E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance

∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP

(Vorschubdoppelplatte, Bite jumping appliance, Sander II).
∞Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ Î·È ·ÚÔ˘Û›·ÛË Ì›·˜ ¯·Ú·ÎÙËÚÈÛÙÈ΋˜
ÎÏÈÓÈ΋˜ ÂÚÈÙÒÛˆ˜
Franz Günter Sander,1 º›ÏÈÔ˜ ¡. ™˘ÓÔ‰ÈÓfi˜,2 ∂ÌÌ·ÓÔ˘‹Ï πÁÁϤ˙Ô˜,3 Martin Sander,3
∞ÈηÙÂÚ›ÓË πÁÁϤ˙Ô˘,4 Christian Sander3
1
∫·ıËÁËÙ‹˜ Î·È ¢È¢ı˘ÓÙ‹˜, ∂ÚÁ·ÛÙ‹ÚÈÔ √ÚıÔ‰ÔÓÙÈ΋˜, √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹, ¶·ÓÂÈÛÙ‹ÌÈÔ Ulm, °ÂÚÌ·Ó›·.
2
√ÚıÔ‰ÔÓÙÈÎfi˜, ∞ı‹Ó·.
3
√ÚıÔ‰ÔÓÙÈÎfi˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘, ∂ÚÁ·ÛÙ‹ÚÈÔ √ÚıÔ‰ÔÓÙÈ΋˜, √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹, ¶·ÓÂÈÛÙ‹ÌÈÔ Ulm, °ÂÚÌ·Ó›·.
4
O‰ÔÓÙÔÙ¯ӛÙÚÈ·., ∞ı‹Ó·.

The functional orthodontic-orthopedic VDP appliance

(Vorschubdoppelplatte, Bite jumping appliance, Sander II).
Literature review and typical clinical case presentation
Franz Günter Sander,1 Filippos N. Synodinos,2 Emmanouil Iglezos,3 Martin Sander,3
Ekaterini Iglezou,4 Christian Sander3
1
Professor and Chairman, Department of Orthodontics, School of Dentistry, University of Ulm, Germany.
2
Orthodontist, Athens.
3
Orthodontist, Research Associate, Department of Orthodontics, School of Dentistry, University of Ulm, Germany.
4
Dental Technician, Athens.

¢OMHMENH ¶EPI§HæH STRUCTURED ABSTRACT

™ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ ÂÚÈÁÚ¿ÊÔÓÙ·È, Ì ‚¿ÛË ÙË Û‡Á-
¯ÚÔÓË ‚È‚ÏÈÔÁÚ·Ê›·, ÔÈ ÂӉ›ÍÂȘ ÂÊ·ÚÌÔÁ‹˜ Î·È ÔÈ
Ì˯·ÓÈÛÌÔ› ‰Ú¿Û˘ Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ÔÚıÔ‰ÔÓÙÈ΋˜-
ÔÚıÔ·È‰È΋˜ Û˘Û΢‹˜ VDP (Vorschubdoppelplatte,
Bite jumping appliance, Sander II). π‰È·›ÙÂÚË ¤ÌÊ·ÛË
‰›ÓÂÙ·È ÛÙË Û‡ÁÎÚÈÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘ ÂÊ·Ú-
ÌÔÁ‹˜ Ù˘ Û ۯ¤ÛË Ì ¿ÏÏ· ÏÂÈÙÔ˘ÚÁÈο ÔÚıÔ‰ÔÓÙÈ-
ο Ì˯·Ó‹Ì·Ù·. ∞ÎfiÌË, ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì›· ¯·Ú·ÎÙË-
ÚÈÛÙÈ΋ ÎÏÈÓÈ΋ ÂÚ›ÙˆÛË Î·Ù¿ ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋
·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÔ›·˜ ÂÊ·ÚÌfiÛıËÎÂ Ë Û˘Û΢‹
VDP. √È ÂȉڿÛÂȘ Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜ VDP
ÛÙÔ Ô‰ÔÓÙÔÛÎÂÏÂÙÈÎfi Û‡ÛÙËÌ· Â›Ó·È Î˘Ú›ˆ˜ ÛÎÂÏÂÙÈ-
΋˜ ʇÛˆ˜ Î·È ·ÊÔÚÔ‡Ó ÙfiÛÔ ÛÙËÓ Â›Ù·ÛË Ù˘
·‡ÍËÛ˘ Ù˘ οو ÁÓ¿ıÔ˘ fiÛÔ Î·È ÛÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘
·‡ÍËÛ˘ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ÚÔ˜ Ù· ÂÌÚfi˜. ∏ ÂÊ·ÚÌÔ-
Á‹ Ù˘ Û˘Û΢‹˜ VDP ÁÂÓÈο, ÏÂÔÓÂÎÙ› ¤Ó·ÓÙÈ ÙÔ˘
Û˘ÓfiÏÔ˘ ÙˆÓ ¿ÏÏˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ-
ÔÚıÔ·È‰ÈÎÒÓ Ì˯·ÓËÌ¿ÙˆÓ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê›
ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, ηıÒ˜ Û˘Ó‰˘¿˙ÂÈ ÙËÓ ‰Ú¿ÛË Ù˘
ÛÙÔ ÚÔÛıÈÔ›ÛıÈÔ Â›Â‰Ô ÙÔ˘ ÎÚ·ÓÈÔÚÔÛˆÈÎÔ‡
This paper describes the indications and action mech-
anisms of the functional orthodontic-orthopedic VDP
appliance (Vorschubdoppelplatte, Bite jumping appli-
ance, Sander II) on the basis of modern literature.
Special emphasis is placed on comparing the VDP
appliance results to those of other functional ortho-
dontic appliances. Furthermore, a typical clinical case
where the VDP appliance was used is presented. The
effects of this appliance on the dentoskeletal system
are mainly of skeletal nature and concern both
enhancement of mandibular growth and inhibition of
forward maxillary growth. Application of the VDP
appliance is overall superior to all other functional
orthodontic-orthopedic appliances described in the
literature, as it has a combined action on both sagittal
and transverse dimensions of the craniofacial com-
plex, while it also controls the vertical facial dimen-
sion. Furthermore, depending on individual clinical
characteristics, the main functional orthodontic-
orthopedic action of the appliance may be combined

E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2007 ñ TOMO™ 10 ñ TEYXO™ 1 11

∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance
Û˘ÌϤÁÌ·ÙÔ˜ Ì ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÔÚıÔ‰ÔÓÙÈ-
ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙÔ ÂÁοÚÛÈÔ Â›Â‰Ô Î·È ÙÔÓ Ù·˘-
Ùfi¯ÚÔÓÔ ¤ÏÂÁ¯Ô Ù˘ οıÂÙ˘ ‰È¿ÛÙ·Û˘ ÙÔ˘ ÚÔÛÒ-
Ô˘. ∞ÎfiÌË, ·Ó¿ÏÔÁ· Ì ٷ ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο
οı ÂÚ›ÙˆÛ˘, Ë Î‡ÚÈ· ÏÂÈÙÔ˘ÚÁÈ΋ ÔÚıÔ‰ÔÓÙÈ΋-
ÔÚıÔ·È‰È΋ ‰Ú¿ÛË Ù˘ Û˘Û΢‹˜ ÌÔÚ› Ó· Û˘Ó‰˘¿-
˙ÂÙ·È Ì ÙËÓ Ù·˘Ùfi¯ÚÔÓË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË
Â› ̤ÚÔ˘˜ ÔÚıÔ‰ÔÓÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÔÌ¿‰·˜
‰ÔÓÙÈÒÓ Ì ÙËÓ ÂÓۈ̿وÛË Ì›·˜ ÛÂÈÚ¿˜ ÂÍ·ÚÙËÌ¿-
ÙˆÓ ÛÙ· ‰‡Ô Ì˯·Ó‹Ì·Ù· Ô˘ ÙËÓ ··ÚÙ›˙Ô˘Ó. ∏
Û˘Û΢‹ VDP ‰È·ÙËÚ› ÙË ‰Ú¿ÛË Ù˘ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘
‡ÓÔ˘ ηıÒ˜ ÔÈ Ô‰ËÁÔ› ‚Ú·¯›ÔÓ˜ ‰ÂÓ ÂÈÙÚ¤Ô˘Ó ÙËÓ
·ÔÛ˘Ó·ÚÌÔÁ‹ ÙˆÓ ‰‡Ô Ì˯·ÓËÌ¿ÙˆÓ ÛÙË Ê˘ÛÈÔÏÔ-
ÁÈ΋ ı¤ÛË Î·Ù¿Û·Û˘ Ù˘ οو ÁÓ¿ıÔ˘. ∏ ÂÊ·ÚÌÔÁ‹
Ù˘ Û˘Û΢‹˜ VDP ÂӉ›ÎÓ˘Ù·È Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ
ÛÎÂÏÂÙÈÎÒÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ∆¿Í˘ ππ.
§¤ÍÂȘ ÎÏÂȉȿ: VDP, bite jumping appliance, ÏÂÈÙÔ˘ÚÁÈ-
ο Ì˯·Ó‹Ì·Ù·, ÔÚıÔ‰ÔÓÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ∆¿Í˘ ππ
∂ÏÏ √ÚıÔ‰ ∂Èı 2007;10:11-27.
¶·ÚÂÏ‹ÊıË: 20.03.2006 – ŒÁÈÓ ‰ÂÎÙ‹: 14.11.2006
EI™A°ø°H
∆· ÏÂÈÙÔ˘ÚÁÈο ÔÚıÔ‰ÔÓÙÈο-ÔÚıÔ·È‰Èο Ì˯·Ó‹Ì·Ù·/
Û˘Û΢¤˜ ıˆÚÔ‡ÓÙ·È, ·fi ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÎÏÈÓÈÎÒÓ
ÔÚıÔ‰ÔÓÙÈÎÒÓ, ˆ˜ ¯Ú‹ÛÈÌ· ÂÚÁ·Ï›· Ô˘ Â͢ËÚÂÙÔ‡Ó
ÙËÓ Â˘ÓÔ˚΋ ÙÚÔÔÔ›ËÛË Ù˘ ‰È‡ı˘ÓÛ˘ Ù˘ ·‡ÍËÛ˘
ÙÔ˘ ÎÚ·ÓÈÔÚÔÛˆÈÎÔ‡ Û˘ÌϤÁÌ·ÙÔ˜ (∫¶™) Û ÂÈÏÂÁ̤-
Ó˜ ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ì ˘ÔÏÂÈfiÌÂÓÔ ·˘ÍËÙÈÎfi
‰˘Ó·ÌÈÎfi (Bjork, 1951; Balters, 1964; Sergl, 1980; Bass,
1982; van Beek, 1982; Rakosi, 1997a; Mauck Î·È Û˘Ó.,
1999). ∞Ó Î·È Ë Ú·ÁÌ·ÙÈ΋/ ·ÏËıÈÓ‹ ÔÚıÔ·È‰È΋ ‰Ú¿ÛË
ÙÔ˘˜ Û ‚¿ıÔ˜ ¯ÚfiÓÔ˘, ·ÔÙÂÏ› ̤¯ÚÈ Û‹ÌÂÚ· ·ÓÙÈΛÌÂ-
ÓÔ ÂÎÙÂٷ̤Ó˘ ÂÈÛÙËÌÔÓÈ΋˜ ¤Ú¢ӷ˜ Î·È Û˘˙‹ÙËÛ˘
(Bjork, 1951; Harvold Î·È Vargervik, 1971; Pancherz,
1984; Nelson Î·È Û˘Ó., 1993; Aelbers Î·È Dermaut, 1996;
Moore, 1997), ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Ì›· ÛÂÈÚ¿ ÏÂÈÙÔ˘ÚÁÈÎÒÓ
Ì˯·ÓËÌ¿ÙˆÓ Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÔÔ›ˆÓ ıˆÚÂ›Ù·È fiÙÈ Û˘Ì-
‚¿ÏÂÈ ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË
ÔÏÏÒÓ ÂÚÈÙÒÛÂˆÓ Ì ÛÎÂÏÂÙÈ΋˜ ʇÛˆ˜ ÔÚıÔ‰ÔÓÙÈ-
Τ˜ ·ÓˆÌ·Ï›Â˜ ∆¿Í˘ ππ (Rakosi, 1997a).
ªÂٷ͇ ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ-ÔÚıÔ·È‰ÈÎÒÓ
Û˘Û΢ÒÓ/ Ì˯·ÓËÌ¿ÙˆÓ Ô˘ ¤¯Ô˘Ó Ù‡¯ÂÈ Â˘Ú‡ÙÂÚ˘ ÎÏÈ-
ÓÈ΋˜ ÂÊ·ÚÌÔÁ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë Û˘Û΢‹ Bionator
(Balters, 1964), Ô ÂÓÂÚÁÔÔÈËÙ‹˜ (activator) Î·È ÔÈ ·Ú·Ï-
Ï·Á¤˜ ÙÔ˘ (Rakosi, 1997b), Ë Û˘Û΢‹ Fränkel (Graber,
1997), Ë Û˘Û΢‹ Twin Block (Clark, 1991, 1997) Î·È Ë
12
HELLENIC ORTHODONTIC REVIEW
with simultaneous treatment of problems in groups of
teeth, using various components incorporated in the
two appliances that constitute the VDP. The appliance
maintains its action during sleep, as its arm-guides do
not allow disassembling of the two appliances at the
normal mandibular opening position. Application of
the VDP appliance is indicated in many cases of skele-
tal Class II malocclusion.
Key words: VDP, bite jumping appliance, functional
appliances, Class II malocclusion.
Hell Orthod Rev 2007;10:11-27.
Received: 20.03.2006 – Accepted: 14.11.2006
INTRODUCTION
Functional orthodontic-orthopedic appliances are consid-
ered by the majority of clinical orthodontists to be use-
ful tools for favorable craniofacial growth modification
in selected cases of patients with residual growth poten-
tial (Björk, 1951; Balters, 1964, Sergl, 1980; Bass, 1982;
van Beek, 1982; Rakosi, 1997a; Mauck et al., 1999).
Although their long-term purely orthopedic action is the
subject of extensive scientific research and discussion to
date (Björk, 1951; Harvold and Vargervik, 1971;
Pancherz, 1984; Nelson et al., 1993; Aelbers and Der-
maut, 1996; Moore, 1997), several functional appliances
considered to contribute to effective therapeutic man-
agement of many skeletal Class II cases have been
described (Rakosi, 1997a).
Functional appliances with wider clinical application
include the Bionator (Balters, 1964), the activator and its
different versions (Rakosi, 1997b), the Fränkel functional
regulator (Graber, 1997), the Twin Block (Clark, 1991,
1997) and the Herbst appliance (Pancherz, 1997) as well
as its different versions (Jasper et al., 1997). The results
of most of these appliances concerning induction /
enhancement of mandibular growth or/and restriction /
inhibition of maxillary complex growth are attributed to
almost exclusively dentoalveolar effects (Tulley, 1972;
Robertson, 1983; Chadwick et al., 2001) or the latter
combined with relatively limited orthopedic/skeletal
changes (Schadlbauer, 1984; Jacobsson and Paulin, 1990;
Albers and Dermaut, 1996; Moore, 1997; Ghafari et al.,
1998). Furthermore, unfavorable skeletal effects con-
cerning the vertical craniofacial dimension or/and unde-
sirable tooth movements are often observed as a result
HELLENIC ORTHODONTIC REVIEW 2007 ñ VOLUME 10 ñ ISSUE 1
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance
Û˘Û΢‹ Herbst (Pancherz, 1997) Î·È ÔÈ ·Ú·ÏÏ·Á¤˜ Ù˘
(Jasper Î·È Û˘Ó., 1997). ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÂÊ·ÚÌÔÁ‹˜
ÙˆÓ ÂÚÈÛÛÔÙ¤ÚˆÓ ·fi ÙȘ Û˘Û΢¤˜/ Ì˯·Ó‹Ì·Ù· ·˘Ù¿,
fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂȉȈÎfiÌÂÓË Â·ÁˆÁ‹/ Â›Ù·ÛË Ù˘
·‡ÍËÛ˘ Ù˘ οو ÁÓ¿ıÔ˘ ‹/ Î·È ÛÙËÓ ·Ó·ÛÙÔÏ‹/ ·Ó·¯·›-
ÙËÛË Ù˘ ·‡ÍËÛ˘ ÙÔ˘ ¿Óˆ ÁÓ·ıÈ·›Ô˘ Û˘ÌϤÁÌ·ÙÔ˜ ·Ô-
‰›‰ÂÙ·È Â›Ù Û ۯ‰fiÓ ·ÔÎÏÂÈÛÙÈο Ô‰ÔÓÙÔÊ·ÙÓȷΤ˜ ÂÈ-
‰Ú¿ÛÂȘ (Tulley, 1972; Robertson, 1983; Chadwick ηÈ
Û˘Ó., 2001) ‹ ÛÂ Û˘Ó‰˘·ÛÌfi ÙÔ˘˜ Ì ۯÂÙÈο ÂÚÈÔÚÈṲ̂-
Ó˜ ÔÚıÔ·È‰ÈΤ˜ / ÛÎÂÏÂÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ (Schadlbauer,
1984; Jakobsson Î·È Paulin, 1990; Aelbers Î·È Dermaut,
1996; ªoore, 1997; Ghafari Î·È Û˘Ó., 1998). ∂ÈϤÔÓ, ˆ˜
·ÔÙ¤ÏÂÛÌ· Ù˘ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘˜ Û˘¯Ó¿ ·Ú·ÙËÚÔ‡ÓÙ·È
‰˘ÛÌÂÓ›˜ ÛÎÂÏÂÙÈΤ˜ ÂȉڿÛÂȘ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ Î¿ıÂ-
ÙË ‰È¿ÛÙ·ÛË ÙÔ˘ ∫¶™ ‹/ Î·È Û ·ÓÂÈı‡ÌËÙ˜ ÌÂÙ·ÎÈÓ‹ÛÂȘ
‰ÔÓÙÈÒÓ. ŒÙÛÈ, ηٿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÂÚÈÛÛÔÙ¤ÚˆÓ ÏÂÈ-
ÙÔ˘ÚÁÈÎÒÓ Ì˯·ÓËÌ¿ÙˆÓ, Ô ıÂÚ¿ˆÓ ÎÏÈÓÈÎfi˜ ¯ÚÂÈ¿˙ÂÙ·È
Ó· ÙÚÔÔÔÈ› ÙÔ Û¯¤‰ÈÔ ıÂÚ·›·˜ ·Ó¿ÏÔÁ·, Ì ÛÎÔfi
ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ οıÂÙ˘ ‰È¿ÛÙ·Û˘ ÙÔ˘ ÚÔÛÒÔ˘ Î·È ÙˆÓ
·ÍÔÓÈÎÒÓ ÎÏ›ÛÂˆÓ ÙˆÓ ‰ÔÓÙÈÒÓ, ȉȷ›ÙÂÚ· Û ÂÚÈÙÒÛÂȘ
Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi (Tulley, 1972; Aelbers ηÈ
Dermaut, 1996; Rakosi, 1997a; ªoore, 1997):
– ηٷÎfiÚ˘ÊË ‰È‡ı˘ÓÛË ·‡ÍËÛ˘ ÙÔ˘ ÚÔÛÒÔ˘
– ˘ÂÚ·ÔÎÏ›ÓÔÓÙ· Ù‡Ô ÚÔÛÒÔ˘
– ·˘ÍË̤ÓÔ Î¿Ùˆ ÚfiÛıÈÔ ‡„Ô˜ ÚÔÛÒÔ˘
– ÚfiÛıÈ· ·ÓˆÁ̤ÓË ‰‹ÍË
– Ù¿ÛË ÂÌÊ¿ÓÈÛ˘ ÚfiÛıÈ·˜ ·ÓˆÁ̤ÓË ‰‹ÍË
– ¤ÓÙÔÓÔ Û˘ÓˆÛÙÈÛÌfi ‹ Î·È ¤ÓÙÔÓË ¯ÂÈÏÈ΋ ·fiÎÏÈÛË ÙˆÓ
ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ Ù˘ οو ÁÓ¿ıÔ˘
– ¤ÓÙÔÓÔ Û˘ÓˆÛÙÈÛÌfi ‹ ˘ÂÚÒÈ· ·fiÎÏÈÛË ÙˆÓ ¿Óˆ
ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ
– ·Ó¿ÁÎË ÂÊ·ÚÌÔÁ‹˜ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Ì ÂÍ·Áˆ-
Á¤˜ ÌÔÓ›ÌˆÓ ‰ÔÓÙÈÒÓ
ªÂٷ͇ ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ-ÔÚıÔ·È‰ÈÎÒÓ
Û˘Û΢ÒÓ/ Ì˯·ÓËÌ¿ÙˆÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë Û˘Û΢‹
VDP (Vorschubdoppelplatte, ÂÓÒ ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ·ÁÁÏÈ-
΋ ‚È‚ÏÈÔÁÚ·Ê›· Î·È ˆ˜ BJA, bite jumping appliance)
(Sander, 1991). ∏ Û˘Û΢‹ ·˘Ù‹ ·ÔÙÂÏ› Ì›· ȉȷ›ÙÂÚ·
¯Ú‹ÛÈÌË Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ (Û ۯ¤ÛË Ì ÙȘ ¿ÏϘ ÏÂÈ-
ÙÔ˘ÚÁÈΤ˜ Û˘Û΢¤˜/ Ì˯·Ó‹Ì·Ù·) ÂÓ·ÏÏ·ÎÙÈ΋ ıÂÚ·¢-
ÙÈ΋ ÂÈÏÔÁ‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Ô‰ÔÓÙÔÛÎÂÏÂÙÈÎÒÓ
ÔÚıÔ‰ÔÓÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ∆¿Í˘ ππ (Sander, 1985; 1988a;
1988b; 1988c, Sander Î·È Wichelhaus, 1995). ∏ Û˘Û΢‹
VDP ÂÈÓÔ‹ıËΠ·fi ÙÔÓ ∫·ıËÁËÙ‹ FG. Sander Î·È Ë
ηٷÛ΢‹ Ù˘ ÔÏÔÎÏËÚÒıËΠ̠‚¿ÛË Ù· ‰Â‰Ô̤ӷ ·fi
ÙË Û¯ÂÙÈ΋ ÎÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ¤Ú¢ӷ (Sander,
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2007 ñ TOMO™ 10 ñ TEYXO™ 1
of the use of such appliances. Thus, during the applica-
tion of most functional appliances, the clinician needs to
modify the treatment plan accordingly, so as to control
the vertical dimension and axial tooth inclinations, espe-
cially in cases characterized (Tulley, 1972; Albers and Der-
maut, 1996; Rakosi, 1997a; Moore, 1997) by:
– vertical facial growth pattern
– hyperdivergent facial type
– increased lower anterior facial height
– anterior open bite
– tendency for anterior open bite
– severe crowding or even severe flaring of lower ante-
rior teeth
– severe crowding or palatal tipping of maxillary anteri-
or teeth
– orthodontic treatment comprising extractions of per-
manent teeth.
The VDP appliance (Vorschubdoppelplatte; also referred
to as the BJA appliance, Bite Jumping Appliance, in Eng-
lish orthodontic literature) is a functional orthodontic-
orthopedic appliance (Sander, 1991). This appliance is a
useful and effective (compared to other functional appli-
ances) therapeutic alternative for the treatment of den-
toskeletal Class II malocclusion (Sander, 1985; 1988a;
1988b; 1988c; Sander and Wichelhaus, 1995). The VDP
was invented by Professor F. G. Sander and its construc-
tion was completed on the basis of data from relevant
clinical and laboratory research (Sander, 1989a; 1989b;
Sander and Lassak, 1990; Sander and Wichelhaus, 1994,
1995) performed at the Orthodontic Clinic of the School
of Dentistry of the University of Ulm, Germany.
This paper describes the principles of the VDP action
mechanism and discusses its dentoskeletal effects as
compared to other functional orthodontic appliances. A
typical clinical case where the VDP appliance was used is
also presented.
DESCRIPTION OF THE VDP APPLIANCE AND PRINCIPLES
OF ITS ACTION MECHANISM
The simple classical form of the VDP appliance includes
two removable orthodontic components, a maxillary and
a mandibular one, each one incorporating a special-type
of jackscrew (Sander, 1988b) (Fig.1).
The functional action of the appliance is effected
13
∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance
1989a, 1989b; Sander Î·È Lassak, 1990; Sander ηÈ
Wichelhaus, 1994, 1995), Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÙËÓ
∫ÏÈÓÈ΋ Ù˘ √ÚıÔ‰ÔÓÙÈ΋˜ Ù˘ √‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘
¶·ÓÂÈÛÙËÌ›Ô˘ ÙÔ˘ Ulm, °ÂÚÌ·Ó›·.
™ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈ ‚·ÛÈΤ˜ ·Ú¯¤˜ ÙÔ˘
Ì˯·ÓÈÛÌÔ‡ ‰Ú¿Û˘ Ù˘ Û˘Û΢‹˜ VDP Î·È Û˘˙ËÙÔ‡ÓÙ·È
ÔÈ Ô‰ÔÓÙÔÛÎÂÏÂÙÈΤ˜ ÂȉڿÛÂȘ ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘
Û˘Û΢‹˜ VDP Û ۇÁÎÚÈÛË Ì ¿ÏÏ· ÔÚıÔ‰ÔÓÙÈο ÏÂÈ-
ÙÔ˘ÚÁÈο Ì˯·Ó‹Ì·Ù·. ∞ÎfiÌË, ı· ·ÚÔ˘ÛÈ·Ûı› Ì›·
¯·Ú·ÎÙËÚÈÛÙÈ΋ ÎÏÈÓÈ΋ ÂÚ›ÙˆÛË, ηٿ ÙË ıÂÚ·¢ÙÈ΋
·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÔ›·˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Û˘Û΢‹
·˘Ù‹.
¶∂ƒπ°ƒ∞º∏ ∆∏™ ™À™∫∂À∏™ VDP ∫∞π µ∞™π∫∂™ ∞ƒÃ∂™ ∆√À
ª∏Ã∞¡π™ª√À ¢ƒ∞™∏™ ∆∏™
™ÙËÓ ·Ï‹ Ù˘È΋ / ÎÏ·ÛÛÈ΋ Ù˘ ÌÔÚÊ‹ Ë Û˘Û΢‹ VDP
ÂÚÈÏ·Ì‚¿ÓÂÈ ‰‡Ô ÎÈÓËÙ¿ ÔÚıÔ‰ÔÓÙÈο Ì˯·Ó‹Ì·Ù· ¤Ó·
ÁÈ· ÙËÓ ¿Óˆ Î·È ¤Ó· ÁÈ· ÙËÓ Î¿Ùˆ ÁÓ¿ıÔ, οı ¤Ó· ÂÎ ÙˆÓ
ÔÔ›ˆÓ ‰È·ı¤ÙÂÈ ÂÓۈ̷و̤ÓË ÂÍÂÏ›ÎÙÚ· ÂȉÈÎÔ‡ Ù‡Ô˘
(Sander, 1988b) (∂ÈÎ. 1).
∏ ÏÂÈÙÔ˘ÚÁÈ΋ ‰Ú¿ÛË Ù˘ Û˘Û΢‹˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì¤Ûˆ
Ù˘ Û˘Ó·ÚÌÔÁ‹˜ ÙˆÓ ‰‡Ô Ì˯·ÓËÌ¿ÙˆÓ ÛÙËÓ ÚÔÁÚ·ÌÌ·-
ÙÈṲ̂ÓË (Ì ‚¿ÛË ÙÔÓ ıÂÚ·¢ÙÈÎfi ۯ‰ȷÛÌfi) ı¤ÛË ÚÔ-
ÔÏ›ÛıËÛ˘ Î·È Î·Ù¿Û·Û˘ Ù˘ οو ÁÓ¿ıÔ˘ Ì ÙËÓ ‚Ô‹-
ıÂÈ· ÙˆÓ ‰‡Ô ‚Ú·¯ÈfiÓˆÓ Ô˘ Û˘Ó¤¯ÔÓÙ·È Ì ÙËÓ ÂÍÂÏ›ÎÙÚ·
ÙÔ˘ Ì˯·Ó‹Ì·ÙÔ˜ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ Î·È ÁÏÈÛÙÚÔ‡Ó Û ·ÓÙ›-
∂ÈÎfiÓ· 1. ∞ÂÈÎÔÓ›˙ÔÓÙ·È Ù· ‰‡Ô ÎÈÓËÙ¿ ÔÚıÔ‰ÔÓÙÈο Ì˯·Ó‹Ì·Ù·
Ô˘ ··ÚÙ›˙Ô˘Ó ÙËÓ Û˘Û΢‹ VDP, οı ¤Ó· ÂÎ ÙˆÓ ÔÔ›ˆÓ ‰È·ı¤-
ÙÂÈ ÂÓۈ̷و̤ÓË ÂÍÂÏ›ÎÙÚ· ÂȉÈÎÔ‡ Ù‡Ô˘.
Figure 1. The two removable appliances constituting the VDP are
shown; each appliance has a special-type jackscrew.
14
HELLENIC ORTHODONTIC REVIEW
through the way that its two removable parts are assem-
bled at the desirable mandibular position of protrusion
and opening, according to the treatment design; this is
aided by the two arm-guides that are connected to the
maxillary appliance jackscrew and slide against an
inclined plane in the middle of the anterior lingual sur-
face of the mandibular appliance (Figures 2 and 3).
The construction bite determines the articulating posi-
tion of the two VDP components; the mandible is
brought by the clinician to a position of 5-7 mm of pro-
trusion (in an edge-to-edge incisor relationship) and 2-3
mm of opening at the anterior dental arch region (Fig. 4).
The maximum permissible mandibular protrusion is con-
∂ÈÎfiÓ· 2. ∞ÂÈÎÔÓ›˙ÂÙ·È Û¯Â‰È·ÁÚ·ÌÌ·ÙÈο Ô ÙÚfiÔ˜ Û˘Ó·ÚÌÔÁ‹˜ ÙˆÓ
‰‡Ô Ì˯·ÓËÌ¿ÙˆÓ Ù˘ Û˘Û΢‹˜ VDP, ηıÒ˜ ÔÈ Ô‰ËÁÔ› ‚Ú·¯›ÔÓ˜ ÙÔ˘
Ì˯·Ó‹Ì·ÙÔ˜ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ÁÏÈÛÙÚÔ‡Ó Û ·ÓÙ›ÛÙÔÈ¯Ë ÂÈÎÏÈÓ‹ ÂÈ-
Ê¿ÓÂÈ· Ô˘ Â›Ó·È ‰È·ÌÔÚʈ̤ÓË ÛÙË ÁψÛÛÈ΋ ÂÈÊ¿ÓÂÈ· ÙÔ˘ Ì˯·-
Ó‹Ì·ÙÔ˜ Ù˘ οو ÁÓ¿ıÔ˘ [∞fi: Sander (2005), ηÙfiÈÓ ·‰Â›·˜].
Figure 2. Fitting of the VDP appliance is schematically presented;
the arm-guides of the maxillary appliance slide against the inclined
plane on the lingual surface of the mandibular appliance [From:
Sander (2005), after permission].
HELLENIC ORTHODONTIC REVIEW 2007 ñ VOLUME 10 ñ ISSUE 1
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance

∂ÈÎfiÓ· 3. ∞ÂÈÎÔÓ›˙ÂÙ·È Ë Û˘Ó·ÚÌÔÁ‹ ÙˆÓ Ô‰ËÁÒÓ ‚Ú·¯ÈfiÓˆÓ ÙÔ˘

Ì˯·Ó‹Ì·ÙÔ˜ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ÛÙËÓ ÂÈÎÏÈÓ‹ ÂÈÊ¿ÓÂÈ· ÙÔ˘ Ì˯·Ó‹-
Ì·ÙÔ˜ Ù˘ οو ÁÓ¿ıÔ˘ Ù˘ Û˘Û΢‹˜ VDP, ÛÙËÓ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË
ı¤ÛË ÚÔÒıËÛ˘ Î·È Î·Ù¿Û·Û˘ Ù˘ οو ÁÓ¿ıÔ˘, fiˆ˜ ·Ó··-
Ú¿ÁÂÙ·È ÛÙÔÓ ·ÚıÚˆÙ‹Ú·.

Figure 3. Fitting of the arm-guides of the maxillary appliance

against the inclined plane on the lingual surface of the mandibular
appliance at the desirable mandibular position (protrusion and
opening) reproduced on the articulator.

ÛÙÔÈ¯Ë ÂÈÎÏÈÓ‹ ÂÈÊ¿ÓÂÈ· Ô˘ Â›Ó·È ‰È·ÌÔÚʈ̤ÓË ÛÙÔ

̤ÛÔÓ Ù˘ ÁψÛÛÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ Ù˘ ÚfiÛıÈ·˜ ÂÚÈÔ¯‹˜
ÙÔ˘ Ì˯·Ó‹Ì·ÙÔ˜ Ù˘ οو ÁÓ¿ıÔ˘ (∂ÈÎfiÓ˜ 2 Î·È 3).
√ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ı¤Û˘ Û˘Ó·ÚÌÔÁ‹˜ ÙˆÓ ‰‡Ô Ì˯·-
ÓËÌ¿ÙˆÓ Ù˘ Û˘Û΢‹˜ VDP Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ì ÙËÓ ·ÓÙ›-
ÛÙÔÈ¯Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ Ì·ÛËÙÈÎÒÓ Â·ÊÒÓ ÙˆÓ Ô‰ÔÓÙÈ-
ÎÒÓ ÙfiÍˆÓ Û ÎÂÚ› ‰‹Íˆ˜ (construction bite), Ì ٤ÙÔÈÔ
ÙÚfiÔ ÒÛÙÂ Ë Î¿Ùˆ ÁÓ¿ıÔ˜ Ó· ʤÚÂÙ·È ·fi ÙÔÓ ÎÏÈÓÈÎfi ÛÂ
ı¤ÛË ÚÔÔÏ›ÛıËÛ˘ Ù˘ οو ÁÓ¿ıÔ˘ 5-7 ¯ÈÏÈÔÛÙÒÓ (fiÛÔ
¯ÚÂÈ¿˙ÂÙ·È ÒÛÙ ӷ ÂÈÙ¢¯ı› Û¯¤ÛË ÎÔÙÈ΋ ÚÔ˜ ÎÔÙÈ-
΋ ÙˆÓ ÙÔ̤ˆÓ) Î·È Î·Ù¿Û·Û˘ 2-3 ¯ÈÏÈÔÛÙÒÓ ÛÙËÓ Úfi-
ÛıÈ· ÂÚÈÔ¯‹ ÙˆÓ Ô‰ÔÓÙÈÎÒÓ ÙfiÍˆÓ (∂ÈÎ. 4). ª¤ÁÈÛÙÔ ÂÈ-
ÙÚÂÙfi fiÚÈÔ ÚÔÒıËÛ˘ Ù˘ οو ÁÓ¿ıÔ˘ ̤ۈ Ù˘ ÂÊ·Ú-
ÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜, ıˆÚÂ›Ù·È fiÙÈ ·ÔÙÂÏÔ‡Ó Ù· 7 mm
ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ı› ÙÔ ÂӉ¯fiÌÂÓÔ Ó· ÂÌÊ·ÓÈ-
ÛıÔ‡Ó ÔÔÈ·‰‹ÔÙ ÚÔ‚Ï‹Ì·Ù· ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘
ÛÙÔÌ·ÙÔÁÓ·ıÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (Sander, 2005).
∏ ÂÈÎÏÈÓ‹˜ ÂÈÊ¿ÓÂÈ· ÙÔ˘ Ì˯·Ó‹Ì·ÙÔ˜ Ù˘ οو ÁÓ¿ıÔ˘
ۯ‰ȿ˙ÂÙ·È Î·È Î·Ù·Û΢¿˙ÂÙ·È Û ÁˆÓ›· 55,o 60o ‹ 65o
ˆ˜ ÚÔ˜ ÙÔ Ì·ÛËÙÈÎfi Â›Â‰Ô ÙˆÓ ‰ÔÓÙÈÒÓ Ù˘ οو ÁÓ¿-
ıÔ˘, ÁÈ· ·ÛıÂÓ›˜ Ì ÔÚÈ˙fiÓÙÈ·, ̤ÛË/ Ô˘‰¤ÙÂÚË ‹ ηٷ-
ÎfiÚ˘ÊË ‰È‡ı˘ÓÛË/ Ù‡Ô ·‡ÍËÛ˘ ÙÔ˘ ÚÔÛÒÔ˘ ·ÓÙ›-
ÛÙÔȯ· (∂ÈÎ. 5). ∏ Ú‡ıÌÈÛË ·˘Ù‹ ¤¯ÂÈ ˆ˜ ÛÙfi¯Ô ÙÔÓ ¤ÏÂÁ¯Ô
Ù˘ ηٷÎfiÚ˘Ê˘ ‰È¿ÛÙ·Û˘ Ù˘ Ô‰ÔÓÙÈ΋˜ Û‡ÁÎÏÂÈÛ˘
∂ÈÎfiÓ· 4. ™ÙË ı¤ÛË Û˘Ó·ÚÌÔÁ‹˜ ÙˆÓ Ì˯·ÓËÌ¿ÙˆÓ Ù˘ Û˘Û΢‹˜
VDP, Ë Î¿Ùˆ ÁÓ¿ıÔ˜ ʤÚÂÙ·È Û ı¤ÛË ÚÔÔÏ›ÛıËÛ˘ ̤¯ÚÈ 5-7 ¯ÈÏÈÔ-
ÛÙÒÓ Î·È Î·Ù¿Û·Û˘ 2-3 ¯ÈÏÈÔÛÙÒÓ ÛÙËÓ ÚfiÛıÈ· ÂÚÈÔ¯‹ ÙˆÓ
Ô‰ÔÓÙÈÎÒÓ ÙfiÍˆÓ [∞fi: Sander (2005), ηÙfiÈÓ ·‰Â›·˜].
Figure 4. When the two appliances composing the VDP are in
contact, the mandible is brought forward by 5-7 mm and opened
by 2-3 mm at the anterior region [From: Sander (2005), after
permission].
sidered to be 7 mm in order to avoid stomatognathic
dysfunction (Sander, 2005).
The inclined surface of the mandibular appliance is
designed and constructed at an angle of 55_, 60_ or 65_
relative to the occlusal plane of the mandibular teeth for
patients with horizontal, medium/neutral or vertical
direction / growth of the face, respectively (Fig. 5). These
variations aim at controlling the vertical dimension of
the dental occlusion and the face (Sander, 2001a; 2001b).
Appropriate activation of both jackscrews provides space
in the dental arches for the proper alignment of teeth in
their apical bases; furthermore, transverse dentoalveolar

E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2007 ñ TOMO™ 10 ñ TEYXO™ 1 15

∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance
Î·È ÙÔ˘ ÚÔÛÒÔ˘ (Sander, 2001a; 2001b).
∏ ηٿÏÏËÏË ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ‰‡Ô ÂÍÂÏÈÎÙÚÒÓ Î·Ù¿ ÙË
‰È¿ÚÎÂÈ· Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ‰Ú¿Û˘ Ù˘ Û˘Û΢‹˜ Â͢ËÚÂ-
Ù› ÙËÓ ‰ËÌÈÔ˘ÚÁ›· ¯ÒÚÔ˘ ÛÙ· Ô‰ÔÓÙÈο ÙfiÍ· ÁÈ· ÙËÓ
ÔÌ·Ï‹ ‰È¢ı¤ÙËÛË ÙˆÓ ‰ÔÓÙÈÒÓ ÛÙȘ ÔÛÙÈΤ˜ ÙÔ˘˜ ‚¿ÛÂȘ
Î·È ·ÎfiÌË, ÙËÓ ·ÔηٿÛÙ·ÛË ÙˆÓ Ô‰ÔÓÙÔÊ·ÙÓÈ·ÎÒÓ Û¯¤-
ÛÂˆÓ ÌÂٷ͇ Ù˘ ¿Óˆ Î·È Ù˘ οو ÁÓ¿ıÔ˘ ÛÙÔ ÂÁοÚÛÈÔ
Â›‰Ô, Ù·˘Ùfi¯ÚÔÓ· Ì ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ÚÔÒıËÛË Ù˘
οو ÁÓ¿ıÔ˘ ÛÙÔ ÚÔÛıÈÔ›ÛıÈÔ Â›‰Ô. ∞Ó¿ÏÔÁ· Ì ٷ
ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ Ô‰ÔÓÙÈ΋˜ Û‡ÁÎÏÂÈÛ˘ Î·È Ù˘
‰È‡ı˘ÓÛ˘ ·‡ÍËÛ˘ ÙÔ˘ ÚÔÛÒÔ˘ οı ÂÚ›ÙˆÛ˘
ͯˆÚÈÛÙ¿, Ë ÂÊ·ÚÌÔÁ‹ Ù˘ Û˘Û΢‹˜ VDP ÌÔÚ› Ó· Û˘Ó-
‰˘¿˙ÂÙ·È Ì ÙËÓ ÂÓۈ̿وÛË ÛÙÔ Ì˯¿ÓËÌ· Ù˘ ¿Óˆ ÁÓ¿-
ıÔ˘, ÛˆÏËÓ›ÛÎˆÓ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÚÔÛÙÔÌÈ·ÎÔ‡ ÙfiÍÔ˘
Â͈ÛÙÔÌ·ÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ˘„ËÏ‹˜ ¤Ï͢ (Sander ηÈ
Wichelhaus, 1993b; 1993c), Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ Â͈ÛÙÔÌ·ÙÈ-
ÎÒÓ ‰˘Ó¿ÌÂˆÓ ¯·ÌËÏ‹˜ ¤Ï͢ ÛÙÔ˘˜ ÚÒÙÔ˘˜ ÌfiÓÈÌÔ˘˜
ÁÔÌÊ›Ô˘˜ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ fiÔ˘ ¤¯Ô˘Ó ÙÔÔıÂÙËı› ‰·ÎÙ‡-
ÏÈÔÈ Ì ·ÚÂÈ·ÎÔ‡˜ ÛˆÏËÓ›ÛÎÔ˘˜ Â͈ÛÙÔÌ·ÙÈÎÔ‡ Ì˯·ÓÈ-
ÛÌÔ‡ (Sander Î·È Wichelhaus, 1993a; 1993d), ηٿÏÏËÏ·
‰È·ÌÔÚÊˆÌ¤ÓˆÓ Û˘ÚÌ¿ÙÈÓˆÓ ÂÏ·ÙËÚ›ˆÓ ÁÈ· ÙËÓ ·ÓfiÚıˆ-
ÛË (˘ÂÚÒÈ· ÛÙÚ¤„Ë Ù˘ ̇Ï˘) ‹ ÙËÓ ¯ÂÈÏÈ΋ ·fiÎÏÈÛË
ÙˆÓ ÙÔ̤ˆÓ, ÂÏ·ÙËÚ›ˆÓ ¿ˆ ÌÂٷΛÓËÛ˘ ÙˆÓ ÁÔÌÊ›ˆÓ,
Ì·ÁÓËÙÒÓ Î.·. (Sander Î·È Wichelhaus, 1994) (¶›Ó·Î·˜ 1).
™À°∫ƒπ™∏ ∆∏™ ™À™∫∂À∏™ VDP ª∂ ∞§§∞ §∂π∆√Àƒ°π∫∞
√ƒ£√¢√¡∆π∫∞-√ƒ£√¶∞π¢π∫∞ ª∏Ã∞¡∏ª∞∆∞
∏ ÂÊ·ÚÌÔÁ‹ Ù˘ Û˘Û΢‹˜ VDP, Û ÁÂÓÈΤ˜ ÁÚ·Ì̤˜, ÏÂ-
ÔÓÂÎÙ› ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ Ù‡ˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ÔÚıÔ‰Ô-
ÓÙÈÎÒÓ-ÔÚıÔ·È‰ÈÎÒÓ Û˘Û΢ÒÓ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê›
ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Î·È Ù˘Á¯¿ÓÔ˘Ó Â˘Ú›·˜ ÂÊ·ÚÌÔ-
Á‹˜ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË (Sander, 1988c; Sander ηÈ
Lassak, 1990) ηıÒ˜:
– ªÔÚ› Ó· ÂÈÙ‡¯ÂÈ ÙËÓ Ù·˘Ùfi¯ÚÔÓË ‰ÈfiÚıˆÛË Ù˘
·Ú·ÙËÚÔ‡ÌÂÓ˘ Ô‰ÔÓÙÔÛÎÂÏÂÙÈ΋˜ ‰˘Û·ÚÌÔÓ›·˜ ÛÙÔ
ÚÔÛıÈÔ›ÛıÈÔ Î·È ÛÙÔ ÂÁοÚÛÈÔ Â›‰Ô, ̤ۈ Ù˘
ηٿÏÏËÏ˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ ÂÓÛˆÌ·ÙˆÌ¤ÓˆÓ ÂÍÂ-
Ï›ÎÙÚˆÓ ÛÙ· Ì˯·Ó‹Ì·Ù· Ù˘ ¿Óˆ Î·È Ù˘ οو ÁÓ¿ıÔ˘.
∏ ‰˘Ó·ÙfiÙËÙ· ·˘Ù‹ ÂÈÙÚ¤ÂÈ ÙËÓ ¿ÌÂÛË ÂÊ·ÚÌÔÁ‹ Ù˘
Û˘Û΢‹˜ ¯ˆÚ›˜ Ó· ÚÔËÁËı›/ ·ÎÔÏÔ˘ı‹ÛÂÈ Ê¿ÛË
‰È‡ڢÓÛ˘ ÙˆÓ Ô‰ÔÓÙÈÎÒÓ ÊÚ·ÁÌÒÓ (Ì ÎÈÓËÙÔ‡˜ ‹
·Î›ÓËÙÔ˘˜ ÔÚıÔ‰ÔÓÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜), fiˆ˜ Û˘Ó‹-
ıˆ˜ ¯ÚÂÈ¿˙ÂÙ·È ÛÙËÓ ÂÚ›ÙˆÛË fiÔ˘ ÂÈϤÁÂÙ·È Ë
ÂÊ·ÚÌÔÁ‹ ÔÏÏÒÓ ¿ÏÏˆÓ Ù‡ˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ Ì˯·-
16
HELLENIC ORTHODONTIC REVIEW
∂ÈÎfiÓ· 5. ∏ ÂÈÎÏÈÓ‹˜ ÂÈÊ¿ÓÂÈ· ÙÔ˘ Ì˯·Ó‹Ì·ÙÔ˜ Ù˘ οو ÁÓ¿ıÔ˘
ۯ‰ȿ˙ÂÙ·È Î·È Î·Ù·Û΢¿˙ÂÙ·È Û ÁˆÓ›· 55Æ, 60Æ ‹ 65Æ ˆ˜ ÚÔ˜ ÙÔ
Ì·ÛËÙÈÎfi Â›Â‰Ô ÙˆÓ ‰ÔÓÙÈÒÓ Ù˘ οو ÁÓ¿ıÔ˘, ·Ó¿ÏÔÁ· Ì ÙËÓ
‰È‡ı˘ÓÛË/ Ù‡Ô ·‡ÍËÛ˘ ÙÔ˘ ÚÔÛÒÔ˘ [∞fi: Sander (2005),
ηÙfiÈÓ ·‰Â›·˜].
Figure 5. The inclined plane of the mandibular appliance is
designed and constructed at an angle of 55Æ, 60Æ or 65Æ in relation
to the occlusal plane of lower teeth depending on the direction /
facial growth type [From: Sander (2005), after permission].
intermaxillary relationships are corrected while the
mandible is protruded. Depending on the clinical charac-
teristics of dental occlusion and the facial growth direc-
tion of individual cases, the VDP may be combined with
high-pull headgear through headgear tubes incorporat-
ed in the maxillary appliance (Sander and Wichelhaus,
1993b; 1993c) or with low-pull extra-oral forces applied
on maxillary molar bands (Sander and Wichelhaus,
1993a; 1993d); it may also include wire springs appropri-
ately designed for uprighting (palatal crown movement)
or labial tipping of incisors, springs for distal molar
movement, magnets, etc. (Sander and Wichelhaus, 1994)
(Table 1).
COMPARISON OF THE VDP WITH OTHER FUNCTIONAL
ORTHODONTIC-ORTHOPEDIC APPLIANCES
The VDP appliance is overall superior to most types of
functional orthodontic-orthopedic appliances described
in international literature and widely used in clinical
practice (Sander 1988c; Sander and Lassak, 1990),
because the VDP:
HELLENIC ORTHODONTIC REVIEW 2007 ñ VOLUME 10 ñ ISSUE 1
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance

¶›Ó·Î·˜ 1. ∫ÏÈÓÈÎfi˜ Ô‰ËÁfi˜ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜ VDP Û ·ÛıÂÓ›˜ Ì ÛÎÂÏÂÙÈΤ˜ Û¯¤ÛÂȘ ÙˆÓ ÁÓ¿ıˆÓ ∆¿Í˘ ππ Î·È Û¯¤ÛË ÚÒÙˆÓ ÌÔӛ̈Ó
ÁÔÌÊ›ˆÓ ∆¿Í˘ ππ ηٿ Angle.
Table 1. Clinical guide for application of the VDP appliance in patients with skeletal Class II and Angle Class II molar relationship.

Facial growth pattern /
¢È‡ı˘ÓÛË ·‡ÍËÛ˘
ÚÔÛÒÔ˘
Inclined surface Highly increased ANB values/Wits / Not especially Upper incisor to NA plane
of mandibular π‰È·›ÙÂÚ· ·˘ÍË̤Ó˜ ÙÈ̤˜ ∞¡µ/ Wits increased ANB [angle]: (in all groups) /
appliance relative [angle] / Wits ™¯¤ÛË ¿Óˆ ÙÔ̤· ÌÂ
to occlusal plane / [distance] (in all Â›Â‰Ô ¡∞ [ÁˆÓ›·]:
∫Ï›ÛË ÂÈÎÏÈÓÔ‡˜ groups) / Ÿ¯È (ÁÈ· fiϘ ÙȘ ηÙËÁÔڛ˜)
ÂÈÊ¿ÓÂÈ·˜ ȉȷ›ÙÂÚ· ·˘ÍË̤Ó˜
Ì˯·Ó‹Ì·ÙÔ˜ οو ÙÈ̤˜ ∞¡µ [ÁˆÓ›·] /
ÁÓ¿ıÔ˘ ÚÔ˜ ÙÔ Wits [·fiÛÙ·ÛË]
Ì·ÛËÙÈÎfi Â›Â‰Ô (ÁÈ· fiϘ ÙȘ
ηÙËÁÔڛ˜)

Horizontal / 55Æ Combination with low-pull Without use of <14Æ: incorporation of

√ÚÈ˙fiÓÙÈ· extra-oral forces applied on maxillary extra-oral forces / springs for upper incisor
first molar bands / ™˘Ó‰˘·ÛÌfi˜ Ì Èڛ˜ ÂÊ·ÚÌÔÁ‹ proclination
ÂÊ·ÚÌÔÁ‹ Â͈ÛÙÔÌ·ÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ Â͈-ÛÙÔÌ·ÙÈÎÒÓ
¯·ÌËÏ‹˜ ¤Ï͢ Û ‰·ÎÙ˘Ï›Ô˘˜ ‰˘Ó¿ÌÂˆÓ >14Æ<26Æ: incorporation
ÌÔÓ›ÌˆÓ ¿Óˆ ÚÒÙˆÓ ÁÔÌÊ›ˆÓ of springs for maxillary
incisor up righting and
Average / 60Æ Combination with low-pull extra-oral of posterior bite plane
∂ӉȿÌÂÛË forces applied on maxillary first molar
bands / ™˘Ó‰˘·ÛÌfi˜ Ì ÂÊ·ÚÌÔÁ‹ >26Æ: no springs or bite
Â͈ÛÙÔÌ·ÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ ¯·ÌËÏ‹˜ plane
¤Ï͢ Û ‰·ÎÙ˘Ï›Ô˘˜ ÌÔÓ›ÌˆÓ ¿Óˆ
ÚÒÙˆÓ ÁÔÌÊ›ˆÓ /

Vertical / 65Æ Combination with high-pull extra-oral <14Æ: ÂÓۈ̿وÛË

∫·Ù·ÎfiÚ˘ÊË
Expected mean annual
difference of
cephalometric values
(in all groups) /
∞Ó·ÌÂÓfiÌÂÓË Ì¤ÛË
ÂÙ‹ÛÈ· ‰È·ÊÔÚ¿ ÙÈÌÒÓ
ÎÂÊ·ÏÔ-ÌÂÙÚÈÎÒÓ
ÌÂÙÚ‹ÛÂˆÓ (Û fiϘ
ÙȘ ηÙËÁÔڛ˜)
forces applied on tubes incorporated ÂÏ·ÙËÚ›ˆÓ ÁÈ· ÙËÓ ¯ÂÈÏÈ΋
in the maxillary appliance and ·fiÎÏÈÛË ÙˆÓ ¿Óˆ ÙÔ̤ˆÓ
posterior bite plane / ™˘Ó‰˘·ÛÌfi˜ ÌÂ
ÂÊ·ÚÌÔÁ‹ Â͈ÛÙÔÌ·ÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ >14Æ<26Æ ÂÓۈ̿وÛË
˘„ËÏ‹˜ ¤Ï͢ Û ۈÏËÓ›ÛÎÔ˘˜ ÂÏ·ÙËÚ›ˆÓ ÁÈ· ÙËÓ
ÂÓۈ̷و̤ÓÔ˘˜ ÛÙÔ Ì˯¿ÓËÌ· Ù˘ ·ÓfiÚıˆÛË (˘ÂÚÒÈ·
¿Óˆ ÁÓ¿ıÔ˘ Î·È Ì·ÛËÙÈ΋˜ Ͽη˜ Û˘ÛÙÚÔÊ‹) ÙˆÓ ¿Óˆ
‰‹Í˘ ÙˆÓ ÔÈÛı›ˆÓ ‰ÔÓÙÈÒÓ ÙÔ̤ˆÓ Î·È Ͽη˜ ‰‹Í˘
ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ
ANB: -1,4Æ ANB: -2,2Æ ANB: -1,4Æ
Wits: -2,3 mm Wits: -3,5 mm Wits: -2,3 mm >26Æ ¯ˆÚ›˜ ÂÏ·Ù‹ÚÈ· ‹
Ͽη ‰‹Í˘

ÓËÌ¿ÙˆÓ. ∏ ‰È·‰Ô¯È΋ ÂÊ·ÚÌÔÁ‹ ‰È·ÊÔÚÂÙÈÎÒÓ Ì˯·-
ÓËÌ¿ÙˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË, ۠ͯˆÚÈÛÙfi ¯ÚfiÓÔ,
ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙÔ ÚÔÛıÈÔ›ÛıÈÔ Î·È ÛÙÔ ÂÁοÚ-
ÛÈÔ Â›Â‰Ô ÔˆÛ‰‹ÔÙ ‰È·ÚΛ ÂÚÈÛÛfiÙÂÚÔ (ÛÂ
Û¯¤ÛË Ì ÙËÓ Ù·˘Ùfi¯ÚÔÓË ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ Ì ÙËÓ
Û˘Û΢‹ VDP), ÂÓÒ ·Ú¿ÏÏËÏ· ηıÈÛÙ¿ ·ÌÊ›‚ÔÏË ÙËÓ
ηϋ Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙË ·Ú·ÙÂٷ̤ÓË
– May achieve simultaneous correction of the den-
toskeletal discrepancy in both the sagittal and trans-
verse planes through appropriate activation of the
jackscrews incorporated in the maxillary and
mandibular appliances. This possibility allows for
direct application of the appliance eliminating the
need for dental arch expansion (with removable or

E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2007 ñ TOMO™ 10 ñ TEYXO™ 1 17

∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance
¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· ·˘Ù‹.
– ªÔÚ› Ó· Û˘Ó‰˘¿˙ÂÙ·È Ì ÙËÓ ÂÓۈ̿وÛË ÛÙ· ‰‡Ô
Ì˯·Ó‹Ì·Ù· Ù˘ ¿Óˆ Î·È Ù˘ οو ÁÓ¿ıÔ˘ ‰È·ÊfiÚˆÓ
ÂÍ·ÚÙËÌ¿ÙˆÓ Ô˘ Û˘Ó‹ıˆ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û ÎÈÓË-
ÙÔ‡˜ ÔÚıÔ‰ÔÓÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Î·È ÛÙÔ¯Â‡Ô˘Ó ÛÂ
Â› ̤ÚÔ˘˜ ‰ÈÔÚıÒÛÂȘ Ù˘ ı¤Û˘ ÙˆÓ ‰ÔÓÙÈÒÓ fiˆ˜
ÂÏ·Ù‹ÚÈ·, Û˘ÚÌ¿ÙÈÓ· ¿ÁÎÈÛÙÚ·, ÛˆÏËÓ›ÛÎÔÈ Â͈ÛÙÔÌ·-
ÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ, Ì·ÁÓ‹Ù˜, Î.·. ™Â ÔÏϤ˜ ÂÚÈÙÒ-
ÛÂȘ fiÔ˘ ÔÈ ı¤ÛÂȘ Î·È ÔÈ Û¯¤ÛÂȘ ÙˆÓ ÚÔÛı›ˆÓ
‰ÔÓÙÈÒÓ ÌÂٷ͇ ÙÔ˘˜ ‰ÂÓ ÂÈÙÚ¤Ô˘Ó ÙËÓ ¿ÌÂÛË ÂÊ·Ú-
ÌÔÁ‹ ÙˆÓ ÂÚÈÛÛÔÙ¤ÚˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ Ì˯·ÓËÌ¿ÙˆÓ
(fiˆ˜ Ô ÂÓÂÚÁÔÔÈËÙ‹˜), ¯ÚÂÈ¿˙ÂÙ·È Ó· ÚÔËÁËı› Ì›·
Ê¿ÛË ‰ÈfiÚıˆÛ˘ ·˘ÙÒÓ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ. ø˜ Ê˘ÛÈ-
Îfi ·ÔÙ¤ÏÂÛÌ·, ÂÈÌË·ÓÂÙ·È Ë Û˘ÓÔÏÈ΋ ‰È¿ÚÎÂÈ· Ù˘
ıÂÚ·›·˜ Î·È Î˘Ú›ˆ˜ ηı˘ÛÙÂÚ› Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÏÂÈ-
ÙÔ˘ÚÁÈÎÔ‡ Ì˯·Ó‹Ì·ÙÔ˜. ∏ ηı˘ÛÙ¤ÚËÛË ·˘Ù‹ ÌÔÚ›
Ó· Â›Ó·È È‰È·›ÙÂÚ· ÎÚ›ÛÈÌË ÁÈ· ·ÛıÂÓ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È
ÎÔÓÙ¿ ÛÙËÓ ·È¯Ì‹ Ù˘ ÂÊË‚È΋˜ ·‡ÍËÛ˘ (pubertal
growth spurt), ÒÛÙÂ Ë ÂÊ·ÚÌÔÁ‹ Ù˘ ÔÚıÔ·È‰È΋˜
Û˘Û΢‹˜ Ó· Â›Ó·È Ô˘ÛÈ·ÛÙÈ΋/ ·ÔÙÂÏÂÛÌ·ÙÈ΋. ∏
ηı˘ÛÙÂÚË̤ÓË, Û ۯ¤ÛË Ì ÙËÓ ·È¯Ì‹ Ù˘ ÂÊË‚È΋˜
·‡ÍËÛ˘, ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÏÂÈÙÔ˘ÚÁÈÎÔ‡ Ì˯·Ó‹Ì·ÙÔ˜
Â›Ó·È Èı·Ófi Ó· ÌËÓ ¤¯ÂÈ Î·ı·Ú¿ ÔÚıÔ·È‰È΋ ‰Ú¿ÛË
ÂÓÒ fi¯È Û¿ÓÈ· Ô‰ËÁ› Û ηٷÛÙ¿ÛÂȘ fiˆ˜ Ë ‰ÈÏ‹
‰‹ÍË ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ÎÚÔÙ·ÊÔÁÓ·ıÈ΋˜ ‰È¿ÚıÚˆ-
Û˘. ∞ÓÙ›ıÂÙ·, Ë ÂÓۈ̿وÛË Î·Ù¿ÏÏËÏ· ‰È·ÌÔÚʈ-
Ì¤ÓˆÓ ÂÍ·ÚÙËÌ¿ÙˆÓ fiˆ˜ ÂÏ·ÙËÚ›ˆÓ, Û˘ÚÌ¿ÙÈÓˆÓ
·ÁΛÛÙÚˆÓ Î.·., ηıÈÛÙ¿ ‰˘Ó·Ù‹ ÙËÓ ¿ÌÂÛË ÂÊ·ÚÌÔÁ‹
Ù˘ Û˘Û΢‹˜ VDP ηıÒ˜ ÂÈÙÚ¤ÂÈ ÙËÓ ÔÚıÔ·È‰È΋
‰Ú¿ÛË Ù˘ ·Ú¿ÏÏËÏ· Ì ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ÌÂٷΛÓËÛË
ÌÂÌÔÓˆÌ¤ÓˆÓ ‹ ÔÌ¿‰·˜ ‰ÔÓÙÈÒÓ.
– ªÂ ÙËÓ Ù·˘Ùfi¯ÚÔÓË ·ÓÙÈÌÂÙÒÈÛË ÔÏÏÒÓ ‰È·ÊÔÚÂÙÈ-
ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ, ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÎÏÈÓÈ΋˜ ÂÊ·Ú-
ÌÔÁ‹˜ ÙˆÓ ÔÏÏ·ÏÒÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ Ù˘ Û˘Û΢‹˜
VDP, ÂÈÙ˘Á¯¿ÓÂÙ·È ÛËÌ·ÓÙÈÎfi˜ ÂÚÈÔÚÈÛÌfi˜ Ù˘ Û˘ÓÔ-
ÏÈ΋˜ ‰È¿ÚÎÂÈ·˜ Ù˘ ıÂÚ·›·˜ Ì ·Î›ÓËÙÔ˘˜ ÔÚıÔ‰ÔÓÙÈ-
ÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜
– Ÿˆ˜ Û˘Ì‚·›ÓÂÈ Î·È Ì ÔÚÈṲ̂ӷ ¿ÏÏ· ÏÂÈÙÔ˘ÚÁÈο
Ì˯·Ó‹Ì·Ù·, ÛÙË Û˘Û΢‹ VDP ÌÔÚÔ‡Ó Ó· ÂÓۈ̷-
ÙˆıÔ‡Ó ÛˆÏËÓ›ÛÎÔÈ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÚÔÛÙÔÌÈ·ÎÔ‡
ÙfiÍÔ˘ Â͈ÛÙÔÌ·ÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ ˘„ËÏ‹˜ ¤Ï͢
(Sander Î·È Wichelhaus, 1993b; 1993c; Wichelhaus ηÈ
Sander, 1995), Û ÂÚÈÙÒÛÂȘ fiÔ˘ ÂÈı˘ÌÂ›Ù·È ÙÚÔÔ-
Ô›ËÛË/ ¤ÏÂÁ¯Ô˜ Ù˘ ‰È‡ı˘ÓÛ˘ Ù˘ ·‡ÍËÛ˘ Ù˘ ¿Óˆ
ÁÓ¿ıÔ˘ ÛÙÔ Î·Ù·ÎfiÚ˘ÊÔ Â›‰Ô. ∂ÈϤÔÓ, fiÔ˘
ÂӉ›ÎÓ˘Ù·È (¶›Ó·Î·˜ 1), Ë Û˘Û΢‹ VDP ÌÔÚ› Ó·
18
HELLENIC ORTHODONTIC REVIEW
fixed orthodontic appliances) before or after the func-
tional appliance phase as usually occurs with other
types of functional appliances. Consecutive applica-
tion of different appliances for treatment of sagittal
and transverse discrepancies at different times is defi-
nitely more time consuming (compared to simultane-
ous correction with the VDP appliance), which under-
mines patient cooperation.
– May be combined with components usually used in
removable orthodontic appliances that are incorpo-
rated in the maxillary and mandibular appliances and
aim at specific corrections of tooth position; these
include springs, wire clasps, headgear tubes, magnets,
etc. In many cases where the positions and relation-
ships of upper and lower anterior teeth do not allow
for direct application of most functional appliances
(such as the activator), a prior phase for correcting
these problems may be necessary. Thus, treatment
time is longer and the functional appliance phase is
delayed. This delay may be critical for patients around
the time period of the pubertal growth spurt, when
the orthopedic appliance is most effective. Delayed
application of the functional appliance may not have
pure orthopedic effect, whereas it is not rare for it to
result in dual bite or temporomandibular joint (TMJ)
dysfunction. On the other hand, incorporation of
appropriate accessories, such as springs, wire clasps,
etc. allows for direct VDP application that achieves
orthopedic action and orthodontic movement of indi-
vidual teeth or groups of teeth simultaneously.
– May significantly shorten treatment time with fixed
orthodontic appliances through simultaneous correc-
tion of various problems.
– May incorporate tubes for application of high-pull
headgear (Sander and Wichelhaus, 1993b; 1993c;
Wichelhaus and Sander, 1995) as is also the case with
other functional appliances, when modification/con-
trol of vertical maxillary growth direction is desirable.
Furthermore, where indicated (Table 1), the VDP may
be combined with low-pull headgear with the labial
arch fitting in the headgear tubes of first maxillary
molar bands (Sander and Wichelhaus, 1993a; 1993d).
– The minimal friction that develops between the arm-
guides and the inclined surface of the two appliances
leads to faster and more effective action.
– Forward mandibular positioning with the appliance is
HELLENIC ORTHODONTIC REVIEW 2007 ñ VOLUME 10 ñ ISSUE 1
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance
Û˘Ó‰˘¿˙ÂÙ·È Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ Â͈ÛÙÔÌ·ÙÈÎÔ‡ Ì˯·ÓÈ-
ÛÌÔ‡ ¯·ÌËÏ‹˜ ¤Ï͢ ÙÔ˘ ÔÔ›Ô˘ ÙÔ ÂÓ‰ÔÛÙÔÌ·ÙÈÎfi
ÛΤÏÔ˜ ÂÊ·ÚÌfi˙ÂÈ ÛÙÔ˘˜ ÛˆÏËÓ›ÛÎÔ˘˜ ‰·ÎÙ˘Ï›ˆÓ Ô˘
¤¯Ô˘Ó ÙÔÔıÂÙËı› ÛÙÔ˘˜ ÚÒÙÔ˘˜ ÌfiÓÈÌÔ˘˜ ÁÔÌÊ›Ô˘˜
Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ (Sander Î·È Wichelhaus, 1993a;
1993d).
– √ ÂÏ¿¯ÈÛÙÔ˜ ‚·ıÌfi˜ ÙÚÈ‚‹˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÌÂٷ͇
ÙˆÓ ‚Ú·¯ÈfiÓˆÓ Î·È Ù˘ ÂÈÎÏÈÓÔ‡˜ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ ‰‡Ô
Ì˯·ÓËÌ¿ÙˆÓ Ô˘ ··ÚÙ›˙Ô˘Ó ÙË Û˘Û΢‹ VDP ‚ÔËı¿
ÛÙËÓ Ù·¯‡ÙÂÚË Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ‰Ú¿ÛË Ù˘
– ∏ ÌÂÙ·ÙfiÈÛË Ù˘ οو ÁÓ¿ıÔ˘ ÛÙËÓ ı¤ÛË ÏÂÈÙÔ˘ÚÁ›·˜
Ù˘ Û˘Û΢‹˜ ÂÈÙ˘Á¯¿ÓÂÙ·È ¯ˆÚ›˜ ÎÏÈÓÈο ÛËÌ·ÓÙÈΤ˜
·ÓÂÈı‡ÌËÙ˜ ·ÚÂÓ¤ÚÁÂȘ ÙˆÓ ·ÛÎÔ‡ÌÂÓˆÓ ‰˘Ó¿ÌÂ-
ˆÓ ÛÙ· ‰fiÓÙÈ· ηıÒ˜ Ô Û¯Â‰È·ÛÌfi˜ Ù˘ Û˘Û΢‹˜ ÂÈ-
ÙÚ¤ÂÈ ÙËÓ ·ÓÂÍ¿ÚÙËÙË ÌÂٷ͇ ÙÔ˘˜ Ó·ÚıËÎÔÔ›ËÛË
ÙˆÓ ‰‡Ô Ô‰ÔÓÙÈÎÒÓ Ùfi͈Ó. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi Ô˘ÛÈ·-
ÛÙÈο ÂÎÌˉÂÓ›˙ÂÙ·È Ô Î›Ó‰˘ÓÔ˜ ·ÔÚÚfiÊËÛ˘ ÙˆÓ
ÚÈ˙ÒÓ ·ÏÏ¿ Î·È ÔÔÈ·Û‰‹ÔÙ ·ÓÂÈı‡ÌËÙ˘ ÌÂٷΛÓË-
Û˘ ÙˆÓ ‰ÔÓÙÈÒÓ.
– ∏ ÂÊ·ÚÌÔÁ‹ Ù˘ Û˘Û΢‹˜ VDP ·Ú¿ÏÏËÏ· Ì ÙËÓ
ÚÔÒıËÛË Ù˘ οو ÁÓ¿ıÔ˘ ‰Ú¿ ·Ó·ÛÙ·ÏÙÈο ÛÙËÓ
ÚÔ˜ Ù· ÂÌÚfi˜ ·‡ÍËÛË ÙÔ˘ ¿Óˆ ÁÓ·ıÈ·›Ô˘ Û˘ÌϤÁ-
Ì·ÙÔ˜ Ì ·ÚfiÌÔÈÔ Ì˯·ÓÈÛÌfi Ì ·˘ÙfiÓ Ù˘ ÂÊ·ÚÌÔÁ‹˜
Â͈ÛÙÔÌ·ÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ ˘„ËÏ‹˜ ¤Ï͢. ∞ÓÙ›ÛÙÔȯË
Â›‰Ú·ÛË ÛÙÔ ¿Óˆ ÁÓ·ıÈ·›Ô Û‡ÌÏÂÁÌ· ·Ó·Ê¤ÚÂÙ·È ˆ˜
·ÔÙ¤ÏÂÛÌ· Ù˘ ÂÊ·ÚÌÔÁ‹˜ ÌfiÓÔ ÙÔ˘ ·Î›ÓËÙÔ˘ ÏÂÈ-
ÙÔ˘ÚÁÈÎÔ‡ Ì˯·Ó‹Ì·ÙÔ˜ Ù‡Ô˘ Herbst (Pancherz ηÈ
Û˘Ó., 1989; Pancherz Î·È Anehus-Pancherz, 1993).
– ∏ ·ÚÔ˘Û›· ÙˆÓ Û¯ÂÙÈο Ì·ÎÚÒÓ Ô‰ËÁÒÓ ‚Ú·¯ÈfiÓˆÓ
ÏÂÈÙÔ˘ÚÁ› ˆ˜ ˘ÂÓı‡ÌÈÛË ÁÈ· ÙËÓ ÂÈı˘ÌËÙ‹ ı¤ÛË Ù˘
οو ÁÓ¿ıÔ˘ ηٿ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Û˘Û΢‹˜ ÛÙË
‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ ÂÓÒ ÂÈÙÚ¤ÂÈ ÙËÓ Û˘Ó¯È˙fiÌÂÓË
‰Ú¿ÛË Ù˘ Û˘Û΢‹˜ ·ÎfiÌ· Î·È fiÙ·Ó Ë Ù· ‰‡Ô Ì˯·Ó‹-
Ì·Ù· ‰ÂÓ ‚Ú›ÛÎÔÓÙ·È Û Ï‹ÚË Â·Ê‹ ÌÂٷ͇ ÙÔ˘˜,
fiˆ˜ Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘,
fiÔ˘ Û˘Ó‹ıˆ˜ ·Ú·ÙËÚÂ›Ù·È Î·Ù¿Û·ÛË Ù˘ οو ÁÓ¿-
ıÔ˘.
– µ¿ÛÂÈ ÙˆÓ ÎÏÈÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘, Ë Û˘Û΢‹
VDP Â›Ó·È Î·Ï‡ÙÂÚ· ·ÓÂÎÙ‹ Û ۯ¤ÛË Ì ¿ÏÏ· ÏÂÈÙÔ˘Ú-
ÁÈο Ì˯·Ó‹Ì·Ù· ·fi ÙÔ˘˜ ·ÛıÂÓ›˜, ÙˆÓ ÔÔ›ˆÓ Ë
ηϋ Û˘ÓÂÚÁ·Û›· Â›Ó·È ·fiÏ˘ÙË ÚÔ¸fiıÂÛË ÁÈ· ÙËÓ
ÂÈÙ˘¯›· Ù˘ ÌÂıfi‰Ô˘
– ªÂÙ¿ ·fi ÂÍ¿ÛÎËÛË, ηı›ÛÙ·Ù·È ‰˘Ó·Ù‹ Ë Û¯Â‰fiÓ
·ÚfiÛÎÔÙË ÏÂÈÙÔ˘ÚÁ›· Ù˘ ÔÌÈÏ›·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÂÓÒ
ÊÔÚ¿ ÙË Û˘Û΢‹ VDP ÛÙÔ ÛÙfiÌ· ∞ÓÙ›ıÂÙ·, Ì ÙÔÓ
ÂÓÂÚÁÔÔÈËÙ‹ Â›Ó·È ·‰‡Ó·ÙË Ë ÏÂÈÙÔ˘ÚÁ›· Ù˘ ÔÌÈÏ›·˜,
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2007 ñ TOMO™ 10 ñ TEYXO™ 1
achieved without clinically significant side effects on
teeth due to forces applied; appliance design allows
independent "splinting" of each dental arch. Thus,
the risk for root resorption and undesirable tooth
movement is virtually eliminated.
– Besides mandibular positioning, the VDP appliance
inhibits forward maxillary growth with a mechanism
similar to that of high-pull extraoral forces. The only
other functional appliance with a similar effect on the
maxillary complex is the Herbst fixed functional appli-
ance (Pancherz et al., 1989; Pancherz and Anehus-
Pancherz, 1993).
– The presence of the rather long arm-guides serves as
a reminder of the desirable mandibular position when
the appliance is worn during the day, while allowing
for continuous effect even when the two appliances
are not in full contact during sleep, when the
mandible is usually open.
– Compared to other functional appliances, the VDP is
better tolerated by patients, whose compliance is a
prerequisite for treatment success.
– Following training, the patient’s speech is almost
unimpeded. On the contrary, speaking is almost
impossible with the activator, while oral breathing is
also impeded. Thus, in cases with relative nasal
obstruction it is almost impossible to use the activator
(even with holes in the appliance acrylic); such prob-
lems are not encountered with the VDP appliance.
A research study (Sander and Wichelhaus, 1995a) inves-
tigated the clinical results of the VDP appliance during
which,
– the VDP was applied in 95 patients (50 males and 45
females, aged 10-13 years) with an Angle Class II mal-
occlusion and a Class II jaw relationship for a period
of at least one year (mean application time 18
months) and,
– the control group included 53 patients (28 males and
25 females, aged 10-12 years) with similar clinical
characteristics of the face and dental occlusion who
received no treatment at all.
According to this study, statistically significant skeletal
effects were observed for the VDP group as compared to
the control group; these effects concerned the sagittal
dimension and involved decrease of the SNA angle and
increase of the SNB angle. The skeletal effect of the VDP
19
∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance
ÂÓÒ ÂÈϤÔÓ Î·ı›ÛÙ·Ù·È È‰È·›ÙÂÚ· ‰˘Û¯ÂÚ‹˜ Î·È Ë ÏÂÈ-
ÙÔ˘ÚÁ›· Ù˘ ·Ó·ÓÔ‹˜ ·fi ÙÔ ÛÙfiÌ·. ŒÙÛÈ, Û ÂÚÈÙÒ-
ÛÂȘ fiÔ˘ ·Ú·ÙËÚÂ›Ù·È Î¿ÔÈÔ˘ ‚·ıÌÔ‡ ·fiÊÚ·ÍË
Ù˘ ÚÈÓÈ΋˜ ·ÂÚÔÊfiÚÔ˘ Ô‰Ô‡ ηı›ÛÙ·Ù·È Û¯Â‰fiÓ ·‰‡-
Ó·ÙË Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÂÓÂÚÁÔÔÈËÙ‹ (·ÎfiÌ· Î·È Ì ÙËÓ
‰È·ÌfiÚʈÛË ÔÒÓ ÛÙÔ ·ÎÚ˘ÏÈÎfi ÙÔ˘ Ì˯·Ó‹Ì·ÙÔ˜)
ÂÓÒ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ·ÓÙ›ÛÙÔÈ¯Ô Úfi‚ÏËÌ· Ì ÙË
Û˘Û΢‹ VDP.
∆· ÎÏÈÓÈο ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Û˘Û΢-
‹˜ VDP ¤¯Ô˘Ó ÌÂÏÂÙËı› Û ۯÂÙÈ΋ ÂÚ¢ÓËÙÈ΋ ÂÚÁ·Û›·
(Sander Î·È Wichelhaus, 1995a), fiÔ˘
– Ë Û˘Û΢‹ VDP ÂÊ·ÚÌfiÛıËΠ۠95 ·ÛıÂÓ›˜ (50
¿ÚÚÂÓ˜ Î·È 45 ı‹ÏÂȘ, ËÏÈΛ·˜ 10-13 ÂÙÒÓ) Ì ·ÓˆÌ·-
Ï›· Û˘ÁÎϛۈ˜ ∆¿Í˘ ππ ηٿ Angle Î·È Û¯¤ÛË ÙˆÓ
ÁÓ¿ıˆÓ ∆¿Í˘ ππ ÁÈ· ‰È¿ÛÙËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÓfi˜ ¤ÙÔ˘˜
(̤ÛË ‰È¿ÚÎÂÈ· ÂÊ·ÚÌÔÁ‹˜ 18 ÌËÓÒÓ) ÂÓÒ
– ¯ÚËÛÈÌÔÔÈ‹ıËΠÔÌ¿‰· ÂϤÁ¯Ô˘ 53 ·ÛıÂÓÒÓ (28
¿ÚÚÂÓ˜, 25 ı‹ÏÂȘ, ËÏÈΛ·˜ 10-12 ÂÙÒÓ) Ì ·ÓÙ›ÛÙÔȯ·
ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÚÔÛÒÔ˘ Î·È Ù˘
Û˘ÁÎϛۈ˜ ÙˆÓ ‰ÔÓÙÈÒÓ fiÔ˘ fï˜ ‰ÂÓ ÂÊ·ÚÌfiÛıË-
Πη̛· ıÂÚ·›·.
™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜, ˆ˜ ·Ô-
Ù¤ÏÂÛÌ· Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜ VDP ·Ú·ÙËÚ‹ıË-
Î·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ÛÎÂÏÂÙÈΤ˜ ÂȉڿÛÂȘ, ÛÂ
Û¯¤ÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, Ô˘ ·ÊÔÚÔ‡Û·Ó ÛÙÔ ÚÔ-
ÛıÈÔ›ÛıÈÔ Â›Â‰Ô Î·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ·fi Ì›ˆÛË Ù˘
ÁˆÓ›·˜ SNA Î·È ·‡ÍËÛË Ù˘ ÁˆÓ›·˜ SNB. ∏ ÛÎÂÏÂÙÈ΋ Â›-
‰Ú·ÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜ VDP ÛÙËÓ ¿Óˆ ÁÓ¿ıÔ
ıˆڋıËΠˆ˜ ·ÓÙ›ÛÙÔÈ¯Ë (Sander Î·È Wichelhaus, 1995)
ÂΛӢ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÌÂÙ¿ ·fi ÙË Û˘Ó‰˘·Ṳ̂ÓË
ÂÊ·ÚÌÔÁ‹ ÏÂÈÙÔ˘ÚÁÈÎÒÓ Ì˯·ÓËÌ¿ÙˆÓ Î·È Â͈ÛÙÔÌ·ÙÈ΋˜
¤Ï͢ (van Beek, 1982; Kigele, 1987; Dermaut Î·È Û˘Ó.,
1992). ¢ÂÓ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ Â›‰Ú·ÛË
Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜ VDP ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘
ÔÌ¿‰·˜ ÌÂϤÙ˘, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÎÏ›ÛË ÙÔ˘ ÂÈ¤‰Ô˘
Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ˆ˜ ÚÔ˜ ÙËÓ ÚfiÛıÈ· ‚¿ÛË ÙÔ˘ ÎÚ·Ó›Ô˘,
ÛÙËÓ ·Ó·ÏÔÁ›· ÚÔÛı›Ô˘ ÚÔ˜ Ô›ÛıÈÔ ‡„Ô˜ ÙÔ˘ ÚÔÛÒ-
Ô˘, Î·È ÛÙËÓ ¯ÂÈÏÈ΋ ·fiÎÏÈÛË ÙˆÓ Î¿Ùˆ ÙÔ̤ˆÓ, ÂÓÒ
·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË Ù˘ ˘ÂÚÒÈ·˜ ·fiÎÏÈÛ˘ ÙˆÓ ¿Óˆ
ÙÔ̤ˆÓ (Sander Î·È Wichelhaus, 1995).
™Â ÂÚ¢ÓËÙÈ΋ ÌÂϤÙË (Sander Î·È Lassak, 1999) fiÔ˘
Û˘ÁÎÚ›ıËÎ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘
Û˘Û΢‹˜ VDP Û ۯ¤ÛË Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ¿ÏÏˆÓ ÏÂÈ-
ÙÔ˘ÚÁÈÎÒÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ Ì˯·ÓËÌ¿ÙˆÓ fiˆ˜ Ô ÂÓÂÚÁÔ-
ÔÈËÙ‹˜, ÙÔ Bionator Î·È ÙÔ Fränkel II ·Ú·ÙËÚ‹ıËÎÂ:
20
HELLENIC ORTHODONTIC REVIEW
appliance on the maxilla was considered similar (Sander
and Wichelhaus, 1995) to that observed with the combi-
nation of functional appliances and extraoral forces (van
Beek, 1982; Kigele, 1987; Dermaut et al, 1992). No sig-
nificant effect of the VDP was observed in the study
group concerning inclination of the maxillary plane rela-
tive to the anterior cranial base, ratio of anterior to pos-
terior facial height and labial tipping of mandibular
incisors; on the other hand, palatal tipping of maxillary
incisors was increased (Sander and Wichelhaus, 1995).
In a research study (Sander and Lassak, 1999) comparing
results from the VDP and other functional appliances,
such as the Bionator and Fränkel II, the following were
observed:
– Significantly greater skeletal effect with the VDP (in
relation to patient groups using different functional
appliances); the SNB angle increased and both the
SNA and ANB angles decreased.
– Minimal effect of the VDP appliance on maxillary
plane inclination (relative to the cranial base). On the
contrary, this angle changed in both the activator
(where it decreased) and Fränkel II (where it
increased) groups.
– Minimal / clinically insignificant change (increase) of
the labial inclination of the lower central incisor as a
result of the VDP appliance. In contrast, significant
increase of incisor inclination was observed in patient
groups using different functional appliances.
– Significant increase of the palatal inclination of the
upper central incisor with the VDP appliance, which
was much smaller than that observed in the activator
group and greater than that in the Fränkel group.
CLINICAL CASE PRESENTATION
A female patient was admitted for orthodontic treat-
ment at the age of 9.5 years. The following were
observed during the extraoral clinical examination (Fig.
6):
– Frontal view: medium facial type, normal to slightly
reduced ratio of lower to total anterior facial height.
– Profile view: convex face with reduced nasolabial
angle and strong labiomental fold.
– Smile: slightly asymmetrical, not spontaneous, no
showing of gingiva or dark corridors at the corners of
HELLENIC ORTHODONTIC REVIEW 2007 ñ VOLUME 10 ñ ISSUE 1
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance

– ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ÛÎÂÏÂÙÈ΋ Â›‰Ú·ÛË Ù˘

Û˘Û΢‹˜ VDP (Û ۯ¤ÛË Ì ÙȘ ˘fiÏÔÈ˜ ÔÌ¿‰Â˜
·ÛıÂÓÒÓ fiÔ˘ ÂÊ·ÚÌfiÛıËÎ·Ó ¿ÏÏ· ÏÂÈÙÔ˘ÚÁÈο
Ì˯·Ó‹Ì·Ù·) ÙfiÛÔ ˆ˜ ÚÔ˜ ÙËÓ ·‡ÍËÛË Ù˘ ÁˆÓ›·˜ SNB
fiÛÔ Î·È ˆ˜ ÚÔ˜ ÙËÓ Ì›ˆÛË Ù˘ ÁˆÓ›·˜ SNA Î·È Ù˘
ÁˆÓ›·˜ ∞¡µ
– ÌˉÂÓÈ΋ Â›‰Ú·ÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜ VDP
ÛÙËÓ ÎÏ›ÛË ÙÔ˘ ÂÈ¤‰Ô˘ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ (ˆ˜ ÚÔ˜ ÙËÓ
ÚfiÛıÈ· ‚¿ÛË ÙÔ˘ ÎÚ·Ó›Ô˘). ∞ÓÙ›ıÂÙ· ·Ú·ÙËÚ‹ıËΠ∂ÈÎfiÓ· 6. ∫·Ù¿ ̤وÔ, ÂÎ ÙÔ˘ Ï·Á›Ô˘ Î·È ÂÈÎfiÓ· ÙÔ˘ ÚÔÛÒÔ˘
ÌÂÙ·‚ÔÏ‹ ÛÙË ÁˆÓ›· ·˘Ù‹ ÙfiÛÔ ÛÙËÓ ÔÌ¿‰· ÂÊ·ÚÌÔÁ‹˜ Ù˘ ·ÛıÂÓÔ‡˜ fiÙ·Ó ¯·ÌÔÁÂÏ¿ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÔÚıÔ‰ÔÓÙÈ-
΋˜ ıÂÚ·›·˜ Ù˘, ÛÙËÓ ËÏÈΛ· ÙˆÓ 9,5 ÂÙÒÓ.
ÙÔ˘ ÂÓÂÚÁÔÔÈËÙ‹ (fiÔ˘ ·Ú·ÙËÚ‹ıËΠ̛ˆÛË) ηÈ
fiÛÔ Î·È ÛÙËÓ ÔÌ¿‰· ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ Fränkel II (fiÔ˘ Figure 6. Frontal, profile and smiling views of the patient before
·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË) orthodontic treatment start at the age of 9.5 years.
– ÂÏ¿¯ÈÛÙË/ ÎÏÈÓÈο ·Û‹Ì·ÓÙË ÌÂÙ·‚ÔÏ‹ (·‡ÍËÛË) Ù˘
¯ÂÈÏÈ΋˜ ·ÍÔÓÈ΋˜ ·fiÎÏÈÛ˘ ÙÔ˘ οو ÎÂÓÙÚÈÎÔ‡
ÙÔ̤·, ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜
VDP. ∞ÓÙ›ıÂÙ· ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙȘ
ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ fiÔ˘ ÂÊ·ÚÌfiÛıËÎ·Ó ¿ÏÏ· ÏÂÈÙÔ˘Ú-
ÁÈο Ì˯·Ó‹Ì·Ù·
– ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ·‡ÍËÛË Ù˘ ˘ÂÚÒÈ·˜ ·fiÎÏÈÛ˘
ÙÔ˘ ¿Óˆ ÎÂÓÙÚÈÎÔ‡ ÙÔ̤· ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÂÊ·ÚÌÔÁ‹˜
Ù˘ Û˘Û΢‹˜ VDP, Ô˘ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ·fi
ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Ù˘ ÔÌ¿‰·˜ ÙÔ˘ ÂÓÂÚÁÔÔÈËÙ‹ Î·È ÌÂÁ·Ï‡-
ÙÂÚË ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Ù˘ ÔÌ¿‰·˜ ÙÔ˘ Fränkel II.

¶Aƒ√À™π∞™∏ ∫§π¡π∫∏™ ¶∂ƒπ¶∆ø™∏™

∏ ·ÛıÂÓ‹˜ ÚÔÛ‹Ïı ÁÈ· ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· ÛÙËÓ ËÏÈ-
Λ· ÙˆÓ 9,5 ÂÙÒÓ. ∫·Ù¿ ÙËÓ Â͈ÛÙÔÌ·ÙÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË
Ù˘ ·ÛıÂÓÔ‡˜ ·Ú·ÙËÚ‹ıËÎ·Ó Ù· ÂÍ‹˜ (∂ÈÎ.6):
∂ÈÎfiÓ· 7. ∞ÂÈÎÔÓ›˙ÂÙ·È ÛÙ· ÂÎÌ·Á›· ÌÂϤÙ˘, Ë Î·Ù¿ ̤وÔ Î·È Ë
ÂÎ ÙÔ˘ Ï·Á›Ô˘ Û¯¤ÛË ÙˆÓ ‰ÔÓÙÈÒÓ Ù˘ ·ÛıÂÓÔ‡˜ Û ۇÁÎÏÂÈÛË Î·È
Ë È‰È·›ÙÂÚ· ·˘ÍË̤ÓË ÔÚÈ˙fiÓÙÈ· ÚfiÙ·ÍË ÙˆÓ ‰ÔÓÙÈÒÓ Ù˘ ÚÈÓ ·fi
ÙËÓ ¤Ó·ÚÍË Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Ù˘, ÛÙËÓ ËÏÈΛ· ÙˆÓ 9,5
ÂÙÒÓ.

– ∫·Ù¿ ̤وÔ: ̤ÛÔ˜ Ù‡Ô˜ ÚÔÛÒÔ˘, Ê˘ÛÈÔÏÔÁÈ΋
ÚÔ˜ ÂÏ·ÊÚ¿ ÂÏ·Ùو̤ÓË ·Ó·ÏÔÁ›· οو ÚÔÛı›Ô˘
‡„Ô˘˜ ÙÔ˘ ÚÔÛÒÔ˘ (ÚÔ˜ ÙÔ Û˘ÓÔÏÈÎfi ÚfiÛıÈÔ
‡„Ô˜ ÙÔ˘ ÚÔÛÒÔ˘)
– ∂Î ÙÔ˘ Ï·Á›Ô˘: ΢ÚÙ‹ ηٷÙÔÌ‹ ÙÔ˘ ÚÔÛÒÔ˘ ÌÂ
ÌÂȈ̤ÓË ÚÈÓÔ¯ÂÈÏÈ΋ ÁˆÓ›· Î·È ¤ÓÙÔÓ· ‰È·ÁÚ·ÊfiÌÂÓË
ÁÂÓÂÈÔ¯ÂÈÏÈ΋ ·‡Ï·Î·
– ÷ÌfiÁÂÏÔ: ÂÏ·ÊÚ¿ ·Û‡ÌÌÂÙÚÔ, ¯ˆÚ›˜ ·˘ıÔÚÌËÙÈÛÌfi,
¯ˆÚ›˜ ·ÔÎ¿Ï˘„Ë Ô‡ÏˆÓ Î·È ÛÎÔÙÂÈÓÒÓ ÂÚÈÔ¯ÒÓ ÛÙȘ
ÁˆÓ›Â˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜
∫·Ù¿ ÙËÓ ÂÓ‰ÔÛÙÔÌ·ÙÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË Î·È ÙËÓ ·ÍÈÔÏfi-
ÁËÛË ÙˆÓ ÂÎÌ·Á›ˆÓ ÌÂϤÙ˘ Ù˘ ·ÛıÂÓÔ‡˜ (∂ÈÎ. 7) ·Ú·-
ÙËÚ‹ıËÎ·Ó Ù· ÂÍ‹˜:
– ∏ ·Ó¿Ù˘ÍË Ù˘ Ô‰ÔÓÙÔÊ˘˝·˜ ‚ÚÈÛÎfiÙ·Ó ÛÙËÓ ·Ú¯‹ Ù˘
fi„ÈÌ˘ Ê¿Û˘ ÙÔ˘ ÌÈÎÙÔ‡ Ô‰ÔÓÙÈÎÔ‡ ÊÚ·ÁÌÔ‡
Figure 7. Frontal and lateral views of patient’s study casts in
occlusion; note the excessive overjet at treatment start (9.5 years
of age).
the mouth.
Intraoral clinical examination and assessment of study
casts (Fig. 7) revealed the following:
– dental stage: beginning of the late mixed dentition
period
– excessive overjet (14 mm)
– spaces between permanent maxillary incisors
– Angle Class II, division 1 malocclusion.
During functional examination, the following were
found:

E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2007 ñ TOMO™ 10 ñ TEYXO™ 1 21

∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance HELLENIC ORTHODONTIC REVIEW

¶›Ó·Î·˜ 2. ªÂÙÚ‹ÛÂȘ Â› Ù˘ Ï¿ÁÈ·˜ ÎÂÊ·ÏÔÌÂÙÚÈ΋˜ ·ÎÙÈÓÔÁÚ·Ê›·˜ Ù˘ ·ÛıÂÓÔ‡˜ ÚÈÓ ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ Î·È ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ‰Ú¿-
Û˘ Ù˘ Û˘Û΢‹˜ VDP.
Table 2. Cephalometric measurements of the patient before and after treatment with the VDP appliance.

Measurement / Normal value / Before / After /

ª¤ÙÚËÛË º˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ ¶ÚÈÓ ªÂÙ¿
SNA (Æ) 82,0±3,0Æ 81,9Æ 82,0Æ
SNB (Æ) 80,0±3,0Æ 75,4Æ 76,7Æ
ANB (Æ) 2,0±3,0Æ 6,5Æ 5,3Æ
Wits (mm) 0,5 mm 6,0 mm 0,3 mm
PP-MP (Æ) 23,5±3,0Æ 27,5Æ 24,5Æ
SN-MP (Æ) 32,0±5,0Æ 32,1Æ 31,4Æ
SN-PP (Æ) 8,5±3,0Æ 4,6Æ 6,9Æ
OCP-SN (Æ) 14,5Æ 10,7Æ 13,5Æ
SGo: NMe (%) 63% 65,7% 66,6%
ArGoMe (Æ) 130,0±7,0Æ 129,6Æ 129,6Æ
LI-GoMe (Æ) 90,0±3,0Æ 88,3Æ 101,1Æ
UI-PP (Æ) 102,0±2,0Æ 117,2Æ 95,7Æ
UI-LI (Æ) 131,0Æ 122,3Æ 131,8Æ
LI-NB (Æ) 25,0Æ 15,9Æ 29,2Æ
LI-NB (mm) 4,0 mm 1,8 mm 1,4 mm
UI-NA (Æ) 22,0Æ 35,3Æ 13,6Æ
UI-NA (mm) 4,0 mm 9,3 mm 5,0 mm
NSp: SpMe (%) 79% 83,1% 82,5%

– π‰È·›ÙÂÚ· ·˘ÍË̤ÓË ÔÚÈ˙fiÓÙÈ· ÚfiÙ·ÍË ÙˆÓ ‰ÔÓÙÈÒÓ (14 – habitual lower lip biting
¯ÈÏÈÔÛÙÒÓ) – swallowing with tongue thrust, whereas,
– ¢È·ÛÙ‹Ì·Ù· ÌÂٷ͇ ÙˆÓ ÌÔÓ›ÌˆÓ ¿Óˆ ÙÔ̤ˆÓ – no TMJ problems were detected.
– √ÚıÔ‰ÔÓÙÈ΋ ·ÓˆÌ·Ï›· ∆¿Í˘ ππ, ηÙËÁÔÚ›·˜ 1 ηٿ Analysis of the lateral cephalometric radiograph showed
Angle (Figures 8 and 9, Table 2):
∫·Ù¿ ÙËÓ ÏÂÈÙÔ˘ÚÁÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË Ù˘ ·ÛıÂÓÔ‡˜ ηٷ- – mandibular retrognathism
ÁÚ¿ÊËÎ·Ó – normal facial growth direction
– ηı’ ¤ÍË ‰‹ÍË ÙÔ˘ οو ¯Â›ÏÔ˘˜, – normal inclination of both jaws (in the vertical plane)
– ηٿÔÛË Ì ·ÚÂÌ‚ÔÏ‹ Ù˘ ÁÏÒÛÛ·˜ ÌÂٷ͇ ÙˆÓ in relation to the anterior cranial base and to each
ÚfiÛıÈˆÓ ÌÔÈÚÒÓ ÙˆÓ Ô‰ÔÓÙÈÎÒÓ ÙfiÍˆÓ ÂÓÒ other
– ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÚÔ‚Ï‹Ì·Ù· ÛÙË Ê˘ÛÈÔÏÔÁ›· ÙˆÓ – reduced interincisal angle, due to increased flaring of
∫°¢. maxillary central incisors.
∞fi ÙËÓ ·Ó¿Ï˘ÛË Ù˘ Ï¿ÁÈ·˜ ÎÂÊ·ÏÔÌÂÙÚÈ΋˜ ·ÎÙÈÓÔ-
ÁÚ·Ê›·˜ Ù˘ ·ÛıÂÓÔ‡˜ ·Ú·ÙËÚ‹ıËÎ·Ó Ù· ÂÍ‹˜ (∂ÈÎ. 8 Î·È Orthodontic treatment goals for this patient included:
9, ¶›Ó·Î·˜ 2): – rehabilitation of jaw relationships in the sagittal
– oÈÛıÔÁÓ·ıÈÛÌfi˜ Ù˘ οو ÁÓ¿ıÔ˘ plane, without interfering with the vertical and hori-
– Ê˘ÛÈÔÏÔÁÈ΋ ‰È‡ı˘ÓÛË ·‡ÍËÛ˘ ÙÔ˘ ÚÔÛÒÔ˘ zontal planes

22 HELLENIC ORTHODONTIC REVIEW 2007 ñ VOLUME 10 ñ ISSUE 1

E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance
∂ÈÎfiÓ· 8. ∞ÂÈÎÔÓ›˙ÂÙ·È Ë Ï¿ÁÈ· ÎÂÊ·ÏÔÌÂÙÚÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· Ù˘
·ÛıÂÓÔ‡˜ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Ù˘,
ÛÙËÓ ËÏÈΛ· ÙˆÓ 9,5 ÂÙÒÓ.
Figure 8. Patient’s lateral cephalometric radiograph before
treatment start (9.5 years of age).
– Ê˘ÛÈÔÏÔÁÈ΋ ·fiÎÏÈÛË ÙˆÓ ÁÓ¿ıˆÓ (ÛÙÔ Î·Ù·ÎfiÚ˘ÊÔ
Â›‰Ô) ˆ˜ ÚÔ˜ ÙËÓ ÚfiÛıÈ· ‚¿ÛË ÙÔ˘ ÎÚ·Ó›Ô˘ ηÈ
ÌÂٷ͇ ÙÔ˘˜
– ÂÏ·Ùو̤ÓË ‰È·ÙÔÌÈ΋ ÁˆÓ›· ÌÂٷ͇ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ
¿Óˆ Î·È Î¿Ùˆ ÁÓ¿ıÔ˘, ÔÊÂÈÏfiÌÂÓË ÛÙËÓ ·˘ÍË̤ÓË ¯ÂÈ-
ÏÈ΋ ·fiÎÏÈÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ.
√È ÛÙfi¯ÔÈ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Ù˘ ·ÛıÂÓÔ‡˜
ÂÚÈÂÏ¿Ì‚·Ó·Ó:
– ÙËÓ ·ÔηٿÛÙ·ÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ Û¯¤ÛÂˆÓ ÙˆÓ ÁÓ¿-
ıˆÓ ÛÙÔ ÚÔÛıÈÔ›ÛıÈÔ Â›‰Ô, ¯ˆÚ›˜ Ó· ‰È·Ù·Ú·¯ı›
Ë Û¯¤ÛË ÙÔ˘˜ ÛÙÔ ÂÁοÚÛÈÔ Î·È ÛÙÔ Î·Ù·ÎfiÚ˘ÊÔ Â›Â-
‰Ô
– ÙËÓ ·ÔηٿÛÙ·ÛË π˘ ∆¿Íˆ˜ ηٿ Angle Û¯¤ÛˆÓ
ÁÔÌÊ›ˆÓ Î·È Î˘ÓÔ‰fiÓÙˆÓ
– ÙËÓ ·ÔηٿÛÙ·ÛË Ê˘ÛÈÔÏÔÁÈ΋˜ Û˘Ó·ÚÌÔÁ‹˜ ÙˆÓ
Ô‰ÔÓÙÈÎÒÓ ÙfiÍˆÓ Ì ·ÔηٿÛÙ·ÛË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜
·ÍÔÓÈ΋˜ ·fiÎÏÈÛ˘ ÙˆÓ ¿Óˆ ÙÔ̤ˆÓ Î·È Ù˘ ÔÚÈ˙fi-
ÓÙÈ·˜ ÚfiÙ·Í˘ ÙˆÓ ‰ÔÓÙÈÒÓ
– ÙËÓ ‚ÂÏÙ›ˆÛË Ù˘ ·ÈÛıËÙÈ΋˜ ÙÔ˘ ÚÔÛÒÔ˘ Î·È ÙÔ˘
¯·ÌfiÁÂÏÔ˘.
™Ù· Ï·›ÛÈ· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Ù˘ ·ÛıÂÓÔ‡˜
ÂÊ·ÚÌfiÛıËÎÂ Ë ÏÂÈÙÔ˘ÚÁÈ΋ ÔÚıÔ‰ÔÓÙÈ΋- ÔÚıÔ·È‰È΋
Û˘Û΢‹ VDP ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÂÚ›Ô˘ 2 ÂÙÒÓ.
∫·ıÒ˜ Ë È‰È·›ÙÂÚ· ·˘ÍË̤ÓË ÚfiÙ·ÍË ÙˆÓ ‰ÔÓÙÈÒÓ ÍÂÂÚ-
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2007 ñ TOMO™ 10 ñ TEYXO™ 1
∂ÈÎfiÓ· 9. ∞ÂÈÎÔÓ›˙ÂÙ·È ÙÔ È¯ÓÔÁÚ¿ÊËÌ· Ù˘ Ï¿ÁÈ·˜ ÎÂÊ·ÏÔÌÂÙÚÈ-
΋˜ ·ÎÙÈÓÔÁÚ·Ê›·˜ Ù˘ ·ÛıÂÓÔ‡˜ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÔÚıÔ‰Ô-
ÓÙÈ΋˜ ıÂÚ·›·˜ Ù˘, ÛÙËÓ ËÏÈΛ· ÙˆÓ 9,5 ÂÙÒÓ.
Figure 9. Tracing of initial lateral cephalometric radiograph.
– restoration to Angle Class I relationship of molars and
canines
– achievement of normal dental occlusion through cor-
rection of overjet and upper incisor inclination
– improvement of facial and smile esthetics.
The VDP orthodontic-orthopedic appliance was used in
this patient for a period of two years. Due to overjet
exceeding 7 mm, two functional appliances were con-
structed for this patient, each applied for one year
approximately. The first appliance brought the mandible
forward by 7 mm and, after one year, the mandible was
brought forward by another 7 mm using a second appli-
ance until an edge-to-edge incisor relationship was
achieved. The VDP was not combined with application of
extra-oral forces or fixed orthodontic appliances. The
anterior acrylic base of the maxillary appliance in the first
VDP set included wire springs that, when activated, con-
tributed to upper incisor uprighting (through palatal
crown tipping) along with the orthopedic effect. During
the entire time that the two VDP sets were used, appro-
priate activation of the jackscrews aimed at restoring
transverse intermaxillary relationships along with the
sagittal orthopedic effect. Appropriate modification of
the acrylic base of both appliances resulted in normal
alignment of erupting permanent teeth.
23
∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance
∂ÈÎfiÓ· 10. ∞ÂÈÎÔÓ›˙ÂÙ·È Ë Ï¿ÁÈ· ÎÂÊ·ÏÔÌÂÙÚÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· Ù˘
·ÛıÂÓÔ‡˜ ÌÂÙ¿ ·fi ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜
VDP, ÛÙËÓ ËÏÈΛ· ÙˆÓ 11,5 ÂÙÒÓ.
Figure 10. Patient’s lateral cephalometric radiograph following
completion of treatment with the VDP appliance at the age of 11.5
years.
ÓÔ‡Û ÙÔ fiÚÈÔ ·ÛÊ·Ï›·˜ ÙˆÓ 7 ¯ÈÏÈÔÛÙÒÓ, ηٿ ÙËÓ Ê¿ÛË
Ù˘ ıÂÚ·›·˜ Ì ÏÂÈÙÔ˘ÚÁÈο Ì˯·Ó‹Ì·Ù·, ηٷÛ΢¿-
ÛıËÎ·Ó Û˘ÓÔÏÈο ‰‡Ô Û˘Û΢¤˜, οı ̛· ÂÎ ÙˆÓ ÔÔ›ˆÓ
ÂÊ·ÚÌfiÛıËΠÁÈ· ¤Ó· ÂÚ›Ô˘ ¯ÚfiÓÔ. ªÂ ÙËÓ ÂÊ·ÚÌÔÁ‹
Ù˘ ÚÒÙ˘ Û˘Û΢‹˜ Ë Î¿Ùˆ ÁÓ¿ıÔ˜ ÚÔˆı›ÙÔ Î·Ù¿ 7
mm Î·È ÌÂÙ¿ ·fi ¤Ó· ÂÚ›Ô˘ ¯ÚfiÓÔ, Ì ÙËÓ ÂÊ·ÚÌÔÁ‹
Ù˘ ‰Â‡ÙÂÚ˘ Ë Î¿Ùˆ ÁÓ¿ıÔ˜ ÚÔˆı›ÙÔ ÂÚ·ÈÙ¤Úˆ 7 mm,
̤¯ÚÈ Ù˘ Â›Ù¢Í˘ ÎÔÙÈ΋˜ ÚÔ˜ ÎÔÙÈ΋˜ Û¯¤Û˘ ÙˆÓ
ÙÔ̤ˆÓ. √È Û˘Û΢¤˜ ÂÊ·ÚÌfiÛıËÎ·Ó ¯ˆÚ›˜ Û˘Ó‰˘·Ṳ̂ÓË
ÂÊ·ÚÌÔÁ‹ Â͈ÛÙÔÌ·ÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ ‹ ·Î›ÓËÙˆÓ ÔÚıÔ-
‰ÔÓÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ. ™ÙËÓ ·ÎÚ˘ÏÈ΋ ‚¿ÛË Ù˘ ÚfiÛıÈ·˜
ÌÔ›Ú·˜ ÙÔ˘ Ì˯·Ó‹Ì·ÙÔ˜ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ Ù˘ ÚÒÙ˘
Û˘Û΢‹˜ ÂÓۈ̷ÙÒıËÎ·Ó Î·Ù¿ÏÏËÏ· ‰È·ÌÔÚʈ̤ӷ
Û˘ÚÌ¿ÙÈÓ· ÂÏ·Ù‹ÚÈ· Ù· ÔÔ›· ÛÙËÓ ÂÓÂÚÁÔÔÈË̤ÓË ÙÔ˘˜
ı¤ÛË Û˘Ó¤‚·ÏÏ·Ó ÛÙËÓ ÛÙ·‰È·Î‹ ÔÚıÔ‰ÔÓÙÈ΋ ·ÓfiÚıˆÛË
(Ì ˘ÂÚÒÈ·˜ ‰È‡ı˘ÓÛ˘ Û˘ÛÙÚÔÊ‹ Ù˘ ̇Ï˘ ÙÔ˘˜) ÙˆÓ
¿Óˆ ÙÔ̤ˆÓ ·Ú¿ÏÏËÏ· Ì ÙËÓ ÔÚıÔ·È‰È΋ ‰Ú¿ÛË Ù˘
Û˘Û΢‹˜. ∫·Ù¿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ù˘ ‰È·‰Ô¯È΋˜
ÂÊ·ÚÌÔÁ‹˜ ÙˆÓ ‰‡Ô Û˘Û΢ÒÓ Ë Î·Ù¿ÏÏËÏË (Û ڢıÌfi
Î·È Û˘ÓÔÏÈ΋ ¤ÎÙ·ÛË) ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ‰‡Ô ÂÍÂÏÈÎÙÚÒÓ
›¯Â ˆ˜ ÛÎÔfi ÙËÓ ·ÔηٿÛÙ·ÛË ÙˆÓ Û¯¤ÛÂˆÓ ÙˆÓ Ô‰Ô-
ÓÙÈÎÒÓ ÙfiÍˆÓ ÛÙÔ ÂÁοÚÛÈÔ Â›Â‰Ô ·Ú¿ÏÏËÏ· Ì ÙËÓ
ÔÚıÔ·È‰È΋ ‰Ú¿ÛË Ù˘ Û˘Û΢‹˜ ÛÙÔ ÚÔÛıÈÔ›ÛıÈÔ Â›-
‰Ô. ™ÙÔ ›‰ÈÔ ‰È¿ÛÙËÌ·, Ë Î·Ù¿ÏÏËÏË ÙÚÔÔÔ›ËÛË Ù˘
·ÎÚ˘ÏÈ΋˜ ‚¿Û˘ ÙˆÓ ‰‡Ô Ì˯·ÓËÌ¿ÙˆÓ Â›¯Â ˆ˜ ·ÔÙ¤ÏÂ-
ÛÌ· ÙËÓ ÔÌ·Ï‹ ‰È¢ı¤ÙËÛË ÛÙ· Ô‰ÔÓÙÈο ÙfiÍ· ÙˆÓ ˘fi
24
HELLENIC ORTHODONTIC REVIEW
∂ÈÎfiÓ· 11. ∞ÂÈÎÔÓ›˙ÂÙ·È ÙÔ È¯ÓÔÁÚ¿ÊËÌ· Ù˘ Ï¿ÁÈ·˜ ÎÂÊ·ÏÔÌÂÙÚÈ-
΋˜ ·ÎÙÈÓÔÁÚ·Ê›·˜ Ù˘ ·ÛıÂÓÔ‡˜ ÌÂÙ¿ ·fi ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘
ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜ VDP, ÛÙËÓ ËÏÈΛ· ÙˆÓ 11,5 ÂÙÒÓ.
Figure 11. Tracing of lateral cephalometric radiograph following
completion of treatment with the VDP appliance at the age of 11.5
years.
Clinical results and dentoskeletal effects of the function-
al appliance were evaluated through analysis of a second
lateral cephalometric radiograph (Figures 10 and 11,
Table 2).
Comparison between the two cephalometric radi-
ographs, before and after VDP application, showed that:
– the skeletal sagittal jaw relationship was improved,
while the normal vertical relationships were not
affected,
– the interincisal angle and dental overjet were
restored, through correction of upper incisor inclina-
tion (incisor uprighting) and increase of lower incisor
proclamation,
– the nasolabial angle was improved, whereas the
labiomental fold became less pronounced,
– Angle Class I molar relationship was achieved.
Following treatment completion with the VDP at the age
of 11.5 years, the patient got full-mouth fixed appliances
for approximately 2 years. Retention of orthodontic
treatment outcome included a removable Hawley appli-
ance in the maxilla and fixed retention of the six anteri-
or lower teeth using a multistranded lingual wire.
The successful orthodontic treatment outcome is obvious
in both the intraoral (Fig. 12) and extraoral clinical exam-
ination, while patient satisfaction is confirmed by her
natural, spontaneous smile (Fig. 13).
HELLENIC ORTHODONTIC REVIEW 2007 ñ VOLUME 10 ñ ISSUE 1
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance
∂ÈÎfiÓ· 12. ∞ÂÈÎÔÓ›˙ÂÙ·È Ë ÂÓ‰ÔÛÙÔÌ·ÙÈ΋ ηٿ ̤وÔ Î·È ÂÎ ÙÔ˘
Ï·Á›Ô˘ Û¯¤ÛË ÙˆÓ ‰ÔÓÙÈÒÓ Ù˘ ·ÛıÂÓÔ‡˜ Û ۇÁÎÏÂÈÛË ÌÂÙ¿ ·fi
ÙËÓ ·Ê·›ÚÂÛË ÙˆÓ ·Î›ÓËÙˆÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Î·È ÙËÓ
ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ Ù˘ ıÂÚ·›·˜, ÛÙËÓ ËÏÈΛ· ÙˆÓ
13,5 ÂÙÒÓ.
Figure 12. Frontal and lateral intraoral views in occlusion following
removal of fixed orthodontic appliances at the age of 13.5 years.
∂ÈÎfiÓ· 13. ∫·Ù¿ ̤وÔ, ÂÎ ÙÔ˘ Ï·Á›Ô˘ Î·È ÂÈÎfiÓ· ÙÔ˘ ÚÔÛÒÔ˘
Ù˘ ·ÛıÂÓÔ‡˜ fiÙ·Ó ¯·ÌÔÁÂÏ¿ ÌÂÙ¿ ·fi ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÔÚıÔ-
‰ÔÓÙÈ΋˜ Ù˘ ıÂÚ·›·˜, ÛÙËÓ ËÏÈΛ· ÙˆÓ 13,5 ÂÙÒÓ.
Figure 13. Frontal, profile and smiling views of patient following
completion of orthodontic treatment at the age of 13.5 years.
·Ó·ÙÔÏ‹ ¢ÚÈÛÎfiÌÂÓˆÓ ÌÔÓ›ÌˆÓ ‰ÔÓÙÈÒÓ.
∆Ô ÎÏÈÓÈÎfi ·ÔÙ¤ÏÂÛÌ· Î·È ÔÈ ÂÈ̤ÚÔ˘˜ Ô‰ÔÓÙÔÛÎÂÏÂÙÈΤ˜
ÂȉڿÛÂȘ Ù˘ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁÈÎÔ‡ Ì˯·Ó‹Ì·ÙÔ˜
·ÍÈÔÏÔÁ‹ıËÎ·Ó Ì ÙËÓ Ï‹„Ë Î·È ·Ó¿Ï˘ÛË Ó¤·˜ Ï¿ÁÈ·˜
ÎÂÊ·ÏÔÌÂÙÚÈ΋˜ ·ÎÙÈÓÔÁÚ·Ê›·˜ (∂ÈÎ. 10 Î·È 11, ¶›Ó·Î·˜
2).
∞fi ÙË Û‡ÁÎÚÈÛË ÙˆÓ ‰‡Ô ÎÂÊ·ÏÔÌÂÙÚÈÎÒÓ ·ÎÙÈÓÔÁÚ·-
ÊÈÒÓ, ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Î·È ÌÂÙ¿ ·fi ÙËÓ ÔÏÔÎÏ‹Úˆ-
ÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜ VDP, ÚԤ΢„ fiÙÈ ÌÂÙ¿
·fi ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜, ˆ˜
·ÔÙ¤ÏÂÛÌ· Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ‰Ú¿Û˘ Ù˘:
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2007 ñ TOMO™ 10 ñ TEYXO™ 1
CONCLUSIONS
– The VDP appliance is an especially useful and effective
treatment alternative for the management of den-
toskeletal Class II malocclusion.
– The appliance may be used without a prior phase of
dental arch expansion (where indicated) or elimina-
tion of anterior crowding. These problems may be
treated at the same time with appliance wear.
– Depending on individual clinical characteristics, the
VDP appliance may be combined with various compo-
nents incorporated in the appliances, such as head-
gear tubes for application of high- or low- pull extra-
oral forces, springs for incisor rotational correction,
springs for distal molar movement, magnets, etc.
– The main advantage of the VDP compared to different
orthodontic-orthopedic appliances is its continuous
action during sleep, as the normal mandibular open-
ing observed does not disarticulate the maxillary and
mandibular VDP components.
References
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tion or reality- a review of the literature. Am J Orthod Dento-
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Bass NM. Dentofacial orthopaedics in the correction of the skeletal
Class II malocclusion. Br J Orthod 1982;9:3-31.
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treatment, a discussion ased on cephalometric X-ray analysis of
treated cases. Am J Orthod 1951;37:437-58.
Balters W. Die Technik und Übung der allgemeinen und speziellen
Bionator- Therapie. Quintessenz 1964;15:77-85.
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treatment of Class II division 1 malocclusions. Eur J Orthod
2001;23:495-505.
Clark WJ. The twin block technique. Funct Orthod 1991;8:24-8.
Clark WJ. The twin block technique. In: Graber TM, Rakosi T, Petro-
vic AG, eds. Dentofacial Orthopedics with Functional Appli-
ances. St. Louis: Mosby Year Book, 1997:268-98.
Dermaut LR, van den Eynde F, de Pauw G. Skeletal and dento-alve-
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to different vertical growth patterns. Eur J Orthod
1992;14:140-6.
Ghafari J, King GJ, Tulloch JFC. Early treatment of Class II division
1 malocclusion- comparison of alternative treatment modali-
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Graber TM. The Frankel function regulator. In: Graber TM, Rakosi T,
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treatment. Am J Orthod 1971;60:478-90.
25
∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance
– ‚ÂÏÙÈÒıËÎÂ Ë ÛÎÂÏÂÙÈ΋ Û¯¤ÛË ÙˆÓ ÁÓ¿ıˆÓ ÛÙÔ ÚÔ-
ÛıÈÔ›ÛıÈÔ Â›‰Ô, ¯ˆÚ›˜ Ó· ÂËÚ·ÛıÔ‡Ó ÔÈ (Ê˘ÛÈÔ-
ÏÔÁÈΤ˜) Û¯¤ÛÂȘ ÙÔ˘˜ ÛÙÔ Î·Ù·ÎfiÚ˘ÊÔ Â›‰Ô,
– ·ÔηٷÛÙ¿ıËÎÂ Ë Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ Ù˘ ‰È·ÙÔÌÈ΋˜
ÁˆÓ›·˜ Î·È Ë Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ Ù˘ ÔÚÈ˙fiÓÙÈ·˜ ÚfiÙ·Í˘
ÙˆÓ ‰ÔÓÙÈÒÓ Ì¤Ûˆ Ù˘ ‰ÈfiÚıˆÛ˘ Ù˘ ·ÍÔÓÈ΋˜ ·fi-
ÎÏÈÛ˘ ÙˆÓ ¿Óˆ ÙÔ̤ˆÓ (ÔÈ ÔÔ›ÔÈ ·ÓÔÚıÒıËηÓ) ηÈ
Ù˘ ·‡ÍËÛ˘ Ù˘ ¯ÂÈÏÈ΋˜ ·fiÎÏÈÛ˘ ÙˆÓ Î¿Ùˆ ÙÔ̤ˆÓ,
– ‚ÂÏÙÈÒıËÎÂ Ë ÚÈÓÔ¯ÂÈÏÈ΋ ÁˆÓ›· ÂÓÒ Ë ÁÂÓÂÈÔ¯ÂÈÏ‹
·‡Ï·Î· ‰È·ÁÚ¿ÊÂÙ·È ϤÔÓ ÏÈÁfiÙÂÚÔ ¤ÓÙÔÓ· ηÈ
– ·ÔηٷÛÙ¿ıËÎÂ Ë Û¯¤ÛË ÙˆÓ ÚÒÙˆÓ ÌÔÓ›ÌˆÓ ÁÔÌ-
Ê›ˆÓ Û ∆¿ÍË π ηٿ Angle
ªÂÙ¿ ·fi ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜
VDP, ÛÙËÓ ËÏÈΛ· ÙˆÓ 11,5 ÂÙÒÓ, ·ÎÔÏÔ‡ıËÛÂ Ë ÂÊ·ÚÌÔ-
Á‹ ÙˆÓ ·Î›ÓËÙˆÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Û fiÏ· Ù·
ÌfiÓÈÌ· ‰fiÓÙÈ· Ù˘ ·ÛıÂÓÔ‡˜ ÁÈ· ‰È¿ÛÙËÌ· ÂÚ›Ô˘ 2 ÂÙÒÓ.
∏ Û˘ÁÎÚ¿ÙËÛË ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜
ıÂÚ·›·˜ ÂÚÈÂÏ¿Ì‚·Ó ÙËÓ ÂÊ·ÚÌÔÁ‹ ÎÈÓËÙÔ‡ Ì˯·Ó‹-
Ì·ÙÔ˜ Ù‡Ô˘ Hawley ÛÙËÓ ¿Óˆ ÁÓ¿ıÔ˘ Î·È ·Î›ÓËÙË
Û˘ÁÎÚ¿ÙËÛË ÌÂٷ͇ ÙˆÓ ÚÔÛı›ˆÓ ¤ÍÈ ‰ÔÓÙÈÒÓ Ù˘ οو
ÁÓ¿ıÔ˘ Ì ÙË Û˘ÁÎfiÏÏËÛË ÂÚÈÂÏÈÁ̤ÓÔ˘ Û‡ÚÌ·ÙÔ˜ ÛÙË
ÁψÛÛÈ΋ ÂÈÊ¿ÓÂÈ· ÙˆÓ ‰ÔÓÙÈÒÓ.
∆Ô ÂÈÙ˘¯¤˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ Ù˘
·ÛıÂÓÔ‡˜ ηı›ÛÙ·Ù·È Û·Ê¤˜ ÙfiÛÔ Î·Ù¿ ÙËÓ ÂÓ‰ÔÛÙÔÌ·ÙÈ΋
(∂ÈÎ. 12) fiÛÔ Î·È ÙËÓ Â͈ÛÙÔÌ·ÙÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË, ÂÓÒ Ë
ÈηÓÔÔ›ËÛË Ù˘ ·ÛıÂÓÔ‡˜ ÂȂ‚·ÈÒÓÂÙ·È ·fi ÙÔÓ
·˘ıÔÚÌËÙÈÛÌfi ÙÔ˘ ¯·ÌfiÁÂÏÔ‡ Ù˘ (∂ÈÎ. 13).
™Àª¶∂ƒ∞™ª∞∆∞
– ∏ Û˘Û΢‹ VDP ·ÔÙÂÏ› Ì›· ȉȷ›ÙÂÚ· ¯Ú‹ÛÈÌË Î·È
·ÔÙÂÏÂÛÌ·ÙÈ΋ ıÂÚ·¢ÙÈ΋ ÂÈÏÔÁ‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂ-
ÙÒÈÛË ÙˆÓ Ô‰ÔÓÙÔÛÎÂÏÂÙÈÎÒÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ ·ÓˆÌ·-
ÏÈÒÓ ∆¿Í˘ ππ.
– ∏ ÂÊ·ÚÌÔÁ‹ Ù˘ Û˘Û΢‹˜ VDP Â›Ó·È ‰˘Ó·Ù‹ ¯ˆÚ›˜ Ó·
ÚÔËÁËı›, fiÔ˘ ÂӉ›ÎÓ˘Ù·È, Ê¿ÛË ‰È‡ڢÓÛ˘ ÙˆÓ
Ô‰ÔÓÙÈÎÒÓ ÊÚ·ÁÌÒÓ ‹ ÂÍ¿ÏÂȄ˘ ÙÔ˘ ·Ú·ÙËÚÔ‡ÌÂ-
ÓÔ˘ Û˘ÓˆÛÙÈÛÌÔ‡ ÙˆÓ ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ. ∆· ÔÚıÔ‰Ô-
ÓÙÈο ÚÔ‚Ï‹Ì·Ù· ·˘Ù¿ ÌÔÚÔ‡Ó Ó· ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó
Ù·˘Ùfi¯ÚÔÓ· Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Û˘Û΢‹˜.
– ∞Ó¿ÏÔÁ· Ì ٷ ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο οı ÂÚ›Ùˆ-
Û˘, Ë ÂÊ·ÚÌÔÁ‹ Ù˘ Û˘Û΢‹˜ VDP ÌÔÚ› Ó· Û˘Ó-
‰˘¿˙ÂÙ·È Ì ÙËÓ ÂÓۈ̿وÛË Ì›·˜ ÛÂÈÚ¿˜ ÂÍ·ÚÙËÌ¿ÙˆÓ
ÛÙ· ‰‡Ô Ì˯·Ó‹Ì·Ù·, fiˆ˜ ÛˆÏËÓ›ÛÎˆÓ ÁÈ· ÙËÓ ÂÊ·Ú-
ÌÔÁ‹ ÚÔÛÙÔÌÈ·ÎÔ‡ ÙfiÍÔ˘ Â͈ÛÙÔÌ·ÙÈÎÒÓ Ì˯·ÓÈ-
26
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HELLENIC ORTHODONTIC REVIEW 2007 ñ VOLUME 10 ñ ISSUE 1
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H ∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ÔÚıÔ‰ÔÓÙÈÎfi- ÔÚıÔ·È‰ÈÎfi Ì˯¿ÓËÌ· VDP / The functional orthodontic-orthopedic VDP appliance
ÛÌÒÓ ¯·ÌËÏ‹˜ ‹ ˘„ËÏ‹˜ ¤Ï͢, ηٿÏÏËÏ· ‰È·ÌÔÚ-
ÊˆÌ¤ÓˆÓ ÂÏ·ÙËÚ›ˆÓ ‰ÈfiÚıˆÛ˘ Ù˘ Û˘ÛÙÚÔÊ‹˜ ÙˆÓ
ÙÔ̤ˆÓ, ÂÏ·ÙËÚ›ˆÓ ¿ˆ ÌÂٷΛÓËÛ˘ ÙˆÓ ÁÔÌÊ›ˆÓ,
Ì·ÁÓËÙÒÓ Î·.
– ∆Ô Î‡ÚÈÔ ÏÂÔÓ¤ÎÙËÌ· Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û˘Û΢‹˜
VDP ¤Ó·ÓÙÈ ÙˆÓ ‰È·ÊfiÚˆÓ ÂÓ·ÏÏ·ÎÙÈÎÒÓ Ù‡ˆÓ ÔÚıÔ-
‰ÔÓÙÈÎÒÓ- ÔÚıÔ·È‰ÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ Ì˯·ÓËÌ¿ÙˆÓ
Â›Ó·È Ë Û˘Ó¯È˙fiÌÂÓË ‰Ú¿ÛË Ù˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘
Ó˘¯ÙÂÚÈÓ‹˜ ηٿÎÏÈÛ˘ ηıÒ˜ Ë Ê˘ÛÈÔÏÔÁÈ΋ ηٿÛ·-
ÛË Ù˘ οو ÁÓ¿ıÔ˘ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔÓ ‡ÓÔ ‰ÂÓ
Û˘ÓÂ¿ÁÂÙ·È ·ÔÛ˘Ó·ÚÌÔÁ‹ ÙˆÓ ‰‡Ô Ì˯·ÓËÌ¿ÙˆÓ
ÙˆÓ ‰‡Ô ÁÓ¿ıˆÓ
¢È‡ı˘ÓÛË ÁÈ· ·Ó¿Ù˘·:
º›ÏÈÔ˜ ¡. ™˘ÓÔ‰ÈÓfi˜
∂ıÓÈ΋˜ ∞ÓÙÈÛÙ¿Ûˆ˜ 31
17237 ¢¿ÊÓË
E-mail: fsynodin@otenet.gr
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Reprint requests:
Filippos N. Synodinos
Ethnikis Antistaseos 31
GR-17237 Dafni
Greece
E-mail: fsynodin@otenet.gr
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