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√‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Î·È ÔÏÊfi˜

√‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ·: Ô ÚfiÏÔ˜ ÙÔ˘˜ ÛÙËÓ ·ÓÙ›‰Ú·ÛË

ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ ÔÏÊÔ‡-Ô‰ÔÓÙ›Ó˘

ÛÙ· Â͈ÙÂÚÈο ÂÚÂı›ÛÌ·Ù·

§. µ·ÛÈÏÂÈ¿‰Ë˜*

∫Àƒπ√ ∫∞∆∂À£À¡√ª∂¡√ ∞ƒ£ƒ√

Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ·, ¢·ÈÛıËÛ›· Ô‰ÔÓÙ›Ó˘, ‰È·ÂÚ·ÙfiÙËÙ· Ô‰ÔÓÙ›Ó˘

§¤ÍÂȘ-ÎÏÂȉȿ

dentinal tubules, dentin sensitivity, dentin permeability

Key words

* ∂ÈÎ. ∫·ıËÁËÙ‹˜ ∂Ó‰Ô‰ÔÓÙÔÏÔÁ›·˜, √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ ∞¶£. *Assistant Professor, Dept of Endodontology, School of Dentistry, Aristotle University of Thessaloniki.

¶ÂÚ›ÏË„Ë

∏ ‰È·ÂÚ·ÙfiÙËÙ· Ù˘ Ô‰ÔÓÙ›Ó˘ Â›Ó·È ·˘Ù‹ Ô˘ ‰ËÌÈÔ˘ÚÁ› ÙËÓ ÂÈ-ÎÔÈÓˆÓ›· ÌÂٷ͇ ÔÏÊÈÎÔ‡ ÈÛÙÔ‡ Î·È ÛÙÔÌ·ÙÈÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÌÂ-Ù¿ ÙËÓ Î·Ù·ÛÙÚÔÊ‹ Ù˘ ·‰·Ì·ÓÙ›Ó˘. ∏ ‰È·ÂÚ·ÙfiÙËÙ· ÂÍ·ÚÌÂ-Ù¿Ù·È ·fi ÙÔÓ ·ÚÈıÌfi, ÙË ‰È¿ÌÂÙÚÔ ÙˆÓ ·ÔÎ·Ï˘ÌÌ¤ÓˆÓ Ô‰ÔÓÙÈÓÔÛˆÏË-Ó·Ú›ˆÓ, fiˆ˜ Î·È ·fi ÙËÓ ÂÚÈÔ¯‹ Ù˘ Ô‰ÔÓÙ›Ó˘. ™˘ÓÂÒ˜ Ù· Ô‰Ô-ÓÙÈÓÔÛˆÏËÓ¿ÚÈ· ‰ÂÓ ÚÔÛʤÚÔ˘Ó, ‚¿ÛÂÈ Ù˘ ˘‰ÚÔ‰˘Ó·ÌÈ΋˜ ıˆ-Ú›·˜ ÙÔ˘ Brännström, ÌfiÓÔ ÙËÓ ·›ÛıËÛË ·ÏÏ¿ Â›Ó·È Î·È Ë ‰›Ô‰Ô˜ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó Â͈ÙÂÚÈο ‚Ï·ÙÈο ÂÚÂı›ÛÌ·Ù· ÁÈ· Ó· ÚÔÛÂÁÁ›ÛÔ˘Ó ÙÔÓ ÔÏÊÈÎfi ÈÛÙfi. ¢È¿ÊÔÚ˜ ‰ÈÂÚÁ·Û›Â˜, fiˆ˜ Ë ÚÔ˜ Ù· ¤Íˆ ΛÓËÛË ÙÔ˘ ˘ÁÚÔ‡, Ë ‰Ë-ÌÈÔ˘ÚÁ›· ϤÁÌ·ÙÔ˜ ÚˆÙÂ˚ÓÒÓ Ô˘ ÂÈοıÔÓÙ·È ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ, οÓÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ·ÎÙ›Ó· ÙÔ˘˜ ÛËÌ·ÓÙÈ-ο ÌÈÎÚfiÙÂÚË ·fi ÙËÓ ·Ó·ÙÔÌÈ΋, ÂÚÈÔÚ›˙ÔÓÙ·˜ Ì ÙÔÓ ÙÚfiÔ ·˘Ùfi ÙË ‰È·ÂÚ·ÙfiÙËÙ· Ù˘ Ô‰ÔÓÙ›Ó˘. ªÂ ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ·˘ÙÔ‡˜ Î·È Ì ÙÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ̤ۈ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·-Ú›ˆÓ ÊÙ¿ÓÔ˘Ó ÛÙÔÓ ÔÏÊfi Î·È Â·Ó·‰Ú·ÛÙËÚÈÔÔÈÔ‡Ó ÙÔ˘˜ Ô‰ÔÓÙÈ-ÓÔ‚Ï¿ÛÙ˜ ‹ ‰È·ÊÔÚÔÔÈÔ‡Ó ÂÌ‚Ú˘˚ο ·ÙÙ·Ú· ÚÔ˜ Ô‰ÔÓÙÈÓÔ‚Ï¿-ÛÙ˜, ‰›ÓÂÙ·È Ë ‰˘Ó·ÙfiÙËÙ· Ó· ÚÔÛٷ٢ٛ Ô ÔÏÊfi˜ ·fi Â͈ÙÂÚÈ-ÎÔ‡˜ ‚Ï·ÙÈÂ͈ÙÂÚÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ™Â ·ÓÙ›ıÂÛË Ì ÙË Ì‡ÏË, ÛÙË Ú›˙· Ë ÚÔÔ‰ÔÓÙ›ÓË ÂÍ·Ê·Ó›˙ÂÙ·È ÚÔԉ¢ÙÈο ·fi Ù· ÔÏÊÈο ÙÔȯÒÌ·-Ù· Ù˘ Ô‰ÔÓÙ›Ó˘ Î·È Ô ·˘Ïfi˜ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ÙˆÓ ·ÓÙÈ-ÛÙÔ›¯ˆÓ ÂÚÈÔ¯ÒÓ Ù˘ Ô‰ÔÓÙ›Ó˘ ·ÔÊÚ¿ÛÛÂÙ·È. ∏ Ô˘Û›· Ô˘ Ù· ·ÔÊÚ¿ÛÛÂÈ Â›Ó·È ·ÚfiÌÔÈ·˜ Û‡ÛÙ·Û˘ Î·È ˘Ê‹˜ Ì ·˘Ù‹Ó Ù˘ Â-ÚÈÈÓÈ΋˜ Ô‰ÔÓÙ›Ó˘ Î·È Ë Ô‰ÔÓÙ›ÓË «ÌÂÙ·ÙÚ¤ÂÙ·È» Û ‰È·Ê·Ó‹ Î·È ÛÎÏËÚˆÙÈ΋. ∏ ‰È·‰Èηۛ· ·˘Ù‹ ·Ú¯›˙ÂÈ ÛÙÔ fiÚÈÔ Ô‰ÔÓÙ›Ó˘-ÔÛÙ½Ó˘ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ·ÎÚÔÚÚÈ˙›Ô˘ Î·È ÚˆÈÔ‡Û˘ Ù˘ ËÏÈΛ·˜ ÂÂÎÙ›ÓÂÙ·È ÔÏÊÈο Î·È Ì˘ÏÈο. ŸÛÔÓ ·ÊÔÚ¿ ÙȘ ÂÌÊÚ¿ÍÂȘ Û˘Ó-ı¤ÙˆÓ ÚËÙÈÓÒÓ ÛÙȘ ‚·ıȤ˜ ÎÔÈÏfiÙËÙ˜, fiÙ·Ó ÙÔ ¿¯Ô˜ Ù˘ ·Ú·Ì¤-ÓÔ˘Û·˜ Ô‰ÔÓÙ›Ó˘ Â›Ó·È ÏÈÁfiÙÂÚÔ ·fi 300 Ìm, ıˆÚÂ›Ù·È ··Ú·›ÙË-ÙË Ë ÙÔÔı¤··Ú·›ÙË-ÙËÛË Ô˘‰¤ÙÂÚÔ˘ ÛÙÚÒÌ·ÙÔ˜ ÒÛÙ ÔÈ ‰È·‰Èηۛ˜ Î·È Ù· ˘ÏÈο Ù˘ ¤ÌÊڷ͢ Ó· ÌËÓ ÚÔηϤÛÔ˘Ó, ̤ۈ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏË-Ó·Ú›ˆÓ, ÔÏÊÈ΋ ÊÏÂÁÌÔÓ‹.

Summary

The role of dentinal tubules in pulp-dentine complex reaction to external stimuli

L. Vassiliadis*

The tubular structure of dentin provides channels for the permeation of external factors. A breach in the integrity of the overlying enamel is sufficient for bacterial products to permeate dentinal tubules towards the pulp. Dentin permeability varies with location, depth and age and depends mainly on the number of the exposed dentinal tubules and the radius of their lumen. Consequently, dentinal tubules are not only responsible for tooth sensitivity according to Brännström’s hydrodynamic theory, but are also the channels through which external irritating factors reach the pulp.

Different mechanisms such as outward interstitial fluid flow, plasma proteins this fluid contains which form a filter in the tubules, the remains of the original contents of the tubules, the presence of intratubular deposits of mineral and collagen, make the functional radius of the dentinal tubules much smaller than the anatomical. These mechanisms together with preformed growth factors released from the carious dentine and diffusing through the dentinal tubules into the pulp, where they can activate appropriate genes to initiate repair processes enable the pulp to protect itself from external irritating factors. In contrast to the crown, in the root area, predentin gradually disappears from the pulpal surfaces of dentin. The lumen of the dentinal tubules of the corresponding areas of the dentine appears completely or almost completely closed. The nature of the occluding material is similar to that of peritubular dentin appears translucent and is sclerotic. This process starts at the cementum-dentin junction in the apical region and extends coronally and pulpally with increasing age. Although increasing linearly with age, it is almost certain that age is not its cause, neither are external irritations, since it is a steady finding even in non-erupted teeth.

1. ∂ÈÛ·ÁˆÁ‹

∏ ÂÚÁ·Û›· ·˘Ù‹ ÂȯÂÈÚ› ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ô˘ ·ÊÔÚ¿ ÙÔ ÚfiÏÔ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ÛÙËÓ ·ÓÙ›‰Ú·-ÛË ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ ÔÏÊÔ‡-Ô‰ÔÓÙ›Ó˘ ÛÙ· Â͈ÙÂÚÈο ÂÚÂı›ÛÌ·Ù·. ™ÎÔfi˜ Ù˘ Â›Ó·È Ë Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ·fi ÙÔÓ ÎÏÈÓÈÎfi Ô‰ÔÓÙ›·ÙÚÔ ÙÔ˘ ÚfiÏÔ˘ ÙÔ˘˜ Î·È Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ô˘ ‰Ë-ÌÈÔ˘ÚÁ› Ë ‰È·ÊÔÚ¿ Ù˘ ·Ó·ÙÔÌÈÎfiÙËÙ·˜ ÙÔ˘˜, ηٿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ‰È·ÊfiÚˆÓ ˘ÏÈ-ÎÒÓ.

2. ∆Ô Û‡ÌÏÂÁÌ·

ÔÏÊÔ‡-Ô‰ÔÓÙ›Ó˘

À¿Ú¯Ô˘Ó ÈηÓÔÔÈËÙÈο Â˘Ú‹Ì·Ù·, ‚·-ÛÈ˙fiÌÂÓ· ΢ڛˆ˜ ÛÙȘ ‚ÈÔ¯ËÌÈΤ˜ ‰È·ÊÔ-Ú¤˜ ÔÏÊÔ‡-Ô‰ÔÓÙ›Ó˘1,2_Ô˘ ÙÂÎÌËÚÈÒ-ÓÔ˘Ó ÙËÓ ¿Ô„Ë fiÙÈ Ô ÔÏÊfi˜ Î·È Ë Ô‰Ô-ÓÙ›ÓË, ·Ó Î·È ÚÔ¤Ú¯ÔÓÙ·È ·ÌÊfiÙÂÚ· ·fi ÙËÓ Ô‰ÔÓÙÈ΋ ıËÏ‹, Â›Ó·È ‰È·ÊÔÚÂÙÈ-ÎÔ› ÈÛÙÔ›. ∏ Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚ¢ÓË-ÙÒÓ, fï˜, Û˘ÌʈÓ› fiÙÈ ÏÂÈÙÔ˘ÚÁÈο ·ÓÙȉÚÔ‡Ó Û·Ó ¤Ó· Û‡ÌÏÂÁÌ· ‹ ·ÎfiÌË Î·È Û·Ó ¤Ó· fiÚÁ·ÓÔ3,4,5,6_. ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·, ÁÈ· ηχÙÂÚË Î·Ù·ÓfiËÛË ÙÔ˘ ÚfiÏÔ˘ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆ-ÏËÓ·Ú›ˆÓ, Ô ÔÏÊfi˜ Î·È Ë Ô‰ÔÓÙ›ÓË ıˆ-ÚÔ‡ÓÙ·È ÏÂÈÙÔ˘ÚÁÈÎÒ˜ ÂÓÈ·›· ÌÔÓ¿‰·.

3. √‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ·

3.1. πÛÙÔÏÔÁ›· µ·ÛÈÎfi ‰ÔÌÈÎfi ÛÙÔÈ¯Â›Ô Ù˘ Ô‰ÔÓÙ›Ó˘ Â›Ó·È ÙÔ Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈÔ. ∆· Ô‰ÔÓÙÈ-ÓÔÛˆÏËÓ¿ÚÈ· Â›Ó·È ÛˆÏËÓÔÂȉ›˜ Û¯ËÌ·-ÙÈÛÌÔ› Ô˘ ‰È·ÙÚ¤¯Ô˘Ó fiÏÔ ÙÔ Ì‹ÎÔ˜ Ù˘ Ô‰ÔÓÙ›Ó˘. ™‡Ìʈӷ Ì ÙËÓ ÎÏ·ÛÈ΋ ÈÛÙÔÏÔÁÈ΋ ÂÚÈÁÚ·Ê‹, Â›Ó·È ·ÔÙ¤ÏÂ-ÛÌ· Ù˘ ‡·Ú͢ Ù˘ ÚˆÙÔÏ··ÔÙ¤ÏÂ-ÛÌ·ÙÈ΋˜ ÚÔÛÂ΂ÔÏ‹˜ Ù˘ Ô‰ÔÓÙÈÓÔ‚Ï¿ÛÙ˘, ÙÔ˘ ΢ÙÙ¿ÚÔ˘ Ô˘ ·Ú¿ÁÂÈ Î·È Û ‰Â‡ÙÂÚÔ ¯ÚfiÓÔ ÂÓ·Û‚ÂÛÙÈÒÓÂÈ ÙÔ ÔÚÁ·ÓÈÎfi (΢-Ú›ˆ˜ ÎÔÏÏ·ÁfiÓÔ) ˘fiÛÙڈ̷ Ù˘ Ô‰ÔÓÙ›-Ó˘. ∏ Ô‰ÔÓÙ›ÓË Ô˘ ‚Ú›ÛÎÂÙ·È ·Ó¿ÌÂÛ· ÛÙ· Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· ÔÓÔÌ¿˙ÂÙ·È ÌÂÛÔ˚ÓÈ-΋, ÂÓÒ ·˘Ù‹ Ô˘ ‰ËÌÈÔ˘ÚÁÂ›Ù·È Û ‰Â‡-ÙÂÚÔ ¯ÚfiÓÔ, ÂȘ ‚¿ÚÔ˜ ÙÔ˘ ·˘ÏÔ‡ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ, ÂÚÈÈÓÈ΋. ∏ ÂÚÈ-ÈÓÈ΋ Ô‰ÔÓÙ›ÓË Â›Ó·È ÊÙˆ¯‹ Û ÎÔÏÏ·Áfi-ÓÔ, ˘ÂÚÂÓ·Û‚ÂÛÙȈ̤ÓË Û ۯ¤ÛË Ì ÙË ÌÂÛÔ˚ÓÈ΋ Î·È Û¯Â‰fiÓ ¤ÓÙ ÊÔÚ¤˜ ÛÎÏË-ÚfiÙÂÚË7_{. ∏ ÔÏÊÈ΋ ÂÈÊ¿ÓÂÈ· Ù˘} Ô‰Ô-ÓÙ›Ó˘ ηχÙÂÙ·È ·fi ÙËÓ ÚÔÔ‰ÔÓÙ›ÓË. ™ÙËÓ ÚÔÔ‰ÔÓÙ›ÓË ÌÔÚԇ̠ӷ ‰È·ÎÚ›-ÓÔ˘Ì ‰‡Ô ÛÙÈ‚¿‰Â˜: ÙË ÛÙÈ‚¿‰· Ù˘ ÒÚÈ-Ì˘ Î·È ÚÔ˜ ÙÔÓ ÔÏÊfi ÙË ÛÙÈ‚¿‰· Ù˘ ¿ˆÚ˘ ÚÔÔ‰ÔÓÙ›Ó˘, Ì ÙËÓ ÔÔ›· ‚Ú›-ÛÎÔÓÙ·È Û Â·Ê‹ ÔÈ Ô‰ÔÓÙÈÓÔ‚Ï¿ÛÙ˜. ∆· Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· ÌÔÚԇ̠ӷ Ù· ηÙËÁÔÚÈÔÔÈ‹ÛÔ˘Ì Û ‰‡Ô ÔÌ¿‰Â˜. 3.2.1. √‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Ù˘ ̇Ï˘ Œ¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Ì‹ÎÔ˜ ·fi ·˘Ù¿ Ù˘ Ú›˙·˜ ÏfiÁˆ Î·È ÙÔ˘ ÌÂÁ·Ï‡ÙÂÚÔ˘ ¿¯Ô˘˜ Ù˘ Ô‰ÔÓÙ›Ó˘ Ù˘ ̇Ï˘ Î·È ÏfiÁˆ Ù˘ Ô-Ú›·˜ ÙÔ˘˜. Œ¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ·˘Ïfi, ‰È·Ì¤ÙÚÔ˘ 3 Ìm ·Ú¯Èο, ÂȘ ‚¿ÚÔ˜ ÙÔ˘ ÔÔ›Ô˘ Û¯ËÌ·Ù›˙ÂÙ·È Ë ÂÚÈÈÓÈ΋ Ô‰ÔÓÙ›-ÓË (∂ÈÎ. 1). Œ¯Ô˘Ó ÔÌ·ÏfiÙÂÚË, ηÌ‡ÏË ÔÚ›·. 3.2.2. √‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Ù˘ Ú›˙·˜ ∂ÎÙfi˜ ·fi ÙȘ ÚÔ·Ó·ÊÂÚı›Û˜ ‰È·ÊÔ-Ú¤˜, Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ ·Ó Î·È «ÓÂfiÙÂÚ·» Î·È Û ÈÔ ÚÔÛÙ·ÙÂ˘Ì¤ÓÔ ÂÚÈ‚¿ÏÏÔÓ ÏfiÁˆ Ê·ÙÓ›Ô˘, Â›Ó·È ·˘Ù¿ Ô˘ ·ÔÊÚ¿ÛÛÔÓÙ·È ÚÒÙ·. ™˘Ó¤ÂÈ· ·˘ÙÔ‡ Â›Ó·È fiÙÈ Ë ‰È·Ê¿ÓÂÈ· ÙÔ˘ ‰ÔÓÙÈÔ‡ ÂÌÊ·Ó›˙ÂÙ·È ·Ú¯Èο ·ÎÚÔÚÚÈ˙Èο Î·È ÚÔ˚Ô‡Û˘ Ù˘ ËÏÈΛ·˜ ÂÂÎÙ›ÓÂÙ·È Ì˘-ÏÈο Î·È ÔÏÊÈο. ∆Ô Ê·ÈÓfiÌÂÓÔ ·˘Ùfi, ·Ó Î·È Â›Ó·È ·ÓÂÍ¿ÚÙËÙÔ ÂÚÂıÈÛÌ¿ÙˆÓ, ÌÈ· Î·È Û˘Ì‚·›ÓÂÈ Î·È ÛÙ· ¤ÁÎÏÂÈÛÙ· ‰fi-ÓÙÈ·, Û¯ÂÙ›˙ÂÙ·È ÔÛÔÙÈο ¿ÌÂÛ· Ì ÙËÓ ËÏÈΛ·, ·ÏÏ¿ ‰ÂÓ ÂÍËÁÂ›Ù·È ·ÔÎÏÂÈÛÙÈο ·fi ·˘Ù‹8_. ∏ ‰È·ÊÔÚ¿ ÙÔ˘ ‡ÚÔ˘˜ ÙÔ˘ ·˘ÏÔ‡ ÙˆÓ Ì˘ÏÈÎÒÓ Î·È ÚÈ˙ÈÎÒÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·-Ú›ˆÓ ‰ÂÓ Â›Ó·È Ù¤ÙÔÈÔ˘ ÌÂÁ¤ıÔ˘˜ Ô˘ Ó· ‰ÈηÈÔÏÔÁ› ÙËÓ ÙfiÛÔ Ù·¯‡ÙÂÚË ·fiÊÚ·-ÍË ÙÔ˘ ·˘ÏÔ‡ ÙˆÓ ÚÈ˙ÈÎÒÓ Ô‰ÔÓÙÈÓÔÛˆÏË-Ó·Ú›ˆÓ, Ô˘ Â›Ó·È Î·È «ÓÂfiÙÂÚ·», ÌfiÓÔ ÏfiÁˆ ËÏÈΛ·˜ fiˆ˜ ˘ÔÛÙËÚ›˙Ô˘Ó ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜6,7,9_{(∂ÈÎ. 2).} ŸÌˆ˜, ‰ÂÓ Â›Ó·È ·˘Ù¿ Ô˘ ÌÂٷʤÚÔ˘Ó, ·Ó ‰ÂÓ ÎÏ›ÛÂÈ Ï‹Úˆ˜ Ô ·˘Ïfi˜ ÙÔ˘˜, Â͈ÙÂÚÈο ÂÚÂı›ÛÌ·Ù· ÛÙÔÓ ÔÏÊfi. √È ·ÎÚȂ›˜ ·Èٛ˜ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ·ÓÙÈ-ΛÌÂÓÔ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜, Ù˘ ÔÔ›·˜ Ô ÛÙfi¯Ô˜ Â›Ó·È Ó· ·Û¯ÔÏËı› ΢-Ú›ˆ˜ Ì ٷ Ì˘ÏÈο Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ·. ∞˘Ù¿ Â›Ó·È Î·Ù¿ ‚¿ÛË Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÙËÓ Â·Ê‹ ÙÔ˘ ÔÏÊÔ‡ Ì ÙÔ ÛÙÔÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ Î·È ÙË Û˘Ìو̷ÙÔÏÔÁ›·. µ·ÛÈÏÂÈ¿‰Ë˜ ∂ÈÎ. 1: ¢ËÌÈÔ˘ÚÁ›· ÂÚÈÈÓÈ΋˜ Ô‰ÔÓÙ›Ó˘ ÂȘ ‚¿ÚÔ˜ ÙÔ˘ ·˘ÏÔ‡ ÙÔ˘ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›Ô˘. ÷ڷÎÙËÚÈÛÙÈÎfi ÙÔ ÏÂ›Ô Ù˘ ÂÈÊ¿ÓÂÈ¿˜ Ù˘.

4. ¢È·ÂÚ·ÙfiÙËÙ·

Ù˘ Ô‰ÔÓÙ›Ó˘

∆Ô ˘ÁȤ˜ ·Î¤Ú·ÈÔ ‰fiÓÙÈ ÚÔÛٷهÂÙ·È ·fiÏ˘Ù· ·fi Ù· Â͈ÙÂÚÈο ÂÚÂı›ÛÌ·Ù·, ÏËÓ ÔÚÈÛÌ¤ÓˆÓ Ì˯·ÓÈÎÒÓ, Ì ‰‡Ô È-ı·Ó¤˜ ÂÍ·ÈÚ¤ÛÂȘ: ·) fiÙ·Ó ÛÙÔÓ ·˘¯¤Ó· ÙÔ˘ ˘¿Ú¯ÂÈ ÂΠη-Ù·Û΢‹˜ ÂÎÙÂıÂÈ̤ÓË ˙ÒÓË Ô‰ÔÓÙ›-Ó˘ Î·È Û˘ÓÂÒ˜ ÂÎÙÂıÂÈ̤ӷ Ô‰ÔÓÙÈ-ÓÔÛˆÏËÓ¿ÚÈ· Î·È ‚) Û ¤ÓÙÔÓÔ ıÂÚÌÈÎfi ÂÚ¤ıÈÛÌ·, ÔfiÙ ÏfiÁˆ ÙÔ˘ ‰È·ÊÔÚÂÙÈÎÔ‡ Û˘ÓÙÂÏÂÛÙ‹ Û˘ÛÙÔÏ‹˜-‰È·ÛÙÔÏ‹˜ Ù˘ Ô‰ÔÓÙ›Ó˘ Î·È ÙÔ˘ ˘ÁÚÔ‡ ÂÓÙfi˜ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆ-ÏËÓ·Ú›ˆÓ, Â›Ó·È ‰˘Ó·Ùfi Ó· Û˘Ì‚Â› ˘‰ÚÔ‰˘Ó·ÌÈ΋ ÂÓÂÚÁÔÔ›ËÛË Ó¢ÚÈ-ÎÒÓ ÔÏÊÈÓ¢ÚÈ-ÎÒÓ ·Ôϋ͈Ó6_. ∏ ηٿÛÙ·ÛË ·˘Ù‹ ·ÏÏ¿˙ÂÈ ‰Ú·Ì·ÙÈο ÌÂÙ¿ ·fi ηٷÛÙÚÔÊ‹ ‹ ·ÔÌ¿ÎÚ˘ÓÛË Ù˘ ·‰·Ì·ÓÙ›Ó˘. ∆Ô Ì¤ÁÂıÔ˜ Ù˘ ·ÏÏ·-Á‹˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÂÈÊ¿ÓÂÈ·, ÙÔ ‚¿-ıÔ˜ ηٷÛÙÚÔÊ‹˜, ÙËÓ ÂÚÈÔ¯‹ Î·È ÙËÓ ËÏÈΛ· ÙÔ˘ ‰ÔÓÙÈÔ‡. √È ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ› ÂËÚ¿˙Ô˘Ó ¿ÌÂÛ· ÙÔÓ ·ÚÈıÌfi, ÙË ‰È¿ÌÂÙÚÔ ÙÔ˘ ·˘ÏÔ‡ ÙˆÓ ÂÎÙÂıÂÈÌ¤ÓˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ Î·È ÙËÓ ·fiÛÙ·ÛË Ù˘ ηٷÛÙÚÔÊ‹˜ ·fi ÙÔÓ ÔÏÊfi. ∏ ÛˆÏËÓÔÂȉ‹˜ ‰ÔÌ‹ Ù˘ Ô‰ÔÓÙ›Ó˘ Â›Ó·È ·˘Ù‹ Ô˘ ‰ËÌÈÔ˘ÚÁ› ÙȘ ‰Èfi‰Ô˘˜ ÂÈÛfi-‰Ô˘-ÌÂٷΛÓËÛ˘ ÌÈÎÚÔ‚›ˆÓ, ÙÔÍÈÓÒÓ Î·È ÁÂÓÈο ˘ÁÚÒÓ ÚÔ˜ Î·È ·fi ÙÔÓ ÔÏÊfi. √ ·ÚÈıÌfi˜ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ÛÙËÓ ¤ÓˆÛË ·‰·Ì·ÓÙ›Ó˘-Ô‰ÔÓÙ›Ó˘ ›-Ó·È 15.000/mm2 _{ÂÓÒ ÎÔÓÙ¿ ÛÙÔÓ ÔÏÊfi} ÏfiÁˆ Ù˘ ·ÎÙÈÓˆÙ‹˜ ÔÚ›·˜ ÙÔ˘˜ ÊÙ¿ÓÂÈ ÙȘ 65.000/mm2_{. √ fiÁÎÔ˜ Ô˘} ηٷϷÌ-‚¿ÓÔ˘Ó Â›Ó·È 4% ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ fiÁÎÔ˘ Ù˘ Ô‰ÔÓÙ›Ó˘ ÛÙËÓ ¤ÓˆÛË ·‰·Ì·ÓÙ›Ó˘-Ô‰ÔÓÙ›Ó˘ Î·È ÊÙ¿ÓÂÈ Ì¤¯ÚÈ 79% ÛÙËÓ ÔÏÊÈ΋ ÂÈÊ¿ÓÂÈ· Ù˘ Ô‰ÔÓÙ›Ó˘ Û ÓÂ-·Ú¿ ¿ÙÔÌ·10_. ∂‰Ò Ú¤ÂÈ Ó· ÙÔÓÈÛÙÔ‡Ó ‰‡Ô ÛÙÔȯ›·: ·) ·Ú·Î›ÌÂÓ· Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· ÂÈÎÔÈÓˆÓÔ‡Ó ÌÂٷ͇ ÙÔ˘˜ (∂ÈÎ. 3) Î·È ‚) Ô fiÁÎÔ˜ Ô˘ ηٷϷ̂¿ÓÔ˘Ó Ù· Ô‰Ô-ÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Î·È Û˘ÓÂÒ˜ ÚÔ-ÛʤÚÂÙ·È ÁÈ· ÌÂٷΛÓËÛË ÙˆÓ ÚÔ·-Ó·ÊÂÚı¤ÓÙˆÓ ÛÙÔȯ›ˆÓ ÂÚÈÔÚ›˙Â-Ù·È ÛËÌ·ÓÙÈο ·fi ÙÔ ÂÚȯfiÌÂÓfi ÙÔ˘˜. ∂Î ÚÒÙ˘ fi„ˆ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÈ· ηٿÛÙ·ÛË fiÔ˘ Ù· ÂÎÙÂıÂÈ̤ӷ Ô‰Ô-ÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Â›Ó·È Ë Â‡ÎÔÏË ‰›Ô‰Ô˜ ÁÈ· Ù· ÌÈÎÚfi‚È·, ÙȘ ÙÔ͛Ә ÙÔ˘˜ Î·È ÁÂ-ÓÈο ÁÈ· ÙÔ˘˜ Â͈ÙÂÚÈÎÔ‡˜ ÂÚÂıÈÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ó· ÊÙ¿ÛÔ˘Ó ÙÔÓ ÔÏÊfi. ∂›-Ó·È fï˜ Î·È Ô ÙÚfiÔ˜ ÁÈ· Ó· ·ÓÙÈÏË-Êı› Ô ÔÏÊfi˜ fiÙÈ Î¿ÙÈ Û˘Ì‚·›ÓÂÈ ÚÔ-ÙÔ‡ Ë Î·Ù·ÛÙÚÔÊ‹ ÊÙ¿ÛÂÈ ‰›Ï· ÙÔ˘, Î·È Ó· ¤¯ÂÈ ¯ÚfiÓÔ Ó· ·ÓÙȉڿÛÂÈ. ∏ ˘‰Ú·˘ÏÈ΋ ·ÁˆÁÈÌfiÙËÙ· Ù˘ Ô‰ÔÓÙ›Ó˘ ÂËÚ¿˙ÂÙ·È ·fi ÌÈ· ÏÂÈ¿‰· ·Ú·Áfi-ÓÙˆÓ, ΢ÚÈfiÙÂÚÔ˜ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È Ë ·ÎÙ›Ó· ÙÔ˘ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›Ô˘ ÛÙËÓ ÙÂÙ¿ÚÙË ‰‡Ó·ÌË11_{. ™ËÌ·ÓÙÈÎÔ› Â›Û˘} ·Ú¿ÁÔÓÙ˜ Â›Ó·È Ë ·ÚÔ˘Û›· ÙÔ˘ Ô‰Ô-ÓÙÈÓÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ Î·È ÙÔ˘ ÂÚȯÔ-̤ÓÔ˘ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ÁÂÓÈÎfi-ÙÂÚ·, Ë ‡·ÚÍË ÙˆÓ ÔÔ›ˆÓ ÌÂÈÒÓÂÈ ÙËÓ ˘‰Ú·˘ÏÈ΋ ·ÁˆÁÈÌfiÙËÙ·12_{, ÙÔ ¿¯Ô˜ Ù˘} Ô‰ÔÓÙ›Ó˘13,14_{ηıÒ˜ Î·È Ë ÂÚÈÔ¯‹ ÙÔ˘} ‰ÔÓÙÈÔ‡. ™˘ÁÎÂÎÚÈ̤ӷ, ¤¯ÂÈ ‚ÚÂı› fiÙÈ ÛÙ· Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Ô˘ ηٷϋ-ÁÔ˘Ó ÛÙËÓ ÎÔÙÈ΋ ‹ Ì·ÛËÙÈ΋ ÂÈÊ¿-ÓÂÈ· ÌfiÓÔ 30% Â›Ó·È Û ÂÈÎÔÈÓˆÓ›· Ì ÙÔÓ ÔÏÊfi Î·È ÂÓÙÔ›˙ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙ· √‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Î·È ÔÏÊfi˜ ∂ÈÎ. 3: ∞. ¢È·ÎÏ¿‰ˆÛË Î·È µ. ∞Ó·ÛÙfïÛË ÎÏ¿‰ˆÓ ·Ú·Î›ÌÂÓˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ. ∂ÈÎ. 2: ¶ÔÏÊÈ΋ ÂÈÊ¿ÓÂÈ· ÌË ·Ó·Ù›ϷÓÙÔ˜ 43, ·fi ¿ÙÔÌÔ ı‹Ï˘ ËÏÈΛ·˜ 15 ÂÙÒÓ. A. M‡ÏË. B. ∞˘¯ÂÓÈÎfi ÙÚÈÙËÌfiÚÈÔ Ù˘ Ú›˙·˜. °. ª¤ÛÔ ÙÚÈÙËÌfiÚÈÔ Ú›˙·˜. ¢. ÕÓˆ ÙÌ‹Ì· ·ÎÚÔÚÚÈ˙ÈÎÔ‡ ÙÚÈÙËÌÔÚ›Ô˘. E. ∫¿Ùˆ ÙÌ‹Ì· ·ÎÚÔÚÚÈ˙ÈÎÔ‡ ÙÚÈÙËÌÔÚ›Ô˘. ∞ µ ° ¢ E ∞ µ

ÔÏÊÈο Τڷٷ15_. ™˘ÁÎÚÈÙÈο Ì ÙË Ì·ÛËÙÈ΋ Ô‰ÔÓÙ›ÓË Ë ·ÍÔÓÈ΋ Ô‰ÔÓÙ›ÓË Â›Ó·È Ôχ ÈÔ ‰È·Â-Ú·Ù‹16_{ÂÓÒ Ë ÛÎÏËÚˆÙÈ΋ Ô‰ÔÓÙ›ÓË Â›Ó·È} ÂÏ¿¯ÈÛÙ· ¤ˆ˜ ηıfiÏÔ˘ ‰È·ÂÚ·Ù‹17_. ∏ ·fiÛÙ·ÛË ·fi ÙÔÓ ÔÏÊfi Ù˘ ÂÈÊ¿-ÓÂÈ·˜ Ù˘ ÔÔ›·˜ Ù· Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· ÂÍÂÙ¿˙Ô˘Ì ÂËÚ¿˙ÂÈ ÙÔÓ ·ÚÈıÌfi Î·È ÙË ‰È¿ÌÂÙÚfi ÙÔ˘˜, fiˆ˜ Â›Û˘ Î·È Ë ËÏÈΛ· Ô˘ Û ¿ÌÂÛË Û¯¤ÛË Ì ·˘Ù‹ Â›Ó·È ÙÔ Ô-ÛfiÓ Ù˘ ÂÚÈÈÓÈ΋˜ Ô‰ÔÓÙ›Ó˘ ªÂ ÙËÓ ·ÔÎ¿Ï˘„Ë ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ‰È¿ÊÔÚÔÈ Â͈ÙÂÚÈÎÔ› ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ì˯·ÓÈÎÔ›, ıÂÚÌÈÎÔ›, ÔÛ̈ÙÈÎÔ›, ηıÒ˜ Î·È Ë ·Ê˘‰¿ÙˆÛË, ÌÔÚÔ‡Ó Ó· ÚÔηϤ-ÛÔ˘Ó ÌÂٷΛÓËÛË ˘ÁÚÔ‡ ÛÙ· Ô‰ÔÓÙÈÓÔÛˆ-ÏËÓ¿ÚÈ·. ™‡Ìʈӷ Ì ÙË ıˆڛ· ÙÔ˘ Brännström, ·˘Ùfi ÌÂÙ·ÊÚ¿˙ÂÙ·È ˆ˜ fi-ÓÔ˜ ÏfiÁˆ ÙˆÓ Ì˯·ÓÈÎÒÓ ȤÛÂˆÓ Î·È Ù¿-ÛÂˆÓ Ô˘ ‰ËÌÈÔ˘ÚÁ› ·˘Ù‹ Ë ÌÂٷΛÓËÛË ÛÙ· ΢ÙÙ·ÚÈο ÛÙÔȯ›· Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙÔ ÔÏÊÈÎfi ¿ÎÚÔ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·-Ú›ˆÓ (Ô‰ÔÓÙÈÓÔ‚Ï¿ÛÙ˜, ÔÏÊÈΤ˜ Ó¢ÚÈ-Τ˜ ·ÔÏ‹ÍÂȘ Î·È ·ÁÁ›· ÛÙËÓ ˘ÔÔ‰Ô-ÓÙÈÓÔ‚Ï·ÛÙÈ΋ ÛÙÈ‚¿‰·)18,19_. ¶ÚfiÛÊ·Ù· ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛÙ› ÛÙË ‚È-‚ÏÈÔÁÚ·Ê›· ÂÚ¢ÓËÙÈο ÛÙÔȯ›· Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ˘‰ÚÔ‰˘Ó·ÌÈ΋ ıˆڛ· ÙÔ˘ Brännström ‰ÂÓ ·ÚΛ ÁÈ· Ó· ÂÍËÁ‹ÛÂÈ fiϘ ÙȘ ÂÚÈÙÒÛÂȘ. ÷ڷÎÙËÚÈÛÙÈο, ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ ·˘¯ÂÓÈ΋˜ ¢·ÈÛıË-Û›·˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û΢¿ÛÌ·Ù· Ô˘ ÚÔηÏÔ‡Ó Û¯ËÌ·ÙÈÛÌfi ÎÚ˘ÛÙ¿ÏÏˆÓ Î·È ·ÔÊÚ¿ÛÛÔ˘Ó, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÂÚÈÎÒ˜, Ù· Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ·. √È ÎÚ‡ÛÙ·ÏÏÔÈ, fï˜, ·˘ÙÔ› ‰ÂÓ ¤¯Ô˘Ó ÈηÓfi ¿¯Ô˜ ÁÈ· Ó· ·ÔÙÂϤÛÔ˘Ó Î·È ıÂÚÌÈ΋ ÌfiÓˆÛË ÙÔ˘ ‰ÔÓÙÈÔ‡. ™‡Ìʈӷ Ì ÙËÓ ˘‰ÚÔ‰˘Ó·ÌÈ΋ ıˆڛ· ÙÔ˘ Brännström, Ì ÙËÓ Â›‰Ú·-ÛË ¤ÓÙÔÓÔ˘ ıÂÚÌÈÎÔ‡ ÂÚÂı›ÛÌ·ÙÔ˜ Ô˘ ÚÔηÏ› ÌÂٷΛÓËÛË ÙÔ˘ ˘ÁÚÔ‡ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ Ë Î›ÓËÛË ÙÔ˘ ˘ÁÚÔ‡ ı· Â›Ó·È ·ÔÎÏÂÈÛÙÈο ÚÔ˜ ÙÔ ÔÏÊÈÎfi ¿ÎÚÔ ÙÔ˘˜, ·ÊÔ‡ ÙÔ ÚÔ˜ ÙËÓ ·‰·Ì·ÓÙ›ÓË ¿ÎÚÔ ÙÔ˘˜ ¤¯ÂÈ ·ÔÊÚ·¯Ù›. ∏ ·›ÛıËÛË ÙÔ˘ fiÓÔ˘ ı· ¤ÚÂ ÙÔ˘Ï¿-¯ÈÛÙÔÓ Ó· Û˘Ó¯›˙ÂÈ Ó· ˘¿Ú¯ÂÈ20,21_, ·˘-Ùfi fï˜ ‰Â Û˘Ì‚·›ÓÂÈ.

5. √ ÚfiÏÔ˜ ÙˆÓ

Ô‰ÔÓÙÈÓÔÛˆ-ÏËÓ·Ú›ˆÓ ÛÙË ‰›Ô‰Ô

ÙÔÍÈ-ÎÒÓ Ô˘ÛÈÒÓ Î·È

ÌÈÎÚÔ-‚›ˆÓ

ŸÏ· Ù· ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ ‰Â›¯ÓÔ˘Ó fiÙÈ ÙÂÏÈο Ù· Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· ‰ÂÓ Â›-Ó·È Â‡ÎÔÏË ‰›Ô‰Ô˜ ÁÈ· ÙȘ ÙÔÍÈΤ˜ Ô˘Û›Â˜ Î·È Ù· ÌÈÎÚfi‚È·. ªÂ ÙËÓ ·ÔÎ¿Ï˘„Ë ÙÔ˘ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›Ô˘ ˘¿Ú¯ÂÈ, ÏfiÁˆ Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ ÔÏÊÈ΋˜ ›ÂÛ˘ ·fi ·˘Ù‹ ÙÔ˘ ÛÙÔÌ·ÙÈÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, Ì›· ÚÔ˜ Ù· ¤Íˆ ΛÓËÛË ÙÔ˘ ˘ÁÚÔ‡ ÙˆÓ Ô‰ÔÓÙÈÓÔ-ÛˆÏËÚ›ˆÓ Î·È Û˘ÓÂÒ˜ «¤ÎÏ˘ÛË» ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ22_{. ∫Ï·ÛÈÎfi} ıˆ-ÚÂ›Ù·È ÙÔ ›ڷ̷ ÙˆÓ Vongsavan and Matthews23_{Ô˘ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÚˆÛÙÈ΋} Evans ‰È·¯¤ÂÙ·È ÛÙËÓ ÂÎÙÂıÂÈ̤ÓË Ô‰Ô-ÓÙ›ÓË in vitro ·ÏÏ¿ fi¯È in vivo.À¿Ú¯Ô˘Ó ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ ÔÛfi-ÙËÙ· ÙÔ˘ ·Ú·ÁfiÌÂÓÔ˘ ÔÏÊÈο ˘ÁÚÔ‡ Î·È Û˘ÓÂÒ˜ ÙËÓ Î›ÓËÛ‹ ÙÔ˘. ∏ ÂÓÂÚÁÔ-Ô›ËÛË ÙˆÓ Û˘Ì·ıËÙÈÎÒÓ ÔÏÊÈÎÒÓ Ó‡ڈÓ, fiˆ˜ Î·È Ù· ·ÁÁÂÈÔÛ˘Û·ÛÙÈο, ÚÔηÏÔ‡Ó Ì›ˆÛË Ù˘ ÚÔ‹˜ ÙÔ˘ ·›Ì·ÙÔ˜ ÛÙÔÓ ÔÏÊfi Î·È Û˘ÓÂÒ˜ ÌÂȈ̤ÓË ·-Ú·ÁˆÁ‹ ˘ÁÚÔ‡23_{. ∞ÓÙ›ıÂÙ·,} ˘‰ÚÔ‰˘Ó·ÌÈ-Îfi˜ ÂÚÂıÈÛÌfi˜ Ù˘ Ô‰ÔÓÙ›Ó˘, .¯. Ì˯·-ÓÈÎfi˜, ÚÔηÏ› ·ÂÏ¢ı¤ÚˆÛË Ó¢ÚÔ-ÂÙȉ›ˆÓ, ÙÔÈ΋ ·‡ÍËÛË Ù˘ ΢ÎÏÔÊÔ-Ú›·˜ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ·˘ÍË̤ÓË Î›ÓËÛË ÙÔ˘ ˘ÁÚÔ‡ ÚÔ˜ Ù· ¤Íˆ. ™˘ÓÂÒ˜, Ë ÚÔ˜ Ù· ¤Íˆ ΛÓËÛË ÙÔ˘ ˘ÁÚÔ‡ Â›Ó·È ÙÔ «Í¤-Ï˘Ì·» Ô˘ ÚÔηÏ› Ë ÚÒÙË ÁÚ·ÌÌ‹ ¿Ì˘Ó·˜ ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ ÔÏÊÔ‡-Ô‰Ô-ÓÙ›Ó˘. √È ÚˆÙ½Ó˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ (·ÓÔÛÔ-ÛÊ·ÈÚ›Ó˜ IgG, IgA, IgM, Î·È ÈÓˆ‰ÔÁfi-ÓÔ) Ô˘ ˘¿Ú¯Ô˘Ó ÛÙÔ ÔÏÊÈÎfi ˘ÁÚfi Î·È Û ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÈ·˜ ÒÚ·˜24 ·ÓÈ-¯Ó‡ÔÓÙ·È ÛÙ· Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ·, η-Ù·ÎÚ·ÙÔ‡ÓÙ·È ·fi ÙÔ ÙÔ›¯ˆÌ¿ ÙÔ˘˜ Î·È ÂÚÈÔÚ›˙Ô˘Ó ÛËÌ·ÓÙÈο ÙËÓ ·ÎÙ›Ó· ÙÔ˘˜. ∞˘Ùfi Ê·›ÓÂÙ·È Ó· ÈÛ¯‡ÂÈ ÁÈ· ÙȘ ÌÂÁ·ÏÔ-ÌÔÚȷΤ˜ ÂÓÒÛÂȘ, ÂÓÒ ÔÈ ·˘ÍËÙÈÎÔ› ·-Ú¿ÁÔÓÙ˜ Ô˘ ·ÂÏ¢ıÂÚÒÓÔÓÙ·È ·fi ÙËÓ Ô‰ÔÓÙ›ÓË ÏfiÁˆ Ù˘ ηٷÛÙÚÔÊ‹˜ Ù˘ ÂÚÓÔ‡Ó ·fi Ù· Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Î·È ÂȉÚÔ‡Ó ÛÙÔÓ ÔÏÊfi25_. ∆Ô ·ÔÙ¤ÏÂÛÌ· ·˘Ù‹˜ Ù˘ Â›‰Ú·Û˘ ›-Ó·È Â›ÙÂ Ë ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ô‰ÔÓÙÈÓÔ-‚Ï·ÛÙÒÓ, Ô˘ ·ÔÎÙÔ‡Ó Í·Ó¿ Ù· Â›Â-‰· ·Ú·ÁˆÁÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ô˘ ›-¯·Ó ÛÙËÓ ÂÌ‚Ú˘˚΋ ÂÚ›Ô‰Ô26_{›Ù Ë} ‰È·-ÊÔÚÔÔ›ËÛË ÂÌ‚Ú˘˚ÎÒÓ ·‰È·ÊÔÚÔÔ›Ë-ÙˆÓ Î˘ÙÙ¿ÚˆÓ27 _{Û ԉÔÓÙÈÓÔ‚Ï¿ÛÙ˜ ÌÂ} ·ÔÙ¤ÏÂÛÌ· Ù·¯Â›· ·Ú·ÁˆÁ‹ ÂÚÈÈÓÈ-΋˜ Ô‰ÔÓÙ›Ó˘ Î·È Ó¤ˆÓ ÛÙÚˆÌ¿ÙˆÓ ÔÏ-ÊÈ΋˜ Ô‰ÔÓÙ›Ó˘.

6. ∞fiÊÚ·ÍË ÙÔ˘ ·˘ÏÔ‡

ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ

(‰È·Ê·Ó‹˜ - ÛÎÏËÚˆÙÈ΋ Ô‰ÔÓÙ›ÓË) √ Tomes28 _{‹Ù·Ó Ô ÚÒÙÔ˜ ÂÚ¢ÓËÙ‹˜} Ô˘ ÂÚȤÁÚ·„ ÙË ‰È·Ê·Ó‹ Ô‰ÔÓÙ›ÓË. √È Tomes Î·È Czermak29 _{‰È·Ù‡ˆÛ·Ó} ÙËÓ ¿Ô„Ë fiÙÈ Ë ‰È·Ê¿ÓÂÈ· ‰ËÌÈÔ˘ÚÁ›-Ù·È ‰ÈfiÙÈ Á›Ó‰ËÌÈÔ˘ÚÁ›-Ù·È ÌÈ· «ÂÍÈÛÔÚÚfiËÛË» ÙˆÓ Ê˘ÛÈÔÏÔÁÈο ‰È·ÊÔÚÂÙÈÎÒÓ ‰ÂÈÎÙÒÓ ‰È¿ıÏ·Û˘ ÙÔ˘ ʈÙfi˜ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆ-ÏËÓ·Ú›ˆÓ Î·È ÙÔ˘ ÂÓ·Û‚ÂÛÙȈ̤ÓÔ˘ ˘ÏÈ-ÎÔ‡ Ù˘ Ô‰ÔÓÙ›Ó˘. ∂›Ó·È ÁÂÓÈο ·Ô‰ÂÎÙfi fiÙÈ Ë ‰È·Ê·Ó‹˜ Ô‰ÔÓÙ›ÓË ·Ú¤¯ÂÈ ·˘Ù‹ ÙËÓ ÂÈÎfiÓ· ÁÈ·Ù› ÂÈÙÚ¤ÂÈ ÙË ‰È¤Ï¢ÛË ÙÔ˘ ʈÙfi˜ Û ·ÓÙ›-ıÂÛË Ì ÙË Ê˘ÛÈÔÏÔÁÈ΋ Ô‰ÔÓÙ›ÓË, Ô˘ ‰È·ıÏ¿, ·Ó·ÎÏ¿ Î·È ‰È·ÛÎÔÚ›˙ÂÈ ÙÔ Êˆ˜. ∏ Èı·ÓfiÙËÙ· Ë Ê˘ÛÈÔÏÔÁÈ΋ Ô‰ÔÓÙ›ÓË Ó· Â›Ó·È ·‰È·Ê·Ó‹˜ ·ÏÒ˜ ÁÈ·Ù› ·ÔÚ-ÚÔÊ¿ ÙÔ Êˆ˜, ·ԉ›¯ıËΠ·fi ÙÔÓ Darling30_{·‚¿ÛÈÌË. √ ÂÚ¢ÓËÙ‹˜} ÙÔÔı¤-ÙËÛ Ï¿ÛÌ·Ù· Ê˘ÛÈÔÏÔÁÈ΋˜ Ô‰ÔÓÙ›Ó˘ Û ˘ÁÚfi Ô˘ ›¯Â ÂÚ›Ô˘ ÙÔÓ ›‰ÈÔ ‰Â›ÎÙË ‰È¿ıÏ·Û˘ Ì ·˘ÙfiÓ Ù˘ Ô‰ÔÓÙ›Ó˘, Û˘-ÁÎÂÎÚÈ̤ӷ ͢ÏfiÏË, ÌÈ· ‰È·‰Èηۛ· Ô˘ ·Ó·ÌÊÈÛ‚‹ÙËÙ· ·˘Í¿ÓÂÈ ÙËÓ ·ÔÚÚfiÊË-ÛË ÙÔ˘ ʈÙfi˜. ∆Ô ·ÔÙ¤ÏÂÛÌ· ‹Ù·Ó Ó· ÂÌÊ·ÓÈÛÙ› ÙÔ Ï¤·ÛÌ· ˆ˜ ‰È·Ê·Ó¤˜ ÏfiÁˆ Ù˘ ·ÓÙÈηٿÛÙ·Û˘ ÙÔ˘ ·¤Ú· Ô˘ ˘‹Ú-¯Â ÛÙ· Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· ·fi ÙËÓ Í˘-ÏfiÏË. ∏ ‰È·Ê¿ÓÂÈ· Ù˘ Ô‰ÔÓÙ›Ó˘ ·˘Í¿ÓÂÙ·È Ì ·ÏÏ·Á¤˜ Ù˘ Ô‰ÔÓÙ›Ó˘, ÔÈ Ôԛ˜ ÌÂÈÒ-ÓÔ˘Ó ÙÔ Ì¤ÁÂıÔ˜, ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰È·-ıÏÔ˘ÛÒÓ ÂÈÊ·ÓÂÈÒÓ Ù˘ ‹ ÙÔ ÔÛfi Ù˘ ‰È¿ıÏ·Û˘ ·Ó¿ ÂÈÊ¿ÓÂÈ·. ∞fi fiÏ· Ù· ‰ÔÌÈο Î·È ÌÔÚÊÔÏÔÁÈο ÛÙÔȯ›· Ù˘ Ô‰ÔÓÙ›Ó˘ ÌfiÓÔ ÙÔ Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈÔ ¤¯ÂÈ ‰È¿ÌÂÙÚÔ ·˘ÏÔ‡ ÌÂÁ·Ï‡ÙÂÚË ·fi ÙÔ µ·ÛÈÏÂÈ¿‰Ë˜

Ì‹ÎÔ˜ ·̷ÙÔ˜ ÙÔ˘ ÔÚ·ÙÔ‡ ʈÙfi˜ Î·È Â›-Ó·È ·˘Ùfi Ô˘ ‰È·ıÏ¿ Î·È ‰È·ÛÎÔÚ›˙ÂÈ ÙÔ Êˆ˜. ™˘ÓÂÒ˜, οı ·ÏÏ·Á‹ Ô˘ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ‹ Ù˘ ‰È·Ì¤ÙÚÔ˘ ÙÔ˘ ·˘ÏÔ‡ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏË-Ó·Ú›ˆÓ ‹ ÙÔ ÔÛfi Ù˘ ‰È¿ıÏ·Û˘ ·Ó¿ Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈÔ Ú¤ÂÈ Ó· ·˘Í¿ÓÂÈ ÙË ‰È·Ê¿ÓÂÈ· Ù˘ Ô‰ÔÓÙ›Ó˘. ∏ ÂͤٷÛË ÙÔ˘ ·˘ÏÔ‡ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏË-Ó·Ú›ˆÓ ÂÚÈÔ¯ÒÓ ‰È·Ê·ÓÔ‡˜ Ô‰ÔÓÙ›Ó˘ ›Ù Ì ÌÈÎÚÔ·ÎÙÈÓÔÁÚ·ÊÈ΋ Ù¯ÓÈ΋31,32 ›Ù Ì ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ Û¿Úˆ-Û˘32_{¤‰ÂÈÍ fiÙÈ Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ} ·˘-ÏÒÓ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ‰ÂÓ ‹Ù·Ó Ï‹Úˆ˜ ·ÔÊÚ·Á̤ӷ ·ÏÏ¿ ۯ‰fiÓ Ï‹-Úˆ˜ ·ÔÊÚ·Á̤ӷ (∂ÈÎ. 6∞). ∏ ÎÔÈÓ‹ ·Ô‰Ô¯‹ fiÙÈ ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ·˘-ÏÔ‡ ÙÔ˘ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›Ô˘ Û˘ÁÎÚÈÙÈο Ì ÙÔ Ì‹ÎÔ˜ ·̷ÙÔ˜ ÙÔ˘ ÔÚ·ÙÔ‡ ʈÙfi˜ Â›Ó·È Ô Î·ıÔÚÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· Ó· ÂÌÊ·ÓÈÛÙ› Ë ·ÓÙ›ÛÙÔÈ¯Ë ÂÚÈÔ¯‹ Ù˘ Ô‰ÔÓÙ›Ó˘ ‰È·Ê·Ó‹˜ ÂȂ‚·ÈÒıËΠÂÈ-Ú·Ì·ÙÈο. ∞˘Ùfi ¤ÁÈÓ ÂÍÂÙ¿˙ÔÓÙ·˜ Â-ÚÈÔ¯¤˜ ‰È·Ê·ÓÔ‡˜ Ô‰ÔÓÙ›Ó˘ Û ÌÈÎÚÔ-ÛÎfiÈÔ, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ʈÙÈÛÌfi ÔÚ·-Ùfi Î·È ÌË ÛÙÔ ·ÓıÚÒÈÓÔ Ì¿ÙÈ, ‰ËÏ·‰‹ ‰È·ÊÔÚÂÙÈÎÔ‡ Ì‹ÎÔ˘˜ ·̷ÙÔ˜ (·fi ˘Â-ÚÈ҉˜ Ô˘ ¤¯ÂÈ Ì‹ÎÔ˜ ·̷ÙÔ˜ 0,36 Ìm ̤¯ÚÈ ˘¤Ú˘ıÚÔ Ô˘ ¤¯ÂÈ Ì‹ÎÔ˜ ·̷ÙÔ˜ 0,80Ìm) Ì ÙË ‚Ô‹ıÂÈ· ÂȉÈÎÔ‡ ʈÙÔÁÚ·-ÊÈÎÔ‡ ÊÈÏÌ. ¢È·ÈÛÙÒıËΠfiÙÈ Ë ÂÚÈÔ¯‹ Ù˘ ‰È·Ê·ÓÔ‡˜ Ô‰ÔÓÙ›Ó˘, fiˆ˜ ηıÔÚ›-˙ÂÙ·È ÛÙÔ ÔÚ·Ùfi ʈ˜, ·˘Í¿ÓÂÙ·È ‹ ÌÂÈÒ-ÓÂÙ·È ·ÓÙ›ÛÙÔȯ· Ì ÙËÓ ·‡ÍËÛË ‹ ÙË Ì›-ˆÛË ÙÔ˘ Ì‹ÎÔ˘˜ ·̷ÙÔ˜ ÙÔ˘ ʈÙfi˜ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ Âͤٷۋ Ù˘32_. ŸÏÔÈ ·ÓÂÍ·Úًو˜ ÔÈ ÂÚ¢ÓËÙ¤˜ Ô˘ ·Û¯ÔÏ‹ıËÎ·Ó Ì ÙËÓ ·fiÊÚ·ÍË ÙÔ˘ ·˘-ÏÔ‡ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ‰È·›ÛÙˆ-Û·Ó fiÙÈ ÙÔ ·ÔÊÚ¿ÛÛÔÓ ˘ÏÈÎfi ‹Ù·Ó ÂÓ·-Û‚ÂÛÙȈ̤ÓÔ Î·È Â›¯Â ·ÚfiÌÔÈÔ ‰Â›ÎÙË ‰È¿ıÏ·Û˘ ÙÔ˘ ʈÙfi˜ Ì ·˘ÙfiÓ Ù˘ Ô‰Ô-ÓÙ›Ó˘. ªÂ ÙË ÌÂÚÈ΋ ‹ Ï‹ÚË ·fiÊÚ·ÍË ÙÔ˘ ·˘-ÏÔ‡ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ Ì ÂÓ·-Û‚ÂÛÙȈ̤ÓÔ ˘ÏÈÎfi Ô˘ ¤¯ÂÈ ·ÚfiÌÔÈÔ ‰Â›ÎÙË ‰È¿ıÏ·Û˘ Ì ·˘ÙfiÓ Ù˘ Ô‰ÔÓÙ›-Ó˘, Ë ÂÚÈÔ¯‹ Á›ÓÂÙ·È ÔÙÈο ÔÌÔÈÔÁÂ-Ó‹˜ Î·È Û˘ÓÂÒ˜ ‰È·Ê·ÔÌÔÈÔÁÂ-Ó‹˜. ∆·˘Ùfi¯ÚÔÓ· fï˜ ÙÚÔÔÔÈÂ›Ù·È Î·È Û ÛÎÏËÚˆÙÈ΋ ÏfiÁˆ Ù˘ ·‡ÍËÛ˘ ÙˆÓ ·ÓfiÚÁ·ÓˆÓ Û˘-ÛÙ·ÙÈÎÒÓ. °È· ÙÔ ÏfiÁÔ ·˘ÙfiÓ ÔÈ fiÚÔÈ ÛÎÏËÚˆÙÈ΋ Î·È ‰È·Ê·Ó‹˜ Ô‰ÔÓÙ›ÓË Â›Ó·È Ù·˘ÙfiÛËÌ·. (EÈÎ. 4). ∏ ÎÏÈÓÈ΋ ÛËÌ·Û›· Ù˘ ‰È·Ê·ÓÔ‡˜ Ô‰Ô-ÓÙ›Ó˘ Â›Ó·È ÛËÌ·ÓÙÈ΋. √ ·˘Ïfi˜ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ Ù˘ Â›Ó·È Û¯Â‰fiÓ Ï‹Úˆ˜ ‹ Ï‹Úˆ˜ ·ÔÊÚ·Á̤ÓÔ˜. ∞Ô-ÙÂÏ› Û˘ÓÂÒ˜ ÊÚ¿ÁÌ· ÛÙË ‰È›ۉ˘ÛË ÌÈ-ÎÚÔ‚›ˆÓ, ÙÔÍÈÓÒÓ Î·È ÁÂÓÈο Â͈ÙÂÚÈ-ÎÒÓ ÂÚÂıÈÛÙÈÂ͈ÙÂÚÈ-ÎÒÓ ·Ú·ÁfiÓÙˆÓ ÚÔ˜ ÙÔÓ ÔÏÊfi, fiˆ˜ Î·È ÛÙË ÌÂٷΛÓËÛË Ô‰ÔÓÙÈ-ÓÈÎÔ‡ ˘ÁÚÔ‡ ÚÔ˜ Ù· ¤Íˆ. ∏ ‰È·‰Èηۛ· Ù˘ ·fiÊڷ͢ ÙˆÓ Ô‰Ô-ÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ fï˜ Â›Ó·È ÌÈ· ·ÚÎÂÙ¿ ÈÔ ÔχÏÔÎË ‰ÈÂÚÁ·Û›·. ¢ÂÓ ˘¿Ú¯ÂÈ Î·Ì›· ·ÌÊÈ‚ÔÏ›· fiÙÈ ÙÔ ÚÒÙÔ ÛÙ¿‰ÈÔ Ù˘ Ì›ˆÛ˘ ÙÔ˘ ·˘ÏÔ‡ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆ-ÏËÓ·Ú›ˆÓ Á›ÓÂÙ·È «Ê˘ÛÈÔÏÔÁÈο» Ì ÙËÓ ·Ú·ÁˆÁ‹ Ù˘ ÂÚÈÈÓÈ΋˜ Ô‰ÔÓÙ›Ó˘ Ô˘ Û¯ËÌ·Ù›˙ÂÙ·È ÂÛˆÙÂÚÈο ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ÂȘ ‚¿ÚÔ˜ ÙÔ˘ ·˘ÏÔ‡ ÙÔ˘˜9_. ∏ ¤ÏÏÂÈ„Ë ÔÚÁ·ÓÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜ ÎÔÏÏ·ÁfiÓÔ˘ ÛÙËÓ ÂÚÈÔ¯‹ fiÔ˘ Û¯ËÌ·Ù›-˙ÂÙ·È Ë ÂÚÈÈÓÈ΋ Ô‰ÔÓÙ›ÓË ¤¯ÂÈ ·ÔÙ¤ÏÂ-ÛÌ· ÙÔ ÌÂÁ¿ÏÔ ‚·ıÌfi ÂÓ·Û‚ÂÛÙ›ˆÛ‹˜ Ù˘ Î·È ÙË ¯·Ú·ÎÙËÚÈÛÙÈ΋ Ï›· ÂÈÊ¿-ÓÂÈ¿ Ù˘ ÛÙË ıÚ·‡ÛË, Û ۯ¤ÛË Ì ·˘Ù‹ Ù˘ ÌÂÛÔ˚ÓÈ΋˜ Ô‰ÔÓÙ›Ó˘7,32_{(∂ÈÎ. 5).} √ Û¯ËÌ·ÙÈÛÌfi˜ Ù˘ ÂÚÈÈÓÈ΋˜ Ô‰ÔÓÙ›Ó˘ Â›Ó·È ÌÈ· ·ÚÁ‹ ‰È·‰Èηۛ·, ÁÈ· ÙÔ ‚ÈÔÏÔ-ÁÈÎfi ¤ÏÂÁ¯Ô Ù˘ ÔÔ›·˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¿ ÛÙÔȯ›·. º˘ÛÈÔÏÔÁÈο, Ë ÂÚÈÈ-ÓÈ΋ Ô‰ÔÓÙ›ÓË ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi Ó· ·Ô-ÊÚ¿ÍÂÈ Ï‹Úˆ˜ ÙÔÓ ·˘Ïfi ÙˆÓ Ô‰ÔÓÙÈÓÔ-ÛˆÏËÓ·Ú›ˆÓ ÂÊfiÛÔÓ ÁÈ· ÙÔ Û¯ËÌ·ÙÈÛÌfi Ù˘ ··ÈÙÂ›Ù·È Ë ·ÚÔ˘Û›· Ù˘ ·ÔÊ˘¿-‰·˜ Ù˘ Ô‰ÔÓÙÈÓÔ‚Ï¿ÛÙ˘. ™Â ÂÚ›ÙˆÛË fï˜ Ô˘ ‰Ôı› ‰˘Ó·ÙfiÙË-Ù· ÛÙÔ Ô‰ÔÓÙÈÓÈÎfi ˘ÁÚfi Ó· ÎÈÓËı› ÚÔ˜ ÙÔ ·‰·Ì·ÓÙÈÓÈÎfi ¿ÎÚÔ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆ-ÏËÓ·Ú›ˆÓ, Ô Ì˯·ÓÈÛÌfi˜ ·fiÊڷ͢ ÙÔ˘ ·˘ÏÔ‡ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ·ÏÏ¿-˙ÂÈ. ∞Ó Î·È Ë ·ÎÚÈ‚‹˜ Û‡ÛÙ·ÛË ÙÔ˘ ˘ÁÚÔ‡ ·˘ÙÔ‡ ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹, Â›Ó·È ‚¤‚·ÈÔ fiÙÈ ÂÚȤ¯ÂÈ ÔÛfi ÈfiÓÙˆÓ ·Û‚ÂÛÙ›Ô˘ Î·È Êˆ-ÛÊfiÚÔ˘ ÎÔÓÙ¿ ‹ Î·È Ï›ÁÔ ¿Óˆ ·fi ÙÔ fiÚÈÔ ÛÙÂÚÂÔÔ›ËÛ˘. ªÂ ÙËÓ ÂχıÂÚË ÌÂٷΛÓËÛË ÙÔ˘ Ô‰ÔÓÙÈÓÈÎÔ‡ ˘ÁÚÔ‡ ÛÙ· Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Â›Ó·È Èı·Ófi Ó· ‰Ë-ÌÈÔ˘ÚÁËı› ÌÈ· ÔÏ˘ÌÔÚÊ›· ÎÚ˘ÛÙ·ÏÏÈ-ÎÒÓ Û¯ËÌ·ÙÈÛÌÒÓ33_. ∞˘Ù‹ Ë ÌÂٷΛÓËÛË ÙÔ˘ Ô‰ÔÓÙÈÓÈÎÔ‡ ˘ÁÚÔ‡ ÌÔÚ› Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ·ÔÎ¿Ï˘„˘ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ÏfiÁˆ Ì·ÛËÙÈ΋˜ ·ÔÙÚÈ‚‹˜, ÔfiÙ ‰ËÌÈÔ˘Ú-ÁÔ‡ÓÙ·È ÎÚ˘ÛÙ·ÏÏÈΤ˜ ‰Ô̤˜ ΢‚ÔÂȉԇ˜ √‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Î·È ÔÏÊfi˜ ∂ÈÎ. 4: ∞. ºˆÙÔÁÚ·Ê›· Î·È µ. ªÈÎÚÔ-·ÎÙÈÓÔÁÚ·Ê›· ÙÔ˘ ȉ›Ô˘ Ï¿ÛÌ·ÙÔ˜. ¶Ï‹Ú˘ ·ÓÙÈÛÙÔȯ›· ÛÙȘ ÂÚÈÔ¯¤˜ Ù˘ ‰È·Ê·ÓÔ‡˜ Ô‰ÔÓÙ›Ó˘ Ù˘ ʈÙÔÁÚ·Ê›·˜ Ì ·˘Ù¤˜ Ù˘ ÛÎÏËÚˆÙÈ΋˜ Ô‰ÔÓÙ›Ó˘ Ù˘ ÌÈÎÚÔ·ÎÙÈÓÔÁÚ·Ê›·˜. ∂ÈÎ. 5: ¢È·Ê·Ó‹˜ Ô‰ÔÓÙ›ÓË Ô˘ ‰Â›¯ÓÂÈ fiÙÈ Ë ·Ú¯È΋ ‰È¿ÌÂÙÚÔ˜ Î·È ÙÔ˘ ·ÓÔȯÙÔ‡ (a) Î·È ÙÔ˘ ۯ‰fiÓ ·ÔÊÚ·Á̤ÓÔ˘ Ô‰Ô-ÓÙÈÓÔÛˆÏËÓ·Ú›Ô˘ (‚) ‰Â ‰È·Ê¤ÚÔ˘Ó ÛË-Ì·ÓÙÈο. ÷ڷÎÙËÚÈÛÙÈÎfi ÙÔ ÏÂ›Ô Ù˘ Â-ÚÈÈÓÈ΋˜ Ô‰ÔÓÙ›Ó˘. ∞ µ · ‚

Î·È ÚÔÌ‚ÔÂȉԇ˜ ÂÌÊ¿ÓÈÛ˘34 _{‹, ·Ó ÁÈ·} οÔÈ· ·ÈÙ›· ÙÔ ÛÒÌ· Ù˘ Ô‰ÔÓÙÈÓÔ‚Ï¿-ÛÙ˘ Î·È Ë ·ÔÊ˘¿‰· Ù˘ ¿„Ô˘Ó Ó· ·ÔÊÚ¿ÛÛÔ˘Ó ÙÔ ÔÏÊÈÎfi ÛÙfiÌÈÔ ÙÔ˘ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›Ô˘, ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ‰Ô̤˜ ·ÚfiÌÔȘ Ù˘ ÂÚÈÈÓÈ΋˜ Ô‰ÔÓÙ›-Ó˘32_{(∂ÈÎ. 6).} ∞˘Ù‹ Ë ÂÈÎfiÓ· Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÛÙË ÚÈ˙È΋ Ô‰ÔÓÙ›ÓË ÙÔ˘ ΢Ófi‰ÔÓÙ·, Èı·ÓfiÓ ÏfiÁˆ Î·È ÙÔ˘ ȉÈfiÌÔÚÊÔ˘ ÂÏÏÂÈ„ÔÂȉԇ˜ Û¯‹Ì·ÙÔ˜ ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ ÙÔ˘. ™Â ÏÂ-¿ÛÌ·Ù· οıÂÙ˘ ‰È‡ı˘ÓÛ˘ ÚÔ˜ ÙÔ ÚÈ-˙ÈÎfi ۈϋӷ Ë ‰È·Ê·Ó‹˜ Ô‰ÔÓÙ›ÓË ÂÌÊ·-Ó›˙ÂÙ·È Û ۯ‹Ì· «ÂÙ·ÏÔ‡‰·˜» Ì ٷ ÊÙÂÚ¿ ÂÁÁ‡˜ - ¿ˆ (∂ÈÎ. 7), ÂÓÒ Ë Âͤٷ-ÛË ·ÓÙ›ÛÙÔȯˆÓ ÔÏÊÈÎÒÓ ÂÈÊ·ÓÂÈÒÓ ‰Â›¯ÓÂÈ ÂÁÁ‡˜ Î·È ¿ˆ Ï‹ÚË ¤ÏÏÂÈ„Ë ÚÔÔ‰ÔÓÙ›Ó˘ Î·È Î·ÏÛÔÛÊ·ÈÚÈÙÒÓ, ¿Ú· Û˘Óı‹Î˜ Ô˘ ÚÔ‰Èο˙Ô˘Ó ÌË ‡·ÚÍË Ô‰ÔÓÙÈÓÔ‚Ï·ÛÙÒÓ ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ê˘ÛÈÔ-ÏÔÁÈο ‰ÚÒÓÙˆÓ, ÂÓÒ Ë ÂÈÎfiÓ· ·ÚÂȷο Î·È ÁψÛÛÈο ‰Â›¯ÓÂÈ ÂÓÂÚÁfi ̤وÔ ÂÓ·Û‚ÂÛÙ›ˆÛ˘32_{(∂ÈÎ. 8).} ∆Ô ›‰ÈÔ ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙÔ˘˜ ¤ÁÎÏÂÈ-ÛÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ Ô˘ ÂÍÂÙ¿ÛÙËηÓ, Û ‰fiÓÙÈ· ‰ËÏ·‰‹ Ô˘ ‰ÂÓ ‹Úı·Ó Û η̛· Â·Ê‹ Ì ÙÔ ÛÙÔÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ. ∏ ÌÔÓ·‰È΋ ÏÔÁÈ΋ ÂÚÌËÓ›· Â›Ó·È fiÙÈ Ë È-ı·Ó‹ Ó¤ÎÚˆÛË ÙˆÓ Ô‰ÔÓÙÈÓÔ‚Ï·ÛÙÒÓ Â¤ÙÚ„ ÙËÓ Â›ÛÔ‰Ô ÙÔ˘ ˘ÁÚÔ‡ ÛÙ· Ô‰Ô-ÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Î·È ÙË ‰ËÌÈÔ˘ÚÁ›· ÎÚ˘-ÛÙ·ÏÏÈ΋˜ ‰ÔÌ‹˜ ·ÚfiÌÔÈ·˜ Ù˘ ÂÚÈÈÓÈ-΋˜ Ô‰ÔÓÙ›Ó˘, Ë ÔÔ›· ¯ÚËÛÈÌÔÔ‹ıËΠˆ˜ Ì‹ÙÚ·32_{(∂ÈÎ. 6).} ™˘ÌÂÚ·ÛÌ·ÙÈο, ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ‰Â-ÎÙ‹ Ë ˘fiıÂÛË fiÙÈ ÔÈ Ô‰ÔÓÙÈÓÔ‚Ï¿ÛÙ˜ Ù˘ Ú›˙·˜ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ·-Ú·ÁˆÁ‹˜ Ù˘ ÚˆÙÔÁÂÓÔ‡˜ Ô‰ÔÓÙ›Ó˘, ÌÂÙ¿ ‰ËÏ·‰‹ ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ·Ó·ÙÔÏ‹˜, Û ·ÓÙ›ıÂÛË Ì ·˘ÙÔ‡˜ Ù˘ ̇-Ï˘, Á›ÓÔÓÙ·È ÛÙ·‰È·Î¿, ÏÂÈÙÔ˘ÚÁÈο ÙÔ˘-Ï¿¯ÈÛÙÔÓ ·ÓÂÓÂÚÁ›˜32_{. ∏ ‰È·‰Èηۛ·} ·˘Ù‹ ·Ú¯›˙ÂÈ ·fi ÙÔ ÛÙÂÓfiÙÂÚÔ ÛËÌÂ›Ô ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ Î·È Â›Ó·È ·ÓÂÍ¿ÚÙË-ÙË Â͈ÙÂÚÈÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ. ∂›Ó·È ‰Â ··Ú·›ÙËÙË, ÁÈ· Ó· ÌËÓ ·ÔÊÚ·¯Ù›, Ïfi-Áˆ Ù˘ ·Ú·Ïfi-ÁˆÁ‹˜ Ù˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ Ô‰ÔÓÙ›Ó˘, ÙÔ ÛÙÂÓfi ÛËÌÂ›Ô ÙÔ˘ ÚÈ˙ÈÎÔ‡ ۈϋӷ Î·È «ÛÙÚ·ÁÁ·ÏÈÛÙ›» Ô ÔÏ-Êfi˜32_.

7. √ ÚfiÏÔ˜ ÙˆÓ

Ô‰ÔÓÙÈÓÔÛˆ-ÏËÓ·Ú›ˆÓ ÛÙȘ ÂÌÊÚ¿ÍÂȘ

ÚËÙÈÓÒÓ

∆· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·Ó·ÛÎfiËÛË Ù˘ ÚfiÛÊ·Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÛÙÔ ı¤Ì· ·˘-Ùfi ÌÔÚÔ‡Ó Ó· Û˘ÓÔ„ÈÛÙÔ‡Ó Û ÙÚÂȘ ÔÌ¿‰Â˜: I. Â›‰Ú·ÛË Ù˘ ÔÚ›·˜ ÙˆÓ Ô‰ÔÓÙÈÓÔ-ÛˆÏËÓ·Ú›ˆÓ ÛÙË Û˘ÁÎÚ¿ÙËÛË Ù˘ ¤Ì-Êڷ͢, II. Â›‰Ú·ÛË ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ, ̤ۈ ÙÔ˘ ˘ÁÚÔ‡ ÂÚȯÔ̤ÓÔ˘ ÙÔ˘˜, ÛÙËÓ ÔÈfiÙËÙ· Ù˘ ¤ÌÊڷ͢, III. Â›‰Ú·ÛË ÙˆÓ ‰È·‰ÈηÛÈÒÓ ‰È¿‚Úˆ-Û˘, Û˘ÁÎfiÏÏËÛ˘ Î·È ÔÏ˘ÌÂÚÈÛÌÔ‡ ÙˆÓ ÚËÙÈÓÒÓ ÛÙÔÓ ÔÏÊfi ̤ۈ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ. 7.1. ∂›‰Ú·ÛË Ù˘ ÔÚ›·˜ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ÛÙË Û˘ÁÎÚ¿ÙËÛË Ù˘ ¤ÌÊڷ͢ ™Â in vitro ¤Ú¢ӷ, ÔÈ Giannini Î·È Û˘Ó.35 ηٷϋÁÔ˘Ó fiÙÈ Ë ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ·Ó¿ mm2 ÂÈ-Ê¿ÓÂÈ·˜ Â·Ê‹˜ Ì ÙË ÚËÙ›ÓË, ¤¯ÂÈ ·ÚÓË-ÙÈ΋ Â›‰Ú·ÛË ÛÙËÓ ÔÈfiÙËÙ· ÙÔ˘ ‰ÂÛÌÔ‡ ·ÓÂÍ¿ÚÙËÙ· ÙÔ˘ Û˘ÁÎÔÏÏËÙÈÎÔ‡ Û˘ÛÙ‹-Ì·ÙÔ˜ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó. √È Cehveli Î·È Akca36 _{ÂÈÚ·Ì·ÙÈ˙fiÌÂÓÔÈ Î·È ·˘ÙÔ›} in vitro Î·È ÎÚ·ÙÒÓÙ·˜ fiÏÔ˘˜ ÙÔ˘˜ ¿Ï-ÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÛÙ·ıÂÚÔ‡˜, ηٷϋ-ÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ fiÙ·Ó Ù· Ô‰Ô-ÓÙÈÓÔÛˆÏËÓ¿ÚÈ· ‹Ù·Ó ·Ú¿ÏÏËÏ· ‹ ÏÔÍ¿ ÚÔ˜ ÙËÓ ÂÈÊ¿ÓÂÈ· ¤ÓˆÛ˘ Ì ÙË ÚËÙ›ÓË Ô ‰ÂÛÌfi˜ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο η-χÙÂÚÔ˜ ·’ fiÙÈ fiÙ·Ó ‹Ù·Ó οıÂÙ·. ∞ÓÙ›-ıÂÙ·, ÔÈ Sattabanasuk Î·È Û˘Ó.37 ‰È·›-ÛÙˆÛ·Ó fiÙÈ Ë ÊÔÚ¿ (οıÂÙË ‹ ·Ú¿ÏÏË-ÏË) ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ›¯Â Â›-‰Ú·ÛË ÌfiÓÔ Û ‚·ıȤ˜ ÎÔÈÏfiÙËÙ˜ Î·È Ì¿ÏÈÛÙ· ·ÓÙ›ıÂÙË ÁÈ· Ù· ‰‡Ô Û˘ÛÙ‹Ì·Ù· Û˘ÁÎfiÏÏËÛ˘ Ô˘ ‰ÔΛ̷۷Ó. ™Â ·ÓÙÈ·-Ú¿ıÂÛË Ì ÙÔ˘˜ Gannini Î·È Û˘Ó.35 _‰Â ‰È·›ÛÙˆÛ·Ó ‰È·ÊÔÚ¿ ÛÙÔ ‰ÂÛÌfi ·Ó¿ÏÔ-Á· Ì ÙËÓ ÂÚÈÔ¯‹ Ù˘ Ô‰ÔÓÙ›Ó˘. 7.2. ∂›‰Ú·ÛË ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ̤ۈ ÙÔ˘ ˘ÁÚÔ‡ ÂÚȯÔ̤ÓÔ˘ ÙÔ˘˜ ÛÙËÓ ÔÈfiÙËÙ· Ù˘ ¤ÌÊڷ͢ Ÿˆ˜ ‰ËÏÒÓÔ˘Ó ÔÈ Pashley Î·È Carval-µ·ÛÈÏÂÈ¿‰Ë˜ ∂ÈÎ. 6: ∞. √‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· ÂÚÈÔ¯ÒÓ ‰È·Ê·ÓÔ‡˜ Ô‰ÔÓÙ›Ó˘. ªÂÁ¤ı˘ÓÛË X5.000. µ. ∂ÌÊ·Ó‹˜ Ë ‰È·¯ˆÚÈÛÙÈ΋ ÁÚ·ÌÌ‹ ÌÂ-ٷ͇ ·ÔÊÚ·ÎÙÈÎÔ‡ ˘ÏÈÎÔ‡ Î·È ÂÚÈÈÓÈ-΋˜ Ô‰ÔÓÙ›Ó˘. ªÂÁ¤ı˘ÓÛË X10.000. °. ∫‡ÏÈÓ‰ÚÔ˜ ÂÓ·Û‚ÂÛÙȈ̤ÓÔ˘ ˘ÏÈÎÔ‡ Ô˘ ·ÔÊÚ¿˙ÂÈ Ï‹Úˆ˜ ÙÔÓ ·˘Ïfi ÙÔ˘ Ô-‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›Ô˘. ªÂÁ¤ı˘ÓÛË X5.000. ∞ µ ° _{∂ÈÎ. 7: ∏ ‰È·Ê¿ÓÂÈ· Ù˘ Ô‰ÔÓÙ›Ó˘ ÛÂ} ÙÔ-̤˜ οıÂÙ˜ ÚÔ˜ ÙÔÓ ÂÈÌ‹ÎË ¿ÍÔÓ· ÙÔ˘ ‰ÔÓÙÈÔ‡ ÂÌÊ·Ó›˙ÂÙ·È Ì ۯ‹Ì· «ÂÙ·-ÏÔ‡‰·˜» Ì ٷ ÊÙÂÚ¿ ÂÁÁ‡˜-¿ˆ.

ho38 _{ÙÔ ÔÛÔÛÙfi ˘ÁÚÔ‡ ÂÚȯÔ̤ÓÔ˘} ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ÛÙ· ÂÓ Ùˆ ‚¿-ıÂÈ ÛÙÚÒÌ·Ù· Ù˘ Ô‰ÔÓÙ›Ó˘ Â›Ó·È ÙÔ˘Ï¿-¯ÈÛÙÔÓ ÂÈÎÔÛ·Ï¿ÛÈÔ ·fi ·˘Ùfi ÙˆÓ ÂÈ-Ê·ÓÂÈ·ÎÒÓ. ™˘ÓÂÒ˜ ·) ÙÔ ‚¿ıÔ˜ Ù˘ ÎÔÈÏfiÙËÙ·˜ Î·È ‚) Ë ·‰ÚÔÔ›ËÛË Ì Ô͇ Ô˘ ·ÔÌ·ÎÚ‡ÓÂÈ ÙÔ Ô‰ÔÓÙÈÓÈÎfi Â›¯ÚÈ-ÛÌ· Î·È ·ÂÏ¢ıÂÚÒÓÂÈ Î·È ‰È¢ڇÓÂÈ Ù· ÛÙfiÌÈ· ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ39_Â›Ó·È ÔÈ ‰‡Ô ·ÚÈÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ηıÔÚ›-˙Ô˘Ó ÙËÓ ÔÛfiÙËÙ· ÙÔ˘ ˘ÁÚÔ‡ ÛÙËÓ ÂÈ-Ê¿ÓÂÈ· ¤ÌÊڷ͢, ÂÓfi˜ ˘ÁÚÔ‡ Ô˘ ·ÓÙ·-ÁˆÓ›˙ÂÙ·È ÙÔ ÌÔÓÔÌÂÚ¤˜ ÙˆÓ ÚËÙÈÓÒÓ ÁÈ· ÙËÓ Î¿Ï˘„Ë Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ ÎÔÏÏ·-ÁfiÓˆÓ ÈÓÒÓ6_. ™Â ·ÓÙ›ıÂÛË Ì ÙË ıˆÚËÙÈ΋ ·˘Ù‹ ÙÔÔ-ı¤ÙËÛË ‚Ú›ÛÎÔÓÙ·È Ù· Â˘Ú‹Ì·Ù· ‰‡Ô Û¯ÂÙÈο ÚfiÛÊ·ÙˆÓ ÂÚÁ·ÛÈÒÓ40,41_. ™˘Ì-ʈÓÔ‡Ó Î·È ÔÈ ‰˘Ô fiÙÈ Ô ‰ÂÛÌfi˜ Ù˘ ÚËÙ›-Ó˘ Â›Ó·È ÈÛ¯˘ÚfiÙÂÚÔ˜ fiÙ·Ó Á›ÓÂÙ·È Û ÂÚÈÔ¯‹ Ê˘ÛÈÔÏÔÁÈ΋˜ Ô‰ÔÓÙ›Ó˘ ·’ fi,ÙÈ Û ÂÚÈÔ¯‹ ‰È·Ê·ÓÔ‡˜ Ô‰ÔÓÙ›Ó˘. ∏ ·-Ú·Ù‹ÚËÛ‹ ÙÔ˘˜ ‹Ù·Ó fiÙÈ Ô ·ÔÊÚ·Á̤ÓÔ˜ ·˘Ïfi˜ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ÂÌfi‰È-Û ÛËÌ·ÓÙÈο ÙÔ Û¯ËÌ·ÙÈÛÌfi ‚˘ÛÌ¿ÙˆÓ ÚËÙ›Ó˘ ÂÓÙfi˜ ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ. ™Â ÌÈ· in vitro ¤Ú¢ӷ, Ô˘ fï˜ Ë fiÏË ‰È·‰Èηۛ· Ù˘ ·‰ÚÔÔ›ËÛ˘ Î·È ¤ÌÊÚ·-͢ ¤ÁÈÓ Ì ÂÍÔÌÔ›ˆÛË Ù˘ ‰È·ÊÔÚ¿˜ Ù˘ ÔÏÊÈ΋˜ ›ÂÛ˘ Ì ·˘Ù‹ ÙÔ˘ ÛÙfiÌ·-ÙÔ˜ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ›ÂÛË 20 mm ÛÙ‹-Ï˘ ‡‰·ÙÔ˜42_{, ‰È·ÈÛÙÒıËΠηχÙÂÚË} ÔÈfiÙËÙ· ‰ÂÛÌÔ‡ fiÙ·Ó ¯ÚËÛÈÌÔÔÈ‹ıË-Î·Ó ÌÔÓÔÊ·ÛÈÎÔ› (·˘ÙÔ·‰ÚÔÔÈÔ‡ÌÂÓÔÈ, Û˘ÁÎÔÏÏËÙÈÎÔ›) ·Ú¿ÁÔÓÙ˜ Ô˘ ‰Â ¯ÚÂÈ-·˙fiÙ·Ó ¤ÎÏ˘ÛË Î·È ÛÙ¤Áӈ̷ Ô‡Ù ·Ô-Ì¿ÎÚ˘Ó·Ó ÂÍ ÔÏÔÎÏ‹ÚÔ˘ Ù· Ô‰ÔÓÙÈÓÈο ‚‡ÛÌ·Ù·. ∂›Û˘, ÂÚÈÁÚ¿ÊÂÙ·È ÌÈ· ΛÓËÛË ˘ÁÚÔ‡ ÚÔ˜ Ù· ¤Íˆ ÚÈÓ ·fi ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ Ô‰ÔÓÙÈÓÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜, Ô˘ ‰Â-ηÏ·ÛÈ¿ÛÙËΠÌÂÙ¿ ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛ‹ ÙÔ˘, fiˆ˜ Â›Û˘ Î·È ÌÈ· ¤ÓÙÔÓË Î›ÓËÛË ÙÔ˘ ˘ÁÚÔ‡ ÚÔ˜ ÙÔÓ ÔÏÊfi ηٿ ÙÔÓ Ô-Ï˘ÌÂÚÈÛÌfi ÙˆÓ Û˘ÁÎÔÏÏËÙÈÎÒÓ ·Ú·Áfi-ÓÙˆÓ Î·È Ù˘ ÚËÙ›Ó˘. ™Â ¤Ú¢ӷ Ô˘ Û˘Ó¤ÎÚÈÓ ÙÔ ‰ÂÛÌfi Ù˘ ÚËÙ›Ó˘ ÛÂ Ê˘ÛÈÔÏÔÁÈ΋ Î·È ‰È·Ê·Ó‹ Â-ÚÈÔ¯‹ Ù˘ Ô‰ÔÓÙ›Ó˘ Ì ‡·ÚÍË ˘ÁÚÔ‡ ·fi ÙË ÌÂÚÈ¿ ÙÔ˘ ÔÏÊÔ‡, ÔÈ Û˘ÁÁÚ·Ê›˜ ‰ËÏÒÓÔ˘Ó fiÙÈ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ‰È·Ê·-ÓÔ‡˜ Ô‰ÔÓÙ›Ó˘, ·ÎfiÌË ÎÈ fiÙ·Ó ·‡ÍËÛ·Ó ÙËÓ ›ÂÛË Û 20 mm ÛÙ‹Ï˘ ‡‰·ÙÔ˜, ‰È·-ÈÛÙÒıËΠ٤ÏÂÈ· ·fiÊÚ·ÍË ÏfiÁˆ ¤ÏÏÂÈ-„˘ ˘ÁÚÔ‡, ·ÏÏ¿ Î·È ÏfiÁˆ Ù˘ ·‰˘Ó·-Ì›·˜ ÙˆÓ ÚËÙÈÓÒÓ Ó· ÂÈÛ¤ÏıÔ˘Ó ÛÙ· Ô‰Ô-ÓÙÈÓÔÛˆÏËÓ¿ÚÈ·, ÂÓÒ Ë ÔÈfiÙËÙ· ÙÔ˘ ‰Â-ÛÌÔ‡ ‹Ù·Ó ˘ԉ¤ÛÙÂÚË ·˘Ù‹˜ Ì ÙË Ê˘-ÛÈÔÏÔÁÈ΋ Ô‰ÔÓÙ›ÓË43_. 7.3. ∂›‰Ú·ÛË ÙˆÓ ‰È·‰ÈηÛÈÒÓ ·‰ÚÔÔ›-ËÛ˘, Û˘ÁÎfiÏÏËÛ˘ Î·È ÔÏ˘ÌÂÚÈÛÌÔ‡ ÙˆÓ ÚËÙÈÓÒÓ ÛÙÔÓ ÔÏÊfi ̤ۈ ÙˆÓ Ô‰Ô-ÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ ∏ ΛÓËÛË ÙÔ˘ ˘ÁÚÔ‡, fiˆ˜ ÂÚÈÁÚ¿ÊËΠÛÙËÓ in vitro ÂÚ¢ÓËÙÈ΋ ÂÚÁ·Û›· ÙˆÓ Hashimoto Î·È Û˘Ó.42_{, ‰ÂÓ ÌÔÚ› Ó· ÌËÓ} ¤¯ÂÈ Î¿ÔÈ· Â›‰Ú·ÛË ÛÙÔÓ ÔÏÊfi. ŸÌˆ˜, ÁÂÓÈο ˘¿Ú¯ÂÈ ÌÈ· Ù¿ÛË ÙËÓ ÙÂ-ÏÂ˘Ù·›· ÂÓÙ·ÂÙ›· Ó· ÂÍÂÙ¿˙ÂÙ·È ÂÚ¢-ÓËÙÈο ÙÔ ı¤Ì· ·fi Ì˯·ÓÈ΋ Î·È fi¯È ‚ÈÔÏÔÁÈ΋ ÔÙÈ΋ ÁˆÓ›·. ™Â in vivo ÂÚÁ·Û›·44 _{ÔÈ Û˘ÁÁÚ·Ê›˜} ·ÍÈÔÏfiÁËÛ·Ó ÂÈÚ·Ì·ÙÈο ÙËÓ Â›‰Ú·ÛË ÙˆÓ ·ÓˆÙ¤Úˆ ·Ú·ÁfiÓÙˆÓ. ÃÚËÛÈÌÔÔ›-ËÛ·Ó 20 ·ÓıÚÒÈÓÔ˘˜ ÚÔÁÔÌÊ›Ô˘˜ Ô˘ ÂÚfiÎÂÈÙÔ Ó· ÂÍ·¯ıÔ‡Ó ÁÈ· ÔÚıÔ‰ÔÓÙÈ-ÎÔ‡˜ ÏfiÁÔ˘˜. √ ¯ÚfiÓÔ˜ ·Ú·Ù‹ÚËÛ˘ ‹Ù·Ó 30 ̤Ú˜. ∫·Ù·Ï‹ÁÔ˘Ó fiÙÈ Ë Ù¯ÓÈ΋ Ù˘ ·Ú·Û΢‹˜ Ù˘ ÎÔÈÏfiÙËÙ·˜, Ë ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Î˘Ú›ˆ˜ Ë ·fiÛÙ·ÛË ÙÔ˘ ‰¿ÊÔ˘˜ Ù˘ ÎÔÈÏfiÙËÙ·˜ ·fi ÙËÓ ÔÏÊÈ΋ ÂÈÊ¿ÓÂÈ·, ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ¤ÓÙ·ÛË Ù˘ ÔÏÊÈ΋˜ ÊÏÂÁÌÔ-Ó‹˜ Î·È ÙË ‰È¤ÁÂÚÛË ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ÙÚÈÙÔÁÂÓÔ‡˜ Ô‰ÔÓÙ›Ó˘. ∞Ó Î·È Û ηÌÈ¿ ·fiÛÙ·ÛË ÙÔ˘ ‰¿ÊÔ˘˜ Ù˘ ÎÔÈÏfiÙËÙ·˜ ·fi ÙËÓ ÔÏÊÈ΋ ÂÈÊ¿ÓÂÈ· ‰ÂÓ ·Ú·Ù‹-ÚËÛ·Ó Ó¤ÎÚˆÛË, ‰È·ÈÛÙÒÓÔ˘Ó fiÙÈ ·Ó Ë ·fiÛÙ·ÛË Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi 300 Ìm, ‰ÂÓ Â›Ó·È ·ÚÎÂÙ‹ Ó· ÚÔÛٷهÂÈ ÙÔÓ ÔÏÊfi fiÙ·Ó ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÈÛ¯˘Ú¿ Ôͤ· ÁÈ· ÙËÓ ·‰ÚÔÔ›ËÛË Î·È ·Ôηχ-ÙÔ˘Ó Ù· ÛÙfiÌÈ· ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆÏËÓ·-Ú›ˆÓ. ™Â ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË ÂÈ‚¿ÏÏÂ-Ù·È Ë ¯Ú‹ÛË Ô˘‰¤ÙÂÚÔ˘ ÛÙÚÒÌ·ÙÔ˜. ∞ÍÈÔ-ÏÔÁÒÓÙ·˜ Ù· Â˘Ú‹Ì·Ù¿ ÙÔ˘˜, Ú¤ÂÈ Ó· ÏËÊı› ˘’ fi„ÈÓ fiÙÈ ÙÔ ˘ÏÈÎfi ÙÔ˘˜ ‹Ù·Ó Ó·ÚÔ›, ¯ˆÚ›˜ ÙÂÚˉÔÓÈ΋ ‚Ï¿‚Ë ÚÔ-ÁfiÌÊÈÔÈ, ¿Ú· ›¯·Ó Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Ì «ÙÂÚ¿ÛÙÈÔ» ·˘Ïfi Î·È «ÌÈÎÚfi» ¿¯Ô˜ Ô‰ÔÓÙ›Ó˘.

8. ™˘ÌÂÚ¿ÛÌ·Ù·

∆· Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Â›Ó·È Ë «Â‡ÎÔ-ÏË» ‰›Ô‰Ô˜ ÁÈ· ÙÔ˘˜ Â͈ÙÂÚÈÎÔ‡˜ ÂÚÂıÈ-ÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ó· ÚÔÛÂÁÁ›ÛÔ˘Ó ÙÔÓ ÔÏÊfi. √ ÎÏÈÓÈÎfi˜ Ô‰ÔÓÙ›·ÙÚÔ˜ ÂÈ-‚¿ÏÏÂÙ·È Ó· Â›Ó·È È‰È·›ÙÂÚ· ÚÔÛÂÎÙÈÎfi˜ ÛÙÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜ ÙÔ˘ Î·È ÛÙËÓ ÂÈÏÔÁ‹ ÙˆÓ ˘ÏÈÎÒÓ Ô˘ ¯ÚËÛÈÌÔÔÈ› fiÙ·Ó ·ÓÙÈ-ÌÂÙˆ›˙ÂÈ ·ÔÎ·Ï˘Ì̤ӷ-ÂÎÙÂıÂÈ̤ӷ Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ·. ∏ Â¤Ì‚·Û‹ ÙÔ˘ Ú¤ÂÈ Ó· ¤¯ÂÈ ÛÙfi¯Ô ÙËÓ ˘Ô‚Ô‹ıËÛË Ù˘ Ê˘ÛÈ΋˜ ¿Ì˘Ó·˜ ÙÔ˘ ÔÏÊÔ‡. ™Â Û˘Ó-‰˘·ÛÌfi Ì ÙȘ ÁÓÒÛÂȘ Ô˘ ·ÔÎÙ‹ıËÎ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Û¯ÂÙÈο Ì ÙËÓ ¿Ì˘-Ó· ÙÔ˘ ÔÏÊÔ‡, ›¿Ì˘-Ó·È ÛËÌ·ÓÙÈÎfi ¿Ì˘-Ó· Á›ÓÂÈ ÚÔÛ¿ıÂÈ· ۯ‰ȷÛÌÔ‡ Ó¤ˆÓ ‚ÈÔ¸ÏÈ-ÎÒÓ Ì ÂÏÂÁ¯fiÌÂÓË Î·È ÂÍÂȉÈÎÂ˘Ì¤ÓË √‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· Î·È ÔÏÊfi˜ ∂ÈÎ. 8: ºˆÙÔÌÔÓÙ¿˙ ÙˆÓ ·ÏÏ·ÁÒÓ ˙ÒÓ˘ ÔÏÊÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ ·fi ÙË ÁψÛÛÈ΋ (°) ÚÔ˜ ÙËÓ ÂÁÁ‡˜ (∂) ÏÂ˘Ú¿. ÕÓˆ ·ÚÈ-ÛÙÂÚfi˜ ΢Ófi‰ÔÓÙ·˜ ı‹Ïˆ˜ ·ÙfiÌÔ˘ ËÏÈ-Λ·˜ 13 ÂÙÒÓ. ™ÙËÓ ÔÏÊÈ΋ ÂÈÊ¿ÓÂÈ· ¤¯ÂÈ ÂȉڿÛÂÈ ˘ԯψÚ҉˜ Ó¿ÙÚÈÔ. i. ∑ÒÓË ÛÙËÓ ÔÔ›· ηÏÛÔÛÊ·ÈÚ›Ù˜ Î·È ÛÙfiÌÈ· Ô‰ÔÓÙÈÓÔÛˆÏËÓ·Ú›ˆÓ Ê·›ÓÔÓÙ·È Î·ı·Ú¿. ii. ∑ÒÓË ÂχıÂÚË ·fi ηÏÛÔÛÊ·ÈÚ›Ù˜ ÛÙËÓ ÔÔ›· Ù· ÛÙfiÌÈ· ÙˆÓ Ô‰ÔÓÙÈÓÔÛˆ-ÏËÓ·Ú›ˆÓ Ê·›ÓÔÓÙ·È Î·ı·Ú¿. iii. ∑ÒÓË ÛÙËÓ ÔÔ›· Ù· Ô‰ÔÓÙÈÓÔÛˆÏË-Ó¿ÚÈ· Ê·›ÓÔÓÙ·È ÎÏÂÈÛÙ¿ Î·È ÌÂÚÈΤ˜ Â-ÚÈÔ¯¤˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ¯ˆÚ›˜ Ô‰ÔÓÙÈÓÔ-ÛˆÏËÓ¿ÚÈ·. ªÂÁ¤ı˘ÓÛË Ã200. i ii iii ° ∂

‰Ú¿ÛË, Ô˘ ı· ÛÙÔ¯Â‡Ô˘Ó ÛÙËÓ ˘Ô‚Ô‹-ıËÛË Ù˘ ¿Ì˘Ó·˜ ÙÔ˘ ÔÏÊÔ‡ Î·È fi¯È ÛÙËÓ ·Ï‹ ·Ó·Û‡ÛÙ·ÛË ÙÔ˘ ηÙÂÛÙÚ·Ì-̤ÓÔ˘ Ô‰ÔÓÙÈÎÔ‡ ÈÛÙÔ‡.

µπµ§π√°ƒ∞ºπ∞

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44. Carlos Alberto de Souza Costa, Alexandre Batista

Lopes do Nascimento, Hilcia Mezzalira Teixeira:

Response of human pulps following acid conditioning and application of a bonding agent in deep cavities. Dent Materials 2002;18: 543-51. ¶·ÚÂÏ‹ÊıË 10/10/07 - EÓÂÎÚ›ıË 29/01/08 µ·ÛÈÏÂÈ¿‰Ë˜ ¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·: §ÂˆÓ›‰·˜ µ·ÛÈÏÂÈ¿‰Ë˜ µÂÓÈ˙¤ÏÔ˘ 65 546 31 £ÂÛÛ·ÏÔÓ›ÎË ∆ËÏ.: 2310 238947; 6976 122162 ∂-mail: vl@dent.auth.gr

∞ÎÚÔÚÚÈ˙ÂÎÙÔÌ‹ Î·È ·Ó¿ÛÙÚÔÊË ¤ÌÊÚ·ÍË

∞ÎÚÔÚÚÈ˙ÂÎÙÔÌ‹ Î·È ·Ó¿ÛÙÚÔÊË ¤ÌÊÚ·ÍË:

Û‡Á¯ÚÔÓË ıÂÒÚËÛË

™. ª. ª¿ÁÎÔ˜*

µπµ§π√°ƒ∞ºπ∫∏ ∞¡∞™∫√¶∏™∏

·ÎÚÔÚÚÈ˙ÂÎÙÔÌ‹, ·Ó¿ÛÙÚÔÊË ¤ÌÊÚ·ÍË, ͤÛÙÚ· ˘ÂÚ‹¯ˆÓ

§¤ÍÂȘ-ÎÏÂȉȿ

apicoectomy, retrograde filling, ultrasonic tips

Key words

* √‰ÔÓÙ›·ÙÚÔ˜, ÂȉÈ΢ı›˜ ÛÙËÓ ∂Ó‰Ô‰ÔÓÙ›·, Û˘ÓÂÚÁ¿Ù˘

∂ÚÁ·ÛÙË-Ú›Ô˘ ∂Ó‰Ô‰ÔÓÙ›·˜, √‰ÔÓÙÈ·ÙÚÈÎfi ∆Ì‹Ì· ∂∫¶∞.

* DDS, MSc in Endodontics, affiliated with the Dept of Endodontics, Dental School of Athens University.

¶ÂÚ›ÏË„Ë

ªÂ ÙËÓ ÂÊ·ÚÌÔÁ‹ Û‡Á¯ÚÔÓˆÓ Ù¯ÓÈÎÒÓ, ˘ÏÈÎÒÓ Î·È ÂÚ-Á·Ï›ˆÓ ÙÔ ÔÛÔÛÙfi ÂÈÙ˘¯›·˜ Ù˘ Û˘ÓÙËÚËÙÈ΋˜ ÂÓ‰Ô‰Ô-ÓÙÈ΋˜ ıÂÚ·›·˜ Â›Ó·È Ôχ ˘„ËÏfi. ¶·Ú’ fiÏ· ·˘Ù¿ ˘¿Ú¯Ô˘Ó Î·È ÂÚÈÙÒÛÂȘ Ô˘ ··ÈÙÔ‡Ó ¯ÂÈÚÔ˘ÚÁÈ΋ Û˘ÌÏ‹ÚˆÛË. ∏ ·ÎÚÔÚÚÈ˙ÂÎÙÔÌ‹ Ì ‹ ¯ˆÚ›˜ ·Ó¿ÛÙÚÔÊË ¤ÌÊÚ·ÍË Â›Ó·È Ë ϤÔÓ Û˘¯Ó‹ Ù¯ÓÈ΋ ÂÚÈ·ÎÚÔÚÚÈ˙È΋˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜. ™ÎÔfi˜ Ù˘ ·ÎÚÔÚÚÈ˙ÂÎÙÔÌ‹˜ Â›Ó·È Ë ·Ô-Ì¿ÎÚ˘ÓÛË ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ÈÛÙÒÓ Î·È Ë ‰È·ÎÔ‹ ÂÍfi‰Ô˘ ÌÈÎÚÔ‚›ˆÓ Î·È ÙÔÍÈÓÒÓ ·fi ÙÔ ÌÔÏ˘Ṳ̂ÓÔ ÚÈ˙ÈÎfi ۈϋӷ ÚÔ˜ ÙÔ˘˜ ÂÚÈ·ÎÚÔÚÚÈ˙ÈÎÔ‡˜ ÈÛÙÔ‡˜, ÁÈ· Ó· ·Ôηٷ-ÛÙ·ı› Ë ‚Ï¿‚Ë. ¶·Ï·ÈfiÙÂÚ· Ë ÚfiÁÓˆÛË Ù˘ Â¤Ì‚·Û˘ ‹Ù·Ó ·ÌÊ›‚ÔÏË, ȉȷ›ÙÂÚ· ÁÈ· Ù· Ô›ÛıÈ· ‰fiÓÙÈ·, ÁÈ·Ù› ÂÌ-Ê·Ó›˙ÔÓÙ·Ó ‰˘ÛÎÔϛ˜ ÛÙËÓ ÚÔÛ¤Ï·ÛË ÙÔ˘ ¯ÂÈÚÔ˘ÚÁÈ-ÎÔ‡ ‰›Ô˘ ·ÏÏ¿ Î·È ÏfiÁˆ ·Ó·ÙÔÌÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÙˆÓ ÚÈ˙ÒÓ (ÈÛıÌÔ›, ·Ú¿Ï¢ڷ ·ÎÚÔÚÚÈ˙Èο ÙÚ‹Ì·Ù· Î.¿.) Ô˘ ‹Ù·Ó ·‰‡Ó·ÙÔ Ó· ·Ú·Û΢·ÛÙÔ‡Ó Î·È Ó· ÂÌÊÚ·-¯ıÔ‡Ó ·ÔÙÂÏÂÛÌ·ÙÈο. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ë Ù¯ÓÈ΋ ¤¯ÂÈ ‚ÂÏÙȈı› Î·È ÙÔ Ô-ÛÔÛÙfi ÂÈÙ˘¯›·˜ Â›Ó·È Ôχ ˘„ËÏfi (75-96%). ªÂ ÙÔ ÔÙÈ-Îfi ÌÈÎÚÔÛÔÙÈ-ÎfiÈÔ Ô ÎÏÈÓÈÔÙÈ-Îfi˜ ·Ú·ÙËÚ› Û ÌÂÁ¿ÏË ÌÂÁ¤-ı˘ÓÛË ÙÔ ·ÎÚÔÚÚ›˙ÈÔ Î·È ÙÔ˘˜ Á‡Úˆ ÈÛÙÔ‡˜ Î·È ÔÈ ¯ÂÈÚÈ-ÛÌÔ› ÙÔ˘ Á›ÓÔÓÙ·È Ì ·ÎÚ›‚ÂÈ·. ∏ ·Ú·Û΢‹ Ù˘ ÎÔÈÏfi-ÙËÙ·˜ ÁÈ· ·Ó¿ÛÙÚÔÊË ¤ÌÊÚ·ÍË ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÂȉÈο ͤÛÙÚ· ˘ÂÚ‹¯ˆÓ, ÈηÓÔÔÈÒÓÙ·˜ ÙȘ ÚÔ¸Ôı¤ÛÂȘ ÁÈ· ÂÚÌËÙÈ΋ ¤ÌÊÚ·ÍË. ∆· ÂÌÊÚ·ÎÙÈο ˘ÏÈο Ô˘ ÂÈϤÁÔ-ÓÙ·È, Î·È Â›Ó·È Û˘ÓËı¤ÛÙÂÚ·, Ë ÎÔÓ›· SuperEBA ‹ ÙÔ ª∆∞, ÙÔÔıÂÙÔ‡ÓÙ·È Ì ÂȉÈο ÌÈÎÚÔÂÚÁ·Ï›· ÁÈ· ηχ-ÙÂÚÔ ·ÔÙ¤ÏÂÛÌ·.

Summary

Apicoectomy and retrograde filling. Modern surgery concept

S. M. Magkos*

The use of new techniques, materials and instruments during conservative endodontic treatment has considerably increased the success of such therapies, without, however, removing the need for surgical treatment in some cases. Apicoectomy with or without retrograde filling is the most often performed periapical surgery. The aim of apicoectomy is the removal of pathological tissues and the prevention of bacteria and toxins from the root canal reaching periapical tissues, so that healing can take place. In the past, this treatment had an uncertain prognosis, especially for posterior teeth, due to difficulties related to the surgical technique as well as anatomical factors (isthmus, lateral foramina and canals), which aggravated the surgical problems.

Fortunately, this changed when the microscope, microinstruments, ultrasonic tips, and more biologically acceptable root-end filling materials were introduced in the last decade. The concurrent development of better techniques has resulted in greater under-standing of the apical anatomy, better success rates and a more favorable patient response. The advantages of microsurgery, as it is now called, include easier identification of root apices, smaller osteotomies and shallower resection angles that conserve cortical bone and root length. In addition, a resectioned root surface under high magnification and illumination readily reveals anatomical details such as isthmuses, canal fins, microfractures, and lateral canals. When combined with the microscope, ultrasonic instru-ments permit conservative, coaxial root-end preparations and precise root-end fillings satisfying the required mechanical and biological principles for endodontic surgery.

∂Ó‰Ô‰ÔÓÙÔÏÔÁ›· 2 (2): 123-132, 2007