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IMPLANT NHA KHOABI M UPHN TH BA:
THIT K I TH IMPLANT
NGND. GS. BS. Hong T [email protected]
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DN BI1- M u
2- Thn implant3- Phn chp
4- Phn c (mo xng)
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1- M U
Gii thiu v implant trongnha khoa phc hi
Gii thiu hai loi implant vqui trnh phu thut
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ng dng implant trong rng hm mt
Trong nha khoa phc hi:Phc hi rng n lPhc hi nhiu rng Lu gi hm gi tho lp Lu gi rng gi c nhTrong chnh hnh: neo chnTrong ti to v phc hnh
hm mt
Bi ny trnh by thit ki th ca implant trongnha khoa phc hi
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Nh trnh by trong phn th nht, implant ph bin trong nha khoa phc hi hin dngl implant trong xng dng chn rng (tooth root form endosteal implant).
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Implant trong xng dng chn rng hin dng c hailoi:Implant mt khi (one-piece), vImplant 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 phuthut (phu thut hai giai on) (two-stage)
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Implant mt khiImplant mt khi c phnci mang phc hnh gnlin vi thn.
Ch p dng qui trnh mtln phu thut (phuthut mt giai on), clt vt hoc khng lt vt
Phc hnh tm thngc t ngay trong lnphu thut hoc t smsau phu thut.
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Implant hai khi gm:1. Thn implant (Implant body)c t trong xng
2. Phn mang phc hnh(tc ci implant , abutment)(Prosthodontic abutment, Implant abutment)Ni t thn implant, qua nim mc nng v/hoc gi phc hnh
Thn implant
Ci implant(abutment)
Implant hai khi
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Qui trnh mt ln phu thut(phu thut mt giai on)
Qui trnh c p dng choimplant mt khi v hai khi
i vi implant hai khi, vtlnh thng xuyn nu hocabutment c t ngay(khng phi phu thut bc lImplant nh qui trnhhai ln phu thut).
Vt lnh thngxuyn nu
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Qui trnh hai ln phu thut(phu thut hai giai on)
A- Giai on 1:t implant vvt che ph, khu ngnim mc.
B- Giai on 2: (thng sau 3 thng): t vtlnh thngxuyn nuhoc ciimplant(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 renBc renDng ren su ren
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Mt s khi nimLc (force): i lng vec t to ra bi tng tc
gia hai vt. Gc vec t l im t lc, hng chhng tc dng ca lc, di ch cng lc. n v: Newton (N)
Lc tc dng c th gy bin dng hoc dch chuynvt nu vt khng c gi c nh.
Trong implant nha khoa, cn ch tc ng trnxng 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. Ct (x) (shear): vt chu ti b ct, x.
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Mt s khi nim Stress = ngu lc, ng sut: Lc tc dng trn
mt n v din tch; s o lc gy bin dng tcng vo mt vt; lc khng bn trong ca vt ivi lc gy bin dng, c o bng lc ti(applied load).
Ngu lc = Lc/Din tch
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Nng: 100 kgDin tch giy: 200 cm
Stress: 0,5 kg/cm (0,05 MPa)
Nng: 50kgDin tip xc: 1,56 cm
Stress: 32 kg/cm (3 MPa)
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Mt s khi nimDin 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 tilc nn
Din tch b mt l thuyt (theoretical total surface area): l din tch ton b b mt implant (bao gmphn din tch th ng, khng tham gia chuynti lc nn)
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Mt s khi nimLin kt b mt implant-xng (implant surface-to-
bone bond): bn ca lin kt c tnh bnglc lm ph hy lin kt implant-xng, trong thik 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 vidin tch b mt implant.
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Vai tr v i hica 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 tilc, nht l ti lc sm (early loading)
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Vai tr v i hica 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 hica thit k i th
i hi ca thit k i thImplant cn c thit k gim ti lc ct & tilc 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 chungHnh dng chung: Tr c ren hay khng ren
Vt (tr thun,hnh nn)Kt hp
Loi tr thun(c ren) hinchim u th.
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Hnh dng chung: hnh tr vs tr thunHnh tr
Giao din xng-implant chu lc ct ln
Hnh tr nhn lm tngthnh phn lc ct giaodin
Tr thun (hnh nn) thun cng ln, cng
tng c thnh phn lcnn trn giao din xng-implant.
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 renRen c thit k nhm:
-Tng din tch b mt implantTng 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 nnHn 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 victruyn ti lc chc nng (load transmission) ludi 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 nhaitheo 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 renRen l gii php thng dng trong cng ngh, i
vi implant, c ba tham s quan trng v hnh thren (thread geometry):
Bc ren (thread pitch) Dng ren (thread shape) su ren (thread depth)
Din tch b mt trn n v di implant c thc thay i bng cch thay i cc tham s hnhth 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 tchb mt implant: bc ren cng nh, cng c nhiuren v cng lm tng din tch ca mi n vchiu di ca thn implant gim ngu lc
Implant c bc ren nh thch hp khi: Phi chu lc ln, Cht lng xng thp, Implant ngn
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Bc ren (thread pitch)
ng knh ngoing knh trung bnhng
ng knh trong
nh Gc reny
Gc vt
Cc chi tit v thng s ca ren
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Dng ren2- 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 trngquan trng ca hnh th ren
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Dng ren
Ren dng V: trong cng ngh ng dng, c gil fixture, theo ngha l c nh hai phn kimloi vi nhau. a s implant (Nobel Biocare, LifeCore, 3i ) dng loi ren ny.
Ren chn ngc: Lc chuyn ca ti lc nhai nxng hm tng t nh ca ren dng V.
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Dng ren
Ren chn: c th chuyn tip ti lc nn, gnging ren vung.
Ren vung: to c din tch b mt ti ucho 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-~, triple-thread lead): Vi cng bc ren, implant c th cs ng ren bt vo xng l 1, 2 hoc 3. Sng ren khng lm thay i bc ren
S ng ren t gip d t, nht l trong cctrng hp xng chc c.
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su ren
3. su ren: l khong cch t ng knh nhn 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 lnhn.
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 CHPPhn chp thng c dng thun
nh chp implant thng phng. (nh nhn c xuhng tp trung lc, d gy kch thch m mmkhi implant nh ra khi bn xng)
Nhiu loi c thit k rnh, khc, hoc l ( tngdin tip xc v chng xoay).
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4- PHN CPhn c hay phn mo* (crest module) ca implant l
phn lin h vi mo xng, cng l phn c hthng 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 chchuyn tip phng(platform-switching).
Yu t chng xoay (antirotation feature): c hai dngchnh: - 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 screw), rnh trong (internal grooves)hoc kt hp.
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VAI TR v I HI CA PHN CV 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 hplin kt si.
To mt khong sinh hc ph hp chc nng
V c hc:Gip to c n nh ban uGim 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, khngb lung lay, xoay, st).
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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 (phnnhn 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 tren 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 tipBI M U (Phn c thm)
THIT K I THMT S IMPLANT
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TM TTTHIT 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 tquan trng trong thit k v la chn implant.
Phn c ca implant c ngha quan trng c vsinh 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 vduy tr c lu di.
Tin lng thnh cng ca iu tr bng implant ph thuc rt nhiu yu t.
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