TCNCYH 40 (1) - 2006

NH GI KT QU IU TR BNH NHN MT RNG LOI

KENNEDY I V II BNG HM KHUNG
Tng Minh Sn
B mn Rng Hm Mt - Trng i hc Y H Ni
Loi hm gi c lm cho bnh nhn mt rng Vit Nam hin nay phn ln l hm tho lp nn nha. Hm
khung l mt loi hm gi tho lp c nhiu u im hn nhng cha c lm nhiu. Mc tiu: (1) nh gi hiu
qu phc hi chc nng v thm m ca hm khung trong iu tr mt rng loi Kennedy I v II. (2) nh gi nh
hng ca hm khung vi cc thnh phn rng ming cn li. i tng v phng php nghin cu: 40 bnh
nhn mt rng tng phn loi Kennedy I v II c lm hm khung. Cc tiu ch nh gi l: s lu gi, thm m,
khp cn, n nhai, tnh trng rng tr, sng hm vng mt rng v s hi lng ca bnh nhn. Bnh nhn nghin cu
c theo di trong 2 nm. Kt qu: T l kt qu iu tr tt l tng i cao (trn 70 %). T l kt qu km l 6,26%.
Kt lun: Hiu qu iu tr bnh nhn mt rng loi Kennedy I v II bng hm khung l tng i cao. Hm khung c
tc dng bo v cc thnh phn rng ming cn li.
T kho: Hm khung, mt rng tng phn.

lm hm khung theo ng cc bc k thut.

I. T VN
T l mt rng nc ta tng i cao, t l ny
l 68,66 % la tui 35 - 44 [2]. V vy nhu cu lm
rng gi rt cao. Hm khung l mt loi hm gi tho
lp tng phn, n c nhiu u im hn hm gi
tho lp nha. Nhng lm hm khung i hi k
thut phc tp hn v kinh ph cao hn hm nha
nn hm khung vn cha c s dng rng ri.
Trong phc hnh, iu tr mt rng loi Kennedy I v
II l kh khn nht.
Cc nghin cu v hm khung Vit Nam cn t
v nu c th thng theo di trong thi gian ngn (6
thng). Vi thi gian trn, vic nh gi kt qu iu
tr ca hm khung cn c nhng hn ch. Nghin
cu ca chng ti c thi gian theo di l 2 nm vi
mc tiu:
1. nh gi hiu qu phc hi chc nng v
thm m ca hm khung trong iu tr mt rng
loi Kennedy I v II.
2. nh gi nh hng ca hm khung vi
cc thnh phn rng ming cn li.

II. I TNG
NGHIN CU

PHNG

PHP

1. i tng
- Bnh nhn mt rng loi Kennedy I v II c ch
nh lm hm khung.
- S lng bnh nhn: 40
2. Phng php nghin cu
2.1. Khm bnh nhn, lp k hoch iu tr v

2.2. nh gi kt qu iu tr theo thi gian:

Theo Stuart. A. Greene [7] thi gian s dng
trung bnh ca mt hm gi l 5 nm, tuy nhin thi
gian ny c th thay i trong tng trng hp bnh
nhn. Chng ti nh gi kt qu iu tr trong 2
nm:
- nh gi kt qu sau khi bnh nhn mang hm
gi 1 tun: Cc tiu ch nh gi:S lu gi, khp
cn, thm m ca hm gi v s hi lng ca bnh
nhn. Cc tiu ch c phn lm 3 mc : tt,
trung bnh v km. nh gi kt qu iu tr c
chia lm 4 mc : Tt, kh, trung bnh v km.
- nh gi kt qu sau khi bnh nhn mang hm
gi 1 thng: Ngoi 4 tiu ch trn, thm 3 tiu
ch:Thi gian thch nghi, nh hng ca hm gi ti
sng hm v chc nng n nhai ca hm gi. nh
gi kt qu iu tr: 4 mc .
- nh gi kt qu sau khi bnh nhn mang hm
gi 6 thng: Ngoi cc tiu ch: s lu gi, khp cn,
thm m, chc nng n nhai cn da vo cc tiu
ch: s nh hng ti sng hm, tnh trng cc rng
tr, cht lng hm gi.
- nh gi kt qu sau khi bnh nhn mang hm
gi 1 nm: Cc tiu ch v: lu gi, khp cn, thm
m, n nhai v cht lng hm gi c nh gi
nh trn. Ngoi ra cn c mt s tiu ch khc nh:
tnh trng sng hm vng mt rng, rng tr.
- nh gi kt qu sau khi bnh nhn mang hm
gi 2nm: nh gi da vo cc tiu ch:Lu gi,
khp cn, thm m, n nhai, cht lng hm gi nh
ch tiu nh gi sau 1 nm.

TCNCYH 40 (1) - 2006

III. KT QU
Bng 1. Phn loi mt rng

V tr

Hm trn

Hm di

N (%)

Kennedy I

14 (30,4)

Kennedy II

14

18

32 (69,6)

Tng s

21

25

46

T l %

45,7

54,3

Loi mt rng

Nhn xt: Trong nhm nghin cu ca chng ti t l mt rng loi Kennedy II nhiu hn so vi loi Kennedy I c hm trn v hm di.
Bng 2: Kiu b phn ni chnh.

Kiu b phn ni chnh

Hm trn

N (%)

Bn khu ci ton b

4 (19,1)

Bn khu ci hnh ch U

2 (9,5)

Bn khu ci kp
Hm di

15 (71,4)

Thanh li

9 (36)

Bn li

12 (48)

Thanh li kp

4 (16)

Nhn xt: Kiu b phn ni chnh c ch nh nhiu nht hm trn l bn khu ci kp, hm di l
bn li.
Bng 3. Cc dng mc c thit k rng tr k cn khong mt rng khng c gii hn

V tr

Hm trn

Hm di

N (%)

Mc ch T

18

23 (38,3)

Dng mc
Mc ch I

2 (3,3)

Mc Nally - Martinet

12 (20)

Mc Aker

8 (13,4)

Mc Aker kp

2 (3,3)

Mc dy un

13 (21,7)

Tng s

28

32

60

Nhn xt:
- Mc ch T v mc dy un c dng nhiu nht, mc Aker t c ch nh hn.
- Theo di iu tr: S bnh nhn khm li sau khi mang hm gi 6 thng l 38, sau 1 nm l 35 v sau 2
nm l 32.
Bng 4. Kt qu iu tr

Kt qu

Tt

Kh

Trung bnh

Km

Thi gian

(%)

(%)

(%)

(%)

1 tun

60

27,5

12,5

1 thng

72,5

20

7,5

6 thng

76,3

18,4

5,3

1 nm

74,3

14,3

11,4

2 nm

71,8

12,5

9,4

6,3

TCNCYH 40 (1) - 2006

Nhn xt:
- Kt qu iu tr tt tng i cao. T l kt qu
tt thi im bnh nhn mang hm gi c 1
thng v 6 thng cao hn mt tun u.
- Theo di trong thi gian di l 2 nm c kt
qu km vi t l thp.

IV. BN LUN
1. Loi mt rng
T l mt rng loi Kennedy I v II c khc nhau
trong tng nghin cu. Trong nghin cu ca Walid
[9] t l mt rng Kennedy I l 47% v Kennedy II l
53%, trong nghin cu ca Filiz Keyf [5] t l mt
rng Kennedy I l 53% v Kennedy II l 47%. Nghin
cu ca chng ti t l mt rng loi Kennedy II
nhiu hn so vi loi Kennedy I.
2. B phn ni chnh
B phn ni chnh ca hm khung c nhiu kiu
v mi kiu li c nhng u, nhc im nht nh.
Kiu ni chnh no c chn ph thuc vo tng
trng hp bnh nhn c th v tu theo s thch
ca nha s.
Trong nghin cu ca chng ti kiu bn khu
ci kp hay c dng nht [71,4%] v kiu ny gn
nh hn kiu bn khu ci ton din m vn m
bo cng. Kt qu ny cng ph hp vi nghin
cu ca Walid [62%] v ca Filiz Keyf [47%].
Bn li c chng ti dng nhiu nht [46%]
v loi ni chnh ny c tc dng np cc rng ca
lung lay v c th thm rng gi vo hm c khi mt
thm rng ca. Ngc li trong nghin cu ca
Walid v Filiz th thanh li li c dng nhiu hn
[77% v 71%].
3. Mc trong hm khung
C nhiu kiu mc c dng trong hm khung.
Mi loi mc c nhng ch nh, chng ch nh v u
- nhc im. Loi mc no c chn l tu tng
trng hp bnh nhn v cng cn tu nha s v c
mt s loi mc c ch nh tng t nh
nhau.Nghin cu ca walid, t l kiu mc ch T v I
ch chim 15% cn theo Filiz t l 2 kiu mc trn l
31,4. Trong nghin cu ca chng ti t l dng 2
loi mc ny li cao nht [41,7 %] v cc mc ny t
c hi ln rng tr bnh nhn mt rng loi
Kennedy I v II.
4. nh gi kt qu iu tr
Kt qu iu tr c nh gi sau khi bnh nhn
mang hm gi 1 tun, 1 thng, 6 thng, 1 nm v 2
nm.
Kt qu ban u cn c mt s bnh nhn xp

loi kh do kh nng nhai cn cha tt ch t trung

bnh - bnh nhn cha kp thch nghi. Cc bnh nhn
c nh gi trung bnh v n nhai cha tt v thm
m mc trung bnh (do l mc bnh nhn mt
rng ti rng ca).
Sau khi mang hm gi 1 thng bnh nhn thch
nghi hn nn kh nng n nhai tt hn do kt qu
iu tr tt hn lc mi lp hm gi. Theo R.M.
Basker [6] kh nng n nhai ca bnh nhn tng dn
sau khi mang hm gi vi tun. Trong nghin cu
ca Zhang DG 82% bnh nhn thch nghi vi hm
gi trong 2 - 3 tun, 13,3% bnh nhn thch nghi
trong 4 - 5 tun [10].
Kt qu xp loi tt l tng i cao (76,31%) v
c cao hn t so vi nghin cu ca Phm L Hng
(70%) [3] nhng li thp hn so vi kt qu nghin
cu ca Nguyn Th Minh Tm (84,3%) [4] v ca
Nguyn Thu Anh (92,8%) [1]. S chnh lch v kt
qu nghin cu gia cc tc gi c th do tiu ch
nh gi khng hon ton ging nhau.
Sau 1 nm mang hm gi, t l kt qu tt vn
tng i cao [74,3%]. S bnh nhn c nh gi
c kt qu trung bnh l do c thm m trung bnh v
rng tr c tng lung lay.
Kt qu iu tr sau 2 nm vn c duy tr
tng i cao. C 2 trng hp xp loi km l do
c su rng tr v phi nh rng tr do lung lay nhiu
bnh c bnh vim quanh rng t trc iu tr.
Trong nghin cu ny c 2 rng tr su (trong 48
rng) chim 4,2%, nghin cu ca Vanzeveren [8] t
l su rng tr l 8,6%-t l ny cao hn do tc gi
khm bnh nhn eo hm gi 11 nm.

V. KT LUN
1. Hiu qu iu tr ca hm khung trong iu tr
bnh nhn mt rng loi Kennedy I v II l tng i
cao (trn 70% tt), c bit trong thi gian u (6
thng 1 nm). Nu bnh nhn c khm v iu
tr nh k, hiu qu iu tr vn c duy tr tt (trn
70% tt sau 2 nm mang hm gi).
2. Hm khung c tc dng bo v thnh phn
rng ming cn li nu qu trnh lm hm khung
c thc hin ng cc bc k thut.

TI LIU THAM KHO

1. Nguyn Thu Anh (2003). Nhn xt mc Aker
v mc RPI trong phc hnh hm khung iu tr mt
rng loi Kennedy I v II. Lun vn thc s. H ni
2003: 45.
2. V Kiu Dim (1994). Kt qu iu tra tnh
trng sc kho rng ming min Nam Vit nam
1991. K yu cng trnh khoa hc 1975-1993 i hc

TCNCYH 40 (1) - 2006

Y Dc TP HCM. 1994: 18.

3. Phm L Hng (1999). Nghin cu so snh
hai loi phc hnh bn phn khung b iu tr mt
rng loi Kennedy I v II. Lun vn chuyn khoa
II.1999: 66.
4. Nguyn Th Minh Tm (2001). Nhn xt phc
hnh mt nhm rng sau bng hm khung. Lun vn
thc s. 2001: 52.
5. Filiz Keyf (2001). Frequency of the Various
Classes of Removable Partial Dentures and
Selection of Major Connector and Direct/ Indirec
Retainers. Turk J Med Sci 31 (2001) 445 - 449.
6. R.M. Basker(2000). Removable partial
dentures: an introduction. British dental journal,
volum 189, No. 7, October 14 2000.

7.Stuart.a. Greene (2002). Conventional

Removable Partial Dentures. Published: Aug 22,
2002.
8. VanZeVenren (2003). Treatment with
removable partial dentures: a longitudinal study.
Journal of Oral Rehabilitation . May 2003, vol.30, no.
5: 459 - 469.
9. Walid. M (2000). Removable partial dentuer Design: A study of a selected population in Saudi
Arabia. Journal of contemporary dental practice.
Volum 3 No 10. 2000
10. Zhang DG (2004). Clinical using and
observation of occlusoin of splint of RPD. Shanghai
Kou Qiang Yi Xue. 2004 Jun ; 13 (3): 230 - 2.

Summary

THE EVALUATION OF TREATMENT OF KENEDY I-II EDENTULOUS PATIENTS BY METAL

FRAME- REMOVABLE PARTIAL DENTURES
In Vietnam, the metal frame - removable partial dentures are not used as much as the resin - removable
partial dentures even though they have some advantages. Purpose: (1) To evaluate the functional and aesthetic restoration of metal frame - removable partial denture in Kenedy I-II edentulous patients. (2) To evaluate
the influence of metal frame - removable partial denture on the remaining teeth and oral tissue. Subjects and
methods: 40 Kennedy I-II edentulous patients have been treated by metal frame - removable partial dentures.
The criterions of evaluation were the retention, aesthetic, occlusion, mastication, abutment teeth, edentulous
ridges and the satisfaction of patients. The clinical aspects were evaluated in the period of time 2 years. Result:
The very good result of more than 70% was acquired. The poor result was 6,26%. Conclusion: The effect of
treatment of Kenedy I-II edentulous patients by metal frame - removable partial dentures was high. The metal
frame - removable partial dentures preserved the remaining teeth and oral tissue.
Keywords: removable partial denture, edentulous.