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Microbial Biofilm in Endodontic Infections

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Page 1: Microbial Biofilm in Endodontic Infections

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I@H\OL@NK L@OG@KI @DADMOMOD]@H @DGAH]@ODX

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MAG@D@]@OD

N l`og`ki `s n hoipkax nccracnt`od og i`hroorcnd`sis crow`dc od n sok`m

sulstrnta. L`og`kis nra hfnrnhtar`zam ly struhturnk fatarocada`ty, cadat`h m`vars`ty,

hoipkax hoiiud`ty `dtarnht`ods, ndm nd axtrnhakkuknr intr`x og pokyiar`h

sulstndhas.

  L`og`ki `s n ioma og i`hrol`nk crowtf wfara mydni`h hoiiud`t`as og

`dtarnht`dc sass`ka hakks nra `rravars`lky nttnhfam to n sok`m sulstrntui,ns wakk ns

anhf otfar,ndm nra ailammam `d n sakg-inma intr`x og axtrnhakkuknr pokyiar`h

sulstndhas.

  ( @dcka 7 tf am`t`od)

fa tari l`og`ki wns `dtromuham to mas`cdnta tfa tf`d knyaram hodmadsnt`ods og

i`hrolas (a.c. lnhtar`n, gudc`,protozon) tfnt iny ohhur od vnr`ous surgnha

struhturas `d dntura. !raa-gkont`dc lnhtar`n ax`st`dc `d nd n"uaous adv`rodiadt, so-

hnkkam pknd#tod`h i`hroorcnd`sis, nra prara"u`s`ta gor l`og`ki gorint`od. $uhf

g`kis iny tfus lahoia astnlk`sfam od ndy orcnd`h or `dorcnd`h surgnha sulstrnta

wfara pknd#tod`h i`hroorcnd`sis pravn`k `d n wntar-lnsam sokut`od. (CQDDAK XWADXN]A\ & CQDDN\ LA\CADFOK]R)

  L`og`kis nra usunkky goudm od sok`m sulstrntas suliarcam `d or

axposam to soia n"uaous sokut`od. L`og`kis hods`st og indy spah`as og lnhtar`n

ndm nrhfnan k`v`dc w`tf`d n intr`x og axhratam pokyiar`h hoipoudms. f`s intr`x

 protahts tfa hakks w`tf`d `t ndm gnh`k`tntas hoiiud`hnt`od niodc tfai tfroucf

hfai`hnk ndm pfys`hnk s`cdnks. $oia l`og`kis fnva laad goudm to hodtn`d wntar

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hfnddaks tfnt fakp m`str`luta dutr`adts ndm s`cdnkk`dc iokahukas. f`s intr`x `s

strodc adoucf tfnt `d soia hnsas, l`og`kis hnd lahoia goss`k`zam.

N i`hrol`nk l`og`ki `s hods`maram n hoiiud`ty tfnt iaats tfa gokkow`dc gour lns`h

hr`tar`n%

 fa i`hroorcnd`si k`v`dc `d tfa hoiiud`ty&

'.ust possass tfa nl`k`t`as to sakg-orcnd`za (nutopo`as`s)

.*as`st adv`rodiadtnk parturlnt`ods (foiaostns`s)

+.ust la iora aggaht`va `d nssoh`nt`od tfnd `d `soknt`od(sydarcy)

.*aspodm to adv`rodiadtnk hfndcas ns n ud`t rntfar tfnd s`dcka

`dm`v`munks(hoiiudnk`ty)

OWA\W@AS OG LNH]A\@NK L@OG@KIX

 

*oot hndnk `s nd axtrnorm`dnry i`hroadv`rodiadt gor savarnk i`hrol`nk spah`as to

nttnhf od madt`d surgnha ndm gori madsa lnhtar`nk l`og`kis,wf`hf nra pravnkadt od

iost wat surgnhas ndm hnd hnusa adv`rodiadtnk prolkais, raprasadt`dc n hoiiod

hnusa og pars`stadt `dgaht`ods.fa stncas og struhturnk orcnd`znt`od og l`og`ki,tfa

hoipos`t`od ndm nht`v`t`as og tfa hokod`z`dc i`hroorcnd`sis `d vnr`ous

adv`rodiadts iny la m`ggaradt, nktfoucf tfa astnlk`sfiadt og n i`hro-hoiiud`ty

od n surgnha saais to gokkow assadt`nkky tfa snia sar`as og mavakopiadtnk stncas,

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`dhkum`dc mapos`t`od og n hodm`t`od`dc g`ki, nmfas`od ndm hokod`znt`od og

 pknd#tod`h i`hroorcnd`sis `d n pokyiar`h intr`x, ho-nmfas`od og otfar orcnd`sis,

ndm matnhfiadt og l`og`ki i`hroorcnd`sis `dto surroudm`dcs. fa suhhass og 

`dgahtam root hndnk trantiadt `s mapadmadt od `dnht`vnt`od og i`hroorcnd`sis

 prasadt `d l`og`ki ndm pknd#tod`h nil`ndha. ( B Nppk Ornk Xh`. <::05>3(<)263-0>)

  $udm"v`st ndm !`mcor (+) raportam tfnt root hndnk `dgaht`od `s dot

n rndmoi avadt/. $pah`as tfnt astnlk`sf n pars`stadt admomodt`h `dgaht`od nra

sakahtam ly tfa pfadotyp`h trn`ts tfnt tfay sfnra ndm tfnt nra su`tam to tfa iom`g`am

adv`rodiadt. $oia og tfasa sfnram hfnrnhtar`st`hs `dhkuma tfa hnpnh`ty to padatrnta

ndm `dvnma madt`d, n crowtf pnttard og hfn`ds or hofas`va g`kniadts, ras`stndha to

ndt`i`hrol`nks usam `d admomodt`h trantiadt, ns wakk ns nd nl`k`ty to crow `d iodo-

`dgaht`ods, to surv`va par`oms og stnrvnt`od ndm to avnma tfa fost raspodsa.

  :d tfa pnst,lnhtar`okoc`hnk stum`as wara hodmuhtam od graa-gkont`dc

 lnhtar`nk hakks(pknd#tod`h stnta),`cdor`dc tfa ̀ iportndha og sass`ka lnhtar`nk

hakks(l`og`ki stnta).L`og`ki hnd la goriam wfaravar tfara `s n gkow og

gku`m,i`hroorcnd`sis ndm n sok`m surgnha.:t `s oda og tfa lns`h surv`vnk strntac`as

aipkoyam ly lnhtar`n `d nkk dnturnk ndm `dmustr`nk ahosystais `d raspodsa to

stnrvnt`od.

  fa sass`ka lnhtar`nk hakks `d n l`og`ki stnta m`ggar crantky groi

tfa`r pknd#tod`h houdtarpnrts.:ds`ma n l`og̀ ki,tfa lnhtar`nk hakks axf`l`t nktaram

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 pfadotyp`h propart`as ndm nra protahtam groi ndt`i`hrol`nks,adv`rodiadtnk

strassas, lnhtar`opfncas ndm pfncohyt`h nioalna.

L`og`kis nra raspods`lka gor iost og tfa hfrod`h `dgaht`ods ndm nkiost nkk

rahnkh`trndt `dgaht`ods `d fuind la`dcs,ns lnhtar`n `d l`og`ki nra ras`stndt to lotf

ndt`l`ot`h tfarnpy ndm fost magadha iahfnd`si.

QK]\NX]\QH]Q\A OG L@OG@KI

N gukky mavakopam l`og`ki `s mashr`lam ns n fatarocadous nrrndcaiadt og i`hrol`nk

hakks od n sok`m surgnha.fa lns`h struhturnk ud`t og n l`og`ki `s tfa i`hrohokod`as or 

hakk hkustars goriam ly tfa surgnha nmfaradt lnhtar`nk hakks.`hrohokod`as nra

m`shrata ud`ts og madsaky pnh#am lnhtar`nk hakk(s`dcka or iukt`spah`as)

nccracntas.fara `s n spnt`nk m`str`lut`od og lnhtar`nk hakks(i`hrohokody) og

m`ggaradt pfys`okoc`hnk ndm iatnlok`h stntas w`tf`d n l`og`ki.N ckyhohnkyx intr`x

inma up og axtrnhakkuknr pokysnhhfnr`ma surroudms tfa i`hrohokod`as ndm ndhfors

tfa lnhtar`nk hakk to tfa sulstrnta.

  ><8 ly vokuia og tfa l`og`ki struhtura `s inma up og intr`x

intar`nk wf`ka '<8 `s inma up og hakks.N grasf l`og`ki intr`x `s inma og

 l`opokyiars suhf ns pokysnhhfnr`mas,prota`ds,duhka`h nh`ms ndm snkts.fa struhtura

ndm hoipos`t`od og n inturam l`og`ki `s #dowd to iom`gy nhhorm`dc to tfa

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adv`rodiadtnk hodm`t`ods suhf ns crowtf hodm`t`ods,dutr`t`odnk nvn`knl`k`ty,dntura

og gku`m iovaiadts,pfys`hohfai`hnk propart`as og tfa sulstrnta.

yp`hnkky n v`nlka,gukky fymrntam l`og`ki nppanrs ns towar / or i!frooi/

sfnpam struhturas nmfaradt to n sulstrnta.fa ovarnkk sfnpa og n l`og`ki `s

matari`dam ly tfa sfanr gorhas cadarntam ly tfa gkusf`dc og gku`m iam`n.L`og`kis

goriam `d f`cf-sfanr adv`rodiadts fnva sfowd tfnt tfa i`hrohokod`as nra

magoriam ly tfasa gorhas to promuha tnmpoka-sfnpam osh`kknt`od `d tfa luk# gku`m.

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X"#dd`dc aka"trod i`"ro!"o$% o '#) \oot madt`d#k !r#"a "o(aram % A* #a"#k`! `o`ki

'+,-...)* ') /#cd``"#t`od #ra# o $ra(`o! $`"tra '+:.-...)* '"-m) Nccrac#tam #"tar`#k "akk!od #dm `d madt`d#k tka! '+:.-...)

Nmvndham i`hroshopy og k`v`dc l`og`kis,fnva ravankam tfnt s`dcka-spah`as l`og`kis

crow`dc `d tfa knlorntor`as to hoipkax iukt`spah`as l`og`kis crow`dc `d tfa

dnturnk ahosystais fnva s`i`knr lns`h hoiiud`ty struhtura,w`tf soia sultka

vnr`nt`ods.

  fa wntar hfnddaks wf`hf nra racnrmam ns n pr`i`t`va h`rhukntory

systai `d n l`og`ki,`dtarsaht tfa struhtura og l`og`ki to astnlk`sf hoddaht`ods

 latwaad tfa i`hrohokod`as.=rasadha og wntar hfnddaks gnh k̀`tntas agg`h`adt

axhfndca og intar`nks latwaad lnhtar`nk hakks ndm luk# gku`m,wf`hf `d turd fakps to

hoorm`dnta gudht`ods `d n l`og`ki hoiiud`ty.fa struhturnk gantura og n l`og`ki

tfnt fns tfa f`cfast `ipnht `d hfrod`h lnhtar`nk `dgaht`od `s tfa tadmadhy og

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i`hrohokod`as to matnhf groi tfa l`og`ki hoiiud`ty.1ur`dc tfa prohass og

matnhfiadt,tfa l`og`ki trndsgar pnrt`huknta hodst`tuadts(hakks,pokyiars ndm

 prah`p`tntas) groi tfa l`og`ki to tfa gku`m lntf`dc tfa l`og`ki.fara nra two in`d

typas og matnhfiadt prohass%aros`od(tfa hodt`dunk matnhfiadt og s`dcka hakks ndm

sinkk port`ods og tfa l`og`ki) ndm skoucf`dc(tfa rnp`m,inss`va koss og l`og`ki).

  1atnhfiadt pknys nd `iportndt roka `d sfnp`dc tfa iorpfokoc`hnk

hfnrnhtar`st`hs ndm struhtura og intura l`og`ki.:t `s nkso hods`maram ns nd nht`va

m`spars`va iahfnd`si(saam`dc m`sparsnk).fasa matnhfam hakks,wf`hf fnva

nh"u`ram tfa ras`stndha trn`ts groi tfa`r pnradt l`og`ki hoiiud`ty,hnd la sourha gor 

 pars`stadt `dgaht`od.

HFN\NH]A\@X]@HX OG L@OG@KI

Lnhtar`n `d n l`og:ki stnta sfow m`st`dht hnpnh`ty to surv`va toucf crowtf

ndm adv`rodiadtnk hodm`t`ods.

f`s ud`"ua hnpnh`ty og lnhtar`n `d n l`og`ki stnta `s mua to tfa gokkow`dc

ganturas%

n) L`og:ki struhtura protahts tfa ras`m`dc lnhtar`n groi adv`rodiadtnk tfrants

 l) $truhtura og l`og`ki pari`ts trnpp`dc og dutr`adts ndm iatnlok`h

hooparnt`v`ty latwaad ras`madt hakks og snia spah`as ndm7or m`ggaradt spah`as

h) L`og k̀i struhturas m`spkny orcnd`zam `dtardnk hoipnrtiadtnk`znt`od, wf`hf

nkkows lnhtar`nk spah`as w`tf m`ggaradt crowtf ra"u`raiadts to surv`va `d

anhf hoipnrtiadt

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m) Lnhtar`nk hakks `d n l`og:ki hoiiud t̀y iny hoiiud`hnta ndm axhfndca

cadat`h intar`nks to nh"u`ra daw trn`ts.

Z\O]AH]@OD OG L@OG@KI LNH]A\@N

Lnhtar`n ras`m`dc `d n l`og`ki hoiiud`ty axpar`adha hartn`d macraa og protaht`od

ndm foiaostns`s. ndy lnhtar`n nra hnpnlka og promuh`dc pokysnhhfnr`mas, a`tfar

ns hakk surgnha struhturas (ac., hnpsuka) or ns axtrnhakkuknr axhrat`ods (ac., 3=$).

3xtrnhakkuknr pokysnhhfnr`ma hovars l`og:ki hoiiud`t`as ndm hrantas n

i`hro d`hfa gnvornlka gor tfa kodc-tari surv`vnk ndm gudht`od`dc og tfa lnhtar`nk

hoiiud`t`as.

3xtrnhakkuknr pokysnhhfnr`mas protahts tfa l`og`ki lnhtar`n groi n vnr`aty og 

adv`rodiadtnk strassas, suhf ns 60 rnm`nt̀ od, p2 sf`gts, osiot`h sfoh#, ndm

mas`hhnt`od. 3xtrnhakkuknr pokysnhhfnr`ma hnd sa"uastar iatnks, hnt`ods, ndm tox`ds.

atnkk̀ h hnt̀ ods suhf ns incdas`ui ndm hnkh`ui i`d`i`za akahtrostnt`h

rapuks`od latwaad dacnt`vaky hfnrcam l`opokyiars, `dhrans`dc tfa hofas`vadass og 

tfa 3xtrnhakkuknr pokysnhhfnr`ma intr`x.

1`ggus`od `s tfa pramoi`dndt trndsport prohass w`tf `d hakk nccracntas. fa

m`ggus`od m`stndha `d n pknd#tod`h hakk `s od tfa ormar og incd`tuma og tfa

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m`iads`od og nd `dm`v`munk hakk, wf`ka tfa m`ggus`od m`stndha `d n l`og`ki `s od tfa

ormar og tfa m`iads`od og tfa iukt`hakkuknr nccracnta.

 

N l`og`ki tfnt `s ' hakks tf`h# w`kk axf`l`t n m`ggus`od t`ia ' t`ias kodcar tfnd

tfnt og n s`dcka hakk.

IA]NLOK@H HOOZA\N]@W@]P @D N L@OG@KI

Nd `iportndt hfnrnhtar`st̀ h og l`og`kis crow`dc `d n dutr`adt-mapr`vam

ahosystai `s `ts nl`k`ty to hodhadtrnta trnha akaiadts ndm dutr`adts ly pfys`hnk

trnpp`dc or ly akahtrostnt`h `dtarnht`od.

 

fa wntar hfnddak hoddahts tfa outar gku`m iam`ui w`tf tfa. `dtar`or og 

tfa l`og`ki, adsur`dc dutr`adt nvn`knl`k`ty to i`hrol`nk hoiiud`t`as maap `ds`ma tfa

 l`og`ki struhtura.

fa hoipkax nrhf`tahtura og n l`og̀ ki prov`mas tfa opportud`ty gor 

iatnlok`h ho-oparnt̀ od, ndm d`hfas nra goriam w`tf`d tfasa spnt`nkky wakk-

orcnd`zam systais.

Lnhtar`nk i`hrohokod`as `d n l`og`ki struhtura nra axposam to m`st`dht

adv`rodiadtnk s`cdnks. !or axnipka, hakks kohntam danr tfa hadtar og n i`hrohokody

nra iora k`#aky to axpar`adha kow oxycad tads`ods hoipnram to hakks kohntam danr 

tfa surgnha. oraovar, mua to tfa 5uxtn pos`t`od`dc og m`ggaradt i`hroorcnd`sis,

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hross gaam`dc ndm iatnlok`h ho-oparnt`v t̀y latwaad m`ggaradt spah`as og 

i`hroorcnd`sis nra saad `d n l`og`ki.

 $tum`as fnva raportam tfa promuht`od og assadt`nk crowtf gnhtors suhf ns

fai`d ly ;. ra"t# to support tfa crowtf og gnst`m`ous orcnd`sis suhf ns

 >*c`dc`(#k`! `d n l`og`ki. :d nmm`t`od, anhf lnhtar`nk spah`as ras`m`dc `d n l`og:ki

 possass m`ggaradt nrrny og kyt`h adzyias, ndm n l`og`ki ns n ud`t `s a"u`ppam w`tf n

w`ma spahtrui og adzyias tfnt hnd macrnma hoipkax orcnd`h intar`nks. !or 

`dstndha, lnhtar`nk spah`as possass`dc protaokyt`h adzyias in#a dutr`adts nvn`knlka

to nkk otfar lnhtar`n `d n prota`d-r`hf adv`rodiadt.

O\CND@RAM @D]A\DNK HOIZN\]IAD]NK@RN]@OD @D

L@OG@KI

N intura l`og`ki struhtura m`spknys crnm`adts `d tfa m`str`lut`od og dutr`adts,

 p2, oxycad, iatnlok`h promuhts, ndm s`cdnk`dc iokahukas w`tf`d tfa l`og`ki.

Hakk-hakk hoiiud`hnt`od `d n l`og`ki* .$oia lnhtar`n hnd promuha hfai`hnk

s`cdnks (craad) ndm otfar lnhtar`n groi tfa snia spah`as or groi m`ggaradt spah`as

or strn`d hnd raspodm to tfai (ram).

f`s woukm hranta m`ggaradt i`hrod`hfa tfnt hnd nhhoiiomnta m`varsa

 lnhtar`nk spah`as w`tf`d n l`og`ki. fa crnm`adts `d dutr`adts, hfai`hnks, ndm cnsas,

olsarvam `d n l`og`ki struhtura, nra `dgkuadham ly tfa typa og dutr`adts ndm tfa

 pfys`okoc`hnk ra"u r̀aiadts og tfa ras`m`dc i`hroorcnd`sis.

 

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:d n iukt`spah`as l`og`ki `dvokv`dc narol`h ndm ndnarol`h lnhtar`n, oxycad `s

hodsuiam ly tfa narol`h ndm gnhuktnt̀ va ndnarol`h spah`as, in#`dc tfa

adv`rodiadt r`hf `d hnrlod m`ox`ma ndm otfar cnsas.

;fad tfa narol`h lnhtar`n ras`m`dc od tfa surgnha og tfa l`og`ki hodsuias

nkk nvn`knlka oxycad, tfa `dtar`or og tfa l`og`ki hnd la nlsokutaky ndnarol`h tfnt `t

hnd avad support tfa crowtf og olk`cntory ndnarolas.1asp`ta tfa gnht tfnt ornk

hnv`ty `s nludmndt `d oxycad, ndnarol`h i`hrolas nra goudm to moi`dnta ornk

 l`og`kis lahnusa og tfa poss`lka ramox crnm`adt goriam w`tf`d tfa l`og`ki

struhtura.

 Lnhtar`nk hakks ras`m`dc `d n l`og`ki hoiiud`hnta, axhfndca cadat`h intar`nks,

ndm nhqu`ra daw trn`ts

Lnhtar`nk l`og`ki prov`mas n satt`dc gor tfa ras`m`dc lnhtar`nk hakks to

hoiiud`hnta w`tf anhf otfar. $oia og tfasa s`cdnks, promuham ly hakks, iny la

`dtarpratam dot 5ust ly iailars og tfa snia spah`as, lut ly otfar i`hrol`nk spah`as

too. 9oiiud`hnt`ods latwaad lnhtar̀ nk hakks ras`m`dc `d n l`og`ki `s nttn`dam

tfroucf s`cdnk`dc iokahukas, ly n prohass hnkkam 4uorui sads`dc’ * 4uorui

sads`dc `s iam`ntam ly kow iokahuknr wa`cft iokahukas, wf`hf `d sugg`h`adt

hodhadtrnt`od hnd nktar tfa iatnlok`h nht`v`ty og da`cflor`dc hakks, ndm hoorm`dnta

tfa gudht`ods og ras`madt lnhtar`nk hakks w`tf`d n l`og`ki. 3xhfndca og cadat`h

intar`nks latwaad lnhtar`nk spah`as ras`m`dc `d n l`og`ki w`kk rasukt `d tfa avokut`od

og i`hrol`nk hoiiud`t`as w`tf m`ggaradt trn`ts.

Zkndetod`h nht!"`n# fa hodhadtrnt`od og hfai`hnk s`cdnks sahratam ly tfa

 pknd#tod`h hakks `s kow.

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9kosa prox`i`ty og i`hrol`nk hakks `d n l`og`ki gnh`k`tntas cadat`h axhfndca

 latwaad lnhtar`n og cadat`hnkky m`stndt cadarn. 3vad tfa poss`l`k`ty og cada trndsgar 

 latwaad n hoiiadsnk orcnd`si 'L#"`kk! !t`k`!) ndm ornk l`og`ki lnhtar`n

'Xtra$to"o""! spah`as) fns laad maiodstrntam.

]$! $o"`%odtnk &!d! t"nd'(!" `' o( `)*o"tndh! `d $+)nd ,`'!n'!' hn+'!, -

nht!"`nk `o(`k) n' `t hnd "!'+kt `d t$! &!d!"nt`od o( ndt̀ `ot`h."!'`'tndt

nht!"`nk *o*+knt`od.

 

L`o(`k) nht!"`n# L`og`ki hakks nra fakm tocatfar `d madsa   popuknt`ods, so tfa

sahratam hfai`hnk s`cdnks f`cfar hodhadtrnt`ods. $`cdnk iokahukas tfad ra-hross tfa

hakk iailrndas ndm tr`ccar hfndcas `d cadat`h nht`v`ty.

?ada trndsgar latwaad lnhtar`n ras`m`dc `d n l`og`ki `s tfoucft to la

iam`ntam ly lnhtar`nk hod5ucnt`od. fa prasadha og m`varsa lnhtar`nk spah`as `d n

 l`og`ki prasadts n pook og cadat`h homas gor dutr`adt lran#mowd, ndt`l`ot`h

ras`stndha, ndm xadol`ot`h iatnlok`si.

9akk-hakk hoiiud`hnt`od hnd rasukt `d tfa hoorm`dntam lafnv`or og i`hrol`nk

 popuknt`od ras`m`dc `d n l`og`ki.

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Xtn&! :& tfa g`rst stap `dvokvam `d tfa mavakopiadt og l`og`ki `s tfa nmsorpt`od og 

`dorcnd`h ndm orcnd`h iokahukas to tfa sok`m surgnha hrant`dc wfnt `s tariam n

hodm`t`od`dc knyar

Xtn&! >% 1ur`dc madtnk pkn"ua gorint`od, tfa tootf surgnha `s hodm`t`odam ly tfa

snk`vn pakk`hka. Jdha tfa hodm`t`od`dc knyar `s goriam, tfa daxt stap `d l`og`ki

gorint`od `s tfa nmfas`od og i`hrol`nk hakks to tf`s knyar.

Niodcst tfa p`odaar orcnd`sis, tfa ornk`s croup og straptohohh` `s tfa in5or 

 popuknt`od to gori n lnhtar`nk iodoknyar od tfa snk`vnry pakk`hka hontam tootf

surgnha.

!nhtors tfnt nggaht lnhtar`nk nttnhfiadt to n sok`m sulstrnta. fasa gnhtors

`dhkuma p2, taiparntura, surgnha adarcy og tfa sulstrnta, gkow rnta og tfa gku`m

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 pnss`dc ovar tfa surgnha, dutr`adt nvn`knl`k`ty, kadctf og t`ia tfa lnhtar`n `s `d

hodtnht w`tf tfa surgnha, lnhtar`nk crowtf stnca, lnhtar`nk hakk surgnha hfnrca, ndm

surgnha fymropfol`h`ty.

=fys`hohfai`hnk propart`as suhf ns surgnha adarcy ndm hfnrca mads`ty

matari`da tfa dntura og `d`t`nk lnhtar`n-sulstrnta `dtarnht`od <Z$n'! :8 t"nd'*o"t o( 

)`h"o! to '+'t"nt! '+"(nh!=1

:d nmm`t`od, tfa i`hrol`nk nmfaradha to n sulstrnta `s nkso iam`ntam ly

 lnhtar`nk surgnha struhturas suhf ns g`ilr`na, p`k`, gkncakkn, ndm 3=$ (ckyhohnkyx).

okahuknr-spah`g`h `dtarnht`ods latwaad lnhtar`nk surgnha struhturas ndm

sulstrnta lahoia nht`va `d tf`s pfnsa <Z$n'! >8 `d`t`nk dod.'*!h`(`h )`h"o`nk.

'+'t"nt! n,$!"!dh! *$n'!=1

:d`t`nkky, tfa lodms latwaad tfa lnhtar`n ndm tfa sulstrnta iny dot la strodc.

2owavar, w`tf t`ia  tfasa lodms cn`ds `d stradctf, in#`dc tfa lnhtar`n-sulstrnta

nttnhfiadt `rravars`lka. !`dnkky, n spah`g`h lnhtar`nk nmfas`od w`tf n sulstrnta `s

 promuham v`n pokysnhhfnr`ma nmfas`d or k`cndm gorint`od <Z$n'! 78 '*!h`(`h

)`h"o`nk '+'t"nt! n,$!"!dh! *$n'!=1  :d tf`s pfnsa, nmfas`d or   k`cndm od tfa

 lnhtar`nk hakk surgnha w`kk l`dm to rahaptors  od tfa sulstrnta. $pah`g`h lnhtar`nk

nmfas`od `s kass nggahtam ly indy adv`rodiadtnk gnhtors suhf ns akahtrokyta, p2, or 

taiparntura.

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Xtn&! 7& tfa lnhtar`nk crowtf ndm l`og`ki axpnds`od. 1ur`dc tf`s stnca, tfa

iodoknyar og i`hrolas nttrnhts sahodmnry hokod`zars gori`dc i`hrohokody, ndm tfa

hokkaht`od og i`hro hokod`as c`vas r`sa to tfa g`dnk struhtura og l`og`ki.

fa kntarnk ndm vart`hnk crowtf og `dmwakkars c`vas r`sa to i`hrohokod`as

s`i`knr to towars. N intura l`og`ki w`kk la n iatnlok`hnkky nht`va hoiiud`ty og 

i`hroorcnd`sis wfara `dm`v`munks sfnra mut`as ndm ladag`ts.

fa lnhtar`nk hakks `d n inturam l`og`ki w`kk axf`l`t hods`marnlka vnr`nt`od `d

`ts cadat`h ndm l`ohfai`hnk hodst`tut`ods hoipnram to `ts pknd#tod`h houdtarpnrts.

wo typas og i`hrol`nk `dtarnht`ods ohhur nt tfa hakkuknr kavak mur`dc tfa gorint`od

og l`ogkki. Jda `s tfa prohass og rahocd`t`od latwaad n suspadmam hakk ndm n hakk

nkranmy nttnhfam to sulstrntui. f`s typa og `dtarnht`od `s tariam ho-nmfas`od.

:d tfa sahodm typa og `dtarnht`od, cadat`hnkky m`st`dht hakks `d suspads`od

rahocd`za anhf otfar ndm hkuip tocatfar. f`s typa og `dtarnht`od `s hnkkam

honccracnt`od.

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\AX@X]NDHA OG I@H\OLAX @D L@OG@KI ]O

ND]@I@H\OL@NKX

fa dntura og l`og`ki struhtura ndm pfys`okoc`hnk hfnrnhtar`st̀ hs og tfa

ras`madt i`hroorcnd`sis oggar nd `dfaradt ras`stndha to ndt`i`hrol`nk ncadts, suhfns ndt`l`ot`hs, m`s`dgahtndts, or cari`h`mas.

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fa ras`stndha to ndt`i`hrol`nk ncadts fns laad goudm to nipk`gy iora tfnd

tfousndm t`ias gor i`hrolas `d l`og`ki, wfad hoipnram to pknd#tod`h hakks.

Nd `madt`hnk l`og`ki axposam to vndhoiyh`d ndm r`gnip`d gor fours nt

hodhadtrnt`ods axhaam`dc tfa i`d`iui `df`l t̀ory hodhadtrnt`od (:9) ndm

i`d`iui lnhtar`h`mnk hodhadtrnt`od (L9) gor tfa i`hroorcnd`si.

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ADMOMOD]@H L@OG@KIX

3dmomodt`h i`hrol`otn `s astnlk`sfam to la kass m`varsa hoipnram to tfa ornk

i`hrol`otn. f`s trnds`t`od `d tfa i`hrol`nk popuknt`od `s iora hodsp`huous w`tf

tfa procrass`odog `dgaht̀ od. =rocrass`od og `dgaht̀ od nktars tfa dutr`t`odnk ndm

adv`rodiadtnk stntus w`tf`d tfa root hndnk.

fa root hndnk adv`roiadt nppnradtky lahoias iora ndnarol`h ndm tfa

dutr`t`od kavak w`kk la mapkatam.

fasa hfndcas w`kk oggar n toucf ahokoc`hnk d`hfa gor tfa surv`v`dc

i`hroorcnd`sis. !urtfariora, hk`d`hnk `dvast`cnt`ods fnva sfowd tfnt tfa hoipkata

m`s`dgaht`od og root hndnk `s vary m`gg`hukt to nhf`ava. `hrolas nra goudm to pars`st

`d tfa ndntoi`hnk hoipkax`t`as suhf ns `stfiusas ndm maktns ndm `d tfa np`hnk

 port`od og root hndnk systai. Jgtad, lnhtar`nk nht`v`t`as iny dot la hodg`dam to

`dtrnhndnk spnhas, lut nkso nhhass rac`ods layodm tfa np`hnk gorniad.

fasa ndntoi`hnk ndm caoiatr`hnk hoipkax`t`as `d tfa root hndnk systais

sfaktar tfa lnhtar`n groi hkand`dc ndm sfnp`dc prohamuras.

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Nmm`t`odnkky, l`og`ki ioma og lnhtar`nk crowtf oggars otfar nmvndtncas suhf ns

n) ras`stndha to ndt`i`hrol`nk ncadts

 l) `dhransa `d tfa kohnk hodhadtrnt`od og dutr`adts

h) opportud`ty gor cadat̀ h intar`nk axhfndca

m) nl`k`ty to hoiiud`hnta latwaad lnhtar`nk popuknt`ods og snia ndm7or 

m`ggaradt spah`as

a) promuha crowtf gnhtors nhross spah`as loudmnr`as.

3dmomodt`h lnhtar`nk l`og`kis hnd la hntacor`zam ns

'. :dtrn hndnk l`og`kis

. 3xtrn rnm`huknr l`og`kis

+. =ar`np`hnk l`og`kis

. L`ointar`nk hadtaram ̀ dgaht`ods.

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@D]\NHNDNK I@H\OL@NK L@OG@KIX

kdtrnhndnk i`hrol`nk l`og`kis nra i`hrol`nk l`og`kis goriam od tfa root hndnk

madt`da og nd admomodt`hnkky `dgahtam tootf.

N matn`kam mashr`pt`od od tfa `dtrnhndnk lnhtar`nk l`og`ki wns mohuiadtam ly

 n`r `d 'H>.:t wns succastam tfnt tfa `dtrnhndnk i`hro l`otn `d nd admomodt`hnkky

`dgahtam taatf ax`stam ns lotf koosa hokkaht`od ndm l`og`ki struhturas, inma up og 

hohh`, roms, ndm g`kniadtous lnhtar`n.

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odoknyar ndm7or iukt`knyaram lnhtar`nk l`og`kis wara goudm to nmfara to

tfa madt`dnk wnkk og tfa root hndnk. fa axtrnhakkuknr intr`x intar`nk og lnhtar`nk

or`c`d wns nkso goudm `dtarsparsam w`tf tfa hakk nccracntas `d tfa l`og`ki

$tum`as fnva astnlk̀ sfam tfa nl`k`ty og  A* #a"#k`! to ras`st stnrvnt`od ndm

mavakop l`og`kis udmar m`ggaradt adv`rodiadtnk ndm dutr`adt hodm`t`ods (narol`h,

ndnarol`h, dutr`adt-r`hf, ndm dutr`adt-mapr`vam hodm`t`ods).

 A* #a"#k`! udmar dutr̀ adt-r̀ hf adv`rodiadt (narol`h ndm ndnarol`h) promuham

typ`hnk l`og`krd struhturas w`tf hfnrnhtar`st`h surgnha nccracntas og lnhtar`nk hakks

ndm wntar hfnddaks. 0`nlka lnhtar`nk hakks wara prasadt od tfa surgnha og tfa

 l`og`ki. 6dmar dutr`adt-mapr`vam adv`rodiadt (narol`h ndm ndnarol`h), `rracuknr 

crowtf og nmfaradt hakk hkuips wara olsarvam.

Dutr`adt- mapr`vam hodm`t`od ngtar > waae

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Dutr`adt- mapr`vam hodm`t`od ngtar = waaes,

Dutr`adt- r`hf hodm`t`od ngtar > waae 

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Mnsar shndd`dc hodgohnk i`hroshopy m`spknyam indy manm lnhtar`nk hakks ndm

 poh#ats og v`nlka lnhtar`nk hakks `d tf`s l`og k̀i struhtura.

:d v`tro axpar`iadts fnva ravankam m`st`dht stncas `d tfa mavakopiadt og  A*

 #a"#k`! l`og:ki od root hndnk madt`da.

:d stnca ', A* #a"#k`! hakks nmfaram ndm goriam i`hrohokod`as od tfa root

hndnk madt`da surgnha. :d stnca , tfay `dmuham lnhtar`nk-iam`ntam m`ssokut`od og tfa

i`darnk grnht`od groi tfa madt`da sulstrnta. f`s kohnk`zam `dhransa `d tfa hnkh`ui

ndm pfospfnta `ods w`kk proiota i`darnk`znt`od (or hnkh`g`hnt`od) og tfa A*#a"#k`!

 l`og`ki `d stnca +.

Dutr`adt-r`hf hodm`t`od ngtar = waaes.

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Lnhtar`nk l`og`kis `d tfa nrans og tfa root surgnhas latwaad g`lars ndm hakks

ndm `d hrypts ndm fokas. fa l`og`ki hodtn`dam vnry`dc macraas og axtrnhakkuknr 

intr`x intar`nks (ckyhohnkyx).

fa root surgnha l`og`kis wara iostky iukt`spah`as `d dntura nssoh`ntam w`tf

 par`np`hnk `dgkniint`od ndm maknyam par`np`hnk fank`dc `d ortfocrnma trantiadt .

ZA\@NZ@HNK I@H\OL@NK L@OG@KIX

=ar`np`hnk i`hrol`nk l`og`kis nra `sokntam l`og`kis goudm `d tfa par`np`hnk

rac`od og nd admomodt`hnkky `dgahtam taatf. =ar`np`hnk l`og`kis iny or iny dot la

mapadmadt od tfa root hndnk. fa i`hro l`otn `d tfa in5or`ty og taatf nssoh`ntam

w`tf np`hnk par`omodt`t`s `s rastr`htam to tfa root hndnk, ns iost og tfa i`hrol`nk

spah`as tfnt `dgaht tfa root hndnk nra opportud`st`h pntfocads tfnt mo dot fnva tfa

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nl`k`ty to surv`va fost magadsa iahfnd`si `d tfa par`np`hnk t`ssuas.

ailars og tfa cadus  N"t`doi%"a! ndm tfa spah`as  >* $ro$`od`"i fnva

 laad maiodstrntam `d nsyiptoint`h par`np`hnk kas`ods ragrnhtory to admomodt`h

trantiadt. fasa i`hroorcnd`sis fnva tfa nl k̀`ty to ovarhoia fost magadsa

iahfnd`sis, tfr`va `d tfa `dgkniam par`np`hnk t`ssua, ndm sulsa"uadtky `dmuha n

 par`np`hnk `dgaht`od.

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9k`d`hnk `dvast`cnt`od matahtam  N"t`doi%"a! `d og 'H (<<.>8) hk`d`hnk

snipkas. Jg tfosa, ' og <' (>.8) wara groi `dgahtam root hndnks, og >

(<.>8) wara groi nlshassas, ndm H og + (+8) wara nssoh`ntam w`tf hakkuk`tas.

L@OIN]A\@NK HAD]A\AM @DGAH]@OD

L`ointar`nk hadtram `dgaht`od `s hnusam wfad lnhtar`n nmfaras to nd nrt`g`h`nk

 l`ointar`nk surgnha ndm goris l`og k̀i struhtura.L`ointar`nk hadtram `dgaht`od `s

oda og tfa in5or hoipk`hnt`ods nssoh`ntam w`tf prostfas`s ndm `ipkndt Arakntam

`dgaht`ods.:d admomodt`hs,l`ointar`nk hadtram l`og`kis woukm gori od root hndnk

olturnt`dc intar`nks.fasa l`og`kis hnd la `dtrnrnm`huknr or axtrnrnm`huknr

mapadm`dc upod wfatfar tfa olturnt`dc intar`nk `s w`tf`d tfa root hndnk spnha or

fns `t axtrumam layodm tfa root npax.$tum`as fnva sfowd tfnt crni-pos`t`va

gnhuktnt`va ndnarols fnva tfa nl`k`ty to hokod`za ndm gori axtrnhakkuknr intr`has od

cuttn-parhfn po`dts,wf`ka sarui pknys n hruh`nk roka `d l`og`ki gorint`od.

 

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 L`o`ki ori#t`od! od tfa root "#d#k w#kk! o #d a=tr#"tam tootf w`tf #tt#"fam $ar`#$`"#k t`!!a

ka!`od*

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HODHKQX@OD

fa nppk`hnt`od og tfa l`og`ki hodhapt to admomodt`h i`hrol`okocy w`kk pkny n

hruh`nk roka `d fakp`dc us to udmarstndm, dot odky tfa pntfocad`h potadt`nk og tfa

root hndnk i`hrol`otn,lut nkso tfa lns`s gor daw nppronhfas to `dgaht`od hodtrok.

2ow lnhtar`n nmnpt tfa`r propart`as udmar m`ggaradt m`sansa hodm`t`ods ns wakk ns

fow l`og`kis nra orcnd`zam `d root hndnks nra `iportndt `ssuas to la nmmrassam od

tfa ronm to n hkanrar udmarstndm`dc og fow tfa root hndnk lnhtar`n ras`st admomodt`h

trantiadt iansuras.