Obsah (Contens): SpolecÏ enskaâ rubrika

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1 rocïnõâk17 cï asopis CÏ eskeâ ortodontickeâ spolecï nosti Published by the Czech Orthodontic Society RocÏ nõâk (Volume): 17 Rok (Year): 2008 CÏ õâslo (Number): 3 _ Obsah (Contens): SpolecÏ enskaâ rubrika str.5 Zpra vy z vyâ boru str.6 ZajõÂmavosti v ortodoncii str.8 Odborna praâ ce str.12 Kotevnõ minisï rouby v ortodoncii. 2. dõâl. DotaznõÂkova studie, mozïneâ komplikace (Miniscrews as orthodontic anchorage. Part 2. Retrospective questionnaire study, possible complications.) Retence premolaâruê (Unerupted premolars) VyuzÏ itõâ kmenovyâ ch buneï k a tkaâ nï oveâ ho inzï enyâ rstvõâ pro naâ hradu zubuê (Stemcells and tissue engineering for tooth substitute) Pro praxi Protokol peâcï e o pacienty s rozsïteï povou vadou oblicï eje na KPECH Brno Kongres CÏ OS Ze zahranicï nõâch cï asopisuê Informace str.40 str.48 str.50 str.52 _ Vydavatel: CÏ eskaâ ortodontickaâ spolecï nost Published by the Czech Orthodontic Society Vedoucõ redaktor (Editor in Chief): Doc. MUDr. MilosÏ SÏ pidlen, Ph.D., Olomouc, Czech Republic RedakcÏ nõâ rada (Editorial Board): MUDr. Karel Floryk, VysÏ kov, Czech Republic MUDr. Milada Ha lkovaâ, Strakonice, Czech Republic MUDr. Jan Horal, Praha, Czech Republic MUDr. Martin HoraÂcÏ ek, HavlõÂcÏkuÊ v Brod, Czech Republic MUDr. Marie JurisÏ icovaâ, CSc., Martin, Slovak Republic Prof. MUDr. Milan KamõÂnek, DrSc., Olomouc, Czech Republic MUDr. Ivana KyralovaÂ, Hradec Kra loveâ, Czech Republic MUDr. Ivo Marek, BrÏeclav, Czech Republic Dr. Malgorzata Sitarek - Madaj, PoznanÂ, Polska MUDr. Milada StehlõÂkovaÂ, KromeÏrÏõÂzÏ, Czech Republic MUDr. Marie SÏ tefkovaâ, CSc., Olomouc, Czech Republic MUDr. Hana TycovaÂ, Praha, Czech Republic Dr. Mariusz Wilk, LodzÂ, Polska Vedoucõ redaktor web stran (Editor in Chief web pages) MUDr. Radek Kokaisl, Praha, Czech Republic Adresa redakce (Contact Address): Olomouc, PalackeÂho12 fax: , tel.: ISSN: 1210±4272, CÏ asopis je vydaâvaâ n 4x rocïneï ( is published in 4 issues per year) Sazba (Type setting): FIS Print Olomouc. Tisk (Printed by): Tiska rna Mor. TrÏebova Cena (Payment): 200,± KcÏ (8,± EUR), CÏ.uÂ.: /0100, konst. symbol: 0558, variab. symbol: rodneâ cï õâslo. CÏ asopis je bezplatneï zasõâlaân cï lenuê mcï eskeâ ortodontickeâ spolecï nosti. A copy of the is sent to all members of the Czech Orthodontic Society in good spending with their subscription. UzaÂveÏ rky (Dedline for the next year): 20.9.a , 24.1., 7.3.a

2 SpolecÏ enskaâ rubrika rocïnõâk17 VcÏervenci a srpnu roku 2008 sveâ vyâznamneâ zïivotnõâ jubileum oslavõâ: MUDr.Helena OkunovaÂ, Ostrava MUDr.ElisÏka AschenbrennerovaÂ, PlzenÏ MUDr.AlzÏbeÏta Ada mkovaâ, FrensÏta t p.radhosïteïm MUDr.Ivana DouchovaÂ, Praha 5 MUDr.Miroslava SÏ vaâ bovaâ, CSc., Praha 5 MUDr.Marie SÏ uraâ nkovaâ, ProsteÏjov MUDr.Eva MaresÏovaÂ,U stõâ nad Labem - VanÏov MUDr.Olba KrejcarovaÂ,CÏ eskeâ BudeÏjovice SrdecÏneÏ blahoprï ejeme! Prof. MUDr. Milan KamõÂnek, DrSc., F.D.S.R.C.S. Eng. Nechce se tomu ani veïrïit, zïe prof. KamõÂnek slavõâ letos 70. narozeniny. Zna me ho jako cï loveï ka plneâ ho energie, kteryâ zvlaâ daâ neuveï rïitelneâ mnozï stvõâ praâ ce a staâ le patrïõâ k nejaktivneï jsï õâm cï lenuê m nasï õâ spolecï nosti. MuÊ zï eme rïõâci: ªVavrÏõÂny maâ, ale neusõânaâ na nichª. Narodil se v KolõÂneÏ. Studium stomatologie na Le karïskeâ fakulteï Univerzity Palacke ho ukoncï il promocõâ v roce ZacÏ al pracovat jako asistent, pozdeï ji odbornyâ asistent na ortodontickeâ m oddeï lenõâ stomatologickeâ kliniky Le karïskeâ fakulty v Olomouci. V letech absolvoval studijnõâ pobyt v Da nsku na ortodontickeâ m oddeï lenõâ v Aarhusu a v Kodani. Po naâ vratu zavedl, prïes obtõâzïneâ ekonomickeâ podmõânky, na oddeï lenõâ fixnõâ ortodontickeâ aparaâ ty a vybudoval pracovisïteï vyhledaâ vaneâ ke studijnõâm pobytuê m ortodontisty zcï eskeâ a Slovenske republiky, z byâ valeâ NDR, z Mad'arska a Polska. Publikoval 7 monografiõâ a ucï ebnõâch textuê, 70 veï deckyâ ch publikacõâ a prïednesl võâce nezï 200 prïednaâ sï ek na veï deckyâ ch akcõâch. KromeÏ zlepsï ovacõâch naâ vrhuê je drzï itelem jednoho patentu a dvou pruê myslovyâ ch vzoruê. V roce 1981 zõâskal cenu CÏ eskeâ stomatologickeâ spolecï nosti. Od Univerzity Palacke ho obdrzïel zlatou medaili UP v roce 2003 a v roce Byl cï estnyâmcï lenem Gesellschaft fuè r OrthopaÈ dische Stomatologie der DDR a v roce 1993 byl jmenovaâ ncï lenem korespondentem Deutsche Gesellschaft fuè r KieferorthopaÈ die. V roce 2000 se stal cï estnyâmcï lenem Polske ortodontickeâ spolecï nosti. V roce 2002 byl jmenovaâ n Fellow in Dental Surgery of The Royal College of Surgeons of England (F.D.S.R.C.S.). V cï ervnu 2008 obdrzï el Cenu FrantisÏ ka Palacke ho, kterou dosud nezõâskal zï aâ dnyâ cï len akademickeâ obce Le karïskeâ fakulty Univerzity Palacke ho v Olomouci. Je mõâstoprïedsedou CÏ eskeâ ortodontickeâ spolecï nosti, cï lenem rady (Council) European Federation of Orthodontic Specialist Associations a redakcï nõâch rad cï asopisuê Ortodoncie (Olomouc) a Ortopedia Szczekowa i Ortodoncia (Lodz ). V letech byl prezidentem EOS a prezidentem kongresu EOS v Praze v roce Ve vyâ zkumneâ a publikacï nõâ cï innosti se veï noval zejmeâ na metodice praâ ce s fixnõâmi ortodontickyâ mi aparaâ ty, problematice objektivizace terapeutickeâ uâ cï innosti, dlouhodobeâ stabiliteï leâ cï ebnyâ chvyâ sledkuê, propracovaâ nõâ diagnostickyâ ch postupuê a indikacõâ leâcï ebnyâ ch metod. Pracoval v EUROQUAL, Biomed I a Biomed II komisõâch Evropske unie pro vyâ zkum kriteâ riõâ kvality ortodontickeâ peâcïe. Prof. KamõÂnek je prïedevsï õâm veï dec a ucï itel, kteryâ ucï õâ rozumeï t ortodoncii, etickeâ mu a zodpoveï dneâ muprïõâstupu k pacientovi racionaâ lnõâ a efektivnõâ leâ cï bou. Probojoval a zavedl u naâ s kvalitnõâ trïõâletou postgraduaâ lnõâ prïõâpravu ortodontistuê. PravidelneÏ prïednaâsï õâ na kurzech nejen u naâ s, ale i v Polsku a na Slovensku. Tyto kurzy prïispeï ly k tomu, zïe se zde leâcïba fixnõâmi aparaâ ty stala samozrïejmostõâ. Spolu s kolektivem autoruê dokoncï uje ucï ebnici ortodoncie. K jeho zaâ libaâ m patrïõâ vaâ zï naâ hudba, volnyâ cï asveï nuje sveâ rodineï - manzï elce, dveï ma synuê mleâ karïuê macï tyrïem vnucï kaâ m. Na zacï aâ tku profesnõâ karieâ ry byla jeho koncepce ortodoncie - dostupnost fixnõâch aparaâ tuê v kazïdeâ ortodontickeâ praxi a systematickaâ trïõâletaâ postgraduaâ lnõâ vyâ chova, povazïovaâ na za utopii. DeÏ kujeme, zïe se staly beïzïnou skutecïnostõâ a v praxi fungujõâ. Vy bor CÏ eskeâ ortodontickeâ spolecï nosti SpecializacÏ nõâ atestace Ve dnech probeï hly specializacï nõâ atestacï nõâ zkousï ky a specialisty v oboru ortodoncie se uâ speïsïneï stali MUDr. Petr Jindra, Ph.D., MUDr. Darina Heringova MUDr. Michaela PetrovaÂ, MUDr. OndrÏej Suchy MUDr. Blanka ZÏ aâcï kovaâ BlahoprÏejeme 5

3 ZpraÂvyzvyÂboru ZpraÂvyzvy boru 1) Na zaâ kladeï rozhodnutõâ vyâboru z byly Ministerstvu zdravotnictvõâ CÏ R poslaâny prïipomõânky CÏ e- skeâ ortodontickeâ spolecï nosti k Vyhla sï ce o dispenzaâ rnõâ peâcïicï. 386/2007 Sb. (viz samostatnaâ prïõâloha). 2) Specialiste v ortodoncii z CÏ R jsou konecïneï uznaâvaâ ni v zemõâch EU! Dle smeï rnice EU 2007/C 165/07 z 19.cÏ ervence 2007 byly pozmeï neï ny prïõâloha B smeï r- nice 78/686/EEC a prïõâloha V, cïlaâ nek V.3, bod smeï rnice 2005/36/EC v tomto smyslu: V EU jsou uznaâvaâ ni specialisteâ z CÏ R, kterïõâ majõâ ¹Diplom o specializaci v oboru ortodoncieª udeï lenyâ 1) Institutempostgradua lnõâho vzdeï laâvaâ nõâ ve zdravotnictvõâ nebo 2) MinisterstvemzdravotnictvõÂ. 3) V raâ mci letosï nõâho kongresu CÏ OS probeï hnou volby do orgaânuêcï OS (viz samostatnaâ prïõâloha). MUDr.JirÏõ Petr PrÏipomõÂnky CÏ eskeâ ortodontickeâ spolecï nosti k VyhlaÂsÏ ce o dispenzaâ rnõâ peâcïicï. 386/2007 Sb. CÏ eskaâ ortodontickaâ spolecï nost navrhuje vypustit z prïõâlohy teâ to vyhlaâsï ky a tõâmz dispenzaâ rnõâ peâcï e tyto vady: progenie, otevrïeneâ skusy a rozsaâ hleâ aplasie zubuê. ZduÊ vodneï nõâ: Jedna se o beï zïneâ ortodontickeâ vady, ktereâ mohou mõât ruê znyâ rozsah a tõâmi dopad na pacienta. VeÏ tsï inou jde o prïevaâ zï neï estetickaâ postizï enõâ, kteraâ stejneï jako ostatnõâ ortodontickeâ vady nevyzï adujõâ speciaâ lnõâ sledovaâ nõâ. Ortodonticka leâ cï ba vsï ech teï chto vad maâ rovneïzï spolecïneâ rysy. Z nemocõâ se vztahem k oboru ortodoncie doporucï u- jeme v prïõâloze teâ to vyhlaâ sï ky ponechat pouze postizï enõâ s vyâ raznyâ mpodõâlemzdravotnõâho handicapu a potrïebou specifickeâ peâcï e,a teï mi jsou rozsïteï poveâ vady a vrozeneâ vyâvojoveâ vady s ortodontickyâmi projevy. Za CÏ eskou ortodontickou spolecï nost MUDr.JirÏõ Petr, prïedseda Va zï eneâ kolegyneï,vaâ zï enõâ kolegoveâ, milõâ cï lenoveâ CÏ OS! Dovoluji si Va s upozornit, zï e v tomto roce koncï õâ funkcï nõâ obdobõâ orgaâ nuê CÏ OS. Na plenaâ rnõâ schuê zi CÏ OS, kteraâ se bude konat v dobeï letosï nõâho kongresu v KrkonosÏ õâch, probeï hnou volby do vyâboru a reviznõâ komise CÏ OS. ZÏ aâdaâmvaâs vsï echny o hojnou uâcï ast na letosïnõâm kongresu nejen z duê voduê odbornyâ ch a spolecï enskyâ ch, ale i pro uplatneï nõâ VasÏ eho vlivu na cï innost CÏ OS. Proto Va mdoporucï uji porozmyâsï let, jak byste si prïedstavovali dalsï õâ fungovaânõâ CÏ OS a koho (vcï etneï sebe) byste proto raâ di videï li v jejõâmvedenõâ. Ty kolegyneï a ti kolegoveâ, kterïõâ VaÂsprÏesveÏdcÏ ili, zï e jimmuêzï ete veïrïit po straâ nce odborneâ i lidskeâ azï e jejich jednaâ nõâ je pro Va s srozumitelneâ, budou mõât dobreâ prïedpoklady pracovat pro Va s stejneï duê veï ryhodneï ve vedenõâ VasÏ õâ odborneâ spolecï nosti. Proto, prosõâm, rozmyâsï lejte pecï liveï, koho byste volili a procï, a kdo byste meï l jizï prïedemneï jakeâ naâ vrhy kandidaâtuê, posï lete je laskaveï na mou adresu (lze i anonymneï ): MUDr. JirÏõ Petr, Uruguayska 3, Praha 2 nebo em: DeÏ kuji Va mza prïedemvasï i aktivitu a teïsï õâmse na VaÂs na letosï nõâmkongresu v KrkonosÏ õâch! MUDr.JirÏõ Petr Spra vy zo Slovenska Plena rna schoã dza Slovenskej ortodontickej spolocïnosti s odbornyâ mprogramomsa tento rok konala na Ta loch v hoteli Stupka 18. aprõâla 2008, zuâcï astnilo sa jej 117 cï lenov Slovenskej ortodontickej spolocï nosti. Su cï ast'ou bola ako kazï dorocï ne vyâ stava firiems ortodontickyâ mmateriaâ lom. V odbornej cï asti sme si vypocï uli erudovanuâ, kraâ sne dokumentovanuâ prednaâsï ku Dr. H. PatocÏ kovej z CÏ eskej republiky o spolupraâ ci ortodontistu a parodontoloâ ga v nasï ej kazï dodennej praxi. Zaujala vyâ bornaâ prednaâ sï ka dr. A. PasÏ kovej o skrõâzï enomzhryze, taktiezï vyâ borne dokumentovanaâ s kraâ snymi liecï ebnyâ m i vyâ sledkami. Dr. J. VancÏona s oboznaâ mil ako sa pripravit' a ako postupovat' v nasï ich ambulanciaâ ch pri prechode SR na EURO. Te ma vel'mi aktuaâ lna a potrebnaâ sa stretla s vel'- kyâmzaâ ujmom, cï o sa prejavilo bohatou diskusiou. Plena rna schoã dza mala tradicï nyâ program. V spraâve o cï innosti spolocï nosti, ktoruâ predniesla MUDr. G. Alexandrova oboznaâ mila prõâtomnyâ ch s podanõâmprihlaâ sï ky nasï ej spolocï nosti do EFOSA. VyÂsledok bude znaâmy na zasadanõâ GAM EFOSA v juâ ni 2008, pri prõâlezïitosti EOS kongresu v Lisabone. SuÂcÏ asne uviedla, zï e situaâ cia v postgraduaâ lnomvzdelaâ vanõâ sa nezmenila, v roku 2007 sa nekonali sï pecializacï neâ atestaâ cie, takzï e do tereâ nu nepribudol ani jeden novyâ cï el'ustnyâ ortopeâ d. MozÏ no celuâ situaâ ciu zmenõâ fakt, zïe na SZU bola vytvorenaâ Katedra cï el'ustnej ortopeâ die, ktorej vedenõâmbola poverenaâ Dr. S. DianisÏ kovaâ, PhD. Novovytvorena samostatnaâ katedra preberaâ na seba organizaâ ciu a priebeh sï pecializacï neâ ho sï tuâ dia v cï el'ustnej ortopeâ dii. II. spolocï nyâ kongres CÏ OS a SOS sa bude konat'v Mikulove Hlavnou teâ mou kongresu je problematika otvoreneâ ho zhryzu a hlavnyâ mprednaâ sï a- juâ cimprof. R. Nanda z USA. Plena rna schoã dza odsuâ hlasila znõâzï enie cï lenskeâ ho prõâspevku do SOS pre postgraduantov plnyâmuâvaè zkom na klinike, pre zï eny na materskej dovolenke a kolegov v plnomstarobnomdoã chodku z 1000 Sk na 500 Sk. Dr.Gabriela Alexandrova 6

4 ZajõÂmavosti v ortodoncii 8. rocïnõâk JihocÏ eskyâ ch orto dnuê Ve dnech se konalo v CÏ eskyâch BudeÏ jovicõâch v hotelu Maly pivovar tradicï nõâ setkaâ nõâ jihocï eskyâch, zaâ padocï eskyâch i jinyâch ortodontistuê. OpeÏt byl zajisïteï n vysoce kvalitnõâ odbornyâ program, prïednesenyâ jak klinickyâ mi pracovnõâky, tak i kolegy z tereâ nnõâch praxõâ. Dobry dojemna mne udeï lala precizneï prïipravenaâ prïednaâsï ka MUDr. SÏ vaâ choveâ z PlzenÏ skeâ kliniky na teâma korekce vertikaâ lneï otevrïeneâ ho skusu s vyuzï itõâmkotevnõâch implantaâ tuê. SoucÏ asneâ nejmoderneï jsï õâ naâ zory na fluoridovou prevenci a na osï etrïovaâ nõâkazuê u docï asnyâch molaâ ruê u nasï ich malyâ ch pacientuê velice hezky prïednesla MUDr. IvancÏ aâ kovaâ z Kra loveâ hradeckeâ kliniky. Kra sneâ vyâ sledky aplikace mezenchymaâ lnõâch sïteïpuê u dospeïlyâch pacientuê s fixnõâmi rovnaâ tky prezentovala MUDr. U lehlovaâ z PõÂsku. KazÏdy z naâ s musõâ neïkdy osï etrïovat pacienta s rozsïteï pem. Proto naâmprïisïla velice vhod prïednaâsï ka MUDr. Kot'ove z PrazÏ skyâch Vinohrad. Ani dalsï õâ prïednaâ sï ejõâcõâ nezuê stali nic dluzï ni dobreâ odborneâ uâ rovni tohoto setkaânõâ. Je velkaâ sï koda, zïe v nasï ich rïadaâ ch staâle prïevlaâ dajõâ kolegoveâ strïednõâho veï ku, mladsï õâ kolegoveâ v nasï em kraji jsou zastoupeni maâ lo. Na tomto setkaânõâmeï li svou sekci poprveâ i zubnõâ technici, kterïõâ pracujõâ v oboru ortodoncie. BeÏ hemteï chto dnuê meïlimozï nost vyslechnout prezentace svyâ ch koleguê, porovnat sveâ pracovnõâ postupy s jinyâmi a posoudit, zda by bylo co vylepsï ovat. ZaÂmeÏ remzubnõâch technikuê bylo zamyslet se nad problematikou zubnõâch technikuê ortodontistuê, sjednotit se a zalozï it organizaci, kteraâ by se teï mito probleâ my zabyâvala. To se skutecïneï podarïilo a to 8.5., 2008, kdy byla ustanovena v prostoraâ ch hotelu Akcent v Praze Asociace Orto Tech. NasÏ e dõâky patrïõâ organizaâ toruêmteâ to akce MUDr. MiladeÏ Ha lkoveâ a AleneÏ Podlahove z firmy ROD, ktereâ zajistily dalsïõâprïõâjemneâ setkaânõâ.uzï dnes se teï sï õâme na dalsïõâ rocïnõâk. MUDr.Alena Zapletalova 8

5 ZajõÂmavosti v ortodoncii rocïnõâk17 JihocÏ eskeâ ortodontickeâ dny Letos poprveâ se k akci JihocÏ eskeâ orto dny pro leâkarïe ortodontisty v CÏ eskyâ ch BudeÏ jovicõâch prïidruzï ila i sekce pro zubnõâ techniky pracujõâcõâ v oboru ortodoncie. NejveÏ tsï õâ zaâ sluhu na vzniku, doufejme, noveâ tradice maâ MUDr. Milada Ha lkovaâ, kteraâ toto spojenõâ leâ karïuê a zubnõâch technikuê umozï nila a podporïila za pomoci Aleny Podlahove z firmy ROD CÏ eskeâ BudeÏ jovice. Na straneï zubnõâch technikuê to byla VeÏ ra KarlovaÂ, kteraâ na podneï t MUDr. Ireny SÏ ubrtoveâ s tõâmto naâ vrhem MUDr. Ha lkovou oslovila a cï aâ stecï neï zorganizovala prïednaâ sï kovou cï aâ st pro zubnõâ techniky. Akce probeï hla v prïekraâ sneâ mprostrïedõâ hotelu Maly pivovar v CÏ eskyâch BudeÏ jovicõâch. PrÏednaÂsÏ ky probõâhaly dva dny a prïinesly mnoho uzïitecï nyâ ch informacõâ. Sve zkusï enosti prezentovali jak leâkarïi, tak zubnõâ technici. Te mata prïednaâ sï ek byla ruê znorodaâ od dokumentacï nõâch modeluê,prïes materiaâ ly pouzï õâvaneâ v ortodoncii, diagnostickeâ prïestavby, vyâ robu splintuê pro ortognaâ tnõâ chirurgii. Prvnõ den prïednaâsï ek zakoncï ila prezentace hornõâ desky s pelotou. Jako vyhlaâ sï enaâ kapacita ve sveâ moboru prïedal uâ vodemdruheâ ho dne svoje zkusï enosti i MUDr. Va clav Bedna rï a jeho laâ ska k funkcï nõâmaparaâ tuê mprosvõâtila sobotnõâ dopoledne. Pak naâ sledovaly prïednaâ sï ky o laboratornõâmzhotovenõâ funkcï nõâch aparaâtuê, transfer systeâm v ordinaci, typy patrovyâch trïmenuê, Wiliamsova a Nancyho desticï ka, lakovaâ nõâ ortodontickyâ ch aparaâ tuê a zhotovenõâ distalizaâ toru. Kladne ohlasy teâ m eï rï trïiceti zuâ cï astneï nyâ ch zubnõâch technikuê udeï laly organizaâ toruê mvelkou radost a tõâm jimvynahradily obrovskyâ kus praâ ce, kteryâ byl samozrïejmeï s prïõâpravou celeâ akce spojen. ZakoncÏ enõâ se konalo okolo trïetõâ hodiny odpolednõâ, kdy zubnõâ technici podeï kovali doktorce Ha lkoveâ za zorganizovaâ nõâ celeâ akce a pak jizï naâ sledovalo loucï enõâ. VsÏ e provaâ zelo kraâ sneâ pocï asõâ a usmeï vaveâ naladeï nõâ vsï ech prïõâtomnyâ ch. SÏ aâ rka Eibichova a VeÏ ra Karlova I toto je cõâlemnoveï vznikajõâcõâ Asociace - zviditelnit zubnõâ techniky, ortodontisty a umozï nit dosazï enõâ dokonalejsï õâho vzdeïlaâvaâ nõâ v oboru, ale i zlepsï enõâ ekonomickyâ ch podmõânek, ktereâ jsou v soucï asnosti jizï zcela neudrzï itelneâ a proto dochaâ zõâ k tomu, zï e nasï i kolegoveâ s velkyâmi zkusï enostmi v oboru odchaâ zõâ za vidinou vysïsïõâch prïõâjmuê. Po prïivõâtaânõâ a prïedstavenõâ hlavnõâch akteâruê, kteryâmi byli Jana VintrovaÂ, Maria n Svorad a VeÏ ra KarlovaÂ, probeï hlo seznaâ menõâ se stanovami, poteâ naâ sledovalo jejich prïipomõânkovaâ nõâ, daâ le diskuze o jizï zm õâneï neâ m naâ zvu organizace, logu a takeâ o znaku Asociace. PrÏedbeÏzÏneÏ byla dohodnuta vyâsïecï lenskyâch prïõâspeï vkuê. Pote naâ sledovalo prïedstavenõâ kandidaâ tuê na funkci prezidenta a viceprezidenta. ZatõÂmneoficia lnõâmprezidentembyla zvolena Jana Vintrova a viceprezidentem Maria n Svorad. VsÏ echna hlasovaâ nõâ byla jednomyslnaâ. Po oficiaâ lnõâmzalozï enõâ Asociace bude naâ sledovat jizï oficiaâ lnõâ volba do jednotlivyâ ch funkcõâ dle stanov. Bude teâ zï jmenovaâ na rïõâdõâcõâ a dozorcï õâ rada. Jsou võâtaâ ny naâ vrhy zrïad zubnõâch technikuê - ortodontistuê na tyto funkce. Velice by pomohlo ¹zmapova nõ⪠pocï tu zubnõâch technikuê, kterïõâ pracujõâ v oboru ortodoncie. PrÏihlasÏ te se, prosõâm, co nejdrïõâve na adresu nebo posï tou na adresu VeÏ ra KarlovaÂ, PrÏesÏ tickaâ 9, PlzenÏ. Od Asociace obdrzïõâte prïihlaâsï ku a pokud budete mõât zaâ jem, prïihlaste se. SÏ aâ rka Eibichova a VeÏ ra Karlova Asociace Orto Tech PrvnõÂ, zatõâmneoficiaâ lnõâ, sjezd zubnõâch technikuê - ortodontistuê, probeï hl v prostoraâ ch hotelu Akcent v Praze. CõÂlembylo seznaâ mit prïõâtomneâ s rozhodnutõâmzalozïit organizaci zubnõâch technikuê, ortodontistuê, pro nõâzï byl schvaâ len naâ zev Asociace Orto Tech. Pravdou je, zï e neprïõâlisï pocï etnaâ skupina ortodontickyâ ch technikuê byâ vaâ neustaâ le opomõâjena prïi duê lezï ityâ ch jednaâ nõâch, z velkeâ cïaâ sti za to muêzï e i nasï e vlastnõâ nepruêbojnost. ¹Non-compliance orthodonticsª PrazÏsky hotel OlsÏ anka byl v sobotu, 24. kveï tna 2008 deï jisï teï mcelodennõâho prïednaâ sï koveâ ho maratonu pod naâ zvem¹non-compliance orthodonticsª. PrÏedna sï ejõâcõâmbyl italskyâ ortodontista Dr. Stefano Velo, prezident Evropske spolecï nosti lingvaâ lnõâ ortodoncie. Na vysoce profesionaâ lnõâ uâ rovni seznaâ mil do poslednõâ zï idle obsazenyâ prïednaâsï kovyâ saâ l kongresoveâ ho centra s ortodontickyâmi postupy leâcï by II. trïõâd, u nichzï jsou minimalizo- 9

6 ZajõÂmavosti v ortodoncii V pruêbeïhuprïednaâsï ek padala rïada dotazuê, na ktereâ dr. Velo okamzï iteï odpovõâdal a hledal ve sveâ mpocï õâtacï i zcela neplaâ novaneï dalsï õâ a dalsï õâ kasuistiky, aby odpoveï deï l co nejleâpe a vsï e zaâ rovenï dokumentoval. Cela prïednaâ sï ka, kterou porïaâ dala firma Italdent byla velmi dobrïe zajisïteï na a k jejõâmu uâ speï chu zaâ sadneï prïispeï l i bezchybnyâ prïeklad dr. KopeckeÂ. MUDr.M.Kot'ovaÂ, Ph.D Kotevnõ mikrosï rouby vaâ ny pozï adavky na spolupraâ ci pacienta. V prvnõâ cïaâ sti byly probraâ ny aparaâ ty typu ¹Jetª na distalizaci molaâ ruê, ktereâ lze v pruêbeïhuleâcï by snadno modifikovat na prïechodneâ retencï nõâ aparaâ ty, na neï zï navazuje terapie fixnõâmi aparaâ ty (vestibulaâ rnõâmi i lingvaâ lnõâmi) s kotevnõâm vyuzï itõâmmikrosï roubuê M.A.S. Da le dr. Velo ukaâ zal mozïnosti expanze hornõâho zubnõâho oblouku s pomocõâ palatinaâ lnõâho aparaâ tu typu ªSpring - Jetª, postup prïi naprïimovaâ nõâ molaâ ruê pruzï inovyâ mnaprïimovacï ema efekt terapie hlubokeâ ho skusu s vyuzï itõâmspeciaâ lnõâch lingvaâ lnõâch zaâ mkuê upravenyâch pro naâ kus. PrÏi leâcïbeï hlubokeâ ho skusu si dr. Velo vypomaâhaâ nejen palatinaâ lnõâmi zaâ mky, ale i naâ kusnyâmi plosï kami vytvorïenyâ mi z volneâ ruky kompozitnõâm materiaâlempalatinaâ lneï na hornõâch rïezaâ cõâch. PoneÏ kud netradicï nõâ postup leâ cï by vertikaâ lneï otevrïeneâ ho skusu ve smõâsï eneâ dentici tzv. rychlou intruzõâ molaâruê vyvolal otaâ zky na teâ ma, zda jsme si jisti indikacõâ chirurgickyâ ch rïesï enõâ ortodontickyâ ch vad a zda maâ m e vzï dy s definitivnõâmnaâ vrhemleâcï by cï ekat na ukoncï enõâ ruê stu. VeÏ tsï inu ortodontickyâ ch anomaâ liõâ zacï õânaâ dr. Velo leâcï it v obdobõâ smõâsï eneâ dentice, kdy klade duê raz na dosazï enõâ optimaâ lnõâho vztahu prvnõâch staâ lyâ ch molaâ ruê, kteryâ je prïedpoklademvytvorïenõâ dobreâ artikulace, kteraâ jedinaâ zajistõâ dlouhodobeï dobryâ vyâ sledek leâ cï by. Dne se pro velkyâ zaâ jemortodontistuê konal jizï potrïetõâ velmi uâ speï sï nyâ kurz KOTEVNI MIKRO- SÏ ROUBY MUDr. I. Marka a doc. M. Starosty, Ph.D. Tentokra t bylo mõâsto konaâ nõâ prïesunuto z Moravy do hotelu ILF v Praze. Na zacï aâ tku prïednaâ sï ky naâ mmudr. Marek podal souhrn informacõâ o historii a evoluci skeletaâ lnõâho kotvenõâ. Da le se zabyâval rozdeï lenõâmkotvenõâna prïõâmeâ a neprïõâmeâ a jeho typy (subperiostaâ lnõâ, enoseaâ lnõâ, kostnõâ desticï ky a kotevnõâ kostnõâ sï rouby. PodrobneÏ ji hovorïil o enoseaâ lnõâch implantaâ tech, jejich umõâsteï nõâ pomocõâ referencï nõâ desticï ky (tj. stanovenõâ mõâsta aplikace) a jejich vyuzï itõâ k distalizaci hornõâch molaâ ruê.daâ le se zabyâ val kostnõâmi mikrosï rouby, jejich materiaâ lem, stabilitou, klinickou uâ speï sï nostõâ a typy. Zna me dva zaâ kladnõâ typy mikrosï roubuê : self tapping (samorïezneâ ) a self dribling (samovrtneâ ). ZduÊ raznil, zïe deâ lka sï roubu nemaâ vliv na stabilitu, naopak ta je zaâ vislaâ na diametru sï roubu. Doc. Starosta uvedl, zïe nejcï asteïji pouzïõâvaâ pruêmeï r 1,6 mm a deâ lku 8 mm (nebo 10 mm). MUDr. Marek podrobneï ji popsal korejskyâ systeâm JEIL, kteryâ saâ mpouzïõâvaâ. Podle MUDr. Marka je nejlepsï õâk intruzi a neprïõâmeâ mu kotvenõâvyuzïõât typ JD. Typ G2 je nejuniverzaâ lneïjsï õâ a typ JB nejcï asteï ji pouzïõâvaâ k mesializaci molaâruê, naopak k intruzi molaâruê je nedoporucï uje. Neju speï sï neï jsï õâ mõâsto pro zavedenõâ implantaâ tu urcï il palatinaâ lneï v hornõâ cï elisti. DoporucÏ il zavaâdeï t kotevnõâ mikrosï rouby vzïdysï ikmo: v hornõâ cï elisti k dlouheâ ose zubu, v dolnõâ cï elisti ZõÂskali jsme podrobnyâ prïehled o zaâ sadaâ ch zavaâdeï nõâ a vyuzïitõâ kotevnõâch mikrosï roubuê v praxi. K intruzi molaâruê MUDr. Marek doporucï uje uzï õât sõâlu 150 g. Den nabityâ informacemi koncï il praktickou cï aâ stõâ. KazÏdy z uâcï astnõâkuê pod vedenõâmdoc. Starosty mohl zaveâ st kotevnõâ mikrosï rouby do prasecï õâ kosti. Kurz byl velkyâmprïõânosemnejen pro ortodontisty, ale takeâ pro vsï echny, kterïõâ se touto teâ matikou chteï jõâ zabyâ vat. Na zaâveï r nezbyâvaâ nezï podeï kovat obeïmaprïednaâsïejõâcõâmza skveï le prïipravenou prïednaâsï ku, porïaâ dajõâcõâ firmeï Altis Group za hladkyâ pruêbeï h akce a teïsïit se na dalsï õâ kvalitnõâ seminaârïe! MUDr.Barbora Velka 10

7 Kotevnõ minisï rouby v ortodoncii. 2. dõâl. DotaznõÂkova studie, mozïneâ komplikace Miniscrews as orthodontic anchorage. Part 2. Retrospective questionnaire study, possible complications. MUDr.OndrÏej HajnõÂk, MUDr.Magdalena Kot'ovaÂ, Ph.D. Ortodonticke oddeï lenõâ Stomatologicke kliniky 3. LF UK a FNKV Praha Department of Orthodontics, Clinic of Dental Medicine, 3rd Medical Faculty of Charles University, and University Hospital Kra lovskeâ Vinohrady Praha Souhrn Jsou probraâ ny mozïneâ komplikace prïi pouzïitõâ kotevnõâch minisï roubuê v ortodoncii, jejich indikace a kontraindikace. Byla provedena dotaznõâkovaâ studie ke zjisï teï nõâ postojuê pacientuê k zavedenõâ minisï roubuê z ortodontickyâ ch duêvoduê.z vyâ sledkuê studie vyplyâ vaâ, zï e 79 % pacientuê necõâtõâ bud'zï aâ dnou, nebo mõârnou bolest po zavedenõâ minisï roubu a 96 % necõâtõâ bud'zïaâ dnou, nebo mõârnou bolest po vyjmutõâ a võâce nezï 90 % pacientuê by si nechalo minisï roub v prïõâpadeï potrïeby zaveâ st znovu. Za teï zï pacienta prïi pouzï itõâ kotevnõâho minisï roubu je nepatrnaâ, terapeutickyâ efekt velmi dobryâ. Zavedenõ a zejmeâ na odstraneï nõâ minisï roubuê je instrumentaâ lneï, cï asoveï i ekonomicky nenaâ rocï neâ a pacienta netraumatizuje (Ortodoncie 2008, 17, cï. 3, s ). Abstract Potential complications accompanying the use of miniscrews as orthodontic anchorage are discussed, their indications and contraindications. The questionnaire study records patients' attitudes on miniscrews. The results suggest that 79% of patients have no pains or just moderate discomfort after the insertion of a miniscrew, 96% patients state no pains or just a moderate discomfort after the miniscrew was removed. More than 90% of patients would agree with a new application of the miniscrew if necessary. Demands on a patient with a miniscrew are insignificant; the effect of therapy is very good. The insertion of a miniscrew and its removal is undemanding in terms of armamentarium, time and economic costs and comfortable for a patient (Ortodoncie 2008, 17, No. 3, p ). KlõÂcÏ ovaâ slova: skeletaâ lnõâ ortodontickeâ kotvenõâ, docï asnaâ kotevnõâ zarïõâzenõâ, kotevnõâ minisï roub. Key Words: skeletal orthodontic anchorage, temporary anchorage devices, miniscrew as orthodontic anchorage U vod Komplikace spojeneâ s minisï rouby a jejich rïesï enõâ V odborneâ literaturïe lze najõât mnozï stvõâ kazuistik a studiõâ, ze kteryâch je zrïejmeâ, zï e pouzï itõâ minisï roubuê v ortodoncii je metoda spolehlivaâ a takto vytvorïeneâ kotvenõâ je stabilnõâ. Nicme neï bez rïaâ dneâ erudice a praktickeâ honaâ cviku muê zï e vyuzï itõâ tohoto druhu skeletaâ lnõâho kotvenõâ veâ st k ne uâ plneï ideaâ lnõâmvyâsledkuêma neï kdy muê zï e byâ t zdrojemzklamaâ nõâ a prïõâpadneï posï kozenõâ pa- Introduction Complications accompanying miniscrew application and their management In literature we can find many case studies suggesting the use of miniscrews in orthodontics is reliable and stable. However, experience and proper training is the prerequisite for successful application of miniscrews. Therefore, it is a must for an orthodontist to be well informed about potential complications and ways 12

8 rocïnõâk17 cienta. Znalost mozï nyâ ch komplikacõâ a jejich rïesï enõâ je nezbytnyâmprïedpokladempro uâ speï ch a spokojenost z hlediska osï etrïujõâcõâho leâ karïe i pacienta [8, 25, 26, 28, 29, 43]. NedostatecÏ naâ primaâ rnõâ stabilita je patrneï nejcï asteï ji uvaâdeï nou komplikacõâ, jde o stav, kdy je minisï roub po zavedenõâ do kosti nepatrneï pohyblivyâ, cozï daâ le vede k jeho zjevneâ mobiliteï s naâ slednyâ muvolneï nõâma selhaânõâm. SoucÏ asneâ poznatky sveïdcï õâ o tom, zï e maximum stability minisï roubu je zajisïteï no kompaktou a jen v mensïõâ mõârïe spongiosou. Je trïeba zvolit takoveâ mõâsto pro zavedenõâ, kde bude kompakty dostatek, poprïõâpadeï zvolit veï tsï õâ velikost minisï roubu. Bylo zjisï teï no, zïe prïi velkeâm uâ hlu kraniometrickyâch basõâ cï elistõâ je kompakta v dolnõâ cï elisti tencï õâ. U tohoto typu pacientuê je proto dobreâ zvolit minisï roub veïtsï õâch rozmeïruê [25]. DalsÏ õâm duê vodemnedostatecï neâ primaâ rnõâ stability muê zïe byât prïedvrtaânõâ prïõâlisï velkeâ sï toly, cozï se zpravidla stane v situaci, kdy osï etrïujõâcõâleâ karï neudrzï õâvrtaâ k v jedneâ rovineï a pruê meï r sï toly se tak zveï tsï õâ. PouzÏ itõâmsamovrtneâ ho minisï roubu se daâ komplikaci tohoto typu prïedejõât. OpozÏdeÏ naâ mobilita minisï roubu muê zïe prïijõât v naâ sledujõâcõâch dnech cï imeï sõâcõâch po zavedenõâ. Tento typ nestability je obvykle zpuê soben prïetõâzï enõâmnebo naopak nedostatecï nyâ mzatõâzï enõâmminisï roubu. OkamzÏ iteâ zatõâzï enõâ minisï roubu stimuluje formaci kosti a postupneï dochaâ zõâ k jeho upevnï ovaâ nõâ. Pokud nenõâ minisï roub zatõâzïen od zacï aâ tku, muê zï e dojõât k vruê staâ nõâ epiteliõâ mezi povrch minisï roubu a kosti, cozï vede k naâ sledneâ mobiliteï. PrÏi iniciaâ lnõâmzateï zï ovaâ nõâ je trïeba zmeï rïit sõâlu, kterou hodlaâ me minisï roub zatõâzïit - nemeïlabyprïesaâ hnout 50 g. Ne vsï echny pohybliveâ minisï rouby musõâ byât okamzï iteï vyjmuty. Pokud je mobilita jen nepatrnaâ, pacient nemaâ zï aâ dneâ obtõâzï e, nejsou patrneâ klinickeâ znaâ mky zaâneï tu a minisï roub je stabilnõâ natolik, aby odolal ortodontickyâmsilaâm,muêzï eme jej ponechat na mõâsteï. Pokud je vsï ak mobilita zjevnaâ, je nutneâ jej vyjmout a pokusit se zaveâ st novyâ minisï roub na jineâ mõâsto. PozdnõÂ mobilita muê zïe byât teâzï zpuê sobena takeâ prïetocï enõâmminisï roubu prïi sï roubovaâ nõâ do kosti. Je trïeba dbaâ t na to, abychom prïestali sï roubovat ve chvõâli, kdy dosaâ hne krcï ek minisïroubu periostu. Pokud nenõâ prïi prïedvrtaâ nõâ zajisï teï no dostatecï neâ chlazenõâ vrtaâ ku, muê zï e dojõât k prïehrïaâ tõâ kosti a neprïõâznivyâ osud minisï roubu je tak zpecï eteïn. PrÏi nedodrzï enõâ anatomickyâch zaâ sad muê zï e prïi zavaâdeï nõâ dojõât k porusï enõâ anatomickyâ ch struktur jako jsou ceâ vy, nervy, zubnõâ korïeny a maxilaâ rnõâ sinus. Z ceâv prïichaâzõâ v uâ vahu arteria palatina maior, z nervuê prïedevsï õâmnervus palatinus a nervus mentalis. V prïõâpadeï, zï e je osï etrïujõâcõâ leâ karï v topografickeâ anatomii dostatecï neï orientovaâ n, nemeï lo by k narusï enõâ ceâ v a nervuê dojõât. of their management. These are preconditions of successful results for both a professional and a patient [8, 25, 26, 28, 29, 43]. Insufficient primary stability is probably amongst the most frequent problems. The miniscrew - after the insertion into a bone - moves subtly, which further results in visible mobility of the screw, followed by its loosening and failure. In the light of current knowledge it is clear that the maximum stability of a miniscrew is facilitated by cortical bone and to a lesser degree by trabecular bone. Therefore, it is necessary to choose the place of insertion with sufficient amount of compact bone, or to use a bigger miniscrew. ¹High angleª patient is accompanied with a thinner cortical bone in the mandible. In such patients it is advisable to use a bigger miniscrew [25]. Insufficient primary stability may be the result of a too large predrilled passageway. This occurs in case an orthodontist fails to keep a drill in one and the same plane, and therefore the passageway diameter is changed. We can avoid the complication when we use a self drilling miniscrew. Delayed mobility of a miniscrew may occur within days or months after the insertion. This is usually the result of overloading or insufficient loading of a miniscrew. Immediate loading of a miniscrew stimulates bone formation, and thus the miniscrew is gradually fixed. In case the miniscrew is not loaded at the very beginning, epitheliummay grow between the surface of the miniscrew and the bone, which results in the mobility of the miniscrew. The initial loading should not exceed 50 g. However, not all mobile miniscrews must be removed immediately. In case the mobility is only moderate, the patient gives no discomfort, there are no symptoms of inflammation, and the miniscrew is stable enough to resist orthodontic forces, the miniscrew may be left in its place. Nevertheless, in case the mobility is visible, the miniscrew must be removed and a new one is inserted in another place. Delayed mobility may be also due to overwind of the miniscrew. We have to stop screwing at the moment when the neck of a miniscrew gets to periosteum. If the drill is not sufficiently cooled during predrilling, the bone may overheat and the treatment results in failure. Anatomical structures may be damaged during the insertion that does not respect anatomical principles. Veins, nerves, roots, and maxillary sinus are disrupted (especially arteria palatina maior, nervus palatinus, and nervus mentalis). Another situation arises in case of a randomcontact of a miniscrew and the tooth root or in case antrumis penetrated. During the insertion between the teeth 13

9 Jina je situace prïi naâ hodneâ mkontaktu minisï roubu s korïenemzubu cï iprïi narusï enõâ antra. PrÏi zavaâdeï nõâ minisïroubu mezi korïeny zubuê m uê zï e ke kontaktu minisï roubu s korïenemzubu dojõât i v prïõâpadeï,zïe leâ karï postupuje naprosto exaktneï podle nejlepsïõâhoveï domõâ a sveïdomõâ. Po zvolenõâ mõâsta pro zavedenõâ a jeho rentgenoveâ verifikaci pomocõâ mõârky maâ totizï leâ karï k dispozici pouze dvourozmeï rnou informaci o postavenõâ zubuê. Pokud nenõâ intraoraâ lnõâ snõâmek prïõâsneï ortoradiaâ lnõâ, muê zïe se vhodneâ mõâsto pro inzerci projikovat nespraâ vneï. PorusÏ enõâ periodoncia cï i korïene zubu je pak dõâlemokamzï iku. Melsenova a rïada dalsï õâch doporucï uje rucï nõâ zavaâdeï nõâ sï roubovaâ kem, nebot' jen tak maâ leâ karï dostatecïnou taktilnõâ kontrolu nad minisï roubem[28]. V prïõâpadeï, zï e dochaâ zõâ ke kontaktu se zubem, leâ karï to zpravidla ucõâtõâ a mõârnyâ mvychyâ lenõâmosy minisï roubu se mu muê zï e podarïit korïen atraumaticky minout. PrÏi zavaâdeï nõâ je trïeba znecitliveï nõâ pouze mukoperiostu a pokud je zvolena spraâ vnaâ daâ vka anestetika, pacient prïõâpadnyâ kontakt minisï roubu s periodonciempocõâtõâ amuêzïe to daâtleâ karïi najevo [10]. Pokud k narusï enõâ periodoncia cï i korïene dojde, hrozõâ vznik ankyloâ zy zubu. Tsukiboshi ve sveâ studii vsï ak tvrdõâ, zïe narusï eneâ periodontaâ lnõâ ligamentum se zhojõâ vznikem noveâ ho attachmentu [41]. Andreasen a Kristerson zjistili, zï e pokud je defekt v periodonciu mensï õâ nezï 2 mm, dochaâ zõâ ke zhojenõâ ad integrumbez vzniku ankyloâ zy [42]. Asscherickxova a kol. ve sveâ mexperimentu na psech podrobili analyâze trïi zuby, jejichzï korïeny byly porusï eny zavedenyâmi minisï rouby. U vsï ech dosïlo beï hem18 tyâdnuê po vyjmutõâ minisï roubuê k teâmeï rï kompletnõâmu zahojenõâ defektuê [43]. Zave st nesï t'astnou naâ hodou minisï roub prïõâmo do korïene je teâ meï rï nemozïneâ. Pokud je zavaâ deï nõâ manuaâ lnõâ, taktilnõâ vjemprïi kontaktu s korïenemje natolik zrïejmyâ, zïe k penetraci do korïene dojõât nemuêzïe. Riziko zavedenõâ minisï roubu do antra vzruê staâ s pneumatizacõâ maxilaâ rnõâho sinu, kteraâ je zpravidla dobrïe patrnaâ na ortopantomogramu. NejveÏ tsï õâmrizikempo vzniku oroantraâ lnõâ komunikace je maxilaâ rnõâ sinusitis a chronickaâ oroantraâ lnõâ põâsï teï l. PorusÏ enõâ integrity antraâ lnõâ dutiny nemusõâ byâ t diagnostikovaâ no. SÏ roub zavedenyâ do antra muêzï e totizï fungovat v perforaci jako ¹zaÂtkaª, prïes nõâzï prïeroste antraâ lnõâ sliznice a po vyjmutõâ leâkarï opeï t nemusõâ prïedesï lou komunikaci vuê bec diagnostikovat. Periimplantitis se projevuje pouze v prïõâpadeï osteointegrovaneâ ho protetickeâ ho implantaâ tu, proto je prïi zaâ neï tu kolemminisï roubu vhodneï jsï õâ pouzï õâvat pojmu ¹periimplantitis okolo docï asneâ ho kotvenõ⪠(TAP - Temporary Anchorage Periimplantitis), jejõâzï prïõâcï inou byâvaâ, jako u praveâ periimplantitis, anaerobnõâ infekce. Mobilita minisï roubu se rozvõâjõâ rychle a je doprovaâ zenaâ bolestõâ. MinisÏ roub je nutneâ vyjmout. roots the contact between a miniscrew and a root may occur even if an orthodontist proceeds exactly. The orthodontist has at his disposal only two-dimensional information about the teeth position. In case the intraoral X-ray is not precisely directed, the appropriate place for the insertion may project incorrectly. Periodontal ligament or a root may be disturbed very easily. Melsen and others recommend manual insertion with a screwdriver as this allows for a good tactile control over the miniscrew [28]. The orthodontist usually feels when the contact occurs, he can moderately deflect the miniscrew axis and avoid the root. Only mucoperiosteum is anesthetized, and the patient may notice the contact of the miniscrew with a periodontal ligament and let the orthodontist know [10]. Disruption of periodontal ligament or a root may lead to ankylosis of the tooth. However, Tsukiboshi [41] states that a disturbed periodontal ligament heals with a creation of a new attachment. Andreasen and Kristerson recorded that in case the defect in periodontium does not exceed 2 mm, it is healed ad integrumwithout the thread of ankylosis [42]. Asscherickx et al. [43] experimented with dogs and made the analysis of three teeth that were disturbed by the inserted miniscrews. Within 18 weeks after the miniscrews were removed, all defects healed completely. To insert a miniscrew directly into the root by accident is virtually impossible. In manual insertion the tactile perception of the contact with a root is so clear that the penetration is impossible. The risk of inserting the miniscrew into antrum increases with pneumatization of maxillary sinus. This is rather obvious in OPG. After the oroantral communication occurs, the greatest risk is the maxillary sinusitis and a chronic oroantral fistula. However, disruption of the antrumintegrity may not be diagnosed. The screw introduced into the antrummay function in the perforation as a sort of a tap. Mucosa may overgrow the screw and an orthodontist may not notice the perforation at all. Periimplantitis occurs only with osseointegrated prosthetic implants, therefore it is better to use the term Temporary Anchorage Periimplantitis (TAP). The cause is usually, as with periimplantitis proper, anaerobic infection. Mobility of the miniscrew occurs very soon and is painful. In such a case the miniscrew must be removed. Lesion of soft tissues due to the insertion is not very frequent. There is no need to manipulate in any way with soft tissue during the insertion of miniscrews, because the place of insertion is in the area of marginal gingiva. If the insertion must be performed in the area of mucosa, mucous membrane tends to wind around the body of the screw. Therefore, we have to use a round mucotom or cut the mucosa with a scalpel - 14

10 rocïnõâk17 Trauma meï kkyâ ch tkaâ nõâ prïi zavaâ deï nõâ byâ vaâ komplikacõâ neprïõâlisï cï astou. PrÏi zavaâ deï nõâ minisï roubuê nenõâ trïeba jakkoli manipulovat s meï kkyâmi tkaâneï mi, nebot' zavaâdeï nõâ je lokalizovaâ no v oblasti prïipojeneâ gingivy. Pokud je nutneâ minisï roub zaveâ st v oblasti sliznice, maâ tato tendenci se omotaâ vat okolo teï la minisï roubu. Je nutneâ pouzï õât kruhovyâ mukotom nebo naâ rïez skalpelem, kteryâ mse vytvorïõâ otvor v mukoperiostu a tõâmto tunelem je poteâ mozïneâ minisï roub zaveâ st. K traumatizaci meïkkyâch tkaânõâmuêzï e dojõât nejen prïi zavaâdeïnõâ.ibeï hemortodontickeâ terapie je nutneâ pecï liveï kontrolovat, zda hlavicï ka minisï roubu cï i prïõâdavnaâ zarïõâzenõâ, jako jsou tazïneâ pruzï inky cï i elastickeâ rïetõâzky, neinterferujõâ s meï kkyâmi tkaâneï mi. NejmeÂneÏ vhodnyâm mõâstem pro zavedenõâ minisï roubu se zdaâ byât v teâ to souvislosti fornix vestibula. KromeÏ traumatizace se muêzï e objevit i zaâneït. Infekce meï kkyâ ch tkaâ nõâ spojenaâ se zavedenõâmminisï roubu se projevuje lehkyâ meryteâ mem. Tuto komplikaci zpravidla vyrïesï õâ zlepsï enaâ uâ stnõâ hygiena a vyâ plachy 0,12 % chlorhexidinempo dobu 1 tyâ dne; je trïeba vcï asnaâ diferenciaâ lnõâ diagnostika periimplantitis. Interference minisï roubu a zubu beï hemterapie je meâneïcï astou komplikacõâ. V pruêbeï hu ortodontickeâ terapie se muêzï e posunovanyâ zub prïiblõâzï it k minisï roubu natolik, zïe vznikne nebezpecï õâ resorpce korïene. Melsenova ale tvrdõâ, zï e pokud se zub postupneï k minisï roubu prïiblizï uje, dojde drïõâve nezï k resorpci korïene k uvolnï ovaâ nõâ minisï roubu. Fraktura minisï roubu prïi zavaâdeï nõâ cï i vyjmutõâ nenõâ cï a- staâ, ale je trïeba ji uveâ st. Ke zlomenõâ dochaâ zõâ, pokud je minisï roub prïõâlisï tenkyâ v oblasti krcï ku. PrÏi vyâbeï ru minisï roubu je nutneâ pecï liveï zvaâzïit kvalitu kosti v mõâsteï zavedenõâ a adekvaâ tneï tomu vybrat spraâ vnou velikost minisï roubu. Pokud k zalomenõâ dojde hloubeï ji v kosti, stojõâ za zvaâ zï enõâ, zda fragment v kosti neponechat. Pokud je vsï ak fragment v uâ zkeâ mvztahu k periodonciu zubu, cïije blõâzï e k povrchu, je nutneâ jej chirurgicky odstranit. Pokud je vyvõâjen prïi zavaâ deï nõâ samovrtneâ ho minisï roubu prïõâlisï velkyâ tlak, nebo je vrstva kompakty prïõâlisï silnaâ, muê zï e dojõât ke zlomenõâ gracilnõâho hrotu, kteryâ zajisï t'uje samovrtnost kotevnõâho zarïõâzenõâ. V tomto prïõâpadeï je nutneâ minisï roub vymeï nit za novyâ a o zavedenõâ se pokusit znovu pomocõâ mensï õâho tlaku, poprïõâpadeï proveâst lehkyâ naâ vrt kompakty [28]. NeÏ kdy byâvaâ komplikovaneâ odstraneï nõâ minisï roubu. Pokud je minisï roub po vyuzï itõâ v ortodontickeâ terapii osteointegrovaân, je prïõâlisï pevnyâ a nenõâ mozïneâ jej prïi prvnõâ naâvsïteï veï vyjmout, doporucï uje se neï kolik dnõâ prïed plaâ novanyâ modstraneï nõâm sï roubu s nõâmopakovaneï pootocï it. JizÏ samotnyâ prvnõâ pokus o vyjmutõâ sï roubu zpuê sobõâ v kosti mikrofraktury a dõâky vyvolanyâm tkaânï ovyâmzmeïnaâ mdojde za neï kolik dnõâ k samovolneâ mu uvolneï nõâ minisï roubu a poteâ jizï nebyâvaâ probleâm jej z kosti beï hem3-7 dnõâ vysï roubovat [13]. to make a hole in mucoperiosteum through which the miniscrew is then inserted. Soft tissues may be injured not only during the insertion. It is necessary to check during orthodontic treatment whether the miniscrew head or additional devices, e.g. traction springs or elastic chains, do not interfere with soft tissues. Fornix of oral vestibule seems to be the least appropriate place for the insertion of a miniscrew. Apart from lesions, an inflammation may arise. Infection of soft tissues due to the miniscrew insertion manifests itself as a mild erythema. The problem is usually solved with improved hygiene of the oral cavity and irrigations with 0.12% chlorhexidine applied for one week. Differential diagnostics for periimplantitis is required. Interference of a miniscrew and a tooth during the therapy is less frequent. The tooth which is moved may get so close to the miniscrew that the danger of a root resorption arises. However, Melsen states that in case the tooth approaches a miniscrew gradually, the miniscrew loosens before the resorption may appear. Fracture of a miniscrew during its insertion or removal is rather rare. The miniscrew that is too thin in the neck area may break. We have to consider the quality of the bone in the place of insertion, and choose an appropriate size of a miniscrew accordingly. In case the miniscrew breaks deeper in the bone, it may be possible to leave the fragment there. If the fragment is close to periodontal ligament, or close to the surface, it must be surgically removed. If there is an enormous pressure during the insertion of a self drilling miniscrew, or the compact bone layer is too thick, the delicate tip of the screw may break. In such a situation we have to use a new miniscrew and try to insert it using less pressure, or to predrill the compact bone [28]. Sometimes the problems may occur in removal of the miniscrew. In case a miniscrew is osseointegrated (after orthodontic therapy), it is too rigid, and we cannot remove it, it is recommended to screw or wobble the miniscrew repeatedly several days before the planned removal. The first attempt to remove the miniscrew results in minifractures of a bone. Thus the changes in tissues are elicited, and within a few days the miniscrew loosens itself. After 3-7 days the miniscrew may be screwed off without any problem [13]. However, complications may occur immediately after the miniscrew was removed. If there is pain, oedema or exudation near the wound, irrigations with 0.12% chlorhexidine are recommended. Late complications following the miniscrew removal are rather rare, and include ankylosis of the tooth close to the place of insertion. The tooth must be regularly controlled to avoid inner or outer resorption. 15

11 I bezprostrïedneï po vyjmutõâ minisï roubu se muêzïeme setkat s komplikacemi. Pokud po vyjmutõâ prïetrvaâvaâ bolest, otok nebo exsudace v okolõâ raâ ny, doporucï ujõâ se vyâ plachy 0,12% chlorhexidinempo dobu neï kolika naâ sledujõâcõâch dnuê. Pozdnõ komplikace po odstraneï nõâ ortodontickeâho kotevnõâho minisï roubu jsou vzaâ cneâ a patrïõâ mezi neï ankyloâ za zubu, v jehozï blõâzkosti byl zaveden minisï roub. Pokud toto podezrïenõâ vznikne, je nutneâ zub pravidelneï kontrolovat, nebot'hrozõâ riziko vnitrïnõâ cï i vneï jsï õâ resorpce. Indikace a kontraindikace Kotvenõ s pomocõâ minisï roubuê m uê zï eme vyuzïõât vsï ude tam, kde nejsme schopni dosaâ hnout kotvenõâ bez sï kodliveâhouâcï inku reciprocï nõâch sil. Dle Melsenove jsou minisï rouby kontraindikovaâny u pacientuê se systeâ movou poruchou kostnõâho metabolismu, zpuê sobenou bud'nemocõânebo leâ ky a u silnyâch kurïaâkuê [28]. Da le jsou kontraindikovaâ ny u ozubeneâho alveolaâ rnõâho vyâbeï zïku ve smõâsï eneâ mchrupu z duê vodu nebezpecï õâ posï kozenõâ zaâ rodkuê staâ lyâ ch zubuê. Pokud jsou dodrzï eny kontraindikace, nenõâ pouzï itõâ kotevnõâch minisï roubuê veï koveï omezeno. U starsï õâch veïkovyâ ch kategoriõâ pacientuê je vsï ak nutno dbaâ t na fakt, zï e kostnõâ metabolismus jizï nenõâ tak aktivnõâ jako u mladistvyâ ch, rovneï zï u zï en po menopauze lze prïedpoklaâ dat, zïe z duê vodu mozïneâ osteoporoâ zy bude riziko selhaânõâ minisï roubu zvyâsï eneâ. CõÂlemstudie bylo zjistit, jak pacienti akceptujõâ osïetrïenõâ ortodontickyâ mkotevnõâmminisï roubem. Materia l a metodika Do souboru bylo vybraâ no 55 pacientuê a byl jimprïedlozï en dotaznõâk. Krite riempro vybraâ nõâ do souboru bylo pouzï itõâ kotevnõâch minisï roubuê cï i palatinaâ lnõâch implantaâ tuê beï hemortodontickeâ terapie fixnõâmaparaâ tem. Dotazovanõ pacienti byli leâ cï eni na Ortodonticke moddeïlenõâ Stomatologicke kliniky 3. LFUK FNKV Praha, na Ortodonticke moddeï lenõâ Stomatologicke kliniky LFUK v Plzni, v soukromeâ ortodontickeâ praxi MUDr. Marka, MUDr. Vandase, MUDr. Petra, MUDr. SÏ rytra a MUDr. HofmanoveÂ. Byl zjisït'ovaâ n typ implantaâ tu a otaâ zky byly Ota zka cï.1.cõâtili jste po zavedenõâ implantaâ tu bolest? (po odezneï nõâ anestesie) (zïaâ dnou/mõârnou/strïednõâ/velkou/krutou - jak dlouho?). Ota zka cï.2.cõâtili jste po vyjmutõâ implantaâ tu bolest? (po odezneï nõâ anestesie) (zïaâ dnou/mõârnou/strïednõâ/velkou/krutou - jak dlouho?). Ota zka cï.3.meï li jste v souvislosti se zavedenõâm implantaâtu neï jakeâ jineâ obtõâzïe? Ota zka cï.5.bylo-li by nezbytneâ, nechali byste si v prïõâpadeï dalsï õâ terapie fixnõâm aparaâ tem implantaâ t znovu zaveâ st? (ano/ne) Indications and contraindications Miniscrews as orthodontic anchorage may be used whenever we are not able to establish anchorage without a harmful effect of reciprocal forces. According to Melsen, miniscrews are contraindicated in patients with systemic alterations in the bone metabolism due to disease, medication, or heavy smoking (28). They are also contraindicated in toothed alveolar process in mixed dentition - there is a risk of damage to permanent dentition buds. The use of miniscrews as orthodontic anchorage does not depend on the patient's age, and is not limited by the age. However, in older patients the bone metabolism is not as active as in adolescents; in postmenopausal women the risk of a miniscrew failure can be higher due to potential osteoporosis. The aimof our study was to find out about how patients accept the treatment with an orthodontic miniscrew anchorage. Material and methods The sample included 55 patients who were asked to answer the questionnaire. In all patients miniscrews or palatal implants were applied during the orthodontic treatment with fixed appliance. The patients were treated at the Department of Orthodontics, Clinic of Dental Medicine, 3rd Medical Faculty of Charles University in Prague; Department of Orthodontics, Clinic of Dental Medicine, Medical Faculty in PlzenÏ, in the private practices of MUDr. Marek, MUDr. Vandas, MUDr. Petr, MUDr. SÏ rytr, and MUDr. HofmanovaÂ. First, the type of implant was determined. The questionnaire included the following questions: Q1. Did you experience any pain after the insertion of the miniscrew? (after anesthesia subsided) (no/minor/moderate/major/severe - how long?) Q2. Did you experience any pain after the miniscrew was removed? (after anesthesia subsided) (no/minor/moderate/major/severe - how long?) Q3. Did you experience any discomfort due to the inserted miniscrew? Q5. In case it is inevitable, during another therapy with fixed appliance - would you agree to have the miniscrew inserted again? (yes/no) Results Type of TAD (palatal implant or miniscrew) Out of 55 patients 52 had a miniscrew, 3 a palatal implant. At the time of questionnaire distribution, 42 patients were already without the miniscrew. The sample of patients with palatal implants is small, so we cannot give detailed results. However, 16

12 rocïnõâk17 Obr.1.Bolest, kterou pacienti cõâtili po zavedenõâ kotevnõâho minisï roubu. PocÏ ty pacientuê a procenta. Fig.1.Pain after the insertion of the miniscrew. Number of patients and percentage. Obr.2.Bolest, kterou pacienti cõâtili po vyjmutõâ kotevnõâho minisï roubu. PocÏ ty pacientuê a procenta. Fig.2.Pain after the miniscrew was removed. Number of patients and percentage. Vy sledky Typ implantaâ tu (patrovyâ implantaâ t nebo miniimplantaât) Z celkoveâ ho pocï tu 55 pacientuê meï lo 52 zavedeno kotevnõâ minisï roub a 3 palatinaâ lnõâ implantaât. PrÏi sbeï ru dat meï lo 42 pacientuê kotevnõâ minisï roub jizï vyjmut. Vzhledemk maleâ mu souboru pacientuê s palatinaâ l- nõâmi implantaâ ty nejsou u teï chto pacientuê podaâ ny detailnõâ vyâ sledky, nicmeâ neï bolest se u nich pohybovala spõâsï e v rozmezõâ charakteristik mõârnaâ cï i strïednõâ a vsï ichni 3 pacienti by si nechali zaveâst v prïõâpadeï potrïeby patrovyâ implantaâ t znovu. DotaznõÂk: Ota zka cï.1.cõâtili jste po zavedenõâ implantaâ tu bolest? (po odezneï nõâ anestesie) (zïaâ dnou/mõârnou/strïednõâ/velkou/krutou - jak dlouho?). ZÏ aâ dnou bolest udalo 21 pacientuê (41 %), mõârnou bolest oznacï ilo 20 pacientuê (38 %). ZÏ aâ dnou nebo mõârnou bolest udaâ valo tedy 79 % pacientuê (Obr. 1). StrÏednõ bolest pocit'ovalo 8 pacientuê (15 %), velkou 2 pacienti (4 %) a krutou 1 pacient (2 %). Na dobu bolesti po zavedenõâ minisï roubu neodpoveïdeï lo 36 pacientuê, proto nenõâ tato cïaâ st otaâ zky prïi zpracovaâ nõâ dat hodnocena Ota zka cï.2.cõâtili jste po vyjmutõâ implantaâ tu bolest? (po odezneï nõâ anestesie) (zïaâ dnou/mõârnou/strïednõâ/velkou/krutou - jak dlouho?). Pacienti popsali mõâru bolestivosti po vyjmutõâ minisï roubu (Obr. 2). ZÏ aâ dnou bolest udalo 26 pacientuê (63 %), mõârnou bolest oznacï ilo 14 pacientuê (33 %). 96 % pacientuê tedy prakticky nemeï lo obtõâzïe v souvislosti s odstraneï nõâmimplantaâ tu. Na dobu bolesti po vyjmutõâ minisï roubu neodpoveïdeï lo 38 pacientuê, proto nenõâ tato cïaâ st otaâ zky prïi zpracovaâ nõâ dat hodnocena. Obr.3.Subjektivnõ pocity pacientuê se zavedenyâmkotevnõâmminisï roubem. PocÏ ty pacientuê. Fig.3.Discomfort due to the inserted miniscrew. Number of patients. the pain was characterized as minor or moderate. All three patients would agree with a new implant. Questionnaire: Q1. Did you experience any pain after the insertion of the miniscrew? (after anesthesia subsided) (no/minor/moderate/major/severe - how long?) No pain was reported by 21 patients (41 %), minor pain was reported from20 patients (38 %). No or minor pain reported 79 % of patients ( Fig. 1). Eight patients had moderate pain (15 %), major 2 patients (4 %) and severe 1 patient (2 %). 36 patients did not specify the time/duration of pain, therefore this part of the question is not evaluated. Q2. Did you experience any pain after the miniscrew was removed? (after anesthesia subsided) (no/minor/moderate/major/severe - how long?) No pain was reported from26 patients (63 %), 14 patients (33 %) had minor pain. So 96% of patients reported no problems after the miniscrew was removed (Fig. 2). 17

13 Ota zka cï.3.meï li jste v souvislosti se zavedenõâm implantaâtuneï jakeâ jineâ obtõâzïe? 38 pacientuê bylo bez obtõâzï õâ, 14 meï lo subjektivnõâ obtõâzï e. Byly to zejmeâ na gingivitis (3 pacienti), prïeruê staâ nõâ sliznice (4 pac.), vzaâ cneï ji jineâ (viz obr. 3). Ota zka cï.4.bylo-li by nezbytneâ, nechali byste si vprïõâpadeï dalsï õâ terapie fixnõâm aparaâ tem implantaâ t znovu zaveâ st? (ano/ne) VprÏõÂpadeÏ potrïeby by si minisï roub nechalo opeï t zaveâ st 92 % pacientuê a 8 % pacientuê nikoliv. Diskuse Pla novaâ nõâ dentoalveolaâ rnõâch, prïõâpadneï skeletaâ lnõâch zmeï n v raâ mci ortodontickeâ leâ cï by dostaâ vaâ s mozï nostõâ vyuzï itõâ teï chto zarïõâzenõâ novyâ rozmeï r. Dle Kurody je nejveï tsï õâ starostõâ pacienta prïi ortodontickeâ terapii praâveï bolest. Ve sveâ praâ ci uvaâdõâ,zï e pro pacienty jsou komfortneï jsï õâ minisï rouby zavaâ deï neâ bez odklaâ peï nõâ mukoperistaâ l- nõâho laloku [27]. Kotevnõ zarïõâzenõâ s jednoduchou faâ zõâ zavaâdeï nõâ jsou pro pacienty mnohem snesitelneï jsï õâ nezï ta, u kteryâ ch se musõâ odklaâ peï t mukoperiostaâ lnõâ lalok. ZaÂveÏr Vzhledemk obavaâ mpacientuê, zda je osï etrïenõâ, spojeneâ s pouzï itõâmminisï roubuê bolestiveâ, jsou prezentovaânynaâ zory pacientuê na tento zpuê sob osï etrïenõâ. Z vyâsledkuê dotaznõâkoveâ studie vyplyâvaâ, zï e 79 % pacientuê necõâtõâ bud'zï aâ dnou, nebo mõârnou bolest po zavedenõâ minisï roubu a 96 % necõâtõâ bud' zïaâ dnou, nebo mõârnou bolest po vyjmutõâ a võâce nezï 90 % pacientuê by si nechalo minisï roub v prïõâpadeï potrïeby zaveâ st znovu. Tyto vyâsledky jsou pro uvedenõâ kotevnõâch minisï roubuê do beï zïneâ ortodontickeâ praxe velice povzbudiveâ pro leâ karïe i pacienty. PrÏi vyâbeï ru nejvhodneï jsï õâho kotevnõâho systeâ mu doporucï ujeme rïõâdit se slozï itostõâ manipulace s kotevnõâm systeâ mem. Pokud jsou zvoleny kotevnõâ minisï rouby, je nutneâ pecï liveï zvaâ zï it spraâ vnou kombinaci minisï roubu a kvality kosti, dostupneâ v mõâsteï plaâ novaneâ inzerce. Za teï zï pacienta prïi pouzï itõâ kotevnõâho minisï roubu je nepatrnaâ, terapeutickyâ efekt velmi dobryâ. Zavedenõ a zejmeâ na odstraneï nõâ minisï roubuê je instrumentaâ lneï, cï a- soveï i ekonomicky nenaâ rocï neâ a pacienta netraumatizuje. 38 patients did not specify the time/duration of pain, therefore this part of the question is not evaluated. Q3. Did you experience any discomfort due to the inserted miniscrew? 38 patients reported no problems; 14 patients reported subjective problems. They were mostly gingivitis (3 patients), mucosa overgrowth (4 patients), others were rare (see Fig. 3). Q4. In case it is inevitable, during another therapy with fixed appliance - would you agree to have the miniscrew inserted again? (yes/no) 92% of patients answered Yes, 8% No. Discussion Planning of dentoalveolar or skeletal changes within orthodontic therapy has a new dimension thanks to the new devices. According to Kuroda the fear of pain is the main patients concern in orthodontic therapy. In his study, Kuroda states that miniscrews placed without flap surgery are more comfortable for patients [27]. Thus the anchorage devices which are inserted with ¹simple surgical stageª are better tolerated. Conclusion Our study presents the views of patients with regard to the application of miniscrews. Results of the retrospective questionnaire study suggest that 79% of patients experience no or moderate pains after the insertion of a miniscrew, 96% experience no or moderate pains after the removal of the miniscrew, and over 90% of patients would agree with repeated placement of a miniscrew if necessary. The results are therefore encouraging for both orthodontists and patients. Difficulty in manipulation should play the main role in choice of an appropriate anchorage system. If we decide for miniscrews, we have to consider in detail the right combination of a miniscrew with regard to the quality of a bone in the place of the planned insertion. In case of a miniscrew as orthodontic anchorage, patients experience only minor discomfort, while the effect of the therapy is very good. Placement of a miniscrew and its removal is undemanding in terms of armamentarium, time and economic costs, and it is comfortable for a patient. Literatura/References: 1. Cope, J. B.: Temporary Anchorage Devices in Orthodontics : A ParadigmShift. Semin. Orthodont. 2005, cï. 11, s Melsen, B.: Is the intraoral - extradental anchorage changing the spectrumof orthodontics? Pozna mky ke kurzu. IOS, Praha, Linkow, L. I.: Implanto-Orthodontics. J. clin. Orthodont. 1970, 4, cï.12, s Melsen, B.; Petersen, J. K.; Costa, A.: Zygoma ligatures: an alternative formof maxillary anchorage. J. clin. Orthodont. 1998, 32, cï.3, s

14 rocïnõâk17 5. Creekmore, T. D.; Eklund, M. K.: The possibility of skeletal anchorage. J. clin. Orthodont. 1983, 17, cï. 4, s Kanomi, R.: Mini-implant for orthodontic anchorage. J. clin. Orthodont. 1997, 31, cï. 11, s Costa, A.; Raffaini, M.; Melsen, B.: Miniscrews as orthodontic anchorage: A preliminary report. Int. J. Adult Orthodont. Orthognath. Surg. 1998, 13, cï. 3, s Mah, J.; Bergstrand, F.; Graham, J. W.: Temporary anchorage devices: A status report. J. clin. Orthodont. 2005, 39, cï. 3, s P-I Branemark Institute Bauru Brazil [online]. Dostupne z: 10. Melsen, B. - osobnõâ sdeï lenõâ 2006, Praha. 11. Wilmes, B.; Rademacher, C.; Olthoff, G.; Drescher, D.: Parameters Affecting Primary Stability of Orthodontic Mini-implants. J. Orofac. Orthop. 2006, 67, cï. 3, s Bumann, A - osobnõâ sdeï lenõâ 2006, Praha. 13. Melsen, B.; Verna, C.: Miniscrew Implants: The Aarhus Anchorage System. Semin. Orthodont. 2005, cï. 11, s Kyung, H. M.; Park, H. S.; Bae, S. M.; Sung, J. H. ; KimI. B.: OVERVIEW Development of Orthodontic Micro-Implants for Intraoral Anchorage. J. clin. Orthodont. 2003, 37, cï. 6, s Park, H. S.; Kwon, T. G.: Sliding Mechanics with Microscrew Implant Anchorage. Angle Orthodont. 2004, 74, cï. 5, s Roth, A.; Yildrim, M.; Diedrich, P.: Forced eruption with microscrew anchorage for preprosthetic leveling of the gingival margin. J. orofac. Orthop. 2004, 65, s Ohnishi, H.; Yagi, T.; Yasuda, Y.; Takada, K.: A Mini-Implant for orthodontic anchorage in a deep overbite case. Angle Orthodont. 2005, 75, cï. 3,s Kuroda, S.; Sugawara, Y.; Yamashita, K.; Mano, T.; Takano-Yamamoto, T.: Skeletal Class III oligodontia patient treated with titaniumscrew anchorage and orthognathic surgery. Amer. J. Orthodont. dentofacial Orthop. 2005, 127, cï. 6, s Gray, J. B.; Smith R.: Transitional implants for orthodontic anchorage. J. clin. Orthodont. 2000, 34, cï. 11, s Park, H. S.; Jeong, S. H.; Kwon, O. W.: Factors affecting the clinical success of screw implants used as orthodontic anchorage. Amer. J. Orthodont. dentofacial Orthop. 2006, 130, cï. 1, s Absolon, K. et al.: VsÏ eobecnaâ encyklopedie Diderot, Praha, Diderot, ISBN Bumann, A.: Latest advancements in temporary orthodontic anchorage devices. Pozna mky ke kurzu. IOS, Praha, Carano, A.; Velo, S.; Leone, P.; Siciliani, G.: Clinical applications of the miniscrew anchorage system. J. clin.orthodont. 2005, 39, cï. 1, s Titan a slitiny titanu [online]. Dostupne z: 25. Miyawaki, S.; Koyama, I.; Inoue, M.; Mishima, K.; Sugahara, T.; Takano-Yamamoto, T.: Factors associated with the stability of titaniumscrews placed in the posterior region for orthodontic anchorage. Amer. J. Orthodont. dentofacial Orthop. 2003, 124, s Motoyoshi, M.; Hirabayashi, M.; Uemura, M.; Shimizu, N.: Recommended placement torque when tightening an orthodontic mini-implant. Clin. Oral Impl. Res. 2006, 17, cï. 1, s Kuroda, S.; Sugawara, Y.; Deguchi, T.; Kyung, H. M.; Takano-Yamamoto, T.: Clinical use of miniscrew implants as orthodontic anchorage: Success rates and postoperative discomfort. Amer. J. Orthodont. dentofacial Orthop. 2007, 131, cï. 1, s Melsen, B.: OVERVIEW Mini-Implants: Where Are We? J. Clin. Orthod. 2005, 39, cï. 9, s Graham, J. W.; Cope, J. B.: Miniscrew Troubleshooting. Orthodontic Products. 2006, April 2006, s. 1-6 [online]. Dostupne z: issues/articles/ _04.asp. 30. Dalstra, M.; Cattaneo, P. M.; Melsen, B.: Load transfer of miniscrews for orthodontic anchorage. Orthodontics 2004, cï. 1, s Chen, Y. J.; Chen, Y. H.; Lin, L. D.; Yao, C. C.: Removal torque of miniscrews used for orthodontic anchorage - a preliminary report. Int. J. Oral Maxillofac. Implants 2006, 21, cï. 2, s Deguchi, T.; Takano-Yamamoto, T.; Kanomi, R.; Hartsfield, J. K.; Roberts, W. E.; Garetto, L. P.: The Use of Small Titanium Screws for Orthodontic Anchorage. J. Dent. Res. 2003, 82, cï. 5, s Ohmae, M.; Saito, S.; Morohashi, T.; Seki, K.; Qu, H.; Kanomi, R.; Yamasaki, K.; Okano, T.; Yamada, S.; Shibasaki, Y.: A clinical and histological evaluation of titanium mini - implants as anchors for orthodontic intrusion in the beagle dog. Amer. J. Orthodont. dentofacial Orthop. 2001, 119, cï. 5, s Motoyoshi, M.; Yano, S.; Tsuruoka, T.; Shimizu, N.: Biomechanical effect of abutment on stability of orthodontic mini-implant. A finite element analysis. Clin. Oral Impl. Res. 2005, 16, s Heidemann, W.; Gerlach, K. L.; Grobel K. H.; Kollner, H. G.: Drill Free Screws: a new formof osteosynthesis screw. J. Craniomaxillofac. Surg. 1998, 26, cï. 3, s Tracey, S.: The Nuts And Bolts of Miniscrews. Orthodontic Products. 2006, February 2006, s. 1-6 [online]. Dostupne z: articles/ _12.asp. 37. Kim, J. W.; Ahn, S. J.; Chang, Y. I : Histomorphometric and mechanical analyses of the drill-free screw as orthodontic anchorage. Amer. J. Orthodont. dentofacial Orthop. 2005, 128, cï. 2, s Melsen, B.; Costa, A.: Immediate loading of implants used for orthodontic anchorage Clin. Orthodont. Res. 2000, cï. 3, s Maino, B. G.; Mura, P.; Bednar, J.: Miniscrew implants: The Spider Screw Anchorage System, Semin. Orthodont. 2005, cï. 11, s Poggio, P. M.; Incorvati, C.; Velo, S.; Carano, A.: ¹Safe Zonesª: A guide for miniscrew positioning in the maxillary and mandibular arch. Angle Orthodont. 2006, 76, cï. 2, s

15 41. Tsukiboshi, M.; Asai, Y.; Nakagawa, K.: Wound healing in transplantation and replantation. In: Tsukiboshi, M. : Autotransplantation of Teeth. Tokyo, Japan: Quintessence, 2001, s (Cit. in: [29]) 42. Andreasen, J. O.; Kristerson, L.: The effect of limited drying or removal of the periodontal ligament: Periodontal healing after replantation of mature permanent incisors in monkeys. Acta Odontol. Scand. 1981, 29, s (Cit. in:[29]) 43. Asscherickx, K.; Vannet, B. V.; Wehrbein, H.; Sabzevar, M. M.: Root repair after injury frommini - screw. Clin. Oral Impl. Res. 2005, 16, cï. 5, s MUDr.OndrÏej HajnõÂk Stomatologicka klinika 3.LF UK Praha SÏ robaâ rova 50, Praha 10 Altis Group, spol. s r. o. ±vyâhradnõâ zastoupenõâ pro CÏ eskou republiku a Slovensko RaÂdi bychom VaÂs pozvali na pokracïovaânõâ dvoudennõâho kurzu Prof. Dr. Bjorn U. Zachrissona DDS, MSD, PhD., Norsko TermõÂn: 7.±8. listopadu 2008 MõÂsto konaânõâ kurzu: ANDEL'S HOTEL PRAGUE (StroupezÏnickeÂho 21, Praha 5) TeÂmata kurzu: 1. PrÏestavba alveolaârnõâch tkaânõâ a kosti ortodontickyâm posunem zubu pro zlepsïenõâ estetiky implantaâtu 2. LeÂcÏebny plaân a kefalometrie - skeletaâlnõâ analyâza a analyâza meïkkyâch tkaânõâ. VyuzÏitõ VTO. 3. DuÊ lezïiteâ aspekty dlouhodobeâ stability vyâsledkuê ortodontickeâ leâcïby. 4. Extrakce jednoho dolnõâho rïezaâku v ortodoncii. 5. Klinicke novinky u fixnõâch lepenyâch retianeruê. 6. Lepenõ na atypickeâ povrchy (porcelaân, amalgaâm, zlato, kompozitum atd.) v klinickeâ praxi - nesrovnalosti mezi laboratornõâmi a klinickyâmi fakty. 7. SpolupraÂce s estetickou stomatologiõâ a uzavõâraânõâ mezer u pacientuê s chybeï jõâcõâmi hornõâmi lateraâlnõâmi rïezaâky. ÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐÐ Praha, hotel ILF ± jednodennõâ seminaârï TeÂma: KlõÂcÏova prïednaâsïka: DalsÏõÂprÏednaÂsÏejõÂcõÂ: Kotevnõ mikrosïrouby v praxi MUDr. JirÏõ Baumruk MUDr. I. Marek, MUDr. K. Iha, MUDr. B. Chadim, MUDr. O. HajnõÂk, MUDr. J. KucÏera, MUDr. S. NovaÂcÏkovaÂ, MUDr. O. Suchy a dalsïõâ PrÏijd'te se s kolegy podeïlit o zkusïenosti z praxe! Altis Group, s. r. o., 17. listopadu 5, BrÏeclav, provozovna: Husova 25, BrÏeclav Tel./fax: , Petra Karafova , Marie PõÂsarÏõÂkova ± Zelena linka: Slovakia Altis Group, s. r. o., K. SÏmidkeho 2424/20, TrencÏõÂn, mobil: , tel./fax: , CÏ lenskyâ poplatek pro rok 2008 cï inõâ 1500,- KcÏ nebo 45,- EUR. CÏ lenoveâ v zameï stnaneckeâ m vztahu 800,- KcÏ nebo 25,- EUR. Postgraduanti, duê chodci a zïeny na materïskeâ dovoleneâ 300,- KcÏ nebo 10,- EUR. RegistracÏ nõâ polatek cï inõâ 500,- KcÏ. PrÏedplatne cï asopisu Ortodoncie pro necï leny CÏ OS je 1000,- KcÏ za rok nebo 35,- EUR. U hrada poplatku do , cï.uâ.: /0100, konst. symbol: 0558, variab. symbol: rodneâ cï õâslo. PrÏi nezaplacenõâ prïõâspeï vkuê po dvou põâsemnyâch urgencõâch bude ukoncï eno cï lenstvõâ v CÏ OS. 20

16 Retence premolaâruê Unerupted premolars MUDr.Hana BenesÏ ovaâ, MUDr.Magdalena Kot'ovaÂ, Ph.D. OddeÏ lenõâ ortodoncie a rozsïteï povyâch vad, stomatologickaâ klinika 3. LF UK, FN Kra lovskeâ Vinohrady Praha Department of Orthodontics and Cleft Defects, Clinic of Dental Medicine, 3rd Medical Faculty of Charles University, University Hospital Kra lovskeâ Vinohrady Prague Souhrn Sledovany soubor tvorïilo 75 pacientuê s retinovanyâ m premolaâ rem a kontrolnõâ soubor tvorïilo 80 pacientuê s fyziologickou vyâ meï nou chrupu. CõÂlem studie byla analyâ za znakuê vyskytujõâcõâch se v chrupu pacientuê s retencõâ/impaktacõâ premolaâruê. Na ortopantomogramech pacientuê jsme sledovaly odchylky erupcï nõâ draâ hy premolaâ ruê a porïadõâ prorïezaâ vaâ nõâ lateraâ lnõâch staâlyâ ch zubuê beï hem druheâ faâzevyâmeï ny chrupu. Na saâ drovyâ ch modelech jsme sledovaly ztraâ tu mõâsta v opeï rneâ zoâneï. DalsÏ õâmi znaky sledovanyâ mi v souvislosti s retencõâ premolaâruê byla ageneze jednoho z premolaâruê, prïõâtomnost nadpocï etnyâ ch zubuê v oblasti premolaâ ruê a reinkluze docï asnyâ ch molaâ ruê. SnazÏ ily jsme se urcï it nejcï asteï jsï õâ kombinace sledovanyâ ch znakuê, ktereâ se u retinovanyâ ch/impaktovanyâ ch premolaâ ruê vyskytovaly a z jejichzï manifestace by prïõâpadneï bylo mozïneâvcï as usuzovat na poruchy erupce premolaâruê. NejcÏ asteï ji retinovanyâ m zubem byl levyâ dolnõâ druhyâ premolaâ r, a nejcï asteï jsï õâ kombinacõâ znakuê, kteraâ se vyskytovala v chrupu pacientuê s retencõâ/impaktacõâ premolaâruê, byla ztraâ ta mõâsta v opeï rneâ zoâ neï a odchylka uâ hlu sklonu erupcï nõâ draâ hy premolaâ ru. Velmi pravdeï podobneï je tedy retence nebo impaktace premolaâ ruê vyâ sledkem võâce potenciaâ lneï patologickyâ ch jevuê a teprve jejich soucï asnyâ m vyâ skytem v daneâ oblasti dochaâ zõâ k retenci nebo impaktaci premolaâ ru(ortodoncie 2008, 17, cï. 3, s ). Abstract The sample involved 75 patients with an unerupted premolar; the control sample included 80 patients with physiological transition of dentition. The aim was to make the analysis of characteristic features in the dentition of patients with unerupted/impacted premolars. In panoramic X-ray pictures we observed deviations of the eruption paths of premolars, and sequence of eruption of lateral permanent teeth during the second phase of transition of dentition. In casts we observed the loss of space in the area. Further we observed agenesis of premolar, supernumerary teeth in the premolar area, submerged deciduous molars. We tried to establish the most frequent combinations of features observed in unerupted premolars, which may help in the early diagnosis of premolar eruption problems. The lower second premolar was the most frequent impacted tooth; the loss of space in the area together with deviation in the inclination of eruption path of premolar was the most frequent combination of characteristic features. It is highly probable, that unerupted or impacted premolars are the result of several potentially pathological phenomena, and that the uneruption and/or impaction occur only if these phenomena co-occur (Ortodoncie 2008, 17, No. 3, p ). KlõÂcÏ ovaâ slova: retence premolaâruê, impaktace Key Words: unerupted premolars, impaction 22

17 rocïnõâk17 U vod Retence zubu je tehdy, kdyzï zalozï enyâ zub neprorïezal ve fyziologickeâ mobdobõâ jeho prorïezaâvaâ nõâ a zub maâ ukoncï enyâ vyâvoj korïene. Na zev retence se vsïak uzïõâvaâ i v pruêbeï hu obdobõâ, kdy zub jesïteï m uêzïe fyziologicky prorïezat, ale jeho ulozïenõâ je tak anomaâ lnõâ, zï e mozïnost prorïezaâ nõâ do dutiny uâ stnõâ je velmi nepravdeï podobnaâ [2, 3]. Definice zadrzïeneâ erupce, cï i impaktace zubu je naâsledujõâcõâ: zub neprorïezal pro urcï itou prïekaâ zï ku, naprï. prïespocï etneâ zuby, cï i uzaâveï r prostoru sousednõâmi zuby [2]. Vy znampremolaâ ruê spocï õâvaâ, vedle jejich mastikacï nõâ funkce, v udrzïenõâ vyâsï ky skusu [1], podle jejich interkuspidace se diagnostikuje I. klõâcï okluze podle Andrewse [2]. Premola ry jsou z hlediska protetickeâ ho pilõârïe II. trïõâdy. Dojde-li ke sblokovaâ nõâ sousednõâch premolaâ ruê, lze je povazï ovat za protetickyâ pilõârï I. trïõâdy [1]. Nezanedbatelna je takeâ jejich uâ loha v oblasti estetiky tzv. bukaâlnõâch koridoruê [3, 4, 5, 6, 7, 8]. Sledova nõâmjednotlivyâ ch znakuê a kombinacõâ znakuê, ktereâ by mohly veâ st k retenci/impaktaci premolaâ ruê, jsme se snazï ily odhalit mozï nou prïõâcï inu retence/impaktace premolaâruê. ZajõÂmalo naâ s rovneï zï, zda lze vyâ voj neprïõâzniveâ situace prïi erupci premolaâruê ovlivnit ortodonticky. MateriaÂl NasÏ e pozorovaâ nõâ bylo provaâdeï no na souboru pacientuê s retencõâ/impaktacõâ premolaâruê (soubor B) a na souboru pacientuê s fyziologickou vyâmeï nou chrupu (soubor A). Soubor A (kontrolnõâ) zahrnoval 80 pacientuê s fyziologickyâ mpruê beï hemvyâ m eï ny chrupu, cozï bylo mozï no dokladovat na ortopantomogramech. Pro zarïazenõâ do kontrolnõâho souboru A byla stanovena naâ sledujõâcõâ kriteâ ria: 1. minimaâ lneï 3 na sebe navazujõâcõâ ortopantomogramy v dobeï vyâvoje a erupce premolaâruê, 2. prvnõâ rentgenovyâ snõâmek byl zhotoven po skoncï enõâ I. faâze vyâmeï ny chrupu, 3. zaâ rodky premolaâruê byly v odpovõâdajõâcõâmstadiu vyâ voje zubu a nachaâ zely se ve fyziologickeâ mpostavenõâ, 4. na dalsï õâch rentgenovyâ ch snõâmcõâch bylo mozï no prokaâ zat pokracï ujõâcõâ fyziologickyâ pruê beï h erupce premolaâruê. Soubor B (retence/impaktace premolaâruê ) zahrnoval 75 pacientuê, u kteryâch bylo mozïno dokladovat na saâdrovyâ ch modelech chrupu a na ortopantomogramech retenci/impaktaci premolaâ ru. Pro zarïazenõâ do sledovaneâ ho souboru B byla stanovena naâ sledujõâcõâ kriteâ ria : Introduction Unerupted tooth occurs when the germinated tooth did not erupt in the physiological phase of its eruption and its root development is finished. However, the termis used also for the period when a tooth may still erupt physiologically but its location is so abnormal that the potential eruption into the oral cavity is very improbable [2, 3]. The definition of arrested eruption, or impaction of a tooth, is the following: the tooth did not erupt due to some obstacle, e.g. supernumerary teeth, or closure of its eruption path by adjacent teeth [2]. Apart from mastication, premolars play an important role in maintaining the overbite [1], their occlusion serves in diagnostics of the 1st key of occlusion according to Andrews [2]. Fromthe prosthetic viewpoint, premolars serve as the prosthetic pillar of the 2nd grade. In case the adjacent premolars create a block, they may be considered a prosthetic pillar of the 1st grade [1]. They also play an important role in the esthetics of the so-called buccal corridors [3, 4, 5, 6, 7, 8]. We monitored individual features and their combinations that may result in uneruption/impaction of premolars, and thus we wanted to find out potential cause of premolars uneruption/impaction. We were also interested in whether the development of unfavorable situation may be affected with orthodontic treatment. Material We worked with the sample of patients with unerupted/impacted premolars (sample B), and with the sample of patients with physiological change of dentition (sample A). The sample A (control) included 80 patients with natural change of dentition (which was documented with panoramic X-ray pictures - OPG). The sample A met the following criteria: 1) minimum of 3 OPG taken during the development and eruption of premolars; 2) the first OPG was taken after the 1st phase of dentition change had been finished; 3) premolar teeth had normal stage of tooth development and their location was physiological; 4) following OPG proved the on-going physiological eruption of premolars. The sample B (unerupted/impacted premolars) included 75 patients in which unerupted/impacted premolars were found in casts and OPG. The sample B met the following criteria: 1) there exists at least one OPG for each patient; OPG may help in diagnostics of premolar uneruption and may help to identify that the development of the 23

18 1. pacient maâ zhotovenyâ minimaâ lneï jeden ortopantomogram, kde je mozï no diagnostikovat retenci premolaâ ru a urcï it, zïevyâvoj retinovaneâ ho zubu je, dle morfologie korïene skutecï neï ukoncï en, nebo, zï e se jednaâ o impaktaci, 2. pacient maâ zhotoven saâ drovyâ model chrupu soucï asneï s analyzovanyâ mrentgenovyâ m snõâmkem. Za duê lezï iteâ povazï ujeme upozorneï nõâ,zï e rentgenoveâ snõâmky nebyly zhotoveny pro uâcï ely teâ to studie. Metodika Na rentgenovyâ ch snõâmcõâch a saâ drovyâ ch modelech chrupu jsme sledovaly potenciaâ lneï patologickeâ znaky retence/impaktace premolaâruê (uâ hel sklonu erupcï nõâ draâ hy, ztraâ ta mõâsta v opeï rneâ zoâneï, porïadõâ erupce zubuê v lateraâ lnõâmuâ seku, ageneze premolaâruê, nadpocï etneâ zuby v oblasti remolaâruê, reinkluze docï asneâ ho molaâ ru). PrÏi pozorovaâ nõâ jednotlivyâ ch znakuê jsme sledovaly takeâ jejich kombinace. VyhodnocovaÂnõÂ erupcï nõâ draâ hy zaâ rodkuê premolaâruê (Obr. 1, 2) bylo provaâdeï no na ortopantomogramech. Byl meï rïen uâhel sklonu erupcï nõâdraâhy premolaâru vuê cï i okluznõâlinii, kteraâbyla urcï ena distaâlnõâm ruê zï kem dolnõâho centraâlnõâho rïezaâku a distaâlnõâm hrbolkem plneï prorïezaneâho prvnõâho staâleâho dolnõâho molaâru. PodeÂlnou osu zaârodku premolaâru tvorïila kolmice na spojnici dvou protilehlyâch boduê, ktereâse nachaâzely naproti sobeï v nejsï irsï õâm mõâsteï klinickeâkorunky. ProdlouzÏ enõâ konstruovaneâosy zaârodku premolaâru prïedstavovalo erupcï nõâdraâhu a protõânalo konstruovanou okluznõâ linii. UÂ hel erupcï nõâdraâhy premolaâru byl meï rïen k distaâlnõâmu konci okluznõâlinie. Na saâ drovyâch modelech chrupu pacientuê byla meïrïenõâmzjisït'ovaâna prïõâpadnaâ ztraâ ta mõâsta v opeï rneâ zoâ neï. Toto meï rïenõâbylo provaâdeï no standardnõâm zpuêsobem pomocõâposuvneâho meï rïidla. Pro zjisïteï nõâztraâty mõâsta v opeï rneâzoâneï byly pouzï ity zjednodusï eneâtabulky podle Moyerse k odhadu mõâsta potrïebneâho pro lateraâlnõâskupinu zubuê (staâleâ sï picïaâky a premolaâry). unerupted tooth is (according to the root morphology) finished, or that it is the case of impaction; 2) casts and analyzed OPG for each patient are present. We want to emphasize the fact that the OPG were not taken for the purpose of the presented study. Method In OPG and casts we observed potentially pathological features of uneruption/impaction of premolars (inclination of eruption path, loss of space for canines and premolars, sequence of teeth eruption in lateral segment, missing premolars, supernumerary teeth in the premolar area, submerged deciduous molar). We also paid attention to the combinations of individual factors. Evaluation of eruption path of premolar teeth (Fig. 1, 2) was made in OPG picture. We measured the inclination of premolar eruption path to the occlusal line. The occlusal line was determined by the distal corner of the lower central incisor, and distal cusp of the fully erupted first lower permanent molar. Long axis of the premolar germ was represented by the perpendicular to the connecting line of two opposite points located in the widest part of clinical crown. Prolongation of the constructed axis of the premolar represented eruption path and crossed constructed occlusal line. The angle of eruption path of premolar was measured with regard to the distal end of occlusal line. The potential loss of space in area of canines and premolars was measured in the casts. The measurement was performed with a calliper rule. Simplified version of Moyers tables was used to assess the loss of space in the area that is required for the group of lateral teeth (permanent canines and premolars). The sequence of teeth eruption in the lateral segment of dentition was assessed according to the position of tooth germs, or clinical crowns, in OPG. We focused especially on the eruption of second per- Obr.1: MeÏrÏenõÂuÂhlu erupcï nõâdraâhy - hornõâcï elist Fig.1: Measurement of eruption path angle - maxilla Obr.2: MeÏrÏenõÂuÂhlu erupcï nõâdraâhy - dolnõâcï elist Fig.2: Measurement of eruption path angle - mandible 24

19 rocïnõâk17 PorÏadõ erupce zubuê v lateraâ lnõâm uâ seku chrupu jsme hodnotily podle polohy zaârodkuê resp. klinickyâch korunek na ortopantomogramech pacientuê. V centru nasï eho zaâjmu byla zejmeâna erupce druheâho staâleâho molaâru, pokud nastala prïed erupcõâdruheâho premolaâru. SledovaÂnõ ageneze premolaâru bylo provaâdeïno opakovanyâm pozorovaânõâm na ortopantomogramech pacientuê. PrÏedmeÏ temnasï eho zaâ jmu se staly rovneïzï prïespocï etneâ zuby v oblasti premolaâ ruê, ktereâjsme pozorovaly na ortopantomogramech pacientuê. Vyhodnocenõ reinkluze docï asneâ ho molaâ ru bylo provaâdeï no pozorovaânõâm na ortopantomogramech pacientuê a na saâdrovyâch modelech chrupu. ZõÂskana data u jednotlivyâ ch souboruê byla zpracovaâ na oddeï leneï a vyhodnocena metodou popisneâ statistiky. Statisticke vyhodnocenõâ bylo provedeno StudentovyÂmt-testemrovnosti strïednõâch hodnot. Vy sledky Soubor A (kontrolnõâ) U kazïdeâ ho z 80 pacientuê v kontrolnõâmsouboru byly hodnoceny angulaâ rnõâ charakteristiky podeâ lneâ osy zaârodkuê vsï ech osmi premolaâruê vuê cï i konstruovaneâ okluznõâ linii. U kazïdeâ ho pacienta kontrolnõâho souboru bylo nameïrïeno 8 hodnot. ZõÂskaly jsme tak 640 nameïrïenyâch hodnot (n=640). Pro kazïdyâ premolaâ r byla stanovena strïednõâ hodnota (mediaâ n) vzestupneï serïazenyâ ch nameï rïenyâ ch hodnot uâ hluê jejich erupcï nõâ draâ hy. Takto zõâskanou hodnotu u kazï deâ ho premolaâ ru jsme povazï ovaly za ¹idea lnõâ uâ helª erupcï nõâdraâ hy pro sledovanyâ zub. Pro prïesneâ stanovenõâ ¹idea lnõâho uâ hluª erupcï nõâ draâ hy bylo pouzïito statistickeâ vyhodnocenõâ, jehozï vyâ sledky uvaâ dõâme v tabulce 1. Hodnotu ¹idea lnõâho uâ hluª jsme pouzïily k posouzenõâ uâ hlu sklonu erupcï nõâ draâhy zaâ rodkuê premolaâ ruê u souboru retinovanyâ ch/impaktovanyâ ch premolaâruê. Tato hodnota slouzï ila takeâ jako rozhranõâ pro stanovenõâ meziaâ lnõâho nebo distaâ lnõâho sklonu erupcï nõâ draâ hy premolaâ ruê v souboru retinovanyâ ch/impaktovanyâch premolaâruê. Pro dalsï õâ hodnocenõâ byla pouzï ita hodnota mediaâ nu uâ hlu erupcï nõâ draâ hy zjisïteïnaâ pro kazïdyâ premolaâ r zvlaâsït'. Tuto hodnotu lze povazï ovat za fyziologickou hodnotu uâ hlu erupcï nõâ draâ hy pro kazïdyâ jednotlivyâ premolaâ r (v Tabulce cï. 1 oznacï eno silneï). Soubor B (retence/impaktace premolaâruê ) U 75 pacientuê, kterïõâ splnï ovali stanovenaâ kriteria souboru B bylo nalezeno 108 retinovanyâ ch nebo impaktovanyâ ch premolaâ ruê (n=108). manent molar in case it preceded the eruption of second premolar. Missing premolar (agenesis) was assessed by repeated examination of OPG. We also paid attention to supernumerary teeth in the premolar area - we assessed the situation with the help of OPG. Submerged deciduous molar was assessed by examination of OPG and casts. The data obtained for individual samples of patients were processed separately, and evaluated with descriptive statistics. Statistic processing involved the t-tests. Results Sample A (control group) Inclination of long axes of the germs of all eight premolars to the constructed occlusal line was evaluated in 80 patients of the control group. For each patient 8 values were measured. The overall number was 640 (n=640). There was set the middle value (median) for each premolar - ascending sequence of the inclinations of their eruption paths. The middle value was taken as a ¹ideal inclinationª of the eruption path for the tooth observed. To state the ¹ideal inclinationª accurately, we use the statistical evaluation (the results are given in Table 1). The value of the ¹ideal inclinationª was used to assess the eruption path inclination of the germs of premolars in the group of impacted premolars. The value also served as the dividing line for setting of mesial or distal inclination of premolar eruption paths in the sample of impacted premolars. The median value of eruption path inclination set for each premolar separately was used. The value may be considered as the physiological inclination of eruption path for each individual premolar (in Table 1 in bold letters). Tabulka 1: StatistickeÂvyhodnocenõÂsledovanyÂch hodnot uâhlu erupcï nõâdraâhy kontrolnõâho souboru Table 1: Statistical evaluation of eruption path inclinations in the control group Tabulka 2: Skupiny souboru B. Znaky a kombinace znakuê v textu Table 2: Groups of sample B. Characteristic features and their combinations in text 25

20 Sledovane znaky a jejich kombinace V souboru B byly zjisï teï ny naâ sledujõâcõâ znaky a jejich kombinace vytvorïily naâ sledujõâcõâ skupiny B1 - B9 (pocï ty zubuê ve skupinaâ ch v tabulce 2): B1 ZtraÂta mõâsta v opeï rneâzoâneï a odchylka uâhlu sklonu retinovaneâho premolaâru B2 ZtraÂta mõâsta v opeï rneâzoâneï, odchylka uâhlu sklonu retinovaneâho premolaâru a erupce druheâho staâleâho molaâru prïed druhyâm premolaârem B3 Odchylka uâhlu sklonu retinovaneâho premolaâru, ageneze sousednõâho nebo druhostranneâho premolaâru a ztraâta mõâsta v opeï rneâzoâneï B4 ZtraÂta mõâsta v opeï rneâzoâneï a odchylka uâhlu sklonu retinovaneâho premolaâru a reinkluze docï asneâho molaâru B5 Erupce druheâho staâleâho molaâru prïed druhyâm premolaârem a odchylka uâhlu sklonu retinovaneâho premolaâru B6 Odchylka uâhlu sklonu retinovaneâho premolaâru B7 Odchylka uâhlu sklonu retinovaneâho premolaâru a reinkluze docï asneâho molaâru B8 Odchylka uâhlu sklonu retinovaneâho premolaâru, erupce druheâho staâleâho molaâru prïed druhyâm premolaârem a reinkluze B9 Odchylka uâhlu sklonu retinovaneâho premolaâru, ageneze sousednõâho nebo druhostranneâho premolaâru, ztraâta opeï rneâzoâny a erupce druheâho staâleâho molaâru prïed druhyâm premolaârem. PrÏi zpracovaânõâvyâsledkuê nameïrïenyâch hodnot u jednotlivyâch skupin B1 - B9 jsme vyhodnocovaly uâ daje oddeï leneï pro kazï dou cï elist pacienta. U pacientuê souboru B jsme roztrïõâdily nameï rïeneâ uâ hly erupcï nõâ draâ hy jednotlivyâ ch premolaâ ruê podle jejich inklinace. Za rozhranõâ jsme povazï ovaly strïednõâ hodnotu (median) uâ hlu erupcï nõâ draâ hy zjisïteï nou pro jednotliveâ premolaâ ry v kontrolnõâmsouboru (soubor A). U hly s hodnotou nizïsïõânezï je strïednõâhodnota uâhlu erupcï nõâdraâhy zjisïteï naâv kontrolnõâm souboru jsme daâle povazï ovaly za uâhly sveï dcï õâcõâ o meziaâ lnõâm sklonu erupcï nõâdraâhy. U hly s hodnotou vysïsïõânezï je strïednõâhodnota uâhlu erupcï nõâdraâhy zjisïteï naâv kontrolnõâm souboru jsme daâle povazï ovaly za uâhly sveï dcï õâcõâ o distaâ lnõâm sklonu erupcï nõâdraâhy. Za kladnõâ vyhodnocenõâ souboru B Ze 75 pacientuê souboru B meï lo 49 pacientuê (65 %) jen jeden retinovanyâ/impaktovanyâ premolaâ r, u 22 pacientuê (29 %) jsme nalezly dva retinovaneâ /impaktovaneâ premolaâ ry. TrÏi retinovaneâ premolaâ ry byly u 2 pacientuê,daâ le byly registrovaânycï tyrïi (1 pacient) a peï t retinovanyâch premolaâruê (1 pacient). Retence/impaktace jednoho premolaâ ru se u pacientuê v souboru B vyskytovala dvakraâtcï asteï ji v dolnõâ cï elisti nezï v hornõâ cï elisti. Sample B (unerupted/impacted premolars) In 75 patients included in the sample B, there were 108 unerupted or impacted premolars (n=108). The features monitored, their combinations In the sample B the following features and their combinations were found and the following groups B1 - B9 were formed (number of teeth in groups are in Table 2): B1 Loss of space in area of canine and premolars, and deviation in inclination of unerupted premolar. B2 Loss of space in area of canine and premolars, deviation in inclination of unerupted premolar, and eruption of the second permanent molar preceding the second premolar. B3 Deviation in the inclination of unerupted premolar, missing neighbouring or opposite premolar, and the loss of space in area of canine and premolars. B4 Loss of space in area of canine and premolars, deviation in inclination of unerupted premolar, and submerged deciduous molar. B5 Eruption of the second permanent molar precedes that of the second premolar, and deviation in inclination of unerupted premolar. B6 Deviation in inclination of unerupted premolar. B7 Deviation in inclination of unerupted premolar, and submerged deciduous molar. B8 Deviation in inclination of unerupted premolar, eruption of the second permanent molar preceding that of the second premolar, and submergence. B9 Deviation in inclination of unerupted premolar, agenesis of the neighbouring or opposite premolar, loss of space in area of canine and premolars, and eruption of the second permanent molar preceding that of the second premolar. The results were processed for each group (B1-B9) and each jaw separately. The eruption path angles of individual premolars were classified according to their inclination. The borderline was the median of eruption path angle of individual premolars in the control sample (group A). Angles below the middle value of the eruption path angle found in the control sample, manifest mesial inclination of eruption path. Angles over the middle value of the eruption path angle found in the control sample, manifest distal inclination of eruption path. Basic evaluation of the sample B From the sample B (75 patients) one unerupted/impacted premolar was found in 49 (65 %) of them. 22 patients (29 %) had two unerupted/impacted premolars, three unerupted premolars were in 2 patients. There were registered also 4 (1 patient) and 5 (1 patient) unerupted premolars. 26

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