Optimisation de la prothèse complète supra-radiculaire mandibulaire par l'usage de l'attachement barre: rapport de cas / Optimization of the mandibular supra-radicular complete prosthesis by the use of the bar attachment: a case report

Introduction : L'équilibre d'une prothèse complète amovible mandibulaire est délicat vu la surface d'appui restreinte. L'objectif du travail était de décrire l'intérêt de la prothèse amovible supra-radiculaire retenue par l'attachement barre dans la gestion d'un édentement subtotal mandibulaire. Observation : Un patient consultait pour bénéficier d'une prothèse esthético-fonctionnelle. L'examen clinique montrait la présence d'un édentement total maxillaire et subtotal mandibulaire avec persistence des canines séparées d'une crête rectiligne. L'examen radiologique révélait un rapport couronne sur racine radiologique égal à 1. L'examen des moulages sur articulateur visualisait une hauteur occlusale utilisable suffisante. La décision prothétique était une prothèse complète maxillaire et une prothèse complète supra-radiculaire (PCSR) mandibulaire retenue par une barre. Le traitement prothétique commençait par une préparation Richmond des plateaux radiculaires. Après sculpture des chapes et fixation de la barre calcinable, la coulée était faite. Une empreinte anatomo-fonctionnelle de situation était réalisée pour confectionner l'infrastructure métallique. Suite à l'enregistrement de l'occlusion, le montage des dents était fait et validé. Le jour de la mise en bouche des conseils d'utilisation et de maintenance étaient prodigués au patient. Commentaires : La PCSR est avantageuse par le maintien du système proprioceptif desmodontal et d'un profil de crête favorable à l'appui. Les racines à conserver doivent valider certains critères pour être exploitables. La barre offre une rétention importante, mais son indication dépend du parallélisme radiculaire, de l'espace prothétique utilisable et de la forme de la crête édentée. Conclusion : Le recours aux attachements en PCSR est intéressant à condition d'établir un plan de traitement rigoureux et d'assurer la maintenance post-prothétique.

Introduction: The balance of a complete removable mandibular prosthesis is delicate given the limited support area. The objective of this work was to describe the benefit of the supra-radicular removable prosthesis retained by the bar attachment in the management of subtotal mandibular edentulism. Observation: A patient consulted to benefit from an aesthetical and functional prosthesis. The clinical examination showed the presence of total maxillary and subtotal mandibular edentulism with persistence of the canines separated by a straight ridge. The radiological examination revealed a crown by radiological root ratio equal to 1. Examination of the casts on the articulator visualized sufficient usable occlusal height. The prosthetic decision was a maxillary complete prosthesis and a mandibular complete supra-radicular prosthesis (CSRP) retained by a bar attachment. The prosthetic treatment began with a Richmond preparation of the root plates. After sculpting the copings and fixing the castable bar, the casting was done. An anatomo-functional impression was made to perform the metal infrastructure. Following the occlusion recording, the assembly of the teeth was done and validated. On the day of denture insertion, instructions about the use and the maintenance was provided to the patient. Comments: PCSR is advantageous by maintaining the periodontal proprioceptive system and a favorable ridge profile for prosthetic bearin. The roots to be kept must validate certain criteria to be usable. The bar offers significant retention, but its indication depends on the root parallelism, the usable prosthetic space and the shape of the edentulous ridge. Conclusion: The use of attachments in CSRP is interesting provided that a rigorous treatment plan is established and post-prosthetic maintenance is ensured.

Cigarette Smoking Effect on Microhardness and Flexural Properties of Denture Base Resins

ABSTRACT Objective: To identify the tobacco effect on flexural properties and the microhardness of three acrylic resins. Material and Methods: Three resins were tested: two thermo-polymerizable acrylic resins (RMB 20 and BMS 014) and one autopolymerized acrylic resin. The 3-point bending and microhardness tests were carried out with a universal tensile-compression machine and a micro-Vickers hardness tester. The acrylic resin specimens have been exposed for 21 days to cigarette smoke in a smoking room. Their mechanical strength was compared to unexposed samples. Statistical analysis was performed using the data processing software SPSS Statistics 21.0. Results: The flexural properties of the resins were affected by cigarette smoke only in the case of Major Base 20® (drop in strength with p= 0.02; 0.6; 0.7 and in elastic modulus with p= 0.86; 0.74 and 0.85 for Major Base 20®, BMS 014® and Major Repair®). The cigarette smoke affected significantly microhardness for all groups (p<0.001). Conclusion: Cigarette smoking does not affect the flexural properties of the acrylic resin (BMS 014® and Major Repair® unlike Major Base 20®), but it does reduce the microhardness.

DMF Index among Amelogenesis Imperfecta Patients: Systematic Review of the Literature.

OBJECTIVES: The aim of this study was to explore the literature in order to assess systematically the association between amelogenesis imperfecta (AI) and caries development and to evaluate the DMF index among AI patients. Basic Research Design. PubMed was used to explore the database Medline. The key words used were "Amelogenesis Imperfecta" [Mesh], "Dental Caries" [Mesh], "Tooth Loss" [Mesh], "DMF Index" [Mesh], and "Dental Restoration, Permanent" [Mesh]. Moreover, an ad hoc search was performed in order to make the study as exhaustive as possible. RESULTS: Fifty-five articles were retained. The total number of patients gathered was 499. A percentage of 68.8% of the articles dealt with cases with a relatively low dental caries process, 20.8% dealt with cases in which the dental caries process was relatively moderate, and 10.4% dealt with cases in which the dental caries process was severe. Teeth extraction due to dental caries was mentioned in 10 articles. Eleven articles, concerning 53 patients, mentioned dental fillings. Four patients did not have dental filling due to dental caries. DMF index was very low in 2 articles and low-to-high in 3 articles. CONCLUSION: Low dental caries susceptibility with AI patients was noticed in this study. A possible factor could be the lack of proximal contacts and elimination of fissures through enamel loss. The lack of dental caries susceptibility was also explained by the microbacterial specificity of hypoplastic AI patients. Moreover, it was also noted that the prevalence of dental caries among AI patients depends on sociodemographic change.

Amelogenesis imperfecta with Class III malocclusion, reduced crown size and decreased OVD: A multi-disciplinary management and a 5-year follow-up.

This clinical report describes the oral rehabilitation of a 22-year-old-man diagnosed with a variant of hypoplastic amelogenesis imperfecta. The treatment approach was multi-disciplinary, and it included the surgical procedure of Lefort I osteotomy, surgical crown lengthening, and metal-ceramic-fixed dental prostheses. The patient was satisfied with the esthetic and functional outcome.

Evaluation of the Treatment Complexity with Single Complete Removable Denture: A Cross-sectional Study in Tunisia.

AIM: The aim of this study is to determine the complaints of patients wearing single complete removable dentures (SCRDs), to evaluate their satisfaction degree, and to identify the main construction faults committed. MATERIALS AND METHODS: One hundred patients with SCRDs were included. A questionnaire was prepared to investigate the patients' complaints and satisfaction. This questionnaire was supplemented by a professional examination of dentures. RESULTS: Loss of retention and chewing difficulties were the most common complaints of the patients. Examination of the complete dentures by a professional in removable prosthodontics has shown prosthetic instability, lack of retention, and poor adaptation of the prosthetic bases in 49%, 42%, and 38% of the cases, respectively. Occlusal errors related to balanced occlusion, occlusal plane orientation, and occlusal vertical dimension were found successively in 41%, 37%, and 27% of the examined dentures, respectively. Sixty-three percent of the patients were overall dissatisfied with their dentures. This dissatisfaction was correlated to the quality of the denture (p < 10-3). CONCLUSION: The complaints expressed by the patients with their dentures are mostly justified. The design of a single removable denture does not seem to be mastered by many practitioners.

Full-mouth rehabilitation of an acromegaly disease patient with removable prostheses: a clinical case report.

Acromegaly is a rare disease that can have serious consequences. This disease is not widely known by stomatologists, although cranio-facial manifestations are important and rapid changes in the oral cavity are frequent and sometimes dramatic. The prosthetic management of patients with acromegaly is not easy because it is necessary to wait for the stabilization of the disease. If this is not the case, the bone changes prevent the stability of prostheses over time. Moreover, because of bone remodeling, some treatments are contra-indicated, which limits our therapeutic choices. Through this clinical case, we will focus on the oral manifestations of patients with acromegaly and the method of prosthetic management.

Implants Placement in Contact with Dental Tissue: A Potential Paradigm Shift? Systematic Literature Review.

The aim of this study was to explore the literature for clinical and histological data of an unconventional treatment with implants placement in contact with dental tissue (IPICDT) and to try to clarify its indications and surgical procedure particularities.Relevant publications published until May 2019 on the IPICDT were thoroughly reviewed. Search strategy was developed using a controlled vocabulary combination.Medline's exploration and manual research identified 397 articles; 15 of these were selected after screening. IPICDT was indicated in three clinical situations: impacted teeth, ankylosed teeth, or residual roots. Clinical and radiological follow-up were satisfied except for implants placed in contact with (and not through) roots. Histological analysis revealed different mineralized tissues formed on the implant surface: cementum on removed implants in human and osteodentin on implants placed in contact with animal teeth dentin and pulp. These findings were described as new concept of implants' "Mineral integration."According to this study, the follow-up results of implants placed in contact with roots were controversial. Some implants were stable and others were either removed or kept and disinfected after root extraction because of bacterial infection. However, implants placed through ankylosed or impacted teeth were stable. These findings suggest that the clinicians have to be cautious when applying this unconventional approach. Further studies are recommended to explore its long follow-up. It is also interesting to explore this technique in cases of syndromic dental diseases with several impacted teeth (such as cleidocranial dysplasia; or amelogenesis imperfecta).

Importance de l'appui dentaire lors de la conception d'une PPA à châssis métallique en pratique privée

CONTEXTE: L'appui dentaire est un élément indispensable dans toute prothèse partielle amovible coulée. Ainsi, tous les auteurs s'accordaient que l'absence de cet élément est beaucoup plus néfaste que sa présence. OBJECTIF: L'objectif de notre travail est de surveiller les prescriptions des médecins dentistes de libre pratique pour la conception des PPAMC en particulier l'intégration des appuis dentaires. MATÉRIELS ET MÉTHODES: une étude descriptive transversale réalisée auprès de 50 laboratoires de prothèses dentaires. Les données de l'enquête étaient recueillis par un questionnaire spécialement conçu pour réponde à l'objectif de l'étude. Les donnees ont été codées puis saisies sur ordinateur et analysées avec le programme Statical Package for Social Sciences version 17.RÉSULTATS: 96% des prothésistes dentaires pensaient que l'appui dentaire était un élément indispensable dans la prothèse partielle amovible à châssis métallique. 49 laboratoires recevaient des empreintes pour réalisation de châssis métallique sans préparations préalables de logettes pour les appuis dentaires. 47 laboratoires acceptaient de réaliser le châssis métallique malgré la présence d'erreurs deconceptions en rapport avec l'absence d'appuis dentaires.CONCLUSION: D'après les résultats de cette enquête, il y'avait une né ccessité absolu de formations continues aux dentistes privés en ce qui concerne les règles de conception du châssis métallique et l'importance de l'emploi des appuis dentaires