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TOMO™ 57 ñ TEYXO™ 1
IANOYAPIO™ - MAPTIO™ 2013
ENTY¶O K§EI™TO AP. A¢. 520/92
£ÂÌÈÛÙÔÎÏ¤Ô˘˜ 38 106 78 Aı‹Ó·
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E§§HNIKH™ O¢ONTIATPIKH™ OMO™¶ON¢IA™
ISSN 1011 - 4181
E¶I™THMONIKO ENTY¶O ME E£NIKH ANA°NøPI™H
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T· E™X ‚Ú›ÛÎÔÓÙ·È Î·Ù·¯ˆÚË̤ӷ ÛÙÔÓ
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¶ÂÚÈÔ‰ÈÎÒÓ ÙÔ˘ EıÓÈÎÔ‡ K¤ÓÙÚÔ˘ TÂÎÌËÚ›ˆÛ˘
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To ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ EOO Î·È Ë ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹
ÙˆÓ «EÏÏËÓÈÎÒÓ ™ÙÔÌ·ÙÔÏÔÁÈÎÒÓ XÚÔÓÈÎÒÓ», ÂÎÙÈÌÒÓÙ·˜
ÙȘ ‰˘Ó·ÙfiÙËÙ˜ Ù˘ Û‡Á¯ÚÔÓ˘ ËÏÂÎÙÚÔÓÈ΋˜ Ù¯ÓÔÏÔÁ›·˜, ·ÔÊ¿ÛÈÛÂ,
Ë ÙÚÈÌËÓÈ·›· ¤Î‰ÔÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Ó· Á›ÓÂÙ·È ·ÔÎÏÂÈÛÙÈο
ËÏÂÎÙÚÔÓÈο, Ì ·Ó¿ÚÙËÛË ÙˆÓ Ù¢¯ÒÓ ÛÙÔ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ
Ù˘ EÏÏËÓÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ OÌÔÛÔÓ‰›·˜.
HÏÂÎÙÚÔÓÈ΋ EÈÎÔÈÓˆÓ›·
Î·È AÔÛÙÔÏ‹ EÈÛÙËÌÔÓÈÎÒÓ EÚÁ·ÛÈÒÓ
ÛÙË ‰È‡ı˘ÓÛË
[email protected]
TOMO™ 57
IANOYAPIO™ - MAPTIO™ 2013
hellenic stomatological review
HELLENIC DENTAL ASSOCIATION
VOLUME 57, ISSUE 1, JANUARY - MARCH 2013
ISSN 1011 - 4181
1
EÏÏËÓÈ΋ O‰ÔÓÙÈ·ÙÚÈ΋ OÌÔÛÔÓ‰›·
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§. ¶··ÁÈ·ÓÓÔ‡ÏË ¢. ™·ÎÂÏÏ¿ÚË
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B. TÔ›ÙÛÔÁÏÔ˘-£ÂÌÂÏ‹
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M. AÓÙˆÓÈ¿‰Ô˘, E.T. º·ÚÌ¿Î˘
E¶IME§EIA EK¢O™H™:
Œ‚ÂÏÈÓ M·Ì¿Ë
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T· ™ÙÔÌ·ÙÔÏÔÁÈο XÚÔÓÈο Â›Ó·È ÙÔ Â›ÛËÌÔ ÂÈÛÙËÌÔÓÈÎfi ¤ÓÙ˘Ô Ù˘ EÏÏËÓÈ΋˜
O‰ÔÓÙÈ·ÙÚÈ΋˜ OÌÔÛÔÓ‰›·˜ Ô˘ ÂΉ›‰ÂÙ·È
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EÙ‹ÛÈ· Û˘Ó‰ÚÔÌ‹: 0,01 e
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TOMO™ 57, TEYXO™ 1
IANOYAPIO™ - MAPTIO™ 2013
ISSN 1011 - 4181
¶EPIEXOMENA
EPEYNHTIKH EP°A™IA
ñ ÕÛÎÔË ÔÏ˘Ê·Ú̷Λ· ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÓÔÛËÌ¿ÙˆÓ
ÙÔ˘ ÛÙfiÌ·ÙÔ˜. AÓ·‰ÚÔÌÈ΋ ÌÂϤÙË Û 458 ·ÛıÂÓ›˜.
E.-M. K·ÏÔÁ‹ÚÔ˘, K.I. TfiÛÈÔ˜ Î·È A. ™ÎÏ·‚Ô‡ÓÔ˘ .........................9-17
£EMA K§INIKOY EN¢IAºEPONTO™
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·fi Ô‰ÔÓÙÔÛÙÔȯ›Â˜. ¶·ÚÔ˘Û›·ÛË ÂÚÈÛÙ·ÙÈÎÔ‡
Î·È ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÛÎfiËÛË.
M. ™ˆÙËÚ›Ô˘, N. ¶ÔÏ˘¯ÚÔÓ¿Î˘, º. ºÚ·ÁΛÛÎÔ˜
Î·È E. ™Ù·‡ÚÔ˘..............................................................................19-26
EN¢IAºEPOY™A ¶EPI¶Tø™H
ñ H ¢È·Ù·ÙÈ΋ OÛÙÂÔÁ¤ÓÂÛË ÛÙËÓ ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋.
¶·ÚÔ˘Û›·ÛË ÂÚ›ÙˆÛ˘ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.
X. ™Ô˘Ï›Ô˘, A. Z·‹, °. B·Á‰Ô‡ÙË Î·È º. T˙¤ÚÌÔ˜ ...................27-37
BIB§IO°PAºIKH ANA™KO¶H™H
ñ MÂÙ·ÌfiÛ¯Â˘ÛË ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ
Î·È ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ ÁÈ· ÙËÓ ·Ó¿Ï·ÛË
ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ.
£. KÔÓ‰‡Ï˘, E. ¶ÂÂÏ¿ÛË ..........................................................39-71
Hellenic Dental Association
Hellenic
Stomatological
Review
PROPRIETOR:
Hellenic Dental Association
EDITOR -IN- CHIEF:
J. G. Tzoutzas
EDITORIAL BOARD:
G. Douvitsas
F. Zervou-Valvi
H. Karkazis
G. Polyzois
A. Kossioni
P. Lagouvardos
G. Mountouris
H. Paximada
L. Papagiannoulis D. Sakellari
F. Tzerbos
V. Topitsoglou-Themeli
D. Tziafas
PRODUCTION SUPERVISORS:
M. Antoniadou, E.T. Farmakis
COPY EDITOR:
Evelin Babai
PRODUCTION - PROMOTION:
TypeProduct
V. & E. Babai Ltd
32 Epikourou Str., Athens Hellas
Phone#: (3210) 32.14.904
Fax#: (3210) 32.14.991
ADVERTISEMENTS - PUBLIC
RELATIONS:
M. Morfoniou - S. Gogas
Phone#: (3210) 33.02.343
Fax: (3210) 38.34.385
e-mail: [email protected]
Hellenic Stomatological Review is the
official publication of the Hellenic Dental
Association, published trimonthly.
Annual subscription
40 $ USD
PUBLISHER:
Athanasios Katsikis
President of the Hellenic Dental Association
HEADQUARTERS
38 Themistokleous Str., Athens, 106 78
Phone#: (3210) 38.13.380
Fax#: (3210) 38.34.385
e-mail: [email protected]
VOLUME 57, ISSUE 1
JANUARY - MARCH 2013
ISSN 1011 - 4181
CONTENTS
CLINICAL INTEREST
ñ Clinical management of epulis fissuratum:
Case presentation and Literature Review.
M. Sotiriou, N. Polychronakis, F. Fragiskos and E. Stavrou.............9-17
RESEARCH PAPER
ñ Drug abuse and overuse in the management of oral diseases.
Retrospective study in 458 patients.
E.-M. Kalogirou, K. I. Tosios and A. Sklavounou...........................19-26
CASE REPORT
ñ The Distraction Osteogenesis in pre-implant surgery.
A case report and review of the literature.
C. Souliou, C. Zappi, G. Bagdouti and F. Tzermpos .....................27-37
LITERATURE REVIEW
ñ Mesenchymal stem cell transplantation and gene transfer
for periodontal tissue regeneration.
T. Kondylis, E. Pepelassi ...............................................................39-71
™YNTAKTIKH ™E§I¢A
H KÚ›ÛË Î·È ÛÙȘ ¢ËÌÔÛȇÛÂȘ
H OÈÎÔÓÔÌÈ΋ KÚ›ÛË Î·È Ù· ·ÚÂÏÎfiÌÂÓ¿ Ù˘, Â›Ó·È ·Ó·ÌÂÓfiÌÂÓÔ Ó· ‰ËÌÈÔ˘ÚÁÔ‡Ó ÛÔ‚·Ú¿
ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ‰È·Î›ÓËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ÏËÚÔÊÔÚ›·˜, ÙËÓ ·ÓÙ·ÏÏ·Á‹ ·fi„ÂˆÓ Î·È
ÙËÓ ÔÌ·Ï‹ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ¯ÒÚˆÓ Î·È ÙˆÓ ÊÔÚ¤ˆÓ Ô˘ ·Ú¿ÁÔ˘Ó ‹ ÌÂÙ·‰›‰Ô˘Ó ÙË °ÓÒÛË.
H OÈÎÔÓÔÌÈ΋ KÚÈÛË Ô˘ Ì·ÛÙ›˙ÂÈ ÙËÓ EÏÏ¿‰· ηٿ ÙËÓ ÙÂÏÂ˘Ù·›· ÂÓÙ·ÂÙ›·, ¤¯ÂÈ ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÔÌ·Ï‹ ‰ÈÂÍ·ÁˆÁ‹ Ù˘ ¤Ú¢ӷ˜ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· Ì¿ÏÈÛÙ· ÛÙËÓ ·Ú·ÁˆÁ‹ ‰ËÌÔÛȇÛÂˆÓ Û ¤ÁÎÚÈÙ· EÏÏËÓÈο Î·È ¢ÈÂıÓ‹ EÈÛÙËÌÔÓÈο ŒÓÙ˘·.
OÈ ‰˘ÛÎÔϛ˜ ÍÂΛÓËÛ·Ó ÚÈÓ ·fi Ï›Á· ¯ÚfiÓÈ· Ì ÙÔÓ ÂÚÈÔÚÈÛÌfi ‹ Â·ÎÚÈ‚¤ÛÙÂÚ· ÙËÓ ·˘ÍË̤ÓË ‰˘ÛÎÔÏ›· Î·È ÙËÓ ·Ó·‚ÏËÙÈÎfiÙËÙ· Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËΠÛÙËÓ ÚfiÛ‚·ÛË Û ÌÂÁ¿Ï·
ÂÚ¢ÓËÙÈο ÚÔÁÚ¿ÌÌ·Ù·, ÙËÓ fiÏÔ Î·È ÈÔ ÔχÏÔÎË NÔÌÈο Î·È T˘Èο ‰È·‰Èηۛ·, ÁÈ·
ÙËÓ ˘Ô‚ÔÏ‹ Î·È ÙËÓ ‰È·Î›ÓËÛË ÂÚ¢ÓËÙÈÎÒÓ ÚˆÙÔÎfiÏψÓ, ÙËÓ ÂÌÏÔ΋ fiÏÔ Î·È ÂÚÈÛÛÔÙ¤ÚˆÓ NfiÌˆÓ Î·È ¢È·Ù¿ÍÂˆÓ ÛÙË ‰È·‰Èηۛ· Ù˘ Û˘ÓÂÚÁ·Û›·˜ ÂÚ¢ÓËÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡ ‹
ÙËÓ ÚÔÌ‹ıÂÈ· ÂÈÛÙËÌÔÓÈÎÔ‡ ÂÍÔÏÈÛÌÔ‡. ŒÊı·Û ̿ÏÈÛÙ· ̤¯ÚÈ Î·È ÙËÓ ·‰˘Ó·Ì›· ¿ÓÙÏËÛ˘ ÛÙÔȯ›ˆÓ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜, ̤ۈ ÙˆÓ ËÏÂÎÙÚÔÓÈÎÒÓ ‚È‚ÏÈÔıËÎÒÓ, ÏfiÁˆ ‰È·ÎÔ‹˜ Ù˘ ¯ÚËÌ·ÙÔ‰fiÙËÛ˘ ‹ χÛ˘ ÙˆÓ Û˘Ì‚·ÙÈÎÒÓ Û¯¤ÛÂˆÓ Ì ¤ÁÎÚÈÙÔ˘˜ ÂΉÔÙÈÎÔ‡˜ Ô›ÎÔ˘˜ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡.
K·Ù¿ Ù· ÚÒÙ· ¯ÚfiÓÈ· Ô˘ Ë ÎÚ›ÛË ¤Î·Ó ÙËÓ ÂÌÊ¿ÓÈÛ‹ Ù˘, ÔÈ ÂÏÏËÓÈΤ˜ ‰ËÌÔÛȇÛÂȘ -ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙÔ ¯ÒÚÔ
ÙˆÓ O‰ÔÓÙÈ·ÙÚÈÎÒÓ EΉfiÛˆÓ- ¤‰ÂÈÍ·Ó Ó· ÌËÓ ÂËÚ¿˙ÔÓÙ·È Ô‡Ù ÔÛÔÙÈο, Ô‡Ù ÔÈÔÙÈο Î·È ÙÔ‡ÙÔ ‰ÈfiÙÈ ˘‹Ú¯Â
·ÎfiÌ· Ë Âʉڛ· ÁÓÒÛ˘ Î·È ÂÈÛÙËÌÔÓÈÎÒÓ ÛÙÔȯ›ˆÓ ·fi ·ÚÂÏıÔ‡Û˜ ÂÚ¢ÓËÙÈΤ˜ Î·È Û˘ÁÁÚ·ÊÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜.
MÈ· ÛÂÈÚ¿ fï˜ ·fi ÁÂÁÔÓfiÙ· Ô˘ Û˘Ó¤‚ËÛ·Ó ¤ÎÙÔÙÂ, ÌÂÚÈο ·fi Ù· ÔÔ›· ·Í›˙ÂÈ Ó· ·Ó·ÊÂÚıÔ‡Ó ·Ú·Î¿Ùˆ, ÂËÚ¤·Û·Ó ÛËÌ·ÓÙÈο ÙȘ ÂȉfiÛÂȘ ÔÏÏÒÓ EÏÏËÓÈÎÒÓ EÈÛÙËÌÔÓÈÎÒÓ ÂÓÙ‡ˆÓ. MÈ· ·Ú¯È΋ ‰È·›ÛÙˆÛË Â›Ó·È fiÙÈ Ù·
ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰ÂÓ ˘¿Ú¯Ô˘Ó ϤÔÓ ÛÔ‚·Ú¿ ΛÓËÙÚ· Û ÌÂÁ¿Ï˜ ÂÈÛÙËÌÔÓÈΤ˜ ÔÌ¿‰Â˜ ÁÈ· ¤Ú¢ӷ Î·È ‰ËÌÔÛȇÛÂȘ, fiˆ˜ ÂÍÂÏ›ÍÂȘ ÛÙÔ˘˜ ¯ÒÚÔ˘˜ ÙˆÓ ¶·ÓÂÈÛÙËÌÈ·ÎÒÓ MÂÏÒÓ ¢E¶, ÚÔÎËÚ‡ÍÂȘ Ó¤ˆÓ ı¤ÛˆÓ, ÂÍÂÏ›ÍÂȘ ÛÙÔ
¯ÒÚÔ ÙÔ˘ EıÓÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ YÁ›·˜, ¢È‰·ÎÙÔÚÈΤ˜ ¢È·ÙÚÈ‚¤˜, MÔÓÔÁڷʛ˜ Î·È ÁÂÓÈο ·Ó¿ÁÎË ‰ËÌÈÔ˘ÚÁ›·˜ ‚ÈÔÁÚ·ÊÈÎÒÓ ÛËÌÂȈ̿وÓ.
¶·Ú¿ÏÏËÏ· Ë ··›ÙËÛË ÔÏÏÒÓ ·ÓÂÈÛÙËÌÈ·ÎÒÓ ÎÚÈÙÒÓ ÁÈ· ÙËÓ ·Ó¿ÁÎË ‡·Ú͢ ‰ÈÂıÓÒÓ ‰ËÌÔÛȇÛÂˆÓ ÛÙ·
‚ÈÔÁÚ·ÊÈο ÛËÌÂÈÒÌ·Ù· ÙˆÓ ÎÚÈÓfiÌÂÓˆÓ, ÌÂٷΛÓËÛ ÙÔ ÂӉȷʤÚÔÓ ÙˆÓ Û˘ÁÁڷʤˆÓ ÚÔ˜ ͤӷ -΢ڛˆ˜ AÁÁÏfiʈӷ- EÈÛÙËÌÔÓÈο ¤ÓÙ˘·, Ù· ÔÔ›· ‰È·ı¤ÙÔ˘Ó Î¿ÔÈÔ Û˘ÓÙÂÏÂÛÙ‹ ‚·Ú‡ÙËÙ·˜ Î·È ‚Ú›ÛÎÔÓÙ·È Î·È ·Ú¯ÂÈÔıÂÙË̤ӷ Û οÔÈ· Ì˯·Ó‹ HÏÂÎÙÚÔÓÈ΋˜ K·Ù·¯ÒÚËÛ˘ Î·È AÓ·˙‹ÙËÛ˘ .
T¤ÏÔ˜ Ë Â› ÙÚÈÂÙ›· ·Ó·ÛÙÔÏ‹ Ù˘ ÂÈÛ‰Ô¯‹˜ Ó¤Ô˘ ¢È‰·ÎÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡ -·ÚÈ· ÂÈÛ·ÁˆÁÈÎÒÓ ‚·ıÌ›‰ˆÓ- ÛÙÔ˘˜
¯ÒÚÔ˘˜ ÙˆÓ AEI, ¤¯ÂÈ ϤÔÓ ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ Î·ıÂÛÙÒ˜ ·‰È·ÊÔÚ›·˜ Î·È ·ÚÓËÙÈÛÌÔ‡ ÛÙËÓ ·Ú·ÁˆÁ‹ ÁÚ·ÙÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡ ÏfiÁÔ˘ ·fi Ó¤Ô˘˜ Î·È ·ÍÈfiÏÔÁÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜, ÂÓÒ ·ÓÙ›ıÂÙ· ·ÓıÔ‡Ó Û ‚·ıÌfi Ì¿ÏÈÛÙ· ÏËıˆÚÈÎfi ÔÈ
·ÚÔ˘ÛÈ¿ÛÂȘ Û ™˘Ó¤‰ÚÈ·, ™˘ÌfiÛÈ·, HÌÂÚ›‰Â˜, KÏÈÓÈο ºÚÔÓÙÈÛÙ‹ÚÈ·, Ì ¿ÊıÔÓÔ ÂÈÛÙËÌÔÓÈÎfi ˘ÏÈÎfi, Ì ¯·Ú·ÎÙ‹Ú· ÂÊËÚÌÔṲ̂Ó˘ ÁÓÒÛ˘ Î·È ÂÌÂÈÚ›·˜.
T· ÂÈÛÙËÌÔÓÈο ÂÚÈÔ‰Èο ¤¯Ô˘Ó Â›Û˘ ÏËÁ› ·fi ÙËÓ ¿ÓÙÏËÛË ÏËÚÔÊfiÚËÛ˘ ̤ۈ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘,·fi fiÔ˘ Ô Î¿ı ÂÈÛÙ‹ÌÔÓ·˜, ÌÔÚ› Ó· ·ÓÙÏ‹ÛÂÈ ÔÔÙ‰‹ÔÙÂ Û˘ÌÏËڈ̷ÙÈ΋ ÁÓÒÛË -fi¯È fiˆ˜ ¿ÓÙÔÙ ˘„ËÏ‹˜ ÔÈfiÙËÙ·˜ Î·È ·ÍÈÔÈÛÙ›·˜- Ì ¯·ÌËÏfi ‹ ·Ó‡·ÚÎÙÔ ÎÔÛÙÔÏfiÁÈÔ Î·È Ì ÂÚÈÔÚÈṲ̂ÓË ÙËÓ ·Ó¿ÁÎË Ó· Û˘ÁÎÂÎÙÚÒÓÂÈ ¤ÓÙ˘· ÛÙÔ ¯ÒÚÔ Ù˘ ÌÂϤÙ˘ ÙÔ˘, Ô˘ Ï›ÁÔ Î·ÈÚfi ÌÂÙ¿ ÌÂÙ·ÙÚ¤ÔÓÙ·È Û ÌÂÁ¿ÏÔ˘ ‚¿ÚÔ˘˜ Î·È ÙÂÚ¿ÛÙÈÔ˘ fiÁÎÔ˘, ÂÓÔ¯ÏËÙÈ΋ ¯·ÚÙfiÌ·˙·.
OÈ ÂÈÛÙËÌÔÓÈÎÔ› ÂΉfiÙ˜, Ú¤ÂÈ Ó· Û˘ÓÂÚÁ·ÛıÔ‡Ó ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Î·È Â›Ï˘ÛË ·˘ÙÔ‡ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜,
‰ÈfiÙÈ Ë ÁÚ·Ù‹ ÁÓÒÛË Ô˘ ¤¯ÂÈ ˘ÔÛÙ› ÙË ‚¿Û·ÓÔ Ù˘ ÔÏÏ·Ï‹˜ ÎÚ›Û˘ Î·È ÂÂÍÂÚÁ·Û›·˜ ·fi ÔÈΛÏÏÔ˘˜ ÎÚÈÙ¤˜,
·ÔÙÂÏ› ÙËÓ ÏÂfiÓ ·ÍÈfiÈÛÙË ÌÔÚÊ‹ ÏËÚÔÊfiÚËÛ˘ ÁÈ· οı ÂÈÛÙ‹ÌÔÓ·, ÔÈ ‰Â EÏÏËÓÈΤ˜ ¢ËÌÔÛȇÛÂȘ Â›Ó·È Ë
ÈÔ Â‡ÂÙË ÔÚÊ‹ ÁÓÒÛ˘ ÁÈ· ÙÔÓ Â˘·ÈÛıËÙÔÔÈË̤ÓÔ E·ÁÁÂÏÌ·Ù›· O‰ÔÓÙ›·ÙÚÔ, Ô˘ ‰ÂÓ ¤¯ÂÈ ÙÔ ¯ÚfiÓÔ Î·È ›Ûˆ˜
Î·È ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÂÚÈËÁÂ›Ù·È ÛÙȘ HÏÂÎÙÚÔÓÈΤ˜ BÈ‚ÏÈÔı‹Î˜ ÁÈ· Ó· ÂÓËÌÂÚˆı› Â› ıÂÌ¿ÙˆÓ Ù˘ ηıËÌÂÚÈÓ‹˜
¿ÛÎËÛ˘ ÙÔ˘ ÏÂÈÙÔ˘ÚÁ‹Ì·Ùfi˜ ÙÔ˘.
I. °. TZOYTZA™
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T· EÏÏËÓÈο ™ÙÔÌ·ÙÔÏÔÁÈο XÚÔÓÈο ÛÙÔ ‰È·‰›ÎÙ˘Ô
O‰ËÁ›Â˜ ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛ‹ ÙÔ˘˜
1.
2.
3.
4.
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6.
¶ÏËÎÙÚÔÏÔÁ›ÛÙ http://www.eoo.gr –
EÈϤͷÙ ÙËÓ ÂÓfiÙËÙ· «EΉfiÛÂȘ» –
EÌÊ·Ó›˙ÂÙ·È Ë ÛÂÏ›‰·
EÌÊ·Ó›˙ÂÙ·È Ë ÛÂÏ›‰·
EÈϤͷÙ ٷ «EÏÏËÓÈο ™ÙÔÌ·ÙÔÏÔÁÈο XÚÔÓÈο».
EÈϤͷÙ ÙÔ ¤ÙÔ˜ Ô˘ Û·˜ ÂӉȷʤÚÂÈ
EÈϤͷÙ ÙËÓ ÂÚÁ·Û›· Ô˘ Û·˜ ÂӉȷʤÚÂÈ
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™˘ÓÙÌ‹ÛÂȘ Î·È ™‡Ì‚ÔÏ· ™Ù·ıÂÚÒÓ MÔÓ¿‰ˆÓ, ™Ù·ÙÈÛÙÈÎÒÓ ŸÚˆÓ Î·È OÚÁ·ÓÔÏÔÁ›·˜
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angström
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barm
b
calorie
cal
candela
cd
coulomb
C
counts per minute
cpm
counts per second
cps
curie
Ci
degree Celsius
ÆC
disintegration
per minute
dpm
disintegration
per second
dps
electron Volt
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Eq
farad
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gauss
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gram
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hertz
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inch
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mole
newton
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ohm
osmol
pascal
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revolutions per minute
second
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week
year
™‡ÓÙÌËÛË
‹ ۇ̂ÔÏÔ
IU
J
K
kg
I or L
m
min
M
mol
N
N
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osmol
Pa
lb
psi
rpm
s
cm2
V
W
wk
yr
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correlation coefficient
degrees of freedom
mean
mean not significant
number of
observations
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TEM:
ESEM:
CSEM:
AFM:
SPM:
EELS:
EDS:
EPMA:
XRF:
XRD:
FTIR:
(1012)
(109)
(106)
(103)
(102)
(10)
(10-1)
™‡ÓÙÌËÛË
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ŸÚÔ˜
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probability
standard deviation
Standard error
of the mean
Student’s test
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variance
r
df
x
NS
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centiG
miliM
microk
nanoh
picoda
femtod
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(10-2)
(10-3)
(10-6)
(10-9)
(10-12)
(10-15)
(10-18)
Scanning Electron Microscopy
Transmission Electron Microscopy
Environmental Scanning Electron Microscopy
Confocal Scanning Electron Microscopy
Atomic Force Microscopy
Scanning Probe Microscopy
Electron Energy Loss Spectrometry
Element Dispersive Spectroscopy
Electron Probe Microanalysis
X-ray Fluorescence analysis
X-ray Diffraction
Fourrier Transformation Infrared Spectroscopy
p
SD
SE
t test
F
c
m
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O¢H°IE™ °IA TOY™ ™Y°°PAºEI™
T· ™TOMATO§O°IKA XPONIKA Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Ù˘ EÏÏËÓÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ OÌÔÛÔÓ‰›·˜ Î·È ˆ˜ ÛÙfi¯Ô ¤¯Ô˘Ó ÙË Û˘Ó¯‹ ÂÈÛÙËÌÔÓÈ΋ ÂÓË̤ڈÛË ÙÔ˘ ŒÏÏËÓ· O‰ÔÓÙÈ¿ÙÚÔ˘ Î·È ÙËÓ ÚÔÒıËÛË Ù˘
O‰ÔÓÙÈ·ÙÚÈ΋˜ EÈÛÙ‹Ì˘ ÛÙÔÓ EÏÏËÓÈÎfi ¯ÒÚÔ. °È· ÙËÓ
Ú·ÁÌ¿ÙˆÛË ÙÔ˘ ÛÎÔÔ‡ ·˘ÙÔ‡ ‰ËÌÔÛȇÔÓÙ·È:
1. K‡ÚÈ· ı¤Ì·Ù·:
ÕÚıÚ· Û ÌÔÚÊ‹ ·Ó·ÛÎfiËÛ˘, Ô˘ ·ÊÔÚÔ‡Ó Â›Î·ÈÚ·
Î·È ·ÌÊÈÏÂÁfiÌÂÓ· ı¤Ì·Ù· Î·È Ô˘ ÁÚ¿ÊÔÓÙ·È Ì ÚÔÙÚÔ‹
Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜ ·fi Û˘Ó·‰¤ÏÊÔ˘˜ Ì ÂȉÈΤ˜
Û ‚¿ıÔ˜ ÁÓÒÛÂȘ ÙÔ˘ ı¤Ì·ÙÔ˜.
2. EÈÛÙËÌÔÓÈο ¿ÚıÚ· Ô˘ ÛÙ¤ÏÓÔÓÙ·È ·fi Û˘Ó·‰¤ÏÊÔ˘˜:
T· ¿ÚıÚ· ·˘Ù¿ ÌÔÚ› Ó· ·Ó‹ÎÔ˘Ó Û ̛· ·fi ÙȘ ·Ú·Î¿Ùˆ ηÙËÁÔڛ˜: ·) AÓ·ÛÎÔ‹ÛÂȘ (̤¯ÚÈ 3 Û˘ÁÁÚ·Ê›˜)
‚) EÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ (¶ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜, KÏÈÓÈΤ˜
ÌÂϤÙ˜, EÚÁ·ÛÙËÚȷΤ˜ ÌÂϤÙ˜, EȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜, KÏÈÓÈÎÔÛÙ·ÙÈÛÙÈΤ˜ ÌÂϤÙ˜, KÏÈÓÔ·ıÔÏÔÁÈΤ˜ ÌÂϤÙ˜) Á) EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ‰) ¶Ú·ÎÙÈο ı¤Ì·Ù·,
Â) E·ÁÁÂÏÌ·ÙÈο ı¤Ì·Ù· ÂÈÛÙËÌÔÓÈο ÙÂÎÌËÚȈ̤ӷ, ÛÙ)
£¤Ì·Ù· ¢ËÌfiÛÈ·˜ YÁ›·˜, ˙) £¤Ì·Ù· ÛÙÚ·ÙËÁÈ΋˜ , Ë)
EÎ·È‰Â˘ÙÈο £¤Ì·Ù· Î·È È) £ÂÌ·ÙÈΤ˜ ÂÓfiÙËÙ˜.
3. °Ú¿ÌÌ·Ù· ÚÔ˜ ÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹:
T· ÁÚ¿ÌÌ·Ù· Ô˘ ‰ËÌÔÛȇÔÓÙ·È ÌÂÙ¿ ·fi ¤ÁÎÚÈÛË Ù˘
™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜ ·ÊÔÚÔ‡Ó: ·) ÎÚ›ÛÂȘ ÁÈ· ‰ËÌÔÛÈÂ˘Ì¤Ó· ¿ÚıÚ· Î·È ‚) Û˘ÁÎÂÎÚÈ̤ӷ ÂÚˆÙ‹Ì·Ù· Û¯ÂÙÈο ÌÂ
ÂÈÛÙËÌÔÓÈο ı¤Ì·Ù· Î·È Ô˘ ı· ‰›ÓÔÓÙ·È ··ÓÙ‹ÛÂȘ ·fi
ÙË ÛÙ‹ÏË Ù˘ ·ÏÏËÏÔÁÚ·Ê›·˜.
4. ™‡ÓÙÔ̘ ÚˆÙfiÙ˘˜ ‰ËÌÔÛȇÛÂȘ:
£· ·ÊÔÚÔ‡Ó ÚˆÙfiÙ˘˜ ÂÚÁ·Û›Â˜ ‹ Â˘Ú‹Ì·Ù·, ‰Â ı·
¤¯Ô˘Ó ¤ÎÙ·ÛË ÌÂÁ·Ï‡ÙÂÚË ·fi 2.000 ϤÍÂȘ Î·È ı· ‰ËÌÔÛȇÔÓÙ·È ÙÔ Û˘ÓÙÔÌfiÙÂÚÔ ‰˘Ó·Ùfi ·fi ·ÍÈÔÏfiÁËÛË Ù˘
™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜.
5. ¶ÂÚÈÏ‹„ÂȘ ¿ÚıÚˆÓ:
OÈ ÂÚÈÏ‹„ÂȘ ·˘Ù¤˜ ı· ·ÊÔÚÔ‡Ó ¿ÚıÚ· EÏÏ‹ÓˆÓ Û˘Ó·‰¤ÏÊˆÓ Ô˘ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÚfiÛÊ·Ù· Û ÂÚÈÔ‰Èο
ÙÔ˘ Â͈ÙÂÚÈÎÔ‡.
ŒÎÙ·ÛË ¿ÚıÚˆÓ: OÈ ·Ó·ÛÎÔ‹ÛÂȘ ‰Â ı· Ú¤ÂÈ Ó· ÍÂÂÚÓÔ‡Ó ÙȘ 7.500 ϤÍÂȘ (25 ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ ÛÂÏ›‰Â˜) Î·È ÙȘ 100 ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ì ÂÍ·›ÚÂÛË
ÂȉÈο ı¤Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ‚·ÛÈΤ˜ ÂÈÛً̘. OÈ
ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Î·È Ù· Ú·ÎÙÈο ı¤Ì·Ù· ‰Â ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 3.000 ϤÍÂȘ (10 ÛÂÏ›‰Â˜) Î·È ÙȘ 40
·Ú·ÔÌ¤˜. T· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ‰Â ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 1.000 ϤÍÂȘ (4
ÛÂÏ›‰Â˜), ÂÓÒ Ù· Â·ÁÁÂÏÌ·ÙÈο ı¤Ì·Ù· ı· Ú¤ÂÈ Ó· ÂÚÈÔÚ›˙ÔÓÙ·È ÛÙȘ 5.000 ϤÍÂȘ (20 ÛÂÏ›‰Â˜). ™ÙËÓ ¤ÎÙ·ÛË
ÙˆÓ ·Ú·¿Óˆ ¿ÚıÚˆÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë ‚È‚ÏÈÔÁÚ·Ê›· Ô˘ ı· Ú¤ÂÈ Ó· Â›Ó·È Â›Î·ÈÚË Î·È Ó· ¤¯ÂÈ ¿ÌÂÛË
Û¯¤ÛË Ì ÙÔ ‰È·Ú·ÁÌ·Ù¢fiÌÂÓÔ ı¤Ì·.
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‰ËÌÔÛ›Â˘ÛË Ú¤ÂÈ Ó· Â›Ó·È ÁÚ·Ì̤ӷ ÛÙË ÓÂÔÂÏÏËÓÈ΋
‰ËÌÔÙÈ΋, Ì ÌÔÓÔÙÔÓÈÎfi Û‡ÛÙËÌ·, ηıÒ˜ Â›Û˘ Î·È ÛÙËÓ
·ÁÁÏÈ΋ ÁÏÒÛÛ·. H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ÂϤÁÍÂÈ ÙËÓ ·ÎÚ›‚ÂÈ· ÙˆÓ ·ÁÁÏfiÊˆÓˆÓ fiÚˆÓ Î·È
‰È·Ù˘ÒÛÂˆÓ ·¢ı˘ÓfiÌÂÓË Û Â·ÁÁÂÏ̷ٛ˜ È·ÙÚÈÎÔ‡˜
ÌÂÙ·ÊÚ·ÛÙ¤˜. O ‰ÈÔÚıˆÙ‹˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ¤¯ÂÈ ÙÔ ‰ÈηÈÒÌ· Ó· ÙÚÔÔÔÈ‹ÛÂÈ ÁψÛÛÈο ÙÔ Î›ÌÂÓÔ, ¯ˆÚ›˜ fï˜ Ó·
·ÏÏÔÈÒÛÂÈ ÙÔ ‡ÊÔ˜ ÙÔ˘ Û˘ÁÁڷʤ·.
OÈ ÂÚÁ·Û›Â˜ ·˘Ù¤˜ Ú¤ÂÈ Ó· Â›Ó·È ÏËÎÙÚÔÏÔÁË̤Ó˜
Û ‰ÈÏfi ‰È¿ÛÙËÌ·, Ì ÁÚ·ÌÌ·ÙÔÛÂÈÚ¤˜ Arial, Tahoma ‹
Verdana Ì ÂÚÈıÒÚÈÔ ·fi ÙȘ ‰‡Ô Ï¢ڤ˜.
™Â ȉȷ›ÙÂÚË ÛÂÏ›‰· ·Ú¯›˙Ô˘Ó ÔÈ ÂÍ‹˜ ÂÓfiÙËÙ˜: Ë ÛÂÏ›‰· Ù›ÙÏÔ˘, Ë ÂÚ›ÏË„Ë Î·È ÔÈ Ï¤ÍÂȘ ÎÏÂȉȿ, ÙÔ Î›ÌÂÓÔ Ù˘
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ÛÙËÓ ·ÁÁÏÈ΋, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜, ÔÈ ÏÂ˙¿ÓÙ˜, ÔÈ ›Ó·Î˜ Î·È ÔÈ ÂÈÎfiÓ˜. ŸÏ˜ ÔÈ ÛÂÏ›‰Â˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ÙËÓ ·ÓˆÙ¤Úˆ ÛÂÈÚ¿.
¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÍÈÔÔÈËıÔ‡Ó ÔÈ Â˘ÎÔϛ˜ Ù˘ Û‡Á¯ÚÔÓ˘ Ù¯ÓÔÏÔÁ›·˜ Î·È ÚÔ˜ ·ÔÊ˘Á‹Ó ÙˆÓ ÛÊ·ÏÌ¿ÙˆÓ Î·Ù¿
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Ù˘ ÂÚÁ·Û›·˜ ÂȘ ÙÚÈÏÔ‡Ó Û˘Óԉ¢fiÌÂÓË ·fi CD fiÔ˘ Ù·
ΛÌÂÓ· ı· Ú¤ÂÈ Ó· Â›Ó·È ÏËÎÙÚÔÏÔÁË̤ӷ Û ÚfiÁÚ·ÌÌ· Word Û ¯·Ú·ÎÙ‹Ú˜ 12 ÛÙÈÁÌÒÓ. Afi ÙÔÓ I·ÓÔ˘¿ÚÈÔ
ÙÔ˘ 2010 ÔÈ ÂÚÁ·Û›Â˜ ˘Ô‚¿ÏÏÔÓÙ·È Î·È ËÏÂÎÙÚÔÓÈο ÛÙËÓ
‰È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜ ÙˆÓ E™X [email protected]
™ÂÏ›‰· Ù›ÙÏÔ˘: ¶ÂÚÈÏ·Ì‚¿ÓÂÈ: ·) ÙÔÓ Ù›ÙÏÔ Ù˘ ÂÚÁ·Û›·˜,
‚) ÙÔ fiÓÔÌ· Î·È ÙÔÓ Ù›ÙÏÔ ÙÔ˘ (ÙˆÓ) Û˘ÁÁڷʤ· (ˆÓ), Á) ÙÔ
›‰Ú˘Ì· ·’ fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·, ‰) ÙÔ ·Ó Ë ÂÚÁ·Û›·
¤¯ÂÈ ·Ó·ÎÔÈÓˆı› Û οÔÈÔ Û˘Ó¤‰ÚÈÔ Î·È ÔÈÔ, Â) ÙÔ fiÓÔÌ·,
‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· ÁÈ· ÙËÓ ·ÏÏËÏÔÁÚ·Ê›·, ÛÙ) ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ÂÚÁ·Û›·˜ (‚¿ÛÂÈ ÙÔ˘ 2 ‹
4), ˙) ¶Èı·Ó‹ ËÁ‹ ¯ÚËÌ·ÙÔ‰fiÙËÛ˘ Ù˘ ¤Ú¢ӷ˜.
¶ÂÚ›ÏË„Ë Î·È Ï¤ÍÂȘ ÎÏÂȉȿ: H ÂÚ›ÏË„Ë ı· Ú¤ÂÈ Ó·
¤¯ÂÈ ¤ÎÙ·ÛË Ì¤¯ÚÈ 200 ϤÍÂȘ. ™ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜,
Ë ÂÚ›ÏË„Ë ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ÛÎÔfi ÂÚÁ·Û›·˜, ÙÔ ˘ÏÈÎfi, ÙË ÌÂıÔ‰ÔÏÔÁ›· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù·. OÈ
ϤÍÂȘ - ÎÏÂȉȿ ı· ·Ú·Ù›ıÂÓÙ·È Ì ÙËÓ ÂÚ›ÏË„Ë Î·È ı·
Ú¤ÂÈ Ó· Â›Ó·È 3-10 ÌÂÌÔӈ̤ÓÔÈ fiÚÔÈ ‹ ÌÈÎÚ¤˜ ÊÚ¿ÛÂȘ.
OÈ Ï¤ÍÂȘ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ˘˜ ‰ÈÂıÓ›˜
fiÚÔ˘˜ ÏÂÍÈÎÔÁÚ¿ÊËÛ˘ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Index
Medicus Î·È Dental Index Î·È Ó· ÂÌÂÚȤ¯ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ
Ù˘ ÂÚ›Ï˄˘.
K›ÌÂÓÔ: T· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ·Ó·ÛÎÔ‹ÛÂȘ ı·
Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ì›· ·ÓÙÈÚÔÛˆ¢ÙÈ΋ ÂÈÛ·ÁˆÁ‹ Î·È Î·ÙfiÈÓ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÙÂÎÌËÚȈ̤Ó˜ ‚È‚ÏÈÔÁÚ·ÊÈο fiϘ ÔÈ ·fi„ÂȘ Ô˘ ·ÊÔÚÔ‡Ó ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì·.
T¤ÏÔ˜, ı· Ú¤ÂÈ Ó· ·Ú·Ù›ıÂÙ·È ÌÈ· ÎÚÈÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ
·fi„ÂˆÓ ·˘ÙÒÓ ·fi ÙÔ Û˘ÁÁڷʤ· Î·È Ó· ηٷϋÁÂÈ ÛÂ
Û˘ÁÎÂÎÚÈ̤ӷ Û˘ÌÂÚ¿ÛÌ·Ù·.
OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ı· Ú¤ÂÈ Ó· ·ÔÙÂÏÔ‡ÓÙ·È
·fi Ù· ÎÂÊ¿Ï·È·: EÈÛ·ÁˆÁ‹, YÏÈο Î·È M¤ıÔ‰Ô˜,
E˘Ú‹Ì·Ù·-AÔÙÂϤÛÌ·Ù·, ™˘˙‹ÙËÛË Î·È ™˘ÌÂÚ¿ÛÌ·Ù·.
™Ù· ˘fiÏÔÈ· ›‰Ë ÙˆÓ ¿ÚıˆÓ ÙÔ Î›ÌÂÓÔ ‰È·ÌÔÚÊÒÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ··ÈÙ‹ÛÂȘ ÙÔ˘ ¿ÚıÚÔ˘.
BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜: OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ÛÙÔ Î›ÌÂÓÔ, fiˆ˜ Î·È ÛÙÔ˘˜ ›Ó·Î˜ Î·È ÛÙȘ ÂÈ-
ÎfiÓ˜ Ì ÙȘ ÏÂ˙¿ÓÙ˜ ÙÔ˘˜, ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. TÂÏ›˜ ‹ ÎfiÌ·Ù· ÛËÌÂÈÒÓÔÓÙ·È ÌÂÙ¿ ÙËÓ ·Ú¤ÓıÂÛË Ô˘ ·Ú¤¯ÂÈ ÙË ‚È‚ÏÈÔÁÚ·ÊÈ΋
·Ú·ÔÌ‹. H ·Ú›ıÌËÛË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Î·Ù’ ·‡ÍÔÓÙ· ·ÚÈıÌfi Î·È Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ.
ŸÏ˜ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È
ÛÙÔ Î›ÌÂÓÔ Î·Ù·¯ˆÚÔ‡ÓÙ·È ÛÙÔ ‚È‚ÏÈÔÁÚ·ÊÈÎfi ηٿÏÔÁÔ
Ô˘ ·Ú¯›˙ÂÈ Û ȉȷ›ÙÂÚË ÛÂÏ›‰· ÌÂÙ¿ ÙÔ Î›ÌÂÓÔ. ¶ÚÈÓ ·fi
οı ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹ ÛÙÔÓ Î·Ù¿ÏÔÁÔ, ÚÔËÁÂ›Ù·È Ô ·ÓÙ›ÛÙÔȯԘ ·ÚÈıÌfi˜ Ô˘ ÛËÌÂÈÒıËΠÛÙÔ Î›ÌÂÓÔ
Î·È ÛÙÔÓ ÔÔ›Ô ·ÓÙÈÛÙÔȯ› Ë ‚È‚ÏÈÔÁÚ·Ê›·.
™ÙÔ ‚È‚ÏÈÔÁÚ·ÊÈÎfi ηٿÏÔÁÔ ÚÔËÁÔ‡ÓÙ·È Ù· ÔÓfiÌ·Ù·
ÙˆÓ Û˘ÁÁڷʤˆÓ (ÚÒÙ· ÙÔ ÂÒÓ˘ÌÔ Î·È ÌÂÙ¿ ÙÔ fiÓÔÌ·,
·ÎÔÏÔ˘ı› ÎfiÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ ÙÔ˘ ÂfiÌÂÓÔ˘ Û˘ÁÁڷʤ·
Î.Ô.Î.), Ù›ıÂÙ·È ¿Óˆ Î·È Î¿Ùˆ ÛÙÈÁÌ‹ (:) Ô Ù›ÙÏÔ˜ ÙÔ˘ ¿ÚıÚÔ˘, ÙÂÏ›·, ÙÔ ÂÚÈÔ‰ÈÎfi ÛÂ Û˘ÓÙÔÌÔÁÚ·Ê›·, ÙÔ ¤ÙÔ˜, ÙÔ
ÚfiÛËÌÔ (;), Ô ÙfiÌÔ˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, Û ·Ú¤ÓıÂÛË ÙÔ
Ù‡¯Ô˜, ¿Óˆ Î·È Î¿Ùˆ ÛÙÈÁÌ‹ Î·È ÔÈ ÛÂÏ›‰Â˜ ÙÔ˘ ¿ÚıÚÔ˘
(ÚÒÙË, ·‡Ï· Î·È ÙÂÏÂ˘Ù·›·). OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙψÓ
ÂÚÈÔ‰ÈÎÒÓ Ú¤ÂÈ Ó· ÁÚ¿ÊÔÓÙ·È Û‡Ìʈӷ Ì ÙÔ Dental
Index Î·È Index Medicus. °È· ÙȘ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ ÂÏÏËÓÈÎÒÓ
ÂÚÈÔ‰ÈÎÒÓ ˘¿Ú¯ÂÈ Û¯ÂÙÈÎfi˜ ηٿÏÔÁÔ˜ ÙÔ˘ IATPOTEK.
¶Ú¤ÂÈ Ó’ ·ÔʇÁÂÙ·È ÁÂÓÈο Ë ¯ÚËÛÈÌÔÔ›ËÛË ÂÚÈÏ‹„ÂˆÓ (abstracts) ˆ˜ ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹, fiˆ˜ Â›Û˘
«·‰ËÌÔÛ›Â˘Ù˜ ·Ú·ÙËÚ‹ÛÂȘ» Î·È «ÚÔÛˆÈΤ˜ ÂÈÎÔÈӈӛ˜». T· «EÏÏËÓÈο ™ÙÔÌ·ÙÔÏÔÁÈο XÚÔÓÈο» Ú¤ÂÈ Ó·
Û˘ÓÙÔÌÔÁÚ·ÊÔ‡ÓÙ·È Û·Ó EÏÏ. ™ÙÔÌ. XÚÔÓ. ‹ ·ÁÁÏfiʈӷ
Hel Stom Rev.
EÚÁ·Û›Â˜ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ ‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË, ·ÏÏ¿
‰Â ‰ËÌÔÛȇıËÎ·Ó ·ÎfiÌË, ÌÔÚÔ‡Ó Ó· ·Ó·ÊÂÚıÔ‡Ó ÛÙË
‚È‚ÏÈÔÁÚ·Ê›·. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ ÛËÌÂÈÒÓÂÙ·È ÛÙÔ ÂÚÈÔ‰ÈÎfi Î·È Ë ÊÚ¿ÛË «˘fi ‰ËÌÔÛ›Â˘ÛË» Û ·Ú¤ÓıÂÛË.
E¿Ó Î·È ÂÊfiÛÔÓ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÌÂÚȤ¯ÔÓÙ·È ¿ÚıÚ·
·fi ÂÚÈÔ‰Èο Ì ϷÙÈÓÔÁÂÓ‹ ÁÏÒÛÛ· Ô˘ ¤¯ÂÈ ÙÔÈΤ˜ ȉȷÈÙÂÚfiÙËÙ˜ (°ÂÚÌ·ÓÈο, ™Î·Ó‰ÈÓ·˘Èο, °·ÏÏÈο), Ô ÙÔÓÈÛÌfi˜ ÙˆÓ Ï¤ÍÂˆÓ Â›Ó·È Â˘ı‡ÓË ÙˆÓ Û˘ÁÁڷʤˆÓ.
¶·Ú¿‰ÂÈÁÌ· ÙÔ˘ ÔÚıÔ‡ ÙÚfiÔ˘ ÁÚ·Ê‹˜ ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ‰›ÓÂÙ·È ·Ú·Î¿Ùˆ:
¶ÂÚÈÔ‰ÈÎfi: AӷʤÚÔÓÙ·È Ù· ÂÒÓ˘Ì· Î·È Ù· ·Ú¯Èο ÙˆÓ
ÔÓÔÌ¿ÙˆÓ fiÏˆÓ ÙˆÓ Û˘ÁÁڷʤˆÓ ̤¯ÚÈ ¤ÍË (fiÙ·Ó Â›Ó·È ÂÚÈÛÛfiÙÂÚÔÈ ·ÎÔÏÔ˘ı› Ë ¤Ó‰ÂÈÍË «et al», ÛÙ· ÂÏÏËÓÈο ¿ÚıÚ· ÁÚ¿ÊÔ˘Ì «Î·È Û˘Ó.»), Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜, Ë Û˘ÓÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, ÙÔ ¤ÙÔ˜, Ô ÙfiÌÔ˜, ÙÔ Ù‡¯Ô˜,
Ë ÚÒÙË Î·È Ë ÙÂÏÂ˘Ù·›· ÛÂÏ›‰· Ù˘ ‰ËÌÔÛ›Â˘Û˘. ¶.¯.
Papagiannoulis L, Kakaboura A, Eliades G: In vivo Vs in
Vitro anticariogenic behavior of glass-ionomer and
resin composite restorative materials. Dent Mater 2002;
18 (8): 561-569.
BÈ‚Ï›· Î·È ¿ÏϘ ÌÔÓÔÁڷʛ˜: AӷʤÚÔÓÙ·È Ì ÙË ÛÂÈÚ¿ Ù· ÂÒÓ˘Ì· Î·È ·Ú¯Èο ÙˆÓ Û˘ÁÁڷʤˆÓ, Ô Ù›ÙÏÔ˜ ÙÔ˘
‚È‚Ï›Ô˘, Ô ·ÚÈıÌfi˜ ¤Î‰ÔÛ˘, Ë fiÏË ¤Î‰ÔÛ˘. AÎÔÏÔ˘ı› Ô
ÂΉfiÙ˘, ÙÔ ¤ÙÔ˜ (¿Óˆ - οو ÙÂÏ›·) ÎÈ Ë ÛÂÏ›‰·. ¶.¯.
Ryge GM: Dental Corrosion. 2nd ed. New York. Harper
and Row. 1985: 204.
AÓ Ë ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹ ·ÔÙÂÏ› ÎÂÊ¿Ï·ÈÔ
ÂÓfi˜ ‚È‚Ï›Ô˘ Ô˘ ¤¯ÂÈ ÁÚ·Ê› ·fi ¿ÏÏÔ Û˘ÁÁڷʤ·, Ë
·Ó·ÊÔÚ¿ Á›ÓÂÙ·È ˆ˜ ÂÍ‹˜: Johnston AJ: Corrosion
Resistance of Amalgams. In: Goldman AK, Johns KO,
eds. Restorative Materials, Baltimore. Williams and
Wilkins Co., 1984-87.
IÛÙÔÛÂÏ›‰Â˜:
http://www.eudental.org/Community
strategy concerning mercury, fiˆ˜ ·˘Ùfi ÂÌÊ·Ó›˙ÂÙ·È ÙËÓ
.............. (ËÌÂÚÔÌËÓ›· ·Ó·˙‹ÙËÛ˘).
H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ˘ÂÓı˘Ì›˙ÂÈ ÛÙÔ˘˜ Û˘ÁÁÚ·Ê›˜
ÙˆÓ ÂÚÁ·ÛÈÒÓ fiÙÈ Î·Ïfi ›ӷÈ, ÛÙȘ ηٷÙÈı¤ÌÂÓ˜ ÂÚÁ·Û›Â˜
Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜, ÂÊfiÛÔÓ ‚¤‚·È· ˘Ê›ÛÙ·ÓÙ·È, ÔÈÔÙÈο EÏÏËÓÈο ¿ÚıÚ· Û¯ÂÙÈο Ì ÙÔ ı¤Ì·.
AÁÁÏÈ΋ ÂÚ›ÏË„Ë: ¶ÂÚÈÏ·Ì‚¿ÓÂÈ, ÛÙËÓ AÁÁÏÈ΋ ÁÏÒÛÛ·, Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Î·È ÙÔÓ Ù›ÙÏÔ Ù˘ ÂÚÁ·Û›·˜. ™ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ ı· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È
ÛÙÔȯ›· ÁÈ· fiÏ· Ù· ÎÂÊ¿Ï·È· Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î·È Ù·
Û˘ÌÂÚ¿ÛÌ·Ù·. ™ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ı· Ú¤ÂÈ Ó·
·Ó·Ê¤ÚÂÙ·È Ë ÂÈÛ·ÁˆÁ‹ Ô ÛÎÔfi˜, Ù· ˘ÏÈο Î·È Ë Ì¤ıÔ‰Ô˜,
Ù· ·ÔÙÂϤÛÌ·Ù· Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Î·È Ë Û˘˙‹ÙËÛË. H
¤ÎÙ·ÛË ÙˆÓ ÂÚÈÏ‹„ÂˆÓ ı· Ú¤ÂÈ Ó· Î˘Ì·›ÓÂÙ·È ÌÂٷ͇
ÙˆÓ 250 ¤ˆ˜ 350 Ϥ͈Ó.
¶›Ó·Î˜: ¢·ÎÙ˘ÏÔÁÚ·ÊÔ‡ÓÙ·È Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰· Ô˘
ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÙË ÏÂ˙¿ÓÙ·. H ÏÂ˙¿ÓÙ· Ú¤ÂÈ Ó· ›ӷÈ
Û‡ÓÙÔÌË Î·È Î·Ù·ÙÔÈÛÙÈ΋. AÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜
·ÚÈıÌÔ‡˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. OÈ ÂÂÍËÁ‹ÛÂȘ
ÙˆÓ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, ηıÒ˜ Î·È ¿ÏϘ ‰È¢ÎÚÈÓ‹ÛÂȘ, Á›ÓÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ›Ó·Î·.
EÈÎfiÓ˜: T· Û¯‹Ì·Ù·, Ù· ‰È·ÁÚ¿ÌÌ·Ù· Î·È ÔÈ ÊˆÙÔÁڷʛ˜ Ú¤ÂÈ Ó· ÂÈÛ˘Ó¿ÙÔÓÙ·È ÛÙÔ ÚˆÙfiÙ˘Ô Î·È Ó· ›ӷÈ
˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜. OÈ ÏÂ˙¿ÓÙ˜ ÙˆÓ ÂÈÎfiÓˆÓ ÁÚ¿ÊÔÓÙ·È
Ì ÙÔÓ ·‡ÍÔÓÙ· ·ÚÈıÌfi ÙÔ˘˜ ۠ͯˆÚÈÛÙ‹ ÛÂÏ›‰· ηٿ
ÙËÓ ˘Ô‚ÔÏ‹ Ù˘ ÂÚÁ·Û›·˜. Y¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ÂÎÙ‡ˆÛ˘ ¤Á¯ÚÒÌˆÓ ÂÈÎfiÓˆÓ ÌÂÙ¿ ·fi Û˘ÓÂÓÓfiËÛË Ì ÙÔ
¢È¢ı˘ÓÙ‹ ™‡ÓÙ·Í˘ Î·È ÙËÓ ËÏÂÎÙÚÔÓÈ΋ ·ÔÛÙÔÏ‹ ÂÁ¯ÚÒÌˆÓ ÊˆÙÔÁÚ·ÊÈÒÓ.
OÈ ÂÈÎfiÓ˜ ı· Ú¤ÂÈ Ó· ¤¯Ô˘Ó Û·Úˆı› Ì ·Ó¿Ï˘ÛË
ÙÔ˘Ï¿¯ÈÛÙÔÓ 300 dpi, Ó· ¤¯Ô˘Ó ÙË ÌÔÚÊ‹ ·Ú¯Â›ˆÓ JPG ηÈ
Ó· ÌËÓ ÂÌÂÚȤ¯ÔÓÙ·È ÛÙË ÚÔ‹ ÙÔ˘ ηٷÙÈıÂ̤ÓÔ˘ ÎÂÈ̤ÓÔ˘. EÊfiÛÔÓ ÛÙȘ ÂÈÎfiÓ˜ ÂÌÊ·Ó›˙ÂÙ·È ÙÔ ÚfiÛˆÔ ÙÔ˘
¿Û¯ÔÓÙÔ˜, Ë ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, ηٿ ÙË ‰ËÌÔÛ›Â˘ÛË,
ı· ηχÙÂÈ ÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ÔÊı·ÏÌÒÓ Ì ̷‡ÚË Ù·ÈÓ›·
ÁÈ· ÏfiÁÔ˘˜ Û‚·ÛÌÔ‡ ÚÔÛˆÈÎÒÓ ‰Â‰Ô̤ӈÓ.
H ÎÚ›ÛË ÙˆÓ ÂÚÁ·ÛÈÒÓ Á›ÓÂÙ·È ·fi ‰‡Ô ÎÚÈÙ¤˜ Ô˘
¤¯Ô˘Ó ÂÈÏÂÁ› ·fi ÙËÓ EÈÙÚÔ‹ ™‡ÓÙ·Í˘. H ™˘ÓÙ·ÎÙÈ΋
EÈÙÚÔ‹ ÙÔ˘ ¶ÂÚÈÔ‰ÈÎÔ‡ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ÚÔÙ›ÓÂÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ Ó· ·ÔÚÚ›ÙÂÈ Ù· ¿ÚıÚ· Ô˘ ‰ÂÓ Â›Ó·È
ÁÚ·Ì̤ӷ Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜.
OÈ Û˘ÁÁÚ·Ê›˜ ¤¯Ô˘Ó ÙËÓ ˘Ô¯Ú¤ˆÛË Ì›·˜ Ù˘ÔÁÚ·ÊÈ΋˜ ‰ÈfiÚıˆÛ˘ ̤۷ Û 2 ‚‰ÔÌ¿‰Â˜ ·fi ÙËÓ ·ÔÛÙÔÏ‹
ÙÔ˘ ‰ÔÎÈÌ›Ô˘. MÂÙ¿ ÙËÓ ÛÙËÏÔı¤ÙËÛË ‰Â Á›ÓÔÓÙ·È ‰ÂÎÙ¤˜
ÌÂÙ·‚ÔϤ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘.
T· ‰ËÌÔÛÈÂ˘Ì¤Ó· ¿ÚıÚ·, ÂÈÎfiÓ˜ Î·È ‰È·ÁÚ¿ÌÌ·Ù· ·ÔÙÂÏÔ‡Ó È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. °È· ÙËÓ ·Ó·‰ËÌÔÛ›Â˘Û‹
ÙÔ˘˜ Â›Ó·È ··Ú·›ÙËÙË Ë ¿‰ÂÈ· Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜
Î·È ÙÔ˘ Û˘ÁÁڷʤ·.
EÈÛ‹Ì·ÓÛË: °È· ÙËÓ ·Ú·Ï·‚‹ ÂÈÛÙËÌÔÓÈ΋˜ ÂÚÁ·Û›·˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË Ú¤ÂÈ Ó· ÂÈÛ˘Ó¿ÙÂÙ·È ‰È·‚‚·›ˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ Î·Ù·ÙÂı› ÛÂ
¿ÏÏÔ ÂÈÛÙËÌÔÓÈÎfi ¤ÓÙ˘Ô ÂÚÈÔ‰ÈÎÔ‡ Ù‡Ô˘, fiÙÈ ‰ÂÓ ÂÚȤ¯ÔÓÙ·È ·˘ÙÔ‡ÛȘ ÚÔÙ¿ÛÂȘ ·fi ¿ÏϘ ÂÈÛÙËÌÔÓÈΤ˜
‰ËÌÔÛȇÛÂȘ –ÏËÓ ÙˆÓ ÔÚÈÛÌÒÓ, ÓfïÓ, ηÓfiÓˆÓ Î·È
‰È·Ù¿ÍˆӖ Î·È fiÙÈ ÙÔ ÊˆÙÔÁÚ·ÊÈÎfi ˘ÏÈÎfi Â›Ó·È ›‰ÈÔ ‹ ÌÂٷۯ‰›·ÛË ‹ ¿Ïψ˜ Ó· ·Ó·Ê¤ÚÂÙ·È Û·ÊÒ˜ Ë ËÁ‹, ηıÒ˜ Â›Û˘ Î·È fiÙÈ ÏËÚÔ‡ÓÙ·È ÔÈ ÚÔ¸Ôı¤ÛÂȘ ÙÔ˘
¶.¢.39 Ù˘ 1˘ AÚÈÏ›Ô˘ 2009 ·Ú. ºEK 55.
INSTRUCTIONS FOR AUTHORS
HELLENIC STOMATOLOGICAL REVIEW is the official
peer-reviewed open access electronic publication of the
Hellenic Dental Association and aims at providing Greek
and international dentists with ongoing up-to-date
scientific information in all fields of dental science.
The Journal publishes the following types of articles:
1. Focus articles:
Review articles addressing contemporary and controversial topics proposed by the Editorial Board and
written by colleagues with expertise on the particular
topics.
2. Original articles:
These articles may fall into one of the following categories: (a) Reviews (up to 3 authors), (b) Research
papers (Experimental studies, Clinical studies, Laboratory studies, Epidemiological Studies, Clinicostatistical
studies, Clinopathological studies), (c) Interesting case
reports, (d) Practice-related topics, (e) Scientifically-documented professional issues, (d) Public Health issues,
(e) Strategy-related topics, (f) Educational issues and (g)
Specific issues.
3. Letters to the Editorial Board:
The letters must be approved by the Editorial Board prior
to publication and may pertain to: (a) critical reviews of
published articles and (b) specific queries on sciencerelated topics, answers to which are provided in the correspondence section.
4. Short reports:
These original papers or findings should not exceed
2.000 words and are published as soon as possible after
undergoing a review process by the Editorial Board.
5. Reviews from published articles:
These reviews focus on Greek colleagues articles
recently published in international journals.
Article length: Reviews should not exceed 7.500 words
(25 typed pages) and should have no more than 100
references, with the exception of special issues related
to basic sciences. Research papers and practice-related
topics should not exceed 3.000 words (10 pages) and
have no more than 40 references. Any articles on
important case reports should not exceed 1.000 words
(4 pages) while articles addressing professional issues
should be no more than 5.000 words (20 pages). The
reference list is included in the total word count and must
be timely and pertinent to the topic under discussion.
Text structure: The manuscripts submitted for publication must be written both in modern Greek, using the
monotonic system and in English. The Editorial Board
reserves the right to check the accuracy of the English
terms and phrasings, consulting with professional medical translators. The Copy Editor of the Journal reserves
the right to proceed to linguistic modifications without
distorting, though, the authors style.
Particularly for the English speaking authors, manuscripts
may be submitted only in English language with an
extensive (300 words) Greek summary. In this case the
scientific editorial board will undertake the preparation of
the summary applying the appropriate Greek terminology.
All papers submitted must be double spaced, typed in
Arial, Tahoma or Verdana font with margins on both
sides.
The title page, the summary and key words, the main
text of the paper, the English summary and key words,
the references, the legends, the tables and the figures
appear on separate pages. All pages are numbered in
the above order.
Starting January 2010 all manuscripts are also submitted
electronically at [email protected].
Title page: This page includes the following information:
(a) title of the paper, (b) name and title of the author(s),
(c) institution, (d) whether the paper has been previously
presented at a conference and, if yes, details, (e) name,
address and telephone of the corresponding author, (f)
type of paper (based on 2 or 4), (g) possible source of
financing for research.
Summary and key words: The summary should be no
longer than 200 words. In research papers the summary
includes the purpose, the material, the methodology and
the conclusions and it is followed by key words which
normally include 3-10 key terms or short phrases. The
particular words must be in accordance with the international lexicographical terminology as it appears in
Index Medicus and Dental Index and must be included in
the summary.
Main text: Literature reviews should include a comprehensive introduction followed by a summarization of
all the views relevant to the topic under discussion,
based on specific references. Finally, the author is
expected to provide a critical analysis of these views and
reach clear conclusions.
Research papers should comprise the following chapters: Introduction, Materials and Method, Findings-Results, Discussion and Conclusions. As regards the remaining types of articles, the text should follow an
appropriate layout to meet the article demands.
References: Any references in the text, the tables and
the figure legends are cited by arabic numerals in
brackets. Any dots or commas appear after the bracketed reference. The references are numbered consecutively in the order of appearance.
All references mentioned in the text are included in the
reference list which appears on a separate page after the
end of the text. Every reference in the list should be
preceded by the number it is identified with in the main
text.
The reference list should be organised in the following
sequence: names of the authors (surname, first name
followed by a comma, then surname of the next author
and so on), colon (:), title of the article, period (.),
abbreviation of the journal, year, semi colon (;),volume,
issue in brackets, colon and pages (first page and last
page separated by a slash). Titles of Greek journals
should be abbreviated in accordance with the IATROTEK
list. The use of summaries, unpublished comments or
personal communications as references should be
avoided. Hellenic Stomatological Review should be
abbreviated as Hel Stom Rev.
Papers accepted for publication, though not published
yet, can be included in the reference list. In this case, the
phrase under publication in brackets is added. If the the
reference list contains articles from journals using a
language of latin origin with language-specific features
(German, Scandinavian, French), the authors are
responsible for word stress. An example of correct
reference presentation is as follows:
Journals: The authors surnames and initials appear first
(unless there are more than six authors in which case the
fifth name is followed by et al), followed by the title of the
paper, the journal abbreviation, the year, the volume, the
issue and, finally, the first and last page of the
publication. E.g. Papagiannoulis L, Kakaboura A, Eliades
G: In vivo Vs in Vitro anticariogenic behavior of glassionomer and resin composite restorative materials. Dent
Mater 2002; 18 (8): 561-569.
Books and other monographs: The authors surnames
and initials appear first followed by the title of the book,
the number of publication and the city of publication.
Next comes the publisher, the year (colon) and the page.
E.g. Ryge GM: Dental Corrosion. 2nd ed. New York.
Harper and Row. 1985: 204.
If the reference corresponds to a chapter from a book
written by another author, it should appear as follows:
Johnston AJ: Corrosion Resistance of Amalgams. In:
Goldman AK, Johns KO, eds. Restorative Materials, Baltimore. Williams and Wilkins Co., 1984-87.
Websites: E.g. http://www.eudental.org/Community
strategy concerning mercury, as it appears in (search
date).
The Editoral Board strongly encourages the authors to
include references to high quality Greek articles related
to the topic under discussion, if possible.
English summary: It includes the names of the authors
and the title of the paper in English. In literature reviews
the summary should present data on all the chapters it
includes as well as the conclusions. In research papers
the summary includes the introduction, the aim, the
materials and methods, the results, the conclusions and
the discussion. A summary should be 250 to 300 words
long.
Tables: They are typed on a separate page including the
legend. The legend should be concise and comprehensive. The tables are numbered with Arabic numerals
which are also used for citation in the text. Any explanations of the abbreviations or other clarifications appear at
the end of the table.
Illustrative material: Any figures, diagrams and
photographs should be attached to the manuscript and
be high-resolution files. Figure legends are numbered
consecutively on a separate page during the submission
process of the paper. Colour images are possible to
print. Authors should contact the Editor-in-Chief and
send the colour images electronically.
The images should be scanned at a minimum resolution
of 300 dpi, in JPG format and should not be included in
the main document submitted for publication. In case a
patients face is visible in the image the Editorial Board
anonymises it, prior to publication, through a black band
across the eyes to protect patient confidentiality.
The review process is assigned to two reviewers
selected by the Editorial Board. The Editorial Board of
the Journal reserves the right to suggest revisions or
reject articles which have failed to comply with the
instructions for authors.
It is the authors responsibility to check for typographical
errors within 2 weeks from the submission date of the
manuscript. After the paper has been formatted in
columns no modifications are accepted.
Copyrights to all published articles, images and
diagrams are assigned to the Journal. Permission by the
Editorial Board and the author(s) is necessary prior to
any republication.
Note: Any paper submitted for publication must be
accompanied by a written statement by the author(s)
certifying that the paper has not been submitted to any
other scientific journal, does not contain unchanged
sentences from other scientific publications excluding
definitions, laws, rules and regulations and that the
illustrative material is the same as the original or a redesign, otherwise the source must be clearly stated.
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
Research Study
ÕÛÎÔË ÔÏ˘Ê·Ú̷Λ· ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÓÔÛËÌ¿ÙˆÓ
ÙÔ˘ ÛÙfiÌ·ÙÔ˜. AÓ·‰ÚÔÌÈ΋ ÌÂϤÙË Û 458 ·ÛıÂÓ›˜.
E. M. K·ÏÔÁ‹ÚÔ˘*, K. I. TfiÛÈÔ˜**, A. ™ÎÏ·‚Ô‡ÓÔ˘***
Drug abuse in the management of oral diseases.
Retrospective study in 458 patients.
E.M. Kalogirou*, K.I. Tosios**, A. Sklavounou***
¶EPI§HæH
SUMMARY
EÈÛ·ÁˆÁ‹: H ¿ÛÎÔË ¯ÔÚ‹ÁËÛË Ê·ÚÌ¿ÎˆÓ ÛÙÔ ¯ÒÚÔ Ù˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ ÂȂ‚·ÈÒÓÂÙ·È ·fi ‰Â‰Ô̤ӷ ÂÏÏËÓÈÎÒÓ ÌÂÏÂÙÒÓ Ù· ÙÂÏÂ˘Ù·›· 25 ¯ÚfiÓÈ· Ô˘
ηٷ‰ÂÈÎÓ‡Ô˘Ó ˆ˜ Ë Ê·Ú̷΢ÙÈ΋ ηٿ¯ÚËÛË Û˘¯Ó¿ ηı˘ÛÙÂÚ› ÙË ‰È¿ÁÓˆÛË, Ì ‰˘ÛÌÂÓ›˜ Û˘Ó¤ÂȘ ·ÎfiÌ· Î·È ÁÈ· ÙË ˙ˆ‹ ÙˆÓ ·ÛıÂÓÒÓ Û ÔÚÈṲ̂Ó˜
ÂÚÈÙÒÛÂȘ, ÂÓÒ ÂÈ‚·Ú‡ÓÂÈ ÔÈÎÔÓÔÌÈο ÙÔ˘˜ ›‰ÈÔ˘˜, ·ÏÏ¿ Î·È ÙË ‰ËÌfiÛÈ· ˘Á›·.
™ÎÔfi˜: H ηٷÁÚ·Ê‹ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ê·Ú̷΢ÙÈ΋˜ ηٿ¯ÚËÛ˘ Û ÓÔÛ‹Ì·Ù· ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÛÂ
¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ Î·È Ë Û‡ÁÎÚÈÛË
ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ·˘ÙÒÓ Ì ٷ Â˘Ú‹Ì·Ù· ÚÔËÁÔ‡ÌÂÓˆÓ ÌÂÏÂÙÒÓ.
YÏÈÎfi Î·È M¤ıÔ‰Ô˜: 458 Ê¿ÎÂÏÔÈ ·ÛıÂÓÒÓ, ·fi ÙÔ
Introduction: The unnecessary dispensing of drugs in
Oral Medicine is confirmed by data from Greek research over the past 25 years, which show that drug
abuse often delays the diagnosis with adverse effects
that burden not only the patients but also the public
health system financially.
Purpose: To record the cases of drug abuse in oral
diseases during a four year period and to compare
the results with those of previous studies.
Materials and Methods: The records of 458 patients,
from a total of 2,662 patients who were referred to the
Department of Oral Pathology and Medicine, Dental
School, University of Athens during the years 20082011, were retrospectively collected on the basis that
* MÂÙ·Ù˘¯È·Î‹ ÊÔÈÙ‹ÙÚÈ· A’ ·ÎÏÔ˘
** E›ÎÔ˘ÚÔ˜ K·ıËÁËÙ‹˜
*** K·ıËÁ‹ÙÚÈ·
* Graduate student
** Assistant Professor
*** Professor
EÚÁ·ÛÙ‹ÚÈÔ ™ÙÔÌ·ÙÔÏÔÁ›·˜, O‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹, EıÓÈÎfi ηÈ
K·Ô‰ÈÛÙÚÈ·Îfi ¶·ÓÂÈÛÙ‹ÌÈÔ AıËÓÒÓ.
Department of Oral Pathology and Medicine, Dental School,
University of Athens.
M¤ÚÔ˜ ·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜ ¤¯ÂÈ ·Ó·ÎÔÈÓˆı› ÛÙËÓ 1Ë HÌÂÚ›‰·
ÙÔ˘ O‰ÔÓÙÈ·ÙÚÈÎÔ‡ ™˘ÏÏfiÁÔ˘ AÙÙÈ΋˜ (26/01/2013), Ì ı¤Ì·
«º¿Ú̷η ÛÙËÓ O‰ÔÓÙÈ·ÙÚÈ΋. EӉ›ÍÂȘ, ·ÓÙÂӉ›ÍÂȘ Î·È ·ÓÂÈı‡ÌËÙ˜ ÚÔÂÎÙ¿ÛÂȘ».
This study was partly presented at the 1st seminar of Attica
Dental Association (26/01/2013): Drugs in dentistry. Indications,
contraindications and adverse side effects.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 57: 9-17, 2013
·ÚÂÏ‹ÊıË 28/6/2013 - ÂÎÚ›ıË 26/9/2013
Hellenic Stomatological Review 57: 9-17, 2013
paper received 28/6/2013 - accepted 26/9/2013
9
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
Research Study
Û‡ÓÔÏÔ 2662 ·ÛıÂÓÒÓ Ô˘ ÚÔÛ‹Ïı·Ó ÛÙËÓ KÏÈÓÈ΋
Ù˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘
¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ Î·Ù¿ Ù· ¤ÙË 2008-2011, ÂÈϤ¯ıËÎ·Ó ·Ó·‰ÚÔÌÈο Ì ÎÚÈÙ‹ÚÈÔ fiÙÈ ÛÙËÓ ·ÚÔ‡Û·
ÓfiÛÔ ·Ó·ÊÂÚfiÙ·Ó Ï‹„Ë Ê·ÚÌ¿ÎÔ˘ ‹ Ê·ÚÌ¿ÎˆÓ ÁÈ·
ÙË ıÂÚ·›· ÙÔ˘ ÛÙÔÌ·ÙÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ ÚÈÓ ÙËÓ
ÚÔÛ¤ÏÂ˘Û‹ ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ KÏÈÓÈ΋.
AÔÙÂϤÛÌ·Ù·: ÕÛÎÔË Ï‹„Ë Ê·ÚÌ¿ÎˆÓ ÚÈÓ ÙËÓ
ÙÂÎÌËÚ›ˆÛË Ù˘ ÙÂÏÈ΋˜ ‰È¿ÁÓˆÛ˘ ÛËÌÂÈÒıËΠÛÙÔ
77% ÙˆÓ ·ÛıÂÓÒÓ, ÌÂ Û˘¯ÓfiÙÂÚË Î·ÙËÁÔÚ›· Ù· ·ÓÙÈÛËÙÈο. TËÓ Â˘ı‡ÓË ·‰ÈηÈÔÏfiÁËÙ˘ Û˘ÓÙ·ÁÔÁÚ¿ÊËÛ˘ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ¤ÊÂÚ·Ó ÔÈ ˆÙÔÚÚÈÓÔÏ·Ú˘ÁÁÔÏfiÁÔÈ.
™˘˙‹ÙËÛË Î·È Û˘ÌÂÚ¿ÛÌ·Ù·: H Ê·Ú̷΢ÙÈ΋ ηٿ¯ÚËÛË ÛÙÔ ¯ÒÚÔ Ù˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ ‰ÂÓ ÂÌÊ·Ó›˙ÂÈ Ù¿ÛË Ì›ˆÛ˘ Ì ÙËÓ ¿ÚÔ‰Ô ÙˆÓ ÂÙÒÓ. TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ÂÈ‚¿ÏÏÂÈ ÙËÓ Â·ÁÚ‡ÓËÛË ÙÔ˘ Ô‰ÔÓÙÈ·ÙÚÈÎÔ‡ Î·È È·ÙÚÈÎÔ‡ ÎfiÛÌÔ˘, ÒÛÙÂ Ë ıÂÚ·›· Ó· ¤ÂÙ·È Ù˘ ‰È¿ÁÓˆÛ˘ Î·È ÔÈ ·ÛıÂÓ›˜ Ó· ÌËÓ ÂÈ‚·Ú‡ÓÔÓÙ·È ·fi ÙȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙˆÓ Ê·Ú̿ΈÓ.
§¤ÍÂȘ ÎÏÂȉȿ: ηٿ¯ÚËÛË Ê·Ú̿ΈÓ, ÓÔÛ‹Ì·Ù· ÛÙfiÌ·ÙÔ˜,
·‰ÈηÈÔÏfiÁËÙË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË.
EI™A°ø°H
«K·Ù¿¯ÚËÛË», «Ï·Óı·Ṳ̂ÓË», «¿ÎÚÈÙË Î·È ·ÏfiÁÈÛÙË» ‹
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2010 ÁÈÓfiÙ·Ó Î·Ù¿¯ÚËÛË Ê·ÚÌ¿ÎˆÓ ·fi 7.000.000 Ôϛ٘ οı ̋ӷ, ·ÚÈıÌfi˜ Ô˘ ÍÂ¤Ú·Û ·ÎfiÌ· Î·È ÙÔ˘˜
¯Ú‹ÛÙ˜ Ó·ÚΈÙÈÎÒÓ Î·È ·Ú·ÈÛıËÛÈÔÁfiÓˆÓ Ô˘ÛÈÒÓ1.
EÈϤÔÓ, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ·Ó Î·È Ô
·ÚÈıÌfi˜ ÙˆÓ ÂÈÛΤ„ÂˆÓ ÛÙ· ÙÌ‹Ì·Ù· ÂÂÈÁfiÓÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ·Ú·Ì¤ÓÂÈ ÛÙ·ıÂÚfi˜, ÙÔ ÔÛÔÛÙfi Ô˘ ÔÊ›ÏÂÙ·È Û ÂÈÏÔΤ˜ ·fi Ï·Óı·Ṳ̂ÓË Ï‹„Ë Ê·ÚÌ¿ÎˆÓ ·˘Í‹ıËΠηٿ 44%1. H Ê·Ú̷΢ÙÈ΋ ηٿ¯ÚËÛË ·ÊÂÓfi˜
ÂÈ‚·Ú‡ÓÂÈ ÙËÓ ˘Á›· ÙˆÓ ·ÛıÂÓÒÓ, ›Ù ÏfiÁˆ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ Î·È Ù˘ Ù˘¯fiÓ Û˘Ó¤ÚÁÂÈ·˜ ÙˆÓ
Ê·Ú̷΢ÙÈÎÒÓ Û΢·ÛÌ¿ÙˆÓ, ηıÒ˜ Î·È ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ fiÙÈ Î·ı˘ÛÙÂÚ› Ë ‰È¿ÁÓˆÛË ÙÔ˘ ÛÙÔÌ·ÙÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜, Î·È ·ÊÂÙ¤ÚÔ˘ Ô‰ËÁ› ÛÙËÓ ÔÈÎÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË
·ÛıÂÓÒÓ Î·È ‰ËÌÔÛ›ˆÓ Ù·Ì›ˆÓ.
H ηٿ¯ÚËÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ‰ÂÓ ·Ê‹ÓÂÈ ·ÓÂËÚ¤·ÛÙË
ÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ÎÔÈÓfiÙËÙ·. Œ¯ÂÈ ˘ÔÏÔÁÈÛÙ› fiÙÈ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 40% ÙˆÓ Ô‰ÔÓÙÈ·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ Ô˘
Ï·Ì‚¿ÓÔ˘Ó Ê¿Ú̷η ÂÈ‚·Ú‡ÓÂÙ·È ·fi ÙȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȤ˜ ÙÔ˘˜, ÔÛÔÛÙfi Ô˘ ·˘Í¿ÓÂÙ·È Î·Ù¿ Ôχ
Û ÂÚÈÙÒÛÂȘ fiÔ˘ Ë Ï‹„Ë ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ‰ÂÓ Á›ÓÂÙ·È
10
the patients had already taken medications for the
treatment of their oral disease before attending the
clinic.
Results: Unnecessary drug abuse before the documentation of the final diagnosis was recorded in 77%
of the patients and antiseptics were the drugs most
commonly overused. ENT specialists more frequently bore the responsibility for irrational drug prescription.
Discussion and conclusions: No decline in the rate of
drug abuse in Oral Medicine is observed over the
years. Awareness of both the dental and medical
community is required so that treatment follows accurate diagnosis and patients are free of the medications’ side effects.
Key Words: drug abuse, oral diseases, irrational prescription.
INTRODUCTION
“Abuse”, “misuse”, “overuse”, “non medical use” of drugs
or “irrational drug prescription” and “unreasonable polypharmacy” are synonymous terms reflecting the medical
community’s concern about the increasing tendency for
drug use without any indication; a concern that is raised
because of epidemiological data from the U.S.A., where
in 2010 medication abuse occurs among 7,000,000 people every month, a number which surpasses the users of
cocaine, heroin or hallucinogens1. Although the number
of drug-related visits in the Emergency Departments
remained stable during the recent years, a 44% increase
in drug overuse-related visits to the Emergency Departments was recorded1. Drug abuse not only affects
patients’ health, because of medications’ side effects or
synergy or even a delay in the diagnosis of their oral
disease, but also affects both the patients and the public
health system financially.
Dentistry could not be unaffected by medications’ abuse.
It has been estimated that more than 40% of dental patients taking drugs suffer from the medications adverse
reactions, a percentage that increases significantly in
cases of non medical drug use2. It is also reported that
5% of visits to the Greek Hospitals are estimated to have
occured as a result of medications’ side effects, while
that ratio among the elderly approximates even 20%2.
A wide variety of drugs are used in the management of
oral diseases, including antiseptics, analgesics-antipyretics, non steroidal anti-inflammatory drugs, antibiotics,
antivirals, antifungals and corticosteroids (topical or systemic), drugs for the central nervous system, antihistamines, healing drugs, immunosuppressive-immunomodulatory drugs, antineoplastic drugs and saliva substitutes for the treatment of xerostomia. Drug abuse has
been presented in three previous Greek studies, all
conducted at the Department of Oral Pathology and
Hellenic Stomatological Review 57: 9-17, 2013
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
Research Study
ÌÂÙ¿ ·fi È·ÙÚÈ΋ Ô‰ËÁ›·2. AӷʤÚÂÙ·È, Â›Û˘, ˆ˜ ÙÔ
5% ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÙ· ÓÔÛÔÎÔÌ›· ÛÙËÓ EÏÏ¿‰· ÔÊ›ÏÂÙ·È Û ·ÚÂÓ¤ÚÁÂȘ Ê·Ú̿ΈÓ, ÔÛÔÛÙfi Ô˘ ÚÔÛÂÁÁ›˙ÂÈ Ì¤¯ÚÈ Î·È ÙÔ 20% ÛÙËÓ ÙÚ›ÙË ËÏÈΛ·2.
°È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ı‹ÛÂˆÓ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ‰È¿ÊÔÚ˜ ηÙËÁÔڛ˜ Ê·Ú̿ΈÓ, ΢ڛˆ˜ ·ÓÙÈÛËÙÈο, ·Ó·ÏÁËÙÈο-·ÓÙÈ˘ÚÂÙÈο, ÌËÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë, ·ÓÙÈ‚ÈÔÙÈο, ·ÓÙÈÈο, ·ÓÙÈÌ˘ÎËÙÈ·ÛÈο Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (ÙÔÈο ‹ Û˘ÛÙËÌ·ÙÈο), Ê¿Ú̷η ÁÈ· ÙȘ ·ı‹ÛÂȘ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡
Û˘ÛÙ‹Ì·ÙÔ˜, ·ÓÙÈÈÛÙ·ÌÈÓÈο, ÂÔ˘ÏˆÙÈο, ·ÓÔÛÔηٷÛÙ·ÏÙÈο-·ÓÔÛÔÙÚÔÔÔÈËÙÈο, ·ÓÙÈÓÂÔÏ·ÛÌ·ÙÈο ηÈ
˘ÔηٿÛٷٷ Û¿ÏÈÔ˘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÍËÚÔÛÙÔÌ›·˜. H ηٿ¯ÚËÛË Ê·ÚÌ¿ÎˆÓ ¤¯ÂÈ ·ÔÙ˘ˆı› ÛÂ
ÙÚÂȘ ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ·fi ÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ, fiϘ ·fi ÙËÓ KÏÈÓÈ΋ Ù˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ EıÓÈÎÔ‡ Î·È K·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, ÙfiÛÔ ÁÈ· Û˘ÁÎÂÎÚÈ̤Ó˜ ηÙËÁÔڛ˜
Ê·Ú̿ΈÓ, fiˆ˜ Ù· ·ÓÙÈÛËÙÈο3 Î·È Ù· ·ÓÙÈÌ˘ÎËÙÈ·ÛÈο4, fiÛÔ Î·È ÛÙÔ Û‡ÓÔÏfi ÙÔ˘˜2.
™ÙËÓ ÂÚÁ·Û›· Ù˘ M·˙ÔÔ‡ÏÔ˘3 ÙÔ 1987 ·ÚÔ˘ÛÈ¿ÛÙËÎÂ Ë ¯Ú‹ÛË Î·È Ë Î·Ù¿¯ÚËÛË ÙÔÈÎÒÓ ·ÓÙÈÛËÙÈÎÒÓ ·fi
100 ·ÛıÂÓ›˜ ÛÂ Û˘ÓÔÏÈÎfi ‰Â›ÁÌ· ÂÚ›Ô˘ 1000 ·ÛıÂÓÒÓ. ™ÙË ÌÂϤÙË ÙˆÓ ™ÎÏ·‚Ô‡ÓÔ˘ Î·È ¢Ú›ÎÔ˘4 ÙÔ 1989
ηٷÁÚ¿ÊËÎ·Ó 80 ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ ·fi Û˘ÓÔÏÈÎfi
‰Â›ÁÌ· ÂÚ›Ô˘ 1000 ·ÛıÂÓÒÓ, ÔÈ ÔÔ›ÔÈ ÚÈÓ ·fi ÙËÓ
ÚÔÛ¤ÏÂ˘Û‹ ÙÔ˘˜ ÛÙËÓ KÏÈÓÈ΋ Ù˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ ›¯·Ó οÓÂÈ ¯Ú‹ÛË ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÌÂÙ¿ ·fi
·Ú·›ÓÂÛË Ô‰ÔÓÙÈ¿ÙÚÔ˘ ‹ È·ÙÚÔ‡, ‹ Ì ‰È΋ ÙÔ˘˜ ÚˆÙÔ‚Ô˘Ï›·. ™ÙËÓ ÈÔ ÚfiÛÊ·ÙË ¤Ú¢ӷ ÙˆÓ X·Ù˙ËÁÈ¿ÓÓË
Î·È Û˘Ó.2 ÙÔ 2007 Û˘ÁÎÂÓÙÚÒıËÎ·Ó 217 ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ ·fi Û‡ÓÔÏÔ ÂÚ›Ô˘ 1000, ÔÈ ÔÔ›ÔÈ Â›¯·Ó οÓÂÈ
¯Ú‹ÛË Î¿ÔÈÔ˘ Ê·ÚÌ¿ÎÔ˘, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ·ÓÙÈ‚ÈÔÙÈÎÔ‡, ·ÓÙÈÛËÙÈÎÔ‡ ‹ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎÔ‡, ÁÈ·
ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÛÙÔÌ·ÙÈÎÔ‡ ÙÔ˘˜ ÓÔÛ‹Ì·ÙÔ˜.
H ·ÏfiÁÈÛÙË ¯Ú‹ÛË Ê·ÚÌ¿ÎˆÓ ·fi ÙÔ˘˜ ÛÙÔÌ·ÙÔÏÔÁÈÎÔ‡˜ ·ÛıÂÓ›˜ ÔÊ›ÏÂÙ·È ¿ÏÏÔÙ ÛÙËÓ ·‰ÈηÈÔÏfiÁËÙË
Û˘ÓÙ·ÁÔÁÚ¿ÊËÛ‹ ÙÔ˘˜ ·fi ÙÔ˘˜ ıÂÚ¿ÔÓÙ˜ Ô‰ÔÓÙÈ¿ÙÚÔ˘˜ ‹ È·ÙÚÔ‡˜, Î·È ¿ÏÏÔÙ ÛÙËÓ Ï‹„Ë ÙÔ˘˜ ÌÂÙ¿ ·fi
Û‡ÛÙ·ÛË ÙÔ˘ Ê·ÚÌ·ÎÔÔÈÔ‡ ‹ ÚˆÙÔ‚Ô˘Ï›· ÙˆÓ ›‰ÈˆÓ
ÙˆÓ ·ÛıÂÓÒÓ2-4.
™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË Ù˘
Èı·Ó‹˜ ·‰ÈηÈÔÏfiÁËÙ˘ ¯Ú‹Û˘ Ê·ÚÌ¿ÎˆÓ ·fi ·ÛıÂÓ›˜ Ì ÛÙÔÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù·, fiˆ˜ ‰È·ÌÔÚÊÒıËÎÂ
ηٿ Ù· ¤ÙË 2008-2011, Î·È Ë Û‡ÁÎÚÈÛË ÙˆÓ ÛËÌÂÚÈÓÒÓ
‰Â‰ÔÌ¤ÓˆÓ Ì ·˘Ù¿ ÚÔËÁÔ˘Ì¤ÓˆÓ ÌÂÏÂÙÒÓ Ô˘ ¤¯Ô˘Ó
‰ÈÂÍ·¯ı› ÛÙËÓ EÏÏ¿‰·.
Medicine of Dental School of the University of Athens,
either with absolute regard to specific drug categories
such as antiseptics3 and antifungal4, or to all medications
for oral diseases2.
In 1987, Bazopoulou3 reported the use and misuse of
topical antiseptics by 100 patients out of a total sample of
1,000 patients. Sklavounou and Drikos4 in 1989 recorded
80 cases over a total sample of 1,000 patients, who had
already used antifungal for their oral disease either with a
dental or medical prescription or on their own initiative. In
the most recent study, Hatziyannis et al2 in 2007 reported
217 cases over a total sample of 1,000 patients, who had
used medications, most commonly antibiotics, antiseptics
or antifungal, for the therapy of their oral disease.
Drug overuse in Oral Medicine occurs due to either
irrational dental or medical prescription, or because of the
patients’ initiative or the pharmacist’s recommendation2-4.
The purpose of this study is to investigate possible drug
abuse among patients with oral diseases during the
years 2008-2011 and to compare those results with the
relevant data of the previous Greek studies.
MATERIALS AND METHODS
Of the 2,662 records of patients that were examined at
the Department of Oral Pathology and Medicine in Dental
School of the University of Athens during the years 20082011, 646 records were retrospectively selected on the
basis that the patients had already taken medications for
the treatment of their oral disease before attending the
clinic. Due to unclear information about either the exact
cause of the drug intake or the drug formulation, 52
records were excluded. The remaining 594 records were
analyzed with regard to the compatibility of the
medication to the final diagnosis. Only the medication
class was evaluated, but not the drug substance or the
dosage regimen.
In 458 out of the 594 (77%) records, there was no
compatibility of the medication to the final diagnosis and
those patients constituted the “drug abuse” group.
Epidemiological data (sex, age), the year of examination
and the drug or drugs category were recorded, as well as
whether the medication was taken following the patients
initiative or a doctor’s recommendation. When there was
a prescription, the specialty of the medical professionals
was also recorded.
RESULTS
Y§IKO KAI ME£O¢O™
Afi 2.662 ʷΤÏÔ˘˜ ·ÛıÂÓÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙËÓ
KÏÈÓÈ΋ Ù˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜
ÙÔ˘ EıÓÈÎÔ‡ Î·È K·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ ·fi ÙÔÓ I·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2008 ¤ˆ˜ Î·È ÙÔ ¢ÂΤ̂ÚÈÔ
ÙÔ˘ 2011, ÂÈϤ¯ıËÎ·Ó ·Ó·‰ÚÔÌÈο 646 Ê¿ÎÂÏÔÈ, ÛÙÔ˘˜
ÔÔ›Ô˘˜ ·Ó·ÊÂÚfiÙ·Ó Ï‹„Ë Ê·ÚÌ¿ÎÔ˘ ‹ Ê·ÚÌ¿ÎˆÓ ÁÈ·
ÙÔ ÓfiÛËÌ· Ô˘ ·ÔÙÂÏÔ‡Û ÙËÓ ·ÈÙ›· ÚÔÛ¤ÏÂ˘Û‹˜. Afi
ÙÔ˘˜ ʷΤÏÔ˘˜ ·˘ÙÔ‡˜ ÂÍ·ÈÚ¤ıËÎ·Ó 52, ÂÍ·ÈÙ›·˜ ·Û·Hellenic Stomatological Review 57: 9-17, 2013
As far as the patients’ gender is concerned, there were
267 females and 191 males with a female to male ratio of
1.4:1. The age range was from 2.5 to 95 years, the mean
age was 50.62 (±19) years, while almost half of the
patients (204/458, 44,5%) were between their 50th and 70th
year. 5% of the patients were under 18 years old. 66% of
the patients (301/458) had taken only one kind of
medication, while 2-5 different drug categories (polypharmacy) were taken by 34% (157/458) of the patients.
11
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
Research Study
ÊÒÓ ÏËÚÔÊÔÚÈÒÓ Û¯ÂÙÈο Ì ÙËÓ ·ÎÚÈ‚‹ ·ÈÙ›· Ù˘ ¯Ú‹Û˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ‹ ÙÔ Â›‰Ô˜ ÙÔ˘ Û΢¿ÛÌ·ÙÔ˜. ™ÙÔ˘˜
˘fiÏÔÈÔ˘˜ 594 ʷΤÏÔ˘˜ ÂÎÙÈÌ‹ıËÎÂ Ë Û˘Ì‚·ÙfiÙËÙ·
ÌÂٷ͇ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ô˘ ›¯Â ÏËÊı› ÚÈÓ ·fi ÙËÓ ÂͤٷÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Ù˘ ÙÂÏÈ΋˜ ‰È¿ÁÓˆÛ˘. AÍÈÔÏÔÁ‹ıËΠÌfiÓÔÓ Ë Î·ÙËÁÔÚ›· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È fi¯È Ë Ê·Ú̷΢ÙÈ΋ Ô˘Û›· ‹ ÙÔ ‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì·.
™Â 458 ·fi ÙÔ˘˜ 594 (77%) ʷΤÏÔ˘˜ ‰ÂÓ ÚԤ΢„Â
Û˘Ìʈӛ· Î·È ·ÔÙ¤ÏÂÛ·Ó ÙȘ ÂÚÈÙÒÛÂȘ «Ê·Ú̷΢ÙÈ΋˜ ηٿ¯ÚËÛ˘». K·Ù·ÁÚ¿ÊËÎ·Ó Ù· ÂȉËÌÈÔÏÔÁÈο
ÛÙÔȯ›· ÙˆÓ ·ÛıÂÓÒÓ (ʇÏÔ, ËÏÈΛ·), ÙÔ ¤ÙÔ˜ ÂͤٷÛ˘,
Ë Î·ÙËÁÔÚ›· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ‹ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ô˘ Ï‹ÊıËηÓ, ÙÔ ·Ó Ï‹ÊıËÎÂ/Ï‹ÊıËÎ·Ó ÌÂÙ¿ ·fi ÚˆÙÔ‚Ô˘Ï›· ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹ ˘fi‰ÂÈÍË È·ÙÚÔ‡, Î·È ÛÙË ‰Â‡ÙÂÚË
ÂÚ›ÙˆÛË Ë ÂȉÈÎfiÙËÙ· ÙÔ˘ È·ÙÚÔ‡.
189 (41.3%) of the patients were examined in the first two
years of the study and 269 (58.7%) in the latter two.
Figure 1 presents the drug categories that were taken by
the 458 patients in detail. As shown, of the 680 drug
formulations that were taken by all of the 458 patients,
there was a clear preference for antiseptics (198/680,
29.1%), antifungals (178/680, 26.2%) and antibiotics
(124/680, 18.2%) which were selected as a “solution” in
almost 3/4 of the cases (500/680), equally by both genders. In particular, antiseptics represented the most commonly used category and in 57% of cases (113/198) they
were chosen as monotherapy, while in the remaining
cases, antiseptics were combined with 1-4 other medications, mainly with antibiotics and antifungals.
A¶OTE§E™MATA
ø˜ ÚÔ˜ ÙÔ Ê‡ÏÔ ÙˆÓ ·ÛıÂÓÒÓ, 267 ‹Ù·Ó Á˘Ó·›Î˜ ηÈ
191 ¿Ó‰Ú˜, ·Ó·ÏÔÁ›· 1,4:1. TÔ Â‡ÚÔ˜ ÙˆÓ ËÏÈÎÈÒÓ ‹Ù·Ó
2,5-95 ¤ÙË, Ô Ì¤ÛÔ˜ fiÚÔ˜ ËÏÈΛ·˜ ‹Ù·Ó Ù· 50,62 (±19) ¤ÙË, ÂÓÒ Û¯Â‰fiÓ ÔÈ ÌÈÛÔ› ·ÛıÂÓ›˜ (204/458, 44,5%) ‚Ú›ÛÎÔÓÙ·Ó ÌÂٷ͇ 50Ô˘ Î·È 70Ô˘ ¤ÙÔ˘˜ ËÏÈΛ·˜. TÔ 5% ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó ·Ó‹ÏÈÎÔÈ. TÔ 66% ÙˆÓ ·ÛıÂÓÒÓ (301/458)
Ï¿Ì‚·Ó ÌfiÓÔ ¤Ó· ›‰Ô˜ Ê·ÚÌ¿ÎÔ˘ (ÌÔÓÔıÂÚ·›·), ÂÓÒ ÛÙÔ 34% (157/458) ÁÈÓfiÙ·Ó Û˘Ó‰˘·ÛÙÈ΋ Ï‹„Ë 2-5
Ê·ÚÌ¿ÎˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ Î·ÙËÁÔÚÈÒÓ (ÔÏ˘Ê·Ú̷Λ·).
Afi ÙÔ˘˜ ·ÛıÂÓ›˜ 189 (41,3%) ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙ· ÚÒÙ·
‰‡Ô ¤ÙË Ù˘ ÌÂϤÙ˘ Î·È ÔÈ 269 (58,7%) ÛÙ· ‰‡Ô ÙÂÏÂ˘Ù·›·.
™ÙÔ ‰È¿ÁÚ·ÌÌ· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ Î·ÙËÁÔڛ˜ Ê·ÚÌ¿ÎˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ·fi ÙÔ˘˜ 458 ·ÛıÂÓ›˜. Ÿˆ˜ Ê·›ÓÂÙ·È, ÌÂٷ͇ ÙˆÓ 680 Û΢·ÛÌ¿ÙˆÓ
Ô˘ Ï‹ÊıËÎ·Ó Û˘ÓÔÏÈο ·fi ÙÔ˘˜ 458 ·ÛıÂÓ›˜, Û·Ê‹˜
‹Ù·Ó Ë ÚÔÙ›ÌËÛË ÁÈ· Ù· ·ÓÙÈÛËÙÈο (198/680, 29,1%),
Ù· ·ÓÙÈÌ˘ÎËÙÈ·ÛÈο (178/680, 26,2%) Î·È Ù· ·ÓÙÈ‚ÈÔÙÈο
(124/680, 18,2%) Ô˘ ÂÈϤ¯ıËÎ·Ó ˆ˜ «Ï‡ÛË» ۯ‰fiÓ
ÛÙ· 3/4 ÙˆÓ ÂÚÈÙÒÛÂˆÓ (500/680), ÂÍ›ÛÔ˘ Î·È ·fi Ù·
‰‡Ô ʇϷ. EȉÈÎfiÙÂÚ·, Ù· ·ÓÙÈÛËÙÈο ·ÓÙÈÚÔÛÒ¢·Ó
ÙË Û˘¯ÓfiÙÂÚË ·ÁˆÁ‹, ÛÙÔ 57% (113/198) ˆ˜ ÌÔÓÔıÂÚ·-
¢È¿ÁÚ·ÌÌ· 1: K·ÙËÁÔڛ˜ ÙˆÓ 680 Ê·ÚÌ¿ÎˆÓ Ô˘ ¤Ï·‚·Ó ÔÈ
458 ·ÛıÂÓ›˜.
12
Figure 1: Categories of the 680 drugs of the 458 patients.
According to patients’ statements, in 157 cases (34.3%)
there was a dental or medical prescription, 21 (4.6%)
patients had gone to 2-4 dentists or physicians, 155
(33.8%) patients had taken the medications on their own
initiative, while in 125 (27.3%) cases, there were no relevant
information. Medications were irrationally prescribed
mainly by ENT specialists (178 cases), followed by dentists,
“oral pathologists”, dermatologists, physicians and other
medical specialists (figure 2). The total ratio of patients who
had taken medications on their own initiative (33.8% or
155/458 cases) was equal to the partial percentages for the
two genders (33.3% or 89/267 cases among females and
34.6% or 66/191 cases among males). No gender
predilection was found in the percentage of patients who
considered their oral disease as “dental” and thus went to a
general dental practitioner, a dental specialist or an “oral
pathologist” (14% or 64/458 cases among all the patients,
14.6% or 39/267 cases among females and 13.1% or
25/191 cases among males).
In conclusion, table 1 presents a few representative
examples of drug abuse from patients that were
examined at the Department of Oral Medicine and
Pathology of Dental School during the years 2008-2011.
Hellenic Stomatological Review 57: 9-17, 2013
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
Research Study
›·, ÂÓÒ ÛÙȘ ˘fiÏÔÈ˜ ÂÚÈÙÒÛÂȘ Û˘Ó‰˘¿ÛÙËÎ·Ó ÌÂ
1-4 ¿ÏÏ· Ê¿Ú̷η, Ì ·ÚÈÔ˘˜ ÂÎÚÔÛÒÔ˘˜ Ù· ·ÓÙÈ‚ÈÔÙÈο Î·È Ù· ·ÓÙÈÌ˘ÎËÙÈ·ÛÈο.
™‡Ìʈӷ Ì ٷ fiÛ· ·Ó·Ê¤ÚÔÓÙ·Ó ·fi ÙÔ˘˜ ·ÛıÂÓ›˜,
Û 157 ÂÚÈÙÒÛÂȘ (34,3%) Ù· Ê¿Ú̷η ›¯·Ó Û˘ÓÙ·ÁÔÁÚ·ÊËı› ·fi Ô‰ÔÓÙÈ¿ÙÚÔ˘˜ ‹ È·ÙÚÔ‡˜, 21 (4,6%) ·¢ı‡ÓıËÎ·Ó Û 2-4 Ô‰ÔÓÙÈ¿ÙÚÔ˘˜ ‹ È·ÙÚÔ‡˜, 155 (33,8%)
·ÛıÂÓ›˜ ¤Ï·‚·Ó οÔÈÔ Ê¿ÚÌ·ÎÔ Ì ‰È΋ ÙÔ˘˜ ÚˆÙÔ‚Ô˘Ï›·, ÂÓÒ Û 125 (27,3%) ÂÚÈÙÒÛÂȘ ‰ÂÓ ˘‹Ú¯·Ó ÔÈ
Û¯ÂÙÈΤ˜ ÏËÚÔÊÔڛ˜. ÕÛÎÔË ¯ÔÚ‹ÁËÛË Ê·Ú̿ΈÓ
Û˘ÛÙ‹ıËΠηٿ ·ÚÈÔ ÏfiÁÔ ·fi ÙÔ˘˜ ˆÙÔÚÚÈÓÔÏ·Ú˘ÁÁÔÏfiÁÔ˘˜ (178 ÂÚÈÙÒÛÂȘ) Î·È ·ÎÔÏÔ˘ıÔ‡Û·Ó Ô‰ÔÓÙ›·ÙÚÔÈ, «ÛÙÔÌ·ÙÔÏfiÁÔÈ», ‰ÂÚÌ·ÙÔÏfiÁÔÈ, ·ıÔÏfiÁÔÈ Î·È
¿ÏÏÔÈ (‰È¿ÁÚ·ÌÌ· 2). TÔ Û˘ÓÔÏÈÎfi ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‹Ú·Ó Ì ‰È΋ ÙÔ˘˜ ÚˆÙÔ‚Ô˘Ï›· Ê¿Ú̷η
(33,8% ‹ 155/458 ÂÚÈÙÒÛÂȘ) ‹Ù·Ó ·Ú·Ï‹ÛÈÔ Ì ٷ
Â› ̤ÚÔ˘˜ ÔÛÔÛÙ¿ ÁÈ· οı ʇÏÔ (33,3% ‹ 89/267 ÂÚÈÙÒÛÂȘ ÛÙȘ Á˘Ó·›Î˜, Î·È 34,6% ‹ 66/191 ÂÚÈÙÒÛÂȘ ÛÙÔ˘˜ ¿Ó‰Ú˜). ¢ÂÓ ˘‹ÚÍ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ
‰‡Ô Ê‡ÏˆÓ ˆ˜ ÚÔ˜ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ıÂÒÚËÛ·Ó ÙÔ ÓfiÛËÌ¿ ÙÔ˘˜ «Ô‰ÔÓÙÈ·ÙÚÈÎfi» Î·È ·¢ı‡ÓıËÎ·Ó Û οÔÈÔ ÁÂÓÈÎfi ‹ ÂÍÂȉÈÎÂ˘Ì¤ÓÔ Ô‰ÔÓÙ›·ÙÚÔ ‹ ÛÂ
«ÛÙÔÌ·ÙÔÏfiÁÔ» (14% ‹ 64/458 ÂÚÈÙÒÛÂȘ ÛÙÔ Û‡ÓÔÏÔ
ÙˆÓ ·ÛıÂÓÒÓ, 14,6% ‹ 39/267 ÂÚÈÙÒÛÂȘ ÛÙȘ Á˘Ó·›Î˜ Î·È 13,1% ‹ 25/191 ÂÚÈÙÒÛÂȘ ÛÙÔ˘˜ ¿Ó‰Ú˜).
T¤ÏÔ˜, ÛÙÔÓ ›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È, ÂÓ‰ÂÈÎÙÈο, ÔÚÈṲ̂ӷ ·Ú·‰Â›ÁÌ·Ù· ηٿ¯ÚËÛ˘ Ê·ÚÌ¿ÎˆÓ ·fi ÙÔ˘˜
·ÛıÂÓ›˜ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙÔ ‰È¿ÛÙËÌ· 2008-2011 ÛÙËÓ
KÏÈÓÈ΋ Ù˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜.
¢È¿ÁÚ·ÌÌ· 2: ¶ÂÚÈÙÒÛÂȘ ¯ÔÚ‹ÁËÛ˘ Ê·ÚÌ¿ÎˆÓ ÌfiÓÔ ·fi Ì›·
ÂȉÈÎfiÙËÙ·.
™YZHTH™H
H ·ÚÔ‡Û· ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË Î·Ù¤ÁÚ·„ ÙËÓ Î·Ù¿¯ÚËÛË Ê·ÚÌ¿ÎˆÓ ÁÈ· ÛÙÔÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù· ηٿ ÙË
‰È¿ÚÎÂÈ· Ì›·˜ ÙÂÙÚ·ÂÙ›·˜ Û ¤Ó· ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÛÙÔÌ·ÙÔÏÔÁÈÎfi ΤÓÙÚÔ. T· ·ÔÙÂϤÛÌ·Ù· ‰Â›¯ÓÔ˘Ó ˆ˜ Ë ·ÏfiÁÈÛÙË ¯Ú‹ÛË Ê·ÚÌ¿ÎˆÓ Â›Ó·È Û˘¯Ófi Ê·ÈÓfiÌÂÓÔ Î·È ‰Â
‰È·Ê·›ÓÂÙ·È Ù¿ÛË Ì›ˆÛ˘ Ì ÙËÓ ¿ÚÔ‰Ô ÙˆÓ ÂÙÒÓ.
Hellenic Stomatological Review 57: 9-17, 2013
Figure 2: Cases of medication administration by one specialty.
DISCUSSION
The present retrospective study recorded the drug abuse
in oral diseases during a four year period in a center
specialized in Oral Medicine and Pathology. The results
indicate that irrational drug use is a common phenomenon with no tendency to decrease over the years.
Comparing the results of the present study with those of
the previous Greek studies, it is obvious that the rates of
drug abuse remain constantly high. The irrational use of
drugs in this research was estimated at 77% of patients,
a higher proportion than in the study of Hatziyannis et al.2
(72%) and Bazopoulou3 (69%), but smaller than that
recorded in the study of Sklavounou and Drikos and4
(90%). It should be also noted that the studies of Bazopoulou3 and Sklavounou and Drikos4 referred to the drug
abuse of a specific drug category. Furthermore, it seems
that antiseptics, antifungals and antibiotics are the most
overused drug categories, a finding that is in accordance
with the results of the study of Hatziyannis et al.2.
Regarding the proportion of drug abuse attributed to the
initiative of the patients in the present study, it was
estimated at 34% and is almost more than double the
19% in the research of Hatziyannis et al. (19%)2, but less
than those of the studies of Sklavounou and Drikos4
(51%) and Bazopoulou3 (57%). It should be noted, however, that as all studies were retrospective, including the
present one, and in that of Hatziyannis et al.2 for a large
number of patients there was no evidence about who
was responsible for the medication administration (27%
and 41%, respectively), which might affect the rates. The
only encouraging element in the present study was that
the percentage of polypharmacy (32%) was lower
compared to previous studies, which was 52.5%2, 72.5%4
and 58%3.
According to the data of the present study, a great
percentage of the irrational prescription was decided by
ENT specialists, who alone or in combination with other
medical specialties were responsible for drug abuse in
15.3% of cases (70 cases), which is clearly greater than
13
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
Research Study
¶›Ó·Î·˜ 1: ¶·Ú·‰Â›ÁÌ·Ù· ¿ÛÎÔ˘ ÔÏ˘Ê·Ú̷Λ·˜ ·fi ÙËÓ KÏÈÓÈ΋
Ù˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ ÛÙÔ ‰È¿ÛÙËÌ· 2008-2011.
E›‰Ë Ê·Ú̿ΈÓ
AfiÊ·ÛË ÁÈ· Ù· Ê¿Ú̷η
·ÓÙÈÛËÙÈÎfi, ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎfi,
·ıÔÏfiÁÔ˜
·ÓÙÈ‚ÈÔÙÈÎfi, ÙÔÈÎfi
TÂÏÈ΋ ‰È¿ÁÓˆÛË
ÏÂ˘Îˆfi Â›¯ÚÈÛÌ·
ÁÏÒÛÛ·˜
ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ¤˜
·ÓÙÈÛËÙÈÎfi, ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎfi,
¯ˆÚ›˜ ÛÙÔȯ›·
¤ÌÊÈÁ·
Ô‰ÔÓÙ›·ÙÚÔ˜
·Î·ÓıÔ΢ÙÙ·ÚÈÎfi
‚Èٷ̛Ә
·ÓÙÈÛËÙÈÎfi, ·ÓÙÈ‚ÈÔÙÈÎfi
ηÚΛӈ̷
Table 1: Examples of irrational polypharmacy from the data of the Department
of Oral Medicine and Pathology during the years 2008-2011.
Medication type
antiseptic, antifungal, antibiotic,
Decision for the drug
administration
general physician
topical corticosteroid
Final diagnosis
white coating
on tongue
antiseptic, antifungal, vitamins
not available
pemphigus vulgaris
antiseptic, antibiotic
dentist
squamous cell
carcinoma
™˘ÁÎÚ›ÓÔÓÙ·˜ Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘
Ì ٷ ·ÓÙ›ÛÙÔȯ· ÙˆÓ ÙÚÈÒÓ ÚÔÁÂÓÂÛÙ¤ÚˆÓ ÌÂÏÂÙÒÓ ·fi ÙËÓ EÏÏ¿‰·, Á›ÓÂÙ·È ÂÌÊ·Ó¤˜ fiÙÈ Ù· ÔÛÔÛÙ¿ Ê·Ú̷΢ÙÈ΋˜ ηٿ¯ÚËÛ˘ ÁÈ· ÛÙÔÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù· ·Ú·Ì¤ÓÔ˘Ó ÛÙ·ıÂÚ¿ ˘„ËÏ¿. H ·ÏfiÁÈÛÙË ¯Ú‹ÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ ˘ÔÏÔÁ›ÛÙËΠÛÙÔ 77%
ÙˆÓ ·ÛıÂÓÒÓ, ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ·fi ÙÔ ·ÓÙ›ÛÙÔȯÔ
ÛÙȘ ÂÚÁ·Û›Â˜ ÙˆÓ X·Ù˙ËÁÈ¿ÓÓË Î·È Û˘Ó.2 (72%) Î·È Ù˘
M·˙ÔÔ‡ÏÔ˘3 (69%), ·ÏÏ¿ ÌÈÎÚfiÙÂÚÔ ·fi ·˘Ùfi Ô˘ ηٷÁÚ¿ÊËΠÛÙË ÌÂϤÙË ÙˆÓ ™ÎÏ·‚Ô‡ÓÔ˘ Î·È ¢Ú›ÎÔ˘4
(90%). £· Ú¤ÂÈ, ‚¤‚·È·, Ó· ÛËÌÂȈı› fiÙÈ ÔÈ ÌÂϤÙ˜
Ù˘ M·˙ÔÔ‡ÏÔ˘3 Î·È ÙˆÓ ™ÎÏ·‚Ô‡ÓÔ˘ Î·È ¢Ú›ÎÔ˘4 ·ÊÔÚÔ‡Û·Ó Û ηٿ¯ÚËÛË Û˘ÁÎÂÎÚÈ̤Ó˘ ηÙËÁÔÚ›·˜
Ê·Ú̷΢ÙÈÎÒÓ Û΢·ÛÌ¿ÙˆÓ. E›Û˘, Ê·›ÓÂÙ·È ˆ˜ Ù·
·ÓÙÈÛËÙÈο, Ù· ·ÓÙÈÌ˘ÎËÙÈ·ÛÈο Î·È Ù· ·ÓÙÈ‚ÈÔÙÈο ›ӷÈ
ÔÈ Î·ÙËÁÔڛ˜ Ê·ÚÌ¿ÎˆÓ Ì ÙË ÌÂÁ·Ï‡ÙÂÚË Î·Ù¿¯ÚËÛË,
‡ÚËÌ· Ô˘ Û˘ÌʈÓ› Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÂÚÁ·Û›·˜ ÙˆÓ X·Ù˙ËÁÈ¿ÓÓË Î·È Û˘Ó.2.
AÓ·ÊÔÚÈο Ì ÙÔ ÔÛÔÛÙfi Ê·Ú̷΢ÙÈ΋˜ ηٿ¯ÚËÛ˘
Ô˘ ·Ô‰fiıËΠ۠ÚˆÙÔ‚Ô˘Ï›· ÙˆÓ ·ÛıÂÓÒÓ, ÛÙËÓ ·14
that recorded in the work of Hatziyannis et al.2 and
Bazopoulou3 (7% and 6%, respectively). Although these
data should be evaluated with caution, since they are
derived from information provided by patients, they
stress the necessity that patients with oral diseases be
treated by a specialist in Oral Medicine.
Studies investigating only the use of drugs in oral diseases, excluding odontogenic infections and periodontal
diseases, are not found in the international literature. On
the contrary, there are numerous publications about
antibiotics for diseases of the dental pulp or periapical
and periodontal tissues administrated by dentists. Regarding antibiotics, which hold the top spot internationally
on dental prescribing5, two types of studies have been
conducted. The first category includes questionnaires
with hypothetical cases of patients, which were sent to
general dentists, asking them to identify in which cases,
in their opinion, patients should take antibiotics6-13. Among those reviews, only Jaunay et al.8 refer to oral
mucosal diseases, and include in patients’ complaints
Hellenic Stomatological Review 57: 9-17, 2013
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
Research Study
ÚÔ‡Û· ÂÚÁ·Û›· ·˘Ùfi ˘ÔÏÔÁ›ÛÙËΠ۠34% Î·È Â›Ó·È
ۯ‰fiÓ ˘ÂÚ‰ÈÏ¿ÛÈÔ ·fi ÙÔ 19% ÛÙËÓ ÂÚÁ·Û›· ÙˆÓ X·Ù˙ËÁÈ¿ÓÓË Î·È Û˘Ó.2 (19%), ·ÏÏ¿ ÌÈÎÚfiÙÂÚÔ ·fi ·˘Ù¿ ÙˆÓ
ÂÚ¢ÓÒÓ ÙˆÓ ™ÎÏ·‚Ô‡ÓÔ˘ Î·È ¢Ú›ÎÔ˘4 (51%) Î·È Ù˘
M·˙ÔÔ‡ÏÔ˘3 (57%). ™ËÌÂÈÒÓÂÙ·È, ˆÛÙfiÛÔ, ˆ˜ ÂÂȉ‹ fiϘ ÔÈ ÌÂϤÙ˜ ‹Ù·Ó ·Ó·‰ÚÔÌÈΤ˜, ÙfiÛÔ ÛÙËÓ ·ÚÔ‡Û·, fiÛÔ Î·È Û ·˘Ù‹ ÙˆÓ X·Ù˙ËÁÈ¿ÓÓË Î·È Û˘Ó.2 Û ¤Ó· ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ ‰ÂÓ ˘‹Ú¯·Ó ÛÙÔȯ›· ÁÈ· ÙÔ
ÔÈÔ˜ ·ÔÊ¿ÛÈÛ ÙË ¯ÔÚ‹ÁËÛË (27% Î·È 41%, ·ÓÙ›ÛÙÔȯ·), ÁÂÁÔÓfi˜ Ô˘ ÂӉ¯Ô̤ӈ˜ ÂËÚ¿˙ÂÈ Ù· ÔÛÔÛÙ¿.
TÔ ÌfiÓÔ ÂÓı·ÚÚ˘ÓÙÈÎfi ÛÙÔÈ¯Â›Ô ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‹Ù·Ó ÙÔ ÔÛÔÛÙfi ÔÏ˘Ê·Ú̷Λ·˜ (32%) Ô˘ ‹Ù·Ó ÌÂȈ̤ÓÔ Û ۯ¤ÛË Ì ÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜, ÛÙȘ Ôԛ˜ ‹Ù·Ó 52,5%2, 72,5%4 Î·È 58%3.
MÂÁ¿ÏÔ ÔÛÔÛÙfi Ù˘ ·‰ÈηÈÔÏfiÁËÙ˘ Û˘ÓÙ·ÁÔÁÚ¿ÊËÛ˘, Û‡Ìʈӷ Ì ٷ ÛÙÔȯ›· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ¤ÁÈÓ ·fi È·ÙÚÔ‡˜ øP§, ÔÈ ÔÔ›ÔÈ ÌfiÓÔÈ ÙÔ˘˜ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¿ÏϘ È·ÙÚÈΤ˜ ÂȉÈÎfiÙËÙ˜ ¤ÊÂÚ·Ó ÙËÓ Â˘ı‡ÓË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ηٿ¯ÚËÛ˘ ÛÙÔ 15,3% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (70 ÂÚÈÙÒÛÂȘ), ÔÛÔÛÙfi Û·ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚÔ ·fi ·˘Ùfi Ô˘ ›¯Â ηٷÁÚ·Ê› ÛÙȘ ÂÚÁ·Û›Â˜ ÙˆÓ X·Ù˙ËÁÈ¿ÓÓË Î·È Û˘Ó.2 Î·È Ù˘ M·˙ÔÔ‡ÏÔ˘3 (7% Î·È 6%,
·ÓÙ›ÛÙÔȯ·) . AÓ Î·È Ù· ÛÙÔȯ›· ·˘Ù¿ Ú¤ÂÈ Ó· ÂÎÙÈÌÒÓÙ·È Ì ÂÈʇϷÍË, ηıÒ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙȘ ÏËÚÔÊÔڛ˜ Ô˘ ‰›ÓÔ˘Ó ÔÈ ·ÛıÂÓ›˜, ÂÈÛËÌ·›ÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ÛÙÔÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù· ·fi ÂȉÈÎÔ‡˜ ÛÙÔÌ·ÙÔÏfiÁÔ˘˜.
MÂϤÙ˜ Ô˘ ‰ÈÂÚ¢ÓÔ‡Ó ·ÔÎÏÂÈÛÙÈο ÙËÓ ¯Ú‹ÛË Ê·ÚÌ¿ÎˆÓ Û ÓÔÛ‹Ì·Ù· ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ÂÍ·ÈÚÔ˘Ì¤ÓˆÓ ÙˆÓ Ô‰ÔÓÙÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Î·È ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÓfiÛˆÓ,
‰ÂÓ ·Ó¢ڛÛÎÔÓÙ·È ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·. AÓÙ›ıÂÙ·,
˘¿Ú¯ÂÈ ÏËıÒÚ· ‰ËÌÔÛȇÛÂˆÓ Û¯ÂÙÈο Ì ÙËÓ ˘ÂÚ‚ÔÏÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÁÈ· ÙȘ ·ı‹ÛÂȘ ÙÔ˘ ÔÏÊÔ‡, ÙˆÓ ÂÚÈ·ÎÚÔÚÚÈ˙ÈÎÒÓ Î·È ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ ·fi Ô‰ÔÓÙÈ¿ÙÚÔ˘˜. ø˜ ÚÔ˜ Ù· ·ÓÙÈ‚ÈÔÙÈο, Ô˘
η٤¯Ô˘Ó ‰ÈÂıÓÒ˜ ÙËÓ ÚÒÙË ı¤ÛË ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋
Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË5, ¤¯Ô˘Ó ‰ÈÂÍ·¯ı› ‰‡Ô ›‰Ë ÌÂÏÂÙÒÓ. H
ÚÒÙË Î·ÙËÁÔÚ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ì ˘ÔıÂÙÈο ÛÂÓ¿ÚÈ· ÂÚÈÙÒÛÂˆÓ ·ÛıÂÓÒÓ Ô˘ ÛÙ¿ÏıËÎ·Ó Û ÁÂÓÈÎÔ‡˜ Ô‰ÔÓÙÈ¿ÙÚÔ˘˜, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ˙ËÙ‹ıËΠӷ ÚÔÛ‰ÈÔÚ›ÛÔ˘Ó Û ÔȘ, ηٿ ÙË ÁÓÒÌË ÙÔ˘˜,
ÂÚÈÙÒÛÂȘ ÔÈ ·ÛıÂÓ›˜ ¤¯ÚË˙·Ó ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜613
. MÂٷ͇ ·˘ÙÒÓ ÙˆÓ ‰ËÌÔÛȇۈÓ, ·Ó·ÊÔÚ¿ Û ‚Ï¿‚˜ ÙÔ˘ ÛÙÔÌ·ÙÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ ˘¿Ú¯ÂÈ ÌfiÓÔ ÛÙËÓ ÂÚÁ·Û›· ÙˆÓ Jaunay Î·È Û˘Ó.8, ÛÙËÓ ÔÔ›· ÛÙȘ Èı·Ó¤˜ ·Èٛ˜ ÚÔÛ¤Ï¢Û˘ ·ÛıÂÓÒÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó Ù· Ôͤ·
ÙÚ·˘Ì·ÙÈο ¤ÏÎË Î·È Ë ‰ËÌÈÔ˘ÚÁ›· ÂÚ˘ı‹Ì·ÙÔ˜ Û ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ·Ê·ÈÚÔ‡Û·Ó ÙȘ Ô‰ÔÓÙÔÛÙÔȯ›Â˜ ÙÔ˘˜ ηٿ
ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. Afi ÙÔ˘˜ 68 Ô‰ÔÓÙÈ¿ÙÚÔ˘˜ Ô˘
Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ ¤Ú¢ӷ, ÙÔ 17% ı· ¯ÔÚËÁÔ‡Û ·ÓÙÈ‚ÈÔÙÈÎfi ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÙÚ·˘Ì·ÙÈÎÔ‡ ¤ÏÎÔ˘˜,
ÂÓÒ ÙÔ 19% ı· Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡Û ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎfi ÁÈ·
ÙË ÛÙÔÌ·Ù›Ùȉ· ·fi Ô‰ÔÓÙÔÛÙÔȯ›·, ¯ˆÚ›˜ Ù·˘Ùfi¯ÚÔÓË
Û‡ÛÙ·ÛË ÁÈ· ·ÔÌ¿ÎÚ˘ÓÛË Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜ ηٿ ÙË
‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘8.
™ÙË ‰Â‡ÙÂÚË Î·ÙËÁÔÚ›· ÌÂÏÂÙÒÓ ˙ËÙ‹ıËΠ·fi ÁÂÓÈÎÔ‡˜
Ô‰ÔÓÙÈ¿ÙÚÔ˘˜ ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi Ì›· ¤ˆ˜ ¤ÓÙÂη
‚‰ÔÌ¿‰Â˜ Ó· ηٷÁÚ¿„Ô˘Ó ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÛıÂÓÒÓ
Hellenic Stomatological Review 57: 9-17, 2013
the acute infected traumatic ulcer and denture stomatitis.
Of the 68 dentists participating in that survey, 17% would
provide an antibiotic for the treatment of traumatic ulcer,
while 19% would prescribe an antifungal for the denture
stomatitis without a simultaneous recommendation for
removal of the denture during sleep8.
In the second category, general dentists were asked to
record the number of patients to whom they prescribed
any drug for a period of one to eleven weeks, while, in the
event of an antibiotic, and to complete the drug type
formulation and the administration instructions (dosage
and duration of intake)14-18. Among these researches,
examples of drug abuse in the field of Oral Medicine
were found only in two studies from Norway14, 16. In these
studies, which were within 14 years, it appeared that the
rates of irrational antibiotic prescriptions increased
significantly for stomatitis (from 17% to 37%) and oral
herpes simplex (from 10% to 21%)14, 16.
CONCLUSIONS
In conclusion, drug abuse is a phenomenon repeated
with the same frequency over the years. The delay in
diagnosis and the patient’s exposure to the risk of
complications of drug abuse in Oral Medicine and Pathology requires, on the one hand, that the medical community be informed about the rational use of medicines
and, on the other, the conscientiousness of dental and
medical representatives, who will undertake to treat only
the cases of patients in their field of knowledge and
expertise.
Contact details:
Eleni-Marina Kalogirou
[email protected]
15
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
Research Study
ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÔÚ‹ÁËÛ·Ó Î¿ÔÈÔ Ê¿ÚÌ·ÎÔ, ÂÓÒ ÛÙËÓ
ÂÚ›ÙˆÛË fiÔ˘ Ë Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË ·ÊÔÚÔ‡Û Û ·ÓÙÈ‚ÈÔÙÈÎfi, Ó· Û˘ÌÏËÚÒÓÔ˘Ó ÙÔ Â›‰Ô˜ ÙÔ˘ Û΢¿ÛÌ·ÙÔ˜
Î·È ÙȘ Ô‰ËÁ›Â˜ ¯ÔÚ‹ÁËÛ˘ (‰ÔÛÔÏÔÁ›· Î·È ‰È¿ÚÎÂÈ· Ï‹„˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘)14-18. AÓ¿ÌÂÛ· ÛÙȘ ·Ú·¿Óˆ ÌÂϤÙ˜, ·Ú·‰Â›ÁÌ·Ù· Ê·Ú̷΢ÙÈ΋˜ ηٿ¯ÚËÛ˘ ÛÙÔ ¯ÒÚÔ Ù˘ ÛÙÔÌ·ÙÔÏÔÁ›·˜ ·Ó¢ڛÛÎÔÓÙ·È ÌfiÓÔ Û ‰‡Ô ÌÂϤÙ˜ ·fi ÙË NÔÚ‚ËÁ›·14, 16. ™ÙȘ ÌÂϤÙ˜ ·˘Ù¤˜ Ô˘ ›¯·Ó
¯ÚÔÓÈ΋ ·fiÛÙ·ÛË 14 ÂÙÒÓ, Ê¿ÓËΠˆ˜ ·˘Í‹ıËÎ·Ó ÛËÌ·ÓÙÈο Ù· ÔÛÔÛÙ¿ ·‰ÈηÈÔÏfiÁËÙ˘ Û˘ÓÙ·ÁÔÁÚ¿ÊËÛ˘
·ÓÙÈ‚ÈÔÙÈÎÒÓ ÁÈ· ÙË ÛÙÔÌ·Ù›Ùȉ· (·fi 17% Û 37%) ηÈ
ÙÔÓ ·Ïfi ¤ÚËÙ· ÙÔ˘ ÛÙfiÌ·ÙÔ˜ (·fi 10% Û 21%)14, 16.
™YM¶EPA™MATA
™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·‰ÈηÈÔÏfiÁËÙË ¯ÔÚ‹ÁËÛË Ê·ÚÌ¿ÎˆÓ ·ÔÙÂÏ› ¤Ó· Ê·ÈÓfiÌÂÓÔ Ô˘ Â·Ó·Ï·Ì‚¿ÓÂÙ·È ÌÂ
ÙËÓ ›‰È· Û˘¯ÓfiÙËÙ· ÛÙËÓ ¿ÚÔ‰Ô ÙˆÓ ÂÙÒÓ. H ηı˘ÛÙ¤ÚËÛË ÛÙË ‰È¿ÁÓˆÛË Î·È Ë ¤ÎıÂÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙÔÓ Î›Ó‰˘ÓÔ ÙˆÓ ÂÈÏÔÎÒÓ Ô˘ Û˘ÓÂ¿ÁÂÙ·È Ë Î·Ù¿¯ÚËÛË
Ê·ÚÌ¿ÎˆÓ ÛÙË ÛÙÔÌ·ÙÔÏÔÁ›·, ÂÈ‚¿ÏÏÂÈ ·ÊÂÓfi˜ ÙËÓ ÂÓË̤ڈۋ Ù˘ È·ÙÚÈ΋˜ ÎÔÈÓfiÙËÙ·˜ ÁÈ· ÙËÓ ÔÚıÔÏÔÁÈ΋
¯Ú‹ÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ Î·È ·ÊÂÙ¤ÚÔ˘ ÙËÓ Â˘Û˘ÓÂȉËÛ›·
ÙˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘ Ô‰ÔÓÙÈ·ÙÚÈÎÔ‡ Î·È È·ÙÚÈÎÔ‡ ¯ÒÚÔ˘, Ô˘ ı· ·Ó·Ï·Ì‚¿ÓÔ˘Ó Ó· ıÂÚ·Â‡Ô˘Ó ÌfiÓÔ ÙȘ ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ô˘ ¿ÙÔÓÙ·È ÙˆÓ ÁÓÒÛÂˆÓ Î·È Ù˘
ÂÍÂȉ›ÎÂ˘Û‹˜ ÙÔ˘˜.
BIB§IO°PAºIA
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ÛÙÔÓ ¯ÒÚÔ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜. EÏÏ ™ÙÔÌ XÚÔÓ 2007; 51 (4):
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Î·È Î·Ù¿¯ÚËÛË Û ÓÔÛ‹Ì·Ù· ÙÔ˘ ÛÙfiÌ·ÙÔ˜. EÏÏ ™ÙÔÌ XÚÔÓ
1987; 31: 161-167.
4. ™ÎÏ·‚Ô‡ÓÔ˘-AÓ‰ÚÈÎÔÔ‡ÏÔ˘ A, ¢Ú›ÎÔ˜ °: A‰ÈηÈÔÏfiÁËÙË
¯Ú‹ÛË ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎÒÓ Û ÓÔÛ‹Ì·Ù· ÙÔ˘ ÛÙfiÌ·ÙÔ˜. O‰ÔÓÙÔÛÙÔÌ ¶ÚfiÔ‰Ô˜ 1989; 43: 291-297.
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10. Salako NO, Rotimi VO, Adib SM, Al-Mutawa S: Pattern of anti16
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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
Research Study
biotic prescription in the management of oral diseases
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prescription among dentists in Iran. Iran Endod J 2007; 2 (1):
19-23.
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¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:
EϤÓË-M·Ú›Ó· K·ÏÔÁ‹ÚÔ˘
[email protected]
Hellenic Stomatological Review 57: 9-17, 2013
17
£¤Ì· ∫ÏÈÓÈÎÔ‡ ∂ӉȷʤÚÔÓÙÔ˜
Clinical Interest
∫ÏÈÓÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘¯ˆÙ‹˜ ÈÓÒ‰Ô˘˜ ˘ÂÚÏ·Û›·˜
·fi Ô‰ÔÓÙÔÛÙÔȯ›Â˜. ¶·ÚÔ˘Û›·ÛË ÂÚÈÛÙ·ÙÈÎÔ‡
Î·È ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÛÎfiËÛË
ª. ™ˆÙËÚ›Ô˘*, ¡. ¶ÔÏ˘¯ÚÔÓ¿Î˘*, ºÚ. ºÚ·ÁΛÛÎÔ˜**, ∂. ™Ù·‡ÚÔ˘**
Clinical management of epulis fissuratum:
Case presentation and literature review
M. Sotiriou*, N. Polychronakis*, Fr. Fragiskos**, E. Stavrou**
¶EPI§HæH
SUMMARY
™ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ ÂÚÈÁÚ¿ÊÂÙ·È Ì›· ̤ıÔ‰Ô˜ ‰È·Ù‹ÚËÛ˘ ÙÔ˘ ‚¿ıÔ˘˜ Ù˘ ÚÔÛÙÔÌȷ΋˜ ·‡Ï·Î·˜ fiˆ˜ ·ÎÚÈ‚Ò˜ ÚÔ·ÙÂÈ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘¯ˆÙ‹˜ ÈÓÒ‰Ô˘˜ ˘ÂÚÏ·Û›·˜ ·fi ˘ÂÚÂÎÙ·ÙÈο ÙÂÚ‡ÁÈ· Ô‰ÔÓÙÔÛÙÔȯ›·˜.
H ̤ıÔ‰Ô˜ ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ Î·Ù·Û΢‹ Ù˘ ÔÏÈ΋˜ Ô‰ÔÓÙÔÛÙÔȯ›·˜ - ÚÈÓ ÙËÓ ·Ê·›ÚÂÛË Ù˘ ‚Ï¿‚˘ - Â¿Óˆ ÛÙÔ ÔÚÈÛÙÈÎfi ÂÎÌ·ÁÂ›Ô ·fi Á‡„Ô ÙÔ ÔÔ›Ô ¤¯ÂÈ ÙÚÔÔÔÈËı› ‚¿ÛÂÈ ÙÔ˘ ÂÈı˘ÌËÙÔ‡ ÙÂÏÈÎÔ‡
Û¯‹Ì·ÙÔ˜ Ù˘ ÚÔÛÙÔÌȷ΋˜ ·‡Ï·Î·˜, fiˆ˜ ·˘Ùfi
ı· ¤¯ÂÈ ‰È·ÌÔÚʈı› ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË.
H ÙÔÔı¤ÙËÛË Ù˘ ÚÔηٷÛ΢·Ṳ̂Ó˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜ Á›ÓÂÙ·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘ ˘ÂÚÏ·Û›·˜ Î·È ÙË Û˘ÚÚ·Ê‹ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜.
The purpose of this study is to describe how the
depth and shape of the vestibular sulcus was maintained, after the surgical removal of an epulis fissuratum, caused by overextended dentures. The hyperplastic lesion covered the anterior area of the residual ridges and the vestibular sulcus.
The technique used entailed the construction of a
complete denture, before the lesion was excised, on
the modified working cast reflecting the final desirable
sulcus shape, as expected to be after surgery.
The denture was placed in situ immediately after the
surgical excision of the epulis fissuratum to maintain
the vestibular sulcus depth.
Key Words: complete dentures, overextended denture, epulis
fissuratum.
§¤ÍÂȘ ÎÏÂȉȿ: ÔÏÈΤ˜ Ô‰ÔÓÙÔÛÙÔȯ›Â˜, ˘ÂÚÂÎÙ·ÙÈο ÙÂÚ‡ÁÈ·
Ô‰ÔÓÙÔÛÙÔȯ›·˜, Ù˘¯ˆÙ‹ ÈÓ҉˘ ˘ÂÚÏ·Û›·
·fi Ô‰ÔÓÙÔÛÙÔȯ›·.
* ∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜ ∫ÈÓËÙ‹˜ ¶ÚÔÛıÂÙÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ∂∫¶∞
** ∞Ó·ÏËÚˆÙ‹˜ ∫·ıËÁËÙ‹˜ ™ÙÔÌ·ÙÈ΋˜ Î·È °Ó·ıÔÚÔÛˆÈ΋˜ ÃÂÈÚÔ˘ÚÁÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ∂∫¶∞
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 57: 19-26, 2013
·ÚÂÏ‹ÊıË 12/3/2013 - ÂÎÚ›ıË 19/3/2013
* Assistant Professor, Removable Prosthodontics, Dental
School, University of Athens
** Associate Professor, Oral & Maxillofacial Surgery, Dental
School, University of Athens
Hellenic Stomatological Review 57: 19-26, 2013
paper received 12/3/2013 - accepted 19/3/2013
19
£¤Ì· ∫ÏÈÓÈÎÔ‡ ∂ӉȷʤÚÔÓÙÔ˜
Clinical Interest
EI™A°ø°H
INTRODUCTION
H Ù˘¯ˆÙ‹ ÈÓ҉˘ ˘ÂÚÏ·Û›· ·fi Ô‰ÔÓÙÔÛÙÔȯ›· ‹ ˘ÂÚÏ·Û›· ·fi Ô‰ÔÓÙÔÛÙÔȯ›· (epulis fissuratum) Â›Ó·È ·ÓÙ›‰Ú·ÛË ÙÔ˘ ÛÙÔÌ·ÙÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Û ̷ÎÚÔ¯ÚfiÓÈÔ
Ì˯·ÓÈÎfi ÂÚÂıÈÛÌfi1-4. OÈ ˘ÂÚÏ·ÛÙÈÎÔ› ÈÛÙÔ› ·˘Í¿ÓÔÓÙ·È,
·ÚÂÌ‚·ÏÏfiÌÂÓÔÈ ÌÂٷ͇ ÙÔ˘ ÔÚ›Ô˘ Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜
Î·È ÙÔ˘ ÚÔÛÙÔÌÈ·ÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘, ÚÔηÏÒÓÙ·˜ ÙËÓ
ηٷÎÚ¿ÙËÛË ˘ÔÏÂÈÌÌ¿ÙˆÓ ÙÚÔÊ‹˜ Î·È ÙËÓ ·Ó¿Ù˘ÍË ÌÈÎÚÔ‚›ˆÓ3. Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ù˘
‚Ï¿‚˘ Û ¿ÙÔÌ· Ô˘ ÊÔÚÔ‡Ó Ô‰ÔÓÙÔÛÙÔȯ›Â˜ Î˘Ì·›ÓÂÙ·È
·fi 5-10%5, ÔÛÔÛÙ¿ Ù· ÔÔ›· Â›Ó·È ÌÈÎÚfiÙÂÚ· ·fi ·˘Ù¿
Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ÓÂÒÙÂÚ˜ ¤Ú¢Ó˜ ÛÙË BÚ·˙ÈÏ›·
16,7%6 Î·È 29,4%7. ™Â ÚfiÛÊ·ÙË ¤Ú¢ӷ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙËÓ TÔ˘ÚΛ· Î·È Û ‰Â›ÁÌ· 64 ·ÛıÂÓÒÓ ÙÔ ÔÛÔÛÙfi ‹Ù·Ó 4,2%8, ·ÔÙ¤ÏÂÛÌ· Ô˘ Â›Ó·È ·ÚfiÌÔÈÔ ÌÂ
·Ï·ÈfiÙÂÚË ÌÂϤÙË ÙˆÓ Xie Î·È Û˘Ó.9, Ì ÙËÓ Î¿Ùˆ ÁÓ¿ıÔ
Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ÂÈÚÚÂ‹˜ Û ۯ¤ÛË Ì ÙËÓ ¿Óˆ. ™Â
ÌÂϤÙË fiÔ˘ ·Ó·Ï‡ıËΠÌË Ù˘¯·›Ô ‰Â›ÁÌ· ·ÛıÂÓÒÓ ÔÈ ÔÔ›ÔÈ ·Ó¤ÊÂÚ·Ó ‰È¿ÊÔÚ· ÚÔ‚Ï‹Ì·Ù· Ì ÙȘ Ô‰ÔÓÙÔÛÙÔȯ›Â˜, ÙÔ ÔÛÔÛÙfi Ù˘ ÂÌÊ¿ÓÈÛ˘ ˘ÂÚÏ·Û›·˜ ·fi Ô‰ÔÓÙÔÛÙÔȯ›· (epulis fissuratum) ‹Ù·Ó 31,7%10.
Denture - induced fibrous inflammatory hyperplasia (epulis fissuratum) is a reaction of the oral mucosa to long-term
mechanical irritation1-4. Hyperplastic tissue appears between denture borders and the vestibular mucosa and this
encourages trapping of food residues and microbial
growth products3. Reported incidence of such lesion in
denture wearers is around 5-10%5, but these rates are
lower than reported in more recent studies from Brazil, i.e.
16.7%6 and 29.4%7. In a recent research study carried out
in Turkey with a sample of 64 patients, the corresponding
rates were 4.2%8, similar to those of an older study by Xie
et al.9, with the mandible being more vulnerable than the
maxilla. In a study analysing a non-randomised sample of
patients reporting various denture issues, epulis fissuratum appeared in 31.7% of them10.
AITIO§O°IA
H ·ÚÈ· ·ÈÙ›· Ù˘ ‚Ï¿‚˘ Â›Ó·È Ù· ˘ÂÚÂÎÙ·ÙÈο ÙÂÚ‡ÁÈ·
Ô‰ÔÓÙÔÛÙÔȯÈÒÓ ÙˆÓ ÔÔ›ˆÓ Ë ÂÊ·ÚÌÔÁ‹ ÛÙÔ˘˜ ˘ÔΛÌÂÓÔ˘˜ ÈÛÙÔ‡˜ ‰ÂÓ Â›Ó·È ÈηÓÔÔÈËÙÈ΋1-3, 11-14. ¶ÔÏϤ˜ ÊÔÚ¤˜ Î·È ÌfiÓÔ Ë Î·Î‹ ÂÊ·ÚÌÔÁ‹ Ù˘ ‚¿Û˘ Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÙË ‚Ï¿‚Ë4, 5, 15, 16.
H ¤Ú·Ó ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ¤ÎÙ·ÛË ÙˆÓ ÙÂÚ˘Á›ˆÓ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ›Ù Ù˘ Ï·Óı·Ṳ̂Ó˘ ÔÚÈÔı¤ÙËÛ‹˜ ÙÔ˘˜ ηٿ
ÙË ‰È¿ÚÎÂÈ· Ù˘ ηٷÛ΢‹˜ ÙˆÓ Ô‰ÔÓÙÔÛÙÔȯÈÒÓ Â›Ù Ù˘
·ÔÚÚfiÊËÛ˘ ÙˆÓ Ê·ÙÓÈ·ÎÒÓ ·ÎÚÔÏÔÊÈÒÓ Ì Â·ÎfiÏÔ˘ıÔ ÙÔ «‚‡ıÈÛÌ·» ÙˆÓ ÙÂÚ˘Á›ˆÓ ÛÙÔ˘˜ Ì·Ï·ÎÔ‡˜ ÈÛÙÔ‡˜8, 15. AÓ¿ÏÔÁÔ ·ÔÙ¤ÏÂÛÌ· «‚‡ıÈÛ˘» ÙˆÓ ÙÂÚ˘Á›ˆÓ
ÛÙÔ˘˜ ˘ÔΛÌÂÓÔ˘˜ ÈÛÙÔ‡˜ ÌÔÚ› Ó· ÚÔηϤÛÂÈ Ë Ï·Óı·Ṳ̂ÓË ‹ ηı’ ¤ÍÈÓ Û‡ÁÎÏÂÈÛË ÙˆÓ Ù¯ÓËÙÒÓ ‰ÔÓÙÈÒÓ13.
K§INIKH EIKONA
H ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ Ù˘¯ˆÙ‹˜ ÈÓÒ‰Ô˘˜ ˘ÂÚÏ·Û›·˜ ·fi
Ô‰ÔÓÙÔÛÙÔȯ›· ÔÈΛÏÏÂÈ ·fi Ì›· ̤¯ÚÈ ÔÏÏ·Ϥ˜ ·Ó·‰ÈÏÔ‡ÌÂÓ˜ Ù˘¯¤˜ Ô˘ ÂÓÙÔ›˙ÔÓÙ·È ÛÙ· ÚÔÛÙÔÌȷο ΢ڛˆ˜ fiÚÈ· ÙˆÓ ÙÂÚ˘Á›ˆÓ Ù˘4, 13 (EÈÎ. 1). O ˘ÂÚÏ·ÛÙÈÎfi˜
ÈÛÙfi˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û¯Â‰fiÓ ¿ÓÙÔÙ Û ÊÏÂÁÌÔÓÒ‰Ë Î·È
·ÚÎÂÙ¿ Û˘¯Ó¿ Û ÂÍÂÏΈ̤ÓË Î·Ù¿ÛÙ·ÛË Î·È Â›Ó·È Â˘Î›ÓËÙÔ˜ Î·È ˘fiÛÎÏËÚÔ˜ ηٿ ÙË „ËÏ¿ÊËÛË1, 12. OÈ ·ÛıÂÓ›˜ Û˘Ó‹ıˆ˜ ‰ÂÓ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙËÓ ‡·ÚÍË ÙˆÓ ˘ÂÚÏ·ÛÙÈÎÒÓ ·˘ÙÒÓ ÈÛÙÒÓ ÂÂȉ‹, ηٿ ÙÔ Ï›ÛÙÔÓ, ‰ÂÓ Û˘Óԉ‡ÔÓÙ·È ·fi fiÓÔ. MfiÓÔÓ fiÙ·Ó Ë Ì¿˙· ÙÔ˘˜ ·˘ÍËı› ·ÚÎÂÙ¿ ÔÈ
·ÛıÂÓ›˜ ·Ú¯›˙Ô˘Ó Ó· ·ÓËÛ˘¯Ô‡Ó (ηÚÎÈÓÔÊÔ‚›·)2. ™Â ÂÏ¿¯ÈÛÙ˜ ÂÚÈÙÒÛÂȘ ¤¯ÂÈ ·Ú·ÙËÚËı› ·Ó¿Ù˘ÍË Î·ÚÎÈÓˆÌ¿ÙˆÓ ÛÙÔ ÂÏΈÙÈÎfi ÙÚ·‡Ì· Ù˘ ˘ÂÚÏ·Û›·˜13, 17.
AETIOLOGY
The lesion is mainly caused by overextended denture
flanges1-3, 11-14 and/or an ill-fitting denture base4, 5, 15, 16.
Overextension of denture flanges may be due to either
erroneous bordering during denture construction or
alveolar ridge resorption, which allows the flanges to “dig
into” soft tissues8, 15. Flanges may “dig into” the underlying
tissues in a similar way because of malocclusion of the
artificial teeth13.
CLINICAL APPEARANCE
Clinically, epulis fissuratum caused by dentures may
present one or more folds in the vestibular sulcus, mainly
around denture borders4, 13 (Fig. 1). The hyperplastic tissue almost always appears to be inflammatory and often
ulcerated; it is mobile and moderately hard on palpation1,
12
. Patients are not usually aware of such hyperplastic
tissues because these usually cause no pain. Only when
the lesion mass increases do patients start to show
concern (cancer phobia)2. In very few cases cancerous
lesions have been observed on the ulcerated hyperplastic
lesion13, 17.
£EPA¶EIA
EÈÎ. 1: KÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘¯ˆÙ‹˜ ÈÓÒ‰Ô˘˜ ˘ÂÚÏ·Û›·˜.
H ıÂÚ·›· Ô˘ ÚÔÙ›ÓÂÙ·È, ·fi ÙÔ˘˜ ÂÚÈÛÛÔÙ¤ÚÔ˘˜
Fig. 1: Epulis fissuratum - clinical appearance.
20
Hellenic Stomatological Review 57: 19-26, 2013
£¤Ì· ∫ÏÈÓÈÎÔ‡ ∂ӉȷʤÚÔÓÙÔ˜
Clinical Interest
Û˘ÁÁÚ·Ê›˜ Â›Ó·È Î·Ù’ ·Ú¯¿˜ Û˘ÓÙËÚËÙÈ΋ ηÈ, ÂÊ’ fiÛÔÓ
Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ‰ÂÓ Â›Ó·È ÈηÓÔÔÈËÙÈο, Û˘ÌÏËÚÒÓÂÙ·È Ì ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË Ù˘ ˘ÂÚÏ·Û›·˜2, 3,
11, 13, 14, 18-20
. AÓÙ›ıÂÙ· ÔÈ ¯ÂÈÚÔ˘ÚÁÔ› ÛÙfiÌ·ÙÔ˜ Û˘ÓÈÛÙÔ‡Ó ÌfiÓÔÓ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‚Ï¿‚˘, ȉȷ›ÙÂÚ·
fiÙ·Ó ÙÔ Ì¤ÁÂıÔ˜ Ù˘ Â›Ó·È ÛËÌ·ÓÙÈÎfi1, 12, 15-17.
™ÎÔfi˜ Ù˘ ıÂÚ·›·˜ Â›Ó·È ·Ú¯Èο Ô ÂÚÈÔÚÈÛÌfi˜ ÙÔ˘
ÌÂÁ¤ıÔ˘˜ Ù˘ ˘ÂÚÏ·Û›·˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ·, ÂÊ’ fiÛÔÓ Ë
‚Ï¿‚Ë ‰ÂÓ ˘Ô¯ˆÚ‹ÛÂÈ Û ÈηÓÔÔÈËÙÈÎfi ‚·ıÌfi, Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ÙÔ˘ ˘ÂÚÏ·ÛÙÈÎÔ‡ ÈÛÙÔ‡11, 19. O ÂÚÈÔÚÈÛÌfi˜ Ù˘ ˘ÂÚÏ·Û›·˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ ¿ÚÛË
ÙÔ˘ ·ÈÙ›Ô˘, ·ÊÂÓfi˜ ÌÂÈÒÓÔÓÙ·˜ ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ÙÂÚ˘Á›Ô˘
Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜ ·ÓÙ›ÛÙÔȯ· Ì ÙË ‚Ï¿‚Ë, ¤ÙÛÈ ÒÛÙ ӷ
·¤¯ÂÈ ·fi ·˘Ù‹Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ 1 ¯ÈÏ., ·ÊÂÙ¤ÚÔ˘ ÂÚÈÔÚ›˙ÔÓÙ·˜ fiÛÔÓ ÙÔ ‰˘Ó·ÙfiÓ ÙË ¯Ú‹ÛË Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜.
™Â ‚·Ú‡ÙÂÚ˜ ηٷÛÙ¿ÛÂȘ ·Ê·ÈÚÂ›Ù·È fiÏÔ ÙÔ ÙÂÚ‡ÁÈÔ
Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜ Î·È ·Ú¿ÏÏËÏ· Û˘ÓÈÛÙ¿Ù·È Ë ·ÔÊ˘Á‹ ¯Ú‹Û˘ ÙˆÓ Ô‰ÔÓÙÔÛÙÔȯÈÒÓ ÁÈ· fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÂÚÈÛÛfiÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·2 ‹ Î·È Î·ıfiÏÔ˘ ¯Ú‹ÛË ÙÔ˘˜
Ì ·Ú¿ÏÏËÏË Ì¿Ï·ÍË Ù˘ ÂÚÈÔ¯‹˜19. ŸÙ·Ó ÔÈ Ô‰ÔÓÙÔÛÙÔȯ›Â˜ ¤¯Ô˘Ó ÌÂȈ̤ÓË Û˘ÁÎÚ¿ÙËÛË Î·È ÛÙ·ıÂÚfiÙËÙ·
Á›ÓÂÙ·È Ì›· ÚÔÛˆÚÈÓ‹ ·Ó·ÚÔÛ·ÚÌÔÁ‹ Ù˘ ‚¿Û˘ ÙÔ˘˜
Ì οÔÈÔ ˘ÏÈÎfi ·ÔηٿÛÙ·Û˘ ÙˆÓ ÈÛÙÒÓ (tissue
conditioner) Ë ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ ÔÔ›Ô˘ ı· Ú¤ÂÈ Ó·
Á›ÓÂÙ·È Î¿ı 4-6 Ë̤Ú˜20. H ηϋ ÛÙÔÌ·ÙÈ΋ ˘ÁÈÂÈÓ‹, Ô ¤ÏÂÁ¯Ô˜ Ù˘ Û‡ÁÎÏÂÈÛ˘ Î·È Ë ‰ÈfiÚıˆÛ‹ Ù˘, ·Ó ¯ÚÂÈ¿˙ÂÙ·È, Û˘ÌÏËÚÒÓÔ˘Ó ÙË Û˘ÓÙËÚËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘
‚Ï¿‚˘11, 14, 20.
H Û˘ÓÙËÚËÙÈ΋ ıÂÚ·›· ‰È·ÚΛ 4-6 ‚‰ÔÌ¿‰Â˜19, 20. ™˘Ó‹ıˆ˜ Ù· ·ÔÙÂϤÛÌ·Ù· Â›Ó·È ÈηÓÔÔÈËÙÈο. E¿Ó fï˜ Ë
‚ÂÏÙ›ˆÛË ‰ÂÓ ÎÚ›ÓÂÙ·È ÈηÓÔÔÈËÙÈ΋, ÚÔ‚·›ÓÔ˘Ì ÛÂ
¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË Ù˘ ˘ÂÚÏ·Û›·˜ ¤ÙÛÈ ÒÛÙ ӷ ‰ËÌÈÔ˘ÚÁËı› ¢ÓÔ˚Îfi ˘fiÛÙڈ̷ ¿Óˆ ÛÙÔ ÔÔ›Ô ı· ηٷÛ΢·ÛıÔ‡Ó ÔÈ Ó¤Â˜ Ô‰ÔÓÙÔÛÙÔȯ›Â˜14. H ·Ê·›ÚÂÛË Ù˘
‚Ï¿‚˘ ÌÔÚ› Ó· Á›ÓÂÈ Î·È Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË Û˘Û΢ÒÓ laser16, 21, 22.
H ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ÙˆÓ ˘ÂÚÏ·ÛÙÈÎÒÓ ÈÛÙÒÓ Î·È Ë
·Ú¿ÏÏËÏË Û˘ÚÚ·Ê‹ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ Èı·ÓfiÓ Ó· ÚÔηϤÛÂÈ ÂÏ¿ÙÙˆÛË ÙÔ˘ ‚¿ıÔ˘˜ Ù˘ ÚÔÛÙÔÌȷ΋˜ ·‡Ï·Î·˜,
ÏfiÁˆ Ù˘ ÂÂÚ¯fiÌÂÓ˘ Ô˘ÏÒ‰Ô˘˜ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ Ú›ÎÓˆÛ˘ ÙˆÓ ÈÛÙÒÓ, Ë ÔÔ›· ı· ¤¯ÂÈ ·ÚÓËÙÈΤ˜ ÂȉڿÛÂȘ
ÛÙË Û˘ÁÎÚ¿ÙËÛË Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜3.
™ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ ÂÚÈÁÚ¿ÊÂÙ·È Ì›· Ù¯ÓÈ΋ Ô˘ ıˆÚÂ›Ù·È fiÙÈ ·Ô‰›‰ÂÈ ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÚfiÏË„Ë Ù˘ Ì›ˆÛ˘ ÙÔ˘ ‚¿ıÔ˘˜ Ù˘ ÚÔÛÙÔÌȷ΋˜ ·‡Ï·Î·˜ ηٿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË Ù˘¯ˆÙ‹˜ ÈÓÒ‰Ô˘˜ ˘ÂÚÏ·Û›·˜ ·fi Ô‰ÔÓÙÔÛÙÔȯ›·.
ANAºOPA KAI ¶EPI°PAºH TOY ¶EPI™TATIKOY
°˘Ó·›Î· ËÏÈΛ·˜ 54 ÂÙÒÓ, ÚÔÛ‹Ïı ÛÙËÓ KÏÈÓÈ΋ Ù˘ KÈÓËÙ‹˜ ¶ÚÔÛıÂÙÈ΋˜ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÚÔ ÙÚÈÂÙ›·˜ ηٷÛ΢·Ṳ̂ӈÓ, ·fi ȉÈÒÙË Ô‰ÔÓÙ›·ÙÚÔ, ÔÏÈÎÒÓ Ô‰ÔÓÙÔÛÙÔȯÈÒÓ Ù˘ Ô˘ ·ÚÔ˘Û›·˙·Ó ÏËÌÌÂÏ‹ ÂÊ·ÚÌÔÁ‹
ÛÙÔ˘˜ ÈÛÙÔ‡˜, ÊıÔÚ¿ ÙˆÓ ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ Î·È Ï·Óı·Ṳ̂ÓË Û‡ÁÎÏÂÈÛË.
K·Ù¿ ÙËÓ ·Ú¯È΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠÂÎÙÂٷ̤ÓË ˘Hellenic Stomatological Review 57: 19-26, 2013
TREATMENT
Most authors recommend that initial treatment should be
conservative and, if results are not satisfactory, it may be
supplemented by surgical excision of the hyperplastic
tissue2, 3, 11, 13, 14, 18-20. On the contrary, oral surgeons
recommend that epulis fissuratum should only be treated
surgically, particularly if it is extensive1, 12, 15-17.
It may be said that the initial treatment goal is to reduce
the size of the hyperplasia and then, if it has not
sufficiently receded, the hyperplastic tissue may be
removed11, 19. Hyperplasia is reduced by eliminating its
cause; this may be achieved by reducing the denture
flange to allow at least 1 mm between its borders and the
surrounding tissue and by minimizing denture use. In
more serious cases the entire denture flange is removed
and it is recommended that denture use should be
avoided as much as possible2 or even completely, while
the area affected is treated with massaging19. When there
is poor denture retention and stability, its base is
temporarily relined using tissue conditioner, which has to
be replaced every 4-6 days20. Thorough oral hygiene and
occlusion check and correction, if necessary, supplement
such conservative treatment of the lesion11, 14,20.
Conservative treatment usually lasts for about 4-6 weeks19,
20
and its results are generally satisfactory. However, if the
improvement is not considered sufficient, the hyperplasia
is surgically excised so as to create a favorable fitting
surface on which to construct the new dentures14. The
lesion can also be removed using laser16, 21, 22.
Surgical removal of hyperplastic tissue and proper trauma
closure may reduce the depth of the vestibular sulcus
because of scar formation and post-surgical tissue
shrinkage, both of which may have a negative effect on
denture retention3.
This paper describes a technique believed to provide
satisfactory results in preventing the reduction of the vestibular sulcus depth following surgical removal of epulis
fissuratum caused by dentures.
CASE REPORT
A 54 year old woman presented at the Prosthodontics
Clinic of the Dental School of the University of Athens to
have her dentures checked. Her complete dentures had
been constructed by a private practitioner three years
earlier and were ill-fitting, presenting posterior teeth wear
and incorrect occlusion.
Initial examination showed extensive hyperplasia in the
anterior mandible area, from the 33 to the 44 tooth, due to
an overextended flange in the lower anterior region.
The patient reported that the hyperplasia had appeared
one year before and caused her no discomfort.
The patient’s history revealed that painful trauma had
appeared in this oral region following denture delivery,
but since the patient “tolerated the pain”, as she said, she
had not sought dental aid. The painful symptoms disappeared after some time, without any modification (grinding) of the denture base to relieve them.
21
£¤Ì· ∫ÏÈÓÈÎÔ‡ ∂ӉȷʤÚÔÓÙÔ˜
Clinical Interest
ÂÚÏ·Û›· ÛÙËÓ Î¿Ùˆ ÁÓ¿ıÔ Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÛÙËÓ ÚfiÛıÈ· ÂÚÈÔ¯‹ ·ÓÙ›ÛÙÔȯ· ÚÔ˜ ÙÔÓ 33 ¤ˆ˜ ÙÔÓ 44 ÏfiÁˆ ˘ÂÚÂÎÙ·ÙÈÎÔ‡ ÙÂÚ˘Á›Ô˘.
H ·ÛıÂÓ‹˜ ·Ó¤ÊÂÚ fiÙÈ Ë ˘ÂÚÏ·Û›· ·ÚÔ˘ÛÈ¿ÛıËÎÂ
ÚÈÓ ·fi 1 ¯ÚfiÓÔ Î·È ‰ÂÓ Ù˘ ÚÔηÏÔ‡Û ηӤӷ ÂÓfi¯ÏËÌ·.
Afi ÙÔ ÈÛÙÔÚÈÎfi ÚԤ΢„ fiÙÈ, ÌÂÙ¿ ÙËÓ ·Ú¯È΋ ÙÔÔı¤ÙËÛË Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜ ÂÌÊ·Ó›ÛÙËÎ·Ó ÂÒ‰˘Ó· ÙÚ·‡Ì·Ù· ÛÙËÓ ÚÔ·Ó·ÊÂÚı›۷ ÂÚÈÔ¯‹ ÁÈ· Ù· ÔÔ›· fï˜
Ë ·ÛıÂÓ‹˜ «ÏfiÁˆ ·ÓÙÔ¯‹˜ ÛÙÔÓ fiÓÔ», fiˆ˜ Ì·˜ ·Ó¤ÊÂÚÂ, ‰ÂÓ ˙‹ÙËÛ ÙË ‚Ô‹ıÂÈ· Ô‰ÔÓÙÈ¿ÙÚÔ˘. T· ÂÒ‰˘Ó· Û˘ÌÙÒÌ·Ù· ÌÂÙ¿ ·fi οÔÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ˘Ô¯ÒÚËÛ·Ó ¯ˆÚ›˜ Ó· Á›ÓÂÈ Î·Ì›· ÙÚÔÔÔ›ËÛË (ÙÚÔ¯ÈÛÌfi˜) Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜ ÁÈ· ÙËÓ ·Ó·ÎÔ‡ÊÈÛ‹ ÙÔ˘˜.
°È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‚Ï¿‚˘, ·Ú¯Èο ·ÎÔÏÔ˘ı‹ıËÎÂ
Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹. EÂȉ‹ fï˜ Ù· ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ
‹Ù·Ó ÈηÓÔÔÈËÙÈο, ·ÔÊ·Û›ÛÙËÎÂ Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘ ÈÓÒ‰Ô˘˜ ˘ÂÚÏ·Û›·˜. ™ÙÔ ‰È¿ÛÙËÌ· Ô˘ ÂÊ·ÚÌfiÛıËÎÂ Ë Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ Î·È ÚÈÓ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘ ˘ÂÚÏ·Û›·˜, ηٷÛ΢¿ÛıËΠ˙‡ÁÔ˜ Ó¤ˆÓ ÔÏÈÎÒÓ Ô‰ÔÓÙÔÛÙÔȯÈÒÓ. H ηٷÛ΢‹ Ù˘ οو
Ô‰ÔÓÙÔÛÙÔȯ›·˜ ¤ÁÈÓ ÛÙÔ ÔÚÈÛÙÈÎfi ÂÎÌ·ÁÂ›Ô ÙÔ ÔÔ›Ô Â›¯Â ÙÚÔÔÔÈËı› ‚¿ÛÂÈ ÙÔ˘ ÚÔÛ‰ÔÎÔ‡ÌÂÓÔ˘ Û¯‹Ì·ÙÔ˜
Ù˘ ÚÔÛÙÔÌȷ΋˜ ·‡Ï·Î·˜ ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË (EÈÎ. 2·, 2‚ ). °È· ÙËÓ ÙÚÔÔÔ›ËÛË ÙÔ˘ ÂÎÌ·Á›Ԣ
¯ÚËÛÈÌÔÔÈ‹ıËΠÙÚÔ¯fiÏÈıÔ˜ Î·È ¯ÂÈÚÔ˘ÚÁÈ΋ Ï¿Ì· No
15.
K·Ù¿ ÙË Û˘ÓÙËÚËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÛıÂÓÔ‡˜ Ô˘
·ÚÔ˘Û›·˙ Ù˘¯ˆÙ‹ ÈÓÒ‰Ë ˘ÂÚÏ·Û›· ·fi Ô‰ÔÓÙÔÛÙÔȯ›· ·ÎÔÏÔ˘ı‹ıËÎÂ Ë ÂÍ‹˜ ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹:
1. ™ÙËÓ ·Ú¯È΋ ÂͤٷÛË Ù˘ ·ÛıÂÓÔ‡˜ ÚÔÛ‰ÈÔÚ›ÛÙËΠË
‡·ÚÍË, ÙÔ Ì¤ÁÂıÔ˜ Î·È Ë ı¤ÛË Ù˘ ˘ÂÚÏ·Û›·˜ ÛÙËÓ
οو ÁÓ¿ıÔ (EÈÎ. 3).
2. ¢ÈÔÚıÒıËÎÂ Ë Û‡ÁÎÏÂÈÛË ÙˆÓ Ô‰ÔÓÙÔÛÙÔȯÈÒÓ Ô˘ ¤ÊÂÚÂ Ë ·ÛıÂÓ‹˜ Ì ηٷÁÚ·Ê‹ Ù˘ ÎÂÓÙÚÈ΋˜ Û¯¤Û˘
Î·È ÂÎÏÂÎÙÈÎfi ÙÚÔ¯ÈÛÌfi ÛÙÔÓ ·ÚıÚˆÙ‹Ú·.
3. TÚÔ¯›ÛıËΠÙÔ ˘ÂÚÂÎÙ·ÙÈÎfi ÙÂÚ‡ÁÈÔ Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜ ·ÓÙ›ÛÙÔȯ· ÚÔ˜ ÙËÓ ÂÚÈÔ¯‹ Ù˘ ˘ÂÚÏ·Û›·˜ (EÈÎ. 4).
4. TÔÔıÂÙ‹ıËΠ˘ÏÈÎfi ·ÔηٿÛÙ·Û˘ ÙˆÓ ÈÛÙÒÓ Visco
- gel DENTSPLY ÛÙËÓ ÂÈÊ¿ÓÂÈ· ¤‰Ú·Û˘ Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÂÊ·ÚÌfiÛÙËΠÛÙÔ ÛÙfiÌ· Ù˘ ·ÛıÂÓÔ‡˜ fiÔ˘ Î·È ·Ú¤ÌÂÈÓ ÁÈ· ÂÚ›Ô˘ 5
min.
5. AÔÌ·ÎÚ‡ÓıËÎÂ Ë Ô‰ÔÓÙÔÛÙÔȯ›· ·fi ÙÔ ÛÙfiÌ·, ‰È·ÌÔÚÊÒıËΠÙÔ fiÚÈfi Ù˘ Î·È ·Ê·ÈÚ¤ıËÎ·Ó ÔÈ ÂÚ›ÛÛÂȘ ÙÔ˘ ˘ÏÈÎÔ‡.
6. TÔ ˘ÏÈÎfi ·ÓÙÈηı›ÛÙ·ÙÔ Î¿ı ‚‰ÔÌ¿‰· ÁÈ· ¤Ó· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 6 ‚‰ÔÌ¿‰ˆÓ Î·È Î·ÙÂÁÚ¿ÊÂÙÔ Ë ÚfiÔ‰Ô˜.
K·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË Ù˘ ˘ÂÚÏ·Û›·˜ ÌÂÙ¿ ·fi 6 ‚‰ÔÌ¿‰Â˜ Û˘ÓÙËÚËÙÈ΋˜ ·ÁˆÁ‹˜19 ‰È·ÈÛÙÒıËΠ̛ˆÛË
ÙÔ˘ ·Ú¯ÈÎÔ‡ ÌÂÁ¤ıÔ˘˜ Ù˘ ˘ÂÚÏ·Û›·˜, fi¯È fï˜ Û ÈηÓÔÔÈËÙÈÎfi ‚·ıÌfi (EÈÎ. 5). H Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ ‰ÂÓ
›¯Â Ù· ·Ó·ÌÂÓfiÌÂÓ· ·ÔÙÂϤÛÌ·Ù· Î·È ·ÔÊ·Û›ÛÙËΠË
¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘ ‚Ï¿‚˘.
1. H ˘ÂÚÏ·Û›· ·Ê·ÈÚ¤ıËΠ̠¯ÂÈÚÔ˘ÚÁÈ΋ Ï¿Ì· No
15 Î·È ‰fiıËΠÁÈ· ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË (EÈÎ. 6). H Û˘Ú22
The patient’s initial treatment was conservative, but
results were not satisfactory, so it was decided that the
fibrous hyperplasia would be surgically removed. Before
the surgical removal of the hyperplastic tissue and while
the patient was being conservatively treated, a new pair of
complete dentures was constructed. The lower denture
was made on the working cast, which had been modified
to comply with the vestibular sulcus to be shaped by the
surgery (Fig. 2a, 2b). The cast was modified using a burr
and a #15 surgical blade.
The patient with epulis fissuratum caused by dentures was
conservatively treated following the course of actions below:
1. During the patients initial examination, the presence,
size and site of the hyperplasia in the mandibular area
were recorded (Fig. 3).
2. The occlusion of the patient’s dentures was corrected
by recording the centric relation and performing selective grinding on the articulator.
EÈÎ. 2· (¿Óˆ): MË ÙÚÔÔÔÈË̤ÓÔ ÔÚÈÛÙÈÎfi ÂÎÌ·ÁÂ›Ô Ù˘ οو
ÁÓ¿ıÔ˘.
EÈÎ. 2‚ (οو):TÚÔÔÔÈË̤ÓÔ ÔÚÈÛÙÈÎfi ÂÎÌ·ÁÂ›Ô Ù˘ οو ÁÓ¿ıÔ˘.
Fig. 2a (up): Non-modified final cast of the mandible.
Fig. 2b (down): Modified final cast of the mandible.
Hellenic Stomatological Review 57: 19-26, 2013
£¤Ì· ∫ÏÈÓÈÎÔ‡ ∂ӉȷʤÚÔÓÙÔ˜
Clinical Interest
3. The overextending denture flange was grinded to
accommodate the hyperplastic area (Fig. 4).
4. Visco-gel DENTSPLY tissue conditioner was placed on
the fitting surface and the denture was placed in the
patients mouth and left to set for about 5 min (Fig. 4).
5. The denture was removed, its borders shaped
appropriately and excess material was eliminated.
6. The material was replaced over a period of 6 weeks
and patient’s progress was recorded.
When the hyperplasia was examined again after 6 weeks
of conservative treatment20 the initial size of the lesion had
been reduced, but not satisfactorily (Fig. 5). The conservative treatment did not have the results expected and it
was decided that the lesion would be surgically removed.
EÈÎ. 3: KÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ Ù˘¯ˆÙ‹˜ ÈÓÒ‰Ô˘˜ ˘ÂÚÏ·Û›·˜ Ù˘ ·ÛıÂÓÔ‡˜.
Fig. 3: Epulis fissuratum - clinical appearance of the patient.
Ú·Ê‹ ¤ÁÈÓ Ì ·ÔÚÚÔÊ‹ÛÈÌÔ Ú¿ÌÌ· NÔ 3-0. T· Ú¿ÌÌ·Ù· ‰ÂÓ ‹Ù·Ó ˘fi ȉȷ›ÙÂÚË Ù¿ÛË ÙfiÛÔ ÁÈ· Ó· ÌËÓ ·ÚÂÌÔ‰ÈÛÙ› Ë ÙÔÔı¤ÙËÛË Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜ fiÛÔ
Î·È Ó· ·ÔÊ¢¯ı› Ë ‰È¿Û·Û‹ ÙÔ˘˜ ·fi ÙÔ ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi Ô›‰ËÌ·.
EÈÎ. 5: KÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ‚Ï¿‚˘ ÌÂÙ¿ 6 ‚‰ÔÌ¿‰Â˜ Û˘ÓÙËÚËÙÈ΋˜ ıÂÚ·›·˜.
Fig. 5: Clinical appearance of the lesion after 6 weeks of conservative treatment.
EÈÎ. 4: TÔÔı¤ÙËÛË Ù˘ ÙÚÔÔÔÈË̤Ó˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜.
Fig. 4: The modified denture in the mouth.
2. M ¤Ó· ‰È·Ê·Ó¤˜ ¯ÂÈÚÔ˘ÚÁÈÎfi ‰ÈÛοÚÈÔ ·fi ·ÎÚ˘ÏÈ΋
ÚËÙ›ÓË, ÈÛÙfi ·ÓÙ›ÁÚ·ÊÔ Ù˘ ‚¿Û˘ Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜23, ÂϤÁ¯ıËÎ·Ó ÔÈ ÈÛÙÔ›, ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ÂÚÈÔ¯ÒÓ Ô˘ Èı·ÓÒ˜ ˘ÂÚȤ˙ÔÓÙ·È ·fi ÙË ‚¿ÛË Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜. ŸÔ˘ ÂÓÙÔ›ÛÙËÎ·Ó ÔÈ ÂÚÈÔ¯¤˜ ·˘Ù¤˜
¤ÁÈÓÂ Ë ÙÚÔÔÔ›ËÛ‹ ÙÔ˘˜.
3. H ÂÛˆÙÂÚÈ΋ ÂÈÊ¿ÓÂÈ· Ù˘ ÚÔηٷÛ΢·Ṳ̂Ó˘ οو Ô‰ÔÓÙÔÛÙÔȯ›·˜ ÏËÚÒıËΠ̠˘ÏÈÎfi ·ÔηٿÛÙ·Û˘ ÙˆÓ ÈÛÙÒÓ Î·È ÙÔÔıÂÙ‹ıËΠÛÙÔ ÛÙfiÌ· Ù˘ ·ÛıÂÓÔ‡˜ (EÈÎ. 7).
4. H ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ ˘ÏÈÎÔ‡ ·ÔηٿÛÙ·Û˘ ÙˆÓ ÈÛÙÒÓ ÁÈÓfiÙ·Ó Î¿ı ‚‰ÔÌ¿‰· Î·È Ì¤¯ÚÈ ÙËÓ Ï‹ÚË ÂԇψÛË Ù˘ ¯ÂÈÚÔ˘ÚÁË̤Ó˘ ÂÚÈÔ¯‹˜ (EÈÎ. 8).
Hellenic Stomatological Review 57: 19-26, 2013
1. The hyperplasia was removed using a No 15 surgical
blade and the material was sent for histological
examination (Fig. 6). NÔ 3-0 absorbable sutures were
used, which were placed with enough tension to
prevent their rupture by post-surgical oedema, yet not
too much as to obstruct denture placement.
2. Using a transparent surgical tray, made of acrylic
resin23, which was a precise copy of the denture base,
the tissues were checked for sites under excessive
pressure; such sites were relieved.
3. The fitting surface of the pre-constructed lower denture
was filled with tissue conditioner and the denture was
placed in the patient’s mouth (Fig. 7).
4. The tissue conditioner was replaced every week until
complete healing of the surgically treated area (Fig. 8).
DISCUSSION - CONCLUSION
Clinical practice has shown that overextended denture
flanges cause tissue trauma, which, if this results in longterm irritation, it might lead to the creation of hyperplastic
tissue. Hyperplasia is not usually accompanied by pain. If
the lesion is painful and if there is also cervical lymphadenopathy present, a clinical picture similar to that of neoplasia4, 19, most patients seek professional help from a dentist.
23
£¤Ì· ∫ÏÈÓÈÎÔ‡ ∂ӉȷʤÚÔÓÙÔ˜
Clinical Interest
EÈÎ. 7: H ÚÔηٷÛ΢·Ṳ̂ÓË Ô‰ÔÓÙÔÛÙÔȯ›· Ì ÙÔ ˘ÏÈÎfi ·ÔηٿÛÙ·Û˘ ÙˆÓ ÈÛÙÒÓ.
Fig. 7: Fitting surface of the pre-constructed lower denture with
tissue conditioner.
EÈÎ. 6: XÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘ ˘ÂÚÏ·Û›·˜.
Fig. 6: Surgical excision of the hyperplasia.
™YZHTH™H - ™YM¶EPA™MATA
H ÎÏÈÓÈ΋ Ú¿ÍË ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ ˘ÂÚÂÎÙÂٷ̤ӷ ÙÂÚ‡ÁÈ·
Ô‰ÔÓÙÔÛÙÔȯ›·˜ ÚÔηÏÔ‡Ó ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ ÙˆÓ ÈÛÙÒÓ ÔÈ
ÔÔ›ÔÈ Â›Ó·È ‰˘Ó·ÙfiÓ, Û ̷ÎÚÔ¯ÚfiÓÈÔ ÂÚÂıÈÛÌfi, Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ˘ÂÚÏ·ÛÙÈÎfi ÈÛÙfi. ™˘Ó‹ıˆ˜ Ë ˘ÂÚÏ·Û›·
‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi fiÓÔ. ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Ë ‚Ï¿‚Ë Â›Ó·È ÂÒ‰˘ÓË Î·È, Â¿Ó Û˘Ó˘¿Ú¯ÂÈ ‰ÈfiÁΈÛË ÙˆÓ ÙÚ·¯ËÏÈÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ, ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ô˘ ÚÔÛÔÌÔÈ¿˙ÂÈ
Ì ÓÂÔÏ·ÛÌ·ÙÈ΋ ‰ÈÂÚÁ·Û›·4, 19, Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ ˙ËÙ¿ ÙË ‚Ô‹ıÂÈ· ÙÔ˘ Ô‰ÔÓÙÈ¿ÙÚÔ˘.
øÛÙfiÛÔ, ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ, ·Ó Î·È ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÂÒ‰˘Ó˜ ÙÚ·˘Ì·ÙÈΤ˜ ηٷÛÙ¿ÛÂȘ ÙˆÓ ÈÛÙÒÓ fiÔ˘ ‰ڿ˙ÂÙ·È Ë Ô‰ÔÓÙÔÛÙÔȯ›·, ›Ù ÏfiÁˆ ·ÓÙÔ¯‹˜ ÛÙÔÓ
fiÓÔ, ›Ù ÏfiÁˆ ¿ÁÓÔÈ·˜ ÁÈ· ÙȘ ‚Ï·‚ÂÚ¤˜ Û˘Ó¤ÂȘ (˘ÂÚÏ·Û›·, ·ÔÚÚfiÊËÛË ÙÔ˘ ÔÛÙÔ‡) Ù˘ Û˘Ó¯ԇ˜ ›ÂÛ˘ Î·È ÙÚÈ‚‹˜ ÙÔ˘ ÙÂÚ˘Á›Ô˘ ÛÙÔ˘˜ ˘ÔΛÌÂÓÔ˘˜ ÈÛÙÔ‡˜, Û˘Ó¯›˙Ô˘Ó Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙȘ ˘ÂÚÂÎÙ·ÙÈΤ˜
·˘Ù¤˜ Ô‰ÔÓÙÔÛÙÔȯ›Â˜ ÁÈ· Ì·ÎÚ‡ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·13.
K¿ÙÈ ·Ó¿ÏÔÁÔ Û˘Ó¤‚Ë Î·È ÛÙËÓ ·ÛıÂÓ‹, Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·. H ·ÛıÂÓ‹˜ ·Ó¤ÊÂÚ fiÙÈ «¤¯ÂÈ
ÌÂÁ¿ÏË ·ÓÙÔ¯‹ ÛÙÔÓ fiÓÔ» Î·È fiÙÈ «‰ÂÓ ÁÓÒÚÈ˙ ÙÈ ÌÔÚÔ‡Û ӷ Ù˘ ÚÔηϤÛÂÈ Ë ¯Ú‹ÛË Ù˘ ˘ÂÚÂÎÙ·ÙÈ΋˜ Ô‰ÔÓÙÔÛÙÔȯ›·˜».
°È’ ·˘Ùfi Î·È fiÙ·Ó ÂÌÊ·Ó›ÛÙËÎ·Ó ÙÚ·‡Ì·Ù· Î·È fiÓÔ˜ ÛÙËÓ
οو ÁÓ¿ıÔ Ô˘ ¤ÊÂÚ ÙËÓ Ô‰ÔÓÙÔÛÙÔȯ›· Ì ٷ ˘ÂÚÂÎÙ·ÙÈο ÙÂÚ‡ÁÈ·, Ë ·ÛıÂÓ‹˜ ‰ÂÓ ˙‹ÙËÛ ÙË ‚Ô‹ıÂÈ· ÙÔ˘
Ô‰ÔÓÙÈ¿ÙÚÔ˘.
ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ù˘¯ˆÙ‹˜ ÈÓÒ‰Ô˘˜ ˘ÂÚÏ·Û›·˜, Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ÙÔ˘
˘ÂÚÏ·ÛÙÈÎÔ‡ ÈÛÙÔ‡, Ô˘ Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ÎÚ›ÓÂÙ·È ·Ó·Áη›·, ·ÚÔ˘ÛÈ¿˙ÂÈ ÔÚÈṲ̂ӷ ÌÂÈÔÓÂÎÙ‹Ì·Ù·.
24
EÈÎ. 8: MÂÙÂÁ¯ÂÈÚËÙÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÌÂÙ¿ ÙËÓ ¿ÚÔ‰Ô 2 ÌËÓÒÓ.
Fig. 8: Post-operative appearance 2 months after surgery.
However, a small percentage of patients, despite the
painful trauma of the tissues on which the denture is
placed, continue to use such overextended dentures for a
long period of time, either due to their pain tolerance or
because they are not aware of the potential harmful
consequences (hyperplasia, bone resorption etc)13.
Such was the case of the patient described in this paper.
She reported that “she is very tolerant to pain” and that
“she did not know what the use of the overextended
denture might cause to her”.
This is why when the trauma and pain appeared in the
mandible on which the denture with the overextended
flanges had been placed, the patient did not seek her
dental aid.
As for the therapeutic treatment of the epulis fissuratum,
the surgical excision of the hyperplastic tissue, which is
often considered necessary, may cause not only the
Hellenic Stomatological Review 57: 19-26, 2013
£¤Ì· ∫ÏÈÓÈÎÔ‡ ∂ӉȷʤÚÔÓÙÔ˜
Clinical Interest
EÎÙfi˜ ·fi Ù· ÁÂÓÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û˘Ó‹ıˆ˜ ‰ËÌÈÔ˘ÚÁ› ÔÔÈ·‰‹ÔÙ ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË, ÛÙȘ Û˘ÁÎÂÎÚÈ̤Ó˜ ÂÚÈÙÒÛÂȘ Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ô˘ÏÈ΋ Û˘ÚÚ›ÎÓˆÛË Èı·ÓfiÓ Ó· ÚÔηϤÛÂÈ Ì›ˆÛË ÙÔ˘ ‚¿ıÔ˘˜ Ù˘
ÚÔÛÙÔÌȷ΋˜ ·‡Ï·Î·˜. H Ì›ˆÛË ·˘Ù‹ ı· ¤¯ÂÈ ·ÚÓËÙÈΤ˜ Û˘Ó¤ÂȘ ÛÙË Û˘ÁÎÚ¿ÙËÛË ÙˆÓ Ô‰ÔÓÙÔÛÙÔȯÈÒÓ.
H ÙÔÔı¤ÙËÛË fï˜ Ù˘ ÂȉÈο ÚÔηٷÛ΢·Ṳ̂Ó˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË
ÏÂÈÙÔ˘ÚÁ› Û·Ó ¯ÂÈÚÔ˘ÚÁÈÎfi˜ Ó¿ÚıËη˜ ÂÌÔ‰›˙ÔÓÙ·˜
ÙËÓ Ô˘ÏÒ‰Ë Ú›ÎÓˆÛË ÙˆÓ ÈÛÙÒÓ Î·È ÙË Ì›ˆÛË ÙÔ˘ ‚¿ıÔ˘˜ Ù˘ ·‡Ï·Î·˜.
H ¯Ú‹ÛË ÙˆÓ laser ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚÎÂÙ¿ ÏÂÔÓÂÎÙ‹Ì·Ù·
fiˆ˜ ÂÏ¿¯ÈÛÙË ·ÈÌÔÚÚ·Á›·, ÌÂȈ̤ÓÔ Ô›‰ËÌ· Ù˘ ÂÚÈÔ¯‹˜, ÏÈÁfiÙÂÚÔ fiÓÔ Î·È ‰ÂÓ Â›Ó·È ··Ú·›ÙËÙË Ë ¯Ú‹ÛË
Ú·ÌÌ¿ÙˆÓ24-27. ¶·ÚfiÏ· ·˘Ù¿, ÂÓÒ Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÎÏ·ÛÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ Ô ÈÛÙfi˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈÎÚ‹ ÌÂÙ·ÙÚ·˘Ì·ÙÈ΋ Û˘ÚÚ›ÎÓˆÛË, Ë ¯ÂÈÚÔ˘ÚÁÈ΋ Ì laser ÂÌÊ·Ó›˙ÂÈ ÈÔ
·ÚÁ‹ ·Ú¯È΋ ÂԇψÛË, Û¯ËÌ·ÙÈÛÌfi ÏÈÁfiÙÂÚÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Î·È Ë ·Ó·Á¤ÓÓËÛË ÙÔ˘ ÂÈıËÏ›Ô˘ Á›ÓÂÙ·È ·ÚÁ¿ ηÈ
·Î·ÓfiÓÈÛÙ·24, 27.
™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ¿ÌÂÛË ÙÔÔı¤ÙËÛË Ù˘ ÂȉÈο ÚÔηٷÛ΢·Ṳ̂Ó˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜ ÛÙÔ ÛÙfiÌ· ÙÔ˘ ·ÛıÂÓÔ‡˜, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘ Ù˘¯ˆÙ‹˜ ÈÓÒ‰Ô˘˜ ˘ÂÚÏ·Û›·˜ ·fi Ô‰ÔÓÙÔÛÙÔȯ›·, Ì ÙËÓ
ÎÏ·ÛÛÈ΋ Ù¯ÓÈ΋, ÂÌÔ‰›˙ÂÈ ÙËÓ Ô˘ÏÒ‰Ë Û˘ÚÚ›ÎÓˆÛË
ÙˆÓ ÈÛÙÒÓ Î·È Î·Ù’ Â¤ÎÙ·ÛË ÙË Ì›ˆÛË Ù˘ ÚÔÛÙÔÌȷ΋˜ ·‡Ï·Î·˜ ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÈÔ¯‹.
O Ô‰ÔÓÙ›·ÙÚÔ˜ ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ı› Û ٷÎÙ¿
¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÊÔÚÔ‡Ó Ô‰ÔÓÙÔÛÙÔȯ›Â˜ ÒÛÙÂ, ·ÚÂÌ‚·›ÓÔÓÙ·˜ ηٿÏÏËÏ·, Ó· ÚÔÏ·Ì‚¿ÓÔÓÙ·È ‰˘Û¿ÚÂÛÙ˜ ηٷÛÙ¿ÛÂȘ (˘ÂÚϷۛ˜, ·ÔÚÚfiÊËÛË ÙÔ˘ ˘ÔΛÌÂÓÔ˘ ÔÛÙÔ‡ Î.¿.) ÛÙ· ·Ú¯Èο ÛÙ¿‰È·.
BIB§IO°PAºIA
1. §¿ÛηÚ˘ °X: ŒÁ¯ÚˆÌÔ˜ ÕÙÏ·˜ ™ÙÔÌ·ÙÔÏÔÁ›·˜. Aı‹Ó·. I·ÙÚÈΤ˜ EΉfiÛÂȘ §›ÙÛ·˜. 1986: 56.
2. Grant AA, Heath JR, McCord JF: Complete Prosthodontics:
Problems, Diagnosis, and Management. Spain. Wolfe Publ
1994: 36.
3. Ogle RE: Preprosthetic surgery. Dent Clin North Am 1977; 21
(2): 219-236.
4. Budtz-J∅ rgensen E: Sequelae Caused by Wearing Complete
Dentures. In: Zarb GA, Bolender CL. Prosthodontic
Treatment for Edentulous Patients. Complete Dentures and
Implant - Supported Prostheses. 12th ed. St. Louis. Mosby
2004: 40.
5. Carlsson GE: Clinical morbidity and sequelae of treatment
with complete dentures. J Prosthet Dent 1997; 79 (1): 17-23.
6. Coelho CMP, Sousa YTCS, Daré AMZ: Denture-related oral
mucosal lesions in a Brazilian school of dentistry. J Oral
Rehabil 2004(2); 31: 135-139.
7. Freitas JB, Gomez RS, De Abreu MHNG, Ferreira E, Ferreira E:
Relationship between the use of full dentures and mucosal
alterations among elderly Brazilians. J Oral Rehabil 2008; 35
(5): 370-374.
8. Bilhan H, Geckili O, Ergin S, Erdogan O, Ates G: Evaluation of
satisfaction and complications in patients with existing
complete dentures. J Oral Sci 2013; 55 (1): 29-37.
9. Xie Q, Närhi TO, Nevalainen JM, Wolf J, Ainamo A: Oral status
and prosthetic factors related to residual ridge resorption in
Hellenic Stomatological Review 57: 19-26, 2013
general problems any surgery may cause, but, in these
specific cases, it may also lead to post-operative scar
formation and tissue shrinkage, which results in loss of
vestibular sulcus depth. This in turn will have a negative
effect on denture retention.
Nevertheless, if specially constructed dentures are placed
in the mouth directly after the surgical intervention, they
function like a surgical splint and prevent scar formation
and tissue shrinkage, while maintaining the depth of the
vestibular sulcus.
The use of laser presents several advantages, such as
minimal haemorrhage, reduced local oedema, less pain
and no need for using sutures24-27. Yet, although the tissue
presents smaller post-traumatic shrinkage compared to
conventional surgery, initial healing following laser surgery is slower, less collagen is formed and the epithelium is
regenerated slowly and irregularly24, 27.
In conclusion, it may be said that placing a specially
constructed denture in the patient’s mouth, directly after
the surgical excision of epulis fissuratum caused by dentures, prevents scar formation and tissue shrinkage and,
therefore, maintains the depth of the vestibular sulcus in
the affected region.
A dentist should regularly examine patients, who wear dentures, so as to promptly intervene and prevent unpleasant sequelae (hyperplasia, bone resorption, etc) at early
stages.
BIB§IO°PAºIA
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1994: 36.
3. Ogle RE: Preprosthetic surgery. Dent Clin North Am 1977; 21
(2): 219-236.
4. Budtz-J∅ rgensen E: Sequelae Caused by Wearing Complete
Dentures. In: Zarb GA, Bolender CL. Prosthodontic
Treatment for Edentulous Patients. Complete Dentures and
Implant - Supported Prostheses. 12th ed. St. Louis. Mosby
2004: 40.
5. Carlsson GE: Clinical morbidity and sequelae of treatment
with complete dentures. J Prosthet Dent 1997; 79 (1): 17-23.
6. Coelho CMP, Sousa YTCS, Daré AMZ: Denture-related oral
mucosal lesions in a Brazilian school of dentistry. J Oral
Rehabil 2004(2); 31:135-139.
7. Freitas JB, Gomez RS, De Abreu MHNG, Ferreira E, Ferreira E:
Relationship between the use of full dentures and mucosal
alterations among elderly Brazilians. J Oral Rehabil 2008; 35
(5): 370-374.
8. Bilhan H, Geckili O, Ergin S, Erdogan O, Ates G: Evaluation of
satisfaction and complications in patients with existing
complete dentures. J Oral Sci 2013; 55 (1): 29-37.
9. Xie Q, Närhi TO, Nevalainen JM, Wolf J, Ainamo A: Oral status
and prosthetic factors related to residual ridge resorption in
elderly subjects. Acta Odontol Scand 1997; 55 (5): 306-313.
10. Canger EM, Celenk P, Kayipmaz S: Denture-related hyperplasia: A clinical study of a Turkish population group. Braz
Dent J 2009; 20 (3): 243-248.
11. Hobkirk JA: Complete dentures. Bristol. Wright. 1986: 11, 26.
25
£¤Ì· ∫ÏÈÓÈÎÔ‡ ∂ӉȷʤÚÔÓÙÔ˜
Clinical Interest
elderly subjects. Acta Odontol Scand 1997; 55 (5): 306-313.
10. Canger EM, Celenk P, Kayipmaz S: Denture-related
hyperplasia: A clinical study of a Turkish population group.
Braz Dent J 2009; 20 (3): 243-248.
11. Hobkirk JA: Complete dentures. Bristol. Wright 1986: 11, 26.
12. BÏËÛ›‰Ë˜ ¢™: O‰ÔÓÙÔÚÔÛıÂÙÈ΋ III. Aı‹Ó·. I·ÙÚÈΤ˜ EΉfiÛÂȘ ¶·Û¯·Ï›‰Ë˜ 1987: 88.
13. Basker RM, Davenport JC, Tomlin HR: Prosthetic treatment of
the edentulous patient. 3rd ed. London. Macmillan Press LTD
1992: 131, 132.
14. Winkler S: Essentials of complete denture prosthodontics.
2nd ed. St. Louis - Tokyo. Ishiyaku EuroAmerica, Inc
Publishers 1994: 47, 48.
15. ºÚ·ÁΛÛÎÔ˜ º: XÂÈÚÔ˘ÚÁÈ΋ ÛÙfiÌ·ÙÔ˜. Aı‹Ó· 2000: 33640.
16. AÁÁÂÏfiÔ˘ÏÔ˜ A¶, AÏÂÍ·Ó‰Ú›‰Ë˜ KA, K·ÙÛÈΤÚ˘ Nº: ™‡Á¯ÚÔÓË ™ÙÔÌ·ÙÈ΋ XÂÈÚÔ˘ÚÁÈ΋. 2Ë ÂΉ. Aı‹Ó· 2008: 414-17.
17. M¿ÚÙ˘ X: ™ÙÔÌ·ÙÔÁÓ·ıÔÚÔÛˆÈ΋ XÂÈÚÔ˘ÚÁÈ΋. Aı‹Ó·.
EΉfiÛÂȘ «ZHTA» 1996: 1469.
18. Thomas GA: Denture - induced fibrous inflammatory
hyperplasia (epulis fissuratum): research aspects. Aust
Prosthodont J 1993; 7: 49-53.
19. McCord JF, Grant AA: A clinical guide to complete denture
prosthetics. London. British Dental Association 2000: 11.
20. ¢ËÌËÙÚ›Ô˘ ¶, Z‹Û˘ A, K·Úη˙‹˜ H, ¶ÔÏ˘˙Ò˘ °, ™Ù·˘Ú¿Î˘
°: KÈÓËÙ‹ ¶ÚÔÛıÂÙÈ΋. OÏÈΤ˜ Ô‰ÔÓÙÔÛÙÔȯ›Â˜. 4Ë ÂΉ. Aı‹Ó·. M. MÔÓÈÛ¤Ï 2001: 185-187.
21. Is,eri U, Ozc,akir-Tomruk C, Gürsoy-Mert H: Treatment of epulis
fissuratum with CO2 laser and prosthetic rehabilitation in
patients with vesiculobullous disease. Photomed Laser Surg
2009; 27 (4): 675-681.
22. Monteiro LS, Mouzinho J, Azevedo A, da Camara MI, Martins
MA, La Fuente JM: Treatment of epulis fissuratum with
carbon dioxide laser in a patient with antithrombotic
medication. Braz Dent J 2012; 23 (1): 77-81.
23. OÈÎÔÓfiÌÔ˘ ¶N: ÕÌÂÛ˜ ÔÏÈΤ˜ Ô‰ÔÓÙÔÛÙÔȯ›Â˜. 2Ë ÂΉ. Aı‹Ó·. O‰ÔÓÙÈ·ÙÚÈΤ˜ EΉfiÛÂȘ ™. Z·¯·ÚfiÔ˘ÏÔ˜ 2004: 93.
24. Fisher SE, Frame JW, Browne RM, Tranter RMD: A
comparative histological study of wound healing following
CO2 laser and conventional surgical excision of canine
buccal mucosa. Arch Oral Biol 1983; 28 (4): 287-291.
25. Nammour S, Romanos G: Lasers in oral surgery and implant
dentistry. In: Proceedings of the 1st International Workshop of
Evidence Based Dentistry. Quintessence Publishing Co. Ltd.
2007: 129-147.
26. Kafas P, Upile T, Stavrianos C, Angouridakis N, Jerjes W:
Mucogingival overgrowth in a geriatric patient. Dermatol
Online J 2010; 16 (8): 7.
27. de Arruda Paes-Junior TJ, Cavalcanti SCM, Nascimento DFF,
de Siqueira Ferreira Anzaloni Saavedra G, Kimpara ET,
Borges ALS, Niccoli-Filho W, de Paiva Komori PC: CO2 Laser
Surgery and Prosthetic Management for the Treatment of
Epulis Fissuratum. ISRN Dentistry 2011; 2011: 282361. doi:
10.5402/2011/282361. Epub 2010 Nov 28, 5pp.
12. Vlisidis DS: Dental Prosthetics III. Athens. Medical Publications. Paschalidis 1987: 88.
13. Basker RM, Davenport JC, Tomlin HR: Prosthetic treatment of
the edentulous patient. 3rd ed. London. Macmillan Press
LTD. 1992: 131,132.
14. Winkler S: Essentials of complete denture prosthodontics.
2nd ed. St. Louis - Tokyo. Ishiyaku EuroAmerica, Inc. Publishers 1994: 47, 48.
15. Fragiskos F: Oral surgery. Athens 2000: 336-40.
16. Angelopoulos AP, Alexandridis CA, Katsikeris NF: Modern
Oral Surgery. 2nd ed. Athens. 2008: 414-17.
17. Martis ChS: Oral and Maxillofacial Surgery. Athens. “ZHTA”
Publications 1996: 1469.
18. Thomas GA: Denture - induced fibrous inflammatory
hyperplasia (epulis fissuratum): research aspects. Aust
Prosthodont J 1993; 7: 49-53.
19. McCord JF, Grant AA: A clinical guide to complete denture
prosthetics. London. British Dental Association 2000: 11.
20. Dimitriou P, Zissis A, Karkazis H, Polyzois G, Stavrakis G:
Removable Prosthodontics. Complete dentures. 4nd ed.
Athens. M Bonisel 2001: 185-187.
21. Is,eri U, Ozc,akir-Tomruk C, Gürsoy-Mert H: Treatment of epulis
fissuratum with CO2 laser and prosthetic rehabilitation in
patients with vesiculobullous disease. Photomed Laser Surg
2009; 27 (4): 675-681.
22. Monteiro LS, Mouzinho J, Azevedo A, da Camara MI, Martins
MA, La Fuente JM: Treatment of epulis fissuratum with
carbon dioxide laser in a patient with antithrombotic
medication. Braz Dent J 2012; 23 (1): 77-81.
23. Economou PN: Immediate complete dentures. 2nd ed.
Athens. Dental Publicatons. S Zacharopoulos 2004: 93.
24. Fisher SE, Frame JW, Browne RM, Tranter RMD: A
comparative histological study of wound healing following
CO2 laser and conventional surgical excision of canine
buccal mucosa. Arch Oral Biol 1983; 28 (4): 287-291.
25. Nammour S, Romanos G: Lasers in oral surgery and implant
dentistry. In: Proceedings of the 1st International Workshop
of Evidence Based Dentistry. Quintessence Publishing Co.
Ltd. 2007: 129-147.
26. Kafas P, Upile T, Stavrianos C, Angouridakis N, Jerjes W:
Mucogingival overgrowth in a geriatric patient. Dermatol
Online J 2010; 16 (8): 7.
27. de Arruda Paes-Junior TJ, Cavalcanti SCM, Nascimento DFF,
de Siqueira Ferreira Anzaloni Saavedra G, Kimpara ET,
Borges ALS, Niccoli-Filho W, de Paiva Komori PC: CO2 Laser
Surgery and Prosthetic Management for the Treatment of
Epulis Fissuratum. ISRN Dentistry 2011; 2011: 282361. doi:
10.5402/2011/282361. Epub 2010 Nov 28, 5pp.
Contact details:
ªichael Sotiriou
e-mail: [email protected]
¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:
ªÈ¯¿Ï˘ ™ˆÙËÚ›Ô˘
e-mail: [email protected]
26
Hellenic Stomatological Review 57: 19-26, 2013
∂ӉȷʤÚÔ˘Û· ¶ÂÚ›ÙˆÛË
Case report and literature review
∏ ¢È·Ù·ÙÈ΋ OÛÙÂÔÁ¤ÓÂÛË ÛÙËÓ ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋
¯ÂÈÚÔ˘ÚÁÈ΋. ¶·ÚÔ˘Û›·ÛË ÂÚ›ÙˆÛ˘
Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜
Ã. ™Ô˘Ï›Ô˘*, ∞. ∑·‹*, °. μ·Á‰Ô‡ÙË*, º. Δ˙¤ÚÌÔ˜**
The Distraction Osteogenesis in pre-implant surgery.
A case report and review of the literature
C. Souliou*, C. Zappi*, G. Bagdouti*, F. Tzermpos**
¶EPI§HæH
SUMMARY
H ¢È·Ù·ÙÈ΋ OÛÙÂÔÁ¤ÓÂÛË (¢O) ·ÔÙÂÏ› ÌÈ· ÌÔÓ·‰È΋ ̤ıÔ‰Ô Û¯ËÌ·ÙÈÛÌÔ‡ Ó¤Ô˘ ÔÛÙÔ‡ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ ÂÔ˘ÏˆÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡.
EÈÙ˘Á¯¿ÓÂÙ·È Ì ÔÛÙÂÔÙÔÌ›· ÙÔ˘ ÚÔ˜ ÂÈÌ‹Î˘ÓÛË
ÔÛÙÔ‡ Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ ‰È·Ù·ÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ Âη٤ڈıÂÓ Ù˘ ÔÛÙÂÔÙÔÌ›·˜ ·fi ÂȉÈ΋ Û˘Û΢‹. H
‰È¿Ù·ÛË, Ë ÔÔ›· ÂÊ·ÚÌfi˙ÂÙ·È, Ô‰ËÁ› ÛÙË ‰ËÌÈÔ˘ÚÁ›· Ó¤Ô˘ ÔÛÙÔ‡ ·Ó¿ÌÂÛ· ÛÙ· ÔÛÙÈο ¿ÎÚ·, ·Ú¿ÏÏËÏ· ÚÔ˜ ÙË ÊÔÚ¿ Ù˘ ÂÊ·ÚÌÔ˙fiÌÂÓ˘ ‰‡Ó·Ì˘. H
¢O ÂÊ·ÚÌfiÛÙËΠ·Ú¯Èο ·fi oÚıÔ‰ÈÎÔ‡˜ ÁÈ· ÙËÓ
ÂÈÌ‹Î˘ÓÛË Ì·ÎÚÒÓ ÔÛÙÒÓ. H Ù¯ÓÈ΋ Ù˘ ‰È·Ù·ÙÈ΋˜ ÔÛÙÂÔÁ¤ÓÂÛ˘ ÂÊ·ÚÌfiÛÙËΠÛÙËÓ ÎÚ·ÓÈÔÁÓ·ıÔÚÔÛˆÈ΋ ÂÚÈÔ¯‹ Û ÔÈΛϘ ÂÚÈÙÒÛÂȘ
Û˘ÁÁÂÓÒÓ ‹ ÂÈÎÙ‹ÙˆÓ ÔÛÙÈÎÒÓ ÂÏÏÂÈÌÌ¿ÙˆÓ Ì ÛÙfi¯Ô ÙËÓ ·‡ÍËÛË ÙÔ˘ ÔÛÙÔ‡. TÔ Î˘ÚÈfiÙÂÚÔ ÏÂÔÓ¤ÎÙËÌ· Ù˘ ¢O ÂÎÙfi˜ ·fi ÙËÓ ÔÈÔÙÈ΋ ·Ó¿Ï·ÛË ÙÔ˘ ÔÛÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜ Â›Ó·È Î·È Ë Ù·˘Ùfi¯ÚÔÓË ·Ó¿Ï·ÛË ÙˆÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ. M ˘„ËÏ¿ ÔÛÔÛÙ¿ ÂÈ-
Distraction osteogenesis (DO) is a unique method
of new bone formation using body’s healing ability.
DO can be achieved with osteotomy of the bone
and the application of distraction forces to either
side of the osteotomy by a special distraction device. The applied distraction leads to new bone
formation between the bone segments in the direction of the force. DO was initially used by orthopedists for elongation of long bones. The procedure
of distraction osteogenesis is applied in the craniomaxillofacial region in various cases of congenital
or acquired bone defects, aimed bone augmentation. The main advantage of DO, apart from bone
regeneration, is the simultaneous regeneration of
soft tissues. High success rates are also indicated
in pre-implant surgery. For achieving these outcomes, a special surgical experience and absolute
patient’s cooperation is required. The purpose of
* O‰ÔÓÙ›·ÙÚÔ˜
** ∂›Î. ∫·ıËÁËÙ‹˜ ™ÙÔÌ·ÙÈ΋˜ Î·È °Ó·ıÔÚÔÛˆÈ΋˜
ÃÂÈÚÔ˘ÚÁÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ∂∫¶∞
∫ÏÈÓÈ΋ ™ÙÔÌ·ÙÈ΋˜ Î·È °Ó·ıÔÚÔÛˆÈ΋˜ ÃÂÈÚÔ˘ÚÁÈ΋˜
O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ∂∫¶∞
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 57: 27-37, 2013
·ÚÂÏ‹ÊıË 10/6/2013 - ÂÎÚ›ıË 5/7/2013
* Dentist
** Assistant Professor of Oral and Maxillofacial Surgery,
National and Kapodistrian University of Athens, School of
Dentistry
Oral and Maxillofacial Clinic, National and Kapodistrian
University of Athens, School of Dentristry
Hellenic Stomatological Review 57: 27-37, 2013
paper received 10/6/2013 - accepted 5/7/2013
27
∂ӉȷʤÚÔ˘Û· ¶ÂÚ›ÙˆÛË
Case report and literature review
Ù˘¯›·˜ ÂÊ·ÚÌfi˙ÂÙ·È Î·È ÛÙËÓ ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋
¯ÂÈÚÔ˘ÚÁÈ΋. °È· ÙËÓ Â›Ù¢ÍË ·˘ÙÒÓ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ··ÈÙÂ›Ù·È È‰È·›ÙÂÚË ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÌÂÈÚ›·
Î·È ·fiÏ˘ÙË Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·ÛıÂÓÔ‡˜.
™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ë ·ÚÔ˘Û›·ÛË
ÌÈ¿˜ ÂÚ›ÙˆÛ˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ¢O ÛÙËÓ Î¿Ùˆ
ÁÓ¿ıÔ ·ÛıÂÓÔ‡˜. °›ÓÂÙ·È ÂÚÈÁÚ·Ê‹ Ù˘ Ù¯ÓÈ΋˜,
ÙˆÓ ÏÂÔÓÂÎÙËÌ¿ÙˆÓ Î·È ÌÂÈÔÓÂÎÙËÌ¿ÙˆÓ Î·ıÒ˜
Î·È ÙˆÓ Èı·ÓÒÓ ÂÈÏÔÎÒÓ. T¤ÏÔ˜ Á›ÓÂÙ·È Û˘ÁÎÚÈÙÈ΋ ‚È‚ÏÈÔÁÚ·ÊÈ΋ ÌÂϤÙË Ù˘ ¢O Û ۯ¤ÛË Ì ٷ ÔÛÙÈο ·˘ÙÔÌÔۯ‡̷ٷ ÛÙ· Ï·›ÛÈ· Ù˘ ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜.
§¤ÍÂȘ ÎÏÂȉȿ: ‰È·Ù·ÙÈ΋ ÔÛÙÂÔÁ¤ÓÂÛË, ÂÌÊ˘Ù‡̷ٷ, ÔÛÙÈο
ÌÔۯ‡̷ٷ, ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋.
EI™A°ø°H
™‹ÌÂÚ· ÙÔ ·ÁÎfiÛÌÈÔ ÂӉȷʤÚÔÓ ÛÙÚ¤ÊÂÙ·È ÛÙËÓ ·Ó¿Ù˘ÍË ÌÂıfi‰ˆÓ ÂÏ¿¯ÈÛÙ˘ ÂÂÌ‚·ÙÈ΋˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜.
T¤ÙÔÈÔ˘ ›‰Ô˘˜ ̤ıÔ‰Ô˜ Â›Ó·È Î·È Ë ‰È·Ù·ÙÈ΋ ÔÛÙÂÔÁ¤ÓÂÛË. H ¢È·Ù·ÙÈ΋ OÛÙÂÔÁ¤ÓÂÛË (¢O) ·ÔÙÂÏ› ÌÈ· ÌÔÓ·‰È΋ ̤ıÔ‰Ô ·‡ÍËÛ˘ ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ ÙÔ˘ ÔÛÙÔ‡ ÌÂ
Û¯ËÌ·ÙÈÛÌfi Ó¤Ô˘ ÔÛÙÔ‡ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ ÂÔ˘ÏˆÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡. EÈÙ˘Á¯¿ÓÂÙ·È Ì ÔÛÙÂÔÙÔÌ›· ÙÔ˘ ÚÔ˜ ·‡ÍËÛË ÔÛÙÔ‡ Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ ‰È·Ù·ÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ Âη٤ڈıÂÓ Ù˘ ÔÛÙÂÔÙÔÌ›·˜ ·fi ÂȉÈ΋ Û˘Û΢‹. MÂٷ͇ ÙˆÓ ÔÛÙÈÎÒÓ ÙÂÌ·¯›ˆÓ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÒÚÔ˜, Ô ÔÔ›Ô˜ ÛÙ·‰È·Î¿ ‰È·Ù›ÓÂÙ·È Ì ÙËÓ ÂÓÂÚÁÔÔ›ËÛË Ù˘ ‰È·Ù·ÙÈ΋˜ Û˘Û΢‹˜ Î·È ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ÙˆÓ ÔÛÙÈÎÒÓ ÙÌËÌ¿ÙˆÓ ÌÂٷ͇ ÙÔ˘˜. H ‰È¿Ù·ÛË
·˘Ù‹ Ô‰ËÁ› ÛÙË ‰ËÌÈÔ˘ÚÁ›· Ó¤Ô˘ ÔÛÙÔ‡ ·Ó¿ÌÂÛ· ÛÙ· ÔÛÙÈο ÙÂÌ¿¯È·, ·Ú¿ÏÏËÏ· ÚÔ˜ ÙË ÊÔÚ¿ Ù˘ ÂÊ·ÚÌÔ˙fiÌÂÓ˘ ‰‡Ó·Ì˘1.
H ¢O ÂÊ·ÚÌfiÛÙËΠ·Ú¯Èο ·fi oÚıÔ‰ÈÎÔ‡˜ ÁÈ· ÙËÓ ÂÈÌ‹Î˘ÓÛË Ì·ÎÚÒÓ ÔÛÙÒÓ2. TÔ 1905, Ô A. Codivilla ÂÚȤÁÚ·„ ÁÈ· ÚÒÙË ÊÔÚ¿, ÂÚ›ÙˆÛË ÂÈÌ‹Î˘ÓÛ˘ ÌËÚÈ·›Ô˘ ÔÛÙÔ‡ Ì ¢O. ø˜ ·Ù¤Ú·˜ Ù˘ ¢O ıˆÚÂ›Ù·È Ô
Illizarov, Ô ÔÔ›Ô˜ ÙË ‰ÂηÂÙ›· ÙÔ˘ 1950 ·ÚÔ˘Û›·Û ÙËÓ
ÂÊ·ÚÌÔÁ‹ Ù˘ Û ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ, ‰ËÌÔÛ›Â˘ÛÂ
Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÂÈÚ·Ì·ÙÈÎÒÓ ÌÂÏÂÙÒÓ ÙÔ˘ Û ÂÈÚ·Ì·Ùfi˙ˆ· Î·È Î·ıfiÚÈÛ ÙȘ ‚·ÛÈΤ˜ ·Ú¯¤˜ Ù˘ ¢O3.
H Ù¯ÓÈ΋ Ù˘ ¢O ‚Ú›ÛÎÂÈ ÔÈΛϘ ÂÊ·ÚÌÔÁ¤˜ ÛÙË ÁÓ·ıÔÚÔÛˆÈ΋ ÂÚÈÔ¯‹ Î·È ·Ó¿ÌÂÛ· Û ·˘Ù¤˜ Û˘ÁηٷϤÁÂÙ·È Ë ·‡ÍËÛË ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ ÙÔ˘ ÔÛÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜ ÛÙ· Ï·›ÛÈ· Ù˘ ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜.
™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Â›Ó·È Ë ·ÚÔ˘Û›·ÛË
ÌÈ·˜ ÎÏÈÓÈ΋˜ ÂÚ›ÙˆÛ˘ ·ÛıÂÓÔ‡˜ 22 ÂÙÒÓ Ô˘ ˘Ô‚Ï‹ıËΠ۠¢O Ù˘ ÚfiÛıÈ·˜ ÂÚÈÔ¯‹˜ Ù˘ οو ÁÓ¿ıÔ˘ Ì ÛÙfi¯Ô ÙËÓ ÂÈÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ·ÔηٿÛÙ·ÛË.
¶APOY™IA™H ¶EPI™TATIKOY
ÕÓ‰Ú·˜ ËÏÈΛ·˜ 22 ÂÙÒÓ ·ÚÂ¤ÌÊıË ÁÈ· ·ÔηٿÛÙ·28
this article is to present a clinical case, where DO
was applied in the anterior region of the a patient’s
mandible. The procedure as well as its indications,
advantages and disadvantages are described additionally to the method’s complications. Finally, a
literature review is also presented comparing DO to
bone grafts within the area of pre-implant surgery.
Key Words: distraction osteogenesis, implants, bone grafts,
pre-implant surgery.
INTRODUCTION
Nowadays the worldwide interest is turning in developing
methods for minimally invasive surgery. Such a method
is distraction osteogenesis. Distraction osteogenesis
(DO) stands as a unique method of new bone formation
using body’s healing ability. This is achieved with
osteotomy of the bone in augmentation need and the
application of distracting forces on the two sides of the
osteotomy from a special device. Between the bone
segments, an initial callus is created, which is gradually
distracted with the activation of the device and the
separation of the segments. This way osteogenesis is
created between the bone segments towards the
direction of the power stress1.
DO was initially used by orthopedists for the elongation
of the long bones2. In 1905, A. Codvilla described for the
first time a case of femur lengthening with DO. Father of
this procedure is considered to be Illizarov who used the
technique among a great amount of patients in the
1950s. He published his experimental research outcomes and he introduced the basic principles of DO3.
DO procedures meets a variety of applications in maxillofacial region which include augmentation of deficient
ridges in preprosthetic surgery.
This paper’s purpose is to present a clinical case of a 22
year old male patient who underwent a DO procedure in
the anterior area of his mandible for implant supported
restoration.
CASE PRESENTATION
A 22 years old male patient was referred for the
restoration of the partial edentulous area of his anterior
mandible. The patient reported that at the age of 13 he
was involved in a motor vehicle accident resulting to a
fracture of the mandible in the area of symphysis and loss
of eight teeth from the lower left second premolar up to
lower right canine (35 to 43). The treatment at that time
was open reduction with internal fixation using two
osteosynthesis plates. Since then the patient carried a
partial denture. His medical history was not contributory
for any disease, he was not taking drugs systematically
or mentioned any allergies and he was not a smoker. The
clinical and radiographic findings (Fig. 1, 2) showed the
Hellenic Stomatological Review 57: 27-37, 2013
∂ӉȷʤÚÔ˘Û· ¶ÂÚ›ÙˆÛË
Case report and literature review
ÛË ÂÎÙÂٷ̤Ó˘ ÌÂÚÈ΋˜ ·ÓÔ‰ÔÓÙ›·˜ ÛÙËÓ ÚfiÛıÈ· ÂÚÈÔ¯‹ Ù˘ οو ÁÓ¿ıÔ˘. O ·ÛıÂÓ‹˜ Û ËÏÈΛ· 13 ÂÙÒÓ ˘‹ÚÍ ı‡Ì· ·˘ÙÔÎÈÓËÙÈÛÙÈÎÔ‡ ·Ù˘¯‹Ì·ÙÔ˜ ÌÂ Û˘Ó¤ÂÈ·
οٷÁÌ· ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ Û‡ÌÊ˘Û˘ Ù˘ οو ÁÓ¿ıÔ˘,
ÁÈ· ÙÔ ÔÔ›Ô ˘‚ϋıË Û ·ÓÔÈÎÙ‹ ·Ó¿Ù·ÍË Î·È ·ÎÈÓËÙÔÔ›ËÛË Ì ‰‡Ô ϿΘ ÔÛÙÂÔÛ‡ÓıÂÛ˘ Î·È ·ÒÏÂÈ· Û˘ÓÔÏÈο ÔÎÙÒ ‰ÔÓÙÈÒÓ ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÂÚÈÔ¯‹ Ù˘ οو
ÁÓ¿ıÔ˘ Î·È Û˘ÁÎÂÎÚÈ̤ӷ ·fi ÙÔ 35 ̤¯ÚÈ Î·È ÙÔ 43.
ŒÎÙÔÙÂ Ô ·ÛıÂÓ‹˜ ¤ÊÂÚ ÌÂÚÈ΋ Ô‰ÔÓÙÔÛÙÔȯ›·. TÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi ‰ÂÓ ‹Ù·Ó ÛËÌ·ÓÙÈÎfi ÁÈ· οÔÈ· ·Ûı¤ÓÂÈ·,
‰ÂÓ ¤·ÈÚÓ ʿÚ̷η Û˘ÛÙËÌ·ÙÈο, ‰ÂÓ ·Ó¤ÊÂÚ ·ÏÏÂÚÁ›Â˜ Î·È ‰ÂÓ Î¿ÓÈ˙Â. Afi ÙËÓ ÎÏÈÓÈ΋ Î·È ·ÎÙÈÓÔÁÚ·ÊÈ΋
ÂͤٷÛË (EÈÎ. 1, 2) ‰È·ÈÛÙÒıËÎÂ Ë ‡·ÚÍË ÙˆÓ ‰‡Ô Ï·ÎÒÓ ÔÛÙÂÔÛ‡ÓıÂÛ˘ Î·È ÂÎÙÂٷ̤ÓÔ ¤ÏÏÂÈÌÌ· ÙÔ˘ ÔÛÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜, ÙÔ ÔÔ›Ô ·fi ÙËÓ ÂÚÁ·ÛÙËÚȷ΋
ÚÔÂÁ¯ÂÈÚËÙÈ΋ ÌÂϤÙË ˘ÔÏÔÁ›ÛÙËΠ۠12 mm ÛÙÔ Î¿ıÂÙÔ Â›Â‰Ô (ηı’ ‡„Ô˜). AÓ Î·È ÙÔ ˘¿Ú¯ÔÓ ÔÛÙÈÎfi ˘fiÛÙڈ̷ ı· ÌÔÚÔ‡Û ӷ ˘ԉ¯ı› ÔÛÙÂÔÂÓۈ̷ÙÔ‡ÌÂÓ· ÂÌÊ˘Ù‡̷ٷ (EÈÎ. 3), ÂÈϤ¯ıËÎÂ Ë ÔÛÙÈ΋ ·Ó¿Ï·ÛË Ù˘ ÂÚÈÔ¯‹˜, ÁÈ· ÏfiÁÔ˘˜ ÂÌ‚ÈÔÌ˯·ÓÈÎÔ‡˜ ·ÏÏ¿
Î·È Î˘Ú›ˆ˜ ·ÈÛıËÙÈÎÔ‡˜ Î·È ˆ˜ ̤ıÔ‰Ô˜ ·˘Ù‹ Ù˘ ‰È·Ù·ÙÈ΋˜ ÔÛÙÂÔÁ¤ÓÂÛ˘. Yfi ÙÔÈ΋ ·Ó·ÈÛıËÛ›· Î·È Ó¢ÚÔÏËÙ·Ó·ÏÁËÛ›·, ¤ÁÈÓ ÚÔÛ¤Ï·ÛË Ì ÚÔÛÙÔÌÈ·Îfi
ÎÚËÌÓfi ÔÏÈÎÔ‡ ¿¯Ô˘˜ ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Óˆ‰‹ ÂÚÈÔ¯‹
Ù˘ Û‡ÌÊ˘Û˘ Î·È ·ÊÔ‡ ÂÓÙÔ›ÛıËÎ·Ó Î·È ·Ú·Û΢¿ÛÙËÎ·Ó Ù· ÁÂÓÂȷο Ó‡ڷ, ·Ê·ÈÚ¤ıËÎ·Ó ÔÈ ϿΘ ÔÛÙÂÔÛ‡ÓıÂÛ˘, ·ÎÈÓËÙÔÔÈ‹ıËΠÚÔÛˆÚÈÓ¿ Ë Î·Ù¿ÏÏËÏ· ‰È·ÌÔÚʈı›۷ ÂÓ‰ÔÛÙÔÌ·ÙÈ΋ ‰È·Ù·ÙÈ΋ Û˘Û΢‹
(EÈÎ. 4) Ì ÛÙfi¯Ô ˘ÂÚ‰ÈfiÚıˆÛË Î·È ‰È¿Ù·ÛË 15mm. MÂ
ÙËÓ ¯Ú‹ÛË Î·Ù·ÏÏ‹ÏÔ˘ ÏÂÙÔ‡ ‰›ÛÎÔ˘ ¤ÁÈÓÂ Ë ·Ú¯È΋ ÌÂÚÈ΋ ÔÛÙÂÔÙÔÌ›· ÛÙËÓ Óˆ‰‹ ÂÚÈÔ¯‹ (ÂÁÁ‡˜ ÙÔ˘ 35 ¤ˆ˜
ÂÁÁ‡˜ ÙÔ˘ 43) (EÈÎ. 5), ·Ê·ÈÚ¤ıËÎÂ Ë Û˘Û΢‹ Î·È ÔÏÔÎÏËÚÒıËÎÂ Ë ÔÛÙÂÔÙÔÌ›· ‰›ÓÔÓÙ·˜ ȉȷ›ÙÂÚË ÚÔÛÔ¯‹
ÛÙËÓ ·ÎÂÚ·ÈfiÙËÙ· ÙÔ˘ ÁψÛÛÈÎÔ‡ ÎÚËÌÓÔ‡ (EÈÎ. 6). AÎÔÏÔ‡ıˆ˜ Â·Ó·ÙÔÔıÂÙ‹ıËÎÂ Ë Û˘Û΢‹ (EÈÎ. 7) Î·È ·ÊÔ‡ ÂϤÁ¯ıËÎÂ Ë ·ÚfiÛÎÔÙË ÏÂÈÙÔ˘ÚÁ›· Ù˘ (EÈÎ. 8) ¤ÁÈÓ ÂÚÈÔ›ËÛË ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ Î·È Û‡ÁÎÏÂÈÛ‹ ÙÔ˘ ÌÂ
3:0 Vicryl (EÈÎ. 9). XÔÚËÁ‹ıËΠ·ÓÙÈÌÈÎÚԂȷ΋ Î·È ·Ó·ÏÁËÙÈ΋ ·ÁˆÁ‹ Î·È Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ¯ˆÚ›˜ ÂÈÏÔΤ˜ Î·È ¯ˆÚ›˜ ˘·ÈÛıËÛ›· ÛÙËÓ
ÂÚÈÔ¯‹ ηٷÓÔÌ‹˜ ÙˆÓ ÁÂÓÂÈ·ÎÒÓ Ó‡ڈÓ. TËÓ ¤ÎÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ ¤ÁÈÓÂ Ë ÚÒÙË ÂÓÂÚÁÔÔ›ËÛË Ù˘
Û˘Û΢‹˜, Ë ÔÔ›· ÂÚÈÂÏ¿Ì‚·Ó ̛· Ï‹ÚË ÛÙÚÔÊ‹ ÙÔ˘
¿ÍÔÓ· Ù˘ Û˘Û΢‹˜ ÙÔ Úˆ› Î·È Ì›· ÙÔ ‚Ú¿‰˘. M ÙÔÓ
ÙÚfiÔ ·˘Ùfi ‰ÈÂÙ›ÓÔÓÙ·Ó Ù· ÔÛÙÈο ÎÔÏÔ‚ÒÌ·Ù· ηٿ 1
mm ËÌÂÚËÛ›ˆ˜. MÂÙ¿ ÙËÓ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ÂÚ›Ô‰Ô
‰È¿Ù·Û˘ ÙˆÓ 15 ËÌÂÚÒÓ Î·È ÙËÓ ·ÎÙÈÓÔÁÚ·ÊÈ΋ ÂȂ‚·›ˆÛË Ù˘ ÚÔ‚ÏÂfiÌÂÓ˘ ˘ÂÚ‰ÈfiÚıˆÛ˘ ÙÔ˘ ÔÛÙÈÎÔ‡ ÂÏÏ›ÌÌ·ÙÔ˜ (EÈÎ. 10), Ë Û˘Û΢‹ ·Ú¤ÌÂÈÓ ·‰Ú·ÓÔÔÈË̤ÓË ÁÈ· ÂÚ›Ô‰Ô 4 ÌËÓÒÓ. AÊÔ‡ ÂȂ‚·ÈÒıËÎÂ
·ÎÙÈÓÔÁÚ·ÊÈο Ë ÂÈÙ˘¯›· Ù˘ ÔÛÙÈ΋˜ ·Ó¿Ï·Û˘, ˘fi
ÙÔÈ΋ ·Ó·ÈÛıËÛ›· ¤ÁÈÓ ·Ê·›ÚÂÛË Ù˘ ‰È·Ù·ÙÈ΋˜ Û˘Û΢‹˜ ÂȂ‚·ÈÒıËÎÂ Ë ÔÛÙÈ΋ ·Ó¿Ï·ÛË (EÈÎ. 11) ηÈ
ÙÔÔıÂÙ‹ıËÎ·Ó 5 ÔÛÙÂÔÂÓۈ̷ÙÔ‡ÌÂÓ· ÂÌÊ˘Ù‡̷ٷ
Â͈ÙÂÚÈÎÔ‡ ÂÍ·ÁÒÓÔ˘ ‰È·ÛÙ¿ÛÂˆÓ 3,75 x 15 mm (EÈÎ.
12), Ù· ÔÔ›· ¤¯ÔÓÙ·˜ ÙËÓ Î·Ù¿ÏÏËÏË ÚˆÙÔÁÂÓ‹ ÛÙ·ıÂÚfiÙËÙ· ÊÔÚÙ›ÛıËÎ·Ó ¿ÌÂÛ·. H ÙÂÏÈ΋ ÂÈÂÌÊ˘ÙÂ˘Ì·ÙÈ΋
·ÔηٿÛÙ·ÛË ÙÔÔıÂÙ‹ıËΠÌÂÙ¿ ·Ô 3 Ì‹Ó˜ (EÈÎ.13)
Hellenic Stomatological Review 57: 27-37, 2013
EÈÎ. 1: ¶ÚÔÂÁ¯ÂÈÚËÙÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·ÛıÂÓÔ‡˜.
Fig. 1: Preoperative clinical picture of the patient.
EÈÎ. 2: ¶ÚÔÂÁ¯ÂÈÚËÙÈ΋ ·ÓÔÚ·ÌÈ΋ ·ÎÙÈÓÔÁÚ·Ê›·.
Fig. 2: Preoperative panoramic x-ray of the patient.
two osteosynthesis plates and extensive bone loss which
according to preoperative work up was vertically estimated up to 12 mm. Even though the existing bone could
easily accept osseointegrated implants (Fig. 3), bone
EÈÎ. 3: ¶ÚÔÂÁ¯ÂÈÚËÙÈ΋ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·.
Fig. 3: Preoperative dental Scan of the patient.
29
∂ӉȷʤÚÔ˘Û· ¶ÂÚ›ÙˆÛË
Case report and literature review
EÈÎ. 4: ¢È·ÌfiÚʈÛË ‰È·Ù·ÙÈ΋˜ Û˘Û΢‹˜.
EÈÎ. 5: ¢ÈÂÓ¤ÚÁÂÈ· Ù˘ ÔÚÈ˙fiÓÙÈ·˜ ÔÛÙÂÔÙÔÌ›·˜.
Fig. 4: Extraoral adaptation of the unidirectional distraction
device.
Fig. 5: The horizontal osteotomy.
Î·È Ô ·ÛıÂÓ‹˜ ‚Ú›ÛÎÂÙ·È Û ÂÚÈÔ‰È΋ ·Ú·ÎÔÏÔ‡ıËÛË
ÁÈ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ· ¯ˆÚ›˜ ÛÙÔȯ›· ÊÏÂÁÌÔÓ‹˜.
reconstruction before implant placement was decided
due to bioengineering as well as aesthetic reasons and
the method of DO was chosen. Under local anesthesia
with i.v. sedation, through a labial full thickness flap
access was achieved to the edentulous region of the
symfysis and after the plates were removed, the
appropriate type of the internal distraction device was
temporarily immobilized aiming to 15mm vertical
distraction. Then the first partial osteotomy was done in
the edentulous area (proximal of 35 to proximal of 43)
(Fig. 5), the device was removed and the osteotomy was
completed, while special attention was taken for the
integrity of the lingual flap (Fig. 6). Afterwards, the device
was reinstalled (Fig. 7) and the mobility of the bone
segment was tested, the wound was sutured with 3:0
Vicryl (Fig. 9). Antibiotics and pain control medications
were prescribed and the patient’s postoperative course
was uncomplicated. The sixth postoperative day the
distraction phase began at a rate of 1 mm per day, which
was usually applied by activating the device doing a
™YZHTH™H
H ¢O ·ÔÙÂÏ› ÌÈ· ÂÓ·ÏÏ·ÎÙÈ΋ ıÂÚ·›· ÁÈ· ÙËÓ ·ÔηٿÛÙ·ÛË Ì¤ÙÚÈˆÓ ¤ˆ˜ ÛÔ‚·ÚÒÓ ÔÛÙÈÎÒÓ ÂÏÏÂÈÌÌ¿ÙˆÓ
ÛÙËÓ ÚfiÛıÈ· ÂÚÈÔ¯‹ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ fiÛÔ Î·È ÛÙËÓ
ÚfiÛıÈ· Î·È Ô›ÛıÈ· ÂÚÈÔ¯‹ Ù˘ οو ÁÓ¿ıÔ˘2.
TÔ ÚˆÙfiÎÔÏÏÔ Ù˘ ¢O fiÙ·Ó ÂÊ·ÚÌfi˙ÂÙ·È ÛÙËÓ ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ·ÎfiÏÔ˘ı·
ÛÙ¿‰È·:
ñ ¶Ï‹Ú˘ ÔÛÙÂÔÙÔÌ›·. ¢ÈÂÓÂÚÁÔ‡ÓÙ·È Ï‹ÚÂȘ ÔÛÙÂÔÙƠ̂˜, ‰È·ÙËÚÒÓÙ·˜, fiÛÔ Â›Ó·È ‰˘Ó·Ùfi, ÙÔ˘˜ Ì·Ï·ÎÔ‡˜ ÈÛÙÔ‡˜ ÚÔÛÎÔÏÏË̤ÓÔ˘˜ ÁÈ· Ó· ÂÍ·ÛÊ·ÏÈÛı›
Ë Â·Ú΋˜ ·ÈÌ¿ÙˆÛË ÙÔ˘ ÔÛÙÈÎÔ‡ ÎÔÏÔ‚ÒÌ·ÙÔ˜.
ñ §·Óı¿ÓÔ˘Û· ÂÚ›Ô‰Ô˜. E›Ó·È Ë ÂÚ›Ô‰Ô˜ ÙˆÓ 7 ÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ ËÌÂÚÒÓ Î·Ù¿ ÙËÓ ÔÔ›· ‰ÂÓ Á›ÓÂÙ·È ÂÓÂÚÁÔÔ›ËÛË Ù˘ Û˘Û΢‹˜, Ô‡Ùˆ˜ ÒÛÙ ›Ó˜ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ I Ó· Û¯ËÌ·ÙÈÛÙÔ‡Ó ÛÙÔÓ ÒÚÔ ‰È¿Ù·Û˘.
A˘Ù¤˜ ÔÈ ›Ó˜ ·Ó·Ù‡ÛÛÔÓÙ·È ÂÚ›Ô˘ 5 ¤ˆ˜ 6 Ë̤Ú˜
ÌÂÙ¿ ÙËÓ ÔÛÙÂÔÙÔÌ›·.
ñ ¶ÂÚ›Ô‰Ô˜ ÂÓÂÚÁÔÔ›ËÛ˘. A˘Ù‹ Ë ÂÚ›Ô‰Ô˜ ÍÂÎÈÓ¿
ÙËÓ ¤‚‰ÔÌË Ë̤ڷ Î·È ‰È·ÚΛ ̤¯ÚÈ Ë ‰È·Ù·ÙÈ΋ Ͽη Ó· οÓÂÈ ÙËÓ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ÌÂٷΛÓËÛË, Ë ÔÔ›· ¤¯ÂÈ Û¯Â‰È·ÛÙ› ÂÎ ÙˆÓ ÚÔÙ¤ÚˆÓ ÛÙÔ ‰È·ÁÓˆÛÙÈÎfi Τڈ̷, Ì 20-30% ˘ÂÚ‰ÈfiÚıˆÛË.
ñ ¶ÂÚ›Ô‰Ô˜ ÛÙ·ıÂÚÔÔ›ËÛ˘. O ¯ÚfiÓÔ˜ ÁÈ· ÙËÓ Ï‹ÚË
ÂÓ·Û‚ÂÛÙ›ˆÛË ÙÔ˘ Ó¤Ô˘ ÔÛÙÔ‡ ÌÔÚ› Ó· ‰È·ÚΤÛÂÈ
·fi 10 ¤ˆ˜ 12 Ì‹Ó˜. IÛÙÔÏÔÁÈο, ÛÙȘ 8 ‚‰ÔÌ¿‰Â˜,
·Ú·ÙËÚÂ›Ù·È ¤ÓÙÔÓË ÂÓÂÚÁ‹˜ ÔÛÙÈ΋ ·Ó·‰È·ÌfiÚʈÛË Û fiÏË ÙËÓ ¤ÎÙ·ÛË ÙÔ˘ ‰È·Ù·ÙÈÎÔ‡ ÒÚÔ˘. OÈ ‰‡Ô
¿ÎÚ˜ ÙÔ˘ ‰È·ÙÂٷ̤ÓÔ˘ ÔÛÙÔ‡ ¤Ú¯ÔÓÙ·È Û Â·Ê‹ ÌÂ
ÙÔ ÓÂÔÛ¯ËÌ·ÙÈÛı¤Ó ‰ÔÎȉ҉˜ ÔÛÙfi Î·È ÂÚÈ‚¿ÏÏÔÓÙ·È ·fi ÔÏÏ·Ï·ÛÈ·˙fiÌÂÓ˜ ÔÛÙÂÔ‚Ï¿ÛÙ˜. EÈÚfiÛıÂÙ·, Ô ÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ ÙÔ˘ Ó¤Ô˘ ÔÛÙÔ‡ ›ӷÈ
·Ú¿ÏÏËÏÔ˜ Ì ÙË ‰È‡ı˘ÓÛË Ù˘ ‰È¿Ù·Û˘.
ñ TÔÔı¤ÙËÛË ÂÌÊ˘Ù‡̷ÙÔ˜. H ÙÔÔı¤ÙËÛË ÙˆÓ ÂÌ30
EÈÎ. 6: OÏÔÎÏ‹ÚˆÛË ÙˆÓ ÔÛÙÂÔÙÔÌÈÒÓ Ì ÔÛÙÂÔÙfiÌÔ.
Fig. 6: Completing the osteotomies with osteotomes.
Hellenic Stomatological Review 57: 27-37, 2013
∂ӉȷʤÚÔ˘Û· ¶ÂÚ›ÙˆÛË
Case report and literature review
complete turn of the axis of the device once in the
morning and once in the evening. After the
predetermined period of 15 days distraction and radiographic confirmation of predicted overcorrection of the
bone defect (Fig. 10), the device remained in place for a
EÈÎ. 7: TÂÏÈ΋ ÙÔÔı¤ÙËÛË Ù˘ Û˘Û΢‹˜.
Fig. 7: The final placement of the device.
EÈÎ. 10: AÎÙÈÓÔÁÚ·ÊÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·ÛıÂÓÔ‡˜ ÌÂÙ¿ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË Ù˘ Û˘Û΢‹˜.
Fig. 10: Radiographical picture of the patient after device activation.
period of four months (consolidation period). After radiographic confirmation of successful bone regeneration
under local anesthesia the distraction device was removed, bone regeneration was confirmed (Fig. 11) and 5
EÈÎ. 8: ŒÏÂÁ¯Ô˜ Ù˘ ·ÚfiÛÎÔÙ˘ ΛÓËÛ˘ ÙÔ˘ ÎÈÓËÙÔ‡ ÎÔÏÔ‚ÒÌ·ÙÔ˜
Fig. 8: Testing the movement of the movable bone segment.
EÈÎ. 11: OÛÙÈÎfi ˘fiÛÙڈ̷ ÌÂÙ¿ ÙÔ ¤Ú·˜ Ù˘ ‰È·Ù·ÙÈ΋˜ ÔÛÙÂÔÁ¤ÓÂÛ˘.
Fig. 11: New bone formation between the two bone segments.
EÈÎ. 9: ™˘ÚÚ·Ê‹ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜.
osseointegrated implants dimensions 3,75 x 15 mm were
placed (Fig. 12) and immediately loaded, since they had
the appropriate primary stability. The final implant restoration was delivered after 3 months (Fig. 13) and the
patient has periodic follow up for the last four years
without any sign of inflammation.
Fig. 9: The closure of the wound.
Hellenic Stomatological Review 57: 27-37, 2013
31
∂ӉȷʤÚÔ˘Û· ¶ÂÚ›ÙˆÛË
Case report and literature review
Ê˘ÙÂ˘Ì¿ÙˆÓ Á›ÓÂÙ·È 3 - 4 Ì‹Ó˜ ÌÂÙ¿ ÙÔ ÚÒÙÔ ¯ÂÈÚÔ˘ÚÁÈÎfi ÛÙ¿‰ÈÔ. EÂȉ‹ Ë ÙÂÏÈ΋ ‰È·ÌfiÚʈÛË Î·È ˆÚ›Ì·ÓÛË (ÌÂÙ·ÏÏÔÔ›ËÛË) ÙÔ˘ ÓÂÔÛ¯ËÌ·ÙÈÛı¤ÓÙÔ˜ ÔÛÙÔ‡ ÌÔÚ› Ó· ‰È·ÚΤÛÂÈ ¤ˆ˜ Î·È 12 Ì‹Ó˜, ÁÈ· ·˘Ùfi
ÙÔ ÏfiÁÔ Ù· ÂÌÊ˘Ù‡̷ٷ Ú¤ÂÈ Ó· ¤¯Ô˘Ó ·ÚÎÂÙfi Ì‹ÎÔ˜ ÁÈ· Ó· ÊÙ¿ÛÔ˘Ó Î·È Ó· ‰È·ÂÚ¿ÛÔ˘Ó ÙÔ ÓÂÔÛ¯ËÌ·ÙÈṲ̂ÓÔ ÔÛÙfi ηıfiÏÔ ÙÔ ‡„Ô˜ ÙÔ˘ , ÒÛÙ ӷ ÂÈÙ¢¯ı› ÛÙ·ıÂÚfiÙËÙ· ÙÔ˘ ÔÛÙÔ‡ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘
ÙÂÏÈ΋˜ ÂÚÈfi‰Ô˘.
ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋ Ù˘ ¢O Ë fiÛÔ ÙÔ
‰˘Ó·ÙfiÓ ÏÈÁfiÙÂÚË ·ÔÎfiÏÏËÛË ÙÔ˘ ÂÚÈÔÛÙ¤Ô˘ ·fi ÙÔ ÔÛÙÈÎfi ˘fiÛÙڈ̷ Î·È Ë ·ÚfiÛÎÔÙË ·ÈÌ¿ÙˆÛ‹ ÙÔ˘ ıˆÚÂ›Ù·È ÚˆÙ·Ú¯È΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙË ‚ÂÏÙÈÛÙÔÔ›ËÛË ÙÔ˘
ÔÛÙÂÔÁÂÓÂÙÈÎÔ‡ ‰˘Ó·ÌÈÎÔ‡ ÙÔ˘ ÔÛÙÔ‡-ÍÂÓÈÛÙ‹. AÓ ÙÔ
ÙÌ‹Ì· Ô˘ ÚfiÎÂÈÙ·È Ó· ÔÛÙÂÔÙÔÌËı› Â›Ó·È ·ÔÎÔÏÏË̤ÓÔ ·fi Ù· ÁÂÈÙÔÓÈο ̷Ϸο ÌfiÚÈ·, ÙfiÙ ·˘Ùfi ı· Û˘ÌÂÚÈÊÂÚı› ˆ˜ ÂχıÂÚÔ ÔÛÙÈÎfi ÌfiÛ¯Â˘Ì·, Ì ÛÔ‚·ÚÔ‡ ηÈ
·Úfi‚ÏÂÙÔ˘ ‚·ıÌÔ‡ ·ÔÚÚfiÊËÛË. H ÔÛÙÂÔÙÔÌ›· Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›Ù·È ˘fi ηٷÈÔÓÈÛÌfi Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚÔ‡
ÒÛÙ ӷ ‰È·ÙËÚËı› Ë ıÂÚÌÔÎÚ·Û›· ÂÓÙfi˜ ‚ÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ, ·ÔʇÁÔÓÙ·˜ ÙËÓ ˘ÂÚı¤ÚÌ·ÓÛË ÙÔ˘ ÔÛÙÔ‡. H
οıÂÙË ÔÛÙÂÔÙÔÌ›· ‰ÂÓ Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ôχ ÎÔÓÙ¿ ÛÙ· ·Ú·Î›ÌÂÓ· ‰fiÓÙÈ· ÏfiÁˆ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·ÔÎ¿Ï˘„˘ Ù˘ ÂÈÊ¿ÓÂÈ·˜ Ù˘ Ú›˙·˜ ÌÂ Û˘Ó¤ÂÈ· ÙËÓ
ηı˘ÛÙ¤ÚËÛË ÛÙÔ Û¯ËÌ·ÙÈÛÌfi Ó¤Ô˘ ÔÛÙÔ‡ Î·È ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ Ù˘ ÂÚÈÔ¯‹˜.
H ÔÚÈ˙fiÓÙÈ· ÔÛÙÂÔÙÔÌ›· Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ¤ÙÛÈ ÒÛÙ ӷ ‰ËÌÈÔ˘ÚÁÂ›Ù·È fiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÙÈÎfi ÎÔÏfi‚ˆÌ· Á›ÓÂÙ·È ¯ˆÚ›˜ Ó· Ù›ıÂÙ·È Û ΛӉ˘ÓÔ Ë ·ÎÂÚ·ÈfiÙËÙ· ÙÔ˘ ÔÛÙÔ‡ Ô˘ ·Ú·Ì¤ÓÂÈ. TÔ ÂÏ¿¯ÈÛÙÔ ‡„Ô˜ ÔÛÙÔ‡ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜ Ù˘ ¢O Â›Ó·È ÁÈ· ÙËÓ
¿Óˆ ÁÓ¿ıÔ 8 mm Î·È ÁÈ· ÙË Î¿Ùˆ 15 mm ¤ÙÛÈ ÒÛÙ ӷ ·ÔÊ¢¯ıÔ‡Ó ·ÓÂÈı‡ÌËÙ· ηٿÁÌ·Ù·. O Û¯ËÌ·ÙÈÛÌfi˜
Ó¤Ô˘ ÔÛÙÔ‡ ÚԂϤÂÙ·È Î·Ï‡ÙÂÚ· ·Ó ÛÙËÓ ÔÚÈ˙fiÓÙÈ· ÔÛÙÂÔÙÔÌ›· Â›Ó·È ·Ó·ÏÔÁÈο ÂÚÈÛÛfiÙÂÚË Ë Ì˘ÂÏ҉˘
ÌÔ›Ú· ÙÔ˘ ÔÛÙÔ‡ Û ۯ¤ÛË Ì ÙË ÊÏÔÈÒ‰Ë4.
M ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÔÛÙÂÔÙÔÌ›·˜, Ú¤ÂÈ Ó· Á›ÓÂÈ
ÚÔÛÂÎÙÈ΋ Û‡ÁÎÏÂÈÛË ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜, ¤ÙÛÈ ÒÛÙ ӷ ·ÔʇÁÂÙ·È Ë ‰È¿Û·Û‹ ÙÔ˘ Î·È Ë ÂÈÌfiÏ˘ÓÛË, ·fi ÙÚÔʤ˜ ‹ Û›·ÏÔ, Ù˘ ÔÛÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È Ó· ‰È¢ÎÔχÓÂÙ·È Ë ÂÓ·fiıÂÛË ·Ï¿ÙˆÓ Û fiÏÔ ÙÔ Â‡ÚÔ˜ ÙÔ˘ ÔÛÙÔ‡.
ŸÛÔÓ ·ÊÔÚ¿ ÙȘ ÂÈÏÔΤ˜ Ù˘ ¢O, Û’ ·˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë Ï·Óı·Ṳ̂ÓË Î·Ù‡ı˘ÓÛË ÌÂٷΛÓËÛ˘ ÙÔ˘ ‰È·ÙÂٷ̤ÓÔ˘ ÙÌ‹Ì·ÙÔ˜, Ë ·ÔÎ¿Ï˘„Ë Ù˘ ‰È·Ù·ÙÈ΋˜ Û˘Û΢‹˜, Ë ıÚ·‡ÛË Ù˘ Û˘Û΢‹˜, Ë ·‰˘Ó·Ì›· ÂÓÂÚÁÔÔ›ËÛ˘ Ù˘ ‰È·Ù·ÙÈ΋˜ Û˘Û΢‹˜ Î·È Û·ÓÈfiÙÂÚ· Ô
ÙÚ·˘Ì·ÙÈÛÌfi˜ ÙÔ˘ ÙÚ›ÙÔ˘ ÎÏ¿‰Ô˘ ÙÔ˘ ÙÚȉ‡ÌÔ˘ Î·È ÙÔ
οٷÁÌ· Ù˘ οو ÁÓ¿ıÔ˘4.
H ¢O ·ÔÙÂÏ› ÌÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Ì Ôχ ηϿ
ÌÂÙÂÁ¯ÂÈÚËÙÈο ·ÔÙÂϤÛÌ·Ù·. K·Ù’ ·Ú¯‹Ó ¤Ó· ·fi Ù·
·ÚÈ· ÏÂÔÓÂÎÙ‹Ì·Ù¿ Ù˘ Û ۯ¤ÛË Ì ÙȘ ¿ÏϘ Ù¯ÓÈΤ˜ Â›Ó·È Ë ‰È¿Ù·ÛË ÙˆÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ Ù˘ ÂÚÈÔ¯‹˜ Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡, ÙˆÓ Ì˘ÒÓ,
ÙÔ˘ ÂÈıËÏ›Ô˘, ÙÔ˘ ÂÚÈÔÛÙ¤Ô˘, ÙˆÓ ·ÁÁ›ˆÓ Î·È ÙˆÓ
Ó‡ڈÓ, Ô˘ ¤¯ÂÈ ˆ˜ Â·ÎfiÏÔ˘ıÔ ÙËÓ ÌÂȈ̤ÓË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ·ÔÚÚfiÊËÛË ÙÔ˘ ‰È·ÙÂٷ̤ÓÔ˘ ÔÛÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜. E›Û˘, Ë ÙÔÔı¤ÙËÛË ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Â›Ó·È
‰˘Ó·Ù‹ Û ÂÍ·ÈÚÂÙÈο Û‡ÓÙÔÌË ÂÚ›Ô‰Ô (8-12 ‚‰ÔÌ¿32
EÈÎ. 12: TÔÔı¤ÙËÛË ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ.
Fig. 12: The placement of the implants.
EÈÎ. 13: TÂÏÈ΋ ÚÔÛıÂÙÈ΋ ·ÔηٿÛÙ·ÛË.
Fig. 13: The final prosthesis.
DISCUSSION
DO is considered to be an alternative treatment for the
reconstruction of moderate to severe bone defects in the
anterior maxilla as well as in the anterior and posterior
mandible2.
The distraction protocol in the pre-implant surgery
includes the following phases:
ñ Surgical phase: Complete segmental osteotomies are
carried out, maintaining the soft tissues attached, as
much as possible, to ensure adequate vascularization.
ñ Latency phase: This includes the 7 postoperative
days, in which the device is left without any activation
to allow the collagen type I fibers to form at the
distraction site. These fibers are being developed 5 to
6 days approximately after the osteotomy.
ñ Distraction or Activation phase: This period starts on
the seventh day and lasts until the appropriate amount
of distraction bone has been achieved. The amount of
distraction is determined in advance on the prediction
wax-up, with 20-30% of overcorrection.
Hellenic Stomatological Review 57: 27-37, 2013
∂ӉȷʤÚÔ˘Û· ¶ÂÚ›ÙˆÛË
Case report and literature review
‰Â˜) ÌÂÈÒÓÔÓÙ·˜ ·ÚÎÂÙ¿ ÙÔ ¯ÚfiÓÔ ıÂÚ·›·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜. O ıÂÚ¿ˆÓ È·ÙÚfi˜ ¤¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· ÎÏÈÓÈÎÔ‡ ÂϤÁ¯Ô˘ Î·È ·Ú¤Ì‚·Û˘ ηı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ·‡ÍËÛ˘ ÙÔ˘ ÔÛÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜. EÈÚÔÛı¤Ùˆ˜ Ë ‰ËÌÈÔ˘ÚÁ›· Ê˘ÛÈÎÔ‡ ·˘ÙÔÁÂÓÔ‡˜ ÔÛÙÔ‡ ÛÙË ÂÚÈÔ¯‹ ÙÔ˘ ÂÏÏ›ÌÌ·ÙÔ˜ ˘ÂÚ¤¯ÂÈ Î·Ù¿ Ôχ Û ۇÁÎÚÈÛË Ì ÙËÓ ¯ÚËÛÈÌÔÔ›ËÛË ÔÛÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜, ·ÎfiÌË Î·È ·˘ÙÔÁÂÓÔ‡˜, Ô˘ ı· ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó¿ÁÎË ‰Â˘Ù¤ÚÔ˘ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜ ·fi ÙË ‰fiÙÚÈ· ı¤ÛË ·ÏÏ¿
Î·È ÙË Èı·Ó‹ ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ ÛÙË ÂÚÈÔ¯‹ ·˘Ù‹.
T¤ÏÔ˜ Ë ·ÔÊ˘Á‹ ¯ÚËÛÈÌÔÔ›ËÛ˘ Í¤ÓˆÓ ˘ÏÈÎÒÓ ÚÔ˜
ÙÔÓ ÔÚÁ·ÓÈÛÌfi ·ÔÙÂÏ› ¤Ó·Ó ·ÎfiÌË ‚·ÛÈÎfi ÏfiÁÔ ˘ÂÚÔ¯‹˜ Ù˘ ‰È·Ù·ÙÈ΋˜ ÔÛÙÂÔÁ¤ÓÂÛ˘ Û ۯ¤ÛË Ì ÙȘ ¿ÏϘ Ù¯ÓÈΤ˜ ÔÛÙÈ΋˜ ·Ó¿Ï·Û˘ fiÔ˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÍÂÓÔÌÔۯ‡̷ٷ ‹ ·ÏÏÔÌÔۯ‡̷ٷ5-10.
™Ù· ÌÂÈÔÓÂÎÙ‹Ì·Ù· Ù˘ Ù¯ÓÈ΋˜ ÂÚÈÏ·Ì‚¿ÓÂÙ·È Ô ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ÙÔ˘ οو Ê·ÙÓÈ·ÎÔ‡ Ó‡ÚÔ˘, Û ÂÚÈÙÒÛÂȘ ·‡ÍËÛ˘ ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ÔÛÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜ ÛÙËÓ Ô›ÛıÈ· ÂÚÈÔ¯‹ Ù˘ οو ÁÓ¿ıÔ˘.
E›Û˘ Ë ¯Ú‹ÛË ‰È·‚ÏÂÓÓÔÁÔÓ›Ô˘ Ù‡Ô˘ Û˘Û΢‹˜ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ‰È¿Û·ÛË ÙˆÓ ÎÚËÌÓÒÓ Î·È Èı·Ó‹ ÂÈÌfiÏ˘ÓÛË Ù˘ ÂÚÈÔ¯‹˜. H ‡·ÚÍË Ù˘ Û˘Û΢‹˜ ÛÙË
Ì¤Ó ÚfiÛıÈ· ÂÚÈÔ¯‹ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ·ÈÛıËÙÈÎfi
Úfi‚ÏËÌ· ÛÙÔÓ ·ÛıÂÓ‹, ÂÓÒ Û ÔÔÈ·‰‹ÔÙ ı¤ÛË Èı·ÓfiÓ Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ÚÔ‚Ï‹Ì·Ù· ηٿ ÙËÓ ÔÌÈÏ›·, ÙË
Ì¿ÛËÛË ·ÏÏ¿ Î·È ‰˘Û¯¤ÚÂÈ· ÛÙË ÛÙÔÌ·ÙÈ΋ ˘ÁÈÂÈÓ‹. OÈ
ÂÚÈÛÛfiÙÂÚ˜ ‰È·Ù·ÙÈΤ˜ Û˘Û΢¤˜ ÌÔÚÔ‡Ó Ó· ÂÈÙ‡¯Ô˘Ó ·‡ÍËÛË ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ Ù˘ ÁÓ¿ıÔ˘ Û ¤Ó· ÌfiÓÔ Â›‰Ô. K·Ù¿ Û˘Ó¤ÂÈ· fiÙ·Ó ÂÈı˘ÌÂ›Ù·È ÂÎÙfi˜ ·fi ‰ÈfiÚıˆÛË ÙÔ˘ ‡„Ô˘˜ Î·È ÙÔ Â‡ÚÔ˜ Ù˘ ÁÓ¿ıÔ˘, ηÏfi Â›Ó·È ÙÔ
Û¯¤‰ÈÔ ıÂÚ·›·˜ Ó· ÛÙÚ¤ÊÂÙ·È Û ¿ÏϘ Ù¯ÓÈΤ˜. T¤ÏÔ˜ Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ¢O Â›Ó·È ÌÈ· ıÂÚ·›· ÌÂ
Û¯ÂÙÈο ·˘ÍË̤ÓÔ ÎfiÛÙÔ˜ Î·È ··ÈÙÂ›Ù·È È‰È·›ÙÂÚË ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÌÂÈÚ›·, ÂÓÒ Ë ÈηÓÔÔÈËÙÈ΋ ¤Î‚·ÛË Ù˘ ÂÍ·ÚÙ¿Ù·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙËÓ ·fiÏ˘ÙË Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·ÛıÂÓÔ‡˜7-9.
™Ù· Ï·›ÛÈ· Ù˘ ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ‰È¿ÊÔÚ˜ ÌÂϤÙ˜, ÛÙȘ Ôԛ˜ Û˘ÁÎÚ›ÓÔÓÙ·È Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¢O Û ۯ¤ÛË Ì ٷ ÔÛÙÈο ÌÔۯ‡̷ٷ. TÔ 2004, Ô Chiapasco Î·È Û˘ÓÂÚÁ¿Ù˜ Û ÌÈ· ¤Ú¢ӷ Û‡ÁÎÚÈÓ·Ó Ù· ÎÏÈÓÈο ·ÔÙÂϤÛÌ·Ù·
Ù˘ Ù¯ÓÈ΋˜ Ù˘ ¢O Û ۯ¤ÛË Ì ٷ ÔÛÙÈο ÌÔۯ‡̷ٷ
Û ÂÏÏÂÈÌÌ·ÙÈΤ˜ ·ÎÚÔÏÔʛ˜ Ì οıÂÙÔ ¤ÏÏÂÈÌÌ· ÔÛÙÔ‡. H ¤Ú¢ӷ ·˘Ù‹ ·ÍÈÔÏfiÁËÛ ·Ú·Ì¤ÙÚÔ˘˜ fiˆ˜
ÙËÓ ÔÛÙÈ΋ ·ÔÚÚfiÊËÛË ÚÈÓ Î·È ÌÂÙ¿ ÙË ÙÔÔı¤ÙËÛË
ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Î·È ÙËÓ ÂÚÈÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ÔÛÙÈ΋ ·ÒÏÂÈ· ÛÙÔ ÚÒÙÔ, ÙÔ ‰Â‡ÙÂÚÔ Î·È ÙÔ ÙÚ›ÙÔ ¯ÚfiÓÔ ÌÂÙ¿
ÙËÓ ÙÔÔı¤ÙËÛË Ù˘ ÚÔÛıÂÙÈ΋˜ ·ÔηٿÛÙ·Û˘. T·
·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ Ë ‰È·Ù·ÙÈ΋ ÔÛÙÂÔÁ¤ÓÂÛË Ê·›ÓÂÙ·È Ó· ˘ÂÚ¤¯ÂÈ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÎÂÚ·ÈfiÙËÙ· ÙÔ˘ ÂÚÈÂÌÊ˘ÙÂ˘Ì·ÙÈÎÔ‡ ÔÛÙÔ‡11.
ÕÏÏË Ì›· ¤Ú¢ӷ ÙˆÓ Chiapasco M. Î·È Û˘Ó. ÙÔ 2007, Ô˘
Û˘Ó¤ÎÚÈÓ ÙËÓ Ù¯ÓÈ΋ ÙˆÓ ·˘ÙfiÏÔÁˆÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ Î·È
Ù˘ ¢O Û ۇÓÔÏÔ 17 ·ÛıÂÓÒÓ, ¤‰ÂÈÍ fiÙÈ Ë ÔÛÙÈ΋ ·ÔÚÚfiÊËÛË ÚÈÓ ÙËÓ ÙÔÔı¤ÙËÛË ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ ÔÌ¿‰· Ô˘ ‰¤¯ıËΠٷ
ÌÔۯ‡̷ٷ. AÓÙÈı¤Ùˆ˜, ‰Â ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ fiÛÔÓ ·ÊÔÚ¿ Ù·
Hellenic Stomatological Review 57: 27-37, 2013
ñ Consolidation phase: The time for complete mineralization may extend from 10 to 12 months. However,
histologically, at 8 weeks, very active remodelling occurs throughout the distraction chamber. Both sides of
the distracted bone edges contact newly formed bone
trabeculae and are surrounded by proliferating osteoblasts. Additionally, the orientation of the new bone is
parallel to the direction of the distraction.
ñ Implant placement: The insertion of dental implants
takes place 3 or 4 months after the first surgical stage.
Since the final formation and mineralization of the new
bone may extend up to 12 months, the implants need
to be long enough to reach and penetrate the newly
made bone through its whole height, in order to
achieve bone stability during the final period.
As far as the surgical technique is concerned, preservation of the periosteum attachment to the bone and the
endosteal blood supply are considered to be of primary
importance to optimizing the osteogenic potential of the
host bone. If the segment which is going to be osteotomized is detached from the adjacent soft tissues, then it
will act as a free bone graft, with a severe and unpredictable degree of resorption. The osteotomy must be carried out under abundant irrigation to conserve the temperature within biologic limits, avoiding bone overheating.
The vertical osteotomy should not be performed right
next to the adjacent teeth, because of the risk of exposing
the root surface, which may cause slower bone formation
and damage to periodontal tissues within this area.
The horizontal osteotomy should be positioned to construct a transport segment as large as possible without
compromising the integrity of the remaining bone. The
minimal bone height of the maxilla is 8mm and 15mm for
the mandible, to avoid undesired fractures. Osseous
formation can be better predicted if at the horizontal
osteotomy the medullary space is proportionally more
than the cortical bone4.
Once the osteotomies are completed, the wound must be
carefully sutured, in order to avoid saliva and food contamination into the distraction champer and to facilitate full
bone mineralization.
Concerning the complications of the procedure incorrect
distraction vector, distraction device exposure, distraction
device fracture, inability to activate the device and rarely
injuries concerning the third branch of trigeminal nerve
and fracture of the mandible are included4.
DO is a surgical procedure with predictable postoperative results. One of the main advantages of DO compared
to other techniques is the simultaneous distraction of
local soft tissues, in which are included the connective
tissue, the muscles, the epithelium, the periosteum, the
vessels and the nerves, which has as a result of minimum
bone absorption after the surgery. Moreover, in addition
to mucosal distraction a soft tissue augmentation is counted along with connective tissue, muscle, epithelium,
periosteal, vessels and nerves. Furthermore, implant
placement is able during a short time frame (4- 8 weeks),
decreasing sufficiently patients treatment time. The
33
∂ӉȷʤÚÔ˘Û· ¶ÂÚ›ÙˆÛË
Case report and literature review
ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘ Î·È ÂÈÙ˘¯›·˜ ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ, fiˆ˜ Â›Û˘ Î·È ÙËÓ ÂÚÈÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ÔÛÙÈ΋ ·ÔÚÚfiÊËÛË ‡ÛÙÂÚ· ·fi ÙË ÊfiÚÙÈÛË ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ12.
OÈ Perez-Sayans Î·È Û˘Ó. (2008) ‰ÂÓ ¤‰ÂÈÍ·Ó ‰È·ÊÔÚ¿
ÛÙË Î¿ıÂÙË ·ÔÚÚfiÊËÛË Û ‰È·ÙÂٷ̤ÓÔ Î·È ÌË ‰È·ÙÂٷ̤ÓÔ ÔÛÙfi, ÂÓÒ Ë ÂÈÙ˘¯›· ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Â›¯Â Ù·
›‰È· ÂÚ›Ô˘ ÔÛÔÛÙ¿ Î·È ÛÙȘ ‰‡Ô Ù¯ÓÈΤ˜13. O Uckan
Î·È Û˘Ó. (2007) ÌÂϤÙËÛ·Ó ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Î·È ÙȘ ÂÈÏÔΤ˜ ηٿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜
Û ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ ÛÙȘ Ôԛ˜ ›¯Â ÚÔËÁËı› ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ ›Ù Ì ¢O ›Ù Ì ·˘ÙfiÏÔÁ·
ÔÛÙÈο ÌÔۯ‡̷ٷ. T· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘˜ ¤‰ÂÈÍ·Ó ¤Ó·
ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÂÈÏÔÎÒÓ ÛÙË ¢O (66,8% ¤Ó·ÓÙÈ
33,8%). OÈ ÂÈÏÔΤ˜ ·˘Ù¤˜ fï˜ ‰ÂÓ ‹Ù·Ó ÙfiÛÔ ÛÔ‚·Ú¤˜ Û ۯ¤ÛË Ì ·˘Ù¤˜ Ô˘ ÂÌÊ·Ó›ÛÙËÎ·Ó Î·Ù¿ ÙË ıÂÚ·›· Ì ·˘ÙÔÌfiÛ¯Â˘Ì·. K·È Û ·˘Ù‹ ÙË ÌÂϤÙË Ë ÂÈÙ˘¯›· ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ ‹Ù·Ó ·ÚfiÌÔÈ· (91,4% ¢O ¤Ó·ÓÙÈ 93,7 ÌfiÛ¯Â˘Ì·)14.
TÔ 2005, Ô Enislidis G. Î·È Û˘Ó. Ú·ÁÌ·ÙÔÔ›ËÛ·Ó ÌÈ· ·Ó·‰ÚÔÌÈ΋ ¤Ú¢ӷ ÁÈ· Ó· ·ÍÈÔÏÔÁ‹ÛÔ˘Ó ÙȘ ÂÈÏÔΤ˜
ÚÈÓ, ηٿ ÙË ‰È¿ÚÎÂÈ· Î·È ÌÂÙ¿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ¢O Û ÔÚÈ˙fiÓÙÈÔ Â›‰Ô, ηıÒ˜ Î·È ÁÈ· Ó· ÂÎÙÈÌ‹ÛÔ˘Ó Ù· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘ ÙˆÓ Ô‰ÔÓÙÈÎÒÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Ô˘ ÙÔÔıÂÙ‹ıËÎ·Ó ÛÙȘ ‰È·ÙÂٷ̤Ó˜ ÂÚÈÔ¯¤˜. ™Â ÔÛÔÛÙfi
75,7% ·ÚÔ˘ÛÈ¿ÛıËÎ·Ó ÂÈÏÔΤ˜ Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÙË
‰È¿Ù·ÛË, fï˜ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ‹Ù·Ó ‹ÛÛÔÓÔ˜ ÛËÌ·Û›·˜, ÂÓÒ ÙÔ ÔÛÔÛÙfi ÂÈ‚›ˆÛ˘ ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ
‹Ù·Ó 95,7%15.
AÓÙÈı¤Ùˆ˜ ÔÈ Bianchi Î·È Û˘Ó. (2008) ¤‰ÂÈÍ·Ó fiÙÈ ·Ó Î·È Ë
·Ó¿Ï·ÛË ÔÛÙÔ‡ Ì Ù¯ÓÈΤ˜ ¢O ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË (10 mm ¤Ó·ÓÙÈ 5,8 mm), ÙÔ ÔÛÔÛÙfi ÂÈÏÔÎÒÓ
‹Ù·Ó ηٿ Ôχ ÌÂÁ·Ï‡ÙÂÚÔ ÛÙË ¢O (60%) Û ۯ¤ÛË ÌÂ
ÙË ¯Ú‹ÛË ·˘ÙÔÌÔۯ‡̷ÙÔ˜ (14,3%)16.
TÔ 2008, ÔÈ Froum Î·È Û˘Ó. ‰ËÌÔÛ›Â˘Û·Ó Ù· ·ÔÙÂϤÛÌ·Ù· ÌÈ·˜ ¤Ú¢ӷ˜ Ô˘ ·ÊÔÚÔ‡Û 30 ·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ¢O Î·È ÛÙÔ˘˜ 17 ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂÓ‰ÔÔÛÙÈΤ˜ Û˘Û΢¤˜, ÂÓÒ ÛÙÔ˘˜ ˘fiÏÔÈÔ˘˜ 13 Â͈ÔÛÙÈΤ˜. Afi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 55 ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Ô˘ ÙÔÔıÂÙ‹ıËÎ·Ó ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ‰È¿Ù·Û˘ ·¤Ù˘¯·Ó Ù· 5,
‰È·ÌÔÚÊÒÓÔÓÙ·˜ ÙÔ ÔÛÔÛÙfi ÂÈÙ˘¯›·˜ ÛÙÔ 90,9%. T· 4
·fi ·˘Ù¿ Ô˘ ·¤Ù˘¯·Ó ‚Ú›ÛÎÔÓÙ·Ó Û ÂÚÈÔ¯¤˜ fiÔ˘
˘‹Ú¯Â ÌÂÁ¿ÏË ·ÔÚÚfiÊËÛË ÙÔ˘ ÎÈÓËÙÔ‡ ÎÔÏÔ‚ÒÌ·ÙÔ˜, ÂÓÒ ÙÔ ¿ÏÏÔ ¤Ó· ·¤Ù˘¯Â ÏfiÁˆ ÌfiÏ˘ÓÛ˘ ÙÔ˘ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ‰›Ô˘. ™ÙËÓ ¤Ú¢ӷ ·˘Ù‹ ÌÂÏÂÙ‹ıËÎ·Ó Â›Û˘ ÔÈ ÂÈÏÔΤ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Î·È ÌÂÙ¿ ÙÔ ¤Ú·˜ Ù˘
‰È¿Ù·Û˘. OÈ ÂÈÏÔΤ˜ ‹Ù·Ó ΢ڛˆ˜ ÛÙÔ˘˜ Ì·Ï·ÎÔ‡˜ ÈÛÙÔ‡˜ (‰ËÌÈÔ˘ÚÁ›· ·‚·ıÔ‡˜ ÚÔÛÙÔÌ›Ô˘, ‰È¿ÓÔÈÍË ÙÔ˘
ÎÚËÌÓÔ‡ ÛÙȘ ı¤ÛÂȘ Ô˘ ‹Ù·Ó ÙÔÔıÂÙË̤Ó˜ ÔÈ ‰È·Ù·ÙÈΤ˜ Û˘Û΢¤˜), ̤ÙÚÈÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, ‰˘ÛÎÔÏ›· ÚÔÛˆÚÈÓ‹˜ ·ÔηٿÛÙ·Û˘, ·ÛÙ¿ıÂÈ· Ù˘ Û˘Û΢‹˜, ÌfiÏ˘ÓÛË Î·ıÒ˜ Î·È ·ÔÚÚfiÊËÛË ÙÔ˘ ÎÈÓËÙÔ‡ ÎÔÏÔ‚ÒÌ·ÙÔ˜17.
™Â ÌÈ· ÂÚ¢ÓËÙÈ΋ ÌÂϤÙË, Ô˘ ¤ÁÈÓ ·fi ÙÔÓ Ettl Î·È Û˘Ó.
ÙÔ 2010, ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÔÈ ÂÈÏÔΤ˜ Ù˘ ‰È·‰Èηۛ·˜
Ù˘ ¢O ‰›ÓÔÓÙ·˜ ¤ÌÊ·ÛË ÛÙËÓ ÔÛÙÈ΋ ·ÔÚÚfiÊËÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ê¿Û˘ ÛÙ·ıÂÚÔÔ›ËÛ˘ Î·È Ù˘ Ê¿Û˘ ·Ó·‰È·ÌfiÚʈÛ˘ ÙÔ˘ ÔÛÙÔ‡ Û ‰Â›ÁÌ· 30 ÌÂÚÈÎÒ˜
Óˆ‰ÒÓ ·ÛıÂÓÒÓ. T· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó ˆ˜ Ë ÂÈ34
surgeon has the ability to clinically control and intervene
during the entire alveolar bone augmentation. Additionally, the native bone creation in the defect area is significantly more effective compared to bone graft incorporation, even that if it is autogenous. Another advantage of
DO comparing to autogenous bone graft is that there is
no need for second surgical procedure at the donor area
avoiding thus possible complications and additional
postoperative discomfort of the patient. Finally, the fact
that with this method, foreign origin materials can be
avoided, is considered to be one of the main advantages
of DO compared to other bone growth techniques, where
xeno- or allografts are being used5-10.
Among procedure’s disadvantages, there is a great risk
of inferior alveolar nerve damage in cases where alveolar
ridge height of mandible is needed. In addition, the use of
transmucosal device can lead to the dehiscence of the
wound and possible contamination of the area. If the
device is placed in the anterior region creates an aesthetic problem in the patient. While, in any other position
can create problems in talking, eating and difficulty in
oral hygiene. Most of the distraction devices can achieve
augmentation of the size of the jaw only at one level.
Therefore, when besides height correction, jaw width
adjustment is desired, it would be better to turn to other
techniques. Finally, it can be mentioned that DO is a
treatment with fairly high cost and requires surgical
experience, whereas the satisfactory outcome is highly
dependent on the complete patient’s cooperation7-9.
In preprosthetic surgery, several studies have been
mentioned in which distraction osteogenesis’s results
have been compared to bone grafts. In 2004, Chiapasco et
al., conducted a study to compare the clinical outcomes
between the technique of DO and bone graft in deficient
ridges with vertical bone deficiency. The study evaluated
parameters such as bone absorption before and after the
placement of the implants and the periimplant bone loss
after one, two or three years of implants’ loading. The
results showed that DO is a better technique as far as the
integrity of periimplant bone is concerned11.
An other study of Chiapasco et al., (2007) where
techniques of autogenous bone grafts and DO were
compared in total of 17 patients, showed that bone
resorption before implant placement was significantly
higher in the group with the autogenous bone grafts. On
the contrary, no statistically significant differences were
found between the two groups as far as survival and
success rates of implants and peri-implant bone resorption after the loading of the implants12.
Perez-Sayans et al., (2008) showed no difference in vertical absorption in distracted or in nondistracted bone,
while the success rate of the implant was about the same
in both techniques13. Uckan et al., (2008) studied the
implant survival and complications rates during treatment after preprosthetic surgery comparing DO to autogenous onlay bone graft. Their results showed a higher
complication rate in DO (66.8% versus 33.8%). However,
the complications have been less severe and easier to
Hellenic Stomatological Review 57: 27-37, 2013
∂ӉȷʤÚÔ˘Û· ¶ÂÚ›ÙˆÛË
Case report and literature review
‚›ˆÛË ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ ÌÂÙ¿ ·fi ·Ú·ÎÔÏÔ‡ıËÛË
45,8 ÌËÓÒÓ ‹Ù·Ó 95,1%, ÂÓÒ Ù· ·ÚÈ· ÚÔ‚Ï‹Ì·Ù· Ô˘
·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó ·ÊÔÚÔ‡Û·Ó ÙËÓ ·ÓÂ·Ú΋ ‰È¿Ù·ÛË
ÙˆÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ Û ÔÛÔÛÙfi 43% Î·È ÙËÓ ÔÛÙÈ΋ ·ÔÚÚfiÊËÛË Û ÔÛÔÛÙfi 21,1 % ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ÙÔÔı¤ÙËÛË ÙÔ˘ ÂÌÊ˘Ù‡̷ÙÔ˜18.
Afi ÌÈ· Û˘ÛÙËÌ·ÙÈ΋ ·Ó·ÛÎfiËÛË ÙˆÓ Aghaloo Î·È Moy,
Ë ÔÔ›· ·ÍÈÔÏfiÁËÛ ¿ÚıÚ· ‰ËÌÔÛÈÂ˘Ì¤Ó· ·fi ÙÔ 1980 ¤ˆ˜ ÙÔ 2005, ÚԤ΢„ 94,7% ÔÛÔÛÙfi ÂÈÙ˘¯›·˜ ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Û ı¤ÛÂȘ Ô˘ ÚÔËÁÔ˘Ì¤Óˆ˜ ›¯·Ó ‰Â¯ı›
¢O T· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ ‹Ù·Ó 92% ÁÈ· ·˘ÙÔÁÂÓ‹ ηÈ
·˘ÙÔÁÂÓ‹/Û‡ÓıÂÙ· ÌÔۯ‡̷ٷ Î·È 81% ÁÈ· ·ÏÏÔÏ·ÛÙÈο ˘ÏÈο Î·È ·ÏÏÔÏ·ÛÙÈο ˘ÏÈο/ÍÂÓÔÌÔۯ‡̷ٷ19.
H ÂÈ‚›ˆÛË ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ ÌÂÙ¿ ·fi ¢O ¤¯ÂÈ ÌÂÏÂÙËı› Û Â›Â‰Ô Û˘ÛÙËÌ·ÙÈ΋˜ ·Ó·ÛÎfiËÛ˘ Î·È ·fi
ÙÔ˘˜ Saulacic Î·È Û˘Ó. ÙÔ 2007 fiÔ˘ ·ÍÈÔÏÔÁ‹ıËÎ·Ó Ù·
·ÔÙÂϤÛÌ·Ù· ÎÏÈÓÈÎÒÓ ÂÚ¢ÓÒÓ Û¯ÂÙÈο Ì ÙË ¢O ηÈ
‰È·ÈÛÙÒıËÎÂ Ë Û ÌÂÁ¿ÏÔ ‚·ıÌfi ˘ÂÚÔ¯‹ ¢O Û ۯ¤ÛË
Ì ¿ÏϘ Ù¯ÓÈΤ˜. TÔ ÔÛÔÛÙfi ÂÈÙ˘¯›·˜ ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Ô˘ ÙÔÔıÂÙ‹ıËÎ·Ó ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ‰È·‰Èηۛ·˜ ·Ó¤Ú¯ÔÓÙ·Ó ÛÙÔ 97%20.
™Â ÌÈ· ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙÔ ·ÓÂÈÛÙ‹ÌÈÔ Aarhus ·fi
ÙÔ˘˜ Kristian Î·È Û˘Ó. (2004-2011) ·ÍÈÔÏÔÁ‹ıËÎ·Ó Ù· Èı·Ó¿ Û˘ÌÙÒÌ·Ù· Û 20 ·ÛıÂÓ›˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘
ÂÚÈÂÁ¯ÂÈÚËÙÈ΋˜ ÂÚÈfi‰Ô˘ Ô˘ ›¯·Ó ˘Ô‚ÏËı› Û ¢O
ÛÙËÓ ¿Óˆ ÁÓ¿ıÔ Ì ÂÓ‰ÔÛÙÔÌ·ÙÈΤ˜ ‰È·Ù·ÙÈΤ˜ Û˘Û΢¤˜. T· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤Ú¢ӷ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ 80%
ÙˆÓ ·ÛıÂÓÒÓ Â›¯·Ó ÌÈÎÚ¤˜ ÂÓԯϋÛÂȘ, fiˆ˜ fiÓÔ˜ ηٿ
ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘ Ù˘ ‰È·Ù·ÙÈ΋˜ Û˘Û΢‹˜ Î·È ‰È¿ÊÔÚ˜ ÏÔÈÌÒÍÂȘ21.
TÔ 2003, Ú·ÁÌ·ÙÔÔÈ‹ıËΠÌÈ· ¤Ú¢ӷ ·fi ÙÔ˘˜
Garcia-Garcia. Î·È Û˘Ó. Û ‰Â›ÁÌ· 7 ·ÛıÂÓÒÓ ÛÙËÓ Ô›ÛıÈ· ÂÚÈÔ¯‹ Ù˘ οو ÁÓ¿ıÔ˘ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ¢O Û ÌÂȈ̤ÓÔ ‡„Ô˜ ÔÛÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜.
T· ·ÔÙÂϤÛÌ·Ù¿ Ù˘ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¢O ·ÔÙÂÏ› ÌÈ· ·ÔÙÂÏÂÛÌ·ÙÈ΋ Ù¯ÓÈ΋ ÁÈ· ÙËÓ ·‡ÍËÛË ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ÔÛÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜ ÛÙËÓ Ô›ÛıÈ· ÂÚÈÔ¯‹ Ù˘ οو
ÁÓ¿ıÔ˘ Î·È Û˘ÛÙ‹ÓÂÙ·È Ó· ÂÊ·ÚÌfi˙ÂÙ·È ÁÈ· ÙËÓ ‚ÂÏÙ›ˆÛË Ù˘ Ì˘ÏÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋˜ ·Ó·ÏÔÁ›·˜ fiÙ·Ó ·˘Ù‹ ›ӷÈ
ȉȷ›ÙÂÚ· ‰˘ÛÌÂÓ‹˜ ÏfiÁˆ Ù˘ οıÂÙ˘ ·ÔÚÚfiÊËÛ˘
ÙÔ˘ ÔÛÙÔ‡22.
¶ÚfiÛÊ·Ù· ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ ‰ËÌÔÛ›Â˘Û·Ó ÙÔ 2012
ÔÈ Yamauchi Î·È Û˘Ó. ÔÈ ÔÔ›ÔÈ ÂÊ¿ÚÌÔÛ·Ó ÙËÓ Ù¯ÓÈ΋
Ù˘ ‰È·Ù·ÙÈ΋˜ ÔÛÙÂÔÁ¤ÓÂÛ˘ Û 12 ·ÛıÂÓ›˜ Ì ÛÔ‚·Ú‹
ÔÚÈ˙fiÓÙÈ· ·ÙÚÔÊ›· ÌÂÚÈÎÒ˜ Óˆ‰‹˜ ÁÓ¿ıÔ˘ (¿Óˆ ‹ οو)
Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÙÔÔı¤ÙËÛ·Ó ÂÌÊ˘Ù‡̷ٷ. ⁄ÛÙÂÚ·
·fi ̤ÛÔ fiÚÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ 5,4 ¯ÚfiÓÈ· Ù· ÔÛÔÛÙ¿
ÂÈ‚›ˆÛ˘ Î·È ÂÈÙ˘¯›·˜ ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ ‹Ù·Ó 100%
ÛÙËÓ ¿Óˆ Î·È 94,2% ÛÙËÓ Î¿Ùˆ ÁÓ¿ıÔ23.
™˘ÌÂÚ·ÛÌ·ÙÈο Ë ¢È·Ù·ÙÈ΋ OÛÙÂÔÁ¤ÓÂÛË ·ÔÙÂÏ›
Ì›· ·ÍÈfiÈÛÙË Ì¤ıÔ‰Ô ÔÛÙÈ΋˜ ·Ó¿Ï·Û˘ ÛÙËÓ ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋. EӉ›ÎÓ˘Ù·È Û ̤ÙÚÈ· ‹ ÛÔ‚·Ú¿ ÔÛÙÈο ÂÏÏ›ÌÌ·Ù· ΢ڛˆ˜ ÛÙËÓ ÚfiÛıÈ· ÂÚÈÔ¯‹
Ù˘ οو ÁÓ¿ıÔ˘. TÔ Î‡ÚÈÔ ÏÂÔÓ¤ÎÙËÌ¿ Ù˘ Â›Ó·È Ë ‰È¿Ù·ÛË Î·È ÙˆÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ Ù·˘Ùfi¯ÚÔÓ· Ì ÙËÓ ÔÛÙÈ΋
ÂÓÒ ··ÈÙÂ›Ù·È È‰È·›ÙÂÚË ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÌÂÈÚ›· ·fi ÙÔÓ
ÂÂÌ‚·›ÓÔÓÙ· Î·È Ë ·fiÏ˘ÙË Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·ÛıÂÓÔ‡˜.
Hellenic Stomatological Review 57: 27-37, 2013
manage with DO than those observed after treatment
with autograft. In this study, the success rate of the
implants was similar in both techniques (91.4% versus
93.7 DO graft)14.
In 2005, Enislidis G. et al., conducted a retrospective study
which evaluated complications before, during, and after
horizontal alveolar distraction osteogenesis and assessed
the survival rate of dental implants placed in distracted
bone. Complications associated with the distraction
procedure affected 75.7% of patients, but the majority of
them were not significant and the implant survival was
95.7%15.
On the other hand, Bianchi et al. (2008) showed that
although the bone remodeling by DO techniques was
significantly higher (10 mm instead of 5,8 mm), the
complication rate was significantly greater in DO’ patients
(60%) than those in the graft technique (14.3%)16.
In 2008, Froum et al., published the results of a survey in
which distraction procedures were performed in 30
patients using 17 intraosseous and 13 extraosseous
devices. Of the overall of 55 implants placed after the
distraction, 5 of them failed, so the success rate was
90.9%. The 4 of these failed in areas where there was a
large absorption of the distracted segment, while the
other one has failed due to contamination of the surgical
field. This study also investigates the complications
during and after distraction. Complications involving the
soft tissues (diminished vestibule of the mouth, flap
dehiscence), compromised aesthetic results, difficulties
in transitional prosthesis, distractor instability, infection,
and resorption of the transport segment17.
In a retrospective study by Ettl et al. in 2010 the
complications of DO with specific focus on bone
resorption during the consolidation period and the
follow-up period after dental implant insertion into
distracted bone in a sample of 30 partially edentulous
patients were evaluated. Treatment results showed a
survival rate of 95.1% after 45.8 months, whereas the
main problems were the inadequate soft tissue extension
(43%) and mean resorption (21.1%) at the time of dental
implant insertion18.
According to a systematic review from Aghaloo and Moy
which evaluated published articles between 1980 to
2005, implant survival was 94,7% for implants placed
into bone which had previously been distracted. On the
contrary implant survival rate was 92% for implants
placed into autogenous and autogenous-composite
grafts and 81% for implants placed into alloplast and
alloplast-xenograft materials19.
Implant survival rates after DO have also been studied in
a systemic review from Saulacic et al. in 2007, where the
outcomes of clinical studies referred to alveolar
distraction osteogenesis have been analysed and it was
found the superiority of DO compared to other
techniques. The survival rate for implants placed after the
end of the procedure was 97%20.
Kristian et al., conducted a study, which took place in
Aarhus university from 2004 up to 2011 and was
35
∂ӉȷʤÚÔ˘Û· ¶ÂÚ›ÙˆÛË
Case report and literature review
BIB§IO°PAºIA
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distraction osteogenesis for severe airway obstruction in
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Sep; 38 (6): 431-5. doi: 10.1016/j.jcms. 2009.10.019. Epub
2009 Dec 11.
2. McCarthy J., Kerwin Williams J: Maxillofacial surgery, ‰Â‡ÙÂÚË ¤Î‰ÔÛË 2007 vol. 2, 959-980, St. Louis Missouri.
3. Lambrechut J, Filippi A, Hoffmeister B, Krevsh T, Wangerin K:
Oral and implant surgery. Principles and procedures,
Quintessence 2009, UK.
4. Bell WH, Guerrero CA: Distraction Osteogenesis of the
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5. Hupp JR, Ellis E, Tucker HR: Oral and maxillofacial surgery
5th edition, 2008, St. Louis Missouri.
6. Oda T, Sawaki Y, Ueda M: Experimental alveoral ridge augmentation distraction osteogenesis using a simple device that
permits secondary implant placement, The International
JÔurnal of Oral and Maxillofacial Implants 2000; 15 (1): 95-101.
7. Lster Z, Rachmiel A, Jensen O: Alveoral width distraction
osteogenesis for early implant placemenet, J Oral Maxilofac
Surg 2005; 63: 1724-1730.
8. Lster Z: Alveoral distraction osteogenesis- Crestal widening
by distraction osteogenesis. Hellenic archives of oral and
maxilloafacial surgery, 2010: 3-14.
9. Vega L, Bilbao A: Alveoral distraction osteogenesis for dental implant preparation. An update 2010: 370-383.
10. Jensen O: Alveoral Distraction Osteogenesis, Quintessence
Publishing, 2002, China.
11. Chiapasco M, Consolo U, Bianchi A, Ronchi P: Alveolar distraction osteogenesis for the correction of vertically deficient
edentulous ridges: a multicenter prospective study on
humans. Int J Oral Maxillofac Implants 2004; 19 (3): 399-407.
12. Chiapasco M, Zaniboni M, Rimondini L: Autogenous onlay
bone grafts vs. alveolar distraction osteogenesis for the
correction of vertically deficient edentulous ridges: a 2-4year prospective study on humans. Clin Oral Implants Res
2007; 18 (4): 432-440.
13. Perez-Sayans M, Fernandez-Gonzalez B, Somoza-Martin
’
M, Gandara-Rey
JM, Garc›a-Garc›a: A Peri-implant bone
resorption around implants placed in alveolar bone
subjected to distraction osteogenesis. J Oral Maxillofac
Surg 2008; 66 (4): 787-790.
14. Uckan S, Oguz Y, Bayram B: Comparison of intraosseous
and extraosseous alveoral distraction osteogenesis. J Oal
Maxillofac Surg 2007; 65 (4): 671- 674.
15. Enislidis G, Fock N, Millesi-Schobel G, Klug C, Wittwer G,
Yerit K, Ewers R: Analysis of complications following alveoral
distraction osteogenesis and implant placement in the
partially edentulous mandible. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2005 Jul; 100 (1): 25-30.
16. Bianchi A, Felice P, Lizio G, Marchetti C: Alveolar distraction osteogenesis versus inlay bone grafting in posterior
mandibular atrophy: a prospective study. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2008 Mar; 105 (3): 282-292.
17. Froum SJ, Rosenberg ES, Elian N, Tarnow D, Choon Cho S:
Distraction Osteogenesis for Ridge Augmentation: Prevention and Treatment of Complications. Thirty Case Reports.
Int J Periodontics Restorative Dent 2008; 28: 337-345.
18. Ettl T, Gerlach T, Schüsselbauer T, Gosau M, Reichert TE,
Driemel O: Bone resorption and complications in alveolar
distraction osteogenesis. Clin Oral Investig 2010; 14 (5):
481-489.
19. Aghaloo TL, Moy PK: Which hard tissue augmentation techni36
assessed the frequency and distribution of incidents in
20 patients encountered during the perioperative period
of maxillary distraction with internal devices. The results
of the study have shown that 80% of the patients
experienced minor incidents, of which the most frequent
were pain during activation and infections21.
In 2003, a study took place from Garcia-Garcia et al., in
seven patients, where the efficacy of DO in cases of
reduced crown height in the posterior mandible was
investigated. The results showed that alveolar DO is an
effective technique for increasing the height of the
alveolar ridge in the posterior mandibular region, and
should be considered for the improvement of a negative
crown to implant ratio in severely absorbed areas22.
Recent research data have been published in 2012, by
Yamauchi et al, who treated 12 patients with severe
horizontal atrophy of a partially edentulous maxillas or
mandibles using horizontal DO for implant placement.
After mean follow-up of 5.4 years. the implant survival
and success rates were 100% and 94.2%, respectively23.
Conclusively, Distraction Osteogenesis is a reliable
method of bone regeneration in pre-implant surgery. It is
mainly indicated in moderate or severe bone loss mainly
in the anterior region of the mandible. Its main advantage
is the distraction of the soft tissues and bone at the same
time, whereas special surgical experience and full
cooperation of the patient is required.
Contact details:
Fotios Tzermpos
e-mail: [email protected]
Hellenic Stomatological Review 57: 27-37, 2013
∂ӉȷʤÚÔ˘Û· ¶ÂÚ›ÙˆÛË
Case report and literature review
ques are the most successful in furnishing bony support for
implant placement?: Int J Oral Maxillofac Implants 2007; 22
Suppl: 49-70.
20. Saulacic N, Iizuka T, Martin MS, Garcia AG: Alveolar distraction osteogenesis: a systematic review. Int J Oral Maxillofac
Surg 2008; 37 (1): 1-7.
21. Kristian A, Erik NS, Annelise K, John J, Klit PT: Perioperative incidents associated with internal maxillary distraction
osteogenesis: a retrospective study of 20 patients. Oral Surg
Oral Med Oral Pathol Oral Radiol 2012 Aug 15-25 [Epub
ahead of print].
22. Garcia-Garcia A, Somoza-Martin M, Gandara-Vila P, Saulacic
N, Gandara-Rey JM: Alveolar distraction before insertion of
dental implants in the posterior mandible. Br J Oral Maxillofac
Surg 2003 Dec; 41 (6): 376-379.
23. Yamauchi K, Takahashi T, Nogami S, Kataoka Y, Miyamoto
I, Funaki K: Horizontal alveolar distraction osteogenesis for
dental implant: long-term results. Clin Oral Implants Res
2012 Jan 26. doi: 10.1111/j.1600-0501.2011.02417.x. [Epub
ahead of print].
¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:
ºÒÙÈÔ˜ Δ˙¤ÚÌÔ˜
e-mail: [email protected]
Hellenic Stomatological Review 57: 27-37, 2013
37
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
Literature Review
MÂÙ·ÌfiÛ¯Â˘ÛË ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ
Î·È ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ ÁÈ· ÙËÓ ·Ó¿Ï·ÛË
ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ
£. KÔÓ‰‡Ï˘*, E. ¶ÂÂÏ¿ÛË**
Mesenchymal stem cell transplantation
and gene transfer
for periodontal tissue regeneration
T. Kondylis*, E. Pepelassi**
¶EPI§HæH
SUMMARY
H ÂÈÙ˘¯›· ÙˆÓ ·Ó·Ï·ÛÙÈÎÒÓ Ù¯ÓÈÎÒÓ ÛÙȘ ÂÚÈÔ‰ÔÓÙÈΤ˜ ÂÓ‰ÔÛÙÈΤ˜ ‚Ï¿‚˜ ÂËÚ¿˙ÂÙ·È ·fi ÙË
ÌÔÚÊÔÏÔÁ›· Ù˘ ÔÛÙÈ΋˜ ‚Ï¿‚˘ Î·È Ù· ·Ó·Ï·ÛÙÈο ̤۷ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È. ¶ÚfiÛÊ·Ù· ¤¯ÂÈ
·Ú¯›ÛÂÈ Ó· ÌÂÏÂÙ¿Ù·È Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ Î·È Ë ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ
ÁÈ· ÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ Ì ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù·. T· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È Û ·ÙÙ·Ú· ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ Î·È Û˘Ó‰ÂÙÈÎÒÓ ÈÛÙÒÓ. £· ÌÔÚÔ‡Û·Ó Ó· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ Â›Ù ·ÂÏ¢ıÂÚÒÓÔÓÙ·˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ‰ÚÔ˘Ó Û ÂÓ‰ÔÁÂÓ‹ ·ÙÙ·Ú· ‹ ÔÏÏ·Ï·ÛÈ·˙fiÌÂÓ· Î·È ‰È·ÊÔÚÔÔÈÔ‡ÌÂÓ· Û ·ÙÙ·Ú· ÙÔ˘ ÂÚÈÔ‰ÔÓÙ›Ô˘. H ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ıÂÚ·¢ÙÈÎÔ‡˜
·Ú¿ÁÔÓÙ˜ Û ·ÙÙ·Ú· ÙÔ˘ ÂÚÈÔ‰ÔÓÙ›Ô˘ ÚÔÛʤÚÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ¤ÎÊÚ·Û‹˜ ÙÔ˘˜ ÁÈ· ÌÂÁ·Ï‡ÙÂÚÔ
The success of the regenerative techniques in
periodontal defects depends on the osseous defect
morphology and the regenerative means used.
Recently, the study of mesenchymal stem cell transplantation and gene transfer for periodontal regeneration has been initiated with encouraging results.
Mesenchymal stem cells have the ability to differentiate into cells of mesenchymal and connective tissues. They might help in periodontal regeneration
either by releasing growth factors acting on endogenous cells or by proliferating and differentiating
into cells of the periodontium. Transferring genes
that encode therapeutic agents to periodontal cells
offers the possibility of longer expression than local
application does, expression of a combination of
therapeutic agents and time-controlled expression
in correspondence to the tissue healing process.
The first purpose of the present literature review was
* O‰ÔÓÙ›·ÙÚÔ˜
** E›ÎÔ˘ÚË K·ıËÁ‹ÙÚÈ·, EÚÁ·ÛÙ‹ÚÈÔ ¶ÂÚÈÔ‰ÔÓÙÔÏÔÁ›·˜,
O‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 57: 39-71, 2013
·ÚÂÏ‹ÊıË 29/4/2013 - ÂÎÚ›ıË 11/6/2013
* Dentist
** Assistant Professor, Department of Periodontology,
University of Athens School of Dentistry
Hellenic Stomatological Review 57: 39-71, 2013
paper received 29/4/2013 - accepted 11/6/2013
39
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
‰È¿ÛÙËÌ· Û ۇÁÎÚÈÛË Ì ÙËÓ ÙÔÈ΋ ÂÊ·ÚÌÔÁ‹, ¤ÎÊÚ·Û˘ Û˘Ó‰˘·ÛÌÔ‡ ÂÚÈÛÛfiÙÂÚˆÓ ·Ú·ÁfiÓÙˆÓ
Î·È ¯ÚÔÓÈο ÂÏÂÁ¯fiÌÂÓ˘ ¤ÎÊÚ·Û˘ ·ÓÙ›ÛÙÔȯ· ÌÂ
ÙȘ ‰ÈÂÚÁ·Û›Â˜ ÂԇψÛ˘ ÙˆÓ ÈÛÙÒÓ. O ÚÒÙÔ˜
ÛÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ‚È‚ÏÈÔÁÚ·ÊÈ΋˜ ·Ó·ÛÎfiËÛ˘ ‹Ù·Ó Ë ·Ó¿Ï˘ÛË ÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ·ÊÔÚÔ‡Ó
ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ÛÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ, ÙËÓ ·ÛÊ¿ÏÂÈ· Ù˘ Ù¯ÓÈ΋˜ ÁÈ· ÙÔÓ ‰¤ÎÙË ÔÚÁ·ÓÈÛÌfi Î·È ÙËÓ Â›‰Ú·ÛË Ù˘ ÚÔ¤Ï¢Û˘
ÙˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ Î·È ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Ù˘ ‰¤ÎÙÚÈ·˜ ÂÚÈÔ¯‹˜ ÛÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi Î·È ÙË ‰È·ÊÔÚÔÔ›ËÛË ÙÔ˘˜. O ‰Â‡ÙÂÚÔ˜
ÛÎÔfi˜ Ù˘ ·Ó·ÛÎfiËÛ˘ ‹Ù·Ó Ë ·Ó¿Ï˘ÛË ÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÌÂÙ·ÊÔÚ¿˜ ÁÔÓȉ›ˆÓ ÁÈ· ÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ
ÈÛÙÒÓ, ÔÈ ÙÚfiÔÈ ÌÂÙ·ÊÔÚ¿˜ ÙÔ˘˜ Î·È Ë ·ÛÊ¿ÏÂÈ·
Ù˘ Ù¯ÓÈ΋˜.
§¤ÍÂȘ ÎÏÂȉȿ: ΢ÙÙ·ÚÈ΋ ıÂÚ·›·, ÁÔÓȉȷ΋ ıÂÚ·›·, ÌÂÙ·ÌfiÛ¯Â˘ÛË ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ,
ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ, ÂÚÈÔ‰ÔÓÙ›Ùȉ·, ·Ó¿Ï·ÛË
ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ.
EI™A°ø°H
H ÂÚÈÔ‰ÔÓÙ›Ùȉ· Â›Ó·È ÌÈ· ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜
ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ ÌÈÎÚԂȷ΋˜ ·ÈÙÈÔÏÔÁ›·˜. H ıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ ÂÚÈÔ‰ÔÓÙ›Ùȉ·˜ ·ÔÛÎÔ›
ÛÙËÓ ·Ó·¯·›ÙÈÛË Ù˘ ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘ Î·È ÛÙËÓ Î·Ù¿ ÙÔ
‰˘Ó·ÙfiÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ Ô˘ ¤¯Ô˘Ó
·ˆÏÂÛı› ÏfiÁˆ Ù˘ ÓfiÛÔ˘. OÈ ¯ÂÈÚÔ˘ÚÁÈΤ˜ Ù¯ÓÈΤ˜
Ô˘ ¤¯Ô˘Ó ·Ó·Ù˘¯ı› ÁÈ· ÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ Î·Ù¢ı˘ÓfiÌÂÓË ÈÛÙÈ΋ ·Ó¿Ï·ÛË, Ù· ÔÛÙÈο ÌÔۯ‡̷ٷ, ÙÔ˘˜ ‚ÈÔÏÔÁÈÎÔ‡˜ ÌÂÛÔÏ·‚ËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È ÙÔ Û˘Ó‰˘·ÛÌfi ·˘ÙÒÓ.
OÈ ·Ó·Ï·ÛÙÈΤ˜ Ù¯ÓÈΤ˜ ÂÊ·ÚÌfi˙ÔÓÙ·È ÌfiÓÔ Û ÂÚÈÔ¯¤˜ Ì ÁˆÓÈÒ‰Ë ·ÒÏÂÈ· ÔÛÙÔ‡ Î·È ÂÓ‰ÔÛÙÈΤ˜ ‚Ï¿‚˜1.
H ÂÈÙ˘¯›· ·˘ÙÒÓ ÙˆÓ Ù¯ÓÈÎÒÓ ÂËÚ¿˙ÂÙ·È ÛËÌ·ÓÙÈο
·fi ÙË ÌÔÚÊÔÏÔÁ›· Ù˘ ÂÓ‰ÔÛÙÈ΋˜ ‚Ï¿‚˘ Î·È Ù· ·Ó·Ï·ÛÙÈο ̤۷ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È2. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË
ÌÔÚÊÔÏÔÁ›· Ù˘ ÔÛÙÈ΋˜ ‚Ï¿‚˘, Ë ÂÈÙ˘¯›· ÙˆÓ ·Ó·Ï·ÛÙÈÎÒÓ Ù¯ÓÈÎÒÓ Â›Ó·È ˘„ËÏfiÙÂÚË Û ÂÓ‰ÔÛÙÈΤ˜ ‚Ï¿‚˜
ÙÚÈÒÓ ÔÛÙÈÎÒÓ ÙÔȯˆÌ¿ÙˆÓ, ÛÙȘ Ôԛ˜ ÙÔ ÂÓ‰ÔÛÙÈÎfi
ÙÌ‹Ì· Ô˘ ÂÚÈ‚¿ÏÏÂÙ·È ·fi ÙÚ›· ÔÛÙÈο ÙÔȯÒÌ·Ù· ¤¯ÂÈ
‚¿ıÔ˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 mm ηıÒ˜ Î·È Û ‚Ï¿‚˜ Ù˘ ÂÚÈÔ¯‹˜ Û˘Ì‚ÔÏ‹˜ ÙˆÓ ÚÈ˙ÒÓ Î·ÙËÁÔÚ›·˜ II. ™Â ‚Ï¿‚˜ Ù˘
ÂÚÈÔ¯‹˜ Û˘Ì‚ÔÏ‹˜ ÙˆÓ ÚÈ˙ÒÓ Î·ÙËÁÔÚ›·˜ III Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ·˘ÙÒÓ ÙˆÓ Ù¯ÓÈÎÒÓ Â›Ó·È ÙfiÛÔ ¯·ÌËÏ‹ ÒÛÙ ·˘Ù¤˜ ‰ÂÓ ÂÊ·ÚÌfi˙ÔÓÙ·È2.
¶ÚfiÛÊ·Ù·, ÁÈ· ÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ
¤¯ÂÈ ·Ú¯›ÛÂÈ Ó· ÌÂÏÂÙ¿Ù·È Ë Î˘ÙÙ·ÚÈ΋ Î·È Ë ÁÔÓȉȷ΋ ıÂÚ·›·. ø˜ ΢ÙÙ·ÚÈ΋ ıÂÚ·›· ÔÚ›˙ÂÙ·È Ë ıÂÚ·›· ÌÈ·˜
ÓfiÛÔ˘ ‹ ηٿÛÙ·Û˘ Ì ÙË ÌÂÙ·ÊÔÚ¿ Ó¤ˆÓ ΢ÙÙ¿ÚˆÓ ÛÂ
¤Ó·Ó ÈÛÙfi. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ıÂÚ·›· Ù˘ ÂÚÈÔ‰ÔÓÙ›ÙÈ40
the analysis of the studies concerning the use of
mesenchymal stem cell transplantation in periodontal regeneration and the safety of the technique as
well as the effect of cell origin and recipient site
environment on their proliferation and differentiation. The second purpose of this review was the
analysis of the studies concerning the use of gene
transfer in periodontal regeneration, the transferring
modes and the safety of the technique.
Key Words: cell therapy, gene therapy, mesenchymal stem cell
transplantation, gene transfer, periodontits,
periodontal tissue regeneration.
INTRODUCTION
Periodontitis is a chronic inflammatory disease of the periodontal tissues, of microbial etiology. The aim of the
periodontal treatment is to restrain the progression of the
periodontal disease and regenerate the lost periodontal
tissues, whenever possible. The surgical techniques that
have been used for the regeneration of the periodontal
tissues include the guided tissue regeneration, the osseous grafts, the biologic mediators of the regeneration
and the combination of these techniques.
Regenerative techniques are used only in areas with
angular bone loss and intraosseous defects1. Their
success is significantly affected by the morphology of the
intraosseous defect and the regenerative means used2.
Concerning the morphology of the osseous defect, the
success of the regenerative techniques is highest for
three-wall intraosseous defects, where the three-wall part
of the defect is at least 3mm deep, as well as for class II
furcation defects. The effectiveness of the regenerative
techniques is so low for class III furcation defects that
they are not used in such defects2.
Recently, cell-based therapy and gene therapy have
been studied for the regeneration of the periodontal
tissues. Cell-based therapy is defined as the treatment of
a disease or condition by transferring new cells into a
tissue. Concerning cell-based therapy in periodontitis,
the new cells transferred to the periodontal tissues might
help in the regeneration of the periodontal tissues either
by releasing growth factors that act on endogenous cells
or by proliferating and differentiating into cells of the
periodontium, irrespective of endogenous cells3, 4. Such
cells are stem cells, which have the ability to proliferate
and differentiate into progenitor cells5.
Gene therapy is defined as the treatment of a disease or
condition by transferring genetic material that aims to
introduce, suppress or manipulate specific genes that
direct the target-cells of the host to the production of a
therapeutic agent6. Gene therapy is advantageous over
local application of therapeutic agents. The duration of
the expression of genes encoding therapeutic agents
ranges from weeks to years while the half-life of locally
Hellenic Stomatological Review 57: 39-71, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
‰·˜, Ù· Ó¤· ·ÙÙ·Ú· Ô˘ ÌÂٷʤÚÔÓÙ·È Ì ÙËÓ Î˘ÙÙ·ÚÈ΋
ıÂÚ·›· ÛÙÔ˘˜ ÂÚÈÔ‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜ ı· ÌÔÚÔ‡Û·Ó
Ó· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ Â›Ù ·ÂÏ¢ıÂÚÒÓÔÓÙ·˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜
Ô˘ ‰ÚÔ˘Ó Û ÂÓ‰ÔÁÂÓ‹ ·ÙÙ·Ú· ‹ ÔÏÏ·Ï·ÛÈ·˙fiÌÂÓ·
Î·È ‰È·ÊÔÚÔÔÈÔ‡ÌÂÓ· Û ·ÙÙ·Ú· ÙÔ˘ ÂÚÈÔ‰ÔÓÙ›Ô˘, ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· ÂÓ‰ÔÁÂÓ‹ ·ÙÙ·Ú·3, 4. T¤ÙÔÈ· ·ÙÙ·Ú·
Â›Ó·È Ù· ‚Ï·ÛÙÔ·ÙÙ·Ú·, Ô˘ ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó·
ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È Î·È Ó· ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È Û ÚÔÁÔÓÈο ·ÙÙ·Ú·5.
ø˜ ÁÔÓȉȷ΋ ıÂÚ·›· ÔÚ›˙ÂÙ·È Ë ıÂÚ·›· ÌÈ·˜ ÓfiÛÔ˘ ‹
ηٿÛÙ·Û˘ Ì ÙË ÌÂÙ·ÊÔÚ¿ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ Ô˘ ·ÔÛÎÔ› ÛÙËÓ ÂÈÛ·ÁˆÁ‹, ηٷÛÙÔÏ‹ ‹ ‰È·¯Â›ÚÈÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÁÔÓȉ›ˆÓ Ô˘ ηÙ¢ı‡ÓÔ˘Ó Ù· ·ÙÙ·Ú·-ÛÙfi¯Ô˘˜ ÙÔ˘ ÍÂÓÈÛÙ‹ ÛÙËÓ ·Ú·ÁˆÁ‹ ÂÓfi˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˘
ıÂÚ·¢ÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·6. H ÁÔÓȉȷ΋ ıÂÚ·›· ÏÂÔÓÂÎÙ› ¤Ó·ÓÙÈ Ù˘ ÙÔÈ΋˜ ÂÊ·ÚÌÔÁ‹˜ Ê·ÚÌ·ÎÔÏÔÁÈÎÒÓ
·Ú·ÁfiÓÙˆÓ. H ‰È¿ÚÎÂÈ· ¤ÎÊÚ·Û˘ ÙˆÓ ÁÔÓȉ›ˆÓ Ô˘
Έ‰ÈÎÔÔÈÔ‡Ó ıÂÚ·¢ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î˘Ì·›ÓÂÙ·È ·fi ‚‰ÔÌ¿‰Â˜ ¤ˆ˜ ¯ÚfiÓÈ· ÂÓÒ Ô ¯ÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜
ÙˆÓ ÙÔÈο ÂÊ·ÚÌÔ˙fiÌÂÓˆÓ Ê·ÚÌ·ÎÔÏÔÁÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Â›Ó·È Ôχ ÌÈÎÚfiÙÂÚÔ˜ Î·È Û˘Ó‹ıˆ˜ Î˘Ì·›ÓÂÙ·È ·fi
ÒÚ˜ ¤ˆ˜ Ë̤Ú˜. EÈϤÔÓ, Ë ÁÔÓȉȷ΋ ıÂÚ·›· ÚÔÛʤÚÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ¤ÎÊÚ·Û˘ Û˘Ó‰˘·ÛÌÔ‡ ÂÚÈÛÛfiÙÂÚˆÓ ÙÔ˘ ÂÓfi˜ ıÂÚ·¢ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. H ¤ÎÊÚ·ÛË
·˘Ù‹ ÌÔÚ› Ó· Â›Ó·È ¯ÚÔÓÈο ÂÏÂÁ¯fiÌÂÓË ·ÓÙ›ÛÙÔȯ· ÌÂ
ÙȘ ‰ÈÂÚÁ·Û›Â˜ ÂԇψÛ˘ ÙˆÓ ÈÛÙÒÓ3.
KYTTAPIKH £EPA¶EIA
T·ÍÈÓfiÌËÛË ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ
T· ‚Ï·ÛÙÔ·ÙÙ·Ú· Ì ‚¿ÛË ÙËÓ ÚÔ¤ÏÂ˘Û‹ ÙÔ˘˜ ‰È·ÎÚ›ÓÔÓÙ·È Û ÂÌ‚Ú˘˚ο Î·È ÂÓ‹ÏÈη. T· ÂÌ‚Ú˘˚ο ‚Ï·ÛÙÔ·ÙÙ·Ú· ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ÂÛˆÙÂÚÈ΋ ΢ÙÙ·ÚÈ΋ ÛÙÈ‚¿‰· Ù˘ ‚Ï·ÛÙÔ·ÛÙ˘ ÚÈÓ ÙËÓ ÂÌʇÙÂ˘Û‹ Ù˘ ÛÙË Ì‹ÙÚ· (ÂÌ‚Ú˘Ô‚Ï¿ÛÙË), Ô˘ ·ÔÙÂÏ› ÙËÓ Î·Ù·‚ÔÏ‹ ÙÔ˘ ÂÌ‚Ú‡Ô˘. T· ÂÓ‹ÏÈη ‚Ï·ÛÙÔ·ÙÙ·Ú· ÂÓÙÔ›˙ÔÓÙ·È ÛÙÔ˘˜
ÂÚÈÛÛfiÙÂÚÔ˘˜ ÈÛÙÔ‡˜ Î·È fiÚÁ·Ó· Î·È Û ÂÚ›ÙˆÛË
‚Ï¿‚˘ ÌÂÙ·Ó·ÛÙÂ‡Ô˘Ó ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ‚Ï¿‚˘ ηÈ
Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·ÔηٿÛÙ·Û‹ Ù˘7, 8.
T· ‚Ï·ÛÙÔ·ÙÙ·Ú· Ù·ÍÈÓÔÌÔ‡ÓÙ·È Ì ‚¿ÛË ÙËÓ ÈηÓfiÙËÙ·
‰È·ÊÔÚÔÔ›ËÛ‹˜ ÙÔ˘˜ Û ÔÏÔ‰‡Ó·Ì·, ÔÈÎÈÏÔ‰‡Ó·Ì·,
ÔÏ˘‰‡Ó·Ì·, ÔÏÈÁÔ‰‡Ó·Ì· Î·È ÌÔÓÔ‰‡Ó·Ì·. T· ÔÏÔ‰‡Ó·Ì· ·ÙÙ·Ú· ÌÔÚÔ‡Ó ÌÂÙ¿ ·fi ÂÌʇÙÂ˘Û‹ ÙÔ˘˜ ÛÙËÓ
Ì‹ÙÚ· ˙ˆÓÙ·ÓÔ‡ ÔÚÁ·ÓÈÛÌÔ‡ Ó· ‰ÒÛÔ˘Ó Á¤ÓÂÛË Û ¤Ó·Ó
Ó¤Ô ÔÚÁ·ÓÈÛÌfi. T· ÔÈÎÈÏÔ‰‡Ó·Ì· ·ÙÙ·Ú· ÌÔÚÔ‡Ó Ó·
·Ú¿ÁÔ˘Ó fiÏ· Ù· ·ÙÙ·Ú· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ·ÏÏ¿ fi¯È Â͈ÂÌ‚Ú˘˚ÎÔ‡˜ ÈÛÙÔ‡˜, fiˆ˜ ÙÔÓ Ï·ÎÔ‡ÓÙ·. T¤ÙÔÈ· ·ÙÙ·Ú· Â›Ó·È Ù· ÂÌ‚Ú˘˚ο ‚Ï·ÛÙÔ·ÙÙ·Ú·. ¶ÔÈÎÈÏÔ‰‡Ó·Ì·
·ÙÙ·Ú· ÌÔÚÔ‡Ó Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó Î·È ÌÂÙ¿ ·fi ÂÈÛ·ÁˆÁ‹ Û ۈ̷ÙÈο ·ÙÙ·Ú· Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÁÔÓȉ›ˆÓ, fiˆ˜ ÙˆÓ Oct-4, Sox2, c-Myc Î·È Klf4. T· ·ÙÙ·Ú· ·˘Ù¿ ÔÓÔÌ¿˙ÔÓÙ·È Â·¯ı¤ÓÙ· ÔÈÎÈÏÔ‰‡Ó·Ì· ·ÙÙ·Ú·. T· ÔÏ˘‰‡Ó·Ì· ·ÙÙ·Ú· ÌÔÚÔ‡Ó Ó· ·Ú¿ÁÔ˘Ó Î‡ÙÙ·Ú· Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÛÂÈÚÒÓ. T¤ÙÔÈ· ·ÙÙ·Ú· Â›Ó·È Ù· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú·. T· ÔÏÈÁÔ‰‡Ó·Ì· ·ÙÙ·Ú·
ÌÔÚÔ‡Ó Ó· ‰È·ÊÔÚÔÔÈËıÔ‡Ó Û ϛÁÔ˘˜ Ù‡Ô˘˜ ΢ÙÙ¿ÚˆÓ Î·È Ù· ÌÔÓÔ‰‡Ó·Ì· ÌfiÓÔ Û ¤Ó·Ó7, 8.
Hellenic Stomatological Review 57: 39-71, 2013
applied pharmacologic agents ranges from hours to
days. Furthermore, gene therapy offers the possibility to
express a combination of therapeutic agents. This
expression can be time-controlled, in correspondence to
the healing process3.
CELL-BASED THERAPY
Classification of stem cells
Based on their origin, stem cells are classified into embryonic and adult. Embryonic stem cells originate from
the blastocyst, the inner cell layer of the embryoblast,
prior to implantation in the uterus, which comprises the
ascend of the embryo. Adult stem cells are located in
most tissues and organs and in case of damage they
migrate to the damaged area and help restoring it7, 8.
Based on the ability to differentiate, stem cells are classified into totipotent, pluripotent, multipotent, oligopotent
and unipotent. Totipotent cells after implantation in the
uterus of a living organism can give birth to a new
organism. Pluripotent cells can produce all cells of the
organism except from extra-embryonic tissues, such as
the placenta. Embryonic stem cells belong to this cell
group. Pluripotent cells can be created by introducing
certain genes, such as Oct-4, Sox2, c-Myc and Klf4, into
somatic cells. These cells are called induced pluripotent
cells. Multipotent cells, such as mesenchymal stem cells,
produce cells of specific lineages. Oligopotent cells
differentiate into a few cell types, whereas unipotent cells
differentiate only into one cell type7, 8.
Mesenchymal stem cells
Mesenchymal stem cells are adult stem cells that have
the capacity to differentiate into cells of mesenchymal
and connective tissues. Mesenchymal stem cells have
been isolated from spleen, thymus, trabecular bone, bone marrow, periosteum, articular cartilage, synovium, synovial fluid, skeletal muscle, tendons, adipose tissue,
blood and blood vessels. Moreover, they have been isolated from dental and periodontal tissues, namely the periodontal ligament, the dental pulp and the dental bud3, 7, 8.
Cells have to fulfill a number of minimal criteria in order to
be considered as mesenchymal stem cells. Table 1
presents the minimal criteria for the definition of cells as
mesenchymal stem cells, as proposed by the International Society for Cellular Therapy9.
Transplantation of mesenchymal stem cells in
periodontal defects
Mesenchymal stem cell transplantation for periodontal
tissue regeneration has been extensively studied in
animal models. Transplantation of mesenchymal stem
cells, derived from dental and periodontal tissues, bone
marrow and adipose tissue, into periodontal defects of
animal models, by using various vehicles, has demonstrated encouraging results (Table 2).
The evaluation of mesenchymal stem cell transplantation
41
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Table 1: Minimal criteria for the definition of cells as mesenchymal stem cells9
Criteria
Detailed description
Adherence to plastic
Adherence to plastic when cultured
under certain conditions and
in certain flasks.
Expression of specific
surface antigens
At least 95% of the population
expresses CD105, CD73 and CD90
markers and less than 2% of the
population CD45, CD34, CD14 or
CD11b, CD79a or CD19 markers
and HLA class II.
Potential of multipotentdifferentiation
Differentiation into 3 cell lineages,
osteoblasts, adipocytes and
chondroblasts under specific in-vitro
conditions.
MÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú·
T· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· Â›Ó·È ÂÓ‹ÏÈη ‚Ï·ÛÙÔ·ÙÙ·Ú· Ô˘ ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È Û ·ÙÙ·Ú· ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ Î·È Û˘Ó‰ÂÙÈÎÒÓ ÈÛÙÒÓ.
MÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ¤¯Ô˘Ó ·ÔÌÔÓˆı› ·fi
ÙÔÓ ÛÏ‹Ó·, ÙÔÓ ı‡ÌÔ, ÙÔ ÛÔÁÁ҉˜ ÔÛÙÔ‡Ó, ÙÔ Ì˘ÂÏfi
ÙˆÓ ÔÛÙÒÓ, ÙÔ ÂÚÈfiÛÙÂÔ, ÙÔÓ ·ÚıÚÈÎfi ¯fiÓ‰ÚÔ, ÙËÓ ·ÚıÚÈ΋ ÌÂÌ‚Ú¿ÓË, ÙÔ ·ÚıÚÈÎfi ˘ÁÚfi, ÙÔ˘˜ ÛÎÂÏÂÙÈÎÔ‡˜
̇˜, ÙÔ˘˜ Ù¤ÓoÓÙ˜, ÙÔ ÏÈÒ‰Ë ÈÛÙfi, ÙÔ ·›Ì· Î·È Ù· ·ÁÁ›·. Œ¯Ô˘Ó, Â›Û˘, ·ÔÌÔÓˆı› ·fi Ô‰ÔÓÙÈÎÔ‡˜ ηÈ
ÂÚÈÔ‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜, Û˘ÁÎÂÎÚÈ̤ӷ ÙÔ ÂÚÈÚÚ›˙ÈÔ, ÙÔÓ
Ô‰ÔÓÙÈÎfi ÔÏÊfi Î·È ÙÔ Ô‰ÔÓÙÔı˘Ï¿ÎÈÔ3, 7, 8.
¶ÚÔÎÂÈ̤ÓÔ˘ Û˘ÁÎÂÎÚÈ̤ӷ ·ÙÙ·Ú· Ó· ıˆÚËıÔ‡Ó ˆ˜
ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· Ú¤ÂÈ ·˘Ù¿ Ó· ÏËÚÔ‡Ó ÔÚÈṲ̂ӷ ÂÏ¿¯ÈÛÙ· ÎÚÈÙ‹ÚÈ·. H ¢ÈÂıÓ‹˜ EÙ·ÈÚ›·
K˘ÙÙ·ÚÈ΋˜ £ÂÚ·›·˜ ¤¯ÂÈ ıÂÛ›ÛÂÈ Ù· ÂÏ¿¯ÈÛÙ· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙÔÓ ÔÚÈÛÌfi Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ ˆ˜ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ9. T· ÎÚÈÙ‹ÚÈ· ·˘Ù¿ Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1.
MÂÙ·ÌfiÛ¯Â˘ÛË ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ÛÂ
ÂÚÈÔ‰ÔÓÙÈΤ˜ ‚Ï¿‚˜
H ÌÂÙ·ÌfiÛ¯Â˘ÛË ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ÁÈ·
ÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ ¤¯ÂÈ ÌÂÏÂÙËı› ÂÎÙÂٷ̤ӷ Û ÂÈÚ·Ì·ÙÈο ÚfiÙ˘· (ÂÈÚ·Ì·Ùfi˙ˆ·). H
ÌÂÙ·ÌfiÛ¯Â˘ÛË ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ Ô‰ÔÓÙÈÎÒÓ Î·È ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ, Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Î·È
ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ Û ÂÚÈÔ‰ÔÓÙÈΤ˜ ‚Ï¿‚˜ ÂÈÚ·Ì·Ùfi˙ˆˆÓ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÔÈÎÈÏ›· Ì¤ÛˆÓ ÌÂÙ·ÊÔÚ¿˜ ¤¯ÂÈ ‰Â›ÍÂÈ ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· (¶›Ó. 2).
™ÙÔÓ ¿ÓıÚˆÔ, Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ Û ÂÚÈÔ‰ÔÓÙÈΤ˜ ‚Ï¿‚˜ ¤¯ÂÈ ÌÂÏÂÙËı›
Ôχ ÂÚÈÔÚÈṲ̂ӷ. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯Ô˘Ó ÌfiÓÔ ·Ó·ÊÔÚ¤˜ ÂÚÈÙÒÛÂˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ·ÛıÂÓÒÓ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ
‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ4, 24. ™˘ÁÎÂÎÚÈ̤ӷ, ÔÈ Yamada Î·È Û˘Ó.24
42
in human periodontal defects is limited. There are only
few case reports of periodontal patients treated with
mesenchymal stem cell transplantation4, 24. Specifically,
Yamada et al.24 treated a mandibular second premolar
intraosseous defect, which presented a 5mm-deep residual periodontal pocket (mesially and bucally) and bleeding on probing, with iliac crest bone marrow-derived
mesenchymal stem cells mixed with platelet-rich plasma.
At 12 months, elimination of the periodontal pocket
(1mm-deep gingival sulcus) and significant gain of clinical attachment level (by 4mm messially and 3mm
bucally) were achieved. McAllister4 presented two case
reports, where periodontal osseous defects were treated
with open flap debridement (without phase I periodontal
treatment prior to surgery) and allogenic trabecular
osseous graft in which the vitality of mesenchymal stem
cells and osteoprogenitor cells had been preserved. An
horizontal osseous defect located between maxillary
central and lateral incisors, with a 9 mm-deep periodontal
pocket, was treated with the allogenic graft. At 6 months,
there were 4mm alveolar crest level gain and 5 mm
pocket depth reduction. Moreover, a class II furcation
defect, which was located lingually to a mandibular
second molar and presented a 9mm-deep periodontal
pocket, was treated with the allogenic graft and at 6
months the defect was eliminated (bone fill and pocket
elimination).
Effect of the environment on the differentiation of
mesenchymal stem cells
Mesenchymal stem cells have the capacity to differentiate
into all cells of the tissue they derive from. However, the
cell type in which they will differentiate seems to depend
on the environment in which they develop.
Kim et al.25 studied in immunodeficient mice the subcutaneous implantation of human periodontal mesenchymal
Hellenic Stomatological Review 57: 39-71, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
¶›Ó·Î·˜ 1. EÏ¿¯ÈÛÙ· ÎÚÈÙ‹ÚÈ· Ô˘ Ú¤ÂÈ Ó· ÏËÚÔ‡Ó Ù· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú·9
KÚÈÙ‹ÚÈ·
§ÂÙÔÌÂÚ‹˜ ÂÚÈÁÚ·Ê‹
IηÓfiÙËÙ· ÚÔÛÎfiÏÏËÛ˘ ÛÂ
Ï·ÛÙÈÎfi
¶ÚÔÛÎfiÏÏËÛË Û Ï·ÛÙÈÎfi fiÙ·Ó
ηÏÏÈÂÚÁÔ‡ÓÙ·È Î¿Ùˆ ·fi
Û˘ÁÎÂÎÚÈ̤Ó˜ Û˘Óı‹Î˜ Î·È ÛÂ
Û˘ÁÎÂÎÚÈ̤Ó˜ ÊȿϘ.
ŒÎÊÚ·ÛË Û˘ÁÎÂÎÚÈ̤ӈÓ
ÂÈÊ·ÓÂÈ·ÎÒÓ ·ÓÙÈÁfiÓˆÓ
TÔ˘Ï¿¯ÈÛÙÔÓ ÙÔ 95% ÙÔ˘ ÏËı˘ÛÌÔ‡
ÂÎÊÚ¿˙ÂÈ ÙÔ˘˜ ‰Â›ÎÙ˜ CD105, CD73
Î·È CD90 Î·È ÏÈÁfiÙÂÚÔ ·fi ÙÔ 2%
ÙÔ˘˜ ‰Â›ÎÙ˜ CD45, CD34, CD14 ‹
CD11b, CD79a ‹ CD19 Î·È HLA Ù¿Í˘ II.
IηÓfiÙËÙ· ÔÏ˘‰‡Ó·Ì˘
‰È·ÊÔÚÔÔ›ËÛ˘
¢È·ÊÔÚÔÔ›ËÛË Û 3 ÛÂÈÚ¤˜
΢ÙÙ¿ÚˆÓ, ÔÛÙÂÔ‚Ï¿ÛÙ˜, ÏÈÔ·ÙÙ·Ú·
Î·È ¯ÔÓ‰ÚÔ‚Ï¿ÛÙ˜ οو ·fi Û˘ÁÎÂÎÚÈ̤Ó˜
in-vitro Û˘Óı‹Î˜.
·ÓÙÈÌÂÙÒÈÛ·Ó ÂÓ‰ÔÛÙÈ΋ ‚Ï¿‚Ë ÂÁÁ‡˜ ‰Â˘Ù¤ÚÔ˘ οو
ÚÔÁÔÌÊ›Ô˘, fiÔ˘ ˘‹Ú¯Â ˘ÔÏÂÈÌÌ·ÙÈÎfi˜ ÂÚÈÔ‰ÔÓÙÈÎfi˜ ı‡Ï·ÎÔ˜ ‚¿ıÔ˘˜ 5mm (ÂÁÁ‡˜ Î·È ·ÚÂȷο) Î·È ·ÈÌÔÚÚ·Á›· ÛÙËÓ ·Ó›¯Ó¢ÛË, Ì ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÚÔÂÚ¯fiÌÂÓ· ·fi ÙË Ï·ÁÒÓÂÈ· ·ÎÚÔÏÔÊ›· ·Ó·ÌÂÌÂÈÁ̤ӷ Ì Ï¿ÛÌ· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ·ÈÌÔÂÙ¿ÏÈ·. MÂÙ¿ ·fi 1 ¯ÚfiÓÔ, ·Ú·ÙËÚ‹ıËΠÂÍ¿ÏÂÈ„Ë ÙÔ˘ ı˘Ï¿ÎÔ˘ (‚¿ıÔ˜ Ô˘ÏÔ‰ÔÓÙÈ΋˜
Û¯ÈÛÌ‹˜ 1mm) Î·È ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÂÈ¤‰Ô˘ ÎÏÈÓÈ΋˜ ÚfiÛÊ˘Û˘ (ηٿ 4mm ÂÁÁ‡˜ Î·È 3mm ·ÚÂȷο).
O McAllister4 ·ÚÔ˘Û›·Û ‰‡Ô ÂÚÈÛÙ·ÙÈο ÂÚÈÔ‰ÔÓÙÈÎÒÓ ·ÛıÂÓÒÓ, fiÔ˘ ÂÚÈÔ‰ÔÓÙÈΤ˜ ÔÛÙÈΤ˜ ‚Ï¿‚˜ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ÚÈ˙È΋ ·fiÍÂÛË Ì ÎÚËÌÓfi (¯ˆÚ›˜ Ó· ¤¯ÂÈ ÚÔËÁËı› Ë Ê¿ÛË ÂϤÁ¯Ô˘ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ) Î·È ·ÏÏÔÁÂÓ¤˜ ÌfiÛ¯Â˘Ì· ÛÔÁÁÒ‰Ô˘˜ ÔÛÙÔ‡ ÛÙÔ ÔÔ›Ô Â›¯Â ‰È·ÙËÚËı› Ë ˙ˆÙÈÎfiÙËÙ· ÙˆÓ
ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ Î·È ÙˆÓ ÔÛÙÂÔÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ™Â ÔÚÈ˙fiÓÙÈ· ÔÛÙÈ΋ ‚Ï¿‚Ë ÌÂٷ͇ ¿Óˆ
ÎÂÓÙÚÈÎÔ‡ Î·È Ï¿ÁÈÔ˘ ÙÔ̤· Ì ‚¿ıÔ˜ ı˘Ï¿ÎÔ˘ 9mm, 6
Ì‹Ó˜ ÌÂÙ¿ ·fi ÙÔ ÔÛÙÈÎfi ÌfiÛ¯Â˘Ì· ·Ó·Ê¤ÚıËΠ‚ÂÏÙ›ˆÛË ÙÔ˘ ÂÈ¤‰Ô˘ ÙÔ˘ Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡ ηٿ 4mm ηÈ
Ì›ˆÛË ÙÔ˘ ‚¿ıÔ˘˜ ı˘Ï¿ÎÔ˘ Û 4mm. AÓÙ›ÛÙÔȯ·, ÛÂ
‚Ï¿‚Ë Ù˘ ÂÚÈÔ¯‹˜ Û˘Ì‚ÔÏ‹˜ ÙˆÓ ÚÈ˙ÒÓ Î·ÙËÁÔÚ›·˜ II
ÁψÛÛÈο ‰Â˘Ù¤ÚÔ˘ οو ÁÔÌÊ›Ô˘ Ì ‚¿ıÔ˜ ı˘Ï¿ÎÔ˘
9mm, 6 Ì‹Ó˜ ÌÂÙ¿ ·fi ÙÔ ÔÛÙÈÎfi ÌfiÛ¯Â˘Ì· ·Ó·Ê¤ÚıËΠÂÍ¿ÏÂÈ„Ë Ù˘ ‚Ï¿‚˘ (ÔÛÙÈ΋ Ï‹ÚˆÛË Î·È ÂÍ¿ÏÂÈ„Ë
ÙÔ˘ ı˘Ï¿ÎÔ˘).
E›‰Ú·ÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ
ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ
T· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ·
Ó· ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È Û fiÏ· Ù· ·ÙÙ·Ú· ÙÔ˘ ÈÛÙÔ‡ ·fi
ÙÔÓ ÔÔ›Ô ÚÔ¤Ú¯ÔÓÙ·È. øÛÙfiÛÔ ÙÔ Â›‰Ô˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ
ÛÙÔ ÔÔ›Ô ı· ‰È·ÊÔÚÔÔÈËıÔ‡Ó Ê·›ÓÂÙ·È Ó· ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÛÙÔ ÔÔ›Ô ·Ó·Ù‡ÛÛÔÓÙ·È.
OÈ Kim Î·È Û˘Ó.25 ÌÂϤÙËÛ·Ó Û ·ÓÔÛÔ·ÓÂ·Ú΋ ÔÓÙ›ÎÈ·
Hellenic Stomatological Review 57: 39-71, 2013
stem cells mixed with hydroxyapatite and b-tricalcium
phosphate granules. Initially, on the third day and at the
end of the first week, proliferation and migration of
mesenchymal stem cells among the graft granules was
noted. Moreover, there was a shapeless collagen mass.
The morphology of the cell nuclei differed depending on
the area. There were sparsely ordered cementoblast-like
cells with round nuclei around the granules, whereas
dispersed fibroblast-like cells with atractoid nuclei were
found within the shapeless collagen mass. At the end of
the second week, the shapeless collagen mass had been
transformed into well-organized collagen fibers, located
among the granules and in contact with them. Cells with
round nuclei were densely ordered in a layer around the
granules. Eosinophilic non-mineralized cementoid-like
tissue was found among the round nuclei cells and the
granules. There were collagen fibers, similar to
Sharpey’s fibers, entering the eosinophilic tissue. At the
end of the fourth week, the cementoid-like tissue
surrounding the granules seemed to get mineralized.
Well-organized fibers, similar to Sharpey’s fibers, ended
into this cementum-like tissue. Furthermore, there were
concave areas on the granule surface with increased
density of cementoblast-like cells, cementum-like tissue
and fibers, similar to Sharpey’s fibers.
Park et al.15 studied the subcutaneous implantation of
human periodontal mesenchymal stem cells mixed with
hydroxyapatite and b-tricalcium phosphate bone graft granules in immunodeficient mice. After 8 weeks, there were
cellular cementum containing cementocytes (cementoblasts which had been entrapped into the cementum during the process of its output) and Sharpey’s fibers
entering into the cementum. In this study, periodontal tissue-derived mesenchymal stem cells produced periodontal connective like-tissue and cementum-like tissue. The
cells which were in contact with the graft granules differe43
44
M¤ÛÔ
PRP,
ÊıÔÚÈÔ¸‰ÚÔ͢··Ù›Ù˘
PRP
XÂÈÚÔ˘ÚÁÈο
ÚÔÎÏËı›Û˜
ÔÛÙÈΤ˜ ‚Ï¿‚˜
‰È·Ì¤ÙÚÔ˘ 3.5mm
Î·È ‚¿ıÔ˘˜ 8mm
OÛÙÈΤ˜ ‚Ï¿‚˜
™Î‡ÏÔÈ
XÔÈÚ›‰È·
™Î‡ÏÔÈ
ZÒ·
MÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
MÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
MÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
K‡ÙÙ·Ú·
¶ÂÚÈÔ‰ÔÓÙÈΤ˜
‚Ï¿‚˜ ÛÙÔÓ
·ÚÂÈ·Îfi ÊÏÔÈfi
Ù˘ οو ÁÓ¿ıÔ˘
KÔÏÏ·ÁÔÓÔ‡¯o˜
ÛfiÁÁÔ˜
AÓÔÛÔ·ÓÂ·Ú΋
ÔÓÙ›ÎÈ·
EÙÂÚÔÁÂÓ‹
ÌÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
ÙÔ˘ ÂÚÈÔ‰ÔÓÙ›Ô˘
MÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· Ô‰ÔÓÙÈÎÒÓ Î·È ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ
¶Ï¿ÛÌ·
ÏÔ‡ÛÈÔ ÛÂ
·ÈÌÔÂÙ¿ÏÈ·
(PRP)
XÂÈÚÔ˘ÚÁÈο
ÚÔÎÏËı›Û˜
‚Ï¿‚˜ Ù˘
ÂÚÈÔ¯‹˜ Û˘Ì‚ÔÏ‹˜
ÙˆÓ ÚÈ˙ÒÓ
ÚÔÁÔÌÊ›ˆÓ
ηÙËÁÔÚ›·˜ II ‡„Ô˘˜
5mm Î·È ‚¿ıÔ˘˜ 2mm
MÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú·
BÏ¿‚Ë
-
2,4 Î·È 8
‚‰ÔÌ¿‰Â˜
3 Ì‹Ó˜
8 ‚‰ÔÌ¿‰Â˜
¢È¿ÚÎÂÈ·
¢ËÌÈÔ˘ÚÁ›· ÈÛÙÔ‡ ÚÔÛÔÌÔÈ¿˙ÔÓÙ· ÌÂ
ÂÚÈÚÚ›˙ÈÔ, ÎÔÏÏ·ÁfiÓˆÓ ÈÓÒÓ Î·È ÔÛÙÔ‡ ·ÏÏ¿ ÌË
ÏÂÈÙÔ˘ÚÁÈ΋ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ
ÈÛÙÒÓ.
™ÙȘ 2 Î·È 4 ‚‰ÔÌ¿‰Â˜ ‰ËÌÈÔ˘ÚÁ›· ηϿ
Û¯ËÌ·ÙÈṲ̂ÓÔ˘ ÒÚÈÌÔ˘ ÔÛÙÔ‡ Î·È ·ÁÁÂÈ·ÎÔ‡
ÈÛÙÔ‡ Û ۇÁÎÚÈÛË Ì ·Ô˘Û›· ıÂÚ·›·˜, ÌfiÓÔ
ÙÔ Ì¤ÛÔ ÌÂÙ·ÊÔÚ¿˜ Î·È Û˘Ó‰˘·ÛÌfi ·˘ÙÔÁÂÓÔ‡˜
ÛÔÁÁÒ‰Ô˘˜ ÔÛÙÔ‡ Î·È Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ.
¢ËÌÈÔ˘ÚÁ›· ÔÛÙÔ‡: ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο
ÌÂÁ·Ï‡ÙÂÚË Û ۇÁÎÚÈÛË Ì ·Ô˘Û›· ıÂÚ·›·˜
Î·È ÌfiÓÔ ÙÔ Ì¤ÛÔ ÌÂÙ·ÊÔÚ¿˜ ÛÙȘ 8 ‚‰ÔÌ¿‰Â˜,
·ÚfiÌÔÈ· ÌÂ Û˘Ó‰˘·ÛÌfi ·˘ÙÔÁÂÓÔ‡˜
ÛÔÁÁÒ‰Ô˘˜ ÔÛÙÔ‡ Î·È Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ.
¢ËÌÈÔ˘ÚÁ›· ÔÛÙÔ‡: ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο
ÌÂÁ·Ï‡ÙÂÚË Û ۇÁÎÚÈÛË ÌÂ
ÊıÔÚÈÔ¸‰ÚÔ͢··Ù›ÙË ÛÂ Û˘Ó‰˘·ÛÌfi ‹ ÌË ÌÂ
PRP, ·ÚfiÌÔÈ· Ì ·˘ÙÔÁÂÓ¤˜ ÔÛÙÔ‡Ó. ™Ù·ÙÈÛÙÈο
ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË Â·Ê‹ ÌÂٷ͇
ÊıÔÚÈÔ¸‰ÚÔ͢··Ù›ÙË Î·È ÓÂÔ‰ËÌÈÔ˘ÚÁËı¤ÓÙÔ˜
ÔÛÙÔ‡ Û ۯ¤ÛË Ì ÊıÔÚÈÔ¸‰ÚÔ͢··Ù›ÙË
ÛÂ Û˘Ó‰˘·ÛÌfi ‹ ÌË Ì PRP.
¢ËÌÈÔ˘ÚÁ›· ÔÛÙÔ‡: ·ÚfiÌÔÈ· ÁÈ· fiϘ ÙȘ
ÔÌ¿‰Â˜
¢ËÌÈÔ˘ÚÁ›· ÔÛÙ½Ó˘: ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο
ÌÂÁ·Ï‡ÙÂÚË Û ۇÁÎÚÈÛË Ì ÙËÓ Ê¿ÛË ÂϤÁ¯Ô˘
ÊÏÂÁÌÔÓ‹˜ Î·È ÌfiÓÔ ÙÔ Ì¤ÛÔ ÌÂÙ·ÊÔÚ¿˜,
·ÚfiÌÔÈ· Ì ·˘ÙÔÁÂÓ¤˜ Û˘Ì·Á¤˜ ÔÛÙÔ‡Ó ÛÂ
Û˘Ó‰˘·ÛÌfi ‹ ÌË Ì ÙÔ Ì¤ÛÔ ÌÂÙ·ÊÔÚ¿˜
AÔÙÂϤÛÌ·Ù·
13
12
11
10
MÂϤÙË
¶›Ó·Î·˜ 2. MÂϤÙ˜ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ÁÈ· ÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ Î·È ÂÚÈÂÌÊ˘ÙÂ˘Ì·ÙÈÎÒÓ ÈÛÙÒÓ Û ÂÈÚ·Ì·Ùfi˙ˆ·.
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Hellenic Stomatological Review 57: 39-71, 2013
Hellenic Stomatological Review 57: 39-71, 2013
-
-
-
¶ÂÚÈÔ‰ÔÓÙÈΤ˜
‚Ï¿‚˜
ÂÂÎÙÂÈÓfiÌÂÓ˜
̤¯ÚÈ ÙÔ ·ÎÚÔÚÚ›˙ÈÔ
XÂÈÚÔ˘ÚÁÈο
‰ËÌÈÔ˘ÚÁË̤Ó˜
ÂÚÈÔ‰ÔÓÙÈΤ˜
‚Ï¿‚˜
KÚ›ÛÈÌÔ˘ ÌÂÁ¤ıÔ˘˜
ÔÛÙÈΤ˜ ‚Ï¿‚˜ ÛÙËÓ
οو ÁÓ¿ıÔ
XÔÈÚ›‰È·
XÔÈÚ›‰È·
™Î‡ÏÔÈ
beagle
New
Zealand
Ï·ÁÔ›
KfiÏÏ·
ÈÓÒ‰Ô˘˜
AÙÂÏÔÎÔÏÏ·ÁfiÓÔ
XÂÈÚÔ˘ÚÁÈο
ÚÔÎÏËı›Û˜
‚Ï¿‚˜ ÛÙÔ
Ê·ÙÓÈ·Îfi ÔÛÙfi
Ù˘ ¿Óˆ ÁÓ¿ıÔ˘
XÂÈÚÔ˘ÚÁÈο
ÚÔÎÏËı›Û˜
‚Ï¿‚˜ Ù˘
ÂÚÈÔ¯‹˜ Û˘Ì‚ÔÏ‹˜
™Î‡ÏÔÈ
beagle
SpragueDawley
Â›Ì˘Â˜
MÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ
AÓ·Û˘Ó‰˘·Ṳ̂ÓË
·ÓıÚÒÈÓË
ÌÔÚÊÔÁÂÓÂÙÈ΋
ÚˆÙ½ÓË
ÙÔ˘ ÔÛÙÔ‡-2,
Ó·ÓÔ¸‰ÚÔ͢··Ù›Ù˘,
ÎÔÏÏ·ÁfiÓÔ,
ÔÏ˘-LÏ·ÎÙ›‰ÈÔ
KÚ›ÛÈÌÔ˘ ÌÂÁ¤ıÔ˘˜
ÔÛÙÈΤ˜ ‚Ï¿‚˜ ÛÙÔ
Ê·ÙÓÈ·Îfi ÔÛÙÔ‡Ó
A˘ÙÔÁÂÓ‹
ÌÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
Ì˘ÂÏÔ‡ ÙˆÓ
MÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ
A˘ÙÔÁÂÓ‹
ÌÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
ÓÂÔÁÈÏÒÓ ‰ÔÓÙÈÒÓ
A˘ÙÔÁÂÓ‹
ÌÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
ÂÚÈÚÚÈ˙›Ô˘
A˘ÙÔÁÂÓ‹
ÌÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
ÂÚÈÚÚÈ˙›Ô˘
‹ ÔÏÊÔ‡ ‹
Ô‰ÔÓÙÔı˘Ï·Î›Ô˘
A˘ÙÔÁÂÓ‹
ÌÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
ÔÏÊÔ‡
4
‚‰ÔÌ¿‰Â˜
6 ‚‰ÔÌ¿‰Â˜
6 Ì‹Ó˜
-
-
12 ‚‰ÔÌ¿‰Â˜
™¯Â‰fiÓ Ï‹Ú˘ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ
ÈÛÙÒÓ. EÓÙÔÈÛÌfi˜ ÛËÌ·ÛÌ¤ÓˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ,
ÔÛÙÂÔ΢ÙÙ¿ÚˆÓ, ÔÛÙ½ÓÔ‚Ï·ÛÙÒÓ Î·È
ÈÓÔ‚Ï·ÛÙÒÓ ÚÔÂÚ¯fiÌÂÓˆÓ ·fi Ù· ÛËÌ·Ṳ̂ӷ
™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ‰ËÌÈÔ˘ÚÁ›·
ÔÛÙÔ‡ Û ۇÁÎÚÈÛË Ì ·Ô˘Û›· ıÂÚ·›·˜ ηÈ
ÌfiÓÔ ÙÔ Ì¤ÛÔ ÌÂÙ·ÊÔÚ¿˜.
AÓ¿Ï·ÛË ÙÔ˘ ÔÛÙÔ‡.
AÓ¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ.
T· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ÙÔ˘
ÂÚÈÚÚÈ˙›Ô˘ ·ÚÔ˘Û›·Û·Ó ÙË ÌÂÁ·Ï‡ÙÂÚË
‰ËÌÈÔ˘ÚÁ›· ÔÛÙÔ‡, ÂÚÈÚÚÈ˙›Ô˘ Î·È ÔÛÙ½Ó˘,
Ó¢ÚÈÎÔ‡ Î·È ·ÁÁÂÈ·ÎÔ‡ ÈÛÙÔ‡.
¶Úˆ˚ÌfiÙÂÚË ÂÓ·Û‚ÂÛÙ›ˆÛË Î·È ÌÂÁ·Ï‡ÙÂÚË
‰ËÌÈÔ˘ÚÁ›· ÔÛÙÔ‡ Û ۇÁÎÚÈÛË Ì ÙÔ Ì¤ÛÔ
ÌÂÙ·ÊÔÚ¿˜, Û˘Ó‰˘·ÛÌfi ÙÔ˘ ̤ÛÔ˘ ÌÂÙ·ÊÔÚ¿˜
Ì ·Ó·Û˘Ó‰˘·Ṳ̂ÓË ·ÓıÚÒÈÓË ÌÔÚÊÔÁÂÓÂÙÈ΋
ÚˆÙ½ÓË ÙÔ˘ ÔÛÙÔ‡-2, Û˘Ó‰˘·ÛÌfi ÙÔ˘ ̤ÛÔ˘
ÌÂÙ·ÊÔÚ¿˜ Ì ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú·,
·˘ÙÔÁÂÓ¤˜ ÔÛÙÔ‡Ó.
19
18
17
16
15
14
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
45
46
PRP
E›Ì˘Â˜
Wistar
Y‰ÚÔ͢··Ù›Ù˘/‚ʈÛÊÔÚÈÎfi
·Û‚¤ÛÙÈÔ
PRP
XÂÈÚÔ˘ÚÁÈο
ÚÔÎÏËı›Û˜
·Ú·ÏÏËÏfiÁÚ·Ì̘
ÂÊÈÈÔÂȉ›˜
ÂÚÈÂÌÊ˘ÙÂ˘Ì·ÙÈΤ˜
‚Ï¿‚˜
XÂÈÚÔ˘ÚÁÈο
ÚÔÎÏËı›Û˜
ÔÛÙÈΤ˜ ‚Ï¿‚˜
Y‚ÚȉÈÎÔ›
Û·ÏÔÈ
™Î‡ÏÔÈ
beagle
MÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ‰È·ÊÔÚÂÙÈÎÒÓ ÈÛÙÒÓ
¶ÂÚÈÔ‰ÔÓÙÈΤ˜
‚Ï¿‚˜
MÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡
A˘ÙÔÁÂÓ‹
ÌÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
A˘ÙÔÁÂÓ‹
ÌÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
Ì˘ÂÏÔ‡ ÙˆÓ
ÔÛÙÒÓ ‹
ÂÚÈÚÚÈ˙›Ô˘
AÏÏÔÁÂÓ‹
ÌÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡
A˘ÙÔÁÂÓ‹
ÌÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
Ì˘ÂÏÔ‡ ÙˆÓ
ÔÛÙÒÓ
KÔÏÏ·ÁfiÓÔ
¶ÂÚÈÔ‰ÔÓÙÈΤ˜
‚Ï¿‚˜ 5x5mm
ÂÎÙÂÈÓfiÌÂÓ˜ ·fi
ÙËÓ
·‰·Ì·ÓÙÈÓÔÔÛÙ½ÓÈ΋ ¤ÓˆÛË
™Î‡ÏÔÈ
beagle
A˘ÙÔÁÂÓ‹
ÌÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
Ì˘ÂÏÔ‡ ÙˆÓ
ÔÛÙÒÓ
AÙÂÏÔÎÔÏÏ·ÁfiÓÔ ÛÂ
Û˘ÁΤÓÙÚˆÛË 2x106,
5x106,
1x107, ηÈ
2x107
·ÙÙ·Ú·/ml
XÂÈÚÔ˘ÚÁÈο
ÚÔÎÏËı›Û˜
‚Ï¿‚˜ Ù˘
ÂÚÈÔ¯‹˜ Û˘Ì‚ÔÏ‹˜
ÙˆÓ ÚÈ˙ÒÓ
ηÙËÁÔÚ›·˜ III
™Î‡ÏÔÈ
beagle
ÔÛÙÒÓ
ÙˆÓ ÚÈ˙ÒÓ
ηÙËÁÔÚ›·˜ III
2,4 Î·È 8
‚‰ÔÌ¿‰Â˜
8 Î·È 16
‚‰ÔÌ¿‰Â˜
2, 4, 8
‚‰ÔÌ¿‰Â˜
8
‚‰ÔÌ¿‰Â˜
1 Ì‹Ó·˜
™ÙȘ 4 Î·È 8 ‚‰ÔÌ¿‰Â˜ ‰ËÌÈÔ˘ÚÁ›· ·ÁÁÂÈ·ÎÔ‡
ÈÛÙÔ‡ Î·È ÒÚÈÌÔ˘ ÔÛÙÔ‡, ıÂÙÈÎÔ‡ ÁÈ·
ÔÛÙÂÔηÏÛ›ÓË ÛÙȘ 8 ‚‰ÔÌ¿‰Â˜. ™Ù·ÙÈÛÙÈο
¢ËÌÈÔ˘ÚÁ›· ÔÛÙÔ‡: ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο
ÌÂÁ·Ï‡ÙÂÚË Û ۇÁÎÚÈÛË Ì ÙÔ Ì¤ÛÔ ÌÂÙ·ÊÔÚ¿˜
ÌfiÓÔ, ÌÂÁ·Ï‡ÙÂÚË ÁÈ· Ù· ·‰È·ÊÔÚÔÔ›ËÙ·
ÌÂÛÂÁ¯˘Ì·ÙÈο ·ÙÙ·Ú· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÛÙȘ
8 ‚‰ÔÌ¿‰Â˜. ™ÙȘ 16 ‚‰ÔÌ¿‰Â˜ ÛÙ·ÙÈÛÙÈο
ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ‰ËÌÈÔ˘ÚÁ›· ÔÛÙÔ‡ ÌfiÓÔ
ÁÈ· Ù· ·‰È·ÊÔÚÔÔ›ËÙ· ÌÂÛÂÁ¯˘Ì·ÙÈο ·ÙÙ·Ú·
Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ. T· ÛËÌ·Ṳ̂ӷ Ì ÊıÔÚÈÛÌfi
ÌÂÙ·ÌÔÛ¯Â˘Ì¤Ó· ·ÙÙ·Ú· ·ÓȯÓ‡ıËÎ·Ó ÛÂ
Â·Ê‹ Ì ÙÔ Ì¤ÛÔ ÌÂÙ·ÊÔÚ¿˜ Î·È ÌÂÚÈÎÒ˜ Ì ÙÔ
Û˘Ó‰ÂÙÈÎfi ÈÛÙfi Î·È ÙÔ ÔÛÙÂÔÂȉ¤˜.
™ÙȘ 2 Î·È 4 ‚‰ÔÌ¿‰Â˜ ÌÈÎÚ‹ ‰ËÌÈÔ˘ÚÁ›· ÔÛÙÔ‡.
™ÙȘ 8 ‚‰ÔÌ¿‰Â˜ ‰ËÌÈÔ˘ÚÁ›· ÔÛÙÔ‡ Î·È ÈÛÙÔ‡
ÚÔÛÔÌÔÈ¿˙ÔÓÙÔ˜ ÌÂ ÂÚÈÚÚ›˙ÈÔ.
™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ‰ËÌÈÔ˘ÚÁ›·
ÔÛÙÔ‡, ÔÛÙ½Ó˘ Î·È ÂÚÈÚÚÈ˙›Ô˘ Û ۇÁÎÚÈÛË ÌÂ
ÙÔ Ì¤ÛÔ ÌÂÙ·ÊÔÚ¿˜ ÌfiÓÔ. H ÎÚ˘Ô‰È·Ù‹ÚËÛË ÙˆÓ
·‰È·ÊÔÚÔÔ›ËÙˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ
‰ÂÓ Â›¯Â ÂÈÙÒÛÂȘ ÛÙÔ ıÂÚ·¢ÙÈÎfi
·ÔÙ¤ÏÂÛÌ·.
MÂÁ·Ï‡ÙÂÚË ‰ËÌÈÔ˘ÚÁ›· ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ ÛÂ
Û‡ÁÎÚÈÛË Ì ·ÙÂÏÔÎÔÏÏ·ÁfiÓÔ. TÔ ÔÛÔÛÙfi ÙÔ˘
Ì‹ÎÔ˘˜ Ù˘ ÔÛÙ½Ó˘ ÁÈ· ÙË Û˘ÁΤÓÙÚˆÛË
·ÙÂÏÔÎÔÏÏ·ÁfiÓÔ˘ 5x106 Î·È 2x107 ·ÙÙ·Ú·/ml
Î·È ÙÔ ÔÛÔÛÙfi ÙÔ˘ ÓÂÔ‰ËÌÈÔ˘ÚÁËı¤ÓÙÔ˜ ÔÛÙÔ‡
ÁÈ· ÙË Û˘ÁΤÓÙÚˆÛË ·ÙÂÏÔÎÔÏÏ·ÁfiÓÔ˘ 2x107
·ÙÙ·Ú·/ml ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο
ÌÂÁ·Ï‡ÙÂÚ·.
Ì Ú¿ÛÈÓË ÊıÔÚ›˙Ô˘Û· ÚˆÙ½ÓË
ÌÂÙ·ÌÔÛ¯Â˘Ì¤Ó· ·ÙÙ·Ú· ÛÙÔÓ
ÓÂÔ‰ËÌÈÔ˘ÚÁËı¤ÓÙ· Û˘Ó‰ÂÙÈÎfi ÈÛÙfi.
23
5
22
21
20
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Hellenic Stomatological Review 57: 39-71, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Ì˘ÂÏÔ‡ ÙˆÓ
ÔÛÙÒÓ ‹
Ô‰ÔÓÙÈÎÔ‡
ÔÏÊÔ‡ ‹
·ÏÏÔÁÂÓ‹
ÌÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú·
ÓÂÔÁÈÏÒÓ
‰ÔÓÙÈÒÓ
ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ‰ËÌÈÔ˘ÚÁ›· ÔÛÙÔ‡ ÛÙȘ 8
‚‰ÔÌ¿‰Â˜ Û ۇÁÎÚÈÛË Ì ·Ô˘Û›· ıÂÚ·›·˜
Î·È ÙÔ Ì¤ÛÔ ÌÂÙ·ÊÔÚ¿˜ ÌfiÓÔ.
Literature Review
ntiated into cementoblast-like cells and produced cementum-like tissue. It has been reported that the hydroxyapatite and b-calcium phosphate granules (due to their
morphology and release of calcium and phosphate ions)
become apatite aggregation nodules which enhance the
differentiation of mesenchymal stem cells into cells
producing mineralized tissues15.
During the morphogenesis of the dental tissues, prior to
cementum formation, dental follicle cells penetrate the
disintegrated Hertwig’s epithelial root sheath and come
in contact with non-mineralized root dentin matrix. Wen
et al.26 explored the impact of the contact between dental
follicle cells and dentin matrix on cementoblast differentiation and cementum formation. They studied the
differentiation of adipose tissue-derived mesenchymal
stem cells cultured in the medium of dental follicle cells,
where non-collagenous dentin proteins were added. The
spindle-shaped cells were transformed into cementoblast-like, flat, cuboidal or polygonal cells. Cell proliferation was suppressed whereas cell differentiation was
enhanced. Cells exhibited high alkaline-phosphatase
(ALP) activity and calcified nodule formation. Moreover,
mineralization markers mainly expressed in the dental
hard tissues, by cementoblasts, odontoblasts or ameloblasts, were detected at mRNA and protein level, such as
bone sialoprotein (BSP), osteonectin (ON), osteocalcin
(OCN), osteopontin (OPN) and type I collagen. However,
cementoblast-specific cementum attachment protein
(CAP) was detected whereas odontoblast-specific dentin
sialophosphoprotein gene, which encodes two major
non-collagenous dentine matrix proteins, dentin sialoprotein and phosphoprotein, was not detected. Therefore, Wen et al.’s study26 demonstrated that mesenchymal stem cells differentiated into cells with cementoblast
characteristics.
Risk of carcinogenesis by mesenchymal stem cells
The ability of mesenchymal stem cells to differentiate into
various cell lineages entails the risk of carcinogenesis.
The type of the transplanted cells and the environment of
the recipient area affect the chance of developing cancer27. Carcinogenesis after mesenchymal stem cell transplantation for periodontal tissue regeneration has not
been reported. Culturing mesenchymal stem cells in a
medium promoting differentiation into a specific cell type,
prior to transplantation, has been reported to reduce the
carcinogenesis risk27.
Immunogenic and immunomodulatory properties of
the allogenic mesenchymal stem cells
The mesenchymal stem cells might be of autologous or
allogeneic origin. The autologous mesenchymal stem
cells do not induce immune reaction. However, their ability to produce an adequate number of cells is doubtful
due to differences in cell growth and differentiation
among individuals. Allogenic mesenchymal stem cells
have specific regenerative potential. However, they entail
Hellenic Stomatological Review 57: 39-71, 2013
47
48
PRP,
fluorohydroxyapatite
PRP
Surgically induced
osseous defects of
3.5mm diameter
and 8mm depth
Osseous defects
Dogs
Minipigs
Dogs
Animal
model
Mesenchymal
stem cells
Mesenchymal
stem cells
Mesenchymal
stem cells
Transplanted
cells
Mandibular buccal
cortical periodontal
defects
Collagensponge
Immunodeficient
mice
Heterologous
periodontalderived
mesenchymal
stem cells
Dental and periodontal tissue-derived mesenchymal stem cells
Platelet-rich
plasma(PRP)
Vehicle
Surgically induced
premolar class II
furcation defects of
5mm height and
2mm depth
Mesenchymal stem cells
Defect
Not
reported
2, 4 and
8 weeks
3 months
8 weeks
Study
duration
Creation of periodontal ligament-like tissue,
collagen fibers and bone, but no regeneration of
functional periodontal tissues.
At 2 and 4 weeks well-formed mature bone and
vascular tissue creation as compared to
absence of treatment, vehicle only and
combination of autologous trabecular bone and
bone marrow. Bone creation: statistically
significantly higher at 8 weeks as compared to
absence of treatment and vehicle only, similar to
combination of autologous trabecular bone and
bone marrow.
Bone creation: statistically significanly higher as
compared to fluorohydroxyapatite and
combination of fluorohydroxyapatite with PRP,
similar to autologous bone. Statistically
significantly higher contact between
fluorohydroxyapatite and newly-created bone as
compared to fluorohydroxyapatite and
combination of fluorohydroxyapatite with PRP.
Bone creation: similar for all groups.
Cementum creation: statistically significantly
higher as compared to phase I periodontal
treatment and vehicle only, similar to autologous
cortical bone and combination of autologous
cortical bone with PRP.
Results
Table 2: Mesenchymal stem cell transplantation studies for periodontal and peri-implant tissue regeneration
in animal models.
13
12
11
10
Study
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Hellenic Stomatological Review 57: 39-71, 2013
Hellenic Stomatological Review 57: 39-71, 2013
Minipigs
Autologous
deciduous
teeth-derived
mesenchymal
stem cells
Periodontal
ligamentderived
mesenchymal
stem cells
Atelocollagen
Beagle
dogs
Autologous
bone marrowderived
Not
reported
Critical size
mandibular osseous
defects
Minipigs
Autologous
periodontal
ligament, pulp
or dental
follicle-derived
mesenchymal
stem cells
Surgically induced
class III furcation
defects
Not
reported
Surgically induced
periodontal defects
Beagle
dogs
Autologous
pulp-derived
mesenchymal
stem cells
Bone marrowderived
mesenchymal
stem cells
Not
reported
Periodontal defects
extending to the
apex
New
Zealand
rabbits
Bone marrow-derived mesenchymal stem cells
Maxillary alveolar
Fibrin
Sprabone traumatic
glue
guedefects
Dawley
rats
Human
recombinant
bone
morphogenetic
protein,
nanohydroxyapatite,
collagen,
poly-Llactide
Critical size alveolar
osseous defects
4 weeks
6 weeks
6 months
-
-
12 weeks
Almost complete periodontal tissue
regeneration. Detection of labeled osteoblasts,
osteocytes, cementoblasts and fibroblasts
Statistically significantly higher bone creation as
compared to absence of treatment and
application of vehicle only.
Bone regeneration
Periodontal tissue regeneration
Periodontal ligament-derived mesenchymal
stem cells presented the highest bone,
periodontal ligament, cementum, neural and
vascular tissue creation.
More rapid mineralization and higher bone
creation as compared to vehicle only,
combination of vehicle with BMP-2, combination
of vehicle with mesenchymal stem cells,
autologous bone.
19
18
17
16
15
14
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
49
50
Collagen
Periodontal defects
(5x5mm) extending
from
cementoenamel
junction andapically
Beagle
dogs
Beagle
dogs
PRP
Wistar
rats
Surgically induced
osseous defects
Surgically induced
rectangular, saddlelike peri-implant
defects
PRP
Hybrid
dogs
Hydroxyapati- Beagle
te/‚-tricalcium- dogs
phosphate
Diverse tissue-derived mesenchymal stem cells
Periodontal defects
Adipose tissue-derived mesenchymal stem cells
Atelocollagen in
concentrations 2x106,
5x106,
1x107,and
2x107 cells/ml
Surgically induced
class III furcation
defects
Autologous
bone marrowor dental pulpderived or
allogenic
deciduous
teeth-derived
mesenchymal
stem cells
Autologous
bone marrowor periodontal
ligamentderived
mesenchymal
stem cells
Allogenic
adipose tissuederived
mesenchymal
stem cells
Autologous
bone marrowderived
mesenchymal
stem cells
Autologous
bone marrowderived
mesenchymal
stem cells
mesenchymal
stem cells
2,4 and 8
weeks
8 and 16
weeks
2,4 and 8
weeks
8 weeks
1 month
At 4 and 8 weeks vascular tissue and mature
bone creation, at 8 weeks osteocalcin-positive
tissue. Statistically significantly higher bone
creation at 8 weeks as compared to absence of
treatment and vehicle only.
Bone creation: statistically significantly higher as
compared to vehicle only, higher for bone
marrow-derived mesenchymal stem cells at 8
weeks. At 16 weeks statistically significantly
higher bone creation only for bone marrowderived mesenchymal stem cells. Fluorescentlabeled transplanted cells were detected in
contact to the vehicle and partially to connective
tissue and osteoid
At 2 and 4 weeks low bone creation. At 8 weeks
bone and periodontal ligament-like tissue
creation.
Statistically significantly higher bone, cementum
and periodontal ligament creation as compared
to vehicle only. Mesenchymal stem cell
cryopreservation had no effect on the
therapeutic result.
Higher periodontal tissue creation as compared
to atelocollagen. Statistically significantly higher
% of newly-created cementum length for
atelocollagen concentration of 5x106 and 2x107
cells/ml and statisticallysignificanly higher % of
newly-created bone for atelocollagen
concentration of 2x107 cells/ml were.
deriving from GFP-labeled cells transplanted in
the newly-created connective tissue.
23
5
22
21
20
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Hellenic Stomatological Review 57: 39-71, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
ÙËÓ ˘Ô‰fiÚÈ· ÂÌʇÙ¢ÛË ·ÓıÚÒÈÓˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ
‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÔ‰ÔÓÙ›Ô˘ ·Ó·ÌÂÌÂÈÁÌ¤ÓˆÓ ÌÂ
ÎfiÎÎÔ˘˜ ÔÛÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜, ·ÔÙÂÏÔ‡ÌÂÓÔ˘ ·fi ˘‰ÚÔ͢··Ù›ÙË Î·È ‚-ʈÛÊÔÚÈÎfi ·Û‚¤ÛÙÈÔ. AÚ¯Èο, ÙËÓ
ÙÚ›ÙË Ë̤ڷ Î·È ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÚÒÙ˘ ‚‰ÔÌ¿‰·˜, ·Ú·ÙËÚ‹ıËΠÔÏÏ·Ï·ÛÈ·ÛÌfi˜ Î·È ÌÂÙ·Ó¿ÛÙ¢ÛË ÙˆÓ
ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ÌÂٷ͇ ÙˆÓ ÎfiÎΈÓ
ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. E›Û˘, ·Ú·ÙËÚ‹ıËΠ‰ËÌÈÔ˘ÚÁ›· ¿ÌÔÚÊ˘ Ì¿˙·˜ ÎÔÏÏ·ÁfiÓÔ˘. H ÌÔÚÊÔÏÔÁ›· ÙˆÓ ˘Ú‹ÓˆÓ
ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‰È¤ÊÂÚ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÂÚÈÔ¯ÒÓ.
°‡Úˆ ·fi ÙÔ˘˜ ÎfiÎÎÔ˘˜ ·Ú·ÙËÚ‹ıËÎ·Ó ·Ú·È¿ ‰È·ÙÂÙ·Á̤ӷ ·ÙÙ·Ú· Ì ΢ÎÏÔÙÂÚ‹ ˘Ú‹Ó· ÚÔÛÔÌÔÈ¿˙ÔÓÙ· Ì ÔÛÙÂ˚ÓÔ‚Ï¿ÛÙ˜ ÂÓÒ Ì¤Û· ÛÙËÓ ¿ÌÔÚÊË Ì¿˙· ÎÔÏÏ·ÁfiÓÔ˘ ‚Ú¤ıËÎ·Ó ‰È¿Û·ÚÙ· ·ÙÙ·Ú· Ì ·ÙÚ·ÎÙÔÂȉ‹
˘Ú‹Ó· ÚÔÛÔÌÔÈ¿˙ÔÓÙ· Ì ÈÓÔ‚Ï¿ÛÙ˜. ™ÙÔ Ù¤ÏÔ˜ Ù˘
‰Â‡ÙÂÚ˘ ‚‰ÔÌ¿‰·˜, Ë ¿ÌÔÚÊË Ì¿˙· ÎÔÏÏ·ÁfiÓÔ˘ ›¯Â
·ÓÙÈηٷÛÙ·ı› ·fi ηϿ ÔÚÁ·ÓˆÌ¤Ó˜ ›Ó˜ ÎÔÏÏ·ÁfiÓÔ˘
·Ó¿ÌÂÛ· ÛÙÔ˘˜ ÎfiÎÎÔ˘˜ Î·È Û Â·Ê‹ Ì ·˘ÙÔ‡˜. T·
·ÙÙ·Ú· Ô˘ ›¯·Ó ΢ÎÏÔÙÂÚ‹ ˘Ú‹Ó· ‹Ù·Ó ˘ÎÓ¿ ‰È·ÙÂÙ·Á̤ӷ Û ÛÙÈ‚¿‰· Á‡Úˆ ·fi ÙÔ˘˜ ÎfiÎÎÔ˘˜. HˆÛÈÓfiÊÈÏÔ˜ ÌË ÂÓ·Û‚ÂÛÙȈ̤ÓÔ˜ ÈÛÙfi˜ ÚÔÛÔÌÔÈ¿˙ˆÓ Ì ÔÛÙÂ˚ÓÔÂȉ¤˜ ·Ú·ÙËÚ‹ıËΠÌÂٷ͇ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì ΢ÎÏÔÙÂÚ‹ ˘Ú‹Ó· Î·È ÙˆÓ ÎfiÎΈÓ. M¤Û· ÛÙÔÓ ËˆÛÈÓfiÊÈÏÔ ÈÛÙfi ÂÈÛ¤Ú¯ÔÓÙ·Ó ›Ó˜ ÎÔÏÏ·ÁfiÓÔ˘, ·ÚfiÌÔȘ Ì ›Ó˜
ÙÔ˘ Sharpey. ™ÙÔ Ù¤ÏÔ˜ Ù˘ ٤ٷÚÙ˘ ‚‰ÔÌ¿‰·˜, Ô ÚÔÛÔÌÔÈ¿˙ˆÓ Ì ÔÛÙÂ˚ÓÔÂȉ¤˜ ÈÛÙfi˜ Ô˘ ÂÚȤ‚·Ï ٷ ÎÔÎΛ· Ê¿ÓËΠӷ ÂÓ·Û‚ÂÙÈÒÓÂÙ·È. M¤Û· Û ·˘ÙfiÓ ÙÔÓ ÚÔÛÔÌÔÈ¿˙ÔÓÙ· Ì ÔÛÙ½ÓË ÂÓ·Û‚ÂÛÙȈ̤ÓÔ ÈÛÙfi η٤ÏËÁ·Ó ηϿ ÔÚÁ·ÓˆÌ¤Ó˜ ›Ó˜ ·ÚfiÌÔȘ Ì ›Ó˜ ÙÔ˘
Sharpey. E›Û˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÎԛϘ ÂÚÈÔ¯¤˜ Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ ÎfiÎÎˆÓ Ì ·˘ÍË̤ÓË ˘ÎÓfiÙËÙ· ΢ÙÙ¿ÚˆÓ
ÚÔÛÔÌÔÈ·˙fiÓÙˆÓ Ì ÔÛÙÂ˚ÓÔ‚Ï¿ÛÙ˜, ÈÛÙfi˜ ÚÔÛÔÌÔÈ¿˙ˆÓ Ì ÔÛÙ½ÓË Î·È ›Ó˜ ·ÚfiÌÔȘ Ì ›Ó˜ ÙÔ˘ Sharpey.
OÈ Park Î·È Û˘Ó.15 ÌÂϤÙËÛ·Ó Â›Û˘ ÙËÓ ˘Ô‰fiÚÈ· ÂÌʇÙ¢ÛË ·ÓıÚÒÈÓˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ÙÔ˘
ÂÚÈÔ‰ÔÓÙ›Ô˘ ·Ó·ÌÂÌÂÈÁÌ¤ÓˆÓ Ì ÎfiÎÎÔ˘˜ ÔÛÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ ˘‰ÚÔ͢··Ù›ÙË Î·È ‚-ʈÛÊÔÚÈÎÔ‡ ·Û‚ÂÛÙ›Ô˘
Û ·ÓÔÛÔ·ÓÂ·Ú΋ ÔÓÙ›ÎÈ·. MÂÙ¿ ·fi 8 ‚‰ÔÌ¿‰Â˜ ·Ú·Ù‹ÚËÛ·Ó ‰ËÌÈÔ˘ÚÁ›· ΢ÙÙ·ÚÔÊfiÚÔ˘ ÔÛÙ½Ó˘ Ô˘ ÂÚÈ›¯Â ÔÛÙÂ˚ÓÔ·ÙÙ·Ú·, ‰ËÏ·‰‹ ÔÛÙÂ˚ÓÔ‚Ï¿ÛÙ˜ Ô˘ ›¯·Ó
ÂÁÎψ‚ÈÛÙ› Û ·˘Ù‹Ó ηٿ ÙË ‰È·‰Èηۛ· ÂÓ·fiıÂÛ‹˜ Ù˘,
̤۷ ÛÙËÓ ÔÔ›· ÂÈÛ¤Ú¯ÔÓÙ·Ó ›Ó˜ ÙÔ˘ Sharpey.
™ÙË ÌÂϤÙË ·˘Ù‹, Ù· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ÙÔ˘
ÂÚÈÔ‰ÔÓÙ›Ô˘ ·Ú‹Á·Á·Ó ÈÛÙfi ÚÔÛÔÌÔÈ¿˙ÔÓÙ· ÌÂ Û˘Ó‰ÂÙÈÎfi ÈÛÙfi ÙÔ˘ ÂÚÈÔ‰ÔÓÙ›Ô˘ Î·È ÔÛÙ½ÓË. T· ·ÙÙ·Ú·
Ô˘ ‚Ú›ÛÎÔÓÙ·Ó Û Â·Ê‹ Ì ÙÔ˘˜ ÎfiÎÎÔ˘˜ ÙÔ˘ ÔÛÙÈÎÔ‡
ÌÔۯ‡̷ÙÔ˜ ‰È·ÊÔÚÔÔÈ‹ıËÎ·Ó Û ·ÙÙ·Ú· ÚÔÛÔÌÔÈ¿˙ÔÓÙ· Ì ÔÛÙÂ˚ÓÔ‚Ï¿ÛÙ˜ Î·È ·Ú‹Á·Á·Ó ÈÛÙfi ÚÔÛÔÌÔÈ¿˙ÔÓÙ· Ì ÔÛÙ½ÓË. Œ¯ÂÈ ·Ó·ÊÂÚı› ˆ˜ Ù· ÎÔÎΛ· ˘‰ÚÔ͢··Ù›ÙË Î·È ‚-ʈÛÊÔÚÈÎÔ‡ ·Û‚ÂÛÙ›Ô˘, ÏfiÁˆ Ù˘
ÌÔÚÊÔÏÔÁ›·˜ ÙÔ˘˜ Î·È Ù˘ ·ÂÏ¢ı¤ÚˆÛ˘ ÈfiÓÙˆÓ ·Û‚ÂÛÙ›Ô˘ Î·È ÊˆÛÊfiÚÔ˘, ·ÔÙÂÏÔ‡Ó ˘Ú‹Ó˜ ηٷÎÚ‹ÌÓÈÛ˘ ··Ù›ÙË, Ô˘ Â¿ÁÔ˘Ó ÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ Û ·ÙÙ·Ú· Ô˘ ·Ú¿ÁÔ˘Ó ÂÓ·Û‚ÂÛÙȈ̤ÓÔ˘˜ ÈÛÙÔ‡˜15.
K·Ù¿ ÙË ÌÔÚÊÔÁ¤ÓÂÛË ÙˆÓ Ô‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ, ÚÈÓ ·fi ÙÔ
Û¯ËÌ·ÙÈÛÌfi ÔÛÙ½Ó˘, Ù· ·ÙÙ·Ú· ÙÔ˘ Ô‰ÔÓÙÔı˘Ï·Î›Ô˘
‰ÈÂÈÛ‰‡Ô˘Ó ÛÙÔ ·ÔÛ˘ÓÙÂıÂÈ̤ÓÔ ÂÈıËÏÈ·Îfi ¤Ï˘ÙÚÔ
Hellenic Stomatological Review 57: 39-71, 2013
the risk of rejection by the recipient’s immune system,
due to possible major histocompatibility complex (MHC)
mismatching between the cells and the recipient
organism28. Though, it has been shown that mesenchymal stem cells have low immunogenicity, since culture of
human periodontal ligament-derived mesenchymal stem
cells with allogenic peripheral blood mononuclear cells
did not induce mononuclear cell proliferation29.
Furthermore, mesenchymal stem cells have the ability to
suppress immune response. It has been found that
culture of human periodontal ligament-derived mesenchymal stem cells with allogenic peripheral blood mononuclear cells, that had been stimulated by a mitogenic
agent or had been co-cultured with allogenic mononuclear cells, led to a dose-dependent inhibition of mononuclear cell proliferation28. At the highest dose, almost
complete inhibition of their proliferation was noted. The
authors claimed that mononuclear cell proliferation
inhibition was due to cell division prevention, following
interaction between mononuclear cells and mesenchymal stem cells rather than to cell apoptosis28. Specifically,
it was suggested that mononuclear cell proliferation was
mainly inhibited by mesenchymal stem cell-released
factors after stimulation by mononuclear cells rather than
by mere contact with them. Intrerferon-Á, which is
released by T-cells after stimulation by a mitogenic agent
or exposure to an antigen to which they have been
sensitized, has been found to stimulate the release of
such agents by bone marrow-derived mesenchymal
stem cells. In Wada et al.’s study28 mesenchymal stem
cells were cultured in the presence of interferon-Á, which
had been produced by mononuclear cells stimulated by
a mitogenic agent. Culturing mononuclear cells in this
medium resulted in partial suppression of the proliferation. Contrary to this, in the absence of interferon-Á the
proliferation of mononuclear cells cultured in mesenchymal stem cell medium was not suppressed. This
indicates that interferon-Á, secreted by mononuclear
cells, is partially responsible for the suppression of the
proliferation of mononuclear cells by mesenchymal stem
cells. Moreover, the expression of transforming growth
factor-1(TGF-1), hepatocyte growth factor (HGF) and
indoleamine 2,3-dioxygenase(IDO), which are involved
in the mesenchymal stem cell immunosuppressive
effect, has been found to increase in periodontal
ligament-derived mesenchymal stem cells cultured with
mononuclear cells29. Interestingly, the expression of
indoleamine 2,3-dioxygenase, contrary to the other
factors, increased after mesenchymal stem cell culture in
the presence of interferon-Á, which indicates that
indoleamine 2,3-dioxygenase production is promoted by
interferon-Á released by mononuclear cells. Suppression
of the mononuclear cell proliferation by mesenchymal
stem cells has been reversed, since isolation of
mononuclear cells and re-stimulation by a mitogenic
agent triggered rapid proliferation29. The immunosuppressive properties of mesenchymal stem cells seem to
be of particular significance for their application in perio51
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Ù˘ Ú›˙·˜ ÙÔ˘ Hertwig Î·È ¤Ú¯ÔÓÙ·È Û Â·Ê‹ Ì ÙË ÌË ÂÓ·Û‚ÂÛÙȈ̤ÓË ıÂ̤ÏÈ· Ô˘Û›· Ù˘ Ô‰ÔÓÙ›Ó˘ Ù˘ Ú›˙·˜.
OÈ Wen Î·È Û˘Ó.26 ‰ÈÂÚ¢ÓÒÓÙ·˜ ÙËÓ Â›‰Ú·ÛË Ù˘ Â·Ê‹˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ô‰ÔÓÙÔı˘Ï·Î›Ô˘ Ì ÙË ıÂ̤ÏÈ·
Ô˘Û›· Ù˘ Ô‰ÔÓÙ›Ó˘ ÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ÔÛÙÂ˚ÓÔ‚Ï·ÛÙÒÓ Î·È ÙÔ Û¯ËÌ·ÙÈÛÌfi ÔÛÙ½Ó˘, ÌÂϤÙËÛ·Ó ÙË ‰È·ÊÔÚÔÔ›ËÛË ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ Ô˘ ηÏÏÈÂÚÁ‹ıËÎ·Ó Û ıÚÂÙÈÎfi ˘ÏÈÎfi ηÏÏȤÚÁÂÈ·˜ ΢ÙÙ¿ÚˆÓ ÙÔ˘ Ô‰ÔÓÙÔı˘Ï·Î›Ô˘ ÛÙÔ ÔÔ›Ô
ÚÔÛÙ¤ıËÎ·Ó ÌË ÎÔÏÏ·ÁÔÓÔ‡¯Â˜ Ô‰ÔÓÙÈÓÈΤ˜ ÚˆÙ½Ó˜. T· ·ÙÙ·Ú· ÌÂÙ·Û¯ËÌ·Ù›ÛÙËÎ·Ó ·fi ·ÙÚ·ÎÙÔÂȉ‹ Û Â›‰· ·ÙÙ·Ú· ΢‚ÔÂȉԇ˜ ‹ ÔÏ˘ÁˆÓÈÎÔ‡ Û¯‹Ì·ÙÔ˜, ·ÚfiÌÔÈÔ˘ Ì ·˘ÙÔ‡ ÙˆÓ ÔÛÙÂ˚ÓÔ‚Ï·ÛÙÒÓ. ¶·Ú·ÙËÚ‹ıËΠηٷÛÙÔÏ‹ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÚÔ·ÁˆÁ‹ Ù˘ ‰È·ÊÔÚÔÔ›ËÛ‹ ÙÔ˘˜. T· ·ÙÙ·Ú· ·ÚÔ˘Û›·Û·Ó ˘„ËÏ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· ·ÏηÏÈ΋˜
ʈÛÊ·Ù¿Û˘ Î·È Û¯ËÌ·ÙÈÛÌfi ÂÓ·Û‚ÂÛÙÈˆÌ¤ÓˆÓ ÂÛÙÈÒÓ
ÂÓÒ ·ÓȯÓ‡ÙËηÓ, Û Â›Â‰Ô mRNA Î·È ÚˆÙÂ˚ÓÒÓ, ‰Â›ÎÙ˜ ÂÓ·Û‚ÂÛÙ›ˆÛ˘, Ô˘ ÂÎÊÚ¿˙ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙÔ˘˜
ÛÎÏËÚÔ‡˜ Ô‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜ ·fi ÔÛÙÂ˚ÓÔ‚Ï¿ÛÙ˜, Ô‰ÔÓÙÈÓÔ‚Ï¿ÛÙ˜ ‹ ·‰·Ì·ÓÙÈÓÔ‚Ï¿ÛÙ˜, fiˆ˜ ÛÈ·ÏÔÚˆÙ½ÓË ÙÔ˘ ÔÛÙÔ‡, ÔÛÙÂÔÓÂÎÙ›ÓË, ÔÛÙÂÔηÏÛ›ÓË, ÔÛÙÂÔÔÓÙ›ÓË Î·È ÎÔÏÏ·ÁfiÓÔ Ù‡Ô˘ I. øÛÙfiÛÔ ·ÓȯÓ‡ıËÎÂ Ë ÂȉÈ΋ ÁÈ· ÙȘ ÔÛÙÂ˚ÓÔ‚Ï¿ÛÙ˜ ÚˆÙ½ÓË Û‡Ó‰ÂÛ˘ ÔÛÙ½Ó˘ ÂÓÒ ‰ÂÓ ·ÓȯÓ‡ÙËΠÙÔ ÂȉÈÎfi ÁÈ· ÙȘ Ô‰ÔÓÙÈÓÔ‚Ï¿ÛÙ˜ ÁÔÓ›‰ÈÔ Ô‰ÔÓÙÈÓÈ΋˜ ÛÈ·ÏÔʈÛÊÔÚˆÙ½Ó˘, ÙÔ
ÔÔ›Ô Îˆ‰ÈÎÔÔÈ› ‰‡Ô ·ÚȘ ÌË ÎÔÏÏ·ÁÔÓÔ‡¯Â˜ ÚˆÙ½Ó˜ Ù˘ ıÂ̤ÏÈ·˜ Ô˘Û›·˜ Ù˘ Ô‰ÔÓÙ›Ó˘, ÙËÓ Ô‰ÔÓÙÈÓÈ΋ ÛÈ·ÏÔÚˆÙ½ÓË Î·È ÊˆÛÊÔÚˆÙ½ÓË. OÈ Wen ηÈ
Û˘Ó.26 Û˘Ì¤Ú·Ó·Ó, ÂÔ̤ӈ˜, ˆ˜ Ù· ÌÂÛÂÁ¯˘Ì·ÙÈο
‚Ï·ÛÙÔ·ÙÙ·Ú· ‰È·ÊÔÚÔÔÈ‹ıËÎ·Ó Û ·ÙÙ·Ú· Ì ¯·Ú·ÎÙËÚÈÛÙÈο ÔÛÙÂ˚ÓÔ‚Ï·ÛÙÒÓ.
K›Ó‰˘ÓÔ˜ ηÚÎÈÓÔÁ¤ÓÂÛ˘ ·fi Ù· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú·
H ÈηÓfiÙËÙ· ÙˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ Ó·
‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È Û ·ÙÙ·Ú· ‰È·ÊÔÚÂÙÈÎÒÓ ÛÂÈÚÒÓ ÂÓ¤¯ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·ÚÎÈÓÔÁ¤ÓÂÛ˘. TÔ Â›‰Ô˜ ÙˆÓ ÌÂÙ·ÌÔÛ¯Â˘fiÌÂÓˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ Ù˘ ‰¤ÎÙÚÈ·˜
ÂÚÈÔ¯‹˜ ÂËÚ¿˙Ô˘Ó ÙËÓ Èı·ÓfiÙËÙ· ÚfiÎÏËÛ˘ ηÎÔ‹ıÔ˘˜ ÓÂÔÏ·Û›·˜27. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ηÚÎÈÓÔÁ¤ÓÂÛË ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ÛÙ· Ï·›ÛÈ· Ù˘ ÚÔÛ¿ıÂÈ·˜ ·Ó¿Ï·Û˘ ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ. Œ¯ÂÈ ˘ÔÛÙËÚȯı› fiÙÈ Î·ÏÏȤÚÁÂÈ· ÙˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ, Û ̤ÛÔ Ô˘ ÚÔ¿ÁÂÈ ÙË ‰È·ÊÔÚÔÔ›ËÛ‹ ·˘ÙÒÓ ÛÂ
Û˘ÁÎÂÎÚÈ̤ÓÔ Â›‰Ô˜ ΢ÙÙ¿ÚˆÓ, ÚÈÓ ÙË ÌÂÙ·ÌfiÛ¯Â˘Û‹
ÙÔ˘˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ‚Ï¿‚˘ Â›Ó·È ‰˘Ó·Ùfi Ó· ÌÂÈÒÛÂÈ
ÙÔÓ Î›Ó‰˘ÓÔ ·˘Ùfi27.
AÓÙÈÁÔÓÈÎfiÙËÙ· Î·È ·ÓÔÛÔÚÚ˘ıÌÈÛÙÈΤ˜ ȉÈfiÙËÙ˜ ÙˆÓ
·ÏÏÔÁÂÓÒÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ
T· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ÌÔÚÔ‡Ó Ó· Â›Ó·È ·˘ÙÔÁÂÓÔ‡˜ ‹ ·ÏÏÔÁÂÓÔ‡˜ ÚÔ¤Ï¢Û˘. T· ·˘ÙÔÁÂÓ‹ ‰ÂÓ
ÚÔηÏÔ‡Ó ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË ·fi ÙÔÓ ÍÂÓÈÛÙ‹. øÛÙfiÛÔ, Â›Ó·È ·ÌÊ›‚ÔÏË Ë ÈηÓfiÙËÙ¿ ÙÔ˘˜ Ó· ·Ú¿ÁÔ˘Ó Â·Ú΋ ·ÚÈıÌfi ΢ÙÙ¿ÚˆÓ ÂÍ·ÈÙ›·˜ Ù˘ ‰È·ÊÔÚ¿˜ ÙÔ˘ ‰˘52
dontal tissue regeneration, since immune response
activation might negatively affect the therapeutic result.
Mesenchymal stem cells derived from inflammed
tissues
The granulation tissue surgically excised from periodontal defects during phase II periodontal treatment (surgical periodontal treatment) contains numerous mesenchymal stem cells. Mesencymal stem cells have been
isolated from granulation tissue removed from intraosseous periodontal defects15. Comparison between cultured mesenchymal stem cells derived from granulation
tissue isolated from intraosseous periodontal defects
and cultured mesenchymal stem cells derived from
healthy periodontium showed similar cell proliferation
but statistically significant different cell migration, with
mesenchymal stem cells derived from affected periodontium presenting higher migration15. In healthy periodontium, mesenchymal stem cells were restricted to the
paravascular area. Contrary to this, in periodontal defects mesenchymal stem cells were located in the
extravascular area close to the cementum, where they
might have migrated under the effect of inflammatory
mediators released by inflamed periodontal tissues.
Inflammatory mediators may enhance cell migration,
though the exact mechanism is yet to be clarified.
Furthermore, statistically significant lower mineralization
was noted while following subcutaneous implantation of
mesenchymal stem cells isolated from periodontal defects
in immunodeficient mice statistically significant lower cementum formation was noted. Inflammation is likely to
inhibit cell differentiation, however the effect of agents
enhancing cell differentiation might overcome this15.
GENE THERAPY
Techniques
Genetic material can be introduced into target-cells
either directly or indirectly. In the direct technique,
genetic material is directly transferred to the target-cells
of the organism (in-vivo technique). In the indirect
technique, genetic material is transferred to target cells
that have been isolated from the organism, have been
cultured and after introducing the genetic material into
them they are re-implanted into the organism (in-vitro
technique)3, 30 (Fig. 1).
Genetic material vectors
Genetic material is transferred to target-cells via vectors.
Viruses can be used as genetic material vectors, such as
retroviruses, lentiviruses, adenoviruses and adenoassociated viruses.
For retroviruses, the genetic material is single-stranded
RNA which, after being transcribed into DNA in the host
cell, is incorporated into the host cellular genome. Therefore, the cells deriving from the host cell proliferation contain the viral genetic material, thus enabling sustained
Hellenic Stomatological Review 57: 39-71, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Ó·ÌÈÎÔ‡ ·‡ÍËÛ˘ Î·È ‰È·ÊÔÚÔÔ›ËÛ˘ ÙˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ÌÂٷ͇ ÙˆÓ ·ÙfïÓ. T· ·ÏÏÔÁÂÓ‹ ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ¤¯Ô˘Ó ηıÔÚÈṲ̂ÓÔ
·Ó·Ï·ÛÙÈÎfi ‰˘Ó·ÌÈÎfi. EÓ¤¯Ô˘Ó, fï˜, ÙÔÓ Î›Ó‰˘ÓÔ ·fiÚÚȄ˘ ·fi ÙÔ ·ÓÔÛÔÏÔÁÈÎfi Û‡ÛÙËÌ· ÙÔ˘ ‰¤ÎÙË, ÏfiÁˆ Èı·Ó‹˜ ·Û˘Ì‚·ÙfiÙËÙ·˜ ÌÂٷ͇ ÙÔ˘ Ì›˙ÔÓÔ˜ Û˘ÌϤÁÌ·ÙÔ˜ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙÔ˘
‰¤ÎÙË ÔÚÁ·ÓÈÛÌÔ‡28. ¶·Ú’ fiÏ· ·˘Ù¿, ¤¯ÂÈ ‰Âȯı› ˆ˜ Ù·
ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ‰È·ı¤ÙÔ˘Ó ¯·ÌËÏ‹ ·ÓÙÈÁÔÓÈÎfiÙËÙ· ηıÒ˜ ηÏÏȤÚÁÂÈ· ·ÓıÚÒÈÓˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÚÚÈ˙›Ô˘ Ì ·ÏÏÔÁÂÓ‹ ÌÔÓÔ‡ÚËÓ· ·ÙÙ·Ú· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ‰ÂÓ ÚÔοÏÂÛ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ÌÔÓÔ‡ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ29.
EÈÚfiÛıÂÙ·, Ù· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ¤¯Ô˘Ó
ÙËÓ ÈηÓfiÙËÙ· Ó· ηٷÛÙ¤ÏÏÔ˘Ó ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË. Œ¯ÂÈ ‚ÚÂı› fiÙÈ Î·ÏÏȤÚÁÂÈ· ·ÓıÚÒÈÓˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÚÚÈ˙›Ô˘ Ì ·ÏÏÔÁÂÓ‹ ÌÔÓÔ‡ÚËÓ· ·ÙÙ·Ú· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Ô˘ ›¯·Ó
‰ÈÂÁÂÚı› Ì ÌÈÙÔÁfiÓÔ ·Ú¿ÁÔÓÙ· ‹ Û˘ÁηÏÏÈÂÚÁËı› ÌÂ
·ÏÏÔÁÂÓ‹ ÌÔÓÔ‡ÚËÓ· ·ÙÙ·Ú· ÚÔοÏÂÛ ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË ·Ó·ÛÙÔÏ‹ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ ÌÔÓÔ‡ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ28. ™ÙËÓ ˘„ËÏfiÙÂÚË ‰fiÛË Ô˘ ÌÂÏÂÙ‹ıËÎÂ, ‰È·ÈÛÙÒıËΠۯ‰fiÓ Ï‹Ú˘ ·Ó·ÛÙÔÏ‹ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙÔ˘˜. ™Â ·˘Ù‹ ÙË ÌÂϤÙË28 ˘ÔÛÙËÚ›¯ıËΠfiÙÈ Ë ·Ó·ÛÙÔÏ‹ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ ÌÔÓÔ‡ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ ÔÊÂÈÏfiÙ·Ó Û ·ÚÂÌfi‰ÈÛË Ù˘ ΢ÙÙ·ÚÈ΋˜ ‰È·›ÚÂÛ˘ ‡ÛÙÂÚ· ·fi ·ÏÏËÏÂ›‰Ú·ÛË ÙÔ˘˜ Ì ٷ
ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· Î·È fi¯È Û ·fiÙˆÛË
ÙˆÓ Î˘ÙÙ¿ÚˆÓ. ™˘ÁÎÂÎÚÈ̤ӷ, ˘ÔÛÙËÚ›¯ıËΠfiÙÈ Ô ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÙˆÓ ÌÔÓÔ‡ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ ·Ó·ÛÙ¿ÏıËΠ΢ڛˆ˜ ·fi ·Ú¿ÁÔÓÙ˜ Ô˘ ·ÂÏ¢ı¤ÚˆÛ·Ó Ù· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ηÙfiÈÓ ‰È¤ÁÂÚÛ˘ ·fi Ù·
ÌÔÓÔ‡ÚËÓ· ·ÙÙ·Ú· Î·È fi¯È ·fi ·Ï‹ Â·Ê‹ ÙÔ˘˜ ÌÂ
·˘Ù¿. H ÈÓÙÂÚÊÂÚfiÓË-Á, Ô˘ ·ÂÏ¢ıÂÚÒÓÂÙ·È ·fi T·ÙÙ·Ú· ηÙfiÈÓ ‰È¤ÁÂÚÛ‹˜ ÙÔ˘˜ Ì ÌÈÙÔÁfiÓÔ ·Ú¿ÁÔÓÙ· ‹ ¤ÎıÂÛ‹˜ ÙÔ˘˜ Û ·ÓÙÈÁfiÓÔ ÛÙÔ ÔÔ›Ô ¤¯Ô˘Ó ¢·ÈÛıËÙÔÔÈËı›, ¤¯ÂÈ ‚ÚÂı› fiÙÈ ‰ÈÂÁ›ÚÂÈ Ù· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÛÙËÓ ·ÂÏ¢ı¤ÚˆÛË Ù¤ÙÔÈˆÓ ·Ú·ÁfiÓÙˆÓ. ™ÙË ÌÂϤÙË ÙˆÓ Wada ηÈ
Û˘ÓÂÚÁ·ÙÒÓ28, ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ηÏÏÈÂÚÁ‹ıËÎ·Ó ·ÚÔ˘Û›· ÈÓÙÂÚÊÂÚfiÓ˘-Á Ô˘ ·Ú¿¯ıËΠ·fi
ÌÔÓÔ‡ÚËÓ· ·ÙÙ·Ú· ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛ‹ ÙÔ˘˜ Ì ÌÈÙÔÁfiÓÔ ·Ú¿ÁÔÓÙ·. K·ÏÏȤÚÁÂÈ· ÌÔÓÔ‡ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ
ÛÙÔ ıÚÂÙÈÎfi ˘ÏÈÎfi ·˘Ù‹˜ Ù˘ ηÏÏȤÚÁÂÈ·˜ ·Ó¤ÛÙÂÈÏÂ
ÌÂÚÈÎÒ˜ ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙÔ˘˜. AÓÙ›ıÂÙ·, ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ·Ó·ÛÙÔÏ‹ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÌÔÓÔ‡ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ηÏÏÈÂÚÁ‹ıËÎ·Ó Û ıÚÂÙÈÎfi ˘ÏÈÎfi
ηÏÏȤÚÁÂÈ·˜ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ·Ô˘Û›· ÈÓÙÂÚÊÂÚfiÓ˘-Á, ÁÂÁÔÓfi˜ Ô˘ Ô‰‹ÁËÛ ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ÈÓÙÂÚÊÂÚfiÓË-Á Ô˘ ÂÎÎÚ›ÓÂÙ·È ·fi Ù· ÌÔÓÔ‡ÚËÓ· ·ÙÙ·Ú· ¢ı‡ÓÂÙ·È ÌÂÚÈÎÒ˜ ÁÈ· ÙËÓ ·Ó·ÛÙÔÏ‹
ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙÔ˘˜ ·fi Ù· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú·. E›Û˘, Ë ¤ÎÊÚ·ÛË ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·-1 (TGF-1), ÙÔ˘ Ë·ÙÔ΢ÙÙ·ÚÈÎÔ‡ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (HGF) Î·È Ù˘ ÈÓ‰ÔÏ·̛Ó˘ 2,3-‰ÈÔ͢ÁÂÓ¿Û˘ (IDO), ·Ú·ÁfiÓÙˆÓ Ô˘ ¤¯ÂÈ ‚ÚÂı› fiÙÈ ÂÌϤÎÔÓÙ·È ÛÙËÓ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ‰Ú¿ÛË ÙˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ, ‚Ú¤ıËΠӷ ·˘Í¿ÓÂÙ·È ÛÙ·
Hellenic Stomatological Review 57: 39-71, 2013
Figure 1: Gene transfer in periodontal defects via direct or
indirect technique (modified from Rios et al3).
gene expression. Arbitrary introduction of the viral
genetic material into the host cellular genome may cause
gene mutagenesis resulting in carcinogenesis. Most retroviruses affect dividing cells only3, 30.
Lentiviruses comprise a distinct retrovirus type characterized by long incubation time. Their genetic material is
being incorporated into the host cell genome as well.
Although the introduction sites of their genetic material
are more restricted, carcinogenesis is possible. Furthermore, for lentiviruses there is a high replication risk, after
genetic material incorporation into the host cell genome.
Lentiviruses can affect both dividing and non-dividing
cells3.
For adenoviruses, the genetic material is doublestranded DNA, which does not get incorporated into the
host cellular genome, resulting in transient gene expression and no risk of carcinogenesis. The affected cells do
not present phenotypic changes3, 30. In order to eliminate
the risk of replication and production of harmful agents
by adenoviruses used as genetic material vectors,
removal of the E1 gene, which is necessary for the
replication and expression of viral genes, from their
genome has been suggested31. There is a risk of host
immune reaction to viral capsid proteins, since they are
not surrounded by an envelope. The application of the
indirect technique, where adenoviral genetic material is
transferred in-vitro to target-cells, prevents this32. They
affect both dividing and non-dividing cells3.
Adeno-associated viruses derive from parvoviruses.
Their genetic material is single-stranded DNA, which gets
incorporated into the host cellular genome. It is
introduced in a specific site of the human genome, although arbitrary introduction cannot be excluded. They
affect both dividing and non-dividing cells. They have not
been related to any known human disease, they have low
immunogenicity but their small size does not permit
transfer of genetic material greater than 5kb3, 30.
Moreover, plasmids, DNA polymers, peptides and lipids
have been used as vectors for gene transfer. Their ability
53
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ÙÔ˘ ÂÚÈÚÚÈ˙›Ô˘ ÌÂÙ¿ ·fi ηÏÏȤÚÁÂÈ¿ ÙÔ˘˜ Ì ÌÔÓÔ‡ÚËÓ· ·ÙÙ·Ú·29. M¿ÏÈÛÙ·, Ë ¤ÎÊÚ·ÛË Ù˘ ÈÓ‰ÔÏ·̛Ó˘ 2,3-‰ÈÔ͢ÁÂÓ¿Û˘, ÛÂ
·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜, ·˘Í‹ıËΠÌÂÙ¿
·fi ηÏÏȤÚÁÂÈ· ÙˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ
·ÚÔ˘Û›· ÈÓÙÂÚÊÂÚfiÓ˘-Á, ÁÂÁÔÓfi˜ Ô˘ Ô‰‹ÁËÛ ÛÙÔ
Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ·Ú·ÁˆÁ‹ Ù˘ ÈÓ‰ÔÏ·̛Ó˘ 2-3 ‰ÈÔ͢ÁÂÓ¿Û˘ ÚÔ¿ÁÂÙ·È ·fi ÙËÓ ·ÂÏ¢ıÂÚÔ‡ÌÂÓË ·fi
Ù· ÌÔÓÔ‡ÚËÓ· ·ÙÙ·Ú· ÈÓÙÂÚÊÂÚfiÓË-Á. Œ¯ÂÈ ·Ú·ÙËÚËı› ˆ˜ Ë Î·Ù·ÛÙÔÏ‹ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÌÔÓÔ‡ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ ·fi ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ‹Ù·Ó ·ÓÙÈÛÙÚÂÙ‹ ηıÒ˜ ·ÔÌfiÓˆÛË ÙÔ˘˜ Î·È ÂÎ Ó¤Ô˘
‰È¤ÁÂÚÛË ÙÔ˘˜ Ì ÌÈÙÔÁfiÓÔ ·Ú¿ÁÔÓÙ· ÚÔοÏÂÛ ٷ¯‡Ú˘ıÌÔ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙÔ˘˜29. OÈ ·ÓÔÛÔηٷÛÙ·ÏÙÈΤ˜ ȉÈfiÙËÙ˜ ÙˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ
Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ȉȷ›ÙÂÚË ÛËÌ·Û›· ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹
ÙÔ˘˜ ÛÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ, ηıÒ˜ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ Â›Ó·È ‰˘Ó·Ùfi Ó· ¤¯ÂÈ ·ÚÓËÙÈΤ˜ ÂÈÙÒÛÂȘ ÛÙÔ
ıÂÚ·¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ·.
MÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ·fi ÊÏÂÁÌ·›ÓÔÓÙ˜
ÈÛÙÔ‡˜
O ÎÔÎÎÈ҉˘ ÈÛÙfi˜ Ô˘ ·ÔÌ·ÎÚ‡ÓÂÙ·È ·fi ÙȘ ÂÚÈÔ‰ÔÓÙÈΤ˜ ‚Ï¿‚˜ ηٿ ÙË Ê¿ÛË ·ÔηٿÛÙ·Û˘ ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ‚Ï·‚ÒÓ (¯ÂÈÚÔ˘ÚÁÈ΋ ÂÚÈÔ‰ÔÓÙÈ΋ ıÂÚ·›·) ÂÚȤ¯ÂÈ ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ. MÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ¤¯Ô˘Ó ·ÔÌÔÓˆı› ·fi ÎÔÎÎÈÒ‰Ë ÈÛÙfi Ô˘ ·Ê·ÈÚ¤ıËΠ·fi ÂÓ‰ÔÛÙÈΤ˜ ‚Ï¿‚˜ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ·ÛıÂÓÒÓ15. ™‡ÁÎÚÈÛË
ÌÂٷ͇ ÙˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÎÔÎÎÈÒ‰Ë ÈÛÙfi ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÂÓ‰ÔÛÙÈÎÒÓ
‚Ï·‚ÒÓ Î·È ·˘ÙÒÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ˘ÁȤ˜ ÂÚÈÔ‰fiÓÙÈÔ ¤‰ÂÈÍÂ, ÌÂÙ¿ ·fi ηÏÏȤÚÁÂÈ¿ ÙÔ˘˜, ·ÚfiÌÔÈÔ ÔÏÏ·Ï·ÛÈ·ÛÌfi ·ÏÏ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ‰È·ÊÔÚÂÙÈ΋
ÌÂÙ·Ó¿ÛÙ¢ÛË, Ì ˘„ËÏfiÙÂÚË ÌÂÙ·Ó¿ÛÙ¢ÛË ÁÈ· Ù· ·ÙÙ·Ú· ·fi ÙÔ ÚÔۂ‚ÏË̤ÓÔ ÂÚÈÔ‰fiÓÙÈÔ15. ™ÙÔ ˘ÁȤ˜
ÂÚÈÔ‰fiÓÙÈÔ, Ù· ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ÂÚÈÔÚ›˙ÔÓÙ·Ó ÛÙÔÓ ÂÚÈ·ÁÁÂÈ·Îfi ¯ÒÚÔ. AÓÙ›ıÂÙ·, ÛÙȘ ÂÚÈÔ‰ÔÓÙÈΤ˜ ‚Ï¿‚˜, ÌÂÛÂÁ¯˘Ì·ÙÈο ‚Ï·ÛÙÔ·ÙÙ·Ú· ÂÓÙÔ›˙ÔÓÙ·Ó ÛÙÔÓ Â͈·ÁÁÂÈ·Îfi ¯ÒÚÔ Î·È ÎÔÓÙ¿ ÛÙËÓ ÔÛÙ½ÓË, fiÔ˘ ÌÂÙ·Ó·ÛÙÂ‡Ô˘Ó Èı·Ó¿ ˘fi ÙËÓ Â›‰Ú·ÛË
ÌÂÛÔÏ·‚ËÙÒÓ Ù˘ ÊÏÂÁÌÔÓ‹˜ Ô˘ ·ÂÏ¢ıÂÚÒÓÔÓÙ·È ·fi ÙÔ˘˜ ÊÏÂÁÌ·›ÓÔÓÙ˜ ÂÚÈÔ‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜. OÈ ÌÂÛÔÏ·‚ËÙ¤˜ Ù˘ ÊÏÂÁÌÔÓ‹˜ Èı·ÓfiÓ Ó· ÚÔ¿ÁÔ˘Ó ÙË ÌÂÙ·Ó¿ÛÙ¢ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ, Ô ·ÎÚÈ‚‹˜ Ì˯·ÓÈÛÌfi˜, fï˜, Ì ÙÔÓ ÔÔ›Ô Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ·˘Ùfi ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ‰È¢ÎÚÈÓÈÛÙ›. E›Û˘, ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ÂÓ·Û‚ÂÛÙ›ˆÛË. MÂÙ¿ ·fi ˘Ô‰fiÚÈ·
ÂÌʇÙ¢ÛË ÙˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ Ô˘
·ÔÌÔÓÒıËÎ·Ó ·fi ÙȘ ÂÚÈÔ‰ÔÓÙÈΤ˜ ‚Ï¿‚˜ Û ·ÓÔÛÔ·ÓÂ·Ú΋ ÔÓÙ›ÎÈ·, ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ˜ Û¯ËÌ·ÙÈÛÌfi˜ ÔÛÙ½Ó˘. H ‡·ÚÍË ÊÏÂÁÌÔÓ‹˜ Èı·ÓfiÓ ÚÔηÏ› ·Ó·ÛÙÔÏ‹ Ù˘ ‰È·ÊÔÚÔÔ›ËÛ˘
ÙˆÓ Î˘ÙÙ¿ÚˆÓ, Ë ÔÔ›·, fï˜, Â›Ó·È ‰˘Ó·Ùfi Ó· ˘ÂÚÎÂÚ·ÛÙ› ηÙfiÈÓ ‰Ú¿Û˘ ·Ú·ÁfiÓÙˆÓ Ô˘ ÚÔ¿ÁÔ˘Ó ÙË
‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ15.
54
to affect the target-cells is significantly reduced in comparison to viral vectors. However, the low immunogenicity, the ability to transfer genetic material irrespective
of its size and their massive production makes them a
promising alternative option for genetic material transfer
to the target-cells. Electroporation and ultrasound waves
have also been used for genetic material transfer to the
target-cells3, 30.
Safety of the viral vector administration
Systematic administration of adenoviruses as genetic
material vectors may cause acute toxicity and hepatic
pathology. It has been found that 99% of systemically
administered adenoviruses ends up in the liver, where via
the hepatocytes, the Kupffer cells and the blood
circulation may be distributed to the lungs and the
spleen. Local application reduces systemic dissemination and achieves a more favorable efficiency-toxicity
ratio. However systemic dissemination (at 10 min), since
the viral vectors might enter the systemic circulation via
microvessels, and inflammatory infiltrate within liver (at
15 min) have been reported even after local application.
Chang et al.33 found that local application of adenoviruses carrying luciferase gene incorporated into a
collagen matrix led to an effective localized therapeutic
result. Two weeks after local adenovirus application at a
concentration of 5.5x108 pfu/ml the luciferase expression
was reduced to non-detectable levels both in the defect
area and in any organ. Similar results were reported after
local adenovirus application at a concentration of 5.5x109
pfu/ml, though a persistent, weak luciferase expression
was detected around the defect in a few rats, which
derived from the muscles. Despite the low luciferase
expression detected in several organs within the first two
weeks, there was no enzyme increase indicative of organ
damage. There was no indication of toxicity within the 35
days of the study duration.
Genetic material transferred
Genes that have been transferred for periodontal tissue
regeneration encode growth factors. Studies of direct or
indirect transfer of bone morphogenetic protein-2 and -7
(BMP-2 and BMP-7, respectively), basic fibroblast growth
factor (bFGF), osteoprotegerin (OPG) and plateletderived growth factor- B (PDGF-B) via viruses or
plasmids in periodontal defects of animal models have
demonstrated encouraging results (Table 3). Concerning
periodontal regeneration, gene transfer aiming at host
immune response regulation, in an attempt to ameliorate
the conditions of the periodontal tissue environment, has
attracted distinct interest.
Target-cells might be genetically modified in order to
express two or more genes. Genes can be independent,
their transcription being regulated by different promoters. In this case, antagonistic reactions might occur
among the various promoters. Alternatively, genes may
be linked to each other with internal ribosome entry site
Hellenic Stomatological Review 57: 39-71, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
°ONI¢IAKH £EPA¶EIA
T¯ÓÈΤ˜
H ÂÈÛ·ÁˆÁ‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÛÙ· ·ÙÙ·Ú·-ÛÙfi¯Ô˘˜ ÌÔÚ› Ó· Á›ÓÂÈ ¿ÌÂÛ· ‹ ¤ÌÌÂÛ·. K·Ù¿ ÙËÓ ¿ÌÂÛË Ù¯ÓÈ΋ ÙÔ
ÁÂÓÂÙÈÎfi ˘ÏÈÎfi ÌÂٷʤÚÂÙ·È ·¢ı›·˜ ÛÙ· ·ÙÙ·Ú·-ÛÙfi¯Ô˘˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ (in-vivo Ù¯ÓÈ΋) ÂÓÒ Î·Ù¿ ÙËÓ ¤ÌÌÂÛË Ù¯ÓÈ΋ ÙÔ ÁÂÓÂÙÈÎfi ˘ÏÈÎfi ÌÂٷʤÚÂÙ·È Û ·ÙÙ·Ú·ÛÙfi¯Ô˘˜ Ô˘ ¤¯Ô˘Ó ·ÔÌÔÓˆı› ·fi ÙÔÓ ÔÚÁ·ÓÈÛÌfi, ¤¯Ô˘Ó ηÏÏÈÂÚÁËı› Î·È ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡
˘ÏÈÎÔ‡ Û ·˘Ù¿ Â·ÓÂÌÊ˘Ù‡ÔÓÙ·È ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi (invitro Ù¯ÓÈ΋)3, 30 (EÈÎ. 1).
EÈÎ. 1: MÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ ÛÙËÓ ÂÚÈÔ‰ÔÓÙÈ΋ ‚Ï¿‚Ë Ì ÙËÓ ¿ÌÂÛË (in-vivo) Î·È ¤ÌÌÂÛË (in-vitro) Ù¯ÓÈ΋ (ÙÚÔÔÔÈË̤ÓÔ ·fi
Rios et al3).
ºÔÚ›˜ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡
H ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÛÙ· ·ÙÙ·Ú·-ÛÙfi¯Ô˘˜
Á›ÓÂÙ·È Ì¤Ûˆ ‰È·ÊfiÚˆÓ ÊÔÚ¤ˆÓ. ø˜ ÊÔÚ›˜ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÈÔ›, fiˆ˜ ÚÂÙÚÔ˚Ô›,
Ê·ÎÔ˚Ô›, ·‰ÂÓÔ˚Ô› Î·È ÈÔ› Û¯ÂÙÈ˙fiÌÂÓÔÈ Ì ·‰ÂÓÔ˚Ô‡˜.
OÈ ÚÂÙÚÔ˚Ô› ¤¯Ô˘Ó ˆ˜ ÁÂÓÂÙÈÎfi ˘ÏÈÎfi ÌÔÓfiÎψÓÔ RNA, ÙÔ
ÔÔ›Ô ·ÊÔ‡ ÌÂÙ·ÁÚ·Ê› Û DNA ÛÙÔ Î‡ÙÙ·ÚÔ-ÍÂÓÈÛÙ‹,
ÂÓۈ̷ÙÒÓÂÙ·È ÛÙÔ ÁÔÓȉ›ˆÌ· ÙÔ˘. A˘Ùfi ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù· ·ÙÙ·Ú· Ô˘ ı· ÚÔ·„Ô˘Ó ·fi ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙÔ˘ ΢ÙÙ¿ÚÔ˘-ÍÂÓÈÛÙ‹ Ó· ÂÚȤ¯Ô˘Ó ÙÔ ÁÂÓÂÙÈÎfi ˘ÏÈÎfi ÙÔ˘ ÈÔ‡, ÁÂÁÔÓfi˜ Ô˘ ηıÈÛÙ¿ ‰˘Ó·Ù‹ ÙËÓ ·Ú·ÙÂٷ̤ÓË ¤ÎÊÚ·ÛË ÁÔÓȉ›ˆÓ. øÛÙfiÛÔ, Ë ·˘ı·›ÚÂÙË ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÙÔ˘ ÈÔ‡ ÛÙÔ ÁÔÓȉ›ˆÌ· ÙÔ˘
΢ÙÙ¿ÚÔ˘-ÍÂÓÈÛÙ‹ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÌÂÙ¿ÏÏ·ÍË ÁÔÓȉ›ˆÓ Ì ·ÔÙ¤ÏÂÛÌ· ηÚÎÈÓÔÁ¤ÓÂÛË. OÈ ÂÚÈÛÛfiÙÂÚÔÈ
ÚÂÙÚÔ˚Ô› ÌÔÚÔ‡Ó Ó· ÚÔÛ‚¿ÏÔ˘Ó ÌfiÓÔ ‰È·ÈÚÔ‡ÌÂÓ·
·ÙÙ·Ú·3, 30.
OÈ Ê·ÎÔ˝Ô› ·ÔÙÂÏÔ‡Ó ÂȉÈ΋ ηÙËÁÔÚ›· ÚÂÙÚÔ˚ÒÓ, Ô˘
¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ì·ÎÚ‡ ¯ÚfiÓÔ ÂÒ·Û˘. TÔ ÁÂÓÂÙÈÎfi
ÙÔ˘˜ ˘ÏÈÎfi Â›Û˘ ÂÓۈ̷ÙÒÓÂÙ·È ÛÙÔ ÁÔÓȉ›ˆÌ· ÙÔ˘
΢ÙÙ¿ÚÔ˘-ÍÂÓÈÛÙ‹. AÓ Î·È ÔÈ ı¤ÛÂȘ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ÙÔ˘˜ ˘ÏÈÎÔ‡ Â›Ó·È ÈÔ ÂÚÈÔÚÈṲ̂Ó˜, ˘¿Ú¯ÂÈ Èı·ÓfiÙËÙ· ηÚÎÈÓÔÁ¤ÓÂÛ˘. E›Û˘, Ô Î›Ó‰˘ÓÔ˜ ·ÓÙÈÁÚ·Ê‹˜
ÙˆÓ Ê·ÎÔ˚ÒÓ ÌÂÙ¿ ÙËÓ ÂÓۈ̿وÛË ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ÙÔ˘˜
˘ÏÈÎÔ‡ ÛÙÔ ÁÔÓȉ›ˆÌ· ÙÔ˘ ΢ÙÙ¿ÚÔ˘-ÍÂÓÈÛÙ‹ Â›Ó·È ·˘ÍËHellenic Stomatological Review 57: 39-71, 2013
sequences (IRES sequences), their transcription being
regulated by the same promoter. Genes are transcribed
to the same mRNA but they are bound to ribosomes via
the IRES sequences and are independently translated.
Though, it has been reported that the expression of the
second gene, which follows the IRES sequence, usually
does not exceed the 20-50% of the expression of the first
gene31.
Bone morphogenetic proteins (BMPs)
It has been shown that prolonged exposure to a low
concentration of human recombinant bone morphogenetic protein-2 enhances cementogenesis. However,
in case of local application in the defect high bone
morphogenetic protein-2 (BMP-2) dosages are required,
due to short half-life. High concentrations have been
associated with increased risk of local complications,
such as ankylosis and root resorption. Sustained release
from cells that have been genetically modified to express
BMP-2 reduced the required concentration by
approximately 1,000 times32, 41.
Yang et al.31 found that human periodontal ligament cells
genetically modified to express bone morphogenetic
protein-7 (BMP-7) and insulin-like growth factor-1 (IGF-1)
or BMP-7 only, at 3 days presented statistically significant
greater BMP-7 expression, alkaline phosphatase activity
and collagen type I, Runx2 and bone sialoprotein
expression in comparison with periodontal ligament cells
genetically modified to express green fluorescent protein
(GFP) and non-genetically modified periodontal ligament
cells. Cells genetically modified to express BMP-7 and
IGF-1 presented statistically significantly greater alkaline
phosphatase activity and type I collagen and Runx2
expression in comparison with cells genetically modified
to express BMP-7 only. The BMP-7 expression was
highest after 9 days for both cell groups, whereas their
expression remained statistically significantly higher in
comparison to the cells that were genetically modified to
express GFP and the non-genetically modified cells up to
27 days31.
Platelet-derived growth factor (PDGF)
Platelet-derived growth factor-AA (PDGF-AA), which
consists of two A chains of PDGF, binding to the PDGFa
receptor, a tyrosine kinase receptor, induces its phosphorylation which triggers an intracellular and extracellular signaling cascade. Chen and Giannobile42 infected
rat dermal fibroblasts with adenoviruses carrying the
PDGF-A chain gene and found PDGFa receptor phosphorylation at 8 hours, which increased till 96 hours,
when the last cells to be studied were collected. ERK1/2
and Akt, which are involved in the signaling cascade that
PDGFa receptor phosphorylation triggers, presented
similar alteration of phosphorylation levels. After human
recombinant PDGF-AA administration, PDGFa receptor
phosphorylation was maintained till 48 hours but at 72
hours had started to weaken. Similarly, ERK1/2 and Akt
55
56
Rats
BMP-7,
noggin
(antagonist)
BMP-2
Beagle
dogs
Surgicallyinduced
periodontal
defects
(buccal
tomandibularpremolar
mesial root,
U-shaped
defects)
Mandibular
alveolar
defects
BMP-2
New
Zealand
rabbits
Surgicallyinduced
periodontal
defects
Gene
Animal
Defect
Adenoviru
s
Plasmids
Adenovirus
Vector
Dermal
fibroblast
Bone marrowderived
mesenchymal
stem cells
Target-cells
Ex-vivo
Gelatin
-
Pluronic
F127
Ex-vivo
In-vivo
Vehicle
Technique
-
8 weeks
-
Duration
Rapid osteogenesis,
cementogenesis
and predictable
regene-ration.
Suppression of
osteogenesis by
noggin-expressing cells.
Complete bone
regeneration and fibers
and vessel-rich
connective tissue
creation. Statistically
significantly
highercementum,
connective tissue and
bone creationas
compared to saline
application, similar to
human recombinant
BMP-2 application.
Cementum and
Sharpey’s fibers
creation. Statistically
significantly higher bone
creation compared to
non- genetically
modified cell
transplantation and
vehicle only application.
Results
Table 3: Gene transfer studies for periodontal and peri-implant tissue regeneration in animal models.
32
35
34
Study
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Hellenic Stomatological Review 57: 39-71, 2013
Fibroblast
basic growth
factor and
GFP
BMP-7
BMP-7
Beagle
dogs
Beagle
dogs
-
Furcation
defects
Surgicallyinduced
class II
furcation
defects
Mandibular
peri-implant
defects
Hellenic Stomatological Review 57: 39-71, 2013
Adenovirus
-
Eukaryotic
plasmid
pDC316
12 weeks
Collagen
membrane
Chitosan/
collagen/
periodontal
ligament
cells
Ex-vivo
In-vivo
Bone marrowderived stromal
cells
3 months
6 weeks
Ex-vivo
Bone marrow
derived
mesenchymal
stromal cells
Higher alkalinephosphatase activity,
osteopontin and
sialoprotein expression
by vehicle cells prior to
application and higher
bone creationafter 4 and
8 weeks as compared to
vehicle application
alone, without
adenoviruses carrying
BMP-7 gene.
Statistically significantly
greater newly-created
bone area and newlycreated cementum
length as compared to
no transplantation and
non-genetically modified
cell transplantation,
which presented
statistically significantly
differences as
compared to no cell
transplantation.
Statistically significantly
higher bone
regeneration rate as
compared to nongenetically modified cell
transplantation.
38
37
36
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
57
Osteoprotegerin
PDGF-B chain
BMP-2
Dogs
Rats
Beagle
dogs
Surgicallyinduced
premolar
buccal
horizon-tal
osseous
(4x4x3mm)
Surgically
induced periimplant
defects
58
Mandibul
molar
periodntal
defects
Adenovirus
Adenovirus
in concentrations
5.5x108
or 5.5x109
pfu/ml
Plasmid
Mesenchymal
stem cells
Bone marrowstromal cells
-
Collagen
matrix
In-vivo
Ex-vivo
PLGA
Ex-vivo
8 weeks
-
6 weeks
Cementum and
Sharpey’s fibers
creation on cementumdenuded root surfaces
in contrast to nongenetically modified
cells transplantation,
where incomplete
healing and localized
root resorption were
noted. Statistically
significantly higher bone
creation at 8 weeks.
Bone regeneration
acceleration as
compared to
transplantation of cells
carrying luciferase gene,
similar to hrPDGF-BB
administration. The
highest adenovirus
concentration was more
effective.
Statistically significantly
higher cementum,
connective tissue and
bone creation as
compared to nongenetically modified cell
transplantation, vehicle
application alone and
root scaling alone.
41
40
39
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Hellenic Stomatological Review 57: 39-71, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
̤ÓÔ˜. OÈ Ê·ÎÔ˚Ô› ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ÚÔÛ‚¿ÏÔ˘Ó
‰È·ÈÚÔ‡ÌÂÓ· Î·È ÌË Î‡ÙÙ·Ú·3.
OÈ ·‰ÂÓÔ˚Ô› ¤¯Ô˘Ó ˆ˜ ÁÂÓÂÙÈÎfi ˘ÏÈÎfi ‰›ÎψÓÔ DNA, ÙÔ ÔÔ›Ô ‰ÂÓ ÂÓۈ̷ÙÒÓÂÙ·È ÛÙÔ ÁÔÓȉ›ˆÌ· ÙÔ˘ ΢ÙÙ¿ÚÔ˘ÍÂÓÈÛÙ‹ Ì ·ÔÙ¤ÏÂÛÌ· Ë ¤ÎÊÚ·ÛË ÁÔÓȉ›ˆÓ Ó· Â›Ó·È ·ÚÔ‰È΋ Î·È Ó· ÌËÓ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ÚfiÎÏËÛ˘ ηÚÎÈÓÔÁ¤ÓÂÛ˘. T· ·ÙÙ·Ú· Ô˘ ÚÔÛ‚¿ÏÏÔ˘Ó ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ê·ÈÓÔÙ˘ÈΤ˜ ·ÏÏ·Á¤˜3, 30. ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·ÏÂÈÊı› Ô Î›Ó‰˘ÓÔ˜ ·ÓÙÈÁÚ·Ê‹˜ Î·È ·Ú·ÁˆÁ‹˜ ‚Ï·ÙÈÎÒÓ
·Ú·ÁfiÓÙˆÓ ·‰ÂÓÔ˚ÒÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙËÓ
ÚÔÛ‚ÔÏ‹ ΢ÙÙ¿ÚˆÓ-ÛÙfi¯ˆÓ ˆ˜ ÊÔÚ›˜ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡, ¤¯ÂÈ ÌÂÏÂÙËı› Ë ·Ê·›ÚÂÛË ÙÔ˘ ÁÔÓȉ›Ô˘ E1 ·fi ÙÔ
ÁÔÓȉ›ˆÌ· ÙˆÓ ·‰ÂÓÔ˚ÒÓ ÙÔ ÔÔ›Ô Â›Ó·È ··Ú·›ÙËÙÔ ÁÈ·
ÙËÓ ·ÓÙÈÁÚ·Ê‹ Î·È ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ È˚ÎÒÓ ÁÔÓȉ›ˆÓ31. TÔ
ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ÂÚÈ‚¿ÏÏÔÓÙ·È ·fi ¤Ï˘ÙÚÔ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ‡·ÚÍË ÎÈÓ‰‡ÓÔ˘ ÂΉ‹ÏˆÛ˘ ·ÓÔÛÔÏÔÁÈ΋˜
·ÓÙ›‰Ú·Û˘ ÂÓ¿ÓÙÈ· ÛÙȘ ÚˆÙ½Ó˜ Ù˘ È˚΋˜ ο„·˜. TÔ
Úfi‚ÏËÌ· ·˘Ùfi ÌÔÚ› Ó· ·Ú·Î·ÌÊı› Ì ÂÊ·ÚÌÔÁ‹
Ù˘ ¤ÌÌÂÛ˘ Ù¯ÓÈ΋˜, ηٿ ÙËÓ ÔÔ›· ÙÔ ÁÂÓÂÙÈÎfi ˘ÏÈÎfi
Ô˘ ʤÚÔ˘Ó ÔÈ ·‰ÂÓÔ˚Ô› ÌÂٷʤÚÂÙ·È in-vitro ÛÙ· ·ÙÙ·Ú·-ÛÙfi¯Ô˘˜32. OÈ ·‰ÂÓÔ˚Ô› ¤¯Ô˘Ó ˘„ËÏ‹ ÈηÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜ ‰È·ÈÚÔ‡ÌÂÓˆÓ Î·È ÌË ‰È·ÈÚÔ‡ÌÂÓˆÓ Î˘ÙÙ¿ÚˆÓ3.
OÈ Û¯ÂÙÈ˙fiÌÂÓÔÈ Ì ·‰ÂÓÔ˚Ô‡˜ ÈÔ› ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ˘˜
·Ú‚Ô˚Ô‡˜. Œ¯Ô˘Ó ˆ˜ ÁÂÓÂÙÈÎfi ˘ÏÈÎfi ÌÔÓfiÎψÓÔ DNA,
ÙÔ ÔÔ›Ô ÂÓۈ̷ÙÒÓÂÙ·È ÛÙÔ ÁÔÓȉ›ˆÌ· ÙÔ˘ ΢ÙÙ¿ÚÔ˘ÍÂÓÈÛÙ‹. TÔ ÁÂÓÂÙÈÎfi ÙÔ˘˜ ˘ÏÈÎfi ÂÈÛ¿ÁÂÙ·È ÛÂ Û˘ÁÎÂÎÚÈ̤ÓË ı¤ÛË ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÁÔÓȉÈÒÌ·ÙÔ˜, ·Ó Î·È ¤¯ÂÈ ·Ú·ÙËÚËı› Î·È ·˘ı·›ÚÂÙË ÂÈÛ·ÁˆÁ‹ ÙÔ˘. ¶ÚÔÛ‚¿ÏÏÔ˘Ó
‰È·ÈÚÔ‡ÌÂÓ· Î·È ÌË ‰È·ÈÚÔ‡ÌÂÓ· ·ÙÙ·Ú·. ¢ÂÓ ¤¯Ô˘Ó Û¯ÂÙÈÛÙ› Ì ÁÓˆÛÙ‹ ÓfiÛÔ ÛÙÔÓ ¿ÓıÚˆÔ, ¤¯Ô˘Ó ¯·ÌËÏ‹ ·ÓÙÈÁÔÓÈÎfiÙËÙ·, ˆÛÙfiÛÔ ÙÔ ÌÈÎÚfi ÙÔ˘˜ ̤ÁÂıÔ˜ ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙË ÌÂÙ·ÊÔÚ¿ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂÁ¤ıÔ˘˜ ÌÂÁ·Ï‡ÙÂÚÔ˘ ·fi 5kb3, 30.
ÕÏÏÔÈ ÊÔÚ›˜ Ô˘ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙË ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ï·ÛÌ›‰È·, ÔÏ˘ÌÂÚ‹ DNA,
ÂÙ›‰È· Î·È ÏÈ›‰È·. A˘ÙÔ› ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ·ÓÙÈο ÌÂȈ̤ÓË ÈηÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ-ÛÙfi¯ˆÓ ÛÂ
Û¯¤ÛË Ì ÙÔ˘˜ È˚ÎÔ‡˜ ÊÔÚ›˜. øÛÙfiÛÔ, Ë ¯·ÌËÏ‹ ·ÓÔÛÔÁÔÓÈÎfiÙËÙ¿ ÙÔ˘˜, Ë ÈηÓfiÙËÙ· ÌÂÙ·ÊÔÚ¿˜ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ ÂÚÈÔÚÈÛÌfi˜ ÛÙÔ Ì¤ÁÂıfi˜ ÙÔ˘ ηÈ
Ë ‰˘Ó·ÙfiÙËÙ· Ì·˙È΋˜ ·Ú·ÁˆÁ‹˜ ÙÔ˘˜ Ù· ηıÈÛÙ¿ ÌÈ·
Èı·Ó‹ ÂÓ·ÏÏ·ÎÙÈ΋ ÂÈÏÔÁ‹. °È· ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÛÙ· ·ÙÙ·Ú·-ÛÙfi¯Ô˘˜ ¤¯Ô˘Ó Â›Û˘ ¯ÚËÛÈÌÔÔÈËı› Ê˘ÛÈΤ˜ ̤ıÔ‰ÔÈ, fiˆ˜ ËÏÂÎÙÚÔfiÚˆÛË Î·È ˘ÂÚ˯ËÙÈο ·̷ٷ3, 30.
AÛÊ¿ÏÂÈ· ¯ÔÚ‹ÁËÛ˘ ÈÈÎÒÓ ÊÔÚ¤ˆÓ
H Û˘ÛÙÂÌÈ΋ ¯ÔÚ‹ÁËÛË ·‰ÂÓÔ˚ÒÓ ˆ˜ ÊÔÚ¤ˆÓ ÁÂÓÂÙÈÎÔ‡
˘ÏÈÎÔ‡ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÔÍ›· ÙÔÍÈÎfiÙËÙ· Î·È ·ıÔÏÔÁ›· ÙÔ˘ ‹·ÙÔ˜. Œ¯ÂÈ ‚ÚÂı› fiÙÈ ÙÔ 99% ÙˆÓ Û˘ÛÙÂÌÈο ¯ÔÚËÁÔ‡ÌÂÓˆÓ ·‰ÂÓÔ˚ÒÓ Î·Ù·Ï‹ÁÂÈ ÛÙÔ ‹·Ú, fiÔ˘
ÚÔÛÏ·Ì‚¿ÓÂÙ·È ·fi Ë·ÙÔ·ÙÙ·Ú· Î·È Î‡ÙÙ·Ú· ÙÔ˘
Kupffer, Ù· ÔÔ›· ̤ۈ Ù˘ ΢ÎÏÔÊÔÚ›·˜ ÌÔÚ› Ó· ‰È·ÓÂÌËıÔ‡Ó ÛÙÔ˘˜ Ó‡ÌÔÓ˜ Î·È ÙÔÓ ÛÏ‹Ó·. H Û˘ÛÙÂÌÈ΋
‰È·ÛÔÚ¿ ÌÔÚ› Ó· ÌÂȈı› Î·È Ó· ‚ÂÏÙȈı› Ë ·Ó·ÏÔÁ›·
·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜-ÙÔÍÈÎfiÙËÙ·˜ Ì ÙÔÈ΋ ÂÊ·ÚÌÔÁ‹
ÙÔ˘˜. øÛÙfiÛÔ, Î·È ÌÂÙ¿ ·fi ÙÔÈ΋ ÂÊ·ÚÌÔÁ‹ ¤¯ÂÈ ·Ó·ÊÂÚı› Û˘ÛÙÂÌÈ΋ ‰È·ÛÔÚ¿ ÌÂÙ¿ ·fi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·
Hellenic Stomatological Review 57: 39-71, 2013
phosphorylation was noted at 8 hours and was
maintained till 72 and 48 hours respectively. The delay in
PDGFa receptor phosphorylation found after infecting
the cells with the viruses might be due to the time needed
for the gene transfer and expression42. Lin et al.43 after
infecting human gingival fibroblasts with adenoviruses
carrying PDGF-B chain gene demonsrated PDGF-BB
expression at 6 hours, which was sustained at least up to
96 hours. Contrary to the immediate but short-term effect
(a few days) of the locally applied recombinant PDGF-BB
cell infection with adenoviruses carrying PDGF-B chain
resulted in delayed but sustained expression, which was
gradually reduced so that on day 14 it reached down to
20% of the highest level40.
Giannobile et al.44 infected cementoblasts with viruses
carrying PDGF-A chain gene, there was gene exression
at 24 hours, which was sustained up to 7 days, when the
last cells to be studied were collected. After 24 hours,
cementoblasts infected by viruses carrying PDGF-A
chain gene presented statistically significantly higher
DNA synthesis and statistically significantly lower
alkaline phosphatase activity in comparison to cementoblasts genetically modified to express GFP. DNA
synthesis and proliferation were at similar levels between
cementoblasts infected by viruses carrying PDGF-A
chain gene and cementoblasts, where PDGF was
continuously applied. On days 4 and 7, cementoblasts
genetically modified to express PDGF and cementoblasts to which PDGF was administered demonstrated
statistically significant greater increase in number in
comparison to cementoblasts genetically modified to
express GFP. However, the first group showed statistically significant greater increase in number as compared to
the second one. Therefore, the duration of the cell
exposure to PDGF seems to affect the periodontal tissue
regeneration.
It has been claimed that recombinant PDGF application
is indicated for defects where rapid initiation of the regeneration process is extremely important, since its short
half-life after local application induces cell proliferation
and chemotactic cell adhesion without significantly
delaying the initiation of their differentiation. Contrary to
this, application of adenoviruses carrying PDGF chain
gene may be more appropriate for greater defects, where
the sustained PDGF effect results in the creation of more
cells, though further delaying differentiation initiation40.
Regulation of the host immune response
Tumor necrosis factor receptor (TNFR)
Tumor necrosis factor-a (TNF-a) enhances osseous
resorption by stimulating osteoclast differentiation and
activation. TNF binds to two receptors (TNFR), namely
p55 and p75. Immunomodulatory therapy based on TNF
binding has successfully been studied in humans for the
management of rheumatoid arthritis by using either
monoclonal TNF antibodies or proteins containing TNFR
p75 linked to the Fc portion of human IgG145.
59
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
10 min, ÂÍ·ÈÙ›·˜ Ù˘ ÂÈÛfi‰Ô˘ ÙˆÓ È˚ÎÒÓ ÊÔÚ¤ˆÓ ÛÙË Û˘ÛÙÂÌÈ΋ ΢ÎÏÔÊÔÚ›· Èı·Ó¿ ̤ۈ ÙˆÓ ÙÚȯÔÂȉÒÓ ·ÁÁ›ˆÓ, Î·È ÊÏÂÁÌÔÓ҉˘ ‰È‹ıËÛË ÙÔ˘ ‹·ÙÔ˜ ÌÂÙ¿ ·fi 15
min. OÈ Chung Î·È Û˘Ó.33 ‰È·›ÛÙˆÛ·Ó ˆ˜ ÙÔÈ΋ ¯ÔÚ‹ÁËÛË ·‰ÂÓÔ˚ÒÓ Ô˘ ¤ÊÂÚ·Ó ÙÔ ÁÔÓ›‰ÈÔ Ù˘ ÏÔ˘ÛÈÊÂÚ¿Û˘ ÂÓÛˆÌ·ÙˆÌ¤ÓˆÓ Û ̋ÙÚ· ÎÔÏÏ·ÁfiÓÔ˘ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ηϿ ÂÓÙÔÈṲ̂ÓË Â›‰Ú·ÛË Ù˘ ıÂÚ·›·˜. H
¤ÎÊÚ·ÛË ÏÔ˘ÛÈÊÂÚ¿Û˘ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ·‰ÂÓÔ˚ÒÓ
ÛÂ Û˘ÁÎÂÓÙÚÒÛÂȘ 5.5x108 pfu/ml ÌÂÈÒıËΠ۠ÌË ·ÓȯÓ‡ÛÈÌ· Â›‰· ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ‚Ï·‚ÒÓ ÌÂÙ¿ ·fi 2
‚‰ÔÌ¿‰Â˜, ¯ˆÚ›˜ Ó· ·ÓȯÓ‡ÂÙ·È Û fiÚÁ·Ó· ÌÂÙ¿ ·fi
·˘Ùfi ÙÔ ‰È¿ÛÙËÌ·. AÓÙ›ÛÙÔȯ· ·ÔÙÂϤÛÌ·Ù· ‰È·ÈÛÙÒıËÎ·Ó Î·È ÌÂÙ¿ ·fi ÙÔÈ΋ ¯ÔÚ‹ÁËÛË ·‰ÂÓÔ˚ÒÓ ÛÂ Û˘ÁΤÓÙÚˆÛË 5.5x109 pfu/ml, ˆÛÙfiÛÔ Û ÔÚÈṲ̂ÓÔ˘˜ Â›Ì˘Â˜ ·ÓȯÓ‡ıËΠÂÌ̤ÓÔ˘Û· ·ÛıÂÓ‹˜ ¤ÎÊÚ·ÛË ÏÔ˘ÛÈÊÂÚ¿Û˘, Ô˘ ÚÔÂÚ¯fiÙ·Ó ·fi ÙÔÓ Ì˘˚Îfi ÈÛÙfi Ô˘ ÂÚȤ‚·Ï ÙËÓ ÂÚÈÔ¯‹ Ù˘ ‚Ï¿‚˘. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË ÂÓ˙‡ÌˆÓ ÂÓ‰ÂÈÎÙÈ΋ ‚Ï¿‚˘ Û οÔÈÔ fiÚÁ·ÓÔ ·Ú¿ ÙËÓ ·Ó›¯Ó¢ÛË Û ¯·ÌËÏ¿ Â›‰· ¤ÎÊÚ·Û˘ ÏÔ˘ÛÈÊÂÚ¿Û˘ Û fiÚÁ·Ó· ̤۷ ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÙˆÓ ‰‡Ô
ÚÒÙˆÓ Â‚‰ÔÌ¿‰ˆÓ. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠη̛· ¤Ó‰ÂÈÍË
ÙÔÍÈÎfiÙËÙ·˜ ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÙˆÓ 35 ËÌÂÚÒÓ Ô˘
‰È‹ÚÎËÛÂ Ë ÌÂϤÙË.
MÂÙ·ÊÂÚfiÌÂÓÔ ÁÂÓÂÙÈÎfi ˘ÏÈÎfi
T· ÁÔÓ›‰È· ÙˆÓ ÔÔ›ˆÓ ¤¯ÂÈ ÌÂÏÂÙËı› Ë ÌÂÙ·ÊÔÚ¿ ÌÂ
ÛÎÔfi ÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ Îˆ‰ÈÎÔÔÈÔ‡Ó ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ŒÚ¢Ó˜ ¿ÌÂÛ˘ ‹ ¤ÌÌÂÛ˘ ÌÂÙ·ÊÔÚ¿˜ ÙˆÓ ÁÔÓȉ›ˆÓ Ù˘ ÌÔÚÊÔÁÂÓÂÙÈ΋˜
ÚˆÙ½Ó˘ ÙÔ˘ ÔÛÙÔ‡-2 Î·È -7 (BMP-2 Î·È BMP-7, ·ÓÙ›ÛÙÔȯ·), ÙÔ˘ ‚·ÛÈÎÔ‡ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ (bFGF), Ù˘ ÔÛÙÂÔÚÔÙÂÁÂÚ›Ó˘ (OPG) Î·È ÙÔ˘
ÚÔÂÚ¯fiÌÂÓÔ˘ ·fi Ù· ·ÈÌÔÂÙ¿ÏÈ· ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·-B (PDGF-B), ̤ۈ ÈÒÓ ‹ Ï·ÛÌȉ›ˆÓ Û ÂÚÈÔ‰ÔÓÙÈΤ˜ ‚Ï¿‚˜ ÂÈÚ·Ì·Ùfi˙ˆˆÓ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ¿ÛÂÈ ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· (¶›Ó. 3). ™Ù· Ï·›ÛÈ· Ù˘ ÚÔÛ¿ıÂÈ·˜ ·Ó¿Ï·Û˘ ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ È‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ¤¯ÂÈ ÚÔÛÂÏ·ÛÂÈ Î·È Ë ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ
Ô˘ ·ÔÛÎÔÔ‡Ó ÛÙË Ú‡ıÌÈÛË Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ ÙÔ˘ ÍÂÓÈÛÙ‹, Ì ÛÎÔfi ÙË ‚ÂÏÙÈÛÙÔÔ›ËÛË ÙˆÓ
Û˘ÓıËÎÒÓ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ.
E›Ó·È ‰˘Ó·ÙfiÓ Ù· ·ÙÙ·Ú·-ÛÙfi¯ÔÈ Ó· ÙÚÔÔÔÈËıÔ‡Ó ÁÂÓÂÙÈο ÒÛÙ ӷ ÂÎÊÚ¿˙Ô˘Ó ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚ· ÁÔÓ›‰È·.
T· ÁÔÓ›‰È· ÌÔÚÔ‡Ó Ó· Â›Ó·È ·ÓÂÍ¿ÚÙËÙ·, ÔfiÙÂ Ë ·ÓÙÈÁÚ·Ê‹ ÙÔ˘˜ Ú˘ıÌ›˙ÂÙ·È ·fi ‰È·ÊÔÚÂÙÈÎÔ‡˜ ˘ÔÎÈÓËÙ¤˜.
™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹, fï˜, ÌÔÚ› Ó· ˘¿ÚÍÂÈ ·ÓÙ·ÁˆÓÈÛÙÈ΋ ‰Ú¿ÛË ÌÂٷ͇ ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ˘ÔÎÈÓËÙÒÓ.
EÓ·ÏÏ·ÎÙÈο, Ù· ÁÔÓ›‰È· ÌÔÚÔ‡Ó Ó· Û˘Ó‰ÂıÔ‡Ó ÌÂٷ͇
ÙÔ˘˜ Ì ÂÛˆÙÂÚÈΤ˜ ·ÏÏËÏÔ˘¯›Â˜ RNA Û‡Ó‰ÂÛ˘ Ì ÚÈ‚ÔÛÒÌ·Ù· (internal ribosome entry site sequences, IRES
sequences) Î·È Ë ÌÂÙ·ÁÚ·Ê‹ ÙÔ˘˜ Ó· Ú˘ıÌ›˙ÂÙ·È ·fi ÙÔÓ
›‰ÈÔ ˘ÔÎÈÓËÙ‹. T· ÁÔÓ›‰È· ÌÂÙ·ÁÚ¿ÊÔÓÙ·È ÛÙÔ ›‰ÈÔ
mRNA ·ÏÏ¿ Û˘Ó‰¤ÔÓÙ·È ÛÙ· ÚÈ‚ÔÛÒÌ·Ù· ̤ۈ ÙˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ IRES Î·È ÌÂÙ·ÊÚ¿˙ÔÓÙ·È ·ÓÂÍ¿ÚÙËÙ·. øÛÙfiÛÔ, ¤¯ÂÈ ·Ó·ÊÂÚı› ˆ˜ Ë ¤ÎÊÚ·ÛË ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ÁÔÓȉ›Ô˘, Ô˘ ¤ÂÙ·È Ù˘ ·ÏÏËÏÔ˘¯›·˜ Û‡Ó‰ÂÛ˘ Ì ٷ ÚÈ‚ÔÛÒÌ·Ù· ‰ÂÓ ÍÂÂÚÓ¿ Û˘Ó‹ıˆ˜ ÙÔ 20-50% Ù˘ ¤ÎÊÚ·Û˘
ÙÔ˘ ÚÒÙÔ˘ ÁÔÓȉ›Ô˘31.
60
Cirelli et al.45 administered intramuscularly adeno-associated viruses carrying TNFR- immunoglobulin Fc fusion
gene in rats. After 4 weeks, the rats were subjected to
induction of experimental periodontitis by intra-gingival
application of Porphyromonas gingivalis lipopolysaccharide three times per week for 8 weeks. They studied three
groups of rats: (1) rats to which virus application had
preceded lipopolysaccharide administration (in order to
induce periodontitis) (combination of virus application
and lipopolysaccharide administration), (2) rats with no
virus application prior to lipopolysaccharide administration (lipopolysaccharide administration only) and (3) rats
which received only the adenovirus delivery vehicle (with
no adenovirus) and they were not subjected to lipopolysaccharide administration (no periodontitis induction,
control group). Inflammatory cell number in the alveolar
bone and the subepithelial area at 4 weeks as well as
inflammatory cell number in the subepithelial area at 8
weeks were statistically significantly lower in the group
with combined virus application and lipopolysaccharide
administration in comparison to the group with lipopolysaccharide administration. Moreover, in the group with
combined virus application and lipopolysaccharide
administration there was statistically significantly lower
linear bone resorption by 61.2% and 48.5% at 4 and 8
weeks, respectively. The volumetric bone loss was reduced and the bone density was increased for the group
with combined virus application and lipopolysaccharide
administration. Comparison between the group of
combined virus application and lipopolysaccharide
administration and the group of lipopolysaccharide
administration alone in terms of volumetric bone loss,
revealed statistically significant difference at 8 weeks. For
the group of combined virus application and lipopolysaccharide administration, there were statistically significantly lower osteoclast number, bone surface in contact
to osteoclast cells (at 4 and 8 weeks), interleukin-6(IL-6),
interleukin-10( IL-10), receptor activator of nuclear factor
kappa-B ligand (RANKL) and OPG expression (at 4
weeks) in comparison to the group of lipopolysaccharide
administration alone. Comparison between the group
with the combination of virus application and lipopolysaccharide administration and the control group showed
similar osteoclast number, IL-6, IL-10, RANKL, OPG,
interleukin-1‚ (IL-1‚) and TNF-· expression levels for
both groups. Furthermore, IL-1‚ and TNF-· expression
levels were similar for all three groups45. At 24 and 48
hours, the group with lipopolysaccharide administration
alone presented statistically significantly higher IL-1‚ and
TNF-· expression in comparison to the control group.
The group with the combination of virus application and
lipopolysaccharide administration presented higher IL1‚ and TNF-· expression, which reached statistically
significant levels at 48 hours. Though, they were statistically significantly lower as compared to the group with
lipopolysaccharide administration alone. This indicates
that the inhibitory effect of TNFR on the expression of
these inflammatory mediators is more prominent in the
Hellenic Stomatological Review 57: 39-71, 2013
Hellenic Stomatological Review 57: 39-71, 2013
In-vitro
A‰ÂÓÔ˝Ô›
E›Ì˘Â˜
MÔÚÊÔÁÂÓÂÙÈ΋ ÚˆÙ½ÓË
ÙÔ˘ ÔÛÙÔ‡-7,
noggin (·ÓÙ·ÁˆÓÈÛÙ‹˜)
BÏ¿‚˜ Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡
οو ÁÓ¿ıÔ˘
In-vivo
¶Ï·ÛÌ›‰È·
MÔÚÊÔÁÂÓÂÙÈ΋ ÚˆÙ½ÓË
ÙÔ˘ ÔÛÙÔ‡-2
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ÚÔÎÏËı›Û˜ beagle
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‚Ï¿‚˜ Û¯‹Ì·ÙÔ˜ U ÛÙËÓ
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ÚÈ˙ÒÓ Î¿Ùˆ
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MÂÛÂÁ¯˘Ì·ÙÈο
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Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ
In-vitro
A‰ÂÓÔ˝Ô›
MÔÚÊÔÁÂÓÂÙÈ΋ ÚˆÙ½ÓË
ÙÔ˘ ÔÛÙÔ‡-2
New
XÂÈÚÔ˘ÚÁÈο
ÚÔÎÏËı›Û˜ Zealand
ÂÚÈÔ‰ÔÓÙÈΤ˜ Ï·ÁÔ›
‚Ï¿‚˜
K‡ÙÙ·Ú·ÛÙfi¯ÔÈ
T¯ÓÈ΋
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ZÒÔ
°ÔÓ›‰ÈÔ
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ZÂÏ·Ù›ÓË
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F127
M¤ÛÔ
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8
‚‰ÔÌ¿‰Â˜
-
¢È¿ÚÎÂÈ·
32
35
¶Ï‹Ú˘ ÔÛÙÈ΋ ·Ó¿Ï·ÛË Î·È ‰ËÌÈÔ˘ÚÁ›· Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ ÏÔ‡ÛÈÔ˘
Û ›Ó˜ Î·È ·ÁÁ›·. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ‰ËÌÈÔ˘ÚÁ›· ÔÛÙ½Ó˘, Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ Î·È ÔÛÙÔ‡ Û ۇÁÎÚÈÛË Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÌfiÓÔ ·Ï·ÙÔ‡¯Ô˘ ÔÚÔ‡, ·ÚfiÌÔÈ· Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ·ÓıÚÒÈÓ˘
·Ó·Û˘Ó‰˘·Ṳ̂Ó˘ ÌÔÚÊÔÁÂÓÂÙÈ΋˜ ÚˆÙ½Ó˘
ÙÔ˘ ÔÛÙÔ‡-2
T·¯Â›· ÔÛÙÂÔÁ¤ÓÂÛË, ÔÛÙÂ˚ÓÔÁ¤ÓÂÛË Î·È ÚԂϤ„ÈÌË ·Ó¿Ï·ÛË ÙˆÓ
‚Ï·‚ÒÓ. AÓ·ÛÙÔÏ‹ Ù˘
ÔÛÙÂÔÁ¤ÓÂÛ˘ ·fi ·ÙÙ·Ú· ÂÎÊÚ¿˙ÔÓÙ·
noggin.
34
MÂϤÙË
¢ËÌÈÔ˘ÚÁ›· ÔÛÙ½Ó˘
Î·È ÈÓÒÓ ÙÔ˘ Sharpey.
™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈο
ÌÂÁ·Ï‡ÙÂÚË ‰ËÌÈÔ˘ÚÁ›·
ÔÛÙÔ‡ Û ۇÁÎÚÈÛË ÌÂ
ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÌË ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӈÓ
΢ÙÙ¿ÚˆÓ Î·È ÂÊ·ÚÌÔÁ‹
ÌfiÓÔ ÙÔ˘ ̤ÛÔ˘.
AÔÙÂϤÛÌ·Ù·
¶›Ó·Î·˜ 3. MÂϤÙ˜ ÌÂÙ·ÊÔÚ¿˜ ÁÔÓȉ›ˆÓ ÁÈ· ÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ Î·È
ÂÚÈÂÌÊ˘ÙÂ˘Ì·ÙÈÎÒÓ ÈÛÙÒÓ Û ÂÈÚ·Ì·Ùfi˙ˆ·.
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
61
62
™Î‡ÏÔÈ
beagle
¶ÂÚÈÂÊ˘ÙÂ˘Ì·ÙÈΤ˜ ‚Ï¿‚˜ οو ÁÓ¿ıÔ˘
-
™Î‡ÏÔÈ
XÂÈÚÔ˘ÚÁÈο
ÚÔÎÏËı›Û˜ Beagle
‚Ï¿‚˜ ÂÚÈÔ¯‹˜ Û˘Ì‚ÔÏ‹˜ ÙˆÓ ÚÈ˙ÒÓ
ηÙËÁÔÚ›·˜ II
BÏ¿‚˜ Ù˘
ÂÚÈÔ¯‹˜
Û˘Ì‚ÔÏ‹˜
ÙˆÓ ÚÈ˙ÒÓ
In-vitro
In-vivo
-
A‰ÂÓÔ˚Ô›
MÔÚÊÔÁÂÓÂÙÈ΋ ÚˆÙ½ÓË
ÙÔ˘ ÔÛÙÔ‡-7
MÔÚÊÔÁÂÓÂÙÈ΋ ÚˆÙ½ÓË
ÙÔ˘ ÔÛÙÔ‡-7
In-vitro
E˘Î·ÚȈÙÈÎfi
Ï·ÛÌ›‰ÈÔ
pDC316
B·ÛÈÎfi˜
·˘ÍËÙÈÎfi˜
·Ú¿ÁÔÓÙ·˜
ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ Î·È
Ú¿ÛÈÓË
ÊıÔÚ›˙Ô˘Û·
ÚˆÙ½ÓË
MÂÌ‚Ú¿ÓË
ÎÔÏÏ·ÁfiÓÔ˘
™Ùڈ̷ÙÈο
·ÙÙ·Ú· Ì˘ÂÏÔ‡
ÙˆÓ ÔÛÙÒÓ
KÈÙÔ˙¿ÓË/
KÔÏÏ·ÁfiÓÔ/
·ÙÙ·Ú·
ÂÚÈÚÚÈ˙›Ô˘
-
MÂÛÂÁ¯˘Ì·ÙÈο
ÛÙڈ̷ÙÈο
·ÙÙ·Ú· Ì˘ÂÏÔ‡
ÙˆÓ ÔÛÙÒÓ
MÂÁ·Ï‡ÙÂÚË ‰Ú·ÛÙËÚÈfiÙËÙ· ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘, ¤ÎÊÚ·ÛË ÔÛÙÂÔÔÓÙ›Ó˘ Î·È ÛÈ·ÏÔÚˆÙ½Ó˘ ·fi Ù· ·ÙÙ·Ú· ÙÔ˘ ̤ÛÔ˘ ÚÈÓ
ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ηÈ
ÌÂÁ·Ï‡ÙÂÚË ‰ËÌÈÔ˘ÚÁ›·
ÔÛÙÔ‡ 4 Î·È 8 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿, Û ۇÁÎÚÈÛË
Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ÙÔ˘
̤ÛÔ˘ ¯ˆÚ›˜ ·‰ÂÓÔ˚Ô‡˜
ʤÚÔÓÙ˜ ÙÔ ÁÔÓ›‰ÈÔ Ù˘
ÌÔÚÊÔÁÂÓÂÙÈ΋˜ ÚˆÙ½Ó˘ ÙÔ˘ ÔÛÙÔ‡-7.
38
37
™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈο
ÌÂÁ·Ï‡ÙÂÚË ÂÚÈÔ¯‹ ÓÂÔ‰ËÌÈÔ˘ÚÁËı¤ÓÙÔ˜ ÔÛÙÔ‡ Î·È Ì‹ÎÔ˜ ÓÂÔ‰ËÌÈÔ˘ÚÁËı›۷˜ ÔÛÙ½Ó˘
Û ۇÁÎÚÈÛË Ì ÙË ÌË
ÌÂÙ·ÌfiÛ¯Â˘ÛË Î˘ÙÙ¿ÚˆÓ Î·È ÌÂÙ·ÌfiÛ¯Â˘ÛË
ÌË ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ, Ù· ÔÔ›· ·ÚÔ˘Û›·Û·Ó Â›Û˘ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ Û ۇÁÎÚÈÛË Ì ÙË ÌË ÌÂÙ·ÌfiÛ¯Â˘ÛË Î˘ÙÙ¿ÚˆÓ.
12
‚‰ÔÌ¿‰Â˜
3 Ì‹Ó˜
36
™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈο
ÌÂÁ·Ï‡ÙÂÚË Ù·¯‡ÙËÙ·
·Ó¿Ï·Û˘ ÙÔ˘ ÔÛÙÔ‡
Û ۇÁÎÚÈÛË Ì ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÌË ÁÂÓÂÙÈο
ÙÚÔÔÔÈË̤ӈÓ
΢ÙÙ¿ÚˆÓ
6
‚‰ÔÌ¿‰Â˜
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Hellenic Stomatological Review 57: 39-71, 2013
In-vivo
In-vitro
A‰ÂÓÔ˚Ô›
ÛÂ Û˘ÁΤÓÙÚˆÛË
5.5x108 ‹
5.5x109
pfu/ml
A‰ÂÓÔ˚Ô›
AÏ˘Û›‰· B
·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ
·ÈÌÔÂÙ·Ï›ˆÓ
MÔÚÊÔÁÂÓÂÙÈ΋ ÚˆÙ½ÓË
ÙÔ˘ ÔÛÙÔ‡-2
¶ÂÚÈÂÌÊ˘Ù¢- E›Ì˘Â˜
Ì·ÙÈΤ˜ ‚Ï¿‚˜, ¯ÂÈÚÔ˘ÚÁÈο ÚÔÎÏËı›Û˜ Ù·˘Ùfi¯ÚÔÓ· ÌÂ
ÚÔÂÙÔÈÌ·Û›·
ÙÔ˘ ÔÛÙÔ‡ ÁÈ·
ÙÔÔı¤ÙËÛË
ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ
™Î‡ÏÔÈ
¶ÂÚÈÔ‰ÔÓÙÈbeagle
Τ˜ ‚Ï¿‚˜
ÁÔÌÊ›ˆÓ οو
ÁÓ¿ıÔ˘
In-vitro
¶Ï·ÛÌ›‰ÈÔ
OÛÙÂÔÚÔÙÂÁÂÚ›ÓË
™Î‡ÏÔÈ
XÂÈÚÔ˘ÚÁÈο
ÚÔÎÏËı›Û˜
ÔÚÈ˙fiÓÙȘ ÔÛÙÈΤ˜ ‚Ï¿‚˜
4x4x3mm
ÛÙËÓ ·ÚÂȷ΋ ÂÈÊ¿ÓÂÈ·
ÚÔÁÔÌÊ›ˆÓ
A‰È·ÊÔÚÔÔ›ËÙ·
ÌÂÛÂÁ¯˘Ì·ÙÈο
·ÙÙ·Ú·
™Ùڈ̷ÙÈο
·ÙÙ·Ú· Ì˘ÂÏÔ‡
ÙˆÓ ÔÛÙÒÓ
Hellenic Stomatological Review 57: 39-71, 2013
-
M‹ÙÚ·
ÎÔÏÏ·ÁfiÓÔ˘
PLGA
8
‚‰ÔÌ¿‰Â˜
-
6
‚‰ÔÌ¿‰Â˜
¢ËÌÈÔ˘ÚÁ›· ÔÛÙ½Ó˘
Î·È ÈÓÒÓ ÙÔ˘ Sharpey
ÛÙȘ ·ÔÁ˘Ìӈ̤Ó˜
·fi ÔÛÙ½ÓË ÚÈ˙ÈΤ˜
ÂÈÊ¿ÓÂȘ, Û ·ÓÙ›ıÂÛË
Ì ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÌË
ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ, fiÔ˘
·Ú·ÙËÚ‹ıËΠ·ÙÂÏ‹˜
ÂԇψÛË Î·È ÂÓÙÔÈṲ̂ӷ ·ÔÚÚfiÊËÛË Ú›˙·˜. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ‰ËÌÈÔ˘ÚÁ›· ÔÛÙÔ‡ ÛÙȘ 8
‚‰ÔÌ¿‰Â˜.
EÈÙ¿¯˘ÓÛË Ù˘ ÔÛÙÈ΋˜
·Ó¿Ï·Û˘ Û ۇÁÎÚÈÛË Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË
΢ÙÙ¿ÚˆÓ ÊÂÚfiÓÙˆÓ ÙÔ
ÁÔÓ›‰ÈÔ Ù˘ ÏÔ˘ÛÈÊÂÚ¿Û˘, ·ÚfiÌÔÈ· Ì ÙËÓ
¯ÔÚ‹ÁËÛË ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ ·ÓıÚÒÈÓÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ
·ÈÌÔÂÙ·Ï›ˆÓ BB. H ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË ·‰ÂÓÔÈÒÓ ‹Ù·Ó ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋.
™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈο
ÌÂÁ·Ï‡ÙÂÚË ‰ËÌÈÔ˘ÚÁ›·
ÔÛÙ½Ó˘, Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ Î·È ÔÛÙÔ‡ Û ۇÁÎÚÈÛË Ì ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÌË ÁÂÓÂÙÈο
ÙÚÔÔÔÈËÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ, ÙËÓ ÂÊ·ÚÌÔÁ‹ ÌfiÓÔ ÙÔ˘ ̤ÛÔ˘ Î·È ÌfiÓÔ
ÙËÓ ÚÈ˙È΋ ·fiÍÂÛË.
41
40
39
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
63
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
MÔÚÊÔÁÂÓÂÙÈΤ˜ ÚˆÙ½Ó˜ ÙÔ˘ ÔÛÙÔ‡ (BMPs)
Œ¯ÂÈ ‰Âȯı› fiÙÈ ·Ú·ÙÂٷ̤ÓË ¤ÎıÂÛË Û ¯·ÌËÏ‹ Û˘ÁΤÓÙÚˆÛË ·Ó·Û˘Ó‰˘·Ṳ̂Ó˘ ·ÓıÚÒÈÓ˘ ÌÔÚÊÔÁÂÓÂÙÈ΋˜
ÚˆÙ½Ó˘ ÙÔ˘ ÔÛÙÔ‡-2 ÚÔ¿ÁÂÈ ÙËÓ ÔÛÙÂ˚ÓÔÁ¤ÓÂÛË. øÛÙfiÛÔ, ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ÌÈÎÚÔ‡ ¯ÚfiÓÔ˘ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜
Ù˘ fiÙ·Ó ¯ÔÚËÁÂ›Ù·È ÙÔÈο ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ‚Ï¿‚˘ ηıÈÛÙ¿ ··Ú·›ÙËÙË ÙË ¯ÔÚ‹ÁËÛË ˘„ËÏÒÓ ‰fiÛˆÓ. Y„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ, fï˜, ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÙÔÈÎÒÓ ÂÈÏÔÎÒÓ, fiˆ˜ ·Á·ψÛË Î·È ÔÛÙÈ΋ ·ÔÚÚfiÊËÛË. H ·Ú·ÙÂٷ̤ÓË ·ÂÏ¢ı¤ÚˆÛË ·fi ·ÙÙ·Ú· Ô˘ ¤¯Ô˘Ó ÙÚÔÔÔÈËı› ÁÂÓÂÙÈο
ÒÛÙ ӷ ÂÎÊÚ¿˙Ô˘Ó ÌÔÚÊÔÁÂÓÂÙÈ΋ ÚˆÙ½ÓË ÙÔ˘ ÔÛÙÔ‡2 ¤¯ÂÈ ‰Âȯı› fiÙÈ ÌÔÚ› Ó· ηٷÛÙ‹ÛÂÈ ‰˘Ó·Ù‹ ÙË Ì›ˆÛË Ù˘ ··ÈÙÔ‡ÌÂÓ˘ Û˘ÁΤÓÙÚˆÛ‹˜ Ù˘ ηٿ ÂÚ›Ô˘
1.000 ÊÔÚ¤˜32, 41.
OÈ Yang Î·È Û˘Ó.31 ‰È·›ÛÙˆÛ·Ó fiÙÈ ·ÓıÚÒÈÓ· ·ÙÙ·Ú·
ÙÔ˘ ÂÚÈÚÚÈ˙›Ô˘ Ô˘ ›¯·Ó ÙÚÔÔÔÈËı› ÁÂÓÂÙÈο ÒÛÙÂ
Ó· ÂÎÊÚ¿˙Ô˘Ó ÌÔÚÊÔÁÂÓÂÙÈ΋ ÚˆÙ½ÓË ÙÔ˘ ÔÛÙÔ‡-7
(BMP-7) Î·È ÚÔÛÔÌÔÈ¿˙ÔÓÙ· Ì ÈÓÛÔ˘Ï›ÓË ·˘ÍËÙÈÎfi ·Ú¿ÁÔÓÙ·-1 (IGF-1) ‹ ÌfiÓÔ BMP-7, ÌÂÙ¿ ·fi 3 Ë̤Ú˜ ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ¤ÎÊÚ·ÛË
BMP-7, ‰Ú·ÛÙËÚÈfiÙËÙ· ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ Î·È ¤ÎÊÚ·ÛË ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ I, Runx2 Î·È ÛÈ·ÏÔÚˆÙ½Ó˘
ÙÔ˘ ÔÛÙÔ‡ Û ۯ¤ÛË Ì ·ÙÙ·Ú· ÙÔ˘ ÂÚÈÚÚÈ˙›Ô˘ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÒÛÙ ӷ ÂÎÊÚ¿˙Ô˘Ó Ú¿ÛÈÓË ÊıÔÚ›˙Ô˘Û· ÚˆÙ½ÓË Î·È ÌË ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ·ÙÙ·Ú·
ÙÔ˘ ÂÚÈÚÚÈ˙›Ô˘. T· ·ÙÙ·Ú· Ô˘ ›¯·Ó ÙÚÔÔÔÈËı› ÁÂÓÂÙÈο ÒÛÙ ӷ ÂÎÊÚ¿˙Ô˘Ó BMP-7 Î·È IGF-1 ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ‰Ú·ÛÙËÚÈfiÙËÙ·
·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ Î·È ¤ÎÊÚ·ÛË ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ I Î·È Runx2 Û ۯ¤ÛË Ì ٷ ·ÙÙ·Ú· Ô˘ ›¯·Ó ÙÚÔÔÔÈËı› ÒÛÙ ӷ ÂÎÊÚ¿˙Ô˘Ó ÌfiÓÔ BMP-7. H ̤ÁÈÛÙË
¤ÎÊÚ·ÛË BMP-7 Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ΢ÙÙ¿ÚˆÓ ·Ú·ÙËÚ‹ıËΠ9 Ë̤Ú˜ ÌÂÙ¿, ÂÓÒ Ë ¤ÎÊÚ·Û‹ ÙÔ˘˜ ·Ú¤ÌÂÈÓÂ
ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÙˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ ÒÛÙ ӷ
ÂÎÊÚ¿˙Ô˘Ó Ú¿ÛÈÓË ÊıÔÚ›˙Ô˘Û· ÚˆÙ½ÓË Î·È Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÙˆÓ ÌË ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӈÓ
΢ÙÙ¿ÚˆÓ Ì¤¯ÚÈ Î·È ÙȘ 27 Ë̤Ú˜31.
A˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÚÔÂÚ¯fiÌÂÓÔ˜ ·fi Ù· ·ÈÌÔÂÙ¿ÏÈ· (PDGF)
O ÚÔÂÚ¯fiÌÂÓÔ˜ ·fi Ù· ·ÈÌÔÂÙ¿ÏÈ· ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜-AA (PDGF-AA), Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi ‰‡Ô ·Ï˘Û›‰Â˜ A ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ ÚÔÂÚ¯fiÌÂÓÔ˘ ·fi
Ù· ·ÈÌÔÂÙ¿ÏÈ· (PDGF), Û˘Ó‰ÂfiÌÂÓÔ˜ ÛÙÔÓ ˘Ô‰Ô¯¤· ·
ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, Ô˘ ›ӷÈ
˘Ô‰Ô¯¤·˜ Ù˘ÚÔÛÈÓÈ΋˜ ÎÈÓ¿Û˘, Â¿ÁÂÈ ÙË ÊˆÛÊÔÚ˘Ï›ˆÛ‹ ÙÔ˘ Ë ÔÔ›· ˘ÚÔ‰ÔÙ› ¤Ó· ηٷÚÚ¿ÎÙË ÂÓ‰Ô΢ÙÙ·ÚÈÎÒÓ Î·È ÂÍˆÎ˘ÙÙ·ÚÈÎÒÓ ÛËÌ¿ÙˆÓ. OÈ Chen ηÈ
Giannobile42 ÌÂÙ¿ ·fi ÚÔÛ‚ÔÏ‹ ‰ÂÚÌ·ÙÈÎÒÓ ÈÓÔ‚Ï·ÛÙÒÓ Â›Ì˘ˆÓ Ì ·‰ÂÓÔ˚Ô‡˜ Ô˘ ¤ÊÂÚ·Ó ÙÔ ÁÔÓ›‰ÈÔ Ù˘
·Ï˘Û›‰·˜ A ·Ú·Ù‹ÚËÛ·Ó ÊˆÛÊÔÚ˘Ï›ˆÛË ÙÔ˘ ˘Ô‰Ô¯¤· · ÛÙȘ 8 ÒÚ˜ Î·È ·‡ÍËÛ‹ Ù˘ ̤¯ÚÈ Î·È ÙȘ 96 ÒÚ˜,
ÔfiÙÂ Î·È Û˘ÏϤ¯ıËÎ·Ó Ù· ÙÂÏÂ˘Ù·›· ·ÙÙ·Ú· Ô˘ ÌÂÏÂÙ‹ıËηÓ. AÓÙ›ÛÙÔÈ¯Ë ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÂÈ¤‰ˆÓ ʈÛÊÔÚ˘Ï›ˆÛ˘ ·ÚÔ˘Û›·Û·Ó ÔÈ ERK1/2 Î·È Akt, ÔÈ ÔÔ›ÔÈ ÂÌϤ64
short term. This may be due to the reduction of the lipopolysaccharide-enhanced expression of the inflammatory mediators with time, due to the development of resistance to endotoxins in an attempt of the host to regulate
the local immune reaction45.
Other gene transferring means
It has been suggested that among the non-viral vectors
plasmids can be used for genetic material transfer in
gene therapy for periodontal tissue regeneration. Chen
et al.46 studied the luciferase expression after transferring
recombinant plasmids containing luciferase gene to rat
periodontal tissues by using nanobubbles and ultrasound waves (pulse 10Ìs and energy 36J/cm2). Transferring recombinant plasmids containing luciferase gene by
using nanobubbles and ultrasound waves led to statistically significantly higher luciferase expression on day 1
as compared to plasmids alone, plasmids mixed with
nanobubbles as well as to plasmids followed by ultrasound waves. However, on day 3 luciferase expression
returned to the initial levels. It was claimed that the
collapse of nanobubbles and cavitation bubbles by the
ultrasound waves caused a transient increase in cell
permeability leaving plasmids to enter into them. Ultrasound waves should be of a short duration, since longlasting waves result in a non-reversible increase in cell
permeability, and they of low energy, since high energy
results in reduction of their vitality.
The short-term expression of genes transferred in such
way that make repeating treatment necessary for the
maintenance of high gene expression levels, might be
attributed to the rapid plasmid degradation due to the
high blood circulation in the area. Optimizing ultrasound
wave parameters and developing an ultrasound wave
production device specifically for this purpose might
increase the gene expression time46.
CONCLUSION
Successful periodontal tissue regeneration is based on
the presence of cells, cellular signals regulating cellular
activity, scaffolds supporting periodontal regeneration,
vascularization, where cellular signals are involved, and
microbial control. Mesenchymal stem cell transplantation for periodontal tissue regeneration by providing new
cells, which proliferate, differentiate, secret cellular signals and help in tissue growth and differentiation, has
showed encouraging results in periodontal regeneration,
mainly in a pre-clinical level. Moreover, it is being studied
in clinical trials. Gene transfer has demonstrated promising pre-clinical results in periodontal regeneration,
which offers the possibility to express cellular signals by
target-cells aiming at the induction of tissue growth and
differentiation or the control of the host immune response
to microbial stimuli. Mesenchymal stem cell transplantation and gene transfer, either alone or combined,
might prove to offer further benefit to periodontal tissue
regeneration, which is currently explored.
Hellenic Stomatological Review 57: 39-71, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
ÎÔÓÙ·È ÛÙÔÓ Î·Ù·ÚÚ¿ÎÙË ÛËÌ¿ÙˆÓ Ô˘ ˘ÚÔ‰ÔÙ› Ë ÊˆÛÊÔÚ˘Ï›ˆÛË ÙÔ˘ ˘Ô‰Ô¯¤· ·. MÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ ·ÓıÚÒÈÓÔ˘ PDGF-AA, Ë ÊˆÛÊÔÚ˘Ï›ˆÛË
ÙÔ˘ ˘Ô‰Ô¯¤· · ‰È·ÙËÚ‹ıËΠ̤¯ÚÈ ÙȘ 48 ÒÚ˜, ·ÏÏ¿
ÛÙȘ 72 ÒÚ˜ ›¯Â ·Ú¯›ÛÂÈ Ó· ÂÍ·ÛıÂÓ›. AÓÙ›ÛÙÔȯ·, ʈÛÊÔÚ˘Ï›ˆÛË ÙˆÓ ERK1/2 Î·È Akt ·Ú·ÙËÚ‹ıËΠÛÙȘ 8 ÒÚ˜ Î·È ‰È·ÙËÚ‹ıËΠ·ÓÙ›ÛÙÔȯ· ̤¯ÚÈ ÙȘ 72 Î·È 48 ÒÚ˜.
H ηı˘ÛÙÂÚË̤ÓË ÊˆÛÊÔÚ˘Ï›ˆÛË ÙÔ˘ ˘Ô‰Ô¯¤· Ô˘
·Ú·ÙËÚ‹ıËΠÌÂÙ¿ ·fi ÙË ÌfiÏ˘ÓÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂ
ÙÔ˘˜ ÈÔ‡˜ ˘ÔÛÙËÚ›¯ıËΠfiÙÈ ÔÊ›ÏÂÙ·È ÛÙÔ ¯ÚfiÓÔ Ô˘ ··ÈÙÂ›Ù·È ÁÈ· ÙË ÌÂÙ·ÊÔÚ¿ Î·È ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ÁÔÓȉ›Ô˘42. OÈ Lin Î·È Û˘Ó.43 ÌÂÙ¿ ·fi ÌfiÏ˘ÓÛË ·ÓıÚÒÈÓˆÓ Ô˘ÏÈÎÒÓ ÈÓÔ‚Ï·ÛÙÒÓ Ì ·‰ÂÓÔ˚Ô‡˜ Ô˘ ¤ÊÂÚ·Ó ÙÔ ÁÔÓ›‰ÈÔ
Ù˘ ·Ï˘Û›‰·˜ B ÙÔ˘ PDGF ·Ú·Ù‹ÚËÛ·Ó ¤ÎÊÚ·ÛË ÙÔ˘
ÚÔÂÚ¯fiÌÂÓÔ˘ ·fi Ù· ·ÈÌÔÂÙ¿ÏÈ· ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·-BB (PDGF-BB) ÛÙȘ 6 ÒÚ˜, Ë ÔÔ›· ‰È·ÙËÚ‹ıËÎÂ
ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì¤¯ÚÈ ÙȘ 96 ÒÚ˜. Œ¯ÂÈ ·Ó·ÊÂÚı› ˆ˜, ÛÂ
·ÓÙ›ıÂÛË Ì ÙËÓ ¿ÌÂÛË ·ÏÏ¿ ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ ‰Ú¿ÛË (Ï›ÁˆÓ ËÌÂÚÒÓ) ÙÔ˘ ÙÔÈο ÂÊ·ÚÌÔ˙fiÌÂÓÔ˘ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ PDGF-BB, ÌfiÏ˘ÓÛË Î˘ÙÙ¿ÚˆÓ Ì ·‰ÂÓÔ˚Ô‡˜ Ô˘
ʤÚÔ˘Ó ÙÔ ÁÔÓ›‰ÈÔ Ù˘ ·Ï˘Û›‰·˜ B ÙÔ˘ PDGF ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ηı˘ÛÙÂÚË̤ÓË ·ÏÏ¿ ·Ú·ÙÂٷ̤ÓË ¤ÎÊÚ·Û‹ ÙÔ˘, Ô˘ ÌÂÈÔ‡ÌÂÓË ÛÙ·‰È·Î¿, ÙËÓ 14Ë Ë̤ڷ ÊÙ¿ÓÂÈ
ÛÙÔ 20% ÙÔ˘ ˘„ËÏfiÙÂÚÔ˘ ÂÈ¤‰Ô˘ Ù˘40.
™Â ÌÂϤÙË ÙˆÓ Giannobile Î·È Û˘Ó.44 ÔÛÙÂ˚ÓÔ‚Ï¿ÛÙ˜ Ô˘
ÌÔχÓıËÎ·Ó Ì ÈÔ‡˜ Ô˘ ¤ÊÂÚ·Ó ÙÔ ÁÔÓ›‰ÈÔ Ù˘ ·Ï˘Û›‰·˜
A ÙÔ˘ PDGF ·ÚÔ˘Û›·Û·Ó ¤ÎÊÚ·Û‹ ÙÔ˘ ÌÂÙ¿ ·fi 24 ÒÚ˜ Ô˘ ‰È·ÙËÚ‹ıËΠ̤¯ÚÈ Î·È ÙȘ 7 Ë̤Ú˜, ÔfiÙÂ Û˘ÏϤ¯ıËÎ·Ó Ù· ÙÂÏÂ˘Ù·›· ·ÙÙ·Ú· Ô˘ ÌÂÏÂÙ‹ıËηÓ. MÂÙ¿
·fi 24 ÒÚ˜, ÔÈ ÔÛÙÂ˚ÓÔ‚Ï¿ÛÙ˜ Ô˘ ÌÔχÓıËÎ·Ó Ì ÈÔ‡˜ Ô˘ ¤ÊÂÚ·Ó ÙÔ ÁÔÓ›‰ÈÔ Ù˘ ·Ï˘Û›‰·˜ A ÙÔ˘ PDGF ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË Û‡ÓıÂÛË
DNA Î·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ‰Ú·ÛÙËÚÈfiÙËÙ· ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ Û ۇÁÎÚÈÛË Ì ÔÛÙÂ˚ÓÔ‚Ï¿ÛÙ˜ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ˘˜ ÒÛÙ ӷ ÂÎÊÚ¿˙Ô˘Ó
Ú¿ÛÈÓË ÊıÔÚ›˙Ô˘Û· ÚˆÙ½ÓË. H Û‡ÓıÂÛË DNA Î·È Ô
ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ‹Ù·Ó Û ·ÚfiÌÔÈ· Â›‰· ÌÂٷ͇ ÔÛÙÂ˚ÓÔ‚Ï·ÛÙÒÓ Ô˘ ÌÔχÓıËÎ·Ó Ì ÈÔ‡˜ Ô˘ ¤ÊÂÚ·Ó ÙÔ
ÁÔÓ›‰ÈÔ Ù˘ ·Ï˘Û›‰·˜ A ÙÔ˘ PDGF Î·È ÔÛÙÂ˚ÓÔ‚Ï·ÛÙÒÓ
ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÁÈÓfiÙ·Ó Û˘Ó¯‹˜ ÂÊ·ÚÌÔÊ‹ PDGF. TËÓ 4Ë
Î·È ÙËÓ 7Ë Ë̤ڷ ÔÈ ÔÛÙÂ˚ÓÔ‚Ï¿ÛÙ˜ ÔÈ Ôԛ˜ ›¯·Ó ÙÚÔÔÔÈËı› ÁÂÓÂÙÈο ÒÛÙ ӷ ÂÎÊÚ¿˙Ô˘Ó PDGF Î·È ÔÈ ÔÛÙÂ˚ÓÔ‚Ï¿ÛÙ˜ ÛÙȘ Ôԛ˜ ÚÔÛÙ¤ıËΠPDGF ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙÔ˘˜ Û ۇÁÎÚÈÛË Ì ÙȘ ÔÛÙÂ˚ÓÔ‚Ï¿ÛÙ˜ ÔÈ Ôԛ˜ ›¯·Ó ÙÚÔÔÔÈËı› ÁÂÓÂÙÈο ÒÛÙ ӷ ÂÎÊÚ¿˙Ô˘Ó Ú¿ÛÈÓË ÊıÔÚ›˙Ô˘Û· ÚˆÙ½ÓË. øÛÙfiÛÔ, ÔÈ ÚÒÙ˜ ·ÚÔ˘Û›·˙·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙÔ˘˜ Û ۇÁÎÚÈÛË Ì ÙȘ ‰Â‡ÙÂÚ˜. EÔ̤ӈ˜, Ë
¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· Ù˘ ¤ÎıÂÛ˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔÓ PDGF
Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ
ÈÛÙÒÓ.
Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë ÂÊ·ÚÌÔÁ‹ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘
PDGF ÂӉ›ÎÓ˘Ù·È Û ‚Ï¿‚˜ fiÔ˘ Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ Ë Ù·¯Â›· ¤Ó·ÚÍË ÙˆÓ ‰ÈÂÚÁ·ÛÈÒÓ Ù˘ ·Ó¿Ï·Û˘,
ηıÒ˜ Ô ÌÈÎÚfi˜ ¯ÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ
ÌÂÙ¿ ÙËÓ ÙÔÈ΋ ÂÊ·ÚÌÔÁ‹ ÙÔ˘, Â¿ÁÂÈ ÔÏÏ·Ï·ÛÈ·ÛÌfi
Î·È ¯ËÌÂÈÔÙ·ÎÙÈ΋ ÚÔÛÎfiÏÏËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ¯ˆÚ›˜ Ó·
Hellenic Stomatological Review 57: 39-71, 2013
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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
ηı˘ÛÙÂÚ› ÛËÌ·ÓÙÈο ÙËÓ ¤Ó·ÚÍË Ù˘ ‰È·ÊÔÚÔÔ›ËÛ‹˜
ÙÔ˘˜. AÓÙ›ıÂÙ·, Ë ¯ÔÚ‹ÁËÛË ·‰ÂÓÔ˚ÒÓ Ô˘ ʤÚÔ˘Ó ÙÔ ÁÔÓ›‰ÈÔ ·Ï˘Û›‰ˆÓ ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ ÚÔÂÚ¯fiÌÂÓÔ˘ ·fi Ù· ·ÈÌÔÂÙ¿ÏÈ· ›Ûˆ˜ Ó· ÂӉ›ÎÓ˘Ù·È ÂÚÈÛÛfiÙÂÚÔ Û ÌÂÁ·Ï‡ÙÂÚ˜ ‚Ï¿‚˜, fiÔ˘ Ë ·Ú·ÙÂٷ̤ÓË
‰Ú¿ÛË ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ ÚÔÂÚ¯fiÌÂÓÔ˘ ·fi Ù· ·ÈÌÔÂÙ¿ÏÈ· ı· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·Ú·ÁˆÁ‹ ÌÂÁ·Ï‡ÙÂÚÔ˘ ·ÚÈıÌÔ‡ ΢ÙÙ¿ÚˆÓ Î·ı˘ÛÙÂÚÒÓÙ·˜, fï˜,
ÂÚÈÛÛfiÙÂÚÔ ÙËÓ ¤Ó·ÚÍË Ù˘ ‰È·ÊÔÚÔÔ›ËÛ‹˜ ÙÔ˘˜, Ô˘
·ÎÔÏÔ˘ı› ÙËÓ ÂÍ·Ûı¤ÓËÛË Ù˘ ‰Ú¿Û˘ ÙÔ˘40.
P‡ıÌÈÛË Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ ÙÔ˘ ÍÂÓÈÛÙ‹
YÔ‰Ô¯¤·˜ ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙˆÓ fiÁÎˆÓ (TNFR)
O ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛ˘ ÙˆÓ fiÁΈÓ-· (TNF-·) ÚÔ¿ÁÂÈ
ÙËÓ ÔÛÙÈ΋ ·ÔÚÚfiÊËÛË ‰ÈÂÁ›ÚÔÓÙ·˜ ÙË ‰È·ÊÔÚÔÔ›ËÛË Î·È ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÔÛÙÂÔÎÏ·ÛÙÒÓ. O TNF Û˘Ó‰¤ÂÙ·È Ì ‰‡Ô ˘ԉԯ›˜, ÙÔÓ p55 Î·È p75 ˘Ô‰Ô¯¤·. £ÂÚ·›˜ ·ÓÔÛÔÏÔÁÈ΋˜ Ú‡ıÌÈÛ˘ Ô˘ ¤¯Ô˘Ó ˆ˜ ‚¿ÛË ÙË ‰¤ÛÌ¢ÛË ÙÔ˘ TNF ¤¯Ô˘Ó ÂÊ·ÚÌÔÛÙ› ÂÈÙ˘¯Ò˜ Û ·ÓıÚÒÔ˘˜ ÁÈ· ÙË ıÂÚ·›· Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜. T·
Ê¿Ú̷η Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â›ÙÂ Â›Ó·È ÌÔÓÔÎψÓÈο
·ÓÙÈÛÒÌ·Ù· ÙÔ˘ TNF ›Ù ÚˆÙ½Ó˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ
p75 ˘Ô‰Ô¯¤· ÙÔ˘ TNF Û˘ÓÙËÁ̤Ó˜ Ì ÙÔ Fc ÙÌ‹Ì· ·ÓıÚÒÈÓ˘ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ IgG145.
OÈ Cirelli Î·È Û˘Ó.45 ¯ÔÚ‹ÁËÛ·Ó ÂÓ‰ÔÌ˘˚ο ÈÔ‡˜ Û¯ÂÙÈ˙fiÌÂÓÔ˘˜ Ì ·‰ÂÓÔ˚Ô‡˜ Ô˘ ¤ÊÂÚ·Ó ÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ ˘Ô‰Ô¯¤·
ÙÔ˘ TNF Û˘ÓÙËÁ̤ÓÔ˘ Ì ÙÔ ÙÌ‹Ì· Fc ·ÓÔÛÔÛÊ·ÈÚ›Ó˘
Û Â›Ì˘Â˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÌÂÙ¿ ·fi 4 ‚‰ÔÌ¿‰Â˜ ÚÔÎÏ‹ıËΠÂÚÈÔ‰ÔÓÙ›Ùȉ· Ì ÙÔÈ΋ ÂÊ·ÚÌÔÁ‹ ÛÙ· ԇϷ
ÏÈÔÔÏ˘Û·Î¯·ÚÈÙÒÓ ÙÔ˘ ÌÈÎÚÔ‚È·ÎÔ‡ ÛÙÂϤ¯Ô˘˜
Porphyromonas gingivalis, ÙÚÂȘ ÊÔÚ¤˜ ‚‰ÔÌ·‰È·›ˆ˜
ÁÈ· 8 ‚‰ÔÌ¿‰Â˜. MÂϤÙËÛ·Ó ÙÚÂȘ ÔÌ¿‰Â˜ Â›Ì˘ˆÓ, ÙȘ
ÂÍ‹˜: Â›Ì˘Â˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ›¯Â ÚÔËÁËı› Ë ¯ÔÚ‹ÁËÛË ÈÒÓ ÚÈÓ ·fi ÙËÓ ¯ÔÚ‹ÁËÛË ÏÈÔÔÏ˘Û·Î¯·ÚÈÙÒÓ (ÌÂ
ÛÎÔfi ÙËÓ ÚfiÎÏËÛË ÂÚÈÔ‰ÔÓÙ›Ùȉ·˜), Â›Ì˘Â˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ Â›¯Â ÚÔËÁËı› Ë ¯ÔÚ‹ÁËÛË ÈÒÓ Ù˘ ¯ÔÚ‹ÁËÛ˘ ÏÈÔÔÏ˘Û·Î¯·ÚÈÙÒÓ Î·ıÒ˜ Î·È Â›Ì˘Â˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıËΠÌfiÓÔ ÙÔ Ì¤ÛÔ ÌÂÙ·ÊÔÚ¿˜ ÙˆÓ ·‰ÂÓÔ˚ÒÓ ¯ˆÚ›˜ Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ ¯ÔÚ‹ÁËÛË ÏÈÔÔÏ˘Û·Î¯·ÚÈÙÒÓ. O ·ÚÈıÌfi˜ ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ Ê·ÙÓÈ·Îfi ÔÛÙÔ‡Ó Î·È ÛÙËÓ ˘ÔÂÈıËÏȷ΋ ÂÚÈÔ¯‹ ÌÂÙ¿ ·fi
4 ‚‰ÔÌ¿‰Â˜ Î·È ÛÙËÓ ˘ÔÂÈıËÏȷ΋ ÂÚÈÔ¯‹ ÌÂÙ¿ ·fi
8 ‚‰ÔÌ¿‰Â˜ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ˜
ÛÙËÓ ÔÌ¿‰· Â›Ì˘ˆÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ›¯Â ÚÔËÁËı› Ù˘
ÚfiÎÏËÛ˘ ÂÚÈÔ‰ÔÓÙ›Ùȉ·˜ Ë ¯ÔÚ‹ÁËÛË ÈÒÓ ¤Ó·ÓÙÈ ·˘ÙÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ Â›¯Â ÚÔËÁËı› Ë ¯ÔÚ‹ÁËÛË ÈÒÓ.
E›Û˘, ÛÙËÓ ÔÌ¿‰· ÛÙËÓ ÔÔ›· ›¯Â ÚÔËÁËı› Ë ¯ÔÚ‹ÁËÛË ÈÒÓ ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ÁÚ·ÌÌÈ΋ ·ÒÏÂÈ· ÔÛÙÔ‡ ÛÙȘ 4 Î·È 8 ‚‰ÔÌ¿‰Â˜ ηٿ 61,2% Î·È 48,5%, ·ÓÙ›ÛÙÔȯ·. H ÔÁÎÔÌÂÙÚÈ΋ ·ÒÏÂÈ·
ÔÛÙÔ‡ ‹Ù·Ó Â›Û˘ ÌÂȈ̤ÓË Î·È Ë ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· ·˘ÍË̤ÓË ÛÙËÓ ÔÌ¿‰· Û˘Ó‰˘·ÛÌÔ‡ ·‰ÂÓÔ˚ÒÓ Î·È ÏÈÔÔÏ˘Û·Î¯·ÚÈÙÒÓ. ¶·Ú’ fiÏ· ·˘Ù¿, ÌfiÓÔ Ë ‰È·ÊÔÚ¿ Ù˘ ÔÁÎÔÌÂÙÚÈ΋˜ ·ÒÏÂÈ·˜ ÙÔ˘ ÔÛÙÔ‡ ÍÂ¤Ú·Û ٷ fiÚÈ· Ù˘
ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÛÙȘ 8 ‚‰ÔÌ¿‰Â˜ ÌÂٷ͇
ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ. ™ÙËÓ ÔÌ¿‰· ÛÙËÓ ÔÔ›· ›¯Â ÚÔËÁËı›
Ë ¯ÔÚ‹ÁËÛË ÈÒÓ ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ˜ ·ÚÈıÌfi˜ ÔÛÙÂÔÎÏ·ÛÙÒÓ, ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο
66
17. Zheng Y, Liu Y, Zhang CM, Zhang HY, Li WH, Shi S et al: Stem
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Hellenic Stomatological Review 57: 39-71, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
ÌÈÎÚfiÙÂÚË ÂÈÊ¿ÓÂÈ· Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡ Û Â·Ê‹ Ì ÔÛÙÂÔÎÏ·ÛÙÈο ·ÙÙ·Ú· (ÛÙȘ 4 Î·È 8 ‚‰ÔÌ¿‰Â˜) ηıÒ˜
Î·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ¤ÎÊÚ·ÛË ÈÓÙÂÚÏ¢ΛÓ˘-6 (IL-6), ÈÓÙÂÚÏ¢ΛÓ˘-10 (IL-10), Û˘Ó‰¤ÙË ÙÔ˘ ÂÓÂÚÁÔÔÈËÙ‹ ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ ˘ÚËÓÈÎÔ‡ ·Ú¿ÁÔÓÙ·kB (Receptor activator of nuclear factor-kB ligand,
RANKL) Î·È ÔÛÙÂÔÚÔÙÂÁÂÚ›Ó˘ (OPG) (ÛÙȘ 4 ‚‰ÔÌ¿‰Â˜) ¤Ó·ÓÙÈ Ù˘ ÔÌ¿‰·˜ ÛÙËÓ ÔÔ›· ‰ÂÓ Â›¯Â ÚÔËÁËı› Ë
¯ÔÚ‹ÁËÛË ÈÒÓ. ™‡ÁÎÚÈÛË ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜ ÛÙËÓ ÔÔ›·
›¯Â ÚÔËÁËı› Ë ¯ÔÚ‹ÁËÛË ÈÒÓ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÏÈÔÔÏ˘Û·Î¯·ÚÈÙÒÓ Î·È Ù˘ ÔÌ¿‰·˜ ÛÙËÓ ÔÔ›· ¯ÔÚËÁ‹ıËΠÌfiÓÔ ÙÔ Ì¤ÛÔ ÌÂÙ·ÊÔÚ¿˜ ÙˆÓ ·‰ÂÓÔ˚ÒÓ ¯ˆÚ›˜ Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ ¯ÔÚ‹ÁËÛË ÏÈÔÔÏ˘Û·Î¯·ÚÈÙÒÓ ¤‰ÂÈÍ ·ÚfiÌÔÈÔ ·ÚÈıÌfi ÔÛÙÂÔÎÏ·ÛÙÒÓ Î·ıÒ˜ Î·È ·ÚfiÌÔÈ· ¤ÎÊÚ·ÛË IL-6, IL-10, RANKL, OPG, ÈÓÙÂÚÏ¢ΛÓ˘-1‚ (IL-1‚) ηÈ
TNF-· ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ. EÈÚfiÛıÂÙ·, Ù· Â›‰· ¤ÎÊÚ·Û˘ ÙˆÓ IL-1‚ Î·È TNF-· ‹Ù·Ó ·ÚfiÌÔÈ· Î·È ÁÈ·
ÙȘ ÙÚÂȘ ÔÌ¿‰Â˜45. ™ÙËÓ ›‰È· ÌÂϤÙË, ‰È·ÈÛÙÒıËΠˆ˜
ÌÂÙ¿ ·fi 24 ¤ˆ˜ 48 ÒÚ˜, Ë ÔÌ¿‰· ÛÙËÓ ÔÔ›· ¯ÔÚËÁ‹ıËÎ·Ó ÌfiÓÔ ÏÈÔÔÏ˘Û·Î¯·Ú›Ù˜ ·ÚÔ˘Û›·Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ¤ÎÊÚ·ÛË IL-1‚ Î·È TNF-· ÛÂ
Û‡ÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÛÙËÓ ÔÔ›· ¯ÔÚËÁ‹ıËΠÌfiÓÔ ÙÔ
̤ÛÔ ¯ÔÚ‹ÁËÛ˘ ÙˆÓ ·‰ÂÓÔ˚ÒÓ ¯ˆÚ›˜ Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ
¯ÔÚ‹ÁËÛË ÏÈÔÔÏ˘Û·Î¯·ÚÈÙÒÓ. H ÔÌ¿‰· ÛÙËÓ ÔÔ›·
ÚÔËÁ‹ıËÎÂ Ë ¯ÔÚ‹ÁËÛË ·‰ÂÓÔ˚ÒÓ ·ÚÔ˘Û›·Û Â›Û˘
ÌÂÁ·Ï‡ÙÂÚ· Â›‰· ¤ÎÊÚ·Û‹˜ ÙÔ˘˜, Ô˘ ÍÂ¤Ú·Û·Ó ÙÔ
fiÚÈÔ Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÛÙȘ 48 ÒÚ˜, ˆÛÙfiÛÔ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚ· Û ۇÁÎÚÈÛË ÌÂ
ÙËÓ ÔÌ¿‰· ÛÙËÓ ÔÔ›· ¯ÔÚËÁ‹ıËÎ·Ó ÌfiÓÔ ÏÈÔÔÏ˘Û·Î¯·Ú›Ù˜. TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ˘Ô‰ËÏÒÓÂÈ ˆ˜ Ë ·Ó·ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ TNF-· ÛÙËÓ ¤ÎÊÚ·ÛË ·˘ÙÒÓ
ÙˆÓ ÌÂÛÔÏ·‚ËÙÒÓ Ù˘ ÊÏÂÁÌÔÓ‹˜ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ÂÌÊ·Ó‹˜ ‚Ú·¯˘ÚfiıÂÛÌ·. A˘Ùfi ›Ûˆ˜ Ó· ÔÊ›ÏÂÙ·È ÛÙË Ì›ˆÛË Ù˘ ÚÔ·ÁfiÌÂÓ˘ ·fi ÙÔ˘˜ ÏÈÔÔÏ˘Û·Î¯·Ú›Ù˜
¤ÎÊÚ·Û˘ ÙˆÓ ÌÂÛÔÏ·‚ËÙÒÓ Ù˘ ÊÏÂÁÌÔÓ‹˜ Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, ÂÍ·ÈÙ›·˜ Ù˘ ·Ó¿Ù˘Í˘ ·ÓÙÔ¯‹˜ ÙÔ˘
ÍÂÓÈÛÙ‹ ¤Ó·ÓÙÈ ÙˆÓ ÂÓ‰ÔÙÔÍÈÓÒÓ Ì ÛÎÔfi ÙË Ú‡ıÌÈÛË Ù˘
ÙÔÈ΋˜ ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘45.
ÕÏÏÔÈ ÙÚfiÔÈ ÌÂÙ·ÊÔÚ¿˜ ÁÔÓȉ›ˆÓ
Œ¯ÂÈ ÚÔÙ·ı› fiÙÈ ÌÂٷ͇ ÙˆÓ ÌË È˚ÎÒÓ ÊÔÚ¤ˆÓ ÁÂÓÂÙÈÎÔ‡
˘ÏÈÎÔ‡, Ù· Ï·ÛÌ›‰È· ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ·
ÙË ÌÂÙ·ÊÔÚ¿ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÛÙË ÁÔÓȉȷ΋ ıÂÚ·›·
ÁÈ· ÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ. OÈ Chen ηÈ
Û˘Ó.46 ÌÂϤÙËÛ·Ó ÙËÓ ¤ÎÊÚ·ÛË ÏÔ˘ÛÈÊÂÚ¿Û˘ ÌÂÙ¿ ·fi
ÌÂÙ·ÊÔÚ¿ Ï·ÛÌȉ›ˆÓ ·Ó·Û˘Ó‰˘·ÛÌ¤ÓˆÓ ÒÛÙ ӷ ÂÚȤ¯Ô˘Ó ÙÔ ÁÔÓ›‰ÈÔ Ù˘ ÏÔ˘ÛÈÊÂÚ¿Û˘ Û ÂÚÈÔ‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜ Â›Ì˘ˆÓ Ì ÙË ‚Ô‹ıÂÈ· Ó·ÓfiÊÔ˘ÛÎˆÓ Î·È ˘ÂÚ˯ËÙÈÎÒÓ Î˘Ì¿ÙˆÓ (ÂÚÈfi‰Ô˘ 10Ìs Î·È ÂÓ¤ÚÁÂÈ·˜ 36J/cm2).
™ÙËÓ ÔÌ¿‰· Â›Ì˘ˆÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¤ÁÈÓ ¯ÔÚ‹ÁËÛË Ï·ÛÌȉ›ˆÓ ·Ó·ÌÂÌÂÈÁÌ¤ÓˆÓ Ì ӷÓfiÊÔ˘ÛΘ ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi ÂÊ·ÚÌÔÁ‹ ˘ÂÚ˯ËÙÈÎÒÓ Î˘Ì¿ÙˆÓ ·Ú·ÙËÚ‹ıËÎÂ
ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ¤ÎÊÚ·ÛË ÏÔ˘ÛÈÊÂÚ¿Û˘ ÙËÓ ÚÒÙË Ë̤ڷ Û ۇÁÎÚÈÛË Ì ÙË ¯ÔÚ‹ÁËÛË ÌfiÓÔ
Ï·ÛÌȉ›ˆÓ, ÙË ¯ÔÚ‹ÁËÛË Ï·ÛÌȉ›ˆÓ ·Ó·ÌÂÌÂÈÁ̤ӈÓ
Ì ӷÓfiÊÔ˘ÛΘ Î·È ÙË ¯ÔÚ‹ÁËÛË ÌfiÓÔ Ï·ÛÌȉ›ˆÓ ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi ÂÊ·ÚÌÔÁ‹ ˘ÂÚ˯ËÙÈÎÒÓ Î˘Ì¿ÙˆÓ. øÛÙfiÛÔ, ÙËÓ ÙÚ›ÙË Ë̤ڷ Ë ¤ÎÊÚ·ÛË Ù˘ ÏÔ˘ÛÈÊÂÚ¿Û˘ ÂHellenic Stomatological Review 57: 39-71, 2013
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Contact details:
T. Kondylis
e-mail: [email protected]
67
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
¤ÛÙÚ„ ÛÙ· ·Ú¯Èο Â›‰· Û ·˘Ù‹ ÙËÓ ÔÌ¿‰·. OÈ ÂÚ¢ÓËÙ¤˜ ˘ÔÛÙ‹ÚÈÍ·Ó ˆ˜ Ë ‰È¿ÚÚËÍË ·fi Ù· ˘ÂÚ˯ËÙÈο ·̷ٷ ÙˆÓ Ó·ÓfiÊÔ˘ÛÎˆÓ Î·È ÙˆÓ Ê˘ÛÛ·Ï›‰ˆÓ Ô˘
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Î˘Ì¿ÙˆÓ ÚÔοÏÂÛ ·ÚÔ‰È΋ ·‡ÍËÛË Ù˘ ‰È·ÂÚ·ÙfiÙËÙ·˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì ·ÔÙ¤ÏÂÛÌ· ›ÛÔ‰Ô ÙˆÓ Ï·ÛÌȉ›ˆÓ
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H ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ ¤ÎÊÚ·ÛË ÁÔÓȉ›ˆÓ Ô˘ ÌÂٷʤÚÔÓÙ·È Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ Î·È Î·ıÈÛÙÔ‡Ó ÂȂ‚ÏË̤ÓË ÙËÓ
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Ù˘ ¿ÊıÔÓ˘ ·ÈÌ¿ÙˆÛ˘ Ù˘ ÂÚÈÔ¯‹˜. Œ¯ÂÈ ÚÔÙ·ı› fiÙÈ Ë Â¤ÎÙ·ÛË Ù˘ ‰È¿ÚÎÂÈ·˜ ¤ÎÊÚ·Û˘ ÙˆÓ ÁÔÓȉ›ˆÓ Èı·Ó¿ Ó· Â›Ó·È ÂÊÈÎÙ‹ Ì ‚ÂÏÙÈÛÙÔÔ›ËÛË ÙˆÓ ·Ú·Ì¤ÙÚˆÓ
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H ÂÈÙ˘¯‹˜ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ ‚·Û›˙ÂÙ·È ÛÙËÓ ‡·ÚÍË Î˘ÙÙ¿ÚˆÓ, ΢ÙÙ·ÚÈÎÒÓ ÛËÌ¿ÙˆÓ Ô˘
Ú˘ıÌ›˙Ô˘Ó ÙËÓ Î˘ÙÙ·ÚÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, ÈÎÚȈ̿وÓ
Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ Î·È ·ÈÌ¿ÙˆÛ˘ ÁÈ· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Ù˘ ÔÔ›·˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ΢ÙÙ·ÚÈο Û‹Ì·Ù· ηıÒ˜ Î·È ÛÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘
ÌÈÎÚÔ‚È·ÎÔ‡ ·Ú¿ÁÔÓÙ·. H ÌÂÙ·ÌfiÛ¯Â˘ÛË ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·ÛÙÔ΢ÙÙ¿ÚˆÓ ·Ú¤¯ÔÓÙ·˜ Ó¤· ·ÙÙ·Ú· Ù· ÔÔ›·
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Î·È ‰È·ÊÔÚÔÔ›ËÛË ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ Î˘Ú›ˆ˜ Û ÚÔÎÏÈÓÈÎfi Â›Â‰Ô Î·È ÌÂÏÂÙ¿Ù·È Û ÎÏÈÓÈÎfi Â›‰Ô. ¶·Ú¿ÏÏËÏ·, ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ Û ÚÔÎÏÈÓÈÎfi Â›Â‰Ô ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ Ë ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ, Ë ÔÔ›· ‰›ÓÂÈ
ÙË ‰˘Ó·ÙfiÙËÙ· ¤ÎÊÚ·Û˘ ΢ÙÙ·ÚÈÎÒÓ ÛËÌ¿ÙˆÓ ·fi Ù·
·ÙÙ·Ú·-ÛÙfi¯Ô˘˜ Ì ÛÎÔfi ÙËÓ Â·ÁˆÁ‹ Ù˘ ÈÛÙÈ΋˜ ·‡ÍËÛ˘ Î·È ‰È·ÊÔÚÔÔ›ËÛ˘ ‹ ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ ÙÔ˘ ÍÂÓÈÛÙ‹ Û ÌÈÎÚԂȷο ÂÚÂı›ÛÌ·Ù·,
Ô˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂËÚ¿ÛÂÈ ·ÚÓËÙÈο ÙÔ ıÂÚ·¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ·. OÈ Ù¯ÓÈΤ˜ ·˘Ù¤˜ ÂÊ·ÚÌÔ˙fiÌÂÓ˜ ·ÓÂÍ¿ÚÙËÙ· ‹ Û˘Ó‰˘·˙fiÌÂÓ˜ ÌÂٷ͇ ÙÔ˘˜ Èı·Ó¿ Ó· ÚÔÛʤÚÔ˘Ó ÂÈÚfiÛıÂÙ· ÔʤÏË ÛÙËÓ ·Ó¿Ï·ÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ, Ù· ÔÔ›· ‰ÈÂÚÂ˘Ó¿ Ë Û˘Ó¯È˙fiÌÂÓË ¤Ú¢ӷ Ô˘ ÂÈÙÂÏÂ›Ù·È Û ·˘Ùfi ÙÔ ‰›Ô.
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¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:
£. KÔÓ‰‡Ï˘
e-mail: [email protected]
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