g mi nh. Th k 18, y vn cng c ghi
nhn vi trng hp ghp rng ca nhng ngi cho tng. "K thut Implant" ban u c
v th s, nhng cng l c m v l nn tng ban u cho s tm ti, nghin cu v pht
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 48


trin k thut cy ghp rng.
u th k 19, cc bc s dng cc vt liu bng vng, bch kim,., thc hin
Mi n 1952, GS. Per Ingvar Branemark, trng nhm nghin cu i hc
Lund, Thy in c cng nghin cu, lp bo co chuyn khoa hc v ti Vt
liu ghp trong phu thut Chnh hnh. Vic pht hin ra vt liu lm Implant rt tnh c.
Trong mt ln phu thut ni li xng i b gy ca mt ch th, ng t mt tr
titanium vo xng i ca th c nh tm thi ni gy. Sau vi thng tri qua, khi
xng th lnh v ng mun ly cht titanium ra nhng khng th no ly c. Tip
tc theo di sau nhiu thng na v ng nhn thy khng c mt phn ng no trong i
vi cht c nh titanium.
Tip tc nghin cu m rng v tng bc tin hnh, ng cng ghi nhn khng c
mt phn ng sinh - ha hc no tc ng xu trn c th sng. ng gi hin tng l
S tng hp - tch hp xng (Osseointegration)
Titanium tr thnh cht liu m ng cho thnh cng ca cy ghp rng. Ca cy
ghp rng bng titanium u tin c thc hin vo nm 1965 ti Thy in. Sau 40 nm
rng cy ghp vn cn tn ti v n nhai tt.
Vi s pht trin vt bc ca k thut - cng ngh trong vi thp nin gn y,
ngnh nha khoa hin i c nhng nghin cu ng dng v t c nhiu thnh tu
ng k trong vic pht minh ra vt liu mi, phng php iu tr v phc hnh mi. Gn
y nht l k thut cy ghp implant vo xng hm h tr cho vic phc hnh rng
gi mt cch chc chn hn, thm m hn v khng phi mi cc rng k bn khi cn lm
phc hnh. Ni mt cch khc implant m ra mt hng iu tr mi, thm s la chn ti
u nu ta chng may mt mt hay nhiu rng.
5.2.2 Rng s Cercon
Rng s Cercon p ng c c hai tiu chun vng ca phc hnh rng l: chu
c lc v tnh thm m cao.
Rng s Cercon khc phc hon ton nhc im ca kim loi thng thng
(khng en vin nu, khng i mu, khng b nh hng di nh sng...) tng hp
sinh hc m rng rt tt.
Chnh v vy m gi thnh tng i cao, do quy trnh sn xut vi cng ngh
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 49


CAD/CAM, trang thit b hin i t chnh xc tuyt i.
5.2.3 Rng s Zirconia
S ra i ca loi rng s ny l mt bc tin di v phc hnh rng s thm m.
Ziconia c nhiu ng dng nh lm khp hng nhn to, lm mo rng thm m,
v tu phi thuyn, cc thit b in t ngy nay v c ng dng trong nha khoa thm
m....
Nh c tnh cng chc, chu c lc nn, lc vn xon, mu trng, c kh nng
tng hp sinh hc tt, khng gy kch thch vi c th, khng dn nhit v tng phn
nh sng, ging nh rng tht. Nn Ziconia l vt liu l tng cho phc hnh rng vi yu
cu thm m cao.
Vt liu Zirconia dng cho phc hnh s trong nha khoa rt cng v nhit nng
chy rt cao, nn khng th dng phng php c thng thng to ra mt "khung
sn" nng cho lp s ph bn ngoi lin kt vi n (ging nh b xng ngi
dng nng ton b c th).
5.2.4 Cc loi kh c (mc ci) chnh hnh rng
Invsalgn: c thc hin bng cch s dng nhng tin b mi nht ca
cng ngh vi tnh 3-D to nhng b khay ph hp cho tng bnh nhn. Ton b qui
trnh iu tr s c lp trnh qua vi tnh t lc bt u cho n lc kt thc. Khay
Invisalign c lm t mt loi nha trong sut, bn chc v c tnh an ton sc khe cao.
Khi mang Khay thi hu nh khng th pht hin.
ng dng cng ngh 3D m phng trc quan qu trnh di chuyn rng, dng li
trc rng trong sut qu trnh chnh nha s to ra nhng b khay trong sut ph hp vi
tng thi im ca s di chuyn ca rng.
Trm Amalgam
T rm Amalgam l cht trm bao gm thy ngn vi cc thnh phn mt kim loi
khc nh bc, ng, thic,... Amalgam thng c s dng nh mt vt liu trm cc
rng sau. Trm Amalgam c dng thnh cng trong 150 nm nay v cht lng ca n
cng tng dn theo thi gian. Nu c s dng ng k thut v ch nh th ming trm
Amalgam bn v r hn so vi cc vt liu trm khc. Tuy nhin, c nhiu s nghi ng v
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 50


an ton ca ming trm Amalgam do c s hin din ca thy ngn nhng theo T chc
Y Te Th Gii (WHO) th cho n nay Amalgam vn l vt liu trm rng an ton. Hin
thi, cha c mt nghin cu no cho thy amalgam gy ra nhng hiu ng bt li cho sc
kh, cng cha c mt bng chng no chng minh nu ly ming trm amalgam ra th
sc khe s tt hn.
Nh vy nu khng c nhu cu dc bit v thm m v nu cc ming trm
Amalgam vn cn tt th khng cn phi thay bng vt liu khc. Ngoi ra, xin lu l mi
ln thay ming trm c th s b mt mt s m rng v rng thm mt ln kch thch. Nh vy
ch thay ming trm khi tht cn thit.
III. KT LUN
Qua tm hiu chng ti bit c tng quan v cc vt liu y sinh c s dng
trong chn thng chnh hnh , nha khoa nh xng , khp , hn , u gi , rng nhn to
v li ch phc v ca cc vt liu y sinh ny trong vic cha bnh cho con ngi. Nh c
cc vt liu y sinh m cuc sng ca con ngi tr nn tt p hn.
TI LIU THAM KHO
Gio trnh - bi ging
1. Bi ging Rng Hm Mt, Trng i hc Y khoa Phm Ngc Thch, 2010.
2. Bi Ging Phc Hnh Rng c nh, B Mn Phc Hnh, Khoa Rng Hm Mt
HYD Thnh ph H.C.M.
3. CNG NGH VT LIU Y SINH HC, TS. Trn L Bo H, Trng H
KHTN-HQG TP.HCM
4. Rng Hm Mt tp 1, B Mn RHM H Ni, NXBYH, 1979.
Ngun internet:
1 . http://www.vip-nhp.vn/News/QQ9/Dich-vu-kham-chua-benh/63/Thav-khop-
hang-nhan-tao
2 . http://khQpgQikhophang.com/index.php7option-com content&view=article&i
d=76:thav-kJip-gi-nhan-to&catid=29:k-thut-phu-thut-cao
3 . http://www.hoanmvcuulong.com/?page=servicesContent&content id=24
4 . http://www.vip-nhp.vn/News/0Q9/Dich-vu-kham-chua-benh/63/Thav-khop-
hang-nhan-tao
5 . http://www.bacsinamanh.com/index.php7optionFCom content&view=article&
id=112:thav-khp-gi-nhan-to&catid=29:phu-thut-chnh-hinh&Itemid-2
Tiu lun: Vt liu sinh hc Nhm 13
Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.
Trang 51


6 . http://www.nlm.nih.gov/medlineplus/encv/article/002974.htm
7 . http://www.nlm.nih.gov/medlineplus/encv/patientinstructions/0Q0368.htm
8 . http://www.genou.com/vietnam/modelespt-vn.htm
9 . http://nhakhoanetviet.com/chuven-de-nha-khoa/50-phc-hinh-rng-s/478rang-
su-la-gi-.html
1 0 . http://www.nhakhoa.com/vn/kien-thuc-nha-khoa
1 1 . http://www.khoahoc.com.vn/khampha/dai-duong-hoc/508 San-ho-Viet- Nam-
co-the-so-sanh-voi-san-ho-the-gioi.aspx
1 2 . http://thaivu.com/vat-lieu-gom-v-sinh-hvdroxvapatit-hap/