EMC - Odontologie最新文献

The purpose of this chapter is to report a novel technique for the placement of aesthetic composite resin restorations in posterior teeth. The advantages of direct composite restorations in posterior teeth include class I and small to moderate class II restorations in premolar and molar teeth. All posterior composites should be placed under rubber dam, with the provision of such restorations involving four phases of treatment: cavity preparation and hybridization of the dentin to effectively protect the pulpo dentin complex; pre-wedging and placement of thin sectional, precontoured metal matrix to facilitate the formation of proximal contact points; placement of a chemically self cured flowable composite in the base of the cavity to speed up the restorative procedure and limit stresses associated with polymerisation shrinkage; restoration of the occlusal portion using the "composite up" technique. This technique involves a multi increment approach in which each increment is light cured for 3 seconds. With the occlusal portion placed, the surface of the restoration is finished by applying and light curing (40 s) a thin layer of resin sealant to reduce microcracks. With this operative procedure, we answer to the biological, functional and aesthetic problems.

Providing information for patients is a pre-requisite to obtain appropriate patient's consent for a research project or for health care. After having been fully informed, the patient can decide whether or not to participate in the suggested procedure. In a dentistry private practice context or for aesthetic surgery, the treatment contract reflects the specificity inherent in the fee-for-service system. Recognizing the place of the patient's consent is recognizing the right of patients to autonomy. Consent is a counter-weight to that medical paternalism which has long shackled patients in the inferior position of dominated/dominator relationships; it marks the end of medical imperialism. The consent, as based on the patient's autonomy, creates a new equilibrium in medical team/patient relationships. Law n^o 2002-303 of March 4, 2002, which deals with patients' rights and the quality of the health system, is a crucial text in terms of patient/care provider relationship.

Similarly to what is observed in periodontics, tobacco is a crucial risk factor in dental implantology. Despite a deficit of research concerning the relationships between tobacco and implantology, it remains possible to lean on the numerous studies achieved in the periodontics field to formulate pathogenic hypotheses that permit to explain the frequent implant failures observed in smoking patient. Among these, we may mention nicotinic affinity for some oral tissues, post-surgical healing delay or local inflammatory aftermaths of previous acute periodontal history. When dealing with such unfavorable clinical picture, the dental implantologist must avoid any exclusion attitude towards this category of patients and must privilege the largest possible information concerning the range of negative consequences potentially generated by tobacco intoxication.

In odontology, bonding has become an efficient means, useful in consolidating restorations while remaining conservative and aesthetic. However, due to the complexity of the bonding process, available materials need to keep evolving. New glues have been developed, with specific utilization protocols, aimed at bonding materials that also progress perpetually. Methacryl resins, glass ionomer cements and other glues have different properties. The bonding effectiveness depends on a good knowledge of both advantages and defects of each available glue. It is also necessary to understand how adhesion to the tooth tissues works, in order to adequately select, in any situation, the best compromise. Bonding to dentin is more effective today than it was 10 years earlier, despite products of easier handling. Metal alloys and ceramics necessitate surface treatments to be effectively bonded. Both the status of the dental tissue and the nature of the prosthetic material are to be taken into account to ensure effective bonding.

Basal implantology is a rising discipline with wide and multiple applications still unrecognized today. Indeed, if the technology of the set sat back implants exists for more than 20 years, the development of associated therapeutic remains very confidential. This article points out the main historical steps, theoretical bases and technological principles, before describing in details the associated surgical techniques and their therapeutic implications. Thus it emphasises the global treatment of single and complex anatomical lesions of the low and middle face. Finally, if the strictly dental use of these implants are very interesting, the underlying orthopaedic concept shows its great efficacy only during huge and delicate rehabilitations.