B CNG THNG TRNG I HC CNG NGHIP TP.HCM VIN CNG NGH SINH HC & THC PHMMN:CNG NGH SINH HC TRN NGI V NG VTTIU LUN:VT LIU SINH HC TRONG CHN THNG CHNH HNH, NHA KHOAGVHD: Th.s Trn Th Phng Nhung. Nhm: 131. L Khnh Duy11306331

2. Hong Th Lc11333531

3. Phan Phc Thin11325911

4. Nguyn Thanh Thy11307391

5. Tng Th Thanh Thy11261831

6. Trn Th Minh Thy11276771

7. Nhan Minh Tr11270841

8. Phm Dng T Trinh11315091

9. Phan Nguyn Thanh Tuyn11299711

B CNG THNG TRNG I HC CNG NGHIP TP.HCM VIN CNG NGH SINH HC & THC PHMMN:CNG NGH SINH HC TRN NGI V NG VTTIU LUN:VT LIU SINH HC TRONG CHN THNG CHNH HNH, NHA KHOAGVHD: Th.s Trn Th Phng Nhung. Nhm: 131. L Khnh Duy11306331

2. Hong Th Lc11333531

3. Phan Phc Thin11325911

4. Nguyn Thanh Thy11307391

5. Tng Th Thanh Thy11261831

6. Trn Th Minh Thy11276771

7. Nhan Minh Tr11270841

8. Phm Dng T Trinh11315091

9. Phan Nguyn Thanh Tuyn11299711

TP.HCM, thng 03 nm 2012.

TP.HCM, thng 03 nm 2012.

MC LCI M U21. t vn 21.2 Mc ch nghin cu21.3 Phng php nghin cu2II. NI DUNG21. Tnh tng hp ca vt liu sinh hc21.1 p ng min dch ca c th vi vt liu sinh hc21.2 Quy trnh nh gi tnh tng hp ca vt liu sinh hc42. Vt liu s dng trong ch to vt liu sinh hc ng dng trong chn thngchnh hnh92.1 Silicone92.2 Vt liu gm y sinh Hydroxyapatit (HAp)112.3 Composite cacbon122.4 INTOST- 4132.5 Zirconia(lm rng gi)143. ng dng vt liu sinh hc trong chn thng chnh hnh143.1 Xng nhn to143.2 Khp nhn to184. ng dng vt liu sinh hc trong nha khoa264.1 Cu to, c im v phn loi rng gi264.2 Vt liu s dng trong chnh hnh nha khoa355. Thnh tu ng dng vt liu sinh hc trong chn thng chnh hnh, nha khoa 465.1 Thnh tu ng dng vt liu sinh hc trong chn thng chnh hnh465.2 Thnh tu ng dng vt liu sinh hc trong nha khoa50III. KT LUN53TI LIU THAM KHO54I M U1. 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. 2Mc ch nghin cuTm 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 cuVi 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 DUNG1. 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 dchp ng min dch c hiu l phn ng bnh thng ca ng vt cxng 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.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 - Tc ) 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.LoiKhng thT bo lin quanCht trung gianKt qu

IIgELympho BHistamin,cc amin vn mchNga, vim mi, gin mch

IIIgG, IgMLympho BHistamin,cc amin vn mchGin mch

IIIIgG, IgMLympho BCc amin vn mchau, sng, nghn mch, gin mch

IV-Lympho TCytokinau, sng

Bng 1: Cc c im chnh ca bn loi p ng min dch.

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 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 hcCc 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.1.2.2. Cc phng php th nghim v nh gi tnh tng hp sinh hcnh 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 invitrou 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 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 vtCc 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 nghimCc 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 nnsTrong 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 vivoCc 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 nn2Th 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 thngS 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 sngs Cc quy trnh v cc quy nhNeu cc th nghim invitro v trn ng vt thnh cng th cng khngth 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.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 giMt thng tin khc quan trng v c gi tr c th c thu nhn t vicnh 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 SiliconeSilicone 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.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 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 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 cacbonNh, 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- 4Sau 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 xngHin 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 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 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 to3.1.1 Xng nhn to t san hSan 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.3.1.2 Quy trnh x l san h nhm ch to xng c ng dng ti Vit NamTrn 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).

Hnh 2: Ghp san h vo ct sng c.3.1.3 Mt s cht thay xng thng mi hin nayProOsteon 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

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 toKhp 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 ccphng 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.3.2.2 Vt liu dng trong to khp nhn toHp 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 10-12 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 to3.2.3.1 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 c u bng gm gn vi thn.

Hnh 3: Khp hng nhn to

3.2.3.2 Phn loi khp hng nhn to Khp hng c xi mngKhp 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.

Khp hng khng xi mngTiu lun: Vt liu sinh hcNhm13Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.

Tiu lun: Vt liu sinh hcNhm13Trong chn thng chnh hnh, nha khoa GVHD: Th.s Trn Th Phng Nhung.

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.Trang 18

Trang 19

i_ . 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

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 khoaS 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 (Zr02) Alumina (A1203) Feldspar (KAlSi308) Leucite (KAlSi206) Spinel (MgAl204) Lithium disilicate (Li2Si205) Lithium phosphate (L3PO4) Fluorapatite (Ca5(P04)3F)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, schnh lchv dnnnhit gia cc pha thy tinh dn. Dophatinhthtngirnchc,ng nt s i theo pha thy tinh.Kch thcv lanrngdncang nt c th c gii hntrong khang cchgiaccphn tcapha tinh th.4.2.2.1 Thnh phn cu to trong s nha khoaS 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 1100 - 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 1100c.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,...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 nhL 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 phcS 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 rngVt 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.4.2.3.1 Tnh cht cn c ca ciment gn dnh vnh vinS 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 (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 khungThnh 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 nnL 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 mi mn cao v co thp. Composite doL loi composite c c trung bnh, thng dng trm cc rng trc hoc cc l trm v tr khng chu lc. Composite lngL 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 hpDa 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.5. Thnh tu ng dng yt liu sinh hc trong chn thng chnh hnh, nha khoa5.1 Thnh tu ng dng vt liu sinh hc trong chn thng chnh hnh5.1.1 Nghin cu ng dng san h trong chn thng chnh hnhNghin 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.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 ngiKhng 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 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 hcGn 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 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 ncCh 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 di5.2 Thnh tu ng dng vt liu sinh hc trong nha khoa5.2.1 Implant_thnh tu mi ca nn nha khoa hin iVn 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 trin k thut cy ghp rng.u th k 19, cc bc s dng cc vt liu bng vng, bch kim,., thc hinMi 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 CerconRng 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 CAD/CAM, trang thit b hin i t chnh xc tuyt i.5.2.3 Rng s ZirconiaS 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 AmalgamT 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 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 LUNQua 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 KHOGio trnh - bi ging1. 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.HCM4. 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-tao2. http://khQpgQikhophang.com/index.php7option-com content&view=article&i d=76:thav-kJip-gi-nhan-to&catid=29:k-thut-phu-thut-cao3. http://www.hoanmvcuulong.com/?page=servicesContent&content id=244. http://www.vip-nhp.vn/News/0Q9/Dich-vu-kham-chua-benh/63/Thav-khop- hang-nhan-tao5. http://www.bacsinamanh.com/index.php7optionFCom content&view=article& id=112:thav-khp-gi-nhan-to&catid=29:phu-thut-chnh-hinh&Itemid-26. http://www.nlm.nih.gov/medlineplus/encv/article/002974.htm7. http://www.nlm.nih.gov/medlineplus/encv/patientinstructions/0Q0368.htm8. http://www.genou.com/vietnam/modelespt-vn.htm9. http://nhakhoanetviet.com/chuven-de-nha-khoa/50-phc-hinh-rng-s/478rang- su-la-gi-.html10. http://www.nhakhoa.com/vn/kien-thuc-nha-khoa11. http://www.khoahoc.com.vn/khampha/dai-duong-hoc/508 San-ho-Viet- Nam-co-the-so-sanh-voi-san-ho-the-gioi.aspx12. http://thaivu.com/vat-lieu-gom-v-sinh-hvdroxvapatit-hap/