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ROČNÍK (Volume): 23
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ROK (Year): 2014
ČÍSLO (Number): 4
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ORTODONCIE
ORTODONCIE
Recenzovany cÏasopis CÏeske ortodonticke spolecÏnosti
Published by the Czech Orthodontic Society
RocÏnõÂk (Volume): 23
Rok (Year): 2014
CÏõÂslo (Number): 4
CÏasopis ORTODONCIE je veden v rejstrÏõÂku recenzovanyÂch, neimpaktovanyÂch cÏasopisuÊ.
IndexovaÂno: Bibliographia Medica CÏechoslovaca od roku 1992
Vydavatel: CÏeska ortodonticka spolecÏnost (Published by the Czech Orthodontic Society)
VedoucõÂ redaktor (Editor in Chief):
Doc. MUDr. MilosÏ SÏpidlen, Ph.D., Olomouc, Czech Republic
VedoucõÂ redaktor web stran (Editor in Chief web pages)
MUDr. JirÏõÂ Tvardek, HustopecÏe, Czech Republic
RedakcÏnõÂ rada (Editorial Board):
MUDr. Gabriela AlexandrovaÂ, Bratislava, Slovensko
Prof. Dr. Hans-Peter Bantleon, Wien, OÈsterreich
Dr. Ewa Czochrowska, Ph.D., Warszawa, Polska
Prof. Dr. Nejat Erverdi, Ph.D., Istanbul, Turkey
MUDr. Karel Floryk, VysÏkov, Czech Republic
Doc. Dr. Piotr Fudalej, Ph.D., Bern, Switzerland
MUDr. Milada HaÂlkovaÂ, Strakonice, Czech Republic
MUDr. Martin HoraÂcÏek, HavlõÂcÏkuÊv Brod, Czech Republic
MUDr. Jan Horal, Praha, Czech Republic
Prof. MUDr. Milan KamõÂnek, DrSc., Olomouc, Czech Republic
Prof. Dr. Stavros Kiliaridis, Ph.D., Geneve, Switzerland
MUDr. Irena KlõÂmovaÂ, Bratislava, Slovensko
Prof. dr. hab. Anna Komorowska, Lublin, Polska
MUDr. Martin Kotas, Ph.D., ZlõÂn, Czech Republic
MUDr. Magdalena Kot'ovaÂ, Ph.D., Praha, Czech Republic
Prof. Dr. Anne-Marie Kuijpers-Jagtman, Ph.D., Nymegen, Nederlands
MUDr. Ivana KyralovaÂ, Hradec KraÂloveÂ, Czech Republic
MUDr. Ivo Marek, Ph.D., BrÏeclav, Czech Republic
Prof. dr. hab. Agnieszka Pisulska, Zabrze, Polska
MUDr. Milada StehlõÂkovaÂ, KromeÏrÏõÂzÏ, Czech Republic
MUDr. Marie SÏtefkovaÂ, CSc., Olomouc, Czech Republic
MUDr. JirÏõÂ Tvardek, Ph.D., HustopecÏe, Czech Republic
Dr. Mariusz Wilk, LodzÂ, Polska
Recenzenti cÏasopisu Ortodoncie:
MUDr. Hana BoÈhmovaÂ
Doc. MUDr. PavlõÂna CÏernochovaÂ, Ph.D.
Prof. MUDr. Milan KamõÂnek, DrSc.
MUDr. Irena KlõÂmovaÂ
MUDr. Martin Kotas, Ph.D.
MUDr. Magdalena Kot'ovaÂ, Ph.D.
MUDr. Ivo Marek, Ph.D.
MUDr. JirÏõÂ Petr
Prof. MUDr. Jaroslav Racek, DrSc.
Doc. MUDr. MilosÏ SÏpidlen, Ph.D.
MUDr. Eva SÏraÂmkovaÂ
MUDr. Marie SÏtefkovaÂ, CSc.
MUDr. Miroslava SÏvaÂbovaÂ, CSc.
MUDr. JirÏõÂ Tvardek, Ph.D.
MUDr. Hana TycovaÂ
MUDr. Wanda UrbanovaÂ, Ph.D.
Recenzenti pro hranicÏnõÂ obory:
Doc. MUDr. Oliver Bulik, Ph.D.
Prof. MUDr. Miroslav Eber, CSc.
Prof. MUDr. Tat'jana DostaÂlovaÂ, DrSc., MBA
Doc. MUDr. Rene FoltaÂn, Ph.D.
MUDr. PrÏemysl KrejcÏõÂ, Ph.D.
Doc. MUDr. Milan MachaÂlka, CSc.
Doc. RNDr. Eva MatalovaÂ, Ph.D.
Prof. MUDr. JirÏõÂ MazaÂnek, DrSc.
Adresa redakce (Contact Address):
Doc. MUDr. KveÏtoslava NovaÂkovaÂ, CSc.
772 00 Olomouc, PalackeÂho 12
Prof. MUDr. JindrÏich Pazdera, CSc.
fax: 585 223 907, tel.: 585 859 229
Doc. MUDr. LudeÏk PerÏinka, CSc.
e-mail: [email protected]
Doc. MUDr. Lenka RoubalõÂkovaÂ, Ph.D.
www.orthodont-cz.cz
Doc. MUDr. Radovan SlezaÂk, CSc.
Doc. MUDr. Martin Starosta, Ph.D.
ISSN: 1210±4272
Doc. MUDr. Jitka StejskalovaÂ, CSc.
Doc. MUDr. AntonõÂn SÏimuÊnek, CSc.
Prof. MUDr. JirÏõÂ VaneÏk, CSc.
Doc. MUDr. AntonõÂn Zicha, Ph.D.
CÏasopis je vydaÂvaÂn 4x rocÏneÏ (ORTODONCIE is published in 4 issues per year)
Sazba (Type setting): FIS Print Olomouc. Tisk (Printed by): TiskaÂrna PRATR a. s.
Cena (Payment): 200,± KcÏ (10,± EUR), cÏ. uÂ.: 32932-021/0100, konst. symbol: 0558, variab. symbol: rodne cÏõÂslo.
CÏasopis je bezplatneÏ zasõÂlaÂn cÏlenuÊm CÏeske ortodonticke spolecÏnosti.
A copy of the ORTODONCIE is sent to all members of the Czech
Orthodontic Society in good spending with their subscription.
UzaÂveÏrky (Dedline for the next year): 7. 3., 9. 5., 12. 9. a 7. 11. 2015
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
Obsah (Contens):
SpolecÏenska rubrika . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
ZpraÂvy z vyÂboru . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
ZajõÂmavosti v ortodoncii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Odborna praÂce
DentaÂlnõÂ hygiena u ortodontickyÂch pacientuÊ
(Dental hygiene in orthodontic patients) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
5-lety index u pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem
(5-year index in patients with complete unilateral cleft lip and palate) . . . . . . . . . . . . . . . . . . . . . . 211
SpolupraÂce ortodontisty a pedostomatologa. InterceptivnõÂ leÂcÏba.
(Cooperation of orthodontist and pedodontist. Interceptive orthodontic treatment.) . . . . . . . . . . 228
Kongres CÏOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Ze zahranicÏnõÂch cÏasopisuÊ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Informace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
REKLAMA
UverÏejneÏnõÂ:
1 cm2 plochy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25,± KcÏ
1 strana A4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 000,± KcÏ
1/2 strany A4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 000,± KcÏ
zadnõÂ strana desek. . . . . . . . . . . . . . . . . . . . . . . . . . . . . + 50% ceny
vnitrÏnõÂ strana desek . . . . . . . . . . . . . . . . . . . . . . . . . . . . + 30% ceny
strana 1 a 2 cÏasopisu . . . . . . . . . . . . . . . . . . . . . . . . . . + 20% ceny
Inzerce v kazÏdeÂm cÏõÂsle rocÏnõÂku . . . . . . . . ±2 000,± KcÏ/1 str. A4
VlozÏenõÂ reklamnõÂho letaÂku: . . . . . . . . . . . . . . . . . . . . . 5 000,± KcÏ
VlozÏenõÂ reklamnõÂ publikace (do 4 stran): . . . . . . . . . 12 000,± KcÏ
ZhotovenõÂ reklamy: uÂcÏtovaÂno samostatneÏ
Doc. MUDr. MilosÏ SÏpidlen, Ph.D.
vedoucõÂ redaktor,
Klinika zubnõÂho leÂkarÏstvõÂ LF UP
PalackeÂho 12
772 00 Olomouc
tel.: +420 585 859 229
mob.: +420 602 752 189
e-mail: [email protected]
www. orthodont-cz.cz
TeÏsÏõÂme se na spolupraÂci s VaÂmi
www.orthodont-cz.cz e-mail: [email protected]
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SpolecÏenska rubrika
ORTODONCIE
V rÏõÂjnu, listopadu a prosinci roku 2014
sve vyÂznamne zÏivotnõ jubileum oslavili:
MUDr. Marta BohuslavickaÂ, Praha
Prof. MUDr. Jaroslav Racek, DrSc., Praha
MUDr. VeÏra KravcÏenkovaÂ, UnhosÏt'
MUDr. Olga UhrovaÂ, MeÏlnõÂk
MUDr. Brigita Stan
Ï kovaÂ, Jablonec nad Nisou
MUDr. Hana VavrÏõÂcÏkovaÂ, TyÂnisÏteÏ nad OrlicõÂ
MUDr. EvzÏenie MatzenauerovaÂ, Znojmo
MUDr. Anna TaitlovaÂ, Karlovy Vary
MUDr. Marie MarkovaÂ, CSc., Praha
MUDr. Josef DevaÂt, ZlõÂn
MUDr. Vlasta OdstrcÏilovaÂ, Brno
MUDr. VeÏra PrÏibõÂkovaÂ, LitomeÏrÏice
MUDr. Justina PaucÏkovaÂ, Ostrava
MUDr. Marie SÏtefkovaÂ, CSc., Olomouc
MUDr. Vlasta NovaÂkovaÂ, UÂstõÂ nad Labem - Skorotice
MUDr. ZdeneÏk Micek, VrÏesina
MUDr. Marie MarkupovaÂ, Praha
MUDr. AlzÏbeÏta ChrzovaÂ, MeÏstec KraÂloveÂ
MUDr. VladimõÂra KonecÏnaÂ, Kralice na HaneÂ
MUDr. Dagmar KadlasovaÂ, Liberec
MUDr. Marie SÏaÂmalovaÂ, Plzen
Ï
MUDr. Jana ZÏaÂdnõÂkovaÂ, ValasÏske MezirÏõÂcÏõÂ
MUDr. Sylva MatulõÂkovaÂ, ZlõÂn
MUDr. KaterÏina PodlesÏaÂkovaÂ, Praha
SrdecÏneÏ blahoprÏejeme!
CÏlensky poplatek pro rok 2015 cÏinõ 2500,- KcÏ nebo 100,- EUR.
CÏlenove v zameÏstnaneckeÂm vztahu 800,- KcÏ nebo 35,- EUR.
Postgraduanti, duÊchodci a zÏeny na materÏske dovolene 300,- KcÏ nebo 15,- EUR.
RegistracÏnõÂ polatek cÏinõÂ 500,- KcÏ nebo 20,- EUR.
PrÏedplatne cÏasopisu Ortodoncie pro necÏleny CÏOS je 1000,- KcÏ za rok nebo 50,- EUR.
UÂhrada poplatku do 28. 2. 2015, cÏ. uÂ.: 32932021/0100, konst. symbol: 0558, variab. symbol: rodne cÏõÂslo.
PrÏi nezaplacenõÂ prÏõÂspeÏvkuÊ po dvou põÂsemnyÂch urgencõÂch bude ukoncÏeno cÏlenstvõÂ v CÏOS.
190
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
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ZemrÏela prim. MUDr. Eva VelõÂsÏkovaÂ, CSc.
V puÊli rÏÂõjna letosÏnõÂho roku naÂs zastihla smutna zpraÂva, zÏe naÂs navzÏdy opustila panõÂ
prim. MUDr. Eva VelõÂsÏkovaÂ, CSc., nositelka titulu Osobnost cÏeske stomatologie, cÏestnyÂ
cÏlen CÏeske ortodonticke spolecÏnosti a laureaÂt cÏestne prÏednaÂsÏky BedrÏicha Neumanna.
PrÏestozÏe se dozÏila pozÏehnaneÂho veÏku 88 let, jejõÂ odchod je velkyÂm smutkem pro celou
cÏeskou ortodontickou obec. Kdo jste ji znali, jisteÏ si vybavujete jejõÂ noblesu a prÏitom
skromnost vystupovaÂnõÂ azÏ do pozdnõÂho veÏku.
Prim. VelõÂsÏkova byla jednõÂm z pilõÂrÏuÊ rozvoje modernõ ortodonticke terapie a fixnõ ortodoncie v prÏedrevolucÏnõ dobeÏ. Profesnõ i osobnõ vztah k vyÂznacÏneÂmu sveÏtoveÂmu ortodontistovi s cÏeskoslovenskyÂmi korÏeny prof. Jarabakovi jõ umozÏnil kolem roku 1968 otevrÏÂõt vstup tohoto specialisty na
cÏeskoslovenskou ortodontickou sceÂnu. PuÊsobil nejen jako lektor, ale i jako fakticky podporovatel nasÏÂõ ortodoncie.
Osud vsÏak rozhodl, zÏe prof. Jarabak opustil tento sveÏt, anizÏ dokoncÏil sve dõÂlo v nasÏÂõ republice. Prim. VelõÂsÏkova nadaÂle ve funkci vedoucõÂho ortodontickeÂho oddeÏlenõ stomatologicke katedry tehdejsÏÂõho ILF prosazovala teoretickou vyÂuku i prakticke provaÂdeÏnõ modernõ ortodoncie v obtõÂzÏnyÂch podmõÂnkaÂch totalitnõÂho rezÏimu zejmeÂna s vyuzÏitõÂm poznatkuÊ zõÂskanyÂch spolupracõ s prof. Jarabakem. Pro mnoho nasÏich ortodontistuÊ, kterÏÂõ sve vzdeÏlaÂnõ realizovali v prÏedrevolucÏnõ dobeÏ, byla mozÏnost odbornyÂch kontaktuÊ s prim. VelõÂsÏkovou jednou z maÂla prÏÂõlezÏitostõÂ, jak prÏijõÂt
k novyÂm poznatkuÊm v oboru.
KromeÏ neÏkolika generacõÂ vyleÂcÏenyÂch ortodontickyÂch pacientuÊ a kromeÏ stovek cÏeskyÂch a slovenskyÂch
ortodontistuÊ, ktere lidsky a profesneÏ ovlivnila, zuÊstaÂvaÂ
po panõ primaÂrÏce i vyÂznamne veÏdecke dõÂlo. DizertacÏnõÂ
praÂci veÏnovala zkoumaÂnõÂ vlivu extraoraÂlnõÂch sil na vyÂvoj
orofaciaÂlnõÂho skeletu deÏtõÂ se skolioÂzou, zajõÂmala se
o mandibulaÂrnõ progenii. NadcÏasovou hodnotu majõ zejmeÂna jejõ unikaÂtnõ studie na dvojcÏatech, zapocÏate ve
spolupraÂci s brneÏnskyÂm VyÂzkumnyÂm uÂstavem pediatrickyÂm.
Panõ primaÂrÏka VelõÂsÏkova naÂm bude velice chybeÏt.
CÏest jejõÂ pamaÂtce.
Za CÏeskou ortodontickou spolecÏnost
MUDr. JirÏÂõ Petr, MUDr. Miroslava SÏvaÂbovaÂ, CSc.
www.orthodont-cz.cz e-mail: [email protected]
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ZpraÂvy z vyÂboru
ZpraÂvy z vyÂboru
1) VyÂbor vzal na veÏdomõÂ vyÂsledek souteÏzÏe o cenu
ÏCeske ortodonticke spolecÏnosti pro rok 2014. PodrobneÏji v samostatne prÏõÂloze.
2) VyÂbor se vyjaÂdrÏil o vhodnosti zvaÂzÏit veÏtsÏõÂ zastoupenõÂ hlavnõÂch prÏednaÂsÏejõÂcõÂch z CÏR - nasÏe republika disponuje rÏadou kvalitnõÂch lektoruÊ, kterÏõÂ nemajõÂ na kongrese dostatek prostoru; naopak zahranicÏnõÂ prÏednaÂsÏejõÂcõÂ znamenajõÂ obvykle veÏtsÏõÂ naÂklady.
3) VyÂbor schvaÂlil nominaci Dr. Marka do funkce ambasadora AAO pro CÏR.
4) VyÂbor vzal na veÏdomõÂ stanovisko praÂvnõÂka CÏOS
k problematice privaÂtnõÂch praxõÂ:
- pokud leÂkarÏ pozÏaduje proplacenõ laboratornõÂho vyÂrobku, ktery saÂm zhotovil ve sve praxi bez laboratorÏe,
zdravotnõÂ pojisÏt'ovnou, je trÏeba se na tomto dohodnout
s touto pojisÏt'ovnou,
- zdravotnicka dokumentace - bude v samostatneÂ
prÏõÂloze
- poskytovaÂnõ ortodonticke peÂcÏe v CÏR nespecialistou v ortodoncii bez prÏõÂslusÏneÂho opraÂvneÏnõ - hrozõ pokuta 1.000.000,- KcÏ.
5) VyÂbor vzal na veÏdomõÂ prÏipomenutõÂ Dr. Kot'oveÂ
o konaÂnõÂ dalsÏõÂho jednodennõÂho ¹RozsÏteÏpoveÂho dneª
v paÂtek 28. 11. 2014 v Nemocnici KraÂlovske Vinohrady.
6) VyÂbor vzal na veÏdomõÂ informaci prof. KamõÂnka
o konaÂnõÂ kurzuÊ pro 1. rocÏnõÂk postgraduaÂlnõÂ prÏõÂpravy
v termõÂnech 5.-9. ledna 2015 a beÏhem zaÂrÏõÂ 2015 na klinice v Olomouci.
7) VyÂbor vzal na veÏdomõÂ informaci veÏdeckeÂho sekretaÂrÏe Dr. Kotase o podmõÂnkaÂch udeÏlenõÂ grantuÊ CÏOS pro
rok 2015 - podrobnosti na webu CÏOS.
8) VyÂbor stanovil konaÂnõÂ prÏõÂsÏtõÂ schuÊze na uÂteryÂ
9. 12. 2014 od 17 hod. v BrneÏ, mõÂsto bude uprÏesneÏno.
MUDr. JirÏõÂ Petr
SpraÂvy z katedry cÏel'ustnej
ortopeÂdie lakaÂrskej fakulty SZU
V suÂcÏasnosti prebieha sÏtvrty rok postgraduaÂlnej vyÂuky v sÏpecializacÏnom sÏtuÂdiu v odbore cÏes,ustna ortopeÂdia na LekaÂrskej fakulte SZU v Bratislave.
Od 1. oktoÂbra 2014 nastuÂpilli novõ uÂcÏastnõÂci sÏpecializacÏneÂho sÏtuÂdia: MDDr. I. MonÏokovaÂ, MDDr. A. NadaÂzÏdyovaÂ, MDDr. E. IvancÏova , Dr. A. Papoutsi a Dr. Ch.
Katsigianni do prveÂho rocÏnõÂka. Spolu maÂme vo vsÏetkyÂch
troch rocÏnõÂkoch 11 sÏtudentov. VyucÏujeme dvojjazycÏne,
prednaÂsÏky a seminaÂre prebiehaju v slovenskom a anglickom jazyku. Prakticku a teoreticku cÏast' vyÂuky zabezpecÏuju zvaÈcÏsÏa externõ lektori: doktorky medicõÂny AlexandrovaÂ, AntalovaÂ, JakubovaÂ, KlõÂmova a PasÏkova a Dr. med.
192
ORTODONCIE
dent Sabo. Na univerzitnej klinike v KosÏiciach, nasÏom
partnerskom pracovisku, vedie vyÂuku MUDr. SurovkovaÂ. SÏpeciaÂlne predmety ako naprõÂklad medicõÂnske
praÂvo, ergonoÂmiu cÏi dentaÂlnu hygienu chodia prednaÂsÏat'
odbornõÂci z praxe. VsÏeobecne medicõÂnske predmety
ako epidemioloÂgia, genetika cÏi sÏtatistika prednaÂsÏaju ucÏitelia z nasÏej LekaÂrskej fakulty.
Tento semester posilnõ rady lektorov aj cÏerstvy absolvent nasÏej katedry - MDDr. Jozef BobaÂk. Spolu
s nõÂm uÂspesÏne zlozÏili sÏpecializacÏnu skuÂsÏku kolegovia:
M. MarcÏekovaÂ, P. SasaÂkovaÂ, L. Bodrucka Lenka a K.
CÏervenÏovaÂ. Ak spomenieme v juÂni diplomovanu kolegynÏu L. RichterovuÂ, naraÂtame 6 absolventov noveÂho
univerzitneÂho sÏpecializacÏneÂho programu.
Okrem plneÂho pracovneÂho tyÂzÏdnÏa organizujeme
pravidelne raz do mesiaca v sobotu tzv. VõÂkendove seminaÂre z cÏel'ustnej ortopeÂdie. PrednaÂsÏaju na nich domaÂci aj zahranicÏnõ odbornõÂci a seminaÂre su otvoreneÂ
v raÂmci kontinuaÂlneho vzdelaÂvania aj pre cÏel'ustnyÂch
ortopeÂdov z praxe cÏi zahranicÏnyÂch zaÂujemcov.
V juÂni zavrÂsÏil letny semester MUDr. Kotas s MUDr. Liberdom, ked' zaujali vsÏetkyÂch svojou celodennou prednaÂsÏkou o Kombinovanej ortodonticko-chirurgickej terapii, zimny semester zasa zahaÂjil Dr. Simon Littlewood
z Vel'kej BritaÂnie, ktory prednaÂsÏal o LiecÏbe II. a III. triedy,
MUDr. HoraÂcÏek s MUDr. DianisÏkovou predniesli InovaÂcie v MBT technike a naposledy doc. Visconti a odb.as.
Bonetti z Univerzity Brescia zozÏali uÂspech s prednaÂsÏkou
o VcÏasnej ortodontickej liecÏbe. SpolupraÂca s Univerzitou
v Brescii je intenzõÂvna, 13.decembra ukoncÏõÂ program võÂkendovyÂch prednaÂsÏok v tomto kalendaÂrnom roku dekan
tamojsÏej Fakulty zubneÂho lekaÂrstva prof. Corrado Paganelli s teÂmou: Vedecka praÂca v ortodoncii a praÂca s odbornou literatuÂrou. VzÏdy raz rocÏne sa kona stretnutie
postgraduaÂlnych sÏtudentov, na ktorom sa stretnu vsÏetci
zaradenõÂ, teda aj kolegovia dobiehajuÂci v prõÂprave v privaÂtnych praxiach podl'a poÃvodnej vyhlaÂsÏky, aby predstavili svoje liecÏene prõÂpady pacientov. PocÏet zubnyÂch
lekaÂrov v prõÂprave na akreditovanom tereÂnnom pracovisku sa postupne zmensÏuje absolvovanõÂm zaÂverecÏnej
skuÂsÏky. NasledujuÂca sÏpecializacÏna skuÂsÏka je plaÂnovanaÂ
na 12. decembra 2014.
Na LF SZU sa od septembra 2013 realizuje aj pregraduaÂlna vyÂuka v odbore Zubne lekaÂrstvo, cÏõÂm sa napIÂnÏa scenaÂr zjednotenia pre- a postgraduaÂlnej vyÂuky
v jednej insÏtituÂcii. Tento sÏkolsky rok pokracÏujeme druhyÂm rocÏnõÂkom pregraduaÂlnych sÏtudentov zubneÂho lekaÂrstva. VsÏeobecna medicõÂna sa na LF SZU vyucÏuje uzÏ
po oÃsmy rok. Na zaÂver dodaÂm, zÏe nasÏim postgraduaÂlnym sÏtudentom sa vel'mi paÂcÏil nielen odbornyÂ, ale aj
spolocÏensky program na Kongrese CÏOS a SOS v Olomouci a tesÏia sa na stretnutie s posluchaÂcÏmi cÏeskyÂch
univerzõÂt na kongrese EOS v BenaÂtkach.
MUDr. Simona DianisÏkovaÂ, PhD., MPH
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
ZpraÂvy z vyÂboru
rocÏnõÂk 23
cÏ. 4. 2014
Pokyny pro autory
Instructions for Authors
CõÂlem cÏasopisu ORTODONCIE je informovat cÏleny CÏeske ortodontickeÂ
spolecÏnosti a ostatnõÂ ortodontickou a stomatologickou verÏejnost o deÏnõÂ
v odborne spolecÏnosti, o vyÂvoji v ortodoncii a prÏõÂbuznyÂch oborech, poskytovat materiaÂly pro postgraduaÂlnõ a celozÏivotnõ vzdeÏlaÂvaÂnõ specialistuÊ
v oboru ortodoncie a informovat o odbornyÂch a sÏkolicõÂch akcõÂch. CÏasopis
je vydaÂvaÂn v cÏeskeÂm jazyce, odborne praÂce dvojjazycÏneÏ v cÏeskeÂm/slovenskeÂm a anglickeÂm jazyce.
PrÏõÂspeÏvky v cÏasopise se rÏadõÂ do teÏchto rubrik:
1. SpolecÏenska rubrika;
2. ZpraÂvy z vyÂboru CÏeske ortodonticke spolecÏnosti;
3. ZajõÂmavosti v ortodoncii (zpraÂvy o probeÏhlyÂch odbornyÂch a sÏkolicõÂch akcõÂch, zpraÂvy z kongresuÊ a cest;
4. Diskusnõ a polemicke prÏõÂspeÏvky, dopisy redakci;
5. Odborne praÂce (puÊvodnõ praÂce, souborne referaÂty, prÏedbeÏzÏna sdeÏlenõÂ,
kazuistiky);
6. Ze zahranicÏnõÂch cÏasopisuÊ (referaÂty z cÏasopisuÊ);
7. Recenze (odbornyÂch knih a atestacÏnõÂch pracõÂ);
8. Informace.
PrÏõÂspeÏvky se zasõÂlajõ v tisÏteÏne formeÏ ve formaÂtu A4 a soucÏasneÏ v elektronicke formeÏ na CD psane v textoveÂm editoru obvykleÂho typu (Word) v souladu s novyÂmi pravidly cÏeskeÂho nebo slovenskeÂho pravopisu a americkyÂm
standardem anglickeÂho pravopisu jednotneÏ v celeÂm sdeÏlenõÂ. Fotografie
musõÂ byÂt ulozÏeny ve formaÂtu JPG v rozlisÏenõÂ min. 250-300 dpi. Tabulky, grafy
a texty v obraÂzcõÂch se publikujõ v anglickeÂm jazyku. PraÂce zaslane redakci
musõÂ byÂt formulovaÂny s konecÏnou platnostõÂ.
PozÏadavky na odborne praÂce. Redakce prÏijõÂma praÂce, ktere nebyly
a nebudou zadaÂny jineÂmu periodiku, vyhovujõ po straÂnce odborne a majõÂ
odpovõÂdajõÂcõÂ uÂrovenÏ metodologickeÂho a statistickeÂho zpracovaÂnõÂ. PublikovaÂnõÂ vyÂsledkuÊ klinickyÂch a experimentaÂlnõÂch (pokusy na zvõÂrÏatech) vyÂzkumuÊ
prÏedpoklaÂdaÂ, zÏe byly dodrzÏeny prÏõÂslusÏne eticke zaÂsady, zejmeÂna principy
Helsinske deklarace a souhlas eticke komise. MateriaÂly prÏevzate z jinyÂch
pramenuÊ musõÂ byÂt doplneÏny põÂsemnyÂm souhlasem drzÏitele autorskyÂch
praÂv, ktery svoluje k reprodukci. RedakcÏnõ rada nevyzÏaduje imprimatur vedoucõÂho pracovisÏteÏ. Za uÂrovenÏ sdeÏlenõ odpovõÂdajõ autorÏi. KazÏdy rukopis
prochaÂzõ recenznõÂm rÏõÂzenõÂm, ktere je oboustranneÏ anonymnõ a je provaÂdeÏno
dveÏma na sobeÏ nezaÂvislyÂmi odbornõÂky. Posudek je spolu s naÂvrhy uÂprav
zasõÂlaÂn autorovi k uÂpravaÂm. KonecÏne rozhodnutõ o prÏijetõ cÏlaÂnku k publikaci
a o uÂpraveÏ rukopisu si vyhrazuje redakce. PraÂce mohou byÂt v cÏeskeÂm, slovenskeÂm nebo anglickeÂm jazyce. PrÏeklad do anglickeÂho jazyka zajisÏt'uje redakce. V zaÂjmu zvyÂsÏenõÂ kvality prÏekladu do anglicÏtiny redakce doporucÏuje
speciaÂlnõ anglicke odborne vyÂrazy uveÂst v prÏõÂloze.
Na titulnõ straneÏ se uvaÂdõÂ: naÂzev praÂce, cela jmeÂna autoruÊ vcÏetneÏ tituluÊ,
naÂzev a sõÂdlo pracovisÏteÏ, odkud praÂce vychaÂzõÂ, event. poznaÂmka o prÏõÂpadne prÏedchozõ publikaci ve formeÏ prÏednaÂsÏky.
Souhrn se põÂsÏe na samostatne straÂnce v deÂlce do 15 rÏaÂdek. U experimentaÂlnõÂch pracõ je souhrn strukturovanyÂ. Obsahuje cõÂl praÂce, metody, zaÂveÏry. Souhrn se põÂsÏe ve trÏetõ osobeÏ, slova se nezkracujõÂ. Na zvlaÂsÏtnõÂm rÏaÂdku
se uvaÂdõÂ 2-5 klõÂcÏovyÂch slov.
VlastnõÂ text je u puÊvodnõÂch pracõÂ zpravidla rozdeÏlen na uÂvod, materiaÂl
(nebo soubor) a metodiku, vyÂsledky, diskusi a zaÂveÏr. CÏleneÏnõÂ ostatnõÂch odbornyÂch pracõÂ se rÏõÂdõÂ povahou sdeÏlenõÂ.
Literatura: citace se rÏadõ a cÏõÂslujõ podle porÏadõ vyÂskytu v textu. PorÏadove cÏõÂslo citace se v textu uvaÂdõ v hranatyÂch zaÂvorkaÂch, naprÏ. [1]. Cituje
se podle CÏSN ISO 690 ¹Bibliograficke citaceª a CÏSN ISO 4 ¹Pravidla zkracovaÂnõ slov z naÂzvuÊ a naÂzvuÊ dokumentuʪ, s prÏihleÂdnutõÂm k PrÏõÂloze k CÏSN 01
0196 ¹Seznam zkratek... v naÂzvech periodikª. PrÏõÂklady typuÊ citacõÂ:
a) citace jednosvazkoveÂho dõÂla:
1. Proffit, W.R.; Fields, H.W.: Contemporary orthodontics. 2nd ed., St.
Louis: Mosby, 1993.
b) citace prÏÂõspeÏvku ze sbornõÂku nebo monografie:
2. Bittner, J.; Vacek, M.: Esteticke aspekty v protetice. In: Urban, F. (ed.):
Pokroky ve stomatologii. Praha: Avicenum, 1980.
c) citace cÏlaÂnku:
3. Andrews, L.F.: The six keys to normal occlusion. Amer. J. Orthodont.
1972, 62, cÏ.3, s.296-309.
Zkratky naÂzvuÊ nejcÏasteÏji citovanyÂch ortodontickyÂch a stomatologickyÂch cÏasopisuÊ jsou uvedeny v Tab.1. Za literaturou se uvaÂdõÂ jmeÂno a kontaktnõÂ adresa prvnõÂho autora.
PrÏõÂlohy. ObraÂzky (grafy, scheÂmata, fotografie) a tabulky se prÏiklaÂdajõÂ
volneÏ k rukopisu, kazÏda prÏõÂloha zvlaÂsÏt'. Legenda k tabulce se uvaÂdõ nad tabulkou, vysveÏtlivky pod tabulkou. Legenda k ostatnõ dokumentaci se prÏiklaÂda na zvlaÂsÏtnõÂm listeÏ. MõÂsto, kam se ma prÏõÂloha v textu umõÂstit, je mozÏno
oznacÏit na okraji straÂnky cÏtverecÏkem s cÏõÂslem prÏõÂlohy. Orientaci obraÂzkuÊ je
vhodne vyznacÏit na rubu sÏipkou. ObraÂzky musõ byÂt upraveny tak, aby se
The objective of the journal ORTODONCIE is to give the Czech Orthodontic Society members and other orthodontists and dentists information
on the activities within the scientific society, on research and developments in orthodontics and related subjects, bring study materials for the
postgraduate studies and continuing education of the specialists in orthodontics, provide information on research and training courses. The journal
is published in the Czech language, however, original articles are published
in Czech/Slovak and in English.
Articles may be divided into the following columns:
1) News, society.
2) News from the Council of the Czech Orthodontic Society.
3) Featured topics in orthodontics (reports on the recent scientific and training activities, reports from congresses and study stays.
4) Discussion and critical rubric, letters to editor.
5) Scientific articles (original works, reviews of the literature, preliminary
reports, case reports).
6) Abstracts from foreign journals.
7) Reviews (books and postgraduate theses).
8) Information.
Works should be submitted printed in A4 format hard copy and in electronic form (CD) using a common text editor (MS Word). The text should follow the new rules of Czech or Slovak spelling and the US English spelling
standard. Pictures must be saved in a JPG format min. 250-300 dpi. Tables, graphs and text in pictures are in English language. Works once sent
to the editorial board cannot be changed or amended.
Requirements for scientific papers. The editorial board receives the
works which were not and will be not sent to another journal, are professionally
correct and have the appropriate level of methodology and statistical elaboration. To publish the results of clinical and experimental (tests on animals) research requires that the principles of ethics (especially Helsinki declaration)
be followed and the Board of Ethics agreement be given. Materials from other
sources must be supplemented with the written statement of the copyright
owner giving the agreement with reprint. The editorial board does not ask for
the imprimatur by the head of the department. Authors are responsible for the
standard of their work. Each manuscript is subjected to the double-blind peer
review process. Two independent reviewers do not know the identity of authors
and authors do not know the identity of reviewers. The reviews with the comments are sent to authors for the requested changes. The editorial board makes
a final decision on the acceptance of the manuscript and on its revision. Texts
may be written in Czech, Slovak or English. Translations into English are the responsibility of the editors. To improve the quality of English translations the editors recommend to attach to a text the special English terminology.
The title page includes: title of the work, full names of the authors and
their academic degrees, name and seat of the department, note on the previous publishing of the work in the form of a lecture.
Summary is written on a separate page and should not exceed 15 lines. The abstract should be structured in experimental studies. It includes:
objectives, methods, results and conclusions. Summary is written in the
3rd person sg, no abbreviations should be used. Key-Words (2-5) are given
on a separate line.
The original work text body is usually divided into introduction, material
(or samples), methods, results, discussion and conclusions. In other cases
this depends on the character of a publication.
Bibliography: works cited are listed and numbered according to their
occurrence in the text. Ordinal number of the work cited is given in square
brackets, e.g. [1]. The norm to follow is CÏSN ISO 690 ¹Bibliograficke citaceª
and CÏSN ISO 4 ¹Pravidla zkracovaÂnõ slov z naÂzvuÊ a naÂzvuÊ dokumentuʪ, with
regard to Appendix to CÏSN 01 0196 ¹Seznam zkratek... v naÂzvech periodikª. Examples of citations:
a) one-volume work:
1. Proffit, W.R.; Fields, H.W.: Contemporary orthodontics. 2nd ed., St.
Louis: Mosby, 1993.
b) paper from collections of work or monography:
2. Bittner, J.; Vacek, M.: Esteticke aspekty v protetice. In: Urban, F. (ed.):
Pokroky ve stomatologii. Praha: Avicenum, 1980.
c) article:
3. Andrews, L.F.: The six keys to normal occlusion. Amer. J. Orthodont.
1972, 62, No.3, p.296-309.
The abbreviations of the most frequent orthodontic and dental journals
are given in Table 1. Under Bibliography the name and mailing (contact)
address of the first author is given.
Appendices. Pictures (diagrams, schemes, photos) and tables are enclosed free to the text, each appendix separately. Keys are written above the table,
explanatory notes below. Notes dealing with other documentation are enclo-
www.orthodont-cz.cz e-mail: [email protected]
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ZpraÂvy z vyÂboru
daly reprodukovat (zvl. nesmõÂ po zmensÏenõÂ velikost põÂsma klesnout pod 2
mm). Tabulky jsou prÏilozÏeny ve formaÂtu Word, grafy ve formaÂtu Excel v originaÂlnõÂ verzi vcÏetneÏ vyÂchozõÂch tabulek a automatickeÂho propojenõÂ. ZasõÂlaÂnõÂ
obraÂzkuÊ a grafuÊ v editoru Word nebo Power Point je neprÏõÂpustneÂ. Fotografie a rentgenove snõÂmky na CD musõ byÂt ulozÏeny ve formaÂtu JPG ve formaÂtu
min. 250-300 dpi. Fotografie oblicÏeje pacienta musõÂ mõÂt souhlas zobrazeneÂ
osoby se zverÏejneÏnõÂm, v opacÏneÂm prÏõÂpadeÏ bude redakce nucena upravovat (maskovat) fotografie tak, aby se znemozÏnila identifikace. Pacienti nesmõÂ byÂt oznacÏovaÂni jmeÂny nebo iniciaÂlami, ale pouze porÏadovyÂmi cÏõÂsly.
V pruÊvodnõÂm dopise k odborne praÂci prvnõ autor stvrdõ svyÂm podpisem, zÏe:
± se jedna o jejich vlastnõ puÊvodnõ praÂci;
± praÂce soucÏasneÏ nebyla a nebude nabõÂdnuta jineÂmu periodiku;
± zÏe autorÏi nemajõ komercÏnõÂ, vlastnicke nebo financÏnõ zaÂjmy na produktech
nebo spolecÏnostech popsanyÂch v tomto cÏlaÂnku;
a daÂle, v prÏÂõpadeÏ potrÏeby, zÏe:
± klinicke nebo experimentaÂlnõ zkousÏky na lidech cÏi zvõÂrÏatech dodrzÏujõ prÏõÂslusÏne eticke zaÂsady a majõ souhlas eticke komise;
± autorÏi majõÂ souhlas jineÂho drzÏitele autorskyÂch praÂv k reprodukci obraÂzkuÊ
a jineÂho prÏevzateÂho materiaÂlu;
± autorÏi majõÂ souhlas fotografovaneÂho pacienta se zobrazenõÂm oblicÏeje.
V pruÊvodnõÂm dopise je daÂle trÏeba uveÂst kontaktnõÂ adresu prvnõÂho autora, telefonnõÂ cÏõÂslo a e-mail. K dopisu je trÏeba prÏilozÏit fotografie autoruÊ
v elektronicke formeÏ (jpg nebo tiff) nebo ve fyzicke podobeÏ, oznacÏene na
rubu celyÂm jmeÂnem.
Rukopis bude posouzen odbornyÂmi recenzenty redakcÏnõÂ rady. PraÂce
nevyhovujõÂcõ po obsahove nebo formaÂlnõ straÂnce budou vraÂceny autoruÊm
k prÏepracovaÂnõÂ. PraÂce prÏijate k publikovaÂnõ budou zaslaÂny na kontaktnõ adresu autoruÊ ke korekturÏe. Autorska korektura slouzÏõ pouze k opraveÏ tiskovyÂch chyb, nelze prÏi nõ text obsahoveÏ meÏnit nebo doplnÏovat. ProvaÂdõ se pomocõ zavedenyÂch korekturnõÂch znameÂnek (CÏSN 88 04 10) nebo elektronicky. Korektury je trÏeba vraÂtit obratem, jinak si redakce vyhrazuje praÂvo
vydat text bez autorizace. Zaslana dokumentace se vracõ jen po dohodeÏ.
UverÏejneÏna praÂce se staÂva majetkem cÏasopisu Ortodoncie. PrÏetisknout jejõÂ
cÏaÂst nebo pouzÏõÂt obraÂzku v jine publikaci lze jen s citacõ puÊvodu.
Adresa ke korespondenci:
Redakce cÏasopisu Ortodoncie, Doc. MUDr. M. SÏpidlen, Ph.D., klinika zubnõÂho leÂkarÏstvõÂ, PalackeÂho 12, 772 00 Olomouc. Tel.: +420 585 859 229.
E-mail: [email protected]
CÏeska a anglicka verze PokynuÊ pro autory je uverÏejneÏna na internetovyÂch straÂnkaÂch vydavatele: www.orthodont-cz.cz.
ORTODONCIE
sed and written on a separate sheet. The place where to put the appendix within
the text may be designated with a square and the number of appendix on the
margin. The picture orientation should be marked at the back with an arrow.
Pictures must allow copying (characters size must not be less than 2 mm). Tables should be saved in a Word format, graphs in MS Excel in original version
including basic tables. Do not send pictures or graphs in text editor Word or Power Point format. Pictures and X-rays should be saved in a JPG format min.
250-300 dpi. The photographs showing a patientÂs face must be accompanied
with a written statement by the patient expressing the agreement with publication. If such a statement is missing the editors will adapt (mask) the pic to make
the identification of a person impossible. No names should be used, no initial
letters of patients' names - just ordinal numbers.
Accompanying letter will include the signed statement by the author
expressing:
± that the submitted text is their own original work;
± that the work has not been and will not be submitted to another periodical;
± the authors have no comercial, proprietary, or financial interests in the
products or companies described in this article;
in some cases also:
± that the clinical or experimental testings on humans or animals follow the
principles of ethical codex and were done with the agreement of the
Board of Ethics;
± that the authors were given agreement of the copyright owner to reprint
a certain material;
± that the authors were given agreement of the patient to publish a pic of
his/her face.
The letter should further include the contact address of the first author,
phone number(s) and e-mail address. Enclosed should be found photographs of the authors with their names written at the back or in the electronic
form in JPG format.
The submitted text will be reviewed by the reviewers of the editorial
board. Works which do not meet the requirements (content or formal
aspects) will be sent back to the authors for revision. Works accepted will
be sent to the authors for correction (proof-reading) - only the misprints can
be corrected, not the text contents or its parts. Official press reader's marks
must be used (CÏSN 88 04 10). Electronic way of proofreading is possible.
The corrected text must be sent back immediately otherwise it will be published without authorization. Sent items are given back only upon a prior
agreement. The published work becomes the property of the journal
ORTODONCIE. If it is to be reprinted (a part of the work or a picture) in another publication the original publisher must be cited.
Address for correspondence:
Redakce cÏasopisu Ortodoncie, Doc. MUDr. M. SÏpidlen, Ph.D., klinika zubnõÂho leÂkarÏstvõÂ, PalackeÂho 12, 772 00 Olomouc. Tel.: +420 585 859 229.
E-mail: [email protected]
The versions of the Guidelines for Author in Czech and English are available on the publisher`s webside: www.orthodont-cz.cz.
Tab. 1. Zkratky naÂzvuÊ nejcÏasteÏji citovanyÂch ortodontickyÂch a stomatologickyÂch cÏastopisuÊ (CÏSN 01 0196)
Table 1: Abbreviations of the most frequently cited orthodontic and dental journals (in accordance with CÏSN 01 0196)
American journal of orthodontics
Amer. J. Orthodont.
American journal of orthodontics and dentofacial orthopedics
Amer. J. Orthodont. dentofacial Orthop.
American journal of physical anthropology
Amer. J. phys. Anthropol.
Angle orthodontist
Angle Orthodont.
British journal of orthodontics
Brit. J. Orthodont.
CÏeska stomatologie
Ces. Stomat.
CÏeskoslovenska stomatologie
Cs. Stomat.
European journal of orthodontics
Eur. J. Orthodont.
Fortschritte der Kieferorthopedie
Fortschr. Kieferorthop.
International journal of adult orthodontics and orthognathic surgery
Int. J. adult Orthodont. orthognathic Surg.
Journal of clinical orthodontics
J. clin. Orthodont.
Journal of prosthetic dentistry
J. prosthet. Dent.
Journal of the American Dental Association
J. Amer. dent. Assoc.
Journal of clinical periodontology
J. clin. Periodont.
Journal of cranio-maxillo-facial surgery
J. craniomaxillofacial Surg.
Journal of oral surgery
J. oral Surg.
Journal of oral and maxillofacial surgery
J. oral maxillofacial Surg.
Journal of orthodontics
J. Orthodont.
Journal of periodontology
J. Periodont.
Ortodoncie
Ortodoncie
Prakticke zubnõ leÂkarÏstvõÂ
Prakt. zubnõÂ LeÂk.
Seminars in orthodontics
Semin. Orthodont.
World journal of orthodontics
World. J. Orthodont.
196
www.orthodont-cz.cz e-mail: [email protected]
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ZajõÂmavosti v ortodoncii
ORTODONCIE
Kongres v srdci Olomouce
Jako je jizÏ kraÂsnyÂm zvykem, i letos jsme se sesÏli u prÏõÂlezÏitosti kongresu CÏeske ortodonticke spolecÏnosti.
TentokraÂt se akce konala ve dnech 18. - 20. 9. 2014
v centru malebne Olomouce. O jejõÂm uÂspeÏchu bezesporu sveÏdcÏõ i rekordnõ pocÏet uÂcÏastnõÂkuÊ.
JizÏ slavnostnõÂ zahaÂjenõÂ kongresu napovõÂdalo, zÏe naÂs
cÏeka neobycÏejny zaÂzÏitek a to jak na poli odborneÂm, tak
po straÂnce spolecÏenskeÂ. BeÏhem trÏõÂ prÏednaÂsÏkovyÂch dnõÂ
mohli uÂcÏastnõÂci ve trÏech sekcõÂch vyslechnout 25 zajõÂmavyÂch odbornyÂch sdeÏlenõÂ a shleÂdnout dveÏ desõÂtky
posteruÊ.
V programu jsme mohli najõÂt veÏhlasna jmeÂna zahranicÏnõÂch prÏednaÂsÏejõÂcõÂch z ruÊznyÂch zemõ sveÏta, ale i rÏadu
kvalitnõÂch tuzemskyÂch lektoruÊ. JednõÂm z nejzvucÏneÏjsÏõÂch jmen kongresu bylo jmeÂno Vincenta Kokiche jr.,
ktery naÂs provedl celyÂm prvnõÂm prÏednaÂsÏkovyÂm dnem.
Jeho prÏednaÂsÏky obsahovaly nescÏetneÏ zajõÂmavyÂch
a prÏõÂnosnyÂch informacõÂ. Prof. Vincent Kokich jr. je nejen
vyÂznamnyÂm odbornõÂkem na poli sveÏtove ortodoncie,
ale take velmi milyÂm a skromnyÂm cÏloveÏkem. DalsÏõÂm
duÊlezÏityÂm okamzÏikem olomouckeÂho kongresu bylo
udeÏlenõ cÏestneÂho cÏlenstvõ v CÏeske ortodonticke spolecÏnosti prof. Milanu KamõÂnkovi, ktery vystoupil s prÏednaÂsÏkou, jezÏ prÏedevsÏõÂm naÂm, mladyÂm leÂkarÏuÊm, otevrÏela
pohled do historie ortodoncie v CÏeske republice a na
Slovensku. Za tuto prÏednaÂsÏku velmi deÏkujeme, jelikozÏ
je vzÏdy dobre veÏdeÏt, kde jsou nasÏe korÏeny. V dalsÏõÂm cÏasoveÂm prostoru se vystrÏõÂdala rÏada zkusÏenyÂch prÏednaÂsÏejõÂcõÂch i mladsÏõÂch koleguÊ. UÂrovenÏ vsÏech sdeÏlenõ byla
na vysoke uÂrovni a z odborne cÏaÂsti jsme si odnesli
mnoho novyÂch informacõÂ, ktere jisteÏ uplatnõÂme v praxi.
ZajõÂmava byla i prÏidruzÏena vyÂstava firem, kde jsme
meÏli mozÏnost videÏt nejruÊzneÏjsÏõ nove ortodonticke materiaÂly, pocÏõÂtacÏove technologie nebo pomuÊcky pro
uÂstnõÂ hygienu. VsÏem vystavovateluÊm deÏkujeme.
ZlatyÂm hrÏebem kongresu byl bezesporu prezidentsky vecÏer porÏaÂdany v nove budoveÏ PrÏõÂrodoveÏdecke fakulty PalackeÂho Univerzity. V raÂmci prezidentskeÂho
198
vecÏera byly udõÂleny ceny za nejlepsÏõÂ poster, postgraduantskou prÏednaÂsÏku a atestacÏnõÂ praÂci. VsÏem võÂteÏzuÊm
srdecÏneÏ blahoprÏejeme. TeÂmaticky vecÏer prÏesveÏdcÏil, zÏe
veÏtsÏina koleguÊ ma dobry smysl pro humor a dokonce
se nebojõÂ si udeÏlat sami ze sebe legraci. DuÊkazem toho
byla rÏada leÂkarÏuÊ, kterÏõÂ prÏekvapili nejen nevsÏednõÂmi kostyÂmy, ale i tanecÏnõÂmi kreacemi a poÂzovaÂnõÂm pro objektiv fotoaparaÂtu.
I letosÏnõÂ kongres meÏ prÏesveÏdcÏil o tom, zÏe podobneÂ
akce jsou skveÏlou prÏõÂlezÏitostõ k zõÂskaÂnõ novyÂch odbornyÂch poznatkuÊ, ale nemeÂneÏ duÊlezÏita je i spolecÏenskaÂ
straÂnka. MaÂme dõÂky nim totizÏ mozÏnost se setkat s kolegy, diskutovat nad spolecÏnou problematikou a utuzÏit
prÏaÂtelstvõÂ. Proto deÏkuji za kazÏde podobne setkaÂnõÂ.
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
ZajõÂmavosti v ortodoncii
Na tomto mõÂsteÏ bych chteÏla podeÏkovat vsÏem organizaÂtoruÊm, kterÏõ se na prÏõÂpraveÏ teÂto rozsaÂhle akce podõÂleli, prÏedevsÏõÂm vsÏak prezidentovi kongresu MUDr. Ivo
Markovi. Take bych raÂda podeÏkovala zaÂstupcuÊm firem
za prezentaci sortimentu. PodeÏkovaÂnõ patrÏõ take firmeÏ
Guarant a kolektivu NH Hotelu, kterÏõ vytvorÏili skveÏle zaÂzemõÂ, jezÏ zprÏõÂjemnilo cely pruÊbeÏh kongresu. DeÏkujeme
tedy vsÏem, dõÂky kteryÂm jsme se mohli zuÂcÏastnit teÂto
nad mõÂru povedene akce a budeme doufat, zÏe se v podobneÏ hojneÂm pocÏtu sejdeme i na dalsÏõÂm kongresu CÏOS
v Hradci KraÂloveÂ. Ja osobneÏ se jizÏ velmi teÏsÏõÂm.
MDDr. KarolõÂna FlorykovaÂ
rocÏnõÂk 23
cÏ. 4. 2014
veÂho sÏvu a lze jej pouzÏõÂt jako alternativu u pacientuÊ odmõÂtajõÂcõÂch extraoraÂlnõÂ kotevnõÂ systeÂmy. DõÂky zdarÏilyÂm
kazuistikaÂm jsme byli seznaÂmeni s leÂcÏebnyÂm protokolem, ktery Dr. Hettige vypracoval na zaÂkladeÏ svyÂch neÏkolikaletyÂch zkusÏenostõÂ, uÂspeÏchuÊ i nezdaruÊ, ktere spocÏõÂvaly prÏedevsÏõÂm v selhaÂnõ minisÏroubuÊ. PraÂveÏ dvojice
minisÏroubuÊ je zaÂkladnõÂm kamenem systeÂmu a na jejõÂm
prÏesneÂm umõÂsteÏnõ zaÂvisõ uÂspeÏsÏna terapie. IdeaÂlnõ lokalizacõ je strÏed spojnice prvnõÂch hornõÂch premolaÂruÊ, kde
se anatomicky nachaÂzõ dostatecÏneÏ sÏiroka a kvalitnõÂ
kost a tenka patrova sliznice. Pokud budou minisÏrouby
umõÂsteÏny prÏed touto spojnicõÂ, hrozõÂ prÏi jejich zavaÂdeÏnõÂ
kolize minisÏroubu s korÏeny rÏezaÂkuÊ. V pruÊbeÏhu leÂcÏby
pak vznikajõ nevyÂhodne prostorove podmõÂnky pro retruzi protrudovanyÂch hornõÂch rÏezaÂkuÊ. Oba minisÏrouby
by meÏly byÂt zavedeny v sagitaÂlnõÂ rovineÏ co nejvõÂce paralelneÏ. Jejich optimaÂlnõÂ vzdaÂlenost je 5 milimetruÊ.
Vzhledem k teÏmto specifickyÂm podmõÂnkaÂm umõÂsteÏnõÂ
bylo doporucÏeno zavaÂdeÏnõÂ minisÏroubuÊ ortodontistou
(nejleÂpe rucÏneÏ) a nedelegovat tento klõÂcÏovy vyÂkon do
rukou chirurga.
SysteÂm ¹Benefitª
V raÂmci pravidelnyÂch vzdeÏlaÂvacõÂch seminaÂrÏuÊ ortodontickeÂho oddeÏlenõ stomatologicke kliniky FakultnõÂ
nemocnice KraÂlovske Vinohrady 3. leÂkarÏske fakulty
Univerzity Karlovy v Praze jsme se dne 24. 6. seznaÂmili
se zajõÂmavou ortodontickou problematikou.
Jako prÏednaÂsÏejõÂcõ naÂs navsÏtõÂvil Dr. Sunil Hettige z AustraÂlie. V raÂmci sve prÏednaÂsÏkove cesty do Evropy, kde
prÏednaÂsÏel naprÏõÂklad na setkaÂnõÂ
ortodontistuÊ v DuÈsseldorfu,
zavõÂtal i na vinohradskou kliniku na zaÂkladeÏ pozvaÂnõÂ MDDr.
MaÂji KonvalinkoveÂ, ktera v jeho
praxi nedaleko Brisbane absolvovala v lonÏskeÂm roce trÏõÂtyÂdennõ staÂzÏ. PrÏedstavil naÂm leÂcÏebny systeÂm Benefit, pochaÂzejõÂcõ od prof. Dr. Benedicta Wilmese, praÂveÏ
z ortodontickeÂho oddeÏlenõÂ univerzity v DuÈsseldorfu.
SysteÂm ªBenefitª slouzÏõÂ k distalizaci molaÂruÊ v hornõÂ
cÏelisti pomocõÂ skeletaÂlnõÂho kotvenõÂ palatinaÂlnõÂho
trÏmene k dvojici minisÏroubuÊ umõÂsteÏnyÂch v mõÂsteÏ patrowww.orthodont-cz.cz e-mail: [email protected]
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Ve druhe cÏaÂsti seminaÂrÏe naÂs
provedl slozÏitou problematiku
biomechaniky ortodontickyÂch
aparaÂtuÊ MUDr. JirÏõÂ Tvardek,
Ph. D., odbornõÂk veÏnujõÂcõ se tomuto teÂmatu jizÏ rÏadu let. V soucÏasne dobeÏ puÊsobõ v praxi
v HustopecÏõÂch u Brna a na nasÏem oddeÏlenõÂ uzÏ v minulosti
neÏkolikraÂt trpeÏliveÏ prÏednaÂsÏel.
Po uÂvodu do biomechaniky
a uprÏesneÏnõÂ terminologie se
ponorÏil do veÏcÏneÂho teÂmatu center rotace/resistence,
momentu sõÂly a torze, typu pohybuÊ zubu od kontrolovaneÂho sklonu, nekontrolovaneÂho sklonu, ªbodilyª pohybu azÏ po torznõÂ pohyb. DõÂky teÏmto zaÂkladuÊm jsme si
zopakovali naprÏõÂklad obecnou mechaniku V-ohybu
a dalsÏõÂch. VeÏnovali jsme se mechanice puÊsobenõÂ jednotlivyÂch typuÊ klicÏek a jejich praktickeÂmu vyuzÏitõÂ. Stra199
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ZajõÂmavosti v ortodoncii
ORTODONCIE
nou nezuÊstala ani mechanika obloukuÊ - nivelizacÏnõÂch,
extruznõÂch, intruznõÂch, ¹AntiSpeeª, Utility, retrakcÏnõÂch
nebo torznõÂch. ProtozÏe byl cÏasto doporucÏovanyÂm materiaÂlem uvaÂdeÏn TMA, byla na konkreÂtnõÂch prÏõÂkladech
demonstrovaÂna preaktivacÏnõÂ uÂprava danyÂch typuÊ klicÏek a obloukuÊ.
ObeÏma nezisÏtnyÂm prÏednaÂsÏejõÂcõÂm patrÏõ velky dõÂk ze
strany uÂcÏastnõÂkuÊ seminaÂrÏe, leÂkarÏuÊ v prÏedatestacÏnõ prÏõÂpraveÏ i ze strany vedenõ oddeÏlenõ ortodoncie a rozsÏteÏpovyÂch vad Fakultnõ nemocnice KraÂlovske Vinohrady
3. leÂkarÏske fakulty Univerzity Karlovy v Praze.
MDDr. Martin Linka
MUDr. Magdalena Kot'ovaÂ, Ph.D.
skupiny renomovanyÂch odbornõÂkov na niektoryÂch univerzitaÂch, ktere vede Assistent Professor Dr. Antoinin Secci
z PensylvaÂnskej Univerzity.
Tento systeÂm sa uzÏ stal suÂcÏast'ou vyÂuky na niekol'kyÂch univerzitaÂch vo svete.
CCO - Complete Clinical
Orthodontics - PokrocÏilaÂ
straight wire mechanika
a estetika
Dr. Jullia Garcia - Baeza je Diplomate of the American
Board of Orthodontics a cÏlenka SÏpanielskej Ortodontickej SpolocÏnosti. DMD dostala na Universidad Europea
de Madrid, diplom v ortodoncii a Master of Science
v oraÂlnej bioloÂgii na University of Pennsylvania.
V dnÏoch 24.-25. oktoÂbra naÂm v KosÏiciach predstavila filozofiu CCO a podrobne jednu jej jednu cÏast', mechanicke poÃsobenie systeÂmu. CCO je tõÂmova praÂca
Dr. Baeza najprv zodpovedala otaÂzku, cÏi je voÃbec potrebna d'alsÏia preskripcia. LaboratoÂrnymi meraniami ako aj klinickyÂm vyÂskumom
bolo preukaÂzaneÂ, zÏe nie je vhodne automaticky preniest' existujuÂce preskripcie z konvencÏnyÂch do aktõÂvnych samoligovacõÂch zaÂmkov. Tie si v poslednom cÏase
zõÂskali vel'ku popularitu, nakol'ko poskytuju vyÂhodu nõÂ-
1. NivelizaÂcia a vyrovnanie obluÂkov (Sentalloy .014ª, BioForce .020 x .020ª)
2. Pracovna faÂza (Ocel' .019 x .025ª)
3. Finishing, kontrola rezaÂkoveÂho a lateraÂlneho vedenia.
(Multibraid .019 x .025ª)
Foto z archivu Dr. Jullie Garcia - Baeza, uverÏejneÏne s jejõÂm laskavyÂm souhlasem.
200
www.orthodont-cz.cz e-mail: [email protected]
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rocÏnõÂk 23
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ZajõÂmavosti v ortodoncii
zkej frikcie v pocÏiatocÏnyÂch faÂzach liecÏby a zaÂrovenÏ
vd'aka aktõÂvnemu klipu su pri pouzÏitõ hranatyÂch obluÂkov
schopne priviest' geometriu zakomponovanu do zaÂmkov do plneÂho prejavu. Bolo potrebne vraÂtit' sa k definõÂcii spraÂvnej anatomickej a funkcÏnej okluÂzie, preniest'
tieto hodnoty do geometrie zaÂmkov a odstraÂnit' roÃzne
korekcie, ktore vniesli jednotlivõ autori preskripciõ kvoÃli
voÃli medzi droÃtom a slotom u klasickyÂch, alebo pasõÂvnych samoligovacõÂch zaÂmkov.
Ale CCO nie je len preskripcia. Je to uceleny systeÂm
biomechanickyÂch postupov integrujuÂci a vyuzÏõÂvajuÂci
najnovsÏie technologicke mozÏnosti. TaÂto filozofia kombinujuÂca vyÂhody straight-wire, aktõÂvnych samoligovacõÂch
zaÂmkov a termoaktõÂvnych droÃtov ma za ciel'ul'ahcÏit' a maximaÂlne zefektõÂvnit' ortodonticku liecÏbu. SysteÂm CCO
(Complete Clinical Orthodontics) je postaveny na 3 pilieroch, ktoryÂmi suÂ:
1. Kvalita vyÂsledku liecÏby
2. Konzistencia
3. Efektivita
www.orthodont-cz.cz e-mail: [email protected]
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PocÏas takmer dvojdnÏoveÂho kurzu sme sa mali mozÏnost' podrobne oboznaÂmit' s jednotlivyÂmi postupmi od
lepenia zaÂmkov azÏ po vyÂsledok liecÏby. PrednaÂsÏajuÂca
demosÏtrovala techniku na mnozÏstve klinickyÂch prõÂkladov a prebrala s nami biomechanicke princõÂpy, ktoreÂ
prehl'adne rozdelila do faÂz, tak ako ich poznaÂme:
1. NivelizaÂcia a vyrovnanie obluÂkov (Sentalloy .014ª,
BioForce .020 x .020ª)
2. Pracovna faÂza (Ocel' .019 x .025ª)
3. Finishing, kontrola rezaÂkoveÂho a lateraÂlneho vedenia. (Multibraid .019 x .025ª)
O tom, zÏe teÂma vyvolala zaÂujem u uÂcÏasnõÂkov kurzu,
svedcÏilo aj mnozÏstvo otaÂzok, ktoryÂmi sme Dr. Julliu
Garciu zahrnuli.
Prekvapila naÂs jej snaha o dokonalost', odovzdanie
sa svojej praÂci a uÂprimnost' - hovorõÂ, cÏo robõÂ a zÏije
tyÂm, cÏo robõÂ.
DÏakujeme.
MUDr. Jana SurovkovaÂ
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rocÏnõÂk 23
cÏ. 4. 2014
DentaÂlnõÂ hygiena u ortodontickyÂch pacientuÊ
Dental hygiene in orthodontic patients
*MDDr. KarolõÂna FlorykovaÂ, *Doc. MUDr. PavlõÂna CÏernochovaÂ, Ph.D., **Mgr. KaterÏina LangovaÂ, Ph.D.
* Ortodonticke oddeÏlenõÂ, Stomatologicka klinika FN u Sv. Anny a LF MU v BrneÏ
* Department of Orthodontics, Clinic of Stomatology, University Hospital of St.Anne, Masaryk University Brno
** UÂstav leÂkarÏske biofyziky, LF UP Olomouc
** Department of Medical Biophysics, Medical Faculty, Palacky University in Olomouc
Souhrn
CõÂl praÂce: CõÂlem praÂce bylo zjistit, s jakou uÂrovnõÂ dentaÂlnõÂ hygieny prÏichaÂzejõÂ do ortodontickyÂch ordinacõÂ pacienti odesõÂlanõÂ od praktickyÂch zubnõÂch leÂkarÏuÊ.
MateriaÂl a metodika: Soubor 98 pacientuÊ byl osloven formou dvou dotaznõÂkuÊ, prvnõ dotaznõÂk pacienti vyplnÏovali prÏed nasazenõÂm fixnõÂho ortodontickeÂho aparaÂtu a druhy v pruÊbeÏhu leÂcÏby. Pacienti take absolvovali hygienickeÂ
vysÏetrÏenõÂ a instruktaÂzÏ s kontrolami.
VyÂsledky: Podle vyÂsledkuÊ meÏrÏenõ indexuÊ (PBI, API, QHI) bylo konstatovaÂno, zÏe znacÏna cÏaÂst pacientuÊ prÏichaÂzejõÂcõÂch od praktickyÂch zubnõÂch leÂkarÏuÊ, nema dostatecÏnou uÂrovenÏ dentaÂlnõ hygieny. 72 % dotaÂzanyÂch nikdy neabsolvovalo hygienickou instruktaÂzÏ, prÏestozÏe 97 % z nich by o toto sÏkolenõ meÏlo zaÂjem. V dotaznõÂku vsÏichni pacienti uvaÂdõÂ, zÏe si na naÂmi doporucÏene pomuÊcky zvykli dobrÏe, techniku si neosvojil pouze jeden pacient. 99 %
pacientuÊ pocõÂtilo po instruktaÂzÏi pozitivnõÂ zmeÏnu. Pouze 12 % dotaÂzanyÂch meÏlo s cÏisÏteÏnõÂm fixnõÂho aparaÂtu probleÂmy.
ZaÂveÏr: Pacienti odesõÂlanõ od praktickyÂch zubnõÂch leÂkarÏuÊ cÏasto nejsou po straÂnce uÂstnõ hygieny dostatecÏneÏ prÏipraveni. Proto je nutne zajistit hygienickou instruktaÂzÏ prÏed zahaÂjenõÂm ortodonticke leÂcÏby. Po prakticke instruktaÂzÏi
se uÂrovenÏ dentaÂlnõÂ hygieny pacientuÊ lepsÏÂõ (Ortodoncie 2014, 23, cÏ. 4, s. 203-210).
Abstract
Aims: The study purpose was to determine the level of dental hygiene in orthodontic patients sent by dentists.
Material and methods: The sample of 98 patients replied to two questionnaires: the first questionnaire was
filled in before the adjustment of orthodontic appliance, the second one was filled in during the orthodontic treatment. The patients underwent examination of their oral hygiene, and they were instructed how to maintain hygiene.
Results: The results of index analyses (PBI, API, QHI) suggest that most patients coming from dentists lack the
sufficient level of dental hygiene. 72% of the patients included in the study stated that they never underwent instruction in hygiene maintaining, in spite of the fact that 97% of them would like to be educated about the effects.
In the questionnaire all patients stated that they got used to the recommended equipment very well, only one patient did not learn the technique. 99% of patients reported positive changes after the instruction. Only 12% of
patients had problems with cleaning of the fixed appliance.
Conclusion: Often the patients coming from their general dentists are not sufficiently prepared with regard to
oral hygiene. Therefore it is necessary to secure the instruction in dental hygiene before the orthodontic treatment. After practical instruction the level of dental hygiene increases (Ortodoncie 2014, 23, No. 4, p. 203-210).
KlõÂcÏova slova: dentaÂlnõ hygiena, dentaÂlnõ pomuÊcky, zubnõ plak, white spots leÂze, gingivitis
Key-words: dental hygiene, dental equipment, dental biofilm, white spots lesion, gingivitis
www.orthodont-cz.cz e-mail: [email protected]
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UÂvod
ORTODONCIE
Introduction
Vysoka uÂrovenÏ uÂstnõ hygieny beÏhem ortodontickeÂ
leÂcÏby je zaÂkladnõÂm prÏedpokladem pro jejõ uÂspeÏsÏny vyÂsledek. DodrzÏovaÂnõ uÂstnõ hygieny je pro pacienty s fixnõÂm aparaÂtem naÂrocÏneÏjsÏõÂ. KrejcÏõÂrÏova [1] uvaÂdõÂ, zÏe hygienicka nebo iniciaÂlnõ faÂze u pacientuÊ zarÏazenyÂch do
ortodonticke peÂcÏe by meÏla zacÏõÂt uzÏ neÏkolik meÏsõÂcuÊ
prÏed prvnõÂ fixacõÂ aparaÂtu.
Dle klinickyÂch studiõÂ autoruÊ Liu, H. a kol. [2], Al-Jewair, T. S. a kol. [3] a Baka, Z. M. a kol. [4] bylo zaznamenaÂno zhorsÏenõÂ hygieny a signifikantnõÂ zvyÂsÏenõÂ PlI
(Plaque index) a GI (gingivaÂlnõÂ index) beÏhem prvnõÂch
trÏõÂ meÏsõÂcuÊ po nasazenõÂ fixnõÂho aparaÂtu. Hodnoty indexuÊ se po 6 meÏsõÂcõÂch od nasazenõÂ naopak vyÂrazneÏ
snõÂzÏily.
Studie autoruÊ Kim, S. H. a kol. [5] se zabyÂvala popsaÂnõÂm zmeÏny bakteriaÂlnõÂ mikrofloÂry cÏasneÏ po nasazenõÂ fixnõÂho aparaÂtu a dosÏla k zaÂveÏru, zÏe jizÏ v pocÏaÂtku
ortodonticke leÂcÏby dochaÂzõ k signifikantnõÂmu naÂruÊstu
neÏkteryÂch patogenuÊ, naprÏ. Tannerella forsythia, Campylobactor rectus, Prevotella nigrescens. TuÈrkkahraman a kol. [6] uvaÂdõÂ, zÏe po nasazenõÂ fixnõÂho aparaÂtu
se v dutineÏ uÂstnõÂ zveÏtsÏuje mnozÏstvõÂ Streptococcus mutans a laktobaciluÊ, roste i objem zubnõÂho plaku.
Ticha a kol. [7] uvaÂdeÏjõÂ, zÏe sklovinne demineralizace
jsou zpuÊsobeny nerovnovaÂhou mezi procesem demineralizace a remineralizace prÏi dlouhodobeÂm nedodrzÏovaÂnõÂ adekvaÂtnõÂ uÂstnõÂ hygieny a hromadeÏnõÂ zubnõÂho
mikrobiaÂlnõÂho povlaku na povrchu zubuÊ. VyÂsledkem
jsou tzv. white spot leÂze neboli krÏõÂdove skvrny, ktereÂ
jsou poklaÂdaÂny za prÏedstupenÏ kazuÊ skloviny. Jak zminÏuje Ticha a kol. [7] nejveÏtsÏõ vyÂskyt demineralizacõ byl
nalezen v hornõÂm frontaÂlnõÂm (15 %) a dolnõÂm distaÂlnõÂm
(16 %) uÂseku. NejcÏasteÏji postizÏenyÂmi zuby byÂvajõÂ dle
Gorelicka a kol. [8] hornõÂ rÏezaÂky, prvnõÂ molaÂry a dolnõÂ
premolaÂry. NejcitliveÏjsÏõÂ ke vzniku demineralizacõÂ jsou
dle Geigera a kol. [9] hornõ postrannõ rÏezaÂky. CÏernochova a IzakovicÏova Holla [10] zkoumaly vyÂskyt demineralizacõ skloviny na souboru 106 pacientuÊ po leÂcÏbeÏ
fixnõÂm aparaÂtem a uvaÂdeÏjõÂ, zÏe u 44 pacientuÊ (41,5 %)
dosÏlo k vyÂskytu demineralizace skloviny po ortodonticke leÂcÏbeÏ. Julienova a kol. [11] zjistili beÏhem studie
na 885 pacientech, zÏe u 23,4 % z nich se beÏhem ortodonticke leÂcÏby vytvorÏila alesponÏ jedna bõÂla skvrna.
UvaÂdõ takeÂ, zÏe pohlavõ nema zÏaÂdny signifikantnõ vliv
na vyÂvoj teÏchto leÂzõÂ, na rozdõÂl od fluoroÂzy, leÂcÏby prÏesahujõÂcõ 36 meÏsõÂcuÊ, sÏpatne uÂrovneÏ hygieny prÏed zapocÏetõÂm leÂcÏby, zmeÏn uÂrovneÏ hygieny beÏhem leÂcÏby a jizÏ existujõÂcõÂch leÂzõÂ. DalsÏõ klinicka studie dle Richtera a kol.
[12] uvaÂdõ azÏ 72,9 % pacientuÊ, kteryÂm se beÏhem ortodonticke leÂcÏby vytvorÏila alesponÏ jedna white spot leÂze,
kavitovana leÂze se vytvorÏila 2,3 % pacientuÊ s fixnõÂm
aparaÂtem.
204
The high level of dental hygiene during orthodontic
treatment is the basic prerequisite of the successful result. For patients with fixed appliance the hygiene
maintenance is more difficult. KrejcÏõÂrÏova [1] states that
hygienic or initial phase in patients with planned orthodontic treatment should start as early as several
months before the first adjustment of fixed orthodontic
appliance.
Clinical trials by Liu,H. et al [2], Al-Jewair, T.S. et al
[3], Baka, Z.M. et al [4] reported worsened hygiene
and significant increase of PlI (Plaque Index) and GI
(gingival index) within the first three months after the
adjustment of fixed appliance. On the contrary, the indexes values decreased sharply after six months since
the adjustment.
The study of Kim, S.H. et al [5] focused on the
change in bacterial microflora early after the fixed appliance adjustment, and concluded that at the very beginning of orthodontic treatment there is significant increase in several pathogenes, e.g. Tannerella forsythia, Campylobactor rectus, Prevotella nigrescens.
TuÈrkkahraman et al. [6] reported the increase in the
amount of Streptococcus mutans and lactobacilli as
well as in the amount of dental plaque.
Ticha et al. [7] state that enamel demineralization are
caused by the imbalance between the process of demineralization and remineralization during a long-time
lack of adequate dental hygiene and accumulation of
dental biofilm on teeth surface. This results in the socalled white spot lesions that she considered the first
stage of enamel caries. The greatest occurrence of demineralization was determined in upper front (15%)
and lowers distal (16%) segments [7]. Gorelick et al.
[8] identified upper incisors, first molars and lower premolars as the most frequently affected teeth. According to Geiger et al. [9] upper lateral incisors are the
most vulnerable to demineralization. CÏernochovaÂ
and IzakovicÏova Holla [10] examined enamel demineralization in the sample of 106 patients after the treatment with fixed orthodontic appliance. In 44 patients
(41.5%) enamel demineralization occurred after the
orthodontic treatment. Julien et al. [11] worked with
the sample of 885 patients. They found out that in
23.4% of the patients at least one white spot lesion
was formed during the orthodontic treatment. The authors also concluded that the gender of patients shows
no significant impact on the lesions development, as
opposed to fluorosis, therapy extending 36 months,
bad dental hygiene prior to treatment, change in the level of dental hygiene during the treatment, and already
existing lesions. Another clinical trial by Richter et al.
[12] reported 72.9% of patients with at least one white
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
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DalsÏõ komplikacõ pruÊbeÏhu ortodonticke leÂcÏby pro
naÂs prÏedstavuje zaÂneÏt daÂsnõÂ. SlezaÂk a DrÏõÂzhal [13] uvaÂdeÏjõÂ, zÏe plakem podmõÂneÏna gingivitida je v soucÏasnosti
nejcÏasteÏji vyskytujõÂcõÂ se chronickou bakteriaÂlnõÂ infekcõÂ
v lidske populaci. Vyskytuje se prÏiblizÏneÏ u 90 % jedincuÊ. Z toho vyplyÂvaÂ, zÏe cela rÏada pacientuÊ trpõ zaÂneÏtem daÂsnõ jesÏteÏ prÏed zapocÏetõÂm ortodonticke leÂcÏby.
Abychom se vyhnuli podobnyÂm komplikacõÂm prÏi
leÂcÏbeÏ nasÏich pacientuÊ, je nutne je rÏaÂdneÏ poucÏit o duÊlezÏitosti dodrzÏovaÂnõ uÂstnõ hygieny. NestacÏõ vsÏak slovnõÂ
uÂvod a ukaÂzka na modelu, je trÏeba pacientovi zajistit
praktickou instruktaÂzÏ v uÂstech se vsÏemi potrÏebnyÂmi
pomuÊckami. BeÏhem ortodonticke leÂcÏby doporucÏujeme pouzÏõÂvaÂnõ meÏkkeÂho rucÏnõÂho kartaÂcÏku, poprÏ. jeho
varianty ortodontickeÂho kartaÂcÏku se speciaÂlnõÂm zaÂstrÏihem. Nezbytne je pouzÏõÂvaÂnõ jednosvazkoveÂho kartaÂcÏku a long stem kartaÂcÏkuÊ, dõÂky kteryÂm je cÏisÏteÏnõ velmi
efektivnõÂ. PouzÏõÂvaÂnõÂ mezizubnõÂch kartaÂcÏkuÊ by meÏlo byÂt
samozrÏejmostõ jizÏ prÏed zahaÂjenõÂm ortodonticke leÂcÏby.
Vzhledem k tomu, zÏe v jejõÂm pruÊbeÏhu se meÏnõÂ velikosti
mezizubnõÂch prostor, je potrÏeba kartaÂcÏky opakovaneÏ
kalibrovat. PacientuÊm bychom v prÏõÂpadeÏ nutnosti meÏli
poskytnout opakovane sÏkolenõ uÂstnõ hygieny.
MateriaÂl a metodika
V raÂmci prakticke cÏaÂsti praÂce byl vytvorÏen soubor
respondentuÊ - ortodontickyÂch pacientuÊ. Pacienti byli
sledovaÂni jednak ve faÂzi prÏed zapocÏetõÂm leÂcÏby fixnõÂm
ortodontickyÂm aparaÂtem a teÂzÏ v jejõÂm pruÊbeÏhu. Pacienty jsme oslovovali formou dotaznõÂkuÊ.
Skupina ortodontickyÂch pacientuÊ obdrzÏela dva dotaznõÂky. PrvnõÂ byl vyplneÏn v raÂmci prvnõÂ naÂvsÏteÏvy, druhyÂ
beÏhem naÂsledne kontrolnõ naÂvsÏteÏvy v pruÊbeÏhu leÂcÏby
fixnõÂm aparaÂtem. Studie byla rozsÏõÂrÏena o praktickou
cÏaÂst, jezÏ spocÏõÂvala ve vstupnõÂm hygienickeÂm vysÏetrÏenõÂ
provaÂdeÏneÂm v prvnõÂ naÂvsÏteÏveÏ. Toto vstupnõÂ vysÏetrÏenõÂ
zahrnovalo seznaÂmenõÂ s problematikou, meÏrÏenõÂ gingivaÂlnõÂho indexu PBI (Papila Bleeding Index), obarvenõÂ
plaku na zubech plak detektorem, meÏrÏenõÂ hygienickyÂch indexuÊ indexuÊ API a QHI (API - Approximal Plaque
Index hodnotõÂ vyÂskyt plaku v mezizubnõÂch prostoraÂch,
QHI registruje pokrytõ povrchu korunky plakem), meÏrÏenõ mezizubnõÂch prostor kalibrovanou sondou, instruktaÂzÏ a prakticky naÂcvik pouzÏõÂvaÂnõ doporucÏenyÂch
pomuÊcek (rucÏnõ kartaÂcÏek, mezizubnõ kartaÂcÏky, jednosvazkovy kartaÂcÏek) a depuraci zubuÊ. PruÊbeÏh celeÂho
vysÏetrÏenõÂ byl fotograficky dokumentovaÂn. BezprostrÏedneÏ po nasazenõÂ fixnõÂho ortodontickeÂho aparaÂtu
naÂsledovala kontrola s uprÏesneÏnõÂm cÏisÏteÏnõÂ aparaÂtku
a daÂle jesÏteÏ jedna kontrola pro kontrolu stavu a vyhotovenõ zpeÏtne vazby formou druheÂho dotaznõÂku.
VsÏechny dotaznõÂky byly vyhodnoceny popisnou
statistikou. VyÂsledky byly prezentovaÂny formou grafuÊ.
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spot lesion created during the orthodontic treatment,
and 2.3% of patients with dental cavity.
Gingivitis is another complication of the orthodontic
treatment. SlezaÂk and DrÏõÂzhal [13] stated that gingivitis
due to dental plaque is currently the most frequent
chronic bacterial infection in humans. It occurs in approx. 90% of individuals. The fact suggests that a number of patients suffer from gingivitis before the commencement of orthodontic treatment.
To avoid similar complications during the treatment,
our patients should be duly instructed about the importance of dental hygiene. However, the lecture and demonstration on a model is not enough. The patient
must be practically instructed and acquainted with all
tools and equipment required. We recommend using
soft toothbrush during the orthodontic treatment, or
orthodontic toothbrush with trimmed bristles. Singletuft toothbrush and long-stem toothbrush are necessary as they are very effective. The use of interdental
toothbrush should be commonplace before the commencement of orthodontic therapy. With regard to
the fact that interdental spaces change during the
treatment, toothbrushes must be repeatedly calibrated. Patients should be re-instructed in dental hygiene
maintenance whenever necessary.
Material and methods
For the practical part of our study the sample of respondents-orthodontic patients was established. The
patients were monitored both in the phase prior to the
treatment with fixed orthodontic appliance and during
the therapy. The patients were addressed by means of
questionnaires.
The sample of orthodontic patients was sent two
questionnaires. The first was filled up during the first
appointment, the second within the check-up during
the treatment with fixed appliance. The study included
the practical part, i.e. the initial examination of dental
hygiene taken during the first appointment. The examination included acquaintance with the problem, measuring of gingival index PBI (Papila Bleeding Index),
dyeing of dental plaque with a plaque detector, measuring of hygiene indexes API a QHI (API - Approximal
Plaque Index examines plaque in interdental spaces,
QHI registeres plaque on the tooth surface), calibration
of interdental space with a probe, instruction and practice in the use of recommended dental equipment
(toothbrush, interdental toothbrush, single-tuft toothbrush), and dentition cleaning. The examination was
documented in photographs. Immediately after the
adjustment of fixed orthodontic appliance a checkup followed with more instructions on the appliance
cleaning, and another examination took place in order
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ORTODONCIE
Obr. 1. Absolvoval/a jste neÏkdy neÏjake sÏkolenõ o dentaÂlnõ hygieneÏ?
Fig.1. Have you ever undergo any instruction on dental hygiene?
Obr. 2. KrvaÂcõÂ VaÂm prÏi cÏisÏteÏnõÂ zubuÊ daÂsneÏ?
Fig.2. Are your gums bleeding during toothbrushing?
Obr. 3. HodnocenõÂ uÂstnõÂ hygieny podle PBI
Fig. 3. Evaluation of dental hygiene according to PBI
Obr. 4. HodnocenõÂ uÂstnõÂ hygieny podle API
Fig. 4. Evaluation of dental hygiene according to API
Obr. 5. HodnocenõÂ uÂstnõÂ hygieny podle QHI
Fig. 5. Evaluation of dental hygiene according to QHI
VyÂsledky
Ze zõÂskanyÂch vyÂsledkuÊ jsme vybrali odpoveÏdi na
nejzajõÂmaveÏjsÏõ otaÂzky, ktere uvaÂdõÂme formou naÂsledujõÂcõÂch grafuÊ.
1. Absolvoval/a jste neÏkdy neÏjake sÏkolenõ o dentaÂlnõÂ
hygieneÏ?
Z obraÂzku 1 je patrneÂ, zÏe pouze 27 pacientuÊ (28 %)
absolvovalo sÏkolenõÂ o dentaÂlnõÂ hygieneÏ, naopak 71 pacientuÊm (72 %) se nikdy zÏaÂdneÂho hygienickeÂho sÏkolenõÂ
nedostalo.
2. KrvaÂcõÂ VaÂm daÂsneÏ prÏi cÏisÏteÏnõÂ zubuÊ?
Podle obraÂzku 2 uvaÂdõÂ 34 pacientuÊ (34,7 %), zÏe jim
prÏi cÏisÏteÏnõÂ zubuÊ krvaÂcõÂ daÂsneÏ, 64 probanduÊ (65,3 %)
s krvaÂcenõÂm daÂsnõÂ beÏhem domaÂcõÂ dentaÂlnõÂ hygieny
probleÂm nemajõÂ.
3. MeÏrÏenõÂ PBI
Podle vyÂsledkuÊ meÏrÏenõÂ jsme pacienty rozdeÏlili do trÏõÂ
skupin urcÏujõÂcõÂch uÂrovenÏ jejich uÂstnõÂ hygieny. Z 98 probanduÊ majõÂ pouze 4 pacienti (4,1 %) vyÂbornou hygienu,
206
to check up the dentition condition and to get the feedback by means of the second questionnaire.
All questionnaires were processed by descriptive
statistic methods. The results were presented in
graphs.
Results
We selected the most interesting answers from the
results obtained. The results are summed up in graphs.
1. Have you ever undergo any instruction about
dental hygiene?
Figure 1 suggests that only 27 patients attended the
instruction in dental hygiene, while 71 patients (72%)
never got any information on the topic.
2. Are your gums bleeding during toothbrushing?
As you can see in Figure 2, 34 patients (34.7%) report gum bleeding, 64 probands (65.3%) do not
encounter any problems during dental hygiene at
home.
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ORTODONCIE
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14 pacientuÊ (14,3 %) ma hygienu dobrou a u 80 probanduÊ konstatujeme hygienu nevyhovujõÂcõ (obr. 3).
4. MeÏrÏenõÂ API
Podle vyÂsledkuÊ meÏrÏenõÂ jsme pacienty rozdeÏlili do
dvou skupin. Podle obr. 4 vidõÂme, zÏe nevalnou hygienu
ma 13 pacientuÊ (14 %), nedostatecÏnou pak 83 probanduÊ (86 %).
5. MeÏrÏenõÂ QHI
Podle vyhodnocenõÂ indexu QHI jsme pacienty rozdeÏlili do dvou skupin. ProbanduÊ s nizÏsÏõÂm rizikem vzniku
zubnõÂho kazu bylo 84 (86 %), teÏch s vysÏsÏõÂm rizikem
vzniku kazu bylo 14 (14 %) (obr. 5).
Diskuse
DuÊlezÏitost duÊsledneÂho dodrzÏovaÂnõÂ dentaÂlnõÂ hygieny
ve vsÏech oblastech stomatologie je zmõÂneÏna v mnoha
odbornyÂch pracõÂch [14, 15, 16, 17]. Hygienou v ortodoncii se ve sve praÂci zabyÂva Stolzova [18], ktera mimo
jine uvaÂdõÂ, zÏe dentaÂlnõ hygienistka ma pozitivnõ vliv na
uÂrovenÏ uÂstnõÂ hygieny a tõÂm i oraÂlnõÂ zdravõÂ pacientuÊ s nasazenyÂm fixnõÂm aparaÂtem.
CõÂlem dotaznõÂkove studie pro pacienty bylo zjistit,
jake jsou jejich znalosti a dovednosti v dentaÂlnõ hygieneÏ, jake pouzÏõÂvajõ pomuÊcky, zda jizÏ neÏkdy absolvovali neÏjake sÏkolenõ o dentaÂlnõ hygieneÏ a jestli pravidelneÏ
navsÏteÏvujõÂ dentaÂlnõÂ hygienistku.
AcÏ by meÏli pacienti na ortodoncii od praktickeÂho
zubnõÂho leÂkarÏe prÏichaÂzet po hygienicke straÂnce prÏipraveni, 72 % dotaÂzanyÂch uvaÂdõÂ, zÏe jesÏteÏ nikdy neabsolvovali sÏkolenõ o dentaÂlnõ hygieneÏ (obr. 1). Toto cÏõÂslo je
alarmujõÂcõ a vznikla situace muÊzÏe ortodontistovi komplikovat leÂcÏbu fixnõÂm aparaÂtem. Z pacientuÊ, kterÏõ sÏkolenõ absolvovali, 59,3 % uvaÂdõÂ, zÏe toto sÏkolenõ jim deÏlal
leÂkarÏ cÏasteÏji, nezÏ dentaÂlnõÂ hygienistka, jak uvaÂdõÂ
40,7 % respondentuÊ. Tento fakt naznacÏuje, zÏe spolupraÂce praktickyÂch zubnõÂch leÂkarÏuÊ a dentaÂlnõÂch hygienistek se muÊzÏe nadaÂle rozvõÂjet. Z dotaÂzanyÂch 43 %
uvaÂdõÂ, zÏe jejich prakticky zubnõ leÂkarÏ nema na pracovisÏti spolupracujõÂcõ hygienistku, 24 % potvrzuje, zÏe leÂkarÏ hygienistku na pracovisÏti ma a 33 % dotaÂzanyÂch
nevõÂ, zda ma leÂkarÏ na pracovisÏti hygienistku. NicmeÂneÏ
pouze 62 % leÂkarÏuÊ, kterÏõÂ hygienistku na pracovisÏti majõÂ,
pacientuÊm neÏkdy nabõÂdlo konzultaci u nõÂ. Tuto konzultaci vyuzÏilo 60% pacientuÊ.
Dobrou zpraÂvou je, zÏe 97 % dotaÂzanyÂch ma o instruktaÂzÏ dentaÂlnõ hygieny zaÂjem. Jen 5 % pacientuÊ,
kteryÂm nebyla nabõÂdnuta naÂvsÏteÏva u dentaÂlnõÂ hygienistky, ji vyhledalo z vlastnõÂ iniciativy. PravidelneÏ navsÏteÏvuje dentaÂlnõÂ hygienistku pouze 8 % dotaÂzanyÂch.
Fakt, nad kteryÂm bychom se meÏli pozastavit je, zÏe
55 % respondentuÊ odpoveÏdeÏlo, zÏe vuÊbec neveÏdõÂ
o mozÏnosti navsÏtõÂvit dentaÂlnõ hygienistku, nevõÂ, zÏe podobna sluzÏba existuje.
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3. PBI measurement
The patients were divided into three groups according to the level of their oral hygiene. Only 4 patients
(4.1%) have excellent dental hygiene, 14 patients
(14.3%) good dental hygiene, and in 80 patients the level of their dental hygiene is insufficient (Fig.3).
4. API measurement
The patients were divided into two groups. In 13 patients (14%) dental hygiene is poor, in 83 (86%) it is insufficient.
5. QHI measurement
The patients were divided into two groups. The lower risk of caries occurrence was determined in 84 patients (86%), the increased risk was found in 14 patients (14%) (Fig.5).
Discussion
A number of works emphasize the importance of
proper dental hygiene in all areas of dentistry
[14,15,16,17]. Stolzova [18] deals with dental hygiene
specifically in orthodontics, and mentions the positive
impact of a dental hygienist on the level of oral hygiene,
and thus also on oral health in patients with fixed appliance.
The aim of the questionnaire survey was to determine the patients' information about dental hygiene
and their skills, what equipment they use, whether they
underwent any instruction in dental hygiene at all, and
whether they regularly visit a dental hygienist.
Though patients should come to orthodontic practice prepared in terms of dental hygiene, 72% of our
probands stated that they never underwent any instruction on dental hygiene (Fig.1). The number is rather alarming, and the patients' condition may complicate the treatment with fixed appliance. Out of those
who were instructed, 59.3% state that the instruction
was given by a dentist, 40.7% were instructed by
a dental hygienist. This fact suggests that the cooperation between a dentist and a dental hygienist should
develop in the future. 43% of probands report that
there is not a dental hygienist in the office of their dentist, 24% report that a dental hygienist works alongside
their dentist, 33% do not know. However, only 62% of
the dentists who have a dental hygienist in their general
practices recommend their patients to consult them
(60% of patients made use of the offer).
The good news is that 97% of probands are interested in the instruction on dental hygiene. Only 5% of
the patients who were not recommended to see a dental hygienist made an appointment with them out of
their own will. Only 8% of probands visit a dental hygienist regularly. The alarming is the fact that 55% of probands said they did not know about the existence dental hygienist services.
207
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Trembova [17] ve svyÂch zaÂveÏrech uvaÂdõÂ, zÏe z pruÊzkumu hygienickyÂch naÂvykuÊ vyplynulo, zÏe prÏed edukacõ patrÏily k nejcÏasteÏji pouzÏõÂvanyÂm pomuÊckaÂm pro
uÂstnõ hygienu strÏedneÏ tvrdy kartaÂcÏek, zubnõ pasta
a uÂstnõ voda, po edukaci to byl meÏkky kartaÂcÏek a mezizubnõ kartaÂcÏek. Z nasÏeho vyÂzkumu vyplynulo, zÏe nejcÏasteÏji pouzÏõÂvanou dentaÂlnõ pomuÊckou je meÏkky kartaÂcÏek na zuby, ktery pro cÏisÏteÏnõ vyuzÏõÂva 63,3 % pacientuÊ,
strÏedneÏ tvrdou variantu 38,8 % dotaÂzanyÂch a tvrdyÂ
kartaÂcÏek pouze 3 respondenti. PouzÏõÂvaÂnõÂ mezizubnõÂch
kartaÂcÏkuÊ uvaÂdõ pouze 15,3 % dotaÂzanyÂch a jednosvazkoveÂho kartaÂcÏku 11,2 %. Po instruktaÂzÏi si naÂmi doporucÏene pomuÊcky ponechalo 99 % dotaÂzanyÂch.
Z teÏchto pacientuÊ pravidelneÏ cÏistõÂ meÏkkyÂm kartaÂcÏkem
100 %, jednosvazkovyÂm 89,5 % a mezizubnõÂmi kartaÂcÏky 88,2 % probanduÊ. V porovnaÂnõ s vyÂsledky Trembove [17] pacienti v nasÏõ studii pouzÏõÂvajõ prÏed instruktaÂzÏõ cÏasteÏji meÏkky kartaÂcÏek, nicmeÂneÏ staÂle je dost pacientuÊ, kterÏõ volõ strÏedneÏ tvrdou variantu. Nedostatek
vidõÂme prÏedevsÏõÂm v tom, zÏe pouze 15,3 % dotaÂzanyÂch
pouzÏõÂva mezizubnõ kartaÂcÏek. Po instruktaÂzÏi se situace
vyÂrazneÏ zlepsÏila, v cÏemzÏ muÊzÏeme s vyÂsledky Trembove [17] souhlasit.
PacientuÊ jsme se prÏed instruktaÂzÏõÂ dotazovali, jestli
majõÂ probleÂmy s krvaÂcenõÂm daÂsnõÂ. Na tuto otaÂzku
naÂm kladneÏ odpoveÏdeÏlo 35 % probanduÊ (obr. 2). Po instruktaÂzÏi, ve ktere jim byly zmeÏrÏeny mezizubnõ prostory
a prÏedaÂny odpovõÂdajõÂcõÂ mezizubnõÂ kartaÂcÏky, uvaÂdõÂ 65,7
% pacientuÊ, zÏe jednou z pozitivnõÂch zmeÏn, kterou zaznamenali, bylo praÂveÏ vymizenõÂ krvaÂcenõÂ daÂsnõÂ. V tomto
ohledu tedy muÊzÏeme souhlasit s vyÂsledky TremboveÂ
[17], ktera uvaÂdõÂ, zÏe dõÂky zmeÏnaÂm hygienickyÂch naÂvykuÊ
dosÏlo u vsÏech probanduÊ ke zmõÂrneÏnõÂ zaÂneÏtu daÂsnõÂ, cozÏ
dokazuje snõÂzÏenõÂ hodnoty gingivaÂlnõÂho indexu PBI po
edukaci. Na tomto faktu se shodujõÂ i vyÂsledky StolzoveÂ
[18], ktera uvaÂdõÂ, zÏe pacienti, jezÏ neprosÏli instruktaÂzÏõÂ
dentaÂlnõÂ hygienistky, meÏli v pruÊmeÏru PBI 23,1 a tudõÂzÏ
nevyhovujõÂcõ uÂstnõ hygienu a trpeÏli ve zvyÂsÏene mõÂrÏe zaÂneÏtem daÂsnõÂ. Pacienti, kterÏõ byli od dentaÂlnõ hygienistky
poucÏeni, meÏli pruÊmeÏrneÏ PBI 17,5, ktere sveÏdcÏõ o vyhovujõÂcõ uÂrovni uÂstnõ hygieny. Tato skupina pacientuÊ vykazuje o celyÂch 25 % lepsÏõ pruÊmeÏrne hodnoty PBI.
BeÏhem prakticke cÏaÂsti v ordinaci jsme pacientuÊm
kromeÏ motivace a instruktaÂzÏe meÏrÏili trÏi indexy: PBI,
API a QHI. Dle PBI ma vyÂbornou hygienu pouze 4 %
probanduÊ, 14 % ma dobrou hygienu a u 82 % byla zjisÏteÏna hygiena nevyhovujõÂcõ (obr. 3). PodobneÏ se hygienicky stav odrazil v API, u ktereÂho bylo zjisÏteÏno, zÏe 14
% pacientuÊ ma hygienu nevalnou a 86 % dokonce nedostatecÏnou (obr. 4). Dle vyÂsledkuÊ meÏrÏenõ QHI je u 14
% probanduÊ zjisÏteÏno vysoke riziko vzniku zubnõÂho
kazu (obr. 5). Tyto vyÂsledky opeÏt sveÏdcÏõÂ o pomeÏrneÏ
znacÏnyÂch nedostatcõÂch instruktaÂzÏõÂ provaÂdeÏnyÂch
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ORTODONCIE
Trembova [17] reports that the research on hygiene
habits shows that prior to education the most often
used dental equipment included medium toothbrush,
toothpaste and mouth rinse, while after education
the equipment included soft toothbrush and interdental toothbrush. From our study it follows that the most
frequently used dental aid is soft toothbrush (used by
63.3% of patients), medium toothbrush (38.8%); hard
toothbrush was used by 3 respondents. Interdental
toothbrush is used by 15.3%, and single-tuft toothbrush 11.2% of the patients. After the instruction
99% of respondents continue to use the recommended equipment (100% of them regularly uses soft
toothbrush, 89.5% single-tuft toothbrush, 88.2% interdental toothbrush). Unlike the results given by
Trembova [17], before the instruction our patients preferred soft toothbrush. However, there are still a number of patients who opt for a medium toothbrush and
only 15.3% of respondents use interdental brush. Nevertheless, after the education the situation improved
which corresponds to the results given by TrembovaÂ
[17].
We asked about the problems with gum bleeding.
The question was answered positively by 35% of respondents (Fig.2). After the instruction during which
we measured the patients' interdental space and recommended appropriate interdental toothbrushes,
65.7% of patients reported that one of the positive
changes they noticed was the end of bleeding. This
corresponds to the results given by Trembova [17] she reports that due to improved hygiene gingivitis
decreased in all probands which was reflected in the
lower value of gingival index PBI. Stolzova [18] reports
that patients who did not underwent the instruction by
a dental hygienist had PBI mean value 23.1, i.e. insufficient oral hygiene, and suffered from gingivitis. Those
who were instructed had PBI mean value of 17.5, i.e.
satisfactory oral hygiene. The latter group had PBI
mean values better by 25%.
Within the practical part, besides motivating and instructing the patients, we measured three indexes:
PBI, API and QHI. According to PBI only 4% of respondents had excellent oral hygiene, 14% good oral hygiene, and 82% insufficient hygiene (Fig.3). According
to API 14% of patients had poor oral hygiene, and 86%
insufficient (Fig.4). According to QHI there is a high risk
of caries formation in 14% of probands (Fig.5). The results suggest that instructions given by general dentists before their patients come to orthodontic surgery
are unsatisfactory.
The positive result is that all patients got used to
new equipment. Only one patient did not master new
techniques of toothbrushing. 99% of respondents
continue to use the recommended dental equipment.
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u praktickeÂho zubnõÂho leÂkarÏe prÏed odeslaÂnõÂm na ortodoncii.
PozitivnõÂm vyÂsledkem pro naÂs bylo, zÏe vsÏichni pacienti si i na nove pomuÊcky zvykli dobrÏe. Na nove techniky cÏisÏteÏnõ zubuÊ si nezvykl dobrÏe jen jeden pacient
z celeÂho souboru. NaÂmi doporucÏene pomuÊcky si ponechalo 99 % dotaÂzanyÂch.
SubjektivneÏ zmeÏnu po instruktaÂzÏi zaznamenalo 94
% dotaÂzanyÂch, ze kteryÂch 99 % uvaÂdõÂ, zÏe tato zmeÏna
byla pozitivnõÂ. SubjektivneÏ lepsÏõÂ pocit uvaÂdõÂ 95,7 % pacientuÊ, 65,7 % probanduÊ prÏestaly krvaÂcet daÂsneÏ, 60 %
se zlepsÏil vzhled zubuÊ a 37,1 % pocõÂtilo zlepsÏenõÂ dechu.
Pouze 12 % pacientuÊ cÏinõÂ cÏisÏteÏnõÂ aparaÂtu probleÂmy,
nejcÏasteÏji uvaÂdeÏjõÂ, zÏe je cÏisÏteÏnõ cÏasoveÏ naÂrocÏne (78 %),
manuaÂlneÏ naÂrocÏne (67 %) nebo je nebavõ (33 %). DotaÂzanõ v 93,5 % prÏõÂpaduÊ nemajõ pocit, zÏe by potrÏebovali
neÏco znovu vysveÏtlit, ukaÂzat nebo nacvicÏit.
ZaÂveÏr
Podle dotaznõÂkove studie byla ve skupineÏ pacientuÊ
zjisÏteÏna horsÏõÂ informovanost, nicmeÂneÏ beÏhem nasÏeho
vyÂzkumu pacienti prokaÂzali snahu a odhodlaÂnõÂ s noveÏ
nabytyÂmi zkusÏenostmi a dovednostmi naklaÂdat
spraÂvneÏ.
1) TeÂmeÏrÏ trÏi cÏtvrtiny pacientuÊ nikdy neabsolvovalo
sÏkolenõÂ o uÂstnõÂ hygieneÏ, prÏestozÏe teÂmeÏrÏ vsÏichni pacienti majõÂ o toto sÏkolenõÂ zaÂjem. BohuzÏel võÂce nezÏ polovina probanduÊ nevõÂ, zÏe sluzÏba dentaÂlnõÂ hygienistky existuje.
2) Jen jedna cÏtvrtina dotaÂzanyÂch potvrzuje, zÏe prakticky zubnõ leÂkarÏ ma na sveÂm pracovisÏti dentaÂlnõ hygienistku.
3) PrÏed instruktaÂzÏõ võÂce nezÏ polovina pacientuÊ pouzÏõÂvala meÏkky kartaÂcÏek na zuby, ale teÂmeÏrÏ 40 % dotaÂzanyÂch si zuby cÏistilo strÏedneÏ tvrdyÂm kartaÂcÏkem. Mezizubnõ kartaÂcÏky a jednosvazkovy kartaÂcÏek pouzÏõÂvala
jen mala cÏaÂst pacientuÊ.
4) Po instruktaÂzÏi se situace zmeÏnila vyÂrazneÏ k lepsÏõÂmu. VsÏichni pacienti pouzÏõÂvali meÏkky kartaÂcÏek a teÂmeÏrÏ 90 % pouzÏõÂvalo jak mezizubnõÂ, tak jednosvazkoveÂ
kartaÂcÏky. VsÏichni si na naÂmi doporucÏene pomuÊcky
zvykli dobrÏe, neponechal si je pouze jeden pacient
z celeÂho souboru.
5) Velka veÏtsÏina pacientuÊ po instruktaÂzÏi pocõÂtila pozitivnõ subjektivnõ zmeÏnu tyÂkajõÂcõ se cÏisÏteÏnõ zubuÊ. NadpolovicÏnõ veÏtsÏineÏ pacientuÊ prÏestaly krvaÂcet daÂsneÏ.
6) VeÏtsÏineÏ pacientuÊ cÏisÏteÏnõÂ zubuÊ s fixnõÂm aparaÂtem
necÏinõÂ probleÂmy.
AutorÏi nemajõ komercÏnõÂ, vlastnicke nebo financÏnõ zaÂjmy na produktech nebo spolecÏnostech popsanyÂch v tomto cÏlaÂnku.
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94% of respondents reported a subjectively perceived change, 99% of them stated that the change was
positive. 95.7% of respondents reported a subjectively
perceived better feeling, 65.7% reported that gum
bleeding stopped, in 60% the dentition appearance
improved, and 37.1% reported better breath.
12% of patients had problems in cleaning the appliance: they considered it time consuming (78%), manually demanding (67%), or they were tired of it (33%).
93.5% of respondents stated they did not need a new
instruction, demonstration or practice.
Conclusion
The questionnaire survey proved rather poor knowledge, however, during our research the patients showed will and determination to use the new experiences
and skills correctly.
1) Almost 3/4 of the patients never underwent instruction in oral hygiene, though nearly all of them
would like to take part in such education. Unfortunately, more than half of them do not know about the existence of dental hygienists at all.
2) Only 1/4 of respondents states that there is a dental hygienist in their dentist's office.
3) Prior to education more than half of respondents
used soft toothbrush, however, almost 40% still preferred medium toothbrush. Only a small percentage
of the patients used interdental toothbrush and
single-tuft toothbrush.
4) The situation rapidly improved after the instruction. All patients started to use soft toothbrush and almost 90% used interdental and single-tuft toothbrush.
All patients got used to the recommended dental
equipment and continue to use it. Only one patient
from the sample did not master the new cleaning technique.
5) Majority of patients reported positive subjectively
perceived change in terms of toothbrushing. More
than half of respondents reported that gum bleeding
stopped.
6) Majority of patients with fixed appliance report
that they have no problems with toothbrushing.
The authors have no commercial, proprietary or financial interest
in products or companies mentioned in the article.
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Literatura/References
1. KrejcÏõÂrÏovaÂ, P.: Desatero dentaÂlnõÂ hygieny u ortodontickyÂch pacientuÊ. DH skripta 2008. 2008, cÏ. 1, s. 32-35.
2. Liu, H.; Sun, J.; Dong, Y.; Lu, H.; Zhou, H.; Hansen, B. F.;
Song, X.: Periodontal health and relative quantity of subgingival Porphyromonas gingivalis during orthodontic
treatment. Angle Orthodont. 2011, 81, cÏ. 4, s. 609-615.
3. Al-Jewair, T. S.; Suri, S.; Tompson, B. D.: Predictors of
adolescent compliance with oral hygiene instructions
during two-arch multibracket fixed orthodontic treatment. 2011, 81, cÏ. 3, s. 525-531.
4. Baka, Z. M.; Basciftci, F. A.; Arslan, U.: Effects of 2 bracket and ligation types on plaque retention: a quantitative
microbiologic analysis with re al-time polymerase chain
reaction. Amer. J. Orthodont. dentofacial Orthop. 2013,
144, cÏ. 2, s. 260-267.
5. Kim, S. H.; Choi, D. S.; Jang, I.; Cha, B. K.; Jost-Brinkmann, P. G.; Song, J. S.: Microbiologic changes in subgingival plaque before and during the early period of
orthodontic treatment. Angle Orthodont. 2012, 82, cÏ. 2,
s. 254-260.
6. Turkkahraman, H., Sayin, M.O., Bozkurt, F.Y.; Yetkin, Z.;
Kaya, S.; Onal S.: Archwire ligation techniques, microbial
colonization, and periodontal status in orthodontically
treated patients. Angle Orthodont. 2005, 75, s. 231-236.
7. TichaÂ, R.; TichyÂ, J.; BoÈhmovaÂ, H.: UÂstnõÂ hygiena a ortodoncie - jak na to?. CÏes. Stomat. 2007, 107, cÏ. 3, s. 5761.
8. Gorelick, L.; Geiger, A. M.; Gwinnett, A. J.: Incidence of
white spots formation after bonding and banding. Amer.
J. Orthodont. 1982, 81, cÏ. 2, s. 93-98.
9. Geiger, A. M.; Gorelick, L.; Gwinnett, A. J.; Griswold, P.
G.: The effect of the fluoride program on white spot formation during orthodontic treatment. Amer. J. Orthodont. Dentofacial Orthop., 1988, 93, cÏ. 1, s. 29-37.
10. CÏernochovaÂ, P.; IzakovicÏova HollaÂ, L.: VyÂskyt demineralizacõ skloviny po leÂcÏbeÏ pevnyÂm ortodontickyÂm aparaÂtem. LKS. 2012, cÏ. 10, s. 205-209.
11. Julien, K. C.; Buschang, J. K. C.; Campbell, P. M.: Prevalence of white spot lesion formation during orthodontic
treatment. Angle Orthodont. 2013, 83, cÏ. 4, s. 641-647.
12. Richter, A. E.; Arruda, A. O.; Peters, M. C.; Sohn, W.: Incidence of caries lesions among patients treated with
comprehensive orthodontics. Amer. J. Orthodont. dentofacial Orthop. 2011, 139, cÏ. 5, s. 657-664.
13. SlezaÂk, R.; DrÏõÂzhal, I.: Atlas chorob uÂstnõÂ sliznice. Praha:
Quintessenz, 2004.
14. DundaÂlkovaÂ, P.: DentaÂlnõÂ hygiena v parodontologii
[online]. Brno, 2013, bakalaÂrÏska praÂce. Masarykova univerzita. LeÂkarÏska fakulta. Katedra osÏetrÏovatelstvõÂ. Dostupne na: http://is.muni.cz/th/319781/lf_b/BP-DentalnihÅÅ ygiena_v_parodontologii.pdf
15. Valenta, I.: SpolupraÂce ortodontisty s parodontologem.
Praha, 2009, atestacÏnõ praÂce. Karlova univerzita. 3. LeÂkarÏska fakulta. OddeÏlenõ ortodoncie a rozsÏteÏpovyÂch
vad Stomatologicke kliniky 3. LF UK.
16. Skupien GoÈbel, A.: Vliv aminfluoriduÊ na uÂrovenÏ hygieny
beÏhem ortodonticke terapie. Olomouc, 2010. Univerzita
PalackeÂho. LeÂkarÏska fakulta. Ortodonticke oddeÏlenõÂ
Stomatologicke kliniky LF UP.
17. TrembovaÂ, T.: EdukaÂcia klienta v dentaÂlnej hygiene
[online]. Brno, 2012. Masarykova univerzita. LeÂkarÏska fakulta. Katedra osÏetrÏovatelstvõÂ. Dostupne na: http://is.muni.cz/th/358752/lf_b/bakalarska_praca.pdf
18. StolzovaÂ, A.: Profylakticke aspekty ortodonticke leÂcÏby
a spolupraÂce ortodontisty a dentaÂlnõÂ hygienistky. Praha,
2008, atestacÏnõ praÂce. Karlova univerzita. 1. LeÂkarÏska fakulta. Ortodonticke oddeÏlenõ Stomatologicke kliniky 1.
LF UK a VFN.
MDDr. KarolõÂna FlorykovaÂ
Stomatologicka klinika FN u sv. Anny
PekarÏska 53, 656 91 Brno
CÏlensky poplatek pro rok 2015 cÏinõ 2500,- KcÏ nebo 100,- EUR.
CÏlenove v zameÏstnaneckeÂm vztahu 800,- KcÏ nebo 35,- EUR.
Postgraduanti, duÊchodci a zÏeny na materÏske dovolene 300,- KcÏ nebo 15,- EUR.
RegistracÏnõÂ polatek cÏinõÂ 500,- KcÏ nebo 20,- EUR.
PrÏedplatne cÏasopisu Ortodoncie pro necÏleny CÏOS je 1000,- KcÏ za rok nebo 50,- EUR.
UÂhrada poplatku do 28. 2. 2015, cÏ. uÂ.: 32932021/0100, konst. symbol: 0558, variab. symbol: rodne cÏõÂslo.
PrÏi nezaplacenõÂ prÏõÂspeÏvkuÊ po dvou põÂsemnyÂch urgencõÂch bude ukoncÏeno cÏlenstvõÂ v CÏOS.
210
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5-lety index u pacientuÊ s celkovyÂm jednostrannyÂm
rozsÏteÏpem
5-year index in patients with complete unilateral
cleft lip and palate
MDDr. Ivana KratochvõÂlovaÂ, MUDr. Wanda UrbanovaÂ, Ph.D., MUDr. Magdalena Kot'ovaÂ, Ph.D.,
OddeÏlenõ ortodoncie a rozsÏteÏpovyÂch vad Stomatologicke kliniky 3. LF UK, FNKV Praha
Department of Orthodontics and Cleft Defects, Clinic of Stomatology, 3rd Medical Faculty of Charles University,
University Hospital KraÂlovske Vinohrady, Prague
Souhrn
CõÂl praÂce: Studie se zabyÂva hodnocenõÂm vyÂsledkuÊ primaÂrnõ chirurgicke rekonstrukce rtu a patra u prÏedsÏkolnõÂch
deÏtõÂ s celkovyÂm jednostrannyÂm rozsÏteÏpem. UÂspeÏsÏnost peÂcÏe je hodnocena u peÏtiletyÂch pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem v rozsÏteÏpoveÂm centru FNKV Praha zhodnocenõÂm vztahu zubnõÂch obloukuÊ a tzv. ¹5-letyÂm
indexemª, jehozÏ vyÂsledky jsou porovnaÂny s jinyÂmi rozsÏteÏpovyÂmi pracovisÏti.
MateriaÂl a metodika: Bylo analyzovaÂno 30 saÂdrovyÂch diagnostickyÂch modeluÊ peÏtiletyÂch pacientuÊ s celkovyÂm
jednostrannyÂm rozsÏteÏpem leÂcÏenyÂch na nasÏem pracovisÏti a dle vztahu zubnõÂch obloukuÊ byl kazÏdy pacient zarÏazen
do jedne z peÏti kategoriõ uvedeneÂho indexu.
VyÂsledky: PruÊmeÏrna hodnota 5-leteÂho indexu byla 3,3. PorovnaÂnõÂm vyÂsledkuÊ 5-leteÂho indexu s jinyÂmi rozsÏteÏpovyÂmi centry a zemeÏmi se rozsÏteÏpove pracovisÏteÏ FNKV rÏadõ na zÏebrÏÂõcÏku uÂspeÏsÏnosti vyÂsledkuÊ primaÂrnõ rekonstrukce rtu a patra do spodnõ trÏetiny tabulky. U sledovaneÂho souboru meÏla cÏasna primaÂrnõ rekonstrukce rtu do
trÏÂõ meÏsõÂcuÊ veÏku veÏtsÏÂõ negativnõ vliv na vyÂvoj hornõ cÏelisti nezÏ klasicka primaÂrnõ rekonstrukci rtu provedena pozdeÏji.
Ve vysÏetrÏovaneÂm souboru nebyl prokaÂzaÂn negativnõ vliv chirurgicke faryngofixace na vyÂvoj hornõ cÏelisti. CelkoveÏ
veÏtsÏÂõ postizÏenõ a ruÊstovy deficit hornõ cÏelisti lze ocÏekaÂvat, vyskytuje-li se v chrupu veÏtsÏÂõ hloubka skusu a zaÂvazÏneÏjsÏÂõ
postizÏenõ strany bez rozsÏteÏpu. U vysÏetrÏovaneÂho souboru pacientuÊ byl cÏasty vyÂskyt III. trÏÂõd dle Baumea, obraÂcenyÂ
skus ve frontaÂlnõÂm uÂseku chrupu a vyÂskyt zkrÏÂõzÏeneÂho skusu u docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ rozsÏteÏpu.
ZaÂveÏr: Je duÊlezÏite kontinuaÂlneÏ pokracÏovat ve sledovaÂnõ vyÂsledkuÊ uÂspeÏsÏnosti nejen primaÂrnõ chirurgicke rekonstrukce rtu a patra u pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem, ale i dalsÏÂõch operacõ a ortodonticke leÂcÏby
a hodnotit vztah zubnõÂch obloukuÊ u sledovanyÂch souboruÊ pacientuÊ take v dalsÏÂõch letech a jejich pozdeÏjsÏÂõm veÏku.
Dlouhodobe vyÂsledky prÏedstavujõ podklady pro uÂpravy leÂcÏebneÂho protokolu specializovaneÂho pracovisÏteÏ a pro
volbu optimaÂlnõÂch pracovnõÂch postupuÊ (Ortodoncie 2014, 23, cÏ. 4, s. 211-226).
Abstract
Aims: The study evaluates the results of primary surgery of lip and palate in pre-school children with complete
unilateral cleft lip and palate (UCLP). Success rate is evaluated in five-year old patients with UCLP treated at the
center of cleft defects University Hospital KraÂlovske Vinohrady, Prague by means of assessing the dental arches
relationship and the so-called ¹5-year indexª. The results are compared with those obtained in other cleft centers.
Material and methods: We analyzed 30 study models of five-year old patients with complete ULCP treated at
our department. According to the dental arches relationship each patient was ranked into one of the five categories of the given index.
Results: The mean value of 5-year index was 3.3. In the list of the best results of primary surgery of lip and
palate, the comparison of the 5-year index results with other cleft centers and countries put the cleft defects dewww.orthodont-cz.cz e-mail: [email protected]
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partment of FNKV into the lower third of the chart. In our sample of patients, the early primary surgery of lip - until 3
months of age - showed greater negative impact on the maxilla development than the classic primary surgery of
lip made later. In our sample of patients the negative impact of surgical pharyngofixation on the maxilla development was not proved. More significant defect and maxilla growth deficiency may be expected in case there is
deeper bite and more severe impairment of the side without cleft. In the sample of our patients there was frequently Class III according to Baume, reversed bite in the anterior segment of dentition, and crossbite in deciduous
canines on the cleft side.
Conclusion: It is important to continue monitoring of the success rate not only in primary surgery of lip and
palate of patients with UCLP, but in the following interventions and orthodontic treatment, and to evaluate the
relationship of dental arches in the sample of patients observed in the following years as well as in their older age.
Long-term results serve as the basis for modifications of the treatment protocol of a specialized department,
and they help to choose optimum approaches (Ortodoncie 2014, 23, No. 4, p. 211-226).
KlõÂcÏova slova: 5-lety index, celkovy jednostranny rozsÏteÏp
Key-words: 5-year index, unilateral cleft of lip and palate (UCLP)
UÂvod
Introduction
LeÂcÏba pacientuÊ s rozsÏteÏpem zacÏõÂna jizÏ brzy po narozenõ a provaÂzõ nositele vady azÏ do dospeÏlosti. ProtozÏe se
svyÂm umõÂsteÏnõÂm jedna o vrozenou vadu velmi naÂpadnou, je duÊlezÏiteÂ, aby leÂcÏba tyto jedince plneÏ rehabilitovala. ZaÂkladem leÂcÏby celkovyÂch rozsÏteÏpuÊ je primaÂrnõÂ
chirurgicka rekonstrukce rtu a patra [1], ktera rekonstruuje ret a uzavõÂra defekt rozsÏteÏpu patra. JejõÂm cõÂlem
je vyÂrazne zlepsÏenõ estetiky oblicÏeje, zlepsÏenõ prÏõÂjmu,
zpracovaÂnõ a polykaÂnõ potravy [2] a take vcÏasneÏ provedena primaÂrnõ operace patra napomaÂha spraÂvneÂmu rozvoji rÏecÏi [3]. PrÏes rÏadu pozitivnõÂch vlivuÊ ma primaÂrnõ chirurgicka rekonstrukce take sva negativa. Mezi nejvõÂce
diskutovane patrÏõ negativnõ vliv jizevnate tkaÂneÏ na ruÊst
a vyÂvoj hornõÂ cÏelisti [4, 5]. Pacienti s celkovyÂm jednostrannyÂm rozsÏteÏpem po primaÂrnõÂ rekonstrukci rtu a patra
majõÂ signifikantneÏ mensÏõÂ hornõÂ cÏelist oproti deÏtem bez
rozsÏteÏpu odpovõÂdajõÂcõÂho veÏku [6-10]. Velikost deficitu
ruÊstu hornõ cÏelisti je individuaÂlnõ a kromeÏ primaÂrnõ rekonstrukce rtu a patra jej ovlivnÏuje vrozene postizÏenõ tkaÂnõÂ,
ruÊstova retardace postizÏene cÏelisti [8, 9, 11-13], etnickeÂ
a geneticke rozdõÂly [8, 14]. V duÊsledku ruÊstoveÂho deficitu
hornõÂ cÏelisti se u teÏchto pacientuÊ cÏasto vyskytujõÂ malokluze III. trÏõÂdy a konkaÂvnõÂ profil oblicÏeje [15, 16]. PrÏestozÏe
vyÂslednou velikost ruÊstoveÂho deficitu hornõÂ cÏelisti u pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem lze zjistit
azÏ po ukoncÏenõ ruÊstu jedince, zmeÏny ve vyÂvoji hornõ cÏelisti jsou patrne jizÏ v deseti [15, 17], peÏti [18-20] a dokonce jizÏ ve trÏech letech [7].
Treatment of patients with cleft begins early after
they are born and continues until they are adult. Because the congenital defect is very prominent, it is important that the therapy fully rehabilitate the affected
individuals. The basic management of unilateral cleft
of lip and palate (UCLP) is the primary surgery of lip
and palate [1] which restores the lip and closes the palate cleft defect. The aim is a distinct improvement of
face esthetics, better intake, processing and swallowing of food [2], and correct development of speech
[3]. However, the primary surgery brings about also
negative aspects, one of the most frequently discussed being the negative impact of scar tissue on the
growth and development of the maxilla [4, 5]. The patients with UCLP after the primary surgery of lip and
palate have significantly smaller maxilla compared
with children of the same age without cleft [6-10].
The extent of the maxilla growth deficiency is individual, and it is also influenced by congenital defective
tissues, retarded growth of the affected jaw [8, 9, 1113], ethnic and genetic differences [8, 14]. The maxillary growth deficiency often results in Class III malocclusions and concave profile of face [15, 16]. Although
the resulting amount of maxillary growth deficiency in
patients with UCLP can be determined only after the finished growth of an individual, the changes in the maxilla development are apparent as early as in ten [15,
17], five [18-20] or even three years of age [7].
NejcÏasteÏji pouzÏõÂvanyÂm neinvazivnõÂm ukazatelem
hodnocenõ oblicÏejoveÂho ruÊstu, vyÂsledkuÊ primaÂrnõ rekonstrukce rtu a patra a celkove kvality leÂcÏby rozsÏteÏpuÊ
je hodnocenõÂ vztahu zubnõÂch obloukuÊ [21].
The relationship of dental arches is the most frequently used indicator for the assessment of facial
growth, results of primary lip and palate surgery, and
overall quality of the cleft therapy [21].
U deÏtskyÂch pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem je mozÏne toto zhodnocenõ proveÂst tzv. 5-letyÂm
indexem, ktery vytvorÏil v roce 1997 Atack [22, 23]. Pacienty ve veÏku prÏiblizÏneÏ peÏti let rozdeÏluje do jedne z peÏti
skupin, kde skupina 1 je nejlepsÏõÂ a skupina 5 je nejhorsÏõÂ
In children with UCLP the evaluation may be accomplished by means of the so-called 5-year index introduced by Atack in 1997 [22, 23]. Patients of the age
of about five years are divided into five groups, where
group 1 is the best, and group 5 the worst [22]. The
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[22]. HlavnõÂm kriteÂriem pro zarÏazenõ do jedne z peÏti skupin je prÏedevsÏõÂm sagitaÂlnõÂ, daÂle transverzaÂlnõ a vertikaÂlnõÂ
vztah zubnõÂch obloukuÊ [6]. SagitaÂlnõ vztah je prÏi hodnocenõ zaÂsadnõÂ, protozÏe na rozdõÂl od transverzaÂlnõÂho nepomeÏru jsou mozÏnosti jeho ortodonticke kompenzace ve
staÂle dentici mnohem võÂce omezeneÂ. KriteÂria pro zarÏazenõ do jednotlivyÂch skupin 5-leteÂho indexu uvaÂdõ tabulka 1, prÏõÂklady zarÏazenõ do 2. a 4. skupiny jsou na obraÂzku 1 a 2. Hodnocenõ lze provaÂdeÏt na saÂdrovyÂch diagnostickyÂch modelech [22], 3D digitaÂlnõÂch modelech
nebo na fotografiõÂch [24] peÏtiletyÂch deÏtõÂ s celkovyÂm jednostrannyÂm rozsÏteÏpem. Index slouzÏõÂ k mezicentroveÂmu
srovnaÂnõÂ vyÂsledkuÊ leÂcÏby, nenõÂ urcÏen k individuaÂlnõÂ prÏedpoveÏdi ruÊstu a vyÂvoje hornõÂ cÏelisti [23].
PrÏesto lze pouzÏitõÂm modifikace 5-leteÂho idexu cÏaÂstecÏneÏ prÏedvõÂdat prognoÂzu dalsÏõÂho vyÂvoje vztahu obloukuÊ a s tõÂm souvisejõÂcõÂ budoucõÂ rozsah ortodontickeÂ
cÏi ortodonticko-chirurgicke peÂcÏe: IdeaÂlnõ skupina zahrnuje pacienty 1. a 2. skupiny peÏtileteÂho indexu. Tito
pacienti majõ z dlouhodobeÂho hlediska dobrou prognoÂzu, v budoucnu by jim meÏla stacÏit pouze beÏzÏna ortodonticka leÂcÏba. HranicÏnõ skupina je 3. skupina 5-leteÂho
indexu. U pacientuÊ v teÂto skupineÏ nelze prÏesneÏ urcÏit,
zda bude v budoucnu stacÏit pouze komplexnõ ortodonticka nebo kombinovana ortodonticko-chirurgickaÂ
leÂcÏba. NeprÏõÂzniva skupina zahrnuje pacienty 4. a 5. skupiny 5-leteÂho indexu. Tito pacienti majõ v budoucnu vysokou pravdeÏpodobnost vzniku zaÂvazÏne cÏelistnõ anomaÂlie a prÏedpoklaÂdana je u nich ortodonticko-chirurgicka terapie [25].
DlouhodobyÂm sledovaÂnõÂm a srovnaÂvaÂnõÂm vyÂsledkuÊ
leÂcÏby primaÂrnõ chirurgicke rekonstrukce rtu a patra
u pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem byly
nalezeny rozdõÂly v ruÊstu a vyÂvoji hornõÂ cÏelisti mezi technikami a nacÏasovaÂnõÂm primaÂrnõÂ operace rtu a patra
i mezi jednotlivyÂmi centry navzaÂjem [3,17,26-28]. Z tohoto duÊvodu se dodnes neustaÂle meÏnõ a upravujõ chirurgicke techniky i nacÏasovaÂnõ primaÂrnõ rekonstrukce
rtu a patra s cõÂlem vytvorÏenõÂ co nejsÏetrneÏjsÏõÂho a nejefektivneÏjsÏõÂho leÂcÏebneÂho protokolu pro pacienty s rozsÏteÏpem.
MateriaÂl
Do studie byli zarÏazeni pacienti s celkovyÂm jednostrannyÂm rozsÏteÏpem (UCLP), kterÏõÂ splnÏovali naÂsledujõÂcõÂ
kriteÂria:
- pacienti s UCLP bez syndromoveÂho postizÏenõÂ
- leÂcÏba rozsÏteÏpove vady teÏchto pacientuÊ trvale probõÂhala na Klinice plasticke chirurgie FNKV
- pacienti byli sledovaÂni a leÂcÏeni na OddeÏlenõÂ ortodoncie a rozsÏteÏpovyÂch vad FNKV, kde byly zhotoveny
diagnosticke modely docÏasneÂho chrupu
- pacienti meÏli kompletnõ docÏasny chrup, toto kriteÂrium nezahrnovalo docÏasny lateraÂlnõ hornõ rÏezaÂk na
www.orthodont-cz.cz e-mail: [email protected]
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Obr. 1. Pacient ve druhe skupineÏ 5-leteÂho indexu
Fig.1. Patient in the second group of 5-year index
Obr. 2. Pacient ve cÏtvrte skupineÏ 5-leteÂho indexu
Fig. 2. Patient in the fourth group of 5-year index
main criterium for the categorization is especially sagittal, but also transversal and vertical relationships
of dental arches [6]. Sagittal relationship is the essential one, because the possibilities of orthodontic compensation in permanent dentition are rather limited
(unlike transversal disproportions). The criteria for subcategorization into individual groups of 5-year index
are given in Table 1, examples of groups 2 and 4 are
in Fig. 1 and Fig. 2. The evaluation may be performed
on study models [22], 3D digital models or in photographs [24] of five-year olds with UCLP. The index is
used to compare the treatment results; it does not serve to predict individual maxillary growth and development [23].
However, the modification of five year index may
partially predict further development in the relationship
of dental arches and related scope of future orthodontic or orthodontic-surgical management. The ideal
group includes patients from group 1 and group 2 of
five year index. From the long-term perspective these
patients have good prognosis with only common
orthodontic treatment in the future. The borderline
group is group 3 of five year index. In these patients
it is impossible to determine whether there will be
enough complex orthodontic treatment or whether
they will require combined orthodontic-surgical management. The unfavourable group includes patients
from group 4 and group 5 of five year index. In these
patients there is a high probability of the occurrence
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straneÏ rozsÏteÏpu z duÊvodu cÏasto se vyskytujõÂcõÂch numerickyÂch anomaÂliõÂ tohoto zubu u pacientuÊ s rozsÏteÏpem
- veÏk pacientuÊ byl v intervalu 4 - 6 let
- u pacientuÊ dosud nenastala I. faÂze vyÂmeÏny chrupu.
Z puÊvodnõÂho pocÏtu 40 vysÏetrÏenyÂch pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem, narozenyÂch od roku
1998 do roku 2009, bylo pro nesplneÏnõ neÏktere z vyÂsÏe
uvedenyÂch podmõÂnek vyloucÏeno 10 jedincuÊ. VyÂslednaÂ
meÏrÏenõÂ byla provedena na 30 saÂdrovyÂch diagnostickyÂch modelech u pacientuÊ s celkovyÂm jednostrannyÂm
rozsÏteÏpem. Z tohoto pocÏtu bylo 17 chlapcuÊ a 13 dõÂvek,
pruÊmeÏrny veÏk pacientuÊ byl 4,7 let, (SD = 0,7). VeÏkoveÂ
rozmezõ pacientuÊ bylo stanoveno tak, aby veÏkovy interval souboru jedincuÊ odpovõÂdal studiõÂm, s nimizÏ byly
zõÂskane vyÂsledky porovnaÂny. Celkovy pravostrannyÂ
rozsÏteÏp byl u 14 a celkovy levostranny rozsÏteÏp byl
u 16 pacientuÊ. PrimaÂrnõÂ chirurgickou rekonstrukci rtu
provaÂdeÏlo peÏt plastickyÂch chirurguÊ, u 29 pacientuÊ byla
provedena operacõÂ dle Tennisona (z tohoto pocÏtu byla
u 14 pacientuÊ operace dle Tennisona modifikovanaÂ),
u 1 pacienta byla provedena modifikovana operace
dle Millarda, pruÊmeÏrny veÏk pacientuÊ byl 0,4 let, (SD =
0,2). PrimaÂrnõÂ chirurgickou rekonstrukci patra provaÂdeÏlo 5 plastickyÂch chirurguÊ, u 15 pacientuÊ byla provedena operace se dveÏma laloky, retropozicõÂ a farynfofixacõÂ (2 LR+F) a u 15 pacientuÊ operace se dveÏma laloky
a retropozicõ (2 LR), pruÊmeÏrny veÏk pacientuÊ byl 2,2 let,
(SD = 1,2). U 9 pacientuÊ jizÏ probõÂhala aktivnõ ortodonticka leÂcÏba pomocõ hornõÂho snõÂmacõÂho deskoveÂho
aparaÂtu v pruÊmeÏrne dobeÏ trvaÂnõ 1,4 roku, (SD = 0,8).
Metodika
HodnocenõÂ byla provedena na diagnostickyÂch saÂdrovyÂch modelech hornõÂ a dolnõÂ cÏelisti pacienta s prÏilozÏenyÂm standardneÏ zhotovenyÂm voskovyÂm skusovyÂm registraÂtem. VsÏechna meÏrÏenõÂ a hodnocenõÂ studijnõÂch modeluÊ byla provedena jednõÂm hodnotõÂcõÂm, celkem trÏikraÂt
s odstupem jednoho meÏsõÂce mezi jednotlivyÂmi meÏrÏenõÂmi. Pro dalsÏõ zhodnocenõ byly pouzÏity pruÊmeÏrne hodnoty ze trÏõ provedenyÂch meÏrÏenõÂ. K meÏrÏenõ na diagnostickyÂch modelech bylo pouzÏito posuvne meÏrÏõÂtko (Somet) s prÏesnostõ 0,1 mm, meÏrÏenõ deÂlky hornõÂho
a dolnõÂho zubnõÂho oblouku bylo provedeno pomocõÂ
Korkhausova milimetroveÂho meÏrÏidla (Dentaurum).
Statisticke zpracovaÂnõ provedl Ing. ZdeneÏk Roth,
CSc. v pocÏõÂtacÏoveÂm programu SPSS verze 12Ò a v programu MS ExcelÒ.
Hodnocene a meÏrÏene parametry:
1. Klasifikace dle Baumea - hodnotõÂ vztah zubnõÂch
obloukuÊ ve smeÏru anteroposteriornõÂm podle vztahu
docÏasnyÂch druhyÂch molaÂruÊ v maximaÂlnõÂ interkuspidaci. ZvlaÂsÏt' byla hodnocena strana s rozsÏteÏpem
a zvlaÂsÏt' strana bez rozsÏteÏpu.
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of a severe jaw anomaly in the future, and orthodonticsurgical therapy is assumed [25].
The long-term follow-up and comparison of results
of the primary surgery of lip and palate in patients with
UCLP have shown differences in the growth and development of the maxilla related to methods of therapy,
timing of the primary surgery of lip and palate, and between different therapeutic centers [3, 17, 26-28]. Methods and timing of primary surgery of lip and palate
are being still modified in order for cleft patients to
establish as careful and effective treatment protocol
as possible.
Material
The sample included the patients with UCLP meeting the following criteria:
- Patients with UCLP without syndromic defects
- Cleft defect of the patients was treated at the Clinic
of plastic surgery FNKV
- Patients were monitored and treated at the Department of Orthodontics and Cleft Defects FNKV, study
models of deciduous dentition were made there
- Patients have complete deciduous dentition, the
criterion did not include temporary lateral upper incisor
on the cleft side due to frequent numeric anomalies related to this tooth in patients with cleft
- The age of patients between 4 and 6 years
- The first phase of dentition change had not started
yet.
From the original number of 40 patients with complete unilateral cleft born between 1998 and 2009, 10
did not meet some of the above given parameters
and were therefore excluded from the study sample.
Measurements were performed on 30 study models 17 males and 13 females; the mean age of patients
was 4.7 years (SD = 0.7). The age interval corresponded to that in the studies with which the results were
compared. 14 patients had right-sided UCLP, 16 had
left-sided UCLP. Primary surgery of lip was performed
by five plastic surgeons; in 29 patients Tennison's
technique was chosen (in 14 of the patients the technique was modified), in 1 patient modified Millard's technique was used; the mean age of patients was 0.4
years (SD = 0.2). Primary surgery of palate was performed by five plastic surgeons; in 15 patients the operation with two flaps, retroposition and pharynofixation
(2LR+P) was applied, in 15 patients the operation with
two flaps and retroposition (2LR) was chosen; the
mean age of patients was 2.2 years (SD = 1.2). 9 patients had been already orthodontically treated with
upper removable plate appliance, the mean length of
the therapy was 1.4 years (SD = 0.8).
www.orthodont-cz.cz e-mail: [email protected]
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Tab. 1. 5-lety index: KriteÂria pro zarÏazenõ do jednotlivyÂch skupin [23].
Tab. 1. 5-year index. Criteria for classification in individual groups [23].
2. TransverzaÂlnõÂ vztah u docÏasnyÂch hornõÂch sÏpicÏaÂkuÊ
v maximaÂlnõÂ interkuspidaci - hodnoceno zvlaÂsÏt' pro
stranu s rozsÏteÏpem a zvlaÂsÏt' pro stranu bez rozsÏteÏpu.
Byl hodnocen prÏekus docÏasneÂho hornõÂho sÏpicÏaÂku,
skus hrbolek na hrbolek a zaÂkus.
3. TransverzaÂlnõÂ vztah zubnõÂch obloukuÊ u docÏasnyÂch
druhyÂch hornõÂch molaÂruÊ v maximaÂlnõÂ interkuspidaci hodnoceno zvlaÂsÏt' pro stranu s rozsÏteÏpem a zvlaÂsÏt'
pro stranu bez rozsÏteÏpu. Byl hodnocen prÏekus docÏasneÂho druheÂho hornõÂho molaÂru, skus hrbolek na hrbolek
a zkrÏõÂzÏeny skus.
4. IncizaÂlnõÂ schuÊdek (OJ) - je vzdaÂlenost mezi labiaÂlnõÂ
plochou dolnõÂho strÏednõÂho rÏezaÂku a labiaÂlnõÂ plochou
hornõÂho strÏednõÂho rÏezaÂku v maximaÂlnõÂ interkuspidaci,
pro meÏrÏenõÂ byly pouzÏity rÏezaÂky s veÏtsÏõÂ anomaÂliõÂ (meÏrÏeno
vyÂsuvnyÂm hloubkomeÏrem na dolnõÂm konci posuvneÂho
meÏrÏõÂtka)
5. Hloubka skusu (OB) - je velikost vertikaÂlnõÂho prÏekrytõÂ dolnõÂho strÏednõÂho rÏezaÂku hornõÂm strÏednõÂm rÏezaÂkem, pro meÏrÏenõÂ byly pouzÏity rÏezaÂky s veÏtsÏõÂ anomaÂliõÂ
(meÏrÏeno vyÂsuvnyÂm hloubkomeÏrem na dolnõÂm konci
posuvneÂho meÏrÏõÂtka
6. DeÂlka hornõÂho (LUA) a dolnõÂho (LLA) zubnõÂho oblouku dle Moorreese [29] - je vzdaÂlenost strÏedu spojnice tecÏen k vestibulaÂrnõÂm plosÏkaÂm docÏasnyÂch strÏednõÂch hornõÂch a dolnõÂch rÏezaÂkuÊ a spojnice distaÂlnõÂch
aproximaÂlnõÂch plosÏek docÏasnyÂch druhyÂch hornõÂch
a dolnõÂch molaÂruÊ.
7. HodnocenõÂ vztahu zubnõÂch obloukuÊ v maximaÂlnõÂ
interkuspidaci pomocõ 5-leteÂho indexu: kazÏdy pacient
byl zarÏazen do jedne z peÏti skupin, kde skupina 1 je nejlepsÏõ a skupina 5 je nejhorsÏõÂ, rozdeÏlenõ do skupin bylo
podle sagitaÂlnõÂho, transverzaÂlnõÂho a vertikaÂlnõÂho
vztahu zubnõÂch obloukuÊ (Tab. 1).
www.orthodont-cz.cz e-mail: [email protected]
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Methods
The evaluation was performed on study models of
the upper and lower arch, together with wax bite register. All measurements and assessments of study models were made by one and the same evaluator, three
times, with the interval of one month between the individual measurements. For further evaluation the mean
values of the three measurements were used. Slide caliper (Somet), the accuracy of 0.1 mm was used; the
length of upper and lower dental arches was measured
with Korkhaus millimeter caliper (Dentaurum). Statistical processing of the data was performed by Ing. ZdeneÏk Roth, CSc., with software SPSS, version 12Ò and
in MS ExcelÒ.
Evaluated and measured parameters:
1. Baume classification - it evaluates the relationship of dental arches in anterio-posterior direction according to the relationship of temporary second molars in the maximum intercuspation. The side with cleft
and the noncleft side were evaluated separately.
2. Transversal relationship in deciduous canines in
maximum intercuspation - evaluated separately for
each side. Overbite of temporary upper canine, cusp
to cusp bite, and lingual occlusion of upper canine
were evaluated.
3. Transversal relationship of dental arches in temporary second upper molars in maximum intercuspation - evaluated separately for each side. Overbite of
temporary second upper molar, cusp to cusp bite,
and crossbite were evaluated.
4. Overjet (OJ) - it is the distance between the labial
surface of lower central incisor and the labial surface of
upper central incisor in maximum intercuspation; inci215
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VyÂsledky
PruÊmeÏrna hodnota pro 5-lety index v celeÂm souboru
byla 3,3 (SD = 1,0). ProcentuaÂlnõÂ zastoupenõÂ jednotlivyÂch
skupin bylo: 1. skupina 0 %, 2. skupina 30 %, 3. skupina
26,7 %, 4. skupina 30 % a 5. skupina 13, 3%.
Klasifikace dle Baumea na straneÏ rozsÏteÏpu byla I.
trÏõÂda 60 %, II. trÏõÂda 3,3 %, III. trÏõÂda 36,7 %, na straneÏ
bez rozsÏteÏpu byla I. trÏõÂda 63,3 %, II. trÏõÂda 0 %, III. trÏõÂda
36,7 %.
PruÊmeÏrna hodnota incizaÂlnõÂho schuÊdku byla -0,72
mm (SD = 2,76) a hloubka skusu 2,05 mm (SD = 1,65).
U transverzaÂlnõÂch vztahuÊ docÏasnyÂch sÏpicÏaÂkuÊ na
straneÏ rozsÏteÏpu byl prÏekus 16,66 %, skus hrbolek na
hrbolek 6,66 % a zkrÏõÂzÏeny skus 76,6 6%, na straneÏ
bez rozsÏteÏpu byl prÏekus 73,33 %, skus hrbolek na
hrbolek 13,33 % a zkrÏõÂzÏeny skus 13,33 %.
U transverzaÂlnõÂch mezicÏelistnõÂch vztahuÊ docÏasnyÂch
druhyÂch molaÂruÊ na straneÏ rozsÏteÏpu byl prÏekus 83,33
%, skus hrbolek na hrbolek 10 % a zkrÏõÂzÏeny skus
6,66 %, na straneÏ bez rozsÏteÏpu byl prÏekus 83,33 %,
skus hrbolek na hrbolek 10 % a zkrÏõÂzÏeny skus 6,66 %.
DeÂlka hornõÂho zubnõÂho oblouku byla 25,59 mm (SD
= 2,29) a deÂlka dolnõÂho zubnõÂho oblouku byla 24, 98
mm (SD = 1,44).
CÏasna primaÂrnõ operace rtu (jako cÏasna byla oznacÏena operace provedena do 3 meÏsõÂcuÊ od narozenõ dõÂteÏte) ma horsÏõ vyÂsledky nezÏ pozdnõÂ. Pomocõ t-testu byl
nalezen signifikantnõÂ rozdõÂl u 5-leteÂho indexu (p =
0,018), klasifikace dle Baumea na straneÏ rozsÏteÏpu (p
= 0,002), incizaÂlnõÂho schuÊdku (p = 0,002) a veÏku provedenõÂ primaÂrnõÂ operace patra (p = 0,001).
HodnocenõÂm primaÂrnõÂ operace patra s faryngofixacõÂ
a bez faryngofixace pomocõÂ t-testu byl nalezen signifikantnõÂ rozdõÂl u incizaÂlnõÂho schuÊdku (p = 0,045), u deÂlky
hornõÂho zubnõÂho oblouku (p = 0,028) a veÏku provedenõÂ
primaÂrnõÂ operace patra (p < 0,001).
PearsonovyÂm c2 testem byl nalezen signifikantnõÂ
vztah mezi transverzaÂlnõÂm vztahem docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ bez rozsÏteÏpu a 5-letyÂm indexem (p =
0,013) a tento vztah je lineaÂrnõÂ (p = 0,002).
McNemaruÊv test prokaÂzal signifikantnõÂ rozdõÂl mezi
transverzaÂlnõÂm vztahem docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ
s rozsÏteÏpem a na straneÏ bez rozsÏteÏpu (p = 0,001).
PearsonovyÂmi korelacÏnõÂmi koeficienty byly zjisÏteÏny
korelace mezi daty zobrazenyÂmi v tabulce 2.
Diskuse
Dosud neznaÂme jednotnou odpoveÏd' na otaÂzku
¹Kdy nejleÂpe operovat a jakou chirurgickou techniku
zvolit pro primaÂrnõÂ rekonstrukci rtu a patra u pacientuÊ
s celkovyÂm jednostrannyÂm rozsÏteÏpem, abychom dosaÂhli co nejlepsÏõÂch funkcÏnõÂch i estetickyÂch vyÂsledkuÊ
s minimaÂlnõ zaÂteÏzÏõ pro pacienta?ª [30]. Touto problematikou se zabyÂvalo a staÂle zabyÂva rÏada odbornyÂch
216
ORTODONCIE
sors with more profound anomaly were chosen for the
measurement (measured with sliding depth gauge).
5. Overbite (OB) - it is the amount of vertical overlap
of lower central incisor with upper central incisor; incisors with more expressed anomaly were chosen for
the measurement (measured with sliding depth
gauge).
6. Length of upper dental arch (LUA) and length of
lower dental arch (LLA) according to Moorrees [29] it is the distance between a line tangent to the deciduous central upper and lower incisors and a line tangent to the distal crown surfaces of the deciduous
upper and lower second molars.
7. Assessment of the relationship of dental arches in
the maximum intercuspation with the help of 5-year index - each patient was put into one of the five groups,
where group 1 is the best, and group 5 the worst; classification into groups was done according to sagittal,
transversal, and vertical relationships of dental arches
(Tab. 1).
Results
The mean value of 5-year index in the whole sample
was 3.3 (SD = 1.0). The proportional representation of
individual groups was the following: group 1 - 0%,
group 2 - 30%, group 3 - 26.7%, group 4 = 30%, group
5 - 13.3%.
Baume classification on the cleft side: Class I - 60%,
Class II - 3.3%, Class III - 36.7%
Baume classification on the noncleft side: Class I 63.3%, Class II - 0%, Class III - 36.7%
The mean value of overjet was -0.72 mm (SD =
2.76), and overbite 2.05 mm (SD = 1.65)
Transversal relationships of deciduous canine - the
cleft side: overbite 16.66%, cusp to cusp bite 6.66%,
crossbite 76.6%; the noncleft side: overbite 73.33%,
cusp to cusp bite 13.33%, crossbite 13.33%.
Transversal relationships of deciduous second molars - the cleft side: overbite 83.33%, cusp to cusp bite
10%, crossbite 6.66%; the noncleft side: overbite
83.33%, cusp to cusp bite 10%, crossbite 6.66%.
Upper dental arch length was 25.59 mm (SD = 2.29),
lower dental arch length was 24.98 mm (SD = 1.44).
The early primary lip surgery (till 3 months of age)
has worse results than the late primary lip surgery.
The significant difference was found with t-test in 5year index (p = 0.018), Baume classification on the cleft
side (p = 0.002), overjet (p = 0.002), and the age in
which the primary palate surgery was performed (p =
0.001).
The evaluation of primary palate surgery with pharyngofixation and without pharyngofixation with t-test
revealed significant difference in overjet (p = 0.045),
length of upper dental arch (p = 0.028), and the age
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Tab. 2. Korelace mezi daty PearsonovyÂmi korelacÏnõÂmi koeficienty
Tab. 2. Correlation between the data with Pearson's correlation coefficients
CÏerveneÏ je oznacÏen statisticky signifikantnõÂ korelacÏnõÂ koeficient, statistically significant correlation coefficient is highlighted in red; * = 5% hladina
vyÂznamnosti, 5% level of significance, ** = 1% hladina vyÂznamnosti, 1% level of significance; Baume C = klasifikace dle Baumea na straneÏ rozsÏteÏpu, Baume classification on the cleft side; Baume NC = klasifikace dle Baumea na straneÏ bez rozsÏteÏpu, Baume classification on the noncleft
side; OJ = incizaÂlnõÂ schuÊdek, overjet; OB = hloubka skusu,overbite, Transv. m2 C = transverzaÂlnõÂ vztah u docÏasnyÂch druhyÂch molaÂruÊ na straneÏ
rozsÏteÏpu, transversal relationship in temporary second molars on the cleft side; Transv. m2 NC = transverzaÂlnõÂ vztah u docÏasnyÂch druhyÂch molaÂruÊ
na straneÏ bez rozsÏteÏpu, transversal relationship in temporary second molars on the noncleft side; Transv. c C = transverzaÂlnõÂ vztah u docÏasnyÂch
sÏpicÏaÂkuÊ na straneÏ rozsÏteÏpu, transversal relationship in temporary canines on the cleft side; Transv. c NC = transverzaÂlnõÂ vztah u docÏasnyÂch sÏpicÏaÂkuÊ
na straneÏ bez rozsÏteÏpu, transversal relationship in temporary canines on the noncleft side; LUA = deÂlka hornõÂho zubnõÂho oblouku, length of upper
dental arch; LLA = deÂlka dolnõÂho zubnõÂho oblouku, length of lower dental arch.
studiõÂ, jejichzÏ hlavnõÂm cõÂlem je zõÂskat optimaÂlnõÂ leÂcÏebnyÂ
protokol pro primaÂrnõÂ chirurgickou rekonstrukci rtu
a patra u pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem [6, 19, 22, 23, 31-35].
U naÂmi sledovaneÂho souboru byl statistickyÂm zpracovaÂnõÂm dat nalezen vztah mezi transverzaÂlnõÂm vztahem zubnõÂch obloukuÊ u docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ
bez rozsÏteÏpu a 5-letyÂm indexem, tento vztah je lineaÂrnõÂ,
kdy horsÏõ kategorie 5-leteÂho indexu odpovõÂda horsÏõÂmu
transverzaÂlnõÂmu vztahu zubnõÂch obloukuÊ u docÏasnyÂch
sÏpicÏaÂkuÊ na straneÏ bez rozsÏteÏpu. Tento vyÂsledek odpovõÂda kriteÂriõÂm pro zarÏazenõ pacientuÊ do jednotlivyÂch kategoriõ 5-leteÂho indexu [6]. Zde je nutno uprÏesnit, zÏe 5lety index je shovõÂvaveÏjsÏõ v hodnocenõ transverzaÂlnõÂch
vztahuÊ docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ rozsÏteÏpu a s kategoriemi 5-leteÂho indexu tak uÂzce nesouvisõÂ jako transverzaÂlnõÂ vztah docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ bez rozsÏteÏpu.
Byl prokaÂzaÂn rozdõÂl mezi transverzaÂlnõÂm vztahem
docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ s rozsÏteÏpem a na straneÏ
bez rozsÏteÏpu, kdy transverzaÂlnõ vztah docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ rozsÏteÏpu je horsÏõ nezÏ na straneÏ bez rozsÏteÏpu. To odpovõÂda cÏasteÂmu transverzaÂlnõÂmu kolapsu
a rotaci mensÏõÂho lateraÂlnõÂho segmentu na straneÏ rozsÏteÏpu, ktery zpuÊsobuje transverzaÂlnõ konstrikci prÏednõÂ
cÏaÂsti hornõÂho zubnõÂho oblouku [16] a zpuÊsobuje cÏastyÂ
vyÂskyt zkrÏõÂzÏeneÂho skusu praÂveÏ v oblasti docÏasneÂho
sÏpicÏaÂku na straneÏ rozsÏteÏpu [13].
PorovnaÂnõÂm primaÂrnõ operace rtu cÏasne (jako cÏasnaÂ
byla oznacÏena operace provedena do trÏõ meÏsõÂcuÊ od
narozenõÂ dõÂteÏte) a pozdnõÂ (jako pozdnõÂ byla oznacÏena
operace po trÏetõÂm meÏsõÂci veÏku dõÂteÏte) bylo zjisÏteÏno,
zÏe u cÏasne primaÂrnõ operace rtu byl horsÏõ 5-lety index,
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in which the primary palate surgery was performed (p <
0.001).
Pearson c2 test revealed significant relationship
between the transversal relationship of temporary canines on the noncleft side and 5-year index (p = 0.013),
and this relationship is linear (p = 0.002).
McNemar test proved a significant difference between the transversal relationship of temporary canines
on the cleft side and the noncleft side (p = 0.001).
Pearson correlation coefficients revealed correlations between the data given in Table 2.
Discussion
¹When is the optimum time for primary lip and palate
surgery in patients with complete unilateral cleft lip and
palate, and which surgery technique to choose in order
to achieve the best possible functional and esthetic results with the minimum discomfort for the patient?ª the answer has not been agreed upon yet [30]. The problem has been the topic of a number of studies the
main objective of which is to establish the optimum
treatment protocol for the primary surgery of lip and
palate in patients with UCLP [6, 19, 22, 23, 31-35]. In
our sample of patients, the statistically processed data
revealed the relationship between the transversal relationship of dental arches in temporary canines on the
noncleft side and 5-year index. The relationship is linear; the worse category of 5-year index corresponds
to the worse transversal relationship of dental arches in
temporary canines on the noncleft side. This result
meets the criteria of classification of patients into individual subclasses of 5-year index [6]. It should be pointed out that 5-year index is more tolerant in the eva217
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ORTODONCIE
horsÏõÂ klasifikace dle Baumea na straneÏ rozsÏteÏpu, horsÏõÂ
incizaÂlnõÂ schuÊdek a pacienti drÏõÂve podstoupili primaÂrnõÂ
rekonstrukci patra. Ze zõÂskanyÂch vyÂsledkuÊ vyplyÂvaÂ, zÏe
jizÏ v 5 letech lze naleÂzt rozdõÂly ve vztazõÂch zubnõÂch obloukuÊ, kdy drÏõÂveÏjsÏõ provedenõ primaÂrnõ chirurgicke rekonstrukce rtu vykazuje horsÏõ vyÂsledky ruÊstu a vyÂvoje
hornõÂ cÏelisti [8]. ProtozÏe soucÏasneÏ s cÏasnou primaÂrnõÂ
rekonstrukcõ rtu take dosÏlo ke zmeÏneÏ nacÏasovaÂnõ primaÂrnõ rekonstrukce patra v rozsÏteÏpoveÂm centru FNKV,
ktera se z puÊvodnõÂch trÏõ let veÏku dõÂteÏte zacÏala provaÂdeÏt
jizÏ okolo jednoho roku dõÂteÏte, nelze veÏtsÏõÂ negativnõÂ vliv
na ruÊst a vyÂvoj hornõ cÏelisti prÏisuzovat pouze cÏasne primaÂrnõ rekonstrukci rtu, ale take zrÏejmeÏ drÏõÂve provedeneÂ
primaÂrnõÂ rekonstrukci patra [20, 36].
luation of transversal relationships of temporary canines on the cleft side and is not so closely related to
5-year index of the transversal relationship of temporary canines on the noncleft side.
PorovnaÂnõÂm primaÂrnõÂ operace patra s faryngofyxacõÂ
a bez faryngofixace bylo zjisÏteÏno, zÏe u primaÂrnõÂ rekonstrukce patra s faryngofixacõÂ meÏli pacienti lepsÏõÂ incizaÂlnõÂ schuÊdek, veÏtsÏõÂ deÂlku hornõÂho zubnõÂho oblouku
a primaÂrnõÂ rekonstrukce patra byla provedena pozdeÏji.
V prÏedchozõÂch studiõÂch byl prokaÂzaÂn negativnõ vliv faryngofixace na ruÊst hornõ cÏelisti do deÂlky, ktery se
podle JelõÂnka projevõÂ ihned po rekonstrukci, dalsÏõÂ ruÊst
pokracÏuje normaÂlneÏ, ale ruÊstovy deficit hornõ cÏelisti
do deÂlky jizÏ zuÊstane [37]. Z tohoto duÊvodu se faryngofixace prÏestala od roku 2005 v rozsÏteÏpoveÂm centru
FNKV rutinneÏ provaÂdeÏt [2]. Ze zjisÏteÏnyÂch vyÂsledkuÊ se
ale zdaÂ, zÏe faryngofixace provedena ve trÏech letech
spolecÏneÏ s primaÂrnõ rekonstrukcõ patra ma mensÏõ negativnõ vliv na ruÊst a vyÂvoj hornõ cÏelisti do peÏti let veÏku
dõÂteÏte, nezÏ cÏasna primaÂrnõ rekonstrukce patra bez faryngofixace provedena okolo jednoho roku dõÂteÏte,
cozÏ opeÏt potvrzuje zaÂveÏry rÏady studiõÂ, zÏe cÏasna primaÂrnõ rekonstrukce patra ma veÏtsÏõ negativnõ efekt na
ruÊst a vyÂvoj hornõ cÏelisti oproti pozdeÏji provedene primaÂrnõ rekonstrukci patra [20, 36]. OpeÏt je nutno prÏipomenout, zÏe soucÏasneÏ s drÏõÂveÏjsÏõ primaÂrnõ rekonstrukcõÂ
patra se v rozsÏteÏpoveÂm centru FNKV zacÏala take provaÂdeÏt cÏasna primaÂrnõ rekonstrukce rtu, ktera ma sice
velmi dobre vyÂsledky co se tyÂka estetiky rtu, nosu, jizvy
[38] a rozvoje rÏecÏi [3, 16, 37], ale na druhou stranu maÂ
veÏtsÏõÂ negativnõÂ vliv na ruÊst a vyÂvoj hornõÂ cÏelisti oproti
pozdeÏji provedene primaÂrnõ rekonstrukci rtu [8, 16,
20, 36, 37]. Z teÏchto zjisÏteÏnõÂ vyplyÂvaÂ, zÏe by bylo vhodneÂ
v dalsÏõÂm zkoumaÂnõ porovnat, zda se zjisÏteÏne vyÂsledky
tyÂkajõ pouze pacientuÊ v peÏti letech nebo budou obdobne take v pozdeÏjsÏõÂm veÏku pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem.
The comparison of early primary lip surgery (performed till 3 months after birth) and the late one (after 3
months of age) revealed that in the early lip surgery
the 5-year index was worse as well as Baume classification on cleft side and overjet, and the patients underwent the primary palate surgery earlier. The results
suggest that we can find the differences in the relationship of dental arches as early as in 5-year old children - the early primary lip surgery leads to worse
growth and development of the maxilla [8]. Due to
the fact that in the our Cleft Centre the primary palate
surgery was performed around 1 year of the age (originally it was at the age of 3), the negative impact on the
maxilla growth and development may be attributed
also to the early primary palate surgery [20, 36].
S horsÏõÂ kategoriõÂ 5-leteÂho indexu se zhorsÏuje klasifikace dle Baumea na straneÏ s i bez rozsÏteÏpu, zhorsÏuje
se incizaÂlnõÂ schuÊdek smeÏrem k zaÂpornyÂm hodnotaÂm
a obraÂceneÂmu skusu, zveÏtsÏuje se hloubka skusu, zhorsÏuje se transverzaÂlnõÂ vztah zubnõÂch obloukuÊ u docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ bez rozsÏteÏpu a zmensÏuje se
deÂlka hornõÂho zubnõÂho oblouku. Tyto vyÂsledky odpovõÂ218
We proved the difference between the transversal
relationship of temporary canines on the cleft side
and on the noncleft side - the transversal relationship
of temporary canines is worse on the cleft side. This
corresponds to the frequent transversal collapse and
rotation of a smaller lateral segment on the cleft side
which leads to transversal constriction of the anterior
part of the upper dental arch [16] and to frequent crossbite in the place of temporary canine on the cleft side
[13].
The comparison of primary palate surgery with pharyngofixation and without pharyngofixation revealed
that in the former the patients had better values for
overjet, longer dental arch, and the primary palate surgery was performed later. Previous works proved negative impact of pharyngofixation on the growth of
the maxilla in length that is - according to JelõÂnek [37]
- manifested immediately after the reconstruction;
the growth then continues in a normal way, however,
the growth deficiency of the maxilla is never eliminated. Therefore, since 2005 pharyngofixation is not routinely used in our Cleft Centre [2]. Nevertheless, the results obtained suggest that pharyngofixation performed at the age of 3 alongside the primary palate
surgery has lower negative impact on the growth and
development of the maxilla performed until the age of
5, than the early primary surgery of palate without pharyngofixation performed around the age of 1. This finding agrees with a number of works conclusions stating that the early primary surgery of palate has more
negative effect on the growth and development of
the maxilla compared to the palate surgery done later
[20, 36]. We have to remind that in our Cleft Centre
the early primary lip surgery started to be carried out
alongside the primary palate surgery. The early primary
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dajõÂ kriteÂriõÂm pro zarÏazenõÂ pacientuÊ do jednotlivyÂch kategoriõÂ 5-leteÂho indexu [19, 22, 23].
S horsÏõÂ klasifikacõÂ dle Baumea na straneÏ s i bez rozsÏteÏpu se zhorsÏuje kategorie 5-leteÂho indexu, zhorsÏuje
se incizaÂlnõÂ schuÊdek smeÏrem k zaÂpornyÂm hodnotaÂm
a obraÂceneÂmu skusu a zhorsÏuje se transverzaÂlnõÂ vztah
zubnõÂch obloukuÊ u docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ rozsÏteÏpu. S horsÏõÂ klasifikacõÂ dle Baumea na straneÏ bez rozsÏteÏpu se navõÂc zveÏtsÏuje hloubka skusu, zhorsÏuje se
transverzaÂlnõÂ vztah zubnõÂch obloukuÊ u docÏasnyÂch druhyÂm molaÂruÊ na straneÏ s i bez rozsÏteÏpu a zmensÏuje se
deÂlka hornõÂho zubnõÂho oblouku. Z uvedenyÂch vyÂsledkuÊ
vyplyÂvaÂ, zÏe veÏtsÏõÂ postizÏenõÂ hornõÂ cÏelisti muÊzÏeme ocÏekaÂvat, vyskytuje-li se horsÏõÂ klasifikace dle Baumea (ve
smyslu III. trÏõÂdy) na straneÏ bez rozsÏteÏpu.
S horsÏõÂm incizaÂlnõÂm schuÊdkem smeÏrem k zaÂpornyÂm
hodnotaÂm a obraÂceneÂmu skusu se zhorsÏuje kategorie
5-leteÂho indexu, zhorsÏuje se klasifikace dle Baumea na
straneÏ s i bez rozsÏteÏpu, zhorsÏuje se transverzaÂlnõÂ vztah
zubnõÂch obloukuÊ u docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ bez
rozsÏteÏpu, zmensÏuje se deÂlka hornõÂho zubnõÂho oblouku.
Z uvedenyÂch vyÂsledkuÊ muÊzÏeme usuzovat na to, zÏe se
zhorsÏujõÂcõÂm se (zaÂpornyÂm) incizaÂlnõÂm schuÊdkem se
zmensÏuje ruÊst hornõ cÏelisti do deÂlky, cozÏ odpovõÂda obdobnyÂm zaÂveÏruÊm DiBiase, Garrahy a Gariba [6, 7, 10].
S veÏtsÏõÂ hloubkou skusu se zhorsÏuje kategorie 5-leteÂho indexu a zhorsÏuje se klasifikace dle Baumea na
straneÏ bez rozsÏteÏpu. U veÏtsÏõÂ velikosti hloubky skusu
u peÏtiletyÂch pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem lze usuzovat na vyÂrazneÏjsÏõÂ postizÏenõÂ hornõÂ cÏelisti.
S horsÏõÂm transverzaÂlnõÂm vztahem zubnõÂch obloukuÊ
u docÏasnyÂch druhyÂch molaÂruÊ na straneÏ s rozsÏteÏpem
i bez rozsÏteÏpu se zhorsÏuje klasifikace dle Baumea na
straneÏ bez rozsÏteÏpu a zhorsÏuje se transverzaÂlnõÂ vztah
zubnõÂch obloukuÊ u docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ bez
rozsÏteÏpu. ProtozÏe u sledovaneÂho souboru pacientuÊ
je absolutnõÂ korelace mezi transverzaÂlnõÂm vztahem
zubnõÂch obloukuÊ u docÏasnyÂch druhyÂch molaÂruÊ na
straneÏ s a bez rozsÏteÏpu, platõ vyÂsÏe zmõÂneÏne vyÂsledky
pro obeÏ strany, ale opeÏt se ukazuje, zÏe s horsÏõÂm transverzaÂlnõÂm vztahem zubnõÂch obloukuÊ u docÏasnyÂch
druhyÂch molaÂruÊ na straneÏ bez rozsÏteÏpu se zhorsÏuje postizÏenõ cele nerozsÏteÏpove strany a tedy celkove postizÏenõ hornõ cÏelisti.
S horsÏõÂm transverzaÂlnõÂm vztahem zubnõÂch obloukuÊ
u docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ rozsÏteÏpu se zhorsÏuje
klasifikace dle Baumea na straneÏ bez rozsÏteÏpu. S horsÏõÂm transverzaÂlnõÂm vztahem zubnõÂch obloukuÊ u docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ bez rozsÏteÏpu se zhorsÏuje kategorie 5-leteÂho indexu, zhorsÏuje se klasifikace dle Baumea na straneÏ rozsÏteÏpu, zhorsÏuje se incizaÂlnõÂ schuÊdek
smeÏrem k zaÂpornyÂm hodnotaÂm a obraÂceneÂmu skusu
a zmensÏuje se deÂlka hornõÂho zubnõÂho oblouku. Z uvedenyÂch vyÂsledkuÊ lze usuzovat na to, zÏe daleko horsÏõÂ
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lip surgery shows good results in the esthetics of lip,
nose, scar [38], and speech development [3, 16, 37].
On the other hand, we can see more negative impact
on the growth and development of the maxilla compared with the condition after the primary lip surgery performed later [8, 16, 20, 36, 37]. We should further find
out whether the results apply only to the patients of the
age of 5, or whether there are similar results in older patients with complete UCLP.
In case the 5-year index is worse, Baume classification is worse both on the cleft side and the noncleft
side, overjet worsens to negative values and reversed
bite, overbite is more profound, the transversal relationship of dental arches in temporary canines on the
noncleft side is worse, and the length of upper dental
arch is reduced. The results correspond to the criteria
for patients classification in individual categories of 5year index [19, 22, 23].
Worse Baume classification in both sides (with and
without cleft) is related to a worse category of 5-year
index, overjet worsens towards negative values and
reversed bite, and there is worse transversal relationship of dental arches in temporary canines on the cleft
side. Worse Baume classification on the noncleft side
is related to deeper bite, worse transversal relationship
of dental arches in temporary second molars on both
sides (with and without cleft), and the length of upper
dental arch is reduced. The results suggest that the
maxilla is more affected in case Baume classification
is worse (i.e. Class III) on the noncleft side.
Worse overjet - negative values and reversed bite - relates to worsened categories of 5-year index, worse
Baume classification on both sides (with and without
cleft), worse transversal relationship of dental arches
in temporary canines on the noncleft side, and reduced
length of the upper dental arch. The results suggest
that with worsened (negative) overjet, the growth of
the maxilla is reduced in length which agrees with the
conclusions made by DiBias, Garraha and Garib [6,
7, 10].
The deeper bite is associated with worsened categories of 5-year index and Baume classification on
the noncleft side. Deeper overbite in 5 year-old patients with complete UCLP results in more distinct impairment of the maxilla.
Worse transversal relationship of dental arches in
temporary second molars on both sides (with and without cleft) is associated with worse Baume classification on the noncleft side, and worse transversal relationship of dental arches in temporary canines on the
noncleft side. In the sample of patients monitored
there is an absolute correlation between transversal
relationship of dental arches in temporary second molars on both sides (with and without cleft), the above gi219
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postizÏenõÂ hornõÂ cÏelisti muÊzÏeme ocÏekaÂvat nejen u horsÏõÂ
klasifikace dle Baumea na straneÏ bez rozsÏteÏpu a u horsÏõÂch transverzaÂlnõÂch vztahuÊ zubnõÂch obloukuÊ u docÏasnyÂch druhyÂch molaÂruÊ na straneÏ bez rozsÏteÏpu, ale soucÏasneÏ take u horsÏõÂch transverzaÂlnõÂch vztahuÊ u docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ bez rozsÏteÏpu. PodõÂvaÂme-li se
tedy prÏi vysÏetrÏenõ pacienta na prostorove pomeÏry hornõÂ
cÏelisti a vztahy zubnõÂch obloukuÊ na straneÏ bez rozsÏteÏpu, muÊzÏeme zrÏejmeÏ pomeÏrneÏ dobrÏe odhadnout
mõÂru a zaÂvazÏnost celkoveÂho postizÏenõ hornõ cÏelisti. Obdobne vyÂsledky v odborne literaturÏe - stranove rozlisÏenõ prÏi hodnocenõ zaÂvazÏnosti rozsÏteÏpoveÂho postizÏenõÂ
hornõÂ cÏelisti nebyly nalezeny.
S mensÏõÂ deÂlkou hornõÂho zubnõÂho oblouku se zhorsÏuje kategorie 5-leteÂho indexu, zhorsÏuje se incizaÂlnõÂ
schuÊdek smeÏrem k zaÂpornyÂm hodnotaÂm a obraÂceneÂmu skusu a zhorsÏuje se transverzaÂlnõÂ vztah zubnõÂch
obloukuÊ u docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ bez rozsÏteÏpu,
cozÏ odpovõÂda zaÂveÏruÊm mnoha studiõ [6, 7, 10, 19, 22,
23] a take se zhorsÏuje klasifikace dle Baumea na straneÏ
bez rozsÏteÏpu. Tyto vyÂsledky zrÏejmeÏ souvisejõÂ nejen
s mensÏõ deÂlkou hornõÂho zubnõÂho oblouku, ale take s celkoveÏ kratsÏõ hornõ cÏelistõ u pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem [39].
TeÂmeÏrÏ u 37 % pacientuÊ sledovaneÂho souboru se vyskytovala III. trÏõÂda dle Baumea v docÏasnyÂch druhyÂch
molaÂrech na rozsÏteÏpove straneÏ i straneÏ bez rozsÏteÏpu
a u 63 % pacientuÊ byl frontaÂlnõ obraÂceny skus v docÏasnyÂch rÏezaÂcõÂch, cozÏ odpovõÂda cÏasteÏjsÏõÂmu vyÂskytu III.
trÏõÂd u pacientuÊ s rozsÏteÏpem a pseudoprogennõÂmu
stavu z duÊvodu mensÏõ hornõ cÏelisti. DocÏasny hornõ sÏpicÏaÂk na straneÏ rozsÏteÏpu byl v 83 % ve zkrÏõÂzÏeneÂm cÏi hranoveÂm skusu, zatõÂmco na straneÏ bez rozsÏteÏpu jen v necelyÂch 27 % a docÏasny druhy molaÂr na straneÏ rozsÏteÏpu
i bez rozsÏteÏpu byl ve zkrÏõÂzÏeneÂm cÏi hrbolkoveÂm skusu
v necelyÂch 17 %. TransverzaÂlnõÂ kolaps zubnõÂch obloukuÊ je tedy vyÂrazneÏjsÏõÂ ve prÏednõÂ cÏaÂsti hornõÂho zubnõÂho
oblouku v oblasti docÏasnyÂch sÏpicÏaÂkuÊ a hlavneÏ na
straneÏ rozsÏteÏpu, cozÏ odpovõÂda uÂdajuÊm v odborne literaturÏe [16, 40, 41]. Nenõ prÏesneÏ diskutovaÂno, jaka maÂ
byÂt u peÏtiletyÂch deÏtõÂ hloubka skusu, ale naÂmi nameÏrÏenaÂ
pruÊmeÏrna hodnota 2 mm zrÏejmeÏ odpovõÂda pruÊmeÏrnyÂm
hodnotaÂm u deÏtõÂ v peÏti letech veÏku.
HodnocenõÂm vztahuÊ zubnõÂch obloukuÊ u pacientuÊ
s celkovyÂm jednostrannyÂm rozsÏteÏpem pomocõÂ 5-leteÂho indexu jsme zõÂskali pruÊmeÏrnou hodnotu indexu
3,3 (SD = 1,0) a naÂsledujõÂcõÂ procentuaÂlnõÂ zastoupenõÂ
jednotlivyÂch skupin 5-leteÂho indexu: 1. skupina 0 %,
2. skupina 30 %, 3. skupina 26,7 %, 4. skupina 30 %
a 5. skupina 13,3 %.
PrÏi porovnaÂnõÂ naÂmi zjisÏteÏnyÂch vyÂsledkuÊ 5-leteÂho indexu s jinyÂmi rozsÏteÏpovyÂmi centry, zemeÏmi a odbornyÂmi
studiemi je na prvnõÂ pohled zrÏejmeÂ, zÏe rozdõÂly ve vyÂsledcõÂch leÂcÏby primaÂrnõÂ rekonstrukce rtu a patra mezi centry
220
ORTODONCIE
ven results are valid for both sides. However, worse
transversal relationship of dental arches in temporary
second molars on the noncleft side is associated with
more profound impairment of the whole noncleft side,
and therefore with the overall impairment of the maxilla.
Worse transversal relationship of dental arches in
temporary canines on the cleft side is related to worse
Baume classification on the noncleft side. Worse transversal relationship of dental arches in temporary canines on the noncleft side is associated with worse category of 5-year index, Baume classification on the cleft
side, overjet worsenes to negative values and reversed
bite, and upper dental arch length is reduced. The results suggest that we can expect much more profound
impairment of the maxilla not only in case of worse
Baume classification on the noncleft side and worse
transversal relationships of dental arches in temporary
second molars on the noncleft side, but also in case of
worsened transversal relationships in temporary canines on the noncleft side. If we evaluate space conditions of the maxilla and relationships of dental arches
on the noncleft side during a patient's examination,
we can estimate the extent and gravity of the overall
impairment of the maxilla. We did not find corresponding results in the professional literature available.
Reduced length of the upper dental arch is associated with worse category of 5-year index, overjet worsenes to negative values and reversed bite as well as the
transversal relationship of dental arches in temporary
canines on the noncleft side. This finding agrees to
those reported by a number of studies [6, 7, 10, 19,
22, 23]. Baume classification on the noncleft side worsens, too. The results are related not only to reduced
length of the upper dental arch but also to overall reduced maxilla in patients with complete UCLP [39].
Almost in 37% of patients included in the sample
there was Baume Class III in temporary second molars
on both cleft and noncleft side; in 63% frontal reversed
bite in temporary incisors which corresponds with
more frequent occurrence of Class III in patients with
cleft and pseudoprognathism condition due to reduced maxilla. In 83% temporary upper canine on the
cleft side was in crossbite or cusp to cusp bite (on
the noncleft side it was about 27%); temporary second
molar on both sides was in crossbite or cusp to cusp
bite in 17% of patients. The transversal collapse of
dental arches is therefore more expressed in the anterior segment of the upper dental arch in the area of
temporary canines, and more often occurs on the cleft
side which agrees with the data given in the literature
[16, 40, 41]. The correct overbite in five-year old children was not established. However, the mean value of 2
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existujõÂ a zÏe jizÏ v peÏti letech lze najõÂt rozdõÂly ve vztazõÂch
zubnõÂch obloukuÊ u pacientuÊ s celkovyÂm jednostrannyÂm
rozsÏteÏpem [18, 19, 20]. ProtozÏe jednõÂm z faktoruÊ, jenzÏ
negativneÏ ovlivnÏuje ruÊst a vyÂvoj hornõ cÏelisti, je vliv primaÂrnõ chirurgicke rekonstrukce rtu a patra, je minimalizace negativnõÂch uÂcÏinkuÊ primaÂrnõ rekonstrukce rtu a patra velmi duÊlezÏitaÂ. Negativnõ vliv primaÂrnõ rekonstrukce
lze zmõÂrnit sÏetrnyÂm prÏõÂstupem chirurga, spraÂvnyÂm nacÏasovaÂnõÂm provedenõ operace a vhodneÏ zvolenou operacÏnõ technikou, ktera zpuÊsobuje minimaÂlnõ obnazÏenõÂ
patrove kosti s minimaÂlnõ tvorbou jizevnate tkaÂneÏ. DalsÏõÂmi faktory, jezÏ zlepsÏujõ vyÂsledky primaÂrnõ rekonstrukce
rtu a patra je centralizace leÂcÏby, jednotny leÂcÏebny protokol a nõÂzky pocÏet specializovanyÂch chirurguÊ na rozsÏteÏpoveÂm pracovisÏti [19, 20, 27, 26, 28].
Zde je nutno podotknout, zÏe v rozsÏteÏpoveÂm centru
FNKV dosÏlo v roce 2005 ke zmeÏneÏ leÂcÏebneÂho protokolu. Byl vyÂsledkem pokracÏujõÂcõÂho trendu co nejlepsÏõÂho prÏijetõÂ a zacÏleneÏnõÂ pacienta s rozsÏteÏpem do rodiny a snahy vyuzÏõÂt fetaÂlnõÂho typu hojenõÂ jizvy, co se
tyÂka primaÂrnõ rekonstrukce rtu, a take tlakem z rÏad foniatruÊ z duÊvodu spraÂvneÂho rozvoje rÏecÏi, co se tyÂka primaÂrnõ rekonstrukce patra. ZacÏaly se proto provaÂdeÏt
cÏasne primaÂrnõ rekonstrukce rtu, ktere se provaÂdeÏjõÂ
v prvnõÂch dnech po narozenõÂ dõÂteÏte (pro hodnocenõÂ sledovaneÂho souboru jsme jako cÏasnou primaÂrnõÂ rekonstrukci oznacÏili rekonstrukci rtu provedenou do trÏetõÂho
meÏsõÂce veÏku dõÂteÏte), oproti puÊvodnõÂmu nacÏasovaÂnõÂ primaÂrnõÂ rekonstrukce rtu okolo 3.-6. meÏsõÂce veÏku. TakeÂ
dosÏlo ke zmeÏneÏ nacÏasovaÂnõ a typu primaÂrnõ rekonstrukce patra, ktera se drÏõÂve provaÂdeÏla okolo trÏetõÂho
roku veÏku dõÂteÏte technikou dva laloky a retropozice
dle Bardacha a navõÂc se jesÏteÏ provaÂdeÏla faryngofixace
pro zlepsÏenõ rÏecÏi. Od roku 2005 se nejen upustilo od rutinneÏ provaÂdeÏne faryngofixace, ale celkoveÏ se nacÏasovaÂnõ primaÂrnõ rekonstrukce patra prÏesunulo do obdobõÂ
prÏed rozvojem rÏecÏi dõÂteÏte, tedy okolo 10.-12. meÏsõÂce
veÏku. Mezi dalsÏõ zmeÏnu, kterou zaznamenalo rozsÏteÏpove pracovisÏteÏ FNKV, se stala zmeÏna v zastoupenõÂ
tyÂmu plastickyÂch chirurguÊ, kdy sledovany soubor pacientuÊ byl operovaÂn peÏti plastickyÂmi chirurgy z duÊvodu
probõÂhajõÂcõÂ generacÏnõÂ obmeÏny chirurgickeÂho tyÂmu
FNKV. Obr. 3 zachycuje srovnaÂnõÂ pomocõÂ 5-leteÂho indexu a obr. 4 zachycuje srovnaÂnõÂ pomocõÂ modifikovaneÂho 5-leteÂho indexu mezi jednotlivyÂmi rozsÏteÏpovyÂmi
centry, odbornyÂmi studiemi a zemeÏmi [1, 6, 8, 14, 19,
20, 21, 25, 26, 31, 34, 35, 42, 28, 43, 44].
Ze srovnaÂnõÂ mezi centry je patrneÂ, zÏe existuje velkaÂ
variabilita v leÂcÏebnyÂch protokolech pro primaÂrnõÂ chirurgickou rekonstrukci rtu a patra u pacientuÊ s celkovyÂm
jednostrannyÂm rozsÏteÏpem v jednotlivyÂch rozsÏteÏpovyÂch
centrech. SrovnaÂnõÂm center pomocõÂ 5-leteÂho indexu
se rÏadõ rozsÏteÏpove pracovisÏteÏ FNKV do spodnõ trÏetiny
na zÏebrÏõÂcÏku uÂspeÏsÏnosti vyÂsledkuÊ primaÂrnõÂ chirurgickeÂ
www.orthodont-cz.cz e-mail: [email protected]
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mm (measured by us) probably corresponds with
mean values measured in five-year old children.
By means of assessment of dental arches relationships in patients with complete UCLP with 5-year index
we got the mean value of the index 3.3 (SD = 1.0) and
the following proportion (in per cents) of individual
groups of 5-year index: Group 1 = 0%, group 2 =
30%, group 3 = 26.7%, group 4 = 30%, group 5 =
13.3%.
The comparison of our results of 5-year index with
other cleft centres, countries and studies, reveals that
there are different results of the primary lip and palate
surgery, and that as early as in five year olds we can
find differences in the relationship of dental arches in
patients with complete UCLP [18, 19, 20]. Because
one of the factors affecting adversely the growth and
development of the maxilla is the impact of primary
surgery of lip and palate, it is very important to minimize negative effects of the surgery. This can be achieved through considerate approach of a surgeon, correct timing of the surgery, and appropriately chosen
type of technique, i.e. minimum exposition of palate
bone and minimum formation of scar tissue. Other factors leading to better results of the surgery include
treatment centralization, unified treatment protocol,
and low number of specialized surgeons in the cleft department [19, 20, 27, 26, 28].
In our Cleft Department the treatment protocol was
modified in 2005 as the result of the continuous tendency to achieve the best possible acceptance and integration of a cleft patient in the family, and the attempt
to use fetal type of scar healing (in case of primary lip
surgery), and also due to the efforts of phoniatrists related to correct development of speech (in case of primary palate surgery). Therefore, we started to perform
early primary lip surgery during first days after a child
birth (by the early surgery we mean the lip surgery performed until 3 months of the age). Originally, the primary lip surgery was planned around 3 - 6 months of
the age. The same applies to primary palate surgery.
Before, it was performed in children of about 3 years
old, the Bardach technique with two flaps and retroposition, and pharyngofixation for the improved speech.
Since 2005 we abandoned routine pharyngofixation,
and the primary palate surgery is performed at the time
before speech development, i.e. around 10 - 12
months of the age. There were also the changes in
the team of plastic surgeons: the sample of patients
was treated by five plastic surgeons due to alternation
of generations within the team of surgeons in University Hospital KraÂlovske Vinohrady, Prague. Fig. 3 gives
the comparison with help of 5-year index, Fig. 4 gives
the comparison with the help of a modified 5-year old
index between individual cleft centres, studies, and
221
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cÏ. 4. 2014
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ORTODONCIE
Obr. 3. Mezicentrove srovnaÂnõ pomocõ 5-leteÂho indexu: Dutchcleft, Holandsko, 2004 (pruÊmeÏr)* = vypocÏteny pruÊmeÏrne hodnoty z hodnocenõÂ
cÏtyrÏletyÂch a peÏtiletyÂch deÏtõÂ; Riga a Vilnius, Litva, 2007 (pruÊmeÏr)* = vypocÏteny pruÊmeÏrne hodnoty z hodnocenõ skupin, jezÏ meÏly a nemeÏly prechirurgickou ortopedickou leÂcÏbu; Oslo, Norsko, 1998 (pruÊmeÏr)* = vypocÏteny pruÊmeÏrne hodnoty z hodnocenõ dvou hodnotõÂcõÂch; Bristol, Anglie, 1998 (pruÊmeÏr)* = vypocÏteny pruÊmeÏrne hodnoty z hodnocenõ dvou hodnotõÂcõÂch, (archiv autorky).
Fig. 3. Intercenter comparison with the help of 5-year index: Dutchcleft, the Netherlands, 2004 (average)*= mean values calculated from
assessments of four-year and five-year old children; Riga and Vilnius, Lithuania, 2007 (average)* - mean values calculated from assessments
of groups with and without pre-surgical orthopedic treatment; Oslo, Norway, 1998 (average)* = mean values calculated from assessments
by two evaluators (the main author's archive).
Obr. 4. SrovnaÂnõ vyÂsledkuÊ leÂcÏby mezi rozsÏteÏpovyÂmi centry pomocõ modifikovaneÂho 5-leteÂho indexu: Dutchcleft, Holandsko, 2004 (pruÊmeÏr)* = vypocÏteny pruÊmeÏrne hodnoty z hodnocenõ cÏtyrÏletyÂch a peÏtiletyÂch deÏtõÂ; Riga a Vilnius, Litva, 2007 (pruÊmeÏr)* = vypocÏteny pruÊmeÏrne hodnoty z hodnocenõÂ
skupin, jezÏ meÏly a nemeÏly prechirurgickou ortopedickou leÂcÏbu; Oslo, Norsko, 1998 (pruÊmeÏr)* = vypocÏteny pruÊmeÏrne hodnoty z hodnocenõ dvou
hodnotõÂcõÂch; Bristol, Anglie, 1998 (pruÊmeÏr)* = vypocÏteny pruÊmeÏrne hodnoty z hodnocenõ dvou hodnotõÂcõÂch, (archiv autorky).
Fig. 4. Intercenter comparison with the help of modified 5-year index: Dutchcleft, the Netherlands, 2004 (average)*= mean values calculated from
assessments of four-year and five-year old children; Riga and Vilnius, Lithuania, 2007 (average)* - mean values calculated from assessments of
groups with and without pre-surgical orthopedic treatment; Oslo, Norway, 1998 (average)* = mean values calculated from assessments by two evaluators; Bristol, England, 1998 (average)* = mean values calculated from assessments by two evaluators, (the main author's archive).
222
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
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rekonstrukce rtu a patra, cozÏ jenom doklaÂdaÂ, jak duÊlezÏiteÂ
je i nadaÂle pokracÏovat ve sledovaÂnõÂ uÂspeÏsÏnosti primaÂrnõÂ
peÂcÏe o pacienty s celkovyÂm jednostrannyÂm rozsÏteÏpem
na rozsÏteÏpoveÂm pracovisÏti FNKV a pokud mozÏno pokusit se vyÂsledky zlepsÏit. NaÂmi zjisÏteÏne vyÂsledky uÂspeÏsÏnosti mohly byÂt ovlivneÏny generacÏnõ obmeÏnou chirurgickeÂho tyÂmu rozsÏteÏpoveÂho pracovisÏteÏ a zmeÏnami leÂcÏebneÂho protokolu, ktere nastaly v pruÊbeÏhu primaÂrnõ leÂcÏby
pacientuÊ sledovaneÂho souboru. Proto je nezbytne sledovat a zhodnotit vztahy zubnõÂch obloukuÊ u sledovaneÂho souboru pacientuÊ take v dalsÏõÂch letech, abychom
zjistili, zda se naÂmi zjisÏteÏne vyÂsledky budou shodovat
i v pozdeÏjsÏõÂm veÏku pacientuÊ.
DlouhodobyÂm monitorovaÂnõÂm vyÂsledkuÊ primaÂrnõÂ
chirurgicke rekonstrukce rtu a patra na rozsÏteÏpoveÂm
pracovisÏti FNKV je trÏeba zjistit, zda zmeÏna leÂcÏebneÂho
protokolu ve smyslu drÏõÂveÏjsÏõÂho provaÂdeÏnõ primaÂrnõ chirurgicke rekonstrukce rtu a patra vede nejenom k lepsÏõÂmu prÏijetõ pacienta s rozsÏteÏpem do rodiny, lepsÏõ psychicke pohodeÏ pacienta i okolõÂ, lepsÏõ estetice rtu, nosu
a jizvy, ale takeÂ, zda vede k prÏijatelneÂmu ruÊstu a vyÂvoji
hornõÂ cÏelisti.
ZaÂveÏr
Z vyÂsledkuÊ prÏedklaÂdane praÂce vyplyÂvaÂ, zÏe u vysÏetrÏovaneÂho souboru peÏtiletyÂch pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem lze po primaÂrnõ chirurgicke rekonstrukci rtu a patra pozorovat cÏasty vyÂskyt III. trÏõÂd dle
Baumea a obraÂceny skus ve frontaÂlnõÂm uÂseku chrupu.
Tento stav prÏedznamenaÂva neprÏõÂznivy vyÂvoj mezicÏelistnõÂch vztahuÊ beÏhem dalsÏõÂho ruÊstu pacienta.
U pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem
se zkrÏõÂzÏeny skus u docÏasnyÂch sÏpicÏaÂkuÊ vyskytuje cÏasteÏji na straneÏ rozsÏteÏpu, cozÏ je zpuÊsobeno vyÂrazneÏjsÏõÂm
transverzaÂlnõÂm kolapsem hornõÂho zubnõÂho oblouku
v oblasti anteriornõÂ cÏaÂsti maleÂho cÏelistnõÂho segmentu.
DaÂle bylo prokaÂzaÂno, zÏe veÏtsÏõÂ postizÏenõÂ a ruÊstovyÂ
deficit hornõÂ cÏelisti lze ocÏekaÂvat, vyskytuje-li se veÏtsÏõÂ
hloubka skusu, horsÏõÂ klasifikace dle Baumea (ve
smyslu III. trÏõÂdy) na straneÏ bez rozsÏteÏpu a horsÏõÂ transverzaÂlnõÂ vztah zubnõÂch obloukuÊ u docÏasnyÂch druhyÂch
molaÂruÊ i docÏasnyÂch sÏpicÏaÂkuÊ na straneÏ bez rozsÏteÏpu,
cozÏ je skutecÏnost, ktera zatõÂm nenõ v odborne literaturÏe
uvaÂdeÏna.
VarujõÂcõÂ je zjisÏteÏnõÂ, zÏe pacienti, kterÏõÂ podstoupili cÏasnou primaÂrnõÂ rekonstrukci rtu do trÏõÂ meÏsõÂcuÊ veÏku, meÏli
horsÏõ 5-lety index, horsÏõ klasifikaci dle Baumea na
straneÏ rozsÏteÏpu, horsÏõÂ incizaÂlnõÂ schuÊdek a kratsÏõÂ deÂlku
hornõÂho zubnõÂho oblouku na straneÏ rozsÏteÏpu oproti pacientuÊm, kterÏõ podstoupili klasickou primaÂrnõ rekonstrukci rtu pozdeÏji. NacÏasovaÂnõ chirurgicke rekonstrukce rtu je proto nutne zvaÂzÏit nejen na zaÂkladeÏ vlivu
veÏku pacienta na hojenõ vyÂsledne jizvy, ale take z hlediwww.orthodont-cz.cz e-mail: [email protected]
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countries [1, 6, 8, 14, 19, 20, 21, 25, 26, 31, 34, 35, 42,
28, 43, 44].
From the comparisons between individual cleft centres it clearly follows that there is a great variability in
treatment protocols for the primary surgical reconstruction of lip and palate in patients with complete
UCLP. The comparison according to 5-year index puts
FNKV Cleft Center in the lower third of the list based on
successful results of the primary lip and palate surgery.
Therefore, it is important to further monitor the success
of the primary care of patients with complete UCLP in
our department and strive for better outcomes. Our results may be a bit distorted due to the alternation of generations in the team of surgeons of the Cleft Centre
and due to modifications of the treatment protocol during the primary treatment of the patients included in
our sample. It is thus necessary to follow and assess
the relationships of dental arches in this sample in
the following years to find out whether the current results will correspond to those achieved in our patients
later in their lives.
The long-term follow-up of the primary surgical lip
and palate results at FNKV Cleft Centre will help us
to conclude whether the modified treatment protocol
(i.e. early surgery of lip and palate) leads to a better acceptance of a cleft patient in his/her family, better psychical comfort of both the patient and his/her neighborhood, better esthetics of lip, nose and scar, and acceptable growth and development of the maxilla.
Conclusion
In the sample of five-year old patients with complete
UCLP after primary surgery of lip and palate we can
frequently observe Baume Class III condition and reversed bite in the anterior segment of dentition. This
signals unfavorable development of arch relationships
during the following growth of a patient.
In patients with complete UCLP crossbite in deciduous canines is more frequent at the cleft side due
to more profound transversal collapse of the upper
dental arch in the area of anterior part of a small jaw segment.
The impairment and growth deficiency of the maxilla is expected in case of deeper bite, worse Baume
classification (i.e. Class III) on the noncleft side, and
worse transversal relationship of dental arches in deciduous second molars and canines on the noncleft
side. This fact has not been described in the literature
yet.
Patients who underwent early primary lip surgery
until 3 months after the birth had worse 5-year index,
Baume classification on the cleft side, overjet, and reduced length of the upper dental arch compared to the
patients who underwent traditional primary lip surgery
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ska dopadu na vyÂvoj hornõ cÏelisti, ktery je, dle nasÏeho
naÂzoru, velmi duÊlezÏityÂ.
Ve vysÏetrÏovaneÂm souboru jsme neprokaÂzali negativnõ vliv chirurgicke faryngofixace na vyÂvoj hornõ cÏelisti. Pacienti, jezÏ podstoupili primaÂrnõ rekonstrukci patra s faryngofixacõ provedenou v pozdeÏjsÏõÂm veÏku, meÏli
dokonce v pruÊmeÏru lepsÏõÂ incizaÂlnõÂ schuÊdek a veÏtsÏõÂ
deÂlku hornõÂho zubnõÂho oblouku oproti pacientuÊm, jezÏ
podstoupili cÏasneÏjsÏõÂ primaÂrnõÂ rekonstrukci patra bez
faryngofixace, cozÏ opeÏt doklaÂdaÂ, zÏe daleko veÏtsÏõÂ vliv
na vyÂvoj hornõ cÏelisti ma nacÏasovaÂnõ primaÂrnõ chirurgicke rekonstrukce rtu a patra.
PruÊmeÏrna hodnota 5-leteÂho indexu byla 3,3 - tedy
spõÂsÏe neprÏõÂznivaÂ. PrÏi porovnaÂnõÂ vyÂsledkuÊ 5-leteÂho indexu s jinyÂmi rozsÏteÏpovyÂmi centry a zemeÏmi se na zÏebrÏõÂcÏku uÂspeÏsÏnosti vyÂsledkuÊ primaÂrnõÂ rekonstrukce rtu
a patra rozsÏteÏpove pracovisÏteÏ FNKV rÏadõ svyÂmi vyÂsledky do spodnõ trÏetiny tabulky. Proto je duÊlezÏite i nadaÂle pokracÏovat ve sledovaÂnõ vyÂsledkuÊ uÂspeÏsÏnosti primaÂrnõ rekonstrukcÏnõ chirurgie rtu a patra u pacientuÊ
s celkovyÂm jednostrannyÂm rozsÏteÏpem a zhodnotit
vztah zubnõÂch obloukuÊ u sledovaneÂho souboru pacientuÊ take v dalsÏõÂch letech a pozdeÏjsÏõÂm veÏku pacientuÊ.
AutorÏi nemajõ komercÏnõÂ, vlastnicke nebo financÏnõ zaÂjmy na produktech nebo spolecÏnostech popsanyÂch v tomto cÏlaÂnku.
ORTODONCIE
later. Timing of the lip surgery should be considered
not only according to the impact of patient's age on
the healing of the resulting scar, but also from the viewpoint of the impact on the development of the maxilla
which we consider very important.
In the sample of our patients we did not prove negative impact of surgical pharyngofixation on the maxilla
development. The patients who underwent primary
surgery of palate with pharyngofixation later had better
overjet and length of the upper dental arch in comparison with the patients who underwent early primary palate surgery without pharyngofixation. This supports
the fact that timing of primary lip and palate surgery
has much greater impact on the maxilla development.
The mean value of 5-year index was 3.3, i.e. rather
poor. The comparison of 5-year index in other cleft
centers and countries puts our Cleft Centre to the lower third of the list. Therefore, it is necessary to follow
up the results of the management and evaluate the relationships of dental arches in the sample of the patients in later phases of their life.
The authors have no comercial, proprietary, or financial interests
in the products or companies described in this article.
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Surg. 2001, 29, cÏ. 3, s. 131-140, discussion 141-142.
Bongaarts, C.A.; Kuijpers-Jagtman, A.M.; van't Hof,
M.A.; Prahl-Andersen, B.: The effect of infant orthopedics on the occlusion of the deciduous dentition in children with complete unilateral cleft lip and palate (Dutchcleft). Cleft Palate Craniofac. J. 2004, 41, cÏ. 6, s.
633-641.
Moorrees, C.F.A.; Reed, R.B.: Change in dental arch dimensions expressed on the basis of tooth eruption as
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Gray, D.; Mossey, P.A.: Evaluation of a modified Huddart/Bodenham scoring system for assessment of maxillary arch constriction in unilateral cleft lip and palate
subjects. Eur. J. Orthod. 2005, 27, cÏ. 5, s. 507-511.
Sandy, J.; Williams, A.; Mildinhall, S.; Murphy, T.; Bearn,
D.; Shaw, B.; Sell, D.; Devlin, B.; Murray, J.: The Clinical
Standards Advisory Group (CSAG) Cleft Lip and Palate
Study. Br. J. Orthod. 1998, 25, cÏ. 1, s. 21-30.
Williams, A.C.; Bearn, D.; Mildinhall, S.; Murphy, T.; Sell,
D.; Shaw, W.C.; Murray, J.J.; Sandy, J.R.: Cleft lip and
palate care in the United Kingdom - the Clinical Standards Advisory Group (CSAG) Study. Part 2: dentofacial
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Bearn, D.; Mildinhall, S.; Murphy, T.; Murray, J.J.; Sell, D.;
Shaw, W.C.; Williams, A.C.; Sandy, J.R.: Cleft lip and palate care in the United Kingdom - the Clinical Standards
Advisory Group (CSAG) Study. Part 4: outcome comparisons, training, and conclusions. Cleft Palate Craniofac.
J. 2001, 38, cÏ. 1, s. 38-43.
Pereira, R.M.R.; Costa de MeÏlo, E.M.; Coutinho, S.B.;
Maria do Vale, D.; Siqueira, N.; Alonso, N.: Evaluation
of craniofacial growth in patients with cleft lip and palate
undergoing one-stage palate repair. Rev. Bras. Cir.
Plast. 2011, 26, cÏ. 4, s. 624-630.
Suzuki, A.; Sasaguri, M.; Hiura, K.; Yasunaga, A.; Mitsuyasu, T.; Kubota, Y.; Ninomiya, T.; Takenoshita, Y.:
Can occlusal evaluation of children with unilateral cleft
lip and palate help determine future maxillofacial morphology? Cleft Palate Craniofac. J. 2013 (epub ahead of
print).
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cleft lip and palate: a systematic review. Cleft Palate Craniofac. J. 2006, 43, cÏ. 5, s. 563-570.
JelõÂnek, R.; DostaÂl, M.; Peterka, M.: RozsÏteÏp rtu a patra
v obraze experimentu, Praha: Univerzita Karlova, 1983.
BorskyÂ, J.; KozaÂk, J.; Tvrdek, M.; HubaÂcÏek, M.; DostaÂlovaÂ, T.; CÏernyÂ, M.: RozsÏteÏpova vada v oblasti hornõÂho
rtu. LKS. 2007, 17, cÏ.11, s. 18-21.
SÏmahel, Z.: Monograph on craniofacial growth and development in patients with cleft lip and/or palate. Acta
Universitatis Carolinae - Biologica. 2000, 44, s. 3 -72.
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40. Long, R.E.; Semb, G.; Shaw, W.C.: Orthodontic treatment of the patient with complete clefts of lip, alveolus,
and palate: Lessons of the past 60 years. Cleft Palate
Craniofac. J. 2000, 37, cÏ. 6, s. 533-1 - 533-13.
41. Berkowitz S.: Cleft Lip and Palate. 2nd ed. Berlin: Springer-Verlag; 2006.
42. Lilja, J.; Mars, M.; Elander, A.; Enocson, L.; Hagberg, C.;
Worrell, E.; Batra, P.; Friede, H.: Analysis of dental arch
relationships in Swedish unilateral cleft lip and palate
subjects: 20-year longitudinal consecutive series trea-
ORTODONCIE
ted with delayed hard palate closure. Cleft Palate Craniofac. J. 2006, 43, cÏ. 5, s. 606-611.
43. Clark, S.A.; Atack, N.E.; Ewings, P.; Hathorn, I.S.; Mercer, N.S.: Early surgical outcomes in 5-year-old patients
with repaired unilateral cleft lip and palate. Cleft Palate
Craniofac. J. 2007, 44, cÏ. 3, s. 235-238.
44. Maulina, I.; Priede, D.; Maulina, I.; Barkane, B.; Akota, I.:
Assessment of complete cleft (CLP) patients' occlusion
at age of five. Stomatologija, Baltic Dental and Maxillofac. J. 2004, 6, cÏ. 4, s. 103-105.
MDDr. Ivana KratochvõÂlovaÂ
Stomatologicka klinika FNKV Praha
SÏrobaÂrova 50, 100 34, Praha 1
226
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SpolupraÂce ortodontisty a pedostomatologa.
InterceptivnõÂ leÂcÏba.
Cooperation of orthodontist and pedodontist.
Interceptive orthodontic treatment.
*MDDr. Hana RÏehaÂcÏkovaÂ, *Doc. MUDr. PavlõÂna CÏernochovaÂ, Ph.D., **Mgr. KaterÏina LangovaÂ, Ph.D.
* Ortodonticke oddeÏlenõÂ, Stomatologicka klinika FN u sv. Anny a LF MU v BrneÏ
* Department of Orthodontics, Clinic of Stomatology, University Hospital of St.Anne, Masaryk University Brno
** UÂstav leÂkarÏske biofyziky, LF UP Olomouc
** Department of Medical Biophysics, Medical Faculty, Palacky University Olomouc
Souhrn
CõÂlem studie bylo formou dotaznõÂkoveÂho sÏetrÏenõ zmapovat indikace, celkovy zaÂjem a zkusÏenosti s jednotlivyÂmi
ortodontickyÂmi anomaÂliemi vhodnyÂmi k interceptivnõÂ leÂcÏbeÏ z pohledu praktickeÂho zubnõÂho leÂkarÏe. Do studie bylo
zahrnuto 448 dotaznõÂkuÊ, ktere se tyÂkaly konkreÂtnõÂch ortodontickyÂch anomaÂliõÂ, vhodne doby jejich odeslaÂnõ na konzultaci k ortodontistovi, leÂcÏebnyÂch postupuÊ a mozÏnyÂch duÊsledkuÊ v prÏÂõpadeÏ zanedbaÂnõÂ. Na zaÂkladeÏ nasÏeho sÏetrÏenõÂ
bylo v prevenci a profylaxi ortodontickyÂch anomaÂliõÂ ze strany osÏetrÏujõÂcõÂch zubnõÂch leÂkarÏuÊ zjisÏteÏno mnoho poteÏsÏujõÂcõÂch vyÂstupuÊ, ale zaÂrovenÏ i rÏada nedostatkuÊ (Ortodoncie 2014, 23, cÏ. 4, s. 228-234).
Abstract
The purpose of the questionnaire survey was to map the indications, overall demand, and experience with individual orthodontic anomalies suitable for interceptive treatment from the viewpoint of a general dentist. The
survey included 448 questionnaires focused on specific orthodontic anomalies, appropriate time of the first consultation with an orthodontist, therapeutic approaches, and possible consequences due to neglect. Our study
brought about a number of satisfying outcomes regarding prevention and prophylaxis of orthodontic anomalies
provided by general dentists, however, we also found some deficiencies (Ortodoncie 2014, 23, No. 4, p. 228-234).
KlõÂcÏova slova: Interceptivnõ leÂcÏba, ortodonticke anomaÂlie, spolupraÂce ortodontisty a pedostomatologa
Key-words: Interceptive treatment, orthodontic anomalies, cooperation of orthodontist and pedodontist
UÂvod
Introduction
Interceptivnõ leÂcÏba, tedy leÂcÏba zahaÂjena v docÏasneÂm
cÏi smõÂsÏeneÂm chrupu, je staÂle velmi kontroverznõÂ teÂma
a v odborne literaturÏe se muÊzÏeme setkat se dveÏma odlisÏnyÂmi naÂzory na tuto problematiku. CÏaÂst leÂkarÏuÊ zastaÂva naÂzor, zÏe jsou ortodonticke anomaÂlie, u nichzÏ
je vhodne zapocÏõÂt leÂcÏbu jizÏ v docÏasneÂm cÏi smõÂsÏeneÂm
chrupu. CõÂlem takove leÂcÏby je uÂprava existujõÂcõ nebo
vyvõÂjejõÂcõ se odchylky a celkove zlepsÏenõ funkce orofaciaÂlnõÂho komplexu jesÏteÏ prÏed prorÏezaÂnõÂm staÂle dentice
[1]. NeÏktere brzke intervence zabranÏujõ rozvoji anomaÂ228
Interceptive treatment, i.e. treatment commenced
in deciduous or mixed dentition, has been a rather controversial issue. There exist two contrary views in the
literature. One view believes that there are orthodontic
anomalies which should be solved as early as in deciduous or mixed dentition. The purpose of such treatment is to solve already existing or developing anomalies, and to improve the function of orofacial complex
before permanent teeth erupt [1]. Some early interventions prevent an anomaly development. However, we
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lie, ale je nutne pocÏõÂtat s tõÂm, zÏe veÏtsÏina prÏõÂpaduÊ bude
vyzÏadovat jesÏteÏ naÂslednou, druhou faÂzi leÂcÏby beÏhem
dospõÂvaÂnõÂ. VhodneÏ nacÏasovana leÂcÏba tedy muÊzÏe snõÂzÏit
zaÂvazÏnost probleÂmu, ale neeliminuje potrÏebu dalsÏõÂ korekce ve staÂleÂm chrupu [2]. LeÂkarÏi, kterÏõÂ interceptivnõÂ
leÂcÏbu nepodporujõÂ, varujõÂ, zÏe dvoufaÂzova leÂcÏba muÊzÏe
zbytecÏneÏ veÂst k vycÏerpaÂnõÂ spolupraÂce pacienta i jeho
rodicÏuÊ, k prodlouzÏenõ celkove doby leÂcÏby a zvyÂsÏeneÂmu
riziku posÏkozenõÂ tkaÂnõÂ.
DuÊlezÏityÂm aspektem uÂspeÏsÏne ortodonticke leÂcÏby je
vzaÂjemna spolupraÂce ortodontisty a pedostomatologa. Prakticky zubnõ leÂkarÏ cÏi pedostomatolog by meÏl
zajistit nejen pecÏlivou sanaci chrupu deÏtskeÂho pacienta, ale i depistaÂzÏ jednotlivyÂch ortodontickyÂch anomaÂliõÂ. V prÏõÂpadeÏ zjisÏteÏnõÂ jakeÂkoliv odchylky od fyziologickeÂho vyÂvoje, by meÏl zubnõÂ leÂkarÏ dõÂteÏ vcÏas odeslat
na konzultaci na specializovane ortodonticke pracovisÏteÏ a zpeÏtneÏ se o vyÂsledek teÂto konzultace zajõÂmat [3,
4]. Prvnõ seznam znakuÊ, na ktere by se meÏl zubnõ leÂkarÏ
beÏhem preventivnõÂ prohlõÂdky zameÏrÏit, byl vytvorÏen na
celostaÂtnõÂm sjezdu vsÏech vedoucõÂch ortodontickyÂch
pracovisÏt' v roce 1957 ve Svratce. Tato smeÏrnice, tzv.
Svratecky program, obsahuje 9 zaÂkladnõÂch boduÊ [5, 6].
Mezi anomaÂlie, ktere by nemeÏly byÂt v deÏtskeÂm veÏku
prÏehlõÂzÏeny, muÊzÏeme podle odborne literatury zarÏadit
zkrÏõÂzÏeny skus s nucenyÂm vedenõÂm, zaÂkus a obraÂcenyÂ
skus, prÏevisly skus, otevrÏeny skus, zlozvyky, vyÂraznou
protruzi hornõÂch rÏezaÂkuÊ, primaÂrnõÂ steÏsnaÂnõÂ, prÏedcÏasneÂ
ztraÂty docÏasnyÂch zubuÊ, vyÂrazne diastema a poruchy
erupce zubuÊ (hlavneÏ retence) [7, 8, 9, 10, 11].
should take into account that in majority of patients
there will be required the second phase of treatment
during their adolescence. Well timed treatment thus
may lower the problem severity, but it does not eliminate the need for intervention in permanent dentition
[2]. The other view warns that a two-phased treatment
may result in the exhaustion of both patients and their
parents, in the prolongation of the treatment time, and
in higher risk of tissue damage.
The cooperation of orthodontist and pedodontist is
an important aspect influencing the success of orthodontic treatment. General dentist or pedodontist
should provide not only proper care of a children dentition, but also screening of individual orthodontic anomalies. In case of any deviation from physiological development, the child should be sent to orthodontic surgery in time, and the dentist should be provided the
feedback [3,4]. The first list of traits that should be
the focus of any routine check-up was set up in the national meeting of heads of orthodontic departments in
Svratka in 1957. The directive, the so-called Svratka
Programme (Svratecky program) included 9 basic points [5, 6].
Among the anomalies that should not be neglected
in children there are crossbite with forced bite, anterior
crossbite and reversed occlusion, cover bite, open
bite, bad habits, strong protrusion of upper incisors,
primary crowding, premature loss of temporary teeth,
distinctive diastema, and problems in teeth eruption
(especially impaction) [7, 8, 9, 10, 11].
MateriaÂl a metodika
DotaznõÂkove sÏetrÏenõ bylo zameÏrÏeno na praktickeÂ
zubnõÂ leÂkarÏe, jejichzÏ alesponÏ minimaÂlnõÂ procento klientely tvorÏõÂ deÏtsÏtõÂ pacienti. Osloveni byli zubnõÂ leÂkarÏi ze
vsÏech krajuÊ CÏeske republiky. PozÏaÂdaÂno o spolupraÂci
prÏi vyplneÏnõÂ dotaznõÂkuÊ bylo 1150 zubnõÂch leÂkarÏuÊ, tedy
14,5 % z celkoveÂho pocÏtu leÂkarÏuÊ, kteryÂch bylo ke konci
roku 2013 dle RocÏenky LKS [12] evidovaÂno 7931. Celkovy soubor spraÂvneÏ vyplneÏnyÂch a statisticky pouzÏitelnyÂch dotaznõÂkuÊ v konecÏneÂm soucÏtu tvorÏil 448 dotaznõÂkuÊ, naÂvratnost dotaznõÂkuÊ cÏinõ 36 %. DotaznõÂk obsahoval 24 otaÂzek, na ktere zubnõ leÂkarÏi odpovõÂdali zcela
anonymneÏ. U neÏkteryÂch z otaÂzek, bylo mozÏne zvolit
võÂce odpoveÏdõÂ. DotaznõÂk byl vytvorÏen v programu
Google Chrome a naÂsledneÏ s pruÊvodnõÂm dopisem
elektronicky rozeslaÂn na naÂhodneÏ vybrane emailoveÂ
adresy zubnõÂch leÂkarÏuÊ ze vsÏech 14 krajuÊ CÏeske republiky. SbeÏr dat probeÏhl v obdobõ od zacÏaÂtku cÏervence
2013 do konce listopadu 2013.
KromeÏ zaÂkladnõÂho zpracovaÂnõÂ do tabulek a grafuÊ,
byly z nejzajõÂmaveÏjsÏõÂch odpoveÏdõÂ vybraÂny a naÂsledneÏ
statisticky vyhodnoceny neÏktere hypoteÂzy. Ke statistickeÂmu zpracovaÂnõ byl pouzÏit statisticky software
Material and methods
The questionnaire survey focused on dentists with
a proportion of children among their clients. Dentists
from all regions of the Czech Republic were addressed.
We asked for cooperation 1150 dentists, i.e. 14.5% of all
the dentists listed in LKS Statistical Yearbook of 2013
[12]; the total number of dentists was 7931 at that time.
The sample of correctly filled in and statistically usable
questionnaires included 448 forms, i.e. 36% of questionnaires were returned. There were 24 questions to
be replied anonymously. In some questions it was possible to choose more options. The questionnaire was
created in Google Chrome, and together with a cover
letter it was sent via e-mail to randomly chosen addresses of dentists from the 14 regions of the Czech Republic. The data were collected from the beginning of July
2013 till the end of November 2013.
The answers were processed and summed up in
form of tables and charts; the most interesting replies
were chosen and there were statistically evaluated
some hypotheses based on the answers. Statistic
software SPSS, version 15, SPSS Inc. Chicago USA
was used. Charts were made in Microsoft Excel 2010.
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Obr. 1. ProcentuaÂlnõ zastoupenõ deÏtske klientely
Fig. 1. Proportion of children within dentists' clientele
ORTODONCIE
Obr. 2. ZhotovenõÂ OPG
Fig. 2. OPG taking
SPSS verze 15, SPSS Inc. Chicago USA. Grafy byly vytvorÏeny v programu Microsoft Excel 2010.
VyÂsledky
U 172 leÂkarÏuÊ (39,1 %) tvorÏõÂ deÏti 11 - 30 % klientely
a 55 leÂkarÏuÊ (12,5 %) odpoveÏdeÏlo, zÏe deÏti v jejich praxõÂch
zastupujõÂ võÂce nezÏ 30 % klientely (Obr. 1).
BeÏhem preventivnõÂch prohlõÂdek sleduje ortodonticke anomaÂlie 96,2 % leÂkarÏuÊ, pouhyÂch 2,3 % leÂkarÏuÊ
sleduje ortodonticke anomaÂlie neÏkdy a 1,7 % leÂkarÏuÊ
tuto problematiku prÏehlõÂzÏõÂ uÂplneÏ.
Naprosta veÏtsÏina zubnõÂch leÂkarÏuÊ (99,5 %) ma v dostupne vzdaÂlenosti (30 km) mozÏnost konzultace cÏi
odeslaÂnõ dõÂteÏte na ortodonticke pracovisÏteÏ.
Na otaÂzku, zda zubnõÂ leÂkarÏi u dõÂteÏte zhotovujõÂ z profylaktickyÂch duÊvoduÊ OPG odpoveÏdeÏlo 436 leÂkarÏuÊ,
z toho 100 leÂkarÏuÊ (22,3 % ) odpoveÏdeÏlo, zÏe ano a zaÂrovenÏ uvedli veÏk, ve ktereÂm zhotovenõÂ rentgenu indikujõÂ.
DalsÏõÂch 285 leÂkarÏuÊ (65,4 %) zhotovuje OPG pouze v prÏõÂpadeÏ, kdy je to pro dõÂteÏ prÏõÂnosem a 51 leÂkarÏuÊ (11,4 %)
OPG z profylaktickyÂch duÊvoduÊ nezhotovuje vuÊbec
(Obr. 2).
MozÏnost uvedenõÂ veÏku dõÂteÏte, ve ktereÂm zubnõÂ leÂkarÏi
nejcÏasteÏji indikujõÂ zhotovenõÂ OPG, vyuzÏilo celkem 100
leÂkarÏuÊ, z cÏehozÏ 41 leÂkarÏuÊ (41 %) zadalo veÏk 6 let dõÂteÏte,
15 leÂkarÏuÊ (15 %) odpoveÏdeÏlo, zÏe OPG zhotovujõÂ v 7 a v 8
letech dõÂteÏte a 9 leÂkarÏuÊ (9 %) OPG indikuje v 10 letech
a v 9 letech dõÂteÏte. JizÏ v 5 letech dõÂteÏte nechaÂva OPG
zhotovit 5 leÂkarÏuÊ (5 %) a dalsÏõÂch 5 leÂkarÏuÊ (5 %) poteÂ
zhotovuje OPG azÏ ve 12 letech dõÂteÏte. Pouze 1 leÂkarÏ
(1 %) uvedl, zÏe OPG zhotovuje azÏ v 15 letech (Obr. 3).
Na otaÂzku, zda zubnõÂ leÂkarÏi vysÏetrÏujõÂ palpacõÂ prÏõÂtomnost hornõÂch sÏpicÏaÂkuÊ, odpoveÏdeÏlo celkem 420 leÂkarÏuÊ,
z toho 229 leÂkarÏuÊ (54,5 % ) povazÏuje toto vysÏetrÏenõÂ za
soucÏaÂst preventivnõÂ prohlõÂdky a 191 leÂkarÏuÊ (45,5 %) leÂkarÏuÊ uvedlo, zÏe prÏõÂtomnost sÏpicÏaÂkuÊ nevysÏetrÏujõÂ.
Na otaÂzku, kdy zubnõÂ leÂkarÏi odesõÂlajõÂ deÏtskeÂho pacienta se zkrÏõÂzÏenyÂm skusem a nucenyÂm vedenõÂm na
konzultaci k ortodontistovi, naprosta veÏtsÏina z leÂkarÏuÊ
(393 leÂkarÏuÊ, 87,7 %) uvedla, zÏe odesõÂla jizÏ v docÏasneÂm
230
Obr. 3. ZhotovenõÂ OPG podle veÏku pacienta
Fig. 3. OPG according to patients' age
Results
In 172 dentists (39.1%) the proportion of childrenclients is between 11-30%; in 55 dentists (12.5%)
the proportion of child patients is more than 30%
(Fig.1).
During routine check-ups 96.2% of dentists monitor orthodontic anomalies regularly, 2.3% sometimes,
and 1.7% of dentists do not pay attention to orthodontic problems at all.
Most dentists (99.5%) can send a child patient to
orthodontic practice that is within reach (30 km).
The question whether dentists make OPG in their
child clients for prophylactic reasons was answered
by 436 respondents. 100 dentists (22.3%) answered
in positive and gave the age when they indicate
OPG. 285 dentists (65.4%) make OPG only if a child
benefits from it. 51 dentists (11.4%) do not make
OPG for prophylactic reasons (Fig. 2).
100 respondents gave also the age of a child in
which they usually indicate OPG: 41 dentists (41%)
stated 6 years, 15 (15%) 7 and 8 years, 9 dentists
(9%) indicated OPG at the age of 10 and 9, respectively. 5 (5%) respondents indicated OPG as early as
in 5 year olds, and 5 dentists (5%) made the second
OPG at the age of 12. Only one respondent (1%) made
OPG as late as at the age of 15 (Fig. 3).
The question whether dentists make palpation examination of upper canines presence was answered by
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Obr. 4. VyÂskyt nejcÏasteÏjsÏõÂch duÊvoduÊ k odeslaÂnõÂ pacienta s vyÂraznou
protruzõ hornõÂch rÏezaÂkuÊ na konzultaci. a) fonetickyÂ; b) prevence traumatu; c) zveÏtsÏeny inicizaÂlnõ schuÊdek; d) esteticky cÏi psychologickyÂ;
e) prÏõÂtomnost hlubokeÂho skusu
Fig. 4. The most frequent reasons for orthodontic consultation in patients with strong protruded upper incisors; a) fonetic problems; b)
trauma prevention; c) increased overjet; d) esthetic and/or psychological reasons; e) deep bite
cÏi smõÂsÏeneÂm chrupu a pouhyÂch 41 leÂkarÏuÊ (9,4 %) tento
probleÂm rÏesÏõÂ azÏ po prorÏezaÂnõÂ staÂleÂho chrupu.
Jako nejcÏasteÏjsÏõ jednotlivy duÊvod pro odeslaÂnõ dõÂteÏte s vyÂraznou protruznõ vadou na konzultaci, leÂkarÏi
uvaÂdeÏli prÏõÂtomnost hlubokeÂho skusu (275 leÂkarÏuÊ, 64
%), daÂle duÊvody esteticke cÏi psychologicke (230 leÂkarÏuÊ, 53,5 %), zveÏtsÏeny incizaÂlnõ schuÊdek (137 leÂkarÏuÊ,
31,9 %), prevence traumatu (112 leÂkarÏuÊ, 26 %) cÏi duÊvod foneticky (79 leÂkarÏuÊ, 18,4 %) (Obr. 4).
V prÏõÂpadeÏ zjisÏteÏnõÂ otevrÏeneÂho skusu, z jednotlivyÂch
postupuÊ 333 leÂkarÏuÊ (76,2 %) nejcÏasteÏji volilo variantu,
zÏe sledujõÂ, zda nenõ duÊvodem prÏõÂtomny zlozvyk. OstatnõÂ
mozÏne postupy jsou uvedeny v Obr. 5.
Na otaÂzku, jak zubnõÂ leÂkarÏi postupujõÂ u pacienta
s prÏevislyÂm skusem, naprosta veÏtsÏina leÂkarÏuÊ (371 leÂkarÏuÊ, 85,9 %) odpoveÏdeÏla, zÏe odesõÂla na konzultaci
k ortodontistovi jizÏ ve smõÂsÏeneÂm chrupu. PouhyÂch 61
leÂkarÏuÊ (14,1 %) nepovazÏuje za nutne tuto anomaÂlii odeslat na konzultaci k ortodontistovi.
Na otaÂzku, zda zubnõ leÂkarÏi navsÏteÏvujõ odborne ortodonticke kurzy cÏi prÏednaÂsÏky, 284 z nich (65 %) uvedlo,
zÏe neÏkdy, 98 leÂkarÏuÊ (22,4 %) takove kurzy nenavsÏteÏvuje a 55 leÂkarÏuÊ (12,6 %) se o odbornou ortodontickou
teÂmatiku zajõÂma aktivneÏ.
Diskuse
VzaÂjemna spolupraÂce obou stomatologickyÂch oboruÊ ortodoncie a pedostomatologie je pro uÂspeÏsÏnou
profylaxi, zachycenõÂ a prÏõÂpadnou leÂcÏbu ortodontickyÂch
anomaÂliõÂ naprosto nezbytnaÂ. VhodnyÂm prÏedpokladem
tohoto uÂspeÏchu je i ochota obou oboruÊ zajõÂmat se
nejen o sve primaÂrnõ zameÏrÏenõÂ, ale i o nove metody, postupy a problematiku jinyÂch stomatologickyÂch odveÏtvõÂ.
PoteÏsÏujõÂcõÂ je, zÏe 65 % leÂkarÏuÊ odpovõÂdajõÂcõÂch na otaÂzku,
zda se zajõÂmajõÂ a navsÏteÏvujõÂ kurzy s ortodontickou teÂmatikou, odpoveÏdeÏlo, zÏe neÏkdy ano.
Podstatnou podmõÂnkou spolupraÂce je dostupnost
ortodonticke peÂcÏe v dane oblasti. Na otaÂzku, zda majõÂ
zubnõÂ leÂkarÏi mozÏnost odesõÂlaÂnõÂ a konzultace s ortodontistou maximaÂlneÏ do vzdaÂlenosti 30 km, 99,5 % leÂkarÏuÊ
odpoveÏdeÏlo, zÏe ano. Stejny vyÂsledek prezentovala Kliwww.orthodont-cz.cz e-mail: [email protected]
Cyan Magenta Yellow -
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Obr. 5. VyÂskyt postupuÊ u dõÂteÏte s otevrÏenyÂm skusem. a) s odeslaÂnõÂm
na konzultaci k ortodontistovi vycÏkaÂvaÂm do obdobõÂ staÂleÂho chrupu;
b) povazÏuji za nutne leÂcÏit co nejdrÏõÂve a odesõÂlaÂm ihned po zjisÏteÏnõÂ
k ortodontistovi; c) sleduji, zda se stejna anomaÂlie nevyskytuje i u rodicÏuÊ; d) odesõÂlaÂm na konzultaci; e) sleduji, zda nenõ duÊvodem prÏõÂtomny zlozvyk
Fig. 5. Way of management in children with open bite. a) I wait till permanent dentition to send to orthodontist; b) I consider to treat early
and I send immediately to orthodontist; c) I follow if the same anomaly is in parents; d) I send to consultation; e) I observe whether
a bad habit is the reason
420 dentists. 229 respondents (54.5%) consider the
examination an integral part of a routine check-up,
191 respondents (45.5%) said they did not check the
canines presence.
The question whether dentists send a child patient
with crossbite and forced bite to orthodontic practice
was answered as follows: majority of them (393, i.e.
87.7%) send children even with deciduous or mixed
dentition to an orthodontic department. Only 41 dentists (9.4%) deal with the problem only after permanent
dentition erupts.
Among the most frequent reasons for orthodontic
consultation in case of children with strong protrusion
are the following: deep bite (257 dentists, i.e. 64%),
esthetic and/or psychological reasons (230 dentists,
i.e. 53.5%), increased overjet (137 dentists, i.e.
31.9%), trauma prevention (112 dentists, i.e. 26%),
or phonetic problems (79 dentists, i.e. 18.4%) (Fig. 4).
In case of open bite, 333 dentists (76.2%) observed
whether a bad habit is the reason for the anomaly. Other approaches are given in Fig. 5.
Majority of dentists (371, i.e. 85.9%) said that patients with cover bite are sent to orthodontic practice
as early as in mixed dentition. Only 61 respondents
(14.1%) do not consider the orthodontic consultation
necessary.
The question whether dentists attend orthodontic
workshops or lectures was answered as follows: 284
dentists (65%) sometimes, 98 dentists (22.4%) never,
55 dentists (12.6%) take active part in instructions on
orthodontic problems.
Discussion
Cooperation of orthodontist a pedodontist is necessary for succesful prophylaxis, timely detection
and possible treatment of orthodontic anomalies. Both
areas - orthodontics as well as pediatric dentistry should be interested not only in their primary focus,
231
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Odborna praÂce
mesÏova [4]. Na zaÂkladeÏ jejõÂho dotaznõÂku ma ortodontistu
v dostupne vzdaÂlenosti (20 km) 94 % dotaÂzanyÂch leÂkarÏuÊ.
V dotaznõÂku naÂs zajõÂmalo, jake je procentuaÂlnõ zastoupenõ deÏtske klientely v praxõÂch zubnõÂch leÂkarÏuÊ.
Z vyÂsledkuÊ sÏetrÏenõ lze konstatovat, zÏe u nejveÏtsÏõÂho pocÏtu odpovõÂdajõÂcõÂch leÂkarÏuÊ (172 leÂkarÏuÊ) tvorÏõ deÏti maximaÂlneÏ trÏetinu klientely. TeÂmeÏrÏ stejny pocÏet leÂkarÏuÊ
(147) ma zastoupenõ deÏtske klientely pouhyÂch 6 - 10 %.
KontroverznõÂm teÂmatem je, zda u deÏtõÂ z profylaktickyÂch duÊvoduÊ nechaÂvat zhotovit rentgen OPG cÏi takto
cÏinit pouze v prÏõÂpadeÏ podezrÏenõÂ na urcÏitou odchylku.
Na tuto otaÂzku v dotaznõÂku veÏtsÏina leÂkarÏuÊ (285) odpoveÏdeÏla, zÏe OPG zhotovuje pouze, je-li to pro dõÂteÏ prÏõÂnosem, 100 leÂkarÏuÊ, kterÏõÂ zhotovujõÂ OPG z profylaktickyÂch
duÊvoduÊ, zaÂrovenÏ uvedlo veÏk dõÂteÏte. NejcÏasteÏji zubnõÂ leÂkarÏi zhotovujõÂ OPG z profylaktickyÂch duÊvoduÊ u deÏtõÂ ve
veÏku mezi 6 - 8 lety. Stejnou otaÂzkou se ve sve atestacÏnõ praÂci zabyÂvala i KlimesÏova [4]. Z vyÂsledkuÊ jejõÂho
dotaznõÂkoveÂho sÏetrÏenõÂ vyplyÂvaÂ, zÏe 22,8 % leÂkarÏuÊ zhotovuje OPG v prvnõÂ faÂzi vyÂmeÏny chrupu, 17,9 % leÂkarÏuÊ
takto cÏinõÂ ve 2. faÂzi smõÂsÏeneÂho chrupu a celkem 50 %
leÂkarÏuÊ zhotovuje OPG pouze v prÏõÂpadeÏ, zÏe ma dõÂteÏ neÏjaky probleÂm.
DalsÏõ anomaÂliõÂ, kterou je nutne vcÏas odhalit a leÂcÏit je
retence staÂlyÂch rÏezaÂkuÊ a sÏpicÏaÂkuÊ. Dle neÏkolika studiõÂ,
bylo chybeÏnõÂ cÏi retence hornõÂho rÏezaÂku uvaÂdeÏno jako
vyÂznamny faktor v porusÏenõ zubnõ a oblicÏejove estetiky
a jako prÏispõÂvajõÂcõÂ faktor k poruchaÂm rÏecÏi [13]. CõÂlem
vcÏasne leÂcÏby retinovaneÂho rÏezaÂku je eliminace funkcÏnõÂch a estetickyÂch probleÂmuÊ, zpuÊsobenyÂch neprorÏezanyÂm zubem [14]. PonechaÂnõ retinovaneÂho sÏpicÏaÂku bez
leÂcÏby cÏi jineÂho, i kdyby kompromisnõÂho rÏesÏenõÂ, muÊzÏe
zpuÊsobit rÏadu komplikacõÂ. ZubnõÂ leÂkarÏ by meÏl sledovat
symetrii prorÏezaÂvaÂnõÂ a na erupci druhostranneÂho zubu
vycÏkaÂvat maximaÂlneÏ 3 - 6 meÏsõÂcuÊ. V 9 letech veÏku dõÂteÏte by meÏla byÂt nedõÂlnou soucÏaÂstõÂ preventivnõÂ prohlõÂdky palpace prÏõÂtomnosti symetrickeÂho vyklenutõÂ alveolu v hornõÂm vestibulu. Z celkoveÂho pocÏtu odpovõÂdajõÂcõÂch leÂkarÏuÊ jich 229 (54,5 % ) prÏõÂtomnost sÏpicÏaÂkuÊ
vysÏetrÏuje a 191 leÂkarÏuÊ (45,5 %) nikoliv.
Mnoho otaÂzek v dotaznõÂku bylo zameÏrÏeno na konkreÂtnõ anomaÂlie. ZkrÏõÂzÏeny skus s nucenyÂm vedenõÂm patrÏõ mezi anomaÂlie, u kteryÂch se doporucÏuje zahaÂjit
leÂcÏbu co nejdrÏõÂve. Mezi mozÏne duÊsledky neleÂcÏeneÂho
zkrÏõÂzÏeneÂho skusu patrÏõÂ naprÏõÂklad posturaÂlnõÂ probleÂmy,
trvaly posun dolnõ cÏelisti v duÊsledku asymetricke svalove aktivity cÏi muÊzÏe mõÂt trvaly dopad na ruÊst a vyÂvoj
zubuÊ a cÏelistõ a naÂsledne asymetrie [15, 16]. VeÏtsÏina leÂkarÏuÊ povazÏuje (87,7 %) za nutne odeslat a rÏesÏit tuto
anomaÂlii jizÏ v docÏasneÂm cÏi smõÂsÏeneÂm chrupu. OstatnõÂ
leÂkarÏi (41, 9,2 %) sdõÂlejõÂ naÂzor, zÏe tuto anomaÂlii postacÏõÂ
odeslat a leÂcÏit azÏ po prorÏezaÂnõÂ staÂleÂho chrupu.
V prÏõÂpadeÏ ponechaÂnõÂ protruze hornõÂch rÏezaÂkuÊ bez
zaÂsahu se mohou vyskytnout fonetickeÂ, funkcÏnõÂ cÏi pa232
ORTODONCIE
but also in new methods, approaches and problems of
other areas of dentistry. The positive outcome is that
65% of dentists are interested and sometimes take
part in workshops, etc., focused on orthodontic issues.
The important condition of cooperation is the availability of orthodontic care in the given locality.
99.5% of respondents stated that an orthodontic practice is within 30 km from their office. The same result
was reported by KlimesÏova [4]: 94% of respondents
had an orthodontic practice within 20 km from their
office.
We asked about the proportion of child clients in
dentists' offices. In most respondents (172) the proportion was up to one third. Almost the same number
of respondents (147) gave 6-10%.
There is a controversy in whether to take OPG for
prophylactic reasons or whether to take it only when
there is an anomaly suspected. Most respondents
(285) opt for OPG only in case a child benefits from it;
100 dentists taking OPG for prophylaxis gave the
age of the child patients - the most frequent being 68 years. The same problem was solved by KlimesÏovaÂ
in her postgraduate diploma dissertation [4]. Her findings are the following: 22.8% of dentists take OPG
during the first phase of dentition change, 17.9% during the second phase of mixed dentition, and 50%
of dentists decide for OPG only in case a child patient
has a problem.
Another anomaly requiring timely detection and
treatment is impaction of permanent incisors and canines. Several studies cite missing upper incisor as the
important factor disturbing dental as well as facial
esthetics, and as the factor contributing to impaired
speech [13]. The aim of timely treatment of impacted
incisors is to eliminate emotional involvement of the
child due to functional and esthetic problems caused
by a missing tooth [14]. To neglect the condition may
result in a number of complications. A dentist should
observe symmetry of teeth eruption and wait for the
eruption of the opposite counterpart for the maximum
of 3-6 months. In nine year olds the palpation of symmetric convexity of upper alveolus should be an integral part of a routine check-up. 229 respondents
(54.5%) examine the canines presence, 191 (45.5%)
do not make this examination.
A number of questions focused on individual anomalies. Lateral crossbite with forced bite belongs to
anomalies that should be treated as early as possible.
The consequence of neglected crossbite include postural problems, permanent shift of the mandible due
to asymmetry of muscles activity, permanent impact
on teeth and jaws growth and development, and the
resulting asymmetry [15,16]. Majority of dentists
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
Odborna praÂce
rodontologicke probleÂmy. DaÂle je nutne myslet na psychologicky a esteticky aspekt teÂto anomaÂlie. Velmi
podstatnyÂm duÊvodem k leÂcÏbeÏ pote muÊzÏe byÂt i nebezpecÏõ uÂrazu vykloneÏnyÂch rÏezaÂkuÊ. DõÂteÏ s vyÂraznou protruzõ rÏezaÂkuÊ je k ortodontistovi praktickyÂm zubnõÂm leÂkarÏem odesõÂlaÂno hlavneÏ z duÊvodu hlubokeÂho skusu
a z duÊvodu estetickeÂho a psychickeÂho dopadu teÂto
anomaÂlie na dõÂteÏ (Obr. 4).
PonechaÂnõÂ otevrÏeneÂho skusu bez leÂcÏby s sebou
nese mnoha rizika v podobeÏ mozÏnyÂch budoucõÂch zÏvyÂkacõÂch a fonacÏnõÂch probleÂmuÊ, estetickyÂch probleÂmuÊ cÏi
v dopadu na sebeveÏdomõÂ pacienta [17]. DyÂchaÂnõÂ uÂsty
prÏi stavu neustaÂle otevrÏenyÂch uÂst, muÊzÏe daÂle zpuÊsobit
onemocneÏnõÂ krku cÏi zaÂneÏty hltanu. VeÏtsÏina leÂkarÏuÊ
(76,2 %) se shodla, zÏe u teÂto anomaÂlie je nutne paÂtrat
po mozÏneÂm zlozvyku a zaÂrovenÏ odeslat dõÂteÏ na konzultaci na ortodoncii (Obr. 5).
PrÏevisly skus Angle definoval jako distaÂlnõ polohu
dolnõ cÏelisti, nedostatecÏny vertikaÂlnõ ruÊst oblasti pod
nosem a excesivnõÂ hloubku skusu. V takoveÂm prÏõÂpadeÏ
stolicÏky nemohou dostatecÏneÏ prorÏezat do sve normaÂlnõ deÂlky, dolnõ rÏezaÂky pote mohou prÏijõÂt do styku
s gingivou na patrÏe a inciznõÂ hrany hornõÂch rÏezaÂkuÊ
prÏesahujõÂ gingivaÂlnõÂ hranici rÏezaÂkuÊ dolnõÂch [18]. U pacienta muÊzÏe dochaÂzet k patologickeÂmu zranÏovaÂnõÂ
uÂponu gingivy u dolnõÂch frontaÂlnõÂch zubuÊ a naÂsledneÏ
k ruÊznyÂm parodontopatiõÂm a chronickyÂm zaÂneÏtuÊm
[19]. VeÏtsÏina zubnõÂch leÂkarÏuÊ (83 %) povazÏuje za nutneÂ
leÂcÏit tuto anomaÂlii jizÏ ve smõÂsÏeneÂm chrupu.
ZaÂveÏr
Na zaÂkladeÏ nasÏeho sÏetrÏenõ bylo zjisÏteÏno neÏkolik zajõÂmavyÂch skutecÏnostõÂ. NaprÏõÂklad rentgenove vysÏetrÏenõÂ
ve smyslu OPG mnoho leÂkarÏuÊ indikuje pouze v prÏõÂpadeÏ,
zÏe ma podezrÏenõ na mozÏnou odchylku cÏi problematika
vysÏetrÏovaÂnõÂ prÏõÂtomnosti sÏpicÏaÂkuÊ v hornõÂm vestibulu,
ktere nebyÂva rutinnõ soucÏaÂstõ preventivnõ prohlõÂdky dõÂteÏte ve veÏku okolo 9. roku. Pozitivnõ je, zÏe veÏtsÏina leÂkarÏuÊ
vzÏdy beÏhem vysÏetrÏenõ sleduje i ortodonticke anomaÂlie.
Mnoho leÂkarÏuÊ si uveÏdomuje maximaÂlnõ cÏasovy odstup
pro vycÏkaÂvaÂnõÂ v prÏõÂpadeÏ neprorÏezaÂnõÂ druhostranneÂho
zubu. PrÏi prÏedcÏasnyÂch ztraÂtaÂch docÏasnyÂch molaÂruÊ cÏi
sÏpicÏaÂkuÊ, leÂkarÏi znajõÂ riziko posunu sousednõÂch zubuÊ
do mezery cÏi mozÏny prÏesun strÏedu zubnõÂho oblouku.
rocÏnõÂk 23
cÏ. 4. 2014
(87.7%) believe that the anomaly should be solved as
early as in deciduous or mixed dentition. The rest
(41, i.e.9.2%) conclude that the anomaly may be treated only after eruption of permanent dentition.
Untreated upper incisors protrusion may result in
phonetic, functional or periodontal problems. We
should also bear in mind psychological and esthetic
aspects of this anomaly. The risk of injury of protruded
incisors is one of the most essential reasons of treatment. Children with distinctive protrusion of incisors
are sent to orthodontic practices especially due to
deep bite, and for esthetic and psychological impact
on a child (Fig. 4).
Neglected open bite may lead to masticatory and
phonetic problems in the future, as well as to esthetic
problems that may affect patient's self-confidence
[17]. Mouth breathing, when the mouth is always open,
may lead to sore throat and pharyngitis. Most dentists
(72.6%) agreed on that in case of this anomaly it is necessary to find out whether a bad habit is not the cause,
and to send a child to an orthodontic practice (Fig. 5).
Angle defined cover bite as a distal position of the
mandible, insufficient vertical growth of the area under
the nose, and excessive overbite. Molars cannot erupt
to their normal length, lower incisors may touch the
gingiva on the palate, and incisal edges of upper incisors exceed gingival level of lower incisors [18]. Gingival ligament of lower anterior teeth may be pathologically damaged, which may lead to various periodontal
problems and chronic inflammations [19]. Majority of
dentists (83%) believe the anomaly should be solved
as early as in mixed dentition.
VzaÂjemna spolupraÂce nejen stomatologickyÂch oboruÊ je pro zdravy vyÂvoj a plnou funkci zÏvyÂkacõÂho systeÂmu dõÂteÏte nezastupitelnaÂ. DeÏti jsou nedõÂlnou soucÏaÂstõ populace, je trÏeba se jejich specifickyÂmi probleÂmy zabyÂvat v plneÂm rozsahu a vcÏasnyÂm zaÂchytem
ortodontickyÂch anomaÂliõÂ prÏedchaÂzet mozÏnyÂm komplikacõÂm vyplyÂvajõÂcõÂm z jejich pozdnõÂ leÂcÏby.
Conclusion
Our survey proved several interesting facts. E.g.
OPG is indicated by many dentists only in case an anomaly is suspected; examination of upper canine's
presence is not an integral part of a routine check-up
of children around the age of 9. The good news is that
most dentists pay attention to orthodontic anomalies.
A lot of them are aware of the maximum time gap between the eruption of a tooth and its opposite counterpart. In case of premature loss of deciduous molars or
canines, the dentists know about the risk of shift of adjacent teeth into the space, or about possible shift of
the dental arch centre.
Cooperation of different specialists is indispensable
for healthy development and fully functional masticatory
system of a child. Children make the integral part of population, therefore it is necessary to focus on their specific problems and through timely identification of orthodontic anomalies prevent their potential complications.
AutorÏi nemajõ komercÏnõÂ, vlastnicke nebo financÏnõ zaÂjmy na produktech nebo spolecÏnostech popsanyÂch v tomto cÏlaÂnku.
The authors have no commercial, proprietary or financial interest
in products or companies mentioned in the article.
www.orthodont-cz.cz e-mail: [email protected]
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Odborna praÂce
ORTODONCIE
Literatura/References
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2014, 24, cÏ. 3, nestr.
13. Yaqoob, O.; O' Neill, J.; Gregg, T.: Management of unerupted maxillary incisors. V [online]. [cit. 2014-04-13].
Dostupne na internetu: http://www.rcseng.ac.uk/fds/
publications-clinical-guidelines/clinical-guidelines/documents/ManMaxIncisors2010.pdf.[online].
14. Rizzatto S.M.; Menezes, L.M.; Allgayer, S.; Batista E.L.:
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dentofacial Orthop. 2013, 144, cÏ. 1, s. 119-129.
15. Martin, C.; AlarcoÂn, J.A.; Palma, J.C.: Kinesiographic
study of the mandible in young patients with unilateral
posterior crossbite. Amer. J. Orthodont. dentofacial
Orthop. 2000, 118, cÏ. 5, s. 541-548.
16. PetreÂn, S.; Bondemark, L.: Correction of unilateral posterior crossbite in the mixed dentition : A randomized
controlled trial. Amer. J. Orthodont. dentofacial Orthop.
2008, 133, cÏ. 6, s. 790.e7-790.e13.
17. Torres, F.C.; Almeida, R.R.; Almeida-Pedrin, R.R.; Pedrin, F.; Paranhos, L.R.: Dentoalveolar comparative study
between removable and fixed cribs, associated to chincup, , in anterior open bite treatment. J. Appl. Oral. Sci.
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II, Division 2 malocclusions: Part I. Amer. J. Orthodont.
dentofacial Orthop. 1990, 97, cÏ. 6, s. 510-521.
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1976.
1. Graber, T.M.; Vanarsdall, R.L.; Vig, K.W.L.: Orthodontics:
Current principles and Techniques. 4th edition, St. Louis:
Elsevier, 2005.
2. Proffit, W.R,; Fields, H.W.; Sarver, D. M.: Contemporary
orthodontics. 4th. edition, St. Louis: Mosby Elsevier,
2007.
3. Kot'ovaÂ, M.: Kdy poslat dõÂteÏ na ortodonticke vysÏetrÏenõÂ. 2.
cÏaÂst. LKS. 2008, 18, cÏ. 3, s. 76-82.
4. KlimesÏovaÂ, H. SpolupraÂce ortodontisty a pedostomatologa. AtestacÏnõÂ praÂce ke specializacÏnõÂ zkousÏce z oboru
Ortodoncie. OddeÏlenõÂ ortodoncie a rozsÏteÏpovyÂch vad
Stomat. kliniky 3. LF UK v Praze. Praha, 2010.
5. KamõÂnek, M.; SÏtefkovaÂ, M.: Ortodoncie I. Olomouc: Univerzita PalackeÂho, 2001.
6. KamõÂnek, M.: CÏeska Ortodoncie ve 20. stoletõÂ. Ortodoncie 1999, 8, cÏ. 4, s. 17-22.
7. Kot'ovaÂ, M.: Ortodonticky pruÊvodce praktickeÂho zubnõÂho
leÂkarÏe. Praha: Grada Publishing, 2006.
8. KamõÂnek, M.; SÏtefkovaÂ, M.: Ortodoncie II. Olomouc: Univerzita PalackeÂho, 1991.
9. Kot'ovaÂ, M.: Kdy poslat dõÂteÏ na ortodonticke vysÏetrÏenõÂ. 1.
cÏaÂst. LKS. 2008, 18, cÏ. 2, s. 46-53.
10. Abari, R.F.: Problems to watch for in seven year old.
V [online]. [cit. 2014-04-13]. Dostupne na internetu:
http://www.drabari.com/seven-year-olds.pdf. [online].
11. AlarcoÂn, J.A.; Martin, C.; Palma, J.C.: Effect of unilateral
posterior crossbite on the electromyographic activity of
human masticatory muscles. Amer. J. Orthodont. dentofacial Orthop. 2000, 118, cÏ. 3, s. 328-334.
MDDr. Hana RÏehaÂcÏkovaÂ
Stomatologicka klinika FN u sv. Anny
PekarÏska 53, 656 91 Brno
Materiály pro stomatologii a ortodoncii
Mojmírovců 799/45, 70900 Ostrava
www.beldental.cz, [email protected]
T.: 596 638 222-3, 777 727 031, 800 100 793
Ryze česká firma
18. 04. 2015
Praha
8.±9. 5. 2015
Olomouc
29. 5. 2015
Olomouc
PrÏehled chystanyÂch domaÂcõÂch akcõÂ 2014:
prof. COZZANI Mauro
¹Neviditelna rovnaÂtka ALL INª ± certifikacÏnõ kurz
MUDr. SÏTEFKOVAÂ Marie, CSc.
¹Role sestry prÏi jednotlivyÂch etapaÂch ortodonticke leÂcÏbyª ± prakticky kurz
MUDr.DUBOVSKAÂ Ivana
¹NeprÏõÂme lepenõ zaÂmkuÊ a 2D technikaª ± prakticky kurz
*
*
*
Informace: BeÏlova Olga, MojmõÂrovcuÊ 799/45, 709 00 Ostrava-MariaÂnske Hory Tel.: 777 727 152, 800 100 793
234
www.orthodont-cz.cz e-mail: [email protected]
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rocÏnõÂk 23
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Ze zahranicÏnõÂch cÏasopisuÊ
PrognoÂza perzistujõÂcõÂch docÏasnyÂch molaÂruÊ bez
staÂlyÂch naÂstupcuÊ: infraokluze, korÏenova resorpce
a prÏõÂtomnost vyÂplnõÂ.
The prognosis of retained primary molars without
successors: infraocclusion, root resorption and restoration
Hvaring C. L., Ogaard B.: The prognosis of retained primary molars without successors: infraocclusion, root
resorption and restoration
Eur.J.Orthodont. 2014, 36, n. 1, p. 26-30.
Hypodoncie je vrozene chybeÏnõ jednoho cÏi võÂce docÏasnyÂch cÏi staÂlyÂch zubuÊ a je to nejcÏasteÏjsÏõ polymorfismus u cÏloveÏka. Jejõ vyÂskyt u SkandinaÂvskyÂch se deÏtõ se
udaÂva 6,5- 7,8 %, postihuje prÏevaÂzÏneÏ dõÂvky. S vyÂjimkou
3. molaÂru jsou mandibulaÂrnõ druhe premolaÂry nejcÏasteÏji
nezalozÏene zuby. JizÏ drÏõÂve byla objevena znacÏna souvislost mezi agenezõ druheÂho premolaÂru a infraokluzõÂ
docÏasneÂho molaÂru paÂny Bjerklinem a spol. (1992)
a Baccettim (1998). Jakmile dojde k diagnostikovaÂnõÂ
agenezõ staÂleÂho zubu, volba leÂcÏebneÂho postupu vyzÏaduje opatrne rozhodnutõÂ. Faktory, ktere musõÂme vzõÂt
beÏhem plaÂnovaÂnõÂ v potaz, jsou: 1.) mnozÏstvõÂ a pozice
chybeÏjõÂcõÂch zubuÊ, 2.) stav perzistujõÂcõÂho docÏasneÂho
zubu, 3.) skeletaÂlnõÂ vztahy a okluze, 4.) naÂroky na prostor, 5.) profil oblicÏeje, 6.) pacientuÊv prÏõÂstup k leÂcÏbeÏ.
PerzistujõÂcõ docÏasny zub slouzÏõ k udrzÏenõ mõÂsta, zabraÂneÏnõ resorpce alveolaÂrnõ kosti, muÊzÏe slouzÏit jako semipermanentnõ rÏesÏenõ trvajõÂcõ azÏ do dospeÏlosti a odlozÏit
tak nutnost protetickeÂho osÏetrÏenõÂ. CõÂlem teÂto studie
bylo posoudit infraokluzi, resorpci korÏene a prÏõÂtomnost
vyÂplnõÂ a jejich duÊlezÏitost pro prognoÂzu perzistujõÂcõÂho
docÏasneÂho molaÂru.
Studie byla provaÂdeÏna na 212 pacientech se zaÂvazÏnou hypodonciõÂ na FakulteÏ zubnõÂho leÂkarÏstvõÂ University v Oslu. K potvrzenõÂ prÏõÂtomnosti a stavu docÏasneÂho
molaÂru byl pouzÏit panoramaticky snõÂmek. PruÊmeÏrnyÂ
veÏk pacientuÊ byl 12,6 let. KriteÂria zarÏazenõÂ do studie
byla kvalitnõ panoramaticky snõÂmek a prÏõÂtomny docÏasny molaÂr, k posouzenõ infraokluze mezi kriteÂria prÏibyla i neprÏõÂtomnost aproximaÂlnõÂch vyÂplnõ meziaÂlnõÂho
a distaÂlnõÂho souseda docÏasneÂho molaÂru.
Dle Kurola (1981) je zub v infraokluzi, je-li jeho okluzaÂlnõÂ rovina asponÏ 1 mm pod okluzaÂlnõÂ rovinou plneÏ
prorÏezaneÂho sousednõÂho zubu. AnalyÂza infraokluze
zde zahrnovala 92 pacientuÊ, prÏicÏemzÏ 43,6 % z nich vykazovala klinicky vyÂznamnou infraokluzi. ZhorsÏovaÂnõÂ
infraokluze u dospeÏlyÂch pacientuÊ s ukoncÏenyÂm ruÊstem
bylo zanedbatelneÂ, u mladistvyÂch se infraokluze zhorsÏovala nejvõÂce v obdobõÂ ruÊstoveÂho spurtu. Proto, pokud nenõÂ prÏõÂtomna signifikantnõÂ infraokluze po ruÊstoveÂm spurtu, muÊzÏeme ocÏekaÂvat, zÏe se bude zhorsÏovat
jizÏ minimaÂlneÏ. PrÏi studii byla take zjisÏteÏna vyÂznamnaÂ
238
ORTODONCIE
souvislost mezi infraokluzõÂ a korÏenovou resorpcõÂ. AnalyÂza resorpce korÏene a prÏõÂtomnostõÂ vyÂplnõÂ byla provaÂdeÏna na 111 pacientech a zjistila, zÏe obecneÏ, distaÂlnõÂ
korÏen byl resorpcõÂ postizÏen võÂce, nezÏ meziaÂlnõÂ, a to
v 18,9 a 33,3 procentech prÏõÂpaduÊ. BeÏhem studie nebyl
pozorovaÂn vyÂznamneÏjsÏõÂ vztah mezi pohlavõÂm a infraokluzõÂ cÏi resorpcõÂ korÏenuÊ. I prÏesto nenõÂ pravdeÏpodobneÏ
resorpce korÏene kritickyÂm faktorem zÏivotnosti zubu.
VeÏtsÏina pacientuÊ (78,4%) nemeÏla docÏasny molaÂr osÏetrÏen vyÂplnõÂ.
ZaÂveÏrem bylo stanoveno, zÏe klinicky vyÂznamna infraokluze byla zjisÏteÏna u 43,6 % pacientuÊ. Resorpce
korÏenuÊ a vyÂplneÏ na perzistujõÂcõÂm zubu nejsou klinicky
vyÂznamneÂ. Infraokluze je tedy povazÏovaÂna za nejkriticÏteÏjsÏõ faktor pro prognoÂzu docÏasneÂho molaÂru bez staÂleÂho naÂstupce. Proto je duÊlezÏite braÂt infraokluzi v potaz
prÏi stanovovaÂnõ leÂcÏebne strategie u pacientuÊ s hypodonciõÂ. Toto je zvlaÂsÏteÏ duÊlezÏite u teÏch, u nichzÏ jesÏteÏ neskoncÏil skeletaÂlnõ ruÊst.
MDDr. SÏaÂrka MraÂzkovaÂ
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Efekt interceptivnõÂ extrakce docÏasneÂho sÏpicÏaÂku na
palatinaÂlneÏ ulozÏeny hornõ sÏpicÏaÂk
Prospektivnõ randomizovana studie
Effect of interceptive extraction of deciduous canine on palatally displaced maxillary canine:
A prospective randomized controlled study
Farhan Bazargania; Anders Magnusonb; Bertil Lennartssonc
Angle Orthodont. 2014, 84, cÏ.1, s. 3-10
CõÂlem teÂto studie bylo zhodnotit efekt extrakce docÏasneÂho sÏpicÏaÂku na palatinaÂlneÏ umõÂsteÏny staÂly sÏpicÏaÂk,
analyzovat vliv veÏku pacienta na tento interceptivnõ zaÂkrok a posoudit, zda jednostranna extrakce docÏasneÂho sÏpicÏaÂku ma vliv na posun strÏednõ cÏaÂry hornõ cÏelisti.
K palatinaÂlnõÂmu ulozÏenõ sÏpicÏaÂku vede jednak geneticka predispozice, jednak jeho dlouha a naÂrocÏnaÂ
erupcÏnõ cesta do spraÂvne pozice. U bõÂle populace se
palatinaÂlneÏ ulozÏeny sÏpicÏaÂk vyskytuje u 2-3 % populace. PalatinaÂlneÏ umõÂsteÏny sÏpicÏaÂk je cÏasteÏjsÏõ nezÏ vestibulaÂrneÏ ulozÏeny sÏpicÏaÂk. NejcÏasteÏjsÏõÂm naÂsledkem nespraÂvne polohy sÏpicÏaÂku je jeho retence, cozÏ vyÂznamneÏ
zvysÏuje riziko resorpce okolnõÂch zubuÊ.
Studie zahrnovala 24 pacientuÊ (8 chlapcuÊ, 16 dõÂvek)
s bilateraÂlneÏ palatinaÂlneÏ umõÂsteÏnyÂmi sÏpicÏaÂky. PruÊmeÏrny veÏk pacientuÊ byl 11,6 roku (SD 1,2 roku). NaÂhodneÏ byl u kazÏdeÂho pacienta vybraÂn jeden docÏasnyÂ
sÏpicÏaÂk k extrakci a kontralateraÂlnõÂ slouzÏil jako kontrola.
Pacienti byli pote sledovaÂnõ v sÏesti meÏsõÂcÏnõÂch intervawww.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
Ze zahranicÏnõÂch cÏasopisuÊ
lech po dobu 18 meÏsõÂcuÊ. Zhotovovaly se ortopantomogramy a intraoraÂlnõ okluzaÂlnõ rentgenove snõÂmky.
Po 18 meÏsõÂcõÂch dosÏlo k uÂspeÏsÏne erupci staÂleÂho sÏpicÏaÂku na straneÏ s extrakcõ docÏasneÂho sÏpicÏaÂku u 67 %,
na straneÏ kontrolnõÂ (bez extrakce docÏasneÂho sÏpicÏaÂku)
pouze u 42 %. RozdõÂl u obou stran byl statisticky signifikantnõÂ a efekt byl mnohem vyÂrazneÏjsÏõÂ u mladsÏõÂch
pacientuÊ. Nebyl zaznamenaÂn signifikantnõÂ rozdõÂl mezi
pohlavõÂm. DaÂle bylo zjisÏteÏno, zÏe extrakce docÏasneÂho
sÏpicÏaÂku ovlivnila meÂneÏ erupci staÂleÂho sÏpicÏaÂku pokud
byl võÂce vzdaÂleny od mõÂsta extrakce docÏasneÂho sÏpicÏaÂku (viz. obr. - zoÂna 4 + 5). ZaÂrovenÏ dosÏlo k vyÂznamneÂmu zmensÏenõ obvodu oblouku na extrakcÏnõ straneÏ
v porovnaÂnõÂ s kontrolnõÂ stranou beÏhem sledovaneÂho
obdobõÂ. U zÏaÂdneÂho pacienta nebyl zaznamenaÂn posun
strÏednõ cÏaÂry smeÏrem k extrakcÏnõ straneÏ. Zda se, zÏe jakmile jsou lateraÂlnõ rÏezaÂky jizÏ prorÏezaÂny, nema jednostranna extrakce docÏasneÂho sÏpicÏaÂku na posun strÏednõÂ
cÏaÂry vliv.
ZaÂveÏrem lze rÏõÂci, zÏe extrakce hornõÂho docÏasneÂho
sÏpicÏaÂku je efektivnõÂm opatrÏenõÂm u palatinaÂlneÏ dislokovanyÂch staÂlyÂch sÏpicÏaÂkuÊ, ale musõÂ byÂt provedena vcÏas,
nejleÂpe ve veÏku 10-11 let. Proto je velmi duÊlezÏita brzkaÂ
diagnoÂza. Abychom zabraÂnili zmensÏenõ obvodu oblouku, je vhodne pouzÏõÂt transpalatinaÂlnõ oblouk
k udrzÏenõÂ postavenõÂ molaÂruÊ.
MDDr. Gabriela KrejcÏõÂ
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Pevnost vazby lepenyÂch draÂteÏnyÂch retaineru
Rebond strenght of bonded lingual wire retainers
Westing, K.; Algera, T.J.; Kleverlaan, C.J.
Eur. J. Orthodont. 2012, 34, cÏ.1, s.345-349
Bez retencÏnõÂ faÂze je tendence zubuÊ vraÂtit se do postavenõÂ prÏed leÂcÏbou (Al Yami et al., 1999). PrÏõÂcÏiny towww.orthodont-cz.cz e-mail: [email protected]
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hoto jevu nejsou zatõÂm plneÏ znaÂmy, ale mohou byÂt spojeny s tahem periodontaÂlnõÂch vlaÂken, tlakem rtuÊ, tvaÂrÏõÂ
a jazyka, pokracÏujõÂcõÂm ruÊstem a okluzõÂ (Melrose and
Millet, 1998). UkaÂzalo se, zÏe prÏiblizÏneÏ 7 meÏsõÂcuÊ po ortodontickeÂm posunu se remodelujõÂ vlaÂkna kolem zubu
do nove pozice (Reitan, 1967). NicmeÂneÏ i po teÂto dobeÏ
muÊzÏe dojõÂt k relapsu (Little et al., 1981, 1988). NeÏkterÏõÂ
leÂkarÏi proto uprÏednostnÏujõÂ dlouhodobou retenci, neÏkdy
dozÏivotnõÂ.
CõÂlem teÂto in-vitro studie bylo zhodnotit pevnost
vazby retaineru ke sklovinneÂmu povrchu bud'se zbytky
kompozitu nebo bez nich. Retainery byly lepeny pomocõÂ materiaÂluÊ Excite a Tetric flow na trÏech ruÊznyÂch
povrsÏõÂch: na cÏiste sklovineÏ, na sklovineÏ zbaveneÂ
zbytkuÊ kompozitu pomocõ wolfram-karbidove freÂzy
a na sklovineÏ se zbytkem kompozitu zdrsneÏneÂm wolfram-karbidovou freÂzou. Pevnost vazby byla zkoumaÂna
paÂkovyÂm testem. KazÏdy zub byl znovu nalepen dvakraÂt a testovaÂn trÏikraÂt. Povrch byl zkoumaÂn pomocõÂ
elektronoveÂho mikroskopu a zaznamenaÂn pomocõÂ
ARIskore. Jako substraÂt byla pouzÏita sklovina z 38 cÏerstveÏ extrahovanyÂch zubuÊ hoveÏzõÂho dobytka, naÂhodneÏ
sbõÂranyÂch od dva roky stareÂho dobytka. Byla uzÏita zkrÏõÂzÏena studie. KazÏdy zub byl znovu lepen dvakraÂt a testovaÂn trÏikraÂt a naÂhodneÏ prÏideÏlen do jedne ze dvou
skupin A nebo B a sledovaÂn v cÏase T1 azÏ T3. lepenõÂ retaineru bylo standardizovaÂno podle naÂsledujõÂcõÂho protokolu: leptaÂnõÂ 37% H3PO4 po dobu 30 sekund a dalsÏõÂch 30 sekund vydatneÏ oplachovaÂn s naÂslednyÂch
susÏenõÂm proudem vzduchu, 10 sekund bondovaÂnõÂ
a rozfouknutõÂ vzduchem. NaÂsledovalo prÏilozÏenõÂ
15 mm dlouheÂho retencÏnõÂho draÂtu Pentaflex (American orthodontics, Sheboygan, Wisconzin, USA, nerezaveÏjõÂch ocel, CO-AX spool) a pokrytõÂ nevytvrzenyÂch
kompozitnõÂm materiaÂlem Excite, ktery byl osvõÂcen 20
sekund. PrÏi vlastnõÂm meÏrÏenõ bylo zatõÂzÏenõ meÏrÏeno v Newtonech. Po testu byl vyÂsledek meÏrÏen pomocõ ARI (Artun and Bugland, 1984). K urcÏenõ nejslabsÏõÂho bodu systeÂmu draÂt-kompozit-zub. Nula-zÏaÂdny zbytek kompozitu 1 - meÂneÏ nezÏ polovina a 2 - võÂce nezÏ polovina
kompozitu na sklovinneÂm povrchu. VyÂsledky byly
urcÏovaÂny pomocõÂ stereomikroskopu (Olympus, Tokio,
Japonsko). Po testu byl vzorek prÏipraven pro znovunalepenõ a odstraneÏny vesÏkere zbytky pryskyrÏice. ARI
ukaÂzalo, zÏe 96,5% selhaÂnõÂ vazby bylo mezi povrchem
pryskyrÏice-retainer.
VyÂsledky tohoto vyÂkumu neukaÂzaly statisticky vyÂznamne rozdõÂly mezi prvotneÏ lepenyÂmi a dolepovanyÂmi
draÂteÏnyÂmi retainery, stejneÏ jako mezi vzorky, ze kteryÂch byl odstraneÏn vesÏkery zbyly kompozitnõ materiaÂl
prÏed dolepenõÂm. TudõÂzÏ hypoteÂza, zÏe pevnost vazby
prvotneÏ lepenyÂch a dolepovanyÂch retaineruÊ je rozdõÂlnaÂ,
byla poprÏena.
MUDr. Lucie SÏveÂbisÏovaÂ
239
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Informace
ORTODONCIE
PrÏehled chystanyÂch zahranicÏnõÂch akcõÂ
Datum
NaÂzev
(jednacõ jazyk jiny nezÏ angl.)
Informace
4.±7. 3. 2015
Guadalajara, Mexiko
48th Annual Session of Asociation
Mexicana de Ortodoncia
Website: www.amo.org.mx, www.alado.org.br
15.±17. 4. 2015
Napier, New Zealand
Conference of New Zealand
Association of Orthodontists
Website: www.nzao2015.co.nz
22.±25. 4. 2015
Warszaw, Poland
Warszaw Orthodontic Congress
Website: www.kursy.ortofan.pl
15.±19. 5. 2015
San Francisco, USA
115th Congress of the American
Association of Orthodontists
American Association of Orthodontists,
401 North Lindbergh Boulevard, ST.LOUIS, MO, USA
Website: www.aaomembers.org
13.±18. 6. 2015
Lido, Venice, Italy
91st Congress of the European
Orthodontic Society
Oltrex, Ca' Vignola-Dorsoduro, Salizada San Baseggio 1648,
I-30123 Venice, Italy
Website: www.eos2015.org
17.±19. 9. 2015
Victoria, British
Columbia, Canada
Canadian Association of
Orthodontists Annual Session
Website: www.cao-aco.org/EVENTS/future.asp
27.±30. 9. 2015
London, England
8th International Orthodontic
Congress
Website: www.wfo2015london.org
29.±30. 10. 2015
Milan, Italy
46th Internation Congress of
Italian Society of Orthodontics
Website: www.sido.it
18.±21. 11. 2015
88. Wisenschaftliche Jahrestagung
Mannheim,Deutschland der DGKFO
Website: www.dgkfo.de
11.±12. 3. 2016
Rome, Italy
Spring Meeting of Italian Society
or Orthodontics
Website: www.sido.it
29. 4.±3. 5. 2016
Orlando, Florida, USA
116th Congress of the American
Association of Orthodontists
American Association of Orthodontists.
401 North Lindbergh Boulevard, ST.LOUIS, MO, USA
Website: www.aaomembers.org
11.±16. 6. 2016
Stockholm, Sweden
92nd Congress of the European
Orthodontic Society
Professor Jan Huggare
MCI, PO Box 6911, SE-10239 Stockholm, Sweden
24.±26. 8. 2016
Santiago de Chile
XVI International Congress of
Orthodontics
Website: www.sortchile.cl
21.±25. 4. 2017
San Diego, CA, USA
117th Congress of the American
Association of Orthodontists
American Association of Orthodontists.
401 North Lindbergh Boulevard, ST.LOUIS, MO, USA
Website: www.aaomembers.org
6.±10. 6. 2017
93rd Congress of the European
Montreaux, Switzerland Orthodontic Society
Protessor Christos Katsaros
17.±23. 6. 2018
Edinburgh, UK
94th Congress of the European
Orthodontic Society
Dr. Dirk Bister
12.±17. 6. 2019
Nice, France
95th Congress of the European
Orthodontic Society
Professor Olivier Sorel
Jste ORTODONTISTA s praxõÂ a chcete se staÂt nepostradatelnou soucÏaÂstõÂ zavedeneÂho tyÂmu stomatologuÊ?
Je pro VaÂs vyÂzvou zaÂzemõÂ stabilnõÂ kliniky s nadstandardneÏ vybavenyÂmi ordinacemi v centru Prahy, vyÂbornyÂm
provoznõÂm servisem, smlouvami se zdravotnõÂmi pojisÏt'ovnami, vlastnõÂ laboratorÏõÂ a dostatkem pacientuÊ? LaÂkaÂ
VaÂs pruzÏna pracovnõ doba a financÏnõ ohodnocenõ dle vlastnõ odvedene praÂce? Pak se prÏidejte k naÂm na stomatologii DENT MEDICO (cely i cÏaÂstecÏny pracovnõ uÂvazek).
VõÂce informacõÂ na www.dentmedico.cz, daÂle na [email protected] nebo tel. +420 739 486 168.
240
www.orthodont-cz.cz e-mail: [email protected]
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Informace
ORTODONCIE
PrÏehled chystanyÂch domaÂcõÂch akcõÂ
Datum
NaÂzev
Informace
6. 2. 2015
Praha
Kurz I: VysÏetrÏenõÂ pacienta v ortodoncii
(pro orto. asistentky)
Informace: Vendula HnõÂzdilovaÂ, tel.: 724 100 477
E-mail: [email protected]
20. 3. 2015
Praha
Kurz II: AparaÂty a leÂcÏebne postupy v ortodoncii
(pro orto. asistentky)
Informace: Vendula HnõÂzdilovaÂ, tel.: 724 100 477
E-mail: [email protected]
3. 4. 2015
Praha
Kurz III: Ortodoncie a zubnõÂ kaz
(pro orto. asistentky)
Informace: Vendula HnõÂzdilovaÂ, tel.: 724 100 477
E-mail: [email protected]
10.±11. 4. 2015
Praha
II. rocÏnõÂk sympozia s konceptem
¹Dva obory ± jeden cõÂlª se zameÏrÏenõÂm na
spolupraÂci ortodontisty s implantologem
Inf.: Altis Group spol. s.r.o., ZÏerotõÂnova 901/12, 690 02 BrÏeclav
Tel./fax: 519 325 414, e-mail: [email protected]
Zelena linka: 800 100 535
18. 04. 2015
Praha
prof. COZZANI Mauro
¹Neviditelna rovnaÂtka ALL INª ± certifikacÏnõ kurz
± spolecÏna akce firem BELdental a ItalDent
Informace: BeÏlova Olga, MojmõÂrovcuÊ 799/45,
709 00 Ostrava-MariaÂnske Hory
Tel.: 777 727 152, 800 100 793
Informace: ItalDent s.r.o., Rousovicka 623/1, Praha 8
Ing. PavlõÂna CÏertykovcev, tel.: 223 552 022
E-mail: [email protected], www.italdent.cz
23.±25. 4. 2015
SÏtrbske Pleso
MUDr. KatarõÂna JakubovaÂ
¹Ortodonticka teoÂria v praxi - Iª
Informace: Petka s.r.o., KuzmaÂnyho 2, 953 01 Zlate Moravce, SR
www.kapedent.sk
8.±9. 5. 2015
Olomouc
MUDr. SÏTEFKOVAÂ Marie, CSc.
¹Role sestry prÏi jednotlivyÂch etapaÂch
ortodonticke leÂcÏbyª ± prakticky kurz
Informace: BeÏlova Olga, MojmõÂrovcuÊ 799/45,
709 00 Ostrava-MariaÂnske Hory
Tel.: 777 727 152, 800 100 793
16. 5. 2015
Praha
Dr. Cesare LUZI, DDS, MSc.
¹Revoluce skeletaÂlnõÂho kotvenõÂ: paradima
modernõÂ ortodoncie?ª
Informace: ItalDent s.r.o., Rousovicka 623/1, Praha 8
Ing. PavlõÂna CÏertykovcev, tel.: 223 552 022
E-mail: [email protected], www.italdent.cz
29. 5. 2015
Olomouc
MUDr.DUBOVSKAÂ Ivana
¹NeprÏõÂme lepenõ zaÂmkuÊ a 2D technikaª
± prakticky kurz
Informace: BeÏlova Olga, MojmõÂrovcuÊ 799/45,
709 00 Ostrava-MariaÂnske Hory
Tel.: 777 727 152, 800 100 793
15.±17. 10. 2015
Hradec KraÂloveÂ
¹XVI. kongres CÏeske ortodonticke spolecÏnostiª
Informace: GUARANT INTERNATIONAL, spol. s r. o.
Jitka PuldovaÂ, Na PankraÂci 17, 140 21 Praha 4
Tel.: 284 001 444, e-mail: [email protected]
20.±21. 11. 2015
Praha
Dr. Marco Rosa, MD, DMD, DOrthod
Angle Society of Europe
Prof. A C. Insurbia University - Italy
Inf.: Altis Group spol. s.r.o., ZÏerotõÂnova 901/12, 690 02 BrÏeclav
Tel./fax: 519 325 414, e-mail: [email protected]
Zelena linka: 800 100 535
CÏlensky poplatek pro rok 2015 cÏinõ 2500,- KcÏ nebo 100,- EUR.
CÏlenove v zameÏstnaneckeÂm vztahu 800,- KcÏ nebo 35,- EUR.
Postgraduanti, duÊchodci a zÏeny na materÏske dovolene 300,- KcÏ nebo 15,- EUR.
RegistracÏnõÂ polatek cÏinõÂ 500,- KcÏ nebo 20,- EUR.
PrÏedplatne cÏasopisu Ortodoncie pro necÏleny CÏOS je 1000,- KcÏ za rok nebo 50,- EUR.
UÂhrada poplatku do 28. 2. 2015, cÏ. uÂ.: 32932021/0100, konst. symbol: 0558, variab. symbol: rodne cÏõÂslo.
PrÏi nezaplacenõÂ prÏõÂspeÏvkuÊ po dvou põÂsemnyÂch urgencõÂch bude ukoncÏeno cÏlenstvõÂ v CÏOS.
242
www.orthodont-cz.cz e-mail: [email protected]
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Mala nocÏnõ vigilie o znamenõ heraldickeÂm a znamenõ doby
Moji milõ cÏtenaÂrÏove nocÏnõÂch vigiliõÂ. CÏas se opeÏt vaÂnocÏneÏ nachyÂlil a uzÏ jsem meÏl v hlaveÏ vigilii ortodontickou.
JeÂeÂeÂnzÏe, naÂmeÏty se rodõÂ rychlostõÂ mõÂsenyÂch karet...
Dnes nelze bez povsÏimnutõ minout jedno heraldicke znamenõÂ. Kdykoliv saÂhnete do kapsy pro drobne na
sÏatnu v divadle, nebo u parkovacõÂho automatu, muÊzÏete si je prohleÂdnout. Je na kazÏde nasÏÂõ minci. Jako na brakteaÂtu ze 13. stol. po Kr., kde se na platidle objevilo poprveÂ. PrÏÂõbeÏh tohoto
heraldickeÂho znamenõ zacÏÂõna praÂveÏ v onom cÏase. VaÂclav I., cÏtvrty cÏesky kraÂl,
meÏl dva syny. To zacÏÂõna jako pohaÂdka. Jeden, Vladislav CÏeskyÂ, markrabeÏ
moravsky a veÂvoda rakousky zemrÏel ve dvaceti letech snad prÏirozenou
smrtõÂ. Zbyl jen jeden princ. PrÏemyslovskyÂ
kraÂl nosil na svyÂch pecÏetõÂch, sÏtõÂtech, praporcõÂch a cÏabrakaÂch konõÂ svatovaÂclavskeÂ
heraldicke znamenõÂ. CÏernou orlici. Jeho
syn, PrÏemysl Otakar, po smrti VladislavoveÏ
kralevic, nikoliv. KraÂl VaÂclav byl povazÏovaÂn
za stareÂho, slabeÂho, nerozhodneÂho vlaÂdce a neperspektivnõÂho panovnõÂka. I vnukla skupina strÏedoveÏkyÂch hujeruÊ kralevici mysÏlenku, urychlit tok deÏjin v cÏase a starÏÂõka svrhnout. Za vyÂrazneÂho prÏispeÏnõ typicky ¹cÏeskyª veÏrnyÂch sÏlechticuÊ, kterÏÂõ jisteÏ nosili PrÏemyslovi i sÏvesticÏky ze sve zahraÂdky. Kralevic obsadil
veÏtsÏinu kraÂlovskyÂch hraduÊ. A hujerÏi se jizÏ teÏsÏili, jak budou mladõÂka sÏkubat. Nebot' cõÂle hujerske jsou prÏÂõsneÏ soukrome a nikdy se nemeÏnõÂcõÂ. JeÂeÂeÂeÂnzÏe. StaryÂ, slabyÂ, nerozhodny a neperspektivnõ vzal do ruky mecÏ, vsedl na
kuÊnÏ a vsÏechny hrady dobyl zpeÏt. VsÏechny. A jisteÏ za nemaleÂho prÏispeÏnõÂ tyÂchzÏ hujeruÊ, kterÏÂõ do pruÊsÏvihu pomohli
MladeÂmu kraÂli. Ti pak veÏrnostneÏ prohleÂdli a rychle prÏehodnotili otvorovou hierarchii. V nasÏich velkyÂch, sÏiryÂch, rodnyÂch laÂnech. Nebo LaÂnech? Ta cÏesÏtina je uÂzÏasnaÂ. A otec uvrhl syna do veÏzenõÂ. Ve strÏedoveÏku. Ale kdezÏe se naÂm ztraÂcõÂ prÏÂõbeÏh heraldickyÂ? KraÂl VaÂclav I. tedy nosil na svyÂch korouhvõÂch cÏernou svatovaÂclavskou orlici, ale PrÏemysl Otakar, markrabeÏ moravskyÂ, nosil erb jinyÂ.
BõÂleÂho lva. Lev byl samozrÏejmeÏ strÏÂõbrnyÂ, v cÏerveneÂm poli, heraldika ma pravidla barev a kovuÊ.
Pravidla, ktera se dodrzÏujõÂ. DodrzÏovaÂnõ pravidel se ale do dnesÏnõ nestrÏedoveÏke doby nehodõÂ.
Ale kdo by jim to pocÏÂõtal, zÏe. KdyzÏ sÏkrtnutõÂm pera v ZaÂkoneÏ cÏ. 61/1918 uzÏ 10 prosince zrusÏili
sÏlechticke tituly a jizÏ udeÏlene rÏaÂdy. ZpeÏtneÏ. To je praÂvnicky majstrsÏtyk. A ihned zacÏali chystat
rÏaÂdy sveÂ. CÏeskoslovenskeÂho, a pak uzÏ bõÂleÂho lva, ktery je strÏÂõbrnyÂ. A s rÏeteÏzy. Pak jinõ zrusÏili
penõÂze, v prvnõÂ faÂzi sice jen penõÂze teÏch druhyÂch, ale meÏlo to jõÂt daÂl. UzÏ to daÂl nesÏlo. A chteÏli zrusÏit VaÂnoce, no jsme
to ale vesela zemeÏ. Ale zpeÏt k heraldice. Osobnõ erb markrabeÏte moravskeÂho tedy byl strÏÂõbrny lev v cÏerveneÂm poli.
VaÂclav vyÂchovnou rukou otcovskou, ve strÏedoveÏku rukou s mecÏem, umozÏnil synovi na vlastnõÂ
kuÊzÏi poznat nikdy se nemeÏnõÂcõÂ farizejstvõÂ hujerskyÂch povah a prÏenesmõÂrnou duÊlezÏitost pokory
ve skutecÏnyÂch staÂtnickyÂch rozhodnutõÂch. Nejen ve staÂtnickyÂch, to je odkaz pro naÂs, nestaÂtnõÂky.
A za nemaleÂho prÏispeÏnõ zÏenske moudrosti PrÏemysloven, vraÂtil kralevici jeho statut. JizÏ moudrÏejsÏÂõmu kralevici. A pak se PrÏemysl Otakar stal PrÏemyslem II. Otakarem. PaÂtyÂm cÏeskyÂm kraÂlem. A na
pecÏetõÂch, sÏtõÂtech, praporcõÂch a cÏabrakaÂch konõÂ si ponechal svuÊj osobnõÂ erb. Onoho strÏÂõbrneÂho
lva. ZalozÏil na sÏedesaÂt meÏst, zaslouzÏil se o staÂt. Bylo to dobre rozhodnutõÂ, udeÏlat jej kraÂlem. PraÂveÏ
on by dnes mohl dostat rÏaÂd sveÂho BõÂleÂho lva. VlastneÏ nemohl, nebyl cizinec a jako kraÂl byl zrusÏen
zaÂkonem cÏ. 61/1918 Sb. Na svatovaÂclavskou orlici nezapomneÏl. NeopousÏteÏl stare znaÂme pro
noveÂ. CÏerna perut' se strÏÂõbrnyÂmi lipovyÂmi lõÂstky je v klenotu na vsÏech vyobrazenõÂch jeho erbuÊ.
Ani BõÂly lev neskoncÏil zavrazÏdeÏnõÂm PrÏemysla II. Otakara na MoravskeÂm poli. KdyzÏ dnes projõÂzÏdõÂ
historicky pruÊvod kraÂle Jana z Lucemburka kolem Domu U rovneÂho zubu ve ZnojmeÏ, je na jeho
praporcõÂch a cÏabrakaÂch konõ znamenõ BõÂleÂho lva. Ne cÏerveneÂho, lucemburskeÂho. Take Lucemburkove meÏli totizÏ v erbu lva. CÏerveneÂho lva. A Jan, kdyzÏ snÏatkem s prÏespanilou ElisÏkou PrÏemyslovnou zõÂskal kraÂlovstvõ cÏeskeÂ, stal se cÏeskyÂm kraÂlem s bõÂlyÂm lvem na korouhvõÂch. Jeden z prvnõÂch rytõÂrÏuÊ sveÂ
doby, pozdeÏji ocejchovany hanlivyÂm souslovõÂm ¹kraÂl cizaÂkª, vytvorÏil ZemeÏ koruny cÏeskeÂ, za
jeho vlaÂdy nevstoupila na toto uÂzemõ noha cizõÂho zÏoldaÂka. KdovõÂ, zda by si praÂveÏ on nezaslouzÏil RÏaÂd BõÂleÂho lva in memoriam. Jako cizaÂk, zÏe... ale kdovõÂ, zda se zaslouzÏil o staÂt... Spravoval zemi s hrdostõ kraÂle. A v rytõÂrÏskeÂm duchu. Ne jako prÏÂõslusÏnõÂk nizÏsÏÂõ sÏlechty, zbeÏhle prÏedevsÏÂõm v intrikaÂch a uÂcÏelovyÂch lzÏÂõch. Kdyby udeÏloval RÏaÂd BõÂleÂho lva PrÏemysl II. Otakar, jisteÏ by
jej udeÏlil svyÂm oblõÂbenyÂm. TrÏeba Milotovi z DeÏdic, vysÏkovskeÂmu rodaÂkovi. A jisteÏ by mezi
oceneÏnyÂmi nebyl ZaÂvisÏ z FalkensÏtejna, zemsky sÏkuÊdce. Je to odveÏke praÂvo panovnõÂkuÊ, vyznamenat koho chteÏjõÂ. Nenõ na tom nic negativnõÂho. Ani dnes. AvsÏak povsÏimneÏme si, kdo
jsou vyznamenanõÂ. A jak reagujõÂ, sledujme lakmusove papõÂrky sociaÂlnõÂch reakcõÂ. A dostaÂvaÂm
www.orthodont-cz.cz e-mail: [email protected]
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se k neuralgickeÂmu bodu dnesÏnõÂ vigilie. Je to mezigeneracÏnõÂ komunikace. Ta byla impulzem k teÂto vigilii. Letos 28.
rÏÂõjna se mezi vyznamenane nedostal navrzÏeny Josef FrantisÏek, cÏesky pilot, stõÂhacõ eso 303. stõÂhacõ peruteÏ RAF,
muzÏ, ktery prÏi kazÏdeÂm startu sve stõÂhacÏky Hawker Hurrican nasazoval zÏivot za vlast. SestrÏelil 18 neÏmeckyÂch letadel
a stal se nejuÂspeÏsÏneÏjsÏÂõm spojeneckyÂm stõÂhacÏem bitvy o BritaÂnii. KromeÏ jinyÂch byl nositelem vyznamenaÂnõÂ Virtuti
Militari a dvou Distinguished Flying Medal. Jako prvnõÂ cizinec. V kokpitu letadla zahynul 8. rÏÂõjna 1940. NenõÂ se
cÏemu divit, kdyzÏ staÂtnõ tajemnõÂk pro EU T. P. v reakci na projev britskeÂho premieÂra stavõ do jedne rÏady piloty
RAF a soucÏasne modernõ kocÏovnõÂky, kterÏÂõ kocÏujõ za sociaÂlnõÂmi daÂvkami. Poprve v zÏivoteÏ musõÂm pouzÏÂõt odkaz. Echo
24.cs, 29. 11. 2014. MyslõÂm, zÏe staÂtnõ tajemnõÂk pro EU borÏÂõ poslednõ hranice. Jeho pohled na SveÏt prozrazuje existenci lidskeÂho blbstvõÂ. BlbstvõÂ, ktereÂmu se dokonce dostaÂva potlesku. Blbstvõ bez hranic. Chucpe. Dostalo se na
absolventy FAMU. PeÏkneÏ se naÂm odkopali, akademici. NeÏco takoveÂho Vladislavsky saÂl jesÏteÏ nevideÏl, pravil velmistr etikety pan SÏpacÏek. Mikina, mikina... To je pouhe uplatneÏnõ vzÏdy uÂspeÏsÏne metody zviditelneÏnõ neviditelneÂho. Kdo by si vsÏiml bez mikiny, zÏe. Krystalicky nevkus. Epizodnõ komik. Ale lakmusovy papõÂrek druhe rejzÏovskeÂ
exhibice musõÂm citovat celyÂ. Stojõ za to. ¹ZÏe pan NeÏmec deÏla takovy gerontofiligicky gesta, prÏijde mi to smeÏsÏnyÂ
a smutnyÂ. NechteÏl bych byÂt takhle hloupy a zapsÏkly starÏÂõk.ª Konec citace mladeÂho, akademicky vzdeÏlaneÂho
umeÏlce. V kontrastu k jednoducheÂmu, pregnantnõÂmu, asertivnõÂmu, striktneÏ neemotivnõÂmu vyjaÂdrÏenõ naÂzoru rezÏiseÂrske legendy Jana NeÏmce, je to hystericka nevychovanost. VsÏimneÏte si, Vy mladõÂ. Jak se nemluvõ se staÂrÏÂõm. DovolõÂm si uhadovat, zÏe Jan NeÏmec by svyÂm intelektem lehce zvlaÂdl to, co dokaÂzal cÏtvrty cÏesky kraÂl mecÏem. PokorÏit.
AvsÏak procÏ by to deÏlal. Nestalo se nic historicky vyÂznamneÂho. To jen pod uÂzÏasne klenby VladislavskeÂho saÂlu na
hradeÏ cÏeskyÂch kraÂluÊ vstoupila znamenõÂ doby. Nevychovanost, buranstvõÂ, netolerance, arogance, neuÂcta k historickeÂmu mõÂstu a k lidem s jinyÂm naÂzorem. ZnamenõÂ doby. ZnamenõÂ nasÏÂõ doby. A jak je to dlouho, kdy jsme s Karlem
Krylem zpõÂvali, zÏe ¹uzÏ nerejeme drzÏkou v zemiª, s Karlem PlõÂhalem, zÏe ¹kdyzÏ kveÏtina svobody hynula naÂrod se probudil a neochveÏjneÏ vykrocÏil z onoho minula, kde vsÏichni meÏli mõÂt stejneÏ ... a s JaromõÂrem Nohavicou se ptali, ¹kde
ztratila se slova o nadeÏji, o tom, zÏe zaÂzraky se deÏjõÂ, kdyzÏ cÏloveÏk chce...ª, zÏe... MozÏna tomu nebudete veÏrÏit, ale vloni
se mi psalo leÂpe...
V mediaÂlnõÂm sveÏteÏ obecneÏ platõÂ, zÏe za kazÏdyÂm sprostyÂm slovem se krcÏÂõ sprosty cÏin. Sprosta slova jsou jen
mimikry sprostyÂch cÏinuÊ.
Ale zÏaÂdnyÂmi historickyÂmi peripetiemi, kteryÂmi nasÏe zemeÏ prosÏla, nebylo to hodnotne znicÏeno. PrÏemyslovskou orlici neposkvrnila nacisticka kraÂdezÏ symbolu beÏhem okupace a bõÂleÂho lva neponõÂzÏili komunisticke plamõÂnky
a hveÏzdicÏky. Lev a orlice prosÏli celou historiõÂ, stejneÏ jako zemsky naÂzev Morava. Na kazÏde minci ve VasÏÂõ kapse je erb
markrabeÏte moravskeÂho. ZkraÂtka, kdo chteÏl ve strÏednõÂ EvropeÏ neÏco znamenat, kdo se chteÏl staÂt cÏeskyÂm kraÂlem,
musel byÂt nejprve markrabeÏtem moravskyÂm. A dosõÂci jiste pokory prÏed kraÂlovskyÂm uÂrÏadem. Ale procÏ vlastneÏ põÂsÏi
o erbech. Jsou to symboly. A vsÏe, co se kolem nich deÏje, je symbolickeÂ. Nad hradem s filmovyÂmi akademiky vlaje
modra vlajka s hveÏzdicÏkami. Vygoogloval jsem si symboly Bruselu. Jsou dva. Pavilon Atom a cÏuÊrajõÂcõ chlapecÏek.
V raÂmci slovesneÂho vidu dokonaveÂho v jazyce cÏeskeÂm, perspektivneÏ a nevyhnutelneÏ, chlapecÏek vycÏuÊranyÂ. Jan
Werich napsal, zÏe: ¹KdyzÏ je cÏloveÏk na neÏco kraÂtkej, ma se tomu asponÏ smaÂt. Platõ to o politice a o smrti.ª A ta mrcha
s kosou je porÏaÂd vlezlejsÏÂõ. MozÏna tomu nebudete veÏrÏit, ale uprÏÂõmneÏ, vloni se mi psalo leÂpe.
A poselstvõÂ? Nejsem praktikujõÂcõÂ veÏrÏÂõcõÂ. Ale ani bezveÏrec. Jen nejsem stran võÂry striktneÏ organizovaÂn. LetosÏnõÂ
poselstvõ je od papezÏe FrantisÏka pro noveÏ zvolene europoslance ve SÏtrasburku.
PoselstvõÂ pro mne i pro VaÂs. ¹Evropa nenõÂ schopna otevrÏÂõt transcendentnõÂ dimenzi zÏivota a hrozõÂ jõÂ ztraÂta
vlastnõ dusÏe i humanistickeÂho ducha. Hrozõ riziko, zÏe se lidska bytost stane pouhyÂm kolecÏkem v soukolõÂ, uzÏitecÏnyÂm
spotrÏebnõÂm statkem. Hrozõ skartacÏnõ kultura, kde slabõÂ, nemocnõÂ, nebo starÏÂõ jsou urcÏeni ke skartaci. Hrozõ vyhroceny konzumizmus, kde lid je redukovaÂn na kusy a jako s kusy cÏehosi ekonomickeÂho je s nimi naklaÂdaÂno.ª PapezÏ
FrantisÏek hovorÏil o rodineÏ, dnes decimovane ¹prÏaÂtelskyÂmiª singl vztahy a o vlaÂdcõÂch, kterÏÂõ nesmõ byÂt paÂny, ale opatrovnõÂky. O samoteÏ cÏloveÏka, o ztraÂteÏ mezilidskyÂch svazkuÊ. O daÂvaÂnõ prÏednosti ekonomice prÏed cÏloveÏkem, peneÏzuÊm prÏed lidstvõÂm.
Ne nepodoben starozaÂkonnõÂm prorokuÊm.
PrÏeji tedy VaÂm i sobeÏ, abychom neztratili vlastnõÂ dusÏi, nestali se my sami, ani nikdo
jiny pouhyÂm kolecÏkem v soukolõÂ, abychom neskartovali slabeÂ, nemocne a stareÂ. MnozõÂ
z nich by mohli jako kraÂl VaÂclav I. vsednout na kuÊnÏ, zÏe. A to byste videÏli ten mazec. Abychom nepoztraÂceli mezilidske vztahy a pecÏovali o instituci rodiny. Abychom zuÊstali lidskyÂmi bytostmi. Abychom jednou, jak zpõÂva Karel Kryl,
k vyÂkazu ztraÂt nemuseli prÏicÏÂõst... sebe.
NenõÂ toho maÂlo, cÏeho je trÏeba.
P.S. A nepouzÏÂõvejme sprosta slova, jsou to jen mimikry sprostyÂch cÏinuÊ ... K. F.
VaÂnoce 2014
244
VaÂsÏ staryÂ, sÏedy vlk Akela
Dr. Karel Floryk
www.orthodont-cz.cz e-mail: [email protected]
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