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1
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Periodontal aspects associated with the surgical and orthodontic
treatment of impacted canines
Aristides B. Melkos,1 Moschos A. Papadopoulos 2
Postgraduate student, Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Assistant Professor & Postgraduate Program Coordinator, Department of Orthodontics, School of Dentistry, Aristotle University of
Thessaloniki, Thessaloniki, Greece.
1
2
¶EPI§HæH
ABSTRACT
√È ¤ÁÎÏÂÈÛÙÔÈ Î˘Ófi‰ÔÓÙ˜ ·ÔÙÂÏÔ‡Ó Û˘ÓËıÈṲ̂ÓÔ Â‡ÚËÌ· ÛÂ
·ÛıÂÓ›˜ Ô˘ ÂÈ˙ËÙÔ‡Ó ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·. ∏ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ··ÈÙ› Û˘Ó‹ıˆ˜ Û˘ÓÂÚÁ·Û›· ÌÂٷ͇ ¯ÂÈÚÔ˘ÚÁÔ‡ ÛÙfiÌ·ÙÔ˜, ÔÚıÔ‰ÔÓÙÈÎÔ‡ Î·È ÂÚÈÔ‰ÔÓÙÔÏfiÁÔ˘. ∏ ÔÚıÔ‰ÔÓÙÈ΋
ÚÔÛ¤ÁÁÈÛË ¤¯ÂÈ ˆ˜ ÛÙfi¯Ô ÙË ÌÂٷΛÓËÛË ÙÔ˘ ˘·›ÙÈÔ˘ ‰ÔÓÙÈÔ‡
ÛÙË ÛˆÛÙ‹ ÙÔ˘ ı¤ÛË ÛÙÔ Ô‰ÔÓÙÈÎfi ÙfiÍÔ ¯ˆÚ›˜ ÚfiÎÏËÛË ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ. ∏ Â›Ù¢ÍË ‚¤ÏÙÈÛÙ˘ ÂÚÈÔ‰ÔÓÙÈ΋˜
ÛÙ‹ÚÈ͢ ÙÔ˘ ¤ÁÎÏÂÈÛÙÔ˘ ‰ÔÓÙÈÔ‡ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ·Ú¯È΋ ÙÔ˘
ı¤ÛË Î·È ·fi ÙÔ Â›‰Ô˜ Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ Î·È ÔÚıÔ‰ÔÓÙÈ΋˜
Ù¯ÓÈ΋˜ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËı›.
™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· Á›ÓÂÈ ÌÈ· ÎÚÈÙÈ΋ ·Ó·ÛÎfiËÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Î·Ù¿ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË
ÂÁÎÏ›ÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Î·È ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ Î·È
¯ÂÈÚÔ˘ÚÁÈÎÒÓ Ù¯ÓÈÎÒÓ.
∆Ô Û˘Ì¤Ú·ÛÌ· Ô˘ ÚÔ·ÙÂÈ Â›Ó·È fiÙÈ ÙÔ ÂÚÈÔ‰fiÓÙÈÔ ÙˆÓ ÂÁÎÏ›ÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ ÂËÚ¿˙ÂÙ·È Û¯Â‰fiÓ ¿ÓÙ·, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙȘ
¯ÂÈÚÔ˘ÚÁÈΤ˜ ‹ ÔÚıÔ‰ÔÓÙÈΤ˜ ‰È·‰Èηۛ˜. ∂Ó ÙÔ‡ÙÔȘ, Ê·›ÓÂÙ·È fiÙÈ
ÔÈ ÎÏÂÈÛÙ¤˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ Ù¯ÓÈΤ˜ ·ÔÎ¿Ï˘„˘ ÙˆÓ ÂÁÎÏ›ÛÙˆÓ
΢ÓÔ‰fiÓÙˆÓ, ‰ËÏ·‰‹ ·Ó‡„ˆÛË ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ÎÚËÌÓÔ‡, Û˘ÁÎfiÏÏËÛË Û˘Ó‰¤ÛÌÔ˘ Î·È Â·Ó·Û˘ÚÚ·Ê‹ ÙÔ˘ ÎÚËÌÓÔ‡ ÛÙË ı¤ÛË ÙÔ˘,
ÂÁ΢ÌÔÓÔ‡Ó ÙÔ˘˜ ÏÈÁfiÙÂÚÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙÔ ÂÚÈÔ‰fiÓÙÈÔ.
Impacted canines are a common finding in patients seeking
orthodontic treatment. The management of impacted canines
usually requires cooperation between oral surgery,
orthodontics and periodontology. The orthodontic approach
aims in moving the corresponding tooth into its correct position
in the dental arch without causing periodontal problems.
Optimum periodontal support is related to initial position of the
impacted tooth as well as to the type of the surgical and
orthodontic technique used.
Aim of this paper was to critically review the periodontal
interactions in reference to the management of impacted
canines and the corresponding orthodontic and surgical
techniques used.
It can be concluded that the periodontal condition of treating
impacted canines is almost always affected not-depending
from the surgical or orthodontic procedures used. However, it
seems that less damaging effects on the periodontium should
anticipated when using the closed-surgical exposure
techniques, which involve raising of a surgical flap, bonding
of an attachment and finally resuturing of the flap to its original
position.
§∂•∂π™ ∫§∂π¢π∞: ŒÁÎÏÂÈÛÙÔÈ Î˘Ófi‰ÔÓÙ˜, ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË, ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·, ÂÚÈÔ‰fiÓÙÈÔ
∂ÏÏ √ÚıÔ‰ ∂Èı 2004;7:9-24.
¶·ÚÂÏ‹ÊıË: 15.01.2003 - ŒÁÈÓ ‰ÂÎÙ‹: 26.03.2003
KEY WORDS: impacted canines, surgery, orthodontic
treatment, periodontium
Hell Orthod Rev 2004;7:9-24.
Received: 15.01.2003 - Accepted: 26.03.2003
EI™A°ø°H
INTRODUCTION
√È ¤ÁÎÏÂÈÛÙÔÈ Î˘Ófi‰ÔÓÙ˜ ·ÔÙÂÏÔ‡Ó Û˘ÓËıÈṲ̂ÓÔ
‡ÚËÌ· Û ·ÛıÂÓ›˜ Ô˘ ÂÈ˙ËÙÔ‡Ó ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·-
Impacted canines are a common finding in patients
seeking orthodontic treatment. Great differences are
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
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A.B. ME§KO™ Î·È Û˘Ó. ¶ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋
observed among researchers concerning the
frequency of impaction and location of the impacted
teeth, but it is generally agreed that the most frequently
impacted teeth are the third molars followed by the
maxillary canines (Papadopoulos et al. 2001).
Impacted maxillary canines constitute about 18% of all
impacted teeth (Wolf and Matilla, 1979) and
represent 0,9% of all maxillary canines while the
incident of mandibular canine impaction is 0,35%
(Dachi and Howell, 1961).
Each patient with an impacted canine must undergo a
comprehensive evaluation of the malocclusion.
Depending on the exact position of the impacted
tooth, the prognosis for its orthodontic movement and
placement in a normal position in the dental arch can
vary widely (Elefteriadis and Athanasiou, 1996).
According to Bishara (1992) and to Kokich and
Mathews (1993), by managing impacted canines the
clinician should consider the various treatment options
available for the patient, including the following: (a) no
treatment if the patient does not desire it and if there is
absence of any pathologic changes, (b) auto
transplantation of the canine (Shaw et al., 1981;
Sayne et al., 1986), (c) extraction of the impacted
canine and movement of the first premolar in its position
(replacement of the impacted canine by the first
premolar), (d) extraction of the canine and posterior
segmental osteotomy to move the buccal segment
mesially to close the residual space (Maloney, 1985),
(e) prosthetic replacement of the canine, and (f) surgical
exposure of the canine and orthodontic treatment to
bring the tooth into the line of occlusion. The last option
which is obviously the most desirable approach, aims
in bringing the tooth into its correct position in the dental
arch without causing any periodontal damage.
Although numerous surgical techniques have been
used in the management of unerupted teeth, there has
been little documentation of the influences of such
surgeries and of orthodontic treatment on the
periodontal tissues of these teeth (Heasman et al.,
1996). On the other hand, although several studies
have shown that the periodontal status after
orthodontic movement of impacted teeth is related to
the position of the impacted tooth as well as to the type
of the surgical and orthodontic technique used, there is
still controversy about these issues.
Aim of this paper was to critically review the
periodontal interactions in reference to the management
of impacted canines and the corresponding orthodontic
and surgical techniques used.
›·. √È ‰È¿ÊÔÚÔÈ ÂÚ¢ÓËÙ¤˜ ‰È·ÊˆÓÔ‡Ó ÌÂٷ͇ ÙÔ˘˜
Û¯ÂÙÈο Ì ÙË Û˘¯ÓfiÙËÙ· ¤ÁÎÏÂÈÛ˘ Î·È ÙËÓ ÂÓÙfiÈÛË ÙˆÓ
¤ÁÎÏÂÈÛÙˆÓ ‰ÔÓÙÈÒÓ, ÁÂÓÈο fï˜ Û˘ÌʈÓÔ‡Ó fiÙÈ Ù·
‰fiÓÙÈ· Ô˘ Â›Ó·È Û˘¯ÓfiÙÂÚ· ¤ÁÎÏÂÈÛÙ· Â›Ó·È ÔÈ ÙÚ›ÙÔÈ
ÁÔÌÊ›ÔÈ ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔÈ ·fi ÙÔ˘˜ ¿Óˆ ΢Ófi‰ÔÓÙ˜
(Papadopoulos Î·È Û˘Ó., 2001). √È ¤ÁÎÏÂÈÛÙÔÈ ¿Óˆ
΢Ófi‰ÔÓÙ˜ ·ÔÙÂÏÔ‡Ó ÂÚ›Ô˘ 18% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ
ÂÁÎÏ›ÛÙˆÓ ‰ÔÓÙÈÒÓ (Wolf Î·È Matilla, 1979) Î·È 0.9%
fiÏˆÓ ÙˆÓ ¿Óˆ ΢ÓÔ‰fiÓÙˆÓ, ÂÓÒ Ë Û˘¯ÓfiÙËÙ· ¤ÁÎÏÂÈÛ˘
ÙˆÓ Î¿Ùˆ ΢ÓÔ‰fiÓÙˆÓ Â›Ó·È 0.35% (Dachi Î·È Howell,
1961).
™Â οı ·ÛıÂÓ‹ Ì ¤ÁÎÏÂÈÛÙÔ Î˘Ófi‰ÔÓÙ· Ú¤ÂÈ Ó· Á›ÓÂÈ
Û˘ÓÔÏÈ΋ ·ÍÈÔÏfiÁËÛË Ù˘ Û‡ÁÎÏÂÈÛ˘. ∞Ó¿ÏÔÁ· Ì ÙËÓ
·ÎÚÈ‚‹ ı¤ÛË ÙÔ˘ ¤ÁÎÏÂÈÛÙÔ˘ ‰ÔÓÙÈÔ‡ ÔÈΛÏÏÂÈ Ë ÚfiÁÓˆÛË ÁÈ· ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ÌÂٷΛÓËÛË Î·È ‰È¢ı¤ÙËÛ‹
ÙÔ˘ ÛÂ Ê˘ÛÈÔÏÔÁÈ΋ ı¤ÛË ÛÙÔ ÙfiÍÔ (Elefteriadis ηÈ
Athanasiou, 1996).
™‡Ìʈӷ Ì ÙÔÓ Bishara (1992) Î·È ÙÔ˘˜ Kokich ηÈ
Mathews (1993), ηٿ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÂÁÎÏ›ÛÙˆÓ
΢ÓÔ‰fiÓÙˆÓ, Ô ÎÏÈÓÈÎfi˜ ı· Ú¤ÂÈ Ó· ·ÍÈÔÏÔÁ‹ÛÂÈ ÙȘ
‰È¿ÊÔÚ˜ ıÂÚ·¢ÙÈΤ˜ ÂÈÏÔÁ¤˜ Ô˘ ¤¯ÂÈ Ô ·ÛıÂÓ‹˜
Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ·Ú·Î¿Ùˆ: (·) ·ÔÊ˘Á‹
ıÂÚ·›·˜, ÂÊfiÛÔÓ ‰ÂÓ ÙÔ ÂÈı˘Ì› Ô ·ÛıÂÓ‹˜ ηÈ
ÂÊfiÛÔÓ ·Ô˘ÛÈ¿˙Ô˘Ó ·ıÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ, (‚)
·˘ÙÔÌÂÙ·ÌfiÛ¯Â˘ÛË ÙÔ˘ ΢Ófi‰ÔÓÙ· (Shaw Î·È Û˘Ó.,
1981; Sayne Î·È Û˘Ó., 1986), (Á) ÂÍ·ÁˆÁ‹ ÙÔ˘ ¤ÁÎÏÂÈÛÙÔ˘ ΢Ófi‰ÔÓÙ· Î·È ÌÂٷΛÓËÛË ÙÔ˘ ÚÒÙÔ˘ ÚÔÁÔÌÊ›Ô˘ ÛÙË ı¤ÛË ÙÔ˘ (·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ ΢Ófi‰ÔÓÙ· ·fi ÙÔÓ
ÚÒÙÔ ÚÔÁfiÌÊÈÔ), (‰) ÂÍ·ÁˆÁ‹ ÙÔ˘ ΢Ófi‰ÔÓÙ· Î·È Ô›ÛıÈ· ÙÌËÌ·ÙÈ΋ ÔÛÙÂÔÙÔÌ›· ÁÈ· ÂÁÁ‡˜ ÌÂٷΛÓËÛË ÙÔ˘
·ÚÂÈ·ÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ÒÛÙ ӷ ÎÏ›ÛÂÈ ÙÔ ÎÂÓfi Ù˘ ÂÍ·ÁˆÁ‹˜ (Maloney, 1985), (Â) ÚÔÛıÂÙÈ΋ ·ÓÙÈηٿÛÙ·ÛË
ÙÔ˘ ΢Ófi‰ÔÓÙ· Î·È (ÛÙ) ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë ÙÔ˘
΢Ófi‰ÔÓÙ· Î·È ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· ÁÈ· Ó· ÙÔÔıÂÙËı› ÙÔ ‰fiÓÙÈ Û ı¤ÛË Û‡ÁÎÏÂÈÛ˘. ∏ ÙÂÏÂ˘Ù·›· ÂÈÏÔÁ‹,
Ë ÔÔ›· ·ÔÙÂÏ›, ÚÔÊ·ÓÒ˜, Î·È ÙËÓ ϤÔÓ ÂÈı˘ÌËÙ‹
ÚÔÛ¤ÁÁÈÛË, ¤¯ÂÈ ˆ˜ ÛÙfi¯Ô Ó· ʤÚÂÈ ÙÔ ‰fiÓÙÈ ÛÙË ÛˆÛÙ‹
ÙÔ˘ ı¤ÛË ÛÙÔ ÙfiÍÔ ¯ˆÚ›˜ ÚfiÎÏËÛË ÂÚÈÔ‰ÔÓÙÈ΋˜ ‚Ï¿‚˘.
¶·ÚfiÏÔ Ô˘ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ‰È¿ÊÔÚ˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ Ù¯ÓÈΤ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ‰ÔÓÙÈÒÓ Ô˘
‰ÂÓ ¤¯Ô˘Ó ·Ó·Ù›ÏÂÈ, Ë Â›‰Ú·ÛË ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ Î·È
Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ ÛÙÔ˘˜ ÂÚÈÔ‰ÔÓÙÈÎÔ‡˜
ÈÛÙÔ‡˜ ·˘ÙÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ Â›Ó·È ·ÓÂ·ÚÎÒ˜ ÙÂÎÌËÚȈ̤ÓË ‚È‚ÏÈÔÁÚ·ÊÈο (Heasman Î·È Û˘Ó., 1996). ∞fi ÙËÓ
¿ÏÏË ÏÂ˘Ú¿, ·ÚfiÏÔ Ô˘ ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ÂÚÈÔ‰ÔÓÙÈ΋ ηٿÛÙ·ÛË ÌÂÙ¿ ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋
ÌÂٷΛÓËÛË ÙˆÓ ÂÁÎÏ›ÛÙˆÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙË ı¤ÛË ÙˆÓ
‰ÔÓÙÈÒÓ ·˘ÙÒÓ Î·È ÙÔ Â›‰Ô˜ Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ Î·È ÔÚıÔ‰ÔÓÙÈ΋˜ Ù¯ÓÈ΋˜ Ô˘ ·ÎÔÏÔ˘ı‹ıËÎÂ, ÂÍ·ÎÔÏÔ˘ı› Ó·
˘¿Ú¯ÂÈ ‰È¯ÔÁӈ̛· Û¯ÂÙÈο Ì ·˘Ù¿ Ù· ı¤Ì·Ù·.
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
PALATALLY IMPACTED CANINES
Palatally impacted canines rarely erupt of their own,
without surgical intervention (Jacoby, 1983). There are
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™Ùfi¯Ô˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ó· Á›ÓÂÈ ÎÚÈÙÈ΋ ·Ó·ÛÎfiËÛË ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ
·ÓÙÈÌÂÙÒÈÛË ÂÁÎÏ›ÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Î·È ÛÙȘ ·ÓÙ›ÛÙÔȯ˜ ÔÚıÔ‰ÔÓÙÈΤ˜ Î·È ¯ÂÈÚÔ˘ÚÁÈΤ˜ Ù¯ÓÈΤ˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È.
numerous surgical methods for exposing the impacted
canine and moving it to the line of occlusion. Many
different variations have been suggested concerning
these surgical procedures, from the more radical
exposure (Lappin, 1951; Azaz et al., 1980) to the
minimal one (Hunt, 1977). According to Bishara
(1992) and to Pearson et al. (1997), two of the most
commonly used methods are: (a) the simple surgical
exposure and (b) the surgical exposure with placement
of an auxiliary orthodontic attachment.
Y¶EPøIA E°K§EI™TOI
KYNO¢ONTE™
√È ˘ÂÚÒÈ· ¤ÁÎÏÂÈÛÙÔÈ Î˘Ófi‰ÔÓÙ˜ Û·Ó›ˆ˜ ·Ó·Ù¤ÏÏÔ˘Ó
ÌfiÓÔÈ ÙÔ˘˜, ¯ˆÚ›˜ ‰ËÏ·‰‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ú¤Ì‚·ÛË
(Jacoby, 1983). À¿Ú¯Ô˘Ó ‰È¿ÊÔÚ˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜
̤ıÔ‰ÔÈ ÁÈ· ·ÔÎ¿Ï˘„Ë ÙˆÓ ÂÁÎÏ›ÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Î·È
ÌÂٷΛÓËÛ‹ ÙÔ˘˜ Û ı¤ÛË Û‡ÁÎÏÂÈÛ˘. Œ¯Ô˘Ó ÚÔÙ·ı›
‰È¿ÊÔÚ˜ ÙÚÔÔÔÈ‹ÛÂȘ ÙˆÓ ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ‰È·‰ÈηÛÈÒÓ, ·fi ÙËÓ ϤÔÓ ÚÈ˙È΋ ·ÔÎ¿Ï˘„Ë (Lappin, 1951;
Azaz Î·È Û˘Ó., 1980) ˆ˜ ÙËÓ ÂÏ¿¯ÈÛÙ· ÂÂÌ‚·ÙÈ΋ Ù¯ÓÈ΋ (Hunt, 1977). ™‡Ìʈӷ Ì ÙÔÓ Bishara (1992) ηÈ
ÙÔ˘˜ Pearson Î·È Û˘Ó. (1997), ‰‡Ô ·fi ÙȘ ϤÔÓ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˜ ÌÂıfi‰Ô˘˜ ›ӷÈ: (·) Ë ·Ï‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë Î·È (‚) Ë ·ÔÎ¿Ï˘„Ë Î·È ÙÔÔı¤ÙËÛË
‚ÔËıËÙÈÎÔ‡ ÔÚıÔ‰ÔÓÙÈÎÔ‡ Û˘Ó‰¤ÛÌÔ˘.
Simple surgical exposure
The philosophic belief on which the first method is
based, in that the majority of teeth will erupt if all bony
or soft tissue impringement or any other obstructions
are removed from the path of eruption (Clark, 1971).
This method is most useful when the canine has a
correct axial inclination and does not need to be
uprighted during its eruption. A favorable axial
inclination of the tooth is more frequent in labially
impacted teeth; the palatally impacted teeth are in
more horizontal/oblique direction (Theofanatos et al.,
1994).
Surgical exposure with placement of an auxiliary
attachment
Regarding the surgical exposure with placement of an
auxiliary orthodontic attachment, there are generally
two approaches recommended in regard to the timing
of placing the attachment: (a) the one-step approach
and (b) the two-step approach.
The one-step approach
According to the one-step approach the orthodontic
attachment is placed on the tooth at the time of surgical
exposure (Becker et al., 1982) using either an openor a closed-surgical exposure (McSherry, 1996).
Regarding the open surgical exposure, a gingival flap
is reflected and the bone over the crown is removed.
The soft tissue in the flap is excised and a window to
expose the crown of the impacted tooth is created.
Then the flap is re-approximated and after bonding of
an orthodontic attachment a periodontal dressing is
placed in order to prevent the window from closing
(Fig.1). According to Becker et al. (1996), the onestep approach is superior to the two-step-approach;
the ability to gain attachment permits a more
conservative approach to the exposure. However, the
palatal mucosa is very thick and will leave a broad cut
surface, which will tend to close over unless its edges
are more radically trimmed back and the dental follicle
is removed. Thus, when the tooth is placed deeply, the
exposure will additionally need to be maintained using
a surgical pack. This type of approach will therefore
leave the tooth with a soft tissue deficiency and a long
clinical crown at the completion of the orthodontic
alignment (Becker, 1998).
∞Ï‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë
∆Ô ıˆÚËÙÈÎfi ˘fi‚·ıÚÔ Ù˘ ÚÒÙ˘ ÌÂıfi‰Ô˘ ‚·Û›˙ÂÙ·È
ÛÙËÓ ¿Ô„Ë fiÙÈ Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ‰ÔÓÙÈÒÓ ı· ·Ó·Ù›ÏÂÈ,
ÂÊfiÛÔÓ ·ÔÌ·ÎÚ˘Óı› ÔÔÈ·‰‹ÔÙ ·ÚÂÌ‚ÔÏ‹ ·fi
ÔÛÙfi ‹ Ì·Ï·ÎÔ‡˜ ÈÛÙÔ‡˜ ‹ ¿ÏÏÔ ÂÌfi‰ÈÔ ·fi ÙËÓ Ô‰fi
·Ó·ÙÔÏ‹˜ (Clark, 1971). ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ ¤¯ÂÈ Ì¤ÁÈÛÙË
¯ÚËÛÈÌfiÙËÙ· fiÙ·Ó Ô Î˘Ófi‰ÔÓÙ·˜ ¤¯ÂÈ ÛˆÛÙ‹ ·ÍÔÓÈ΋
ÎÏ›ÛË Î·È ‰ÂÓ ··ÈÙÂ›Ù·È ·ÓfiÚıˆÛË Î·Ù¿ ÙËÓ ·Ó·ÙÔÏ‹
ÙÔ˘. ∂˘ÓÔ˚΋ fï˜ ·ÍÔÓÈ΋ ÎÏ›ÛË ÙÔ˘ ΢Ófi‰ÔÓÙ· ··ÓÙ¿Ù·È Û˘¯ÓfiÙÂÚ· Û ·ÚÂȷο ¤ÁÎÏÂÈÛÙ· ‰fiÓÙÈ·. ∆· ˘ÂÚÒÈ· ¤ÁÎÏÂÈÛÙ· ‰fiÓÙÈ· ¤¯Ô˘Ó Ì¿ÏÏÔÓ ÔÚÈ˙fiÓÙÈ·/ÏÔÍ‹
‰È‡ı˘ÓÛË (Theofanatos Î·È Û˘Ó., 1994).
∞ÔÎ¿Ï˘„Ë Î·È ÙÔÔı¤ÙËÛË ‚ÔËıËÙÈÎÔ‡ Û˘Ó‰¤ÛÌÔ˘
™¯ÂÙÈο Ì ÙËÓ ·ÔÎ¿Ï˘„Ë Î·È ÙÔÔı¤ÙËÛË ‚ÔËıËÙÈÎÔ‡
ÔÚıÔ‰ÔÓÙÈÎÔ‡ Û˘Ó‰¤ÛÌÔ˘, ˘¿Ú¯Ô˘Ó ÁÂÓÈο ‰‡Ô ÚÔÛÂÁÁ›ÛÂȘ, fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ ¯ÚfiÓÔ ÙÔÔı¤ÙËÛ˘ ÙÔ˘
Û˘Ó‰¤ÛÌÔ˘: (·) Ë Ù¯ÓÈ΋ ÂÓfi˜ ÛÙ·‰›Ô˘ Î·È (‚) Ë Ù¯ÓÈ΋
‰‡Ô ÛÙ·‰›ˆÓ.
∆¯ÓÈ΋ ÂÓfi
fi˜˜ ÛÙ·‰›Ô˘
™‡Ìʈӷ Ì ·˘Ù‹ ÙËÓ Ù¯ÓÈ΋, Ô ÔÚıÔ‰ÔÓÙÈÎfi˜ Û‡Ó‰ÂÛÌÔ˜ ÙÔÔıÂÙÂ›Ù·È ÛÙÔ ‰fiÓÙÈ Î·Ù¿ ÙÔÓ ¯ÚfiÓÔ Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·ÔÎ¿Ï˘„˘ (Becker Î·È Û˘Ó., 1982), ›ÙÂ
Ì ·ÓÔȯً ›Ù Ì ÎÏÂÈÛÙ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋
(McSherry, 1996).
∫·Ù¿ ÙËÓ ·ÓÔȯً ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë, ·Ó·ÛËÎÒÓÂÙ·È ¤Ó·˜ Ô˘ÏÈÎfi˜ ÎÚËÌÓfi˜ Î·È ·Ê·ÈÚÂ›Ù·È ÔÛÙfi ¿Óˆ
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
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A.B. ME§KO™ Î·È Û˘Ó. ¶ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋
·fi ÙË Ì‡ÏË ÙÔ˘ ‰ÔÓÙÈÔ‡. ∞Ê·ÈÚÂ›Ù·È Ô Ì·Ï·Îfi˜ ÈÛÙfi˜
ÙÔ˘ ÎÚËÌÓÔ‡ Î·È ‰ËÌÈÔ˘ÚÁÂ›Ù·È ·Ú¿ı˘ÚÔ ·ÔÎ¿Ï˘„˘
Ù˘ ̇Ï˘ ÙÔ˘ ¤ÁÎÏÂÈÛÙÔ˘ ‰ÔÓÙÈÔ‡. ∞ÎÔÏÔ˘ı› Â·Ó·Û˘ÌÏËÛ›·ÛË ÙÔ˘ ÎÚËÌÓÔ‡ Î·È ÌÂÙ¿ ÙË Û˘ÁÎfiÏÏËÛË
ÔÚıÔ‰ÔÓÙÈÎÔ‡ Û˘Ó‰¤ÛÌÔ˘ ÛÙÔ ‰fiÓÙÈ ÙÔÔıÂÙÂ›Ù·È ÂÚÈÔ‰ÔÓÙÈ΋ ÎÔÓ›· ÒÛÙ ӷ ÌËÓ ÎÏ›ÛÂÈ ÙÔ ·Ú¿ı˘ÚÔ (EÈÎ.
1). ™‡Ìʈӷ Ì ÙÔ˘˜ Becker Î·È Û˘Ó. (1996), Ë Ù¯ÓÈ΋ ÂÓfi˜ ÛÙ·‰›Ô˘ Â›Ó·È Î·Ï‡ÙÂÚË ·fi ·˘Ù‹ ÙˆÓ ‰‡Ô ÛÙ·‰›ˆÓ. ∏ ‰˘Ó·ÙfiÙËÙ· ΤډԢ˜ ÚfiÛÊ˘Û˘ ÂÈÙÚ¤ÂÈ ÌÈ·
ÈÔ Û˘ÓÙËÚËÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ ·ÔÎ¿Ï˘„˘. ∂Ó ÙÔ‡ÙÔȘ, Ô ˘ÂÚÒÈÔ˜ ‚ÏÂÓÓÔÁfiÓÔ˜ Â›Ó·È Ôχ ·¯‡˜ ηÈ
·Ê‹ÓÂÈ Â˘Ú›· ÂÈÊ¿ÓÂÈ· ·ÔÎÔ‹˜ Ì ٿÛË Û‡ÁÎÏÂÈÛ˘
ÙˆÓ ¿ÎÚˆÓ Ù˘, ÂÎÙfi˜ Î·È ·Ó ·˘Ù¿ ·ÔÍÂÛıÔ‡Ó ÈÔ ÚÈ˙Èο Î·È ·Ê·ÈÚÂı› ÙÔ Ô‰ÔÓÙÔı˘Ï¿ÎÈÔ. ŒÙÛÈ, fiÙ·Ó ÙÔ
‰fiÓÙÈ ‚Ú›ÛÎÂÙ·È Û ÌÂÁ¿ÏÔ ‚¿ıÔ˜, Ë ·ÔÎ¿Ï˘„Ë ı·
Ú¤ÂÈ ÂÈϤÔÓ Ó· ‰È·ÙËÚËı› Î·È Ì ¯ÂÈÚÔ˘ÚÁÈ΋
ÎÔÓ›·. ∞˘ÙÔ‡ ÙÔ˘ ›‰Ô˘˜ Ë Ù¯ÓÈ΋, ÏÔÈfiÓ, ı· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ÛÙÔ ‰fiÓÙÈ ¤ÏÏÂÈÌÌ· Ì·Ï·ÎÒÓ ÈÛÙÒÓ Î·È Ì·ÎÚÈ¿
ÎÏÈÓÈ΋ ̇ÏË ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ‰È¢ı¤ÙËÛ˘
(Becker, 1998).
∏ ·ÓÔȯً ¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋ ·ÚÔ˘ÛÈ¿˙ÂÈ ÔÚÈṲ̂ӷ
ÏÂÔÓÂÎÙ‹Ì·Ù·, fiˆ˜ ÙË ‰˘Ó·ÙfiÙËÙ· Ô˘ ¤¯ÂÈ Ô ÔÚıÔ‰ÔÓÙÈÎfi˜ ÁÈ· ·Ú·Ù‹ÚËÛË Î·È Û˘Ó¯‹ ÚfiÛ‚·ÛË ÛÙÔ
¤ÁÎÏÂÈÛÙÔ ‰fiÓÙÈ Î·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÚ›·˜ ÙÔ˘
ÚÔ˜ ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÙÔ˘ ı¤ÛË ÛÙÔ Ô‰ÔÓÙÈÎfi ÙfiÍÔ
(Wisth Î·È Û˘Ó., 1976b; Vanarsdall Î·È Corn, 1977),
ηıÒ˜ Î·È Ù·¯‡ÙÂÚË ·Ó·ÙÔÏ‹ (Vanarsdall Î·È Corn,
1977). ∂Ó ÙÔ‡ÙÔȘ, Ë Ì¤ıÔ‰Ô˜ ·˘Ù‹ Û˘¯Ó¿ Û˘Û¯ÂÙ›˙ÂÙ·È
Ì ‰È¿ÊÔÚ· ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ ˘Ê›˙ËÛË
ÙˆÓ Ô‡ÏˆÓ (Vanarsdall Î·È Corn, 1977; Boyd, 1984;
Tegsjö Î·È Û˘Ó., 1984; Odenrick Î·È Modeer, 1978),
ÔÛÙÈ΋ ·ÒÏÂÈ· (Vanarsdall Î·È Corn, 1977), ÌÂȈ̤ÓÔ
‡ÚÔ˜ ÎÂÚ·ÙÈÓÔÔÈËÌ¤ÓˆÓ Ô‡ÏˆÓ (Tegsjö Î·È Û˘Ó.,
1984, Kohavi Î·È Û˘Ó., 1984b), ηı˘ÛÙ¤ÚËÛË Ù˘
ÂÚÈÔ‰ÔÓÙÈ΋˜ ÂԇψÛ˘ (Becker, 1996) Î·È ÊÏÂÁÌÔÓ‹ ÙˆÓ Ô‡ÏˆÓ (Tegsjö Î·È Û˘Ó., 1984).
∫·Ù¿ ÙËÓ ÎÏÂÈÛÙ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋, ·ÔηχÙÂÙ·È Ë
̇ÏË ÙÔ˘ ¤ÁÎÏÂÈÛÙÔ˘ ‰ÔÓÙÈÔ‡ Ì ·Ó‡„ˆÛË ÎÚËÌÓÔ‡
‚ÏÂÓÓÔÁÔÓÔÂÚÈÔÛÙ¤Ô˘, ·Ê·ÈÚÂ›Ù·È ÙÔ ÔÛÙfi Ô˘ ÙËÓ
ηχÙÂÈ, Á›ÓÂÙ·È Û˘ÁÎfiÏÏËÛË Û˘Ó‰¤ÛÌÔ˘ ÛÙÔ ‰fiÓÙÈ Î·È
Â·Ó·ÙÔÔı¤ÙËÛË ÙÔ˘ ÎÚËÌÓÔ‡. ™‡ÚÌ· Ì eyelet ‹
¯Ú˘Û‹ ·Ï˘Û›‰·, Ô˘ Û˘Ó‰¤ÂÙ·È ÛÙÔ ¤Ó· ¿ÎÚÔ Ì ÙÔÓ
Û‡Ó‰ÂÛÌÔ, ‰È¤Ú¯ÂÙ·È ‰È· ÙÔ˘ ÎÚËÌÓÔ‡ ̤۷ ÛÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ· Î·È ÚÔÛ‰¤ÓÂÙ·È ÛÙÔ ¿ÏÏÔ ¿ÎÚÔ ÙÔ˘ ÛÙȘ
·Î›ÓËÙ˜ Û˘Û΢¤˜, ÒÛÙ ӷ ·ÛÎËı› ¿ÌÂÛË ¤ÏÍË
(McSherry, 1998).
∂ÎÙfi˜ ·fi Ù· Û‡ÚÌ·Ù· Î·È ÙȘ ·Ï˘Û›‰Â˜, ÁÈ· ÙËÓ ·Ó·ÙÔÏ‹ ¤ÁÎÏÂÈÛÙˆÓ ‰ÔÓÙÈÒÓ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ηٿ ηÈÚÔ‡˜ ‰È¿ÊÔÚ· ›‰Ë ÔÚıÔ‰ÔÓÙÈÎÒÓ Û˘Ó‰¤Û̈Ó, fiˆ˜
ÎÔ¯ÏÈÔ‡ÌÂÓ˜ ηÚÊ›‰Â˜, ¯˘Ù¿ ¯Ú˘Û¿ ¤ÓıÂÙ·, ¯Ú˘Û¤˜
ηχÙÚ˜ Ì cleats, Û˘ÚÌ¿ÙÈÓ˜ ÚÔÛ‰¤ÛÂȘ, Û˘ÁÎÔÏE§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
The open surgical exposure presents some advantages
such as ability of the orthodontist to observe and have
a continuing access to the impacted tooth as it is
moved to its normal position in the dental arch (Wisth
et al., 1976b; Vanarsdall and Corn, 1977), as well
as faster eruption (Vanarsdall and Corn, 1977).
However, this method is often associated with multiple
periodontal problems, such as gingival recession
(Vanarsdall and Corn, 1977; Boyd, 1884; Tegsjö et
al., 1984; Odenrick and Modeer, 1978), bone loss
(Vanarsdall and Corn, 1977), decreased width of
keratinized gingiva (Tegsjö et al., 1984; Kohavi et al.,
1984b), delayed periodontal healing (Becker, 1996),
and gingival inflammation (Tegsjö et al., 1984).
Regarding the closed-surgical exposure, a
mucoperiosteal flap is raised exposing the crown of
the impacted tooth, the bone covering the crown is
removed, an attachment is bonded and the flap is
repositioned. An eyelet wire or (gold) chain connected
to the attachment exits through the flap into the oral
cavity to gain attachment to the fixed appliance for
immediate traction (McSherry, 1998).
In addition to eyelet wires or chains, several other
kinds of orthodontic attachments have been used in
order to erupt impacted teeth, such as threaded pins,
cast gold inlays, gold cups with cleats, ligature wires,
bonded attachments, bands, and extracoronal caps.
Some of them can produce more damaging effects
than others to the periodontium, the impacted tooth, or
the adjacent teeth. For example, a threaded pin can
damage the pulp of an impacted tooth (Theofanatos et
al., 1994), a circumferential ligature wire can cause
ankylosis, external resorption, and alveolar bone loss
(Shapira and Kuftinek, 1981; Boyd, 1982), while
gold cups, inlays, bands, and extracoronal caps
require significant bone removal.
Wisth et al. (1976a) compared the periodontal status
between treated impacted canines which had been
moved by means of orthodontic forces and the
contralateral control ones, which had erupted
unaided, and found that the pocket on the distal
surface was significantly deeper in the treated
impacted canines. Both the buccal and the palatal
surfaces of the previously impacted canines displayed
significantly greater loss of attachment than the control
teeth did. The significant difference between the loss of
attachment on the buccal surface of both the previously
impacted canines and the control teeth, confirms the
findings of Zachrisson and Alnaes (1974), according
to which the pressure side is particularly prone to
exhibit periodontal destruction, even when it is not
related to an extraction site.
Hansson and Rindler (1998) observed an increased
depth of the mesio-lingual and mesio-labial pockets of
the previously impacted canines which were
orthodontically moved after surgical exposure (a flap
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A.B. ME§KO™ Î·È Û˘Ó. ¶ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
A
B
C
D
∂ÈÎfiÓ· 1.
∞ÓÙÈÌÂÙÒÈÛË ˘ÂÚÒÈ· ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Ì ·ÓÔȯً ¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋ ÂÓfi˜ ÛÙ·‰›Ô˘. ∞. ÃÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ÙÔ˘ ˘ÂÚÒÈÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ÙÔ˘ ‰ÂÍÈÔ‡ ¿Óˆ ¤ÁÎÏÂÈÛÙÔ˘ ΢Ófi‰ÔÓÙ·. µ. ÃÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë Î·È Û˘ÁÎfiÏÏËÛË Û˘Ó‰¤ÛÌÔ˘ ÛÙÔ ›‰ÈÔ
‰fiÓÙÈ. C. ÃÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë Î·È Û˘ÁÎfiÏÏËÛË Û˘Ó‰¤ÛÌÔ˘ ÛÙÔ˘˜ ¿Óˆ ¤ÁÎÏÂÈÛÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ ‰ÂÍÈ¿ Î·È ·ÚÈÛÙÂÚ¿. D. ∏
ÔÚıÔ‰ÔÓÙÈ΋ Û˘Û΢‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂٷΛÓËÛ˘ ÙˆÓ ¿Óˆ ÂÁÎÏ›ÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ.
Figure 1.
Management of palatally impacted canines with the open surgical exposure in one-step approach. A. Surgical removal of the
palatal mucosa of the right upper palatally impacted canine. B. Surgical exposure and attachment bonding of same canine. C.
Surgical exposure and attachment bonding of the right and left upper palatally impacted canines. D. Orthodontic appliance insitu during movement of the upper palatally impacted canines.
ÏÔ‡ÌÂÓÔÈ Û‡Ó‰ÂÛÌÔÈ, ‰·ÎÙ‡ÏÈÔÈ Î·È ÂÍˆÌ˘ÏÈΤ˜ ηχÙÚ˜. √ÚÈṲ̂ӷ ·fi ·˘Ù¿ ÚÔηÏÔ‡Ó ÌÂÁ·Ï‡ÙÂÚ˜
‚Ï¿‚˜ ·fi ¿ÏÏ· ÛÙÔ ÂÚÈÔ‰fiÓÙÈÔ, ÛÙÔ ¤ÁÎÏÂÈÛÙÔ ‰fiÓÙÈ
‹ ÛÙ· ·Ú·Î›ÌÂÓ· ‰fiÓÙÈ·. °È· ·Ú¿‰ÂÈÁÌ·, Ë ÎÔ¯ÏÈÔ‡ÌÂÓË Î·ÚÊ›‰· ÌÔÚ› Ó· ‚Ï¿„ÂÈ ÙÔÓ ÔÏÊfi ÙÔ˘
¤ÁÎÏÂÈÛÙÔ˘ ‰ÔÓÙÈÔ‡ (Theofanatos Î·È Û˘Ó., 1994), Ë
Û˘ÚÌ¿ÙÈÓË ÚfiÛ‰ÂÛË ‰›ÎËÓ ‚Úfi¯Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·Á·ψÛË, Â͈ÙÂÚÈ΋ ·ÔÚÚfiÊËÛË Î·È ·ÒÏÂÈ·
Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡ (Shapira Î·È Kuftinek, 1981; Boyd,
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
had been raised and resutured after bone removal in
11 of the 42 cases examined), compared to the
canines of the untreated contralateral control site. They
also noticed that the marginal bone level was
significantly lower on the distal surface of the treated
canines, but they concluded that in general their results
showed a good gingival and periodontal status with
slight differences between treated and untreated sides.
In a comparison of the probing attachment level
between the treated impacted canines and the
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A.B. ME§KO™ Î·È Û˘Ó. ¶ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋
A
B
untreated contralateral ones, Woloshyn et al. (1994)
observed an increased probing attachment level at the
mesial and distal aspects of the treated canines, while
the crestal bone height was significantly lower at the
mesial aspect of the previously impacted canines than
at the control ones. These results agree with the
findings of Becker et al. (1983), who also observed
that the mean pocket depth was significantly greater in
the previously impacted teeth and the bone support
was also significantly lower on the distal and on the
mesial side of these teeth as well.
The two-step approach
According to the two-step approach (Lewis, 1971),
initially the canine is surgically uncovered and then the
area is packed with a surgical pack to avoid the filling
in of tissues around the tooth. After wound healing,
within 2 to 3 weeks, the pack is removed, and an
attachment is placed on the uncovered tooth (Fig. 2)
(Becker 1998).
Boyd (1982) observed that the comparison between
the impacted canines treated with the two-step
approach and direct bonding and the contralateral
non-impacted ones, revealed no clinically significant
differences in the mean values of loss of attachment.
The same finding was observed in all six tooth sites,
where the measurements were taken. However, it must
be mentioned that all probing measurements were
ended off to the nearest millimeter; thus, only differences
greater than 1 mm were clinically significant.
Listing of the findings of the various studies concerning
the periodontal status of orthodontically treated
palatally impacted canines, are presented in Table 1.
C
∂ÈÎfiÓ· 2.
∞ÓÙÈÌÂÙÒÈÛË ˘ÂÚÒÈ· ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Ì ·ÓÔȯً
¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋ ‰‡Ô ÛÙ·‰›ˆÓ. ∞. ∆ÔÔı¤ÙËÛË Û˘Ó‰¤ÛÌÔ˘
Î·È ÂÊ·ÚÌÔÁ‹ ÔÚıÔ‰ÔÓÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ Ì ÙÌËÌ·ÙÈÎfi ÙfiÍÔ
ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë, ¤ÙÛÈ ÒÛÙ ӷ ˘ÂÚÂÎÊ˘ı›
Ô Î˘Ófi‰ÔÓÙ·˜. µ. ∏ ·Ú¯È΋ ‰È‡ı˘ÓÛË Ù˘ ‰‡Ó·Ì˘ ›ӷÈ
Ù¤ÙÔÈ· Ô˘ Ó· ·ÔÌ·ÎÚ‡ÓÂÈ ÙÔ ‰fiÓÙÈ ·fi Ù· ·Ú·Î›ÌÂÓ·
ÒÛÙ ·˘Ù¿ Ó· ÌËÓ ÙÚ·˘Ì·ÙÈÛÙÔ‡Ó Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi ÌÂÙ·‚¿ÏÏÂÙ·È Ë ‰È‡ı˘ÓÛË ÂÊ·ÚÌÔÁ‹˜ Ù˘ ‰‡Ó·Ì˘ ÚÔ˜ Ù· ¿ˆ
‰È·Ì¤ÛÔ˘ ÂÏ·ÛÙÈ΋˜ ·Ï˘Û›‰·˜ ·fi ÙÔÓ ÁψÛÛÈÎfi ÛˆÏËÓ›ÛÎÔ
ÙÔ˘ ‰·ÎÙ˘Ï›Ô˘ ÙÔ˘ ÚÒÙÔ˘ ÁÔÌÊ›Ô˘. C. ¶ÂÚ·ÈÙ¤Úˆ ·ÏÏ·Á‹
Ù˘ ‰‡Ó·Ì˘ ÚÔ˜ ·ÚÂȷ΋ ηÙ‡ı˘ÓÛË ‰È·Ì¤ÛÔ˘ ‰‡Ô ÂÏ·ÛÙÈÎÒÓ ·Ï˘Û›‰ˆÓ ·fi ÙÔÓ ÁψÛÛÈÎfi ÛˆÏËÓ›ÛÎÔ ÙÔ˘ ‰·ÎÙ˘Ï›Ô˘ ÙÔ˘ ÚÒÙÔ˘ ÁÔÌÊ›Ô˘ Î·È ·fi ÙÔ Û˘ÚÌ¿ÙÈÓÔ ÙfiÍÔ.
Figure 2.
Management of palatally impacted canines with the open
surgical exposure in two-step approach. A. Placement of
attachment and application of orthodontic forces by means of
a sectional arch following surgical exposure in order to extrude
the canine. B. The initial direction of the force should be to
move the tooth away from the neighboring teeth to avoid
their injury and therefore a change in force application in distal
direction is performed by means of an elastic chain attached to
the lingual sheath of the first molar band. C. Further change in
force application in buccal direction by means of two elastic
chains attached to the lingual sheath of the first molar band
and to the archwire.
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
LABIALLY IMPACTED CANINES
The most common methods of uncovering labial
impacted canines are: (a) the simple surgical
exposure, (b) the closed-flap eruption technique, and
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A.B. ME§KO™ Î·È Û˘Ó. ¶ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋
(c) the apically positioned flap technique (Clark,
1971; Shiloah and Kopezyk, 1978; Vanarsdall and
Corn, 1977; Hunt, 1977; Boyd, 1984; McSherry,
1998). According to Becker (1998), there is also one
more method to add, namely the relief of crowding, if
that was the cause of the canine displacement.
1982), ÂÓÒ ÔÈ ¯Ú˘Û¤˜ ηχÙÚ˜, Ù· ¤ÓıÂÙ·, ÔÈ ‰·ÎÙ‡ÏÈÔÈ Î·È ÔÈ ÂÍˆÌ˘ÏÈΤ˜ ηχÙÚ˜ ··ÈÙÔ‡Ó ÛËÌ·ÓÙÈ΋
·Ê·›ÚÂÛË ÔÛÙÔ‡.
√È Wisth Î·È Û˘Ó. (1976a) Û˘Ó¤ÎÚÈÓ·Ó ÙËÓ ÂÚÈÔ‰ÔÓÙÈ΋ ηٿÛÙ·ÛË ıÂÚ·Â˘Ì¤ÓˆÓ ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Ô˘ ÌÂÙ·ÎÈÓ‹ıËÎ·Ó Ì ÔÚıÔ‰ÔÓÙÈΤ˜ ‰˘Ó¿ÌÂȘ
Î·È ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ‰ÔÓÙÈÒÓ Ù˘ ¿ÏÏ˘ ÏÂ˘Ú¿˜ Ô˘
›¯·Ó ·Ó·Ù›ÏÂÈ ¯ˆÚ›˜ ·Ú¤Ì‚·ÛË Î·È ‚Ú‹Î·Ó fiÙÈ Ô
ı‡Ï·ÎÔ˜ Ù˘ ¿ˆ ÂÈÊ¿ÓÂÈ·˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ‚·ı‡ÙÂÚÔ˜ ÛÙÔ˘˜ ¤ÁÎÏÂÈÛÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜
›¯Â Á›ÓÂÈ ıÂÚ·›·. ∆fiÛÔ Ë ·ÚÂȷ΋ fiÛÔ Î·È Ë ˘ÂÚÒÈ· ÂÈÊ¿ÓÂÈ· ÙˆÓ ÚÒËÓ ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ
·ÚÔ˘Û›·˙·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·ÒÏÂÈ· ÚfiÛÊ˘Û˘ Û ۯ¤ÛË Ì ٷ ‰fiÓÙÈ· ÂϤÁ¯Ô˘. ∏ ÌÂÁ¿ÏË
‰È·ÊÔÚ¿ ÌÂٷ͇ Ù˘ ·ÒÏÂÈ·˜ ÚfiÛÊ˘Û˘ ÛÙËÓ
·ÚÂȷ΋ ÂÈÊ¿ÓÂÈ· ÙfiÛÔ ÙˆÓ ÚÒËÓ ¤ÁÎÏÂÈÛÙˆÓ
‰ÔÓÙÈÒÓ fiÛÔ Î·È ÙˆÓ ‰ÔÓÙÈÒÓ ÂϤÁ¯Ô˘ ÂȂ‚·ÈÒÓÂÈ Ù·
Â˘Ú‹Ì·Ù· ÙˆÓ Zachrisson Î·È Alnaes (1974), Û‡Ìʈӷ Ì ٷ ÔÔ›· Ë ÏÂ˘Ú¿ Ô˘ ‰¤¯ÂÙ·È ›ÂÛË Â›Ó·È È‰È·›ÙÂÚ· ÂÈÚÚÂ‹˜ Û ÂÚÈÔ‰ÔÓÙÈ΋ ηٷÛÙÚÔÊ‹,
·ÎfiÌË Î·È fiÙ·Ó ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È Ì ı¤ÛË ÂÍ·ÁˆÁ‹˜.
√È Hansson Î·È Rindler (1998) ·Ú·Ù‹ÚËÛ·Ó ·‡ÍËÛË ÙÔ˘ ‚¿ıÔ˘˜ ÙÔ˘ ÂÁÁ‡˜-ÁψÛÛÈÎÔ‡ Î·È ÂÁÁ‡˜·ÚÂÈ·ÎÔ‡ ı˘Ï¿ÎÔ˘ ÛÙÔ˘˜ ÚÒËÓ ¤ÁÎÏÂÈÛÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ Ô˘ ÌÂÙ·ÎÈÓ‹ıËÎ·Ó ÔÚıÔ‰ÔÓÙÈο ÌÂÙ¿ ·fi
¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë (¤ÁÈÓ ·Ó‡„ˆÛË ÎÚËÌÓÔ‡
Î·È Â·Ó·Û˘ÚÚ·Ê‹ ÌÂÙ¿ ·fi ·Ê·›ÚÂÛË ÔÛÙÔ‡ ÛÙȘ
11 ·fi ÙȘ 42 ÂÚÈÙÒÛÂȘ Ô˘ ÂÍÂÙ¿ÛıËηÓ) ÛÂ
Û¯¤ÛË Ì ÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ Ù˘ ¿ÏÏ˘ ÏÂ˘Ú¿˜ fiÔ˘
‰ÂÓ ¤ÁÈÓ ıÂÚ·›·. ¶·Ú·Ù‹ÚËÛ·Ó ·ÎfiÌË fiÙÈ ÙÔ Â›Â‰Ô ÙÔ˘ ÔÛÙÔ‡ Ù˘ Ê·ÙÓȷ΋˜ ·ÎÚÔÏÔÊ›·˜ ‹Ù·Ó
ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ÛÙËÓ ¿ˆ ÂÈÊ¿ÓÂÈ· ÙˆÓ
ıÂÚ·Â˘Ì¤ÓˆÓ Î˘ÓÔ‰fiÓÙˆÓ. ™˘Ì¤Ú·Ó·Ó, fï˜, fiÙÈ
ηٿ ηÓfiÓ· Ù· ·ÔÙÂϤÛÌ·Ù¿ ÙÔ˘˜ ‰Â›¯ÓÔ˘Ó Î·Ï‹
Ô˘ÏÈ΋ Î·È ÂÚÈÔ‰ÔÓÙÈ΋ ηٿÛÙ·ÛË Ì Ôχ ÌÈÎÚ¤˜
‰È·ÊÔÚ¤˜ ÌÂٷ͇ Ù˘ ıÂÚ·Â˘Ì¤Ó˘ ÏÂ˘Ú¿˜ Î·È Ù˘
ÏÂ˘Ú¿˜ ÂϤÁ¯Ô˘. ™‡ÁÎÚÈÛË ÙÔ˘ ÌÂÙÚÔ‡ÌÂÓÔ˘ ÂÈ¤‰Ô˘ ÚfiÛÊ˘Û˘ Ì ÂÚÈÔ‰ÔÓÙÈ΋ Ì‹ÏË ÌÂٷ͇ ıÂÚ·Â˘Ì¤ÓˆÓ ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Î·È ·ÓÙ›ÛÙÔȯˆÓ
‰ÔÓÙÈÒÓ ÂϤÁ¯Ô˘ ·fi ÙÔ˘˜ Woloshyn Î·È Û˘Ó.
(1994) ¤‰ÂÈÍ ·˘ÍË̤ÓË ÙÈÌ‹ ̤ÙÚËÛ˘ ÂÁÁ‡˜ ηÈ
¿ˆ ÙˆÓ ıÂÚ·Â˘Ì¤ÓˆÓ Î˘ÓÔ‰fiÓÙˆÓ, ÂÓÒ ÙÔ ‡„Ô˜ ÙÔ˘
ÔÛÙÔ‡ Ù˘ Ê·ÙÓȷ΋˜ ·ÎÚÔÏÔÊ›·˜ ‹Ù·Ó ÛËÌ·ÓÙÈο
ÌÂȈ̤ÓÔ ÛÙËÓ ÂÁÁ‡˜ ÂÈÊ¿ÓÂÈ· ÙˆÓ ÚÒËÓ ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Û ۯ¤ÛË Ì ٷ ‰fiÓÙÈ· ÂϤÁ¯Ô˘. ∆·
·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Û˘ÌʈÓÔ‡Ó Ì ٷ Â˘Ú‹Ì·Ù· ÙˆÓ
Becker Î·È Û˘Ó. (1983), ÔÈ ÔÔ›ÔÈ Â›Û˘ ·Ú·Ù‹ÚËÛ·Ó fiÙÈ ÙÔ Ì¤ÛÔ ‚¿ıÔ˜ ı˘Ï¿ÎÔ˘ ‹Ù·Ó ÛËÌ·ÓÙÈο
ÌÂÁ·Ï‡ÙÂÚÔ ÛÙ· ÚÒËÓ ¤ÁÎÏÂÈÛÙ· ‰fiÓÙÈ· Î·È Ë ÔÛÙÈ΋ ÛÙ‹ÚÈÍË ·ÍÈÔÛËÌ›ˆÙ· ÌÂȈ̤ÓË ÛÙȘ ÂÁÁ‡˜ ηÈ
¿ˆ ÂÈÊ¿ÓÂȘ ·˘ÙÒÓ ÙˆÓ ‰ÔÓÙÈÒÓ.
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
Simple surgical exposure
The simple surgical exposure includes the excision of the
covering tissues of the crown of the impacted tooth.
Fournier et al. (1982) suggested that labially impacted
canines with a favorable vertical position may be treated
initially by surgical exposure without the application of a
traction force. They believe that in younger patients the
tooth will erupt on its own after surgical exposure,
whereas in older patients traction is almost always
indicated. Tegsjö et al. (1984) observed that the width
of keratinized gingiva of the treated canines with a
simple but "radical" surgical exposure alone was
significantly reduced compared to the contralateral
normally erupted canines. In addition, the sulcus depth
of the treated canines was significantly lower and the
gingival recession was significant increased in
comparison to the contralateral control ones.
Boyd (1984) compared the "window approach"
(exposure of the entire labial aspect of the anatomic
crown with total excision of the keratinized tissue), with
a more conservative surgical approach which
exposed only 4-5 mm of the most superficial portion of
the labial aspect of the cusp, maintaining 2-3 mm of
keratinized tissue. Evaluation of twelve patients in each
category six months to two years after orthodontic
alignment revealed that those treated by the window
approach presented statistically more gingival
recession, gingival inflammation and loss of
attachment on the labial and labio-proximal surfaces of
the impacted teeth when compared to controls. These
findings were confirmed also by Kohavi et al. (1984b)
and by Artun et al. (1986), who found significantly
less attached gingiva and loss of attachment on
labially erupting maxillary canines after their
orthodontic alignment.
The closed-flap eruption technique
In the closed-eruption technique a flap is elevated, an
attachment is placed on the impacted tooth, and then
the flap is returned to its original location (Fig. 3) (Gaulis
and Joho, 1978; Kokich and Mathews, 1993).
Vermette et al. (1995) observed that the width of the
attached gingiva of the labially impacted canines
treated with the closed-eruption technique, was
reduced on the distal surface and the crestal bone was
located more apically on their facial surface of them
than of the untreated control canines. Crescini et al.
(1994) reported on the periodontal effects of the
closed surgical technique with tunnel traction for deep
15
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A.B. ME§KO™ Î·È Û˘Ó. ¶ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋
∆¯ÓÈ΋ ‰‡Ô ÛÙ·‰›ˆÓ
™‡Ìʈӷ Ì ÙËÓ Ù¯ÓÈ΋ ·˘Ù‹ (Lewis, 1971), ηْ ·Ú¯‹Ó
·ÔηχÙÂÙ·È ¯ÂÈÚÔ˘ÚÁÈο Ô Î˘Ófi‰ÔÓÙ·˜ Î·È ÙÔÔıÂÙÂ›Ù·È ÛÙËÓ ÂÚÈÔ¯‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ÎÔÓ›· ÒÛÙ ӷ ÌËÓ
Î·Ï˘Êı› ÙÔ ‰fiÓÙÈ ·fi ÙÔ˘˜ Á‡Úˆ ÈÛÙÔ‡˜. ªÂÙ¿ ÙËÓ
ÂԇψÛË ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ ÂÓÙfi˜ 2-3 ‚‰ÔÌ¿‰ˆÓ, ·Ê·ÈÚÂ›Ù·È Ë ÎÔÓ›· Î·È Û˘ÁÎÔÏÏ¿Ù·È ÛÙÔ ‰fiÓÙÈ ÔÚıÔ‰ÔÓÙÈÎfi˜
Û‡Ó‰ÂÛÌÔ˜ (∂ÈÎ. 2) (Becker, 1998).
√ Boyd (1982) ·Ú·Ù‹ÚËÛ fiÙÈ Î·Ù¿ ÙË Û‡ÁÎÚÈÛË
¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì Ù¯ÓÈ΋
‰‡Ô ÛÙ·‰›ˆÓ Î·È ¿ÌÂÛË Û˘ÁÎfiÏÏËÛË Î·È ÌË ¤ÁÎÏÂÈÛÙˆÓ
΢ÓÔ‰fiÓÙˆÓ Ù˘ ¿ÏÏ˘ ÏÂ˘Ú¿˜ ‰ÂÓ ‚Ú¤ıËÎ·Ó ÎÏÈÓÈο
ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙȘ ̤Û˜ ÙÈ̤˜ ·ÒÏÂÈ·˜ ÚfiÛÊ˘Û˘. ∆Ô ›‰ÈÔ ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙȘ ¤ÍÈ ı¤ÛÂȘ ÛÂ
fiÏ· Ù· ‰fiÓÙÈ· ÛÙ· ÔÔ›· ¤ÁÈÓ·Ó ÌÂÙÚ‹ÛÂȘ. ∂Ó ÙÔ‡ÙÔȘ,
Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ fiϘ ÔÈ ÌÂÙÚ‹ÛÂȘ Ì ÙËÓ ÂÚÈÔ‰ÔÓÙÈ΋ Ì‹ÏË ÛÙÚÔÁÁ˘ÏÔÔÈ‹ıËÎ·Ó ÚÔ˜ ÙÔ ÏËÛȤÛÙÂÚÔ ¯ÈÏÈÔÛÙfi. ŒÙÛÈ, ÌfiÓÔ ‰È·ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚ˜ ÙÔ˘
ÂÓfi˜ ¯ÈÏÈÔÛÙÔ‡ ‹Ù·Ó ÎÏÈÓÈο ÛËÌ·ÓÙÈΤ˜.
™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Â˘Ú‹Ì·Ù· ‰È·ÊfiÚˆÓ
ÌÂÏÂÙÒÓ Û¯ÂÙÈο Ì ÙËÓ ÂÚÈÔ‰ÔÓÙÈ΋ ηٿÛÙ·ÛË ÙˆÓ ˘ÂÚÒÈ· ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÌÂ
ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·.
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
infra-osseous labially impacted canines. They found no
attachment loss and no recession at the end of active
treatment and after three years follow-up. In addition,
no significant differences were observed in the width
of keratinized tissue between the surgically uncovered
and the contralateral spontaneous erupted canines.
The apically positioned flap technique
In the apically repositioned flap technique, a partial
thickness flap is raised and the wound is carefully
curetted to remove the dental sac and to expose the
tooth. There is no need for bone removal unless it is
necessary to reach the canine crown. The latter must
be executed as conservatively as possible and not
beyond the cemento-enamel-junction. Interrupted
periosteal sutures are placed to position the flap
apically and the surgical area is packed for 7-10 days
(Theofanatos et al.,1994). According to Becker
(1998), when an apically repositioned flap is
performed, tooth eruption is speeded up. This method
is not recommended if the impacted tooth is very high
positioned, since the apically repositioned flap would
then leave a wide area of the labial bony plate
unnecessarily exposed to the oral environment.
Nevertheless, an important advantage of this method
is that the buccally impacted canine remains
accessible for attachment bonding at any appropriate
later date, if the orthodontist decides for an active
extrusion.
Regarding the periodontal conditions following use of
this technique, Vermette et al. (1995) found that the
gingival margin of labially impacted canines
uncovered with the apically positioned flap technique
was located more apically on the mesial and facial
surfaces, and more bone was lost on the mesial, facial
and distal surfaces than in the control canines. On the
contrary, Tegsjö et al. (1984) observed no significant
differences in the periodontal status between treated
canines and the non-treated contralaterals (Table 2).
¶APEIAKA E°K§EI™TOI
KYNO¢ONTE™
√È Û˘ÓËı¤ÛÙÂÚ˜ ̤ıÔ‰ÔÈ ·ÔÎ¿Ï˘„˘ ·ÚÂȷο
¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Â›Ó·È: (·) Ë ·Ï‹ ¯ÂÈÚÔ˘ÚÁÈ΋
·ÔÎ¿Ï˘„Ë, (‚) Ë Ù¯ÓÈ΋ ·Ó·ÙÔÏ‹˜ Ì ÎÏÂÈÛÙfi ÎÚËÌÓfi
Î·È (Á) Ë Ù¯ÓÈ΋ ·ÎÚÔÚÚÈ˙Èο ÌÂÙ·ÙÔÈ˙fiÌÂÓÔ˘ ÎÚËÌÓÔ‡
(Clark, 1971; Shiloah Î·È Kopezyk, 1978;
Vanarsdall Î·È Corn, 1977; Hunt, 1977; Boyd,
1984; McSherry, 1998). ™‡Ìʈӷ Ì ÙÔÓ Becker
(1998), ˘¿Ú¯ÂÈ ·ÎfiÌË Ì›· ̤ıÔ‰Ô˜, ÂΛÓË Ù˘ Â›Ï˘Û˘ ÙÔ˘ Û˘ÓˆÛÙÈÛÌÔ‡, ÂÊfiÛÔÓ ·˘Ùfi˜ ‹Ù·Ó Ë ·ÈÙ›· Ù˘
·ÚÂÎÙfiÈÛ˘ ÙÔ˘ ΢Ófi‰ÔÓÙ·.
DISCUSSION
∞Ï‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë
∏ ·Ï‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÎÙÔÌ‹ ÙˆÓ ÈÛÙÒÓ Ô˘ ηχÙÔ˘Ó ÙË Ì‡ÏË ÙÔ˘ ¤ÁÎÏÂÈÛÙÔ˘
‰ÔÓÙÈÔ‡.
√È Fournier Î·È Û˘Ó. (1982) ÚÔÙ›ÓÔ˘Ó Ë ·ÓÙÈÌÂÙÒÈÛË
·ÚÂȷο ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Ì ¢ÓÔ˚΋ ηٷÎfiÚ˘ÊË ı¤ÛË Ó· Á›ÓÂÙ·È ·Ú¯Èο Ì ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë
¯ˆÚ›˜ ÂÊ·ÚÌÔÁ‹ ‰‡Ó·Ì˘ ¤Ï͢. ¶ÈÛÙÂ‡Ô˘Ó fiÙÈ Û ÈÔ
Ó¤Ô˘˜ ·ÛıÂÓ›˜ ÙÔ ‰fiÓÙÈ ı· ·Ó·Ù›ÏÂÈ ÌfiÓÔ ÙÔ˘ ÌÂÙ¿ ÙËÓ
¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë, ÂÓÒ Û ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜
·ÛıÂÓ›˜ ۯ‰fiÓ ¿ÓÙ· ÂӉ›ÎÓ˘Ù·È Ë ¤ÏÍË. √È Tegsjö
Î·È Û˘Ó. (1984) ·Ú·Ù‹ÚËÛ·Ó fiÙÈ ÙÔ Â‡ÚÔ˜ ÙˆÓ ÎÂÚ·ÙÈ-
Periodontal evaluation is an important requisite for the
patient prior to combined surgical/orthodontic
treatment. Periodontal problems many times can be
prevented by careful case planning and appropriate
oral hygiene control.
Regarding the palatally impacted canines, their
surgical exposure and alignment (open-surgical
exposure) results to a significantly greater loss of
attachment both on the buccal and palatal surfaces
when compared to the control teeth, which erupted
unaided (Wisth et al., 1976a; Zachrisson and Alnaes,
1974). According to Becker (1998), this method will
leave the tooth with a soft tissue deficiency and a long
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A.B. ME§KO™ Î·È Û˘Ó. ¶ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
¶›Ó·Î·˜ 1. ™‡ÁÎÚÈÛË Ù˘ ÂÚÈÔ‰ÔÓÙÈ΋˜ ηٿÛÙ·Û˘ ˘ÂÚÒÈ· ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ ÌÂÙ¿ ·fi ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·
(CEJ: ÔÛÙÂ˚ÓÔ-·‰·Ì·ÓÙÈÓÈ΋ ¤ÓˆÛË [√∞∂], NA: ÌË ‰È·ı¤ÛÈÌÔ, NS: ÌË ÛËÌ·ÓÙÈÎfi).
Table 1. Comparisons of the periodontal status of palatally impacted canines following surgical and orthodontic treatment (CEJ: Cementoenamel junction, NA: not available, NS: non-significant).
¢fifiÓÓÙÈ· ˘fi ÂͤٷÛË
Experimental teeth
–x
s.d.
¢fifiÓÓÙÈ· ÂϤÁ¯Ô˘
Control teeth
–x
s.d.
ÂÁÁ‡˜/mesial
·ÚÂȷ΋/buccal
¿ˆ/distal
˘ÂÚÒÈ·/palatal
ÂÁÁ‡˜/mesial
·ÚÂȷ΋/buccal
¿ˆ/distal
˘ÂÚÒÈ·/palatal
2,59
1,85
2,66
2,06
0,91
0,82
1,12
1,85
0,82
0,66
0,77
0,34
0,67
0,80
0,84
0,58
2,29
1,62
2,24
2,03
0,62
0,47
0,76
0,79
0,52
0,55
0,61
0,46
0,60
0,56
0,70
0,73
0,30
0,23
0,44
0,03
0,29
0,35
0,36
1,06
MÂÙÚÔ‡ÌÂÓÔ Â›‰Ô
ÚfiÛÊ˘Û˘
robing attachment level
ÂÁÁ‡˜/mesial
·ÚÂȷ΋/buccal
¿ˆ/distal
˘ÂÚÒÈ·/palatal
1,96
1,67
1,66
1,63
0,53
0,74
0,47
0,71
1,64
1,37
1,46
1,47
0,30
0,39
0,14
0,49
0,32
0,30
0,30
0,16
p<0,05
NS
p<0,05
NS
⁄„Ô˜ ÙÔ˘ ÔÛÙÔ‡ Ù˘
Ê·ÙÓȷ΋˜ ·ÎÚÔÏÔÊ›·˜
Crestal bone height
ÂÁÁ‡˜/mesial
¿ˆ/distal
0,98
1,25
0,82
0,66
0,46
1,02
0,58
0,60
0,52
0,23
p<0,01
NS
E›Â‰Ô ÙÔ˘ ÔÛÙÔ‡ Ù˘
Ê·ÙÓȷ΋˜ ·ÎÚÔÏÔÊ›·˜
(·fiÛÙ·ÛË Û mm Ù˘
OAE ·fi ÙËÓ ÎÔÚ˘Ê‹
ÙÔ˘ Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡)
Marginal bone level
distance in mm from CEJ
to peak of marginal bone)
ÂÁÁ‡˜/mesial
¿ˆ/distal
3,03
3,42
1,58
1,62
2,74
2,85
1,22
1,04
0,29
0,57
NS
p<0,01
B¿ıÔ˜ ı˘Ï¿ÎÔ˘
Pocket depth
ÂÁÁ˘˜-ÁψÛÛÈ΋/mesio-lingual
ÁψÛÛÈ΋/lingual
¿ˆ ÁψÛÛÈ΋/disto-lingual
¿ˆ ¯ÂÈÏÈ΋/disto-labial
¯ÂÈÏÈ΋/labial
ÂÁÁ‡˜-¯ÂÈÏÈ΋/mesio-labial
1,98
1,38
1,79
2,19
1,14
1,98
0,87
0,54
0,84
1,13
0,35
0,87
1,57
1,31
1,79
1,95
1,05
1,74
0,67
0,47
0,72
0,76
0,22
0,63
0,41
0,07
0,00
0,24
0,09
0,24
p<0,01
NS
NS
NS
NS
p<0,05
Boyd (1982)
AÒÏÂÈ· ÚfiÛÊ˘Û˘
Loss of attachment
ÂÁÁ˘˜-ÁψÛÛÈ΋/mesio-lingual
ÁψÛÛÈ΋/lingual
¿ˆ ÁψÛÛÈ΋/disto-lingual
¿ˆ ¯ÂÈÏÈ΋/disto-labial
¯ÂÈÏÈ΋/labial
ÂÁÁ‡˜-¯ÂÈÏÈ΋/mesio-labial
0,5
0,66
0,33
0,33
0,41
0,41
NA
0,33
0,5
0,5
0,41
0,33
0,33
NA
0,17
0,16
-0,17
-0,08
0,08
0,08
NA
Becker et al.
(1983)
B¿ıÔ˜ ı˘Ï¿ÎÔ˘
Pocket depth
OÛÙÈ΋ ÛÙ‹ÚÈÍË
Bone support
ŸÏ˜ (6) ÔÈ ÂÈÊ¿ÓÂȘ
All six tooth surfaces
ÂÁÁ‡˜/mesial
¿ˆ/distal
2,52
0,71
2,17
0,49
0,35
p<0,05
90,26%
88,91%
4,80
5,97
93,7%
92,87%
3,91
3,99
-3,44%
-3,96%
p<0,05
p<0,05
™˘ÁÁÚ·Ê›˜
Authors
MÂÙÚ‹ÛÂȘ
Measurements
EÈÊ¿ÓÂÈ·
Surface
B¿ıÔ˜ ı˘Ï¿ÎÔ˘
Pocket Depth
Wisth et al.
(1976a)
AÒÏÂÈ· ÚfiÛÊ˘Û˘
Loss of attachment
Woloshyn
et al. (1994)
Hansson
and
Rindler
(1998)
P-value
NA
NA
clinical crown, especially when it is placed deeply in
the palatal mucosa.
Periodontal health may be also compromised when the
closed-surgical exposure is performed. Woloshyn et al.
(1994) observed that the probing attachment level was
ÓÔÔÈËÌ¤ÓˆÓ Ô‡ÏˆÓ ÛÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÌfiÓÔ Ì ·Ï‹, ·ÏÏ¿ "ÚÈ˙È΋" ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂȈ̤ÓÔ Û ۯ¤ÛË Ì ÙÔ˘˜
΢Ófi‰ÔÓÙ˜ Ù˘ ¿ÏÏ˘ ÏÂ˘Ú¿˜ Ô˘ ·Ó¿ÙÂÈÏ·Ó Ê˘ÛÈÔÏÔÁÈο. ∂ÈϤÔÓ, ÙÔ ‚¿ıÔ˜ Ù˘ Ô˘ÏÔ‰ÔÓÙÈ΋˜ Û¯ÈÛÌ‹˜
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
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Difference
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A.B. ME§KO™ Î·È Û˘Ó. ¶ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
A
B
C
D
E
F
∂ÈÎfiÓ· 3 (Û˘Ó¤¯ÂÈ· ÛÙËÓ ÂfiÌÂÓË ÛÂÏ›‰·).
∞ÓÙÈÌÂÙÒÈÛË ·ÚÂȷο ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Ì ÎÏÂÈÛÙ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋. ∞. ÃÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë ÙÔ˘ ¿Óˆ ‰ÂÍÈÔ‡ ¤ÁÎÏÂÈÛÙÔ˘ ΢Ófi‰ÔÓÙ·. µ. ™˘ÁÎfiÏÏËÛË Û˘Ó‰¤ÛÌÔ˘. C. ∂·Ó·ÙÔÔı¤ÙËÛË ÙÔ˘ ÎÚËÌÓÔ‡ Î·È Û˘ÚÚ·Ê‹, ÂÓÒ ·fi ÙÔÓ ÎÚËÌÓfi ÂͤگÂÙ·È Û˘ÚÌ¿ÙÈÓË ÚfiÛ‰ÂÛË. D. ∏ ·Ú¯È΋ ‰È‡ı˘ÓÛË Ù˘ ‰‡Ó·Ì˘ Â›Ó·È Ù¤ÙÔÈ· Ô˘ Ó· ·ÔÌ·ÎÚ‡ÓÂÈ ÙÔ ‰fiÓÙÈ ·fi Ù· ·Ú·Î›ÌÂÓ·, ÒÛÙ ·˘Ù¿
Ó· ÌËÓ ÙÚ·˘Ì·ÙÈÛÙÔ‡Ó, Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi Ë ÔÚıÔ‰ÔÓÙÈ΋ ‰‡Ó·ÌË ÂÊ·ÚÌfi˙ÂÙ·È ÌÂ Û˘Ó‰˘·ÛÌfi ÙÌËÌ·ÙÈÎÔ‡ Û˘ÚÌ¿ÙÈÓÔ˘ ÙfiÍÔ˘ ηÈ
ÂÏ·ÛÙÈ΋˜ ·Ï˘Û›‰·˜. ∂. ∂Ê·ÚÌÔÁ‹ ÔÚıÔ‰ÔÓÙÈ΋˜ ‰‡Ó·Ì˘ Ì ÂÏ·ÛÙÈ΋ ·Ï˘Û›‰· Ô˘ Û˘Ó‰¤ÂÙ·È Ì ÙÔ ·Á·ÏÈÔ ÙÔ˘ ÚÔÁÔÌÊ›Ô˘. F.
¶ÂÚ·ÈÙ¤Úˆ ÂÊ·ÚÌÔÁ‹ ÔÚıÔ‰ÔÓÙÈ΋˜ ‰‡Ó·Ì˘ Ì ÂÏ·ÛÙÈ΋ ·Ï˘Û›‰· Ô˘ Û˘Ó‰¤ÂÙ·È Ì ÙÔ Û˘ÚÌ¿ÙÈÓÔ ÙfiÍÔ.
Figure 3 (continued on next page).
Management of labially impacted canines with the closed-flap eruption technique. A. Surgical exposure of the right upper labially
impacted canine. B. Bonding of the attachment. C. Repositioning of the flap and surgical closure. A twisted ligature exits through the
flap. D. The initial direction of the force should be to move the tooth away from the neighboring teeth to avoid their injury and
therefore orthodontic force application is performed by means of a combination of a sectional arch wire and an elastic chain. E.
Orthodontic force application by means of an elastic chain attached to the premolar bracket. F. Further orthodontic force application
by means of an elastic chain attached to the archwire.
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AP.B. ME§KO™ Î·È Û˘Ó. ¶ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋
increased and the crestal bone height was significantly
lower in the impacted canines treated with this method.
These findings agree also with the results of Becker et al.
(1983), in their study group of 23 patients with unilateral
palatal impaction of a maxillary canine. On the other
hand, Crescini et al. (1994), found no attachment loss,
no recession and no significant differences in keratinized
tissue width in a follow-up examination of eight cases
with impacted canines treated with this method, when
compared to the contralateral unaided erupted canines.
A good gingival and periodontal status with slight
differences between treated and untreated sides was
also reported by Hansson and Rindler (1998), in their
follow-up study 1 to 18 years after completion of
orthodontic treatment of unilateral palatally impacted
maxillary canines; though, increased pocket depth and
lower marginal bone level were registered. Caminiti et
al. (1998) reported also no gingival inflammation and
no recession after forced eruption of 60 palatally
impacted canines treated with this technique.
By comparing the open- and closed surgical exposure,
it has been found that the open exposure causes more
periodontal damage (loss of attachment and interdental
bone height) than the closed one although the mean
differences between the two techniques were small
(Wisth et al., 1976b). Furthermore, Kohavi et al.
(1984a) found a consistent significant loss of alveolar
bone height on the mesial proximal surface of the
exposed tooth with the amount of bone loss being
greater if exposure is carried out to below of the
cemento-enamel-junction. According to Becker (1998),
the full flap closure (close-surgical exposure technique)
after attachment placement on the exposed tooth must
be recommended over any other, because the tooth is
then exposed with the minimum tissue removal and
consequent surgical trauma, which in combination with
appropriate orthodontic biomechanics will provide
healthy mucogingival tissues and the best bone support.
Becker based scientifically his recommendation on
various clinical comparisons of surgical methods of
exposure (Heaney and Atherton, 1976; Wisth et al.,
1976a; Odenrick and Modeer, 1978; Boyd, 1982;
Becker et al., 1983; Kohavi et al., 1984a; Crescini et
al., 1994; Vermette et al., 1995).
By using the two-step method and direct bonding in a
study group of 20 patients with one palatally impacted
maxillary canine and one non-impacted, Boyd (1982)
found no significant differences in the mean values of
attachment loss on any of the six tooth sites between
the treated canines and their contralaterals. On the
contrary, the impacted canines, which were ligated
with wire, showed significant loss of attachment on the
proximal and lingual surfaces when compared to the
non-impacted ones. These data were probably
influenced by the surgical procedure used to gain
access for the wire ligation placement, which was
G
∂ÈÎfiÓ· 3.
G. ¶ÚfiÛ‰ÂÛË ÙÔ˘ ·ÁÎ˘Ï›Ô˘ ÙÔ˘ ΢Ófi‰ÔÓÙ· ÛÙÔ ‚·ÛÈÎfi Û˘ÚÌ¿ÙÈÓÔ ÙfiÍÔ.
Figure 3.
G. Ligation of the canine bracket to the main archwire.
ÙˆÓ ıÂÚ·Â˘Ì¤ÓˆÓ Î˘ÓÔ‰fiÓÙˆÓ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂȈ̤ÓÔ Î·È Ë Ô˘ÏÈ΋ ˘Ê›˙ËÛË ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ÛÂ
Û¯¤ÛË Ì ٷ ‰fiÓÙÈ· ÂϤÁ¯Ô˘.
√ Boyd (1984) Û‡ÁÎÚÈÓ ÙËÓ "Ù¯ÓÈ΋ ÙÔ˘ ·Ú¿ı˘ÚÔ˘"
(·ÔÎ¿Ï˘„Ë fiÏ˘ Ù˘ ·ÚÂȷ΋˜ ÂÈÊ¿ÓÂÈ·˜ Ù˘ ·Ó·ÙÔÌÈ΋˜ ̇Ï˘ Ì ÔÏÈ΋ ÂÎÙÔÌ‹ ÙÔ˘ ÎÂÚ·ÙÈÓÔÔÈË̤ÓÔ˘
ÈÛÙÔ‡) Ì ̛· ÈÔ Û˘ÓÙËÚËÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ ÚÔÛ¤ÁÁÈÛË
Ô˘ ·ÔηχÙÂÈ ÌfiÓÔ 4-5 mm ÙÔ˘ ÈÔ ÂÈÊ·ÓÂÈ·ÎÔ‡
ÙÌ‹Ì·ÙÔ˜ Ù˘ ·ÚÂȷ΋˜ fi„˘ ÙÔ˘ ʇ̷ÙÔ˜ ‰È·ÙËÚÒÓÙ·˜ 2-3 mm ÎÂÚ·ÙÈÓÔÔÈË̤ÓÔ˘ ÈÛÙÔ‡. ∞ÍÈÔÏfiÁËÛË 12
·ÛıÂÓÒÓ ·fi οı ηÙËÁÔÚ›·, ¤ÍÈ Ì‹Ó˜ Ì ‰‡Ô ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ‰È¢ı¤ÙËÛË, ·ÔÎ¿Ï˘„ fiÙÈ ÔÈ
·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¤ÁÈÓÂ Ë "Ù¯ÓÈ΋ ÙÔ˘ ·Ú¿ı˘ÚÔ˘" ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÌÂÁ·Ï‡ÙÂÚË Ô˘ÏÈ΋ ˘Ê›˙ËÛË, ÊÏÂÁÌÔÓ‹ ÙˆÓ Ô‡ÏˆÓ Î·È ·ÒÏÂÈ· ÚfiÛÊ˘Û˘
ÛÙËÓ ·ÚÂȷ΋ Î·È ÛÙȘ ÔÌÔÚÔ-·ÚÂȷΤ˜ ÂÈÊ¿ÓÂȘ
ÙˆÓ ¤ÁÎÏÂÈÛÙˆÓ ‰ÔÓÙÈÒÓ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜
Ì¿ÚÙ˘Ú˜. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ÂȂ‚·ÈÒıËÎ·Ó Î·È ·fi
ÙÔ˘˜ Kohavi Î·È Û˘Ó. (1984b), Î·È ÙÔ˘˜ Artun Î·È Û˘Ó.
(1986), ÔÈ ÔÔ›ÔÈ ‚Ú‹Î·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ˙ÒÓË
ÚÔÛÂÊ˘ÎfiÙˆÓ Ô‡ÏˆÓ Î·È ·ÒÏÂÈ· ÚfiÛÊ˘Û˘ ÌÂÙ¿
ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ‰È¢ı¤ÙËÛË ¿Óˆ ΢ÓÔ‰fiÓÙˆÓ Ô˘ ·Ó¤ÙÂÈÏ·Ó ·ÚÂȷο.
∆¯ÓÈ΋ ·Ó·ÙÔÏ‹˜ Ì ÎÏÂÈÛÙfi ÎÚËÌÓfi
™ÙËÓ Ù¯ÓÈ΋ ·˘Ù‹ Á›ÓÂÙ·È ·Ó‡„ˆÛË ÎÚËÌÓÔ‡, Û˘ÁÎfiÏÏËÛË Û˘Ó‰¤ÛÌÔ˘ ÛÙÔ ¤ÁÎÏÂÈÛÙÔ ‰fiÓÙÈ Î·È Â·Ó·Û˘ÚÚ·Ê‹
ÙÔ˘ ÎÚËÌÓÔ‡ ÛÙËÓ ·Ú¯È΋ ÙÔ˘ ı¤ÛË (∂ÈÎ. 3) (Gaulis ηÈ
Joho, 1978; Kokich Î·È Mathews, 1993).
√È Vermette Î·È Û˘Ó. (1995) ·Ú·Ù‹ÚËÛ·Ó fiÙÈ ÙÔ
‡ÚÔ˜ ÙˆÓ ÚÔÛÂÊ˘ÎfiÙˆÓ Ô‡ÏˆÓ ÛÙÔ˘˜ ·ÚÂȷο
¤ÁÎÏÂÈÛÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ÙËÓ
Ù¯ÓÈ΋ ·Ó·ÙÔÏ‹˜ Ì ÎÏÂÈÛÙfi ÎÚËÌÓfi ‹Ù·Ó ÌÂȈ̤ÓÔ ÛÙËÓ
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
AR.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
19
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¢ONTIKH
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™ 1963
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A.B. ME§KO™ Î·È Û˘Ó. ¶ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋
considerably more extensive and often involved
exposure of the entire crown and a small part of the
root in the area of the cemento-enamel junction.
As far as the treatment of labially impacted canines
concerned, it was found that, when compared to nonimpacted contralateral ones, their simple surgical
exposure resulted to damaging effects on the
periodontium (Tegsjö et al., 1984; Boyd, 1984).
Regarding the closed-eruption technique, it was
observed that a reduced width of attached gingiva
and an increased probing bone level of the uncovered
teeth (Vermette et al., 1995), while there have been
also contradictory results (Crescini et al., 1994).
Furthermore, regarding the apically positioned flap
procedure, Vermette et al. (1995) reported significant
damaging effects on the periodontium, although
Tegsjö et al. (1994) found no significant differences on
the periodontal status between impacted canines
treated with this method and the non-treated controls.
Finally, the comparison of the closed-eruption
technique with the apically repositioned flap
technique, Vermette et al. (1995) revealed that teeth
uncovered with the apically repositioned flap
technique presented more un-esthetic sequelae than
those uncovered with the closed-eruption technique
(Vermette et al. 1995).
¿ˆ ÂÈÊ¿ÓÂÈ· Î·È ÙÔ ÔÛÙfi Ù˘ Ê·ÙÓȷ΋˜ ·ÎÚÔÏÔÊ›·˜
‚ÚÈÛÎfiÙ·Ó ÂÚÈÛÛfiÙÂÚÔ ·ÎÚÔÚÚÈ˙Èο ÛÙËÓ ·ÚÂȷ΋
ÙÔ˘˜ ÂÈÊ¿ÓÂÈ· Û ۯ¤ÛË Ì ٷ ‰fiÓÙÈ· ÂϤÁ¯Ô˘. √È
Crescini Î·È Û˘Ó. (1994) ·Ó·Ê¤ÚÔÓÙ·È ÛÙȘ ÂÚÈÔ‰ÔÓÙÈΤ˜ ÂȉڿÛÂȘ Ù˘ ÎÏÂÈÛÙ‹˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜ Ù¯ÓÈ΋˜ ÌÂ
¤ÏÍË ‰È·Ì¤ÛÔ˘ ÙÔ‡ÓÂÏ ÁÈ· ·ÚÂȷο ¤ÁÎÏÂÈÛÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ÌÂÁ¿ÏÔ ‚¿ıÔ˜. ¢ÂÓ ‚ڋηÓ
·ÒÏÂÈ· ÚfiÛÊ˘Û˘ Î·È ˘Ê›˙ËÛË ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÂÓÂÚÁÔ‡ ıÂÚ·›·˜ Î·È ÌÂÙ¿ ·fi ÂÚ›Ô‰Ô ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙÚÈÒÓ ¯ÚfiÓˆÓ. ∂ÈϤÔÓ, ‰ÂÓ ·Ú·ÙËÚ‹ıËηÓ
ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙÔ Â‡ÚÔ˜ ÙˆÓ ÎÂÚ·ÙÈÓÔÔÈË̤ӈÓ
Ô‡ÏˆÓ ÌÂٷ͇ ÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Ô˘ ·ÔηχÊıËÎ·Ó ¯ÂÈÚÔ˘ÚÁÈο Î·È ÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Ù˘ ¿ÏÏ˘ ÏÂ˘Ú¿˜ Ô˘
·Ó¿ÙÂÈÏ·Ó ·˘ÙfiÌ·Ù·.
∆¯ÓÈ΋ ·ÎÚÔÚÚÈ˙Èο ÌÂÙ·ÙÔÈ˙fi
fiÌÌÂÓÔ˘ ÎÚËÌÓÔ‡
™‡Ìʈӷ Ì ÙËÓ Ù¯ÓÈ΋ ·˘Ù‹, Á›ÓÂÙ·È ·Ó‡„ˆÛË ÎÚËÌÓÔ‡ ÌÂÚÈÎÔ‡ ¿¯Ô˘˜ Î·È ÚÔÛÂÎÙÈ΋ ·fiÍÂÛË ÙÔ˘
ÙÚ·‡Ì·ÙÔ˜ ¤ÙÛÈ ÒÛÙ ӷ ·Ê·ÈÚÂı› Ô Ô‰ÔÓÙÈÎfi˜ Û¿ÎÔ˜
Î·È Ó· ·ÔÎ·Ï˘Êı› ÙÔ ‰fiÓÙÈ. ¢ÂÓ ··ÈÙÂ›Ù·È ·Ê·›ÚÂÛË ÔÛÙÔ‡, ÂÎÙfi˜ Î·È ·Ó ·˘Ùfi Â›Ó·È ··Ú·›ÙËÙÔ ÁÈ· Ó·
ÚÔÛÂÁÁÈÛÙ› Ë Ì‡ÏË ÙÔ˘ ΢Ófi‰ÔÓÙ·. ∏ ÚÔÛ¤Ï·ÛË
Ù˘ ̇Ï˘ Ú¤ÂÈ Ó· ÂÎÙÂÏÂÛÙ› fiÛÔ ÈÔ Û˘ÓÙËÚËÙÈο
Á›ÓÂÙ·È Î·È fi¯È ¤Ú·Ó Ù˘ ÔÛÙÂ˚ÓÔ-·‰·Ì·ÓÙÈÓÈ΋˜ ¤ÓˆÛ˘. √ ÎÚËÌÓfi˜ Â·Ó·Û˘ÚÚ¿ÙÂÙ·È ·ÎÚÔÚÚÈ˙Èο ÌÂ
‰È·ÎÂÎÔÌ̤ӷ ÂÚÈÔÛÙÈο Ú¿ÌÌ·Ù· Î·È ÙÔÔıÂÙ›ٷÈ
ÛÙËÓ ÂÚÈÔ¯‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ÎÔÓ›· ÁÈ· 7-10 ̤Ú˜
(Theofanatos Î·È Û˘Ó., 1994). ™‡Ìʈӷ Ì ÙÔÓ
Becker (1998), Ë ·Ó·ÙÔÏ‹ ÙÔ˘ ‰ÔÓÙÈÔ‡ ÂÈÙ·¯‡ÓÂÙ·È
Ì ÙËÓ Ù¯ÓÈ΋ ·˘Ù‹. ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ ‰ÂÓ Û˘ÓÈÛٿٷÈ
Û ÂÚ›ÙˆÛË Ô˘ ÙÔ ¤ÁÎÏÂÈÛÙÔ ‰fiÓÙÈ ‚Ú›ÛÎÂÙ·È Ôχ
„ËÏ¿, ÂÊfiÛÔÓ Ô ·ÎÚÔÚÚÈ˙Èο Â·Ó·ÙÔÔıÂÙÔ‡ÌÂÓÔ˜
ÎÚËÌÓfi˜ ı· ·Ê‹ÛÂÈ Â˘Ú›· ÂÚÈÔ¯‹ ÙÔ˘ ·ÚÂÈ·ÎÔ‡
ÔÛÙÈÎÔ‡ ÂÙ¿ÏÔ˘ ÂÎÙÂıÂÈ̤ÓË ÛÙÔ ÛÙÔÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ ¯ˆÚ›˜ ÏfiÁÔ. ∂Ó ÙÔ‡ÙÔȘ, ÛËÌ·ÓÙÈÎfi ÏÂÔÓ¤ÎÙËÌ·
Ù˘ ÌÂıfi‰Ô˘ ·ÔÙÂÏ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ·ÚÂȷο
¤ÁÎÏÂÈÛÙÔ˜ ΢Ófi‰ÔÓÙ·˜ ·Ú·Ì¤ÓÂÈ ÚÔÛÂÏ¿ÛÈÌÔ˜
ÁÈ· Û˘ÁÎfiÏÏËÛË ÔÚıÔ‰ÔÓÙÈÎÔ‡ Û˘Ó‰¤ÛÌÔ˘ Û ‰Â‡ÙÂÚÔ ¯ÚfiÓÔ, ÂÊfiÛÔÓ Ô ÔÚıÔ‰ÔÓÙÈÎfi˜ ·ÔÊ·Û›ÛÂÈ Ó·
οÓÂÈ ÂÓÂÚÁfi ˘ÂÚ¤ÎÊ˘ÛË ÙÔ˘ ‰ÔÓÙÈÔ‡.
™¯ÂÙÈο Ì ÙËÓ ÂÚÈÔ‰ÔÓÙÈ΋ ηٿÛÙ·ÛË ÌÂÙ¿ ·fi
ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜ ·˘Ù‹˜, ÔÈ Vermette Î·È Û˘Ó.
(1995) ‚Ú‹Î·Ó fiÙÈ ÙÔ Ô˘ÏÈÎfi fiÚÈÔ ·ÚÂȷο ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ·˘Ù‹ ÙË
̤ıÔ‰Ô ‚ÚÈÛÎfiÙ·Ó ·ÎÚÔÚÚÈ˙ÈÎfiÙÂÚ· ÛÙËÓ ÂÁÁ‡˜ ηÈ
·ÚÂȷ΋ ÂÈÊ¿ÓÂÈ·, Î·È ˘‹Ú¯Â ÌÂÁ·Ï‡ÙÂÚË ÔÛÙÈ΋
·ÒÏÂÈ· ÛÙȘ fiÌÔÚ˜ Î·È ÛÙËÓ ·ÚÂȷ΋ ÂÈÊ¿ÓÂÈ· ÛÂ
Û¯¤ÛË Ì ٷ ‰fiÓÙÈ· ÂϤÁ¯Ô˘. ∞ÓÙ›ıÂÙ· ÔÈ Tegsjö ηÈ
Û˘Ó. (1984) ‰ÂÓ ·Ú·Ù‹ÚËÛ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜
ÛÙËÓ ÂÚÈÔ‰ÔÓÙÈ΋ ηٿÛÙ·ÛË ÌÂٷ͇ ıÂÚ·Â˘Ì¤ÓˆÓ
Î·È ÌË ‰ÔÓÙÈÒÓ (¶›Ó·Î·˜ 2).
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
CONCLUSIONS
Purpose of orthodontic treatment should not only be to
correct a malocclusion but to correct it with minimal
side effects to the teeth and their supporting tissues.
When alternative treatment procedures are discussed,
it is important to be able to select that kind of treatment
which causes the least damage.
Although the opinions of the researchers are at some
degree controversial, it can be concluded that, both
palatally and labially impacted canines are almost
always affected, not-depending from the surgical or
orthodontic procedures used. However, it seems that
less periodontal affection should anticipated when
orthodontic forces are applied after performing closedsurgical exposure techniques, which involve raising of
a surgical flap, bonding of an attachment and finally
resuturing of the flap to its original position.
REFERENCES
Artun J, Osterberg SK, Joondeph DR. Long-term
periodontal status of labially erupted canines
following orthodontic treatment. J Clin Periodontol
1986;13:856-61.
Azaz B, Steiman Z, Koyoumdjisky-Kaye E, LewinEpstein J. The sequelae of surgical exposure of
20
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A
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A.B. ME§KO™ Î·È Û˘Ó. ¶ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
¶›Ó·Î·˜ 2. ™‡ÁÎÚÈÛË Ù˘ ÂÚÈÔ‰ÔÓÙÈ΋˜ ηٿÛÙ·Û˘ ·ÚÂȷο ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ ÌÂÙ¿ ·fi ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·
(CEJ: ÔÛÙÂ˚ÓÔ-·‰·Ì·ÓÙÈÓÈ΋ ¤ÓˆÛË [√∞∂], NS: ÌË ÛËÌ·ÓÙÈÎfi).
Table 2. Comparisons of the periodontal status of labially impacted canines following surgical and orthodontic treatment (CEJ: Cementoenamel junction, NS: non-significant).
T¯ÓÈ΋ ·Ó·ÙÔÏ‹˜ Ì ÎÏÂÈÛÙfi ÎÚËÌÓfi
Closed eruption technique
™˘ÁÁÚ·Ê›˜
Authors
Vermette et al.
(1995)
MÂÙÚ‹ÛÂȘ
Measurements
EÈÊ¿ÓÂÈ·
Surface
¢fifiÓÓÙÈ·
˘fi ÂͤٷÛË
Experimental
teeth
–x
s.d.
¢fifiÓÓÙÈ·
ÂϤÁ¯Ô˘
P-value
Control
teeth
–x
s.d.
¢fifiÓÓÙÈ·
˘fi ÂͤٷÛË
Experimental
teeth
–x
s.d.
¢fifiÓÓÙÈ·
ÂϤÁ¯Ô˘
Control
teeth
–x
s.d.
P-value
E‡ÚÔ˜ ÚÔÛÂÊ˘ÎfiÙˆÓ
ÂÁÁ‡˜/mesial
ԇψÓ
ÚfiÛıÈ·/facial
Width of attached
¿ˆ/distal
gingiva
4,3
2,2
3,5
2,14
0,89
1,49
4,6
2,0
4,2
1,48 NS
1,18 NS
1,33 p<0,05
5,6
3,5
3,9
2,78
2,08
2,08
4,7
1,9
3,8
1,48
0,68
1,60
NS
p<0,01
NS
O˘ÏÈÎfi fiÚÈÔ
Gingival margin
ÂÁÁ‡˜/mesial
ÚfiÛıÈ·/facial
¿ˆ/distal
2,3
0,9
2,3
0,78
1,12
0,63
2,3
1,3
2,4
0,62
0,75
0,63
2,1
0,6
2,3
0,67
1,04
0,69
2,4
1,3
2,4
0,61
0,69
0,62
p<0,00
1
p<0,00
NS
MÂÙÚÔ‡ÌÂÓÔ Â›‰Ô
ÙÔ˘ Ê·ÙÓ·ÈÎÔ‡ ÔÛÙÔ‡
Probing bone level
ÂÁÁ‡˜/mesial
ÚfiÛıÈ·/facial
¿ˆ/distal
1,7
2,1
1,8
0,49
0,79
0,45
1,8
1,6
1,6
0,45 NS
0,51 p<0,05
0,51 NS
2,3
2,4
2,2
0,57
0,98
0,62
1,8
1,6
1,7
0,71
0,61
0,57
p<0,01
p<0,01
p<0,01
NS
NS
NS
AÏ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë
Simple surgical exposure technique
E‡ÚÔ˜ ÚÔÛÂÊ˘ÎfiÙˆÓ
ԇψÓ
Width of attached
gingiva
Tegsjö et al.
(1984)
T¯ÓÈ΋ ·ÎÚÔÚÚÈ˙Èο ÌÂÙ·ÙÔÈ˙fifiÌÌÂÓÔ˘ ÎÚËÌÓÔ‡
Apically positioned flap technique
¯ÂÈÏÈ΋/labial
B¿ıÔ˜ Ô˘ÏÔ‰ÔÓÙÈ΋˜ ¯ÂÈÏÈ΋/labial
ÂÁÁ‡˜/mesial
Û¯ÈÛÌ‹˜
˘ÂÚÒÈ·/palatal
Sulcus depth
¿ˆ/distal
AfiÛÙ·ÛË ÛÂ mm
Ù˘ OAE ·fi ÙÔ
Ô˘ÏÈÎfi fiÚÈÔ
Distance in mm
from CEJ to
gingival margin
¯ÂÈÏÈ΋/labial
2,6
1,4
4,1
1,5 p<0,01
4,3
1,8
3,9
1,5
NS
1,2
2,4
2,1
2,6
0,4
0,6
0,5
0,6
1,6
1,9
1,9
2,0
0,6
0,6
0,5 p<0,01
0,6
1,4
2,1
2,0
2,2
0,4
0,5
0,5
0,6
1,6
2,2
2,0
2,1
0,4
0,7
0,5
0,6
NS
-0,5
1,0
-1,5
0,8 p<0,01
-0,9
1,2
-1,1
0,9
NS
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™YZHTH™H
∏ ÂÚÈÔ‰ÔÓÙÈ΋ ·ÍÈÔÏfiÁËÛË Â›Ó·È ÛËÌ·ÓÙÈ΋ ÁÈ· ÙÔÓ
·ÛıÂÓ‹ ÚÈÓ ·fi Û˘Ó‰˘·Ṳ̂ÓË ¯ÂÈÚÔ˘ÚÁÈ΋/ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·. ∆· ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· ÌÔÚ›
ÔÏϤ˜ ÊÔÚ¤˜ Ó· ÚÔ‚ÏÂÊıÔ‡Ó Ì ÚÔÛÂÎÙÈÎfi ۯ‰ȷÛÌfi ÙÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡ Î·È Î·Ù¿ÏÏËÏÔ ¤ÏÂÁ¯Ô Ù˘ ÛÙÔÌ·ÙÈ΋˜ ˘ÁÈÂÈÓ‹˜.
™¯ÂÙÈο Ì ÙÔ˘˜ ˘ÂÚÒÈ· ¤ÁÎÏÂÈÛÙÔ˘˜ ΢Ófi‰ÔÓÙ˜, Ë ¯ÂÈE§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
T¯ÓÈ΋ ·ÎÚÔÚÚÈ˙Èο ÌÂÙ·ÙÔÈ˙fifiÌÌÂÓÔ˘ ÎÚËÌÓÔ‡
Apically positioned flap technique
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Kohavi D, Becker A, Zilberman Y. Surgical exposure,
orthodontic movement , and final tooth position as
ÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„Ë Î·È ‰È¢ı¤ÙËÛ‹ ÙÔ˘˜ (·ÓÔȯً ¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋) ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·ÒÏÂÈ· ÚfiÛÊ˘Û˘ ÛÙËÓ ·ÚÂȷ΋ Î·È ˘ÂÚÒÈ· ÂÈÊ¿ÓÂÈ· Û˘ÁÎÚÈÙÈο Ì ٷ ‰fiÓÙÈ· ÂϤÁ¯Ô˘ Ô˘ ·Ó·Ù¤ÏÏÔ˘Ó ¯ˆÚ›˜ ˘Ô‚Ô‹ıËÛË (Wisth Î·È Û˘Ó., 1976a;
Zachrisson Î·È Alnaes, 1974). ™‡Ìʈӷ Ì ÙÔÓ Becker
(1998), Ë Ì¤ıÔ‰Ô˜ ·˘Ù‹ ‰ËÌÈÔ˘ÚÁ› ÛÙÔ ‰fiÓÙÈ ¤ÏÏÂÈÌÌ· Ì·Ï·ÎÒÓ ÈÛÙÒÓ Î·È ÌÂÁ¿ÏË ÎÏÈÓÈ΋ ̇ÏË, ȉȷ›ÙÂÚ·
fiÙ·Ó ÙÔ ‰fiÓÙÈ ‚Ú›ÛÎÂÙ·È Û ÌÂÁ¿ÏÔ ‚¿ıÔ˜ ÛÙÔÓ ˘ÂÚÒÈÔ ‚ÏÂÓÓÔÁfiÓÔ.
¶ÂÚÈÔ‰ÔÓÙÈΤ˜ Û˘Ó¤ÂȘ ÌÔÚ› Ó· ˘¿ÚÍÔ˘Ó Î·È ÌÂ
ÙËÓ ÎÏÂÈÛÙ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋. √È Woloshyn Î·È Û˘Ó.
(1994) ·Ú·Ù‹ÚËÛ·Ó ·‡ÍËÛË ÙÔ˘ ÌÂÙÚÔ‡ÌÂÓÔ˘ ÂÈ¤‰Ô˘ ÚfiÛÊ˘Û˘, ÂÓÒ ÙÔ ‡„Ô˜ ÙÔ˘ ÔÛÙÔ‡ Ù˘ Ê·ÙÓȷ΋˜
·ÎÚÔÏÔÊ›·˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂȈ̤ÓÔ ÛÙÔ˘˜ ¤ÁÎÏÂÈÛÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ·˘Ù‹ ÙË
̤ıÔ‰Ô. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ Û˘ÌʈÓÔ‡Ó Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙˆÓ Becker Î·È Û˘Ó. (1983), ÔÈ ÔÔ›ÔÈ ÌÂϤÙËÛ·Ó
23 ·ÛıÂÓ›˜ Ì ÂÙÂÚfiÏ¢ÚË ·ÚÂȷ΋ ¤ÁÎÏÂÈÛË ¿Óˆ
΢Ófi‰ÔÓÙ·. ∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, ÔÈ Crescini Î·È Û˘Ó.
(1994) ‰ÂÓ ‚Ú‹Î·Ó ·ÒÏÂÈ· ÚfiÛÊ˘Û˘, ˘Ê›˙ËÛË ‹
ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙÔ Â‡ÚÔ˜ ÙÔ˘ ÎÂÚ·ÙÈÓÔÔÈË̤ÓÔ˘
ÈÛÙÔ‡ ηٿ ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÔÎÙÒ ÂÚÈÙÒÛˆÓ
ÂÁÎÏ›ÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ÙËÓ
Ù¯ÓÈ΋ ·˘Ù‹ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ ÂϤÁ¯Ô˘
Ù˘ ¿ÏÏ˘ ÏÂ˘Ú¿˜ Ô˘ ·Ó¤ÙÂÈÏ·Ó ¯ˆÚ›˜ ˘Ô‚Ô‹ıËÛË.
∫·Ï‹ Ô˘ÏÈ΋ Î·È ÂÚÈÔ‰ÔÓÙÈ΋ ηٿÛÙ·ÛË Ì ÌÈÎÚ¤˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ¯ÂÈÚÔ˘ÚÁËÌ¤ÓˆÓ Î·È ÌË Ï¢ÚÒÓ ·Ó·Ê¤ÚÔ˘Ó Î·È ÔÈ Hansson Î·È Rindler (1998) Û ÌÂϤÙË
·Ú·ÎÔÏÔ‡ıËÛ˘ 1 ¤ˆ˜ 18 ¯ÚfiÓÈ· ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘
ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ ÂÙÂÚfiÏÂ˘ÚˆÓ ˘ÂÚÒÈ·
¤ÁÎÏÂÈÛÙˆÓ ¿Óˆ ΢ÓÔ‰fiÓÙˆÓ, ·ÚfiÏÔ Ô˘ ηٷÁÚ¿ÊËÎÂ
·˘ÍË̤ÓÔ ‚¿ıÔ˜ ı˘Ï¿ÎÔ˘ Î·È ¯·ÌËÏfiÙÂÚÔ Â›‰Ô
ÔÛÙÔ‡ Ù˘ Ê·ÙÓȷ΋˜ ·ÎÚÔÏÔÊ›·˜. √È Caminiti ηÈ
Û˘Ó. (1998) ·Ó·Ê¤ÚÔ˘Ó ·Ô˘Û›· ÊÏÂÁÌÔÓ‹˜ ÙˆÓ
Ô‡ÏˆÓ Î·È ˘Ê›˙ËÛ˘ ÌÂÙ¿ ·fi ˘Ô‚ÔËıÔ‡ÌÂÓË ·Ó·ÙÔÏ‹
60 ˘ÂÚÒÈ· ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ÙËÓ ÎÏÂÈÛÙ‹ Ù¯ÓÈ΋.
™˘ÁÎÚ›ÓÔÓÙ·˜ ÙËÓ ·ÓÔȯً Î·È ÎÏÂÈÛÙ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋ ·ÔÎ¿Ï˘„˘ ÙˆÓ ¤ÁÎÏÂÈÛÙˆÓ ‰ÔÓÙÈÒÓ, ‚Ú¤ıËΠfiÙÈ Ë
·ÓÔȯً Ù¯ÓÈ΋ ÚÔηÏ› ÌÂÁ·Ï‡ÙÂÚË ÂÚÈÔ‰ÔÓÙÈ΋ ηٷÛÙÚÔÊ‹ (·ÒÏÂÈ· ÚfiÛÊ˘Û˘ Î·È ‡„Ô˘˜ ÌÂÛÔ‰fiÓÙÈÔ˘
ÔÛÙÔ‡) ·fi ÙËÓ ÎÏÂÈÛÙ‹ ̤ıÔ‰Ô, ·ÚfiÏÔ Ô˘ ÔÈ Ì¤Û˜
‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙÔ˘˜ ‹Ù·Ó ÌÈÎÚ¤˜ (Wisth Î·È Û˘Ó.,
1976b). ∂ÈϤÔÓ, ÔÈ Kohavi Î·È Û˘Ó. (1984a) Â·ÓÂÈÏËÌ̤ӈ˜ ‚Ú‹Î·Ó ÛËÌ·ÓÙÈ΋ ·ÒÏÂÈ· ‡„Ô˘˜ Ê·ÙÓÈ·ÎÔ‡
ÔÛÙÔ‡ ÛÙËÓ ÂÁÁ‡˜ fiÌÔÚË ÂÈÊ¿ÓÂÈ· ÙÔ˘ ·ÔÎ·Ï˘Ì̤ÓÔ˘
‰ÔÓÙÈÔ‡. ∏ ÔÛÙÈ΋, ‰Â, ·ÒÏÂÈ· ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË fiÙ·Ó Ë
·Ê·›ÚÂÛË ÈÛÙÒÓ ÁÈ· ·ÔÎ¿Ï˘„Ë ÙÔ˘ ‰ÔÓÙÈÔ‡ ÂÎÙÂÈÓfiÙ·Ó
¤Ú·Ó Ù˘ ÔÛÙÂ˚ÓÔ-·‰·Ì·ÓÙÈÓÈ΋˜ ¤ÓˆÛ˘. ™‡Ìʈӷ ÌÂ
ÙÔÓ Becker (1998), Ë ÎÏÂÈÛÙ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋ ıˆE§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
22
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¢ONTIKH
£O
ET
OP
E§
™ 1963
¢O
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A
PEI
AI
A.B. ME§KO™ Î·È Û˘Ó. ¶ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋
factors in periodontal breakdown of treated
palatally impacted canines. Am J Orthod
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Kohavi D, Zilberman Y, Becker A. Periodontal status
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Kokich VG, Mathews DP. Surgical and orthodontic
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Lappin MM. Practical management of the impacted
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Lewis PD. Preorthodontic surgery in the treatment of
impacted canines. Am J Orthod 1971;60:383-97.
Maloney FM. The palatally impacted cuspid tooth: a
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McSherry PF. The assessment of and treatment options
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McSherry PF. The ectopic canine: A Review. Br J
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Odenrick L, Modeer T. Periodontal status following
surgical-orthodontic alignment of impacted teeth.
Acta Odontol Scand 1978;36:233-6.
Papadopoulos MA, Ioannidou-Marathiotou I, Gianniou
E, Kolokithas G. Impacted teeth in a Greek
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Pearson MH, Robinson SN, Reed R, Birnie DJ, Zaki
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Sayne S, Lennartson B, Thilander B. Transalveolar
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Shapira Y, Kuftinec M. Treatment of impacted cuspids
the hazard lasso. Angle Orthod 1981;51:203-7.
Shaw B, Schneider SS, Zeyer J. Surgical management
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Assoc 1981;102:497-500.
Shiloah J, Kopezyk RA. Mucogingival considerations in
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Tegsjö U, Valerius-Olsson H, Anderson L. Periodontal
conditions following surgical exposure of unerupted
maxillary canines-a long term follow-up study of two
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Theofanatos GD, Zavras AI, Turner IM. Periodontal
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Vanarsdall RL, Corn H. Soft tissue management of
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Vermette ME, Kokich VG, Kennedy DB. Uncovering
labially impacted teeth: apically positioned flap and
ÚÂ›Ù·È Ë Î·Ï‡ÙÂÚË ‰ÈfiÙÈ ÙÔ ‰fiÓÙÈ ·ÔηχÙÂÙ·È Ì ÙËÓ
ÂÏ¿¯ÈÛÙË ‰˘Ó·Ù‹ ·Ê·›ÚÂÛË ÈÛÙÒÓ Î·È, ηٿ Û˘Ó¤ÂÈ·, ÌÂ
ÂÏ¿¯ÈÛÙÔ ¯ÂÈÚÔ˘ÚÁÈÎfi ÙÚ·‡Ì·, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ ηٿÏÏËÏ· ÔÚıÔ‰ÔÓÙÈο ÂÌ‚ÈÔÌ˯·ÓÈο
Û˘ÛÙ‹Ì·Ù· ·Ú¤¯ÂÈ ˘ÁÈ›˜ Ô˘ÏÔ‚ÏÂÓÓÔÁfiÓÈÔ˘˜ ÈÛÙÔ‡˜
Î·È ÙËÓ Î·Ï‡ÙÂÚË ‰˘Ó·Ù‹ ÔÛÙÈ΋ ÛÙ‹ÚÈÍË. ∏ ÂÈÛÙËÌÔÓÈ΋ ‚¿ÛË Ù˘ ¿Ԅ˘ ÙÔ˘ Becker ¤ÁÎÂÈÙ·È ÛÙËÓ ÎÏÈÓÈ΋ Û‡ÁÎÚÈÛË ‰È·ÊfiÚˆÓ ÌÂıfi‰ˆÓ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·ÔÎ¿Ï˘„˘ (Heaney Î·È Atherton, 1976; Wisth ηÈ
Û˘Ó., 1976a; Odenrick Î·È Modeer, 1978; Boyd,
1982; Becker Î·È Û˘Ó., 1983; Kohavi Î·È Û˘Ó.,
1984a; Crescini Î·È Û˘Ó., 1994; Vermette Î·È Û˘Ó.,
1995).
√ Boyd (1982), ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Ù¯ÓÈ΋ ‰‡Ô ÛÙ·‰›ˆÓ Î·È ¿ÌÂÛË Û˘ÁÎfiÏÏËÛË Û ÔÌ¿‰· ÌÂϤÙ˘ 20
·ÛıÂÓÒÓ Ì ¤Ó·Ó ˘ÂÚÒÈ· ¤ÁÎÏÂÈÛÙÔ ¿Óˆ ΢Ófi‰ÔÓÙ·
Î·È ¤Ó·Ó ÌË ¤ÁÎÏÂÈÛÙÔ, ‰ÂÓ ‚ڋΠÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙȘ ̤Û˜ ÙÈ̤˜ Ù˘ ·ÒÏÂÈ·˜ ÚfiÛÊ˘Û˘ ÛÂ
ηӤӷ ·fi Ù· ¤ÍÈ ÛËÌ›· οı ‰ÔÓÙÈÔ‡ fiÔ˘ ¤ÁÈÓ·Ó
ÌÂÙÚ‹ÛÂȘ ÌÂٷ͇ ıÂÚ·Â˘Ì¤ÓˆÓ Î·È ÌË Î˘ÓÔ‰fiÓÙˆÓ.
∞ÓÙ›ıÂÙ·, ÛÙÔ˘˜ ¤ÁÎÏÂÈÛÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ fiÔ˘ ¤ÁÈÓÂ
ÚfiÛ‰ÂÛË Ì ۇÚÌ·, ‚Ú¤ıËΠÛËÌ·ÓÙÈ΋ ·ÒÏÂÈ·
ÚfiÛÊ˘Û˘ ÛÙȘ fiÌÔÚ˜ Î·È ÙËÓ ÁψÛÛÈ΋ ÂÈÊ¿ÓÂÈ·
Û ۯ¤ÛË Ì ٷ ÌË ¤ÁÎÏÂÈÛÙ· ‰fiÓÙÈ·. ∆· ‰Â‰Ô̤ӷ
·˘Ù¿ Èı·ÓÒ˜ ÂËÚ¿ÛÙËÎ·Ó ·fi ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ‰È·‰Èηۛ· Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÒÛÙ ӷ ‰ËÌÈÔ˘ÚÁËı›
ÚfiÛ‚·ÛË ÁÈ· ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ Û‡ÚÌ·ÙÔ˜ ÚfiÛ‰ÂÛ˘. ∏ ‰È·‰Èηۛ· ·˘Ù‹ ‹Ù·Ó Ôχ ÈÔ ÂÎÙÂٷ̤ÓË Î·È
·ÊÔÚÔ‡ÛÂ Û˘¯Ó¿ ·ÔÎ¿Ï˘„Ë fiÏ˘ Ù˘ ̇Ï˘ ηÈ
ÌÈÎÚÔ‡ ÙÌ‹Ì·ÙÔ˜ Ù˘ Ú›˙·˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÔÛÙÂ˚ÓÔ·‰·Ì·ÓÙÈÓÈ΋˜ ¤ÓˆÛ˘.
™¯ÂÙÈο Ì ÙË ıÂÚ·›· ÙˆÓ ·ÚÂȷο ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ ÌË ¤ÁÎÏÂÈÛÙÔ˘˜, ‚Ú¤ıËΠfiÙÈ Ë ·Ï‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔÎ¿Ï˘„‹
ÙÔ˘˜ ›¯Â ‚Ï·ÙÈΤ˜ ÂȉڿÛÂȘ ÛÙÔ ÂÚÈÔ‰fiÓÙÈÔ (Tegsjö
Î·È Û˘Ó., 1984; Boyd, 1984). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ
Ù¯ÓÈ΋ ÎÏÂÈÛÙ‹˜ ·Ó·ÙÔÏ‹˜, ·Ú·ÙËÚ‹ıËΠÌÂȈ̤ÓÔ
‡ÚÔ˜ ÚÔÛÂÊ˘ÎfiÙˆÓ Ô‡ÏˆÓ Î·È ·˘ÍË̤ÓÔ ÌÂÙÚÔ‡ÌÂÓÔ
Â›Â‰Ô ÙÔ˘ Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡ ÛÙ· ‰fiÓÙÈ· Ô˘ ·ÔηχÊıËÎ·Ó (Vermette Î·È Û˘Ó., 1995), ÂÓÒ ˘¿Ú¯Ô˘Ó ηÈ
·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤÛÌ·Ù· (Crescini Î·È Û˘Ó.,
1994). ∂ÈϤÔÓ, Û¯ÂÙÈο Ì ÙÔÓ ·ÎÚÔÚÚÈ˙Èο ÌÂÙ·ÙÔÈ˙fiÌÂÓÔ ÎÚËÌÓfi, ÔÈ Vermette Î·È Û˘Ó. (1995) ·Ó·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈΤ˜ ‚Ï·ÙÈΤ˜ ÂȉڿÛÂȘ ÛÙÔ ÂÚÈÔ‰fiÓÙÈÔ, ·ÚfiÏÔ Ô˘ ÔÈ Tegsjö Î·È Û˘Ó. (1994) ‰ÂÓ ‚Ú‹Î·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ ÂÚÈÔ‰ÔÓÙÈ΋ ηٿÛÙ·ÛË
ÌÂٷ͇ ¤ÁÎÏÂÈÛÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÌÂ
·˘Ù‹ ÙË Ì¤ıÔ‰Ô Î·È ‰ÔÓÙÈÒÓ ÂϤÁ¯Ô˘.
∆¤ÏÔ˜, Û‡ÁÎÚÈÛË Ù˘ Ù¯ÓÈ΋˜ ÎÏÂÈÛÙ‹˜ ·Ó·ÙÔÏ‹˜ Ì ÙË
̤ıÔ‰Ô ÙÔ˘ ·ÎÚÔÚÚÈ˙Èο ÌÂÙ·ÙÔÈ˙fiÌÂÓÔ˘ ÎÚËÌÓÔ‡ ·fi
ÙÔ˘˜ Vermette Î·È Û˘Ó. (1995), ·ÔÎ¿Ï˘„ fiÙÈ ‰fiÓÙÈ· Ô˘
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
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™ 1963
¢O
§A
A
PEI
AI
A.B. ME§KO™ Î·È Û˘Ó. ¶ÂÚÈÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È ÔÚıÔ‰ÔÓÙÈ΋
A.B. MELKOS et al. Periodontal aspects associated with the surgical and orthodontic treatment
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Wisth PJ, Norderval K, Boe OE. Comparison of two
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Wisth PJ, Norderval K, Boe OE. Periodontal status of
orthodontically treated impacted maxillary canines.
Angle Orthod 1976a;46:69-76.
Wolf JE, Matilla K. Localisation of impacted maxillary
canines
by
panoramic
tomography.
Dentomaxillofac Radiol 1979;8:85-91.
Woloshyn H, Artun J, Kennedy DB, Joondeph DR.
Pulpal and periodontal reactions to orthodontic
alignement of palatally impacted canines. Angle
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Zachrisson BU, Alnaes L. Periodontal condition in
orthodontically treated and untreated individuals. II.
Alveolar bone loss: Radiographic findings. Angle
Orthod 1974;44:48-55.
·ÔηχÊıËÎ·Ó Ì ÙËÓ Ù¯ÓÈ΋ ÙÔ˘ ·ÎÚÔÚÚÈ˙Èο ÌÂÙ·ÙÔÈ˙fiÌÂÓÔ˘ ÎÚËÌÓÔ‡ ·ÚÔ˘Û›·Û·Ó ÌÂÁ·Ï‡ÙÂÚ˜ ·ÈÛıËÙÈΤ˜
ÂÈÙÒÛÂȘ Û ۯ¤ÛË Ì ·˘Ù¿ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ÙËÓ
Ù¯ÓÈ΋ ÎÏÂÈÛÙ‹˜ ·Ó·ÙÔÏ‹˜ (Vermette Î·È Û˘Ó., 1995).
™YM¶EPA™MATA
™ÎÔfi˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ ‰ÂÓ Ú¤ÂÈ Ó·
Â›Ó·È ÌfiÓÔ Ë ‰ÈfiÚıˆÛË Ù˘ Û˘ÁÎÏÂÈÛȷ΋˜ ‰È·Ù·Ú·¯‹˜,
·ÏÏ¿ Ë ‰ÈfiÚıˆÛË ·˘Ù‹ Ó· Á›ÓÂÙ·È Ì ÙȘ ÂÏ¿¯ÈÛÙ˜ ‰˘Ó·Ù¤˜ ·ÓÂÈı‡ÌËÙ˜ ·ÓÙȉڿÛÂȘ ·fi Ù· ‰fiÓÙÈ· Î·È ÙÔ˘˜
˘ÔÛÙËÚÈÎÙÈÎÔ‡˜ ÈÛÙÔ‡˜. ∫·Ù¿ ÙË Û˘˙‹ÙËÛË ÂÓ·ÏÏ·ÎÙÈÎÒÓ
ıÂÚ·¢ÙÈÎÒÓ ‰È·‰ÈηÛÈÒÓ, Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ÌÔÚ›
ηÓ›˜ Ó· ÂÈϤÍÂÈ ÙÔ Â›‰Ô˜ ÂΛÓÔ Ù˘ ıÂÚ·›·˜ Ô˘
ÚÔηÏ› ÙËÓ ÂÏ¿¯ÈÛÙË ‚Ï¿‚Ë.
¶·Ú¿ ÙȘ ˆ˜ ¤Ó· ‚·ıÌfi ·ÓÙÈÊ·ÙÈΤ˜ ÁÓÒ̘ ÙˆÓ ÂÚ¢ÓËÙÒÓ, ÌÔÚ› ηÓ›˜ Ó· Û˘ÌÂÚ¿ÓÂÈ fiÙÈ ÂËÚ¿˙ÔÓÙ·È
ۯ‰fiÓ ¿ÓÙ· ÙfiÛÔ ÔÈ ·ÚÂȷο fiÛÔ Î·È ÔÈ ˘ÂÚÒÈ·
¤ÁÎÏÂÈÛÙÔÈ Î˘Ófi‰ÔÓÙ˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙȘ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ‹ ÙȘ ÔÚıÔ‰ÔÓÙÈΤ˜ ‰È·‰Èηۛ˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È. ∂Ó ÙÔ‡ÙÔȘ, Ê·›ÓÂÙ·È fiÙÈ ·Ó·Ì¤ÓÂÙ·È ÌÈÎÚfiÙÂÚË
ÂÚÈÔ‰ÔÓÙÈ΋ Â›‰Ú·ÛË fiÙ·Ó ÔÈ ÔÚıÔ‰ÔÓÙÈΤ˜ ‰˘Ó¿ÌÂȘ
ÂÊ·ÚÌfi˙ÔÓÙ·È ÌÂÙ¿ ·fi ÎÏÂÈÛÙ¤˜ Ù¯ÓÈΤ˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜
·ÔÎ¿Ï˘„˘ ηٿ ÙȘ Ôԛ˜ Á›ÓÂÙ·È ·Ó‡„ˆÛË ÎÚËÌÓÔ‡,
Û˘ÁÎfiÏÏËÛË Û˘Ó‰¤ÛÌÔ˘ Î·È Â·Ó·Û˘ÚÚ·Ê‹ ÙÔ˘ ÎÚËÌÓÔ‡ ÛÙËÓ ·Ú¯È΋ ÙÔ˘ ı¤ÛË.
Reprint requests to:
Moschos A. Papadopoulos
Assistant Professor
Department of Orthodontics
School of Dentistry
Aristotle University of Thessaloniki
GR-54124 Thessaloniki
Greece
E-mail: [email protected]
¢È‡ı˘ÓÛË ÁÈ· ·Ó¿Ù˘·:
ªfiÛ¯Ô˜ ∞. ¶··‰fiÔ˘ÏÔ˜
∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜
∂ÚÁ·ÛÙ‹ÚÈÔ √ÚıÔ‰ÔÓÙÈ΋˜
∆Ì‹Ì· √‰ÔÓÙÈ·ÙÚÈ΋˜
∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢
54124 £ÂÛÛ·ÏÔÓ›ÎË
E-mail: [email protected]
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2004 ñ TOMO™ 7
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HELLENIC ORTHODONTIC REVIEW 2004 ñ VOLUME 7