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Présentation de cas

Présentation de cas. MEOUCHY Peter-CES Paro. Nom : HAKIM Dolly Date de naissance : 1971 Date de consultation : 18-05-09 Motifs de la consultation : - changement des couronnes 11-12-16-25 à cause de leur aspect inesthétique - fétidité d’haleine - mobilité 11-12 Anamnèse :

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Présentation de cas

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  1. Présentation de cas MEOUCHY Peter-CES Paro

  2. Nom: HAKIM Dolly • Date de naissance: 1971 • Date de consultation: 18-05-09 • Motifs de la consultation: -changement des couronnes 11-12-16-25 à cause de leur aspect inesthétique -fétiditéd’haleine -mobilité 11-12 • Anamnèse: couronnesréaliséesdepuis 10 ans (accident de la voiepublique) • Etatgénéral: rien à signaler

  3. Examenendobuccal: -couronnes: 11-12-16-17-25 46 -restaurations: 13-14-15-18-26-27-28 34-35-36-37-44-45-47 • Diagnostic :parodontitechroniquemarginale lésionendo-parodontale site 11 sévère • Plan de traitement: 1. phase initiale 2. évaluation (11), extraction et remplacement par implant avec greffeosseuse 3. traitementendodontique(reprise)+prothèsefixée: 12-24

  4. BILAN RADIOGRAPHIQUE18-05-09

  5. ETAPES DU TRAITEMENT ETABLI : sites 11-12

  6. 1-Extraction 2-Greffe osseuse en bloc (prélèvementramique) 3-Pose d’implant: Branemark 4-Echec: 4.1.greffe régénérationosseuse guidée (ROG) 4.2.implant (cause infectieuse) 5-Greffe osseusse en bloc (prélèvementsymphysaire) 6-Pose d’implant: Bone Level + greffeconjonctifenfoui (2 temps chirurgicaux) 7-Traction orthodontiquelente(site 12)

  7. Extraction11-06-09

  8. Extraction (11) et curetage du tissuinflammatoire avec une suture simple croisée

  9. 1-Extraction 2-Greffe osseuse en bloc (prélèvementramique) 3-Pose d’implant: Branemark 4-Echec: 3.1.greffe régénérationosseuse guidée (ROG) 3.2.implant (cause infectieuse) 5-Greffe osseusse en bloc (prélèvementsymphysaire) 6-Pose d’implant: Bone Level + greffeconjonctifenfoui (2 temps chirurgicaux) 7-Traction orthodontiquelente(site 12)

  10. Greffeosseuse en bloc (14-10-09)

  11. branchehorizontalemandibulaire • beaucoup d’os (épaisseurconfirmée par CBCT) • réduction en épaisseur possible • 4-5 mm d’épaisseur • 1 cm en hauteur Prélèvementramique

  12. 28-10-09 04-03-10(2 sem post op) (5 mois environ)

  13. 4principes pour le succès des greffesosseuses en bloc: 1-préparation site receveurpour apportvasculaire, cellules ostéogéniques et FDC 2-stabilisation de la greffe 3-fermeture sans tension du lambeau 4-placement des implants après incorporation de la greffe

  14. littérature

  15. 40 patients receiving autogenous block transplants prior to implant placement • clinical parameters: BOP, mobility, suppuration, mucosal recession and buccal tissue transparency, recorded at yearly intervals • (CT) scan was taken at an average of 42 months (n = 20) postaugmentation • clinical examination: no implant transparency, mucosal recession, mobility, BOP or suppuration (n = 40) at 48 months • (CT) scans: varying thicknesses (0.5 to 4 mm) of buccal cortical bone around the implants • the increased width at the recipient site postgraft was 7.6 mm, maintaining, on average, 98% of the augmented width • the buccal osseous thickness at the implant sites averaged 2.0 mm compared to 0.7 mm for the adjacent teeth (P <0.0001) • even when adjacent teeth had a thin biotype, the transplanted sites maintained statistically significant thicker buccal cortical plate at all sites (P <0.0001) Conclusion: • grafted site phenotype did not seem to be influenced by the adjacent teeth biotype • autogenous osseous transplants can predictably reconstruct function and esthetics and seemed to maintain stable bone volume around implants at an average of 3.5 years Fernando Verdugo, KrikorSimonian, HessamNowzari.Periodontal Biotype Influence on the Volume Maintenance of Onlay Grafts. J Periodontol 2009;80:816-823

  16. retrospective study conducted from 1999 to 2001 • 50 healthy patients who received 129 implants in augmented sites reviewed implant survival, radiologic implant success (marginal bone loss), and complications recorded. • follow-up from time of implantation ranged from 6 to 67 months (mean: 24.3 months) • the overall survival rate was 96.9% (4 implants were removed) • MBL around implants ranged from 0 to 3.3 mm (average: 0.22 mm) • Only 5% of the implants presented marginal bone loss more than 1.5 mm over the follow-up time Conclusion: • intraoral bone block graft surgery is a predictable operation for the use of dental implants • implant placement in augmented areas presents high survival and radiologic success rates with minimal bone loss Liran Levin, Daniel Nitzan, Devorah Schwartz-Arad.Success of Dental Implants Placed in Intraoral Block Bone Grafts. J Periodontol 2007;78:18-21

  17. 1-Extraction 2-Greffe osseuse en bloc (prélèvementramique) 3-Pose d’implant: Branemark 4-Echec: 3.1.greffe régénérationosseuse guidée (ROG) 3.2.implant (cause infectieuse) 5-Greffe osseusse en bloc (prélèvementsymphysaire) 6-Pose d’implant: Bone Level + greffeconjonctifenfoui (2 temps chirurgicaux) 7-Traction orthodontiquelente(site 12)

  18. Pose d’implant (zone esthétique)

  19. littérature

  20. 41adult patients, 41 implant-supported single restorations • pink esthetic score (PES)/white esthetic score (WES) twice with an interval of 4 weeks (8 observers) • visual analog scale (VAS) Summarized the PES and WES of the 41 implants(Belser): Hae-Lyung Cho, Jae-Kwan Lee, Heung-Sik Um, Beom-Seok Chang. Esthetic evaluation of maxillary single-tooth implants in the esthetic zone. J Periodontal Implant Sci 2010;40:188-193 • doi: 10.5051/jpis.2010.40.4.188

  21. in the PES/WES, very good and moderate intraobserver agreements were noted between the first and second rating. • mean total PES/WES = 11.19 ± 3.59, mean PES was 5.17 ± 2.29 and mean WES was 6.02 ± 1.96. • in the total PES/WES, no significant difference; in the WES, significant difference • prosthodontists assigned poorer ratings than the other groups; periodontists gave higher ratings than prosthodontists and senior dental students; orthodontists were clearly more critical than the other observers • statistical analysis revealed statistically significant correlation between patients’ esthetic perception and dentists’ perception of the anterior tooth (except for the first premolar) Conclusion: • the PES/WES is an objective tool in rating the esthetics of implant supported single crowns and adjacent soft tissues • orthodontists were the most critical observers, while periodontists were more generous than other observers Hae-Lyung Cho, Jae-Kwan Lee, Heung-Sik Um, Beom-Seok Chang. Esthetic evaluation of maxillary single-tooth implants in the esthetic zone. J Periodontal Implant Sci 2010;40:188-193 • doi: 10.5051/jpis.2010.40.4.188

  22. 45 patients, 45 maxillary anterior single implant crowns, mean functional time of 32.5 months • dimensions of peri-implant mucosa by bone sounding at (MI), (F), (DI) aspects of the implant restoration and the proximal aspects (MT, DT) of adjacent natural teeth(in mms) Conclusion: • the level of the interproximal papilla of the implant is independent of the proximal bone level next to the implant, but is related to the interproximal bone level next to the adjacent teeth Joseph Y.K Kan, KitichaiRungcharassaeng, KiyotakaUmezu, John C. Kois. Dimensions of Peri-Implant Mucosa: An Evaluation of Maxillary Anterior Single Implants in Humans. J Periodontol 2003;74:557-562

  23. 40 single-tooth implants, anterior maxilla, 75% upper central incisors • variables possibly associated with the soft tissue level were obtained from clinical measurements, study models, peri-apical radiographs, and computerized tomograms Conclusion: • the papilla level around single-tooth implants in the anterior maxilla was mainly influenced by the interproximal bone crest level of the adjacent tooth • facial marginal mucosal level, on the other hand, was affected by multiple factors including the peri-implant biotype, the facial bone crest level, the implant fixture angle, the interproximal bone crest level, the depth of implant platform, and the level of first bone to implant contact. Nisapakultorn K, Suphanantachat S, Silkosessak O, Rattanamongkolgul S. Factors affecting soft tissue level around anterior maxillary single-tooth implants. Clin. Oral Impl. Res. 21,2010; 662–670

  24. a-axe de forage +/- palatin b-diamètreadéquat c-table osseusevestibulairesuffisante Règlesd’or # récessionpéri- implantaire

  25. 26-05-10

  26. Implant BK (3.75 х 11.5 mm) !! Première complication!!

  27. Déhiscencevestibulaire

  28. 1-Extraction 2-Greffe osseuse(prélèvementramique) 3-Pose d’implant: Branemark 4-Echec: 3.1.greffe régénérationosseuse guidée (ROG) 3.2.implant (cause infectieuse) 5-Greffe osseusse (prélèvementsymphysaire) 6-Pose d’implant: Bone Level + greffeconjonctifenfoui (2 temps chirurgicaux) 7-Traction orthodontiquelente (site 12)

  29. Membrane ACE (R) + bio-oss® Régénérationosseuseguidée

  30. littérature

  31. porcine-derived bioabsorbable collagen membrane v/s ePTFE membrane (NR) +bovine bone xenograft/autograft bone composite in defects surrounding dental implants • effect of primary barrier fixation on GBR • 48 subjects, 23 collagen membrane, 25ePTFE, 34sites+barrier fixation (polylacticresorbable pins) (6months) • postoperative complications when barrier fixation was lacking at initial surgery Conclusion: • both barriers are suitable for achieving GBR of osseous defects surrounding dental implants • importance of barrier fixation at the time of initial surgery Lillian Carpio, Juan Loza, Samuel Lynch, Robert Genco. Guided Bone Regeneration Around Endosseous Implants With Anorganic Bovine Bone Mineral. A Randomized Controlled Trial Comparing Bioabsorbable Versus Non-Resorbable Barriers. J Periodontol 2000; 71:1743-1749

  32. augmentation horizontalejusqu’à7.5 mm (v/s 4.5 mm) • cicatrisationrapided’environ4-5mois (v/s 6-9 mois) • densitéosseuseoptimale pour la stabilitéimplantaire • stabilité du bloc pendant la cicatrisation et perteosseusepostopréduite • augmentation verticalejusqu’à4 mm Avantages des greffesosseuses(P/R aux ROG)

  33. 1-Extraction 2-Greffe osseuse en bloc (prélèvementramique) 3-Pose d’implant: Branemark 4-Echec: 3.1.greffe régénérationosseuse guidée (ROG) 3.2.implant (cause infectieuse) 5-Greffe osseusse en bloc (prélèvementsymphysaire) 6-Pose d’implant: Bone Level + greffeconjonctifenfoui (2 temps chirurgicaux) 7-Traction orthodontiquelente(site 12)

  34. dépose sutures • perte de l’implant site 11 pour cause d’infectionapicale et vestibulaire • tissuinflammatoirecureté • comblement avec du bio-oss® et double membrane ACE !! Deuxième complication!!16-06-10

  35. 1-Extraction 2-Greffe osseuse en bloc (prélèvementramique) 3-Pose d’implant: Branemark 4-Echec: 3.1.greffe régénérationosseuse guidée (ROG) 3.2.implant (cause infectieuse) 5-Greffe osseusse en bloc (prélèvementsymphysaire) 6-Pose d’implant: Bone Level + greffeconjonctifenfoui (2 temps chirurgicaux) 7-Traction orthodontiquelente(site 12)

  36. grefferéalisée après essayage de pose d’implantmais pas de stabilité • prélèvement d’un bloc osseux du sitesymphysairedroit: facile, épaisseur ≤ 4 mm, loiourègle des 5 mm • fixation du bloc avec 2 vis Greffeosseuse en bloc -2-prélèvementsymphysaire04-05-11

  37. 1-Extraction 2-Greffe osseuse en bloc (prélèvementramique) 3-Pose d’implant: Branemark 4-Echec: 3.1.greffe régénérationosseuse guidée (ROG) 3.2.implant (cause infectieuse) 5-Greffe osseusse en bloc (prélèvementsymphysaire) 6-Pose d’implant: Bone Level + greffeconjonctifenfoui (2 temps chirurgicaux) 7-Traction orthodontiquelente(site 12)

  38. Pose d’implant et greffeconjonctifenfoui en deux temps chirurgicaux23-02-12 et 23-05-12

  39. Implant Bone Level (ITI) (4.1 х 12 mm)

  40. 16-02-12 23-02-12(9 mois post onlay graft-2) (1e tps.chir.)

  41. Amoxicilline® (500 mg) • Ponstan forte® • Paro-ex® Suivi post opératoire après pose d’implant Bone Level

  42. littérature

  43. 75 patients experienced the failure of 96 implants. Of those, 31 implants in 28 patients were replaced by a similar implant placed in the same location. Follow-up ranged from 6 to 46 month • 9 of the replacement implants failed, resulting in an overall survival rate of 71% • replacement of maxillary and mandibular failed implants was similar • on average, implant replacement occurred 5.8 months after original implant removal • 3 implants were placed immediately after implant removal • a third attempt for single implant replacement was made in two patients. However, one failed. Yoav Grossmann, Liran Levin. Success and Survival of Single Dental Implants Placed in Sites of Previously Failed Implants. J Periodontol 2007;78:1670-1674.

  44. Conclusion: • replacement of a failed implant presents a challenge to achieve osseointegration in a healed bone site and may result in a decline in the survival rates • patients and clinicians should be aware of these results before a replacement attempt is considered • the success of replacement may be increased by the use of wider implants or with improved surfaces. Yoav Grossmann, Liran Levin. Success and Survival of Single Dental Implants Placed in Sites of Previously Failed Implants. J Periodontol 2007;78:1670-1674.

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