Journal de parodontologie最新文献

Osseointegrated dental implants are now in common usage in dentistry. Since their placement requires considerable work it is important that the patient be motivated. The author explores the major psychological features of candidates for implant therapy.

The reliability of the Brånemark implant system has been well documented. In addition, the technique has been employed in the anterior portion of the mouth with good cosmetic results. Fundamental to the success of these procedures is the multidisciplinary approach. The "Drilling Guide" is the outcome of an intimate relationship between members of the therapeutic team, this allows for the control of all parameters of aesthetics. The preparation of the prosthetic cradle by selecting splaying and eversion is presented as a new approach. The impression method is atraumatic and employs personalized unitary transfers. This leads to the required emergence profile and guarantees the optimum aesthetic result.

In recent years, much emphasis has been placed on the refinement and enhancement of prosthetic components and techniques in implant dentistry, while the surgical protocol has remained fairly constant. The evolution of the concept of the immediate placement of fixtures into extraction sites, along with the related concept of guided tissue regeneration, is a major advancement in the surgical field. It provides significant benefit to both patient and clinician in terms of the reduced treatment time and an enhanced prognosis related to biomechanics and aesthetics.

The authors experience on twelve patients in the field of bone grafting prior to implant surgery is presented. The technique employed depends largely on the anatomical location of bone insufficiency, such as: 1) Where there is not enough bone beneath sinus locations, grafting with cancellous iliac bone blended with coral particles is suggested. 2) Where the jaw is not sufficiently thick, such as in the incisor-cuspid regions, the authors employ cancellous and/or cortical bone grafts. 3) Horizontal osteotomy and interposition of cortical-cancellous bone graft is proposed where there is a lack of bone height in the incisor-cuspid regions. The results of the various techniques are analysed from a clinical, radiographic and histologic perspective. Twelve patients have been treated with 2 years follow-up.

Dramatic improvements in aesthetics in osseointegrated implants can be accomplished with the new prosthetic solutions. These consist of the subgingival displacement of the "aesthetic limit" between the abutment (UCLA attachment), or by the utilization of the new components from the Brånemark System. A peri-implant soft tissue flap is suggested to create sufficient gingival thickness and, the same time, to allow for aesthetic and plaque removal considerations.

The use of expanded polytetrafluorethylene membranes to attain bone regeneration around dental implants is described. Membranes discourage "non-desirable" cells form colonizing the healing site. These cells are essentially derived from gingival epithelium and gingival connective tissue. It is suggested that this procedure could be employed directly after tooth extraction.

The length of certain implant surgery operation as well as their precision requires the complete cooperation of patients. The vigilambulant anesthesia, regularly used in other medical specialties, ensures in total security, anxiolism, sedation, analgesia and amnesia for patients. The presence of an anesthesist having at his disposal all the material and all drugs for anesthesia and reanimation gives the surgeon an unequalled operatory comfort.

Plaque, which is a major etiologic factor in human periodontal disease, also can be found around dental implant fixtures. The authors compare peri-implant disease to periodontitis in order to attempt to define more precisely the principles of maintenance therapy.

Periodontal diseases are thought to occur in an episodic manner with periods of breakdown and remission. This phenomenon can differ from one site to another. Clinical indices are unable to provide useful information about disease activity, but certain biologic markers may reflect periods of breakdown of connective tissue component of the periodontium. Procaryotic markers were excluded because they are difficult to identify and the results were uncertain. Tissue breakdown factors within the gingival sulcus were examined. Some of these factors could be correlated with the active stages of disease. These include: mediators of inflammation, catabolic enzymes, and enzymes associated with tissue necrosis. Among the eucaryotic tissue components, one or several could be of use to the dentist to assay disease activity. These tests could conceivably be done without complex and expensive equipment and could offer a new diagnosis index, "the active site index."

Bacterial colonization is investigated: before eruption, in primary dentition, mixed dentition and permanent dentition, with and without gingival inflammation. Microorganisms such as spirochetes and Black pigmented Bacteroides are implicated in the periodontal disease. These germs arrive later than teeth and their importance grows with age and gingival inflammation. Different reviews have emphasised the potential role of specific pathogens in the aetiology of periodontitis. The plaque composition of necrotizing ulcerative gingivitis and periodontitis in their pre and post pubertal forms, localized and generalized is investigated. A actinomycetemcomitans, B. intermedius and spirochetes can be isolated from children having destructive periodontal disease. Changes in flora can then be explained.