IMPLANT NHA KHOA

BI M U
PHN TH BA:

THIT K I TH IMPLANT
NGND. GS. BS. Hong T Hng
htuhung@yahoo.com
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DN BI
1- M u
2- Thn implant
3- Phn chp
4- Phn c (mo xng)

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1- M U
Gii thiu v implant trong
nha khoa phc hi
Gii thiu hai loi implant v
qui trnh phu thut

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ng dng implant
trong rng hm mt
Trong nha khoa phc hi:
Phc hi rng n l
Phc hi nhiu rng
Lu gi hm gi tho lp
Lu gi rng gi c nh

Trong chnh hnh: neo chn

Trong ti to v phc hnh
hm mt
Bi ny trnh by thit k
i th ca implant trong
nha khoa phc hi
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Nh trnh by trong phn th nht, implant

ph bin trong nha khoa phc hi hin dng
l implant trong xng dng chn rng (tooth
root form endosteal implant).

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Implant trong xng dng chn rng hin dng c hai

loi:
Implant mt khi (one-piece), v
Implant hai khi (two-piece).
Trong , implant hai khi thng dng hn implant
mt khi
Implant mt khi: p dng qui trnh mt ln phu thut
(phu thut mt giai on) (one-stage)
Implant hai khi: thng p dng qui trnh hai ln phu
thut (phu thut hai giai on) (two-stage)

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Implant mt khi
Implant mt khi c phn
ci mang phc hnh gn
lin vi thn.
Ch p dng qui trnh mt
ln phu thut (phu
thut mt giai on), c
lt vt hoc khng lt vt
Phc hnh tm thng
c t ngay trong ln
phu thut hoc t sm
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sau phu thut.

Implant hai khi

Ci implant
(abutment)

Implant hai khi gm:

1. Thn implant (Implant body)
c t trong xng

2. Phn mang phc hnh

(tc ci implant , abutment)
(Prosthodontic abutment,
Thn implant
Implant abutment)
Ni t thn implant, qua nim mc
nng v/hoc gi phc hnh
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Qui trnh mt ln phu thut

(phu thut mt giai on)
Qui trnh c p dng cho
implant mt khi v hai khi
Vt lnh thng
xuyn nu

i vi implant hai khi, vt

lnh thng xuyn nu hoc
abutment c t ngay
(khng phi phu thut bc l
Implant nh qui trnh
hai ln phu thut).
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Qui trnh hai ln phu thut

(phu thut hai giai on)
A- Giai on 1:
t implant v
vt che ph,
khu ng
nim mc.
B- Giai on 2:
(thng sau 3
thng): t vt
lnh thng
xuyn nu
hoc ci
implant
(abutment)

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2- THN IMPLANT

Mt s khi nim
Vai tr v i hi ca thit k i th
Cc phn ca thn implant
Hnh dng chung
Ren
Vai tr ca ren
Bc ren
Dng ren
su ren
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Mt s khi nim
Lc (force): i lng vec t to ra bi tng tc
gia hai vt. Gc vec t l im t lc, hng ch
hng tc dng ca lc, di ch cng lc.
n v: Newton (N)
Lc tc dng c th gy bin dng hoc dch chuyn
vt nu vt khng c gi c nh.

Trong implant nha khoa, cn ch tc ng trn

xng ca cc lc v ngu lc:
Nn (compression): lm vt chu ti b nn p, c
th b rn v.
Cng (ko) (tension): vt chu ti b cng dn.
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Ct (x) (shear): vt
chu ti b ct, x.

Mt s khi nim
Stress = ngu lc, ng sut: Lc tc dng trn
mt n v din tch; s o lc gy bin dng tc
ng vo mt vt; lc khng bn trong ca vt i
vi lc gy bin dng, c o bng lc ti
(applied load).
Ngu lc = Lc/Din tch

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Nng: 100 kg
Din tch giy: 200 cm
Stress: 0,5 kg/cm (0,05 MPa)

Nng: 50kg
Din tip xc: 1,56 cm
Stress: 32 kg/cm (3 MPa)
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Mt s khi nim
Din tch b mt chc nng (functional surface area):
l din tch c ch ng cung ng implant
phn tn ti lc nn n giao din xng-implant

ch gm cu trc thn implant tham gia chuyn ti
lc nn
Din tch b mt l thuyt (theoretical total surface
area): l din tch ton b b mt implant (bao gm
phn din tch th ng, khng tham gia chuyn
ti lc nn)
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Mt s khi nim
Lin kt b mt implant-xng (implant surface-tobone bond): bn ca lin kt c tnh bng
lc lm ph hy lin kt implant-xng, trong thi
k chu ti u tin ch yu ph thuc bn ct.
Tip xc xng-implant (BIC: bone-implant contact):
din tch c tip xc gia xng v implant,
thng tnh bng t l % din tch tip xc so vi
din tch b mt implant.
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Vai tr v i hi
ca thit k i th
Tm quan trng ca thit k i th
Thit k i th quyt nh b mt chc nng
cc lc c phn phi thun li v lu di
C ngha quan trng i vi din tch chu ti
lc, nht l ti lc sm (early loading)
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Vai tr v i hi
ca thit k i th
C th tng din tch b mt implant bng:
i vi thn implant:
Tng chiu di
Tng ng knh (tng 1mm
tng 15-25% d.tch)

i vi thit k ren:
Gim bc ren,
Tng su ren (tng 1mm
tng 150% d.tch)
Thay i dng ren,
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Vai tr v i hi
ca thit k i th
i hi ca thit k i th
Implant cn c thit k gim ti lc ct & ti
lc ko, chuyn thnh ti lc nn.
Xng chu c lc nn cao, nhng:
i vi lc ko: km hn 30%, v
i vi lc ct: km hn 65%
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Cc phn ca thn implant

Thn implant c ba phn
Phn mo xng hay phn c
(crest module, cervical geometry)

Phn thn
(body)

Phn chp
(apex)
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Hnh dng chung

Hnh dng chung:

Tr c ren hay khng ren

Vt (tr thun,hnh nn)
Kt hp

Loi tr thun
(c ren) hin
chim u th.

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Hnh dng chung: hnh tr vs tr thun

Hnh tr

Tr thun (hnh nn)

Giao din xng-implant

chu lc ct ln
Hnh tr nhn lm tng
thnh phn lc ct giao
din

thun cng ln, cng

tng c thnh phn lc
nn trn giao din xngimplant.

Implant hnh tr thun c ren:

(tapered threaded implant)

D t n nh ban u (initial stability)

Tng c thnh phn ti lc nn
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Vai tr ca ren
Ren c thit k nhm:
-Tng din tch b mt implant

Tng tip xc ban u v trong qu trnh chc nng

-To ra cu trc vt gip d t vng chc (n

nh) ngay khi t
-To ra cu trc gip chuyn ti lc theo hng
gim lc ct, tng lc nn

Hn ch tht bi do tiu xng

-Thun li trong thao tc t implant

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Vai tr ca ren
Implant nha khoa i hi dng ren ti u cho vic
truyn ti lc chc nng (load transmission) lu
di v khng c xu hng lm lng implant.
Khi c ti lc theo trc ln phc hnh trn inplant,
gc b mt ca ren c th thay i ti lc nhai
theo trc thnh gc ti lc xng-implant.

Gim ti lc ct giao din xng-ren (thread-bone
interface)

To c s chuyn lc ct thnh lc nn
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Hnh th ren
Ren l gii php thng dng trong cng ngh, i
vi implant, c ba tham s quan trng v hnh th
ren (thread geometry):
Bc ren (thread pitch)
Dng ren (thread shape)
su ren (thread depth)

Din tch b mt trn n v di implant c th

c thay i bng cch thay i cc tham s hnh

th ren
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Bc ren
Bc ren: L khong cch ca hai ren k nhau.
Bc ren c nh hng ln n thay i din tch
b mt implant: bc ren cng nh, cng c nhiu
ren v cng lm tng din tch ca mi n v
chiu di ca thn implant
gim ngu lc
Implant c bc ren nh thch hp khi:
Phi chu lc ln,
Cht lng xng thp,
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Implant ngn

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ng knh ngoi
ng knh trung bnh
ng
knh trong

n
g

Bc ren (thread pitch)

Gc vt

nh

Gc ren

Cc chi tit v thng s ca ren

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Dng ren
2- Dng ren: ty theo hnh dng mt ct ca ren, dng
ren ca implant c th l:
Hnh V (V shape) (A)
Ren chn (buttress) (B)
Ren chn ngc
(reverse buttress) (C)
Vung (square) (D)
Hnh dng ren l mt c trng
quan trng ca hnh th ren
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Dng ren
Ren dng V: trong cng ngh ng dng, c gi
l fixture, theo ngha l c nh hai phn kim
loi vi nhau. a s implant (Nobel Biocare,
LifeCore, 3i ) dng loi ren ny.
Ren chn ngc: Lc chuyn ca ti lc nhai n
xng hm tng t nh ca ren dng V.

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Dng ren
Ren chn: c th chuyn tip ti lc nn, gn
ging ren vung.
Ren vung: to c din tch b mt ti u
cho vic chng ni lng, truyn lc nn.
Trong cng ngh, hu ht jack ca xe t,
cc my c kh s dng loi ren ny.
Implant ca BioHorizontal, Ankilosis s dng.

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Dng ren
Ren n, i v ba (single-~, double-~, triplethread lead): Vi cng bc ren, implant c th c
s ng ren bt vo xng l 1, 2 hoc 3. S
ng ren khng lm thay i bc ren
S ng ren t gip d t, nht l trong cc
trng hp xng chc c.

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 su ren
3. su ren: l khong cch t ng knh nh
n ng knh ln ca ren.
Vi cng c im v cc yu t khc, implant c
su ren cng ln, cng c din tch b mt ln
hn.
Vi implant c hnh tr thun:
Nu thit k ng knh nh v/hoc su ren
gim dn v pha chp
gim din tch b mt.
Nu thit k c ng knh nh gim nhng su
ren c duy tr
tng din tch b mt.
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3- PHN CHP
Phn chp thng c dng thun
nh chp implant thng phng. (nh nhn c xu
hng tp trung lc, d gy kch thch m mm
khi implant nh ra khi bn xng)
Nhiu loi c thit k rnh, khc, hoc l ( tng
din tip xc v chng xoay).

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4- PHN C
Phn c hay phn mo* (crest module) ca implant l
phn lin h vi mo xng, cng l phn c h
thng tip ni (connection system) vi ci
C cu ca h thng tip ni implant-ci gm:
Mm (platform): l mt mt phng, cho php tip xc
tt nht vi mt phng tng ng ca ci theo c ch
chuyn tip phng(platform-switching).
Yu t chng xoay (antirotation feature): c hai dng
chnh:
- Li ln t mm: Lc gic ngoi (external hex)
- Lm xung t mm: c th l: lc gic trong (internal hex),
bt gic (octagon), ba mi (tri-lobe), vt hnh nn (cone
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screw), rnh trong (internal grooves)hoc kt hp.

VAI TR v I HI CA PHN C
V sinh hc, phn c cn:
Kht st vi hc xng t c tch hp sm v tt,
trnh xm nhp vi khun, biu m v trnh tch hp
lin kt si.
To mt khong sinh hc ph hp chc nng
V c hc:
Gip to c n nh ban u
Gim c ng sut vng c (phn mo vn l ni tp
trung ngu lc nhai cao nht)
gim tiu mo xng

V kt ni vi ci:
m bo c lin kt c hc vng chc, n nh, kht
kn gia ci v thn implant (khng c khe h, khng
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b lung lay, xoay, st).

THIT K PHN C:
Vn , Gii php v La chn
Vn :
C nhiu kiu dng phn c, hai cu hi thng
c t ra:
1. Nhn hay nhm?
2. C ren hay khng ren?

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THIT K PHN C:
Vn , Gii php v La chn
Gii php:
1. Phn c nhm: khng c mt vng nhn (ai c cervical collar >0,5 mm) vng xung quanh (phn
nhn cng di, tiu mo xng cng din ra nhanh)

khng t phn ai c (nhn) vo trong xng
2. Phn c c ren: a s implant hin nay c ren
phn c. (tiu xng thng dng hoc chm li t
ren u tin).
Ren phn c c th

lin tc vi phn thn

thit k bc ren ln hoc nh hn,

su ren t hn
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Xem tip
BI M U (Phn c thm)

THIT K I TH
MT S IMPLANT

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TM TT
THIT K I TH
Thit k i th c vai tr quan trng i vi:
S n nh,
Chu ti sm,
Thun li v phu thut v thnh cng lu di
Tng din tch tip xc xngimplant l mt yu t
quan trng trong thit k v la chn implant.
Phn c ca implant c ngha quan trng c v
sinh hc, c hc v kt ni gia implant v ci
(abutment)
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(nhc li) KT THC BI M U

Implant l mt la chn tt cho iu tr mt rng.
C nhiu loi implant, khc nhau v hnh dng,
kch thc, vt liu v c tnh b mt.
i hi quan trng nht ca implant l tng tc
vi m cn din ra nhanh chng, vng chc v
duy tr c lu di.
Tin lng thnh cng ca iu tr bng implant
ph thuc rt nhiu yu t.
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