EMC - Dentisterie最新文献

Tooth extraction in a child may seem a simple, ordinary act. It should be remembered, however, that when he becomes an adult, this patient will have an attitude to dental treatment that will depend on how he experienced this “paediatric extraction”. The initial contact and the way one addresses the child are therefore essential. The way of talking and adequately chosen words are a key in the patient/doctor relationship. Milk teeth are morphologically and physiologically different from permanent teeth, first, due to root resorption which confers them their temporary character. The main reasons for tooth extraction in children are the decay and its related infectious complications; other reasons are trauma, and scheduled orthodontic extractions of either milk teeth, or buds of permanent teeth. Between the indication and the extraction itself, anaesthesia is an intermediary stage which can sometimes constitute an obstacle (fear of the injection). This is why much is to be done to make it as non-traumatic as possible. The operating technique must comply with precise rules and take into account factors such as the morphology of the tooth, the presence of underlying permanent tooth buds and, for a time, the co-existence of milk and permanent teeth. For more complicated acts, such as removing odontoids or more generally unerupted teeth, general anaesthesia may be considered.

Acquired or congenital loss of structure can cause facial deformity. This may result in destroyed identity and certain forms of exclusion. In these cases, surgical reconstruction and sometimes prosthetic reconstruction are required. Maxillofacial prosthesis refers to the art and science of artificial reconstruction of facial bones. There is a continual increase in patient demand for this type of prosthesis with the development of new materials, methodologies and techniques. New technologies such as the Computer Aided Design (CAD) and Computer Aided Manufacturing (CAM) make possible nowadays to combine the advantages of traditional facial prosthesis and the potential of Rapid Prototyping, resulting in an improvement in terms of time and quality. Therefore the practitioner can concentrate on his main task which is to optimise individually created facial prosthesis. This new concept of maxillofacial prosthesis should find its place in medicine given the overall scope of rehabilitations that it makes available, in terms of aesthetic and psychology as well, but above all in terms of functional perspective.

The aging of the face is not limited to the cutaneous ptosis. There are changes interesting the sub-cutaneous tissues, masticators muscles and facial skull. The cutaneous aging is characterized by a skin atrophy and a loss of elasticity. The superficial musculo-aponevrotic system get loose as the orbital septum. Some cutaneous muscles are invaded by sub-cutaneous fat and the masseter muscle shows thicked aponeurosis. Maxilla and mandible aging is caused by edentulousness. There is a bone resorption and a loss of height of the lower third of the face.

Guidelines for prescribing dental radiography are necessary in order to warrant the most adapted and the most precise approach to a given problem. This chapter describes the principles of radiographic interpretation, various dental abnormalities and diseases, and lesions of the jaws (the temporomandibular joint is included).

Cranio-facial traumas associate concomitant traumatic injuries of face and skull, particularly the anterior cranial base. Their severity is potentially lethal due to the possible lesions of the brain tissues and dura mater. They also have a major impact on some functions such as vision, olfaction, mastication, and may affect the aesthetic of the head. Various mechanisms are involved and the numerous classifications that have been proposed reflect their complexity. Different tissues and major elements of the face and skull can be concerned. The trauma can be central, lateral or both, illustrating its violence; it may be associated with visceral and orthopedic lesions that aggravate the prognosis. Management must be immediate, from the accident’s scene. Clinical neurological and maxillo-facial examination, using modern CT scan and MRI allows the lesion’s inventory. Complications are mainly represented by presence, persistence or recurrence of a cerebrospinal fluid (CSF) leakage with post-traumatic meningitis risk. Nevertheless, nowadays these CSF leaks are easily visualized and safely treated by transnasal endoscopic techniques. Early single-stage repair of complex craniofacial trauma includes bony repair methods with rigid fixation and uses grafts when massive comminutions or tissue’s lost occurs. Damaged dura must also be repaired. Frontal sinus state depends on involvement of the anterior table, the posterior table, the floor and the naso-frontal duct. This kind of traumas requires a close co-operation between maxillo-facial surgeons, neuro-surgeons, and ENT specialists to manage a one-stage definitive primary treatment with which ophthalmologists and anesthesiologists are associated.