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ATLAS OF

THIRD EDITION

EDWARD S. COHEN, DMD


Clinical Instructor
Tufts Dental School
Associate Clinical Instructor
Boston University Goldman School
of Graduate Dentistry
Boston, Massachusetts

2007

BC Decker Inc
Hamilton

..
..

616.31-089
56.6
76



,
,

..
76
/ . . ; . . . . . . - .:
, 2011. - 512 .: .
ISBN 978-5-98811-198-6

616.31-08
56.6

,

.

.
-
.
,
, ,
-, ,
.
,
:
, ,
, , .
.

ISBN 978-5-98811-198-6 (.)


ISBN 1-55009-267-7 (.)

The original English language work has been published by B.C. DECKER, INC
Hamilton, Ontario, Canada, 2007, All rights reserved

, , 2 0 1 1

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1.

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2.

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3.

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4.

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5.

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6.

- ............................................................................................................................................ 71

7.

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8.

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9.

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10.

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11. ......................................................................................................................... 194


12.

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25

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26
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13. ...............................................................................................................
14.

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15. ........................................................... 28
16. ............................................................................................................... 29
17. .................................................................................................... 29
18. .................................................................................................................... 29
19. : ........................................................

30

................................................ 31
20. .............................................................................................. 31
21. ............................................................................... 32
22. .................................................................................... 37
23. ...................................................................................................................... 39
24. ................................................................................................ 41
25.

.......................................................................... 42


26.
27.
28.
29.

43
................................................................................................................... 43
.......................................................................................................... 44
, ..................... 47
.......................................................................................................................... 49

.....................................................................................................................................

50'

EDTA
ENAP

AJIK

,
-


.





.


.
.
,

,
-
, ,

.

,


.

.
,

.
,

,

.

,
,
.


.
Drs. Dennis Shanelec Leonard S. Tibbits
,
, Drs. Arun . Garg
Craig Misch

,
Dr. Eiji Funakoshi

,
, Dr. James
Hanratty ,
,


, Dr. Periklis Proussaefs
Loma Linda.

Drs. Scott Kissel, Roger Wise, Fed

erico Brugnami, Irving Glickman, Ken


neth Kornman George Goumenous 3i
.



.
, ,
,

,

: The Principles of Vi

sual Perception and Their Clinical Application to


Denture Esthetics, Richard E. Lombardi, Es
thetics of Anterior Fixed Prosthodontics, Gerard
J. Chiche and Alain Pinault, Fundamen
tals of Esthetics, Claude R. Rufenacht.
Shanon
OBrien-Cohen, Christine Watson, Ju
dith Cohen Brigette Deveraux

.
.

Robert Ullrich,


.
,


.

.
Boston, Massachusetts




,
(1988 .) .
.


.
,

,



.

,

,
,
,


,
,
.


.


.

.

,

(
):
Burton Becker, Gerald . Bowers,
Daniel Buser, Robert Del Castillo, Stuart
Froum, Bernard Gantes, Gary Golovic,
Jan Gottlow, Claude G. Ibbot, L. Laurell,

James T. Mellovig, Sture Nyman, Knut


Selvig, Richard H. Shanaman, Athenos
Spiros, Sigmond Stahl, Dennis R Tarnow
Theodore West.

W. R. Gore Associates, Flagstaff,
AZ Guidor AB, Gothenburg, Sweden
( 13
) Ethicon Inc., Somerville.
NJ ( 3
)

.

Bob Ullrich (
) Harry Maskell (),


.

.
Boston, Massachusetts

10

,

.

,
,

-
.


,
-.

.


.

.

, ,

.

,
,

.

,
.


.

Glickmans Clinical Periodontology,

,
Lindhes: Clinical Periodon
tology,

.


Edward Allen, Raul Caffesse, Jose
Carvalho, Giovanni Castellucci, David
Garber, Barry Jaye Edwin Rosenberg

; Mark Hirsh, Mayer Liebman
Peter Ferrigno
Jeanne McCormack.
Rebecca Mugherini, Christine Roberts
Judith Cohen .

Harry W. Maskell,
, Robert
. Ullrich, Jr.





.
.
Boston, Massachusetts

14





/ .
,


,
.

,

.


. 1.1.


,
:

1.
,
.
2. ,

,

(. 1.1) (Newman Kornman,
1994).
3.
,


(. 1.2)
(McGuire Nunn, 1996).

1.1.


Newman Kornman (1994).

Newman . (1994)
,
,

( )
(
). Kornman .
(2000) ,
,

:
, ,

(. 1.2).

Page

Schroeder (1976).
,


(Page Kornman, 1997). ,



( ),
,

(
) (Haffajee et al., 1983; Haffajee, Socransky, 1996).


,

,

(. 1.3) (McGuire, 2000).

(. . 1.2).

,
(Tjan, 1986):
1. Ante: (Ante,

1926).

-1

* , , .
**
.
+ .
++ , ,
.

,


,

.

. 1.1.

1.2.
,


( )

: 0,1, 2, 3
: 0,1, 2, 3

:
: /
: /
: /

. 1.2.

( / )
(, , ):
//
: , ,
: /
: 2 . , 2 .,
3 . , 3 .
,

McGuire Newman (1996).

. 1-3.

15

16

(Smith, 1961).
3.
(Reynolds, 1968).

1.3.

2.

( ):
, ,
,

( ): 25%

. , / I .

( ): 50%- ,


(5-14 ) McGuire (1991) Mc
Guire Nunn (1996, 1996b, 1999)

(. 1.3)

, . 1.2.

:
1.

.
2.

.
3.
,
,
, .
4.

,

5096
5 35 % 8 .

Ghiai Bissada (1994).
5.

.
McGuire Nunn (1996)
:
, ,


.


, , ,


(. 1.4).

II .

( ): 50% ,
; ;
II ,
III ; 2+ ;

: ;

McGuire Nunn (1996).

1.4.

1 - 2
( )2
2


1 - 2


(

) 12
1
2

Ghiai Bissada (1994)


Nieri . (2002)


,



,
(Brown Loe, 1993). ,
(
)
( )
,

,

(Newman
et al., 1994).
Loe . (1986),
,

-1
Kornman . (1997)
,

,


. (Kornman et al., 2000)
,


,

,

(,
, ) ,
(. 1.4).
Kornman . (1997)

-1 (-1)

.
-1,
,


2

, ,

.
,
78% (

17

, 1.4.
. Dr. . Kornman.
( Munksgaard,
Copenhagen, Denmark)


> 30%

= 36

= 63

-1-
(-1 2 + -1 + 3953 2)
. 1.5.
. (
Dr. . Kornman et al., J Clinical Periodontology, 1997)

40-60 ),

, 18,9,

-1
86% 1
(. 1.5 1.6).

Packhill . (2000),
,

4,9

,

.
Kornman .
:
,

. 1.6.
(> 30 %) . (
Dr. . Kornman et al., J Clinical Periodontology, 1997)


-1,


(. 1.7).

, -1


(Masada et al., 1990; Stashenko
et al., 1991; Wilton et al., 1992; Feldner
et al., 1994). Cavanaugh
. (1998)


.
Lang . (2000)
,
-1

. Socransky . (2000)


-1.
,
-1


,
.

18

: Fc-V
RII,
,

:
lgG2

:
-1

( Dr. . Kornman, editor.


Periodontology 2000
Munksgarrd, Copenhagen,
Denmark)



1999 . McGuire Nunn
42 ,
14 ,
-1.
,
-1

,

.


,
4.5% (47 1044 ),
27 (57,5%)

-1, 38%
.
McGuire Nunn
. 1.5.
DeSanctis Zuchelli (1999)


-1. ,

-1
4 ,
-1
70 % .

Axelson (2002)
10-
283

-1
.

. 1.7.

.



.



,

1.5.
1

(-1)

2,7

2,9

-1 /

7,7

-1 ():

8,8

9,2

6,2

3,6

3,2

,
, -1- ,
.



.

PST (Genetic Test for Susceptibility to
Periodontal Disease, Kimball Genetics,
Denver, Colorado)
-1.
,
. 1.6,
(. 1.8 1.9).

1.6.
-1

PST-

0,16

0.26

PST+

0,30

0,33

PST-

0,43

0.55

PST+

0,95

1,20

0,40

,
, ,

,


,
Kornman (1997, 2002), Hart Kornman
(1997), McGuire Nunn (1999), Meisel
. (2004),

Nieri . (2002).
Nieri . (2002) 10-

60 (
40-58 )
(23 , 38,3%)
-1 (37 , 61,7%)

,

(1566 ), :
1.

-


= 22

>

CD

PST + ( )
PST - ( )
. 1.8. 10
(PST+) (PST-)
. ( Ayelson et al. Diagnosis and Risk Prediction of Periodontal Disease, 2002.
Quintessence, Illinois)

19

Kimball Genetics
PST
(Genetic Test for Susceptibility to
Periodontal Disease)
-1.
:
1.
,
:
;
.
2.
,
.
3.
.
4.
.
5.
.
. ,
Greenstein Hart (2002)

, (the American Academy of Periodontology Research, Science and Therapy Committee, 2005),



-1,
,
,
,
,
,
.


SMO - PST - (
, )
SMO + PST - (
, )
SMO - PST + (
, )
SMO + PST + (
, )
. 1.9. ,
(SMO-PST+), , (SMO+PST-), ,
(SMO+PST+) -1. (
Ayelson et al. Diagnosis and Risk Prediction of Periodontal Disease, 2002. Quintessence,
Illinois)


3,3% (52 1566).
2.

.
3.



:
;


;

;

;
.
Nieri . (2002)
: ,
,
.

(. 1.10)


(Stillman, 1917; Box, 1935).


(Loe et al., 1965), Glickman
Smulow (1962, 1965, 1967)

,


.
,

(
) (. 1.11).

20

. 1.11.
Glickman. ()
,
. ()
,
. () ,

. (D)
. (
Dr. Irving Glickman)

. 1.10.
. ()
,
. ()


. (
Dr. Irving Glickman)

,
(Svanberg, 1974; Linane
Ericsson, 1976; Lindhe Svanberg, 1976)
(Poison, 1974; Kantor et al.,
1976; Poison et al., 1976),

(1989)
,


.
1992 . Burgett .
, -

@@

IV .
,


,
.
,

. Wang . (1994)
,
2,5
,
.
Gilbert . (2005) ,
,
,

, ,
.

(1996) Gehr
,




.

. Wang
. (1994) ,

.
2001 . Nunn Harrel

,

.
,


(Shefter McFall, 1984; Philstrom
et al., 1986; Cao, 1992), Harrel Nunn


(2147) ,

(41), , (18) (30).

:
.
, .


, :

1)
2)

1.
2.

3.


;

:

;



;
.
:
.



.

,
(

), (

, )
(

,

), ,

-
(Kornman et al., 1997; McGuire
and Nunn, 1999),

-
1
.

,
.

,
:
1)
;
2) ;
3)
(. 1.12 1.13).

21

. 1.12.
,
. (
Harrel Nunn, J Perio 2001)

. 1.13.
,

. ( Nunn
Harrell, J Perio 2001)

Harrel (2003) ,

,
,

(Hallmon
Harrel, 2004).

.
,

.

Harrel

Nunn

: <
,
,

-'.





,
,

22
, .



:
,
.



,
.


,
,
.

, ..
. (American Academy of

Periodontology, 1995).

,

,

, ,
,
. ,

,

.

,

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/


.
,

(Becker et al 1984; Neuman et


al 1994; Nieri et al., 2002).

,

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.

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(
- ).
2.

.
3.

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, ,
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:

5.


Barkman Kois (2005) ,


.


:
1. .
2. :
;

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3. :
- ;
.
4. -.
-

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. Barkman Kois (2005) ,


.

6.

7.

8.

;
1 ;

;

;

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.

-1
,


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-1
,

-1


.

,
.


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,

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11. . , Kaldahl (1996)


,

,

.

1. ,
,

', S

. 4 10 \
( \icri. 20112).

>.

, 2610

(102
),

Nieri . (2002)
McGuire Nunn (1999), 99
(3,8%).

(
51,9).
, ,
, /
,

(10-14).

,

/ ,



.
,


, ,
(. 1.7).

23

1.7.



1.
. -1 (PST+)
. -1 (PST-)
2.
.
.
3. (. )
.
.
4. /
.
.

1.
.
.
.
2.
3.
4.
5.
6.
. ()
. /
8.
. ()
.
.


1.
.
. + - 1
. 1-1 +
. 1 + - 2
. .

2.
. 0-3
. 4-6
. 7-10
. , .

3.
. 0-25%
. 25-50% *
. 50%
. ,
. , Khocht . (2003) : ,
,

4.
. 1:2 - 1:1,5
. 1:1,5-1
. 1:1
5. ( )
.
. (2-3 )
. (1 )
. ,

6.
.
. I
. II ( )
. III
. II III ,

24

1.7.

()

7.
. , *
i . :
, , :

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. ( ;
; ; ;
; ;
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;
)
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1.
2.
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/,



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1.
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2.
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3.
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4.
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( ) )

5.
.

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1.7.
()

6.
.


.



7. /
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.


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. 5

.

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.
.

25

26

(,

, ,
, ),

(. 2.1).
-
. ,

,


.

.
1. .



.

, (. 2.2, ).
2. .

.


(. 2.2, ).

3.

(-
) .



- (
,

),
,

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,

(. 2.2, ).
4. ()
. ,

(. 2.2, ).
5. (
-)
.


,


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-


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i
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:
(. 2.2, ).
. 2.1 2.2

. ,
,


. 2.3

.

1. .
2.

(ENAP) :
ENAP
3. Wid
man.



1862-1884
S.Robicsek


Cizezinky
1914
Bentler 1916


Norberg1926

Kirkland 1931


( )
Kronfeid1935

27


Neuman 1912
Widman 1916


Zemsky 1926

Kirkland 1936




Ingle 1952

Goldman 1953
Friedman 1957

Goldman 1950

Nabers 1957


Pushback1953
Pouch 1953
Kazanjian
1936

i

Grupe 1956 j


1954

1961,1962

1963

_____ 1962______

Grupe 1966

1964

1967

1965

1967

1968

1963,1964,1966

1968

1968

1969



1963



1963

i
j
S.V.E.
1976

1985

1991

1968,1985

1983


1976,1986

1979


1982,1985


1979,1983

1985,1986

1979,1982


1985


1980,1981

1986


1985


G-TAM
1991,1992


1989


? 1983


G-TAM1988

1996

- .......
1996

1996

1958

1957


.
1964

Obwegeser
1956

Elden-Mejchar
1963

1957

1964


1960

Stewart
1954

Goldman 1949


Schluger1949


1963,1964

()
___ 1965,1968

-

1958,1965


1969



1971

1972

ENAP
1976

ENAP
1977

1990

1988


1969

1970

Widman 1974

1976

1965

1968

1972

_____ 1986_____


1964

1985,1988,1991

1990

. 2.1.

. -

28

. 2.2. . ( ) . ( )
( , - (). ( )
() () - . (D) .
( ) -

2.1. ()
()

()

(
)

1. :

;
;
.
2. Prichard
.
.
.

2.2.


(-
) ()



,





-

4.


) :


;

.
5. :
;

.
6.
:
;
.
:

1. .
2. .

29

1.

(
) :
;
.
2. .
3.

Widman.

1.

1.
:
;
;
;

Widman.
2.
.
3. .

2.
3.

4.

5.

6.

7.
8.


.
.
(
):
;
;
;

.
:
;
;
.
Edlan-Mejchar,

1 .
:
;
.

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. ped


2.3.



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ie


Widman

0,5-1

2-3 .
2

3



,
,

: Kinoshita S, Wen RC. Color atlas of periodontics. St. Louis: Mosby-Year Book; 1985.



( ):

1. .
2. .
3. .
4. ,
.
5. .
6.
.
:

1. .
2. .


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:

1. .
2. .

,


:

1. .
2.

.
3.

.
4.
.
5. .

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1. :
-
;

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2.
.
3. CollaPlug (Sulzer Medica, Carlsbad,
California).

4. .

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.



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1.


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2.
/
.



(Lindhe, 2003)
1. .
2. - :

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3. .
4. .
5. :
;
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6. :

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7.
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1.

31

,
.

2.



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3.

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,

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4.

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. .).

32

1.


;
;
;
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;

(,

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,

);

(,
, ,
, ,
).

2.
.

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,
.
3.


,

.
4.

.
5.


.
6.

,
,

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7.
,
.
8.

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9.

.
10.

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,
,

,

.

33




.
:
1.

,

,

.
2. .
3.
.
4.


,

.
5.
.
6.

.
7.
.




(50 . 30 .
. ).
4 . . .

(Macht Krizek, 1978).



: ,
, , , ,
,
.



,
Postlethwait (1971), Varma
. (1974) Ethicon (1985),

:
1. (
).
2. .
3. .
4. .
5. .
6.
,
.
7.


.
(Ethicon, Somerville, New Jer
sey),
, ,
.
. 3.1
, :
,


) .

1.

.
2.

,


. ,

,
.
3. (
)


,
.

. ,


.
W(

Eiliicon.

4.


,
-

34


.
(10-14 ).
5. Gore- (Flag
staff, Arizona) Vicryl



:
1. :


4-0 6-0.
-3.

, , .

3-0 5-0.
-3; RT-16 2 .
Gore-Tex, Vicryl.

4-0.
-1; FS2; -3 .

4-0 5-0.
J-1; -3.
.

3-0 4-0.
FS-2; -1.
.
2. 3 .
3.
.
4.
.
5.
.
. 3.2

.
. . - , *,
,
(
, , ,
),
(Silverstein Kurtzman, 2005).

.

2
3

(-3)

.
Gore-.

.




(Thacker et al, 1975).



.
,
,

(Worsfield, 1961; Thacker et
al., 1975). - ,
,
,
. ,
,

,
(Price, 1948; Hermann, 1971).

,
.
(, )

,
,
Dacron ,

(Taylor, 1938).
,
,

,


(Hermann, 1971).

(Postlethwait, 1968;
Taylor, 1978),

, ,
(Hermann, 1971).

.

,

(Hermann, 1971).

(. 34) (Thacker
et al, 1975):
1.
(. 34,4).
2.
(. 34, ), -

35


.
3.
.
. 3-2 .

. Thacker
(1975) ,


,
,
.

( )


.

, . .

, .

,


.

Ethicon (1985)

:
1.
,
,
.
2.

.
3. ,
(23 ).
4.

, . .
.
5.
.
6.
,

,
,
.
7.
, -

36

37

.
.
8.
, .
9.
,
.
10.
<-> , ,

.
, . .
.

, . Ethicon (1985)

:
1.

, .
2.
,
.
23 , ,
.

.
3.
.
, .

.
11

II

U U

. -10 , -




,
,
(Ethicon, 1985).
(. 3.3):
1.
( ).
.
2. ,
.
(, , ,
).
3.
.
( ,
, , -, ,
) (. 3.4).
.

38

. 3.1, .
()
.
()

7-

2-

3- 2- 7

4- 2-2
. 3.2.

,
.


Ethicon (1985)

:
1.
(
,
).

2.




(. 3.5).
3.
,

.
4.

, ,
.

5.


(

,
. .

).
6.
,

.
7.

, . .

39

. 3.3. . , .
- 3/8 1/2.

. 3.4.


.

40



Ethicon (1985)

:
1.
.
2.

.
3.
,

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42

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46

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3




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(1989)
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52

! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....

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1977 . Fredi Rosenfeld
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Widman, 1974 .
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Ramfjord,

Widman (
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55

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60

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1 (Lange, Loe, 1972; Miyasato et al 1977; Hangorsky, Bissada,
1980; de Trey, Bernimoulin, 1980; Dorfman et al., 1980, 1982). Kirch
. (1986), Wennstrom (1987)
Salkin . (1987) ,



.




(Maynard, Wilson, 1979; Ericsson, Lindhe, 1984),
(Maynard, Ochsenbein, 1975;
Coatoam et al., 1981)
(Gottsegen, 1954; Corn, 1964;
Gorman, 1967),

(Baker, Seymour, 1976; de , Berni
moulin, 1980).

Goldman Cohen (1979)



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72

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(Sullivan, Atkins, 1968).

,

, . . j
.
, , <
, ;

, hi
.

88

. 6.15.
. ( ) :

. ( )

. ( C , D )

.
, -
. ( E , F )
-
() ,
. ( G ) ,

. () ,
,
. (/)
-
. (/) ,



.
( )

. ( L ) ,




(. 6.15, ) .

, . .


(. 6.15, 0).

.


,
(. 6.15, R ) . ,



,
-.


:
(Avitene, . R. Bard Inc., Murray
Hill, New Jersey)
() (Colastat, Kendal Co.,
Boston, Massachusetts).
,
.

(Saroff et al., 1980; Stein et al.,


1985).
.



(. 6.15, S ).


.
,
,
,

15 (. 6.15, ).

,
.

;


,
.

,
Corn:
(. 6.15, U , 7);
,
.

,
.
Castroviejo .

,


.

,

.

(Sullivan,
Atkins, 1968).


,
.

-
(. 6.15, W ) ,
,

(. 6.15, "),
(
Carvalho et al., 1982; Holbrook
Ochsenbein, 1983).

. 6.17-6.21.



1.


.



2.

3.

4.

5.

87

,
,

(. 6.22,4).

,

.


.


5 ,

,

.


(. 6 . 2 2 , ) .

/
(. 6.22, ) . ,

,
.

,
,
,

(. 6.22, D ) .

,
.
,

.
,



,
,

.

88

. 6.1S.
. ( ) :

. ( )

. ( C , D )

.
, -
. ( E , F )
-
() ,
. ( G ) ,

. ( ) ,
,
. ( )
-
. ( J ) ,



.
( )

. ( L ) ,

89

. 6.15. (). () , . (N)


, . ( )
. ( ) . ( Q )
. (. R ) , . (5)
. ( )
. ( U ) . ( V ) . ( W ) ,
. ,
. ( X )

go

<0,5

3,5-0,75


( )

0,75-1,25

> 1,25

( )

. 6.16. .

. 6.17,
. ( ) :
. ( )

. ( )
. ( D ) . ( )
.
( F ) . ( G ) .
() 6 .

91

. 6.18. . (/I) . ( )
. ( ) -
. , . ( D )
. ( ) . ( F ) 4 . William Irving, Needham,

. 6.19. . ( ) . ( ) .
. ( D ) . ( ) . ( F ) 2 .

( )

92

. 6.21. ,
. ( ) . .
( ) , . ()
(
Irving Lickman). (D)
5-0. ( ) . { F ) 1

. 6.20. .
. ( )
. ( ) . ( )
.
(D)
6 . . .
(E)
: . ( F ) 12 :

93

()
()

()

. 6.22. . ()
, , ,

(). ,

(). ( ) ()
()
. ( )
. ( D ) -




.

,

.

,

(Dordick
et al, 1976).
,

,
,
,

. Seibert (1980)


,

.
,

,

.
,
-
.
.
15
-
(. 6.23, ) .


, , ,
(. 6.23, , D ).

(. . ,

).
.
.
,
.



,


(. 6.24, ) .



.
.

(Robin
son, 1961; Corn, 1962)

(. 6.24, ) .

15
.

, 1-2 .

.

,

;
-

. , Morman .
(1979) , , . .

,
-,

.


(
)
(
)

94

. 6.23.

. { , )
, ,
- 1 . ( C , D )

- 6.24. -

. ( )



. ( )

,

95

Corn, , 1964

Dhalberg, , 1969
Goldman,
, 1982

. 6.25.
.
( ) Grupe. ( )

. ( ) ,
,
. ( D )
,
. ( )
,


( )

(
,
,
).


.




1956 . Grupe Warren

,

,

(. 6.25, 4).

- ,


.

Grupe (1966)

(. 6.25, ) .
Staffileno (1964)

,
.
Corn (194)
,

,
(. 6.25, - >


. Dahlberg
(1969)

,
(. 6.25, D ).
Goldman Smukler (1978) 1983 .

,
,

,

,

(. 6.25, ) .

1. .
2.
.
3.
.

1.



.
2.
.
3.
.
4.
.

1.


.
2. .
3. .

96
4.



,
.

-.
. .26,
,
-
,
.
(,
. )
(d, , f)
. 6.26, .



,

.
(pH 1,0),

(EDTA) (pH 7,0)


3-5 ,
.

,


.


(Stahl, Tarnow, 1985).
V-


15
( . 6.26, ) .

,
V-


(. 6.26, , D ) . ,
V-

,
, ,

(. 6.26, D ) . ,

,
.


. . 6.26,
(d, , f),

.
2
-,
, 3-4 .



15. V ,
(. 6.26, ) .

.
-
.
,
.


, .
,

.
, ,
,
,
.

- (. 6.26, F ) .

;
,
.
;
,
.
.

. 15




(. 6.26, G ) .
,
.


,

( 6.26, ) .
,


.

-
,


(. 6.26, /).
. 6.26, , L
.
1-2 -
,
. ,


,
.
4-0, 5-0 6-0.
,
,
,

.



.
,

,
.



.

V- .

. 6.27-6.30.

1. . 6.31,4


.


.
2. . 6 . 3 1 ,

.
,
.
,

. 6.26. . () ,
. ( ) . ( ) V- . (D) V-
. , ()
. ( ) . ( F ) - .
(G)
(). () ,
() . (/) . (J)
(-F). () , . (I)
. - -

97

98

. 6.27. . ( ) .
. ( ) : V- , .
- , -' ^' (. . 6.5). ( ) V- , V- .
, . ( D ) .
-. ( ) . . ( F ) 2 .
. William Irving, Needham,

. 6.28. . ( , ) ,
. ( , ) , ( ) ( ) , . ( , )

99

. 6.29.
. ( ) .

. ( ) -
. ( )
. ( D ) 3 . .
( ) 2 . .

. 6.30. . [ )
31 41.
32 42. ( ) .
. ( ) . ( D )
,

2 .
3. . 6 3 1 ,
:


.
, / .
. 6.31,0

.


.
4. . 6.31,

.

,
,

100

. 6.31.
. ( )

- . ( )
.
( ) (),

.
CD)
- .
- ; -
-

,
,

. ,

.
. 6.32,

,
.
. 6.32,
,
-
. V- (, , )



.


.


.
. 6.32,
15
V-
.


(. 6.32, D ).

-

.
. 6.32, , F
,

(. 6.32, ),
(. 6.32, F ) .

()


.

.

, -

(. 6.32, G ).


(. 6.32, ).
. 6.32, 1 ,
,
- V-

,
. . 6.32,/

.
. 6.32, , L
,
.
,

.

. 6.33-6.35.

. 6.32. , . ( ) . ( ) : - V- ; d-e -
, . . () V- .
CD) V- . ( E , F )
( ) ( F ) . ( G )
- . () . ( I )
V- , . { ] ) . ( K , L )
. - ; - ; - -

101

102

. 6.33.
,
.
(A) .
.
(B)
V- . ( )
,
. ()) 8 . .

. ( )

. .
Edward
S. Cohen, DMD, Glickman's Clinical Periodon
tology
W.B. Saunders

, 6.34. ,

. (/1) ,


. ( )
. ( )
, .
V-
-.
(D)

. ( ) 3 .

.
McDonald, Foxboro,

103

. 6.35.
. ( ) .
. ( )
: V-
, . ( ) V- ,
.

. ( D ) ,
. ( ) 3
,


Dahlberg (1969)
,

,

. . 6.36,
.
,
V .

. 6.36. . : [ ) V- . ( )
, V- . . ( )
. : ( 1 ) , . -
(). ( 2 ) . (3) . .
( 4 ) 7 . . . -

104

.

,
V-

-,

.
V-

15, ,
(. 6.36, ) .

(. 6.36, ) .

, Goldman
Smukler (1978)
.
. 6.37, ,
25

,
.

17-21 ,

.
,


.
. 6.37,

17-21 .
-
(. 6.37, ) .

Goldman . (1982)
,
,




.
. 6.38, ,
V-

15.

.


-
(. 6.38, ) .

.
.

15

.


(. 6.38, D ) .
. 6.38,
,

.

V- .
. 6.38, F
,
.

. 6.39.

. 6,37. . : () () 17-21
. ( ) , () . ( )
-. : ( 1) , 21 . (2) , V-
. (3) -. ( 4 ) 6 . ,
. - -

105

. 6,38. . () . ( ) V- . () V-
() , . (D)
. ( ) . ( F )
. ; ; -

. 6.39. , . () . ()
. () V- -. (D) . ()
-. ( F ) 7 . . . -

106

(25 )
.

,

, , ,

,
. . 6.40,
. . 6.40,
(
),
V- .

-
(. 640, ).

. 6.416.42.

Wainberg
(Goldman
et al., 1964),
Cohen Ross (1968)
.

/


.

1. ,

, .
2.

.
3.
.

. 6.40.
. ( , )
. ( , )
, V-
. ( , )
, .


. CD) .
; ;

1.
,

, .
2.

,
,
.
3.

.

1.

:
,
.

. 6.41. . ( ) . ( ) : '; '. .


, . ( ) V-
. ( D ) . ( ) ( ,
) ( , ) . (F) 4 :
,

. () 14. ( ) . ( )
V- -. ( D ) . ( )
. . ( ) .

. 6.42.

107

108

-
,

(. 6.43, ) . , ,
1
-
(. 6.43, ); 1

.

. 6.43, .




,
,
. V-

.


,

, .

,
.
15
V- ,

,
(. 6.43, ). V-
,

(. 6.43, D ) . ,
.


(. 6.43, ),

,

.
,
,

.
-


. ,
,



-
(. 6.43, F ),

(,
- ) (. 6.43,6).

-
,
(. 6.43, ) .

,
-
,
.

Corn,

(. 6.45,1)
(. 6.43,./).



4-0, 5-0 6-0 -3.

,
.

,


.


(. 6.43, ).

(. 6.43, ), -

,
.

5 ,



.

. 6.44.

,

- .


.
,
,

; ,


.


(1)
(2)
.



(. 6.45,4,4).
,
-
(. 6.45).
(,
V-)
,
(. 6.45, , ).
,

,
,
(. 6.45, ,
). ,

1 .
,
.

,


, .


. 6.46.

1.


,

.

. 6.43. . () . () ; -
. () V- . (D) V- . () ()
. ( F ) - . (G)
, . () () . ( ! )
Corn. { ] ) . () . (L)
. ; ; ; ; -

109

110

. 6.44. . ( ) . . ()
. () V- . ( D ) ,
. () . ( F ) 6 .

. 6.45. . (, ) ; . (, )
, V- .
. - ; -

(, )

2.

3.

4.

5.

6.

. 6.46.
. () .
04) . ()
. () . ()
- . ( )
- . (D)
. ( D ' ) 6 100%-

111

.

(. 6.47, ).

(
)

,



.


(. 6.47, ).

,



.


,

(. 6.47, ).


,
. ,


,
. ,

(. 6.47, D).


,

.

,
,
. 6.47, .

. 6.47, ,


,
.

Hattier (1967)
-

112

. 6.47. : . ( ) . ()
() () . () . (D)
. ( E , F ) - . ;

. 6.48. Hattler. ( ) .
24 25. ( ) . () . ( D )
. ( ) 2 . . ( F ) 6 . .
- .

113

,

, .




. ,

.




.


. 6.50


. 6.49. Hattler
. ( ) . () . ()
. ( D ) .
.

,


.


.

,
,
.

(.
21
).
,
,
.

. 6.48
6.49.

()

()

,


.


,
.
,
(Corn, 1964):
1. .
2. .
3.
.

,
, -


.
,

, .
.


.
,

15.

,
.
.

,
.

.


.



,
.

.


. 6.50-6.54.

114

, 6.50. (). () . () . ,
. () . .
. ( ) -. ( F ) 6 . ,

(D)

. 6.51. (). () . () . ()
. . (D) -
, . ( ) . ( F ) 5 . .

. 6.52. (). () . () 4-0. () .


6-0. ( F )

(D)

()

. 6.53. () . ( , ) { )
G4). ( , ) - . ( , )

115

1 1 6

. 6.54. () . (,) , .

(. ) .

(, )

, ,

117

,
,
.

,

. ,

,

.

(-)



.
, Ochsenbein
Bohannan (1963,1964)

.
. 7.1
:

(-)
(. 7.1, ),

(. 7.1, )
(. 7.1, ).

: ,
,


(. 7.1, D).
Ochsenbein Bohannan,

,
,

.

1. .
2.
.
3.
.
4.
.
5.
-
.


1. .
2. .
3.
.
4. ,

,
.

1. ,
.
2.
.
3.
.



, . .

.




(Easley, 1967).

,


.

(. 7.2).

118

. 7.2. .

. 7.1.
. ( )
(-)

. ( )
.
(C)

.
(D) ,



(. 7.3). , -




.


: ,
.

,


.

. 7.4


.
,



.



Staffileno (1969)
,
,
j
,


.

1.

.
2. .
3.
.
4. ]
.

119

. 7.3. . ( )
,
. () . () . (D)

. 7.4. /. , , , . .
, . ( ) . ()
. () . (D) . () ,

120
,




,

.




. ,
. .
.
,
,
,
.
,

.



.


(. 7.5, ).

,

-



(. 7.5, ).
, .

15 () 12 (
).

,

.
,


(. 7.5,5)
, .
,



,


.

.



,
(. 7.5, , ).

.



.

,
,
.


, 15 12
(. 7.5, D, >).

,
.

Ochsenbein 1 2

,

(. 7.5, , ). 1

- ,


. 2

,
,
.
,


.


Friedman.

,
,


.


, ,
,
(. 7.5, , F).
.
,

,
2,

(Edel, 1974)

(Langer, Calagna, 1980; Langer, Langer,


1985).

. 7.6 7.7.

121

<

, 7.5. . () . [ ' )
. ( ) . ( ) ,
. ( , )
V , . . ,

122

S.
( ). {D)

,

: , ) Ochsenbein
,
(). (F, F)

. 7.6.
. () ,
,

. () () .
() (2) . (D)
.
( ) .
() . (G)
. () 7 . .


.

123

124

. 7.7. . () . .

() (2). () .
. (.D) . () . ( F) 8 . ;



Ochsenbein 1958 ., Och
senbein Bohannan 1963 .
, 1965 .,
Prichard,
.
-
(ledge-and-wedge).

.
,


.

,
Widman, ENAP,
,
,
.


.




,
.
,
,


I. .

,
(. 7.8, , ).

(. 7.8, , ).

(. 7.8, , ).

,
, .

,
.


.



.
, . .

.
II. .




.


(. 7.8, D, D).
,
.

125

. 7.8. -.

[)

. () .
. (, )
. ( , )
. ,

.


(. 7.8, D, D). Ochsenbein 1 2
Friedman



(. 7.8, ,
) .
,

,


(. 7.8, '').

. 7.9 7.10.

126

. 7.8. (). D , D )
. , ,
.
- ,
. (,) Ochsenbein
(). (F, F)
;

127

. 7.9. ( -). ()
. ( ) . () .
CD) . () (2) .
. (G)

(F)

. 7.10.
. () .
( )
. ()
. CD)
. ( )
. ( F ) 5 .

128

1. .

,



(. 7.11, ).

.
2.
, -
.

(. 7.11, ).



.


.
3.


(. 7.11, ).


.
4.



(. 7.11,11).
5.


.



(. 7.11, );

.
,
.

. 7,11.
.
() . ( )

. ()
,




.

,

. ( D)

. ( )

,
().


,

,
. ,


,



.
Robinson 1963 .,
Kramer Schwartz (194),
Rob
inson
(1966)
,
.


,

1.


.
2.

.
3.
, .
4.

.


(,
).

129


1. .
2. ,
-.
3. .
, ,

.




.

.


, 12 15
(. 7.12, ). ,

. 7.12. . () .
(, ), . () ,
. () . (D) . ( , )

130


(. 7.12, ).

,

. . 7.12, ,
D ,

.

.



(. 7.12, ).
,
,


(. 7.12, E,F).
,
,

.

,
-



.

.

.

15 ;

]
.


(. 7.13, , )

,
,

(. . 7.13, ).


.

()
.
kocti
Kirkland Or
ban (. 7.13, , D).
,
, i

(. 7.13, )
(. 7.13,--

. 7.13. - , - . () . ,
(, ). ( )
. ( C , D ) ,
. ( ) . ( )

131

. 7.14. . () . () : 1 -
; 2 ; 3 - .

() .

(D)

()

(F)

, 3 .


.

. 7.14-7.16.

. 7.15. . () . () :
1 ; 2 - ; 3 -
. () . (D) , .

()

(F)

132

. 7.16.
. (4)
. ( )
12 . () ,
.
(D) . ( )
(2). () 2
. ( G ) . ( )
, 3 .



,

,
, Langer Langer (1990)
.

1.

.
2.


1.


5-6
,
15 (. 7.17, ).
2.
,
15
.
(. 7.17, ).
.

.

3.


.
4.


.

.
5.
Oschenbein

(. 7.17, ).
6.

()
(. 7.17, D).
7. (. 7.17, ).
8.

/
.


(. 7.17, F).

. 7.18.

. 7.17. . () .

() (. . 7.5 ). () ,
. (D) . () . [F)
. ,

134

. 7.18. . ( ) . ( )
; . () . (D) ;
. (. ) .

()

3 .

135



,
.



(),

.
1967 . Frisch .
,


.
,
,
Kirkland (
, 1931, 1936),

,


.



,

.
,


. Lie (1992)

,

.

1. .
2.
.
3.
.
4.
.

1.
.
2.


.


Frisch .
,
.

(,
, );

4 ,

.




.

.

,

.

1. . 8.1,

.

.

. 8.1. . ( , ) . ( C,D) , , .

( E , F ) , . . . 8.2

2. . 8.1,
.



.

,
.
3.
11 15.



(. 8.1, ).

,
.


.
4.


(. 8.1, D).

,

,

.
5. . 8.1, E,F

.
. 8.2
, ,


.




.
(. 8.3
8.4)
,

.

,

.

. 8.2. . [)
, . () (. . 6 - ).
()
. . . (D)
. () ,
( ). (F)

138

. 8.3. . (, ) ; . ( )
. ( D , E ) . ( F )
. ( G ) . () . (/,/)
, . (. K , L ) 4 . .

13S

. 8.4. . ( , )
; . ()
.
( D ) . ( E , F )
. ( G , H )
; 5 .

Takei . (1985, 1988, 1991)



. ,
,
Genon Bender (1984),



.

1.

1.


.
2.
.
3.

1. .
2. .

1. .

1. ,
/ -

,
.
2.
/
,
.
,
,
3
5
(. 8.5, ).
3.
,

Kirkland
(. 8.5, ) .
4.



.
II.
(. 8.5, ).

140

5.



.

.

(. 8.5, D).
6.

(. 8.5, ).
7. ,
,



(. 8.5, F).

. 8.6, 8.7.

. 8.5. . ( ) . ( ) . ( ) . ( D )
, . ( ) ,
. ( F ) .

. 8.6. . ( , ) ,
. ( ) .
, .
( D ) . ( ) - ,
. ( F ) . ( G , H )
. . . A . ( I J ) 8 .; .
, .

. .7. . ( , ) ; . (C , D ) ,
. . ( ) .
( F ) . ( G , H ) , . (/) 2 .; .
. ( J ) . ( ) 3 .; . ( L ) 1 .

:; 8^^^1^1|^^^^58^5&'-'-- - - i






.
,
1935 . Kronfeld

.


,

:
1. Goldman (1950) The Development
of Physiologic Gingival Contours by
Gingivoplasty /
.
2. Schluger (1949) Osseous Resec
tion A Basic Principle in Periodon
tal Surgery /
.
3. Friedman (1955) Periodontal Osse
ous Surgery: Osteoplasty and Osteot
omy /
:
.
4. Prichard (1957) The Infrabony Tech
nique as a Predictable Procedure /


.

5. Goldman and Cohen (1958) The In

frabony Pocket: Classification and


Treatment /
: .
6. Ochsenbein (1958) Osseous Resec
tion in Periodontal Surgery /
.
7. Ochsenbein (1986) Primer for Os
seous Surgery /
.

,

, ,
.




,

,
,
.

. ,
,
,
, ,

.

,
.




.



() ,
,

(. 9-1).

,


(. 9-2).



,
.
, ,
Ochsenbein (1977),

.

. 9.1. . (, )

. (] )
, . .

Ochsenbein ,

.


:
1. :
(. . 10
. 11

),
2. :
:
:


;
* :


,


.




()
.
1. , :

,

.
2. :
.
3. , :
.
.

.

. 9.2.
.
,
, -



, ,


(Mombellil
et al., 1995; Rawlinson et al., 1995; Levy
et al., 1999, 2004a, 2004b; Tuan et al.,

146

2000). Chevy . (2002)


,
,
,

...

...
.

(1996)


:
1. :
;
;

.
2. .
3. .
4. .
5.

,
; .


:
1)

(Townsend-Olsen 1985; Saxen et al.,
1990);
2)
(1dahl et al., 1996, 1996b);
3)


(Gunsolley et al., 1994; Mobelli et al.,
1995).




(Ea
sley, 1967; Mealey et al., 1997).

:
1) ;

2) (,
);
3)
( I, II, III);
4) .

,
,
(
,

),


(


).

,

.



.





.
.

,


,

(. . 6
- ).

-

,
,

,

.



.
,

.

, ,
,
.


(Friedman, 1955), ,

.


,



,
(. 9-3):
1.
.
2. .
3.
,
.
4.

.
5. ,
/
.
6.
.
7.
.
8.


.
9.
.

,
(Ochsenbein, 1958), (
) (Carranza, 1984).
,
,

.

,



.

.


.

.



,

147

. 9.3. . ( ) . () . ()
. (D)
. ()







.

,
.



, (
) .





.

. 9-4,

.

,

,

.

.
,


6, 8 10

(. 94, ).



.
,
,


.
,
.

,


.


,
.
, ..


,
. ,



,
4-5 .

148
, . .


.
,


(. . 9.2)

. ,


,
.
.
. 9-4, D 2 4


(. . ) .

.


( Ochsenbein
1 2) (. 94, ).

,

(. 9-4, F).
. 95-9.7

. 9.4. , . ()
. () . ()
. (D) . ()
. ( F ) .

. 9.5, ,
. ( ) ;
. ( )
.
(
. (D)
. ()
.
( F) . (G)
. ( )
.

149

. 9,6. . ( , ,
) ,
. .

( C . D ) .
.

.
-
. ( , ' )

.
. ( F ,
G )
{ F )
( G ) . ( I ) ( ' ) . (/ )
.
( )

151

. 9.7. , . (. -D) .

(A-D')

152

1.

.
2.
.
3. .
4.
.
5.
.

6.



.
7. .

1.
.
2.
.
3.

.

1. .
2. .

3.
.

1.


,


.
2. (

,
..).
3.
( ,
. .).
4. .

. 9.8. : , , . ( ) . ( )
. . ( )
, . ( D )
Ochsenbein. . (. )
. ( F ) ;



,
.


.
,
,
,
,
.
:
1.

.
2. .
3. .

,

,

.


, -.
,


,
.
,


.



.



,
.

,

/ ()
.


.


,
.

. 9.8,

,


.

.
. 9.8,

.

(2, 4 6)

,

.

() ,

.
,
,
,

,
,
, .

153

,



.
. 9.8,
,


.
2, 4
. ,

.



(. 9.8, D).

,

.



,
(Schluger, 1949) (. 9.8, ).

.

.

( Ochsenbein)
.

. 9-8, F.

,

.

. 9-9 9-.

154

. 9.9.
(
)

. 1.
( )


. ( )
.




. ( C , D )


;
,


-
,
-


( ).
( )
( )
. ( F )


.



. { G )

; .
( )

.
;


. 9.10.
(
)
. 2. (,)

.

. (C,D)
,
.
-
.
() ()

. ( F )
( )

. ()
.


155







(. 9.11, ), . .

/
.

, ,


(. 9.11, ).




(. 9.11, , ).




:
1. .
2.
.
3.

.
4. .
5. .
,
,
.

(, )
,


.


. 9.11. . (,) .
(,) . (, ) ,

157

.



.
(. . 8


),

,
,
,
.



.

,

.


Tibbetts . (1976),
Ochsenbein (1986)


.
,

. Ochsenbein ,


...
,
. Tibbetts
., Ochsenbein



.


,

,
,

.

. 9-12-9-14.

. 9.12. . 1. ( )
. ( )
. . ( ) .
. ( D ) (
) , . ( )
; ()
. ( F )
. ( G ) . . ()
. ,
- .
- ; - ; . .

158

. 9.12. (). (J) . .


- . () . (L) (
). () , (). (N)
.

. 9.13. . 2. ()
. ( ) , . ()
. (D) . ( ) .
. ( F ) . . - ; . - .

159

. 9.13. (). ( G)

. ()
,
. (/)

,
. (J) ,
. ()

, .
F. - ; . -

. 9.14. . ( ) .
. ( ) - ; . ()
, . (D) .
() , , . OF) 6 . . Edward D. Cohen, DMD Glickmans Clinical
Periodontology W. . Saunders

160


(. 9-15).


(. . 9-15).

.
, . 11.13,
,

.


(),
,

(),
,
,
,
.



.

(
) (. 9.16). Gargulio .
(1961) ,
2,04 (
0,97 ,
1,07 ),
0,69 .
(

II, . 2

.)


.
:

. 9.15.
.
04) ,

.
,



. ( )

1: - 2:

- .
2: - ,
, 2:
.




.
3:

.
0,69
4:

,
0,97


2,04
.

5:


1,07





.
6:



,
. 9.16. .


.

161


,

.


,
,
() .

Goldman (1949, 1958)


(. 10.1),

(Ellegaard, Loe, 1971).



,


.
,

.
Reynolds . (2003),


, 1966
2002 .,

(), (2005)
,
:
1.
.
2.
.
3.
.
4.

.
5.

()


,

.
6.
:

;

. 10.1.
.

162

();
(Bio-Oss,
Osteohealth,
Uniondale,
New
York);


(Emdogain Straumann, Basel,
Switzerland).
:

,
<-



(1989)
(2001).

,

,

.


,

!'
,

.

,
.



,
.



,
(
)

.


.




. 10.2
,
(Ratcliff, 1966; Glickman, 1972; Wirthlin, 1981):
1. (. 10.2, Al).
2.
(. 10.2, 2)
,
(. 10.2, 2).
3. (. 10.2, ).

:
1. ,
,

(. 10.2,5).
2.

(. 10.2, ).
3.
,
(. 10.2, , ).
4.

(. 10.2, D).


. . 10.4


.

,

.

( , ,
EDTA)

.
Takei . (1985)
,


,

(. . 8

,
. 8.5-S.7). Cortellini
1995 .,
, 2001 .
,
.
4.


2-3
(. 10.3, 5.

.

:
,
.

1.



1.

.
2.

(. 10.3, ).
3.
-

(. 10.3, -).


,

(. 10.2, 10.3, G).
,

,
,

.


.

,

163

. 10.2.
: ( ) 1 - ; 2 - ; 2 -
, ;
3 . () ,
(1) .
(C)
(2)
(2).
(D)

(Stahl, 1977) (Aleo et al, 1975).


,

(Pritchard, 1983) ,

.

2.


,
(. 10.2,
[2, ] 10.3, /).
,
.



.



(. 10.3,/).

3.



.

,


,
.
.

( 2)

,

,

(. . 10.2, D).
. -

(. 10.3,1).
6.
(,
, , )

,
( ) (


) (. 10.3, ).
7.

,
,
(. 10.3, N, 0).
8.

,
(. 10.5).

,
.

164
9.

,

.
100%,
/
15
(. 10.6).

,
.



,
Gore- (Vicryl)
(. 10.3, ).

,


14 .

,

.
11.

(100 2
) (250
3 ) 10-14.
7 .
14 .

3 .

.
,

, . 10.3.
,

,
. 10.7.
10.




:
1.
.
2. (,
Osteohealth, NY; Emdogain Bio-Oss).
3.
.
4. (
).
. 10.1

. 10.3.
. () , 7 . (-D)

. () , .
(F)
. (G ) ,
. ()



.
Bowers . (1982)

,

? .&? ^

165

. 103. ( ). ( I) . (/)
. ,
, . ()
. (. L )
. ()
. ( N)
. () . ( )
100%- . () 1 .
. (R)
. James Mellonig, San Antonio, TX

10.1.
,
, ,
, .
,
,
,
.
, Bio-Oss, Endogain,

.

,
SD

,
95%

,-

1172

1,8 1,4

1 6 1,9

407

2,8 1,6

921

480

3,5 1,6

3 2 3,7

1283

3,8 1,7

3,7-4,0

1^-5 ; ;

,-

Tonetti Cortellini (2001) Tonetti (2004).


95% 95%- : ;
; - .
2001 .

166

. 10.4. . ( )
. . ( )

. 10.5. .
,

(A-)

. 10.6.
. {,')
.


.
(, )
,
100 %

167

. 10.7. , . (A-)
. (-)
.

Mellonig (1992),


:
1. .
2.
(, ).
3.
.
4.
.
5.

.
6. ,
.
7.
.
8. .
9.
.
10.

.



,
(Ramfjord,
1971).
,

,
,

.

.
Pritchard (1983),

,
,

.
,

.
:


.
,



.

Becker . (1986).
Ellegaard . (1974),
Karring Ellegaard (1976),


,

,
(. . 11
).
,



.


,
.

168

,
,





.

(Goldman, Cohen, 1979):
1. (Urist, McLean,
1952)
:
;
;
.
2. (Urist et al., 1958).

,
, ,
.
3. (Ellegaard
et al., 1976) ,


.


Mellonig (1992)
:
1. .
2.
.
3.

.
4.
.
5.
.

6.

.
7. .
8.
.





,
.

,
(Bell, 1964; Schallhorn, 1976):
1. .
2. .
3.
.
4. .
5. :
;

;


- .
6. .



.

.


.

1.
:
;
.
2. :
;
;
;
;

.


1. .
2.

(AJIK) /
.
3. .
,
/

,
(Bowers
et al., 1985).


,

.

1. .
2. .

1. .



. Froum . (1982)

,

.

1. /3-.
2.

, (
[HTR]).


,

,
(. . 11
).


Schallhorn (1967, 1968)


,


.


Turkell
,
(Min
imum Essential Media)
.

.

,
.
(
)

.



(. 10.8).


-

(Dragoo, 1973; Hiatt, Schallhorn, 1973),

,
,

(El
legaard et al., 1976).


3 3,5 ,

(Nabors, OLeary, 1965;


Hiatt, Schallhorn, 1973; Froum, 1976)

. 10.8.
. () .
() -
. () ,
. (D)

. () 7 . .
(.F )
. (G) 7 .
,
, .
Edward S. Cohen, DMD
Glickman's Periodontology
W. . Saunders .

169

170

-, - ( )
. ,

(Ross, Cohen, 1968; Naber, 1972),
(Listgarten, Rosenbert, 1979).
.
:
1. (Salvin Dental, North Carolina)
(. 10.9).
2. Maxillon (Maxillon Co., Hollis,
N'H) (. 10.10).
. Robinson (1969)


,

,
.


. ,
,
Nabers OLeary (1965).

.

,

(. 10.11).

, ,
,
.

. 10.9. (Salvin Dental,


North Carolina) .
() . {)
. ()
. (D)
. () .
,

, Robinson ,

-

,
-
.
Freeman (1973)

. 10.10.
Maxillon (Maxillon Co., NH). G4)
. () Maxillon
. () .
. (D)
. ()
. ,
,


.
.
Diem . (1972)

Robinson
,

.
,
,
, ,
. ( ),
,
60
,

. Froum
. (1975, , 1976) ,


,
,

.
,

,
.
. Hiatt Schallhorn
(1973)



.
, ,

.


(. 10.12).
166

,
(. 10.13)
,

,
.

:

. 10.11.
:


. ()
. () 23, 5
6 . { ) 24,
7 . ( D ) -

. ()
. (. F )
,



,
,

.

. Haliiday (1969)

172

. 10.12. . () . () . () - . (D) . () .
(F) . (G) . ()
. ( I ) . (/) ,
. ( ) , . (I) ,

. 10.13.

. () ,
. ()
. ( ) .
CD)
. ( )

.
6-7 .
,

.



.


,

6-8 . (. 10.14).

.
Ewen
(1965)


,


.

,


(Nabers, OLeary, 1967).

,

.


,
.


. ,
,
,

.
,
(
) (Louise, 1992).

()
(. 10.15).

,
(Interpore) (Oreamuno et
al., 1980; Kennedy et al, 1985, 1988; Bar
nett et al., 1989; Bowen et al, 1989)


. Egelbert (1992),
,
,
2 ,
3 .

173

Kennedy . (1988),
(In
terpore 200)
II
,

( 1,82 ;
< 0,0001)
. Corsair (1990)
51%

(OsteoGen Impladent Ltd. Holliswood, New York)

. 5-

(Periograf) Yukna (1980) ,

86%
62 %
38%
, ,

. Yukna (1990).

(HTR), , 71%

( 50%
),
,
, 24%. Shahmiri
(1992) -

174

. 10.14.
. ()
- . ()
. ()
. (D)

8-10 . . ()

. (F ) ()
.

(). (G,H)
,
. .
Edward S. Cohen, DMD Glickman's
Periodontology,
W. . Saunders .

175

. 10.15.
. 04) , 10-
. ( ) , 13 . ()

. (D)

. () 3 . :
3 . ( F ) 10 .
,


(
HTR).
Saffar . (1990)

, ,
.
,
(. . 10.15). Pepelassi
. (1991)
,
,
50%
II

,

.

III

.

,



,
, HTR-,
,

.



(). Urist (1965, 1.968,
1971, 1980)
.

,
- .


(
),
.

250 500 .
:
1) ;
2) ;

3)

-.
250
,
.


(. 10.2):
1. .
2. .
3. .
4. .
5. .
6. .
7. .
Mellonig (1984)

.
64,7 %
37,8% ( < 0,01).
,
,
78%, 90%. Bowers .
(1985) ,

176

10.2.

Bio-Ossa

+++

++

+++

++

++

++

+++

++

+++

++

++

+++

+++

+++

+++

+++

++

+++

++

+++

+++

++

+++

++

+++

++++

+++

Bio-Oss
b . . 10.3.

,

, . Bowers
. (1989, )


32 25

(. 10.16).

( < 0,005),
( < 0,005),
( < 0,05)
( < 0,001)

, ,
.



.
Laurell . (1998) 21
(512 )
:
1.



(2,2 1,1 ).
2.
1,2
2,3


,
.
3.


2 ,
:

, %
00 +
+

49
66

, %
38,7
61,2

4.
4 5

,
(> 6 ),

.
. Schwartz . (1996), Becker (1995)
Garraway . (1998) ,

, ,

. .


. 10.17-10.22.

50% 39
50% 1 .

,
.
Yukna Vastardis (2005)
in vitro
( ),

, .
,

,

, .
Plattelli Scarano (1996)
Paul . (2001),

. Rummeltart (1989)
,

.
. ,

.

,


,

(. 10.23).

().

,

.
.


(Saun
ders et al., 1983). Sepe . (1978)
Mellonig (1980, 1981) ,
60% 50%

. Saun
ders . (1983) ,

80%
50%

.
Yukna Sepe (1982)

4:1 62

22 ,

(
,
1996). Gross (1997)

,
:
1. .
2. ()
.
3.

.
4.
, ,
.
5. .
6. .
7.
.

17

8.

(

).
9.
.
10.
(

;
).
. .
12.
.
13.

.
14.

(,
,
).
15.

.
16.

.

. 10.16. () , ,
()
(). .
()
( -, 4). ( ) () .
. ,
() () (). , (
-, 40). () , ,
(). , ()
().
() ( -, 40).
Gerald . Bowers, Baltimore, MD. -

- .
,
,
,


.
,
( )
( Louise, 1992).



(. . 10.15).

(1996),
(2003)


.
,
(
).
Reynolds . (2003)
,

,
-

178

. 10.17. . () :
. ( ) . ( ) . ( D )
. . ( ) . ( F )

. 10.18.
. ( , ' ) . ( , ' ) .
. ( , " ) .

179

()
. ,
. () .
(D) . ( )

. 10.19. . () .

II
III . Martin . (1988),
Gantes . (1988, 1991),
Garrett . (1990)

.


(2003)

(2009)
.
.



. Stahl

Froum (1991)





.

II .
(Martin et al., 1988; Garrett et
al., 1990) ,

,
.


6770% , 100%
43 56% .

(
).
III
15 % .
,


. Egelberg (1992)



(Renvert et al., 1981, 1985, 1985;
Chamberlin, 1985),

-

180

. 10.20. . (, )
. (C , D )

II . ( E , F )
. ( G , H )
, . ( I J ) (
), . . ( )
( ), . c D \ a E

6} {&

. 10.21, .
G4) . ( ) -,
. ( )

. (D) .
,

. ( ) 4
. { F )

11 21. 11 21
. ( G ) 9,5 .
. ()
: , 5
.

(Renvert et al., 1985b)



(1,1-2,0 )
(0,61,3 ).

1. II III
.
2.
II
.

1. .
2. .
3. .

18

1.




,
(. 10.24, ).
2.

,
.
15 .
,
(. 10.24, ).
3.

(. 10.24, ).
4.
- .



.
-

182

. 10.22. . (,
) , . () -
. (D) . (E,F) .

. (G ) 10 . .
. () :

. 10,23.
. ( )
. ( )
.
. ( )
.

. ( D )

; .
()


. ( F )
;
(G )
.

18!

184




(. 10.24, ) .
5.
.
6. -

(. 10.24, D ) .
".

(pH 1,0)
,
3 ,

(. 10.24, ) .
8.


.
9.

. 4-0

;


;

,
,

,


;
,

(. 10.24, F ) .
10.
(3% ).
.
. 250
2 .
,

, .
2 .

. 10.25.

(1996)
,
,

. 10.24. . () ,
. ( ) . ()
. ( D )
.() (pH 1,0 3 ).
( F )

. ,
(Murphy, Gunsolly, 2003; Reynolds et al..
2003;
, 2005) , ,

,
.

(Bio-Oss)
(
) ,
(, 2001).
Bio-Oss
.
-

185

Massachusetts),
Bio-Oss
,

.

1.
2.
3.
4.
5.

.
.
.
.

.
6.
.
7. ,
:

. 10.25. . () . ( )

II . ( ) . (D)
. (D) .
. Bernard Gantes



300 .

,
,
.
, OsteoGraft

(1100 );


(Gross, 1997). Bio-Oss
Bio-Oss,
10% .
Nu-Oss ( Surgical Supply, Brockton,


;

;

.




(Co
hen et al., 1990; Brion, 1991; Clergeau et al., 1996). Richardson .
(1999)
, ,

,


. Schwartz . (1998)
,


, ,
.
,
,





[
/?] -2. Benke
. (2001)


,
/3.
,
Wenz . (2001)
, -

186

4-
Bio-Oss
. ,



( , ,
).

. Mellonig (2000), Camelo . (1998)



(Bio-Gide, Osteohealth)


.
Nevins . (2003)

Bio-Oss
(Osteohealth) (Bio-Guide, Os
teohealth, Uniondale, New York)


.

.



1996 .
3,0; 1,9; 3 1,7
.
,
(. 10.26-10.29).


Reynolds
. (2003) ,

,

, .

(2005),
,


,

, (
)

. 10.26. -

. 10.28.


().
Bio-Oss,
,
() (
, )

. 10.29.

( )
.
Bio-Oss (
) (
, )

. 10.27.

: Bio-Oss .

.

; - .
() 3d () (
, 10,5)


. . 10.30-10.34

. . 10.3

.
,

,
, Bio-Oss BioOss ,

( ,


).
,
,
Bio-Oss. Bio-Oss

,

(
)
(Gross,
1977).

Bio-Oss
. 10.30-10.34.

() . () . ()BioOss . (D) BioGuide . () . (F) .


. 10.30. , Bio-Oss/BioGuide.

186

188

. 10.31.

, Bio-Oss /BioGuide.
( ) . ( ) .
( ) Bio-Oss . ( D ) BioGuide
. ( )
Gore-Tex. (F )
11 .
. ( G , H ) -

,

. 10.32.



. ( )
;
II . ( , )
(-5). ( )
(RCM6[Ace Surgical Supply,
Brockton, Massachusetts]) .
( ) (Resolute,
Adapt, WL Gore Inc, Flaggstaff, Arizona)
. ( D , D )

189

190

. 10.33.

II

. 04) .
( ) II
. ( ) (Bio-Oss). (D) (Bio-Mend,
Zimmer Dental, Carlsbad, California)
. ( )
. ( F )
100%-

191

. 10.34.
,
. (,)
, ,

. ()

. (D.E)

. (F) Bio-Oss .
(G,H) Resolute Adapt,
. (IJ) 2 .

192

(). ( , ) ; .
(. L,L) 2 . ; . ,) 3 . ;
. ( N , N ) 4-5 . .
, . ,

. 10.34.

192

194

(,
).

(Stahl, 1977, 1986).
,


,

(Melcher, 1976; Aukhil et al.,
1988).



,

(McHugh, 1988).


.

,

. Caton (1980)

:

;
Widman


,

.
.

,

(Bowers et al, 1982, 1985, 1989b).
Ellegaard . (1974)
,

,

.


. (Ellegaard,
1983) ,

10-12 ,


.
Melcher (1976) ,



: 1
lamina propria
; 2 ;
3 ; 4 .
,

,


(. 11.1).



. Melcher (1962, 1976)
Aukhil . (1988) ,

:
,
(),

;
(,
) (. . 11.1).
Aukhil . (1988) ,

,
,

.



,
,


. Karring . (1980)
, ,
, . Nyman

195

. 11.1. . ( ) ,
. ( ) . ( ) . (D )
(). ( )

. (1980)

.
,
,
.

. Nyman .
(1982)
,
,

,
,

. Gottlow . (1984)
, Gore (W.L. Gore, Inc. Flagstaff, )

,
( )

. Karring .
(1986)


,




. ,
,


.

196





. Nyman . (1982)

,
(. 11.2).

5
3 .
. Gottlow . (1986)
12 (5
) 10 ,

-

.
,

,
,


,
()


, ,

, ,
,
. Caffesse . (1991)

,
,

, ,


().
(Boyle et al.,
1983; Gottlow et al., 1984; Lindhe et al.,
1984; Houston et al.. 1985)
,

.
,

19 1 . (Dines, Cohen; . 11.3).

,
-

. 11.2.
. ( )
:
,
, ,
. ()
. ()

. (D)
,




. ()
. ( F)





,
(Boyle et al,
1983; Gottlow et al., 1984; Lindhe et al.,

. 11.3.


(Millipore
Co., New Bedford, Massachusetts) (1971).
[ ) . ( )
.
.

1984; Houston et al., 1985).




,


. Gottlow . (1986)
,

(
)
-

:
,

,
,

.

Becker
. (1988) Handelsman .
(1991), ,


. Cortellini . (1993,
1993b) Tonetti . (1993)
,
4,3 2,5
40
.
100/6-
32,5% ,
50% 57,5 %
, 50% 10%
. ,




.
Lindle . (2003) Laurell
. (1998)
(78 ; 1795 )
,

:
1.

.
2.


, .
3. (,
)
.
4. (
< 27)

197


,
* 37).
5.
> 4 .
6.

.
7.
.
8.
4
5 .
9. ,
,
.
10.

2,3-3,5
.
11.

,
.
Cortellini Tonetti (2005)


,
.

, , ,

,



(. 11.4),



1 92,7 12%.

Becker . (1988)
II III
27

2,3 1,5
II III
,
3,7 (< 0,01). ,


, ,
, ,

.
.

198

I.

> 2

< 2

> 4 MMd

> 37

3-

< 4

II.

< 4 _

__>4

> 4

< 37


: , .
(Cortellini et al., 1995).
(Cortellini et al., 1999).
d .
.
, Bio-Oss, Emdogain.

. 11.4.

Pontoriero
(1987, 1988, 1989, 1992)
II III ,
(

Gore-Tex).

,
90% II 25-35%
III ,
,
20%
II 0% III
.
III
50-60%
. ,

,
III 3

.
,
3 .
Metzer . (1991)
,



II
.
Lekovic . (1989)


,


4,09 .
Selvig (1990) ,


,

,

.
Gottlow Karring (1992)

,
.
,
, -

,
.
Lindhe (2003) 21
(423
II )
:
1.
.
2.




: 2,5 1,3 .
3. 0
67%.
4.


.
5.

1,6 ,

.
6.

.
Bowers . (2003)

II
84
68 % ,
II I .




(,
, )
,
. Schallhorn McClaine (1988)

(
Gore-)

. , ,

, 72%
(33 46)
,

,

31 %
(5 16),
.


5,3 4,5

,


4,2 ( )
3,1 ( ). ,


.
Kerstein . (1992)
,


(1996, 2003) (2005)
, ,

,

,
.
McClaine Shallhorn (1993)
,

53-70 . ,



(J) = 0,005)

( = 0,003).
II ,

,
(40 %)

.

. ,
31 %
,
.
Gotlow
Karring (1992),

4-5 .

Anderegg . (1991)
(
Gore-)
.

199


( = 0,05)
,
,

.
,

. Lekovic (1990)

, ,

,



.
Stahl Froum (1991)

,

. Camelo . (2000)
89%

-.


(Garrett, 1996; Murphy, Gun-solly, 2003;
Reynolds et al., 2003) (Wang.
2005)


:
1.

,


.
2.


.
3.


.
4.

200

.

5. -

6.





.
7.

.
8.


:
;
;
(Bio-Oss);
;
:
;

:
;
;

(

);


.
9.


-
II .
10.


(III )

I
III .
. , Cortellini
. (1994)
,
50 ,
168 22
.
, (
)
.



(1989) ,

.
(1996)
,

II
,

,
,



,

,


, ,

.

Gore-Tex Barrier.
Gore-Tex
(Murphy, Gunsolly, 2003),
.
,

.

, ,


.

,

,

,
.
(. 11.5).
.

(, ,
,
,

. 11.S.
(Gore-Tex)

,
)

,
Gore-Tex,
.

1.
.
2. ;
.
.


.

1. II

,

, ,
,
,

.
,
-
,
.


2.

> 4-5 .

1.

II .
2. .

1. III

, ,

, ,

.
2. .

3.
,
.
4. :
;
.
5. (Lu, 2002;
Villaco et al., 2004)


.

1. ,
.
2.

.
3. .
4. .

1. III
.
2. .
Bowers . (2003)
,

II ,

:
1.

:
9 4 % ,


;

70% ,


.
2.
:

:
>5 , 53%;
<4 , 84%;
:
> 4 , 61 ";
< 3 , 93 %;

;

;
:
<4 , 71 %;
5 6 , 100%;


1.
.
2.

.
3. .
4. .
5. (
):
:
, , Bio-Oss;
: , ;

.
:
,
, EDTA;

;
(
).

,
,
,

.


()
.

1.

201

-
.



(. 11.6,4).
2.

.


(. 11.6,5).
3.
- /
,
,
.

. Cortellini(2005)
,
.

4.


,
.


1. .



.
2.

(. 11.6, ,).
3.

/ .
4.

EDTA.
,
,
.
5.



.
6.
: , ,
Bio-Oss, Emdogain,
.

202
.
,
.

1.

1.
.
2. ,

(. 11,6,E,F).
3.
.
.
4.
,

,

3

(. 116,E,F).
5.


.
.
6.
, , ,
,

.
7.


.
.

,

,
.


1. Gore-Tex (
)



(. 11.6, G,H).
2.


, .
3.

.

2.

3.

4.

5.

6.


,
(),
, (Reso
lute Adapt [W. L. Gore Inc, Flagstaff,
Arizona], RCM6 [Ace Surgical Supply,
Brockton, Massachusetts],

Gore-Tex,

(. 11.6, G).


,


.

2-3
.

,

.



.
,
.
,

, .

Gore-Tex

2 . (. 11.6, ).

()
1.
4-8 .

.
2. ,


.

(. 11.6,/).
3.

,

.
,
(. 11.6,/).

4.

(. 11.6, iv).
5.


.
6.
.
7.
Go
re-
(. 11.6,1).

1.
10 .


Peridex.
2. 7-10
250
100 .
.

3.
.
4.
6 .
5.

,
.
6.
2 .,
,
, .
7. ,
.
8.

.
9.

6-9 .

. 11.7-11.9;
,
,
. 11.10-11.12.

. 11.6. . G4) .

203

( )
. ( , D ) , ,
. ( ) . OF) U-
. ( G ) Gore-Tex: . () .
(.I,J) . - . () .
( L )

204

. 11.7.

. () .
12- . ()

: 1) ; 2)
; 3)
; 4)
. ( ) ,

. ( D )

. ( ) ( Gore-Tex)
. ( F )
.
( G ) Gore-Tex 10 .

. ()
12 . (/) .
5- . { ] )
( )

. 11.8. . ( )
. () . ()
. (D ) . ( )
. (F ) .

206

. 11.9.

.
( , )

14. ( , )

( , )
Gore-Tex .
( D , D )
,

207

. 11.10. I!

. (,') II . ( )
. ( ) (Gore-Tex). ( ' ) . ( D')
.

208

. 11.11.
( III ). ()
. ( ) III
. ( )

. ( D )

. ( )
U-
. ( F )
Gore-Tex. (61
. ()
.

. (/)
. (/) ,

.

209

. 11.12. . ( ) ,
. ( ) , . ( )
, III . ( D )
, III . ( ) Colatape. ( F )
. (G ) Gore-Tex.
() 4 . . ( 1 , ] , ) , . (L )

210

,


:
1. .
2.
(
).
3. .
4.
.
5.

.
6.
(
).
7.
100%.


(Bunyaratavaj, Wang, 2001),
(Murphy, Gunsolley, 2003)

(2005)
,


. ,


, ,

;

) (. 11.16)

, (Javanovic, 2004).
(

)
.
.
. 11.1 .
, .
.

. 11.1311.15. . . 9 Gore-Tex

.

(Nevins,
. Mellonig, 1992; Javanovic, Buser, 1994;
- Buser et al., 1990)
(Simion et al,
2001). ,
,
,

, ,
(G-TAM, [W.L. Gore Inc, Flagstaff,
,
Arizona]) (Fiorellini, Nevins, 2003).
.
, . Gore-Tex
:
.
1)

(
),
,
. ; 2) ,

, ,
(

),

( (. . 11.5).

11.1.

BioGide

RCM6

I III

24 .

100%- I

26-38 .

BioMend
Bio-Mend-Extend
OSSIX
Periogen

6-8 .
18 .
6 .
4-8 .

Paroguide

DPPA

100%- I
100%- I
100%- I
I III
96%- I 4%-

Osteohealth, Shirley, NY
Surgical Supply,
Brockton, MA
Sulzer Calcitek, Carlsbad, CA
Sulzer Calcitek, Carlsbad, CA
31, West Palm Beach, FI.
Collagen Inc., Palo Alto, CA

4-8 .

Coletica, Lyon, France


Resolute Adapt X
Resolute Adapt LT
Guidor
Cytoplast (Vicryl Mesh)
Epi-guide
Resolute Adapt

PGA/TMC
PGA/TMC
PLA
Polyglactin 9
PLA
PLA/PGA/TMC

Bunyaratavej Wang (2001).


DPPA - ; PGA
.

, .
16-24
16-24
10-12
3-6
10-12
8-10

- ; PLA - ; - .

W.L. Gore 8c Associates


W.L. Gore & Associates
John 0 Butler
Ace Surgical Supply
THM Biomedical
W.L. Gore & Associates

. 11.13. Bio-Oss, . ( ) . ( ) ; -
. ( ) Bio-Oss . ( D ) . ( )
. ( F ) Gore-Tex. ( G ) . ()

211

212

. 11.14.


. () . ( )
; -
. ()

. ( D)
. ( ) .
( F) 11 . .
( G,H ) ,
,

. 11.15. . ( ) .

13 , . ( ) , 13 . (C , D ) ,
. . (E,F)
, . (G,H) . (I)
. (/) 10 . . (K,L) , ,

214



,
(. . 11.18, 11.19). Buse
(1991, 1993) Javanovic (2004)



(. . 11.23).
1. :

:
;
;
;

.
2. :

.
3. :
.
.


.

.

. 11.16. . (,)
. (,) .
(, ) ,

.

.

1. .
2. .

1. .

2. .
3. .
4.
.
5. .
.

.



(. 11.17).
1.
- !

.
. ,
,
(Schenk et al.
1994).
2.
,

(. 11.17, , ).
3. (
)
i
.

,


Gore-Tex (. 11.17, ).
4. , ,

, .


5. (Shallhorn, McClaine, 1988,
1993)
(Nevins et al., 2003)

(. 11.17 )).
6.
,
.

3 .

(. 11.17,,).
7.

,

.

2 (. 11.17, ).

8. Gore-Tex


.
,
.
9.

, ,

(Beck
er, Becker, 1990) -
(Buser et al., 1990,1993).
10.
-

215

Gore-Tex
(. 11.17,/',/").
11.
,
1-9 .
.
12.



-
.


.

. 11.18-11.25.

. 11.17.
(
). (,*)
. ( , ' ) /
. ( , ) .
.
(. D , D ) ,

,
. ( , )
Gore-Tex
.
,
. (F,F)
.

216

11.17.

. 11.18.

. ()
.
. ( )

,
. ()
.
. ( D )
. ( )
Gore-Tex 5. ( F )
Gore-Tex.


. ( G )
. ( )
. Richard Shanamen,
Reading,

217

218

. 11.20.

. ( )
,
. ( )
. ( )
1-3 .
( D )
. ( )
Gore-Tex .
( F ) 6 .,
. ( G )
,
. ()

219

. 11.21. , . () . ( ) .

( ) , . ( D )
. () . ( F ) ;

220

. 11.22. ,
. ( ) . ( ) . () .
( D ) . ( ) .
. ( F ) . ( G ) Gore-Tex

221

. 11.22. (). {)

. ( )
. (/)
6 .
. ( )
,

. (I)

. ( )

. ( N )
, .
( 0 , )
.
.
Dr. Edward
Cohen, Sharon, MA

222

. 11.23.
Gore-Tex (ITI). 04)
. ( , )
. ( , ) . ( D , D )

. 11.23. (). (., ) . (F,F)


. (G) 6 ., .
() , . (/) .
(/) . Daniel Buser, Bern, Switzerland

223

224

225

. 11.24. () . ( )
2 .
. ( N )
.

. ()

. ( )
6 . . ( Q )
3 .
. ( R ) .
(5)
. Scott
Kessel Practical
Periodontics and Aesthetic Dentistry 2005

226
3. ,
,

,
, , ,


.
4. ,
.
5.
2 .
6.

250
10-14 .

,
.

10 2001

7451$

( , ' )
Memfix (Straumann, USA). ( B , B ! )
Bove.
Straumann, USA. ( )
Bio-Tac (Implant Innovations,
Florida)
. 11.25.



Gore-Tex
,

,


1.
.
2. ,
, 2 .

GTAM
1.
,

.

.
2. Gore-Tex
,

,
1
9 .
3. .
,
,

,


, :
,


, .

,
,

,
.



.

227

.

:
1.
.
2.
.
3.
.
4. ,
. .
.
5. ,
.
6.
.
.

, 2 .

.

,

.
1. .
2. .
3. .
4. .
5. .
6. .
7. .
8. .
9. .

1. 6-12 .
.
2.
(
)
.

,
,

Hertwig,

,
.



.
(90%)
.


()

(Emdogain, Strauman).
, ,


(FDA)

: , (Hammarstrom,
1997, 1997b).
,
Sculean . (2002) ,
2 .,
4 .






(Heden, 1999, 2000; Tonetti et al., 2002).
Pontoriero . (1999) Silverstri
. (2000)

. Heidi Gestrelius (2001)
FDA 1998 2001 .
,

,
.

(,
) Heijl (1997)
Hukna Mellonig (2000).

II Jepsen
. (2003) ,



. Francetti
. (2005) ,

12 .,
6 .
Rasperini . (2005)

7 .
Giannobile . (2003)


(2005) ,



.

,
,
,

.
Heden Wennstrom (2006)
(5 )



,

(5,4 , < 0,001)
(5,2 .
< 0,001) .
. (, Bio-Oss),
.


1.

-
(. 11.26, ):

(. 11.26, );

.
2.
(. 11.26, ).
3.

(. 11.26, ).
4.

24% EDTA
(Biora), pH
2 (. 11.26, ).
,

EDTA

5.

,
(. 11.26, F).
6. :


.

:
;


.
,
.

228




.
7. (. 11.26, G,
).

,
.

.
,


, ,
.


.
. ,
. ,
,
.

8. ,
,
.
.
/ ,
.
(. 11.26, IJ).

9.

, .

,

(. 11.26, " I).
.
.

10.


.
11.

:

( 0, 12%);

* 100
10-21 (Mellonig, 1999).

. 11.27-11.30.

11.4.

< 2



' 1

> 2

> 37

< 27

< 4

> 4

4
> 4

< 4 1

Cortellini Tonetti (2005) Cortellini Bowers (1995).


MMCC - (Cortellini et al., 1995);
; YCCJI - , (Cortellini et al., 1999).
, .
.
' : , Bio-Oss, Emdogain.


. 11.26. Emdogain

229

. ()
. ()
. () -
,
. ( D )
. ( )
EDTA (24%). (. F )
.
(G) . ()

. (/)
,

. (J)
,
. () . (L)
. (
Strauman, USA)

230

. 11.27. Emdogain . ( ) .

( ) - . ( ) ,
. ( D ) Emdogain EDTA. ( ) . ( F ) .
Struman, USA

*!

. 11.28. (. !> ( )
- , i,
'-. ( 1
0 | , > oiroxoi
( 1 ) ) ->
-, ,
0 1 < . (- ) Peno?m,w: -a v
Emdogain.
(F) 10 . .

. ( G ) ,
. () 26 . ,

231

232

() .
() ,

. 11.29.

EDTA. ()
Emdogain

Emdogain. (D)
. ()
. (F )
. ,

. 11.30.
. {, ) 12 . (
David . Yu, San Antonia,
). ( , ) 36 .
( Gunner Henden,
rlstadt, Sweden). {, )
5 (
Gunnar Henden, Karlstadt,
Sweden).
Straumm, USA

233

234



.
() -
,

, -

,
- ,
.


:

(. 12.2, ).
.

(. 12.2, D )
.

Carnevale . (2003)

.

,
- ,
:
(. 12.3).

-
.
,
.

.

(. 12.3,5).


(. 12.3,5).

(. 12.3, ).

24

,


.


23
Nabers 1 2. (. 12.1).


.

,
,
, (. 12.2, , ).

. 12 .1 . ,
.
() N 2 23. () Nabers
12


(. 12.3, ).

235

Newell (1981, 1984)


,

Glickman
(1958), . (1975) Lindhe
(1983).

. Newell
Tarnow
Fletcher (1984), ,

.

Glickman (1958):

I:


(. 12.4).
II:

(. 12.4, ).
III:
(. 12.4, ).
IV:


(. 12.4, ).

Lindhe(7983):

. 12.2. . (, )
, , .
(C,D ) , . ,
,

(. 12.3, D ).


:

1.
2.
3.
4.

.
.
.

/.
5.
.

I:

(. 12.5,4) ().
II:

(. 12.5,5) ().
III:
(. 12.5, ) ().

Tarnow Fletcher
(1984):

:
1-3 .
:
4-6 .

236

KOPHfli

. 12.3. . () . () . ()
. (D) . () .
.
, . - ; -
; - ; - ; - ; -


:
7 .

,
,
Lindhe (I, II, III).



. ,
,


. 12.1.
,

:
1. ,
.

237

IV cm

. 12.4.
Glickman. ( ) I II .
. ( ) IV

()

III

,
,

(
)

,

( I, Glickman)
. ,

,
(Goldman.
1958), .

. 12.5.
Lindhe. () I .
() III

()

II .

2. .
3. (
-
).
4. /.
5.
.

. (1975)

-




, ;


238

.


.
I II
(. 12.6, 12.7).

,


.



.

. ,

,

, .


(Sepe et al., 1978; Saunders et al., 1983).


(I II )
, ,
,

12.1.


,
-

Glickman (1958)
Lindhe (1983)
Tarnow (1984)

(Bowers et al., 2003).


. . 11
.

,
II III ,

(. 12.8).

,

I
I
.

2

II
II
,

III IV
III
,

"

, .
.
1 .
2 .

. 12.6,
I (Lindhe). () . ()
. ()
.

. 12.7. II (Lindhe). () . ()
. ()
. (D)


.


(Lindhe, 1983).
Hellden . (1989)

149
10 107 . (
37,5 .).
, 75 %
, 6,7% (10 ) ,
4% (7 )
15,4% (23 )

. ,

,
(. . 12.4,
12.5).




.

.


,
,
.
,


/ (. 12.9).

,
96,7%
(701 ),
(97%; 1472 ) (Fugazzatto, 2001), , ,

(65-74%) (Engquist et al.;
1991; Jaffin, Berman, 1991). Oarnivale
(1990) 3,6%
(19 488 )
5 , Ricchetti
(2004),

9,6% 11,5 (19


169 ). Langer (1981)
38% (38 100
).

(.
).


,



, ,
.

(
,
,
),

. 12.8. . [)
III . ()
. ( ) ,
,

239

.

(Haskill, Stanley,
1982),
.

. 12.9. -
. (, )

,
/

,
.



()


,

.

240


( et al., 1975, 1992; Langer et
al., 1981; Carnevale et al., 1991; Suardstrfom, 2001)
(5- )
. ,


85-100% .
.

, III IV
.

14.
(.
).



, ,
.

,
(Bassada,
1969; Langer et al., 1981).
,

(. 12.11).

, ,
, .

, ,
,

(. 12.10):
1.
/
.
2.

.
. -
3. -
-
.
- .
4. .
5. .
6.
.
, ,
7. .
,
8. ,
. - ,

.

9.
.
.
10.


,
.

11.

.
,
12.
.
.
13.

.
,
14.
-
.

(> 30%).

15.
, (. 12.12).
.
. Gher Dunlap (1980). Herman
16.
.
. (1983) ,
17.
.
.
18.
:
;




.
, ,
.
1. III .
2.
II

.
3.
.
4. .
5.
.
6.


(

),

,
.
7.
(< 3 );
.

8.


.
.
9. .
10.
.

11.
.
,
12.
.
13.
,

. -
.



(Corranza ., 2002)

1. .
2.
.
3.
.

241

. 12.1, . ( ) /.
. ( ) . ( ) /.
. ( D ) . ( ) . { F )

4.

. 12.11.
.
,
,
. ; - ; -

. 12.12.
.
,
. -
; -


.
5.
:
;
;
;

.
6.

.

242


:





.
-
- .


,
.
,
.
,
.
701L
700,
.
,
,
.
.

.
.



.


4
.

.


.



.


.
-

.

,

.
.


.
. 12.13-12.15.




(. 12.16).




.


.
Majzoub (1992) ,


86%

(< 2,04 ).
. 12.17, ,

,
.

-
.

4 6
,
.


,

(. 12.17, , ).
. 12.17, ,
7016



,
()
.
,

.


,
.

-

(. 12.17, D, D).


.


(. 12.17, , F).
,




(. 12.17, F, F).

.
Rosenberg (1988)


:
1.
,


(. 12.17, F).
2.


(. 12.17, F,F).
3.


.
4.


.
5.

(. 12.17 ).
6.


,
.

. 12.13.
. (,)
. () .
(D,E)
II .
(. F ) ,
. (G)
.

, . ( ) , ,
,

. (/) . (/) 5 ;
. (
5

243

244

. 12.14.

. (. )

. ( ) .
( D) 6 ,

. Dr. William
Irving, Needham, MA

. 12.15,
. () ,
. ()
. ()
,
.

. (D)
. () ,
;
. (F)
. {(])
. ()
5

245

. 12.16. . () . () . ()
. ( D ) . ( )
. (F ) .
Cary Golavic, Portsmouth, NH



,


(. 12.17, , ).

. 12.18-12.22.

246

. 12.17.

-
. (,') ,
.

. (, )

701L. (, )

.
(D,D)

>

247

, 12.17. (). (,')


. ( F)
,

6 . (G, G')

, . (,)
.

248

. 12.18. ( , ) , - . ( )
. ( D ) (6) . ( ) N 2 7011_
. ( F ) - ( 2) . ( G) . ()
( 3). (/) ; . (/) (4). ( , . (L)

. 12.19. - - . ( , ) ,
. () II . ( D ) , - , . ( )
. ( F ) - ;
. ( G ) , ,
. () . (I)
. (/) . () . (Z) , .
, . John
Dolbec, Easton,

249

250

. 12.21. -

. ()
. 12.20. . ( ) . ( ) -
; .

() - . . ( ) 5
, . ( D ) . .
(E,F ) , . ,
. [ C , D )
. ( G ) , ,
. () .
5 .
Dr. Bernard Croll, New York, NY
.
Dr. William Irving, Needham, MA

251

. 12.22. - . () . () 701L. ()
.

(D) . () . . (F ) 4 .

1. :




;

;


.
2. .
3. .
4.
.
5.
,
.
6.
.
7.

.




,
.

;


.


,

.

, 76%

),



.


(. 12.23).

,


,

.
,

.

,

.
.

.

252

. 12.23. - . (,') ,
. (,) .
(, ) 1 ; . Dr. Barry Jaye, Brockton, MA




. 12.2.

253

12.2.

()

()

..

:



(Tseng et al.,
1996; Brugnami, Mellonig, 1999). Doutthitt . (2001)


. Brit
ain . (2005)
in vitro ,
(BioGide [Osteo-health, Shirley, NY])

(Bio-Oss [Osteohealth, Shirley, NY])



.

,

(. 12.24, 12.25).

254

, 12.24.

. () 1 1 .
( B )
.
(C)


. ( D )
. ( )
.
(F ) ,
. ( G ) 1 .
()
.
.
Federico Brignami, Rome, Italy

255

. 12.25.
. 04) ,
N9 21. ()
.
(C) .
(D)
.
(E )
. ( F ) 1
,
. (G )
. ()
12 .

260


,

(, ,
, ).

,

.


.

aesthesis,
.


.


(Rufenacht, 1990).


,

, (. 13.1).

.



.
,
-
(Lombard, 1973).


(Lombard, 1973).


,
. ,
,
,



(. 13-2).

( Rufenacht,
1990).
(. 13-3):
1. .
2. .
3. ( ).
4. .
5. : , ,
.

(. 13.4):
1. .
2. .

. 13.1.

. 13.2.

. 13.3. - ,

261

. 13.4. ,

3. .
4. .
5. : , .

,

,


(Graves,
1951) (. 13.5, 13.6).



, ,

.
(
) (
).


,
,
. -

,


(. 13.7).

,
,
.

,


(. 13.8).

. 13.5. ,
,

. 13.6.
,

,

. 13.7.

:



.



(Gulamerian, 1963; Lombard,
1973) (. 13.9):

262

. 13.8.
:

1) ,
;
2) ;
3)
;
4) .


(. 13.10):
1) ;
2)
.
-

(Rufenacht, 1990)
(. 13.11).

. 13.9. , ,





.
,

,
(. 13.12):
1. .
2. .
3. .
4.
.
, ,
(. 13.13):
1. .
2. /
.
3.
.

,
.

. 13.10. ()
.
(, ) .
,




,


,


- .

. 13.11. ,

-
,


.


.
, /

.

263

. 13.12.

. 13.13. ,

,


,
.

(. 13-14).
,



.

(Lombard, 1973) ,

, ,

(. 13.15).

. 13.14. . () .
( ). (, )

. 13.16. .




,
(. 13-16).
-

. 13.15. {)
. ()
. ()

264


-
(. 13-17).

(. 13.18):
1. .
2. .
3. .
. 13.17. ,
4. .

5. .

,
(. 13.19):
1. .
2. .
3. .
4. .
5. .
,

( )
.
,
, ,
,
.

, -


,
.
. 14
,

(. 13.20).


,

.

.

,
,

,
(. 13.21).

. 13.19.

() ()
,

=+

. 13.18. .

. 13.20.

. ( )
. ()



.
, -
,
, .
.

()

,
1,618 1,

.





.
-,



,
. 13.21.
,

, .


,

. ,

265

,


,
.

266


,
. ,
- ,
,
.

-
,

. ,


, ,

. ,


,
,

(Rifkin, 2000).


,
. - ,
,
,
, . .

,
,

,
5
,


(Goldstein, 1998).

.
,

( )
-
;
,
,
.

. , '',
,

.


(Lumbard, 1973). ,
,

,
.

I. .
II. -.
III. -.
IV. .

I.

. (. 14.1)
1. (Annette, Berg
man, 1992, 1992b; Chiche, Pinault,
1994; Moskowitz, Nayar, 1995; Rifkin,
2000 ).

:
();
();
();
().

(. 14.2, , ):
:
;
: ;
: .

(Rifkin, 2000):

267

. 14.1. .


.

.
,



, 18-20 ;

,
36-40 .

(Arnett, Bergman, 1993) (. 14.3):


:

;
III .

:

;

.
2. (. 14.4).

:
();
(
);
().


(Ahmad,
1998).
:

;
;
.
,
,
.


, ,
.

. 14.2. .
,

( ) ( )

. 14.3.
.

. 14.4.
. -

268

,
, .

Kokish (1999)
,
,
3 ,
.
,

(. 14.5).

. . .
(Rifkin, 2000).
,
.
,
,
( ).
(
).


(Golub, 1988) (. 14.6). ,
, :
;
.

(Rufenacht, 1990).
, -
,
(. 14.7, 14.8).



.
() .
-
(. 14.9).

(Arnett, Bergman,
1993, 1993b; Rifkin, 2000; Spear, 1991; Strub,Turp, 2001; Subtelny, 1959).

:
.
: , , , .
.
.
:
.
.
, (. 14.10):
(. 14.10, ).
(. 14.10,5).
Ricketts (. 14.10, ).
(. 14.10, ):
// (G-S-P);
// (N-S-P);
/ / (
) (Subtelny, 1959).

. 14.5. .

,
. (
,
)

. 14.6. .

. 14.7. .

,
-

G-S-P

(
) (. 14.10, ).
,
(

269

. 14.8. .
, -
,

. 14.10.
. ( ) . ()
. ()
Ricketts. (D)
. () Simon
. 14.9. .

,


).

(. 14.10, ).
,


.
( )
(

).
1. (. 14.11).


:

.

.
: , ,
.
:
3 .
.
: ->,
.

- :
:
(Maritato, Douglas, 194);

:
III, II, II;
: II, I,
(Pound, 1962).

:

, ;

;

;
.
2. (. 14.12).

. -

270

,
.
85-105 (85
95 ; 95-105
).
,



.

85-105
(Arnett, Bergham, 1993).
3. Ricketts,
(. 14.13).
,

().
4 2
.
;

;

;
.
4.
(. 14.14).
:

G-S-P (//
) 165
175 (Arnette, Bergham,
1993b);
N-S-P (// ) 11
165 (Subtelny, 1959).

:
(
> 175 G-S-P):

();

().
*

( < 15 G-S-P):

();

(
);

().
5. Simon (Hughes, 1951)
(. 14.15).

() ( ), (S) (G)

. 14.11. . {,)
. ,
. (, )
. (, ) .
, .
, , ,
. (D,D)
[] [] . ,
[]
[]

. 14.12. .

. 14.13. - Ricketts

. 14.14. . () . ()
(). ()

271

Ricketts
,
.

- (1999)
.
:
1.
:
.
2. :
;
.
3.
: ,
.
4. :
;
.
5. , : ,
;
.
6. :
.
:
1.
: ; III .
2. :
.
3.
Andy Gump (
):
; II .
4. :
.
5. : ,
;
.
:
1. : :

II. -
,
- .
, , .

. 14.15. Simon.

. (. 14.16).

.
. /

C-S-G.

(G-S-P), Simon, -

:
1. .
2. .
3. .
,
:
1. .
2. .

272

. 14.16. -

. 14.17.


3.
.
4. .
5.
,


.
6. .


,
, .

.
(. . 14.16).
1.

. 14.18.

;
;
;
,
;
;
.
2. ,
,

,

(Golub, 1988).

,

(Golub, 1988; Rufenacht, 1990; Chiche, Pinault, 1994).

71% ,

(71,3%), (68,8%)
(. 14.1 . 14.17).

27,8% ,

(26,9%)
(28,3%) (. 14.2 . 14.18).
,

14.1. ,

500

352 (70,4%)

148 (29,6%)

Miller et al. (1979).


95/6 66,4-74,4%.

14.2. ,

500

352 (70,4%)

148 (29,6%)

Miller et al. (1979).


95% 23,9-31,7%.



(Golub, 1988),



.
. .
.
,
.

,

. ,


(Lombard, 1973).
Lombard (1973) ,
, ,

, ,
,
,

.
,
()

.

( -

273


);

.


,
, .
,

(. 14.19).
,
-.


.
1. ()
(. 14.20).
,
, ,
.
2. (
) (. 14.21).
(. 14.22)
,
.

:
, ;
;

;
;
,
.

(. 14.23):
1. , .
2. .
3. .


,

(Rufenacht, 1990).
/

, (Pound,
1962) (. 14.24).
Lieb . (1967)


.


.


(. 14.25).

. 14.19.
.

. 14.20.

. 14.21.

. 14.22. ,
. ()
{Orbicularis oris). ()
(Levator labiisuperioris). ()
{Zygomaticus minor). (D)
(Zygomaticus major). ()
(Buccinator). (F)
(Masseter). ( G)
(Platysma). () (Depressor
angulioris). (D (De
pressor labii inferioris). (J)
(Mentalis). (Modiolus)

. 14.23.

. 14.24. . ()
. ()
,

274


14.3.

. 14.25.
. ,
.


(Moskowitz,
Nayyar, 1995):
1. :
().
2.
:

.
3. :
().
4. .
LARS.
:
1. (Lip morphology).
2. (Age).
3. (Race).
4. (Sex).

LARS. (Vig Bruno, 1972).
1. .
,
.
16 24 .
(< 15 )

,
(> 24 )
(. 14.3).
2. .

(. 14.4).

,


.

,

(Ahmed, 1998).



(Lieber et al., 1967).

,


,

10-15
16-20

21-25
26-30
31-35

0,77

3,92
3,44
2,18

0,68

0,93
0,25

1,95
2,25

0,98

Vig Bruno (1978)

14.4.

14.5.

(
)

Vig Bruno (1978).

Vig Bruno (1978).


. ,

,

( ),
. ,
,
.
,

.
5. .

,


(. 14.5).
4 .

(. 14.6).

III.


,

14.6.

(
)
,

Vig Bruno (1978).

(Ahmad,
1998). Studer . (1996) Gold
stein (2002)




(. 14.26):
1. .
2. .
3. .
4. .
5. .
6. .

275

7. .
8. .
9. .
10.

.
11.
.
12.
.
11

: . ,


(. 14.27).

1.
,

, ,
.
, ,


(Ahmad, 1998),
,

.
(
),
,
.

, ,

(Chiche, Pinault, 1994); ,

(. 14.28,
14.29).




(Moskowitz, Nayyar, 1995; Cranham, 1999; Spear, 1999),
.

:
1. ,
,

(Spear, 1999).
2.


(Kokish, 1999)3. ,



(Ortman Tsao,
1979; Shiftman, 1984).
4. ,
,

. 14.27. -

(,)
. 1.
. 2. . 3.
. 4. . 5. .
6. . 7. .
8. . 9.
. 10.

. 14.26.


(Spear,
1999) (. 14.30).


(Shiftman, 1984).
Miller
. (1979), ,
,
,
,
,



.

,
(Spear, 1999).
,

,


(. 14-31).
Kokich (1999)

. 14.28.

. 14.29.
.

-
,


4 ,
.


2 .
,

276

. 14.30.

() , ( ) -
()

. 14.33.

. 14.32.
. 14.31.
.

30 %

,
,
,

(. 14.32).
2. ,

;


.

,

1 .


(Frush, Fisher, 1958)
(. 14.33).
Ahmad (1998)
.


,

> 45, < 90.
Struder . (1996)
-

. () . ( )
. ()
. ,

,


(. 14.34):
.

.
.
.
.
( ).
.
.

.
3. .

,
.

.



(. 14.35).
4. .

. -



,
,

.

,
(. 14.36).


(Chiche, Pinault, 1994).


:

,
(. . 14.30):
;

;
(
).
,
:
( )
( )

;
[] [];
;

.
5. .





(. 14.37).
6. .


.

277

. 14.34.

. - ,
. () . ()
. () . (D) . () . ()
. (G) . ()
. (!)

. 14.35.

. 14.36.

. 14.37.

278



,
,

(. 14.38).


( 2x2 )
.


,

(Morely, Eubank,
2000) (. 14.39).

. 14.38.

. 14.39.

. 14.40. ,

. 14.41.
,

7. ,
.


(. 14.40):
:
.
:
.
: .
: .
.
,
(. 14.41).

8.
.

. ,


,

(. . 18
),

,


(. 14.42).



(Weisgolci, 1977) (. 14.43).
* .

. 17,

9.
.

. 14.42.
.
( )
( )

-

.


(Moskowitz, Nayyar, 1995; Morely,
Eubank, 2001) (. 14.44, 14.45).
10. .
,
.

, .


,

. 14.43. . ()
. ()

(. 14.46,
14.47).
11. ().
-

279

. 14.44.

. 14.46.

. 14.45.
,
.
(. )

. ( )

. ( )

.

,

,
(Frush, Fisher, 1958).
,

, -- (. 14.48).

IV.
. .
1.

.

,

.

,
(Frush, Fisher, 1958; Lombard, 1973).
0,20,4 (. 14.49).
:
;

( [] []);
;

. 14.47.

. ,

. 14.48.

280

. 14.51.

. 14.49.

. 14.50.

(
);
:
:
;
: .


(Lumbard,
1973).
:

(37 %, . . 0,2 ).

:
;
;
* ;
.
:

( );
(
).
2. .
,

.

,
( )
(Frush, Fisher,
1958).


(3,98 ) .

, ,
, ,
. ,
,

(Chiche, Pinault, 1994)
(. 14.50).

:

.

.
.
:

;
.
3. . ,


.



(. 14.51).
.

. 14.52-14.54

.

:
.
.

.

.

. 14.52.

. 14.53.

. 14.54.


.
. .


(. 14.55),

. , . . -


,

,

, ,
(Lombard,
1973) (. 14.56).


.
,
,
, (Frush
Fisher, 1958).
,

.
Chiche Pinault (1994)

:
.

.
.
1. .
,
/,

. ,
0,75-0,80 .

(> 0,8 )
,
(< 0,65 )

(Lombard, 1973) (. 14.57).

:

. 14.55. .
.
,



, ,
.

,
,
(phi) (Phillips, 1999).
,
(
, ),
( ,
), (
(Fi
bonacci)), (
) (. 14.58).

1:1,6
:
S/L = L/(S + L) - 2/(1 + V5) = 0,618

/ =
= 0,75-0,80.
Chiche Pinault (1994) ,

8,37 9,3 ,
10,4 11,2 . ,

/
0,74 0,89 ,

Wheeler 8,0
(8,5/10,5 ) Woelfel 0,76 (8,6/11,2 ), Bjorndal
. 0,8 (9,0/11,2 ) Shellingburg 0,8 (8,5/10,4 ) (Wheel
er, 1966; Bjornaul, 1974; Wuelfel, 1990).
2. .

.

281


,

,
,

. 14.56. .
, ()
,
()

()

.
,
.
Levin (1978)

,

. 14.57.

282

. 14.58. . ( ) .
()
. ()
. (D )
. ()

.
,

.
, Levin

,

.
II . <
,
(Javaheri Shahnavoz, 2002):
;
;
;
.


.
:
= 1,68.
= 1.
= 0,68.


.
.
,
(Javaheri, Shahnavoz, 2002).

3. . ,

,
.

(Lumbard, 1973).
, Chiche Pinault (1994)
,

:


(Berry, 1905):

.

(House et al., 1929):
*/16
.

(Wil
liams, 1914):
.
(Frush,
Fisher, 1973):
,
SAP.

,


0,75-0,80
,

,



,
-
.



:
1.
-
:
;
;
;
.
2.
.
3.
.
4.
.
5. 2-4
.
6.
1-3 .
7.
.
8.
.
9. .

284





,


(. 15.1).

,

,

.
,
,

, ,
. ,
,
,
; ,

. Spear . (2006)
,




. ,
, ,
,


.

:
,
,

*
.

*

( II).

. 15.1.
. -, , .
.


,
, . .

(Cliche, Pinault,
1994; Morley, Eubank, 2001; Spear co., 2006).
,


(0,70-0,80)


,
,

(Ahmad,
1998; Cranham, 1999) (. 15.2).

285

15.1. ()
-

1,91 3,40

3,65 0,59


3,37 1,26

Vig Bruno (1978), Cliche Pinault (1994).


.


,
(. 15.1).

,

, ,
, ,
.

,
,

(Ahmad, 1998) (. 15.3).


-
, ,


,

-, /

.
,
,

.
- (Moskow- ,
itz, Nayyor, 1995; Morely, Eubank, 2001),
.
. . [] ,
(. 15.4).


, Morely Eubank
(2001)
(.),
-.

,
,
, .

. ,
,
. 15.2.
.

(-D) , -,

, ,
.
,


:
1. :

:


1-3
(Kokich, 1999);

:

,
,
,
.

(. 15.5).
2. /
:

:


;
( )

(
) (. 15.6).
3. :

,

:
F:

;
V:

;
S: Pound (1977)


.

>1,5
.
.

( > 2,5 ),
(Cliche, Pinault.
1994). F
V (. 15.7).

286

. 15.4.

. () ,
.
. () .


. 15.3. , . {,')
. (,) . (, )

4. Spear . (2006)


:
;
;
.

:
1. 8,3-9,3 .
2. 10,4-11,2 .
3.
0,75-8,0.


( -
)
. ,
-
,

/

.

-


,

(Kois, 1996).




,

.
Robins (1999) ,

,
, ,
(. 15.8).





,



.


(Spear, 1999).

288


,

, -
,
/
,
.
:
1.
.
2.
( )
(
- ).
3. .
4. .
5. .
,

,
:
1) ;
2) ;
3) (. 15.9).

:

1. :
.
2. :
(),
() /
.
3. :
.
4. .
II , , ,

,

,
(360) (Levine, McGuire, 1997).
,


(Keough, 2003).

. 1S.9.

.


,

,

. 15.8.

: (
) . (, 1 )
:
,
, -
. (, 1 )
:
, -
. (, )
.
; -
.
, . .
(Spear, 1999)


(2-4 ),
,

(10,4-11,2 ),
-

,
-

289

. 15.10. .
() . () /. ()
. (D)

(. 15.10).
:
1.
.
2.
.

3. .
,

, .
. / (. 15.11).

15.2.


-
()

- - ; - - .
;|
.

. 1S.11. . (, ')
: ()
, ,
. (,)
: ,
, .
(, ) .
, ,

290

(
),
,
( ),


,
,


.

,


, ,
,


(. 16.1).

,
(

).
Sicher 1959 . Gargiulo
. (1961)


2,04 (
0,97 ,
1,07 ) 0,69
(. 16.1). ,


(IIV)
(. 16.2).


( ) 1,80
(III I 1,77 (IV),
2,04 .

Nevins Skurow (1984)




,

.
3 ,
.
Vacek . (1994)

(,
, )
-

16.1.




III
( )
IV
( )

0,97

1,07

2,04

0,69

2,73

0,74

1,06

1,80

0.61

2,41

0,71

1,06

1,77

1,77

3.54

- .

16.2.
() ,

291

. 16.1.

. ,

( 1,75 2,08 )
15% ,
,
2,04 .

,
.


,
(,
, ).





(Gargiulo et al., 1961; Vacek et al 1994),

. Kois (1994)
Spear (1999) ,

3,0 4,55,5 . ,


.
Becker . (1997)
(
, )

(2,1, 2,8
4 ).
3,0 3,5 (Wheeler,
1961).
Spear ,
1,5-2,5


.

,
3,0

,
.

16.3-

Tarnow . (1992),
, ,

,

55,5 .


(. 16.3, . 16.2).
Cho
. (2006),
,

,
.
Van der Velon (1982),
, ,

4,33 3 .
Nyman (1977) Rusling
(1976) , 2
3,5 5,1
.

6 . (Maynard Daniel.
1977; Rosenberg et al., 1999; banning et
al., 2003; Deas et al., 2004) 3 (Kois.
1994),
.


, ,
,
.
,

,
(N)
34
5
67
8
9 10
(2) (11)
(73)
(112) (63)
(21)
(4) (2)

II , -

,

| ||\ . 1! 1 )

2 (100) 11 (100)

0 (0) 0 (0)

(%)

72 (98)

63 (56) 17 (27)

2(10)

1(2)

49 (44) 46 (73)

19 (90)

1 (25) 0 (0)
3 (75) 2 (100)

Tarnow et al. (1992).

. 16.2. . ()
. ( ) ,
I . ( ) ,
2 . - ; ; - -

292


:

(Oschenbein, Ross, 1973; Weisgold,
1977; Jensen, Weisgold, 1995). Olsson
Lindhe (1991)
.
Oschenbein Ross (1969, 1973)





. Olsson Lind
he (1991) ,

,
(85 15 %).

(Oschen
bein, Ross, 1969; Jensen, Weisgold, 1995;
Seadoun, Le Gall, 1998).

(. 17.1,4):
1. .
2.
.

3.

,
.
4.
.
5. /
.
6. .
7.
.
8. .
9. .
10.


.

, ,
,
5
, ,

(Tarnow et
al., 1992).



.

()

(. 17.1, By.
1.
.
2. .
3. , ,
- .
4. , .

5.
6.
7.
8.

9.

.

.
.


.


.

. 17.1. :
. (4)
. ()




.
Maynard Wilson (1979),

5 (3 ),
Stetler Bissada (1987),
,

,
.

293

Kois (2004) -

, , (. 17.1).

17.1.

()

()

()

- .

294


D.W. Cohen (1962)


,
/
. ,

( 4 ),


,

, ,



(Ingber et al., 1977; Rosenberg et al.,
1980; Saadoun et al., 1983; Allen, 1993;
Miller, Allan, 1996; Kois, 1994, 1996,
2004; Rosenberg et al., 1999; Spear, 1999;
Becker et al., 1998; banning et al., 2003).
,

:
, (Kois, 1994).
( )
, ,
.

3.
.
4. .
5.
.
6. .


1.
2.
3.
4.
5.

1. .
2.
.
3. .
4. .
5. .
6. .
7. / (

).
8. .
.
,
(Allen, 1993).
, ,
(
).


1.
2.
3.
4.
5.
6.
7.
8.

1, .
2. .

.
.
.
.
.

9.

.
.
.
.

.
.
.
,

.

.



1.
2.
3.
4.
5.
6.


/.

.
.

.
.

.


295

7. .
8.
.
9. .
,

295

18.1.

DGC, DGC,

>3

> 3-4,5

3-4,5

<3

<3-4,5

DGC .

(Alien, 1993)
1.
.
2. .
3.
.
4.
:
;

;

, ;

.
5. :
;
,
4 6 .
.
6. :
;


.
7. :

;
.
8.
.
.

Rosenberg . (1999)
:


3 . .



Kois (1994) ,

3 (2,04
, 1

). ,
,




(. 18.1).
Bragger . (1992) ,

3



6 .
Ingber . (1977) ,


...
,
. ,
3
,


(. Vacek et al., 1994). Herrero . (1995)
,
,
3 ,
, ,
3 . Rosenberg
. (1980 1999) Weinberg Eskow
(2000)
3,5 4 , Wagenberg
. (1989)
5-5,25 .
Pontoriero Carnevale (2001)

84
30
12 . .
,
3,7 0,8
0,5 0,6
3,2 0,8 .


(


). ,

:
1)

;
2)


.

, ban
ning . (2003), ,
> 3
,
,

3- .

Smukler Chaibi (1997)




:
1.
.
2. ,

.
3.



:
;
.
4.

.
5.


,
.
6. ,

:

296


;
.

. Dibart . (2003) ,

4 ,

.

1.




.
2. -
,
.
3.

,

.
4.

(4-5 ),


.
5. :

,

.
6. :

(Oschen
bein, Ross, 1969, 1973).

7.


, :



;


.
8.
-
, , (Becker et al., 1998;
Rosenberg et al., 1999):




;


.
9. :

;




;

.
10. : ,

.
.
,
4
.
.


,
Brassier (958; 957).

12.

,


.
13.


:

;

.

,
;

:

.
14.
:

:
(> 4-5 ):
1 ;
(3 ):
;
(< 3 ):

(
), ,

.
.


,
(6 .) (Deas et al., 2004).


. 18.1-18.7.

. 18.1. . ( ) . ( )
. ( - . ( D ) . ( ) . (. F )
. ( G )
. () ( Dr. Michael Katz, Westport,
MA)

297

298

. 18.2.
. () , . () .
. () 3 .
(D) 3 . ()
. ( F) 8 . ,

. 18.3. : . (,)
. (C,D )
. (E,F) ,
. (G,H) 3 . . (/,/) 12- 22- 32-
42-. . ( ) . ( L )
. . ( Dr. David Edwards, West
Bridgewater, MA)

299

300

. 18.4. . (4) .

. ( ) .
. () .
. (D) . . ()
. ( F. , G) . ()
. .
13- 1 1 -

. 18.5. . () .

. () . ( .
,
. (D) . () . ( F)
4 . . (G, ) ,
( Dr. Joe Nash, Brockton, MA)

301

302

() .
11 - 21- . () . () . (D)
. () 11 . .
. (F) 2

. 18.6. : .

. 18.7. . (,)
, ,
11 - 21 - . () . (D)
. ) . (F) . (G,H)
. (
Dr. Michael Katz, Westport, MA)

303

304


:
(Weinberg, Eskow,
2000).


,
, ,


(Mox-Salentign, Klyvert, 1990).



(Gottlieb, Orban, 1933).




,
,

(Gottlieb, Orban, 1922;
Manson, 1963). Gargiulo .
(1961)

:
1:

.
II:
.
,
.

III:

- ,

.
IV:

- .
II , I II
,
(. 19.1).

Goldman Cohen (1968)






. Volcansky
Cleaton-Jones (1974)


. Volcansky
Cleaton-Jones (1976)
, 12,1 % 1025
,
24,2 6,2 ,

.
1979 . Volcansky Cleaton-Jones
Black (1902),
Gottlieb Orban (1933) Manson
(1963),
.
Tjan . (1984)
7 % 14 % .

,
,

Coslet . (1977)
,



(. 19-2).

. 19.1. .
(/) .
( I I )
. ( I I I )
- .
( I V )
-

305

1.
- ,
-

.
,
Bowers (1963)
Loe, Aniamo (1966).
. .

-
, -

- .

() I,
. () I, . () II, A. (D) II, . -
- ; -

. 19.2. .

.
1,5
2 -
.
.
-
.


:
1.
.
2. -
.
3.



. 19-1

. 19.3.

. 19.3. .

I, . - I, II,

306

| I TI 1
19.1.

I-A

I-B


,
- ,
()

(
)

. 19.4.
- ( I, ). (, )
, .
() . D ) ,
-
( I, ). ()
. (F)
. ( G )
(6 . ). ( )
. .

( )





:
1. .
2. .
3.
.
4.
,

;

.
5. ,
.
6. .
, , ,
.

Davis (1999) ,


,
(
)
(
).

I- II-A
. 19.4-19.10.

! ; ;

307

. 19.5. - . () . () ,
. () . (D) . (E,F)
.

. 19.6.

( I-). (,) ,
.
()
. (D)
.
- . ()

. . (F )
. (GM) (8 .
). , G.H. -
.

308

. 19,7. ( I-). (,) ,


. 13-23. () -
(D) . (E,F) - - . (G,H) -
- . ,
, . (/) .
. (/) 7 . .
. (K,L ) - . . ( William
Irving, Needham, )

309

. 19.8. -
. () .

,
11 21. ()

. (D)
. ,
. (E.F)
. (G, ) -
.
,

14, 18 24

. 19.9. . I,

, -
. ( )
. ()
. (D)
. () .

310


C&P1Y
Trjbyte

Triad
VLC Provisional Material

. 19.10. Triad
. (,
) ,
,
. ()
Triad. (D)
. () .
(.F) ,
. (G)

. ()
. (/)
. (],)
.
( ). (L) .
. , . . (
Dickerman, Sharon, ; Michael Katz, Westport, )


,



.



,
3-5 (Allen, 1988).
1. ,
,

-
, .
2.




- .
3. (
)


:
:
:

-
;
. :
;

-
;

;

,

.
4.

,

(Robbins, 1999).
5.

.
6.

:
3
(. 18 ' );

:
1-2
-

:


;

1-2

;
:

;

;
> .
7. (
) ( I)
- () (
II) -
.
8.
,
.


:
* ;

;
*
.

I-A (Allen, 1988;
Kois, 1994) . 19.7.




5-
2 :
1.
-


.
2.
.
3.
.
4.

15,

.
5. -

311

,
.
. , .


, ,

,
,



(Johnson, Sievers, 1985),
, ,

(Levine, 1997).
Heithersay (1973)


. Imber (1975, 1976.
1077, 1989) ,
.
Imber (1989)

,


,

.
,
,
,

.
3-4

.

20-30

(
),
(Johnson, Sievens, 1986:
Wang, Wang, 1992).

2 . (Ingber, 1976).

, (Nemcovsky et al 2001).

312

1.
.
2.
.
3.
.
4.
:
,
;

;
;
.
5.
.

1. ,
.
2. .
3. .
4. .

1. .
2. .

3.
.
4.
.
5.
.
6. ,

.

1.
2.
3.
4.

.
.
.
.

1.
.


,
.





.
Pontoriero . (1987) zlowsky . (1988)

.

,


.
,
15


, .
,
,

. glungh . (1991) ,


-

( . 19-1119.14).

. 19.11.
. (,)

. ()
,
.
CD) . (,
F)
,

. (G)
.
. ()

.
.

. {JK)

314

. 19.12. . (, ) . () .
18. (D )
.
. . (E,F, G)
. . (
Arnold Rosen, Boston, )

. 19.13. . ( , )
. ( ) , 21, . ( D ) 21. ( ) . ( David
Edward, Bridgewater, )

315

316

. 19.14.
. (,
) . . () 4 .
. . ( D ) 1 . .
( E , F ) 3 . .
, . ((7,)
.

319



(Loe et
al., 1965; Theilade et al., 1966).

,
(genhausen et al., 1966; Simon et al., 1970,
1971; Synderman, 1972).

(
)




(Aleo et al., 1974).
,
,
in vitro (Aleo et al., 1975;
Fine et al., 1980) (Hatfield, Bauhammers, 1971); in vitro
,

(Aleo et
al., 1975; Cogen et al., 1983, 1984),
, in vivo

(OLeary, Kafrany, 1983; Borghetti et al., 1987)
(Jones, OLeary, 1978).

,


,

,

, (Wirthlin, 1981)

(Karring et al.,
1980; Lopez et al., 1980).





(Miller, 1985b)
(Yukna,
1980, 1990).


,



(. 20.1).



New York Dental Re
cord 1846 ., Younger (1893,
1897) Stewart (1899).

,

.




(Register, 1973).


Register (1973, 1975, 1976),
,


(Bang et al., 1967; Dubuc, 1967;
Ueo-mans, Urist, 1967; Urist, 1971),


. Register Burdick
(1975) ,



(pH 1,0)

2-3 . Sterratt
. (1991) ,
pH
1,42,

.

320

()

,
,

Garrett (1978),

, ,

,
3-5

.
,

.
Poison . (1984),

, ,

. 20.1 -
. ( )
.

;
. ()
/
. ()
-
. (D)

.
( )


,
,


(pH 1,0; 2-3 )
, -

321



(. 20.2).


in vitro ,



(Boyko et al.,
1980). ,
- ,

(Leighton 1982; Pol-son, Prove, 1982;
Steinberg, 1987).
-1. .'/

-a

- *. . Mg*


.

(Crigger
et al., 1978; Craig et al., 1980; Nilveus et
al., 1980; Nilveus, Egelberg, 1980; Ririe et
al., 1980; Selvig et al., 1981, 1990),




.
,


.



(Poison, Caton, 1982; Poi
son, Prove, 1982, 1983; Prove, Poison,
1982). ,


,

,

(Poison,
Caton 1982). Poison Prague (1982)
,

,
... .

, 20,2, . ()
(1 500). ()

(pH 1,0 3 ). ,
(1500). Knut A. Selvig, Bergen, Norway




(Steinberg, 1987).

(Poison,
Prove,
1982) (. 20.3),

(Steinberg, 1987).



,

,
,
(Poison, , 1983;
Wikesjo et al., 1991).
,



(,

Widman,

, )

(Cole, 1980; Shiloah, 1980; Bogle et al..


1981; Common, McFall, 1983; Frank.
1983; Stahl, 1985; Gantes et al., 1988a.
1988b; Schallhorn, McClain, 1988;
Hanes, Poison, 1989; Stahl, Froum, 1991;
McClain, Schallhorn, 1993),
(Stahl, Froum.
1977; Ibbott et al., 1985; Gottlow et al..
1986; Marks, Mehta, 1986; Handelsman, 1991; Lamell et al., 1998).

.

(Gantes et al., 1988,1991)
,

322

pH 1,0


,


XIII

. 20.3. .
,

II (
/ ;
)



(66-70%
; 44-67%
100% ).
Stahl Froum (1991) (. 20.4),
Cole
(1980),

4,5

( 1,7






.
,
,


:
1. (Daly,
1982).

2. (Aleo et al.,
1975).
3.
(Poi
son et al., 1984).
4. (Poison
et al., 1984).
5.
(Wikesjo, 1991).
6. (Register, 1975, 1976).
7.
(Boyko et al., 1980).
8.
(Stahl, Tarnow,
1985; Stahl, 1986)

(Levine, Stahl,
1972; Masileti, 1975).
9.
(Hagner, Poison, 1986) (Poison, Haynes, 1986).
.
EDTA Blonlol (1996, 1995,
1995b, 2000)

, EDTA ( EDTA).



,
,
:
1. (Bak
er et al., 1983).
2.
,
(Wikesjo et
al, 1986).
3. (Bjorvatn, 1983).
4.

(Terranova et al., 1986).


5.

(Alger et al.,
1990).

:
1.

(Golub et al., 1984).


2.

(Al-Ali et al., 1989; Papelarsi et al.,
1991).
3.
2 14
(Baker, 1983b).
4.
(Hars,
Massler, 1972).
5.

(Terranova, 1986).
,
(> 100 )
(Somerman et al., 1988),
.



(Haynes et
al., 1991). ,


(> 0,5%) /
(> 5 ).
,


,


.

323

. 20,4.
. ( )
. ( )
,
(pH 1,0). ( )
. ( D )

. ,
.

. (Alger et al.,
1990; Machtei et al., 1993; Parashis et al., 1993; Darhous et al,
1995)
.


24% EDTA
pH (7,0),



pH
(1,0) :

1.
(Blomlof et al.,
1997).
2.
(Blomlof et al.,
1996).
3.
(Blomlof, Lindskog,
1995).
4.
(Blomlof et al.,
2000 ).
5.

(Blomlof et al., 1996).


, EDTA

(Posthethwane et al, 1978;


Fernyhaugh, Page, 1983)

.
,

,
EDTA .

324

(
= 440 ),

,

(Seelich, Redl, 1979;


Baum, Wright, 1980).
(Kleinman et
al., 1976; Boyko et al., 1980)
(Ruoslahti et al., 1980)
(Terranova, Lundquist, 1981)

(Kleinman
et al., 1981; Mensing et al., 1983).

(1)

(Caffesse et al., 1978b) (2)

(Caffesse et al
1987b).

0,38/
(Smith et al., 1987).
,
(Prato et
al., 1987), Tissucol, Cortelliln . (1991)

1.


.
2.



.
.

.

3. EDTA

2 .
2-5 .
4.

1-2 .
5.

, ,
,

(
,
) (Miller, 1983, 1985; Allen,
Miller, 1989)

(
),
,
(
) (Schallhorn, McClain, 1988;
McClain, Schallhorn, 1993)

II (
)
.

, Annals ]
Periodontology (Garrett, 1996; Mariotti, 2003; , 2005)
,
,

EDTA



,
,

.

,
(Reynolds et
al., 2003).
.
EDTA
(pH 7,0).

}) .
,
/
,
.

.
.

325


,

.



:
1.
.
2. .
3. 1
.
4. .
5. .
6. .
7.
.
II . Pagliaro . (2004) Clauser
. (2004) (1970-2000)
,

. , :
1, (
,
,
) .
2,
.
3- 1-2
.
4 -

2 .
Hwang Wnag (2006) Boldi . ,
,
. Pini-Prato . ,

- .



. Sullivan Atkins (198, 198)
Hall (1984)

.
, ,

,
20%
(Mlinek, 1973).

,

, ,

.
1972 1982 .

(Hawley, Staffilino, 1970; Ward, 1974; Livingston, 1975),


Miller (1982, 1985b)

,
,
, ,
II (
).

( Holbrook, Ochsenbein,
1983; Ibbott et al., 1985; Bertrand, Dun
lap, 1988; Borghetti, Gardella, 1990; Tolmie, 1991),

,
.

Baker
Seymour (1976),

.

(. 21.1):
1.

.
2.
.
3.
,
.
4. ,
.


Sullivan Atkins (1968)
:
, ,
, .
, ,


. Miller (1985b)
,


.

-)

II

ill


III

. 21.1. . (,') . ( ') . (, )

, , . (D,D")

, 21.2 . {,) I . ( ") II . (, ) III . ( D") IV .


-


I .
(
).

/
. :
. : . :
100% (. 212,).
II . .
/
. :
. : .
: 100%
(. 21.2,5).

III . II
. :
.
:
. :
100% (. 21.2, ).
IV .

. :
. :

. :
(. 21.2,0).

. 21.3.


(. 21.3,%):
1.


, ,

2.

3.

4.

5.
6.

7.

8.

,
.

.
(pH 10)


3-5 (Miller, 1982).

,


.

,

,
,

(. . 20
),


. ,

,

(. 21.3,5).


,

4-6

(. 21.3, ).

.

1,5-2 (Miller, 1982)
(. 21.3, D').



(. 21.4, 5).


.

(Hol-brook,
Ochsenbein, 1983).

(3-4 )
,

(. 21.3, D,D).
9.

,

(. 21.3, ).
10.

(. 21.3,5,/:).
11.
( 21.3,5).

. 21.4-21.6.




Carvalho (1972) Holbrook Och
senbein (1983)
,


.
,

. , ,
,
- .


,


(. 21.7),

1.

,

, , Sul
livan Atkins (1968),


(. 21.8, ).
2-3 .

2.


,
(. 21.8,5).
3.


(. 21.8, ).
4. . 21.8, D

,

. . 21.8, 5


. 21.3, 21.6 21.9.

Goldman . (194) Matter


(1976, 1980)

.


.
,
,
(. . 21.9).

.
1965 . Harvey
,

,

.
. Bernimoulin (1975)

,
.

.

. 21.3. . { , ' ) :
. ( ) . ( ' ) . ( D ' )
. ( , ' ) . ( ) 8 .
. - ; - ; - -

. 21.4.
. ()
. . ()
. II .
( ) ,
. (D,E)

. (F) .
( G )
. () 2 .
.

, 21.5. . (/) . ( , ' )


, . ( , ) II , . (
D ' ) .

. 21,6. . (, ') .
. ( , ' ) , , . { , ) . ( D . D ' ) 7 . .

. 21.7,



.
.

. 21.8.
( Holrook Ochsenbein). G4)

(). ( )
(). ( ) ,

(). ( D ) /

. ( )

. - ; ; - ; -
;

. 21.9.

32 31 . ()
. () ,
. ()

. ( D)
6 . . ( ) 6
.

Allen Miller (1989)



8 (97,8%)
.


.

1.
.
2.
.


(> ).

1.
.
2.
.
3. .
4.


.
---sgsgsssss " - - ' , t

. 21.10, ,


.

,
, ,
,
.


,
,

.
(pH 1,0)

3-5 .

-
(. 21.10, , ),

.
,
. 15


.

,
.
.
(. 21.10, ,
) 1 -
.

,
,
.

.
,
.

. . 21.10, D
(.
. 21.11).
. 21.12-21.14.

, 21.10. , . { ) .
, (). ( ) -
, ().
(). ( ) , . . (/)
. ( ' ) - . ( )
, , . ( 1 ) 2
. . - -

. 21.11. . (,) . , ,
, .
. () . (] ) - . { . - -

. 21.12. . . () . () . ,
() ('). () . ( D ) .
( ) . ( F ) .

. 21.13. . (,') . (,) -


. ( ) (, ) ( ) .
(D,D) . -

. 21.14. . {,) .
. (,) , . {, )
. (D,D) . ,


,


(Karring et al.,
1971),
, (Edel, 1974; Becker
Becker, 1986).
Langer Langer (1985)
,
,


. Nelson (1987)


90%.


(Nelson
1987; Harris, 1992),



.
,

.
Jahnke . (1993),

,
( < 0,03)
.


.
2. .


,
,

.
1.
5-6

15.
.

(. 21.16,4,4).

1.

1. ,

.
2. ,
.


1.

2.

3.

4.

1.
2.
3.
4.

.
.
.
.
5.
.
6.
.

5.


,
,
, ,
.



.


(pH 1,0
3-5 ), ( 3-5
) EDTA (pH 7,0).
15
,
(
).


-


(. 21.15, , ).



.
(. 21.15, ).

,

(. 21.15,0).

II .
,
.

,

,

.
2.

3
15.

.


(. 21.16, , ).
.
2-3
1,5-2 .

3.


.
,
.

(. 21.16, , ).
.

,
(
),
-
.


; ,


.

.. 21.15.
:
. () . ()
. ()
. (D)
(),
. ()
()
,
. ( F )
. - ; -

4.


(. 21.16, D,D).
5.

,

(. 21,16, ,').

6.

(. 21.16, ').
Monnet-Corti . (2006)
,

,
, 100%

5 93%
8 .


, 21.17.

3
. 21.16,
:
( ). (
') ,
5-7 ,
. (,' )
,
2-3 .
,
()
1,5-2 ,
. (, ')


1. 15

.

.
2.
,


.


(. . 21.15, ).
3.
,




,
.
,
,
(.
. 21.15, ).

3
. 21.16.
:
( ). (,
) ,
5-7 ,
. ( , ' )
,
2-3 .
,
()
1,5-2 ,
. ( ')


1. 15

.

.
2.
.


.


(. . 21.15, ).
3.
,




,
.
,
,
(.
. 21.15, ).

. 21.16. (). ( D)
.


. [,)
, .
(F,F) ,

, .
,

.
,

.

4.




,
,

(-3).
,
(.
. 21.15, F).
,
610 .



Langer Langer (1992),

:
1.

.
2. .
3. .

4.

.
5.

.
6.
.
7.
.

. 21.18-21.32.

. 21.26-21.28.

. 21.29-21.31.

. 21.17. I. . (,)
.
.
.
(,)
.

. {, )
1. (D,D)
2.
()
.

. 21.17. I (). (F,F )



. (G, (?)
() .
(. )
, .
(D
. (/) . (
Dr. Roger
Wise, Swampscott, MA
Quintessence Publishing )

. 21.17. II. ( ) .
. () . ()
. ,
. () . (D)

. 21.18. . ( ) . . ( ) . ( ) - . ( D )

, . ( )
, . ( F ) . ( G )

. 21.18. { ). () , . (/) .
(/) ; - , . ()
. (L)
. () ( ). (N)
. (0) . ,
. ( )
(: 1 , 4 ; : 2 - , 3
). (Q) . ( R) 6 .
. ( S) . . -

. 21.19.
. (,) . (, )
. . (, ) . (D, D)
.

. 21.20. 04) 23- 24- . ( )


. ( ) . (D) , . ,
2 . ( ) .
( F ) 6 .

. 21.21.
. (1,1, C1,D1,E1) , , :
. [2,2, C2,D2,E2) . , . (,, C3,D3,E3)
. (. 4,4, C4,D4,E4) .
(45,-65, C5,D5,E5) 6 ., 5 , 2 , 12 10 .

, 21.22,


. ( ) :
. ()
. ( )

. ( D )
. ( ) 4 .:

. 21.23
. () : . ( )
. ( )
. ( D ) 4 . ( ) 5 :

. 21.24. . ( ) . . ( )
; . ( ) . CD)
. ( ) . (F )
.

. 21.25.


. ( )
:

. ( ) ;
. ( )
. ( D ) . ( )

. ( F )
1 2 , 1 1 21 . ( G )
. ( ) 3 .
.
George Goumenos,
,

. 21.26. . ( ) . ( )
; . () . ()) ( )
. ( F ) 10 . 100%-

. 21.27. . ( ) .
. ( ) , . ( )
. ( D ) . (. E , F )
( - Michael Katz, Westport, )

. 21.28.


. [) .
(B)
.
(C)
, . (D)
. ()
. ( F )
. ( G )
8 . () 5

. 21.29. . () :
. () . () . CD)
-. () . ( F ) . ( Dr. Scott
Kissel, New York, NY James Hanratty, Swampscott, MA)

. 21.30.


. ()
: 23. ()
; . ()
.
(D)
.
(E) . ( F )

. (G) . D.
()



Nelson
(1987)

Langer
Langer (1985).

.

.

( 7 10 ) 88%
. Harris (1992)
97,4%
,

.


,
.

1. .
2.
.


,
.

. 21.33 (
) 21.34 (
) .
1.

.


.

2. 15

(. 21.33,
21.34, ).
-
.
3. (. 21.33,
21.34, ),


(. 21.33,5 21.34, ).
4.
,
(. 21.34, ), .
4-0
5-0, -3 (. 21.33,-F 21.34, )

. 21.37-21.39,
. 21.40 21.41.

. 21.31.
. () :
,
() . ()
.
(D)
;
.
(E)
.
(F )
.
(G)
. () :

() :
10 . () . ()
. (D) . (,) 4 . 1
. 21.32. .

. 21.33. : . () : . ()
, . . ()
. (D) . ()
. (F) . ; - -

. 21.34. (): . ()

. () . () . (D)
. () . (F) .
. - ; -

. 21.35. .
. {) : . ( ) . ()
. (D) . ( ) . (F) 8 .: 100%-
. . - -

. 21.36, .
() . ( ) . ( ) . ( D )
5-0. ( ) . ( F ) 7 . .
- -

. 21.37. () . () . () . . (D)
. ( ) 4-0. (F ) 12 .;
100%- . SCTG -

. 21.38.


. () ;

. ( )
. ()

-
5-0. ( D ) ^
.
( ) . *

. 21.39.
. () :
. () ,
() . ()
. ( ) . ()
. ( D,D) 8 .: 100%-
. - -

. 21.40.
. . ( ) : . () : - ; , . ()
. (D) . ()
. (F) 8 .: 100%-
.

. 21.41.




. (1,2,,
4)
:
.
(1,2,,4)

. (Cl, 2, ,
4)

4-0 6-0. (D1,
D2, D4)
. (1,
2,,4) 8-12 .

.

. -


,
,
Tarnow (1986).


2-3 .

2.


1. .

.

2.

2-3 .

1.
,

.
2.
.
3.
.

1.
2-3 .

1.



( ).
2.
. 21.42, , .

.
3. 15
,
(. 21.42, ) .
.
4.
,


(.
. 21.41, ) .
.

(. 21.42, ).

5.
,

2

(. 21.42,0).
6. ,


(. 21.42, ) .
7.
-
, 5
.

,
(
)
(. 21.42, ).

. 21.43 21.44.

. 21.42. . ( ) . . ( ) ,
. ( ) , . ( D )
. ( ) . ( F ) . -

. 21.43. . 04)
. ()
. ()
. ( D )

. () 3 .

. 21.44. : . ( ) . () ;
. (C,D) 1 . (E,F) 1 . .
- Dennis Tarnow, New York, NY


1.
.
2.
.

15

(
, , ,

).

( )

-

(. 21.45, , ).


,
.




(1,5-2 )

(. 21.45,5).

, -

15
(. 21.45, ).
4.
-
-

,
(. 21.45, ).
5.
,
(. 21.45 ,D).
6.

2
.

(. 2145, ).
7. ,



(. 21.45, F).
8. 10

.

. 21.46.

() :
. () ; . (D) .
() - . ( F )
,

. 21.45. (). ( ) : .

. 21.46. . () . ( )
. () . ( D ) . ()
. ( F ) 5 .



Carvalho . (1982)




.


,

.


,
(. 21.47,).



(. 21.47, ).

,
.

)
,
, 5-0
(. 21.47, ).
21.47, D,

. . 21.47, F
.

(. 21.48).



Cortellilni . (1991), Tinti
. (1992), McGuire (1992) Pra
to . (1992)



(AlloDerm[LifeCell Inc. Palo Alto,
California])

Miller (1985),

.
Langer Langer (1982)

.
,
,

.

,
.
.
:
1.
.
2. :
;
;
.

. 21.47,, ( Carvalho). () ()
. () . ()
(); . (D) . () ,
. (F)

. 21.48. ( ). ()
. . () .
() . (D) . () . (F) 1 .
(: JC Carvalho, FE Putiglioni, and S Kon. Combination of a connective tissue pedicle flap with a
free gingival graft to cover localized gingival recession. Int J Periodont Rest Dent 1982;4:27)

:
1.
.
2.
.
3. .
4. .
5.
.
6. .
7.
.

:
1. (Callan, 1990).
2. (Yukna
et al 1977).
3. :
* Guidor (Guidor AB, Huddinge,
Sweden) (Harris, 1998);
Gore-Tex (Pini Prato et al., 1993;
Jensen et al., 1998);
Biomend ( Wang et al., 1999);
Bioguide (Burns et al., 2000);
Epiguide;
> Emdogain;
Vicryl (DeSanctis and Zucchelli,
1996).

,
:
1.
.
2. .
3. .
4. .
5.
(Gore-).
6.
(Guidor).



.
(AichelmanReidy et al., 1999, 2001: Harris, 1999
2000, 2001, 2002; Henderson et al., 2001;
Mahn, 2001; Novaes et al., 2001; Tal et al.,
2002)
(87-96%)
,

.
Cores . (2004) Woodyard
. (2004) ,

.

(Cummings et al., 2005)


.
Mi' U (Harris, 2004) -

, 5 ,
.

1. .
2.
.
3.

.
4. .
5. .
6.
:
: ;
;
:
;

;
.


:
1. .
2.

.
3. .


1. .
2. .
3. .
4.
.



.
,
,
,
.



,
,

,

(7 ) (James, Klein, 19 7 4).


,


(
)

-,

(Livesey et al., 1994; Wainwright et al..


1994).

(14-21 ),
(4-5 .) (Wainwright et al., 1996).
,
.

, ,
,

.


, . .
.
1
II ,
,

,
,

(. 21.49).
(2003)
(2005),

. 2 1 . 4 9 . . ()
. ( ) . ()
. ( D ) .
( ) . ( F )

. (G) . ( )
1 .
.
Biohorizons

. 21.50. . () . ( )
. () . ( D )
. Biohorizons

.
,




.





10 , 4 .

40 .

,
,

(. 21.50).
II {1 >1 .
37 .

1. .
(
, );
:
100

.

,
.
2,
.

,
,
, .
(

.)
,

, .


50
.


5 .

.
, ,

. 21.51. .

, . (
Biohorizons)


.


50

.

5 .

40 .

,
,

.

.

,


.
,

10 .

1.
,




,
,
.
,

.


(. 21.51):


:
.
:

.


.
:



, ,
.


,
,
.

i I . , .
(
), .

.

1.



'
.
2.

-
3-5 ,

.

.
.



:
1. .
2. .

5.

. ,

.


1.

.
2.
(,

).
3.
:
(pH 1,0);
EDTA (pH 7,0)


;
(100-125 ).
4. / :
-
(X);
X
;
(
)
X.

. 21.52.
. ()
. () .
. ()

. (D) 5-0. ()
1



()
.

.


(Allen, 1994, 1994b; Harris, 2001;
Novaes, 2001).
, .. ,
.
1.

.
2.

.
3.
.
4.
(
),
1-2
,

.

. . (2004) , ,

,
.

5.



.
6.
;


-
.
7. ,

.
8. ,
,

4-0, 5-0

6-0.

.
3-4 -
.
, .

, , . Dodge '.
(1998) ,

,


(. ).

9.

4-0 5-0, 5-0
5-0.

10.

-
(ISO-Dent,
Ellman International);
, Harris (2002).
11.
(. 21.52,
21.53).

-
.


.
1.

.
2.

.
3.

.
4.
, 3-4
.
5.

.
.

,
.

6.

;
.
,

- .
7. ,

( 3-4
).
8.
(Dodge et
al., 1998; Henderson et al., 2001):

- ;


(

);

.


.


;

. 21.S3.

. (,) :
N? 13-24. {,) ( ) .
(, ) () ( ). (D,D)
5-0. (, ) 10 .



-
;

5-0


5-0

-
.
9.

5-0,
5-0,
5-0 Gore- 5-0.
.

/
,
.

10.


0,12%
.
. . 21.54-21.56.

1. 0,12 %.
2. :
50 1
14 ;
50 3
10 .
3. ( ).
4. 1 18 (

):
1-3- : 3 ;
4-5- : 2 ;
7-9- : 1 .
5.
(
2 ).

.


, , .


.


.

. 21.54. . () . ()
. . () .
Dodge. (D)
( Dodge). () .
( F ) . . 100%-

(. 21.56-21.59).

(Mahn,
1999).
:
1. .
2.
.
3.
.

1.

.
2.


.
3.

Orban
(

)
(
).
4.


5-0.
5.

4-0 5-0,

(. 21.60).
. / ,

.

. 21.55.

. (,) .
()
; Dodge.
(, ) 5-0. (.D,D)

[,) :
. () . (D) Dodge. () .
(. F) 10 .: 100%-

. 21.56. .

. 21.57. . ( ) . . ()

12-22. () . CD) .
() . (F) . (G) 4 .
. ( ) . (I) . (/)
. () . (L) . . (
- Richard Rossman, Randolph, )

. 21.58. . ()
. 22. ()
. 23 24 . () . (D)
. ( ) 20() 7(B) 6().
. (F)
. (G) . ()
. ( 8 . .
. . (J) (2- ). ()
. . ( L )

. 21.59.
. ()
:
. () .
(C)
.
(D)

377



.
,


.


Seibert (1983)

:
I.
-

-

(. 22.1).
II.
-


-
(. 22.2).
III. -
-
,

(. 22.3).



Meltzer (1979)




. Seibert (1983, 1983b)
,

. . 22.4
22.5

.
,


(. 22.5, G).

.


.

,
.

. 22.1, I

. 22.2, I


Garber Rosenberg (1981)


.
-

. 22.3. III



,

,
.

Langer (1980) Abrams (1980).
. 22.6,


,
.
15
,

(. 22.6, ).

.


4-0 5-0.

(. 22.6, ).


. . 22.6, D


. . 22.6,


,
.
. 22.6, F

,
.

. 22.7-22.9.




1985 . Allen .


,
Kaldahl . (1982),
,

.

. 22.4.
III. ( ) III.
. ()
. . () 2 .
.
.
- . (D)
- . () 2 .
. , , 10.4,
(F) . Dr. Jay Seibert, Philadelphia, PA

. 22.10, , .

6-12

.


.


(. 22.10, ).

(. 22.10, , D).


,
. 22.10, , F.

379

. 22.5. 2- III . {)
. III . () .

. () . (D) . ( E,F ) 2 . .
.
. (G) 2 . ,
. ( ) . ()
. (/) 14 .
( 2 .
. (I) (1 ). Dr. Jay Seibert, Philadelphia,
PA

. 22.6. . () - .

. () . ()
. (D) . () ; .
( F) :

. 22.7. . () . .

( ) . () . CD)
. ( F ) 3 . . Garber D, Rosenberg .
. Compend Contin Educ Gen Dent 1981 ;2:212

. 22.8. . ( A) ; I . ( ) . ()
. ()) . () 2 .
. . ( F)

. 22.9. . (, )
; . ( )

. (D) ,
; . () .
. ( F)

,
.

, ,

(. 22.10, F).

. 22.11.
.
,
.

1.
.
2.
-

.

1.
.

1. .
2.
.
3. .
4.


.
5. .

1.
15



(

) (. 22.12, ).
2.
'

(. 22.12, ).
3.

.


-

.

,

(. 22.12, ).
4.
,
,


.
5.
(. . 21
)


.


(. 22.12, ).
6.


.


(. 22.12, ).
. 22.13-22.20.

. 22.10. : . 04) ; .

()
. ( ) ; . ( D )
. ( ) . ( F )
. ( G )

. 22.11. : . () ;

. () . () . ,
10-15 . (D)
. () - . ( F)
. (G,H) : . ,

. 22.12. . {) . ()

. () . (D)
. (Z)) , . ()
. -

. 22.13.

:
(). {, )
:
III . ( )

. {D,D)
. (,
)

. ( F,F )



. -

, 22,13. (). (G, G') .


() , . ( )
. (/) . ( )

. ( L , ) :
. - -

, 22.14. I . () :
I . () . ()
5-0. (D)
. () .
. ( F)
. (G) ;

, 22.15. II . (,) : .
() II , 1 3 x 5 . (D) . , , ,
, . () . ( F ) 3 .
. (,) .

. 22.16.
II .
() .
. () -
. ()


. (D)


. ()
.
(F) . (G)

. . ()

. 22.17. II . () .
( 22). (C,D)
III . () : . (F, G) . ()
. ()
. (/) ; . () 3 . .
. (L)
. ()
. GV. ) . .

. 22.18.

(
). ( ) .
111 22 II 23.
II .
()
. (D)
.
(E)

.
( F ) . ( G)
6 .

. 22.19.

( ).
() . ( )

1 0 x 5 . ( )
. ( D )

. ( )

. (F )

. (G )

. ()
.

394

. 22.20.
. () . 11 21
. ( ) , ,
. ( )
. ( D ) 3 .
()
. . (F )
. (G ) (
). () . Dr.
Scott Kissel, New York, NY

Siebert Louis (1995, 1996)




III .


.
1.

.
2.
.
3. .
4.

:

-
;
- .
5.

.

3.

1.
15


1.
(.

),
15.
2.
2.



Siebert Louis (1995, 1996)


.

.
.
, .

.
.

3.

1.

.

.
.
. ,
, .
2.
4-0.

. 22.21 22.22.

(Siebert, 1992)
,
, ,
-


.

I .

,

,
.


1.

(4-0 5-0) -3.


2.


.
3.
.
4.


.
.

. 22.21. . ( )

, .
. ( )
.
. ( )
. (D ) ,
. { ) .
(F)
- ,
. ( G , H )


, .
.
. 22.5.

(, )
, . . ()
. (D)
. ( ) .
. (F ) . (G) . ( )
. (/, /) . .

. 22.22. .



Greenstein (1985) Ashman, Bruins
(1985).
Cohen (1988)
,
,

.



.



, .

,

, ,

(Amler et al., I960; Atwood,


1963; Carlson et al., 1967a, 1967b; John
son, 1969; Pietrokows, 1969; Abrams
1987; Lekovic et al., 1997; Lekovic et al.,
1998; Isel-la et al, 2003; Schropp et al.,
2003).


(1,5-2 )
40-50% 6-12 .
,

3 .
(Schropp et al., 2003). ,
,
,

,
,
(Lekoic et
al, 1997,1998; Isella et al, 2003).





,
.

1. .
2. .
3.
.
4. :
;
.
5.
:
;

.
6. .
7. .
8.
.
9.
.


(Saadoun,LeGall, 1998)
1. .
2. .
3. (Oschenbein,
Ross, 1969; Weisgold, 1977).
4
(Tarnow et al,
1992, 2003; Cho H-S et al, 2006).
5. .
6.

(),

()
(Tarnow et al, 2000; Gastaldo et al,
2004).
Kois (1994, 1998) Spear (1999)
1,5-2,5
(3 ) (4,55,5 )
. Kois (1998) :

,
3
, .





()
(Kois,
1998).


;
,
:
.
.
.
.
.
II.
,
. 23.1.
.

1.
.
2.
:

;
,
.

(. 23.1).

,

.
4.
:
;
;
- .

,

.

1.
2.
3.
4.
5.


.

.
.

.
.

1. .
2. .
3.

.
4.

.


(Sottosanti, 2003)

:
1. .
2. :
;
.
3. :
.


(. 23.2),
,
.

.
1.
(Langer, Calangar,
1980) (. 23.3-23.8).
2.

(Landsberg, Bichacho, 1994)


(. 23-9).
3. Bio-Col (Sklar, 1999) (. 23.10).
4.
(. 23-1123-15):
;
:

(4-6 .);

(4-6 .).
5. (Misch, 1998)
(. Alloderm).
6.
(. 23.15):
(Misch, 1998; Kois,
Kan, 2001) (. 23.16);

(Kois, 1998; Spear,


1999; Sklar, 1999) (. 23.17,
23.18).


.
.



.
1. :
15;
;
;

:
Neumeyer-;
701L.
2.
15

(
).


.
2.

2-3
.
3. .
4.



,
.
5. ,

.
.

. 23.2 . ( ) () . ( ) . ( )
() . CD)
(). ( ) . ( F )

. 23.3. , . { ) . 12- 22-


. ( ) . ( )

. 23.3. ( ). (D)
. ()
3 . (F )


; -
. (G )

. ,


. () ;
.

Dr. Richard Rossman, Randolph, MA

. 23.4. . ( ) . () 12- 21-

; . ()
. (D) . ()
. ( F )
. (G ) . ()
. .
Prosthetics courtesy of Dr William Irving, Needham, MA

. 23.5, . ( ) 13 , .
( ) . ( ) . ( D )
. ( )
. (F) . (G)
. . ()
. Richard Rossman, Randolph, MA

, 23.6. . 04) . ( ) - 24. ()


. ( D ) .
4-0 5-0 2 . ( F ) 4 .

()

. 23.7. . () .

() . () .
. (D) . ()
. (F )
. (G) . () .
. Dr. David Edward,
Bridgewater, MA

404

. 23.8. , . ( )
(); . ( )
21 22 (). ( ) 21 - 22- . CD)

. ( ) . (F )
. (G , H ) .
. ( Dr. Michael Katz, Westport, MA)

. 23.9. / . () . () 11
. () . (D )
. () . (F) . (G) .
(. )

. 23.10. . Bio-Cal. ( , ) .
12, 21 . .
()
. (D) ( 12 -
; 21 Bio-Oss). ( ) Collaplug .
. ( F )
. ( G , ) .
.

. 23.11.
. () . (,
) : . (D)
. ( )
. . ,

, (),
. .
(F ) . (G )
. ( )
. ( I J ) , .

.
, (Gore-)

!1

408

. 23.12. /


. ( ) . ()
;
. ( )


. (D) ,

(Gore-TEX). ( )
. ( F )
: ,
100%- .
( G )
. ()
.
Dr William Irving,
Needham, MA

. 23.13. , () . 21, : . ( )
, . , . () () .
22. ( D ) 6 . .
( ) .
. ( F ) , . (G )
. () .

. 23.14. . () .
31 41. () 31 41;
. ,
. () ( Rocky
Mountain). (D) Gore-Tex. ( ) .
( F ) Gore-Tex 2 . . (G ) .
{) .

. 23.15. . 04) .

() . () ,
. (D) -
, . ()
. (F )
. (G )
( ) . ( ) :

, 23.16.

. (4) .
11 21
. ( ) 11 21.

. ( ) .
( D )

. ( )



. ( F )
.

.
( G ) .
()
.
. S.
Silverman, Massachusetts

. 23.17. . () . ( ) ;
11 - . ( )
. ( D ) . ( )
. . ( )
(3-4 ).
. ( G , G ' ) -

. 23.18. , . ( ) . ( ) ;
. (C , D ) . ()
. (F )
. (3-4 ). (G ) , ()
. . ( I ) . ( ] )
. ( ) . (L ) .
, . Dr. David Edward,
Bridgewater, MA
.

.

6.


,


.


.
. Horowitz ( 2 0 0 6 )
.

7.


.

Neumeyer
701L
-
.
.

8.



.

.


(
(. . 23.2, ).
,
CaS0 (
)
-
2


.
12.
.
(Sottosanti, 2003; Guarnieri, 2004).
9. . ' .
, (/ Bio-Oss
/ - CaSOj. 4:1 (.
. 23.2, ).
.

13-

(CollaPlug),

(
.


) ,

.
,
10.

-
,

(. . 23.2, ).
< 1 p H ;; ,
3-4 .
,
()
.
.

,
14.
,
(. . 23.2, E,F).

15.
.

-
,



,

1,5
.
.
11.
16. 4 .

1 .

23-1.

23.2. ,


( ,
, ,
, )









Meln ick n Camargo (2004).

416



,

. ,
,

(Takei, 1996; Azzi et al 1999,
2001) Neurcovsky
(2001)

.

onepai Takei
(1996)
,

.

, Azzi .
( Azzi) (1999)
.

3.


(360)
(
15).
4.
,

,

.
5.
360 .
,

6.
3-5 -
,

.
.

7.
,


.
8.
.


2.
-


-

.
, EDTA.

9.

.
10.



Orban.
.

11.


,
,
.
12.


,

3-0
4-0.
.

,
. .

.

1.

13.

,

(4-0 5-0, -3,
Vicryl) .

,
.

14.

(
4-0, 5-0)
.

. ,
.

. 24.1-24.3.



,
( )
,
.



.


(Sclar, 2003)
.

(Sciar, 2003 )

1.
.
2.
.
3. .
4.
.
5. .
6.
.
7.
.
8.
.

1. 10 .
2. 4
.
3. .
4. > 4-5 .


-
1. 15

, 24,1, { , )

. ( ) . ( , )
,
. ( D ' )

. 24.2. ( Azzi)
. ( ) : . ( - D )
. ( ) . (F )
. ( G )
. ()
Orban. . ( . { ] ) .
D . ( ) . 23-

. 24.3. . Azzi. (, ) ,
5 - , 22- 23- . (\ ')
, . (, )
, . -
. (/ 22 23, 100%-
. 8 . . /!, \ '


.
2.

.
.
-
.
(
)
.

3.


.

.




.
,

.
.

5.


.
6.
,


.

8-10 .

1.
,
,
2-3
. , ,
,
,
.
.
,
.
2.

15 .
3.



.
4.

15

.

7.



()
Prich
ard
.
8.
,

,

.
9.
;

.

,



(Sclar,
2004).
10.
.
,

.

.
, .



,
.
12.
.


.
11.

13.

:
.
,

,
(.
. 22
>>),
,

.

.
.

-




,

.



.

.


.

.
,
(CollaCote, CollaTape, CollaPlug
[Integra Lifesciences Corp. Plainsboro, NJ]),
.


. 24.4-24.6.

. 24.4. . ( ) ;
. . () -
( ) . ( )
. ( D ) . ( )
. ( )

. 24.5. . ( ) . ( )
. ( D ) . ( ) .
(. F ) . ( G ) . ()
. (/) .
(/) . ( ) . ( L )

. 24.$, (). () . . (N, )


. (, Q) 4 .; . (R, S) ;
.

. 24.6. . ( , ) . ()
. (>) . ( ) . ( F , G ) ,
. () . (I ) . (/)
. ( K , L ) . .
12 11



-.

):
1. :

.
2.

:
.
3.
:
.
4. :
.


,

(Erikson, 1938; Fastlicht, 1959).


(2:1),
(Johnston, 1969; Gensior, Strauss,
1974),
(2/) (Bass, 1967). ,
,

(Smukler et
al 1987):

1.
.
2.
.
3.
.



:
1. (Stock,
1938).
2.

(Clark, 1971).
3. (Von der
Heydt, 1975).
4. (Prescott, Boldberg, 1969).
5- (Hunt
er, 1983).
6. (Ziegler,
1977).

:
1.
(Lappin, 1951);
2.
(Gensior, Strauss, 1974).
3. (Vanarsdall, Corn, 1977).


.


,


.

,


. Vanarsdall
Corn (1977), ,

(Clark, D. 1971), -,

.


:
1. .
2.
.
3. .




- .

, ,


(Richards, 1980). Clark
(19)
(,
)
(. 25.1, 25.2).



,
. 25.1. Clark,


. /!

,
.



30
.
.

,
:
27 (

30

).

,
( , .
-
)
, .
,
.
,

,
.


,

.
, ,
, .


1. ,
,

.
2.
:
: 1:100 000
1:50 000 ;

,

;



. 25.2. . () . ()
, . ( ) , .

;
;

;
4-0 5-0
-3;
.

,
, , .

.


.

,


.

1.
- .
2.
.
3.
2-3
-
.

1. .
2.
.
3.
-
.

1. Kirkland
15
.
2.
,
, .
II

1.
- .
2.
.
3. .

1.
.

1.

15 15.
.
2.
,

,

.
3.
,

.
4. ,


.
,
.

5.


,
.
6.
.
7.
4-0 5-0

(. 25.3-25.5).
. -

. - ,
.


, ,
(Kokich.
Mathews, 1993):
1.
.
2. .
3.

.

,
.

1.
15 15

.
2.

.
3. 2-3
.
4. ,

.
5.


,
(Smukler et
at., 1987).
6.


,
,
,
.
7.


.
.

. (. 25.6).

( ) . ( ) .
( ) . ( D ) / . ( )
4-0 5-0 , (i 7 )

. 25.3. .

( ) .
. ( ) 5-0 . ( )
. . (D) . ( ) . (F ) .

. 25.4. .

. 25.S. . ( , ) . [ , )
. ( , ) .
, . [ D , D )
.

( ) .
.
(C)
, . ( D ) . { )

. 25.6. .

(B)




.
,


.



:
1. (Lappin,
1951; Kokich, Mathews, 1993).
2.


(Smukleret al., 1987).


*
.
,


,
.

. -
.

1.
15 15

.

2.

-

,

.
3. ,
(

).
. .
1.
15
,
.


.
2.
U-
.
3.

.
4.

,

.

-

,

.
6. ,
(

).
.
.
1.


.
2.
.
3.



, .
4.
.
,


.
5.
.

5.

.
( )

,
.
6.



.

:


1:50 000;

(1:50 000) ;

;

:

,
,
,

.

7.

.

- (Kokich,
Mathews, 1993).

1.
.
2.
.
3. 15

,
.
4.
.
5.
.

1.
.
2. 15

.
3. .
:
: I' 1

.

.


1. 0-5%.
2.
.

. 25.7, 25.8.

110 , ,
.
,
.

, 25.7 , . -
. () . () - .
()
. (D) . ( )
. . (F ) 2 . .

. 25.8, . () . ( )
. ( ) , . ( D )
. ( ) . ( F ) .
. { G , H ) . ,
. ( 1 J ) . ( K . L )

'

-~ ~-~~1!11^^





.



,

(
),

:
1. IllIV
(Zitzmann et al., 1985; Jaffin, Bermann, 1995).
2.
(Zitzmann, Scharer, 1988; Misch,
1990):
* ;
;
* .
3.
(Jaffin, Berman,
1991).
4.
(Chanaverz, 1990, 1995;
Smiler et al., 1992; Coatam, 1997a,
1997b; Smiler, 1997):
* :

;
*

;
.
:
5. .
1) ;
6. (Adell et al., 1981,1990).2) ;
7. (Bahat, 1993).
3) ;
. 27 4) ;
^ 5) .
Caldwell-Luc.
- ,
,
,
Summers (1994)
.
,
.

,
Summers (1994), ,
Tatum (1977),

.
. ,
,
, -

.


:
. ,
1)

;
(Summers, 1994)- 2)

;
, 3) ;
4)
:
.
1. .

2.

.
3. .

4. .
.

Reiser . (2001)

,

4-5 (6-8 )
(24%)
(. 26). ,

.

26.1.


, 1

II
0

6-8

10 2

Reiser . (2001).
: I < 2 ; II > 2 .


:
1.
.
2.
2-

1 (
Reiser).

3.


,
,
.
4.



.
5.
,


.



4-5 .
Nkenke . (2002)

, ,

. ,


3 .

Fugazxotto (2003)
(. 26.2)
,

85-100%
> 3,5 (
1 7 ).


,
(> 3,5
>11 ).

.
Emmerich . (2005)
1139 (8
)
(> 3 )
(96%) .


(
).
Summers (1994)


, ,

26.2. ,

.
* : , (13

5,3%).
.
Tatum (1977), Summers.
, .


99 143 >13
(
). Misch (1999)
10-12 , Jensen (1999) 7-10 ,
Zitzmann Scharer (1999) > 6
.
Rosen . (1998)
,


> 4
(. 26.3).

43

(Del Fabbro et al 2004; Wallace,


Froum, 2004).
1 i II . - ,

(Jaffin,
.1995),
10-11,5 . , ,
> 3.5 ,
,
, > 6-7 .

.

, > 6-7
.

26.3.

<4
5-6
>7

14
50

12

85,7

48

96,0

110

106

96,4

Rosen et al. (1999).


Toffler (2004),
73%
> 4 94,6% < 5 .
Deporter . (2000)
> 3
, ,
100 % ,

6,9 4,56 .
, ,


,
,


.
:
1. .
2.
.
3. .
4. .
5.
.
6. ,
.
7.
(, , )


.
(. 26.1)



.
, ,

,
,

.


1.
:
*
.
2.
-

:

;
*
;
* .


,
,
.

. 26.1,

. (4) (3-I). ( )


1.


.
2. :
;

:
;

()

.


:

1 2-


.

1.

. -


.
2.
.

6.

.
7.

.
8.

.
9.

.

1. :
, . .

.

2. ,

.

3. ,
,
,
.

4. .
5. ,
- ,
,
, /.


.
6. :
1.
.
7.
(Yildirim et al.,
.
1998).
8. 2.

IV (Glauser et al., 1998).
3.
(Nkenke et al., 2002).
.
9. 4.
(Roc
cuzzo, Wilson, 2002).
,
.

10.

.
1.

.
2.
.
1.
3.
IV .
2.
.
4.

10-15

.

3. (

,

.
,


).

4.
.
.
5.
.
.


(Summers, 1994)
,



1-2 .

9-10 .

1.
1-2 ,
(



).
2. ,
.






.
.
1.

.
2.

1 .
.


,
.
,
,
.


.
,
,

,
.
,
,
(. 26.2).

1.



.
2.

< 4 > 5 (Jen
sen, 1996;

, 1996; Rosen et al., 1998;
Toffler, 2004).
3.
.

1. 4 .
2. ().
3.

.






(Lazzara et al.,
1999; Cavicchia et al., 2001; Toffler, 2004).


(Summers, 1994)

.



.

1. .
2. .
3. .
4. (
).
5.
.
6. .


(IV )

.

3.
4.

5.
6.

I! , IV X; 2
3 3 (
Reiser).

7.


3- .


8. .


,


.
,
,
.
11 . .

9. (Toffler, 2004).

Reiser.
,


1.
.
,
11 ('
.
.
2.
.
,
3.
Valsalva ,
.

4.
.
.
I ,
,
IV .

. 26.2,
.
.
,
,

2.




.

2-3

.
1 ,
2- .

2-
.
3- .
1 ,
3- .

1.

-

,
.

1 1 ( .

.

Valsalva.

,

.




.
.
2.
13.

4-6 (Reiser et

1 2- .
al., 2001; Lazzara, 2004).
14.
3.

.

2-xMM
Summers 4
,

. 1
5.
15.

,
.
. 11 . ,
.
,

(Reiser et al., 2001).
Reiser.
. 16.
,

4. ,
,
, 7-8 .

.
.
.
17.
5.
:


;
1 .
.
;
6.
;
1-2 ,
,


.
.

V .
. Bio-Oss -

.
.
. .
0T0M0B:

V: 3.3-3,75 :
10.

1
Nft 4 - 4,0-4,-5 ;
Summers
jVa 5 4,8-5, 0 .
,
3 (31 Implant Innovation, Palm

Beach, FL)
.


7.

.
20.3,
26.4.


,
-


.
( ).

8.

2 3,


.

.

IV
.
9.

1-1.5 .
,


11,

Reiser

.
Summers

3.
3
. ,
s s }1 >1 ,


1. ( 8-17).
2
-
,
.

12.
-


. 26.5 ,

26.7.
.


.
,

4 . (Davarpanah
et al, 2000). Toffler (2004) ,
Nkenke . (2002)

. Toffler (2004)
,
(, 1992; Baumann, Ewers,
1999; Reiser et al., 2001)


.

. 26.3. . . ( , )

> 5 . ( )
. (D)
1 . () 2- 2- . (F ) 1
3- . (G ) 3- . ()
. . (/)
. 0,5-1 .
. (/) ,
. ( ) . (L )
7-8 11,5- . () 10 .
. (N, )

, 26.4,

. ()

7 .
()
1
2-
. ( ) 2-
.
(D )
3- .

.
,

. ( )
5 . ,
5-6 ,
3-4
. ( )

. 26.S. , . ( , )

, . (C , D )
. ()
1 . (F ) , . (G) (
Summers 3 N 2 4, 31) . ( ) .
(I ) . ( ] ) ,
. ( ) , . . (L )

. 26.5. (). (M , N ) ,
. () . ( ) . ( Q , R )
12 . . . D

. 26,6 (, ,

). ( ) . ( )
(
27). ( ) ,
Summers. (D )
, 10 . ( )
7 . . (F )
26 . . Eiji
Funakoshi, Osaka,

. 26.7.

(, ,
). ()


(
27).
()

(5 )
,
. ()


. (D)

2
.

Eiji Funakoshi, Osaka,

,

(< 4 ),


,

, :
1.
Caldwell-Luc.
2. FSD.

, ,

1.


.
2.
5 FS (Sum
mers).
,

.
,
6 . Fugazzato (2002, 2003)
3- .
(3-6 ).

3.



.
4.
FS

.
.
.

, Valsalva
(
).
5.



,

,

.

. ,
.

6.
,
,

.
7.

,

.

.
,
5-8 .

8.

,

.

. 26.8, 26.9.

. 26.8. , . ( )

. ( ) 6-
1 . () (3I-FS)
. ( D , E ) .
( F ) 6-8 . , . ( G ) .
. ,

. 26.9.
. 04)
. ( )
4
. ( )
. ( ) )
- . ( )
( )
6-

. 26.9. ( ).

(F) . (G)
. () . ( I ) .
{ ] ) . ( ) . (L)
. () . (N) 8 . .
() (11,5 5 Osteotite, 31). () . (Q)
3 .

448


,
20 % ( 18 )


(. 27.1). . 27.1, 27.2

,

. 3. (Smil
er et al., 1992):

;
:

1.
.
( III IV ) (Jaffin, Berman, 4.

(Tatum, 1986,1989);
1991).
2. 5.
(Watzel et al.,
(Zimmer, Small, 1999).
1998);

. 27.1. . () . ( ) . ( )

6.

(Rangert et al., 1997,
1998).




(Fugazzatto, Vlassis, 1998; Jensen et al., 1998; Khoury,
1999; Fugazzatto, 2003).


. Ta
tum (1977, 1986)
,
Boyne James (1980)

.

,


(. 27.2).



(Chanavaz, 1990),


.
,


//
38 33 38 (Schaf
fer, 1920).

,

(
).
,
.

,

(Chanavaz, 1990).

. 27.2. , . () . ( )
. ( ) ( ). (D ) (
()). ( ) . (F )


,

(Misch, 1999).



,

. (
) ,
.


.


(Ulm et al., 1995) (Tallgren, 1972).


,
-
.

.

.



. ,

(Chanavaz, 1990).

,


,
.

.



.

,
.


,

.

.
, ( ),
,
,
.


( )


.
,

.


,
(Schaeffer, 1910).

Chavanez (1990)


,
,

(),
. Underwood (19)
:
1.

:
;
;
.
2. ,

- ,

.
3. ,
,

.

:
1. .
2.
-
.


,


:

1.

.
2. ,
,

(Chanavez, 1990).
Underwood (1910) 66%
(30 45 )
6,5 13 ,
,
(3:1). Ulm . (1995)
,
31,7% (13 41 ),
7,9 .
Kim . (2006),

100 (200
),
26%
(53/200).
:
25,4% , 50,8%
23,7 % .


.
. ,
,
3-4 .
,
,
.


(. 27.3).

1.
.
2.
.
3. .
4 , ,
.

1. - .
2.
-
.

1. .

451

, 27.3. . 04)
, . ( - D )
(
, )
,
.

2. .
3. .




(< 5 )

:
1. .
2. .
3. .

1. :
* ;

;
.
2. ,
.
3. .
4. .
5. , .
6.
.
7. .
8.
.
9.
.
10. .
11. .
12. .
13.
.

14.
15.

.
>2:1.

1=



.

,

.

, :
1. .
2.
().
> 2:1,


.
3. .


.
4. ,

(
).
5. ! .

5-7 .

,


(Misch, 1987):


;


;

.
6. .

(Engstrom
et al., 1988; Moskow, 1992) -


(Eberhardt et al., 1992)

( > 0,50)
,
:

(Evian et al., 2004).
Beaumont . (2005 )
, 41 % ,

, .





(. 27.4).


,
,

20-25 %


(Fredholm et al., 1993):
1.
.
2. .
3. .
4. .
5. .

()


.
,
,

.




(Rothman
et al., 1988: Solar et al., 1992; Ulm et al
1995).


(. 27.5, 27.6).

, 27.4, . () . ()
(> 1:1). () . (D) - . ()
. ( F )

. 27.5. .
()
.
. ( )
.

. ()
.

. ( D ) .
( )
. (F )
,
,

. 27.6. . ( )
. ( ) . ( )
. ( D )
, ,

, ,
()
/

.

1. :
;
.
2. :
;
;
.

3. :
;
;
;
;
.
4. :
();
(,
).
5. :

6.
7.
8.
9.

;
.
.

(Misch, 1984).
(
).
:
;

.

, 2 7 . 7 . (SA)
Misch.

. ( , ) SA-I. { C , D ) SA-2.
( E , F ) SA-3. ( G , H ) SA-4

I.

27.1,

Misch (1984, 1987)




,

(, 27.7).
2 .

SA - .

1. :
> 5 .
(. 27.1).
2. :
2,5 5 .



.
. Ulm . (1995) ,


, .

Misch (1999) ,
(SA-3 SA4; . . 27.1)
1993 .,

:
1.

.
2.
.
3.
.
4.
,
.
5.
,
.
6.
.
".

.

,
> 5
.

27.2.
VRH-1 > 12

VRH-2 >7-10

VRH-3 > 5 , < 7


(
)

VRH-4 < 4


6-8 .
6 .

VRH . , VRH-3 VRH-4


.

273.

500
()

1 . 3
710

150
()

300 1 .
150 3 7

, ,
, (Montgomery, 1985; Peterson, 1990; Misch, 1992).

1.
.
2. .
3. .
4. .
5.
.

. 27.2




.
*

Peleg .
(1998) Winter . (2002) ,

1 .

II.

(
(Sinus Consensus Con
ference), 1996; Del Fabbro et al., 2004;
Wallace, Froum, 2004).

:



. , ,
,
,
,
(Del Fabbro et
al., 2004; Wallace, Froum, 2004).

Misch (1992)


,


/
. ,

,
(. 27.3).


(Misch, Moore, 1989)
3 :

1. 9
.
2. 6 1-
.
3. 3 2-

Medrol:
6
.
:

1. (400-800 3
).
2. ()
6 .

1. ().
2. : 1 3
, 1
2
.


1. 0,05% 1
.
2. 1 %.


5

,
(
, ).
,
,

.


. 27.8, 27.9.

I.

1.
,
:
3-5
;
*

,

.
.
,
,
.

2.
(.
Langer . 7
)

.
8-10


,


().
.

, ,
,
.



.

.
3.

(. . 27.9, A-D):
.

,



.
,


.
.

,

.
4.
.


Molt (Smiler, 1992).


-

- ,

,
. ,

,
,
.
,

,

.

5.


3-0 4-0,

(Misch,
1992).

if.

1.
.

:
,
;
;


,
;


;

.
2. (
) (Rosenlicht, 1992).
-
,

,
,

,
.
3.


6 8

(50 000 ).

,

.

,

.

,
,
(
).
, . .

.


,
.
.

(Vesson, Petrik, 1992).

. 27.8. . ,
, , . (, )
. (, D) . ,
, , . ( E . F )
. (G , ) , .
( I ) . (/) .
. . (A',L ) ,
.


. 27.8. (). () , 360. (N)

. () . ( ) :
. : ,
. (Q ) , . (R ) ,
. ( S, ) ,
. (U, V) ,
. (W) . ( X)
CollaTape

. 27.8. (). () . ( Z ) . ( )

, . ,
. ( ) , . ( )
. ( D D ) . ( )
(F F ) . ( G G )
. (,) . (]])

[). ( )
. (LL)

. ( )

. ( N N )
10-12 . (00) 26.

. . ( )
,

. (QQ,RR) .
( S S )
. 27.8.

. 27.9. ( ). () . () .

() , . ,
10 . (D) . ,
. (,F) . . ( G)

. () .
. () . (/)
. () . ( L)
360

4.
3-4
,

.
20 .
,

,

,

,
.

,
(Smiler et al.,
1992).

.
I 3 (
)
.

5.


,

5

( ). (N) .

. () ,
. ()
. (Q)
, . ( R )

. (S, )
.

,


. 27.9.


. -

,

.
6.

20
.

,

.
. , ,
!.

7. (
)
10-15

(VRH-3
VRH-4; . . 27.2).

,


.
4-5
,
,

(,
)

(. . 27.9, ).
3-5
,
,
,
.


5
(. . 27.9, F).
8. ,


.
,

.
,

.
,

(. . 27.9, G, ).



.
,
()

.


, ,
,
.

(
)
(
).

10.

,
(Fugazzotto, 1994; Garg, Quinones, 1997).
,
- (. . 27.9,/,).
,

, :


.
,

.
,

Molton,


, .
.

, . .
,
,

. ,
( ).
,
.

.

,
,
.
(Garg, 1997,1999).

1.

.
2.
1:50 .
3. .
Gelfoam.
Surgicel.
Avatine.
.

1.


.
2.
,
, .

-
.

III.

(. . 27.8, J)

1.
,
.

,
(. . 27.8, L , M ) .
2.
,

,



.

,

.

, ,


.

,
,
.
(,
)
.



.
.

.

3. .



360.


/
,

, .
.

,
.

,
.

4.


.
,
.
, . .
.

,
.
5.

-
. ,
,

.

, 5-10 ,

,
,

.


(Friedman)
.
6.
,


, 16-20
(Misch, 1999).
.

,
,
.

7.
,

(Misch, 1996;
Tarnow, 2004) (. . 27.9, N ) .





-

(Jensen et al., 1994; Wheeler et al
1996; Froum et al., 1998; Mazor et al.,
1999; Misch, 1999; Pikos, 1999). Chanavez (2000) ,


()



,
. Proussaefs . (2004)


(14,17%)
(33,58%).

.
.

Misch (1999)
,


,

.

,
,
,
. Fugazzotto Vlassis (2003)
,

.



.
,
.

. 27.10. .
( )
. ( )
(
). ()
. ( D )
. ( )

,
(. 27.10).



60
(Tarnow, 2004). ,


.


.

.
. .
:
1.
.
2. .
3.
.
:
1.


.
2.

Gelfoam, Surgicel Collatape
(Garg et al., 1992; Rosenlicht, 1992;
Fugazzotto, 2003)

. .
1.

Collatape
(
)

(Biomend,
Resolute Adapt, BioGuide, Ossix). (Vassos,
Petrik, 1992)
,
,

.
.

,
.
.

2.



,

(Biomend,
Resolute Adapt, BioGuide, Ossix).
3. ,


(3-4 .) .

. ,
.
,

,

(.
.
. 27.9).

Loma Linda
(. 27.11).
Proussafs Lozada (2003) ,

,
,

.


.

Loma Linda ,
,



(Proussafs, Lozada, 2003).
,


,
,


.

(),

.
,

,



(. . 27.10). Fugazzotto
Vlassis (2003)
,
Loma Linda,
,
,

().
,
,

,
-
.

IV.
()



:
1) /
2) .


(Boyne et al., 1980; Smiler et al.,
1994; Lundgren et al., 1996; Chanavaz,
1996, 2000; Valentini et al., 1997, 2000;
Jensen et al., 1998; Tong et al., 1998;
Wood, Moore, 1988; Del Fabbro et al.,
2004; Wallace, Froum, 2004).
Ll3
,


.
(
),
,
,

(Vlassis et al., 1993).
,


;


...
,

,
,
(Nevins
et al., 1996). Misch (1996) Wallace
Froum (2004)

,
,
.

( , . ,
,

,
,
Pikos (1999). ,
)


,

.
, ,



,
. , ,

, ,

,
,
()
(94,88 % )
(95,98%)
(94%)


(< 10-12 .)

(Wallace,
1996; Froum et al., 1998; Jensen et al.,
1998; Misch, 1999; Valentini et al., 2000;
Del Fabbro et al., 2004 ; Froum, Wallace,
2004).
.

1. :
:
;

;

;

.
2. :

;

;
;

:
.
.

1. :
(
);
;
;


:
;
.
2. :
;

.
(CaSO+),

^. 27.11. Loma Linda. () ,


. ( ) .

, , ,
. () . ( D )
. . ( )
. ( F ) (),
. () .
() . (/)
. (/) ,
. (), .
( ) . ( )
, , .
Dr. Perklias Proussaefs, Loma Linda, CA, Quintessence Publishing Co

27=4


(
CaSO, 4:1) (Sottosanti, Horowitz, |


, %
2003; Guarnieri et al., 2004);
Jensen et al., 1998
2 997
1 007
90
1.
Tong et al., 1998
1 097
295
93

Wallace, Froum, 2004


5 277
2 178
92,6
.
Del Fabbro et al., 2004
2 046
6 990
91,5
'
2. (
, (> 10-12 .)
) .
. Tarnowc . (1998) , 24% ( 9-34%)
3.
6- 9- ., 33% ( 10-65%)
12- 15- .
()
.

4. .
, ,
5.

.
() .

Tarnow (2004) ,
(92,3 83,3%).
4.


.
:

1. (> 12-15 .).

(93,6
2. :
;
88,7%).

5.
*
(. . 27.9, ).
4.
.


3. .
(897

89,6/).

w ..
6.
,




(Smiler, Holms, 1987).
, .
,
,
.


.

.

( )
.

, 1.
U -'-- : ; ' - / 1 -
()

,
- .
(. 27.4).
.

2.
5.
:
(

1.
500 , 150 ).

,

.

,



,

.


3.
,
(92 95,1 %),

, . .
,

1
.
,
, /
,
IV (Jaffin, Berman, 1991) , 1- ,
(92 65 %).

Cera Med Surgical Supply.
2.

( >;

,
,

, .
, ,
15 (Gargand Quinones, .
1997),
(95,111
,
, 6. ,
82,4%).



3. ()
.


(. . 27.9, 0).

470
300 3 .

,

.


.
, ,
,



.

1.

Caldwell-Luc,

-,



.
2.

* ^ * <

3.



, :
*
;

;
*
.
4.
,

.
,

12-14 .
.

. .
, ,
.


. 27.12-27.15.

v: ft a s' s a

. 27.12. , . (,)

. (, D ) - , .
() . (F) , .
. (G) , . () . (/) .
6 .; , , ; ;
. (/) . ( )
. (L) , .

. 27.13, -
,
. 27.12.
. :
(4) 24; ( ) 25; ( ) 26.
: (/) 24; (') 25
() 26

, 27,14. -, . (,)
. () . (I )) . ()
. (). (F ) .
. (G) ,
. () . ( I )

. 27.14, (). { ] )
. ( ) Gore-Tex
. (L )

. ( )
12 . . (N )
Gore-Tex
. ()
.
. ( )

. 27,15. . . ( )
. ( ) . ( )
. ( D ) , . ( ) ,
. (F ) . . (G ) .
-. () ( ) ,
. (/) . {/)

. 27.15. ( ) . ( ) (13).
. ( L )
( ) . (
() . ( )
. . ( Q )
. ( R ) 2 .
. . ( S )
. ( , U ) 5







,

.


,
( ),

.


,

.


()
,


() .


4 7 ,
15
20 (
1-3 )
10 .

,

21 10 7 .




,
.

,
III (
, )

( ),
(

()

/
). ,

,
,


,
.


4 , 30
10 .




.

,
. ,

,
,


.


. ,



.
,
,


.
.

,


.

,


.



,


.
(
)
,

,

.
,



.

,


. . 27.1

(),

27.1.

( )


, 1




-
> 1 3
< 1 '


2 > 1
()


/




I.

.
1. .
2. .
3.

.
4.

.
5. .
6.

.
7.
.

2 >1

()


()

8.
,
.
9.
,

.

1.
() .
2.
.
3.
.
4.
.
5. ()
.
6.
.
7.

.

C.
1.

1 > 2

B.

-
> 1,5 3


.
2.
.

3. ,

.
4.
!
.

D.
1.
:

;
;
;
.
2. ()

.
3. .

E.
1. :
:

;
:
;
;
:
;
;
;


;
s
;
3 :
* (
):
j
;
j
;

;
;
():

;

;
(

),

-

.
2. :
*
:
1
300 ,

;

(
).
!I : ! , ,
3
.

:


;
:
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