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ORTODONCIE
ORTODONCIE
Recenzovany cÏasopis CÏeske ortodonticke spolecÏnosti
Published by the Czech Orthodontic Society
RocÏnõÂk (Volume): 21
Rok (Year): 2012
CÏõÂslo (Number): 2
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
Dr. Piotr Fudalej, Ph.D., Warszawa, Polska
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. Marie SÏtefkovaÂ, CSc.
MUDr. Miroslava SÏvaÂbovaÂ, CSc.
MUDr. JirÏõÂ Tvardek, Ph.D.
MUDr. Hana TycovaÂ
MUDr. Wanda UrbanovaÂ
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.: 585 418 151
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 Moravska TrÏebovaÂ
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): 15. 9., 10. 11. 2012, 2. 3., 11. 5. a 14. 9. 2013.
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
Obsah (Contens):
SpolecÏenska rubrika . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50
ZpraÂvy z vyÂboru . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
ZajõÂmavosti v ortodoncii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
54
Odborna praÂce
Ageneze druhyÂch dolnõÂch premolaÂruÊ a zmeÏny na perzistujõÂcõÂch docÏasnyÂch molaÂrech
a okolnõÂch tkaÂnõÂch (Agenesis of lower second premolars and changes of persisting primary
molars and surrounding tissues) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
60
Estetika profilu oblicÏeje u dospeÏleÂho pacienta s anomaÂliõÂ Angle II, 1. oddeÏlenõÂ; zmeÏny
po chirurgicke a ortodonticke leÂcÏbeÏ (Esthetics of facial profile in adult patients with Class II,
Division 1. Changes in orthognathic surgery and orthodontic treatment) . . . . . . . . . . . . . . . . . . .
73
CÏasove odchylky vyÂvoje chrupu u deÏtõ s ruÊznyÂmi typy rozsÏteÏpu
(Dental development in children with different types of cleft) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
85
Vliv prÏedoperacÏnõÂho zachovaÂnõÂ Speeovy krÏivky v dolnõÂm zubnõÂm oblouku na vertikaÂlnõÂ
parametry a estetiku oblicÏeje po operaci (Curve of Spee - maintenance of the curve
before surgery in lower dental arch and its impact on vertical parameters and esthetic
results after surgery) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Kongres CÏOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Ze zahranicÏnõÂch cÏasopisuÊ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Informace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
REKLAMA
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48
TeÏsÏÂõme se
na spolupraÂci
s VaÂmi
Doc. MUDr. MilosÏ SÏpidlen, Ph.D
vedoucõÂ redaktor,
Klinika zubnõÂho leÂkarÏstvõÂ LF UP
PalackeÂho 12
772 00 Olomouc
tel.: 585 418 151
fax: 585 223 907
e-mail: [email protected]
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
V dubnu, kveÏtnu a cÏervnu roku 2012
sve vyÂznamne zÏivotnõ jubileum oslavili:
MUDr. Irena SÏubrtovaÂ, Plzen
Ï
prof. MUDr. Milan KamõÂnek, DrSc. , Olomouc
MUDr. ZÏiva Mu
È llerovaÂ, CSc. , Praha 8 - Kobylisy
MUDr. Blanka MalaÂ, Teplice
MUDr. Jana KucÏerovaÂ, Praha1
MUDr. Alena BejcÏkovaÂ, Brno
MUDr. VojteÏch Svoboda, Praha 4 - KrcÏ
MUDr. JirÏina NeÏmcovaÂ, Praha 4
MUDr. Zuzana MazurovaÂ, Praha 5
MUDr. Irena ChourovaÂ, VrchlabõÂ
MUDr. Dagmar StrakovaÂ, Hranice na MoraveÏ
MUDr. Milada SoldaÂnovaÂ, JindrÏichu
Ê v Hradec
SrdecÏneÏ blahoprÏejeme!
SpecializacÏnõÂ atestace
Ve dnech 29.-30.5.2012 probeÏhly specializacÏnõÂ atestacÏnõÂ zkousÏky a specialisty v oboru ortodoncie se
uÂspeÏsÏneÏ stali
MUDr. Marta BalzarovaÂ
MUDr. Blanka DvorÏaÂkovaÂ
MUDr. Petra EliaÂsÏovaÂ
MUDr. Tereza FoltyÂnkovaÂ
MUDr. Daniela HlousÏkovaÂ
MUDr. Ilona ChmelovaÂ
MUDr. VaÂclav Mrovec
MUDr. Jan Palas
MUDr. Adam UhlõÂrÏ
BlahoprÏejeme
50
www.orthodont-cz.cz e-mail: [email protected]
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ZpraÂvy z vyÂboru
ORTODONCIE
ZpraÂvy z vyÂboru
1) VyÂbor schvaÂlil zÏaÂdost orto odd. v Olomouci o zakoupenõ a bezplatne zapuÊjcÏenõ fotograficke techniky
pro toto oddeÏlenõÂ.
2) VyÂbor schvaÂlil financÏnõÂ prÏõÂspeÏvek na uÂhradu ubytovaÂnõÂ na letosÏnõÂm kongresu EOS prof. KamõÂnkovi,
ktery se v raÂmci kongresu zuÂcÏastnõ NEBEOP, a prÏõÂspeÏvek na uÂhradu kongresoveÂho poplatku EOS as. SÏtefkoveÂ, ktera teÂzÏ v raÂmci kongresu se zuÂcÏastnõ jednaÂnõÂ
¹Teachers Forumª.
3) Komise pro prÏõÂsÏtõÂ termõÂn atestacÏnõÂch zkousÏek (11.
a 12. prosinec 2012 Praha) - vyÂbor doporucÏuje zachovat slozÏenõÂ komise jako v jarnõÂm termõÂnu.
4) VyÂbor upozornÏuje na nebezpecÏõ uzavrÏenõ nevyÂhodne a nechteÏne smlouvy zaplacenõÂm faktury za nabõÂdku urcÏityÂch neznaÂmyÂch, zejmeÂna zahranicÏnõÂch firem, nabõÂzejõÂcõÂch zpravidla zajisÏteÏnõ mezinaÂrodnõ publicity. NechteÏnyÂm uzavrÏenõÂm takoveÂto smlouvy se
vystavujeme riziku i neÏkolikanaÂsobne dalsÏõ platby za
sluzÏby, ktere jsme si veÏdomeÏ neobjednali a neprÏejeme
si je.
VyÂbor CÏOS prÏeje vsÏem cÏlenuÊm CÏOS prÏõÂjemne straÂvenõ letnõÂch meÏsõÂcuÊ, dostatek odpocÏinku, a teÏsÏõ se na
setkaÂnõÂ se vsÏemi v zaÂrÏõÂ na kongresu CÏOS v LuhacÏovicõÂch. SoucÏaÂstõÂ kongresu bude jako kazÏdorocÏneÏ plenaÂrnõÂ schuÊze, ovsÏem tentokraÂt s volbami. VyÂbor zve
rocÏnõÂk 21
cÏ. 2. 2012
vsÏechny, zejmeÂna rÏaÂdne cÏleny CÏOS s volebnõÂm praÂvem,
aby se zuÂcÏastnili volebnõÂ schuÊze dne 20. 9. 2012
a mohli tak ovlivnit k obrazu sveÂmu chod sve odborneÂ
organizace.
Za vyÂbor CÏOS
JirÏõÂ Petr
KandidaÂti pro volby do orgaÂnuÊ CÏOS v r. 2012
navrzÏenõÂ staÂvajõÂcõÂm vyÂborem a RK CÏOS
NaÂvrh
Souhlas navrzÏeneÂho
MUDr. JirÏõÂ Baumruk
+
MUDr. Hana BoÈhmovaÂ
+
doc. MUDr. PavlõÂna CÏernochovaÂ, Ph.D.
+
MUDr. VladimõÂr Filipi
+
prof. MUDr. Milan KamõÂnek, DrSc.
+
MUDr. Martin Kotas, Ph.D.
+
MUDr. Magdalena Kot'ovaÂ, Ph.D.
+
MUDr. Josef KucÏera
+
MUDr. Ivo Marek, Ph.D.
+
MUDr. JirÏõÂ Petr
+
doc. MUDr. MilosÏ SÏpidlen, Ph.D.
+
MUDr. Eva SÏraÂmkovaÂ
+
MUDr. JirÏõÂ Tvardek
+
MUDr. Hana TycovaÂ
+
MUDr. Wanda UrbanovaÂ
+
KolegoveÂ,
vyuzÏijte mozÏnosti
doprovodneÂho programu
Kongresu CÏOS
pro rodinne prÏõÂslusÏnõÂky
v laÂznõÂch LuhacÏovice.
www.orthodont-cz.cz e-mail: [email protected]
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ZpraÂvy z vyÂboru
ORTODONCIE
Pokyny pro autory
Instructions for Authors
CõÂlem cÏasopisu ORTODONCIE je informovat cÏleny CÏeske ortodonticke spolecÏnosti a ostatnõ ortodontickou a stomatologickou verÏejnost
o deÏnõ 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. ZpraÂvy z vyÂboru CÏeske ortodonticke spolecÏnosti;
2. ZajõÂmavosti v ortodoncii (zpraÂvy o probeÏhlyÂch odbornyÂch a sÏkolicõÂch akcõÂch, zpraÂvy z kongresuÊ a cest, diskusnõ a polemicke prÏõÂspeÏvky);
3. Odborne praÂce (puÊvodnõ praÂce, souborne referaÂty, prÏedbeÏzÏna sdeÏlenõÂ, kazuistiky);
4. Ze zahranicÏnõÂch cÏasopisuÊ (referaÂty z cÏasopisuÊ)
5. Recenze (odbornyÂch knih a atestacÏnõÂch pracõÂ);
6. Informace;
7. SpolecÏenska rubrika.
PrÏõÂspeÏvky se zasõÂlajõ 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 musõ byÂt ulozÏeny ve formaÂtu JPG v rozlisÏenõ min. 250300 dpi. Tabulky, grafy a texty v obraÂzcõÂch se publikujõ v anglickeÂm jazyku. PraÂce zaslane redakci musõ byÂt formulovaÂny s konecÏnou platnostõÂ.
PozÏadavky na odborne praÂce. Redakce prÏijõÂma praÂce, ktere nebyly a nebudou zadaÂny jineÂmu periodiku, vyhovujõ po straÂnce odborneÂ
a majõÂ odpovõÂdajõÂcõÂ uÂrovenÏ metodologickeÂho a statistickeÂho zpracovaÂnõÂ. PublikovaÂnõÂ vyÂsledkuÊ klinickyÂch a experimentaÂlnõÂch (pokusy na
zvõÂrÏatech) vyÂzkumuÊ prÏedpoklaÂdaÂ, zÏe byly dodrzÏeny prÏõÂslusÏne etickeÂ
zaÂsady, zejmeÂna principy Helsinske deklarace a souhlas eticke komise. MateriaÂly prÏevzate z jinyÂch pramenuÊ musõ 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 pracõÂ je souhrn strukturovanyÂ. Obsahuje cõÂl praÂce,
metody, zaÂveÏry. Souhrn se põÂsÏe ve trÏetõÂ 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.
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 from the Council of the Czech Orthodontic Society.
2) Featured topics in orthodontics (reports on the recent scientific
and training activities, reports of congresses and study stays, discussion and critical rubric).
3) Scientific articles (original works, reviews of the literature, preliminary reports, case reports).
4) Abstracts from foreign journals.
5) Reviews (books and postgraduate theses).
6) Information.
7) News, society.
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 doubleblind 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. KeyWords (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.
52
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
ZpraÂvy z vyÂboru
PrÏõÂlohy. ObraÂzky (grafy, scheÂmata, fotografie) a tabulky se prÏiklaÂdajõ 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 musõÂ byÂt upraveny tak, aby se 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. ZasõÂlaÂnõ 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 zobrazene 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 dodrzÏujõÂ
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, telefonnõ cÏõÂslo a e-mail, rodne cÏõÂslo a cÏõÂslo bankovnõÂho uÂcÏtu,
kam ma byÂt zaslaÂn autorsky honoraÂrÏ. K dopisu je trÏeba prÏilozÏit fotografie autoruÊ ve fyzicke nebo elektronicke formeÏ 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 nõÂ text obsahoveÏ meÏnit nebo doplnÏovat. ProvaÂdõÂ se pomocõÂ 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 jejõ 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.: +420 585 418 151, fax: +420 585 223 907.
E-mail: [email protected]
CÏeska a anglicka verze PokynuÊ pro autory je uverÏejneÏna na internetovyÂch straÂnkaÂch vydavatele: www.orthodont-cz.cz.
rocÏnõÂk 21
cÏ. 2. 2012
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 enclosed 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), e-mail address, personal number and the number of a bank account for a fee to be sent. 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.: +420 585 418 151, fax: +420 585 223 907.
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.
Angle Orthodontist
Angle Orthodont.
British Journal of Orthodontics
Brit. J. Orthodont.
CÏeska stomatologie
CÏes. Stomat.
CÏeskoslovenska stomatologie
CÏs. Stomat.
European Journal of Orthodontics
Eur. J. Orthodont.
Fortschritte der Kieferorthopedie
Fortschr. Kieferorthop.
Journal of Prosthetic Dentistry
J. prosthet. Dent.
Journal of Clinical Orthodontics
J. clin. Orthodont.
Journal of the American Dental Association
J. Amer. dent. Assoc.
Ortodoncie
Ortodoncie
Prakticke zubnõ leÂkarÏstvõÂ
Prakt. zubnõÂ LeÂk.
www.orthodont-cz.cz e-mail: [email protected]
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ZajõÂmavosti v ortodoncii
ORTODONCIE
Orto-perio-implantologickeÂ
probleÂmy
KazÏdy rok se teÏsÏõÂme na neÏktereÂho ze zahranicÏnõÂch
hostuÊ, ktery k naÂm prÏijede vneÂst trochu toho sveÏtoveÂho
ortodontickeÂho sveÏtla. TentokraÂt se podarÏilo firmeÏ Altis Group s.r.o. zorganizovat kurz Dr. Giuliana Maina
na teÂma: ¹Orto-perio-implantologicke probleÂmy.ª BeÏhem dvou dnuÊ v hotelu AndeÏl v Praze 23.-24.3. 2012
o naÂs bylo kraÂlovsky postaraÂno, zvlaÂsÏteÏ co se tyÂka cateringu.
UÂvodem prvnõÂho dne jsme se zevrubneÏ veÏnovali
stavbeÏ parodontu, jak je duÊlezÏite jeho rÏaÂdne vysÏetrÏenõÂ
prÏed leÂcÏbou, abychom se vyhnuli mozÏnyÂm naÂslednyÂm
komplikacõÂm, jako jsou cÏerne trojuÂhelnõÂky, recesy gingivy i traumaticke periodontitidy vznikle vadnyÂm skusem cÏi funkcÏnõÂm prÏetõÂzÏenõÂm zubuÊ. NaÂsledovala pravidla pro zahaÂjenõ ortodonticke leÂcÏby u pacientuÊ s parodontologickyÂmi probleÂmy a pak jizÏ prakticke poznatky
souvisejõÂcõÂ s leÂcÏbou teÏchto pacientuÊ.
TeÂma kurzu, tedy spolupraÂce ortodontisty s parodontologem, je v dnesÏnõÂ dobeÏ vysoce aktuaÂlnõÂ. At' uzÏ
se jedna o parodontopatie braÂnõÂcõ ortodonticke leÂcÏbeÏ,
cÏi o probleÂmy se zaÂveÏsnyÂm aparaÂtem trvaleÂho charakteru. NaprÏ. s prÏõÂtomnou gingivitidou nenõ mozÏne zahaÂjit
terapii fixnõÂm aparaÂtem, dr. Maino doporucÏuje v teÏchto
prÏõÂpadech nejprve komplexnõ sanaci parodontologickou, pote 3 meÏsõÂce klidu a teprve naÂsledneÏ ortodontickou leÂcÏbu, u periodontitidy je klidove staÂdium jednou
tak dlouheÂ. Pro naÂs neobvykle je doporucÏenõ zhotovit
rtg status intraoraÂlnõÂch snõÂmkuÊ.
DalsÏõÂ zajõÂmavou oblastõÂ, o nõÂzÏ dr. Maino pohovorÏil,
byly vertikaÂlnõ posuny zubuÊ. MeÏkke tkaÂneÏ se prÏizpuÊsobujõ mnozÏstvõ kosti, proto bychom meÏli prÏi extruzi znaÂt
vyÂsÏku alveolaÂrnõÂ kosti, aby se naÂm podarÏilo zub extrudovat i s gingivou. V neÏkteryÂch prÏõÂpadech doporucÏuje
fibrotomii k ¹rÏõÂzeneÂmuª posunu meÏkkyÂch tkaÂnõÂ. Dr.
Maino hojneÏ vyuzÏõÂva kotevnõ miniimplantaÂty a ne-
54
zdraÂha se pro intruzi molaÂru vyuzÏõÂt i 3 (2 z vestibulaÂrnõÂ
strany a 1 z oraÂlnõÂ). NeÏktere zpuÊsoby pouzÏitõ kotevnõÂch
zarÏõÂzenõ pro naÂs byly velkou novinkou. VeÏnuje take velkou pozornost vzdaÂlenosti hrÏebene alveolu od bodu
kontaktu, prÏõÂpadneÏ se snazÏõÂ tuto vzdaÂlenost modifikovat, aby nebyla porusÏena estetika mezizubnõÂ papily.
Zaujaly naÂs take pravidla pro pouzÏitõ chirurgie - u pacientuÊ, kde zuby posouvaÂme ¹do parodontologickeÂho
defektuª, je vhodne chirurgickou sanaci proveÂst prÏed
leÂcÏbou, u pacientuÊ, kde posouvaÂme zub ¹z defektuª
pak doporucÏuje chirurgii proveÂst azÏ po ortodontickeÂ
leÂcÏbeÏ. SoucÏaÂstõ kurzu bylo take nacÏasovaÂnõ ortodonticke leÂcÏby v souvislosti s chirurgickou leÂcÏbou.
Na zaÂveÏr kurzu jsme take byli obeznaÂmeni se zkusÏenosti s kortikotomiemi, pomocõ nõÂzÏ dokaÂzÏe zkraÂtit deÂlku
leÂcÏby i o 60%. Dokonce naÂm ukaÂzal kazuistiku, kdy se
mu podarÏilo ortodonticky posunout zubnõÂ implantaÂt,
vyuzÏil kortikotomie kolem implantaÂtu a takto uvolneÏnyÂ
blok posunul fixnõÂm aparaÂtem do pozÏadovane pozice.
PouzÏitõ prostrÏedkuÊ k urychlenõ ortodonticke leÂcÏby je
nynõ celosveÏtovyÂm trendem a dr. Maino v teÂto veÏci nijak nezaostaÂva a pracuje na vyÂvoji metod, ktere ortodontickou leÂcÏbu urychlujõÂ.
www.orthodont-cz.cz e-mail: [email protected]
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ZajõÂmavosti v ortodoncii
ZaÂveÏrem muÊzÏeme konstatovat, zÏe jsme zase o neÏco
chytrÏejsÏõÂ. ChteÏli bychom take podeÏkovat organizaÂtoruÊm akce za bezchybny pruÊbeÏh kurzu a teÏsÏõÂme se na
dalsÏõ zajõÂmave prÏednaÂsÏky.
MDDr. D. StrakovaÂ
MUDr. J. Tvardek, Ph.D.
Retinovane sÏpicÏaÂky od A do Z
Ve dnech 20.-21. dubna 2012 jsme se zuÂcÏastnili
odborneÂho kurzu doc. MUDr. PavlõÂny CÏernochoveÂ,
Ph.D. ¹Retinovane sÏpicÏaÂky od A do Zª, ktery se konal
v Praze.
PrvnõÂ den jsme se veÏnovali problematice poruch
prorÏezaÂvaÂnõ sÏpicÏaÂkuÊ. PrÏes fyziologicky vyÂvoj, etiologii
poruch prorÏezaÂvaÂnõÂ, diagnostiku a leÂcÏbu jsme se dostali azÏ ke kazuistikaÂm leÂcÏenyÂch pacientuÊ. Na mnoha
fotografiõÂch a rentgenovyÂch snõÂmcõÂch pacientuÊ jsme
byli upozornÏovaÂni na mozÏna uÂskalõ a chyby prÏi postupech leÂcÏby, jak se jim vyvarovat a jak je rÏesÏit, pokud
jizÏ nastanou. NaÂsledoval prÏehled stomatochirurgickyÂch metod k expozici retinovanyÂch zubuÊ s upozorneÏnõÂm, zÏe mnoho ortodontistuÊ mylneÏ prÏedpoklaÂdaÂ, zÏe jejich stomatochirurg võÂ, jakou chirurgickou metodu maÂ
pouzÏõÂt pro expozici daneÂho zubu. Proto VaÂzÏenõ kolegove nevaÂhejte sva prÏaÂnõ sdeÏlovat stomatochirurguÊm
võÂce podrobneÏji.
NaÂsledoval druhy den kurzu a s nõÂm komplikace
zpuÊsobene retinovanyÂmi nebo dystopicky ulozÏenyÂmi
sÏpicÏaÂky a pote prÏõÂcÏiny selhaÂnõ leÂcÏby retinovanyÂch sÏpicÏaÂkuÊ. OpeÏt prÏisÏlo na rÏadu neÏkolik kazuistik, na kteryÂch
jsme si mohli zopakovat noveÏ nabyte veÏdomosti a kurz
se pomalu ale jisteÏ chyÂlil ke konci.
TõÂmto bych chteÏla podeÏkovat doc. MUDr. PavlõÂneÏ
ÏCernochoveÂ, Ph.D. za cenne informace, ktere s vyÂhodou vyuzÏijeme prÏi leÂcÏbeÏ svyÂch pacientuÊ.
MDDr. I. HorÏaÂkovaÂ
www.orthodont-cz.cz e-mail: [email protected]
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Americky sen
a necÏekana setkaÂnõÂ
Jednoho pochmurneÂho podzimnõÂho vecÏera, prÏemyÂsÏlejõÂc o rozsÏõÂrÏenõÂ svyÂch ortodontickyÂch obzoruÊ, jsme
dospeÏli k naÂzoru, zÏe by bylo vhodne navsÏtõÂvit neÏktereÂ
z pracovisÏt' za onou Velkou louzÏõÂ. NejveÏtsÏõÂ zaÂjem,
i vzhledem k pouzÏõÂvanyÂm leÂcÏebnyÂm postupuÊm a biomechanice, budilo pracovisÏteÏ prof. Nandy v Connecticutu. Po kraÂtkeÂm oveÏrÏovaÂnõ informacõ a shaÂneÏnõ kontaktuÊ (deÏkujeme nejmenovane firmeÏ z BrÏeclavi), jsme
pod heslem ¹lõÂna huba - hole nesÏteÏstõª napsali prof.
Nandovi mail, zda by bylo mozÏne navsÏtõÂvit jeho pracovisÏteÏ. A jake bylo nasÏe prÏekvapenõÂ, kdyzÏ prof. Nanda,
po neÏkolika tyÂdnech cÏekaÂnõÂ, odpoveÏdeÏl, zÏe to nenõ probleÂm. NaÂsledovala ne zcela jednoducha domluva
ohledneÏ termõÂnu, lecÏ vyÂsledkem byl trÏõÂtyÂdennõÂ pobyt
na veÏhlasneÂm pracovisÏti v UCHC (University of Connecticut Health Center) ve Farmingtonu. A nasÏe nadsÏenõÂ neznalo mezõÂ, kdyzÏ jsme se dozveÏdeÏli, zÏe beÏhem
teÏchto trÏõ tyÂdnuÊ bude mozÏno se zuÂcÏastnit take dvou
jednodennõÂch kurzuÊ prof. Kuijpers-Jagtman, prof. Proffita a seminaÂrÏe s otcem biomechaniky prof. Burstonem. V dubnu 2012 jsme tedy plni ocÏekaÂvaÂnõÂ a nadsÏenõÂ
odcestovali prÏes New York do Connecticutu. A nynõÂ jizÏ
k postrÏehuÊm a poznatkuÊm z pobytu:
Po neÏkolika dnech jsme zcela prÏirozeneÏ splynuli s kolobeÏhem na ortodontickeÂm oddeÏlenõÂ a meÏli tak mozÏnost
zazÏõÂt pravy ortodonticky sen. Informace jsme nasaÂvali
jako houby, at' uzÏ na oddeÏlenõÂ prÏi praÂci, na kazÏdodennõÂch
seminaÂrÏõÂch, tak i prÏi vypraÂveÏnõÂ pana profesora Nandy
a samozrÏejmeÏ nejvõÂce na prÏednaÂsÏkaÂch profesora Proffita a profesorky Kuijpers-Jagtman z Holandska, kteraÂ
prÏijela na dvoudennõÂ naÂvsÏteÏvu. PrÏivõÂtaÂnõÂ bylo velmi vrÏeleÂ,
prof. Nanda vsÏechny prÏipravil na naÂsÏ prÏõÂjezd a tak jsme
rychle zapadli, jak mezi postgraduanty, tak i do ucÏitelskeÂho a veÏdeckeÂho kolektivu. RaÂdi bychom se s vaÂmi
podeÏlili o informace, ktere jsme meÏli mozÏnost zõÂskat, neÏktere byly opravdu prÏekvapujõÂcõÂ.
MozÏna bychom meÏli na zacÏaÂtek popsat, jak to na takoveÂm ortodontickeÂm oddeÏlenõ vypadaÂ. V jedne velkeÂ
mõÂstnosti je dvacõÂtka zubnõÂch krÏesel, kazÏde pro jednoho
postgraduanta (teÏch je nynõÂ 18 - v kazÏdeÂm ze trÏõÂ rocÏnõÂkuÊ
6), 2 jsou reservovaÂny pro pana profesora a ucÏitele. VybavenõÂ nenõÂ nejnoveÏjsÏõÂ, ale to proto, zÏe se nynõÂ zacÏõÂnaÂ
staveÏt uÂplneÏ nove krÏõÂdlo nemocnice pro stomatologickou kliniku za 200 mil. dolaruÊ, takzÏe se vsÏichni teÏsÏõ do noveÂho. Postgraduanti nemajõ k ruce sestrÏicÏky, vsÏe si prÏipravujõ sami, na celeÂm oddeÏlenõ jsou pouze 2 asistentky,
ktere nachystajõ krÏeslo pro noveÂho pacienta, jedna recepcÏnõ a jedna financÏnõ managerka, ktera se staraÂ
o platby a splaÂtky pacientuÊ. PrÏesto vsÏe funguje bez nejmensÏõÂch probleÂmuÊ a cÏasovyÂch prostojuÊ.
55
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ZajõÂmavosti v ortodoncii
A kolik stojõ ortodonticka leÂcÏba? Na klinice je samozrÏejmeÏ levneÏjsÏõ nezÏ v privaÂtnõ ordinaci. Platõ se pausÏaÂlneÏ $4.200, at' ma pacient samoligujõÂcõÂ, keramickeÂ
cÏi kovove zaÂmecÏky, nezaÂlezÏõ ani na deÂlce leÂcÏby. PojisÏt'ovna prÏispõÂva zhruba $1.000, pacienti cÏasto vyuzÏõÂvajõÂ
splaÂtkove kalendaÂrÏe. BohuzÏel pojisÏt'ovna prÏestala hradit ortognaÂtnõ operace, jejichzÏ cena se pohybuje kolem
$10.000, cozÏ take vede ke snaze naleÂzt metody, jak
chirurgii co nejvõÂce omezit.
PostgraduaÂlnõ prÏõÂprava je stejna jako u naÂs v deÂlce
trvanõÂ a to 3 roky. Dostat se na tak prestizÏnõÂ pracovisÏteÏ
je cÏest a proto sõÂtem projdou jen nejlepsÏõÂ z nejlepsÏõÂch
v USA, jsou ochotni obeÏtovat i svuÊj soukromy zÏivot,
v praÂci byÂvajõ od raÂna azÏ do vecÏera. KazÏdy rok stojõÂ
$40.000, dõÂky stipendiu a prÏõÂspeÏvkuÊm z nadace prof. Nandy toto vzdeÏlaÂnõÂ vychaÂzõÂ teÂmeÏrÏ zadarmo, ale pouze na
teÂto univerziteÏ. Co se vsÏak od naÂs lisÏõÂ, je mnozÏstvõÂ seminaÂrÏuÊ a ucÏiteluÊ, kterÏõÂ se kazÏdeÂmu pecÏliveÏ veÏnujõÂ. KazÏdyÂ
den raÂno nebo odpoledne se postgraduanti schaÂzõÂ kvuÊli
konzultacõÂm, leÂcÏebnyÂm plaÂnuÊm, vyÂzkumnyÂm projektuÊm,
seminaÂrÏuÊm na aktuaÂlnõ teÂmata nebo lekcõÂm z biomechaniky s profesorem Burstonem, ktery zasveÏtil cely zÏivot
ortodoncii a teÂto klinice, protozÏe v nõÂ skoro bydlõÂ, i kdyzÏ
mu je jizÏ prÏes 85 let. Na oddeÏlenõ ma vsÏechno rÏaÂd, vlaÂdne
tu klid a pohoda, kdyzÏ neordinuje prof. Nanda nebo jeho
naÂstupce Dr.Uribe, o ktereÂm urcÏiteÏ jesÏteÏ uslysÏõÂme, strÏõÂdajõ se ve vyÂuce ortodontiste z privaÂtnõÂch praxõ nebo veÏdecÏtõ pracovnõÂci. Na oddeÏlenõ je v podstateÏ vzÏdy alesponÏ
jeden z ucÏiteluÊ cÏi externistuÊ, mnohdy i võÂce. A protozÏe maÂ
kazÏdy trosÏku jiny pohled na veÏc, nabõÂzõ se postgraduantuÊm variace mozÏnostõÂ, ze kteryÂch se ucÏõ vybõÂrat a tõÂm zõÂskaÂvajõ cenne zkusÏenosti.
Velmi naÂs nadchl prÏõÂstup prof. Nandy ke zjednodusÏovaÂnõ ¹nepapõÂroveª dokumentace. Zcela beÏzÏneÏ prÏevaÂdõ ortodonticke modely do digitaÂlnõ podoby, softwarove zpracovaÂnõ pak nabõÂzõ neomezene mozÏnosti. Digitalizace se tyÂka i dalsÏõÂch oblastõ dokumentace, kazÏdyÂ
z leÂkarÏuÊ v prÏõÂpraveÏ ma vlastnõ fotoaparaÂt a vlastnõ software Dolphin. Lehce diskutabilnõ je pak naÂzor omezit
take provaÂdeÏnõ rutinnõÂch panoramatickyÂch cÏi kefalometrickyÂch snõÂmkuÊ u ¹estetickyÂch pacientuʪ.
Velmi prÏõÂnosnou byla take zmõÂneÏna prÏednaÂsÏka prof.
Kuijpers-Jagtman, ktera prÏijela na dvoudennõ pobyt
z Nijmegenu (NL). SeznaÂmila naÂs s chodem sveÂho oddeÏlenõÂ, systeÂmem vzdeÏlaÂvaÂnõÂ a zpuÊsobem praÂce. Zde
jsme opeÏt mohli pouze obdivovat pocÏet vyucÏujõÂcõÂch,
mnozÏstvõÂ seminaÂrÏuÊ a prÏednaÂsÏek a systeÂmy kontroly
vzdeÏlaÂvaÂnõÂ (vcÏetneÏ ruÊznyÂch testuÊ a pohovoruÊ). DaÂle
jsme byli seznaÂmeni s neÏkteryÂmi z mnoha oblastõÂ vyÂzkumu na univerziteÏ v Nijmegenu. Za velmi prÏõÂnosnyÂ
povazÏujeme novy pohled na pouzÏitõ sil a jejich vlivu
na pohyb zubuÊ. DaÂle jsme byli zasypaÂnõÂ novinkami
a poslednõÂmi vyÂsledky z vyÂzkumuÊ tyÂkajõÂcõÂch se retencÏnõÂ
faÂze leÂcÏby a relapsu po orto leÂcÏbeÏ, samoligujõÂcõÂch zaÂ56
ORTODONCIE
mkuÊ, lingvaÂlnõÂch aparaÂtuÊ apod. Nutno podotknout, zÏe
vsÏechny vyÂsledky byly sdeÏleny racionaÂlneÏ a ¹evidence-basedª, tedy bez cÏasto tak slyÂchanyÂch nadsÏenõÂ
z jednotlivyÂch jmenovanyÂch technik bez podlozÏenõ serioznõÂmi vyÂzkumy. Prof. Kuijpers-Jagtman take navrhla
neÏkolik teÂmat, ktere by bylo mozÏno zpracovat v raÂmci
atestacÏnõÂ praÂce. A jak jizÏ tomu dnesÏnõÂ doba nutõÂ,
mnoho z jejich vyÂzkumnyÂch projektuÊ je zameÏrÏeno na
urychlenõ ortodonticke leÂcÏby - naprÏ. pouzÏitõ vibracõÂ,
ultrazvuku, laseru, kortikotomiõÂ cÏi medikamentuÊ.
Za zvlaÂsÏtnõ kapitolu pak lze povazÏovat naÂzor na pouzÏõÂvaÂnõ CT vysÏetrÏenõÂ. Zcela v souladu s prof. Nandou poukazujõ na zbytecÏne a v neÏkteryÂch prÏõÂpadech non lege
artis vyuzÏõÂvaÂnõÂ CT (zvlaÂsÏteÏ v USA je v poslednõÂ dobeÏ
dõÂky neÏkolika studiõÂm pouzÏitõ rtg vysÏetrÏenõ v zaÂjmu verÏejnosti a meÂdiõÂ). SoucÏaÂstõ prÏednaÂsÏky bylo take zverÏejneÏnõ vyÂsledkuÊ a doporucÏenõ evropske studie SEDENTEXCT, ktera se zbytecÏneÂmu pouzÏõÂvaÂnõ CT vysÏetrÏenõÂ
veÏnuje. HlavnõÂm probleÂmem je nesrovnatelneÏ vysÏsÏõÂ
daÂvka s beÏzÏnyÂm digitaÂlnõÂm OPG a bocÏnõÂm snõÂmkem
a daÂle pak cÏitelnost struktur, ktera je po CT rekonstrukci panoramatickeÂho snõÂmku ve veÏtsÏineÏ prÏõÂpaduÊ
nizÏsÏõÂ nezÏ na ¹2Dª OPG snõÂmcõÂch. Vzhledem k tomu,
zÏe i v CÏeske republice zacÏõÂna byÂt CT pouzÏõÂvaÂno jako rutinnõ vysÏetrÏenõÂ, bylo toto teÂma velmi prÏõÂnosne a poucÏneÂ
a zaslouzÏilo by sÏirsÏõÂ diskuzi i u naÂs.
NemeÂneÏ nadsÏenõÂ jsme byli z kurzu prof. Proffita. SeznaÂmil naÂs s poneÏkud odlisÏnyÂm naÂzorem na pohyb
zubuÊ prÏes tekutinu v periodonciu a podobneÏ jako prof.
Kuijpers-Jagtman se daÂle veÏnoval otaÂzkaÂm urychlenõÂ
ortodonticke leÂcÏby s vyuzÏitõÂm farmakologie, hormonaÂlnõ terapie, kortikotomiõÂ, mikroperforacõ alveolaÂrnõÂ
kosti, vibracõÂ, sveÏtla o vysoke intenziteÏ, ultrazvuku
apod. DaÂle plynule navaÂzal na genetickou analyÂzu pacientuÊ a vztah teÏchto analyÂz na pohyb zubuÊ a ortodontickou leÂcÏbu. PrÏi plaÂnovaÂnõ ortodonticke leÂcÏby neopomneÏl zmõÂnit v nyneÏjsÏõ dobeÏ cÏaste a zbytecÏne uzÏõÂvaÂnõ CT technologiõÂ. Druha cÏaÂst prÏednaÂsÏky byla
veÏnovaÂna srovnaÂnõÂ poveÏtsÏinou komercÏnõÂch hypoteÂz
s realitou. ObzvlaÂsÏteÏ pak samoligujõÂcõÂm zaÂmkuÊm a jejich vztahu ke trÏenõÂ a rychlosti posunu zubuÊ, zpuÊsobuÊm
ligace, lingvaÂlnõÂm aparaÂtuÊm, preskripcõÂm zaÂmkuÊ a konecÏneÏ take noveÏjsÏõÂm technologiõÂm typu Invisalign
apod. Ve veÏtsÏineÏ prÏõÂpaduÊ byl velky rozdõÂl mezi teoretickyÂmi zaÂklady teÏchto technologiõ a reaÂlnyÂmi vyÂsledky
vyÂzkumuÊ. ZaÂveÏrem prof. Proffit nastõÂnil mozÏne trendy
v budoucõ ortodoncii, zbyÂva tedy jen oveÏrÏit, zda se jeho
tipy stanou realitou.
Ale snad nejveÏtsÏõ soubor poznatkuÊ, ktery lze na oddeÏlenõ UCHC zõÂskat, se tyÂka biomechaniky aparaÂtuÊ
a leÂcÏebnyÂch postupuÊ. ZaÂklady bezpochyby polozÏil
prof. Burstone, a naÂsledne rozsÏõÂrÏenõ a rozpracovaÂnõÂ
prof. Nandou nabõÂzõ rÏesÏenõ i u prÏõÂpaduÊ, ktere jsou klasickou straight-wire technikou bez pouzÏitõ chirurgie
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
ZajõÂmavosti v ortodoncii
nerÏesÏitelneÂ. KoneckoncuÊ i v prÏõÂpadeÏ, zÏe je chirurgie nezbytnaÂ, je nynõÂ snaha pouzÏõÂvat prÏõÂstup ¹surgery firstª,
ktery opeÏt celou leÂcÏbu zrychluje a posouva daÂle. PlaÂnovaÂnõ a pozÏadavky na cÏelistnõÂho chirurga a naplaÂnovaÂnõ samotne operace s naÂslednyÂm skeletaÂlnõÂm kotvenõÂm jsou naÂrocÏneÂ, ale vyÂsledky a doba leÂcÏby hovorÏõ za
vsÏe. SamozrÏejmostõ je pak vyuzÏõÂvaÂnõ vsÏemozÏnyÂch prÏõÂdatnyÂch zarÏõÂzenõ k fixnõÂm aparaÂtuÊm (kotevnõ miniimplantaÂty, rozlicÏne jumping aparaÂty, prÏõÂdatne oblouky
a pruzÏiny, funkcÏnõ aparaÂty, atd.) Tato ruÊznorodost je zajiste daÂna i mnozÏstvõÂm jednak ucÏiteluÊ na plny uÂvazek,
tak i mnozÏstvõÂm leÂkarÏuÊ, kterÏõÂ zde ucÏõÂ jako externisteÂ.
KazÏdy z nich prÏinaÂsÏõ vlastnõ postupy a poznatky a je
pak jen na leÂkarÏõÂch v prÏõÂpraveÏ si tyto postupy a metody
vyzkousÏet.
ZaÂveÏrem nelze rÏõÂci jinak, nezÏ zÏe tento studijnõÂ pobyt
prÏedcÏil vesÏkera nasÏe ocÏekaÂvaÂnõ a naplnil naÂs prÏesveÏdcÏenõÂm, zÏe je u naÂs co zlepsÏovat, prÏedevsÏõÂm v systeÂmu
prÏedatestacÏnõÂho vzdeÏlaÂvaÂnõ a organizace praÂce. ZatõÂmco nasÏe leÂcÏebne postupy a mechanika jsou na srovnatelne uÂrovni, systeÂm a efektivita praÂce a dokumentace je naÂm mõÂsty na mõÂle vzdaÂlenyÂ, o financÏnõÂm ohodnocenõ nasÏõ ne vzÏdy jednoduche praÂce ani nemluveÏ.
Potvrzuje se tedy ono znaÂmeÂ: ¹StaÂle je na cÏem pracovatª.
MDDr. D. StrakovaÂ
MUDr. JirÏõÂ Tvardek, Ph.D.
Diagnostika a leÂcÏba
ve II. a III. AngleoveÏ trÏÂõdeÏ
aneb studijnõÂ relaxace
bez legrace
Kouzlo a umeÏnõ spojit prÏõÂjemne s uzÏitecÏnyÂm prokaÂzala rodinna firma Beldental ve spolupraÂci s doc.
MUDr. Olgou JedlicÏkovou, CSc. A tak jsme meÏli mozÏnost se v polovineÏ dubna zuÂcÏastnit kurzu, ktery se zabyÂval teÂmatem diagnostiky a leÂcÏby ve II. a III. AngleoveÏ
trÏõÂdeÏ. TeÂma jizÏ mnohokraÂt zminÏovaneÂ, avsÏak nesmõÂrneÏ
duÊlezÏiteÂ. A v podaÂnõ skveÏle prÏednaÂsÏejõÂcõ i velmi poutaveÂ.
PocÏaÂtek kurzu byl veÏnovaÂn povõÂdaÂnõ o II. trÏõÂdeÏ. DuÊlezÏita byla hlavneÏ cÏaÂst o mozÏnostech cÏasne leÂcÏby. V pruÊbeÏhu prÏednaÂsÏky cÏasto zaznõÂvala poucÏenõÂ, cÏeho si vsÏõÂmat a jak spraÂvneÏ diagnostikovat, rady, jak postupovat, typy, jak si praÂci ulehcÏit a hlavneÏ cennaÂ
doporucÏenõÂ, cÏemu se vyhnout a co naopak neopomenout. Je obdivuhodneÂ, zÏe je neÏkdo ochotny se podeÏlit
o sve mnohalete zkusÏenosti a upozornit na rizikoveÂ
faktory leÂcÏby a jejich nezÏaÂdoucõÂ uÂcÏinky.
www.orthodont-cz.cz e-mail: [email protected]
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DalsÏõ velmi duÊlezÏita cÏaÂst byla spõÂsÏe individuaÂlnõÂho
raÂzu. KazÏdy meÏl mozÏnost doneÂst si svoje - jak panõ docentka rÏõÂka - prÏõÂsÏerky. A zÏe jich bylo. Modely se strÏõÂdaly,
rady se udõÂlely a plaÂny se tvorÏily. A takto by to meÏlo byÂt.
MnohogeneracÏnõ diskuse ma sve kouzlo a je mnohem
duÊlezÏiteÏjsÏõÂ, nezÏ by se na prvnõÂ pohled mohlo zdaÂt.
Hodina se vsÏak s hodinou sesÏla, uÂcÏastnõÂci kurzu zacÏali vyuzÏõÂvat pohostinnosti hotelu Horal se vsÏemi jeho
velkorysyÂmi vyÂhodami. Saunovy sveÏt, bazeÂn, nejruÊzneÏjsÏõ typy masaÂzÏõÂ, fitness centrum nebo pouha prochaÂzka prÏõÂrodou. To vsÏe bylo k dispozici k rÏaÂdne relaxaci, ktera je pro zÏivot i praÂci velmi duÊlezÏitaÂ. VysportovanõÂ, vyspanõ nebo zrelaxovaÂnõ jsme se ve vecÏernõÂch
hodinaÂch sesÏli v malebne hospuÊdce s opravdu vyÂbornou kuchynõÂ. O vinneÂm lõÂstku nemluveÏ. UtuzÏili jsme
profesionaÂlnõÂ i osobnõÂ vztahy a po celeÂm dlouheÂm dni
si oveÏrÏili i skveÏle mozÏnosti ubytovaÂnõ tohoto relaxacÏnõÂho komplexu.
DalsÏõÂ den jsme otevrÏeli teÂma III. trÏõÂdy, jezÏ bylo takeÂ
velmi zajõÂmaveÂ. Po oba dny byla soucÏaÂstõ kurzu i vyÂstava organizujõÂcõ firmy Beldental, ktera byla opeÏt rozmanita a plna novinek. Po dokoncÏenõ teÂmatu a diskuse
- at' uzÏ verÏejne nebo te v kuloaÂrech, jsme se vydali zpeÏt
vstrÏõÂc domovuÊm. Nejeden kolega vsÏak navsÏtõÂvil toto re-
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ZajõÂmavosti v ortodoncii
ORTODONCIE
laxacÏnõ centrum s celou rodinnou a udeÏlal si prodlouzÏeny võÂkend. CozÏ je moc dobry naÂpad, at' uzÏ je na programu kurz nebo ne.
RaÂdi bychom podeÏkovali firmeÏ Beldental za perfektnõ organizaci a panõ docentce MUDr. Olze JedlicÏkoveÂ, CSc. za kraÂsnou prÏednaÂsÏku, ktera naÂm jisteÏ
mnohe dala.
MDDr. K. FlorykovaÂ
TradicÏnõÂ kurz v Olomouci
V prvnõÂm cÏervnoveÂm tyÂdnu se jizÏ tradicÏneÏ konal na
Klinice zubnõÂho leÂkarÏstvõÂ v Olomouci 5-dennõÂ kurz pro
noveÏ nastoupene leÂkarÏe v prÏedatestacÏnõ ortodontickeÂ
prÏõÂpraveÏ. Kurz se konal za laskaveÂho prÏispeÏnõÂ firmy
ROD Praha, ktera v zastoupenõ pana Daniela Mastracciho dodala potrÏebny materiaÂl. SesÏlo se zde võÂce nezÏ
20 zacÏõÂnajõÂcõÂch ortodontistuÊ z cele republiky, kterÏõÂ
pod vedenõÂm profesora MUDr. M. KamõÂnka, DrSc.
a odborne asistentky MUDr. M. SÏtefkoveÂ, CSc. zõÂskali
hodneÏ teoretickyÂch znalostõÂ a hlavneÏ praktickyÂch dovednostõÂ. NacvicÏili jsme ideaÂlnõÂ oblouky na kulateÂm
i cÏtyrÏhranneÂm draÂteÏ, ohyby I., II., III. rÏaÂdu, diagnostickyÂ
set-up a mnoho dalsÏõÂho. Kurz jsme zakoncÏili v paÂtek
kolem poledne analyÂzou a porovnaÂvaÂnõÂm kefalometrickyÂch snõÂmkuÊ. ZaÂveÏrem bych chteÏla podeÏkovat vyÂsÏe
zmõÂneÏne firmeÏ ROD Praha, prof. MUDr. M. KamõÂnkovi,
DrSc. odborne asistence MUDr. M. SÏtefkoveÂ, CSc.
a Klinice zubnõÂho leÂkarÏstvõÂ LF UP Olomouc za poskytnutõÂ prostor pro konaÂnõÂ kurzu.
MUDr. Blanka StrnadovaÂ
Altis Group spol. s r. o.
± vyÂhradnõÂ zaÂstupce pro CÏeskou republiku a Slovensko
V roce 2013 pro VaÂs prÏipravujeme historicky I. sympozium v CÏR v konceptu
¹Dva obory ± jeden cõÂlª
se zameÏrÏenõÂm na spolupraÂci ortodontisty s implantologem (respektive protetikem)
PrÏednaÂsÏet budou spolupracujõÂcõ tyÂmy z cele CÏR.
UÂcÏast prÏislõÂbili: MUDr. Petr - MUDr. ZaÂbrodskyÂ, MUDr. KucÏera - MUDr. Streblov,
MUDr. Hofman - MUDr. Mounajjed DDS, PhD., MUDr. Baumruk - MUDr. VlnarÏ,
MUDr. Marek PhD. - Doc. MUDr. Starosta PhD., MUDr. Filipi - MUDr. Gregor
TermõÂn: brÏezen 2013 ± bude uprÏesneÏn
MõÂsto konaÂnõÂ: Praha
Dr. Christophe Gualano: ¹Lingual Jet ± leÂcÏba lingvaÂlnõÂm aparaÂtem na mõÂru pacientoviª
TermõÂn: 19.-20. rÏõÂjna 2012
MõÂsto konaÂnõÂ: Praha
TeÏÏsõÂ se na VaÂs kolektiv Altis Group s.r.o.
Altis Group spol. s r. o., ZÏerotõÂnova 901/12, 690 02 BrÏeclav
Tel./fax: 519 325 414, e-mail: [email protected], Petra Karafova
 - 731 476 456, Marie PõÂsarÏÂõkova ± 606 746 716
Zelena linka: 800 100 535 (VOLEJTE ZDARMA!)
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ORTODONCIE
Ageneze druhyÂch dolnõÂch premolaÂruÊ a zmeÏny
na perzistujõÂcõÂch docÏasnyÂch molaÂrech a okolnõÂch tkaÂnõÂch
Agenesis of lower second premolars and changes
of persisting primary molars and surrounding tissues
*MUDr. PavlõÂna AdamkovaÂ, *MUDr. Ivo Marek, Ph.D., **Mgr. KaterÏina LangovaÂ, Ph.D.
*Ortodonticke oddeÏlenõ Kliniky zubnõÂho leÂkarÏstvõ LF UP Olomouc
*Department of Orthodontics, Clinic of Dental Medicine, Medical Faculty of Palacky University Olomouc
**UÂstav leÂkarÏske biofyziky, LF UP Olomouc
**Institute of Medical Biophysics, Medical Faculty of Palacky University Olomouc
Souhrn
CõÂl studie: U pacientuÊ s agenezõÂ staÂlyÂch premolaÂruÊ bylo uÂkolem sledovat stupenÏ resorpce korÏenuÊ perzistujõÂcõÂch docÏasnyÂch molaÂruÊ vzhledem k veÏku pacienta, zaÂvislost resorpce korÏenuÊ docÏasnyÂch molaÂruÊ na mõÂrÏe infraokluze, uÂhel mezi staÂlyÂm molaÂrem, premolaÂrem a perzistujõÂcõÂm docÏasnyÂm molaÂrem, zaÂvislost sklonu staÂlyÂch zubuÊ
k docÏasneÂmu molaÂru na infraokluzi a faktory, ktere mohou ovlivnit stav perzistujõÂcõÂch docÏasnyÂch molaÂruÊ.
MateriaÂl a metodika: Do souboru bylo zarÏazeno 238 druhyÂch dolnõÂch docÏasnyÂch molaÂruÊ 164 pacientuÊ s agenezõÂ dolnõÂch premolaÂruÊ. ZmeÏny na korÏenech docÏasneÂho molaÂru, jeho infraokluze a sklony okolnõÂch zubuÊ byly meÏrÏeny na ortopantomogramech.
VyÂsledky: PruÊrÏezovou studiõÂ bylo zjisÏteÏno, zÏe u deÏtõÂ do 15 let dochaÂzõÂ ke zhorsÏenõÂ resorpce korÏenuÊ perzistujõÂcõÂch
docÏasnyÂch molaÂruÊ. U starsÏÂõch pacientuÊ jsou resorpcÏnõÂ stupneÏ nezmeÏneÏny. Infraokluze perzistujõÂcõÂch docÏasnyÂch
molaÂruÊ u pacientuÊ nad 16 let je signifikantneÏ veÏtsÏÂõ nezÏ u 7-9 letyÂch deÏtõÂ. Nebyl nalezen signifikantnõÂ vztah mezi
stupneÏm resorpce a velikostõÂ infraokluze. U dolnõÂch docÏasnyÂch molaÂruÊ s infraokluzõÂ byly nalezeny signifikantneÏ
vysÏsÏÂõ uÂhly mezi prvnõÂm dolnõÂm premolaÂrem a prvnõÂm staÂlyÂm molaÂrem. Byla nalezena zaÂvislost mezi ztraÂtou marginaÂlnõÂ kosti a resorpcõÂ korÏenuÊ docÏasnyÂch molaÂruÊ. Se zvysÏujõÂcõÂm se veÏkem pacienta se zmensÏuje vzdaÂlenost mezi
prvnõÂm premolaÂrem a prvnõÂm staÂlyÂm molaÂrem.
ZaÂveÏr: Resorpce korÏenuÊ docÏasnyÂch molaÂruÊ po 16. roku ustaÂvaÂ, stejneÏ jako jejich infraokluze a sklon okolnõÂch
zubuÊ. U zubuÊ s prÏÂõtomnostõÂ ankyloÂzy byla resorpce korÏenuÊ mensÏÂõ. U docÏasnyÂch molaÂruÊ s nõÂzkyÂm stupneÏm resorpce po 16. roku veÏku muÊzÏeme usuzovat na dobrou prognoÂzu zubu (Ortodoncie 2012, 21, cÏ. 2, s. 60-71).
Abstract
Aims: The degree of root resorption of persisting primary molars in patients with agenesis of permanent premolars was monitored in relation to patients` age; the relation of root resorption and the degree of infraocclusion,
angle between a permanent molar, premolar and persisting primary molar; the relation of permanent teeth inclination to primary molar and infraocclusion, and factors that may influence the condition of persisting primary molars were also studied.
Material and method: The sample had 238 second lower primary molars, 164 patients with agenesis of lower
premolars. The changes on the roots of primary molar, its infraocclusion, and inclination of adjacent teeth were
measured in pantomographic X-ray pictures.
Results: By means of crossectional study we came to the conclusion that in children up to the age of 15 the resorption of roots of persisting primary molars worsened. In older patients the degree of resorption remained unchanged. Infraocclusion of persisting primary molars in patients over 16 is significantly bigger than in children up to the
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age of 7-9. The degree of root resorption and severity of infraocclusion has no significant correlation. In lower primary molars with infraocclusion there were found significantly larger angles between the first lower premolar and
first permanent molar. We also found relationship between the loss of marginal bone and primary molar root resorption. The older the patient, the shorter the distance between the first premolar and the first permanent molar.
Conclusion: The resorption of temporary molar roots slows down over the age of 16; the same applies to their
infraocclusion and inclination of adjacent teeth. In teeth with infraocclusion the resorption of roots was less significant. In primary molars with low degree of resorption over the age of 16 we can suppose a good prognosis for
the tooth (Ortodoncie 2012, 21, No. 2, p. 60-71).
KlõÂcÏova slova: ageneze, resorpce, ankyloÂza, infraokluze
Key words: agenesis/congenital absence of teeth, resorption, ankylosis, infraocclusion
UÂvod
Introduction
S agenezõÂ staÂlyÂch zubuÊ se setkaÂvaÂme u pacientuÊ
pomeÏrneÏ cÏasto. Vrozene chybeÏnõ zubuÊ je vyÂsledkem
poruchy beÏhem pocÏaÂtecÏnõÂ faÂze formace zubu: iniciace
a proliferace. Rodova ageneze zubu je prÏenaÂsÏena jako
autozomaÂlneÏ dominantnõÂ, autozomaÂlneÏ recesivnõÂ nebo
vaÂzana na X chromozom [1, 2]. Mnohe studie dokazujõÂ,
zÏe s vyÂjimkou trÏetõÂch molaÂruÊ, jsou nejcÏasteÏji chybeÏjõÂcõÂmi druhe dolnõ premolaÂry [3]. Prevalence u dolnõÂch
premolaÂruÊ je dvakraÂt cÏasteÏjsÏõÂ nezÏ u hornõÂch premolaÂruÊ.
CÏetnost ageneze druhyÂch dolnõÂch premolaÂruÊ v populaci je 2,4-4,3% [4, 5]. DiagnoÂza ageneze by vsÏak meÏla
byÂt z duÊvodu opozÏdeÏneÂho vyÂvoje zaÂrodku staÂleÂho premolaÂru urcÏena teprve azÏ v 9-10 letech veÏku [6]. ZpuÊsob
rÏesÏenõ ageneze druhyÂch dolnõÂch premolaÂruÊ je duÊlezÏityÂm faktorem prÏi plaÂnovaÂnõ a nacÏasovaÂnõ celkove terapie [7]. JakyÂm smeÏrem se bude terapie ubõÂrat, urcÏuje
neÏkolik faktoruÊ. Mezi celkova kriteÂria rÏadõÂme veÏk pacienta, diskrepanci v dolnõÂm zubnõÂm oblouku, vertikaÂlnõÂ
vztah zubnõÂch obloukuÊ, profil oblicÏeje pacienta, typ ruÊstu, poloha dolnõÂch rÏezaÂkuÊ, financÏnõÂ mozÏnosti pacienta.
LokaÂlnõÂ kriteÂria zahrnujõÂ stav docÏasneÂho druheÂho
dolnõÂho molaÂru, kdy sledujeme stav korunky (sÏõÂrÏku, destrukce, karieÂznõÂ leÂze, infraokluzi) a stav korÏenuÊ (resorpci, ankyloÂzu), daÂle stav okolnõÂch zubuÊ (sklon do
mezery, zalozÏene trÏetõ molaÂry), stav alveolu (sÏõÂrÏku alveolu, vyÂsÏku alveolaÂrnõÂho hrÏebene). Infraokluze docÏasnyÂch molaÂruÊ vyjadrÏuje okamzÏitou polohu zubu, je cÏasto spojena s ankyloÂzou a ma vliv na rozvoj alveolaÂrnõÂ
kosti s nizÏsÏõÂ vyÂsÏkou kosti obklopujõÂcõÂ molaÂr [7]. PrÏesnyÂ
mechanismus vzniku ankyloÂzy nenõÂ znaÂm. Diagnostikujeme ji na rtg snõÂmcõÂch zhotovenyÂch s cÏasovyÂm odstupem. V dobeÏ ruÊstu alveolu je jizÏ po 6 meÏsõÂcõÂch na
dvou po sobeÏ zhotovenyÂch snõÂmcõÂch viditelna zmeÏna
uÂrovneÏ vyÂsÏky alveolaÂrnõÂho hrÏebene, muÊzÏe byÂt znatelnaÂ
obliterace periodontaÂlnõÂho prostoru, korÏeny jsou meÂneÏ
radioopaÂknõÂ. AnkyloÂza zjisÏteÏna v dobeÏ ruÊstu cÏelisti je
duÊvodem k extrakci perzistujõÂcõÂho docÏasneÂho molaÂru.
Je- li provedena pozdeÏ, naÂsledkem je velka ztraÂta
kosti, ktera se projevõ uÂzkyÂm alveolaÂrnõÂm hrÏebenem
se soucÏasnyÂm vertikaÂlnõÂm defektem.
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Agenesis of permanent teeth is a rather frequent
problem in our patients. Congenital absence of teeth
results from the disorder during the initial phase of
a tooth formation: initiation and proliferation. Congenital absence of a tooth is autosomally dominant, autosomally recessive, or related to X chromosome [1,2].
A number of studies show that after third molars, the
second frequently missing teeth are lower second premolars [3]. Prevalence of missing lower premolars is
twice more frequent than that of upper premolars.
The rate of second lower premolar agenesis in population oscillates between 2.4 - 4.3% [4,5]. However, due
to the delayed development of the permanent premolar germ the diagnosis should be made only at the age
od 9-10 [6]. The way of solving the second lower premolar agenesis is one of the key factors that should
be considered in planning and timing of the complex
therapy [7]. The treatment is affected by several factors. Amongst the criteria there are the patient's age,
discrepancy in the lower dental arch, vertical relationship between dental arches, facial profile of a patient,
growth type, position of lower incisors, and financial
position of a patient.
Local criteria include the condition of the temporary
second lower molar - we follow the situation of the
crown (width, destruction, caries lesions, infraocclusion) and roots (resorption, ankylosis), the situation
of surrounding teeth (inclination to the space, present
third molars), the state of alveolus (width, height of alveolar ridge). Infraocclusion of primary molars expresses the momentary position of the tooth, it is often caused by ankylosis, and affects the development of alveolar bone with the lower height of the bone
surrounding the molar [7]. The precise mechanism of
ankylosis origin is not known. We can diagnose it in radiograms made in intervals. During the growth, the
comparison of two X-rays made after 6 months shows
the change in the height of alveolar ridge, the obliteration of periodontal space can be seen, and the roots
are less radio-opaque. Ankylosis diagnosed at the time
of jaw growth is the reason for extraction of a persisting
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TerapeutickyÂch mozÏnostõÂ prÏi rÏesÏenõÂ ageneze docÏasneÂho dolnõÂho molaÂru je neÏkolik: Extrakce docÏasneÂho
molaÂru a uzavrÏenõÂ prostotu pomocõÂ fixnõÂho aparaÂtu;
ponechaÂnõÂ docÏasneÂho molaÂru v puÊvodnõÂ sÏõÂrÏce nebo
se zaÂbrusy na sÏõÂrÏku premolaÂru; proteticka naÂhrada
chybeÏjõÂcõÂho premolaÂru prÏi ponechaÂnõÂ extrakcÏnõÂ mezery
adhezivnõÂm muÊstkem, fixnõÂm muÊstkem nebo implantaÂtem; prÏõÂpadneÏ autotransplantace.
UÂkolem studie je registrace faktoruÊ majõÂcõÂch vliv na
perzistenci docÏasnyÂch molaÂruÊ ve staÂleÂm chrupu, ale
i neprÏõÂznivyÂch naÂsledkuÊ, ktere dlouhodoba perzistence
docÏasnyÂch molaÂruÊ v neÏkteryÂch prÏõÂpadech muÊzÏe mõÂt.
MateriaÂl
Soubor byl sestaven z pacientuÊ z ortodontickeÂho
oddeÏlenõ Kliniky zubnõÂho leÂkarÏstvõ v Olomouci, z ortodontickeÂho oddeÏlenõ Stomatologicke kliniky VFN
v Praze, ze StomatologickeÂho centra MUDr. Ivo Marka,
Ph.D., z ortodonticke praxe MUDr. Agaty Mohammad.
Skupina byla tvorÏena 164 pacienty, z toho bylo 95 zÏen
a 69 muzÏuÊ. PruÊmeÏrny veÏk pacientuÊ byl 13,1 let. NejmladsÏõ pacient meÏl 7 let a nejstarsÏõ 56 let.
Do vyÂzkumneÂho souboru byli zarÏazeni pacienti
podle teÏchto kriteÂriõÂ:
1. DiagnostikovaÂna ageneze jednoho nebo obou
druhyÂch dolnõÂch premolaÂruÊ
2. PerzistujõÂcõ jeden nebo oba druhe dolnõ docÏasneÂ
molaÂry
3. Ortopantomogram u kazÏdeÂho pacienta.
CelkoveÏ bylo zmeÏrÏeno 238 druhyÂch dolnõÂch docÏasnyÂch molaÂruÊ, z toho 117 pravyÂch a 121 levyÂch.
Soubor pacientuÊ byl rozdeÏlen podle dostupne dokumentace do peÏti skupin podle veÏku: 1. skupina 7 9 let, 2. skupina 10 - 11 let, 3. skupina 12 - 13 let, 4. skupina 14 - 15 let, 5. skupina 16 a võÂce let.
Tento soubor byl sledovaÂn minimaÂlneÏ 2 roky. Pacienti, u kteryÂch byla pozorovaÂna zveÏtsÏujõÂcõÂ se infraokluze a zaÂrovenÏ dosÏlo k zmeÏneÏ uÂrovneÏ vyÂsÏky alveolaÂrnõÂho hrÏebene (võÂce nezÏ 1 mm) byli zarÏazeni do skupiny
A (pracovneÏ nazvaÂna ªs ankyloÂzouª, 44 pacientuÊ),
ostatnõÂ pacienti tvorÏili skupinu B (pracovneÏ nazvaÂna
ªbez ankyloÂzyª, 120 pacientuÊ).
Metodika
Hodnocene parametry:
1. UÂrovenÏ infraokluze (obr. 1)
2. StupenÏ resorpce korÏenuÊ docÏasneÂho molaÂru (na
meziaÂlnõÂm a distaÂlnõÂm korÏeni) (obr. 2)
3. UÂrovenÏ kosti u docÏasneÂho molaÂru vzhledem
k okolnõÂm zubuÊm (obr. 3)
4. Velikost uÂhlu mezi docÏasnyÂm molaÂrem a prvnõÂm
premolaÂrem (obr. 4)
5. Velikost uÂhlu mezi docÏasnyÂm a staÂlyÂm molaÂrem
62
ORTODONCIE
primary molar. Late extraction results in a considerable
loss of bone which is manifested by narrow alveolar
ridge accompanied with vertical defect.
There are several solutions to the agenesis of primary lower molar: extraction of the primary molar
and the space closure by means of fixed appliance;
preserving the primary molar in its original width or
changed to the width of premolar; prosthetic substitution by means of an adhesive bridge, fixed bridge or an
implant; autotransplantation.
The study records the factors affecting persistency
of primary molars in permanent dentition, as well as the
adverse consequences of a long-time persistency of
primary molars.
Material
The sample included patients of the Department of
Orthodontics, Medical Faculty in Olomouc, the Department of Orthodontics of General University Hospital (VFN) in Prague, Stomatological Centre of MUDr.
Ivo Marek, Ph.D., and the private orthodontic practice
of MUDr. Agata Mohammad. The sample comprised
164 patients (95 females, 69 males). The mean age
was 13.1 years. The youngest patient was 7 years
and the oldest one 56 years old.
The patients met the following criteria:
1. Agenesis of one or both second lower premolars.
2. Persistent one or both primary second lower molars.
3. OPG made for each patient.
Overall 238 primary second lower molars were measured (117 on the right side and 121 on the left side.)
The sample was divided (according to records) into
5 age groups: Group 1 = 7-9 years, Group 2 = 10-11
years, Group 3 = 12-13 years, Group 4 = 14-15 years,
Group 5 = 16 years and more.
The sample was monitored at least for further 2
years. The patients with increasing infraocclusion
and with simultaneous change in the height of alveolar
ridge (more than 1 mm) were included into Group
A (group called ªwith ankylosisª) - 44 patients. Other
patients were in Group B (called ªwithout ankylosisª)
- 120 patients.
Methods
Registered parameters:
1. The level of infraocclusion ( Fig.1)
2. The degree of primary molar roots resorption (mesial and distal root) (Fig.2)
3. The level of bone at primary molar related to surrounding teeth (Fig.3)
4. The angle between primary molar and first premolar (Fig.4)
5. The angle between primary and permanent molar.
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6. VzdaÂlenost mezi prvnõÂm staÂlyÂm molaÂrem a prvnõÂm
premolaÂrem (obr. 5)
K meÏrÏenõÂ byl pouzÏit uÂhlomeÏr s odecÏõÂtaÂnõÂm na 0,5
stupneÏ a digitaÂlnõ posuvne meÏrõÂtko Mitutoyo 500123U s odecÏõÂtaÂnõÂm na setiny milimetru.
6. The distance between permanent first molar and
first premolar (Fig.5)
The protractor with 0.5° reading was used for measurements together with a digital caliper Mitutoyo 500123U with millimeter centesima reading.
UÂrovenÏ infraokluze (Obr. 1):
Na ortopantomogramu byla zkonstruovaÂna spojnice mezi hrbolky prvnõÂho premolaÂru a prvnõÂho staÂleÂho
molaÂru a okluznõÂ linie perzistujõÂcõÂho docÏasneÂho molaÂru.
VzdaÂlenost mezi teÏmito liniemi byla meÏrÏena posuvnyÂm
meÏrÏõÂtkem.
The level of infraocclusion (Fig.1):
In OPG the connecting line was construed between
the cusps of the first premolar and the first permanent
molar and the occlusal line of the persisting primary
molar. The distance between the two lines was measured with a caliper.
StupenÏ resorpce korÏenuÊ docÏasneÂho molaÂru (Obr. 2):
Resorpce korÏenuÊ perzistujõÂcõÂho docÏasneÂho molaÂru
byla odecÏõÂtaÂna na zaÂkladeÏ hodnotõÂcõ sÏkaÂly, ktera maÂ
sÏest uÂrovnõÂ. Toto hodnocenõÂ pouzÏili Bjerklin a Bennett
v praÂci v roce 2000 [8]. SÏkaÂla klasifikace resorpce:
1. Zub bez resorpce
2. Resorpce 1/4 korÏene
3. Resorpce 1/2 korÏene
4. Resorpce 3/4 korÏene
5. Resorpce celeÂho korÏene
6. Zub je odloucÏen
KazÏdy korÏen byl hodnocen zvlaÂsÏt'. DeÂlka byla odecÏõÂtaÂna od bifurkace korÏenuÊ po apex.
The degree of primary molar roots resorption (Fig.2):
Persisting primary molar roots resorption was measured by the assessment scale of six levels. This assessment was used by Bjerklin and Bennett in 2000 [8].
The resorption scale:
1. Tooth without resorption
2. 1/4 root resorption
3. 1/2 root resorption
4. 3/4 root resorption
5. Complete root resorption
6. Tooth fell out
Each root was evaluated separately. The length was
measured from roots bifurcation till apex.
UÂrovenÏ kosti u docÏasneÂho molaÂru (Obr. 3 ):
Na ortopantomogramu byla zaznamenaÂna cementosklovinna hranice perzistujõÂcõÂho docÏasneÂho molaÂru
a vrchol hrÏebene alveolu. VzdaÂlenost mezi teÏmito liniemi byla meÏrÏena posuvnyÂm meÏrÏõÂtkem. ZvlaÂsÏt' byla
meÏrÏena uÂrovenÏ hladiny kosti na meziaÂlnõÂ a distaÂlnõÂ
straneÏ molaÂru.
The level of bone at primary molar (Fig.3):
In OPG the cement-enamel junction in persisting
primary molar and the top of alveolar ridge were recorded. The distance between the two lines was measured with a caliper, separately for mesial and distal side
of the molar.
Velikost uÂhlu mezi docÏasnyÂm molaÂrem a premolaÂrem (Obr. 4):
Na ortopantomogramu byla zaznamenaÂna dlouhaÂ
osa prvnõÂho dolnõÂho premolaÂru a perzistujõÂcõÂho dolnõÂho
docÏasneÂho molaÂru. UÂhel, ktery tvorÏõ dlouhe osy zubuÊ.
The angle between primary molar and first premolar
(Fig. 4):
In OPG the long axis of the first lower premolar and
persisting lower primary molar were taken as well as
the angle between the long axes of the teeth. In some
cases the angle was not sharp, and therefore it was recorded in ªminusª values.
Obr. 1. MeÏrÏenõÂ infraokluze na ortopantomogramu
Fig. 1. Measurement of infraocclusion in OPG
Obr. 2. OdecÏõÂtaÂnõÂ stupneÏ resorpce korÏenuÊ na ortopantomogramu
Fig. 2. Measurement of the root resorption in OPG
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Obr. 3. MeÏrÏenõÂ uÂrovneÏ kosti u perzistujõÂcõÂho docÏasneÂho molaÂru na
ortopantomogramu
Fig. 3. Measurement of the bone level at persisting primary molar in
OPG
ORTODONCIE
Obr. 4. ZobrazenõÂ uÂhlu mezi docÏasnyÂm molaÂrem, prvnõÂm premolaÂrem a prvnõÂm staÂlyÂm molaÂrem na ortopantomogramu
Fig. 4. Angle between primary molar, first premolar and first permanent molar in OPG
The angle between primary molar and permanent
first molar (Fig. 4):
In OPG the long axis of the second primary molar
and first permanent molar were taken as well as the
angle between the long axes of the teeth. In case the
angle was obtuse it was recorded in negative values.
Obr. 5. VzdaÂlenost mezi prvnõÂm premolaÂrem a prvnõÂm staÂlyÂm molaÂrem na ortopantomogramu
Fig. 5. Distance between first premolar and first permanent molar in
OPG
V neÏkteryÂch prÏõÂpadech nebyl uÂhel ostryÂ, proto byl zaznacÏen v minusove hodnoteÏ.
Velikost uÂhlu mezi docÏasnyÂm molaÂrem a prvnõÂm staÂlyÂm molaÂrem (Obr. 4):
Na ortopantomogramu byla zaznamenaÂna dlouhaÂ
osa druheÂho docÏasneÂho molaÂru a prvnõÂho staÂleÂho mo64
The distance between permanent first molar and
first premolar (Fig. 5):
In OPG the lines were construed as perpendicular
tangents to mesial surface of the first permanent molar
and to distal surface of the first premolar. The distance
between the two lines was measured on the connecting line between these two lines running parallel to
the occlusal plane of the primary molar with a caliper.
In case in OPG permanent teeth overlapped with
persisting primary molar, the point of measurement
was in the middle of the overlap.
The measurement error was calculated according
to Dahlberg formula. Repeated measurements were
done on OPGs in 20 randomly chosen patients. The
measurement error was 3.2 %.
Quantitative parameters are described by statistical
characteristics - mean, median, minimum and maximum values and standard deviation.
All tests were performed at the level of statistical
significance = 0.05.
Data were tested by mean of normality Shapiro-Wilk
tests. The testing proved that the level of significance
in most parameters was below 0.05. Therefore, to
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laÂru. UÂhel, ktery tvorÏõ dlouhe osy zubuÊ. Pokud byl uÂhel
tupyÂ, byl zaznamenaÂn v negativnõÂch hodnotaÂch.
VzdaÂlenost mezi prvnõÂm staÂlyÂm molaÂrem a prvnõÂm
premolaÂrem (Obr. 5):
Na ortopantomogramu byly naryÂsovaÂny linie jako
svisle tecÏny k meziaÂlnõ plosÏe prvnõÂho staÂleÂho molaÂru
a distaÂlnõÂ plosÏe prvnõÂho premolaÂru. VzdaÂlenost mezi teÏmito liniemi byla meÏrÏena na uÂsecÏce spojujõÂcõÂ tyto dveÏ
linie, ktera byla rovnobeÏzÏna s okluznõ plochou docÏasneÂho molaÂru meÏrÏena posuvnyÂm meÏrÏõÂtkem.
Pokud bylo na ortopantomogramu prÏekrytõÂ staÂlyÂch
zubuÊ s perzistujõÂcõÂm docÏasnyÂm molaÂrem, bod meÏrÏenõÂ
byl ve strÏedu tohoto prÏekrytõÂ.
Chyba meÏrÏenõÂ byla pocÏõÂtaÂna podle Dahlbergovy formule. OpakovanyÂm meÏrÏenõÂm OPG u 20 naÂhodneÏ vybranyÂch pacientuÊ cÏinila chyba 3,2 %.
KvantitativnõÂ parametry jsou popsaÂny pomocõÂ zaÂkladnõÂch statistickyÂch charakteristik - pruÊmeÏru, mediaÂnu, minimaÂlnõÂ a maximaÂlnõÂ hodnoty a smeÏrodatneÂ
odchylky.
VsÏechny testy byly provedeny na hladineÏ statistickeÂ
vyÂznamnosti 0,05. Data byla testovaÂna pomocõÂ testuÊ
normality Shapiro-Wilk. ProkaÂzaly, zÏe signifikance je teÂmeÏrÏ u vsÏech velicÏin mensÏõÂ nezÏ 0,05. Na zaÂkladeÏ teÏchto
skutecÏnostõÂ byly pro oveÏrÏovaÂnõÂ hypoteÂz pouzÏity pouze
neparametricke metody - SpearmanuÊv korelacÏnõ koeficient, Mann-Whitney test, Kruskal-Wallis test.
VyÂsledky
Resorpce u veÏkovyÂch skupin:
K porovnaÂnõ byly pouzÏity neparametricke testy Kruskal-Wallis.
Ve veÏkove skupineÏ 7 - 9 let byl stupenÏ resorpce (mediaÂn) 2 (SD 1); ve skupineÏ 10 - 11 let byla resorpce u pravyÂch korÏenuÊ 3, u levyÂch 2 (SD 1); ve skupineÏ 16 a võÂce
let byl stupenÏ resorpce v pruÊmeÏru 3 (SD 1,1) (Tab. 1).
U deÏtõÂ mezi 14. azÏ 15. rokem jsou statisticky signifikantneÏ (p = 0,033) horsÏõÂ resorpcÏnõÂ stupneÏ nezÏ u deÏtõÂ
mladsÏõÂch. Ve skupineÏ starsÏõÂch pacientuÊ, po 16 roku
veÏku, zuÊstaÂvajõÂ resorpcÏnõÂ stupneÏ nezmeÏneÏny (Obr. 6).
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prove hypotheses only non-parametric values were
used - Spearman correlation coefficient, Mann-Whitney test, Kruskal-Wallis test.
Results
Resorption in age groups
For comparison non-parametric Kruskal-Wallis
tests were used. In Group 1 (7-9 years) the degree of
resorption (median) was 2 (SD 1); in Group 2 (10-11
years) the median was 3 for right roots, and 2 for left
roots (SD 1); in Group 5 (16- years) the mean value of
resorption was 3 (SD 1.1) (Table 1).
In children between 14 and 15 the degree of resorption is significantly (p=0.033) worse than in younger
children. In the group of older patients (over 16), the degree of resorption remains unchanged (Fig.6).
Bone loss (in mm) according age groups
In Group 1 (7-9 years) the bone loss mean value was
0.7-1.2 (SD 0.7-1.5); in Group 2 (10-11 years) 1.1-1.3
(SD 0.8-2.1); in Group 3 (12-13 years) 1.0-1.3 (SD
0.8-1.4); in Group 4 (14-15 years) 1.5 (SD 1.3-2.3); in
Group 5 (16- years) it was between 1.6 and 2.1 (SD
1.1-1.4) (Table 2).
Statistically significant difference was found between Group 1 and Group 5 (p = 0.005) (Fig. 7, 8) and
between Group 2, resp. Group 3 and Group 5
(p = 0.006).
Infraocclusion of primary molars related to individual age groups:
In Group 1 (7-9 years) the mean value of infraocclusion was 0 (SD 0.8); in Group 2 (10-11 years) it was 0
(SD 0.9 and 1.6); in Group 3 (12-13 years) the value reached 0 (SD 1.4); in Group 4 (14-15 years) it was 0 and
1.1 (SD 2.4); in Group 5 (16- years) the mean value of
infraocclusion was 0.2 and 1.0 (SD 1.5 and 1.9).
ZtraÂty kosti (v mm) podle veÏkovyÂch skupin:
V 1. veÏkove skupineÏ 7-9 let byla ztraÂta kosti
v pruÊmeÏru mezi 0,7-1,2 (SD 0,7-1,5); ve 2. skupineÏ
10-11 let byl pruÊmeÏr 1,1-1.3 (SD 0,8-2,1); ve 3. skupineÏ
12-13 let byl pruÊmeÏr 1-1,3 (SD 0,8-1,4); ve 4. skupineÏ
14-15 let byl pruÊmeÏr 1,5 (SD 1,3-2,3); v 5. skupineÏ 16
a võÂce let byla ztraÂta kosti v pruÊmeÏru 1,6-2,1 mm (SD
1,1-1,4) (Tab. 2).
Statisticky signifikantnõÂ zmeÏna byla nalezena mezi
1. a 5. veÏkovou skupinou (p = 0,005) (Obr. 7, 8) a mezi
2., resp. 3. a 5.veÏkovou skupinou (p = 0,006).
Infraokluze docÏasnyÂch molaÂruÊ u jednotlivyÂch veÏkovyÂch skupin:
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Obr. 6. Resorpce korÏenuÊ u veÏkovyÂch skupin
Fig. 6. Root resorption in age groups
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Tab. 1. Resorpce korÏenuÊ druheÂho docÏasneÂho molaÂru. StupneÏ resorpce podle Bjerklina a Bennetta
Tab. 1. Root resorption of second deciduous molar. Degrees of resorption according to Bjerklin a Bennett
Ve veÏkove skupineÏ 7 - 9 let byla infraokluze v pruÊmeÏru 0 (SD 0,8); ve skupineÏ 10 - 11 let byl pruÊmeÏr infraokluze 0 (SD 0,9 a 1,6); ve skupineÏ 12 - 13 let byl pruÊmeÏr infraokluze 0 (SD 1,4); ve skupineÏ 14 - 15 let byl
pruÊmeÏr infraokluze 0 a 1,1 (SD 2,4); ve skupineÏ 16 a võÂce
let byla infraokluze v pruÊmeÏru 0,2 a 1(SD 1,5 a 1,9).
Infraokluze perzistujõÂcõÂch docÏasnyÂch molaÂruÊ u 79letyÂch deÏtõÂ je signifikantneÏ mensÏõÂ nezÏ u pacientuÊ nad
16 let (p=0,005) (Obr. 9,10).
66
Infraocclusion of persisting primary molars in Group
1 is significantly less than in patients over 16 years of
age (p=0.005) (Fig.9, 10).
Distance between first premolar and first permanent
molar according the age:
Correlation analysis was performed by calculation of
Spearman correlation coefficients. With higher age of
a patient the distance between left premolar and first permanent molar is significantly shorter (r = 0.234; p = 0.011).
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Tab.2. UÂrovenÏ kosti u perzistujõÂcõÂho docÏasneÂho molaÂru (ztraÂta v mm)
Tab. 2. Bone loss (in mm) at persisting primary molar
VzdaÂlenost mezi prvnõÂm premolaÂrem a prvnõÂm staÂlyÂm molaÂrem podle veÏku:
KorelacÏnõÂ analyÂza byla provedena vyÂpocÏtem SpearmanovyÂch korelacÏnõÂch koeficientuÊ.
Se zvysÏujõÂcõÂm se veÏkem pacienta se signifikantneÏ
zmensÏuje vzdaÂlenost mezi levyÂm premolaÂrem a prvnõÂm
staÂlyÂm molaÂrem (r = 0,234; p = 0,011).
VzdaÂlenost mezi prvnõÂm premolaÂrem a prvnõÂm staÂlyÂm
molaÂrem vzhledem k infraokluzi docÏasneÂho molaÂru:
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Distance between first premolar and first permanent
molar related to infraocclusion of primary molar:
With increasing infraocclusion of a persisting primary molar, the distance between first premolar and
first permanent molar decreases (r = 0.239; p = 0.01).
Inclination of permanent teeth related to infraocclusion:
Increased infraocclusion of persisting primary molars
results in the increased inclination of first lower premolars and permanent molars (r = 0.355; p = 0.0001).
67
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Obr. 7. ZtraÂta kosti u pravyÂch docÏasnyÂch molaÂruÊ podle veÏku pacientuÊ
Fig. 7. Bone loss in right deciduous molars according the age of patients
Obr. 8. ZtraÂta kosti u levyÂch docÏasnyÂch molaÂruÊ podle veÏku pacientuÊ
Fig. 8. Bone loss in left deciduous molars according the age of patients
Obr. 9. Infraokluze u pravyÂch docÏasnyÂch molaÂruÊ podle veÏku pacientuÊ
Fig. 9. Infraocclusion in right deciduous molars according the age
Obr. 10. Infraokluze u levyÂch docÏasnyÂch molaÂruÊ podle veÏku pacientuÊ
Fig. 10. Infraocclusion in left deciduous molars according the age
Se zveÏtsÏujõÂcõÂ se infraokluzõÂ perzistujõÂcõÂho docÏasneÂho
molaÂru se zmensÏuje vzdaÂlenost mezi prvnõÂm premolaÂrem a prvnõÂm staÂlyÂm molaÂrem (r = 0,239; p = 0,01).
Inclination of permanent dentition related to reinclusion:
Sklon staÂlyÂch zubuÊ vzhledem k infraokluzi:
VeÏtsÏõÂ infraokluze perzistujõÂcõÂch docÏasnyÂch molaÂruÊ
vede k veÏtsÏõÂmu sklonu prvnõÂch dolnõÂch premolaÂruÊ a staÂlyÂch molaÂruÊ (r = 0,355; p = 0,0001).
ZaÂvislost sklonu staÂlyÂch zubuÊ podle skupin:
PrÏi srovnaÂnõÂ sklonu staÂlyÂch zubuÊ u pacientuÊ skupiny
A (s ankyloÂzou) oproti pacientuÊm skupiny B (bez ankyloÂzy) byly prokaÂzaÂny signifikantnõÂ rozdõÂly (p=0,0003).
PruÊmeÏrna hodnota uÂhluÊ mezi pravyÂm docÏasnyÂm molaÂrem, staÂlyÂm molaÂrem a premolaÂrem (11°) byla signifikantneÏ vysÏsÏõ u skupiny pacientuÊ A (s ankyloÂzou) nezÏ
skupiny B (bez ankyloÂzy) (6° a 8°).
68
Testing proved significant differences (p=0.0003).
Mean value of angles between the right primary molar,
permanent molar and premolar (11°) was significantly
higher in patients A (with ankylosis) than in patients B
(without ankylosis) (6°and 8°).
Discussion
The aim of the study was to monitor the factors affecting retention of persisting primary molars in patients with agenesis of the permanent teeth.
Resorption is a physiological process. Roots are
protected against resorption with a thin layer of periodontium with collagenous fibres, fibroblasts and cewww.orthodont-cz.cz e-mail: [email protected]
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Diskuse
CõÂlem studie bylo sledovat faktory, ktere mohou
ovlivnit retenci perzistujõÂcõÂch docÏasnyÂch molaÂruÊ u pacientuÊ s agenezõÂ staÂlyÂch naÂstupcuÊ.
Resorpce je fyziologicky proces. KorÏeny jsou chraÂneÏny proti resorpci uÂzkou vrstvou periodoncia kde jsou
kolagennõÂ vlaÂkna, fibroblasty a cementoblasty. OdbouraÂnõÂ periodoncia je hlavnõÂm krokem v iniciaci procesu resorpce [9].
ResorpcõÂ korÏenuÊ docÏasnyÂch molaÂruÊ se zabyÂvali
mimo jine Kurol s Thilanderovou. Dle jejich studie docÏasne molaÂry s agenezõ staÂlyÂch zubuÊ vykazujõ velmi pomalou resorpci korÏenuÊ, s tendencõ zpomalenõ u deÏtõÂ
starsÏõÂch 13 let [7]. U nasÏeho souboru se objevujõÂ pokrocÏilejsÏõÂ resorpcÏnõÂ stupneÏ u pacientuÊ ve veÏku 12-15 let.
Ve skupineÏ starsÏõÂch pacientuÊ, po 16. roku veÏku, zuÊstaÂvajõÂ resorpcÏnõÂ stupneÏ nezmeÏneÏny.
Infraokluze docÏasnyÂch molaÂruÊ muÊzÏe mõÂt vliv na rozvoj alveolaÂrnõ kosti, s nizÏsÏõ vyÂsÏkou kosti obklopujõÂcõ docÏasny molaÂr v infraokluzi [7]. Infraokluze postihuje prÏevaÂzÏneÏ docÏasne molaÂry v dolnõÂm zubnõÂm oblouku s vyÂskytem mezi 8 a 14% u 6-11letyÂch deÏtõ [10]. Kurol
a Thilanderova provedli studii, ktera dlouhodobeÏ sledovala 20 docÏasnyÂch molaÂruÊ - 18 dolnõÂch, 2 hornõÂ
s agenezõÂ staÂlyÂch premolaÂruÊ. Byla nalezena pocÏaÂtecÏnõÂ
infraokluze od 1,3 do 4,6 mm (2,7 mm). PruÊmeÏrny veÏk
prvnõÂho meÏrÏenõÂ byl 10,9 let. Progrese infraokluze byla
pozorovaÂna v kazÏdeÂm veÏku, ale pomalejsÏõ byla u starsÏõÂch deÏtõÂ. PruÊmeÏrne kazÏdorocÏnõ zanorÏenõ bylo 0,5 mm ±
0,26 mm [7].
NasÏe studie sledovala 5 veÏkovyÂch skupin pacientuÊ.
Infraokluze perzistujõÂcõÂch docÏasnyÂch molaÂruÊ u 7-9letyÂch a 10-11letyÂch deÏtõÂ je signifikantneÏ nizÏsÏõÂ nezÏ u 1415letyÂch. PruÊmeÏrneÏ se infraokluze zveÏtsÏila o 0,6 mm za
rok.
Infraokluzõ docÏasneÂho molaÂru vznika rÏada komplikacõ - sklon sousednõÂch zubuÊ, nedostatek mõÂsta v zubnõÂm oblouku, supraokluze antagonistuÊ. DalsÏõÂm rizikem
muÊzÏe byÂt uÂbytek marginaÂlnõ cÏaÂsti alveolaÂrnõ kosti sledujõÂcõ cemento-sklovinne spojenõ zubu v infraokluzi
a pokracÏujõÂcõÂ zanorÏovaÂnõÂ [11]. VyÂsledky potvrzujõÂ, zÏe
se zveÏtsÏujõÂcõÂ se infraokluzõÂ dochaÂzõÂ k veÏtsÏõÂmu sklonu
sousednõÂch zubuÊ. DocÏasny molaÂr je cÏasto spojen s ankyloÂzou, cozÏ znamena vytvorÏenõ kostnõ jednotky mezi
zubem a alveolaÂrnõÂ kostõÂ [12]. Podle Biedermana maÂ
vyÂznam pro vznik porucha lokaÂlnõÂho metabolismu,
nebo rozvoj trhliny v periodontaÂlnõÂ membraÂneÏ. Porucha metabolismu vede k obliteraci ligament a naÂsledneÏ
uzavrÏenõ kontaktu mezi kostõ a zubnõ strukturou spojenõÂm [13]. DocÏasne molaÂry s ankyloÂzou zuÊstaÂvajõ v infraokluzi nemeÏnneÂ, okolnõ zuby se pohybujõ vertikaÂlneÏ
s ruÊstem alveolaÂrnõÂho vyÂbeÏzÏku, dochaÂzõÂ tak k reinkluzi
docÏasneÂho molaÂru a muÊzÏe se vyskytnout kdykoliv beÏhem prorÏezaÂvaÂnõÂ [7]. Kurol a Magnusson provedli hiwww.orthodont-cz.cz e-mail: [email protected]
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mentoblasts. Elimination of periodontium triggers the
resorption [9].
Resorption of primary molar roots was studied by
Kurol and Thilander. They stated that primary molars
with agenesis of their permanent successors show
a very slow root resorption which further slows down
in patients over 13 years of age [7]. In our sample the
higher degrees of resorption were recorded in patients
between 12 and 15 years of age. In the group of older
patients (over 16 years), the degrees of resorption tend
to remain stable.
Infraocclusion of primary molars may affect the development of alveolar bone resulting in the lower
height of the bone surrounding primary molar in infraocclusion [7]. Infraocclusion affects especially primary molars in the lower dental arch, the prevalence
in children of the age between 6 and 11 is 8-14%
[10]. Kurol and Thilander performed the longitudinal
study of 20 primary molars (18 lower, 2 upper) with missing permanent premolars. They recorded initial infraocclusion from 1.3 to 4.6 mm (2.7 mm). The mean
age of patients during the first measurement was
10.9 years. Progressing infraocclusion was recorded
in any age, however, it was slower in older children.
Mean annual burrow was 0.5 mm ± 0.26 mm [7].
Our study followed 5 age groups of patients. Infraocclusion of persisting primary molars was significantly lower in Group 1 and 2 than in Group 4. The mean
increase of infraocclusion per year was by 0.6 mm.
Infraocclusion of primary molar results in a number
of complications: inclination of adjacent teeth, lack of
space in dental arch, supraocclusion of antagonists.
Another risk is represented by the loss of marginal portion of the alveolar bone that copies cement-enamel
junction of a tooth in infraocclusion, and the following
burrow [11]. The results prove that increasing infraocclusion leads to greater inclination of adjacent teeth. Primary molar is often associated with ankylosis, that is
the creation of a bone connection between the tooth
and alveolar bone [12]. Biederman believes the reason
for this is to be sought in the disorder of local metabolism, or the developing fissure in periodontal membrane. The metabolic disorder results in ligament obliteration and the consequent closure of the contact
between the bone and the tooth structure [13]. Primary
molars with ankylosis remain stable in infraocclusion,
adjacent teeth move vertically with the growth of alveolar process, which leads to reinclusion of primary
molar any time during eruption [7]. Kurol and Magnusson carried out a histological study of 102 primary molars; 62 teeth were in infraocclusion, 40 teeth in standard position. Ankylosis was best manifested in infraoccluded teeth, while in the other teeth it was not
found [14]. This corresponds to the results of our study
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stologickou studii na 102 docÏasnyÂch molaÂrech, 62
zubuÊ bylo v infraokluzi, 40 v normaÂlnõÂm postavenõÂ. AnkyloÂza byla nejvõÂce prokazatelna u zubuÊ v infraokluzi,
zatõÂmco u ostatnõÂch nebyla nalezena [14]. To koresponduje s nasÏõÂ studiõÂ, kde byla infraokluze docÏasneÂho
molaÂru u 44 z celkoveÂho pocÏtu 164 pacientuÊ. Infraokluze u pacientuÊ s ankyloÂzou byla vyÂznamneÏ veÏtsÏõÂ
nezÏ u pacientuÊ bez ankyloÂzy (ankyloÂza byla zjisÏteÏna
na druheÂm OPG, zhotoveneÂm po 2 letech).
Mancini a kol. sledovali docÏasne molaÂry v infraokluzi, s klinickyÂmi a rtg. znaÂmkami ankyloÂzy. KorÏeny jevily znaÂmky pokracÏujõÂcõÂch resorpcÏnõÂch a reparacÏnõÂch
procesuÊ cementu, ktery splynul s jednoduchou lamelaÂrnõ nebo osteotonickou kostõÂ. VyÂsledky ukazujõÂ, zÏe
ankyloÂza docÏasneÂho molaÂru muÊzÏe byÂt vyÂsledkem poruch resorpce korÏene, kdy reparacÏnõÂ procesy prÏevlaÂdajõÂ nad resorpcÏnõÂmi a to vede k nadmeÏrneÂmu uklaÂdaÂnõÂ
kosti [17]. SledovaÂnõÂm uÂrovneÏ resorpce korÏenuÊ docÏasnyÂch molaÂruÊ jsme zjistili, zÏe u skupiny pacientuÊ bez ankyloÂzy docÏasnyÂch molaÂruÊ je signifikantneÏ vysÏsÏõÂ stupenÏ
resorpce korÏenuÊ nezÏ u pacientuÊ s ankyloÂzou.
Vlivem infraokluze bylo zaznamenaÂno narusÏenõÂ
marginaÂlnõÂ cÏaÂsti okolnõÂ alveolaÂrnõÂ kosti. Aby se zabraÂnilo teÏmto komplikacõÂm doporucÏovala rÏada autoruÊ
extrakci docÏasneÂho molaÂru [13, 15]. Na druhe straneÏ
Kurol s Kochem dosÏli k zaÂveÏru, zÏe extrakce nenõÂ
u kazÏde docÏasneÂho molaÂru v infraokluzi nutna [16].
ZtraÂta marginaÂlnõÂ cÏaÂsti alveolaÂrnõÂ kosti u docÏasnyÂch
molaÂruÊ byla porovnaÂvaÂna s veÏkem pacientuÊ. Byla zjisÏteÏna signifikantnõÂ zaÂvislost mezi veÏkem pacienta
a uÂbytkem kosti na meziaÂlnõÂ i distaÂlnõÂ straneÏ docÏasneÂho
molaÂru. Korelace vzhledem k zjisÏteÏnyÂm hodnotaÂm je
slabaÂ. Z vyÂsledkuÊ vyplyÂva i statisticka vyÂznamnost
mezi ztraÂtou marginaÂlnõÂ kosti a resorpcõÂ korÏenuÊ docÏasnyÂch molaÂruÊ. U pacientuÊ se zvyÂsÏenou ztraÂtou kosti nachaÂzõÂme vysÏsÏõÂ stupneÏ resorpce.
ZaÂveÏr
1. U deÏtõÂ do 15let dochaÂzõÂ ke zhorsÏenõÂ resorpce korÏenuÊ perzistujõÂcõÂch docÏasnyÂch molaÂruÊ. U starsÏõÂch pacientuÊ jsou resorpcÏnõÂ stupneÏ nezmeÏneÏny.
2. PerzistujõÂcõ docÏasne molaÂry bez ankyloÂzy majõÂ
vysÏsÏõÂ stupenÏ resorpce korÏenuÊ, nezÏ molaÂry s ankyloÂzou.
3. Byla prokaÂzaÂna statisticky vyÂznamna ztraÂta kosti
docÏasnyÂch molaÂruÊ u pacientuÊ vysÏsÏõÂho veÏku nezÏ u 911letyÂch deÏtõÂ.
4. Infraokluze perzistujõÂcõÂch docÏasnyÂch molaÂruÊ je
u 7-9letyÂch deÏtõÂ signifikantneÏ nizÏsÏõÂ nezÏ u 15letyÂch.
5. Se zvysÏujõÂcõÂm se veÏkem pacienta se zmensÏuje
vzdaÂlenost mezi prvnõÂm premolaÂrem a prvnõÂm staÂlyÂm
molaÂrem.
6. VeÏtsÏõÂ infraokluze perzistujõÂcõÂch docÏasnyÂch molaÂruÊ
vede k veÏtsÏõÂmu sklonu prvnõÂch dolnõÂch premolaÂruÊ a staÂlyÂch molaÂruÊ.
70
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- there was infraocclusion of primary molar in 44 out of
164 patients. In patients with ankylosis the infraocclusion was significantly more frequent than in patients
without ankylosis. Infraocclusion in patients with ankylosis was considerably more pronounced than in patients without ankylosis (ankylosis registered in the second OPG, after 2 years).
Mancini et al. monitored primary molar in infraocclusion with clinical and OPG symptoms of ankylosis.
Roots showed progressing resorption and reparation
processes in cement which merged either with single
lamelar or ostheotonic bone. The results suggest that
primary molar ankylosis may be the result of root resorption disorder, when reparation processes prevail
over resorption processes, which results in extensive
bone deposition [17]. We followed the degree of primary molar root resorption and found out that in the
group of patients without ankylosis of primary molars
the degree of root resorption is significantly higher
than in patients with ankylosis.
Infraocclusion disturbed marginal part of surrounding
alveolar bone. To avoid these complications, a number
of authors recommended extraction of primary molar
[13,15]. On the contrary, Kurol and Koch conclude that
extraction is not necessary in each primary molar in infraocclusion [16]. Loss of marginal part of alveolar bone
in primary molars was compared with the age of patients.
There was found a significant relationship between the
age of patients and the loss of bone in both mesial and
distal side of primary molar. However, with regard to
the values obtained, the correlation is not conclusive.
The results also suggest statistical significance between
the loss of marginal bone and root resorption of primary
molars. In patients with increased loss of bone there are
found higher degrees of resorption.
Conclusion
1. In children up to 15 resorption of persisting primary molar roots tends to worsen. In older patients
the degree of resorption remains unchanged.
2. Persisting primary molars without reinclusion
show higher degree of root resorption compared to
molars with ankylosis.
3. There was proved statistically significant loss of
bone in primary molars in older patients than in children between 9 and 11 years of age.
4. In children of 7-9 years of age the infraocclusion
of persisting primary molars is significantly lower than
in children of the age of 15.
5. The older the patient the smaller the distance between first premolar and first permanent molar.
6. Increased infraocclusion of persisting primary
molars leads to greater inclination of first lower premolars and permanent molars.
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7. U dolnõÂch docÏasnyÂch molaÂruÊ s reinkluzõÂ byly nalezeny signifikantneÏ vysÏsÏõÂ uÂhly mezi prvnõÂm dolnõÂm premolaÂrem a prvnõÂm staÂlyÂm molaÂrem.
7. In lower primary molars with reinclusion significantly higher angles between the first lower premolar
and first permanent molar were recorded.
AutorÏi nemajõ komercÏnõÂ, vlastnicke nebo financÏnõ zaÂjmy na produktech nebo spolecÏnostech popsanyÂch v tomto cÏlaÂnku.
Authors have no commercial, proprietary or financial interest in
products or companies mentioned in the article.
Literatura/ References:
1. Slavkin, H. C.: Entering the era of molecular dentistry.
J. Amer. Dent. Assoc 1999, 130, s. 413-417.
2. Graber, L. W.: Congenital absence of teeth: a review with
emphasis on inheritance patterns. J. Amer. Dent. Assoc.
1987, 96, s. 266-275.
3. BergstroÈm, K.: An orthopantomographic study of hypodontia, supernumeraries and other anomalies in school
children between the ages of 8-9 years. Swed. Dent. J.
1977, 1, s. 145-157.
4. Rolling, S.: Hypodontia of permanent teeth in Danish
schoolchildren. Scand. J. Dent. Res. 1980, 88, s. 365-369
5. Thilander, B., Myrberg, N.: The prevalence of malocclusion in Swedish schoolchildren. Scan. J. Dent. Res.
1973, 81, s. 12-20.
6. Wist, P. J. et al.: Frequency of hypodontia in relation to
tooth size and dental arch with. Acta Odontol. Scand.
1974, 32, s. 201-206.
7. Kurol, J., Thilander, B.: Infraocclusion of Primary Molars
with Aplasia of the Permanent Successor. A longitudinal
study. Angle Orthodont. 1984,54, s. 283-294.
8. Bjerklin, K., Bennett, J.: The long-term survival of lower
second primary molars in subject with agenesis of the premolars. Eur. J. Orthodont. 2000,22, s. 245-255.
9. Rygh, P.: Orthodontic root resorption studied by electron
microscopy. Angle Orthodont. 1977, 47, s. 1-16.
10. Kurol, J.: Infraocclusion of primary molars: an epidemiologic and familial study. Community Dent. Oral Epidemiol. 1981, 2, s. 94-102.
11. Sidhu, H. K., Ali, A.: Hypodontia, ankylosis and infraocclusion: report of a case restored with a fibre-reinforced
ceromeric bridge. British Dental Journal. 2001, 11, Vol.
191, s. 613-616.
12. Kurol, J., Thilander, B.: Infraocclusion of primary molars
and effect on occlusal development, a longitudinal
study. Eur. J. Orthodont. 1984, 6, s. 277-293.
13. Biederman, W.: Etiology and treatment of tooth ankylosis. Amer. J. Orthodont. 1962, 48, s. 670-684.
14. Kurol, J., Magnusson, B. C.: Infraocclusion of primary
molars: a histologic study. Scand. J. Dent. Res. 1984,
6, s. 564-576.
15. Krakowiak, F. J.: Ankylosed primary molars. ASDC
J. Dent. Child. 1978, 45, s. 288-292.
16. Kurol, J., Koch, G.: The effect of extraction of infraoccluded primary molars. A longitudinal study. Amer. J. Orthodont. 1985, 87, cÏ. 1, s. 46-55.
17. Mancini, G., et al.: Primary tooth ankylosis: report of case
with histological analysis. ASDC J. Dent. Child. 1965, 62,
s. 215-219.
MUDr. PavlõÂna AdamkovaÂ
Klinika zubnõÂho leÂkarÏstvõÂ LF UP
PalackeÂho 12, 772 00 Olomouc
CÏlensky poplatek pro rok 2012 cÏinõ 1500,- KcÏ nebo 65,- EUR.
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RegistracÏnõÂ polatek cÏinõÂ 500,- KcÏ nebo 20,- EUR.
PrÏedplatne cÏasopisu Ortodoncie pro necÏleny CÏOS je 1000,- KcÏ za rok nebo 40,- EUR.
UÂhrada poplatku do 28. 2. 2012, cÏ. uÂ.: 32932021/0100, konst. symbol: 0558, variab. symbol: rodne cÏõÂslo.
PrÏi nezaplacenõÂ prÏõÂspeÏvkuÊ po dvou põÂsemnyÂch urgencõÂch bude ukoncÏeno cÏlenstvõÂ v CÏOS.
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Estetika profilu oblicÏeje u dospeÏleÂho pacienta
s anomaÂliõÂ Angle II, 1. oddeÏlenõÂ; zmeÏny po chirurgickeÂ
a ortodonticke leÂcÏbeÏ
Esthetics of facial profile in adult patients with Class II,
Division 1. Changes in orthognathic surgery
and orthodontic treatment
*MUDr. Jana FendrychovaÂ, *MUDr. Petra HofmanovaÂ, **RNDr. Lenka KomaÂrkovaÂ, Ph.D.
*Ortodonticke oddeÏlenõ DeÏtske stomatologicke kliniky FN v Motole, Praha
**Katedra managementu informacõÂ, Fakulta managementu, JindrÏichuÊv Hradec
Souhrn
CõÂlem studie bylo zjistit, jak vnõÂmajõ laici a ortodontiste profil oblicÏeje pacienta s anomaÂliõ II. trÏÂõdy, 1. oddeÏlenõÂ
podle Anglea a jeho zmeÏny po ortodonticke a ortodonticko-chirurgicke terapii. DotaznõÂkova studie obsahovala
dva soubory dotaznõÂkuÊ: 130 kusuÊ dotaznõÂkuÊ od laikuÊ, z toho 78 zÏen a 58 muzÏuÊ a 93 dotaznõÂkuÊ od ortodontistuÊ,
58 zÏen, 35 muzÏuÊ.
RespondentuÊm byly k hodnocenõÂ prÏedklaÂdaÂny dva typy profiluÊ, profil muzÏe a profil zÏeny nizÏsÏÂõho strÏednõÂho veÏku.
PosuzovaÂny byly trÏi kategorie profiluÊ: profil neleÂcÏeneÂho jedince, profil pacienta leÂcÏeneÂho ortodontickou kompenzacõÂ (extrakcÏneÏ), profil pacienta leÂcÏeneÂho ortodonticko-chirurgicky (prÏedsunutõÂm dolnõÂ cÏelisti) (Ortodoncie 2012, 21,
cÏ. 2, s. 73-83).
Abstract
The perception (of laymen and orthodontists) of facial profile in a patient with Class II, Division 1, and of the
changes due to orthognathic surgery and orthodontic treatment were studied. The questionnaire study consisted of two sets of questionnaires: 130 pcs filled in by laymen (78 women and 58 men), and 93 questionnaires
filled in by orthodontists (58 women and 35 men).
Respondents evaluated two types of a profile - a male and a female profile, of a person in his/her early middle
age. Three categories of profile were evaluated: a profile of an individual that did not undergo any treatment, a profile of a patient treated with orthodontic compensation (involving extractions), and a profile of a patient treated
with orthodontic-surgical treatment (with mandible advancement) (Ortodoncie 2012, 21, No. 2, p. 73-83).
KlõÂcÏova slova: AnomaÂlie II. trÏÂõdy, 1. oddeÏlenõ podle Anglea; dospeÏly pacient; profil oblicÏeje
Key words: Class II, Division 1; adult patients; face profile
UÂvod
Jednou z nejcÏasteÏji se vyskytujõÂcõÂch ortodontickyÂch
anomaÂliõ nasÏõ populace je protruznõ vada spojena s distookluzõÂ, tedy anomaÂlie II. trÏõÂdy, 1. oddeÏlenõ podle
Anglea [1].
Do ortodontickyÂch praxõÂ prÏichaÂzõÂ s touto anomaÂliõÂ
pacienti ruÊznyÂch veÏkovyÂch skupin, ale oproti drÏõÂveÏjsÏõÂm
www.orthodont-cz.cz e-mail: [email protected]
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Introduction
Distoocclusion with protrusion of upper incisors, i.e.
Class II, Division 1, is one of the most frequent orthodontic anomalies found in our population [1].
Patients belonging to different age groups come to
seek treatment, however, in comparison with earlier times, we can see an increase in the number of adult pa73
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dobaÂm byl v poslednõÂch dvou desetiletõÂch zaznamenaÂn naÂruÊst pocÏtu dospeÏlyÂch pacientuÊ. Kokich [2] uvaÂdõÂ,
zÏe procentuaÂlnõÂ zastoupenõÂ pacientuÊ starsÏõÂch 25 let se
pohybuje v rozmezõÂ 30-40%.
Za dospeÏleÂho pacienta je v ortodoncii oznacÏovaÂn
jedinec, jenzÏ ukoncÏil veÏtsÏinu sveÂho teÏlesneÂho ruÊstu,
k cÏemuzÏ obvykle dochaÂzõ ve veÏku 18 let a vyÂsÏe [3]. Williams [4] posouva hranici ukoncÏenõ teÏlesneÂho ruÊstu
u zÏen do veÏku 21 let a u muzÏuÊ do veÏku 25 let. HlavnõÂm
faktorem ovlivnÏujõÂcõÂm naÂruÊst pocÏtu leÂcÏenyÂch dospeÏlyÂch pacientuÊ jsou psychosociaÂlnõ vlivy dnesÏnõ spolecÏnosti. Pacienti si staÂle võÂce uveÏdomujõÂ, jake vyÂhody jim
muÊzÏe prÏineÂst hezky uÂsmeÏv a harmonicky puÊsobõÂcõ oblicÏej [5]. CÏasto praÂveÏ z duÊvodu touhy po lepsÏõ estetice
jsou ortodontiste konfrontovaÂni s pozÏadavkem dospeÏlyÂch pacientuÊ jejich anomaÂlie korigovat.
V prÏõÂpadeÏ leÂcÏby dospeÏlyÂch pacientuÊ s protruznõ vadou se velmi ruÊznõ naÂzory odbornõÂkuÊ na to, zda je vhodneÏjsÏõ leÂcÏba ortodonticka nebo ortodonticko-chirurgickaÂ. Obvyklou oblastõ sporu byÂva diskuse na teÂma
vyÂsledne poleÂcÏebne estetiky profilu oblicÏeje u ¹propagovaneª metody leÂcÏby. DuÊlezÏityÂm aspektem prÏi teÏchto
debataÂch je dodnes ne zcela objasneÏna otaÂzka vnõÂmaÂnõ neleÂcÏenyÂch a leÂcÏenyÂch profiluÊ s protruznõ vadou
laickou verÏejnostõÂ.
MateriaÂl a metodika
Soubor tvorÏily dotaznõÂky prÏedklaÂdane laikuÊm a ortodontistuÊm. DotaznõÂky byly rozdeÏleny do dvou skupin,
skupiny s zÏenskyÂm a muzÏskyÂm profilem oblicÏeje.
KazÏda z teÏchto skupin zahrnovala trÏi varianty profiluÊ:
nativnõÂ fotografii, simulaci chirurgickeÂho rÏesÏenõÂ a simulaci nechirurgickeÂho rÏesÏenõÂ (Obr. 1).
DotaznõÂky byly distribuovaÂny do rÏad laicke verÏejnosti a rÏad specialistuÊ v oboru ortodoncie. Celkem bylo
zõÂskaÂno 130 dotaznõÂkuÊ z rÏad laikuÊ. Z tohoto souboru
bylo 52 dotaznõÂkuÊ hodnoceno muzÏi a 78 dotaznõÂkuÊ zÏenami. PruÊmeÏrny veÏk respondentuÊ - laikuÊ byl 38,5 let.
Ortodontiste odevzdali celkem 93 dotaznõÂkuÊ, prÏicÏemzÏ
35 dotaznõÂkuÊ hodnotili muzÏi, 58 zÏeny. PruÊmeÏrny veÏk respondentuÊ - ortodontistuÊ cÏinil 39,8 let.
Do rÏad laikuÊ byly dotaznõÂky rozdaÂvaÂny v pruÊbeÏhu
prvnõÂch trÏõÂ cÏtvrtletõÂ roku 2011 (leden - zaÂrÏõÂ 2011). Respondenti - laici nebyli prÏed vyplneÏnõÂm dotaznõÂkuÊ seznamovaÂni se zaÂmeÏrem tohoto sÏetrÏenõÂ. Nebyli poucÏeni
o ortodonticke specifikaci anomaÂlie ani mozÏnostech
jejõÂ leÂcÏby. VyÂbeÏr respondentuÊ nebyl limitovaÂn pohlavõÂm
ani dosazÏenyÂm vzdeÏlaÂnõÂm. JedinyÂm limitem omezujõÂcõÂm volbu respondentuÊ byla veÏkova hranice 21 let,
aby byl zajisÏteÏn racionaÂlneÏjsÏõÂ prÏõÂstup k dotaznõÂkoveÂmu
sÏetrÏenõÂ. DotaznõÂky byly distribuovaÂny mezi jedince
laicke verÏejnosti, kterÏõ nemeÏli medicõÂnske vzdeÏlaÂnõÂ.
Do rÏad specialistuÊ byly dotaznõÂky rozdaÂvaÂny v pruÊbeÏhu hlavnõÂho programu prÏednaÂsÏek XII. kongresu CÏe74
ORTODONCIE
tients during the last two decades. Kokich [2] reports
that patients over 25 years of age make about 30-40%.
In orthodontics, an adult patient is an individual with
almost finished physical growth, which comes usually
of or around the age of 18 [3]. Williams [4] sees the finished growth in women at the age of 21, and in men at
the age of 25. The main factor leading to the increase
in the number of adult patients is probably the psycho-social impact of the current society. Patients become more aware of the fact that they can benefit from
a pretty smile and a graceful face [5]. This is one of the
major reasons adult patients come to an orthodontic
practice and seek a solution to their malocclusion.
There are different views on the treatment of adults
with protrusion of upper incisors; the question resides
in that, whether the best choice is orthodontic therapy
or combined orthodontic-orthognathic intervention.
There is still an open debate on the resulting esthetics
of face profile. One of the aspects discussed is the lay
public perception of treated and non-treated profiles
with protrusion of upper teeth.
Material and method
The sample consisted in questionnaires for laymen
and orthodontists. Questionnaires were divided into
two groups - one with a female face profile, another
with a male face profile. Each of the groups was further
subdivided according to three varieties of a profile: native photography, simulation of orthognathic surgery,
and simulation of non-surgical treatment (Fig.1).
Questionnaires were distributed among laymen and
experts-orthodontists. Laymen responded to 130
questionnaires; 52 filled in by men, 78 by women.
The mean age of respondents-laymen was 38.5 years.
Orthodontists responded to 93 questionnaires; 35 filled in by men, 58 by women. The mean age of respondents-orthodontists was 39.8 years.
Questionnaires were distributed among the public
from January to September 2011. The respondents laymen were not informed about the aim of the survey.
They were not instructed about orthodontic specifications of the malocclusion or about possible methods of
treatment. The choice of respondents was not limited
in terms of sex or the level of their education. The only
condition was the age of 21 years at least, in order to
ensure a more rational approach to the survey. Questionnaires were distributed among laymen without
medical training or education.
Questionnaires were distributed among orthodontists during the 12th Congress of the Czech Orthodontic Society held in Prague in 2011. Respondents orthodontists were not informed about the aims of
the survey.
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Obr. 1a - zÏensky profil s anomaÂliõ Angle II, 1.oddeÏlenõÂ, b - profil se simulacõ ortodonticko-chirurgicke leÂcÏby, c - profil se simulacõ kompenzacÏnõÂ
ortodonticke leÂcÏby
Fig. 1a - female profile with malocclusion Class II, Division 1, b - profile with simulation of orthodontic-surgical treatment, c - profile with
simulation of compensatory orthodontic treatment
Obr. 2a - muzÏsky profil s anomaÂliõ Angle II, 1. oddeÏlenõÂ, b - profil se simulacõ ortodonticko-chirurgicke leÂcÏby, c - profil se simulacõ kompenzacÏnõ ortodonticke leÂcÏby
Fig. 2a - male profile with malocclusion Class II, Division 1, b - profile with simulation of orthodontic-surgical treatment, c - profile with simulation of compensatory orthodontic treatment
ske ortodonticke spolecÏnosti roku 2011 v Praze. Respondenti - ortodontiste rovneÏzÏ nebyli prÏed vyplneÏnõÂm
dotaznõÂkuÊ seznamovaÂni se zaÂmeÏrem tohoto sÏetrÏenõÂ.
Byly vybraÂny dveÏ fotografie pacientuÊ nizÏsÏõÂho strÏednõÂho veÏku, jeden muzÏ a jedna zÏena, s anomaÂliõÂ II. trÏõÂdy,
1. oddeÏlenõÂ podle Anglea.
Nativnõ profilove snõÂmky muzÏe i zÏeny (Obr. 1a, 2a)
byly upraveny v programu Dolphin Imaging System.
Superimpozicõ nativnõ profilove fotografie s analyzovanyÂm kefalometrickyÂm snõÂmkem a naÂslednou simulacõÂ
ortodonticko-chirurgicke leÂcÏby byl vytvorÏen obraz vyÂsledku ortodonticko-chirurgicke leÂcÏby (Obr. 1b, 2b),
a to ortognaÂtnõÂ operace typu prÏedsunutõÂ dolnõÂ cÏelisti
(advancement) bez genioplastiky. TakteÂzÏ byla provedena simulace vyÂsledku kompenzacÏnõÂ ortodontickeÂ
leÂcÏby s extrakcemi dvou hornõÂch prvnõÂch premolaÂruÊ
a retrakcõÂ frontaÂlnõÂho uÂseku hornõÂho zubnõÂho oblouku
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Two photographs of patients in their early middle age
were chosen (one male, one female), with Class II, Division 1.
Native profile photos of a man and a woman (Fig. 1a,
2a) were adjusted with the software Dolphin Imaging
System. By superimposition of a native profile photograph with an analyzed cephalogram and the following
simulation of orthodontic-surgical treatment, the model image of the orthodontic-surgical treatment result
was created (Fig. 1b, 2b), i.e. orthognathic surgery advancement of the mandible without genioplasty.
The simulation of the result of compensatory orthodontic treatment with extraction of two upper first premolars and retraction of anterior part of the upper dental arch was done in similar way (Fig. 1c, 2c). Eyes were
hidden in all pictures.
75
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(Obr. 1c, 2c). Na obrazu oblicÏeje byla zakryta oblast
ocÏõÂ.
Soubor fotografiõÂ ve vyÂsledku sestaÂval z sÏesti typuÊ
profilu oblicÏeje, trÏõÂ typuÊ muzÏskeÂho a trÏõÂ typuÊ zÏenskeÂho
oblicÏeje. MuzÏsky a zÏensky profil byly zvlaÂsÏt' rozdeÏleny
na profily nativnõÂ, kompenzacÏnõ a chirurgicke (Obr. 1,
2).
KazÏdy respondent z tohoto souboru obdrzÏel k hodnocenõ jeden dotaznõÂk s muzÏskyÂm profilem a jeden dotaznõÂk s zÏenskyÂm profilem. Nebyl prÏedtõÂm poucÏen,
o kterou kategorii profilu se jednaÂ, aby nedochaÂzelo
k mozÏnosti ovlivneÏnõÂ jeho odpoveÏdõÂ.
DotaznõÂk obsahoval otaÂzku tyÂkajõÂcõÂ se hodnocenõÂ
celkove estetiky oblicÏeje prÏilozÏeneÂho profiloveÂho cÏernobõÂleÂho snõÂmku, bud' muzÏe nebo zÏeny. Respondent
meÏl na vzestupne jedenaÂctimõÂstne cÏõÂselne stupnici od
0 do 10 oznacÏit, jak by individuaÂlneÏ ohodnotil celkovyÂ
esteticky dojem z prÏedlozÏeneÂho profilu oblicÏeje. OdpoveÏdi na stupnici v rozsahu boduÊ 0 azÏ 4 byly naÂmi zarÏazeny do kategorie ¹profil esteticky nevyhovujõÂcõª. OdpoveÏdi na stupnici v rozsahu boduÊ 5 azÏ10 byly zarÏazeny jako ¹profil esteticky vyhovujõÂcõª. Byly
vyhodnocovaÂny odpoveÏdi laikuÊ a ortodontistuÊ, oddeÏleneÏ vzÏdy muzÏuÊ a zÏen. Byly hodnoceny reakce urcÏiteÂho
pohlavõ zvlaÂsÏt' na zÏensky profil a zvlaÂsÏt' na muzÏsky profil.
LeÂkarÏuÊm - ortodontistuÊm byla v raÂmci dotaznõÂku polozÏena zvlaÂsÏtnõ otaÂzka, tyÂkajõÂcõ se toho, jakyÂm zpuÊsobem ve sve praxi nejcÏasteÏji leÂcÏõ dospeÏleÂho pacienta
s anomaÂliõÂ II. trÏõÂdy,1. oddeÏlenõÂm podle Anglea, zda ortodontickou kompenzaci nebo ortognaÂtnõÂ chirurgii.
AnalyÂza odpoveÏdõÂ respondentuÊ byla provedena pomocõÂ volneÏ sÏirÏitelneÂho (GNU GPL licence) [26] statistickeÂho software R1 verze 2.13.1. VyÂsledky jsou uvaÂdeÏny
ve formeÏ absolutnõÂch, resp. relativnõÂch cÏetnostõÂ. Z duÊvodu maleÂho pocÏtu respondentuÊ pro jednotlive kombinace typu profilu, byla analyÂza cÏtyrÏpolnõÂch kontingencÏnõÂch tabulek provedena pomocõ Fisherova faktoriaÂloveÂho testu a pro veÏtsÏõ tabulky (2x3) bylo pouzÏito
zobecneÏnõÂ tohoto testu. TestovaÂnõÂ bylo provedeno na
5% hladineÏ vyÂznamnosti.
VyÂsledky
Celkem bylo laiky vyhodnoceno 130 dotaznõÂkuÊ.
Z tohoto souboru 52 dotaznõÂkuÊ hodnotili muzÏi a 78 dotaznõÂkuÊ hodnotily zÏeny. KazÏdy respondent obdrzÏel ke
zhodnocenõ jiny typ profilove fotografie. OrtodontisteÂ
odevzdali celkem 93 dotaznõÂkuÊ, prÏicÏemzÏ 35 dotaznõÂkuÊ
hodnotili muzÏi, 58 zÏeny.
Ze vsÏech typuÊ zÏenskeÂho profilu oblicÏeje respondenti - laici nejleÂpe hodnotili nativnõÂ typ zÏenskeÂho profilu. Z celkoveÂho pocÏtu 67 respondentuÊ - laikuÊ reagovalo kladneÏ 25 respondentuÊ. Ze vsÏech typuÊ muzÏskeÂho
profilu oblicÏeje byl respondenty - laiky nejleÂpe hodno76
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The set of photographs thus involved six types of
face profile - three male and three female faces. Male
and female profiles were further subdivided into native,
compensatory and surgical one (Fig.1, 2).
Each respondent - orthodontist was given one questionnaire with a male profile and one with a female
profile. They did not know which photograph represents which category.
In the questionnaire the question focused on the
overall face esthetics of the B/W photograph, either female or male. On the numerical scale (0-10), the respondent should give his/her esthetic impression. Responds from 0 to 4 pts. were in the category ¹unsatisfactory esthetics of a profileª; responds from 5 to 10
pts. were in the category ¹satisfactory esthetics of
a profileª. Responds by laymen and orthodontists, separately those given by men and those given by women, were evaluated. Responds of men and women
to female profiles and male profiles were evaluated separately.
Orthodontists were asked a specific question about
their usual way of treatment for patients with Class II,
Division 1. We wanted to know whether they prefer
orthodontic compensation or orthognathic surgery.
The analysis of responds was made by free version
(GNU GPL License) [26] of statistical software R1 version 2.13.1. Results are given as absolute abundance,
resp. empirical probability. Due to low numbers of respondents for individual combinations of profile type,
the analysis of 2x2 contingency tables was performed
with Fisher's factorial test, and for larger tables (2x3)
a modification of the test was used. Tests were made
on the level of significance 5%.
Results
Laymen evaluated 130 questionnaires (52 men, 78
women). Each respondent evaluated a different type
of a profile shot. Orthodontists evaluated 93 questionnaires (35 men, 58 women).
Respondents-laymen evaluated as the best female
profile the native one. From the overall number of 67 respondents, 25 reacted in a positive way. Respondents-laymen evaluated as the best male profile the
model simulating the condition after orthognathic surgery. From the overall number of 63 respondents, 25
reacted in a positive way.
Respondents-orthodontists evaluated as the best
female profile the native one and the model simulating
the condition after ortognathic surgery. From the overall number of 48 respondents, 18 reacted in a positive
way to the natural profile, and 18 to the orthognathic simulation. Out of 45 respondents-orthodontists 20
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cen chirurgicky muzÏsky profil. Z celkoveÂho pocÏtu 63
respondentuÊ - laikuÊ hodnotõÂcõÂch muzÏske profily, jej
kladneÏ ohodnotilo 25 respondentuÊ.
Ze vsÏech typuÊ zÏenskeÂho profilu oblicÏeje respondenti - ortodontiste nejleÂpe hodnotili nativnõ profil a chirurgicky typ profilu. 18 ortodontistuÊ z celkoveÂho pocÏtu
48 respondentuÊ - ortodontistuÊ ohodnotilo kladneÏ nativnõ zÏensky profil a stejneÏ tj. 18 ohodnotilo kladneÏ chirurgicky zÏensky profil. Z celkoveÂho pocÏtu 45 respondentuÊ - ortodontistuÊ ohodnotilo nejleÂpe tj. v pocÏtu
kladnyÂch odpoveÏdõ 20 chirurgicky muzÏsky profil.
ZÏeny - laici ze vsÏech typuÊ zÏenskeÂho profilu nejleÂpe
hodnotily nativnõ zÏensky profil, a sice v pocÏtu 18 ze
40. ZÏeny - ortodontistky nejleÂpe hodnotily chirurgickyÂ
zÏensky profil, a to v pocÏtu 12 z 29. Nativnõ zÏensky profil
ohodnotilo zÏeny - ortodontistky kladneÏ v 10-ti prÏõÂpadech.
MuzÏi - laici ohodnotili nejleÂpe nativnõ zÏensky profil,
a to v 7 prÏõÂpadech z celkoveÂho pocÏtu 27. MuzÏi - ortodontiste takteÂzÏ ohodnotili nejleÂpe tento typ zÏenskeÂho
profilu. Celkem jich kladneÏ reagovalo 8 z 19.
Bez ohledu na typ zÏenskeÂho profilu zÏeny-ortodontistky hodnotily muzÏsky profil cÏasteÏji kladneÏ nezÏ
zÏeny-laici, ktere se zuÂcÏastnily studie. NejveÏtsÏõ rozdõÂl
(22,1 %) v naÂzorech panoval u profilu po kompenzacÏnõÂ
ortodonticke leÂcÏbeÏ. NicmeÂneÏ ani v tomto prÏõÂpadeÏ nebyl
dany rozdõÂl statisticky vyÂznamnyÂ, p ­ 0,05.
ZÏeny-ortodontistky ohodnotily cÏasteÏji kladneÏ nezÏ
zÏeny-laici pouze muzÏsky profil po ortodonticko-chirurgicke leÂcÏbeÏ. Tento profil se lõÂbil vsÏem odbornicõÂm, ktereÂ
ho hodnotily. NejveÏtsÏõÂ rozdõÂl v proporcõÂch (19,2 %) byl
u nativnõÂho oblicÏejoveÂho profilu. FisherovyÂm exaktnõÂm
testem nelze prokaÂzat, zÏe rozdõÂly v naÂzorech na muzÏsky profil se lisÏõÂ.
VsÏem muzÏskyÂm ortodontistuÊm, kterÏõ posuzovali prÏõÂslusÏny snõÂmek, se lõÂbil (na stupnici 5-10) nativnõÂ, resp.
kompenzacÏnõÂ typ zÏenskeÂho profilu. U muzÏuÊ-laikuÊ tomu
tak nebylo. ZÏensky profil po kompenzacÏnõ ortodonticke leÂcÏbeÏ byl kladneÏ ohodnocen 60 % z nich. Profil
po ortodonticko-chirurgicke leÂcÏbeÏ byl cÏasteÏji ohodnocen na sÏkaÂle 5-10 muzÏskyÂmi laiky, konkreÂtneÏ 3/4 z teÏch,
co dotaznõÂk s danyÂm profilem obdrzÏeli. Ani v jednom
prÏõÂpadeÏ pozorovane rozdõÂly mezi muzÏi-laiky a odbornõÂky nejsou statisticky vyÂznamneÂ.
Naprosto ve stejneÂm pomeÏru 1:3 ohodnotili muzÏilaici a muzÏi-odbornõÂci muzÏsky profil po kompenzacÏnõÂ
ortodonticke leÂcÏbeÏ. Ve zbylyÂch dvou prÏõÂpadech profiluÊ
võÂce cÏasto kladneÏ reagovali na prezentovany snõÂmek
muzÏi-ortodontisteÂ. NejveÏtsÏõÂ rozdõÂl cÏinil 30,0 %, a to
u nativnõÂho typu profilu.
U zÏenskeÂho oblicÏeje meÏli cÏasteÏji respondenti-odbornõÂci pozitivnõÂ reakce na nativnõÂ a kompenzacÏnõÂ typ
profilu. KazÏdopaÂdneÏ pozorovane rozdõÂly prÏi daneÂm pocÏtu respondentuÊ nejsou statisticky vyÂznamneÂ.
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considered the male profile after ortognathic surgery
as the most esthetic one.
Women-laymen considered the female native profile as the best (18 out of 40). Women-orthodontists
considered the female profile after orthognathic surgery as the best (12 out of 29). 10 women-orthodontists preferred the female native profile.
Men-laymen considered the female native profile as
the best (7 out of 27). Men-orthodontists considered
the female native profile as the best (8 out of 19).
Women-orthodontists evaluated male profiles positively more often than women-laymen. The greatest
difference (22.1%) was in case of the profile simulating
the condition after compensation orthodontic therapy.
However, the difference was not statistically significant, p­0.05.
Women-orthodontists evaluated a male profile after
the combined surgical-orthodontic treatment positively more often than lay women. This profile was accepted by all experts who evaluated it. The greatest
difference was found in the evaluation of a native face
profile (19.2%). However, Fisher's exact test cannot
prove the difference in views of the male profile.
All men-orthodontists who evaluated a given photograph appreciated a native female profile, or a profile
after orthodontic compensation. It was different in lay
men. 60% of them appreciated a female profile after
orthodontic compensation. They also appreciated a female profile after combined surgical-orthodontic therapy (3/4 of those who evaluated the given photograph). However, the differences between men-laymen and experts are not statistically significant.
The same proportion, 1:3, showed the evaluation of
a male profile after orthodontic compensation treatment given by men-laymen and men-orthodontists.
The other two profiles were better appreciated by
men-orthodontists. The greatest difference - 30.0% was reported in case of a native profile.
In female facial profiles, respondents-orthodontists
appreciated a native profile and a profile after orthodontic compensation more often. However, the differences are not statistically significant due to the small
number of respondents.
The greatest difference (11.1%) between the evaluation given by orthodontists and laymen was recorded in the male profile after combined surgical-orthodontic therapy. Orthodontists did not evaluate the profile always positively. However, the difference between
laymen and experts was not statistically significant.
Out of 93 orthodontists who were asked about the
most frequent method of treatment in adult patients
with Angle Class II, Division 1, 72 responded that they
preferred orthodontic compensation therapy (47 women, 25 men). 21 orthodontists responded they prefer77
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NejveÏtsÏõÂ rozdõÂl (11,1 %) v hodnocenõÂ odbornõÂkuÊ
a laikuÊ byl u muzÏskeÂho profilu po ortodonticko-chirurgicke leÂcÏbeÏ. Zde odbornõÂci reagovali vzÏdy kladneÏ. Test
vsÏak neprokaÂzal ani v tomto prÏõÂpadeÏ rozdõÂl mezi laiky
a odbornõÂky.
Z 93 ortodontistuÊ, kteryÂm byla polozÏena otaÂzka, jak
nejcÏasteÏji leÂcÏõ dospeÏle pacienty s anomaÂliõ II. trÏõÂdy, 1.
oddeÏlenõÂ podle Anglea odpoveÏdeÏlo 72 ortodontistuÊ,
zÏe cÏasteÏji vadu rÏesÏõÂ ortodontickou kompenzacõÂ. Z tohoto pocÏtu bylo 47 respondentek zÏen a 25 respondentuÊ muzÏuÊ. 21 ortodontistuÊ odpoveÏdeÏlo, zÏe se cÏasteÏji
rozhodujõÂ pro ortodonticko-chirurgickou leÂcÏbu teÏchto
pacientuÊ. Tato skupina respondentuÊ sestaÂvala z 10
muzÏuÊ a 11 zÏen.
OrtodontisteÂ, jak muzÏi, tak i zÏeny cÏasteÏji volõÂ ve sveÂ
praxi ortodontickou kompenzaci pro dospeÏleÂho pacienta s anomaÂliõÂ II. trÏõÂdy, 1. oddeÏlenõÂm podle Anglea.
ZÏeny - ortodontistky sice tento leÂcÏebny postup volily
o zhruba 10 % cÏasteÏji nezÏ jejich muzÏske proteÏjsÏky.
Tento rozdõÂl vsÏak nenõ statisticky vyÂznamnyÂ, nebot' dosazÏena hladina chõÂ-kvadraÂt testu nezaÂvislosti je 0,283.
(Tab. 1)
Jak uzÏ bylo rÏecÏeno vyÂsÏe, ortodonticka kompenzace
je pouzÏita cÏasteÏji nezÏ ortognaÂtnõÂ chirurgie. Na zaÂkladeÏ
zjisÏteÏnyÂch uÂdajuÊ lze tvrdit se spolehlivostõÂ 95 %, zÏe jõÂ
pro danou situaci daÂva prÏednost võÂce nezÏ 69,0 % ortodontistuÊ.
ORTODONCIE
red combined ortognathic-orthodontic therapy (10
men, 11 women).
Orthodontists, both men and women, prefer to treat
Class II, Division 1 anomaly in adults with orthodontic
compensation therapy. Women-orthodontists decided for the approach more often (approx.by 10%) than
men-orthodontists. However, the difference is not statistically significant, as the level of chi-quadrat non-dependency test was 0.283 (Table 1).
Tab. 1. Volba leÂcÏebne metody podle pohlavõ ortodontisty
Table 1. Treatment approach according to the gender of an orthodontist
Typ léčby, type of treatment
Pohlaví, sex
Orthodontic
compensation
Orthodontic-orthognathic
therapy
Muž, male
25 (71.4 %)
10 (28.6 %)
Žena,
woman
47 (81.0 %)
11 (19.0 %)
Celkem,
total
72 (77.4 %)
21 (22.6 %)
As already stated above, orthodontic compensation prevails over ortognathic surgery. Based on the
data collected we can state with 95% reliability that
in the above described condition the approach is the
method of choice for 69.0% of orthodontists.
Discussion
Diskuse
SoucÏasna doba klade velky duÊraz na estetiku a harmonii oblicÏeje. PrÏi plaÂnovaÂnõ terapie u pacientuÊ s Angleovou II. trÏõÂdou 1. oddeÏlenõÂm se rÏada ortodontistuÊ zamyÂsÏlõ nad otaÂzkou, zda bude u konkreÂtnõÂho pacienta
vhodny a ve vyÂsledku esteticky prÏijatelneÏjsÏõ postup
extrakcÏnõÂ, neextrakcÏnõÂ nebo operacÏnõÂ [7]. U pacientuÊ
s ruÊznyÂm stupneÏm anomaÂlie II. trÏõÂdy, 1. oddeÏlenõÂ je
hlavnõÂm estetickyÂm probleÂmem vyÂrazna protruze hornõÂch rÏezaÂkuÊ. Pacienti cÏasto subjektivneÏ vnõÂmajõÂ, zÏe acÏkoliv je tvar jejich zubnõÂch obloukuÊ uspokojivyÂ, je na jejich oblicÏeji zjevna anterio-posteriornõ skeletaÂlnõ diskrepance. Proffit [6] uvaÂdõÂ, zÏe prÏiblizÏneÏ u 80%
pacientuÊ s anomaÂliõÂ II. trÏõÂdy, 1. oddeÏlenõÂm vykazuje
urcÏity stupenÏ ruÊstoveÂho deficitu mandibuly, oproti
pouhyÂm 20% s nadmeÏrnyÂm ruÊstovyÂm potenciaÂlem
hornõÂ cÏelisti. V extreÂmnõÂch prÏõÂpadech anomaÂliõÂ II. trÏõÂdy
1. oddeÏlenõ je cÏasto indikovaÂna ortodonticko-chirurgicka leÂcÏba zameÏrÏena na prÏedsunutõ dolnõ cÏelisti. Jinou
metodou volby je ortodonticka terapie, ktera zahrnuje
extrakcÏnõÂ nebo neextrakcÏnõÂ postupy. Mezi neextrakcÏnõÂ
leÂcÏebne postupy se rÏadõ distalizace hornõÂch molaÂruÊ
a pouzÏitõÂ funkcÏnõÂch aparaÂtuÊ na korekci vad II. trÏõÂdy.
PrÏi extrakcÏnõÂm postupu se obvykle jedna o izolovaneÂ
extrakce hornõÂch prvnõÂch premolaÂruÊ nebo kombinaci
78
Today an esthetic and harmonious face is very important. In planning the treatment of patients with
Class II, Division 1, a number of orthodontists spend
a lot of time considering which of the methods available (extraction, non-extraction, orthognathic) will be
the most suitable for a concrete patient and which will
lead to the best esthetic results [7]. In patients with
Class II, Division 1 the main esthetic problem is represented by protrusion of upper incisors. Patients very
often perceive that even if the shape of their dental arches is satisfactory, their faces show an obvious anterio-posterior skeletal discrepancy. Proffit [6] states
that in approx. 80% of patients with Class II, Division
1 anomaly, there is a certain degree of growth deficit
of the mandible, compared to 20% with extensive
growth of the maxilla. In severe cases a combined
orthodontic-surgical therapy is indicated; the aim is
the mandible advancement. Another method may be
orthodontic therapy involving extraction or without
extraction. The latter is represented by distalization
of upper molars and application of functional appliances to correct Class II anomalies. In extraction approach there are usually performed isolated extractions of upper first premolars, or extraction of upper
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ORTODONCIE
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extrakcõÂ hornõÂch prvnõÂch premolaÂruÊ s dolnõÂmi druhyÂmi
premolaÂry [6].
V souvislosti s plaÂnovaÂnõÂm vhodneÂho leÂcÏebneÂho
postupu se nabõÂzõÂ otaÂzka, zda muÊzÏe extrakcÏnõÂ leÂcÏba
negativneÏ ovlivnit profil oblicÏeje pacienta. Mihalik [8]
uvaÂdõÂ, zÏe okluze vytvorÏena u pacientuÊ s anomaÂliõ II.
trÏõÂdy (zpuÊsobene nedostatecÏnyÂm ruÊstem mandibuly)
ortodontickou kompenzacõÂ, tedy extrakcõÂ dvou hornõÂch prvnõÂch premolaÂruÊ je stabilnõÂ, a zÏe vyÂsledek teÂto
metody, tedy extrakce dvou hornõÂch premolaÂruÊ a retrakce hornõÂho frontaÂlnõÂho uÂseku, s konecÏnyÂm vztahem prvnõÂch molaÂruÊ ve II. trÏõÂdeÏ a sÏpicÏaÂkuÊ v I. trÏõÂdeÏ , je
reaÂlny a plneÏ funkcÏnõÂ.
Burstone [9] prÏipomenul, zÏe velikost retrakce frontaÂlnõÂch uÂsekuÊ chrupu a z nõÂ vyplyÂvajõÂcõÂ zmeÏna polohy
rtuÊ je ve velke mõÂrÏe ovlivneÏna typem kotvenõ a nikoliv
pouze extrakcemi zubuÊ.
V souvislosti s touto otaÂzkou byla a je provaÂdeÏna
rÏada studiõ srovnaÂvajõÂcõ profilove hodnoty tvrdyÂch a zejmeÂna meÏkkyÂch tkaÂnõ oblicÏeje u pacientuÊ podstoupivsÏõÂch extrakcÏnõ a neextrakcÏnõ terapii [8, 10]. Na daÂlkovyÂch rentgenovyÂch snõÂmcõÂch zhotovenyÂch prÏed zahaÂjenõÂm terapie, bezprostrÏedneÏ po ukoncÏenõ terapie
a v obdobõÂ neÏkolika let po ukoncÏenõÂ leÂcÏby jsou odecÏõÂtaÂny hodnoty tvrdyÂch a meÏkkyÂch tkaÂnõÂ profilu pacienta.
CõÂlem studiõÂ je zjistit souvislost mezi polohou meÏkkyÂch
tkaÂnõÂ vzhledem k poloze tvrdyÂch tkaÂnõÂ a odhalit pravdu
ohledneÏ mozÏnosti vytvaÂrÏenõÂ neestetickyÂch zmeÏn prÏi
nevhodneÏ zvoleneÂm postupu leÂcÏby pacienta.
Conley a kol. [10] ve sve studii zkoumali vliv
extrakcÏnõÂ leÂcÏby na plnost profilu oblicÏeje u pacientuÊ
s anomaÂliõ II. trÏõÂdy, 1. oddeÏlenõÂ. OpeÏt zduÊraznil, zÏe v prÏõÂpadech leÂcÏby teÂto anomaÂlie ortodontickou kompenzacõ je nutne zajistit absolutnõ kotvenõÂ. OdpoveÏd' meÏkkyÂch tkaÂnõ je vyÂrazna a lze dosaÂhnout vyvaÂzÏeneÂho profilu. V zaÂveÏru studie celkoveÏ poukazuje na to, zÏe
extrakcÏnõ ortodonticka leÂcÏba muÊzÏe zaprÏõÂcÏinit mõÂrnou
redukci plnosti profilu v souvislosti s mõÂrnyÂm prodlouzÏenõÂm dolnõ oblicÏejove etaÂzÏe. Pacient by meÏl byÂt s tõÂmto
efektem prÏedem obeznaÂmen. Redukce plnosti rtuÊ je prÏi
retrakci hornõÂch rÏezaÂkuÊ velmi maÂlo patrnaÂ. U pacientuÊ
s plnyÂmi rty a relativnõÂ mandibulaÂrnõÂ deficiencõÂ je snõÂzÏenõÂ
projekce rtuÊ zÏaÂdoucõÂm cõÂlem ortodonticke leÂcÏby.
Mnoho negativnõÂch naÂzoruÊ na extrakcÏnõÂ leÂcÏbu je zalozÏeno na tvrzenõÂ, zÏe extrakce ve staÂleÂm chrupu podminÏujõÂ vznik neestetickeÂho profilu meÏkkyÂch tkaÂnõÂ oblicÏeje,
protozÏe zaprÏõÂcÏinÏujõÂ relativnõÂ oplosÏteÏnõÂ nebo vpadnutõÂ rtuÊ
vzhledem k bradeÏ a nosu. Liebermann [11] tvrdõÂ, zÏe
¹...nasÏe uÂloha v dlouhodobyÂch zmeÏnaÂch oblicÏeje zaujõÂma mnohem mensÏõ roli, nezÏ si myslõÂme.ª Studiõ srovnaÂvajõÂcõÂch vliv extrakcÏnõ a neextrakcÏnõ leÂcÏby na profil
meÏkkyÂch tkaÂnõÂ oblicÏeje nenõÂ mnoho, ale majõÂ urcÏitou
hodnotu pro vyrÏesÏenõÂ teÂto otaÂzky.
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first premolars combined with extraction of lower second premolars [6].
When deciding about the appropriate treatment approach we have to consider whether therapy involving
extraction could show negative effects on the patient's
facial profile. Mihalik [8] reports that occlusion in patients with Class II anomaly (resulting from insufficient
growth of the mandible) created with orthodontic compensation, i.e. extraction of two upper first premolars,
is stable, and that the result of this approach (i.e.
extraction of two maxillary premolars and retraction
of maxillary anterior segment with resulting relationship of first molars in Class II and canines in Class I) is
realistic and fully functional.
Burstone [9] mentions the amount of retraction of
anterior segments of dentition and that resulting modification in the position of lip is influenced to a great
extent by the type of anchorage, not only by extractions of teeth.
A number of comparative studies have been performed that focus on profiles of hard and soft tissues in
patients after therapy involving extraction or without
extraction [8, 10]. In radiograms taken before the commencement of therapy, immediately after the therapy
ended and during several years following the therapy
hard and soft tissues of a patient's profile are read.
The aim of such studies is to find out the relationship
between the positions of soft tissues relative to the position of hard tissues, and establish which procedures
are not appropriate as they may result in non-esthetic
modifications.
Conley et al. [10] focused on the impact of treatment
involving extraction on the facial profile in patients with
Class II, Division 1. They put the emphasis on the importance of an absolute anchorage. The reaction of
soft tissues is noticeable and it is possible to achieve
a balanced profile. They also underlined the fact that
orthodontic treatment involving extraction may result
in a partial reduction of profile ampleness due to a moderate prolongation of the lower part of a face. Patients
should be informed about this before. Reduction of lips
associated with retraction of maxillary incisors is virtually invisible. In patients with ample lips and relative
deficiency of the mandible, the reduction of lips is
amongst the desired outcomes of the treatment. Negative approach to treatment involving extractions is
based on the assumption that extractions in permanent dentition may lead to an non-esthetic profile of
soft tissues of face, because they cause relative flattening or recession of lips in relation to chin and nose.
Liebermann [11] says that ¹in a long-time changes of
face our role is less important than we think.ª There
are not many studies comparing the impact of extraction or treatment without extractions on facial soft tis79
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ORTODONCIE
Finnoy a kol. [12] porovnaÂvali profily oblicÏeje pacientuÊ s anomaÂliõÂ II. trÏõÂdy, 1. oddeÏlenõÂ leÂcÏenyÂch
extrakcÏneÏ cÏi neextrakcÏneÏ a zjistili, zÏe v cÏasoveÂm horizontu 3 azÏ 5 let dosÏlo k velmi malyÂm zmeÏnaÂm profilu
meÏkkyÂch tkaÂnõÂ. UrcÏite odlisÏnosti meÏkkyÂch tkaÂnõÂ
u extrakcÏnõÂch a neextrakcÏnõÂch prÏõÂpaduÊ navõÂc existovaly
jizÏ prÏed leÂcÏbou.
sues profile, however, they may contribute to the solution of this problem.
Finnoy et al. [12] compared facial profiles of patients
with Class II, Division 1 treated with or without extractions, and found out that within the period of 3 to 5
years there were only moderate modifications of soft
tissues. Moreover, differences in soft tissues had exiLooi a Mills [13] oveÏrÏovali souvislost zmeÏn v posta- sted already prior to treatment.
venõÂ rtuÊ a rÏezaÂkuÊ u skupin extrakcÏneÏ a neextrakcÏneÏ leÂLooi and Mills [13] verified changes in position of lips
cÏenyÂch pacientuÊ s anomaÂliõÂ II. trÏõÂdy, 1. oddeÏlenõÂm. Do- and incisors in patients with Class II, Division 1 treated
speÏli k zaÂveÏru, zÏe retrakce rtuÊ i rÏezaÂkuÊ je prokazatelneÏ with and without extractions. They concluded that reveÏtsÏõ u extrakcÏnõÂch prÏõÂpaduÊ, avsÏak srovnaÂnõ je obtõÂzÏne traction of both lips and incisors is probably more sigdõÂky znacÏnyÂm rozdõÂluÊm v pouzÏite biomechanice nificant in patients with extractions. However, the
u kazÏde jednotlive skupiny.
comparison is rather difficult due to considerable diffePaquette, Beatty a Johnston [14] porovnaÂvali vliv rences in biomechanics used in each individual group
extrakcÏnõÂ a neextrakcÏnõÂ terapie na profil oblicÏeje u pa- of patients.
cientuÊ s ¹hranicÏnõª anomaÂliõ II. trÏõÂdy, 1. oddeÏlenõÂ. DoPaquette, Beatty and Johnston [14] studied the imspeÏli k zaÂveÏru, zÏe zuby byly po ukoncÏenõ neextrakcÏnõ pact of therapy with and without extractions on facial
leÂcÏby podstatneÏ võÂce protrudovaÂny a tento zaÂveÏr po- profile in patients with ¹borderlineª Class II, Division
tvrdily i studie provaÂdeÏne o 10 let pozdeÏji. PrÏes stati- 1. They concluded that after completed treatment wisticky prokazatelnou retruzivnõ tendenci u extrakcÏnõÂch thout extractions teeth protruded considerably. This
prÏõÂpaduÊ byl vyÂsledek leÂcÏby povazÏovaÂn za uÂspeÏsÏnyÂ, conclusion was proved by studies carried out ten years
stejneÏ jako vyÂsledky neextrakcÏnõÂch metod leÂcÏby.
later. In spite of statistically significant tendency to reDveÏ pruÊvodne studie Dobrockeho a Smithse [15] trusion related to extraction, the result was considered
a Younga a Smithse [16] zmõÂnily skutecÏnost, zÏe i prÏes successful as well as the results of approaches without
podstatneÏ veÏtsÏõÂ retrakci rtuÊ u extrakcÏnõÂ skupiny pa- extractions.
Two works by Dobrocki and Smiths [15] and Young
cientuÊ existuje u obou zkoumanyÂch skupin, extrakcÏnõÂ
i neextrakcÏnõÂ, urcÏita individuaÂlnõ variabilita ve zmeÏnaÂch and Smiths [16] point out the fact that in spite of subprofilu oblicÏeje, ktera je podmõÂneÏna standardnõÂmi od- stantially larger lip retraction in patients treated with
chylkami od pruÊmeÏru. NejduÊlezÏiteÏjsÏõÂm zaÂveÏrem teÏchto extractions, in both groups (the one treated with
studiõÂ vsÏak bylo, zÏe frekvence nezÏaÂdoucõÂch zmeÏn v ob- extractions and the other without extractions) there is
licÏejove estetice byla shodna u extrakcÏnõÂch i neextrakcÏ- observed some individual variability in facial profile
nõÂch prÏõÂpaduÊ. Studie kvantitativneÏ urcÏujõÂcõÂ odpoveÏd' changes that is given by standard deviations from
meÏkkyÂch tkaÂnõ na zmeÏny tvrdyÂch tkaÂnõ jsou cÏetneÂ, ale the average. However, the most important conclujejich vyÂsledky se velmi ruÊznõÂ. Mnohe studie [12, 17, sions brought by the studies mentioned state that
18, 19, 20] popisujõÂ vztah mezi rÏezaÂky a retrakcõÂ rtuÊ, the prevalence of unfavourable changes in facial
ale mõÂra tohoto vztahu se mezi jednotlivyÂmi studiemi esthetics is the same in patients with extractions and
vyÂrazneÏ lisÏõÂ. HlavnõÂm zaÂveÏrem teÏchto studiõÂ je, zÏe vztah in patients without extractions. A lot of research
meÏkkyÂch a tvrdyÂch tkaÂnõ podleÂha sÏiroke individuaÂlnõ [12,17,18,19,20] deal with relationship between incivariabiliteÏ a domneÏnka, zÏe se tato variabilita u extrakcÏ- sors and lips retraction, but they give very different renõÂch a neextrakcÏnõÂch skupin lisÏõ je neoduÊvodneÏnaÂ. sults. The main point of these studies is that the relaDlouhodobe promeÏrÏovaÂnõ zmeÏn meÏkkyÂch tkaÂnõ profilu tionship between soft and hard tissues shows an
oblicÏeje musõ braÂt ohled na normaÂlnõ vyÂvojove zmeÏny extensive individual variability and that the assumption
a jejich individuaÂlnõÂ variabilitu. RuÊst nosu a brady u ne- that this variability differs in groups with and without
leÂcÏenyÂch mladistvyÂch prÏesahuje mnohonaÂsobneÏ do- extractions is ungrounded. Longitudinal analyses of
provodne zmeÏny rtuÊ. Tyto normaÂlnõ ruÊstove zmeÏny majõ changes of facial profile soft tissues have to take into
tendenci pokracÏovat i v dospeÏlosti, kdy dochaÂzõÂ k ¹rela- consideration normal developmental changes and
tivnõÂ retrakciª rtuÊ [21, 22]. RuÊst nosu a brady mnohonaÂ- their individual variability. Nose and chin growth in
sobneÏ prÏevysÏuje zmeÏny rtuÊ u ortodonticky leÂcÏenyÂch young adults without treatment exceeds associated
mladistvyÂch [18, 23]. Zierhut a kol. [24] ve sve studii po- changes of lips many times. These normal growth
rovnaÂvali postterapeuticke a dlouhodobe zmeÏny changes tend to continue in adult age when we obu uÂspeÏsÏneÏ vyleÂcÏenyÂch pacientuÊ s anomaÂliõ II. trÏõÂdy, 1. serve ¹relative retractionª of lips [21,22]. Nose and chin
oddeÏlenõÂm, leÂcÏenyÂmi bud' neextrakcÏneÏ nebo extrakcõÂ growth in young adults that undergo orthodontic treatcÏtyrÏ prvnõÂch premolaÂruÊ. Profil meÏkkyÂch tkaÂnõÂ byl u obou ment exceeds changes of lips many times [18, 23].
80
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skupin podobnyÂ, s postupnyÂm oplosÏt'ovaÂnõÂm, v zaÂvislosti na vyÂvojovyÂch zmeÏnaÂch dolnõÂ cÏelisti a nosu
a bez ohledu na to, zda byly extrahovaÂny zuby. Dlouhodobe zmeÏny polohy rtuÊ byly võÂce retruzivnõÂho charakteru, nezÏ by odpovõÂdalo ideaÂlu Rickettse a Steinera,
ale jejich hodnoty byly blõÂzke pruÊmeÏrnyÂm hodnotaÂm
u neleÂcÏenyÂch pacientuÊ. TlousÏt'ka a pozice tkaÂnõÂ dolnõÂho
rtu, stejneÏ jako maxilomandibulaÂrnõÂ skeletaÂlnõÂ vztah
mohou slouzÏit jako faktory prÏedpovõÂdajõÂcõÂ poleÂcÏebnou
polohu dolnõÂho rtu.
HlavnõÂm cõÂlem studie bylo zjistit, jak vnõÂmajõÂ laici
a ortodontiste nativnõ profil oblicÏeje pacienta s anomaÂliõÂ
II. trÏõÂdy, 1. oddeÏlenõ podle Anglea a jeho zmeÏny po ortodonticke a chirurgicke terapii. Vypracovana studie obsahovala dva soubory dotaznõÂkuÊ: 130 kusuÊ dotaznõÂkuÊ
od laikuÊ, z toho 78 zÏen a 58 muzÏuÊ a 93 dotaznõÂkuÊ od
ortodontistuÊ, 58 zÏen, 35 muzÏuÊ.
VyÂsledky provedene studie ukazujõÂ, zÏe mezi nejleÂpe
hodnocene profily oblicÏejuÊ patrÏõ zÏensky nativnõ profil
a muzÏsky chirurgicky profil. ZÏensky nativnõ profil ohodnotilo jako esteticky atraktivnõ celkem 86,2% laikuÊ
a 100,0% ortodontistuÊ. MuzÏsky chirurgicky profil
ohodnotilo kladneÏ 88,9% laikuÊ a 100,0% ortodontistuÊ.
Ortodontiste take velmi kladneÏ hodnotili zÏensky kompenzacÏnõ profil (90,9%). Tyto vyÂsledky mohou poukazovat na veÏtsÏinove sexuaÂlnõ preference, kdy u zÏen je lõÂbivy spõÂsÏe neÏzÏny profil oblicÏeje s mõÂrnou protruzõ a lehce
ustupujõÂcõ bradou a u muzÏuÊ vyÂrazneÏjsÏõÂ, dominantneÏ puÊsobõÂcõ dolnõ cÏelist. K podobnyÂm zaÂveÏruÊm ve sve studii
z roku 1998 dospeÏli take Perrett a kol. [25] UvaÂdõÂ, zÏe
pohlavnõ hormon testosteron je zodpoveÏdny za vyÂvoj
sekundaÂrnõÂch pohlavnõÂch znakuÊ u muzÏuÊ. ProtozÏe pohlavnõÂ hormony snizÏujõÂ obranyschopnost organismu,
mohou se vyÂrazneÏ maskulinnõÂ znaky vyvinout pouze
u jedincuÊ s dostatecÏneÏ schopnyÂm imunitnõÂm systeÂmem. MuzÏske oblicÏeje s naÂpadnyÂmi maskulinnõÂmi
znaky mohou tedy puÊsobit jako signaÂl, zÏe jejich nositel
ma zvyÂsÏenou odolnost vuÊcÏi chorobaÂm. Tento znak je
uplatnÏovaÂn prÏi sexuaÂlnõÂm vyÂbeÏru u velkeÂho mnozÏstvõÂ
zÏivocÏisÏnyÂch druhuÊ, vcÏetneÏ cÏloveÏka. U zÏen se na vyÂvoji
sekundaÂrnõÂch pohlavnõÂch znakuÊ podõÂlõÂ hormony ze
skupiny estrogenuÊ, ktere jsou spojovaÂny s vlastnostmi
jako je zdravõÂ a schopnost reprodukce. ZvyÂsÏenõÂ sexuaÂlnõÂho dimorfismu prostrÏednictvõÂm znakuÊ zaÂvislyÂch na
pohlavnõÂch hormonech by meÏlo vyvolat i zvyÂsÏenõ atraktivity. U muzÏuÊ by to byly takove charakteristiky jako dominance a obranyschopnost, u zÏen mladistvost a plodnost. VyÂzkum provedeny v japonske a britske populaci
potvrdil souvislost mezi intenzitou projevu sexuaÂlneÏ dimorfnõÂch znakuÊ a prÏitazÏlivostõÂ oblicÏeje. Jako atraktivnõÂ
byly oznacÏeny ty muzÏske oblicÏeje, ktere se vyznacÏovaly vysÏsÏõÂm mnozÏstvõÂm maskulinnõÂch rysuÊ a pak takeÂ
pruÊmeÏrne zÏenske oblicÏeje. ZvyÂrazneÏne maskulinnõ rysy
vsÏak nebyly spojovaÂny pouze se zvyÂsÏenou dominancõÂ,
www.orthodont-cz.cz e-mail: [email protected]
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Zierhut et al. [24] compared posttraumatic and longterm changes in successfully treated patients with
Class II, Division 1, solved either with or without extraction of four first premolars. Soft tissues profile was similar in both groups, showed gradual flattening due
to developmental changes of the mandible and nose,
and regardless to teeth extraction. Long-term changes
of lips position showed more retrusive features that do
not correspond to the ideal established by Ricketts
and Steiner. However, the values cited were similar
to mean values found in patients without any treatment. Thickness and position of lower lip tissues together with skeletal relationship between the mandible
and the maxilla may serve as the factors predicting
the lower lip position after the therapy.
The main aim of our study was to find out the differences in lay and expert perception of a photograph of
a patient with Class II, Division 1, and of its changes after the orthodontic and orthognathic therapy. There
were two sets of questionnaires: 130 responded by
lay public (78 women, 58 men) and 93 responded by
orthodontists (58 women, 35 men).
The results suggest that a female native profile and
a male profile simulating the condition after surgical intervention belong to the best evaluated facial profiles.
A female native profile was evaluated as attractive by
86.2% of lay people, and 100.0% orthodontists.
A male profile after surgery was evaluated positively
by 88.9% of lay public, and 100.0% of orthodontists.
Orthodontists appreciated also a female profile simulating the condition after orthodontic compensation
(90.9%). The results may refer to prevailing sexual preferences: women prefer a gentle facial profile with moderate protrusion and moderately retracting chin,
while men prefer more expressed and dominant mandible. Similar conclusions are given also by Perrett et
al. [25] in their study published in 1998. Testosterone
is responsible for the development of secondary sexual features in men. Due to the fact that sexual hormones reduce immune system of organisms, the expressive masculine features can develop only in individuals
with sufficient immune system. Faces of men with striking masculine features may thus signal that the individual has a strong resistance to diseases. This feature
plays an important role in sexual selection of many animal species, including humans. Estrogens are responsible for the development of secondary sexual features
in women. These hormones are related to health and
fertility. Enhanced sexual dimorphism should elicit attractiveness. In men it is dominance and resistance
that are attractive, in women youthfulness and fertility.
The research on Japanese and British population proved the relationship between the intensity of sexual dimorphism and face attractiveness. Attractive faces of
81
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ale take s neÏkteryÂmi negativnõÂmi atributy, jako je naprÏ.
vysÏsÏõÂ agresivita, bezcitnost cÏi nepoctivost. Preference
pro vnõÂmaÂnõÂ atraktivity mohou byÂt ovlivneÏny i kulturnõÂm
prostrÏedõÂm [25].
SpeciaÂlnõ otaÂzka teÂto studie mõÂrÏena do rÏad odbornõÂkuÊ meÏla zmapovat, zda se ortodontiste ve sve kazÏdodennõ praxi prÏi leÂcÏbeÏ anomaÂliõ II. trÏõÂdy, 1. oddeÏlenõ podle
Anglea u dospeÏlyÂch pacientuÊ prÏiklaÂnõ spõÂsÏe k ortodonticke kompenzaci nebo ortognaÂtnõ chirurgii. Z vyÂsledkuÊ
je patrneÂ, zÏe ortodontiste leÂcÏõ tuto vadu spõÂsÏe ortodontickou kompenzacõ (77,4%). Tato skutecÏnost muÊzÏe byÂt
i duÊsledkem preferencõÂ sÏkolõÂcõÂho pracovisÏteÏ, na ktereÂm
leÂkarÏ absolvoval svou specializacÏnõÂ prÏõÂpravu, i vlivem
generacÏnõÂm. Je patrneÂ, zÏe k leÂcÏbeÏ ortodontickou kompenzacõÂ se ve vsÏech veÏkovyÂch kategoriõÂch prÏõÂklaÂnõÂ võÂce
zÏeny - ortodontistky (81,0%).
ZaÂveÏr
1) Nativnõ zÏensky profil ohodnotilo jako esteticky
atraktivnõÂ 100% dotazovanyÂch respondentuÊ z rÏad
ortodontistuÊ a 86,2% resondentuÊ z rÏad laikuÊ
2) Nativnõ zÏensky profil byl kladneÏ ohodnocen
100,0% respondentuÊ - ortodontistuÊ muzÏuÊ i zÏen
3) Nativnõ zÏensky profil byl kladneÏ ohodnocen
90,0% respondentuÊ - laikuÊ, zÏen a 77,0% respondentuÊ
- laikuÊ, muzÏuÊ
4) KompenzacÏnõ zÏensky profil byl shledaÂn jako esteticky atraktivnõ u 100,0% respondentuÊ - ortodontistuÊ,
muzÏuÊ
5) Chirurgicky zÏensky profil byl shledaÂn jako esteticky atraktivnõ u 100,0% respondentuÊ - ortodontistuÊ,
zÏen
6) Chirurgicky muzÏsky profil ohodnotilo jako esteticky atraktivnõ 100% dotazovanyÂch respondentuÊ
z rÏad ortodontistuÊ a 88,9% resondentuÊ z rÏad laikuÊ
7) Chirurgicky muzÏsky profil byl shledaÂn jako esteticky atraktivnõ u 100,0% u respondentuÊ - ortodontistuÊ,
muzÏuÊ i zÏen
8) Chirurgicky muzÏsky profil byl shledaÂn jako esteticky atraktivnõ v 88,9% u respondentuÊ - laikuÊ, muzÏuÊ
i zÏen
AutorÏi nemajõ komercÏnõÂ, vlastnicke nebo financÏnõ zaÂjmy na produktech nebo spolecÏnostech popsanyÂch v tomto cÏlaÂnku.
ORTODONCIE
males were those with more masculine features, and
attractive women had average female faces. However,
enhanced masculine features were not related only to
a higher degree of dominance but also to some negative attributes, such as intense aggression, cold-heartedness and dishonesty. Of course, perception of attractiveness is different in different cultures [25].
The question aimed at orthodontists sought to find
whether orthodontists prefer orthodontic compensation or orthognathic surgery in solving Class II, Division 1. The results showed that orthodontic compensation is preferred (77.4%). This treatment is even
more preferred by women-orthodontists (81.0%).
Conclusion
1) Native female profile was considered esthetically
attractive by 100% orthodontists and 86.2% lay respondents.
2) Native female profile was evaluated positively by
100.0% of respondents-orthodontists, both men and
women.
3) Native female profile was evaluated positively by
90.0% of lay respondents-women, and 77.0% lay respondents - men.
4) Female profile after orthodontic compensation
was considered esthetically attractive by 100.0% of
respondents - orthodontists, men.
5) Female profile after orthognathic surgery was
considered esthetically attractive by 100.0% of respondents-orthodontists, women.
6) Male profile after orthognathic surgery was considered esthetically attractive by 100% respondentsorthodontists, and 88.9% lay respondents.
7) Male profile after orthognathic surgery was considered esthetically attractive by 100.0% respondentsorthodontists, both men and women.
8) Male profile after orthognathic surgery was considered esthetically attractive by 88.9% of lay respondents, both men and women.
Authors have no commercial, proprietary or financial interest in
products or companies mentioned in the article.
Literatura/ References
1. KamõÂnek, M. ; SÏtefkovaÂ, M.: Ortodoncie I. Olomouc: Univerzita PalackeÂho, 2001.
2. Kokich, V. G.: Adult orthotontics in the 21st century: Guidelines for achieving successful result. Papers and abstracts: 6th International Orthodontic Congress, Paris,
2005.
3. Goldstein, M. C.: Adult orthodontics. Amer. J. Orthodont. dentofacial Orthop. 1953, 39, cÏ. 6, s. 400-424.
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4. Williams, S.: KoncepcÏna ortodoncia. Bratislava: Orthoexpress, 2002.
5. Kokich, V. G.: Esthetics and vertical tooth position:
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7. Bolla, E.; Muratore, F.; Carano, A.; Bowman, S. J.: Evaluation of maxillary molar distalization with the distal
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ORTODONCIE
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jet: a comparison with other contemporary methods.
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9. Burstone, C. J.: The segmental arch approach to space
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10. Conley, R. S.; Jernigan, Ch.: Soft tissue changes after
upper premolar extraction in Class II camouflage therapy. Angle Orthodont. 2006, 76, cÏ. 1, s. 59-65.
11. Liebermann, M. A.; Gazit, E. : Facial profile as afected by
extraction or non-extraction decisions. Quintessence
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12. Finnoy, J. P.; Wisth, P. J.; Boe, O. E.: Changes in soft tissue profile during and after orthodontic treatment. Eur. J.
Orthodont. 1987, 10, cÏ. 9, s. 68-78.
13. Looi, L. K.; Mills, J. R.: The effect of two contrasting
forms of orthodontic treatment on the facial profile.
Amer. J. Orthodont. dentofacial Orthop. 1986, 89,
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14. Paquette, D. E.; Beattie, J. R.; Johnston,L. E. Jr.: A longterm comparison of nonextraction and premolar extraction edgewise therapy in ¹borderlineª Class II patients.
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15. Drobocky, O. B.; Smith, R. J.: Changes in facial profile
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16. Young,T. M.; Smith, R. J.: Effects of orthodontic on the
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with orthodontic therapy. Amer. J. Orthodont. dentofacial Orthop. 1964, 50, cÏ. 79, s. 421-434.
Anderson, J. P.; Joondeph,D.R.; Turpin, D. L.: A cephalometric study of profile changes in orthodontically treated
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Roos,N.: Soft-tissue profile changes in Class II treatment. Amer. J. Orthodont. dentofacial Orthop. 1977,
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Talass, M.F.; Talass, L.; Baker, R.C.: Soft-tissue profile
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Nanda, R. S.; Meng, H.; Kapila, S.; Goorhuis, J.: Growth
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Beget, B. C.: A cephalometric study of profile changes to
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Perrett, D. I.; Lee, K. J.; Penton-Voak, I.; Rolland, D.; Yoshikawa, S.; Burt, D. M. : Effects of sexual dimorfism on facial attractiveness. Nature 1998, cÏ. 394, s. 884-887.
R Development Core Team (2011). R: A language and
environment for statistical computing. R Foundation for
Statistical Computing, Vienna, Austria.
ISBN 3-900051-07-0, URL http://www.R-project.org/.
MUDr. Jana FendrychovaÂ
DeÏtska stomatologicka klinika FN v Motole
V UÂvalu 84, 150 06 Praha 5
LuhacÏovice jsou prÏedevsÏõÂm laÂzenÏskyÂm meÏstem, protozÏe se zde nachaÂzejõ cÏtvrte nejveÏtsÏõÂ
laÂzneÏ v CÏesku a nejveÏtsÏõ na MoraveÏ. LuhacÏovice vdeÏcÏõ za svuÊj veÏhlas prÏedevsÏõÂm mineraÂlnõÂm pramenuÊm ± vyveÏra zde celkem sÏest prÏõÂrodnõÂch pramenuÊ a desõÂtky pramenuÊ navrtanyÂch. NejznaÂmeÏjsÏõ je pramen Vincentka.
Pro uÂcÏastnõÂky kongresu a jejich doprovod je prÏipraven
bohaty balneo program s vyuzÏitõÂm leÂcÏivyÂch pramenuÊ.
TeÏsÏõÂme se na VasÏi naÂvsÏteÏvu!
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
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CÏasove odchylky vyÂvoje chrupu u deÏtõ s ruÊznyÂmi typy rozsÏteÏpu
Dental development in children with different types of cleft
MUDr. VladimõÂr Patrik KolaÂrÏ, 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
and University Hospital KraÂlovske Vinohrady, Prague
Souhrn
CõÂlem praÂce bylo zjistit, zda se u pacientuÊ s rozsÏteÏpy lisÏÂõ vyÂvoj dentice v cÏase od vyÂvoje chrupu kontrolnõÂho souboru.
VysÏetrÏeny soubor byl vytvorÏen ze skupiny pacientuÊ s izolovanyÂm rozsÏteÏpem patra (n=129), skupiny s celkovyÂm
jednostrannyÂm rozsÏteÏpem (n=119) a z kontrolnõ skupiny (n=126). U kazÏdeÂho jedince byla na jednom ortopantomogramu vyhodnocena cÏasova odchylka vyÂvoje dentice (rozdõÂl zubnõÂho a chronologickeÂho veÏku) a data byla statisticky zpracovaÂna.
PrÏi porovnaÂnõ cÏasovyÂch odchylek vyÂvoje chrupu vsÏech trÏÂõ skupin nebyly nalezeny statisticky vyÂznamne odlisÏnosti. Statisticky vyÂznamne rozdõÂly nebyly nalezeny ani prÏi porovnaÂnõ skupin podle pohlavõ a podle veÏku. U skupiny
s izolovanyÂm rozsÏteÏpem patra nebyla nalezena statisticky vyÂznamna souvislost cÏasoveÂho vyÂvoje dentice a rozsahu postizÏenõ rozsÏteÏpem (Ortodoncie 2012, 21, cÏ. 2, s. 85-93).
Abstract
The issue of the study was whether there are significant differences in time of dental development in patients
with clefts from patients in a control group.
The sample included groups of patients with isolated cleft palate (n=129), with complete unilateral cleft
(n=119), and a control group (n=126). In each individual the delay in dental development (the difference between
dental and chronological age) was assessed in one OPG, and the data were statistically processed.
There were found no statistically significant differences between the three groups in terms of delayed development of dentition. No differences were found for individual age groups and gender of patients. In the group
with isolated cleft palate there was not recorded any significant relationship between the development of dentition and the extent of the anomaly (Ortodoncie 2012, 21, No. 2, p. 85-93).
KlõÂcÏova slova: rozsÏteÏp, izolovany rozsÏteÏp patra, celkovy jednostranny rozsÏteÏp, zubnõ veÏk, Demirjianova metoda
stanovenõÂ zubnõÂho veÏku
Key words: cleft, isolated cleft palate, complete unilateral cleft, dental age, Demirjian's method of dental age assessment
UÂvod
Introduction
NejcÏasteÏjsÏõÂ vrozenou vyÂvojovou vadou u cÏloveÏka
jsou rozsÏteÏpy orofaciaÂlnõÂ soustavy. Pro postizÏeneÂho
jsou znacÏnyÂm zatõÂzÏenõÂm nejen estetickyÂm a funkcÏnõÂm,
ale i zdravotnõÂm. PostizÏenõ orofaciaÂlnõÂm rozsÏteÏpem zasahuje oblicÏejovy skelet, meÏkke tkaÂneÏ i chrup.
www.orthodont-cz.cz e-mail: [email protected]
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Clefts of orofacial system represent the most common inherited anomaly in humans. A person affected
suffers from esthetic, functional and health problems.
Orofacial cleft affects facial skeleton, soft tissues,
and dentition.
85
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ZubnõÂ vyÂvoj u pacientuÊ s rozsÏteÏpem se odlisÏuje od
vyÂvoje chrupu zdravyÂch jedincuÊ. TeÂmeÏrÏ vsÏechny deÏti
s rozsÏteÏpem potrÏebujõ v urcÏite faÂzi vyÂvoje orofaciaÂlnõÂ
soustavy ortodontickou leÂcÏbu a znalost zubnõÂho vyÂvoje u teÏchto pacientuÊ je zaÂsadnõ pro individuaÂlnõ plaÂnovaÂnõ komplexnõ ortodonticke terapie.
Klinicky cÏasto pozorujeme, zÏe u deÏtõÂ s rozsÏteÏpem je
zpomaleny vyÂvoj zubuÊ i jejich erupce [1]. LeÂcÏba fixnõÂm
aparaÂtem ve staÂleÂm chrupu se tak muÊzÏe posunout do
vysÏsÏõÂho veÏku. Proto jsme se rozhodli vyhodnotit vyÂvoj
chrupu u pacientuÊ s dveÏma ruÊznyÂmi typy orofaciaÂlnõÂho
rozsÏteÏpu (s rozsÏteÏpem primaÂrnõÂho patra, kdy je prÏõÂmo
zasazÏena zubnõÂ lisÏta, a s rozsÏteÏpem sekundaÂrnõÂho patra, kdy zubnõÂ lisÏta zasazÏena nenõÂ).
Je otaÂzkou, zda pozdeÏjsÏõÂ ukoncÏenõÂ vyÂvoje chrupu,
pozorovane klinicky u pacientuÊ s rozsÏteÏpem, je duÊsledkem rovnomeÏrneÂho opozÏdeÏnõ chrupu jako celku, nebo
zda se vlivem postizÏenõÂ opozÏd'uje nerovnomeÏrneÏ pouze
jedna cÏelist. ZameÏrÏili jsme se na nepostizÏenou dolnõÂ cÏelist, abychom eliminovali z nasÏeho vyÂzkumu vliv rozsÏteÏpu na vyÂvoj a mineralizaci zubnõÂch zaÂrodkuÊ a zjistili
prÏõÂpadnou cÏasovou odchylku vyÂvoje zubuÊ v mandibule.
MateriaÂl
VysÏetrÏovany soubor tvorÏilo 374 pacientuÊ oddeÏlenõÂ
ortodoncie a rozsÏteÏpovyÂch vad Stomatologicke kliniky
Fakultnõ nemocnice KraÂlovske Vinohrady v Praze. Probandi byli rozdeÏleni do trÏõ skupin podle diagnoÂzy: skupina s izolovanyÂm rozsÏteÏpem patra, skupina s celkovyÂm jednostrannyÂm rozsÏteÏpem a kontrolnõ skupina
ortodontickyÂch pacientuÊ bez rozsÏteÏpoveÂho postizÏenõÂ.
Probandi ve vsÏech skupinaÂch byli bez syndromoveÂho
postizÏenõÂ a bez prÏidruzÏenyÂch vrozenyÂch vyÂvojovyÂch
vad. PodmõÂnkou zarÏazenõÂ do souboru byl jeden dobrÏe
cÏitelny a jasneÏ hodnotitelny ortopantomogram v dobeÏ
vyÂvoje chrupu. VsÏechny rentgenove snõÂmky byly primaÂrneÏ zhotoveny pro potrÏeby ortodonticke diagnostiky a leÂcÏby.
Skupinu s diagnoÂzou izolovaneÂho rozsÏteÏpu patra tvorÏilo 129 deÏtõÂ (64 dõÂvek a 65 chlapcuÊ) ve veÏku 5,0 - 14,2 let
(pruÊmeÏr 8,9 roku, ± 1,8). Tato skupina byla rozdeÏlena na
dveÏ podskupiny podle veÏku: mladsÏõÂ (do 9 let) - 71 jedincuÊ
a starsÏõÂ (nad 9 let) - 58 jedincuÊ. Pro uÂcÏely vysÏetrÏenõÂ podle
rozsahu postizÏenõÂ rozsÏteÏpem patra byla tato skupina rozdeÏlena na trÏi podskupiny: rozsÏteÏp tvrdeÂho i meÏkkeÂho patra - 73 jedincuÊ; rozsÏteÏp meÏkkeÂho patra - 35 jedincuÊ; submukoÂznõÂ rozsÏteÏp patra - 21 jedincuÊ.
Skupinu s diagnoÂzou celkoveÂho jednostranneÂho
rozsÏteÏpu tvorÏilo 119 deÏtõÂ (43 dõÂvek a 76 chlapcuÊ) ve
veÏku 4,3 - 13,9 let (pruÊmeÏr 8,9 roku, ± 1,7). Skupina byla
rozdeÏlena na dveÏ podskupiny podle veÏku: mladsÏõÂ (do 9
let) - 63 jedincuÊ a starsÏõÂ (nad 9 let) - 56 jedincuÊ.
KontrolnõÂ skupinu tvorÏilo 126 deÏtõÂ bez postizÏenõÂ rozsÏteÏpem (60 dõÂvek a 66 chlapcuÊ) ve veÏku 5,3 - 15,5 let
86
ORTODONCIE
Dental development in patients with cleft differs
from that in healthy individuals. Nearly all children with
cleft require - during a certain phase of orofacial system development - orthodontic intervention, and
the assessment of dental development in these patients is the key factor in planning of complex orthodontic therapy.
Clinically, we often see that in children with cleft
both dental development and eruption of teeth are slowed down [1]. Therefore, the treatment with fixed appliance in permanent dentition may be postponed until
the patients are older. We decided to assess dental development in patients with two types of orofacial cleft
(cleft of primary palate, directly involving dental lamina,
and cleft of secondary palate, in which dental lamina is
not affected).
The question is whether later completion of dental
development, observed clinically in patients with cleft,
is the consequence of later development of the whole
dentition, or whether the anomaly affects the development of one jaw only. We focused on healthy mandible
to eliminate the effects of cleft on the development and
mineralization of dental germs, and to find out eventual
delay in the development of lower teeth.
Material
The sample had 374 patients treated at the Department of Orthodontics and Cleft Defects, Clinic of Stomatology, 3rd Medical Faculty of Charles University
and University Hospital KraÂlovske Vinohrady, Prague.
The probands were divided into three groups based on
the diagnosed type of anomaly: Group with isolated
cleft palate, group with complete unilateral cleft, and
a control group of orthodontic noncleft patients. Probands in all groups had no syndrome defects or associated inherited developmental anomalies. For each
patient we had a good quality panoramic radiographic
records (OPG) allowing good assessment. All radiograms were primarily taken for the purpose of orthodontic diagnostics and treatment.
The group with isolated cleft palate had 129 children
(64 girls, 65 boys) of the age between 5.0 and 14.2
years (mean age of 8.9 yrs ± 1.8). This group was further divided into two subgroups according to the
age: younger (up to the age of 9) - 71 patients, and
older (over 9 years of age) - 58 patients. The group
was divided into three subgroups according to the
extent of cleft: hard and soft palate cleft - 73 patients,
soft palate cleft - 35 patients, submucose cleft palate 21 patients.
The group with complete unilateral cleft had 119
children (43 girls and 76 boys) of the age between
4.3 and 13.9 years (mean age of 8.9 ± 1.7). The group
was divided into two subgroups according to the
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Obr. 1. PrÏõÂklad pouzÏitõÂ Demirjianovy metody ke stanovenõÂ zubnõÂho veÏku u pacienta muzÏskeÂho pohlavõÂ ve veÏku 9,5 let s diagnoÂzou izolovaneÂho rozsÏteÏpu patra (CPO)
Fig. 1. Example of Demirjian`s method of dental age assessment in a male patient, 9.5 yrs, cleft palate only (CPO)
tooth / zub
31
32
33
34
35
36
37
developmental stage / stadium vyÂvoje
H
G
F
E
E
G
D
11.8
11.7
10
11
12
17
10.1
score / skoÂre
Celkove skoÂre vyzraÂlosti dentice = 83,6. Zubnõ veÏk = 9,0 let. Chronologicky veÏk = 9,5 let. CÏasova odchylka vyÂvoje dentice (= zubnõ veÏk - chronologicky veÏk) = - 0,5 roku. VyÂvoj chrupu pacienta je opozÏdeÏn o 0,5 roku ( rtg - archiv FNKV)
Maturity of dentition overall score = 83.6. Dental age = 9.0 yrs. Chronological age = 9.5 yrs. Time deviation of dental development (= dental
age - chronological age) = - 0.5 yrs. Dental development of the patient is delayed by 0.5 yrs ( OPG courtesy of FNKV archive)
(pruÊmeÏr 9,2 roku, ± 1,7). KontrolnõÂ skupina byla rozdeÏlena na dveÏ podskupiny podle veÏku: mladsÏõÂ (do 9 let) 63 jedincuÊ a starsÏõÂ (nad 9 let) - 63 jedincuÊ.
VeÏk probanduÊ v jednotlivyÂch skupinaÂch nebyl statisticky vyÂznamneÏ odlisÏny (p = 0,49).
Metodika
Od kazÏdeÂho jedince byl jednõÂm hodnotitelem vyhodnocen jeden ortopantomogram. Na snõÂmcõÂch byl
stanoven zubnõÂ veÏk metodou dle Demirjiana [2]. Tato
metoda stanovuje zubnõÂ veÏk vyhodnocenõÂm osmi stadiõÂ vyÂvoje korunky a korÏene, oznacÏenyÂch põÂsmeny (A azÏ
H), u sedmi staÂlyÂch zubuÊ leveÂho dolnõÂho kvadrantu,
kromeÏ trÏetõÂho molaÂru. Na zaÂkladeÏ vyhodnocenõ vyÂvojovyÂch stadiõ byla kazÏdeÂmu zubu prÏirÏazena urcÏita cÏõÂselnaÂ
hodnota podle tabulek, navrzÏenyÂch Demirjianem et al.
[2]. Ke zjisÏteÏnõ cÏasove odchylky vyÂvoje dentice od
chronologickeÂho veÏku bylo jesÏteÏ nutne odecÏõÂst chronologicky veÏk od zubnõÂho (cÏasova odchylka vyÂvoje
dentice = zubnõ veÏk - chronologicky veÏk). ZõÂskana hodnota muÊzÏe nabyÂvat kladnyÂch i zaÂpornyÂch hodnot
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age: younger (up to the age of 9) - 63 patients, and
older (over 9 years of age) - 63 patients.
Control group involved 126 children without cleft
(60 girls and 66 boys) of the age between 5.3 and
15.5 years (mean age of 9.2 years ± 1.7). The control
group was further divided into two subgroups according to the age: younger (up to the ahe of 9) - 63 patients, and older (over 9 years) - 63 patients.
The age of probands in individual groups was not
significantly different (p=0.49).
Method
One and the same evaluator described one OPG of
each patient. Dental age was assessed by Demirjian`s
method [2]; i.e. by assessment of eight developmental
stages of crown and root marked with letters (A-H), in
seven teeth of the left lower quadrant with the exception of the third molar. Each tooth was assigned a numerical value according to the scale proposed by Demirjian et al. [2]. To determine a time deviation of dental
development from chronological age, it was necessary
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a udaÂva mõÂru urychlenõ cÏi opozÏdeÏnõ vyÂvoje dentice. PrÏõÂklad pouzÏitõ Demirjianovy metody je na obr. 1.
PorovnaÂnõ skupin z hlediska cÏasove odchylky vyÂvoje dentice bylo provedeno dvouvyÂbeÏrovyÂm WilcoxonovyÂm testem, prÏõÂpadneÏ pro võÂce skupin KruskalWallisovyÂm testem. VsÏechny statisticke testy byly provedeny na hladineÏ vyÂznamnosti 0,05.
1. U vsÏech trÏõ skupin (izolovany rozsÏteÏp patra, celkovy jednostranny rozsÏteÏp a kontrolnõ skupina) byla
porovnaÂna cÏasova odchylka vyÂvoje dentice.
2. CÏasova odchylka vyÂvoje dentice byla porovnaÂna
daÂle podle pohlavõÂ v raÂmci jednotlivyÂch skupin i v raÂmci
pohlavõÂ mezi jednotlivyÂmi skupinami.
3. Pacienti kazÏde skupiny byli rozdeÏleni do dvou
podskupin podle veÏku (mladsÏõÂ nezÏ 9 let a starsÏõÂ nezÏ 9
let). CÏasove odchylky vyÂvoje jejich dentice byly porovnaÂny mezi sebou v raÂmci jednotlivyÂch skupin.
4. Skupina s izolovanyÂm rozsÏteÏpem patra byla rozdeÏlena na trÏi podskupiny podle rozsahu postizÏenõ izolovanyÂm rozsÏteÏpem patra. Byla porovnaÂna jejich cÏasova odchylka vyÂvoje dentice vzaÂjemneÏ a s kontrolnõÂ
skupinou.
Pro vyhodnocenõÂ chyby meÏrÏenõÂ byla provedena
u cÏaÂsti souboru opakovana meÏrÏenõ a byly vypocÏteny
hodnoty vaÂzÏeneÂho koeficientu Kappa. Hodnoty koeficientu Kappa ukazujõÂ dobrou shodu meÏrÏenõÂ.
VyÂsledky
1. CÏasova odchylka vyÂvoje dentice: pruÊmeÏr skupiny
s izolovanyÂm rozsÏteÏpem patra je vysÏsÏõÂ nezÏ pruÊmeÏr kontrolnõÂ skupiny o 0,05 roku, pruÊmeÏr skupiny s celkovyÂm
jednostrannyÂm rozsÏteÏpem je vysÏsÏõ nezÏ pruÊmeÏr kontrolnõ skupiny o 0,04 roku (Tabulka 1, Obr. 2). PrÏi porovnaÂnõ cÏasove odchylky vyÂvoje dentice u vsÏech trÏõ skupin
(izolovany rozsÏteÏp patra, celkovy jednostranny rozsÏteÏp, kontrolnõÂ) nebyly nalezeny statisticky vyÂznamneÂ
ORTODONCIE
to subtract chronological age from dental age (time deviation of dental development = dental age - chronological age). The value thus obtained may be positive or
negative, and it determines the rate of acceleration or
deceleration of dental development. An example of
Demirjian`s method is given in Fig.1.
Comparison of the groups was done by paired Wilcoxon test, for more groups by Kruskal-Wallis test, respectively. All statistical tests were performed on the
level of significance = 0.05.
1. In all groups (isolated cleft palate, complete unilateral cleft, control group) time deviation of dentition development was compared.
2. Time deviation of dental development was further
compared according to gender within individual
groups, and in genders (separately for females and
males) between individual groups.
3. Patients in each group were divided into two subgroups according to the age (younger than 9 years,
older than 9 years). Time deviations of their dental development were compared within individual groups.
4. The group with isolated cleft palate was divided
into three subgroups according to the extent of the
anomaly. Their time deviations of dental development
were compared mutually and with the control group.
To evaluate measurement error there were repeated
measurements in a part of the sample, and the values
of weighted Kappa coefficient were calculated. The
Kappa coefficient values show good measurement
equality.
Tabulka 1. CÏasova odchylka vyÂvoje dentice u jednotlivyÂch skupin
(roky)
Table 1. Time deviation of dental development in individual groups
(yrs)
Difference of dental and chronological
age (years)
group
CPO
(n=129)
UCLP
(n=119)
Control
(n=126)
mean
0.12
0.11
0.07
median
0.15
0.19
0.13
standard
deviation
1.01
0.91
1.06
minimum
-2.88
-2.23
-4.08
maximum
3.23
2.25
2.45
CPO - izolovany rozsÏteÏp patra, cleft palate only, UCLP - celkovy jednostranny rozsÏteÏp, unilateral cleft lip and palate, Control - kontrolnõÂ
skupina, control group
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Obr. 2. Odhad hustoty pravdeÏpodobnosti pro cÏasovou odchylku vyÂvoje dentice, porovnaÂnõ vsÏech trÏõ skupin. CPO - izolovany rozsÏteÏp
patra. UCLP - celkovy jednostranny rozsÏteÏp. Control - kontrolnõ skupina.
Fig. 2. Probability density estimate for time deviation of dental development, comparison of the three groups. CPO - cleft palate only.
UCLP - unilateral cleft lip and palate. Control - control group.
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ORTODONCIE
Tab. 2. CÏasova odchylka vyÂvoje dentice u jednotlivyÂch podskupin podle pohlavõ (roky)
Tab. 2. Time deviation of dental development in individual groups according to gender (yrs]
Difference of dental and chronological age (years)
group
CPO (n=129)
sex
UCLP (n=119)
Control (n=126)
female
(n=64)
male
(n=65)
female
(n=43)
male
(n=76)
female
(n=60)
male
(n=66)
mean
0.27
-0.02
0.20
0.06
0.01
0.13
median
0.24
0.07
0.35
0.14
0.13
0.15
standard deviation
0.97
1.01
0.96
0.88
1.04
1.08
maximum
3.23
2.05
2.25
2.01
2.32
2.45
minimum
-1.80
-2.88
-1.81
-2.23
-3.20
-4.08
variance
0.94
1.02
0.92
0.77
1.09
1.16
CPO - izolovany rozsÏteÏp patra, cleft palate only, UCLP - celkovy jednostranny rozsÏteÏp, unilateral cleft lip and palate, Control - kontrolnõ skupina, control group
Obr. 4. Odhad hustoty pravdeÏpodobnosti pro cÏasovou odchylku vyÂvoje dentice, porovnaÂnõÂ jedincuÊ dle pohlavõÂ mezi skupinami
Fig. 4. Probability density estimate for time deviation of dental development, comparison of boys and girls between individual groups.
Obr. 3. Odhad hustoty pravdeÏpodobnosti pro cÏasovou odchylku vyÂvoje dentice, porovnaÂnõÂ chlapcuÊ a dõÂvek v raÂmci jednotlivyÂch skupin.
CPO - izolovany rozsÏteÏp patra. UCLP - celkovy jednostranny rozsÏteÏp. Control - kontrolnõ skupina
Fig. 3. Probability density estimate for time deviation of dental development, comparison of boys and girls within individual groups. CPO
- cleft palate only. UCLP - unilateral cleft lip and palate. Control control group.
odlisÏnosti. Vztah zubnõÂho vyÂvoje a chronologickeÂho
veÏku zkoumanyÂch skupin se vzaÂjemneÏ neodlisÏuje.
2. CÏasova odchylka vyÂvoje dentice v prÏõÂpadeÏ rozdeÏlenõ jednotlivyÂch skupin podle pohlavõÂ: v rozsÏteÏpovyÂch
skupinaÂch majõ dõÂvky v pruÊmeÏru cÏasove odchylky vyÂvoje dentice vysÏsÏõ nezÏ chlapci ze stejne skupiny. RozdõÂl
pruÊmeÏruÊ cÏasove odchylky vyÂvoje dentice dõÂvek
a chlapcuÊ ve skupineÏ s izolovanyÂm rozsÏteÏpem patra
byl 0,29 roku. Ve skupineÏ s celkovyÂm jednostrannyÂm
rozsÏteÏpem byl rozdõÂl mezi pruÊmeÏry dõÂvek a chlapcuÊ
0,14 roku. V kontrolnõÂ skupineÏ naopak meÏli vysÏsÏõÂ cÏasovou odchylku vyÂvoje dentice chlapci: rozdõÂl mezi pruÊwww.orthodont-cz.cz e-mail: [email protected]
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Results
1. Time deviation of dental development: mean values in the group with isolated cleft lip and palate are
higher than mean values of the control group by 0.05
yrs; mean values of the group with complete unilateral
cleft are higher than the mean values of the control
group by 0.04 yrs (Table 1, Fig.2). Comparison of time
deviation of dental development in all three groups
(isolated cleft lip and palate, complete unilateral cleft,
control) did not prove statistically significant differences. The relationship between dental development
and chronological age of the groups tested is identical.
2. Time deviation of dental development in subdivisions of groups according to gender: in groups with
cleft girls show greater time deviations than boys of
the same group. The difference of mean values of time
deviation between girls and boys in the group with isolated cleft palate was 0.29 yrs. In the group with complete unilateral cleft it was 0.14 yrs. On the contrary, in
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ORTODONCIE
Tab. 3. CÏasova odchylka vyÂvoje dentice u jednotlivyÂch skupin podle veÏkovyÂch kategoriõ (roky)
Tab. 3. Time deviation of dental development in individual groups according to the age category (yrs)
Difference of dental and chronological age (years)
group
CPO (n=129)
age category
UCLP (n=119)
Control (n=126)
younger
(n=71)
older
(n=58)
younger
(n=63)
older
(n=56)
younger
(n=63)
older
(n=63)
mean
0.27
-0.06
0.21
0.00
0.35
-0.21
median
0.25
-0.15
0.25
0.04
0.37
-0.18
standard deviation
0.73
1.23
0.70
1.09
0.73
1.25
variance
0.54
1.51
0.48
1.20
0.53
1.57
CPO - izolovany rozsÏteÏp patra, cleft palate only, UCLP - celkovy jednostranny rozsÏteÏp, unilateral cleft lip and palate, Control - kontrolnõ skupina, control group
younger - mladsÏõ - veÏkova kategorie do 9 let, up to the age of 9
older - starsÏõ - veÏkova kategorie od 9 let, over the age of 9
Obr. 5. Odhad hustoty pravdeÏpodobnosti pro cÏasovou odchylku vyÂvoje dentice, porovnaÂnõ jedincuÊ dle veÏkovyÂch kategoriõ v raÂmci skupin; 1 - mladsÏõ - veÏkova kategorie do 9 let; 2 - starsÏõ - veÏkova kategorie od 9 let.
Fig. 5. Probability density estimate for time deviation of dental development, comparison of individuals according to age category within individual groups; 1 - younger - up to the age of 9; 2 - older - over
the age of 9.
meÏry byl 0,12 roku (Tabulka 2, Obr. 3 a 4). Podle nasÏich
vyÂsledkuÊ se v zÏaÂdne skupineÏ cÏasova odchylka vyÂvoje
dentice chlapcuÊ od dõÂvek statisticky vyÂznamneÏ nelisÏila.
DaÂle jsme porovnaÂvali cÏasovou odchylku vyÂvoje dentice chlapcuÊ a dõÂvek mezi skupinami. Ani zde nebyl nalezen statisticky vyÂznamny rozdõÂl.
3. CÏasova odchylka vyÂvoje dentice prÏi rozdeÏlenõ jedincuÊ podle veÏkovyÂch kategoriõ (do 9 let a od 9 let). Ve
vsÏech trÏech skupinaÂch nachaÂzõÂme pruÊmeÏr i mediaÂn cÏasove odchylky vyÂvoje dentice vysÏsÏõ u mladsÏõ veÏkoveÂ
kategorie. Naopak rozptyl je veÏtsÏõ u starsÏõ veÏkove kategorie. U skupiny s izolovanyÂm rozsÏteÏpem patra je rozdõÂl
mezi pruÊmeÏry u veÏkovyÂch kategoriõÂ 0,33 roku; u sku90
the control group the greater time deviation of dental
development was found in boys, the difference being
0.12 yrs (Table 2, Fig. 3 and 4). Our results did not show
statistically significant differences between boys and
girls. We also compared time deviation of dental development in boys and girls between individual groups.
No statistically significant difference was recorded.
3. Time deviation of dental development in subdivisions of groups according to age (up to 9 yrs, over 9
yrs): In all groups both mean value and median of time
deviation are higher in younger patients. On the contrary, dispersion variance is greater in older patients.
In the group with isolated cleft palate the difference
between the age categories is 0.33 yrs; in the group
with complete unilateral cleft the difference is 0.21
yrs; and in the control group the difference reached
0.56 yrs (Table 3, Fig.5). However, the differences are
not statistically significant.
4. Time deviation of dental development in subdivisions of the group with isolated cleft palate according
to the extent of anomaly (Table 4, Fig.6). The relationship between dental development and chronological
age does not depend on the extent of the anomaly.
Discussion
In patients with complete unilateral cleft Huyskens
et al. report both statistically and clinically significant
delay in dental development in both girls and boys in
comparison with a control group. In boys the delay
was more significant [3]. In our study we did not find
statistically significant delay in dental development in
individuals with cleft, and there was found no statistically significant difference between boys and girls.
The different results may be due to the different size
of the sample, different population, or different processing of Demirjian`s method.
HeidbuÈchel et al. focused on complete bilateral cleft
in children [4]. In girls they did not find statistically significant delay in dental development. In boys, when
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Tabulka 4. CÏasova odchylka vyÂvoje dentice ve skupineÏ s izolovanyÂm
rozsÏteÏpem patra, rozdeÏleno podle rozsahu postizÏenõÂ rozsÏteÏpem patra (roky)
Table 4. Time deviation of dental development in the group with isolated cleft palate (subdivison according to the extent of the anomaly
(yrs))
CPO
Difference of dental and chronological age (years)
subgroup
cpo - complete
(n=73)
cpom
(n=35)
cposm
(n=21)
mean
0.24
-0.06
0.02
median
0.25
0.17
-0.05
standard
deviation
0.98
1.10
0.87
cpo - complete - rozsÏteÏp tvrdeÂho a meÏkkeÂho patra, cleft of hard and
soft palate
cpom - rozsÏteÏp meÏkkeÂho patra, cleft of soft palate
cposm - submukoÂznõÂ rozsÏteÏp, submucous cleft
piny s celkovyÂm jednostrannyÂm rozsÏteÏpem je rozdõÂl
mezi pruÊmeÏry u veÏkovyÂch kategoriõ 0,21 roku a u kontrolnõ skupiny je rozdõÂl mezi pruÊmeÏry u veÏkovyÂch kategoriõ 0,56 roku (Tabulka 3, Obr. 5). Tyto nalezene rozdõÂly nejsou statisticky vyÂznamneÂ.
4. Byla porovnaÂna cÏasova odchylka vyÂvoje dentice
prÏi rozdeÏlenõÂ skupiny s izolovanyÂm rozsÏteÏpem patra
na podskupiny dle rozsahu postizÏenõÂ rozsÏteÏpem patra
(Tabulka 4, Obr. 6). Vztah zubnõÂho vyÂvoje a chronologickeÂho veÏku nezaÂvisõÂ na rozsahu postizÏenõÂ izolovanyÂm rozsÏteÏpem patra.
Diskuse
Huyskens et al. ve svyÂch vyÂsledcõÂch popisujõ u pacientuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem statisticky i klinicky vyÂznamne opozÏdeÏnõ vyÂvoje dentice
u obou pohlavõÂ oproti kontrolnõÂ skupineÏ. Chlapci meÏli
opozÏdeÏnõ veÏtsÏõ [3]. V nasÏõ studii jsme nenalezli statisticky vyÂznamne opozÏdeÏnõ vyÂvoje chrupu u jedincuÊ
s rozsÏteÏpem a ani chlapci se od dõÂvek ve vyÂvoji chrupu
statisticky vyÂznamneÏ nelisÏili. OdlisÏnost vyÂsledkuÊ muÊzÏe
byÂt daÂna rozdõÂlem ve velikosti souboru, odlisÏnou populacõÂ cÏi odlisÏnou metodikou zpracovaÂnõÂ vyÂsledkuÊ Demirjianovy metody.
HeidbuÈchel et al. se zabyÂvali ve sve praÂci vyÂvojem
chrupu u deÏtõÂ s celkovyÂm oboustrannyÂm rozsÏteÏpem
[4]. U dõÂvek postizÏenyÂch rozsÏteÏpem neprokaÂzali statisticky vyÂznamne opozÏdeÏnõ vyÂvoje chrupu. Chlapci meÏli
opozÏdeÏny vyÂvoj chrupu oproti kontrolnõ skupineÏ pouze
ve veÏku peÏti let. PozdeÏji, v 9,5 a ve 14 letech, jizÏ opozÏdeÏnõÂ pozorovaÂno nebylo. VyÂsledky autoruÊ HeidbuÈchel
et al. se, kromeÏ nalezeneÂho opozÏdeÏnõÂ vyÂvoje dentice
chlapcuÊ v peÏti letech, shodujõÂ s nasÏimi. V prÏõÂpadeÏ studie
HeidbuÈchel et al. se vsÏak jedna o jedince s veÏtsÏõÂm rozsahem postizÏenõ primaÂrnõÂho patra nezÏ v nasÏem souboru nebo v souboru Huyskens et al [3].
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Obr. 6. Odhad hustoty pravdeÏpodobnosti - porovnaÂnõ cÏasove odchylky vyÂvoje dentice ve skupineÏ s izolovanyÂm rozsÏteÏpem patra rozdeÏlene podle mõÂry postizÏenõ na podskupiny s rozsÏteÏpem tvrdeÂho
i meÏkkeÂho patra, s rozsÏteÏpem meÏkkeÂho patra a se submukoÂznõÂm
rozsÏteÏpem patra; cpo - complete - rozsÏteÏp tvrdeÂho a meÏkkeÂho patra;
cpom - rozsÏteÏp meÏkkeÂho patra; cposm - submukoÂznõÂ rozsÏteÏp.
Fig. 6. Probability density estimate - comparison of time deviation of
dental development in the group with isolated cleft palate subdivided according to the extent of anomaly: cleft of hard and soft palate,
cleft of soft palate, submucous cleft palate. cpo - complete - hard
and soft palate; cpom - cleft of soft palate; cposm - submucous cleft.
compared to a control group, they recorded delayed
dental development only in the group of the age of five.
Later, i.e. at the age of 9.5 and 14 years, no delay was
recorded. The results thus correspond to our data. However, Huyskens et al. [3] as well as HeidbuÈchel et al.
worked with individuals with more extensive anomaly
of the primary palate.
Lai et al., Harris and Hullings, report that teeth developing earlier show greater delay.This may be due to
the improved health during the complex treatment,
and due to fewer surgical interventions in mouth cavity
performed in older patients [1,5]. Another explanation
may be that the development of roots in teeth established during a prenatal period (incisors and first molars)
is finished around the age of 9, and therefore, they do
not have much impact on dental age calculation. Most
probands included in our study were between 8.5 and
9 years of age. Dental development was thus evaluated according to the teeth developing later. These
teeth show - according to Lai et al., Harris and Hullings
- fewer tendencies to delay, and this may be the reason
why we did not record dental development delay in individuals with cleft.
Heliovaara and NystroÈm studied dental development
in patients with isolated cleft palate and compared the
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Lai et al. a Harris a Hullings konstatovali ve svyÂch
pracõÂch, zÏe zuby, ktere se vyvõÂjejõ drÏõÂve, jsou opozÏdeÏny
võÂce. DomnõÂvajõÂ se, zÏe je to zpuÊsobeno zlepsÏujõÂcõÂm se
zdravotnõÂm stavem v pruÊbeÏhu komplexnõÂ leÂcÏby a takeÂ
mensÏõÂm pocÏtem chirurgickyÂch vyÂkonuÊ v oblasti dutiny
uÂstnõ v pozdeÏjsÏõÂm veÏku [1, 5]. Je take mozÏneÂ, zÏe jsou
postizÏeny hlavneÏ prenataÂlneÏ se zaklaÂdajõÂcõ zuby (rÏezaÂky a prvnõ molaÂry), ktere majõ ve veÏku okolo 9 let
ukoncÏeny vyÂvoj korÏenuÊ, a proto odecÏõÂtaÂnõ zubnõÂho
veÏku prÏõÂlisÏ neovlivnõÂ. V nasÏõÂ studii bylo maximum probanduÊ praÂveÏ v tomto veÏku (8,5 - 9 let). Lze rÏõÂci, zÏe vyÂvoj
chrupu jsme hodnotili podle pozdeÏji se vyvõÂjejõÂcõÂch
zubuÊ. Ty majõÂ podle Lai et al. a Harris a Hullings mensÏõÂ
tendenci k opozÏdeÏnõÂ a proto je mozÏneÂ, zÏe jsme opozÏdeÏnõÂ vyÂvoje dentice u jedincuÊ s rozsÏteÏpem nenalezli.
Heliovaara a NystroÈm se zabyÂvali vyÂvojem chrupu
u izolovaneÂho rozsÏteÏpu patra a jeho porovnaÂnõÂm podle
mõÂry postizÏenõÂ [6]. Skupina v pruÊmeÏrneÂm veÏku 6,1 let se
submukoÂznõÂm rozsÏteÏpem patra nebyla statisticky vyÂznamneÏ opozÏdeÏna, ale skupina s rozsÏteÏpem meÏkkeÂho
patra byla statisticky signifikantneÏ opozÏdeÏna o 0,2
roku oproti finskyÂm populacÏnõÂm standarduÊm. V nasÏõÂ
praÂci jsme nenalezli statisticky signifikantnõÂ rozdõÂly
mezi podskupinami s ruÊznou mõÂrou postizÏenõÂ izolovanyÂm rozsÏteÏpem patra.
Demirjianova metoda vyuzÏõÂva k hodnocenõ zubnõÂho
veÏku zuby nepostizÏene dolnõ cÏelisti, takzÏe je eliminovaÂno puÊsobenõ rozsÏteÏpu na vyÂvoj zubuÊ a lokaÂlnõ postnataÂlnõ vliv prostrÏedõ (chirurgicke trauma, porusÏeneÂ
ceÂvnõÂ zaÂsobenõÂ a inervace, ...).
Jordan et al. se domnõÂvajõÂ, zÏe za mozÏne opozÏdeÏnõÂ
vyÂvoje chrupu mohou stejne geneticke faktory, jako
za tvorbu orofaciaÂlnõÂho rozsÏteÏpu [7]. Proto bychom
mohli ocÏekaÂvat, zÏe v prÏõÂpadeÏ silneÂho genetickeÂho
ovlivneÏnõÂ vyÂvoje chrupu rozsÏteÏpem je opozÏdeÏnõÂ, jak nalezli Ranta, Harris a Hullings, Lai et al. a Brouwers
a Kuijpers-Jagtman [1, 5, 8, 9], prÏõÂtomno v obou cÏelistech. Bartl a Kot'ova nalezli ve sve praÂci signifikantnõÂ
opozÏdeÏnõ ve vyÂvoji staÂlyÂch sÏpicÏaÂkuÊ v oblasti rozsÏteÏpove sÏteÏrbiny jedincuÊ s celkovyÂm jednostrannyÂm rozsÏteÏpem oproti kontrolnõ skupineÏ jedincuÊ bez rozsÏteÏpu
[10], cozÏ souhlasõÂ s naÂzory dalsÏõÂch autoruÊ, kterÏõÂ teÂzÏ uvaÂdeÏjõÂ veÏtsÏõÂ opozÏdeÏnõÂ vyÂvoje zubnõÂch zaÂrodkuÊ v blõÂzkosti
rozsÏteÏpove sÏteÏrbiny celkoveÂho jednostranneÂho rozsÏteÏpu [11, 12] nebo v rozsÏteÏpem postizÏene hornõ cÏelisti
jako celku [13, 14]. Proto i v souvislosti s nasÏimi vyÂsledky usuzujeme, zÏe vyÂvoj dentice v dolnõ nepostizÏene cÏelisti rozsÏteÏpem nenõ ovlivneÏn a opozÏdeÏnõ se
projevuje hlavneÏ v blõÂzkosti malformace. OpozÏdeÏnõÂ vyÂvoje chrupu v hornõÂ cÏelisti oproti zubuÊm dolnõÂ cÏelisti maÂ
klinicke duÊsledky pro ortodontickou terapii a jejõ plaÂnovaÂnõÂ. PrÏi leÂcÏbeÏ pacientuÊ s rozsÏteÏpem se ortodontista
cÏasto soustrÏedõÂ na situaci v hornõÂ cÏelisti a v oblasti rozsÏteÏpu. V prÏõÂpadeÏ, zÏe je vyÂvoj dentice v dolnõÂ cÏelisti rela92
ORTODONCIE
patients with different extent of anomaly [6]. The group
of mean age 6.1 yrs with submucose cleft palate did
not show statistically significant delay in dental development. However, the group with cleft soft palate showed
statistically significant delay by 0.2 yrs - compared to
population standards in Finnland. In our study we did
not find statistically significant differences between
subgroups with different extent of anomaly.
Demirjian's method is used to assess dental age according to lower teeth without anomaly. Thus the cleft
does not impact dental development, and the impact
of environment in postnatal period is eliminated
(trauma due to surgery, disturbed vascular supply, innervation, etc.).
Jordan et al. believe that delayed dental development is caused by the same genetic factors which
cause orofacial clefts [7]. Thus, it is to be expected that
in case of a substantial genetic influence of dental development by cleft, the delay is present in both jaws
(Ranta, Harris and Hullings, Lai et al., Brouwers and
Kuijpers-Jagtman [1,5,8,9]). Bartl and Kot'ova report
significant delay in development of permanent canines
in the area of cleft in individuals with complete unilateral cleft compared to the control group without cleft
[10]. This is in agreement with the results of other authors who reported greater delay of dental germs development near to cleft in complete unilateral cleft
[11,12] or in the maxila with cleft [13,14]. Therefore,
we infer (based on the results obtained) that dental development in the non-cleft mandible is not affected
and that the delay manifests itself near the anomaly.
Delay in dental development in the maxilla compared
to the situation in the mandible has clinical consequences for orthodontic therapy and planning of the orthodontic treatment. During the therapy of patients with
cleft an orthodontist tends to focus on the maxilla
and the area with cleft. However, when dental development in the mandible is relatively faster than in the maxilla, it is important to solve orthodontic anomalies in
the lower dental arch, too.
To find more relationships in terms of dental development in individuals with cleft it is vital to pay more
attention to dental development in terms of individual
teeth and compare their development in both mandible
and maxilla. We should also pay attention to whether
there are differences in the development of various
groups of teeth.
Conclusion
The aim of the presented study was to compare
dental development in patients with complete unilateral cleft, isolated cleft palate, and a control group.
1. There is no difference in time of dental development in patients with cleft anomaly affecting dental lawww.orthodont-cz.cz e-mail: [email protected]
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tivneÏ rychlejsÏõÂ oproti vyÂvoji v hornõÂ cÏelisti, je trÏeba se
vcÏas veÏnovat rovneÏzÏ rÏesÏenõÂ ortodontickyÂch anomaÂliõÂ
v dolnõÂm zubnõÂm oblouku. Nenõ spraÂvne orientovat se
podle opozÏdeÏneÂho vyÂvoje zubuÊ v postizÏene oblasti.
Pro nalezenõÂ hlubsÏõÂch souvislostõÂ vyÂvoje dentice u jedincuÊ s rozsÏteÏpem by bylo trÏeba detailneÏji prozkoumat
vyÂvoj chrupu z hlediska jednotlivyÂch zubuÊ a porovnat
jejich vyÂvoj mezi obeÏma cÏelistmi. Take by bylo zajõÂmave zjistit, zda se od sebe lisÏõ v rychlosti vyÂvoje ruÊzneÂ
skupiny zubuÊ.
mina and patients with isolated cleft palate without affected dental lamina.
2. There is no difference in time of dental development in patients with isolated cleft palate and children
without cleft.
3. There is no difference in time of dental development in patients with complete unilateral cleft and
children without cleft.
4. It is important to respect differences in development of individual teeth adjacent to cleft area.
ZaÂveÏr
CõÂlem praÂce bylo porovnat vyÂvoj chrupu pacientuÊ
s celkovyÂm jednostrannyÂm rozsÏteÏpem, s izolovanyÂm
rozsÏteÏpem patra a kontrolnõÂ skupiny zdravyÂch jedincuÊ.
1. NenõÂ rozdõÂl mezi cÏasovou odchylkou vyÂvoje dentice u pacientuÊ s rozsÏteÏpovyÂm postizÏenõÂm zasahujõÂcõÂm
oblast dentaÂlnõÂ lisÏty a s izolovanyÂm rozsÏteÏpovyÂm postizÏenõÂm patra, kde nenõÂ dentaÂlnõÂ lisÏta zasazÏena.
2. NenõÂ rozdõÂl mezi cÏasovou odchylkou vyÂvoje dentice u pacientuÊ s postizÏenõÂm izolovanyÂm rozsÏteÏpem
patra a u jedincuÊ bez postizÏenõÂ rozsÏteÏpem.
3. NenõÂ rozdõÂl mezi cÏasovou odchylkou vyÂvoje dentice u pacientuÊ s postizÏenõÂm celkovyÂm jednostrannyÂm
rozsÏteÏpem a u jedincuÊ bez postizÏenõÂ rozsÏteÏpem.
4. Je trÏeba respektovat vyÂvojove odlisÏnosti zubuÊ vyvõÂjejõÂcõÂch se v bezprostrÏednõÂm okolõ rozsÏteÏpoveÂho defektu.
Acknowledgment: Authors want to express their
thanks to Ing. Nikola KasprÏÂõkovaÂ, Ph.D. for her substantial help in data statistical processing.
PodeÏkovaÂnõÂ: AutorÏi deÏkujõÂ Ing. Nikole KasprÏÂõkoveÂ,
Ph.D. za vyÂznamnou pomoc prÏi zpracovaÂnõÂ statistickyÂch vyÂsledkuÊ.
AutorÏi nemajõ komercÏnõÂ, vlastnicke nebo financÏnõ zaÂjmy na produktech nebo spolecÏnostech popsanyÂch v tomto cÏlaÂnku.
Literatura/ References
1. Harris, E. F.; Hullings, J. G.: Delayed dental development
in children with isolated cleft lip and palate. Arch. Oral Biol.
1990, 35, cÏ. 6, s. 469 - 473.
2. Demirjian, A.; Goldstein, H.; Tanner, J. M.: A new system
of dental age assessment. Hum. Biol. 1973, 45, cÏ. 2,
s. 211-227.
3. Huskens, R. W. F. et al.: Dental age in children with a complete unilateral cleft lip and palate. Cleft Palate Craniofac.
J. 2006, 43, cÏ. 5, s. 612-615.
4. HeidbuÈchel, K. L. W. M. et al.: Dental maturity in children
with a complete bilateral cleft lip and palate. Cleft Palate
Craniofac. J. 2002, 39, cÏ. 5, s. 509-512.
Authors have no commercial, proprietary or financial interest in
products or companies mentioned in the article.
5. Lai, M. C.; King N. M.; Wong, H.M.: Dental development
of Chinese children with cleft lip and palate. Cleft Palate
Craniofac. J. 2008, 45, cÏ. 3, s. 289-296.
6. Heliovaara, A.; NystroÈm, M.: Dental age in 6-year-old
children with submucous cleft palate and cleft of the soft
palate. Acta Odontol. Scand. 2009, 67, cÏ. 2, s. 80-84.
7. Jordan, R. E.; Kraus, B. S.; Neptune, C. M.: Dental abnormalities associated with cleft lip and/or palate. Cleft Palate J. 1966, 3, cÏ. 1, s. 22-55.
8. Brouwers, H. J.; Kuijpers-Jagtman, A. M.: Development
of permanent tooth length in patients with unilateral cleft
lip and palate. Amer. J. Orthodont. dentofacial Orthop.
1991, 99, cÏ. 6, s. 543-549.
9. Ranta, R.: A review of tooth formation in children with
cleft lip/palate. Amer. J. Orthod. dentofacial Orthop.
1986, 90, cÏ. 1, s. 11-18.
10. Bartl, J.; Kot'ovaÂ, M: ProrÏezaÂvaÂnõÂ hornõÂho staÂleÂho sÏpicÏaÂku
u pacientuÊ s rozsÏteÏpovou vadou. Ortodoncie. 2011, 20,
cÏ.4, s.198-207.
11. Solis, A. et al. Maxillary dental development in complete
unilateral alveolar clefts. Cleft Palate Craniofac. J. 1998,
35, cÏ. 4, s. 320-328.
12. Ribeiro, L. L. et al.: Dental anomalies of the permanent lateral incisors and prevalence of hypodontia outside the
cleft area in complete unilateral cleft lip and palate. Cleft
Palate Craniofac. J. 2003, 40, cÏ. 2, s. 172-175.
13. Haring, F. N.: Dental development in cleft and noncleft
subjects. Angle Orthodont. 1976, 46, cÏ. 1, s. 47-50.
14. Borodkin, A. F. et al.: Permanent tooth development in
children with cleft lip and palate. Pediatr. Dent. 2008,
30, cÏ. 5, s. 408-413.
MUDr. VladimõÂr Patrik KolaÂrÏ
Stomatologicka klinika FNKV Praha
SÏrobaÂrova 50, 100 34, Praha 10
www.orthodont-cz.cz e-mail: [email protected]
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Vliv prÏedoperacÏnõÂho zachovaÂnõÂ Speeovy krÏivky v dolnõÂm
zubnõÂm oblouku na vertikaÂlnõÂ parametry a estetiku
oblicÏeje po operaci
Curve of Spee - maintenance of the curve before surgery
in lower dental arch and its impact on vertical parameters
and esthetic results after surgery
*MUDr. Eva MichalcovaÂ, *MUDr. Hana TycovaÂ, *MUDr. Josef KucÏera, **RNDr. JaromõÂr BeÏlaÂcÏek, CSc.
*Ortodonticke oddeÏlenõ Stomatologicke kliniky 1. LF UK Praha
*Department of Orthodontics, Clinic of Stomatology, 1st Medical Faculty of Charles University in Prague
**OddeÏlenõÂ Biostat prÏi UÂstavu biofyziky a informatiky, 1. LF UK Praha
**Biostat, Institute of Biophysics and Information Technologies, 1st Medical Faculty of Charles University Prague
Souhrn
Studie se zabyÂvala vlivem prÏedoperacÏnõÂho zachovaÂnõÂ Speeovy krÏivky v dolnõÂm zubnõÂm oblouku na estetiku dolnõÂ trÏetiny oblicÏeje u pacientuÊ s II. skeletaÂlnõÂ trÏÂõdou a ortognaÂtnõÂm posunem dolnõÂ cÏelisti smeÏrem doprÏedu. U pacientuÊ se zachovanou Speeovou krÏivkou bylo prÏedpoklaÂdaÂno, zÏe po operaci dojde ke zveÏtsÏenõÂ vertikaÂlnõÂch parametruÊ a mensÏÂõ prominenci bradoveÂho vyÂbeÏzÏku.
Soubor obsahoval 36 dospeÏlyÂch pacientuÊ s II. skeletaÂlnõÂ trÏÂõdou, rozdeÏlenyÂch do dvou skupin podle hloubky
Speeovy krÏivky prÏed ortognaÂtnõÂ operacõÂ. Skupinu A (n = 18, 9 zÏen, 9 muzÏuÊ) tvorÏili pacienti se zachovanou Speeovou krÏivkou (HS ³ 3 mm). Skupinu B (n = 18, 7 zÏen, 11 muzÏuÊ) tvorÏili pacienti s vyrovnanou Speeovou krÏivkou
(HS £ 2 mm). U vsÏech pacientuÊ byly zhodnoceny trÏi kefalometricke snõÂmky, prÏed zahaÂjenõÂm ortodonticke leÂcÏby
(T0), prÏed ortognaÂtnõÂ operacõÂ (T1) a po sejmutõÂ fixnõÂho aparaÂtu (T2).
PorovnaÂnõÂm vyÂsledkuÊ mezi skupinami pacientuÊ byly potvrzeny statisticky signifikantnõÂ rozdõÂly pouze u hloubky
skusu. U pacientuÊ s vyrovnanou Speeovou krÏivkou prÏed operacõÂ dosÏlo k statisticky signifikantnõÂmu zmensÏenõÂ
hloubky skusu beÏhem ortodonticke prÏedoperacÏnõ prÏÂõpravy (T1-T0), zatõÂmco u pacientuÊ se zachovanou Speeovou
krÏivkou prÏed operacõÂ dosÏlo k statisicky signifikantnõÂ redukci hloubky skusu azÏ v obdobõÂ beÏhem operace a ortodontickeÂho doleÂcÏenõÂ po operaci (T2-T1). U ostatnõÂch sledovanyÂch parametruÊ nebyly prokaÂzaÂny statisticky signifikantnõÂ rozdõÂly mezi skupinou pacientuÊ se zachovanou a vyrovnanou Speeovou krÏivkou (Ortodoncie 2012, 21, cÏ. 2,
s. 94-101).
Abstract
The impact of preserved Spee curve in the lower dental arch prior to surgery on the esthetics of the lower third
of face in patients with Class II and orthognathic advancement of the mandible is studied. It was hypothesized
that in patients with preserved Spee curve the vertical parameters would increase and mental protuberance
would be less prominent after surgical management.
The sample had 36 adult patients with Class II, subdivided into two groups according to the depth of the Spee
curve prior to orthognathic surgery. Group A (n = 18, 9 females, 9 males) included patients with preserved Spee
curve (DB ³ 3 mm). Group B (n = 18, 7 females, 11 males) included patients with leveled Spee curve (DB £ 2 mm).
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In all patients three cephalograms were taken: prior to orthodontic treatment (T0), prior to orthognathic surgery
(T1), after the removal of fixed orthodontic appliance (T2).
Comparison of results between groups of patients proved statistically significant differences only in the overbite. In patients with leveled Spee curve before the surgery statistically significant reduction of depth of bite during the treatment prior to surgery (T1-T0) was observed, whilst in patients with preserved Spee curve before surgery the depth of bite significantly reduced only in the period following the intervention and during the orthodontic after-treatment (T2-T1). In other parameters monitored no statistically significant differences were recorded
(Ortodoncie 2012, 21, No. 2, p. 94-101).
KlõÂcÏova slova: Speeova krÏivka, ortognaÂtnõ operace, skeletaÂlnõ II.trÏÂõda
Key words: curve of Spee, orthognathic surgery, skeletal Class II
UÂvod
Kombinovana ortodonticko-chirurgicka terapie je
indikovaÂna u pacientuÊ se zaÂvazÏnou skeletaÂlnõÂ II. trÏõÂdou,
kde by kompenzacÏnõ ortodonticka leÂcÏba vedla k esteticky nevyhovujõÂcõÂmu vyÂsledku. Pokud se pacient rozhodne podstoupit ortognaÂtnõ operaci, je uÂkolem ortodontisty prÏipravit zubnõ oblouky tak, aby vyÂsledek po
operaci byl nejen funkcÏnõÂ, ale take co nejvõÂce estetickyÂ.
U pacientuÊ s II. skeletaÂlnõÂ trÏõÂdou, vertikaÂlnõÂm deficitem
a vyÂraznyÂm bradovyÂm vyÂbeÏzÏkem je neÏkteryÂmi autory
doporucÏovaÂno prÏed operacõÂ zachovaÂnõÂ vyÂrazneÂ
Speeovy krÏivky v dolnõÂm zubnõÂm oblouku [1, 2, 3, 4, 5,
6]. Pokud nejsou dolnõÂ rÏezaÂky prÏedoperacÏneÏ intrudovaÂny, dostaÂvajõÂ se beÏhem chirurgickeÂho posunu dolnõÂ
cÏelisti smeÏrem doprÏedu po lingvaÂlnõÂ plosÏe hornõÂch rÏezaÂkuÊ võÂce doluÊ [7]. TõÂm dochaÂzõÂ k rotaci dolnõÂ cÏelisti po
smeÏru hodinovyÂch rucÏicÏek, zveÏtsÏenõÂ dolnõÂ trÏetiny oblicÏeje a zmensÏenõÂ prominence bradoveÂho vyÂbeÏzÏku [4, 5,
6, 7]. Speeova krÏivka je vyrovnaÂna po chirurgickeÂm vyÂkonu extruzõ lateraÂlnõÂch uÂsekuÊ pomocõ vertikaÂlnõÂch intermaxilaÂrnõÂch elastickyÂch tahuÊ. NavõÂc, pooperacÏnõÂm vyrovnaÂnõÂm Speeovy krÏivky nenõ nutne prÏekonaÂvat velkeÂ
zÏvyÂkacõ sõÂly typicke pro pacienty s hlubokyÂm skusem
a je mozÏne zkraÂtit celkovou dobu leÂcÏby [7].
CõÂlem teÂto studie bylo urcÏit vliv prÏõÂpravy Speeovy
krÏivky v dolnõÂm zubnõÂm oblouku na estetiku dolnõÂ trÏetiny oblicÏeje u pacientuÊ s II. skeletaÂlnõÂ trÏõÂdou po posunu
dolnõ cÏelisti smeÏrem doprÏedu v raÂmci ortodontickochirurgicke spolupraÂce.
MateriaÂl
VysÏetrÏovany soubor tvorÏilo 44 dospeÏlyÂch pacientuÊ
s II. skeletaÂlnõÂ trÏõÂdou. Z tohoto souboru muselo byÂt vyloucÏeno 8 pacientuÊ pro neuÂplnou dokumentaci, nedostatecÏnou cÏitelnost kefalometrickyÂch snõÂmkuÊ nebo nesplneÏnõÂ podmõÂnek pro zarÏazenõÂ do skupiny A nebo B.
Z teÏchto duÊvoduÊ konecÏny soubor obsahoval 36 pacientuÊ - 16 zÏen a 20 muzÏuÊ. VsÏichni pacienti byli bõÂleÂ
rasy, s ukoncÏenyÂm ruÊstem a podstoupili monomaxilaÂrnõÂ operaci s posunem dolnõÂ cÏelisti smeÏrem doprÏedu.
U vsÏech pacientuÊ byly zhodnoceny trÏi kefalometricke snõÂmky a to prÏed zahaÂjenõÂm ortodonticke leÂcÏby
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Introduction
Combined orthodontic-orthognathic therapy is indicated in patients with serious Skeletal Class II, the
condition in which orthodontic compensation therapy
might lead to esthetically insufficient outcome. In case
a patient decides for orthognathic surgery, an orthodontist has to prepare dental arches in such way that
the intervention result is not only functional but meets
also esthetic standards.
In patients with skeletal Class II, vertical deficit, and
expressed mental protuberance some authors recommend to preserve a distinct curve of Spee in the lower
dental arch [1, 2, 3, 4, 5, 6]. In case lower incisors are
not intruded prior to surgery, they move more downwards along lingual surface of maxillary incisors during
advancement of the mandible [7]. Thus the mandible
rotates clockwise, the lower third of face is longer
and mental protuberance is reduced [4, 5, 6, 7]. The
curve of Spee is leveled after surgery by lateral segments extrusion through vertical intermaxillary elastics. Moreover, due to the Spee curve levelling it is
not necessary to fight the extensive masticatory force
of patients, which is otherwise typical in patients with
deep bite, and, therefore, the treatment is shorter [7].
The aim of our study was to determine the role of the
curve of Spee arrangement in the lower dental arch on
the esthetics of the lower third of face in patients with
Skeletal Class II after the mandible advancement within the cooperation between an orthodontist and an
orthognathic surgeon.
Material
The sample had 44 adults with Skeletal Class II. 8
patients were eliminated from the sample due to incomplete records, bad quality of cephalograms, or because they did not meet the conditions of group A or B.
Thus the final sample had 36 patients - 16 women and
20 men. All patients were Caucasians with finished
growth, and they underwent monomaxillary surgery involving the mandible advancement.
For each patient there were made three cephalograms - before orthodontic treatment (T0), before
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(T0), prÏed ortognaÂtnõÂ operacõÂ (T1) a po sejmutõÂ fixnõÂho
aparaÂtu (T2).
Soubor pacientuÊ byl rozdeÏlen do dvou zaÂkladnõÂch
skupin podle hloubky Speeovy krÏivky v cÏase T1. Skupinu A (n = 18, 9 zÏen, 9 muzÏuÊ) tvorÏili pacienti se zachovanou Speeovou krÏivkou a hloubkou Speeovy krÏivky
prÏed operacõ v cÏase T1 ³ 3mm. PruÊmeÏrna hloubka
Speeovy krÏivky u skupiny A v cÏase T1 byla 3,23 mm
a smeÏrodatna odchylka (SD) 0,24. Skupinu B (n = 18,
7 zÏen, 11 muzÏuÊ) tvorÏili pacienti s vyrovnanou Speeovou
krÏivkou a hloubkou Speeovy krÏivky prÏed operacõÂ v cÏase
T1 £ 2mm. PruÊmeÏrna hloubka Speeovy krÏivky u skupiny B v cÏase T1 byla 1,57 mm a SD 0,39. Pacienti
s hloubkou Speeovy krÏivky 2,1 - 2,9 mm byli ze souboru pacientuÊ vyrÏazeni.
Kefalometricke snõÂmky byly prÏekreslovaÂny rucÏneÏ
jednou osobou na negatoskopu na acetaÂtovy papõÂr
s prÏesnostõÂ 0,5 mm nebo 0,5°. SnõÂmky byly zõÂskaÂvaÂny
z ruÊznyÂch zdrojuÊ, proto bylo nutne na kazÏdeÂm snõÂmku
stanovit dle meÏrÏõÂtka koeficient zveÏtsÏenõ a vsÏechny lineaÂrnõ hodnoty jõÂm vynaÂsobit, aby vyÂsledne hodnoty
odpovõÂdaly skutecÏnyÂm velikostem.
Metodika
Hloubka Speeovy krÏivky byla hodnocena na kefalometrickyÂch snõÂmcõÂch zhotovenyÂch v cÏase T1. Na kazÏdeÂm snõÂmku byla vyznacÏena Speeova krÏivka jako linie
sahajõÂcõÂ od incizaÂlnõÂch hran dolnõÂch rÏezaÂkuÊ, pokracÏujõÂcõÂ
prÏes hrot sÏpicÏaÂku a hrbolky premolaÂruÊ na hrbolky nejvõÂce distaÂlneÏ ulozÏenyÂch plneÏ prorÏezanyÂch zubuÊ. JejõÂ
hloubka byla hodnocena v mõÂsteÏ nejveÏtsÏõÂ konvexity
jako kolmice k prÏõÂmce sahajõÂcõÂ od incizaÂlnõÂch hran dolnõÂch rÏezaÂkuÊ k distaÂlnõÂmu hrbolku nejvõÂce vzadu prorÏezaneÂho zubu. HodnocenõÂ hloubky Speeovy krÏivky je
patrne z obraÂzku cÏ. 1.
Na kefalometrickyÂch snõÂmcõÂch v cÏase T0, T1 a T2
byly hodnoceny 4 parametry uÂhloveÂ, 5 parametruÊ lineaÂrnõÂch a vypocÏteny 2 pomeÏrne indexy (Tab. 1,
Obr. 3). NeÏktere byly stanoveny za pomoci horizontaÂlnõ referencÏnõ linie (HRL), prochaÂzejõÂcõ bodem Sela
Obr. 1. HodnocenõÂ hloubky Speeovy krÏivky
Fig. 1. Evaluation of the depth of Spee curve
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orthognathic surgery (T1), and after removal of fixed
appliance (T2).
The sample was divided into two groups according to
the depth of Spee curve at T1. Group A (n=18, 9 women,
9 men) involved patients with preserved curve of Spee,
the depth of which at T1 ³ 3 mm. The mean depth of
Spee curve at T1 was 3.23 mm, standard deviation
(SD) 0.24. Group B (n=18, 7 women, 11 men) involved
patients with levelled Spee curve, the depth of which
was at T1 £ 2 mm. The mean depth of Spee curve at
T1 £ 1.57, SD 0.39. Patients with the depth of Spee curve
of 2.1 - 2.9 mm were excluded from the sample.
Cephalograms were traced manually by one and the
same person using negatoscope and acetate film, with
the accuracy of 0.5 mm or 0.5°. Cephalograms were
obtained from different sources; therefore, in each
cephalogram there was determined coefficient of
enlargement and all linear parameters were multiplied
by the coefficient so that the resulting values corresponded to actual dimensions.
Method
The depth of Spee curve was evaluated in cephalograms taken at T1. In each image the curve of Spee
Obr. 2a - pacient se zachovanou Speeovou krÏivkou prÏed operacõÂ
v cÏase T1, b - pacient s vyrovnanou Speeovou krÏivkou prÏed operacõÂ
Fig. 2a - patient with retained Spee curve at T1, b - patient with levelled Spee curve at T1.
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a svõÂrajõÂcõÂ s liniõÂ SN 7° a vertikaÂlnõÂ referencÏnõÂ linie (VRL),
kolme k HRL a prochaÂzejõÂcõ Subnasale.
NeÏktere parametry:
LAFH - dolnõ prÏednõ oblicÏejova vyÂsÏka, vzdaÂlenost
Spina nasalis anterior a Menton paralelnõÂ s VRL,
APFH index - pomeÏr zadnõ oblicÏejove vyÂsÏky a prÏednõÂ
oblicÏejove vyÂsÏky, SGo/NMe,
AFH index - pomeÏr dolnõ prÏednõ oblicÏejove vyÂsÏky
a celkove prÏednõ oblicÏejove vyÂsÏky paralelnõ k VRL.
VyÂsledky meÏrÏenõ byly vlozÏeny do tabulkoveÂho programu Excel (Microsoft Office, 2007). U vsÏech nameÏrÏenyÂch hodnot byl stanoven aritmeticky pruÊmeÏr, mediaÂn,
minimaÂlnõ a maximaÂlnõ hodnota a smeÏrodatna odchylka.
Data byla statisticky zpracovaÂna v programu Statistica 9 (Statsoft) a SPSS 17. NormaÂlnõÂ distribuce dat byla
u obou skupin testovaÂna pomocõ Kolmogorov-Smirnovova testu a pomocõ testu zalozÏeneÂho na vyÂbeÏrove sÏikmosti (skewness) a vyÂbeÏrove sÏpicÏatosti (kurtosis). Pro zji-
was represented as the line running from incisal edge
of lower incisors, continuing over canine tip and premolars cusps onto the cusps of fully erupted most distal teeth. The depth was evaluated in the point of the
greatest convexity as a perpendicular to the straight
line running from incisal edge of lower incisors to the
distal cusp of the most distal erupted tooth. The evaluation is represented in Figure 1.
In cephalograms taken at T0, T1, and T2, there were
evaluated 4 angular parameters, 5 linear parameters,
and 2 proportional indexes were calculated (Fig. 3).
Some of them were determined with the help of horizontal reference line (HRL), running through Sella point
and containing with SN line 7°, and vertical reference
line (VRL), perpendicular to HRL and running through
Subnasale.
Some parameters:
LAFH - lower anterior facial height, distance of
Spina nasalis anterior and Menton parallel with VRL,
APFH index - proportion of posterior and anterior facial height, SGo/NMe,
AFH index - proportion of anterior facial height and
overal anterior facial height parallel to VRL, Spa-Me/NMe.
Measurements were fed into Excel (Microsoft
Office, 2007). For all values there was assessed arithmetic mean, median, minimum and maximum value,
and standard deviation.
The data were statistically processed with Statistica
9 (Statsoft) and SPSS 17. Normal distribution of the
data in both groups was tested with KolmogorovSmirnov test, and tests based on selective skewness
and selective kurtosis. To establish statistical significance of differences between measurements done at
3 Obr. 3. RozmeÏry na kefalometrickeÂm snõÂmku
Fig.3: Measurement on cephalogram
HRL - horizontaÂlnõÂ referencÏnõÂ linie, horizontal reference line, VRL - vertikaÂlnõÂ referencÏnõÂ linie, vertical reference line, OB (HS) - hloubka
skusu, vzdaÂlenost Incisale superius a Incisale inferius paralelnõÂ
s VRL, overbite, distance of Incisale superius and Incisale inferius
parallel with VRL, OJ (IS) - incizaÂlnõÂ schuÊdek, vzdaÂlenost Incisale superius k bukaÂlnõÂmu povrchu dolnõÂho rÏezaÂku, overjet, distance between Incisale superius and buccal surface of lower incisor, Pog - pozice brady, vzdaÂlenost bodu Pogonion a VRL paralelnõÂ s HRL, chin
position, distance of Pogonion and VRL parallel with HRL.
Tab. 1. MeÏrÏene rozmeÏry
Tab. 1. Measurements
Úhlové parametry
Angular parameters (°)
SNB
ANB
SNML
NLML
Lineární parametry
Linear parameters (mm)
Wits
OB (HS)
OJ (IS)
Pog
LAFH
Poměrné indexy
Proportional indexes
APFH index
AFH index
Popis parametruÊ je v legendeÏ k obr. 3, description of measurements in legend to Fig. 3
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Tabulka cÏ. 2: Hodnoty u skupiny A (zachovana Speeova krÏivka v T1).
Table 2: Values for group A (preserved Spee curve at T1)
T0
SNB
ANB
Wits
OB(HS)
OJ(IS)
SNML
NLML
Pog
LAFH
APFH
AFH
Mean
75.28
5.83
7.83
7.63
7.93
26.36
18.58
25.36
59.46
0.61
0.46
SD
3.23
2.20
3.44
1.97
4.29
7.01
6.21
4.45
5.23
0.067
0.039
Skupina A, Group A
T1
Mean
SD
75.11
3.20
5.50
2.08
7.62
3.90
6.54
1.57
8.78
3.09
27.11
7.77
18.89
6.66
25.22
4.69
60.37
5.39
0.63
0.128
0.47
0.094
T2
Mean
78.50
1.67
-0.44
2.91
2.42
29.75
21.61
19.10
62.94
0.68
0.55
SD
3.15
1.99
2.65
0.72
0.67
7.26
6.60
4.62
6.11
0.215
0.186
Tabulka cÏ. 3: Hodnoty u skupiny B (vyrovnana Speeova krÏivka v T1)
Table 3: Values for group B (levelled Spee curve at T1)
T0
SNB
ANB
Wits
OB (HS)
OJ (IS)
SNML
NLML
Pog
LAFH
APFH
AFH
Mean
77.11
6.28
8.02
7.47
6.76
25.06
19.17
25.50
59.55
0.63
0.46
SD
3.29
1.90
2.53
2.51
4.19
5.88
6.34
4.49
6.81
0.076
0.052
Skupina B, Group B
T1
Mean
SD
77.14
3.19
6.22
2.03
7.37
2.30
5.08
1.72
7.86
2.59
25.31
5.57
19.22
5.82
26.01
4.47
62.93
7.16
0.72
0.193
0.53
0.144
sÏteÏnõ statisticke vyÂznamnosti rozdõÂluÊ mezi meÏrÏenõÂm v cÏase
T0, T1 a T2 ve skupinaÂch byl pouzÏit paÂrovy t-test a mezi
skupinami dvouvyÂbeÏrovy t-test. VsÏechny testy byly provedeny na hladineÏ statisticke vyÂznamnosti 0,05.
VyÂsledky
V raÂmci skupin A a B byly pruÊmeÏrne hodnoty jednotlivyÂch meÏrÏenyÂch parametruÊ v cÏasech T0, T1, T2 porovnaÂvaÂny paÂrovyÂm t-testem mezi cÏasy meÏrÏenõ T1T0, T2-T0 a T2-T1.
U skupiny A (zachovana Speeova krÏivka) byl prokaÂzaÂn statisticky signifikantnõ rozdõÂl v naÂsledujõÂcõÂch parametrech: v cÏase T1-T0 u parametru HS, v cÏase T2-T0
a T2-T1 u meÏrÏenyÂch parametruÊ SNB, ANB, Wits, HS,
IS, NSML, NLML, Pog, LAFH a AFH indexu. VyÂsledky
jsou patrne z tabulky cÏ. 4.
U skupiny B (vyrovnana Speeova krÏivka) byl prokaÂzaÂn statisticky signifikantnõ rozdõÂl v naÂsledujõÂch parametrech: v cÏase T1-T0 u parametruÊ HS, LAFH, APFH
indexu, AFH indexu, v cÏase T2-T0 u SNB, ANB, Wits,
HS, IS, NSML, NLML, Pog, LAFH, AFH indexu a v cÏase
T1-T2 u SNB, ANB, Wits, HS, IS, NSML, NLML, Pog,
LAFH (Tab. 5).
Pro porovnaÂnõÂ pruÊmeÏrnyÂch rozdõÂluÊ mezi skupinami
A a B v jednotlivyÂch meÏrÏenyÂch parametrech mezi cÏasy
98
T2
Mean
80.25
2.64
1.50
2.89
2.56
26.94
21.03
20.60
65.49
0.75
0.61
SD
2.38
1.80
2.68
0.80
0.79
4.63
6.00
3.80
7.81
0.255
0.251
T0, T1 and T2, paired t-test was used in groups, and
two-sample t-test between the groups. All tests were
performed on the level of statistical significance 0.05.
Results
Within groups A and B the mean values of individual
parameters measured at T0, T1, T2 were compared
with paired t-test at T1-T0, T2-T0, and T2-T1.
In Group A (preserved Spee curve) the statistically
significant difference was found in the following parameters: at T1-T0 for parameter OB; at T2-T0 and T2-T1
for parameters SNB, ANB, Wits, OB, IS, NSML, NLML,
Pog, LAFH and AFH. The results are summarized in Table 4.
In Group B (levelled Spee curve) the statistically significant difference was found in the following parameters: at T1-T0 for OB, LAFH, APFH index, AFH index; at
T2-T0 for SNB, ANB, Wits, OB, OJ, NSML, NLML, Pog,
LAFH, AFH index; at T1-T2 for SNB, ANB, Wits, OB,
OJ, NSML, NLML, Pog, LAFH (Table 5).
To compare mean differences between groups
A and B in different parameters measured between
T1-T0, T2-T0, and T2-T1, two-sample t-test was used.
Statistically significant difference was found in OB at
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Tabulka cÏ. 4: ZmeÏny u skupiny A (zachovana Speeova krÏivka v T1)
Table 4: Changes in Group A (preserved Spee curve at T1)
Skupina A, Group A
∆ T2 -T0
∆ T1 -T0
SNB
ANB
Wits
OB (HS)
OJ (IS)
NSML
NLML
Pog
LAFH
APFH
AFH
Mean
SD
-0.17
-0.33
-0.21
-1.08
0.86
0.75
0.31
-0.13
0.91
0.02
0.01
0.86
1.06
2.14
1.27
5.13
1.95
0.94
2.08
2.12
0.10
0.08
Sig.
**
∆ T2 -T1
Mean
SD
Sig.
Mean
SD
Sig.
3.22
-4.16
-8.27
-4.72
-5.51
3.39
3.03
-6.26
3.49
0.08
0.09
1.40
2.04
3.44
1.76
4.22
3.48
2.40
2.25
3.09
0.20
0.17
***
***
***
***
***
***
***
***
***
3.39
-3.83
-8.06
-3.63
-6.36
2.64
2.72
-6.12
2.58
0.06
0.08
1.50
2.03
3.78
1.54
2.80
2.33
2.05
3.05
1.84
0.14
0.12
***
***
***
***
***
***
***
***
***
*
*
*, **, *** statisticky vyÂznamny rozdõÂl na hladineÏ spolehlivosti 95 %, 99 %, 99,9 %
*, **, *** statistically significant difference on the level of reliability 95 %, 99 %, 99.9 %
Tabulka cÏ. 5: ZmeÏny u skupiny B (vyrovnana Speeova krÏivka v T1)
Table 5: Changes in Group B (levelled Spee curve at T1)
Parameters
measured
SNB
ANB
Wits
OB (HS)
OJ (IS)
NSML
NLML
Pog
LAFH
APFH
AFH
Skupina B, Group B
∆ T2 -T0
∆ T1 -T0
Mean
SD
0.03
-0.06
-0.66
-2.39
1.10
0.25
0.06
0.51
3.38
0.09
0.07
1.16
1.24
1.97
2.06
3.44
1.71
1.32
1.61
5.83
0.17
0.14
Sig.
***
*
*
*
∆ T2 -T1
Mean
SD
Sig.
Mean
SD
Sig.
3.14
-3.64
-6.52
-4.58
-4.19
1.89
1.86
-4.90
5.94
0.12
0.16
1.43
1.89
3.85
2.43
4.19
2.33
2.36
2.59
6.62
0.24
0.23
***
***
***
***
***
**
**
***
**
3.11
-3.58
-5.87
-2.19
-5.29
1.64
1.81
-5.40
2.56
0.03
0.08
1.55
1.87
3.14
1.62
2.46
2.04
2.20
2.97
4.27
0.12
0.18
***
***
***
***
***
**
**
***
*
*
*, **, *** statisticky vyÂznamny rozdõÂl na hladineÏ spolehlivosti 95 %, 99 %, 99,9 %
*, **, *** statistically significant difference on the level of reliability 95 %, 99 %, 99.9 %
Tabulka cÏ. 6: RozdõÂly v cÏase T1-T0 mezi skupinou A a B u hloubky skusu
Table 6: Differences at T1-T0 between A and B for overbite
OB
Group
A
B
Mean
-1.08
-2.39
SD
1.27
2.06
Sig.
SD
1.54
1.62
Sig.
*
* statisticky vyÂznamny rozdõÂl na hladineÏ spolehlivosti 95 %
* statistically significant difference on the level of reliability 95 %
Tabulka 7. RozdõÂly v cÏase T2-T1 mezi skupinou A a B u hloubky skusu
Table 7 Differences at T2-T1 between A and B for overbite
OB
Group
A
B
Mean
-3.63
-2.19
**
** statisticky vyÂznamny rozdõÂl na hladineÏ spolehlivosti 99 %
** statistically significant difference on the level of reliability 99 %
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meÏrÏenõÂ T1-T0, T2-T0 a T2-T1 byl pouzÏit dvouvyÂbeÏrovyÂ
t-test. Byl prokaÂzaÂn statisticky signifikantnõÂ rozdõÂl u HS
v cÏase T1-T0 a T2-T1. V ostatnõÂch meÏrÏenyÂch parametrech se zkoumane skupiny mezi sebou statisticky signifikantneÏ nelisÏily.
Diskuse
CõÂlem teÂto studie bylo zhodnocenõÂ vlivu prÏedoperacÏnõÂho zachovaÂnõÂ Speeovy krÏivky prÏedevsÏõÂm na vertikaÂlnõÂ parametry oblicÏeje a pozici bodu Pogonion.
PrÏi hodnocenõÂ vyÂsledkuÊ v raÂmci skupin A a B studie
prokaÂzala u pacientuÊ s vyrovnanou Speeovou krÏivkou
(skupina B) beÏhem prechirurgicke ortodonticke prÏõÂpravy
(T1-T0) statisticky signifikantnõÂ zmensÏenõÂ hloubky skusu
a statisticky signifikantnõÂ zveÏtsÏenõÂ parametruÊ LAFH,
APFH indexu a AFH indexu. Z teÏchto vyÂsledkuÊ by bylo
mozÏne soudit, zÏe jizÏ vyrovnaÂnõ Speeovy krÏivky prÏedevsÏõÂm extruzõ lateraÂlnõÂch uÂsekuÊ ma vliv na vertikaÂlnõ parametry a vede ke zveÏtsÏenõ dolnõ trÏetiny oblicÏeje.
V obdobõÂ beÏhem operace azÏ do ukoncÏenõÂ leÂcÏby a sejmutõÂ fixnõÂho aparaÂtu (T2-T1) dosÏlo u obou skupin pacientuÊ k statisticky signifikantnõÂmu zveÏtsÏenõÂ uÂhlu
SNB, zmensÏenõÂ uÂhlu ANB, rozmeÏru Wits, hloubky
skusu a incizaÂlnõÂho schuÊdku. Co se tyÂka vertikaÂlnõÂch
parametruÊ, u obou skupin pacientuÊ dosÏlo k statisticky
signifikantnõÂmu zveÏtsÏenõÂ NSML, NLML, LAFH a u pacientuÊ se zachovanou Speeovou krÏivkou (skupina A)
zaÂrovenÏ k statisticky signifikantnõÂmu zveÏtsÏenõÂ pomeÏrneÂho indexu AFH. ZaÂrovenÏ u obou skupin pacientuÊ dosÏlo k statisticky signifikantnõÂmu posunu kostnõÂho Pogonion smeÏrem doprÏedu.
Statisticky signifikantnõ zmeÏny, ke kteryÂm dosÏlo beÏhem cele leÂcÏby, tedy od nasazenõ fixnõÂho aparaÂtu azÏ ke
konci leÂcÏby a sejmutõÂ fixnõÂho aparaÂtu (T2-T0) byly u obou
skupin pacientuÊ stejneÂ. DosÏlo k statisticky signifikantnõÂmu zveÏtsÏenõÂ SNB, NSML, NLML, LAFH, AFH indexu,
zmensÏenõÂ ANB, Wits, HS, IS a statisticky signifikantnõÂmu
posunu kostnõÂho Pogonion smeÏrem doprÏedu.
U pacientuÊ se zachovanou Speeovou krÏivkou prÏed
operacõÂ (skupina A) dochaÂzõÂ k statisticky signifikantnõÂm
zmeÏnaÂm azÏ po operaci. ZatõÂmco u pacientuÊ s vyrovnanou
Speeovou krÏivkou (skupina B) dochaÂzõ k statisticky signifikantnõÂm zmeÏnaÂm jizÏ beÏhem prechirurgicke ortodontickeÂ
faÂze; statisticky signifikantnõÂmu zveÏtsÏenõ dolnõ prÏednõ oblicÏejove vyÂsÏky a pomeÏrnyÂch indexuÊ APFH, AFH.
PrÏi hodnocenõÂ rozdõÂluÊ mezi skupinami byly prokaÂzaÂny statisticky signifikantnõÂ rozdõÂly pouze v hloubce
skusu (HS). BeÏhem prÏedchirurgicke ortodonticke faÂze
(T1-T0) dosÏlo u pacientuÊ s vyrovnanou Speeovou krÏivkou (skupina B) k veÏtsÏõ redukci hloubky skusu a v obdobõ od operace do ukoncÏenõ ortodonticke leÂcÏby (T2T1) dosÏlo k signifikantneÏ veÏtsÏõ redukci hloubky skusu
u pacientuÊ se zachovanou Speeovou krÏivkou (skupina
A). TõÂm by nebyla potvrzena hypoteÂza o vlivu zacho100
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T1-T0, and T2-T1. There were no significant differences in the rest of parameters.
Discussion
This study aimed to evaluate the impact of retained
Spee curve before the orthognathic advancement of
the mandible on vertical facial parameters and the position of Pogonion point after surgery.
The evaluation of results obtained in groups A and B
proved in patients with levelled Spee curve (group B)
during orthodontic pretreatment (T1-T0) statistically
significant reduction of overbite, and statistically significant increase in parameters LAFH, APFH index and
AFH index. The results therefore suggest that levelling
of Spee curve, especially through extrusion of lateral
segments, affects vertical parameters and results in
enlargement of the lower third of face.
In the period of surgical intervention till the completion of therapy and removal of fixed appliance (T2-T1)
in both groups there were observed the following
changes: statistically significant increase in SNB, reduction of ANB, Wits, overbite, and overjet. In vertical
parameters, in both groups, there was observed statistically significant increase of NSML, NLML, LAFH,
and in patients with retained Spee curve (group A) also
statistically significant increase of AFH index. In both
groups there was statistically significant advancement
of bone Pogonion.
Statistically significant differences that occurred in
the course of the whole treatment, i.e. from the application of fixed appliance till its removal at the end of
therapy (T2-T1) were the same in both groups. Statistically significant increase of values was observed in parameters SNB, NSML, NLML, LAFH, AFH index, reduction of ANB, Wits, OB, IS, and advancement of
bone Pogonion forward.
In patients with preserved Spee curve prior to surgery (group A) statistically significant changes are observed only after surgery. In patients with levelled Spee
curve (group B) statistically significant changes are observed as early as during orthodontic pretreatment
prior to surgery; statistically significant enlargement
of lower anterior facial height, and APFH, AFH indexes.
Evaluation of parameters between the groups showed statistically significant differences only in overbite
(OB). During orthodontic pretreatment prior to surgery
(T1-T0), in patients with levelled Spee curve (group B)
there was more substantial reduction of overbite, and
in the period after surgery till the orthodontic posttreatment (T2-T1) significant reduction of overbite was observed in patients with preserved Spee curve (group
A). Thus the hypothesis about the impact of preserved
Spee curve on statistically significant increase in vawww.orthodont-cz.cz e-mail: [email protected]
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vane Speeovy krÏivky na statisticky signifikantnõ zveÏtsÏenõ vertikaÂlnõÂch parametruÊ oblicÏeje a mensÏõ prominenci bradoveÂho vyÂbeÏzÏku po operaci.
ZatõÂm nenõÂ prÏõÂlisÏ mnoho studiõÂ tyÂkajõÂcõÂch se teÂto problematiky. S tõÂm souvisõÂ i nemozÏnost plnohodnotneÂho porovnaÂnõÂ vyÂsledkuÊ zõÂskanyÂch touto studiõÂ. Studii zabyÂvajõÂcõÂ
se vlivem zachovane Speeovy krÏivky na vyÂslednou estetiku oblicÏeje po operaci uskutecÏnili De Coul et al. [6]. RozdõÂly mezi pacienty se zachovanou a vyrovnanou Speeovou krÏivkou hodnotili na kefalometrickyÂch snõÂmcõÂch zhotovenyÂch prÏed operacõ a na konci leÂcÏby. Nehodnotili
zmeÏny, ke kteryÂm dosÏlo beÏhem prÏedchirurgicke ortodonticke faÂze a vliv vyrovnaÂnõ Speeovy krÏivky na kefalometricke hodnoty. Zjistili, zÏe u pacientuÊ se zachovanou
Speeovou krÏivkou dosÏlo na konci leÂcÏby k signifikantneÏ
veÏtsÏõÂmu prodlouzÏenõÂ dolnõÂ trÏetiny oblicÏeje a mensÏõÂmu posunu kozÏnõÂho Pogonion smeÏrem doprÏedu. V pozici kostnõÂho Pogonion, podobneÏ jako v nasÏõÂ studii nebyly zjisÏteÏny
statisticky signifikantnõÂ rozdõÂly.
lues of vertical facial parameters and less prominent
mental protuberance after the surgery was not proved.
There are only few studies dealing with the problem
discussed above. Therefore comparison of our results
with other studies is virtually impossible. De Coul et al
[6] published the study focused on the impact of
preserved Spee curve on the esthetic result after surgery. The differences between patients with preserved
and levelled Spee curve were evaluated in cephalograms taken before surgery and after completed therapy. They did not deal with changes that occurred during orthodontic pretreatment before surgery or with
the impact of levelled Spee curve on cephalograms values. They found out that in patients with preserved
Spee curve, the lower third of face was significantly
prolonged and skin Pogonion was less moved forward
at the end of treatment. In bone Pogonion no significant differences were found, which corresponds to
our findings.
ZaÂveÏr
PorovnaÂnõÂm rozdõÂluÊ mezi skupinou pacientuÊ se zachovanou a vyrovnanou Speeovou krÏivkou nebyl prokaÂzaÂn vliv zachovane Speeovy krÏivky v dolnõÂm zubnõÂm
oblouku na vertikaÂlnõÂ parametry a estetiku dolnõÂ trÏetiny
oblicÏeje po operaci.
V nasÏem prÏõÂpadeÏ se jednalo o studii retrospektivnõÂ.
Tuto studii by bylo vhodne zopakovat, ale jizÏ jako prospektivnõ s veÏtsÏõÂm rozdõÂlem preoperacÏnõ hloubky
Speeovy krÏivky mezi pacienty se zachovanou a vyrovnanou Speeovou krÏivkou a s veÏtsÏõÂ kontrolou zachovaÂnõÂ
Speeovy krÏivky v indikovanyÂch prÏõÂpadech.
Conclusion
Comparison of differences between the group of patients with preserved Spee curve and that with levelled
Spee curve did not prove the impact of preserved Spee
curve in the lower dental arch on vertical parameters and
esthetics of the lower third of face after surgery.
Our study was retrospective. The study should be
repeated in the form of a prospective study with a more
significant difference in depth of Spee curve prior to
surgery in patients with preserved and levelled Spee
curve, and with more controlled preserved Spee curve
in indicated cases.
AutorÏi nemajõ komercÏnõÂ, vlastnicke nebo financÏnõ zaÂjmy na produktech nebo spolecÏnostech popsanyÂch v tomto cÏlaÂnku.
Authors have no commercial, proprietary or financial interest in
products or companies mentioned in the article.
Literatura/ References
1. Proffit, W. R.; White, R. P.; Sarver, D. M.: Contemporary
treatment of dentofacial deformity, St. Louis: Mosby Elsevier, 2003.
2. Jacobs, J. D.; Sinclair, P. M.: Principles of orthodontic mechanics in orthognathic surgery cases. Amer. J. Orthodont. 1983, 84, cÏ. 5, s. 399-407.
3. Low, L. E.; Moore, T. E.; Austin, K. R.; Burton, R. G.; Marshall, S. D.; Southard, K. A.; Southard, T. E.: Mandibular
¹tripodª advancement of a Class II Division 2 deepbite malocclusion. Amer. J. Orthodont. dentofacial Orthop. 2010,
137, cÏ. 2, s. 285-292.
4. Yousefian, J.; Trimble, D.; Folkman, G.: A new look at the
treatment of Class II Division 2 malocclusions. Amer. J.
Orthodont. dentofacial Orthop. 2006, 130, cÏ. 6, s. 771-778.
5. Rubenstein, L. K.; Strauss, R. A.; Isaacson, R. J.; Landauer, S. J.: Quantitation of rotational movements associated with surgical mandibular advancement. Angle
Orthodont. 1991, 61, cÏ. 3, s. 167-173.
6. Op de Coul, F.; Oosterkamp, B. C. M.; Jansma, J.; Bierman, M. W. J.; Pruim, G. J.; Sandham, A.: Maintenance
of a deep bite prior to surgical mandibular advancement.
Eur. J. Orthodont. 2010, 32, cÏ. 3, s. 342-345.
7. Pepicelli, A.; Woods, M.; Briggs, C.: The mandibular
muscles and their importance in orthodontics: A contemporary review. Amer. J. Orthodont. dentofacial Orthop.
2005, 128, cÏ. 6, s. 774-778.
MUDr. Eva MichalcovaÂ
Ortodonticke oddeÏlenõÂ
Stomatologicka klinika 1. LF UK
KaterÏinska 32, 120 00 Praha 2
www.orthodont-cz.cz e-mail: [email protected]
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HlavnõÂ prÏednaÂsÏejõÂcõÂ XIII. kongresu CÏOS
Ewa M. Czochrowska
Dr. Ewa Monika Czochrowska vystudovala zubnõ leÂkarÏstvõ na leÂkarÏske fakulteÏ ve VarsÏaveÏ a absolvovala roku 1991. Mezi lety 1991-1994 puÊsobila jako odborna asistentka na
katedrÏe konzervativnõÂ stomatologie a parodontologie. Roku 1997 ukoncÏila postgraduaÂlnõÂ specializacÏnõÂ studium ortodoncie na univerziteÏ v Oslo, kde pak puÊsobila jako
cÏlenka vyÂzkumneÂho tyÂmu na katedrÏe ortodoncie do roku 2002. V roce 2003 zõÂskala doktoraÂt (nejvysÏsÏõ akademicky titul udõÂleny ve SkandinaÂvii) na UniverziteÏ v Oslo za praÂci tyÂkajõÂcõ se leÂcÏby dospõÂvajõÂcõÂch pacientuÊ s chybeÏjõÂcõÂmi zuby se zameÏrÏenõÂm na autotransplantace zubuÊ. Je nositelkou oceneÏnõ AJODO Helen and B.F. Dewel Orthodontic Award
za rok 2002. Je cÏlenkou vyÂboru European Orthodontic Society a President-Elect Evropske ortodonticke spolecÏnosti na rok 2014; daÂle pracuje jako cÏlenka vyÂboru Polske ortodonticke spolecÏnosti. Ve
VarsÏaveÏ vede svou privaÂtnõ ortodontickou praxi. Na katedrÏe parodontologie leÂkarÏske fakulty ve VarsÏaveÏ se v soucÏasnosti zabyÂva prÏedevsÏõÂm vyÂsledky transplantace zubuÊ v Polsku a ruÊznyÂmi aspekty multidisciplinaÂrnõ leÂcÏby.
HlavnõÂ prÏednaÂsÏka, sobota 22. 9. 2012
PrÏednaÂsÏejõÂcõÂ: Ewa M. Czochrowska, D.D.S., Dr. Odont.
KLIÂCÏOVEÂ FAKTORY UÂSPEÏSÏNEÂ TRANSPLANTACE ZUBUÊ A DALSÏIÂ MOZÏNOSTI ROZVOJE
Paweø Plakwicz
Dr. Paweø Plakwicz je absolventem stomatologie leÂkarÏske fakulty varsÏavske univerzity. V letech 1995-2003 pracoval jako odborny asistent na katedrÏe uÂstnõ chirurgie leÂkarÏske fakulty ve VarsÏaveÏ. Roku 2000 zõÂskal stipendium a ukoncÏil postgraduaÂlnõ studium
v oblasti autotransplantace zubuÊ na univerziteÏ v norskeÂm Oslu. Roku 2001 zõÂskal atestaci
v oboru uÂstnõÂ chirurgie. Roku 2009 obdrzÏel titul Ph.D. v oboru uÂstnõÂ chirurgie na leÂkarÏskeÂ
fakulteÏ varsÏavske univerzity. Od roku 2009 pracuje na katedrÏe parodontologie a uÂstnõÂ
medicõÂny leÂkarÏske fakulty ve VarsÏaveÏ. V roce 1995 zalozÏil ve VarsÏaveÏ soukromou praxi
zameÏrÏenou na uÂstnõÂ a parodonaÂlnõÂ chirurgii a na implantologii. Je cÏlenem organizace Polskie Towarzystwo Chirurgii Jamy Ustnej i Chirurgii SzczeÎkowo-Twarzowej, American
Academy of Periodontology, International Association of Oral and Maxillofacial Surgery, American Dental Association. Dr. Plakwicz prÏednaÂsÏõÂ na celostaÂtnõÂch i mezinaÂrodnõÂch symposiõÂch a kongresech zejmeÂna o autotransplantacõÂch zubuÊ.
HlavnõÂ prÏednaÂsÏka, sobota 22. 9. 2012
PrÏednaÂsÏejõÂcõÂ: Paweø Plakwicz, D.D.S., Ph.D.
CHIRURGICKEÂ ASPEKTY AUTOTRANSPLANTACE VYVIÂJEJIÂCIÂCH SE ZUBUÊ
Hans Ulrik Paulsen
Dr. Hans Ulrik Paulsen absolvoval obor zubnõ medicõÂny roku 1965 na kodanÏske Royal
Dental College. Roku 1971 zõÂskal specializaci v oboru ortodoncie, a roku 1999 akademickou hodnost Doctor of Science (nejvysÏsÏõÂ akademickou hodnost ve SkandinaÂvii) na
Karolinska Institutet, Stockholm University, SÏveÂdsko. Byl docentem na Royal Dental
College, Department of Orthodontics v daÂnskeÂm Arhusu, a hostujõÂcõÂm profesorem na
sÏveÂdskeÂm Karolinska Institutet, Department of Orthodontics, ve Stockholmu. Dr. Paulsen je dozÏivotnõÂm cÏlenem European Orthodontic Society (EOS) a cÏestnyÂm cÏlenem Societa Italiana di Ortodonzia (SIDO). Je rovneÏzÏ cÏlenem redakcÏnõÂch rad neÏkolika odbornyÂch
ortodontickyÂch a stomatologickyÂch cÏasopisuÊ. Dr. Paulsen se jako prÏednaÂsÏejõÂcõÂ zuÂcÏastnil
jizÏ 154 mezinaÂrodnõÂch sympoziõ a kongresuÊ, 79 postgraduaÂlnõÂch kurzuÊ zameÏrÏenyÂch na klinicky vyÂzkum a prÏispeÏl
jako autor 29 puÊvodnõÂmi publikacemi cÏi kapitolami do publikacõÂ. K teÂmatuÊm patrÏõÂ autotransplantace zubu
www.orthodont-cz.cz e-mail: [email protected]
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v ortodonticke leÂcÏbeÏ, remodelace kosti temporomandibulaÂrnõÂho kloubu v reakci na leÂcÏbu HerbstovyÂm aparaÂtem
a dlouhodobe studie sledujõÂcõ stav docÏasnyÂch molaÂruÊ v prÏõÂpadech hypodoncie premolaÂruÊ.
HlavnõÂ prÏednaÂsÏka, sobota 22. 9. 2012
PrÏednaÂsÏejõÂcõÂ: Hans Ulrik Paulsen, D.D.S., Odont. Dr.
AUTOTRANSPLANTACE PREMOLAÂRUÊ: MOZÏNOSTI A DLOUHODOBEÂ HODNOCENIÂ
Ole Schwartz
Dr. Ole Schwartz ukoncÏil studium stomatologie na Royal Dental College v Kodani roku
1972. V roce 1983 zõÂskal specializaci v oboru uÂstnõÂ a maxilofaciaÂlnõÂ chirurgie, a roku 1979
Ph.D. na kodanÏske univerziteÏ. Od roku 1997 je vedoucõÂm katedry uÂstnõ a maxilofaciaÂlnõÂ
chirurgie a prÏednostou teÂhozÏ oddeÏlenõ fakultnõ nemocnice University Hospital Rigshospitalet. Na cÏaÂstecÏny uÂvazek pracuje take v soukrome stomatologicke praxi, kde se veÏnuje uÂstnõ chirurgii.Dr. Schwartz prÏispeÏl jizÏ 52 publikacemi cÏi kapitolami ve sbornõÂcõÂch,
kde se zabyÂva zejmeÂna teÏmito teÂmaty: transplantacÏnõ imunologie prÏi klinicke a experimentaÂlnõ allotransplantaci zubuÊ, kryopreservace zubuÊ, zubnõ banky, jejich vyÂvoj a klinickeÂ
vyuzÏitõ prÏi transplantaci a replantaci zubuÊ, zubnõ autotransplantace jako mozÏny leÂcÏebnyÂ
postup u pacientuÊ s traumatickou luxacõÂ nebo s agenezõÂ zubuÊ, rÏesÏenõÂ ztraÂty zubuÊ spolenyÂch s velkyÂm uÂbytkem
kosti, vcÏetneÏ transplantace velkyÂch kostõÂ, distrakcÏnõÂ osteogeneze a dentaÂlnõÂ implantologie.
HlavnõÂ prÏednaÂsÏka, sobota 22. 9. 2012
PrÏednaÂsÏejõÂcõÂ: Ole Schwartz, D.D.S., Ph. D.
AUTOTRANSPLANTACE ZUBUÊ Z HLEDISKA CHIRUGA
Josef Kunkela
MUDr. Josef Kunkela promoval na 1. leÂkarÏske fakulteÏ University Karlovy v Praze v roce
1993. Od r. 1993 byl zameÏstnaÂn jako zubnõ leÂkarÏ ve stomatologicke ordinaci Donau Dental s.r.o. v CÏeskyÂch BudeÏjovicõÂch a od r. 1995 jako odborny asistent LeÂkarÏske fakulty UK
v Hradci KraÂloveÂ. V r. 1996 slozÏil atestaci I. stupneÏ v oboru stomatologie a v r. 1996 atestaci II. stupneÏ v oboru stomatologicka protetika. V r. 1997 - zalozÏil vlastnõ privaÂtnõ stomatologickou praxi v JindrÏichoveÏ Hradci - DentalPoint. Dr. Kunkela je prezidentem CÏeske stomatologicke akademie, externõÂm ucÏitelem Stomatologicke kliniky LeÂkarÏske fakulty
University Karlovy v Hradci KraÂloveÂ, soudnõÂm znalcem ve zdravotnictvõÂ obor stomatologie, zakladatelem vzdeÏlaÂvacõÂho centra Dental Laser Institut spoluzakladatelem 1. stomatologickeÂho internetoveÂho portaÂlu DentalCare (CZ/SK), prÏedsedou redakcÏnõÂ rady odborneÂho stomatologickeÂho
periodika DentalCare magazõÂn, sÏeÂfredaktorem magazõÂnu pro laickou verÏejnost Zdravy uÂsmeÏv. PrÏednaÂsÏkova cÏinnost a prakticke kurzy v CÏechaÂch, na Slovensku, v Polsku, Mad'arsku, v Rakousku a NeÏmecku, na teÂma: stomatologicka protetika, lasery ve stomatologii, marketing, management, logistika a ergonomie ve stomatologii.
Sekce pro ortodonticke asistentky, hlavnõ prÏednaÂsÏka, cÏtvrtek 20. 9. 2012
PrÏednaÂsÏejõÂcõÂ: MUDr. Josef Kunkela
MANAGEMENT, ERGONOMIE A LOGISTIKA PRIVAÂTNIÂ ORTODONTICKEÂ PRAXE
JirÏÂõ SÏusta
Ing. JirÏõ SÏusta je prÏednõ odbornõÂk na ekonomiku a organizaci provozu soukromyÂch leÂkarÏskyÂch praxõÂ. PrÏednaÂsÏõ ekonomicke a praÂvnõ aspekty provozu zubnõÂch ordinacõ na
LFUK v Hradci KraÂlove a v Praze pro studenty 5. rocÏnõÂkuÊ, dentaÂlnõ hygienistky a zubnõÂ
instrumentaÂrÏky. Je majitelem poradenske kancelaÂrÏe pro leÂkarÏske subjekty a konzultant
v oboru ekonomiky a rÏõÂzenõ zdravotnickyÂch zarÏõÂzenõÂ. V 90. letech staÂl u zrodu prvnõÂch soukromyÂch stomatologickyÂch praxõ a problematice provozu se od te doby soustavneÏ veÏnuje. NavõÂc je saÂm spolumajitelem a provozovatelem zubnõÂch ordinacõÂ. Jeho dlouhodobyÂm cõÂlem je zvysÏovaÂnõ efektivity provozu nestaÂtnõÂch zdravotnickyÂch zarÏõÂzenõ a snizÏovaÂnõÂ
104
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zaÂvislosti na systeÂmu verÏejneÂho zdravotnõÂho pojisÏteÏnõÂ. Poradenska kancelaÂrÏ, v jejõÂmzÏ cÏele stojõÂ, se specializuje na
komplexnõ servis pro zubnõ leÂkarÏe od vzniku praxe prÏes jejõ efektivnõ provoz azÏ k uÂspeÏsÏneÂmu prodeji. Spolu s tyÂmem spolupracovnõÂkuÊ rÏesÏõ vesÏkerou provoznõÂ, uÂcÏetnõ a danÏovou problematiku souvisejõÂcõ s provozem praxe fyzicke osoby, spolecÏnosti s rucÏenõÂm omezenyÂm nebo s prÏechodem fyzicke osoby na s.r.o.
Sekce pro ortodonticke asistentky, hlavnõ prÏednaÂsÏka, paÂtek 21. 9. 2012
PrÏednaÂsÏejõÂcõÂ: Ing. JirÏõÂ SÏusta
PROVOZNIÂ DOKUMENTACE PRO ZDRAVOTNIÂ SESTRY A ZUBNIÂ INSTRUMENTAÂRÏKY
Marie SÏtefkovaÂ
MUDr. Marie SÏtefkovaÂ, CSc. ukoncÏila studia na LF UP, obor stomatologie v r. 1965,
atestaci z ortodontie slozÏila v r. 1978, titul CSc. obhaÂjila v r. 1989. VeÏnuje se nejen leÂcÏbeÏ
pacientuÊ, ale zejmeÂna vyÂuce studentuÊ a postgraduantuÊ. Je spoluautorkou autorkou
ucÏebnõÂch textuÊ, cÏasto prÏednaÂsÏõÂ na kurzech a kongresech u naÂs i v zahranicÏõÂ. Je cÏlenkou
CÏeske ortodonticke spolecÏnosti, kde pracovala jako prÏedseda reviznõ komise, cÏlenkou
Evropske ortodonticke spolecÏnosti a CÏestnou cÏlenkou Polske ortodonticke spolecÏnosti.
V poslednõÂch letech vede kurzy nejen pro leÂkarÏe, ale i pro ortodonticke asistentky a zubnõÂ
techniky.
Sekce pro zubnõÂ techniky, Workshop, cÏtvrtek 20. 9. 2012
PrÏednaÂsÏejõÂcõÂ: MUDr. Marie SÏtefkovaÂ, CSc. & Jaroslava PetrovaÂ
ORTODONTICKYÂ SET-UP A WAX-UP
Claudia StoÈûer
Claudia StoÈûer vystudovala obor zubnõÂ technik zubnõÂho technika v Karlsruhe v letech
1972-1976. Do r. 1999 pracovala v ruÊznyÂch zubnõÂch laboratorÏõÂch se zameÏrÏenõÂm na zubnõÂ
naÂhrady. V letech 1999 - 2006 pracovala jako ortodonticka technicÏka v ortodontickeÂ
praxi Dr. Michael Zealand ve Woerthu a od r. 2006 do soucÏasnosti jako ortodontickaÂ
technika v ortodonticke praxi Dr. Barbara Greiner ve Speyeru. V raÂmci CDC, vzdeÏlaÂvacõÂho centra Dentaurum Group v Ispringen vede odborne kurzy se zameÏrÏenõÂm na KFO
Creativ. Na teÂma KFO Creativ take publikuje v odbornyÂch cÏasopisech, zvl. v cÏasopisech
nakladatelstvõÂ Quintessenz.
Kongresovy kurz, Sekce pro zubnõ techniky, paÂtek 21. 9. 2012
PrÏednaÂsÏejõÂcõÂ: ZT Claudia StoÈûer
KFO CREATIV: ORTHOCRYL BLACK & WHITE
ROD OSTRAVA
PrÏehled chystanyÂch domaÂcõÂch akcõÂ 2012:
20.-21. 10. 2012
Brno, Hotel Myslivna
MUDr. JirÏõ Petr, Doc. MUDr. et MUDr. Rene FoltaÂn, Ph.D.
¹ZaÂklady ortodonticko-chirurgicke leÂcÏby pacientuÊ
s cÏelistnõÂmi vadamiª
*
* *
Informace: ROD Ostrava ± BeÏlova Olga, MojmõÂrovcuÊ 799/45, 709 00 Ostrava-Mar. Hory
Tel.: 777 727 152, 800 100 793, e-mail: [email protected]
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE
Ze zahranicÏnõÂch cÏasopisuÊ
MeÏrÏõÂcõÂ studie o ortodontickeÂm uzavrÏenõÂ mezery po
rÏõÂzene kostnõ regeneraci
Pilot study on orthodontic space closure after guided bone regeneration
Reichert Ch. et al.
J. Orofac. Orthop., 2011, 72, cÏ. 1, s. 45-49
Ve studii byla hodnocena vyÂhoda ortodontickeÂho
posunu zubu do extrakcÏnõÂho luÊzÏka chraÂneÏneÂho kostnõÂ
naÂhrazÏkou a prÏedchaÂzenõÂ vzniku gingivaÂlnõÂch invaginacõÂ.. Byly provedeny extrakce dvou analogickyÂch
premolaÂruÊ, prÏicÏemzÏ jedna extrakcÏnõÂ raÂna byla vyplneÏna
silikagelem (kostnõ substituent nanokrystalu hydroxyapatitu) - NanoBoneÒ, druhaÂ, analogicka byla ponechaÂna volneÏ a slouzÏila jako kontrolnõ skupina. Mezera
byla naÂsledneÏ ortodonticky uzavõÂraÂna pouzÏitõÂm kontrakcÏnõÂ NiTi pruzÏiny o sõÂle 200 g. Pro dokumentaci byly
zhotoveny rtg snõÂmky a fotografie.
ZaruÊstaÂnõÂ gingivy je lineaÂrnõÂ invaginace interproximaÂlnõÂch tkaÂnõÂ s definovanou mesio-distaÂlnõÂ sÏõÂrÏkou
a hloubkou minimaÂlneÏ 1mm, ktere se cÏasto (azÏ ve
35%) vyskytujõÂ beÏhem ortodontickeÂho uzavõÂraÂnõÂ mezer
po extrakci zubu. Invaginace jsou zpuÊsobeny zvyÂsÏenou proliferacõÂ spojovacõÂho epitelu a vaziva, zmeÏnou
topografie a morfologie kosti (zvyÂsÏena ztraÂta marginaÂlnõ kosti a redukce interdentaÂlnõ vyÂsÏky kosti), posÏkozenõÂm volne gingivy a transseptaÂlnõÂch vlaÂken nebo
frakturou kosti beÏhem extrakce zubu. DõÂky zmõÂneÏnyÂm
invaginacõÂm je neÏkdy nemozÏne kompletneÏ uzavrÏõÂt zbyÂvajõÂcõ mezeru. Ochrana extrakcÏnõÂho luÊzÏka kostnõÂm substitucÏnõÂm materiaÂlem zajisÏt'uje prostorovou stabilitu alveolaÂrnõ kosti a zabranÏuje vzniku gingivaÂlnõÂch invaginacõÂ. Indikace pro rÏõÂzenou kostnõ regeneraci muÊzÏeme
najõÂt v dentaÂlnõÂ chirurgii, leÂcÏbeÏ paradentoÂz a chirurgii
rozsÏteÏpuÊ patra. SoucÏasne publikace zabyÂvajõÂcõ se
tõÂmto probleÂmem jsou znacÏneÏ ruÊznorode v termõÂnech,
uzÏityÂch materiaÂlech i ve zpuÊsobech provedenõÂ. NeÏktereÂ
ukazujõ pozitivnõ vyÂsledky, kdezÏto jine zminÏujõ i nega-
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tivnõÂ vedlejsÏõÂ efekty jako resorpce korÏenuÊ nebo absence pohybu zubu (u keramickyÂch hydroxyapatituÊ
nevstrÏebatelnyÂch).
Pacienti a metody: Analogicke premolaÂry od 3 pacientuÊ s bezvyÂznamnou medicõÂnskou anamneÂzou byly
z ortodontickyÂch duÊvoduÊ extrahovaÂny. Na jedneÂ
straneÏ byla postextrakcÏnõÂ alveolaÂrnõÂ kost zaplneÏna
vstrÏebatelnyÂm kostnõÂm substitucÏnõÂm materiaÂlem (nanocÏaÂsticemi hydroxyapatitu v krÏemicÏite matrix) a pokryta tkaÂnÏovyÂm lepidlem. RaÂna po extrahovaneÂm premolaÂru na opacÏne straneÏ slouzÏila jako kontrolnõ skupina, kde byly do alveolaÂrnõ kosti aplikovaÂny sutury
ke stabilizaci krevnõÂho koagula. Tato studie byla
schvaÂlena etickou komisõ Univerzity v Bonnu v NeÏmecku. Po 6 tyÂdnech hojive faÂze bylo provaÂdeÏno uzavõÂraÂnõ mezery pouzÏitõÂm edgewise oblouku z nerezoveÂ
oceli a konstantnõ ortodonticke sõÂly kontrakcÏnõ NiTi
pruzÏinou.
VyÂsledky: Nebyly pozorovaÂny zÏaÂdne komplikace tyÂkajõÂcõ se extrakcõ nebo hojenõÂ. GingivaÂlnõ invaginace se
vyvinuly u 2 pacientuÊ kontrolnõÂch skupin, kde u jednoho
byla pruÊrva o hloubce 5 mm v horizontaÂlnõÂm i vertikaÂlnõÂm smeÏru. Asi v polovineÏ procedury uzaÂveÏru mezer
nebyly zaznamenaÂny zÏaÂdne rozdõÂly v hojenõÂ, pouze
u 1 pacienta kontrolnõ skupiny bylo zpozÏdeÏnõ zaÂveÏrecÏneÂho uzaÂveÏru mezery, praÂveÏ kvuÊli gingivaÂlnõÂm invaginacõÂm. Na rtg nebyly pozorovaÂny zÏaÂdne znaÂmky korÏenovyÂch resorpcõÂ. GoÈtz a kol. ve sve histologicke studii
zjistili, zÏe materiaÂl NanoBoneÒ je velmi citlivyÂ
k extreÂmneÏ rychle resorpci a rozlisÏili 4 faÂze jeho degradace: v 1. faÂzi se materiaÂl hrubeÏ degraduje, ve 2. faÂzi
dochaÂzõ k aktivnõ remodelaci, ve 3. faÂzi se zvysÏuje osifikace a v poslednõ faÂzi dochaÂzõ k uÂplne osifikaci. Tyto
faÂze se znacÏneÏ lisÏõ v dobeÏ trvaÂnõÂ. 1. a 2. f. trvajõ 3-5 meÏsõÂcuÊ a 3. a 4. f. trva 4-12 meÏsõÂcuÊ.
PouzÏõÂvaÂnõÂ syntetickyÂch kostnõÂch substituentuÊ se
v budoucnu bude staÂle võÂce rozvõÂjet a v dalsÏõÂch klinickyÂch studijõÂch se ocÏekaÂva celkove vysÏetrÏenõ teÂto metody.
MDDr. Zuzana NavraÂtilovaÂ
CÏlensky poplatek pro rok 2012 cÏinõ 1500,- KcÏ nebo 65,- 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 40,- EUR.
UÂhrada poplatku do 28. 2. 2012, cÏ. uÂ.: 32932021/0100, konst. symbol: 0558, variab. symbol: rodne cÏõÂslo.
PrÏi nezaplacenõÂ prÏõÂspeÏvkuÊ po dvou põÂsemnyÂch urgencõÂch bude ukoncÏeno cÏlenstvõÂ v CÏOS.
www.orthodont-cz.cz e-mail: [email protected]
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cÏ. 2. 2012
Informace
ORTODONCIE
PrÏehled chystanyÂch domaÂcõÂch akcõÂ
Datum
20.±21. 10. 2012
Brno
9. 11. 2012
Praha
20.±22. 9. 2012
LuhacÏovice
19.±20. 10. 2012
Praha
brÏezen 2013
Praha
NaÂzev
Mudr. JirÏõÂ Petr
Doc. MUDr. et MUDr. Rene FoltaÂn, Ph.D.
¹ZaÂklady ortodonticko-chirurgicke leÂcÏby
pacientuÊ s cÏelistnõÂmi vadamiª
Mgr. JirÏõÂ BeÏl
¹DigitaÂlnõ fotografie v ortodonticke praxiª
XIII. kongres CÏeske ortodonticke spolecÏnosti
Dr. Christophe Gualano
¹Lingual Jet ± leÂcÏba lingvaÂlnõÂm aparaÂtem
na mõÂru pacientoviª
¹Dva obory ± jeden cõÂlª
± I. ortodonticko-implantologicke sympozium
Informace
Inf.: ROD Ostrava - Olga BeÏlovaÂ, MojmõÂrovcuÊ 799/45,
705 00 Ostrava-MariaÂnske Hory
Tel.: 777 727 152, 800 100 793, e-mail: [email protected]
Inf.: ROD Ostrava - Olga BeÏlovaÂ, MojmõÂrovcuÊ 799/45,
705 00 Ostrava-MariaÂnske Hory
Tel.: 777 727 152, 800 100 793, e-mail: [email protected]
Inf.: www.kongrescos.cz
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
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
PrÏehled chystanyÂch zahranicÏnõÂch akcõÂ
Datum
NaÂzev
(jednacõ jazyk jiny nezÏ angl.)
Informace
26.±29. 9. 2012
Stuttgart, Deutschland
85. Wissenschaftliche Jahrestagung
der Gesellschaft fuÈr KieferorthopaÈdie
(Deutsch)
Website: dgkfo2012.de
27.±30. 9. 2012
Poznan, Poland
16th Congress of the Polish
Orthodontic Society (Polish, English)
Biuro 16 Zjazdu PTO, ul. èuzÇycka 32 A, 61-614 PoznanÂ
Tel./fax: 61 65 64 325, 509 404 675, 531 557 708
Website www.16zjazdpto.pl, e-mail: [email protected]
10.±13. 10. 2012
Florence, Italy
24th International Congress
Societa Italiana di Ortodonzia
Website: www.sido.it
24.±26. 10. 2012
Tehran, Iran
10th International Congress of
Iranian Association of Orthodontists
Website: www.iaocongress1391.ir, www.iao.ir
E-mail: [email protected], [email protected]
29. 11.±2. 12. 2012
New Delhi, India
8th Asian Pacific Orthodontic
Conference & 47th Indian
Orthodontic Conference
Website: www.8thapoc-47thioc.in
3.-7. 5. 2013
Philadelphia, PA
113th Congress of the American
Association of Orthodontics
American Association of Orthodontics,
401 North Lindbergh Boulevard, ST.LOUIS
MO 63141-7816, USA. Tel.: 001-314-993-1700
Fax: 001-314-997-1745, Website: www.AAOinfo.org
26.±30. 6. 2013
Reykjavik, Iceland
89th Congress of the European
Orthodontic Society
Congress Reykjavik, Engjateigi 5, 105 Reykjavik, Iceland
Tel.: +354 585 3900. E-mail: [email protected],
[email protected]
Website: www.congress.is, www.eos2013.com
25.±29. 4. 2014
New Orleans, USA
114th Congress of the American
Association of Orthodontics
American Association of Orthodontics,
401 North Lindbergh Boulevard, ST.LOUIS
MO 63141-7816, USA. Tel.: 001-314-993-1700
Fax: 001-314-997-1745, Website: www.AAOinfo.org
18.±21. 6. 2014
Warszaw, Poland
90th Congress of the European
Orthodontic Society
Mazurkas Travel, Congress&Conference Bureau,
27 Wojska Polskiego Av, 01-515 Warsaw, Poland
Tel.: +48 22 38 94 150. E-mail: [email protected]
Website: www.eos2014.com
June 2015
Venice, Italy
91st Congress of the European
Orthodontic Society
Professor Francesca Miotti
27.±30. 9. 2015
London, England
8th International Orthodontic
Congress
Website: www.wfo2015london.org
11.±16. 6. 2016
Stockholm, Sweden
92nd Congress of the European
Orthodontic Society
Professor Jan Huggare
June 2017
Bern, Switzerland
93rd Congress of the European
Orthodontic Society
Protessor Christos Katsaros
108
www.orthodont-cz.cz e-mail: [email protected]
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ORTODONCIE