Ianouarios Martios-2005

stomatologika exof.
3-10-08 13:05
599
ENTYO KEITO AP. A. 520/92

38 106 78 A
KIKO 6705
TPIMHNIAIA EKOH
EHNIKH OONTIATPIKH OMOONIA
EITHMONIKO ENTYO ME ENIKH ANANPIH

EK 431/2 5 A 2005
ISSN 1011 - 4181
1
TOMO 49
IANOYAPIO - MAPTIO 2005
hellenic
stomatological review
HELLENIC DENTAL ASSOCIATION
VOLUME 49, ISSUE 1, JANUARY - MARCH 2005
ISSN 1011 - 4181
stomatologika exof.
3-10-08 13:05
601
E O O
IIOKTHTH:
E O O
IEYYNTH YNTAH:
I. . T
TOMO 49, TEYXO 1

ISSN 1011 - 4181
EPIEXOMENA
EPEYNHTIKE EPAIE
YNTAKTIKH EITPOH:
.
. Z - B
H. K
H. K
. M
.
. T
B. T -
M T
. Z, X. , .
E. P...................................................................................9-14
M

(surface gloss)
X. , H. M, . H H. K..............15-20
EIMEEIA YNTAH:
M
K M
T
40 : K
47
E. X, E. , M. I . I. ...21-27
Y. TYH:
TypeProduct
B. & E. M EE
E 31 &
T.: (210) 32.14.904
KINIKH MEETH
IAHMIEI - HMOIE XEEI:
M. M - .
T.: (210) 33.02.343
Fax: (210) 38.34.385
E-mail: eoo@otenet.gr
T X E
O O
.
E : 0,01 e
40 $
EKOTH:
A, E.O.O.
EPA EKOH:
38 - A 106 78
KIKO: 6705
T.: (210) 38.13.380
Fax: (210) 38.34.385
E-Mail: eoo@otenet.gr
H
.

. K, . M . K ................................29-35
ENIAEPOYA EPITH
E () . A
( )
. , M. , A. X ..........................37-40
. B ,
. X, K. A ....................................................41-45
BIBIOPAIKE ANAKOHEI
H

I. K, M. T I. .................................47-55
stomatologika exof.
3-10-08 13:05
602
E O O
IIOKTHTH:
E O O
IEYYNTH YNTAH:
I. . T
YNTAKTIKH EITPOH:
.
. Z - B
H. K
H. K
. M
.
. T
B. T -
EIMEEIA YNTAH:
M
Y. TYH:
TypeProduct
B. & E. M EE
E 31 &
T.: (210) 32.14.904
IAHMIEI - HMOIE XEEI:
M. M - .
T.: (210) 33.02.343
Fax: (210) 38.34.385
T X E
O O
.
E : 0,01 e
40 $
EKOTH:
A, E.O.O.
EPA EKOH:
38 - A 106 78
T.: (210) 38.13.380
Fax: (210) 38.34.385
E-Mail: eoo@otenet.gr
TOMO 49, TEYXO 1

ISSN 1011 - 4181

M. A- .............................................................57-65
E

. K, B E. M N. ......................................67-71
O O
. A ...........................................................................73-80

. , A. Z..............................................................81-91

. A

. A, . B A. P.............................93-107
O
.
B. K, . A, I. . M ......109-115
EIHMIOOIKH MEETH
K
A
-
T. , E. K E. .........................117-126
stomatologika exof.
3-10-08 13:05
603
Hellenic Dental Association
Hellenic
Stomatological
Review
CONTENTS
PROPRIETOR:
EDITOR -IN- CHIEF:
J. G. Tzoutzas
EDITORIAL BOARD:
G. Douvitsas
F. Zervou - Valvi
H. Karkazis
E. Katsavrias
G. Mountouris
L. Papagiannoulis
D. Tziafas
V. Topitsoglou - Themeli
RESEARCH PAPERS
Assessment of hardness of experimental Titanium alloys

S. Zinelis, C. Panagopoulos, G. Papadimitriou and H. Ragousi ......9-14
Effect o grinding of orthodontic bonding resins on their
surface gloss
C. Gioka, E. Bitsanis, G. Eliades and E. Katsavrias .......................15-20
Oral squamous cell carcinoma in young adults under the age
of 40 years. A clinicopathologic study of 47 cases
E. Chrysomali, E. Piperi, M. Iakovou and S. I. Papanikolaou........21-27
CLINICAL STUDY
COPY EDITOR:
Evelin Babai
PRODUCTION - PROMOTION:
TypeProduct
V. & E. Babai Ltd
32 Epikourou Str., Athens Hellas
Phone#: (3210) 32.14.904
Fax#: (3210) 32.14.991
ADVERTISEMENTS - PUBLIC
RELATIONS:
M. Morfoniou - S. Gogas
Phone#: (3210) 33.02.343
Fax: (3210) 38.34.385
Hellenic Stomatological Review is the
official publication of the Hellenic Dental
Association, published trimonthly.
Annual subscription
VOLUME 49, ISSUE 1

JANUARY - MARCH 2005
ISSN 1011 - 4181
40 $ USD
PUBLISHER:
Panos Alexiou
President of the Hellenic Dental Association
HEADQUARTERS
38 Themistokleous Str., Athens, 106 78
Phone#: (3210) 38.13.380
Fax#: (3210) 38.34.385
Teeth and gingival display of maxillary central incisors.

A preliminary report
D. Kapagiannidis, P. Bikos and P. Koidis ......................................29-35
CASE REPORTS
Submerged (ankylosed) teeth. A rare case report

S. Dalabiras, M. Drydaki and A. Chatzivassileiou ..........................37-40
Bifid mandibular condyle. Case report and review of the
literature
L. Hadjipetrou, K. Antoniades.......................................................41-45
LITERATURE REVIEWS
The importance of the zone of attached gingival for the

maintenance of periodontal health
I. Karoussis, M. Trianti and I. Fourmousis .....................................47-55
Burning mouth syndrome
M. Androutsou-Pantziou ...............................................................57-65
Management in Patients with Aquired Haemoragic Disorders
in Oral Surgery
S. Kamberos, E. Vardas and N. Mallios.........................................67-71
The use of conscious sedation in Dentistry
D. Apostolakis...............................................................................73-80
stomatologika exof.
3-10-08 13:05
604
Hellenic
Stomatological
Review
PROPRIETOR:
EDITOR -IN- CHIEF:
J. G. Tzoutzas
EDITORIAL BOARD:
G. Douvitsas
F. Zervou - Valvi
H. Karkazis
E. Katsavrias
G. Mountouris
L. Papagiannoulis
D. Tziafas
V. Topitsoglou - Themeli
COPY EDITOR:
Evelin Babai
PRODUCTION - PROMOTION:
TypeProduct
V. & E. Babai Ltd
32 Epikourou Str., Athens Hellas
Phone#: (3210) 32.14.904
Fax#: (3210) 32.14.991
ADVERTISEMENTS - PUBLIC
RELATIONS:
M. Morfoniou - S. Gogas
Phone#: (3210) 33.02.343
Fax: (3210) 38.34.385
Hellenic Stomatological Review is the
official publication of the Hellenic Dental
Association, published trimonthly.
Annual subscription
40 $ USD
PUBLISHER:
Panos Alexiou
President of the Hellenic Dental Association
HEADQUARTERS
38 Themistokleous Str., Athens, 106 78
Phone#: (3210) 38.13.380
Fax#: (3210) 38.34.385
VOLUME 49, ISSUE 1

JANUARY - MARCH 2005
ISSN 1011 - 4181
Guidelines for crowning the tooth abutments of a removable

partial denture
S. Yannikakis, A. Zissis..................................................................81-91
The surgical management of ameloblastomas of the jaws.
Review of the literature
D. Andressakis, S. Valsamis and A. Rapidis.................................93-107
Acute anaphylaxis and severe side effects after the infusion
of local anesthetics during dental surgery
V. Karagkiozaki, T. Almagout, I. Litsas and T. Milidis ................109-115
EPIDEMIOLOGICAL STUDY
Oral status of the school-age population of Aigina island in

correlation with socioeconomic factors
T. Gatou, E. Kazazakis and H. Papadopoulou ..........................117-126
stomatologika exof.
3-10-08 13:05
605
YNTAKTIKH EIA
ME TAEPH OPEIA
O E K
, , O
E.
T 1998 DentEd, 2003 European Academy of Paediatric Dentristy

EEAEK I EEAK II.
E
, E O A 31
Association for Dental Education in Europe (ADEE)
E.
E ,
,
.
T, Wilmer
Souder Anthony Rizzo,
O E .
I. . TZOYTZA

stomatologika exof.
3-10-08 13:05
606
T E X
O
http://www.eoo.gr

E E

M, O

ampere
A
angstrm
A
barm
b
calorie
cal
candela
cd
coulomb
C
counts per minute
cpm
counts per second
cps
curie
Ci
degree Celsius
C
disintegration
per minute
dpm
disintegration
per second
dps
electron Volt
eV
equivalent
Eq
farad
F
gauss
G
gram
g
henry
H
hertz
Hz
hour
h
inch
in
international unit
joule
kelvin
kilogram
liter/litre
meter, metre
minute
molar
mole
newton
normal (concentration)
ohm
osmol
pascal
pound
pound per square inch
revolutions per minute
second
square centimeter
volt
watt
week
year
IU
J
K
kg
I or L
m
min
M
mol
N
N
osmol
Pa
lb
psi
rpm
s
cm2
V
W
wk
yr
correlation coefficient
degrees of freedom
mean
mean not significant
number of
observations
teragigamegakilohectodecadeciSEM:
TEM:
ESEM:
CSEM:
AFM:
SPM:
EELS:
EDS:
EPMA:
XRF:
XRD:
FTIR:
(1012)
(109)
(106)
(103)
(102)
(10)
(10-1)

probability
standard deviation
Standard error
of the mean
Students test
n
variance
r
df
x
NS

T
centiG
miliM
microk
nanoh
picoda
femtod
atto-
(10-2)
(10-3)
(10-6)
(10-9)
(10-12)
(10-15)
(10-18)
Scanning Electron Microscopy

Transmission Electron Microscopy
Environmental Scanning Electron Microscopy
Confocal Scanning Electron Microscopy
Atomic Force Microscopy
Scanning Probe Microscopy
Electron Energy Loss Spectrometry
Element Dispersive Spectroscopy
Electron Probe Microanalysis
X-ray Fluorescence analysis
X-ray Diffraction
Fourrier Transformation Infrared Spectroscopy
p
SD
SE
t test
F
c
m
m
n
p
f
a
stomatologika exof.
3-10-08 13:05
607
ANAEPHMENE OHIE IA TOY YPAEI

T TOMATOOIKA XPONIKA E O O
O O E E .
:
1. K :
, E
.
2. E :
T : ) A ( 3 ) ) E ( ,
K , E , E , K , K ) ) E )
, ) E , ) Y )
E .
3. E:
T
E : ) ) .
4. :
,
2.000

E.
5. :
O E
.
: O
7.500 (25 ) 100 . O
3.000 (10 ) 40 . T
1.000 (4 ), 5.000 (20
).
.
: T -
, . O
,
.
O , A4,
.
: , ,
,
, ,
, .
.

3.5
Word
12 .
: : ) , ) ()
(), ) , )

, ) , , )
( 2 4), ) .
: H
200 . ,
, , . O - 3-10 . O Index Medicus Dental Index
.
K: T
. T,
.
O
: E, Y M, E-A, .
.
B : O ,
, . T -
stomatologika exof.
3-10-08 13:05
608
. H
.
.
,
.
(
,
...), (:) , , , , (;), ,
, (, ). O
Dental Index Index Medicus.

IATPOTEK. (abstracts) , .
E , ,
.
.
E (, , ),
.
:
: A
(
et al, .), , , , , , . .. Papagiannoulis L, Kakaboura A,
Eliades G: In vivo Vs in Vitro anticariogenic behavior
of glass-ionomer and resin composite restorative
materials. Dent Mater 2002; 18 (8): 561-569.
B : A
,
, , . A , ( - ) . .. Ryge GM: Dental Corrosion. 2nd ed. New
York. Harper and Row. 1985: 204.
A
,
: Johnston AJ: Corrosion
Resistance of Amalgams. In: Goldman AK, Johns KO,
eds. Restorative Materials, Baltimore. Williams and
Wilkins Co., 1984-87.
H E ,

, ,
E .
A : , A
,
.
.
,
,
. H 250 350 .
:
. H
. A . O , , .
E: T , ( ) :

. H
. O

. Y
slides, .
E
( CD) , ,
.
O
300 dpi, JPG

.
H
E . H E

.
O 2
. M
.
T ,
.
E .
E:
,
, ,

.
9-14 SEL. - ZHNELIS*
3-10-08 12:59
E E
M T
. Z*, X. **, . **, E. P***
T T
,
. ,
T
. T . M (Al, Sn, In, Ga) T (Co, Mn)
T (% ..): I: 80Ti-18Sn-1,5In-0,5Mn, II:
76Ti-12Ga-7Sn-4Al-1Co, III: 87Ti-13Ga, IV: 79Ti-13Ga-7Al-1Co, V: 82Ti-18In, VI: 75,5Ti-18In-5Al1Co-0,5Mn, VII: 85Ti-10Sn-5Al, VIII: 78Ti-12Co-7Ga-3Sn.

30x3x1mm cp Ti . T
Vickers 5 Kp. T Kruskal-Wallis one way ANOVA
on Ranks Student-Newman-Keuls (=0,05). T
: cp Ti=16818a, V=29309d, VII=32726b, VIII=33408b, I=33608b, III=34427b,
IV=38716c, II=38929c, VI=42715e.
Ni-Cr
(~300VHN) .
49: 9-14, 2005
10/3/2004 - 4/6/2004
EIAH
H T
: K, T, X, .
* . M M, M M.
, E B, O ,
A
** K E.M.. T M M M M
*** O, E A , O A
H T ABE 96BE94.

(Hip joints), (, ,
..)(1). H (316L)
Co-Cr-M,

T(2). T
(316L
Co-Cr-M)(3)
(fretting corrosion) 9
3-10-08 12:59
10
E E
.

T(2) ( Ti6Al-4V) (4-10) T
(commercially pure Ti) cp Ti ( 1) T (3) (11-13)
.
K cp Ti
(grade II)

Ni-Cr Co-Cr IV X(14) ( 2). A

, (E), .
T

. H

.

(15). H T

(solid solution
hardening mechanism) .
A +
, (16).

T .
YIKA KAI MEOO
H cp Ti
A, , , K, K M T
(Cyclarc, Morita, Kyoto, Japan)
(Ar). M , (17), T 3.

10
1. M T

K
(% ..)
cp Ti (B 2)
Ti-6Al-4V
Ti-5Al-2,5Fe
Ti-6Al-7Nb
Ti-13Nb-13Zr
Ti-11,5Mo-6Zr-2Fe
Ti-15Mo-5Zr-3Al
+
+
+
E
(0,2%)
f
(Gpa)
(MPa)
(MPa)
(%)
110
275
345
20
88-116 789-1013 990-1184 2-30
110
818-892 943-1050 13-16
108
910-970 900-1100 11-14
79
345-932 550-1035 8-15
74-85 1000-10660 1060-1100 18-22
14-113 870-1284 882-1312 11-20
*
(7)
(8)
(9)
(10)
(11)
(12)
(13)
*B
2. M
(14)
K
T
E
(VHN)
(MPa)
(%)
M M M

(I)
72
264
30
(II)
89
294
25
(III)
110
121
328
402
20
12
(IV)
147
237
490
735
20
Ni-Cr1
200
519
Ni-Cr2
277
725
Co-Cr1
380
735
Ti
210
539
13
Ti-6Al-4V
320
912
K .
2
K .
3. O
T
K
I
II
III
IV
V
VI
VII
VIII
O (%..)
80Ti-18Sn-1,5In-0,5Mn
76Ti-12Ga-7Sn-4Al-1Co
87Ti-13Ga
79Ti-13Ga-7Al-1Co
82Ti-18In
75,5Ti-18In-5Al-1Co-0,5Mn
85Ti-10Sn-5Al
78Ti-12Co-7Ga-3Sn
49: 9-14, 2005
3-10-08 12:59
11
E E
30x3x1mm . O
(Titavest CB, Morita, Kyoto,
Japan) cp Ti . T
SiC 220 ~ 1200 grit 3 m (DP-Paste M,
Struers, Copenhagen, Denmark)
(Dap-V, Struers, Copenhagen, Denmark).
(Diatronic 2RC, Wolpert,
Ludwigshafen, FRG) 5 Kp 5 sec. To
1 mm .
H
Kruskal-Wallis one way ANOVA
on Ranks . O
Student-Newman-Keuls
95%.
AOTEEMATA
4
. T VI
II
IV. A I, III, VII VIII V
cp Ti .
4. A

Y
cp Ti
I
II
III
IV
V
VI
VII
VIII
(VHN)
16818a
33608b
38929c
34427b
38716c
29309d
42715e
32726b
33408b
: O
(p > 0.05)
YZHTHH
T
49: 9-14, 2005

. T
100 300 m
(18) (19, 20). H (21)
( Si O) (22).

1 mm (1000 m)
.
H
(23).

:
(1)
HV = 2,9 Re
HV Vickers Re . K Hill(24) :
(2)
HV = 3 ( )
T,

(25)

T(16).
(26) A,
K T (Solid Solution Strengthening Mechanism)
(% ..:
A=31,5, =19,2, K=~25,7)(27) T (% ..: A=33,8,
=31,5, K=~34,5). M (28, 29)
(. 5).
5. P T

(28, 29)
K
Al
Ga
Sn
Mn
Co
P
Kg*mm-2*at.%-1
15
24
24
12
18
11
3-10-08 12:59
12
E E

T(16). A ( K M)

(16). H
5.
(precipitation hardeners) (solid solutions strengtheners). T T . Ti-5Al-2,5Sn 60% 370C(16). E .
H cp Ti (30) X IV(14). A
V
cp Ti Ni-Cr
Ni-Cr Co-Cr
VI
Co-Cr. E 1
T .
A
-
,

. (31).
,

Ni-Cr. H
.
YMEPAMATA
T
T
.
EYXAPITIE
T . B
.
SUMMARY
Assessment of hardness of experimental

Titanium alloys
S. Zinelis, Ch. Panagopoulos, G. Papadimitriou,
H. Ragousi
hellenic stomatological review 49: 9-14, 2005
The development of Ti alloys for orthopedic and dental

applications has recently attracted the interest of many
E. 1: T .
12
49: 9-14, 2005
3-10-08 12:59
13
E E
research studies. The aim of this study was to evaluate the

hardness of some experimental Ti alloys for dental
applications. The preparation of Ti alloys was made by
means of a non consumable arc in a two chamber electric
arc vacuum/inert gas dental casting machine utilizing
metallic elements characterized as alpha-phase (Sn, In,
Ga, Al) and beta-phase (Mn, Co) stabilizers. Eight
experimental Ti alloys were produced by melting the
following elemental weight ratios (wt%): I:80Ti-18Sn1.5In-0.5Mn, II:76Ti-12Ga-7Sn-4Al-1Co, III:87Ti-13Ga,
IV:79Ti-13Ga-7Al-1Co, V:82Ti-18In, VI:75.5Ti-18In-5Al1Co-0.5Mn, VII:85Ti-10Sn-5Al and VIII:78Ti-12Co-7Ga3Sn. For the preparation of cast specimens, nine groups
of three rectangular wax pattern each (30x3x1mm), were
invested with a magnesia based investment material
(Titavest CB, Morita, Kyoto, Japan) and cast with cpTi and
the eight experimental Ti alloys in a two chamber inert gas
arc-melting casting machine (Cyclarc, Morita, Kyoto,
Japan). Castings were subsequently cleaned by
sandblasting with 250 m Al2O3. The specimens of each
group were embedded in resin and after metallographical
grinding and polishing were used for the determination of
Vickers hardness. The results were analyzed using one
way ANOVA followed by Student-Newman-Keuls pairwise
test (=0.05) and the materials were classified in the
following increasing order (VH5): cp Ti=16818a,
V=29309d, VII=32726b, VIII=33408b, I=33608b,
III=34427b, IV=38716c, II=38929c, VI=42715e.
According to the results of this study all the experimental
alloys demonstrated much greater hardness compared to
cp Ti castings. Although an increase in hardness is
favorable, the hardness of Ti alloys should not be greater
than the hardness of Ni-Cr alloys (~300VHN) due to
increased difficulty of surface finishing. Therefore the
increase in hardness induced by alloying should be also
taken into account regarding the type and the extent of
alloying elements.
Key words: Alloys, Titanium, Casting, Hardness
BIBIOPAIA
1. Polmear IJ: Light Alloys 3rd ed. London. Arlond. 1981: 312314.
2. Kobayashi E, Matsumoto S, Doi H, Yoneyama T, Hamanaka
H: Mechanical properties of the binary titanium - zirconium
alloys and their potential for biomedical materials. J Biomed
Mater Res 1995; 29(8):943-950.
3. Long M, Rack HJ: Titanium alloy in total joint replacement a
materials science perspective. Biomaterials 1998; 19(18):
1621-1639.
4. ISO 5832-2 Implants for surgery-Metallic materials Part 2;
Unalloyed Titanium 2nd ed. Geneva. International
association for Standardization. 1993.
5. Imam MA, Gilmore CM: Fatigue and Microstructural
Properties of Quenched Ti-6Al-4V. Met Trans 1983; 14A:
233.
6. Borowy KH, Kramer KH: On the properties of a new titanium
alloy (Ti-5Al-2.5 Fe), as implant material, Proccedings of the
5th Intl. Conf. On Ti. In Lutjering G., Zwicker U., Bunk W. eds.
Titanium science and technology. 1984: 1381.
49: 9-14, 2005
7. Pilliar RM: Modern metal processing for improved loadbearing surgical implants, Biomaterials 1991; 12(2): 95-101.
8. Mishra AK, Davidson JA, Kovacs P, Poggie RA: New surfacehardened, low-modulus, corrosion-resistant Ti-13Nb-13Zr
alloy for total hip arthroplasty. J Biomed Mater Eng
1994;4(3):231-43.
9. Wang K, Gustavson L, Dumbleton J: The characterization of
Ti-12Mo-6Zr-2Fe. A new biocompatible Ti alloy developed
for surgical implants In Boyer R.R. Koss D.A. eds. Beta
titanium alloys in 90s. The metallurgical Society. Warrendale
PA. 1993: 2689-2696.
10. Steneiman et al: Beta-titanium alloy for surgical implants. In
Frohes F.H., Caplan IL: Proceedings of 7th Intl. Conf. On Ti:
Titanium 92. The Metallurgical Society. Warrendale PA
1993: 2689-2696.
11. Wang K, Gustavson LG, Dumbleton JH: Microstructure and
properties of new beta titanium alloy, Ti-12M-6Zr-2Fe,
developed for surgical implants, in: Brown SA, Lemon JM,
eds. Medical application of titanium and its alloys, West
Conshohocken PA. ASTM STP 1272, 1996: 76-87.
12. McKellop H, Rostlund T: The wear behavior of ion implanted
Ti-6Al-4V against UHMWPE, J Biomed Mater Res 1990;
24(11): 1413-1425.
13. Milliano M, Whiteside L, Kaiser A, Zwirkoski P: Evaluation of
the effect of articular surface material on a metal-bracket
patellar component. Transactions of the 36th annual
meeting of the orthopedic research society. The orthopedic
research society. Palatine IL 1990: 279.
14. Ida K, Togaya T, Tsutsumi S, Takeuchi M: Effect of magnesia
investments in the dental casting of pure Titanium or
Titanium alloys. Dent Mater J 1982; 1(1): 8-21.
15. Tuccillo JJ, Cascone P: The evolution of porcelain-fused-tometal (PFM) alloy systems. In Mclean J. eds. Dental
Ceramics Quintessence Chicago 1983: 348-350.
16. Collings EW: Physical metallurgy of titanium alloys. In Boyer
R, Welsch G, Collings EW eds. Titanium alloys. ASM
International. Materials Park OH. 1994: 1-11, 69-70.
17. Z : M o Ti X (XRF). O
2000; 54(2): 260-267.
18. Z , A H, : M
Ti
. O
1998; 52(1): 40-48.
19. Syverud M, Okabe T, Hero H: Casting of Ti-6Al-4V alloy
compared with pure Ti in an Ar-arc casting machine. Eur J
Oral Sci 1995; 103(5): 327-330.
20. Z .: M Ti
. O
1998; 52(6): 328-336.
21. Miyakawa O, Watanabe K, Okawa S, Nakano S, Kobayashi M,
Shiokawa N: Layered structure of cast titanium surface. Dent
Mater J 1989; 8(2): 175-185.
22. Papadopoulos T, Zinelis S, Vardavoulias M: A metallurgical
study of the contamination zone at the surface of dental Ti
castings due to the phosphate-bonded SiO2-based
investment material: The protection efficacy of a ceramic
coating. J Mater S 1999; 34(8): 3639-3646.
23. : M I A. E EM. 1990: 122.
24. Hill R: The Mathematical Theory of Plasticity, Oxford
University Press.
25. Ashby M, Jones D: Engineering Materials 1. 1st ed Oxford.
Pergamon 1980: 98.
13
3-10-08 12:59
14
E E
26. Z , M , : M
T
2001. E X 2003; 47: 50-56.
27. Massalski T, eds: Binary alloy phase diagrams. 2th ed. ASM
International. Materials Park Ohio. 1990. 225-227, 12501253, 1866-1868, 2306-2307, 2615-2616, 3405-3407.
28. Hammond C, Nutting J: The physical metallurgy of
superalloys and Titanium alloys, in Forging and properties
of aerospace materials, The Metals Society 1978: 75-102.
29. Collings EW: The physical metallurgy of titanium alloy, Ohio.

American Society for Metals. 1984.
30. Zinelis S: Effect of pressure of Helium, Argon, Krypton and
Xenon on the porosity, microstructure and mechanical
properties of commercially pure Titanium castings J
Prosthet Dent 2000; 84:575-582.
31. Bertolloti LR: Rational Selection of Casting Alloys. In Preston
JD. ed. Perspectives in Dental Ceramics. Proceedings of the
Fourth International Symposium on Ceramics. Chicago,
Quintessence Publishing Co. 1988; 81.
:
. Z
E B, O , / A
2, , 115 27, A
T: 210-7461102
Fax: 210-7461306
E-mail: szinelis@dent.uoa.gr
14
49: 9-14, 2005
15-20 SEL. - HLIADIS*
3-10-08 12:52
15
E E
M

(surface gloss)
X. *, H. M**, . H*, H. K**
H .
. (Assure, Enlight,
Lightbond, Kurasper)
60 (60 G%). K
12 . T,
. T
ANOVA (, , ) Tukey *=0.05. O . H ,
. , Enlight . M ,

.
49: 15-20, 2005
22/1/2004 - 16/6/2004
EIAH
O
(brackets) . ,
: 1, 2, ,
3. E
, :
* E B, O /
A
** E O, O / A

, , 4.

,
o . T
:

, 5, (resin tags)3 50 m.

2, 6,
15
3-10-08 12:52
16
E E
.
H
. O
- (.. , , ,
). O
,
. O , (colour centers
chromophores), ,
,
7, 8.
(
),

5. K ,
,
,

.
H

(/)
, 5. E ,
,
.
H (surface gloss)
,
, o . To
9. T (specular reflection) ( ),
,
8, 10. A
,

(random reflection) (diffuse
reflection). H , , ,
8.
H
, 16
. A,
, , 8.

. H
.
YIKA KAI MEOO
T
1. H

, 1,5
mm,
. T , ,
-. A ,
20 s (Elipar Visio II, Espe GmbH, Seefeld,
Germany), 650 mW/cm2
500-400 nm, (Model 100, Demetron Corp., Danbury,
CT, U.S.A.). A . K, IG-330A Gloss Checker
(Horiba Ltd, Kyoto, Japan),
(
90%). O / 60 (E. 1)
5x3 mm,
1. O

YIKO/KIKO
KATAKEYATH
Assure/AS
Reliance, Itaca, IL, USA
Enlight/EL
ORMCO, Glendora, CA, USA
Lightbond/LB
Reliance , Itaca, IL, USA
Kurasper /KS
Kurakay, Okayama, JPN
TYO*
X+
*:, X: X
49: 15-20, 2005
3-10-08 12:52
17
E E
E. 1: 60. H
() () . : . : (==60).
.
H ( -A)
. ,
( E). O

12
(Fressima, F.I.T., Turin, Italy) 15 s. A
. T,
,
( E+Y), .
T (three-way ANOVA) (), (E)
(E+Y) . O -
E. 2: I
60 G (5).
A: O
E: M
E+Y: M
Tukey. =0.05. H Sigma Stat

(Jandel, S. Rafael, CA, USA).
AOTEEMATA
E 2

(60oG %)
. O 2
,
( )
. O 3. H
(7,17-2,22 %) (82,5-
2
ANOVA
M
T
E
T
T
F
()
140,99
46,99
0,38
p*
0,762
E (E)
104.400,1
52.200,6
430,68
<0,001
E+Y (E+Y)
2.234,3
62.234,5
345,3
<0,001
A x E
474,53
79,09
0,653
0,688
x E+Y
234,45
65,45
0,34
0,456
E x E+Y
342,56
70,32
0,43
0,534
x E x E+Y
10
201,23
60,34
0,39
0,332
*O .
49: 15-20, 2005
17
3-10-08 12:52
18
E E
3

(n=4, =0.05).
/ (60oG %) KATATAH
E*
SD
Tukey**
EN/A
82.50 7.35
AS/A
81.60 10.40
LB/A
80.60
5.70
KS/A
77.30 6.60
KS/E+Y
34.10 18.15
AS/E+Y
33.44 18.49
EN/E+Y
32.80 8.26
LB/E+Y
26.50 13.50
AS/E
7.17
1.09
KS/E
6.11
3.88
LB/E
6.01
3.12
EN/E
2.22
0.44
* A: , E: , E+Y:

** M p= 0.05.
77,3 %). H
(34,1-26,5%),
.
YZHTHH
O
, ,
, , . T
,
,

,
, 11-13.

, 18
.

14. H , .
,
15. ,

,

5
m. ,
, . , 1 m,
55 % , 16. K
, ,

.
H . E
(resin-rich
layer), , 17. T
,
,
.
H (),
, (n1=1 ), (n2)
()8. ,
0 ( ) 0 =(n2n1/n2+n1)2. E 1,49-1,52,
,
, .
M ,
49: 15-20, 2005
3-10-08 12:52
19
E E
(1/10-1/30
) , 18.
Enlight

. H
,
(L*)
Munsell19. ,
: 400 nm
(). K ,

(200 nm 0,2 m), , 8.
H
( 5-15 ) 1/3
. H ,
, (nH2O=1,33) ,
-, ,
,
. T
(wet
roughness)8 , . H (. . )
, , . ,
,
15.
,
,
,

49: 15-20, 2005
. H
. O

. E
, ,
. A, .
SUMMARY
Effect of grinding of orthodontic bonding resins

on their surface gloss
C. Gioka, E. Bitsanis, G. Eliadies, E. Katsavrias
The purpose of this study was to assess the effect of a

resin removal method used following debonding of
orthodontic brackets, on the gloss of the resin surface.
Four specimens of four brands of orthodontic adhesives
(Assure, Enlight, Lightbond, Kurasper) were prepared and
subjected to 60o-angle loss measurements (60o G%). The
resin surfaces were ground with a 12-flute tungsten
carbide bur simulating the clinical resin removal process
following debonding, and the surface gloss was recorded
as previously. The same surfaces were wetted with water
and the gloss was measured again. Gloss differences
between the three measurement conditions (baselineground-ground and wet) and between the adhesives were
analyzed employing three-way ANOVA and the Tukeys
test at an =0.05 significance level. No differences were
identified between the adhesive brands, except Enlight
after grinding, which demonstrated the lowest 60o G%
values. Grinding strongly reduced surface gloss (p<0,05),
which was increased after wetting (p<0,05), but failed to
rich the reference values. Based on the results of this
study, the documented changes in the optical properties
of enamel following debonding of orthodontic resins may
partially be assigned to the gloss reduction of residual
resin from the resin grinding procedures.
Key words:
BIBIOPAIA
1. Van Waes H, Matter T, Krejci I: Three-dimensional
measurement of enamel loss caused by bonding and
debonding of orthodontic brackets. Am J Orthod Dentofacial
Orthop 1997;112:666-669.
2. gaard B, R lla G, Arends J: Orthodontic appliances and
enamel demineralization. Part 1. Lesion development. Am J
Orthod Dentofacial Orthop 1998;94:68-73.
3. Sandisson R: Tooth surface appearance after debonding. Br
J Orthod 1981;8:199-201.
4. gaard B: Prevalence of white spot lesions in 19-year olds: a
19
3-10-08 12:52
20
E E
study on untreated and orthodontically treated persons 5

years after treatment. Am J Orthod Dentofacial Orthop
1989;96:423-7.
5. Eliades T, Kakaboura A, Eliades G, Bradley TG: Comparison
of enamel colour changes associated with orthodontic
bonding using two different adhesives. Eur J Orthod
2001;23:85-90.
6. Maijer R, Smith DC: Corrosion of orthodontic bracket bases.
Am J Orthod 1982;81:43-48.
7. Turner GPA: Introduction to Paint Chemistry, Interscience,
London 1985.
8. Darvell BW: Materials Science for Dentistry, 7th ed, B.W.
Darvell, Hong Kong 2002.
9. Inokoshi S, Kataumi M, Pereira PNR, Yamada T, Tagami J:
Appearance of composite resins in posterior teeth. In:
Factors Influencing the Quality of Composite RestorationsTheory and Practice, Prati C, Dondi dallOrologio G (eds),
Vardellino Z, Bergamo,1997;141-152.
10. Nadal, M, Thompson E: New primary standard for specular
gloss measurements. J Coatings Technology 2000; 72 (911):
61-66.
11. Inokoshi S, Burrow MF, Katanni M, Yamada T, Tekatsu T:
Opacity and color changes of tooth colored restorative
materials. Oper Dent 1996;21:73-80.

12. Kap A, Sim C, Loganathan V: Polymerization color changes of
esthetic restoratives. Oper Dent 1999;24:306-311.
13. Ruyter IE Svedsen SA: Remaining methacrylate groups in
composite restorative materials. Acta Odontol Scand
1978;36:75-82.
14. Zachrisson BU: Enamel surface appearance after various
debonding techniques. Am J Orthod 1979:75:121-137.
15. Jogrensen KD, Shimokobe H: Adaptation of resinous
restorative materials to acid etched enamel surfaces. Scand
J Dent Res 1975;83:31-36.
16. Perdigao J: An Ultra Morhological Study of Human Dentine
Exposed to Adhesive Systems, PhD Thesis,Van Der Poorten,
Leuven 1995.
17. Okazaki M, Douglas WH: ESCA investigation of the resin-rich
layer on composites. J Dent Res 1983; 62 (Spec. Issue): 671,
Abstr 195.
18. Chung K: Effects of finishingand polishing procedures on the
surface texture of resin composites. Dent Mater 1994;10:325330.
19. Saton N, Khan AM, Matsumae I, Saton J, Sinteni H: In vitro
color change of composite-based resins. Dent Mater
1989;5:384-387.
:
. H
E B
O /
A
2
A 11527
20
49: 15-20, 2005
21-27 SEL. - CHRYSOMALI*
3-10-08 12:53
21
K M
T
40 :
K 47
E. X*, E. **, M. I***, .I. ****
H (AK)
,
. AK
40
. Y
47 AK E
1970-2001. T 629 AK, 7,5%
40 . A . H 32,7 , 74,5% . O
(63%) 70,7% , 55.5% . , 52,3% 43,2% 4,5% .
49: 21-27, 2005
30/12/2003 - 12/5/2004
EIAH
A , 80% (AK) (1). T AK -
: ,
40 , , .
*
**
***
****
E K
E , Y IKY
Y
K
E , O A
H 21 O , , 2001
, 500.000
(2-4).
5 - 8 , / (3-6). H 40
0,4%-3,6%(714)
. ,
AK (15-19).
H
,
, , ..(3-6). H AK
, 21
3-10-08 12:53
22
K M
de novo
(7, 20-23). ,
, , ,
. , AK (20-25).
O AK < 45 ,

,
(26-28).
AK
40

.
YIKO KAI MEOOI
T
E O
A. K
(40 ),
in situ,
, 1970- 2001.
O
, ,
. I
-, O Y
(WHO) : in situ,
AK
AK , .
1. (AK) 40
AK*
AK
40 **
AK 40
***
1970-1979 43 (1.38%)
3 (6.97%)
0.01%
3107
1980-1990 384 (4.51%)
29 (7.55%)
0.34%
8514
1991-2001 202 (2.49%)
15 (7.42%)
0.18%
8107
629 (3.18%) 47 (7.47%)

0.24%
19728
31
* AK (%) ** T (%)
AK, *** T (%)

A
, 3 in situ 44 AK,
3 . , 23 AK
(52,3%),19 (43,2%)
2 (4,5%).
H 32,7 .
76% , AK 31-40 , 14-20 21-30
(. 2). ,
(74,5%) (25,5%)
2,9: 1 (E. 1).
2. H 40

H
A. (%)
14-20
5 (11%)
21-30
6 (13%)
31-40
36 (76%)
47 (100%)
AOTEEMATA
A 629 AK
E
1970-2001, 47 40 . O 7,5% AK 0,24%
19728
. T AK ,
(. 1).
22
E. 1: K 47 AK 40 .
H AK
63%, " "
AK, ,
, 49: 21-27, 2005
3-10-08 12:53
23
K M
80,4%. A
8,7% 13,7%
(. 3).
3. E 46 AK 40
E
A. . (%)
29 (63%)
4 (8.7%)
4 (8.7%)
4 (8.7%)
1 (2.7%)
1 (2.7%)
1 (2.7%)
1 (2.7%)
1 (2.7%)
T
41/47 ( 4). H

70,7% 41 (E. 2),
(E. 3). O in situ AK (E.
4) 9,8%
7,3% .
E. 3: K

18 , .
4. K 40
K
A (%)
23
6
5
4
3
41
(56.1%)
(14.6%)
(12.2%)
(9.8%)
(7.3%)
(100%)
E. 4: K 21 . M
, in situ.
H
36/47 10
3 66,7% (. 5). H 6 16,7% ,
in situ
AK
6 2 . T
0,4 - 4 55,5% (. 6).
E. 2: K
35 .
49: 21-27, 2005
5. X 36 40
A (%)
10 1
9 (25%)
>1 3
15 (41.7%)
>3 6
6 (16.7%)
>6 12
4 (11.1%)
>1 2
2 (5.5%)
23
3-10-08 12:53
24
K M
6. M 27 40
M ( )
0.4 < 1
1 <2
2 4
A (%)
3 (11 %)
12 (44.5%)
12 (44.5%)
27 (100%)
36/47 . A , 19
(52,7%), 17 (47,3%) .
,

,
26 (E. 5).
E. 5:
26 AK 40 .
H
(33/39, 84,6%). H

(. 7).
7. 39 40
K
(. .)
A
T
K
84,6% (33 .)
5,1% (2 .)
2,6% (1 .)
5,1% (2 .)
2,6% (1 .)

, . , 2/4 AK
, AK, (). 24
, 18
(E.3).
YZHTHH
H AK ,
AK 0,4% 3,6%
40 (7-14, 28), 45
6,7%(15) 12,8%(29).

(16-20, 27). E I K
HA, 1973-1997 AK < 40 60%(19),
Myers .(18)
4% 1971 18% 1993.
, 7,5%
AK 40 . A
(8-14, 28),

( 1980-90 1991-01).
H AK
6,97% 1970-79 7,55%
1980-90 ,

AK
.
H AK (30), 75% < 45 /
( 21 ). 25% , AK
. , , (30). A
AK , , ,
AK ( ).
T AK
/ ,
49: 21-27, 2005
3-10-08 12:53
25
K M
AK ,

(8, 12, 21-23, 31-33). H
Schantz .(31) 83 < 40 AK , - 9 , 5
. Foulkes .(32)
,
AK - ,
.
T AK 45
,
(21-23, 32). A , -, ,

(.. CYPIA1 GSTM1),

p53, p21, Rb MDM2(21-23, 25).
O
AK , (HPV) Epstein Barr Virus, . H

(
, ),

(.. , )(5,
11, 28, 34-37)
. E , 18
,
.

,
(29, 30).

, AK < 40 (8, 11, 16, 33, 38, 39). T ,
(22, 40). , (76%)
31-40 , (30).
, AK
49: 21-27, 2005
80% " " , ,

. T
(2, 11, 13, 26, 29, 30, 38, 39). T 70,7%
AK .
55,5%,
TNM
T1(1, 5). T 44,5% AK T2.
H . K AK. 10-30
25% ,
41,7%
3 .
(41) AK <45 ,
21 62%
. (41), AK, . E,

(41). H AK
AK.
, 52,3% . AK
58,7%(29)
70,6%(7). O AK
, (33). O AK ,
. M

(8, 11, 27, 42). A,
25
3-10-08 12:53
26
K M
40 , (7, 10,
17-19, 38, 39, 43-45)
.
YMEPAMATA
T AK
40 7,5% 629 AK. H
AK
.
T AK , 31-40
76% . O (63%) 70,7%
, 55,5%
.
, 52,3% 43,2% 4,5%
.
A ,

,

,
.
SUMMARY
Oral squamous cell carcinoma in young adults

under the age of 40 years: A clinicopathologic
study of 47 cases
E. Chrysomali, E. Piperi, M. Iakovou, S.I. Papanikolaou
Background: Squamous cell carcinoma of the oral cavity

(OSCC) is rare in patients of age 40 and younger, being
primarily a malignant neoplasm that occurs in males in
their sixth and seventh decade. Recent studies indicate
the presence of a sharply increasing incidence in Western
countries.
Objective: The evaluation of the clinical and histopathological features of OSCC in patients less than 40
years of age.
Patients and Methods: The OSCC cases of age 40 years
or younger, which were diagnosed in the Department of
Oral Pathology between 1970 and 2001, were
retrospectively analyzed on the basis of their clinicopathological features.
Results: Forty-seven cases of OSCC were found in
patients less than 40 years, accounting for about 7.5 % of
the 629 total cases of OSCC during the 31 years period.
The age of the patients ranged between 14 and 40 years
old at the time of diagnosis and the mean age was 32.7
26
years; the male-to-female ratio was 2.9:1. The tongue

(63%), gingiva (11.4%), and floor of the mouth (8.7%),
were the most commonly affected sites. In 70.7% of the
cases, the OSCC appeared as an ulcer or ulcerative tumor
and the size of the lesions was less than 2 cm in 55.5% and
2-4 cm in 44.5% respectively. In 25% of the cases, the
duration of the lesions at the time of diagnosis ranged
between 10 days and 1 month after the initial presentation
in the mouth. In 41.7% of the cases the duration of the
lesion was more than 1 to 3 months. The histopathologic
evaluation revealed 3 cases of in situ carcinoma, 23 well
differentiated, 19 moderately, and 2 poorly differentiated
OSCCs .
Conclusions: The data of the present study indicate that
young patients under the age of 40 comprise 7.5% of all
cases of OSCC. The incidence of OSCC in young adults
was not significantly increased during the last three
decades.
Key words: oral squamous cell carcinoma, clinicopathologic
study, young adults, under the age of 40
BIBIOPAIA
1. Vokes EE, Weichselbaum RR, Lippman SM et al: Head and
neck cancer. N Engl J Med 1993; 328: 184-194.
2. Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E,
et al: Cancer Statistics, 2004. CA Cancer J Clin 2004; 54: 829.
3. Blott WJ, McLaughlin JK, Winn D et al: Smoking and drinking
in relation to oral and pharyngeal cancer. Cancer Research
1988; 48: 3282-3287.
4. Cann CI, Fried MP, Rothman KJ: Epidemiology of squamous
cell cancers of the head and neck. Otolaryngol Clin 1985; 18:
367-388.
5. A A, , A E: . 3 . I , A, 2000: . 57-60.
6. Brugere J, Guenel P, Leclerc A, Rodriguez J: Differential
effects of tobacco and alcohol in cancer of the larynx,
pharynx, and mouth.Cancer 1986; 57: 391-395.
7. Atula S, Grenman R, Laippala P, Syrjanen S: Cancer of the
tongue in patients younger than 40 years. A distinct entity?
Arch Otolaryngol Head Neck Surg 1996; 122: 1313-1319.
8. Jones JB, Lampe HB, Cheung HW: Carcinoma of the tongue
in young patients. J Otolaryng 1989; 18: 105-108.
9. La Vecchia C, Franceschi S, Levi F, Lucchini F, Negri E: Diet
and human oral carcinoma in Europe. Eur J Cancer B Oral
Oncol 1993; 29: 17-22.
10. MacFarlane GJ, Boyle P, Evstifeeva TV, Robertson C, Scully
C: Rising trends of the oral cancer mortality among males
worldwide: the return of an old public health problem. Cancer
Causes Control 1994; 5: 259-265.
11. McGregor GI, Davis N, Robins RE: Squamous cell carcinoma
of the tongue and lower oral cavity in patients under 40 years
of age. Am J Surg 1983; 146: 88-92.
12. Carniol PJ, Fried MP: Head and neck carcinoma in patients
under 40 years of age. Ann Otol 1982; 91: 152-155.
13. Friedlander PL, Schantz SP, Shaha AR, Yu G, Shah JP:
Squamous cell carcinoma of the tongue in young patients: a
matched-pair analysis. Head Neck 1998; 20: 363-368.
14. Hindle I, Downer MC, Speight PM: The epidemiology of oral
cancer. Br J Oral Maxillofac Surg 1996; 34: 471-476.
49: 21-27, 2005
3-10-08 12:53
27
K M
15. Son YH, Kapp DS: Oral cavity and oropharyngeal cancer in a
younger population. Cancer 1985; 55: 441-444.
16. Cusumano RJ, Persky MS: Squamous cell carcinoma of the
oral cavity and oropharynx in young adults. Head Neck
Surgery 1988; 19:229-234.
17. Annertz K, Anderson H, Biorklund A et al: Incidence and
survival of squamous cell carcinoma of the tongue in
Scandinavia, with special reference to young adults. Int J
Cancer 2002; 101:95-99.
18. Myers JN, Elkins T, Roberts D, Byers RM: Squamous cell
carcinoma of the tongue in young adults: increasing
incidence and factors that predict treatment outcomes.
Otolaryngol Head Neck Surg 2000; 122: 44-51.
19. Schantz SP, Yu GP: Head and neck cancer incidence trends
in young Americans, 1973-1997, with a special analysis for
tongue cancer. Arch Otolaryngol Head Neck Surg 2002; 128:
268-274.
20. Hindle I, Nally F: Oral cancer: a comparative study between
1962-67 and 1980-84 in England and Wales. Br Dent J 1991;
170: 15-19.
21. Regezi JA, Dekker NP, Mc Millan A, Ramirez-Amador V,
Meneses-Garcia A, Ruiz-Godoy Rivera LM et al: p53, p21, Rb,
and MDM2 proteins in tongue carcinoma from patients <35
versus >75 years. Oral Oncology 1999; 35: 379-383.
22. Mork J, Moller B, Glattre E: Familiar risk in head and neck
squamous cell carcinoma diagnosed before the age of 45: a
population-based study. Oral Oncol 1999; 35: 360-367.
23. Jin YT, Myers J, Tsai ST, Goepfert H, Batsakis JG, El-Naggar
AK: Genetic alterations in oral squamous cell carcinoma of
young adults. Oral Oncol 1999; 35: 251-256.
24. Franceschi S, Barra S, La Vecchia C, Bidoli E, Negri E,
Talamini R: Risk factors for cancer of the tongue and the
mouth. A case control study from northern Italy. Cancer
1992; 70: 2227-2233.
25. Sorensen DM, Lewark TM, Haney JL, Meyers AD, Krause G,
Franklin WA: Absence of p53 mutations in squamous
carcinomas of the tongue in nonsmoking and nondrinking
patients younger than 40 years. Arch Otol Head Neck Surg
1997; 123: 503-506.
26. Oliver RJ, Dearing J, Hindle I: Oral cancer in young adults:
report of three cases and review of the literature. Br Dent J
2000; 188: 362-366.
27. Lund VJ, Howard DJ: Head and neck cancer in the young
adults: A prognostic conundrum? J Laryngol Otol 1990; 104:
544-548.
28. Llieweiiyn CD, Johnson NW, Warnakulasuriya K: Risk factors
for squamous cell carcinoma of the oral cavity in young
people-a comprehensive literature review. Oral Oncology
2001; 37: 401-418.
29. Iamaroon A, Pattanaporn K, Pongsiriwet S, Wanachantararak
S, Prapayasatok S, Jittidecharaks S, et al. Analysis of 587
cases of oral squamous cell carcinoma in northern Thailand
with a focus on young people. Int J Oral Maxillofac Surg
2004; 33: 84-88.
30. Llewellyn CD, Linklater K, Bell J, Johnson NW,
Warnakulasuriya KAAS: Squamous cell carcinoma of the oral
cavity in patients aged 45 years and under: a descriptive

analysis of 116 cases diagnosed in the South East of
England from 1990 to 1997. Oral Oncology 2003; 39: 106114.
31. Schantz SP, Byers RM, Goepfert H, Shallenberger RC,
Bedigfield N: The implication of tobacco use in the young
adult with head and neck cancer. Cancer 1988; 62: 13741380.
32. Foulkes WD, Brunet JS, Sieh W, Black MJ, Shenouda G,
Narod SA: Familiar risks of squamous cell carcinoma of the
head and neck in Brazil: retrospective case-control study.
British Medical Journal 1996; 313: 716-721.
33. Kyriakose M, Sankaranarayanan M, Nair MK et al:
Comparison of oral squamous cell carcinoma in younger
and older patients in India. Oral Oncol Eur J Cancer 1992;
28B: 113-120.
34. Maden C, Backmann AM, Thomas B et al: Human
papillomaviruses, herpes simplex viruses and the risk of oral
cancer in men. Am J Epidemiol 1992; 135: 1093-1102.
35. Van Heerden WFP, Van Rensburg EJ et al: Prevalence of EBV
in oral squamous cell carcinomas in young patients.
Anticancer Res 1995; 15: 2335-2340.
36. Flaitz CM, Nichols CM, Adler-Storthz K, Hicks MJ: Intraoral
squamous cell carcinoma in human immunodeficiency virus
infection. A clinicopathologic study. Oral Surg Oral Med Oral
Pathol Oral Radiol Oral Endod 1995; 80: 55-62.
37. Birkerland SA, Storm HH, Lamm LU et al: Cancer risk after
renal transplantation in the Nordic countries, 1964-1986.
International J Cancer 1995; 60:183-189.
38. Siegelmann-Danieli N, Hanlon A, Ridge JA, Padmore R, Fein
DA, Langer CJ: Oral tongue cancer in patients less than 45
years old: institutional experience and comparison with older
patients. J Clin Oncol 1998; 16: 745-753.
39. Pitman KT, Johnson JT, Wagner RL: Cancer of the tongue in
patients less than forty. Head Neck 2000; 22: 297-302.
40. Muscat JE, Richie Jr JP, Thompson S, Wynder EL: Gender
differences in smoking and risk for oral cancer. Cancer
Research 1996; 56: 5192-5197.
41. Llewellyn CD, Johnson NW, Warnakulasuriya S: Factors
associated with delay in presentation among younger
patients with oral cancer. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2004; 97:707-13.
42. Sarkaria JN, Harari PM: Oral tongue cancer in young adults
less than 40 years of age: rationale for aggressive therapy.
Head Neck 1994; 16: 65-68.
43. Davidson BJ, Root WA, Bruce JT: Age and survival from
squamous cell carcinoma of the oral tongue. Head Neck
2001; 23: 273-279.
44. Hart AKE, Karakla DW, Pitman KT, Adams JF: Oral and
oropharyngeal squamous cell carcinoma in young adults. A
report of 13 cases and review of the literature. Otolaryngol
Head Neck Surg 1999; 120: 728-833.
45. Manuel S, Raghavan SK, Pandey M, Sebastian P: Survival in
patients under 45 years with squamous cell carcinoma of the
oral tongue. Int J Oral Maxillofac Surg 2003; 32: 167-173.
:
E. X
M 1, N. 152 36, A
T: 210-8032063
email: echryso@dent.uoa.gr
49: 21-27, 2005
27
29-35 SEL. - KOIDIS
3-10-08 12:53
29
K M
H
.
. K*, . M**, . K***
H , O. H , , .

. E 65 72 ( 17-82 )
. A : . , . . , 21, 21 , .
(ANOVA) students' t-tests. 21
,
. O ,
50 ,
, 21.
49: 29-35, 2005
2/3/2004 - 14/5/2004
EIAH
T , ,
(1). K-
: K , , ,
.
* O
** O, Y , T O A...
*** A K, E. A &
E, T O
A...
A
19 O
E O O, H
O 1999.
(
- )
, (2).
H ,
,
.
H (lip line),
,
(3) (smile line), . T (4): 1. T ( ),
2. ( ), 3.
( ,
(commissures) ).
29
29-35 SEL. - KOIDIS
3-10-08 12:53
30
K M
H Tjan .(5) :
1) Y (
-).
2) M ( 75-100%
).
3) X ( 75% ).
O Jensen .(6)
(
), :
0: X . 25% .
1: M . 25% - 75%
.
2: Y . 75%
.
3: . 2mm.
A
Crispin & Watson(7),
(showing), (not showing),
(normal smile) (exaggerated smile) ,
Peck .(4),
mm 0
,
( ,
) (rest position)
(smiling).
A
,
,

. H
, " "
, "" , . ,

.
, . E 65 72 ( 17-82 , 38,61 ) . A
: (
), ( (4)
(E.1). O
Nikon F90 Nikkor
Medical Lenses (Nikon Corporation, Tokyo, Japan), 50 .
YIKA KAI MEOO

,
,
30
E. 1: : . , .
, . .
49: 29-35, 2005
29-35 SEL. - KOIDIS
3-10-08 12:53
31
K M
0,05 . Y
: . 21 ( - ), . 21 ( ), .
21 (
- ) . 21 (
-
). 2mm 21.

. H

: . 30 , . 30 50
. 50 (4).
H
21 ,
,
50%, 50% 100%
21.

( Peck .(4))
,
.

2 , 21
30 . T (students't-Testpaired samples) 95% (. A.=0.7094, . =0.1295,
p=0.826).

(One-way analysis of variance-ANOVA)
students' t-tests ( 95%).
100%
(E. 3). O (
0,125) , (E. 2),
( 2,5:1) (E. 4).
E. 2: T 21, 21
21 . * p<0,05.
E. 3: E 21:
(%) .
AOTEEMATA
T

( 0,108)
(E. 2). A,

( 0,807 0,823
, p<0,05) (E. 2). T, 49: 29-35, 2005
E. 4: (%) .
31
29-35 SEL. - KOIDIS
3-10-08 12:53
32
K M
50 (p<0,05 <30 p<0,001

30-50 ) (E. 5).
5,
,
50 . A,
(E. 5),
50 (E. 4).
E. 5: T 21, 21
21 . * p<0,05, ** p<0,001
YZHTHH
H
, 1-3 .,

(gummy smile)(2). T
(altered
passive eruption),
(vertical maxillary excess)(8).
O . :
A. H , . (9-11)

- , .

(, , ) ,

150m(12, 13), .
, .
32
B.

2mm(14). A "",
Boucher .(15). O Sharry(16) '

l-2mm, '
5-6mm
. O Ellinger .(17)

. T Zarb
.(18)

.
K (normal smile)
,
.
. T (scalloped)

, , .
H
.

(6, 8).
. ,
, . ,

. ' (19).

, (20).
,
(21). A
, ,
- (22).
M 49: 29-35, 2005
29-35 SEL. - KOIDIS
3-10-08 12:53
33
K M
, .
YO
T
,
. K

,

(23-27),
,

(16, 28).
H
, . O Vig Brundo(29) , Peck .(4) , . ,
, , 47%, (20%)
(E. 3),
Tjan (5).
H , Peck .(4)
.
H
Peck .(4) 15 . T , ( > 1 ,
Peck .(4)) ,
( 2,4:1) (E. 6). A (5, 6, 30).
T
,
(47% 83%
) ,

, .
HIKIA
T

50 (E. 5). T
49: 29-35, 2005
(23-27). H
50 ,
,
, Vig Brundo(29),
Dong .(31) Choi .(32). A,
Wichman(33)

,
25 55 .
T

,
1 . ( , Peck .(4)) (E.
6). H
Wichman(33).
A, Jensen .(6),

,
11 71 .
E. 6: Y Peck . (4) ()
() .
T

,
,
.

, ,

.
YMEPAMATA
1. H

,
.
2. M
33
29-35 SEL. - KOIDIS
3-10-08 12:53
34
K M
, ( 2,5:1 2,4:1 ).
3. 50
.
4. H

.
SUMMARY
Teeth and gingival display of maxillary central

incisors. A preliminary report.
D. Kapagiannidis, P. Bikos, P. Koidis
Teeth and gingival display are important characteristics of

the smile, with increased clinical significance in fixed
prosthodontics. The purpose of this study was to
investigate maxillary central incisor and associated
gingival display during smile and to reveal possible
differences related to gender and age. The sample
consisted of 65 men and 72 women (17-82 years)
attending regular dental care. Three pictures from each
individual, one with lips in rest position, another in
maximum smile and a last one in frontal view with
retractors were taken, and clinical crown length, as well
as amount of teeth and gingival display, were measured in
left maxillary central incisor. One-way analysis of variance
was used to assess any statistically significant impact of
gender and age on teeth and gingival display, while
student t tests for independent samples were performed
in order to determine differences among gender and age
groups. Women presented statistically significant
(p<0,05) greater amount of central incisor display in both
rest and smiling positions, while men displayed greater
amount of gingiva (not statistically significant, p>0,05).
Women displayed maxillary central incisor gingiva in a
percentage of 43%, more than double of that recorded in
men (17%), and presented high smile lines in a 2,4:1 ratio
over men. Statistically significant less incisor display was
recorded in ages greater than 50 years old (p<0,05) in
both rest and smiling positions, while no statistically
significant differences were revealed between age
subgroups concerning gingival display.
Key words: Central incisors, gingival exposure, maximum smile,
smile line, lip line
BIBIOPAIA
1. Goldstein R: Study of need for esthetics in dentistry. J
Prosthet Dent 1969;21:589-98.
2. Peck S, Peck L, Kataja M (a): The gingival smile line. The
Angle Orthodontist 1992;62:91-100.
3. Lichter JA, Solomowitz BH, Sauco M, Sher M: N Y State Dent
J. 1999 Dec;65:34-9.
34
4. Peck S, Peck L, Kataja M (b): Some Vertical Lineaments of the

lip Position. Am J Ortod Dentofac Orthop 1992; 101:519-24.
5. Tjan AHL, Miller GT: The J G P. Some esthetic factors in a
smile. J Prosth Dent 1984; 51:24-8.
6. Jensen J, Joss A, Lang N P: The Smile Line of Different
Ethnic Groups in Relation to Age and Gender. Acta Med
Dent Helv 1999; 4:38-46.
7. Crispin BJ, Watson JF: Margin placement of esthetic veneer
crowns. Part I : Anterior tooth visibility. J Prosth Dent 1981;
45:278-82.
8. Garber DA, Salama MA: The Aesthetic Smile: Diagnosis and
Treatment. Periodontology 2000, 1996; 11:18-28.
9. Waerhaug J: Tissue reactions around artificial crowns. J
Periodont 1953; 24:172-85.
10. Valderhaug J, Birkeland JM: Periodontal conditions in
patients 5 years following the insertion of fixed prostheses. J
Oral Rehabil 1976; 3: 237-43.
11. Valderhaug J: A 15-years clinical evaluation of fixed
prosthodontics, Acta Odontol Scand 1991; 49:35-40.
12. Glantz PO, Nyman S: Technical and Biophysical aspects of
fixed partial dentures for patients with reduced periodontal
support. J Prosthet Dent 1982; 47:47-51.
13. Lang NP, Kaamp-Hansen D, Joss A, Siegrist BE, Weber HP,
Gerber C, Saxer P, Cmilovic Z: The significance of overhanging filling margins in the status of interdental
periodontal tissues of young adults Schweiz Monatsschr
Zahnmed 1988; 98:725-30.
14. Heartwell CM, Rahn A: Syllabus of Complete Dentures. 2nd
ed. Philadelphia. Lea & Febiger. 1986: 224.
15. Boucher CO. Hickey JD, Zarb GA, Bolender GD: Boucher's
Prosthodontic treatment for the Edentulous Patient. 7th ed.
St Louis. Mosby Corp. 1975: 224.
16. Sharry JJ: Complete Denture Prosthodontics 2nd Ed, New York,
Blakiston Division, McGraw-Hill Book Company. 1968: 228.
17. Ellinger CW, Rayson JH, Terry JM, Rahn AO: Synopsis of
Complete Dentures, Philadelphia, Lea&Febiger,1975:163.
18. Zarb GA, Bolender CL, Carlsson GE, Boucher CO:
Boucher's Prosthodontic Treatment for Edentulous
Patients. 11th Ed. St. Louis, Mosby. 1997: 311.
19. Zitzmann NU, Marinello CP: Treatment Plan for Restoring the
Edentulous Maxilla with Implant-Supported Restorations:
Removable Overdentures Versus Fixed Partial Denture
Design. J Prosthet Dent 1999; 82:188-96.
20. Lewis S, Sharma A, Nishimura R: Treatment of edentulous
maxillae with osseointegrated implants. J Prosthet Dent
1992; 68:503-8.
21. Mecall RA, Rosenfeld AL: Influence of Residual Ridge
Resolution Patterns on FLxure Placement and Tooth
Position, Part III: Presurgical Assessment of Ridge
Augmentation Requirements. Int J Periodont Rest Dent
1996; 16: 323-37.
22. Hess D, Buser D.Dietschi D, Grossen G, Schonenberger A,
Reiser U: Esthetic single-tooth replacement with implants: A.
team approach Quintessence Int 1998; 29:77-S6.
23. Ekfeldt A, Hugoson A, Bergendal T, Helkimo M: An individual
tooth wear index and an analysis of factors correlated to
incisal and occlusal wear in an adult Swedish population.
Acta Odontol Scand 1990; 48: 343-9.
24. Johansson A, Kiliaridis S, Haraldson T, Omar R, Carlsson GE:
Co-variation of some factors associated with occlusal tooth
wear in a selected high-wear sample. Scand J Dent Res
1993; 101: 398-406.
25. Smith BG, Robb ND: The prevalence of tooth wear in 1007
dental patients. J Oral Rehabil 1996; 23: 232-6.
49: 29-35, 2005
29-35 SEL. - KOIDIS
3-10-08 12:53
35
K M
26. Pigno MA, Hatch JP, Rodrigues-Garcia RC, Sakai S, Rugh

JD: Severity, distribution, and correlates of occlusal tooth
wear in a sample of Mexican-American and EuropeanAmerican adults. Int J Prosthodont 2001; 14: 65-70.
27. Chuajedong P, Kedjarune-Leggat U, Kertpon D, Chongsuvuvat-Wong V, Benjakul P: Associated factors of tooth wear in
southern Thailand. J Oral Rehabil 2002; 29: 997-1002.
28. Magne PPD, Gallucci GO, Belser UC: Anatomic crown
width/length ratios of unworn and worn maxillary teeth in
white subjects. J Prosthet Dent 2003; 89: 453-61.
29. Vig GR, Brundo GC: The Kinetics of anterior tooth display. J
Prosth Dent 1978; 39:502-504.
30. Rigsbee OH, Sperry TP, BeGole EA: The influence of facial
animation on smile characteristics. Int J Adult Orthod
Orthogn Surg 1988; 3: 233-9.
31. Dong JK, Jin TH, Cho HC, Oh SC: The Esthetics of the Smile:
A Review of Some Recent Studies Int J Prosthodont 1999;
12:9-19.
32. Choi TR, Jin TH, Dong JK: A study on the exposure of
maxillary and mandibular central incisor in smiling and
physiologic rest position. J Wonkwang Dent Res Instit 1995;
5:371-9.
33. Wichmann M: Visibility of front and side teeth. [Uber die
Sichtbarkeit der Front- und Seiten-zahne], ZWR 1990;
99:623-6.
:
. K
E A 36
546 21 EAONIKH
T.: 2310-999659, 2310-273472
Fax: 2310-999676
E-mail: pkoidis@dent.auth.gr
49: 29-35, 2005
35
37-40 SEL. - DALABIRAS
3-10-08 12:54
37
E () .
A
. *, M. **, A. X***
(submerged)
, .
19 ,
, . O , . O . H .
M ,
. H ,

. H . , . T
.
49: 37-40, 2005

25/9/2003 - 19/5/2004
EIAH
(submerged), ,
, 1.
: , , , , , .
* E K A...
** X O, M. Eastman Dent. Inst.
*** X O, M. A...
O
Humm (1861) Edgelow (1877)2.
K
, , , , .. O
(submerged
teeth)1,2,3,4,5,6,7,8,9,10,11,12.13,14.
A
1,12. O
2,10,12. , 0,5-3% 1,2,9,11,12.
37
3-10-08 12:54
38
, () () ,

1,2,3,7,10,11,12.
,

. M

.

35 .
APOYIAH EPITATIKOY
A, 19 . A 36.
35, 36
. O 34 37 ,
75, . K , 35
,
33 34. (E. 1)
E. 2: . O 35
.
H . E 2
35
, . (E.3). T
35
.
E. 3: 35 .
E. 1: O 75
. O (floating) .
A 75 35 .
K 75
. H .
H , 35
, , . (E. 2)
38
YZHTHH
O (submerged)
,
(ankylosed)1,2,4,9,10,11,12.

,
1,12.
,

1,2,4,9,10,11,12.
49: 37-40, 2005
3-10-08 12:54
39

,
, , ,
, ,

1,2.
15.
T

7-10 4-6 11-15 . Y
1,2.
H ,

1,2,9.
, Darling
1. E 2. A 3. M
() 4. B 5.

.
H Darling
75.
O A . (2002)
, 3 , ,

12.
Darling
. (1973)
. K
,
2.

, Rune (1971) 30 Darling .
(1973) 54 ,

A .
H
, lamina dura, 49: 37-40, 2005

1,2,4,5,6,7,8,11.

,
. , , .
H

, 8,10,11,12.
(infra occlusions)

. A

8.
,
. M , .
O Kurol Koch (1985) ,
16. E Cobourne
(2002) ,
.
,
,

.
K
17
. A , ,
. O
.
39
3-10-08 12:54
40
SUMMARY
Submerged (ankylosed) teeth.

A rare case report
S. Dalabiras, M. Drydaki, A. Chatzivassileiou
Teeth are described as submerged when they for some

reason fail to maintain their position in level with the other
teeth of the dental arch. After their eruption, they gradually
lose contact with their antagonists and may finally be
more or less covered by the surrounding tissue.
An interesting case of a 19- yearold female patient with a
submerged lower left second deciduous molar is
presented. The permanent successor failed to erupt due
to the presence of the submerged tooth and remained
impacted. The deciduous molar with total root resorption
was surgically extracted. The impacted premolar moved
to the right direction towards his place into the dental arch
without the use of orthodontic means.
Given the opportunity, a bibliography review is conducted
towards the subject. Opinions of many authors are
discussed concerning the pathogenesis, the clinical and
radiographic picture and histological features of this rare
condition. The treatment plan of analogous cases is also
commented
Key words: submerged teeth, pathogenesis, clinical and
radiographic picture, histologic features, treatment plan.
BIBIOPAIA
1. Rune B: Submerged deciduous molars Odontol.Revy 1971;
22 (3): 257-73.
2. Darling AI, Levers BGH: Submerged human deciduous
molars and ankylosis Arch. Oral Biol 1973; 18: 1021-1040.
3. Koyoumdjisky-Kaye E, Steigman S: Ethnic variability in the

prevalence of submerged primary molars J Dent Res 1982
Dec; 61(12): 1401-4.
4. Rogers J, Nelson J: Amalgam restoration in a submerged
tooth Oral Surg Oral Med Oral Pathol 1984 Feb; 57(2): 233.
5. Park J: Submerged impacted primary molar Oral Surg Oral
Med Oral Pathol 1979 Oct; 48(4): 383.
6. Rental JR: Transposed and submerged teeth. Oral Surg Oral
Med Oral Pathol 1978 Oct; 46(4): 599.
7. Kessel LJ, Bisset RC: Bilateral submerged deciduous teeth.
Oral Surg Oral Med Oral Pathol 1978 Aug; 46(2): 328.
8. Cobourne MT, Brown JE, F. McDonald: Analysis of the
morbidity of submerged deciduous molars: the use of
imaging techniques. Oral Surg Oral Med Oral Pathol 2002
Jan; 93(1): 98-102.
9. Steigman S, Koyoumdjisky-Kaye E, Matrai Y: Submerged
deciduous molars in preschool children: An epidemiologic
survey. J Dent Res 1973 Mar-Apr; 52(2): 322-6.
10. Alexander SA: Premolar impaction related to ankylosed,
totally submerged primary molar: A case report. J Ped Dent
1992; 16 (4): 267-270.
11. Allsopp P, Johns M: Restored, totally submerged deciduous
molar. A case report. Austr Dent J Feb 1982; 27:1, 27-29.
12. Antoniades K, Kavadia S, Milioti K., Antoniades V, Markovitsi
E: Submerged teeth J Ped Dent 2002; 26 (3): 239-242.
13. Antoniades K, Tsodoulos S, Karakasis D: Totally submerged
deciduous maxillary molars. Case reports Austr Dent J
1993; 38 (6): 436-8.
14. Steigman S, Koyoumdjisky-Kaye G and Matrai Y:
Relationship of submerged deciduous molars to root
resoption and development of permanent successors. J
Dent Res 1974 Jan-Feb; 53(1): 88-93.
15. Bjerklin K, Bennet J: The long -term survival of lower second
primary molars in subjects of agenesis of the premolars. Eur
J Orthod 2000; 22: 245-55.
16. Kurol J, Koch J: The effect of extraction of infraoccluded
deciduous molars: a longitudinal study. Am J Orthod 1985;
87:46-55.
17. Kurol J, Thilander B: Infraocclusion of primary molars and
the effect on occlusal development, a longitudal study. Eur
J Orthod 1984; 6: 277-93.
:
.
M 33
546 22 EAONIKH
T: 2310-231624
40
49: 37-40, 2005
41-45 SEL. - XATZHPETROU*
3-10-08 12:55
41
. B ,

A. X*, K. A**
A , . O

. H , . H
.
,
. H . K ,
. T

49: 41-45, 2005
8/3/2004 - 3/9/2004
EIAH
O ,
.
H
, , .
O , Sicher 1948
(1). M 39

( I). H

: , , .
.
* X
** K X
E X, O , A
: K .. K
, . ,
(
)
.
T
/ .
H . O
, (2-6).

,

. E .
ANAOPA EPITH
N , 23 41
3-10-08 12:55
42
1. B
A/
A.
Sicher, 1948*
Stadnicki, 1971 (12)
N ()
Lysell and Oberg, 1975 (28)
21
Farmand, 1981 (27)
45
Forman and Smith, 1984

(9)
1
1
28
30
A
A
A
A
T
T
Huls et al., 1984*
Smith, 1985 (10)
32
Balciunas, 1986 (22)
67
Thomason and Yusuf,

1986 (15)
1
1
5
6
N
N
10
Quayle and Adams, 1986 (14)
15
11
Shaber, 1987 (26)
26
A &
12
Gundlach et al., 1987 (87)
23
A
A
1
1
1
13
Sahm and Witt, 1989 (18)
14
McCormick et al., 1989

(23)
1
1
1
38
61
50
15
To, 1989 (13)
34
16
To, 1989 (17)
17
Loh and Yeo, 1990 (7)
, clicking,
A &
A &
A &
T , K
T , K
T , K
: 17mm
53
,
: 13mm
24
1
1
21
27
T , clicking
Clicking,
18
Antoniades et al., 1993 (2)
59
Follow up # , T
19
Wu et al., 1994 (19)
1
1
21
23
A
A
N
N
25mm
28mm
20
., 1994 (24)
34
21
Kahl et al., 1995 (6)
14
22
Cowan et al., 1997 (5)
23
Stefanou et al., 1998 (21)
1
1
1
1
55
47
39
69
A &
A &
A &
A &
T
T
T

24
Garcia Gonzalez et al.,

2000 (25)
63
Clicking, , : 34mm
25
Artvinli and Kansu, 2003 (4)
A &
26
Antoniades et al., 2004 (3)
15
A &
P, ,
, : 24mm
27
23
T , clicking
A, 2004
T:40
* A Szentpetery et al., 1990 (1). =, A=, =, A=, K= ,
= , T= .
42
49: 41-45, 2005
3-10-08 12:55
43

. O

. T .
M
. T
, (E. 1 2). K

, , . .
.
M

. H CT
, (E. 3) , , (E. 4). .
E. 3: E

.
E. 1:
) 48 ) .
E. 4: . H .
YZHTHH
E. 2: M .
49: 41-45, 2005
H . 43
3-10-08 12:55
44
,
, , (1, 5, 7-12). E ,

,
(13, 14). T (remodeling) (2, 6, 15, 16). M
,
35% (2-4, 6, 8, 12, 13, 15, 17-19). T
Hlawitschka Eckelt(20). O , , 30% (20).
T ,
, (7, 9, 21-24).

. A ,

() (7, 14, 23, 25).

, ,
( ), ,
, ,
(2, 3, 7, 12-15, 17-19, 21, 25-28).
H
,
. H 3 69 , 33,8
1,3:1.
O . ,
(3, 4, 18, 21, 23, 26).
H . T
. H
(CT)
(2-4, 6, 18, 20). H CT

,
, 44

.
, -,
(1, 9, 21),
. E - (3, 4). ,

. O
- ,
,
. H
. (E. 3)
,
(E. 4).
H
. H (12, 14, 17).
YMEPAMATA
O ,
. X
. H .
SUMMARY
Bifid mandibular condyle.
Case report and review of the literature
L. Hadjipetrou, K. Antoniades
Bifid mandibular condyle is a rather uncommon condition. It

is characterized by the duplicity of the head of the
mandibular condyle; thus it is also known as double-headed
condyle. The bifid condyles etiology and pathogenesis is
uncertain. The most tenable theory is that it is of traumatic
origin. Trauma may result in condylar bifidism, which would
then represent a developmental anomaly. Others support
the opinion that bifid condyle develops in cases with
insufficient remodeling capacity. According to the current
English literature, history of condylar trauma is evident in
approximately 30% of all cases reported.
49: 41-45, 2005
3-10-08 12:55
45
The bifidism of the condylar head can be found unilaterally or bilaterally. Concerning the unilateral bifid condyle,
it is found that there is no age predilection. The male
/female ratio seems to be 1.3:1. Bifid condyles more often
appear to involve the left side.
Symptoms described with bifid condyles vary from case
to case. Bifid condyle may be associated with temporomandibular joint (TMJ) sounds, pain, restriction of
mandibular movement, trismus, swelling, ankylosis, facial
asymmetries, snoring, and mandibular hypoplasia. In
some instances symptoms are absent.
The diagnosis of the bifid condyle is based on its
radiographic appearance. The bifid condyle may be
discovered on dental radiographic examination or during
the investigation of another problem. The ideal method for
the detailed evaluation of condylar morphology seems to
be coronal computed tomography (CT). On coronal CT
views, the condylar splitting ranges from a shallow groove
to two distinct condyles with a separate neck.
The treatment of the symptomatic bifid condyle is usually
conservative and similar to the treatment for the closely
associated TMJ pain dysfunction syndrome.
The purpose of this article is to report a new case of a
unilateral bifid condyle in a young male. The diagnosis
was based on the radiological examination, which
included CT. Since the condition was asymptomatic and
it was incidentally found, no treatment was indicated. The
presented data are discussed in connection with the
relevant literature.
Key words: bifid mandibular condyle, double-headed mandibular
condyle, condylar head duplication
BIBIOPAIA
1. Szentpetery A, Kocsis G, Marcsik A: The problem of the bifid
mandibular condyle. J Oral Maxillofac Surg 1990; 48:12541257.
2. Antoniades K, Karakasis D, Elephteriades J: Bifid mandibular
condyle resulting from a sagittal fracture of the condylar
head. Br J Oral Maxillofac Surg 1993; 31:124-126.
3. Antoniades K, Hadjipetrou L, Antoniades V, Paraskevopoulos
K: Bilateral bifid mandibular condyle. Oral Surg Oral Med
Oral Pathol Oral Radiol Entod 2004; 97:535-538.
4. Artvinli LB, Kansu O: Trifid mandibular condyle: A case
report. Oral Surg Oral Med Oral Pathol Oral Radiol Entod
2003; 95:251-254.
5. Cowan DF, Ferguson MM: Bifid mandibular condyle.
Dentomaxillofac Radiol 1997; 26:70-73.
6. Kahl B, Fischbach R, Gerlach KL: Temporomandibular joint
morphology in children after treatment of condylar fractures
with functional appliance therapy: a follow-up study using
computed tomography. Dentomaxillofac Radiol 1995;

24:37-45.
7. Loh FC, Yeo JF: Bifid mandibular condyle. Oral Surg Oral
Med Oral Pathol 1990; 69:24-27.
8. Gundlach KK, Fuhrmann A, Beckmann-Van der Ven G: The
double-headed mandibular condyle. Oral Surg Oral Med
Oral Pathol 1987; 2:249-253.
9. Forman GH, Smith NJ: Bifid mandibular condyle. Oral Surg
Oral Med Oral Pathol 1984; 57:371-373.
10. Smith AC: Duplication of the condyle. Oral Surg Oral Med
Oral Pathol 1985; 60:456.
11. Poswillo DE: The late effects of condylectomy. Oral Surg
Oral Med Oral Pathol 1972; 33:500-512.
12. Stadnicki G: Congenital double condyle of the mandible
causing tempormandibular joint ankylosis: report of case. J
Oral Surg 1971; 29:208.
13. To EW: Supero-lateral dislocation of sagitally split bifid
mandibular condyle. Br J Oral Maxillofac Surg 1989; 27:107113.
14. Quayle AA, Adams JE: Supplemental mandibular condyle.
Br J Oral Maxillofac Surg 1986; 24:349-356.
15. Thomason JM, Yusuf H: Traumatically induced bifid mandibular
condyle: Report of two cases. Br Dent J 1986; 161:291-293.
16. Lund K: Mandibular growth and remodeling processes after
condylar fracture. Acta Odont Scand Suppl 1974; 32:3-117.
17. To EW: Mandibular ankylosis associated with a bifid
condyle. J Craniomaxillofac Surg 1989; 17:326-328.
18. Sahm G, Witt E: Long tem results after childhood condylar
fractures. A computer tomographic study. Eur J Orthod
1989; 11:154-160.
19. Wu XG, Hong M, Sun KH: Severe osteoarthrosis after fracture
of the mandibular condyle: a clinical and histologic study of
seven patients. J Oral Maxillofac Surg 1994; 52:138-142.
20. Hlawitschka M, Eckelt U: Assessment of patients treated for
intracapsular fractures of the mandibular condyle by closed
techniques. J Oral Maxillofac Surg 2002; 60:784-791.
21. Stefanou EP, Fanourakis IG, Vlastos K, Katerelou J: Bilateral
bifid mandibular condyles. Report of four cases.
Dentomaxillofac Radiol 1998; 27:186-188.
22. Balciunas BA: Bifid mandibular condyle. J Oral Maxillofac
Surg 1986; 44:324-325.
23. McCormick SU, McCormick SA, Graves RW, Pifer RG:
Bilateral bifid mandibular condyles. Oral Surg Oral Med Oral
Pathol 1989; 68:555-557.
24. X, E, E: O
: . O 1994; 48:30-34.
25. Garcia-Gonzalez D, Martin-Granizo R, Lopez P: Imaging quiz
case 4. Bifid mandibular condyle. Arch Otolaryngol. Head
Neck Surg 2000; 126:795 126:798-799.
26. Shaber EP: Bilateral bifid mandibular condyles. J
Craniomandibular Pract 1987; 5:191-195.
27. Formand M: Mandibular condylar head duplication. J
Maxillofac Surg 1981; 9:59-60.
28. Lysell G, Oberg T: Unilateral doubling of mandibular
condyle. Dentomaxillofac Radiol 1975; 4:95-98.
:
. X
E
X
O , A
540 06 EAONIKH
T.: 2310999651
Fax: 2310999451
e-mail: lhadjip@hotmail.com
49: 41-45, 2005
45
47-55 SEL./ FOURMOUZIS*
3-10-08 12:55
47
B A
H

I. K*, M. T**, I. ***
.

. T .

, . K ,
. E, ,
, ,
, .
49: 47-55, 2005
5/12/2003 - 11/5/2004
EIAH
.
. O Friedman1
,
.
: ,
, .
* E. / A
** O
*** / A
T , . T

. X
,
. T

,
2. H

, 3. H ,
,

. ,
47
3-10-08 12:55
48
B A

1, 3, 4, 5, 6, 7. E,
, , 8, 9. K
,

10, 11, 12. O ,
. O Corn12
3 , Bowers13 , 1 . Friedman8 De Trey Bernimulin14 , ,
(E. 1).
M
-
E. 1: A 31, 41.
.

Lang Le15.
,

(mm),

. O , , . K
2mm
48
. T

, . M ,
.
() . A .
TEXNIKE AYHH TOY EYPOY TH ZNH
TN POEYKOTN OYN
O , . H
,
.
T
(denudation technique):
H Ocshenbein
19605, gingival replacement.
H
, .
,
.

.

12, 16.
H ,
, ,
8. O Wilderman17
, , ,
. H
49: 47-55, 2005
3-10-08 12:55
49
B A

Carranza Carraro6 .
T
(periosteal retention procedure split flap procedure)
H Staffileno 1962,
, , , 18. M ,
, 19.
A
(apically repositioned flap procedure)
H Friedman8,
.
,
, ,
, 3-5mm, 8.
M ,
. , , 20.
O ,
21.
22. A
,
. A . ,

,
.
.
E (free gingival graft)
H 1963 Bjorn23
,
Nabers 196624 . ,
, . T , 49: 47-55, 2005
,
,

.
O Dordick .25
, .
H , , 26, 27 (E. 2). M , , -
E. 2: , 2 .
, ( , ),
. ,
, ,
. T,

, 28, 29.
Y
T
Edel30
. A Langer Calagna31
.
T 1985 Langer
Langer32. ,

49
3-10-08 12:55
50
B A
. E . H
22, 33, ,

. , ,
, ' .
H :

,
. A
, .

. ,
, , .
O ,
. T

. T
.
A
(Acellular Dermal Matrix Allograft)
To .
A 1994
. T ,
. M , . H
,
,
,
. H :
, . T
. O Wei . . K ,
. H 50
,

34.
YZHTHH
H
,

, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. H
35, 36,
. O
, ,
. M

Lang Le 197215. O , , 2mm , 1mm
. O Wennstrom Lindhe
198337, 38 ,
, .
,
(
). T , . , ,

. H ,

, . ,

39. O Dorfman
.40 , , 49: 47-55, 2005
3-10-08 12:55
51
B A
. M

,
. T 4
6 41, 42. 14, 43. O Wennstrom44
5 ,

. T

,
45, 46, 47, 48, 49.
H
.
50, 51, 52, 53. H ,

7, 54.O Coatam
.52 , 100 , (<2mm)
.
O , . K ,
-
52, 55. Steiner .56
. E,
. H
Wennstrom .57 49: 47-55, 2005
, . K
, , o
, . K ,
. H
52, 53,
. 56, 57,
. , , 58, 59. ,
56, 57. ,

. ,

59.
.
,

, ,
. A , , 57 (E. 3, 4). A ,

, 60, 61.
H
, . H ,
62,
63, 64. O Stetler Bissada65 ,
51
3-10-08 12:55
52
B A
E. 3: A
. , ,
41-43 .
E. 4: H 7 . , .

(<2mm), .
H , , , 66, 67, 68. B
, . O Maynard Wilson69 ,
. K , ,
3mm. T
52
. O Donaldson62 .

,
.
I , ,
,
70. T
, (46-74%),
71, 72, 73, 74, 75, 76.
O Wennstrom .76 . Y
77,

.

Warrer .78 , ,
.
T
,

. H

79, 80. O . H
. , . T, ,
,
,
.
49: 47-55, 2005
3-10-08 12:55
53
B A
SUMMARY
The importance of the zone of attached gingiva

for the maintenance of periodontal health
I. Karoussis, M. Trianti, I. Fourmousis
For many years the presence of a certain zone of attached

gingiva surrounding teeth was considered as an
important prerequisit for the maintenance of periodontal
health. One of the main objectives of mucogingival
surgery was the preservation or increase of this zone.
Recent studies questioned the initial opinion about the
minimum width of keratinized tissue required for the
preservation of periodontal health.
In the present review of the literature the initial concept
about the relationship between the width of attached
gingiva and periodontal health is presented. Furthermore,
mucogingival surgery techniques performed to increase
the zone of attached gingiva are described.Currently
used surgical procedures include autogenous grafts and
allografts. Moreover, current research data concerning
the importance of a zone of attached gingiva and the
indications of mucogingival surgery techniques, in case
of orthodontic treatment, subgingival restoration and
implant therapy are presented.
Key words: zone of attached gingiva, mucogingival surgery,

keratinized periimplant mucosa
BIBIOPAIA
1. Friedman N: Mucogingival surgery. Texas Dent J 1957;75:358362.
2. Carranza F, Newman M: Clinical Periodontology 8th edition.
Saunders, Philadelphia, 1996:12-51.
3. Friedman N, Levine L: Mucogingival surgery: Current status.
J Periodontol 1964:5-21.
4. Nabers CL: Repositioning the attached gingiva. J
Periodontol 1954;25:38-39.
5. Ocshenbein C: Newer concept of mucogingival surgery. J
Periodontol 1960;31:175-185.
6. Carranza FA, Carraro JJ: Effect of removal of periosteum on
post-operative results of mucogingival surgery. J Periodontol 1963;34:223-226.
7. Hall WB: The current status of mucogingival problems and
their therapy. J Periodontol 1981;52:569-575.
8. Friedman N: Mucogingival surgery: The apically
repositioned flap. J Periodontol 1962;33:328-340.
9. Ruben MP: A biological rationale for gingival reconstruction
by grafting procedures. Quintessence 1979;10:47-55.
10. Gottsegen R: Frenulum position and vestibular depth in
relation to gingival health. Oral Surgery 1954;7:1069-1078.
11. Rosenberg NM: Vestibular alterations in periodontics. J
Periodontol 1960;31:231-237.
12. Corn H: Periosteal separation- Its clinical significance. J
Periodontol 1962;33:140-152.
13. Bowers GM: A study of the width of attached gingiva. J
Periodontol 1963;34:201-209.
14. De Trey E, Bernimulin J: Influence of free gingival grafts on
49: 47-55, 2005
the health of the marginal gingiva. J Clin Periodontol

1980;7:381-393.
15. Lang N, Le H: The relationship between the width of
keratinized gingiva and gingival health. J Periodontol
1972;43:623-627.
16. Wilderman MN: Exposure of bone in periodontal surgery.
Dent Clin North Am 1964, March: 23-26.
17. Wilderman MN, Wentz FM, Orban BJ: Histogenesis of repair
after mucogingival surgery. J Periodontol 1961;31:283-299.
18. Staffileno H, Wentz, Orban B: Histologic study of split
thickness flap surgery in dogs. J Periodontol 1962;33:56-69.
19. Costich ER, Ramfjord SF: Healing after partial denudation of
the alveoral process. J Periodontol 1968;39:5-12.
20. Donnenfeld OW, Marks RM, Glickman I: The apiocally repositioned flap- a clinical study. J Periodontol 1964;35:381-387.
21. Pfeifer JS: The growth of gingival tissue over denuded bone.
J Periodontol 1963;34:10-16.
22. Karring T, Ostergaard E, Le H: Conservation of tissue
specificity after heterotopic transplantation of gingiva and
alveoral mucosa. J Periodont Res 1971;6:282-293.
23. Bjorn H: Free transplantation of gingival propia. Odont.Revy.
1963;14:323.
24. Nabers CL: Free gingival grafts. Periodontics 1966;4:243245.
25. Dordick B, Coslet JG, Seibert JS: Clinical evaluation of free
autogenous grafts placed on alveolar bone. Part I. Clinical
predictability. J Periodontol 1976;47:559-567.
26. Schoo WH, Coppes L: Use of palatal mucosa and lyophilized
dura mater to create attached gingiva. J Clin Periodontol
1976;3:166-172.
27. Hall WB, Lundergan WP: Free gingival grafts. Current
indications and techniques. Dent Clin North Am
1993;37:227-242.
28. Haeri Alireza, Serio Francis: Mucogingival surgical
procedures: A review of the literature. Quintessence
International 1999;7:475-483.
29. Proceedings of the World Workshop in Clinical Periodontics
(1989). Discussion section VII. Gingival Augmentation/
Mucogingival Surgery.
30. Edel A: Clinical evaluation of free connective tissue grafts
used to increase the width of keratinized gingiva. J Clin
31. Langer B, Calagna L: The subepithelial connective tissue
graft. J Prosthet Dent 1980;44:363.
32. Langer B, Langer L: Subepithelial connective tissue graft
technique for root coverage. J Periodontol 1985;56:715-720.
33. Wennstrm Jan L: Mucogingival Therapy. Annals of
Periodontology 1996; 1:671-701.
34. Wei PC, Laurell L, Geivelis M, Lingen MW, Maddalozzo D:
Acellular dermal matrix allografts to achieve increased
attached gingiva. Part I. A clinical study. J Periodontol
2000;71:1297-1305.
35. Stoner J, Mazdyasna S: Gingival recession in the lower
incisor region of 15-year old subjects. J Periodontol
1980;51:74-76.
36. Tenenbaum H: A clinical study comparing the width of
attached gingiva and the prevalence of gingival recessions.
J Clin Periodontol 1982;9:86-92.
37. Wennstrm J, Lindhe J: The role of attached gingiva for
maintenance of periodontal health. Healing following
excisional and grafting procedures in dogs. J Clin
Periodontol 1983a;10:206-221.
38. Wennstrm J, Lindhe J: Plaque-induced gingival
inflammation in the absence of attached gingiva in dogs. J
Clin Periodontol 1983b;10:266-276.
39. Miyasato M, Crigger M, Egelberg J: Gingival condition in
53
3-10-08 12:55
54
B A
areas of minimal and appreciable width of keratinized

gingiva. J Clin Periodontol 1977;4:200-209.
40. Dorfman HS, Kennedy JE, Bird WC: Longitudinal evaluation
of free autogenous gingival grafts. J Clin Periodontol
1980;7:316-324.
41. Dorfman HS, Kennedy JE, Bird WC: Longitudinal evaluation
of free gingival grafts. A four-year report. J Periodontol
1982;53:349-352.
42. Kennedy JE, Bird WC, Palcanis KG, Dorfman HS: A
longitudinal evaluation of varying widths of attached gingiva.
J Clin Periodontol 1985;12:667-675.
43. Hangorsky U, Bissada NB: Clinical assessment of free
gingival graft effectiveness on maintenance of periodontal
health. J Periodontol 1980;51:274-278.
44. Wennstrm JL: Lack of association between width of
attached gingiva and development of gingival recessions. A
5-year longitudinal study. J Clin Periodontol 1987;14:181184.
45. Lindhe J & Nyman S: Alterations of the position of the
marginal soft tissue following periodontal surgery. J Clin
46. Schoo WH, van der Welden U: Marginal soft tissue
recessions with and without attached gingiva J Periodont
Research 1985;20:209-211.
47. Kisch J, Badersten A, Egelberg J: Longitudinal observation
of unattached, mobile gingival areas. J Clin Periodontol
1986;13:131-134.
48. Salkin L, Fredman AL, Stein MD, Bassiouny MA: A
longitudinal study of untreated mucogingival defects. J
Periodontol 1987;58:164-166.
49. Freedman AL, Salkin LM, Stein MD, Green K: A 10-year
longitudinal study of untreated mucogingival defects. J
50. Pearson LE: Gingival height of lower central incisors
orthodontically treated and untreated. Angle Orthodontist
1968;38:337-339.
51. Maynard JG, Ocshenbein D: Mucogingival problems,
prevalence and therapy in children. J Periodontol
1975;46:543-552.
52. Coatoam G, Behrents RG, Bissada NF: The width of
keratinized gingiva during orthodontic treatment: its
significance and impact on periodontal status. J Periodontol
1981;52:307-313.
53. Foushee DG, Moriarty JD, Simpson DM: Effects of
mandibular orthognathic treatment on mucogingival tissue.
54. Boyd RL: Mucogingival considerations and their relationship
to orthodontics. J Periodontol 1978;49:67-76.
55. Andlin-Sobocki A, Bodin L: Dimensional alterations of the
gingiva related to changes of facial/lingual position in
permanent anterior teeth of children. A 2-year longitudinal
study. J Clin Periodontol 1993;20:219-224.
56. Steiner GC, Pearson JK, Ainamo J: Changes of the marginal
periodontium as a result of labial tooth movement in
monkeys. J Periodontol 1981;52:314-320.
57. Wennstrm JL, Lindhe J, Sinclair F, Thilander B: Some
periodontal tissue reactions to orthodontic tooth movement
in monkeys. J Clin Periodontol 1987;14:121-129.
58. Ericsson I, Thilander B, Lindhe J: Periodontal condition after
orthodontic tooth movement in the dog. Angle Orthodontics
1978;48:210-218.
59. Baker DL, Seymour GJ: The possible pathogenesis of
gingival recession. A histological study of induced recession
in the rat. J Clin Periodontol 1976;3:208-219.
60. Engelking G, Zachrisson BU: Effects of incisor repositioning
54
on monkey periodontium after expansion through the

cortical plate. Am J Orthodontics 1982;82:23-32.
61. Karring T, Nyman S, Thilander B, Magnusson I, Lindhe J:
Bone regeneration in orthodontically produced alveoral
bone dehiscences. J Periodont Res 1982;17:309-315.
62. Donaldson D: The etiology of gingival recession associated
with temporary crowns. J Periodontol 1974;45:468-471.
63. Valderhaug J: Periodontal conditions and caries lesions
following the insertion of fixed prostheses: a 10- year followup study. Int Dent J 1980;30:296-304.
64. Parma- Benfenati S, Fugazzato PA, Ruben MP: The effect of
restorative margins on the postsurgical development and
nature of the periodontium. Int. J Periodont Restor Dent
1985;5(6):31-51.
65. Stetler KJ, Bissada NF: Significance of the width of
keratinized gingiva on the periodontal status of teeth with
submarginal restorations. J Periodontol 1987;58:696-700.
66. Ocshenbein C, Ross S: A concept of osseous surgery and
its clinical application. In: Ward HL, Chas C, eds A
periodontal point of view. Springfield, IL: Charles C.
Thomas, 1973.
67. Gorman WJ: Prevalence and aetiology of gingival recession.
68. Ericsson I, Lindhe J: Recession in sites with inadequate
width of the keratinized gingiva. An experimental study in the
dog. J Clin Periodontol 1984;11:95-103.
69. Maynard JG, Wilson RD: Physiologic dimensions of the
periodontium significant to the restorative dentist. J
Periodontol 1979;50:170-174.
70. Berglundh T, Lindhe J, Ericsson I, Marinello CP, Liljenberg B,
Thomsen P: The soft tissue barrier at implants and teeth. Clin
Oral Implants Res 1991;2:81-90.
71. Adell R, Lekholm U, Rockler B et al: Marginal tissue reactions
at osseointegrated implants. A 3-year longitudinal
prospective study. Int J Oral Maxillofac Surg 1986;15:39-52.
72. Lekholm U, Adell R, Lindhje J et al: Marginal tissue reactions
at osseointegrated titanium fixtures. A cross-sectional
retrospective study. Int J Oral Maxillofac Surg 1986;15:53-61.
73. Bower RC, Radney NR, Wall CD, Henry RJ: Clinical and
microscopics findings in edentulous patients 3 years after
incorporation of osseointegrated implant-supported
bridgework. J Clin Periodontol 1989;16:580-587.
74. Apse P, Zarb GA, Schmitt A, Lewis DW: The longitudinal
effectiveness of osseointegrated dental implants. The
Toronto study: Peri-implant mucosal response. Int. J.
Periodontics Restorative Dent 1991;11:95-111.
75. Mericske-Stern R, Steinlin Schaffner T, Marti P, Geering AH:
Peri-implant mucosal aspects of ITI implants supporting
overdentures. A five-year longitudinal study. Clin Oral
Implants Res 1994;5:9-18.
71. Adell R, Lekholm U, Rockler B et al: Marginal tissue reactions
at osseointegrated implants. A 3-year longitudinal
prospective study. Int J Oral Maxillofac Surg 1986;15:39-52.
72. Lekholm U, Adell R, Lindhje J et al: Marginal tissue reactions
at osseointegrated titanium fixtures. A cross-sectional
retrospective study. Int J Oral Maxillofac Surg 1986;15:53-61.
73. Bower RC, Radney NR, Wall CD, Henry RJ: Clinical and
microscopics findings in edentulous patients 3 years after
incorporation of osseointegrated implant-supported
bridgework. J Clin Periodontol 1989;16:580-587.
74. Apse P, Zarb GA, Schmitt A, Lewis DW: The longitudinal
effectiveness of osseointegrated dental implants. The
Toronto study: Peri-implant mucosal response. Int J
Periodontics Restorative Dent1991;11:95-111.
49: 47-55, 2005
3-10-08 12:55
55
B A
75. Mericske-Stern R, Steinlin Schaffner T, Marti P, Geering AH:

Peri-implant mucosal aspects of ITI implants supporting
overdentures. A five-year longitudinal study. Clin Oral
Implants Res 1994;5:9-18.
76. Wennstrm JL, Bengazi F, Lekholm U: The influence of the
masticatory mucosa on the peri-implant soft tissue
condition. Clin Oral Implants Res 1994;5:1-8.
77. Strub JP, Garberthuel T W, Scharer P: The role of attached
gingiva in the health of periimplant tissue in dogs. Part I.
Clinical findings. Int J Periodont Restor Dent 1991;11:317-333.
78. Warrer K, Buser D, Lang NP, Karring T: Plaque- induced periimplantitis in the presence or absence of keratinized
mucosa. An experimental study in monkeys. Clin Oral Impl
Res 1995;6:131-138.
79. Proceedings of the 1st European Workshop in
Periodontology. Lang NP, Karring T, eds London
Quintessence 1994; pp. 210-214.
80. Proceedings of the World Workshop in Periodontics.
Consensus report on mucogingival therapy. Annals of
Periodontology 1996;1:397-402.
:
I.
E
A
2,
T.: 210- 7461104
49: 47-55, 2005
55
57-65 SEL. - ANDROYTSOY*
3-10-08 12:56
57
B A
M. A-
H . H . , , Burning Mouth Syndrome. , . T,

.
, , , ,
.
49: 57-65, 2005
11/10/2002 - 19/9/2003
EIAH
T , . O
,

Burning
mouth syndrome. M ,
, , .

(1). T
,
, ,
(2).
104 ,
, 312 , , ,
, , , -
: , , , , .
, , , .
(3).
T -, , .
O Van Der Waal ,
( 4).
H
, 7 (5).
, ,
.
O , , ,
, ,
, , .
57
3-10-08 12:56
58
B A
YMTMATA
T
burning mouth syndrome, : , , .

,
:
H ,
, , , ,
.
Y -, . H ,
, 71%,
50%,
46%, 46%
46%(6).
O Land . , .
1,
,
, .
2. O
, .
3. , (7).
T :
1. . , (8).
,
, IgA (9).
H , , , , , Sjogren, AIDS (, ), , (
, , ...) (10, 11).
2. H laser Doppler .
13 13
, , . H
. ,
. O ,
,
, .
H
(12).
3. , 58
. 30
30 , ,
,
. O
Zn, , 30% , ( 10%). T ,
, ,
(13).
4. , . A
.

, (), (), (),
(). 57 , , . O ,
(>0.10M), . O
,
(<0.10M) .
, . E, ,
19%
, 8% . K , , . H
,
.
, ,

(14, 15).
,
(16).
5. , (17).
6. , .
M ,
, ,
. ,
38 , 22
, 10 6 , , 49: 57-65, 2005
3-10-08 12:56
59
B A
. T N3 P4

. T
, . A
(18).
AITIA
, . ( 1).
T
O Mein & Basker, , . H
, ,

,
. ,
, (19, 20).
, . ,
22 , , .
, , , -
, . .
,
, ,
6 (27%) . NN- 4- 3 , 4- 2 ,
2 . 6 (27%) 4 (21).
(22).
E , , , , , , ,
. O

. H
. H
.
(23).
M , -
1. KATHOPIOOIHH TN AITIN TH TOMATOYNIA

TOIKA
1. A
K
A
K

2. A

3. O
4. K

E
5. A
6.

E
7.
49: 57-65, 2005
YTHMATIKA
1. E
O
2.
3. , M
4. Z
5. N
6.Y
7.
A
A
8. A
9.
K
A
M.
Sjgren
AIDS
10.
11. N

59
3-10-08 12:56
60
B A
,
. O

. H
(24).
O Gorsky . , , 86% 13% (25).

, . T
.
O , . A , , , . H
(26).
, , ,
(27).
O , ,
(27).

.
. , ,

,
.
O
, ,
, , , ,
(28).
A , ,
, . A ,

. O
,
, , ,
. , (29, 30).
O Basker . 26% , (31).
60
,
(32).

,
,
(33, 34).
2. M
H M . O
, , ,
(35).
, 41
35 ,
, B12, ,
. T Fairbanks & Klee.T B12
, . T
. ,
,

B12 . K
,
, (36).
, B1, B2, B6, 88% . O B (37).
3. Z
O 10%-37%.
, (38).
, ,
. A
, ,
, (39).
H
, 50%
2 , (40).
4. N
, , N .
24% 5
49: 57-65, 2005
3-10-08 12:56
61
B A
. H , ,
(41).
5. Y
H ,
,
,
(ACE)(42).
6.
E , , , , , (43).
7. B
H ,

. ,
. M
, ,
(44).
8.
E ,
, . , , ,
50% , (45, 46).
. H

,
(47).
O Van Der Waal ,
, (48).
, 67% . T . , ,

24% (49).
, 25 25 ,

(self-regulated strategy development =
SRSD, state trait anxiety inventory = STAI, eyesenck
personality questionnaire = EPQ, hostility and direction
of hostility questionnaire = HDHQ, SSPS), ,
HDHQ.
49: 57-65, 2005
E , . O N () L
(), EPQ. E . , , , , (50).
9. N
, , . , , 37 , .
, , , , . M ,
().
A 50% , . I
50% . H
,
70% .
, , (51, 52).
IANH
H ,
,
.
H , .
E
, .

, , , (RBC),
(MCV), (MCH),
(WBC), B12,
B1, B2 B6, TIBC, , , %
(53).
, 61
3-10-08 12:56
62
B A
.
, DT-1 - 36-38
K.
A ,
, 7 . H

33 K. (). ,
,
(54).
T
,
, ,
.
EPAEIA
H .
, .
E ,
, .
(55).
A ,
, (56). M
, ,
, 7% 70% ,
10(57). H . M Regnard . , , (58, 59).
O Van Der Waal,
2% , ,
.
T
,
, (60).
O . , , . H
, 25mg 10mg . A
,
62
, , , . 75
mg (61).

, ,
. ,
(62).
M
. 25
10
, 6 9 . H , 1-3 , , (3,3 ng/ml+/-0,66 & 3,3
ng/ml +/- 0,52 ). E
. O , ,
,
, (63).
, - (ALA),
, ,
. X 42
21 30 600mg , 20
200mg .
100 mg
30 . A , 2/3 15% placebo, (64).

(SSRIs), ,
. X 76
, 50mg/ , 20mg/
, 50 mg/ . T
,
. E
.
H

, .
A , . H
(65).
49: 57-65, 2005
3-10-08 12:56
63
B A
EIOO
H , ,
. E , ,
. A . T . ,
,
, , ,
, , ,
, , , , . ,
, , M , , , , , . H , ,
,
. A
,
. H
,
.
,
, ,
, , . T , ,
,
,
, .
SUMMARY
Burning Mouth Syndrome

M. Androutsou-Pantziou
The aim of this article is to review the most recent studies,

concerning Burning Mouth Syndrome. Complaint of burning
mouth is an increasingly common problem, in the aging
population. It has remained an enigma for the treating
49: 57-65, 2005
clinician, because there are no visible pathologic lesions.

The complaint of a burning sensation in the mouth may
possibly be a symptom of another disease or syndrome of
unknown etiology. In patients where no underlying dental
or medical causes are identified and no oral signs are
found, the term burning mouth syndrome should be used.
The prominent feature is the symptom of burning pain,
which can be localized just to the tongue and/or lips, but
can be more widespread and involve the whole of the oral
cavity. Reported prevalence rates in general populations
vary from 0.7%to 15%. Many of these patients show
evidence of anxiety, depression and personality disorders.
The patient suffering from stomatodynia, glossodynia
finds him/herself in a viscous cycle of anguish, involuntary
movements lingual pain, which they fear, is the beginning
of neoplastic disease in the area. Therapy should first
address the patients distress, by looking very closely at
the patient, by examining very carefully, by absolutely
gaining the confidence and by asserting the absence of
cancer while admitting the reality of the disease. We refer
to the local (denture, allergies galvanism, candida,
precancer situation, oral cancer), systemic (hormonal
disorders, infections, sideropenic anemia, Parkinson
disease, hypertension, medication, xerostomia), psychiatric causes of Burning Mouth Syndrome, the
symptoms, the laboratory tests that should be made, to
identify the BMS, or to exclude systematic problems,
masqueraded as BMS.
We refer to some therapeutic alternatives (medication and
psychiatric support) that a number of authors, suggest to
managing this difficult problem.
Given the chronic nature of burning mouth syndrome, the
need to identify an effective mode of treatment for patients
is very important. However, there is little research
evidence that provides clear guidance for dentists.
Further trials, of high methodological quality, need to be
undertaken in order to establish effective forms of
treatment for patients.
Key words: Burning Mouth Syndrome, Glossodynia, dysgeusia,
dysphagia, xerostomia
BIBIOPAIA
1. : ,
. 2 . E A 1999.
2. Lamey PJ, Lamb AB: Lip component of Burning Mouth
Syndrome. Oral surg Oral med Oral path 1994; 78(5): 590-3.
3. Pajukoski H, Meurman JH, Halonen P, Sulkava R: Prevalence
of subjective dry mouth and burning mouth in hospitalized
elderly patients and outpatients in relation to saliva,
medication, and systemic diseases. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2001; 92 (6): 641-9.
4. Van Der Waal: The Burning Mouth Syndrome. Copenhagen:
Munksgaard 1990; 19: 5-90.
5. Perno M: Burning Mouth Syndrome. J Dent Hyg 2001; 75(3):
24-32.
6. Van Der Ploeg HM, Van der Waal N, Eijkman M, et al:
Psychological aspects of patients with burning mouth
syndrome. Oral Surg Oral Med Oral Path 1987; 63: 664-668.
63
3-10-08 12:56
64
B A
7. Lamb AB, Lamey PJ, Reeve PF: Burning Mouth Syndrome,

Psychological aspects. Br Dent Jurn 1988; 165: 256-260.
8. Van Der Waal N: The Burning Mouth Syndrome.
Copenhagen: Munksgaard 1990; 19: 5-90.
9. Ben Aryeh H, Gottlieb I, Ish-Shalom S, et al: Oral complaints
related to menopause. Maturitas 1996; 24: 185-189.
10. Gao S, Wang Y, Wang Z: Assessment of trigemind
somatosensory evoked potentials in Burning Mouth
Syndrome. Chin J Dent Res 2000; 3 (1): 40-6.
11. Kassan SS: Managing dry eyes and dry mouth in Sjogrens
syndrome. Am J Mang Care 2001; 71 (4): 447-50.
12. Heckmann SM, Heekmann JG, Hilz MJ, Popp M, Merthol H,
Neundorfen B, Hummel T: Oral mucosal blood flow in
patients with burning mouth syndrome. Pain 2001; 15;
90(3): 281-86.
13. Maragou P, Ivanyi L: Serum Zinc levels in patients with
burning mouth syndrome Oral Surg Oral Med Oral Path
1991; 71(4): 447-50.
14. Formaker BK, Frank ME: Taste function in patients with oral
burning. Chem Senses 2000; 25(5): 575-81.
15. Grushka M, Epstein JR, Gorsky M: Burning Mouth
Syndrome. Am Fam Physician 2002; 63: 30-36.
16. Bergdahl J, Anneroth G, Anneroth I: Clinical study of patients
with burning mouth Syndrome. Scand J Dent Res 1994;
102: 299-305.
17. Grushka M: Clinical features of burning mouth syndrome.
Oral Surg Oral Med Oral Path 1987, 63: 30-36.
18. Gao S, Wang Y, Wang Z: Assessment of trigemind somatosensory evoked potential in Burning mouth syndrome. Chin
J Dent Res 2000; 3 (1): 40-6.
19. Main DM, Basker RM: Patients complaining of a burning
mouth. Further experience in Clinical assessment and
management. Br Dent J 1983; 154: 206-211.
20. Svensson P, Kaaber S: General health factors and denture
function in patients with Burning mouth syndrome and
matched control subjects. J Oral Rehabil 1995; 22: 887-895.
21. Dutree-Meulenberg RO, Kozel MM, Van Joost T: Burning
mouth syndrome: a possible Etiologic role for local contact
hypersensivity. J Am Acad Dermatol 1992; 26 (6): 35-40.
22. Bergdahl J, Anneroth G, Anneroth J. Clinical study of
patients with burning mouth. Scand J Dent Res 1994; 102:
299-305.
23. Van Der Waal J: The burning mouth syndrome Copenhagen
Munksgaard: 1990; 5-90.
24. Zakrzewska JM: The burning mouth syndrome remains an
enigma. Pain 1995; 62:253-257.
25. Gorsky M, Silverman S, Chinn H: Burning mouth syndrome;
A review of 98 cases J Oral Med 1987; 42: 7-9.
26. Van Der Waal: The Burning Mouth Syndrome. Copenhagen:
Munksgaard 1990; 19: 5-90.
27. : 2 . E . A 1999.
28. Ben Aryeh H, Gottlieb J, Ish-Shalom S, et al: Oral complaints
related to menopause. Maturitas 1996; 24:185-189.
29. Pisanti S, Rafaely B, Polishuk WK: The effect of steroid
hormones on buccal mucosa of menopausal women. Oral
Surg Oral Med Oral Path 1987; 40: 346-353.
30. Myers A, Naylor GD: Glossodynia as an oral manifestation of
sex hormone alterations. Ear Nose Throat J 1989;
68(10):786- 789.
31. Basker RM, Sturdce DW, Davenport JC: Patients with burning
mouth. A clinical investigation of causative factors including
the climacteric and diabetes. Br Dent J 1978; 145: 9-16.
32. Ferguson MM, Carter J, Boyle P, et al: Oral complaints
related to climacteric symptoms in oophorectomized
women. J R Soc Med 1981; 74: 491-498.
64
33. Farobosco A, Criscuolo M, Coukos G, et al: Efficacy of

menopausal women with oral discomfort. Oral Surg Oral
Med Oral Path 1992; 73: 570-74.
34. Zachariasen RD: Oral manifestations of menopause. Compedium 1993; 1584:1586-1591.
35. Vucicevic-Boras V, Topic B, Cekie-Arambasin A, Zadro R,
Stavlijenic-Rukavina A: Lack of association between burning
mouth syndrome and hematinic deficiencies. Eur J Med Res
2001; 28 ( 6): 409-12.
36. Huber MA, Hall EH: Glossodynia in patients with nutritional
deficiency Ear Nose Throat J 1989; 68 (10): 771-5.
37. Lamey PJ, Hammond A, Allan BF, Mcentosh WB: Vitamin
status of patients with burning mouth syndrome and the
response to replacement therapy. Br Dent J 1986, 160: 8184.
38. Gibson J, Lewis M, Frier B: Oral manifestation of previously
undiagnosed non-insulin dependent diabetes mellitus J
Oral Pathol Med 1990; 19: 284-287.
39. Carrington J, Getter L, Brown RS: Diabetic neuropathy
masquerading as Glossodynia. J Am Dent Assoc 2001; (11):
1549-51.
40. Basker RM, Sturdee DM, Davenport JC: Patients with
burning mouth a clinical investigation of causative factors
including the climacteric and diabetes. Br Dent J 1978; 145:
9-16.
41. Clifford TJ, Warsi NJ, Burnett CA, Lamey PJ: Burning mouth
in Parkinsons disease sufferers. Gerontology 1998; 15 (20):
73-8.
42. Brown RS, Krabom AM, Douglas T, Choksi SK: Scalded
mouth syndrome caused by angiotensin converting enzyme
inhibitors: Two case reports. Oral Surg Oral Med Oral Path
Oral Radiology Endod 1997;( 83): 665-667.
43. : . , 2 , E . A 1999.
44. Ito M, Kurita K, Ito T, et al: Pain threshold and pain stimulation
in patients with burning mouth syndrome. Psychiatry Clin
Neurosci 2002, 56 (2): 161-8.
45. Bogetto F, Maina G, Ferro G, Carbone M, Gandolfo S:
Psychiatric co morbidity in patiens with burning mouth
syndrome. Psychosom Med 1998, 60 (3): 378-85.
46. Dubois-Gosnet CH: The oral mucosa and delayed
hypersensitivity. Allerg Immunol 2002, 34 (1): 19-21.
47. Maresky LS, Van Der Bill J, Gird J: burning mouth syndrome.
Evaluation of multiple variables among 85 patients. Oral
Surg Oral Med Oral Path 1993; 75:303-307.
48. Van Der Waal J: The Burning Mouth Syndrome Copenhagen: Munksgaard; 1990; 5-90.
49. Trombelli L, Zangari F, Calura G: The psychological aspects
of patients with burning mouth syndrome. Minerva Stomatologica 1994; 43 (5): 215-21.
50. Trikkas G, Nikolatou O, Samara C, Bazopoulou-Kyranidou
E, Rabavilas AD, Christodoulou GN: Glossodynia; Personality characteristics and psychopathology. Psychoter
Psychosom 1996; 65 (3): 163-8.
51. Lauritano D, Spadari F, Formaglio F, Zambellini Artini M,
Salvato A: Ethiopathogenic, clinical-diagnostic and therapeutic aspects of the BMS. Research and treatment
protocols in a patients group. Minerva Stomatol 1998; 47
(6): 239-51
52. Zakrewska JM: The burning mouth syndrome remains an
enigma. Pain 1995; 62: 253-257.
53. Cecic-Arabasin A, Vidas I, Stipetic-Mravac M: Clinical oral
tests for the assessment of oral symptoms of Glossodynia
and glossopyrosis. J Oral Rehabil 1990; 17 (5): 495-502.
54. Gorsky M, Silverman S, Chinn H: Burning mouth syndrome.
A review of 98 cases J Oral Med 1987; 42: 7-9.
49: 57-65, 2005
3-10-08 12:56
65
B A
55. Zakrewska JM, Glenny AM, Forssell H: Interventions for the

treatment of burning mouth syndrome. Cochran Database
SYST Rev 2001; (3): cd002779.
56. Huang W, Rothe MJ, Grant-Kels JM: The burning mouth
syndrome J Am Acad Dermatol 1996; 34: 91-98.
57. Regnard C, Allport S, Stephenson L: Abc of palliative care.
Mouth care, Skin care, and lynphoedema BMS 1997; 315:
1002-1005.
58. Woda A, Navarez MZ, Picard P, Gremeau C, Pichard-Leandri
E: A possible therapeutic solution for stomatodynia (Burning
mouth syndrome). J Orofac Pain 1998; 12 (4): 272-8.
59. Sardella A, Uglietti D, Demarosi F, et al: Benzydamine
hydrochloride oral rinses in management of burning mouth
syndrome. A clinical trial. Oral Surg Oral Med Oral Path Oral
Radiol Endod 1999; 88 (6): 683-6.
60. Elad S, Czerninski R, Eliay E: Burning mouth syndrome.
Harefuah 2002; 141 (4): 384-7, 407.
61. Mc Quay HJ, Carroll D, Glynn CJ: Dose response for
analgesic effect of amtriptyline in chronic pain. Anesthesia

1993; 48: 281-285.
62. Van Houdenhove B, Soostens P: Burning mouth syndrome.
Successful treatment with combined psychotherapy and
psychopharmacotherapy. Gen Hosp Psychiatry 1995; 17:
385-388.
63. Culhane MS, Hodle AD: Burning mouth syndrome after
taking clonazepam. Ann Pharmacotherapy 2001; 35 (7-8):
874-6.
64. Femiano F, Gombos F, Scully C, Busciolano M, Luca PD:
Burning mouth syndrome 9BMS); Controlled open trial of
the efficacy of alpha-lipoic acid (thiotic acid) on
symtomatology. Oral Dis 2000; 6 (5): 274-77.
65. Maina G, Vitalucci A, Gandolfo S, Bogetto F: Comparative
efficacy of SSRIs and amisulpride in burning mouth
syndrome: a single-blind study. J Clin Psychiatry 2002;
63(1): 38-43.
:
M. A-
X O
. B 41
115 25 N.
T: 210-6715834
49: 57-65, 2005
65
67-71 SEL. - KAMPEROS*
3-10-08 12:57
67
B A
E

. K*, E. B**, N. M***
O
. T , , .
, . O K,
: , , ,
,
. O
. H , ,
, .
49: 67-71, 2005
27/9/2002 - 26/3/2003
EIAH
O , ,
(1).
: ) ,
: , , .
* K O
A
** E O
A
*** E O
A
K X
O A
A : Sixth congress of the Balkan Stomatological
Society. Bucharest, Romania, 2001.

) (1). A , (2).
. O :
A. K
H K
, VII, IX

(1). O K (3, 4, 5):
1. K
67
3-10-08 12:57
68
B A
2. E .
3. . ( ..).
4. M ,
( ) .
H
K,
. E 48
(6).
T
K (1). K1 (5-25mg) (2, 7).
B.
H (1, 2, 8):
1. M I, II,V,VII, IX, X XIII .
2. A
.
3.
4. K .
E
.
, K . E PT PTT.
.
H

, Von
Willenbrand
. (3, 4, 9, 10).
E
. K ,
(DDAVP).
.
H
, , ,

. T
,
, (1, 11, 12, 13).
68
H
(6). H

( ), (1, 6). H

III XII, XI, IX, X (II). A (1).
.
, , , 15000 UI/24 6
(14, 15).
T ,
. E K II,
VII, X IX 1 - 2 (16, 17).
M
.

K ( ,
, ,
..), ,
..(1, 6).

K ,
, , 4-, ..(1, 6).
O K
, , . H -

(18, 19, 20).
E. E
H
,
(21).
O )

)
) 49: 67-71, 2005
3-10-08 12:57
69
B A

(4, 22).
,
PTT,
. H . .
C.
, 70%(1, 23, 24).
T. I
H
. H

. . (6).
Z. E .
O ,
VIII, II, V IX, X, XI, XIII von Willebrand.
.
,
o (1, 6, 20)
YZHTHH
H

,

.
,

.

(25). 2-3 ,
(16-18)(1). H
(26). T 10 ml 4.8% 49: 67-71, 2005
. H

(27). I I. N. R.
(International Normalization Ratio).
(28). I. N. R.
2. 0 - 3. 0 (29).
(30).
() , 6-8
(1).
. H
. H DDAVP, ,
(1, 29).
K
V I. E . 50%
.
K K.

.

: ,
,
(1, 26).
YMEPAMATA
O
69
3-10-08 12:57
70
B A
. :
. N .
. N
, .
. N .
. A ,
,
, .
Disseminated intravascular coagulation is an uncommon,

complex and not fully understood process in which the
main effect is probably activation of the haemostaticrelated mechanisms within the circulation. The management of disseminated intravascular coagulation is
controversial and must in any case depend on the cause
and pathological changes taking place. Fibrinolytic states
may cause abnormal bleeding. Dental surgery should be
deferred where possible in patients on fibrinolytic therapy.
Essential is the investigation of the patient with acquired
hemorrhagic disorders. An adequate history is the most
important part of the evaluation, physical examination is
also necessary and laboratory tests are needed. An
accurate diagnosis is essential in order to provide
appropriate therapy and other necessary management
procedures to be organized.
Key words: Acquired Disorders, Oral Surgery, Coagulation
SUMMARY
BIBIOPAIA
Management in Patients with Acquired

Haemoragic Disorders in Oral Surgery
S. Kamberos, E. Vardas, N. Mallios
Haemorrhagic disease can be caused by platelet,

vascular disorders or by disorders of the clotting
mechanism. The coagulation disorders characteristically
cause severe bleeding deep in the tissues after superficial
injury, while bleeding after surgery or trauma, can be so
prolonged and severe, in the absence of treatment, as to
be potentially lethal. The purpose of this study is the
management at the patients with aquired hemorrhagic
disorders in oral surgery. Acquired hemorrhagic disorders
are much more prevalent than the congenital diseases but
are usually less severe, they are often caused by
combined defects of several haemostatic mechanism.
The most frequent causes include: vitamin K deficiency,
anticoagulant therapy, aspirin, indomethacin and related
analgesics, liver disease and fibronolytic states. However,
some of those with clinical bleeding tendencies do not
apparently have a detectable by current laboratory
methods. Hemorrhage is alarming to the patient and may
be an emergency. Hemorrhagic disease may, result from
inadequate amounts of vitamin K reaching the liver. Dental
management in vitamin K deficiency may be complicated
by problems resulting from the clotting defect and the
underlying disorder. These should preferably corrected,
but vitamin K can be given if surgery is urgent. The risk of
postoperative hemorrhage from office oral surgical
procedures has long been concern in the treatment of
patients who are receiving long-term anticoagulation
therapy. The aim of treatment is to minimize the risk of
hemorrhage while continuing to protect the patient against
thromboembolism. Recent articles have suggested
various methods for avoidance of bleeding complications
after office surgery while reducing the need for
discontinuation of the patient anticoagulation regimen.
70
1. - :
.
, , University studio press. 1997;3856:69-75.
2. Scully C and Cawson R: Medical problems in dentistry.1st ed.
Bristol London Boston.1992:72-76.
3. Ziccardi VB, Saini J, Demas PN, Braun TW: Management of
the oral and maxillofacial surgery patient with end-stage
renal disease. J Oral Maxillofac Surg 1992; 50:1207-1212.
4. K: A. 3, A,
1991: 350-362.
5. IK: B A, T, A, 1984:468-474.
6. M : A ,4
, A, E N, 1998:53-286.
7. Gunning A: Surgery in the haemorrhagic diatheses In:
Handfield J. and Hobsiey M. Current Surgical Practice.
London, Arnold,1976:35-46.
8. Pollock A: The bleeding disorders. Brit Dent J 1977;143: 405409.
9. T A., T ., M N: O . O , 1995; 49:88-102.
10. A: A. E 1991:199209.
11. Palareti G, Legnasi C, Guazzaloca G: Activation of blood
coagulation after abrupt or stepwise withdrawhal of oral
anticoagulants: A prospective study. Thrombosis &
Haemostasis.1994; 72:222.
12. Genewein U, Haeberli A, Straub P: Rebound after cessation
of oral anticoagulant therapy:The biochemical evidence. Br J
Haematol 1996; 92:479.
13. Grip L, Blomback M, Schulman S: Hypercoagulate state and
thromboembolism following warfarin withdrawal in postmyocardial-infarction patients. Eur Heart J 1991;12:1225.
14. A: A -A K. I. 1995;68:100-105.
15. Hurwitt E, Henderson J, Lord G, Lebendigger: A. New
Surgical Absorbable Haemostatic Agent. Amer. J
Surgery1960;100:439-446.
16. Wahl M: Dental surgery in anticoagulated patients. Arch
Intern Med 1998;158:1610.
17. Beirne OR, Koehler JR: Surgical management of patients on
49: 67-71, 2005
3-10-08 12:57
71
B A
warfarin sodium. J Oral Maxillofac Surg 1996; 54:1115.

18. Johnson W, Leary J: Management of dental patients with
bleeding disorders: Review and update. Oral Surg Oral Med
Oral Pathol 1988;66:297-303.
19. Hoffbrand A and Lewis S: Postgraduate hematology,
Heineman Oxford, 1989:45-48.
20. Harrison P: Principles of Internal Medicine, McGraw-Hill, New
York, 1991:123-125.
21. Giles A: Disseminated intravascular coagulation. In: Bloom
AL, Forbes C, Thomas D, Tuddenham E eds. Haemostasis
and Thrombosis.3rd ed. Churchill Livingstone, Edinbourgh,
1994: 969-986.
22. Z: A . , E
,1991.
23. K: . I
1995;68:71-76.
24. Okajima U: Treatment of patients with DIC by protein C. Am J
Haematol 1990;33:277-281.
25. Blinder D: Use of tranexamic acid mouthwash to prevent
postoperative bleeding in oral surgery patient on oral

anticoagulant medication .Quintessense International
1997;28:375-379.
26. Souto J, Oliver A, Zuazu-Jausoro I: Oral surgery in
anticoagulated patients without reducing the dose of oral
anticoagulant: A prospective randomized study. J Oral
Maxillofac Surg 1996;54:27.
27. Sindet-Pedersen S: Haemostatic effect of tranexamic acid
mouthwash in anticoagulated treated patients undergoing
oral surgery. N England Med 1989;320:840-843.
28. Ogle O and Hernandez A: Management of patients with
hemophilia, anticoagulation and sickie ceii disease
Management of medical problems. Oral and Maxillofacial
Surgery clinics of North America. 1998;3:401-416.
29. Campbell J, Alvarado F, Murrey A: Anticoagulation and Minor
Oral Surgery: Should the Anticoagulation Regimen Be
Altered J Oral Maxillofac Surg 2000;58:131-135.
30. T X:
, I , 1998;339-340.
:
K
A 2-4
161 21 AHNA
T. 210.7227763
49: 67-71, 2005
71
73-80 SEL. APOSTOLAKIS*
3-10-08 12:58
73
B A
O

. A*
H (conscious sedation)

,
.
:
A) T
B) O .
M
, , , O.
49: 73-80, 2005
12/3/2004 - 29/6/2004
EIAH
H
,

.
45% M B(1)
, , .
T
.

, -
: , , , , ,
.
* O - MSc (Oral Surg)
(- , )
-, , (2).

.
O (conscious sedation)
I
Lee B. 1972
(3).
M. B B
O KN ,
. T

73
3-10-08 12:58
74
B A
. T
, (4).
HA American Society of Anesthesiologists

. K . H

(5).

,
,
. H
.
T : ,
, , .
H , ,
. , ,
. H .

O
.
ITOPIKH ANAPOMH
I, . H
1776 J.
Priestley . E
, H. Davy
. H
H. Wells
.
1960 Harold Laga HA
(6).
E .
, N. Jorgensen
, (7). M
74

Drummond-Jackson(8). T

1960.
, , , (9).
APMAKEYTIKE OYIE OY XPHIMOOIOYNTAI
THN OONTIATPIKH IA THN EITEYH
ENYNEIHTH KATATOH
1.
T
,
, ,
. 25% (10). , (MAC
105) , , , (11). T
(pc=0,47),

, . 70%, 50%.
T
, Guedel.
, ,
, (12):
E 1: M ,
5-25%.
E 2: M
, 25-55%
.
E 3: O , 55%.
T 1 2. T

,
.
T , 49: 73-80, 2005
3-10-08 12:58
75
B A
, , (13).
,
. . ,
B12
,
(14). Y

, , (15).
K
B12, DNA
. . H , ,
. , .
A ,

.
100% 1-2 (46).
T . O , . X , 30%,
(E. 1).
2. B
H --
Hoffmann-La-Roche 1956.
1960 Librium. T
-Valium Upjohn Xanax (alprazolam). M

. O
,
,
(16). M - (GABA), 49: 73-80, 2005
KN, , .
M
GABA
,

,
KN(17, 18).
O
, . , , (20, 21, 22). H
(23). Y (24).
, 65 ,

, , (25).
H ,
Anexate. H
. E , ,
(26). O . ,
,
, , (E. 2).
H per os
O
H ,
,
. O
,
.
10-30mg
75
3-10-08 12:58
76
B A
E. 1: H Matrx Medical

.
E. 2: O

E Dormicum Anexate
.
(27), 0,25 mg
(28).
.
H
0,1-0,5mg/kg(29).
H
H
.
H ,

, .
, (1,5-3 ), . H

15mg/3ml 50mg/10 ml .
K , , - (30) 1,5 ,
.
M
20-30 ,
.
Y :

(E. 3).
76
E. 3: T .
H
1mg . M
1mg
.
6-8mg
. T 80

(31).
E,

H ,
. H
(32), (33).H
0,3 ( 49: 73-80, 2005
3-10-08 12:58
77
B A
0,1-0,5)mg/kg (29).
O Roelofse et al(51) 23 % 60 , , .
AE APMAKEYTIKE OYIE OY
XPHIMOOIOYNTAI IA KATATOH
H
.
H .
E
. H

. X
(34, 50).
H KN , .
H 60 10(35). H

,
(36).
H , , (37). H ,
,

.
ENEIEI XPHH TH ENYNEIHTH
KATATOH
T
,
. T ,
""
,
, (38). H

.
M
.
, 49: 73-80, 2005
, (39).
A 30%
(27).
,
stress,
,
, ,
stress .

, (41, 44).
O

.

, Parkinson, , , (42).
ANTENEIEI XPHH TH ENYNEIHTH
KATATOH

. ,
, ,
, (41). A CO2 KN
. A
(47).
A DNA (41, 42, 43).
, ASA 3, ASA 4, ASA 5 ASA
6, ASA 2
(27, 41, 42) (. 1).
77
3-10-08 12:58
78
B A
. 1: K American Society of Anesthesiologists.

KATH. 1 (ASA 1):
KATH. 2 (ASA 2):
O
.
KATH. 3 (ASA 3):
O .
KATH. 4 (ASA 4):
O
.
KATH. 5 (ASA 5):
O .
KATH. 6 (ASA 6):
O
.
A
(45),
, (27).
,
. H

(40). O
,
(. 2).
. 2: O

A () E
A
H E
78
T

(38, 40, 45).
O . A , ,
.
T,
, .
H .
.
EIOH AENN IA KATATOH
H

.
,

. H .
T ,
,
. O , ,
. , , ,
,
. , ,

, (
2-4 ) 24 .
EOIMO ANAKH
O
49: 73-80, 2005
3-10-08 12:58
79
B A
,
.
(49) ,

. ,

, ,
,

Guedel ,
.
YMEPAMATA
H

.
T

. A ,

.
O ,

. E ,
. H

.
H .
SUMMARY
The use of conscious sedation in Dentistry

D. Apostolakis
Conscious sedation is being used today by dentists all

over the world in order to successfully treat patients,
whose dental problems would otherwise remain either
untreated, or in need of use of general anaesthesia.
Two methods are mainly used to achieve the goals of
conscious sedation:
A) A mixture of nitrous oxide and oxygen and
B) Benzodiazepines, with midazolam as the main drug.
49: 73-80, 2005
After many years of use of the above mentioned methods,

both their safety and effectiveness have been proved and
established, while the use of propofol, with patient
controlled infusion pump, may become the next step to a
longlasting career of conscious sedation in dentistry.
Key words: conscious sedation, nitrous oxide, benzodiazepines,
midazolam, propofol, ketamine
BIBIOPAIA
1. Todd JE, Lader D: Adult Dental Health, London, HMSO,
1991:12.
2. Chaves JF: Hypnosis in Dentistry; Historical overview and
current appraisal. In Hypnosis in Dentistry, Munich, Stiftung.
1997: 45.
3. Lee B: The dental anxiliary and oxygen-nitrous oxide
conscious sedation. J Natl Analg Soc 1972; 1 : 31-4.
4. General Dental Counsil: Maintaining standards, 1997,
revised May 1999.
5. American Society of Anesthesiologists: Practice guidelines
for Sedation and Analgesia by non-anesthesiologists,
Anesthesiology 2002; 96 : 1004-1017.
6. Langa H: Postgraduate teaching of relative analgesia with
nitrous oxide and oxygen, J Am Dent Assoc 1963; 67 : 28-34.
7. Jorgensen NB: Premedication as an adjunct to local
analgesia in Dentistry. Br Dent J 1967; 5 : 202-204.
8. Drummond-Jackson SL: Intravenous analgesia and
anaesthesia. Dent Delin 1967; 18 : 9-11.
9. Rodrigo C, Irwin MG, Yan BS, Wong MH: Patient controled
sedation with Propofol in minor oral surgery. J Oral
Maxxilofac Surg 2004; 62 : 52-56.
10. Parbrook GD, Rees GA, Robertson G: Relief of postoperative
pain: Comparison of a 25 per cent nitrous oxide and oxygen
mixture with morphine. Br Med J 1964; 22 : 480-482.
11. Herry RG, Vaikuntam J: The influence of midazolam and
nitrous oxide on respiratory depresion in laboratory rats.
Pediatr Dent 1996; 18 : 281-286.
12. Langa H: Relative analgesia (The Langa Technique), SAAD
Dig. 1970;1:49-51.
13. Berge TI: Acceptance and side effects of nitrous oxide
oxygen sedation for oral surgery procedures. Acta Odontol
Scand 1999; 57 : 2001-2006.
14. Clark MS, Renehan BW, Jeffers BW: Clinical use and potential
biohazards of nitrous oxide/oxygen, Gen Dent1997; 45 : 486489.
15. Kugel G, Letelier C, Zive MA, King JC: Nitrous oxide and
infertility. Anesth Prog 1990; 37 : 176-180.
16. Greenblatt DJ, Shader RI, Abernethy D: Drug therapy. Current
Status of the benzodiazepines. New England Journal of
Medicine. 1983: 309-354.
17. Snyder SH, Enna SJ: Biochemical identification of GABA
receptor in mammalian brain. Psychofarmacol Bull 1977;13:
29-30.
18. Fritschy JM, Brunig I: Formation and plasticity of GABAergic
synapses: Physiological mechanisms and pathophysiological implications. Pharmac Ther 2003; 98 : 299-323.
19. Milgrom P, Beirne OR, Fiset L, Weinstein P, Tay KM: The
safety and efficacy of outpatient midazolam intravenous
sedation for oral surgery with and without fentanyl. Anest
Prog 1993; 40 : 57-62.
20. Middleherst RJ, Gibbs A, Walton G: Cardiovascular risk: The
safety of local anesthesia, vasoconstiction and sedation in
heart dsease. Anesth Prog 1999; 46: 118-123.
21. Middlehurst R, Coulthard P: The effect of midazolam sedation
79
3-10-08 12:58
80
B A
on indications for myocardial ischemia. Oral Surg Oral Med

Oral Path Oral Radiol and Endod 1999; 88 : 400-405.
22. Gueye DN, Lofas F et al: Mechanism of respiratory insufficiency in pure or mixed drug induced coma involving
benzodiazepines. J Toxicol Clin Toxicol 2002; 40 : 35-47.
23. TREC Collaborative Group: Rapid tranquillisation for agitated
patients in emergency psychiatric rooms: a randomised trial
of midazolam versus haloperidol plus promethazine. BMJ
2003; 327 : 708-713.
24. Cote CJ, Karl HW, Notterman DA: Adverse sedation events in
pediatrics: analysis of medication used for sedation,
Pediatrics 2000; 106 : 633-644.
25. Van der Bijl P, Roelofse JA: Disinhibitory reactions to
benzodiazepines: a review. J Oral Maxxilofac Surg 1991; 49 :
519-523.
26. Rodrigo C: Flumazenil in Dentistry. Anesth Prog 1995; 42 :
121-125.
27. Girdler NM, Hill CM: Oral sedation and premedication in
dentistry. In Sedation in Dentistry, London, Wright. 2002 :
97-108.
28. Berthold CD, Dionne RA, Corey SE: Comparison of sublingually and orally administered triazolam for premedication
before oral surgery. Oral Surg Oral Med Oral Path Oral Radiol
and Endod 1997; 84 : 119-124.
29. Klingberg G: Pharmacological approach to the managment of
dental anxiety in Children- Comments from a Scandinavian
point of view. Int J of peadiatr Dent 2002; 12 : 357-358.
30. Johnson TN, Rostami- Hodjegan A, Goddard JM, Tanner MS,
Tucker GT: Contribution of midazolam and its 1-hydroxy
metabolite to preoperative sedation in children. Br J Anaesth
2002; 89 : 428-437.
31. Takarada T, Kawahara M et al: Clinical recovery time from
conscious sedation for dental outpatients. Anaeth Prog
2002; 49 : 124-127.
32. Ljungman G, Kreuger A, Andreason S, Gorth T, Sorensen S:
Midazlam nasal spray reduses procedural anxiety in
children. Pediatrics 2000; 105 : 73-78.
33. Lu DP, Lu GP, Reed JF: Safety, efficacy and acceptance of
intramuscular sedation: assessment of 900 dental cases,
Compedium 1994; 15 : 1348, 1350, 1352.
34. Roelfose J: Overview of pharmacological aspects of
sedation. Part 2. Combination sedative/analgesics, SADJ
2000; 55 : 441-442.
35. Swanson ER, Seaberg D, Mathias S: The use of Propofol for
sedation in the emergency department. Acad Emerg Med
1996; 3 : 234-238.
36. Victors RA, White PF: Propofol: An update. Anesthesiol Clin
North Am 1993; 11 : 831-834.
37. Rodrigo C, Irwin MG, Van BS: Patient-controlled sedation
with Propofol in minor oral surgery. J Oral Maxilloof Surg

2004; 62 : 52-56.
38. Chadick B, Hosey MT: Child Taming: How to manage
children in Dental Practice. Quintessense, London, 2003.
39. Gerhardt RT, King KM, Wiegert RS: Inhaled nitrous oxide
versus placebo as an analgesic and anxiolytic adjunct to
peripheral intravenous cannulation. Am J Emerg Med
2001;19 : 492-494.
40. Cohen CI: A case report: Periodontal surgery in Parkinsonism utilising intravenous sedation. NY State Dent J 1978;
44 : 19.
41. Stranway G: Potensial hazards of trace inhalation of
anaesthetic gases: a risk assessment, SAAD Dig 2002; 19 :
14-19.
42. Ramazzotto LJ, Carlin RD, Warchalowski GA: Effects of
nitrous oxide during organogenesis in the rat. J Dent Res
1976; 58 : 1940-1943.
43. Kil N, Zhu JF, VanWagen C, Abdulhamid I: The effects of
midazolam on pediatric patients with asthma. Pediatr Dent
2003; 25 : 137-142.
44. Fujita Y, Ishikaa H, Yokota K: Anaphylactoid reaction to
midazolam. Anesth Analg 1994; 79 : 811-812.
45. Hoses MT: UK National Clinical Guidelines in Paediatric
dentistry. Managing anxious children: The use of conscious
sedation in paediatric dentistry. Int J of Paediatr Dent 2002;
12 : 359-372.
46. Dunn-Russel T, Adair SM, Sums DR, Russel CM, Barenie JT:
Oxygen saturation and diffusion hypoxia in children following
nitrous oxide sedation. Pediatr Dent 1993; 15 : 88-92.
47. P Coulthard: Conscious Sedation for Dentistry, Manchester,
Univ. f Manchester, 1994 : 3.
48. P Blackburn, R Vissers: Pharmacology of emergency
department pain management and conscious sedation.
Emerg. Med. Clinics of N America. 2000; 4 : 1-23.
49. Perrott GH, Yuen JP, Andressen RV, Dodson TB: Officebased ambulatory anesthesia: outcomes of clinical practice
of oral and maxillofacial surgeons. J Oral Maxillofac Surg
2003; 61(9):983-95.
50. Lokken P, Bakstad OJ, Fonnelop E, Skogedal N, Hellsten K,
Bjerkelund CE, Storhaug K, Oye I: Conscious sedation by
rectal administration of midazolam or midazolam plus
ketamine as alternatives to general anesthesia for dental
treatment of uncooperative children. Scand J Dent Res
1994;102(5):274-80.
51. Roelofse JA, van der Bijl P, Stegmann DH, Hartshorne JE:
Preanesthetic medication with rectal midazolam in children
undergoing dental extractions. J Oral Maxillofac Surg
1990;48(8):791-7.
:
. A
730 14 ATANIA XANIN
T.: 28210-60095
80
49: 73-80, 2005
81-91 SEL. - GIANNIKAKIS*
3-10-08 12:58
81
B A

. *, A. Z**
H ,
, , ,
, , ,
.

, .
O .
A . A , . , ,
.
,
.
,
. O .
E , , (, ) ,
.
H , ,
, .
49: 81-91, 2005
17/2/2004 - 7/5/2004
EIAH
H O , , : , , , .
* E K, T O T,
E Y , T.E.I. A.
** A K, T , O A.
.
,

.

. H
,
, .
81
3-10-08 12:58
82
B A

, .
I. ANAKAIOTHTA KATAKEYH TEANN TA ONTIA THPIMATA MIA MEPIKH OONTOTOIXIA
H
:
A.
H
. ,

, ,
(, ),
1-7.
B. T
O

, :
1. A
O )
, ) )
.
) .
, ,

,
()
. O :8-10
,
, .
,
( ,
...).
)
H , , 8, 11-16.
) N
H :8, 9, 16-20
82

,
,

. T
, . E
() , .
2. A M

,
.
. H
( ) :1, 3, 4, 7, 21
) ( , ),
)
( , ).
3.
:2, 4, 6, 8, 9, 22
T .
, ,
.
O ,

, .
,
,
,
.
T .
, , .
T
. .
49: 81-91, 2005
3-10-08 12:58
83
B A
T
.

.
) :
, .
H , .
) : ,

.
) : .
) :
.
E ,
(, ).
II. KATAKEYH TEANN TA ONTIA THPIMATA
H
. ,
, 16, 18, 20.
A .

H :
1. ,
2. ,
3. ,
4. ,
5. :
. ,
. -
,
49: 81-91, 2005
. ,
6. ,
7. .
A.
O , , . , , , , ,
24-27. E
:
) 1, 5, 8, 23
A
.
, ,
, . ,
, . H

. B,
.
(E. 1). E
. .
E. 1: M .
.
)
O , , ,
83
3-10-08 12:58
84
B A
. , . H

, . I
, . A ,
, , . (. 1-3).
1. 28-31
O . M , . M ,
,
- ,
. T , ,
. M , , ,
. 3: H , , ,
.
. ,
, . E,
. (. 4)
. 4:
.
. 1: I ,
.
. 2: , , .
84
E ,
,
, ,

. A
( ), . A
, .
T ,
,
, . H 49: 81-91, 2005
3-10-08 12:58
85
B A
. E ,
, (E. 2).
. 5: H

(), ()
().
E. 2: .
2. M 25, 28, 30-32

O ( )
(). O
.
, , ( ),
. ,
1/3 - , .
T 1 2mm,
. (. 5, E. 3)
, , , . A , . E
, ,
,
, V
U. O ,

,
. (. 6, E. 4)
, , . H
. T
. (E. 5)
49: 81-91, 2005
E. 3: M
.
. 6: Y V U .
E. 4: Y
V U .
85
3-10-08 12:58
86
B A
E. 5: M
.

, ,
. E
. (E. 6)
E. 6: .

.
, , ,

. A

. (. 7)
,
. A in vitro , , , , , ,
,
. ,
in
vivo , ,

86
. 7: H

.
. E

, 33-37.
,
, , , , .
3. - 28, 31, 38
K , .

. T, 2-3 mm
, ( ),
, . (E. 7) ,
. (. 8)
E. 7:
.
49: 81-91, 2005
3-10-08 12:58
87
B A
. 8: H
:
() ().

. , ,
( ...),
, 8.
4. Y 29-31
. E
, . H ( ). (E. 8)
) : , ,
,
. ,
,

. (. 9)
E. 8: .
. 9: H

.
) : . , , , , 0,25mm . T (Roach, RPI)

0,50mm,
0,75mm.
T
.
.
A
.
,
49: 81-91, 2005
T
. H , -

, , ,
. A

,
. T
,
. T - . (. 10)
T . ,

. E R.P.I, . H (Rest) (Proximal
plate).
87
3-10-08 12:58
88
B A
. 10: T . K
.
,
,
. (E. 9)
B.

E
. O ,
.
:
) ,
,
) , .
) ,
.
A ,
. I , . (E. 10) E, , 16.
E. 9: .

H
:
A) M :
1. ()
2. -
3. .
B) M :
1. ()
2. -
3. ().
4. .
88
E. 10: .
M E 16, 39-43
H
,
(, ) . T
,
.
A) M
H , . (E. 11)
49: 81-91, 2005
3-10-08 12:58
89
B A
(). H
- ,
. E, () ,
. (E. 13-15)
E. 11: ,
.
B) M .

. (E. 12)
E. 13: .
E. 12: ,
.
M E 16, 39-43.
A ( ),
. ,
,
, ,

,

.
O

, , 49: 81-91, 2005
E. 14: E .
E. 15: T .
89
3-10-08 12:58
90
B A
YZHTHH
,

.
A ,

.
, ,

( )

.
T ,
, , ,
. T

44-50.
E ,

, ,
.
. T , , ,
.
H

.
YMEPAMATA
E
, :
1)
.
2) K .
O ,
.
90
SUMMARY
Guidelines for crowning the tooth abutments

of a removable partial denture
S. Yannikakis, A. Zissis
Crowning the tooth abutments of a removable partial

denture should be carried out since not only all the
alternative designs of the metal framework have been
excluded but also the following factors have been
considered: the age, the health conditions and the esthetic demands of the patient, the necessity for combination
of fixed and removable prostheses, the usage of precision
attachments, the rehabilitation of the occlusal plane and
the suitable morphology of the abutment teeth.
This paper deals with the guidelines for the proper
designing of crowns intended to accept the retentive
elements of the metal framework of a removable partial
denture, either clasps or precision attachments.
The following guidelines must rule the crown designing for
a clasp as retentive element: a) The proximal surfaces of
the crown should form guide planes parallel to the path of
insertion of the removable partial denture b) the occlusal
surface of posterior tooth crowns should perform restseats for the occlusal rests c) the lingual surface of anterior
tooth crowns should perform rest-seats for the cingulum
rests d) a labial or a buccal surface should perform a
retentive undercut for the retentive clasp arm e) a palatal or
a lingual surface should be formed as guide plane which
terminates into a step for the reciprocating clasp arm.
As it concerns the precision attachment usage, the crown
morphology is adapted so that the proper relationship
between the attachment and the periodontal tissues, the
function of the attachment and its durability are achieved.
For an extracoronal precision attachment, its projection
should follow the morphology of the gingiva, not compress
the interdental papillae and permit the easy cleaning.
When a rigid type attachment is used, the crown should
form a palatal or a lingual step for the reciprocating arm.
For an intracoronal precision attachment, the instructions
of its manufacturer should be followed.
A gold crown should be used, but where aesthetics
demand, a porcelain bonded gold crown is chosen.
Since the crowning of the abutment teeth has been
decided, it is of outmost importance such crowns to fulfill
all those requirements of a fixed restoration and be
designed according to the type of the retentive element
that had been pre-chosen.
Key words: removable partial dentures, crown design, clasps,
precision attachments
BIBIOPAIA
1. Renner RP, Boucher LJ: Removable Partial Dentures.
Quintessence Publishing Co. Chicago 1987 pp 119, 123,
127, 129, 130, 142-146, 150, 176.
2. Miller EL, Grasso JF: Removable partial prosthodontics.
Second edition. Williams and Wilkins. Baltimore 1981 pp 3, 4,
27, 67, 119, 124.
49: 81-91, 2005
3-10-08 12:58
91
B A
3. Bates JF, Huggett R, Stafford GD: Removable denture

construction. Third edition. Wright. London 1991 pp 56, 76, 77.
4. Walter JD: Removable partial design. British Dental
Association. London 1990 pp 7, 15, 16, 25.
5. Davenport JC, Basker RM, Heath JR, Ralph JP: A color atlas
of removable partial dentures. Wolfe Medical Publications
Ltd. London 1992 pp 37, 41.
6. Henderson D, Steffel V: McCrackens Removable Partial
Prosthodontics. Fifth edition. CV Mosby Co. Saint Louis 1977
pp 196-223.
7. Kratochvil FJ: Partial removable prosthodontics. WB
Saunders Co. 1988 pp 83-88, 90, 91.
8. , Z A, , : K
-M O. E M.
A 2002, . 62, 103, 104, 114, 115.
9. Z A: M : . O 1995;15:273-283.
10. McCracken WL: Differential diagnosis: Fixed or removable
partial dentures. J Am Dent Assoc 1961;63:767.
11. Z A: . 2000;57:13-20.
12. Pardo-Mindan S, Ruiz-Villandiego JC: A flexible lingual clasp
as an esthetic alternative: A clinical report. J Prosthet Dent
1993;69:245-46.
13. Ben-Ur Z, Aviv I, Gorfil C: The internally braced removable
partial denture clasp. A solution to a common esthetic
problem. Quintessence Int 1989;20:25-55.
14. King GE: Dual path design for removable partial dentures. J
15. King GE, Barco MT, Olson RJ: Incospicious retention for
removable partial dentures. J Prosthet Dent 1978; 39:5050-507.
16. , Z A: A :
; E
X 2002;46:152-61.
17. Owall B, Jonsson L: Precision attachment-retained
removable partial dentures. Part 3. General practitioner
results up to 2 years. Int J Prosthodont 1998;11:574-579.
18. Altay OT, Tsolka P, Preiskel HW: Abutment teeth with
extracoronal attachments: the effects of splinting on tooth
movement. Int J Prosthodont 1990;3:441-448.
19. Berg T, Caputo AA: Maxillary distal-extension removable
partial denture abutments with reduced periodontal support.
J Prosthet Dent 1993;70:245-250.
20. Aydinlik E, Dayangac B, Celik E: Effect of splinting on
abutment tooth movement. J Prosthet Dent 1983;49:477-480.
21. Sheppard IM, Sheppard SM: Denture occlusion. J Prosthet
Dent 1968;20:307-12.
22. Beck HO: Occlusion as related to complete removable
prosthodontics. J Prosthet Dent 1972;27:246-9.
23. Dixon DL, Breeding LC, Smith EJ: Use of a partial coverage
porcelain laminate to enhance clasp retention. J Prosthet
Dent 1990;63:55-58.
24. A A, B: A O . E . A 1981; .16, 20, 25.
25. Preston JD: Preventing ceramic failures when integrating
fixed and removable prostheses. Dent Clin North Am
1979;23:37.
26. Curtis DA, Curtis TA, Holmes JB: Use of a paralleling post for
cast orientation when fabricating removable partial denture
abutments crowns. J Prosthet Dent 1988;59:117-118.
27. A : A . E Z. A 2002.
28. Seals R, Schwartz I: Successful integration of fixed and
removable prosthodontics. J Prosthet Dent 1985;53:763-766.

29. Bezzon OL, Mattos MGC, Ribero RF: Surveying removable
partial dentures: the importance of guiding planes and path
of insertion for stability. J Prosthet Dent 1997;78:412-418.
30. Rudd R, Bagne A, Rudd K, Montalvo R: Preparing teeth to
receive a removable partial denture. J Prosthet Dent
1999;82:536-49.
31. Fowler J, Tamura K: Essentials of Dental Technology.
Quintessence Publ., Co., Chicago 1987:529-541.
32. Berg T, Caputo AA: Anterior rests for maxillary removable
partial dentures. J Prosthet Dent 1978;39:139-146.
33. Berg E: Periodontal problems associated with thw use of
distal extension removable partial dentures - a matter of
construction? J Oral rehabil 1985;12:369-379.
34. Maxfield JB, Nicholls JI, Smith DE: The measurment of forces
transmitted to abutment teeth of removable dentures. J
35. Browing JD, meadors LW, Eick JD: Movement of three
removable partial dentures clasp assemblies under occlusal
loading. J Prosthet Dent 1986;55:69-74.
36. Navas Maria Tereza and M Del Capo: A new free end
removable partial denture design. J Prosthet Dent
1993;70:176-179.
37. Hosman HJ: The influence of clasp design of distal extension
removable partial dentures on the periodontium of the
abutment teeth. Int J Prosthodont 1990;3:356-359.
38. Culpepper WD, Moulton PS: Considerations in Fixed
Prosthodontics. Dent Clin North Am 1979;23:21-35.
39. Kratochvil FJ, Thompson WD, Caputo AA: Photoelastic
analysis of stress patterns on teeth and bone with attachment
retainers for removable partial dentures. J Prosthet Dent
1981;46:21-28.
40. Preiskel HW: Precision attachments in Prosthodontics.
Quintessence Pub. Co. Chicago 1984 pp 45-76.
41. Pezzoli M, Highton R, Caputo A, Matyas J: Magnetizable
abutment crowns for distal-extension removable partial
dentures. J Prosthet Dent. 1986;55:475-80.
42. Owall B, Jonsson L: Precision attachment-retained
removable partial dentures. Part 3. General practitioner
results up to 2 years. Int J Prosthodont 1998;11:574-9.
43. O N.: K M O. E
. A 2000:236-258.
44. Wilding JC, Reddy J: Periodontal disease in partial denture
wearers - a biological index. J Oral Rehabil 1987;14:111-124.
45. Tuominen R, Ranta K, Paunio I: Wearing of removable partial
dentures in relation to dental caries. J Oral Rehabil
1988;15:515-520.
46. Kapur KK, Deupree R, dent R, Hasse AL: A randomized
clinical trial of two basic removable partial denture designs.
Part I: comparisons of five-year success rates and
periodontal health. J Prosthet Dent 1994;72:268-282.
47. Wright PS, Hellyer PH: Gingival recession related to
removable partial dentures in older patients. J Prosthet Dent
1995;74:602-607.
48. Budtz-Jorgensen E, Bochet G: Alternate framework design for
removable partial dentures. J Prosthet Dent 1998;80:58-66.
49. Petridis H, Hempton TJ: Periodontal consideration in
removable partial denture treatment: a review of the
literature. Int J Prosthodont 2001;14:164-172.
50. Zlataric DK, Celebic A, Valentic-Peruzovic M: The effect of
removable partial dentures on periodontal health of
abutment and non-abutment teeth. J Periodontol
2002;73:137-144.
:
.
N 6, 10680 A
T: 210-7715814, 210-3600005
E-mail: yannista@otenet.gr
49: 81-91, 2005
91
93-107 SEL. - RAPIDIS
3-10-08 13:00
93
B A

.
A
. A*, . B**, A. P***
T , 11%
. I . H
, , , ,
. H .
M .
. H
, ,
. I . , .
.
49: 93-107, 2005
1/9/2003 - 3/9/2004
EIAH
T 1, 2. A 1%

11% 3, 4. I 4, 5. H
,
: , , .
* , MSc, E
K
** K N
K
*** E K A, K N O
X K, E A
I, N O , A.
, , 6-9. H . 1, 10-12. T . H 15-25%13-15,

75 - 90% 10, 13-16.
T
, ' . H

8, 12, 17-20. O Reichart
21 327
17,7%,
22,6%.
93
3-10-08 13:00
94
B A
HIKIA-YO
T 12,
15, 22-24
, 13, 25.
, 8% 15, 26-28. O
8 29, 82 15. O 21, 25, 30, 31, 32,
12, 31, 32.
ENTOIH
O ( , )12, 29, 33-35. 70%
20% 10%15, 20, 28,
33
.
90%15, 24, 34. , ( )36, 37.
KINIKH EIKONA
T
3, 5, 38. ,

4. 1, 39
(E. 1). -
E. 1: E
.
94

20, 33. M
30%
22, 35.
,
, , 13, 24, 25. 34,
40
. 41,
42
(E. 2).
4: 1) T , 1, 5,
12, 20
(E. 3), 2) T ,

8, 25 (E. 4), 3) T . H
38, 43-47 (E. 5), 4)
. H
, . K 4, 36 (E. 6).
T 5, 43 44 . K

.
,
,

4, 5.
O
4. M , 45 46. O 49: 93-107, 2005
3-10-08 13:00
95
B A
2A
2B
E. 3:
.

. I

.
E. 4: K

.
2
E. 2: A. E
.
.
B. E
.
. T
.
.
49: 93-107, 2005
E. 5: A . H
.
95
3-10-08 13:00
96
B A
E. 6: K (-) .
E. 8: O
.
13, 25 (E. 7, 8). , , 2, 23. 5, 25, 33. O

,
,

8, 17. , ,

. A
4. 13, 25, 1 (E. 9). E 34, 40 (E. 10).

, 22, 27.
E. 7: .
.
E. 9: E
. H
. H ,
.

24, 43. 6, 45, 46, , , , , , 6, 9.
AKTINOPAIKA XAPAKTHPITIKA
96
49: 93-107, 2005
3-10-08 13:00
97
B A
12A
E. 10: M (Waters projection). T

.

" "
(floating teeth in the air) (E. 11).
12B
E. 11: K

. H

(floating
in the air).
H
. I (3D-CT)

Denta-scan (E. 12). H

24, 32 (E. 13).
49: 93-107, 2005
12
E. 12: A. O
. H
.
B. H Denta-scan .
. H (3D-CT)
.
97
3-10-08 13:00
98
B A
13A
13B
13
E. 13: A. M T1 . .
B. H T2 .
. H T2 , .
ITOENEH
ITOAOOIA
T 2, 5. O 4.

( ): 1) , 2) ( ), 3) Malassez, 4) 1,
4, 5
. T ,
4.
I
7, 47. O
Stanley Diehl48 641 17% . , , 38, 49-51,
, 3, 49, 52. O . K , , , ,
, 53.
M : ,
, , , 3, 4, 7, 34, 54. (E. 14). T 1, 4. . O
,
2, 4
(E. 15). O
3, 4 (E. 16).
,
2, 3 (E. 17). O

,
2, 5 (E. 18). ( )
12. O 4.
-55, -56 57.
98
49: 93-107, 2005
3-10-08 13:00
99
B A
14A
14B
E. 14: A. M .
(A H x 40).
B. T (A H x 400).
15A
15B
E. 15: A. . T (A H x 200).
B. H (A
H x 400).
16A
16B
E. 16: A. I .
(A H x 50).
B. H (A H x 400).
49: 93-107, 2005
99
3-10-08 13:00
100
B A
BIOOIKH YMEPIOPA - XEIPOYPIKH

ANTIMETIH
17A
17B
H
. H
. O

: ,
, , ,
28, 39, 58. H .
,

, 34, 47
(E. 19). E , , . A
4, 59. O
58, 60, 61. O
,
E. 17: A. M . H
(A H x 100).
B.
(A H x
400).
E. 18: I . O (A H x 100).
E. 19: A -
. .
100
49: 93-107, 2005
3-10-08 13:00
101
B A
, 17. A 12 (E. 20). T

.
O
7, 8, 55, 62 (E. 21). A
. O
7, 64 , 19, 22.
O 12, 29, 32. M

.

12, 19 (E. 22).
-
E. 20: O . H
.
E. 21: M .
.
- . (A H x 200).

12, 17, 21.

58, 63. H 49: 93-107, 2005
E. 22: A. E

.
B.

. H .
101
3-10-08 13:00
102
B A
.
M

19. O

15,
29, 35
. H 1-2
28, 39 (E. 23).

12.
M
. M

. E
.
E

23
23
23A
23B
E. 23: A. O
.
B. A
.
. H .
. H .
H .
.
. A 12, 19, 32.
H

28, 41, ,
32, 65. O
, ,

, . T
, 65. K102
49: 93-107, 2005
3-10-08 13:00
103
B A

. O

66.

,

.

. T
(). . T
68 . . T
. O
24A
,
, , 13, 22, 32, 41. M

. M

(E. 24).
M
, , 67 (E. 25). T

. T

, . H
69.
24B
E. 24: A. O . H
.
B. O .
25A
25B
E. 25: A. A .
B. -- .
49: 93-107, 2005
103
3-10-08 13:00
104
B A
H . M ,
, 25 ,
. X
,

(E. 26).
H 33. O
41, 42.
26, 39, 65. O

(E. 27).
26A
27A
27B
26B
26
E. 26: A.
.
B. . T
.

.
. O . H .
104
E. 27: A. A . H .
B. H . ,
. E

.
49: 93-107, 2005
3-10-08 13:00
105
B A

. T . E
, . O
.
,
.
decades, due to a high rate of local recurrences that follow

incomplete resection.
The purpose of the present paper is to discuss and
evaluate the various methods of surgical treatment of
ameloblastoma. The choice of either conservative treatment (marsipulization and enucleation with or without
curettage) or radical surgery (segmental or marginal
resection) depends on a number of clinical, radiological
and histological factors the most important of which are:
the anatomical location of the tumor, its extension, the
histological type of the tumor, the age and general health
status of the patient and its cooperation. Careful preoperative planning safeguards adequate surgery and a
lower rate of recurrences.
YMEPAMA
Key words: ameloblastoma, odontogenic tumors, surgical management.
'

. T
. M . H
, . H ,
. H
,
-

.
SUMMARY
The surgical management of ameloblastomas

of the jaws. Review of the literature
D.D. Andressakis, S. Valsamis, A.D. Rapidis
The ameloblastoma is an uncommon benign odontogenic

neoplasm of the maxillofacial region. It constitutes approximately 1% of tumors of the oral cavity and 11% of all tumors
of odontogenic origin. The ameloblastoma originates from
epithelial remnants of primitive odontogenic epithelium and
has a unique biologic behavior with a slow-growing pattern,
local invasive properties and the contingency of malignant
transformation. Surgical management is the treatment of
choice. The method of surgical approach, radical or
conservative, has been a point of dispute for several
49: 93-107, 2005
BIBIOPAIA
1. Cawson RA, Binnie WH, Speight PM, Barrett AW, Wright JM,
Thorogood P: Ameloblastoma. In Lucas 's Pathology of
tumors of the oral tissues. 5th ed Churchill Livingstone.
London 1998, p. 25-44.
2. Neville BW, Damm DD, Allen CM, Bouquot JE: Oral and
Maxillofacial Pathology. Saunters Co, Philadelphia, London,
1995, pp 512-520.
3. Shafer WG, Hine MK, Levy BM: A textbook of Oral Pathology.
2nd ed. Saunders Co, Philadelphia, London. 1983, p.276285.
4. A A, , A E: . I , A 2000, . 459-465.
5. Appel BN, Verbin RS: Odontogenic Tumors. In Barnes L.:
Surgical Pathology of the Head and Neck Vol. 2 Marcel
Dekker, New York, 1985, p.1331.
6. Madiedo G, Choi H, Kleinman JG: ameloblastoma of the
maxilla with distant metastases and hypercaliemia. Am J
Clin Pathol 1981; 75: 585-591.
7. Rapidis AD, Angelopoulos AP, Skouteris CA, Papanicolaou
S: Mural (intracystic) ameloblastoma. Int J Oral Surg 1982;
11: 166-174.
8. Gardner DG, Corio RL: Plexiform unicystic ameloblastoma:
a variant of ameloblastoma with a low recurrence rate after
enucleation. Cancer 1984; 53: 1730-1735.
9. Ueda M, Kaneda T, Imaizami M, Abe T: Mandibular
ameloblastoma with metastasis to the lungs and lymph
nodes. A case report and review of the literature. J Oral
Maxillofac Surg 1989; 47: 623-628.
10. Tsaknis P, Nelson JF: The maxillary ameloblastoma: an
analysis of 24 cases. J Oral Surg 1980; 38: 336-342.
11. Gardner DG: Controversies in the nomenclature, diagnosis
and treatment of ameloblastoma. In Worthinghton P, Evans
JR (eds): Controversies in Oral & Maxillofacial Surgery.
Philadelphia, PA, Saunders Co, 1994, p. 301.
12. Nakamura N, Higuchi Y, Mitsuyasu T, Santra F, Ohishi M:
Comparison of long-term results between different
approaches to ameloblastoma. Oral Surg 2002; 93: 13-20.
13. Shatkin S, Hoffmeister FS: Ameloblastoma. A rational
approach to therapy. Oral Surg 1965; 20: 421-435.
14. Sehdev MK, Huvos AG, Strong EW, Gerold FP, Willis GW:
Ameloblastoma of maxilla and mandible. Cancer 1974; 33:
324-333.
15. Mehlisch DR, Dahlin DC, Masson JK: Ameloblastoma: a
105
3-10-08 13:00
106
B A
clinicopathologic report. J Oral Surg 1972; 30: 9-22.

16. Vedtofte P, Hjorting-Hansen E, Jensen BN, Roed-Peterson B:
Conservative
surgical
treatment
of
mandibular
ameloblastomas. Int J Oral Surg 1978; 7: 156-161.
17. Muller H, Slootweg PG: The Ameloblastoma, the
controversial approach to therapy. J Maxillofac Surg 1985;
13:79-84.
18. Feinberg SE, Steinberg B: Surgical management of
ameloblastoma. Current status of the literature. Oral Surg
1996; 81: 383-388.
19. T I, I, N: H . K .
E X 1998; 13: 119-123.
20. Nakamura N, Mitsuyasu T, Higuchi Y, Santra F, Ohishi M:
Growth characteristics of ameloblastoma involving the
inferior alveolar nerve: A clinical and histopathologic study.
Oral Surg 2001; 91: 557-562.
21. Reichart PA, Philipsen HP, Sonner S: Ameloblastoma:
biological profile of 367 cases. Eur J Cancer B Oral Oncol
1995; 31B: 86-94.
22. Adekeye EO: Ameloblastoma of the jaws: a survey of 109
Nigerian patients. J Oral Surg 1980; 38: 36-41.
23. Shirichitra V, Dhiravarangura P: Intrabony ameloblastoma of
the jaws. An analysis of 147 Thai patients. Int J Oral Surg
1984; 13: 187-193.
24. Joseph BK, Savage NW: Maxillary ameloblastoma. Case report
and review of the literature. Austr Dent J 1992; 37 :98-102.
25. Rosestein T, Pogrel AM, Smith RA, Regezi JA: Cystic
ameloblastoma-Behavior and treatment of 21 cases. J Oral
Maxillofac Surg 2001; 59: 1311-1316.
26. Adekeye EO, Lavery KM: Recurrent ameloblastoma of the
maxillofacial region. J Maxillofac Surg 1986; 14: 153-157.
27. Kahn MA: Ameloblastoma in young persons: a
clinicopathologic analysis and etiologic investigation. Oral
Surg 1989; 67: 706-715.
28. Ord RA, Blanchaert RH, Nikitakis NG, Saunk JJ:
Ameloblastoma in children. J Oral Maxillofac Surg 2002; 60:
762-770.
29. Al-Khateeb T, Ababneh KT: Ameloblastoma in young
Jordanians: a review of the clinicopathologic features and
treatment of 10 cases. J Oral Maxillofac Surg 2003; 61: 1318.
30. Akinosi JO, Williams AO: Ameloblastoma in Ibadan, Nigeria.
Oral Surg 1969; 27:257-265.
31. Reichart PA, Philipsen HP: Odontogene Tumoren. Ameloblastome. In Rateitschak KH, Wolf HF (eds).
Oralpathologie Stuttgard: Thieme, 1999; p.223-228.
32. Sampson DE, Pogrel MA: Management of mandibular
ameloblastoma: The clinical basis for the treatment
algorithm. J Oral Maxillofac Surg 1999; 57: 1074-1077.
33. Kim SG, Jang HS: Ameloblastoma: A clinical, radiographic,
and histopathologic analysis of 71 cases. Oral Surg 2001;
91: 649-653.
34. Zwahlen RA, Gratz KW: Maxillary ameloblastomas: a review
of the literature and of a 15-year database. J CranioMaxilofac Surg 2002; 30:273-279.
35. Adebayo ET, Ajike SA, Adekeye EO: Odontogenic tumours in
children and adolescents: a study of 78 Nigerian cases. J
Cranio-Maxilofac Surg 2002; 30: 267-272.
36. O , E E: . A .
O 1990; 44: 351-360.
37. El-Mofty SK, Gerard NO, Farish SE, Rodu B: Peripheral
ameloblastoma: a clinical and histologic study of 11 cases.
J Oral Maxillofac Surg 1991; 49: 970-976.
106
38. A , A B, K, A N, P A: T
. . E X
1998; 13: 183-193.
39. Olatain AA, Adekeye EO: Clinical features and management
of ameloblastoma of the mandible in children and
adolescents. Br J Oral Maxillofac Surg 1996; 34: 248-251.
40. Fox JE, Dyson DP: Ameloblastoma of the maxilla: A report of
two cases. Br Dent J 1975; 138 :61-64.
41. Al-Bayaty HF, Murti PR, Thomson ERE, Niamat J: Soft tissue
recurrence of a mandibular ameloblastoma causing facial
deformity in the temporal region: Case report. J Oral
Maxillofac Surg 2002; 60: 204-207.
42. Pizer ME, Page DG, Svirsky JA: Thirteen-Year follow-up of
large recurrent unicystic ameloblastoma of mandible in a 15year-old boy. J Oral Maxillofac Surg 2002; 60: 211-215.
43. Baden E, Doyle JL, Petriella V: Malignant transformation of
peripheral ameloblastoma. Oral Surg 1993; 75: 214-220.
44. Infante-Cossio P, Hernandez-Guisado JM, FernandezMachin P, Garsia-Perla A, Rollon-Mayordomo A, GutierrezPerez JL: Ameloblastic carcinoma of maxilla: a report of 3
cases. J Cranio-Maxillofac. Surg 1998; 26: 159-162.
45. Buff SJ, Chen JT, Ravin CC, Moore JO: Pulmonary metastasis
from ameloblastoma of the mandible. Report of case and
review of the literature. J Oral Surg 1980; 38: 374-378.
46. Campbell D, Jeffrey RR, Wallis F, Hulks G, Kerr KM:
Metastatic pulmonary ameloblastoma. An unusual case. Br
47. E E, A, , ,
T : T . A . E X
1994; 9: 59-63.
48. Stanley IA, Diehl DL: Ameloblastoma potential of follicular
cysts. J Oral Surg 1965; 20: 260-266.
49. Motamedi MH: Periapical Ameloblastoma: a case report. Br
Dent J 2002; 193: 443-445.
50. P A: O .
K 112 . A, A 1983.
51. Byrd DL, Allen JW, Dunsworth AR: Ameloblastoma
originating in the wall of a premordial cyst: report of a case.
J Oral Surg 1973; 31: 301-305.
52. Levin MP, Kratochvil FJ, Nolan J: Ameloblastoma of the
mandible: a case report. J Periodontol. 2003; 74: 883-6.
53. Namin AK, Azad TM, Eslami B, Sarkarat F, Shahrokhi M,
Kashanian F: A study of the relationship between
ameloblastoma and human papilloma virus. J Oral
Maxillofac Surg. 2003; 61: 467-70.
54. Gruica B, Staufer E, Buser D, Bornstein M: Ameloblastoma of
the follicular,plexiform, and acanthomatous type in the
maxillary sinus: a case report. Quintessence Int 2003; 34:
311-314.
55. Siar CH, Ng KH: Calcifying and keratinizing ameloblastoma
of the maxilla. J Laryngol Otol 1991; 105: 971-974.
56. Slabbert H, Altini M, Crooks J, Uys P: Ameloblastoma with
dentinoid induction: dentinoameloblastoma. J Oral Pathol
Med 1992; 21: 46-52.
57. Odukoya O, Arole O: Clear-cell ameloblastoma of the
mandible (a case report). Int J Oral Maxillofac Surg 1992; 21:
358-364.
58. Nakamura N: Clinical and histopathological studies on the
characteristics of growth of mandibular Ameloblastoma. Jpn
59. Gardner DG, Pecak AM: The treatment of ameloblastoma
based on pathologic and anatomic principles. Cancer 1980;
49: 93-107, 2005
3-10-08 13:00
107
B A
46: 2514-2519.
60. Nakamura N, Higuchi Y, Tashiro H, Ohishi M:
Marsupialization of cystic ameloblastoma. J Oral Maxillofac
Surg 1995; 53: 748-754.
61. Gardner DG: A pathologist approach to the treatment of
ameloblastoma. J Oral Maxillofac Surg 1984; 42: 161-166.
62. Reichart PA, Philipsen HP: Unicystic ameloblastoma. A
review of 193 cases from the literature. Eur J Cancer B. Oral
Oncology 1998; 34: 317-325.
63. Santra F, Mitsuyasu T, Nakamura N, Shiratsuchi Y, Ohishi M:
Immunohistochemical evaluation of PCNA and Ki-67 in
ameloblastoma. Eur J Cancer B. Oral Oncol 2001; 37: 193198.
64. Fung EM: Ameloblastomas. Int J Oral Surg 1978; 7: 305-311.
65. Ferretti C, Polakow R, Coleman H: Recurrent ameloblastoma. Report of 2 cases. J Oral Maxillofac Surg 2000; 58:
800-804.
66. K T, A , B , A I,
E E, P A: H
. I X 1997; 20:485-495.
67. Riediger D, Feifel H: Common free vascularized flaps: the
fibula. In Booth P.W., Schendel S.A., Hausamen J-A. (eds):
Maxillofacial Surgery, Churchill Livingstone London 1999;

Vol 1, p. 549.
68. Rapidis AD, Alexandridis CA, Eleftheriadis E, Angelopoulos
AP: The use of buccal fat pad for reconstruction of oral
defects: review of the literature and report of 15 cases. J Oral
Maxillofac Surg 2000; 58:158-163.
69. , K , P A, B , Z , T K, , M ,
A X: M . E X 2001; 1:43-48.
HMEIH TN YPAEN
O
X K N
.
:
A.. P
X K, E A I, N O
. A 171,
115 22 AHNA
T: 210-6409477
Fax: 210-6420146
e-mail: rapidis@usa.net
49: 93-107, 2005
107
109-115- SEL. -
KARAGIOZAKI*
3-10-08 12:49
109
B A
O

B. K*, . A**, I. ***, . M****
H

. H
. O , , , ,
.
E , , .
A
, , . H , ,
, , , .
O , .
, ,
.
49: 109-115, 2005
5/3/2003 - 9/6/2003
EIAH
H
,
.
, , : , , , , , , .
* E K, B N IKA /
** E , O I A
*** E
**** K .N.N.
.
K

,
.
AOYIOOIA KAI KINIKE EKHEI
TH ANAYAIA
H

- 1.

-
IgE, ,
2-4.
109
109-115- SEL. -
KARAGIOZAKI*
3-10-08 12:49
110
B A

, E (IgE)5. O IgE
.
, -
IgE
(E.1)2, 6, 7.
E. 1: M I. B: B
. TH: B . APC: A , FcRl: Y
IgE. (A Brostoff . 1991, ).
O
, , 3, 8, 9.
, ,
, . (. 1) H

-.
110
INAKA I. B
I

I,
H,

X .
N
,
,
,
(PAF)
. M : , University
Studio Press, 1996.
E,

7.
H , , .
O
, , , ,
.
M
. T
, .
M

.
O ,
, (collapsus). H ,

. T ,
6.
E ,
/
.
A,
, , . T . M , 48 . O ,
, , ,
6, 10, 11.
E, ,
49: 109-115, 2005
109-115- SEL. -
KARAGIOZAKI*
3-10-08 12:49
111
B A
.
T
. M , ,
, 10.
T, , , , 6, 7, 12.
EPAEYTIKH ANTIMETIH OEIA
ANAYAIA
H ,
. A,
,
13.
O :
1. H
, (1-),
.(2-).

, ,
11, 14.
I , , , , , ( ), . O, / 15, 16.
E
, 0,2 0,5 ml
1:1000 , (0,01ml/kgr. ) 20 .

(0,1-0,3 ml 1:1.000 10 ml )6.
2. , ( )

.
3. , , ( 49: 109-115, 2005
: 5-20gr/kg/min ) 15.
4. H .
E ()
,
(4-6 lit/min) .
A

4, 12.
5. O 2-
, ( :6 mg/kg B 20 ) 0,5 mgr/kgr/h, 10
20gr/ml7, 16.
6. E,
6 48
, . E,
50 100 mgr, 6, 12.
7. H
o (1 mgr o 500 ml D/W
5%, 0,5-1ml/min )3, 7.
8. , .
9. T, , .
, . T 5 mg /kgB (
) 4-6
6.
10. A
.
, (1mg bolus 1 mg/ )4.
KYPIOTEPE ENEIEI KAI ANEIYMHTE
ENEPEIE TN TOIKN ANAIHTIKN
T :
A. T , :
I. E :
111
109-115- SEL. -
KARAGIOZAKI*
3-10-08 12:49
112
B A
K, A, B, B, E, .
II. E - :
, X, .
B. T
, M, B, , E, A.
T
,
, .
E,
: ,
.

, , ,
17.
H . 2%
(5-10 ) 2% 3% 1:80.000, 1:100.000, 1:200.000. T
1:50.000

17, 18.
H 15 ml,
300 mgr. E 25 ml
2%, 500 mgr

.
M , .

. 5gr/ml,
KN, , ,
, .
, , , ,
.
.
H ,
.
H
112
, , , , Adams-Stokes15, 16.
H

. H
.
K 2% 1:20.000 , 1:100.000 , 1:100.000 -, 1:200.000 3% . T
18, 19.
A
.
H , 40% .
H .
,
, , 10%.
,
18, 19.
,
4% , 4%
1:200.000 , 3% 1:2.000.000 20.
T .
H
0,009mgr
4 .
1:200.000 , , .
H
400 mgr 10 ml
4% 13 ml 3%.
49: 109-115, 2005
109-115- SEL. -
KARAGIOZAKI*
3-10-08 12:49
113
B A
8,8 ml
14.
T,
4% 1:100.000
1,7 ml. 1,7 ml
( : 1ml/). H
15-30 . H

7 mgr Kgr .
,
, , ,
, , , 8.
T,
4 ,
.
E
1, 5, 10.
ENEIEI KAI ANEIYMHTE ANTIPAEI TN AEIOYATIKN OYIN EMEPIEXOMENN TA
TOIKA ANAIHTIKA
A. K

.
T -,
, ,
. A ,
.
H ,
,
,
.
A , ,
,
(20-30%)
15, 18.

. T

49: 109-115, 2005

.
.
A,

,
, .
E,
. H
, , ,

3, 16.
T, , 1
, 15.
E, , , ,
.
M A K
E,
1:100.000 .
0,2 mgr 1 mgr . (.2).
O , 0,04 mgr 0,2 mgr . 2%
1:100.000 INAKA 2: M
(mgr)

A
0,2
0,04
N-
0,34
0,14
1,0
0,2
4,0
1,6
0,27 IU
A Malamed SF. Hand Book of Local Anesthesia 3rd edition,

Mosby 1990 .: T - O, 1995.
113
109-115- SEL. -
KARAGIOZAKI*
3-10-08 12:49
114
B A
1,8-5,4ml
14, 18.
B.
,
, 4, 6.
,
,
. A
1,8-5,4 ml 1:100.000
14.
T,
, 4, 18.
EIOO
K
, , . A

. M

.
SUMMARY
Acute anaphylaxis and severe side effects after

the infusion of local anesthetics during dental
surgery
V. Karagkiozaki, T. Almagout, I. Litsas, T. Milidis
The infusion of local anesthetics with or without

vasoconstrictors, during dental surgery may cause acute
anaphylaxis, which may be fatal.
Its mechanism of action is rather complicated and it is
characterized by a variety of clinical manifestations. The
most dangerous clinical conditions involve obstructive
angiodema of the upper airway, arrhythmias, cardiogenic
114
shock, laryngeal edema or bronchospasm and being

unresponsive to therapy may lead to death.
Except from anaphylaxis, the local anesthetics, especially
those with vasoconstrictors, may cause severe side
effects in patients with cardiovascular or other severe
diseases. The most commonly used local anesthetic in
dentistry is lidocaine, which may cause hypertension,
arrhythmias, central nervous system suppress, or
difficulty in breathing.
As a result, it is necessary for dentists to have good
knowledge of the main indications and side effects of
these drugs. The usage of vasoconstrictors, such as
epinephrine, should be made with caution, as it may
cause an increase in heartbeats and systolic blood pressure, especially in patients with Coronary Heart Disease.
Furthermore, these vasoconstrictors should be avoided in
patients with pheochromocytoma, as they may cause
pulmonary edema or stroke due to the increase in systolic
blood pressure. Eventually, hyperthyroidism and diabetes
mellitus are regarded as clinical conditions in which
vasoconstrictors should be given with caution.
It can be concluded that the role of dentists involves the
awareness of clinical manifestations of anaphylaxis and
its therapy otherwise it can be fatal. Furthermore, dentists
should be well informed about the main indications and
side effects of local anesthetics, particularly those with
vasoconstrictors, in order for severe clinical conditions to
be prevented.
Key words: local anaesthetics in dentistry, anaphylaxis,
lidocaine, prilocaine, mepivacaine, adrenaline and articaine
BIBIOPAIA
1. Malamed SF, Gagnon S, Leblane D: A comparison between
articaine HCl and lidocaine HCl in pediatric dental patients.
Dent 2000 Jul-Aug; 22(4): 307-311.
2. Romagnani S: T-cells, cytokines and IgE regulation in
allergic disease. Progress in allergy and clinical
immunology 1995; 3: 5-12.
3. Austen KF, Metcalfe DD: Anaphylactic syndrome, in
Immunological Diseases, 5th ed. M Frank et al. Boston,
Little, Brown, 1995.
4. Stein JH, Hutton JJ, Kohler PO, Orouke RA, Reynols HY, et al:
Pathology 4th ed. Vol. III, . , 1998.
5. Malamed SF, Gagnon S, Leblane D: Efficacy of articaine: a
new amide local anesthetic. Am Dent Assoc 2000 May;
131(5): 635-42.
6. Harrisons AS, Fauci E, Braunwald KJ, Isselbacher JD,
Wilson, et al: Principles of Internal Medicine 14th ed. Vol. III,
McGraw-Hill, 2001.
7. M : ,University
Studio Press, 1996.
8. Malamed SF, Gagnon S, Leblane D: Articaine hydrochloride:
a study of the safety of a new amide local anesthetic. Am
Dent Assoc 2001 Feb; 132(2): 177-85.
9. Pepys J: Atopy: a study in definition. Allergy 1994; 49: 397399.
10. Gunaydin B, Demiryurek AT: Effects of prilocaine and
articaine on human leucocytes and reactive oxygen species
in vitro. Acta Anaesthesiol Scand 2001 Jul; 45(6): 741-745.
11. Soter NA: Urticaria and angioedema, in Dermatology and in
49: 109-115, 2005
109-115- SEL. -
KARAGIOZAKI*
3-10-08 12:49
115
B A
General Medicine, 4th ed. TB Fitzpatrick et al. New York, Mc

Graw-Hill, 1993.
12. Berkow R, Fletcher AJ, Bondy PK, et al: The Merck Manual of
diagnosis and therapy, Merck &Co., Inc. Rahway 1992; p:
331-333.
13. Marquardt DL and Wasserman SI: Anaphylaxis. In Middleton
E.E. et al, editors: Allergy: principles and practice, 4th ed. St.
Louis, 1993, Mosby.
14. Goodman-Gilman A, Rall TW, Nies AS, Taylor P: The
Pharmacological Basis of Therapeutics. 8th ed. Vol.1.
Maxwell Macmillan, New York. 1991.
15. Braunwald E, Zipes DP, Libby P et al: Heart disease, 6th ed.
2001.
16. T : K. I. E ,
1999.
17. Covino BG, Wildsmith JAW: General Considerations,

Toxicity and Complications of Local Anaesthesia. In:
Nimmo, W.S, Rowbothan, D.J, Smith, G: Anesthesia, 2nd
ed. Blackwell Scientific Publications, Oxford, 1994.
18. Katzung G: Basic and Clinical Pharmacology.5th ed.
Appleton and Lange, New Jersey, 1992.
19. Malamed SF: Handbook of Local Anesthesia. 3rd ed.
Mosby, St. Louis, 1990.
20. Mc Lean C, Reader A, Beck M, Meyers WJ: An evaluation of
4% prilocaine and 3% mepivacaine compared with 2%
lidocaine (1:100000 epinephrine) for inferior alveolar nerve
block. J Endod 1993; 19(3): 146-150.
21. : To -
O, . 8, . 79-85, 1995.
:
K B,
B 145,
T. 6972221820
49: 109-115, 2005
115
117-126 SEL. -
GATOU*
3-10-08 12:50
117
E M
K
A
-
T. *, E. K**, E. ***

A, - ,
. O 1626 A-A (2000), : (dft DMFT), (d/d+f%, D/D+F%), (DIs) . E 1450 , 6-18 , 107 .
E 6 12 25,7% 29,8%,
dft=0,69 DMFT=0,65 . - E
, 1/3 . T
. T 36%
.H - : dft, DMFT, d/d+f%, D/D+F%, % . ,
A . O , - . T , .
49: 117-126, 2005
15/7/2003 - 29/4/2004
EIAH
K , E

(1). 5-6 ,
50%, O Y (.O.Y.) 2000(2).
,
: , ,
, , , - .
* O, E K O
** E A K.Y. A
*** E A K.Y. A
K Y A
M 32 , , 24-26 M 2002.
,
,
'70-'80(3), '90 (1, 4). M, , E(1, 5). E,

, - .
, E , 20% 80% (6, 7). I
- , ,
,
,
(4, 8).

117
117-126 SEL. -
GATOU*
3-10-08 12:50
118
E M
K.Y. A,
, . , - , , , ,
.
YIKO - MEOO

A A. K 2001-2002 1626
K Y, (E),
, .
O : , , , .
O dft DMFT
. K ,
, .
. ,

.O.Y. (9). ,
,
,
, . T, Gluck(d/d+f% D/D+F%)
(10).
Greene Vermillion-DIs(11), . ,
I
, II III
.
: , ,
, (A/A) . ,

. M ,
- , ESOMAR(12). O , .
E 1450 , 734 716
, 6-18 . O 107
, . A, A. 1 E , .
1. K E ,
-
EHNE
METANATE
YNOO
YO
A
K
667 (49,7%)
676 (50,3%)
67 (62,6%)
40 (37,4%)
734 (50,6%)
716 (49,4%)
6-8
9-11
12-14
15+
306 (22,8%)
350 (26,0%)
334 (24,9%)
353 (26,3%)
39 (36,5%)
31 (28,9%)
24 (22,4%)
13 (12,2%)
345 (23,8%)
381 (26,3%)
358 (24,7%)
366 (25,2%)
K
M
A
512 (38,1%)
631 (47,0%)
137 (10,2%)
63 (4,7%)
93 (86,9%)
5 (4,7%)
3 (2,8%)
6 (5,6%)
605 (41,6%)
636 (43,9%)
140 (9,7%)
69 (4,8%)
1343 (100%)
107 (100%)
1450 (100%)
HIKIAKH OMAA
KOINNIKO-OIKONOMIKH TAH
YNOO
118
49: 117-126, 2005
117-126 SEL. -
GATOU*
3-10-08 12:50
119
E M
H
SPSS.
, , -
, .
dft, DMFT, d/d+f% D/D+F% , ,
.
AOTEEMATA
T
2

. T

dft .
6 74,3% E
, dft 0,69. , 36,4%
, dft 2,64.
, 10,5% dft>3 4,2% dft>5
( ).
,
. H -
: 27%
(d/d+f%=0) 58% (d/d+f%=100),

( ).
T ,
( 4), , - dft.
, dft 0,29 ,
0,91
0,20 .
O d/d+f%
- . O
18 , 9
. K , (p>0,05),
, .
T
O 3 -
2. E

n
dft(SD)
d/d+f%
70
11
25,7
63,6*
0,60
2,64
0,09
0,00
0,69(1,45)
2,64(2,46)
i85
100
131
16
22,9
62,5*
0,55
1,31
0,30
0,94
0,85(2,02)
2,25(2,46)
66
65
105
11
33,3
81,8*
0,68
2,45
0,34
0,64
1,02(1,96)
3,09(3,21)
61
78
104
10
43,3
70,0
0,88
1,90
0,42
0,20
1,30(1,89)
2,10(2,33)
64
83
10
109
7
37,6
57,1
0,70
1,86
0,24
0,14
0,94(1,52)
2,00(2,52)
72
75
11
89
8
38,2
38,5
0,39
0,75
0,36
0,00
0,75(1,17)
0,75(1,16)
50
00
12
51
4
29,4
25,0
0,24
0,25
0,16
0,00
0,39(0,70)
0,25(0,50)
58
100
6-12
659
67
33,1
61,2*
0,61
1,73
0,29
0,37
0,90(1,69)
2,10(2,44)
64
81
* , : % , : , p<0,05
49: 117-126, 2005
119
117-126 SEL. -
GATOU*
3-10-08 12:50
120
E M
4. M , , -
A .
E
dft
A
d/d+f%
DMFT
D/D+F%
E. p
E. p
E. p
E. p
-0,33
0,010
-4,68
0,386
0,19
0,010
-5,08
0,279
E2
1,16
0,001
18,04
0,015
0,49
0,001
20,22
0,005
K- 3
-0,30
0,002
-8,87
0,034
-0,15
0,012
-9,88
0,015
T 4
0,42
0,124
5,31
0,580
0,34
0,084
-6,37
0,543
1,35
0,001
76,95
0,001
0,69
0,001
69,24
0,001
-0,29
0,026
-3,21
0,557
0,21
0,007
-4,43
0,358
0,91
0,001
10,89
0,181
0,52
0,001
15,13
0,053
K-
-0,20
0,044
-7,40
0,096
-0,10
0,095
-6,70
0,127
0,48
0,086
13,49
0,174
0,31
0,122
-1,76
0,870
A (n)
730
258
1335
361
K: 1/, 2/, 3//, 4A/A

,
. T E , 7-8 10-12 .
12 , 70,2% E DMFT 0,65. A,
, 20%
DMFT 2,40. , 6,4% DMFT>3 ( ). T 56%
76% . H
: 33%
0% 50% 100% ( ).
T , -
DMFT ( 4). T , 0,19, 0,49 0,15
. ,
-
120
E .
O (D/D+F%)
, 20 10 . ,
(p=0,053). M 11%
(D/D+F=O%),
E 36% (T ).
E
5 , , - . M E ,
, ,
.
7 - .
49: 117-126, 2005
117-126 SEL. -
GATOU*
3-10-08 12:50
121
E M
3. E
.
n
DMFT(SD)
D/D+F%
47
8
0,0
0,0
0,00
0,00
0,00
0,00
0,00
0,00
0,0(0,00)
0,0(0,00)
0
0
113
14
1,8
14,3*
0,01
0,29
0,00
0,00
0,02
0,07
0,03(0,21)
0,36(1,05)
50
87
105
12
5,7
33,3*
0,07
0,67
0,00
0,00
0,01
0,00
0,08(0,36)
0,67(1,07)
83
100
105
10
15,2
30,0
0,24
0,70
0,00
0,00
0,08
0,00
0,31(0,87)
0,70(1,25)
79
100
10
116
8
17,2
75,0*
0,21
1,00
0,00
0,00
0,08
0,50
0,28(0,71)
1,50(1,31)
80
78
11
129
13
26,4
61,5*
0,33
1,00
0,01
0,00
0,17
0,23
0,51(0,98)
1,23(1,30)
68
85
12
114
5
29,8
80,0*
0,33
1,40
0,00
0,00
0,30
1,00
0,65(1,16)
2,40(1,82)
62
68
13
115
13
32,2
46,2
0,44
0,46
0,00
0,23
0,27
0,15
0,71(1,30)
0,85(1,07)
64
60
14
105
6
45,7
66,7
0,58
1,50
0,02
0,17
0,56
0,17
1,16(1,64)
1,83(1,83)
44
92
15
133
8
33,1
50,0
0,54
1,25
0,01
0,25
0,47
0,38
1,02(1,87)
1,88(2,59)
57
77
16
97
2
43,3
100,0
0,71
1,50
0,03
0,00
0,68
3,50
1,42(2,06)
5,00(1,41)
44
33
17
87
1
42,5
100,0
0,52
1,00
0,01
0,00
0,62
2,00
1,15(1,90)
3,00 ( - )
36
33
18
36
2
44,4
100,0
0,61
1,00
0,00
0,50
0,50
1,50
1,11(1,92)
3,00(2,83)
45
25
6-18
1302
102
25,8
45,1*
0,35
0,76
0,01
0,07
0,28
0,30
0,64(1,38)
1,14(1,59)
56
76
* , : % , : , p<0,05
,
2,3
. T

1,5
. E, A 4
A.
O
A 36,0% 8,6% ( 6). T
- 49: 117-126, 2005
, , , ( 7). T
1,5

. K .
YZHTHH

A A
(89,2% ). . H
E
(12),
E .
, 121
117-126 SEL. -
GATOU*
3-10-08 12:50
122
E M
5. K , ,
-
TOMATIKH YIEINH
KAKH
METPIA
KAH
YNOO
A
K
87 (11,9%)
47 (6,6%)
268 (36,5%)
192 (26,8%)
379 (51,6%)
477 (66,6%)
734 (100%)
716 (100%)
109 (8,1%)
25 (23,4%)
409 (30,5%)
51 (47,7%)
825 (61,4%)
31 (29,1%)
1343 (100%)
107 (100%)
203
198
36
23
336
380
102
38
YO
ENIKOTHTA
K
M
A
66
58
2
8
(10,9%)
(9,1%)
(1,4%)
(11,6%)
(33,6%)
(31,1%)
(25,7%)
(33,3%)
(55,5%)
(43,9%)
(72,9%)
(55,1%)
605
636
140
69
(100%)
(100%)
(100%)
(100%)
TOO KATOIKIA
A
A
YNOO
119 (8,5%)
15 (27,3%)
435 (31,2%)
25 (45,5%)
841 (60,3%)
15 (27,3%)
1395 (100%)
55 (100%)
134 (9,2%)
460 (31,7%)
856 (59,0%)
1450 (100%)
6. K , ,
- .
OPOONTIKE ANAKE

YNOO
YO
A
K
423
381
(57,6%)
(53,2%)
255 (34,7%)
267 (37,3%)
56 (7,6%)
68 (9,5%)
734 (100%)
716 (100%)
730
74
(54,4%)
(69,2%)
489 (35,4%)
33 (30,8%)
124 (9,2%)
(0%)
1343 (100%)
107 (100%)
356
351
69
28
(58,8%)
(55,2%)
(49,3%)
(40,6%)
211
229
50
32
767
37
(55,0%)
(67,3%)
506 (36,32%)
16 (29,1%)
122 (8,7%)
2 (3,6%)
1395 (100%)
55 (100%)
804
(55,4%)
522 (36,0%)
124 (8,6%)
1450 (100%)
ENIKOTHTA
M
K
M
A
(34,9%)
(36,0%)
(35,7%)
(46,4%)
38
56
21
9
(6,3%)
(8,8%)
(15,0%)
(13,0%)
605
636
140
69
(100%)
(100%)
(100%)
(100%)
TOO KATOIKIA
A
A
YNOO
122
49: 117-126, 2005
117-126 SEL. -
GATOU*
3-10-08 12:50
123
E M
7. M
, ,
.
.
E

O
Exp (B)
(95%
E.
p
Exp (B)
95%
E.
p
M
1
0,52 (0,36 - 0,76)
0,001
0,86 (0,58 - 1,28)
0,460
E2
3,45 (2,12 - 5,63)
0,001
-*
K- 3
0,62 (0,46 - 0,84)
0,002
-0,67 (0,49 - 0,90)
0,009
T 4
4,02 (2,16 - 7,49)
0,001
1,92 (0,43 - 8,46)
0,386
0,56 (0,38 - 0,82)
0,003
0,84 (0,55 - 1,26)
0,393
2,30 (1,33 - 3,99)
0,003
-*
K-
0,66 (0,48 - 0,92)
0,014
-0,71 (0,52 - 0,96)
0,028
3,96 (2,01 - 7,81)
0,001
1,71 (0,38 - 7,70)
0,484
A (n)
1381
605
.
K : 1, 2, 3, 4A
*
12-15 ( ) 15 ( ).
O A E. Reich E(1), E dft
1,5 5-7 ,
dft 2,5
5,5. , dft 6
0,69 , 2,82 ( ).
O N 2001(13) 6-12 K,

. A
49: 117-126, 2005
.(14), 1991 55% 6 65% 12

. 25,7% 29,8%,
.
O B .(15) 1996 A,
5 41% dmft 1,62, 12, 43%
DMFT 2,35.
.(16) 1993 A, 12 55% DMFT 1,63, 1998(17) 75%
DMFT 2,41 . O -(18) 1999 B . 6 61%
123
117-126 SEL. -
GATOU*
3-10-08 12:50
124
E M
dmft 2,73, 92% 4,33. 12 ,

82%
DMFT 2,85,
100% 4,63. T, .(19) 89% dmft 5,51 5 . O ,

E, .
T A (61% E ). T ,
. A . O O . 1990(20)
14% 5-12
A, . O A .(14) 6-12 A
1982-1991,
DIs 1,6,
. O M-X .(21) 1986 617 A, OHI-s 1,69,
.
, ,
,

. O .(20)
1990 A, 36% , B .(15)
1996 A, 12,5%. , - , .
H
, , , . H
20 E(14, 16, 22) . K.Y.A
. T ,
.
,
. 124
. M
( , ) ' . T, ,

,
, .
, . A 6,4% DMFT>3
50% . A
, .

- . , -
(23, 24). E,
, , ,
(25-27).
YMEPAMATA
T
- ,
, ,
K Y.

, .
, .
M
(28),

E
49: 117-126, 2005
117-126 SEL. -
GATOU*
3-10-08 12:50
125
E M
,

.
SUMMARY
Oral status of the school - age population

of Aigina island in correlation
with socioeconomic factors
T. Gatou, E. Kazazakis, H. Papadopoulou
The purpose of this study was to record the main

parameters determining the oral status of the school
population of Aigina island, as well as to investigate their
relation with socioeconomic factors, in order to reveal
differentiations that need further investigation and
intervention. 1626 children, according with school
registers of Aigina, were called for the year 2000 annual
orodental examination. Caries prevalence (%caries free,
dft and DMFT), and caries treatment needs (d/d+f%,
D/D+F%), oral hygiene status(DIs) and orthodontic
needs, were recorded. From 1450 children examined, age
6-18, 107 were immigrants. Among Greek children, at age
6 and 12, 25,7% and 29,8% had caries experience, with
caries prevalence of dft=0,69 and DMFT=0,65
respectively. Two-thirds of Greek children, versus only 1/3
of the immigrants' children had high oral hygiene level,
while girls showing better oral hygiene than boys. Thirty-six
percent needed orthodontic treatment. Ethnicity and
socioeconomic status significantly differentiated the
following parameters:, dft, d/d+f%, DMFT, D/D+F%, oral
hygiene, and %orthodontic treated children. In
comparison with other relevant studies in Greece, Greek
children of Aigina present better oral hygiene and lower
prevalence of caries. However, treatment needs remain
high, especially within the lower socioeconomic class.
Immigrants' children have poorer oral health status, and
need more sensitive approach, in order to develop a more
positive attitude toward dentist and dental care.
Key words: caries prevalence, oral status, epidemiology, children, immigrants, socioeconomic status.
BIBIOPAIA
1. Reich E: Trends in caries and periodontal health
epidemiology in Europe. Int Dent J 2001;51:392-398.
2. Marthaler TM, O'Mullane DM, Vribic V: The prevalence of
dental caries in Europe 1990-95. Orca Symposium 1995.
Caries Res 1996;30:237-255.
3. Downer MC: Time trends in dental decay in young children.
Health Trends 1989;21:7-9.
4. Downer MC: Description and explanation of the distribution
of caries in the population of Europe. In: Johnson NW(ed).
Risk Markers for Oral Diseases, Volume1, Dental Caries.
Cambridge University Press, Cambridge 1991, pp100-131.
49: 117-126, 2005
5. Haugejorden O, Birkeland JM: Evidence for reversal of the

caries decline among Norwegian children. International
Journal of Paediatric Dentistry 2002;12:306-315.
6. Venkalati M, Tarkokonen L, Varsio S, et al: Decrease in and
polarization of dental caries occurrence among child and
youth populations, 1976-1993. Caries Res 1997;31:161-165.
7. Pitts NB: Inequalities in childrens caries experience: the
nature and size of the UK problem. Community Dent Health
1998;15:296-300.
8. Beck JD, Kohout F, Hunt RJ: Identification of high caries risk
adults: attitudes, social factors and diseases. Int Dent J
1988;38:231-238.
9. WHO, Oral Helath Surveys. Basic methods (3rd ed.). WHO,
Geneva. 1987.
10. Gluck MG, Jong A: A community health center dental
program in Boston, USA. Community Dent Oral Epidemiol
1976;4:51-54.
11. Greene JC, Vermillion JR: The simplified oral hygiene index.
JADA 1964;68:7-13.
12. ESOMAR Standard Demographic Classification. A system of
International Socio-Economic Classification of Respondents
to Survey Research, Amsterdam 1997, Internet:
http://www.esomar.nl.
13. N : E 6 12 B K. E X 2001;45:65-71.
14. Athanassouli T, Mamai-Homata E, Panagopoulos H, KoletsiKounari H, Apostolopoulos A: Dental caries changes
between 1982 and 1991 in Athens, Greece. Caries Res
1994;28:378-382.
15. Vadiakas G, Tsinidou K, Oulis C: Dental health status and
treatment needs of 5- and 12-year old children in Athens,
Greece. Hellenic Dental Journal 1996;6:49-53.
16. Salapata GJ, Bakoula C, Hawley GM, Blinkhorn AS: A five year
follow up into changes in caries experience amongst a
sample of 12 year old children from Athens. Int Dent J
1995;45:160-162.
17. Salapata J, Blinkhorn AS, Attwood D: Dental health of 12-yearold children in Athens. Community Dent Oral Epidemiol
1990;18:80-81.
18. I, : E
6 12
N B.
1999;13:55-63.
19. Lygidakis NA, Karatolios T, Bidaki E, Oulis KI: Epidemiological
study of oral health and dietary habits in pre-school
immigrant children in Athens. Int Dent J 1996;46:211-217.
20. O K, I, B A, A : O A.
E X 1990;34:29-39.
21. M-X E, K-K X, X,
A : E

A. O 1987;43:139-145.
22. X E: T E. O 2003;
57(3): 294-311.
23. Watt R, Sheiham A: Inequalities in oral health: a review of the
evidence and recommendations for actions. Br Dent J
1995;187:6-12.
24. Watson MR, Horowitz AM, Garcia I, Canto MT: Caries
conditions among 2-5-year-old immigrant Latino children
related to parents' oral health knowledge, opinions and
practices. Community Dent oral Epidemiol 1999;27:8-15.
125
117-126 SEL. -
GATOU*
3-10-08 12:50
126
E M
25. Bradnock G, Jadaua SI, Hamburger R: The dental health of

indigenous and non-indigenous infant school children in
West Birmingham. Community Dent Health 1988;2:139-150.
26. Watson MR, Manski RJ, Macek MD: The impact of income on
children's and adolescents preventive dental visits. JADA
2001;132:1580-1587.
27. Schou L, Wight C: Does dental health education affect
inequalities in dental health? Community Dent Health

1994;11:97-100.
28. Sheiham A, Joffe M: Public dental health strategies for
identifying and controlling dental caries in high and low risk
populations. In: Johnson NW (ed.): Risk Markers for oral
Diseases Volume 1 Dental Caries. Cambridge, Cambridge
University Press, pp.445-481.
:
T.
17
111 42 A
T: 210-2136093
126
49: 117-126, 2005
127 sel.
3-10-08 12:51
365
EYXAPITHPIA TOY KPITE TOY TOMOY 48/2004

EHNIKN TOMATOOIKN XPONIKN
H E
48/2004
E X,
,
.
A K/
A- E
A
B A
B E
B -M
B I
M

I

A

B
E E
E
E A
Z
H
I I
I
K A
K
K
K H
K- E
K H
K N
K N
K N
K A
K-K
K E
K A
K N
K A

M

M
M
M Z
M A
M K
M E
M
M
N- O
O
O K/
E
B

E
N
-M K
E

N

P A
P
-A A
X
A
E

T
T K
T- B
T K/
T
T A
T K/
I
X M
X N
X E
127
128 sel. BIBLIOPAROYSIASH
3-10-08 12:52
366
T B Wilmer Souder 2005 K . . H

H O E K A O O (IADR) HA, 21/12/2004 K E B
. . H B Wilmer Souder 2005.
T B IADR . K 1955 Dr. Wilmer Souder, O T E HA (NBS), E I T (NIST).
T B .
T B Wilmer Souder , ,
O B. H B M 83 IADR B
HA. N B 50 .
O . H, B, K E IADR B Wilmer Souder, 2010 E.
H O . H - .
O
K . B
T B Anthony Rizzo A. K . M
T Anthony Rizzo Periodontal Research Award E O (Periodontal Research Group) O O
(International Association for Dental Research) ( 40 )
. O O O
5 .
B
O
. E .
T K A O, , , , .
A .
,
.
T A K . K A O .
N K
A K
O
128

Ianouarios Martios-2005

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ianouarios Martios-2005

Uploaded by

Copyright:

Available Formats

stomatologika exof.

ENTYO KEITO AP. A. 520/92

EITHMONIKO ENTYO ME ENIKH ANANPIH

ISSN 1011 - 4181

ISSN 1011 - 4181

TOMO 49, TEYXO 1

TOMO 49, TEYXO 1

Hellenic Dental Association

Assessment of hardness of experimental Titanium alloys

VOLUME 49, ISSUE 1

Teeth and gingival display of maxillary central incisors.

Submerged (ankylosed) teeth. A rare case report

The importance of the zone of attached gingival for the

Hellenic Dental Association

VOLUME 49, ISSUE 1

Guidelines for crowning the tooth abutments of a removable

Oral status of the school-age population of Aigina island in

Scanning Electron Microscopy

ANAEPHMENE OHIE IA TOY YPAEI

9-14 SEL. - ZHNELIS*

9-14 SEL. - ZHNELIS*

9-14 SEL. - ZHNELIS*

9-14 SEL. - ZHNELIS*

Assessment of hardness of experimental

The development of Ti alloys for orthopedic and dental

49: 9-14, 2005

9-14 SEL. - ZHNELIS*

research studies. The aim of this study was to evaluate the

9-14 SEL. - ZHNELIS*

29. Collings EW: The physical metallurgy of titanium alloy, Ohio.

49: 9-14, 2005

15-20 SEL. - HLIADIS*

15-20 SEL. - HLIADIS*

15-20 SEL. - HLIADIS*

Tukey. =0.05. H Sigma Stat

49: 15-20, 2005

15-20 SEL. - HLIADIS*

15-20 SEL. - HLIADIS*

Effect of grinding of orthodontic bonding resins

The purpose of this study was to assess the effect of a

15-20 SEL. - HLIADIS*

study on untreated and orthodontically treated persons 5

materials. Oper Dent 1996;21:73-80.

49: 15-20, 2005

21-27 SEL. - CHRYSOMALI*

21-27 SEL. - CHRYSOMALI*

629 (3.18%) 47 (7.47%)

21-27 SEL. - CHRYSOMALI*

21-27 SEL. - CHRYSOMALI*

21-27 SEL. - CHRYSOMALI*

80% " " , ,

21-27 SEL. - CHRYSOMALI*

Oral squamous cell carcinoma in young adults

Background: Squamous cell carcinoma of the oral cavity

years; the male-to-female ratio was 2.9:1. The tongue

21-27 SEL. - CHRYSOMALI*

cavity in patients aged 45 years and under: a descriptive

49: 21-27, 2005

29-35 SEL. - KOIDIS

29-35 SEL. - KOIDIS

YIKA KAI MEOO

29-35 SEL. - KOIDIS

29-35 SEL. - KOIDIS