EMC - Dentisterie最新文献

The mandible has been reported to be one of the most fractured bone in human. Several factors are involved in mandible fracture such as anatomy and biomechanisms. Long-term studies show a progressive increase in the incidence of mandibular fractures. The two predominant mechanisms of these injuries are interpersonal violence associated with addictive substance abuse, and vehicle accidents. Young males constitute the predominant population concerned by mandibular fractures. In this context, the accuracy of clinical signs and symptoms is high. Appropriate radiographic evaluation is utilised to confirm diagnosis.

Some general pathologies may have consequences on dental pulp and dentin. The incidence of such diseases on pulp can be necrosis, calcification, and metaplasia. On dentin, an excess or a defect of dentinogenesis and/or mineralisation have been observed. A review of recent literature provides new information on the various pulp-dentinal pathologies and on the pathogenic mechanisms involved; these may be induced by poorly controlled diabetes mellitus, atherosclerosis, hyperbilirubinemia, chronic renal pathologies, oxalosis, anachoresis, disorders of parathyroid, hypervitaminosis D, scleroderma, certain malignant tumours, genetic diseases such as hereditary rickets, hypophosphatasia, osteogenesis imperfecta and various rare hereditary syndromes, dietetic ion and vitamin deficiencies, mercury intoxication, fungal infections with Candida, zona, leprosy, and various general treatments (glucocorticoids, tetracyclines, fluoride supplementation and anti-cancer therapy).

Dental alloys are used in all odontological fields. They can constitute medical devices usable as they are or be implemented as part of medical custom-made devices such as dental prosthesis and orthodontic appliances. Preparation of these devices requires various processes such as the foundry of the dental alloys, its sintering, electro-deposition and shaping. All these processes meet criteria and requirements which are described in this chapter.

The outcome research, like the clinical research, examines the end results of medical interventions. However, unlike clinical research, the outcome research systematically considers outcomes from the patient’s perspective. Therefore, assessments do not focus on physical data or laboratory test, but on the patient’s feelings. This approach is essential in cosmetic surgery where the main outcome is psychological and subjective rather than functional. Outcome research is useful in solving the ethical problem of the risk-benefit ratio in cosmetic surgery. Parallel to its evolution and advances, it should allow a better definition of the indications for cosmetic surgery. In outcome research, the assessment may be an index of satisfaction, a scale for quality of life, or a scale for psychological evaluation. Satisfaction indexes present a great advantage related to their simplicity, but such easiness of response constitutes also a limitation. They are essentially based on visual analogue scales such as those commonly used to assess pain. Evaluation tests for quality of life assessment include in a single score several dimensions such as physical condition, and social, psychological, and emotional criteria. Specific tests take into account the pathology or the need for care as asked by the patient, such as cosmetic surgery. Generic health status tests focus on the quantification of overall quality of life independently from the patient’s demand; this makes them less biased. Finally, psychological scales are the most commonly used due to the psychological aspect of a need for cosmetic surgery. They screen depression, anxiety, etc. A literature review revealed that maxillofacial surgery doesn’t improve depression indexes. It improves significantly self-confidence, self-esteem, and physical self-image. Cosmetic surgery improves the results of generic or specific tests for quality of life assessment, provided these tests include some of such psychological parameters.

The most frequently encountered lesions are epithelial cysts which are absolutely benign. On the other side, sarcomas are uncommon but have a poor prognosis. Many other benign lesions may be identified by clinical examination. Diagnosis will be confirmed by histology. Most lesions will need surgical treatment. In some cases, no treatment is required (haemangioma, papilloma, naevus, small mucous retention cyst, capillary or lymphatic malformation…). Some lesions may be of prognostic value (nevromas of the phacomatosis). The oral cavity of the infant or the new-born may be affected by various tumours or tumour-like lesions.