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ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο TPIMHNIAIA EK¢O™H E§§HNIKH™ O¢ONTIATPIKH™ OMO™¶ON¢IA™ TOMO™ 59 IANOYAPIO™ - ¢EKEMBPIO™ 2015 hellenic stomatological review HELLENIC DENTAL ASSOCIATION VOLUME 59, ISSUE 1-4, JANUARY - DECEMBER 2015 ISSN 1011 - 4181 E¶I™THMONIKO ENTY¶O ME E£NIKH ANA°NøPI™H ºEK 431/2 Ù˘ 5 AÚÈÏ›Ô˘ 2005 T· E™X ‚Ú›ÛÎÔÓÙ·È Î·Ù·¯ˆÚË̤ӷ ÛÙÔÓ EıÓÈÎfi ™˘ÏÏÔÁÈÎfi K·Ù¿ÏÔÁÔ EÈÛÙËÌÔÓÈÎÒÓ ¶ÂÚÈÔ‰ÈÎÒÓ ÙÔ˘ EıÓÈÎÔ‡ K¤ÓÙÚÔ˘ TÂÎÌËÚ›ˆÛ˘ ISSN 1011 - 4181 1 ENTY¶O K§EI™TO AP. A¢. 520/92 £ÂÌÈÛÙÔÎÏ¤Ô˘˜ 38 106 78 Aı‹Ó· Kø¢IKO™ 6705 HÏÂÎÙÚÔÓÈ΋ EÈÎÔÈÓˆÓ›· Î·È AÔÛÙÔÏ‹ EÈÛÙËÌÔÓÈÎÒÓ EÚÁ·ÛÈÒÓ ÛÙË ‰È‡ı˘ÓÛË [email protected] ÂÏÏËÓÈη ÛÙÔÌ·ÙÔÏÔÁÈη ¯ÚÔÓÈη TOMO™ 59 ñ TEYXH 1-4 IANOYAPIO™ - ¢EKEMBPIO™ 2015 To ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ EOO Î·È Ë ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ 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 ÙfiÔ Ù˘ EÏÏËÓÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ OÌÔÛÔÓ‰›·˜. TA «E§§HNIKA ™TOMATO§O°IKA XPONIKA» ™TO ¢IA¢IKTYO

ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

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Page 1: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

ÂÏÏËÓÈοÛÙÔÌ·ÙÔÏÔÁÈο¯ÚÔÓÈο TPIMHNIAIA EK¢O™H

E§§HNIKH™ O¢ONTIATPIKH™ OMO™¶ON¢IA™

TOMO™ 59IANOYAPIO™ - ¢EKEMBPIO™ 2015

hellenic stomatological reviewHELLENIC DENTAL ASSOCIATION

VOLUME 59, ISSUE 1-4, JANUARY - DECEMBER 2015

ISSN 1011 - 4181E¶I™THMONIKO ENTY¶O ME E£NIKH ANA°NøPI™H

ºEK 431/2 Ù˘ 5 AÚÈÏ›Ô˘ 2005

T· E™X ‚Ú›ÛÎÔÓÙ·È Î·Ù·¯ˆÚË̤ӷ ÛÙÔÓ EıÓÈÎfi ™˘ÏÏÔÁÈÎfi K·Ù¿ÏÔÁÔ EÈÛÙËÌÔÓÈÎÒÓ ¶ÂÚÈÔ‰ÈÎÒÓ ÙÔ˘ EıÓÈÎÔ‡ K¤ÓÙÚÔ˘ TÂÎÌËÚ›ˆÛ˘

ISSN 1011 - 4181

1

ENTY¶O K§EI™TO AP. A¢. 520/92£ÂÌÈÛÙÔÎÏ¤Ô˘˜ 38 106 78 Aı‹Ó·

Kø¢IKO™ 6705

HÏÂÎÙÚÔÓÈ΋ EÈÎÔÈÓˆÓ›·Î·È AÔÛÙÔÏ‹ EÈÛÙËÌÔÓÈÎÒÓ EÚÁ·ÛÈÒÓÛÙË ‰È‡ı˘ÓÛËstomhron@otenet .gr

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To ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ EOO Î·È Ë ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ 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 ÙfiÔ Ù˘ EÏÏËÓÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ OÌÔÛÔÓ‰›·˜.

TA «E§§HNIKA ™TOMATO§O°IKA XPONIKA» ™TO ¢IA¢IKTYO

Page 2: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

ÂÏÏËÓÈοÛÙÔÌ·ÙÔÏÔÁÈο¯ÚÔÓÈο

EÏÏËÓÈ΋ O‰ÔÓÙÈ·ÙÚÈ΋ OÌÔÛÔÓ‰›·

TOMO™ 59, TEYXH 1-4IANOYAPIO™ - ¢EKEMBPIO™ 2015

ISSN 1011 - 4181

I¢IOKTHTH™:EÏÏËÓÈ΋ O‰ÔÓÙÈ·ÙÚÈ΋ OÌÔÛÔÓ‰›·

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Y¶EY£YNO™ EKTY¶ø™H™:TypeProductB. & E. M·Ì¿Ë E¶EEÈÎÔ‡ÚÔ˘ 31 & ¶ÂÈÚ·ÈÒ˜TËÏ.: (212) 70.03.210

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¶EPIEXOMENA

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X. X·Ú·Ï¿ÌÔ˘˜, M. £ÂÔ‰ÒÚÔ˘, ¶. °·Ï¿Ó˘ Î·È X. TÛ¤ÏÂÔ˜ ......................................9-24

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ÊÔÈÙËÙ¤˜ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ EıÓÈÎÔ‡ ηÈ

K·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ

¶. M·ÓÈ·Ù¿ÎÔ˜, ¡. §Ô˘ÌÚ›Ó˘, ∫. ™ÈÒÙÔ˘,

¶. M·ÙÛԇη Î·È ª. T˙¿Î˘ ..........................................................25-34

ñ §ÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ ÙÔ˘ ÛÙÔÌ·ÙÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Û˘Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÙËÓ Â·Ê‹ Ì ÂÌÊÚ¿ÍÂȘ ·Ì·ÏÁ¿Ì·ÙÔ˜

¢. ¢ÈÔÓ˘ÛfiÔ˘ÏÔ˜, E. ¶·Ú¯·Ú›‰Ë˜ Î·È K. K·Ú·Ô˘Ï¿ÓË.....................................35-49

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K. BÏ·ÛÈ¿‰Ë˜, A. M. MÔ˘˙¿, I. T˙Ô‡Ù˙·˜ Î·È A. ºÈÏ·Ï‹ı˘...........................83-99

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Page 3: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

HellenicStomatologicalReview

Hellenic Dental Association

VOLUME 59, ISSUE 1-4JANUARY - DECEMBER 2015

ISSN 1011 - 4181

CONTENTS

ñ Oral health in 6-year old schoolchildren in Cyprus

C. Charalambous, M.Theodorou, P. Galanis and C. Tselepos ....................................9-24

ñ Sleep bruxism as monitored among students of School of

Dentistry, NKUA

P. Maniatakos, N. Loubrinis, K. Siotou,

P. Matsouka and M. Tzakis ...................................................................................................................................25-34

ñ Oral lichenoid reactions related to contact with dental amalgam

D. Dionysopoulos, E. Parcharidis and K. Karaoulani................................................35-49

ñ Recently introduced endodontic sealing materials and sealers

C. Koutoulas, V. Makris and E.-T. Farmakis............................................................................51-68

ñ Fiber post debonding: causes, explanation and treatment

M. Fragkouli ...................................................................................................................................................................................71-82

ñ Performance appraisal in dental units

K. Vlasiadis, A. M. Mouza, I. Tzoutzas and A. Philalithis .....................................83-99

PROFESSIONAL TOPIC

LITERATURE REVIEWS

RESEARCH PAPER

PROPRIETOR:Hellenic Dental Association

EDITOR -IN- CHIEF:J. G. Tzoutzas

EDITORIAL BOARD:G. Douvitsas F. Zervou-ValviH. Karkazis G. PolyzoisA. Kossioni P. LagouvardosG. Mountouris H. PaximadaL. Papagiannoulis D. SakellariF. Tzerbos V. Topitsoglou-ThemeliD. Tziafas

PRODUCTION SUPERVISORS:M. Antoniadou, E.T. Farmakis

COPY EDITOR:Evelin Babai

PRODUCTION - PROMOTION:TypeProductV. & E. Babai Ltd32 Epikourou Str., Athens HellasPhone#: (3212) 70.03.200Fax#: (3212) 70.03.240

ADVERTISEMENTS - PUBLICRELATIONS:M. Morfoniou - S. GogasPhone#: (3210) 33.02.343Fax: (3210) 38.34.385e-mail: [email protected]

Hellenic Stomatological Review is theofficial publication of the Hellenic DentalAssociation, published trimonthly.

Annual subscription 40 $ USD

PUBLISHER:Athanasios KatsikisPresident of the Hellenic Dental Association

HEADQUARTERS38 Themistokleous Str., Athens, 106 78Phone#: (3210) 38.13.380Fax#: (3210) 38.34.385e-mail: [email protected]

Page 4: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

™YNTAKTIKH ™E§I¢A

¶ˆ˜ ı· ÏÂÈÙÔ˘ÚÁԇ̠ÛÙÔ Ì¤ÏÏÔÓ?

K·È Ë Û˘˙‹ÙËÛË ÁÈ· Ù· O‰ÔÓÙÈ·ÙÚÈο BÈÔ˘ÏÈο Û˘Ó¯›˙ÂÙ·È. TÔ ÎÏ·ÛÛÈÎfi ·Ì¿ÏÁ·Ì· ‚Ú›-

ÛÎÂÙ·È ÁÈ· ¿ÏÏË ÌÈ· ÊÔÚ¿ ÛÙÔ ÛÙfi¯·ÛÙÚÔ ÙˆÓ ÂÚÈ‚·ÏÏÔÓÙÔÏfiÁˆÓ, ÙˆÓ ˘ÁÈÂÈÓÈÛÙÒÓ Î·È

ÙÔ˘ E˘ÚˆÎÔÈÓÔ‚Ô˘Ï›Ô˘. OÈ ÚÔÙ¿ÛÂȘ ÁÈ· ÙËÓ Î·Ù¿ÚÁËÛ‹ ÙÔ˘ ‹ ÙÔ ‰Ú·ÛÙÈÎfi ÂÚÈÔÚÈÛÌfi

ÙÔ˘ ‰È·ÛÙ·˘ÚÒÓÔÓÙ·È Î·ıËÌÂÚÈÓ¿ Î·È Ë ̆ ÔÁÚ·Ê‹ Ù˘ Û˘Óı‹Î˘ Ù˘ MINAMATA ÙÔ 2013

·fi 140 ¯ÒÚ˜, Ô˘ ÛÙԯ‡ÂÈ ÛÙÔÓ ÂÚÈÔÚÈÛÌfi ÙÔ˘ ˘‰Ú·ÚÁ‡ÚÔ˘, ı· ·ÔÙÂϤÛÂÈ ÙËÓ Â-

Èه̂ȷ Ͽη ÁÈ· ÙÔ ·Ú·‰ÔÛÈ·Îfi ·˘Ùfi ˘ÏÈÎfi.

Afi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿ Î·È Ù· ÔÏ˘ÌÂÚ‹ ˘ÏÈο ‚Ú›ÛÎÔÓÙ·È Ï¤ÔÓ ÛÙÔ Ê¿ÛÌ· ÙˆÓ ‰˘ÓËÙÈ-

ο ÂÈΛӉ˘ÓˆÓ ÁÈ· ÙË ÁÂÓÈ΋ ˘Á›·, ÌÈ· Î·È Ë ÂÌÂÚȯfiÌÂÓË ‰ÈÊ·ÈÓfiÏË A, Ë Î·ÌÊÔÚÔÎÈ-

ÓfiÓË, Î·È ÔÈ ‰È¿ÊÔÚÔÈ ‰È·Ï‡Ù˜, Ê·›ÓÂÙ·È fiÙÈ ·ÔÙÂÏÔ‡Ó ·ÓÙÈΛÌÂÓÔ ¤Ú¢ӷ˜ Î·È ÂÚÈÔ-

ÚÈÛÙÈÎÒÓ Ù¿ÛˆÓ, Ì ÛÎÔfi Ó· ·‡ÛÔ˘Ó Ó· ·ÔÙÂÏÔ‡Ó ‰ÔÌÈÎfi ÛÙÔÈ¯Â›Ô ÙˆÓ ·ÈÛıËÙÈÎÒÓ

˘ÏÈÎÒÓ. H ¤Ú¢ӷ Ô˘ ‰ÈÂÍ¿ÁÂÙ·È Á‡Úˆ ·fi ÙÔ˘˜ ÂÓ‰ÔÎÚÈÓÈÎÔ‡˜ ·ÔÛ˘ÓÙÔÓÈÛÙ¤˜

(endocrine disruptors) ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·ÔÎÏÂÈÛÌÔ‡˜ Î·È ÂÚÈÔÚÈÛÌÔ‡˜ ÛÙË ¯Ú‹ÛË ÙˆÓ ¿Ï·È ÔÙ¤ ·ÛÊ·-

ÏÒÓ Î·È ÌË ÙÔÍÈÎÒÓ ÔÏ˘ÌÂÚÒÓ ˘ÏÈÎÒÓ.

T· ÂÌÂÚȯfiÌÂÓ· Ó·ÓÔۈ̷ٛ‰È·, Ô˘ ·ÔÙÂÏÔ‡Û·Ó Ú›Ó ·fi Ï›Á· ¯ÚfiÓÈ· ÙËÓ Ï¤ÔÓ ÚˆÙÔÔÚÂȷ΋ ¤ÎÊÚ·ÛË

ÛÙË ‰ÔÌ‹ Î·È Û‡ÓıÂÛË ÙˆÓ Û˘Óı¤ÙˆÓ ˘ÏÈÎÒÓ, ηÙËÁÔÚÔ‡ÓÙ·È ÙÒÚ· fiÙÈ ÂËÚ¿˙Ô˘Ó ÙÔ ÚˆÙfiÏ·ÛÌ· Î·È ÙÔ ˘ÚË-

ÓÈÎfi ˘ÏÈÎfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ı· ÌÔÚÔ‡Û·Ó ÂÓ ‰˘Ó¿ÌÂÈ Ó· ÚÔηϤÛÔ˘Ó ÛÔ‚·Ú¤˜ Î·È ·ÓÂÈı‡ÌËÙ˜ ÚÔÂÎÙ¿ÛÂȘ

ÛÙÔ Ì¤ÏÏÔÓ.

™ÂÈÚ¿ ¿ÏÏˆÓ ˘ÏÈÎÒÓ fiˆ˜ ÂÓ‰ÂÈÎÙÈο Ô æ¢‰¿ÚÁ˘ÚÔ˜, Ô X·ÏÎfi˜, Ô AÚÁ˘ÚÔ˜, ÙÔ ÔÏ˘·ÎÚ˘ÏÈÎfi Ô͇, ÙÔ HEMA,

ÙÔ ÊˆÛÊÔÚÈÎfi Ô͇, ηÙËÁÔÚÔ‡ÓÙ·È ÁÈ· ÛÔ‚·Ú¤˜ ·ÚÓËÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ Û ÏÂÈÙÔ˘ÚÁ›Â˜ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÔÚÁ·-

ÓÈÛÌÔ‡, ÙfiÛÔ ·fi ÙËÓ ÏÂ˘Ú¿ ÙˆÓ ·ÛıÂÓÒÓ fiÛÔ Î·È ·fi ÙËÓ ÏÂ˘Ú¿ ÙˆÓ ÂÂÌ‚·ÈÓfiÓÙˆÓ Ô‰ÔÓÙÈ¿ÙÚˆÓ.

K·Ù¿ Û˘Ó¤ÂÈ· ÌfiÓÔ Ù· ÎÂÚ·ÌÈο ˘ÏÈο Ì ÙȘ ÔÈΛϘ ÂÎÊÚ¿ÛÂȘ ÙÔ˘˜ ·Ú·Ì¤ÓÔ˘Ó ÛÙÔ ·˘Úfi‚ÏËÙÔ, ·ÏÏ¿ ηÈ

·˘Ù¿ ÔÊ›ÏÔ˘Ó Ó· Û˘ÁÎÔÏÏËıÔ‡Ó ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘˜ ·ÚÈ· Ì ÔÏ˘ÌÂÚ‹ ˘ÏÈο.

K·Ù¿ Û˘Ó¤ÂÈ·, ÙÈ ·Ô̤ÓÂÈ ÛÙÔÓ O‰ÔÓÙ›·ÙÚÔ ¤Ú·Ó Ù˘ ¶ÚfiÏ˄˘, ÙˆÓ XÂÈÚÔ˘ÚÁÈÎÒÓ T¯ÓÈÎÒÓ Î·È Èı·Ó¿ ÙˆÓ

·ÓÂÚ¯fiÌÂÓˆÓ Ï¤ÔÓ EÓ·ÏÏ·ÎÙÈÎÒÓ ÌÔÚÊÒÓ ıÂڷ›·˜ Â¿Ó Î·È ÂÊfiÛÔÓ fiÏ· Ù· O‰ÔÓÙÈ·ÙÚÈο BÈÔ˘ÏÈο ÙÂıÔ‡Ó Û ·Ì-

ÊÈÛ‚‹ÙËÛË?

¶ÚÔ˜ ÙÔ ·ÚfiÓ Ù· ÚÔÁÚ¿ÌÌ·Ù· ÛÔ˘‰ÒÓ ÙˆÓ ·Ó· ÙÔÓ KfiÛÌÔ ¶·ÓÂÈÛÙËÌ›ˆÓ ‰ÂÓ ‰›ÓÔ˘Ó Î¿ÔÈ· ˘ÔÛ¯fiÌÂÓË

‰È¤ÍÔ‰Ô ÛÙÔÓ ÚÔ‚ÏËÌ·ÙÈÛÌfi.

I. °. TZOYTZA™¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘

Page 5: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

ŸÚÔ˜ ™‡ÓÙÌËÛË ™‡ÓÙÌËÛË ™‡ÓÙÌËÛË ™‡ÓÙÌËÛË‹ ۇ̂ÔÏÔ ŸÚÔ˜ ‹ ۇ̂ÔÏÔ ŸÚÔ˜ ‹ ۇ̂ÔÏÔ ŸÚÔ˜ ‹ ۇ̂ÔÏÔ

™Ù·ıÂÚ¤˜ ÌÔÓ¿‰Â˜ampere Aangström AÆbarm bcalorie calcandela cdcoulomb Ccounts per minute cpmcounts per second cpscurie Cidegree Celsius ÆCdisintegrationper minute dpmdisintegrationper second dpselectron Volt eVequivalent Eqfarad Fgauss Ggram ghenry Hhertz Hzhour hinch in

international unit IUjoule Jkelvin Kkilogram kgliter/litre I or Lmeter, metre mminute minmolar Mmole molnewton Nnormal (concentration) Nohm øosmol osmolpascal Papound lbpound per square inch psirevolutions per minute rpmsecond ssquare centimeter cm2

volt Vwatt Wweek wkyear yr

™Ù·ÙÈÛÙÈÎÔ› fiÚÔÈcorrelation coefficient r probability pdegrees of freedom df standard deviation SDmean x Standard errormean not significant NS of the mean SEnumber of Student’s test t testobservations n variance F

™˘Ó‰˘·ÛÌfi˜ ÚÔıÂÌ¿ÙˆÓtera- (1012) T centi- (10-2) cgiga- (109) G mili- (10-3) mmega- (106) M micro- (10-6) Ìmkilo- (103) k nano- (10-9) nhecto- (102) h pico- (10-12) pdeca- (10) da femto- (10-15) fdeci- (10-1) d atto- (10-18) a

SEM: Scanning Electron MicroscopyTEM: Transmission Electron MicroscopyESEM: Environmental Scanning Electron MicroscopyCSEM: Confocal Scanning Electron MicroscopyAFM: Atomic Force MicroscopySPM: Scanning Probe MicroscopyEELS: Electron Energy Loss SpectrometryEDS: Element Dispersive SpectroscopyEPMA: Electron Probe MicroanalysisXRF: X-ray Fluorescence analysisXRD: X-ray DiffractionFTIR: Fourrier Transformation Infrared Spectroscopy

™˘ÓÙÌ‹ÛÂȘ Î·È ™‡Ì‚ÔÏ· ™Ù·ıÂÚÒÓ MÔÓ¿‰ˆÓ, ™Ù·ÙÈÛÙÈÎÒÓ ŸÚˆÓ Î·È OÚÁ·ÓÔÏÔÁ›·˜

T· EÏÏËÓÈο ™ÙÔÌ·ÙÔÏÔÁÈο XÚÔÓÈο ÛÙÔ ‰È·‰›ÎÙ˘Ô O‰ËÁ›Â˜ ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛ‹ ÙÔ˘˜

¶ÏËÎÙÚÔÏÔÁ›ÛÙ http://www.eoo.gr – EÌÊ·Ó›˙ÂÙ·È Ë ÛÂÏ›‰·

EÈϤͷÙ ÙËÓ ÂÓfiÙËÙ· «EΉfiÛÂȘ» – EÌÊ·Ó›˙ÂÙ·È Ë ÛÂÏ›‰·

EÈϤͷÙ ٷ «EÏÏËÓÈο ™ÙÔÌ·ÙÔÏÔÁÈο XÚÔÓÈο».

EÈϤͷÙ ÙÔ ¤ÙÔ˜ Ô˘ Û·˜ ÂӉȷʤÚÂÈ

EÈϤͷÙ ÙËÓ ÂÚÁ·Û›· Ô˘ Û·˜ ÂӉȷʤÚÂÈ

¢ÒÛÙ ÂÓÙÔÏ‹ ÁÈ· ·Ôı‹Î¢ÛË ‹ ÂÎÙ‡ˆÛË Ù˘ ÂÓfiÙËÙ·˜ Ô˘ Û·˜ ÂӉȷʤÚÂÈ

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Page 6: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

O¢H°IE™ °IA TOY™ ™Y°°PAºEI™

T· ™TOMATO§O°IKA XPONIKA Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙË-ÌÔÓÈ΋ ¤Î‰ÔÛË Ù˘ EÏÏËÓÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ OÌÔ-ÛÔÓ‰›·˜ Î·È ˆ˜ ÛÙfi¯Ô ¤¯Ô˘Ó ÙË Û˘Ó¯‹ ÂÈÛÙËÌÔÓÈ΋ ÂÓË-̤ڈÛË ÙÔ˘ ŒÏÏËÓ· O‰ÔÓÙÈ¿ÙÚÔ˘ Î·È ÙËÓ ÚÔÒıËÛË Ù˘O‰ÔÓÙÈ·ÙÚÈ΋˜ EÈÛÙ‹Ì˘ ÛÙÔÓ EÏÏËÓÈÎfi ¯ÒÚÔ. °È· ÙËÓÚ·ÁÌ¿ÙˆÛË ÙÔ˘ ÛÎÔÔ‡ ·˘ÙÔ‡ ‰ËÌÔÛȇÔÓÙ·È:

1. K‡ÚÈ· ı¤Ì·Ù·:ÕÚıÚ· Û ÌÔÚÊ‹ ·Ó·ÛÎfiËÛ˘, Ô˘ ·ÊÔÚÔ‡Ó Â›Î·ÈÚ·

Î·È ·ÌÊÈÏÂÁfiÌÂÓ· ı¤Ì·Ù· Î·È Ô˘ ÁÚ¿ÊÔÓÙ·È Ì ÚÔÙÚÔ‹Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜ ·fi Û˘Ó·‰¤ÏÊÔ˘˜ Ì ÂȉÈΤ˜Û ‚¿ıÔ˜ ÁÓÒÛÂȘ ÙÔ˘ ı¤Ì·ÙÔ˜.

2. EÈÛÙËÌÔÓÈο ¿ÚıÚ· Ô˘ ÛÙ¤ÏÓÔÓÙ·È ·fi Û˘Ó·‰¤ÏÊÔ˘˜:T· ¿ÚıÚ· ·˘Ù¿ ÌÔÚ› Ó· ·Ó‹ÎÔ˘Ó Û ̛· ·fi ÙȘ ·Ú·-

οو ηÙËÁÔڛ˜: ·) AÓ·ÛÎÔ‹ÛÂȘ (̤¯ÚÈ 3 Û˘ÁÁÚ·Ê›˜)‚) EÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ (¶ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜, KÏÈÓÈΤ˜ÌÂϤÙ˜, EÚÁ·ÛÙËÚȷΤ˜ ÌÂϤÙ˜, EȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤ-Ù˜, KÏÈÓÈÎÔÛÙ·ÙÈÛÙÈΤ˜ ÌÂϤÙ˜, KÏÈÓÔ·ıÔÏÔÁÈΤ˜ ÌÂϤ-Ù˜) Á) EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ‰) ¶Ú·ÎÙÈο ı¤Ì·Ù·,Â) E·ÁÁÂÏÌ·ÙÈο ı¤Ì·Ù· ÂÈÛÙËÌÔÓÈο 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΋ EÈÙÚÔ‹:T· ÁÚ¿ÌÌ·Ù· Ô˘ ‰ËÌÔÛȇÔÓÙ·È ÌÂÙ¿ ·fi ¤ÁÎÚÈÛË Ù˘

™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜ ·ÊÔÚÔ‡Ó: ·) ÎÚ›ÛÂȘ ÁÈ· ‰ËÌÔÛÈ¢-̤ӷ ¿ÚıÚ· Î·È ‚) Û˘ÁÎÂÎÚÈ̤ӷ ÂÚˆÙ‹Ì·Ù· Û¯ÂÙÈο ÌÂÂÈÛÙËÌÔÓÈο ı¤Ì·Ù· Î·È Ô˘ ı· ‰›ÓÔÓÙ·È ··ÓÙ‹ÛÂȘ ·fiÙË ÛÙ‹ÏË Ù˘ ·ÏÏËÏÔÁÚ·Ê›·˜.

4. ™‡ÓÙÔ̘ ÚˆÙfiÙ˘Â˜ ‰ËÌÔÛȇÛÂȘ:£· ·ÊÔÚÔ‡Ó ÚˆÙfiÙ˘Â˜ ÂÚÁ·Û›Â˜ ‹ Â˘Ú‹Ì·Ù·, ‰Â ı·

¤¯Ô˘Ó ¤ÎÙ·ÛË ÌÂÁ·Ï‡ÙÂÚË ·fi 2.000 ϤÍÂȘ Î·È ı· ‰ËÌÔÛÈ-‡ÔÓÙ·È ÙÔ Û˘ÓÙÔÌfiÙÂÚÔ ‰˘Ó·Ùfi ·fi ·ÍÈÔÏfiÁËÛË Ù˘™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜.

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‰ÈοÙÔ˘ 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·Ô̤˜ Ì ÂÍ·›ÚÂÛËÂȉÈο ı¤Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ‚·ÛÈΤ˜ ÂÈÛً̘. OÈÂÚ¢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·Ô̤˜. T· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÂӉȷʤÚÔ˘Û˜ Â-ÚÈÙÒÛÂȘ ‰Â ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 1.000 ϤÍÂȘ (4ÛÂÏ›‰Â˜), ÂÓÒ Ù· ·ÁÁÂÏÌ·ÙÈο ı¤Ì·Ù· ı· Ú¤ÂÈ Ó· Â-ÚÈÔÚ›˙ÔÓÙ·È ÛÙȘ 5.000 ϤÍÂȘ (20 ÛÂÏ›‰Â˜). ™ÙËÓ ¤ÎÙ·ÛËÙˆÓ ·Ú·¿Óˆ ¿ÚıÚˆÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë ‚È‚ÏÈÔ-ÁÚ·Ê›· Ô˘ ı· Ú¤ÂÈ Ó· Â›Ó·È Â›Î·ÈÚË Î·È Ó· ¤¯ÂÈ ¿ÌÂÛËÛ¯¤ÛË Ì ÙÔ ‰È·Ú·ÁÌ·Ù¢fiÌÂÓÔ ı¤Ì·.

™‡ÓÙ·ÍË ÎÂÈ̤ӈÓ: T· ¿ÚıÚ· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÁÈ·‰ËÌÔÛ›Â˘ÛË Ú¤ÂÈ Ó· Â›Ó·È ÁÚ·Ì̤ӷ ÛÙË ÓÂÔÂÏÏËÓÈ΋‰ËÌÔÙÈ΋, Ì ÌÔÓÔÙÔÓÈÎfi Û‡ÛÙËÌ·, ηıÒ˜ ›Û˘ Î·È ÛÙËÓ

·ÁÁÏÈ΋ ÁÏÒÛÛ·. H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰È-η›ˆÌ· Ó· ÂϤÁÍÂÈ ÙËÓ ·ÎÚ›‚ÂÈ· ÙˆÓ ·ÁÁÏfiÊˆÓˆÓ fiÚˆÓ Î·È‰È·Ù˘ÒÛÂˆÓ ·Â˘ı˘ÓfiÌÂÓË Û ·ÁÁÂÏ̷ٛ˜ È·ÙÚÈÎÔ‡˜ÌÂÙ·ÊÚ·ÛÙ¤˜. O ‰ÈÔÚıˆÙ‹˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ¤¯ÂÈ ÙÔ ‰ÈηÈ-ÒÌ· Ó· ÙÚÔÔÔÈ‹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 ‰ÈÏfi ‰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˘ÂÚÁ·Û›·˜, Ë ÂÚ›ÏË„Ë ÛÙËÓ ·ÁÁÏÈ΋ Î·È ÔÈ Ï¤ÍÂȘ ÎÏÂȉȿÛÙËÓ ·ÁÁÏÈ΋, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜, ÔÈ ÏÂ˙¿-ÓÙ˜, ÔÈ ›Ó·Î˜ Î·È ÔÈ ÂÈÎfiÓ˜. ŸÏ˜ ÔÈ ÛÂÏ›‰Â˜ ·ÚÈıÌÔ‡-ÓÙ·È Ì ÙËÓ ·ÓˆÙ¤Úˆ ÛÂÈÚ¿.

¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÍÈÔÔÈËıÔ‡Ó ÔÈ Â˘ÎÔϛ˜ Ù˘ Û‡Á¯ÚÔ-Ó˘ Ù¯ÓÔÏÔÁ›·˜ Î·È ÚÔ˜ ·ÔÊ˘Á‹Ó ÙˆÓ ÛÊ·ÏÌ¿ÙˆÓ Î·Ù¿ÙËÓ ÏËÎÙÚÔÏfiÁËÛË ÎÚ›ÓÂÙ·È Û·Ó ··Ú·›ÙËÙË Ë ˘Ô‚ÔÏ‹Ù˘ ÂÚÁ·Û›·˜ ÂȘ ÙÚÈÏÔ‡Ó Û˘Óԉ¢fiÌÂÓË ·fi CD fiÔ˘ ٷΛÌÂÓ· ı· Ú¤ÂÈ Ó· Â›Ó·È ÏËÎÙÚÔÏÔÁË̤ӷ Û ÚfiÁÚ·Ì-Ì· Word Û ¯·Ú·ÎÙ‹Ú˜ 12 ÛÙÈÁÌÒÓ. Afi ÙÔÓ I·ÓÔ˘¿ÚÈÔÙÔ˘ 2010 ÔÈ ÂÚÁ·Û›Â˜ ˘Ô‚¿ÏÏÔÓÙ·È Î·È ËÏÂÎÙÚÔÓÈο ÛÙËӉȇı˘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· ·’ fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·, ‰) ÙÔ ·Ó Ë ÂÚÁ·Û›·¤¯ÂÈ ·Ó·ÎÔÈÓˆı› Û οÔÈÔ Û˘Ó¤‰ÚÈÔ Î·È ÔÈÔ, Â) ÙÔ fiÓÔÌ·,‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· ÁÈ· ÙËÓ ·ÏÏËÏÔ-ÁÚ·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 ÛÎÔfi ÂÚÁ·-Û›·˜, ÙÔ ˘ÏÈÎfi, ÙË ÌÂıÔ‰ÔÏÔÁ›· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù·. OÈϤÍÂȘ - 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 IndexMedicus Î·È Dental Index Î·È Ó· ÂÌÂÚȤ¯ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔÙ˘ ÂÚ›Ï˄˘.

K›ÌÂÓÔ: T· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ·Ó·ÛÎÔ‹ÛÂȘ ı·Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ì›· ·ÓÙÈÚÔÛˆÂ˘ÙÈ΋ ÂÈÛ·Áˆ-Á‹ Î·È Î·ÙfiÈÓ 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 ÛÂÛ˘ÁÎÂÎÚÈ̤ӷ Û˘ÌÂÚ¿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·-AÔÙÂϤÛÌ·Ù·, ™˘˙‹ÙËÛË Î·È ™˘ÌÂÚ¿ÛÌ·Ù·.

™Ù· ˘fiÏÔÈ· ›‰Ë ÙˆÓ ¿ÚıˆÓ ÙÔ Î›ÌÂÓÔ ‰È·ÌÔÚÊÒÓÂ-Ù·È Û‡Ìʈӷ Ì ÙȘ ··ÈÙ‹ÛÂȘ ÙÔ˘ ¿ÚıÚÔ˘.

BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜: OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·-Ú·Ô̤˜ ÛÙÔ Î›ÌÂÓÔ, fiˆ˜ Î·È ÛÙÔ˘˜ ›Ó·Î˜ Î·È ÛÙȘ ÂÈ-

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ÎfiÓ˜ Ì ÙȘ ÏÂ˙¿ÓÙ˜ ÙÔ˘˜, ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Ì ·Ú·‚È-ÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. TÂÏ›˜ ‹ ÎfiÌ·Ù· ÛËÌÂÈÒ-ÓÔÓÙ·È ÌÂÙ¿ ÙËÓ ·Ú¤ÓıÂÛË Ô˘ ·Ú¤¯ÂÈ ÙË ‚È‚ÏÈÔÁÚ·ÊÈ΋·Ú·ÔÌ‹. H ·Ú›ıÌËÛË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·Ô-ÌÒÓ Á›ÓÂÙ·È Î·Ù’ ·‡ÍÔÓÙ· ·ÚÈıÌfi Î·È Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌ-Ê·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ.

ŸÏ˜ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·ÈÛÙÔ Î›ÌÂÓÔ Î·Ù·¯ˆÚÔ‡ÓÙ·È ÛÙÔ ‚È‚ÏÈÔÁÚ·ÊÈÎfi ηٿÏÔÁÔÔ˘ ·Ú¯›˙ÂÈ Û ȉȷ›ÙÂÚË ÛÂÏ›‰· ÌÂÙ¿ ÙÔ Î›ÌÂÓÔ. ¶ÚÈÓ ·fiοı ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹ ÛÙÔÓ Î·Ù¿ÏÔÁÔ, ÚÔËÁ›-Ù·È Ô ·ÓÙ›ÛÙÔȯԘ ·ÚÈıÌfi˜ Ô˘ ÛËÌÂÈÒıËΠÛÙÔ Î›ÌÂÓÔÎ·È ÛÙÔÓ ÔÔ›Ô ·ÓÙÈÛÙÔȯ› Ë ‚È‚ÏÈÔÁÚ·Ê›·.

™ÙÔ ‚È‚ÏÈÔÁÚ·ÊÈÎfi ηٿÏÔÁÔ ÚÔËÁÔ‡ÓÙ·È Ù· ÔÓfiÌ·Ù·ÙˆÓ Û˘ÁÁڷʤˆÓ (ÚÒÙ· ÙÔ ÂÒÓ˘ÌÔ Î·È ÌÂÙ¿ ÙÔ fiÓÔÌ·,·ÎÔÏÔ˘ı› ÎfiÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ ÙÔ˘ ÂfiÌÂÓÔ˘ Û˘ÁÁڷʤ·Î.Ô.Î.), Ù›ıÂÙ·È ¿Óˆ Î·È Î¿Ùˆ ÛÙÈÁÌ‹ (:) Ô Ù›ÙÏÔ˜ ÙÔ˘ ¿Ú-ıÚÔ˘, ÙÂÏ›·, ÙÔ ÂÚÈÔ‰ÈÎfi ÛÂ Û˘ÓÙÔÌÔÁÚ·Ê›·, ÙÔ ¤ÙÔ˜, ÙÔÚfiÛËÌÔ (;), Ô ÙfiÌÔ˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, Û ·Ú¤ÓıÂÛË ÙÔÙ‡¯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›ÙψÓÂÚÈÔ‰ÈÎÒÓ Ú¤ÂÈ Ó· ÁÚ¿ÊÔÓÙ·È Û‡Ìʈӷ Ì ÙÔ DentalIndex Î·È Index Medicus. °È· ÙȘ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ ÂÏÏËÓÈÎÒÓÂÚÈÔ‰ÈÎÒÓ ˘¿Ú¯ÂÈ Û¯ÂÙÈÎfi˜ ηٿÏÔÁÔ˜ ÙÔ˘ IATPOTEK.¶Ú¤ÂÈ Ó’ ·ÔʇÁÂÙ·È ÁÂÓÈο Ë ¯ÚËÛÈÌÔÔ›ËÛË ÂÚÈÏ‹„Â-ˆÓ (abstracts) ˆ˜ ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹, fiˆ˜ ›Û˘«·‰ËÌÔÛ›Â˘Ù˜ ·Ú·ÙËÚ‹ÛÂȘ» Î·È «ÚÔÛˆÈΤ˜ ÂÈÎÔÈÓˆ-ӛ˜». T· «EÏÏËÓÈο ™ÙÔÌ·ÙÔÏÔÁÈο XÚÔÓÈο» Ú¤ÂÈ Ó·Û˘ÓÙÔÌÔÁÚ·ÊÔ‡ÓÙ·È Û·Ó EÏÏ. ™ÙÔÌ. XÚÔÓ. ‹ ·ÁÁÏfiʈӷHel Stom Rev.

EÚÁ·Û›Â˜ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ ‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË, ·ÏÏ¿‰Â ‰ËÌÔÛȇıËÎ·Ó ·ÎfiÌË, ÌÔÚÔ‡Ó Ó· ·Ó·ÊÂÚıÔ‡Ó ÛÙË‚È‚ÏÈÔÁÚ·Ê›·. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ ÛËÌÂÈÒÓÂÙ·È ÛÙÔ Â-ÚÈÔ‰ÈÎfi Î·È Ë ÊÚ¿ÛË «˘fi ‰ËÌÔÛ›Â˘ÛË» Û ·Ú¤ÓıÂÛË.E¿Ó Î·È ÂÊfiÛÔÓ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÌÂÚȤ¯ÔÓÙ·È ¿ÚıÚ··fi ÂÚÈÔ‰Èο Ì ϷÙÈÓÔÁÂÓ‹ ÁÏÒÛÛ· Ô˘ ¤¯ÂÈ ÙÔÈΤ˜ ȉÈ-·ÈÙÂÚfiÙËÙ˜ (°ÂÚÌ·ÓÈο, ™Î·Ó‰ÈÓ·˘Èο, °·ÏÏÈο), Ô ÙÔÓÈ-ÛÌfi˜ ÙˆÓ Ï¤ÍÂˆÓ Â›Ó·È Â˘ı‡ÓË ÙˆÓ Û˘ÁÁڷʤˆÓ.¶·Ú¿‰ÂÈÁÌ· ÙÔ˘ ÔÚıÔ‡ ÙÚfiÔ˘ ÁÚ·Ê‹˜ ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈ-ÎÒÓ ‰›ÓÂÙ·È ·Ú·Î¿Ùˆ:

¶ÂÚÈÔ‰ÈÎfi: AӷʤÚÔÓÙ·È Ù· ÂÒÓ˘Ì· Î·È Ù· ·Ú¯Èο ÙˆÓÔÓÔÌ¿ÙˆÓ fiÏˆÓ ÙˆÓ Û˘ÁÁڷʤˆÓ ̤¯ÚÈ ¤ÍË (fiÙ·Ó Â›Ó·È Â-ÚÈÛÛfiÙÂÚÔÈ ·ÎÔÏÔ˘ı› Ë ¤Ó‰ÂÈÍË «et al», ÛÙ· ÂÏÏËÓÈο ¿Ú-ıÚ· 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 inVitro anticariogenic behavior of glass-ionomer andresin composite restorative materials. Dent Mater 2002;18 (8): 561-569.

BÈ‚Ï›· Î·È ¿ÏϘ ÌÔÓÔÁڷʛ˜: AӷʤÚÔÓÙ·È Ì ÙË ÛÂÈ-Ú¿ Ù· ÂÒÓ˘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› ÔÂΉfiÙ˘, ÙÔ ¤ÙÔ˜ (¿Óˆ - οو ÙÂÏ›·) ÎÈ Ë ÛÂÏ›‰·. ¶.¯.Ryge GM: Dental Corrosion. 2nd ed. New York. Harperand Row. 1985: 204.

AÓ Ë ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹ ·ÔÙÂÏ› ÎÂÊ¿Ï·ÈÔÂÓfi˜ ‚È‚Ï›Ô˘ Ô˘ ¤¯ÂÈ ÁÚ·Ê› ·fi ¿ÏÏÔ Û˘ÁÁڷʤ·, Ë·Ó·ÊÔÚ¿ Á›ÓÂÙ·È ˆ˜ ÂÍ‹˜: Johnston AJ: CorrosionResistance of Amalgams. In: Goldman AK, Johns KO,eds. Restorative Materials, Baltimore. Williams andWilkins Co., 1984-87.

IÛÙÔÛÂÏ›‰Â˜: http://www.eudental.org/Communitystrategy concerning mercury, fiˆ˜ ·˘Ùfi ÂÌÊ·Ó›˙ÂÙ·È ÙËÓ.............. (ËÌÂÚÔÌËÓ›· ·Ó·˙‹ÙËÛ˘).

H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ˘ÂÓı˘Ì›˙ÂÈ ÛÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ÙˆÓ ÂÚÁ·ÛÈÒÓ fiÙÈ Î·Ïfi ›ӷÈ, ÛÙȘ ηٷÙÈı¤ÌÂÓ˜ ÂÚÁ·Û›Â˜Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô-̤˜, ÂÊfiÛÔÓ ‚¤‚·È· ˘Ê›ÛÙ·ÓÙ·È, ÔÈÔÙÈο EÏÏËÓÈο ¿Ú-ıÚ· Û¯ÂÙÈο Ì ÙÔ ı¤Ì·.

AÁÁÏÈ΋ ÂÚ›ÏË„Ë: ¶ÂÚÈÏ·Ì‚¿ÓÂÈ, ÛÙËÓ AÁÁÏÈ΋ ÁÏÒÛ-Û·, 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·ÈÛÙÔȯ›· ÁÈ· fiÏ· Ù· ÎÂÊ¿Ï·È· Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î·È Ù·Û˘ÌÂÚ¿ÛÌ·Ù·. ™ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ı· Ú¤ÂÈ Ó··Ó·Ê¤ÚÂÙ·È Ë ÂÈÛ·ÁˆÁ‹ Ô ÛÎÔfi˜, Ù· ˘ÏÈο Î·È Ë Ì¤ıÔ‰Ô˜,Ù· ·ÔÙÂϤÛÌ·Ù· Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Î·È Ë Û˘˙‹ÙËÛË. H¤ÎÙ·ÛË ÙˆÓ ÂÚÈÏ‹„ÂˆÓ ı· Ú¤ÂÈ Ó· Î˘Ì·›ÓÂÙ·È ÌÂÙ·Í‡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· ›ӷÈÛ‡ÓÙÔÌË Î·È Î·Ù·ÙÔÈÛÙÈ΋. AÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜·ÚÈıÌÔ‡˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. OÈ ÂÂÍËÁ‹ÛÂÈ˜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 ÊˆÙÔÁÚ·-ʛ˜ Ú¤ÂÈ Ó· ÂÈÛ˘Ó¿ÙÔÓÙ·È ÛÙÔ ÚˆÙfiÙ˘Ô Î·È Ó· Â›Ó·È˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜. OÈ ÏÂ˙¿ÓÙ˜ ÙˆÓ ÂÈÎfiÓˆÓ ÁÚ¿ÊÔÓÙ·ÈÌ ÙÔÓ ·‡ÍÔÓÙ· ·ÚÈıÌfi ÙÔ˘˜ ۠ͯˆÚÈÛÙ‹ ÛÂÏ›‰· ηٿÙËÓ ˘Ô‚ÔÏ‹ Ù˘ ÂÚÁ·Û›·˜. Y¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ÂÎÙ‡ˆ-Û˘ ¤Á¯ÚÒÌˆÓ ÂÈÎfiÓˆÓ ÌÂÙ¿ ·fi Û˘ÓÂÓÓfiËÛË Ì ÙԢȢı˘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˘ÛËÙÔ˘Ï¿¯ÈÛÙÔÓ 300 dpi, Ó· ¤¯Ô˘Ó ÙË ÌÔÚÊ‹ ·Ú¯Â›ˆÓ JPG ηÈÓ· ÌËÓ ÂÌÂÚȤ¯ÔÓÙ·È ÛÙË ÚÔ‹ ÙÔ˘ ηٷÙÈıÂ̤ÓÔ˘ ÎÂÈ̤-ÓÔ˘. EÊfiÛÔÓ ÛÙȘ ÂÈÎfiÓ˜ ÂÌÊ·Ó›˙ÂÙ·È ÙÔ ÚfiÛˆÔ ÙÔ˘¿Û¯ÔÓÙÔ˜, Ë ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, ηٿ ÙË ‰ËÌÔÛ›Â˘ÛË,ı· ηχÙÂÈ ÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ÔÊı·ÏÌÒÓ Ì ̷‡ÚË Ù·ÈÓ›·ÁÈ· ÏfiÁÔ˘˜ Û‚·ÛÌÔ‡ ÚÔÛˆÈÎÒÓ ‰Â‰Ô̤ӈÓ.

H ÎÚ›ÛË ÙˆÓ ÂÚÁ·ÛÈÒÓ Á›ÓÂÙ·È ·fi ‰‡Ô ÎÚÈÙ¤˜ Ô˘¤¯Ô˘Ó ÂÈÏÂÁ› ·fi ÙËÓ EÈÙÚÔ‹ ™‡ÓÙ·Í˘. H ™˘ÓÙ·ÎÙÈ΋EÈÙÚÔ‹ ÙÔ˘ ¶ÂÚÈÔ‰ÈÎÔ‡ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ÚÔÙ›-ÓÂÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ Ó· ·ÔÚÚ›ÙÂÈ Ù· ¿ÚıÚ· Ô˘ ‰ÂÓ Â›Ó·ÈÁÚ·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· ·Ô-ÙÂÏÔ‡Ó È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. °È· ÙËÓ ·Ó·‰ËÌÔÛ›Â˘Û‹ÙÔ˘˜ Â›Ó·È ··Ú·›ÙËÙË Ë ¿‰ÂÈ· Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜Î·È ÙÔ˘ Û˘ÁÁڷʤ·.

EÈÛ‹Ì·ÓÛË: °È· ÙËÓ ·Ú·Ï·‚‹ ÂÈÛÙËÌÔÓÈ΋˜ ÂÚÁ·-Û›·˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË Ú¤ÂÈ Ó· ÂÈÛ˘Ó¿ÙÂÙ·È ‰È·‚‚·›ˆ-ÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ Î·Ù·ÙÂı› Û¿ÏÏÔ ÂÈÛÙËÌÔÓÈÎfi ¤ÓÙ˘Ô ÂÚÈÔ‰ÈÎÔ‡ Ù‡Ô˘, fiÙÈ ‰ÂÓ Â-ÚȤ¯ÔÓÙ·È ·˘ÙÔ‡ÛȘ ÚÔÙ¿ÛÂȘ ·fi ¿ÏϘ ÂÈÛÙËÌÔÓÈΤ˜‰ËÌÔÛȇÛÂȘ –ÏËÓ ÙˆÓ ÔÚÈÛÌÒÓ, ÓfïÓ, ηÓfiÓˆÓ Î·È‰È·Ù¿ÍˆӖ Î·È fiÙÈ ÙÔ ÊˆÙÔÁÚ·ÊÈÎfi ˘ÏÈÎfi Â›Ó·È ›‰ÈÔ ‹ ÌÂ-ٷۯ‰›·ÛË ‹ ¿Ïψ˜ Ó· ·Ó·Ê¤ÚÂÙ·È Û·ÊÒ˜ Ë ËÁ‹, η-ıÒ˜ ›Û˘ Î·È fiÙÈ ÏËÚÔ‡ÓÙ·È ÔÈ ÚÔ¸Ôı¤ÛÂȘ ÙÔ˘¶.¢.39 Ù˘ 1˘ AÚÈÏ›Ô˘ 2009 ·Ú. ºEK 55.

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INSTRUCTIONS FOR AUTHORS

HELLENIC STOMATOLOGICAL REVIEW is the officialpeer-reviewed open access electronic publication of theHellenic Dental Association and aims at providing Greekand international dentists with ongoing up-to-datescientific information in all fields of dental science. The Journal publishes the following types of articles:

1. Focus articles:Review articles addressing contemporary and contro-versial topics proposed by the Editorial Board andwritten by colleagues with expertise on the particulartopics.

2. Original articles:These articles may fall into one of the following cate-gories: (a) Reviews (up to 3 authors), (b) Researchpapers (Experimental studies, Clinical studies, Labora-tory studies, Epidemiological Studies, Clinicostatisticalstudies, Clinopathological studies), (c) Interesting casereports, (d) Practice-related topics, (e) Scientifically-do-cumented 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 priorto publication and may pertain to: (a) critical reviews ofpublished articles and (b) specific queries on science-related topics, answers to which are provided in the cor-respondence section.

4. Short reports:These original papers or findings should not exceed2.000 words and are published as soon as possible afterundergoing a review process by the Editorial Board.

5. Reviews from published articles:These reviews focus on Greek colleagues articlesrecently published in international journals.

Article length: Reviews should not exceed 7.500 words(25 typed pages) and should have no more than 100references, with the exception of special issues relatedto basic sciences. Research papers and practice-relatedtopics should not exceed 3.000 words (10 pages) andhave no more than 40 references. Any articles onimportant case reports should not exceed 1.000 words(4 pages) while articles addressing professional issuesshould be no more than 5.000 words (20 pages). Thereference list is included in the total word count and mustbe timely and pertinent to the topic under discussion.

Text structure: The manuscripts submitted for publi-cation must be written both in modern Greek, using themonotonic system and in English. The Editorial Boardreserves the right to check the accuracy of the Englishterms and phrasings, consulting with professional medi-cal translators. The Copy Editor of the Journal reserves

the right to proceed to linguistic modifications withoutdistorting, though, the authors style. Particularly for the English speaking authors, manuscriptsmay be submitted only in English language with anextensive (300 words) Greek summary. In this case thescientific editorial board will undertake the preparation ofthe summary applying the appropriate Greek terminology.All papers submitted must be double spaced, typed inArial, Tahoma or Verdana font with margins on bothsides. The title page, the summary and key words, the maintext of the paper, the English summary and key words,the references, the legends, the tables and the figuresappear on separate pages. All pages are numbered inthe above order.Starting January 2010 all manuscripts are also submittedelectronically 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 previouslypresented 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 offinancing for research.

Summary and key words: The summary should be nolonger than 200 words. In research papers the summaryincludes the purpose, the material, the methodology andthe conclusions and it is followed by key words whichnormally include 3-10 key terms or short phrases. Theparticular words must be in accordance with the inter-national lexicographical terminology as it appears inIndex Medicus and Dental Index and must be included inthe summary.

Main text: Literature reviews should include a com-prehensive introduction followed by a summarization ofall the views relevant to the topic under discussion,based on specific references. Finally, the author isexpected to provide a critical analysis of these views andreach clear conclusions. Research papers should comprise the following chap-ters: Introduction, Materials and Method, Findings-Re-sults, Discussion and Conclusions. As regards the re-maining types of articles, the text should follow anappropriate layout to meet the article demands.

References: Any references in the text, the tables andthe figure legends are cited by arabic numerals inbrackets. Any dots or commas appear after the bracke-ted reference. The references are numbered consecu-tively in the order of appearance.All references mentioned in the text are included in thereference list which appears on a separate page after theend of the text. Every reference in the list should bepreceded by the number it is identified with in the maintext.

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The reference list should be organised in the followingsequence: names of the authors (surname, first namefollowed by a comma, then surname of the next authorand 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 lastpage separated by a slash). Titles of Greek journalsshould be abbreviated in accordance with the IATROTEKlist. The use of summaries, unpublished comments orpersonal communications as references should beavoided. Hellenic Stomatological Review should beabbreviated as Hel Stom Rev. Papers accepted for publication, though not publishedyet, can be included in the reference list. In this case, thephrase under publication in brackets is added. If the thereference list contains articles from journals using alanguage of latin origin with language-specific features(German, Scandinavian, French), the authors areresponsible for word stress. An example of correctreference presentation is as follows:

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Books and other monographs: The authors surnamesand 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 bookwritten by another author, it should appear as follows:Johnston AJ: Corrosion Resistance of Amalgams. In:Goldman AK, Johns KO, eds. Restorative Materials, Balti-more. Williams and Wilkins Co., 1984-87.

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E›Â‰Ô ÛÙÔÌ·ÙÈ΋˜ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 6 ÂÙÒÓ ÛÙË K‡ÚÔ

X. X·Ú·Ï¿ÌÔ˘˜*, M. £ÂÔ‰ÒÚÔ˘**, ¶. °·Ï¿Ó˘***, X. TÛ¤ÏÂÔ˜****

¶EPI§HæH

™ÎÔfi˜: Ë ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÂȤ‰Ô˘ Ù˘ ÛÙÔÌ·ÙÈ΋˜˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 6 ÂÙÒÓ ÛÙËÓ K‡ÚÔ.YÏÈÎfi M¤ıÔ‰Ô˜: XÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË Ì¤ıÔ‰Ô Ù˘ Ù˘-¯·›·˜ ‰È·ÛÙڈ̷ÙÈ΋˜ ‰ÂÈÁÌ·ÙÔÏË„›·˜, ÂÈϤÁËηÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· 675 6¯ÚÔÓˆÓ ·È‰ÈÒÓ ·fifiÏË ÙËÓ K‡ÚÔ, ·fi Ù· ÔÔ›·, Ù· 577 ·È‰È¿ (85,5%)¤Ï·‚·Ó Û˘ÁηٿıÂÛË ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ ÁÈ· Ó·Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ¤Ú¢ӷ. H ·ÔÙ‡ˆÛË ÙˆÓ ‰ÂÈ-ÎÙÒÓ dmft Î·È PI ¤ÁÈÓ ̤ۈ Ù˘ ÎÏÈÓÈ΋˜ ÂͤٷÛË˜ÙˆÓ ·È‰ÈÒÓ ÛÙÔ˘˜ ¯ÒÚÔ˘˜ ÙˆÓ Û¯ÔÏÈÎÒÓ È·ÙÚ›ˆÓ˘fi Û˘Óı‹Î˜ Ê˘ÛÈÎÔ‡ ʈÙfi˜. O ‰Â›ÎÙ˘ ÙÂÚˉfiÓ·˜Î·È Ͽη˜ Û˘Û¯ÂÙ›ÛÙËΠ̠‰È¿ÊÔÚ˜ ÌÂÙ·‚ÏËÙ¤˜(ËÏÈΛ·, ʇÏÔ, ·گ›·, ÂıÓÈÎfiÙËÙ· Î·È Â¿ÁÁÂÏÌ·ÁÔÓ¤ˆÓ) Ú·ÁÌ·ÙÔÔÈÒÓÙ·˜ ‰È·Ú·ÁÔÓÙÈΤ˜ Î·È Ô-Ï˘·Ú·ÁÔÓÙÈΤ˜ ·Ó·Ï‡ÛÂȘ.

SUMMARY

Purpose: To evaluate the oral health status of childrenaged 6 years in Cyprus.Material and Method: This World Health Organizationpathfinder study was conducted among 675 six-yearold children, living in Cyprus. A total of 577 (85.5%)participated in this study. Caries and plaque level wasanalyzed at univariate and multivariate levels, accor-ding to age, gender, location, ethnicity and parentsoccupational level. Results: The mean dmft was 1.83 (SD = 2.84) lowercompared to 2.23 in 2006 and 2.14 in 2010. Overall,54.2% of the 6 year children had no caries experience,37.4% had related treatment needs (dt>0). Childrenwhose parents worked in low-level occupations hadmore often decayed teeth (dt>0) compared with

9

Oral health in 6-year old schoolchildren in CyprusC. Charalambous*, M. Theodorou**, P. Galanis***, C. Tselepos****

EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

* O‰ÔÓÙÈ·ÙÚÈ΋ §ÂÈÙÔ˘ÚÁfi˜, YÔ„‹ÊÈ· ¢È‰¿ÎÙˆÚ AÓÔÈÎÙÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ K‡ÚÔ˘

** K·ıËÁËÙ‹˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ «¶ÔÏÈÙÈ΋ YÁ›·˜ Î·È ™¯Â‰È·ÛÌfi˜ YËÚÂÛÈÒÓ YÁ›·˜» AÓÔÈÎÙfi ¶·ÓÂÈÛÙ‹ÌÈÔ K‡ÚÔ˘

*** PhD,TÌ‹Ì· NÔÛËÏ¢ÙÈ΋˜, EK¶A**** AÓ. ¢È¢ı˘ÓÙ‹˜ O‰ÔÓÙÈ·ÙÚÈÎÒÓ YËÚÂÛÈÒÓ

AÓÔÈÎÙfi ¶·ÓÂÈÛÙ‹ÌÈÔ K‡ÚÔ˘

* Dental Officer, PhD (c), Open University of Cyprus** Prof. Dr, Open University of Cyprus

*** PhD, Faculty of Nursing, Greece**** Acting Director Public Dental Services Cyprus

Open University of Cyprus

ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 59: 9-24, 2015 Hellenic Stomatological Review 59: 9-24, 2015

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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

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Hellenic Stomatological Review 59: 9-24, 2015

AÔÙÂϤÛÌ·Ù·: O ̤ÛÔ˜ fiÚÔ˜ ÙÔ˘ ‰Â›ÎÙË ÙÂÚˉfiÓ·˜‚Ú¤ıËΠӷ Â›Ó·È dmft= 1,83 (SD 2,84), Û ۯ¤ÛËÌ ÙËÓ ÙÈÌ‹ 2,14 ÙÔ˘ 2010 Î·È 2,23 ÙÔ˘ 2006. TÔ 54,2%ÙˆÓ ·È‰ÈÒÓ ‹Û·Ó ÂχıÂÚ· ·fi ÙÂÚˉfiÓ· (dmft=0)ÂÓÒ ÙÔ 37,4% ·ÚÔ˘Û›·˙ ·Ó¿ÁΘ ıÂڷ›·˜ (dt>0).™ÙÔÓ ¤ÏÂÁ¯Ô ÔÏÏ·Ï‹˜ ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘,Ù· ·È‰È¿ Ô˘ ÔÈ ÁÔÓ›˜ ÙÔ˘˜ ·ÛÎÔ‡Û·Ó Â·ÁÁ¤Ï-Ì·Ù· ¯·ÌËÏÔ‡ ÂȤ‰Ô˘ ÂÌÊ¿ÓÈ˙·Ó Ì ÌÂÁ·Ï‡ÙÂÚËÛ˘¯ÓfiÙËÙ· ÙÂÚˉÔÓÈΤ˜ ‚Ï¿‚˜ (dt>1) Î·È ÂÌÂÈ-Ú›· ÙÂÚˉfiÓ·˜ (dmft>1), Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ô˘ÔÈ ÁÔÓ›˜ ÙÔ˘˜ ·ÛÎÔ‡Û·Ó ˘„ËÏÔ‡ ÂȤ‰Ô˘ ·Á-Á¤ÏÌ·Ù· (OR=0,35 95%¢E =0,22-0,57 p<0,001 ηÈOR=0,48 95%¢E =0,30-0,77 p=0,001, ·ÓÙ›ÛÙÔȯ·).¶ÂÚ·ÈÙ¤Úˆ, Ù· ·È‰È¿ ·fi ̄ ÒÚ˜ Ù˘ AÓ·ÙÔÏÈ΋˜ E˘-ÚÒ˘ ›¯·Ó Û˘¯ÓfiÙÂÚ· ÛÊÚ·ÁÈṲ̂ӷ ‰fiÓÙÈ· ·fiÙ· K˘ÚÈfiÔ˘Ï· (OR=2,65 95%¢E =1,32-5,34p=0,006). AÓ·ÊÔÚÈο Ì ÙËÓ Î·Ù¿ÛÙ·ÛË ÙˆÓ Ô‡-ÏˆÓ 41,2% ÙˆÓ 6¯ÚÔÓˆÓ Â›¯·Ó ‰Â›ÎÙË Ï¿Î·˜ =0. ™˘ÌÂÚ¿ÛÌ·Ù·: O ‰Â›ÎÙ˘ ÙÂÚˉfiÓ·˜ ÁÈ· Ù· 6¯ÚÔ-Ó· ·È‰È¿ Ù˘ K‡ÚÔ˘ ‚Ú›ÛÎÂÙ·È Û ÈηÓÔÔÈËÙÈ·, ηٷÁÚ¿ÊÔÓÙ·˜ ‰È·¯ÚÔÓÈο ‚ÂÏÙ›ˆÛË. ¶·-ÚfiÏ· ·˘Ù¿, ·Ó·‰Â›¯ıËÎ·Ó ·ÓÈÛfiÙËÙ˜ ÌÂٷ͇ ‰È·-ÊfiÚˆÓ ÎÔÈÓˆÓÈÎÒÓ ÔÌ¿‰ˆÓ, ÂıÓÈÎÔÙ‹ÙˆÓ Î·È ÂÚÈÔ-¯ÒÓ, ÁÂÁÔÓfi˜ Ô˘ ÂÈÙ¿ÛÛÂÈ ÙËÓ ·Ó¿ÁÎË ¯¿Ú·Í˘ÌÈ·˜ Ó¤·˜ ÛÙÚ·ÙËÁÈ΋˜ ÁÈ· ÙË ÛÙÔÌ·ÙÈ΋ ˘Á›·. HÛÙÚ·ÙËÁÈ΋ ·˘Ù‹, ÛÙ· Ï·›ÛÈ· Ù˘ ÔÏ˘ÙÔÌ·΋˜ Û˘-ÓÂÚÁ·Û›·˜, ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÈ ÔÏÈÛÙÈο ÙÔ˘˜·Ú¿ÁÔÓÙ˜ Ô˘ ÙËÓ ÂËÚ¿˙Ô˘Ó, ‰›ÓÔÓÙ·˜ ÚÔÙÂ-Ú·ÈfiÙËÙ· ÛÙËÓ ÚfiÏË„Ë Î·ıÒ˜ Î·È ÛÙȘ ¢¿ÏˆÙ˜ÔÌ¿‰Â˜ ÏËı˘ÛÌÔ‡.

§¤ÍÂȘ ÎÏÂȉȿ: ÛÙÔÌ·ÙÈ΋ ˘Á›·, ÂÍ¿¯ÚÔÓ· ·È‰È¿, K‡ÚÔ˜

EI™A°ø°H

TȘ ÙÂÏÂ˘Ù·›Â˜ ÙÚÂȘ ‰ÂηÂٛ˜, ̤۷ ·fi ÔÏϷϤ˜ÌÂϤÙ˜ ηٷ‰ÂÈÎÓ‡ÂÙ·È ÌÈ· ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙÔ˘ ÂÈ-ÔÏ·ÛÌÔ‡ Ù˘ ÙÂÚˉfiÓ·˜ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi ÌÂÙ·-͇ ÙˆÓ ·ÓÂÙ˘ÁÌ¤ÓˆÓ ¯ˆÚÒÓ1,2. ™ÙË °·ÏÏ›· ÙÔ 93% ÙˆÓ6¯ÚÔÓˆÓ ‚Ú¤ıËΠÂχıÂÚÔ ÙÂÚˉfiÓ·˜3. H Ì›ˆÛË ·˘-Ù‹ ‹Ù·Ó ·ÔÙ¤ÏÂÛÌ· ÔÏÏÒÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ Ë ·˘ÍË-̤ÓË ¯Ú‹ÛË ÊıÔÚÈÔ‡¯·˜ Ô‰ÔÓÙfiÎÚÂÌ·˜, ÔÈ Û˘¯ÓfiÙÂÚ˜ÙÔÈΤ˜ ÂÊ·ÚÌÔÁ¤˜ ÊıÔÚ›Ô˘ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi ·fiÏÂ˘Ú¿˜ Ô‰ÔÓÙÈ¿ÙÚˆÓ, Ë ÌÂȈ̤ÓË Î·Ù·Ó¿ÏˆÛË ̇ ¿¯·ÚË˜Î·È Ë Û˘¯ÓfiÙÂÚË ÛÙÔÌ·ÙÈ΋ ˘ÁÈÂÈÓ‹. ™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÁÈ·ÙË ‚ÂÏÙ›ˆÛË ·˘Ù‹ η٤ÁÚ·„Â Î·È Ë Â˘Ú‡ÙÂÚË ÎÔÈÓˆÓÈÎ‹Î·È ÔÈÎÔÓÔÌÈ΋ ·Ó¿Ù˘ÍË4. ¶·ÚfiÏ· ·˘Ù¿ Û˘Ó¯›˙Ô˘Ó, ·Îfi-

children whose parents worked in medium (OR=0.61,95% CI=0.39- 0.94 p<0,001) or high-level occupa-tions (OR=0.35, 95% CI=0.22-0.57 p<0,001). Simi-larly, children whose parents worked in low-level oc-cupations had more often dmft ≥1 compared withchildren whose parents worked in medium (OR =0.77, 95% CI=0.50- 1.21 p=0.001) or high level occu-pations (OR=0.48, 95% CI=0.30-0.77 p=0.001). Inaddition, immigrants from Eastern Europe were morelikely to have filled teeth than Cypriot children (OR= 2.65, 95% CI=1.32-5.34 p=0,006). Regarding thecondition of the gums, 41.2% of six-year old childrenhad no plaque.Conclusions: Oral health of the six-year old childrenliving in Cyprus has improved over the last ten years.Nevertheless, social inequalities have been recordedamong different social groups and nationalities. Thishighlights the need for a new strategy for better oralhealth that will address all factors that affect oral health,giving emphasis on prevention and on vulnerablegroups with increased need.

Key Words: oral health, 6 year old children, Cyprus

INTRODUCTION

During the past three decades, several epidemiologicalstudies have reported a marked decrease in cariesexperience in developed countries1,2. In France, 93% ofchildren at the age of six were caries free3. The reason forthis decline is complex and involves many factors such asthe extensive use of fluoride toothpastes, topical appli-cations of fluoride by dentists, reduced sugar consumptionand improved oral hygiene practices. In addition, socialand economic development was found to be significantlyassociated with the decline in the caries level4. Even indeveloped countries, inequalities exist in caries indexamong different socio-economic groups. The poor anddisadvantaged are suffering from a higher burden of thedisease while at the same time they have less access toappropriate care5. As a result, caries remains the most com-mon disease affecting children, especially those from lowersocio-economic groups6. Specifically, in 2010, untreatedcaries in deciduous teeth was the 10th-most prevalentcondition, affecting 621 million children worldwide7.Cypriots overall enjoy quite good health services similarto those in other European countries. The existing healthcare system, which is expected to change in 2017i, consistsof two parallel delivery systems: a public and a separate

i In 2013 Cyprus signed a Memorandum of Understanding with the EU. The obligations emanating from the Memorandum included theprovision for a new National Health System which will be based on universal insurance and will provide free care to people. Regardingdental care only preventive care for children aged 3-16 will be reimbursement.

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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

private one. The public is exclusively financed by the statebudget and offers access to 78% of the population.However, only 70% of the beneficiaries make use of it9.As a result, Cyprus records high percentage of privateexpenditure on health care (53.6%8). Regarding dentalcare, only 12% of the beneficiaries use the public servicesalthough a wide range of services are offered by the PublicDental Services, except from implants and fixed prosthetics.The rest of the population prefers the private sector whereservices are covered by out of pocket payments with pricesregulated by the market forces9,10. The first pathfinder study on oral health of people living inCyprus was conducted in 1992 and concerned the agegroups of 12, 15, 35-44 and 55-6411. This survey was followedby a pilot study in 2006 for children aged 6 and 12 yearsold12, and another pilot study in 2010 for children aged 6,12 and 1513. However, all these studies used only clinicaldata to describe the level of oral health. This is the first timethat clinical data are related with different socio-economicfactors, as well as with peoples own perceptions about theiroral health and their quality of life.

METHODOLOGY

The present study is part of a larger pathfinder surveyconducted by the Cyprus Public Dental Services in orderto assess the level of oral health of people living in Cyprus.The objective of this article is to present the level of dentalcaries as well as the gingival status of the six year oldchildren.Six hundred seventy five six-year old children (n=675) fromall different districts in Cyprus were randomly selectedusing the pathfinder method to participate in this cross-sectional study. This number corresponds to 7.8% of allchildren aged 6 who attend primary public schools inCyprusii. Written parental consent was provided from fivehundred seventy-seven children (n=577, 85.5%) whoformed the final sample of this study. The schools that were selected (in total 26) to participatein this study were the same as in the 2010 studyiii; in orderthe results to be comparable and reliable conclusions tobe drawn. The final sample of the children was selectedfrom the school lists with the help of tables of randomnumbers. Of note that the schools that took part in the 2010study, were selected following the pathfinder method14.Initially the reference population was divided according tothe administrative division of Cyprus into 5 districts (Nicosia,

ÌË Î·È ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ̄ ÒÚ˜, Ó· ηٷÁÚ¿ÊÔÓÙ·È ·ÓÈ-ÛfiÙËÙ˜ ÛÙÔ ‰Â›ÎÙË ÙÂÚˉfiÓ·˜ ÌÂٷ͇ ‰È·ÊfiÚˆÓ ÎÔÈÓˆ-ÓÈÎÔ-ÔÈÎÔÓÔÌÈÎÒÓ ÛÙڈ̿وÓ5 Ì ·ÔÙ¤ÏÂÛÌ· Ë ÙÂÚË-‰fiÓ· Ó· ·Ú·Ì¤ÓÂÈ Ì›· ·fi ÙȘ ÈÔ Û˘¯Ó¤˜ ·ı‹ÛÂȘ Ô˘ÂËÚ¿˙ÂÈ Ù· ·È‰È¿ Î·È Î˘Ú›ˆ˜ fiÛ· ÚÔ¤Ú¯ÔÓÙ·È ·fiÙ· ¯·ÌËÏfiÙÂÚ· ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈο ÛÙÚÒÌ·Ù·6. EȉÈ-ÎfiÙÂÚ· ÙÔ 2010 ÛÙÔÓ ·ÁÎfiÛÌÈÔ ›Ó·Î· ÙˆÓ ·ı‹ÛˆÓË ÌË ıÂÚ·Â˘Ì¤ÓË ÙÂÚˉfiÓ· ÛÙ· ÓÂÔÁÈÏ¿ ‰fiÓÙÈ· ηÙ›-¯Â ÙË 10Ë ı¤ÛË, ÂËÚ¿˙ÔÓÙ·˜ 62 ÂηÙÔÌ̇ÚÈ· ·È‰È¿7.H K‡ÚÔ˜ ·Ó‹ÎÂÈ ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ Î·È Â›Ó·È Ì¤-ÏÔ˜ Ù˘ EE ·fi ÙÔ 2004. TÔ ˘¿Ú¯ÔÓ Û‡ÛÙËÌ· ˘Á›·˜,Ô˘ ·Ó·Ì¤ÓÂÙ·È fï˜ Ó· ÙÚÔÔÔÈËı› ÂÓÙfi˜ ÙÔ˘ 2017i,ÛÙËÚ›˙ÂÙ·È ÛÙË ÊÔÚÔÏÔÁ›· Î·È ÚÔÛʤÚÂÈ ÚfiÛ‚·ÛË Û¢ËÚÂۛ˜ ˘Á›·˜ (‰ˆÚÂ¿Ó ‹ Î·È Ì ¯·ÌËÏ¿ Ù¤ÏË) ·fiÙÔ ‰ËÌfiÛÈÔ ÙÔ̤· ÛÙÔ 78% ÙÔ˘ ÏËı˘ÛÌÔ‡. ¶·ÚfiÏ· ·˘-Ù¿, ÌfiÓÔ ÙÔ 70% ÙˆÓ ‰ÈηÈÔ‡¯ˆÓ οÓÂÈ ¯Ú‹ÛË ÙÔ˘ ‰ËÌfi-ÛÈÔ˘ ÙÔ̤·, Ì ·ÔÙ¤ÏÂÛÌ· Ë K‡ÚÔ˜ Ó· ηٷÁÚ¿ÊÂÈ ̆ „Ë-Ïfi (53,6%) ÔÛÔÛÙfi ȉȈÙÈÎÒÓ ‰··ÓÒÓ ÁÈ· ÙËÓ ˘Á›·8.H ηٿÛÙ·ÛË Â›Ó·È ÂÓÙÔÓfiÙÂÚË, ·Ó·ÊÔÚÈο Ì ÙËÓ Ô‰Ô-ÓÙÈ·ÙÚÈ΋ ÂÚ›ı·Ï„Ë, fiÔ˘ ÌfiÓÔ ÙÔ 12% οÓÂÈ ̄ Ú‹ÛË ÙˆÓ‰ËÌfiÛÈˆÓ ˘ËÚÂÛÈÒÓ, ·ÚfiÏÔ Ô˘ ·fi ÙÔÓ ‰ËÌfiÛÈÔ ÙÔ-̤· ÚÔÛʤÚÂÙ·È ¤Ó· ¢ڇ Ê¿ÛÌ· Ô‰ÔÓÙÈ·ÙÚÈ΋˜ ÊÚÔ-ÓÙ›‰·˜ (Ì ÂÍ·›ÚÂÛË ÙËÓ ·Î›ÓËÙË ÚÔÛıÂÙÈ΋ Î·È Ù· ÂÌ-Ê˘Ù‡̷ٷ), ÁÈ· fiϘ ÙȘ ËÏÈ˘. O ˘fiÏÔÈÔ˜ ÏËı˘-ÛÌfi˜ ·Â˘ı‡ÓÂÙ·È ÛÙÔÓ È‰ÈˆÙÈÎfi ÙÔ̤·, fiÔ˘ Ë ÏËڈ̋Á›ÓÂÙ·È ·fi ÙȘ ȉȈÙÈΤ˜ ‰·¿Ó˜ Ì ÙÈ̤˜ Ô˘ Ú˘ıÌ›˙Ô-ÓÙ·È ·fi ÙȘ ‰˘Ó¿ÌÂȘ Ù˘ ·ÁÔÚ¿˜9,10.H ÚÒÙË ¤Ú¢ӷ ·ÍÈÔÏfiÁËÛ˘ ÙÔ˘ ÂȤ‰Ô˘ Ù˘ ÛÙÔÌ·-ÙÈ΋˜ ˘Á›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ Ù˘ K‡ÚÔ˘ ¤ÁÈÓ ÙÔ 1992Î·È ·ÊÔÚÔ‡Û ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ 12, 15, 35-44 Î·È 55-6411. AÎÔÏÔ‡ıËÛÂ Ë ÈÏÔÙÈ΋ ¤Ú¢ӷ ÁÈ· Ù· ·È‰È¿ ËÏÈΛ·˜6 Î·È 12 ÙÔ 200612 Î·È Ë ÈÏÔÙÈ΋ ¤Ú¢ӷ ÁÈ· Ù· ·È‰È¿ËÏÈΛ·˜ 6, 12 Î·È 15 ÙÔ 201013. OÈ ÚÔ·Ó·ÊÂÚı›Û˜ ¤Ú¢-Ó˜, fï˜, ÛÙËÚ›¯ÙËÎ·Ó ÌfiÓÔ Û ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ÁÈ· ÙËÓ·ÔÙ‡ˆÛË ÙÔ˘ ÂȤ‰Ô˘ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ˘Á›·˜. A˘Ù‹Â›Ó·È Ë ÚÒÙË ÊÔÚ¿ Ô˘ ÂȯÂÈÚÂ›Ù·È ·ÔÙ‡ˆÛË ÙÔ˘ ÂÈ-¤‰Ô˘ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ˘Á›·˜ ÙˆÓ ÔÏÈÙÒÓ Ù˘ K‡ÚÔ˘,fi¯È ÌfiÓÔ Ì ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· ·ÏÏ¿ ·Ú¿ÏÏËÏ· Ï·Ì‚¿ÓÔ-ÓÙ·˜ ̆ fi„Ë ÙËÓ ̆ ÔÎÂÈÌÂÓÈ΋ ÂÎÙ›ÌËÛË ÙˆÓ ÔÏÈÙÒÓ. ¶·-Ú¿ÏÏËÏ·, ÁÈ· ÚÒÙË ÊÔÚ¿ ‰È·Û˘Ó‰¤ÔÓÙ·È ÔÈ ÎÏÈÓÈÎÔ› ‰Â›-ÎÙ˜ (‚ÈÔÏÔÁÈΤ˜ ·Ú¿ÌÂÙÚÔÈ) Ì ‰È¿ÊÔÚ˜ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜, ‚¿ÛË ÙÔ˘ ‚ÈÔ-„˘¯Ô-ÎÔÈÓˆÓÈÎÔ‡ÌÔÓÙ¤ÏÔ˘ ıÂÒÚËÛ˘ Ù˘ ˘Á›·˜/ÓfiÛÔ˘ .H ·ÚÔ‡Û· ÌÂϤÙË ·ÔÙÂÏ› ̤ÚÔ˜ ¢ڇÙÂÚ˘ ¤Ú¢ӷ˜Ô˘ ‰ÈÂÍ‹¯ıË ·fi ÙÔÓ I·ÓÔ˘¿ÚÈÔ Ì¤¯ÚÈ Î·È ÙÔÓ IÔ‡ÓÈÔÙÔ˘ 2014 Ì ÛÙfi¯Ô Ó· ·ÍÈÔÏÔÁ‹ÛÂÈ ÙÔ Â›Â‰Ô Ù˘ ÛÙÔ-Ì·ÙÈ΋˜ ˘Á›·˜ ÙˆÓ ÔÏÈÙÒÓ Ù˘ K‡ÚÔ˘ ÁÈ· 5 ËÏÈÎȷΤ˜

Hellenic Stomatological Review 59: 9-24, 2015

i H K‡ÚÔ˜ ÂÓÙ¿¯ıËΠÛÙÔ M˯·ÓÈÛÌfi ™Ù‹ÚÈ͢ ÙÔ 2013. M›· ·fi ÙȘ MÓËÌÔÓȷΤ˜ ̆ Ô¯ÚÂÒÛÂȘ ·ÔÙÂÏ› ÂÓÙfi˜ ÙÔ˘ 2017 Ë ÂÈÛ·ÁˆÁ‹ÂÓfi˜ N¤Ô˘ ™¯Â‰›Ô˘ YÁ›·˜ Ô˘ ı· ÛÙËÚ›˙ÂÙ·È ÛÙËÓ Î·ıÔÏÈ΋ ·ÛÊ¿ÏÈÛË Î·È ı· ÚÔÛʤÚÂÈ ‰ˆÚÂ¿Ó ÂÚ›ı·Ï„Ë ÛÙÔ˘˜ Ôϛ٘ Ì ‰È-η›ˆÌ· ÂÈÏÔÁ‹˜ ÙÔ˘ ÚÔÛˆÈÎÔ‡ È·ÙÚÔ‡. AÓ·ÊÔÚÈο Ì ÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ÂÚ›ı·Ï„Ë ı· ηχÙÂÙ·È ÌfiÓÔ ‰ˆÚÂ¿Ó ÚÔÏËÙÈ΋ ·Áˆ-Á‹ ÁÈ· ÙȘ ËÏÈ˘ 3-16

ii Attendance to schools in Cyprus is compulsory until the age of 15. To attend the first grade a child must be 6 years old, thus the samplewas collected from the school lists of children attending the first grade.

iii The total number of public schools in Cyprus has remained stable the last years

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Hellenic Stomatological Review 59: 9-24, 2015

ÔÌ¿‰Â˜ ÙˆÓ 6, 12, 15, 35-44 Î·È 65-74 ÂÙÒÓ. ™ÙËÓ ·ÚÔ‡-Û· ÌÂϤÙË ı· ·ÚÔ˘ÛÈ·ÛıÔ‡Ó Ù· Â˘Ú‹Ì·Ù· ÁÈ· Ù· 6¯ÚÔ-Ó· ·È‰È¿.

ME£O¢O§O°IA

TÔ ‰Â›ÁÌ· ·ÔÙÂÏÔ‡Û·Ó 675 ÂÍ¿¯ÚÔÓ· Ô˘ ·ÓÙÈÛÙÔȯԇ-Û ÛÙÔ 7,8% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 6 ÂÙÒÓ Ô˘ÊÔÈÙÔ‡Û·Ó Û ۯÔÏ›· ÛÙËÓ K‡ÚÔii. °Ú·Ù‹ Û˘Áηٿ-ıÂÛË ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ ÁÈ· Û˘ÌÌÂÙÔ¯‹ ÛÙË ÌÂϤÙËÚÔÛÎfiÌÈÛ·Ó Ù· 577 (85,5%). ™˘ÓÔÏÈο, ¤Ï·‚·Ó ̤ÚÔ˜ 26 Û¯ÔÏ›·, Ù· ÔÔ›· Û˘ÌÌÂÙ›-¯·Ó Î·È ÛÙÔ ·ÚÂÏıfiÓ Û ·ÚfiÌÔȘ ¤Ú¢Ó˜, ÚÔÎÂÈ̤-ÓÔ˘ Ó· ‰È·ÛÊ·ÏÈÛÙ› Ë ‰˘Ó·ÙfiÙËÙ· Û‡ÁÎÚÈÛ˘ ÙˆÓ ·Ô-ÙÂÏÂÛÌ¿ÙˆÓiii. H ÂÈÏÔÁ‹ ÙˆÓ ·È‰ÈÒÓ ·Ó¿ Û¯ÔÏÂ›Ô ¤ÁÈÓ·fi ÙÔ˘˜ Û¯ÔÏÈÎÔ‡˜ ηٷÏfiÁÔ˘˜ Ì ÙË ‚Ô‹ıÂÈ· ÈӿΈÓÙ˘¯·›ˆÓ ·ÚÈıÌÒÓ ÁÈ· Ó· ÂÍ·ÛÊ·ÏÈÛÙ› ÙÔ Ù˘¯·›ÔÓ ÙÔ˘ ‰Â›Á-Ì·ÙÔ˜. ŸÏ˜ ÔÈ ¤Ú¢Ó˜ ÙfiÛÔ ÙÔ˘ ·ÚfiÓÙÔ˜ fiÛÔ Î·È ÛÙÔ·ÚÂÏıfiÓ ·ÎÔÏÔ‡ıËÛ·Ó ÙË Ì¤ıÔ‰Ô pathfinder Ô˘ ÂÈÛË-ÁÂ›Ù·È Û ٤ÙÔȘ ÂÚÈÙÒÛÂȘ Ô ¶.O.Y ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘‰Â›ÁÌ·ÙÔ˜14. ™˘ÁÎÂÎÚÈ̤ӷ, Ô ÏËı˘ÛÌfi˜ ·Ó·ÊÔÚ¿˜ ̄ ˆ-Ú›ÛÙËΠÛÙȘ 5 ·گ›Â˜ Ô˘ Â›Ó·È ÁˆÁÚ·ÊÈο ‰È·¯ˆÚÈ-Ṳ̂ÓË Ë K‡ÚÔ˜ (§Â˘ÎˆÛ›·, §ÂÌÂÛfi˜, §¿Úӷη, AÌÌfi-¯ˆÛÙÔ˜, ¶¿ÊÔ˜). AÎÔÏÔ‡ıˆ˜, ÔÈ Â·Ú¯›Â˜ ‰È·¯ˆÚ›ÛÙË-Î·Ó Û ̆ ÔÔÌ¿‰Â˜, ‰ËÏ·‰‹ ·ÛÙÈΤ˜/ÂÚÈ·ÛÙÈΤ˜ Î·È ·ÁÚÔ-ÙÈΤ˜ ÂÚÈÔ¯¤˜, Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë fiÙÈ ÙÔ 70% ÙÔ˘ÏËı˘ÛÌÔ‡ Ù˘ K‡ÚÔ˘ ̤ÓÂÈ Û ·ÛÙÈΤ˜/ ÂÚÈ·ÛÙÈΤ˜ Â-ÚÈÔ¯¤˜ Î·È ÙÔ 30% Û ·ÁÚÔÙÈΤ˜15. H ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ ‰È‹ÚÎËÛ 4 Ì‹Ó˜ (I·ÓÔ˘¿ÚÈÔ˜ M¿Ú-ÙÈÔ˜ 2014) Î·È ¤ÁÈÓ ÛÙȘ ·›ıÔ˘Û˜ ÙˆÓ Û¯ÔÏÈÎÒÓ È·ÙÚ›ˆÓ˘fi Û˘Óı‹Î˜ Ê˘ÛÈÎÔ‡ ʈÙfi˜ Î·È ÙË ‚Ô‹ıÂÈ· ηÙfiÙÚÔ˘ÌÈ·˜ ̄ Ú‹Û˘ Î·È ÂȉÈ΋˜ ÂÚÈÔ‰ÔÓÙÈ΋˜ Ì‹Ï˘ Ô˘ Û˘ÛÙ‹-ÓÂÈ Ô ¶.O.Y. H ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ Ú·ÁÌ·ÙÔÔÈ‹ıËηfi 5 Ô‰ÔÓÙÈ¿ÙÚÔ˘˜-ÂÍÂÙ·ÛÙ¤˜, ÌÂÙ¿ ·fi ‚·ıÌÔÓfiÌËÛË(calibration) Î·È ¤ÏÂÁ¯Ô Ù˘ ÌÂٷ͇ ÙÔ˘˜ Û˘Ìʈӛ·˜ ÛÙËÓ·ÍÈÔÏfiÁËÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ (‚·ıÌfi˜ Kappa =0,87). K·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÏÈÓÈ΋˜ ÂͤٷÛ˘, Û˘ÁÎÂÓÙÚÒıË-Î·Ó Ù· ‰Â‰Ô̤ӷ Û¯ÂÙÈο Ì ÙÔ˘˜ ‰Â›ÎÙ˜ ÙÂÚˉfiÓ·˜ ηÈÙÔ ‰Â›ÎÙË Ï¿Î·˜. ¶·Ú¿ÏÏËÏ·, ·fi Ù· Û¯ÔÏÈο ÌËÙÚҷηٷÁÚ¿ÊËÎ·Ó Ù· ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· Û¯ÂÙÈο Ì ÙËÓÂÚÈÔ¯‹ ηÙÔÈΛ·˜ ÙˆÓ ·È‰ÈÒÓ (·ÛÙÈ΋/ÂÚÈ·ÛÙÈ΋ ηȷÁÚÔÙÈ΋), ÙËÓ ÂıÓÈÎfiÙËÙ· (K‡ÚÈÔÈ, Ôϛ٘ EE Ô˘ ÚÔ-¤Ú¯ÔÓÙ·È ·fi ¯ÒÚ˜ Ù˘ AÓ·ÙÔÏÈ΋˜ E˘ÚÒ˘, Ôϛ٘EE ÏËÓ ÙˆÓ ̄ ˆÚÒÓ Ù˘ AÓ·ÙÔÏÈ΋˜ E˘ÚÒ˘, ¿ÏϘ ̄ Ò-Ú˜), ηıÒ˜ ›Û˘ Î·È ÙÔ Â¿ÁÁÂÏÌ· ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜.H ηÙËÁÔÚÈÔÔ›ËÛË ÙˆÓ Â·ÁÁÂÏÌ¿ÙˆÓ ÙˆÓ ÁÔÓ¤ˆÓ ¤ÁÈ-Ó Ì ‚¿ÛË ÙËÓ Ù·ÍÈÓfiÌËÛË ISCO-0816. OÈ 10 ÌÂÁ¿Ï˜ ÔÌ¿-‰Â˜ ·ÁÁÂÏÌ¿ÙˆÓ (450 ÂÚ›Ô˘ ·ÁÁ¤ÏÌ·Ù·) ÔÌ·‰Ô-ÔÈ‹ıËÎ·Ó Û ÙÚÂȘ ηÙËÁÔڛ˜: ·) ˘„ËÏÔ‡ ÂȤ‰Ô˘ ‚)ÌÂÛ·›Ô˘ ÂȤ‰Ô˘ (ÁÚ·ÊÂȷΤ˜ ÂÚÁ·Û›Â˜) Î·È Á) ̄ ·ÌËÏÔ‡ÂȤ‰Ô˘ (¯ÂÈÚˆÓ·ÎÙÈΤ˜ ÂÚÁ·Û›Â˜).

Limassol, Larnaca, Famagusta and Paphos). Then, thedistricts were separated into geographical subgroups(clusters), ie urban, suburban and rural areas taking intoconsideration that 70% of Cyprus' population lives in urbanand suburban areas and 30% in rural15. The examination of children lasted 4 months, namelybetween January and May 2014 and took place in the hallsof school clinics, according to WHO criteria14, under artificiallight using dental mirrors and the WHO CDI periodontalprobes. The data of the clinical examination concerneddental caries (dmft) and plaque index (PI). The five dentists-examiners were trained and calibrated prior to the studyand the kappa in inter-examiner consistency in thediagnosis of caries was satisfactory (0.87). Besides the clinical examination, the school records werean additional source of information regarding: area of living(urban, suburban, rural), ethnicity (Cypriots, EU citizenswith origin from Eastern Europe countries, EU citizensexcept the Eastern European countries, other countries)and parents occupation.The classification of occupations was based on theclassification of ISCO 08 (International Standard Classifi-cation of Occupations)16. As the number of people wasextremely small in some occupational categories, occupa-tional categories were grouped into three broader groups:a) high-level occupations, b) medium-level occupationsand c) low level occupations. Ethical considerations: Participation was voluntary andwritten informed consent was obtained from the parentsof the children. All data were confidential. The NationalCommittee of Bioethics as well as the Ministry of Educationand Civilization gave approval for the study.

STATISTICAL ANALYSIS

The categorical variables are presented as absolute (n)and frequencies (%), while the quantitative presented asmean (standard deviation) and median (range). TheKolmogorov-Smirnov test and regularity diagrams wereused to check the distribution of the quantitative variables.It was found that the quantitative variables (dmft, dt, ft,DI) did not follow a normal distribution. Subsequently,quantitative dependent variables were converted to ordinalor dichotomous variables, using as boundary the medianvalues for the latter. More specifically, the conversion ofquantitative variables included the following:

i) The number of decayed teeth (dt) was divided into thefollowing two categories: 0 carious teeth, ≥1 cariousteeth

ii) The number of filled teeth (ft) was converted into thefollowing two categories: 0, ≥1 filled teeth

ii H ÊÔ›ÙËÛË ÛÙËÓ K‡ÚÔ Â›Ó·È ̆ Ô¯ÚˆÙÈ΋ ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 15 ÂÙÒÓ. °È· Ó· ÊÔÈÙ‹ÛÂÈ ¤Ó· ·È‰› ÛÙËÓ A Ù¿ÍË ‰ËÌÔÙÈÎÔ‡ ı· Ú¤ÂÈ Ó·¤¯ÂÈ Û˘ÌÏËÚÒÛÂÈ Ù· 6 ÙÔ˘ ¯ÚfiÓÈ·. ø˜ ÂÎ ÙÔ‡ÙÔ˘ ÙÔ ‰Â›ÁÌ· ÂÈϤ¯ıËΠ·fi ÙÔ˘˜ Û¯ÔÏÈÎÔ‡˜ ηٷÏfiÁÔ˘˜ ÙˆÓ Ì·ıËÙÒÓ Ù˘ A Ù¿Í˘.

iii ¢È¢ÎÚÈÓ›˙ÂÙ·È fiÙÈ Ô Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ‰ËÌfiÛÈˆÓ Û¯ÔÏ›ˆÓ ÛÙËÓ K‡ÚÔ ·Ú¤ÌÂÈÓ ·Ó·ÏÏÔ›ˆÙÔ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·

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Research Study

H Û˘ÌÌÂÙÔ¯‹ ÛÙËÓ ¤Ú¢ӷ ‹Ù·Ó ÂıÂÏÔÓÙÈ΋, ÁÈ· ÙË ‰ÈÂÍ·-ÁˆÁ‹ Ù˘ ÔÔ›·˜ Ï‹ÊıËΠ¿‰ÂÈ· ·fi ÙËÓ EıÓÈ΋ EÈÙÚÔ-‹ BÈÔËıÈ΋˜ K‡ÚÔ˘, ηıÒ˜ Î·È ·fi ÙÔÓ E›ÙÚÔÔ ¶ÚÔ-ÛˆÈÎÒÓ ¢Â‰ÔÌ¤ÓˆÓ Î·È ·fi ÙÔ YÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜ ηȶÔÏÈÙÈÛÌÔ‡. ¶ÚÈÓ ·fi ÙËÓ ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ, ‰È·ÛÊ·-Ï›ÛÙËÎÂ Ë ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ÁÈ·ÙË Û˘ÌÌÂÙÔ¯‹ ÛÙËÓ ¤Ú¢ӷ, ÂÓÒ ˘‹Ú¯Â Ë ‰˘Ó·ÙfiÙËÙ·Ó· ‹Û·Ó ·ÚfiÓÙ˜ ÛÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜.

™TATI™TIKH ANA§Y™HAÚ¯Èο ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ Ù˘ ηÓÔÓÈÎfiÙËÙ·˜ Ù˘ ηٷÓÔÌ‹˜ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙˆÓ ÂÍËÚÙËÌ¤ÓˆÓ ÌÂÙ·‚ÏËÙÒÓ (dmft, dt,ft, PI). Afi ÙÔÓ ¤ÏÂÁ¯Ô (Kolmogorov-Smirnov test ηÈregularity diagrams), ‰È·ÈÛÙÒıËΠÌË Î·ÓÔÓÈ΋ ηٷÓÔ-Ì‹ ÙÔ˘˜, ÁÈ ·˘Ùfi Î·È ·ÎÔÏÔ˘ı‹ıËÎ·Ó ÌË ·Ú·ÌÂÙÚÈΤ˜ ̤-ıÔ‰ÔÈ ÛÙ·ÙÈÛÙÈ΋˜ ·Ó¿Ï˘Û˘. °È· ÙÔ ÛÎÔfi ·˘Ùfi ¤ÁÈÓÂÔÌ·‰ÔÔ›ËÛË ÙˆÓ ÌÂÙ·‚ÏËÙÒÓ Î·È ÌÂÙ·ÙÚÔ‹ ÙÔ˘˜ Û‰ȷٿÍÈ̘. ™˘ÁÎÂÎÚÈ̤ӷ, Ù· ·È‰È¿ ÔÌ·‰ÔÔÈ‹ıËηÓ:

·) Ì ‚¿ÛË ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÙÂÚˉÔÓÈÛÌ¤ÓˆÓ ÙÔ˘˜ ‰ÔÓÙÈÒÓ(dt) Û 2 ÔÌ¿‰Â˜: ÔÌ¿‰· 1= 0 ÙÂÚˉÔÓÈṲ̂ӷ ‰fiÓÙÈ·,ÔÌ¿‰· 2 = ≥1 ÙÂÚˉÔÓÈṲ̂ӷ ‰fiÓÙÈ·,

‚) Ì ‚¿ÛË ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÌÊÚ·ÁÌ¤ÓˆÓ ‰ÔÓÙÈÒÓ (ft) ÛÂ2 ÔÌ¿‰Â˜: ÔÌ¿‰· 1 = 0 ÂÌÊÚ¿ÍÂȘ, ÔÌ¿‰· 2= ≥1 ÂÌ-ÊÚ¿ÍÂȘ.

Á) Ì ‚¿ÛË ÙÔ ‰Â›ÎÙË dmft Û 2 ÔÌ¿‰Â˜: 1=0 dmft, ÔÌ¿-‰· 2 =>0 dmft,

‰) Ì ‚¿ÛË ÙÔ ‰Â›ÎÙË Ï¿Î·˜ (PI) Û 2 Î·È ¿ÏÈ ÔÌ¿‰Â˜:ÔÌ¿‰· 1=‰Â›ÎÙ˘ Ͽη˜ 0, ÔÌ¿‰· 2= ‰Â›ÎÙ˘ Ï¿-η˜ >0.

H ‰ÈÂÚ‡ÓËÛË Ù˘ ‡·Ú͢ Û¯¤Û˘ ÌÂٷ͇ ‰‡Ô ÔÓÔÌ·-ÛÙÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ‰ÈÂÚ¢ӋıËΠ̠ÙÔÓ ¤ÏÂÁ¯Ô X2 ηÈÌÂٷ͇ ‰‡Ô ‰È·Ù¿ÍÈÌˆÓ ‰ÈÂÚ¢ӋıËΠ̠ÙÔÓ ¤ÏÂÁ¯Ô X2

Ù¿Û˘, ÂÓÒ ÌÂٷ͇ ÌÈ·˜ ÔÛÔÙÈ΋˜ ÌÂÙ·‚ÏËÙ‹˜ Î·È ÌÈ·˜‰È·Ù¿ÍÈÌ˘ ÂÊ·ÚÌfiÛıËÎÂ Ô Û˘ÓÙÂÏÂÛÙ‹˜ Spearman. TÔ·ÌʛϢÚÔ Â›Â‰Ô Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÛÙˉÈÌÂÙ·‚ÏËÙ‹ ·Ó¿Ï˘ÛË ÔÚ›ÛÙËΠÙÔ <0,2. MÂÙ·‚ÏËÙ¤˜ Ô˘‚Ú¤ıËÎ·Ó ÛÙË ‰ÈÌÂÙ·‚ÏËÙ‹ ·Ó¿Ï˘ÛË Ó· ‹Û·Ó ÛÙ·ÙÈÛÙÈ-ο ÛËÌ·ÓÙÈΤ˜ (p<0,2) ÂÓÙ¿¯ıËÎ·Ó Û ¤ÏÂÁ¯Ô ÔÏÏ·Ï‹˜ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘, fiÔ˘ ÂΛ ÙÔ ·ÌʛϢÚÔ Â›-Â‰Ô Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÔÚ›ÛÙËΠÙÔ 0,05.H ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̠ÙÔ IBMSPSS 21.0 (Statistical Package for Social Sciences).

A¶OTE§E™MATAO ̤ÛÔ˜ fiÚÔ˜ ËÏÈΛ·˜ ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó 6,5 ¤ÙË (6,2 - 6,8),ÂÓÒ Ù· ÎÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈο ̄ ·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ‰Â›Á-Ì·ÙÔ˜, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ›Ó·Î· 1, ·ÓÙÈηÙÔÙÚ›˙Ô˘ÓÙÔÓ ÏËı˘ÛÌfi ·Ó·ÊÔÚ¿˜.O ̤ÛÔ˜ ‰Â›ÎÙ˘ ÙÂÚˉfiÓ·˜ dmft ·Ó‹Ïı ÛÙÔ 1,83 (SD2,74) Î·È ‰È·Î˘Ì¿ÓıËΠ·fi 0 ̤¯ÚÈ 18, ηٷÁÚ¿ÊÔÓÙ·˜·Ú¿ÏÏËÏ· Ì›ˆÛË Û ۯ¤ÛË Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙÔ˘2006 Î·È 2010, fiÔ˘ ·ÓÙ›ÛÙÔȯ· Ô ‰Â›ÎÙ˘ ‹Ù·Ó ÛÙÔ 2,23Î·È 2,14 . TÔ 54,2% (n=313) ÙˆÓ 6¯ÚÔÓˆÓ ‹Û·Ó ÂχıÂÚ· ·fi ÙÂ-ÚˉfiÓ· (dmft=0), ÙÔ 17% (n=98) ›¯Â ‰Â›ÎÙË ÙÂÚˉfiÓ·˜dmft 1-2 Î·È ÙÔ 28,82% (n= 166) ‰Â›ÎÙË ÙÂÚˉfiÓ·˜ dmft>2.

iii) The dmft index was converted into the following twocategories: 0, ≥1

iv) The plaque index (DI) was converted into the followingtwo categories: 0, >0 .

Gender, district, area of living, nationality and the occupationof the parents were used as independent variables.Chi-square (X2) for trend was used to determineassociations between ordinal variables or between ordinaland categorical variables. Correlation between continuousvariables was assessed with Spearmans correlationcoefficient, since these variables do not follow normaldistribution. Variables that were associated with theoutcomes in bivariate analysis (p<0.2) were entered intothe backward stepwise multivariable logistic regressionanalysis. Criteria for entry and removal of variables werebased on the likelihood ratio test, with enter and removelimits set at p<0.05 and p>0.05. We estimated adjustedodds ratios (OR) with 95% confidence intervals (CI) for therisk factors included in the model. All tests of statisticalsignificance were two-tailed, and P values of less than 0.05were considered significant. Statistical analysis wasperformed using the IBM SPSS 21.0 (IBM Corp. Released2012. IBM SPSS Statistics for Windows, Version 21.0.Armonk, NY:: IBM Corp.).

RESULTS

The mean age of the participants was 6.5 (6.2-6.8). Thesocio demographic characteristics of the sample are inline with the reference population (Table 1). The mean dmft was 1.83 (SD 2.7) showing a decrease incomparison with the previous studies of 2006 and 2010 wherethe mean dmft was 2.23 and 2.14 respectively. 54.2% (n =313) of the 6-year-old children were caries free (dmft = 0),17% (n = 98) had dmft 1-2 and 28.8% (n = 166) dmft >2. The mean number of decayed teeth (dt) was 1.23 (SD 2.3),the filled (ft) 0.54 (SD 1.3) and missing (mt) 0.06 (SD 0.4).The d component was dominant and accounted for 67.2%of the total of dmft (dt / dmft); the filled for 29.5% (ft / dmft)and missing for 3.3% (mt/dmft).37.6% (n = 217) of the six-year-old children had decayedteeth (dt>0). More specifically, 18.7% (n = 108) had 1-2decayed teeth and 18.9% (n = 109) ≥3 decayed teeth.21.3% (n = 123) needed one surface filling while 3.5% (n= 20) had premature loss of deciduous teeth.Although 89.3% (n = 515) have permanent first molars intheir mouth, only 5.4% (n = 31) had at least one sealant.In multiple logistic regression adjusting for area of living,nationality, parents occupation, there was a clear gradientin decayed teeth by parental occupation, with lower oddsfor decayed teeth for each higher occupation groupcompared to children whose parents had lower leveloccupations (OR:0.35; 95%CI:0.22-0.57 for p<0.001).Similarly, in multiple logistic regression it was found thatchildren whose parents were coming from Eastern Europehad more often filled teeth compared with Cypriot children(OR = 2.65, 95% CI = 1.32-5.34, p = 0.006). Table 2 presents the results of the bivariate analysis between

Hellenic Stomatological Review 59: 9-24, 2015

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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

Hellenic Stomatological Review 59: 9-24, 2015

AӷχÔÓÙ·˜ ÙÔ˘˜ ÂÈ̤ÚÔ˘˜ ‰Â›ÎÙ˜ ÙÂÚˉfiÓ·˜, ·Ú·-ÙËÚÂ›Ù·È ·˘ÍË̤ÓË ·ÚÔ˘Û›· ÙˆÓ ÙÂÚˉÔÓÈÛÌ¤ÓˆÓ ‰Ô-ÓÙÈÒÓ (dt) Ì ̤ÛÔ fiÚÔ 1,23 (67,2%), Û ۯ¤ÛË Ì ·˘ÙfiÓÙˆÓ ÂÌÊÚ·ÁÌ¤ÓˆÓ (ft) Ì ̤ÛÔ fiÚÔ 0,54 (29,5%) Î·È ÙˆÓÂÏÏÂÈfiÓÙˆÓ (mt) Ì ̤ÛÔ fiÚÔ 0,06 (3,3%).OÈ ·Ó¿ÁΘ ıÂڷ›·˜ (dt>0) ηٷÁÚ¿ÊËÛ·Ó ÛÙÔ 37,4%(n=216) ÙˆÓ 6¯ÚÔÓˆÓ. ™˘ÁÎÂÎÚÈ̤ӷ, ÙÔ 18,7% (n=108)›¯Â 1-2 ÙÂÚˉÔÓÈṲ̂ӷ ‰fiÓÙÈ· Î·È ÙÔ 18,9% (n=109) ›-¯Â 3 ‹ Î·È ÂÚÈÛÛfiÙÂÚ· ÙÂÚˉÔÓÈṲ̂ӷ ‰fiÓÙÈ·. TÔ 3,5%(n=20) ÙˆÓ 6¯ÚÔÓˆÓ ÂÌÊ¿ÓÈÛ·Ó ÚfiˆÚË ·ÒÏÂÈ· ÓÂÔ-ÁÈÏÒÓ ‰ÔÓÙÈÒÓ.AÓ Î·È ÙÔ 89,3 % (n=515) ¤ÊÂÚ·Ó ÚÒÙÔ˘˜ ÌfiÓÈÌÔ˘˜ ÁÔÌ-

the demographic characteristics and the caries index (dmft).In multiple logistic regression, adjusting for district, areaof living, nationality and parents occupation, it was foundthat children whose parents worked in low-level occupationshad more often dmft≥1 compared with children whoseparents worked in a medium (OR = 0.77, 95% CI = 0.50-1.21, p = 0.001) or a high level occupation (OR = 0.8, 95%CI = 0.30 0.77, p =0.001).The mean plaque index was 0.33 (SD 0.35). 41.2% (n =238) of the six-year-old children had plaque index 0. Inmultiple logistic regression, it was found that children fromNicosia (OR = 3.32, 95% CI = 1.91 5.79, p <0.001) and

¢Â›ÁÌ· ¶ÏËı˘ÛÌfi˜ (*, **)

º‡ÏÔAÁfiÚÈ· 297 (51,5) 4330 (51,3)KÔÚ›ÙÛÈ· 280 (48,5) 4108 (48,7)

E·Ú¯›·§Â˘ÎˆÛ›· 193 (33,4) 3141 (37,7)§ÂÌÂÛfi˜ 160 (27,7) 2054 (24,7)§¿Úӷη 83 (14,4) 1518 (18,2)AÌÌfi¯ˆÛÙÔ˜ 64 (11,1) 604 (7,3)¶¿ÊÔ˜ 77 (13,3) 1008 (12,1)

¶ÂÚÈÔ¯‹ ηÙÔÈΛ·˜AÛÙÈ΋ 269 (46,6)¶ÂÚÈ·ÛÙÈ΋ 168 (29,1) 5848 (69,3)AÁÚÔÙÈ΋ 140 (24,3) 2590 (30,7)

EıÓÈÎfiÙËÙ·K‡ÚÈÔÈ 466 (80,8) 6700 (79,4)¶Ôϛ٘ EE (ÏËÓ ÚÒËÓ AÓ·ÙÔÏÈÎÔ‡ ÌÏÔÎ) 45 (7,8) 548 (6,5)¶Ôϛ٘ EE ÚÒËÓ AÓ·ÙÔÏÈÎÔ‡ ÌÏÔÎ 38 (6,6) 489 (5,8)ÕÏÏÔÈ 28 (4,9) 701 (8,3)

KÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô Ì ‚¿ÛË ÙËÓ ÂÚÁ·Û›· ÙˆÓ ÁÔÓ¤ˆÓY„ËÏfi 180 (32,3) (21,7)MÂÛ·›Ô (ÁÚ·ÊÂȷΤ˜ ÂÚÁ·Û›Â˜) 234 (41,8) (43,7)X·ÌËÏfi (¯ÂÈÚˆÓ·ÎÙÈΤ˜ ÂÚÁ·Û›Â˜) 146 (25,9) (34,6)

¶›Ó·Î·˜ 1: KÔÈÓˆÓÈÎÔ-‰ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·È‰ÈÒÓ ËÏÈΛ·˜ 6 ÂÙÒÓ Î·ıÒ˜ Î·È ÙÔ˘ ÏËı˘ÛÌÔ‡ ·Ó·ÊÔÚ¿˜

OÈ ÙÈ̤˜ ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ n (%).(*) ™Ù·ÙÈÛÙÈ΋ YËÚÂÛ›· 2014 ™Ù·ÙÈÛÙÈΤ˜ Ù˘ Eη›‰Â˘Û˘ 2011-12.

(**) ™Ù·ÙÈÛÙÈ΋ YËÚÂÛ›· 2013 AÔÁÚ·Ê‹ ÏËı˘ÛÌÔ‡ (Â›Â‰Ô ÌfiÚʈÛ˘, ˘ËÎÔfiÙËÙ·)

(*) http://www.mof.gov.cy/mof/cystat/statistics.nsf/All/4A240F088B34155BC22577E4002C70CD/$file/EDUCATION-1112-150914.pdf?OpenElement

(**) http://www.mof.gov.cy/mof/cystat/statistics.nsf/All/27793F0FA8DB3A15C2257CEF002FC4E0?OpenDocument&sub=1&sel=1&e=&print

}

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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

Ê›Ô˘˜ ÛÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ·, ÂÓ ÙÔ‡ÙÔȘ ÌfiÓÔ ÙÔ 5,4%(n=31) ÙˆÓ 6¯ÚÔÓˆÓ Â›¯·Ó ¤ÛÙˆ Î·È Ì›· ÚÔÏËÙÈ΋ ¤Ì-ÊÚ·ÍË.™ÙË ‰ÈÌÂÙ·‚ÏËÙ‹ ·Ó¿Ï˘ÛË, fiÔ˘ Ù· 6¯ÚÔÓ· ÔÌ·‰ÔÔÈ‹-ıËÎ·Ó Ì ‚¿ÛË ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÙÂÚˉÔÓÈÛÌ¤ÓˆÓ ÙÔ˘˜ ‰Ô-ÓÙÈÒÓ (dt), ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ Û¯¤ÛÂȘ ÛÙÔÂ›Â‰Ô ÙÔ˘ 0,20 (p<0,20) ÌÂٷ͇ ÙÔ˘ ·ÚÈıÌÔ‡ ÙÂÚˉÔ-ÓÈÛÌ¤ÓˆÓ ‰ÔÓÙÈÒÓ Î·È Ù˘ ÂÚÈÔ¯‹˜ ‰È·ÌÔÓ‹˜, Ù˘ ÂıÓÈ-ÎfiÙËÙ·˜ Î·È ÙÔ˘ ·ÁÁ¤ÏÌ·ÙÔ˜. °È· ÙÔÓ ÏfiÁÔ ·˘ÙfiÓ, Ú·Á-Ì·ÙÔÔÈ‹ıËΠÔÏÏ·Ï‹ ÏÔÁÈÛÙÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, fiÔ˘‰È·Ê¿ÓËΠfiÙÈ Ù· ·È‰È¿, ÙˆÓ ÔÔ›ˆÓ ÔÈ ÁÔÓ›˜ ·ÛÎÔ‡-Û·Ó ¯·ÌËÏÔ‡ ÂȤ‰Ô˘ ¿ÁÁÂÏÌ·, Û˘¯ÓfiÙÂÚ· ÂÌÊ¿ÓÈ-˙·Ó ÙÂÚˉÔÓÈṲ̂ӷ ‰fiÓÙÈ· Û ۯ¤ÛË Ì ٷ ·È‰È¿, ÙˆÓÔÔ›ˆÓ ÔÈ ÁÔÓ›˜ ·ÛÎÔ‡Û·Ó ÌÂÛ·›Ô˘ (OR: 0,61 95% ¢E:0,39-0,94, p<0,001) ‹ Î·È „ËÏÔ‡ ÂȤ‰Ô˘ ·ÁÁ¤ÏÌ·Ù·(OR: 0,35, 95% ¢E: 0,22-0,57, p<0,001). ™ÙË ‰ÈÌÂÙ·‚ÏËÙ‹ ·Ó¿Ï˘ÛË ÁÈ· ÙËÓ ÂͤٷÛË Ù˘ Û¯¤Û˘

Famagusta (OR = 2.24, 95% CI = 1.13 4.41, p = 0.02)had more frequently plaque index >0 compared withchildren from Paphos.Positive correlation was found between the plaque indexand the caries index (rs = 0.30, p <0.001).

DISCUSSION

The increased percentage of children who participate inthe study (85.5%), along with the fact that the samplessocio-demographic characteristics were in line with thoseof the reference population, enhance the reliability of thefindings.Dental decay in children aged six living in Cyprus hasdeclined the last years from 2.23 in 2006 to 2.14 in 2010(4% decrease) and 1.83 in 2014 (14.5% decrease comparedwith 2010) (table 3).

Hellenic Stomatological Review 59: 9-24, 2015

Sample Population (*, **)

SexBoys 297 (51.5) 4330 (51.3)Girls 280 (48.5) 4108 (48.7)

DistrictNicosia 193 (33.4) 3141 (37.7)Limassol 160 (27.7) 2054 (24.7)Larnaca 83 (14.4) 1518 (18.2)Ammochostos 64 (11.1) 604 (7.3)Paphos 77 (13.3) 1008 (12.1)

Place of livingUrban 269 (46.6) 5848 (69.3)Peri-urban 168 (29,1)Rural 140 (24,3) 2590 (30,7)

NationalityCypriots 466 (80,8) 6700 (79,4)Citizens from EU Countries (except from Eastern Europe) 45 (7,8) 548 (6,5)Citizens from Eastern Europe 38 (6,6) 489 (5,8)Others 28 (4,9) 701 (8,3)

Socioeconomic status according to parents occupationUpper 180 (32,3) (21,7)

Middle 234 (41,8) (43,7)Low 146 (25,9) (34,6)

Table 1: Sociodemographic characteristics of the sample and the study population

Values are expressed as n (%).(*) Cyprus Statistical Service (2014) – Statistics of education 2011-12

(**) Cyprus Statistical Service (2013) – Census of the population 2011

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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

Hellenic Stomatological Review 59: 9-24, 2015

ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ‰ËÌÔÁÚ·ÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓÎ·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÌÊÚ·ÁÌ¤ÓˆÓ ‰ÔÓÙÈÒÓ (ft) ‚Ú¤ıËηÓÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ Û¯¤ÛÂȘ ÛÙÔ Â›Â‰Ô ÙÔ˘ 0,20(p<0,20) ÌÂٷ͇ ÙÔ˘ ·ÚÈıÌÔ‡ ÂÌÊÚ·ÁÌ¤ÓˆÓ ‰ÔÓÙÈÒÓ Î·ÈÙ˘ ·گ›·˜ Î·È Ù˘ ÂıÓÈÎfiÙËÙ·˜. ™ÙÔÓ ¤ÏÂÁ¯Ô ÔÏÏ·-Ï‹˜ ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ‰È·Ê¿ÓËΠfiÙÈ Ù· ·È‰È¿·fi ¯ÒÚ˜ Ù˘ AÓ·ÙÔÏÈ΋˜ E˘ÚÒ˘ ·ÚÔ˘Û›·˙·Ó Û˘-¯ÓfiÙÂÚ· ÂÌÊÚ·Á̤ӷ ‰fiÓÙÈ· Û ۯ¤ÛË Ì ٷ K˘ÚÈfiÔ˘Ï·(OR: 2,65 95% ¢E: 1,32-5,34, p=0,006).EϤÁ¯ÔÓÙ·˜ ÙË Û¯¤ÛË ÙÔ˘ ‰Â›ÎÙË ÙÂÚˉfiÓ·˜ (dmft) ÌÂÙ· ‰È¿ÊÔÚ· ‰ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο (›Ó·Î·˜ 2)‚Ú¤ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ Û¯¤ÛÂȘ ÛÙÔ Â›Â‰ÔÙÔ˘ 0,20 (p<0,20) ÌÂٷ͇ ÙÔ˘ ‰Â›ÎÙË ÙÂÚˉfiÓ·˜ Î·È Ù˘·گ›·˜, Ù˘ ÂÚÈÔ¯‹˜ ‰È·ÌÔÓ‹˜, Ù˘ ÂıÓÈÎfiÙËÙ·˜ ηÈÙÔ˘ ·ÁÁ¤ÏÌ·ÙÔ˜. ™ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÔÏÏ·Ï‹˜ ÏÔÁÈ-ÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ‰È·Ê¿ÓËΠfiÙÈ Ù· ·È‰È¿, ÙˆÓ ÔÔ›-ˆÓ ÔÈ ÁÔÓ›˜ ·ÛÎÔ‡Û·Ó ̄ ·ÌËÏÔ‡ ÂȤ‰Ô˘ ¿ÁÁÂÏÌ·, ›-

Although comparisons between different countries can bemisleading, because of the different time that the data havebeen collected, different types of samples involved (nationalrepresentative, regional, pathfinder etc.) and also of thedifferent age groups examined, however, it is fair to saythat there are marked differences among the Europeancountries. In Portugal, more than 10 years ago, the dmft for the six-year-old children stood at 2.118 while more recentunpublished data from Portugal (Rui Manuel Calada, ChiefDental Officer, Portugal, personal communication) showthat the dmft fell at 1.62. In Spain (Valencia region), 8 yearsago, the dmft for the 6-year-olds was 1.0819. Similarly, thedmft for the five-year-olds in Italy (Veneto region) amountedto 1.220, while in Scotland, Wales and England it was 1.86,1.98 and 1.11 respectively21.In spite of this decline, the disease still remains common

X·Ú·ÎÙËÚÈÛÙÈÎfi ¢Â›ÎÙ˘ ÙÂÚˉfiÓ·˜ TÈÌ‹ p

0 ≥1

º‡ÏÔ 0,8·

AÁfiÚÈ· 166 (55,9) 131 (44,1)KÔÚ›ÙÛÈ· 147 (52,5) 133 (47,5)

E·Ú¯›· 0,03·

§Â˘ÎˆÛ›· 91 (47,2) 102 (52,8)AÌÌfi¯ˆÛÙÔ˜ 39 (60,9) 25 (39,1)§¿Úӷη 36 (43,4) 47 (56,6)§ÂÌÂÛfi˜ 95 (59,4) 65 (40,6)¶¿ÊÔ˜ 52 (67,5) 25 (32,5)

¶ÂÚÈÔ¯‹ ‰È·ÌÔÓ‹˜ 0,07·

AÛÙÈ΋ 148 (55,0) 121 (45)¶ÂÚÈ·ÛÙÈ΋ 98 (58,3) 70 (41,7)AÁÚÔÙÈ΋ 67 (47,9) 73 (52,1)

EıÓÈÎfiÙËÙ· 0,04·

K‡ÚÈÔÈ 259 (55,6) 207 (44,4)¶Ôϛ٘ EE (ÏËÓ ÚÒËÓ AÓ·ÙÔÏÈÎÔ‡ ÌÏÔÎ) 27 (60,0) 18 (40)¶Ôϛ٘ EE ÚÒËÓ AÓ·ÙÔÏÈÎÔ‡ ÌÏÔÎ 15 (39,5) 23 (60,5)

KÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô 0,001·

Ì ‚¿ÛË ÙËÓ ÂÚÁ·Û›· ÙˆÓ ÁÔÓ¤ˆÓ

X·ÌËÏfi 55 (45,8) 65 (54,2)M¤ÛÔ (ÁÚ·ÊÂȷΤ˜ ÂÚÁ·Û›Â˜) 122 (52,1) 112 (47,9)AÓÒÙÂÚÔ (¯ÂÈÚÔÓ·ÎÙÈΤ˜ ÂÚÁ·Û›Â˜) 115 (63,9) 65 (34,1)

¶›Ó·Î·˜ 2: ¢ÈÌÂÙ·‚ÏËÙ‹ ·Ó¿Ï˘ÛË ÌÂٷ͇ ‰ËÌÔÁÚ·ÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Î·È ‰Â›ÎÙË ÙÂÚˉfiÓ·˜ Ì ‰È¯ÔÙfiÌÔ DMFT≥1

OÈ ÙÈ̤˜ ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ n (%).· ¤ÏÂÁ¯Ô˜ x2 ÁÈ· Ù¿ÛË.

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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

¯·Ó Û˘¯ÓfiÙÂÚ· ‰Â›ÎÙË ÙÂÚˉfiÓ·˜ ≥1 Û ۯ¤ÛË Ì ٷ ·È-‰È¿, ÙˆÓ ÔÔ›ˆÓ ÔÈ ÁÔÓ›˜ ·ÛÎÔ‡Û·Ó ÌÂÛ·›Ô˘ (OR: 0,7795% ¢E: 0,501,21, p=0,001) ‹ ·ÓˆÙ¤ÚÔ˘ ÂȤ‰Ô˘ ¿Á-ÁÂÏÌ· (OR: 0,48 95% ¢E: 0,30 0,77, p=0,001). O ̤ÛÔ˜ ‰Â›ÎÙ˘ Ͽη˜ ·Ó‹Ïı ÛÙÔ 0,33 (SD=0,35).MfiÓÔ ÙÔ 41,2% (n=238) ÙˆÓ 6¯ÚÔÓˆÓ Â›¯·Ó ‰Â›ÎÙË Ï¿-η˜ 0. ™ÙË ‰ÈÌÂÙ·‚ÏËÙ‹ ·Ó¿Ï˘ÛË ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈÛÙÈοÛËÌ·ÓÙÈΤ˜ Û¯¤ÛÂȘ ÛÙÔ Â›Â‰Ô ÙÔ˘ 0,20 (p<0,20) ÌÂ-ٷ͇ ÙÔ˘ ‰Â›ÎÙË Ï¿Î·˜ Î·È Ù˘ ·گ›·˜ Î·È Ù˘ ÂıÓÈ-ÎfiÙËÙ·˜. ™ÙÔÓ ¤ÏÂÁ¯Ô ÔÏÏ·Ï‹˜ ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ‰È·-Ê¿ÓËΠfiÙÈ Ù· ·È‰È¿ ·fi ÙË §Â˘ÎˆÛ›· Î·È ÙËÓ AÌÌfi¯ˆ-ÛÙÔ Â›¯·Ó Û˘¯ÓfiÙÂÚ· ‰Â›ÎÙË Ï¿Î·˜ >0 Û ۯ¤ÛË Ì ٷ·È‰È¿ ·fi ÙËÓ ¶¿ÊÔ (OR: 3,32, 95% ¢E: 1,91-5,79,p<0,001, OR: 2,24 95% ¢E: 1,13-4,41 p=0,02). T¤ÏÔ˜, ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ‚Ú¤ıËΠÌÂٷ͇ ÙÔ˘ ‰Â›ÎÙË Ï¿-η˜ Î·È ÙÔ˘ ‰Â›ÎÙË ÙÂÚˉfiÓ·˜ (rs=0,30, p<0,001).

as 47.8% of the 6-year-olds are affected by caries and 29%had dmft>2. Moreover, the distribution of caries was highlyskewed. If only the children with dental caries were includedin the study, then the dmft almost would double and riseto 3.83. This finding is supported by other studies whichshow that most caries is found on a relatively small groupof population2,17. Although in all districts a decrease is recorded in the levelof dmft, on the contrary, Larnaca presents a steady increasefor the last 10 years (Table 3). In addition, it shows thehighest percentage of children (31.3%) with dmft >2 andthe lowest (45.8%) with dmft = 0. Different socio-economicfactors might play a significant role for that. Among alldistricts, Larnaca records the highest percentage ofunemployed people as well as the highest percentage ofthose who worked in low-level occupations22. In addition,the concentration of fluoride in the drinking water is limited

Hellenic Stomatological Review 59: 9-24, 2015

Demographic characteristics dmft P value

0 ≥1

Sex 0,8a

Boys 166 (55,9) 131 (44,1)Girls 147 (52,5) 133 (47,5)

District 0,03a

Nicosia 91 (47,2) 102 (52,8)Ammochostos 39 (60,9) 25 (39,1)Larnaca 36 (43,4) 47 (56,6)Limassol 95 (59,4) 65 (40,6)Paphos 52 (67,5) 25 (32,5)

Area of living 0,07a

Urban 148 (55,0) 121 (45)Peri-urban 98 (58,3) 70 (41,7)Rural 67 (47,9) 73 (52,1)

Nationality 0,04a

Cypriots 259 (55,6) 207 (44,4)

Citizens from EU Countries(except from Eastern Europe) 27 (60,0) 18 (40)

Citizens from Eastern Europe 15 (39,5) 23 (60,5)

Socioeconomic status according 0,001a

to parents occupation

Low 55 (45,8) 65 (54,2)Middle 122 (52,1) 112 (47,9)Upper 115 (63,9) 65 (34,1)

Table 2: Bivariate analysis of demographic characteristics and dmft

Values are expressed as n (%).a x2 for trend

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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

Hellenic Stomatological Review 59: 9-24, 2015

™YZHTH™H

TÔ ˘„ËÏfi Â›Â‰Ô Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ·È‰ÈÒÓ ÛÙË ÌÂϤÙË,ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ Î·Ù·ÁÚ·ÊfiÌÂÓË ·ÓÙÈÛÙÔȯ›· ÙˆÓÎÔÈÓˆÓÈÎÔ-‰ËÌÔÁÚ·ÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ‰Â›ÁÌ·-ÙÔ˜ Î·È ·˘ÙÒÓ ÙÔ˘ ÏËı˘ÛÌÔ‡ ·Ó·ÊÔÚ¿˜, ÂÓÈÛ¯‡Ô˘Ó ÙËÓ·ÍÈÔÈÛÙ›· ÙˆÓ Â˘ÚËÌ¿ÙˆÓ.Afi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û˘ ÌÂϤÙ˘, ·Ú·ÙË-ÚÂ›Ù·È ‰È·¯ÚÔÓÈο ÌÈ· Ì›ˆÛË ÙÔ˘ ‰Â›ÎÙË dmft ÁÈ· ÙËÓËÏÈÎȷ΋ ÔÌ¿‰· ÙˆÓ 6¯ÚÔÓˆÓ Ù˘ K‡ÚÔ˘ ·fi ÙÔ 2,23ÙÔ ¤ÙÔ˜ 2006, ÛÙËÓ ÙÈÌ‹ ÙÔ˘ 2,14 ÙÔ 2010 (Ì›ˆÛË Î·Ù¿4%) Î·È Ù¤ÏÔ˜ ÛÙËÓ ÙÈÌ‹ ÙÔ˘ 1,83 ÙÔ 2014 (Ì›ˆÛË Î·Ù¿14,49% Û ۯ¤ÛË Ì ÙÔ 2010) (¶›Ó·Î·˜ 3). AÓ Î·È ÔÔÈ·‰‹ÔÙ ۇÁÎÚÈÛË Ì ٷ ·ÔÙÂϤÛÌ·Ù· ¿Ï-

in the city of Larnaca as well as to the majority of the villageswithin the Larnaca district23iv,v.Although the dt / dmft ratio has recorded a decrease by4.8% since 2010 (from 72% to 67.2%) (Table 4) and it islower than in studies in Greece (87%,25) and Spain (Valenciaregion) (82%)19, there are still increased treatment needsamong the 6-year-old children as nearly four out of tenchildren (37.4%) have unmet treatment needs showingthat the disease is not yet under control. The significantdental treatment needs may be attributed to the lack ofpreventive programs on children under the age of 6 carriedout on a systematic basis, meaning that the prevention isleft at parents discretion. The percentage of children who were caries-free exceeded

E·Ú¯›· dmft

2005 2010 2014

§Â˘ÎˆÛ›· 1,88 2,14 1,83

§ÂÌÂÛfi˜ 2,37 2,12 1,73

§¿Úӷη 2,00 2,39 2,93

AÌÌfi¯ˆÛÙÔ˜ 3,14 2,99 1,72

¶¿ÊÔ˜ 2,00 1,43 0,93

¶·Á·ÚÈ· 2,23 2,14 1,83

¶›Ó·Î·˜ 3: ¢Â›ÎÙ˘ ÙÂÚˉfiÓ·˜ (Ì.Ô. dmft) ÁÈ· Ù· ÂÍ¿¯ÚÔÓ· Ù˘ K‡ÚÔ˘ ·Ó¿ ·گ›· ηٿ Ù· ¤ÙË 2005, 2010 Î·È 2014

E·Ú¯›· dmft

2005 2010 2014

Nicosia 1,88 2,14 1,83

Limassol 2,37 2,12 1,73

Larnaca 2,00 2,39 2,93

Ammochostos 3,14 2,99 1,72

Paphos 2,00 1,43 0,93

Cyprus 2,23 2,14 1,83

Table 3: Mean dmft for the 6-year-olds the years 2005, 2010, 2014 in various districts

iv According to recent analyzes in the 50% of the water sources in Larnaca district, the concentration of fluoride is undetectable. At the 19.4%the content reaches 0.2 mgF/L, 16.7% is ranging from 0.21-0.5 mgF/L, 2.8% from 0.51-1.00 mgF/L and at the remaining 11.1% the fluorideconcentration is more than 1 mgF/L. Of note that the sample was not derived from areas where the fluoride concentration in the drinkingwater exceeds the 1mgF/L23

v Of course it should be noted that the protective action of fluoride is mainly attributed to the free presence, even in traces, in the fluidenvironment of the tooth and slightly to the integrated presence of the apatite crystals (enamel structure)24

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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

ÏˆÓ ÂÚ¢ÓÒÓ Ù›ÓÂÈ Ó· Â›Ó·È ÂÈÛÊ·Ï‹˜, ÏfiÁˆ ÙˆÓ ‰È·-ÊÔÚÂÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ, ‰È·‰ÈηÛÈÒÓ, ‰Â›ÁÌ·ÙÔ˜, ÎÏ Ô˘Èı·Ófi Ó· ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı›, ·fi ÙËÓ ¿ÏÏË Â›Ó·È ÏÔ-ÁÈÎfi Ó· ·Ó·ÊÂÚı› fiÙÈ ˘¿Ú¯Ô˘Ó ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ¯ˆÚÒÓ Ù˘ E˘ÚÒ˘. ™˘ÁÎÂÎÚÈ̤ӷ, Û ¤Ú¢ӷ ÛÙËÓ ¶ÔÚ-ÙÔÁ·Ï›· ÚÈÓ ·fi 10 Î·È Ï¤ÔÓ ¯ÚfiÓÈ·, Ô ‰Â›ÎÙ˘ dmftÁÈ· Ù· ÂÍ¿¯ÚÔÓ· ›¯Â ·Ó¤ÏıÂÈ ÛÙÔ 2,118, ÂÓÒ Ì ‚¿ÛË Ù·ÚfiÛÊ·Ù· ÛÙÔȯ›· Ô ‰Â›ÎÙ˘ ÌÂÈÒıËΠÛÙÔ 1,62 (RuiManuel Calado, Chief Dental Office, ÚÔÛˆÈ΋ ÂÈÎÔÈ-ÓˆÓ›· 2015). AÓÙ›ÛÙÔȯ·, ÛÙËÓ IÛ·Ó›· (ÂÚÈÔ¯‹ Valencia)Ô ‰Â›ÎÙ˘ dmft ÁÈ· Ù· 6¯ÚÔÓ· Ô˘ ›¯Â ηٷÁÚ·Ê› ÙÔ 2006‹Ù·Ó 1,0819, Ô ›‰ÈÔ˜ ‰Â›ÎÙ˘ ÁÈ· Ù· 5¯ÚÔÓ· ›¯Â ÙËÓ ÙÈÌ‹ 1,2ÛÙËÓ IÙ·Ï›· (ÂÚÈÔ¯‹ Veneto)20, Î·È ÙȘ ÙÈ̤˜ 1,86 ÛÙË ™Îˆ-Ù›·, 1,98 ÛÙËÓ O˘·Ï›· Î·È 1,11 ÛÙËÓ, AÁÁÏ›·21. ¶·Ú¿ ÙË ‰È·¯ÚÔÓÈ΋ Ì›ˆÛË ÙÔ˘ ̤ÛÔ˘ ‰Â›ÎÙË ÙÂÚˉfiÓ·˜ÙˆÓ 6¯ÚÔÓˆÓ Ù˘ K‡ÚÔ˘, ·ÍÈÔÛËÌ›ˆÙË Â›Ó·È Ë ·‡ÍËÛËÙÔ˘ ‰Â›ÎÙË dmft, fiÙ·Ó ·fi ÙÔ ‰Â›ÁÌ· ·Ê·ÈÚÂıÔ‡Ó Ù· ·È-‰È¿ Ô˘ Â›Ó·È ÂχıÂÚ· ·fi ÙÂÚˉfiÓ·, ÔfiÙ ۯ‰fiÓ ‰È-Ï·ÛÈ¿˙ÂÙ·È Î·È ·fi 1,83 ÊÙ¿ÓÂÈ ÙÔ 3,83. EÂȉ‹ ÙÔ 29%ÙˆÓ ·È‰ÈÒÓ Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜ ›¯·Ó ‰Â›ÎÙË dmft>2,ÂȂ‚·ÈÒÓÂÙ·È ·˘Ùfi Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·fiÙÈ ‰ËÏ·‰‹ ÌÈ· ÌÂÚ›‰· ·È‰ÈÒÓ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ ‰Â›ÎÙË ÙÂ-ÚˉfiÓ·˜17 Î·È Î·Ù Â¤ÎÙ·ÛË ÂȂ‚·ÈÒÓÂÙ·È Ë ‡·ÚÍË ·ÓÈ-ÛÔÙ‹ÙˆÓ ÌÂٷ͇ ÙˆÓ ÂÍ¿¯ÚÔÓˆÓ ˆ˜ ÚÔ˜ ÙÔ Â›Â‰ÔÙ˘ ÛÙÔÌ·ÙÈ΋˜ ˘Á›·˜. EÍÂÙ¿˙ÔÓÙ·˜ ·Ó·Ï˘ÙÈÎfiÙÂÚ· Ù· ·ÔÙÂϤÛÌ·Ù· (›Ó·Î·˜3) ·Ú·ÙËÚÂ›Ù·È fiÙÈ Û fiϘ ÙȘ ·گ›Â˜ ηٷÁÚ¿ÊÂٷȉȷ¯ÚÔÓÈ΋ Ì›ˆÛË ÙÔ˘ ‰Â›ÎÙË dmft, ÂÎÙfi˜ ·fi ÙËÓ Â·Ú-¯›· §¿Úӷη˜, Ë ÔÔ›· ·ÓÙÈı¤Ùˆ˜, ·fi ÙÔ 2005 Î·È ÂÓÙ‡-ıÂÓ ÛËÌÂÈÒÓÂÈ ·‡ÍËÛË (¶›Ó·Î·˜ 3). EÈϤÔÓ, Ë Â·Ú¯›·§¿Úӷη˜ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·È ÙÔ ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ·È-‰ÈÒÓ (31,3%) ÌÂٷ͇ ÙˆÓ Â·Ú¯ÈÒÓ Ì ‰Â›ÎÙË dmft>2 ηÈÙÔ ¯·ÌËÏfiÙÂÚÔ (45,8%) Ì ‰Â›ÎÙË dmft=0. TÔ ÁÂÁÔÓfi˜ Ù˘ ‰È·¯ÚÔÓÈ΋˜ Âȉ›ӈÛ˘ ÙÔ˘ ‰Â›ÎÙË dmftÁÈ· Ù· 6¯ÚÔÓ· ÛÙËÓ Â·Ú¯›· §¿Úӷη˜ ˘Ô‰ËÏÒÓÂÈ ÙËÓ·Ó¿ÁÎË ·ÊÂÓfi˜ ÙÔ˘ ÂÓÙÔÈÛÌÔ‡ ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ÂȉÚÔ‡Ó ·ÚÓËÙÈο ÛÙÔ Â›Â‰Ô Ù˘ ÛÙÔÌ·ÙÈ΋˜ ˘Á›·˜Î·È ·ÊÂÙ¤ÚÔ˘ Ù˘ ÂÈΤÓÙÚˆÛ˘ Î·È ÂÓ›Û¯˘Û˘ Ù˘ ‰Ú¿-Û˘ ÙˆÓ ÚÔÏËÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÙˆÓ O‰ÔÓÙÈ·ÙÚÈ-ÎÒÓ YËÚÂÛÈÒÓ Û ·˘Ù‹ ÙËÓ Â·Ú¯›·. ™ÙÔ˘˜ ÂÓ ‰˘Ó¿ÌÂÈ·ÚÓËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ı· Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏËÊıÔ‡ÓÎ·È ‰È¿ÊÔÚÔÈ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎÔ›, ·ÊÔ‡ Ë Â·Ú¯›· §¿Ú-ӷη˜ ηٷÁÚ¿ÊÂÈ ÙÔ ̆ „ËÏfiÙÂÚÔ ÔÛÔÛÙfi ·Ó¤ÚÁˆÓ, ·Ï-Ï¿ Î·È ·˘ÙÒÓ Ô˘ ·ÛÎÔ‡Ó ¯·ÌËÏÔ‡ ÂȤ‰Ô˘ ·ÁÁ¤Ï-Ì·Ù· Û ۯ¤ÛË Ì ÙȘ ¿ÏϘ ·گ›Â˜22 ηıÒ˜ Î·È ·-Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙË ‰ÔÌÈ΋ Û‡ÛÙ·ÛË ÙˆÓ ‰Ô-ÓÙÈÒÓ fiˆ˜ .¯ Ë ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÓÂÚÔ‡ Û ÊıfiÚÈÔ,Ë ÔÔ›· ÛÙËÓ fiÏË Ù˘ §¿Úӷη˜ ·ÏÏ¿ Î·È ÛÙ· Ï›ÛÙ·

50% (54.2%) capturing the target set in 2000 by WHO forchildren aged 5-6. However, in the Nordic countries, morethan 70% of 6-year-old children were caries-free25, while inSpain (Valencia Region)19, Greece26 and northeastern Italy20

68%, 57.2% and 62% respectively of five-year-old childrenwere caries-free.The present study identified disparities in the level of dentalcaries for six-year-old children associated with the ethnicityand occupation of their parents. Specifically, the observationthat children whose parents were engaged in low leveloccupations have higher caries index (dmft) and higherdecayed teeth (dt) coincides with the findings of othersurveys showing interconnection of the educational level20,29,the occupation27,28 and the income2 with the dmft/DMFT. The finding that immigrants, the majority of which originatefrom Eastern European countries, have higher dmft thanthat of the local population has been reported in manystudies19, 30. The worse caries status of children from EasternEuropean countries31,32 has been associated with varioussocio-economic factors (poverty, unemployment) and thisis also true in Cyprus, where the majority of those livingin Cyprus come from low socio-economic classes.Finally, another remarkable finding of this study is theabsence of sealants in permanent teeth. Of the 515 children(89.3%) who had the first permanent molars in their mouth,only 5.4% had sealants, which indicate absence ofsystematic preventive actions until the age of 6. Thepreventive programs of the Cyprus Public Dental Servicesare addressing primarily the ages of 6-12 and only in thelast 2 years there have been pilot programs to cover 5-year-old children. Thus, there is a need to expand and reinforcethese programs so that they start as soon as possible, ideallyeven at the stage of pregnancy and child birth and targetingon individuals with increased risk. It should be noted thatthe consistent use of sealants, for over a decade, in a healthcenter in Eastern Macedonia, has led to the reduction ofthe caries experience among children33, 34. Anotherexplanation for the absence of sealants in permanent teethfor this age group is that dentists in Cyprus may not haveembraced the practice of prevention, especially in relationto the use of sealants. Surveys in the US35, Greece36,Scotland37 and Spain38 have recorded similarly limited useof sealants. The New Health Care System in Cyprus willreimburse the use of sealants, as well as the topicalapplications of fluoride. This is expected to positively affectthe use of preventive measures, providing that the level ofreimbursement will be satisfactory for dentists.

Hellenic Stomatological Review 59: 9-24, 2015

dmft dt (%) ft (%) mt (%)

2010 2.14 1.54 (71,96) 0.51 (23,83) 0.09 (4,21)

2014 1.83 1.23 (67,21) 0.54 (29,51) 0.06 (3,28)

Table 4: Mean dmft scores and other indices in 6-year-olds in Cyprus the years 2010 and 2014

Page 21: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

¯ˆÚÈ¿ Ù˘ ·گ›·˜ §¿Úӷη˜ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË23 iv, v.AÍÈÔÏÔÁÒÓÙ·˜ ÙÔ˘˜ ÂÈ̤ÚÔ˘˜ ‰Â›ÎÙ˜ ÙÔ˘ dmft, ·Ú·ÙË-Ú‹ıËΠfiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÙÂÚˉÔÓÈÛÌ¤ÓˆÓ ‰ÔÓÙÈÒÓ ˆ˜ÚÔ˜ ÙÔ Û‡ÓÔÏÔ ÙÔ˘ ‰Â›ÎÙË (dt/dmft), ‹Ù·Ó ·˘ÍË̤ÓÔ (67,2%).TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ·ÓÙÈηÙÔÙÚ›˙ÂÙ·È Î·È ÛÙÔ fiÙÈ Ù¤ÛÛÂÚ·ÛÙ· ‰¤Î· ۯ‰fiÓ ·È‰È¿ (37,4%) ·ÚÔ˘Û›·Û·Ó ̆ „ËϤ˜ ·Ó¿-ÁΘ ıÂڷ›·˜. ¶·ÚfiÏ· ·˘Ù¿, ‰È·¯ÚÔÓÈο ηٷÁÚ¿ÊÂ-Ù·È ‚ÂÏÙ›ˆÛË Û ۯ¤ÛË Ì ÙÔ 2010 Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ì›-ˆÛË ÙˆÓ ·Ó·ÁÎÒÓ ıÂڷ›·˜ ηٿ 4,7% Î·È ·‡ÍËÛË ÙÔ˘‰Â›ÎÙË ÂÚ›ı·Ï„˘ (ft/dmft) ηٿ 5,7% (¶›Ó·Î·˜ 4).™Ù· ıÂÙÈο Â˘Ú‹Ì·Ù· ÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈÙo ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ‹Û·Ó ÂχıÂÚ· ·fi ÙÂÚË-‰fiÓ· (dmft=0) ͤڷÛ ÙÔ 50% (54,2%), ηٷÎÙÒÓÙ·˜ ÙÔÛÙfi¯Ô Ô˘ Ù¤ıËΠÙÔ 2000 ·fi ÙÔÓ ¶.O.Y. fiÔ˘ ÙÔ 50% وӷȉÈÒÓ ËÏÈΛ·˜ 5-6 ¯ÚÔÓÒÓ ı· ¤Ú ӷ Â›Ó·È ÂχıÂÚ··fi ÙÂÚˉfiÓ·. ™ÙȘ ™Î·Ó‰ÈÓ·‚ÈΤ˜, fï˜, ¯ÒÚ˜ ÂÚÈÛ-ÛfiÙÂÚ· ·fi ÙÔ 70% ÙˆÓ 6¯ÚÔÓˆÓ ‹Û·Ó ÂχıÂÚ· ·fi ÙÂ-ÚˉfiÓ·25, ÂÓÒ ÛÙËÓ IÛ·Ó›· (ÂÚÈÔ¯‹ Valencia)19, EÏÏ¿‰·(26) Î·È BÔÚÂÈÔ·Ó·ÙÔÏÈ΋ IÙ·Ï›·20 ÙÔ 68%, 57,2% Î·È 62%·ÓÙ›ÛÙÔȯ· ÙˆÓ 5¯ÚÔÓˆÓ ‹Û·Ó ÂχıÂÚ· ·fi ÙÂÚˉfiÓ·.H ·ÚÔ‡Û· ÌÂϤÙË ÂÓÙfiÈÛ ·ÓÈÛfiÙËÙ˜ ÌÂٷ͇ ÙˆÓ 6¯ÚÔ-ÓˆÓ ˆ˜ ÚÔ˜ ÙÔ ‰Â›ÎÙË ÙÂÚˉfiÓ·˜, ÔÈ Ôԛ˜ Î·È Û˘Ó‰¤-ıËÎ·Ó Ì ‰È¿ÊÔÚÔ˘˜ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎÔ‡˜ Î·È Ê˘ÏÂÙÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ÂıÓÈÎfiÙËÙ·, ÙÔ Â¿ÁÁÂÏÌ· ÙˆÓÁÔÓ¤ˆÓ Î·È Ë Â·Ú¯›·, ·Ó·‰ÂÈÎÓ‡ÔÓÙ·˜ ¤ÙÛÈ fiÙÈ Ù· ·›ÙÈ·ÙˆÓ ÛÙÔÌ·ÙÈÎÒÓ ·ı‹ÛÂˆÓ Â›Ó·È ‚·ı‡ÙÂÚ· Î·È ˆ˜ Ù¤ÙÔÈ·Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È. ™˘ÁÎÂÎÚÈ̤ӷ ÙÔ Â‡ÚËÌ· fiÙÈÙ· ·È‰È¿ ÁÔÓ¤ˆÓ Ì ̄ ·ÌËÏÔ‡ ÂȤ‰Ô˘ ¿ÁÁÂÏÌ· ¤¯Ô˘Ó˘„ËÏfiÙÂÚÔ ‰Â›ÎÙË ÙÂÚˉfiÓ·˜ (dmft) ·ÏÏ¿ Î·È ̆ „ËÏfiÙÂÚԉ›ÎÙË ÙÂÚˉÔÓÈÛÌ¤ÓˆÓ ‰ÔÓÙÈÒÓ (dt), Ù·˘Ù›˙ÂÙ·È Ì ٷ ¢-Ú‹Ì·Ù· ÏËıÒÚ·˜ ÂÚ¢ÓÒÓ Ô˘ ‰Â›¯ÓÔ˘Ó ‰È·Û‡Ó‰ÂÛË ÙԢ·ÁÁ¤ÏÌ·ÙÔ˜27,ÙÔ˘ ÌÔÚʈÙÈÎÔ‡ ÂȤ‰Ô˘20, 29, ·ÏÏ¿ ηÈÙÔ˘ ÂÈÛÔ‰‹Ì·ÙÔ˜2 Ì ÙÔ ‰Â›ÎÙË ÙÂÚˉfiÓ·˜.O ·˘ÍË̤ÓÔ˜ ‰Â›ÎÙ˘ ÙÂÚˉfiÓ·˜ Î·È ÂÌÊÚ¿ÍÂˆÓ Û ·È-‰È¿ ÌÂÙ·Ó·ÛÙÒÓ ·Ó·Ê¤ÚÂÙ·È Û ‰È¿ÊÔÚ˜ ¤Ú¢Ó˜ ÛÙË ‚È-‚ÏÈÔÁÚ·Ê›·28, 30. TÔ ‚‚·Ú˘Ì̤ÓÔ fï˜ Â›Â‰Ô Ù˘ ÛÙÔ-Ì·ÙÈ΋˜ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ ·fi ¯ÒÚ˜ Ù˘ AÓ·ÙÔÏÈ΋˜E˘ÚÒ˘, ÂȂ‚·ÈÒÓÂÙ·È ÙfiÛÔ ·fi ÙËÓ ¤Ú¢ӷ ÙˆÓWidstrom et al.31, fiÛÔ Î·È ·fi ÚfiÛÊ·Ù· ÂȉËÌÈÔÏÔÁÈ-ο ÛÙÔȯ›· ·fi ÙËÓ ÈÛÙÔÛÂÏ›‰· ÙˆÓ Chief Dental Officers32

CONCLUSIONS

In summary, there has been an improvement over the lastyears in the level of oral health of 6-year-old children livingin Cyprus. However, a marked increase in the level of dmftwas recorded in specific regions / provinces in Cyprus,in children with origin from Eastern European countries,as well as children whose parents practiced low leveloccupations, confirming a significant effect of social class,region, and ethnicity on the level of oral health.This highlights the need for a new strategy for better oralhealth that will address all factors that affect oral health(included socio-economic), giving emphasis on preventionand on vulnerable groups with increased needs.

LIMITATIONS OF THE STUDY

Data about children attending private schools (around 15%of the 6-year-old children) have not been included in thisstudy. Children from private schools usually belong tofamilies of higher social class and have better oral healthlevels. Although this was common to all the previoussurveys in 2006 and 2010, this runs the risk for undere-stimating the level of oral health of children living in Cyprus.In order to avoid that, schools from affluent areas wereincluded in the sample. On the other hand, dental caries was diagnosed throughvisual inspection as recommended by the WHO. This mighthave underestimated the number of carious teeth in thestudy population.

REFERENCES

1. Christenesen LB, Twetman S, Sundby A: Oral health in childrenand adolescents with different socio-cultural and socio-economic background. Acto Odontologica Scandinavica2010; 68: 34-42

2. http://www.hscic.gov.uk/catalogue/PUB17137 (assessed10/3/16)

3. Lupi-Pegurier L, Bourgeois D, Muller-Bolla M: Encyxlopediemedico-chirurgicale, Medecine Buccale 2009: 28-260-D-10

dmft dt (%) ft (%) mt (%)

2010 2,14 1,54 (71,96) 0,51 (23,83) 0,09 (4,21)

2014 1,83 1,23 (67,21) 0,54 (29,51) 0,06 (3,28)

¶›Ó·Î·˜ 4: ™‡ÁÎÚÈÛË ‰Â›ÎÙË dmft Î·È ÙˆÓ ÂÈ̤ÚÔ˘˜ ‰ÂÈÎÙÒÓ ÙÔ˘ ÁÈ· Ù· ¤ÙË 2010 Î·È 2014

iv ™‡Ìʈӷ Ì ÚfiÛÊ·Ù˜ ·Ó·Ï‡ÛÂȘ ÙÔ˘ KÚ·ÙÈÎÔ‡ XËÌ›Ԣ Ù˘ K‡ÚÔ˘ ÛÙÔ 50% ÙˆÓ ËÁÒÓ Ù˘ ·گ›·˜ §¿Úӷη˜ Â›Ó·È ÌË ·ÓȯÓ‡-ÛÈÌË Ë Û˘ÁΤÓÙÚˆÛË ÊıÔÚ›Ô˘ ÛÙÔ fiÛÈÌÔ ÓÂÚfi. ™ÙÔ 19,4% Ë Û˘ÁΤÓÙÚˆÛË ÊÙ¿ÓÂÈ Ì¤¯ÚÈ 0,2 mgF/L, ÛÙÔ 16,7% Î˘Ì·›ÓÂÙ·È ·fi 0,21-0,5 mgF/L, ÛÙÔ 2,8% Î˘Ì·›ÓÂÙ·È ·fi 0,51-1,00 mgF/L Î·È ÛÙÔ ˘fiÏÔÈÔ 11,1% ÍÂÂÚÓ¿ ÙÔ 1 mgF/L. £· Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ùԉ›ÁÌ· ‰ÂÓ ·ÓÙÏ‹ıËΠ·fi ÂÚÈÔ¯¤˜ fiÔ˘ Ë ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ fiÛÈÌÔ˘ ÓÂÚÔ‡ Û ÊıfiÚÈÔ ÍÂÂÚÓÔ‡Û ÙÔ 1mgF/L23

v B‚·›ˆ˜ ı· Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ Ë ÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË ÙÔ˘ ÊıÔÚ›Ô˘ ·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ÂχıÂÚË ·ÚÔ˘Û›· ÙÔ˘, ¤ÛÙˆÎ·È Û ›¯ÓË, ÛÙÔ ˘ÁÚfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ‰ÔÓÙÈÔ‡ Î·È ÂÏ¿¯ÈÛÙ· ÛÙËÓ ÂÓۈ̷و̤ÓË ·ÚÔ˘Û›· ÙÔ˘ ÛÙÔ˘˜ ÎÚ˘ÛÙ¿ÏÏÔ˘˜ ÙÔ˘ ··Ù›ÙË (‰Ô-Ì‹ ·‰·Ì·ÓÙ›Ó˘)24

Hellenic Stomatological Review 59: 9-24, 201520

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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

Î·È ¤¯ÂÈ ‰È·Û˘Ó‰Âı› Ì ‰È¿ÊÔÚÔ˘˜ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ·fiÚÚÔÈ· ÙˆÓ ÔÏÈÙÈÎÒÓ ÂÍÂÏ›ÍÂˆÓ ÛÙȘ¯ÒÚ˜ ·˘Ù¤˜ Ô˘ ‰È·‰Ú·Ì·Ù›ÛÙËÎ·Ó ÙË ‰ÂηÂÙ›· ÙÔ˘ 1990.T¤ÏÔ˜, ·ÍÈÔÛËÌ›ˆÙÔ Â‡ÚËÌ· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ›-Ó·È Ë ·Ô˘Û›· ÚÔÏËÙÈÎÒÓ Î·Ï‡„ÂˆÓ ·fi Ù· ÌfiÓÈÌ· ‰fi-ÓÙÈ·. Afi Ù· 89,3% (n=515) ·È‰È¿ Ô˘ ›¯·Ó ÌfiÓÈÌÔ˘˜ÚÒÙÔ˘˜ ÁÔÌÊ›Ô˘˜ ÛÙÔ ÛÙfiÌ·, ÌfiÓÔ ÙÔ 5,4% (n=31) ›-¯·Ó ÚÔÏËÙÈΤ˜ ηχ„ÂȘ, ηٷ‰ÂÈÎÓ‡ÔÓÙ·˜ ÙËÓ ·Ô˘-Û›· Û˘ÛÙËÌ·ÙÈÎÒÓ ÚÔÏËÙÈÎÒÓ ‰Ú¿ÛÂˆÓ Ì¤¯ÚÈ ÙËÓ ËÏÈ-Λ· ÙˆÓ 6 ¯ÚfiÓˆÓ. TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ÌÔÚ› Ó· ÔÊ›ÏÂÙ·ÈÛ ÔÏÏÔ‡˜ ·Ú¿ÁÔÓÙ˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ӈÓ: ·) Ù˘·Ô˘Û›·˜ ̤¯ÚÈ ÚfiÙÈÓÔ˜ ÔÚÁ·ÓˆÌ¤ÓˆÓ ÚÔÏËÙÈÎÒÓ Ô‰Ô-ÓÙÈ·ÙÚÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÁÈ· Ù· ·È‰È¿ ËÏÈΛ·˜ ̤¯ÚÈ 5ÂÙÒÓ ·fi ÙÔ ‰ËÌfiÛÈÔ ÙÔ̤·, ‚) Ù˘ ¿ÁÓÔÈ·˜ ÂΠ̤ÚÔ˘˜ ÙˆÓÁÔÓ¤ˆÓ ÁÈ· ÙËÓ ·Ó¿ÁÎË Î·È ÙÔ fiÊÂÏÔ˜ ÙˆÓ ÚÔÏËÙÈÎÒÓηχ„ˆÓ, Á) Ù˘ ÌË Â·ÚÎÔ‡˜ ÚÔÒıËÛ˘ ÙÔ˘ ÚÔÏË-ÙÈÎÔ‡ ·˘ÙÔ‡ ̤ÙÚÔ˘ ·fi ÙÔ˘˜ Ô‰ÔÓÙÈ¿ÙÚÔ˘˜. ¶¿ÓÙˆ˜,fiÙ·Ó ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û˘ÛÙËÌ·ÙÈο Î·È Â› ÌÈ· ‰ÂηÂ-Ù›· ÛÙ· ·È‰È¿ ÂÓfi˜ ÂÚÈÊÂÚÈÎÔ‡ K¤ÓÙÚÔ˘ YÁ›·˜ Ù˘ AÓ·-ÙÔÏÈ΋˜ M·Î‰ÔÓ›·˜, Ì›ˆÛ·Ó ηıÔÚÈÛÙÈο ÙËÓ ÂÌÂÈÚ›·ÙÂÚˉfiÓ·˜33, 34. °ÂÓÈο, ÁÈ· ÙÔ ı¤Ì· ·˘Ùfi ÙˆÓ ÚÔÏËÙÈÎÒÓηχ„ˆÓ, Ù· ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ Û H¶A (35), EÏÏ¿‰·(36) Î·È ™ÎˆÙ›·37 ηٷÁÚ¿ÊÔ˘Ó ÂÚÈÔÚÈṲ̂ÓË ¯Ú‹ÛË ÙˆÓÚÔÏËÙÈÎÒÓ Î·Ï‡„ÂˆÓ ·fi ÏÂ˘Ú¿˜ ȉȈÙÒÓ Ô‰ÔÓÙÈ¿-ÙÚˆÓ. AÓÙ›ÛÙÔȯ·, ÌÈ· ¤Ú¢ӷ ÛÙËÓ IÛ·Ó›·38 ·Ó¤‰ÂÈÍ fiÙÈ·Ó Î·È ÔÈ Ô‰ÔÓÙ›·ÙÚÔÈ ÁÓÒÚÈ˙·Ó fiÙÈ ÔÈ ÚÔÏËÙÈΤ˜ ηχ-„ÂȘ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈΤ˜, ÙȘ ˘Ô¯ÚËÛÈÌÔÔÈÔ‡Û·Ó. K·Ù ¤ÎÙ·ÛË, Ë ·Ô˙ËÌ›ˆÛË Î·Ù¿ Ú¿ÍË ·fi ÙÔ N¤Ô ™¯¤-‰ÈÔ YÁ›·˜ Ù˘ K‡ÚÔ˘ ÁÈ· ÙËÓ ÙÔÔı¤ÙËÛË ÚÔÏËÙÈÎÒÓηχ„ˆÓ, ·Ó·Ì¤ÓÂÙ·È fiÙÈ ı· ÂËÚ¿ÛÂÈ ıÂÙÈο Î·È ı·ÚÔ¿ÁÂÈ ÙËÓ ÂÊ·ÚÌÔÁ‹ ·˘ÙÔ‡ ÙÔ˘ ̤ÙÚÔ˘ ÛÙÔÓ ·È‰ÈÎfiÏËı˘ÛÌfi Ù˘ K‡ÚÔ˘, ˘fi ÙËÓ ÚÔ¸fiıÂÛË, ‚‚·›ˆ˜,fiÙÈ ÙÔ ‡„Ô˜ Ù˘ ·Ô˙ËÌ›ˆÛ˘ ı· Â›Ó·È ·Ô‰ÂÎÙfi ·fi ÙÔ˘˜È‰ÈÒÙ˜ Ô‰ÔÓÙÈ¿ÙÚÔ˘˜. Afi ÙËÓ ¿ÏÏË, ÂȂ‚ÏË̤ÓË ÎÚ›-ÓÂÙ·È Ë ÂÓ›Û¯˘ÛË ÙˆÓ ÚÔÏËÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÙˆÓO‰ÔÓÙÈ·ÙÚÈÎÒÓ YËÚÂÛÈÒÓ, Ù· ÔÔ›· Î·È ı· Ú¤ÂÈ Ó· ÍÂ-ÎÈÓÔ‡Ó ·fi ÙËÓ ÂÚ›Ô‰Ô Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, ηٿÏÏËÏ· ‰È·-ÌÔÚʈ̤ӷ ÁÈ· fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜. K·Ù·Ï˘ÙÈÎfiÚfiÏÔ ÛÙËÓ ÚÔÒıËÛ‹ ÙÔ˘˜ ·Ó·Ì¤ÓÂÙ·È Ó· ‰È·‰Ú·Ì·Ù›ÛÂÈË Û˘ÓÂÚÁ·Û›· Ì ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ·ÁÁÂÏ̷ٛ˜ Ù˘¶ÚˆÙÔ‚¿ıÌÈ·˜ ºÚÔÓÙ›‰·˜ YÁ›·˜, ÛÙ· Ï·›ÛÈ· Ù˘ ÔÏÈ-ÛÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ. °È· ÙÔ ı¤Ì· ·˘Ùfifï˜ Û·ÊÒ˜ ··ÈÙÔ‡ÓÙ·È ÚˆÙfiÎÔÏÏ·, ηÙ¢ı˘ÓÙ‹ÚȘÁÚ·Ì̤˜ Î·È Âη›‰Â˘ÛË ÙˆÓ ÏÂÈÙÔ˘ÚÁÒÓ ˘Á›·˜.

™YM¶EPA™MATA

H ·ÚÔ‡Û· ÌÂϤÙË ·Ó¤‰ÂÈÍ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÂȤ‰Ô˘ Ù˘ÛÙÔÌ·ÙÈ΋˜ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 6 ÂÙÒÓ ÛÙËÓ K‡-ÚÔ˘ Î·È Ì›ˆÛË ÙˆÓ ·Ó·ÁÎÒÓ ıÂڷ›·˜. ¶·ÚfiÏ· ·˘Ù¿,·˘Ù¤˜ ηٷÁÚ¿ÊÔÓÙ·È È‰È·›ÙÂÚ· ·˘ÍË̤Ó˜ ÛÂ Û˘ÁÎÂÎÚÈ-̤Ó˜ ÂÚÈÔ¯¤˜/·گ›Â˜. E›Û˘, ·˘ÍË̤Ó˜ ‚Ú¤ıËηÓÔÈ ·Ó¿ÁΘ ıÂڷ›·˜ Î·È Û ·È‰È¿ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi¯ÒÚ˜ Ù˘ AÓ·ÙÔÏÈ΋˜ E˘ÚÒ˘, ηıÒ˜ Î·È Û ·È‰È¿ Ô˘ÔÈ ÁÔÓ›˜ ÙÔ˘˜ ·ÛÎÔ‡Ó Â·ÁÁ¤ÏÌ·Ù· ¯·ÌËÏÔ‡ ÂȤ‰Ô˘,ÂȂ‚·ÈÒÓÔÓÙ·˜ ·˘Ùfi Ô˘ ·Ó·Ê¤ÚÂÈ Ë ‚È‚ÏÈÔÁÚ·Ê›· ÁÈ·ÙËÓ Â›‰Ú·ÛË Ù˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘, Ù˘ ÂÚÈÔ¯‹˜, ·ÏÏ¿Î·È Ù˘ ÂıÓÈÎfiÙËÙ·˜ ÛÙÔ Â›Â‰Ô Ù˘ ÛÙÔÌ·ÙÈ΋˜ ˘Á›·˜.

4. Do LG: Distribution of caries in children: variations betweenand within populations. J Dent Res 2012; 91(6):536-43

5. Guarnizo-Herreno CC, Watt R, Pickhart H, Sheiham A, TsakosG: Socioeconomic inequalities in oral health in differentEuropean welfare state regimes. Epidemiol Community Health2013; 67:728-35

6. Ekback G, Persson C: Caries in five different socio-economicclusters in Orebro country. Com Dental Health 2012; 29: 229-32

7. Marcenes W, Kassebaum NJ, Bernabe E, Flaxman A, Naghavi M,Lopez A, Murray AJL: Global burden of oral conditions in 1999-2010: A systematic analysis. Dent Res 2013; 92 (7) :592-97

8. Eurostat, 2015: http://ec.europa.eu/eurostat/web/health/health-care/data/database (assessed 10/3/2016)

9. Theodorou M, Charalambous C, Petrou C, Cylus J: Cyprus. Healthsystem review. Health Systems in Transition2012; Vol 14: 6

10. Charalambous C, Theodorou M: Systems for the provisionof oral health care in the Black Sea Countries. Part 11 Cyprus.OHDM 2013; Vol 12 (1), March

11. Burhani H, Lagoudes S, Savvidou N: National Oral HealthSurvey in Cyprus. Dental Services. Ministry of Health.1992

12. Charalambous C, Giannaki G. Level of oral health of childrenliving in Cyprus. Cyprus Ministry of Health.2006

13. Charalambous C, Theodorou M: AÍÈÔÏfiÁËÛË ÙÔ˘ ÂȤ‰Ô˘ Ù˘ÛÙÔÌ·ÙÈ΋˜ ̆ Á›·˜ ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ K‡ÚÔ. (Oral health statusof children living in Cyprus). Hel Stom Rev 2011; 55: 29-36.

14. WHO. Oral health Surveys. Basic Methods.199915. Cyprus Statistical Service, 2013. Census of the population

http://www.mof.gov.cy/mof/cystat/statistics.nsf/populationcondition_22main_gr/populationcondition_22main_gr?OpenForm&sub=2&sel=2 (assessed 10/3/16)

16. http://www.ilo.org/public/english/bureau/stat/isco/ (assessed10/3/16)

17. Hart JT: The inverse care law. Lancet 1971;7696:405-1218. de Almeida CM, Petersen PE, Andre SJ, Toscano A: Changing

oral health status of 6 and 12-year old schoolchildren inPortugal. Com Dental Health 2003; 20: 211-16

19. Almerich Silla JM, Montiel Company JM: Oral health survey ofthe child population in the Valencia Region of Spain (2004).Med Oral Patol Oral Cir Bucal 2006;11(4):369-81

20. Ferro R, Cecchin C, Besostri A, Olivier, A, Stellini E, MazzoleniS: Social difference in tooth decay occurrence in a sampleof children aged 3 to 5 in North- East Italy. Com Dental Health2010; 27: 163-66

21. Davies GM, Jones CM, Monaghan N, Morgan MZ, Pine CM,Pitts NB, et al: The caries experience of 5 year old childrenin Scotland, Wales and England in 2007-2008 an the impactof consent arrangements. Reports of co-ordinate surveysusing BASCD criteria. Com Dental Health 2011; XX 1-7

22. http://www.mof.gov.cy/mof/cystat/statistics.nsf/labour_31main_gr/labour_31main_gr?OpenForm&sub=1&sel=1 (assessed 10/3/16)

23. State Genral Laboratory Cyprus. Quality of drinking water.200924. Topitsoglou V. Map of fluoride in Greece and Cyprus. Naturally

fluorinated drinking water. Monograph. Thessaloniki, 200425. Nordenram G: Dental health in Sweden: The National Public

Health Report 2012. Chapter 16. Scandinavian Journal ofPublic Health 2012;. 40 (Suppl 9):281-86

26. Oulis CJ, Theodorou M, Mastrogiannakis H, Mamai-HomataH, Polychronopoulou A, Papayiannoulis L, Athanasouli T: OralHealth status and treatment needs of the Hellenic populationproposals for improvement. Hel Stom Rev 2009;53:97-120

27. Vanobbergen JAN , Martens LC, Lesaffre E, Declerck D:Parental occupational status related to dental caries experiencein 7-year-old children in Flanders (Belgium).Com Dental Health2001;18(4):256-62

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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

Hellenic Stomatological Review 59: 9-24, 2015

T· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ̆ Ô‰ËÏÒÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË ÁÈ· ÌÈ·Ó¤· ÛÙÚ·ÙËÁÈ΋ ÚÔ·ÁˆÁ‹˜ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ˘Á›·˜ Ô˘ı· ¤¯ÂÈ ˆ˜ ›ÎÂÓÙÚfi Ù˘ ÙËÓ ÚfiÏË„Ë Î·È È‰È·›ÙÂÚ· Ù·¿ÙÔÌ· Ì ·˘ÍË̤ӷ ÛÙÔÌ·ÙÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·. ¶·-Ú¿ÏÏËÏ·, ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ‚·ı‡ÙÂÚˆÓ ·ÈÙÈÒÓ ÙˆÓ ˘ÁÂÈÔÓÔÌÈÎÒÓ ·ÓÈÛÔًوÓ, ··È-ÙÔ‡ÓÙ·È Â˘Ú‡ÙÂÚ· ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈο ̤ÙÚ· Î·È ‰ËÌÈ-Ô˘ÚÁ›· ˘ÔÛÙËÚÈÎÙÈÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Ô˘ ı· ÚÔ¿ÁÂÈÙȘ ÛˆÛÙ¤˜ Û˘Ó‹ıÂȘ ‰È·ÙÚÔÊ‹˜, ÛÙÔÌ·ÙÈ΋˜ ˘ÁÈÂÈÓ‹˜Î·È ›Û΄˘ ÛÙÔÓ Ô‰ÔÓÙ›·ÙÚÔ.

¶EPIOPI™MOI ™THN EPEYNA

™ÙËÓ ¤Ú¢ӷ ‰ÂÓ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ·È‰È¿ Ô˘ ÊÔÈÙÔ‡ÓÛ ȉȈÙÈο Û¯ÔÏ›· (ÂÚ›Ô˘ ÙÔ 15% ÁÈ· Ù· 6¯ÚÔÓ·). T··È‰È¿ ·˘Ù¿ ¤¯Ô˘Ó οÔÈ· ȉȷ›ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο ηÈÛ˘ÁÎÂÎÚÈ̤ӷ ÚÔ¤Ú¯ÔÓÙ·È ·fi ‡ÔÚ˜ ÎÔÈÓˆÓÈΤ˜ Ù¿-ÍÂȘ Î·È Î·Ù’ ¤ÎÙ·ÛË, Û‡Ìʈӷ Î·È Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ÌÂϤÙ˘, Ôχ Èı·ÓfiÓ Ó· ›¯·Ó Î·È Î·Ï‡ÙÂÚÔ Â›Â‰Ô ÛÙÔ-Ì·ÙÈ΋˜ ˘Á›·˜. AÓ Î·È Ë ›‰È· Ù·ÎÙÈ΋ ·ÎÔÏÔ˘ı‹ıËΠηÈÛÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ¤Ú¢Ó˜, Ë ÌË Û˘ÌÂÚ›ÏË„‹ ÙÔ˘˜ ÂÁ΢-ÌÔÓ› ÙÔÓ Î›Ó‰˘ÓÔ ̆ ÂÚÂÎÙ›ÌËÛ˘ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡, ·ÏÏ¿Î·È Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ÙÂÚˉÔÓÈ΋˜ ÚÔÛ‚ÔÏ‹˜, ÛÙÔÓ6¯ÚÔÓÔ ·È‰ÈÎfi ÏËı˘ÛÌfi Ù˘ K‡ÚÔ˘. ¶ÚÔ˜ ·ÔÊ˘Á‹ÂÈÛ·ÁˆÁ‹˜ Û˘ÛÙËÌ·ÙÈÎÔ‡ ÛÊ¿ÏÌ·ÙÔ˜ ÛÙËÓ ¤Ú¢ӷ, Û˘-ÌÂÚÈÏ‹ÊıËÎ·Ó Î·È ‰ËÌfiÛÈ· Û¯ÔÏ›· Ô˘ ‚Ú›ÛÎÔÓÙ·Ó ÛÂÂÚÈÔ¯¤˜ ˘„ËÏÔ‡ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎÔ‡ ÂȤ‰Ô˘.E›Û˘, Ë ·ÍÈÔÏfiÁËÛË ÙÔ˘ ‰Â›ÎÙË dmft ¤ÁÈÓ ÌfiÓÔ ÌÂÎÏÈÓÈο ‰Â‰Ô̤ӷ, ¯ˆÚ›˜ ÙË Ï‹„Ë ·ÎÙÈÓÔÁÚ·Ê›·˜, ÁÂÁÔ-Ófi˜ Ô˘ ÂÓ¤¯ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î¿ÔȘ fiÌÔÚ˜ ÙÂÚˉÔÓÈ-Τ˜ ‚Ï¿‚˜ Ó· ÌËÓ Â›¯·Ó ‰È·ÁÓˆÛÙ› Î·È Î·Ù Â¤ÎÙ·ÛËÓ· ˘ÔÂÎÙÈÌ‹ıËÎÂ Ë ÙÂÚˉÔÓÈ΋ ÚÔÛ‚ÔÏ‹.

BIB§IO°PAºIA

1. Christenesen LB, Twetman S, Sundby A: Oral health in childrenand adolescents with different socio-cultural and socio-economic background. Acto Odontologica Scandinavica2010; 68: 34-42

2. http://www.hscic.gov.uk/catalogue/PUB17137 (ËÌÂÚÔÌËÓ›·ÚfiÛ‚·Û˘ 10/3/16)

3. Lupi-Pegurier L, Bourgeois D, Muller-Bolla M: Encyxlopediemedico-chirurgicale, Medecine Buccale 2009: 28-260-D-10

4. Do LG: Distribution of caries in children: variations betweenand within populations. J Dent Res 2012; 91(6):536-43

5. Guarnizo-Herreno CC, Watt R, Pickhart H, Sheiham A, TsakosG: Socioeconomic inequalities in oral health in differentEuropean welfare state regimes. Epidemiol Community Health2013; 67:728-35

6. Ekback G, Persson C: Caries in five different socio-economic clu-sters in Orebro country. Com Dental Health 2012; 29: 229-32

7. Marcenes W, Kassebaum NJ, Bernabe E, Flaxman A, Naghavi M,Lopez A, Murray AJL: Global burden of oral conditions in 1999-2010: A systematic analysis. Dent Res 2013; 92 (7) :592-97

8. Eurostat, 2015: http://ec.europa.eu/eurostat/web/health/health-care/data/database (ËÌÂÚÔÌËÓ›· ÚfiÛ‚·Û˘ 10/3/2016)

9. Theodorou M, Charalambous C, Petrou C, Cylus J:Cyprus. Healthsystem review. Health Systems in Transition2012; Vol 14: 6

10. Charalambous C, Theodorou M: Systems for the provisionof oral health care in the Black Sea Countries. Part 11 Cyprus.OHDM 2013; Vol 12 (1), March

28. Wigen TI, Wang NJ: Caries and background factors in Nor-wegian and immigrant 5-year-old children. Com Dentistry andOral Epidemiology 2010; 28 (1):19-28

29. Vadiakas G, Oulis C, Tsinidou K, Mamai-Homata E, Polychro-nopoulou, A: Socio-behavioural factors influencing oral healthof 12 and 15 year old Greek adolescents. A national pathfindersurvey. Eur Arch Paediatr 2011; Dent Jun;12(3):139-45

30. Skeie MS, Riordan P, Klock KS, Espelid I: Parental risk attitudesand caries-related behaviours among immigrant and Westernnative children in Oslo. Com Dent Oral Epidemiol 2006; 34:103-13

31. Widstrom E, Eaton K, Borutta A: Oral health in transition inEastern Europe. Br. Dent J 2001; 190, 580-84

32. http://www.cecdo.org/pages/database%20intro.html(assessed 10/3/16)

33. Demertzi A, Topitsoglou V, Konstantopoulos G, SpyridonidouS. Dental status of children 7-12 years of Nestos province andobjectives of the Health Center in 2010. Paidodontic 2006: 20(4): 158-165. (article in greek)

34. Demertzi A, Topitsoglou V and Muronidis S. Caries prevalenceof 11, 5 year-olds between 1989 and 2001, in a province of North-eastern Greece. Community Dental Health 2006: 23:140-146

35. Ferracane J T, Hilton A, Korpak J, Gillette P,Speed McIntyre J,Berg and Northwest PRECEDENT: Use of caries preventionservices in the Northwest PRECEDENT dental network.Community Dentistry and Oral Epidemiology 2011; Volume39( 1): 6978

36. Oulis CJ, Berdouses E.D, Mamai-Homata H, PolychronopoulouA: Prevalence of sealants in relation to dental caries on thepermanent molars of 12 and 15- year old Greek adolescents.A national pathfinder survey. BMC Public Health 2011; 11, 100

37. Sarmadi R, Gahnberg L, Gabre P: Clinicians preventive strategiesfor children and adolescents identified as at high risk ofdeveloping caries. Int J Paediatr Dent 2011; 21(3):167-74

38. San Martin L, Castano A, Bravo M, Tavares M, Niederman R,O Gunbodede E: Dental sealant knowledge, opinion, valuesand practice of Spanish dentists. BMC Oral Health 2013;13:12

Corresponding author:C. Charalambous [email protected],[email protected]

Page 24: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

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11. Burhani H, Lagoudes S, Savvidou N: National Oral HealthSurvey in Cyprus. Dental Services. Ministry of Health.1992

12. X·Ú·Ï¿ÌÔ˘˜ X, °È·ÓÓ¿ÎË X. E›Â‰Ô ÛÙÔÌ·ÙÈ΋˜ ̆ Á›·˜ ÙÔ˘·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÙËÓ K‡ÚÔ. YÔ˘ÚÁÂ›Ô YÁ›·˜ K‡ÚÔ˘.2006

13. X·Ú·Ï¿ÌÔ˘˜ X, £ÂÔ‰ÒÚÔ˘ M: AÍÈÔÏfiÁËÛË ÙÔ˘ ÂȤ‰Ô˘ Ù˘ÛÙÔÌ·ÙÈ΋˜ ̆ Á›·˜ ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ K‡ÚÔ. EÏÏ. ™ÙÔÌ. XÚÔÓ.2011;55

14. WHO. Oral health Surveys. Basic Methods.199915. ™Ù·ÙÈÛÙÈ΋ YËÚÂÛ›· K‡ÚÔ˘, 2013. AÔÁÚ·Ê‹ ÏËı˘ÛÌÔ‡

http://www.mof.gov.cy/mof/cystat/statistics.nsf/populationcondition_22main_gr/populationcondition_22main_gr?OpenForm&sub=2&sel=2 (ËÌÂÚÔÌËÓ›· ÚfiÛ‚·Û˘ 10/3/16)

16. http://www.ilo.org/public/english/bureau/stat/isco/(ËÌÂÚÔ-ÌËÓ›· ÚfiÛ‚·Û˘ 10/3/16)

17. Hart JT: The inverse care law. Lancet; 1971:7696:405-1218. de Almeida CM, Petersen PE, Andre SJ, Toscano A: Changing

oral health status of 6 and 12-year old schoolchildren inPortugal. Com Dental Health 2003; 20: 211-16

19. Almerich Silla JM, Montiel Company JM: Oral health survey ofthe child population in the Valencia Region of Spain (2004).Med Oral Patol Oral Cir Bucal 2006;11(4):369-81

20. Ferro R, Cecchin C, Besostri A, Olivier, A, Stellini E, MazzoleniS: Social difference in tooth decay occurrence in a sampleof children aged 3 to 5 in North- East Italy. Com Dental Health2010; 27: 163-66

21. Davies GM, Jones CM, Monaghan N, Morgan MZ, Pine CM,Pitts NB, et al: The caries experience of 5 year old childrenin Scotland, Wales and England in 2007-2008 an the impactof consent arrangements. Reports of co-ordinate surveysusing BASCD criteria. Com Dental Health 2011; XX 1-7

22. http://www.mof.gov.cy/mof/cystat/statistics.nsf/labour_31main_gr/labour_31main_gr?OpenForm&sub=1&sel=1 (ËÌÂÚÔ-ÌËÓ›· ÚfiÛ‚·Û˘ 10/3/16)

23. KÚ·ÙÈÎfi XËÌÂ›Ô K‡ÚÔ˘. AӷχÛÂȘ ÓÂÚÔ‡ ÛÙËÓ K‡ÚÔ. 200924. TÔ›ÙÛÔÁÏÔ˘ B. X¿ÚÙ˘ ÊıÔÚ›Ô˘ EÏÏ¿‰·˜ Î·È K‡ÚÔ˘. º˘ÛÈ-

ο ÊıÔÚȈ̤ӷ fiÛÈÌ· ÓÂÚ¿. MÔÓÔÁÚ·Ê›·. £ÂÛÛ·ÏÔÓ›ÎË, 200425. Nordenram G: Dental health in Sweden: The National Public

Health Report 2012. Chapter 16. Scandinavian Journal ofPublic Health 2012;. 40 (Suppl 9):281-86

26. O˘Ï‹˜ K, £ÂÔ‰ÒÚÔ˘ M, M·ÛÙÚÔÁÈ·ÓÓ¿Î˘ T·, M·Ì¿Ë-Xˆ-Ì·Ù¿ X, ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ A, ¶··ÁÈ·ÓÓÔ‡ÏË A, Aı·Ó·ÛÔ‡-ÏË £: H ÂȉËÌÈÔÏÔÁÈ΋ ηٿÛÙ·ÛË Ù˘ ÛÙÔÌ·ÙÈ΋˜ ˘Á›·˜ÙÔ˘ ÂÏÏËÓÈÎÔ‡ ÏËı˘ÛÌÔ‡. ¶ÚÔÙ¿ÛÂȘ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘.EÏÏ. ™ÙÔÌ. XÚÔÓ. 2009; 53:97-120

27. Vanobbergen JAN , Martens LC, Lesaffre E, Declerck D:Parental occupational status related to dental caries experiencein 7-year-old children in Flanders (Belgium).Com Dental Health2001;18(4):256-62

28. Wigen TI, Wang NJ: Caries and background factors in Nor-wegian and immigrant 5-year-old children. Com Dentistry andOral Epidemiology 2010; 28 (1):19-28

29. Vadiakas G, Oulis C, Tsinidou K, Mamai-Homata E, Polychrono-poulou, A: Socio-behavioural factors influencing oral healthof 12 and 15 year old Greek adolescents. A national pathfindersurvey. Eur Arch Paediatr 2011; Dent Jun;12(3):139-45

30. Skeie MS, Riordan P, Klock KS, Espelid I: Parental risk attitudesand caries-related behaviours among immigrant and Western na-tive children in Oslo. Com Dent Oral Epidemiol 2006; 34:103-13

31. Widstrom E, Eaton K, Borutta A: Oral health in transition inEastern Europe. Br. Dent J 2001; 190, 580-84

32. http://www.cecdo.org/pages/database%20intro.html (ËÌÂ-ÚÔÌËÓ›· ÚfiÛ‚·Û˘ 10/3/16

33. ¢ÂÌÂÚÙ˙‹ A, TÔ›ÙÛÔÁÏÔ˘ B, KˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ° ™˘Úȉˆ-

Hellenic Stomatological Review 59: 9-24, 2015

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Ó›‰Ô˘ ™. O‰ÔÓÙÈ΋ ηٿÛÙ·ÛË ·È‰ÈÒÓ 7-12 ÂÙÒÓ Ù˘ ·Ú-¯›·˜ N¤ÛÙÔ˘ Î·È ÛÙfi¯ÔÈ ÙÔ˘ K¤ÓÙÚÔ˘ YÁ›·˜ ÁÈ· ÙÔ ¤ÙÔ˜ 2010.¶·È‰Ô‰ÔÓÙ›· 2006: 20(4):158-165.

34. Demertzi A, Topitsoglou V and Muronidis S. Caries prevalenceof 11, 5 year-olds between 1989 and 2001, in a province of North-eastern Greece. Community Dental Health 2006: 23:140-146

35. Ferracane J T, Hilton A, Korpak J, Gillette P,Speed McIntyre J,Berg and Northwest PRECEDENT: Use of caries preventionservices in the Northwest PRECEDENT dental network.Community Dentistry and Oral Epidemiology 2011; Volume39( 1): 6978

36. Oulis CJ, Berdouses E.D, Mamai-Homata H, PolychronopoulouA: Prevalence of sealants in relation to dental caries on thepermanent molars of 12 and 15- year old Greek adolescents.A national pathfinder survey. BMC Public Health 2011; 11, 100

37. Sarmadi R, Gahnberg L, Gabre P: Clinicians preventive strategiesfor children and adolescents identified as at high risk ofdeveloping caries. Int J Paediatr Dent 2011; 21(3):167-74

38. San Martin L, Castano A, Bravo M, Tavares M, Niederman R,O Gunbodede E: Dental sealant knowledge, opinion, valuesand practice of Spanish dentists. BMC Oral Health 2013;13:12

Hellenic Stomatological Review 59: 9-24, 2015

¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:X. X·Ú·Ï¿ÌÔ˘˜[email protected],[email protected]

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O Ó˘¯ÙÂÚÈÓfi˜ ‚Ú˘ÁÌfi˜ fiˆ˜ ηٷÁÚ¿ÊÂÙ·È ÛÙÔ˘˜ ÚÔÙ˘¯È·ÎÔ‡˜ ÊÔÈÙËÙ¤˜ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ÙÔ˘ ∂ıÓÈÎÔ‡ Î·È ∫·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

¶. M·ÓÈ·Ù¿ÎÔ˜*, ¡. §Ô˘ÌÚ›Ó˘*, ∫. ™ÈÒÙÔ˘*, ¶. M·ÙÛԇη*, ª. T˙¿Î˘**

¶EPI§HæH

EÈÛ·ÁˆÁ‹: N˘¯ÙÂÚÈÓfi˜ ‚Ú˘ÁÌfi˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ÙÔ·ÎÔ‡ÛÈÔ, ÌË ÏÂÈÙÔ˘ÚÁÈÎfi ÛÊ›ÍÈÌÔ Î·È ÙÚ›ÍÈÌÔ ÙˆÓ ‰Ô-ÓÙÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. H ·ÈÙÈÔ·ıÔÁ¤-ÓÂÈ· ÙÔ˘ ‚Ú˘ÁÌÔ‡ ·Ú·Ì¤ÓÂÈ ·ÎfiÌ· ·‰È¢ÎÚ›ÓÈÛÙË.™ÎÔfi˜: H ·ÍÈÔÏfiÁËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ Ó˘¯ÙÂ-ÚÈÓÔ‡ ‚Ú˘ÁÌÔ‡ Û ÚÔÙ˘¯È·ÎÔ‡˜ ÊÔÈÙËÙ¤˜ Ù˘ O‰Ô-ÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ EK¶A Î·È Ë Û˘Û¯¤ÙÈÛ‹ ÙÔ˘ ÌÂÛ˘ÌÙÒÌ·Ù· ·fi ÙÔ ÛÙÔÌ·ÙÔÁÓ·ıÈÎfi Û‡ÛÙËÌ·.M¤ıÔ‰Ô˜ Î·È ̆ ÏÈο: 489 ÊÔÈÙËÙ¤˜ ‰¤¯ıËÎ·Ó Ó· Û˘Ì-ÌÂÙ¿Û¯Ô˘Ó ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ. OÈ ÊÔÈÙËÙ¤˜ Û˘-ÌÏ‹ÚˆÛ·Ó ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û¯ÂÙÈο Ì ÙËÓ ·ÍÈÔ-ÏfiÁËÛË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘˜, ÙËÓ ÔÈfiÙËÙ· ÙÔ˘‡ÓÔ˘ ÙÔ˘˜ Î·È ‰È¿ÊÔÚ˜ Û˘Ó‹ıÂȘ, fiˆ˜ ÙÔ ÛÊ›-ÍÈÌÔ Î·È ÙÚ›ÍÈÌÔ ÙˆÓ ‰ÔÓÙÈÒÓ. E›Û˘ ˙ËÙ‹ıËΠ·fiÙÔ˘˜ ÊÔÈÙËÙ¤˜ Ô˘ ›¯·Ó ‰È·ÁÓˆÛÙ› Ì Ӣ¯ÙÂÚÈÓfi‚Ú˘ÁÌfi Ó· ·Ó·ÊÂÚı› Â¿Ó Î¿ÓÔ˘Ó Î¿ÔÈ· ıÂڷ›·Î·È ·Ó Ó·È ÔÈÔ Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ¿ Ù˘.

SUMMARY

Introduction: Sleep Bruxism is the non- functionalclenching and grinding of teeth during the night.Bruxism’s etiology remains unclear.Aims: We sought to evaluate the frequency of sleepbruxism among undergraduate students of School ofDentistry, University of Athens, and potential asso-ciations between sleep bruxism and multiple commonsymptoms of the stomatognathic system. Methods: 489 students participated in the presentstudy. Students were given a questionnaire regardingthe evaluation of their behavior, the quality of theirsleep and various habits like teeth clenching andgrinding. Students diagnosed with sleep bruxismreposed in addition to questions regarding receivedtreatments and related outcomes.Results: Statistical tests chi - square have beenemployed. Our results indicate that diurnal bruxism

25

Sleep bruxism as monitored among students of School of Dentistry, NKUA

P. Maniatakos*, N. Loubrinis*, K. Siotou*, P. Matsouka*, M. Tzakis**

EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

* O‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ ÙÔ˘ EıÓÈÎÔ‡ Î·È K·Ô‰ÈÛÙÚÈ·ÎÔ‡¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, ÙÂÏÂÈfiÊÔÈÙÔ˜ ÊÔÈÙËÙ‹˜, Aı‹Ó·,EÏÏ¿‰·

** O‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ ÙÔ˘ EıÓÈÎÔ‡ Î·È K·Ô‰ÈÛÙÚÈ·ÎÔ‡¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, AÓ·ÏËÚˆÙ‹˜ K·ıËÁËÙ‹˜ KÏÈÓÈ΋˜ AÓÙÈÌÂÙÒÈÛ˘ ™ÙÔÌ·ÙÔÚÔÛˆÈÎÔ‡ ¶fiÓÔ˘ ,Aı‹Ó·, EÏÏ¿‰·

* School of Dentistry, National and Kapodistrian Universityof Athens, Undergraduate student, Athens, Greece

** School of Dentistry, National and Kapodistrian Universityof Athens, Orofacial Pain Management Unit, AssociateProfessor, Athens, Greece

ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 59: 25-34, 2015 Hellenic Stomatological Review 59: 25-34, 2015

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Hellenic Stomatological Review 59: 25-34, 2015

AÔÙÂϤÛÌ·Ù·: ¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Ë ‰ÔÎÈÌ·Û›· ¯2

Î·È ‚Ú¤ıËΠÈÛ¯˘Ú‹ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ËÌÂÚ‹ÛÈÔ˘Î·È Ó˘¯ÙÂÚÈÓÔ‡ ‚Ú˘ÁÌÔ‡ (p-value<0.01) ηıÒ˜ ›-Û˘, Û˘Û¯¤ÙÈÛË ÙÔ˘ Ó˘¯ÙÂÚÈÓÔ‡ ‚Ú˘ÁÌÔ‡ Ì ÙÔ ¿Á-¯Ô˜ (p-value<0,05) Î·È ÙÔÓ ÛÙÔÌ·ÙÔÚÔÛˆÈÎfi fi-ÓÔ (p-value<0,01). T¤ÏÔ˜ ·Ú·ÙËÚ‹ıËΠ‚ÂÏÙ›ˆÛËÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ fiÛˆÓ Â›¯·Ó ‰È·ÁÓˆÛÙ› Ì Ӣ-¯ÙÂÚÈÓfi ‚Ú˘ÁÌfi Î·È ¤Î·Ó·Ó ıÂڷ›· Ì ÂÓ‰ÔÛÙÔ-Ì·ÙÈΤ˜ Û˘Û΢¤˜ (p-value <0,01).™˘ÌÂÚ¿ÛÌ·Ù·: O ·Á¯Ò‰Ë˜ ÙÚfiÔ˜ ˙ˆ‹˜, Ô fiÓÔ˜ÛÙË ÛÙÔÌ·ÙÔÚÔÛˆÈ΋ ÂÚÈÔ¯‹ Î·È Ô ÌË ÈηÓÔÔÈ-ËÙÈÎfi˜ ‡ÓÔ˜ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ Ó˘¯ÙÂÚÈÓfi ‚Ú˘ÁÌfiÛÙÔ˘˜ ÚÔÙ˘¯È·ÎÔ‡˜ ÊÔÈÙËÙ¤˜ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜™¯ÔÏ‹˜ ÙÔ˘ EıÓÈÎÔ‡ Î·È K·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈ-ÛÙËÌ›Ô˘ AıËÓÒÓ.

§¤ÍÂȘ ÎÏÂȉȿ: ·Ú·ÏÂÈÙÔ˘ÚÁÈΤ˜ ¤ÍÂȘ, ÔÈfiÙËÙ· ‡ÓÔ˘,Ó˘¯ÙÂÚÈÓfi˜ ‚Ú˘ÁÌfi˜, ÛÙÔÌ·ÙÔÚÔÛˆÈÎfi˜ fiÓÔ˜

EI™A°ø°H

O ‚Ú˘ÁÌfi˜ Â›Ó·È Ë Â·Ó·Ï·Ì‚·ÓfiÌÂÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓÌ˘ÒÓ ÙÔ˘ ÛÙÔÌ·ÙÔÁÓ·ıÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ë ÔÔ›· ¯·Ú·-ÎÙËÚ›˙ÂÙ·È ·fi ÛÊ›ÍÈÌÔ ‹ ÙÚ›ÍÈÌÔ ÙˆÓ ‰ÔÓÙÈÒÓ Î·È Û˘Û¯ÂÙ›-˙ÂÙ·È Ì ÈÛ¯˘Ú¤˜ ÎÈÓ‹ÛÂȘ Ù˘ οو ÁÓ¿ıÔ˘. O ‚Ú˘ÁÌfi˜ ¤¯Âȉ‡Ô ‰È·ÎÚÈÙ¤˜ ÎÈÚη‰ÈΤ˜ ÂΉËÏÒÛÂȘ: ÌÔÚ› Ó· Û˘Ì‚Â› η-Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (ÔfiÙ ÌÈÏ¿Ì ÁÈ· Ó˘¯ÙÂÚÈÓfi ‚Ú˘Á-Ìfi) ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ (ÔfiÙ ÚfiÎÂÈÙ·È ÁÈ·ËÌÂÚ‹ÛÈÔ ‚Ú˘ÁÌfi)1. X·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Ú·ÏÂÈÙÔ˘ÚÁÈ΋‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ Ì·ÛËÙ‹ÚÈˆÓ Ì˘ÒÓ Î·È ·Ú·ÙËÚÂ›Ù·È ÛÂÂÓ‹ÏÈΘ Î·È ·È‰È¿2. H ·ÈÙÈÔÏÔÁ›· ÙÔ˘ Ó˘¯ÙÂÚÈÓÔ‡ ‚Ú˘Á-ÌÔ‡ ‰ÂÓ Â›Ó·È ·ÎfiÌ· Ï‹Úˆ˜ ηٷÓÔËÙ‹3, ·Ó Î·È Ê·›ÓÂÙ·ÈfiÙÈ Û¯ÂÙ›˙ÂÙ·È ÈÛ¯˘Ú¿ Ì ÙÔ ¿Á¯Ô˜ Î·È Ë Ê˘ÛÈÔ·ıÔÏÔÁ›·ÙÔ˘ ÂÍËÁÂ›Ù·È ÂÓ Ì¤ÚÂÈ ·fi ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ ÎÂÓÙÚÈ-ÎÔ‡ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Û ÂÚÈfi‰Ô˘˜ ÌÈ-ÎÚÔ·Ê˘Ó‹ÛˆÓ4, 5. E›Û˘ ̆ ÔÛÙËÚ›˙ÂÙ·È fiÙÈ ÁÂÓÂÙÈÎÔ› ·-Ú¿ÁÔÓÙ˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘6. O Ó˘¯ÙÂÚÈÓfi˜‚Ú˘ÁÌfi˜ ¤¯ÂÈ Û˘Ó‰Âı› Ì ÎÚ·ÓÈÔÁÓ·ıÈΤ˜ ‰È·Ù·Ú·¯¤˜fiˆ˜ ÔÓÔΤʷÏÔÈ, ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ÎÚÔÙ·ÊÔÁÓ·ıÈ΋˜‰È¿ÚıÚˆÛ˘ Î·È Ì˘˚ÎÔ› fiÓÔÈ, ÚÒÈÌË ·ÒÏÂÈ· ‰ÔÓÙÈÒÓ Ïfi-Áˆ ˘ÂÚ‚ÔÏÈ΋˜ ÙÚÈ‚‹˜ Î·È ·˘ÍË̤Ó˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ηȉȷٷڷ¯¤˜ ÙÔ˘ ‡ÓÔ˘7. O ÛÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Î·È ÙˆÓ ¯·Ú·ÎÙËÚÈ-ÛÙÈÎÒÓ ÙÔ˘ Ó˘¯ÙÂÚÈÓÔ‡ ‚Ú˘ÁÌÔ‡ ÛÙÔ˘˜ ÚÔÙ˘¯È·ÎÔ‡˜ÊÔÈÙËÙ¤˜ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ EıÓÈÎÔ‡ Î·È K·-Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ Î·È Ë Û˘Û¯¤ÙÈÛ‹ ÙÔ˘Ì ÎÔÈÓ¿ Û˘ÌÙÒÌ·Ù· Î·È ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜.

ME£O¢O™ KAI Y§IKA

¢Â›ÁÌ·: Afi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 675 ÚÔÙ˘¯È·ÎÒÓ ÊÔÈÙË-ÙÒÓ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ EıÓÈÎÔ‡ Î·È K·Ô‰È-ÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ Ô˘ ˙ËÙ‹ıËΠӷ Û˘Ì-ÌÂÙ¤¯Ô˘Ó ÛÙË ÌÂϤÙË, ÔÈ 489 ‰¤¯ÙËÎ·Ó Ó· Û˘ÌÏËÚÒÛÔ˘ÓÙÔ Û¯ÂÙÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ. H ÌÂϤÙË ·˘Ù‹ Ú·ÁÌ·ÙÔ-

was statistical significantly correlated with sleepbruxism (p-value<0.01), In addition, significantcorrelations of sleep bruxism with stressful lifestyle(p-value<0.05) and orofacial pain (p-value <0.01)were established. Finally, patients who used oraldevices demonstrated significant improvement (p-value <0.01).Conclusions: Stressful lifestyle, orofacial pain andunsatisfactory sleep were related to sleep bruxism ina cohort of undergraduate students of the DentalSchool of Athens.

Key Words: parafunctional habits, sleep quality, sleep bruxism, orofacial pain

INTRODUCTION

Bruxism is a repetitive jaw-muscle activity characterizedby clenching or grinding of the teeth and/or by bracingor thrusting of the mandible. Bruxism has two distinctcircadian manifestations: it can occur during sleep(indicated as sleep bruxism) or during wakefulness(indicated as awake bruxism)1. It is characterized byparafunctional activity of the masticatory muscles and canbe observed in both adults and children2. The Etiology ofsleep bruxism is not yet well understood3, however literaturesupports a strong relation of sleep bruxism with stress. Thephysiopathology of the condition is partly explained by there-activation of both the cerebral and the autonomic nervoussystems during periods of sleep instability4, 5. It has beensupported that genetic factors might also contribute to theappearance of sleep bruxism6. Sleep bruxism has beenlinked to various craniomandibular disorders includingheadaches, temporomandibular joint discomfort, muscleaches, sleep disruption, and premature loss of teeth dueto excessive attrition and mobility7. The aim of the studywas to investigate the frequency and characteristics ofSleep bruxism (SB), along with related symptoms andburdening factors among undergraduate students ofSchool of Dentistry, University of Athens.

MATERIALS AND METHODS

Sample: A total of 675 undergraduate students of Schoolof Dentistry, University of Athens, were asked to participatein the present study, of which 489 (72.4%) of them acceptedto voluntarily complete the questionnaires. The study wasperformed during the academic year 2014-2015 and thematerial was collected between May and June of 2015.The studys protocol and the related materials (i.e.questionnaires) were approved by the Human ResearchEthics Committee of the National and KapodistrianUniversity of Athens. Questionnaire: A questionnaire (Table 1) was made. Theresponses were collected anonymously, only the year ofthe studies and the gender were recorded. It included

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HELLENIC REPUBLIC

National and KapodistrianUniversity of Athens Thivon 2, Goudi

Athens, 11527SCHOOL OF HEALTH SCIENCES Phone 210 746 1321DENTAL SCHOOL Fax 210 746 1240SECTION OF DENTAL PATHOLOGY AND THERAPEYTICSOrofacial Pain Management ClinicDirector: Michalis Tzakis, Dr DDS, PhD Assoc Professor

Table 1

Questionnaire for the uandergraduate students of Dental School regarding oral parafunctional habbits

Dear colleagues, please complete this questionnaire with coutious. This information is confidential.

1. Gender Male Female Year of Study....................... Date.......................

2. Do you chew gum or mastic?

Never Less than half an hour a day More than half an hour a day

3. Do you bite your nails?

Never When I’m stressed I bite them often - Constantly

4. Do you clench or grind your teeth during the day?

Never Sometimes When I’m stressed Constantly

5. Do you clench or grind your teeth during the night?

Never / I don’t know Sometimes When I’m stressed Constantly

6. Has anybody closely related to you stated that you clench / grind your teeth during your sleep?

Never / I don’t know Sometimes When I’m stressed Constantly

7. How do you evaluate your sleep?

I don’t rest at all Is not enough Satisfactory - Very good

8. How many hours do you sleep at night? I sleep ........... hours

9. Do you get pain jaw - facial pain at wake up?

2-7 times a week 2-4 times a month Never

10. How often do you get headaches?

2-7 times a week 2-4 times a month Never

11. Rate yourself from 1-3 how stressed / nervous you think you are?

Not at all 1 A little - stressed enough 2 Much stressed 3

12. Have you beenndiagnosted with Sleep Bruxism? YES NO

13. If yes, what kind of treatment have you received? .............................................................................

14. Have you seen any improvements? YES NO

Hellenic Stomatological Review 59: 25-34, 2015

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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

ÔÈ‹ıËΠÙÔ ·Î·‰ËÌ·˚Îfi ¤ÙÔ˜ 2014-2015 Î·È ÙÔ ̆ ÏÈÎfi Û˘Ï-Ϥ¯ıËΠÙÔ M¿ÈÔ Î·È ÙÔÓ IÔ‡ÓÈÔ ÙÔ˘ 2015. H ¤Ú¢ӷ ·‰ÂÈ-Ô‰ÔÙ‹ıËΠ·fi ÙËÓ EÈÙÚÔ‹ ¢ÂÔÓÙÔÏÔÁ›·˜ Î·È ŒÚ¢ӷ˜ÙÔ˘ EıÓÈÎÔ‡ Î·È K·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓÚÈÓ ÙËÓ ¤Ó·ÚÍ‹ Ù˘. EÚˆÙËÌ·ÙÔÏfiÁÈÔ: ¢ËÌÈÔ˘ÚÁ‹ıËΠ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ(›Ó·Î·˜ 1) ·ÔÙÂÏÔ‡ÌÂÓÔ ·fi ‰Âη٤ÛÛÂÚȘ ÂÚˆÙ‹ÛÂÈ˜Ô˘ ·ÊÔÚÔ‡Û·Ó ÙȘ ·Ú·ÏÂÈÙÔ˘ÚÁÈΤ˜ ¤ÍÂȘ ÙÔ˘ ÛÙÔÌ·-ÙÔÁÓ·ıÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ÊÔÈÙËÙÒÓ. TÔ ÂÚˆÙËÌ·ÙÔ-ÏfiÁÈÔ Û˘ÌÏËÚÒıËΠ·ÓÒÓ˘Ì·, ÔÈ ÊÔÈÙËÙ¤˜ ÛËÌ›ˆÓ·ÓÌfiÓÔ ÙÔ ¤ÙÔ˜ ÛÔ˘‰ÒÓ Î·È ÙÔ Ê‡ÏÔ ÙÔ˘˜ Î·È ÂÚˆÙ‹ıËηÓÁÈ· ÙË Û˘¯ÓfiÙËÙ· Ú·ÁÌ·ÙÔÔ›ËÛ˘ ¤ÍÂˆÓ fiˆ˜ Ì¿ÛËÌ·ÙÛ›¯Ï·˜, Ì·ÛÙ›¯·˜, Ó˘¯ÈÒÓ (ÔÙ¤, fiÙ·Ó Â›Ì·È ·Á¯ˆÌ¤ÓÔ˜,Û˘¯Ó¿-Û˘Ó¯fiÌÂÓ·). E›Û˘ ·Ó ÛÊ›ÁÁÔ˘Ó ‹ ÙÚ›˙Ô˘Ó Ù· ‰fi-ÓÙÈ· ÙÔ˘˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ̤ڷ˜ Î·È Ù˘ Ó‡ÎÙ·˜ (‰ÂÁÓˆÚ›˙ˆ, ÔÙ¤, ÌÂÚÈΤ˜ ÊÔÚ¤˜, fiÙ·Ó Â›Ì·È ·Á¯ˆÌ¤ÓÔ˜, Û˘-Ó¯fiÌÂÓ·), ¿Ì· ·ÚÔ˘ÛÈ¿˙Ô˘Ó fiÓÔ ÛÙÔ ÎÂÊ¿ÏÈ Î·Ù¿ ÙÔ͇ÓËÌ· (2-7 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·, 2-4 ÊÔÚ¤˜ ÙÔ Ì‹Ó·,ÔÙ¤), fiÛ˜ ÒÚ˜ ÎÔÈÌÔ‡ÓÙ·È Î·È fiÛÔ ÈηÓÔÔÈËÙÈÎfi˜ ›-Ó·È Ô ‡ÓÔ˜ ÙÔ˘˜ (‰ÂÓ ÍÂÎÔ˘Ú¿˙ÔÌ·È Î·ıfiÏÔ˘, fi¯È ·ÚÎÂ-Ù¿, ÈηÓÔÔÈËÙÈÎfi˜ - Ôχ ηÏfi˜). ¶·Ú¿ÏÏËÏ· ·¿ÓÙËÛ·ÓÁÈ· ÙÔ fiÛÔ Û˘¯Ó¿ ¤¯Ô˘Ó ÔÓÔÎÂÊ¿ÏÔ˘˜ (2-7 ÊÔÚ¤˜ ÙËÓ‚‰ÔÌ¿‰·, 2-4 ÊÔÚ¤˜ ÙÔÓ Ì‹Ó·, ÔÙ¤) Î·È fiÛÔ ·Á¯Ò-‰ÂȘ Â›Ó·È (ηıfiÏÔ˘, Ï›ÁÔ ¤ˆ˜ ·ÚÎÂÙ¿, Ôχ). T¤ÏÔ˜, ·¿-ÓÙËÛ·Ó Û ‰‡Ô ÂÚˆÙ‹ÛÂȘ Û¯ÂÙÈο Ì ·Ó ¤¯Ô˘Ó ‰È·ÁÓˆÛı›Ì NB Î·È ·Ó Ë ·¿ÓÙËÛË ‹Ù·Ó ıÂÙÈ΋ ÂÚˆÙ‹ıËÎ·Ó Ì ÙÔ›‰Ô˜ Ù˘ ıÂڷ›·˜ ·Ó ˘‹Ú¯Â.™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË: ¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈΤ˜‰ÔÎÈ̷ۛ˜ x2 ÁÈ· ÙËÓ Â‡ÚÂÛË ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙË-Ù·˜ ÌÂٷ͇ ‰È·ÊfiÚˆÓ ÔÌ¿‰ˆÓ Î·È Û˘¯ÓÔًوÓ. H ·Ó¿-Ï˘ÛË Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙÔ ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ·SPSS, ¤Î‰ÔÛË 20.

A¶OTE§E™MATA

Afi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 675 ÊÔÈÙËÙÒÓ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯Ô-Ï‹˜ ÙÔ˘ EıÓÈÎÔ‡ Î·È K·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ AıË-ÓÒÓ, ÔÈ 489 Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË. OÈ ÊÔÈÙËÙ¤˜ Ô˘ ‰ÂÓÛ˘ÌÌÂÙ›¯·Ó (38%) ¤ÏÏÂÈ·Ó ·fi ÙË Û¯ÔÏ‹ fiÙ·Ó ‰È·Ó¤-ÌÔÓÙ·Ó Ù· ÂÚˆÙËÌ·ÙÔÏfiÁÈ·. ™ÙËÓ ¤Ú¢ӷ ·˘Ù‹ ¤Ï·‚·Ó̤ÚÔ˜ 316 Á˘Ó·›Î˜ (64,6%) Î·È 173 ¿Ó‰Ú˜ (35,4%). AfiÙÔ˘˜ Û˘ÌÌÂÙ¤¯ÔÓÙ˜, 49 ¿ÙÔÌ· (10%) ›¯·Ó ÂÍÂÙ·ÛÙ› ηȉȷÁÓˆÛı› Ì Ӣ¯ÙÂÚÈÓfi ‚Ú˘ÁÌfi (NB) Û‡Ìʈӷ Ì ÙËÓ·¿ÓÙËÛË Ô˘ ¤‰ˆÛ·Ó Û ·ÓÙ›ÛÙÔÈ¯Ë ÂÚÒÙËÛË, Ë ÔÔ›·‚·Û›˙ÂÙ·È Û ‰È΋ ÙÔ˘˜ ·Ú·‰Ô¯‹ Î·È fi¯È Û ÎÏÈÓÈ΋ Âͤ-Ù·ÛË ÛÙ· Ï·›ÛÈ· ·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜ (¶›Ó·Î·˜ 2). øÛÙfi-ÛÔ ÛÙ· Ï·›ÛÈ· ·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜ ·Ó·ÊÂÚfiÌ·ÛÙ Û·˘ÙÔ‡˜ ̂ ˜ ‰È·ÁÓˆÛı¤ÓÙ˜ Ì Ӣ¯ÙÂÚÈÓfi ‚Ú˘ÁÌfi. 37 ÊÔÈ-ÙËÙ¤˜/-ÙÚȘ ·fi ÙÔ˘˜ 49 ‰È·ÁÓˆÛı¤ÓÙ˜ (76%) ¤ÏÂÍ·ÓοÔÈÔ ıÂڷ¢ÙÈÎfi ̤ÛÔ ÁÈ· ÙÔ Úfi‚ÏËÌ¿ ÙÔ˘˜ ·˘Ùfi ηÈÛ˘ÁÎÂÎÚÈ̤ӷ fiÏÔÈ Â¤ÏÂÍ·Ó ıÂڷ›· Ì ÂÓ‰ÔÛÙÔÌ·ÙÈ-Îfi Ó¿ÚıËη Î·È ¤Ó·˜ ·fi ·˘ÙÔ‡˜ ÂÈÎÔ˘ÚÈο Î·È ÔÌÔÈÔ-·ıËÙÈ΋. TÔ 89,2% ÙÔ˘ Û˘ÓfiÏÔ˘ Ô˘ ¤ÏÂÍ οÔÈ· ıÂ-ڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ‰‹ÏˆÛ ˆ˜ ¤¯ÂÈ ·Ú·ÙËÚ‹ÛÂÈοÔÈ· ‚ÂÏÙ›ˆÛË ‡ÛÙÂÚ· ·fi ÙË ıÂڷ›· (p<0.01). ¶·-Ú¿ÏÏËÏ· ·fi ÙË Û˘ÏÏÔÁ‹ Î·È ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰Ô̤ӈӂڤıËΠˆ˜ ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË Ù˘ ·Á¯Ò‰Ô˘˜ Û˘ÌÂ-ÚÈÊÔÚ¿˜ ÙfiÛÔ Ì ÙÔ NB fiÛÔ Î·È Ì ÙË Û˘¯ÓfiÙËÙ· ÛÊÈÍ›-

fourteen questions concerning different aspects of oralparafunctional habits of the students, along with questionsabout the frequency of some oral habits, such as gumchewing, nail biting (never, when I’m stressed, I bite themoften - constantly). Moreover, participants were askedwhether they clench their teeth during day and/or nighttime (never/don’t know, sometimes, when I’m stressed,constantly) and questions regarding experience ofheadaches when they wake up (2-7 times a week, 2-4 timesa month, never), duration and quality of their sleep (I don’trest at all, is not enough, satisfactory - very good). Otherquestions included the frequency of their headaches (2-7 times a week, 2-4 times a month, never) and self-reportedlevels of stress (not at all, a little - stressed enough, muchstressed). Finally, two questions referred to whether theyare diagnosed with SB and if they have received anytreatment for that. Statistical analysis: Statistical tests chi - square have beenemployed to investigate statistical significance amongdifferent teams and frequencies of the study. The analysiswas set on statistical program Statistical Package for SocialSciences (SPSS), edition 20.

RESULTS

Out of a total of 675 students enrolled in School of Dentistry,University of Athens through years 1-5, 489 participated inthe study. Most common reason for no participation (38%)was absence the day the questionnaire was distributed.Our sample consisted by 316 women (64.6%) and 173men (35.4%). Overall, 49 students (10%) had beendiagnosed with Sleep Bruxism (SB) according to theiranswer at the questionnaires which is based on their ownadmission and not in a clinical test for this research (Table2). In the current study these students are referred asdiagnosed with SB. 37 (76%) students out of these 49diagnosed with SB have tried any form of treatment. Theform of treatment was the use oral devices, while onestudent was using homeopathy also as a supplementaltreatment. Of those with at least one trial of treatment, 89.2%reported some improvement following the treatment(p<0.01). On gathering and analysis of data, associationwas established among frequency of teeth clenching duringthe sleep and reported stress. In particular, students thatwere diagnosed with SB reported stress more often (57.1%)than those with no diagnosis of SB (38.4%). This differencewas statistically significant (p<0.05).Additionally, 41% of those who clench their teeth duringsleep, declare to be very stressed, whereas none of themdeclared no stress. On the other hand, of those who neverclench their teeth, only 36.2% declared a high level of stresscompared to the same percentage of those who clenchtheir teeth constantly summing 71%. (p<0.01). Yet a relationship was found of clinically diagnosed SBwith the frequency of teeth clenching during the day andthe night and the frequency of occurring headaches andjaw-facial-pain at wake up. More specifically those whohave been diagnosed with SB, constantly clench their teeth

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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

E§§HNIKH ¢HMOKPATIA

EıÓÈÎfi Î·È Î·Ô‰ÈÛÙÚÈ·ÎfiÓ¶·ÓÂÈÛÙ‹ÌÈÔÓ AıËÓÒÓ £Ë‚ÒÓ 2, °Ô˘‰‹

Aı‹Ó·, T.K. 11527™XO§H E¶I™THMøN Y°EIA™ TËÏ. 210 746 1321O¢ONTIATPIKH ™XO§H Fax 210 746 1240TOMEA™ O¢ONTIKH™ ¶AO£O§O°IA™ & £EPA¶EYTIKH™K§INIKH ANTIMETø¶I™H™ ™TOMATO¶PO™ø¶IKOY ¶ONOYºY™IO§O°IA ™TOMATO°NA£IKOY ™Y™THMATO™ & ™Y°K§EI™H¢È¢ı˘ÓÙ‹˜: Mȯ·‹Ï T˙¿Î˘, ¢Ú. O¢., PhD AÓ·Ï. K·ıËÁËÙ‹˜

¶›Ó·Î·˜ 1

EÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÙÔ˘˜ ÊÔÈÙËÙ¤˜ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ AıËÓÒÓ Ô˘ ·ÊÔÚ¿ ÙȘ ·Ú·ÏÂÈÙÔ˘ÚÁÈΤ˜ ¤ÍÂȘ

AÁ·ËÙÔ› Û˘Ó¿‰ÂÏÊÔÈ, ·Ú·Î·ÏÔ‡ÌÂ Û˘ÌÏËÚÒÛÙ ÚÔÛÂÎÙÈο Î·È Ì ·ÎÚ›‚ÂÈ· ÙȘ ÂÚˆÙ‹ÛÂȘ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó. OÈ ÏËÚÔÊÔڛ˜ Â›Ó·È ¿ÎÚˆ˜ ÂÌÈÛÙ¢ÙÈΤ˜.

1. º‡ÏÔ ÕÓ‰Ú·˜ °˘Ó·›Î· ŒÙÔ˜ ™Ô˘‰ÒÓ....................... HÌÂÚÔÌËÓ›·.......................

2. M·Û¿˜ ηıËÌÂÚÈÓ¿ ÙÛ›¯Ï·/Ì·ÛÙ›¯·;

¶ÔÙ¤ §ÈÁfiÙÂÚÔ ·fi ó ÒÚ· ¶ÂÚÈÛÛfiÙÂÚÔ ·fi 1 ÒÚ·

3. TÚÒ˜ Ù· Ó‡¯È· ÛÔ˘;

¢ÂÓ Ù· ÙÚÒˆ ÔÙ¤ ŸÙ·Ó Â›Ì·È ·Á¯ˆÌ¤ÓÔ˜/Ë T· ÙÚÒˆ Û˘¯Ó¿ - Û˘Ó¤¯ÂÈ·

4. ™Ê›ÁÁÂȘ ‹ ÙÚ›˙ÂȘ Ù· ‰fiÓÙÈ· ÛÔ˘ ÙËÓ Ë̤ڷ;

MÂÚÈΤ˜ ÊÔÚ¤˜ ŸÙ·Ó Â›Ì·È ·Á¯ˆÌ¤ÓÔ˜ T· ÛÊ›ÁÁˆ Û˘Ó¤¯ÂÈ· T· ÛÊ›ÁÁˆ Û˘Ó¤¯ÂÈ·

5. ™Ê›ÁÁÂȘ ‹ ÙÚ›˙ÂȘ Ù· ‰fiÓÙÈ· ÛÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘;

¶ÔÙ¤ / ‰ÂÓ ÁÓˆÚ›˙ˆ MÂÚÈΤ˜ ÊÔÚ¤˜ ŸÙ·Ó Â›Ì·È ·Á¯ˆÌ¤ÓÔ˜/Ë T· ÛÊ›ÁÁˆ Û˘Ó¤¯ÂÈ·

6. Œ¯ÂÈ ·Ú·ÔÓÂı› οÔÈÔ˜ ·fi ÙÔ ÛÙÂÓfi ÛÔ˘ ÂÚÈ‚¿ÏÏÔÓ fiÙÈ Î¿ÓÂȘ ıfiÚ˘‚Ô ÛÊ›ÁÁÔÓÙ·˜ Î·È / ‹ ÙÚ›˙ÔÓÙ·˜ Ù· ‰fiÓÙÈ· ÛÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘;

MÂÚÈΤ˜ ÊÔÚ¤˜ ŸÙ·Ó Â›Ì·È ·Á¯ˆÌ¤ÓÔ˜/Ë T· ÛÊ›ÁÁˆ Û˘Ó¤¯ÂÈ·

7. ¶ˆ˜ Â›Ó·È Ô ‡ÓÔ˜ ÛÔ˘;

¢ÂÓ ÍÂÎÔ˘Ú¿˙ÔÌ·È Î·ıfiÏÔ˘ ¢ÂÓ ÌÔ˘ ÊÙ¿ÓÂÈ IηÓÔÔÈËÙÈÎfi˜ - ¶Ôχ ηÏfi˜

8. ¶fiÛ˜ ÒÚ˜ ÎÔÈÌ¿Û·È; KÔÈÌ¿Ì·È ........... ÒÚ˜

9. ¶·ÚÔ˘ÛÈ¿˙ÂȘ fiÓÔ ÛÙÔ ÚfiÛˆÔ ‹ ÙȘ ÁÓ¿ıÔ˘˜ ηٿ ÙÔ Í‡ÓËÌ·;

2-7 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· 2-4 ÊÔÚ¤˜ ÙÔ Ì‹Ó· ¶ÔÙ¤

10. ¶fiÛÔ Û˘¯Ó¿ ¤¯ÂȘ ÔÓÔÎÂÊ¿ÏÔ˘˜;

2-7 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· 2-4 ÊÔÚ¤˜ ÙÔ Ì‹Ó· ¶ÔÙ¤

11. B·ıÌÔÏÔÁfiÓÙ·˜ ÙÔÓ Â·˘Ùfi ÛÔ˘ ·fi ÙÔ 1 ¤ˆ˜ 3 fiÛÔ ·Á¯Ò‰Ë˜ ‹ Î·È Ó¢ÚÈÎfi˜ ÈÛÙ‡ÂȘ fiÙÈ Â›Û·È;

K·ıfiÏÔ˘ 1 §›ÁÔ - ·ÚÎÂÙ¿ 2 ¶Ôχ 3

12. Œ¯ÂȘ ÂÍÂÙ·ÛÙ› Î·È ‰È·ÁÓˆÛÙ› Ì Ӣ¯ÙÂÚÈÓfi ‚Ú˘ÁÌfi; NAI OXI

13. AÓ Ó·È ¤¯ÂȘ οÓÂÈ Î¿ÙÈ ÁÈ· Ó· ÙÔ ·ÓÙÈÌÂÙˆ›ÛÂȘ Î·È ÙÈ .............................................................................

14. Œ¯ÂȘ ·Ú·ÙËÚ‹ÛÂÈ Î¿ÔÈ· ‚ÂÏÙ›ˆÛË; NAI OXI

Hellenic Stomatological Review 59: 25-34, 2015

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30

EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

Hellenic Stomatological Review 59: 25-34, 2015

Ì·ÙÔ˜ ÙˆÓ ‰ÔÓÙÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. Afi ÙÔ˘˜ÊÔÈÙËÙ¤˜ Ô˘ ›¯·Ó ‰È·ÁÓˆÛı› Ì NB ·˘ÙÔ› Ô˘ ‰‹Ïˆ-Û·Ó Ôχ ·Á¯Ò‰ÂȘ ‹Ù·Ó ÙÔ 57,1% Û ·ÓÙ›ıÂÛË Ì ÙÔ ·ÓÙ›-ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÙˆÓ ÌË ‰È·ÁÓˆÛı¤ÓÙˆÓ Ô˘ ‹Ù·Ó 38,4%(p<0.05).EÈϤÔÓ ·fi ÂΛÓÔ˘˜ Ô˘ ¤ÛÊÈÁÁ·Ó Û˘Ó¤¯ÂÈ· Ù· ‰fiÓÙÈ·ÙÔ˘˜ ηٿ ÙÔÓ ‡ÓÔ, Ôχ ·Á¯Ò‰Ë˜ ‰‹ÏˆÛ ÙÔ 41% ÂÓÒηӤӷ˜ ‰Â ‰‹ÏˆÛ ηıfiÏÔ˘ ·Á¯Ò‰Ë˜. EÓÒ ·fi ·˘ÙÔ‡˜Ô˘ ‰ÂÓ Ù· ¤ÛÊÈÁÁ·Ó ÔÙ¤ ÌfiÓÔ ÙÔ 36,2% ‰‹ÏˆÛ Ôχ·Á¯Ò‰Ë˜ Û ·ÓÙ›ıÂÛË Ì ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi fiÛˆÓ Ù·¤ÛÊÈÁÁ·Ó Û˘Ó¤¯ÂÈ· Ô˘ ‹Ù·Ó 71% (p<0.01). ¢È·ÈÛÙÒıËΠ·ÎfiÌ· ˆ˜ ˘‹Ú¯Â Û˘Û¯¤ÙÈÛË ÙÔ˘ ÎÏÈÓÈο‰È·ÁÓˆṲ̂ÓÔ˘ NB Ì ÙË Û˘¯ÓfiÙËÙ· ÛÊÈ̷͛ÙÔ˜ ÙˆÓ ‰Ô-ÓÙÈÒÓ, ÙfiÛÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ fiÛÔ Î·È Ù˘ Ó‡-¯Ù·˜, Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ ÔÓÔÎÂÊ¿ÏˆÓ Î·ÈfiÓÔ˘ ηٿ ÙÔ Í‡ÓËÌ· ÛÙȘ ÁÓ¿ıÔ˘˜ ‹ Î·È ÙÔ ÚfiÛˆÔ.EȉÈÎfiÙÂÚ· ·˘ÙÔ› Ô˘ ›¯·Ó ‰È·ÁÓˆÛı› Ì ӢÎÙÂÚÈÓfi ‚Ú˘Á-Ìfi ¤ÛÊÈÁÁ·Ó Û˘Ó¤¯ÂÈ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ̤ڷ˜ Ù· ‰fi-ÓÙÈ· ÙÔ˘˜ Û ÔÛÔÛÙfi 25,6%, ÂÓÒ ·fi ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ›¯·Ó ‰È·ÁÓˆÛı› Ì NB ÌfiÓÔ 4,3% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙÔ˘˜ Ù·¤ÛÊÈÁÁÂ Û˘Ó¤¯ÂÈ·. EΛÓÔÈ ¿ÏÈ Ô˘ ›¯·Ó ‰È·ÁÓˆÛı› ÌÂNB Î·È ‰ÂÓ Ù· ¤ÛÊÈÁÁ·Ó ÔÙ¤ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ̤ڷ˜·ÔÙÂÏÔ‡Û·Ó ÙÔ 10,2% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙÔ˘˜, ÂÓÒ ÙÔ ·ÓÙ›-ÛÙÔÈ¯Ô ÔÛÔÛÙfi Û ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ Â›¯·Ó ‰È·ÁÓˆÛı› ‹Ù·Ó39,6%. EÈÚfiÛıÂÙ· ·˘ÙÔ› Ô˘ ›¯·Ó ‰È·ÁÓˆÛı› Ì NB¤ÛÊÈÁÁ·Ó Ù· ‰fiÓÙÈ· ÙÔ˘˜ οÔÈ· ÛÙÈÁÌ‹ ηٿ ÙË ‰È¿ÚÎÂÈ·Ù˘ ̤ڷ˜ Û ÔÛÔÛÙfi 89,8% (p<0.01).(›Ó·Î·˜ 3). ŸÛÔÓ ·ÊÔÚ¿ ÙÔ˘˜ ÎÚ¿ÓÈÔ-ÚÔÛˆÈÎÔ‡˜ fiÓÔ˘˜ ·˘ÙÔ›Ô˘ ›¯·Ó ‰È·ÁÓˆÛı› Ì NB Î·È ·ÚÔ˘Û›·˙·Ó fiÓÔ ÛÙÔ͇ÓËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2-4 ÊÔÚ¤˜ ÙÔ Ì‹Ó· ·ÔÙÂÏÔ‡Û·ÓÙÔ 24,5%, ÂÓÒ ·ÓÙ›ÛÙÔȯ· ·˘ÙÔ› Ô˘ ‰ÂÓ Â›¯·Ó ‰È·ÁÓˆÛı›ÙÔ 7,7% (p<0,01). OÈ ÚÔ·Ó·ÊÂÚı¤ÓÙ˜ fiÓÔÈ ·Ô‰Â›-¯ıËΠˆ˜ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó Î·È Ì ÙË Û˘¯ÓfiÙËÙ· Ô˘ ¤ÛÊÈÁ-Á·Ó ÔÈ ÊÔÈÙËÙ¤˜ Ù· ‰fiÓÙÈ· ÙÔ˘˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ÙÔ˘˜. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ÙÔ 38,8% ·˘ÙÒÓ Ô˘ ¤ÛÊÈÁÁ·ÓÛ˘Ó¯Ҙ Ù· ‰fiÓÙÈ· ÙÔ˘˜ ÛÙÔÓ ‡ÓÔ ·ÚÔ˘Û›·˙·Ó fiÓÔÛÙÔ Í‡ÓËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2-4 ÊÔÚ¤˜ ÙÔ Ì‹Ó·, ÂÎ ÙˆÓ ÔÔ›-ˆÓ ÙÔ 83% Ù· ¤ÛÊÈÁÁ·Ó Û˘Ó¤¯ÂÈ· Î·È ÙÔ 23,3% fiÙ·Ó ‹Ù·Ó·Á¯ˆÌ¤ÓÔÈ. AÓÙ›ıÂÙ· ÌfiÓÔ ÙÔ 4,2% ·˘ÙÒÓ Ô˘ ‰ÂÓ ¤ÛÊÈÁ-Á·Ó ÔÙ¤ Ù· ‰fiÓÙÈ· ÙÔ˘˜ ÛÙÔÓ ‡ÓÔ ·ÚÔ˘Û›·˙·Ó fiÓÔ

during the day in a percentage of 25.6%, while those whohave not been diagnosed with SB, only 4.3% of those whoclench their teeth constantly. Those diagnosed with SBbut never clench their teeth during the day consisted the10.2% of our sample, while the respective percentage ofthose without SB diagnosis and no clenching was the39.6%. Furthermore, the students who were diagnosedwith SB, reported clenching of their teeth at least one timeduring the day 89.8% (p<0.01) (Table 3).In concern to orofacial pain, all the students diagnosedwith SB had jaw-facial pain when they wake up for at least2-4 times a month. Of them 24.5% had establisheddiagnosis of SB, while 7.7% did not (p<0.01). Accordingto our analysis, the aforementioned jaw aches were relatedto the frequency of nocturnal teeth clenching. In particular,38.8% of those who were clenching their teeth constantlyduring their sleep, reported jaw pain when they wake upat least 2-4 times a month, of which 83% clench their teethconstantly ans 23.3% when stressed. In comparison, only4.2% of those who never clench during sleep appearedhaving pain at wake up at least 2-4 times a month. 35.5%of those clenching constantly their teeth during sleep werehaving headaches 2-4 times a month and 18% of them 2-7 times a week. On the contrary, those who never clenchtheir teeth during sleep and experience headaches at least2-4 times a month sum 11.9% (p<0.01). (Table 4) We found no statistical significant relationship of SB diagnosiswith the gender, chewing of gum and nail biting. Our analysisshowed that SB may be correlated with the quality of sleepand the frequency of headaches without a statisticallysignificant result (p=0.06). Students who were diagnosedwith SB and considered their sleep unsatisfactory sum upto 59.2% of the total sample, while unsatisfactory sleep wasreported in 44.1% who were not diagnosed with SB.

DISCUSSION

The prevalence of SB among our sample was 10%.However, it might be underestimated because 27.6% didnot complete the questionnaire. As it is referred8 only 74%

¶›Ó·Î·˜ 2: ¢È·ÁÓˆÛı¤ÓÙ˜ Ì Ӣ¯ÙÂÚÈÓfi ‚Ú˘ÁÌfi

N·È Ÿ¯È

ŒÙÔ˜ ÛÔ˘‰ÒÓ

1Ô 4 (3.4%) 112 (96.6%)

2Ô 4 (3.4%) 115 (96.6%)

3Ô 13 (12.5%) 91 (87.5%)

4Ô 10 (14.3%) 60 (85.7%)

5Ô 18 (22.5%) 62 (77.5%)

™‡ÓÔÏÔ 49 (10%) 440 (90%)

Table 2:Diagnosed with sleep bruxism

Yes No

Year of Studing

1st 4 (3.4%) 112 (96.6%)

2nd 4 (3.4%) 115 (96.6%)

3rd 13 (12.5%) 91 (87.5%)

4th 10 (14.3%) 60 (85.7%)

5th 18 (22.5%) 62 (77.5%)

total 49 (10%) 440 (90%)

Page 32: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

31Hellenic Stomatological Review 59: 25-34, 2015

* SB: sleep bruxism** Table’s labels are modified according to the distributed questionnaire

¶›Ó·Î·˜ 3:

™YXNOTHTA ™ºI•IMATO™ TøN ¢ONTIøN ™YXNOTHTA ™ºI•IMATO™ TøN ¢ONTIøN KATA TH ¢IAPKEIA TH™ NYXTA™ KATA TH ¢IAPKEIA TH™ MEPA™

¶ÔÙ¤ K¿ÔȘ ŸÙ·Ó Â›Ì·È ™˘Ó¤¯ÂÈ· ¶ÔÙ¤ K¿ÔȘ ŸÙ·Ó Â›Ì·È ™˘Ó¤¯ÂÈ·ÊÔÚ¤˜ ·Á¯ˆÌ¤ÓÔ˜ ÊÔÚ¤˜ ·Á¯ˆÌ¤ÓÔ˜

¢È¿ÁÓˆÛË ÁÈ· Ó˘¯ÙÂÚÈÓfi ‚Ú˘ÁÌfi

N·È (%) 2 20.4 34.7 42.9 10.2 30.6 32.7 25.6

Ÿ¯È (%) 70.7 18.2 11.5 6.3 39.6 36.2 19.8 4.3

Table 3:

FREQUENCY OF TEETH CLENCHING FREQUENCY OF TEETH CLENCHING DURING SLEEP DURING DAYTIME

Never Sometimes When I’m Constantly Never Sometimes When I’m Constantlystressed stressed

Diagnosedwith SB

Yes (%) 2 20.4 34.7 42.9 10.2 30.6 32.7 25.6

No (%) 70.7 18.2 11.5 6.3 39.6 36.2 19.8 4.3

* SB: sleep bruxism** Table’s labels are modified according to the distributed questionnaire

Table 4:

FREQUENCY OF JAW- FACIAL - PAIN HEADACHE - FREQUENCY

Never 2-4 times At least every Never 2-4 times At least every

per month other day per month other day

Diagnosedwith SB

Yes (%) 75.5 18.4 6.1 75.5 20.4 4.1

No (%) 92.3 5.9 1.8 85.8 12.8 1.4

FREQUENCY OF TEETH CLENCHING DURING SLEEP

Never (%) 95.8 3.2 1 88.1 10.6 1.3

Sometimes (%) 91.1 5.6 3.3 77.8 21.1 1.1

When Im stressed (%) 76.8 17.9 5.4 89.3 8.9 1.8

Constantly (%) 61.3 32.3 6.5 64.5 29 6.5

Page 33: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

32

EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

Hellenic Stomatological Review 59: 25-34, 2015

ÛÙÔ Í‡ÓËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2-4 ÊÔÚ¤˜ ÙÔ Ì‹Ó· (p<0.01).TÔ 35,5% ·˘ÙÒÓ ¿ÏÈ Ô˘ ¤ÛÊÈÁÁ·Ó Û˘Ó¯Ҙ Ù· ‰fiÓÙÈ·ÙÔ˘˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ·ÚÔ˘Û›·˙·Ó ÔÓÔÎÂ-Ê¿ÏÔ˘˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 2-4 ÊÔÚ¤˜ ÙÔ Ì‹Ó·, ÂÎ ÙˆÓ ÔÔ›ˆÓÙÔ 18% 2-7 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·. øÛÙfiÛÔ ·˘ÙÔ› ÔÈ ÔÔ›-ÔÈ ‰ÂÓ ¤ÛÊÈÁÁ·Ó ÔÙ¤ Ù· ‰fiÓÙÈ· ÙÔ˘˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘‡ÓÔ˘ Î·È ·ÚÔ˘Û›·˙·Ó ÔÓÔÎÂÊ¿ÏÔ˘˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 2-4ÊÔÚ¤˜ ÙÔ Ì‹Ó· ·ÔÙÂÏÔ‡Û·Ó ÙÔ 11,9% (p<0.01). (¶›Ó·-η˜ 4). T¤ÏÔ˜ ‰ÂÓ ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË ÙÔ˘ NB Ì ÙÔ Ê‡-ÏÔ, ÙÔ Ì¿ÛËÌ· Ì·ÛÙ›¯·˜ Î·È ÙË ‰‹ÍË ÙˆÓ Ó˘¯ÈÒÓ. AÓÙ›ıÂ-Ù· Ê·›ÓÂÙ·È Ó· ˘¿Ú¯ÂÈ Î¿ÔÈ· Û¯¤ÛË ·Ó¿ÌÂÛ· ÛÙÔ NBÎ·È ÙËÓ ÔÈfiÙËÙ· ÙÔ˘ ‡ÓÔ˘ Î·È ÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ÔÓÔÎÂÊ¿ÏˆÓ (p=0,06) ·Ó Î·È ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛË-Ì·ÓÙÈ΋. OÈ ‰È·ÁÓˆÛı¤ÓÙ˜ Ì NB Ô˘ ıˆÚÔ‡Û·Ó ÙÔÓ‡ÓÔ ÙÔ˘˜ ÌË ÈηÓÔÔÈËÙÈÎfi ·ÔÙÂÏÔ‡Û·Ó ÙÔ 59,2% ÙÔ˘Û˘ÓfiÏÔ˘ ÙÔ˘˜, ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi Û’ ·˘ÙÔ‡˜ Ô˘‰ÂÓ Â›¯·Ó ‰È·ÁÓˆÛÙ› Â›Ó·È 44,1%.

™YZHTH™H

TÔ ÁÂÁÔÓfi˜ fiÙÈ ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÊÔÈÙËÙÒÓ Ô˘ Û˘Ì-ÌÂÙ›¯·Ó ÛÙËÓ ¤Ú¢ӷ (489) ÌfiÓÔ 49 ›¯·Ó ‰È·ÁÓˆÛı›Ì ӢÎÙÂÚÈÓfi ‚Ú˘ÁÌfi, ‰Â ÛËÌ·›ÓÂÈ ˆ˜ ÔÈ ˘fiÏÔÈÔÈ ‰ÂÓ›¯·Ó Ó˘ÎÙÂÚÈÓfi ‚Ú˘ÁÌfi. T· ÔÛÔÛÙ¿ ·˘ÙÒÓ Ô˘ Ú·Á-Ì·ÙÈο ¤¯Ô˘Ó NB ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ·. Ÿˆ˜¤¯ÂÈ ·Ó·ÊÂÚı›8 ÌfiÓÔ ÙÔ 74% ·˘ÙÒÓ Ô˘ ¤¯Ô˘Ó ‚Ú˘ÁÌfiÁÓˆÚ›˙Ô˘Ó fiÙÈ ÙÚ›˙Ô˘Ó - ÛÊ›ÁÁÔ˘Ó Ù· ‰fiÓÙÈ· ÙÔ˘˜ ηٿÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. ™‡Ìʈӷ Ì ÌÈ· ¿ÏÏË ¤Ú¢ӷ9 Ìfi-ÓÔ ÙÔ 8% ÙÔ˘ ÂÓ‹ÏÈÎÔ˘ ÏËı˘ÛÌÔ‡ Ê·›ÓÂÙ·È Ó· ÁÓˆÚ›˙ÂÈfiÙÈ ¿Û¯ÂÈ ·fi Ó˘ÎÙÂÚÈÓfi ‚Ú˘ÁÌfi, ÂÓÒ Û ¿ÏÏË ·Ó·Ê¤-

of those who do have SB are aware of clenching / grindingtheir teeth during sleep. According to the literature9 only 8%of adult population seems to be aware of having SB whileaccording to a second research the percentage is between48-58% clinical oral examination has preceded10. Thedifference of diagnosed with SB stratified per year ofacademic studies can partially be explained by the fact thatduring the first 2 years of study the curriculum in the DentalSchool Of Athens, there is no relevant course, so theawareness regarding SB is limited among these students.Examining the interaction of SB and the levels of stress ourresults showed that (bruxers experience high levels of stress),which is in compliance with other researches11, 12, 13, 14. In addition, our results indicate a statistically significantassociation between diagnosis of SB and teeth clenchingduring the day. Investigators of other studies have reachedthe same conclusion. In fact, 54.4% of those who areexperiencing daily bruxism they are having SB too23. Anotherstudy15 mentions that 8% of the population clench theirteeth at night as stated by their close related persons. Inthe same study we can find an association of SB withcraniofacial pain but not with the gender of the patient,which is in total agreement with our study too. The relationbetween craniofacial pain and SB has been establishedby multiple studies11, 16. In reference to our data on teeth clenching at night and theoccurrence of headaches, it is supported that persons whoclench their teeth at night are suffering headachesconsiderably more frequently17. Additionally it is declaredthat there is an association between quality of sleep and

NB: Ó˘¯ÙÂÚÈÓfi˜ ‚Ú˘ÁÌfi˜

¶›Ó·Î·˜ 4:

™YXNOTHTA °NA£O¶PO™ø¶IKOY ¶ONOY ™YXNOTHTA ¶ONOKEºA§OY

¶ÔÙ¤ 2-4 ÊÔÚ¤˜ ™¯Â‰fiÓ ¶ÔÙ¤ 2-4 ÊÔÚ¤˜ ™¯Â‰fiÓ

ÙÔ Ì‹Ó· οı ̤ڷ ÙÔ Ì‹Ó· οı ̤ڷ

¢È¿ÁÓˆÛËÌ NB

N·È (%) 75.5 18.4 6.1 75.5 20.4 4.1

Ÿ¯È (%) 92.3 5.9 1.8 85.8 12.8 1.4

™˘¯ÓfiÙËÙ· ÛÊÈ̷͛ÙÔ˜ ÙˆÓ ‰ÔÓÙÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘

¶ÔÙ¤ (%) 95.8 3.2 1 88.1 10.6 1.3

K¿ÔȘ ÊÔÚ¤˜ (%) 91.1 5.6 3.3 77.8 21.1 1.1

ŸÙ·Ó Â›Ì·È ·Á¯ˆÌ¤ÓÔ˜ (%) 76.8 17.9 5.4 89.3 8.9 1.8

™˘Ó¤¯ÂÈ· (%) 61.3 32.3 6.5 64.5 29 6.5

Page 34: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

33

EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

ÚÂÙ·È fiÙÈ ÙÔ ÔÛÔÛÙfi Ó· Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 48-58% ÌÂÙ¿·fi ·ÍÈÔÏfiÁËÛË Ì ÎÏÈÓÈ΋ ÂͤٷÛË10. H ‰È·ÊÔÚ¿ ÙˆÓ ‰È·-ÁÓˆÛı¤ÓÙˆÓ Ì NB ·Ó¿ ¤ÙÔ˜ ÛÔ˘‰ÒÓ ÌÔÚ› Ó· ·Ô-‰Ôı› ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙ· ‰‡Ô ÚÒÙ· ¤ÙË ÙÔ ÚfiÁÚ·ÌÌ·ÛÔ˘‰ÒÓ Ù˘ Ô‰ÔÓÙÈ·ÙÚÈ΋˜ Û¯ÔÏ‹˜ Ù˘ Aı‹Ó·˜ ‰ÂÓ Â-ÚÈÏ·Ì‚¿ÓÂÈ Û¯ÂÙÈÎfi Ì¿ıËÌ·, ÂÔ̤ӈ˜ ÔÈ ÊÔÈÙËÙ¤˜ ¤¯Ô˘ÓÊÙˆ¯‹ Û¯ÂÙÈ΋ ÁÓÒÛË. ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÏÏËÏ›‰Ú·ÛË NB Î·È ÙÔ˘ fiÛÔ Ó¢-ÚÈÎfi˜/·Á¯Ò‰Ë˜ Â›Ó·È Î¿ÔÈÔ˜, Ù· ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ Û˘Ì-ʈÓÔ‡Ó Ì ¿ÏϘ ¤Ú¢Ó˜ Û‡Ìʈӷ Ì ÙȘ Ôԛ˜ ÔÈ ‚Ú˘Á-ÌÔÌ·Ó›˜ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Â›Â‰Ô ¿Á¯Ô˘˜11, 12, 13, 14. AÎfiÌ· ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂÙ·-͇ Ù˘ ‰È¿ÁÓˆÛ˘ NB Î·È ÛÊÈ̷͛ÙÔ˜ ÙˆÓ ‰ÔÓÙÈÒÓ ÙË Ì¤-Ú·, ÁÂÁÔÓfi˜ Ô˘ Ê·›ÓÂÙ·È Î·È ·fi ¿ÏÏË ¤Ú¢ӷ ÛÙËÓ ÔÔ›·ÙÔ 54,4% ·˘ÙÒÓ Ô˘ ¤¯Ô˘Ó ËÌÂÚ‹ÛÈÔ ‚Ú˘ÁÌfi ¤¯Ô˘Ó ηÈÓ˘ÎÙÂÚÈÓfi23. MÈ· ÌÂϤÙË15 ·Ó·Ê¤ÚÂÈ ˆ˜ ÙÔ 8% ÏËı˘ÛÌÔ‡ÛÊ›ÁÁÔ˘Ó Ù· ‰fiÓÙÈ· ÙÔ˘˜ ÙË Ó‡¯Ù· fiˆ˜ ·˘Ùfi Á›ÓÂÙ·È ·ÓÙÈ-ÏËÙfi Î·È ·Ó·Ê¤ÚÂÙ·È ·fi ÙÔ˘˜ Û˘ÓÙÚfiÊÔ˘˜ ÙÔ˘˜. ™ÙËÓ›‰È· ÂÚÁ·Û›· ·Ó·Ê¤ÚÂÙ·È Â›Û˘ ˆ˜ ̆ ¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛËÙÔ˘ Ó˘¯ÙÂÚÈÓÔ‡ ‚Ú˘ÁÌÔ‡ Ì ÙÔ ÛÙÔÌ·ÙÔÚÔÛˆÈÎfi fi-ÓÔ ÂÓÒ Î¿ÙÈ Ù¤ÙÔÈÔ ‰Â Û˘Ì‚·›ÓÂÈ Ì ÙÔ Ê‡ÏÔ, ÁÂÁÔÓfi˜Ô˘ ÂȂ‚·ÈÒÓÂÙ·È Î·È ·fi Ù· Â˘Ú‹Ì·Ù· Ù˘ ÂÚÁ·Û›·˜Ì·˜. H Û˘Û¯¤ÙÈÛË ‰Â ÙÔ˘ ÛÙÔÌ·ÙÔÚÔÛˆÈÎÔ‡ fiÓÔ˘ ·Ó·-ʤÚÂÙ·È Û ÔÏϤ˜ ¤Ú¢Ó˜11, 16.ŸÛÔÓ ·ÊÔÚ¿ Ù· ‰Â‰Ô̤ӷ Ì·˜ ÁÈ· ÙÔ ÛÊ›ÍÈÌÔ ÙˆÓ ‰ÔÓÙÈÒÓÙË Ó‡ÎÙ· Î·È ÙËÓ ÂÌÊ¿ÓÈÛË ÔÓÔÎÂʿψÓ, Û ÂÚÁ·Û›· ·Ó·-ʤÚÂÙ·È fiÙÈ Ù· ¿ÙÔÌ· Ô˘ ÛÊ›ÁÁÔ˘Ó Ù· ‰fiÓÙÈ· ÙÔ˘˜ ηٿÙË ‰È¿ÚÎÂÈ· Ù˘ Ó‡¯Ù·˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÈÔ Û˘¯Ó¿ ÔÓÔ-ÎÂÊ¿ÏÔ˘˜17. AÎfiÌ· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ̆ ¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË Ù˘ÔÈfiÙËÙ·˜ ÙÔ˘ ‡ÓÔ˘ Î·È ÙÔ˘ ‚Ú˘ÁÌÔ‡. EȉÈÎfiÙÂÚ·, ÔÈ ‚Ú˘Á-ÌÔÌ·Ó›˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ‰ÂÓ ÍÂÎÔ˘Ú¿˙ÔÓÙ·È ·ÚÎÂÙ¿1, 17.H ‚ÂÏÙ›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ Ì NB ·fi ÙÔ Ó¿ÚıËη ÛÙ·ıÂ-ÚÔÔ›ËÛ˘ ÂȂ‚·ÈÒÓÂÙ·È Î·È ·fi ¤Ú¢Ó˜18, 19 fiÔ˘ Ô Ó¿Ú-ıËη˜ ÛÙ·ıÂÚÔÔ›ËÛ˘ ÌÂÈÒÓÂÈ Ù· ÂÂÈÛfi‰È· ‚Ú˘ÁÌÔ‡ ηÈÙȘ Ì˘˚Τ˜ Û˘Û¿ÛÂȘ ·Ó¿ ÒÚ· Û ‚·ı‡ non-REM ‡ÓÔ. ¶·-ÚfiÏÔ Ô˘ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¤¯ÂÈ ·Ú·ÙËÚ‹ÛÂÈ‚ÂÏÙ›ˆÛË Â›Ó·È È‰È·›ÙÂÚ· ˘„ËÏfi, ˘¿Ú¯Ô˘Ó ¤Ú¢Ó˜ Ô˘·ÌÊÈÛ‚ËÙÔ‡Ó ÙfiÛÔ ÙËÓ ·ÈÙÈÒ‰Ë Û¯¤ÛË ÌÂٷ͇ ·Ú·ÏÂÈ-ÙÔ˘ÚÁÈÎÒÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Î·È ¯ÚfiÓÈÔ˘ fiÓÔ˘ ÙˆÓ Ì˘ÒÓÙˆÓ ÁÓ¿ıˆÓ fiÛÔ Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ıÂÚ·-›·˜ Ì ӿÚıËη Î·È ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ Ù˘ ÂÎÙ›ÌËÛ˘ ÙÔ˘·ÛıÂÓÔ‡˜ ˆ˜ ¤¯ÂÈ ·Ú·ÙËÚ‹ÛÂÈ ıÂÙÈΤ˜ ·ÏÏ·Á¤˜ ηٿ ÙˉȿÚÎÂÈ· Ù˘ ıÂڷ›·˜1, 20. EȉÈÎfiÙÂÚ· ̆ ÔÛÙËÚ›˙Ô˘Ó ˆ˜Ë ıÂÙÈ΋ ›‰Ú·ÛË ÙÔ˘ Ó¿ÚıËη ̂ ˜ ıÂڷ¢ÙÈÎfi ̤ÛÔ ‰ÂÓÂÈÙ˘Á¯¿ÓÂÙ·È Ì¤Ûˆ Ù˘ Ì›ˆÛ˘ ÙˆÓ Ó˘¯ÙÂÚÈÓÒÓ ·Ú·-ÏÂÈÙÔ˘ÚÁÈÒÓ, ·ÏÏ¿ Ì¿ÏÏÔÓ Û¯ÂÙ›˙ÂÙ·È Ì ¿ÏÏÔ˘˜ ·Ú¿ÁÔ-ÓÙ˜ fiˆ˜ Ë ›ÛÙË-ÂÔ›ıËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙËÓ ·ÔÙÂ-ÏÂÛÌ·ÙÈÎfiÙËÙ· ·˘ÙÔ‡ ÙÔ˘ ıÂڷ¢ÙÈÎÔ‡ ̤ÛÔ˘21.H ¿Ô„Ë·˘Ù‹ ‰Â ı· ÌÔÚÔ‡Û ӷ ÌË ÏËÊı› ̆ fi„Ë Î·ıÒ˜ ÙÔ ‰Â›Á-Ì· Ù˘ ¤ÚÂ˘Ó¿˜ Ì·˜ Â›Ó·È È‰È·›ÙÂÚ· ¢·ÈÛıËÙÔÔÈË̤ÓÔ Î·ÈÏËÚÔÊÔÚË̤ÓÔ ¿Óˆ Û’ ·˘Ù‹ ÙË ıÂڷ¢ÙÈ΋ ÚÔÛ¤ÁÁÈ-ÛË. AÎfiÌ· Ì ·ÊÔÚÌ‹ ÙÔ ¿ÙÔÌÔ Ô˘ ¤Ú·Ó Ù˘ ̄ Ú‹Û˘ Ó¿Ú-ıËη ¤ÏÂÍ ̂ ˜ ̤ÛÔ ·ÓÙÈÌÂÙÒÈÛ˘ Î·È ÙËÓ ÔÌÔÈÔ·ıË-ÙÈ΋ ‰‡Ó·Ù·È Ó· Á›ÓÂÈ ·Ó·ÊÔÚ¿ Û ÌÈ· ¿ÏÏË ÌÂϤÙË ÛÙËÓÔÔ›· ÂÎÙÈÌ¿Ù·È ˆ˜ Ô Ó˘¯ÙÂÚÈÓfi˜ ‚Ú˘ÁÌfi˜ Â›Ó·È Ì¤¯ÚÈ Û‹-ÌÂÚ· ÌÈ· ·Ûı¤ÓÂÈ· ¯ˆÚ›˜ ·ÈÙÈÔÏÔÁÈ΋ Î·È ·fiÏ˘ÙË ıÂÚ·-›· Î·È ÁÈ ·˘Ùfi Û˘Ó›ÛÙ·Ù·È Ë ·Ó·˙‹ÙËÛË Î·È ¿ÏÏˆÓ ÂÓ·Ï-Ï·ÎÙÈÎÒÓ ıÂÚ·ÂÈÒÓ fiˆ˜ Ë ÔÌÔÈÔ·ıËÙÈ΋. YÔÛÙËÚ›˙Â-

bruxism. Most specifically bruxers state that they dont restsatisfactorily during the night1, 17.Furthermore, the improvement of patients with SB by oraldevices has been shown in the literature18, 19. It is do-cumented that oral devices reduce SB episodes and musclecontractions per hour and time in deep non REM sleep.Although the percentage of people who declare im-provement is particularly high, there are studies doubtingboth the causal relation between parafunctional habits andchronic pain of the oral muscles and the effectively of thecure with oral devices especially the patients feeling ofhaving positive changes during the cure1, 20. They supportthe positive change due to the use of oral devices it is morelikely related to placebo effect rather than by the decreaseof night parafunctions21. This view cannot be ignored asthe sample of our research is particularly sensitized andinformed on this type of treatment. As mentioned to theanalysis, one of the participants additionally to oral devicehas applied homeopathy at the same time, gives us theopportunity to refer to another research in which SB isstated as an incurable decease so far and therefore wemust expand to alternative cures as homeopathy.Homeopathy medicine (Apis mellifica, Belladonna andHyoscyamus) includes well known anticholinergics, whichare supposed to help decreasing bruxism under stressfuloccasions in combination with the use of oral devices22. The fact that only 5.1% of the patients, who were diagnosedwith SB, have visited dentist or physician for a treatmentis considerable23. This deviation from the relative 76% ofour study is owed mainly to their sensitization andinformation. No statistical significance was found between SB diagnosisand the gender, a fact reassured also by other sources23,

24. No statistical significant result was found betweendiagnosis of SB and chewing of gum / nail biting a fact thatis proved from other research as well15. Oppositely inanother study a relation between bruxism and gum chewing/ lip biting is stated25. Obviously more research needs tobe done and these data may serve to improve future studies.

CONCLUSIONS

In conclusion, sleep bruxism is a common parafunctionalactivity among students of School of Dentistry, Universityof Athens, In that case, recognition of the basic symptomsis essential for diagnosing and seeking of appropriatetreatment. According to our results, common symptomsinclude clenching of teeth (p-value<0.01) during the dayor night, stressful lifestyle and unsatisfactory sleep. All thisspread symptomatology should raise the suspicion of thedentist for SB.

Hellenic Stomatological Review 59: 25-34, 2015

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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·

Research Study

Hellenic Stomatological Review 59: 25-34, 2015

Ù·È ˆ˜ Ù· ÔÌÔÈÔ·ıËÙÈο Ê¿Ú̷η (Apis mellifica,Belladonna Î·È Hyoscyamus) Ô˘ Â›Ó·È ÁÓˆÛÙ¿ ·ÓÙȯÔ-ÏÈÓÂÚÁÈο, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ̄ Ú‹ÛË Ó¿ÚıËη, ‚ÔËıÔ‡ÓÛÙËÓ Î·Ù·ÔϤÌËÛË ÙÔ˘ ‚Ú˘ÁÌÔ‡ Ô ÔÔ›Ô˜ ·Ó·Ù‡ÛÛÂ-Ù·È Î¿Ùˆ ·fi ÛÙÚÂÛÛÔÁfiÓ˜ Û˘Óı‹Î˜22.X·Ú·ÎÙËÚÈÛÙÈÎfi Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÌfiÏȘ ÙÔ 5,1% ÙˆÓ·ÙfiÌˆÓ Ô˘ ¤¯Ô˘Ó ‰È·ÁÓˆÛı› Ì ӢÎÙÂÚÈÓfi ‚Ú˘ÁÌfi ¤¯Ô˘ÓÂÈÛÎÂÊı› Ô‰ÔÓÙ›·ÙÚÔ ‹ ¿ÏÏ˘ ÂȉÈÎfiÙËÙ·˜ È·ÙÚfi ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘23. H ÌÂÁ¿ÏË ·fiÎÏÈÛË ·fi ÙÔ ·ÓÙ›ÛÙÔÈ-¯Ô ÔÛÔÛÙfi 76% ÙˆÓ ÊÔÈÙËÙÒÓ ÚˆÙ›ÛÙˆ˜ ¤¯ÂÈ Ó· οÓÂÈÌ ÙËÓ ÂÓË̤ڈÛË Î·È ÙË Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘˜.K·Ì›· ÛÙ·ÙÈÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ· ‰Â ‚Ú¤ıËΠÌÂٷ͇ ‰È¿-ÁÓˆÛ˘ NB Î·È ÙÔ˘ ʇÏÔ˘, ÁÂÁÔÓfi˜ Ô˘ ÂȂ‚·ÈÒÓÂÙ·ÈÎ·È ·fi ¿ÏϘ ¤Ú¢Ó˜23, 24. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ·ÔÙ¤-ÏÂÛÌ· ‰ÂÓ ‚Ú¤ıËΠԇÙ ÌÂٷ͇ ‰È¿ÁÓˆÛ˘ NB Î·È Ì¿-ÛËÛ˘ ÙÛ›¯Ï·˜/Ó˘¯ÈÒÓ, ÁÂÁÔÓfi˜ Ô˘ ·ÏËı‡ÂÙ·È Î·È·fi ¿ÏÏË ¤Ú¢ӷ15. AÓÙ›ıÂÙ· Û ¿ÏÏË ¤Ú¢ӷ ·Ó·Ê¤ÚÂÙ·ÈË ‡·ÚÍË Û˘Û¯¤ÙÈÛ˘ ·Ó¿ÌÂÛ· ÛÙÔ ‚Ú˘ÁÌfi Î·È ÛÙÔ Ì¿-ÛËÌ· ÙÛ›¯Ï·˜ Î·È ÙË ‰‹ÍË ÙˆÓ ¯ÂÈϤˆÓ25. ¶ÂÚÈÛÛfiÙÂÚˤÚ¢ӷ Ú¤ÂÈ Ó· Á›ÓÂÈ Î·È Ù· ‰Â‰Ô̤ӷ ·˘Ù¿ ÌÔÚÔ‡Ó Ó·¯ÚËÛÈ̇ÛÔ˘Ó ÛÙË ‚ÂÏÙ›ˆÛË ÌÂÏÏÔÓÙÈÎÒÓ ÌÂÏÂÙÒÓ.

™YM¶EPA™MATA

O Ó˘¯ÙÂÚÈÓfi˜ ‚Ú˘ÁÌfi˜ Â›Ó·È ÌÈ· ÎÔÈÓ‹ ·Ú·ÏÂÈÙÔ˘ÚÁÈ΋‰Ú·ÛÙËÚÈfiÙËÙ· ÌÂٷ͇ ÙˆÓ ÊÔÈÙËÙÒÓ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, Î·È Ë ·Ó·ÁÓÒÚÈÛËÙˆÓ ‚·ÛÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ·Ó·-˙‹ÙËÛË Î·Ù¿ÏÏËÏ˘ ıÂڷ›·˜, ηı›ÛÙ·Ù·È ··Ú·›ÙËÙË.T· ÎÔÈÓ¿ Û˘ÌÙÒÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ·˘Ù‹ ÙËÓ¤Ú¢ӷ Â›Ó·È ÙÔ ÛÊ›ÍÈÌÔ ÙˆÓ ‰ÔÓÙÈÒÓ (p-value <0,01) η-Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ ‹ Ù˘ Ó‡¯Ù·˜, o ·Á¯Ò‰Ë˜ ÙÚfi-Ô˜ ̇ ˆ‹˜ Î·È Ô ÌË ÈηÓÔÔÈËÙÈÎfi˜ ‡ÓÔ˜, Ù· ÔÔ›· Ô Ô‰Ô-ÓÙ›·ÙÚÔ˜ Ú¤ÂÈ Ó· Û˘Û¯ÂÙ›˙ÂÈ Ì ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Î·È Ó·Ô‰ËÁÂ›Ù·È ÛÙË ÛˆÛÙ‹ ‰È¿ÁÓˆÛË.

BIB§IO°PAºIA / REFERENCES

1. F. Lobezzo, J. Ahlberg, A. G. Glaros, T. Kato, K. Koyano, G.J. Lavigne, R. De Leeuw, D. Manfredini, P. Svensson. E.Winocur: Bruxism defined and graded: an internationalconsensus. Journal of Oral Rehabilitation 2013 40; 2-4.

2. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A,Remise C, Lavigne GJ: Prevalence and risk factors of sleepbruxism and wake-time tooth clenching in a 7- to 17-yr oldpopulation. Eur J Oral Sci. 2011 Oct; 119(5): 386-94.

3. Koyano K, Tsukiyama Y, Ichiki R, Kuwata T: Assessment ofbruxism in the clinic. J Oral Rehabil. 2008 Jul; 35(7): 495-508.

4. Hartmann E, Metha N: Bruxism: personality traits and othercharacteristics. Sleep Res 1987; 16: 350.

5. Lavigne GJ, Huynh N, Kato T, Okura K, Adachi K, Yao D, SessleB: Genesis of sleep bruxism: Motor and autonomic-cardiacinteractions. Arch Oral Biol. 2007 Apr; 52(4): 381-4.

6. Abe K, Shimakawa M: Genetic and developmental aspectsof sleeptalking and teeth-grinding. Acta Paedopsychiatr 1966Nov; 33(11): 339-44.

7. Vanderas AP: Relationship between oral parafunctions andcraniomandibular dysfunction in children and adolescents: areview. ASDC J Dent Child. 1994 Sep-Dec; 61(5-6): 378-81.

8. Rompré PH, Daigle-Landry D, Guitard F, Montplaisir JY, LavigneGJ: Identification of a sleep bruxism subgroup with a higherrisk of pain. J Dent Res. 2007 Sep; 86(9): 837-42.

9. Lavigne GJ, Guitard F, Rompré PH, Montplaisir JY: Variabilityin sleep bruxism activity over time. J Sleep Res. 2001 Sep;10(3): 237-44.

10. Seligman DA, Pullinger AG, Solberg WK: The prevalence ofdental attrition and its association with factors of age, gender,occlusion, and TMJ symptomatology. J Dent Res. 1988 Oct;67(10): 1323-33.

11. Vernallis FF: Teeth Grinding: Some relationship of anxiety,hostility and hyperactivity. J Clin Psychol. 1955 Oct; 11(4):389-91.

12. Manfredini D, Lobbezoo F: Role of psychosocial factors in theetiology of bruxism. J Orofac Pain. 2009 Spring; 23(2): 153-66.

13. Flor H, Birbaumer N, Schulte W, Roos R: Stress relatedelectromyiographic responses in patients with chronictemporomandibular pain. Pain. 1991 Aug; 46(2): 145-52.

14. Didier H, Marchetti C, Borromeo G, Tullo V, Bussone G, SantoroF: Persistent idiopathic facial pain: multidisciplinary approachand assumption of comorbidity. Neurol Sci. 2010 Jun; 31Suppl 1: S189-95.

15. Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael K: Bruxismphysiology and pathology: an otherview for clinicians. J OralRehabil. 2008 Jul; 35(7): 476-94.

16. Svensson P, Jadidi F, Arima T, Baad-Hansen L, Sessle BJ:Relationships between craniofacial pain and bruxism J OralRehabil. 2008 Jul; 35(7): 524-47.

17. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A,Remise C, Lavigne GJ: Prevalence and risk factors of sleepbruxism and wake-time tooth clenching in a 7- to 17-yr-oldpopulation. Eur J Oral Sci. 2011 Oct; 119(5): 386-94.

18. Solberg WK, Clark GT, Rugh JD: Nocturnal electromyographicevaluation of bruxism patients undergoing short term splinttherapy. J Oral Rehabil. 1975 Jul; 2(3): 215-23.

19. Dubé C, Rompré PH, Manzini C, Guitard F, de Grandmont P,Lavigne GJ: Quantitative polygraphic controlled study onefficacy and safety of oral splint devices in tooth-grindingsubjects J Dent Res. 2004 May; 83(5): 398-403.

20. Van Selms MK, Lobbezoo F, Visscher CM, Naeije M: Shortcommunication myofascial temporomandibular disorder pain,parafunctions and psychological stress. J Oral Rehabil. 2008Jan; 35(1): 45-52.

21. Dao TT, Lavigne GJ: Oral splints:the crutches for tempo-romandibular disorders and bruxism? Crit Rev Oral Biol Med.1998; 9(3): 345-61.

22. Roland Schule: Parafunktionen als Ventil bei Stress - Bruxismusund seine homöopathische Bewertung Komplementäre undIntegrative Medizin 49(6) June 2008.

23. Ohayon MM, Li KK, Guilleminault C: Risk Factors for SleepBruxism in the general Population. Chest. 2001 Jan; 119(1):53-61.

24. Manfredini D, Winocur E, Guarda-Nardini L, Paesani D, Lob-bezoo F: Epidemology of bruxism in adults : a systematic re-view of the literature. J Orofac Pain. 2013 Spring; 27(2): 99-110.

25. Cortese SG, Fridman DE, Farah CL, Bielsa F, Grinberg J, BiondiAM: Frequency of oral habits, dysfunctions,and personalitytraits in bruxing and nonbruxing children: a comparativestudy.Cranio. 2013 Oct; 31(4): 283-90.

¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:Corresponding author:¶. M·ÓÈ·Ù¿ÎÔ˜P. [email protected]

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¢. ¢ÈÔÓ˘ÛfiÔ˘ÏÔ˜*, E. ¶·Ú¯·Ú›‰Ë˜**, K. K·Ú·Ô˘Ï¿ÓË***

¶EPI§HæH

O ÛÎÔfi˜ Ù˘ ‚È‚ÏÈÔÁÚ·ÊÈ΋˜ ·˘Ù‹˜ ·Ó·ÛÎfiËÛ˘‹Ù·Ó Ë ·ÚÔ˘Û›·ÛË ÙˆÓ ÁÓÒÛÂˆÓ Û¯ÂÙÈο Ì ÙËÓÙÔÈ΋ ÙÔÍÈ΋ ‰Ú¿ÛË ÙÔ˘ Ô‰ÔÓÙÈ·ÙÚÈÎÔ‡ ·Ì·ÏÁ¿Ì·-ÙÔ˜ ÛÙÔ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, Ì ȉȷ›ÙÂÚË ·Ó·-ÊÔÚ¿ ÛÙȘ ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ. O ÛÙÔÌ·ÙÈÎfi˜‚ÏÂÓÓÔÁfiÓÔ˜ ÔÏϤ˜ ÊÔÚ¤˜ ˘Ê›ÛÙ·Ù·È ÂÈ‚Ï·‚›˜ÂȉڿÛÂȘ ÏfiÁˆ Ù˘ ·ʋ˜ ÙÔ˘ Ì ‰È¿ÊÔÚ· ̆ ÏÈο.ŒÓ· ·fi ·˘Ù¿ Ù· ˘ÏÈο Â›Ó·È Î·È ÙÔ ·Ì¿ÏÁ·Ì· ÙˆÓÔ‰ÔÓÙÈÎÒÓ ÂÌÊڿ͈Ó. T· Û˘ÛÙ·ÙÈο ÙÔ˘ ·Ì·ÏÁ¿-Ì·ÙÔ˜, Û ۿÓȘ ÂÚÈÙÒÛÂȘ ÌÔÚÔ‡Ó Ó· ÚÔ-ηϤÛÔ˘Ó ÙÔÈΤ˜ ‚Ï¿‚˜ ‹ ·ÏÏÂÚÁÈΤ˜ ·ÓÙȉڿÛÂȘ,ÔÈ Ôԛ˜ ·Ó·Ê¤ÚÔÓÙ·È ˆ˜ ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿ-ÛÂȘ. EÂȉ‹ ÔÈ ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ Â›Ó·È ·-ÚfiÌÔȘ Ì ·˘Ù¤˜ ÙÔ˘ ÔÌ·ÏÔ‡ ÏÂȯ‹Ó·, Â›Ó·È ··-Ú·›ÙËÙÔ Ó· Á›ÓÂÙ·È ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË. AÏÏÔÈÒÛÂȘÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ÌÔÚÔ‡Ó Ó· ıˆÚËıÔ‡Ó ‡ÔÙ˜

SUMMARY

The aim of this literature review was to present anddiscuss the knowledge regarding the effect of dentalamalgam on oral mucosa, emphasizing on oral liche-noid reactions. Human oral mucosa is subjected tomany noxious stimuli. One of these substances isdental amalgam which contains mercury, silver, tin,copper, zinc and other trace metals. Componentsof amalgam may, in rare instances, cause local sideeffects or allergic reactions referred to as oral lichenoidreactions. Oral lichenoid reactions resemble thoseof oral lichen planus, and it is therefore necessaryto exclude likely lichenoid reactions when making adiagnosis of oral lichen planus. Both oral lichen planusand oral lichenoid reactions can be consideredpotentially malignant and is important for subsequentmanagement to be able to accurately diagnose each

35

Oral lichenoid reactions related to contact with dental amalgam

D. Dionysopoulos*, E. Parcharidis**, K. Karaoulani***

BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË

Literature Review

* ¢È‰¿ÎÙÔÚ·˜ Î·È ¶·ÓÂÈÛÙËÌÈ·Îfi˜ YfiÙÚÔÊÔ˜, EÚÁ·ÛÙËÚ›Ô˘ O‰ÔÓÙÈ΋˜ XÂÈÚÔ˘ÚÁÈ΋˜ A.¶.£.

** MÂÙ·Ù˘¯È·Îfi˜ ÊÔÈÙËÙ‹˜ EÚÁ·ÛÙËÚ›Ô˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ A.¶.£.

*** MÂÙ·Ù˘¯È·Î‹ ÊÔÈÙ‹ÙÚÈ· EÚÁ·ÛÙËÚ›Ô˘ O‰ÔÓÙÈ΋˜ XÂÈÚÔ˘ÚÁÈ΋˜ A.¶.£.

AÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢

* PhD, University scholar, Department of OperativeDentistry, Aristotle University of Thessaloniki

** Postgraduate student, Department of Oral Medicine and Oral Pathology, Aristotle University of Thessaloniki

*** Postgraduate student, Department of Operative Dentistry,Aristotle University of Thessaloniki

ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 59: 35-49, 2015 Hellenic Stomatological Review 59: 35-49, 2015

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

Hellenic Stomatological Review 59: 35-49, 2015

ˆ˜ ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ, fiÙ·Ó ‚Ú›ÛÎÔÓÙ·È ÛÙÔ‚ÏÂÓÓÔÁfiÓÔ Ù˘ ·ÚÂÈ¿˜ ‹ Ù˘ ÁÏÒÛÛ·˜ ÌÔÓfiÏ¢-Ú·, Û ¿ÌÂÛË Â·Ê‹ Ì ÂÌÊÚ¿ÍÂȘ ·Ì·ÏÁ¿Ì·ÙÔ˜ ηȉÂÓ ˘Ô¯ˆÚÔ‡Ó ‡ÛÙÂÚ· ·fi ·Ó¿ÏÔÁË ıÂڷ›·. H‰È¿ÁÓˆÛË ÙˆÓ ÏÂȯËÓÔÂȉÒÓ ·ÏÏÔÈÒÛÂˆÓ ‰ÂÓ ÌÔÚ›ӷ Á›ÓÂÈ ÌfiÓÔ Ì ÈÛÙÔ·ıÔÏÔÁÈ΋ ÂͤٷÛË, ÂÂȉ‹ ›-Ó·È Ôχ ‰‡ÛÎÔÏÔ Ó· ‰È·ÊÔÚÔÔÈËıÔ‡Ó ÔÈ ÈÛÙÔÏÔ-ÁÈΤ˜ ÂÈÎfiÓ˜ ÙˆÓ ÏÂȯËÓÔÂȉÒÓ ·ÏÏÔÈÒÛÂˆÓ ·fi ·˘-Ù¤˜ ÙÔ˘ ÔÌ·ÏÔ‡ ÏÂȯ‹Ó·. H ıÂڷ›· ÙˆÓ ÏÂȯËÓÔÂÈ-‰ÒÓ ·ÏÏÔÈÒÛÂˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ¢·ÈÛıËÛ›·ÂÍ’ ·ʋ˜ Û˘Ó›ÛÙ·Ù·È ÛÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË, ·ÓÙÈη-Ù¿ÛÙ·ÛË ‹ Î¿Ï˘„Ë ÙˆÓ ÂÌÊÚ¿ÍÂˆÓ Ô˘ ‚Ú›ÛÎÔÓÙ·ÈÛ ¿ÌÂÛË Â·Ê‹ Ì ÙȘ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘Î·È ıˆÚÂ›Ù·È fiÙÈ Â›Ó·È Ë ·ÈÙ›· ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜.

§¤ÍÂȘ ÎÏÂȉȿ: §ÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ, Ô‰ÔÓÙÈ·ÙÚÈÎfi ·Ì¿ÏÁ·Ì·, ÛÙÔÌ·ÙÈÎfi˜ ‚ÏÂÓÓÔÁfiÓÔ˜

EI™A°ø°H

O ÛÙÔÌ·ÙÈÎfi˜ ‚ÏÂÓÓÔÁfiÓÔ˜ ̆ Ê›ÛÙ·Ù·È Û˘¯Ó¿ ÂÈ‚Ï·‚›˜ÂȉڿÛÂȘ, fiˆ˜ ¤ÓÙÔÓ· ıÂÚÌÈο ‹ ¯ËÌÈο ÂÚÂı›ÛÌ·Ù··fi ÙȘ ÙÚÔʤ˜ Î·È Ù· ̆ ÁÚ¿ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙË ‰È·-ÙÚÔÊ‹ ÙÔ˘ ·ÙfiÌÔ˘. E›Û˘, Û˘¯Ó¿ ‚Ú›ÛÎÂÙ·È Û ·ʋÌ ηÓfi, ·ÏÎÔfiÏ Î·È ¿ÏϘ ¯ËÌÈΤ˜ Ô˘Û›Â˜ Ô˘ ÚÔ-ÛÏ·Ì‚¿ÓÔÓÙ·È ·fi ÙÔ ÛÙfiÌ·. ™Â ¿ÙÔÌ· Ì ԉÔÓÙÈΤ˜ ·Ô-ηٷÛÙ¿ÛÂȘ ¤Ó· ̆ ÏÈÎfi ÙÔ ÔÔ›Ô ‚Ú›ÛÎÂÙ·È Û˘¯Ó¿ ÛÙÔ ÛÙfi-Ì· Â›Ó·È ÙÔ Ô‰ÔÓÙÈ·ÙÚÈÎfi ·Ì¿ÏÁ·Ì·, ÛÙÔ ÔÔ›Ô ÂÚȤ¯Â-Ù·È Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ˘‰Ú¿ÚÁ˘ÚÔ˜ (Hg). TÔ Ô‰ÔÓÙÈ·-ÙÚÈÎfi ·Ì¿ÏÁ·Ì· Â›Ó·È ¤Ó· ÎÚ¿Ì· Ô˘ ·ÔÙÂÏÂ›Ù·È ·fiÂÚ›Ô˘ ›Û˜ ÔÛfiÙËÙ˜ Hg Î·È ÛÎfiÓ˘ ÎÚ¿Ì·ÙÔ˜ ÌÂ-Ù¿ÏψÓ. H ÂÚÈÂÎÙÈÎfiÙËÙ· % Î.‚. ÙÔ˘ οı ÛÙÔÈ¯Â›Ô˘ ÛÙÔÎÚ¿Ì· ›ӷÈ: ≥40% ¿ÚÁ˘ÚÔ˜ (Ag), ≤32% ηÛÛ›ÙÂÚÔ˜ (Sn),≤30% ¯·ÏÎfi˜ (Cu), ≤5% ›Ó‰ÈÔ (In), ≤1% ·ÏÏ¿‰ÈÔ (Pd),≤1% Ï¢Îfi¯Ú˘ÛÔ˜ (Pt), ≤2% „¢‰¿ÚÁ˘ÚÔ˜ (Zn) Î·È ≤3%˘‰Ú¿ÚÁ˘ÚÔ˜ (Hg), Û‡Ìʈӷ Ì ÙË ‰ÈÂıÓ‹ ÚԉȷÁÚ·Ê‹ISO 24234 ÙÔ˘ 20051.TÔ ·Ì¿ÏÁ·Ì· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ ÎÏÈÓÈ΋ Ô‰ÔÓÙÈ·ÙÚÈ΋ÁÈ· ÔÏϤ˜ ‰ÂηÂٛ˜ Î·È ·Ú·Ì¤ÓÂÈ ÙÔ ÂÚÈÛÛfiÙÂÚÔ ̄ ÚË-ÛÈÌÔÔÈÔ‡ÌÂÓÔ ÂÌÊÚ·ÎÙÈÎfi ̆ ÏÈÎfi ÛÙÔÓ ÎfiÛÌÔ2. ™Â ÔÚÈṲ̂Ó˜¯ÒÚ˜, fï˜, fiˆ˜ Ë ™Ô˘Ë‰›·, Ë ¢·Ó›· Î·È Ë °ÂÚÌ·Ó›·¤¯Ô˘Ó ÙÂı› ÂÚÈÔÚÈÛÌÔ› ÛÙË ̄ Ú‹ÛË ÙÔ˘ ·Ì·ÏÁ¿Ì·ÙÔ˜3, ÂÓÒË NÔÚ‚ËÁ›· ¤¯ÂÈ ··ÁÔÚ‡ÛÂÈ Ï‹Úˆ˜ ÙË ¯Ú‹ÛË ÙÔ˘4. TÔ·Ì¿ÏÁ·Ì· Û‹ÌÂÚ· ıˆÚÂ›Ù·È fiÙÈ Â›Ó·È ¤Ó· ·ÛʷϤ˜ ÂÌ-ÊÚ·ÎÙÈÎfi ˘ÏÈÎfi ·Ú¿ ÙËÓ Û˘Ó¯‹ ·ÂÏ¢ı¤ÚˆÛË ÌÈÎÚÒÓÔÛÔÙ‹ÙˆÓ ÙÔÍÈÎÒÓ ·ÙÌÒÓ Hg5. AÙÌÔ› Hg ·ÂÏ¢ıÂÚÒÓÔ-ÓÙ·È Î·Ù¿ ÙË Ì›ÍË, ÙËÓ ÙÔÔı¤ÙËÛË, ÙËÓ Û˘Ì‡ÎÓˆÛË, ÙˉȷÌfiÚʈÛË Î·È ÙËÓ ÛٛςˆÛË ÙÔ˘ ·Ì·ÏÁ¿Ì·ÙÔ˜, fiˆ˜Î·È ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ê·›ÚÂÛ˘ ·Ï·ÈÒÓ ÂÌÊڿ͈ӷ̷ÏÁ¿Ì·ÙÔ˜. H ·ÂÏ¢ı¤ÚˆÛË ÙˆÓ ·ÙÌÒÓ Hg ηٿ ÙˉȿÚÎÂÈ· ·˘ÙÒÓ ÙˆÓ ‰È·‰ÈηÛÈÒÓ ÌÔÚ› Ó· ÂÏ·ÙÙˆı› ·Ó¯ÚËÛÈÌÔÔÈËı› ηٿÏÏËÏË „‡ÍË Ì ηٷÈÔÓÈÛÌfi ÓÂÚÔ‡ ηȯÚËÛÈÌÔÔÈËı› ÈÛ¯˘Ú‹ ·Ó·ÚÚfiÊËÛË6.K·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÌÔÓ‹˜ ÙˆÓ ÂÌÊÚ¿ÍÂˆÓ ·Ì·Ï-Á¿Ì·ÙÔ˜ ÛÙÔ ÛÙfiÌ· Î·È È‰È·›ÙÂÚ· ηٿ ÙË Ì¿ÛËÛË, Ô Hg

condition. Oral lichenoid reactions should be suspe-cted clinically when reactions of the buccal mucosaor tongue are unilateral, in intimate contact withamalgam fillings and fail to heal following treatment.It is not possible to confirm the diagnosis of oral liche-noid reactions through histology, due to the difficultyin differentiating oral lichen planus from oral lichenoidreactions from the histological viewpoint. Histopatho-logical study is not always necessary except whentheir clinical presentation is atypical in order to excludethe possibility of malignancy. Currently, the use ofepicutaneous patch test to detect sensitivity to specificsubstances in patients suspected of suffering contactallergy is controversial. Treatment of oral lichenoidreactions related to amalgam contact containsremoval, replacement or recovering of amalgamfillings which are in direct contact with lichenoidreactions and are suspected of playing a causal role.

Key Words: Lichenoid reactions, dental amalgam, oral mucosa

INTRODUCTION

Oral mucosa is commonly subjected to a number of noxiousstimuli, such as intense thermal or chemical stimuli fromnutrition. Moreover, it is often in contact with tobacco,alcohol and other chemical substances that are insertedin the oral environment. One of the materials that arecommonly found in the oral cavity of patients with dentalrestorations is dental amalgam, which contains highamounts of mercury (Hg). Dental amalgam is an alloycomposed of approximately equal parts of liquid mercuryand a powder alloy of metals. The concentration of eachelement in the alloy is: ≥40% silver (Ag), ≤32% tin (Sn),≤30% copper (Cu), ≤5% indium (In), ≤1% palladium (Pd),≤1% platinum (Pt), ≤2% zinc (Zn) and ≤3% mercury (Hg),according to ISO 24234:20051.Amalgam has been used in dentistry for many decadesand still remains the most widely used restorative materialin the world2. Certain countries, however, such as Sweden,Denmark and Germany have limited its use3, while Norwayhas completely prohibited it4. Nowadays, amalgam isconsidered a safe restorative material despite the conti-nuous release of small amounts of toxic Hg vapors5. Hgvapors are released during mixing, application, conden-sation, carving and polishing of amalgam as well as duringremoval of old amalgam fillings. The release of Hg vaporsduring these procedures should be reduced using waterirrigation and high-power dry suction6.As long as amalgam fillings remain in the oral cavity andparticularly during mastication, Hg can be released eitherin the form of vapor or salt dissolved in saliva7. It has beenfound that the amount of released Hg depends on thenumber of existing restorations and on their surface area7.The daily amount of Hg absorbed by the organism from

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

amalgam fillings is very low, approximately 1.2 Ìg viainspiration and 1.5 Ìg via swallowing8. This is lower thanthe amount of Hg ingested daily from food or the air andfalls below the threshold of safe Hg intake which has beenrecently reduced to 0.1 Ìg/ day/ Kg of body weight9.Due to Hg release, amalgam fillings have been accusedof causing or exacerbating certain diseases but to this date,no relation has been proved between these diseases andHg10. According to existing scientific data, Hg release fromamalgam restorations is not a threat for health of the patients,except in rare cases of hypersensitivity reactions11, 12.The aim of this literature review was to present and discussthe knowledge regarding the effect of dental amalgamon oral mucosa, emphasizing on oral lichenoid reactions.

REACTIONS OF ORAL MUCOSA TO AMALGAM

Three different reactions of soft tissues to amalgam fillingshave been described13: a) local toxic reaction, b) delayedor Type IV hypersensitivity reaction and c) acute or gene-ralized hypersensitivity. It is very important to identify thetype of reaction because their treatment varies considerably.

a. Local toxic reactionToxic reaction of skin or mucosa is the result of the actionof a primary stimulus, capable to cause tissue damage,when exists in a sufficient amount and time. This stimulusmay be mechanical, chemical, thermal or ionizing radiation3. Inflamed gums are frequently observed in proximity toamalgam fillings and biopsies of these areas revealed thatthey contain greater amount of Hg compared to biopsiesfrom witness areas14. The so-called staining or amalgamtattoo due to implantation of amalgam residues in thesoft tissues, can be characterized as a toxic reaction15.Differential diagnosis between this lesion and otherscausing black spots is achieved radiographically whereamalgam residues are detected through the soft tissues16.There is no much information about local toxic reactionscaused by dental amalgam, but they are supposed to occurwhen an irritant is in direct contact with the oral mucosafor a long period of time. These reactions of the oral mucosaclinically resemble lichenoid reactions which are type IVhypersensitivity reactions and differential diagnosis canonly be made with patch test17.

b. Delayed or type IV hypersensitivity reaction The most common reaction to amalgam fillings is thedevelopment of lichenoid reactions, localized to the mucosain direct contact with amalgam restorations. The lichenoidlesion, as mentioned above, is a Type IV hypersensitivityreaction18. Type IV hypersensitivity is commonly calleddelayed, since the reaction takes a long time to develop,for instance after 48 h up to months or years. StimulatedT-lymphocytes are responsible for the reaction mechanismwhile here is no involvement of immunoglobins18.Mercury salts accumulated in the oral mucosa causehypersensitivity reaction only in a small sensitive groupof patients, which is expressed as white reticulated lesions,

ÌÔÚ› Ó· ·ÂÏ¢ıÂÚˆı› ›Ù ˆ˜ ·ÙÌfi˜ ›Ù Ì ÙË ÌÔÚ-Ê‹ ·Ï¿ÙˆÓ ÙÔ˘ Ô˘ ‰È·Ï‡ÔÓÙ·È ÛÙÔ Û¿ÏÈÔ7. H ÔÛfiÙËÙ·ÙÔ˘ Hg Ô˘ ·ÂÏ¢ıÂÚÒÓÂÙ·È ¤¯ÂÈ ‚ÚÂı› fiÙÈ ÂÍ·Úٿٷȷfi ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÌÊÚ¿ÍÂˆÓ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙÔ ÛÙfi-Ì· Î·È ·fi ÙË Û˘ÓÔÏÈ΋ ÙÔ˘˜ ÂÈÊ¿ÓÂÈ·7. H ËÌÂÚ‹ÛÈ· Ô-ÛfiÙËÙ· Hg Ô˘ ·ÔÚÚÔÊ¿Ù·È ·fi ÙÔÓ ÔÚÁ·ÓÈÛÌfi ·fi ÂÌ-ÊÚ¿ÍÂȘ ·Ì·ÏÁ¿Ì·ÙÔ˜ Â›Ó·È ¯·ÌËÏ‹ Î·È Â›Ó·È Î·Ù¿ ̤ÛÔfiÚÔ 1,2 Ìg ‰È· ÂÈÛÓÔ‹˜ Î·È 1,5 Ìg ‰È· ηٷfiÛˆ˜8. HÔÛfiÙËÙ· ·˘Ù‹ Â›Ó·È Ôχ ÌÈÎÚfiÙÂÚË ·fi ·˘Ù‹Ó Ô˘ ÚÔ-ÛÏ·Ì‚¿ÓÂÙ·È ËÌÂÚËÛ›ˆ˜ ·fi ÙȘ ÙÚÔʤ˜ Î·È ÙÔÓ ·¤Ú· ηÈÂ›Ó·È ¯·ÌËÏfiÙÂÚË ·fi ÙÔ ÂÈÙÚÂfiÌÂÓÔ fiÚÈÔ ·ÛÊ·ÏÔ‡˜ÚfiÛÏ˄˘ Hg, Ô˘ Û¯ÂÙÈο ÚfiÛÊ·Ù· ¤¯ÂÈ ÂÏ·ÙÙˆı›ÛÙ· 0,1 Ìg/Ë̤ڷ/Kg ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜9. OÈ ÂÌÊÚ¿ÍÂȘ ·Ì·ÏÁ¿Ì·ÙÔ˜ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› fiÙÈ ÏfiÁˆÙÔ˘ Hg Ô˘ ·ÂÏ¢ıÂÚÒÓÂÙ·È Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηϤ-ÛÔ˘Ó ‹ Ó· ÂȉÂÈÓÒÛÔ˘Ó ÔÚÈṲ̂Ó˜ ÁÂÓÈΤ˜ ÓfiÛÔ˘˜, ¯ˆ-Ú›˜ fï˜ Ó· ¤¯ÂÈ ‚ÚÂı› Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÓfiÛˆÓ·˘ÙÒÓ Î·È ÙÔ˘ Hg10. M ‚¿ÛË Ù· ˘¿Ú¯ÔÓÙ· ÂÈÛÙËÌÔÓÈ-ο ‰Â‰Ô̤ӷ Ë ·ÂÏ¢ı¤ÚˆÛË ÙÔ˘ Hg ·fi ÙȘ ÂÌÊÚ¿-ÍÂȘ ·Ì·ÏÁ¿Ì·ÙÔ˜ ‰ÂÓ ·ÔÙÂÏ› ΛӉ˘ÓÔ ÁÈ· ÙË ÁÂÓÈ΋ ̆ Á›·ÙˆÓ ·ÛıÂÓÒÓ, ÂÎÙfi˜ ·fi Û¿ÓȘ ÂÚÈÙÒÛÂȘ Ô˘ ÌÔ-Ú› Ó· ÂÌÊ·ÓÈÛıÔ‡Ó ·ÓÙȉڿÛÂȘ ˘ÂÚ¢·ÈÛıËÛ›·˜11, 12.O ÛÎÔfi˜ Ù˘ ‚È‚ÏÈÔÁÚ·ÊÈ΋˜ ·˘Ù‹˜ ·Ó·ÛÎfiËÛ˘ ›-Ó·È Ë ·ÚÔ˘Û›·ÛË ÙˆÓ ÁÓÒÛÂˆÓ Û¯ÂÙÈο Ì ÙËÓ ÙÔÈ΋ ÙÔ-ÍÈ΋ ‰Ú¿ÛË ÙÔ˘ ·Ì·ÏÁ¿Ì·ÙÔ˜ Î·È ÙÔ˘ Hg ÛÙÔ ‚ÏÂÓÓÔÁfi-ÓÔ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, Ì ȉȷ›ÙÂÚË ·Ó·ÊÔÚ¿ ÛÙȘ ÏÂȯËÓÔÂÈ-‰Â›˜ ·ÓÙȉڿÛÂȘ.

ANTI¢PA™EI™ TOY ™TOMATIKOY B§ENNO°ONOY ™TO AMA§°AMA

Œ¯Ô˘Ó ÂÚÈÁÚ·Ê› ÙÚ›· ‰È·ÊÔÚÂÙÈο ›‰Ë ·ÓÙȉڿÛˆÓÙˆÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ ÛÙȘ ÂÌÊÚ¿ÍÂȘ ·Ì·ÏÁ¿Ì·ÙÔ˜13: ·) ËÙÔÈ΋ ÙÔÍÈ΋ ·ÓÙ›‰Ú·ÛË (toxic reactions), ‚) Ë ÂÈ‚Ú·-‰˘ÓfiÌÂÓË ‹ T‡Ô˘ IV ·ÓÙ›‰Ú·ÛË ˘ÂÚ¢·ÈÛıËÛ›·˜(delayed or type IV hypersensitivity reactions) Î·È Á) Ë ÔÍ›·‹ ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÂÚ¢·ÈÛıËÛ›· (acute or generalizedsensitivity). E›Ó·È ÛËÌ·ÓÙÈÎfi Ô Ô‰ÔÓÙ›·ÙÚÔ˜ Ó· ÁÓˆÚ›˙ÂÈÙÔÓ Ù‡Ô Ù˘ ·ÓÙ›‰Ú·Û˘ ÂÂȉ‹ Ë ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÓÙÈ-‰Ú¿ÛÂˆÓ ·˘ÙÒÓ ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈο.

·. TÔÈ΋ ÙÔÍÈ΋ ·ÓÙ›‰Ú·ÛË H ÙÔÍÈ΋ ·ÓÙ›‰Ú·ÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ‹ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘, ›-Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰Ú¿Û˘ ÂÓfi˜ ÚˆÙÔÁÂÓÔ‡˜ ÂÚÂ-ı›ÛÌ·ÙÔ˜, Ô˘ Â›Ó·È ÈηÓfi Ó· ÚÔηϤÛÂÈ ‚Ï¿‚Ë ÛÙÔ˘˜ÈÛÙÔ‡˜, Â¿Ó ‚Ú›ÛÎÂÙ·È Û ·Ú΋ ÔÛfiÙËÙ· ÁÈ· ·ÚÎÂÙfi¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. TÔ ÚˆÙÔÁÂÓ¤˜ ÂÚ¤ıÈÛÌ· ÌÔÚ› Ó·Â›Ó·È Ì˯·ÓÈÎfi, ̄ ËÌÈÎfi, ıÂÚÌÈÎfi ‹ ÈÔÓÈṲ̂ÓË ·ÎÙÈÓÔ‚ÔÏ›·3. Œ¯ÂÈ ·Ú·ÙËÚËı› ÔÏϤ˜ ÊÔÚ¤˜ ÊÏÂÁÌÔÓ‹ ÙˆÓ Ô‡ÏˆÓfiÙ·Ó ‚Ú›ÛÎÔÓÙ·È Û ÛÙÂÓ‹ Û¯¤ÛË Ì ·˘¯ÂÓÈΤ˜ ÂÌÊÚ¿ÍÂȘ·Ì·ÏÁ¿Ì·ÙÔ˜ Î·È ‚ÈÔ„›Â˜ ·fi ÙȘ ÂÚÈÔ¯¤˜ ·˘Ù¤˜ ¤‰ÂÈÍ·ÓfiÙÈ ÂÚȤ¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ÔÛfiÙËÙ· Hg Û ۯ¤ÛË Ì ‚ÈÔ-„›Â˜ ·fi ÂÚÈÔ¯¤˜ Ì¿ÚÙ˘Ú˜14. H ÁÓˆÛÙ‹ ̂ ˜ ̄ ÚÒÛË ‹ Ù·-ÙÔ˘¿˙ ·Ì·ÏÁ¿Ì·ÙÔ˜ (amalgam tattoo), Ô˘ ÔÊ›ÏÂÙ·È ÛÂÂÌʇÙ¢ÛË ̆ ÔÏÂÈÌÌ¿ÙˆÓ ·Ì·ÏÁ¿Ì·ÙÔ˜ ÛÙÔ˘˜ Ì·Ï·ÎÔ‡˜ÈÛÙÔ‡˜, ÌÔÚ› Ó· ̄ ·Ú·ÎÙËÚÈÛı› ̂ ˜ ÙÔÍÈ΋ ·ÓÙ›‰Ú·ÛË15.H ‰È·ÊÔÚԉȿÁÓˆÛË Ù˘ ‚Ï¿‚˘ ·˘Ù‹˜ ·fi ¿ÏϘ Ô˘ÚÔηÏÔ‡Ó ÌÂÏ·Ó¤˜ ÎËÏ›‰Â˜ Á›ÓÂÙ·È ·ÎÙÈÓÔÁÚ·ÊÈο, fiÔ˘

Hellenic Stomatological Review 59: 35-49, 2015

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Literature Review

Hellenic Stomatological Review 59: 35-49, 2015

Ê·›ÓÔÓÙ·È Ù· ̆ ÔÏ›ÌÌ·Ù· ·Ì·ÏÁ¿Ì·ÙÔ˜ ̤۷ ÛÙÔ˘˜ Ì·-Ï·ÎÔ‡˜ ÈÛÙÔ‡˜16. ¢ÂÓ ˘¿Ú¯Ô˘Ó ÔÏϤ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙȘ ÙÔÈΤ˜ ÙÔ-ÍÈΤ˜ ·ÓÙȉڿÛÂȘ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙÔ Ô‰ÔÓÙÈ·-ÙÚÈÎfi ·Ì¿ÏÁ·Ì·, ·ÏÏ¿ ıˆÚÂ›Ù·È fiÙÈ ÌÔÚÔ‡Ó Ó· ÂÌÊ·-ÓÈÛÙÔ‡Ó fiÙ·Ó Î¿ÔÈ· ÂÚÂıÈÛÙÈ΋ Ô˘Û›· ÙÔ˘ ·Ì·ÏÁ¿Ì·-ÙÔ˜ Â›Ó·È Û ¿ÌÂÛË Â·Ê‹ Ì ÙÔÓ ÛÙÔÌ·ÙÈÎfi ‚ÏÂÓÓÔÁfiÓÔÁÈ· ÌÂÁ¿ÏÔ ̄ ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. OÈ ·ÓÙȉڿÛÂȘ ·˘Ù¤˜ ÙÔ˘‚ÏÂÓÓÔÁfiÓÔ˘ ÎÏÈÓÈο ÌÔÈ¿˙Ô˘Ó Ì ÙȘ ÏÂȯËÓÔÂȉ›˜ ·ÓÙÈ-‰Ú¿ÛÂȘ, ÔÈ Ôԛ˜ Â›Ó·È ·ÓÙȉڿÛÂȘ ˘ÂÚ¢·ÈÛıËÛ›·˜Ù‡Ô˘ IV Î·È Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÌÔÚ› Ó· Á›ÓÂÈ ÌfiÓÔÌ ÂȉÂÚÌÈ΋ ‰ÔÎÈÌ·Û›· ¢·ÈÛıËÛ›·˜17.

‚. EÈ‚Ú·‰˘ÓÔ̤ÓË ‹ Ù‡Ô˘ IV ·ÓÙ›‰Ú·ÛË ˘ÂÚ¢·ÈÛıËÛ›·˜

H ÈÔ Û˘¯Ó‹ ·ÓÙ›‰Ú·ÛË ÛÙȘ ÂÌÊÚ¿ÍÂȘ ·Ì·ÏÁ¿Ì·ÙÔ˜ ›-Ó·È Ë ·Ó¿Ù˘ÍË ÏÂȯËÓÔÂȉÒÓ ·ÓÙȉڿÛˆÓ, Ô˘ ÂÓÙÔ›-˙ÔÓÙ·È ÛÙÔ˘˜ Á‡Úˆ Ì·Ï·ÎÔ‡˜ ÈÛÙÔ‡˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û¿ÌÂÛË Û¯¤ÛË Ì ÙȘ ·ÔηٷÛÙ¿ÛÂȘ ·fi ·Ì¿ÏÁ·Ì·18. HÏÂȯËÓÔÂȉ‹˜ ·ÓÙ›‰Ú·ÛË, fiˆ˜ ÚԷӷʤÚıËÎÂ, Â›Ó·È ÌÈ··ÓÙ›‰Ú·ÛË ˘ÂÚ¢·ÈÛıËÛ›·˜ T‡Ô˘ IV. ™ÙËÓ ˘ÂÚ¢·È-ÛıËÛ›· Ù‡Ô˘ IV ‰ÂÓ Û˘ÌÌÂÙ¤¯Ô˘Ó ·ÓÙÈÛÒÌ·Ù· ·ÏÏ¿ ÂÓÂÚ-ÁÔÔÈË̤ӷ T-ÏÂÌÊÔ·ÙÙ·Ú· Î·È Î·ÏÂ›Ù·È Î·È ˘ÂÚ¢·È-ÛıËÛ›· ÂÈ‚Ú·‰˘ÓfiÌÂÓÔ˘ Ù‡Ô˘ ÂÂȉ‹ Ë ·ÓÙ›‰Ú·ÛË ̄ ÚÂÈ-¿˙ÂÙ·È ÌÂÁ¿ÏÔ ̄ ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÁÈ· Ó· ·Ó·Ù˘¯ı› (·fi48 ÒÚ˜ ̤¯ÚÈ Ì‹Ó˜ ‹ Î·È ¯ÚfiÓÈ·)18.H ·ÓÙ›‰Ú·ÛË ˘ÂÚ¢·ÈÛıËÛ›·˜ Ù‡Ô˘ IV ÌÔÚ› Ó· ·Ó·-Ù˘¯ı› ΢ڛˆ˜ ·fi ¿Ï·Ù· Hg Ô˘ ÂÎχÔÓÙ·È ·fi ÙȘ ÂÌ-ÊÚ¿ÍÂȘ ÙÔ˘ ·Ì·ÏÁ¿Ì·ÙÔ˜ Î·È Û˘ÛÛˆÚ‡ÔÓÙ·È ÛÙÔ ÛÙÔ-Ì·ÙÈÎfi ‚ÏÂÓÓÔÁfiÓÔ. H ˘ÂÚ¢·ÈÛıËÛ›· ·˘Ù‹ ÂΉËÏÒÓÂ-Ù·È Ì Ï¢Τ˜ ‰ÈÎÙ˘ˆÙ¤˜ ·ÏÏÔÈÒÛÂȘ, ‚Ï·Ù›‰Â˜, ϿΘ,‰È·‚ÚÒÛÂȘ ‹ ¤ÏÎË ·ÚfiÌÔÈ· Ì ·˘Ù¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·ÈÛÙÔÓ ÔÌ·Ïfi ÏÂȯ‹Ó·19. Afi ÙËÓ ÔÌÔÈfiÙËÙ· ÙˆÓ ÂΉËÏÒ-ÛÂˆÓ ÛÙÔ ‚ÏÂÓÓÔÁfiÓÔ Ì ÙȘ ÂΉËÏÒÛÂȘ ÙÔ˘ ÔÌ·ÏÔ‡ ÏÂÈ-¯‹Ó·, ÚÔ·ÙÂÈ Ô fiÚÔ˜ ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ. OÈ·ÓÙȉڿÛÂȘ ·˘Ù¤˜ ÌÔÚ› Ó· Â›Ó·È ·Û˘Ìو̷ÙÈΤ˜ ‹ ÂÒ-‰˘Ó˜ Î·È ÂΉËÏÒÓÔÓÙ·È ÌfiÓÔ Û ÌÈ· ÌÈÎÚ‹ ¢·›ÛıËÙË ÔÌ¿-‰· ·ÛıÂÓÒÓ. OÈ ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ ÌÔÚÔ‡Ó Ó·ÂÌÊ·ÓÈÛÙÔ‡Ó ÛÙÔ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È ·fi ÙÔ-ÍÈ΋ ›‰Ú·ÛË ‰È·ÊfiÚˆÓ Ô˘ÛÈÒÓ ¯ˆÚ›˜ Ó· Â›Ó·È ·ÔÙ¤-ÏÂÛÌ· ˘ÂÚ¢·ÈÛıËÛ›·˜19.H ˘ÂÚ¢·ÈÛıËÛ›· ÛÙÔ ·Ì¿ÏÁ·Ì· Â›Ó·È Û¿ÓÈ· Î·È ÔÊ›-ÏÂÙ·È Û ÚÔ˚fiÓÙ· ‰È¿‚ÚˆÛ˘ ÙˆÓ ÂÌÊÚ¿ÍÂˆÓ ·Ì·ÏÁ¿-Ì·ÙÔ˜ Î·È fiˆ˜ Ê·›ÓÂÙ·È Û fiϘ ۯ‰fiÓ ÙȘ ÂÚÈÙÒÛÂȘۯÂÙ›˙ÂÙ·È Ì ÙÔÓ Hg, Ì ϛÁ˜ ÌfiÓÔ ÂÍ·ÈÚ¤ÛÂȘ fiÔ˘ ÂÌϤ-ÎÂÙ·È Ô Ag, Ô Cu, Ô Sn ‹ ÙÔ Pd20-22. OÈ ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ ÙÔ˘ ÛÙÔÌ·ÙÈÎÔ‡ ‚ÏÂÓÓÔÁfi-ÓÔ˘ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙÔ ·Ì¿ÏÁ·Ì· Â›Ó·È ·ÏÏÂÚÁÈ-Τ˜ ·ÓÙȉڿÛÂȘ ÂÍ’ ·ʋ˜. OÈ ·ÓÙȉڿÛÂȘ ÂÍ’ ·ʋ˜ÂÓÒ Â›Ó·È Û˘¯Ó¤˜ ÛÙÔ ‰¤ÚÌ· Â›Ó·È Û¯ÂÙÈο Û¿ÓȘ ÛÙÔÛÙÔÌ·ÙÈÎfi ‚ÏÂÓÓÔÁfiÓÔ23. °È· ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ·ÏÏÔÈÒ-ÛÂˆÓ Ê·›ÓÂÙ·È fiÙÈ ¯ÚÂÈ¿˙ÂÙ·È ÌÂÁ¿ÏË ÂÚ›Ô‰Ô˜ ÛÙÂÓ‹˜Â·Ê‹˜ ÙÔ˘ ÛÙÔÌ·ÙÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Ì ÂÌÊÚ¿ÍÂȘ ·Ì·Ï-Á¿Ì·ÙÔ˜, Ô˘ ÌÔÚ› Ó· Â›Ó·È Î·È ¯ÚfiÓÈ·, ÂÓÒ ÈÔ Û˘¯Ó¿ÂÌÊ·Ó›˙ÔÓÙ·È Û ¿ÙÔÌ· ¿Óˆ ÙˆÓ 50 ÂÙÒÓ24. °È· Ó· ÚÔÎÏËı› ·ÏÏÂÚÁÈ΋ ·ÓÙ›‰Ú·ÛË ÂÍ Â·Ê‹˜, Ù·¿Ï·Ù· ÙÔ˘ Hg Î·È Ù· ¿ÏÏ· ÌÂÙ·ÏÏÈο ÈfiÓÙ· Ô˘ ÂÎχÔÓÙ·È·fi ÙÔ ·Ì¿ÏÁ·Ì·, Ú¤ÂÈ Ó· ‰ÈÂÈÛ‰‡ÛÔ˘Ó ÛÙÔ ÂÈıËÏÈ·-

papules, plaques, erosions or ulcers similar to those seenin oral lichen planus19. The term lichenoid lesion wasestablished due to its similarity with the mucosal lesionsof lichen planus. These lesions may be asymptomatic orpainful, especially to hot or spicy foods. Lichenoid reactionscan occur also from the toxic effect of different substanceswithout resulting from a hypersensitivity reaction19. Hypersensitivity to amalgam is rare and attributed to erosiveproducts of amalgam fillings. In most of the cases it isrelated with Hg, with some exceptions where Ag, Cu, Snor Pd is involved20-22.Lichenoid reactions of the oral mucosa caused by dentalamalgam are considered contact allergies. Althoughcontact allergies are common in the skin are relatively rarein the oral mucosa23. For the development of lichenoidreactions, a long period of close contact of oral mucosato amalgam fillings is necessary. This period of time is oftenyears and the lesions are predominately discovered inpatients over 50-year old24.To induce an allergic reaction by contact, Hg salts andother metallic ions released from amalgam must penetratethe epithelial layer and be received by the surface proteinsof the cells of the stratum corneum25. In susceptibleindividuals, cellular immune responses are induced in thecells of the basal layer, provided that they have beenpreviously sensitized25. It is speculated that the cellularimmune response is genetically determined by specificHLA type proteins (Human Leukocyte Antigens), butcurrently the evidence is insufficient3.

c. Acute or generalized hypersensitivityAlthough the exact nature of these reactions is not fullyunderstood, they are considered Type I hypersensitivityreactions (allergic reactions). In Type I hypersensitivityreactions, allergens are combined with immunoglobins ofbasophile and mast cells leading to release of histamine,which enhances vasodilation and vascular permeability.For this reason, some authors recommend the use ofantihistamines for remission26.Reports of acute or generalized hypersensitivity reactionsto amalgam are rare. They may be occurred in susceptibleindividuals after inhalation during the procedure of amalgamrestoration or immediately after. The symptoms are skinerythema and exanthema (urticarial rash) on the face andextremities, particularly on their flexor surface and arelocated in side of the restoration11. Acute reactions inintraoral mucosa are even less common and appear asbubbles that rupture and form erosions27. These symptomsusually become visible within a few hours after theplacement or removal of amalgam and usually resolvewithout treatment and disappear after a few days28. In case of an acute reaction, unlike in lichenoid reactions,amalgam fillings may remain in the oral cavity unless thesymptoms of acute reaction persist29. If it is decided toremove the amalgam fillings the use of rubber dam,continuous water irrigation, high-power dry suction andadministration of antihistamines before the procedure areconsidered obligatory30. For these acute reactions an

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Literature Review

Îfi ÛÙÚÒÌ· Î·È Ó· ‰ÂÛÌ¢ÙÔ‡Ó ·fi ÙȘ ÂÈÊ·ÓÂȷΤ˜ Úˆ-Ù½Ó˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ù˘ ÎÂÚ·Ù›Ó˘ ÛÙÈ‚¿‰·˜25. ™Â ¢·›-ÛıËÙ· ¿ÙÔÌ· ÚÔηÏÔ‡ÓÙ·È ·ÓÙȉڿÛÂȘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔ-Û›·˜ ÛÙ· ·ÙÙ·Ú· Ù˘ ‚·ÛÈ΋˜ ÛÙÈ‚¿‰·˜, Ì ÙËÓ ÚÔ¸-fiıÂÛË fiÙÈ ¤¯Ô˘Ó ¢·ÈÛıËÙÔÔÈËı› ÚÔÁÂÓ¤ÛÙÂÚ·25.¶Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ Ë ·ÓÙ›‰Ú·ÛË Î˘ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ η-ıÔÚ›˙ÂÙ·È ÁÂÓÂÙÈο ·fi ÂȉÈΤ˜ ÚˆÙ½Ó˜ Ù‡Ô˘ HLA(Human Leukocyte Antigens), ·Ó Î·È ‰ÂÓ ̆ ¿Ú¯Ô˘Ó ÚÔ˜ÙÔ ·ÚfiÓ Â·ÚΛ˜ ·Ô‰Â›ÍÂȘ3.

Á. OÍ›· ‹ ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÂÚ¢·ÈÛıËÛ›· H ÔÍ›· ‹ ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÂÚ¢·ÈÛıËÛ›· ·fi ÂÌÊÚ¿ÍÂȘ·Ì·ÏÁ¿Ì·ÙÔ˜ ıˆÚÂ›Ù·È fiÙÈ ÔÊ›ÏÂÙ·È Û ·ÓÙȉڿÛÂȘ ̆ Â-Ú¢·ÈÛıËÛ›·˜ T‡Ô˘ I (·Ó·Ê˘Ï·ÎÙÈ΋ ‹ ·ÏÏÂÚÁÈ΋ ·ÓÙ›-‰Ú·ÛË), ·Ó Î·È ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È·Û·ÊËÓÈÛÙ› Ë Ê‡ÛË·˘Ù‹˜ Ù˘ ·ÓÙ›‰Ú·Û˘. ™ÙËÓ ˘ÂÚ¢·ÈÛıËÛ›· T‡Ô˘ I Ë·ÏÏÂÚÁÈÔÁfiÓÔ˜ Ô˘Û›· ¤Ú¯ÂÙ·È Û ·ʋ Ì ÙËÓ ÔÌfiÏÔÁË·ÓÔÛÔÛÊ·ÈÚ›ÓË IgE, Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙËÓ ÂÈÊ¿ÓÂÈ· ‚·-ÛÂfiÊÈÏˆÓ Î·È ÛÈÙ¢ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ·ÂÏ¢ı¤ÚˆÛË ÈÛÙ·Ì›Ó˘, Ë ÔÔ›· ÚÔηÏ› ·ÁÁÂÈԉȷ-ÛÙÔÏ‹ Î·È ·‡ÍËÛË ·ÁÁÂȷ΋˜ ‰È·ÂÚ·ÙfiÙËÙ·˜. °È· ÙÔÏfiÁÔ ·˘Ùfi, ¤¯ÂÈ ÚÔÙ·ı› Ë ¯Ú‹ÛË ·ÓÙÈÛÙ·ÌÈÓÈÎÒÓ Ê·Ú-Ì¿ÎˆÓ ÁÈ· ÙËÓ ˘Ô¯ÒÚËÛË ÙˆÓ Û˘Ìو̿وÓ26.H Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÔÍ›·˜ ‹ ÁÂÓÈÎÂ˘Ì¤Ó˘ ˘ÂÚ¢-·ÈÛıËÛ›·˜ ÛÙÔ ·Ì¿ÏÁ·Ì· Â›Ó·È Ôχ ÌÈÎÚ‹ Î·È ÂÌÊ·Ó›˙Â-Ù·È Û ¢·›ÛıËÙ· ¿ÙÔÌ· Û˘Ó‹ıˆ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘‰È·‰Èηۛ·˜ ¤ÌÊڷ͢ ÙÔ˘ ·Ì·ÏÁ¿Ì·ÙÔ˜ ‹ ·Ì¤Ûˆ˜ ÌÂ-Ù¿. T· Û˘ÌÙÒÌ·Ù· ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ÛÙÔ ‰¤ÚÌ·Î·È ÛÙÔÓ ÛÙÔÌ·ÙÈÎfi ‚ÏÂÓÓÔÁfiÓÔ. T· Û˘ÌÙÒÌ·Ù· ÛÙÔ ‰¤Ú-Ì· Ô˘ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Â›Ó·È ÂÚ‡ıËÌ· Î·È ÂÍ¿Ó-ıËÌ· (urticarial rash) ÛÙÔ ÚfiÛˆÔ Î·È ÛÙ· ¿ÎÚ· (ÛÙËÓηÌÙÈ΋ ÙÔ˘˜ ÂÈÊ¿ÓÂÈ·) Î·È ÂÓÙÔ›˙ÔÓÙ·È ¿ÓÙ· ÛÙÔ ËÌÈ-ÌfiÚÈÔ Ô˘ Á›ÓÂÙ·È Ë ¤ÌÊÚ·ÍË11. OÍ›˜ ·ÓÙȉڿÛÂȘ ÛÙÔÓÛÙÔÌ·ÙÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Â›Ó·È ·ÎfiÌ· ÈÔ Û¿ÓȘ Î·È ÂÌ-Ê·Ó›˙ÔÓÙ·È ̂ ˜ Ê˘Û·Ï›‰Â˜ Ô˘ Ú‹ÁÓ˘ÓÙ·È Î·È Û¯ËÌ·Ù›˙Ô˘Ó‰È·‚ÚÒÛÂȘ27. T· Û˘ÌÙÒÌ·Ù· ·˘Ù¿ Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙Ô-ÓÙ·È Ì¤Û· Û ÌÂÚÈΤ˜ ÒÚ˜ ÌÂÙ¿ ÙËÓ ÙÔÔı¤ÙËÛË ‹ ·Ê·›-ÚÂÛË ÙÔ˘ ·Ì·ÏÁ¿Ì·ÙÔ˜ Î·È Û˘Ó‹ıˆ˜ ˘Ô¯ˆÚÔ‡Ó ¯ˆÚ›˜ıÂڷ›· Î·È ÂÍ·Ê·Ó›˙ÔÓÙ·È ‡ÛÙÂÚ· ·fi ÌÂÚÈΤ˜ Ë̤Ú˜28. °È· ÙËÓ ˘Ô¯ÒÚËÛË ÙˆÓ Û˘Ìو̿وÓ, Û ·ÓÙ›ıÂÛË ÌÂÙȘ ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ, ÔÈ ÂÌÊÚ¿ÍÂȘ ·Ì·ÏÁ¿Ì·-ÙÔ˜ ÌÔÚÔ‡Ó Ó· ·Ú·Ì›ÓÔ˘Ó ÛÙÔ ÛÙfiÌ· ÂÎÙfi˜ Î·È ·Ó Ù·Û˘ÌÙÒÌ·Ù· ÂÈ̤ÓÔ˘Ó29. AÓ ¯ÚÂÈ·ÛÙ› Ó· ·Ê·ÈÚÂıÔ‡ÓÔÈ ÂÌÊÚ¿ÍÂȘ ·Ì·ÏÁ¿Ì·ÙÔ˜ Â›Ó·È ··Ú·›ÙËÙË Ë ¯Ú‹ÛË·ÔÌÔÓˆÙ‹Ú·, Ô Î·Ù·ÈÔÓÈÛÌfi˜ ÓÂÚÔ‡, Ë ÈÛ¯˘Ú‹ ·Ó·Ú-ÚfiÊËÛË Î·È Ë ̄ ÔÚ‹ÁËÛË ·ÓÙÈÛÙ·ÌÈÓÈÎÒÓ ÚÈÓ ·fi ÙËÓ Â¤Ì-‚·ÛË30. ™ÙȘ ÔÍ›˜ ·˘Ù¤˜ ·ÓÙȉڿÛÂȘ ‰ÂÓ Û˘Ó›ÛÙ·Ù·È Ó·Á›ÓÂÈ ‰ÔÎÈÌ·Û›· ÂȉÂÚÌÈ΋˜ ¢·ÈÛıËÛ›·˜ ÂÂȉ‹ ‰ÂÓ ̄ ÚË-ÛÈ̇ÂÈ Û ٛÔÙ· ÛÙȘ ·ÏÏÂÚÁÈΤ˜ ·ÓÙȉڿÛÂȘ Ù‡Ô˘ I24.

¢IA°Nø™H TøN §EIXHNOEI¢øN ANTI¢PA™EøN

H ‰È¿ÁÓˆÛË ÙˆÓ ÏÂȯËÓÔÂȉÒÓ ·ÓÙȉڿÛÂˆÓ Î·ıÒ˜ Î·È Ë‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛ‹ ÙÔ˘˜ ·fi ·ÚfiÌÔȘ ·ÏÏÔÈÒÛÂȘ Á›-ÓÂÙ·È Ì ‚¿ÛË (3): ·) Ù· ÎÏÈÓÈο ̄ ·Ú·ÎÙËÚÈÛÙÈο, ‚) Ù· ÈÛÙÔ-ÏÔÁÈο Â˘Ú‹Ì·Ù· Î·È Á) Ì ‰ÔÎÈ̷ۛ˜ ÂȉÂÚÌÈ΋˜ ¢·È-ÛıËÛ›·˜.

epidermal sensitivity test is not required since it is not usefulin type I allergic reactions24.

DIAGNOSIS OF LICHENOID RECTIONS

Diagnosis of lichenoid reactions and differential diagnosisfrom similar lesions are based on3: a) clinical features, b)histological findings, and c) epicutaneous patch testing.

a. Clinical featuresClinical features of oral lichenoid reactions resemble thoseof oral lichen planus, and it is therefore necessary to excludethe possibility of oral lichenoid reactions when making adiagnosis of oral lichen planus. Oral lichen planus is aimmunologic response to stimuli such as viruses, bacteriaor drugs. T-lymphocytes activate a mechanism which leadsto apoptosis of the epithelium cells and formation of thelesions31. Although some authors32 do not differentiatethe two conditions, the majority supports that the twoconditions are distinct29, 30. In the past, lichenoid reactionswere described as “galvanic lesions” because it wasassumed that they were attributed to galvanic currentsassociated with the metal fillings. However, there is neitherclinical nor experimental evidence of this hypothesis, sothe term is no longer used in the international literature. Oral lichen planus is a more widespread condition involvingmany anatomical sections within the oral cavity and mayalso extend to the skin and genitalia differentiating this wayfrom the lichenoid reactions. Some forms of oral lichenplanus can be considered potentially malignant33, 34 suchas corrosive form (<5%)35. It is important, therefore forsubsequent management to be able to accurately diagnoseeach condition. Moreover, in oral lichen planus lesionsthere is no need for replacement of amalgam restorations36. Typically the clinical characteristics of both conditions mayinclude reticular white patches, papules, or plaques withor without erosions or ulcerated areas (Fig. 1-3). Recently,it has been reported a clinical case with black lesions37.Diagnosis of the lesion based solely on the clinical featuresis difficult because similar oral lesions may occur as a resultof other conditions, such as drug-related lichenoidreactions, autoimmune diseases or graft versus hostdisease (GVHD). Diagnosis is facilitated by detailed medicalhistory, clinical and immunohistological findings38. Lichenoid reactions caused by hypersensitivity to amalgamconstituents, usually have a clear anatomical relationshipto dental amalgam fillings24, are unilateral and notsymmetrical. In a recent study, it has been demonstratedthat old and corrosive amalgam restorations more frequentlystimulate lichenoid lesion formation39. They are mostcommonly appeared on the buccal mucosa and tonguewhere the mucosa is in contact with the restorations. Thegingivae, palate and floor of the mouth, which are in distancefrom the restorations, are rarely affected and the patientshardly ever have associated cutaneous symptoms39. Clinical features facilitate the differential diagnosis betweenlichenoid reactions, oral lichen planus, and other conditions,but in case of numerous and scattered amalgam resto-

Hellenic Stomatological Review 59: 35-49, 2015

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

·. KÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈοOÈ ‚Ï¿‚˜ ÙˆÓ ÏÂȯËÓÔÂȉÒÓ ·ÓÙȉڿÛˆÓ, fiˆ˜ ÚÔ·-ӷʤÚıËÎÂ, ÌÔÈ¿˙Ô˘Ó Ôχ Ì ·˘Ù¤˜ ÙÔ˘ ÔÌ·ÏÔ‡ ÏÂȯ‹-Ó· Î·È ¤ÙÛÈ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ·ÔÎÏÂÈÛÙ› Ë Èı·ÓfiÙË-Ù· ÙˆÓ ÏÂȯËÓÔÂȉÒÓ ·ÓÙȉڿÛˆÓ, fiÙ·Ó Á›ÓÂÙ·È ‰È¿ÁÓˆ-ÛË ÔÌ·ÏÔ‡ ÏÂȯ‹Ó·. O ÔÌ·Ïfi˜ ÏÂȯ‹Ó·˜ ·ÔÙÂÏ› ÌÈ· ·ÓÔ-ÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Û οÔÈÔ ÂÎÏ˘ÙÈÎfiÂÚ¤ıÈÛÌ· fiˆ˜ ÔÈ ÈÔ›, Ù· ‚·ÎÙ‹ÚÈ· ‹ ÔÚÈṲ̂ӷ Ê¿Ú̷η.M ÙË ‰È·ÌÂÛÔÏ¿‚ËÛË ÙˆÓ T-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÂÓÂÚÁÔ-ÔÈÂ›Ù·È ¤Ó·˜ ÔχÏÔÎÔ˜ Ì˯·ÓÈÛÌfi˜ Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ·fiÙˆÛË ÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙȘ ÂÚÈÔ¯¤˜ Ô˘ÂÌÊ·Ó›˙ÔÓÙ·È ÔÈ ‚Ï¿‚˜31. AÓ Î·È ÔÚÈṲ̂ÓÔÈ Û˘ÁÁÚ·Ê›˜˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰˘ÔÔÓÙÔًوÓ32, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ̆ ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÚfiÎÂÈÙ·ÈÁÈ· ‰˘Ô ‰È·ÊÔÚÂÙÈΤ˜ ηٷÛÙ¿ÛÂȘ29, 30. ¶·Ï·ÈfiÙÂÚ·, ÔÚÈ-Ṳ̂ÓÔÈ Û˘ÁÁÚ·Ê›˜ ÔÓfiÌ·˙·Ó ÙȘ ÏÂȯËÓÔÂȉ›˜ ‚Ï¿‚˜ ̂ ˜«Á·Ï‚·ÓÈΤ˜ ‚Ï¿‚˜», ÂÂȉ‹ ıˆÚÔ‡Û·Ó fiÙÈ ÔÊ›ÏÔÓÙ·ÈÛ Á·Ï‚·ÓÈο Ú‡̷ٷ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙȘ ÌÂÙ·ÏÏÈΤ˜ÂÌÊÚ¿ÍÂȘ. ŸÌˆ˜, ‰ÂÓ ˘¿Ú¯ÂÈ Ô‡Ù ÎÏÈÓÈ΋ Ô‡Ù ÂÈÚ·-Ì·ÙÈ΋ ·fi‰ÂÈÍË Ù˘ ˘fiıÂÛ˘ ·˘Ù‹˜, ÔfiÙÂ Ô fiÚÔ˜ ·˘-Ùfi˜ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ï¤ÔÓ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·.OÈ ‚Ï¿‚˜ ÙÔ˘ ÔÌ·ÏÔ‡ ÏÂȯ‹Ó· ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚˉȷÛÔÚ¿ Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÔÏϤ˜ ·Ó·ÙÔÌÈΤ˜ ÂÚÈÔ-¯¤˜ ÛÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ· Î·È Â›Û˘, ÌÔÚ› Ó· ÂÂ-ÎÙ›ÓÔÓÙ·È ÛÙÔ ‰¤ÚÌ· Î·È Ù· ÁÂÓÂÙÈο fiÚÁ·Ó· Î·È ¤ÙÛÈ ‰È·-ÊÔÚÔÔÈÔ‡ÓÙ·È ·fi ÙȘ ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ. EÂÈ-‰‹ ÔÚÈṲ̂Ó˜ ÌÔÚʤ˜ ÙÔ˘ ÔÌ·ÏÔ‡ ÏÂȯ‹Ó· ÌÔÚ› Ó· ıÂ-ˆÚËıÔ‡Ó ‰˘ÓËÙÈο ηÎÔ‹ıÂȘ33, 34, fiˆ˜ Ë ‰È·‚ÚˆÙÈ΋ÌÔÚÊ‹, ·Ó Î·È Ì Ôχ ÌÈÎÚ‹ Û˘¯ÓfiÙËÙ· ‰È·ÊÔÚÔÔ›ËÛ˘(<0.5%)35, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó Ú¤ÂÈ Ó· ›-Ó·È ·ÎÚÈ‚‹˜ Ë ‰È¿ÁÓˆÛ‹ ÙÔ˘˜. EÈϤÔÓ, ¤Ó·˜ ·ÎfiÌ· Ïfi-ÁÔ˜ ÁÈ· ‰È·ÊÔÚԉȿÁÓˆÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÓÙÔÙ‹ÙˆÓ Â›-Ó·È Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ÔÌ·ÏÔ‡ ÏÂÈ-¯‹Ó· ‰ÂÓ ̄ ÚÂÈ¿˙ÂÙ·È ·ÓÙÈηٿÛÙ·ÛË ÙˆÓ ÂÌÊÚ¿ÍÂˆÓ ·Ì·Ï-Á¿Ì·ÙÔ˜36. KÏÈÓÈο ÙfiÛÔ Ô ÔÌ·Ïfi˜ ÏÂȯ‹Ó·˜ fiÛÔ Î·È ÔÈ ÏÂȯËÓÔÂÈ-‰Â›˜ ·ÓÙȉڿÛÂȘ ÂÌÊ·Ó›˙Ô˘Ó Ï¢Τ˜ ‚Ï·Ù›‰Â˜ Ì ÙË ÌÔÚ-Ê‹ ‰ÈÎÙ‡Ô˘ ‹ ϿΘ Ì ‹ ̄ ˆÚ›˜ ‰È·‚ÚÒÛÂȘ, ÂÍÂÏÎÒÛÂȘ‹ ·ÎfiÌ· Î·È ÂÏÎÒÛÂȘ (EÈÎ. 1-3). ¶ÚfiÛÊ·Ù· ¤¯ÂÈ ·Ó·ÊÂÚıÂ›Î·È ÎÏÈÓÈ΋ ÂÚ›ÙˆÛË Ì ÌÂÏ·Ó¤˜ ·ÏÏÔÈÒÛÂȘ37. H ‰È¿-ÁÓˆÛË Ù˘ ‚Ï¿‚˘ ÎÏÈÓÈο Â›Ó·È ‰‡ÛÎÔÏË ÂÂȉ‹ ·Úfi-ÌÔȘ ÂΉËÏÒÛÂȘ ·fi ÙÔ ÛÙfiÌ· Â›Ó·È ‰˘Ó·Ùfi Ó· ÂΉË-ψıÔ‡Ó Î·È ·fi ¿ÏϘ ηٷÛÙ¿ÛÂȘ, fiˆ˜ ·fi ÔÚÈṲ̂-Ó· Ê¿Ú̷η, ·fi ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· ‹ ·fi ·Û˘Ì‚·-ÙfiÙËÙ· ÌÔۯ‡̷ÙÔ˜. H ‰È¿ÁÓˆÛË ÌÔÚ› Ó· ‰È¢ÎÔÏ˘Óı›·fi ÙË Ï‹„Ë ÏÂÙÔÌÂÚÔ‡˜ ÈÛÙÔÚÈÎÔ‡ ηıÒ˜ Î·È ·fi ÎÏÈ-ÓÈο ·ÓÔÛÔÏÔÁÈο Î·È ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù·38.OÈ ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ̆ Â-Ú¢·ÈÛıËÛ›· ÛÙ· Û˘ÛÙ·ÙÈο ÙÔ˘ ·Ì·ÏÁ¿Ì·ÙÔ˜ Û˘Ó‹ıˆ˜¤¯Ô˘Ó Û·Ê‹ ·Ó·ÙÔÌÈ΋ Û¯¤ÛË Ì ÙȘ ÂÌÊÚ¿ÍÂȘ ·Ì·ÏÁ¿-Ì·ÙÔ˜24, ‚Ú›ÛÎÔÓÙ·È ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÏÂ˘Ú¿ Î·È ‰ÂÓÂ›Ó·È Û˘ÌÌÂÙÚÈΤ˜. Œ¯ÂÈ ‚ÚÂı› fiÙÈ Ë ÂÌÊ¿ÓÈÛË ÙˆÓ ÏÂÈ-¯ËÓÔÂȉÒÓ ·ÓÙȉڿÛÂˆÓ Â›Ó·È Û˘¯ÓfiÙÂÚ˜ fiÙ·Ó ‚Ú›ÛÎÔ-ÓÙ·È Û ·ʋ Ì ·ÏȤ˜ Î·È ‰È·‚ڈ̤Ó˜ ÂÌÊÚ¿ÍÂȘ ·Ì·Ï-Á¿Ì·ÙÔ˜ ·Ú¿ Û Ӥ˜ Î·È ·Î¤Ú·È˜39. ™˘Ó‹ıˆ˜ ‚Ú›ÛÎÔ-ÓÙ·È ÛÙÔ ‚ÏÂÓÓÔÁfiÓÔ Ù˘ ·ÚÂÈ¿˜ Î·È Ù˘ ÁÏÒÛÛ·˜, fiÔ˘Ô ‚ÏÂÓÓÔÁfiÓÔ˜ ‚Ú›ÛÎÂÙ·È Û ÛÙÂÓ‹ ·ʋ Ì ÙȘ ÂÌÊÚ¿-ÍÂȘ. T· ԇϷ, Ë ˘ÂÚÒ· Î·È ÙÔ ¤‰·ÊÔ˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜,

EÈÎ. 1. §ÂȯËÓÔÂȉ‹˜ ·ÏÏÔ›ˆÛË ÛÙË ‰ÂÍÈ¿ ·ÚÂÈ¿ Û ¿Ó‰Ú· ·ÛıÂ-Ó‹ 49 ÂÙÒÓ (·fi ÙÔ ÊˆÙÔÁÚ·ÊÈÎfi ·Ú¯Â›Ô ÙÔ˘ EÚÁ·ÛÙËÚ›Ô˘ ™ÙÔ-Ì·ÙÔÏÔÁ›·˜ ÙÔ˘ AÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙ‹ÌÈÔ˘ £ÂÛÛ·ÏÔӛ΢).

Fig. 1: Lichenoid lesion located at the right buccal mucosa of a49-year old man (from archives of Department of Stomatology ofAristotle University of Thessaloniki).

EÈÎ. 3. §ÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ Û ·ÚÂÈ¿ Î·È ÁÏÒÛÛ· ·ÚÈ-ÛÙÂÚ¿ Û ¿Ó‰Ú· ·ÛıÂÓ‹ 75 ÂÙÒÓ (·fi ÙÔ ÊˆÙÔÁÚ·ÊÈÎfi ·Ú¯Â›ÔÙÔ˘ EÚÁ·ÛÙËÚ›Ô˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ ÙÔ˘ AÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈ-ÛÙ‹ÌÈÔ˘ £ÂÛÛ·ÏÔӛ΢).

Fig. 2: Lichenoid lesions located at the buccal mucosa and tongueof a 75-year old man (from archives of Department of Stomatologyof Aristotle University of Thessaloniki).

Hellenic Stomatological Review 59: 35-49, 2015

EÈÎ. 2. §ÂȯËÓÔÂȉ‹˜ ·ÏÏÔ›ˆÛË ÛÙËÓ ·ÚÈÛÙÂÚ‹ ·ÚÂÈ¿ ÛÙÔÓ ›‰ÈÔ¿Ó‰Ú· ·ÛıÂÓ‹ 49 ÂÙÒÓ (·fi ÙÔ ÊˆÙÔÁÚ·ÊÈÎfi ·Ú¯Â›Ô ÙÔ˘ EÚÁ·-ÛÙËÚ›Ô˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ ÙÔ˘ AÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙ‹ÌÈÔ˘ £ÂÛ-Û·ÏÔӛ΢).

Fig. 2: Lichenoid lesion located at the left buccal mucosa of a 49-year old man (from archives of Department of Stomatology ofAristotle University of Thessaloniki).

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

ÂÂȉ‹ ‚Ú›ÛÎÔÓÙ·È Û ·fiÛÙ·ÛË ·fi ÙȘ ÂÌÊÚ¿ÍÂȘ Û¿-ÓÈ· ÂÌÊ·Ó›˙Ô˘Ó ·ÓÙȉڿÛÂȘ Î·È ÔÈ ·ÛıÂÓ›˜ ۯ‰fiÓ Ô-Ù¤ ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ÂΉËÏÒÛÂȘ ·fi ÙÔ ‰¤ÚÌ·39.T· ÎÏÈÓÈο ·˘Ù¿ ¯·Ú·ÎÙËÚÈÛÙÈο ‚ÔËıÔ‡Ó ÛÙË ‰È·ÊÔÚÈ΋‰È¿ÁÓˆÛË ÙˆÓ ÏÂȯËÓÔÂȉÒÓ ·ÓÙȉڿÛÂˆÓ ·fi ÙÔÓ ÔÌ·-Ïfi ÏÂȯ‹Ó· Î·È ·fi ¿ÏϘ ηٷÛÙ¿ÛÂȘ, ·ÏÏ¿ Â›Ó·È ‰‡ÛÎÔÏÔÓ· Á›ÓÂÈ ·ÎÚÈ‚‹˜ ‰È¿ÁÓˆÛË fiÙ·Ó ÔÈ ÂÌÊÚ¿ÍÂȘ ·Ì·ÏÁ¿Ì·-ÙÔ˜ Â›Ó·È ÔÏϤ˜ Î·È Û ‰È¿ÊÔÚ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜.

‚. IÛÙÔ·ıÔÏÔÁÈ΋ ÂͤٷÛË ™ÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË Â›Ó·È Û˘ÓËıÈṲ̂ÓË Ë Ï‹„Ë ‚ÈÔ„›·˜ ÂÚ˘-ıÚÒÓ Î·È Ï¢ÎÒÓ ·ÏÏÔÈÒÛÂˆÓ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ÒÛÙ ӷ ‚ÔË-ıËı› Ë ‰È¿ÁÓˆÛË40 Î·È Ó· ·ÔÎÏÂÈÛÙ› Ë Èı·ÓfiÙËÙ· η-ÎÔ‹ıÔ˘˜ ÂÍ·ÏÏ·Á‹˜ ·Ó ÚfiÎÂÈÙ·È ÁÈ· ÌÔÚÊ‹ ÔÌ·ÏÔ‡ ÏÂÈ-¯‹Ó·41. O fiÚÔ˜ «ÏÂȯËÓÔÂȉ‹˜ ÈÛÙÈ΋ ·ÓÙ›‰Ú·ÛË» (lichenoidtissue reaction) ÂÈÛ‹¯ıË ·fi ÙÔÓ Pinkus42 ÙÔ 1973 ÁÈ· Ó·ÂÚÈÁÚ¿„ÂÈ ÙÔÓ ÈÛÙÔÏÔÁÈÎfi Ù‡Ô Ô˘ ̄ ·Ú·ÎÙËÚ›˙ÂÙ·È ·fi‚Ï¿‚Ë ÙˆÓ ÎÂÚ·ÙÈÓÔ΢ÙÙ¿ÚˆÓ, ‰È‹ıËÛË ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ÈÛÙÔ‡ ·fi ÊÏÂÁÌÔÓÒ‰Ë Î‡ÙÙ·Ú·, Ù· ÔÔ›· ÌÔÚ› Ó· ÂÂ-ÎÙ›ÓÔÓÙ·È Ì¤Û· ÛÙÔ ÂÈı‹ÏÈÔ Î·È ·ÚÔ˘Û›· ÎÂÚ¿ÙˆÛ˘ ‹˘ÂÚÎÂÚ¿ÙˆÛ˘. O ›‰ÈÔ˜ ÂÚ¢ÓËÙ‹˜ ·Ú·Ù‹ÚËÛ fiÙÈ ÔÈÛÙÔ·ıÔÏÔÁÈÎfi˜ ·˘Ùfi˜ Ù‡Ô˜ ‹Ù·Ó ÎÔÈÓfi˜ Û ‰È¿ÊÔÚ˜ÓfiÛÔ˘˜ Ô˘ ‹‰Ë ·Ó·Ê¤ÚıËÎ·Ó Î·È ‰ÂÓ ·ÔÙÂÏÔ‡Û ȉÈ-·›ÙÂÚË ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ·.H ÈÛÙÔ·ıÔÏÔÁÈ΋ ÂÈÎfiÓ· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÛÙȷ΋ ˘ÂÚ·-οÓıˆÛË Î·È ˘ÂÚÎfiÎΈÛË ÌÂ Û˘ÓÔ‰‹ ˘ÂÚÎÂÚ¿ÙˆÛË ‹·Ú·ÎÂÚ¿ÙˆÛË ÛÙËÓ ÂÈÔÏ‹˜ ÛÙÈ‚¿‰·. ™ÙȘ ‚·ı‡ÙÂÚ˜ÛÙÈ‚¿‰Â˜ ·Ú·ÙËÚÔ‡ÓÙ·È Ù· ÎÔÏÏÔÂȉ‹ ۈ̿ÙÈ·, Ô˘ ›-Ó·È ÂÎÊ˘ÏÈṲ̂ӷ ÎÂÚ·ÙÈÓÔ·ÙÙ·Ú· Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ˆ˜¿ÌÔÚÊ· ˈÛËÓfiÊÈÏ· ۈ̿ÙÈ·, ÁÓˆÛÙ¿ Î·È ˆ˜ ۈ̿ÙÈ·Civatte ‹ ۈ̿ÙÈ· Saboraud ‹ ۈ̿ÙÈ· ̆ ·Ï›Ó˘. ™ÙË ‚·-ÛÈ΋ ÛÙÈ‚¿‰· ·Ú·ÙËÚÂ›Ù·È ̆ ÁÚÔÔ›ËÛË ÙˆÓ ‚·ÛÈÎÒÓ Î˘Ù-Ù¿ÚˆÓ. ™ÙË ıËÏÒ‰Ë ÌÔ›Ú· ÙÔ˘ ¯ÔÚ›Ô˘ ·Ú·ÙËÚÂ›Ù·È ˘-ÎÓ‹ ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ Î·È ÈÛÙÈÔ΢ÙÙ·ÚÈ΋ ‰È‹ıËÛË. ™¿-ÓÈ· ÌÔÚ› Ó· ·Ú·ÙËÚËı› ·ÒÏÂÈ· ‹ ·ÙÚÔÊ›· ÙÔ˘ ÂÈ-ıËÏ›Ô˘38 (EÈÎ. 4 Î·È 5).

rations an accurate diagnosis can be proved challenging.

b. Histopathological examinationIn clinical practice it is common to obtain a biopsy fromred and white oral lesions to facilitate diagnosis40 and toexclude the possibility of malignancy in case of oral lichenplanus41. The term “lichenoid tissue reaction” wasintroduced by Pinkus42 in 1973 to describe a histologicaltype characterized by damage of keratinocytes, infiltrationof the connective tissue by inflammatory cells, which mayextend inside the epithelium and the presence of keratosisor hyperkeratosis. The same researcher observed that thishistopathological type was common in various diseases,already described, and it was not a particular clinical entity. Histopathological features include hyperakanthosis,hyperkeratosis and parakeratosis detected in superficiallayer. In deeper layers colloid particles called Civate orSaboraud or hyaloid particles may be observed. In basallayer there is liquefaction of the basal cells, while in papillarydermis infiltration of lymphocytes and mast cells can bedetected. In rare cases loss or atrophy of epithelium maybe occurred38 (Fig. 4 and 5). It has been suggested that the subepithelial infiltration ofvarious cell types as well as their deeper and widespreaddistribution, may help to identify a lichenoid lesion29.However, Neville et al.38 argued that histologically there areno significant differences between lichenoid reactions andoral lichen planus. In addition, the differential diagnosisbetween the two entities is very difficult based solely onhistological criteria and for this reason detailed medicalhistory and clinical examination should also be considered24,

43. These difficulties are derived from the activity of thedisease, which varies over time, resulting in a wide rangeof possible histopathological images observed both inlichenoid reactions and oral lichen planus24. The same authors24 suggested specific histopathologic

41

EÈÎ. 4. IÛÙÔ·ıÔÏÔÁÈ΋ ÂÈÎfiÓ· ÏÂȯËÓÔÂȉԇ˜ ·ÏÏÔ›ˆÛ˘ (·fiÙÔ ÊˆÙÔÁÚ·ÊÈÎfi ·Ú¯Â›Ô ÙÔ˘ EÚÁ·ÛÙËÚ›Ô˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ ÙÔ˘AÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙ‹ÌÈÔ˘ £ÂÛÛ·ÏÔӛ΢).

Fig. 4:Histopathological characteristics of a lichenoid lesion (Archivesof Department of Stomatology of Aristotle University of Thessaloniki).

EÈÎ. 5. IÛÙÔ·ıÔÏÔÁÈ΋ ÂÈÎfiÓ· ÏÂȯËÓÔÂȉԇ˜ ·ÏÏÔ›ˆÛ˘ (·fiÙÔ ÊˆÙÔÁÚ·ÊÈÎfi ·Ú¯Â›Ô ÙÔ˘ EÚÁ·ÛÙËÚ›Ô˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ ÙÔ˘AÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙ‹ÌÈÔ˘ £ÂÛÛ·ÏÔӛ΢).

Fig. 4:Histopathological characteristics of a lichenoid lesion (Archivesof Department of Stomatology of Aristotle University of Thessaloniki).

Hellenic Stomatological Review 59: 35-49, 2015

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

Hellenic Stomatological Review 59: 35-49, 2015

Œ¯ÂÈ ˘ÔÛÙËÚȯı› fiÙÈ Ë ˘ÔÂÈıËÏȷ΋ ‰È‹ıËÛË ‰È·Êfi-ÚˆÓ Ù‡ˆÓ ΢ÙÙ¿ÚˆÓ Î·ıÒ˜ Î·È Ë ‚·ı‡ÙÂÚË Î·È ‰È¿¯˘ÙËηٷÓÔÌ‹ ÙÔ˘˜, ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙÔÓ ÚÔÛ‰ÈÔÚÈ-ÛÌfi ÌÈ·˜ ÏÂȯËÓÔÂȉԇ˜ ·ÏÏÔ›ˆÛ˘29. ¶¿ÓÙˆ˜, ÔÈ Nevilleet al.38 ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÍÈÔÛËÌ›ˆÙ˜ÈÛÙÔ·ıÔÏÔÁÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÏÂȯËÓÔÂȉԇ˜ ‚Ï¿-‚˘ Î·È ÔÌ·ÏÔ‡ ÏÂȯ‹Ó·. º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ Ë ‰È·ÊÔÚÈ-΋ ‰È¿ÁÓˆÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÓÙÔÙ‹ÙˆÓ Â›Ó·È Ôχ ‰‡-ÛÎÔÏË Ì ηı·Ú¿ ÈÛÙÔÏÔÁÈο ÎÚÈÙ‹ÚÈ· Î·È ÁÈ· ÙÔ ÏfiÁÔ·˘Ùfi Ë ‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂÙÔ ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË24, 43. OÈ ‰˘ÛÎÔϛ˜ ·˘-Ù¤˜ ÔÊ›ÏÔÓÙ·È ÛÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ÓfiÛÔ˘, Ë ÔÔ›· ÌÂ-Ù·‚¿ÏÏÂÙ·È Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ̄ ÚfiÓÔ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ó·Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÌÊ·ÓÈÛı› ¤Ó· ¢ڇ Ê¿ÛÌ· ÈÛÙÔ·ıÔ-ÏÔÁÈ΋˜ ÂÈÎfiÓ·˜, Ô˘ ÌÔÚ› Ó· ·Ú·ÙËÚËı› ÙfiÛÔ ÛÙȘÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ fiÛÔ Î·È ÛÙÔÓ ÔÌ·Ïfi ÏÂȯ‹Ó·24.OÈ ›‰ÈÔÈ ÂÚ¢ÓËÙ¤˜24 ÚfiÙÂÈÓ·Ó Û˘ÁÎÂÎÚÈ̤ӷ ÈÛÙÔ·ıÔ-ÏÔÁÈο Â˘Ú‹Ì·Ù· Ù· ÔÔ›· ÌÔÚÔ‡Ó Ó· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙˉȿÁÓˆÛË ÙˆÓ ÏÂȯËÓÔÂȉÒÓ ·ÏÏÔÈÒÛˆÓ, Ù· ÔÔ›· ›ӷÈË ÊÏÂÁÌÔÓ҉˘ ‰È‹ıËÛË, Ë ÔÔ›· ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ‚¿ıÔ˜Ù˘ ·ÏÏÔ›ˆÛ˘ ÙÔÈο ‹ Û fiÏË ÙËÓ ¤ÎÙ·ÛË Ù˘ ‚Ï¿‚˘, ËÂÛÙȷ΋ ÂÚÈ·ÁÁÂȷ΋ ‰È‹ıËÛË Î·È Ë ·ÚÔ˘Û›· Ï·ÛÌ·-ÙÔ΢ÙÙ¿ÚˆÓ Î·È ‚·ÛÂfiÊÈÏˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ Û˘Ó‰ÂÙÈÎfi ÈÛÙfi. OÈ Al-Hashimi et al.44 ıˆÚÔ‡Ó fiÙÈ Ë ÈÛÙÔ·ıÔÏÔÁÈ΋ Âͤ-Ù·ÛË ‰ÂÓ Â›Ó·È ··Ú·›ÙËÙË Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÏÂÈ-¯ËÓÔÂȉԇ˜ ·ÓÙ›‰Ú·Û˘, ÂÎÙfi˜ ·fi ÙȘ ÂÚÈÙÒÛÂȘ fiÔ˘Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Â›Ó·È ¿Ù˘Ë, Ì ÛÎÔfi Ó· ·ÔÎÏÂÈÛÙ› ËÂÚ›ÙˆÛË ÚÔηÚÎÈÓÈ΋˜ ÌÔÚÊ‹˜ (‰È·‚ÚˆÙÈ΋˜) ÔÌ·ÏÔ‡ÏÂȯ‹Ó·. AÓÙ›ıÂÙ· ÔÈ Cobos-Fuentes et al.45 ˘ÔÛÙËÚ›˙Ô˘ÓfiÙÈ Ë ÈÛÙÔ·ıÔÏÔÁÈ΋ ÂͤٷÛË ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û fiϘÙȘ ÂÚÈÙÒÛÂȘ, Ì ÛÎÔfi fi¯È ÌfiÓÔ ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ηÎÔ‹ıÂÈ·˜, ·ÏÏ¿ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ ¿ÏÏ· Â˘Ú‹Ì·Ù· Ó·Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÙÂÏÈ΋ ‰È¿ÁÓˆÛË Ù˘ ·ÏÏÔ›ˆÛ˘. ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ Èı·ÓfiÙËÙ· ηÎÔ‹ıÔ˘˜ ÂÍ·ÏÏ·Á‹˜ ÙˆÓÏÂȯËÓÔÂȉÒÓ ·ÓÙȉڿÛˆÓ, ÔÚÈṲ̂ÓÔÈ ÂÚ¢ÓËÙ¤˜ ˘Ô-ÛÙËÚ›˙Ô˘Ó ˆ˜ ÔÈ ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ fi¯È ÌfiÓÔ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ˘ÔÛÙÔ‡Ó Î·ÎÔ‹ıË ÂÍ·ÏÏ·Á‹,·ÏÏ¿ Î·È Ì ÌÂÁ·Ï‡ÙÂÚ˜ Èı·ÓfiÙËÙ˜ ·fi ÙÔÓ ÔÌ·Ïfi ÏÂÈ-¯‹Ó·46. OÈ Mares et al.47 Û ÌÈ· ÚfiÛÊ·ÙË ÎÏÈÓÈ΋ ÌÂϤÙË,fiÔ˘ ·Ú·ÎÔÏÔ‡ıËÛ·Ó 8 ·ÛıÂÓ›˜ Ì ÔÌ·Ïfi ÏÂȯ‹Ó·Î·È 24 Ì ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ, ÌÂÙ¿ ·fi 164 Ì‹Ó˜ÛÙËÓ Â·ÓÂͤٷÛË ÂÓÙfiÈÛ·Ó Î·ÎÔ‹ıË ÂÍ·ÏÏ·Á‹ ÙˆÓ ‚Ï·-‚ÒÓ ÌfiÓÔ Û 2 ·ÛıÂÓ›˜ Ì ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ. T··ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Â›Ó·È ·ÚfiÌÔÈ· Ì ÙË ÌÂϤÙË ÙˆÓ vander Meij et al.34. ™Â ÌÈ· ÚfiÛÊ·ÙË Û˘ÛÙËÌ·ÙÈ΋ ·Ó·ÛÎfi-ËÛË48, fiÔ˘ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó 16 ÎÏÈÓÈΤ˜ ÌÂϤÙ˜, ·fiÙÔ˘˜ 7806 ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘Û›·˙·Ó ‚Ï¿‚˜ ÔÌ·ÏÔ‡ ÏÂÈ-¯‹Ó·, ÛÙÔ˘˜ 85 ÂÓÙÔ›ÛÙËΠηÎÔ‹ı˘ ÂÍ·ÏÏ·Á‹ (1,09%),ÂÓÒ ÌÂٷ͇ 125 ·ÛıÂÓÒÓ Ì ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ ÔÈ4 ·ÚÔ˘Û›·Û·Ó ηÎÔ‹ıË ÂÍ·ÏÏ·Á‹ (3,2%).

Á. ¢ÔÎÈ̷ۛ˜ ÂȉÂÚÌÈ΋˜ ¢·ÈÛıËÛ›·˜ (Patch testing)¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÂȉÂÚÌÈΤ˜ ‰ÔÎÈ̷ۛ˜ Â›Ó·È ̄ Ú‹-ÛÈ̘ ÁÈ· ÙË ‰È·›ÛÙˆÛË Ù˘ ¢·ÈÛıËÛ›·˜ ÛÙÔ ·Ì¿ÏÁ·-Ì· ‹ ÛÙÔÓ Hg, ˘¿Ú¯ÂÈ ·ÌÊÈÛ‚‹ÙËÛË fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘˜24. H ·ÌÊÈÛ‚‹ÙËÛË ·˘Ù‹ ÔÊ›-ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ·ÔÙÂϤÛÌ·Ù· ÔÏÏÒÓ ÂȉÂÚ-ÌÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÛÙÔ ·ÚÂÏ-

findings which should contribute to the diagnosis oflichenoid reactions such as inflammatory infiltration locatedin the deeper layers of the lesion locally or throughoutthe lesion, focal perivascular infiltration and presence ofplasma cells and mast cells through the connective tissue.Al-Hashimi et al.44 supported that histopathologicalexamination is not necessary for every case of lichenoidlesion, except when the clinical features are atypical inorder to exclude the possibility of the precancerous(corrosive) form of oral lichen planus. On the contrary,Cobos-Fuentes et al.45 demonstrated that histopathologicalexamination must be performed in all cases, not only torule out the possibility of malignancy, but also to contributein combination with other findings to the final diagnosisof the lesion. It has been reported that patients with lichenoid reactionsmay be more prone to malignant alteration in comparisonto oral lichen planus46. Mares et al.47 in a recent clinicalstudy reported that among 8 patients with diagnosed orallichen planus and 24 patients with diagnosed lichenoidreactions only 2 patients presented oral cancer after 164months mean follow-up. These results correlate with thoseof Van Der Meij et al.34. Moreover, in a recent systematicreview48, where sixteen studies were eligible, among 7,806patients with oral lichen planus, 85 developed squamouscell carcinoma (1,09%) while among 125 patients with orallichenoid reactions, four developed squamous cellcarcinoma (3.2%).

c. Epicutaneous sensitivity testing (Patch testing)Even though patch tests are useful in detecting sensitivityto amalgam or Hg, their effectiveness is dubious24. Thisis due to the fact that the results of many patch tests carriedout in the past did not decisively help differential diagnosisbetween oral lichen planus and lichenoid reactions. Ithas also been found that clinical diagnosis is more effectivethan patch tests49.Patch testing should be carried out in dermatologic centersusing specific preparations available on the market, whichare placed on the skin of the back or the forearm and keptfor 48 hours using hypoallergenic adhesive tape. The testis considered positive when erythema or eczema forms50.There is no general consensus regarding the type ofallergens that should be used in patch tests. However theuse of 5% amalgam and 1% ammonium mercury (HgNH4)is generally considered to be suitable. The results are usuallyrecorded after 48 or 72 hours, but it has been proven thateven after 10-14 days positive reactions can be detectedthat had been missed in the initial control51, 52.Skin test is preferable to oral mucosa because theprocedure is simpler and has higher sensitivity andspecificity11. Furthermore, the concentration of the allergenrequired to induce a reaction on oral mucosa is 5-12 timesgreater than that needed to induce reaction on the skin,resulting in a risk of toxic reaction in the mucosa11.Based on clinical characteristics, the cases which a patchtest may be required are20: a) the presence of lesions inthe oral mucosa resembling oral lichen planus or inflam-

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

ıfiÓ, ‰ÂÓ ‚Ô‹ıËÛ·Ó Î·ıÔÚÈÛÙÈο ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆ-ÛË ÙÔ˘ ÔÌ·ÏÔ‡ ÏÂȯ‹Ó· ·fi ÙȘ ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿ-ÛÂȘ. ™Â ÌÈ· ÎÏÈÓÈ΋ ÌÂϤÙË49 ‚Ú¤ıËΠfiÙÈ Ë ÎÏÈÓÈ΋ ‰È¿-ÁÓˆÛË Â›Ó·È ÈÔ ·ÍÈfiÈÛÙË Ì¤ıÔ‰Ô˜ ·fi ÙȘ ‰ÔÎÈ̷ۛ˜ÂȉÂÚÌÈ΋˜ ¢·ÈÛıËÛ›·˜ Û¯ÂÙÈο Ì ÙËÓ ·fiÊ·ÛË ÁÈ··ÓÙÈηٿÛÙ·ÛË ÙˆÓ ÂÌÊÚ¿ÍÂˆÓ ·Ì·ÏÁ¿Ì·ÙÔ˜.OÈ ÂȉÂÚÌÈΤ˜ ‰ÔÎÈ̷ۛ˜ Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È Û ÂȉÈο‰ÂÚÌ·ÙÔÏÔÁÈο ΤÓÙÚ· Î·È Ó· Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·È Ì ÂÈ-‰Èο Û΢¿ÛÌ·Ù· Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó ÛÙÔ ÂÌfiÚÈÔ, Ù· ÔÔ›·ÙÔÔıÂÙÔ‡ÓÙ·È ÛÙÔ ‰¤ÚÌ· Ù˘ Ï¿Ù˘ ‹ ÛÙÔÓ ‹¯Ë Î·È ·-ڷ̤ÓÔ˘Ó ÁÈ· 48 ÒÚ˜ Ì ÙË ‚Ô‹ıÂÈ· ˘Ô·ÏÏÂÚÁÈÎÒÓÛ˘ÁÎÔÏÏËÙÈÎÒÓ Ù·ÈÓÈÒÓ. H ÂȉÂÚÌÈ΋ ·ÓÙ›‰Ú·ÛË ıˆ-ÚÂ›Ù·È ıÂÙÈ΋ fiÙ·Ó Û¯ËÌ·Ù›˙ÂÙ·È ÂÚ‡ıËÌ· ‹ ¤Î˙ÂÌ·50.¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ̆ ¿Ú¯ÂÈ ÁÂÓÈ΋ ÔÌÔʈӛ· ÁÈ· ÙÔ›‰Ô˜ ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Ô˘ Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡-ÓÙ·È ÛÙȘ ÂȉÂÚÌÈΤ˜ ‰ÔÎÈ̷ۛ˜, Ë ̄ Ú‹ÛË Û΢·ÛÌ¿ÙˆÓ5% ·Ì·ÏÁ¿Ì·ÙÔ˜ Î·È 1% ·Ì̈ÓÈÔ‡¯Ô˘ ˘‰Ú·ÚÁ‡ÚÔ˘(HgNH4) ıˆÚÂ›Ù·È ÁÂÓÈο fiÙÈ Â›Ó·È Î·Ù¿ÏÏËÏË ÁÈ· ÙË ‰Ô-ÎÈÌ·Û›· ·˘Ù‹. T· ·ÔÙÂϤÛÌ·Ù· Û˘Ó‹ıˆ˜ ÂϤÁ¯ÔÓÙ·È ÌÂ-Ù¿ ·fi 48 ‹ 72 ÒÚ˜, ·ÏÏ¿ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ ¤ÏÂÁ¯Ô˜‡ÛÙÂÚ· ·fi 10-14 Ë̤Ú˜ ÌÔÚ› Ó· ÂÓÙÔ›ÛÂÈ ıÂÙÈΤ˜·ÓÙȉڿÛÂȘ Ô˘ ‰È¤Ê˘Á·Ó ·fi ÙÔÓ ·Ú¯ÈÎfi ¤ÏÂÁ¯Ô51, 52. H ÂȉÂÚÌÈ΋ ‰ÔÎÈÌ·Û›· ÚÔÙÈÌ¿Ù·È ·fi ÙË ‰ÔÎÈÌ·Û›· ÛÙÔ‚ÏÂÓÓÔÁfiÓÔ ÂÍ·ÈÙ›·˜ ÙÔ˘ fiÙÈ Ë ‰È·‰Èηۛ· Â›Ó·È ·ÏÔ‡-ÛÙÂÚË Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ·Ï‡ÙÂÚË Â˘·ÈÛıËÛ›· Î·È ÂȉÈ-ÎfiÙËÙ·11. E›Û˘, Ë ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ·ÏÏÂÚÁÈÔÁfiÓÔ˘ÛÙÔ ‚ÏÂÓÓÔÁfiÓÔ Ú¤ÂÈ Ó· Â›Ó·È 5-12 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË·fi ·˘Ù‹ Ô˘ ̄ ÚÂÈ¿˙ÂÙ·È ÁÈ· Ó· ÚÔÎÏËı› ·ÓÙ›‰Ú·ÛË ÛÙÔ‰¤ÚÌ·, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ Ó· ·Ó·Ù˘-¯ı› ÙÔÍÈ΋ ·ÓÙ›‰Ú·ÛË ·fi ÙÔ ‚ÏÂÓÓÔÁfiÓÔ11. M ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÔÈ Î·Ù·ÛÙ¿ÛÂȘ ÛÙȘ Ôԛ˜ÌÔÚ› Ó· ˙ËÙËı› ·fi ¤Ó·Ó ·ÛıÂÓ‹ Ó· οÓÂÈ ÂȉÂÚÌÈ΋‰ÔÎÈÌ·Û›· ¢·ÈÛıËÛ›·˜ Â›Ó·È ÔÈ ÂÍ‹˜20: ·) Ë ·ÚÔ˘Û›· ‚Ï·-‚ÒÓ ÛÙÔ ÛÙÔÌ·ÙÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Ì ÙË ÌÔÚÊ‹ ÙÔ˘ ÔÌ·ÏÔ‡ÏÂȯ‹Ó· ‹ ÊÏÂÁÌÔÓ‹˜ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Ô˘ ‰ÂÓ ˘Ô¯ˆ-ÚÔ‡Ó ‡ÛÙÂÚ· ·fi ıÂڷ›·, ‚) Ë Û·Ê‹˜ ·Ó·ÙÔÌÈ΋ Û¯¤-ÛË ÌÂٷ͇ Ù˘ ‚Ï¿‚˘ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È Ù˘ ‡ÔÙ˘¤ÌÊڷ͢ Î·È Á) fiÙ·Ó ÔÈ ‚Ï¿‚˜ ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó Û˘ÌÌÂ-ÙÚ›· ÛÙȘ ‰˘Ô Ï¢ڤ˜.H ϤÔÓ ÈÛ¯˘Ú‹ ¤Ó‰ÂÈÍË ÁÈ· ÙË ‰È¿ÁÓˆÛË ÌÈ·˜ ÏÂȯËÓÔÂÈ-‰Ô‡˜ ‚Ï¿‚˘ Â›Ó·È Ë ÛÙÂÓ‹ ·Ó·ÙÔÌÈ΋ Û¯¤ÛË Ù˘ Ì ÂÌ-ÊÚ¿ÍÂȘ ·Ì·ÏÁ¿Ì·ÙÔ˜. Œ¯ÂÈ ‚ÚÂı› fiÙÈ ÙÔ 70% ÙˆÓ ·ÛıÂ-ÓÒÓ Ì ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ̆ ¿Ú-¯ÂÈ ÛÙÂÓ‹ ·Ó·ÙÔÌÈ΋ Û¯¤ÛË ÌÂٷ͇ Ù˘ ‚Ï¿‚˘ Î·È ÙÔ˘·Ì·ÏÁ¿Ì·ÙÔ˜, ÂÌÊ¿ÓÈÛ·Ó ıÂÙÈ΋ ·ÓÙ›‰Ú·ÛË Â˘·ÈÛıËÛ›·˜ÛÙÔ ·Ì¿ÏÁ·Ì· Î·È ÛÙÔÓ HgNH4. AÓÙ›ıÂÙ·, ÌfiÓÔ ÙÔ 3,9%ÙˆÓ ·ÛıÂÓÒÓ Ì ÏÂȯËÓÔÂȉ›˜ ·ÓÙȉڿÛÂȘ, ÔÈ Ôԛ˜ ‰ÂÓ›¯·Ó ÛÙÂÓ‹ ·Ó·ÙÔÌÈ΋ Û¯¤ÛË Ì ÙÔ ·Ì¿ÏÁ·Ì·, ÂÌÊ¿ÓÈ-Û·Ó ıÂÙÈ΋ ·ÓÙ›‰Ú·ÛË ÛÙË ‰ÔÎÈÌ·Û›· ¢·ÈÛıËÛ›·˜45, 53. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ÂȉÂÚÌÈ΋ ‰ÔÎÈÌ·Û›· ¢·È-ÛıËÛ›·˜ ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ·ÍÈfiÈÛÙË, ηıÒ˜ Â›Ó·È ‰˘-Ó·Ùfi Ó· ÚÔ·„Ô˘Ó ÂÛÊ·Ï̤ӷ ıÂÙÈο ·ÔÙÂϤÛÌ·Ù·.™ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ÙÔ 3,2% Ê·›ÓÂÙ·È fiÙÈ ÂÌÊ·Ó›˙ÂÈ ̆ Â-Ú¢·ÈÛıËÛ›· ÛÙÔ ·Ì¿ÏÁ·Ì· ‹ ÛÙÔÓ Hg53. H ıÂÙÈ΋ ·ÓÙ›-‰Ú·ÛË ÛÙË ‰ÂÚÌ·ÙÈ΋ ‰ÔÎÈÌ·Û›·, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ıÂ-ڷ›· Ù˘ ÏÂȯËÓÔÂȉԇ˜ ‚Ï¿‚˘ ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË Ù˘¤ÌÊڷ͢ ·Ì·ÏÁ¿Ì·ÙÔ˜ Ì ÙËÓ ÔÔ›· ¤Ú¯ÂÙ·È Û ·ʋ,·ÔÙÂÏÔ‡Ó ·fi‰ÂÈÍË fiÙÈ Ë ‚Ï¿‚Ë ÔÊ›ÏÂÙ·È Û ·ÓÙ›‰Ú·-ÛË ˘ÂÚ¢·ÈÛıËÛ›·˜45, 54-56.

mation of the mucosa that does not subside after treatment,b) the direct anatomical relationship between the lesionsand a suspicious restoration, and c) if the lesions are notsymmetrical on both sides.The most important evidence for the diagnosis of a lichenoidlesion is a direct anatomical relationship with amalgamfillings. It has been found that 70% of patients with lichenoidreactions in a direct anatomical relationship with amalgamhad a positive sensitivity test to amalgam and HgNH4. Incontrast, only 3.9% of patients with lichenoid reactions withno direct anatomical relationship to amalgam sustaineda positive reaction45, 53.It should be noted that patch tests are not reliable, as falsepositives are possible. In general population 3.2% showhypersensitivity to amalgam or Hg53. A positive reaction topatch test combined with the resolution of the lesion afterremoving the amalgam filling, are strong evidence ofhypersensitivity reaction45, 54-56.Suter & Warnakulasuriya54 in a clinical study, observed thatamong 26 patients with oral lichenoid reactions in contactwith dental amalgam and positive patch test, in 81% wereresolution of the lesions after replacement of the amalgamrestorations with other dental restoratives.

THERAPY

Treatment of lichenoid reactions directly related to amalgamfillings, involves removal of the suspicious restorations andreplacing amalgam with other materials (e.g. compositeresins, ceramics) or covering the tooth with a full crown44, 57.Several clinical studies have shown that replacing amalgamwith other restorative materials resulted in resolution of thelesions or clinical improvement within a few days or weeks19,

21, 51. Regression of clinical symptoms after replacing theamalgam fillings is observed in 48 to 95% of the cases9, 58.This means that in some cases the lesions do not heal afterthe elimination of the suspected cause, indicating that theyare not attributed to a purely allergic effect or the diagnosisis incorrect20. It has been found that lesions which were in direct contactwith amalgam responded more positively after removal ofamalgam compared to lesions that were not in directcontact with it59. These patients showed an improvementof 97% regardless the results of epicutaneous sensitivitytests, while complete healing occurred more frequently incases where the test was positive59. Further studies haveshown a positive response when replacing amalgam fillingsin patients with a positive sensitivity test to Hg salts19, 51,while in others no positive response was observed60, 61. Symptoms usually subside within 5 weeks62 or more21, 30,although rapid resolution of the symptoms within 2-3 daysafter removal of amalgam fillings has also been reported.Montebugnoli et al.63 reported that although after amalgamremoval, complete clinical healing was obtained in 14 patients,complete histologic healing was obtained in only 7 cases(50% of clinically healed patients). Lichenoid reactions onthe tongue respond more favorably to removal of amalgamfillings compared to lesions on other parts of the oral cavity59.

Hellenic Stomatological Review 59: 35-49, 2015

Page 45: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

Hellenic Stomatological Review 59: 35-49, 2015

OÈ Suter & Warnakulasuriya54 Û ÌÈ· ÎÏÈÓÈ΋ ÌÂϤÙË ÙÔ˘˜,·Ú·Ù‹ÚËÛ·Ó fiÙÈ ·fi ÙÔ˘˜ 26 ·ÛıÂÓ›˜ Ì ÏÂȯËÓÔÂȉ›˜·ÓÙȉڿÛÂȘ Û ÂÌÊÚ¿ÍÂȘ ·Ì·ÏÁ¿Ì·ÙÔ˜ Ô˘ ›¯·Ó ıÂÙÈ-΋ ·ÓÙ›‰Ú·ÛË Û ‰ÔÎÈÌ·Û›· ÂȉÂÚÌÈ΋˜ ¢·ÈÛıËÛ›·˜, ÛÙÔ81% ˘‹ÚÍ ˘Ô¯ÒÚËÛË ÙÔ ‚Ï·‚ÒÓ ÌÂÙ¿ ·fi ·ÓÙÈηٿ-ÛÙ·ÛË ÙÔ˘ ·Ì·ÏÁ¿Ì·ÙÔ˜ Ì ¿ÏÏÔ ÂÌÊÚ·ÎÙÈÎfi ˘ÏÈÎfi.

£EPA¶EYTIKH ANTIMETø¶I™H

H ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÏÂȯËÓÔÂȉÒÓ ·ÓÙȉڿ-ÛÂˆÓ Ô˘ ¤¯Ô˘Ó ¿ÌÂÛË Û¯¤ÛË Ì ÙȘ ÂÌÊÚ¿ÍÂȘ ·Ì·ÏÁ¿-Ì·ÙÔ˜, Û˘Ó›ÛÙ·Ù·È ÛÙËÓ ·Ê·›ÚÂÛË Î·È ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘·Ì·ÏÁ¿Ì·ÙÔ˜ Ì ¿ÏÏ· ÂÌÊÚ·ÎÙÈο ˘ÏÈο (.¯. Û‡ÓıÂÙËÚËÙ›ÓË, ÎÂÚ·ÌÈο) ‹ Î¿Ï˘„Ë Ì ÛÙÂÊ¿ÓË ÔÏÈ΋˜ Î¿Ï˘-„˘ ÙˆÓ ÂÌÊÚ¿ÍÂˆÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ¿ÌÂÛË Â·Ê‹Ì ÙȘ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È ıˆÚÂ›Ù·È fiÙÈ Â›-Ó·È ˘Â‡ı˘Ó˜ ÁÈ· ÙËÓ ÂΉ‹ÏˆÛ‹ ÙÔ˘˜44, 57.T· ·ÔÙÂϤÛÌ·Ù· ‰È·ÊfiÚˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ ¤¯Ô˘Ó ‰Â›-ÍÂÈ fiÙÈ Ë ·ÓÙÈηٿÛÙ·ÛË ÙˆÓ ÂÌÊÚ¿ÍÂˆÓ ·Ì·ÏÁ¿Ì·ÙÔ˜·fi ¿ÏÏ· ÂÌÊÚ·ÎÙÈο ˘ÏÈο, ›¯·Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓÂÍ·Ê¿ÓÈÛË ÙˆÓ ·ÏÏÔÈÒÛÂˆÓ ‹ ÙËÓ ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛËÙ˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ ̤۷ Û ÌÂÚÈΤ˜ Ë̤Ú˜, ‚‰ÔÌ¿-‰Â˜ ‹ Ì‹Ó˜19, 21, 51. TÔ ÔÛÔÛÙfi ̆ Ô¯ÒÚËÛ˘ ÙˆÓ ÎÏÈÓÈÎÒÓÛ˘ÌÙˆÌ¿ÙˆÓ ‡ÛÙÂÚ· ·fi ÙËÓ ·ÓÙÈηٿÛÙ·ÛË ÙˆÓ ÂÌ-ÊÚ¿ÍÂˆÓ ·Ì·ÏÁ¿Ì·ÙÔ˜ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 48 ¤ˆ˜ 100%9,

58. TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ ˘¿Ú¯Ô˘Ó ÂÚÈÙÒÛÂȘfiÔ˘ ÔÈ ·ÏÏÔÈÒÛÂȘ ‰ÂÓ ̆ Ô¯ˆÚÔ‡Ó ‡ÛÙÂÚ· ·fi ÙËÓ ÂÍ¿-ÏÂÈ„Ë Ù˘ Èı·ÓÔÏÔÁÔ‡ÌÂÓ˘ ·ÈÙ›·˜, οÙÈ Ô˘ ‰Â›¯ÓÂÈ fiÙț٠‰ÂÓ ÔÊ›ÏÔÓÙ·È Û ¤Ó· ·ÌÈÁÒ˜ ·ÏÏÂÚÁÈÎfi Ê·ÈÓfiÌÂÓÔ,›ÙÂ Ë ‰È¿ÁÓˆÛË ‰ÂÓ Â›Ó·È ÛˆÛÙ‹ ‹ Î·È Ù· ‰˘Ô Ì·˙›20. ™Â ÌÈ· ÌÂϤÙË ‚Ú¤ıËΠfiÙÈ ‚Ï¿‚˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ¿ÌÂ-ÛË Â·Ê‹ Ì ·Ì¿ÏÁ·Ì· ·ÓÙ·ÔÎÚ›ıËÎ·Ó ÂÚÈÛÛfiÙÂÚÔıÂÙÈο ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ ·Ì·ÏÁ¿Ì·ÙÔ˜ Û ۇÁÎÚÈ-ÛË Ì ‚Ï¿‚˜ Ô˘ ‰ÂÓ ¤Ú¯ÔÓÙ·Ó Û ¿ÌÂÛË Â·Ê‹ Ì ·˘-Ùfi59. ™ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ÂÌÊ·Ó›ÛÙËΠοÔÈ· ‚ÂÏ-Ù›ˆÛË Û ÔÛÔÛÙfi 97%, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ·ÔÙ¤ÏÂ-ÛÌ· ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ÂȉÂÚÌÈ΋˜ ¢·ÈÛıËÛ›·˜, ÂÓÒ Ï‹-Ú˘ ıÂڷ›· ÂÌÊ·Ó›ÛÙËΠÈÔ Û˘¯Ó¿ Û ·ÛıÂÓ›˜ ÛÙÔ˘˜ÔÔ›Ô˘˜ Ë ‰ÔÎÈÌ·Û›· ‹Ù·Ó ıÂÙÈ΋59. EÈϤÔÓ, Û ¿ÏϘÌÂϤÙ˜ ·ÚÔ˘ÛÈ¿ÛÙËΠıÂÙÈ΋ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·ÓÙÈ-ηٿÛÙ·ÛË ÂÌÊÚ¿ÍÂˆÓ ·Ì·ÏÁ¿Ì·ÙÔ˜ Û ·ÛıÂÓ›˜ Ì ıÂ-ÙÈ΋ ·ÓÙ›‰Ú·ÛË Â˘·ÈÛıËÛ›·˜ Û ¿Ï·Ù· Hg19, 51, ÂÓÒ Û ¿Ï-ÏÔ˘˜ ‰ÂÓ ·ÚÔ˘ÛÈ¿ÛÙËΠıÂÙÈ΋ ·ÓÙ·fiÎÚÈÛË60, 61.Œ¯ÂÈ ·Ú·ÙËÚËı› Ù·¯Â›· ̆ Ô¯ÒÚËÛË ÙˆÓ Û˘Ìو̿وÓ̤۷ Û 2-3 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙˆÓ ÂÌÊڿ͈ӷ̷ÏÁ¿Ì·ÙÔ˜ ·Ó Î·È ·˘Ùfi Û˘Ó‹ıˆ˜ Á›ÓÂÙ·È Û ‰È¿ÛÙË̷̤¯ÚÈ 5 ‚‰ÔÌ¿‰Â˜62 ‹ Î·È ÂÚÈÛÛfiÙÂÚÔ21, 30. OÈ Montebu-gnoli et al.63 Ô˘ ÌÂϤÙËÛ·Ó ÙËÓ ˘Ô¯ÒÚËÛË ÙˆÓ ÏÂȯË-ÓÔÂȉÒÓ ‚Ï·‚ÒÓ ÌÂÙ¿ ·fi ·Ê·›ÚÂÛË ÂÌÊÚ¿ÍÂˆÓ ·Ì·Ï-Á¿Ì·ÙÔ˜, ·Ú·Ù‹ÚËÛ·Ó fiÙÈ ·fi ÙÔ˘˜ 14 ·ÛıÂÓ›˜ Ô˘ ›-¯·Ó ˘Ô¯ÒÚËÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÎÏÈÓÈο, ÌfiÓÔ ÛÙÔ˘˜7 (50%) ˘‹Ú¯Â Î·È ÈÛÙÔÏÔÁÈο ÂԇψÛË ÙˆÓ ‚Ï·‚ÒÓ.OÈ ÏÂȯËÓÔÂȉ›˜ ‚Ï¿‚˜ ÛÙË ÁÏÒÛÛ·, ¤¯ÂÈ ‚ÚÂı› fiÙÈ ·ÓÙ·-ÔÎÚ›ÓÔÓÙ·È ÈÔ ıÂÙÈο ÛÙËÓ ·Ê·›ÚÂÛË ÙˆÓ ÂÌÊڿ͈ӷ̷ÏÁ¿Ì·ÙÔ˜ Û ۯ¤ÛË Ì ‚Ï¿‚˜ Û ¿ÏÏ· ÛËÌ›· Ù˘ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜59.OÈ Issa et al.64 Ú·ÁÌ·ÙÔÔ›ËÛ·Ó ÌÈ· Û˘ÛÙËÌ·ÙÈ΋ ·Ó·-ÛÎfiËÛË ÁÈ· ÙË ıÂڷ›· ÙˆÓ ÏÂȯËÓÔÂȉÒÓ ·ÏÏÔÈÒÛˆÓ,

Issa et al.64 conducted a systematic review regarding the-rapy of lichenoid reactions after replacement of amalgamfillings from 1966 to 2000. They evaluated 19 studies, 14of which were clinical studies, while the rest five were casereports. The total number of patients was 1158 of whom16-91% tested positive to amalgam components sensitivitytesting. For therapeutic reasons amalgam fillings werereplaced in 636 patients and the results were recorded fora two-month period to 9.5 years. Complete healing wasobserved in 37.5% to 100% of cases. Melioration of thelesions was greater after one week to three months whilethe greatest improvement was observed in the lesions thatwere in direct contact with the amalgam.The same study64 reported that despite the fact that patchtests provide important information about the sensitivity ofa patient to specific substances, a positive result cannotbe an indication for replacing the amalgam fillings nor itcan predict the outcome. Furthermore, topographicalcorrelation between lichenoid reactions and amalgamfillings, although useful for the prognosis of the lesion,cannot predict the outcome of the replacement of the fillings.After a positive sensitivity testing only amalgam fillings thatare in direct contact with lichenoid reactions should beremoved. If the patch test is negative but there is a strongsuspicion that a lichenoid lesion is caused by an amalgamfilling, covering amalgam with a full crown in order to avoidcontact with oral mucosa offers an alternative solution. Anotherway is to remove only the amalgam fillings which are in contactwith the lesion and to observe whether the symptoms subsidebefore deciding to replace all amalgam restorations63, 64.

CONCLUSIONS

1. Dental amalgam can cause lichenoid reactions in oralmucosa but their diagnosis is difficult.

2. Diagnosis of lichenoid reactions is mainly based onclinical findings, which are the characteristics of thelesions and their anatomical relationship with theamalgam fillings.

3. Patch tests in combination with the clinical featurescontribute to diagnosis of the lesion and prognosis ofthe treatment.

4. Histopathological examination is only required in caseswhere the clinical characteristics are atypical in orderto rule out the possibility of malignancy.

5. Replacement of amalgam fillings commonly improvesor eliminates oral lichenoid reactions and their symptomswhich are related with amalgam contact.

ACKNOWLEDGEMENTS

The authors of this study would like to thank Professor andHead of the Department of Stomatology of AristotleUniversity of Thessaloniki Alexandros Kolokotronis for hispermission to use images from the archives of the Clinicof Stomatology as well as Assistant Professor DimitriosAndreadis for his contribution to image selection.

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Literature Review

REFERENCES

1. Kakaboura A, Vougiouklakis G: Basic Principles in OperativeDentistry, Paschalidis PH Broken Hill Pullishers LTD, Athens,2012, pp. 128.

2. Bharti R, Wadhwani KK, Tikku AP, Chandra A: Dental amalgam:An update. J Conserv Dent 2010; 13(4): 204-208.

3. McParland H, Warnakulasuriya S: Oral lichenoid contact lesionsto mercury and dental amalgam. A review. J Biomed Biotech2012; 2012 Article ID: 589569.

4. Kopperud SE, Staxrud F, Espelid I, Tveit AB: The post-amalgamera: Norwegian dentists’ experiences with composite resinsand repair of defective amalgam restorations. Int J EnvironRes Public Health 2016; 13(4).

5. ADA Council on Scientific Affairs. Dental amalgam update onsafety concerns. J Am Dent Assoc 1998; 129(4): 444-503.

6. Richards JM, Warren PJ: Mercury vapour released during theremoval of old amalgam restoration. Br Dent J 1985; 159(7):231-232.

7. Berglund A: Estimation by a 24-hour study of the daily doseof intra-oral mercury vapour inhaled after release from dentalamalgam. J Dent Res 1990; 69(10): 1646-1651.

8. Mackert JR: Factors affecting estimation of dental amalgammercury exposure from measurements of mercury vapourlevels in intra-oral and expired air. J Dent Res 1987; 66(12):1775-1780.

9. Clarkson TW, Magos L, Myers GJ: The toxicology of mercurycurrent exposures and clinical manifestation. N Engl J Med2003; 349(18): 1731-1737.

10. Roberts HW, Charlton DG: The release of mercury fromamalgam restoration and its health effects: A review. OperDent 2009; 34(5): 605-614.

11. Eyeson J, House I, Yang YH, Warrnakulasuriya KA: Relationshipbetween mercury levels in blood and urine and complaints ofchronic mercury toxicity from amalgam restoration. Br DentJ 2010; 27: 208(4): E7, discussion 162-163.

12. Dionysopoulos D: Oral reactions related to contact with dentalamalgam. J Dent Appl 2014; 1(2): 21-22.

13. Holmstrup P: Reaction of the oral mucosa related to silveramalgam: a review. J Oral Pathol Med 1991; 20(1): 1-7.

14. Freden H, Hellden L, Milleding P: Mercury content in gingivaltissues adjacent to amalgam fillings. Odontol Revy 1974; 25(2):207-209.

15. Leite CM, Botelho AS, Oliveira JR, Cardoso SV, Loyola AM,Gomez RS, et al: Immunolocalization of HLA-DR andmetallothionein on amalgam tattoos. Braz Dent J 2004; 15(2):99-103.

16. Buchner A, Hansen LS: Amalgam pigmentation (amalgamtattoo) of the oral mucosa. A clinicopathological study of 268cases. Oral Surg Oral Med Oral Pathol 1980; 49(2): 139-147.

17. Jontell M, Holmstrup P: Red and white lesions of the oralmucosa, in Burkets Oral Medicine, MS Greenberg, M Glick,JA Ship, Eds., pp. 77-78, BC Decker, Hamilton, Canada, 2008.

18. Cawson RA, Odell EW: Eds., Cawson’s Essentials of OralMedicine and Pathology, Churchill Livingston, London, UK,2008.

19. Bolewska I, Holmstrup P, Moller-Madsen B, Kenrad B, DanscherG: Amalgam associated mercury accumulations in normal oralmucosa, oral mucosal lesions of planus and contact lesionsassociated with amalgam. J Oral Pathol Med 1990; 19(1): 39-42.

20. Holmstrup P: Oral mucosa and skin reactions related toamalgam. Adv Dent Res 1992; 6: 120-124.

21. Sharma R, Handa S, De D, Radotra BD, Rattan V: Role of dentalrestoration materials in oral mucosal lichenoid lesions. IndianJ Dermatol Venereol Leprol 2015; 81(5): 478-484.

‡ÛÙÂÚ· ·fi ÙËÓ ·ÓÙÈηٿÛÙ·ÛË ÙˆÓ ÂÌÊÚ¿ÍÂˆÓ ·Ì·Ï-Á¿Ì·ÙÔ˜, ÁÈ· ÙËÓ ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô ·fi ÙÔ 1966 ̤¯ÚÈ ÙÔ2000. Afi ÙȘ 19 ÂÚÁ·Û›Â˜ Ô˘ ÌÂϤÙËÛ·Ó ÔÈ 14 ‹Ù·Ó ÛÙ·-ÙÈÛÙÈΤ˜ ÌÂϤÙ˜ Û ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ, ÂÓÒ ÔÈ 5 ‹Ù·Ó ·Ó·-ÊÔÚ¤˜ ÂÚÈÙÒÛˆÓ. O Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ‹Ù·Ó 1.158 Î·È ·fi ·˘ÙÔ‡˜ ÔÈ ıÂÙÈÎÔ› Û ‰ÔÎÈÌ·Û›· ÂÈ-‰ÂÚÌÈ΋˜ ¢·ÈÛıËÛ›·˜ ÛÙ· Û˘ÛÙ·ÙÈο ÙÔ˘ ·Ì·ÏÁ¿Ì·ÙÔ˜Î˘Ì·›ÓÔÓÙ·Ó ·fi 16% ¤ˆ˜ 91%. Afi ÙÔ˘˜ 1.158 ·ÛıÂÓ›˜,¤ÁÈÓ ÁÈ· ıÂڷ¢ÙÈÎÔ‡˜ ÏfiÁÔ˘˜ ·ÓÙÈηٿÛÙ·ÛË ÙˆÓ ÂÌ-ÊÚ¿ÍÂˆÓ ÛÙÔ˘˜ 636 Î·È Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÓÙÈηٿ-ÛÙ·Û˘ ηٷÁÚ¿ÊËÎ·Ó ÁÈ· ‰È¿ÛÙËÌ· ·fi ‰˘Ô Ì‹Ó˜ ̤-¯ÚÈ 9,5 ̄ ÚfiÓÈ·. ¶Ï‹Ú˘ ›·ÛË ÙˆÓ ·ÛıÂÓÒÓ Î·Ù·ÁÚ¿ÊËÎÂÛ ÔÛÔÛÙfi ·fi 37,5% ¤ˆ˜ 100%. H ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ï-ÏÔÈÒÛÂˆÓ ÂÌÊ·Ó›ÛÙËΠ۠ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ̤۷ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÌÈ· ‚‰ÔÌ¿‰· ̤¯ÚÈ 3 Ì‹Ó˜,ÂÓÒ ÙË ÌÂÁ·Ï‡ÙÂÚË ‚ÂÏÙ›ˆÛË ÂÌÊ¿ÓÈÛ·Ó ÔÈ ·ÏÏÔÈÒÛÂÈ˜Ô˘ ‚Ú›ÛÎÔÓÙ·Ó Û ¿ÌÂÛË Â·Ê‹ Ì ÙÔ ·Ì¿ÏÁ·Ì·.™ÙËÓ ›‰È· ÌÂϤÙË64 ·Ó·Ê¤ÚÂÙ·È fiÙÈ ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë‰ÔÎÈÌ·Û›· ÂȉÂÚÌÈ΋˜ ¢·ÈÛıËÛ›·˜ Ì·˜ ‰›ÓÂÈ ÛËÌ·ÓÙÈΤ˜ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ Â˘·ÈÛıËÛ›· ÂÓfi˜ ·ÙfiÌÔ˘ Û ÔÚÈ-Ṳ̂Ó˜ ̄ ËÌÈΤ˜ Ô˘Û›Â˜, Ë ıÂÙÈ΋ ·ÓÙ›‰Ú·ÛË ‰ÂÓ ÌÔÚ› Ó··ÔÙÂϤÛÂÈ ¤Ó‰ÂÈÍË ·ÓÙÈηٿÛÙ·Û˘ ÙˆÓ ÂÌÊÚ¿ÍÂˆÓ ·Ì·Ï-Á¿Ì·ÙÔ˜ Ô‡Ù ÌÔÚ› Ó· ÚÔ‰ÈοÛÂÈ Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘·ÓÙÈηٿÛÙ·Û˘. E›Û˘, Ë ÙÔÔÁÚ·ÊÈ΋ Û˘Û¯¤ÙÈÛË ÌÂ-ٷ͇ ÌÈ·˜ ÏÂȯËÓÔÂȉԇ˜ ·ÓÙ›‰Ú·Û˘ Î·È ÂÌÊÚ¿ÍÂˆÓ ·Ì·Ï-Á¿Ì·ÙÔ˜, ÂÓÒ Â›Ó·È ¯Ú‹ÛÈÌË ÁÈ· ÙËÓ ‰È·Ù‡ˆÛË Ù˘ Úfi-ÁÓˆÛ˘ Ù˘ ·ÏÏÔ›ˆÛ˘, ‰ÂÓ ÌÔÚ› Ó· ÚÔ‰ÈοÛÂÈ ÙÔ ·Ô-Ù¤ÏÂÛÌ· Ù˘ ·ÓÙÈηٿÛÙ·Û˘ ÙˆÓ ÂÌÊڿ͈Ó. ⁄ÛÙÂÚ· ·fi ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÛÙË ‰ÔÎÈÌ·Û›· ¢·È-ÛıËÛ›·˜ ı· Ú¤ÂÈ Ó· ·Ê·ÈÚÂ›Ù·È ÌfiÓÔ ÙÔ ·Ì¿ÏÁ·Ì· Ô˘‚Ú›ÛÎÂÙ·È Û ¿ÌÂÛË Â·Ê‹ Ì ÙË ÏÂȯËÓÔÂȉ‹ ·ÓÙ›‰Ú·ÛË.AÓ ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰ÔÎÈÌ·Û›·˜ ¢·ÈÛıËÛ›·˜ Â›Ó·È ·Ú-ÓËÙÈÎfi ·ÏÏ¿ ̆ ¿Ú¯ÂÈ ÛÔ‚·Ú‹ ̆ Ô„›· fiÙÈ ÌÈ· ÏÂȯËÓÔÂȉ‹˜·ÓÙ›‰Ú·ÛË ÔÊ›ÏÂÙ·È Û ¤ÌÊÚ·ÍË ·Ì·ÏÁ¿Ì·ÙÔ˜, ÌÈ· χ-ÛË Â›Ó·È Ë Î¿Ï˘„Ë ÙÔ˘ ·Ì·ÏÁ¿Ì·ÙÔ˜ Ì ÛÙÂÊ¿ÓË ÒÛÙ ӷ·ÔÊ¢¯ı› Ë Â·Ê‹ ÙÔ˘ Ì ÙÔ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÛÙfiÌ·-ÙÔ˜. MÈ· ¿ÏÏË ÂÓ¤ÚÁÂÈ· ÌÔÚ› Ó· Â›Ó·È Ë ·Ê·›ÚÂÛË ÙÔ˘·Ì·ÏÁ¿Ì·ÙÔ˜, Û ·ʋ Ì ÙÔ ÔÔ›Ô ‚Ú›ÛÎÂÙ·È Ë ÏÂȯË-ÓÔÂȉ‹˜ ·ÓÙ›‰Ú·ÛË, ÁÈ· Ó· ÂÏÂÁ¯ı› ·Ó ı· ̆ Ô¯ˆÚ‹ÛÂÈ Ë·ÓÙ›‰Ú·ÛË ÚÈÓ ·ÔÊ·ÛÈÛÙ› Ë ·ÓÙÈηٿÛÙ·ÛË fiÏˆÓ ÙˆÓÂÌÊÚ¿ÍÂˆÓ ·Ì·ÏÁ¿Ì·ÙÔ˜63, 64.

™YM¶EPA™MATA

1. TÔ Ô‰ÔÓÙÈ·ÙÚÈÎfi ·Ì¿ÏÁ·Ì· Â›Ó·È ‰˘Ó·Ùfi Ó· ÚÔηϤ-ÛÂÈ ÏÂȯËÓÔÂȉ›˜ ·ÏÏÔÈÒÛÂȘ ÛÙÔ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÛÙfi-Ì·ÙÔ˜, Ë ‰È¿ÁÓˆÛË ÙˆÓ ÔÔ›ˆÓ ÂÍ·ÎÔÏÔ˘ı› Ó· ›ӷȉ‡ÛÎÔÏË.

2. H ‰È¿ÁÓˆÛË ÙˆÓ ÏÂȯËÓÔÂȉÒÓ ·ÏÏÔÈÒÛÂˆÓ ÛÙËÚ›˙ÂÙ·Èηٿ ·ÚÈÔ ÏfiÁÔ ÛÙ· ÎÏÈÓÈο Â˘Ú‹Ì·Ù·, ÛÙ· ÔÔ›· Â-ÚÈÏ·Ì‚¿ÓÔÓÙ·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÏÏÔÈÒÛÂˆÓ Î·ÈË ·Ó·ÙÔÌÈ΋ ÙÔ˘˜ Û¯¤ÛË Ì ÙȘ ÂÌÊÚ¿ÍÂȘ ·Ì·ÏÁ¿Ì·ÙÔ˜.

3. H ‰ÔÎÈÌ·Û›· ¢·ÈÛıËÛ›·˜ ·fi ÌfiÓË Ù˘ ‰ÂÓ ¤¯ÂÈ ÌÂ-Á¿ÏË ·Í›·, ·ÏÏ¿ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙËÓ ÚfiÁÓˆÛË Ù˘ ıÂڷ›·˜.

4. H ÈÛÙÔ·ıÔÏÔÁÈ΋ ÂͤٷÛË ‰ÂÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÛÂfiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÏÂȯËÓÔÂȉԇ˜ ·ÏÏÔ›ˆÛ˘, ÂÎÙfi˜

Hellenic Stomatological Review 59: 35-49, 2015

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Literature Review

Hellenic Stomatological Review 59: 35-49, 2015

·fi ÙȘ ÂÚÈÙÒÛÂȘ fiÔ˘ Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Â›Ó·È ¿Ù˘Ë,Ì ÛÎÔfi Ó· ·ÔÎÏÂÈÛı› Ë ÂÚ›ÙˆÛË Î·ÎÔ‹ıÂÈ·˜.

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EYXAPI™TIE™

OÈ Û˘ÁÁÚ·Ê›˜ ı· ‹ıÂÏ·Ó Ó· ¢¯·ÚÈÛÙ‹ÛÔ˘Ó ÙÔÓ K·ıËÁË-Ù‹ Î·È ¢È¢ı˘ÓÙ‹ ÙÔ˘ EÚÁ·ÛÙËÚ›Ô˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ ÙÔ˘A.¶.£. Î. AϤͷӉÚÔ KÔÏÔÎÔÙÚÒÓË ÁÈ· ÙËÓ Â˘ÁÂÓÈ΋ ¯Ô-ÚËÁ›· ÙˆÓ ÂÈÎfiÓˆÓ ·fi ÙÔ ÊˆÙÔÁÚ·ÊÈÎfi ·Ú¯Â›Ô ÙÔ˘ EÚÁ·-ÛÙËÚ›Ô˘, ηıÒ˜ Î·È ÙÔÓ E›ÎÔ˘ÚÔ K·ıËÁËÙ‹ ÙÔ˘ EÚÁ·-ÛÙËÚ›Ô˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ ÙÔ˘ A.¶.£. Î. ¢ËÌ‹ÙÚÈÔ AÓ‰Ú¿-‰Ë ÁÈ· ÙËÓ ÔχÙÈÌË ‚Ô‹ıÂÈ¿ ÙÔ˘ ÛÙËÓ ÂÈÏÔÁ‹ ÙˆÓ ÂÈÎfiÓˆÓ.

BIB§IO°PAºIA

1. K·Î¿ÌÔ˘Ú· A, BÔ˘ÁÈÔ˘ÎÏ¿Î˘ °: B·ÛÈΤ˜ ·Ú¯¤˜ O‰ÔÓÙÈ΋˜XÂÈÚÔ˘ÚÁÈ΋˜, ¶·Û¯·Ï›‰Ë˜ ¶X Broken Hill Pullishers LTD,Aı‹Ó·, 2012, pp: 128.

2. Bharti R, Wadhwani KK, Tikku AP, Chandra A: Dental amalgam:An update. J Conserv Dent 2010; 13(4): 204-208.

3. McParland H, Warnakulasuriya S: Oral lichenoid contact lesionsto mercury and dental amalgam. A review. J Biomed Biotech2012; 2012 AÚÈıÌfi˜ ¿ÚıÚÔ˘: 589569.

4. Kopperud SE, Staxrud F, Espelid I, Tveit AB: The post-amalgamera: Norwegian dentists’ experiences with composite resinsand repair of defective amalgam restorations. Int J EnvironRes Public Health 2016; 13(4).

5. ADA Council on Scientific Affairs. Dental amalgam update onsafety concerns. J Am Dent Assoc 1998; 129(4): 444-503.

6. Richards JM, Warren PJ: Mercury vapour released during theremoval of old amalgam restoration. Br Dent J 1985; 159(7):231-232.

7. Berglund A: Estimation by a 24-hour study of the daily doseof intra-oral mercury vapour inhaled after release from dentalamalgam. J Dent Res 1990; 69(10): 1646-1651.

8. Mackert JR: Factors affecting estimation of dental amalgammercury exposure from measurements of mercury vapourlevels in intra-oral and expired air. J Dent Res 1987; 66(12):1775-1780.

9. Clarkson TW, Magos L, Myers GJ: The toxicology of mercurycurrent exposures and clinical manifestation. N Engl J Med2003; 349(18): 1731-1737.

10. Roberts HW, Charlton DG: The release of mercury fromamalgam restoration and its health effects: A review. OperDent 2009; 34(5): 605-614.

11. Eyeson J, House I, Yang YH, Warrnakulasuriya KA: Relationshipbetween mercury levels in blood and urine and complaints ofchronic mercury toxicity from amalgam restoration. Br DentJ 2010; 27: 208(4): E7, discussion 162-163.

12. Dionysopoulos D: Oral reactions related to contact with dentalamalgam. J Dent Appl 2014; 1(2): 21-22.

13. Holmstrup P: Reaction of the oral mucosa related to silveramalgam: a review. J Oral Pathol Med 1991; 20(1): 1-7.

14. Freden H, Hellden L, Milleding P: Mercury content in gingivaltissues adjacent to amalgam fillings. Odontol Revy 1974; 25(2):207-209.

22. Aggarwal V, Jain A, Kabi D: Oral lichenoid reaction associatedwith tin component of amalgam restorations: a case report.Am J Dermatopathol 2010; 32(1): 46-48.

23. Merritt K: International Workshop: Biocompatibility, Toxicityand Hypersensitivity to Alloy System Used in Dentisitry, 1986.

24. Thornhill MH, Pemberton MN, Simmons RK, Theaker ED:Amalgam contact hypersensitivity lesions and oral lichenplanus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod2003; 95(3): 291-299.

25. Sugerman PB, Savage NW, Walsh LS: The pathogenesis oforal lichen planus: Crit Rev Oral Biol 2002; 13(4): 350-365.

26. Wiltshire WA, Ferreira MR, Ligthelm AJ: Allergies to dentalmaterials. Quintessence Int 1996; 27(8): 513-520.

27. Nakayama H, Niki F, Shono M, Hada S: Mercury exanthema.Contact Dermatitis 1983; 9(5): 411-417.

28. McGivern B, Pemberton M, Theaker ED, Buchanan JA, ThornhillMM: Delayed and immediate hypersensitivity reactions as-sociated the use of amalgam. Br Dent J 2000; 188(2): 73-76.

29. Solomom LW, Helm TN, Stevens C, Neidas ME, Kumar V:Clinical and immunopathological findings in oral lichen planuspemphigoides. Oral Surg, Oral Med, Oral Pathol, Oral RadiolEndod 2007; 103(6): 808-813.

30. Ibbotson SH, Speight EL, Macleod RI, Smart ER, LawrenceCM: The relevance and effect of amalgam replacement insubject with oral lichenoid reactions. Br J Dermatol 1996;134(3): 420-423.

31. Xanthinaki A, Sklavounou A: Whats new in the pathogenesis oforal lichen planus. EÏÏ EÈı ¢ÂÚÌ AÊÚ 2008; 19(3): 221-227.

32. Yiannias JA, El- Azhary RA, Hand JH, Pakzad SY, Rogers RS:Relevant contact sensitivities in patients with the diagnosis oforal lichen planus. J Am Acad Dermatol 2000; 42(2): 177-182.

33. Mignogna MD, Muzio L, Russo L, Fedele S, Ruoppo E, BucciE: Clinical guidelines in early detection of oral squamouscell carcinoma arising in oral lichen planus: a 5-year experience.Oral Oncol 2001; 37(3): 262-267.

34. van der Meij EH, Mast H, Van der Waal I: The possiblepremalignant character of oral lichen planus and oral lichenoidlesions: a prospective five-year follow-up study of 192 patients.Oral Oncol 2007; 43(8): 742-748.

35. van der Waal I: Oral lichen planus and oral lichenoid lesions;a critical appraisal with emphasis on the diagnostic aspects.Med Oral Patol Oral Cir Bucal 2009; 14(7): e310-314.

36. MÆarell L, Tillberg A, Widman L, Bergdahl J, Berglund A: Re-gression of oral lichenoid lesions after replacement of dentalrestorations. J Oral Rehabil 2014; 41(5): 381-391.

37. Ramnarayan B, Maligi P, Smitha T, Patil U: Amalgam contacthypersensitivity lesion: an unusual presentation-report of a rarecase. Ann Med Health Sci Res 2014; 4(Suppl 3): S320-323.

38. Neville BW, Damm DD, Allen CM, Bouquot J: Oral andMaxillofacial Pathology, 3ed. Saunders, Elsevier, 2008.

39. Lartitegui-Sebasti ’an MJ, Martnez-Revilla B, Saiz-Garcia C,Eguizabal-Saracho S, Aguirre-Urizar JM: Oral lichenoid lesionsassociated with amalgam restorations: a prospective pilotstudy addressing the adult population of the Basque Country.Med Oral Patol Oral Cir Bucal 2012; 17(4): e545-549.

40. Ostman PO, Anneroth G, Skoglund A: Oral lichen planus lesionsin contact with amalgam fillings: a clinical, histologic, andimmunohistochemical study. Scand J Dent Res 1994; 102(3):172-179.

41. Warnakulasuriya S, Reibel J, Bouquot J, Dabelsteen E: Oralepithelial dysplasia classification system: predictive value,utility, weaknesses and scope for improvement. J Oral PatholMed 2008; 37(3): 127-133.

42. Pinkus H: Lichenoid tissue reactions; a speculative review ofthe clinical spectrum of epidermal cell damage with special

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

15. Leite CM, Botelho AS, Oliveira JR, Cardoso SV, Loyola AM, GomezRS, et al: Immunolocalization of HLA-DR and metallothioneinon amalgam tattoos. Braz Dent J 2004; 15(2): 99-103.

16. Buchner A, Hansen LS: Amalgam pigmentation (amalgamtattoo) of the oral mucosa. A clinicopathological study of 268cases. Oral Surg Oral Med Oral Pathol 1980; 49(2): 139-147.

17. Jontell M, Holmstrup P: Red and white lesions of the oralmucosa, in Burkets Oral Medicine, MS Greenberg, M Glick,JA Ship, Eds., pp. 77-78, BC Decker, Hamilton, Canada, 2008.

18. Cawson RA, Odell EW: Eds., Cawson’s Essentials of Oral Me-dicine and Pathology, Churchill Livingston, London, UK, 2008.

19. Bolewska I, Holmstrup P, Moller-Madsen B, Kenrad B, DanscherG: Amalgam associated mercury accumulations in normaloral mucosa, oral mucosal lesions of planus and contactlesions associated with amalgam. J Oral Pathol Med 1990;19(1): 39-42.

20. Holmstrup P: Oral mucosa and skin reactions related toamalgam. Adv Dent Res 1992; 6: 120-124.

21. Sharma R, Handa S, De D, Radotra BD, Rattan V: Role of dentalrestoration materials in oral mucosal lichenoid lesions. IndianJ Dermatol Venereol Leprol 2015; 81(5): 478-484.

22. Aggarwal V, Jain A, Kabi D: Oral lichenoid reaction associatedwith tin component of amalgam restorations: a case report.Am J Dermatopathol 2010; 32(1): 46-48.

23. Merritt K: International Workshop: Biocompatibility, Toxicityand Hypersensitivity to Alloy System Used in Dentisitry, 1986.

24. Thornhill MH, Pemberton MN, Simmons RK, Theaker ED:Amalgam contact hypersensitivity lesions and oral lichenplanus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod2003; 95(3): 291-299.

25. Sugerman PB, Savage NW, Walsh LS: The pathogenesis oforal lichen planus: Crit Rev Oral Biol 2002; 13(4): 350-365.

26. Wiltshire WA, Ferreira MR, Ligthelm AJ: Allergies to dentalmaterials. Quintessence Int 1996; 27(8): 513-520.

27. Nakayama H, Niki F, Shono M, Hada S: Mercury exanthema.Contact Dermatitis 1983; 9(5): 411-417.

28. McGivern B, Pemberton M, Theaker ED, Buchanan JA, ThornhillMM: Delayed and immediate hypersensitivity reactionsassociated the use of amalgam. Br Dent J 2000; 188(2): 73-76.

29. Solomom LW, Helm TN, Stevens C, Neidas ME, Kumar V:Clinical and immunopathological findings in oral lichen planuspemphigoides. Oral Surg, Oral Med, Oral Pathol, Oral RadiolEndod 2007; 103(6): 808-813.

30. Ibbotson SH, Speight EL, Macleod RI, Smart ER, LawrenceCM: The relevance and effect of amalgam replacement insubject with oral lichenoid reactions. Br J Dermatol 1996;134(3): 420-423.

31. •·ÓıÈÓ¿ÎË A, ™ÎÏ·‚Ô‡ÓÔ˘ A: OÌ·Ïfi˜ ÏÂȯ‹Ó·˜ ÙÔ˘ ÛÙfiÌ·-ÙÔ˜: ™‡Á¯ÚÔÓ˜ ·fi„ÂȘ ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÈ·. EÏÏ EÈı ¢ÂÚÌAÊÚ 2008; 19(3): 221-227.

32. Yiannias JA, El- Azhary RA, Hand JH, Pakzad SY, Rogers RS:Relevant contact sensitivities in patients with the diagnosis oforal lichen planus. J Am Acad Dermatol 2000; 42(2): 177-182.

33. Mignogna MD, Muzio L, Russo L, Fedele S, Ruoppo E, BucciE: Clinical guidelines in early detection of oral squamouscell carcinoma arising in oral lichen planus: a 5-year experience.Oral Oncol 2001; 37(3): 262-267.

34. van der Meij EH, Mast H, Van der Waal I: The possiblepremalignant character of oral lichen planus and oral lichenoidlesions: a prospective five-year follow-up study of 192 patients.Oral Oncol 2007; 43(8): 742-748.

35. van der Waal I: Oral lichen planus and oral lichenoid lesions;a critical appraisal with emphasis on the diagnostic aspects.Med Oral Patol Oral Cir Bucal 2009; 14(7): e310-314.

36. MÆarell L, Tillberg A, Widman L, Bergdahl J, Berglund A: Regres-

reference to erythema dyschromium pestans. Arch Dermatol1973; 107(6): 840-843.

43. Thornhill MH, Sankar V, Xu XJ, Barrett AW, High AS, OdellEW, Speight PM, Farthing PM: The role of histopathologicalcharacteristics in distinguishing amalgam-associated orallichenoid reactions and oral lichen planus. J Oral Pathol Med2006; 35(4): 233-240.

44. Al-Hashimi I, Schifter M, Lockhart PB, Wray D, Brennan M,Migliorati CA, et al: Oral lichen planus and oral lichenoid lesions:diagnostic and therapeutic considerations. Oral Surg, Oral Med,Oral Pathol, Oral Radiol Endod. 2007; 103 Suppl:S25.e1-12.

45. Cobos-Fuentes MJ, Martinez-Sahuquillo-Marquez A, Gallardo-Castillo I, Armas-Padron JR, Moreno-Fernandez A, Bullon-Fernandez P: Oral lichenoid lesions related to contact withdental materials: A literature review. Med Oral Patol Cir Bucal2009; 14(10): e514-520.

46. Rotim Z, Bolanca Z, Rogulj AA, Andabak M, Boras VV, VrdoljakDV: Oral lichen planus and oral lechenoid reaction. An update.Acta Clin Croat 2015; 54(4): 516-520.

47. Mares S, Ben Slama L, Gruffaz F, Goudot P, Bertolus C:Potentially malignant character of oral lichen planus andlichenoid lesions. Rev Stomatol Chir Maxillofac Chir Orale2013; 114(5): 293-298.

48. Fitzpatrick SG, Hirsch SA, Gordon SC: The malignanttransformation of oral lichen planus and oral lichenoid lesions:a systematic review. J Am Dent Assoc 2014; 145(1): 45-56.

49. Luiz AC, Hirota SK, Dal Vechio A, Reis VM, Spina R, MigliariDA: Diagnosing oral lichenoid contact reaction: clinicaljudgment versus skin-patch test. Minerva Stomatol 2012; 61(7-8): 311-317.

50. Ditrichova D, Kapralova S, Tichy M, Ticha V, Dobesova J,Justova E, et al: Oral lichenoid lesions and allergy to dentalmaterials. Biomed Pap Med Fac Univ Palacky Olomouc CzechRepub 2007; 151(2): 333-339.

51. Laine L, Kalimo K, Happonen RP: Contact allergy to dentalrestorative materials in patients with oral lichenoid lesions.Contact Dermatitis 1997; 36(3): 141-146.

52. Koch R, Bahmer FA: Oral lesions and symptoms related to me-tals used in dental restorations: a clinical, allergological, andhistologic study. Am Acad Dermatol 1999; 41(3): 422-430.

53. Enestrom S, Hultman P: Does amalgam affects the immunesystem? A controversial issue. Int Arch Allergy Immunol 1995;106(3): 180-203.

54. Suter VG, Warnakulasuriya S: The role of patch testing in themanagement of oral lichenoid reactions. J Oral Pathol Med2016; 45(1): 48-57.

55. Pigatto PD, Spadari F, Bombeccari GP, Guzzi G: Oral lichenoidreactions, patch tests, and mercury dental amalgam. J OralPathol Med 2016; 45(2): 153.

56. Thanyavuthi A, Boonchai W, Kasemsarn P: Amalgam contactallergy in oral lichenoid lesions. Dermatitis 2016 [Epub aheadof print].

57. Pawar RR, Mattigatti SS, Mahaparale RR, Kamble AP: Lichenoidreaction associated with silver amalgam restoration in aBombay blood group patient: A case report. J Conserv Dent2016; 19(3): 289-292.

58. Lynch M, Ryan A, Galvin S, Flint S, Healy CM, O’Rourke N, LynchK, Rogers S, Collins P: Patch testing in oral lichenoid lesionsof uncertain etiology. Dermatitis 2015; 26(2): 89-93.

59. Dunsche A, Kastel I, Tenheyden H, Springer ING, ChristopersE, Brash J: Oral lichenoid reactions associated with amalgam;improvement after amalgam removal. Br J Dermatol 2003;148(1): 70-76.

60. Ostman PO, Anneroth G, Skoglund A: Oral lichen planus lesionsin contact with amalgam fillings: a clinical, histologic, and

Hellenic Stomatological Review 59: 35-49, 2015 47

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Hellenic Stomatological Review 59: 35-49, 2015

sion of oral lichenoid lesions after replacement of dental re-storations. J Oral Rehabil 2014; 41(5): 381-391.

37. Ramnarayan B, Maligi P, Smitha T, Patil U: Amalgam contacthypersensitivity lesion: an unusual presentation-report of a rarecase. Ann Med Health Sci Res 2014; 4(Suppl 3): S320-323.

38. Neville BW, Damm DD, Allen CM, Bouquot J: Oral andMaxillofacial Pathology, 3ed. Saunders, Elsevier, 2008.

39. Lartitegui-Sebasti ’an MJ, Mart›nez-Revilla B, Saiz-Garcia C,Eguizabal-Saracho S, Aguirre-Urizar JM: Oral lichenoid lesionsassociated with amalgam restorations: a prospective pilotstudy addressing the adult population of the Basque Country.Med Oral Patol Oral Cir Bucal 2012; 17(4): e545-549.

40. Ostman PO, Anneroth G, Skoglund A: Oral lichen planus lesionsin contact with amalgam fillings: a clinical, histologic, andimmunohistochemical study. Scand J Dent Res 1994; 102(3):172-179.

41. Warnakulasuriya S, Reibel J, Bouquot J, Dabelsteen E: Oralepithelial dysplasia classification system: predictive value,utility, weaknesses and scope for improvement. J Oral PatholMed 2008; 37(3): 127-133.

42. Pinkus H: Lichenoid tissue reactions; a speculative review ofthe clinical spectrum of epidermal cell damage with specialreference to erythema dyschromium pestans. Arch Dermatol1973; 107(6): 840-843.

43. Thornhill MH, Sankar V, Xu XJ, Barrett AW, High AS, OdellEW, Speight PM, Farthing PM: The role of histopathologicalcharacteristics in distinguishing amalgam-associated orallichenoid reactions and oral lichen planus. J Oral Pathol Med2006; 35(4): 233-240.

44. Al-Hashimi I, Schifter M, Lockhart PB, Wray D, Brennan M,Migliorati CA, et al: Oral lichen planus and oral lichenoid lesions:diagnostic and therapeutic considerations. Oral Surg, Oral Med,Oral Pathol, Oral Radiol Endod. 2007; 103 Suppl:S25. e1-12.

45. Cobos-Fuentes MJ, Martinez-Sahuquillo-Marquez A, Gallardo-Castillo I, Armas-Padron JR, Moreno-Fernandez A, Bullon-Fernandez P: Oral lichenoid lesions related to contact withdental materials: A literature review. Med Oral Patol Cir Bucal2009; 14(10): e514-520.

46. Rotim Z, Bolanca Z, Rogulj AA, Andabak M, Boras VV, VrdoljakDV: Oral lichen planus and oral lechenoid reaction. An update.Acta Clin Croat 2015; 54(4): 516-520.

47. Mares S, Ben Slama L, Gruffaz F, Goudot P, Bertolus C:Potentially malignant character of oral lichen planus andlichenoid lesions. Rev Stomatol Chir Maxillofac Chir Orale2013; 114(5): 293-298.

48. Fitzpatrick SG, Hirsch SA, Gordon SC: The malignanttransformation of oral lichen planus and oral lichenoid lesions:a systematic review. J Am Dent Assoc 2014; 145(1): 45-56.

49. Luiz AC, Hirota SK, Dal Vechio A, Reis VM, Spina R, MigliariDA: Diagnosing oral lichenoid contact reaction: clinicaljudgment versus skin-patch test. Minerva Stomatol 2012; 61(7-8): 311-317.

50. Ditrichova D, Kapralova S, Tichy M, Ticha V, Dobesova J,Justova E, et al.: Oral lichenoid lesions and allergy to dentalmaterials. Biomed Pap Med Fac Univ Palacky Olomouc CzechRepub 2007; 151(2): 333-339.

51. Laine L, Kalimo K, Happonen RP: Contact allergy to dentalrestorative materials in patients with oral lichenoid lesions.Contact Dermatitis 1997; 36(3): 141-146.

52. Koch R, Bahmer FA: Oral lesions and symptoms related tometals used in dental restorations: a clinical, allergological,and histologic study. Am Acad Dermatol 1999; 41(3): 422-430.

53. Enestrom S, Hultman P: Does amalgam affects the immunesystem? A controversial issue. Int Arch Allergy Immunol 1995;106(3): 180-203.

immuno-histochemical study, Scand J Dent Res 1994; 102(3):172-179.

61. Skoglund A: Value of epicutaneous patch testing in patientswith oral, mucosal lesions of lichenoid character. Scand JDent Res 1994; 102(4): 216-222.

62. Smart ER, Macleod RI, Lawrence CM: Resolution of lichenplanus following removal of amalgam restoration in patientswith proven allergy to mercury salts: a pilot study. Br Dent J1995; 178(3): 108-112.

63. Montebugnoli L, Venturi M, Gissi DB, Cervellati F: Clinical andhistologic healing of lichenoid oral lesions following amalgamremoval: a prospective study. Oral Surg Oral Med Oral PatholOral Radiol 2012; 113(6): 766-772.

64. Issa Y, Brunton PA, Glenny AM, Duxbury AJ: Healing of orallichenoid lesions after replacing amalgam restorations: asystematic review. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2004; 98(5): 553-565.

Corresponding author:Dimitrios [email protected]

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Literature Review

54. Suter VG, Warnakulasuriya S: The role of patch testing in themanagement of oral lichenoid reactions. J Oral Pathol Med2016; 45(1): 48-57.

55. Pigatto PD, Spadari F, Bombeccari GP, Guzzi G: Oral lichenoidreactions, patch tests, and mercury dental amalgam. J OralPathol Med 2016; 45(2): 153.

56. Thanyavuthi A, Boonchai W, Kasemsarn P: Amalgam contactallergy in oral lichenoid lesions. Dermatitis 2016 [Epub aheadof print].

57. Pawar RR, Mattigatti SS, Mahaparale RR, Kamble AP: Lichenoidreaction associated with silver amalgam restoration in aBombay blood group patient: A case report. J Conserv Dent2016; 19(3): 289-292.

58. Lynch M, Ryan A, Galvin S, Flint S, Healy CM, O’Rourke N,Lynch K, Rogers S, Collins P: Patch testing in oral lichenoidlesions of uncertain etiology. Dermatitis 2015; 26(2): 89-93.

59. Dunsche A, Kastel I, Tenheyden H, Springer ING, ChristopersE, Brash J: Oral lichenoid reactions associated with amalgam;improvement after amalgam removal. Br J Dermatol 2003;148(1): 70-76.

60. Ostman PO, Anneroth G, Skoglund A: Oral lichen planus lesionsin contact with amalgam fillings: a clinical, histologic, andimmuno-histochemical study, Scand J Dent Res 1994; 102(3):172-179.

61. Skoglund A: Value of epicutaneous patch testing in patientswith oral, mucosal lesions of lichenoid character. Scand JDent Res 1994; 102(4): 216-222.

62. Smart ER, Macleod RI, Lawrence CM: Resolution of lichenplanus following removal of amalgam restoration in patientswith proven allergy to mercury salts: a pilot study. Br Dent J1995; 178(3): 108-112.

63. Montebugnoli L, Venturi M, Gissi DB, Cervellati F: Clinical andhistologic healing of lichenoid oral lesions following amalgamremoval: a prospective study. Oral Surg Oral Med Oral PatholOral Radiol 2012; 113(6): 766-772.

64. Issa Y, Brunton PA, Glenny AM, Duxbury AJ: Healing of orallichenoid lesions after replacing amalgam restorations: asystematic review. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2004; 98(5): 553-565.

Hellenic Stomatological Review 59: 35-49, 2015

¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:¢ËÌ‹ÙÚÈÔ˜ ¢ÈÔÓ˘ÛfiÔ˘ÏÔ˜[email protected]

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™‡Á¯ÚÔÓ· ÂÓ‰Ô‰ÔÓÙÈο ÂÌÊÚ·ÎÙÈο ˘ÏÈο Î·È Ê˘Ú¿Ì·Ù·K. KÔ‡ÙÔ˘Ï·˜*, B. M·ÎÚ‹˜**, E.-T. º·ÚÌ¿Î˘***

¶EPI§HæH

™ÙËÓ ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›·, Ë ÂÚÌËÙÈ΋ ¤ÌÊÚ·ÍË ÙÔ˘Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ ·ÔÙÂÏ› ‚·ÛÈ΋ÚÔ¸fiıÂÛË ÁÈ· ÙËÓ ÂÈÙ˘¯›· Ù˘ ÂοÛÙÔÙ ıÂÚ·-›·˜. TÔ ÂÌÊÚ·ÎÙÈÎfi ˘ÏÈÎfi ÂÎÏÔÁ‹˜ Â›Ó·È Ë ÁÔ˘Ù·-¤Úη. OÈ ÎÒÓÔÈ ÁÔ˘Ù·¤Úη˜ Û˘Ó‰˘¿˙ÔÓÙ·È ··-Ú·›ÙËÙ· Ì οÔÈÔ Ê‡Ú·Ì· ÏfiÁˆ Ù˘ ÌË ÚÔÛÎfiÏ-ÏËÛ˘ Ù˘ ÁÔ˘Ù·¤Úη˜ ÛÙËÓ Ô‰ÔÓÙ›ÓË Ù˘ Ú›˙·˜. ™ÎÔ-fi˜ ·˘Ù‹˜ Ù˘ ‚È‚ÏÈÔÁÚ·ÊÈ΋˜ ·Ó·ÛÎfiËÛ˘ ›ӷÈÓ· ·ÚÔ˘ÛÈ¿ÛÂÈ Ù· ÓÂfiÙÂÚ· ÂÓ‰Ô‰ÔÓÙÈο Ê˘Ú¿Ì·Ù·(Ô˘ Ì ‚¿ÛË ÙË ̄ ËÌÈ΋ ÙÔ˘˜ Û‡ÛÙ·ÛË, ‰È·ÎÚ›ÓÔÓÙ·ÈÛ ÛÈÏÈÎÔÓÔ‡¯·, ‚ÈÔÎÂÚ·ÌÈο Î·È Û ÂÚȤ¯ÔÓÙ· MTA)ηıÒ˜ Î·È ÂÓfi˜ Ó¤Ô˘ ˘ÏÈÎÔ‡ ¤ÌÊڷ͢ ÙˆÓ ÚÈ˙ÈÎÒÓۈϋӈÓ. ¶Ú·ÁÌ·ÙÔÔÈ‹ıËΠÂÎÙÂٷ̤ÓË ¤Ú¢ӷ Ù˘‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ‰ËÌÔÛȇÛÂˆÓ Ô˘·ÊÔÚÔ‡Ó Ù· ·Ú·¿Óˆ ̆ ÏÈο Î·È Ê˘Ú¿Ì·Ù·. B·ÛÈÎfiÎÚÈÙ‹ÚÈÔ Ù˘ ¤Ú¢ӷ˜ ‹Ù·Ó Ë ¯ÚÔÓÔÏÔÁ›· ‰ËÌÔÛ›Â˘-Û˘ Û‡Ìʈӷ Ì ÙË ÔÔ›· ·ÔÌÔÓÒıËÎ·Ó Ù· ¿Ú-

SUMMARY

The hermetic sealing of the root canal system, iscrucial in order to prevent recontamination of the rootcanal and periapical tissues. The material that is usedfor obturation in Endodontology is gutta-percha.Because of the non-adherence of gutta-percha to theroot dentin, it is always combined with a sealer, toavoid inefficient sealing of the root canal system. Aimof this literature review is to present the propertiesof newly introduced endodontic sealers, namelysilicone-based, bioceramics, mineral trioxide aggre-gate (MTA) sealers and self-sealing points. Anextended investigation of endodontic literature wascarried out to identify publications on the aforeme-ntioned materials and sealers. The basic criterion ofthis study was the publication date according to which,articles published from January 2000 until September2015 were isolated. The new obturating material

51

Recently introduced endodontic sealing materials and sealers

C. Koutoulas*, V. Makris**, E.-T. Farmakis***

BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË

Literature Review

* TÂÏÂÈfiÊÔÈÙÔ˜ EK¶A** TÂÏÂÈfiÊÔÈÙÔ˜ EK¶A

*** DDS, MSD, PhD, E›ÎÔ˘ÚÔ˜ K·ıËÁËÙ‹˜ EÓ‰Ô‰ÔÓÙ›·˜EK¶A

EıÓÈÎfi Î·È K·Ô‰ÈÛÙÚÈ·Îfi ¶·ÓÂÈÛÙ‹ÌÈÔ AıËÓÒÓ

* DDS** DDS

*** DDS, MSD, PhD, Associate Professor

National and Kapodistrian University of Athens, Faculty of Dentistry

ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 59: 51-69, 2015 Hellenic Stomatological Review 59: 51-69, 2015

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

Hellenic Stomatological Review 59: 51-69, 2015

ıÚ· Ô˘ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ·fi ÙÔÓ I·ÓÔ˘¿ÚÈÔ ÙÔ˘2000 ¤ˆ˜ ÙÔÓ ™Â٤̂ÚÈÔ ÙÔ˘ 2015. T· ÓÂfiÙÂÚ· ÂÌ-ÊÚ·ÎÙÈο ˘ÏÈο ·ÔÙÂÏÔ‡ÓÙ·È ·fi ˘‰ÚfiÊÈÏ· ÔÏ˘-ÌÂÚ‹ Ù· ÔÔ›· Û‡Ìʈӷ Ì ÙÔÓ Î·Ù·Û΢·ÛÙ‹, ÚÔÛ-ÚÔÊÒÓÙ·˜ ˘ÁÚ·Û›· ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ, ‰È·ÛÙ¤ÏÏÔ-ÓÙ·È Î·È ÚÔÛ·ÚÌfi˙ÔÓÙ·È ÛÙÂÓfiÙÂÚ· Ì ٷ ÙÔȯÒÌ·-Ù· ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ. OÈ Û¯ÂÙÈΤ˜ Ì ÙȘ ȉÈfiÙËÙ˜ÙÔ˘ ˘ÏÈÎÔ‡ ·˘ÙÔ‡, ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ¤Ú¢Ó˜ Â›Ó·È Â-ÚÈÔÚÈṲ̂Ó˜. OÈ ¤Ú¢Ó˜ ÁÈ· Ù· ÓÂfiÙÂÚ· Ê˘Ú¿Ì·Ù·Î·Ù·‰ÂÈÎÓ‡Ô˘Ó ˘„ËÏ‹ ÂÌÊÚ·ÎÙÈ΋ ÈηÓfiÙËÙ·, ·Ô-‰ÂÎÙ‹ ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ·, ÌÈÎÚ‹ ‰È·Ï˘ÙfiÙËÙ· ÛÙ· ‚ÈÔ-ÏÔÁÈο ˘ÁÚ¿, ηϤ˜ ÚÂÔÏÔÁÈΤ˜ Î·È ·ÓÙÈÌÈÎÚԂȷΤ˜È‰ÈfiÙËÙ˜. ŸÌˆ˜ ÔÈ ‚Ú·¯˘ÚfiıÂÛ̘ ÂÚÁ·ÛÙËÚȷΤ˜¤Ú¢Ó˜ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÚÔηıÔÚ›ÛÔ˘Ó ÙË Ì·ÎÚÔ-ÚfiıÂÛÌË ÎÏÈÓÈ΋ ·fi‰ÔÛË ÙˆÓ Ê˘Ú·Ì¿ÙˆÓ. °È’ ·˘-Ùfi ··ÈÙÂ›Ù·È ÂÚÈÛÛfiÙÂÚË ¤Ú¢ӷ ¿Óˆ ÛÙ· ÚÔ·-Ó·ÊÂÚı¤ÓÙ· ÓÂfiÙÂÚ· ÂÓ‰Ô‰ÔÓÙÈο Ê˘Ú¿Ì·Ù· ÚÈÓ ÙËÓ¢Ú›· ̆ ÈÔı¤ÙËÛË ÙÔ˘˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú¿-ÍË, ÛÂ Û˘Ó¿ÚÙËÛË ¿ÓÙ· Ì ÙË ‚¤ÏÙÈÛÙË Û¯¤ÛË ·fi-‰ÔÛ˘/ÙÈÌ‹˜.

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™ÙËÓ ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›·, Ë ÂÚÌËÙÈ΋ ¤ÌÊÚ·ÍË ÙÔ˘ Û˘-ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ, ÌÂÙ¿ ÙË ¯ËÌÈÎÔÌ˯·ÓÈ΋ÙÔ˘˜ ÂÂÍÂÚÁ·Û›·, Â›Ó·È Î·ıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜ ÒÛÙ ӷ·ÔÙڷ› Ë Â·Ó·ÌfiÏ˘ÓÛË ·˘ÙÒÓ ·ÏÏ¿ Î·È ÙˆÓ ÂÚÈ·-ÎÚÔÚÈ˙ÈÎÒÓ ÈÛÙÒÓ1. TÔ ÂÌÊÚ·ÎÙÈÎfi ̆ ÏÈÎfi ÂÎÏÔÁ‹˜ ·ÔÙÂÏÂ›Â‰Ò Î·È ¿Óˆ ·fi ¤Ó· ·ÈÒÓ·, Ë ÁÔ˘Ù·¤Úη2. EÂȉ‹ fÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘ÁÎfiÏÏËÛË Ì ÙËÓ Ô‰ÔÓÙ›ÓË, ··ÈÙ›ٷÈË ·Ú¿ÏÏËÏË ¯Ú‹ÛË Î¿ÔÈÔ˘ Ê˘Ú¿Ì·ÙÔ˜ ÁÈ· ÙËÓ ÂÚÌËÙÈ-΋ ¤ÌÊÚ·ÍË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ3. OÈ ÂÈ-ı˘ÌËÙ¤˜ ȉÈfiÙËÙ˜ ÂÓfi˜ ÂÓ‰Ô‰ÔÓÙÈÎÔ‡ Ê˘Ú¿Ì·ÙÔ˜ ÚˆÙÔ-‰È·Ù˘ÒıËÎ·Ó ·fi ÙÔÓ Grossman Ùo 19584, Î·È Ì ÂÏ¿¯È-ÛÙ˜ ÙÚÔÔÔÈ‹ÛÂȘ, ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· Â›Ó·È ÔÈ ·ÎfiÏÔ˘ı˜:

ñ BÈÔÛ˘Ì‚·ÙfiÙËÙ·: £· Ú¤ÂÈ Ó· Â›Ó·È ·ÓÂÎÙfi ·fi ÙÔ˘˜ÂÚÈ·ÎÚÔÚÚÈ˙ÈÎÔ‡˜ ÈÛÙÔ‡˜, Ó· ÌËÓ ÂÁ›ÚÂÈ ·ÓÔÛÔÏÔ-ÁÈ΋ ·¿ÓÙËÛË, Î·È Ó· ÌËÓ Â›Ó·È ÌÂÙ·ÏÏ·ÍÈÔÁfiÓÔ ‹ ηÚ-ÎÈÓÔÁfiÓÔ

ñ KÏÈÓÈο ·Ô‰ÂÎÙfi˜ ̄ ÚfiÓÔ˜ ÂÚÁ·Û›·˜: TÔ Ê‡Ú·Ì· Ú¤-ÂÈ Ó· ¤¯ÂÈ ·ÚÎÂÙfi ¯ÚfiÓÔ ÂÚÁ·Û›·˜ ÒÛÙ ӷ ‰È¢ÎÔ-χÓÂÙ·È Ô ÎÏÈÓÈÎfi˜, ·ÏÏ¿ Ë ‹ÍË ÙÔ˘ Ó· ÔÏÔÎÏËÚÒÓÂ-Ù·È Û ‡ÏÔÁÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÒÛÙ ӷ ÌËÓ Î·ı˘-ÛÙÂÚ› Ë Ì˘ÏÈ΋ ·ÔηٿÛÙ·ÛË.

ñ A‰È¿Ï˘ÙÔ ÛÙ· ‚ÈÔÏÔÁÈο ˘ÁÚ¿ ·ÏÏ¿ ‰È·Ï˘Ùfi Û ‰È·-χÙ˜: H ȉÈfiÙËÙ· ·˘Ù‹ ·ÔÙÂÏ› ·ÎfiÌË ¤Ó·Ó ¿Ï˘ÙÔ°fiÚ‰ÈÔ ¢ÂÛÌfi Ù˘ EÓ‰Ô‰ÔÓÙ›·˜.

ñ A‰Ú·Ó¤˜ ̂ ˜ ÚÔ˜ ÙÔ ̄ ڈ̷ÙÈÛÌfi ÙˆÓ Ô‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ:H Û˘ÓÔ‰‹ ‰˘Û¯ÚˆÌ›· ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ‰ÔÓÙÈÒÓ ¤¯ÂÈ ÌÂȈı› ÛËÌ·ÓÙÈο ÏfiÁˆ Ù˘ ·Ê·›ÚÂÛ˘

consists of hydrophilic polymers which, accordingto the manufacturer, expand by absorbing moisturefrom the environment inside the root canal system.Thus, a narrower and closer fit between the cone andthe canal is achieved. The bibliography regarding theproperties of this material is limited. Studies relatedto the new sealers show sufficient sealing ability,acceptable biocompatibility, low solubility in biologicalfluids, good flow and antimicrobial properties. Con-cluding, short-term laboratory studies cannot prede-termine the long-term clinical performance of sealers.More research (especially Randomized Control Traials)on the aforementioned newer endodontic sealers isrequired, before their broad adoption in everydayendodontic treatment, always in connection withthe best cost to benefit ratio.

Key Words: silicone sealers, bioceramic sealers, MTA sealers,endodontic sealers

INTRODUCTION

The hermetic sealing of the root canal system, followingthe chemomechanical preparation, is crucial in order toprevent recontamination of the root canal and periapicaltissues1. The material that is exclusively used for obturationin endodontology is gutta-percha2. Because of the non-adherence of gutta-percha to the root dentin, it is alwayscombined with a sealer, to avoid inefficient sealing of theroot canal system3. The ideal properties of an endodonticsealer, first stated by Grossman in 19584, and with minormodifications, are still as follows:

ñ Biocompatibility: It has to be tolerated by periapicaltissues, not to raise an immune response, and has tobe non-mutagenic or carcinogenic.

ñ Clinically acceptable working time: The sealer shouldhave sufficient working time, until the completion ofan endodontic treatment but the final setting has to becompleted in a reasonable timeframe so that the finalrestoration can be performed.

ñ Insoluble in biological fluids but soluble to solvents: Thisproperty is still an unsolvable Gordian Knot of Endodontics.

ñ Inert in coloring dental tissues: The concomitantdiscoloration of endodontically treated teeth hassignificantly decreased and tends to become past.

ñ Radiopacity: A required property for better visualizationof the obturated pulp cavity.

ñ Hermetic sealing: It should display zero or minimalshrinkage after setting, whilst a slight expansion wouldbe desirable. It requires close adhesion and moisteningof both the dentin and the gutta-percha from the pastewith the desirable bonding. Furthermore it should be

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unyielding in a static situation but partially elastic indynamic tension.

ñ Antimicrobial activity: Property desired for suppressingand/or eliminating residual microbial agent, but alsoto prevent the re-establishment of the sealed pulp cavity,combined with hermetic coronal restoration.

(Modified from Grossman 19584)None of the existing endodontic sealers fully meet theabove requirements, but most of them are clinicallyacceptable and widely used5.According to their chemical composition, the commerciallyavailable sealers are categorized to those that are basedon glass-ionomer, zinc oxide-eugenol (chelate sealers),calcium hydroxide, epoxy resin, methacrylate resin, mineraltrioxide aggregate, silicone and bioceramics6.The purpose of this literature review was to report the invitro experiment findings and clinical studies related withthe newly introduced endodontic sealers, namely silicone-based, bioceramics, mineral trioxide aggregate (MTA)sealers and self-sealing points.

MATERIALS AND METHODS

An extended investigation of endodontic literature wascarried out to identify publications on the aforementionedmaterials and sealers. The information was collected fromvarious databases (http://www.ncbi.nlm.nih.gov/pubmed/,http://www.scopus.com, http://scholar.google.gr/, googlefree search engine) and from the manufacturers’ websites.The basic criterion of this study was the publication dateaccording to which, articles published from January 2000 untilSeptember 2015 were isolated. The keywords used were:silicone endodontic sealers, silicone sealers, RoekoSeal,Guttaflow, Guttaflow 2, MTA based sealers, bioceramic sealers,bioceramic endodontic sealers, self-sealing points, smartseal.

Silicone based sealers:The use of silicone as an endodontic sealer was firstsuggested in 19777. The first silicone sealers were basedon condensation silicone, whilst the newer materials arebased on addition silicone8. Modern scholarship cites threecommercially available silicone sealers: RoekoSeal,Guttaflow and Guttaflow 2 (all manufactured by Coltene-Whaledent, Swizerland) (Fig.1).

Chemical composition of the sealers:The first commercially available silicone based sealer,RoekoSeal, was distributed to the market in1999 andcontains polydimethylsiloxane, silicone oil, zirconium oxide9.RoekoSeal was followed by Guttaflow, which containsgutta-percha powder, polydimethylsiloxane, silicone oil,paraffin oil, platinum catalyst, zirconium oxide, silver nano-particles (as conservative) and pigments8.An evolution of Guttaflow is Guttaflow 2, which consistsof gutta-percha powder, polydimethylsiloxane, silicone oil,paraffin oil, platinum catalyst, silver microparticles (asconservative) and pigments10.

ÙˆÓ ‚·Ú¤ˆÓ ÌÂÙ¿ÏÏˆÓ Î·È ÙÔ˘ ·ÚÁ‡ÚÔ˘ ·fi ÙË Û‡Ó-ıÂÛË ÙˆÓ Ê˘Ú·Ì¿ÙˆÓ.

ñ AÎÙÈÓÔÛÎÈÂÚfiÙËÙ·: I‰ÈfiÙËÙ· ··Ú·›ÙËÙË ÁÈ· ÙËÓ Î·-χÙÂÚË ·ÂÈÎfiÓÈÛË Ù˘ ÌÔÚÊÔÏÔÁ›·˜ Ù˘ ÂÌÊÚ·Á̤-Ó˘ ÔÏÊÈ΋˜ ÎÔÈÏfiÙËÙ·˜.

ñ EÚÌËÙÈ΋ ÂÌÊÚ·ÎÙÈÎfiÙËÙ·: £· Ú¤ÂÈ Ó· ÂÌÊ·Ó›˙ÂÈ ÌË-‰ÂÓÈ΋ ‹ ÂÏ¿¯ÈÛÙË Û˘ÛÙÔÏ‹ ‹Í˘ ÂÓÒ ı· ‹Ù·Ó ÂÈı˘-ÌËÙ‹ Ë ÂÏ·ÊÚ¿ ‰È·ÛÙÔÏ‹. A·ÈÙÂ›Ù·È ÛÙÂÓ‹ Û˘Ó¿ÊÂÈ·Î·È ‰È·‚ÚÔ¯‹ ÙfiÛÔ Ù˘ Ô‰ÔÓÙ›Ó˘ fiÛÔ Î·È Ù˘ ÁÔ˘Ù·-¤Úη˜ ·fi ÙÔ Ê‡Ú·Ì·, Ì ÂÈı˘ÌËÙ‹ ÙËÓ ¤ÎÊÚ·ÛËÛ˘ÁÎfiÏÏËÛ˘. EÈϤÔÓ ı· Ú¤ÂÈ Ó· Â›Ó·È ·Ó¤Ó‰ÔÙÔÛ ÛÙ·ÙÈ΋ ηٿÛÙ·ÛË, ÂÓÒ Û ‰˘Ó·ÌÈ΋ ÊfiÚÙÈÛË Ó·ÂÌÊ·Ó›˙ÂÈ ÌÂÚÈ΋ ÂÏ·ÛÙÈÎfiÙËÙ·.

ñ AÓÙÈÌÈÎÚԂȷ΋ ‰Ú¿ÛË: I‰ÈfiÙËÙ· ÂÈı˘ÌËÙ‹ ÁÈ· ÙËÓ Î·-Ù·ÛÙÔÏ‹ ‹/Î·È ÂÍ¿ÏÂÈ„Ë ÂÓ·ÔÌ›ӷÓÙÔ˜ ÌÈÎÚÔ‚È·-ÎÔ‡ ·Ú¿ÁÔÓÙ·, ·ÏÏ¿ Î·È ÙËÓ ·ÔÙÚÔ‹ Ù˘ ÂÎ Ó¤Ô˘ÂÁηٿÛÙ·Û˘ ÙÔ˘ ÛÙËÓ ÂÌÊÚ·Á̤ÓË ÔÏÊÈ΋ ÎÔÈÏfi-ÙËÙ·, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÂÚÌËÙÈ΋ Ì˘ÏÈ΋ ¤ÌÊÚ·ÍË.

(TÚÔÔÔÈË̤ÓÔ ·fi Grossman 19584)K·Ó¤Ó· ·fi Ù· ˘¿Ú¯ÔÓÙ· ÂÓ‰Ô‰ÔÓÙÈο Ê˘Ú¿Ì·Ù· ‰ÂÓ·ÓÙ·ÔÎÚ›ÓÂÙ·È Ï‹Úˆ˜ ÛÙȘ ·Ú·¿Óˆ ··ÈÙ‹ÛÂȘ, ·Ï-Ï¿ ÔÏÏ¿ ·fi ·˘Ù¿ Â›Ó·È ÎÏÈÓÈο ·Ô‰ÂÎÙ¿ Î·È ¯ÚËÛÈÌÔ-ÔÈÔ‡ÓÙ·È Â˘Ú¤ˆ˜5.AÓ·ÏfiÁˆ˜ Ì ÙË ̄ ËÌÈ΋ ÙÔ˘˜ Û‡ÓıÂÛË, Ù· ‰È·ı¤ÛÈÌ· ÂÌÔ-ÚÈο Û΢¿ÛÌ·Ù· ηÙËÁÔÚÈÔÔÈÔ‡ÓÙ·È Û ·˘Ù¿ Ô˘ ‚·-Û›˙ÔÓÙ·È ÛÙËÓ ̆ ·ÏÔ˚ÔÓÔÌÂÚ‹ ÎÔÓ›·, ÛÙÔ ÔÍ›‰ÈÔ ÙÔ˘ „¢-‰·ÚÁ‡ÚÔ˘ Ì ¢ÁÂÓfiÏË, ÛÙÔ ˘‰ÚÔÍ›‰ÈÔ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘,ÛÙËÓ ÂÔÍÈ΋ ÚËÙ›ÓË, ÛÙË ÌÂı·ÎÚ˘ÏÈ΋ ÚËÙ›ÓË, ÛÙÔ Ì›Á-Ì· ÙÚÈÔÍÂȉ›ˆÓ ÌÂÙ¿ÏÏˆÓ (MTA), ÛÙË ÛÈÏÈÎfiÓË Î·È ÛÙ· ‚ÈÔ-ÎÂÚ·ÌÈο6.™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ‚È‚ÏÈÔÁÚ·ÊÈ΋˜ ·Ó·ÛÎfiËÛ˘ ‹Ù·Ó Ó·ÂÍÂÙ¿ÛÂÈ Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Î·È ÙȘ ÎÏÈÓÈΤ˜ ÌÂ-ϤÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ٷ ÛÈÏÈÎÔÓÔ‡¯·, Ù· ‚ÈÔÎÂÚ·ÌÈ-ο, Ù· ÂÚȤ¯ÔÓÙ· MTA Ê˘Ú¿Ì·Ù· Î·È ÙÔ self-sealing points(·˘ÙÔÚÔÛ·ÚÌÔ˙fiÌÂÓÔÈ ÎÒÓÔÈ ¤ÌÊڷ͢).

Y§IKA KAI ME£O¢OI

¶Ú·ÁÌ·ÙÔÔÈ‹ıËΠÂÎÙÂٷ̤ÓË ¤Ú¢ӷ Ù˘ ‚È‚ÏÈÔÁÚ·-Ê›·˜ ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ‰ËÌÔÛȇÛÂˆÓ Ô˘ ·ÊÔÚÔ‡Ó Ù··Ú·¿Óˆ ÂÌÊÚ·ÎÙÈο ˘ÏÈο Î·È Ê˘Ú¿Ì·Ù·. H ‚È‚ÏÈÔ-ÁÚ·Ê›· Û˘ÁÎÂÓÙÚÒıËΠ·fi ÙÔ˘˜ ÈÛÙfiÙÔÔ˘˜http://www.ncbi.nlm.nih.gov/pubmed,http://www.scopus.com, http://scholar.google.gr, ·fi ÙËÓÂχıÂÚË Ì˯·Ó‹ ·Ó·˙‹ÙËÛ˘ Ù˘ google Î·È ·fi ÙȘ ÈÛÙÔ-ÛÂÏ›‰Â˜ ÙˆÓ Î·Ù·Û΢¿ÛÙÚÈˆÓ ÂÙ·ÈÚÂÈÒÓ. B·ÛÈÎfi ÎÚÈÙ‹-ÚÈÔ ÂÈÏÔÁ‹˜ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ,‹Ù·Ó Ë ¯ÚÔÓÔÏÔÁ›· ‰ËÌÔÛ›Â˘Û˘. ŒÙÛÈ ¯ÚËÛÈÌÔÔÈ‹ıË-Î·Ó ¿ÚıÚ· Ô˘ ›¯·Ó ‰ËÌÔÛÈ¢ı› ·fi ÙÔÓ I·ÓÔ˘¿ÚÈÔ ÙÔ˘2000 ¤ˆ˜ ÙÔÓ ™Â٤̂ÚÈÔ ÙÔ˘ 2015. ø˜ ϤÍÂȘ ÎÏÂȉȿ ̄ ÚË-ÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ·ÎfiÏÔ˘ı˜: ÛÈÏÈÎÔÓÔ‡¯· ÂÓ‰Ô‰ÔÓÙÈÎ¿Ê˘Ú¿Ì·Ù·(silicone based endodontic sealers), ÛÈÏÈÎÔ-ÓÔ‡¯· Ê˘Ú¿Ì·Ù·(silicone based sealers), RoekoSeal,Guttaflow, Guttaflow 2, Ê˘Ú¿Ì·Ù· Ì ‚¿ÛË ÙÔ Ì›ÁÌ· ÙÚÈÔ-ÍÂȉ›ˆÓ ÙˆÓ ÌÂÙ¿ÏÏˆÓ (MTA based sealers), ‚ÈÔÎÂÚ·ÌÈ-ο Ê˘Ú¿Ì·Ù· (bioceramic sealers), ‚ÈÔÎÂÚ·ÌÈο ÂÓ‰Ô-

Hellenic Stomatological Review 59: 51-69, 2015

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Hellenic Stomatological Review 59: 51-69, 2015

‰ÔÓÙÈο Ê˘Ú¿Ì·Ù·(bioceramic endodontic sealers), selfsealing points, smartseal.

™ÈÏÈÎÔÓÔ‡¯· Ê˘Ú¿Ì·Ù·:H ÛÈÏÈÎfiÓË ÚÔÙ¿ıËΠÙÔ 1977 ÁÈ· ÚÒÙË ÊÔÚ¿ ˆ˜ ÂÓ-‰Ô‰ÔÓÙÈÎfi ʇڷ̷7. T· ÚÒÙ· ÛÈÏÈÎÔÓÔ‡¯· ÂÓ‰Ô‰ÔÓÙÈ-ο Ê˘Ú¿Ì·Ù· ›¯·Ó ̂ ˜ ‚¿ÛË ÛÈÏÈÎfiÓ˜ Û˘Ì‡ÎÓˆÛ˘, ÂÓÒÙ· ÓÂfiÙÂÚ· ̆ ÏÈο ¤¯Ô˘Ó ̂ ˜ ‚¿ÛË ÙË ÛÈÏÈÎfiÓË ÚÔÛı‹Î˘8.™ÙË Û‡Á¯ÚÔÓË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ÙÚ›· ÂÌÔÚÈ-ο ‰È·ı¤ÛÈÌ· ÛÈÏÈÎÔÓÔ‡¯· Ê˘Ú¿Ì·Ù·: RoekoSeal,Guttaflow, Î·È GuttaFlow 2, fiÏ· ηٷÛ΢·˙fiÌÂÓ· ·fiÙËÓ Coltene Whaledent, Swizerland (EÈÎ. 1).

XËÌÈ΋ Û‡ÛÙ·ÛË ÙˆÓ Ê˘Ú·Ì¿ÙˆÓ:TÔ ÚÒÙÔ Â˘Ú¤ˆ˜ ÂÌÔÚÈο ‰È·ı¤ÛÈÌÔ ÛÈÏÈÎÔÓÔ‡¯Ô ʇ-Ú·Ì·, ÙÔ RoekoSeal ‰È·Ù¤ıËΠÛÙËÓ ·ÁÔÚ¿ ÙÔ 1999 ηÈÂÚȤ¯ÂÈ: ¶ÔÏ˘‰ÈÌÂı˘ÏÔÛÈÏÔÍ¿ÓË, ÛÈÏÈÎÔÓÔ‡¯Ô ¤Ï·ÈÔ, ÔÍ›-‰ÈÔ ÙÔ˘ ˙ÈÚÎÔÓ›Ô˘9.TÔ Ê‡Ú·Ì· RoekoSeal, ·ÎÔÏÔ‡ıËÛ ÙÔ GuttaFlow Ô˘ÂÚȤ¯ÂÈ: ™ÎfiÓË ÁÔ˘Ù·¤Úη˜, ÔÏ˘‰ÈÌÂı˘ÏÔÛÈÏÔÍ¿ÓË,ÛÈÏÈÎÔÓÔ‡¯Ô ¤Ï·ÈÔ, ·Ú·Ê›ÓË, ηٷχÙË Ï¢Îfi¯Ú˘ÛÔ˘,‰ÈÔÍ›‰ÈÔ ÙÔ˘ ˙ÈÚÎÔÓ›Ô˘, Ó·ÓÔۈ̷ٛ‰È·-·ÚÁ‡ÚÔ˘ (Û˘-ÓÙËÚËÙÈÎfi), Î·È ¯ÚˆÛÙÈ΋8. MÈ· ÂͤÏÈÍË ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ GuttaFlow ·ÔÙÂÏ› ÙÔGuttaFlow 2 Î·È ÂÚȤ¯ÂÈ: ÛÎfiÓË ÁÔ˘Ù·¤Úη˜, ÔÏ˘‰È-̤ı˘ÏÔÛÈÏÔÍ¿ÓË, ÛÈÏÈÎÔÓÔ‡¯Ô ¤Ï·ÈÔ, ¤Ï·ÈÔ ·Ú·Ê›Ó˘,ηٷχÙË Ï¢Îfi¯Ú˘ÛÔ˘, ‰ÈÔÍ›‰ÈÔ ÙÔ˘ ˙ÈÚÎÔÓ›Ô˘, ÌÈÎÚÔ-ۈ̷ٛ‰È· ·ÚÁ‡ÚÔ˘ (Û˘ÓÙËÚËÙÈÎfi), ¯ÚˆÛÙÈ΋10.TÔ RoekoSeal ‰È·Ê¤ÚÂÈ ·fi ÙÔ Guttaflow Î·È Guttaflow 2ÏfiÁˆ ·Ô˘Û›·˜ ۈ̷Ùȉ›ˆÓ ·ÚÁ‡ÚÔ˘ Î·È ÛÎfiÓ˘ ÁÔ˘-Ù·¤Úη˜. TÔ Guttaflow Î·È Guttaflow 2 ÂÚȤ¯Ô˘Ó ÁÔ˘-Ù·¤Úη Û ÛÎfiÓË (Û ̤ÁÂıÔ˜ ¤ˆ˜ 30Ìm), ¿ÚÁ˘ÚÔ Û ̛-ÎÚÔ Î·È Ó¿ÓÔ ÛˆÌ·Ù›‰È· ·ÓÙ›ÛÙÔȯ·10.

º˘Ú¿Ì·Ù· Ì ‚¿ÛË M›ÁÌ· ÙÚÈÔÍÂȉ›ˆÓ ÌÂÙ¿ÏÏˆÓ (MineralTrioxideAggregate)To MTA ·Ó·Ù‡¯ıËΠ·fi ÙÔÓ Torabinejad Î·È ÙËÓ ÔÌ¿‰·ÙÔ˘, ÛÙȘ ·Ú¯¤˜ ÙÔ˘ 1990 Î·È Ë ÚÒÙË ÌÂϤÙË ¿Óˆ Û ·˘-Ùfi ‰ËÌÔÛȇıËΠÙÔ 1993 ·fi ÙÔ˘˜ Lee Î·È Û˘Ó.11. ™ÙË ‚È-‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È 4 ÂÌÔÚÈο ‰È·ı¤ÛÈÌ· Ê˘Ú¿Ì·Ù·Ì ‚¿ÛË ÙÔ Ì›ÁÌ· ÙÚÈÔÍÂȉ›ˆÓ ÌÂÙ¿ÏψÓ: TÔ MTA Filla-pex(Angelus, Londrina, Brazil), ÙÔ ProRoot Endo Sealer (De-ntsplyTulsa Dental Specialities, Dentsply/Maillefer, Ballaigues,Switzerland), ÙÔ CPM Sealer (EGEOSRL, MTM Argentina SA,BuenosAires, Argentina), Î·È ÙÔ MTA Obtura (Angelus, AngelusOdontologica, Londrina, PR, Brazil)9, 12 (EÈÎ. 2,3).

XËÌÈ΋ Û‡ÛÙ·ÛËTÔ MTA Fillapex ÌÂÙ¿ ÙËÓ ·Ó¿ÌÂÈÍË ÙÔ˘ ÂÚȤ¯ÂÈ: Û·ÏÈ-΢ÏÈ΋ ÚËÙ›ÓË, Ê˘ÛÈ΋ ÚËÙ›ÓË, ·Ú·ÈˆÌ¤ÓË ÚËÙ›ÓË, ÔÍ›-‰ÈÔ ÙÔ˘ ‚ÈÛÌÔ˘ı›Ô˘, Ó·ÓÔ-ۈ̷ٛ‰È· ˘ÚÈÙ›Ô˘, MTA, ̄ Úˆ-ÛÙÈΤ˜ Ô˘Û›Â˜12.TÔ CPM Sealer ÂÚȤ¯ÂÈ: MTA, ‰ÈÔÍ›‰ÈÔ ÙÔ˘ ˘ÚÈÙ›Ô˘, ·Ó-ıÚ·ÎÈÎfi ·Û‚¤ÛÙÈÔ, ÔÍ›‰ÈÔ ÙÔ˘ ‚ÈÛÌÔ˘ı›Ô˘, ıÂÈÈÎfi ‚¿-ÚÈÔ, ÚÔ‡ÏÂÓÔ-ÁÏ˘ÎÔÏÈÎfi ·ÏÁÈÓÈÎfi, ÚÔ‡ÏÂÓÔ-ÁÏ˘Îfi-ÏË, ÎÈÙÚÈÎfi Ó¿ÙÚÈÔ, ¯ÏˆÚÈÔ‡¯Ô ·Û‚¤ÛÙÈÔ9.TÔ Ê‡Ú·Ì· ProRoot Endo Sealer ·ÔÙÂÏÂ›Ù·È ·fi ˘ÁÚfiÎ·È ÛÎfiÓË. ™ÎfiÓË: ˘ÚÈÙÈÎfi ·Û‚¤ÛÙÈÔ, ıÂÈ˚Îfi ·Û‚¤ÛÙÈÔ,

RoekoSeal differs from Guttaflow and Guttaflow 2 due tothe absence of silver particles and gutta-percha powder.Guttaflow and Guttaflow 2 contain gutta-percha (at amaximum size of 30Ìm), silver nano- and micro- particlesrespectively10.

Sealers based on mineral trioxide aggregate (MTAsealers):MTA was developed by Torabinejad and his partners, inearly 1990, and his first study on the material was publishedin 1993 by Lee et al.11. Four commercially available sealersbased on mineral trioxide aggregate are cited inbibliography: MTA Fillapex (Angelus, Londrina, Brazil),ProRoot Endo sealer (Dentsply Tulsa Dental Specialties,Dentsply/Maillefer, Ballaigues, Swizerland), CPM Sealer(EGEOSRL, MTM Argentina SA, Buenos Aires, Argentina)and MTA Obtura (Angelus, Angelus Odontologica,Londrina, PR, Brazil)9, 12 (Fig. 2,3).

Chemical composition:The MTA Filapex contains after its mixture: salicylate resin,natural resin, diluted resin, bismuth oxide, nano-siliconparticles, MTA, pigments12.The CPM Sealer contains: MTA, silica dioxide, calciumcarbonate, bismuth oxide, barium sulfate, propylene glycolalginate, propylene glycol, sodium citrate, calcium chloride9.The ProRoot Endo Sealer consists of powder and liquid.Powder: calcium silicate, calcium sulfate, bismuth oxide,calcium aluminate. Liquid: viscous aqueous solution of asoluble polymer in water9.The MTA Obtura is composed by white MTA, viscous fluidaqueous base9.

Bioceramics:Bioceramic materials are recently introduced toEndodontics, mainly as restorative cements and pastes,but also as root canal sealers13. In the bibliography reportedone commercially available bioceramic sealer is cited,

EÈÎ. 1. H ÂÌÔÚÈ΋ Û˘Û΢·Û›· ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ Guttaflow

Fig. 1: The commercial package of Guttaflow sealer

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ÔÍ›‰ÈÔ ÙÔ˘ ‚ÈÛÌÔ˘ı›Ô˘, ·ÚÁÈÏÈÎfi ·Û‚¤ÛÙÈÔ. YÁÚfi: ·-¯‡ÚÚ¢ÛÙÔ ˘‰·ÙÈÎfi ‰È¿Ï˘Ì· ÂÓfi˜ ¢‰È¿Ï˘ÙÔ˘ ÛÙÔ ÓÂÚfiÔÏ˘ÌÂÚÔ‡˜9.T· ÂÚȯfiÌÂÓ· ÙÔ˘ MTA Obtura ›ӷÈ: Ï¢Îfi MTA, ·-¯‡ÚÚ¢ÛÙÔ ˘‰·ÙÈ΋˜ ‚·Û˘ ˘ÁÚfi9.

BÈÔÎÂÚ·ÌÈοT· ‚ÈÔÎÂÚ·ÌÈο ̆ ÏÈο ÂÈÛ‹¯ıËÛ·Ó ÚfiÛÊ·Ù· ÛÙËÓ EÓ‰Ô-‰ÔÓÙ›·, ΢ڛˆ˜ ̂ ˜ ·ÓÔÚıˆÙÈΤ˜ ÎÔӛ˜ ·ÏÏ¿ Î·È ̂ ˜ Ê˘-Ú¿Ì·Ù· ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ13. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂ-Ù·È ¤Ó· ÂÌÔÚÈο ‰È·ı¤ÛÈÌÔ ‚ÈÔÎÂÚ·ÌÈÎfi ʇڷ̷, ÙÔEndoSequence BC ÙÔ ÔÔ›Ô Â›Ó·È ÁÓˆÛÙfi Î·È ˆ˜ iRootSP14 Î·È ÛÙËÓ E˘ÚÒË Î˘ÎÏÔÊÔÚ› ˆ˜ Totalfill15 (EÈÎ. 4).

XËÌÈ΋ Û‡ÛÙ·ÛËTÔ ÚÒÙÔ Â˘Ú¤ˆ˜ ÂÌÔÚÈο ‰È·ı¤ÛÈÌÔ ‚ÈÔÎÂÚ·ÌÈÎfi ʇ-Ú·Ì·, EndoSequence BC (iRoot SP), ‰È·Ù¤ıËΠÛÙËÓ ·ÁÔ-Ú¿ ÙÔ 2009 Î·È ÂÚȤ¯ÂÈ: ÔÍ›‰ÈÔ ÙÔ˘ ˙ÈÚÎÔÓ›Ô˘, ˘ÚÈÙÈÎfi·Û‚¤ÛÙÈÔ, ‰ÈÛfiÍÈÓÔ ÊˆÛÊÔÚÈÎfi ·Û‚¤ÛÙÈÔ, ̆ ‰ÚÔÍ›‰ÈÔ ÙÔ˘·Û‚ÂÛÙ›Ô˘ Î·È ‰È¿ÊÔÚÔ˘˜ ÂÓÈÛ¯˘ÙÈÎÔ‡˜ Î·È ıÈÍÔÙÚÔÈÎÔ‡˜·Ú¿ÁÔÓÙ˜13.

Self sealing/expanding points (A˘ÙÔÚÔÛ·ÚÌÔ˙fiÌÂÓÔÈÎÒÓÔÈ ¤ÌÊڷ͢)H ‰È·ÛÙÔÏ‹ ÙˆÓ ÈÛÙÒÓ (tissue expansion) ¤¯ÂÈ Â‰Ú·Èˆı›ˆ˜ ÌÈ· ¯Ú‹ÛÈÌË Ï‡ÛË ÛÙËÓ ·ÔηٿÛÙ·ÛË ÙˆÓ Ì·Ï·ÎÒÓÈÛÙÒÓ Û ·È‰È¿ Î·È ÂÓ‹ÏÈΘ ÌÂÙ¿ ·fi ·Ù˘¯‹Ì·Ù·. TËÓȉ¤· ÁÈ· ÙËÓ ÔÛ̈ÙÈ΋ ‰È·ÛÙÔÏ‹ ÙˆÓ ÈÛÙÒÓ ÙËÓ Û˘Ó¤Ï·-

Endosequence BC, which is also known as iRoot SP14 andis released in Europe as Totalfil15 (Fig. 4).

Chemical composition:The first commercially available bioceramic sealer,EndoSequence BC (iRoot SP), released on the market in2009, contains zirconium oxide, calcium silicate, calciumdihydrogen phosphate, calcium hydroxide and variousfilling and thickening agents13.

Self-sealing/expanding points:Tissue expansion was established as a useful solution tothe restoration of the soft tissues in children and adultsafter accidents. The idea of the osmotic tissue expansionwas conceived by Austad and Rose16, who were based onthe way in which the osmotic forces drive the water fromthe surrounding tissues, via a semi-permeable membrane,in a “balloon” with hypertonic fluid17.The aforementioned idea was applied in dentistry andespecially in the field of endodontics.The literature review revealed just one system of self-sealingpoints: Smartseal. The system was released on the marketin 2007 as an innovative sealing material of the root canals,which could help the accomplishment of more hermeticendodontic therapies18.

Chemical composition:The smartseal is a system consisting of:

ñ Propoint

ñ Smartpaste/Smartpaste Bio

The propoint (also known as C-Point) is the solid part ofthe obturting system and consists of two parts: the centralcore and the outer polymer surface.The central core is the combination of two nylon polymers,Trogamid T and Trogamid CX.The outer polymer surface is comprised by acrylonitrilecopolymer and vinylpirolidone, resulting from thecombination of allyl methacrylate and a thermal initiator.

Hellenic Stomatological Review 59: 51-69, 2015

EÈÎ. 4. H ÂÌÔÚÈ΋ Û˘Û΢·Û›· ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ Endosequence BC

Fig. 4: The commercial package of Endosequence BC sealer

EÈÎ. 2. H ÂÌÔÚÈ΋ Û˘Û΢·Û›· ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ MTA Fillapex

Fig. 2: The commercial package of MTA Fillapex sealer

EÈÎ. 3. H ÂÌÔÚÈ΋ Û˘Û΢·Û›· ÙÔ˘ ·˘ÙÔ·Ó·Ì˘ÁÓ˘fiÌÂÓÔ˘ Ê˘-Ú¿Ì·ÙÔ˜ MTA Fillapex

Fig. 3: The commercial package of auto-mix MTA Fillapex sealer

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‚·Ó ÔÈ Austad Î·È Rose16 ‚·ÛÈ˙fiÌÂÓÔÈ ÛÙÔÓ ÙÚfiÔ Ì ÙÔÓÔÔ›Ô ÔÈ ÔÛ̈ÙÈΤ˜ ‰˘Ó¿ÌÂȘ Ô‰ËÁÔ‡Ó ÙÔ ÓÂÚfi ·fi ÙÔ˘˜Á‡Úˆ ÈÛÙÔ‡˜, ̤ۈ ÌÈ·˜ ËÌÈ-‰È·ÂÚ·Ù‹˜ ÌÂÌ‚Ú¿Ó˘, Û¤ӷ Ì·ÏfiÓÈ Ì ˘ÂÚÙÔÓÈÎfi ˘ÁÚfi17. H ·Ú·¿Óˆ ȉ¤· ‚ڋΠÂÊ·ÚÌÔÁ‹ Î·È ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ-΋ Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÛÙËÓ ÂÓ‰Ô‰ÔÓÙ›·. ™ÙË ‚È‚ÏÈÔÁÚ·-Ê›· ·Ó·Ê¤ÚÂÙ·È ¤Ó· Û‡ÛÙËÌ· self sealing: ÙÔ smartseal.TÔsmartseal ¿Ú¯ÈÛ ӷ Â›Ó·È ÂÌÔÚÈο ‰È·ı¤ÛÈÌÔ ÙÔ 2007 ̂ ˜¤Ó· ηÈÓÔÙfiÌÔ ÂÌÊÚ·ÎÙÈÎfi ˘ÏÈÎfi ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ Ô˘ı· ‚ÔËıÔ‡Û ÛÙËÓ Â›Ù¢ÍË ÂÚÌËÙÈÎfiÙÂÚˆÓ ÂÓ‰Ô‰ÔÓÙÈ-ÎÒÓ ıÂÚ·ÂÈÒÓ18.

XËÌÈ΋ Û‡ÛÙ·ÛËTÔ smartseal Â›Ó·È ¤Ó· Û‡ÛÙËÌ· Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi Ù·:

ñ Propoint

ñ Smartpaste/Smartpaste Bio

To Propoint (ÁÓˆÛÙfi Î·È ̂ ˜ C-Point) ·ÔÙÂÏÂ›Ù·È ·fi ‰‡Ô̤ÚË: ÙÔÓ ÎÂÓÙÚÈÎfi ˘Ú‹Ó· Î·È ÙËÓ Â͈ÙÂÚÈ΋ ÔÏ˘ÌÂÚ‹ÂÈÊ¿ÓÂÈ·.KÂÓÙÚÈÎfi˜ ˘Ú‹Ó·˜: AÔÙÂÏÂ›Ù·È ·fi ÙÔÓ Û˘Ó‰˘·ÛÌfi ‰‡ÔNylon ÔÏ˘ÌÂÚÒÓ, Trogamid T Î·È Trogamid CX. E͈ÙÂÚÈ΋ ÔÏ˘ÌÂÚ‹˜ ÂÈÊ¿ÓÂÈ·: AÔÙÂÏÂ›Ù·È ·fi ÙÔÓÛ˘Ó‰˘·ÛÌfi Û˘ÌÔÏ˘ÌÂÚÔ‡˜ ÙÔ˘ ·ÎÚ˘ÏÔÓÈÙÚÈÏ›Ô˘ ηȂÈÓ˘ÏÈÚÔÏȉfiÓ˘ Ô˘ ÚԤ΢„·Ó ·fi ÙÔÓ Û˘Ó‰˘·ÛÌfiÌÂı·ÎÚ˘ÏÈÎÔ‡ ·ÏÏ˘ÏÂÛÙ¤Ú· (allyl methacrylate) Î·È ÂÓfi˜ıÂÚÌÈÎÔ‡ ηٷχÙË. A˘Ù‹ Ë ˘‰ÚfiÊÈÏË ÂÈÊ¿ÓÂÈ· ˘‰ÚÔ-Á¤Ï˘, ÂÈÙÚ¤ÂÈ ÛÙÔÓ ÎÒÓÔ Ó· ‰È·ÛÙ·Ï› ¤ÙÛÈ ÒÛÙ ӷÚÔÛ·ÚÌÔÛÙ› ÛÙÔÓ ÚÈ˙ÈÎfi ۈϋӷ. A˘Ù‹ Ë Â›ÛÙÚˆÛËۯ‰ȿÛÙËΠӷ ‰È·ÛÙ¤ÏÏÂÙ·È Ï·Á›ˆ˜ Î·È fi¯È ·ÎÚÔÚÈ˙È-ο, ‰È·ÙËÚÒÓÙ·˜ ·ÌÂÙ¿‚ÏËÙÔ ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ÎÒÓÔ˘19, 20. HÂÈÊ¿ÓÂÈ· ·˘Ù‹ Â›Ó·È ̆ ‰ÚfiÊÈÏË Î·È ÚÔÛÚÔÊÒÓÙ·˜ ̆ ÁÚ·-Û›· ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ, ‰È·ÛÙ¤ÏÏÂÙ·È Î·È ÚÔÛ·ÚÌfi˙ÂÙ·ÈÛÙÂÓfiÙÂÚ· Ì ٷ ÙÔȯÒÌ·Ù· ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ.Smartpaste: E›Ó·È ¤Ó· ʇڷ̷ ‚·ÛÈṲ̂ÓÔ ÛÙË ÚËÙ›ÓË, Ô˘ÂÚȤ¯ÂÈ ¤Ó· ÂÓÂÚÁfi ÔÏ˘ÌÂÚ¤˜ ÙÔ ÔÔ›Ô ‰È·ÛÙ¤ÏÏÂÙ·ÈÒÛÙ ӷ ÁÂÌ›ÛÂÈ ÔÔÈÔ‰‹ÔÙ ÎÂÓfi ‹ ÎÔÈÏfiÙËÙ· ÙÔ˘ ÚÈ˙È-ÎÔ‡ ۈϋӷ19. H ‰È·ÛÙÔÏ‹ ÙÔ˘ Smartpaste Ú·ÁÌ·ÙÔ-ÔÈÂ›Ù·È Ì ÙËÓ ÂÓ˘‰¿ÙˆÛË ÙÔ˘ ·fi ÙÔ˘˜ Ô‰ÔÓÙÈÎÔ‡˜ÈÛÙÔ‡˜21.Smartpaste Bio: E›Ó·È ¤Ó· ÚËÙÈÓÔ‡¯Ô ʇڷ̷ Ô˘ Û¯Â-‰È¿ÛÙËΠӷ ‰È·ÛÙ¤ÏÏÂÙ·È, Ì ÙËÓ ÚÔÛı‹ÎË ÏÂÈÔÙÚÈ‚Ë-̤ÓÔ˘ ÔÏ˘ÌÂÚÔ‡˜. O ηٷÛ΢·ÛÙ‹˜ ÈÛ¯˘Ú›˙ÂÙ·È fiÙÈÌ ÙËÓ ÚÔÛı‹ÎË ‚ÈÔÎÂÚ·ÌÈÎÒÓ ÚÔÛ‰›‰ÂÈ ÛÙÔ Ê‡Ú·Ì·ÂÍ·ÈÚÂÙÈ΋ ÛÙ·ıÂÚfiÙËÙ· ‰È·ÛÙ¿ÛÂˆÓ Î·È ÙÔ Î·ıÈÛÙ¿ ÌË·ÔÚÚÔÊ‹ÛÈÌÔ Ì¤Û· ÛÙÔÓ ÚÈ˙ÈÎfi ۈϋӷ19. TÔ Smartseal (DRFPL Ltd, Stamford, United Kingdom)‚Ú›ÛÎÂÙ·È ÛÙÔ ÂÌfiÚÈÔ Î·È ˆ˜ Smartpoint, Ô˘ Â›Ó·È ÔÎÒÓÔ˜ ¤ÌÊڷ͢, Î·È Smartpaste, Ô˘ Â›Ó·È ÙÔ Ê‡Ú·Ì·(EÈÎ. 5,6).

A¶OTE§E™MATA

H ·ÚÔ˘Û›·ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘ ·Ó·ÛÎfiËÛ˘ Á›-ÓÂÙ·È ÔÌ·‰ÔÔÈË̤ӷ ·Ó¿ÏÔÁ· Ì ÙËÓ Î¿ı ÌÂÏÂÙÒÌÂÓËȉÈfiÙËÙ·. EÈϤÔÓ ÛÙÔÓ ¶›Ó·Î· 1 Á›ÓÂÙ·È ·Ú¿ıÂÛË ÙˆÓ·Ó·ÊÂÚÔÌ¤ÓˆÓ Ê˘Ú·Ì¿ÙˆÓ ·Ó¿ ̄ ËÌÈ΋ ÔÈÎÔÁ¤ÓÂÈ· ÚÔ˜‰È¢ÎfiÏ˘ÓÛË ÙˆÓ ·Ó·ÁÓˆÛÙÒÓ.

This hydrophilic hydrogel surface allows the cone to expandin order to adjust to the internal canal anatomy. This coatingis designed to expand laterally and not vertically withoutaltering the working length of the cone19, 20. Its surface ishydrophilic and it expands by absorbing moisture from theenvironment inside the root canal system. Thus, a narrowerand closer fit between the cone and the canal is achieved. Smartpaste: Is a resin-based sealer that contains anexpanding active polymer in order to fill any gap, void orcavity of the root canal19. The expansion of Smartpastedepends on its hydration from the dental tissues21.Smartpaste Bio: Is also a resin-based sealer that is designedto expand with the addition of a ground polymer. Themanufacturer claims that the addition of bioceramics givesthe sealer excellent dimensional stability and makes it non-absorbable within the root canal19.The Smartseal (DRFPL Ltd, Stamford, United Kingdom) isavailable on the market also as Smartpoint, i.e. the sealingcone, and Smartpaste, i.e. the sealer (Fig. 5,6).

EÈÎ. 5. O ÎÒÓÔ˜ ¤ÌÊڷ͢ Propoint

Fig. 5: The Propoint obturation point

EÈÎ. 6. TÔ Û‡ÛÙËÌ· ¤ÌÊڷ͢ Smartseal

Fig. 6: The Smartseal obturation system

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

EÌÊÚ·ÎÙÈ΋ ÈηÓfiÙËÙ·H ÂÚÌËÙÈ΋ ¤ÌÊÚ·ÍË ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ Â›Ó·È ÌÂÁ¿Ï˘ÎÏÈÓÈ΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ Ì·ÎÚÔÚfiıÂÛÌË ÂÈÙ˘¯›· Ù˘ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂڷ›·˜22 ηıÒ˜ ÂÌÔ‰›˙ÂÈ ÙËÓ ÙËÓ Â·-Ó·ÌfiÏ˘ÓÛË ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ Î·È ̂ ˜ ÂÎ ÙÔ‡ÙÔ˘ Î·È ÙˆÓÂÚÈ·ÎÚÔÚÚÈ˙ÈÎÒÓ ÈÛÙÒÓ23.™ÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ¤Ú¢ӷ ÙˆÓ Bouillaguet Î·È Û˘Ó. ÂϤÁ-¯ıËÎÂ Ë ÂÌÊÚ·ÎÙÈ΋ ÈηÓfiÙËÙ· ÙÂÛÛ¿ÚˆÓ Ê˘Ú·Ì¿ÙˆÓ ·Ó¿‰È¿ÊÔÚ· ̄ ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·. TȘ ÚÒÙ˜ 12 ÒÚ˜ Ë ‰È·Ú-ÚÔ‹ ÌÂȈÓfiÙ·Ó Û˘Ó¯Ҙ Î·È ÌÂÙ¿ ·fi 24 ÒÚ˜ ÙÔ AH PlusÎ·È ÙÔ PCS ÂÌÊ¿ÓÈÛ·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ‰È·ÚÚÔ‹Û ۯ¤ÛË Ì ÙÔ GuttaFlow Î·È ÙÔ Epiphany. T¤ÏÔ˜, ·Ú¿ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ˘‹Ú¯Â ÌÈ· Ù¿ÛË ÚÔ˜ ·‡ÍËÛË Ù˘ ‰È·Ú-ÚÔ‹˜, ‰ÂÓ ̆ ‹ÚÍ·Ó ÛËÌ·ÓÙÈΤ˜ ·ÏÏ·Á¤˜ ·Ó¿ÌÂÛ· ÛÙȘ 24ÒÚ˜ Î·È ÙÔÓ 1 ̄ ÚfiÓÔ23. ™‡ÌʈÓË Ì ٷ ·ÔÙÂϤÛÌ·Ù· ·˘-Ù¿ Â›Ó·È Î·È Ë ex vivo ¤Ú¢ӷ ÙˆÓ Savariz et al, ÛÙËÓ ÔÔ›·Ë ÂÌÊÚ·ÎÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ GuttaFlow Â›Ó·È Î·Ï‡ÙÂÚË·˘Ù‹˜ ÙÔ˘ AH Plus Û fiÏ· Ù· ‰È·ÛÙ‹Ì·Ù· Ù˘24. EÓ ·ÓÙÈ-ı¤ÛÂÈ Ì ٷ ·Ú·¿Óˆ,Û ÌÈ· ¿ÏÏË ¤Ú¢ӷ Ë ÂÌÊÚ·ÎÙÈ-΋ ÈηÓfiÙËÙ· ÙÔ˘ GuttaFlow ‰ÂÓ ÂÌÊ¿ÓÈÛ ÛÙ·ÙÈÛÙÈο ÛË-Ì·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û˘ÁÎÚÈÓfiÌÂÓË Ì ·˘Ù‹ ÙÔ˘ AH Plus Û‰ȿÛÙËÌ· 23 ËÌÂÚÒÓ25. ŸÌˆ˜ ÙÔ GuttaFlow Î·È ÙÔ AH Plus

ResultsThe results are presented grouped, according to the studiedproperty. Additionally, for the readers convenience allthe reported sealers per chemical composition are listed(Table 1).

Sealing abilityThe sufficient sealing of the root canals is of great clinicalimportance in the long-term success of the endodontictreatment22, because it prevents bacterial penetration andthe recontamination of the root canal and periapical tissues23.Bouillaguet et al. tested the in vitro sealing ability of foursealers at various time intervals. During the first 12 hours theleakage was decreasing steadily and after 24 hours theAH Plus and PCS showed significantly greater leakage thanGuttaFlow and Epiphany. In conclusion, despite the fact thatthere was a tendency in incensement of the leakage, therewere no significant changes between 24 hours and 1 year23.In agreement with these results is the ex vivo study of Savarizet al., which showed that the sealing ability of GuttaFlow isbetter than that of AH Plus at all the tested time intervals24.Elias et al. are in contrast with the above results demonstrating

Hellenic Stomatological Review 59: 51-69, 2015

º˘Ú¿Ì·Ù· EÌÔÚÈ΋ OÓÔÌ·Û›·

¶›Ó·Î·˜ 1: OÌ·‰ÔÔ›ËÛË ÙˆÓ ·Ó·ÊÂÚfiÌÂÓˆÓ ÂÓ‰Ô‰ÔÓÙÈÎÒÓ Ê˘Ú·Ì¿ÙˆÓ, ·Ó¿ÏÔÁ· Ì ÙË ¯ËÌÈ΋ ÙÔ˘˜ Û‡ÛÙ·ÛË

ñ EÔÍÈ΋ ÚËÙ›ÓË AH26AH Plus

ñ MÂı·ÎÚ˘ÏÈ΋ ÚËÙ›ÓË RealSeal SEEpiphany

ñ OÍ›‰ÈÔ ÙÔ˘ „¢‰·ÚÁ‡ÚÔ˘ Ì ¢ÁÂÓfiÏË Roth 801Pulp Canal Sealer (PCS)Tubli-Seal

ñ ¢ÈÔÍ›‰ÈÔ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ ApexitSealapex

ñ ™ÈÏÈÎfiÓË RoekoSealGuttaFlowGuttaFlow 2

ñ MTA MTA FillapexCPM SealerPro Root Endo SealerMTA Obtura

ñ BÈÔÎÂÚ·ÌÈο Endosequence BC/iRoot SP

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Hellenic Stomatological Review 59: 51-69, 2015

‰ÂÓ ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ÌÈ-ÎÚԉțۉ˘ÛË ÌÂٷ͇ ÙÔ˘˜26. TÔ GuttaFlow Û ۯ¤ÛË ÌÂÙÔ AH 26 Î·È ÙÔ RoekoSeal ÂÌÊ¿ÓÈÛ ÌÈÎÚfiÙÂÚË ÂÌÊÚ·-ÎÙÈ΋ ÈηÓfiÙËÙ·27. TÔ GuttaFlow Û˘ÁÎÚÈÙÈο Ì ÙÔ AH Plus‰ÂÓ ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÂÌÊÚ·ÎÙÈÎfiÙËÙ·˜ ›-Ù Û ‰È¿ÛÙËÌ· ÌÈ·˜ ‚‰ÔÌ¿‰·˜ ›Ù ÙÚÈÒÓ ÌËÓÒÓ28.TÔ MTA Fillapex ·ÚÔ˘Û›·Û ÌÈÎÚfiÙÂÚË ÌÈÎÚԉțۉ˘ÛËÛ ۯ¤ÛË Ì ÙÔ Endo-CPM29 ÂÓÒ ‰ÂÓ ÂÌÊ¿ÓÈÛ ÛÙ·ÙÈÛÙÈ-ο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Ì ÙÔ AH2630.TÔ iRoot SP ¤¯ÂÈ ·Ô‰Âȯı› ˆ˜ ¤¯ÂÈ ÈÛÔ‰‡Ó·ÌË ·ÎÚÔÚ-ÚÈ˙È΋ ÂÌÊÚ·ÎÙÈ΋ ÈηÓfiÙËÙ· Ì ÙÔ Ê‡Ú·Ì· AH Plus31.

ñ º˘ÛÈÎÔ¯ËÌÈΤ˜ ȉÈfiÙËÙ˜OÈ Ê˘ÛÈÎÔ¯ËÌÈΤ˜ ȉÈfiÙËÙ˜ ÙˆÓ Ê˘Ú·Ì¿ÙˆÓ ¤¯Ô˘Ó ÛË-Ì·ÓÙÈ΋ ›‰Ú·ÛË ÛÙËÓ ÔÈfiÙËÙ· Ù˘ ÙÂÏÈ΋˜ ¤ÌÊڷ͢.H Û˘ÌÂÚÈÊÔÚ¿ ÛÙÔÓ ¯ÂÈÚÈÛÌfi ηıÒ˜ Î·È ÛÙËÓ ÎÏÈÓÈ΋ÙÔ˘˜ ̄ Ú‹ÛË ÌÔÚ› Ó· ·ÍÈÔÏÔÁËı› Ì ÂÚÁ·ÛÙËÚȷο ÂÈ-Ú¿Ì·Ù·, Ô˘ ÂÍÂÙ¿˙Ô˘Ó ÙȘ Ê˘ÛÈΤ˜ ÙÔ˘˜ ȉÈfiÙËÙ˜. OÈ Ê˘-ÛÈΤ˜ ȉÈfiÙËÙ˜ ÔÏÏÒÓ ÂÓ‰Ô‰ÔÓÙÈÎÒÓ Ê˘Ú·Ì¿ÙˆÓ ¤¯Ô˘ÓÌÂÏÂÙËı› ÂÎÙÂÓÒ˜ Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÙÔ ¯ÚfiÓÔ ÂÚÁ·-Û›·˜, ÙÔ ¯ÚfiÓÔ ‹Íˆ˜, ÙË ÚÔ‹, ÙÔ ¿¯Ô˜ ÙÔ˘ ‰ËÌÈÔ˘Ú-ÁÔ‡ÌÂÓÔ˘ ÛÙÚÒÌ·ÙÔ˜ (film thickness), ÙË ‰È·Ï˘ÙfiÙËÙ·,ÙËÓ ·ÏÏ·Á‹ ‰È·ÛÙ¿ÛÂˆÓ Î·È ÙËÓ ·ÎÙÈÓÔÛÎÈÂÚfiÙËÙ·32.

that the sealing ability of GuttaFlow has not showed significantdifference statistically compared to AH Plus in a 23 daysperiod25. Furthermore, the leakage of the zinc oxide-eugenolsealer was significantly greater than GuttaFlow and AH Plus.But GuttaFlow and AH Plus showed no significant differencestatistically in microleakage between them26. GuttaFlowcompared with AH 26 and RoekoSeal showed lower sealingability27. Nevertheless, when compared with AH Plus,Guttaflow has not shown significant sealing difference eitherin one week or in three month period28.MTA Fillapex has shown less microleakage compared withEndo-CPM29, whilst it has not shown significant differencestatistically with AH 2630.It was reported that iRootSp has an apical sealing abilityequivalent to that of AH Plus31.

Physicochemical propertiesThe sealer properties affect significantly the sealing qualityof the root canal. The behavior in handling and in clinicaluse can be assessed by laboratory experiments, testingtheir physical properties. The physical properties of severalendodontic sealers have been extensively studied andinclude: working time, setting time, flow, film thickness,solubility, dimensional stability and radiopacity32.

Sealers Trademark

Table 1: Categorization of the reported sealers according to their chemical composition

ñ Epoxy resin AH26AH Plus

ñ Methacrylate resin RealSeal SEEpiphany

ñ Zinc oxide-Eugenol Roth 801Pulp Canal Sealer (PCS)Tubli-Seal

ñ Calcium dioxide ApexitSealapex

ñ Silicone RoekoSealGuttaFlowGuttaFlow 2

ñ MTA MTA FillapexCPM SealerPro Root Endo SealerMTA Obtura

ñ Bioceramics Endosequence BC/iRoot SP

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XÚfiÓÔ˜ ÂÚÁ·Û›·˜ Î·È ¯ÚfiÓÔ˜ ‹Íˆ˜O ¯ÚfiÓÔ˜ ÂÚÁ·Û›·˜ Â›Ó·È ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙËÓ¤Ó·ÚÍË Ù˘ ·Ó¿ÌÂÈ͢ ̤¯ÚÈ ÙË ÛÙÈÁÌ‹ Ô˘ Ô ¯ÂÈÚÈÛÌfi˜ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ ı· ÚÔηϤÛÂÈ ÌË ·Ó·ÛÙÚ¤„È̘ ‚Ï¿‚˜ÛÙȘ ȉÈfiÙËÙ˜ ÙÔ˘12. EÓÒ Ô ̄ ÚfiÓÔ˜ ‹Í˘ Â›Ó·È ÚˆÙ›ÛÙˆ˜ÌÈ· ‰ÔÎÈÌ‹ ÂϤÁ¯Ô˘ Û¯ÂÙÈο Ì ÙË ÛÙ·ıÂÚ‹ Û˘ÌÂÚÈÊÔÚ¿ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ Î·È ÂÍ·ÚÙ¿Ù·È ·fi Ù· Û˘ÛÙ·ÙÈο Ô˘ ·Ô-ÙÂÏ›ٷÈ, ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÛˆÌ·Ùȉ›ˆÓ, ÙË ıÂÚÌÔÎÚ·Û›·ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Î·È ÙË Û¯ÂÙÈ΋ ˘ÁÚ·Û›·1.O ¯ÚfiÓÔ˜ ‹Íˆ˜ ÙˆÓ RoekoSeal, GuttaFlow Î·È AH Plus‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙÔ˘˜, fï˜ Ù· GuttaFlow ηÈRoekoSeal ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚË Ì¤ÛË ÙÈÌ‹ ̄ ÚfiÓÔ˘ ‹Í˘ ·fiÙÔ AH Plus Î·È ‚Ú›ÛÎÔÓÙ·È ÛÂ Û˘Ìʈӛ· Ì ÙËÓ Ù˘ÔÔ›Ë-ÛË ANSI/ADA 20001. T· Ê˘Ú¿Ì·Ù· AH Plus, MTA Fillapex,EndoSequence BC Î·È GuttaFlow ¤¯Ô˘Ó ̄ ÚfiÓÔ ‹Í˘ Ô˘Â›Ó·È Û‡ÌʈÓÔ˜ Ì ÙȘ ÙÈ̤˜ Ô˘ ·Ó·Ê¤ÚÂÈ Ô Î·Ù·Û΢·-ÛÙ‹˜ Ì ÙËÓ Ù˘ÔÔ›ËÛË ANSI/ADA 2000. AӷʤÚÂÙ·È fiÙÈÙÔ Guttaflow ¤¯ÂÈ ÌÈÎÚfiÙÂÚÔ ¯ÚfiÓÔ ‹Í˘ ·fi ÙÔ AH PlusÎ·È ÙÔ MTA Fillapex, ÂÓÒ ÙÔ EndoSequence BC ¤¯ÂÈ ÌÂÁ·-χÙÂÚÔ ̄ ÚfiÓÔ ‹Í˘ ·fi Ù· ÚÔ·Ó·ÊÂÚı¤ÓÙ· Ê˘Ú¿Ì·Ù·32.O ¯ÚfiÓÔ˜ ÂÚÁ·Û›·˜ ÙˆÓ GuttaFlow, AH Plus, Endo-Sequence BC Î·È MTA Fillapex ‹Ù·Ó ÛÂ Û˘Ìʈӛ· Ì ÙÔ˘˜Î·Ù·Û΢·ÛÙ¤˜, ÂÎÙfi˜ ·fi ÙÔ PCS ÙÔ ÔÔ›Ô ‚Ú¤ıËΠӷ¤¯ÂÈ Ôχ ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚfiÓÔ ÂÚÁ·Û›·˜ ·fi ·˘ÙfiÓ Ô˘·Ó·ÊÂÚfiÙ·Ó ÛÙȘ Ô‰ËÁ›Â˜ ̄ Ú‹Û˘ ÙÔ˘. TÔ GuttaFlow ·-ÚÔ˘Û›·Û ÙÔÓ ÌÈÎÚfiÙÂÚÔ ¯ÚfiÓÔ ÂÚÁ·Û›·˜ Î·È Û ·˘Í·-ÓfiÌÂÓË ÛÂÈÚ¿ ·ÎÔÏÔ˘ıÔ‡Û·Ó MTA Fillapex, AH Plus ηÈEndoSequence BC32.™‡Ìʈӷ Ì ÙÔÓ Pino Vitti ÙÔ MTA Fillapex ¤¯ÂÈ ÌÈÎÚfiÙÂÚÔ¯ÚfiÓÔ ÂÚÁ·Û›·˜ Î·È ̄ ÚfiÓÔ ‹Íˆ˜ ·fi ÙÔ AH Plus, ̂ ÛÙfi-ÛÔ ÔÈ ¯ÚfiÓÔÈ ·˘ÙÔ› Â›Ó·È ÎÏÈÓÈο ·Ô‰ÂÎÙÔ›12. AÎfiÌ·, ÙÔMTA Fillapex ·ÚÔ˘Û›·Û ¯ÚfiÓÔ ÂÚÁ·Û›·˜ 35 ÏÂÙ¿33, 11,ÁÂÁÔÓfi˜ Ô˘ ÙÔ Î·ıÈÛÙ¿ ηٿÏÏËÏÔ ÁÈ· ÎÏÈÓÈο ÂÚÈÛÙ·-ÙÈο Ì ÔÏÏÔ‡˜ ÚÈ˙ÈÎÔ‡˜ ۈϋÓ˜11.ŸÙ·Ó ·fi ÙÔ EndoSequence BC ·Ô˘ÛÈ¿˙ ÙÔ ÓÂÚfi ηÈÙ· ‰Â›ÁÌ·Ù· Ê˘Ï¿¯ıËÎ·Ó Û 100% Û¯ÂÙÈ΋ ̆ ÁÚ·Û›·, ̄ ÚÂÈ-¿ÛÙËÎ·Ó 72 ÒÚ˜ ÁÈ· Ó· ÂÈÙ¢¯ı› Ë ·Ú¯È΋ ‹ÍË Î·È 240ÒÚ˜ ÁÈ· ÙËÓ ÙÂÏÈ΋ ‹ÍË34. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Endo-Sequence BC Ô ¯ÚfiÓÔ˜ ÂÚÁ·Û›·˜ ÌÔÚ› Ó· Â›Ó·È ÌÂÁ·-χÙÂÚÔ˜ ·fi 4 ÒÚ˜ Û ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘. O ¯Úfi-ÓÔ˜ ‹Í˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ·ÚÔ˘Û›· ˘ÁÚ·Û›·˜ ÛÙ·Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Î·È ÌÔÚ› Ó· Î˘Ì·›ÓÂÙ·È ·fi 4 ̤-¯ÚÈ ÂÚÈÛÛfiÙÂÚÔ ·fi 10 ÒÚ˜ Û Ôχ ÍËÚÔ‡˜ ۈϋÓ˜35.

¢È·Ï˘ÙfiÙËÙ·MÈ· ·fi ÙȘ ÂÈı˘ÌËÙ¤˜ ȉÈfiÙËÙ˜ ·ÊÔÚ¿ ÙË ÌË ‰È·Ï˘Ùfi-ÙËÙ·, ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙË ÏÈÁfiÙÂÚË ‰˘Ó·Ù‹ ‰È·Ï˘ÙfiÙËÙ·. HȉÈfiÙËÙ· ·˘Ù‹ Â›Ó·È ÌÂÁ¿Ï˘ ÛËÌ·Û›·˜, ηıÒ˜ Ë ÂÈÙ˘¯›·Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂڷ›·˜ ÂÍ·ÚÙ¿Ù·È Û ÌÂÁ¿ÏÔ ‚·ı-Ìfi ·fi ÙËÓ ·ÎÂÚ·ÈfiÙËÙ· ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜. H Ù˘¯fiÓ ·Ô-Û‡ÓıÂÛË ÙÔ˘ Â›Ó·È Èı·Ófi Ó· Ô‰ËÁ‹ÛÂÈ ÛÙÔ Û¯ËÌ·ÙÈÛÌfiÎÂÓÒÓ Î·Ù¿ Ì‹ÎÔ˜ ÙˆÓ ÂÈÊ·ÓÂÈÒÓ Ê˘Ú¿Ì·ÙÔ˜-Ô‰ÔÓÙ›Ó˘‹ Ê˘Ú¿Ì·ÙÔ˜-ÁÔ˘Ù·¤Úη˜. T· ÎÂÓ¿ ·˘Ù¿ ÌÔÚÔ‡Ó Ó··ÔÙÂϤÛÔ˘Ó ¤Ó· ÌÔÓÔ¿ÙÈ ÁÈ· ÙÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜Î·È Ù· ÙÔÍÈο ÚÔ˚fiÓÙ· ÙÔ˘˜ ÚÔ˜ ÙÔ˘˜ ÂÚÈ·ÎÚÔÚÚÈ˙È-ÎÔ‡˜ ÈÛÙÔ‡˜36. E›Û˘ ÌÔÚ› Ó· ÚÔÎÏËı› ·ÂÏ¢ı¤-ÚˆÛË ̆ ÏÈÎÒÓ ÚÔ˜ ÙÔ ·ÎÚÔÚÚ›˙ÈÔ Ô˘ ı· ÂÚÂı›ÛÔ˘Ó ÙÔ˘˜ÂÚÈ·ÎÚÔÚÚÈ˙ÈÎÔ‡˜ ÈÛÙÔ‡˜1.

Working and setting timeWorking time is the time from the beginning of the mixingto the moment that the handling of the sealer will causeirreversible damage to its properties12. Whilst the settingtime is primarily a control test of the sealers stability behaviorand depends on the consisting components, the particlessize, the environmental temperature and relative humidity1.The setting time of RoekoSeal, GuttaFlow and AH Plusdiffers significantly between them, but GuttaFlow andRoekoSeal have a lower average setting time than AH Plusand are in accordance with the ANSI/ADA 2000 standar-dization1. AH Plus, MTA Fillapex, Endosequence BC andGuttaFlow have a setting time that is in agreement with thevalues stated by the manufacturer and the ANSI/ADA 2000standardization. It is reported that GuttaFlow has a lowersetting time than AH Plus and MTA Fillapex, but Endo-sequence BC has a higher setting time than the sealersmentioned above32.The working time of GuttaFlow, AH Plus, EndosequenceBC and MTA Fillapex was in accordance with themanufacturers’ statement, with the exception of PCS thatwas found to have a much higher working time than theone mentioned in the instructions s. GuttaFlow showedthe lower working time and followed in ascending orderby MTA Fillapex, AH Plus and Endosequence BC32.According to the report of Vitti and co-workers, MTA Fillapexhas lower working and setting time than AH Plus, never-theless these times are clinically acceptable12. Furthermore,the reported working time of MTA Fillapex is 35 minutes33,

11, making it suitable for clinical cases with many root canals11.When EndoSequence BC was used without water and thesamples were stored at 100% relative humidity, it took 72hours to reach the initial setting and 240 hours to the finalset34. Regarding EndoSequence BC, the working time maybe greater than 4 hours in room temperature. The settingtime depends on the presence of moisture in the dentinaltubules and can range from 4 to more than 10 hours at verydry root canals35.

SolubilityOne of the desirable properties is related to non-solubilityor at least the minimum of solubility. This property is ofgreat importance, since the success of endodontic therapydepends on the integrity of the sealer. Any decompositionis likely to lead to the formation of gaps along the dentin-sealer or sealer-gutta-percha surfaces. These gaps canbecome a pathway for microorganisms and their toxicproducts to the periapical tissues36. It may also cause therelease of material to the apex that will irritate the periapicaltissues1.GuttaFlow had the lower rates of solubility and in ascendingorder is followed by AH Plus, MTA Fillapex andEndosequence BC32. Furthermore, it has been observedthat GuttaFlow and RoekoSeal have low solubility andrelease of metal ions1. Additionally, it has been reportedthat hydrophobic GuttaFlow has minimal water absorptionand solubility37.A significant difference was observed in solubility between

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Literature Review

Hellenic Stomatological Review 59: 51-69, 2015

To GuttaFlow ›¯Â ÙȘ ÌÈÎÚfiÙÂÚ˜ ÙÈ̤˜ ‰È·Ï˘ÙfiÙËÙ·˜ ηȷÎÔÏÔ˘ıÂ›Ù·È Î·Ù¿ ·‡ÍÔ˘Û· ÛÂÈÚ¿ ·fi Ù· AH Plus, MTAFillapex Î·È EndoSequence BC32. AÎfiÌË ·Ú·ÙËÚ‹ıËΠfiÙÈÙÔ GuttaFlow Î·È ÙÔ RoekoSeal ¤¯Ô˘Ó ÌÈÎÚ‹ ‰È·Ï˘ÙfiÙËÙ·Ì ÙËÓ ÂÏ¿¯ÈÛÙË ·ÂÏ¢ı¤ÚˆÛË ÌÂÙ·ÏÏÈÎÒÓ ÈfiÓÙˆÓ1. EÈ-ÚfiÛıÂÙ·, ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ÙÔ ̆ ‰ÚfiÊÔ‚Ô GuttaFlow ¤¯ÂÈÂÏ¿¯ÈÛÙË ÚÔÛÚfiÊËÛË ÓÂÚÔ‡ ηıÒ˜ Î·È ‰È·Ï˘ÙfiÙËÙ·37.¶·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË ‰È·-Ï˘ÙfiÙËÙ· ÌÂٷ͇ ÙÔ˘ MTA Fillapex Î·È ÙÔ˘ AH Plus, ÌÂÙÔ ‰Â‡ÙÂÚÔ Ó· ÂÌÊ·Ó›˙ÂÈ ÌÈÎÚfiÙÂÚ˜ ÙÈ̤˜6. E›Û˘, ‚Ú¤-ıËΠfiÙÈ ÙÔ ‚¿ÚÔ˜ ÙÔ˘ MTA Fillapex ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÙ·-‚ÔÏ‹ Ù˘ ٿ͈˜ ÙÔ˘ 0,1% ÌÂÙ¿ ·fi ÙË ‰ÔÎÈÌ·Û›· ‰È·-Ï˘ÙfiÙËÙ·˜, ÙÈÌ‹ ÌÈÎÚfiÙÂÚË ·fi ÙÔ ·ÓÒÙÂÚÔ ÂÈÙÚÂÙfifiÚÈÔ ‰È·Ï˘ÙfiÙËÙ·˜ Ù˘ Ù˘ÔÔ›ËÛ˘ ISO 687633. A˘Ùfi ¤Ú-¯ÂÙ·È ÛÂ Û˘Ìʈӛ· Ì ÌÈ· ·ÎfiÌË ¤Ú¢ӷ, Û‡Ìʈӷ Ì ÙËÓÔÔ›· ÙÔ Fillapex ·ÚÔ˘ÛÈ¿˙ÂÈ ‰È·Ï˘ÙfiÙËÙ· ÌÂÁ·Ï‡ÙÂÚË·fi ÙËÓ ÚÔÙÂÈÓfiÌÂÓË ·fi ÙËÓ Ù˘ÔÔ›ËÛË ADA No.5738.

PÔ‹H ÚÔ‹ Â›Ó·È ÛËÌ·ÓÙÈ΋ Ê˘ÛÈ΋ ȉÈfiÙËÙ· Ô˘ ÂÈÙÚ¤ÂÈ ÛÙÔʇڷ̷ Ó· ÏËÚÒÛÂÈ ̄ ÒÚÔ˘˜ ‰‡ÛÎÔÏ˘ ÚfiÛ‚·Û˘ fiˆ˜ÈÛıÌÔ‡˜ Î·È ·Ú¿Ï¢ÚÔ˘˜/‰Â˘ÙÂÚ‡ÔÓÙ˜ ÚÈ˙ÈÎÔ‡˜ Ûˆ-Ï‹Ó˜. ¶·Ú¿ Ù·‡Ù· Ë ·˘ÍË̤ÓË ÚÔ‹ ·˘Í¿ÓÂÈ ÙËÓ Èı·Ófi-ÙËÙ· ÂÍfi‰Ô˘ ÙÔ˘ ˘ÏÈÎÔ‡ ÚÔ˜ ÙËÓ ÂÚÈ·ÎÚÔÚÚÈ˙È΋ Â-ÚÈÔ¯‹13.TÔ GuttaFlow ›¯Â ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ÚÔ‹ ·fi ÙÔ AHPlus Î·È ÙÔ EndoSequence BC, ÂÓÒ ÙÔ MTA Fillapex ·-ÚÔ˘Û›·Û ̆ „ËÏfiÙÂÚË ÚÔ‹ ·fi Ù· ·Ú·¿Óˆ29. M ٷ ·Ô-ÙÂϤÛÌ·Ù· ·˘Ù¿ Û˘ÌʈÓ› Î·È Ô Silva, Ô ÔÔ›Ô˜ ·Ó·Ê¤-ÚÂÈ fiÙÈ ÙÔ MTA Fillapex ¤¯ÂÈ ˘„ËÏfiÙÂÚË ÚÔ‹ ·fi ÙÔ AHPlus39. AÓÙÈı¤Ùˆ˜ Ô Vitti Ô ·Ó·Ê¤ÚÂÈ fiÙÈ ÙÔ AH Plus ÂÌÊ·-Ó›˙ÂÈ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ÚÔ‹˜ ·fi ÙÔ MTA Fillapex12. A˘-Ùfi ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙË ÌÂÙ·‚ÏËÙfiÙËÙ· ÙˆÓ Ê˘ÛÈÎÔ-¯ËÌÈÎÒÓ È‰ÈÔÙ‹ÙˆÓ ÙÔ˘ AH Plus Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÙÌ‹-Ì· ÙÔ˘ ۈϋӷ ·fi ÙÔ ÔÔ›Ô ·ÔÌÔÓÒıËΠÙÔ Ê‡Ú·Ì·Û‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ Baildi Î·È Û˘Ó. Ô˘‚ڋΠ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ÚÔ‹˜ fiÙ·Ó ÙÔ Ê‡Ú·Ì· Û˘ÏϤ-¯ıËΠ·fi ÙËÓ ·Ú¯‹ ÙÔ˘ ۈϋӷ12. EÓ ·ÓÙÈı¤ÛÂÈ Ì ÌÈ·¤Ú¢ӷ ÛÙËÓ ÔÔ›· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÙÔ MTA Fillapex ·-ÚÔ˘Û›·Û ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ÚÔ‹˜ ·fi Ù· AH Plus,EpiphanySE, Epiphany Î·È Sealapex40. AÎfiÌ·, ÙÔ MTAFillapex ·ÚÔ˘Û›·Û ÙÈ̤˜ ÚÔ‹˜ ˘„ËÏfiÙÂÚ˜ ·fi ÙÔ ¯·-ÌËÏfiÙÂÚÔ fiÚÈÔ Ù˘ Ù˘ÔÔ›ËÛ˘ ISO 687633.ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÚÔ‹, Ù· Ê˘Ú¿Ì·Ù· EndoSequence BCÎ·È AH Plus ·ÚÔ˘Û›·Û·Ó ·Ô‰ÂÎÙ¤˜ ÙÈ̤˜ Û‡Ìʈӷ ÌÂÙËÓ Ù˘ÔÔ›ËÛË ISO 6786/2001. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ ÙÔEndoSequence BC ÂÌÊ·Ó›˙ÂÈ ÌÂÁ·Ï‡ÙÂÚË ÚÔ‹ ·fi ÙÔ AHPlus13.

AÎÙÈÓÔÛÎÈÂÚfiÙËÙ·O ‚·ıÌfi˜ ·ÎÙÈÓÔÛÎÈÂÚfiÙËÙ·˜ Â›Ó·È ÌÈ· ··Ú·›ÙËÙË È‰Èfi-ÙËÙ· ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ,¤Ó· ·ÎÙÈÓÔÛÎÈÂÚfi ʇڷ̷ Â›Ó·È ÂÈı˘ÌËÙfi Ó· ¤¯ÂÈ ‰È·ÊÔ-ÚÂÙÈ΋ ·ÎÙÈÓÔÁÚ·ÊÈ΋ ·ÂÈÎfiÓÈÛË, Ó· ‰È·ÊÔÚÔÔÈÂ›Ù·È ·fiÙÔ˘˜ Ô‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜ Î·È Ù· ·Ó·ÙÔÌÈο ÂÚÈÚÈ˙Èο ÛÙÔÈ-¯Â›·, Î·È ¤ÙÛÈ Ó· ηı›ÛÙ·Ù·È ‰˘Ó·Ùfi˜ Ô ¤ÏÂÁ¯Ô˜ ÌÈ· Èı·-Ó‹˜ ˘ÂÚ¤ÌÊڷ͢ (overfilling) ‹ Ô ÂÓÙÔÈÛÌfi˜ ÂÌÊÚ·Á-Ì¤ÓˆÓ ·Ú¿ÏÂ˘ÚˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ. ŸÌˆ˜, ·Ú¿ ÙÔ

MTA Fillapex and AH Plus, with the latter showing lowerratio6. Also, it was found that the weight of MTA Fillapexshows variation of 0.1% after the solubility test, a value lessthan the upper permissible limit of solubility of the ISOstandards 687633. These findings are in agreement withanother study, according to which Fillapex showed highersolubility than the suggested by the ADA No. 57 stan-dardization38.

FlowFlow is an important physical property that allows the sealerto fill less accessible areas such as the isthmus andadditional lateral/secondary root canals. However, theincreased flow increases the possibility of material extrusionto the periapical area13.GuttaFlow had a significantly lower flow than AH Plusand Endosequence BC, whilst MTA Fillapex showed ahigher flow than the aforementioned sealers29. These resultsare in accordance with Silva, who reported that MTA Fillapexhas a higher flow than AH Plus39. On the other hand, Vittiand co-workers reported that AH Plus is more flowablethan MTA Fillapex12. This may be due to the variability ofthe physicochemical properties of AH Plus, which dependon the section of the tube from which the sealer was isolatedaccording to the results of Baildi et al. who found higherflow rates when the sealer was collected from the top ofthe tube12. These findings are in contrast with a study statingthat MTA Fillapex showed higher flow rates than AH Plus,EpiphanySE, Epiphany and Sealapex40. Still, the MTAFillapex showed higher flow rates than the lower limit ofthe ISO 6876 standards33.Regarding the flow the EndoSequence BC and AH Plussealers showed acceptable values according to the ISO6786/2001 standardization. More specifically EndoSequenceBC showed higher flow than AH Plus13.

RadiopacityThe degree of radiopacity is a necessary property for theevaluation of the sealer. More specifically a radiopaquesealer is distinguishable from the tooth and the periapicalanatomical structures, so it becomes possible to detectan overfilling or the presence of lateral root canal. Despitethe fact of the standardization that determines minimumradiopacity, excessive contrast material in a radiographcan lead to the false impression of a dense and homo-geneous seal41.The AH Plus sealer reported higher radiopacity than MTAFillapex, however both sealers meet the requirements ofANSI/ADA standards 576. This is confirmed by two otherstudies, which indicate that MTA Fillapex has less radiopacitythan AH Plus42, 40. In a test that examined the radiopacity ofMTA Fillapex, it showed prices 77% larger than 3mmAlsuggested by the ISO 6786 standardization34.In addition, it is reported that radiopacity difference betweenMTA Fillapex and RoekoSeal is not significant statistically;however, it is lower than that of AH Plus41. ConcerningEndoSequence BC, it presented radiopacity rates signi-ficantly lower than those of AH Plus13.

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Literature Review

ÁÂÁÔÓfi˜ fiÙÈ ˘¿Ú¯ÂÈ Ù˘ÔÔ›ËÛË Ô˘ ηıÔÚ›˙ÂÈ ÙËÓ ÂÏ¿-¯ÈÛÙË ·ÎÙÈÓÔÛÎÈÂÚfiÙËÙ·, Ë ̆ ÂÚ‚ÔÏÈ΋ ·ÓÙ›ıÂÛË ÂÓfi˜ ̆ ÏÈ-ÎÔ‡ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ÂÛÊ·Ï-̤ÓË ÂÓÙ‡ˆÛË ÌÈ·˜ ˘ÎÓ‹˜ Î·È ÔÌÔÁÂÓÔ‡˜ ¤ÌÊڷ͢41.TÔ Ê‡Ú·Ì· AH Plus ·ÚÔ˘Û›·Û ÌÂÁ·Ï‡ÙÂÚË ·ÎÙÈÓÔÛÎÈÂ-ÚfiÙËÙ· ·fi ÙÔ MTA Fillapex, ˆÛÙfiÛÔ Î·È Ù· ‰‡Ô Ê˘Ú¿-Ì·Ù· ÏËÚÔ‡Ó ÙȘ ··ÈÙ‹ÛÂȘ Ù˘ Ù˘ÔÔ›ËÛ˘ ANSI/ADA576. A˘Ùfi ÂȂ‚·ÈÒÓÂÙ·È Î·È ·fi ‰‡Ô ·ÎfiÌ· ¤Ú¢Ó˜ ÔÈÔԛ˜ ·Ó·Ê¤ÚÔ˘Ó ˆ˜ ÙÔ MTA Fillapex ¤¯ÂÈ ÌÈÎÚfiÙÂÚË·ÎÙÈÓÔÛÎÈÂÚfiÙËÙ· ·fi ÙÔ AH Plus42, 40. ™Â ÌÈ· ‰ÔÎÈÌ·Û›·Ô˘ ÂͤٷÛ ÙËÓ ·ÎÙÈÓÔÛÎÈÂÚfiÙËÙ· ÙÔ˘ MTA Fillapex, ·˘-Ùfi ÂÌÊ¿ÓÈÛ ÙÈ̤˜ ηٿ 77% ÌÂÁ·Ï‡ÙÂÚ˜ ·fi Ù· 3mmAlÔ˘ ÚÔÙ›ÓÔÓÙ·È ·fi ÙËÓ Ù˘ÔÔ›ËÛË ISO678634.AÎfiÌ·, ·Ó·Ê¤ÚÂÙ·È ˆ˜ Ë ‰È·ÊÔÚ¿ ·ÎÙÈÓÔÛÎÈÂÚfiÙËÙ·˜ÌÂٷ͇ MTA Fillapex Î·È RoekoSeal ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈοÛËÌ·ÓÙÈ΋, ˆÛÙfiÛÔ Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi ·˘Ù‹ ÙÔ˘ AHPlus41. ŸÛÔÓ ·ÊÔÚ¿ ÙÔ EndoSequence BC, ·˘Ùfi ·ÚÔ˘-Û›·Û ÙÈ̤˜ ·ÎÙÈÓÔÛÎÈÂÚfiÙËÙ·˜ ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜·fi ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙÔ˘ AH Plus13.

ñ AÓÙÈÌÈÎÚԂȷΤ˜ ȉÈfiÙËÙ˜ŒÓ·˜ ·fi ÙÔ˘˜ ·ÚÈÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂ-ڷ›·˜ Â›Ó·È Ë ÂÍ¿ÏÂÈ„Ë ÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ·fi ÙÔÓÌÔÏ˘Ṳ̂ÓÔ ÚÈ˙ÈÎfi ۈϋӷ. ¶·ÚfiÏ· ·˘Ù¿, Ë ¯ËÌÈÎÔÌ˯·-ÓÈ΋ ÂÂÍÂÚÁ·Û›· ÌÂÈÒÓÂÈ ·ÏÏ¿ ‰ÂÓ ÂÍ·Ï›ÊÔ˘Ó ··Ú·›-ÙËÙ· fiÏ· Ù· ÌÈÎÚfi‚È· Î·È ̇ ˆÓÙ·Ó¿ ‚·ÎÙ‹ÚÈ· Û˘¯Ó¿ ·Ú·-̤ÓÔ˘Ó ÛÙ· Ô‰ÔÓÈÓÔÛˆÏËÓ¿ÚÈ· Î·È ÛÙÔ˘˜ ·Ú¿Ï¢ÚÔ˘˜ÚÈ˙ÈÎÔ‡˜ ۈϋÓ˜. ŒÙÛÈ, Ë ¯Ú‹ÛË Ê˘Ú·Ì¿ÙˆÓ Ô˘ ¤¯Ô˘Ó·ÓÙÈ‚·ÎÙËÚȷ΋ ‰Ú·ÛË, ıˆÚÂ›Ù·È Â˘ÂÚÁÂÙÈ΋ ÛÙËÓ ÚÔ-Û¿ıÂÈ· ÁÈ· ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÓ·Ô-Ì›ӷÓÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ43, Ì Èı·Ó‹ Û˘Ì‚ÔÏ‹ ÛÙËÓ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÂÈÙ˘¯›·˜ ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈÎÒÓ ıÂ-Ú·ÂÈÒÓ44.TÔ RoekoSeal ‰ÂÓ ÂÌÊ¿ÓÈÛ ·Ó·ÛÙÔÏ‹ Ù˘ ‚·ÎÙËÚȷ΋˜·Ó¿Ù˘Í˘ ÙÔ˘ E. faecalis, F. nucleatum, P. gingivalis ÂÓÒÙÔ AH Plus ·Ó¤ÛÙÂÈÏ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ E. Faecalis ηÈF. nucleatum, ·ÏÏ¿ ‰ÂÓ ÂËÚ¤·Û ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ P.Gingivalis45. AÎfiÌ· ÌÈ· ¤Ú¢ӷ Ô˘ ÂÍÂÙ¿˙ÂÈ ÙȘ ·ÓÙÈÌÈ-ÎÚԂȷΤ˜ ȉÈfiÙËÙ˜ ÙÔ˘ RoekoSeal η٤‰ÂÈÍ ÙËÓ ·‰˘-Ó·Ì›· ÙÔ˘ Ó· ·Ó·ÛÙ›ÏÂÈ ÙË ‚·ÎÙËÚȷ΋ ·Ó¿Ù˘ÍË ÙÔ˘ E.Faecalis46. O Cobankara Î·È Û˘Ó. ¤¯Ô˘Ó ·Ó·Ê¤ÚÂÈ fiÙÈ ÙÔAH Plus Â›Ó·È ÈÔ ÈÛ¯˘Úfi˜ ‚·ÎÙËÚÈ·Îfi˜ ·Ó·ÛÙÔϤ·˜ ·fiÙÔ RoekoSeal47.T· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤Ú¢ӷ˜ ÙÔ˘ Senges Î·È Û˘Ó. ¤‰ÂÈ-Í·Ó fiÙÈ Ù· Ê˘Ú¿Ì·Ù· AH Plus Î·È GuttaFlow ›¯·Ó ̤ÛÔ·ÚÈıÌfi ÚÔÛÎfiÏÏËÛ˘ ÙˆÓ ÂÍÂÙ·˙fiÌÂÓˆÓ ‚·ÎÙËÚ›ˆÓ, Ù·ÔÔ›· ›ӷÈ: C. albicans, P. nigrescens,S. sanguis, S. mutans,E. Faecalis48. TÔ Epiphany ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈο ˘„Ë-ÏfiÙÂÚË ·ÓÙÈÌÈÎÚԂȷ΋ ‰Ú·ÛÙÈÎfiÙËÙ· ·fi ÙÔ GuttaFlowÎ·È ÙÔ AH Plus. TÔ GuttaFlow ‰ÂÓ ÚÔοÏÂÛ Ì›ˆÛË ÙÔ˘·ÚÈıÌÔ‡ ÙˆÓ ‚·ÎÙËÚ›ˆÓ, ÁÂÁÔÓfi˜ Ô˘ ηٷ‰ÂÈÎÓ‡ÂÈ ·Ô˘-Û›· ·ÓÙÈÌÈÎÚԂȷ΋˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜47. H ¤ÏÏÂÈ„Ë·ÓÙÈÌÈÎÚԂȷ΋˜ ‰Ú¿Û˘ ÙÔ˘ GuttaFlow ÂȂ‚·ÈÒÓÂÙ·ÈÎ·È ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ Ô˘ ‰ËÏÒÓÔ˘Ó ˆ˜ ÙÔ Ê‡Ú·-Ì· ·˘Ùfi ‰ÂÓ ÂÌÊ·Ó›˙ÂÈ ̇ ÒÓ˜ ·Ó·ÛÙÔÏ‹˜ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ49.O Zhang Î·È Û˘Ó. ·¤‰ÂÈÍ·Ó ÙËÓ ·ÓÙÈÌÈÎÚԂȷ΋ ‰Ú·ÛÙÈ-ÎfiÙËÙ· ÙÔ˘ iRoot SP ÂÓ¿ÓÙÈ· ÛÙÔÓ E. Faecalis50, 35. MÂÙ·Í‡ÙˆÓ Ê˘Ú·Ì¿ÙˆÓ Endosequence BC Î·È AH Plus ‰ÂÓ ·-

Antimicrobial propertiesOne of the main targets in endodontic therapy is theelimination of microorganisms from the infected root canal.However, the chemomechanical preparation decreasesbut does not necessarily eliminate the microflora, so livingbacteria often remain in the dentinal tubules and lateralroot canals. Thus, the use of sealers that have antibacterialactivity is considered beneficial in the attempt to reducethe remaining microorganisms or even eliminate thecontamination completely43, increasing the success rateof endodontic therapy44. RoekoSeal showed no bacterial growth inhibition of E.faecalis, F. nucleatum, P. gingivalis, whilst AH Plus inhibitedgrowth of E. faecalis and F. nucleatum, but did not influencethe growth of P. gingivalis45. Furthermore, a study that testedthe antimicrobial properties of RoekoSeal, demonstratedits weakness in the bacterial growth inhibition of E. faecalis46.Cobancara et al. reported that AH Plus was a more potentbacterial inhibitor than RoekoSeal47.The results of Senges et al.’s research showed that AH Plusand GuttaFlow had an average number of adhesion ofthe tested bacteria, which were: C. albicans, P. nigrescens,S. sanguis, S. mutans, E. faecalis48. Epiphany showedsignificantly higher antimicrobial activity than GuttaFlowand AH Plus. GuttaFlow causes no reduction in the numberof bacteria, which demonstrates lack of antimicrobialefficacy47. The lack of antimicrobial activity of GuttaFlow isconfirmed also by other researchers, who indicate thatthe sealer does not show microbial inhibition zones49.Zhang et al. demonstrated the antimicrobial activity of iRootSP against the E. faecalis50, 35. The sealers EndosequenceBC and AH Plus did not present a significant differencestatistically in their activity against E. faecalis, since after30 days they had acted against the 45% and 46% of thebacteria respectively43.The in vitro Direct Contact Test (DCT) showed that AH Pluseliminated completely E. faecalis at a period of 1-168 hours,unlike EndosequenceBC, which exhibited antibacterialactivity after 24 hours of direct contact. However, En-dosequence BC, compared with AH Plus, had similarantibacterial effect against E. faecalis51. In contrast with theabove results is a study mentioning that GuttaFlow,EndoSequence BC and AH Plus are ineffective againstE. faecalis. EndoSequence BC showed no antibacterialeffect against Parviromonas micra52. Still, EndosequenceBC has a stronger antimicrobial activity than Epiphany, AHPlus, Apexit, Tubli-Seal and Sealapex, because of its highpH, hydrophylic nature and diffusion of the active calciumhydroxide53.Morgental et al. showed that freshly mixed MTA Fillapexand Endofill have antibacterial effectiveness against E.faecalis, but none of them maintained its antibacterial activityafter the setting43. Another study examined the antimicrobialactivity of the sealers MTA Fillapex, Apexit Plus, Dorifill andEpiphany against E. faecalis over a 3, 5 and 7 days period.It was shown that MTA Fillapex had the greatest activityagainst E. faecalis during all the individual stages of theinvestigation. Additionally, the antimicrobial activity of all

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Literature Review

Hellenic Stomatological Review 59: 51-69, 2015

ÚÔ˘ÛÈ¿ÛÙËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË ‰Ú¿ÛËÙÔ˘˜ ÂÓ¿ÓÙÈ· ÛÙÔÓ E. faecalis, ηıÒ˜ ‡ÛÙÂÚ· ·fi 30 Ë̤-Ú˜ ›¯·Ó ‰Ú¿ÛÂÈ Î·Ù¿ ÙÔ˘ 45% Î·È 46% ·ÓÙ›ÛÙÔȯ·43.™Â ÂÚÁ·ÛÙËÚȷ΋ ‰ÔÎÈÌ·Û›· ¿ÌÂÛ˘ ·ʋ˜ (direct contacttest (DCT) ÙÔ AH Plus ÂÍ¿ÏÂÈ„Â Ï‹Úˆ˜ ÙÔÓ E. faecalisÛ ‰È¿ÛÙËÌ· 1-168 ˆÚÒÓ, Û ·ÓÙ›ıÂÛË Ì ÙÔ Endo-sequenceBC ÙÔ ÔÔ›Ô ÂÌÊ¿ÓÈÛ ·ÓÙÈ‚·ÎÙËÚȷ΋ ‰Ú¿ÛËÌÂÙ¿ ·fi 24 ÒÚ˜ ¿ÌÂÛ˘ ·ʋ˜. ¶·Ú’ fiÏ· ·˘Ù¿, ÙÔEndosequence BC ›¯Â ·ÚfiÌÔÈ· ·ÓÙÈ‚·ÎÙËÚȷ΋ ‰Ú¿ÛˤӷÓÙÈ ÙÔ˘ E. faecalis Û ۇÁÎÚÈÛË Ì ÙÔ AH Plus51. ™Â ·ÓÙ›-ıÂÛË Ì ٷ ·Ú·¿Óˆ ·ÔÙÂϤÛÌ·Ù· ¤Ú¯ÂÙ·È ÌÈ· ¤Ú¢-Ó· Ô˘ ·Ó·Ê¤ÚÂÈ fiÙÈ Ù· Ê˘Ú¿Ì·Ù· GuttaFlow, Endo-Sequence BC Î·È AH Plus Jet ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·Ì›··ÓÙÈÌÈÎÚԂȷ΋ ‰Ú¿ÛË ÂÓ¿ÓÙÈ· ÛÙÔÓ E. faecalis. TÔEndoSequence BC ‰ÂÓ ·ÚÔ˘Û›·Û ·ÓÙÈ‚·ÎÙËÚȷ΋ ›-‰Ú·ÛË ÂÓ¿ÓÙÈ· ÙÔ˘ Parviromonas micra52. AÎfiÌ·, ÙÔEndosequence BC ›¯Â ÙËÓ ÈÛ¯˘ÚfiÙÂÚË ·ÓÙÈÌÈÎÚԂȷ΋‰Ú·ÛÙÈÎfiÙËÙ· Û ۯ¤ÛË Ì ٷ: Epiphany, AH Plus, Apexit,Tubli-Seal Î·È Sealapex, ÏfiÁˆ ˘„ËÏÔ‡ pH, Ù˘ ˘‰ÚfiÊÈ-Ï˘ ʇÛ˘ ÙÔ˘ Î·È Ù˘ ‰È¿¯˘Û˘ ÙÔ˘ ÂÓÂÚÁÔ‡ ˘‰ÚÔÍÂÈ-‰›Ô˘ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘53.O Morgental Î·È Û˘Ó. ¤‰ÂÈÍ·Ó fiÙÈ Ù· ÚfiÛÊ·Ù· ·Ó·ÌÂ-ÌÂÈÁ̤ӷ MTA Fillapex Î·È Endofill ¤¯Ô˘Ó ·ÓÙÈ‚·ÎÙËÚÈ·ÎˉڿÛË ÂÓ¿ÓÙÈ· ÛÙÔÓ E. faecalis, ·ÏÏ¿ ηӤӷ ·fi ·˘Ù¿ ‰ÂӉȷًÚËÛ ÙËÓ ·ÓÙÈ‚·ÎÙËÚȷ΋ ÙÔ˘ ‰Ú¿ÛË ÌÂÙ¿ ÙËÓ ‹-ÍË43. ™Â ÌÈ· ·ÎfiÌË ¤Ú¢ӷ Ô˘ ÌÂÏÂÙ‹ıËÎÂ Ë ·ÓÙÈÌÈÎÚÔ-‚ȷ΋ ‰Ú·ÛÙÈÎfiÙËÙ· ÙˆÓ Ê˘Ú·Ì¿ÙˆÓ MTA Fillapex, ApexitPlus, Dorifill and Epiphany ÂÓ¿ÓÙÈ· ÙÔ˘ E. faecalis Û ‰È¿-ÛÙËÌ· 3, 5 Î·È 7 ËÌÂÚÒÓ ÚÔ·ÙÂÈ fiÙÈ ÙÔ MTA Fillapex›¯Â ÙËÓ ÌÂÁ·Ï‡ÙÂÚË ‰Ú·ÛÙÈÎfiÙËÙ· ÂÓ·ÓÙÈ· ÙÔ˘ E. faecalisÛ fiÏ· Ù· ÂÈ̤ÚÔ˘˜ ‰È·ÛÙ‹Ì·Ù· Ù˘ ¤Ú¢ӷ˜. EÈÚfi-ÛıÂÙ· Ë ·ÓÙÈÌÈÎÚԂȷ΋ ‰Ú·ÛÙÈÎfiÙËÙ· fiÏˆÓ ÙˆÓ Ê˘Ú·-Ì¿ÙˆÓ ¤‚·ÈÓ ÌÂÈÔ‡ÌÂÓË Ì ÙÔ ¤Ú·ÛÌ· ÙÔ˘ ¯ÚfiÓÔ˘, ÁÂ-ÁÔÓfi˜ Ô˘ ¤Ú¯ÂÙ·È ÛÂ Û˘Ìʈӛ· Ì ٷ ·ÔÙÂϤÛÌ·Ù··ÏÏˆÓ ÂÚ¢ÓÒÓ54. ™Â ·ÓÙ›ıÂÛË Ì ٷ ·Ú·¿Óˆ ·ÔÙÂϤ-ÛÌ·Ù· ¤Ú¯ÂÙ·È ·Ï·ÈfiÙÂÚË ¤Ú¢ӷ Ô˘ ‰Â›¯ÓÂÈ fiÙÈ Ë ‚·-ÎÙËÚÈÔÎÙfiÓÔ˜ ‰Ú¿ÛË ÙÔ˘ MTA Fillapex ηıÒ˜ Î·È ÙÔ˘ iRootSP ÂÌÊ·Ó›˙ÂÙ·È ·fi ÙËÓ ¤‚‰ÔÌË Ë̤ڷ Î·È ‰È·ÚΛ ˆ˜ ηÈÙËÓ ÙÚÈ·ÎÔÛÙ‹ Ë̤ڷ, ÌÂÙ¿ ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ ηٿ ÙˉȿÚÎÂÈ· ÙÔ˘ ÂÈÚ¿Ì·ÙÔ˜55. øÛÙfiÛÔ, Û‡Ìʈӷ Ì ¤Ú¢-Ó· Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠‰fiÓÙÈ· ÛÎ‡ÏˆÓ Ì ÂÚÈ·-ÎÚÔÚÈ˙΋ ÊÏÂÁÌÔÓ‹, ·Ú·ÙËÚ‹ıËΠfiÙÈ ÙÔ MTA Fillapex,ÙÔ Endo-CPM Sealer Î·È ÙÔ Sealapex ‰ÂÓ Â›¯·Ó ÈηÓÔÔÈ-ËÙÈο ·ÔÙÂϤÛÌ·Ù· ˆ˜ ÚÔ˜ ÙËÓ ›·ÛË ÙˆÓ ÂÚÈ·ÎÚÔÚÈ-˙ÈÎÒÓ ÈÛÙÒÓ. TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë ·ÓÙÈÌÈ-ÎÚԂȷ΋ ‰Ú·ÛÙÈÎfiÙËÙ· ÙˆÓ ·Ú·¿Óˆ Ê˘Ú·Ì¿ÙˆÓ ‰ÂÓ·ÚΛ ÒÛÙ ӷ ·ÓÙÈÌÂÙˆÈÛı› Ë ÌfiÏ˘ÓÛË ÙˆÓ ÚÈ˙ÈÎÒÓ Ûˆ-Ï‹ÓˆÓ, ȉȷ›ÙÂÚ· ÌÂÙ¿ ÙËÓ ‹ÍË ÙÔ˘˜29. ™Â Û˘Ìʈӛ· Ì ٷ·Ú·¿Óˆ ·ÔÙÂϤÛÌ·Ù· ‚Ú›ÛÎÂÙ·È Î·È ¿ÏÏË ÌÈ· ÂÚÁ·-ÛÙËÚȷ΋ ¤Ú¢ӷ ÛÙËÓ ÔÔ›· ÙÔ MTA Fillapex, ÙÔ SealapexÎ·È ÙÔ ProRoot MTA ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ·ÓÙÈÌÈÎÚԂȷ΋ ‰Ú¿-ÛË ¤Ó·ÓÙÈ ÙˆÓ ÛÙÂϯÒÓ E. faecalis, E. coli, S. aureus Û‰ȷÛÙËÌ· 24 ˆÚÒÓ ·fi ÙËÓ ·Ó¿ÌÂÈÍ‹ ÙÔ˘˜56. ™Â ·ÎfiÌËÌÈ· ¤Ú¢ӷ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ·ÓÙÈÌÈÎÚԂȷ΋ ‰Ú·ÛÙÈÎfiÙË-Ù· ÙÔ˘ MTA Fillapex ÂÓ¿ÓÙÈ· ÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ÛÙÂϯÒÓ E.faecalis Î·È Lactobacillus, Ë ÔÔ›· fï˜ ‹Ù·Ó ÌÈÎÚfiÙÂÚË·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙÔ˘ AH 2657. EÈϤÔÓ, Ë ‚·ÎÙËÚÈÔ-ÎÙfiÓÔ˜ ȉÈfiÙËÙ· ÙÔ˘ MTA Fillapex ÂÓ¿ÓÙÈ· ÛÙÔ˘˜ E. faecalis

the sealers decreased with the passage of time, which is inagreement with the results of other investigations54. Incontrast with the above results was an earlier study, whichshowed that the bactericidal activity of MTA Fillapex andiRoot SP appeared in the seventh day and lasts up to thethirtieth day55. However, according to a survey conductedin dog teeth with periapical inflammation MTA Fillapex,Endo-CPM Sealer and Sealapex had not satisfactory resultsin terms of healing the periapical tissues. This indicated thatthe antimicrobial activity of these sealers was not sufficientto deal with the infection of the root canal, particularlyafter setting29. In accordance with the above results is onemore in vitro study in which MTA Fillapex, Sealapex, andProRoot MTA did not show antimicrobial activity againstthe microbial strains of E. faecalis, E. Coli, S. aureus within24 hours after mixture56. In another study is demonstratedthe antimicrobial activity of MTA Fillapex against microbialstrains of E. faecalis and Lactobacillus, which was lowerthan that of AH 2657. Furthermore, the bactericidal propertyof MTA Fillapex against the E. faecalis and S. aureus wasconfirmed from Kuga et al. More specifically, it is reportedthat the microbial growth inhibition zones -which weredeveloped from the MTA Fillapex, AH Plus and Sealapexsealers- against E. faecalis were not significantly differentstatistically, but Sealapex was more effective against S.aureus compared to MTA Fillapex and AH Plus58.

Cytotoxicity-BiocompatibilityThe biocompatibility of endodontic sealers is extremelyimportant, as these materials come often in contact withperiapical tissue’s. The tissues response to these materialscan affect the outcome of the treatment59.Miletic et al. reported that RoekoSeal is not cytotoxic60.Furthermore, another study stated that RoekoSeal’scytotoxicity was lower compared with methacrylate, zincoxide-eugenol and epoxy resin-based sealers. Contraryto the above are Oztan et al. argued that the silicone-basedsealer’s cytotoxicity equals that of epoxy resin-basedsealers34, 59. It is also reported that RoekoSeal had not showncytotoxic properties in any of the tested times comparedto MTA Fillapex and AH Plus. The freshly mixed AH Pluswas initially slight cytotoxic and after 2 weeks was convertedto non-cytotoxic, while MTA Fillapex remained mild cytotoxicthroughout the tested period36. Furthermore, it was foundthat AH Plus shows better cytotoxic results compared toMTA Fillapex61 in contrast with previous studies that indicatelack of cytotoxicity and therefore biocompatibility to MTA60.GuttaFlow 2 showed no variation in cytotoxicity comparedto GuttaFlow in all the test periods. AH Plus Jet presentedsignificantly higher cytotoxicity compared to Guttaflow andGuttaFlow 262. GuttaFlow showed higher cytotoxicity thanRoekoSeal and GuttaFlow 2. In the first case, maybe beattributed to the presence of silver nanoparticles and inthe second, to the size difference of the silver particles10.The GuttaFlow products allowed the attachment of theperiodontal ligament fibroblasts and the material promotedthe regeneration of periodontal ligament and periapicaltissues62. Even if the bibliography reported an increase of

Page 63: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

Î·È S. aureus ÂȂ‚·ÈÒÓÂÙ·È ·fi ÙÔ˘˜ Kuga Î·È Û˘Ó. ¶ÈÔÛ˘ÁÎÂÎÚÈ̤ӷ, ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÔÈ ̇ ÒÓ˜ ·Ó·ÛÙÔÏ‹˜ Ù˘ ÌÈ-ÎÚԂȷ΋˜ ·Ó¿Ù˘Í˘ Ô˘ ‰ËÌÈÔ˘ÚÁ‹ıËÎ·Ó ·fi Ù· Ê˘-Ú¿Ì·Ù· MTA Fillapex, AH Plus Î·È Sealapex ÂÓ¿ÓÙÈ· ÛÙÔÓE. faecalis ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο, ·ÏÏ¿ ÙÔSealapex ‹Ù·Ó ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÂÓ¿ÓÙÈ· ÛÙÔÓ S. aureusÛ ۯ¤ÛË Ì ÙÔ MTA Fillapex Î·È ÙÔ AH Plus58.

KYTTAPOTO•IKOTHTA - BIO™YMBATOTHTA

H ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ· ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈÎÒÓ Ê˘Ú·Ì¿ÙˆÓ Â›Ó·ÈÌ›˙ÔÓÔ˜ ÛËÌ·Û›·˜ ηıÒ˜ Ù· ˘ÏÈο ·˘Ù¿ ¤Ú¯ÔÓÙ·È, Û˘-¯Ó¿, Û ·ʋ Ì ÙÔ˘˜ ÂÚÈ·ÎÚÔÚÈ˙ÈÎÔ‡˜ ÈÛÙÔ‡˜. H ÈÛÙÈ-΋ ·ÓÙ›‰Ú·ÛË Û ·˘Ù¿ Ù· ̆ ÏÈο ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ÙËÓÙÂÏÈ΋ ¤Î‚·ÛË Ù˘ ıÂڷ›·˜59.™Â ¤Ú¢ӷ ÙÔ˘ Miletic Î·È Û˘Ó. ·Ó·Ê¤ÚıËΠfiÙÈ ÙÔRoekoSeal ‰ÂÓ Â›Ó·È Î˘ÙÙ·ÚÔÙÔÍÈÎfi60. T·˘Ùfi¯ÚÔÓ·, Û ‰È·-ÊÔÚÂÙÈ΋ ÌÂϤÙË, ÂÌÊ·Ó›˙ÂÈ ÌÈÎÚfiÙÂÚË Î˘ÙÙ·ÚÔÙÔÍÈÎfi-ÙËÙ· Û ۯ¤ÛË Ì ٷ Ê˘Ú¿Ì·Ù· Ô˘ ‚·Û›˙ÔÓÙ·È ÛÙÔ ÌÂ-ı·ÎÚ˘ÏÈÎfi, ÛÙÔ ÔÍ›‰ÈÔ ÙÔ˘ „¢‰·ÚÁ‡ÚÔ˘-¢ÁÂÓfiÏ˘ ηÈÛÙËÓ ÂÔÍÈ΋ ÚËÙ›ÓË. ™Â ·ÓÙ›ıÂÛË Ì ٷ ·Ú·¿Óˆ ‚Ú›-ÛÎÂÙ·È Ë ¤Ú¢ӷ ÙÔ˘ Oztan Î·È Û˘Ó. Ô˘ ·ÍÈÔÏÔÁ› ÙËÓ Î˘Ù-Ù·ÚÔÙÔÍÈÎfiÙËÙ· ÙÔ˘ ÛÈÏÈÎÔÓÔ‡¯Ô˘ Ê˘Ú¿Ì·ÙÔ˜ ˆ˜ ›ÛËÌ ·˘Ù‹ ÙˆÓ Ê˘Ú·Ì¿ÙˆÓ Ì ‚¿ÛË ÙËÓ ÂÔÍÈ΋ ÚËÙ›ÓË34, 59.E›Û˘ ·Ó·Ê¤ÚıËΠfiÙÈ ÙÔ RoekoSeal ‰ÂÓ ÂÌÊ¿ÓÈÛ ΢Ù-Ù·ÚÔÙÔÍÈΤ˜ ȉÈfiÙËÙ˜ Û η̛· ·fi ÙȘ ÂÍÂÙ·˙fiÌÂÓ˜ ̄ ÚÔ-ÓÈΤ˜ ÛÙÈÁ̤˜ Û ۯ¤ÛË Ì ÙÔ MTA Fillapex Î·È ÙÔ AH Plus.TÔ ÚfiÛÊ·Ù· ·Ó·ÌÂÌÂÈÁ̤ÓÔ AH Plus ‹Ù·Ó ·Ú¯Èο ÂÏ·-ÊÚÒ˜ ΢ÙÙ·ÚÔÙÔÍÎfi Î·È ÌÂÙ·ÙÚ¿ËΠ۠ÌË Î˘ÙÙ·ÚÔÙÔ-ÍÈÎfi ÌÂÙ¿ ·fi 2 ‚‰ÔÌ¿‰Â˜, ÂÓÒ ÙÔ MTA Fillapex ·Ú¤-ÌÂÈÓ ‹È· ΢ÙÙ·ÚÔÙÔÍÈÎfi ηıfiÏË ÙËÓ ÂÍÂÙ·˙fiÌÂÓË Â-Ú›Ô‰Ô36. AÎfiÌ·, ¤¯ÂÈ ‚ÚÂı› fiÙÈ ÙÔ AH Plus ÂÌÊ¿ÓÈÛ η-χÙÂÚ· ·ÔÙÂϤÛÌ·Ù· ΢ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ·˜ Û˘ÁÎÚÈÙÈοÌ ÙÔ MTA Fillapex61. EÓ ·ÓÙÈı¤ÛÂÈ Ì ·Ï·ÈfiÙÂÚ˜ ¤Ú¢-Ó˜ Ô˘ ·Ó·Ê¤ÚÔ˘Ó ÙËÓ ¤ÏÏÂÈ„Ë Î˘ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ·˜ ηÈÛ˘ÓÂÒ˜ Ù˘ ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ·˜ ÙÔ˘ MTA60.TÔ GuttaFlow 2 ‰ÂÓ ·ÚÔ˘Û›·Û ‰È·ÊÔÚ¿ ÛÙËÓ Î˘ÙÙ·ÚÔ-ÙÔÍÈÎfiÙËÙ· Û˘ÁÎÚÈÙÈο Ì ÙÔ GuttaFlow Û fiϘ ÙȘ ¯ÚÔ-ÓÈΤ˜ ÂÚÈfi‰Ô˘˜ Ù˘ ÂͤٷÛ˘. EÓ ·ÓÙÈı¤ÛÂÈ Ì ÙÔ AH PlusJet Ô˘ ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË Î˘ÙÙ·ÚÔÙÔ-ÍÈÎfiÙËÙ· Û ۯ¤ÛË Ì ٷ Guttaflow Î·È GuttaFlow 262. TÔGuttaflow ÂÌÊ·Ó›˙ÂÈ ÌÂÁ·Ï‡ÙÂÚË Î˘ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ· ·fiÙÔ RoekoSeal Î·È GuttaFlow 2. ™ÙËÓ ÚÒÙË ÂÚ›ÙˆÛ˛ۈ˜ ÔÊ›ÏÂÙ·È ÛÙ· Ó·ÓÔۈ̷ٛ‰È· ·ÚÁ‡ÚÔ˘ Î·È ÛÙË ‰Â‡-ÙÂÚË ÛÙË ‰È·ÊÔÚ¿ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ÛˆÌ·Ùȉ›ˆÓ ·ÚÁ‡ÚÔ˘10.T· ÚÔ˚fiÓÙ· ÙÔ˘ GuttaFlow ÂÈÙÚ¤Ô˘Ó ÙËÓ ÚÔÛÎfiÏÏË-ÛË ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ ÙÔ˘ ÂÚÈÔ‰ÔÓÙÈÎÔ‡ Û˘Ó‰¤ÛÌÔ˘ Î·È ÙÔ˘ÏÈÎfi ÚÔ¿ÁÂÈ ÙËÓ ·Ó·Á¤ÓÓËÛË ÙÔ˘ ÂÚÈÔ‰ÔÓÙÈÎÔ‡ Û˘Ó-‰¤ÛÌÔ˘ Î·È ÙˆÓ ÂÚÈ·ÎÚÔÚÈ˙ÈÎÒÓ ÈÛÙÒÓ62. AÓ Î·È Ë ‚È‚ÏÈÔ-ÁÚ·Ê›· ·Ó·Ê¤ÚÂÈ ·‡ÍËÛË Ù˘ ΢ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ·˜ ÙÔ˘GuttaFlow Ì ÙÔ ¤Ú·ÛÌ· ÙÔ˘ ¯ÚfiÓÔ˘ ÌÂÙ¿ ÙË Ì›ÍË ÙÔ˘,ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ ÙÔ ˘ÏÈÎfi ‹Ù·Ó ÏÈÁfiÙÂÚÔ Î˘ÙÙ·ÚÔ-ÙÔÍÈÎfi Û ۯ¤ÛË Ì ÙÔ AH Plus, RealSeal SE Î·È Roth 80163.A˘Ùfi ¤Ú¯ÂÙ·È ÛÂ Û˘Ìʈӛ· Ì ÌÈ· ·ÎfiÌË ¤Ú¢ӷ Ô˘ ·-ÚÔ˘ÛÈ¿˙ÂÈ ÙË ÌÈÎÚfiÙÂÚË Î˘ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ· ÙÔ˘ GuttaflowÛ˘ÁÎÚÈÙÈο Ì ÙÔ AH Plus Î·È Û‡Ìʈӷ Ì ÙÔÓ YesiloyÎ·È Û˘Ó. ‹Ù·Ó Î·È ÂÚÈÛÛfiÙÂÚÔ ‚ÈÔÛ˘Ì‚·Ùfi ·fi Ù· ¢ÁÂ-ÓÔÏÔ‡¯· Ê˘Ú¿Ì·Ù·64. TÔ GuttaFlow Û˘ÁÎÚÈÓfiÌÂÓÔ Ì ٷ

GuttaFlows cytotoxicity with the passage of time aftermixture, in the present study the material was less cytotoxicthan AH Plus, RealSeal SE and Roth 80163. Also this is inagreement with another study, which showed GuttaFlowslower cytotoxicity compared with AH Plus, and accordingto Yesiloy et al. it was also more biocompatible than zincoxide-eugenol sealers64. GuttaFlow compared to AH Plus,EndoRez and Pulp Canal Sealer was the only materialwhich was not toxic37. Additionally, GuttaFlow did not showcytotoxicity immediately after mixture as the percentageof viable periodontal fibroblasts was 99%. After 24 hoursthere was also no toxic effect and the percentage of viableperiodontal fibroblasts was 95.2% and after 48 hours thispercentage was 96.9%. Therefore, GuttaFlow was notcytotoxic65. Consistent with the above, is another inve-stigation of GuttaFlow, which showed its high biocom-patibility. Mouse fibroblasts, immediately after mixture,exhibit viability rates of approximately 90.9%. After 24 hoursthe rate is 98.1%, after 48 hours is 79.2% and finally after7 days is 77.4%66. Also according to another study, itshowed low cytotocity67.The MTA Fillapex in the seventh day of the experiment,showed mild? cytotoxicity, which was lower compared tothat exhibited by Sealapex. The cytotoxicity levelsdecreased with the passage of time29. ProRoot MTA alsoshowed no toxic effects68. The freshly mixed MTA Fillapexwas significantly more cytotoxic than BC Sealer, and whenset was more cytotoxic than both BC Sealer and AH Plus.The Endosequence BC showed no cytotoxicity at any stageof the study69. In contrast with the above, in this investigationMTAFillapex and iRoot SP had no cytotoxic effect on theperiodontal fibroblasts 2 weeks after treatment. This is thefirst study, which evinced that MTA Fillapex and iRootSP are promoting the osteogenesis and do not causeinflammatory response70.Zhang et al. reported that iRoot SP was less toxic thanthe AH Plus sealer14. Additionally, Endosequence BCshowed significantly less cytotoxicity than AH Plus againstfibroblasts51. Also, AH Plus showed higher cytotoxicity thanGuttaFlow and Endosequence BC both in freshly mixedand in the set condition of the sealers. EndosequenceBC and GuttaFlow had rates of cell viability at 90-100%53.However, the freshly mixed iRoot SP’s toxicity was higherthan ProRoot MTA68. Additionally, the cytotoxicity ischanging with the passage of time as the EndoSequenceBC Sealer remained moderate cytotoxic up to the fifth weekof the experiment and was mildly cytotoxic in the sixthweek. This toxicity, however, against L929 mouse fibroblastswas lower compared to the AH Plus71. The dependence ofthe fibroblast proliferation by the sealer and the cultivationtime is also mentioned. After 72 and 96 hours of theexperiment the sealers GuttaFlow and EndoSequence BCshowed some non-cytotoxicity, whilst Pulp Canal SealerEWT and AH Plus Jet caused significant cell reduction52.Koch and Brave claim that bioceramic sealers haveincreased biocompatibility72.

Hellenic Stomatological Review 59: 51-69, 2015 63

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

Hellenic Stomatological Review 59: 51-69, 2015

AH Plus, EndoRez, Î·È ÙÔ Pulp Canal Sealer ‹Ù·Ó ÙÔ Ìfi-ÓÔ ̆ ÏÈÎfi Ô˘ ‰ÂÓ ‹Ù·Ó ÙÔÍÈÎfi37. EÈÚfiÛıÂÙ· ÙÔ GuttaFlow,‰ÂÓ ÂÌÊ¿ÓÈÛ ΢ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ·Ó¿-ÌÂÈÍ‹ ÙÔ˘ ηıÒ˜ ÙÔ ÔÛÔÛÙfi ÙˆÓ ˙ˆÓÙ·ÓÒÓ ÈÓÔ‚Ï·ÛÙÒÓÙÔ˘ ÂÚÈÔ‰ÔÓÙ›Ô˘ ‹Ù·Ó 99%. MÂÙ¿ ·fi 24 ÒÚ˜, ›Û˘‰ÂÓ ˘‹Ú¯Â ÙÔÍÈ΋ ›‰Ú·ÛË Î·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ˙ˆÓÙ·-ÓÒÓ ÈÓÔ‚Ï·ÛÙÒÓ ÙÔ˘ ÂÚÈÔ‰ÔÓÙ›Ô˘ ‹Ù·Ó 95,2% Î·È ÌÂÙ¿·fi 48 ÒÚ˜ ÙÔ ÔÛÔÛÙfi ·˘Ùfi ‹Ù·Ó 96,9%. EÔ̤ӈ˜ ÙÔGuttaFlow ‰ÂÓ Â›Ó·È Î˘ÙÙ·ÚÔÍÈÎÔ65. ™Â Û˘Ìʈӛ· Ì ٷ ·-Ú·¿Óˆ ‚Ú›ÛÎÂÙ·È Î·È Ì›· ·ÎfiÌË ¤Ú¢ӷ ηٿ ÙËÓ ÔÔ›·ÙÔ GuttaFlow, ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ·. OÈÈÓÔ‚Ï¿ÛÙ˜ ÔÓÙÈÎÈÒÓ, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ·Ó¿ÌÂÈÍ‹ ÙÔ˘,·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÛÔÛÙ¿ ‚ȈÛÈÌfiÙËÙ·˜ Ù˘ ٿ͈˜ ÙÔ˘90,9%. MÂÙ¿ ·fi 24 ÒÚ˜ ÙÔ ÔÛÔÛÙfi Â›Ó·È 98,1%, ÌÂÙ¿·fi 48 ÒÚ˜ Â›Ó·È 79,2% Î·È Ù¤ÏÔ˜ ÌÂÙ¿ ·fi 7 Ë̤ÚÂ˜Â›Ó·È 77,4%66. E›Û˘, Û‡Ìʈӷ Ì ÌÈ· ¿ÏÏË ¤Ú¢ӷ, ·-ÚÔ˘ÛÈ¿˙ÂÈ ¯·ÌËÏ¿ ›‰· ΢ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ·˜67.TÔ MTA Fillapex ÙËÓ ¤‚‰ÔÌË Ë̤ڷ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ÂÈÚ¿Ì·ÙÔ˜, ·ÚÔ˘Û›·Û ̤ÛË Î˘ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ· Ë ÔÔ›·‹Ù·Ó ÌÈÎÚfiÙÂÚË Û ۯ¤ÛË Ì ·˘Ù‹ Ô˘ ÂÌÊ¿ÓÈÛ ÙÔSealapex. T· ›‰· ΢ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ·˜ ÌÂÈÒıËÎ·Ó ÌÂÙÔ ¤Ú·ÛÌ· ÙÔ˘ ¯ÚfiÓÔ˘29. O‡Ù ÙÔ ProRoot MTAÂÌÊ¿ÓÈ-Û ÙÔÍÈ΋ ‰Ú¿ÛË68. TÔ ÚfiÛÊ·Ù· ·Ó·ÌÂÌÂÈÁ̤ÓÔ MTAFillapex ‹Ù·Ó ÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚÔ Î˘ÙÙ·ÚÔÙÔÍÈÎfi ·fiÙÔ BC Sealer, ÂÓÒ fiÙ·Ó ¤ËÍ ‹Ù·Ó ÈÔ Î˘ÙÙ·ÚÔÙÔÍÈÎfi Ùfi-ÛÔ ·fi ÙÔ BC Sealer fiÛÔ Î·È ·fi ÙÔ AH Plus.TÔEndosequence BC ‰ÂÓ ÂÌÊ¿ÓÈÛ ΢ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ· ÛÂηӤӷ ÛÙ¿‰ÈÔ Ù˘ ¤Ú¢ӷ˜69. ™Â ·ÓÙ›ıÂÛË Ì ٷ ·Ú·-¿Óˆ, ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ ÙÔ MTAFillapex Î·È ÙÔ iRootSP ‰ÂÓ Â›¯·Ó ΢ÙÙ·ÚÔÙÔÍÈ΋ ›‰Ú·ÛË ÛÙÔ˘˜ ÈÓÔ‚Ï¿ÛÙ˜ÙÔ˘ ÂÚÈÔ‰ÔÓÙ›Ô˘ Û ‰È¿ÛÙËÌ· 2 ‚‰ÔÌ¿‰ˆÓ ÌÂÙ¿ ÙËÓ ıÂ-ڷ›·. A˘Ù‹ Â›Ó·È Ë ÚÒÙË ¤Ú¢ӷ Ô˘ ηٷ‰ÂÈÎÓ‡ÂÈfiÙÈ ÙÔ MTA Fillapex Î·È ÙÔ iRoot SP ÚÔ¿ÁÔ˘Ó ÙËÓ ÔÛÙÂ-ÔÁ¤ÓÂÛË Î·È ‰ÂÓ ÚÔηÏÔ‡Ó ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË70.Œ¯ÂÈ ·Ó·ÊÂÚı› ·fi ÙÔ˘˜ Zhang Î·È Û˘Ó. fiÙÈ ÙÔ iRootSP ‹Ù·Ó ÛËÌ·ÓÙÈο ÏÈÁfiÙÂÚÔ ÙÔÍÈÎfi ·fi ÙÔ Ê‡Ú·Ì· AHPlus14. E›Û˘, ÙÔ Endosequence BC ÂÌÊ¿ÓÈÛ ÛËÌ·ÓÙÈ-ο ÌÈÎÚfiÙÂÚË Î˘ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ· Û ۯ¤ÛË Ì ÙÔ AH Plus¤Ó·ÓÙÈ ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ51. AÎfiÌ·, ÙÔ AH Plus ·ÚÔ˘Û›·-Û ÌÂÁ·Ï‡ÙÂÚË Î˘ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ· ·fi Ù· GuttaFlow ηÈEndoSequence BC ›ÙÂ Ë ‰ÔÎÈÌ·Û›· ·ÊÔÚÔ‡Û ÊÚ¤ÛÎ·Ê˘Ú¿Ì·Ù· ›ÙÂ Ê˘Ú¿Ì·Ù· Ô˘ ¤¯Ô˘Ó ‹ÍÂÈ. T·EndoSequence BC Î·È GuttaFlow ÂÌÊ¿ÓÈÛ·Ó ÔÛÔÛÙ¿Î˘ÙÙ·ÚÈ΋˜ ‚ȈÛÈÌfiÙËÙ·˜ 90-100%53. øÛÙfiÛÔ, ÙÔ Úfi-ÛÊ·Ù· ·Ó·ÌÂÌÂÈÁ̤ÓÔ iRootSP ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ÙÔÍÈÎfi-ÙËÙ· ·fi ÙÔ ProRoot MTA68. EÈϤÔÓ, ÂÌÊ·Ó›˙ÂÙ·È ÌÂ-Ù·‚ÔÏ‹ Ù˘ ΢ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ·˜ Ì ÙÔ ¤Ú·ÛÌ· ÙÔ˘ ̄ Úfi-ÓÔ˘ ηıÒ˜ ÙÔ EndoSequence BC Sealer ·Ú¤ÌÂÈÓ ̤-ÙÚÈ· ΢ÙÙ·ÚÔÙÔÍÈÎfi ˆ˜ ÙËÓ ¤ÌÙË Â‚‰ÔÌ¿‰· ‰È¿ÚÎÂÈ·˜ÙÔ˘ ÂÈÚ¿Ì·ÙÔ˜ Î·È ¤ÁÈÓ ‹È· ΢ÙÙ·ÚÔÙÔÍÈÎfi ÙËÓ ¤ÎÙË‚‰ÔÌ¿‰·. H ÙÔÍÈÎfiÙËÙ· ÙÔ˘, ̂ ÛÙfiÛÔ, ÂÓ¿ÓÙÈ· ÛÙÔ˘˜ L929ÈÓÔ‚Ï¿ÛÙ˜ ÔÓÙÈÎÈÒÓ ‹Ù·Ó ÌÈÎÚfiÙÂÚË Û˘ÁÎÚÈÙÈο Ì ÙÔAH Plus71. EÈÚfiÛıÂÙ·, Á›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙËÓ ÂÍ¿ÚÙË-ÛË ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ ·fi ÙÔ Ê‡-Ú·Ì· ηıÒ˜ Î·È ÙÔÓ ̄ ÚfiÓÔ Î·ÏÏȤÚÁÂÈ·˜. MÂÙ¿ ·fi 72 ηÈ96 ÒÚ˜, ‰È¿ÚÎÂÈ·˜ ÙÔ˘ ÂÈÚ¿Ì·ÙÔ˜, Ù· Ê˘Ú¿Ì·Ù·GuttaFlow Î·È EndoSequence BC ·ÚÔ˘Û›·Û·Ó Û¯ÂÙÈ΋ÌË Î˘ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ·, ÂÓÒ Ù· Pulp Canal Sealer EWT ηÈ

Self-expanding pointsDue to limited bibliography regarding the comparison ofthis new sealing system of self-expanding points with thesealing systems-sealers, the properties will not bethoroughly analyzed.The Smartseal system is radiopaque because the Smartpointcone and the Smartpaste sealer are radiopaque21. Smartpointis radiopaque because of its composition, since its centralcore consists of zirconium oxide/polyamide mix73. Regardingthe SmartpasteBio sealer, this sealer produced during itssetting reaction, calcium hydroxide and hydroxyapatite asby-products, making the material antibacterial and bioco-mpatible19. Additionally, it has a prolonged setting time,ranging from 4 to 10 hours, which in combination with thehydrophilic nature of the Propoint allowed hydrating andexpanding, filling thus any gaps19. The expansion increasedthe material movement to fill gaps between the master coneand the root canal walls, and allowed the filling of any rootcanal abnormalities resulting in the sealing of the lateral rootcanals and the apical delta73. The materials that expandedafter their placement are considered to exhibit desirableadhesive and sealing properties. As far as the adhesion isconcerned, no significant difference is observed betweenthe mean bond strength in canals that are sealed with theSmartseal system and those sealed with gutta-percha andthe AH 26 sealer73. According to the manufacturer and the toxicity standardizationof ISO, the polymer hydrogel Prosmart was nontoxic, whilstgutta-percha showed significant level of cytotoxicity. TheSmartpaste Bio sealer was also biocompatible74. This contrastswith Eid et al. who claimed that cytotoxic results of C-Pointwere ephemeral and comparable with gutta-percha75.

Discussion An integral part of dental science is, undoubtedly, theperpetual effort and research of the composition andconsequently the establishment in clinical procedures ofthe most suitable restoration materials.Research in the field of endodontics has focused on thesynthesis of new sealers that meet the requirements statedby Grossman on the one hand and the demands of clinicaldoctors on the other. Thus, new preparations arose inthe effort to create the ideal material.According to the collected papers, were examined theantimicrobial properties of the sealers, their sealing ability,the physicochemical properties and their biocompatibility.International standards suggest that the assessment ofbiocompatibility is crucial for the clinical use of the rootcanal sealing materials63. Even if the presence of endodonticsealers should be restricted in the root canal, sometimesthey can be extruded through the apical foramen to theperiapical tissues increasing the risk of irritation or delayedhealing37. The periodontal ligament fibroblasts are cells thatare found in the apical underlying tissues and are the firstcells that are affected by the materials that may be extruded,risking cell degeneration64. Thus, the endodontic sealersmust be biocompatible because they will possibly come incontact with the periapical tissues for an extended period76.

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AH Plus Jet ÚÔοÏÂÛ·Ó ÛËÌ·ÓÙÈ΋ ΢ÙÙ·ÚÈ΋ Ì›ˆÛË52.OÈ Koch Î·È Brave ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ù· ‚ÈÔÎÂÚ·ÌÈο Ê˘-Ú¿Ì·Ù· ¤¯Ô˘Ó ·˘ÍË̤ÓË ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ·72.

SELF EXPANDING POINTS

§fiÁˆ Ù˘ ÂÚÈÔÚÈṲ̂Ó˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ Û fiÙÈ ·ÊÔÚ¿ ÛÙËÛ‡ÁÎÚÈÛË ÙÔ˘ Ó¤Ô˘ ÂÌÊÚ·ÎÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·˘ÙÔÚÔ-Û·ÚÌÔ˙fiÌÂÓˆÓ ÎÒÓˆÓ Ì ٷ ̆ fiÏÔÈ· ÂÌÊÚ·ÎÙÈο Û˘ÛÙ‹-Ì·Ù·-Ê˘Ú¿Ì·Ù·, ÔÈ È‰ÈfiÙËÙ˜ ÙÔ˘ ‰ÂÓ ı· ·Ó·Ï˘ıÔ‡Ó Û‡Ì-ʈӷ Ì ÙËÓ ·Ú·¿Óˆ ηÙËÁÔÚÈÔÔ›ËÛË.TÔ Û‡ÛÙËÌ· Smartseal Â›Ó·È ·ÎÙÈÓÔÛÎÈÂÚfi ηıÒ˜ Ô ÎÒÓÔ˜Smartpoint Î·È ÙÔ Ê‡Ú·Ì· Smartpaste Â›Ó·È ·ÎÙÈÓÔÛÎÈÂÚ¿21.H Û‡ÛÙ·ÛË ÙÔ˘ Smartpoint ÙÔ˘ ÚÔÛ‰›‰ÂÈ ·˘Ù‹ ÙËÓ È‰Èfi-ÙËÙ· ηıÒ˜ Ô ÎÂÓÙÚÈÎfi˜ ÙÔ˘ ˘Ú‹Ó·˜ ·ÔÙÂÏÂ›Ù·È ·fi ÔÍ›-‰ÈÔ ÙÔ˘ ˙ÈÚÎÔÓ›Ô˘/Ì›ÁÌ· ÔÏ˘·Ìȉ›Ô˘73. ™Â fiÙÈ ·ÊÔÚ¿ ÙÔʇڷ̷ SmartpasteBio,ηٿ ÙËÓ ·ÓÙ›‰Ú·ÛË ‹Í˘ ÙÔ˘ ·-Ú¿ÁÂÈ ̂ ˜ ̆ ÔÚÔ˚fiÓÙ· ̆ ‰ÚÔÍ›‰ÈÔ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ Î·È ̆ ‰ÚÔ-͢··Ù›ÙË, Ô˘ ηıÈÛÙÔ‡Ó ÙÔ ̆ ÏÈÎfi ·ÓÙÈ‚·ÎÙËÚÈ·Îfi Î·È ‚ÈÔ-Û˘Ì‚·Ùfi19. AÎfiÌ·, ‰È·ı¤ÙÂÈ ·Ú·ÙÂٷ̤ÓÔ ¯ÚfiÓÔ ‹Í˘,Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 4 ˆ˜ 10 ÒÚ˜, Ô ÔÔ›Ô˜ ÛÂ Û˘Ó‰˘·-ÛÌfi Ì ÙËÓ ̆ ‰ÚfiÊÈÏË Ê‡ÛË ÙÔ˘ ÂÈÙÚ¤Ô˘Ó ÛÙÔ Propoint Ó·ÂÓ˘‰·Ùˆı› Î·È Ó· ‰È·ÛÙ·Ï›, ÁÂÌ›˙ÔÓÙ·˜ Ì ·˘ÙfiÓ ÙÔÓ ÙÚfi-Ô Ù· ÎÂÓ¿19. M ÙË ‰È·ÛÙÔÏ‹ ·˘Í¿ÓÂÙ·È Ë Î›ÓËÛË ÙÔ˘ ˘ÏÈ-ÎÔ‡ Ó· ÁÂÌ›ÛÂÈ Ù· ÎÂÓ¿ ÌÂٷ͇ ·ÚÈÔ˘ ÎÒÓÔ˘ Î·È ÙÔȯˆÌ¿-ÙˆÓ ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ Î·È ÂÈÙÚ¤ÂÙ·È Ë ÚÔ‹ ÛÙȘ ·Óˆ-̷ϛ˜ ÙÔ˘ ۈϋӷ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÂÌÊÚ¿ÛÛÔÓÙ·È ·-Ú¿Ï¢ÚÔÈ ÚÈ˙ÈÎÔ› ۈϋÓ˜ Î·È ·ÎÚÔÚÈ˙Èο ‰¤ÏÙ·73. T· ̆ ÏÈÎ¿Ô˘ ˘fiÎÂÈÓÙ·È ‰È·ÛÙÔÏ‹ ÌÂÙ¿ ÙËÓ ÙÔÔı¤ÙËÛË ıˆÚ›ٷȈ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÈı˘ÌËÙ¤˜ Û˘ÁÎÔÏÏËÙÈΤ˜ Î·È ÂÌÊÚ·-ÎÙÈΤ˜ ȉÈfiÙËÙ˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘ÁÎfiÏÏËÛË, ‰ÂÓ ¤¯Ô˘Ó·Ú·ÙËÚËı› ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ Ù˘ ̤Û˘ ·ÓÙÔ-¯‹˜ ÙÔ˘ ‰ÂÛÌÔ‡ Û ÚÈ˙ÈÎÔ‡˜ ۈϋÓ˜ Ô˘ ¤¯Ô˘Ó ÂÌÊÚ·¯ı›Ì ÙÔ Û‡ÛÙËÌ· Smartseal Î·È Û ·˘ÙÔ‡˜ Ô˘ ¤¯Ô˘Ó ÂÌ-ÊÚ·¯ı› Ì ÁÔ˘Ù·¤Úη Î·È Ì ÙÔ Ê‡Ú·Ì· AH 2673.™‡Ìʈӷ Ì ÙÔÓ Î·Ù·Û΢·ÛÙ‹ Î·È ÙËÓ Ù˘ÔÔ›ËÛË ÙÔÍÈ-ÎfiÙËÙ·˜ ηٿ ISO, Ë ÔÏ˘ÌÂÚ‹˜ ˘‰ÚÔÁ¤ÏË Prosmart ›ӷÈÌË ÙÔÍÈ΋ ÂÓÒ Ë ÁÔ˘Ù·¤Úη ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈο ›-‰· ΢ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ·˜. TÔ Ê‡Ú·Ì· Smartpaste Bio ›-Ó·È, ›Û˘, ‚ÈÔÛ˘Ì‚·Ùfi74. A˘Ùfi ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ÙÔÓEid Î·È Û˘Ó. ÔÈ ÔÔ›ÔÈ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ù· ΢ÙÙ·ÚÔÙÔÍÈο·ÔÙÂϤÛÌ·Ù· ÙÔ˘ C-Point ‹Ù·Ó ·ÚÔ‰Èο Î·È Û˘ÁÎÚ›ÛÈÌ·Ì ÙË ÁÔ˘Ù·¤Úη75.

™YZHTH™H

AÓ·fiÛ·ÛÙÔ ÎÔÌÌ¿ÙÈ Ù˘ Ô‰ÔÓÙÈ·ÙÚÈ΋˜ ÂÈÛÙ‹Ì˘, ·Ô-ÙÂÏ› ·Ó·ÌÊ›‚ÔÏ·, Ë ·¤Ó·Ë ÚÔÛ¿ıÂÈ· Î·È ¤Ú¢ӷ ÁÈ·ÙËÓ Û‡ÓıÂÛË Î·È Î·Ù’ ¤ÎÙ·ÛË ÙËÓ ÂÁηı›‰Ú˘ÛË ÛÙȘ ÎÏÈ-ÓÈΤ˜ ‰È·‰Èηۛ˜ ÙˆÓ Ï¤ÔÓ Î·Ù¿ÏÏËÏˆÓ ˘ÏÈÎÒÓ ·Ôη-Ù¿ÛÙ·Û˘.™ÙÔÓ ÙÔ̤· Ù˘ ÂÓ‰Ô‰ÔÓÙ›·˜, Ë ¤Ú¢ӷ ¤¯ÂÈ ÂÈÎÂÓÙÚˆı›ÛÙËÓ Û‡ÓıÂÛË Ó¤ˆÓ Ê˘Ú·Ì¿ÙˆÓ Ù· ÔÔ›· Ó· ÏËÚÔ‡Ó ÙȘÚÔ¸Ôı¤ÛÂȘ Ô˘ ›¯Â ÂÎÊÚ¿ÛÂÈ Ô Grossman ·ÊÂÓfi˜ ·Ï-Ï¿ Î·È ÙȘ ··ÈÙ‹ÛÂȘ ÙˆÓ ÎÏÈÓÈÎÒÓ. ŒÙÛÈ, ÚԤ΢„·Ó ηÈ-ÓÔ‡ÚÁÈ· Û΢¿ÛÌ·Ù· ÛÙËÓ ÚÔÛ¿ıÂÈ· ‰ËÌÈÔ˘ÚÁ›·˜ ÙÔ˘È‰·ÓÈÎÔ‡ ˘ÏÈÎÔ‡.™‡Ìʈӷ Ì ٷ ¿ÚıÚ· Ô˘ Û˘ÁÎÂÓÙÚÒıËÎ·Ó ÂÍÂÙ¿ÛÙË-

The cytotoxicity of endodontic sealers can be affected bymany factors, such as the composition, the characteristicsof setting, the dimensional stability and the area betweenthe sealing material and adjacent soft and hard tissues63. Asuccessful endodontic treatment demands the minimizationof the potential inflammatory response caused by the fillingmaterial and suppressing bacterial growth52.Gallego et al. argued that MTA offered a biologically activesubstrate for the bone and cells. Also Gandolfi et al. reportedthe desired reaction of the osteoblasts to MTA68. MTA’sbiocompatibility was because of the high levels of calciumrelease68. Conversely, a paste based on MTA, MTA Fillapex,exhibited cytotoxicity, which is probably because of itscomponents and more specifically because of salicylateresin, diluted resin and silica particles35, 51, 76. Bramante etal. showed that several MTA formulations contain highlevels of arsenic, a heavy metal with known toxicity to cells.However, they found that MTA-Angelus contains arsenicwithin the permissible limits specified by the ISO 9917-1standardization38. Although it was expected that sealersbased on MTA would have restorative properties, therewas no advantage in tissue reaction from MTA-Fillapexcompared with AH Plus and the zinc oxide-eugenol sealer,EndoFill61.The slightly cytotoxic activity of iRoot SP, maybe becauseof the high pH of its surface, caused denaturation of theadjacent cells and proteins68.The increase of GuttaFlow cytotoxicity through time afterits mixture could be attributed to the silver particles release63,

23. Also, it is reported that the mild inflammatory responsepossibly occurred because of the small amounts of non-polymerized silicone64.Endodontic sealing materials with antimicrobial propertieswere able to eliminate or bury remaining microorganisms,after the chemomechanical preparation76.The alkaline pH developed by Endosequence BC,promoted the elimination of microbes, such as E. faecalis,that may survived the chemomechanical preparation andinduced or maintained the periapical inflammation13.It was also reported that the extended antibacterial abilitymay occur because of the process of bio-mineralization,which was the result of the action of the silicate/calciumphosphate sealer with the participation of dentinhydroxyapatite crystals43. The combination of high pH, thehydrophilic nature of the sealer and the diffusion of activecalcium hydroxide possibly gave antibacterial activity tothe sealer50, 55.Balazs et al. reported that silver nitrate solutions causedchemical modification of the gutta-percha surface, whichled to reduced adhesion and growth potential of bacteria.This was GuttaFlows base, which contains silver nano-particles as antimicrobial factor48, 23.MTA Fillapex contains calcium silicate and with dentinsmoistening calcium hydroxide and calcium silicate hydrogelare produced, resulting to the high pH and antibacterialproperties of the sealer55.Despite the fact that endodontic therapies have a greatsuccess rate, failures are likely to occur. The removal of

Hellenic Stomatological Review 59: 51-69, 2015

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

Î·Ó ÔÈ ·ÓÙÈÌÈÎÚԂȷΤ˜ ȉÈfiÙËÙ˜ ÙˆÓ Ê˘Ú·Ì¿ÙˆÓ, Ë ÂÌ-ÊÚ·ÎÙÈ΋ ÙÔ˘˜ ÈηÓfiÙËÙ·, ÔÈ Ê˘ÛÈÎÔ¯ËÌÈΤ˜ ȉÈfiÙËÙ˜ η-ıÒ˜ Î·È Ë ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ¿ ÙÔ˘˜.T· ‰ÈÂıÓ‹ ÚfiÙ˘· ÚÔÙ›ÓÔ˘Ó fiÙÈ Ë ÂÎÙ›ÌËÛË Ù˘ ‚ÈÔÛ˘Ì-‚·ÙfiÙËÙ·˜ Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋ ÁÈ· ÙËÓ ÎÏÈÓÈ΋ ¯Ú‹ÛËÙˆÓ ÂÌÊÚ·ÎÙÈÎÒÓ ̆ ÏÈÎÒÓ ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ63. AÓ Î·È Ù·ÂÓ‰Ô‰ÔÓÙÈο Ê˘Ú¿Ì·Ù· Ú¤ÂÈ Ó· ·Ú·Ì¤ÓÔ˘Ó ÛÙÔÓ ÚÈ˙ÈÎfiۈϋӷ, ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ ÂͤگÔÓÙ·È ·fi ÙÔ ·ÎÚÔÚÈ˙ÈÎfiÙÚ‹Ì· ÛÙÔ˘˜ ÂÚÈ·ÎÚÔÚÈ˙ÈÎÔ‡˜ ÈÛÙÔ‡˜ ·˘Í¿ÓÔÓÙ·˜ ÙÔÓ Î›Ó-‰˘ÓÔ ÂÚÂıÈÛÌÔ‡ ‹ ηı˘ÛÙÂÚË̤Ó˘ ›·Û˘37. OÈ ÈÓÔ‚Ï¿ÛÙ˜Ù˘ ÂÚÈÔ‰ÔÓÙÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Â›Ó·È Î‡ÙÙ·Ú· Ô˘ ‚Ú›ÛÎÔ-ÓÙ·È ÛÙÔ˘˜ ˘ÔΛÌÂÓÔ˘˜ ÈÛÙÔ‡˜ ÙÔ˘ ·ÎÚÔÚÈ˙›Ô˘ Î·È Â›Ó·ÈÙ· ÚÒÙ· ·ÙÙ·Ú· Ô˘ ÂËÚ¿˙ÔÓÙ·È ·fi Ù· ˘ÏÈο Ô˘Èı·ÓÒ˜ ÂͤÏıÔ˘Ó, Ì ΛӉ˘ÓÔ Ó· ÚÔηϤÛÔ˘Ó ÙÔÓ ÂÎÊ˘-ÏÈÛÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ64.ŒÙÛÈ Ù· ÂÓ‰Ô‰ÔÓÙÈο Ê˘Ú¿Ì·Ù· ÔÊ›-ÏÔ˘Ó Ó· Â›Ó·È ‚ÈÔÛ˘Ì‚·Ù¿ ·ÊÔ‡, Èı·ÓÒ˜, ı· ¤ÚıÔ˘Ó Û·ʋ Ì ÙÔ˘˜ ÂÚÈ·ÎÚÔÚÈ˙ÈÎÔ‡˜ ÈÛÙÔ‡˜ ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔ-ÓÈÎfi ‰È¿ÛÙËÌ·76. H ΢ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ· ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈÎÒÓÊ˘Ú·Ì¿ÙˆÓ ÌÔÚ› Ó· ÂËÚ¿˙ÂÙ·È ·fi ÔÏÏÔ‡˜ ·Ú¿-ÁÔÓÙ˜, fiˆ˜ Â›Ó·È Ë Û‡ÛÙ·ÛË, Ù· ̄ ·Ú·ÎÙËÚÈÛÙÈο Ù˘ ‹-͢ ÙÔ˘˜, Ë ÛÙ·ıÂÚfiÙËÙ· Î·È Ë ÂÚÈÔ¯‹ ÌÂٷ͇ ÙÔ˘ ÂÌ-ÊÚ·ÎÙÈÎÔ‡ ̆ ÏÈÎÔ‡ Î·È ÙˆÓ ·Ú·Î›ÌÂÓˆÓ Ì·Ï·ÎÒÓ Î·È ÛÎÏË-ÚÒÓ ÈÛÙÒÓ63. °È· ÙËÓ ÂÈÙ˘¯Ë̤ÓË ıÂڷ›· ÙÔ˘ ÚÈ˙ÈÎÔ‡ Ûˆ-Ï‹Ó·, Ë ÂÏ·¯ÈÛÙÔÔ›ËÛË Ù˘ Èı·Ó‹˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜·ÓÙ›‰Ú·Û˘ Ô˘ ÚÔηÏÂ›Ù·È ·fi Ù· ÂÌÊÚ·ÎÙÈο ˘ÏÈÎ¿Î·È Ë Î·Ù·ÛÙÔÏ‹ Ù˘ ‚·ÎÙËÚȷ΋˜ ·Ó¿Ù˘Í˘ Â›Ó·È ıÂÌÂ-ÏÈÒ‰ÂȘ ÚÔ¸Ôı¤ÛÂȘ52.O Gallego Î·È Û˘Ó. ·ÚÔ˘Û›·Û·Ó fiÙÈ ÙÔ MTA ÚÔÛ¤ÊÂÚ ¤Ó·‚ÈÔÏÔÁÈο ÂÓÂÚÁfi ̆ fiÛÙڈ̷ ÁÈ· ÙÔ ÔÛÙfi Î·È Ù· ·ÙÙ·Ú·, η-ıÒ˜ Î·È Ô Gandolfi Î·È Û˘Ó. ·Ó¤ÊÂÚ·Ó ÙËÓ ÂÈı˘ÌËÙ‹ ·ÓÙ›-‰Ú·ÛË ÙˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ ÛÙÔ MTA68. H ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ· ÙÔ˘MTA ÔÊ›ÏÂÙ·È ÛÙ· ˘„ËÏ¿ ›‰· ·ÂÏ¢ı¤ÚˆÛ˘ ·Û‚Â-ÛÙ›Ô˘68. AÓÙÈı¤Ùˆ˜, ¤Ó· ʇڷ̷ ‚·ÛÈṲ̂ÓÔ ÛÙÔ MTA, ÙÔ MTAFillapex, ÂÌÊ·Ó›˙ÂÈ Î˘ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ· Ë ÔÔ›· Èı·ÓÒ˜ ÔÊ›-ÏÂÙ·È ÛÙ· Û˘ÛÙ·ÙÈο ÙÔ˘ Î·È ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ ÛÙË Û·ÏÈÎÈÏÈ-΋ ÚËÙ›ÓË, ÛÙËÓ ·Ú·ÈˆÌ¤ÓË ÚËÙ›ÓË Î·È ÛÙ· ۈ̷ٛ‰È· ˘ÚÈÙ›-Ô˘35, 51, 76. O Bramante Î·È Û˘Ó. ¤‰ÂÈÍ·Ó fiÙÈ ·ÚÎÂÙÔ› Û¯ËÌ·ÙÈÛÌÔ›MTA ÂÚȤ¯Ô˘Ó ̆ „ËÏ¿ ›‰· ·ÚÛÂÓÈÎÔ‡, ¤Ó· ‚·Ú‡ ̤ٷÏ-ÏÔ Ì ÁÓˆÛÙ‹ ÙÔÍÈÎfiÙËÙ· ÛÙ· ·ÙÙ·Ú·. øÛÙfiÛÔ, ‚Ú‹Î·Ó fiÙÈÙÔ MTA-Angelus ÂÚÈ›¯Â ·ÚÛÂÓÈÎfi ̤۷ ÛÙ· ÂÈÙÚÂÙ¿ fiÚÈ·Ô˘ ηıÔÚ›˙ÔÓÙ·È ·fi ÙËÓ Ù˘ÔÔ›ËÛË ISO 9917-138. ¶·Úfi-Ï· ·˘Ù¿ ·Ó·ÌÂÓfiÙ·Ó Ù· Ê˘Ú¿Ì·Ù· Ì ‚¿ÛË ÙÔ MTA Ó· ¤¯Ô˘Ó·ÔηٷÛÙ·ÙÈΤ˜ ȉÈfiÙËÙ˜, fï˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠηӤ-Ó· ÏÂÔÓ¤ÎÙËÌ· ÛÙËÓ ÈÛÙÈ΋ ·ÓÙ›‰Ú·ÛË ·fi ÙÔ MTA-FillapexÛ˘ÁÎÚÈÙÈο Ì ÙÔ AH Plus Î·È ÙÔ Â˘ÁÂÓÔÏÔ‡¯Ô ʇڷ̷EndoFill61.H ÂÏ·ÊÚÒ˜ ΢ÙÙ·ÚÔÙÔÍÈ΋ ‰Ú¿ÛË ÙÔ˘ iRoot SP ›Ûˆ˜ ÔÊ›-ÏÂÙ·È ÛÙÔ ˘„ËÏfi pH Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘, Ô˘ ÚÔηÏ›ÌÂÙÔ˘Û›ˆÛË ÙˆÓ ·Ú·Î›ÌÂÓˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÚˆÙÂ˚ÓÒÓ68.H ·‡ÍËÛË Ù˘ ΢ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ·˜ ÙÔ˘ GuttaFlow Ì ÙÔ ¤-Ú·ÛÌ· ÙÔ˘ ̄ ÚfiÓÔ˘, ÌÂÙ¿ ÙË Ì›ÍË ÙÔ˘, ı· ÌÔÚÔ‡Û ӷ ·Ô-‰Ôı› ÛÙËÓ ·ÂÏ¢ı¤ÚˆÛË ÛˆÌ·Ùȉ›ˆÓ ·ÚÁ‡ÚÔ˘63, 23. AÎfi-Ì·, ·Ó·Ê¤ÚÂÙ·È ˆ˜ Ë ‹È· ÊÏÂÁÌÔÓ҉˘ ·ÓÙ›‰Ú·ÛË Ô˘ÚÔηÏ›ٷÈ, ›Ûˆ˜ ÔÊ›ÏÂÙ·È Û ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜ ÌË Ô-Ï˘ÌÂÚÈṲ̂Ó˘ ÛÈÏÈÎfiÓ˘64.T· ÂÓ‰Ô‰ÔÓÙÈο ÂÌÊÚ·ÎÙÈο ̆ ÏÈο Ì ·ÓÙÈÌÈÎÚԂȷΤ˜ ȉÈfi-ÙËÙ˜ ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÂÍ·Ï›„Ô˘Ó ‹ Ó· ÂÓÙ·ÊÈ¿-ÛÔ˘Ó ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ô˘ ·Ú¤ÌÂÈÓ·Ó ÌÂÙ¿ ÙË ¯ËÌÈÎÔ-

the root canal sealing materials is necessary to revealthe necrotic tissue debris or the bacteria responsible forthe persisting inflammation. Their complete removal enablesreduction of bacteria through the chemomechanicalpreparation of the root canal system77.As far as Endosequence BC is concerned, it was impossibleto retrieve the working length in 70% of samples where itwas used as a sealer31. Regarding MTA Fillapex, the removalwas faster than the other examined sealers; however, noneof the sealers was completely removed from the walls ofthe root canal77. Within the root canal after the removal ofMTA Fillapex remained a much smaller amount of sealercompared with AH Plus78.

ConclusionsShort-term laboratory studies cannot predetermine the long-term clinical performance of sealers37. More study on theaforementioned newer endodontic sealers is required, beforetheir broad adoption in everyday endodontic treatment,always in connection with the best cost to benefit ratio.

BIB§IO°PAºIA / REFERENCES

1. D Flores DSH, Rached-Junior FJA, Versiani MA, Guedes DFC,Sousa-Neto MD, Pecora JD: Evaluation of physicochemicalproperties of four root canal sealers. Int Endod J 2011; 44(2):126-135

2. Zielinski TM, Baumgartner JC, Marshall JG: An Evaluation ofGuttaFlow and Gutta-Percha in the Filling of Lateral Groovesand Depressions. J Endod 2008; 34(3): 295-298

3. Huumonen S, Lenander-Lumikari M , Sigurdsson A, OrstavikD: Healing of apical periodontitis after endodontic treatment:a comparison between a silicone-based and zinc oxide-eugenol-based sealer. Int Endod J 2003; 36 (4): 296-301

4. Grossman LI: An improved root canal cement. J Am DentAssoc. 1958; 56 (3): 381-385.

5. Mokeem-Saleh A, Hammad M, Silikas N, Qualtrough A, WattsDC: A laboratory evaluation of the physical and mechanicalproperties of selected root canal sealers. Int Endod J. 2010;43(10): 882-888.

6. Borges AH, Orcati Dorileo MC, Dalla Villa R, Borba AM,Semenoff TA, Guedes OA, Estrela CR, Bandeca MC:Physicochemical properties and surfaces morphologiesevaluation of MTA Fillapex and AH Plus. Scien World J 2014;2014: 589-732.

7. Bergenholtz G, Horsted-Bindslev P, Reit C: Textbook ofEndodontology, 2nd ed., Willey-Blackwell

8. www.coltene.com (As read on 16/3/2016)9. Tyagi S, Mishra P, Tyagi P: Evolution of root canal sealers:

An insight story. Eur J Gen Dent 2013; 2: 199-218.10. Mandal P, Zhao J, Sab SK, Huang Y, Liu J: In Vitro Cytotoxicity

of GuttaFlow 2 on Human Gingival Fibroblasts. J Endod 2014;40(8): 1156-1159.

11. Rawtiya M, Verma K, Munuga S, Khan S: MTA-Based RootCanal Sealers.J Orofac Res 2013; 3(1): 16-21.

12. Vitti RP, Prati C, Silva EJNL, Sinboreti MAC, Zancbi CH, SilvaMGS, Ogliari FA, Piva E, Gandolfi MG: Physical Properties ofMTA Fillapex Sealer. J Endod. 2013; 39(7): 915-918.

13. Candeiro GTM, Correia FC, Duarte MAH, Ribeiro-Siqueira DC,Gavini G: Evaluation of Radiopacity, pH, Release of CalciumIons, and Flow of a Bioceramic Root Canal Sealer. J Endod.2012; 38(6): 842-845.

Hellenic Stomatological Review 59: 51-69, 2015

Page 67: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

14. Shokouhinejad N, Gorjestani H, Nasseh AA, Hoseini A,Mohammadi M, Shamshiri AR: Push-out bond strength of gutta-percha with a new bioceramic sealer in the presence orabsence of smear layer. Aust Endod J. 2013; 39(3): 102-106.

15. Trope M, Bunes A, Debelian G: Root filling materials andtechniques: bioceramics a new hope? Endod Topics. 2015;32(1): 89-96.

16. Austad ED, Rose GL: A Self-Inflating Tissue Expander. PlastReconstr Surg. 1982; 70 (5): 588-594.

17. Chummun S, Addison P, Stewart KJ: The osmotic tissueexpander: A 5-year experience. J Plast Reconstr Aesthet Surg.2010; 63(12): 2128-2132.

18. SMARTSEALS SIMPLICITY IS THE KEY (2008), PrivateDentistry, Company Promotion, pp. 79

19. Pathivada L, Munagala KK, Dang AB: Smartseal: New AgeObturation. Annals of Dent Special 2013; 1(1): 13-15.

20. Didato A, Eid AA, Levin MD, Khan S, Tay FR, RueggebergFA:Time-based lateral hygroscopic expansion of a water-expandable endodontic obturation point. J Dent. 2013; 41(9):796-801.

21. Kim YK, Grandini S, Ames JM, Gu L, Kim SK, Pashley DH,Gutmann JL, Tay FR: Critical Review on Methacrylate Resin-based Root Canal Sealers. J Endod. 2010; 36(3): 383-399.

22. Kontakiotis EG, Tzanetakis GN, Loizides AL: A12-monthlongitudinal in vitro leakage study on new silicon-based rootcanal filling material (Gutta-Flow). Oral Surg Oral Med OralPathol Oral Radiol Endod. 2007; 103(6): 854-859.

23. Bouillaget S, Shaw L, Barthelemy J, Krejci I, Watha JC: Long-term sealing ability of Pulp Canal Sealer, AH-Plus, Guttaflowand Epiphany Int Endod J. 2008; 41(3): 219-226.

24. Savarik A, Gonzalez-Rodriguez MP, Ferrer-Luque CM: Long-term sealing ability of GuttaFlow versus Ah Plus using differentobturation techniques. Med Oral Patol Oral Cir Bucal 2010;15(6): 936-941.

25. Elias I, Guimaraes GO, Caldeira CL, Gavini G, Cai S, Akisue E:Apical sealing ability comparison between GuttaFlow and AHPlus: in vitro bacterial and dye leakage. J Health Sci Inst 2010;28(1): 77-79.

26. Shariff S: Sealing ability of two commonly used sealers witha recently introduced sealer, guttaflow, a comparativeevaluation-an in vitro study RGUHS - 2009.

27. Ozok AR, van der Sluis LWM, Wu MK, Wesselink PR: SealingAbility of a New Polydimethylsiloxane-based Root Canal FillingMaterial. J Endod. 2008; 34(2): 204-207.

28. Vasiliadis L, Kodonas K, Economides N, Gogos C, StavrianosC: Short- and long-term sealing ability of Gutta-flow and AH-Plus using ex vivo fluid transport model. Int Endod J. 2010;43(5): 377-381.

29. Gomes-Filho JE, Moreira JV, Watanabe S, Lodi CS, Cintra LTA,Dezan Junior E, Bernabe PFE, Nery MJ, Otoboni Filho JA:Sealability of MTA and calcium hydroxide-containing sealers.J Appl Oral Sci. 2012; 20(3): 347-351.

30. Soleymani A, Mirzairad S, Mesgarani A, Harandi A, Khafri A,Feizi F, Bahmannia M: A comparative evaluation of apicalmicroleakage of MTA fillapex and AH26 sealers in the presenceof blood in the canal space of the teeth. Caspian J of Dent Res2014; 3(1): 35-40.

31. Zhang W, Li Z,Peng B: Assesment of a new root canal sealersapical sealing ability. Oral Surg Oral Med Oral Pathol OralRadiol Endod. 2009;107: e79-e82.

32. Zhou HM, SHen Y, Zheng W, Li L, Zheng YF, Haapasalo M:Physical Properties of 5 Root Canal Sealers. J Endod. 2013;39 (10): 1281-1286.

33.http://www.endoexperience.com/documents/MTAFillapexphycalandmechanicalproperties.pdf (As read on 16/3/2016)

Ì˯·ÓÈ΋ ÂÂÍÂÚÁ·Û›·76.TÔ ·ÏηÏÈÎfi pH Ô˘ ·Ó·Ù‡ÛÂÈ ÙÔ Endosequence BC ÚÔ-ˆı› ÙËÓ ÂÍ¿ÏÂÈ„Ë ÌÈÎÚÔ‚›ˆÓ, fiˆ˜ Ô E. Faecalis Ô˘ ÌÔ-Ú› Ó· ÂÈ‚ÈÒÛÂÈ ÌÂÙ¿ ÙËÓ ̄ ËÌÈÎÔÌ˯·ÓÈ΋ ÂÂÍÂÚÁ·Û›· ηÈÓ· ¿ÁÂÈ ‹ Ó· ‰È·ÙËÚ‹ÛÂÈ ÙËÓ ÂÚÈ·ÎÚÔÚÈ˙È΋ ÊÏÂÁÌÔ-Ó‹13. AӷʤÚÂÙ·È ·ÎfiÌ·, ˆ˜ Ë ÌÂÁ¿Ï˘ ‰È¿ÚÎÂÈ·˜ ·ÓÙÈ‚·-ÎÙËÚȷ΋ ÈηÓfiÙËÙ· ÙÔ˘, ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙË ‰È·‰Èη-Û›· ‚ÈÔ-ÌÂÙ·ÏÏÈÎÔÔ›ËÛ˘ Ô˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰Ú¿-Û˘ ÙÔ˘ ˘ÚÈÙÈÎÔ‡/ʈÛÊÔÚÈÎÔ‡ ·Û‚ÂÛÙ›Ô˘ ÙÔ˘ Ê˘Ú¿Ì·-ÙÔ˜ Ì ÙË Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÎÚ˘ÛÙ¿ÏÏˆÓ ̆ ‰ÚÔ͢··Ù›ÙË Ù˘ԉÔÓÙ›Ó˘43. O Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘ ˘„ËÏÔ‡ pH, Ù˘ ˘‰ÚfiÊÈ-Ï˘ ʇÛ˘ ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ ηıÒ˜ Î·È Ù˘ ‰È¿¯˘Û˘ ÂÓÂÚ-ÁÔ‡ ˘‰ÚÔÍÂȉ›Ô˘ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ Èı·ÓÒ˜ ÚÔÛ‰›‰ÂÈ ÙËÓ·ÓÙÈ‚·ÎÙËÚȷ΋ ‰Ú¿ÛË ÛÙÔ Ê‡Ú·Ì·50, 55.OÈ Balazs Î·È Û˘Ó. ·Ó¤ÊÂÚ·Ó fiÙÈ Ù· ‰È·Ï‡Ì·Ù· ÓÈÙÚÈÎÔ‡ ·Ú-Á‡ÚÔ˘ ÚÔηÏÔ‡Ó ̄ ËÌÈ΋ ÙÚÔÔÔ›ËÛË ÛÙËÓ ÂÈÊ¿ÓÂÈ· Ù˘ÁÔ˘Ù·¤Úη˜ Ô˘ Ô‰ËÁ› Û Ì›ˆÛË Ù˘ ‰˘Ó·ÙfiÙËÙ·˜ ÚÔ-ÛÎfiÏÏËÛ˘ Î·È ·Ó¿Ù˘Í˘ ÙˆÓ ‚·ÎÙËÚ›ˆÓ. ™Â ·˘Ùfi ¤¯ÂÈ ÛÙË-Úȯı› ÙÔ Guttaflow ÙÔ ÔÔ›Ô ÂÚȤ¯ÂÈ Ó·ÓÔ-ۈ̷ٛ‰È· ·Ú-Á‡ÚÔ˘, ˆ˜ ·ÓÙÈÌÈÎÚÔ‚È·Îfi ·Ú¿ÁÔÓÙ·48, 23.TÔ MTA Fillapex ÂÚȤ¯ÂÈ ˘ÚÈÙÈÎfi ·Û‚¤ÛÙÈÔ Î·È Ì ÙËÓ ̆ ÁÚ·-Û›· Ù˘ Ô‰ÔÓÙ›Ó˘ ·Ú¿ÁÂÙ·È ̆ ‰ÚÔÍ›‰ÈÔ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ η-ıÒ˜ Î·È ˘‰ÚÔÁ¤ÏË ˘ÚÈÙÈÎÔ‡ ·Û‚ÂÛÙ›Ô˘, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ˘„ËÏfi pH Î·È ÙȘ ·ÓÙÈ‚·ÎÙËÚȷΤ˜ ȉÈfiÙËÙ˜ ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜55.¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÂÓ‰Ô‰ÔÓÙÈΤ˜ ıÂڷ›˜ ¤¯Ô˘ÓÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÂÈÙ˘¯›·˜, ·ÔÙ˘¯›Â˜ Â›Ó·È Èı·Ófi Ó· ·-Ú·ÙËÚËıÔ‡Ó. H ·Ê·›ÚÂÛË ÙˆÓ ˘ÏÈÎÒÓ ¤ÌÊڷ͢ ÙˆÓ ÚÈ˙È-ÎÒÓ ÛˆÏ‹ÓˆÓ, Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ·ÔÎ¿Ï˘„Ë ÙˆÓ˘ÔÏÂÈÌÌ¿ÙˆÓ ÓÂÎÚˆÙÈÎÔ‡ ÈÛÙÔ‡ ‹ ‚·ÎÙËÚ›ˆÓ Ô˘ Â›Ó·È˘Â‡ı˘Ó· ÁÈ· ÙËÓ ÂÌ̤ÓÔ˘Û· ÊÏÂÁÌÔÓ‹. H Ï‹Ú˘ ·Ê·›-ÚÂÛ‹ ÙÔ˘˜ ·Ú¤¯ÂÈ ÙËÓ ‰˘Ó·ÙfiÙËÙ· Ì›ˆÛ˘ ÙˆÓ ‚·ÎÙËÚ›ˆÓ̤ۈ Ù˘ ̄ ËÌÈÎÔÌ˯·ÓÈ΋˜ ÂÂÍÂÚÁ·Û›·˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ77.Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ÛÙÔ Endosequence BC ‰ÂÓ ‹Ù·Ó ‰˘-Ó·Ù‹ Ë ·Ó¿ÎÙËÛË ÙÔ˘ Ì‹ÎÔ˘˜ ÂÚÁ·Û›·˜ ÛÙÔ 70% ÙˆÓ ‰ÂÈÁ-Ì¿ÙˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËηÓ31. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ MTAFillapex Ë ·Ê·›ÚÂÛË ÙÔ˘ ¤ÁÈÓ ÁÚËÁÔÚfiÙÂÚ· Û˘ÁÎÚÈÙÈοÌ ٷ ˘fiÏÔÈ· ÂÍÂÙ·˙fiÌÂÓ· Ê˘Ú¿Ì·Ù·, ˆÛÙfiÛÔ Î·Ó¤Ó··fi Ù· Ê˘Ú¿Ì·Ù· ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ùfi Ó· ·Ê·ÈÚÂı› Ï‹-Úˆ˜ ·fi Ù· ÙÔȯÒÌ·Ù· ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ77. EÓÙfi˜ ÙˆÓÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ, ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ MTA Fillapex, ·-Ú¤ÌÂÈÓ Ôχ ÌÈÎÚfiÙÂÚË ÔÛfiÙËÙ· Ê˘Ú¿Ì·ÙÔ˜ Û ۯ¤ÛËÌ ÙÔ AH Plus78.

™YM¶EPA™MATA

OÈ ‚Ú·¯˘ÚfiıÂÛ̘ ÂÚÁ·ÛÙËÚȷΤ˜ ¤Ú¢Ó˜ ‰ÂÓ ÌÔÚÔ‡ÓÓ· ÚÔηıÔÚ›ÛÔ˘Ó ÙË Ì·ÎÚÔÚfiıÂÛÌË ÎÏÈÓÈ΋ ·fi‰ÔÛËÙˆÓ Ê˘Ú·Ì¿ÙˆÓ37. °È’ ·˘Ùfi ··ÈÙÂ›Ù·È Ë ‰ÈÂÓ¤ÚÁÂÈ· Ù˘¯·ÈÔ-ÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ (ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏË Î·È ÎÔ-È҉˘ ÚÔÛ¿ıÂÈ·) ¿Óˆ ÛÙ· ÚÔ·Ó·ÊÂÚı¤ÓÙ· ÓÂfiÙÂ-Ú· ÂÓ‰Ô‰ÔÓÙÈο Ê˘Ú¿Ì·Ù· ÚÈÓ ÙËÓ Â˘Ú›· ̆ ÈÔı¤ÙËÛË ÙÔ˘˜ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÂÓ‰Ô‰ÔÓÙÈ΋ Ú¿ÍË, ÛÂ Û˘Ó¿ÚÙËÛË ¿ÓÙ·Ì ÙË ‚¤ÏÙÈÛÙË Û¯¤ÛË ·fi‰ÔÛ˘/ÙÈÌ‹˜.

Hellenic Stomatological Review 59: 51-69, 2015 67

¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:EÏ¢ı¤ÚÈÔ˜- T¤ÚÚ˘ º·ÚÌ¿Î˘[email protected]

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

Hellenic Stomatological Review 59: 51-69, 2015

34. Dartar Oztan M, Yilmaz S, Kalayci A, Zaimoglu L: A comparisonof the in vitro cytotoxicity of two root canal sealers. J OralRehabil. 2003; 30(4): 426-429.

35. Hess D, Solomon E, Spears R, He J: Retratability of aBioceramic Root Canal Sealing Material. J Endod. 2011;37(11): 1547-1549.

36. Poggio C, Arciola CR, Dagna A, Colombo M, Bianchi S, VisaiL: Solubility of root canal sealers: A comparative study. Int JArtif Organs. 2010; 33(9): 676-681.

37. Brackett MG, Lewis JB, Kious AR, Messer RLW, LockwoodPE, Brackett WW, Wataha JC: Cytotoxicity of endodontic sealersafter one year of aging in vitro. J Biomed Mater Res B ApplBiomater. 2012; 100(7): 1729-1735.

38. Zmener O, Lalis RM, Pameijer CH, Chaves C, Kokubu G, GranaD: Reaction of Rat Subcutaneous Connective Tissue to aMineral Trioxide Aggregate-based and Zinc Oxide and EugenolSealer. J Endod. 2012; 38(9): 1233-1238.

39. Silva EJNL, Rosa TP, Herrera DR, Jacinto RC, Gomes BPFA,Zaia AA: Evaluation of Cytotoxicity and PhysicochemicalProperties of Calcium Silicate-based Endodontic Sealer MTAFillapex. J Endod. 2013; 39(2): 274-277.

40. Tanomaru-Filho M, Bosoo R, Viapiana R, Guerreiro-TanomaruJM: Radiopacity and Flow of different endodontic sealers.Acta Odontol Latinoam. 2013; 26(2): 121-125.

41. Vidotto APM, Cunha RS, Zeferino EG, Rocha DGP, Sigrist deMartin A, da Silveira Bueno CE: Comparison of MTA Fillapexradiopacity with five root canal sealers. Rev Sul Bras Odont2011; 8(4): 404-409.

42. Abesi F, Haghanifar S, Khafri S, Hamzeh M, Habibi A, EhsaniM: Comparison of Radiopacity of Six Endodontic Sealers.Journal of Dentomaxillofacial Radiology, Pathology andSurgery 2013; 2(2): 23-27 Vol

43. Wang Z, Shen Y, Haapasalo M: Dentin Extends the AntibacterialEffect of Endodontic Sealers against Enterococcus faecalisBiofilms. J Endod. 2014; 40(4): 505-508.

44. Bodrumlu E, Semiz M: Antibacterial Activity of a NewEndodontic Sealer against Enterococcus faecalis. J Can DentAssoc. 2006; 72(7): 637.

45. Heyder M, Kranz S, Volpel A, Pfister W, Watts DC, Jandt KD,Sigusch BW: Antibacterial effect of different root canal sealerson three bacterial species. Dent Mater. 2013; 29(5): 542-549.

46. Slutzky-Goldberg I, Slutzky H, Solomonou M, Moshonou J,Weiss EI, Matalon S: Antibacterial Properties of Four EndodonticSealers. J Endod. 2008; 34(6): 735-738.

47. Nawal RR, Parande M, Sehgal R, Naik A, Rao NR: A comparativeevaluation of antimicrobial efficacy and flow properties forEpiphany, Guttaflow and AH-Plus sealer. Int Endod J. 2011;44(4): 307-313.

48. Senges C, Wrbas KT, Altenburger M, Follo M, Spitzmuller B,Al-Ahmad A: Bacterial and Candida albicans Adhesion onDifferent Root Canal Filling Materials and Sealers. J Endod.2011; 37(9): 1247-1252.

49. Farmakis ETR, Kontakiotis EG, Tseleni-Kotsovili A, Tsatsas VG:Comparative in vitro antibacterial activity of six root canalsealers against Enterococcus faecalis and Proteus vulgaris.J Investig Clin Dent. 2012; 3(4): 271-275.

50. Zhang H, Shen Y, Ruse ND, Haapassalo M: Antibacterial Activityof Endodontic Sealers be Modified Direct Contact Test AgainstEnterococcus faecalis. J Endod. 2009; 35(7): 1051-1055.

51. Candeiro GTM, Moura-Netto C, DAlmeida-Couto RS, Azambuja-Jnior N, Marques MM, Cai S, Gavini G: Cytotoxicity, genotoxicityand antibacterial effectiveness of a bioceramic endodonticsealer. Int Endod J. 2015 doi:10.1111/iej.12523 (Ahead of print)

52. Willershausen I, Callaway A, Briseno B, Willerhausen B: In vitroanalysis of the cytotoxicity and the antimicrobial effect of four

endodontic sealers. Head Face Med. 2011: 10; 7: 15.53. Zoufan K, Jiang J, Komabayashi T, Wang YH, Safavi KE, Zhu

Q: Cytotoxicity evaluation of Gutta Flow and Endo SequenceBC. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112 (5): 657-661.

54. Reyhani MF, Ghasemi N, Eskandarinejad M, Milani AS, MokhtariH, Tootunchian K: Antimicrobial effects of Apexit Plus,Epiphany, MTA Fillapex and Dorifill sealers on Enterococcusfaecalis at different time intervals. IJSRIT 2015; 2(4): 10-15.

55. Ustun Y, Sagsen B, Durmaz S, Percin D: In vitro antimicrobialefficiency of different root canal sealers against Enterecoccusfaecalis. Eur J Gen Dent 2013; 2: 134-138.

56. Miyagak DC, de Carvalho EMOF, Robazza CRC, ChavasoJK, Levorato GL: In vitro evaluation of the antimicrobial activityof endodontic sealers. Braz Oral Res. 2006; 20(4): 303-306.

57. Ehsani M, Marashi MA, Zabihi E, Issazadeh M, Khafri S: AComparison between Antibacterial Activity of Propolis andAloe Vera on Enterococcus faecalis (an In Vitro Study). Int JMol Cell Med. 2013; 2(3): 110-116.

58. Kuga MC, Faria G, Weckwerth PH, Duarte MAH, Campos EA,So MVR, Viola KS: Evaluation of the pH, calcium release andantibacterial activity of MTA Fillapex. Rev. Odontol. UNESP.2013; 42(5): 330-335.

59. Lodiene G, Morisbak E, Bruzell E, Orstavik D: Toxicity evaluationof root canal sealers in vitro. Int Endod J. 2008; 41 (1): 72-77.

60. Miletic` I, Anic` I, Karlovic` Z, Marsan T, Pezelj-Ribaric` S, OsmakM: Cytotoxic effect of four root filling materials. Endod DentTraumatol. 2000; 16(6): 287-290.

61. Tavares CO, Bottcher DE, Assmann E, Kopper PMP, FigueiredoJAP, Grecca FS: Tissue Reactions to a New Mineral TrioxideAggregate-containing Endodontic Sealer. J Endod. 2013;39(5): 653-657.

62. Accardo C, Himel VT, Lallier TE: A Novel GuttaFlow SealerSupports Cell Survival and Attachment. J Endod. 2014; 40(2):231-234.

63. Scelza MZ, Coil J, Alves GG: Effect of time of extraction on thebiocompatibility of endodontic sealers with primary humanfibroblasts. Braz. Oral Res. 2012; 26(5): 424-430.

64. Rodriguez JC, Hegde MN, Kumari M: A comparative evaluationof root canal sealers on human gingival fibroblasts A cell culturestudy. Endodontology 2012: 1: 46-53(medind.nic.in/eaa/t12/i1/eaat12i1p46.pdf)

65. Konjhodzic-Prcic A, Gorduysus O, Kucukkaya S, Atila B,Muftuoglu S, Zeybek D: In Vitro Comparison of Cytotoxicity ofFour Root Canal Sealers on Human Gingival Fibroblasts. MedArh. 2015; 69(1): 24-27.

66. Konjhodzic-Prcic A, Jakupovic S, Hasic-Brankovic L, VukovicA: Evaluation of Biocompatibility of Root Canal Sealers onL929 Fibroblasts with Multiscan EX Spectrophotometer. ACTAINFORM MED. 2015; 23(3): 135-137.

67. Martins VJM, Lins RX, Berlinck TCA, Fidel RAS: Cytotoxicity ofroot canal sealer on endothelial cell cultures. Braz Dent J.2013; 24(1): 15-20.

68. Zhang W, Li Z, Peng B: Ex vivo cytotoxicity of a new calciumsilicate-based canal filling material. Int Endod J. 2010; 43(9):769-774.

69. Zhou HM, Du TF, Shen Y, Wang ZJ, Zheng YF, Haapasalo M:In Vitro Cytotoxicity of Calcium Silicatecontaining EndodonticSealers. J Endod. 2015; 41(1): 56-61.

70. Chang SW, Lee SY, Kang SK, Kum KY, Kim EC: In VitroBiocompatibility, Inflammatory Response, and OsteogenicPotential of 4 Root Canal Sealers: Sealapex, Sankin ApatiteRoot Sealer, MTA Fillapex, and iRoot SP Root Canal Sealer.J Endod. 2014; 40(10): 1642-1648.

71. Loushine BA, Bryan TE, Looney SW, Gillen BM, Loushine RJ,

Page 69: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

69

μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

Weller RN, Pashley DH, Franklin R. Tay FR: Setting Propertiesand Cytotoxicity evaluation of a Premixed Bioceramic RootCanal Sealer. J Endod. 2011; 37(5): 673-677.

72. Topcuoglu HS, Tuncay O, Karatas E, Yeter HAK: In Vitro FractureResistance of Roots Obturated with Epoxy Resin-based,Mineral Trioxide Aggregate-based, and Bioceramic Root CanalSealers. J Endod. 2013; 39(12): 1630-1633.

73. Economides N, Gogos C, Kodonas K, Beltes C, Kolokouris I:An ex vivo comparison of the push-out bond strength of a newendodontic filling system (Smartseal) and various gutta-perchafilling techniques. Odontology. 2012; 100(2): 187-191

74. Prosmart-product information, www.pro-smart.com (As readon 16/3/2016)

75. Eid AA, Nikonov SY, Looney SW, Didato A, Niu LN , Levin MD,Rueggeberg FA, Pashley DH, Watanabe I, Tay FR: In VitroBiocompatibility Evaluation of a Root Canal Filling MaterialThat Expands on Water Sorption. J Endod. 2013; 39(7): 883-888.

76. Barros J, Silva MG, Rodriguez MA, Alves FRF, Lopes MA, Pina-Vaz I, Siqueira JF: Antibacterial, Physicochemical, and mecha-nical properties of endodontic sealers containing quaternaryammonium polyethylenimine nanoparticles. Int Endod J.2014; 47(8): 725-734.

77. Uzunoglu E, Yilmaz Z, Sungur DD, Altundasar E: Retreatabilityof Root Canals Obturated Using Gutta-Percha with Bioceramic,MTA and Resin-Based Sealers. Iran Endod J. 2015; 10(2):93-98.

78. Neelakantan P, Grotra D, Sharma S: Retreatability of 2 MineralTrioxide Aggregatebased Root Canal Sealers: A Cone-beamComputed Tomography Analysis. J Endod. 2013; 39(7): 893-896.

Hellenic Stomatological Review 59: 51-69, 2015

Corresponding author:Eleftherios-Terry [email protected]

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AÔÎfiÏÏËÛË ÔÏ˘ÌÂÚÒÓ ÂÓ‰ÔÚÚÈ˙ÈÎÒÓ ·ÍfiÓˆÓ: A›ÙÈ·, ÂÚÌËÓ›· Î·È ·ÓÙÈÌÂÙÒÈÛË

M. ºÚ·ÁÎÔ‡ÏË*

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OÈ ÂÓ‰ÔÚÚÈ˙ÈÎÔ› ¿ÍÔÓ˜ ·ÔÙÂÏÔ‡Ó ÌÈ· ÎÏ·ÛÈ΋ ηÈ¢ڤˆ˜ ·Ô‰ÂÎÙ‹ ̤ıÔ‰Ô ·ÔηٿÛÙ·Û˘ ÙˆÓ ÂÓ-‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ. Afi ηٷ‚ÔÏ‹˜ÙÔ˘˜ ̤¯ÚÈ ÙÔ ÚfiÛÊ·ÙÔ ·ÚÂÏıfiÓ ÔÈ ÂÓ‰ÔÚÚÈ˙ÈÎÔ›¿ÍÔÓ˜ ηٷÛ΢¿˙ÔÓÙ·Ó ·fi ‰È¿ÊÔÚ· ÎÚ¿Ì·Ù·.™ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1990 ÚÔÙ¿ıËÎÂ Ë ̄ ÚË-ÛÈÌÔÔ›ËÛË ÔÏ˘ÌÂÚÒÓ ·ÍfiÓˆÓ ·fi ·ÓıÚ·ÎÔÓ‹Ì·-Ù· Î·È ˘·ÏÔÓ‹Ì·Ù· Ì ‚¿ÛË ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ Ê˘ÛÈ-ÎÔÌ˯·ÓÈΤ˜ ÙÔ˘˜ ȉÈfiÙËÙ˜ Â͢ËÚÂÙÔ‡Û·Ó Ï‹-Úˆ˜ ÙȘ ··ÈÙ‹ÛÂȘ ÌÈ·˜ ¿ÌÂÛ˘ ·ÔηٿÛÙ·Û˘.Afi ÙfiÙ ¤¯ÂÈ ÚÔÙ·ı› ÛÂÈÚ¿ ÔÏ˘ÌÂÚÒÓ ·ÍfiÓˆÓÌ ÌÂÁ¿ÏË ÔÈÎÈÏ›· Û¯ËÌ¿ÙˆÓ, ΈÓÈÎfiÙËÙ·˜ Î·È ÂÂ-ÍÂÚÁ·Û›·˜ Â͈ÙÂÚÈ΋˜ ÂÈÊ¿ÓÂÈ·˜. H ÔÈÎÈÏÔÌÔÚ-Ê›· ·˘Ù‹ ÙˆÓ ·ÍfiÓˆÓ ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ‰È¿ÊÔÚ·ÚˆÙfiÎÔÏÏ· Î·È Ù¯ÓÈΤ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙËÓÛ˘ÁÎfiÏÏËÛË ÙˆÓ ·ÍfiÓˆÓ ÛÙÔ˘˜ ÚÈ˙ÈÎÔ‡˜ ۈϋÓÂ˜Î·È ÛÙËÓ Î·Ù·Û΢‹ Ù˘ „¢‰Ô̇Ï˘.

ABSTRACT

Intracnal posts are a classic and widely acceptedmethod for the restoration of endodontically treatedteeth. Since they were first introduced up until therecent past intra canal posts were made of variousalloys. In the early 1990s carbon fiber posts andglassfiber posts were developed based on the factthat their physicomechanical properties fully servedthe requirements relating to the construction of animmediate restoration. Eversince, a number of Co-mposite fiber posts with large variety of shapes, ta-per and an outer surface were proposed. The va-riety of those posts was supported by the variousprotocols and techniques mentioned in the bondingof the fiber posts in the root canal and the constru-ction of the core build up.However after some years the widespread acce-ptance and application of the fiber post systems, a

71

Fiber post debonding: Causes, explanation and treatment

M. Fragkouli*

BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË

Literature Review

* O‰ÔÓÙ›·ÙÚÔ˜, MSc ÛÙ· BÈÔ¸ÏÈη, ÂȉÈ΢ı›۷ ÛÙËÓ O‰ÔÓÙÈ΋ XÂÈÚÔ˘ÚÁÈ΋, ˘Ô„‹ÊÈ· ¢È‰¿ÎÙˆÚ, O‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ EK¶A

H ·ÚÔ‡Û· ¤Ú¢ӷ ¤¯ÂÈ Û˘Á¯ÚËÌ·ÙÔ‰ÔÙËı› ·fi ÙËÓ E˘Úˆ·˚΋ŒÓˆÛË (E˘Úˆ·˚Îfi KÔÈÓˆÓÈÎfi T·ÌÂ›Ô - EKT) Î·È ·fi ÂıÓÈÎÔ‡˜ fi-ÚÔ˘˜ ̤ۈ ÙÔ˘ EȯÂÈÚËÛÈ·ÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ «Eη›‰Â˘ÛË Î·È¢È· B›Ô˘ M¿ıËÛË» ÙÔ˘ EıÓÈÎÔ‡ ™ÙÚ·ÙËÁÈÎÔ‡ ¶Ï·ÈÛ›Ô˘ AÓ·ÊÔÚ¿˜(E™¶A) EÚ¢ÓËÙÈÎfi XÚËÌ·ÙÔ‰ÔÙÔ‡ÌÂÓÔ ŒÚÁÔ: HÚ¿ÎÏÂÈÙÔ˜ II. E¤Ó-‰˘ÛË ÛÙËÓ ÎÔÈÓˆÓ›· Ù˘ ÁÓÒÛ˘ ̤ۈ ÙÔ˘ E˘Úˆ·˚ÎÔ‡ KÔÈÓˆÓÈ-ÎÔ‡ T·Ì›Ԣ.

* Dentist, MSc in Dental Biomaterials, PhD candidate,Department of Operative Dentistry School of Dentistry,National and Kapodistrian University of Athens, Greece

This research has been co-financed by the European Union (Eu-ropean Social Fund ESF) and Greek national funds through theOperational Program "Education and Lifelong Learning" of theNational Strategic Reference Framework (NSRF) - Research FundingProgram: Heracleitus II. Investing in knowledge society throughthe European Social Fund.

ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 59: 71-82, 2015 Hellenic Stomatological Review 59: 71-82, 2015

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Hellenic Stomatological Review 59: 71-82, 2015

EÓÙÔ‡ÙÔȘ ÌÂÙ¿ ÙËÓ ·Ú¤Ï¢ÛË Î¿ÔÈˆÓ ¯ÚfiÓˆÓ ·-fi ÙËÓ Â˘Ú›· ·Ô‰Ô¯‹ Î·È ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜ÙˆÓ ÔÏ˘ÌÂÚÒÓ ÂÓ‰ÔÚÚÈ˙ÈÎÒÓ ·ÍfiÓˆÓ ‰È·ÈÛÙÒÓÂ-Ù·È ÛÂÈÚ¿ ÚÔ‚ÏËÌ¿ÙˆÓ ·Ó·ÊÔÚÈο Ì ÙËÓ Û˘ÁÎÚ¿-ÙËÛË ÙˆÓ ·ÍfiÓˆÓ Ì¤Û· ÛÙÔ ÚÈ˙ÈÎfi ۈϋӷ Î·È ÙËÓηٷÁÚ·Ê‹ ÂÚÈÛÙ·ÙÈÎÒÓ ·ÔÎfiÏÏËÛ˘ ÙÔ˘ Û˘ÛÙ‹-Ì·ÙÔ˜ „¢‰Ô̇Ï˘ ¿ÍÔÓ· ·fi Ù· ÙÔȯÒÌ·Ù· ÙÔ˘ÚÈ˙ÈÎÔ‡ ۈϋӷ. ™ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ Á›ÓÂÙ·È ÌÈ· ÚÔ-Û¿ıÂÈ· ηٷÁÚ·Ê‹˜ ÙˆÓ ÛÙÔȯ›ˆÓ Ô˘ ÂËÚ¿-˙Ô˘Ó ÙËÓ Û˘ÁÎfiÏÏËÛË ÙˆÓ ·ÍfiÓˆÓ ÛÙËÓ Ô‰ÔÓÙ›ÓËÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ. T· ÛÙÔȯ›· ·˘Ù¿ ·ÊÔÚÔ‡Ó ÙËÓÔÈfiÙËÙ· ÙË Ô‰ÔÓÙ›Ó˘ ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ ÌÂÙ¿ ÙÔ¤Ú·˜ Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂڷ›·˜ Î·È ÙËÓ ÂÈÏÔÁ‹ÙˆÓ ηٿÏÏËÏˆÓ Û˘ÁÎÔÏÏËÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ. T¤-ÏÔ˜ Á›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÙˆÓ ÛÙÔȯ›ˆÓ Ô˘ ÚÔ¿ÁÔ˘ÓÙËÓ Û˘ÁÎfiÏÏËÛË ÛÙÔÓ ÚÈ˙ÈÎfi ۈϋӷ Ô‰ËÁÒÓÙ·˜ Û‚ÈÒÛÈ̘ ÏÂÈÙÔ˘ÚÁÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ.

§¤ÍÂȘ ÎÏÂȉȿ: ¶ÔÏ˘ÌÂÚ›˜ ÂÓ‰ÔÚÚÈ˙ÈÎÔ› ¿ÍÔÓ˜, Û˘ÁÎfiÏÏËÛË,·ÔÎfiÏÏËÛË, ÚËÙÈÓÒ‰ÂȘ ÎÔӛ˜.

EI™A°ø°H

™Ù· Ï·›ÛÈ· ÙˆÓ Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓˆÓ ·Ó·ÁÎÒÓ ÁÈ· ·È-ÛıËÙÈΤ˜ ·ÔηٿÛÙ·ÛÂȘ Î·È Û ÌÈ· ÚÔÛ¿ıÂÈ· Ó· ‚ÂÏ-ÙȈı› Ë ÎÏÈÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Î·È Ë ·ÓÙÔ¯‹ ÛÙËÓ ıÚ·‡ÛËÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ Ô˘ ·Ôηı›ÛÙ·-ÓÙ·È Ì ÂÓ‰ÔÚÚÈ˙ÈÎfi ¿ÍÔÓ· Ë ¤Ú¢ӷ ÂÛÙÈ¿˙ÂÈ Û ӤԢ˜Ù‡Ô˘˜ ÂÓ‰ÔÚÚÈ˙ÈÎÒÓ ·ÍfiÓˆÓ1, 2, 3, 4, 5. H Û‡Á¯ÚÔÓË Ô‰ÔÓÙÈ·-ÙÚÈ΋ ¤¯ÂÈ Ó· Âȉ›ÍÂÈ ÌÈ· ÙÂÚ¿ÛÙÈ· ÔÈÎÈÏÏ›· Û˘ÛÙËÌ¿-ÙˆÓ ·ÈÛıËÙÈÎÒÓ ÂÓ‰ÔÚÚÈ˙ÈÎÒÓ ·ÍfiÓˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷÔÏ˘ÌÂÚÒÓ Û˘ÛÙËÌ¿ÙˆÓ ÂÓÈÛ¯˘Ì¤Ó· Ì ›Ó˜ ˘¿ÏÔ˘, ›Ó˜¯·Ï·˙›·, ·ÓıÚ·ÎÔÓ‹Ì·Ù· Î·È ›Ó˜ ÔÏ˘·Èı˘ÏÂÓ›Ô˘1, 2. T·ÔÏ˘ÌÂÚ‹ ·˘Ù¿ Û˘ÛÙ‹Ì·Ù· ÚÔÙÈÌÒÓÙ·È Î·È ̄ ÚËÛÈÌÔÔÈ-Ô‡ÓÙ·È ÂÓ·ÏÏ·ÎÙÈο Ì ٷ ÔÏÔÎÂÚ·ÌÈο Û˘ÛÙ‹Ì·Ù· ̇ ÈÚÎÔ-Ó›Ô˘ ÁÈ· ÙËÓ ·ÔηٿÛÙ·ÛË ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤-ÓˆÓ ‰ÔÓÙÈÒÓ, ·ÓÙÈηıÈÛÙÒÓÙ·˜ Û ¤Ó· ‚·ıÌfi Ù· ¢ڤˆ˜¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· Û˘ÛÙ‹Ì·Ù· ÌÂÙ·ÏÏÈÎÒÓ ·ÍfiÓˆÓ 4, 5, 6.OÈ ÔÏ˘ÌÂÚ›˜ ÂÓ‰ÔÚÚÈ˙ÈÎÔ› ¿ÍÔÓ˜ fiˆ˜ ¤¯ÂÈ ÂÈÎÚ·Ù‹-ÛÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È, Â›Ó·È ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ¿ÍÔÓ˜·fi ÚËÙ›ÓË ÂÓÈÛ¯˘Ì¤ÓÔÈ Ì ›Ó˜ (fiber reinforced com-posite posts) Î·È ÂÈÛ‹¯ıËÛ·Ó ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ Ú·ÎÙÈ-΋ Á‡Úˆ ÛÙ· 1990. H ·Ú¯È΋ ÙÔ˘˜ ÂÌÊ¿ÓÈÛË ‹Ù·Ó Ì ÙËÓÌÔÚÊ‹ ÙˆÓ ·ÍfiÓˆÓ ·ÓıÚ·ÎÔÓËÌ¿ÙˆÓ, ÚÔÛʤÚÔÓÙ·˜ÌÈ· ·ÍÈfiÈÛÙË ÂÓ·ÏÏ·ÎÙÈ΋ Ù¯ÓÈ΋ ˆ˜ ÚÔ˜ ÙÔ˘˜ ÂÍ·ÙÔ-ÌÈÎÂ˘Ì¤ÓÔ˘˜ ÌÂÙ·ÏÏÈÎÔ‡˜ ÂÓ‰ÔÚÚÈ˙ÈÎÔ‡˜ ¿ÍÔÓ˜ Ô˘ η-Ù¿ ·ÚÈÔ ÏfiÁÔ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó ˆ˜ ÙfiÙÂ6, 7. ¶Ôχ ÁÚ‹-ÁÔÚ· ÂÍÂÏ›¯ıËÎ·Ó Î·È ·Ó·Ù‡¯ıËÎ·Ó ÂÚÈÏ·Ì‚¿ÓÔÓÙ·˜·ÈÛıËÙÈÎÔ‡˜ ¿ÍÔÓ˜ Ì ›Ó˜ ˘¿ÏÔ˘ ‹ ¯·Ï·˙›·. OÈ ›Ó˜ ¿Ó-ıڷη, ˘¿ÏÔ˘, ¯·Ï·˙›· Î·È ÔÏ˘·Èı˘ÏÂÓ›Ô˘ ÂÁÎÏ›ÔÓÙ·ÈÛ ÌÈ· ÚËÙÈÓÒ‰Ë Ì‹ÙÚ· ·fi ÂÔÍÈ΋ ‹ ‰ÈÌÂı·ÎÚ˘ÏÈ΋ÚËÙ›ÓË (EÈÎ. 1) Ì ÙËÓ ·ÚÂÌ‚ÔÏ‹ ÂÓfi˜ ÛÈÏ·ÓÈÔ‡¯Ô˘ Û˘-ÁÎÔÏÏËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·8. TÔ ÌÂÁ¿ÏÔ ÏÂÔÓ¤ÎÙËÌ· ·˘-ÙÔ‡ ÙÔ˘ Ù‡Ô˘ ÙˆÓ ·ÍfiÓˆÓ Â›Ó·È ÔÙÈ ÂÌÊ·Ó›˙Ô˘Ó Ì¤ÙÚÔ Â-Ï·ÛÙÈÎfiÙËÙ·˜ ·ÚfiÌÔÈÔ Ì ·˘Ùfi Ù˘ Ô‰ÔÓÙ›Ó˘ (ÂÚ› Ù·

number of problems arises regarding the retentionof the posts through the canal and the recording ofdebonding incidents regarding the bonding of thepost- core system to the root canal walls. This paperis an attempt to record data affecting the adhesionof posts in the dentin of the root canal. These datarelate to the quality of the dentin of the root canal afterendodontic treatment and selection of suitable ad-hesive systems. Finally reference is made of elementsthat promote adhesion to the canal leading to dura-ble and functional restorations.

Key Words: composite fiber posts, bonding to the root canal,debonding, resin cements

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™Y°KO§§H™H - ¶POB§HMATI™MOI

H Û˘ÁÎfiÏÏËÛË Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÂÓfi˜ Û˘Ó‰˘·ÛÌÔ‡Ê˘ÛÈÎÒÓ Î·È ¯ËÌÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Ô˘ ÂÈÙÚ¤ÂÈ ÙËÓÚÔÛÎfiÏÏËÛË ÂÓfi˜ ̆ ÔÛÙÚÒÌ·ÙÔ˜ Û ¤Ó· ¿ÏÏÔ19. T· Û˘-ÁÎÔÏÏËÙÈο Û˘ÛÙ‹Ì·Ù· Û˘Ì‚¿ÏÏÔ˘Ó Î·ıÔÚÈÛÙÈο ÛÙËÓ·˘ÍË̤ÓË ·ÓÙÔ¯‹ ÛÙËÓ ·fiÛ·ÛË ·Ó¿ÌÂÛ· ÛÙÔ ˘fi-ÛÙڈ̷ Î·È ÙÔ ̆ ÏÈÎfi ·ÔηٿÛÙ·Û˘ ‹ ÙËÓ ÎÔÓ›· Î·È ÙËÓηٷÓÔÌ‹ ÙˆÓ Ù¿ÛÂˆÓ Û fiÏË ÙËÓ ¤ÎÙ·ÛË Ù˘ ‰ÈÂÈÊ¿-ÓÂÈ·˜ Û˘ÁÎfiÏÏËÛ˘20. OÈ Û‡Á¯ÚÔÓ˜ ·fi„ÂȘ ÁÈ· ÙËÓ Û˘-ÁÎfiÏÏËÛË ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ¤¯Ô˘Ó ˆ˜ ·ÊÂÙËÚ›· ÙÔÓ M.Buonocore Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜ Ù˘ ·‰ÚÔÔ›-ËÛ˘. H Ù¯ÓÈ΋ ·˘Ù‹, ÂÛÊ·Ï̤ӷ ηٿ ÙÔ ·ÚÂÏıfiÓ Â›-¯Â ıˆÚËı› ˆ˜ Ù¯ÓÈ΋ Û˘ÁÎfiÏÏËÛ˘, ÂÓÒ ÂÚfiÎÂÈÙÔÁÈ· ηı·Ú¿ ÌÈÎÚÔÌ˯·ÓÈ΋ Û˘ÁÎÚ¿ÙËÛË. H Ù¯ÓÔÏÔÁ›·ÙˆÓ Û˘ÁÎÔÏÏËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ ·˘Ù‹ ÂÌÊ·Ó›ÛÙË-ΠÛÙÈ· ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1980 Î·È Ô˘ ÛÙËÓ Û˘-Ó¤¯ÂÈ· ÂÓۈ̿وÛ ‰È¿ÊÔÚ· Ôͤ· ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÂ-ÍÂÚÁ·ÛÙ› ‹ ÙÚÔÔÔÈ‹ÛÂÈ ÙËÓ Ô‰ÔÓÙ›ÓË, ¤ÊÂÚ Ӥ· ÁÓÒ-ÛË ÛÙËÓ Â›Ù¢ÍË ÈÛ¯˘ÚÔ‡ Î·È ÌfiÓÈÌÔ˘ ‰ÂÛÌÔ‡ ÌÂٷ͇ Ô-‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ Î·È ÔÏ˘ÌÂÚÒÓ ˘ÏÈÎÒÓ. Afi ÙfiÙ ¿Ú·ÔÏÏ¿ ‚‹Ì·Ù· ¤¯Ô˘Ó Á›ÓÂÈ Ì ÙËÓ ÚÔÛı‹ÎË ÌÔÓÔÌÂÚÒÓÌ ‰˘Ô ÂÓÂÚÁ¿ ¿ÎÚ· -˘‰ÚfiÊÈÏ· Î·È ˘‰ÚfiÊÔ‚·- ÛÙÔ˘˜Û˘ÁÎÔÏÏËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. T· ̆ ‰ÚfiÊÈÏ· ÌÔÓÔÌÂÚ‹ Â-ÈÙÚ¤Ô˘Ó ÙËÓ Û˘ÁÎfiÏÏËÛË Ì ÙËÓ Ô‰ÔÓÙ›ÓË, ÂÓÒ Ù· ˘-‰ÚfiÊÔ‚· ÌÔÓÔÌÂÚ‹ ÙË Û‡Ó‰ÂÛË Ì ٷ ˘ÏÈο ·Ôηٿ-ÛÙ·Û˘ ‹ ÙȘ ÚËÙÈÓÒ‰ÂȘ ÎÔӛ˜22.M ‚¿ÛË ÙȘ ·Ú¯¤˜ Ù˘ Ê˘ÛÈ΋˜ Ë Û˘ÁÎfiÏÏËÛË Â›Ó·È Ë ·-Ó¿Ù˘ÍË ‰ÂÛÌÒÓ fiˆ˜ ·˘Ù‹ ÚÔ·ÙÂÈ ·fi ÙËÓ Û¯¤ÛËÌÂٷ͇ Ù˘ ÂχıÂÚ˘ ÂÓ¤ÚÁÂÈ·˜ Ù˘ Ô‰ÔÓÙÈ΋˜ ÂÈÊ¿-ÓÂÈ·˜ Î·È Ù˘ ÈηÓfiÙËÙ·˜ ‰È·‚ÚÔ¯‹˜ ÙÔ˘ Û˘ÁÎÔÏÏËÙÈÎÔ‡Û˘ÛÙ‹Ì·ÙÔ˜23.B·ÛÈ΋ ÚÔ¸fiıÂÛË ÁÈ· Û˘ÁÎfiÏÏËÛË Ì ÙËÓ Ô‰ÔÓÙ›ÓË ÙÔ˘ÚÈ˙ÈÎÔ‡ ۈϋӷ Â›Ó·È Ë ÈηÓfiÙËÙ· ÙÔ˘ ÂÂÌ‚·›ÓÔÓÙ· Ó·ÂÙ‡¯ÂÈ ¤Ó· ·fiÏ˘Ù· «Î·ı·Úfi» Î·È ÂÏÂÁ¯fiÌÂÓÔ ¯ÒÚÔ ÁÈ·ÙËÓ Û˘ÁÎfiÏÏËÛË ÙÔ˘ ¿ÍÔÓ·. K¿ÙÈ Ù¤ÙÔÈÔ ‰ÂÓ Â›Ó·È È‰È·›ÙÂ-Ú· ‡ÎÔÏÔ Î·ıÒ˜ ‰È¿ÊÔÚ· ÛÙÔȯ›· Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂ-ڷ›·˜ ÙÚÔÔÔÈÔ‡Ó ÙËÓ Û˘ÌÂÚÈÊÔÚ¿ Ù˘ ÂÓ‰ÔÚÚÈ˙È-΋˜ Ô‰ÔÓÙ›Ó˘, ÂÓÒ Ë fiÏË ‰È·‰Èηۛ· Â›Ó·È ÂÍ·ÈÚÂÙÈο ‰‡-ÛÎÔÏË ·Ô ÂÚÁÔÓÔÌÈ΋˜ ¿Ô„˘24. MÔÏÔÓfiÙÈ Ë ÙÔÔı¤ÙË-ÛË ÙÔ˘ ÂÓ‰ÔÚÚÈ˙ÈÎÔ‡ ¿ÍÔÓ· ÚÔ˘Ôı¤ÙÂÈ ÙËÓ ÂÈÙ˘¯‹ Ô-ÏÔÎÏ‹ÚˆÛË Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂڷ›·˜ ˘¿Ú¯Ô˘Ó ÛÙÔÈ-¯Â›· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›· ηı’ ·˘Ù‹ÓÎ·È Î·Ù¿ Û˘Ó¤ÂÈ· ÎÚ›ÓÂÙ·È ÛÎfiÈÌË Ë ·Ó·ÊÔÚ¿ ÙÔ˘˜.

EÓ‰Ô‰ÔÓÙÈ΋ ˙ÒÓË ÍÂÛÌ¿ÙˆÓ: H ˙ÒÓË ÙˆÓ ÍÂÛÌ¿ÙˆÓÛÙÔ ÚÈ˙ÈÎfi ۈϋӷ ·Ú¿ÁÂÙ·È Î·Ù¿ ÙËÓ ¯ËÌÈÎÔÌ˯·ÓÈ΋ÂÂÍÂÚÁ·Û›· ÙÔ˘ ۈϋӷ. OÈ ÎÈÓ‹ÛÂȘ ÙÚÈ‚‹˜ ÙˆÓ ÂÓ‰Ô-‰ÔÓÙÈÎÒÓ ÂÚÁ·Ï›ˆÓ ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛËÙ˘ ıÂÚÌÔÎÚ·Û›·˜ Î·È ÙˆÓ ‰˘Ó¿ÌÂˆÓ ¤Ï͢. K·Ù¿ Û˘Ó¤-ÂÈ· Ë ˙ÒÓË ÙˆÓ ÍÂÛÌ·ÙˆÓ ÚÔÛÎÔÏÏ¿Ù·È ÛÙËÓ ˘ÔΛ-ÌÂÓË ÂÈÊ¿ÓÂÈ· Ù˘ Ô‰ÔÓÙ›Ó˘ ηٿ ÙÚfiÔ Ô˘ ηıÈÛÙ¿‰‡ÛÎÔÏË Âˆ˜ ·‰‡Ó·ÙË ÙËÓ ·Ê·›ÚÂÛË Ù˘ Ì ٷ ̆ ÁÚ¿ وӉȷÎÏ˘ÛÌÒÓ25. H ˙ÒÓË ÙˆÓ ÍÂÛÌ¿ÙˆÓ ¤¯ÂÈ ·¯Ô˜ ·fi 0,5ˆ˜ 2 Ìm ÂÓÒ Û ÈÔ ·ÎÚÔÚÚÈ˙È΋ Ô‰ÔÓÙ›ÓË ÌÔÚ› Ó·ÊÙ¿ÛÂÈ ˆ˜ Î·È Ù· 40 Ìm. AÔÙÂÏÂ›Ù·È ·fi ÔÚÁ·ÓÈΤ˜ ηȷÓfiÚÁ·Ó˜ Ô˘Û›Â˜, ·ÂÛ·Ṳ̂ӷ ÎÔÌÌ¿ÙÈ· Ô‰ÔÓÙÈÓÔ-‚Ï·ÛÙÒÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Î·È ÓÂÎÚˆÙÈÎfi ˘ÏÈÎfi26, 27. A-

20 GPa), ¢ÓÔÒÓÙ·˜ ÙËÓ Ï¤ÔÓ ÔÌÔÈfiÌÔÚÊË Î·Ù·ÓÔÌ‹Ù¿ÛÂˆÓ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÙËÓ Ì›ˆÛË ÙÔ˘ ÔÛÔÛÙÔ‡ η-Ù·ÁÌ¿ÙˆÓ Ú›˙·˜1, 6.OÈ ÚÔηٷÛ΢·Ṳ̂ÓÔÈ ÔÏ˘ÌÂÚ›˜ ÂÓ‰ÔÚÚÈ˙ÈÎÔ› ¿ÍÔ-Ó˜ ʤÚÔÓÙ·È Û ‰È¿ÊÔÚ· Û¯‹Ì·Ù·. ™Â fiÙÈ ·ÊÔÚ¿ ÙÔ ÚÈ-˙ÈÎfi ÙÔ˘˜ ÙÌ‹Ì· ÂÌÊ·Ó›˙ÔÓÙ·È Î˘ÏÈÓ‰ÚÈÎÔ›, ΈÓÈÎÔ› ‹ ‰È-Ï‹˜ ΈÓÈÎfiÙËÙ·˜ (΢ÏÈÓ‰ÚÔΈÓÈÎÔ›) ÌÈÌÔ‡ÌÂÓÔÈ ÙËÓ Îˆ-ÓÈÎfiÙËÙ· ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ.1 ¶ÔÈÎÈÏÏ›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó›Û˘ Î·È ·Ó·ÊÔÚÈο Ì ÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ ÊÂÚfiÌÂÓÔȈ˜ Ï›ÔÈ, ÂÁί¿Ú·ÎÙÔÈ Î·È Ô‰ÔÓÙˆÙÔ›8, 9, 10. EÈϤÔÓ ÌÔ-Ú› Ó· Â›Ó·È ÂÚÁÔÛÙ·Ûȷο ÚÔÛÈÏ·ÓÔÔÈË̤ÓÔÈ ‹ fi¯È.A˘Ù‹ Ë ‰È·ÊÔÚÔÔ›ËÛË ÛÙÔ Û¯‹Ì· Î·È ÛÙËÓ ÂÂÍÂÚÁ·Û›·Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ ÔÏ˘ÌÂÚÒÓ ·ÍfiÓˆÓ ¤¯ÂÈ ˆ˜ ·ÚÈÔÛÙfi¯Ô ÙËÓ ‚¤ÏÙÈÛÙË ÚÔÛ·ÚÌÔÁ‹ ÙÔ˘ ¿ÍÔÓ· ÛÙ· ÙÔȯÒ-Ì·Ù· ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÙËÓ Ì·ÎÚÔ-‚ÈfiÙËÙ· Ù˘ ·ÔηٿÛÙ·Û˘11, 12, 12, 14, 15.OÈ ÔÏ˘ÌÂÚ›˜ ÂÓ‰ÔÚÚÈ˙ÈÎÔ› ¿ÍÔÓ˜ ̄ ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÂÛ˘Ó‰˘·ÛÌfi Ì ÔÏ˘ÌÂÚ‹ ˘ÏÈο ·ÔηٿÛÙ·Û˘ fiˆ˜ÂÌÊÚ·ÎÙÈΤ˜ Û‡ÓıÂÙ˜ ÚËÙ›Ó˜ ‹ ÔÏ˘ÌÂÚ‹ ̆ ÏÈο ·Ó·Û‡-ÛÙ·Û˘ ÎÔÏÔ‚ˆÌ¿ÙˆÓ. H Û˘ÁÎfiÏÏËÛË ÛÙÔ ÚÈ˙ÈÎfi ۈϋ-Ó· Á›ÓÂÙ·È ·ÔÎÏÂÈÛÙÈο Ì ÚËÙÈÓÒ‰ÂȘ ÎÔӛ˜11. MÔÏÔÓfi-ÙÈ Ë Â·Ó¿ÛÙ·ÛË ÛÙÔÓ ÙÔ̤· ÙˆÓ ÔÏ˘ÌÂÚÒÓ ·Ú¤¯ÂÈ ÙËÓ‰˘Ó·ÙfiÙËÙ· ·ÔηٿÛÙ·Û˘ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤-ÓˆÓ ‰ÔÓÙÈÒÓ Ì ¤Ó· ÂÓÈ·›Ô Û‡ÛÙËÌ· ÂÓ‰ÔÚÚÈ˙ÈÎÔ‡ ¿ÍÔÓ·,Û˘ÁÎÔÏÏËÙÈ΋˜ ÎÔÓ›·˜ Î·È ˘ÏÈÎÔ‡ ·ÔηٿÛÙ·Û˘, ÌÂÌ˯·ÓÈΤ˜ ȉÈfiÙËÙ˜ ·Ó¿ÏÔÁ˜ Ì ·˘Ù¤˜ Ù˘ Ô‰ÔÓÙ›Ó˘,Û˘¯Ó¿ ·Ú·ÙËÚÔ‡ÓÙ·È ÚÔ‚Ï‹Ì·Ù· Ô˘ ‰È·Î˘‚‡ԢÓÙËÓ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· Ù˘ fiÏ˘ ηٷÛ΢‹˜16, 17, 18. ™ÎÔfi˜·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ë ·Ó·ÛÎfiËÛË ÙˆÓ ÛÙÔȯ›ˆÓÂÎÂ›ÓˆÓ ÙˆÓ Û˘ÁÎÔÏÏËÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ Ô˘ ÂËÚ¿-˙Ô˘Ó ÙËÓ ÈηӋ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ Û˘ÁÎfiÏÏËÛË ÙˆÓ Ô-Ï˘ÌÂÚÒÓ ÂÓ‰ÔÚÚÈ˙ÈÎÒÓ ·ÍfiÓˆÓ Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘‰È·ÛÊ·Ï›˙Ô˘Ó ÙËÓ ÂÈÙ˘¯›· Ù˘ ·ÔηٿÛÙ·Û˘.

Hellenic Stomatological Review 59: 71-82, 2015

EÈÎ. 1: OÈ ›Ó˜ ÙÔ˘ ¿Óıڷη ̤۷ ÛÙËÓ ÚËÙÈÓÒ‰Ë Ì‹ÙÚ·.

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

ÓÙÈÏ·Ì‚¿ÓÂÙ·È Î·Ó›˜ fiÛÔ ÎÚ›ÛÈÌË Â›Ó·È Ë ·ÚÔ˘Û›· Ù˘ÁÈ· ·ÔÙÂÏÂÛÌ·ÙÈ΋ Û˘ÁÎfiÏÏËÛË, ÂÓÒ ÂÍ›ÛÔ˘ ÎÚ›ÛÈÌË Â›-Ó·È Ë ÂÈÏÔÁ‹ ÙÔ˘ Û˘ÁÎÔÏÏËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ô˘ ı· ·-Ê·ÈÚ¤ÛÂÈ ‹ ı· ÙÚÔÔÔÈ‹ÛÂÈ ÙËÓ ˙ÒÓË ÙˆÓ ÍÂÛÌ¿ÙˆÓ.

¶ÚÔÂÙÔÈÌ·Û›· ÙÔ˘ ÊÚÂ·Ù›Ô˘ ÁÈ· ÙÔÓ ¿ÍÔÓ· Î·È ‰Â˘ÙÂ-ÚÔÁÂÓ‹˜ ˙ÒÓË ÍÂÛÌ¿ÙˆÓ: EÎÙfi˜ ·fi ÙËÓ ˙ÒÓË ÍÂÛÌ¿-ÙˆÓ Ô˘ ‰ËÌÈÔ˘ÚÁÂ›Ù·È Î·Ù¿ ÙËÓ Ê¿ÛË Ù˘ ̄ ËÌÈÎÔÌ˯·ÓÈ-΋˜ ÂÂÍÂÚÁ·Û›·˜ ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÌÈ·ÂÈÚfiÛıÂÙË ˙ÒÓË ÍÂÛÌ¿ÙˆÓ Î·Ù¿ ÙËÓ ‰ËÌÈÔ˘ÚÁ›· ÙÔ˘ÊÚÂ·Ù›Ô˘ ÁÈ· ÙËÓ ˘Ô‰Ô¯‹ ÙÔ˘ ¿ÍÔÓ·28. A˘Ù‹ Â›Ó·È ÌÂÁ·-χÙÂÚË Û ¿¯Ô˜ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ Í¤ÛÌ·Ù· Î·È ̆ ÔÏ›Ì-Ì·Ù· Ê˘Ú¿Ì·ÙÔ˜ Î·È Î˘Ú›ˆ˜ ÂÌÊÚ·ÎÙÈÎÔ‡ ˘ÏÈÎÔ‡ Ô˘Û·ÊÒ˜ ÂËÚ¿˙Ô˘Ó ÙËÓ Û˘ÁÎfiÏÏËÛË (EÈÎ. 2 Î·È EÈÎ. 3).T· ˘ÔÏ›ÌÌ·Ù· ·˘Ù¿ Ï·ÛÙÈÎÔÔÈÔ‡ÓÙ·È ·fi ÙËÓ ·Ó·-

Ù˘ÛÛfiÌÂÓË ıÂÚÌfiÙËÙ· ·fi ÙËÓ ¯Ú‹ÛË ÙˆÓ ÙÚ˘¿ÓˆÓÎ·È Û·ÊÒ˜ ‰˘Û¯ÂÚ·›ÓÔ˘Ó ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ·‰ÚÔÔÈË-ÙÈÎÒÓ Î·È Û˘ÁÎÔÏÏËÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ29. °È· ÙËÓ ·Ê·›ÚÂ-ÛË ·˘Ù‹˜ Ù˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ˙ÒÓ˘ ÍÂÛÌ¿ÙˆÓ ¤¯Ô˘Ó¯ÚËÛÈÌÔÔÈËı› ‰È¿ÊÔÚ· ̤۷ (¶›Ó·Î·˜ 1). Afi οÔÈ-Ô˘˜ ÂÚ¢ÓËÙ¤˜ ÚÔÙ›ÓÂÙ·È Ë ¯Ú‹ÛË ÊˆÛÊÔÚÈÎÔ‡ Ôͤ-Ô˜, Ë ÔÔ›· fï˜ ÎÚ›ÓÂÙ·È ÂÈÛÊ·Ï‹˜ ·ÊÔ‡ Ô‰ËÁ› ÛÙˉËÌÈÔ˘ÚÁ›· ÂÚÈÔ¯ÒÓ «‚·ıÈ¿˜» ·ÔÌÂÙ·ÏÏÈÎÔÔ›ËÛ˘Ù˘ ÂÓ‰ÔÛˆÏËÓ·Úȷ΋˜ Ô‰ÔÓÙ›Ó˘, ÂÓ·ÏÏ·ÛÛfiÌÂÓˆÓ ÌÂÂÚÈÔ¯¤˜ Î·Ï˘Ì¤Ó˜ Ì ÔÈÎÈÏÏ›· ÍÂÛÌ¿ÙˆÓ. ÕÏÏÔÈ ÂÚ¢-ÓËÙ¤˜ ÚÔÙ›ÓÔ˘Ó ÙËÓ ¤ÎÏ˘ÛË Ì ̆ ԯψÚÈ҉˜ Ó¿ÙÚÈÔÚÈÓ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÚËÙÈÓÒ‰Ô˘˜ ÎÔÓ›·˜30 ÚfiÙ·ÛË ËÔÔ›· Ù›ıÂÙ·È Î·È ·˘Ù‹ ˘fi ·ÌÊÈÛ‚‹ÙËÛË ·ÊÔ‡ ÙÔ ˘Ô-¯ÏˆÚÈ҉˜ ÚÔηÏ› ·Ó·ÛÙÔÏ‹ ÔÏ˘ÌÂÚÈÛÌÔ‡ ÛÙ· ÚËÙÈ-ÓÒ‰Ë. T¤ÏÔ˜ ·Ó·Ê¤ÚÂÙ·È Ë ¯Ú‹ÛË Û˘ÛÙËÌ¿ÙˆÓ ˘ÂÚ‹-¯ˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂÊ·ÚÌÔÁ‹ EDTA Ô˘ Ô‰ËÁ› Û ·-Ê·›ÚÂÛË ÙˆÓ ÍÂÛÌ¿ÙˆÓ Î·È ‰È¿ÓÔÈÍË ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏË-Ó·Ú›ˆÓ29. AÓÂÍ·Úًو˜ fï˜ Ù˘ Ù¯ÓÈ΋˜ Ô˘ ı· ÂÈÏÂ-Á› ÁÈ· ÙËÓ ·Ê·›ÚÂÛË ÙˆÓ ÍÂÛÌ¿ÙˆÓ È‰È·›ÙÂÚË ÛËÌ·Û›· ¤-¯ÂÈ ÙÔ Û˘ÁÎÔÏÏËÙÈÎfi Û‡ÛÙËÌ· Ô˘ ı· ¯ÚËÛÈÌÔÔÈËı›.

XÚ‹ÛË ‰È·Ï˘Ì¿ÙˆÓ: K·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ıÂڷ›·˜ Ë Ô‰ÔÓÙ›ÓË ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ ÂÎÙ›ıÂÙ·È Û‰ȿÊÔÚ· ‰È·Ï‡Ì·Ù· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·Ô-χ̷ÓÛË ÙÔ˘ ۈϋӷ Î·È ÙËÓ ‰È¢ÎfiÏ˘ÓÛË Ù˘ ÂÓ‰Ô‰Ô-ÓÙ΋˜ ıÂڷ›·˜.T· Û΢¿ÛÌ·Ù· ·˘Ù¿ ‰‡Ó·Ù·È Ó· ÚÔ-ηϤÛÔ˘Ó ÙÚÔÔÔÈ‹ÛÂȘ ÛÙËÓ ÂÈÊ¿ÓÂÈ· Ù˘ Ô‰ÔÓÙ›ÓË˜Î·È Î·Ù’ ¤ÎÙ·ÛË Ó· ÂËÚ¿ÛÔ˘Ó ÙËÓ ·ÏÏËÏ›‰Ú·ÛËÌ ٷ ÚËÙÈÓÒ‰Ë ˘ÏÈο Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ¤Ì-ÊÚ·ÛË ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ ‹ ÁÈ· ÙËÓ Û˘ÁÎfiÏÏËÛË ÛÙˆÓÂÓ‰ÔÚÚÈ˙ÈÎÒÓ ·ÍfiÓˆÓ. T· Û˘ÓËı¤ÛÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡-ÌÂÓ· Û΢¿ÛÌ·Ù· Â›Ó·È ÙÔ ˘Ô¯ÏˆÚÈ҉˜ Ó¿ÙÚÈÔ Î·È ÙÔEDTA31, 32, 33 ÂÓÒ ÁÈ· ÙËÓ ¯ËÌÈ΋ ÂÂÍÂÚÁ·Û›· ÙÔ˘ ÚÈ˙ÈÎԇۈϋӷ ¤¯ÂÈ ÚÔÙ·ı› ÙÔ ÎÈÙÚÈÎfi Ô͇ Î·È Ë ¯ÏˆÚÂÍȉ›ÓË.TÔ ˘Ô¯ÏˆÚÈ҉˜ Ó¿ÙÚÈÔ ·Ó Î·È ıˆÚÂ›Ù·È ÙÔ È‰Â҉˜ ˘-ÁÚfi ‰È·ÎÏ˘ÛÌÒÓ ÁÈ· ÙËÓ ·Ôχ̷ÓÛË Î·È ÙËÓ ·ÓÙÈÛË„›·ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ ‰ËÌÈÔ˘ÚÁ› ÚÔ‚Ï‹Ì·Ù· ÏfiÁˆ ÙˆÓ ¤-ÓÙÔÓˆÓ ÔÍÂȉˆÙÈÎÒÓ È‰ÈÔÙ‹ÙˆÓ ÙÔ˘. ™˘ÁÎÂÎÚÈ̤ӷ ‰ËÌÈ-Ô˘ÚÁ› ÛÙËÓ ÂÈÊ¿ÓÂÈ· Ù˘ Ô‰ÔÓÙ›Ó˘ ÌÈ· ̇ ÒÓË ÏÔ‡ÛÈ· ÛÂÔ͢ÁfiÓÔ, Ô˘ ·Ô‰Â‰ÂÈÁ̤ӷ ÂËÚ¿˙ÂÈ ÙËÓ ‰‡Ó·ÌË ÙÔ˘‰ÂÛÌÔ‡ Ì ٷ Û˘ÁÎÔÏÏËÙÈο Û˘ÛÙ‹Ì·Ù· Î·È ÚÔηÏ› ·‡-ÍËÛË Ù˘ ÌÈÎÚԉțۉ˘Û˘32, 33, 34. °È· ÙËÓ ˘ÂÚΤڷÛË ·˘-ÙÔ‡ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÚÔÙ›ÓÂÙ·È ·ÎÔÏÔ‡ıˆ˜ Ù˘ ¯Ú‹-Û˘ ÙÔ˘ ˘Ô¯ÏˆÚÈÒ‰Ô˘˜ Ó·ÙÚ›Ô˘ Ë ¯Ú‹ÛË 10% ·ÛÎÔÚ‚È-ÎÔ‡ ÔͤԘ ‹ ·ÛÎÔÚ‚ÈÎÔ‡ Ó·ÙÚ›Ô˘. M ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ

EÈÎ. 3: EÈÎfiÓ· ·fi ÔÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ fiÔ˘ ÂÌÊ·Ó›˙ÂÙ·ÈÛ ÙÔÌ‹, ¿ÍÔÓ·˜ ̆ ·ÏÔÓËÌ¿ÙˆÓ, ÚËÙÈÓ҉˘ ÎÔÓ›·, ̆ ÔÏ›Ì-Ì·Ù· ÂÌÊÚ·ÎÙÈÎÔ‡ Ê˘Ú¿Ì·ÙÔ˜ Î·È ÁÔ˘Ù·¤Úη˜, ηıÒ˜Î·È Í¤ÛÌ·Ù· ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ Ô‰ÔÓÙ›Ó˘.

EÈÎ. 2: EÈÎfiÓ· ·fi ÔÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ fiÔ˘ ÂÌÊ·Ó›˙ÂÙ·ÈÛ ÙÔÌ‹, ¿ÍÔÓ·˜ ̆ ·ÏÔÓËÌ¿ÙˆÓ, ÚËÙÈÓ҉˘ ÎÔÓ›·, ̆ ÔÏ›Ì-Ì·Ù· ÂÌÊÚ·ÎÙÈÎÔ‡ Ê˘Ú¿Ì·ÙÔ˜ Î·È ÁÔ˘Ù·¤Úη˜, ηıÒ˜Î·È Í¤ÛÌ·Ù· ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ Ô‰ÔÓÙ›Ó˘.

1. XPH™H ºø™ºOPIKOY O•EO™

2. EK¶§Y™H ME NaOCl

3. XPH™H ™Y™THMATøN Y¶EPHXøN

4. XPH™H EDTA

¶›Ó·Î·˜ 1:A¶OMAKPYN™H •E™MATøN A¶O TO PIZIKO ™ø§HNA

Hellenic Stomatological Review 59: 71-82, 2015

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

‰È·Ï˘Ì¿ÙˆÓ ·˘ÙÒÓ Ë ÔÍÂȉˆÌ¤ÓË ÂÈÊ¿ÓÂÈ· Ù˘ ÂÓ‰ÔÛˆ-ÏËÓ·Úȷ΋˜ Ô‰ÔÓÙ›Ó˘ ÌÂÙ·ÙÚ¤ÂÙ·È Û ·Ó·ÁˆÁÈ΋, Ôfi-Ù ·Ôηı›ÛÙ·Ù·È ÙÔ ÔÍÂȉ·Ó·ÁˆÁÈÎfi ‰˘Ó·ÌÈÎfi Ù˘ Ô‰Ô-ÓÙ›Ó˘ Î·È ‰È¢ÎÔχÓÂÙ·È Ô ÔÏ˘ÌÂÚÈÛÌfi˜ ÙÔ˘ ¯ÚËÛÈÌÈ-ÔÈÔ‡ÌÂÓÔ˘ ÚËÙÈÓÒ‰Ô˘˜ Û˘ÛÙ‹Ì·ÙÔ˜. EÎÙfi˜ ·fi ÙÔ ̆ Ô-¯ÏˆÚÈ҉˜ Ó¿ÙÚÈÔ Î·È ÙÔ EDTA, Î·È Ë ̄ Ú‹ÛË H2O2 Ô˘ ÛÂοÔȘ ÂÚÈÙÒÛÂȘ ̄ ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙË ·Ê·›ÚÂÛË ̆ -ÔÏÂÈÌÌ¿ÙˆÓ ÔÏÊÈÎÔ‡ ÈÛÙÔ‡ Î·È ÚÈÓÈÛÌ¿ÙˆÓ Ô‰ÔÓÙ›Ó˘‰Ú· ·ÚÓËÙÈο ÛÙËÓ Â›Ù¢ÍË ÈηÓÔÔÈËÙÈÎÔ‡ ‰ÂÛÌÔ‡ ÌÂ-ٷ͇ Û˘ÁÎÔÏÏËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Ô‰ÔÓÙ›Ó˘34. EÓ·ÏÏ·ÎÙÈο ÚÔÙ›ÓÂÙ·È Ë ¯Ú‹ÛË ‰È·Ï˘Ì¿ÙˆÓ ‰ÈÁÏ˘ÎÔ-ÓÈ΋˜ ¯ÏˆÚÂÍȉ›Ó˘ ˆ˜ ˘ÁÚfi ‰È·ÎÏ˘ÛÌÒÓ Ì ÔÏÏ¿ ÏÂ-ÔÓÂÎÙ‹Ì·Ù· ÛÙËÓ ·ÓÙÔ¯‹ ÙÔ˘ ‰ÂÛÌÔ‡ ÌÂٷ͇ Ô‰ÔÓÙ›ÓË˜Î·È Û˘ÁÎÔÏÏËÙÈÎÒÓ ÔÏ˘ÌÂÚÒÓ35. ™ËÌ·ÓÙÈ΋ Â›Ó·È Î·È Ë Â-›‰Ú·ÛË ÙÔ˘ ˘‰ÚÔÍÂȉ›Ô˘ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ ÛÙËÓ ‰‡Ó·ÌËÙÔ˘ ‰ÂÛÌÔ‡. TÔ ˘‰ÚÔÍ›‰ÈÔ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘, Û ÔÏÙÒ‰ËÌÔÚÊ‹, ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÌÂٷ͇ ÙˆÓ Û˘Ó‰ÚÈÒÓ ÌÈ·˜ ÂÓ-‰Ô‰ÔÓÙÈ΋˜ ıÂڷ›·˜ ÏfiÁˆ ÙˆÓ ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ ÙÔ˘ È-‰ÈÔًوÓ. M ‰Â‰Ô̤ÓÔ fiÙÈ Ë Ï‹Ú˘ ·Ê·›ÚÂÛ‹ ÙÔ˘ ›ӷÈÚ·ÎÙÈο ·‰‡Ó·ÙË, ·˘Ùfi ‰Ú· ·ÚÓËÙÈο ÛÙËÓ Û˘ÁÎfiÏÏË-ÛË ÏÂÈÙÔ˘ÚÁÒÓÙ·˜ ˆ˜ Ê˘ÛÈÎfi˜ ÊÚ·ÁÌfi˜. EÈϤÔÓ Ïfi-Áˆ ÙÔ˘ ‚·ÛÈÎÔ‡ pH ·ÏÏËÏÂȉڿ Ì ÙÔ˘˜ fiÍÈÓÔ˘˜ ÙÚÔ-ÔÈËÙ¤˜/·‰ÚÔÔÈËÙ¤˜ ÙˆÓ ·˘ÙÔÛ˘ÁÎÔÏÏÔ‡ÌÂÓˆÓ ÚËÚÈ-Óˆ‰ÒÓ ÎÔÓÈÒÓ ÌÂÈÒÓÔÓÙ·˜ ÙË ·‰ÚÔÔÈËÙÈ΋ ÙÔ˘˜ ÈηÓfi-ÙËÙ· Î·È Û˘ÓÂÒ˜ ÙË ‰‡Ó·ÌË ÙÔ˘ ‰ÂÛÌÔ‡36,37.EÈϤÔÓ, Ù· ‰È·Ï‡Ì·Ù· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ·ӿÏË„Ë Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂڷ›·˜ Ê·›ÓÂÙ·È Ó· Â-ËÚ¿˙Ô˘Ó ÙËÓ Û˘ÁÎfiÏÏËÛË. TÔ ¯ÏˆÚÔÊfiÚÌÈÔ Î·È Ë ·-ÏÔı¿ÓË, Ù· ÈÔ ÎÔÈÓ¿ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· ‰È·Ï˘ÙÈο ÁÔ˘-Ù·¤Úη˜, ÂËÚ¿˙Ô˘Ó ÙfiÛÔ ÙËÓ ¯ËÌÈ΋ Û‡ÓıÂÛË Ù˘ Â-ÈÊ¿ÓÂÈ·˜ Ù˘ Ô‰ÔÓÙ›Ó˘ fiÛÔ Î·È ÙËÓ ˘ÔΛÌÂÓË ÔÚÁ·-ÓÈ΋ Ì‹ÙÚ· Ù˘ Ô‰ÔÓÙ›Ó˘ ‰È·Ù·Ú¿ÛÛÔÓÙ·˜ ÙËÓ ·ÏÏËÏÂ-›‰Ú·ÛË Ù˘ Ì ٷ ÚËÙÈÓÒ‰Ë Û˘ÁÎÔÏÏËÙÈο Û˘ÛÙ‹Ì·Ù·.™˘Á¯ÚfiÓˆ˜ Ù· ‰È·Ï‡Ì·Ù· ·˘Ù¿ ÂÈοıÔÓÙ·È Û·Ó ÌÂÌ-‚Ú¿ÓË ÛÙ· ÙÔȯÒÌ·Ù· Ù˘ Ô‰ÔÓÙ›Ó˘ ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋ-Ó·, ÌÂÈÒÓÔÓÙ·˜ ÛËÌ·ÓÙÈο ÙËÓ ·ÓÙÔ¯‹ ÙÔ˘ ‰ÂÛÌÔ‡ ÌÂÙÔ˘˜ Û˘ÁÎÔÏÏËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜38, 39.

E˘ÁÂÓfiÏË: Ÿˆ˜ ÂÈÓ·È ÁÓˆÛÙfi Ë ¯Ú‹ÛË Â˘ÁÂÓfiÏ˘ ‰Ú· ·-Ó·ÛÙ·ÏÙÈο ÛÙÔÓ Â·Ú΋ ÔÏ˘ÌÂÚÈÛÌfi ÙˆÓ ÚËÙÈÓÒÓ. H ¢-ÁÂÓfiÏË ÂÎÙfi˜ ·fi Û˘ÛÙ·ÙÈÎfi Ê˘Ú¿Ì·ÙÔ˜ ÁÈ· ÙËÓ ¤ÌÊÚ·ÍËÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ ÌÔÚ› Ó· ̆ ¿Ú¯ÂÈ ̂ ˜ ηٿÏÔÈÔ ÚÔ-ÛˆÚÈÓÒÓ ÎÔÓÈÒÓ ‹ ÚÔÛˆÚÈÓÒÓ ·ÔηٷÛÙ¿ÛˆÓ40, 41, 42. H¢ÁÂÓfiÏË ·˘Ù‹ ¤¯ÂÈ ÙËÓ ‰˘Ó·ÙfiÙËÙ· ‰È›ۉ˘Û˘ ÛÙ· Ô‰Ô-ÓÙÈÓÔÛˆÏËÓ¿ÚÈ· ηıÈÛÙÒÓÙ·˜ ÂÈÛÊ·Ï‹ ÙËÓ Û˘ÁÎfiÏÏËÛËÌ ÙȘ ÚËÙÈÓÒ‰ÂȘ ÎÔӛ˜. AÔÙÂÏÂÛÌ·ÙÈ΋ ÁÈ· ÙËÓ ·ÔÌ¿-ÎÚ˘ÓÛË Ù˘ ¢ÁÂÓfiÏ˘ Ê·›ÓÂÙ·È Ó· Â›Ó·È Ë ÂÊ·ÚÌÔÁ‹ ʈ-ÛÊÔÚÈÎÔ‡ ÔͤԘ 37%. TÔ ÊˆÛÊÔÚÈÎfi Ô͇ ‰ÂÓ Â›Ó·È ··-Ú·›ÙËÙÔ Ó· Â›Ó·È Û ÌÔÚÊ‹ Á¤Ï˘ ·ÏÏ¿ Î·È Û ̆ ‰·Ú‹ ÌÔÚÊ‹ÔfiÙ ‰ÈÂÈÛ‰‡ÂÈ Î·Ï‡ÙÂÚ· Î·È ÂÎχÂÙ·È Î·Ï‡ÙÂÚ·. ™‡Ì-ʈӷ Ì¿ÏÈÛÙ· Ì οÔÈÔ˘˜ ÂÚ¢ÓËÙ¤˜ Ë ÌÔÏ˘Óı›۷ ˙ÒÓËÌÂÈÒÓÂÙ·È ÛËÌ·ÓÙÈο Î·È Ë Ô‰ÔÓÙ›ÓË ·ÔÌÂÙ·ÏÏÈÎÔÔÈ›ٷÈÛ ‚¿ıÔ˜ 9-10 Ìm43. IηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù· Ê·›ÓÂÙ·ÈÓ· ¤¯ÂÈ Î·È Ë ¤ÎÏ˘ÛË Ì ·ÏÎÔfiÏË Ì¤Ûˆ ÂȉÈÎÒÓ ÂÓÙÚÈÙ‹-ÚˆÓ (EÈÎ. 4). K·Ù¿ Û˘Ó¤ÂÈ· ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú·-ÎÙÈ΋ ı· Ú¤ÂÈ Ó· ÚÔÙÈÌ¿Ù·È Ë ̄ Ú‹ÛË Û˘ÁÎÔÏÏËÙÈÎÒÓ Û˘-ÛÙËÌ¿ÙˆÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Í¯ˆÚÈÛÙfi ·‰ÚÔÔÈËÙ‹44.

§Â˘Î·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜: O ·Ô¯ÚˆÌ·ÙÈÛÌfi˜ ÙˆÓ ÂÓ‰Ô-

‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ, Û˘¯Ó¿ ·ÔÙÂÏ› ¤Ó· ·-ÓÂÈı‡ÌËÙÔ Â·ÎfiÏÔ˘ıÔ Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂڷ›·˜.°È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·˘ÙÔ‡ ÙÔ˘ ·ÈÛıËÙÈÎÔ‡ ÚÔ‚Ï‹Ì·-ÙÔ˜, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ‰È¿ÊÔÚ· Û΢¿ÛÌ·Ù· χηÓ-Û˘45, 46. øÛÙfiÛÔ ·Ú¿ Ù· ÈηÓÔÔÈËÙÈο ·ÈÛıËÙÈο ·ÔÙÂ-ϤÛÌ·Ù· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Î·È Î¿ÔȘ «·ÚÂÓ¤ÚÁÂȘ»·˘Ù‹˜ Ù˘ ıÂڷ›·˜, ÔÈ Ôԛ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ì›ˆÛËÙ˘ ·ÓÙÔ¯‹˜ ÙÔ˘ ‰ÂÛÌÔ‡ ÙˆÓ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓˆÓ ÚËÙÈ-Óˆ‰ÒÓ Û΢·ÛÌ¿ÙˆÓ. Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë Ì›ˆÛË Ù˘·ÓÙÔ¯‹˜ ÙÔ˘ ‰ÂÛÌÔ‡ ÔÊ›ÏÂÙ·È ÛÙËÓ ÏÔ‡ÛÈ· Û Ô͢ÁfiÓÔÛÙÔÈ‚¿‰· Ô˘ ηٷÏ›ÂÙ·È ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓÚÔÈfiÓÙˆÓ Ù˘ χηÓÛ˘. T· ÚÔÈfiÓÙ· ·˘Ù¿ ÂÚȤ¯Ô˘ÓÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ˘ÂÚÔÍ›‰ÈÔ ÙÔ˘ ˘‰ÚÔÁfiÓÔ˘ ‹ ˘-ÂÚÔÍ›‰ÈÔ ÙÔ˘ ηڂ·Ìȉ›Ô˘ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÙÔ ÂÓÂÚÁfiÔ͢ÁfiÓÔ ‰ËÌÈÔ˘ÚÁ› ÌÈ· ̇ ÒÓË ·Ó·ÛÙÔÏ‹˜ ÔÏ˘ÌÂÚÈÛÌÔ‡ÙˆÓ ÚËÙÈÓˆ‰ÒÓ Û΢·ÛÌ¿ÙˆÓ47. EÈϤÔÓ ·Ó·Ê¤ÚÂÙ·È ·-fi οÔÈÔ˘˜ ÂÚ¢ÓËÙ¤˜ fiÙÈ Ë ˘„ËÏ‹ Û˘ÁΤÓÙÚˆÛË ˘Â-ÚÔÍÂȉ›Ô˘ ÙÔ˘ ˘‰ÚÔÁfiÓÔ˘ ÚÔηÏ› Ì›ˆÛË Ù˘ ÌÈÎÚÔ-ÛÎÏËÚfiÙËÙ·˜ Ù˘ Ô‰ÔÓÙ›Ó˘, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô Èı·Ófi-ٷٷ ÂËÚ¿˙ÂÈ ÙËÓ Û˘ÁÎÔÏÏËÙÈ΋ ÈηÓfiÙËÙ· ÙˆÓ ÚËÙÈ-Óˆ‰ÒÓ Û΢·ÛÌ¿ÙˆÓ Ì ÙËÓ Ï¢ηṲ̂ÓË ÂÈÊ¿ÓÂÈ·48.

°ÂˆÌÂÙÚÈÎÔ› ·Ú¿ÁÔÓÙ˜: H ̄ ÚËÛÈÌÔÔ›ËÛË ÚËÙÈÓˆ‰ÒÓÎÔÓÈÒÓ ÁÈ· ÙËÓ Û˘ÁÎfiÏÏËÛË ÙˆÓ ÂÓ‰ÔÚÚÈ˙ÈÎÒÓ ·ÍfiÓˆÓÌÂÙ¿ ÙÔ ¤Ú·˜ Ù˘ ÂÓ‰Ô‰Ô‰ÓÙÈ΋˜ ıÂڷ›·˜ ÂÁ›ÚÂÈ Â-ÚˆÙ‹Ì·Ù· Û¯ÂÙÈο Ì ÙȘ Ù¿ÛÂȘ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È Ïfi-Áˆ Ù˘ Û˘ÛÙÔÏ‹˜ ÔÏ˘ÌÂÚÈÛÌÔ‡. E›Ó·È ÁÓˆÛÙfi fiÙÈ Î·Ù¿ÙËÓ ‰È·‰Èηۛ· ÙÔ˘ ÔÏ˘ÌÂÚÈÛÌÔ‡ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ‰˘-Ó¿ÌÂȘ Û˘ÛÙÔÏ‹˜ ÈηӤ˜ Ó· ÚÔηϤÛÔ˘Ó ÙËÓ ·ÔÎfiÏÏË-ÛË Ù˘ ÚËÙ›Ó˘ ·fi ÙËÓ Ô‰ÔÓÙ›ÓË Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ‰Ë-ÌÈÔ˘ÚÁ›· ÌÈÎÚÔÎÂÓÒÓ Î·È ÙËÓ ÚfiÎÏËÛË ÌÈÎÚԉțۉ˘-Û˘ (EÈÎ. 5). øÛÙfiÛÔ ÂÎÙfi˜ ·fi ÙËÓ Û˘ÛÙÔÏ‹ ÔÏ˘ÌÂÚÈ-ÛÌÔ‡ Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ ÂËÚ¿˙Ô˘Ó ÙȘ ‰˘Ó¿ÌÂÈ˜Û˘ÛÙÔÏ‹˜ Î·È ÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÌÈÎÚÔÎÂÓÒÓ49.OÈ Feilzer Î·È Û˘Ó. ·Ó·Ê¤ÚÔ˘Ó ÔÙÈ ÔÈ ‰˘Ó¿ÌÂȘ Û˘ÛÙÔÏ‹˜Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ ·Ú¿ÁÔÓÙ· ‰È·ÌfiÚʈÛ˘ ÎÔÈÏfiÙË-Ù·˜ ‹ ·ÏÏÔÈÒ˜ C-factor50. O ·Ú¿ÁÔÓÙ·˜ ·˘Ùfi˜ ÔÚ›˙ÂٷȈ˜ Ë ·Ó·ÏÔÁ›· ÙˆÓ Û˘ÁÎÔÏÏËÌ¤ÓˆÓ ÚÔ˜ ÙȘ ÂχıÂÚ˜ÂÈÊ¿ÓÂȘ Î·È fiÙ·Ó Â›Ó·È ¿Óˆ ·fi ¤Ó· ÔÚÈṲ̂ÓÔ fiÚÈÔ, Ë·Ó¿Ù˘ÍË Ù¿ÛÂˆÓ ˘ÂÚ‚·›ÓÂÈ ÙËÓ ·ÓÙÔ¯‹ ÙÔ˘ ‰ÂÛÌÔ‡ÔÏÏÒÓ Û˘ÁÎÔÏÏËÙÈÎÒÓ ·Ú¿ÁfiÓÙˆÓ. H ÁˆÌÂÙÚ›· Ù˘

Hellenic Stomatological Review 59: 71-82, 2015

EÈÎ. 4: EȉÈÎÔ› ÂÓÙÚÈÙ‹Ú˜.

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Literature Review

Hellenic Stomatological Review 59: 71-82, 2015

ÎÔÈÏfiÙËÙ·˜ ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ Â›Ó·È ÌË Â˘ÓÔÈ΋ ·ÊÔ‡ ÔÈÂχıÂÚ˜ ÂÈÊ¿ÓÂȘ ÌÂÈÒÓÔÓÙ·È Î·È ·˘Ùfi ¤¯ÂÈ Û·Ó ·-ÔÙ¤ÏÂÛÌ· ÔÈ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ‰˘Ó¿ÌÂȘ Û˘ÛÙÔÏ‹˜ Ó·ÌËÓ ·ÔÛ‚·›ÓÓ˘ÓÙ·È ·˘Í¿ÓÔÓÙ·˜ ¤ÙÛÈ ÙËÓ Èı·ÓfiÙËÙ· ·-ÔÎfiÏÏËÛ˘ ÙÔ˘ Û˘ÁÎÔÏÏËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ·fi Ù· ÙÔÈ-¯ÒÌ·Ù· ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ. O Braga Î·È Û˘Ó ÌÂÏÂÙÒ-ÓÙ·˜ ÙËÓ ÛËÌ·Û›· ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ Ù˘ ÎÔÈÏfiÙËÙ·˜ ÛÙËÓ·Ó¿Ù˘ÍË ‰˘Ó¿ÌÂˆÓ Û˘ÛÙÔÏ‹˜ ÛÙȘ ÔÏ˘ÌÂÚ›˜ ·Ôη-Ù·ÛÙ¿ÛÂȘ, ¤‰ÂÈÍ fiÙÈ ÌÂÁ·Ï‡ÙÂÚË ÛËÌ·Û›· ÛÙË ‰‡Ó·ÌËÙÔ˘ ‰ÂÛÌÔ‡ ·›˙ÂÈ ÙÔ ‚¿ıÔ˜ Ù˘ ÎÔÈÏfiÙËÙ·˜ Û˘ÁÎÚÈÙÈοÌ ÙËÓ ‰È¿ÌÂÙÚÔ51. AÓ¿ÁÔÓÙ·˜ ·˘Ù¿ Ù· ·ÔÙÂϤÛÌ·Ù·ÛÙÔ ÚÈ˙ÈÎfi ۈϋӷ ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È Î·Ó›˜ fiÙÈ Ë Âȉڷ-ÛË ÙˆÓ ‰˘Ó¿ÌÂˆÓ Û˘ÛÙÔÏ‹˜ Â›Ó·È ·ÎfiÌ· ¯ÂÈÚfiÙÂÚË.ŒÙÛÈ ÛÙÔÓ ÚÈ˙ÈÎfi ۈϋӷ Ô ·Ú¿ÁÔÓÙ·˜ C ·›ÚÓÂÈ ÙÈ̤˜¿Óˆ ·fi 200, ÂÓÒ ÛÙȘ Ì˘ÏÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ ÔÈ ÙÈ-̤˜ ·˘ÙÔ‡ ÙÔ˘ ·Ú¿ÁÔÓÙ· Î˘Ì·›ÓÔÓÙ·È ·fi 1 ˆ˜ 5.52°È· ÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙÔ˘ ÙÈ ·ÎÚÈ‚Ò˜ Û˘Ì‚·›ÓÂÈÌ ÙËÓ Û˘ÁÎfiÏÏËÛË Ì¤Û· ÛÙÔÓ ÚÈ˙ÈÎfi ۈϋӷ ¤¯ÂÈ Á›ÓÂÈÚÔÛ¿ıÂÈ· Ó· Û˘ÌÂÚÈÏËÊıÔ‡Ó Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜fiˆ˜ ÙÔ ¿¯Ô˜ Ù˘ Û˘ÁÎÔÏÏËÙÈ΋˜ ÎÔÓ›·˜. BÚ¤ıËΠÏÔÈ-fiÓ fiÙÈ fiÛÔ ÙÔ ¿¯Ô˜ ÙÔ˘ Û˘ÁÎÔÏÏËÙÈÎÔ‡ ÌÂÈÒÓÂÙ·È, ÌÂÈ-ÒÓÂÙ·È Ë ÔÁÎÔÌÂÙÚÈ΋ Û˘ÛÙÔÏ‹ Ë ÔÔ›· Ô‰ËÁ› Û Ì›ˆ-ÛË Ù˘ Ù¿Ûˆ˜ Û˘ÛÙÔÏ‹˜ (shrinkage stress ‹ S-factor).E›Û˘ Ì ‰Â‰Ô̤ÓÔ fiÙÈ Ë Ú¢ÛÙfiÙËÙ· ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓÛ˘ÁÎfiÏÏËÛ˘ ÛÙÔÓ ÚÈ˙ÈÎfi ۈϋӷ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ·˘-Ù‹˜ ÙˆÓ ÂÌÊÚ·ÎÙÈÎÒÓ Û˘Óı¤ÙˆÓ ˘ÏÈÎÒÓ, Ë ·Ó¿Ù˘ÍË Ù¿-ÛÂˆÓ ÌÂÈÒÓÂÙ·È. ¶·ÚfiÏ· ·˘Ù¿, Ë Û˘ÁÎfiÏÏËÛË ÛÙÔÓ ÚÈ˙È-Îfi ۈϋӷ ·Ú·Ì¤ÓÂÈ ÂÈÛÊ·Ï‹˜ ÂȉÈο fiÙ·Ó Û˘ÁÎÚÈı›Ì ¤ÌÌÂÛ˜ ˘ÂÚÌ˘ÏÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ50.™¯ÂÙÈο ÚfiÛÊ·Ù· οÔÈÔÈ ÂÚ¢ÓËÙ¤˜ ÂÈÛ‹Á·Á·Ó ÙËÓ ˘-fiıÂÛË fiÙÈ Ë Û˘ÁÎÚ¿ÙËÛË ÙÔ˘ ¿ÍÔÓ· ÛÙÔÓ ÚÈ˙ÈÎfi ۈϋ-Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙÚÈ‚‹˜ ÙˆÓ ÙÔȯˆÌ¿ÙˆÓ ÙÔ˘ ¿ÍÔÓ·Ì ٷ ÙÔȯÒÌ·Ù· ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ ̤ۈ Ù˘ ·ÚÂÌ-

‚ÔÏ‹˜ Ù˘ Û˘ÁÎÔÏÏËÙÈ΋˜ ÎÔÓ›·˜. øÛÙfiÛÔ Ë ÙÚÈ‚‹ ÌÔ-Ú› Ó· ·›ÍÂÈ ÚfiÏÔ ÛÙËÓ Û˘ÁÎÚ¿ÙËÛË ÙÔ˘ ¿ÍÔÓ· ÌfiÓÔ fi-Ù·Ó ¤¯ÂÈ ÚÔËÁËı› ·ÔÙ˘¯›· ÛÙËÓ Û˘ÁÎfiÏÏËÛË. A˘ÙfiÚ·ÎÙÈο ÛËÌ·›ÓÂÈ ˆ˜ Ë ‰ËÌÈÔ˘ÚÁ›· ‰ÂÛÌÔ‡ ÌÂٷ͇ ¿-ÍÔÓ· Î·È ÚËÙÈÓÒ‰Ô˘˜ ÎÔÓ›·˜, ÚÔ¤Ú¯ÂÙ·È Î˘Ú›ˆ˜ ·fi ÌÈ-ÎÚÔÌ˯·ÓÈ΋ Î·È fi¯È ¯ËÌÈ΋ Û˘ÁÎÚ¿ÙËÛË ·ÊÔ‡ ÛÙÔ ·˘-¯ÂÓÈÎfi ÙÚÈÙËÌfiÚÈÔ ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ ̆ ‚ÚȉÈ΋ ̇ ÒÓË ‰‡-ÛÎÔÏ· Û¯ËÌ·Ù›˙ÂÙ·È.EÈϤÔÓ Û ·˘Ù‹ ÙËÓ ˘fiıÂÛË ı·Ú¤ÂÈ Ó· ·›˙ÂÈ ÚfiÏÔ Î·È Ë Û‡ÓıÂÛË ÙÔ˘ Û˘ÁÎÔÏÏËÙÈÎÔ‡·Ú¿ÁÔÓÙ· Û ÌÔÚÈ·Îfi ›‰Ô. A˘Ù¿ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂÙÔ ·Ó·Ú΋ ·ÚÈıÌfi ÌÂÏÂÙÒÓ ‰Â›¯ÓÂÈ ˆ˜ Ë ̆ fiıÂÛË ·˘-Ù‹ ¯ÚÂÈ¿˙ÂÙ·È ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ53, 54.™ÙÔ˘˜ ÁˆÌÂÙÚÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ı· Ú¤ÂÈ Ó· Û˘ÌÂÚÈ-Ï¿‚Ô˘ÌÂ Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·ÍfiÓˆÓ¤¯ÂÈ Î˘ÏÈÓ‰ÚÈÎfi Û¯‹Ì· Î·È Û˘ÁÎÔÏÏÒÓÙ·È Û ¤Ó· ·ÔÂ-Ï·Ù˘Ṳ̂ÓÔ ‹ ˆÔÂȉ¤˜ Î·È Ì¿ÏÏÔÓ ÎˆÓÈÎfi ÚÈ˙ÈÎfi ۈϋ-Ó·. ŒÙÛÈ ÙÔ ¿¯Ô˜ Ù˘ Û˘ÁÎÔÏÏËÙÈ΋˜ ÎÔÓ›·˜ ‰ÂÓ Â›Ó·È Ô-ÌÔÈfiÌÔÚÊÔ Û fiÏÔ ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ¿ÍÔÓ· (EÈÎ. 6 Î·È EÈÎ. 7).A˘Ùfi ÂËÚ¿˙ÂÈ ÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ Û˘ÁÎÏÂÈÛÈ·ÎÒÓ ‰˘Ó¿-ÌÂˆÓ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÙËÓ ÔÈfiÙËÙ· Î·È ÙËÓ ‰È¿ÚÎÂÈ·Ù˘ Û˘ÁÎfiÏÏËÛ˘. °È· ÙËÓ ‚ÂÏÙ›ˆÛË ·˘ÙÔ‡ ÙÔ˘ ÚÔ‚Ï‹-EÈÎ. 5: EÈÎfiÓ· ·fi ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ fiÔ˘ Ê·›ÓÂÙ·È ÛÂ

ÙÔÌ‹ ηٷÛ΢·ÛÙÈ΋ ·ÓˆÌ·Ï›·-ÎÂÓÔÙfiÈÔ ÛÙËÓ Ì¿˙· ÙÔ˘ ¿ÍÔ-Ó· ηıÒ˜ Î·È Ê˘Û·Ï›‰· ÛÙËÓ Ì¿˙· Ù˘ ÚËÙÈÓÒ‰Ô˘˜ ÎÔÓ›·˜

EÈÎ. 7: KÏÈÓÈ΋ ÂÈÎfiÓ· ·ÔÎÔÏÏË̤Ó˘ ·ÔηٿÛÙ·Û˘ Ô-Ï˘ÌÂÚÔ‡˜ ¿ÍÔÓ·

EÈÎ. 6: KÏÈÓÈ΋ ÂÈÎfiÓ· ·ÔÎÔÏÏË̤Ó˘ ·ÔηٿÛÙ·Û˘ Ô-Ï˘ÌÂÚÔ‡˜ ¿ÍÔÓ·.

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Literature Review

Ì·ÙÔ˜ ¤¯Ô˘Ó ÂÈÛ·¯ı› ÛÙËÓ ·ÁÔÚ¿ ¿ÍÔÓ˜ ÔÈΛÏ˘ ΈÓÈ-ÎfiÙËÙ·˜ ηıÒ˜ Î·È ÂÁ¯¿Ú·ÎÙÔÈ, ÙˆÓ ÔÔ›ˆÓ Ë ·ÔÙÂÏÂ-ÛÌ·ÙÈÎfiÙËÙ· Â›Ó·È ˘fi ‰ÈÂÚ‡ÓËÛË55, 56, 57.

EÈÏÔÁ‹ Û˘ÁÎÔÏÏËÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ: °È· ÙË ‚ÂÏÙ›ˆÛËÙ˘ Û˘ÁÎfiÏÏËÛ˘ Ì ÙËÓ Ô‰ÔÓÙ›ÓË ¤¯ÂÈ ÚÔÙ·ı› ÌÈ· ÙÂ-¯ÓÈ΋ «˘ÁÚ‹˜» Û˘ÁÎfiÏÏËÛ˘ Ë ÔÔ›· ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ·È-ı·ÓfiÏË58. H ·Ú¯È΋ Ù¯ÓÈ΋ Ù˘ «˘ÁÚ‹˜» Û˘ÁÎfiÏÏËÛ˘,ÙˆÓ Û˘ÁÎÔÏÏËÙÈÎÒÓ ‰ËÏ·‰‹ Ô˘ ÏÂÈÙÔ˘ÚÁÔ‡Ó Ì ·‰ÚÔ-Ô›ËÛË Î·È ¤ÎÏ˘ÛË, ÚÔ¸Ôı¤ÙÂÈ ÓÂÚfi ÙÔ ÔÔ›Ô ‚Ú›ÛÎÂ-Ù·È ÛÙÔÓ ÂÓ‰ÔÛˆÏËÓ·ÚÈ·Îfi ¯ÒÚÔ ÙÔ˘ ‰ÈÎÙ‡Ô˘ ÎÔÏÏ·Áfi-ÓÔ˘ Ù˘ Ô‰ÔÓÙ›Ó˘ Î·È ÙÔ ÔÔ›Ô ·ÓÙÈηı›ÛÙ·Ù·È ·fi ÔÏÈ-Τ˜ ÂÓÒÛÂȘ ·˘ÙÒÓ ÙˆÓ Û˘ÁÎÔÏÏËÙÈÎÒÓ Î·È ÙÂÏÈο ·fiÚËÙ›Ó˜. AӷʤÚÂÙ·È fiÙÈ ·ÓÙÈηıÈÛÙÒÓÙ·˜ ÙÔ ÓÂÚfi ÛÙËÓ·ÔÌÂÙ·ÏÏÈÎÔÔÈË̤ÓË Ì‹ÙÚ· ÎÔÏÏ·ÁfiÓÔ˘ Ì ·Èı·ÓfiÏËÌÔÚ› Ó· ÚÔÏËÊı› Ô ‰È·¯ˆÚÈÛÌfi˜ ÙˆÓ Ê¿ÛÂˆÓ ÙˆÓ ˘-‰ÚfiÊÔ‚ˆÓ ‰ÈÌÂı·ÎÚ˘ÏÈÎÒÓ ·ÊÔ‡ ϤÔÓ ı· ÂÊ·ÚÌfi˙Ô-ÓÙ·È Û ‚¿ÛË Ô‰ÔÓÙ›Ó˘ Ì ·Èı·ÓfiÏË58, 59. OÈ Pashley ηÈÛ˘Ó ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ¤Ó· ÌÔÓÙ¤ÏÔ Ù˘ ˘‚ÚȉÈ΋˜ ÛÙÔÈ-‚¿‰·˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë «˘ÁÚ‹» Û˘ÁÎfiÏÏËÛË Ì ·Èı·ÓfiÏË Â›-Ó·È ·ÓÒÙÂÚË ·fi ·˘Ù‹ Ì ÓÂÚfi, ̂ ÛÙfiÛÔ Ë ·ÔÙÂÏÂÛÌ·ÙÈ-ÎfiÙËÙ· ·˘Ù‹˜ Ù˘ ÌÂıfi‰Ô˘ ‚Ú›ÛÎÂÙ·È ·ÎfiÌ· Û ¤Ú¢ӷ58.

M·ÎÚÔÚfiıÂÛÌË ·ÔÙ˘¯›· Û˘ÁÎfiÏÏËÛ˘ ÏfiÁˆ Á‹Ú·Ó-Û˘, ·Ô‰fiÌËÛ˘: M ‰Â‰Ô̤ÓÔ fiÙÈ Ë ˘‚ÚȉÈ΋ ÛÙÔÈ‚¿-‰· Â›Ó·È ¤Ó· Û‡ÓıÂÙÔ Ì›ÁÌ· ÎÔÏÏ·ÁfiÓÔ˘, ˘‰ÚÔ͢··Ù›-ÙË Î·È Û˘ÁÎÔÏÏËÙÈÎÒÓ ÌÔÓÔÌÂÚÒÓ ‰ÂÓ ı· Ú¤ÂÈ Ó· ·-Ú·‚Ï¤Ô˘Ì fiÙÈ Î·È Ù· ÙÚ›· ·˘Ù¿ Û˘ÛÙ·ÙÈο ˘Ê›ÛٷٷÈÙËÓ ‰È·‰Èηۛ· Ù˘ Á‹Ú·ÓÛ˘, Ë ÔÔ›· Û·ÊÒ˜ ÌÔÚ› Ó·Ô‰ËÁ‹ÛÂÈ Û ηٿÚÚ¢ÛË Ù˘ ‰ÈÂÈÊ¿ÓÂÈ·˜ Û˘ÁÎfiÏÏË-Û˘ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· Û ·ÔÎfiÏÏËÛË. ¶ÂÚÈÁÚ¿ÊÔÓٷȉ‡Ô ÌÔÓ٤Ϸ ·Ô‰fiÌËÛ˘ Ù˘ ˘‚ÚȉÈ΋˜ ÛÙÔÈ‚¿‰·˜60,ÌÂÙ¿ ·fi ʇϷÍË Û ÓÂÚfi ÁÈ· ¤Ó· ¯ÚfiÓÔ: 1)˘‰ÚfiÏ˘ÛËÙ˘ ÚËÙ›Ó˘ ·fi ÙÔÓ ¯ÒÚÔ Ù˘ ÂÓ‰ÔÛˆÏËÓ·Úȷ΋˜ Ô‰Ô-ÓÙ›Ó˘ Î·È 2) ·Ô‰ÈÔÚÁ¿ÓˆÛË ÙˆÓ ÈÓÒÓ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘.A˘Ù¿ Ù· Ê·ÈÓfiÌÂÓ· ÂÍ·ÛıÂÓÔ‡Ó ÙÔÓ ‰ÂÛÌfi ÚËÙ›Ó˘ - Ô-‰ÔÓÙ›Ó˘ ÂÈÙÚ¤ÔÓÙ·˜ ÙËÓ ÌÈÎÚԉțۉ˘ÛË Î·È ÙÂÏÈοÙËÓ ·ÔÙ˘¯›· Ù˘ Û˘ÁÎfiÏÏËÛ˘. H ‰È·‰Èηۛ· Á‹Ú·ÓÛË˜Î·È ·Ô‰fiÌËÛ˘ Ù˘ ˘‚ÚȉÈ΋˜ ÛÙÔÈ‚¿‰·˜ ·ÔÙÂÏ› ÌÈ·ÂÍ·ÈÚÂÙÈο ÂÚ›ÏÔÎË ‰È·‰Èηۛ· ÛÙËÓ ÔÔ›· ÂÌϤÎÂÙ·ÈË ‰Ú¿ÛË ÂȉÈÎÒÓ ÂÓ˙‡ÌˆÓ MMPs61. øÛÙfiÛÔ ·ÔÙÂÏ› ‰È·-‰Èηۛ· Ô˘ ¤¯ÂÈ ÌÂÏÂÙËı› ΢ڛˆ˜ ÛÙËÓ Ì˘ÏÈ΋ Ô‰ÔÓÙ›ÓËÎ·È ·Ú·Ì¤ÓÔ˘Ó ÂÚˆÙËÌ·ÙÈο ÁÈ· ÙÔ ·Ó Ù· ›‰È· Ê·ÈÓfiÌÂ-Ó· Ï·Ì‚¿ÓÔ˘Ó ¯ÒÚ· ÛÙ· ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fi-ÓÙÈ· fiÔ˘ ÙÔ ÔÛÔÛÙfi Ù˘ ˘ÁÚ·Û›·˜ Â›Ó·È Û·ÊÒ˜ ¯·ÌË-ÏfiÙÂÚÔ Î·È Ô˘ Ë Û‡ÛÙ·ÛË Ù˘ Ô‰ÔÓÙ›Ó˘ ¤¯ÂÈ ÂËÚ·-ÛÙ› ·fi Ù· ‰È·Ï‡Ì·Ù· Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂڷ›·˜.

ºˆÙÔÔÏ˘ÌÂÚÈÛÌfi˜: ™ÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ·ÁÔÚ¿ ‰È·Ù›ıÂ-ÓÙ·È ‰È·Ê·Ó›˜ ÔÏ˘ÌÂÚ›˜ ¿ÍÔÓ˜ ÔÈ ÔÔ›ÔÈ Û‡Ìʈӷ ÌÂÙÔ˘˜ ηٷÛ΢·ÛÙ¤˜ ÙÔ˘˜ ʤÚÔÓÙ·È Ó· ¤¯Ô˘Ó ÙËÓ ‰˘Ó·-ÙfiÙËÙ· Ó· ÂÈÙÚ¤Ô˘Ó ÙËÓ ‰È¤Ï¢ÛË ÙÔ˘ ʈÙfi˜ ηٿ Ì‹-ÎÔ˜ ÙˆÓ ·ÍfiÓˆÓ, ÂÈÙÚ¤ÔÓÙ·˜ ÙÔÓ ÊˆÙÔÔÏ˘ÌÂÚÈÛÌfiÙ˘ ÚËÙÈÓÒ‰Ô˘˜ ÎÔÓ›·˜. EÓÙÔ‡ÙÔȘ ÂÁ›ÚÔÓÙ·È ÂÚˆÙËÌ·-ÙÈο ηıÒ˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÚΛ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔÔÈÔÈ Â›Ó·È ÔÈ ¿ÍÔÓ˜ Ô˘ ÂÈÙÚ¤Ô˘Ó ÙËÓ ÌÂÙ¿‰ÔÛË ÙÔ˘ÊˆÙfi˜ Î·È Û ÔÈ· ¤ÓÙ·ÛË. E›Û˘ Â›Ó·È ·Û·Ê¤˜ ¿Ó ÙÔʈ˜ ΢ڛˆ˜ ‰Ú· ÛÙÔ ·ÎÚÔÚÚÈ˙ÈÎfi ÙÌ‹Ì· ÙÔ˘ ¿ÍÔÓ· ‹ÛÙ· Ï¢ÚÈο ÙÔȯÒÌ·Ù·, ·ÏÏ¿ Î·È ÁÈ· ÙËÓ Â›‰Ú·ÛË ÛÙËÓ

ÛÎÏËÚfiÙËÙ· Ù˘ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˘ ÚËÙÈÓÒ‰Ô˘˜ ÎÔÓ›·˜.AÓ·ÌÊ›‚ÔÏ· ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È Ë ¯Ú‹ÛË ÊˆÙÔÔÏ˘ÌÂÚÈ˙fi-ÌÂÓˆÓ ÚËÙÈÓˆ‰ÒÓ ÎÔÓÈÒÓ, ·ÏÏ¿ ÚÔÙ›ÓÂÙ·È Ë ¯ÚËÛÈÌÔ-Ô›ËÛË ÚËÙÈÓˆ‰ÒÓ ÎÔÓÈÒÓ ‰ÈÏÔ‡ ÔÏ˘ÌÂÚÈÛÌÔ‡62. H¯Ú‹ÛË ·˘ÙÔÔÏ˘ÌÂÚÈ˙fiÌÂÓˆÓ ÚËÙÈÓˆ‰ÒÓ ÎÔÓÈÒÓ ÂÁÁ˘¿-Ù·È ÙÔÓ ÔÏ˘ÌÂÚÈÛÌfi ¯ˆÚ›˜ ÙËÓ Â›‰Ú·ÛË ÙÔ˘ Ì‹ÎÔ˘˜ÙÔ˘ ·Ú·Û΢·Ṳ̂ÓÔ˘ ÁÈ· ÙËÓ ̆ Ô‰Ô¯‹ ÙÔ˘ ¿ÍÔÓ· ÊÚÂ-·Ù›Ô˘, fï˜ ·fi ¿Ô„Ë ÂÚÁÔÓÔÌÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ˘ÛÙÂÚ› ·ÊÔ‡ ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÓÙ›‰Ú·Û˘ÔÏ˘ÌÂÚÈÛÌÔ‡ Î·È ·Ú¿ÏÏËÏ· ÂÚÈÔÚ›˙ÂÈ Ù· ¯ÚÔÓÈο Â-ÚÈıÒÚÈ· ÙˆÓ ¯ÂÈÚÈÛÌÒÓ63. OÈ ‰ÈÏÔ‡ ÔÏ˘ÌÂÚÈÛÌÔ‡ ÚËÙÈ-ÓÒ‰ÂȘ ÎÔӛ˜ Û˘Ó‰˘¿˙Ô˘Ó Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙˆÓ ·˘ÙÔ-ÔÏ˘ÌÂÚÈ˙fiÌÂÓˆÓ Î·È ÊˆÙÔÔÏ˘ÌÂÚÈ˙fiÌÂÓˆÓ ÎÔÓÈÒÓ, ˘-fi ÙËÓ ÚÔ˘fiıÂÛË fiÙÈ ÚÔËÁÂ›Ù·È Ë Ê¿ÛË ÙÔ˘ ·˘ÙÔÔ-Ï˘ÌÂÚÈÛÌÔ‡ Î·È ¤ÂÙ·È ÂΛÓË ÙÔ˘ ʈÙÔÔÏ˘ÌÂÚÈÛÌÔ‡ÌÂÙ¿ ÙËÓ ·Ú¤Ï¢ÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÚÈÒÓ ÏÂÙÒÓ ·fi ÙËÓ¤‰Ú·ÛË ÙÔ˘ ¿ÍÔÓ· ÛÙÔ ÚÈ˙ÈÎfi ۈϋӷ. O Ù‡Ô˜ ÔÏ˘ÌÂ-ÚÈÛÌÔ‡ Û¯ÂÙ›˙ÂÙ·È Î·È Ì ÙÔ ÔÛÔÛÙfi Ù˘ Û˘ÛÙÔÏ‹˜ ÌÂÙ¿ÙÔÓ ÔÏ˘ÌÂÚÈÛÌfi, Ë ÔÔ›· ·ÔÙÂÏ› ‚·ÛÈÎfi ·Ú¿ÁÔÓÙ·ÁÈ· ÙËÓ ÂÈÙ˘¯›· Ù˘ Û˘ÁÎfiÏÏËÛ˘, ·Ó Ï¿‚ÂÈ Î·Ó›˜ ̆ fi-„ËÓ ÙÔ˘˜ ÁˆÌÂÙÚÈÎÔ‡˜ ÂÚÈÔÚÈÛÌÔ‡˜ Ô˘ ˘¿Ú¯Ô˘ÓÛÙÔ ÚÈ˙ÈÎfi ۈϋӷ63, 64, 65 (EÈÎ. 8 Î·È EÈÎ. 9).

™TOIXEIA ¶OY ¶POA°OYN THN ™Y°KO§§H™H

H Û˘ÁÎÚ¿ÙËÛË ÙÔ˘ ¿ÍÔÓ· ˘·ÏÔÓËÌ¿ÙˆÓ Î·È Ù˘ ÔÏ˘ÌÂ-ÚÔ‡˜ ·ÔηٿÛÙ·Û˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÔÈfiÙËÙ· ÙÔ˘‰ÂÛÌÔ‡ Ô˘ ÂÈÙ˘Á¯¿ÓÂÙ·È ·Ó¿ÌÂÛ· ÛÙȘ ‰È¿ÊÔÚ˜ ‰ÈÂÈ-Ê¿ÓÂȘ66. Y¿Ú¯ÂÈ ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÌÂÏÂÙÒÓ Ô˘·ÊÔÚ¿ ÙËÓ Û˘ÁÎfiÏÏËÛË ÙˆÓ ÔÏ˘ÌÂÚÒÓ ·ÍfiÓˆÓ Ì ÙËÓÔ‰ÔÓÙ›ÓË ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ. Afi ÙËÓ ÂÈÛ·ÁˆÁ‹ ·ÎfiÌ·ÙˆÓ ÔÏ˘ÌÂÚÒÓ ÂÓ‰ÔÚÚÈ˙ÈÎÒÓ ·ÍfiÓˆÓ ÔÈ ÚÔÛ¿ıÂÈÂ˜ÙˆÓ ÂÚ¢ÓËÙÒÓ ÛÙÚ¤ÊÔÓÙ·È ÛÙËÓ ‚ÂÏÙ›ˆÛË ÙÔ˘ ‰ÂÛÌÔ‡ÙÔ˘ ¿ÍÔÓ· Ì ÙËÓ Ô‰ÔÓÙ›ÓË Ù˘ Ú›˙·˜67, 68, 69. ¶·Ú¿ ÙȘ Û˘-Ó¯fiÌÂÓ˜ ‚ÂÏÙÈÒÛÂȘ ÙˆÓ Û˘ÁÎÔÏÏËÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ ËÛ˘ÁÎfiÏÏËÛË Ì ÙËÓ Ô‰ÔÓÙ›ÓË Ù˘ Ú›˙·˜ ·Ú·Ì¤ÓÂÈ ˘Ô-‰Â¤ÛÙÂÚË Û ۇÁÎÚÈÛË Ì ÙË Ì˘ÏÈ΋ Ô‰ÔÓÙ›ÓË70. B·ÛÈοÚÔÙ›ÓÔÓÙ·È ÙÚÂȘ ηÙÂÚÁ·Û›Â˜ ÔÈ Ôԛ˜ ¤¯Ô˘Ó Û·Ó ÛÙfi-¯Ô ÙËÓ ‚ÂÏÙÈÛÙÔÔ›ËÛË Ù˘ ÔÈfiÙËÙ·˜ ÙÔ˘ ‰ÂÛÌÔ‡ ÌÂÙ·-͇ ÙÔ˘ ¿ÍÔÓ· ˘·ÏÔÓËÌ¿ÙˆÓ Î·È Ù˘ ÚËÙÈÓÒ‰Ô˘˜ ÎÔÓ›·˜.

ñ K·ÙÂÚÁ·Û›Â˜ Ô˘ Ô‰ËÁÔ‡Ó Û ¯ËÌÈÎfi ‰ÂÛÌfi ÌÂٷ͇ÚËÙ›Ó˘ Î·È ¿ÍÔÓ·.

✓ ™ÈÏ¿ÓÈÔ: ŒÓ·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÌÂÏÂÙÒÓ ÚÔÙ›ÓÂÈ Ù˯ڋÛË ÛÈÏ·ÓÈÔ‡¯ˆÓ Û˘ÁÎÔÏÏËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ì ÙËÓÌÔÚÊ‹ ÂÈÎ¿Ï˘„˘ ¿Óˆ ÛÙÔÓ ¿ÍÔÓ· Ì ÛÙfi¯Ô ÙËÓ ÚÔ·-ÁˆÁ‹ Ù˘ Û˘ÁÎfiÏÏËÛ˘ ÙˆÓ ·ÓfiÚÁ·ÓˆÓ ÂÈÊ·ÓÂÈÒÓ Ì ٷÌfiÚÈ· ÙˆÓ ÔÏ˘ÌÂÚÒÓ69, 71, 72. T· ÔÚÁ·ÓÔÛÈÏ¿ÓÈ· ÌÂ Ù‡Ô R-Si- (OR)3 ·ÔÙÂÏÔ‡ÓÙ·È ·fi ÌÈ· ÔÚÁ·ÓÈ΋ ÏÂÈÙÔ˘ÚÁÈ΋ Ô-Ì¿‰· (R’) Î·È ÙÚÂȘ ·ÏÎÔ͢ÏÔÌ¿‰Â˜ (R). H ̄ ËÌÈ΋ ·ÓÙ›‰Ú·-ÛË ÍÂÎÈÓ¿ Ì ÙËÓ ̆ ‰ÚfiÏ˘ÛË ÙˆÓ ·ÏÎÔ͢ÏÔÌ¿‰ˆÓ (R) Û ÛÈ-Ï·ÓfiϘ (SiOH) Ô˘ Û˘Ì˘ÎÓÒÓÔÓÙ·È Û¯ËÌ·Ù›˙ÔÓÙ·˜ ‰Â-ÛÌÔ‡˜ ÛÈÏÔÍ¿Ó˘. MÔÏÔÓfiÙÈ ÔÈ ÛÈÏ·ÓÈÔ‡¯ÔÈ Û˘ÁÎÔÏÏËÙÈÎÔ›·Ú¿ÁÔÓÙ˜ ¤¯Ô˘Ó ·Ô‰Âȯı› ȉȷ›ÙÂÚ· ·ÔÙÂÏÂÛÌ·ÙÈÎÔ›ÛÙËÓ Û˘ÁÎfiÏÏËÛË ÔÏ˘ÌÂÚÒÓ Ì ÎÂÚ·ÌÈο ˘ÏÈο Ë ¯Ú‹ÛËÙÔ˘˜ ÁÈ· ¿ÏÂÈ„Ë ÙˆÓ ÔÏ˘ÌÂÚÒÓ ·ÍfiÓˆÓ Ì ÛÙfi¯Ô ÙËÓ ·-ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË Û˘ÁÎfiÏÏËÛË ·fi ÔÏÏÔ‡˜ ·ÌÊÈÛ‚Ë-

Hellenic Stomatological Review 59: 71-82, 2015

Page 77: ÂÏÏËÓÈο - eoo.gr Stomatological Review Hellenic Dental Association VOLUME 59, ISSUE 1-4 JANUARY - DECEMBER 2015 ISSN 1011 - 4181 CONTENTS ñ Oral health in 6-year old schoolchildren

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

Hellenic Stomatological Review 59: 71-82, 2015

Ù›ٷÈ. OÈ Goracci Î·È Û˘Ó Â¤ÍÂÈÍ·Ó ‚ÂÏÙ›ˆÛË ÙÔ˘ ‰ÂÛÌÔ‡ÌÂٷ͇ ÚÔÛÈÏ·ÓÔÔÈËÌ¤ÓˆÓ ÔÏ˘ÌÂÚÒÓ ÂÓ‰ÔÚÚÈ˙ÈÎÒÓ ·-ÍfiÓˆÓ Î·È Û‡ÓıÂÙ˘ ÚËÙ›Ó˘ ˘„ËÏ‹˜ Ú¢ÛÙfiÙËÙ·˜ fiÙ·Ó·˘Ù‹ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Û·Ó ˘ÏÈÎfi ·ÔηٿÛÙ·Û˘70. ™Â ·-ÓÙ›ÛÙÔȯ· ·ÔÙÂϤÛÌ·Ù· Ô‰ËÁ‹ıËÎ·Ó Î·È ÔÈ AksornmuangÎ·È Û˘Ó fiÔ˘ Û ¤ÚÂ˘Ó¿ ÙÔ˘˜ ÂȂ‚·›ˆÛ·Ó ÙËÓ ÂÓÈÛ¯˘ÙÈ΋‰Ú¿ÛË ÂÊ·ÚÌÔÁ‹˜ ÛÈÏ·Ó›Ô˘ ÛÙËÓ ·ÓÙÔ¯‹ ÙÔ˘ ‰ÂÛÌÔ‡ ÌÂ-ٷ͇ ÔÏ˘ÌÂÚÒÓ ˘ÏÈÎÒÓ ·ÔηٿÛÙ·Û˘ ‰ÈÏÔ‡ ÔÏ˘ÌÂ-ÚÈÛÌÔ‡ Î·È ‰È·Ê·ÓÒÓ ·ÍfiÓˆÓ ˘·ÏÔÓËÌ¿ÙˆÓ73, 74. T· ·ÔÙÂ-ϤÛÌ·Ù· ·˘ÙÒÓ ÙˆÓ ÂÚ¢ÓÒÓ ÛÙËÚ›˙ÔÓÙ·È ÛÙËÓ ÈηÓfiÙËÙ·ÙÔ˘ ÛÈÏ·Ó›Ô˘ Ó· ·˘Í¿ÓÂÈ ÙËÓ ‰˘Ó·ÙfiÙËÙ· ‰È·‚ÚÔ¯‹˜ Ù˘ Â-ÈÊ¿ÓÂÈ·˜ ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ ¯ËÌÈÎfi ‰ÂÛÌfi Ì ÙȘ –OH ÔÌ¿-‰Â˜ ÙÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜. ¶·Ú¿ Ù· ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤ-ÛÌ·Ù· Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Û οÔȘ ÌÂϤÙ˜, ÔÈ ·ÓÙÔ¯¤˜Ô˘ ÂÈÙ˘Á¯¿ÓÔÓÙ·È Â›Ó·È Û›ÁÔ˘Ú· ¯·ÌËÏfiÙÂÚ˜ ÂΛӈÓÔ˘ ·ÊÔÚÔ‡Ó ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÛÈÏ·Ó›Ô˘ ·Â˘ı›·˜ ÛÙËÓÔ‰ÔÓÙÈ΋ Ô˘Û›·. H ‚·ÛÈ΋ ·ÈÙ›· ÁÈ· ·˘Ùfi Â›Ó·È Ë ·‰˘Ó·Ì›·

¯ËÌÈ΋˜ Û‡Ó‰ÂÛ˘ ÙˆÓ ÌÂı·ÎÚ˘ÏÈÎÒÓ ÌÔÓÔÌÂÚÒÓ ÙˆÓÛ˘Óı¤ÙˆÓ ÚËÙÈÓÒÓ Î·È Ù˘ ÂÔÍÈ΋˜ ÚËÙ›Ó˘ Ô˘ ̆ ¿Ú¯ÂÈÛÙËÓ Ì‹ÙÚ· ÙˆÓ ÔÏ˘ÌÂÚÒÓ ·ÍfiÓˆÓ Î·È ·˘Ùfi ‰ÈfiÙÈ Ù· Â-ÔÍÈο ÔÏ˘ÌÂÚ‹ ÂÌÊ·Ó›˙Ô˘Ó ˘„ËÏfi ‚·ıÌfi ÌÂÙ·ÙÚÔ‹˜Î·È ˘„ËÏ¿ ‰È·ÛÙ·˘ÚÔ‡ÌÂÓ˜ ‰Ô̤˜75.°È· ÙËÓ ‚ÂÏÙ›ˆÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ¯ËÌÈ΋˜ ·ÓÙ›‰Ú·-Û˘ ·Ó¿ÌÂÛ· ÛÙÔ ÛÈÏ¿ÓÈÔ Î·È ÛÙËÓ ·ÓfiÚÁ·ÓË ÂÈÊ¿ÓÂÈ·,Ë ·ÓÙ›‰Ú·ÛË ÌÔÚ› Ó· ÂÈÙ·¯˘Óı› ̤ۈ ηÙÂÚÁ·Û›·˜Ì Ô͇ ‹ ̤ۈ ıÂÚÌÈ΋˜ ηÙÂÚÁ·Û›·˜. H ıÂÚÌÈ΋ ηÙÂÚ-Á·Û›· Ù˘ ÛÈÏ·ÓÔÔÈË̤Ó˘ ˘¿ÏÔ˘ ·ÔÙÂÏ› ÌÈ· ȉȷ›ÙÂ-Ú· ÎÔÈÓ‹ ‰È·‰Èηۛ· ÛÙËÓ ‚ÈÔÌ˯·Ó›· Ù˘ ˘¿ÏÔ˘ Ô˘ ÌÂ-ÁÈÛÙÔÔÈ› ÙËÓ ·ÓÙÔ¯‹ ‰ÂÛÌÔ‡76.¶ÚfiÛÊ·Ù· ÌÂÏÂÙ‹ıËÎ·Ó Ù· Èı·Ó¿ ÏÂÔÓÂÎÙ‹Ì·Ù· Ù˘ÛÈÏ·ÓÔÔ›ËÛ˘ ÌÂ Û˘Ó·ÎfiÏÔ˘ıË ÂÊ·ÚÌÔÁ‹ Û˘ÁÎÔÏ-ÏËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ì ·ÓÙÈÊ·ÙÈο ·ÔÙÂϤÛÌ·Ù·. O Fer-rari Î·È Û˘Ó. ·Ó·Ê¤ÚÔ˘Ó77 ÌË ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÛÙËÓ ·-ÓÙÔ¯‹ ÙÔ˘ ‰ÂÛÌÔ‡ ̠ͯˆÚÈÛÙ‹ ÂÊ·ÚÌÔÁ‹ ÛÈÏ·Ó›Ô˘ ηÈÛ˘ÁÎÔÏÏËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ô‰ÔÓÙ›Ó˘ Û ¿ÍÔÓ˜ ¯·Ï·-˙›· ÌÂı·ÎÚ˘ÏÈ΋˜ Ì‹ÙÚ·˜. MÈ· Èı·Ó‹ ÂÚÌËÓ›· Â›Ó·È Ë‰ËÌÈÔ˘ÚÁ›· ÌÈ·˜ ÌÂÁ¿ÏÔ˘ ¿¯Ô˘˜ Û˘˙¢ÎÙÈ΋˜ ÛÙÔÈ‚¿-‰·˜ ÛÙËÓ ÔÔ›· ÌÔÚ› Ôχ ‡ÎÔÏ· Ó· Û˘Ì‚Ô‡Ó ‰È¿ÊÔ-Ú˜ ·Ù¤ÏÂȘ ηٿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ Û˘ÁÎÔÏÏËÙÈÎÒÓÛÙڈ̿وÓ. K¿ÔÈÔÈ Ó¤ÔÈ Û˘˙¢ÎÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‚·Û›-˙ÔÓÙ·È ÛÙËÓ Èı·ÓfiÙËÙ· Û˘Ó‰˘·ÛÌÔ‡ ÂÓfi˜ ÛÈÏ·ÓÈÔ‡¯Ô˘Î·È ÂÓfi˜ Û˘ÁÎÔÏÏËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·. ™Ù· ·˘Ù¿ Ù· Û˘ÛÙ‹-Ì·Ù· ÙˆÓ ‰˘Ô Û˘ÛÙ·ÙÈÎÒÓ ÙÔ ÛÈÏ¿ÓÈÔ ˘‰ÚÔχÂÙ·È Î·ıÒ˜·Ó·ÌÂÈÁÓ‡ÂÙ·È Ì ٷ fiÍÈÓ· ʈÛÊÔÚÈο ÌÔÓÔÌÂÚ‹ Ô˘ ›-Ó·È ·ÚfiÓÙ· ÛÙ· ˘‰ÚfiÊÈÏ· Û˘ÁÎÔÏÏËÙÈο Û˘ÛÙ‹Ì·Ù·.A˘Ùfi Ô‰ËÁ› Û ÌÈ· ·ÓÙ›‰Ú·ÛË Û˘Ì‡ÎÓˆÛ˘ ÂÓÂÚÁÔÔÈ-ÒÓÙ·˜ ÙÔ ·ÏÎÔ͢ÛÈÏ¿ÓÈÔ Ó· ‰Ú¿ÛÂÈ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈο·fi Ù· ÚÔ-˘‰ÚÔÏ˘Ì¤Ó· ‰È·Ï‡Ì·Ù·78. T· ·ÔÙÂϤÛÌ·Ù··˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ Â›Ó·È È‰È·›ÙÂÚ· ÈηÓÔÔÈËÙÈο Ùfi-ÛÔ Û ¿ÍÔÓ˜ ̇ ÈÚÎÔÓ›Ô˘ fiÛÔ Î·È Û ¿ÍÔÓ˜ ̆ ·ÏÔÓËÌ¿ÙˆÓÛ ÂÔÍÈ΋ ÚËÙÈÓÒ‰Ë Ì‹ÙÚ·73, 74, 79.H ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÛÈÏ·Ó›Ô˘ ÁÈ· ÙËÓ ÚÔ·ÁˆÁ‹ ÙÔ˘ ‰Â-ÛÌÔ‡ ·ÍfiÓˆÓ ˘·ÏÔÓËÌ¿ÙˆÓ Î·È ÔÏ˘ÌÂÚÒÓ ˘ÏÈÎÒÓ Â›Ó·È˘fi ·ÌÊÈÛ‚‹ÙÈÛË ·ÊÔ‡ ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ ‰ÂÓ ·Ú·Ù‹-ÚËÛ·Ó ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ÂÍÂÙ·˙fiÌÂÓË ·ÓÙÔ¯‹ÙÔ˘ ‰ÂÛÌÔ‡80, 81.

ñ K·ÙÂÚÁ·Û›Â˜ Ô˘ Ô‰ËÁÔ‡Ó Û ¯ËÌÈÎfi Î·È ÌÈÎÚÔÌË-¯·ÓÈÎfi ‰ÂÛÌfi ÌÂٷ͇ ÚËÙ›Ó˘ Î·È ¿ÍÔÓ·: ™ÙËÓ Û‡Á-¯ÚÔÓË Û˘ÁÎÔÏÏËÙÈ΋ Ô‰ÔÓÙÈ·ÙÚÈ΋ ÔÈ Î·ÙÂÚÁ·Û›Â˜ Ù˘ÂÈÊ¿ÓÂÈ·˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ·‰ÚÔÔ›ËÛË Ù˘ Â-ÈÊ¿ÓÂÈ·˜ Î·È ÚÔ·ÁˆÁ‹ Ù˘ Û˘ÁÎfiÏÏËÛ˘ ÙfiÛÔ ÛÂÊ˘ÛÈΤ˜ Ô˘Û›Â˜ fiˆ˜ ·‰·Ì·ÓÙ›ÓË Î·È Ô‰ÔÓÙ›ÓË fiÛÔÎ·È Û ԉÔÓÙÈ·ÙÚÈο ˘ÏÈο. M ·ÊÂÙËÚ›· ÙËÓ Î·ÙÂÚÁ·-Û›· ÎÂÚ·ÌÈÎÒÓ ÂÈÊ·ÓÂÈÒÓ Ô˘ ›¯Â Û·Ó ÛÙfi¯Ô ÙËÓ‚ÂÏÙ›ˆÛË Ù˘ ·ÓÙÔ¯‹˜ ÙÔ˘ ‰ÂÛÌÔ‡ ÌÂٷ͇ ÎÂÚ·ÌÈÎÒÓÎ·È ÔÏ˘ÌÂÚÒÓ ÔÈ Î·ÙÂÚÁ·Û›Â˜ ·˘Ù¤˜ ÌÂٷʤÚÔÓÙ·ÈÎ·È ÛÙÔ˘˜ ÔÏ˘ÌÂÚ›˜ ¿ÍÔÓ˜.

✓ Y‰ÚÔÊıÔÚÈÎfi Ô͇: H ·‰ÚÔÔ›ËÛË Ì ˘‰ÚÔÊıÔÚÈÎfi Ô-͇ ¤¯ÂÈ Ò˜ ÛÙfi¯Ô Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ÌÈ· Ù¤ÙÔÈ· ·‰ÚfiÙËÙ·ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ·ÍfiÓˆÓ ÒÛÙ ӷ ÂÈÙÚ¤„ÂÈ ÙÔÓ ÌÈÎÚÔ-Ì˯·ÓÈÎfi ÂÁÎψ‚ÈÛÌfi ÙˆÓ ÚËÙÈÓˆ‰ÒÓ ̆ ÏÈÎÒÓ. H ›‰Ú·ÛËÙÔ˘ ˘‰ÚÔÊıÔÚÈÎÔ‡ ÔͤԘ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ˘ÎÓfiÙËÙ·ÙÔ˘, ÙÔÓ ¯ÚfiÓÔ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ·ÏÏ¿ Î·È ·fi ÙËÓ ¯ËÌÈ΋ۇÓıÂÛË ÙÔ˘ ¿ÍÔÓ·. øÛÙfiÛÔ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó ˆ˜ Ë Â-

EÈÎ. 9: EÈÎfiÓ· ·fi ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ fiÔ˘ Ê·›ÓÂ-Ù·È Ë Û¯¤ÛË ¿ÍÔÓ· ÚËÙÈÓÒ‰Ô˘˜ ÎÔÓ›·˜, Î·È Ô‰ÔÓÙ›Ó˘.

EÈÎ. 8: EÈÎfiÓ· ·fi video ÌÈÎÚÔÛÎfiÈÔ fiÔ˘ Ê·›ÓÂÙ·È Ë Ù¤ÏÂÈ·ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ¿ÍÔÓ· Ì ÙËÓ Ô‰ÔÓÙ›ÓË ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ.

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

Ê·ÚÌÔÁ‹ ˘‰ÚÔÊıÔÚÈÎÔ‡ ÔͤԘ ÛÙËÓ Â͈ÙÂÚÈ΋ ÂÈÊ¿-ÓÂÈ· ·ÍfiÓˆÓ ˘·ÏÔÓËÌ¿ÙˆÓ ÂÓÒ ·˘Í¿ÓÂÈ ÙËÓ ‰˘Ó·ÙfiÙËÙ·ÌÈÎÚÔÌ˯·ÓÈ΋˜ Û˘ÁÎÚ¿ÙËÛ˘ ÚÔηÏ› Ê·ÈÓfiÌÂÓ· ·Ô-‰fiÌËÛ˘ ÙÔ˘ ‰ÈÎÙ‡Ô˘ ÙˆÓ ÈÓÒÓ Ô˘ ··ÚÙ›˙Ô˘Ó ÙÔÓ ¿ÍÔ-Ó·. K·Ù¿ Û˘Ó¤ÂÈ· ‰ÂÓ ̆ ¿Ú¯Ô˘Ó ÁÂÓÈΤ˜ ηÙ¢ı˘ÓÙ‹ÚȘÁÚ·Ì̤˜ Ô˘ Ó· ·ÊÔÚÔ‡Ó ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ̆ ‰ÚÔÊıÔÚÈ-ÎÔ‡ ÔͤԘ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ·ÍfiÓˆÓ ˘·ÏÔÓËÌ¿ÙˆÓ.OÈ ¿ÍÔÓ˜ ˘·ÏÔÓËÌ¿ÙˆÓ ÂÌÊ·Ó›˙ÔÓÙ·È ÛËÌ·ÓÙÈο ·ÛıÂ-Ó¤ÛÙÂÚÔÈ ·fi ÙÔ˘ ¿ÍÔÓ˜ Ì ›Ó˜ ̄ ·Ï·˙›· ÏfiÁˆ Ù˘ ÂÍ·È-ÚÂÙÈο ÈÛ¯˘Ú‹˜ ‰È·‚ÚˆÙÈ΋˜ ‰Ú¿Û˘ ÙÔ˘ ̆ ‰ÚÔÊıÔÚÈÎÔ‡ÔͤԘ ÛÙËÓ ˘·ÏÒ‰Ë Ê¿ÛË ÙÔ˘ ¿ÍÔÓ·82, 83. ™Â ·˘Ùfi ÙÔ Û˘-̤ڷÛÌ· ηٷϋÁÂÈ Î·È Ô Vano Î·È Û˘Ó. Ô ÔÔ›Ô˜ ¯ÚË-ÛÈÌÔÔ›ËÛ ˘‰ÚÔÊıÔÚÈÎfi Ô͇ ÁÈ· ÙËÓ ·‰ÚÔÔ›ËÛË ÌÂ-ı·ÎÚ˘ÏÈÎÒÓ ·ÍfiÓˆÓ ̆ ·ÏÔÓËÌ¿ÙˆÓ. AÓ Î·È Ô ‰ÂÛÌfi˜ ¿ÍÔ-Ó· ÔÏ˘ÌÂÚÔ‡˜ ‚ÂÏÙÈÒıËΠÛËÌ·ÓÙÈο, ·Ú·ÙËÚ‹ıËηӷÍÈÔÛËÌ›ˆÙ˜ ÙÚÔÔÔÈ‹ÛÂȘ Ù˘ Â͈ÙÂÚÈ΋˜ ÂÈÊ¿ÓÂÈ-·˜ ÙÔ˘ ¿ÍÔÓ· ÔÈ Ôԛ˜ ÔÈÎ›Ï·Ó ·fi ÌÈÎÚÔÚˆÁÌÒÛÂȘˆ˜ ÂÈÌ‹ÎË Î·Ù¿ÁÌ·Ù·84.

✓ AÌÌÔ‚ÔÏ‹: H ·‡ÍËÛË Ù˘ ·‰ÚfiÙËÙ·˜ Ù˘ ÂÈÊ¿ÓÂÈ·˜Ô˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ٷ ‰È¿ÊÔÚ· Û˘ÛÙ‹Ì·Ù· ·ÌÌÔ‚ÔÏ‹˜ÂÓÒ ‰›ÓÂÈ ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù· Û fiÙÈ ·ÊÔÚ¿ ÙÔ˘˜ÎÂÚ·ÌÈÎÔ‡˜ ¿ÍÔÓ˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ‚Ú›ÛÎÂÈ ÂÊ·ÚÌÔÁ‹ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ÔÏ˘ÌÂÚÒÓ ·ÍfiÓˆÓ85. MÔÏÔÓfiÙÈ Ë È-ηÓfiÙËÙ· ·‰ÚÔÔ›ËÛ˘ Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ¯ÚfiÓÔ ÂÊ·ÚÌÔÁ‹˜ ÙÔ Ì¤ÁÂıÔ˜ Î·È ÙÔ Â›‰Ô˜ ÙˆÓ ·ÔÙÚÈÙÈ-ÎÒÓ ÌÔÚ›ˆÓ Ë Ù¯ÓÈ΋ ·˘Ù‹ Â›Ó·È È‰È·›ÙÂÚ· ÂÈıÂÙÈ΋ ÛÙÔ˘˜ÔÏ˘ÌÂÚ›˜ ¿ÍÔÓ˜ ηٷÛÙÚ¤ÊÔÓÙ·˜ ÙËÓ ‰ÔÌ‹ ÙÔ˘˜.¶ÈÔ ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· ¤Ù˘¯·Ó ÔÈ RadocicÎ·È Û˘Ó Ì ÙÔ Û‡ÛÙËÌ· Rocatec, ÙÔ ÔÔ›Ô ÚԂϤÂÈ ÙËÓÂÎÙfiÍ¢ÛË ÊˆÛÊÔÚÈÎÒÓ ÚÈ˙ÒÓ Â› Ù˘ ÚÔÛ‚·ÏÏfiÌÂÓ˘ÂÈÊ¿ÓÂÈ·˜ (EÈÎ. 10). ŒÙÛÈ Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ Û˘ÛÙ‹-Ì·ÙÔ˜ ̤ۈ Ù˘ ÂÎÙfiÍ¢Û˘ ˘ÏÈÎÔ‡ ÏÔ‡ÛÈÔ˘ Û Si- Â-ÓÒÛÂȘ ÂÈÙ˘Á¯¿ÓÂÙ·È Ë Ì˯·ÓÈ΋ ·ÔÌ¿ÎÚ˘ÓÛË Ù˘ ÂÈ-Ê·ÓÂȷ΋˜ ÛÙÔÈ‚¿‰·˜ ÂÔÍÈ΋˜ ÚËÙ›Ó˘ Î·È ¤ÎıÂÛË ÙˆÓÈÓÒÓ ¯·Ï·˙›· ÛÙËÓ Â·ÎfiÏÔ˘ıË ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÛÈÏ·Ó›-Ô˘.86 ™ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· Ë ÂÊ·ÚÌÔÁ‹ ·˘ÙÒÓ ÙˆÓ Û˘-ÛÙËÌ¿ÙˆÓ ‰Ú· ηٷÛÙÚÔÊÈο ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ¿ÍÔÓ·ÂÍ·ÈÙ›·˜ Ù˘ ηı‹ÏˆÛ˘ ÙˆÓ ·ÔÙÚÈÙÈÎÒÓ ÎfiÎΈÓ.

ñ EÓ·ÏÏ·ÎÙÈΤ˜ Ù¯ÓÈΤ˜: M ÛÙfi¯Ô ÙËÓ Î·Ï‡ÙÂÚË ‰˘-Ó·Ù‹ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ÂÓÈÛ¯˘Ì¤ÓˆÓ Ì ›Ó˜ ÔÏ˘ÌÂ-ÚÒÓ ˘ÏÈÎÒÓ ÚÔÙ›ÓÔÓÙ·È ‰È¿ÊÔÚ˜ Ù¯ÓÈΤ˜ ηÙÂÚÁ·-Û›·˜ Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘˜. ŒÙÛÈ ¤¯Ô˘Ó ·ÍÈÔÏÔÁËı›‰È¿ÊÔÚ˜ ÂÚÁ·ÛÙËÚȷΤ˜ Î·È ‚ÈÔÌ˯·ÓÈΤ˜ Ù¯ÓÈΤ˜.Ÿˆ˜ ÚԷӷʤÚıËÎÂ Ë ·‰˘Ó·Ì›· ÈηÓÔÔÈËÙÈÎÔ‡‰ÂÛÌÔ‡ ÌÂٷ͇ ·ÍfiÓˆÓ ˘·ÏÔÓËÌ¿ÙˆÓ Î·È ÔÏ˘ÌÂÚÒÓ˘ÏÈÎÒÓ ÔÊ›ÏÂÙ·È ÛÙËÓ ·Ô˘Û›· ̄ ËÌÈ΋˜ ·ÏÏËÏ›‰Ú·-Û˘ ÌÂٷ͇ ÙˆÓ ÌÂı·ÎÚ˘ÏÈÎÒÓ ÔÌ¿‰ˆÓ ÙˆÓ Û˘Óı¤ÙˆÓÚËÙÈÓÒÓ Î·È Ù˘ ÂÔÍÈ΋˜ ÚËÙÈÓÒ‰Ô˘˜ Ì‹ÙÚ·˜. M ‰È¿-ÊÔÚ˜ ÂÈÊ·ÓÂȷΤ˜ ÙÚÔÔÔÈ‹ÛÂȘ ÂÈÙÚ¤ÂÙ·È Ë ·Ï-Ï·Á‹ Î·È ‚ÂÏÙ›ˆÛË ÙˆÓ È‰ÈÔÙ‹ÙˆÓ Ù˘ ‰ÈÂÈÊ¿ÓÂÈ·˜ ·-Ó¿ÌÂÛ· ÛÙË ÚËÙÈÓÒ‰Ë Ì‹ÙÚ· Î·È ÙȘ ›Ó˜.¢È·ÊÔÚÂÙÈο ‰È·Ï‡Ì·Ù· Î·È ‰È·Ï‡Ù˜ Ê·›ÓÂÙ·È Ó·‰ÚÔ˘Ó ·ÔÙÂÏÂÛÌ·ÙÈο ÛÙËÓ ÂÔÍÈ΋ Ì‹ÙÚ·. H ÚÔ-·Ú·Û΢‹ Ù˘ ÂÈÊ¿ÓÂÈ·˜ Ù˘ ÚËÙÈÓÒ‰Ô˘˜ Ê¿ÛË˜ÙˆÓ ·ÍfiÓˆÓ ˘·ÏÔÓËÌ¿ÙˆÓ Ê·›ÓÂÙ·È Ó· ÚÔ¿ÁÂÈ ÙËÓÛ˘ÁÎfiÏÏËÛË Ì ÌÂı·ÎÚ˘ÏÈο ÔÏ˘ÌÂÚ‹. YÈÔıÂÙÒÓÙ·˜ÛÙÔȯ›· ‚ÈÔÌ˯·ÓÈÎÒÓ ÂÊ·ÚÌÔÁÒÓ, ·ÎÔÏÔ˘ı‹ıËΠÂ-Ê·ÚÌÔÁ‹ ÙÚÈÒÓ ¯ËÌÈÎÒÓ ‰È·Ï˘Ì¿ÙˆÓ (‰ÈfiÁΈÛË, ·-‰ÚÔÔ›ËÛË Î·È ·‰Ú·ÓÔÔ›ËÛË) Û ‰È·Ê·Ó›˜ ¿ÍÔӘ̠ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù·. ™Â ·˘Ù‹ ÙËÓ ÊÈÏÔÛÔ-Ê›· ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ˘ÂÚÔÍ›‰ÈÔ ÙÔ˘ ˘‰ÚÔÁfiÓÔ˘Î·È ÙÔ ·ÈıÔÍ›‰ÈÔ ÙÔ˘ Ó·ÙÚ›Ô˘ Ù· ÔÔ›· ¤¯Ô˘Ó ÙËÓ Èη-ÓfiÙËÙ· Ó· ‰È·Ï‡Ô˘Ó ÌÂÚÈÎÒ˜ ÙËÓ ÚËÙÈÓÒ‰Ë Ì‹ÙÚ·Û¿˙ÔÓÙ·˜ ÙÔ˘˜ ‰ÂÛÌÔ‡˜ ÂÔÍÈ΋˜ ÚËÙ›Ó˘ ̤ۈ Â-Ófi˜ Ì˯·ÓÈÛÌÔ‡ ÔÍ›‰ˆÛ˘ ÙÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜87.™ÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ÙÔ H2O2 10% ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ·ÙËÓ ÂÌ‚¿ÙÈÛË ÙÔ˘ ¿ÍÔÓ· ˘·ÏÔÓËÌ¿ÙˆÓ Û ˘‰·ÙÈÎfi‰È¿Ï˘Ì· ÁÈ· 10-20 ÂÈÙÚ¤ÔÓÙ·˜ ¤ÙÛÈ ÙÚÔÔÔ›ËÛËÙ˘ ÌÔÚÊÔÏÔÁ›·˜ ÙË ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘ ¿ÍÔÓ·. AÊ·ÈÚÒ-ÓÙ·˜ ÙËÓ ÂÈÊ·ÓÂȷ΋ ÛÙÔÈ‚¿‰· ÂÔÍÈ΋˜ ÚËÙ›Ó˘ ·-ÔηχÙÔÓÙ·È ›Ó˜ ÈηӤ˜ ÁÈ· Û˘ÁÎfiÏÏËÛË88. EÓ·ÏÏ·-ÎÙÈο ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› Î·È ÙÔ ¯ÏˆÚÈÔ‡¯Ô ÌÂ-ı‡ÏÈÔ. H ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÁÈ· 5 ÛÙËÓ ÂÔÍÈ΋ ÚËÙ›ÓË ÙˆÓ·ÍfiÓˆÓ ˘·ÏÔÓËÌ¿ÙˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· Ó· ‚ÂÏ-ÙÈÒÛÂÈ ÙËÓ ·ÓÙÔ¯‹ ÙÔ˘ ‰ÂÛÌÔ‡ ¿ÍÔÓ· Î·È Û‡ÓıÂÙ˘ ÚË-Ù›Ó˘ Ì ·ÓÙÈÊ·ÙÈο ·ÔÙÂϤÛÌ·Ù·88, 89.M ‚¿ÛË fiÛ· ·Ó·Ê¤ÚıËÎ·Ó Á›ÓÂÙ·È Û·Ê¤˜ fiÙÈ Ë Û˘-ÁÎfiÏÏËÛË ÙˆÓ ÔÏ˘ÌÂÚÒÓ ·ÍfiÓˆÓ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ ·ÔÙÂÏ› ÌÈ· ȉȷ›ÙÂÚ· ¢·›ÛıËÙËÎ·È ÔχÏÔÎË ‰È·‰Èηۛ· ·ÊÔ‡ ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈı-Ìfi˜ Â͈ÙÂÚÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÂÌϤÎÔÓÙ·È Û ·˘Ù‹Ó.EÈϤÔÓ Ë ÔÈÎÈÏ›· ÙˆÓ Û˘ÁÎÔÏÏËÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓÔ˘ ‰È·Ù›ıÂÓÙ·È ÁÈ· ÙËÓ Û˘ÁÎfiÏÏËÛË ÛÙÔ ÚÈ˙ÈÎfi ۈϋ-Ó· οÓÂÈ ÙËÓ fiÏË ‰È·‰Èηۛ· ÂÚÈÛÛfiÙÂÚÔ ÂÚ›ÏÔÎËÎ·È ··ÈÙËÙÈ΋90. E›Ó·È ηٷÓÔËÙfi fiÙÈ Ô ÎÏÈÓÈÎfi˜ Ô‰Ô-ÓÙ›·ÙÚÔ˜ ı· Ú¤ÂÈ Ó· Â›Ó·È È‰È·›ÙÂÚ· ÚÔÛÂÎÙÈÎfi˜ ÛÂfiÙÈ ·ÊÔÚ¿ ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ηٿÏÏËÏÔ˘ Û˘ÁÎÔÏÏËÙÈ-ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÚËÙÈÓÒ‰Ô˘˜ ÎÔÓ›·˜. H ÁˆÌÂÙÚ›·ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ Î·È ÔÈ ÂÚÁÔÓÔÌÈΤ˜ ‰˘ÛÎÔϛ˜ Ô˘·˘Ùfi Û˘Ó¿ÁÂÙ·È, ··ÈÙ› ÙËÓ Ï‹ÚË Û˘ÌÌfiÚʈÛËÌ ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹ Û fiÙÈ ·ÊÔÚ¿ ÙË Ûˆ-ÛÙ‹ ¯ÚËÛÈÌÔÔ›ËÛË ÙˆÓ ÚËÙÈÓˆ‰ÒÓ ÎÔÓÈÒÓ. M ·˘ÙfiÙÔÓ ÙÚfiÔ ÂÍ·ÛÊ·Ï›˙ÔÓÙ·È ÔÈ ··Ú·›ÙËÙ˜ ÚÔ˘Ôı¤-ÛÂȘ ÁÈ· ÙËÓ ‰ËÌÈÔ˘ÚÁ›· ÚԂϤ„ÈÌˆÓ ·ÔηٷÛÙ¿ÛÂ-ˆÓ Ì ˘„ËÏ¿ ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘.EÈÎ. 10: ™˘Û΢‹ ·ÌÌÔ‚ÔÏ‹˜ Rocatec

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Hellenic Stomatological Review 59: 71-82, 2015

BIB§IO°PAºIA/REFERENCES

1. Ja Schwartz R.S., Robbins J.W.: Post placement and restorationof endodontically treated teeth: a literature review. J Endod2004; 30: 289-301

2. Teixeira E.C.N., Teixeira F.B., Piasick J.R., Thompson J.Y.: Anin vitro assessment of prefabricated post systems JADA 2006;137: 1006-1012

3. Monticelli F., Grandini S., Goracci C., Ferrarri M.: Clinical be-havior of translucent fiber posts: a 2- year prospective study.Int J Prosthodont 2003; 16: 593-596

4. Lassila L.V., Tanner J., Le Bell A.M., Narva K., Valitu P.K.: Flexuralproperties of fiber reinforced root canal posts. Dent Mater2004; 20: 29-36

5. Galhano G.A., Valandro L.F., de Melo R.M., Scotti R., Bottino M.A.:Evaluation of the flexural strength of carbon fiber-, quartz fiber-and glass fiber- based posts. J Endod 2005; 31:209-211

6. Ferrari M., Vichi A., Garcia-Godoy F.: Clinical evaluation of fiberreinforced epoxy resin posts and cast post and cores. Am JDent 2000; 13: 8B- 15B

7. Stockton L.W.: Factors affecting retention of post systems: aliterature review. J Prosthet Dent 1999; 81: 380-385

8. Tjan A.H., Whang S.B.: Resistance to tooth fracture of dowelchannels with various thicknesses of buccal dentine walls. JProsthet Dent 1985; 53: 496-500

9. Morgano S.M.: Restoration of pulpless teeth: application oftraditional principles in present and future contexts. J ProstheDent 1996; 75: 375-380

10. Nergiz I., Schmage P., Platzer U., McMullan-Vogel C.G.: Effectof different surface textures on retentive strength of taperedposts. J Prosthet Dent 1997; 78: 451-457

11. Mendoza D.B., Eakle W.S., Kahl E.A., Ho R.: Root reinforcementwith a resin bonded preformed post. J Prosthet Dent 1997;78: 10-14

12. Latta M.A., Barkmeier W.W.: Bond strength of a resin cementto a cured composite inlay material. J Prosthet Dent 1994; 72:189-193

13. Kupiec K.A., Barkmeier W.W.: Laboratory evaluation of surfacetreatments for composite repair. Oper Dent 1996; 21:59-62

14. Brosh T., Pilo R., Bichacho N., Blutstein R.: Effect of combi-nations of surface treatments and bonding agents on the bondstrength of repaired composites. J Prosthet Dent 1997; 77:122-126

15. Mentink A.G.B., Creugers N.H., Meeuwissen R., Leempoel P.J.,Kayser A.E.: Clinical performance of different post and core sy-stems: results of a pilot study. J oral Rehabil 1993; 20: 577-584

16. Ferrari M., Vichi A., Garcia-Godoy F.: Clinical evaluation of fiberreinforced epoxy resin posts and cast post and cores. Am JDent 2000; 13( Spec no): 15B- 18B

17. Goracci C., Raffaelli O., Monticelli F., Balleri B., Bertelli E.,Ferrari M.: The adhesion between prefabricated FRC postsand composite resin cores: microtensile bond strength withand without post silanization. Dent Mater 2005; 21: 437-444

18. Ferrari M., Vichi A., Mannocci F., Mason P.N.: Retrospectivestudy of the clinical performance of fiber posts. Am J Dent2000; 13(spec no):9B- 13B

19. Van Meerbeek B., Van Landuyt K., De Munk J., Inoue S., YoshibaY., Perdigao J., Lambrechts P., Peumans M.: Fundamentalsof operative dentistry ed.Quintessense Books 2006:183-260

20. Van Meerbeek B., De Munk J., Yoshiba Y., Inoue S., Vargas M.,Vijay P., Lambrechts P., Van Landuyt K., Lambrechts P., Van-herle G.: Buonocore memorial lecture. Adhesion to enamel anddentine: current status and future challenges. Oper Dent 2003;28:215-235

21. Buonocore M.G.: A simple method of increasing the adhesionof acrylic filling materials to enamel surface. J Dent Res 1955;34:849

22. Bowen R.L.: Adhesive bonding of various materials to hardtooth tissues. 3. Bonding to dentine improved by pre- treatmentand the use of surface active comonomer. J Dent Res 1965;44; 903-905

23. Baier R.E.: Principles of adhesion. Oper Dent Supl 1992;5:124. Schwarta R.S. Adhesive dentistry and endodontics part 2:

bonding in the root canal system the promise and theproblems: A review. J Endod 2006; 32: 1125-1134

25. Prabhu S.G., Rhaim N., Bhat K.S., Mathew J.: Comparison ofremoval of endodontic smear layer using NaOCl, EDTA, anddifferent concentrations of maleic acid- a SEM study.Endodontology 2003; 15:20-25

26. Ishioka S., Caputo A.A.: Interaction between the dentinal smearlayer and composite bond strengths. J Prosthet Dent 1989; 61:480-185

27. Tao L., Pashley D.H.: Shear bond strengths to dentin: effectsof surface treatments depth and position. Dent Mater 1988;4: 371-378

28. Goracci C., Sadek F.T., Fabianelli A., Tay F.R., Ferrari M.: Eva-luation of the adhesion of fiber posts to intaradicular dentin.Oper Dent 2005; 30: 627-635

29. Serafino C., Gallina G.,M Cumbo E., Ferrari M.: Surface debrisof canal walls after post space preparation in endodonticallytreated teeth: a scanning electron microscopic study. Oral SurgOral Med Oral Pathol Oral Radiol Endod 2004; 97: 381-387

30. Standlee J.P., Caputo A.A.: Endodontic dowel retention withresinous cements. J Prosthet Dent 1992; 68: 913-917

31. Saleh A.A., Ettman W.M.: Effect of endodontic irrigation solutionson microhardness of root canal dentine. J Dent 1999; 27: 43-46

32. Ari H., Yasar E., Belli S., Pashley D.H.: Effect of solvents onbonding to root canal dentin. J Endod 2003; 29: 248-251

33. Ozturk B., Ozer F: Effect of NaOCl on bond strengths of bondingagents to pulp chamber lateral walls. J Endod 2004; 30: 362-365

34. Morris M.D., Lee K.W., Agee K.A., Bouillaguet S., Pashley D.H.:Effects of sodium hydrochlorite and RC-prep on bond strengthsof resin cement to endodontic surface. J Endod 2001; 27:753-757

35. Ari H., Erdemir A., Belli S.: Evaluation of the effect of endodonticirrigation solutions on the microhardness and the roughnessof root canal dentin. J Endod 2004; 30: 792-795

36. Lambrianidis T., Margelos J., Beltes P.: Removal efficiencyof calcium hydroxide dressing of the root canal. J Endod 1999;25:85-88

37. Kim S.K., Kim Y.O.: Influence of calcium hydroxide intracanalmedication on apical seal. Int Endod J 2002; 35: 623-628

38. Erdemir A., Eldeniz A.U., Belli S., Pashley D.H.: Effect of solventson bonding of root canal dentin. J Endod 2004; 30:589-592

39. Kaufman D., Mor C., Stabholz A., Rotstein I.: Effect of gutta-percha solvents on calcium and phosphorus levels on humancut denti. J Endod 1997; 23: 614-615

40. Kielbassa A.M., Attin T., Hellwig E.: Diffusion behavior of eugenolfrom zinc oxide- eugenol mixtures through human and bovinedentin in vitro. Oper Dent 1997; 22: 15-20

41. Fujisawa S., Kadoma Y.: Action of eugenol as a retarded againstpolymerization of methyl methacrylate by benzoyl peroxide.Biomaterials 1997; 18: 701-703

42. Bayindir F., Akyil M.S., Bayindir Y.Z.: Effect of eugenol and noneugenol containing temporary cement on permanent cementretention and microhardness of cured composite resin. DentMater 2003; 22: 592-599

43. Pashley D.H., Carvalho R.M.: Dentine permeability and dentinadhesion. J Dent 1997; 25: 355-372

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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË

Literature Review

44. Schwartz R.S., Fransman R.: Adhesive dentistry and endodo-ntics: materials, clinical strategies and procedures for restora-tion of access cavities: a review. J Endod 2005; 31: 151-165

45. Arcani G.M., Araujo E., Baratieri L.N., Lopes G.C.: Microtensilebond strength of a nanofilled composite resin to human dentinafter nonvital tooth bleaching. J Adhes Dent 2007; 9: 333-340

46. Baratieri L.N., Ritter A.V., Monteiro S.Jr., Caldeira de AndradaM.A., Cardoso Vieira L.C.: Nonvital tooth bleaching: guidelinesfor the clinician. Quintessense Int 1995; 26: 597-608

47. Nikaido T., Takano Y., Sasafuchi Y., Burrow M.F., Tagami J.: Bondstrengths to endodontically treated teeth. Am J Dent 1999;12: 177-180

48. Pecora J.D., Cruzfilho A.M., Sousaneto M.D., Silva R.G.: In vitroaction of various bleaching agents on the microhardness ofhuman dentin. Braz Dent J 1994; 5: 129-134

49. Tay F.R., Loushine R.J., Lambrechts P., Wellar R.N., PashleyD.H.: Geometric factors affecting dentin bonding in root canals:a theoretical modeling approach. J Endod 2006; 31: 584-588

50. Feilzer A.J., Dauvillier B.S.: Effect of TEGDMA/ BisGMA ratio onstress development and viscoelastic properties of experimentaltwo paste composites. J Dent Res 2003; 15: 824-828

51. Braga R.R., Boaro L.C., Kuroe T., Azevedo C.L., Singer J.M.: In-fluence of cavity dimensions and their derivatives (volume andC factor) on shrinkage stress development and microleakageof composite restorations. Dent Mater 2006; 22: 818-822

52. Buillaguet S., Troesch S., Wataha J.C., Krejci I., Meyer J.M.,Pashley D.H.: Microtensile bond strength between adhesivecements and root canal dentin. Dent Mater 2003; 19: 199-205

53. Pirani C., Chersoni S., Foschi F., Piana G., Loushine R.J.,Tay F.R., Prati C.: Does hybridization of intraradicular dentinreally improve fiber post retention in endodontically treatedteeth. J Endod 2005; 31: 891-894

54. Bonfante E.A., Pegoraro L.F., de Goes M.F., Carvalho R.M.:SEM observation of the bond integrity of fiber- reinforcedcomposite posts cemented into root canals. Dent Mater 2008;24(4): 483-491

55. Buillaguet S., Shaw L., Barthelemy J., Krejci I., Wataha J.C.:Longterm sealing ability of pulp canal sealer, AHplus, Gutta-Flow and Epiphany. Int Endod J 2008; 41: 219-226

56. Jongsma L.A., Bolhuis P.B., Pallav P., Kleverlaan C.J., FeilzerA.J.: Benefits of two step cementation procedure for prefa-bricated fiber posts. IADR- CED and Israel Division AnnualMeeting, Thessaloniki, Greece, Sept 2007, abstract #0424

57. Parcianni P.F., Vano M., Goracci C., Grandini S., Ferrari M.:Fracture resistance of multiple combinations of new endodonticfiber posts. Am J Dent 2008; 21: 373-376

58. Pashley D.H., Tay F.R., Carvalho R.M., Rueggeberg F.A., AgeeK.A., Carrilho M., Donnelly A., Garcia-Godoy F.: From dry bon-ding to water wet bonding to ethanol wet bonding: a review ofthe interactions between resin matrix and solvated resins usinga macromodel of the hybrid layer. Am J Dent 2007; 20: 7-20

59. Tay F.R., Pashley D.H., Kapur R.R., Carrilho M.R., Hur Y.B.,Garrett L.V. Tay K.C.: Bonding Bis-GMA to dentin a proof ofconcept for hydrophobic dentin bonding. J Dent Res 2007;86: 1034-1039

60. Hashimoto M., Ohno H., Sano H., Kaga M., Oguchi H.: In vitrodegradation of resin dentin bonds analysed by microtensilebond strength, scanning and transmission electron microscopy.Biomaterials 2003; 24: 3795-3803

61. Sorsa T., Tjaderhane I., Salo T.: Matrix metalloproteinases(MMPs) in oral diseases. Oral Disease 2004; 10: 311-318

62. Bolf L.L., Grossi M.L., Prates L.H., Burnett L.H.Jr., SHINKAIR.S.: Effect of the activation mode of post adhesive cementationon push- out bond strength to root canal dentin. QuintessenseInt 2007; 38: 387-394

63. Bouillaguet S, Troesch S, Wataha JC, Krejci I, Meyer JM, PashleyDH.: Microtensile bond strength between adhesive cementsand root canal dentin. Dent Mater 2003;19:199205.

64. Yoldas O, Alac, am T.: Microhardness of composites in simu-lated root canals cured with light transmitting posts andglassfiber reinforced composite posts. J Endod 2005; 31: 1046.

65. Roberts HW, Leonard DL, Vandewalle KS, Cohen ME, CharltonDG.: The effect of a translucent post on resin composite depthof cure. Dent Mater 2004; 20: 617622

66. Ferrari M., Vichi A., Grandini S.: Efficacy of different adhesivetechniques on bonding to root canal walls: a SEM investigation.Dent Mater 2001; 17:422-429

67. Ferrari M., Vichi A., Garcia Godoy F.: A retrospective study offiber reinforced epoxy resin posts vs casts post and cores: a fouryear recall. Am J Dent 2000a; 13: 9B-13B

68. Ferrari M., Vichi A., Manocci F., Mason P.N.: Retrospectivestudy of clinical behaviour of several types of fiber posts.Am J Dent 2000b; 13: 14B-19B

69. Malferrari S., Monaco C., Scotti R.: Clinical evaluation of teethrestored with quartz fiber reinforced epoxy resin posts. Int JProsthod 2003;16: 39-44

70. Goracci C., Raffaelli O., Monticelli F., Balleri E. Bertelli E., FerrariM.: The adhesion between fiber posts and composite resincores: microtensile bond strength with and without postsilanization. Dent Mater 2005; 12:437-444

71. Matinlinna J.P., Ozcan M., Lassila L.V.J., Valittu P.K.: The effectof a 3 methacryloxypropyltrimethoxysilane and vinyltriisopro-poxysilane blend and tris (3 trimethoxysilylpropyl) isocyanurateon shear bond strength of composite resin to titanium metal.Dent Mater 2004; 20: 804-813

72. Della Bona A., Anusavice K.J., Shen C.: Microtensile strengthof composite to hot pressed ceramics. J Adhes Dent 2000; 2:305-313

73. Aksornmuang J., Foxton R.M., Nakajima M., Tagami J.: Micro-tensile bond strength of a dual cure resin core material to glassand quartz fibre posts. J Dent 2004; 32: 433-450

74. Aksornmuang J., Nakajima M., Foxton R.M., Tagami J.: Regionalbond strengths of a dual cure resin core material to transluscentfiber posts. Am J Dent 2006; 19: 51-55

75. Sahafi A., Peutzfeldt A., Asmussen E., Gotfredsen K.: Bondstrength of resin cement to surface treated posts of titaniumalloy, glass fiber, and zirconia and to dentin. J Adhes Dent2003; 5:153-162

76. Shen C., Oh w., Williams J.R.: Effect of post -silanization dryingon the bond strength of composite to ceramic. J Prosthet Dent2004; 91: 453-458

77. Ferrari M., Monticelli F., Goracci C., Balleri P., Cury A.H., RaffaelliO., Borracchini A.: Adhesion of a core material to dentin andfiber post. J Dent Res 2005; 84 (Spec Iss A) : Abstr # 2558

78. Foxton R.M., Pereira P.N., Masatoshi N., Tagami J., Miura H.:Long term durability of a dual cure resin cement /silicon oxideceramic bond. J Adhes Dent 2002; 4: 125-135

79. Monticelli F., Osorio R., Toledano M., Tay F.R., Goracci C.,Ferrari M.: Improving the quality of a quartz fiber post corebond using sodium ethoxide etching and combined silane/adhesive cycling. J Endod 2006; 32: 447-451

80. Sahinkesen G., Erdemir U., Oktay E.A., Sancakli H.S.: The effectof post surface silanization and luting agents on the push- outbond strengths of adhesively inserted fiber reinforced posts.Int J Adhes & Adhes 2011; 31: 265-270

81. Choi Y., Pae A., Park E.J., Wright R.F.: The effect of surfacetreatment of fiber reinforced postson adhesion of a resin basedluting agent. J Prosthet Dent 2010; 103: 362-368

82. Ozcan M., Valittu P.K.: Effect of surface conditioning methodson the bond strength of luting cements to ceramics. DentMater 2004; 19: 725-731

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83. Addison O., Fleming G.J.P.: The influence of cement lutethermocycling and surface preparation on the strength of aporcelain veneering material. Dent Mater 2004; 20:286-292

84. Vano M., Goracci C., Monticelli F., Tognini F., Gabriele M., TayF.R., Ferrari M.: The adhesion between fibre posts and com-posite resin cores: the evaluation of microtensile bond strengthfollowing various surface chemical treatments to posts. Int JEndod 2006; 39: 31-39

85. Sahafi A., Peutzfeldt A. Asmussen E., Gotfredsen K.: Retentionand failure morphology of prefabricated posts. Int J Prost-hodont 2004; 17:307-312

86. Radovic I., Monticelli F., Goracci C., Cury A.H., Coniglio I., Vu-licevic Z.R., Garcia Godoy F., Ferrari M.: The effect of sand-blasting on adhesion of a dual cured resin composite ofmethacrylic fiber posts: microtensile bond strength and SEMevaluation. J Dent 2007; 35: 496-502

87. Monticelli F., Toledano O., Osorio R., Ferrari M.: Effect oftemperature on the silane coupling agents when bonding coreresin to quartz fibre posts. Dent Mater 2006; 22: 1024-1028

88. Monticelli F., Toledano O., Tay F.R., Sadek F.T., Goracci C.,Ferrari M.: A simple etching technique for improving theretention of fiber posts to resin composites. J Endod 2006;32: 44-47

89. Elsaka S.E.: Influence of chemical surface treatments onadhesion of fiber posts to composite core materials. DentMater 2013; 29: 550-558

90. Pereira J.R., do Valle A.L., Ghizoni J.S., Ramos M.B., dos ReisSo M.V.: Push out bond strengths of different dental cementsused to cement glass fiber posts. J Prosthet Dent 2013; 110:134-140

¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:M. ºÚ·ÁÎÔ‡ÏË[email protected]

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AÍÈÔÏfiÁËÛË ÚÔÛˆÈÎÔ‡ Û ԉÔÓÙÈ·ÙÚÈΤ˜ ÌÔÓ¿‰Â˜K. BÏ·ÛÈ¿‰Ë˜*, A. M. MÔ˘˙¿**, I. T˙Ô‡Ù˙·˜***, A. ºÈÏ·Ï‹ı˘****

¶EPI§HæH

AÍÈÔÏfiÁËÛË ÚÔÛˆÈÎÔ‡ Â›Ó·È Ë ‰È·‰Èηۛ· ÂÎÙ›ÌË-Û˘ ÙˆÓ ÂÚÁ·˙ÔÌ¤ÓˆÓ Ì ÛÎÔfi Ó· ÔÚÈÛÙ› Ô ‚·ı-Ìfi˜ ÛÙÔÓ ÔÔ›Ô ·˘ÙÔ› ʤÚÓÔ˘Ó ÂȘ ¤Ú·˜ ÙË ‰Ô˘ÏÂÈ¿ÙÔ˘˜ ·Ô‰ÔÙÈο. ™ÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ‚È‚ÏÈÔÁÚ·Ê›··Ó¢ڛÛÎÔÓÙ·È ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· Ô˘ ·Ó·Ï‡Ô˘ÓÙË ÛËÌ·Û›· Ù˘ ·ÍÈÔÏfiÁËÛ˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡ ÛÙËÓ·Ô‰ÔÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Ô‰ÔÓÙÈ·ÙÚ›Ԣ. O ηıÔ-ÚÈÛÌfi˜ ÙˆÓ ÛÙfi¯ˆÓ ·fi‰ÔÛ˘ ÙˆÓ ÂÚÁ·˙Ô̤ӈÓ, ÔÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ ÙÔ˘˜ ·Ó·ÁÎÒÓ, ËÛ‡Ó‰ÂÛË Ù˘ ·ÌÔÈ‚‹˜ Ì ÙËÓ ·fi‰ÔÛ‹ ÙÔ˘˜ Î·È Ë ‚ÂÏ-Ù›ˆÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÔÛ¤Ï΢Û˘ Î·È ÂÈÏÔÁ‹˜ÙˆÓ ÂÚÁ·˙ÔÌ¤ÓˆÓ ·ÔÙÂÏÔ‡Ó ÌÂÚÈο ÌfiÓÔ ·fi Ù· ıÂ-ÙÈο ·ÔÙÂϤÛÌ·Ù· Ù˘ ‰È·‰Èηۛ·˜ ·ÍÈÔÏfiÁËÛ˘.

SUMMARY

Staff appraisal is the process of assessing employeeswith the aim of determining the extent to which theyperform their work productively. In the dental biblio-graphy there are scientific papers analyzing theimportance of staff appraisal for the effective perfor-mance of the dental practice. Setting staff performanceand development goals, determining staff trainingneeds, linking pay to performance and improving theemployee recruitment and selection process are justsome of the positive results of the appraisal process,leading to more efficient, precise and cost-effectivecommunication and professional performance mea-surement techniques.

83

Performance appraisal in dental unitsK. Vlasiadis*, A. M. Mouza**, I. Tzoutzas***, A. Philalithis****

E·ÁÁÂÏÌ·ÙÈÎfi £¤Ì·

Professional Topic

* O‰ÔÓÙ›·ÙÚÔ˜ EÈÌÂÏËÙ‹˜ A’ ¶·°NH, ¢Ú. I·ÙÚÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ KÚ‹Ù˘, MÂÙ·‰È‰·ÎÙÔÚÈÎfi˜ÂÚ¢ÓËÙ‹˜ I·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ KÚ‹Ù˘

** AÓ·ÏËÚÒÙÚÈ· K·ıËÁ‹ÙÚÈ·, TÌ‹Ì· ¢ÈÔ›ÎËÛ˘ EȯÂÈÚ‹ÛˆÓ, T¯ÓÔÏÔÁÈÎfi EÎ·È‰Â˘ÙÈÎfi ÿ‰Ú˘Ì· KÂÓÙÚÈ΋˜ M·Î‰ÔÓ›·˜

*** K·ıËÁËÙ‹˜, O‰ÔÓÙÈ·ÙÚÈ΋˜ ∂·ÁÁÂÏÌ·ÙÈ΋˜ ¶Ú·ÎÙÈ΋˜, O‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ EK¶A

**** K·ıËÁËÙ‹˜ KÔÈÓˆÓÈ΋˜ I·ÙÚÈ΋˜, TÌ‹Ì· I·ÙÚÈ΋˜, ¶·ÓÂÈÛÙ‹ÌÈÔ KÚ‹Ù˘

* DDS, PhD, Dentist Consultant, Department of Dentistry,University General Hospital of Heraklion, Greece

** Associate Professor, Department of BusinessAdministration, Technological Educational Institute of Central Macedonia, Greece

*** Professor, Dental Practice Managment,School of Dentistry NKUA

**** Professor, Department of Social Medicine, Faculty of Medicine, University of Crete, Greece

ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 59: 83-99, 2015 Hellenic Stomatological Review 59: 83-99, 2015

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84

E·ÁÁÂÏÌ·ÙÈÎfi £¤Ì·

Professional Topic

Hellenic Stomatological Review 59: 83-99, 2015

H ‰È·‰Èηۛ· Ù˘ ·ÍÈÔÏfiÁËÛ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔÓ Î·-ıÔÚÈÛÌfi ÙˆÓ ÛÙfi¯ˆÓ ·fi‰ÔÛ˘ ÙÔ˘ ÂÚÁ·˙fiÌÂÓÔ˘,ÙË Û˘Ó¤ÓÙ¢ÍË ·ÍÈÔÏfiÁËÛ˘, ÙË ‰ËÌÈÔ˘ÚÁ›· ÙÔ˘ ÂÓÙ‡-Ô˘ ·ÍÈÔÏfiÁËÛ˘ Î·È ÙÔ˘ ÂÓÙ‡Ô˘ ·˘ÙÔ·ÍÈÔÏfiÁËÛ˘ηıÒ˜ Î·È ÂȉÈΤ˜ ÌÂıfi‰Ô˘˜ ·ÍÈÔÏfiÁËÛ˘, ̄ Ú‹ÛÈ̘ÁÈ· ÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÂÓÙ‡Ô˘ ·ÍÈÔÏfiÁËÛ˘. T·Î˘ÚÈfiÙÂÚ· Ï¿ıË Ô˘ ÚÔ·ÙÔ˘Ó Î·Ù¿ ÙËÓ ·ÍÈÔÏfi-ÁËÛË Â›Ó·È Ï¿ıË ÂÈ›ÎÂÈ·˜, ·˘ÛÙËÚfiÙËÙ·˜, Ï¿ıË ÂÍ·È-Ù›·˜ ÚÔÛˆÈÎÒÓ ÚÔηٷϋ„ÂˆÓ ÙÔ˘ ·ÍÈÔÏÔÁËÙ‹Î·È Ï¿ıË Ô˘ ÔÊ›ÏÔÓÙ·È ÛÙË ‰È·ÊÔÚÂÙÈ΋ ·ÓÙ›ÏË„ËÙ˘ ¤ÓÓÔÈ·˜ ÙˆÓ fiÚˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙËÓ·ÍÈÔÏfiÁËÛË.™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ë ·ÚÔ˘Û›·ÛË Ù˘ ·ÍÈÔ-ÏfiÁËÛ˘ ÚÔÛˆÈÎÔ‡ Ô‰ÔÓÙÈ·ÙÚÈ΋˜ ÌÔÓ¿‰·˜ ̂ ˜ ÙÂ-¯ÓÈ΋ Ì ȉȷ›ÙÂÚ· ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· ÛÙÔ ÂÚÁ·-ÛÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ, ÛÙË ÔÈfiÙËÙ· ÙˆÓ ·Ú¯fiÌÂÓˆÓ˘ËÚÂÛÈÒÓ Î·È ÛÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ ÈηÓÔÔ›ËÛË ÙˆÓÂÚÁ·˙Ô̤ӈÓ.

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AÍÈÔÏfiÁËÛË ÚÔÛˆÈÎÔ‡ Â›Ó·È Ë ‰È·‰Èηۛ· ÂÎÙ›ÌËÛË˜ÙˆÓ ÂÚÁ·˙ÔÌ¤ÓˆÓ Ì ÛÎÔfi Ó· ÔÚÈÛÙ› Ô ‚·ıÌfi˜ ÛÙÔÓÔÔ›Ô ·˘ÙÔ› ʤÚÓÔ˘Ó ÂȘ ¤Ú·˜ ÙË ‰Ô˘ÏÂÈ¿ ÙÔ˘˜ ·Ô‰Ô-ÙÈο. ™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Ù˘ ‰ÈÔ›ÎËÛ˘ ÂȯÂÈÚ‹-ÛÂˆÓ ÂÌÂÚȤ¯ÔÓÙ·È ÔÏÏ¿ Û‡Á¯ÚÔÓ· ¿ÚıÚ· Û¯ÂÙÈο ÌÂÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡1-5. §ÈÁfiÙÂÚ· Û ·ÚÈıÌfi·ÏÏ¿ ÂÍ›ÛÔ˘ ÛËÌ·ÓÙÈο Â›Ó·È Ù· ¿ÚıÚ· ÛÙËÓ È·ÙÚÈ΋ ‚È-‚ÏÈÔÁÚ·Ê›·6-10. AÏÏ¿ Î·È ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·˘¿Ú¯Ô˘Ó ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ÂÈÛÙËÌfiÓˆÓ, ÂȉÈ-ÎÒÓ ÛÙË ‰ÈÔ›ÎËÛË Ô‰ÔÓÙÈ·ÙÚÈÎÒÓ ÌÔÓ¿‰ˆÓ, Ô˘ ·Ó·Ï‡Ô˘ÓÙË ÛËÌ·Û›· Ù˘ ·ÍÈÔÏfiÁËÛ˘ Î·È Ù˘ ·ӷÏËÚÔÊfiÚË-Û˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡, ÂÚÈÁÚ¿ÊÔÓÙ·˜ ÙÔÓ ÙÚfiÔ ÂÊ·Ú-ÌÔÁ‹˜ Ù˘11-15. ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ Â›Ó·È Ë ·-ÚÔ˘Û›·ÛË Ù˘ ·ÍÈÔÏfiÁËÛ˘ ÚÔÛˆÈÎÔ‡ Û ԉÔÓÙÈ·ÙÚÈ-Τ˜ ÌÔÓ¿‰Â˜ ˆ˜ ‰È·‰Èηۛ· ÂÈÎÔÈÓˆÓ›·˜ Î·È ·Ó¿Ù˘-͢.H ·ÍÈÔÏfiÁËÛË ÌÔÚ› Ó· ÂÊ·ÚÌÔÛÙ› ›ÛËÌ· ‹ ·Ó›-ÛËÌ·. H ηıÔÚÈṲ̂ÓË ÂÙ‹ÛÈ· ÂÈÛÎfiËÛË ÂÚÁ·Û›·˜ ÙˆÓÂÚÁ·˙ÔÌ¤ÓˆÓ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ¤ÓÙ˘· Î·È ÚfiÙ˘· ·ÍÈÔ-ÏfiÁËÛ˘ ·ÔÙÂÏ› ÙËÓ Â›ÛËÌË ÌÔÚÊ‹ ·ÍÈÔÏfiÁËÛ˘. ™ÙËÓ·Ó›ÛËÌ‹ Ù˘ ÌÔÚÊ‹ ·Ó‹ÎÂÈ ÙÔ Î·ıËÌÂÚÈÓfi Û¯fiÏÈÔ ÙÔ˘ÚÔ˚Ûٷ̤ÓÔ˘ fiÙ·Ó ·Ú·ÙËÚ› οÔÈÔ ıÂÙÈÎfi ‹ ·ÚÓËÙÈ-Îfi ÂÚÈÛÙ·ÙÈÎfi ηٿ ÙËÓ ÂÚÁ·Û›·. H ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔ-ÛˆÈÎÔ‡ ÌÔÚ› Ó· ̄ ÚËÛÈÌÔÔÈËı› Ì ÔÏÏÔ‡˜ ÙÚfiÔ˘˜ÒÛÙ ӷ ‚ÂÏÙÈÒÛÂÈ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Ô‰ÔÓÙÈ·ÙÚ›Ԣ ηÈÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÂÚÁ·˙Ô̤ӈÓ. OÈ Î˘ÚÈfiÙÂÚ˜ ¯Ú‹ÛÂȘÙ˘ ›ӷÈ:O ηıÔÚÈÛÌfi˜ ÙˆÓ ÛÙfi¯ˆÓ ·fi‰ÔÛ˘ Î·È ·Ó¿Ù˘Í˘ ÙˆÓÂÚÁ·˙Ô̤ӈÓ. EÚÁ·˙fiÌÂÓÔ˜ Î·È ÚÔ˚ÛÙ¿ÌÂÓÔ˜ ı¤ÙÔ˘Ó·fi ÎÔÈÓÔ‡ ÙÔ˘˜ ÛÙfi¯Ô˘˜ ¿Óˆ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ı· ‚·ÛÈ-ÛÙ› Ë ·ÍÈÔÏfiÁËÛË. H Û˘Ó¿ÓÙËÛË ·˘Ù‹ ηıÒ˜ Î·È ÂΛÓË

Staff appraisal requires a reliable system that isefficient, specific and streamlined to the particularneeds of the dental practice, and which is clear andacceptable to all, both appraisers and appraised. Thepeople handling the appraisal system must be ableto understand the basic principles of the appraisaland guide employees to make them more efficient.The appraisal is considered successful when, at itsconclusion, both parties, appraiser and appraised,believe that their mutual communication and trust hasbeen reinforced and that the employee’s performancewill improve.The appraisal process includes setting the employee’sperformance goals, the appraisal interview, drawingup the appraisal and self-appraisal forms, and specialappraisal methods that are useful for completingthe appraisal form. The main errors that arise during appraisal are errorsof leniency or strictness, errors due to the appraiser’spersonal prejudice, and errors due to differentunderstanding of the appraisal terms. The aim of thispaper is to present dental staff appraisal as a processwith particularly positive results on the workenvironment, the quality of services provided and theemployees’ job satisfaction.

Key Words: Performance appraisal, feedback, productivity

INTRODUCTION

Performance appraisal is the process of assessing em-ployees with the aim of determining the extent to which theyperform their work productively. The internationalbibliography on business management includes many up-to-date papers on performance appraisal1-5. Articles in themedical bibliography are fewer but equally significant6-10. Inthe dental bibliography, too, there are published papers bydental clinic management specialists, analyzing theimportance of performance appraisal and feedback anddescribing its implementation11-15. The aim of this paper isto present performance appraisal in dental units as acommunication and development process. The appraisalcan be performed officially or unofficially. The designated,annual, employee performance review using specificappraisal forms and standards is the official type of appraisal.The unofficial type covers the supervisor’s daily commentswhen noting a positive or a negative incident at work.Performance appraisal can be used in many ways toimprove the operation of the dental practice and staffdevelopment. Its main uses are:Setting staff performance and development goals. Em-ployee and supervisor jointly set the goals on which theappraisal will be based. This meeting, together with theone to discuss the appraisal results, gives employees

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the opportunity to discuss their long-term goals, andsupervisors the opportunity to advise employees on thesteps to take in order to attain them11, 15-17. Determining staff training needs. Determining the trainingneeds of employees is a basic parameter of appraisal,since it can give them the opportunity to cover theirknowledge and skills gaps17-20.Linking pay to performance. The application of a fair appraisalbased on objective criteria allows the company to increaseemployee performance by offering financial incentives andto reinforce their motivation and loyalty6,21-24. Staff feedback. The appraisal process must be accompa-nied by employee feedback on their performance. In thisway, employees will know if their performance meets theorganisation’s requirements and standards and whetherit presents fluctuations compared to their previousperformances15, 25, 26.Improving the employee recruitment and selection process.Improving the employee recruitment and selection processis a basic use of appraisal for every business. Monitoringwhich employees perform better and how they were hiredguides the business to select the most effective recruitmentand selection practices17.

PRECONDITIONS FOR EFFECTIVE APPRAISAL

The performance appraisal process requires an appraisalsystem that is efficient, specific and streamlined to theparticular needs of the dental practice, and which is clearand acceptable to all, both appraisers and appraised. Itmust also be reliable in order to track changes in staffperformance, and focused, to identify elements forimprovement depending on the goals set by each employerjointly with the supervisor. The appraisal system must beefficient and its administration costs must not outweighthe benefits. The people handling the appraisal systemmust be able to understand the basic principles of theappraisal, set the employers’ goals jointly with them, identifydivergences and guide those appraised to make themmore efficient8. However, the appraisers’ special skillsare not enough to make the appraisal successful. Thebusiness culture in general, managers and staff, mustpromote the belief that the appraisal is indispensable tothe efficient operation of the dental practice and thatobjective criteria based on the principle of fairness mustbe applied. There must also be a positive climate ofcontinuous learning, improvement, communication andtrust among members of the dental practice27, 28.

THE APPRAISAL PROCESS

At the beginning of the year, the supervisor, who is usuallythe owner of the dental clinic in the case of private practicesand the coordinating manager in the case of public dentalclinics, sets, together with the employees, the goals andperformances to be achieved by each member. Supervisorand employee mutually agree the goals and improvementsthe employee needs to achieve in order to improve his or

Ô˘ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ÁÈ· ÙË Û˘˙‹ÙËÛË ÙˆÓ ·ÔÙÂÏÂ-ÛÌ¿ÙˆÓ Ù˘ ·ÍÈÔÏfiÁËÛ˘ ‰›ÓÂÈ ÛÙÔÓ ÂÚÁ·˙fiÌÂÓÔ ÙËÓ Â˘-ηÈÚ›· Ó· Û˘˙ËÙ‹ÛÂÈ ÙÔ˘˜ Ì·ÎÚÔ¯ÚfiÓÈÔ˘˜ ÛÙfi¯Ô˘˜ ÙÔ˘Î·È ÛÙÔ ÚÔ˚ÛÙ¿ÌÂÓÔ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· Û˘Ì‚Ô˘Ï‡ÛÂÈ ÙÔÓÂÚÁ·˙fiÌÂÓÔ ÁÈ· Ù· ‚‹Ì·Ù· Ô˘ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ı‹ÛÂÈÒÛÙ ӷ ÂÈÙ‡¯ÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ ·˘ÙÔ‡˜11, 15-17.O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ ÙÔ˘˜ ·Ó·ÁÎÒÓ. OÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ ·Ó·ÁÎÒÓ ÙˆÓ ÂÚÁ·-˙ÔÌ¤ÓˆÓ ·ÔÙÂÏ› ‚·ÛÈ΋ ·Ú¿ÌÂÙÚÔ Ù˘ ·ÍÈÔÏfiÁËÛ˘ηıÒ˜ ÌÔÚ› Ó· ÙÔ˘˜ ‰ÒÛÂÈ ÙËÓ Â˘Î·ÈÚ›· Ó· ‰ÈÔÚıÒÛÔ˘ÓÙȘ ·Ó¿ÚÎÂȤ˜ ÙÔ˘˜ Û ÁÓÒÛÂȘ Î·È ‰ÂÍÈfiÙËÙ˜17-20.H Û‡Ó‰ÂÛË Ù˘ ·ÌÔÈ‚‹˜ Ì ÙËÓ ·fi‰ÔÛË ÙÔ˘˜. H ÂÊ·Ú-ÌÔÁ‹ ‰›Î·È˘ ·ÍÈÔÏfiÁËÛ˘ Ô˘ ‚·Û›˙ÂÙ·È Û ·ÓÙÈÎÂÈÌÂÓÈ-ο ÎÚÈÙ‹ÚÈ· ‰›ÓÂÈ ÛÙËÓ Âȯ›ÚËÛË ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ·˘-Í‹ÛÂÈ ÙËÓ ·fi‰ÔÛË ÙˆÓ ÂÚÁ·˙ÔÌ¤ÓˆÓ Ù˘ Ì ÙËÓ ·ÚÔ-¯‹ ÔÈÎÔÓÔÌÈÎÒÓ ÎÈÓ‹ÙÚˆÓ Î·È Ó· ÂÓÈÛ¯‡ÛÂÈ ÙËÓ ·Ú·Î›ÓË-ÛË Î·È ÙËÓ ·ÊÔÛ›ˆÛ‹ ÙÔ˘˜6, 21-24.H ·ӷÏËÚÔÊfiÚËÛ‹ ÙÔ˘˜. H ‰È·‰Èηۛ· Ù˘ ·ÍÈÔÏfiÁË-Û˘ Ú¤ÂÈ Ó· Û˘Óԉ‡ÂÙ·È ·fi ÙËÓ Â·Ó·ÏËÚÔÊfiÚË-ÛË ÙˆÓ ÂÚÁ·˙ÔÌ¤ÓˆÓ ÁÈ· ÙËÓ ·fi‰ÔÛ‹ ÙÔ˘˜. M ·˘Ùfi ÙÔÓÙÚfiÔ ÔÈ ÂÚÁ·˙fiÌÂÓÔÈ ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÁÓˆÚ›˙Ô˘Ó·Ó Ë ·fi‰ÔÛ‹ ÙÔ˘˜ ÈηÓÔÔÈ› ÙȘ ··ÈÙ‹ÛÂȘ Î·È Ù· Úfi-Ù˘· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Î·È ·Ó ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰È·Î˘Ì¿ÓÛÂȘÛ ۯ¤ÛË Ì ·ÚÂÏıÔÓÙÈΤ˜ ÙÔ˘˜ ·Ô‰fiÛÂȘ15, 25, 26. H ‚ÂÏÙ›ˆÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÔÛ¤Ï΢Û˘ Î·È ÂÈÏÔ-Á‹˜ ÂÚÁ·˙Ô̤ӈÓ. H ‚ÂÏÙ›ˆÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÔÛ¤Ï-΢Û˘ Î·È ÂÈÏÔÁ‹˜ ÂÚÁ·˙ÔÌ¤ÓˆÓ ·ÔÙÂÏ› ‚·ÛÈ΋ ¯Ú‹-ÛË Ù˘ ·ÍÈÔÏfiÁËÛ˘ ÁÈ· οı Âȯ›ÚËÛË. EϤÁ¯ÔÓÙ·˜ÔÈÔÈ ÂÚÁ·˙fiÌÂÓÔÈ Â›Ó·È ·Ô‰ÔÙÈÎfiÙÂÚÔÈ Î·È Ò˜ ¤ÁÈÓ ËÚfiÛÏË„‹ ÙÔ˘˜ ηÙ¢ı‡ÓÂÈ ÙËÓ Âȯ›ÚËÛË ÛÙȘ ·ÔÙÂ-ÏÂÛÌ·ÙÈÎfiÙÂÚ˜ Ú·ÎÙÈΤ˜ ÚÔÛ¤Ï΢Û˘ Î·È ÂÈÏÔÁ‹˜17.

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H ‰È·‰Èηۛ· Ù˘ ·ÍÈÔÏfiÁËÛ˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡ ··ÈÙ›¤Ó· Û‡ÛÙËÌ· ·ÍÈÔÏfiÁËÛ˘ ÙÔ ÔÔ›Ô ı· ¯·Ú·ÎÙËÚ›˙ÂÙ·È·fi ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘, ı· Â›Ó·È Û˘ÁÎÂÎÚÈ̤ÓÔÎ·È Â˘ı˘ÁÚ·ÌÌÈṲ̂ÓÔ ÛÙȘ ȉȷÈÙÂÚfiÙËÙ˜ ÙÔ˘ Ô‰ÔÓÙÈ·-ÙÚ›Ԣ, ı· Â›Ó·È Û·Ê¤˜ Î·È ·Ô‰ÂÎÙfi ·fi fiÏÔ˘˜, ·ÍÈÔ-ÏÔÁËÙ¤˜ Î·È ·ÍÈÔÏÔÁÔ‡ÌÂÓÔ˘˜. E›Û˘ ı· Â›Ó·È ·ÍÈfiÈÛÙÔ,ÒÛÙ ӷ ·ÓȯÓ‡ÂÈ ÙȘ ÌÂÙ·‚ÔϤ˜ ÛÙȘ ÂȉfiÛÂȘ ÙÔ˘ ÚÔ-ÛˆÈÎÔ‡ ·ÏÏ¿ Î·È ÂÛÙÈ·Ṳ̂ÓÔ, ÒÛÙ ӷ ÂÓÙÔ›˙ÂÈ ÛÙÔȯ›·‚ÂÏÙ›ˆÛ˘ ·Ó¿ÏÔÁ· Ì ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ô˘ ¤¯Ô˘Ó ηıÔ-ÚÈÛÙ› ·fi ÙÔÓ ÂÚÁ·˙fiÌÂÓÔ ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙÔÓ ÚÔ˚-ÛÙ¿ÌÂÓÔ ÙÔ˘. TÔ Û‡ÛÙËÌ· ·ÍÈÔÏfiÁËÛ˘ Ú¤ÂÈ Ó· ›ӷȷԉÔÙÈÎfi Î·È ÙÔ ÎfiÛÙÔ˜ ‰È·¯Â›ÚÈÛ‹˜ ÙÔ˘ Ó· ÌËÓ ˘ÂÚ-‚·›ÓÂÈ Ù· ÔʤÏË. T· ¿ÙÔÌ· Ô˘ ¯ÂÈÚ›˙ÔÓÙ·È ÙÔ Û‡ÛÙËÌ··ÍÈÔÏfiÁËÛ˘ Ú¤ÂÈ Ó· Ù· ‰È·ÎÚ›ÓÂÈ ÈηÓfiÙËÙ· ηٷÓfiË-Û˘ ÙˆÓ ‚·ÛÈÎÒÓ ·Ú¯ÒÓ Ù˘ ·ÍÈÔÏfiÁËÛ˘, ÈηÓfiÙËÙ· Ó·ı¤ÙÔ˘Ó ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙÔ˘˜ ÂÚÁ·˙fiÌÂÓÔ˘˜ ÙÔ˘˜ ÛÙfi-¯Ô˘˜ ·fi‰ÔÛ˘ ÙˆÓ ‰Â‡ÙÂÚˆÓ, Ó· ÂÓÙÔ›˙Ô˘Ó ÙȘ ·Ô-ÎÏ›ÛÂȘ Î·È Ó· ηıÔ‰ËÁÔ‡Ó ÙÔ˘˜ ·ÍÈÔÏÔÁÔ‡ÌÂÓÔ˘˜ ÒÛÙÂÓ· Á›ÓÔ˘Ó ·Ô‰ÔÙÈÎfiÙÂÚÔÈ8.¢ÂÓ ÊÙ¿ÓÔ˘Ó fï˜ ÔÈ È‰È·›ÙÂÚ˜ ÈηÓfiÙËÙ˜ ÙˆÓ ·ÍÈÔÏÔÁË-ÙÒÓ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÈÙ‡¯ÂÈ Ë ·ÍÈÔÏfiÁËÛË. A·ÈÙÂ›Ù·È ËÎÔ˘ÏÙÔ‡Ú· Ù˘ Âȯ›ÚËÛ˘ Û˘ÓÔÏÈο, ‰ÈÔ›ÎËÛË Î·È ˘ÊÈ-ÛÙ¿ÌÂÓÔÈ, Ó· ÚÔˆı› ÙËÓ ›ÛÙË fiÙÈ Ë ·ÍÈÔÏfiÁËÛË Â›Ó·È ··-Ú·›ÙËÙË ÁÈ· ÙËÓ ·Ô‰ÔÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Ô‰ÔÓÙÈ·ÙÚ›Ԣ,

Hellenic Stomatological Review 59: 83-99, 2015

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Hellenic Stomatological Review 59: 83-99, 2015

fiÙÈ Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È ·ÓÙÈÎÂÈÌÂÓÈο ÎÚÈÙ‹ÚÈ· ‚·ÛÈ-Ṳ̂ӷ ÛÙËÓ ·Ú¯‹ Ù˘ ‰ÈηÈÔÛ‡Ó˘ Î·È Ó· ̆ ¿Ú¯ÂÈ ıÂÙÈÎfi ÎÏ›-Ì· Û˘Ó¯ԇ˜ Ì¿ıËÛ˘, ‚ÂÏÙ›ˆÛ˘, ÂÈÎÔÈÓˆÓ›·˜ ·ÏÏ¿ ηÈÂÌÈÛÙÔÛ‡Ó˘ ÌÂٷ͇ ÙˆÓ ÌÂÏÒÓ ÙÔ˘ Ô‰ÔÓÙÈ·ÙÚ›Ԣ27, 28.

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™ÙËÓ ·Ú¯‹ ÙÔ˘ ¤ÙÔ˘˜ Ô ÚÔ˚ÛÙ¿ÌÂÓÔ˜, Ô˘ Û˘Ó‹ıˆ˜ ›-Ó·È Ô È‰ÈÔÎÙ‹Ù˘ ÙÔ˘ Ô‰ÔÓÙÈ·ÙÚ›Ԣ ÁÈ· ÙȘ ȉȈÙÈΤ˜ ÌÔ-Ó¿‰Â˜ Î·È Ô Û˘ÓÙÔÓÈÛÙ‹˜ ‰È¢ı˘ÓÙ‹˜ ÁÈ· Ù· ‰ËÌfiÛÈ· Ô‰Ô-ÓÙÈ·ÙÚ›·, ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙÔ˘˜ ÂÚÁ·˙fiÌÂÓÔ˘˜ ÚÔÛ-‰ÈÔÚ›˙Ô˘Ó ÙÔ˘˜ ÛÙfi¯Ô˘˜ Î·È ÙȘ ÂȉfiÛÂȘ Ô˘ Ú¤ÂÈ Ó·ÂÈÙ‡¯ÂÈ Î¿ı ̤ÏÔ˜. ¶ÚÔ˚ÛÙ¿ÌÂÓÔ˜ Î·È ÂÚÁ·˙fiÌÂÓÔ˜ Û˘Ì-ʈÓÔ‡Ó ÁÈ· ÙÔ˘˜ ÛÙfi¯Ô˘˜, ÁÈ· ÙȘ ‚ÂÏÙÈÒÛÂȘ Ô˘ Ú¤-ÂÈ Ó· ÂÈÙ‡¯ÂÈ Ô ÂÚÁ·˙fiÌÂÓÔ˜ ÒÛÙ ӷ ‰ÈÔÚıÒÛÂÈ Ù· ·‰‡-Ó·Ù· ÛËÌ›· ÙÔ˘ Î·È Ë Âȯ›ÚËÛË ‰ÂÛ̇ÂÙ·È ÁÈ· ÙËÓ ̆ Ô-ÛÙ‹ÚÈÍ‹ Ù˘ ÛÙȘ ÚÔÛ¿ıÂȘ ÙÔ˘ ÂÚÁ·˙fiÌÂÓÔ˘.™ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¤ÙÔ˘˜ ÚÔ˚ÛÙ¿ÌÂÓÔ˜ Î·È ÂÚÁ·˙fiÌÂÓÔ˜·Ú·ÎÔÏÔ˘ıÔ‡Ó ÙË ÔÚ›· ÙÔ˘ ‰Â‡ÙÂÚÔ˘ Î·È ·Ó ̆ ¿ÚÍÔ˘Ó‰˘ÛÎÔϛ˜ ̂ ˜ ÚÔ˜ ÙËÓ ÂÎÏ‹ÚˆÛË ÙˆÓ ÛÙfi¯ˆÓ, ·˘ÙÔ› ·-Ó·ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È. ™ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ̄ ÚfiÓÔ˘ Î·È ÔÈ ‰‡Ô Ï¢-Ú¤˜ ÚÔÂÙÔÈÌ¿˙ÔÓÙ·È ÁÈ· ÙË Û˘Ó¤ÓÙ¢ÍË ·ÍÈÔÏfiÁËÛ˘ ηÈÔÚÈÛÙÈÎÔÔÈÔ‡Ó ÙÔ ¤ÓÙ˘Ô ·ÍÈÔÏfiÁËÛ˘ ÙÔ ÔÔ›Ô ·Ô‰¤-¯ÔÓÙ·È Î·È ˘ÔÁÚ¿ÊÔ˘Ó Î·È ÔÈ ‰‡Ô. ¶ÂÚ›Ô˘ ÙÚÂȘ ‚‰Ô-Ì¿‰Â˜ ÚÈÓ ÙËÓ ·ÍÈÔÏfiÁËÛË Ù· ̤ÏË ÙÔ˘ Ô‰ÔÓÙÈ·ÙÚ›Ԣ Ô˘ı· ·ÍÈÔÏÔÁËıÔ‡Ó Û˘ÌÏËÚÒÓÔ˘Ó ÙÔ ¤ÓÙ˘Ô ·˘ÙÔ·ÍÈÔÏfi-ÁËÛ‹˜ ÙÔ˘˜ Î·È ÂÚÈÁÚ¿ÊÔ˘Ó ÙË ı¤ÛË ÙÔ˘˜ ÛÙÔ Ô‰ÔÓÙÈ·-ÙÚ›Ô, ÙȘ ˘Ô¯ÚÂÒÛÂȘ ÙÔ˘˜, ÙȘ ¢ı‡Ó˜ Ô˘ ·Ó·Ï·Ì‚¿-ÓÔ˘Ó, ÙȘ ‰˘ÛÎÔϛ˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Î·È ÙÔ˘˜ ÛÙfi-¯Ô˘˜ Ô˘ ı¤ÙÔ˘Ó ÁÈ· ÙËÓ ÂfiÌÂÓË ¯ÚÔÓÈ¿. AÊÔ‡ Û˘ÌÏË-ÚÒÛÔ˘Ó ÙÔ ¤ÁÁÚ·ÊÔ, ‰›ÓÔ˘Ó ·ÓÙ›ÁÚ·ÊÔ ÛÙÔÓ ÚÔ˚ÛÙ¿ÌÂÓfiÙÔ˘˜. AÓ¿ÏÔÁÔ ¤ÓÙ˘Ô Û˘ÌÏËÚÒÓÂÈ Î·È Ô ÚÔ˚ÛÙ¿ÌÂ-ÓÔ˜ ÁÈ· ÙÔÓ ÂÚÁ·˙fiÌÂÓÔ. ™ÙË Û˘Ó¤¯ÂÈ·, Ù· ‰‡Ô ·Ú·¿-Óˆ ¤ÁÁÚ·Ê· Û˘ÁÎÚ›ÓÔÓÙ·È ·Ó·ÊÔÚÈο Ì ÙȘ ·ÍÈÔÏÔÁ‹ÛÂÈ˜ÙˆÓ ·Ô‰fiÛÂˆÓ Î·È ÙȘ ·Ú·ÙËÚ‹ÛÂȘ ÙˆÓ ‰‡Ô ÌÂÚÒÓ. °È·ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ‚·ıÌÔÏfiÁËÛË ÙˆÓ ÂÚÁ·˙ÔÌ¤ÓˆÓ ·ÎÔ-ÏÔ˘ıÂ›Ù·È Ë ÂÊ·ÚÌÔÁ‹ ÂȉÈÎÒÓ ÌÂıfi‰ˆÓ Ô˘ ‚ÔËıÔ‡Ó ÙÔÓ·ÍÈÔÏÔÁËÙ‹ ÛÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÂÓÙ‡Ô˘ ·ÍÈÔÏfiÁËÛ˘.AÓ Ô ÚÔ˚ÛÙ¿ÌÂÓÔ˜ ‰È·ÈÛÙÒÛÂÈ fiÙÈ Î¿ÔÈÔ˜ ÂÚÁ·˙fiÌÂ-ÓÔ˜ ‰ÂÓ ¤¯ÂÈ ÔÏÔÎÏËڈ̤ÓË ¿Ô„Ë ÁÈ· ÙËÓ ÂÚÁ·Û›· ÙÔ˘,Ô‡Ù ÔÏÔÎÏËڈ̤ÓÔ Û¯¤‰ÈÔ Â›Ù¢Í˘ ÙˆÓ ÛÙfi¯ˆÓ ÙÔ˘ÌÔÚ› Ó· ·ÁÒÛÂÈ ÙË ‰È·‰Èηۛ· Ù˘ ·ÍÈÔÏfiÁËÛ˘ ÒÛÙÂÓ· ‚ÔËı‹ÛÂÈ ÙÔ Ì¤ÏÔ˜ ·˘Ùfi, Ó· ÙÔ Î·ıÔ‰ËÁ‹ÛÂÈ Î·È ÛÙËÛ˘Ó¤¯ÂÈ· Ó· ÚÔ¯ˆÚ‹ÛÂÈ ÛÙË Û˘Ó¤ÓÙ¢ÍË. H ‰È·‰Èηۛ·Ù˘ ·ÍÈÔÏfiÁËÛ˘ Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ì ÙÔÓ ›‰ÈÔÙÚfiÔ ÁÈ· fiÏ· Ù· ̤ÏË ÙÔ˘ Ô‰ÔÓÙÈ·ÙÚ›Ԣ Î·È Ó· ÔÏÔ-ÎÏËÚÒÓÂÙ·È ÂÓÙfi˜ 2 ‚‰ÔÌ¿‰ˆÓ ÁÈ· fiÏÔ˘˜18, 20.

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™ÎÔfi˜ Ù˘ Û˘Ó¤ÓÙ¢Í˘ ·ÍÈÔÏfiÁËÛ˘ Â›Ó·È Ë ·ÓÙ·ÏÏ·-Á‹ ÏËÚÔÊÔÚÈÒÓ ÌÂٷ͇ ÂÚÁ·˙ÔÌ¤ÓˆÓ Î·È ‰ÈÔ›ÎËÛ˘. OÂÚÁ·˙fiÌÂÓÔ˜ ·Ú·ı¤ÙÂÈ Ù· ÚÔ‚Ï‹Ì·Ù· Ô˘ ·ÓÙÈÌÂÙÒ-ÈÛ ÛÙËÓ ÂÚÁ·Û›· ÙÔ˘ ÙÔ ¤ÙÔ˜ Ô˘ ¤Ú·ÛÂ Î·È ÛÙË Û˘-Ó¤¯ÂÈ· ÚÔÁÚ·ÌÌ·Ù›˙ÔÓÙ·È ÔÈ ÛÙfi¯ÔÈ ÁÈ· ÙÔ ÂfiÌÂÓÔ ¤ÙÔ˜.M ÙË ‰È·‰Èηۛ· ·˘Ù‹ ÔÈ ÂÚÁ·˙fiÌÂÓÔÈ ÂÓËÌÂÚÒÓÔÓÙ·È ÛÂÔÈÔ Â›Â‰Ô ‚Ú›ÛÎÔÓÙ·È, ÔȘ Â›Ó·È ÔÈ Â·ÁÁÂÏÌ·ÙÈΤ˜ÙÔ˘˜ ·‰˘Ó·Ì›Â˜ Î·È ‰Ú·ÛÙËÚÈÔÔÈÔ‡ÓÙ·È ÚÔÎÂÈ̤ÓÔ˘ Ó·

her weak points, and the business pledges to supportthe employee’s efforts. Over the course of the year,supervisor and employee monitor the latter’s progress and,if any difficulties arise in meeting the goals, these areredefined. At the end of the year, appraiser and appraisedprepare for the appraisal interview and finalize the appraisalform, which they both sign. About three weeks prior toappraisal, the dental practice staff to be appraised completea self-appraisal form describing their position in the dentalpractice, their duties, their responsibilities, the difficultiesthey face and their goals for the following year. They signthe form, giving a copy to their supervisor and keeping onefor themselves. The supervisor completes the correspon-ding form on the employee and then compares the twoforms prior to the appraisal interview. Special appraisalmethods, both qualitative and quantitative, will assist theappraiser in completing the form. If the supervisor notesthat an employee does not have a rounded view of his workor a comprehensive plan to attain his goals, the supervisormay freeze the appraisal process in order to assist theemployee, guide him and then move on to the appraisal.The appraisal procedure should be implemented in thesame way for all members of the practice and be completedwithin two weeks for everyone18, 20.

APPRAISAL INTERVIEW

The aim of the appraisal interview is the exchange ofinformation between employees and management. Theemployee states the problems he or she has faced overthe previous year, and then the next year’s goals are set.Through this process, employees learn what level they areat and what their professional weaknesses are, and aremotivated to improve their performance. The aims of theinterview also include tightening supervisor-staff relation-ships and rewarding the best-performing employees. Inthe first phase of the interview, appraiser and employeeagree on the aim of the interview and confirm that theyhave prepared for the process. In the next phase, theemployee describes to the supervisor the problems he hasfaced in his work over the previous year, how he plans toovercome them and what his goals are for the next year.In the third phase, the supervisor presents his own viewson what he has heard, states whether he agrees ordisagrees with anything, and justifies his thoughts. In thefinal phase, having mutually solved any disagreements,both parties record the outcomes of the meeting and theagreed goals for the following year, arrange the time andcontent of the next meeting, and conclude the interview20,

29, 30. Of course, the interview does not always have sucha happy outcome. Disagreements between appraiser andemployee regarding the cause of low performance, anddefensiveness by both parties, are common problemsduring the appraisal interview31. In order for the appraiser to reduce the chances of unplea-sant situations arising, he should take some preventativemeasures:

– before the start of the interview, he should ask the

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·˘Í‹ÛÔ˘Ó ÙȘ ÂȉfiÛÂȘ ÙÔ˘˜. ™ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ Û˘Ó¤-ÓÙ¢Í˘ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë Û‡ÛÊÈÍË ÙˆÓ Û¯¤ÛÂ-ˆÓ ÚÔ˚ÛÙ·Ì¤ÓˆÓ - ˘ÊÈÛÙ·Ì¤ÓˆÓ Î·ıÒ˜ Î·È Ë ÂÈ‚Ú¿-‚¢ÛË ÙˆÓ ·Ô‰ÔÙÈÎfiÙÂÚˆÓ ÂÚÁ·˙fiÌÂÓˆÓ. ™ÙËÓ ÚÒÙËÊ¿ÛË Ù˘ Û˘Ó¤ÓÙ¢Í˘, ·ÍÈÔÏÔÁËÙ‹˜ Î·È ·ÍÈÔÏÔÁÔ‡ÌÂÓÔ˜·Ó·ÁÓˆÚ›˙Ô˘Ó ÙÔ ÛÎÔfi Î·È ÙÔÓ ÛÙfi¯Ô Ù˘ Û˘Ó¤ÓÙ¢ÍË˜Î·È ÂȂ‚·ÈÒÓÔ˘Ó fiÙÈ ¤¯Ô˘Ó ÚÔÂÙÔÈÌ·ÛÙ› ÁÈ· ÙË ‰È·‰È-ηۛ·. ™ÙËÓ ÂfiÌÂÓË Ê¿ÛË Ô ÂÚÁ·˙fiÌÂÓÔ˜ ÂÚÈÁÚ¿ÊÂÈÛÙÔÓ ÚÔ˚ÛÙ¿ÌÂÓÔ ÔȘ ‰˘ÛÎÔϛ˜ Û˘Ó¿ÓÙËÛ ÛÙËÓ ÂÚ-Á·Û›· ÙÔ˘ ÙÔ ¤ÙÔ˜ Ô˘ ¤Ú·ÛÂ, Ò˜ ÛΤÊÙÂÙ·È Ó· ÙȘ ·ÓÙÈ-ÌÂÙˆ›ÛÂÈ Î·È ÔÈÔÈ Â›Ó·È ÔÈ ÛÙfi¯ÔÈ ÙÔ˘ ÁÈ· ÙÔ ÂfiÌÂÓÔ¤ÙÔ˜. ™ÙË ÙÚ›ÙË Ê¿ÛË Ô ÚÔ˚ÛÙ¿ÌÂÓÔ˜ ÂÎı¤ÙÂÈ ÙȘ ‰ÈΤ˜ÙÔ˘ ·fi„ÂȘ Û¯ÂÙÈο Ì ٷ fiÛ· ¿ÎÔ˘ÛÂ, ·Ó Û˘ÌʈÓ› ‹‰È·ÊˆÓ› Û οÔÈ· ·fi ·˘Ù¿ Î·È ÙÂÎÌËÚÈÒÓÂÈ ÙȘ ÛΤ„ÂȘÙÔ˘. ™ÙË ÙÂÏÂ˘Ù·›· Ê¿ÛË, ·ÊÔ‡ Û˘ÌʈӋÛÔ˘Ó ÁÈ· ÙËÓ Â›-Ï˘ÛË ÙˆÓ ‰È·ÊˆÓÈÒÓ Ô˘ ÚԤ΢„·Ó, ηٷÁÚ¿ÊÔ˘Ó Ù··ÔÙÂϤÛÌ·Ù· Ù˘ Û˘Ó¿ÓÙËÛ˘, ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ô˘ ‰Â-Û̇ÔÓÙ·È Ó· ÂÈÙ‡¯Ô˘Ó ÁÈ· ÙÔ ÂfiÌÂÓÔ ¤ÙÔ˜, ÔÚ›˙Ô˘ÓÙÔ ¯ÚfiÓÔ Î·È ÙÔ ÂÚȯfiÌÂÓÔ Ù˘ ÂfiÌÂÓ˘ Û˘Ó¿ÓÙËÛË˜Î·È ÔÏÔÎÏËÚÒÓÔ˘Ó ÙË Û˘Ó¤ÓÙ¢ÍË20, 29, 30. º˘ÛÈο Ë Û˘Ó¤-ÓÙ¢ÍË ‰ÂÓ ¤¯ÂÈ ¿ÓÙ· ÙfiÛÔ ·›ÛÈÔ Ù¤ÏÔ˜. H ‰È·ÊˆÓ›· ·Ó¿-ÌÂÛ· Û ·ÍÈÔÏÔÁËÙ‹ Î·È ·ÍÈÔÏÔÁÔ‡ÌÂÓÔ, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ·ÈÙ›· Ù˘ ¯·ÌËÏ‹˜ ·fi‰ÔÛ˘ Î·È Ë ·Ì˘ÓÙÈ΋ ÛÙ¿ÛË Î·ÈÙˆÓ ‰‡Ô ·ÔÙÂÏÔ‡Ó Û˘Ó‹ıË ÚÔ‚Ï‹Ì·Ù· ηٿ ÙË Û˘Ó¤-ÓÙ¢ÍË ·ÍÈÔÏfiÁËÛ˘31. ¶ÚÔÎÂÈ̤ÓÔ˘ Ô ·ÍÈÔÏÔÁËÙ‹˜ Ó· ÂÈ-Ù‡¯ÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ Û˘Ó¤ÓÙ¢Í˘ ı· Ú¤ÂÈ Ó· Ï¿-‚ÂÈ Î¿ÔÈ· ̤ÙÚ·:

– ÚÈÓ ÍÂÎÈÓ‹ÛÂÈ Ë Û˘Ó¤ÓÙ¢ÍË ı· ˙ËÙ‹ÛÂÈ ·fi ÙË ÁÚ·Ì-Ì·Ù¤· ÙÔ˘ Ó· ÌË ÙÔ˘˜ ÂÓԯϋÛÂÈ Î·Ó›˜ Î·È ı· Ú˘ıÌ›-ÛÂÈ ÙÔ ÙËϤʈÓfi ÙÔ˘ Û ·ıfiÚ˘‚Ë ÏÂÈÙÔ˘ÚÁ›·

– Ë fiÚÙ· ÙÔ˘ ‰ˆÌ·Ù›Ô˘ Â›Ó·È Î·Ïfi Ó· ·Ú·Ì›ÓÂÈ ÌÈÛ¿ÓÔÈ-¯ÙË Î·È Û ÎÔÈÓ‹ ı¤·, ·ÚΛ Ó· ÌËÓ ÂÈÛ¤Ú¯ÂÙ·È ıfiÚ˘‚Ô˜

– Ë Ë¯ÔÁÚ¿ÊËÛË Ù˘ Û˘Ó¤ÓÙ¢Í˘ ÌÔÚ› Ó· Ú·ÁÌ·-ÙÔÔÈËı› ·ÚΛ Ó· Û˘Ó·ÈÓ¤ÛÂÈ Û ·˘Ùfi Ô ·ÍÈÔÏÔÁÔ‡-ÌÂÓÔ˜ Î·È Ó· Û˘ÌʈӋÛÂÈ Ô ÓÔÌÈÎfi˜ Û‡Ì‚Ô˘ÏÔ˜ ÙÔ˘Ô‰ÔÓÙÈ·ÙÚ›Ԣ

– Ô ·ÍÈÔÏÔÁËÙ‹˜ Ú¤ÂÈ Ó· ηψÛÔÚ›ÛÂÈ ÙÔÓ ·ÍÈÔÏÔÁÔ‡-ÌÂÓÔ, ˆ˜ ηÏfi˜ ÔÈÎÔ‰ÂÛfiÙ˘ Î·È Ó· ÂӉȷÊÂÚı› ÁÈ·ÙËÓ ¿ÓÂÙË ·Ú·ÌÔÓ‹ ÙÔ˘ ÛÙÔ ‰ˆÌ¿ÙÈÔ Û˘Ó¤ÓÙ¢Í˘31, 32

– Ú¤ÂÈ Ó· ÂȉÈÒÍÂÈ ÌÈ· ÚÒÙË ÎÔ˘‚¤ÓÙ· Ì ÙÔÓ ·ÍÈÔ-ÏÔÁÔ‡ÌÂÓÔ Û¯ÂÙÈο Ì ٷ ÂӉȷʤÚÔÓÙ¿ ÙÔ˘ Û ·Á-ÁÂÏÌ·ÙÈÎfi Â›Â‰Ô Î·È Û ·˘Ù‹ Ó· ÂÈÛËÌ¿ÓÂÈ ÙË ÛËÌ·-Û›· Ù˘ ·ÍÈÔÏfiÁËÛ˘ Î·È Ù˘ ·ӷÏËÚÔÊfiÚËÛ˘ ÛÙËÓ·ÁÁÂÏÌ·ÙÈ΋ ·Ó¿Ù˘ÍË ÙˆÓ ÂÚÁ·˙Ô̤ӈÓ25, 26, 32, 33

– ηٿ ÙËÓ Â·Ó·ÏËÚÔÊfiÚËÛË È‰È·›ÙÂÚË ÚÔÛÔ¯‹ ··È-ÙÂ›Ù·È ÚÔÎÂÈ̤ÓÔ˘ Ó· ÌËÓ ÙËÓ ÂÎÏ¿‚ÂÈ Ô ÂÚÁ·˙fiÌÂÓÔ˜ˆ˜ ÙÈ̈ڛ·, fiÙ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÍÈÔÏfiÁËÛ˘ ›-Ó·È ·ÚÓËÙÈο ÁÈ· ÙÔÓ ÂÚÁ·˙fiÌÂÓÔ. H ·ÚÓËÙÈ΋ ·ӷ-ÏËÚÔÊfiÚËÛË ÌÔÚ› Ó· ÂÎÏËÊı› ˆ˜ ÏÈÁfiÙÂÚÔ ·ÂÈ-ÏËÙÈ΋ ·Ó ‚·Û›˙ÂÙ·È Û ÌÈ· Û˘˙‹ÙËÛË fiÔ˘ ‰›ÓÂÙ·È ¤Ì-Ê·ÛË ÙfiÛÔ ÛÙ· ‰˘Ó·Ù¿ ÛËÌ›· fiÛÔ Î·È ÛÙȘ ·‰˘Ó·Ì›Â˜ÙÔ˘ ·ÍÈÔÏÔÁÔ‡ÌÂÓÔ˘. M¤ıÔ‰Ô˜ ÂÈÏÔÁ‹˜ ÛÙȘ ÂÚÈ-ÙÒÛÂÈ̃ ·ÚÓËÙÈ΋˜ ·ӷÏËÚÔÊfiÚËÛ˘, ηٿ ÙËÓ ÔÔ›·Ô ÚÔ˚ÛÙ¿ÌÂÓÔ˜ Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÛÂÈ ÙÔÓ ·ÍÈÔÏÔÁÔ‡-ÌÂÓÔ ÁÈ· ÙËÓ ¯·ÌËÏ‹ ·fi‰ÔÛË Ô˘ ·ÚÔ˘Û›·ÛÂ, ›ӷÈ

secretary to ensure that they are not disturbed andsilence the telephone

– the door should preferably remain ajar and in open view,as long as it is not too noisy

– the interview may be recorded with the consent of theinterviewee and the legal representative of the dentalsurgery

– the appraiser should welcome the interviewee like agood host and ensure his time in the interview room iscomfortable 31, 32

– the appraiser should first chat with the interviewee abouthis professional interests, using this opportunity to stressthe importance of the appraisal and feedback toemployee career development25, 26, 32, 33

– during feedback, particular care should be taken thatthe employee does not see it as a punishment. Negativefeedback may be seen as less threatening when it isbased on a discussion stressing the employee’s strongpoints as well as their weaknesses. The method of choicein cases of negative feedback, where the supervisormust inform the employee of his low performance, isthe “sandwich feedback method”. In this method, theappraiser begins and ends the feedback with positivecomments, and raises the employee’s poor performanceand weaknesses in the middle of the discussion34, 35

– the appraiser should thank the employee for completingthe self-appraisal form. If the person appraised giveshimself a lower score than he deserves, the appraisershould stress his positive role in the dental practice, toactivate his self-confidence. If he gives himself a higherscore than he deserves, the appraiser must show himwhat areas he needs to improve in order to attain that level

– special emphasis must be placed, once more, on theimportance of the appraisal to employees’ careerdevelopment and the growth of the dental practice ingeneral

– the interview closes with the appraiser thanking theinterviewee for his contribution to the smooth operationof the dental practice, and setting out the career growthprospects of each employee36, 37

– both parties sign the form that the interview process hasbeen completed and keep a copy each.

APPRAISAL FORM

The appraisal form consists of three parts. The first includesthe guidelines and the professional positions of appraiserand appraised. The second part lists the skills on whichthe employee is scored, the rating scales, and commentsand observations. The final part presents the actionsnecessary to improve the employee’s performance. Theappraisal form may conclude with the appraiser’scomments on the employee’s career and salary growth

Hellenic Stomatological Review 59: 83-99, 2015

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Hellenic Stomatological Review 59: 83-99, 2015

Ë Ì¤ıÔ‰Ô˜ ·ӷÏËÚÔÊfiÚËÛË «Û¿ÓÙÔ˘ÈÙ˜» (sandwichfeedback). ™‡Ìʈӷ Ì ÙË Ì¤ıÔ‰Ô ·˘Ù‹, Ô ·ÍÈÔÏÔÁË-Ù‹˜ ÍÂÎÈÓ¿ Î·È ÙÂÏÂÈÒÓÂÈ ÙËÓ Â·Ó·ÏËÚÔÊfiÚËÛ‹ ÙÔ˘ÚÔ˜ ÙÔÓ ·ÍÈÔÏÔÁÔ‡ÌÂÓÔ˘ Ì ٷ ıÂÙÈο Û¯fiÏÈ· Î·È ÛÙË̤ÛË Ù˘ Û˘˙‹ÙËÛ˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÂÎÌËÚȈ̤ӷ ÙÔÓÏfiÁÔ Ô˘ ÙÔÓ Ô‰‹ÁËÛ Û ·ÚÓËÙÈ΋ ·ÍÈÔÏfiÁËÛË34, 35

– ı· ¢¯·ÚÈÛÙ‹ÛÂÈ ÙÔÓ ·ÍÈÔÏÔÁÔ‡ÌÂÓÔ ÁÈ· ÙË Û˘ÌÏ‹Úˆ-ÛË ÙÔ˘ ÂÓÙ‡Ô˘ ·˘ÙÔ·ÍÈÔÏfiÁËÛ˘. AÓ Ô ·ÍÈÔÏÔÁÔ‡ÌÂ-ÓÔ˜ ‚·ıÌÔÏÔÁ‹ÛÂÈ ̄ ·ÌËÏfiÙÂÚ· ÙÔÓ Â·˘Ùfi ÙÔ˘, ·fi fiÙÈ·Í›˙ÂÈ, Ô ·ÍÈÔÏÔÁËÙ‹˜ Ú¤ÂÈ Ó· ÙÔ˘ ÙÔÓ›ÛÂÈ ÙÔ ıÂÙÈÎfiÙÔ˘ ÚfiÏÔ Ì¤Û· ÛÙÔ Ô‰ÔÓÙÈ·ÙÚ›Ô, ÒÛÙ ӷ ÂÓÂÚÁÔÔÈ-‹ÛÂÈ ÙËÓ ·˘ÙÔÂÔ›ıËÛ‹ ÙÔ˘. AÓ ‚·ıÌÔÏÔÁ‹ÛÂÈ ÙËÓ ·fi-‰ÔÛ‹ ÙÔ˘ ̆ „ËÏfiÙÂÚ·, Ô ·ÍÈÔÏÔÁËÙ‹˜ Ú¤ÂÈ Ó· ÙÔ˘ ̆ Ô-‰Â›ÍÂÈ ÔȘ Â›Ó·È ÔÈ ‚ÂÏÙÈÒÛÂȘ Ô˘ Ú¤ÂÈ Ó· ÂÈÙ‡¯ÂÈÒÛÙ ӷ ÚÔÛÂÁÁ›ÛÂÈ ÙË Û˘ÁÎÂÎÚÈ̤ÓË ‚·ıÌÔÏÔÁ›·

– ȉȷ›ÙÂÚË ¤ÌÊ·ÛË Ú¤ÂÈ Ó· ‰Ôı› ÛÙË ÛËÌ·Û›· Ô˘ ¤¯ÂÈË ·ÍÈÔÏfiÁËÛË ÛÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ ·Ó¿Ù˘ÍË ÙˆÓ ÂÚ-Á·˙ÔÌ¤ÓˆÓ ·ÏÏ¿ Î·È ÙÔ˘ Ô‰ÔÓÙÈ·ÙÚ›Ԣ ÁÂÓÈÎfiÙÂÚ·

– Ë Û˘Ó¤ÓÙ¢ÍË ÔÏÔÎÏËÚÒÓÂÙ·È Ì ÙȘ ¢¯·ÚÈÛٛ˜ ÙÔ˘·ÍÈÔÏÔÁËÙ‹ ÚÔ˜ ÙÔ˘˜ ·ÍÈÔÏÔÁÔ‡ÌÂÓÔ˜ ÁÈ· Ù· fiÛ· ÚÔ-ÛʤÚÔ˘Ó ÛÙËÓ Â‡Ú˘ıÌË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Ô‰ÔÓÙÈ·ÙÚÂ›Ô˘Î·È Ì ÙȘ ÚÔÔÙÈΤ˜ ·ÁÁÂÏÌ·ÙÈ΋˜ ÂͤÏÈ͢ ÙÔ˘ η-ıÂÓfi˜36, 37

– Ì ÙÔ ¤Ú·˜ Ù˘ ‰È·‰Èηۛ·˜, Ù· ‰‡Ô ̤ÚË Ú¤ÂÈ Ó·˘ÔÁÚ¿„Ô˘Ó ÙËÓ Ú·ÁÌ·ÙÔÔ›ËÛ‹ Ù˘ Î·È Ó· ·Ú·-Ï¿‚Ô˘Ó ·fi ¤Ó· ·ÓÙ›ÁÚ·ÊÔ.

ENTY¶O A•IO§O°H™H™

TÔ ¤ÓÙ˘Ô ·ÍÈÔÏfiÁËÛ˘ ·ÔÙÂÏÂ›Ù·È ·fi 3 ̤ÚË. TÔ ÚÒ-ÙÔ Ì¤ÚÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Ô‰ËÁ›Â˜ ̄ Ú‹ÛÂÒ˜ ÙÔ˘ Î·È ÙËÓ ÂÙ·È-ÚÈ΋ Ù·˘ÙfiÙËÙ· ÙÔ˘ ·ÍÈÔÏÔÁËÙ‹ Î·È ÙÔ˘ ·ÍÈÔÏÔÁÔ‡ÌÂÓÔ˘.™ÙÔ ‰Â‡ÙÂÚÔ Ì¤ÚÔ˜ ηٷÁÚ¿ÊÔÓÙ·È Ù· ÎÚÈÙ‹ÚÈ· ‚¿ÛÂÈ ÙˆÓÔÔ›ˆÓ ·ÍÈÔÏÔÁÂ›Ù·È Ô ÂÚÁ·˙fiÌÂÓÔ˜, ÔÈ Îϛ̷Θ ‚·ıÌÔ-ÏfiÁËÛ˘ Î·È Û¯fiÏÈ·, ·Ú·ÙËÚ‹ÛÂȘ. ™ÙÔ ÙÂÏÂ˘Ù·›Ô ̤ÚÔ˜·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ··Ú·›ÙËÙ˜ ÂÓ¤ÚÁÂȘ Ô˘ ı· Û˘ÓÙÂ-ϤÛÔ˘Ó ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ÂȉfiÛÂˆÓ ÙÔ˘ ÂÚÁ·˙Ô̤ÓÔ˘.™Â οÔȘ ÂÚÈÙÒÛÂȘ ÙÔ ¤ÓÙ˘Ô ·ÍÈÔÏfiÁËÛ˘ ÔÏÔ-ÎÏËÚÒÓÂÙ·È Ì ۯfiÏÈ· ÙÔ˘ ·ÍÈÔÏÔÁËÙ‹ ÁÈ· ÙȘ ·ÁÁÂÏ-Ì·ÙÈΤ˜ Î·È ÌÈÛıÔÏÔÁÈΤ˜ ‰˘Ó·ÙfiÙËÙ˜ ÂͤÏÈ͢ ÙÔ˘ ÂÚ-Á·˙Ô̤ÓÔ˘38, 39.™ÙÔ ¤ÓÙ˘Ô ·ÍÈÔÏfiÁËÛ˘ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ì¤¯ÚÈ Û‹-ÌÂÚ· (ŒÓÙ˘Ô 1) ÁÈ· ÙȘ ·ÍÈÔÏÔÁ‹ÛÂȘ ÙˆÓ ÁÈ·ÙÚÒÓ ÙÔ˘E™Y, Î·È Û˘ÓÂÒ˜ Î·È ÙˆÓ Ô‰ÔÓÙÈ¿ÙÚˆÓ, Ì ÙÔÓ ÓfiÌÔN.4052/2012, ¿ÚıÚÔ 6, ·Ú¿ÁÚ·ÊÔ˜ 13 ÙÔ YÔ˘ÚÁ›ÔYÁ›·˜ ı· ÚÔÛı¤ÛÂÈ Î·È ÔÛÔÙÈο ÛÙÔȯ›· ÎÏÈÓÈÎÔ‡ ¤Ú-ÁÔ˘ fiˆ˜ ·ÚÈıÌfi˜ ÓÔÛËÏ¢ı¤ÓÙˆÓ ·ÛıÂÓÒÓ, Ë̤Ú˜ ÓÔ-ÛËÏ›·˜, ̤ÛË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜, ÂÍÂÙ¿ÛÂȘ, ¯ÂÈÚÔ˘Ú-ÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ, ‰È·ÁÓˆÛÙÈΤ˜ Ú¿ÍÂȘ, Û˘ÌÌÂÙÔ¯‹ ÛÙËÓËÏÂÎÙÚÔÓÈ΋ Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË Î·È ¿ÏÏ·.

EI¢IKE™ ME£O¢OI A•IO§O°H™H™

OÈ ÂȉÈΤ˜ ̤ıÔ‰ÔÈ ·ÍÈÔÏfiÁËÛ˘ ‰È·ÎÚ›ÓÔÓÙ·È Û ·ÓÙÈÎÂÈ-ÌÂÓÈΤ˜ Î·È ̆ ÔÎÂÈÌÂÓÈΤ˜. OÈ ·ÓÙÈÎÂÈÌÂÓÈΤ˜ ̤ıÔ‰ÔÈ ÂÊ·Ú-Ìfi˙ÔÓÙ·È Î˘Ú›ˆ˜ ÁÈ· Ó· ÌÂÙÚ‹ÛÔ˘Ó ·ÔÙÂϤÛÌ·Ù·, ÙÔÓ

prospects38, 39. Under Law 4052/2012, article 6, paragraph13, the Health Ministry will add, to the current appraisalform that is used for doctors (and consequently dentists)of the Greek National Health System (Doctor AppraisalForm 1), qualitative data on clinical work, such as thenumber of patients hospitalized, the days of hospital stay,the average length of hospitalization, examinations, surgicalprocedures, diagnostic acts, use of e-prescriptions, etc.

SPECIAL APPRAISAL METHODS

Special appraisal methods are divided into objective andsubjective. Objective methods are mainly applied in orderto measure results and the number of ready goods andservices provided, and to evaluate employees’ personaldata, for instance if a person is often absent or the numberof disciplinary penalties imposed on them. Subjectivemethods are qualitative. They, too, can measure results,but they are mainly applied in order to evaluate trends andbehaviors, as they are more dependent on humanjudgement. They are divided into comparative methodsand appraisals compared to absolute performancestandards. Comparative methods include rankingemployees based on performance, and the ForcedDistribution Method, in which the organization haspredetermined the percentage of employees in eachperformance category and classifies them according totheir performance (Table 1). Appraisals in comparison toabsolute standards do not compare employees to eachother but evaluate their performances against absoluteperformance standards. This category includes GraphicRating Scales (Form 2), Weighted Checklist Scales (Form3), BARS (Behaviorally Anchored Rating Scales) (Form 4)and BObS (Behavioral Observational Scales) (Form 5)40.Appraisal with the aid of external advisers or workpsychologists, and the appraisal of all those involved inthe dental practice, supervisors, staff, patients and suppliers,known as 360-degree feedback, are modern appraisalmethods already applied in dental clinics in severalcountries41.

APPRAISAL ERRORS

The main errors may arise either during the appraisalinterview or during the completion of the appraisal form.These are usually errors of leniency or severity, errors dueto the appraiser’s personal prejudice, and errors due todifferent understanding of the appraisal terms. Twoappraisal errors are the Central Tendency Error and theHalo Effect. In Central Tendency Error the appraisal, dueto failed appraisal or often indifference, ranks all employeesin the middle of the performance ranking. In the Halo Effect,the supervisor appraises a person based solely on a singlecharacteristic. They may, for instance, award a low scoreto an employee who is late for work in the morning,irrespective of whether that employee later performsoutstandingly compared to the rest40.

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NATIONAL HEALTH CARE SYSTEM DOCTOR APPRAISAL FORM 1

APPRAISAL PERIOD FROM....................................................... TO ..........................................................

FULL NAME: ................................................................................................................................

SPECIALISATION: .................................................................................................................... DEPARTMENT: ............................................

POSTGRADUATE TITLES: ......................................................................................................................................................................................

..............................................................................................................................................................................................................................................

DATE OF EMPLOYMENT: ........................................................................................................................................................................................

DISTINCTIONS: ............................................................................................................................................................................................................

..............................................................................................................................................................................................................................................

PENALTIES:....................................................................................................................................................................................................................

..............................................................................................................................................................................................................................................

SCORING

0-2........................................................................ INADEQUATE 3-4 ...................................................................... ADEQUATE

5-6........................................................................ GOOD 7-8 ...................................................................... VERY GOOD

9-10........................................................................ EXCELLENT

AVERAGE SCORE ......................................................................................................................................................................................................

THE HEALTH SERVICE DIRECTOR

FULL NAME..................................................................................................................................

Form 1: APPRAISAL FORM FOR DOCTORS OF THE GREEK NATIONAL HEALTH SYSTEM

A/A CRITERIA APPRAISER 1 APPRAISER 2 COMMENTS REASONINGSCORES

1 Scientific Education & Training

2 Scientific Work

3 Research Work

4 Clinical Work

5 Organizational Experience

6 Management Skills

7 Cooperation

8 Behaviour towards patients

9 Participation in departmental activities (shifts, outpatient clinics)

10 Participation in general Hospital activities

11 Character of NHS doctor while on duty

TOTAL AVERAGE SCORE:

APPRAISER 1 (signature) APPRAISER 2 (signature)

DIRECTOR OF CLINIC UNIT LABORATORY SECTION HEA

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Performance Category Ranking percentage

Table 1: Example of Forced Distribution Method

Category 1: Employee does not meet job expectations

Category 2: Employee meets job expectations

but needs improvement

Category 3: Employee performance good

Category 4: Employee performance commendable

Category 5: Employee performance outstanding

5% of total appraised

15% of total appraised

50% of total appraised

20% of total appraised

10% of total appraised

Form 2: Example of the Graphic Rating Scale Method.

Full Name:

Address:

Job Title:

Date:

ATTRIBUTES

Quality of Work

Knowledge

Reliability

Initiative

Independence

Cooperation

Precision

Communication

Creativity

Observations

Date: Full Name:

Signature:

PERFORMANCE RATING

1 2 3 4 5Poor Adequate Average Good Exceptional

TÔtal:

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Form 3: Example of the Weighted Checklist method.

Full Name:

Job Title:

Date:

Note the attributes which you believe best represent the employee

List of Attributes Score

___ Provides solutions to problems that arise 10

_ ✔_ Coordinates work effectively 10

___ Is a team worker and creative 9,5

_ ✔_ Has a very good relationship with subordinates 7,5

_ ✔_ Motivates and encourages subordinates 9,5___ Is interested in quality of work 10

_ ✔_ Has good relationships with peers 8___ Applies disciplinary penalties strictly 7,5___ Carries out duties consistently 9,5

_ ✔_ Monitors subordinates’ work 8,5

_ ✔_ Gives objective appraisals 10

Date: Full Name:

Signature:

Form 4. Example of the Behaviorally Anchored Rating Scales (BARS)

Excellent performance

Good performance

Somewhat good

performance

Somewhat poor

performance

Poor performance

Persuades patient that they require a set of dental therapies,fillings, periodontal treatment, prosthetic work, even though they just came in for cleaning

Soothes an angry patient who is unsatisfied with the services received and sends them away happy

Serves a patient who lives far away and has come in for dental treatment out of hours

Serves patient but not particulary cheerfully

Tells a patient he/she can’t their dental problem, even though it is urgent, because they have come out of hours

�

�

�

�

�1

2

3

4

5

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93

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·ÚÈıÌfi ÙˆÓ ·Ú·ÁfiÌÂÓˆÓ ÚÔ˚fiÓÙˆÓ Î·È ˘ËÚÂÛÈÒÓ Î·ÈÁÈ· Ó· ·ÍÈÔÏÔÁ‹ÛÔ˘Ó ÚÔÛˆÈο ÛÙÔȯ›· ÙˆÓ ÂÚÁ·˙Ô-Ì¤ÓˆÓ fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· ·Ó ·Ô˘ÛÈ¿˙ÂÈ Û˘¯Ó¿ ·fiÙËÓ ÂÚÁ·Û›· ÙÔ˘ ‹ fiÛ˜ ÂÈı·Ú¯ÈΤ˜ Ú¿ÍÂȘ Î·È ÔÈ-Ó¤˜ ¤¯ÂÈ ‰Â¯Ù›. OÈ ̆ ÔÎÂÈÌÂÓÈΤ˜ ̤ıÔ‰ÔÈ ¤¯Ô˘Ó ÔÈÔÙÈÎfi¯·Ú·ÎÙ‹Ú·. MÔÚÔ‡Ó Ó· ÌÂÙÚ‹ÛÔ˘Ó Î·È ·˘Ù¤˜ ·ÔÙÂϤ-ÛÌ·Ù· ·ÏÏ¿ ΢ڛˆ˜ ÂÊ·ÚÌfi˙ÔÓÙ·È ÁÈ· Ó· ·ÍÈÔÏÔÁ‹ÛÔ˘ÓÙ¿ÛÂȘ, Û˘ÌÂÚÈÊÔÚ¤˜ ηıÒ˜ ÛÙËÚ›˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚÔÛÙËÓ ·ÓıÚÒÈÓË ÎÚ›ÛË. ¢È·ÎÚ›ÓÔÓÙ·È ÛÂ Û˘ÁÎÚÈÙÈΤ˜ ÌÂ-ıfi‰Ô˘˜ Î·È Û ÂÎÙÈÌ‹ÛÂȘ Û ۯ¤ÛË Ì ·fiÏ˘Ù· ÚfiÙ˘··fi‰ÔÛ˘ (standards). ™ÙȘ Û˘ÁÎÚÈÙÈΤ˜ ÌÂıfi‰Ô˘˜ ·Ó‹-ÎÂÈ Ë Î·Ù¿Ù·ÍË ÙˆÓ ÂÚÁ·˙ÔÌ¤ÓˆÓ Û ÛÂÈÚ¿ ·Ó¿ÏÔÁ· ÌÂÙËÓ ·fi‰ÔÛ‹ ÙÔ˘˜ Î·È Ë Ì¤ıÔ‰Ô˜ Ù˘ ̆ Ô¯ÚˆÙÈ΋˜ ‰È·-ÛÔÚ¿˜ (Forced Distribution Method) ηٿ ÙËÓ ÔÔ›· ËÂȯ›ÚËÛË ¤¯ÂÈ ÔÚ›ÛÂÈ ·fi ÚÈÓ Û˘ÁÎÂÎÚÈ̤ÓÔ ÔÛÔÛÙfi

CONCLUSIONS

Appraisal in the dental practice should be seen as a questfor more efficient, precise and cost-effective communicationand professional performance measurement techniques.It is a technique with a positive effect on the workenvironment, the quality of services provided andemployees’ job satisfaction. The appraisal is consideredsuccessful when, at its conclusion, both parties, appraiserand appraised, believe that their mutual communicationand trust has been reinforced and that the employee’sperformance will improve. This performance improvementis the basic aim of the appraisal, since it is this which willlead to a better-functioning dental clinic, less stress,increased productivity and more profit.

Hellenic Stomatological Review 59: 83-99, 2015

Form 5. Example of the Behavioural Observational Scales (BObS)

Full name:

Job Title:

Date:

BEHAVIORS

PERFORMANCE SCALE

1 2 3 4 5Almost Rarely Some Often Almost Never times Always

™‡ÓÔÏÔ:

Often gives examples to make him/herselfbetter understood

Motivates and encourages subordinates

His/her motivation methods are successful

Is adequately prepared to manage his/her staff

Respects and accepts view contrary to his/her own

Is knowledgeable on his/her professional field

Poor

6-10

Adequate

11-15

Average

16-20

Good

21-25

Exceptional

26-30

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Hellenic Stomatological Review 59: 83-99, 2015

ÂÚÁ·˙ÔÌ¤ÓˆÓ Ô˘ ı· ·ÓÙÈÛÙÔȯ› Û οı ηÙËÁÔÚ›· ·fi-‰ÔÛ˘ Î·È ÙÔ˘˜ ηٷٿÛÛÂÈ Û ·˘Ù¤˜ ·Ó¿ÏÔÁ· Ì ÙȘ ÂÈ-‰fiÛÂȘ ÙÔ˘˜ (¶›Ó·Î·˜ 1). OÈ ÂÎÙÈÌ‹ÛÂȘ Û ۯ¤ÛË Ì ·fi-Ï˘Ù· ÚfiÙ˘· ‰ÂÓ Û˘ÁÎÚ›ÓÔ˘Ó ÙÔ˘˜ ÂÚÁ·˙fiÌÂÓÔ˘˜ ÌÂ-ٷ͇ ÙÔ˘˜ ·ÏÏ¿ ÂÎÙÈÌÔ‡Ó ÙȘ ÂȉfiÛÂȘ ÙÔ˘˜ Û˘ÁÎÚÈÙÈοÌ ·fiÏ˘Ù· ÚfiÙ˘· ·fi‰ÔÛ˘. ™ÙË Î·ÙËÁÔÚ›· ·˘Ù‹ ·Ó‹-ÎÔ˘Ó ÔÈ Ì¤ıÔ‰ÔÈ Ù˘ ÁÚ·ÊÈ΋˜ ÎÏÈ̷Έً˜ ηٿٷ͢(Graphic Rating Scale Method) (ŒÓÙ˘Ô 2), ÙÔ˘ ÛÙ·ıÌÈ-Ṳ̂ÓÔ˘ ηٷÏfiÁÔ˘ ÂϤÁ¯Ô˘ (Weighted Checklist) (ŒÓÙ˘-Ô 3), Ù˘ ÎÏÈ̷Έً˜ ηٿٷ͢ ̤ÙÚËÛ˘ Ù˘ Û˘ÌÂ-ÚÈÊÔÚ¿˜ BARS (Behaviorally Anchored Rating Scales)(ŒÓÙ˘Ô 4) Î·È Ù˘ ̤ÙÚËÛ˘ Ù˘ ·Ú·ÙËÚÔ‡ÌÂÓ˘ Û˘-ÌÂÚÈÊÔÚ¿˜ BObS (Behavioral Observational Scales)(ŒÓÙ˘Ô 5)40. H ·ÍÈÔÏfiÁËÛË Ì ÙË ‚Ô‹ıÂÈ· Â͈ÙÂÚÈÎÒÓÛ˘Ì‚Ô‡ÏˆÓ Î·È/‹ ÂÚÁ·ÛÈ·ÎÒÓ „˘¯ÔÏfiÁˆÓ ·ÏÏ¿ Î·È Ë ·ÍÈÔ-ÏfiÁËÛË ·fi fiÏÔ˘˜ ÙÔ˘˜ ÂÌÏÂÎfiÌÂÓÔ˘˜ Ì ÙÔ Ô‰ÔÓÙÈ·-ÙÚ›Ô, ÚÔ˚ÛÙ¿ÌÂÓÔÈ, ˘ÊÈÛÙ¿ÌÂÓÔÈ, ·ÛıÂÓ›˜, ÚÔÌËı¢-Ù¤˜, ÁÓˆÛÙ‹ ̂ ˜ ·ÍÈÔÏfiÁËÛË 360Æ ·ÔÙÂÏÔ‡Ó Û‡Á¯ÚÔÓ˜ÌÔÚʤ˜ ·ÍÈÔÏfiÁËÛ˘ Ô˘ ‹‰Ë ÂÊ·ÚÌfi˙ÔÓÙ·È Û ԉÔ-ÓÙÈ·ÙÚÈΤ˜ ÌÔÓ¿‰Â˜ Í¤ÓˆÓ ¯ˆÚÒÓ41.

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T· ΢ÚÈfiÙÂÚ· ÛÊ¿ÏÌ·Ù· ÌÔÚ› Ó· ÚÔ·„Ô˘Ó Â›Ù ηٿÙË Û˘Ó¤ÓÙ¢ÍË ·ÍÈÔÏfiÁËÛ˘ ›Ù ηٿ ÙË Û˘ÌÏ‹ÚˆÛËÙÔ˘ ÂÓÙ‡Ô˘ ·ÍÈÔÏfiÁËÛ˘. AÊÔÚÔ‡Ó Û˘Ó‹ıˆ˜ Ï¿ıË ÂÈ-›ÎÂÈ·˜, ·˘ÛÙËÚfiÙËÙ·˜, Ï¿ıË ÂÍ·ÈÙ›·˜ ÚÔÛˆÈÎÒÓ ÚÔ-ηٷϋ„ÂˆÓ ÙÔ˘ ·ÍÈÔÏÔÁËÙ‹ Î·È Ï¿ıË Ô˘ ÔÊ›ÏÔÓÙ·È ÛÙˉȷÊÔÚÂÙÈ΋ ·ÓÙ›ÏË„Ë Ù˘ ¤ÓÓÔÈ·˜ ÙˆÓ fiÚˆÓ Ô˘ ¯ÚËÛÈ-ÌÔÔÈÔ‡ÓÙ·È ÛÙËÓ ·ÍÈÔÏfiÁËÛË. ¢‡Ô Û˘ÓËıÈṲ̂ӷ ÛÊ¿Ï-Ì·Ù· Ô˘ Û˘Ì‚·›ÓÔ˘Ó Î·Ù¿ ÙËÓ ·ÍÈÔÏfiÁËÛË Â›Ó·È Ë Ù¿ÛËÚÔ˜ ÙÔ Î¤ÓÙÚÔ (Central Tendency Error) Î·È ÙÔ Ï¿ıÔ˜ ÁÂ-Ó›Î¢Û˘ Ù˘ ÎÚ›Û˘ (Halo Effect). ™ÙË Ù¿ÛË ÚÔ˜ ÙÔ Î¤-ÓÙÚÔ Ô ·ÍÈÔÏÔÁËÙ‹˜, ÏfiÁˆ ·ÔÙ˘¯›·˜ ÂÎÙ›ÌËÛ˘ ‹ ηȷ‰È·ÊÔÚ›·˜ ÔÏϤ˜ ÊÔÚ¤˜, ηٷٿÛÛÂÈ fiÏÔ˘˜ ÙÔ˘˜ ·ÍÈÔ-ÏÔÁÔ‡ÌÂÓÔ˘˜ ÛÙÔ Ì¤ÛÔ Ù˘ Îϛ̷η˜ ·fi‰ÔÛ˘. ™ÙÔ Ï¿-ıÔ˜ ÁÂÓ›Î¢Û˘ Ù˘ ÎÚ›Û˘ Ô ÚÔ˚ÛÙ¿ÌÂÓÔ˜ ·ÍÈÔÏÔÁ›¤Ó·Ó ¿ÓıÚˆÔ ‚·ÛÈ˙fiÌÂÓÔ˜ ÌfiÓÔ Û ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘. MÔÚ› ÁÈ· ·Ú¿‰ÂÈÁÌ· Ó· ‰›ÓÂÈ ̄ ·-ÌËÏ‹ ‚·ıÌÔÏÔÁ›· Û ¤Ó·Ó ˘¿ÏÏËÏÔ ÂÂȉ‹ ηı˘ÛÙÂÚ›

REFERENCES

1. Elicker JD, Levy PE, Hall RJ: The role of lead member exchangein the performance appraisal process. Journal of Management2006; 32(4): 531-551.

2. Demartini C: Performance Management System. A Contributionto Management. Springer Verlag: Berlin and Heidelberg, 2014.

3. Atkinson C, Shaw S: Managing performance. In Lucas R,Lupton B, Mathieson H. (eds.) HRM in an International Context,London: CIPD, 2007: 173-193.

4. Soltani E, Van Der Meer R, Williams TM: A contrast of HRM andTQM approaches to performance management: someevidence. British Journal of Management 2005; 16: 211-230.

5. Boswell WR, Boundreau JW: Separating the developmentaland evaluative performance appraisal. Journal of Businessand Psychology 2002; 16: 391-412.

6. Vasset Fm Maruburg E, “Furunes T: The effects of performanceappraisal in the Norwegian mumicipal health services: a casestudy. Human Resaivels for Helth 2011; 9:22-33.

7. Finucane PM, Bourgeois-Law GA, Ineson SL, Kaigas TM: Acomparison of performance assessment programs for medicalpractitioners in Canada, Australia, New Zealand, and the UnitedKingdom. Acad Med 2003; 78: 837-843.

8. Davies P, Walsh M, Pollock C: Performance management,appraisals and revalidation: quantity analysis and qualitycontrol for UK GPs. British Journal of General Practice 2011;61(589): 526-527.

9. Epstein RM, Hundert EM: Defining and assessing professionalcompetence. JAMA 2002; 287(2): 226-35.

10. Rethans J, Norcini J, Baron-Maldonado M: Relationship betweencompetence and performance: implications for assessingpractice performance. Med Educ 2002, 36(10): 901-909.

11. Barr ES: Enhancing staff performance through a customizedevaluation form. JADA 1993; 124(3): 51-53.

12. Levin R: Evaluating your office staff. JADA 2004; 135(11): 1597-1598.

13. Albino JE, Young SK, Neumann LM, Kramer GA, Andrieu SC,Henson L, Horn B, Hendricson WD: Assessing dental studentscompetence: best practice recommendations in theperformance assessment literature and investigation of currentpractices in predoctoral dental education. Journal of DentalEducation 2008; 72(12): 1405-1435.

14. Levin R: Performance reviews. JADA 2005; 136(7): 1035-6.15. Levin R: Performance reviews that empower your staff

members. JADA 2008; 139(5): 621-622.

K·ÙËÁÔÚ›· ·fi‰ÔÛ˘ ¶ÔÛÔÛÙfi ηٿٷ͢

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K·ÙËÁÔÚ›· 1: O ÂÚÁ·˙fiÌÂÓÔ˜ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È

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K·ÙËÁÔÚ›· 2: O ÂÚÁ·˙fiÌÂÓÔ˜ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÙȘ

··ÈÙ‹ÛÂȘ Ù˘ ı¤Û˘ ÙÔ˘ ·ÏÏ¿ ¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË

K·ÙËÁÔÚ›· 3: O ÂÚÁ·˙fiÌÂÓÔ˜ ·Ô‰›‰ÂÈ Û ¤Ó· ηÏfi ›‰Ô

K·ÙËÁÔÚ›· 4: O ÂÚÁ·˙fiÌÂÓÔ˜ ·Ô‰›‰ÂÈ Û ¤Ó· Ôχ ˘„ËÏfi ›‰Ô

K·ÙËÁÔÚ›· 5: O ÂÚÁ·˙fiÌÂÓÔ˜ ·Ô‰›‰ÂÈ ÂÍ·ÈÚÂÙÈο

5% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·ÍÈÔÏÔÁÔ‡ÌÂÓˆÓ

15% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·ÍÈÔÏÔÁÔ‡ÌÂÓˆÓ

50% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·ÍÈÔÏÔÁÔ‡ÌÂÓˆÓ

20% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·ÍÈÔÏÔÁÔ‡ÌÂÓˆÓ

10% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·ÍÈÔÏÔÁÔ‡ÌÂÓˆÓ

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17. Kurtz M: Hiring and Retaining Good Employees. DentalEconomics 2007; 97(8): 122-126.

18. Tan CL, Nasurdin AM: Human Resource Management Practicesand Organizational Innovation: Assessing the mediating roleof knowledge management effectiveness. Electronic Journalof Knowledge Management 2011; 9(2): 156-167.

19. Butt G, Macnab N: Making connections between the appraisal,performance management and professional development ofdentists and teachers: right, what are the problems wevegot and how could we sort this out? Professional Developmentin Education 2013; 39(5): 841-861.

Hellenic Stomatological Review 59: 83-99, 2015 95

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20. Schwartz AE: Performance Management: Appraisal and Meeting,Waverlay, MA 02479-0228, Schwartz & Associates, 2003.

21. Isman R: Appraising the performance of Dentists. Journal ofPublic Health Dentistry 1977; 37(3): 224-234.

22. Mercer P, Bailey H, Cook P: Perceptions, attitudes and opinionsof general dental practitioners and dental nurses to theprovision of lifelong learning for the dental team. British DentalJournal 2007; 202(12): 747-753.

23. Conlon M: Appraisal: the catalyst of personal development.BMJ 2003; 327: 389-391.

24. Dunning DG, Lange BM, Shea GD: A study of staff membersperceptions of performance appraisals: tendencies andimplications. J Dent Pact Admin 1989; 6(2): 77-83.

25. Dunning DG, Durham TM, McDonough D: Performancefeedback as viewed by dental assistants: part I. Dent Assist.2012; 81(5): 6-8.

Hellenic Stomatological Review 59: 83-99, 2015

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BIB§IO°PAºIA

1. Elicker JD, Levy PE, Hall RJ: The role of lead member exchangein the performance appraisal process. J Manag 2006; 32(4):531-551.

2. Demartini C: Performance Management System. A Contributionto Management. Springer Verlag: Berlin and Heidelberg, 2014.

3. Atkinson C, Shaw S: Managing performance. In Lucas R,Lupton B, Mathieson H. (eds.) HRM in an International Context,London: CIPD, 2007: 173-193.

4. Soltani E, Van Der Meer R, Williams TM: A contrast of HRM andTQM approaches to performance management: someevidence. BJM 2005; 16: 211-230.

5. Boswell WR, Boundreau JW: Separating the developmentaland evaluative performance appraisal. J Bus Psychol 2002;16: 391-412.

6. Vasset F, Marnburg E, Furunes T: The effects of performanceappraisal in the Norwegian municipal health services: a casestudy. Human Resourses for Health 2011; 9: 22-33.

7. Finucane PM, Bourgeois-Law GA, Ineson SL, Kaigas TM: Acomparison of performance assessment programs for medicalpractitioners in Canada, Australia, New Zealand, and the UnitedKingdom. Acad Med 2003; 78: 837-843.

8. Davies P, Walsh M, Pollock C: Performance management,appraisals and revalidation: quantity analysis and qualitycontrol for UK GPs. Br J Gen Pract 2011; 61(589): 526-527.

9. Epstein RM, Hundert EM: Defining and assessing professionalcompetence. JAMA 2002; 287(2): 226-35.

10. Rethans J, Norcini J, Baron-Maldonado M: Relationship betweencompetence and performance: implications for assessingpractice performance. Med Educ 2002, 36(10): 901-909.

11. Barr ES: Enhancing staff performance through a customizedevaluation form. JADA 1993; 124(3): 51-53.

12. Levin R: Evaluating your office staff. JADA 2004; 135(11): 1597-1598.

13. Albino JE, Young SK, Neumann LM, Kramer GA, Andrieu SC,Henson L, Horn B, Hendricson WD: Assessing dental studentscompetence: best practice recommendations in theperformance assessment literature and investigation of currentpractices in predoctoral dental education. J Dent Educ 2008;72(12): 1405-1435.

14. Levin R: Performance reviews. JADA 2005; 136(7): 1035-6.15. Levin R: Performance reviews that empower your staff

members. JADA 2008; 139(5): 621-622.16. Thomas M: The performance review: is it making the grade?

Dent Assist 1990; 59(5):17-21.17. Kurtz M: Hiring and Retaining Good Employees. Dent Econ

2007; 97(8): 122-126.18. Tan CL, Nasurdin AM: Human Resource Management Pra-

ctices and Organizational Innovation: Assessing the mediatingrole of knowledge management effectiveness. EJKM 2011;9(2): 156-167.

19. Butt G, Macnab N: Making connections between the appraisal,performance management and professional development ofdentists and teachers: right, what are the problems we’ve gotand how could we sort this out?’ Professional Developmentin Education 2013; 39(5): 841-861.

20. Schwartz AE: Performance Management: Appraisal and Meeting,Waverlay, MA 02479 0228, Schwartz & Associates, 2003.

21. Isman R: Appraising the performance of Dentists. J PublicHealth Dent 1977; 37(3): 224-234.

22. Mercer P, Bailey H, Cook P: Perceptions, attitudes and opinionsof general dental practitioners and dental nurses to theprovision of lifelong learning for the dental team. Br Dent J2007; 202(12): 747-753.

26. Dunning DG, Durham TM, McDonough D: Performancefeedback as viewed by dental assistants: part II. Dent Assist.2012; 81(6): 6-8.

27. Harr R: TQM in dental practice. Int J Health Care Qual Assur2001; 14(2): 68-81.

28. Vlasiadis K, Koutsamani M: Total Quality Management in DentalUnits Hel Stom Rev 2012; 5: 55-59.

29. Dunning DG, Anderson P, Ellingson D: A preliminary studyof staff meetings as viewed by dental hygienist. Dent Hypoth2011; 2(4): 237-246.

30. Spence DG, Wood EE: Registered nurse participation inperformance appraisal interview. Journal of ProfessionalNursing 2007; 23(1): 55-59.

31. Steelman LA: Moderators of employee reactions to negativefeedback. J Manag Psych 2004; 19(1): 6-18.

32. Vlasiadis K, Koutsamani M: Communication guide for dentaloffices. Hel Stom Rev 2011; 55: 89-96.

33. Lussier MT, Richard C: Complaints and legal actions. Roleof doctor patient communication. Can Family Phys 2005;51: 37-39.

34. Schwarz R: The Sandwich Approach undermines yourfeedback. Harvard Business Reviews, April 19, 2013.

35. Van Bergen CW, Bressler MS, Campbele K: The Sandwichfeedback method: not very tasty. Journal of Behavioral Studiesin business 2014; 7: 1-13.

36. Max D, Bacal R: Perfect phrases for performance reviews.New York: McGraw-Hill, 2010.

37. Levin RP: Making staff meetings effective. J Am Dent Assoc2008; 139: 1126-1127.

38. Butt G, Macnab N: Dentists appraisal: a pilot implementationstudy. Birmingham: Centre for Research in Medical and DentalEducation. University of Birmingham, 2010.

39. Dental Appraisal Handbook for the Dental Care Professional.NHS, Health Education North West, Department ofPostgraduate Dentistry, January 2014.

40. Mouza - Lazaridi AM: Human Resource Management, Thessa-loniki, Zygos 2013: 313-318.

41. Papalexandri N, Bourandas D: Human Resource Management,Athens, Mpenos 2003: 334-351.

Hellenic Stomatological Review 59: 83-99, 2015

Corresponding author:K. [email protected]

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E·ÁÁÂÏÌ·ÙÈÎfi £¤Ì·

Professional Topic

23. Conlon M: Appraisal: the catalyst of personal development.BMJ 2003; 327: 389-391.

24. Dunning DG, Lange BM, Shea GD: A study of staff membersperceptions of performance appraisals: tendencies andimplications. J Dent Pact Admin 1989; 6(2): 77-83.

25. Dunning DG, Durham TM, McDonough D: Performancefeedback as viewed by dental assistants: part I. Dent Assist.2012; 81(5): 6-8.

26. Dunning DG, Durham TM, McDonough D: Performancefeedback as viewed by dental assistants: part II. Dent Assist.2012; 81(6): 6-8.

27. Harr R: TQM in dental practice. Int J Health Care Qual Assur2001; 14(2): 68-81.

28. BÏ·ÛÈ¿‰Ë˜ K, KÔ˘ÙÛ·Ì¿ÓË M: ¢ÈÔ›ÎËÛË OÏÈ΋˜ ¶ÔÈfiÙËÙ·˜ ÛÂÔ‰ÔÓÙÈ·ÙÚÈΤ˜ ÌÔÓ¿‰Â˜. EÏÏ NÔÛÔÎ O‰ÔÓÙ 2012; 5: 55-59.

29. Dunning DG, Anderson P, Ellingson D: A preliminary studyof staff meetings as viewed by dental hygienist. Dent Hypoth2011; 2(4): 237-246.

30. Spence DG, Wood EE: Registered nurse participation in perfor-mance appraisal interview. J Prof Nurs 2007; 23(1): 55-59.

31. Steelman LA: Moderators of employee reactions to negativefeedback. J Manag Psych 2004; 19(1): 6-18.

32. BÏ·ÛÈ¿‰Ë˜ K, KÔ˘ÙÛ·Ì¿ÓË M: O‰ËÁfi˜ ÂÈÎÔÈÓˆÓ›·˜ ÁÈ· Ô‰Ô-ÓÙÈ·ÙÚ›·. EÏÏ ™ÙÔÌ XÚÔÓ 2011; 55: 89-96.

33. Lussier MT, Richard C: Complaints and legal actions. Roleof doctor patient communication. Can Family Phys 2005; 51:37-39.

34. Schwarz R: The Sandwich Approach undermines yourfeedback. Harvard Business Reviews, April 19, 2013.

35. Van Bergen CW, Bressler MS, Campbele K: The Sandwichfeedback method: not very tasty. Journal of Behavioral Studiesin business 2014; 7: 1-13.

36. Max D, Bacal R: Perfect phrases for performance reviews.New York: McGraw-Hill, 2010.

37. Levin RP: Making staff meetings effective. J Am Dent Assoc2008; 139: 1126-1127.

38. Butt G, Macnab N: Dentists appraisal: a pilot implementationstudy. Birmingham: Centre for Research in Medical and DentalEducation. University of Birmingham, 2010.

39. Dental Appraisal Handbook for the Dental Care Professional.NHS, Health Education North West, Department ofPostgraduate Dentistry, January 2014.

40. MÔ˘˙¿-§·˙·Ú›‰Ë AM: ¢ÈÔ›ÎËÛË AÓıÚˆ›ÓˆÓ ¶fiÚˆÓ, EΉfi-ÛÂȘ Z˘Áfi˜, £ÂÛÛ·ÏÔÓ›ÎË 2013: 313-318.

41. ¶··ÏÂÍ·Ó‰Ú‹ N, MÔ˘Ú·ÓÙ¿˜ ¢: ¢ÈÔ›ÎËÛË AÓıÚˆ›ÓˆÓ ¶fi-ÚˆÓ, EΉfiÛÂȘ M¤ÓÔ˘, Aı‹Ó· 2003: 334-351.

Hellenic Stomatological Review 59: 83-99, 2015 99

¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:K. BÏ·ÛÈ¿‰Ë˜[email protected]

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