La gestion du patient irradié en prothèse amovible complète

La réhabilitation prothétique à l'aide de prothèse amovible chez un patient irradié présente quelques particularités. Car si le traitement en lui-même n'est pas très diff érent de celui effectué dans des conditions habituelles, la difficulté provient de la fragilité tissulaire, de la limitation de l'ouverture buccale, du risque d'ostéoradionécrose, de l'hyposialie et de la susceptibilité élevée aux infections mycosiques. Or la salive joue un rôle clé dans la tenue et le confort des prothèses amovibles. Elle a également un rôle de protection des surfaces orales. Une telle situation complique la réalisation prothétique et commande de prendre certaines précautions, particulièrement en prothèse amovible. Celle-ci se doit de rétablir les différentes fonctions orales, de restaurer l'esthétique et d'assurer un soutien psychologique du patient sans pour autant être à l'origine d'effets secondaires graves. Le but de notre travail est de montrer, à travers un cas clinique, les différentes particularités et précautions àprendre lors des différentes étapes de réalisation d'une prothèse amovible complète chez les patients édentés ayant subi une irradiation de la sphère oro-faciale

[Complete removable denture retained by symphyseal implant]. / Prothèse amovible complète retenue par un implant symphysaire médian.

INTRODUCTION: Edentulous patients often hope for stable and retentive prostheses. In very unfavorable anatomophysiological circumstances, the implant-retained removable full denture is a simple and reliable option that considerably optimizes the prosthetic balance. We present the case of one of those patients taken in charge in our department. OBSERVATION: A full edentulous 82 years old male patient was referred for a prosthetic rehabilitation. He presented with a negative mandibular crest and a very tonic peri-prosthetic musculature in the anterior region. He refused a bone augmentation surgery; we performed a piezographic mandibular prosthesis retained by a single symphyseal implant in a lingual position. The denture was stable and retentive. Comfort and masticatory efficiency were satisfactory and the psychological integration of the prosthesis was improved. DISCUSSION: Several studies focusing on octogenarian patients concluded that a complete removable denture retained by a single symphyseal implant is a simple, efficient and cost-effective option. Studies including more patients are needed.

[Atraumatic bone expansion: Interest of piezo-surgery, conicals expanders and immediate implantation combination]. / L'expansion osseuse atraumatique : intérêts de la combinaison pièzo-chirurgie, expanseurs coniques et implantation immédiate.

The durability of dental implants depends on the presence of a 1mm coating bone sheath all around the fixture. Therefore, bone resorption represents a challenge for the practitioner. Bone expansion is a surgical technique that allows the management of horizontal bone atrophy. Cortical bone splitting allows for an enlargement of the residual crest by displacement of the vestibular bone flap. The immediate placement of implants secures the widening and allows for a 97% survival rate. However, bone expansion is hard to undertake in sites with high bone density. Furthermore, the use of traditional instruments increases patient's stress and the risk for an interruptive fracture during bone displacement. Non-traumatic bone expansion is one solution to this problem. The combination of piezo-surgery and conical expanders allows for a secured displacement of the selected bone flap as well as an immediate implant placement, avoiding the risk of slipping, overheating, or fracture, all within an undeniable operative comfort. Non-traumatic bone expansion is a reliable, reproducible, conservative, and economical in time and cost procedure. We describe our atraumatic bone expension and immediate implant placement technique in high bone density sites and illustrate it by a clinical case.

[Prosthodontic care of orofacial clefts in adulthood: About a clinical case]. / Prise en charge prothétique des fentes oro-faciales à l'âge adulte: A propos d'un cas Clinique.

This paper relates, through a clinical case, the different steps of the prosthodontic rehabilitation of a palate-pharyngeal cleft, sequelae to surgery, by performing a Suersen's Velar obturator since the soft Palate is divided but toned. A functional reeducation in conjunction with a prosthodontic care improves the quality of life's patients and help for their resocialization. This therapeutic is non-invasive, quick, efficient and evolutive method.

[Original conception of polymerized diagnostic wax-up in an occlusal rehabilitation of distal unilateral edentulous by combined prosthesis]. / Technique originale de conception du montage directeur polymérisé dans la réhabilitation occlusale d'un édentement unilatéral de grande étendue par prothèse composite.

Rehabilitation by combined prosthesis is a therapy that requires a methodical approach especially in the case of large unilateral edentulous when all occlusal parameters are to be restored. The recording of the maxilla-mandibular position is requested at various stages of the treatment. In this context, the use of polymerized diagnostic wax up, is an evident tool for accurately recording and transfer of all occlusal data previously validated, yet concerning the global rehabilitation of unilateral distal edentulous, its stability and exact re-positioning at various prosthetic sequences remain uncertain. The aim of this study was to develop an original conception of the polymerized diagnostic wax up that will allow us to benefit from all its advantages in complex rehabilitation of edentulous unilateral of large extent.

L'expansion osseuse atraumatique. Technique originale

Le succès biologique de tout traitement implantaire dépend de la présence d'une paroi osseuse protectrice d'au moins 1 mm autour des implants. Cela soulève la question de la résorption osseuse ; la masse osseuse atrophiée est souvent incompatible avec la mise en place conventionnelle de l'implant choisi et l'os nécessite une intervention chirurgicale avant ou pendant la mise en place de l'implant. La technique de dilatation osseuse est indiquée en cas de résorption osseuse horizontale : l'agrandissement chirurgical de la crête permet, à la fin d'une seule séance, une pose immédiate des implants avec un taux de réussite de 97%. Par rapport à d'autres techniques régénératives, l'expansion osseuse permet une réduction significative de la durée et du coût du traitement. Néanmoins, il semble compliqué de l'entreprendre en cas de densité osseuse élevée et souffrent des inconvénients de l'instrumentation traditionnelle. La technique d'expansion osseuse traumatique est une réponse simplifiée aux problèmes de la technique conventionnelle. Par l'association de la piézochirurgie et des expanseurs coniques, il permet de réduire les risques et d'optimiser le confort opératoire. Ce travail vise à illustrer, à travers un cas clinique, le protocole de la technique d'expansion osseuse atraumatique en soulignant ses indications et ses limites

[Evaluation of the knowledge, attitude and practices of orthodontists in relation to nickel allergy during orthodontic treatment]. / Evaluation des connaissances, attitudes et pratiques des orthodontistes sur les réactions allergiques au nickel provoquées par les matériaux orthodontiques.

INTRODUCTION: The aim of this study was to evaluate knowledge, attitudes and practices (KAP) of Moroccan dentists about allergy to Nickel (Ni) during orthodontic treatment. POPULATION AND METHODS: Dentists of two Moroccan cities (n = 553) were contacted and a questionnaire was distributed to those who have certified of partial or exclusive practice of orthodontics (N = 202). They were asked to specify the adverse reactions observed and the alloys frequently used. KAP about etiology, prevention and therapeutic management of allergic patients were also addressed. RESULTS: Twenty-two percent of the dentists have reported at least one allergic patient reaction with more implication of fixed appliances. Eleven percent of adverse effects locations reported were mucosal area and facial skin near contact area and less than 5% was systemic eruption outside contact site. Only 34% of the respondents knew the Nickel allergy etiology. CONCLUSION: Nickel-containing orthodontic alloys are generally used even in patient with suspected nickel allergy. It is very important to minimize corrosion factors and use nickel-free appliances in clinical practice.