[After titanium, peek ?]. / L'après titane, le PEEK?

The PEEK-Optima(®), composite mixture of polyetheretherketon and inert materials, is used in orthopedics, spinal surgery and cranio-facial surgery. It could be used in dental implantology because of its biological and mechanical properties. The results of an experimental and finite element study made on basal implant prototypes, on basal implantology show that PEEK, contrary to titanium, has a compound structure that allows to optimize the distribution of masticatory forces around the implant. These results should be confirmed by a clinical study according to research regulation.

[Facial allografts and oral rehabilitation]. / Allogreffes de la face et réhabilitation orale.

The main objective of facial allografts is functional. On this account, oral rehabilitation is pivotal. Two types of cases are possible. Firstly, the indication of facial allograft concerns only the soft tissues. If so, dental care is similar to the one of patients with an organ transplant. Dental implants are a priori contraindicated. A possible indication has to be discussed with the multidisciplinary team. Secondly, the indication is the one of a mandibular and/or maxillary reconstruction. The objective will be a total reconstruction. It could be performed immediately with the allotransplantation of a toothed mandible or maxillar, if the local status permits it. To date, among patients who have benefited from a toothed allotransplant, no tooth has been lost. The first cases have been operated in 2009. If donor teeth cannot be conserved with the allotransplant, the oral rehabilitation will have to be done ideally with adjunctive prostheses. It is rarely possible, for example because of the lack of crests. In case of impossibility, an implant-based rehabilitation can be discussed. One case has been performed with basal implants (cortically anchored disk-design implants) with a five-year follow-up without loosing any loss of implant or infection.

[ Facial allograft transplantation and basal implantology(cortically anchored disk-design implants)]. / Allogreffe de face et implantologie basale (implant-disques à appuis corticaux).

INTRODUCTION: We report a case of total oral rehabilitation with basal implants (cortically anchored disk-design implants) on a patient who received a facial allograft 1 year earlier. OBSERVATION: A 31-year-old patient was suffering from a plexiforme neurofibroma spread into the soft tissues of the oral cavity with huge deformations of the jaws. The operation consisted in pulling out numerous supernumerary impacted teeth, removing unnecessary soft tissues, settling six basal implants in the maxilla and seven in the mandible. The following day, two resin bridges were adjusted and cemented onto the implant abutments. The permanent bridges were settled 2 months and half later. The outcome was still unremarkable 2 years after the implant procedure. DISCUSSION: This case report raises important issues, notably the relevance of an oral rehabilitation with implant-supported prostheses on an immunosuppressed patient. In this specific case, this was impossible to achieve using removable prostheses. A facial reconstruction with its plastic, functional, and social goals seemed inconsistent without an oral rehabilitation. Even if they have not been published, cases of grafted patients with dental implants are unexceptional. Lastly, this rehabilitation has been planned for a particularly monitored patient. The second important question regards the choice of the basal implantology. This option has been motivated by the possibility to complete the case in one sole operation with provisional prostheses cemented the day after that act like orthopaedic external fixators providing an exceptional primary stability. The cortical anchorage, which was the only reliable on this patient, allowed to avoid bone grafting. Finally, the particular thinness of the implant emergence limits to the minimum the communications between bone and oral cavity. We would like to stress that the only objective of this observation was to document a specific case and possibly to open the way to a scientific study in accordance with the regulations of clinical research.

[Presence of Angiostrongylus cantonensis at la Réunion]. / Présence d'Angiostrongylus cantonensis à la Réunion

The eosinophilic meningitis due to Angiostrongylus cantonensis is well known on Madagascar and on Mauritius Island, but was never described on Reunion Island. Two cases have been lately oberved in Doctor Jay's department at Gabriel Martin's hospital. Local achatines were dissected and contained larvae which, when absorbed by rats, were found in there brains ten days later. These larvae belong certainly to Angiostrongylus genus, but the species has not yet been found with certitude. Lately infested rats are passing through the normal laps of time for adult maturation until they will be sacrified for further examinations.