ÌÂ ÙÔ Û‡ÛÙËÌ· ProTaper

S1 Sx S1 S2 F1 F2 F3

-6 mm ·fi ª‹ÎÔ˜ ∂ÚÁ·Û›·˜

-4 mm ·fi ª‹ÎÔ˜ ∂ÚÁ·Û›·˜

ª‹ÎÔ˜ ∂ÚÁ·Û›·˜

ª‹ÎÔ˜ ∂ÚÁ·Û›·˜

ª‹ÎÔ˜ ∂ÚÁ·Û›·˜

ª‹ÎÔ˜ ∂ÚÁ·Û›·˜

ª‹ÎÔ˜ ∂ÚÁ·Û›·˜

EÈÎ. 1: ™˘Û΢‹ Elements Obturation Unit.

EÈÎ. 2: ∆ÔÔı¤ÙËÛË ÙÔ˘ ·ÚÈÔ˘ ÎÒÓÔ˘

ÛÙÔ Ì‹ÎÔ˜ ÂÚÁ·Û›·˜.

EÈÎ. 3: ŒÌÊÚ·ÍË ÙÔ˘ ·ÎÚÔÚÚÈ˙ÈÎÔ‡

ÙÚÈÙËÌÔÚ›Ô˘ ÌÂ ÙÔ System B.

EÈÎ. 4: ŒÌÊÚ·ÍË ÙÔ˘ Ì˘ÏÈÎÔ‡ ÙÚÈÙË-ÌÔÚ›Ô˘ ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ Ì ¤Á¯˘ÛË ıÂÚÌ‹˜ ÁÔ˘Ù·¤Úη˜.

Û·Ï›‰·˜, ÂÓÒ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ıÂÙÈÎÒÓ Ì·ÚÙ‡ÚˆÓ Ë Ê˘Û·Ï›‰· ÌÂÙ·ÎÈÓ‹ıËΠÁÚ‹ÁÔÚ·, ÌfiÏȘ ÂÊ·ÚÌfiÛÙËΠ›ÂÛË ÛÙÔ Û‡ÛÙËÌ·. ∏ ÌÈÎÚԉțۉ˘ÛË ÙˆÓ ‰ÂÈÁÌ¿-ÙˆÓ ÌÂÙÚ‹ıËΠ7 ̤Ú˜, 1 Ì‹Ó· Î·È 3 Ì‹-Ó˜ ÌÂÙ¿ ÙËÓ ¤ÌÊÚ·ÍË Î·È Ù· ·ÔÙÂϤ-ÛÌ·Ù· ÂÎÊÚ¿ÛÙËÎ·Ó Û ÌL/24h (¶›Ó·-η˜ 2). ¢Â ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·-ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Û ηӤӷ ¯ÚfiÓÔ ÂϤÁ¯Ô˘ (p>0,05). ™Â fiϘ ÙȘ ÔÌ¿‰Â˜ Ë ÌÈÎÚԉțۉ˘ÛË ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ÛÙÔ˘˜ 3 Ì‹Ó˜ Û ۯ¤ÛË Ì ÙȘ 7 ̤Ú˜ (p<0.05).

™˘˙‹ÙËÛË- ™˘ÌÂÚ¿ÛÌ·Ù·

∏ ¤ÌÊÚ·ÍË Ì ¤Ó·Ó ÎÒÓÔ ProTaper Gutta-percha Point ·ԉ›¯ıËΠÙÔ ›‰ÈÔ

·ÔÙÂÏÂÛÌ·ÙÈ΋ Ì ÙËÓ ¤ÌÊÚ·ÍË Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ Ï¿ÁÈ·˜ Û˘Ì‡ÎÓˆÛ˘. ∆Ô Â‡ÚËÌ· ·˘Ùfi ¤Ú¯ÂÙ·È ÛÂ Û˘Ìʈӛ· Ì ٷ

·ÔÙÂϤÛÌ·Ù· ÙˆÓ Zmener Î·È Û˘Ó.⁷Î·È ÙˆÓ Gordon Î·È Û˘Ó.⁸ÔÈ ÔÔ›ÔÈ ‰ÂÓ ·-Ú·Ù‹ÚËÛ·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ ‰È·-ÊÔÚ¿ Û Â›Â‰Ô ÌÈÎÚԉțۉ˘Û˘ ηÈ

ÔÈfiÙËÙ·˜ ¤ÌÊڷ͢ ·ÓÙ›ÛÙÔȯ· ÌÂٷ͇

ÂÌÊÚ¿ÍÂˆÓ Ô˘ ¤ÁÈÓ·Ó Ì Ï¿ÁÈ· Û˘-Ì‡ÎÓˆÛË Î·È Ì ¤Ó· ÂȉÈο Ù˘ÔÔÈË-̤ÓÔ ÎÒÓÔ ÁÔ˘Ù·¤Úη˜.

ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË Ì¤ıÔ‰Ô Ì¤ÙÚËÛ˘

ÌÈÎÚԉțۉ˘Û˘ Ì ‚·ÎÙ‹ÚÈ· ÔÈ Yücel ηÈ

ç

iftçi⁹·ÍÈÔÏfiÁËÛ·Ó ÙË ÌÈÎÚԉțۉ˘-ÛË ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ Ô˘ ›¯·Ó ÚÔ·-Ú·Û΢·Ûı› Ì Ì˯·ÓÔΛÓËÙ· ÌÈÎÚÔÂÚ-Á·Ï›· ÓÈÎÂÏ›Ô˘-ÙÈÙ·Ó›Ô˘ ProTaper Î·È ÂÌÊÚ¿¯ıËÎ·Ó Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ Ï¿ÁÈ·˜

Û˘Ì‡ÎÓˆÛ˘ Ì ·ÚÈÔ ÎÒÓÔ ÎˆÓÈÎfiÙË-Ù·˜ 0,2, System B, ÎÒÓÔ ÁÔ˘Ù·¤Úη˜

ProTaper Gutta-percha Point Î·È ÎÒÓÔ ÁÔ˘Ù·¤Úη˜ ProTaper Gutta-percha Point ÛÂ Û˘Ó‰˘·ÛÌfi Ì Ï¿ÁÈ· Û˘Ì‡-ÎÓˆÛË. ∆ÚÈ¿ÓÙ· ̤Ú˜ ÌÂÙ¿ ÙËÓ ¤ÌÊÚ·ÍË ÔÈ ÔÌ¿‰Â˜ Ô˘ Ë ¤ÌÊÚ·ÍË ¤ÁÈÓ Ì System B ‹ ÎÒÓÔ ÁÔ˘Ù·¤Úη˜ ProTaper Gutta-percha Point ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ

Ï¿ÁÈ· Û˘Ì‡ÎÓˆÛË ÂÌÊ¿ÓÈÛ·Ó ÙË ÌÈ-ÎÚfiÙÂÚË ‚·ÎÙËÚȷ΋ ‰È›ۉ˘ÛË. ∞ÓÙ›ıÂ-Ù·, ÂÍ‹ÓÙ· ̤Ú˜ ÌÂÙ¿ ÙËÓ ¤ÌÊÚ·ÍË ‰ÂÓ

·Ú·ÙËÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜

‰È·ÊÔÚ¤˜ ÛÙË ÌÈÎÚԉțۉ˘ÛË ÌÂٷ͇

ÙˆÓ ÔÌ¿‰ˆÓ ÂϤÁ¯Ô˘, ‡ÚËÌ· Ô˘

¤Ú¯Â-Ù·È ÛÂ Û˘Ìʈӛ· Ì ٷ ·ÔÙÂϤÛÌ·Ù·

Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜. £· Ú¤ÂÈ ˆÛÙfi-ÛÔ ÛÙÔ ÛËÌÂ›Ô ·˘Ùfi Ó· ÛËÌÂȈı› fiÙÈ ·Ó Î·È ÔÈ Yücel ηÈ

ç

^iftçi9Â¤ÏÂÍ·Ó ·Úfi-ÌÔȘ ÔÌ¿‰Â˜ ÂϤÁ¯Ô˘ Ì ÙËÓ ·ÚÔ‡Û·

ÂÚÁ·Û›·, Ë ‰È·ÊÔÚ¿ ÛÙË Ì¤ıÔ‰Ô ·ÍÈÔÏfi-ÁËÛ˘ Ù˘ ÌÈÎÚԉțۉ˘Û˘ ‰‡ÛÎÔÏ· ÂÈ-ÙÚ¤ÂÈ Û˘ÁÎÚ›ÛÂȘ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÂÚÁ·-ÛÈÒÓ Î·ıÒ˜ Û‡Ìʈӷ Ì ÙÔ˘˜ Karagenç Î·È Û˘Ó.¹⁰‰ÂÓ ˘¿Ú¯ÂÈ ·ÓÙÈÛÙÔȯ›· ÙˆÓ

·ÔÙÂÏÂÛÌ¿ÙˆÓ ÌÈÎÚԉțۉ˘Û˘ ÌÂٷ͇

Ù˘ ÌÂıfi‰Ô˘ Ì ‚·ÎÙ‹ÚÈ· Î·È Ù˘

ÌÂıfi-‰Ô˘ ÌÂÙ·ÊÔÚ¿˜ ˘ÁÚÔ‡.

∏ Ù¯ÓÈ΋ Ù˘ Ï¿ÁÈ·˜ Û˘Ì‡ÎÓˆÛ˘,

¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ ·ÚÈÔ ÎÒÓÔ ¤Ó·Ó ÎÒÓÔ ÁÔ˘Ù·¤Úη˜ ΈÓÈÎfiÙËÙ·˜ ›‰È·˜ ÌÂ

·˘Ù‹Ó Ù˘ ÚÔ·Ú·Û΢‹˜, ‚Ú¤ıËΠÙÔ

›‰ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ Û ۯ¤ÛË Ì ÙËÓ

ÙÂ-¯ÓÈ΋ Ù˘ Ï¿ÁÈ·˜ Û˘Ì‡ÎÓˆÛ˘ Ì ÙË

¯Ú‹ÛË Î‡ÚÈÔ˘ ÎÒÓÔ˘ ΈÓÈÎfiÙËÙ·˜ 0,2.

™ÙÔ ›‰ÈÔ Û˘Ì¤Ú·ÛÌ· η٤ÏËÍ·Ó ·Úfi-ÌÔȘ ÌÂϤÙ˜ ÌÈÎÚԉțۉ˘Û˘ Ô˘

¤¯Ô˘Ó Á›ÓÂÈ ÛÙÔ ·ÚÂÏıfiÓ^11,12.

∏ Û˘Û΢‹ Elements Obturation Unit Û˘Ó‰˘¿˙ÂÈ ÙËÓ Ù¯ÓÔÏÔÁ›· ÙÔ˘ Û˘ÛÙ‹Ì·-ÙÔ˜ System B Ì ¤Ó· Û‡ÛÙËÌ· ¤Á¯˘Û˘

ıÂÚÌ‹˜ ÁÔ˘Ù·¤Úη˜. ∏ Ù¯ÓÈ΋ οıÂÙ˘

Û˘Ì‡ÎÓˆÛ˘ ıÂÚÌ‹˜ ÁÔ˘Ù·¤Úη˜ ¯ÚË-ÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ Ù¯ÓÈ΋ System B ˆ˜

ËÁ‹ ıÂÚÌfiÙËÙ·˜ Î·È ¤Á¯˘ÛË ıÂÚÌÔÏ·-ÛÙÈÎÔÔÈË̤Ó˘ ÁÔ˘Ù·¤Úη˜ ÁÈ· ÙËÓ

Ï‹ÚˆÛË ÙÔ˘ Ì˘ÏÈÎÔ‡ Î·È Ì¤ÛÔ˘ ÙÚÈÙË-ÌÔÚ›Ô˘ ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ ¤¯ÂÈ Û˘ÁÎÚÈ-ı›, Û in vitro ÌÂϤÙ˜, Ì ÙËÓ Ù¯ÓÈ΋

Ù˘ Ï¿ÁÈ·˜ Û˘Ì‡ÎÓˆÛ˘ ÌÂ

·ÓÙÈÎÚÔ˘fi-ÌÂÓ· ·ÔÙÂϤÛÌ·Ù·^13-16. ™‡Ìʈӷ Ì ٷ

·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜

‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ-΋ ‰È·ÊÔÚ¿ ÛÙË ÌÈÎÚԉțۉ˘ÛË ÌÂٷ͇

ÙˆÓ ÔÌ¿‰ˆÓ Ù˘ Ï¿ÁÈ·˜ Û˘Ì‡ÎÓˆÛ˘

Î·È ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ Elements Obtu-ration Unit.

™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‚Ú¤ıËΠfiÙÈ Ë ¤Ì-ÊÚ·ÍË Ì ¤Ó·Ó ÎÒÓÔ ProTaper Gutta-percha Point ‰ÂÓ ÂÌÊ¿ÓÈÛ ÛÙ·ÙÈÛÙÈο

ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙȘ ÙÈ̤˜ ÌÈÎÚÔ‰È-›ۉ˘Û˘ fiÙ·Ó Û˘ÁÎÚ›ıËΠ̠‰‡Ô ÎÏ·ÛÈ-ο ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˜ ÌÂıfi‰Ô˘˜ ¤ÌÊÚ·-͢ (Ï¿ÁÈ· Î·È Î¿ıÂÙË Û˘Ì‡ÎÓˆÛË).

∞Ó Î·È Ù· in vitro ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÈ-ÎÚԉțۉ˘Û˘ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÌÂÙ·-ÊÂÚıÔ‡Ó ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, ÌÔÚÔ‡Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ Ó· ‰ÒÛÔ˘Ó ÂӉ›ÍÂȘ ÁÈ· ÙË Û˘ÌÂÚÈÊÔÚ¿ ÂÓfi˜ ˘ÏÈÎÔ‡ Û ۯ¤ÛË ÌÂ

¿ÏÏ·. ∏ ¤ÌÊÚ·ÍË Ì ¤Ó·Ó ÎÒÓÔ ProTaper Gutta-percha Point ›ӷÈ

·Ï‹, ··ÈÙÔ‡ÓÙ·È Ï›Á· ÂÚÁ·Ï›·,

Ù˘Ô-ÔÈ› ÙË ‰È·‰Èηۛ· ¤ÌÊڷ͢ Î·È Î˘-Ú›ˆ˜ ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙÔ ¯ÚfiÓÔ ¤Ì-Êڷ͢ ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ ÂÓÒ ‰Â Ê·›-ÓÂÙ·È Ó· ˘ÛÙÂÚ› Û Â›Â‰Ô ÂÌÊÚ·ÎÙÈ-΋˜ ÈηÓfiÙËÙ·˜ Û ۯ¤ÛË Ì ÙËÓ Ï¿ÁÈ·

Î·È ÙËÓ Î¿ıÂÙË Û˘Ì‡ÎÓˆÛË. øÛÙfiÛÔ,

ÚÈÓ ·fi ÙËÓ ÂÍ·ÁˆÁ‹ ·ÛÊ·ÏÒÓ Û˘ÌÂ-Ú·ÛÌ¿ÙˆÓ, ··ÈÙÔ‡ÓÙ·È ¤Ú¢Ó˜ Û ÎÏÈ-ÓÈÎfi Â›‰Ô.

ªÂÙ·Ù˘¯È·Î‹ ‰Èψ̷ÙÈ΋ ÂÚÁ·Û›·

¶›Ó·Î·˜ 2

ªÈÎÚԉțۉ˘ÛË ‰ÂÈÁÌ¿ÙˆÓ 7 ̤Ú˜, 1 Ì‹Ó· Î·È 3 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤ÌÊÚ·ÍË

L=0 0<L≤10 L>10

1 Ì‹Ó·˜

7 Ë̤Ú˜ 3 Ì‹Ó˜

LC P-LC P P-OE

13 10 13 11

2 1 1 2

0 4 1 2

10 10 10 10

2 0 2 1

3 5 3 4

4 5 7 4

2 1 1 1

9 9 7 10 LC: ¤ÌÊÚ·ÍË Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ Ï¿ÁÈ·˜ Û˘Ì‡ÎÓˆÛ˘- ·ÚÈÔ˜ ÎÒÓÔ˜ ΈÓÈÎfiÙËÙ·˜ ,02 P-LC: ¤ÌÊÚ·ÍË Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ Ï¿ÁÈ·˜ Û˘Ì‡ÎÓˆÛ˘- ·ÚÈÔ˜ ÎÒÓÔ˜

ProTaper Gutta-percha Point

P: ¤ÌÊÚ·ÍË Ì ¤Ó· ÎÒÓÔ ProTaper Gutta-percha Point P-OE: ¤ÌÊÚ·ÍË Ì ÙÔ Û‡ÛÙËÌ· Elements Obturation Unit

L=0 0<L≤10 L>10 L=0 0<L≤10 L>10

∂¡¢∂π∫∆π∫∏ µπµ§π√°ƒ∞ºπ∞

1. Schilder H: Filling root canals in three dimen-sions: Dent Clin North Am 1967; 11: 723–44.

2. Allison DA, Weber CR, Walton RE: The influence of the method of canal preparation on the quality of apical and coronal obturation. J Endod 1979; 5: 298–304.

3. Jenkins SM, Hayes SJ, Dummer PMH:A study of endodontic treatment carried out in dental practice within the UK. Int Endod J 2001; 34:

16–22.

4. Bjorndahl L, Reit C: The adoption of new endodontic technology amongst Danish general dental practitioners. Int Endod J 2005; 38: 52–8.

5. Ferraz CC, Gomes NV, Gomes BP, Zaia AA, Teixeira FB, Souza- Filho FJ:Apical extrusion of debris and irrigants using two hand and three engine-driven instrumentation techniques. Int Endod J 2001; 34: 354–8.

6. Park H:A comparison of greater taper files, ProFiles, and stainless steel files to shape curved root canals: Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 9: 715–8.

7. Zmener O, Pameijer CH, Macri E:Evaluation of the apical seal in root canals prepared with a new rotary system and obturated with a methacrylate based endodontic sealer: an in vitro study: J Endod 2005; 31: 392–5.

8. Gordon MP, JLove, R. M. L. Chandler NP: An evaluation of .06 tapered gutta-percha cones for filling of .06 taper prepared curved root canals:

Int J Endod 2005; 38: 87–96.

9. Yücel A,

ç

^{iftçi A:}Effects of different root canal obturation techniques on bacterial penetration.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: 88–92.

10. Karagenç B, Gençoglu N, Ersoy M, Cansever G, Külekçi G: A comparison of four different microleakage tests for assessment of leakage of root canal fillings. . Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: 110-3.

11. Heredia MP, Gonzalez JG, Luque CMF,

Rodriquez MPG:Apical seal comparison of low-temperature thermoplasticized gutta-percha technique and lateral condensation with two different master cones. Med Oral Patol Oral Cir Bucal 2007; 12: 175–9.

12. Bal AS, Hicks ML, Barnett F:Comparison of laterally condensed .06 and .02 tapered gutta-percha and sealer in vitro. J Endod 2001; 27:

786–8.

13. McRobert AS, Lumley PJ: An in vitro investigation of coronal leakage with three gutta-percha backfilling techniques. Int Endod J 1997; 30: 413–7.

14. Jarrett IS, Marx D, Covey D, Karmazin M, Lavin M, Gound T: Percentage of canals filled in apical cross sections - an in vitro study of seven obturation techniques. Int Endod J 2004; 37:

392–8.

15. Jacobson HLJ, Xia T, Baumgartner JC, Marshall JG and Beeler WJ:Microbial leakage evaluation of the continuous wave of condensation. J Endod 2002; 28: 269–71.

16. Mente J, Werner S, Koch MJ, Henschel V, Legner M, Staeble HJ and Friedman S:In vitro leakage associated with three root-filling techniques in large and extremely large root canals. J Endod 2007; 33: 306–9.

SYMMARY

F. Mahera**

Comparative study of sealing ability of four obturation techniques**

The purpose of this study was to compare the microleakage of four obturation techniques (lateral condensation, lateral

compaction of ProTaper Gutta-percha, single ProTaper Gutta-percha and warm vertical condensation) over a 3-month period. A fluid-transport model was used to measure microleakage. Sixty extracted human teeth, divided into four groups, were prepared with ProTaper rotary instruments before the root canals were filled by one of the four examined techniques. Microleakage was measured 7 days, 1 month, and 3 months after the procedures. There were no statistically significant differences between the four groups at any of experimental periods (p>0,05).

ª·¯·›Ú·

¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:

º·Ó‹ ª·¯·›Ú·

∞ÚÈÛÙÔÙ¤ÏÔ˘˜ 29·

153 44 °¤Ú·Î·˜, £ÂÛÛ·ÏÔÓ›ÎË

∆ËÏ.: 6944 463467 E-mail: Fani77@msn.com

* DDS, Msc in Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki 2007.

** Msc Thesis, Dept of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki 2007 .

∞¿ÓÙËÛË

∆· ÎÔ˘Ì·ÚÈÓÈο ·ÓÙÈËÎÙÈο

[Ó·ÙÚÈÔ‡-¯Ô˜ ‚·ÚÊ·Ú›ÓË (PanwarfinN), ·ÎÂÓÔ-ÎÔ˘Ì·ÚfiÏË (Sintrom)] Î·È Ù·

·ÓÙÈ·ÈÌÔ-ÂÙ·Ïȷο Ê¿Ú̷η [·ÎÂÙ˘ÏÔÛ·ÏÈ΢ÏÈ-Îfi Ô͇ (Aspirin, Salospir), ‰È˘Úȉ·ÌfiÏË (Persantin), ÙÈÎÏÔȉ›ÓË (Ticlid),

ÎÏÔÈ-‰ÚÔÁ¤ÏË (Plavix)] ¯ÔÚËÁÔ‡ÓÙ·È ˆ˜ Ì·-ÎÚÔ¯ÚfiÓÈ· ·ÁˆÁ‹ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ ıÚÔÌ‚Ô‚ÔÏÈÎÒÓ Î·Ù¿ÛÙ¿ÛˆÓ^1,2.

∏ ·ÓÙÈËÎÙÈ΋ ‰Ú·ÛÙÈÎfiÙËÙ· ÙˆÓ ÎÔ˘Ì·-ÚÈÓÈÎÒÓ ÂϤÁ¯ÂÙ·È Ì ÙÔ International Normalized Ratio (INR), Ô˘ ·ÔÙÂÏ›

Ô˘ÛÈ·ÛÙÈο «Ì·ıËÌ·ÙÈ΋ ‰ÈfiÚıˆÛË» ÙÔ˘

·Ï·ÈfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ˘ ¯ÚfiÓÔ˘

ÚÔıÚÔÌ‚›Ó˘^3-5. ∆· ·ÓÙÈ·ÈÌÔÂÙ·Ïȷο

Ê¿Ú̷η ÂϤÁ¯ÔÓÙ·È Ì ÙÔ ¯ÚfiÓÔ ÚÔ‹˜,

Ô˘ fï˜ ‰ÂÓ ·ÔÙÂÏ› ·ÍÈfiÈÛÙË ‰ÔÎÈ-Ì·Û›·, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÈÌÔÚÚ·ÁÈ΋

‰È¿ıÂÛË ÙÔ˘ ·ÛıÂÓ‹⁶.

√È ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈËÎÙÈο

‹ ·ÓÙÈ·ÈÌÔÂÙ·Ïȷο Ê¿Ú̷η ¤¯Ô˘Ó

·˘ÍË̤ÓË ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË, ¯ˆÚ›˜

ˆÛÙfiÛÔ ·˘Ùfi Ó· ¤¯ÂÈ ÎÏÈÓÈ΋ ÛËÌ·Û›·

ηٿ ÙË Û˘Ó‹ıË Ô‰ÔÓÙÈ·ÙÚÈ΋ Ú¿ÍË, ·Ó Î·È Û˘¯Ó¿ ÙÚÔÔÔÈÂ›Ù·È Ë ¯ÔÚËÁÔ‡ÌÂÓË

·ÁˆÁ‹ ·fi ÙÔ ıÂÚ¿ÔÓÙ· ÁÈ·ÙÚfi ÚÔÙÔ‡

Ô ·ÛıÂÓ‹˜ ˘Ô‚ÏËı› Û ԉÔÓÙÈ·ÙÚÈΤ˜

ÂÂÌ‚¿ÛÂȘ. ∞ÓÙ›ıÂÙ·, Ë ‰È·ÎÔ‹ Ù˘ ıÂ-Ú·›·˜ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ

ıÚÔÌ‚ÔÂÌ-‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ, ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂ-Ê·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ‹ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘

Ì˘Ôηډ›Ô˘. √È ·ÈÌÔÚÚ·ÁÈΤ˜ ÂÈÏÔ-Τ˜, ·Ó Î·È ÂÓÔ¯ÏËÙÈΤ˜ ÁÈ· ÙÔÓ ·ÛıÂÓ‹,

‰ÂÓ ¤¯Ô˘Ó ÙÔÓ ›‰ÈÔ Î›Ó‰˘ÓÔ Û ۯ¤ÛË Ì ٷ ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È·^5-8.

™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯ÂÈ ÔÌÔʈӛ·

ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÛıÂÓÒÓ ·˘-ÙÒÓ ¯ˆÚ›˜ ÙÚÔÔÔ›ËÛË Ù˘ ·ÁˆÁ‹˜ ÚÈÓ

·fi ÙȘ Û˘Ó‹ıÂȘ Ô‰ÔÓÙÈ·ÙÚÈΤ˜ ÂÂÌ‚¿-ÛÂȘ (ÂÌÊÚ¿ÍÂȘ, ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂÚ·›·,

ÚÔÛıÂÙÈ΋ ·ÔηٿÛÙ·ÛË, ·ÔÙÚ‡Áˆ-ÛË, ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÚÈÔ‰ÔÓÙ›Ô˘, ÂÍ·ÁˆÁ‹

¤ˆ˜ 3 ‰fiÓÙÈ·, ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ‰Ô-ÓÙÈÔ‡), Ô ‰Â ¤ÏÂÁ¯Ô˜ Ù˘ ·ÈÌÔÚÚ·Á›·˜

Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ì ÙÔÈο ·ÈÌÔÛÙ·ÙÈ-ο ̤۷^4-8.

√ Û˘Ó‰˘·ÛÌfi˜ ·ÛÈÚ›Ó˘ Î·È ‰È˘Úȉ·-ÌfiÏ˘ ÂÓ¤¯ÂÈ ÙÔÓ ›‰ÈÔ Î›Ó‰˘ÓÔ ·ÈÌÔÚÚ·-Á›·˜ fiˆ˜ Ë ÌÔÓÔıÂÚ·›· Ì ·ÛÈÚ›ÓË.

¢ÂÓ ˘¿Ú¯ÂÈ, fï˜, Â·Ú΋˜ ‚È‚ÏÈÔÁÚ·-ÊÈ΋ ÙÂÎÌËÚ›ˆÛË ÁÈ· ÙÔÓ Î›Ó‰˘ÓÔ ·ÈÌÔÚ-Ú·Á›·˜ Û ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó

Û˘Ó-‰˘·ÛÌfi ·ÛÈÚ›Ó˘–ÎÏÔȉÔÁÚ¤Ï˘ ‹ Ë·Ú›Ó˜ ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜.

∂Í·ÈÙ›·˜ ÙÔ˘ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘

ıÚÔÌ-‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Â›Ó·È ··Ú·›-ÙËÙË Ë ÚÔËÁÔ‡ÌÂÓË Û˘ÓÂÓÓfiËÛË Ì ÙÔ ıÂÚ¿ÔÓÙ· ÁÈ·ÙÚfi ÁÈ· ÙËÓ ÙÚÔÔÔ›ËÛË

‹ ‰È·ÎÔ‹ Ù˘ ·ÁˆÁ‹˜. ∂Ӊ¯Ô̤ӈ˜ ·˘-ÙÔ› ÔÈ ·ÛıÂÓ›˜ ı· Ú¤ÂÈ Ó· ·Ú·¤-ÌÔÓÙ·È Û ÔÚÁ·ÓˆÌ¤ÓÔ ÓÔÛÔÎÔÌ›Ô⁶.

™˘Ó˘¿Ú¯Ô˘Û˜ ÓÔÛÔÏÔÁÈΤ˜ ηٷÛÙ¿-ÛÂȘ ÂËÚ¿˙Ô˘Ó ‰˘ÛÌÂÓÒ˜ ÙËÓ ËÎÙÈÎfi-ÙËÙ· ÙÔ˘ ·›Ì·ÙÔ˜. ∞ÛıÂÓ›˜ Ô˘ ¿Û¯Ô˘Ó

·fi ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, ·ÏÎÔÔÏÈÛÌfi, Ë·ÙÈ΋ ·ÓÂ¿ÚÎÂÈ·, ıÚÔÌ‚Ô΢ÙÙÔÂ-Ó›·, ·ÈÌÔÚÚÔÊÈÏ›· ‹ ‰È·Ù·Ú·¯¤˜ Ù˘ ·È-ÌfiÛÙ·Û˘, ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó Î˘Ù-Ù·ÚÔÙÔÍÈο Ê·Ú̿η ‹ ‰ÈÏÔıÂÚ·›·

Ì ·ÓÙÈ·ÈÌÔÂÙ·Ïȷο Ê¿Ú̷η ‰ÂÓ

Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÛÙÔ Ô‰Ô-ÓÙÈ·ÙÚÂ›Ô ·ÏÏ¿ Ó· ·Ú·¤ÌÔÓÙ·È Û ÔÚÁ·ÓˆÌ¤ÓÔ ÓÔÛÔÎÔÌ›Ô. √ÌÔ›ˆ˜ Û˘ÓÈ-ÛٿٷÈ^6-8 Ë ·Ú·ÔÌ‹ ·ÛıÂÓÒÓ Ì ̤-ÙÚËÛË INR>4 ÂÓÒ ¿ÏÏÔÈ^3,5 ÚÔÙ›ÓÔ˘Ó

·Ú·ÔÌ‹ ·ÛıÂÓÒÓ ÁÈ· Ú‡ıÌÈÛË ·Áˆ-Á‹˜ fiÙ·Ó Ë Û¯¤ÛË Â›Ó·È INR>3,5.

™ËÌ›· Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ÚÔÛÔ¯‹ ›ӷÈ:

1) ∂ÎÙÂÓ‹˜ Ï‹„Ë ÈÛÙÔÚÈÎÔ‡ÁÈ· ÙËÓ ÂÍ·-ÎÚ›‚ˆÛË ÙÔ˘ ÏfiÁÔ˘ ¯ÔÚ‹ÁËÛ˘ Ù˘

·ÓÙÈËÎÙÈ΋˜ ·ÁˆÁ‹˜.

2) ∂ÈÎÔÈÓˆÓ›· Ì ÙÔ ıÂÚ¿ÔÓÙ· ÁÈ·ÙÚfi

ÚÔÎÂÈ̤ÓÔ˘ Ó· Û˘˙ËÙËı› ÙÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi ÙÔ˘ ·ÛıÂÓ‹, ÙÔ Â›‰Ô˜ Ù˘

Ô‰ÔÓÙÈ·ÙÚÈ΋˜ ıÂÚ·›·˜ Ô˘ ı· ·-Ú·Û¯Âı› Î·È Ô ÂÎÙÈÌÒÌÂÓÔ˜ ΛӉ˘-ÓÔ˜ ·ÈÌÔÚÚ·Á›·˜¹. √ Ô‰ÔÓÙ›·ÙÚÔ˜

‰ÂÓ Ú¤ÂÈ Ó· ÙÚÔÔÔÈ› ÙË ¯ÔÚË-ÁÔ‡ÌÂÓË ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹, ·˘Ùfi (·Ó ··ÈÙËı›) Â›Ó·È ¤ÚÁÔ ÙÔ˘

ıÂÚ¿-ÔÓÙ· ÁÈ·ÙÚÔ‡ ·ıÔÏfiÁÔ˘, ηډÈÔ-ÏfiÁÔ˘ ‹ ·ÈÌ·ÙÔηډÈÔ-ÏfiÁÔ˘⁷.

3) ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜: °È· ÙÔ˘˜

·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÎÔ˘Ì·ÚÈÓÈ-ο ·ÓÙÈËÎÙÈÎÔ˘Ì·ÚÈÓÈ-ο, Ì ÛÙ·ıÂÚÔÔÈË̤ÓÔ INR<4, ̤ÙÚËÛË 72 ÒÚ˜ ÚÈÓ ·fi ÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ıÂÚ·›· Â›Ó·È ÈηÓÔÔÈËÙÈ΋, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·-Ú¤¯ÂÙ·È ¯ÚÔÓÈÎfi ÂÚÈıÒÚÈÔ ÁÈ·

ÙÚÔ-ÔÔ›ËÛË Ù˘ ·ÁˆÁ‹˜. π‰·ÓÈο Ë Ì¤-ÙÚËÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È 24 ÒÚ˜

ÚÈÓ^5,7,8. ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜

‰ÂÓ Â›Ó·È ··Ú·›ÙËÙÔ˜ ÁÈ· ·Ó·›Ì·-ÎÙ˜ Û˘Ó‰ڛ˜, Â›Ó·È fï˜ ··Ú·›-ÙËÙÔ˜ ·Ó ··ÈÙËı› ¯ÔÚ‹ÁËÛË

ÛÙÂÏÂ-¯È·›·˜ ·Ó·ÈÛıËÛ›·˜⁸. ªË Â›ÁÔ˘Û˜

Ô‰ÔÓÙÈ·ÙÚÈΤ˜ ÂÂÌ‚¿ÛÂȘ ÌÔÚÔ‡Ó Ó· ÚÔÁÚ·ÌÌ·Ù›˙ÔÓÙ·È ÌÂÙ¿ ÙÔÓ Ù·-ÎÙÈÎfi ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÙÔ˘

·ÛıÂÓ‹^6,7.

4) ÃÚfiÓÔ˜: ¶ÚÔÙ›ÓÔÓÙ·È Û˘Ó‰ڛ˜ ÙȘ

ÚˆÈÓ¤˜ ÒÚ˜ Î·È Î·Ù¿ ÚÔÙ›ÌËÛË ÙȘ

ÚÒÙ˜ Ë̤Ú˜ Ù˘ ‚‰ÔÌ¿‰·˜, ÒÛÙ ӷ ·Ú¤¯ÂÙ·È Ë ‰˘Ó·ÙfiÙËÙ· ·ÓÙÈÌÂ-ÙÒÈÛ˘ ¿ÌÂÛˆÓ (ÙËÓ ›‰È· Ë̤ڷ) ‹ fi„ÈÌˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÈÏÔÎÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÚÁ¿ÛÈÌ˘

‚‰ÔÌ¿‰·˜^6,7.

5) ∞Ó·ÈÛıËÛ›·: ∆ÔÈ΋ ‰È’ ÂÌÔÙ›Ûˆ˜

·Ó·ÈÛıËÛ›· ‹ ÂÓ‰ÔÛ˘Ó‰ÂÛÌÈ΋ ·Ó·È-ÛıËÛ›· fiÙ·Ó ·˘Ùfi ··ÈÙ›ٷÈ. ™˘ÓÈ-ÛÙ¿Ù·È ¯Ú‹ÛË ‚ÂÏÔÓÒÓ 30 gauge-short ÁÈ· ÂÚÈÔÚÈÛÌfi ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜.

∏ ¯Ú‹ÛË ·ÁÁÂÈÔÛ˘Û·ÛÙÈÎÔ‡ ÂӉ›-ÎÓ˘Ù·È ÂÎÙfi˜ ·Ó ˘¿Ú¯Ô˘Ó ¿ÏÏÔÈ Â-ÚÈÔÚÈÛÌÔ› ·fi ÙÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi.

™ÙÂϯȷ›· ·Ó·ÈÛıËÛ›· ı· Ú¤ÂÈ Ó·

·ÔʇÁÂÙ·È. ŸÙ·Ó ·˘Ùfi ‰ÂÓ Â›Ó·È À‡ı˘ÓoÈ ÛÙ‹Ï˘: ¶. ªÂÏÙ¤˜, ª. °ÂˆÚÁÔÔ‡ÏÔ˘

A¶∞¡∆∏™∂π™ ™∂ ∂ƒø∆∏™∂π™ √¢√¡∆π∞∆ƒø¡

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