ORTODONCIE Recenzovany cï asopis CÏ eskeâ ortodontickeâ spolecïnosti Published by the Czech Orthodontic Society

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1 rocïnõâk21 Recenzovany cï asopis CÏ eskeâ ortodontickeâ spolecïnosti Published by the Czech Orthodontic Society RocÏ nõâk (Volume): 21 Rok (Year): 2012 CÏ õâslo (Number): 4 CÏ asopis je veden v rejstrïõâku recenzovanyâch, neimpaktovanyâch cï asopisuê. Indexova no: Bibliographia Medica CÏ echoslovaca od roku 1992 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 Vedoucõ redaktor web stran (Editor in Chief web pages) MUDr. JirÏõ Tvardek, HustopecÏ e, Czech Republic RedakcÏ nõâ rada (Editorial Board): MUDr. Gabriela AlexandrovaÂ, Bratislava, Slovensko Prof. Dr. Hans-Peter Bantleon, Wien, OÈ sterreich Dr. Ewa Czochrowska, Ph.D., Warszawa, Polska Prof. Dr. Nejat Erverdi, Ph.D., Istanbul, Turkey MUDr. Karel Floryk, VysÏ kov, Czech Republic Doc. Dr. Piotr Fudalej, Ph.D., Bern, Switzerland MUDr. Milada Ha lkovaâ, Strakonice, Czech Republic MUDr. Martin HoraÂcÏ ek, HavlõÂcÏkuÊ v 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 Kra loveâ, 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 SÏ tefkovaâ, CSc., Olomouc, Czech Republic MUDr. JirÏõ Tvardek, Ph.D., HustopecÏ e, Czech Republic Dr. Mariusz Wilk, LodzÂ, Polska Adresa redakce (Contact Address): Recenzenti cï asopisu Ortodoncie: MUDr. Hana BoÈ hmovaâ Doc. MUDr. PavlõÂna CÏ ernochovaâ, Ph.D. Prof. MUDr. Milan KamõÂnek, DrSc. MUDr. Irena KlõÂmova MUDr. Martin Kotas, Ph.D. MUDr. Magdalena Kot'ovaÂ, Ph.D. MUDr. Ivo Marek, Ph.D. MUDr. JirÏõ Petr Prof. MUDr. Jaroslav Racek, DrSc. Doc. MUDr. MilosÏ SÏ pidlen, Ph.D. MUDr. Eva SÏ raâ mkovaâ MUDr. Marie SÏ tefkovaâ, CSc. MUDr. Miroslava SÏ vaâ bovaâ, CSc. MUDr. JirÏõ Tvardek, Ph.D. MUDr. Hana Tycova MUDr. Wanda Urbanova Recenzenti pro hranicï nõâ obory: Doc. MUDr. Oliver Bulik, Ph.D. Prof. MUDr. Miroslav Eber, CSc. Prof. MUDr. Tat'jana Dosta lovaâ, DrSc., MBA Doc. MUDr. Rene Folta n, Ph.D. MUDr. PrÏemysl KrejcÏ õâ, Ph.D. Doc. MUDr. Milan Macha lka, CSc. Doc. RNDr. Eva MatalovaÂ, Ph.D. Prof. MUDr. JirÏõ Maza nek, DrSc. Doc. MUDr. KveÏ toslava Nova kovaâ, CSc Olomouc, PalackeÂho12 Prof. MUDr. JindrÏich Pazdera, CSc. fax: , tel.: Doc. MUDr. LudeÏ k PerÏinka, CSc. Doc. MUDr. Lenka RoubalõÂkovaÂ, Ph.D. Doc. MUDr. Radovan Sleza k, CSc. Doc. MUDr. Martin Starosta, Ph.D. ISSN: 1210±4272 Doc. MUDr. Jitka StejskalovaÂ, CSc. Doc. MUDr. AntonõÂn SÏ imuê nek, CSc. Prof. MUDr. JirÏõ VaneÏ k, CSc. Doc. MUDr. AntonõÂn Zicha, Ph.D. 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 Moravska TrÏebova Cena (Payment): 200,± KcÏ (10,± EUR), CÏ.uÂ.: /0100, konst. symbol: 0558, variab. symbol: rodneâ cï õâslo. CÏ asopis je bezplatneï zasõâlaân cï lenuê m CÏ 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): 2. 3., , a

2 rocïnõâk21 Obsah (Contens): SpolecÏ enskaâ rubrika Zpra vy z vyâ boru ZajõÂmavosti v ortodoncii Korespondence Indikace snõâmkuê Cone Beam CT. Souborny referaâ t. (Indications for Cone Beam CT. Systematic review.) Rodinny vyâ skyt predispozicï nõâch znakuê orofaciaâ lnõâch rozsï teï puê (Family incidence of predisposition signs of orofacial clefts) Porovna nõâ digitaâ lnõâch kefalometrickyâ ch snõâmkuê s kefalometrickyâ misnõâmky generovanyâ mi z dat cone-beam CT (Comparison of digital cephalograms and cephalograms generated from cone-beam computed tomography scans) Skeleta lnõâ veï k podle krcïnõâpaâ terïe (Skeletal age according to cervical spine) Kongres CÏ OS Ze zahranicï nõâch cï asopisuê Informace REKLAMA UverÏejneÏnõÂ: 1cm 2 plochy...25,± KcÏ 1 strana A ,± KcÏ 1/2 strany A ,± KcÏ zadnõâ strana desek %ceny vnitrïnõâ strana desek %ceny strana 1 a 2 cï asopisu...+20%ceny Inzerce v kazïdeâmcï õâsle rocïnõâku... ±2000,± KcÏ /1 str. A4 VlozÏ enõâ reklamnõâho letaâ ku: ,± KcÏ VlozÏ enõâ reklamnõâ publikace (do 4 stran): ,± KcÏ Zhotovenõ reklamy: uâ cï tovaâ no samostatneï HonorovaÂnõ prïõâspeï vkuê : 1 normostrana rukopisu textu odborneâ praâce...300,± KcÏ 1 normostrana prïedkladu zajisïteïneâ ho autorem ,± KcÏ 1 ilustrace (fotografie, obraâ zek apod.)...50,± KcÏ TeÏsÏõÂme se na spolupraâci svaâmi Doc. MUDr. MilosÏ SÏ pidlen, Ph.D vedoucõâ redaktor, Klinika zubnõâho leâ karïstvõâ LF UP PalackeÂho Olomouc tel.: fax:

3 rocïnõâk21 SpolecÏ enskaâ rubrika VrÏõÂjnu, listopadu a prosinci roku 2012 sveâ vyâznamneâ zïivotnõâ jubileum oslavili: MUDr. Marta BohuslavickaÂ, Praha 4 MUDr. Jan PasÏek, Ta bor Prof. MUDr. Jaroslav Racek, DrSc., Praha 2 MUDr. Olga UhrovaÂ,MeÏlnõÂk MUDr. Brigita StanÏ kovaâ, Jablonec nad Nisou MUDr. Hana VavrÏõÂcÏkovaÂ,TyÂnisÏteÏ nad Orlicõ MUDr. Anna TaitlovaÂ, Karlovy Vary MUDr. Marie MarkovaÂ, CSc., Praha 9 - VysocÏany MUDr. Josef Deva t, ZlõÂn MUDr. Vlasta OdstrcÏilovaÂ, Brno MUDr. VeÏra PrÏibõÂkovaÂ, LitomeÏrÏice MUDr. Justina PaucÏkovaÂ, Ostrava - Maria nskeâ Hory MUDr. Helena KozinovaÂ, Brno - LõÂsÏenÏ MUDr. Pavel TichyÂ, Praha 2 MUDr. Erik Vychodil, Boskovice MUDr. Marcela RuÊzÏicÏkovaÂ, Broumov IV MUDr. VladimõÂra SÏ uttovaâ, Louny MUDr. Ladislav Kocman, Praha 4 MUDr. VladimõÂr KolaÂrÏ, Praha 6 MUDr. Helena DvorÏa kovaâ, ZlõÂn - Mladcova MUDr. Marie HrabeÏtovaÂ, KadanÏ MUDr. DanusÏe Petra kovaâ, Most MUDr. Eva PreislerovaÂ, Turnov MUDr. SonÏ a MensÏõÂkovaÂ, Bukovany MUDr. ZdeneÏk Micek, HlucÏõÂn SrdecÏneÏ blahoprï ejeme! CÏ lenskyâ poplatek pro rok 2013 cï inõâ 1500,- KcÏ nebo 65,- EUR. CÏ lenoveâ v zameï stnaneckeâ m vztahu 800,- KcÏ nebo 35,- EUR. Postgraduanti, duê chodci a zïeny na materïskeâ dovoleneâ 300,- KcÏ nebo 15,- EUR. RegistracÏ nõâ polatek cï inõâ 500,- KcÏ nebo 20,- EUR. PrÏedplatne cï asopisu Ortodoncie pro necï leny CÏ OSje 800,- 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. 182

4 MUDr. Jan PasÏek oslavil 95. narozeniny SpolecÏ enskaâ rubrika rocïnõâk21 Narodil se v MerklõÂneÏ v okrese PrÏesÏ tice. V roce 1936 maturoval na reaâ lneâ m MasarykoveÏ gymnaâziu v Plzni, poteâ zapocï al studium na LF UK PlzenÏ. Studium bylo prïerusï eno pro uzavrïenõâ vsï ech vysokyâch sï kol nacisty. Po skoncï enõâ vaâ lky se vraâ til ke studiu a v roce 1946 promoval. V teâmzïe roce se takeâ ozï enil. Praxi zapocï al v PolicÏ ce na chirurgii, po puê l roce pokracï oval na chirurgii v Ta borïe. PrÏi staâzïi na cï elistnõâ chirurgii u profesora MUDr. KostecÏ ky se zacïal veï novat ortodoncii. Po rocï nõâm kurzu na klinice se vracõâ do TaÂbora, kde zrïizuje ortodontickeâ oddeï lenõâ. Ta boru zuê stal veï rnyâ azï do roku 1980, kdy odesï el jako uznaâ vanyâ ordinaârï pro ortodoncii do duê chodu. NeÏ kolik let pracoval teâ zï jako konsiliaâ rï na stomatologickeâ m oddeï lenõâ KU NZ v CÏ eskyâ ch BudeÏ jovicõâch a takeâ jako externista na ortodontickeâ m oddeï lenõâ prïi plastickeâ chirurgii na uâ seku vyâ vojovyâ ch vad ve Vinohradske nemocnici v Praze. Ortodoncii ucï il mnoheâ JihocÏ eskeâ ortodontisty. Za svou celozï ivotnõâ cï innost byl v roce 1997 oceneï n jako ¹Osobnost cï eskeâ stomatologieª. Se svou zïenou Emiliõ vychovali syna a dceru. Sta le spolu zïijõâ ve sveâ m milovaneâmtaâ borïe,cï ilõâ, zdravõâ a zajõâmajõâ se ovsïe. KzÏivotnõÂmu jubileu prïejõâ pevneâ zdravõâ, zïivotnõâ pohodu a mnoho hezkyâ ch chvil v kruhu rodinneâm... JihocÏesÏtõ ortodontisteâ. Dr. Piotr Fudalej, Ph.D. jmenovaâ n docentem Dne 23. listopadu 2012 byl dr. Piotr Fudalej, Ph.D. jmenovaâ n na Palacke ho univerziteï v Olomoucidocentem pro obor stomatologie. Dr. Fudalej se podõâlõâ na cï aâ stecï nyâ pracovnõâ uâ vazek na pregraduaâ lnõâ ipostgraduaâ lnõâ vyâ uce na ortodontickeâ m oddeï lenõâ Kliniky zubnõâho leâ karïstvõâ LF UP v Olomoucia je cï lenem redakcï nõâ rady cï asopisu Ortodoncie. Jeho hlavnõâ pracovnõâ pozice je nynõâ zaâ stupce vedoucõâho Klinik fuè r KieferorthopaÈ die, Medizinische FakultaÈ t, UniversitaÈ t Bern, SÏ vyâ carsko. BlahoprÏejeme Ortodonticke oddeï lenõâ FNKV Praha deï kuje firmeï ROD Praha za umozïneï nõâ bezplatneâ ho zõâskaâ nõâ systeâ mu Damon k vyâ ukovyâmuâcï eluêm. MUDr. M. Kot'ovaÂ, Ph.D. 183

5 rocïnõâk21 ZpraÂvyzvyÂboru Pokyny pro autory CõÂlem cï asopisu je informovat cï leny CÏ eskeâ ortodontickeâ spolecï nosti a ostatnõâ ortodontickou a stomatologickou verïejnost o deï nõâ v odborneâ spolecï nosti, o vyâvojiv ortodonciia prïõâbuznyâch oborech, poskytovat materiaâ ly pro postgraduaâ lnõâ a celozï ivotnõâ vzdeï laâvaâ nõâ specialistuê v oboru ortodoncie a informovat o odbornyâch a sï kolicõâch akcõâch. CÏ asopis je vydaâvaânvcï eskeâ m jazyce, odborneâ praâ ce dvojjazycï neï v cï eskeâ m/slovenskeâ m a anglickeâ m jazyce. PrÏõÂspeÏ vky v cï asopise se rïadõâ do teï chto rubrik: 1. ZpraÂvy z vyâboru CÏ eskeâ ortodontickeâ spolecï nosti; 2. ZajõÂmavostiv ortodoncii(zpraâ vy o probeï hlyâch odbornyâch a sï kolicõâch akcõâch, zpraâ vy z kongresuê a cest, diskusnõâ a polemickeâ prïõâspeï vky); 3. Odborne praâ ce (puê vodnõâ praâ ce, souborneâ referaâ ty, prïedbeï zïnaâ sdeïlenõâ, kazuistiky); 4. Ze zahranicï nõâch cï asopisuê (referaâty z cï asopisuê) 5. Recenze (odbornyâch knih a atestacï nõâch pracõâ); 6. Informace; 7. SpolecÏ enskaâ rubrika. PrÏõÂspeÏ vky se zasõâlajõâ tisïteïneâ formeï ve formaâ tu A4 a soucï asneï v elektronickeâ formeï na CD psaneâ v textoveâ m editoru obvykleâ ho typu (Word) v souladu s novyâmipravidly cï eskeâ ho nebo slovenskeâ ho pravopisu a americkyâm standardem anglickeâ ho pravopisu jednotneï v celeâ m sdeïlenõâ. Fotografie musõâ byât ulozïeny ve formaâ tu JPG v rozlisï enõâ min dpi. Tabulky, grafy a texty v obraâ zcõâch se publikujõâ v anglickeâ m jazyku. Pra ce zaslaneâ redakcimusõâ byât formulovaâ ny s konecï nou platnostõâ. PozÏ adavky na odborneâ praâ ce. Redakce prïijõâmaâ praâ ce, ktereâ nebyly a nebudou zadaâ ny jineâ mu periodiku, vyhovujõâ po straâ nce odborneâ a majõâ odpovõâdajõâcõâ uâ rovenï metodologickeâ ho a statistickeâ ho zpracovaâ nõâ. Publikova nõâ vyâsledkuê klinickyâch a experimentaâ lnõâch (pokusy na zvõârïatech) vyâzkumuê prïedpoklaâ daâ, zï e byly dodrzï eny prïõâslusï neâ etickeâ zaâ sady, zejmeâ na principy Helsinske deklarace a souhlas etickeâ komise. MateriaÂly prïevzateâ z jinyâch pramenuê musõâ byât doplneï ny põâsemnyâm souhlasem drzï itele autorskyâch praâ v, kteryâ svoluje k reprodukci. RedakcÏ nõâ rada nevyzï aduje imprimatur vedoucõâho pracovisï teï. Za uâ rovenï sdeï lenõâ odpovõâdajõâ autorïi. KazÏdy rukopis prochaâ zõâ recenznõâm rïõâzenõâm, ktereâ je oboustranneï anonymnõâ a je provaâdeï no dveï ma na sobeï nezaâ vislyâmiodbornõâky. Posudek je spolu s naâ vrhy uâ prav zasõâlaâ n autorovik uâ pravaâ m. KonecÏ neâ rozhodnutõâ o prïijetõâ cï laâ nku k publikaci a o uâ praveï rukopisu si vyhrazuje redakce. Pra ce mohou byât v cï eskeâm, slovenskeâ m nebo anglickeâ m jazyce. PrÏeklad do anglickeâ ho jazyka zajisï t'uje redakce. V zaâ jmu zvyâsï enõâ kvality prïekladu do anglicï tiny redakce doporucï uje speciaâ lnõâ anglickeâ odborneâ vyârazy uveâ st v prïõâloze. Na titulnõâ straneï se uvaâ dõâ: naâ zev praâ ce, celaâ jmeâ na autoruê vcï etneï tituluê,naâ zev a sõâdlo pracovisïteï, odkud praâ ce vychaâ zõâ, event. poznaâ mka oprïõâpadneâ prïedchozõâ publikaci ve formeï prïednaâsï ky. Souhrn se põâsï e na samostatneâ straâ nce v deâ lce do 15 rïaâ dek. U experimentaâ lnõâch pracõâ je souhrn strukturovanyâ. Obsahuje cõâl praâ ce, metody, zaâveï ry. Souhrn se põâsï e ve trïetõâ osobeï, slova se nezkracujõâ. Na zvlaâsï tnõâm rïaâ dku se uvaâ dõâ 2-5 klõâcï ovyâch slov. Vlastnõ text je u puê vodnõâch pracõâ zpravidla rozdeï len na uâ vod, materiaâ l (nebo soubor) a metodiku, vyâsledky, diskusi a zaâ veï r.cï leneï nõâ ostatnõâch odbornyâch pracõâ se rïõâdõâ povahou sdeï lenõâ. Literatura: citace se rïadõâ a cï õâslujõâ podle porïadõâ vyâskytu v textu. PorÏadove cï õâslo citace se v textu uvaâ dõâ v hranatyâch zaâ vorkaâ ch, naprï. [1]. Cituje se podle CÏ SN ISO 690 ¹Bibliograficke citaceª a CÏ SN ISO 4 ¹Pravidla zkracovaâ nõâslov z naâ zvuê a naâ zvuê dokumentuê ª,s prïihleâ dnutõâm k PrÏõÂloze k CÏ SN ¹Seznam zkratek... v naâ zvech periodikª. PrÏõÂklady typuê citacõâ: a) citace jednosvazkoveâ ho dõâla: 1. Proffit, W.R.; Fields, H.W.: Contemporary orthodontics. 2nd ed., St. Louis: Mosby, b) citace prïõâspeï vku ze sbornõâku nebo monografie: 2. Bittner, J.; Vacek, M.: Esteticke aspekty v protetice. In: Urban, F. (ed.): Pokroky ve stomatologii. Praha: Avicenum, c) citace cïlaâ nku: 3. Andrews, L.F.: The six keys to normal occlusion. Amer. J. Orthodont. 1972, 62, cï.3, s Zkratky naâ zvuê nejcï asteï jicitovanyâch ortodontickyâch a stomatologickyâch cï asopisuê jsou uvedeny v Tab.1. Za literaturou se uvaâ dõâ jmeâ no a kontaktnõâ adresa prvnõâho autora. Instructions for Authors The objective of the journal 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 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. Key- Words (2-5) are given on a separate line. The original work text body is usually divided into introduction, material (or samples), methods, results, discussion and conclusions. In other cases this depends on the character of a publication. Bibliography: works cited are listed and numbered according to their occurrence in the text. Ordinal number of the work cited is given in square brackets, e.g. [1]. The norm to follow is CÏ SN ISO 690 ¹Bibliograficke citaceª and CÏ SN ISO 4 ¹Pravidla zkracovaâ nõâ slov z naâ zvuê anaâzvuê dokumentuê ª, with regard to Appendix to CÏ SN ¹Seznam zkratek... v naâ zvech periodikª. Examples of citations: a) one-volume work: 1. Proffit, W.R.; Fields, H.W.: Contemporary orthodontics. 2nd ed., St. Louis: Mosby, 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, c) article: 3. Andrews, L.F.: The six keys to normal occlusion. Amer. J. Orthodont. 1972, 62, No.3, p 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. 186

6 ZpraÂvyzvyÂboru rocïnõâk21 PrÏõÂlohy. Obra zky (grafy, scheâ mata, fotografie) a tabulky se prïiklaâdajõâ volneï k rukopisu, kazïdaâ prïõâloha zvlaâsït'. Legenda k tabulce se uvaâ dõâ nad tabulkou, vysveï tlivky pod tabulkou. Legenda k ostatnõâ dokumentacise prïiklaâdaâ na zvlaâsï tnõâm listeï. MõÂsto, kam se maâ prïõâloha v textu umõâstit, je mozï no oznacï it na okraji straâ nky cï tverecï kem s cï õâslem prïõâlohy. Orientaci obraâ zkuê je vhodneâ vyznacï it na rubu sï ipkou. Obra zky musõâ byât upraveny tak, aby se daly reprodukovat (zvl. nesmõâ po zmensï enõâ velikost põâsma klesnout pod 2 mm). Tabulky jsou prïilozï eny ve formaâ tu Word, grafy ve formaâ tu Excel v originaâ lnõâ verzi vcï etneï vyâchozõâch tabulek a automatickeâ ho propojenõâ. ZasõÂla nõâ obraâ zkuê a grafuê v editoru Word nebo Power Point je neprïõâpustneâ.fotografie a rentgenoveâ snõâmky na CD musõâ byât ulozïeny ve formaâ tu JPG ve formaâ tu min dpi. Fotografie oblicï eje pacienta musõâ mõât souhlas zobrazeneâ osoby se zverïejneï nõâm, v opacï neâm prïõâpadeï bude redakce nucena upravovat (maskovat) fotografie tak, aby se znemozï nila identifikace. Pacienti nesmõâ byât oznacï ovaâ nijmeâ ny nebo iniciaâlami, ale pouze porïadovyâmicï õâsly. V pruê vodnõâm dopise k odborneâ praâ ciprvnõâ autor stvrdõâ svyâm podpisem, zïe: ± se jednaâ o jejich vlastnõâ puê vodnõâ praâci; ± praâ ce soucï asneï nebyla a nebude nabõâdnuta jineâ mu periodiku; ± zï e autorïinemajõâ komercï nõâ, vlastnickeâ nebo financï nõâ zaâ jmy na produktech nebo spolecï nostech popsanyâch v tomto cïlaâ nku; adaâ le, v prïõâpadeï potrïeby, zïe: ± klinickeâ nebo experimentaâ lnõâ zkousï ky na lidech cï izvõârïatech dodrzï ujõâ prïõâslusï neâ etickeâ zaâ sady a majõâ souhlas etickeâ komise; ± autorïimajõâ souhlas jineâ ho drzï itele autorskyâch praâ v k reprodukciobraâ zkuê a jineâho prïevzateâ ho materiaâ lu; ± autorïimajõâ souhlas fotografovaneâ ho pacienta se zobrazenõâm oblicï eje. V pruê vodnõâm dopise je daâle trïeba uveâ st kontaktnõâ adresu prvnõâho autora, telefonnõâ cï õâslo a , rodneâ cï õâslo a cï õâslo bankovnõâho uâcï tu, kam maâ byât zaslaâ n autorskyâ honoraâ rï. K dopisu je trïeba prïilozï it fotografie autoruê ve fyzickeâ nebo elektronickeâ formeï oznacï eneâ na rubu celyâm jmeâ nem. Rukopis bude posouzen odbornyâmirecenzenty redakcï nõâ rady. Pra ce nevyhovujõâcõâ po obsahoveâ nebo formaâ lnõâ straâ nce budou vraâ ceny autoruê m k prïepracovaâ nõâ. Pra ce prïijateâ k publikovaâ nõâ budou zaslaâ ny na kontaktnõâ adresu autoruê ke korekturïe. Autorska korektura slouzï õâ pouze k opraveï tiskovyâch chyb, nelze prïinõâ text obsahoveï meï nit nebo doplnï ovat. Prova dõâ se pomocõâ zavedenyâch korekturnõâch znameâ nek (CÏ SN ) nebo elektronicky. Korektury je trïeba vraâ tit obratem, jinak siredakce vyhrazuje praâ vo vydat text bez autorizace. Zaslana dokumentace se vracõâ jen po dohodeï. UverÏejneÏna praâ ce se staâvaâ majetkem cï asopisu Ortodoncie. PrÏetisknout jejõâ cï aâ st nebo pouzï õât obraâ zku v jineâ publikaci lze jen s citacõâ puê vodu. Adresa ke korespondenci: Redakce cï asopisu Ortodoncie, Doc. MUDr. M. SÏ pidlen, Ph.D., klinika zubnõâho leâ karïstvõâ, Palacke ho 12, Olomouc. Tel.: , fax: CÏ eskaâ a anglickaâ verze PokynuÊ pro autory je uverïejneï na na internetovyâch straâ nkaâ ch vydavatele:. 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 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), 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 (CÏ SN ). 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. 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 cï asopisu Ortodoncie, Doc. MUDr. M. SÏ pidlen, Ph.D., klinika zubnõâho leâ karïstvõâ, Palacke ho 12, Olomouc. Tel.: , fax: The versions of the Guidelines for Author in Czech and English are available on the publisher`s webside:. Tab. 1. Zkratky naâ zvuê nejcï asteï jicitovanyâch ortodontickyâch a stomatologickyâch cï astopisuê (CÏ SN ) Table 1: Abbreviations of the most frequently cited orthodontic and dental journals (in accordance with CÏ SN ) 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. CÏ eskaâ stomatologie CÏ es. Stomat. CÏ eskoslovenskaâ stomatologie CÏ s. 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 zubnõâ leâ karïstvõâ Prakt. zubnõâ Le k. 187

7 rocïnõâk21 ZajõÂmavosti v ortodoncii XIII. kongres CÏ eskeâ ortodontickeâ spolecï nosti Ve dnech se uskutecï nil XIII. kongres CÏ eskeâ ortodontickeâ spolecï nosti, tentokraâ t v kraâ sneâm prostrïedõâ laâ zenï skeâ ho meï sta LuhacÏ ovice. Jako jizï tradicïneï byl odbornyâ program rozdeï len do 3 sekcõâ pro leâ karïe, ortodontickeâ asistentky a zubnõâ techniky. VeÏ tsï ina odborneâ ho ispolecï enskeâ ho programu se odehraâ vala ve SpolecÏ enskeâ m domeï nalaâzenï skeâ m naâ meï stõâ, tedy v jakeâ msipomyslneâ m srdciluhacï ovic. Prvnõ den vzï dy patrïõâ kongresoveâ mu kurzu, kteryâ tentokraâ t vedliotec a syn Andrewsovi. Prof. Andrewse muê zï eme bezpochyby zarïadit mezi jednu z legend sveïtoveâ ortodoncie. Jeho sï est klõâcïuê okluze a vynaâ lez leâcï ebneâ techniky straight-wire je jaâ drem kazï dodennõâ praxe veïtsï iny z naâ s. NicmeÂneÏ do LuhacÏ ovic naâ s spolu se synem prïijel seznaâ mit s koncepcõâ Orofacia lnõâ harmonie. Prof. Andrews prïedstavil ¹SÏ est klõâcï uê orofaciaâ lnõâ harmonieª, ktereâ, jsou-lirespektovaâ ny, umozï nõâ u kazïdeâ ho pacienta dosaâ hnout ideaâ lnõâho vyâsledku s ohledem na funkcï nost, stabilitu a estetiku. Prvnõ kongresovyâ den poteâ pokracï oval slavnostnõâm prïõâpitkem a moâ dnõâ prïehlõâdkou. Jako poslednõâ pracovnõâ bod prvnõâho dne a byla naplaâ novaâ na plenaâ rnõâ schuê ze CÏ e- skeâ ortodontickeâ spolecï nostis volbami do reviznõâ komise, vyâ boru spolecï nostia naâ sledneï takeâ nejuzï õâsï ho vedenõâ spolecï nostina dalsïõâ cï tyrïteleâ funkcï nõâ obdobõâ. TradicÏ nõâ spolecï enskyâ vecï er pro ortodontickeâ asistentky a zubnõâ techniky ve Vina rneï Domino se nesl v duchu 80. let minuleâ ho stoletõâ. Jako jizï tradicïneïseteïsïõâ tato udaâ lost velkeâ oblibeï i v rïadaâ ch leâ karïuê a leâ karïek, a anicï aâ stecï naâ prohibice nikoho ze zuâ cï astneï nyâ ch neochudila o zaâ zï itek umocneï nyâ dobovyâ m oblecï enõâm a hudbou BrokuÊ FrantisÏ ka KanecÏ ka. Start do dalsï õâho dne zajistil na La zenï skeâmnaâmeï stõâ prïed SpolecÏ enskyâ m domem deï tskyâ folklornõâ soubor 188

8 ZajõÂmavosti v ortodoncii rocïnõâk21 HradisÏ t'aâ nek. Jako prvnõâ otevrïel odbornyâ program MUDr. Va clav Bedna rï, jemuzï bylo udeï leno cï estneâ cï lenstvõâ CÏ eskeâ ortodontickeâ spolecï nostia kteryâ naâsledneï prïednesl cï estnou prïednaâsï ku BedrÏicha Neumanna. MUDr. BednaÂrÏ naâ m v nõâ poskytl velmizajõâmavyâ vhled do udaâ lostõâ spojenyâ ch se samotnyâ m vznikem CÏ eskeâ ortodontickeâ spolecï nosti. Dopolednõ program poteâ znovu zaplnil otec a syn Andrewsovi a ¹SÏ est klõâcïuê orofaciaâ lnõâ harmonieª spolu s Dr. Urbanovou, kteraâ prïedstvila zaâ kladnõâ podstatu geometrickeâ morfometrie. Postprandia lnõâ uâ navu a celyâ odpolednõâ program rozproudila mladaâ krev souteï zï nõâch prïednaâ sï ek, kde svaâ sdeï lenõâ prïedneslimladõâ a nadeï jnõâ leâ karïi- MUDr. VinsÏ, MUDr. EliaÂsÏ ovaâ, MUDr. Mottlova a MUDr. ChmelovaÂ. Posterova sekce byla organizovaâ na inovativneï v elektronickeâ podobeï ve formeï kraâ tkyâ ch elektronickyâch prezentacõâ, cozï zvyâsï ilo zaâ jem meziautory a prïõâspeï vkuê se tak sesï lo võâce nezï v minulyâch letech. Odpoledne pak bylo veï novaâ no polyteâ matice souvisejõâcõâ s orofaciaâ lnõâ harmoniõâ. Sve zaâ veï ry prezentovala Doc. CÏ ernochovaâ, MUDr. PavlõÂkovaÂ, MUDr. Jindra, MUDr. Liberda a MUDr. SÏ vaâ bovaâ. Prezidentsky vecï er ve SpolecÏ enskeâ m domeï byl jako obvykle obohacen takeâ o vyhlaâ sï enõâ vyâ sledkuê souteï zïõâ CÏ eskeâ ortodontickeâ spolecï nosti. Cenu za nejlepsïõâ atestacï nõâ praâ civ oboru ortodoncie sitento rok odnesla MUDr. Elia sï ovaâ za teâ ma ¹Tvorba kostiortodntickyâm posunem zubu v distaâ lnõâm uâ seku chrupu a jejõâ stabilitaª. Jako nejlepsï õâ souteïzïnõâprïednaâsï ka bylo vyhodnoceno sdeï lenõâ MUDr. VinsÏ e a spoluatuoruê ¹Vliv ortodontickeâ leâcï by na vznik gingivaâ lnõâch recesuê ª. Cena za nejlepsï õâ klinickyâ poster byla udeï lena MUDr. Berna tovi a spoluautoruê m za teâ ma ¹Autotransplantace anomaâ lneï ulozï eneâ ho zaâ rodku zubu na pravidelneâ mõâsto v obloukuª, oceneï nõâ za nejlepsïõâveï deckyâ poster s naâzvem ¹CBCT: redukce pohybovyâ ch artefaktuê ª zõâskali MUDr. Hanzelka a spoluautorïi. OceneÏ nyâ m autoruê m blahoprïejeme a veïrïõâme, zï e se neï kteryâm z nich brzy podarïõâ proniknout se svyâmiprïõâspeï vky takeâ na zahranicï nõâch kongresech cï iv zahranicï nõâ odborneâ literaturïe. PrÏõÂjemny m vecï erem naâ s provedla cimbaâ lovaâ muzika spolu s uskupenõâm Two voices. TrÏetõ den zahaâ jila po naâ rocïneâ m vecï ernõâm programu symbolicky prïednaâ sï ka B. Petra koveâ o historii a vyuzï itõâ luhacï ovickyâ ch mineraâ lek. Pote uzï se rozbeï hla seâ rie prïednaâ sï ek dalsï õâho steï zï ejnõâho teâ matu tohoto kongresu, a sice autotransplantace zubuê. PrÏedstavily se tyâ my autoruê (ortodontisty a chirurga) ze zahranicï õâ - naâ m velmidobrïe znaâ myâ Dr. Paulsen a Dr. Schwartz, daâ le Dr. Czochrowska a Dr. Plakwicz z Polska a takeâ nejznaâmeï jsïõâ cï eskaâ dvojice spoluautoruê Dr. Marek s Doc. Starostou. Porova nõâm jsme tak mohlizaznamenat, zï evyâ sledky teâ to dvojice jsou srovnatelneâ is autory sveï toveâhovyâznamu. NezbyÂva tak doufat, zïe se tato leâcï ebnaâ metoda, idõâky prïõâtomnostinasï ich spolupracujõâcõâch chirurguê v saâ le, rozsï õârïõâ ve veï tsï õâm meï rïõâtku ido nasï ich praxõâ. Poslednõ prïednaâsï ka patrïila symbolicky prïõâ- 189

9 rocïnõâk21 ZajõÂmavosti v ortodoncii sï tõâmu prezidentovi kongresu CÏ eskeâ ortodontickeâ spolecï nostimudr. Baumrukovi, kteryâ bude hostit jizï XIV. kongres CÏ eskeâ ortodontickeâ spolecï nostiv Plzni. HlavnõÂm teâ matem dvoudennõâho bloku prïednaâ sï ek pro ortodontickeâ asistentky byl management ortodontickeâ praxe. Program zajistil kongresovyâ kurz MUDr. Kunkely a prïednaâsï ka Ing.SÏ usty, kterïõâ jsou povazï ovaâni za prïednõâ odbornõâky v teâ to oblasti. PrÏednaÂsÏ ky o managementu a provoznõâ dokumentacipak doplnila sdeï lenõâ z oblasti ortodonticko-chirurgickeâ spolupraâ ce. Sekce zubnõâch technikuê byla zameï rïena prïedevsï õâm prakticky. MUDr. SÏ tefkovaâ vedla spolu s J.Petrovou workshop s teâ matem diagnostickeâ prïedstavby modeluê u slozïityâch ortodontickyâchprïõâpaduê. C. St ser pak v celodennõâm kurzu ¹KFO creativ: Orthocryl black&whiteª prïedstavila vyuzï itõâ techniky black&white prïivyâ robeï ortodontickeâ ho aparaâ tu. Prezidentovi kongresu a jeho spolupracovnõâkuêm patrïõâ velkyâ dõâk za organizaci XIII. kongresu CÏ eskeâ ortodontickeâ spolecï nostia sestavenõâ takto kvalitnõâho odborneâ ho ispolecï enskeâ ho programu. Budeme se teï sï it na dalsï õâ setkaâ nõâ v Plzni! za tyâ m autoruê Josef KucÏ era Za klady ortodonticko- -chirurgickeâ spolupraâce leâ cï by pacientuê s cï elistnõâmi vadami Jeden paâ tecï nõâ podvecï er v rïõâjnu jsem polõâbil manzï elku, pohladil syna a vyrazil z Hana ckeâ metropole smeï r Brno. PrÏijal jsem totizï pozvaâ nõâ firmy BELdental Ostrava na kurz ¹Za klady ortodonticko-chirurgickeâ spolupraâce leâcï by pacientuê s cï elistnõâmi vadamiª. StacÏ ilo neï kolik nezapomenutelnyâch zaâ zï itkuê, na jizï teâ meï rï legendaâ rnõâ D1, a najednou jsem se ocitl ve tmeï uprostrïed temneâ ho hvozdu. ChvõÂlijsem zavaâ hal, lecï navigace meï nekompromisneï vedla staâ le hloubeï jido lesa. Hotel Myslivna se nachaâzõâ peï kneï v jeho strïedu s kraâsnyâm vyâhledem na Brno. Oba hlavnõâ akteârïi- Dr. Petr a Dr. Folta n jizï bylina mõâsteï a pilneï se u dobreâ vecïerïe prïipravovali na võâkendovyâ maratoân. AzÏe to tedy maratoâ n byl! PrÏednaÂsÏ ejõâcõâ se v ostreâm tempu pravidelneï strïõâdalive vyâ kladu a navzaâ jem doplnï ovalipo celeâ sobotnõâ dopoledne a odpoledne. Dr. Petr vzï dy podrobneï popsal, a na fotografiõâch demonstroval, vsï echny typy ortodontickyâ ch anomaâ li õâ a zduê vodnil nutnost jejich ortodonticko-chirurgickeâ terapie. Dr. FoltaÂn naâ s naâ sledneï obeznaâ mil s chirurgickyâm postupem terapie daneâ anomaâ lie. MusõÂm prïed obeï ma akteâ ry smeknout pomyslnyâ klobouk, protozï e po celodennõâm martyriu byli jesï teï schopnizasednout ke stolu a probõârat (kolegy prïineseneâ ) modely pacientuê. PrÏizna m se, zïe jaâ uzï jsem opravdu na toto sõâlu nemeï l a podvecï er straâ vil v mõâstnõâm fitnesscentru. VecÏ er jsme nasedli- dle slov pana operateâra - na ¹sockuª (rozumeï j MHD) a vrhlise do võâru nocï nõâho Brna. Sobotnõ program jsme, vzhledem k teâ matu kurzu, nemohlizakoncï it jinak, nezï v klubu s prïõâznacï nyâm naâ zvem Two Faces... NedeÏ le se nesla v podobneâ m duchu a tempu jako sobota. CozÏ bylo jen a jen dobrïe, protozïe dõâky obeïma prïednaâsï ejõâcõâm jsme siudeï laliucelenyâ prïehled o vsï ech typech ortognaâ tnõâch vad a jejich ortodonticko-chirurgickeâm rïesï enõâ. Co rïõâcizaâveï rem? Po kurzu jsem byl natolik zahlcen informacemi, zïe meï pro tentokraâ t aninevadil uâ deï snyâ stav nasï õâ hlavnõâ daâ lnicï nõâ tepny a teïsï il jsem se domuê. S odstupem cï asu ted' musõâm prïiznat, zï e na neï ktereâ sveâ pacienty pohlõâzï õâm zcela jinak. TakzÏ e dõâky firmeï BELdental Ostrava za usporïaâdaâ nõâ kurzu a hlavneï dõâky obeï ma prïednaâ sï ejõâcõâm za to, zï e se s naâ mipodeï lili o sveâ letiteâ zkusï enosti. MUDr. ZdeneÏ k Micek ml. P.S.: PrÏejivsÏ e nejlepsï õâ dnes uzï panõâ Ing. ZuzaneÏ HeinõÂk BeÏ loveâ!!! HodneÏ sïteï stõâ, maâ lo plaâcï e, do roka dva kudrnaâcïe

10 Korespondence rocïnõâk21 Dopisy redakci Implantace do prïipraveneâ mezery prïi agenezi hornõâho postrannõâho rïezaâku Se zaâ jmem jsem si prïecï etl cï laâ nek ¹Implantace do prïipraveneâ mezery prïi agenezi hornõâho postrannõâho rïezaâ kuª autoruê Motlova A., Kotas M., SÏ imuê nek A., publikovaneâ mvcï asopise Ortodoncie, 21/3, 2012 na straâ nce ProtozÏe prïesnost RTG zobrazenõâ je cïaâ st i nasïõâveï deckeâ praâ ce (1), dovolil bych si sdeï lit meâ prïipomõânky k tomuto sdeï lenõâ. Jedna se hlavneï o autory popisovanou metodiku meïrïenõâ interradikulaâ rnõâ vzdaâ lenosti linii C. I kdyzï je z tohoto cïlaâ nku zjevneâ,zïe mu tvuê rci veï novali velkeâ uâ silõâ a stojõâ za nõâm hodneï praâ ce, obaâvaâ m se, zïe vychaâ zõâ z mylneâ hozaâ kladnõâho prïedpokladu. AutorÏi totizï v metodice automaticky prïedpoklaâ dajõâ, zï e jimi zjisï teï neâ zveï t- sï enõâ OPG snõâmku podle sï õârïky implantaâ tu a velikosti strïednõâho rïezaâ ku je konstantnõâ na celeâ m ortopantomogramu. S tõâmto faktem pak daâ le pocï õâtajõâ beï hem celeâ ho zameïrïenõâ. To ale odporuje zaâ veï ru praâ ce Mckee et al. (2), kteryâ porovnaâ val 4 ruê zneâ ortopantomografickeâ prïõâstroje a zjistil, zïeveïtsï ina rozmeïruê na OPG je statisticky signifikantneï rozdõâlnyâ ch od skutecï nosti a nejveïtsï õâ rozdõâl je praâveï v angulaci druhyâchrïezaâkuêasï picïaâkuê. CozÏ je pochopitelneâ, protozïe vzhledem k pozici rentgenky, snõâmacï e a sklonu zubuê, kdy jsou apexy daâ le od RTG snõâmacï e nezï korunky, je oblast apexuê zubuê zobrazena zveï tsï eneï. PrÏõÂkladem tohoto tvrzenõâ je i zrïetelneâ zobrazenõâ krcï ku implantaâ tu na obraâ zku cï. 3 daneâ ho textu, zatõâmco apex implantaâ tu je rozmazanyâ. Proto, dle meâhonaâ zoru, hodnocenõâ ¹danger zoneª v tomto rozmeï ru je nutno braâ t pouze jako velmi hrubyâ odhad a nelze z neï j vyvozovat zïaâ dneâ zaâ veï ry. Objektivnõ je z tohoto pohledu pouze meï rïenõâ v oblasti cementosklovinneâ hranice a interdentaâ lnõâ vzdaâ lenosti (linie A a B). StejneÏ tak nelze souhlasit s tvrzenõâm v zaâveï ru, zïe ¹KorÏeny zubuê sousedõâcõâch s prïipravenou mezerou byly ve 100% prïõâpaduê paralelnõâª. VeÏrÏõÂm, zïe pochopõâte, zïe se jednaâ zmeâ ho pohledu o konstruktivnõâ, jehozï uâcï elem je zlepsï enõâ kvality publikovanyâ ch pracõâ. Doc. MUDr. Rene Folta n, Ph.D., Praha Literatura: 1. Hanzelka, T., Folta n, R., HorkaÂ, E,. SedyÂ, J.: Reduction of the negative influence of patient motion on quality of CBCT scan. Med. Hypothese, 2010 Dec,75, cï. 6, s Mckee, I.W., Williamson, P.C., Lam, E.W., Heo, G., Glover, K.E., Major, P.W.: The accuracy of 4 panoramic units in the projection of mesiodistal tooth angulations. Amer. J. Orthodont. dentofacial Orthop Feb, 121, cï. 2, s OdpoveÏ d' autoruê Z prïipomõânek doc. Folta najezrïejmeâ, zï e celyâ cï laâ nek se zaâ jmem prïecï etl, cï ehozï si vaâ zï õâm a deï kuji za prïipomõânky. Jsem si veï doma nedokonalostõâ formulace zaâ veï ruê a vyâ sledkuê odborneâ praâ ce, ke kteryâ m dosï loprïevaâ zïneï ve snaze, co nejstrucïneï ji shrnout kvantum meïrïenõâ a vyâ sledkuê. Su hlovyâ m zkreslenõâm projekce angulace korïenuê na OPG snõâmcõâch jsme v nasï õâ praâ ci ale uvazïovali a jsme si veïdomi, zïe toto zkreslenõâ je nejveïtsï õâ praâveï v oblasti hornõâch postrannõâch rïezaâkuêasï picïaâkuê, jak kromeï praâ ce McKeeho et all. [1] doklaâ dajõâ i studie Pecka et all. [2], Owensove [3] a Kvapilove [4]. MeÏrÏenõ v linii C tak bylo pouze pomocnyâ m a nepocï õâtali jsme s tõâmto rozmeï rem v zïaâ dneâ m dalsï õâm hodnocenõâ uâ speïsïneâhocï i neuâ speïsïneâ ho zavedenõâ implantaâ tu. ZaÂveÏr,zÏe v nasï em souboru byly vsï echny korïeny sousedõâcõâ s mezerou pro implantaâ t paralelnõâ, je mozïnaâ võâce nezï optimistickyâ. Ale pokud vezmeme v potaz naâ mimeï rïenou pruê meï r- nou sïõârïi mezery 9,20 mm a prïedpoklad, zïe dle studie Pecka [2] se korïeny hornõâch frontaâ lnõâch zubuê projikujõâ na OPG distaâ lneï ji nezï na CT, a nebo naopak podle studie Kvapilove [4] je sklon dlouheâ osy korïene sï picïaâ ku o 5,8 mesiaâ lneïji a dlouheâ osy korïene strïednõâho hornõâho rïezaâ ku o 10,9 distaâ lneï ji na OPG nezï se jevõâ v porovnaâ nõâ s CBCT, tak v tomto prïõâpadeï si dovolõâm staâ le tvrdit, zï e pro implantologa byly vsï echny mezery prïipraveneâ dostatecï neï. SamozrÏejmeÏ pro neprïesnost OPG snõâmkovaânõâzaâ visejõâcõâ na mnoha faktorech a takeâ vzhledem k naâmimeïrïeneâmuvyâ razneâ mu rozptylu hodnot projekcï nõâho zveï tsï enõâ doporucï ujeme prïed implantacõâ, zejmeâ na v krajineï lateraâ lnõâho hornõâho rïezaâ ku asï picïaâ ku, zhotovit CBCT. MUDr. Alena MottlovaÂ, Hradec Kra loveâ Literatura: 1. Mckee, I.W.; Glover, K.E.; Williamson, P.C.; Lam, E.W.; Heo, G.; Major, P.W.: The effect of vertical and horizontal head positioning in panoramic radiography on mesiodistal tooth angulations. Angle Orthodont. 2001, 71, cï. 6, s Peck, J.L.; Sameshima, G.T.; Miller, A.; Worth, P.; Hatcher, D.C.: Mesiodistal root angulation using panoramic and cone beam CT. Angle Orthodont. 2007, 77, cï. 2, s Owens, A.M.; Johal, A.: Near-end treatment panoramic radiograph in the assessment of mesiodistal root angulation. Angle Orthodont. 2008, 78, cï. 3, s KvapilovaÂ, T.; Marek, I.: Srovna nõâ odchylek v meï rïenõâ meziodistaâ lnõâho sklonu korïenuê zubuê na panoramatickeâ m snõâmku a cone beam CT, Ortodoncie (odeslaâ no redakciortodoncie) 191

11 rocïnõâk21 Indikace snõâmkuê Cone Beam CT. Souborny referaât. Indications for Cone Beam CT. Systematic review. MUDr. Daniela HlousÏ kovaâ, MUDr. Hana TycovaÂ, MUDr. Josef KucÏ era Ortodonticke oddeï lenõâ Stomatologicke kliniky 1. LF UK a VFN Praha Department of Orthodontics, Clinic of Stomatology, 1st Medical Faculty of Charles University and General University Hospital (VFN), Prague U vod I kdyzï bylo CBCT (Cone Beam computerized tomography) prïedstaveno jizï prïed cï tvrt stoletõâm, teprve v poslednõâ dekaâ deï se podarïilo vyvinout systeâ m prïimeï rïenyâ ch rozmeï ruê a zaâ rovenï cenoveï dostupnyâ, kteryâ je pouzï itelnyâ i v ortodontickyâ ch praxõâch. OrtodontistuÊ m poskytuje pro diagnoâ zu a stanovenõâ leâcï ebneâ ho plaâ nu nejen zobrazenõâ dvojdimenzionaâ lnõâ (2D), ale zejmeâ na zobrazenõâ trojdimenzionaâ lnõâ (3D) [1]. TeÏ chto mozïnostõâ se v ortodoncii s vyâ hodou vyuzïõâvaâ k detailnõâmu zjisïteï nõâ polohy retinovanyâ ch zubuê, k objasneïnõâ mozïnyâ ch resorpcõâ korïenuê prïilehlyâ ch zubuê, u asymetriõâ oblicï ejoveâ ho skeletu, prïõâpadneï u parodontologickyâ ch pacientuê s insuficiencõâ kosti [2]. PrÏõÂchod CBCT muê zïe prïislõâbit i dokonalejsï õâ 3D kefalometrickou analyâ zu [3]. KromeÏ toho CBCT vysï etrïenõâ nachaâ zõâ svoje mõâsto i v implantologii a v maxilofaciaâ lnõâ chirurgii [2]. Nespornou vyâ hodou CBCT v porovnaâ nõâ s FBCT (Fan Beam computerized tomography) je, zïe je prïesneïjsï õâ, skenovacõâ cï as je kratsïõâ, je znacïneï levneïjsï õâ a zejmeânamaâ mnohem mensïõâdaâ vku zaârïenõâ [4] (Ortodoncie 2012, 21, cï. 4, s ). Introduction Though Cone Beam Computerized Tomography (CBCT) had been introduced twenty five years ago, the appropriate and available system applicable also in orthodontic practice was developed only in the last decade. CBCT provides orthodontists with two-dimensional (2D) as well as three-dimensional (3D) imaging which helps in diagnostics and in preparing the treatment plan [1]. In orthodontics, CBCT is used to identify precisely the position of impacted teeth, to assess potential resorption of roots of adjacent teeth, and to evaluate facial skeletal asymmetries [2]. The insufficient bone in patients with periodontitis can be determined. CBCT can promise the better 3D cephalometric analysis [3]. It is also used in implantology and maxillofacial surgery [2]. In comparison with Fan Beam Computerized Tomography (FBCT), CBCT is more accurate, scanning process is shorter, it involves less radiation, so it is faster and safer for a patient, and it is also far less expensive [4] (Ortodoncie 2012, 21, No. 4, p ). Realita a CBCT CBCT je vsï eobecneï povazï ovaâ no za ªzlaty standardª pro diagnostiku v maxilofaciaâ lnõâ oblasti[5]. Ale zacï õânajõâ prïevlaâ dat iopacïneânaâ zory [6]. V roce 2010 vysï el v americkyâch novinaâ ch The New York Times cïlaânek, na jehozï zaâ kladeï se dostala do poveï domõâ spolecïnostiskutecï nost, zï e pouzïitõâ CBCT v ortodoncii je spojeno s radiacï nõâ zaâ teï zï õâ, kteraâ je pod tlakem marketingu prodejcuê rtg prïõâstrojuê podcenï ovaâ na [7]. Farman, prezident AAOMR (American Academy of Oral and Maxillofacial Radiology) poukazuje na nezbytnost ochrany Current situation and CBCT CBCT is generally considered a ªgolden standardª in maxillofacial diagnostics [5]. However, recently we witness an increased number of opposite views [6]. In 2010, The New York Times published an article focusing on the fact that the use of CBCT in orthodontics involves an amount of radiation which had been underestimated due to the efforts of marketing and false advertisements [7]. Farman, the President of the American Academy of Oral and Maxillofacial Radiology (AAOMR) underlines the need to protect against the radiation load involved 192

12 rocïnõâk21 prïed radiacïnõâzaâteïzïõâ spojenou s pouzïõâvaâ nõâm CBCT a to zejmeâna u deï tõâ, ktereâ jsou radiosenzitivneï jsï õâ [7]. Obavy vidõâ jako opodstatneï neâ, protozïe s prïõâchodem CT prïõâstrojuê do pediatrie dosï lo v minulosti k prïeexponovaânõâ deï tõâ. A podobnyâ trend nastaâvaâ iv soucï asneâ dobeï [8]. Za povsï imnutõâ stojõâ i cïlaâ nek Hujoela a kol., kterïõâ poukazujõâ na to, zï e velkeâ mnozï stvõâ studiõâ se zabyâvaâ orgaâ novyâ mi daâ vkamiu dospeï lyâ ch, zatõâmco veï tsï ina ortodontickyâ ch pacientuê jsou deï tia adolescenti. ZduÊ raznï ujõâ, zï e poloha orgaânuê u mladyâch lidõâ je odlisïnaâ. Pokud se neberou v uâ vahu vsï echny tyto odlisï nosti, muêzï e dochaâzet k chybneâ interpretaci zaâ veï ruê vyâ zkumuê, kdy vyâsledky studiõâ na dospeï lyâ ch budou pausï alizovaâ ny i na deï tskeâ pacienty. AutorÏicÏ laâ nku takeâ poukazujõâ na probleâm prïeexponovaânõâdeïtõâs prïõâchodem CT do medicõâny azaâ rovenï se obaâ vajõâ, zï e pod reklamnõâm tlakem zduê raznï ujõâcõâm nõâzkeâ daâ vky u CBCT prïõâstrojuê klinicï tõâleâ karïipodcenõâ skutecï neâ daâ vky u mladyâ ch lidõâ [8]. Proble m odpoveï dnosti DalsÏ õâprobleâ m, kteryâ se v soucï asneâ dobeï vynorïuje, se tyâkaâ odpoveï dnostiza hodnocenõâ CBCT zobrazenõâ. Patologicke uâ tvary z celeâ maxillofaciaâ lnõâ oblastiby meï l optimaâ lneï hodnotit radiolog a zpraâ vu posõâlat indikujõâcõâmu specialistovi (naprï. stomatologovicï iortodontistovi). SkutecÏ nost je ale takovaâ, zï e CBCT prïõâstroj muê zïe vlastnit jakyâ koliv specialista vcï etneï ortodontistuê a tak iinterpretace snõâmkuê zuê staâ vaâ na teï chto leâ karïõâch. Vzhledem k tomu, zïe se cï asto nejednaâ jen o zobrazenõâ dentice, je nutneâ, aby stomatologoveâ meï lidostatecï neâ veïdomostia zkusï enosti v oblasti anatomie a patologie hlavy a krku. Farman upozornï uje, zï e pokud nebude hodnotit CBCT zkusï enyâ leâ karï, muê zï e dojõât nejen k chybneâ interpretaci s naâ slednou neadekvaâ tnõâ leâ cï bou, ale ik prïehleâ dnutõâ ruê znyâ ch patologickyâ ch procesuê [9]. Organizace HPA (The Health Protection Agency ) ve Velke Brita nii doporucï uje, aby CBCT hodnotil bud' dostatecï neï zkusï enyâ a prosï kolenyâ stomatolog nebo aby poskytovatel CBCT vysï etrïenõâ zameï stnaâ val radiologa, kteryâ pro neï j bude CBCT hodnotit [10]. Podle Melsenove by 3D radiografie meï la byâ t soucï aâ stõâ vzdeï laâ vacõâho programu v ortodoncii [11]. K tomuto naâ zoru se prïiklaâ nõâ iscarfe [12]. V prïõâpadeï patologickyâchnaâ lezuê mimo dentici by se meï l ortodontista radit jesïteï s radiologem [11, 13]. Scarfe upozornï uje na to, zï e nenõâ neobvykleâ, zï e prïõâmo firmy, ktereâ distribuujõâ CBCT prïõâstroje, porïaâ dajõâ vzdeï laâ vacõâ kurzy (kde komercï nõâ zaâ jem prïevlaâ daâ nad zdravotnickyâ m). To vedlo k plaâ novaâ nõâ vzdeï laâ vacõâch kurzuê na firmaâ ch nezaâ vislyâ mi organizacemi. AAOMR (American Academy of Oral and Maxillofacial Radiology) je neziskovaâ organizace reprezentovanaâ maxilofaciaâ lnõâmi radiology v USA. Tato organizace prïedpoklaâ daâ, zïe vsï eobecnyâ nekomercï nõâ vzdeï laâ vacõâ kurz ohledneï CBCT by mohl byât zahaâ jen uzï v roce V podobneâm with CBCT especially in children who are more sensitive to radiation [7]. He points out the fact that after CT had been introduced in pediatrics, children were overly exposed to radiation. He can see the similar trend today connected to CBCT [8]. The article by Hujoel et al., emphasizes the fact that while a number of studies deal with radiation load in adults, most orthodontic patients are children and adolescents. The authors point out that organs are located differently in young people. If the differences are not taken into account, study results interpretations may be wrong (the results obtained in adults may be inappropriately applied to young children). They also mention the problem of children's over-exposure resulting from CT use in medicine, and they voice their worries about that the clinical physicians may underestimate real doses in young people due to the advertised low radiation load connected with CBCT [8]. Responsibility Another question is who is responsible for CBCT images interpretation. Pathological formations of maxillofacial area should be read by a radiologist who would then send the report to the specialist sending the patient (e.g. dentist or orthodontist). However, today CBCT equipment may own any specialist, orthodontists included, and thus images are interpreted by those physicians. With regard to the fact that very often the scan includes more than just a dentition image, it is necessary that dentists have sufficient knowledge and expertise in the anatomy and pathology of head and neck. Farman points out that in case CBCT is evaluated by a less experienced physician, the interpretation may be wrong, and various pathological processes may be unnoticed [9]. The Health Protection Agency (HPA), U.K., recommends that CBCT be evaluated by an experienced and trained dentist or a radiologist [10]. According to Melsen, 3D radiography should become a part of graduation curriculum for orthodontists [11]. The same view is voiced also by Scarfe [12]. In case of pathological findings outside dentition, an orthodontist should always consult a radiologist [11, 13]. Scarfe mentions that companies selling CBCT equipment often offer training programmes (with prevailing commercial interest). Similar courses are also organized by independent institutions. The American Academy of Oral and Maxillofacial Radiology (AAOMR) is a non-profit organization represented by U.S. maxillofacial radiologists. AAOMR assumes that a general non-commercial CBCT training course starts in Similar programmes are to be held also in the United Kingdom, Germany, Greece or in Denmark. Legislation should divide CT devices into two types: - With a small field of view (FOV), that may be operated by a dentist after he attended a short course. 193

13 rocïnõâk21 rozsahu se bude konat iv jinyâch zemõâch, naprï. ve Velke Brita nii, NeÏ mecku, RÏ ecku, cï i Da nsku. Legislativnõ dodatek by meï l rozdeï li t CT prïõâstroje na 2 typy: - s malyâm FOV (field of view), kteryâ muêzïe obsluhovat istomatolog po absolvovaânõâneï kolikadennõâho kurzu - s velkyâm FOV, kteryâ bude dostupnyâ pro stomatology azï po uâ speï sï neâ interpretaci 50 prïõâpaduê za prïõâtomnostiorofaciaâ lnõâho radiologa [12] Zjistilo se, zïe prïipouzïõâvaâ nõâ CBCT vysï etrïenõâ se naâhodneï diagnostikuje veï tsï õâ mnozï stvõâ vedlejsï õâch patologickyâch naâ lezuê. Mezityto naâ lezy patrïõâ naprïõâklad naâhodneâ objevenõâ rozsïteï pu obratluê ( spina bifida ), cizõâho teï lesa v hornõâch dyâ chacõâch cestaâ ch, condylus bifidus temporomandibulaâ rnõâho kloubu [13]. Proto mõâra zodpoveï dnostiprïihodnocenõâ CBCT je vyâ znamnaâ. Je nutno prohleâ dnout celyâ zobrazovanyâ objem CBCT a nezameïrïovat se jen na oblast zaâ jmu. Vzhledem k nedostatecïneâ legislativeï semuêzïe staât,zïe budou stomatologoveâ v budoucnosticï elit zï alobaâ m z chybneâ interpretace CBCT snõâmkuê [11]. ZmeÏ ny vaâ hovyâ ch faktoruê pro jednotliveâ orgaâ ny Mezina rodnõâ komise radiologickeâ ochrany ICRP (International Commission on Radiological Protection) v roce 2007 opeï tovneï prïehodnotila tkaâ nï oveâ vaâ hoveâ faktory. Stimul k revizi hodnot tkaânï ovyâch vaâ hovyâch faktoruê vznikl na zaâ kladeï novyâ ch informacõâ o incidenci naâ doruê. V roce 1990, kdy se urcï ovaly tkaânï oveâ vaâ hoveâ faktory prïed revizõâ naposledy, nebyly tyto informace jesïteï dostupneâ.v teâ dobeï se jako riziko vzniku malignity zohlednï ovala jen mortalita. V roce 2007 se do tohoto rizika prïipocï õâtala icelkovaâ zaâteï zï onemocneï nõâ malignõâm naâ dorem ( morbidita ) tzn., zïe se zohlednily i ty typy naâ doruê, pro ktereâ je charakteristickeâ dlouhodobeâ prïezï itõâ. VeÏ tsï ina uâ dajuê pochaâ zõâ z dlouhodobeâ ho monitorovaâ nõâ osob, ktereâ prïezïili vyâbuch atomoveâ bomby v Japonsku. Na zaâ kladeï teï chto zjisïteï nõâ se usoudilo, zï e riziko vzniku malignõâho tumoru slinnyâch zïlaâ z a mozku je vysï sï õâ a byly jim prïirïazeny vysï sï õâ tkaâ nï oveâ vaâ hoveâ faktory [14]. Riziko vzniku malignity v orofaciaâ lnõâ oblasti vyplyâ vajõâcõâ z radiografickyâ ch vysï etrïenõâ hlavy a krku (vcï etneï CBCT a MSCT ) je tedy vysïsïõânezïsedrïõâveprïedpoklaâ dalo [12]. Ludlow a kol. konstatuje, zïe daâ vka prïi zhotovenõâ CBCT je sice vysïsï õâ nezï u konvencï nõâch radiologickyâ ch vysï etrïenõâ, ale na druheâ straneï je mnohem nizï sï õâ nezï u konvencï nõâ vyâ pocï etnõâ tomografie [14]. Naproti tomu dvojdimenzionaâ lnõâ vysï etrïenõâ je statickeâ a omezeneâ [11]. MozÏ nost volby ze sï irokeâ ho spektra pomocnyâ ch zobrazovacõâch metod vyzï aduje promysï lenou strategii vyâbeï ru vhodneâ ho zobrazovacõâho vysï etrïenõâ tak, aby byla dosazï ena pozï adovanaâ diagnostickaâ i n- formace s minimaâ lnõâminaâ klady a rizikem pro pacienta [15]. - With a big field of view (FOV) that may be operated by dentists only after they successfully evaluate 50 scans under the supervision of an orofacial radiologist [12]. It was found that during diagnosing with CBCT a number of pathological formations is discovered as a by-product. The findings include e.g. spina bifida, a foreign body within upper airways, condylus bifidus of temporomandibular joint [13]. Therefore, the responsibility of those who evaluate CBCT scans is extremely high. It is necessary to survey the whole CBCT content, and not to focus just on the area for which CBCT imaging was originally indicated. Due to the lack of legislature, dentists are at risk of being sued for misinterpretation of CBCT scans [11]. Change in weighted factors for individual organs of body In 2007 the International Commission on Radiological Protection (ICRP) re-evaluated tissue weighted factors. The stimulus for the re-evaluation resulted from the new information on tumour incidence. In 1990 when the tissue weighted factors were established prior to the recent re-evaluation, the information was not available. At the time only mortality was seen as the risk of malign tumours incidence. Since 2007 the risk involves also the overall morbidity, i.e. the tumours characterized by a long-time survival were included. Most data come from a long-time monitoring of survivors of atomic bomb explosion in Japan. The data led to the conclusion that the risk of salivary glands and brain tumours was higher, and therefore they were assigned higher tissue weighted factors [14]. Thus, the risk of malign tumours incidence in the orofacial area due to radiographic examination of head and neck (including CBCT and MSCT) is higher than previously suggested [12]. Ludlow et al. conclude that the dosage in CBCT is higher than in conventional radiological examinations; however, it is still lower than in conventional CT [14]. On the other hand, two-dimensional examination is static and limited [11]. Therefore, the choice of appropriate radiological examination requires a well-thought strategy aimed at the required diagnostic information obtained with minimum costs and risk for a patient [15]. Recommendation for CBCT in dental medicine During CBCT, the field of view (FOV) should cover only the area of interest (in order to decrease the radiation load). Therefore, craniofacial CBCT should be used only in rare cases [9]. We should not ignore the risks of radiographic imaging methods. In indication we should consider the proportion of utilization percentage and risk for individual imaging techniques 194

14 rocïnõâk21 DoporucÏ enõâ pro pouzïõâvaâ nõâ CBCT ve stomatologii PrÏizhotovova nõâ CBCT, by se meï la (v raâ mcisnõâzï enõâ daâ vek) zvolit velikost zobrazovaneâ ho pole ( FOV) tak, aby rozsahem odpovõâdala oblastizaâ jmu. Kraniofacia lnõâ CBCT je tedy vyhrazeno jen na ojedineï leâ prïõâpady [9]. Rizika radiografickyâ ch zobrazovacõâch metod by rozhodneï nemeï la byâ t ignorovaâ na. Za rovenï je nutneâ prïi indikaci jednotlivyâ ch zobrazovacõâch metod zvaâ zï it pomeï r vyâteï zï nosti/rizika pro danou zobrazovacõâ metodu a pacienta. PrÏimale vyâteï zï nostije mozï nost vzniku diagnostickeâ ho omylu a s tõâm naâ sledneï souvisejõâcõâ komplikace prïileâcïbeï. Jsou k dispozici stovky protokoluê pro ruê zneâ vysïetrïenõâ pomocõâ zobrazovacõâch metod. CÏ asto je rozhodnutõâ na radiologovi, nebo na radiologickeâ m asistentovi jakeâ technickeâ parametry pouzï ije. Idea lneï by meï ly byât tyto faktory vybraâ ny tak, aby se dosaâ hlo cõâle vysï etrïenõâ prïico mozïnaâ nejnizïsïõâdaâ vce zaârïenõâ. Realita je vsï ak obvykle takovaâ, zïe veï tsï ina CT prïõâstrojuê je nastavena od vyâ robce bez uvaâ zï enõâ optimalizace daâ vky/kvality a je na samotneâ m radiologovi jestli zvaâ zï õâ faktory, jimizï muêzïedaâ vku snõâzï it [16, 14]. HPA (The Health Protection Agency) vznikla ve Velke Brita nii jako nezaâ vislaâ organizace, kteraâ byla sestavena vlaâ dou v roce 2003, aby chraâ nila zdravõâ verïejnosti. Vzhledem ke zvysï ujõâcõâ tendencik pouzïõâvaânõâ CBCT ve Velke Brita nii se zacï ala zabyâvat iotaâ zkou CBCT ve stomatologii. ZverÏejnila tabulku daâ vek CBCT a panoramatickeâ ho snõâmku. Po zhodnocenõâ vyâ sledkuê prïichaâzõâ k zaâveï ru, zï e CBCT by nemeï lo nahradit panoramatickyâ a kefalometrickyâ snõâmek a jeho indikace by meïlabyât dobrïe zvaâzïena. KvuÊ livysïsï õâ radiacïnõâzaâteïzïi, nepovazï uje HPA za vhodneâ, aby bylo CBCT zhotovovaâ no vyâ hradneï za uâ cï elem rekonstrukce OPG a kefalometrickeâ ho snõâmku, pokud jsou tato vysï etrïenõâ sama o sobeï schopna poskytnout dostatecï nou informaci. Na druhou stranu pokud by bylo nutneâ zhotovit CBCT, tak k zõâskaâ nõâ OPG a kefalometrickeâ ho snõâmku se vyuzï ije rekonstrukcõâ z CBCT [10]. Evropske spolecï enstvõâ pro atomovou energii (European Atomic Energy Community,EAEC) si dalo za cõâl vypracovat projekt SEDENTEXCT (Safety and Efficacy of a New and Emerging Dental X-ray Modality) ( ). ZaÂmeÏ rem projektu je zõâskat co nejvõâce klõâcï ovyâch informacõâ o CBCT a urcï it alesponï provizornõâ smeï rnice a doporucï enõâ pro pouzï õâvanõâ CBCT ve stomatologii [17]. Po vypracovaâ nõâ projektu SEDENTEXCT v roce 2011 uverïejnilo EAEC doporucï enõâ pro pouzïõâvaâ nõâ CBCT ve stomatologii. Hlavnõ zaâ sady jsou [18]: -prïihodnocenõâ retinovanyâ ch zubuê a prïilehlyâ ch tkaâ nõâ, vcï etneï stanovenõâ prïõâtomnostiresorpce okolnõâch zubuê by se meï lo preferovat CBCT vysï etrïenõâ (vzhledem k jeho nizïsï õâ daâ vce) prïed MSCT (multislice CT). CBCT and for a patient. In case of a low utilization percentage, there is a risk of wrong diagnosis, and consequently complications during the treatment. There are hundreds of protocols for various examinations using imaging techniques. Often it is up to a radiologist or radiological assistant which technical parameters are used. Ideally, the factors should be chosen to accomplish the examination with the lowest radiation load possible. However, most CT devices are preset by a manufacturer without regard to optimum dosage/quality, and it is up to a radiologist to consider whether and how to reduce the radiation exposure [16, 14]. The Health Protection Agency (HPA) was established in Great Britain by the government in 2003 as an independent organization to protect public health. With regard to increasing use of CBCT in Great Britain, the organization deals also with the use of CBCT in dental medicine. HPA published the table of CBCT and OPG radiation dosage. They conclude that CBCT should not substitute OPG and cephalograms, and the CBCT indication should be always well grounded. With regard to higher radiation, HPA does not recommend to use CBCT only for the reconstruction of OPG and cephalograms in case the examinations supply sufficient information. On the other hand, if it is necessary to make CBCT, for OPG and cephalogram the reconstructions from CBCT should be used [10]. The European Atomic Energy Community (EAEC) aims to develop the project SEDENTEXCT (Safety and Efficacy of a New and Emerging Dental X-ray Modality) ( ). The project intends to obtain as much key information on CBCT as possible, and determine at least temporary guidelines and recommendations for the use of CBCT in dental medicine [17]. After completion of SEDENTEXCT in 2011 EAEC published the following recommendations [18]: - For assessment of impacted teeth and adjacent tissues, including detection of adjacent teeth resorption, CBCT should be preferred (with regard to lower radiation load) to MSCT (multislice CT). CBCT should be indicated only in case adequate information cannot be obtained by conventional radiography. When CBCT is indicated the field of view (FOV) should be as small as possible in order to reduce dosage. In case only craniofacial CBCT (with a large FOV) is at the disposal, the examination should be thoroughly considered. - In patients with cleft, CBCT is preferred to MSCT; FOV should cover only the area of interest. - CBCT is not usually indicated for introduction of temporary anchorage. - CBCT involving a large FOV should not become a routine in common orthodontic diagnostics 195

15 rocïnõâk21 se muêzï e indikovat, jen pokud se nezõâskaâ adekvaâ tnõâ informace z konvencï nõâ radiografie, kteraâ maâ mnohem mensï õâ daâ vku zaâ rïenõâ. V prïõâpadeï rozhodnutõâ o CBCT vysï etrïenõâ by se meïlo v raâ mciredukce daâ vky pouzïõât co nejmensï õâ zobrazovaneâ pole ( FOV), ktereâ zobrazõâ jen oblast zaâ jmu. Pokud jsou k dispozici jen kraniofaciaâ lnõâ CBCT (s velkyâm FOV ), meïlobybyât rozhodnutõâ o provedenõâ vysï etrïenõâ pecï liveï zvaâ zï eno. - u rozsïteï povyâch pacientuê se dõâky mensïõâdaâ vce daâvaâ prïednost CBCT prïed MSCT, prïicï emzï by FOV meï lo odpovõâdat velikosti oblasti kteraâ maâbyât zobrazena - CBCT nenõâ normaâ lneï indikovaâno v prïõâpadeï zavaâdeï nõâ docï asnyâ ch kotevnõâch zarïõâzenõâ - CBCT s velkyâm FOV by se nemeï lo rutinneï pouzï õâvat v beïzïneâ ortodontickeâ diagnostice - kraniofaciaâ lnõâ CBCT je uprïednostnï ovaâno prïed MSCT u skeletaâ lnõâch deformit hlavneï pokud se jednaâ o ortodonticko-chirurgickyâ prïõâpad - CBCT nenõâ indikovaâ no k diagnostice kazuê - CBCT by se nemeï lo rutinneï pouzï õâvat k hodnocenõâ stavu periodontaâ lnõâ kosti ani k diagnostice parodontaâ l- nõâch patologickyâ ch procesuê. V prïõâpadech, kdy konvencï nõâ radiografie neposkytne potrïebneâ informace ke zhodnocenõâ furkacõâ a jinyâ ch parodontaâ lnõâch defektuê, muêzï e se pouzïõât CBCT s vysokyâm rozlisï enõâm, ale malyâm FOV. Naopak pokud CBCT vysï etrïenõâ zobrazuje izuby, meï la by se zkontrolovat iuâ rovenï prïilehleâ kostia vyâ skyt prïõâpadnyâ ch parodontaâ lnõâch patologickyâ ch procesuê. Limitovane CBCT s velkyâm rozlisï enõâm se muêzïe pouzïõâtke zhodnocenõâ parodontaâ lnõâch procesuê, pokud konvencï nõâ radiografie poskytla negativnõâ vyâ sledek a je prïõâtomnaâ klinickaâ symptomatologie - CBCT se nemaâ rutinneï pouzïõâvat k objasneï nõâanatomie korïenovyâ ch kanaâ lkuê. Jen v omezenyâ ch prïõâpadech se muêzï e pouzï õât limitovaneâ CBCT s vysokyâm rozlisï enõâm a to naprï. u võâcekorïenoveâ ho zubu, kde je nejasnaâ anatomie korïenovyâ ch kanaâ lkuê,daâ le v prïõâpadech resorpce korïene zaâneï tliveâ ho charakteru, cï ivnitrïnõâho granulomu (kde trojdimenzionaâ lnõâ zobrazenõâ poskytne informaci o prognoâ ze zubu), perforace, atypickeâ anatomie pulpy nebo v prïõâpadeï kombinovaneâ pulpoparodontaâ lnõâ leâ ze, kteraâ komplikuje endodontickou leâcïbu - limitovaneâ CBCT s vysokyâm rozlisï enõâm muêzïe byât indikovaânovprïõâpadech fraktur korïene zubu, kde konvencï nõâ intraoraâ lnõâ snõâmky neposkytly dostatecï nou informaci - CBCT muê zï e byâ t indikovaâ no v prïõâpadech, kdy konvencï nõâ radiografie prokaâzïe teï snou souvislost mezi trïetõâm molaâ rem a mandibulaâ rnõâm kanaâ lem, aby se detailneï objasnila jeho poloha prïed chirurgickyâm zaâ krokem - pokud konvencï nõâ radiografie neposkytne dostatecï neâ informace o retinovanyâ ch zubech, muê zï e byâ t indikovaâ no CBCT - Craniofacial CBCT is preferred to MSCT in case of skeletal deformities, especially in patients with orthognathic surgery - CBCT is not indicated for caries diagnostics - CBCT should not become a routine method for the assessment of periodontal bone condition, or for diagnostics of periodontal pathological processes. In case where conventional radiography does not bring information required for the assessment of furcations and other periodontal defects, CBCT with high resolution and small FOV may be used. On the contrary, when CBCT describes teeth, the level of adjacent bone should be examined as well as eventual periodontal pathological processes. Limited CBCT with high-resolution may be used to evaluate periodontal processes in case conventional X-rays brought negative results whilst there are clinical symptoms still present. - CBCT should not become a routine to clarify anatomy of root canals. Only sporadically a limited CBCT with high resolution may be used, e.g. in tooth with multiple roots where there is unclear anatomy of root canals, in case of inflammatory resorption of root, or in inner granuloma (3D imaging provides information on tooth prognosis), perforation, atypical anatomy of the pulp, or in case of a combined pulp-periodontal lesion which complicates endodontic treatment. - Limited CBCT with high resolution may be indicated in root fractures in case conventional intraoral X- ray pictures did not provide sufficient information. - CBCT may be indicated in cases when conventional radiography proves close relation between third molar and mandibular canal, in order to detail its position prior to surgery - CBCT may be indicated in case when conventional radiography did not bring sufficient information on impacted teeth - In planning before implants insertion, CBCT is preferred (due to lower radiation) to other techniques allowing for imaging of jaws in cross-section (e.g.msct) - multislice CT (MSCT) and magnetic resonance (MR) is preferred to CBCT in cases when evaluation of soft tissues is required - CBCT may be used in orofacial carcinoma when there is suspect invasion of tumor into jaw bones, and MSCT together with MR did not brig sufficient information on diagnosis and the stage of the illness - CBCT is preferred to MSCT in case of orofacial traumas when cross-section images are necessary whilst pictures of soft tissues are not - CBCT may be used in case of planning orthognathic surgery when skeletal three-dimensional imaging is required - When CT is indicated to describe TMK, CBCT is preferred over MSCT due to lower radiation load. 196

16 rocïnõâk21 -prïiplaâ novaâ nõâ prïed zavedenõâm implantaâ tuê se daâ vaâ CBCT prïednost (jako alternativeï s nizïsï õâmi daâ vkami) prïed jinyâ mimetodami, ktereâ umozï nï ujõâ zobrazenõâ cï elistõâ vprïõâcïnyâch rïezech (jako je naprï. MSCT) - tam, kde je nutneâ zhodnocenõâ meï kkyâ ch tkaâ nõâ v raâ mci radiologickeâ ho vysï etrïenõâ, se daâ vaâ prïednost MSCT a magnetickeâ resonanci(mr) prïed CBCT - u karcinomuê orofaciaâ lnõâ oblasti, kde je podezrïenõâ na invazi do cï elistnõâch kostõâ a MSCT spolu s MR neposkytly dostatecï nou informaci o diagnoâ ze a stadiu onemocneïnõâ,semuêzïe zhotovit CBCT - v prïõâpadech orofaciaâ lnõâch traumat, kde je potrïebneâ zobrazenõâ v prïõâcï nyâch rïezech a nenõâ potrïebneâ zobrazenõâ meï kkyâch tkaânõâ,semuêzï e kvuê linizïsïõâdaâ vce daâtprïednost CBCT prïed MSCT - CBCT se muêzïe zhotovit v prïõâpadeï plaâ novaâ nõâ ortognaâ tnõâ operace, kde je potrïebneâ trojdimenzionaâ lnõâ zobrazenõâ skeletu - pokud je pro zobrazenõâ TMK indikovaâ no CT, je kvuê limensï õâ daâ vce zaâ rïenõâ uprïednostnï ovaâ no CBCT prïed MSCT ZaÂveÏr Obrovsky rozmach pouzïõâvaâ nõâ CBCT v ortodoncii vedl Kokiche k zamysï lenõâ, zda prïinese 3D zobrazenõâ v ortodoncii skutecï neï vzï dy prospeï ch. Kokich jej povazï uje za naâ pomocneâ u ektopickyâ ch erupcõâ, retinovanyâ ch zubuê a transpozicõâ, kde umozï nõâ prostoroveâ zobrazenõâ a zjednodusï õâ diagnoâ zu. Pochybuje vsï ak o tom, zï e se pomocõâ CBCT zlepsïõâ leâcï ebnyâ vyâsledek ubeïzïnyâch anomaâliõâ.ocï em nenõâ pochyb je skutecï nost, zï e je toto vysï etrïenõâ pro pacienta financï neï naâ kladneï jsï õâ. CBCT jisteï pomuê zï e pochopit zmeï ny po ortognaâ tnõâch operacõâch, protozïe v teï chto prïõâpadech skutecïneï dochaâ zõâ k prostorovyâm zmeïnaâ m. Kokich ale varuje prïed nadmeï rnyâ m pouzï õâvaâ nõâm (zneuzï õâvaâ nõâm) CBCT praâ veï v teï chto studiõâch, kde pacienti absolvovali i 3 CBCT vysï etrïenõâ beï hem jednoho roku. Jako prvnõâ doporucï uje polozï it si otaâ zku, zda zõâskanyâ prospeï ch ze zhotovenõâ trojdimenzionaâ lnõâho vysï etrïenõâ skutecï neï prïevaâ zï õâ potencionaâ lnõâ riziko pro pacienta. ZodpoveÏ dnost je urcï i teï na naâ s, na indikujõâcõâch leâ karïõâch [6]. Z etickeâ ho hlediska je leâ karï povinen jednat v nejlepsï õâm zaâ jmu pacienta i v dlouhodobeâ m horizontu. Je-li jizï CBCT vysï etrïenõâ provedeno, meï lo by byâ t sdõâleno jak v raâ mci interdisciplinaâ rnõâ spolupraâ ce v raâ mcizubnõâho leâ karïstvõâ, tak i mezi specialisty jinyâch oboruê. Conclusion The enormous boom of CBCT use in orthodontics inspired Kokich to reflect on whether 3D imaging may be a real benefit in everyday orthodontics. Kokich believes it is useful in case of ectopic eruptions, impacted teeth and transpositions, as it allows for spatial imaging and simple diagnotics. Nevertheless, he doubts about the influence of CBCT on the better result of treatment in most malocclusions. There is no doubt that the examination is financially more demanding for a patient. CBCT helps to understand the changes occurring after orthognathic surgery because there really are spatial changes observed. However, Kokich warns against excessive use (or abuse) of CBCT in these studies - patients underwent as many as three CBCT examinations within one year. He suggests that first we should ask whether the benefit from 3D examination really outweighs potential risks for a patient. The responsibility is undoubtedly in our hands, in the hands of those who indicate patients for the examination [6]. Health care professional is responsible from the ethical point of view to behave in the best interest of patient also in the long term perspective. In the case the CBCT is performed, it should be shared in the interdisciplinary cooperation in dentistry, and with the other specialists in medicine as well. 13. rocïnõâk JihocÏeskyÂch ortodontickyâch dnuê ¹PolyteÂmatikaª ve dnech 26. a vcï eskyâch BudeÏjovicõÂch v hotelu Maly pivovar. Kontaktnõ adresa: MUDr. Milada HaÂlkovaÂ, VaÂclavska 282, Strakonice, tel.: , 197

17 rocïnõâk21 Literatura/References 1. Scarfe, W. C.; Farman, A. G.: What is Cone-beam CT and how does it work? Dent. Clin. North Amer. 2008, 52, cï.4, s ZoÈ ller, J. E.; Neugebauer, J.: Cone-beam volumetric imaging in dental,oral and maxillofacial medicine. New Malden: Quintessence Publishing Jacobson, A.; Jacobson, R. L.: Radiographic cephalometry from basics to 3-D imaging. Illinois: Quintessence Publishing Farman, A. G.; Scarfe, W. C.: The basics of maxillofacial Cone Beam Computed Tomography. Seminars in Orthodontics. 2009, 15, cï. 1, s Zinman, E. J.; White, S. C.; Tetradis, S.: Legal considerations in the use of cone beam computer tomography imaging. J. Calif. Dent. Assoc. 2010, 38, s [Cit. in Scarfe, W. C.: ªAll that glitters is not goldª: standards for cone-beam computerized tomographic imaging. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2011, 111, cï. 4, s ] 6. Kokich, V. G.: Cone-beam computed tomography: have we identified the orthodontic benefits? Amer. J. Orthodont. dentofacial Orthop. 2010, 137, cï. 4, s Dostupne z URL us/23scan.html?pagewanted=all. 8. Hujoel, P.; Hollender, L.; Bollen, A. M.; Young, J. D.; McGee, M.; Grosso, A.: Head-and-neck organ doses from an episode of orthodontic care. Amer. J. Orthodont. dentofacial Orthop. 2008, 133, cï. 2, s Farman, A. G.: ALARA still applies. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2005, 100, cï. 4, s Dostupne z URL 11. Cattaneo, P. M.; Melsen, B.: The use of cone-beam computed tomography in an orthodontic department in between research and daily clinic. World. J. Orthod. 2008, 9, cï. 3, s Scarfe, W. C.: ¹All that glitters is not goldª: standards for cone-beam computerized tomographic imaging. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2011, 111, cï. 4, s Rogers, S. A.; Drage, N.; Durning P.: Incidental findings arising with cone beam computed tomography imaging of the orthodontic patient. Angle Orthodont. 2011, 81, cï. 2, s Ludlow, J.B.; Ivanovic, M.: Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2008, 106, cï. 1, s McNeill, CH.; Hatcher, D. C.: Science and practice of occlusion. Illinois: Quintessence Publishing Va lek, V.: Modernõ diagnostickeâ metody. II.dõÂl. Vy pocï etnõâ tomografie, Brno : Institut pro dalsï õâ vzdeï laâ vaâ nõâ pracovnõâkuê ve zdravotnictvõâ v BrneÏ, Turpin, D. L.: Clinical guidelines and the use of conebeam computed tomography. Amer. J. Orthodont. dentofacial Orthop. 2010, 138, cï. 1, s Dostupne z URL MUDr. Daniela HlousÏ kovaâ Stomatologicka klinika 1.LF UK KaterÏinska 32, Praha 2 PrÏehled chystanyâch domaâ cõâch akcõâ 2013: ROD OSTRAVA Mgr. JirÏõ BeÏl Praha ¹Digita lnõâ fotografie v ortodontickeâ praxiª ± praktickyâ kurz PrÏehled chystanyâch zahranicï nõâch akcõâ 2013: 26.± th Congress of the European Association of Orthodontics Reykjavik, Island * * * Informace: ROD Ostrava ± BeÏ lovaâ Olga, MojmõÂrovcuÊ 799/45, Ostrava-Mar. Hory Tel.: , , 198

18 rocïnõâk21 Rodinny vyâ skyt predispozicï nõâch znakuê orofaciaâ lnõâch rozsïteï puê Family incidence of predisposition signs of orofacial clefts MUDr. Blanka DvorÏa kovaâ, MUDr. Magdalena Kot'ovaÂ, Ph.D. OddeÏ lenõâ ortodoncie a rozsïteï povyâch vad Stomatologicke kliniky 3. LF UK, FNKV Praha Department of Orthodontics and Clefts Anomalies, Clinic of Stomatology, 3rd Medical Faculty of Charles University, University Hospital Kra lovskeâ Vinohrady, Prague Souhrn Jsou sledovaâ ny predispozicï nõâ znaky (mikroformy) orofaciaâ lnõâch rozsï teï puê v 50 rodinaâ ch s vyâ skytem teâ to vrozeneâ vady. U 50 pacientuê s rozsï teï pem a u 50 jejich zdravyâ ch sourozencuê byly pomocõâ standardnõâ dokumentace (anamneâ za, ortopantomogram, saâ droveâ modely chrupu) sledovaâ ny numerickeâ a tvaroveâ anomaâ lie zubuê. U 50 zdravyâ ch rodicïuê pacientuê s rozsïteï pem a u kontrolnõâ skupiny 50 rodicïuêdeï tõâ bez rozsïteï pu byla na fotografiõâch zkoumaâ na symetrie nosnõâch vchoduê. Potvrdil se signifikantneï vysïsïõâvyâ skyt numerickyâ ch dentaâ lnõâch anomaâ liõâ ve skupineï pacientuê s rozsï teï pem oproti vyâ skytu teï chto anomaâ liõâ u jejich sourozencuê. U sourozencuê se navõâc nepotvrdil ani vysïsïõâvyâ skyt numerickyâ ch dentaâ lnõâch anomaâ liõâ oproti vyâ skytu v beïzïneâ populaci. U sourozencuê deï tõâ s rozsïteï pem se daâ le nepotvrdil vysï sï õâ vyâ skyt mikrodoncie hornõâch lateraâ lnõâch rïezaâ kuê. Neproka zaly se daâ le rozdõâly v symetrii nosnõâch dõârek u rodicïuêdeï tõâ s rozsïteï pem a rodicïuêdeï tõâ bez rozsïteï pu. Sledovane anomaâ lie zubuê a nosnõâch dõârek tudõâzï nejsou, podle nasï ich vyâ sledkuê, jednoznacï neâ predispozicï nõâ znaky, cï i mikroformy orofaciaâ lnõâch rozsï teï puê a nelze je vyuzïõâvat v prevenci teï chto vad (Ortodoncie 2012, 21, cï. 4, s ). Abstract The predisposition signs (microforms) of orofacial clefts in 50 families with history of this congenital defect are studied. We followed - with the help of standard patient records (history, OPG, cast models of dentition) - in 50 cleft patients and their 50 healthy siblings numerical and shape anomalies of dentition. In 50 healthy parents of cleft patients and in the control group of 50 parents of healthy children we examined - in photographs - the symmetry of nostrils. A significantly higher incidence of anomalies in number of teeth was proved for the group of cleft patients (in comparison with the incidence in their healthy siblings). A higher incidence of numerical dental anomalies was not proved in siblings of cleft patients (when compared with common population). Microdontia of maxillary lateral incisors was not found in siblings of the affected children. No difference in the symmetry of nostrils was proved between parents of cleft children and parents of healthy children. The observed dental anomalies and anomalies in nostrils are not - according to our results - predisposition indexes - or microforms - of orofacial clefts, and thus cannot be used in the prevention of these defects (Ortodoncie 2012, 21, No. 4, p KlõÂcÏ ovaâ slova: orofaciaâ lnõâ rozsïteï p, predispozicï nõâ znaky, mikroformy Key words: orofacial cleft, predisposition traces, microforms U vod Studium prïõâcï in vzniku nesyndromickyâ ch orofaciaâ l- nõâch rozsïteïpuê probõâhaâ desõâtky let, prïesto nejsou etiologickeâ faktory teï chto cï astyâ ch vrozenyâ ch vad detailneï objasneï ny. Vy sledky epidemiologickyâ ch a rodinnyâ ch studiõâ veï tsï inou potvrzujõâ, zï e roli v etiologii rozsï teï puê hrajõâ Introduction For the decades the attention has been paid to the study of non-syndromic orofacial clefts. However, in spite of this, the ethiological factors of these congenital anomalies have not been explained in detail yet. Results of epidemiological and family studies usually 200

19 rocïnõâk21 jak vlivy prostrïedõâ, tak genetickeâ faktory. Jedna se o vrozeneâ vady s prïõâcï inou multifaktoriaâ lnõâ. Znalost co nejveï tsï õâho mnozï stvõâ rizikovyâ ch faktoruê u nepostizï enyâ ch prïõâbuznyâch je duê lezïitaâ k predikci mozïneâ ho rizika vzniku vrozeneâ vady u potomka a poskytuje tak budoucõâm rodicï uê m prostor pro uskutecï neï nõâ specifickyâ ch preventivnõâch opatrïenõâ. Problematika predispozicï nõâch znakuê rozsï teï puê nenõâ detailneï prozkoumaâ na, ale nejcï asteï ji jsou za tyto projevy ruê znyâ miautory oznacï ovaâ ny: atypie tvaru maleâ ho hornõâho rïezaâ ku [1, 2, 3], nadpocï etneâ hornõâ rïezaâ ky [2], nezalozïeneâ rïezaâ ky [4, 7], rotace a steï snaânõâ frontaâ lnõâch zubuê v hornõâ cï elisti [4], retinovaneâ hornõâ sï picïaâ ky [5], zïlaâ bek a fistuly na hornõâm rtu [6, 3], defekty musculus orbicularis oris [10], zuâ zï enyâ hornõâ zubnõâ oblouk [2], gotickeâ patro [2, 3, 8], hypoplazie premaxily [3], submukoâ znõâ rozsï teï p [3], velofaryngeaâ lnõâ inkompetence [3], uvula bifida [1, 3], deformity nosu [3], asymetrie nosnõâch dõârek [2], cï iatypickeâ kraniofaciaâ lnõâ rozmeï ry [9]. JednoznacÏ naâ nenõâ aninomenklatura. V literaturïe se muê zï eme setkat s oznacï enõâmi mikroformy, mikrosymptomy, minimaâ lnõâ projevy, minoritnõâ formy cï istigmata. MateriaÂl Zkoumany soubor tvorïilo 50 rodin a celkem bylo vysï etrïeno 200 pacientuê. 50 pacientuê s orofaciaâ lnõâm rozsïteï pem, 50 jejich vlastnõâch sourozencuê leâcï enyâch na ortodontickeâ m oddeï lenõâ rozsï teï poveâ ho centra FNKV v Praze, daâ le 50 jejich rodicïuê a kontrolnõâ skupinu tvorïilo 50 rodicïuêdeï tõâbez rozsïteï pu. Skupinu pacientuê s rozsïteïpem tvorïilo 20 dõâvek a 30 chlapcuê. Bylive veï ku 7-22 let. Ve skupineï sourozencuê bylo 29 dõâvek a 21 chlapcuê ve veï ku 8-22 let. RodicÏedeÏ tõâ s rozsïteï pem tvorïilo 30 matek a 20 otcuê.vsï ichni ve veï ku od let. Kontrolnõ skupinu rodicï uê deï tõâ bez rozsïteï pu reprezentovalo 30 matek a 20 otcuê veveï koveâ m rozpeï tõâ let. Krite ria pro zarïazenõâ do souboru: 1. Orofacia lnõâ rozsïteï p ze skupiny tzv. typickyâch rozsïteïpuê 2. RozsÏ teï p nebyl soucï aâ stõâ syndromoveâ ho postizï enõâ 3. Sourozenec pacienta s rozsïteï pem se leâcï il na tomteâzï pracovisïti 4. U obou sourozencuê byly zhotoveny studijnõâ modely, fotografie a OPG 5. U obou sourozencuê probeï hla minimaâ lneï 1. faâze vyâmeï ny chrupu 6. Oba sourozence doprovaâ zõâ na osï etrïenõâ alesponï jeden rodicï ochotnyâ nechat se vysï etrïit 7. U kontrolnõâ skupiny rodicï uê deï tõâ bez rozsïteï pu byl anamnesticky vyloucïenvyâskyt rozsïteï pu v rodineï Hodnocene parametry: 1. Vy skyt nezalozï enyâ ch a nadpocï etnyâ ch zubuê v hornõâ a dolnõâ cï elisti u pacientuê s rozsïteï pem a u jejich sourozencuê, prove that both environment and genetics contribute to the incidence of orofacial clefts. They are congenital anomalies and there are multiple factors coming into play. Knowledge of as many risk factors in healthy relatives as possible helps significantly in prediction of potential incidence of the congenital defect in offspring, and thus helps the future parents to adopt specific preventive measures. Problems of predisposition symptoms of clefts have not been examined in detail yet, however, a lot of authors consider the following: atypical shape of an upper lateral incisor [1, 2, 3], supernumerary upper incisors [2], incisors aplasia [4, 7], rotation and crowding of upper anterior teeth [4], impacted maxillary canines [5], groove and fistulas in the upper lip [6, 3], defects of musculus orbicularis oris [10], narrowed upper dental arch [2], gothic palate [2, 3, 8], hypoplasia of the premaxilla [3], submucous cleft [3], velopharyngeal incompetency [3], uvula bifida [1, 3], nose deformities [3], assymmetry of nostrils [2], atypical craniofacial dimensions [9]. The nomenclature is not unambiguous either. In the literature we can find terms like microforms, microsymptoms, minimal manifestations, minority forms, or stigmatas. Material The sample comprised 50 families, and the total number of 200 patients were examined, 50 patients with orofacial cleft, 50 patients' full siblings treated in the department of orthodontics of the cleft centre of the Faculty Hospital Kra lovskeâ Vinohrady in Prague, 50 patients' parents; the control group involved 50 parents of children without cleft. The group of patients with cleft included 20 girls and 30 boys, the age between 7 and 22 years. The group of full siblings included 29 girls and 21 boys, the age between 8 and 22 years. The group of parents of children with cleft included 30 mothers and 20 fathers, the age between 26 and 53 years. The control group of parents of children without cleft included 30 mothers and 20 fathers, the age between 26 and 55 years. The criteria were the following: 1. Orofacial cleft of the so-called typical clefts. 2. The cleft is not a part of a syndrome anomaly. 3. A patient's sibling is treated in the same department. 4. In both siblings study models, photographs and OPGs were made. 5. In both siblings at least 1st stage of dentition change was finished. 6. Both siblings are accompanied by at least one parent who is willing to undergo an examination. 7. In the control group the parents' history excluded incidence of cleft in family. 201

20 rocïnõâk21 2. PomeÏ r meziodistaâ lnõâ sï õârïky hornõâch lateraâ lnõâch a strïednõâch rïezaâkuê u sourozencuê pacientuê s rozsïteï pem, 3. RozdõÂl pomeï ru meziodistaâ lnõâ sï õârïky hornõâch lateraâ l- nõâch a strïednõâch rïezaâkuê mezipravou a levou stranou u sourozencuê pacientuê s rozsïteï pem, 4. pomeïrdeâ lky a sïõârïky praveâ a leveâ nosnõâ dõârky u skupiny rodicïuê deï tõâ s rozsïteï pem a rodicïuê deï tõâ bez rozsïteï pu. Metodika VyÂskyt hypodoncie nebo hyperodoncie byl hodnocen na rentgenovyâ ch OPG snõâmcõâch, saâ drovyâ ch modelech chrupu a z dalsï õâ zdravotnõâ dokumentace pacienta. Meziodista lnõâ sï õârïka hornõâho lateraâ lnõâho rïezaâku vuêcï i meziodistaâ lnõâ sïõârïce hornõâho strïednõâho rïezaâ ku byla meï rïena na saâ drovyâ ch modelech chrupu posuvnyâ m meï rïõâtkem v milimetrech. SÏ õârïka a deâ lka nosnõâch vchoduê byla meï rïena na fotografiõâch v pocï õâtacï oveâ ho programu GIMP2 (obr.1). Pro jednotliveâ nosnõâ vchody byl pomeïrem jejich vyâsï ky a sï õârïky vypocï õâtaâ n tzv. ªNostril indexª [11]. De lka byla urcï ena spojenõâm nejkraniaâ lneï jsï õâho a nejkaudaâ lneï jsï õâho vrcholu nosnõâ dõârky. U secï ka, kolmaâ na tuto dlouhou osu, spojujõâcõâ nejvzdaâ leneï jsï õâ body vlevo a vpravo udaâvaâ sïõârïkovyâ rozmeï r nosnõâ dõârky. RozdõÂlem mezi Nostril indexy praveâ a leveâ nosnõâ dõârky byla zõâskaâ na odchylka od symetrie. Pokud by obeï dõârky byly symetrickeâ,vyâsledek vyâpocï tu by se rovnal 0. CÏ õâm võâce byl vyâsledek vzdaâ len od 0, tõâm veïtsï õâ byla iasymetrie. Vy sledky U jedincuê ze skupiny pacientuê s rozsïteï pem se vyskytoval nadpocï etnyâ zub u 14 % jedincuê, nezalozï enyâ zub u 46 % jedincuê. Jednotlive chybeï jõâcõâ zuby znaâ zornï uje obr. 2. NejcÏ asteï jichybeï jõâcõâ zub byl levyâ hornõâ lateraâ lnõâ rïezaâ k,daâ le pravyâ hornõâ lateraâ lnõâ rïezaâ k a dolnõâ levyâ druhyâ premolaâ r. NadpocÏ etneâ zuby byly ve 100 % hornõâ lateraâ lnõâ rïezaâ ky, cï asteï jilevyâ rïezaâ k. Ve skupineï souro- The registered parameters: 1. The incidence of tooth aplasia and supernumerary teeth in the upper and lower jaw in patients with cleft and in their siblings. 2. Proportion of mesiodistal width of upper lateral and central incisors in patients' siblings. 3. The difference in the proportion of mesiodistal width of upper lateral and central incisors on the right and on the left side in patients' siblings. 4. The proportion of length and width of the right and the left nostrils in the group of parents of children with cleft, and in the group of parents of healthy children. Method The incidence of hypodontia or hyperodontia was assessed in OPGs, models of dentition, and using other patient's records. The proportion of mesiodistal width of the upper lateral and central incisors was measured in plaster models of dentition with a sliding gauge in millimetres. The width and length of nostrils was measured in photographs with the software GIMP2 (Fig.1). For individual nostrils the so-called nostril index was calculated [11]. The length was set as the connecting line between the extreme cranial and the extreme caudal end of a nostril. The connecting line perpendicular to this long axis, and connecting the most distant points on the left and on the right, gives the width of a nostril. The deviation from symmetry was calculated as the difference between nostril indexes of the right and the left nostril. In case both nostrils were symmetrical, the result would be 0. The more the result deviated from 0, the greater was the assymmetry. Results In the group of cleft patients the supernumerary tooth was present in 14%, agenesis was in 46%. Individual teeth with agenesis are shown in Figure 2. The most frequently missing tooth was upper left lateral incisor, followed by upper right lateral incisor, and lower Agenesis according to missing tooth Number of affected individuals Missing tooth Obr. 1. MeÏ rïenõâ nosnõâch vchoduê na digitaâ lnõâ fotografii pomocõâ software GIMP2 Fig. 1. Measurement of nostril dimension on digital photograph using PC software GIMP2 Obr. 2. Frekvence ageneze jednotlivyâch zubuê u pacientuê s rozsï teïpem Fig. 2. Frequency of agenesis according to missing tooth in cleft patients group 202

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