Cours 8 RIKZALL Chirurgie préprothétique Partie 1 PDF

Chirurgie préprothétique Partie 1 Plan Définition Buts Atrophie osseuse Vestibuloplastie Frénectomie Recontour osseux Recontour tissus mous Définition Techniques permettant d’établir une fondation biologique fonctionnelle offrant support et rétention...

Chirurgie préprothétique Partie 1 Plan Définition Buts Atrophie osseuse Vestibuloplastie Frénectomie Recontour osseux Recontour tissus mous Définition Techniques permettant d’établir une fondation biologique fonctionnelle offrant support et rétention mécanique à la réhabilitation prothétique Techniques plus agressives beaucoup plus répandues avant l’arrivée des implants dentaires De moins en moins pratiquées de nos jours Principes de bases toujours utiles en reconstruction majeure Buts essayer de rétablir une forme d’arcade le plus anatomique et confo possible (pour le confort ou pour mettre des prothèses ou implant) Éliminer pathologie récurrente ou pré-existante ex cancer, kystes, lésions etc pour avoir une anato normale Éliminer inflammation des tissus si nous avons un patient qui porte les prothèses tout le temps meme la nuit Rétablir une relation maxillo-mandibulaire favorable en classe II ou classe III avec avancement prémaxillaire --> possible de faire une chx orthognatique et on peut tricher en ajustant les os au lieu de faire ca par ex Préserver et restaurer la crête alvéolaire (forme et dimension) Obtenir du tissu kératinisé dans les zones load-bearing dans les zones qui soutiennent la proth;se: mieux soutenir des forces avec moins dinflammation Éliminer les zones de contre-dépouille trop accentuées Buts Rétablir une profondeur vestibulaire adéquate plus quon a de la prodondeur, le plus on a une surface de contact donc plus de stabilité Obtenir une bonne architecture du maxillaire Prévenir les fractures pathologiques de mandibule édentée atrophique toute mandivule est moins de 1cm est à restaurer. ou toute personne avec ostéomyélites ou prend des BPN Reconstruire le procès alvéolaire pour la mise en place d’implant dentaire Satisfaire les attentes esthétiques, masticatoires et de langage Atrophie osseuse Dans les 3 axes de l’espace quand on perd les dents on perd de los (la stimulation des dents nest plus la) Secondaire à la perte de fonction 158physiologique et des dents Part 2: Dentoalveolar Surgery atrophie précipitée après la perte des dents - perte de stimulation via le ligament parodontal decreased overall lower facia ing to the typical overclose Facteurs systémiques intrinsèques decreased alveolar support prostheses, encroachment o tissue attachments to the resulting in progressive inst ventional soft tissue–bor devices, neurosensory change Ostéoporose atrophy, and an overall red and form in all three dime changes result in an overall and increase in patient disco use of conventional dentu B longed effects of edentulism Anomalies endocriniennes A with systemic factors and fun cal demands from prostheti duce atrophy that, in severe c patient at significant risk fracture. As a result of the a goal-oriented approach to tr Insuffisances rénales most appropriate. The ove include the following6: (1) to hyperparathyroidie secondaire existent or recurrent patholo bilitate infected or inflamed reestablish maxillomandib Malnutrition MIAO ships in all spatial dimensio serve or restore alveolar rid (height, width, shape, and C D conducive to prosthetic rest achieve keratinized tissue co FIGURE 9-1 The diagrams show patterns and varying degrees of severity of mandibular atrophy. load-bearing areas; (6) to re A, Mandible shows minimal alveolar bone resorption. B, Cross-section of large alveolar ridge including mucosal and muscular attachments. C, Mandible shows severe loss of alveolar bone that soft tissue undercuts; (7) to e has resulted in residual basal bone only. D, Cross-section shows resorbed alveolar ridge, with mus- er vestibular depth and re cular attachments. Adapted from Tucker MR. Ambulatory preprosthetic reconstructive surgery. In: attachments to allow for pr Peterson LJ, Indresano AT, Marciani RD, Roser SM. Principles of oral and maxillofacial surgery. extension if necessary; (8  Posteroanterior and lateral cephalo- Symphysis metric radiographs can be used to evaluate 35 Preprosthetic and Re interarch space, relative and absolute skele- 25 tal excesses or deficiencies existing in the maxilla or mandible, and the orientation of 15 Posteroanterior and lateral the alveolar ridge between arches. These cephalo- Symphysis 5 metric radiographs are exceptionally can be useful used towhen evaluate the presence 35 Preprosthetic and Reconstruct Classification Cawood et Howell 5 mm 15 mm interarchof space, relative skeletal and absolutemay discrepancies skele- necessitate 25 tal excesses or deficiencies orthognathic correction existing in the accept- to provide Parasymphysis maxilla orable mandible, functional andrelationships the orientation forofprosthetic 15 35 Resorption (mm) Posteroanterior the alveolar andridge rehabilitation.lateral between cephalo-arches. These Cephalometric Symphysis analysis in 5 metric radiographs can be used towhen evaluate 25 are exceptionallycombination usefulwith the presence mounted 35 models dental Preprosthetic and Reconstructive Surge 5 mm 15 mm interarch of space, relative skeletal helps and discrepanciesabsolute one establish skele- maythenecessitate planned path of 15 25 tal excesses or deficiencies orthognathic insertion existing correction of future in prosthetic to provide the accept- devices Parasymphysis as 5 maxilla orable mandible, functional and the orientation forofprosthetic 15 well asrelationships identify discrepancies in interarch 35 Classe Posteroanterior Description and ridgelateral cephalo- 5 mm 15 mm Resorption (mm) the alveolar rehabilitation. between arches. Cephalometric These Symphysis analysis in relationships that affect the restorative 5 plan 25 metric radiographs can be used to evaluate interarch of are exceptionally space, combination relative and useful (Figure when with9-6). the presence 35 mounted dental models 5 mm 15 mm MolarPreprosthetic and Reconstructive Surgery 9 1 skeletal helps oneabsolute discrepancies establish In recent skele- may thenecessitate years planned 25 pathtomography computed of 15 35 tal excesses or deficiencies orthognathic insertion existing correction of future in the to provideprosthetic accept- Parasymphysis devicesl’anatomie as in the maxilla orable mandible, functional and the (CT) has orientation played ofprosthetic toute an increased 15 role 5 25 well asrelationships identify treatment for discrepancies planning inofinterarch complex parodontale 35 cases. et 5 alvéolaire I Posteroanterior Dentition normale and lateral cephalo- Resorption (mm) the alveolar ridge between arches. TheseSymphysis mm 15 mm rehabilitation. Cephalometric relationships Detailedthat affect analysis the restorative evaluation in 5 alveolar of plan 15 metric radiographs can be useful used to evaluate maintenue 25 contour,au niveau deand laReconstructive Surgery are exceptionally combination (Figure when with 9-6). the9 presence mounted neurovascular 35 models dental position, 5and mm sinus anato- 15 mm Molar Preprosthetic 161 interarch of space, relative skeletal and discrepanciesabsolute helps one establish may In recent skele- thenecessitate planned years computed 25 path dent of tomography et 15 du procès alvéol 5 tal excesses or deficiencies existing mythe in is available for the subsequent plan- 35 orthognathic correction insertion of future (CT) to hasprovide prosthetic played accept- devicesimplant Parasymphysis as 5 mm 15 mm maxilla orable mandible, and the orientation ning of of an increased advanced 15 role in applications. the 5 25 I II III IV functional relationships well as identify treatment for discrepancies prosthetic planning in of interarch complex 35 cases. II Posteroanterior Post extraction immédiat and lateral cephalo- Zygomatic implants that obviate the 5 mmneed Resorption (mm) the alveolar ridge between arches. These Symphysis 15 mm FIGURE 9-3 Modified Cawood and Howell classification of reso rehabilitation. Cephalometric relationships that affect Detailed analysis in 5 the restorative evaluation of alveolarplan contour, 15 metric radiographs can are exceptionally be used useful to evaluate when the for sinus lifting can 25 be used in cases of attached mucosa, which decreases with progressive resorptio combination with 9 presence mounted 35 dental models 5and (Figure 9-6). neurovascular involving position, edentulous mm sinus 15 mm anato- atrophic Molar maxillary interarch of space, relative skeletal helps and absolute discrepancies one establish skele- maythe necessitate planned 15 5 In recent mytheis years available 25 path computed for of subsequent tomography the 35 tal excesses or deficiencies orthognathic existing correction to in provide sinuses accept- (Figure 9-7). Carefulplan- Parasymphysis evaluation of 5 mm 15 mm insertion of future (CT) hasning prosthetic played an devices increased as role in the 5 Procès alvéolaire arrondi avec dimension maxilla orable mandible, functionaland the orientation well asrelationships identify treatment for of of prosthetic discrepancies planning advanced the 15 path inofinterarch implant of complex35 insertion applications. cases. is easily 25 accom- results (FigureI 9-9). InII addition, III accuracy IV where V av III Zygomatic implants plished that using coronal CTobviate the need examination of 9-3of Modified the surgical procedure can be greatly mentatio Resorption (mm) the alveolar ridge relationships between arches. These 5 mm 15 mm FIGURE Cawood and Howell classification of resorption. Th rehabilitation. Cephalometric Detailedthat affect analysis evaluation 5in the restorative of plan alveolar contour, 15 adéquate are exceptionally combination of skeletalhelps useful (Figure discrepancies when with9-6). maythe the mounted 9 for presence neurovascular sinus dentalposition, involving necessitate thelifting models 5and the maxillary edentulous can mm sinus clinician be 25sinuses. used mm anato- 15 atrophic CT Molar incancases maxillary 15with information regarding also 5 provide of attached increased mucosa, with which duration of the procedure. an overall decreases with decrease progressive in the resorption. suchAdapted mucosa, as one establish In recent planned years my is available computed path of tomography 35 orthognathic correction to provide sinuses for accept- (Figure bonethe quantity subsequent 9-7). Careful Parasymphysis and plan- evaluation volume as of 5 as well mmden-15 mm depth can insertion (CT) of future hasning prosthetic played of an devicesimplant increased as in applications. of35role the5 Treatment I 9-9). InIIPlanning Lame de couteau, hauteur ok, largeur able functional relationships well as identify treatment for advanced the prosthetic discrepancies planning pathsity inofinterarch complex insertion (Figure 9-8). cases. is easily 25 accom- results (Figure Considerations addition, III accuracy IV where V available VI u overlying IV rehabilitation. Cephalometric relationships Zygomatic that affect Detailed analysis implants plished in alveolar the restorative evaluation of that usingIncoronal plan obviate Resorption (mm) many CT contour, perd the 5 mm cases need en 15 examination the 15 mm of 9-3of Modified combination FIGURE epaisseur the of surgical et Cawood largeur procedure and Howellcan en be greatly classification mentation of resorption. The is col complete thicker combinationinsuffisante with9-6). (Figure mounted9 neurovascular for sinus dentalposition, involving thelifting maxillary can imaging models and sinus anato- theedentulous clinician with 15 be 25sinuses. atrophic with used CT modalities Molar premier incan maxillary information diagnostic cases wax-ups also and et can of provide mounted attached apres 5 regarding be increased helpful mucosa, models on duration in perdof with which The has the de an overall decreases conventional la procedure. given way with to decrease progressive tissue-borne implant-borne in the resorption. such prosthesis Adapted mucosa, devices as dehiscen from excessive and can Caw ob proc helps one establish mythe In recent is planned years computed available path for of subsequent plan- tomography the 35 insertion (CT) of future prosthetic sinuses (Figure bone devicesimplant 9-7). quantity Careful determining as in applications. and hauteur evaluation volume the as of 5(lame well reconstructive as mm den- plan. 15 mmde couteau) These that have proven superior in depth providing canthebe avoi clas hasningplayed of an increased advanced of role the 5 Treatment I InII Planning III accuracy IV V available VI until the VII f well as identify treatment discrepancies planning the in pathsity of interarch complex insertion (Figure 9-8). elements cases. is areeasily useful in theresults also accom- 25 (Figure fabrication of 9-9). increased addition, patient function, whereconfidence, overlying soft tissu accordin Zygomatic implants that obviate the need Considerations V Crête plane, dimension inadéquate relationships that affect Detailed plished the restorative evaluation for sinus of thelifting using planInbe alveolar maxillary can imaging coronal manysurgical contour, sinuses. CT usedCTincan modalities 5 mm cases 15 examination stentsthe cases mm 15 guiding also mounted and FIGURE of combination of attached provide of the 9-3 Modified implant surgical ofplacement mucosa, which increased models Cawood and with The procedure and Howell decreases anpreparation overall conventional can withdecrease be progressive tissue-borne greatly classification esthetics. Preprosthetic inresorption. mentation theprosthesis suchAdapted is Thecomplete, of resorption. surgical complete. thicker line from Cawood as excessive, dehiscence, ifillustra the o reconstru JI, Ho loss removal (Figure 9-6). 9 neurovascular position, and sinus or anato- grafting Molar procedures. Surgical stents fab- of areas directly involved with for his or involving theedentulous clinician with atrophic with diagnostic maxillary informationwax-ups 5 regarding can be duration helpful in of has the procedure. given way to implant-borne mucosa, devices and can obliteration proceed with In recent my is years computed available for tomography the subsequent ricated 35 plan- from CT-based models combine device support and stability are of prima- Man sinuses (Figure bone 9-7). quantity Careful evaluation andesthetic volume as wellof 5 as mmden- 15 mm These bridge that havery proven superior depth canthebe avoided if res (CT) has ning played of an increased role indetermining the the reconstructive and surgical plan. considerations; importance and in providing should be VIaddressed classification achieve advanced the pathsity implant of (Figure insertion applications. is easily accom- results Treatment (Figure I 9-9). InII Planning addition, III accuracy IV where V available until theVII final bony VIII treatmentZygomatic planning of complex cases. 9-8). the elements 25 are also useful in the model gap between fabrication surgeryof and increased the early patient in thefunction, plan. overlyingaccording treatmentconfidence, soft tissue. toOnce because Caw o implants that obviate the need Considerations VI Crête concave, os basal en résorption Detailed for evaluation plished usingIncoronal ofmaxillary sinusthelifting alveolar be many surgical contour, can sinuses. CT usedCTincan casesexamination stentsthe operation; 15 cases also mounted provide ofimplant combination FIGURE guiding of attached 9-3 of Modified the of increased surgical placement and allow cooperation between mucosa, which Cawood procedure and and withconventional The an overall decreases Howell can withdecrease be greatly classification esthetics. Overlying progressive tissue-borne of soft inresorption. mentation resorption. Preprosthetic tissue theprosthesis such Adapted The procedures is complete. complete, thicker surgical as excessive,