EMC - Dentisterie最新文献

Periodontitis development is related to the presence of dental plaque (biofilm). Bacterial deposit accumulation creates an ecological niche where each bacterial species will be able to grow, promoting the development of a pathological periodontal flora. Dental surgery has to eliminate, mechanically or surgically, calculus and bacterial deposits, but the surgeon must also teach the patient daily oral hygiene procedures. This information must be adapted to the nature of the available material, its utilisation, and the adequacy of its use regarding the specific clinical situation of the patient. Associated with regular professional cleaning interventions, individual oral hygiene procedures must allow controlling periodontitis evolution; it necessitates permanent follow-up by both the patient and the practitioner.

Teeth transplantations have been used since centuries. This surgical method has been used in many new situations and has constantly been making breakthrough discoveries. A great number of scientific studies have been published within the last few decades on this subject. Transplantations are used to put back impacted or ectopic teeth in their normal situation. They can also be used as substitute to lost teeth or to compensate for agenesis. As a precaution, only autotransplantations are performed. The re implantation of accidentally lost teeth and the surgical setting of malpositioned teeth are developed with autotransplantations. Difficulties and solutions are similar to those encountered in transplantation procedures. All of these surgical methods are included in oral surgeons’ and orthodontists’ daily practice.

Facial paralysis results from a lesion on the motor nerve of skin muscles, the facial nerve, cranial nerves VII. Even in case of positive diagnosis with clinical evidence, further investigations are necessary to establish topographic and aetiological diagnosis. Depending on the aetiology, patient's age, and time of onset of the event, surgical treatment may be a simple stitch of the facial nerve, a nerve grafting, an anastomosis with a bordering nerve, or a pediculate or micro-anastomotic muscular transfer. Rehabilitation plays a major role in maintaining muscular functioning. Special attention must be paid to the functional rehabilitation of the palpebral cleft, in order to preserve both the cornea and an aesthetic eye expression. The treatment of facial paralysis represents a real challenge for the surgeon who has to analyse its various aspects prior to implementing any adequate management.

The goal, for occlusal adjustment, is to ensure stable and functional occlusion. Anatomical and functional examination of the occlusion is performed by assessing the mandibular position (physiological position or adaptative position), maximal intercuspidation, all teeth overjets and overbites, cuspid depth and occlusal curves. The localization, direction, and depth of wear facets allows differentiating mastication-induced physiological erosion from bruxism-induced para-functional erosion. As complementary examination, a screening for occlusal interferences and orofacial (lingual and labial) parafunctions that may constitute a complication of the clinical presentation. The value of the shift between the physiological mandible position and the habitual intercuspidation position is the basis of the first therapeutic phase. In case of a shift ≤ 1 mm, precontacts are removed but the maximal intercuspidation is preserved. If the shift is > 1 mm, correction necessitates a modification of patient's maximal intercuspidation. This first phase is followed by the adjustment of functional courses and, if necessary, by the correction of orofacial functions.

Pathological relations between the eye and the tooth are known for a long time, although they are extremely rare. There are many ocular demonstrations of dental origin (uveitis, cellulitis, conjunctivitis, accommodation disturbances, watering…). Long-term ophthalmic sequelae of a dental pathology can be extremely serious : permanent reduction of vision, diplopia or even blindness… Consequences of oro-facial infection affecting orbit and central nervous system can be hemiparalysy, even death. Stomatologists, dental surgeons and ophthalmologists should associate their competences for the diagnosis establishment, and the implementation of a local and/or general treatment.