ROČNÍK (Volume): 24 ROK (Year): 2015 ČÍSLO (Number): 4

Transcription

1 ROČNÍK (Volume): 24 ROK (Year): 2015 ČÍSLO (Number): 4

2 ORTODONCIE rocïnõâk24 kterou se rozhodneme pouzïõât.maâ me k dispozici vsï e potrïebneâ. NemozÏne na pocïkaânõâ,zaâ zraky do trïõâ dnuê.zï e takoveâhozaâ zraku ortodontisteâ dosaâ hnou, neveï rïil v dobeï porïadnõâkuê nikdo. UzavrÏel jsem saâ zku o bednu sï ampanï skeâ ho, zïe dokaâ zïu na stupenï okres dostat fixnõâ aparaâ ty. Sa zku jsem vyhraâ l a sï ampanï skeâ nedostal. Takova to byla veselaâ doba. Ale to vsï echno se nestalo samo sebou ani ze dne na den. Za tõâm zaâ zrakem je dvacet peï t let drïiny kolegynï a koleguê ortodontistuê v tereâ nu. RÏ õâ kaâ m jim ¹Stara cõâsarïskaâ gardaª. Ma m je moc raâ d!!! ZpeÏ t k jedenaâ cti duê voduê m. Tak co s tõâm? Co poradit, jak odpovõâdat na jedenaâctduê voduê k sebevrazïdeï. Je to prïece tak snadneâ. Parazity ignorovat, nad pozlaâ tky se usmõâvat, na sprostotu odpovõâdat slusï nostõâ, nebyâ t sluhou mocnyâ ch, hloupost porazit chytrostõâ, neopustit pravdu, i kdyzï je ostatnõâm pro smõâch, a zlu se dõâvat prïõâmodoocïõâ. SnadneÂ?VuÊ bec to nenõâ snadneâ. Ani trochu to nenõâ snadneâ.a? Ano, bude huêrï. William Shakespeare ve sveâ m dõâle popsal vsï echny odstõâny zïivota a Martin Hilsky vsï echny tyto odstõâny prïelozïil. Oba je tedy znajõâ. Lidske poselstvõâ prof. Martina Hilske ho, letosï nõâho nositele oceneïnõâcï eskaâ hlava, je toto: ¹K võâteï zstvõâ zla stacï õâ, aby slusï nõâ lideâ nedeï lali nic.ª A na dobrou noc versï Jana Ska cela... Do strïõâbra jsem Ti vyryl, sine amore nihil... bez laâ sky nenõâ nic... Ale abych nebyl za naivku. VõÂm dobrïe, zïe je dost indiciõâ, ktereâ podporujõâ naâ zor Karla Kryla, zïe ¹demokracie rozkveâtaâ, lecï s kosmetickou vadou, ti co kradli po leâ ta, daâ l nepokryteï kradouª.azïe s tou opravdovou svobodou to nenõâ tak horkeâ.zï enaâm ¹jenom vymeï nili postrojeª.prïesneïjisetorïõâci nedaâ.a¹blbstvõâ zõâvajõâcõâ naâmveâcï ka z prstuê vzaloª. Smutek v dusï i, Karle Kryle. A takeâ nechci vytvorïit dojem, zïe chudoba je zaâ sluha o mravnost. NenõÂ. Je lepsïõâbyâ t zdravyâ a bohatyâ nezï nemocnyâ a chudyâ. Ale neï co mezi Nebem a Zemõ prïece jenom JE. NeÏ co, ¹co nelze rozïniti s cibulõâ a zhltnoutiª, jak pravõâ MUDr. Vladislav VancÏ ura, uzï oneï m byla rïecï. Je to Tajemno a La ska. Sine amore nihil. AzÏ budete mõât vsï echno, na co jste si kdy pomysleli, a vy to mõât budete, pomyslõâte si, zïe v tom, neï co mõât, vlastnit, sïteï stõâ neveïzõâ.daâ vejte si pozor na to, co si prïejete, mohlo by se Va m to splnit. SÏ teï stõâ je vedlejsï õâ produkt, neï co jako koks (Huxley). Ale je to jako s horkyâ mi kamny. KazÏdy si musõâ saâ hnout saâ m, jinak neuveïrïõâ. Ja uzïsisaâ hl. Novinka to vsï ak nenõâ. Vy stava myâch fotografiõâ v sõâdle CÏ SK byla uvedena Viollnovou Baladou. Tak asponï kousek. ¹Ja u pramene jsem a zïõâznõâ hynu, horkyâ jak ohenï zuby drkotaâm... MneÏ leâ kem je, co jineâ poranõâ, mneï prïi zaâ baveï oddech nenõâ prïaâ n... jaâ sõâlu maâmazïaâ dnyâ prospeï ch z nõâ... A tu FrantisÏ ek napsal v roce 1458 svou znalost vdeïcïõâmnaâ hlyâmnaâ hodaâm, vsï e vyhraâ vaje cïõâmdaâ l smolneï j hraâm... MaÂmvsÏ e, co chci, nic na cï em srdce lpõâ, srdecï neï prïijat, kazïdyâ m odmõâtaân... Ale naâsïzaâ zracïnyâ,baâ jecïnyâ a kouzelnyâ sveï t je mozïneâ videï t i prizmatem HoraÂcÏ kova põâsnï oveâ ho textu: ¹SÏ teï stõâ je kraâ snaâ veïc, ale prachy si za neï nekoupõâsï...ª. Je to otaâ zka naâ zoru. Autor vigilie se klonõâ k meâneï pragmatickeâ mu pohledu Plato novu. JesÏteÏ,zÏe vypaâ lili tu irskou whiskey. Dr. Karel Floryk staryâ sï edyâ vlk Akela z Domu U rovneâ ho zubu versï e: William Shakespeare, Karel Kryl, Jan Ska cel, Francois Villon P.S. Poprve võâm,ocï em budu psaâtprïõâsïteï. Bude-li mi daâ no. Vigilie se bude jmenovat ¹Mala nocï nõâ vigilie o cï loveï ku, aneb Ecce homo, Carolus Quartus, Rex Bohemorumª. UzÏ seteïsïõâm.vaâsïsuâ ctou Akela. [email protected] 227

3 rocïnõâk24 ORTODONCIE Cha pu, zï e tyto zaâ zïitky, poznatky a mysï lenkoveâ i skutecï neâ toulky nechybõâ cï lenkaâ macï lenuê mneï kdejsï õâch poulicï nõâch vyâ boruê. Ale jsem velmi raâd, zïe dnes jizï nechybõâ ani mneï. Nepoukazuji na to, kde vsï ude mi bylo byâ t, ale na to, co vsï echno naâ m bylo ostnatyâ mi draâ ty totalitnõâho rezïimu odpõâraâ no. A v teâ VõÂdni jsem uzï takeâ byl, na vyâ staveï obrazuê Gustava Klimta. Kra sa nesmõârnaâ. A kam smeïrïuje dnesï nõâ vigilie? Tedy co je mezi jedenaâ cti duêvody k sebevrazïdeï a suspektnõâm sï estyâ m smrtelnyâ m hrïõâchem? Zda sevaâm,zïe ¹sprostota se saâ pe na slusï nost, zïe umeï nõâ je porïaâ d sluzïkou mocnyâ ch, zïe trapneï zaârïõâ pozlaâ tko vsï ech poct, zïe hloupost zpupneï chytryâ m poroucï õâ, zïe prostaâ pravda je vsï em prosteï pro smõâch a zlo se dobru chechtaâ do ocï õâª? Nezda se Va m to, moji milõâ cï tenaâ rïoveâ, nezdaâ. Je to tak. PrÏesneÏ tak a nejinak. VsÏimneÏ te si, jak dokonale ta slova 400 let mrtveâhobaâ snõâka sedõâ dnes! Ke kazïdeâmu versï isevaâ m vybavõâ i tvaâ rï neï koho ze soucï asnõâkuê.aprïesto! Nebo praâ veï proto! VzÏdycky staveï jme proti jedenaâ cti duê voduê m ten jeden, WilliamuÊv. La sku. I rovnaâ tka se dajõâ deï lat s laâ skou. Jen je trïeba milovat pacienty a ne bankovnõâ konta. I kdyzï je nebezpecï õâ smrtelnyâchhrïõâ- chuê pouze suspektnõâ, cï tenaâ rïi sporïitelnõâch knõâzïek k nim nakonec vzï dycky sklouznou, k tomu sï esteâ mu spolehliveï. A obzïerstvõâ nenõâ jen sobeckaâ, rozezïranaâ mastnaâ huba a chlastot võâna bez polykaâ nõâ hltuê z obrazu Hieronyma Bosche. Obrazu, kteryâ visel v lozïnici sï paneï lskeâho kraâ le v El Eskorialu. KacõÂrÏsky obraz kacõârïskeâ ho malõârïe v lozïnici katolickeâ ho kraâ le. Setkali se malõârï, kteryâ meï l co rïõâci a chytryâ kraâ l.to se nestaâvaâcï asto. Objevil jsem skveïlyâ citaâ t. Hodõ se na dnesï nõâ stav nasï eho stavu. UzÏ nejsme na zïebracï enkaâchamuêzïeme si leccos dovolit. AvsÏ ak pozor! ¹DÏ aâ bel dnesï nõâch dnuê je daleko prohnaneïjsï õâ nezï drïõâve. Aby naâ s pokousï el, cï inõâ naâ s bohatyâ mi, ne chudyâ mi.ª Ma m pocit, zïeprïesneïjisemeâ dnesï nõâ pocity nedajõâ vyjaâdrïit. Doplnil jsem si vzdeïlaâ nõâ a vygoogloval autora citaâ tu. Je to anglickyâ baâ snõâk, satirik a esejista Alexander Pope. Cita t napsal neï kdy kolem roku Nema m, co bych dodal. Ale mozïnaâ se zeptaâ te, kdezïe je neï co pro ortodontistky a ortodontisty. No toto vsï echno!!! PrÏedcÏ asem jsme nemeï li nic. Tak to zas ne, meï li jsme holeâ ruce a holeâ zadnemeï li jsme mozïnost se vzdeïlaâ vat (tedy opravdu vzdeïlaâ vat), nemeï li jsme materiaâ l. NemeÏ li jsme podmõânky k praâ ci. JesÏteÏ v roce 1993 v normaâ lnõâ praâ ci ¹za kony braâ nily naâ mª. A zïe o tom neï co võâm. MeÏ l jsem põâsemnyâ doklad, ¹zÏe umõâm s fixyª põâsemnyâ praâ vnõâ zaâ kaz, ¹zÏe nesmõâm s materiaâ lem, kteryâ nenõâ majetkem OU NZ pracovatª. V majetku nebylo nic z fixuê, no a co, chod'te do praâ ce a drzïte drzï..., ale co to põâsï i, tomu prïece nikdo nemuêzïe veïrïit, jesïteï v roce 1993??? PrycÏ odtud, z OUÂ. My jsme neprivatizovali proto, abychom mohli podnikat, my museli podnikat, abychom mohli normaâ lneï pracovat!!! Tedy to hlavnõâ, co jsme nemeï li, byla svoboda. Svoboda rozhodovaâ nõâ. Ale pozor, nerozhodli jsme se jen cestovat po Americe. Sva Lambare ne jsme budovali doma. My naprïõâklad cï tyrïikraâ t zbrusu novaâ pracovisïteï ve dvou meï stech. Na zeleneâ louce. Podle toho, co vyzïadovala peâcï e o nasï e pacienty. S filosofiõâ sluzïby, nikoliv podnikaâ nõâ. Bylo to nasï e svobodneâ rozhodnutõâ. Nikdy, ani na vterïinu, jsem jej nelitoval. V prvnõâm cïlaâ nku o zrïizovaâ nõâ praxe jsem prïed dvaceti lety citoval irskou lidovou põâsenï. ¹UzÏ võâm,vcï em je ten kousek sï tõâstka, penõâze neï kdy nejsou nic, maâ võâc kdo po sveâmsi põâskaâ ª. PõÂskat si po sveâ m nenõâ samozrïejmost. Ja zazïil dobu, kdy to nesï lo. UzÏ bych to zazïõât nechteï l. ZatõÂm nemusõâm ve svyâch prïedchozõâch cïlaâ ncõâch meï nit ani põâsmenko. Ta k, koupili jsme si kraâ sneâ ordinace (veseleâ historky vynechaâ m, ale jsou vyâzïivneâ ). Ale co pacienti, k cï emu jim to bylo? Mladõ si nepamatujõâ. Bylo by to dobrïe, zïe si nepamatujõâ, kdyby to nebyl chybeïjõâcõâcïlaâ nek rïeteï zu poznatkuê. PorÏadnõÂky byly na vsï echno, od trabantuê azï po rovnaâ tka. TakzÏ e jsme sestavovali porïadnõâky. Na Silvestra jsme je na mejdanu hodili do odpadkoveâ ho kosï e a po Nove m roce zacï ali znova. Ne pracovat, psaâ t noveâ porïadnõâky. PeÏ t let jsem psal ponõâzïeneâ supliky se zïaâ dostmi oprïideï lenõâ deviz (to jsou normaâ lnõâ penõâze, ale my jsme meï li penõâze nenormaâ lnõâ, info pro mladeâ ) na materiaâ l fixnõâ ortodoncie. A pak jednou prïisï el balõâk. Na stupni kraj jej zpola vykradli. Ale zacïaâ tek to byl. Fix dorazil do tereâ nu na maleâ meï sto. HuraÂ. A dnes? KdyzÏ byli na naâvsïteïveï v nasï õâ praxi stomatologoveâ z Francie, konstatovali, zïe dobryâ, no a co, jako u naâ s, v ParÏõÂzÏi. NeuveÏ domili si, jak dlouho jsme meï li nesvobodu v rozhodovaâ nõâ. My ve VysÏ koveï to võâme velmi, velmi dobrïe. Dnes, v okamzïiku prvnõâho vysï etrïenõâ zacï õânaâ komplexnõâ diagnostika. SÏ picï kovaâ diagnostika. A terapie, kteraâ je potrïebnaâ, je zahaâ jena ihned, bez ohledu na techniku, [email protected]

4 ORTODONCIE rocïnõâk24 A pak najednou na hranicõâch nebyly ostnateâ draâ ty ani samopalnõâci s vycvicï enyâ mi psy. NepotrÏebovali jsme vyâ jezdnõâ dolozïky ani devizoveâ prïõâsliby. Ba ani doporucï enõâ poulicï nõâho vyâ boru. Pasy byly skutecïneï pasy a zacï aly se plnit razõâtky võâz zemõâ vsï ech kontinentuê. Novodobõ nevolnõâci odsouzenõâ k dozï ivotnõâmu nenavsï tõâvenõâ VõÂdneÏ najednou mohli leteï t do New Yorku, San Franciska, Rio de Janeira, nebo... kamkoliv. Pokud Va m to prïipadaâ samozrïejmeâ, koupit si letenku a leteï t si kamkoliv, tak nenõâ. NenõÂ, nenõâ to samozrïejmeâ!!! NENIÂ. DoprcÏ icuzïjednou!!! Jak rïõâkaâ klasik JirÏõ SuchyÂ. Zkra tka otevrïela se klec. Jako ilustraci uvedu extreâ my kraâsazaâzïitkuê naâ m dosud zakaâ zaneâ ho SveÏ ta, kam jsme nakoukli. VecÏerÏeli v cï õânskeâ restauraci dveï patra pod zemõâ v Chine Townu v New Yorku. A takeâ ve strïesï nõâ restauraci hotelu Mark Hopkins v San Francisku. Nad hlavami naâ m leteïl kondor v nadmorïskeâ vyâ sï ce 5000 metruê v uâ dolõâ Colca v Peru a fotografovali jsme kolibrïõâky ze vzdaâ lenosti 30 centimetruê ve volneâ prïõârodeï Karibiku. NavsÏ tõâvili jsme bohosluzï bu peruaâ nskyâ ch indiaâ nuê i jazzovou bohosluzïbu afroamericï anuê v babtistickeâ m kostele. Obojõ skveï leâ. Byli jsme v divadle na Broodwayi a sledovali streat akrobaty v Central parku. NahlõÂzÏeli jsme do DÏ aâ blova chrïtaâ nu na argentinskeâ straneï vodopaâ duê Iguasu na rïece Parana z BatlicÏ kovyâ ch klukovskyâ ch dobrodruzïnyâ ch knõâzïek. A slysï eli jsme na vlastnõâ usï i temnyâ hukot padajõâcõâch vod Niaga ry, o ktereâ zpõâvajõâ trampoveâ utaâ boraâkuê odedaâ vna. A to je tedy opravdu temnyâ hukot. ProjõÂzÏdeÏ li jsme Nevadskou pousïtõâuâ dolõâm smrti. A staâ li jsme na Mysu Dobre nadeï je. PrÏed smrtõâ je vzïdycky nadeï je. Bez nadeï je nenõâ nic. A takeâ u kaplicï ky, ve ktereâ se modlil Vasco da Gama prïed vyplutõâm na oceaâ n. Na oceaâ n, ne na morïe, v tom je velkyâ rozdõâl a duê vod k delsï õâ modlitbeï. Taky jsem poklekl u oltaâ rïe. A na druheâ straneï oceaâ nu pak na mõâsteï, kde prïirazily ke brïehu karavely Santa Maria, Pinta a NinÏ a Christofera Colomba. Kra cï eli jsme po prvnõâ kamenneâ evropskeâ cesteï v palaâ coveâ m komplexu Kno ssos na Kre teï. Tam, kde v podzemnõâm labyrintu, postaveneâ m Daidalem, otcem Ikarovy m, zï il MõÂnotaurus. NapuÊ l byâ k a napuêlcï loveï k. PraÂveÏprÏiuÂteÏ ku z Kre ty se Ikaros spaâ lil, kdyzï seprïiblõâzïil ke Slunci tak, zïe se vosk jeho krïõâdel roztavil. Na KreÂteÏ, kde v dobeï mõânojskeâ kultury muzïi zdobili zïeny zlatyâmisï perky s motivem vcï el. A takeâ po vrïeleâ mcï erneâ m põâsku plaâ zïõâ ostrova Santorini. Tam, kde se propadla let prï. Kr. Atlantida, baâ jnaâ zemeï dokonalosti. Plato nem popisovanaâ v roce 360 prï. Kr. v psanyâ ch dialozõâch Timaios a Kritias. ¹Domy zde staveï li z kamenuê cï ernyâ ch, bõâlyâchacï ervenyâ chª. A staveï jõâ je dodnes. PrÏicÏ etbeï Plato na na tomto mõâsteï lze cõâtit absolutnõâ magicï nost ostrova. MorÏe kolem je jineâ nezï jinaâ morïe. NeumõÂm to vysveï tlit, a kdybych to nezazïil, neuveïrïõâm. V noci se cï loveï k divõâ, zïe se na hladinu nevynorïõâ daâ vnõâ prïedkoveâ RÏ ekuê. Je pro mne fascinujõâcõâ, jak se hodõâ do dnesï nõâ vigilie Plato novo vysveï tlenõâ, procï tato civilizace zanikla. Tady je mõâsto pro vysveï tlivku druheâ poloviny jejõâho naâ zvu. Sedm smrtelnyâ chhrïõâchuê nenõâ sedm nejveï tsï õâch zlocï inuê ani soubor cï inuê prïedurcï enyâ ch k trestuê m smrti. Jsou to hrïõâchy vychaâ zejõâcõâ z lidskeâ hlavy (lat. caput), proto neï kdy nazyâ vaneâ capitaâ lnõâ. Tedy lidskeâ vlastnosti. Py cha, lakomstvõâ, zaâ vist, hneï v, smilstvo, sï estyâ je nestrïõâdmost, tedy obzïerstvõâ a lenost. Kra sneï je vytesal do kamene socharï Matya sï Bernard Braun na zaâ mku Kuks. Jsou to tedy lidskeâ vlastnosti. Jsou to hrïõâchy v lidskyâ ch hlavaâ ch. SÏ patneâ lidskeâ vlastnosti. KdyzÏ nabudou vrchu, znicï õâ i geniaâ lnõâ civilizaci. Katolickou tradicõâ jsou pojmenovaânynaprïelomu 5. a 6. stoletõâ po Kr. v dobeï RÏ ehorïe I. Velike ho. Tedy asi 1000 let po napsaâ nõâ spisuê Plato novyâ ch a cca let po zaâ niku Atlantidy. PlatoÂnpõÂsÏe: Atlant'ane byli poslusïnizaâ konuê, meï li smyâ sï lenõâ pravdiveâ a veskrze usï lechtileâ... pomõâjejõâce vsï e, mimo mravnõâ a teï lesnou dokonalost, maâ lo cenili vezdejsï õâ statky a lhostejneï nesli spoustu sveâ ho zlata a ostatnõâho majetku. Nebyli opojeni rozmarïilostõâ ani neupadali do chyb, kdyzï by pro bohatstvõâ ztraâ celi vlaâ du nad sebou samyâ mi, nyâ brzï byli strïõâzlivõâ a bystrïe pozorovali, zïe vsï echny tyto statky rostou ze spolecïneâhoprïaâ telstvõâ spojeneâ ho s dokonalostõâ, kdezïto shonem za teï mito veï cmi a jejich ceneï nõâm hynou tyto veï ci samy a prïaâ telstvõâ hyne spolu s nimi. Ale pak lidskaâ povaha nabyâ vala prïevahu, a kazili se. Ztratili nejvzaâ cneïjsï õâ duchovnõâ statky a plnili se nespravedlivou zisï tnostõâ a mocõâª. SÏ patneâ lidskeâ vlastnosti nabyly vrchu a znicï ily celou civilizaci. MozÏna neï kdo namõâtne, zïe to nenõâ konstatovaâ nõâ explicitneï veï deckeâ. NicmeÂneÏ bylo napsaâ no v roce 360 prï. Kr. a jeho autor je dnes povazïovaân za nejveïtsï õâho myslitele vsï ech dob. Zamyslet se nad vyâ rokem myslitele, je tedy, myslõâm, na mõâsteï. AzcÏ erneâ plaâzïe Plato novy Atlantidy do jihoamerickeâ ho Ria. Norma lneï nebeïhaâ m, necï inõâm dobrovolneï tak zbytecïnyâ ch pohybuê. Po rozzï haveneâ m põâsku plaâ zï e Copacabana jsem beï zïel, tak byl horkyâ. Pla zï e bytostneï nesnaâ sï õâm. Tyhle dveï jsem strpeï l. KamõÂnky z vody jsem vylovil na brïehu jezera Titicaca i v prïõâstavu ostrova Rhodos, odkud kdysi vyplulo deveï t galeâ r, aby se prïidaly k flotile ithackeâ ho kraâ le Odyssea. To kdyzï jeli RÏ ekoveâ dobyâ t Tro ju. A bohuzïel takeâ flotila JohanituÊ, kdyzï jej neubraâ nili proti OsmanuÊ m. Na ostroveï Kos jsme sedeï li a prïemyâ sï leli pod legendaâ rnõâm platanem, kde ucï il sveâ zïaâ ky Hippokrates. Platanovy list maâ m jesï teï schovanyâ. A navsï tõâvili jeho nemocnici. A takeâ uâ zïasnou nemocnici na Rhodu. Nemocnici zrïõâzenou a provozovanou rytõârïi Suvere nnõâho rytõârïskeâ ho vojenskeâ ho a hospitaâ lnõâho rïaâ du svateâ ho Jana KrÏtitele v JeruzaleÂmeÏ, na Rhodu a na MalteÏ. JohaniteÂ, kterïõâmeï li jednu z prvnõâch komend na nasïemuâ zemõâ nedaleko VysÏ kova. Na Malte zskeâmnaâmeï stõâ v Praze majõâ staâ le sveâ VelkoprÏevorstvõÂ. Tito rytõârïi jsou jedinõâ, kterïõâ o sobeï mohou rïõâci ono slavneâ ¹Sta t jsme my.ª Majõ staâ t, majõâ vlajku, majõâ vlastnõâ meï nu, nejen penõâze, meï nu. Majõ zastoupenõâ v OSN, diplomatickyâ sbor a velvyslanectvõâ v kazï deâ duê lezï iteâ zemi. Ale nemajõâ vlastnõâ uâ zemõâ. Sta t jsou tedy opravdu jen ti rytõârïi,tizïivõâ muzïiskrïõâzïi na plaâsï tõâch. A na MalteÏ pak nelze opomenout citaâ t Sira Whinstona Churchilla o pilotech RAF. ¹Nikdy v deï jinaâ ch nevdeïcï ili tak mnozõâ, za tak mnoho, tak maleâ skupineï lidõâª. MyslõÂm, zïe praâveï na MalteÏ to bylo podobneâ v 16. stoletõâ. RÏ aâ doveï stovky rïaâ dovyâ ch rytõârïuê (700 muzïuê, po jejich boku bojovaly i zïeny, deï ti a starci) dokaâ zaly odrazit obrovskou, invazi flotily 140 bojovyâ ch galeâ r Sulejmana I. Na dherneâ ho se dokonale vycvicï enyâ mi vaâ lecï nõâky Osmanske rïõâsï e. Byli to janicïaârïi, zvlaâsït'krutõâ bojovnõâci, puê vodem veïtsï inou balkaânsï tõâ SlovaneÂ. Jak znaâ mo, poturcï enec horsï õâ Turka. ZajatcuÊm urïezali hlavy, stejneï jako dnes neturek John, a teï la prïibitaâ na krïõâzï e hodili do morïe, aby je proud donesl do prïõâstavu. Velmistrem rïaâ du byl tehdy Jean Parisot de la Vallette. Tento muzï odpoveïdeï l stejnou mincõâ, ani nechteï jte veïdeï t jak. A v dvaasedmdesaâti (72)letech osobneï vedl s mecï em v ruce sveâ rytõârïe do vyâ paduê proti OsmanuÊ m. NejlepsÏ õâ motivacõâ je vlastnõâ prïõâklad. Byl dobryâ m prïõâkladem. Doka zal tak zachovat Evropu krïest'anskou. Rhodos braâ nilo 7500 rytõârïuê a geniaâ lnõâ pevnost dokaâ zali braâ nili proti prïesile muzïuê sï est meï sõâcuê. Rhodos neubraâ nili, Maltu ano. Evropsky mi panovnõâky byli Johanite bohateï odmeï neï ni. Tehdy. VõÂme, zïe podobenstvõâ s dnesï kem je mnohem võâc. A teskno je naâmzveïdeïnõâ. [email protected] 225

5 rocïnõâk24 ORTODONCIE Mala nocïnõâ vigilie o Va nocõâch 2015 aneb mezi jedenaâ cti duê vody k sebevrazïdeï a suspektnõâm sï estyâ m smrtelnyâmhrïõâchem jak se kraâtõâmuêjcï as, tak se prodluzïujõâ meâ vigilie, takeâ slov prïibyâ valo beï hem psanõâ, prvnõâ verze byla hotova jizï daâ vno... k adventnõâmu cï asu duchovnõâho zklidneï nõâ patrïõâ i zamysï lenõâ nad minulyâ m a naâ sledujõâcõâm rokem. PrÏõÂsÏ tõâ rok skyâ taâ mnohaâ velmi uâzïasnaâ vyâ rocï õâ, kteraâ laâ kajõâ k snadnyâ m a jasneï pozitivnõâm uâ vahaâ m. NejskveÏ lejsï õâ literaâ t William Shakespeare a pro naâ s nejvyâ znamneï jsï õâ panovnõâk, Karel IV., majõâ svaâ, takrïõâkajõâc nadcï asovaâ a nadnaâ rodnõâ vyâ rocï õâ. 700 a 400 let. Narozenõ a smrt, obojõâ patrïõâ do zïivota. ProcÏ nenapsat vigilii na snadneâ a skveïleâteâ ma??? A nevnõâmat dnesï ek, reaâ lnyâ dnesï ek. A byâ t populaâ rnõâ na vsï e strany. SklõÂzet ovoce stromuê zasazenyâ ch geniaâ lnõâmi prïedky. Na cï inech Karlovy ch se budou prïizïivovat uâ plneï vsï ichni. ZvlaÂsÏteÏ politici, kterïõâoneï m do vcï erejsïkaveïdeï li velkyâ kulovyâ. V lesku koruny cï eskeâ ho kraâle si ti z nejbystrïejsï õâch porïõâdõâ i selfõâcï ka. Ale zamyslet se nad tõâm, co sklõâzõâme z vlastnõâ setby, nenõâ na sï kodu. Realita soucï asnosti meï nutõâ k ne zcela prïõâjemneâ mu pozastavenõâ a ohleâ dnutõâ, nejen o jeden rok. TakzÏe praâ veï proto. PraÂveÏ proto, nenõâ-lizï pravda!!! Dnes poprveâ budou vigilii provaâ zet vysveï tlivky, delsï õâ odbocï ky a budou to samaâ podobenstvõâ. Vra tõâm se azï do doby normalizace. Doby, kdy jsme byli odsouzeni k dozï ivotnõâmu nevycestovaâ nõâ do zaâ padnõâ ciziny. S hruê zou jsem zjistil, zï e ani ti mladõâ, kterïõâ by i z vlastnõâ zkusï enosti seznati mohli, neveï dõâ, jakaâ doba to byla. Chra neï ni peâ cï õâ svyâ ch rodin nijak dramaticky netrpeï li. Mne ochraâ nili mõâ rodicï e (ti jesï teï zvuê li obou totalitnõâch rezïimuê zazï ili na vlastnõâ kuêzïi) a my pak nasïedeï ti, v jizï mnohem meâneï agresivnõâm prostrïedõâ. A to je dobreâ si uveï domit. Ja a mõâ vrstevnõâci (i kdyzï jaâ se cõâtõâm neï kde mezi trilobity a hneïdyâ m uhlõâm) a mladsï õâ nezazïili vaâ lku, hladomor, nebyli veï zneï ni v koncentracï nõâch taâ borech ani vystaveni organisovaneâmunaâ silõâ dvou zlocï innyâ ch ideologiõâ minuleâ ho stoletõâ. NasÏera ny jsou tedy pohrïõâchu necï etneâ a nehlubokeâ. Ale je trïeba znaâ t historii. Jak znaâ mo, kdo ji neznaâ, bude ji muset znova prozïõât. Egypt'an Sinuhet rïõâkaâ,zïe co se stalo, stane se znova. JisteÏ zïe jsem nezapomneï l na komunistickou okupaci v roce 1968, kdy ¹Pod nasï ima oâ knyª rachotily tanky s rudyâ mi hveï zdami na veïzïõâch a ostrïe nabityâ mi kanoâ ny. Do oken mõârïily kalasï nikovy. Sranda na bodeï nula!!! A takeâ zaâ sadneï nesdõâlõâm naâ zor, zïe ¹ za nacistickeâ okupace beï hem 2. sveï toveâ vaâ lky se naâ m zase tak moc nedeï loª. Takovy pohled na vaâ lku je pozoruhodnyâ zuâst JUDr. Va lkoveâ, ministryneï SPRAVEDLNOSTI CÏ eskeâ republiky. Lidice, LezÏa ky, heydrichiaâ da. V deï tstvõâ ji podle jejõâch vlastnõâch slov ucï ili, zïe nejlepsï õâ umeï nõâ je neï meckeâ. TakzÏe stacïõârïõâci Josef CÏ apek a Vladislav VancÏ ura, zïe.vzïdycky, kdyzï beru do ruky vydaânõâ RozmarneÂhole ta s ilustracemi Josefa CÏ apka, a to je velmi cï asto, si na neï vzpomenu. A takeâ na jejich vrahy, na nadlidi. MinistryneÏ spravedlnosti. Chucpe. No ANO, bude lõâp. UznaÂva m tedy, zïe nesnaâ z mojõâ generace nebyla jizï tak krutaâ. SpõÂsÏ e neuveïrïitelnaâ a absurdnõâ. IlustracÏ nõâ historka. Autobus odboraâ rïuê jede na dva dny do bratrskeâ Mad'arske lidoveâ republiky. A dospeï lõâ lideâ, leâ karïi a zdravotnõâ sestry NESMEÏ LI mõât penõâze!!! Lega lneï vydeï laneâ a zdaneï neâ.v raâ mci oficiaâ lnõâ zïebracï enky, odborneï nazyâ vaneâ mzda. Byli jsme na hranicõâch sï acovaâ ni jak pasï eraâ ci drog, vsï ichni ven z autobusu. NeÏ ktereâ odvedli celnõâci se samopalem na rameni do budovy celnice a zda tam prohlõâzïeli i teï lnõâ otvory nevõâm. Skla dacõâ desï tnõâky otevõârali a prohledaâ vali, to võâm naprosto jisteï. Ja jsem vyvaâ zl s bankovkou v boteï. Jel jsem si totizï pro LP (vinylovou dlouhohrajõâcõâ desku, to je informace pro ty mladeâ ) Leonarda Cohena. NesmeÏ li jsme mõât penõâze a nesmeï li jsme si koupit hudebnõâ nosicï. NevõÂm, co tehdy vadilo. ZÏ e je Cohen Kanad'an, zïe zpõâvaâ anglicky, nebo zïe je puê vodem Hebrejec? Asi byla cõâlem jen mozïnost ponõâzïit ty druheâ. Ale jaâ jsem nebyl zïaâ dnyâ pasï eraâ ckyâ amateâ r. KromeÏ bankovky jsem meï l prïipravenou i samolepku s nõâzkou cenou, abych mohl sveâ ho celnõâka veï rohodneï oklamat falesïnou cenovkou na obalu desky. Bylo by to k smõâchu, kdyby to nebylo k plaâ cï i. UveÏ domte si, vy mladõâ, zï e toto nenõâ verbaâ lnõâ zï e- rtovaâ nõâ. Je to holaâ skutecï nost. Tuto neuveï rïitelnou dobu v podobenstvõâ ilustruji ¹jedena cti duê vody k sebevrazïdeï ª, jak rïõâkaâ pan prof. Martin HilskyÂ. Znaven tõâm vsïõâm,jaâ chci jen smrt a klid, jen nevideï t, jak zï ebraâ poctivec, jak pyâ chou dme se pouhyâ parazit jak pokrïivõâ se kazïdaâcï istaâ veï c, jak trapneï zaârïõâ pozlaâ tko vsï ech poct, jak dõâvcï õâ cudnost brutaâ lneï rve chtõâcï, jak sprostota se saâ pe na slusï nost, jak blbost na schopneâ si bere bicï, jak umeï nõâ je porïaâ d sluzï kou mocnyâ ch, jak hloupost zpupneï chytryâ m poroucïõâ, jak prostaâ pravda je vsï em prosteï pro smõâch, jak zlo se dobru chechtaâ doocïõâ. Znaven tõâm vsïõâm,jaâ umrïel bych tak raâd, jen nemuset tu tebe zanechat. Je to 66 sonet Williama Shakespeara, kteryâ naâ m pomaâ hal prïezï õât diktaâ t blbstvõâ. A k zamõâtnutõâ sebevrazïdy stacï il Williamovi jeden duê vod, procï zuê stat. La ska. A nebyâ t letosï nõâho prezidentskeâ ho staâ tnõâho vyznamenaâ nõâ LudvõÂka Karla, asi bychom mnozõâ ani neveïdeï li, zïe jsme meï li docela sïteï stõâ. Nejen v sedmdesaâtyâ ch letech, ale i osmdesaâtyâ ch, kdy ve veï zenõâ ubili Pavla Wonku a kdy byli jesïteï lideâ v otrockyâch veï znicõâch, nejdrïõâve rïõâzenyâ ch a po privatizaci vlastneïnyâ ch. Ha dejte kyâ m, no tõâm, dnes vyznamenanyâ m. KromeÏ neuveïrïitelneâho blbstvõâ, staâ le stejnaâ arogantnõâ krutost [email protected]

6 rocïnõâk24 Informace ORTODONCIE PrÏehled chystanyâch domaâ cõâch akcõâ Datum Na zev Informace 22.± Praha 1.± Vysoke Tatry 26.± Brno Praha 7.± Bratislava 6.± KosÏ ice Stomatochirurgicky seminaârï Kongres Slovenske ortodontickeâ spolecï nosti 2016 InDent ± Mezina rodnõâ dentaâ lnõâ veletrh akonference Vincent O. Kokich, Jr., DMD, MSD MUDr. Ivo Marek, Ph.D. ¹Esteticke rïesï enõâ ageneze a ztraâ ty zubu uâ razemª Kongres Slovenske ortodontickeâ spolecï nosti 2017 Kongres Slovenske ortodontickeâ spolecï nosti 2018 Inf.: CÏ SCHS, Slavojova 22, Praha 2, Zuzana Hroma dkovaâ Tel.: [email protected] Inf.: Inf.: Veletrhy Brno, LenkaBednaÂrÏova Tel.: [email protected] Inf.: CÏ eskaâ akademie dentaâ lnõâ estetiky o.s., Ivana BartuÊnÏ kovaâ Tel.: [email protected] Inf.: Inf.: Do nasï eho tyâmu hledaâ me ortodontistku nacïaâ stecïnyâuâ vazek. Jsme zubnõâ klinikanapraze 3, ZÏ izïkov, moderneï zarïõâzena. Mlady aprïõâjemnyâ kolektiv, ale chybõâ naâ m ortodontista. VprÏõÂpadeÏ VasÏ eho zaâ jmu zasõâlejte zïivotopisy na [email protected]. CÏ lenskyâ poplatek pro rok 2016 cï inõâ 2500,- KcÏ nebo 100,- 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 1000,- KcÏ za rok nebo 50,- 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 [email protected]

7 ORTODONCIE Informace rocïnõâk24 Datum 22.± Palm Springs, California, USA 11.± Cairo, Egypt 19.± Melbourne, Australia 7.± Miami, Florida, USA 11.± Rome, Italy 1.± SÏ trbskeâ Pleso, Slovensko 16.± Athens, Greece ± Orlando, Florida, USA 11.± Stockholm, Sweden ± Athens, Greece 24.± Santiago de Chile 1.± Nusa Dua, Bali, Indonesia 14.± Hannover, Deutschland 15.± Charlottetown, Canada 22.± Olsztyn, Polska 7.± Bratislava, Slovensko 21.± San Diego, CA, USA 6.± Montreaux, Switzerland 6.± KosÏ ice, Slovensko 17.± Edinburgh, UK 12.± Nice, France PrÏehled chystanyâch zahranicï nõâch akcõâ Na zev (jednacõâ jazyk jinyâ nezï angl.) Winter Conference of the American Association of Orthodontics International Congress of the Egyptian Orthodontic Society (joint Meeting with the Greek Orthodontic Society) 25th Australian Orthodontic Congress Asociacion Mexicana de Ortodoncia XLIX Annual Congress Spring Meeting of Italian Society or Orthodontics Kongres Slovenskej Ortodontickej SpolocÏ nosti th International Symposium of the Greek Orthodontic Society (joint Meeting wit the Egyptian Ortodontic Society) 116th Congress of the American Association of Orthodontists 92nd Congress of the European Orthodontic Society 12th Congress of the European Society of Lingual Orthodontics XVI International Congress of Orthodontics 10th Asian Pacific Orthodontic Conference 89. Wissenschaftliche Jahrestagung der DGKFO Canadian Asociation of Orthodontics Annual Session 19. Zjazd Poskiego Towarzystwa Ortodontycznego Kongres Slovenskej Ortodontickej SpolocÏ nosti th Congress of the American Association of Orthodontists 93rd Congress of the European Orthodontic Society Kongres Slovenskej Ortodontickej SpolocÏ nosti th Congress of the European Orthodontic Society 95th Congress of the European Orthodontic Society Informace Website: Website: Website: Website: Website: Website: Website: American Association of Orthodontists. 401 North Lindbergh Boulevard, ST.LOUIS, MO, USA Website: Website: MCI, PO Box 6911, SE Stockholm, Sweden Website: Tel.: Website: Website: Website: Website: Website: Website: American Association of Orthodontists. 401 North Lindbergh Boulevard, ST.LOUIS, MO, USA Website: Professor Christos Katsaros Website: Dr. Dirk Bister Professor Olivier Sorel

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9 U cï innost leâ cï by fixnõâm ortodontickyâ m aparaâ tem s pouzï itõâm FORSUS u pacientuê s malokluzõâ II. trïõâdy Effectiveness of comprehensive fixed appliance treatment used withthe Forsus Fatigue Resistant Device in Class II patients Franchi L., Alvetro L., Giuntini V., Masucci C., Defraia E., Baccetti T. Angle Orthod Jul; 81(4): CõÂl praâ ce: Zhodnotit dentaâ lnõâ askeletaâ lnõâ zmeï ny areakci meï kkyâ ch tkaâ nõâ u pacientuê s distookluzõâ leâ cï e- nyâ ch fixnõâm ortodontickyâ m aparaâ tem kombinovanyâ m s FORSUS aparaâ tem Materia l a metodika: 32 pacientuê s distookluzõâ (pruêmeï rnyâ veï k 12,7 ± 1,2 roku) leâcï enyâch pomocõâ terapeutickeâ ho protokolu, kteryâ zahrnuje nasazenõâ FORSUS aparaâ tu, bylo porovnaâ vaâ no s kontrolnõâm vzorkem 27 pacientuê s distookluzõâ (pruêmeï rnyâ veï k 12,8 ± 1,3 roku), kterïõâ nepodstoupili zïaâ dnou terapii. BocÏ nõâ kefalometrickeâ snõâmky byly porïõâzeny prïed zahaâ jenõâm terapie apo jejõâm ukoncï enõâ. PruÊ meï rnaâ dobaceleâ leâcï by byla 2,4 ± 0,4 roku. Vy sledky byli statisticky zpracovaâ ny StudentovyÂm t-testem (P <.05) Vy sledky: MõÂrau speï sï nosti leâcï by byla87,5%. Skupinale cï enaâ terapeutickyâ m protokolem s FORSUS aparaâ tem vykazovala signifikantnõâ zmensï enõâ prognaâ tnõâ pozice maxily (nejen kostnõâch struktur, ale i meï kkyâch tkaâ nõâ), daâ le signifikantnõâ prïõâruê stek deâ lky mandibuly atakeâ signifikantnõâ zlepsï enõâ sagitaâ lnõâho vztahu bazõâ hornõâ adolnõâ cï elisti. U leâcï eneâ skupiny bylo daâ le prokaâzaâ no signifikantnõâ zvyâsï enõâ hloubky skusu apozitivnõâ posun ve vztahu molaâruê. Signifikantnõ byla takeâ protruze aintruze dolnõâch rïezaâkuê, zatõâmco u prvnõâch dolnõâch molaâ ruê dosï lo k mezializaci a vertikaâ lnõâmu pohybu. ZaÂveÏr: Le cï ebnyâ protokol s FORSUS aparaâ tem je uâ cï innyâ prïi leâ cï beï distookluze dõâky vlivu naskeletaâ lnõâ slozï ku anomaâ lie (prïedevsï õâm v hornõâ cï elisti) i nadentoalveolaâ rnõâ komplex (prïedevsï õâm v cï elisti dolnõâ). MDDr. Martin Linka

10 Hlavnõ prïednaâsï ejõâcõâ XVII. kongresucï OS CÏ asnaâ ortodontickaâ leâ cï ba s aparaâ tem lip bumper v kombinaci s naâ kusnou deskou Early treatment witha maxillary lip bumper-bite plateau combination. Marcel Korn, Brite Melsen Angle orthodontist, Vol 78, No 5, 2008 CõÂl praâ ce: Vyhodnotit zmeï nu postavenõâ hornõâch prvnõâch staâ lyâ ch molaâ ruê po leâ cï beï aparaâ tem typu lipbumper v kombinaci s naâ kusnou deskou. U vod: Le cï badistookluze zuê staâvaâ v centru zaâ jmu soucï asneâ ortodoncie a pro terapii bylo navrzï eno mnoho ruê znyâch postupuê a aparaâtuê. Apara t, jemuzï byla zatõâm veï novanaâ pouze omezenaâ pozornost, je maxilaâ rnõâ lip-bumper. Popisovany efekt puê sobenõâ lip-bumperu nahornõâ prvnõâ staâ leâ molaâ ry zahrnuje mõârnyâ distaâ lnõâ sklon aeliminaci nezïaâ doucõâho anteriornõâho pohybu teï chto zubuê. KromeÏ toho dochaâzõâprïi jeho pouzïitõâ k protruzi rïezaâkuê arozsï õârïenõâ zubnõâho oblouku. VesÏ kereâ tyto zmeï ny jsou zïaâ doucõâ prïi leâcïbeï steï snaâ nõâ ve smõâsï eneâm chrupu u pacientuê s tendencõâ k distookluzi. Dista lnõâ rotace molaâ ruê v kombinaci se snõâmatelnou naâ kusnou deskou zaâ rovenï dovolõâ posun aruê st dolnõâ cï elisti vprïed, cozï vduê sledku prïispõâvaâ ke korekci distookluze. Studie bylavypracovaâ napro zjisï teï nõâ uâ cï inku lipbumperu v kombinaci se snõâmacõâ naâ kusnou deskou. Materia l a metodika: NastudijnõÂch modelech 40 pacientuê (17 chapcuê, 23 dõâvek, veï k 9, 3-11, 5 roku) se smõâsï enyâ m chrupem zhotovenyâ ch prïed apo ortodontickeâ leâcïbeï uvedenou kombinacõâ aparaâtuê byly hodnoceny zmeï ny v postavenõâ prvnõâch staâ lyâ ch molaâ ruê trojdimenzionaâ lnõâ digitaâ lnõâm skenerem. PruÊ meï rnaâ deâ lkaterapie byla18 meïsõâcuê. PrÏi leâ cï beï byl pouzï it maxilaâ rnõâ prefabrikovanyâ flexibilnõâ lip-bumper zhotovenyâ z 1 mm silneâ ho nerezaveï jõâcõâho oceloveâ ho draâ tu. V hornõâm vestibulu jsou klicï ky odstaâ vajõâcõâ 1-3 mm od vestibulaâ rnõâho svahu alveolaâ r- nõâho vyâbeï zï ku, prïed kanylami krouzïkuê nasazenyâch na prvnõâ staâ leâ molaâ ry jsou bajonetoveâ ohyby klicï ky, ktereâ slouzï õâ jako stopky. Lip-bumper byl vzï dy individuaâ lneï prïizpuê soben vestibulu pacienta. SoucÏ asneï byla nasazenasnõâmacõâ naâ kusnaâ deska. BeÏ hem terapie byly postupneï indikovaâ ny extrakce docï asnyâch sï picï aâ kuê amolaâruê. Obr.: Typicky pacient z vysï etrïovaneâ ho souboru prïed leâ cï bou (A), s nasazenyâmi aparaâ ty (B) apo dokoncï enõâ terapie (C). Obra zek je publikovanyâ se souhlasem autora. Posun prvnõâch staâ lyâ ch molaâ ruê byl vyjaâ drïen translacõâ ve smeï ru meziodistaâ lnõâm abukolingvaâ lnõâm, rotacõâ kolem dlouheâ osy ameziodistaâ lnõâm sklonem zubu. DaÂle bylahodnocenazmeï nave vztahu prvnõâch hornõâch adolnõâch staâlyâch molaâruê. Vy sledky: ZmeÏ napostavenõâ molaâruê byladaânaprïevaâzïneï distaâ lnõâ rotacõâ (pruêmeï r 9,7 ; od 6,5 do 26 ) adistaâ lnõâm sklonem (v pruêmeïru 5 ; od -3,9 do 18 ). Dista lnõâ posun byl patrnyâ nejmeâneï (v pruêmeï ru 0,3 mm; smeï rodatnaâ odchylka1,6 mm), posun probeï hl spõâsïe v bukaâ lnõâm smeï ru (v pruêmeï ru 1,6 mm; smeï rodatnaâ odchylka1,5 mm). Vztah hornõâch adolnõâch prvnõâch staâlyâch molaâruê se zlepsïil ve vsï ech prïõâpadech u 36 ze 40 pacientuê aplneâ I.trÏõÂdy dle Angleabylo dosazï eno v 65 z 80 vysï etrïovanyâch polovin chrupu. ZaÂveÏr: CÏ asnaâ leâcï bamaxilaâ rnõâm lip-bumperem v kombinaci s naâ kusnou deskou maâ pozitivnõâ vliv navyâvoj spraâ vneâ okluze u deï tõâ s II. TrÏõÂdou dle AngleaasteÏsna nõâm. Tento postup lze doporucï it zejmeâ naz hlediska dobreâ ho pomeï ru mezi zaâteïzïõâ pacienta a efektem leâcï by. MUDr. W. UrbanovaÂ, MUDr. M. Kot'ova Ph.D.

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13 ORTODONCIE rocïnõâk24 Literatura/References 1. KamõÂnek, M.: Ortodoncie. 1. vydaâ nõâ, Praha: Gale n, Proffit, W. R.; Fields, H. W.; Sarver, D. M.: Contemporary orthodontics. 4th ed., St. Louis: Mosby, PalmovaÂ, E.: Postnata lnõâ ruê st kraniofaciaâ lnõâho skeletu akostnõâ veï k. Odborna praâ ce ke specializacï nõâ atestaci z oboru ortodoncie. Praha, Moyers, R. E.: Handbook of orthodontics. 4th ed., Chicago, London, Boca Raton: Year Book Medical Publishers, Haken, Z.: Prostorove pomeï ry v dolnõâ cï elisti, distaâ lnõâ steï snaâ nõâ. Odborna praâ ce ke specializacï nõâ zkousï ce v oboru ortodoncie. Praha, Nanda, R. S.; Ghosh, J.: Longitudinal growth changes in the sagittal relationship of maxilla and mandible. Amer. J. Orthodont. dentofacial Orthop. 1995, 107, cï. 1, s Hunter, C. J.: The correlation of facial growth with body height and skeletal maturation at adolescence. Angle Orthodont. 1966, 36, cï. 1, s Singer, J.: Posttreatment change: A reality. Amer. J. Orthodont. 1975, 67, cï. 3, s Formby, W. A.; Nanda, R. S.; Currier, G. F.: Longitudinal changes in the adult facial profile. Amer. J. Orthodont. dentofacial Orthop. 1994, 105, cï. 5, s Brodie, A. G.: Late growth changes in the human face. Angle Orthodont. 1953, 23, cï. 3, s Sinclair, P. M.; Little, R. M.: Dentofacial maturation of untreated normals. Amer. J. Orthodont. 1985, 88, cï. 2, s Forsberg, C. M.: Facial morphology and ageing: A longitudinal cephalometric investigation of young adults. Eur. J. Orthodont. 1979, 1, cï. 1, s Bishara, S. E.; Peterson, L. C.; Bishara, E. C.: Changes in facial dimensions and relationships between the ages of 5 and 25 years. Amer. J. Orthodont. 1984, 85, cï. 3, s Foley, T. F.; Mamandras, A. H.: Facial growth in females 14 to 20 years of age. Amer. J. Orthodont. dentofacial Orthop. 1992, 101, cï. 3, s Love, R. J.; Murray, J. M.; Mamandras, A. H.: Facial growth in males 16 to 20 years of age. Amer. J. Orthodont. dentofacial Orthop. 1990, 97, cï. 3, s Gormely, J. S.; Richardson, M. E.: Linear and angular changes in dentofacial dimensions in the third decade. Brit. J. Orthodont. 1999, 26, cï. 1, s West, K. S., McNamara, J. A.: Changes in the craniofacial complex from adolescence to midadulthood: A cephalometric study. Amer. J. Orthodont. dentofacial Orthop. 1999, 115, cï. 5, s Forsberg, C. M.; Odenrick, L.: Changes in the relationship between the lips and the aesthetic line from eight years of age to adulthood. Eur. J. Orthodont. 1979, 1, cï. 4, s Lewis, A. B.; Roche, A. F.: Late growth changes in the craniofacial skeleton. Angle Orthodont. 1988, 58, cï. 2, s Behrents, R. G.: Growth in the aging craniofacial skeleton, Monograph 17, Craniofacial Growth Series. Center for Human Growth and Development, University of Michigan, Ann Arbor, [Cit. in: Proffit, W. R.; Fields, H. W.; Sarver, D. M.: Contemporary orthodontics. 4th ed., St. Louis: Mosby, 2007.] 21. Behrents, R. G.: A treatise on the continuum of growth in the ageing craniofacial skeleton. Center for Human Growth and Development, University of Michigan, Ann Arbor, [Cit. in: Proffit, W. R.; Fields, H. W.; Sarver, D. M.: Contemporary orthodontics. 4th ed., St. Louis: Mosby, 2007.] 22. BjoÈ rk, A.; Skieller, V.: Normal and abnormal growth of the mandible. A synthesis of longitudinal cephalometric implant studies over a period of 25 years. Eur. J. Orthodont. 1983, 5, cï. 1, s BjoÈ rk, A.: Variations in the growth pattern of the human mandible: longitudinal radiographic study by the implant method. J. dental Res. 1963, 42, cï. 1, s Enlow, D. H.; Hans, M. G.: Essentials of facial growth. Philadelphia: W. B. Saunders company, Israel, H.: Recent knowledge concerning craniofacial aging. Angle Orthodont. 1973, 43, cï. 2, s Baccetti, T.; Franchi, L.; McNamara, J. A.: Growth in the untreated class III subject. Semin. Orthodont. 2007, 13, cï. 3, s Reyes, B. C.; Baccetti, T.; McNamara J. A.: An estimate of craniofacial growth in class III malocclusion. Angle Orthodont. 2006, 76, cï. 4, s Kuc-Michalska, M.; Baccetti, T.: Duration of the pubertal peak in skeletal Class I and Class III subjects. Angle Orthodont. 2010, 80, cï. 1, s Lee, Y. S.; Lee, S. J.; An, H.; Donatelli, R. E.; Kim, S. H.: Do Class III patients have a different growth spurt than the general population? Amer. J. Orthodont. dentofacial Orthop. 2012, 142, cï. 5, s Riesmeijer, A. M.; Prahl-Andersen, B.; Mascarenhas, A. K.; Joo, B. H.; Vig, K. W. L.: A comparison of craniofacial Class I and Class II growth patterns. Amer. J. Orthodont. dentofacial Orthop. 2004, 125, cï. 4, s Baccetti, T.; Stahl, F.; McNamara, J. A.: Dentofacial growth changes in subjects with untreated Class II malocclusion from late puberty through young adulthood. Amer. J. Orthodont. dentofacial Orthop. 2009, 135, cï. 2, s MDDr. Michal SÏ õâr stomatologickaâ klinika FN PlzenÏ Alej Svobody 80, PlzenÏ [email protected] 215

14 rocïnõâk24 ORTODONCIE (nad 16 let). Lee a kol. [29] vsï ak ve sveâ studii naopak rïõâkajõâ, zïe rozdõâl mezi ruê stem dolnõâ cï elisti u jedincuê s I. aiii. skeletaâ lnõâ trïõâdou nenõâ. RuÊ st dolnõâ cï elisti u jedincuê se skeletaâ lnõâ III. trïõâdou sleduje podobnyâ trend jako jejõâ ruê st u jedincuê s I. skeletaâ lnõâ trïõâdou, ato jak u muzïuê, tak u zï en. RozdõÂl v ruê stu dolnõâ cï elisti mezi jedinci s I. aii. skeletaâ lnõâ trïõâdou byl popsaâ n ve studii Riesmeijeraakol. [30]. V nõâzkeâm veï ku (do 12 let) nalezli u jedincuê se skeletaâ lnõâ II. trïõâdou kratsï õâ dolnõâ cï elist, od 14. roku veï ku jizï rozdõâl mezi I. aii. trïõâdou nenalezli. Baccetti a kol. [31] pozorovali rozdõâlnost ruê stu mezi II. skeletaâ lnõâ trïõâdou ai. trïõâdou v obdobõâ od pozdnõâ puberty do mladeâ dospeï losti (pruêmeï rnyâ veï k 15,5-19 let) stanoveneâ m podle metody zraânõâ krcï nõâch obratluê (CVMS 6). Absolutnõ velikost dolnõâ cï e- listi bylau jedincuê s II. skeletaâ lnõâ trïõâdou mensï õâ, ale rozdõâl v intenziteï prïõâruê stku prokaâzaâ n nebyl. ZaÂveÏr V postpubertaâ lnõâm obdobõâ (16-31 let) dochaâ zõâ k dalsïõâm prïõâruê stkuê m dolnõâ cï elisti ve smeï ru u muzïuêiuzï en. MuzÏ i vykazovali veïtsïõâ prïõâruê stky veï tve i celkoveâ deâ lky dolnõâ cï elisti nezï zï eny. PrÏõÂruÊ stky teï ladolnõâ cï elisti jsou u muzïuêizïen podobneâ. IntenzitaruÊ stu cï elistõâje v sagitaâlnõâm i vertikaâ lnõâ smeï ru u muzïuê prïiblizïneï dvojnaâ sobnaâ nezï u zï en. IntenzitaruÊ stu dolnõâ cï elisti u muzïuê rovnomeï rneï klesala. Intenzita ruê stu dolnõâ cï elisti u zïen zpocïaâ tku takeâ klesala, ale od 20. roku veï ku bylo patrneâ zrychlenõâ ruê stu veï tve i deâ lky celeâ dolnõâ cï elisti. Po 23. roce jizï prïõâruê stky opeï t klesaly. U muzïuê tento docï asnyâ trend nenõâ pozorovaâ n. Dolnõ cï elist vykazovala prïevaâ zïneï lehce naznacï enou ruê stovou anteriorotaci - goniovyâ uâ hel se zmensï oval, uâ hel betazveï tsï oval, a to võâce uzï en. Uka zalo se, zï e u pacientuê s I., II. nebo III. skeletaâ lnõâ trïõâdou nenõâ v postpubertaâ lnõâm obdobõâ v intenziteï ruê stu dolnõâ cï elisti rozdõâl. Z vyâ sï e uvedenyâ ch skutecï nostõâ vyplyâ vaâ pro klinickou praxi neï kolik duê sledkuê : I v tomto cï asoveâ m obdobõâ musõâme pocï õâtat s malyâmi, ale prïõâtomnyâmi, ruê stovyâmi zmeïnami dolnõâ cï elisti. JestlizÏ e se dolnõâ cï elist, ajisteï ta keâ celyâ stomatognaâ tnõâ systeâ m v postpubertaâ lnõâm obdobõâ meï nõâ, prïizpuê sobuje se teï mto novyâ m podmõânkaâ m takeâ jisteï jeho dentoalveolaâ rnõâ slozï ka. Jinak rïecï eno, dentoalveolaâ rnõâ kompenzacï nõâ mechanismus se daâ le uplatnï uje aprïizpuê sobuje postavenõâ zubuê meï nõâcõâ se situaci na uâ rovni baâ zõâ cï elistõâ. Proto by bylo chybou povazï ovat dvacetileteâ jedince zastabilnõâ, co se tyâcï e postavenõâ zubuê.vsï echny zaâ veï ry je vhodneâ braâ t v uâ vahu prïi plaâ novaâ nõâ aktivnõâ i retencï nõâ faâ ze ortodontickeâ leâ cï by, cï i prïi plaâ novaâ nõâ ortodonticko - chirurgickeâ korekce skeletaâ lnõâch vad a v neposlednõâ rïadeï prïi plaâ novaâ nõâ osï etrïenõâ pomocõâ dentaâ lnõâch implantaâ tuê. ZaÂveÏ ry teâ to studie jsou tudõâzï vhodneâ jak pro ortodontisty, tak pro praktickeâ zubnõâ leâkarïe. with Skeletal Class I under the age of 12, but the difference was not found after the age of 14. Baccetti et al. [31] report different growth between Skeletal Class I and II in the period from late puberty till young adulthood ( years) set according cervical vertebral maturation (CVMS 6). The total size of the mandible was smaller in individuals with Skeletal Class II, the difference in the growth rate was not proved. Conclusion In postpubertal period (16-31 years) the mandible continues to grow in both men and women. In men the growth gains of the mandible ramus and the total length of the mandible are bigger than in women. The growth gains in the body of the mandible are similar in both sexes. In men, the jaws growth rate in both sagittal and vertical directions is approximately twice as big as in women. The mandible growth rate was decreasing evenly in men. In women the mandible growth rate was decreasing at the beginning, but since the age of 20 the mandible ramus as well as the total length of the mandible started to increase. After the age of 23 the growth decreased again. The temporary increase in the growth rate was not observed in men. There was moderate anteriorotation - the gonion angle was decreasing whilst the Beta angle was increasing - observed, more often in women. No difference in the mandible growth rate was found in postpubertal patients with Skeletal Class I, II and III. The results have several implications for clinical practice. In this period we have to take into consideration small, however present, growth changes of the mandible. The mandible, and the whole stomatognathic system, changes in postpubertal period, and the dentoalveolar component is sure to adjust to the new conditions. In other words, dentoalveolar compensation mechanisms adjust the teeth position to the changing situation of jaw bases. Therefore, it would be incorrect to consider twenty-year olds stable in terms of teeth position. This should be taken into account in the planning of both active and retention phases of orthodontic treatment, or in the planning of orthodontic-surgical correction of skeletal malocclusions, and in the planning of treatment with dental implants. Thus the conclusions of the current study are useful for orthodontists as well as for general dentists. The authors have no commercial, ownership or financial interests in the products or companies mentioned in the article. AutorÏi nemajõâ komercï nõâ, vlastnickeâ nebo financï nõâ zaâ jmy na produktech nebo spolecï nostech popsanyâ ch v tomto cïlaâ nku [email protected]

15 ORTODONCIE rocïnõâk24 tech (52 muzïuê a52 zï en) ukaâ zala, zï e v postpubertaâ lnõâm obdobõâ dochaâzõâ k prïõâruê stkuê m dolnõâ cï elisti. Z na sï ich vyâ sledkuê vyplyâ vaâ, zï e v postpubertaâ lnõâm obdobõâ prïevlaâ dala pruê meï rnaâ ruê stovaâ anteriorotace dolnõâ cï elisti. Goniovy uâ hel se zmensï oval, uâ hel Beta se zveï tsï oval. PokracÏ ujõâcõâ anteriorotaci dolnõâ cï elisti prokaâ zali takeâ autorïi Formby akol. [9], Sinclair alittle [11], Bishara a kol. [13], Foley a Mamandras [14], Love a kol. [15] a Gormely a Richardson [16]. Naopak Palmova [3], West amcnamara[17], Forsberg aodenrick [18] popisovali u zï en tendenci k posteriorotaci zatõâmco u muzï uê uvedli opeï t anteriorotacï nõâ zmeï ny. Vna mi sledovaneâ m obdobõâ dochaâ zelo v prïõâruê stcõâch lineaâ rnõâch azmeï naâ ch uâ hlovyâ ch parametruê k rozdõâlu mezi muzï i azï enami. Vy jimku tvorïiladeâ lkateï ladolnõâ cï e- listi. VsÏ eobecneï je uznaâvaâ no, zïe muzïi vykazujõâ procentuaâ lneï vysïsïõâprïõâruê stky nezï zï eny. Je tomu tak i v postpubertaâ lnõâm obdobõâ ruê stu kraniofaciaâ lnõâm systeâ mu [9, 11, 16, 19]. Studie Nandy a Ghoshe [6] ukazuje azï dvakraât veïtsï õâ rozdõâl v prïõâruê stcõâch u muzïuê.acï koliv jsou prïõâruê stky u muzïuêveïtsï õâ, procentuaâ lnõâ zmeï ny jsou u obou pohlavõâ jak v nõâzkeâ m, tak ve vysïsïõâm veï ku (18-24 let) srovnatelneâ. V nasï õâ studii jsme popsali lineaâ rnõâ pokles intenzity ruê stu dolnõâ cï elisti u muzïuê, naopak u zï en bylo pozorovaâ no docï asneâ obnovenõâ ruê stu. K podobnyâm vyâ sledkuê m dosï li Behrents [19, 20], Formby akol. [9] apalmovaâ [3]. Toto pozorovaâ nõâ vysveï tluje Formby [9] v souvislosti s teï hotenstvõâm aprïidruzï enyâ mi hormonaâ lmi zmeï nami. Je ale nutneâ podotknout, zïe Formby svuêj naâ zor prezentoval v 90. letech, kdyby byl pruêmeï rnyâ veï k oteï hotneïnõâzïen nizïsï õâ, nezï je tomu v dnesïnõâ dobeï.daâ le je nutneâ uveâ st, zïevnasï õâ studii nebylavelkaâ veï tsï inapacientek teï hotnyâ ch, tudõâzï se k Formbyho naâzoru neprïiklaâ nõâme, nadruhou stranu nejsme schopni prïõâcï inu docï asneâ ho vzestupu intenzity ruê stu zïen jisteï vysveï tlit. PrÏikla nõâme se vsï ak k mozïneâ neurohumoraâ lnõâ prïõâcï ineï tohoto deï je. Zjistili jsme, zïe lze symfyâzu dolnõâ cï elisti v tomto obdobõâ povazï ovat za tvaroveï staâ lou strukturu s rovnomeï rnyâm ruê stovyâmi zmeï nami. O symfyâze dolnõâ cï elisti, zvlaâsïteï o konturïe jejõâ vnitrïnõâ kortikalis, je cï asto v odborneâ literaturïe psaâ no jako o stabilnõâ strukturïe, vhodneâ k potrïebaâ m prïekryâ vaâ nõâ rentgenovyâ ch snõâmkuê [22, 23]. VneÏjsÏ õâ oblast symfyâzy je v bazaâ lnõâch cïaâ stech, v mõâsteï bodu Menton apogonion, apozicï nõâ oblastõâ [24]. Ve vysï sï õâm veï kumaâ tedy symfyâ zatendenci se ztlusï t'ovat [25]. V postpubertaâ lnõâm obdobõâ nebyl nalezen rozdõâl v intenziteï ruê stu dolnõâ cï elisti mezi jedinci s I., II. nebo III. skeletaâ lnõâ trïõâdou stanovenou podle uâ hlu ANB. V tomto panujõâ v literaturïe ruê zneâ zaâveï ry. Baccetti [26], Reyes a kol. [27] a Kuc-Michalska [28] ukazujõâ, zï e existuje rozdõâl v ruê stu dolnõâ cï elisti mezi jedinci se skeletaâ lnõâ I. aiii. trïõâdou. Ti s progennõâ vadou vykazujõâ delsï õâ trvaâ nõâ pubertaâ lnõâ ruê stoveâ ho spurtu zasahujõâcõâ azï do vysïsïõâho veïku prevailed. The gonion angle was reducing, the Beta angle increasing. Continuing anteriorotation of the mandible was proved also by Formby et al. [9], Sinclair and Little [11], Bishara et al.[13], Foley and Mamandras [14], Love et al. [15], Gormely and Richardson [16]. On the contrary, Palmova [3], West and Mc Namara [17], Forsberg and Odenrick [18] reported about the tendency to posteriorotation in women, and anteriorotation in men. We found sex differences of linear and angular parameters. The length of the mandible body was the only exception. It is generally accepted that in men the growth gains are proportionally bigger than in women. The same holds true for the growth of craniofacial system in postpubertal period [9, 11, 16, 19]. Nanda and Gosh [6] give double growth gains in men. Though growth gains in men are bigger, the proportional changes are comparable in men and women both in early and higher age (18-24). We determined linear decrease in the rate of the mandible growth in men, while in women we determined temporary renewal of growth. Similar results were given by Behrents [19, 20], Formby et al. [9] and Palmova [3]. Formby assigned the fact to pregnancy and accompanying hormonal changes. However, it should be pointed out that Formby gave his opinion in the 90s, when the mean age of pregnant women was lower than today. Most women included in our study were not pregnant and therefore we cannot accept Formby's view. However, we are not able to identify the cause of the temporary increase in the growth rate in women. We tend to explain the fact by neurohumoral causes. In postpubertal period, symphysis of the mandible can be considered a stable structure in terms of shape, with steady growth changes. Symphysis of the mandible, its inner cortical bone contour in particular, is commonly described as a stable structure, appropriate for radiographs superimposition [22,23]. Outer area of symphysis is in basal parts, at menton and pogonion points, appositional area [24]. Therefore, in higher age symphysis tends to thickening [25]. In postpubertal period, there was found no difference in the mandible growth rate among individuals with Skeletal Class I, II and III, determined by ANB angle. Authors are not consensual in that. Baccetti [26], Reyes et al. [27], and Kuc-Michalska [28] show that there is a different growth of the mandible in Skeletal Class I and III. In individuals with prognathism the pubertal growth spurt is longer (over the age of 16). However, Lee et al. [29] found no sex differences in the growth of the mandible between Skeletal Class I and III. Riesmeier et al. [30] described the different growth of the mandible in individuals with Skeletal Class I and II. They found a shorter mandible in individuals [email protected] 213

16 rocïnõâk24 ORTODONCIE Tab. 1. VyÂbeÏ rovaâ korelacï nõâ matice pro rozmeï ry celkoveâ deâ lky mandibuly. Tab. 1. Sample correlation matrix of the mandible total length parameters. Ar - Me p Ar - Gn p Ar - Pg p muzïi men zïeny women Ar - Me < 0.001*** 0.75 < 0.001*** Ar - Gn 0.84 < 0.001*** 0.87 < 0.001*** Ar - Pg 0.75 < 0.001*** 0.87 < 0.001*** Ar - Me 0.76 < 0.001*** 0.59 < 0.001*** Ar - Gn 0.76 < 0.001*** 0.72 < 0.001*** Ar - Pg 0.59 < 0.001*** 0.72 < 0.001*** p - hladina vyâznamnosti Spearmanova koeficientu, level of significance of Spearman coefficient; p*** - test je statisticky signifikantnõâ na 0,001 % hladineï vyâznamnosti; test is statistically significant at the level of %. povazï ovali za smeï rodatnou pro mensï õâpocï et probanduê v tomto veï ku. Pro zjisï teï nõâ, zdase symfyâ zadolnõâ cï elisti v postpubertaâ lnõâm obdobõâ meï nõâ, bylazjisï t'ovaâ nakorelace mezi pruê meï rnou rocï nõâ zmeï nou celkoveâ deâ lky mandibuly (Ar - Me, Ar - Gn a Ar - Pg) (Tab. 1). Hodnoty naznacï ujõâ silnou zaâ vislost vsï ech charakteristik jak v muzï skeâ, tak i zï enskeâ populaci. Na 0,1 % hladineï vyâ znamnosti bylo prokaâzaâ no, zï e lze zmeï ny nasymfyâze dolnõâ cï elisti v postpubertaâ lnõâm obdobõâ povazï ovat za stabilnõâ a proporcionaâ lneï rovnomeï rneâ. Statisticky nebylo prokaâ zaâ no, zï e by intenzitaruê stu dolnõâ cï elisti v postpubertaâ lnõâm obdobõâ souviselase sagitaâ lnõâmi vztahy cï elistõâ. CÏ aâ stecï nou vyâ jimku tvorïõâ rozdõâl v gonioveâm uâ hlu u zïen auâ hlu Betau zï en. Zde se na 5% hladineï vyâ znamnosti prokaâ zalo, zï e se lisï õâ goniovyâ uâ hel u pacientek s II. a III. skeletaâ lnõâ trïõâdou adaâ le, zïe se se lisïõâuâ hel betau pacientek s I. aii. skeletaâ lnõâ trïõâdou. Tato vyâ jimkavsï ak byla pravdeï podobneï zpuê sobena nestejnyâm pomeï rem v pocï tu probanduê v jednotlivyâch skupinaâ ch skeletaâ lnõâch trïõâd, aproto ji nepovazï ujeme zavyâznamnou (Obr. 5). Obr. 5. Srovna nõâ skupin cï leneïnyâch dle uâ hlu ANB. ZÏ luteâ boxy ilustrujõâ statisticky vyâ znamnyâ rozdõâl meï rïeneâ ho parametru mezi skeletaâ lnõâmi trïõâdami. Fig. 5 Comparison of groups according to ANB angle. Yellow boxes represent the statistical signifikance of differences of the parameter measured between skeletal classes. Diskuse VnasÏ õâ studii bylo prokaâzaâ no, zï e v obdobõâ po 16. roce veï ku dochaâ zelo ke statisticky vyâznamnyâm rocïnõâm prïõâruê stkuê m nadolnõâ cï elisti. RuÊ stem kraniofaciaâ lnõâho systeâ mu u ortodonticky neleâ cï enyâ ch jedincuê se v obdobõâ pozdnõâ adolescence a mladeâ dospeï losti v odborneâ literaturïe zabyâ valo mnozï stvõâ autoruê. Odborna literatura astudie ukazujõâ, zï e nejveï tsï õâ ruê stoveâ zmeï ny se objevujõâ prïevaâzïneï prïed 18. rokem veï ku, ale nejsou kompletnõâ adaâ le pokracï ujõâ [6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. Foley a Mamandras [14] nalezli postpubertaâ lnõâ zmeï ny, ktereâ byly prïiblizïneï dvakraât veï tsïõâ ve veï ku let nezï poteâ ve veï ku let. Dolnõ cï elist vykazovala dvakraâtveïtsïõâ prïõâruê stky nezï hornõâ cï elist. NameÏ rïeneâ vyâ sledky jsou vysï sï õâ nezï vyâ sledky nasï õâ studie. Love akol. [15] nasï li ruê stoveâ zmeï ny u muzïuê se skeletaâ lnõâ I. trïõâdou mezi lety. MeÏ rïeneâ rozmeï ry se ve sledovaneâ m obdobõâ zveï tsï ovaly. Po prïepocï tu najeden kalendaâ rïnõâ rok jsou vyâ sledky srovnatelneâ s nasï õâ studiõâ. CelkoveÏ byly zmeï ny ve studii Love akol. veïtsï õâ v prvnõâ polovineï sledovaneâ ho obdobõâ (16-18 let). Take Palmova [3] v atestacï nõâ praâ ci na104 pacienannual growth gains of the mandible. A number of authors have dealt with the growth of the craniofacial system in orthodontically untreated persons during late adolescence and young adulthood. The literature and studies show that the most profound growth changes occur largely before the age of 18; however, the growth is not completed and continues [6-15]. Foley and Mamandras [14] identified postpubertal changes at the age that were twice as big as changes occurring at the age The growth gains of the mandible were twice as big as the growth gains of the maxilla. The results show higher values than those found in our study. Love et al. [15] determined growth changes in men with Skeletal Class I between the age 16 and 20. The parameters were increasing during the period monitored. After recalculation to one calendar year, the results are similar to those reported in our study. The changes in the study by Love et al. were more profound during the first half of the period monitored (16-18 yrs.). Palmova [3], in her work involving 104 patients (52 males and 52 females), reported the growth gains of the mandible during postpubertal period. Our results suggest that in the postpubertal period the moderate growth anteriorotation of the mandible [email protected]

17 ORTODONCIE rocïnõâk24 Obr. 3. PruÊmeÏ rnaâ rocï nõâ zmeï nav intenziteï prïõâruê stkuê veï tve dolnõâ cï elisti (Ar - Go) v zaâ vislosti naveï ku ajejõâ citlivost - muzï i. PruÊmeÏ rnaâ rocïnõâ zmeï na(modraâ krïivka) udaâvaâ, o kolik se meïnõâdeâ lkadolnõâ cï elisti prïepocï tenaâ najeden rok v okolõâ daneâho veïku (± 1,5 roku) a parametr smeï rnice (cï ervenaâ krïivka) pak urcï uje, zdaje vyâsledek ¹stabilnõª, tj. pokud se zmeï nõâ veï k, zdalze ocï ekaâ vat podobneâ zmeï ny (to nastane ve chvõâli, kdy je bude parametr smeï rnice nulovyâ) nebo zdalze ocï ekaâvat, zïe prïõâruê stky se s veï kem snizïujõâ (parametr smeï rnice zaâ pornyâ). Fig. 3. Mean annual change in the rate of growth gains of the mandibular ramus (Ar - Go) related to age and its sensitivity - men. The mean annual change (the blue curve) gives the change of the mandible length recalculated to one year around the given age (± 1,5 years) and the guideline parameter (the red curve) then determines whether the result is ¹stableª, i.e. whether similar changes are to be expected with changing age (which occurs at the moment when the parameter is zero) or whether the growth gains decrease with age (the parameter is negative). se trïõâletyâ ch intervalech byly sestrojeny grafy zvlaâ sï t' pro muzïeazïeny (Obr. 3, 4). Z vyâ sledkuê pro muzï skou populaci uvedenyâ ch na Obr. cï. 3 je zrïejmeâ, zïe s veï kem se pruê meï rnaâ rocï nõâ zmeï na prïõâruê stkuê veï tve dolnõâ cï elisti lineaâ rneï snizï uje (modraâ krïivka) a kolem 22. roku veï ku se jizï nemeï nõâ (zelenaâ krïivka). Zelena krïivkase pohybuje zpocï aâ tku v zaâpornyâch hodnotaâ ch, to znamenaâ,zï e se prïõâruê stky s veïkem snizï ujõâ. MõÂsta, kde se zelenaâ krïivkablõâzï õâ nule, naznacï ujõâ, zï e se intenzitaruê stu s veï kem nemeï nõâ - tedy nemaâ klesajõâcõâ ani vzruê stajõâcõâ tendenci. VzruÊ stajõâcõâ intenzitu prïõâruê stkuê kolem 23. roku veï ku jsme nepovazïovali za smeï rodatnou z duê vodu mensï õâho mnozïstvõâ probanduê v teâto veï koveâ oblasti. Obr. 4 PruÊmeÏ rnaâ rocï nõâ zmeï nav intenziteï prïõâruê stkuê veï tve dolnõâ cï elisti (Ar - Go) v zaâ vislosti naveï ku ajejõâ citlivost - zïeny. PruÊmeÏ rnaâ rocïnõâ zmeï na(ruêzï ovaâ krïivka) udaâvaâ, o kolik se meïnõâdeâ lkadolnõâ cï elisti prïepocï tenaâ najeden rok v okolõâ daneâho veïku (± 1,5 roku) a parametr smeï rnice (modraâ krïivka) pak urcï uje, zdaje vyâsledek ¹stabilnõª, tj. pokud se zmeïnõâveï k, zdalze ocï ekaâ vat podobneâ zmeï ny (to nastane ve chvõâli, kdy je bude parametr smeï rnice nulovyâ) nebo zdalze ocï ekaâ vat, zïe prïõâruê stky se s veï kem snizï ujõâ (parametr smeï rnice zaâ pornyâ). Fig. 4. Mean annual change in the rate of growth gains of the mandibular ramus (Ar - Go) related to age and its sensitivity - women. The mean annual change (the pink curve) gives the change of the mandible length recalculated to one year around the given age (± 1,5 years) and the guideline parameter (the blue curve) then determines whether the result is ¹stableª, i.e. whether similar changes are to be expected with changing age (which occurs at the moment when the parameter is zero) or whether the growth gains decrease with age (the parameter is negative). Nagrafu pro zïenskou populaci na Obr. cï. 4 jsou patrny rozdõâly v prïõâruê stcõâch veï tve dolnõâ cï elisti u zïen od muzï skeâ populace. PrÏõÂruÊ stek zde neklesaâ se zvysï ujõâcõâm se veï kem, ale kolem 20. roku se opeï t navysï uje (ruêzï ovaâ krïivka). SmeÏ rnice zmeï ny (zelenaâ krïivka) se zpocï aâ tku pohybuje v zaâ pornyâch hodnotaâ ch, to znamenaâ,zï e lze ocï ekaâ vat, zïe se v tomto obdobõâ budou prïõâruê stky s veïkem snizï ovat, a toto ocï ekaâvaâ nõâ je tõâm veïtsïõâ,cï õâm je hodnotasmeï rnice zaâ porneïjsï õâ. Kolem 20. roku se smeï rnice dostaâvaâ do pozitivnõâch hodnot, takzï e lze ocï ekaâ vat zvysï ovaânõâprïõâruê stkuê sveï kem. Kolem 22. roku lze opeïtocïekaâ vat pokles intenzity ruê stu (zaâ porneâ hodnoty) av okolõâ 24. roku jsou jizï vyâ sledky stabilnõâ (zelenaâ krïivka) azmeï natedy nenõâ citlivaâ naveï k. Vzestup intenzity ruêstu ve veï ku okolo 26 let jsme, stejneï jako u muzïuê, necurve reaches positive values, i.e. increased growth gains are expected with higher age. Around the age of 22 the rate decreases (negative values), and at the age of 24 the results are stable. Increased rate around the age of 26 was not seen as decisive due to a small number of subjects of that age. To determine whether the mandible symphysis changes in postpubertal period, we examined the correlation between the mean annual change of the total length of the mandible (Ar-Me, Ar-Gn, Ar-Pg) (Table 1 and 2). The values in Table 1 suggest strong dependency of all parameters in both men and women. It was proved (at the level of significance of 0.1%) that changes in the mandible symphysis in late puberty can be assessed as stable and proportionately balanced. It was not statistically proved that the rate of the mandible growth in postpubertal perios is related to sagittal jaw relations. A partial exception is represented by the difference in the gonion angle in female patients with skeletal class II and III, and in the Beta angle in female patients with skeletal class I and II. However, this exception might result from the different number of subjects in individual groups of skeletal classes, and therefore it was not considered as statistically significant (Fig. 5). Discussion The current study proved that during the period following the age of 16 there were statistically significant [email protected] 211

18 rocïnõâk24 ORTODONCIE Pg) we used Spearman rank correlation coefficient. Kruskal-Wallis ANOVA test was used to determine sex differences and skeletal class differences in the rate of the mandible growth. The test was performed separately for men and women. Obr. 2. PruÊmeÏ rneâ rocï nõâ zmeï ny rozmeïruê u muzïuêazï en. ZÏ luteâ boxy ilustrujõâ statistickou vyâ znamnost rozdõâlu meï rïeneâ ho parametru mezi muzïiazï enami. Fig. 2. Mean annual changes in the measured parameters in men and women. Yellow boxes represent the statistical signifikance of the sex difference in the parameter measured. tenziteï ruê stu dolnõâ cï elisti mezi pohlavõâmi a podle skeletaâ lnõâch trïõâd danyâch uâ hlem ANB nai., II. aiii. skeletaâ lnõâ trïõâdu byl pouzïit Kruskal - WallisuÊ v test (Kruskal - WallisovaANOVA). Test byl proveden zvlaâsït' pro muzïe azvlaâ sï t' pro zï eny. Vy sledky Na0,1 % hladineï vyâ znamnosti se podarïilo prokaâ zat, zï e v postpubertaâ lnõâm obdobõâ dochaâzõâk prïõâruê stkuê m lineaâ rnõâch parametruê dolnõâ cï elisti. ZveÏ tsï ovala se celkovaâ deâ lkadolnõâ cï elisti, daâlevyâsïkaveï tve dolnõâ cï elisti i deâ lka teï ladolnõâ cï elisti. PrÏõÂruÊ stky byly pozorovaâ ny u muzïuê uizï en (Obr. 2). Na0,1 % hladineï vyâznamnosti se podarïilo prokaâ zat, zï e v postpubertaâ lnõâm obdobõâ prïevlaâ daâ pruê meï rnaâ ruê stovaâ anteriorotace dolnõâ cï elisti. Goniovy uâ hel se zmensï oval, uâ hel betazveïtsï oval u muzïuêiuzïen (Obr. 2). Na0,1 % hladineï vyâ znamnosti bylo prokaâzaâ no, zï e v postpubertaâ lnõâm obdobõâ existuje rozdõâl v intenziteï ruê stu mezi muzïi azï enami ve vyâsïceveï tve dolnõâ cï elisti acelkoveâ deâ lce dolnõâ cï elisti. ZÏ eny vykazovaly oproti muzïuê m veï tsï õâ zmensï ovaânõâ gonioveâho uâ hlu. Nadruhou stranu se uâ hel betana5 % hladineï vyâznamnosti zveïtsï oval võâce u muzïuê. Existuje tedy rozdõâl v intenziteï ruê stoveâ rotace dolnõâ cï elisti mezi muzï i azï enami. I prïes tyto rozdõâly dolnõâ cï elist prïevaâ zï neï anteriorotuje. Naopak rozdõâl mezi pohlavõâmi nebyl prokaâ zaân v deâ lce teï ladolnõâ cï elisti (Obr. 2). Da le bylo zjisï t'ovaâ no, jak se meï nõâ rychlost prïõâruê stku vyâsïky veï tve dolnõâ cï elisti (rozmeï r Ar - Go) acelkoveâ deâ lky dolnõâ cï elisti (rozmeï r Ar - Me) u muzï skeâ azïenskeâ populace v zaâ vislosti naveï ku. VyuzÏ itak tomu bylanameï rïenaâ data, kteraâ bylavyhodnocovaâ nametodou plovoucõâ regrese spocï õâvajõâcõâ v postupneâ m vyhodnocovaâ nõâ ruê stovyâ ch zmeï n v pohybliveâ mtrïõâleteâ m intervalu. SlozÏ e- nõâm jednotlivyâ ch prïõâruê stkuê v jednotlivyâ ch prolõânajõâcõâch Results We proved that in postpubertal period there are growth gains in linear parameters of the mandible (the level of significance was set at 0.1%). Increase was observed in total length of the mandible, height of the mandible ramus, length of the mandible body. Growth gains were recorded in both men and women (Fig. 2). We proved that in postpubertal period the moderate anteriorotation of the mandible prevails (the level of significance was set at 0.1%). The gonion angle reduced, the Beta angle increased in both men and women. We proved that in postpubertal period there were sex differences in growth rate regarding the height of the mandible ramus and the total length of the mandible (Fig. 2). In women the gonion angle reduced more significantly than in men. On the other hand, the Beta angle increased more significantly in men (the level of significance = 5%). In spite of the differences mentioned, anteriorotation of the mandible prevails. The sex difference in the length of the mandible body was not proved (Fig. 2). We also determined the change of the increase rate of the mandible ramus height (parameter Ar-Go) and of the total length of the mandible (parameter Ar-Me) in male and female populations related to age. The data were processed with floating-point regression, i.e. gradual assessment of growth changes during a movable (floating) three-year interval. The results were represented in graphs constructed separately for men and for women (Fig. 3, 4). The results for males (Fig. 3) show that with age the mean annual change in the growth gain of the mandible ramus decreases linearly (blue curve), and stops around the age of 22 (green curve). At the beginning, the green curve is in negative values, i.e. the growth gains are decreasing with age. The places where the green curve is close to zero suggest that the growth rate does not change with age. Increasing rate around the age of 23 was not seen as decisive due to a small number of subjects of that age. The results for females (Fig. 4) show different growth gains in the mandible ramus in comparison with males. The growth gain does not decrease with higher age, and increases around the age of 20 (pink curve). At the beginning, the green curve fluctuates in negative values, i.e. it is expected that the growth gains will decrease with higher age. Around the age of 20 the green [email protected]

19 ORTODONCIE rocïnõâk24 definovanyâch naskeletu dolnõâ cï elisti: Ar - Go (vyâsïkaveïtve dolnõâ cï elisti v milimetrech), Go - Me (deâ lkateï ladolnõâ cï elisti v milimetrech), Ar - Me, Ar - Gn, Ar - Pg (celkovaâ deâ lkadolnõâ cï elisti v milimetrech), ArGoMe (goniovyâ uâ hel ve stupnõâch) aar - Gn/ML (uâ hel betave stupnõâch) (Obr. 1). ChybameÏ rïenõâ bylastanovenapro lineaâ rnõâ i uâ hloveâ parametry podle Dahlbergova vzorce. Bylo takeâ zjisït'ovaâ no, zdanedosï lo k systematickeâ chybeï meï rïenõâ. VyÂsledek systematickou chybu zamõâtnul. VsÏ echny testy byly provedeny nahladineï statistickeâ vyâznamnosti p 0,05. Ke statistickyâ m vyâ pocï tuê m byl pouzï it software MATLABÁ, verze R2013a, MathWorks, Inc., Massachusetts, USA, vyâpocï ty provedl Ing. Marek Patrice, Ph.D. ZduÊ vodu ruê zneâ deâ lky celeâ ho sledovaneâ ho obdobõâ kazïdeâ ho pacienta, pro ktereâ byladostupnaâ pouze dveï meï rïenõâ, bylazjisïteï nacelkovaâ zmeï nazaceleâ sledovaneâ obdobõâ atabylaprïepocï tenanajeden rok podle vzorce:, [mm/rok], kde PRZ - pruêmeï rnaâ rocï nõâ zmeï na, M2 -meïrïenõâ v cï ase T2, M1 -meïrïenõâ v cï ase T1. Ke zhodnocenõâ zmeï ny rozmeï ru vsï ech sledovanyâch lineaâ rnõâch auâ hlovyâ ch parametruê po prïepocï tu najeden kalendaârïnõâ rok, ato zvlaâsït' pro muzïe azïeny, byl pouzïit neparametrickyâ jednovyâbeï rovyâ WilcoxonuÊ v test. Vedle kvantifikace pruê meï rneâ intenzity ruê stu dolnõâ cï elisti ve vsï ech jednotlivyâ ch parametrech, bylo snahou zobrazit zmeï nu rychlosti ruê stu dolnõâ cï elisti u muzïskeâ a zï enskeâ populace v zaâ vislosti naveï ku. Pro zobrazenõâ, jak byl prïõâruê stek v okolõâ daneâho veï ku stabilnõâ, byla vyuzï itametodaplovoucõâ regrese s odecï tem smeï rnice prïõâmky v daneâ m bodeï. S ohledem namnozï stvõâ dat byla plovoucõâ regrese pocï õâtaâ na vzï dy z poslednõâch trïõâ let. PruÊmeÏ rnaâ rocï nõâ zmeï naudaâvaâ, o kolik se meï nõâ danyâ parametr prïepocï tenyâ najeden rok v okolõâ daneâho veï ku (± 1,5 roku) a parametr smeï rnice urcï uje, zdaje vyâsledek ªstabilnõª, tj. pokud se zmeïnõâveï k, zdalze ocï ekaâvat podobneâ zmeï ny (to nastane ve chvõâli, kdy bude parametr smeï rnice nulovyâ) nebo zdalze ocï ekaâ vat, zïe prïõâruê stky se s veï kem snizï ujõâ (parametr smeï rnice zaâ pornyâ). Ke zhodnocenõâ zmeï n symfyâzy dolnõâ cï elisti byly stanoveny trïi lineaâ rnõâ parametry reprezentujõâcõâ rozmeï r celkoveâ deâ lky dolnõâ cï elisti. Jedna se o rozmeï ry: Ar - Me, Ar - Gn, Ar - Pg, u kteryâch bylo zjisït'ovaâ no, zdamezi sebou korelujõâ s cõâlem zjistit, zdase ve sledovaneâ m obdobõâ meï nõâ tvar symfyâzy, azdaje mozïneâmeïrïit deâ lku cï elisti ke ktereâ mukoliv z teï chto boduê bez obav z rozdõâlnyâch vyâ sledkuê danyâ ch zmeï nou anteriornõâho a kaudaâ lnõâho povrchu symfyâ zy. Pro zjisï teï nõâ korelace mezi pruê meï r- nou rocï nõâ zmeï nou deâ lky mandibuly (Ar - Me, Ar - Gn aar - Pg) byl pouzï it SpearmanuÊ v koeficient porïadoveâ korelace. Ke zhodnocenõâ zda je mozï neâ najõât rozdõâly v in- Obr. 1. RozmeÏrymeÏrÏene na kefalogramech Fig. 1. Parameters measured in cephalograms To evaluate the change in all linear and angular parameters after conversion into one year, separately for men and women, the nonparametric one-sample Wilcoxon test was used. The aim was to represent the change in the rate of mandibular growth in men and women related to age. To represent the stability of growth gains around a given age, the method of floating-point regression with reading of the slope of a straight line at a given point was applied. Floating-point regression was always calculated from the last three years. Mean annual change states the change of a given parameter converted to one year around a given age (± 1.5 yrs). Slope of a straight line determines whether the result is ªstableª, i.e. whether with a changed age similar changes are to be expected (this will appear at the moment when the slope parameter will be zero), or whether growth gain diminishes with age (the slope parameter is negative). To evaluate changes in the mandibular symphysis three linear parameters representing total length of the mandible were set: Ar-Me, Ar-Gn, Ar-Pg. We examined whether the parameters correlated and whether the shape of symphysis was changing, as well as whether we can measure the mandibular length related to any of the points without risk of different results due to the change of anterior and caudal surfaces of symphysis. To identify correlation between mean annual change of the mandibular length (Ar-Me, Ar-Gn, Ar- [email protected] 209

20 rocïnõâk24 ORTODONCIE pohlavõâ na 219 muzïuê (44%) a274 zïen (56 %). PruÊmeÏ rnyâ veï k muzïuêvcï ase T1 byl 17,72 ± 2,33 let s mediaâ nem 16,90 let. PruÊmeÏ rnyâ veï k muzïuêvcï ase T2 byl 20,21 ± 2,66 let s mediaâ nem 19,50 let. PruÊmeÏ rnaâ dobamezi dveï ma, ve studii pouzï ityâ mi, rentgenovyâ mi snõâmky byla 2,49 let. PruÊmeÏ rnyâ veïkzïenv cï ase T1 byl 17,77 ± 2,55 let s mediaâ nem 16,80 let. PruÊmeÏ rnyâ veïk zïen v cïase T2 byl 20,13 ± 3,00 let s mediaâ nem 19,10 let. PruÊmeÏ rnaâ dobamezi dveï ma, ve studii pouzï ityâ mi, rentgenovyâ mi snõâmky cï inila2,36 let. NejnizÏsÏ õâ mozïnyâ veï k pacienta pro zarïazenõâ pacienta do souboru byl fixneï stanoven na16 let. Hornõ veï kovaâ hranice zuê stala neomezenaâ. NejstarsÏõ veï k pacienta ve studii cï inil v cï ase T1 27,20 let u muzïuê a31,00 let u zïen, v cï ase T2 29,60 let u muzïuê a32,30 let u zïen. Da le byli jedinci kazïdeâ ho pohlavõâ rozdeï leni podle sagitaâ lnõâho vztahu cï elistõâ daneâho uâ hlem ANB v cïase zhotovenõâ prvnõâho bocï nõâho kefalometrickeâ ho snõâmku (T1) na: I. skeletaâ lnõâ trïõâda= hodnotaanb uâ hlu -1 azï +5, II. skeletaâ lnõâ trïõâda= hodnotaanb uâ hlu +5,1 avõâce aiii. skeletaâ lnõâ trïõâda= hodnotaanb uâ hlu -1,1 ameâ neï. PocÏ et muzïuê v I. skeletaâ lnõâ trïõâdeï cï inil 135 jedincuê, ve II. skeletaâ lnõâ trïõâdeï 55 jedincuê ave III. skeletaâ lnõâ trïõâdeï 29 jedincuê. PocÏetzÏen v I. skeletaâ lnõâ trïõâdeï cï inil 167 jedincuê,ve II. skeletaâ lnõâ trïõâdeï 77 jedincuê ave III. skeletaâ lnõâ trïõâdeï 30 jedincuê. Metodika ZjisÏ t'ovaâ no bylo, zdav postpubertaâ lnõâm obdobõâ: 1) dochaâzõâ k prïõâruê stkuê m dolnõâ cï elisti; 2) prïevlaâdaâ pruêmeï rnaâ ruê stovaâ anteriorotace dolnõâ cï elisti; 3) v intenziteï ruê stovyâch zmeï n dolnõâ cï elisti je v tomto obdobõâ rozdõâl mezi muzïiazï enami; 4) symfyâzadolnõâ cï elisti je v tomto obdobõâ tvaroveï stabilnõâ struktura; 5) intenzita ruê stu dolnõâ cï elisti se v postpubertaâ lnõâm obdobõâ lisï õâ mezi pacienty s I., II. nebo III. skeletaâ lnõâ trïõâdou. MeÏrÏenõ ruê stovyâch zmeï n bylo provaâdeï no u kazïdeâho ze 493 pacientuê nadvou daâ lkovyâ ch bocï nõâch kefalometrickyâ ch snõâmcõâch porïõâzenyâ ch v minimaâ lneï puê lrocï nõâm cï asoveâ m odstupu. VsÏ echny snõâmky byly zhotoveny naobou pracovisï tõâch tyâmzï prïõâstrojem PaX - Uni3D (Vatech, Vatech - Global, Korea) za standardnõâch podmõânek, se stejnou kalibracõâ na vsï ech snõâmcõâch, k vyloucï enõâ zkreslenõâ lineaâ rnõâch meï rïenõâ. Kefalometricka analyâ zabylaprovaâ deï nadigitaâ lneï v pocï õâta cï oveâ m programu OnyxCeph3 TM (Image Instruments, Chemnitz, NeÏ mecko) zamaximaâ lnõâho mozïneâ ho zveïtsï enõâ. Byly definovaâ ny akonstruovaâ ny naâ sledujõâcõâ kefalometrickeâ body a linie: Nasion (N), Sella (S), Articulare (Ar), Gonion (Go), Menton (Me), Mandibula rnõâ linie (ML), Gnathion (Gn), Pogonion (Pg), bod B, bod A. Po urcï enõâ kefalometrickyâ ch boduê bylo naobou bocï nõâch daâ lkovyâ ch rentgenovyâ ch snõâmcõâch kazï deâ ho pacienta provaâ deï no meï rïenõâ 5 lineaâ rnõâch a2 uâ hlovyâ ch parametruê blished. The oldest men were at T1, at T2; the oldest women were at T1, at T2. The patients were further subdivided according to sagittal jaw relationship given by ANB angle at T1 into: Skeletal Class I = ANB angle values between -1 and +5 ; Skeletal Class II = ANB angle values +5.1 and more; Skeletal Class III = ANB angle values -1.1 and less. There were 135 men in Skeletal Class I, 55 in Skeletal Class II, 29 in Skeletal Class III. There were 167 women in Skeletal Class I, 77 in Skeletal Class II, and 30 in Skeletal Class III. Method We aimed to answer the following questions: 1) Does the mandible continue to grow in late puberty; 2) Does moderate growth anteriorotation of the mandible prevail; 3) Are there any sex differences in terms of the mandible growth changes rate; 4) Is the mandible symphysis a stable structure in terms of its shape; 5) Are there differences in the mandible growth rate between Skeletal Classes I, II, and III? In each patient growth changes were measured in two distant lateral cephalograms taken at the minimum interval of 6 months. All scans in both workplaces were made with PaX-Uni3D (Vatech, Vatech-Global, Korea) under standard conditions, with the same calibration to avoid distortion of linear measurements. Cephalometric analysis was performed digitally with Onyx- Ceph3 TM software (Image Instruments, Chemnitz, Germany) in maximum magnification. The following cephalometric points and lines were set and constructed: Nasion (N), Sella (S), Articulare (Ar), Gonion (Go), Menton (Me), Mandibular line (ML), Gnathion (Gn), Pogonion (Pg), point B, point A. After the cephalometric landmarks were set measurements of 5 linear and 2 angular parameters were done: Ar-Go (height of the mandibular ramus in mm), Go-Me (length of the mandibular body in mm), Ar-Me, Ar-Gn, Ar-Pg (total length of the mandible in mm), ArGoMe (the gonion angle in degrees), Ar-Gn/ML (the Beta angle in degrees) (Fig. 1). Measurement error for both linear and angular parameters was set according the Dahlberg formula. All tests were performed at the level of significance p Statistical data were processed with MATLABÁ software, version R2013a (MathWorks, Inc., Massachusetts, USA). Since the follow-up period was different in each patient, the overall change was determined and converted into one year according to the formula:, [mm/year], where PRZ = mean annual change, M2 = measurement at T2, M1 = measurement at T [email protected]

21 ORTODONCIE rocïnõâk24 the differences in the mandible growth were not observed. The only exception was represented by changes in angular parameters in women (p 0.05). Conclusion: Growth changes of the mandible are evident even after the age of 16. This fact must be considered in timing of compensation and decompensation treatment of orthodontic anomalies or in planning of dental implants (Ortodoncie 2015, 24, No. 4, p ). KlõÂcÏ ovaâ slova: ruê st dolnõâ cï elisti, postpubertaâ lnõâ obdobõâ Key words: growth of the mandible, postpubertal period U vod Jednou z nejduê lezï iteï jsï õâch podmõânek ortodontickochirurgickeâ korekce skeletaâ lnõâch vad cï i zavedenõâ dentaâ lnõâch implantaâ tuê je dokoncï enyâ ruê st cï elistõâ. VeÏ tsï inou se v odbornyâch kruzõâch povazï uje ruêstcï elistõâ po probeïhleâ m pubertaâ lnõâm spurtu cï i ve veï ku 18 let zadokoncï enyâ. Jak vsï ak mnoheâ literaâ rnõâ zdroje uvaâ deï jõâ, ruê st cï e- listõâ nenõâ ani po pubertaâ lnõâm spurtu, aani po 18. roce veï ku zdaleka ukoncï enyâ apokracï uje, i kdyzï mnohem mensï õâ, ale vyâznamnou, mõârou i v dospeï losti [1, 2, 3, 4, 5]. Tento zaâveï r je nutno braât prïi plaâ novaâ nõâ samotneâ ortodontickeâ leâ cï by, co se stability vyâ sledku tyâcï e, cï i prïi chirurgickeâ korekci cï elistõâ nebo prïi zavaâdeï nõâ dentaâlnõâch implantaâtuêvuâ vahu. CõÂlem studie bylo zhodnotit, zdadochaâzõâk ruê stovyâm zmeïnaâ m nadolnõâ cï elisti v obdobõâ po maximaâ lnõâm ruêstoveâ m spurtu, jak jsou tyto zmeï ny intenzivnõâ, zdajsou rozdõâlneâ u muzï uê a u zï en azdase projevuje ruê stovaâ rotace dolnõâ cï elisti. DalsÏ õâm cõâlem bylo zhodnotit, zdase v tomto obdobõâ lisï õâ ruê stoveâ zmeï ny prïi ruê znyâ ch sagitaâ l- nõâch vztazõâch cï elistõâ. DõÂlcÏ õâm cõâlem, kteryâ vyplynul z volby metodiky, bylo oveï rïit, zdav tomto obdobõâ dochaâ zõâ k ruêstovyâm zmeïnaâ m tvaru symfyâzy dolnõâ cï elisti remodelacõâ jejõâho povrchu. MateriaÂl Pro potrïeby teâ to studie byli vyhledaâ ni ortodonticky leâ cï enõâ pacienti bõâleâ rasy s minimaâ lneï dveï mabocï nõâmi kefalometrickyâ mi rentgenovyâ mi snõâmky cï asoveï od sebe vzdaâ lenyâ mi minimaâ lneï 6 meï sõâcuê tak, aby prvnõâ snõâmek zhotovenyâ v cï ase T1 splnï oval naâ sledujõâcõâ kriteâria: zhotovenyâ v kalendaârïnõâm veï ku pacienta 16 let a vysï sï õâm, soucï asneï musely byâ t na ortopantomografickeâ m rentgenoveâ m snõâmku zhotoveneâ m ve stejneâm cï ase (T1) znatelneâ znaâ mky ukoncï enõâ ruê stoveâ ho pubertaâ l- nõâho spurtu podle ukoncï eneâ ho vyâ voje korïene dolnõâho sï picï aâ ku. Druhy bocï nõâ kefalometrickyâ snõâmek zhotovenyâ vcï ase T2 musel byât zhotoven minimaâ lneï 6meÏsõÂcuÊ po snõâmku zhotoveneâm v cï ase T1. Do studie nebyli zarïazeni pacienti se syndromovyâ m onemocneï nõâm sprïõâznaky v orofaciaâ lnõâ oblasti, pacienti s rozsï teï povyâ mi vadami, pacienti s onemocneïnõâmcï elistnõâho kloubu. VysÏ etrïovanyâ soubor celkem tvorïilo podle zadanyâch kriteâ riõâ 493 pacientuê, tj. 986 bocï nõâch rentgenovyâch kefalometrickyâ ch snõâmkuê. Pacienti byli rozdeï leni podle Introduction Finished growth of jaws is one of the most important prerequisites for orthodontic-surgical correction of skeletal anomalies and for introduction of dental implants. Growth of jaws is commonly considered as finished after the growth spurt or at the age of 18. However, a number of authors believe that jaws continue to grow in adulthood, though to a limited extent [1-5]. We should be aware of the fact when planning orthodontic treatment, surgical correction, and insertion of dental implants, as it influences the stability of results. The aim of the current study was to assess potential growth changes of the mandible after the maximum growth spurt, their rate, potential sex differences, and growth rotation of the mandible. We also evaluated growth changes in different sagittal jaw relationships. Another aim was to answer the question whether there are growth changes of the shape of mandibular symphysis resulting from its remodeling. Material The sample included orthodontic patients, Caucasians, with the minimum of two lateral cephalograms taken within the interval of 6 months. The first picture taken at time T1 met the following criteria: patient's age of minimum of 16 years; orthopantomogram taken at the same time (T1) shows obvious signs of finished growth spurt based on the finished development of lower canine root. The second cephalogram was taken at time T2 at least 6 months after the first one (T1). Patients with syndrome disease and symptoms in orofacial area, patients with clefts, and patients with temporomandibular joint disease were excluded from the study. The sample included 493 patients, i.e. 986 lateral cephalograms. There were 219 males (44%) and 274 females (56%). The mean age of male patients at T1 was ± 2.33, median = years, at T ± 2.66, median = years. The mean period between the two cephalograms was 2.49 years. The mean age of female patients at T1 was ± 2.55, median = years, at T ± 3.00, median = years. The mean length of the period between the two cephalograms was 2.36 years. The minimum age was set at 16 years, the upper age limit was not esta- [email protected] 207

22 rocïnõâk24 ORTODONCIE Postpuberta lnõâ ruê st dolnõâ cï elisti - retrospektivnõâ pruê rïezovaâ studie Postpubertal growth of the mandible - a retrospective cross-sectional study *MDDr. Michal SÏ õâr, *MUDr. Hana BoÈ hmovaâ, **Ing. Marek Patrice, Ph.D. * Ortodonticke oddeï lenõâ stomatologickeâ kliniky FN PlzenÏ * Department of Orthodontics, Clinic of Stomatology, University Hospital PlzenÏ ** Fakulta aplikovanyâch veïd,zaâ padocï eskaâ univerzita, PlzenÏ ** Faculty of Applied Sciences, University of West Bohemia PlzenÏ Souhrn CõÂl: CõÂlem studie bylo zhodnotit ruê st dolnõâ cï elisti u ortodontickyâ ch pacientuê v obdobõâ po maximaâ lnõâm ruê stoveâ m spurtu. MateriaÂl:Do studie bylo zahrnuto 493 ortodontickyâ ch pacientuê (219 muzïuê, 274 zïen ve veï ku let, pruêmeï rnyâ veï k 18,95 let) s ruê znyâ mi sagitaâ lnõâmi vztahy cï elistõâ stanovenyâ mi podle uâ hlu ANB. Do studie byli vybraâ ni pacienti, u kteryâ ch byly zhotoveny 2 kefalometrickeâ snõâmky v cï ase T1 a v cï ase T2 s minimaâ lnõâm odstupem 6 meïsõâcuê. Metodika: Na kefalometrickyâ ch snõâmcõâch byly v cï ase T1 a T2 zaznamenaâ ny hodnoty 5 lineaâ rnõâch a 2 uâ hlovyâch parametruê definovanyâ ch na dolnõâ cï elisti. Z pruê meï rnyâ ch rocï nõâch zmeï n teï chto meï rïenõâ byla sestavena ruê stovaâ krïivka pro jednotliveâ parametry a byla posuzovaâ na z hlediska pohlavõâ a skeletaâ lnõâch trïõâd. Vy sledky: PrÏõÂruÊ stky na dolnõâ cï elisti byly na zacïaâ tku sledovaneâ ho obdobõâ patrneâ u obou pohlavõâ. U muzïuê byly prïõâruê stky veï tsï õâ nezï u zï en. U zï en se ve veï ku let objevilo opeï tneâ zrychlenõâ ruê stu, naâ sledneï jizï nebyl ruê st prokazatelnyâ. Goniovy uâ hel se zmensï oval, uâ hel beta zveïtsï oval, dolnõâ cï elist tak celkoveï vykazovala tendenci k mõârneâ ruê stoveâ anteriorotaci. Nebyly pozorovaâ ny odlisï nosti v ruê stu dolnõâ cï elisti prïi rozdeï lenõâ pacientuê do jednotlivyâ ch skeletaâ lnõâch trïõâd. Vy jimkou byly zmeïnyvuâ hlovyâ ch parametrech u zïen (p 0,05). ZaÂveÏr:I po 16. roce veï ku dochaâ zõâ k prokazatelnyâmruê stovyâ m zmeïnaâ m na dolnõâ cï elisti. Tuto skutecï nost je trïeba zohlednit prïi nacï asovaâ nõâ kompenzacï nõâ i dekompenzacï nõâ leâ cï by ortodontickyâ ch anomaâ liõâ cï i zavedenõâ dentaâ lnõâch implantaâtuê (Ortodoncie 2015, 24, cï. 4, s ). Abstract Aims: Evaluation of mandibular growth in orthodontic patients following the pubertal growth peak. Material: The study included 493 orthodontic patients (219 males, 274 females) between the age of 16 to the age of 29 years (mean age = years) with various sagittal jaw relationships determined by ANB angle. In each patient 2 cephalograms were taken, one at time T1 another at T2, minimum 6 months interval between the scans. Method: In cephalograms taken at T1 and T2 five linear and two angular parameters were assessed. Growth curve for individual parameters based on mean values of annual growth changes was constructed. The curve was assessed from the point of view of sex and skeletal class. Results: At the beginning growth gains of the mandible were evident in both sexes. Growth gains in male patients were bigger than in females. Between the age of 21 and 23 years, there occurred accelerated growth in women; however, the subsequent growth was not proved. The gonion angle was diminishing, the Beta angle was increasing, and the mandible showed the tendency to moderate anteriorotation. In individual skeletal classes [email protected]

23 ORTODONCIE rocïnõâk24 Amer. J. Orthodont. dentofacial Orthop. 2012, 142, cï. 1, s Simons, M. E.; Joondeph, D. R.: Changes in overbite: A ten-year postretention study. Amer. J. Orthod. dentofacial Orthop. 1973, 64, cï. 4, s Huang, G. J.; Bates, S. H.; Ehlert, A. A.; Whiting, D. P.; Chen, S. S.; Bollen, A. M.: Stability of deep-bite correction: A systemic review. J. World Fed. Orthodont. 2012, 1, cï. 3, s. e89-e96. MDDr. Mina Poraghaee Stomatologicka klinika, 1. LF UK a VFN KaterÏinska 32, Praha 2 CÏ lenskyâ poplatek pro rok 2016 cï inõâ 2500,- KcÏ nebo 100,- 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 1000,- KcÏ za rok nebo 50,- 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. [email protected] 205

24 rocïnõâk24 ORTODONCIE vyâsledkuê leâcï by hlubokeâ ho skusu [18]. AutorÏi uvaâdõâ,zïe pacienti s anomaâ liõâ hlubokeâ ho skusu podstoupili relativneï uâ speïsï nou leâcïbuauveïtsï iny je vyâsledek stabilnõâ.- Da le se domnõâvajõâ, zïe pocïaâ tecïnõâ zaâvazïnost anomaâ lie prïõâmo ovlivnï uje dlouhodobou stabilitu leâ cï byazï evyâ sledek je stejnyâ bez ohledu nametodu pouzï itou prïi otevõâraâ nõâ skusu. I kdyzï jsme se v nasï õâ studii snazïili poskytnout urcï ityâ prïehled o uâ cï innosti dvou uvedenyâ ch metod, vyskytlo se neï kolik omezenõâ, kteraâ mohou ovlivnit vyâ sledky teâ to studie. Vy sledky mohly byâ t prïesneï jsï õâ amozï naâ s rozdõâlnyâm vyâsledkem v uâcï innosti obou metod, pokud bychom svou studii omezili navõâce homogennõâ vzorek pacientuê, ato prïedevsï õâm s ohledem nahodnoty skeletaâ lnõâch parametruê representujõâcõâ vertikaâ lnõâ konfiguraci pacientuê. ZaÂveÏr U obou zpuê sobuê leâcï by hlubokeâ ho skusu (frontaâ lnõâ naâ kusneâ plosï ky afixnõâ naâ kusnaâ deska) dochaâ zõâ u pacientuê beï hem leâ cï by k vyâ znamneâ uâ praveï. V uâ cï innosti leâ cï ebnyâ ch metod nebyly pozorovaâ ny zï aâ dneâ statisticky vyâ znamneâ rozdõâly. Proto s ohledem naskutecï nosti jakyâ mi jsou: negativnõâ ovlivneï nõâ rïecï i, obtõâzï e s udrzï enõâm optimaâ lnõâ dentaâ lnõâ hygieny afinancï nõâ vyâ daje, a takeâ na zaâ kladeï vyâ sledkuê nasï õâ studie, lze doporucï it pouzï iõât frontaâ lnõâch naâ kusnyâch plosï ek mõâsto fixnõâ naâ kusneâ desky, kdykoli je to mozïneâ. AutorÏi nemajõâ komercï nõâ, vlastnickeâ nebo financï nõâ zaâ jmy na produktech nebo spolecï nostech popsanyâ ch v tomto cïlaâ nku. Huang et al. to estimate the long term stability of deep bite correction [18]. Authors claim that patients with deep bite malocclusion appear to undergo relatively successful treatment, and most of the correction appears stable. The authors also observed that initial severity is related to the long-term stability and the outcome is the same, regardless of the method used in opening the bite. Although this study attempted to provide some views on the effectivity of two presented methods, there are several limitations which can bring the risk of bias to the results of this study. There could be more precise and maybe different results in the effectivity of each method if we have restricted the study to the more homogeneous sample of patients, especially regarding the values of skeletal variables representing the vertical configuration. Conclusion With both methods of deep bite treatment (anterior fixed bite blocks and fixed biteplate), patients show considerable correction of deep bite. No statistically significant differences in the effectivity of each method were observed. Considering the facts such as speech impairment, difficulties to maintain optimal hygiene and expenses, and based on the results of our study, we may recommend to use fixed bite blocks instead of fixed biteplate whenever possible. The authors have no commercial, ownership or financial interests in the products or companies mentioned in the article. Literatura/References 1. Proffit, W. R.; Fields, H. W.: Contemporary orthodontics. 4th ed., St.Louis: Mosby, KamõÂnek, M.: Ortodoncie. Olomouc: Gale n, Nanda, R.: Esthetics and Biomechanics in Orthodontics. 2nd ed., St. Louis: Saunders, Joseph, G.; Anthony, T.; Ramzi, V.: Deep bite: Treatment options and challenges. Semin. Orthodont. 2013, 19, cï. 1, s KamõÂnek, M.; SÏ tefkovaâ, M.: VedlejsÏ õâ uâ cï inky fixnõâch aparaâ tuê, chyby ajejich odstranovaâ nõâ zvysï ovaâ nõâ skusu. Ortodoncie 1996, 5, cï. 1, s Richard, A.; Welsh, A. H.; Donnelly, C.: The association between occlusion and attrition. Aus. Orthodont. J. 1992, 12, cï. 3, s PantoflõÂcÏ kovaâ -EffenberkovaÂ, D.; Kot'ovaÂ, M.; Petr, J.: Fixnõ naâ kusnaâ desticï ka prïõâ terapii hlubokeâ ho skusu. Ortodoncie 2006, 15, cï. 3, s Lema kovaâ, J.; SÏ tefkovaâ, M.: Vliv hloubky skusu naprostor pro dolnõâ frontaâ lnõâ zuby. Ortodoncie 2001, 10, cï. 3, s Sreedhar, C.; Sreenivas, B.: Deep overbite-a review. Annals and Essences of Dentistry 2009, 1, cï. 1, s Chen, Y. J.; Yao, C. C.; Chang, H. F.: Nonsurgical correction of skeletal deep overbite and Class II division 2 malocclusion in an adult patient. Amer. J. Orthodont. dentofacial Orthop. 2004, 126, cï. 3, s Clark, J. W.: Twin block functional therapy. Edinbugh: Mosby, McLaughlin, R. P.; Bennett, J. C.; Trevisi, H. J.: Systemized orthodontic treatment mechanics. Edinburgh: Mosby, Wylie, W. L.: Overbite and vertical facial dimensions in terms of muscle balance. Angle Orthodont. 1944, 14, cï. 1, s Hellsing, E.; Hellsing, G.; Eliasson, S.: Effect of fixed anterior biteplane therapy-a radiographic study. Amer. J. Orthodont. dentofacial Orthop. 1996, 110, cï. 1, s Pollard, D.; Akyalcin, S.; Wiltshire, W. A.; Wellington, J. R.: Relapse of orthodontically corrected deepbites in accordance with growth pattern. Amer. J. Orthodont. dentofacial Orthop. 2012, 141, cï. 4, s Baccetti, T.; Franchi, L.; Giuntini, V.; Masucci, C.; Vangelisti, A.; Defraia. E.: Early vs late orthodontic treatment of deepbite: A prospective clinical trial in growing subjects [email protected]

25 ORTODONCIE rocïnõâk24 kacõâch svaluê, ato zejmeâ nau pacientuê s nõâzkyâm uâ hlem mandibulaâ rnõâ linie. KromeÏ toho je nestabilnõâ u nerostoucõâch jedincuê, jelikozï extrudovaneâ lateraâ lnõâ zuby mohou ovlivnit klidovou mezeru [14, 15]. PrÏekla danaâ studie se zabyâ vala srovnaâ nõâm uâ cï innosti zvysï ovaâ nõâ skusu pomocõâ fixnõâ naâ kusneâ desky afrontaâ l- nõâch naâ kusnyâch plosï ek fixovanyâch na palatinaâ lnõâ plochy hornõâch strïednõâch rïezaâkuê. ObeÏ mametodami lze snizï ovat hloubku skusu, a to kombinacõâ extruze lateraâ l- nõâch zubuê aintruze dolnõâch rïezaâkuê. CõÂlem teâ to studie bylo zjistit uâcï innost zvysï ovaâ nõâ skusu vyuzï itõâm teï chto dvou leâcï ebnyâch metod aprokaâ zat, zda je leâcï bas vyuzïitõâm jedneâ cï i druheâ metody uâcï inneïjsïõâ.vteâ to studii nebyl shledaâ n teâ meï rï zï aâ dnyâ rozdõâl ve vyâ sledku leâ cï by teï chto dvou leâ cï ebnyâch prïõâstupuê prïi snizï ovaâ nõâ mõâry hloubky skusu. U obou metod byl prokaâzaân uâcï inek nazmensï enõâ rozsahu hloubky skusu po leâcï beï. Pacienti skupiny B, kterïõâ byli leâcï eni fixnõâ naâ kusnou deskou, meï li nizïsïõâ hodnoty uâ hlu mandibulaâ rnõâ linie amezicï elistnõâho uâ hlu prïed zahaâ jenõâm leâcï by, cozï ukazuje na zaâvazïneïjsï õâ skeletaâ lnõâ podklad hloubky skusu u teâ to skupiny. Je duê lezï iteâ zmõânit i to, zïeuâcï innost leâcï ebneâ metody nemuêzïebyât hodnocenapouze v zaâ vislosti navyâ sledcõâch leâ cï by, ale inazaâ kladeï zohledneï nõâ trvaâ nõâ doby daneâ leâcï ebneâ varianty a financï nõâch naâ kladech.z hlediska financï nõâho je fixnõâ naâ kusnaâ deskanaâ kladneï jsï õâ nezï varianta frontaâlnõâch naâ kusnyâch plosï ek. S ohledem nadeâ lku trvaânõâ leâ cï by, je obvykle dostatecï neï uâ cï inneâ nosit fixnõâ naâ kusnou desku 3-5 meï sõâcuê, zatõâmco frontaâ lnõâ naâ kusneâ plosïkybymeïlybyât v uâ stech ponechaâ ny nejleâpeazïdo doby ukoncï enõâ leâcï by [2, 7]. Vzhledem ke skutecï nostem, jako jsou potõâzï e prïi mluvenõâ audrzï enõâ optimaâ lnõâ hygieny beï hem nosï enõâ fixnõâ naâ kusneâ desky, aprïi stejneâm uâ speï chu prïi uâ pravy hloubky skusu za pomoci obou metod, jevõâ se u pacientuê s hlubokyâ m skusem jako vhodneï jsï õâ pouzï õât jako leâ cï ebnou variantu frontaâ lnõâ naâ kusneâ plosï ky nezï fixnõâ naâ kusnou desku. ZvysÏ ovaâ nõâ skusu pomocõâ frontaâ lnõâch naâ kusnyâ ch plosï ek je oproti fixnõâ naâ kusneâ desce takeâ meâ neï cï asoveï naâ rocï neâ pro ortodontistu, rovneï zï snizï uje naâ roky naspolupraâ ci s laboratorïõâ, kteraâ je prïi pouzï itõâ fixnõâ naâ kusneâ desky nutnostõâ. Toto jsou pro ortodontisty vyâ znamnaâ fakta pro to, aby daâ vali prïednost prïi zvysï ovaâ nõâ skusu frontaâ lnõâm naâ kusnyâm plosïkaâ m, je-li to mozïneâ. Ota zkadlouhodobeâ stability jednotlivyâch leâcï ebnyâ ch metod nenõâ zcelajasnaâ. Dlouhodoba stabilita vyâsledkuê leâcïby muêzïe byât jednõâm z duê lezïityâch faktoruê, ktereâ prïispõâvajõâ ke stanovenõâ efektivnõâho leâ cï ebneâ ho postupu. Mnozõ autorïi astudie uvaâ dõâ hlubokyâ skus jako anomaâ lii, kteraâ je naâ chylnaâ k recidiveï atakeâ nenõâ znaâ mo, kteryâ typ leâcï by je tõâm nejuâcï inneïjsï õâm astabilnõâm [1, 10, 16, 17]. V roce 1966, azï do roku 2012 probõâhala studie nauniverziteï ve Washingtonu vedenaâ Huangem et al., kteraâ se zabyâ vala dlouhodobou stabilitou strong muscles of mastication especially in low angle patients. In addition, it is less stable in non-growing individuals as the extruded posterior teeth would impinge on the freeway space [14, 15]. The presented study compared the effectivity of raising the bite with fixed biteplate, opposed to anterior fixed bite blocks on the palatal surfaces of central incisors. Both methods reduce the deep overbite by acombination of extrusion of the teeth in lateral segments, and intrusion of the lower incisors. The aim of this study was to find out the effectivity of raising the bite using these two modalities, whether one method is more effective than the other. In this study considering the reduction in amount of deep bite, almost no difference between the treatment outcomes of the two methods was observed. Both methods showed effective reduction in amount of deep bite after treatment. However, subjects of group B, who were treated by fixed biteplate, presented smaller values in NSML and NLML angles which implicates more pronounced skeletal deep bite configuration in this group prior to treatment. It is good to mention that effectivity of a treatment method must be evaluated by not only based on the treatment outcomes, but also considering the duration of that specific treatment approach and the cost. From the financial point of view, fixed biteplate is more expensive than the anterior fixed bite blocks. Considering the duration of the treatment, it is usually sufficient to wear a fixed biteplate for 3-5 months, while anterior fixed bite blocks are best to be left in the mouth up until nearly the end of the treatment [2, 7]. Considering the facts such as difficulties in talking and keeping an optimal hygiene while wearing the fixed biteplate, and having the same success in opening the bite with both methods (fixed biteplate vs. fixed anterior bite blocks), it is preferable to use the fixed anterior bite blocks as an treatment option for deep bite patients rather than fixed biteplate. It is also less time consuming for the orthodontist to raise the bite by installing anterior fixed bite blocks rather than installing the fixed biteplate. Use of the anterior fixed bite blocks also eliminates the cooperation with the laboratory which is needed in case of fixed biteplate. These are the comforting facts for the orthodontist to prefer using of anterior fixed bite blocks in raising the bite, whenever possible. The long-term stability of both of these methods is not quite clear. Long-term stability of treatment results can be one of the important factors which contribute to the efficacy and efficiency of a treatment modality. Many authors and studies listed deep bite as a malocclusion which is prone to relapse and also that it is unknown which types of correction are the most efficient or stable [1, 10, 16, 17]. In 1966 till 2012 there was a study in University of Washington done by [email protected] 203

26 rocïnõâk24 ORTODONCIE Tab. 1. SkupinaA (leâcï enafrontaâ lnõâmi skusovyâmi desticï kami ) vs. skupina B (leâcï enafixnõâ naâ kusnou deskou) prïed (T0) apo (T1) leâcïbeï Tab. 1. Group A (treated by anterior fixed bite blocks) vs. group B (treated by fixed biteplate) before (T0) and after (T1) treatment RozmeÏr, Skupina, group A Skupina, group B Diff. measurement (mean ± SD) (mean ± SD) (mean ± SD) p NSML [ ] ± ± ± NLML [ ] ± ± ± T0 NMe [mm] ± ± ± OB [mm] 6.10 ± ± ± SGo/NMe [%] ± ± ± NSML [ ] ± ± ± NLML [ ] ± ± ± T1 NMe [mm] ± ± ± OB [mm] 3.47 ± ± ± SGo/NMe [%] ± ± ± Mean - pruê meï r, SD - smeï rodatnaâ odchylka, standard deviation. Statisticky vyâznamneâ rozdõâly jsou oznacï eny cï erveneï. Statistically significant differences are marked in red. VsÏ echny testy jsou nauâ rovni statistickeâ significance p < 0,05. All tests were performed at the level of statistical significance of p < Tab. 2. SkupinaA (leâcï enafrontaâ lnõâmi naâ kusnyâmi plosï kami) a skupina B (leâcï enafixnõâ naâ kusnou deskou) prïed (T0) apo leâcïbeï (T1) Tab. 2. Group A (treated by anterior fixed bite blocks) and Group B (treated by fixed biteplate) before (T0) and after (T1) treatment Skupina, RozmeÏr, T0 T1 Diff. group measurement (mean ± SD) (mean ± SD) (mean ± SD) p NSML [ ] ± ± ± NLML [ ] ± ± ± A NMe [mm] ± ± ± OB [mm] 6.10 ± ± ± SGo/NMe [%] ± ± ± NSML [ ] ± ± ± NLML [ ] ± ± ± B NMe [mm] ± ± ± OB [mm] 5.98 ± ± ± SGo/NMe [%] ± ± ± Mean - pruê meï r, SD - smeï rodatnaâ odchylka, standard deviation. Statisticky vyâznamneâ rozdõâly jsou oznacï eny cï erveneï. Statistically significant differences are marked in red. VsÏ echny testy jsou nauâ rovni statistickeâ significance p < 0,05. All tests were performed at the level of statistical significance of p < Tabulka 3. Porovna nõâ zmeïnbeï hem leâcï by u skupiny A (leâcï eneâ frontaâ lnõâmi skusovyâmi desticï kami) a u skupiny B (leâcï eneâ fixnõâ naâ kusnou deskou) Table 3. Comparison of changes during treatment in group A (treated by anterior fixed bite blocks) and group B (treated by fixed biteplate) RozmeÏr, Change in A (T0-T1) Change in B (T0-T1) measurement (mean ± SD) (mean ± SD) p NSML [ ] 0.41 ± ± NLML [ ] 0.61 ± ± NMe [mm] 6.54 ± ± OB [mm] ± ± SGo/NMe [%] 0.70 ± ± VsÏ echny testy jsou nauâ rovni statistickeâ significance p < 0,05. All tests were performed at the level of statistical significance of p < ZmeÏ ny nalezeneâ u zkoumanyâ ch parametruê v pruêbeï hu ortodontickeâ leâcï by (T0-T1) mezi skupinou leâcï e- nou pomocõâ frontaâ lnõâch naâ kusnyâ ch plosï ek (skupina A) apomocõâ fixnõâ naâ kusneâ desky (skupinab) nebyly statisticky signifikantnõâ. Diskuse Hluboky skus je jednou z nejcï asteï jsï õâch ortodontickyâch anomaâ liõâ stejneï tak, jako je velkou vyâzvou i pro zkusï eneâ ho ortodontistu. K jeho leâcï beï lze vyuzïõât ruê zneâ leâ cï ebneâ metody, ktereâ pracujõâ zejmeâ nas extruzõâ lateraâ lnõâch zubuê aintruzõâ frontaâ lnõâch zubuê nebo kombinacõâ obou v zaâ vislosti napovaze prïõâtomneâ ho nesouladu [3, 13]. U prava hlubokeâ ho skusu extruzõâ lateraâ lnõâch zubuê je naâ rocïnaâ, protozï e je vystavena puê sobenõâ silnyâchzïvyâ- The changes found during the orthodontic treatment (T0-T1) in patients treated by by anterior bite blocks (group A) and fixed biteplate (group B) were not statistically significantly different between groups. Discussion Deep bite is one of the most common components of a malocclusion as well as a major challenge even for a competent orthodontist. It can be corrected with various treatment modalities which work mainly to extrude the posterior teeth, and intrude the anterior teeth or a combination of both, depending upon the nature of the existing discrepancy [3, 13]. It has been documented that the correction of a deep bite by extrusion of posterior teeth is difficult to accomplish as it is opposed by [email protected]

27 ORTODONCIE rocïnõâk24 NMe: prïednõâ oblicï ejovaâ vyâsï ka, vzdaâ lenost mezi body nasion (N) a menton (Me) SGo/NMe: pomeï r mezi zadnõâ (SGo) a prïednõâ oblicï e- jovou vyâsï kou (NMe) VsÏ echnameï rïenõâ byla zaznamenaâ nado souboru Excel apopsaâ napomocõâ metod popisneâ statistiky (pruê meï r, smeï rodatnaâ odchylka, mediaâ n, maximum, minimum). Pro oveï rïenõâ normality rozlozï enõâ dat u vsï ech promeï nnyâch v obou skupinaâ ch byl pouzïit Shapiro- Wilk test, kteryâ ukaâ zal na normaâ lnõâ rozlozïenõâ dat. Z tohoto duê vodu byly pouzï ity metody parametrickeâ statistiky. Ke stanovenõâ mõâry skeletaâ lnõâ hloubky skusu byl ve stupnõâch hodnocen uâ hel mezi liniõâ dolnõâ cï elisti (ML) aliniõâ Nasion-Sela(NS). RozdõÂly mezi hodnotami v cï asech T0 a T1 v raâ mci teâ zï e skupiny byly analyzovaâ ny pomocõâ StudentovapaÂrove ho t-testu, rozdõâly mezi skupinami pak pomocõâ nepaâ roveâ ho Studentovat-testu. Vy sledky byly vyhodnoceny jako statisticky vyâ znamneâ pro p < RozdõÂly uvnitrï skupiny byly analyzovaâ ny paâ rovyâ m StudentovyÂm t-testem. VyÂsledky byly zpracovaâ ny jako pruêmeïr ± S.D. (smeï rodatnaâ odchylka). Pro stanovenõâ chyby meï rïenõâ byly meï sõâc po prvnõâm meïrïenõâ znovu prïekresleny kefalometrickeâ snõâmky 20 naâ hodneï vybranyâ ch pacientuê ajako metodapro vyâ pocï et chyby meïrïenõâ byl pouzï it DahlberguÊ v vzorec. Naza kladeï Dahlbergova vzorce byla chyba meïrïenõâ nejvysïsï õâ pro uâ hel NLML, ato 1,08 apro mõâru hloubky skusu 0,99 mm. Vy sledky Porovna nõâ hodnot zkoumanyâ ch promeï nnyâ ch mezi skupinami A a B prïed (T0) apo (T1) leâcïbeï jsou uvedeny v tabulce 1. Hodnoty zkoumanyâ ch parametruê arozdõâly hodnot v raâ mci skupiny A ab prïed leâcï bou (T0) apo leâcïbeï (T1) jsou uvedeny v tabulce 2. Tabulka 3 pak uvaâ dõâ srovnaâ nõâ pruê meï rnyâ ch zmeï n mezi obeï maskupinami prïed leâcï bou (T0) apo nõâ (T1). Mezi skupinou A ab byly prïed leâcï bou (T0) i po leâcïbeï (T1) prokaâ zaâ ny vyâ razneâ rozdõâly u hodnot: uâ hel mandibulaâ rnõâ linie (NSML), mezicï elistnõâ uâ hel (NLML), prïednõâ oblicï ejovaâ vyâsï ka(nme), pomeï r zadnõâ a prïednõâ oblicï e- joveâ vyâsï ky (SGo/NMe) (Tab. 1). Skeleta lnõâ podklad hlubokeâ ho skusu byl tak u skupiny pacientuê leâcï enyâch fixnõâ naâ kusnou deskou (skupinab) vyâ razneï jsï õâ nezï u skupiny pacientuê, u kteryâch byly v leâcïbeï hlubokeâ ho skusu pouzï ity frontaâ lnõâ naâ kusneâ plosï ky (skupinaa). Le cï bou pomocõâ fixnõâch ortodontickyâ ch aparaâ tuê dosï lo u obou skupin k vyâ razneâ a statisticky signifikantnõâ uâ praveï hloubky skusu (OB) aprodlouzï enõâ prïednõâ oblicï ejoveâ vyâsï ky (NMe). ZmeÏ ny ostatnõâch parametruê pa k v raâ mci jednotlivyâ ch skupin nebyly statisticky signifikantnõâ (Tab. 2). NMe: anterior facial height, distance between nasion (N) and menton (Me) SGo/NMe: ratio between posterior (SGo) and anterior facial height (NMe) All measurements were collected and imported into Excel file and described by the means of descriptive statistics (mean, standard deviation, median, maximum, minimum). An exploratory test (Shapiro-Wilks test) revealed normality of the distribution for all variables within each group. Therefore, parametric statistics was used. The inclination of mandibular plane (ML) to Nasion-Sella (NS) line in degrees was used to determine the amount of skeletal deep overbite. In-group differences were analyzed by paired Student's t-test, inter-group differences by non-paired Student's t-test. Data were recognized as significant for p < Intragroup differences were analyzed by paired Student's t-test. Data are reported as mean ± S.D. For determining the amount of measurement error, lateral cephalometric pictures of 20 randomly selected patients were traced again one month after the first measurement and Dahlberg's formula was used as a method to calculate the errors of the measurements. According to Dahlberg's formula the error of the measurement was highest for NLML angle 1.08 degree, and for the amount of overbite 0.99 mm. Results Deep bite reduction was observed (on average deep bite reduction in group A was measured -2,6 mm and in group B -2,2 mm) in both groups after debonding of fixed orthodontic appliances. The comparisons of the variables evaluated in both groups before (T0) and after treatment (T1) are shown in Table 1. Values and differences within both the groups before (T0) and after (T1) the treatment are shown in Table 2. The average difference between the evaluated variables between both groups is represented in Table 3. Statistically significant differences between group A and group B before treatment were found in values: the mandibular plane angle (NSML), the interjaw-base angle (NLML), the total anterior face height (NMe), the ratio of posterior facial height to anterior facial height (SGo/NMe) (Tab. 1). The underlying skeletal deep bite malocclusion was thus more pronounced in patients treated by fixed biteplate (group B) compared to patients treated by anterior bite blocks (group A). According to our results, both approaches in treatment of deep overbite were effective in reducing the deep overbite (OB) and increasing the anterior facial height (NMe) as both these values changed significantly in both groups. No statistically significant changes were found for the other variables (Tab. 2). [email protected] 201

28 rocïnõâk24 ORTODONCIE Fig. 2 a) Fixnõ naâ kusnaâ deskab) skus s naâ kusnou deskou. Fig. 2. a) Fixed biteplate, b) the bite with the fixed biteplate. Fixnõ naâ kusneâ desky byly vyrobeny naâ sledujõâcõâm postupem: po nasazenõâ molaâ rovyâ ch krouzï kuê naprvnõâ staâleâ molaâ ry je zhotoven otisk hornõâho zubnõâho oblouku aodeslaâ n do laboratorïe. V laboratorïi pokryje zubnõâ laborant palatinaâ lnõâ plochy hornõâch rïezaâkuê na saâ droveâ m modelu voskem. Vosk je vyuzï it k vyznacï enõâ rozsahu naâ kusneâ desky. PryskyrÏicÏ naâ naâ kusnaâ deskaje vymodelovaâ narozprasï ovacõâ technikou a pevneï prïipojenak molaâ rovyâm krouzïkuê m pomocõâ draâ tu tlousït'ky 0,8 mm. Baze dosahuje zhruba poloviny vyâsï ky palatinaâlnõâch ploch hornõâch rïezaâkuê. Po polymerizaci pod tlakem je pryskyrïicï naâ naâ kusnaâ deskavylesï teï na. Po nasazenõâ naâ kusneâ desky, veï nujeme pozornost interokluznõâ mezerïe lateraâ lneï (Obr. 2). Interokluznõ mezeraby nemeï la byât po nasazenõâ naâ kusneâ desky veïtsï õâ nezï 3-4 mm, jinak jazyk tlacï õâ nalateraâ lnõâ zuby atõâm braâ nõâ v jejich extruzi [7]. DobaleÂcÏ by naâ kusnou deskou u nasï ich pacientuê se pohybovala mezi 3-5 meï sõâci. Materia l zahrnoval bocï nõâ kefalometrickeâ rentgenoveâ snõâmky v dobreâ kvaliteï, ktereâ byly zhotoveny na dvou ruê znyâ ch rentgenovyâ ch prïõâstrojõâch s kalibracï nõâm meïrïõâtkem. Kefalometricke snõâmky byly vyhodnocovaânyuvsï ech pacientuê ve dvou cï asovyâch bodech, prïed zapocï etõâm leâcï by (T0) aihned po sejmutõâ ortodontickyâ ch aparaâ tuê (T1). Analy zavsï ech kefalometrickyâ ch snõâmkuê bylaprovedenav PC softwaru Onyx (Onyx- Ceph3TM, Image Instruments GmbH, Chemnitz, NeÏmecko). VsÏ echny analyâ zy i vyhodnocenõâ danyâ ch rentgenovyâ ch snõâmkuê provaâ deï lastejnaâ osoba. Byly meïrïeny celkem 2 lineaâ rnõâ, 2 uâ hloveâ a1 pomeï rnaâ promeï nnaâ. Linea rnõâ meï rïenõâ bylaprïepocï tenadle zveï t- sï enõâ aprïõâtomneâhomeï rïõâtka na RTG tak, aby prïedstavovala skutecïnyâ rozmeï r. Seznam meïrïenõâ byl naâ sledujõâcõâ: NSML: uâ hel mandibulaâ rnõâ linie, uâ hel mezi liniemi NS aml OB: hloubkaskusu, vzdaâ lenost mezi incisale superius aincisale inferius nakolmici k funkcï nõâ okluzaâ lnõâ linii NLML: mezicï elistnõâ uâ hel, uâ hel mezi liniemi NL aml The fixed biteplates were manufactured as follows: After fixing the molar bands on the first molars an impression of upper arch is taken and sent to the lab. In the lab, the technician covers the palatal surface of the upper incisors on the plaster model with the wax. The wax is used to mark the extent of the bite plate. Resin bite base\plateau was formed with spray-on technique and it was connected to mm wire which can be attached to the molar bands. The base reaches about half of the height of palatal surfaces of the upper incisors. After polymerization under pressure the acrylic bite plate will be polished. After bonding the bite plate, we took care of interocclusal gap which occurs laterally. Interocclusal gap after installing the fixed bite plate should not be more than 3-4 mm [7], otherwise the tongue will push on the lateral teeth and prevent their extrusion (Fig. 2). Fixed bite plate treatment duration for our cases was between 3 to 5 months. Material consisted of lateral cephalograms of good quality, made on 2 different X-ray machines with a calibration ruler visible. Lateral cephalograms were evaluated in all subjects in 2 time points, prior to treatment (T0) and immediately after removing the orthodontic appliances (T1). All cephalograms were traced in Onyx computer software (OnyxCeph3TM, Image Instruments GmbH, Chemnitz, Germany). All tracings and evaluations were performed by the same operator. A total of 2 linear, 2 angular and 1 ratio variables were measured. Linear measurements were recalculated according to magnification of the X-ray to represent life size. List of the measurements were as follows: NSML: mandibular plane angle, angle between NS and ML planes OB: overbite, distance between incisale superius and incisale inferius on a line perpendicular to the functional occlusal plane NLML: interjaw-base angle, angle between NL and ML planes [email protected]

29 ORTODONCIE rocïnõâk24 sï kami a prokaâ zat, zda je leâcï bas vyuzïitõâm jedneâ cï i druheâ metody uâcï inneïjsïõâ. Materia l a metodika Zkoumany vzorek pacientuê se sklaâ da l ze zaâ znamuê pacientuê leâ cï enyâ ch naortodontickeâ m oddeï lenõâ 1. LF UK v Praze a ze soukromeâ praxe MUDr. Petra Jindry, Ph.D. VsÏ ichni jedinci zahrnutõâ do studie byli leâcï eni pro hlubokyâ skus (kdy hloubkaskusu bylaveï tsï õâ nezï 60 %), bud' pomocõâ fixnõâ naâ kusneâ desky nebo frontaâ l- nõâch naâ kusnyâch plosï ek spolu s nasazenyâmi fixnõâmi aparaâ ty, byli bõâleâ rasy a meï li kompletnõâ prïedleâ cï ebnou i poleâcï ebnou dokumentaci. VsÏ ichni jedinci meï li prïõâtomny vsï echny hornõâ adolnõâ rïezaâ ky adolnõâ staâleâ molaâ ry. Do studie nebyli zahrnuti jedinci s kraniofaciaâ lnõâmi syndromy, cystami, rozsïteï py rtu a patra, s naâ sledky traumatickyâ ch poraneï nõâ v oblicï eji cï i naprïednõâch zubech nebo mnohocï etnyâmi arozsaâ hlyâmi kazy, prïõâp. obojõâm. Celkem bylo do studie zahrnuto 46 osob (26 zï en, 20 muzïuê). Pacienti byli rozdeï leni do dvou skupin. Jednaskupina (skupina A) zahrnovala 24 pacientuê (14 zïen a10 muzïuê ) s hlubokyâm skusem, kterïõâ byli leâcï eni pomocõâ frontaâ lnõâch naâ kusnyâ ch plosï ek (frontaâ lnõâ naâ kusy). Jejich pruêmeï rnyâ veï k byl 16 let (v celkoveâ m rozmezõâ let). Fronta lnõâ naâ kusneâ plosï ky byly vymodelovaâ ny prïõâmou technikou na palatinaâ lnõâch plochaâ ch hornõâch strïednõâch rïezaâ kuê. MuÊ zï eme k tomu vyuzï õât rïadu materiaâluê, jako naprïõâklad: Bandlock (Reliance), Transbond plus (3M Unitek) nebo Ortho band paste (GC Fuji). StejneÏ ta k muê zï eme pouzï õât i skloionomernõâ cementy apryskyrïici Spofacryl. Pod obchodnõâm naâ zvem Bite Guide (Ortho Organizer) cï i Bite Turbos (Ormco) lze rovneï zï pro aplikaci na strïednõâ rïezaâ ky vyuzï õât prefabrikovaneâ kovoveâ naâ kusneâ plosï ky [11, 12] (Obr. 1). Druha skupina (skupina B) zahrnovala 22 pacientuê (12 zïen a10 muzïuê ), kterïõâ byli leâcï eni pomocõâ fixnõâ naâkusneâ desky. Jejich pruêmeï rnyâ veï k byl 16 let (v celkoveâ m rozmezõâ let). cing deep overbite, whether one method is more effective than the other in deep bite treatment. Material and methods The examined sample consisted of the records of patients of Orthodontic department of the First medical faculty of Charles University in Prague, and from private practice of MUDr. Petr Jindra, Ph.D. The subjects enrolled in the study were all treated for deep bite (OB more than 60%) with either fixed biteplate or anterior fixed bite blocks and full fixed orthodontic appliances. Patients were of caucasian origin and had a complete set of pretreatment and post-treatment records. All the maxillary and mandibular incisors and the mandibular permanent molars were present in all subjects. Subjects with craniofacial syndromes, cysts, cleft lip or palate, sequelae of traumatic injuries to the face or anterior teeth or multiple or advanced caries (or both) were not included in the study. Together 46 subjects (26 females, 20 males) were enrolled into the study. The patients were divided in two groups. One group (group A) consisted of 24 patients (14 female and 10 male patients) who were treated for deep bite with anterior fixed bite blocks. Their average age was 16 years (range years). Anterior fixed bite blocks were made with direct technique on palatal surfaces of maxillary central incisors. Number of materials can be used such as: Bandlock (Reliance), Transbond plus (3M Unitek), or Ortho band paste (GC Fuji). Other glass-ionomer cements and resin Spofacryl may be used as well (8). Also small prefabricated metallic bite blocks on the central incisors are found under trade names Bite Guide (Courtesy of Ortho Organizer) or Bite Turbos (Ormco) [11, 12] (Fig. 1). The second group (group B) consisted of 22 patients (12 females and 10 males) who were treated by fixed biteplates. Average age was 16 years (range years). Obr. 1. Fronta lnõâ naâ kusneâ plosï ky, a) adhezivnõâ kompositum, b) frontaâ lnõâ naâ kusneâ plosïky Fig. 1. Anterior fixed bite blocks, a) adhesive composite, b) anterior fixed bite blocks [email protected] 199

30 rocïnõâk24 ORTODONCIE U vod JednõÂm z nejcï asteï ji se vyskytujõâcõâch probleâmuê prïi leâ cï beï ortodontickyâ ch pacientuê, hned po steï snaâ nõâ, je nadmeï rnaâ hloubkaskusu [1,2]. Hluboky skus je anomaâ lie, kdy jsou võâce nezï dveï trïetiny labiaâ lnõâch ploch dolnõâch rïezaâkuêprïekryty hornõâmi rïezaâ ky. V krajnõâch prïõâpadech nakusujõâ dolnõâ rïezaâ ky do oblasti krcï kuê hornõâch rïezaâkuêaprïõâpadneï napatrovou sliznici [2]. Zaidea lnõâ hloubku skusu v centraâ lnõâ okluzi povazïujeme stav, kdy hornõâ rïezaâ ky prïekryâ vajõâ 5-25 % vestibulaâ rnõâch ploch dolnõâch rïezaâkuê, cozï ve veï tsï ineï prïõâpaduê prïedstavuje prïiblizïneï 2-4 mm. Hloubkaskusu je v neïkteryâch pramenech definovaânanaâ sledovneï : 5-25 % - hloubkaskusu je v normeï, % - hloubkaskusu je zvyâsï enaâ,> 40 % -hloubkaskusu je nadmeï rnaâ [3]. U pravy hlubokeâ ho skusu je zpravidla dosazï eno komplexnõâ ortodontickou leâ cï bou. Pro dosazï enõâ optimaâ lnõâch vyâ sledkuê je nutnaâ pecï livaâ diagnoâ zaspolu s vhodnyâm leâcï ebnyâm plaâ nem [3, 4]. Atraumaticky hlubokyâ skus jako jedinaâ prïõâtomnaâ ortodontickaâ vada obvykle saâ m o sobeï nenõâ indikacõâ pro ortodontickou leâ cï bu, ale zvysï ovaâ nõâ hloubky skusu je nezbytnou soucï aâ stõâ ortodontickyâ ch postupuê a je prïedpokladem pro uâ speï sï neâ zvlaâ dnutõâ leâ cï by rïady anomaâ liõâ. Bez uâ pravy hloubky skusu naprïõâklad nenõâ mozïneâ zmensï it incizaâ lnõâ schuê dek a retrudovat protrudovaneâ hornõâ rïezaâ ky; nemuê zï eme zarïadit do zubnõâho oblouku retinovaneâ zuby umõâsteïneâ napatrïe, nemuêzï eme uzavõârat mezery v oblasti hornõâho a dolnõâho frontaâ lnõâho segmentu; nejsme schopni vyrïesï it steï snaâ nõâ v dolnõâm zubnõâm oblouku. Bez uâ pravy hloubky skusu nejsme takeâ schopni adekvaâ tneï nasadit fixnõâ aparaâ t v dolnõâ cï e- listi. Hluboky skus je nutneâ rïesï it tehdy, chceme-li eliminovat traumatizaci tkaâ nõâ zpuê sobeneâ jejich kontaktem se zuby, umozï nit eventuaâ lnõâ budoucõâ rekonstrukce zubuê anebo snõâzï it jejich opotrïebenõâ [1, 5, 6, 7]. JelikozÏ hlubokyâ skus obecneï zmensï uje prostor dostupnyâ pro dolnõâ rïezaâ ky, zvysï ovaâ nõâ skusu umozï nuje vytvorïit dostatek mõâsta pro dolnõâ rïezaâ ky atõâm umozïnit rïesï enõâ steïsnaâ nõâ [7, 8]. Pro leâcï bu hlubokeâ ho skusu byly zavedeny ruê zneâ postupy v zaâ vislosti nadiagnoâ zeaduê sledneâ m rozlisï enõâ mezi dentaâ lnõâm askeletaâ lnõâm hlubokyâ m skusem. VeÏtsÏ inaprïõâstupuê maâ zacõâl intrudovat frontaâ lnõâ zuby cï i extrudovat zuby lateraâ lnõâ, prïõâpadneï kombinovat obeï mozï nosti [1, 9]. PrÏi plaâ novaâ nõâ leâ cï by je nutneâ braâ t vuâ vahu naâ sledujõâcõâ: expozici hornõâch rïezaâ kuê v uâ smeï vu, pacientuê v oblicï ejovyâ profil, skeletaâ lnõâ podklad, ruê stovyâ potenciaâ l azaâ vazï nost ortodontickeâ anomaâ lie [1, 10]. UzaÂvazÏnyÂch skeletaâ lnõâch anomaâ liõâ muêzïe byât jednou zleâ cï ebnyâ ch mozï nostõâ ortognaâ tnõâ chirurgie [1, 9]. CõÂlem teâ to studie bylo zjistit efektivitu leâ cï by hlubokeâ ho skusu fixnõâ naâ kusnou deskou afrontaâ lnõâmi naâ kusnyâ mi plo- Introduction In the treatment of orthodontic patients, excessive overbite malocclusion represents one of the most frequently encountered problems, next to crowding [1,2]. Deep bite is an anomaly, in which more than two third of the labial crown surfaces of the lower incisors are covered by the upper incisors [2]. In more excessive cases the lower incisors are biting on the neck of the upper incisors and eventually to the mucosa of the palate [2]. An ideal overbite in a normal centric occlusion ranges between 5-25 % overlap of the mandibular incisors by the maxillary incisors which is between 2 mm to 4 mm in most cases. Ranges of overbite found in the literature are defined followingly: 5-25% is normal, 25-40% is increased overbite, > 40% excessive (deep) overbite [3]. Although the correction of deep bite is achieved by acomprehensive orthodontic treatment, the need for careful diagnosis and a proper treatment plan are critical for optimal results [3, 4]. Atraumatic deep bite as a single problem usually is not an indication for an orthodontic treatment, but raising the bite is a necessary part of orthodontic procedures and is a precondition for successful management of a number of anomalies. It is not possible to reduce the overjet and retract the protruded upper incisors; we cannot move and align the impacted teeth situated on the palate to the dental arch in presence of deep bite, we cannot close the spaces in the mandibular or maxillary frontal segments if there is not enough space; we are not able to solve the crowding in the lower dental arch, or in general is not possible to bond the lower fixed appliances at all without an adequate adjustment of overbite. Also we need to solve the deep overbite malocclusion to reduce or prevent tissue trauma from teeth contact, facilitating possible future reconstructive dental work, or to reduce increased tooth wear [1, 5, 6, 7]. As deep bite in general reduces space available for the lower incisors, raising the bite allows to expand a significant space for lower incisors in order to relieve the crowding [7, 8]. To treat the deep overbite there have been different approaches being introduced based on the diagnosis and distinction between dental and skeletal deep bite. Most of the approaches are aiming to intrude anterior teeth, or to extrude the posterior teeth, or acombination of both [1, 9]. Treatment considerations include: upper incisor exposure, the patient's facial profile, skeletal pattern, growth potential, and severity of dental malocclusion [1, 10]. In severe skeletal malocclusions, surgery can be also an option [1, 9]. The aim of this study was to find out the effectivity of fixed biteplate versus anterior fixed bite blocks in redu [email protected]

31 ORTODONCIE rocïnõâk24 MozÏ nosti leâcïbyprïi terapii hlubokeâ ho skusu Treatment modalities in deep bite treatment MDDr. Mina Poraghaee, MUDr. Hana TycovaÂ, MUDr. Josef KucÏ era, Ph.D. Ortodonticke oddeï lenõâ Stomatologicke kliniky 1. LF UK avfn Praha Department of Orthodontics Clinic of Stomatology 1st Medical Faculty of Charles University Prague Souhrn CõÂl: CõÂlem teâ to studie bylo zjistit efektivitu leâ cï by hlubokeâ ho skusu fixnõâ naâ kusnou deskou a frontaâ lnõâmi naâ kusnyâ mi plosï kami a prokaâ zat, zda je leâcï ba s vyuzïitõâm jedneâ cï i druheâ metody uâcï inneïjsïõâ. Materia l a metodika: Studie zahrnovala 46 jedincuê (26 zïen, 20 muzïuê ) s hloubkou skusu veïtsï õâ nezï60%.uvsï ech jedincuê probeï hla leâ cï ba hlubokeâ ho skusu plnyâ m fixnõâm ortodontickyâ m aparaâ tem spolu s fixnõâ naâ kusnou deskou nebo frontaâ lnõâmi naâ kusnyâ mi plosï kami. U vsï ech pacientuê byly zhotoveny kefalometrickeâ snõâmky prïed zapocï etõâm ortodontickeâ terapie a po sejmutõâ fixnõâch ortodontickyâ ch aparaâtuê. Byly meïrïeny celkem 2 lineaâ rnõâ, 2 uâ hloveâ a 1 pomeï rovaâ promeï nnaâ. Linea rnõâ meï rïenõâ byla prïepocï tena podle zveï tsï enõâ na RTG tak, aby prïedstavovala skutecï nyâ rozmeïr. Vy sledky: Na zaâ kladeï vyâ sledkuê analyâ zy hodnot: uâ hlu mandibulaâ rnõâ linie (NSML), mezicï elistnõâho uâ hlu (NLML), prïednõâ oblicï ejoveâ vyâ sï ky (NMe) a pomeï ru prïednõâ oblicï ejoveâ vyâ sï ky k zadnõâ oblicï ejoveâ vyâ sï ce (SGo/NMe), byly prokaâzaâ ny statisticky vyâ znamneâ rozdõâly u obou skupin, a to prïed leâcï bou i po nõâ. Po sejmutõâ fixnõâch aparaâtuê byla hloubka skusu v obou skupinaâ ch upravena (skus byl zvyâsï en), nicmeâneï nebyly pozorovaâ ny statisticky vyâ znamneâ rozdõâly mezi obeï ma pouzï ityâ mi leâ cï ebnyâ mi metodami (fixnõâ naâ kusnaâ deska ve srovnaâ nõâ s naâ kusnyâ mi plosï kami ). ZaÂveÏr: Nebyly zjisïteï ny statisticky vyâ znamneâ rozdõâly v uâ praveï hlubokeâ ho skusu pomocõâ fixnõâ naâ kusneâ desky nebo frontaâ lnõâmi naâ kusnyâ mi plosï kami (Ortodoncie 2015, 24, cï. 4, s. 197±205). Abstract Objective: The aim of this study was to find out the effectivity of fixed biteplate versus anterior fixed bite blocks in reducing deep overbite, whether one method is more effective than the other in deep bite treatment. Material and methods: The study included 46 subjects (26 females, 20 males) with deep overbite more than 60%. All subjects were treated for deep bite with either fixed biteplate or anterior fixed bite blocks and full fixed orthodontic appliances. Lateral cephalograms of all the patients were obtained before treatment and after debonding of the full fixed orthodontic appliance. A total of 2 linear, 2 angular and 1 ratio variables were measured. Linear measurements were recalculated according to magnification of the X-ray to represent life size. Results: According to the results of values analysis, the mandibular plane angle (NSML), the inter jaw base angle (NLML), the anterior total face height (NMe) and the ratio of posterior facial height to anterior facial height (SGO/NMe) showed statistically significant differences between the two groups both before and after the treatment. After debonding of the full fixed orthodontic appliances, overbite in both groups was reduced, however no statistically significant differences between the two treatment approaches (fixed biteplate versus anterior fixed bite blocks) were observed. Conclusions: No statistically significant differences were found in reduction of the deep overbite by using fixed biteplate as a treatment approach, or anterior fixed bite blocks (Ortodoncie 2015, 24, No. 4, p. 197±205). KlõÂcÏ ovaâ slova: fixnõâ naâ kusnaâ deska, frontaâ lnõâ naâ kusneâ plosïky Key words: fixed biteplate, anterior fixed bite blocks [email protected] 197

32 ORTODONCIE rocïnõâk24 J. Orthodont. dentofacial Orthop. 2000, 117, cï. 1, s Runge, M. E.; Martin, J. T.; Bukai, F.: Analysis of rapid maxillary molar distal movement without patient cooperation. Amer. J. Orthodont. dentofacial Orthop. 1999, 115, cï. 2, s Gelgor, I. E.; Karaman, A. I.; Buyukyilmaz, T.: Comparison of 2 distalization systems supported by intraosseous screws. Amer. J. Orthodont. dentofacial Orthop. 2007, 131, cï. 2, s. 161.e1-161.e Kinzinger, G. S. M.; GuÈ lden, N.; Yildizhan, F.; Diedrich, P. R.: Efficiency of a skeletonized Distal Jet appliance supported by miniscrew anchorage for noncompliance maxillary molar distalization Amer. J. Orthodont. dentofacial Orthop. 2009, 136, cï. 4, s Kinzinger, G.; Fuhrmann, R.; Gross, U.; Diedrich, P.: Modified pendulum appliance including distal screw and uprighting activation for non-compliance therapy of Class-II malocclusion in children and adolescents. Fortschr. Kieferorthop. 2000, 61, cï. 3, s Brickman, C. D.; Sinha, P. K.; Nanda, R. S.: Evaluation of the Jones Jig appliance for distal molar movement. Amer. J. Orthodont. dentofacial Orthop. 2000, 118, cï. 5, s Kinzinger, G. S. M.; Fritz, U. B.; Sander, F. G.; Diedrich, P. R.: Efficiency of a Pendulum appliance to molar distalization related to second and third molar eruption stage. Amer. J. Orthodont. dentofacial Orthop. 2004, 125, cï. 1, s MDDr. Sabina Chlupova Stomatologicka klinika FN u sv. Anny PekarÏska 53, Brno [email protected] 195

33 rocïnõâk24 ORTODONCIE 18. Nur, M.; Bayram, M.; Celikoglu, M.; Kilkis; D.,Pampu, A. A.: Effects of maxillary molar distalization with Zygoma-Gear appliance. Angle Orthodont. 2012, 82, cï.4, s Jung, B. A.; Kunkel, M.; Wehrbein, H.: GaumenimplantatgestuÈ tzte TherapiemoÈ glichkeiten zur Klasse-II-Behandlung: das Orthosystem. In: Baxmann, M. (Hrsg.): Festsitzende Apparaturen zur Klasse -II- Therapie. BewaÈ hrte Methoden und neueste Entwicklungen. Berlin: Quintessenz, Kapitola 15.1, s Wilmes, B.; Rademacher, C.; Olthoff, G.; Drescher, D.: Parametres affecting primary stability of orthodontic mini-implants. Fortschr. Kieferorthop. 2006, 67, cï.3, s Crismani, A. G.; Bertl, M. H.; CÏ elar, A. G.; Bantleon, H. P.; Burstone, C. J.: Miniscrews in orthodontic treatment: review and analysis of published clinical trials. Amer. J. Orthodont. dentofacial Orthop. 2010, 137, cï. 1, s Wiechmann, D.; Meyer, U.; BuÈ chter, A.: Success rate of mini- and micro-implants used for orthodontic anchorage: a prospective study. Clin. Oral Implants Res. 2007, 18, cï. 2, s Tseng, Y. C.; Hsieh, C. H.; Chen, C. H.; Shen, Y. S.; Huang I. Y.; Chen, C. M.: The application of mini-implants for orthodontic anchorage. Inter. J. oral and maxillofacial Surg. 2006, 35, cï. 8, s Cho, Y. M.; Cha, J. Y.; Hwang, C. J.: The effect of rotation moment on stability of immediately loaded orthodontic miniscrews: apilot study. Eur. J. Orthodont. 2010, 32, cï. 6, 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 Wilmes, B.: Achieving optimal esthetics with palatal miniimplants: The Benefit technique. In: Nanda, R.: Esthetics and biomechanics in orthodontics. 2nd ed., St. Louis: Elsevier Saunders, Kapitola 18, s Ludwig, B.; Glasl, B.; Bowman, S. J.; Wilmes, B.; Kinzinger, G. S. M.; Lisson, J. A.: Anatomical guidelines for miniscrew insertion: palatal sites. J. clin. Orthodont. 2001, 45, cï. 8, s Kim, H. J.; Yun, H. S.; Park, H. D.; Kim, D. H.; Park, Y. C.: Soft-tissue and cortical-bone thickness at orthodontic implant sites. Amer. J. Orthodont. dentofacial Orthop. 2006, 130, cï. 2, s Gahleitner, A.; Podesser, B.; Schick, S.; Watzek, G.; Imhof, H.: Dental CT and orthodontic implants: imaging technique and assessment of available bone volume in the hard palate. Eur. J. Radiol. 2004, 51, cï.3, s Baumgaertel, S.: Quantitative investigation of palatal bone depth and cortical bone thickness for mini-implant placement in adults. Amer. J. Orthodont. dentofacial Orthop. 2009, 136, cï. 4, s Bolla, E.; Muratore, F.; Carano, A.; Bowman, S. J.: Evaluation of maxillary molar distalization with the Distal Jet: a comparison with other contemporary methods. Angle Orthodont. 2002, 72, cï. 5, s Nienkemper, M.; Wilmes, B.; Pauls, A.; Yamaguchi, S.; Ludwig, B.; Drescher, D.: Treatment efficiency of miniimplant-borne distalization depending on age and second-molar eruption. Fortschr. Kieferorthop. 2014, 75, cï. 2, s Byloff, F.; Darendiler, M.; Clar, E.; Darendiler, A.: Distal molar movement using the pendulum appliance. Part 2: The effects of maxillary molar root uprighting bends. Angle Orthodont. 1997, 67, cï. 4, s Ngantung, V.; Nanda, R. S.; Bowman, S. J.: Posttreatment evaluation of the Distal Jet appliance. Amer. J. Orthodont. dentofacial Orthop. 2001, 120, cï. 2, s Sugawara, J.; Kanzaki, R.; Takahashi, I.; Nagasaka, H.; Nanda, R.: Distal movement of maxillary molars in nongrowing patients with the skeletal anchorage system. Amer. J. Orthodont. dentofacial Orthop. 2006, 129, cï. 6, s Byloff, F. K.; Derendeliler, M. A.: Distal molar movement using the Pendulum appliance. Part 1: Clinical and radiological evaluation. Angle Orthodont. 1997, 67, cï. 4, s Kircelli, B. H.; Pektas, Z.; Kircelli, C.: Maxillary molar distalization with a bone-anchored Pendulum appliance. Angle Orthodont. 2006, 76, cï. 4, s Angelieri, F.; Almeida, R. R.; Alemeida, M. R.; Fuziy, A.: Dentoalveolar and skeletal changes associated with the Pendulum appliance followed by fixed orthodontic treatment. Amer. J. Orthodont. dentofacial Orthop. 2006, 129, cï. 4, s Fortini, A.; Lupoli M.; Giuntoli F.; Franchi L.: Dentoskeletal effects induced by rapid molar distalization with the First Class appliance. Amer. J. Orthodont. dentofacial Orthop. 2004, 125, cï. 6, s Gulati, S.; Kharbanda, O. P.; Parkash, H.: Dental and skeletal changes after intraoral molar distalization with Sectional Jig assembly. Amer. J. Orthodont. dentofacial Orthop. 1998, 114, cï. 3, s Keles, A.; Sayinsu, K.: A new approach in maxillary molar distalization: Intraoral bodily molar distalizer. Amer. J. Orthodont. dentofacial Orthop. 2000, 117, cï. 1, s Papadopoulos, M. A.; Melkos, A. B.; Athanasiou, A. E.: Noncompliance maxillary molar distalization with the First class appliance: a randomized controlled trial. Amer. J. Orthodont. dentofacial Orthop. 2010, 137, cï. 5, s. 586.e1-586e Oberti, G.; Villegas, C.; Ealo, M.; Palacio, J. C.; Baccetti, T.: Maxillary molar distalization with the Dual-force distalizer supported by mini- implants: a clinical study. Amer. J. Orthodont. dentofacial Orthop. 2009, 135, cï. 3, s. 282.e Escobar, S. A.; Tellez, P. A.; Moncada, C. A.; Villegas, C. A.; Latorre, C. M.; Oberti, G.: Distalization of maxillary molars with the bone-supported pendulum: a clinical study. American Journal of Orhodnontics and Dentofacial Orthopedics. 2007, 131, cï. 4, s OÈ ncë ag, G.; SecË kin, OÈ.; DincË er, B.; Arikan, F: Osseointegrated implants with pendulum springs for maxillary distalization: A cephalometric study. Amer. J. Orthodont. dentofacial Orthop. 2007, 131, cï. 1, s Haydar, S.; UÈ ner, O.: Comparison of Jones Jig molar distalization appliance with extraorel traction. Amer [email protected]

34 ORTODONCIE rocïnõâk24 rïezaâ n, je duê lezï iteâ zkontrolovat jeho polohu vzhledem k prvnõâmu molaâ ru, protozï e distalizace prvnõâho molaâ ru muêzï e zpuê sobit distaâ lnõâsteï snaâ nõâ, ektopickou erupci trïetõâho molaâ ru, resorpci korïenuê druheâ ho molaâ ru erupcõâ trïetõâho molaâ ru. PrÏed distalizacõâ prvnõâho a prorïezaneâ ho druheâ ho molaâ ru by meï l byâ t u dospeï lyâ ch pacientuê extrahovaâ n trïetõâ molaâr. Velikost extruze prvnõâho molaâ ru lze u aparaâ tu Beneslider ovlivnit zmeï nou uâ hlu vodõâcõâho draâ tu k okluznõâ rovineï. ZaÂveÏr Apara t Beneslider je uâ cï innyâ m zarïõâzenõâm k distalizaci hornõâch staâ lyâ ch prvnõâch molaâ ruê bodily posunem. BeÏhem distalizace nedochaâ zõâ k statisticky vyâ znamneâ mu sklonu staâ leâ ho prvnõâho molaâ ru. Apara tem Beneslider lze pohybovat prvnõâm molaâ rem o velkou vzdaâ lenost distaâ lneï, s rostoucõâ velikostõâ distalizace ale hrozõâ veï tsï õâ riziko sklonu molaâ ru anestability polohy molaâ ru. AutorÏi nemajõâ komercï nõâ, vlastnickeâ nebo financï nõâ zaâ jmy na produktech nebo spolecï nostech popsanyâ ch v tomto cïlaâ nku. eruption of third molar, resorption of second molar roots due to eruption of third molar. In adult patients, third molar should be extracted before distal movement of first molar and erupted second molar. The extent of first molar extrusion can be influenced (in Beneslider appliance) by the change of the angle between guiding wire and occlusal plane. Conclusion Beneslider appliance is an effective device for distalization of maxillary permanent first molar by bodily movement. During distalization there does not occur statistically significant inclination of permanent first molar. Beneslider appliance can move first molar distally at a considerable distance, however, the greater the distalization, the greater the risk of molar inclination and unstable position. The authors have no commercial, ownership or financial interests in the products or companies mentioned in the article. Literatura/References 1. Kloehn, S. J.: Orthodontics-force or persuasion. Angle Orthodont. 1953, 23, cï. 1, s Davidian, E. J.: Use of a computer model to study the force distribution on root of the maxillary central incisor. Amer. J. Orthodont. 1971, 59, cï. 6, s Fortini, A.; Franchi, L.: The First class appliance. In: Papadopoulos, M. A.: Orthodontic treatment of the class II noncompliant patient: Current principles and techniques. Thessaloniki, Mosby Elsevier, Kapitola 22, s Kinzinger, G. S. M.; Diedrich, P. R.: Biomechanics of a Distal Jet appliance. Angle Orthodont. 2008, 78, cï. 4, s Franke, J.; Krey, T.; SchoÈ n, M.: Zahn- und Schleimhautgetragene Apparaturen. In: Baxmann, M. (Hrsg.): Festsitzende Apparaturen zur Klasse -II- Therapie. BewaÈ hrte Methoden und neueste Entwicklungen. Berlin: Quintessenz, Kapitola 14, s Keles, A.: The Keles Slider appliance for bilateral and unilateral molar distalization. In: Papadopoulos, M.A.: Orthodontic treatment of the class II noncompliant patient: Current principles and techniques. Thessaloniki, Mosby Elsevier, Kapitola 19, s Wilmes, B.: Achieving optimal esthetics with palatal miniimplants: The Benefit technique. In: Nanda, R.: Esthetics and biomechanics in orthodontics. 2nd ed., St. Louis: Elsevier Saunders, Kapitola 18, s Bussick, T. J.; McNamara, J. A.: Dentoalveolar and skeletal changes associated with the pendulum appliance. Amer. J. Orthodont. dentofacial Orthop. 2000, 177, cï. 3, s Ghosh, J.; Nanda, R. S.: Evaluation of an intraoral maxillary molar distalization technique. Amer. J. Orthodont. dentofacial Orthop. 1996, 110, cï. 6, s Gianelly, A. A. Distal movement of the maxillary molars. Amer. J. Orthodont. dentofacial Orthop. 1998, 114, cï.1, s Ten Hoeve, A.: Palatal bar and lip bumper in nonextraction treatment. J. clin. Orthodont. 1985, 19, cï. 4, s Jeckel, N.; Rakosi, T.: Molar distalization by intra-oral force application. Eur. J. Orthodont. 1991, 13, cï. 1, s Patel, P.; Janson, G.; Henriques, J.; Almeida, R.; Freitas, M.; Pinzan, A.; Freitasa, K.: Comparative distalization effects of Jones Jig and Pendulum appliances. Amer. J. Orthodont. dentofacial Orthop. 2009, 135, cï. 3, s Bondemark, L.; Kurol, J.; Bernhold, M.: Repelling magnets versus superelastic nickel-titanium coils in the simultaneous distal movement of maxillary first and second molars. Angle Orthodont. 1994, 64, cï. 3, s Chiu, P. P.; McNamara, J. A.; Franchi, L.: A comparison of two intraoral molar distalization appliances: Distal Jet versus Pendulum. Amer. J. Orthodont. dentofacial Orthop. 2005, 128, cï. 3, s Fuziy, A.; Almeida, R. R.; Janson, G.; Angelieri, F.; Pinzan, A.: Sagittal, vertical, and transverse changes consequent to maxillary molar distalization with the Pendulum appliance. Amer. J. Orthodont. dentofacial Orthop. 2006, 130, cï. 4, s Erverdi, N.; Ates, M. B.; Motro, M.: Expanding the limits for esthetic strategies by skeletal anchorage. In: Nanda, R.: Esthetics and biomechanics in orthodontics. 2nd ed., St. Louis: Elsevier Saunders, Kapitola 19, s [email protected] 193

35 rocïnõâk24 ORTODONCIE sourodostõâ kriteâ riõâ k zarïazenõâ do skupiny s prorïezanyâmi druhyâ mi molaâ ryvteâ to studii ave studii Kinzingeraakol. [52]. V teâ to studii stacï ilo, aby byly zuby klinicky viditelneâ amaximaâ lnõâ konvexitameziaâ lnõâ plochy druheâ ho molaâ ru byla na ortopantomogramu ve vyâsï i cementosklovinneâ hranice prvnõâho molaâ ru nebo okluzaâ lneï od nõâ. K stejneâmuvyâsledku jako v teâ to studii dospeï li takeâ Nienkemper akol. [32], kteryâ distalizoval u trïõâ skupin pacientuê pomocõâ aparaâ tu Beneslider. Prvnõ skupina nemeï lahornõâ staâleâ druheâ molaâ ry prorïezaâ ny, druhaâ skupinase sklaâ dala z dospõâvajõâcõâch, kterïõâ meï li hornõâ staâleâ druheâ molaâ ry plneï prorïezaâ ny, trïetõâ skupinabylatvorïena dospeïlyâmi pacienty. U zïaâ dneâ skupiny nedosï lo k statisticky signifikantnõâmu distaâ lnõâmu sklonu hornõâch prvnõâch staâlyâch molaâruê. Mezi skupinou s prorïezanyâmi druhyâmi molaâ ry as neprorïezanyâ mi druhyâ mi molaâ ry nebyl prokaâ zaâ n statisticky signifikantnõâ rozdõâl ve vertikaâ lnõâch zmeï naâ ch staâleâ ho prvnõâho molaâ ru ani ve zmeïneïuâ hlu kraniometrickyâch baâzõâ. Skupinas prorïezanyâmi druhyâmi molaâryvteâ to praâci dosaâ hla statisticky signifikantneï veï tsï õâch hodnot distalizace korunky prvnõâho molaâ ru (4,60 mm) nezï skupina s neprorïezanyâmi staâlyâmi druhyâmi molaâ ry (3,56 mm), p = 0,020. Velikost distalizace se rïõâdilau kazïdeâho pacientaze souboru potrïebou zõâskaâ nõâ mõâstav zubnõâm oblouku, zaâ vazï nostõâ Angleovy druheâ trïõâdy aprïedpokladem maleâ recidivy prvnõâho molaâ ru ve smyslu mezializace molaâruê beï hem naâ sledneâ terapie. Statisticky signifikantnõâ veï tsï õâ hodnoty distalizace korunky u skupiny s prorïezanyâ mi druhyâ mi staâ lyâ mi molaâ ry mohly byâ t takeâ ovlivneï ny tõâm, zïeuteï chto pacientuê jizï nehrozilo riziko, zïe prïõâlisï velkou distalizacõâ zpuê sobõâme retenci staâleâ ho druheâ ho molaâ ru. Gianelly [10], ten Hoeve [11], Jeckel a Rakosi [12] doporucï ujõâ zahaâ jit distalizaci hornõâch staâ lyâ ch prvnõâch molaâ ruê prïed erupcõâ staâ lyâ ch druhyâ ch molaâ ruê. Distalizace prvnõâch adruhyâ ch molaâ ruê muê zï e probõâhat pomaleji. Karlsson a Bondemark [53] uvaâdeïjõâ,zïe prïed erupcõâ staâleâ ho druheâ ho molaâ ru lze dosaâ hnout veïtsï õâ velikosti distalizace. U nasï õâ skupiny s neprorïezanyâmi druhyâmi molaâry bylapruê meï rnaâ rychlost distalizace prvnõâho molaâ ru adruheâ ho aprvnõâho premolaâ ru 0,34 ± 0,12 mm/meï sõâc, u skupiny s prorïezanyâmi druhyâmi molaâ ry bylapruêmeï rnaâ rychlost distalizace rovna 0,40 ± 0,20 mm/meïsõâc. SklaÂneÏ nõâ prvnõâch molaâruê beï hem distalizace muê zïe kromeï zvoleneâ biomechaniky a prïõâtomnosti druhyâch molaâruê takeâ ovlivnit velikost distalizace [4]. Tato studie prokaâ zala slabou korelaci mezi velikostõâ distalizace avelikostõâ distaâ lnõâho sklonu prvnõâho molaâ ru beï hem distalizace. CÏ õâm veï tsï õâ distalizace je dosazï eno, tõâm võâce maâ prvnõâ molaâ r tendenci k distaâ lnõâmu sklonu. Apara t Beneslider umozïnï uje distalizaci prvnõâho i druheâ ho staâleâ ho molaâ ru. Pokud nenõâ druhyâ molaâ r proconvexity of mesial surface of second molar should be in OPG at the height of CEJ of first molar or occlusally from it. The same results are reported by Nienkemper et al. [32]. They worked with three groups of patients using Beneslider appliance. The first group had unerupted maxillary permanent second molars, the second group included adolescents with fully erupted maxillary permanent second molars, the third group included adult patients. There was not statistically significant distal inclination of maxillary permanent first molars in any of the groups. There was found no statistically significant difference in vertical changes of permanent first molar or in change of the angle of craniometric bases between the group with erupted second molars and the group with unerupted second molars. In our study, the group with erupted second molars showed significantly higher values of first molar crown distalization (4.60 mm) compared with the group with unerupted permanent second molars (3.56 mm), p = The amount of distalization in each patient was given by the requirement for space in the dental arch, severity of Angle Class II, and assumption of low relapse of first molar in sense of molars mesialization during the following therapy. Significantly higher values of crown distalization in the group with erupted second permanent molars may be also due to the fact that in these patients there was not risk of too extensive distalization leading to impaction of second molar. Gianelly [10], Hoeve [11], Jeckel and Rakosi [12] recommend to start the distal movement of maxillary permanent first molars prior to permanent second molars eruption. Distalization of first and second molars may proceed more slowly. Karlsson and Bondemark [53] believe that prior to the eruption of permanent second molar it is possible to achieve greater extent of distalization. In our group with unerupted second molars the mean speed of distalization of first molar, and second and first premolars was 0.34 ± 0.12 mm/month, in the group with erupted second molars it was 0.40 ± 0.20 mm/month. Inclination of first molars during distal movement may - apart from chosen biomechanics and presence of second molars - be influenced also by the extent of movement [4]. Our study showed weak correlation between the amount of distal movement and the amount of distal inclination of first molar during the process. The greater the distalization, the greater the tendency of first molar to distal inclination. Beneslider appliance allows for distal movement of both first and second permanent molar. In case the second molar is not erupted, it is important to check its position relative to the first molar, because distalization of first molar may lead to distal crowding, ectopic [email protected]

36 ORTODONCIE rocïnõâk24 BeÏ hem distalizace nedosï lo v celeâ m souboru pacientuê k statisticky vyâznamneâ mu vertikaâ lnõâmu pohybu prvnõâch molaâ ruê. PruÊ meï rnaâ hodnotavertikaâ lnõâho pohybu prvnõâho molaâ ru v celeâ m souboru pacientuê byla 0,47 ± 1,78 mm ve smeï ru extruze. PrÏi distalizaci pomocõâ Distal Jet aparaâ tu bylapruêmeï rnaâ velikost extruze prvnõâho molaâ ru takeâ statisticky nesignifikantnõâ ± velikosti 0,5 ± 1,5 mm [31]. U distalizace IBDM aparaâ tem se polohamolaâ ru ve vertikaâ lnõâ rovineï statisticky signifikantneï nezmeï nila[41]. Statisticky nesignifikantnõâ byla takeâ extruze hornõâho prvnõâho molaâ ru prïi distalizaci Jones Jig aparaâ tem (pruê meï rneï o 0,14mm) [51]. Distalizace prvnõâch molaâruê pomocõâ First Class aparaâ tu bylaprovaâ zenastatisticky signifikantnõâ extruzõâ pruê meï rneï o 1,2 mm [39]. Pendulum aparaâ t beï hem distalizace molaâ ry statisticky signifikantneï intrudoval, a to pruêmeï rneï o 1,68 mm [36]. Mechanika zalozï enaâ nastabilnõâm vodõâcõâm oblouku, jakaâ je pouzï ita u Distal Jet a Beneslider aparaâ tu, je schopnazajistit teï lesnou (bodily) distalizaci bez sklonu molaâ ru. U Distal Jet aparaâ tu se molaârbeï hem distalizace pruêmeï rneï sklonil distaâ lneï pouze o 2,8±3, prïicï emzï pruêmeï rnaâ velikost distalizace se pohybovala mezi 3,2 azï 3,92 [31, 49]. BeÏ hem distalizace Beneslider aparaâtem nedosï lo k statisticky signifikantnõâmu sklonu hornõâho prvnõâho molaâ ru, pruê meï rnaâ velikost zmeï ny sklonu prvnõâho molaâ ru bylarovna0 ± 4,1. Bodily distalizaci lze hodnotit nazaâ kladeï posunu bodu v centru rezistence zubu, kteraâ se u molaâ ruê nachaâ zõâ v trifurkaci korïenuê.vteâ to studii bylapruê meï rnaâ velikost bodily distalizace 4,04 mm. Take ze srovnaâ nõâ s pruê meï rnou hodnotou distalizace korunky 4,11 mm lze usuzovat, zï e se prvnõâ molaâr beï hem posunu distaâ lneï nesklonil. K bodily distalizaci prïispõâvaâ nejen rigiditavodõâcõâho oblouku, ale i to, zïe je ve vertikaâ lnõâ rovineï umõâsteï n prïiblizïneï v uâ rovni centrarezistence hornõâho prvnõâho molaâ ru. Na zory navliv hornõâch staâlyâch druhyâch molaâruê nadistalizaci hornõâch staâ lyâ ch prvnõâch molaâ ruê se ruê znõâ. Kinzinger akol. [52] se domnõâvajõâ, zï e neprorïezanyâ druhyâ staâ lyâ molaâ r muê zï e zpuê sobit distaâ lnõâ sklon staâ leâ ho prvnõâho molaâ rubeï hem distalizace, protozï e vytvaâ rïõâ prïekaâzïku korïeni, okolo ktereâ se prvnõâ molaâ r otaâcï õâ. Ve sveâ studii s pouzï itõâm Pendulum aparaâ tu prokaâ zal mensï õâ sklon prvnõâho molaâ ru u skupiny pacientuê se zcelaprorïezanyâmi druhyâmi molaâ ry nezï u skupiny s neprorïezanyâ mi druhyâ mi molaâ ry. V prezentovaneâ studii se zmeï nasklonu hornõâho staâleâ ho prvnõâho molaâru beï hem distalizace statisticky signifikantneï nelisï ilamezi skupinou s prorïezanyâ mi aneprorïezanyâ mi druhyâ mi molaâ ry. Rigidnõ oblouk, po ktereâ m se prvnõâ molaâ r u aparaâ tu Beneslider pohybuje, udrzï õâ molaâ r beï hem distalizace zrïejmeï i prïi puê sobenõâ odporu ve formeï zaâ rodku druheâ ho molaâ ru naprïõâmenyâ. RozdõÂlne vyâ sledky mohly byâ t ale takeâ zpuê sobeny ne- In distalization with Distal Jet the mean amount of first molar extrusion was not statistically significant either mm [31]. In distalization with IBDM appliance the position of molar in vertical plane did not change significantly [41]. Extrusion of maxillary first molar during distalization with Jones Jig appliance was not statistically significant either (by 0.14 mm on average) [51]. Distalization of first molars with First Class appliance was accompanied by statistically significant extrusion, by 1.2 mm on average [39]. Pendulum appliance significantly intruded molars, during distalization, by 1.68 mm on average [36]. Mechanics based on stable guiding arch, used by Distal Jet and Beneslider appliances, can facilitate bodily distalization without molar inclination. In Distal Jet appliance molar during distalization inclined distally only by 2.8±3 on average, while mean amount of distalization oscillated between 3.2±3.92 [31, 49]. In case of Beneslider appliance there was not statistically significant inclination of maxillary first molar, with the mean change in its inclination 0 ± 4.1. Bodily distalization can be evaluated according to the shift of point in the center of a tooth resistance, that is found in molar at roots trifurcation. In our study the mean amount of bodily distalization reached 4.04 mm. Comparison with the mean value of crown distalization 4.11 suggests that first molar did not incline distally during the movement. Bodily distalization is facilitated by rigidity of guiding arch as well as by the fact that the guiding arch is in vertical plane located approximately at the level of the center of resistance of maxillary first molar. Views on the impact of maxillary permanent second molars on distalization of maxillary permanent first molars are varied. Kinzinger et al. [52] believe that unerupted second permanent molar may cause distal inclination of permanent first molar during the distal movement, because it represents an obstruction for the root around which the first molar rotates. The authors worked with Pendulum appliance and proved lesser inclination of first molar in the group of patients with fully erupted second molars compared with the group with unerupted second molars. In the presented work there was not statistically significant difference in the inclination of maxillary permanent first molar during distalization between the group with erupted and the group with unerupted second molars. Rigid arch along which the first molar moves (in Beneslider appliance) keeps the molar upright during distalization probably also during the resistance created by the germ of second molar. However, different results may be also due to different criteria used for the group with erupted second molars in our study and in the work by Konzinger et al. [52]. In our study, the teeth should be clinically visible, and the maximum [email protected] 191

37 rocïnõâk24 ORTODONCIE daly z 10 azï 51 pacientuê [9, 13, 15, 16, 31±47]. Skupina vteâ to praâcicï õâtala 30 pacientuê.prïestozïe je studie svyâm pocï tem srovnatelnaâ s ostatnõâmi studiemi na daneâ teâ ma, je vzorek pacientuê staâ le malyâ. Existuje mnoho distalizacï nõâch aparaâtuê, ktereâ nevyzï adujõâ spolupraâ ci pacienta. NoveÏ jsou natrhu takeâ aparaâ ty, u nichzï kotvenõâ zajisï t'ujõâ docï asnaâ kotevnõâ zarïõâzenõâ, kteraâ by meï lazarucï ovat stacionaâ rnõâ kotvenõâ. Ztra takotvenõâ se u prïechodnyâ ch kotevnõâch zarïõâzenõâ, pokud jsou vyuzï itak prïõâmeâ mu kotvenõâ, projevõâ jejich uvolneï nõâm, pohybem cï i ztraâ tou. V teâ to studii dosïlo k uvolneï nõâ 1 kotevnõâho miniimplantaâ tu z 62 zavedenyâ ch, pacient byl ze studie vyloucï en. Mechanickou stabilitu a schopnost snaâsï et zatõâzïenõâ aparaâ tu Beneslider vysveï tlujõâ Nienkamper a kol. [32] tõâm, zï e jsou ke kotvenõâ pouzï ity dvakotevnõâ implantaâ ty zavedeneâ do prïednõâ cï aâ sti patra, cozï je oblast nabõâzejõâcõâ dostatek kvalitnõâ kosti. Kotevnõ implantaâ ty jsou umõâsteï neâ na prïõâmce ve smeïru puê sobõâcõâch reciprocï nõâch sil aspojeny Beneplate desticï kou, to daâ le zvysï uje jejich stabilitu amechanickou odolnost. Distalizace prvnõâch molaâruê a vsï ech premolaâruê trvala pruêmeï rneï 11,9 ± 3,4 meïsõâcuê. Distalizace korunky probõâhala pruêmeï rnou rychlostõâ 0,35 mm/meïsõâc. PruÊ meï rnaâ velikost distalizace na uâ rovni korunky hornõâho prvnõâho molaâ ru v celeâ m souboru pacientuê byla 4,11 ± 1,28 mm, s minimaâ lnõâ hodnotou 2,08 mm amaximaâ lnõâ hodnotou 7,17 mm. PruÊmeÏ rnaâ velikost distalizace na uâ rovni korïene (bodu trifurkace) hornõâho prvnõâho molaâ ru, tedy teï lesnaâ distalizace byla 4,04 ± 1,52 mm, s minimaâ lnõâ hodnotou 2 mm amaximaâ lnõâ hodnotou 9,10 mm. Studie o skeletaâ lneï kotvenyâ ch aparaâ tech uvaâ deï jõâ podobnou velikost distalizace s hodnotami mezi 3,78±3,95 mm [35, 45, 48±49]. Take studie, u nichzï byla distalizace provedena konvencïnõâmi, neskeletaâ lneï kotvenyâ mi aparaâ ty nevyzï adujõâcõâmi spolupraâ ci pacienta, udaâ vajõâ podobneâ pruê meï rneâ hodnoty distalizace hornõâch prvnõâch molaâruê. U Distal Jet aparaâ tu se tyto hodnoty pohybujõâ mezi 2,1±3,1 mm [31, 34], u Pendulum aparaâ tu mezi 2±5,7 mm [9, 16, 33, 36, 38], u Jones Jig aparaâ tu mezi 2,23±3,12 mm [13, 50], prïi pouzï itõâ odpuzujõâcõâch se magnetuê uvaâ dõâ Bondemark a kol. [14] distalizaci o velikosti 2,2 mm, Keles asayinsu [41] uvaâ dõâ pruêmeï rnou velikost distalizace prïi pouzïitõâ IBMD aparaâ tu 5,23 mm. U teï chto aparaâtuê ale zaâ rovenï dosï lo ke ztraâteï kotvenõâ, kteraâ se projevilameziaâ lnõâm pohybem asklonem premolaâruê a rïezaâ kuê. Pohyb rïezaâ kuê apremolaâ ruê meziaâ lnõâm smeï rem nenõâ zï aâ doucõâ aje velkyâ m nedostatkem konvencï nõâch non-compliance distalizacï nõâch aparaâ tuê. V teâ to studii bylo pouzï ito prïõâmeâ kotvenõâ kotevnõâmi implantaâ ty, proto by se prïõâpadnaâ ztraâ takotvenõâ projevilauvolneï nõâm cï i pohybem kotevnõâch implantaâtuê. There are many non-compliance appliances. There are also appliances with temporary anchorage securing stationary anchorage. The loss of anchorage in temporary devices used for direct anchorage includes loosening, movement or loss of anchorage. In our study there occurred loosening of one anchorage miniimplant out of 62, the patient was excluded from the study. Nienkamper et al. [32] explain mechanical stability and load capability of Beneslider appliance by the fact that anchorage is facilitated with two implants inserted into anterior part of palate, i.e. into the area with sufficient amount of good quality bone. Anchorage implants are located on the straight line in the direction of working reciprocal forces, and they are connected with Beneplate plate which further increases their stability and mechanical resistance. Distal movement of first molars and all premolars took on average 11.9 ± 3.4 months. The average speed of crown distalization was 0.35 mm/month. The mean amount of distalization of maxillary first molar crown in the whole sample of patients was 4.11 ± 1.28 mm, with the minimum of 2.08 mm and maximum of 7.17 mm. The mean amount of root distalization (trifurcation point) of maxillary first molar, i.e. bodily distalization, was 4.04 ± 1.52 mm, with the minimum of 2 mm and maximum of 9.10 mm. Studies dealing with skeletally anchored appliances give similar amount of distalization - between 3.78±3.95 mm [35, 45, 48, 49]. Studies in which distal movement was performed with conventional, non-skeletally anchored non-compliance appliances give similar mean values of distalization of maxillary first molars. In Distal Jet appliance the values are between 2.1 and 3.1 mm [31, 34], in Pendulum appliance between 2±5.7 mm [9, 16, 33, 36, 38], in Jones Jig appliance between 2.23 and 3.12 mm [13, 50]. In case of repelling magnets, Bondemark et al. [14] report distal movement of 2.2 mm, for IBMD appliance Keles and Sayinsu [41] give the mean distal movement of 5.23 mm. However, in these appliances anchorage was lost which was presented by mesial movement, and premolars and incisors inclination. Mesial movement of incisors and premolars is unwanted and appears to be a great disadvantage of conventional non-compliance distalization appliances. In our study we used direct anchorage with anchorage implants, and thus the potential loss of anchorage would present itself as loosened or moving anchorage implants. In the whole sample of patients there was not statistically significant vertical movement of first molars during the distalization. The mean value of vertical movement of first molar was mm in the direction of extrusion [email protected]

38 ORTODONCIE rocïnõâk24 Tab. 1. VeÏ k, doba distalizace a zmeï ny parametruê Tab. 1. Age, length of distalization and changes of parameters Skupina, group VeÏ k, age (roky, years) Doba distalizace, ZmeÏ ny, changes length of distalization MO [mm] MB [mm] MDvert [mm] Mpat [ ] SNGoMe [ ] (meï s., months) Minimum ± 0.56 ± 5 ± 2.5 Maximum A Median ± 0.5 ± 0.5 Mean ± 0.2 ± 0.5 SD p < < Minimum ± 5.7 ± 11 ± 4 Maximum B Median Mean SD p < < Minimum ± 5.7 ± 11 ± 4 Cely Maximum soubor, Median ± whole Mean ± 0.2 sample SD p < < p - signifikance t-testu zmeï n, significance of t-test of changes, mean - pruêmeï r, SD - smeï rodatnaâ odchylka, standard deviation Tab. 2. Porovna nõâ zmeï n mezi skupinou A ab. Tab. 2. Comparison of changes between Group A and Group B. parameter Skupina, group n mean SD p MO [mm] A B MB [mm] A ZmeÏ na, B change MDvert [mm] A B Mpat [ ] A 14 ± B SNGoMe [ ] A 14 ± B p - significance, mean - pruêmeï r, SD - smeï rodatnaâ odchylka, standard deviation rozdõâl ve velikosti distalizace korunky prvnõâho molaâru (Tab. 2). DvouvyÂbeÏ rovyâ t-test prokaâ zal statisticky vyâznamneï nizïsï õâ hodnoty distalizace u skupiny A nezï u skupiny B (p = 0,020). BylazjisÏ teï nastatisticky vyâ znamnaâ slabaâ korelace mezi velikostõâ distalizace a distaâ lnõâm sklonem prvnõâho molaâ ru. PearsonuÊ v korelacï nõâ koeficient meï l hodnotu = ±0,367, p = 0,049. CÏ õâm veïtsï õâ byla distalizace prvnõâho molaâ ru, tõâm k veïtsï õâmu distaâ lnõâmu sklonu jeho korunky k patroveâ rovineï dosï lo. Diskuse V publikovanyâ ch studiõâch tyâ kajõâcõâch se distalizace hornõâch molaâruê aparaâ ty nevyzï adujõâcõâmi spolupraâcipacienta, se skupiny pacientuê zahrnutyâ ch do studiõâ sklaâcantly lower values of distalization in Group A (p = 0.020). Statistically significant weak correlation was found between distalization extent and distal inclination of first molar. Pearson correlation coefficient = ±0.367, p = The greater the distalization of first molar the greater the distal inclination of its crown related to palatal plane. Discussion In literature on distalization of maxillary molars with non-compliance appliances the samples of patients included between 10 and 51 people [9, 13, 15, 16, 31±47]. Our sample involved 30 patients. Though the number of subjects corresponds to numbers in other studies cited, the sample is still rather small. [email protected] 189

39 rocïnõâk24 ORTODONCIE akoeficient spolehlivosti ICC. ChybameÏ rïenõâ bylavypocï õâtaâ napodle Dahlbergovy formule. ChybameÏ rïenõâ se pohybovala mezi 0,12±0,35 mm pro lineaâ rnõâ meï rïenõâ amezi 0,46±0,52 pro uâ hlovaâ meï rïenõâ. Koeficient spolehlivosti se pohyboval v rozmezõâ 0,988±0,999 pro lineaâ rnõâ meï rïenõâ, av rozmezõâ 0,987±0,993 pro uâ hlovaâ meï rïenõâ. Pa rovyâ m t-testem nebylau zï aâ dneâ ho meï rïeneâ ho parametru prokaâ zaâ nasystematickaâ odchylka mezi prvnõâm adruhyâm meïrïenõâm. Shapiro-Wilkovy mi testy bylo oveï rïeno, zï e data majõâ normaâ lnõâ rozlozï enõâ, proto byly pouzï ity parametrickeâ metody (dvouvyâbeï rovyâ t-test apearsonuê v korelacïnõâ koeficient). Statisticka vyâznamnost zmeïnvsï ech parametruê bylaoveï rïenajednovyâ beï rovyâ mi t-testy. Pro zjisï teï nõâ statistickeâ vyâ znamnosti rozdõâluê zmeï n meï rïenyâ ch parametruê mezi jednotlivyâ mi skupinami bylo pouzï ito porovnaâvaâ nõâ pruêmeï rnyâch hodnot dvouvyâbeï rovyâ mi t-testy. Mezi vybranyâ mi parametry byly takeâ vraâ mci jednotlivyâch skupin i v raâ mci celeâ ho vzorku pacientuê zjisï t'ovaâ ny korelace pomocõâ Pearsonovy korelacï nõâ analyâ zy. Pro statistickeâ zpracovaâ nõâ byl pouzï it statistickyâ software SPSS verze 15, SPSS Inc., Chicago USA. VsÏ echny testy byly provedeny nahladineï statistickeâ vyâ znamnosti 0,05. Vy sledky Apara tem Beneslider byladosaâ hnutastatisticky vyâznamnaâ distalizace korunky a korïene hornõâho prvnõâho molaâ ru, ato jak ve skupineï B askupineï A, tak v celeâm souboru pacientuê (tab. 1). Distalizace korunky hornõâho prvnõâho molaâ ru bylave skupineï A 3,56 ± 0,75 mm, ve skupineï B pruêmeï rneâ velikosti 4,6 ± 1,46 mm. Distalizace hornõâho prvnõâho molaâru nauâ rovni trifurkace korïenuê, bylave skupineï A 3,62 ± 1,37 mm, ve skupineï B pruê meï rneâ velikosti 4,41 ± 1,59 mm. PruÊ meï rnaâ doba distalizace prvnõâch molaâruê, druhyâch premolaâ ruê aprvnõâch premolaâ ruê v celeâ m souboru pacientuê byla11,9 ± 3,4 meïsõâcuê. Rychlost distalizace hornõâch prvnõâch molaâruê a vsï ech premolaâruê bylave skupineï A 0,34 ± 0,12 mm/meï sõâc, ve skupineï B 0,40 ± 0,2 mm/meï sõâc. Nebyl prokaâzaâ n statisticky signifikantnõâ rozdõâl v rychlosti distalizace hornõâch prvnõâch molaâruê a vsï ech premolaâruê mezi skupinou A askupinou B (p = 0,348). Ve skupineï A dosï lo takeâ k statisticky vyâ znamneâ extruzi hornõâho prvnõâho molaâru beï hem distalizace, ato s pruêmeï rnou hodnotou 0,79 ± 0,91 mm (max. 2,26 mm, min. ±0,56 mm). U hel kraniometrickyâ ch bazõâ (uâ hel SNGoMe) se beï hem distalizace ani v jedneâ skupineï pacientuê statisticky vyâ znamneï nezmeï nil. PrÏi porovnaâvaâ nõâ zmeï n parametruê mezi skupinou A a skupinou B byl nalezen pouze statisticky vyâ znamnyâ position of cephalograms were done manually by one and the same examiner. All cephalograms were measured and analyzed again after 3 weeks, so that we could establish measurement error and reliability coefficient ICC. Measurement error was calculated with Dahlberg formula, and was between 0.12±0.35 mm in case of linear parameters, and 0.46±0.52 in case of angular parameters. Reliability coefficient oscillated between and in linear parameters, and and in angular parameters. Pair t-test did not prove systemic deviation between the first and second measurements in any parameter. Shapiro-Wilk tests proved that the data distribution was normal, therefore parametric techniques were used (two-sample t-test and Pearson correlation coefficient). Statistical significance of changes in all parameters was verified with one-sample t-tests. To determine statistical significance of differences in changes of parameters measured between individual groups of patients two-sample t-tests were used to compare mean values. Between chosen parameters were also identified correlations with Pearson correlation analysis. The data were processed with statistical software SPSS, version 15, SPSS Inc., Chicago, USA. All the tests were performed at the level of statistical significance = Results Beneslider appliance allowed for statistically significant distal movements of crown and root of maxillary first molar in both groups (A and B), and in the whole sample of patients (Table 1). In Group A the distal movement of maxillary first molar crown reached 3.56 ± 0.75 mm, in Group B 4.6 ± 1.46mm. The distal movement of maxillary first molar at the level of roots trifurcation reached 3.62 ± 1.37 mm in Group A, 4.41 ± 1.59 mm in Group B. The mean length of distal movement of first molars, second premolars and first premolars in the whole sample of patients was 11.9 ± 3.4 months. The speed of distal movement of maxillary first molars and all premolars was 0.34 ± 0.12 mm/month in Group A, 0.40 ± 0.2 mm/months in Group B. There was not statistically significant difference between the two groups (p = 0.348). Statistically significant extrusion of maxillary first molar during distalization occured in Group A, the mean value was 0.79 ± 0.91 mm (max mm, min. ±0.56 mm). The angle of craniometric bases (SNGoMe) did not change significantly in either group. Statistically significant difference between Group A and B was found only in distal movement of first molar crown (Table 2). Two-sample t-test proved signifi [email protected]

40 ORTODONCIE rocïnõâk24 U vsï ech meï rïenyâ ch parametruê byl vypocï õâtaâ n rozdõâl mezi hodnotami v cï ase T2 a cï ase T1, oznacï ovaândaâle jako zmeï nadaneâ ho parametru. K hodnocenõâ byly pouzï ity kefalometrickeâ rentgenoveâ snõâmky zhotoveneâ prïed zahaâ jenõâm ortodontickeâ terapie a po distalizaci hornõâch staâ lyâ ch prvnõâch molaâ ruê, hornõâch druhyâ ch aprvnõâch premolaâ ruê. PrÏekreslenõÂ, meïrïenõâ i prïekryâvaâ nõâ kefalometrickyâ ch snõâmkuê bylo provedeno rucï neï jednõâm vysï etrïujõâcõâm. VsÏ echny telerentgenoveâ snõâmky byly zmeï rïeny avyhodnoceny po 3 tyâdnech znovu, aby bylo mozïneâ urcï it chybu meï rïenõâ Obr. 6. Kefalometricke body nahornõâm prvnõâm molaâ ru anapatroveâ rovineï : CenM1, TriM1, MD, SpA, SpP Fig. 6. Cephalometric points on maxillary first molar and on palatal plane: CenM1, TriM1, MD, SpA,SpP Linear parameters MO - Sagittal position of molar crown - the distance between centroid and perpendicular on the SpASpP line at SpA point MB - Sagittal position of molar root - the distance between trifurcation point and perpendicular on the SpASpP line at SpA point Mdvert - Upper molar height measured to MD point - the distance of the center of maximum convexity of distal surface of maxillary permanent first molar from SpASpP line Angular parameters Mpat - inclination of maxillary first molar measured to palatal line - the angle between the connecting line of centroid point and trifurcation point and palatal line (SpA-SpP). SNGoMe - the angle of craniometric bases (the mandibular angle), the angle between SN line and GoMe line (mandibular line). The long axis of first molar was contructed as the connecting line between centroid point and roots trifurcation point. Cephalograms taken prior and after distal movement were superimposed on the palatal plane and on the spina nasalis anterior (SpA). Palatal plane was taken as reference straight line for measurements of vertical changes of maxillary first molar. The angle between SN line and mandibular line (SNGoMe) was also measured. In all parameters measured the difference between values at T2 and T1 was calculated, i.e. the change of the given parameter. For evaluation, cephalograms taken prior orthodontic therapy and after distal movement of maxillary permanent first molars, maxillary second and first premolars, were used. Tracing, measurements and superim- Obr. 7. Linea rnõâ parametry MO, MB, MDvert Fig. 7. Linear parameters MO, MB, Mdvert Obr. 8. U hlovyâ parametr Mpat Fig. 8. Angular parameter Mpat [email protected] 187

41 rocïnõâk24 ORTODONCIE Kontroly probõâhaly po 4±8 tyâ dnech. V prvnõâ kontrole po nasazenõâ suprakonstrukce byl Beneslider aktivovaâ n maximaâ lnõâm stlacï enõâm nikltitanoveâ pruzï iny. Jakmile byly molaâ ry distalizovaâ ny o pozï adovanou vzdaâ lenost, Beneslider systeâ m byl ponechaâ n v pasivnõâm stavu a pacientuê m byl nasazen hornõâ fixnõâ ortodontickyâ aparaât. Na sledovala nivelizace hornõâho zubnõâho oblouku adaâ le distalizace hornõâho druheâ ho apoteâ i prvnõâho premolaâ ru. PremolaÂry se u veï tsï iny pacientuê posunuly spontaâ nneï distaâ lneï s pohybem molaâruê, ale ne vzïdy v plneâ m rozsahu distalizace prvnõâch molaâruê, zuê staâ valy mezery mezi staâ lyâ m prvnõâm molaâ rem adruhyâ m premolaâ rem amezi druhyâ m aprvnõâm premolaâ rem. Tyto mezery byly uzavrïeny ortodonticky distaâ lnõâm pohybem premolaâ ruê. Cela konstrukce aparaâ tu Beneslider vcï etneï kotevnõâch implantaâ tuê bylaponechaâ nav pasivnõâm stavu v dutineï uâ stnõâ azï do uâ plneâ distalizace prvnõâch premolaâ ruê, u neï kteryâ ch pacientuê i sï picï aâ kuê. Pote byla konstrukce sejmutaakotevnõâ implantaâ ty vyjmuty. Nakefalometricky ch snõâmcõâch bylo hodnoceno celkem 5 parametruê (2u hloveâ, 3 lineaâ rnõâ) (Obr. 6, 7, 8). Kefalometricke body CenM1 - Centroid - strïed uâ secï ky spojujõâcõâ maximaâ lnõâ meziaâ lnõâ konvexitu amaximaâ lnõâ distaâ lnõâ konvexitu korunky hornõâho staâleâ ho prvnõâho molaâru TriM1 - Trifurkace - bod v trifurkaci korïenuê hornõâho prvnõâho molaâru MD - StrÏed maximaâ lnõâ konvexity distaâ lnõâ plochy korunky hornõâho staâleâ ho prvnõâho molaâru SpA - Spina nasalis anterior SpP - Spina nasalis posterior Linea rnõâ parametry MO - Sagita lnõâ polohakorunky molaâ ru - vzdaâ lenost bodu centroid ke kolmici nalinii SpASpP v bodeï SpA MB - Sagita lnõâ polohakorïene molaâ ru - vzdaâ lenost bodu trifurkace ke kolmici na linii SpASpP v bodeï SpA MDvert - Hornõ molaâ rovaâ vyâsïkameïrïenaâ k bodu MD - vzdaâ lenost strïedu maximaâ lnõâ konvexity distaâ lnõâ plochy hornõâho staâleâ ho prvnõâho molaâ ru od linie SpASpP U hloveâ parametry Mpat - Sklon hornõâho prvnõâho molaâru meïrïen k patroveâ linii - uâ hel mezi spojnicõâ centroid bodu s bodem trifurkace a mezi patrovou liniõâ (SpA- SpP). SNGoMe - U hel kraniometrickyâch bazõâ(uâ hel dolnõâ cï e- listi) uâ hel svõârajõâcõâ linie SN s liniõâ GoMe (mandibulaâ rnõâ liniõâ). Dlouha osaprvnõâho molaâ ru bylavytvorïenaspojenõâm bodu centroid s bodem v trifurkaci korïenuê. Kefalometricke snõâmky prïed distalizacõâ a po distalizaci byly prïekryty v rovineï patra tak, aby se bod spina nasalis anterior (SpA) na obou snõâmcõâch prïekryâval. Jako referencï nõâ prïõâmkak meï rïenõâ vertikaâ lnõâch zmeï n hornõâho prvnõâho molaâ ru byla stanovena rovina patra. Da le byl meïrïen uâ hel mezi liniõâ SN amandibulaâ rnõâ liniõâ (SNGoMe). with dimensions 2.0 x 9 mm or 2.0 x 7 mm (Fig. 2a, b, Fig. 3). In plaster model a supraconstruction of Beneplate type was produced in the laboratory, with guiding steel wire of 1.1 mm in diameter. In Group A distalization of molars was performed with nickel-titanium coil of the force 240 g, in Group B nickel-titanium coil of the force 500 g. For activation an activation lock was used. To connect steel wire with molar bands, a special tube Benetube was used - its flat part is adjusted from the mesial side into palatal tubes, and its hollow part on the steel wire (Fig. 4). The Beneslider appliance was fixed in between 7th and 14th day since anchorage implants insertion. Anchorage implants served for direct anchorage during distal movement in all patients. The Beneslider appliance was activated as early as in adjustment, however only by pressing the coil to half of its length. Check-ups took place after 4-8 weeks. During the first check-up after the supraconstruction adjustment Beneslider was activated by maximum pressing of nickel-titanium coil. After the molars were moved to the distance required, Beneslider system remained in mouth in its passive condition, and patients were applied upper fixed orthodontic appliance. Nivelization of upper dental arch followed as well as distal movement of maxillary second and first premolars. In most patients there was a spontaneous distal movement of premolars, however not always in the full extent of first molar distalization, there remained spaces between permanent first molar and second premolar, and between second and first premolars. The spaces were closed with distal movement of premolars. The whole Beneslider construction including anchorage implants was left in mouth cavity in passive condition until the full distalization of first premolars (in some patients until distalization of canines). After that the construction as well as anchorage implants were removed. We evaluated 5 parameters in cephalograms (2 angular, 3 linear) (Fig. 6, 7, 8). Cephalometric points CenM1 - Centroid - the middle of the connecting line between the maximum mesial convexity and maximum distal convexity of the crown of maxillary permanent first molar TriM1 - Trifurcation - the point at the trifurcation of roots of maxillary first molar MD - the middle of maximum convexity of distal surface of the maxillary permanent first molar crown SpA - Spina nasalis anterior SpP - Spina nasalis posterior [email protected]

42 ORTODONCIE rocïnõâk24 heâ ho kefalometrickeâ ho snõâmku byl u 6 pacientuê takeâ jizï nasazen fixnõâ aparaâ t v dolnõâ cï elisti. SkupinapacientuÊ zahrnutyâ ch do studie bylaleâ cï ena2 osï etrïujõâcõâmi. Apara t Beneslider byl zhotoven jednõâm zubnõâm technikem. VsÏ ichni pacienti byli leâ cï eni dle naâ sledujõâcõâho standardnõâho leâ cï ebneâ ho protokolu. Dvakotevnõ implantaâ ty (Benefit KFO Schraube, PSM, NeÏ mecko), byly zavedeny paramediaâ lneï do prïednõâ oblasti patra (Obr. 1a, b, c). Cely postup zavedenõâ kotevnõâch implantaâtuê byl proveden ambulantneï. Anteriornõ kotevnõâ implantaâ t byl zaveden na uâ rovenï spojnice prvnõâch premolaâruê, posteriornõâ kotevnõâ implantaâ t minimaâ lneï o 4 mm distaâ lneï ji na uâ rovenï spojnice druhyâ ch premolaâ ruê. Kotevnõ implantaâ ty byly zavedeny v jedneâ sagitaâ lnõâ prïõâmce co nejvõâce kolmo k povrchu patroveâ kosti aanteriorneï meïly rozmeï ry 2,3 x 11 nebo 2,3 x 9 mm, posteriorneï 2,0 x 9 mm, 2,0 x 7 mm (Obr. 2a, b, Obr. 3). Na saâ droveâm modelu byla v laboratorïi vytvarovaâ nasuprakonstrukce typu Beneplate s vodõâcõâm ocelovyâm draâ tem o pruêmeï ru 1,1 mm. Ve skupineï A bylak distalizaci molaâ ruê pouzï itanikltitanovaâ pruzï inao sõâle 240 g, ve skupineï B nikltitanovaâ pruzïinao sõâle 500 g. K aktivaci pruzï iny slouzï il aktivacïnõâ zaâ mek. Ke spojenõâ oceloveâ ho draâ tu s molaâ rovyâmi krouzï ky bylapouzï itaspeciaâ lnõâ kanyla typu Benetube, jejõâzï plochaâ cï aâ st se nasazuje z meziaâ lnõâ strany do palatinaâ lnõâch kanyl a dutaâ cïaâ st naocelovyâ draâ t (Obr. 4). Nasazenõ aparaâ tu Beneslider u zïaâ dneâ ho pacienta neprobeï hlo drïõâve nezï 7 dnõâ apozdeï ji nezï 14 dnõâ od zavedenõâ kotevnõâch implantaâ tuê.u vsï ech pacientuê slouzï ily kotevnõâ implantaâ ty k prïõâmeâ mu kotvenõâ beï hem distalizace. JizÏ prïi nasazenõâ suprakonstrukce byl aparaâ t Beneslider aktivovaâ n, ale pouze stlacï enõâm pruzï iny napolovicïnõâdeâ lku. such an extent that all cusps of a tooth were clinically visible and maximal crown convexity was at the height of cement-enamel junction of permanent first molar or occlusally from it. At T2 in six patients fixed appliance was adjusted also in the mandible. Two orthodontists took care of the patients. Beneslider appliance was produced by one dental technician. All patients were treated according the following standard treatment protocol: Two anchorage implants (Benefit KFO Schraube, PSM, Germany) were inserted paramedially in the anterior part of palate (Fig. 1a, b, c). The insertion was performed in an outpatient's surgery. Anterior anchorage implant was inserted at the level of connecting line between first premolars, posterior anchorage implant more distally (minimum by 4 mm) at the level of connecting line between second premolars. Anchorage implants were introduced in one sagittal straight line, perpendicular to the surface of palate bone; anterior with dimensions 2.3 x 11 or 2.3 x 9 mm, posterior Obr. 4. SoucÏ aâ sti aparaâ tu Beneslider: kanyla Benetube (A), nikltitanovaâ pruzïina (B), aktivacïnõâzaâ mek (C) a naznacï enõâ smeï ru aktivace. Fig. 4. Beneslider appliance parts: Benetube tube (A), nickel-titanium coil (B), activation lock (C) and activation direction mark. Obr. 5a, b. Apara t Beneslider Fig. 5a, b. Beneslider appliance [email protected] 185

43 rocïnõâk24 ORTODONCIE U prvnõâ skupiny pacientuê nebyly hornõâ staâleâ druheâ molaâ ry prorïezaâ ny. Druha skupina (skupina B) zahrnovala 16 pacientuê (3 muzïi a13 zï en) s pruêmeï rnyâm veï kem 18,2 ± 8,9 let (tab. 1). U pacientuê vteâ to skupineï byly prïi zahaâ jenõâ distalizace hornõâ staâ leâ druheâ molaâ ry prorïezaâ ny v takoveâ m rozsahu, zï e byly vsï echny hrbolky zubu minimaâ lneï klinicky viditelneâ amaximaâ lnõâ konvexitakorunky bylave vyâsï ce cementosklovinneâ hranice staâleâ ho prvnõâho molaâ ru nebo okluzaâ lneï odnõâ.vcï ase T2 prïi zhotovenõâ dru- The patients were divided into two groups according to the presence of erupted maxillary permanent second molars. The first group (Group A) included 14 children (5 boys, 9 girls), the average age was 11.6 ± 0.9 years. Maxillary permanent second molars were not erupted in this group. The second group (Group B) included 16 patients (3 males, 13 females), the average age was 18.2 ± 8.9 years (Table 1). At the beginning of distalization maxillary permanent second molars were erupted to Obr. 2a, b. Zavedene kotevnõâ implantaâty Fig. 2a, b. Inserted anchorage implants Obr. 1a, b, c. ZavaÂdeÏ nõâ kotevnõâch implantaâtuê Fig. 1a, b, c. Insertion of anchorage implants Obr. 3. Sa drovyâ model Fig. 3. Plaster model [email protected]

44 ORTODONCIE rocïnõâk24 kotevnõâch implantaâ tuê muê zï e provaâ deï t ortodontista. Kotevnõ implantaâ ty nepodleâ hajõâ osteointegraci [17], lze je zatõâzï it velmi brzy po jejich zavedenõâ. Mezi faktory ovlivnï ujõâcõâ stabilitu kotevnõâch implantaâ tuê patrïõâ mnozï stvõâ kosti v mõâsteï jejich inzerce [20], jejich pruêmeï r [21, 22], deâ lka [23], tocï ivyâ moment beï hem jejich zavaâdeï nõâ [24], zaâneït v okolõâ implantaâ tu prïi nedostatecï neâ hygieneï [25], smeï r avelikost sil amomentuê naneïpuê sobõâcõâch [26]. PrÏednõ cïaâ st patra se zdaâ byât jednou z nejvhodneïjsïõâch oblastõâ pro umõâsteï nõâ palatinaâ lnõâch implantaâ tuê cï i kotevnõâch implantaâ tuê, protozï e kvalita a mnozï stvõâ kosti je dostatecïnaâ [27], vrstvasliznice je tenkaâ [28] ariziko kontaktu s korïeny zubuê [26], s ceâ vami a nervy je maleâ. PruÊmeÏ rnaâ vyâsï ka kosti palatinaâ lneï mediaâ nneï a paramediaâ lneï mezi foramen incisivum a 12 mm posteriorneï odneï jje 5,01 mm [29]. Dva milimetry paramediaâ lneï od strïednõâ patroveâ sutury je nejveï tsï õâ vyâsï kakosti nauâ rovni spojnice boduê kontaktu mezi sï picï aâ kem aprvnõâm premolaâ rem (8,7 ± 2,3 mm) anauâ rovni spojnice boduê kontaktu mezi prvnõâm adruhyâm premolaâ rem (8,68 ± 3,77 mm) [30]. CõÂlem teâ to praâ ce bylo retrospektivneï zhodnotit zmeï ny nakefalometrickyâ ch snõâmcõâch prïed terapiõâ a po distalizaci prvnõâch molaâ ruê adruhyâ ch i prvnõâch premolaâruê, ke kteryâm dochaâzõâbeï hem terapie aparaâ tem Beneslider. U tohoto typu aparaâ tu kotvenõâ zajisï t'ujõâ dva palatinaâ lneï paramediaâ lneï umõâsteï neâ kotvenõâ implantaâ ty, ktereâ jsou spojeny v jedneâ sagitaâ lnõâ prïõâmce ve smeï ru puê sobõâcõâ sõâly pomocõâ konstrukce typu Beneplate. Byl zkoumaâ n vliv erupce hornõâch staâlyâch druhyâch molaâruê na distalizaci prvnõâch molaâruê. Materia l a metodika Do studie bylo zahrnuto celkem 30 pacientuê, kteryâm byl v raâ mci ortodontickeâ terapie nasazen aparaâ t Beneslider k distalizaci obou hornõâch staâ lyâ ch prvnõâch molaâruê. K hodnocenõâ byly pouzïity kefalometrickeâ rentgenoveâ snõâmky zhotoveneâ v cï ase T1 prïed zahaâ jenõâm ortodontickeâ terapie a v cï ase T2 po distalizaci hornõâch staâ lyâ ch prvnõâch molaâ ruê aminimaâ lneï hornõâch druhyâ ch i prvnõâch premolaâruê. Studie bylaretrospektivnõâ. Krite riak zarïazenõâ do studie byla naâ sledujõâcõâ: ± AngleovaII. trïõâdav molaâ rech v rozsahu o 1/4 premolaâ roveâ sïõârïky azï po celou sïõârïku premolaâ ru; ± steï snaâ nõâ hornõâho zubnõâho oblouku nebo zveï tsï enyâ incizaâ lnõâ schuê dek ± anteriorotacï nõâ nebo neutraâ lnõâ ruê st dolnõâ cï elisti; ± kompletnõâ ortodontickaâ dokumentace (modely, OPG snõâmek, kvalitnõâ kefalometrickyâ snõâmek prïed zahaâjenõâm terapie a po distalizaci, kompletnõâ zaâ znam terapie beï hem kazïdeânaâvsïteï vy pacienta v ordinaci). Pacienti byli rozdeï leni do dvou skupin podle prïõâtomnosti prorïezanyâ ch hornõâch staâ lyâ ch druhyâ ch molaâ ruê. Prvnõ skupina (skupina A) zahrnovala 14 deïtõâ (5 chlapcuê, 9 dõâvek) s pruêmeï rnyâm veï kem 11,6 ± 0,9 let. months until the implant osseointegration [17, 19]. Introduction and removal of anchorage implants may be performed by an orthodontist. Anchorage implants are not subjected to osseointegration [17], and thus it is possible to load them early after their introduction. Factors affecting stability of anchorage implants include the amount of bone at the place of insertion [20], diameter [21, 22], length [23], force moment during their insertion [24], inflammation surrounding the implant due to insufficient hygiene [25], direction and amount of forces and moments working on them [26]. The anterior part of palate seems to be one of the most suitable areas for the adjustment of palatal or anchorage implants, as the quality and amount of bone is sufficient there [27]. The layer of mucosa is thin [28], and the risk of contact with roots [26], veins and nerves is very low. The average height of bone palatally medially or paramedially between foramen incisivum and 12 mm posteriorly off it reaches 5.01 mm [29]. 2 mm paramedially of central palatal suture the height of bone is the greatest at the level of connecting line of contact points between canine and the first premolar (8,7 ± 2,3 mm) and at the level of contact points between first and second premolar (8.68 ± 3.77 mm) [30]. The aim of this study was the retrospective evaluation of changes in cephalograms prior to therapy and after distalization of first molars and second and first premolars during the use of Beneslider appliance. In this appliance anchorage is secured with two palatally paramedially located anchorage implants that are connected in one sagittal straight line in the direction of the force by means of Beneplate construction. We examined the impact of maxillary permanent second molars on first molars distalization. Material and method The study included 30 patients in orthodontic treatment with Beneslider appliance to distalize both maxillary permanent first molars. We evaluated cephalograms taken at T1 (prior to orthodontic therapy) and at T2 (after distalization of maxillary permanent first molars, and minimum distalization of maxillary second and first premolars). The method adopted was a retrospective study. Criteriafor inclusion to the study: ± Angle Class II in molars from 1/4 of premolar width to the total width of premolar ± Crowding in upper dental arch or increased overjet; ± Anteriorotation or neutral growth of the mandible; ± Complete orthodontic records (models, OPG, a good quality cephalogram prior to therapy and after distalization, complete record of therapy during each patient's appointment). [email protected] 183

45 rocïnõâk24 ORTODONCIE lization of maxillary permanent first molars, first and second premolars, were evaluated. The patients were divided into two groups. Group A included 14 patients without erupted maxillary permanent second molars prior to the appliance adjustment. Group B included 16 patients with erupted maxillary permanent second molars. Results: In both groups first molars were successfully distalized. In Group A the mean distalization at the crown level was 3.56 ± 0.75 mm, at the root level 3.62 ± 1.37 mm. In Group B the mean distalization at the crown level was 4.6 ± 1.46 mm, at the root level 4.41 ± 1.59 mm. During the process of distalization the inclination of molar was not statistically significant in either group, the change in SNGoMe angle was not statistically significant either. Conclusion: Beneslider appliance is an effective tool for the distalization of maxillary permanent first molars with bodily movement, even in cases where maxillary second molars are erupted (Ortodoncie 2015, 24, cï. 4, s. 181±195). U vod Distalizace hornõâch staâ lyâ ch prvnõâch molaâ ruê je jednou z alternativ extrakcï nõâ terapie u Angleovy II. trïõâdy, maâ sveâ specifickeâ indikace a svaâ uâ skalõâ. Existuje rïada technik, jejichzï cõâlem je posunout hornõâ molaâ ry distaâ lneï. NeÏ ktereâ z distalizacï nõâch aparaâ tuê, naprïõâklad extraoraâ lnõâ tah, vyzï adujõâ perfektnõâ spolupraâ ci pacienta [1]. Taje bohuzïel cï asto problematickaâ. V poslednõâch letech se rozsï õârïilo pouzïõâvaâ nõâ distalizacï nõâch aparaâ tuê, u nichzï spolupraâ ce pacienta nenõâ nutnaâ (tzv.non-compliance aparaâ ty). Distalizace by meï laideaâ lneï probõâhat teï lesnyâ m pohybem bez distaâ lnõâho sklonu molaâruê. Aby tomu tak bylo, meï l by vektor sõâly probõâhat co nejblõâzï e centrarezistence zubu [2], ktereâ se u hornõâch prvnõâch molaâruê nachaâ zõâ prïiblizïneï v trifurkaci korïenuê. Bra nit sklonu molaâ ru lze takeâ jeho pohybem po tuheâ m vodõâcõâm oblouku [3]. U Distal Jet aparaâ tu, Keles slider aparaâ tu i aparaâ tu Beneslider puê sobõâ distalizacï nõâ sõâla palatinaâ lneï v uâ rovni centrarezistence molaâ ru amolaâ r je beï hem distalizace veden rigidnõâm vodõâcõâm systeâ mem [4, 5, 6, 7]. Mnoho autoruê se zabyâvaâ vlivem hornõâch druhyâch molaâruê na distalizaci hornõâch prvnõâch molaâruê. Distalizace prvnõâch molaâ ruê je dle neï kteryâ ch studiõâ uskutecï nitelnaâ, i kdyzï jsou druheâ molaâ ry prorïezaneâ, ato i klasickyâmi distalizacï nõâmi aparaâ ty [8,9]. Je ale nutneâ pouzïõât veï tsï õâch sil, cozï muê zï e znacï neï zatõâzï it kotevnõâ jednotku. Distalizace pak takeâ trvaâ deâ le. Proto je doporucï eno distalizovat prvnõâ molaâ ry prïed prorïezaâ nõâm druhyâ ch molaâruê [8, 10, 11, 12]. U aparaâ tuê, u nichzï kotvenõâ zajisï t'uje pryskyrïicï naâ deska spojenaâ pomocõâ oceloveâ ho draâ tu s hornõâmi premolaâry nebo docï asnyâmi molaâ ry, je velkaâ cïaâ st mõâstav zubnõâm oblouku zõâskaâ namesiaâ lnõâm posunem premolaâ ruê aprotruzõâ rïezaâkuê [13,14,15,16]. PrÏi distalizaci je kvalita kotvenõâ pro vyâ sledek terapie klõâcï ovaâ, proto se prïechodnaâ kotevnõâ zarïõâzenõâ stala soucï aâ stõâ aparaâ tuê k distalizaci hornõâch molaâ ruê. NejcÏ asteï ji se pouzï õâvajõâ minidlahy, palatinaâ lnõâ implantaâ ty akotevnõâ implantaâ ty. Nevy hodou palatinaâ lnõâch implantaâ tuê a minidlah je invazivita chirurgickeâho zaâ kroku beï hem jejich zavedenõâ [17, 18, 19]. U palatinaâ lnõâch implantaâ tuê je nutneâ cï ekat neï kolik meï sõâcuê na osteointegraci implantaâ tu [17, 19]. Zavedenõ i vyjmutõâ Introduction Distalization of maxillary permanent first molars is an alternative to extraction therapy in Class II with specific indications and difficulties. There are a number of procedures for maxillary distal movement. Some of the appliances, e.g. extraoral pull, require perfect cooperation of a patient [1], which is often a problem. Recently, distalization appliances have been used in which a patient's cooperation is not necessary (the so-called non-compliance appliances). Ideally, distalization is performed by bodily movement without distal inclination of molars. Therefore, force vector should go as close to the tooth center of resistance as possible [2]. In maxillary first molars the center of resistance is approximately at roots trifurcation. Molar inclination can be prevented also by its movement along the rigid guiding arch [3]. In DistalJet, Keles slider and Beneslider appliances the distalization force works palatally on the level of molar center of resistance, and during the process molar moves along rigid guiding system [4, 5, 6, 7]. A number of authors deal with the impact of maxillary second molars on distalization of maxillary first molars. Some believe that distalization of first molars is possible even if second molars are erupted and with traditional distalization appliances [8, 9]. However, greater forces must be applied, which may be a considerable load for anchorage unit. Distalization then takes alonger time. Therefore, it is recommended to distalize first molars before second molars erupt [8, 10, 11, 12]. In appliances with anchorage of acrylic plate connected by steel wire to maxillary premolars or temporary molars a lot of space in dental arch may be obtained through mesial movement of premolars and protrusion of incisors [13,14,15,16]. In distalization the quality of anchorage is vital for the results, and therefore temporary anchorage units became a part of appliances for maxillary molars distalization. Miniplates, palatal implants and anchorage implants are the most often used. Invasive surgery of palatal implants and miniplates is perceived as disadvantage [17,18,19]. In palatal implants it is necessary to wait for several [email protected]

46 ORTODONCIE rocïnõâk24 Distalizace hornõâch staâlyâ ch prvnõâch molaâruê aparaâ tem Beneslider v zaâ vislosti na stavuerupce hornõâch staâlyâch druhyâ ch molaâruê Distalization of maxillary permanent first molars with Beneslider appliance related to eruption of maxillary permanent second molars *MDDr. Sabina ChlupovaÂ, **,***MUDr. Uwe H. Engels, *Doc. MUDr. PavlõÂna CÏ ernochovaâ, Ph.D., ****Mgr. KaterÏina LangovaÂ, Ph.D. * Ortodonticke oddeï lenõâ, Stomatologicka klinikafn u sv. Anny v BrneÏ * Department of Orthodontics, Clinic of Stomatology, University Hospital of St.Anne, Brno ** Ortodonticke oddeï lenõâ Stomatologicke kliniky FN v Hradci Kra loveâ ** Department of Orthodontics, Clinic of Stomatology, University Hospital, Hradec Kra loveâ *** Priva tnõâ praxe, Dessau-Rosslau, NeÏ mecko *** Private practice, Dessau-Rosslau, Germany **** Katedra leâkarïskeâ biofyziky, LF UP Olomouc **** Department of Medical Biophysics, Medical Fakulty, Palacky University, Olomouc Souhrn CõÂl: Hodnocenõ efektivity distalizace skeletaâ lneï kotvenyâ m aparaâ tem Beneslider v zaâ vislosti na prorïezaâ nõâ hornõâch staâlyâ ch druhyâ ch molaâruê Materia l a metodika: V retrospektivnõâ studii byla na skupineï 30 pacientuê hodnocena distalizace molaâruê pomocõâ aparaâ tu Beneslider, kteryâ byl adaptovaâ n v raâ mci ortodontickeâ terapie. K hodnocenõâ uâ cï inku distalizaâ toru byly pouzï ity kefalometrickeâ rentgenoveâ snõâmky zhotoveneâ prïed zahaâ jenõâm ortodontickeâ terapie a po distalizaci hornõâch staâlyâ ch prvnõâch molaâruê a prvnõâch i druhyâ ch premolaâruê. Pacienti byli rozdeï leni do dvou skupin. Skupina A cï õâtala 14 pacientuê, jejichzï hornõâ staâ leâ druheâ molaâ ry nebyly prïed nasazenõâm aparaâ tu Beneslider prorïezaâ ny. Skupina B zahrnovala 16 pacientuê s prorïezanyâ mi hornõâmi staâlyâ mi druhyâ mi molaâ ry. Vy sledky: U obou skupin pacientuê byly prvnõâ molaâ ry uâ speï sïneï distalizovaâ ny. Ve skupineï A byla pruê meï rnaâ velikost distalizace na uâ rovni korunky 3,56 ± 0,75 mm, na uâ rovni korïene 3,62 ± 1,37 mm. Ve skupineï B dosaâ hla distalizace prvnõâho molaâ ru pruêmeï rneâ velikosti 4,6 ± 1,46 mm na uâ rovni korunky a 4,41 ± 1,59 mm na uâ rovni korïene. Ani v jedneâ skupineï se prvnõâ molaâr beï hem distalizace statisticky signifikantneï nesklonil, uâ hel SNGoMe se beï hem distalizace statisticky signifikantneï nezmeï nil. ZaÂveÏr:Apara t Beneslider je uâ cï innyâ v distalizaci hornõâch staâ lyâ ch prvnõâch molaâ ruê bodily posunem, i kdyzï jsou prorïezaneâ hornõâ staâleâ druheâ molaâry(ortodoncie 2015, 24, cï. 4, s. 181±195). Abstract Aims: Assessment of the effectiveness of distalization with skeletally anchored appliance Beneslider related to eruption of maxillary permanent second molars. Material and method: The retrospective study of 30 patients evaluated distalization of molars with Beneslider appliance adapted for the orthodontic therapy. Cephalograms taken prior to orthodontic therapy and after dista- [email protected] 181

47 rocïnõâk24 ZajõÂmavosti v ortodoncii ORTODONCIE gresoveâ naâ vsï teï vnõâky Hradce Kra loveâ bylaprïipravena zajõâmavaâ prohlõâdkahistorickeâ vodnõâ elektraâ rny ¹HucÏa kª. Jak je uzï zvykem neï kolik let, spolecï enskyâ vecï õârek pro ortodontickeâ asistentky a zubnõâ techniky byl prïõâjemnyâ m pobavenõâm po prvnõâm kongresoveâ m dni. PerlicÏ kou spolecï enskeâ ho programu vsï ak byl presidentskyâ vecï er nesoucõâ se v duchu let prvnõâ republiky. Je teïzïkeâsi prïedstavit jineâ vhodneï jsï õâ mõâsto konanõâ neï zï historickou budovu Muzeavy chodnõâch CÏ ech z dõâlny architekta Jana KoteÏ ry. Na dhernyâ vecï er byl opravdu poteïsï enõâm pro vsï echny smysly. PrÏõÂjemny ¹zÏ ivyâ ª jazz doprovaâ zel raut a degustace võân ve sklepnõâch prostorech muzea bylaozï ivenacimbaâ lovou muzikou. PeÏ knou prïipomõânkou jsou fotografie na webovyâch straâ nkaâ ch: NaprÏõÂsÏ tõâ kongres, v porïadõâ uzï 17., se budeme teï sï it do hlavnõâho meï staprahy. MUDr. Elena Blokhina Stomatologicka klinika LF UK a FN v Hradci Kra loveâ Spolupra ce ortodontisty a praktickeâ ho stomatologa Ve dnech se v prïõâjemneâ m prostrïedõâ hotelu Horal ve Velky ch KarlovicõÂch konalo dvoudennõâ diskusnõâ soustrïedeï nõâ pro ortodontisty nateâ ma¹spolupraâ ce ortodontisty apraktickeâ ho stomatologaª porïaâdaneâ firmou BELdental, s.r.o. Lektorkou kurzu byla Doc. MUDr. OlgaJedlicÏ kovaâ, CSc. HlavnõÂm teâ matem prvnõâho dne soustrïedeï nõâ bylainterdisciplinaâ rnõâ spolupraâ ce a komunikace mezi praktickyâ m zubnõâm leâ ka rïem aortodontistou. Panõ docentka naâ m najednotlivyâ ch kazuistikaâ ch demonstrovala nezbytnost vcï asneâ intervence ze strany praktickeâ ho zubnõâho leâkarïe jako prevenci vzniku ortodontickyâch vad a naopak vyvarovaâ nõâ se nespraâ vneï indikovanyâ m nebo prïedcï asnyâm zaâ krokuê m. DalsÏ õâ teâ mata prïednaâ sï ek se tyâkala ortodoncie dospeïlyâch aprïedoperacïnõâ prïõâpravy, naâ rokuê naestetiku. PrÏedna sï kovyâ den jsme ukoncï ili spolecï enskyâ m vecï erem v doprovodu cimbaâ lu. Druhy den byl veï novaâ n konzultaci leâcï ebnyâch plaânuê, kdy si kazïdyâ z naâ s mohl s panõâ docentkou JedlicÏ kovou prodiskutovat svoje komplikovaneâ pacienty. TõÂmto bych chteï lapodeï kovat nejen panõâ docentce JedlicÏ koveâ za prïõânosnyâ kurz, ale takeâ ostatnõâm koleguê m, kterïõâ se zuâcï astnili diskuse a podeï lili se s naâmi o praktickeâ zkusï enosti ze svojõâ praxe. DalsÏ õâ podeï kovaâ nõâ patrïõâ firmeï BELdental, s.r.o za vyâ bornou organizaci celeâ akce a prïõâjemneï straâ venyâ võâkend v prostrïedõâ Beskyd. MDDR. Dagmar StrakovaÂ, FN Motol CÏ lenskyâ poplatek pro rok 2016 cï inõâ 2500,- KcÏ nebo 100,- 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 1000,- KcÏ za rok nebo 50,- 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 [email protected]

48 ORTODONCIE ZajõÂmavosti v ortodoncii rocïnõâk24 XVI. kongres CÏ eskeâ ortodontickeâ spolecï nosti V letosï nõâm roce se mohli ortodontisteâ vzdeï laâvat na mnohaodbornyâ ch akcõâch. Za prïipomenutõâ stojõâ Vy rocï nõâ konference Americke ortodontickeâ spolecï nosti v San Francisku, 91. kongres Evropske ortodontickeâ spolecïnosti v Bena tkaâ ch av neposlednõâ rïadeï 8. kongres SveÏtove ortodontickeâ spolecï nosti v LondyÂneÏ. OdborneÏ vzdeïlaâ vat jsme se vsï ak mohli takeâ domav CÏ eskeâ republice, kde byl porïaâ daâ n XVI. kongres CÏ eskeâ ortodontickeâ spolecï nosti. Tento rok se stal porïadatelskyâm meï stem Hradec Kra loveâ. Kongres byl porïaâ daâ n k prïõâlezï itosti 70 let vyâ uky naleâ ka rïskeâ fakulteï Univerzity Karlovy v Hradci Kra loveâ. Jeho organizaci meï lanastarosti Dr. A. Mottlova ze zdejsï õâ Stomatologicke kliniky. Kongres se konal ve dnech rïõâjnav historickeâ budoveï byâ valyâ ch jezuistkyâ ch kolejõâ, dnes hotelu Nove Adalbertinum. HlavnõÂmi teâ maty kongresu byly VyuzÏ itõâ zobrazovacõâch metod v ortodoncii akomplikace ortodontickeâ leâ cï by. PrÏednõ odbornõâk naproblematiku tyâ kajõâcõâ se Cone Beam CT dr. A. Bumann naâ s provedl cï tvrtecïnõâm kongresovyâ m prekurzem. Nezvykle jej zahaâ jil otaâ zkou: ¹Jak a procï pouzï õâvat CBCT v rutinnõâ ortodontickeâ praxi?ª. BeÏ hem sveâ prïednaâsï ky se mu podarïilo velmi peï kneï propojit jednotlivosti v logickyâ celek aposkytnout posluchacï uê m zcelajinyâ uâ hel pohledu nasoucï a s- nou diagnostiku v ortodoncii. Poutava sdeï lenõâ nateâ machyby v ortodonticko-chirurgickeâ leâcïbeïmeï li dr. R. Folta n adr. M. Vesper. SvyÂm kritickyâ m pohledem naortognaâ tnõâ operace zaujali nejednoho posluchacï e. U skalõâm a chybaâ m v praxi ortodontisty byly veï novaâny prïednaâsï ky dr. I. Marka a dr. F. Bergstrandta. Jejich prïehlednaâ sdeï lenõâ byla prïõânosnaâ nejen pro postgraduanty a zacï õânajõâcõâ ortodontisty, ale i pro zkusï eneâ leâkarïe. CÏ estneâ cï lenstvõâ CÏ eskeâ ortodontickeâ spolecï nosti bylo udeï leno odb. as. MUDr. Marii SÏ tefkoveâ, CSc., kteraâ se v CÏ estneâ prïednaâsï ce BedrÏichaNeumannavra tilak historii rozvoje ortodoncie nauâ zemõâ CÏ eskeâ Republiky aslovenska. KromeÏ odborneâ ho programu pro leâ ka rïe byly prïepraveneâ sekce pro ortodontickeâ asistentky s celodennõâm kurzem fotografovaâ nõâ asekce pro zubnõâ techniky s celodennõâm praktickyâ m kurzem paâ jenõâ aletovaâ nõâ. Ve volnyâch chvõâlõâch jsme meï li mozïnost navsï tõâvit tradicï nõâ posterovou sekci aprohleâ dnout si prodejnõâ vyâ stavu firem. Navysoke uâ rovni byl nejen odbronyâ program, ale i kulturnõâ doprovodneâ akce. Na slavnostnõâm zahaâ jenõâ naâ s prïivõâtal vlõâdnyâ mi slovy deï kan kraâ loveâ hradeckeâ LeÂkarÏske fakulty Prof. MUDr. M. CÏ ervinka, CSc. a pak naâ s poteïsï ilasvyâm rock n rollovyâm vystoupenõâm studentskaâ kapela Elvis Presley revival. Pro vsï echny kon- [email protected] 179

49 ORTODONCIE ZpraÂvyzvyÂboru rocïnõâk24 daly reprodukovat (zvl. nesmõâ po zmensï enõâ velikost põâsmaklesnout 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 agrafuê v editoru Word nebo Power Point je neprïõâpustneâ.fotografie arentgenoveâ snõâmky nacd 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 opacïneâmprïõâpadeï bude redakce nucena upravovat (maskovat) fotografie tak, aby se znemozï nilaidentifikace. Pacienti nesmõâ byât oznacï ovaâ ni jmeâ ny nebo iniciaâ lami, ale pouze porïadovyâmi cï õâsly. V pruê vodnõâm dopise k odborneâ praâ ci prvnõâ autor stvrdõâ svyâm podpisem, zïe: ± se jednaâ o jejich vlastnõâ puê vodnõâ praâ ci; ± praâ ce soucï asneï nebylaanebude nabõâdnutajineâ mu periodiku; ± zïe autorïi nemajõâ komercï nõâ, vlastnickeâ nebo financï nõâzaâ jmy naproduktech nebo spolecï nostech popsanyâch v tomto cïlaâ nku; adaâ le, v prïõâpadeï potrïeby, zïe: ± klinickeâ nebo experimentaâ lnõâ zkousï ky nalidech cï i zvõârïatech dodrzïujõâ prïõâslusï neâ etickeâ zaâ sady a majõâ souhlas etickeâ komise; ± autorïi majõâ souhlas jineâ ho drzïitele autorskyâch praâ v k reprodukci obraâ zkuê ajineâ ho prïevzateâ ho materiaâ lu; ± autorïi majõâ souhlas fotografovaneâ ho pacienta se zobrazenõâm oblicï eje. V pruê vodnõâm dopise je daâle trïebauveâ st kontaktnõâ adresu prvnõâho autora, telefonnõâ cï õâslo a . K dopisu je trïebaprïilozïit fotografie autoruê v elektronickeâ formeï (jpg nebo tiff) nebo ve fyzickeâ podobeï, oznacï eneâ na rubu celyâm jmeâ nem. Rukopis bude posouzen odbornyâmi recenzenty redakcï nõâ rady. PraÂce nevyhovujõâcõâ po obsahoveâ nebo formaâ lnõâ straâ nce budou vraâ ceny autoruê m kprïepracovaâ nõâ. Pra ceprïijateâ k publikovaâ nõâ budou zaslaâ ny na kontaktnõâ adresu autoruê ke korekturïe. Autorska korekturaslouzï õâ pouze k opraveï tiskovyâch chyb, nelze prïi nõâ text obsahoveï meï nit nebo doplnï ovat. Prova dõâ se pomocõâ zavedenyâch korekturnõâch znameâ nek (CÏ SN ) nebo elektronicky. Korektury je trïebavraâ tit obratem, jinak si redakce vyhrazuje praâ vo vydat text bez autorizace. Zaslana dokumentace se vracõâ jen po dohodeï. UverÏejneÏ naâ praâ ce se staâ vaâ majetkem cï asopisu Ortodoncie. PrÏetisknout jejõâ cïaâ 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., klinikazubnõâho leâkarïstvõâ, Palacke ho 12, Olomouc. Tel.: [email protected]. CÏ eskaâ aanglickaâ verze PokynuÊ pro autory je uverïejneï nanainternetovyâch straâ nkaâ ch vydavatele: sed and written on a separate sheet. The place where to put the appendix within the text may be designated with a square and the number of appendix on the margin. The picture orientation should be marked at the back with an arrow. Pictures must allow copying (characters size must not be less than 2 mm). Tables should be saved in a Word format, graphs in MS Excel in original version including basic tables. Do not send pictures or graphs in text editor Word or Power Point format. Pictures and X-rays should be saved in a JPG format min dpi. The photographs showing a patientâs face must be accompanied with a written statement by the patient expressing the agreement with publication. If such a statement is missing the editors will adapt (mask) the pic to make the identification of a person impossible. No names should be used, no initial letters of patients' names - just ordinal numbers. Accompanying letter will include the signed statement by the author expressing: ± that the submitted text is their own original work; ± that the work has not been and will not be submitted to another periodical; ± the authors have no comercial, proprietary, or financial interests in the products or companies described in this article; in some cases also: ± that the clinical or experimental testings on humans or animals follow the principles of ethical codex and were done with the agreement of the Board of Ethics; ± that the authors were given agreement of the copyright owner to reprint a certain material; ± that the authors were given agreement of the patient to publish a pic of his/her face. The letter should further include the contact address of the first author, phone number(s) and address. Enclosed should be found photographs of the authors with their names written at the back or in the electronic form in JPG format. The submitted text will be reviewed by the reviewers of the editorial board. Works which do not meet the requirements (content or formal aspects) will be sent back to the authors for revision. Works accepted will be sent to the authors for correction (proof-reading) - only the misprints can be corrected, not the text contents or its parts. Official press reader's marks must be used (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 ORTODONCIE. If it is to be reprinted (a part of the work or a picture) in another publication the original publisher must be cited. Address for correspondence: Redakce cï asopisu Ortodoncie, Doc. MUDr. M. SÏ pidlen, Ph.D., klinikazubnõâho leâkarïstvõâ, Palacke ho 12, Olomouc. Tel.: [email protected]. 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 ji citovanyâch ortodontickyâch astomatologickyâch 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. American journal of physical anthropology Amer. J. phys. Anthropol. Angle orthodontist Angle Orthodont. British journal of orthodontics Brit. J. Orthodont. CÏ eskaâ stomatologie Ces. Stomat. CÏ eskoslovenskaâ stomatologie Cs. Stomat. European journal of orthodontics Eur. J. Orthodont. Fortschritte der Kieferorthopedie Fortschr. Kieferorthop. International journal of adult orthodontics and orthognathic surgery Int. J. adult Orthodont. orthognathic Surg. Journal of clinical orthodontics J. clin. Orthodont. Journal of prosthetic dentistry J. prosthet. Dent. Journal of the American Dental Association J. Amer. dent. Assoc. Journal of clinical periodontology J. clin. Periodont. Journal of cranio-maxillo-facial surgery J. craniomaxillofacial Surg. Journal of oral surgery J. oral Surg. Journal of oral and maxillofacial surgery J. oral maxillofacial Surg. Journal of orthodontics J. Orthodont. Journal of periodontology J. Periodont. Ortodoncie Ortodoncie Prakticke zubnõâ leâkarïstvõâ Prakt. zubnõâ LeÂk. Seminars in orthodontics Semin. Orthodont. World journal of orthodontics World. J. Orthodont. [email protected] 177

50 rocïnõâk24 ZpraÂvyzvyÂboru ORTODONCIE Pokyny pro autory CõÂlem cï asopisu ORTODONCIE je informovat cï leny CÏ eskeâ ortodontickeâ spolecï nosti aostatnõâ ortodontickou astomatologickou verïejnost o deï nõâ v odborneâ spolecï nosti, o vyâvoji v ortodoncii aprïõâbuznyâch oborech, poskytovat materiaâ ly pro postgraduaâ lnõâ acelozïivotnõâ vzdeï laâ vaâ nõâ specialistuê v oboru ortodoncie ainformovat o odbornyâch asï kolicõâch akcõâch. CÏ asopis je vydaâ vaâ nvcï eskeâ m jazyce, odborneâ praâ ce dvojjazycï neï v cï eskeâ m/slovenskeâ m aanglickeâ m jazyce. PrÏõÂspeÏ vky v cï asopise se rïadõâ do teï chto rubrik: 1. SpolecÏ enskaâ rubrika; 2. ZpraÂvy z vyâboru CÏ eskeâ ortodontickeâ spolecï nosti; 3. ZajõÂmavosti v ortodoncii (zpraâ vy o probeï hlyâch odbornyâchasï kolicõâch akcõâch, zpraâ vy z kongresuê acest; 4. Diskusnõ apolemickeâ prïõâspeï vky, dopisy redakci; 5. Odborne praâ ce (puê vodnõâ praâ ce, souborneâ referaâ ty, prïedbeï zïnaâ sdeï lenõâ, kazuistiky); 6. Ze zahranicï nõâch cï asopisuê (referaâty z cï asopisuê); 7. Recenze (odbornyâch knih a atestacï nõâch pracõâ); 8. Informace. PrÏõÂspeÏ vky se zasõâlajõâ v tisïteïneâ formeï ve formaâ tu A4 asoucï asneï v elektronickeâ formeï nacd psaneâ v textoveâ m editoru obvykleâ ho typu (Word) v souladu s novyâmi pravidly cï eskeâho nebo slovenskeâho pravopisu a americkyâm standardem anglickeâ ho pravopisu jednotneï v celeâ m sdeï lenõâ. Fotografie musõâbyât ulozïeny ve formaâtu JPG v rozlisïenõâmin dpi. Tabulky, grafy atexty v obraâ zcõâch se publikujõâ v anglickeâ m jazyku. Pra ce zaslaneâ redakci musõâ byât formulovaâ ny s konecï nou platnostõâ. PozÏadavky na odborneâ praâ ce. Redakce prïijõâmaâ praâ ce, ktereâ nebyly anebudou zadaâ ny jineâ mu periodiku, vyhovujõâ po straâ nce odborneâ amajõâ odpovõâdajõâcõâ uâ rovenï metodologickeâ ho astatistickeâ ho zpracovaâ nõâ. Publikova nõâvyâsledkuê klinickyâch aexperimentaâ lnõâch (pokusy nazvõârïatech) vyâzkumuê prïedpoklaâ daâ, zïe byly dodrzïeny prïõâslusï neâ etickeâ zaâ sady, zejmeâ naprincipy Helsinske deklarace a souhlas etickeâ komise. MateriaÂlyprÏevzate z jinyâch pramenuê musõâ byât doplneï ny põâsemnyâm souhlasem drzïitele autorskyâch praâ v, kteryâ svoluje k reprodukci. RedakcÏ nõâ rada nevyzïaduje imprimatur vedoucõâho pracovisï teï. Zau rovenï sdeï lenõâ odpovõâdajõâ autorïi. KazÏdy rukopis prochaâ zõârecenznõâm rïõâzenõâm, ktereâ je oboustranneï anonymnõâa je provaâ deï no dveï manasobeï nezaâ vislyâmi odbornõâky. Posudek je spolu s naâ vrhy uâ prav zasõâlaâ n autorovi k uâpravaâ m. KonecÏne rozhodnutõâ o prïijetõâ cïlaâ nku k publikaci aouâpraveï rukopisu si vyhrazuje redakce. Pra ce mohou byâtvcï eskeâ m, 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 uveâst v prïõâloze. Natitulnõ straneï se uvaâ dõâ:naâ zev praâ ce, celaâ jmeâ naautoruê vcï etneï tituluê, naâ zev asõâdlo pracovisïteï, odkud praâ ce vychaâ zõâ, event. poznaâ mkao prïõâpadneâ 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, slovase nezkracujõâ. NazvlaÂsÏ tnõâm rïaâ dku se uvaâ dõâ 2-5 klõâcï ovyâch slov. Vlastnõ text je u puê vodnõâch pracõâ zpravidla rozdeï len nauâ vod, materiaâl (nebo soubor) ametodiku, vyâsledky, diskusi azaâveï 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 nõâ slov z naâ zvuê anaâ zvuê dokumentuêª,sprïihleâ 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 naâzvuê nejcï asteï ji citovanyâch ortodontickyâch astomatologickyâchcï asopisuê jsou uvedeny v Tab.1. Za literaturou se uvaâ dõâ jmeâ no akontaktnõâ adresa prvnõâho autora. PrÏõÂlohy. Obra zky (grafy, scheâ mata, fotografie) a tabulky se prïiklaâ dajõâ volneï k rukopisu, kazïdaâ prïõâlohazvlaâ sï t'. Legendak tabulce se uvaâ dõâ nad tabulkou, vysveï tlivky pod tabulkou. Legenda k ostatnõâ dokumentaci se prïiklaâdaâ nazvlaâ sï tnõâm listeï. MõÂsto, kam se maâ prïõâlohav textu umõâstit, je mozïno oznacï it naokraji straâ nky cï tverecï kem s cï õâslem prïõâlohy. Orientaci obraâ zkuê je vhodneâ vyznacï it narubu sï ipkou. Obra zky musõâ byât upraveny tak, aby se Instructions for Authors The objective of the journal ORTODONCIE is to give the Czech Orthodontic Society members and other orthodontists and dentists information on the activities within the scientific society, on research and developments in orthodontics and related subjects, bring study materials for the postgraduate studies and continuing education of the specialists in orthodontics, provide information on research and training courses. The journal is published in the Czech language, however, original articles are published in Czech/Slovak and in English. Articles may be divided into the following columns: 1) News, society. 2) News from the Council of the Czech Orthodontic Society. 3) Featured topics in orthodontics (reports on the recent scientific and training activities, reports from congresses and study stays. 4) Discussion and critical rubric, letters to editor. 5) Scientific articles (original works, reviews of the literature, preliminary reports, case reports). 6) Abstracts from foreign journals. 7) Reviews (books and postgraduate theses). 8) Information. Works should be submitted printed in A4 format hard copy and in electronic form (CD) using acommon 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 double-blind peer review process. Two independent reviewers do not know the identity of authors and authors do not know the identity of reviewers. The reviews with the comments are sent to authors for the requested changes. The editorial board makes a final decision on the acceptance of the manuscript and on its revision. Texts may be written in Czech, Slovak or English. Translations into English are the responsibility of the editors. To improve the quality of English translations the editors recommend to attach to a text the special English terminology. The title page includes: title of the work, full names of the authors and their academic degrees, name and seat of the department, note on the previous publishing of the work in the form of alecture. 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. Appendices. Pictures (diagrams, schemes, photos) and tables are enclosed free to the text, each appendix separately. Keys are written above the table, explanatory notes below. Notes dealing with other documentation are enclo [email protected]

51 ORTODONCIE ZpraÂvyzvyÂboru rocïnõâk24 2. SchuÊ ze bere naveï domõâ zpraâvu o cï innosti CÏ OS za uplynuleâ funkcï nõâ obdobõâ, zpraâ vu o hospodarïenõâ za rok 2014 azpraâ vu reviznõâ komise. 3. SchuÊ ze schvaluje rozpocï etcï OS narok 2016 vcï etneï nezmeï neï neâ vyâsïecï lenskyâchprïõâspeï vkuê pro rok 2016: ortodontisteâ v privaâ tnõâch praxõâch 2.500,- KcÏ / 100,- EUR ortodontisteâ v zameï st. pomeï ru naklinikaâ ch 800,- KcÏ / 35,- EUR ostatnõâ cï lenoveâ 300,- KcÏ / 15,- EUR registracï nõâ poplatek 500,- KcÏ / 20,- EUR uâ hrada za jeden rocïnõâkcï asopisu Ortodoncie (pro necï leny CÏ OS) 1000,- KcÏ / 50,- EUR SchuÊ ze se zuâ cï astnilo 77 rïaâ dnyâch cï lenuê CÏ OS. Za naâ vrhovou komisi: MUDr. Josef KucÏ era V Hradci Kra loveâ, dne SouteÏzÏ o CenuCÏ eskeâ ortodontickeâ spolecï nosti za nejlepsïõâ atestacïnõâ praâ ci za rok 2015 Prvnõ cenu CÏ eskeâ ortodontickeâ spolecï nosti zanejlepsï õâ atestacï nõâ praâ ci za rok 2015 zõâskala MDDr. Diana FilipovaÂ, Stomatologicka klinika2. LF UK afn Praha Motol zapraâ ci: ¹ZmeÏ natlousï t'ky vestibulaâ rnõâ kortikaâ lnõâ kosti po protruzi dolnõâch rïezaâkuêª. Druhou cenu CÏ eskeâ ortodontickeâ spolecï nosti za nejlepsï õâ atestacï nõâ praâ ci zarok 2015 zõâskal MDDr. Michal SÏ õâr, Stomatologicka klinikalf UK afn PlzenÏ za praâ ci: ¹Postpuberta lnõâ ruê st dolnõâ cï elisti - retrospektivnõâ pruêrïezovaâ studieª. TrÏetõ cenu CÏ eskeâ ortodontickeâ spolecï nosti zanejlepsï õâ atestacï nõâ praâ ci zarok 2015 zõâskal MDDr. JirÏõ Ha lek, Stomatologicka klinikalf UK afn PlzenÏ zapraâ ci: ¹Spolupra ce prïi ortodontickeâ terapii snõâmacõâmi aparaâ tyª. SouteÏzÏ o ceny XVI. kongresucï eskeâ ortodontickeâ spolecï nosti 2015 v Hradci Kra loveâ Cenu zanejlepsï õâ prïednaâ sï ku mladyâ ch autoruê XVI. kongresu CÏ OS zõâskala MDDr. Hana SimonidesovaÂ, Stomatologicka klinika2. LF UK afn Motol zapraâ ci: ¹Dynamicka analyâzauâ smeï vuª. Cenu zanejlepsï õâ e-poster s veï deckovyâ zkumnou tematikou XVI. kongresu CÏ OS zõâskala MDDr. Daniela Vra tnaâ, Stomatologicka klinika1. LF UK avfn PrahaaKlinika zubnõâho leâ karïstvõâ LF UP v Olomouci zapraâ ci: ¹Settling po ortodontickeâ terapii v zaâ vislosti natypu retenceª. Cenu zanejlepsï õâ e-poster s klinickou tematikou XVI. kongresu CÏ OS zõâskala MUDr. Magdale nagalovicï ovaâ, Stomatologicka klinikalf UK afn PlzenÏ zapraâ ci: ¹Posttraumaticka asymetrie oblicï eje u deï tskeâ ho pacientaª. MUDr. Martin Kotas, Ph.D. [email protected] 175

52 rocïnõâk24 ZpraÂvyzvyÂboru ORTODONCIE praâ ci, nejlepsï õâ prïednaâsï ku nakongresu anejlepsï õâ postery zpracovaâ vajõâcõâ veï deckou aklinickou teâ matiku. CÏ OS chce i v budoucnu sveâ financï nõâ prostrïedky investovat prïedevsï õâm k podporïe azvysï ovaâ nõâ odborneâ uâ rovneï postgraduaâ lnõâ vyâ uky naklinickyâ ch pracovisï tõâch. MUDr. Hana BoÈ hmovaâ VsÏemrÏa dnyâmcï lenuêmcï OS: Volby 2016!!! NaprÏõÂsÏ tõâm kongresu v zaârïõâ 2016 v Praze vyprsïõâ funkcï nõâ obdobõâ cï lenuê orgaânuê CÏ eskeâ ortodontickeâ spolecï nosti anaplenaâ rnõâ schuê zi s volbami bude trïebazvolit noveâ cï leny. ProsõÂm vsï echny rïaâ dneâ cï leny CÏ OS, aby se zamysleli nad fungovaânõâm CÏ OS, poprïemyâsï leli o vhodnyâch kandidaâ tech pro dalsï õâfunkcï nõâobdobõâaprïõâpadneâ naâ vrhy mi posõâlali na [email protected]. Vy bor areviznõâ komise CÏ OS jako prvnõâ kandidaâ ty navrhujõâ tyto cï leny CÏ OS: MUDr. Ladislav Berna t, Ph.D., MUDr. VladimõÂr Filipi, Ph.D., MUDr. Eva Sedlata Jura skovaâ, Ph.D., MUDr. JirÏõ Tvardek, Ph.D. a MUDr. Wanda UrbanovaÂ, Ph.D. Ze vsï ech teï chto i VasÏ ich naâvrhuê bude sestavena prïedbeï zïnaâ kandidaâ tka. Do dalsï õâho funkcï nõâho obdobõâ jizï nehodlajõâ kandidovat tito cï lenoveâ CÏ OS: Prof. MUDr. Milan KamõÂnek, DrSc., MUDr. Magdalena Kot'ovaÂ, Ph.D., MUDr. JirÏõ Petr amudr. HanaTycovaÂ. DeÏ kuji Va m za pozornost teâ to zpraâveï, teïsï õâm se na VasÏena vrhy a veïrïõâm, zïe volby v roce 2016 budete braât velmi vaâzïneïazuâcï astnõâte se v hojneâ m pocï tu. MUDr. JirÏõ Petr, prïedseda CÏ OS U vodnõâ rïecï k udeï lenõâ CÏ estneâ ho cï lenstvõâ CÏ OS as. MUDr. Marii SÏ tefkoveâ, CSc. Va zï eneâ panõâ kolegyneï, vaâ zï enõâ paâ ni kolegoveâ, milõâ prïaâ teleâ, zacï aâ tkem devadesaâ tyâ ch let minuleâ ho stoletõâ jsem nepouzï õâval palatinaâ lnõâ oblouk, ato proto, zïe jsem to prosteï neumeï l. I vyrazil jsem na praktickyâ kurz jedneâ daâ my pronikaveâ ho mysï lenõâ i hlasu, kteraâ meï praâci s tõâmto prïõâstrojem naucï ila, a takto jej pouzïõâvaâ m dodnes. To jsem jesïteï neveïdeïl,zï e s touto daâ mou spolu s dalsïõâmi ortodontisty straâvõâm prïõâjemneâ chvõâle prïi nasï em prvnõâm kongresu zavelkou louzï õâ v USA v roce Bylato rovneï zï ona, kteraâ mneï (ajisteï mnohadalsï õâm koleguê m) otevrïelaocï i pro vnõâmaâ nõâ Evropske ortodontickeâ spolecï nosti atõâm se zaslouzï ilao mou prvnõâ uâcï ast na kongrese EOS v Brightonu v roce Tato daâmameï lato sïteï stõâ, zï e jejõâm otcem byl vyâznacïnyâ olomouckyâ ortodontistadoc. SÏ imek. MeÏ l by z nõâ dnes jisteï velkou radost, protozï e otcovskyâ odkaz vzala vaâ zï neï astalase po straâ nce odborneâ, veï deckeâ i pedagogickeâ pravou rukou nasï eho nejvyâ znamneï jsï õâho ortodontisty druheâ poloviny minuleâ ho stoletõâ prof. KamõÂnka. SamostatneÏ bylaastaâ le je pedagogicky velmi zïaâ daâ napro svou schopnost zaujmout nejen mladeâ leâkarïe, ale i ortodontickeâ asistentky, ktereâ se ka zï dorocï neï nemohou docï kat jejõâho vystoupenõâ na kongresech CÏ OS. PrÏi sveâ m prvnõâm ortodontickeâ m kongresu v roce 1985 v BrneÏ jsem v raâ mci spolecï enskyâch akcõâ byl fascinovaâ n sceâ nou, prïi nõâzï Dr. Paulsen spolu s tehdy mneï neznaâ mou slicï nou temperamentnõâ blondyâ nou tancï ili freneticky najõâdelnõâm stole. Je mi velkyâm poteïsï enõâm, zïe mohu tuto tanecï nici po 30 letech prïivõâtat zde a udeï lit jõâ titul CÏ estnyâ cï len CÏ eskeâ ortodontickeâ spolecï nosti. Va zï enõâ prïaâ teleâ : panõâ asistentka Marie SÏ tefkovaâ, kandidaâ tkaveï d! MUDr. JirÏõ Petr CÏ lenoveâ CÏ OS ke Celkem cï lenuê CÏ OS ) RÏ aâ dnyâch cï lenuê a.leâkarïi v praxi b. leâkarïi naklinice - zameï stnanci ) MimorÏa dnyâch cï lenuê a.cï R - postgr., MD, seniorïi aostatnõâ b. Slovensko, Polsko, NeÏ mecko ) CÏ estnyâch cï lenuê...11 (+1) Nove cï lenstvõâ v roce 2015 (k ) UkoncÏ eneâ cï lenstvõâ v roce 2015 (k )... 6 CÏ asopis Ortodoncie - prïedplatneâ CÏ R Slovensko NeplaticÏ i (po vyâzveï ) CÏ R Slovensko PrÏedplatne (po vyâzveï ) CÏ R... 2 Slovensko (jmennyâ seznam je k dispozici u sekretaârïky CÏ OS) Usnesenõ plenaâ rnõâ schuê ze CÏ OS ze dne , Nove Adalbertinum, Hradec Kra loveâ 1. Plena rnõâ schuê ze zvolilatyto cï leny komisõâ: mandaâ tovaâ : Dr. ZdeneÏ k Hofman, Dr. JirÏõ Baumruk, Dr. JirÏõ Tvardek naâ vrhovaâ : Dr. Josef KucÏ era, Dr. Hana BoÈ hmovaâ, Dr. Ivo Marek [email protected]

53 ORTODONCIE ZpraÂvyzvyÂboru rocïnõâk24 kandidaâ tky. V cï asopise Ortodoncie bude v tomto smyslu uverïejneï no oznaâ menõâ avyâ zva. DeÏ kuji Va m za pozornost. MUDr. JirÏõ Petr HospodarÏenõ CÏ OS za rok 2014 Stav k (pokladna + buâ KB): ,-KcÏ 1) PrÏõÂjmy: U roky z buâ 11,- KcÏ CÏ lenskeâ prïõâspeï vky ,- KcÏ CÏ asopis Ortodoncie ,- KcÏ Odborne akce CÏ OS ,- KcÏ (zaâ lohanazisk z kongresu 2014; doplatek - leden byl ,- KcÏ) Vra cenõâ poskytnuteâ puê jcï ky ± ,- KcÏ Vra cenõâ chybneï poslaneâ platby ± 6.100,- KcÏ Inzerce nawebovyâch straâ nkaâ ch ,- KcÏ PrÏõÂjmy celkem: ,- KcÏ 2) VyÂdaje: Provoz kancelaârïe asekretariaâ tu ,- KcÏ ZameÏ stnanci CÏ OS (pracovnõâ smlouva, DPCÏ ) ,- KcÏ Pra vnõâ sluzï by ,- KcÏ Ekonomicke adanï oveâ sluzï by ,- KcÏ VyÂdaje pro klinickaâ pracovisïteï 8.680,- KcÏ FinancÏ nõâ podporaleâkarïuê v postgr. vyâuce, granty CÏ OS ,- KcÏ VyÂdaje vyâboru ark ,- KcÏ CenaCÏ OS ,- KcÏ PrÏõÂspeÏ vky WFO, EFOSA ,- KcÏ Zahr. cesty cïl.vyâboru, RK adelegaâtuê ,- KcÏ Webove straâ nky ,- KcÏ CÏ asopis Ortodoncie (redakcï nõâ praâ ce, mzdy ahonoraârïe) ,- KcÏ (vyârobaatisk) ,- KcÏ DanÏ zprïõâjmuê PO ,- KcÏ Ostatnõ vyâ daje (bankovnõâ poplatky apod.) ,- KcÏ VyÂdaje celkem: ,- KcÏ VyÂsledek za rok 2014: ,- KcÏ nauâcï tu (k ): ,- KcÏ v pokladneï : ,- KcÏ nauâcï tu (ke ): ,- KcÏ v pokladneï : ,- KcÏ RozpocÏ et pro rok ) PrÏõÂjmy: CÏ lenskeâ prïõâspeï vky CÏ asopis Ortodoncie PrÏõÂjmy celkem: ,- KcÏ ,- KcÏ ,- KcÏ 2) VyÂdaje: Provoz kancelaârïe asekretariaâ tu ZameÏ stnanci CÏ OS (pracovnõâ smlouva, DPCÏ ) Pra vnõâ sluzï by Ekonomicke adanï oveâ sluzï by VyÂdaje vyâboru ark Granty CÏ OS PrÏõÂspeÏ vek naodb. pobyty postrg. studentuê VyÂdaje pro klinickaâ pracovisïteï CenaCÏ OS PrÏõÂspeÏ vky WFO, EFOSA PrÏõÂspeÏ vek nadelegaâtycï OS Webove straâ nky CÏ asopis Ortodoncie (redakcï nõâ praâ ce, mzdy ahonoraârïe) (vyârobaatisk) VyÂdaje celkem: ,- KcÏ ,- KcÏ ,- KcÏ ,- KcÏ ,- KcÏ ,- KcÏ ,- KcÏ ,- KcÏ ,- KcÏ ,- KcÏ ,- KcÏ ,- KcÏ ,- KcÏ ,- KcÏ ,- KcÏ CÏ lenskeâ prïõâspeï vky: Ortodontiste v privaâ tnõâch praxõâch 2.500,- KcÏ / 100,- EUR Ortodontiste v zameï stnaneckeâm pomeï ru naklinikaâ ch 800,- KcÏ / 35,- EUR Ostatnõ (postgraduanti, leâkarïky namd, seniorïi ajinõâ) 300,- KcÏ / 15,- EUR RegistracÏ nõâ poplatek 500,- KcÏ / 20,- EUR CÏ asopis Ortodoncie (1 rocïnõâk) pro necï leny CÏ OS 1000,- KcÏ / 50,- EUR Za vaznyâ termõân uâ hrady prïõâspeï vkuê na uâcïet CÏ OS: do 29. uâ nora Zpra va reviznõâ komise za rok 2014 V roce 2014 pracovala reviznõâ komise ve slozï enõâ MUDr. Hana TycovaÂ, MUDr. JirÏõ Baumruk a MUDr. Hana BohmovaÂ. Reviznõ komise provedlaspolu s panõâ ing. Zelingrovou asekretaârïkou panõâ SÏ aâ rkou RychtaÂrÏovou pravidelnou uâcï etnõâ kontrolu hospodarïenõâ zarok Nebyly shledaâ ny zïaâ dneâ nedostatky. CÏ esko-slovenskyâ kongres 2014 v Olomouci byl uâ speïsïnyâ nejen odborneï, ale i financïneï askoncïilsprïebytkem. CÏ OS zaminulyâ rok hospodarïilas vyrovnanyâ m rozpocï tem. V minuleâ m obdobõâ byly zõâskaneâ prostrïedky vyuzï ity prïedevsï õâm k financï nõâ podporïe odborneâ cï innosti. Zejme na sï lo o cesty navyâ znamneâ mezinaâ rodnõâ kongresy urcï eneâ pro leâ ka rïe klinickyâ ch pracovisï t' agranty naodborneâ staâ zï e pro studenty v postgraduaâ lnõâ prïõâpraveï. Nemalou cï aâ stkou jsou podporovaâ ni postgraduanti, kterïõâ byli oceneï ni CÏ OS zanejlepsï õâ atestacï nõâ [email protected] 173

54 rocïnõâk24 ZpraÂvyzvyÂboru ORTODONCIE Program plenaâ rnõâ schuêzecï OS dne , Nove Adalbertinum, Hradec Kra loveâ 1) Zaha jenõâ, prïivõâtaânõâuâcï astnõâkuê, volbakomisõâ a) mandaâ tovaâ komise b) naâ vrhovaâ komise 2) ZpraÂvaocÏ innosti CÏ OS zauplynuleâ funkcï nõâ obdobõâ 3) Zpra vao financï nõâm hospodarïenõâ CÏ OS zaminulyâ rok anaâ vrh rozpocï tu pro naâ sledujõâcõâ rok 4) Zpra vareviznõâ komise 5) Diskuse 6) Zpra vamandaâ toveâ komise 7) Na vrh usnesenõâ ajeho schvaâ lenõâ 8) ZaÂveÏ r schuêze Plena rnõâ schuêzecï OS , Nove Adalbertinum, Hradec Kra loveâ Zpra va o cï innosti CÏ OS za obdobõâ mezi kongresy 2014 ± ) SpolecÏny kongres CÏ OS asos v roce 2014 v Olomouci byl hodnocen jako velmi uâ speïsïnyâ po straâ nce odborneâ, spolecï enskeâ i ekonomickeâ ; celkovyâ zisk pro CÏ OS byl ,- KcÏ; vyâ bor podeï koval prezidentovi kongresu Dr. Markovi. 2) 1., 2. a3. cenu CÏ eskeâ ortodontickeâ spolecï nosti vyhlaâ sï enou naminuleâ m kongresu zõâskali v tomto porïadõâ Dr. Hanzelka, Dr. KratochvõÂlova adr. FlorykovaÂ. 3) Kongresy v nadchaâ zejõâcõâch letech - rekapitulace: - r Praha, prezident Dr. UrbanovaÂ, cï estneâ oceneï nõâ prof. Williams - r Liberec, prezident Dr. KucÏ era, cï estneâ oceneï nõâ prof. Joho - r CÏ eskeâ BudeÏ jovice, prezident Dr. BernaÂt - r spolecï nyâ cï esko-slovenskyâ, Slovensko, prezident Dr. KlõÂmova - r Brno, prezident doc. CÏ ernochovaâ. 4) CÏ eskyâ den v raâ mci ¹World village dayª prïi kongresu SveÏ toveâ ortodontickeâ asociace v zaârïõâ v LondyÂneÏ byl zrusï en, acï koli byl organizaâ tory kongresu prïislõâben anasï õâ stranou prïipraven. Jeden z lektoruê za CÏ R Dr. Marek meï l nakonec mozï nost prïedneâ st svou prïednaâsïku vraâ mci polskeâ ho dne. 5) AAO s cõâlem propojit naâ rodnõâ ortodontickeâ spolecï nosti s americkou asociacõâ pozïaâ dala o naâ vrh osoby ¹ambasadoraª pro CÏ R. Vy borem je navrzï en Dr. Marek. 6) VyÂbor vyjaâdrïil smutek nad odchodem nasïõâ vyâznamneâ ortodontickeâ osobnosti acï estneâ cï lenky CÏ OS MUDr. Evy VelõÂsÏ koveâ, CSc. 7) Vyja drïenõâ praâ vnõâkacï OS JUDr.Macha: - ortodontickou leâcï bu smõâ v CÏ R provaâdeï t pouze specialista v ortodoncii; pokud by ji neï kdo provaâdeï l bez teâ to kvalifikace, hrozõâ pokuta azï 1 milion KcÏ - sestrabez prïõâtomnosti leâkarïe nesmõâ samostatneï ortodonticky osï etrïovat pacienta, muê zï e poskytovat pouze prvnõâ ortodontickou pomoc. 8) Vy bor vyjaâ drïil podporu aopeï t prïevzal zaâ sï titu nad seminaârïem o rozsïteï poveâ problematice, kteryâ se uskutecï nil ve FNKV dne ) VyÂbor uvõâtal, zïe v lednu av zaârïõâ 2015 se naolomouckeâ klinice opeï t uskutecï nil kurz pro leâkarïe v ortodontickeâ specializaci. 10) Vy bor schvaâ lil tyto podmõânky pro sponzory kongresuê CÏ OS: Pokud generaâ lnõâm partnerem kongresu CÏ OS bude nadnaâ rodnõâ firma, maâ mozï nost spojit se s jednõâm naâ rodnõâm distributorem svyâ ch produktuê auhradit sponzorskou cï aâ stku spolecï neï. Pokud se bude jednat o spolecïnyâ kongres CÏ OS asos, muêzïe se nadnaâ rodnõâ firmazatõâmto uâ cï elem spojit s jednõâm cï e- skyâ m ajednõâm slovenskyâ m distributorem dle vlastnõâho uvaâzïenõâ. Tato pravidla platõâ vyâ hradneï pro generaâ lnõâho partnerakongresu. 11) VyÂbor vzal na veï domõâ informaci prïedsedy atestacï nõâ komise prof. KamõÂnka, zï e atestace z ortodoncie probeï hnou v termõânech a v Olomouci. 12) VyÂbor nadaâ le usiluje o vyrïazenõâ dospeïlyâch pacientuê z uâ hrady zdravotnõâmi pojisï t'ovnami a o prosazenõâ kategorizace i u ortodontickyâch vyâkonuê. 13) Vy bor vyhoveï l zï aâ dosti Dr. Urbanove aschvaâ lil uâ hradu prïedplatneâho cï asopisu The Cleft Palate-Craniofacial Journal na rok 2015 pro stomatologickou kliniku FNKV Praha. 14) Vy bor schvaâ lil prïõâspeï vek ,- KcÏ dr. Kuklove naaktivnõâ uâcï ast na EOS poster. 15) Vy bor schvaâ lil proplacenõâ cestovneâ ho nakongres EOS 2015 v Bena tkaâ ch prof. KamõÂnkovi a kongresoveâ ho poplatku as. SÏ tefkoveâ - jednaâ nõâ Teachers Forum, auâ cï astnickeâ ho poplatku na kongresu WFO 2015 v LondyÂneÏ Dr. Petrovi jako delegaâ tovi CÏ OS. 16) Granty CÏ OS v roce 2015 byly udeï leny teï mto leâkarïuê m: Dr. Urbanove adr. PolaÂcÏ koveâ ze stomatologickeâ kliniky FNKV Praha, kazïdeâ po ,- KcÏ a daâle Dr. ChraÂsÏt'anske adr.vopicï koveâ ze stomatologickeâ kliniky FN UK PlzenÏ, kazïdeâ po ,- KcÏ. 17) PrÏõÂsÏ tõâ kongres CÏ OS v roce 2016 bude volebnõâ, bude koncï it funkcï nõâobdobõâcï lenuê v orgaâ nech CÏ OS. VyÂbor doporucï uje cï lenuê m CÏ OS uâcï astnit se kongresu v hojneâ m pocï tu av pruêbeï hu obdobõâ do kongresu rozmyslet vhodneâ kandidaâ ty do orgaâ nuê CÏ OS aprïõâpadneï je v prïedstihu navrhnout staâ vajõâcõâmu vedenõâ. Z naâ vrhuê pleâ naaorgaâ nuê CÏ OS bude sestaven naâ vrh prïedbeï zïneâ [email protected]

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56 rocïnõâk24 SpolecÏ enskaâ rubrika ORTODONCIE VrÏõÂjnu, listopadu a prosinci roku 2015 sveâ vyâznamneâ zïivotnõâ jubileum oslavili: MUDr. Marta BohuslavickaÂ, Praha prof. MUDr. Jaroslav Racek, DrSc., Praha MUDr. Hana VavrÏõÂcÏkovaÂ,TyÂnisÏteÏ nad Orlicõ MUDr. Marie MarkovaÂ, CSc., Praha MUDr. Josef Deva t, ZlõÂn MUDr. Vlasta OdstrcÏilovaÂ, Brno MUDr. VeÏra PrÏibõÂkovaÂ, LitomeÏrÏice MUDr. Justina PaucÏkovaÂ, Ostrava - Maria nskeâ Hory MUDr. Marie SÏ tefkovaâ, CSc., Olomouc MUDr. Vlasta Nova kovaâ,uâ stõâ nad Labem - Skorotice MUDr. Miroslav SÏ ovan, LedecÏ nad Sa zavou MUDr. Hana PaÂcÏovaÂ, Brno MUDr. Hana NekolovaÂ, Praha MUDr. Hana StrojilovaÂ, Olomouc MUDr. Alena GrigerovaÂ, Hradec Kra loveâ MUDr. Jitka SÏ vaâ chovaâ, Hostivice MUDr. Marie MatousÏkovaÂ, DacÏice MUDr. Amer Abed, Praha MUDr. Agata Mohammad, TrÏinec SrdecÏneÏ blahoprï ejeme! OdesÏ la as. MUDr. Marie MarkovaÂ, CSc. VrÏõÂjnu letosï nõâho roku opustila rïady ortodontistuê as. MUDr. Marie MarkovaÂ, CSc. Narodila se , po vaâ lce s vyznamenaâ nõâm vystudovala obor zubnõâ leâ karïstvõâ na tehdejsï õâ FakulteÏ vsï eobecneâ ho leâ karïstvõâ Karlovy univerzity v Praze. Prvnõ zkusï enosti jako zubnõâ leâ karïka zõâskala v Lounech. V roce 1965 zacï ala pracovat na II. stomatologickeâ klinice prazï skeâ VsÏ eobecneâ fakultnõâ nemocnice a od teâ doby se veï novala ortodoncii. Na ortodontickeâ m oddeï lenõâ, ktereâ vedl nejprve docent Adam a daâ le profesor Racek, se rïadu let veï novala vyâ uce ortodoncie a rïada koleguê si ji dodnes pamatuje jako velmi naâ rocï nou a pecï livou pedagozïku i leâ karïku. BravurneÏ ovlaâ dala praâ ci se snõâmacõâmi aparaâ ty. Ve strïedu jejõâ odborneâ pozornosti byly vyâ vojoveâ odchylky dentice, publikovala a prïednaâsï ela rïadu pracõâ zameïrïenyâ ch na genetiku hypodonciõâ, velice zajõâmaveâ byly jejõâ prïõâspeï vky o vyâ voji trïetõâch molaâruêcï i sledovaâ nõâ vyâ voje a erupce hornõâch staâ lyâ ch sï picï aâ kuê, ktereâ publikovala s prof. Rozkovcovou. Jejõ uâ slovõâ, zï e znalost vyâ voje chrupu a jeho odchylek je prubõârïskyâ m kamenem ortodontisty i pedostomatologa je neustaâ le aktuaâ lnõâ. Za CÏ eskou ortodontickou spolecï nost, kolegy i studenty ortodoncie Jaroslav Racek, JirÏõ Petr, Magdalena Kot'ova SpecializacÏnõ atestace Ve dnech probeï hly specializacï nõâ atestacï nõâ zkousï ky. Specialisty v oboru ortodoncie se uâ speïsïneï stali: MUDr. Eva Sedlata Jura skovaâ, Ph.D., MUDr. Blanka PrÏibylovaÂ, MDDr. Elen StrÏelcova a MDDr. Barbora Procha zkovaâ. BlahoprÏejeme [email protected]

57 ORTODONCIE rocïnõâk24 Obsah (Contens): SpolecÏ enskaâ rubrika Zpra vy z vyâ boru ZajõÂmavosti v ortodoncii Distalizace hornõâch staâlyâch prvnõâch molaâruê aparaâ tem Beneslider v zaâ vislosti nastavu erupce hornõâch staâlyâch druhyâch molaâruê (Distalization of maxillary permanent first molars with Beneslider appliance related to eruption of maxillary permanent second molars) MozÏ nosti leâcïbyprïi terapii hlubokeâ ho skusu (Treatment modalities in deep bite treatment ) Postpuberta lnõâ ruê st dolnõâ cï elisti - retrospektivnõâ pruê rïezovaâ studie (Postpubertal growth of the mandible - a retrospective cross-sectional study) Kongres CÏ OS 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 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 TeÏsÏ õâme se na spolupraâcisvaâmi Doc. MUDr. MilosÏ SÏ pidlen, Ph.D. vedoucõâ redaktor, Klinika zubnõâho leâ karïstvõâ LF UP PalackeÂho Olomouc tel.: mob.: [email protected] www. orthodont-cz.cz [email protected] 169

58 ORTODONCIE rocïnõâk24 ORTODONCIE Recenzovany cï asopis CÏ eskeâ ortodontickeâ spolecïnosti Published by the Czech Orthodontic Society RocÏ nõâk (Volume): 24 Rok (Year): 2015 CÏ õâslo (Number): 4 CÏ asopis ORTODONCIE 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 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. IrenaKlõÂmovaÂ, 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 Vedoucõ redaktor web stran (Editor in Chief web pages): MUDr. JirÏõ Tvardek, HustopecÏ e, Czech Republic Adresa redakce (Contact Address): Olomouc, PalackeÂho12 fax: , tel.: [email protected] ISSN: 1210±4272 Recenzenti cï asopisu Ortodoncie: MUDr. Hana BoÈ hmovaâ Doc. MUDr. PavlõÂna CÏ ernochovaâ, Ph.D. MUDr. VladimõÂr Filipi, Ph.D. MUDr. Petr Jindra, Ph.D. Prof. MUDr. Milan KamõÂnek, DrSc. MUDr. IrenaKlõÂmova MUDr. Martin Kotas, Ph.D. MUDr. Magdalena Kot'ovaÂ, Ph.D. MUDr. Josef KucÏ era, Ph.D. MUDr. Ivo Marek, Ph.D. MUDr. JirÏõ Petr Prof. MUDr. Jaroslav Racek, DrSc. Doc. MUDr. MilosÏ SÏ pidlen, Ph.D. MUDr. EvaSÏ raâ mkovaâ MUDr. Marie SÏ tefkovaâ, CSc. MUDr. Miroslava SÏ vaâ bovaâ, CSc. MUDr. JirÏõ Tvardek, Ph.D. MUDr. Hana Tycova MUDr. Wanda UrbanovaÂ, Ph.D. 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. Prof. MUDr. JindrÏich Pazdera, CSc. Doc. MUDr. LudeÏ k PerÏinka, CSc. Doc. MUDr. LenkaRoubalõÂkovaÂ, Ph.D. Doc. MUDr. Radovan Sleza k, CSc. Doc. MUDr. Martin Starosta, Ph.D. Doc. MUDr. JitkaStejskalovaÂ, 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 (ORTODONCIE is published in 4 issues per year) Sazba (Type setting): FIS Print Olomouc. Tisk (Printed by): Tiska rnapratr a. s. 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 ORTODONCIE is sent to all members of the Czech Orthodontic Society in good spending with their subscription. UzaÂveÏ rky (Dedline for the next year): 5. 3., 7. 5., a [email protected] 167