2018NICED015

Évaluation des dents piliers en prothèse
Cassandre Hanczyk-Panel
To cite this version:

Cassandre Hanczyk-Panel. Évaluation des dents piliers en prothèse. Médecine humaine et pathologie.
2018. �dumas-01880407�
HAL Id: dumas-01880407

https://dumas.ccsd.cnrs.fr/dumas-01880407
Submitted on 24 Sep 2018
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Madame le Professeur L. LUPI-PEGURIER Présidente de jury
Monsieur le Docteur O. LAPLANCHE Directeur de thèse
Monsieur le Docteur Y.ALLARD Assesseur
Monsieur le Docteur T. GEMMI Assesseur
Monsieur le Docteur R. LE ROY Membre invité

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I. INTRODUCTION ................................................................................................................ 8
II. LA DENT « PILIER » ....................................................................................................... 11
II.1. DEFINITION DE LA DENT PILIER ....................................................................................... 13
II.1.1. En Prothèse fixée ................................................................................................. 13
II.1.1.1. Rôle dans le plan prothétique ....................................................................... 13
II.1.1.2. Structures anatomiques concernées ............................................................ 13
II.1.1.2.1. L’émail ................................................................................................... 13
II.1.1.2.2 La dentine ............................................................................................... 15
II.1.1.2.3 Structure dentino-pulpaire ...................................................................... 15
II.1.1.2.4 Parodonte ............................................................................................... 16
II.1.1.2.5 Appareil manducateur ............................................................................ 18
II.1.2 En Prothèse partielle amovible ............................................................................. 19
II.1.2.1 Rôle dans le plan prothétique ........................................................................ 19
II.1.2.2 Structures anatomiques concernées ............................................................. 19
II.1.2.2.1 Le parodonte et la crête alvéolaire : support ostéo muqueux ................. 19
II.1.2.2.2. La dent support de crochet .................................................................... 21
II.2. FORCES APPLIQUEES SUR LA DENT ................................................................................ 23
II.2.1. Sur dent saine autre que pilier prothétique ......................................................... 23
II.2.2. Sur dent saine et selon l’édentement .................................................................. 25
II.2.2.1. En Prothèse fixée ......................................................................................... 25
II.2.2.1.1 .................................................................................................................. 25
Prothèse fixée unitaires .......................................................................................... 25
II.2.2.1.2. Prothèse fixée plurale ............................................................................ 28
II.2.2.1.2. Bridges en cantilever ............................................................................. 31
II.2.2.1.4. Bridges collés et bridges collés en cantilever ........................................ 32
d
II.2.2.1.5. La répartition pilier/intermédiaire ........................................................... 34
II.2.2.1.6. Le paradoxe prothétique ........................................................................ 35
II.2.2.2. En Prothèse partielle amovible ..................................................................... 37
II.2.2.2.1. Classification de Kennedy-Applegate ..................................................... 37
II.2.2.2.2. Eléments constitutifs de la prothèse amovible partielle .......................... 39
II.2.2.2.3. Contraintes exercées .............................................................................. 43
II.3. RISQUES ASSOCIES A LA DENT PILIER ............................................................................. 44
II.3.1. Risques de la dent pulpée ................................................................................... 44
II.3.2. Pronostic des dents pulpées/ dépulpées .............................................................. 45
II.3.3. Pronostic des dents coiffées / non coiffées ........................................................ 46
II.3.4. Pronostic selon la quantité de tissu initial ............................................................ 47
II.3.5. Notion de rapport couronne / racine (C/R) .......................................................... 48
II.4. RESTAURATION CORONO-RADICULAIRE .......................................................................... 49
III. CRITERES DIAGNOSTIQUES DE LA DENT PILIER ..................................................... 54
III.1. NOTIONS DE VALEURS INTRINSEQUES ............................................................................ 54
III.1.1. Historique de la dent ........................................................................................... 56
III.1.2. Etat biologique ..................................................................................................... 56
III.1.3. Etat parodontal .................................................................................................... 60
III.1.4. Etat dentaire structurel ........................................................................................ 63
III.1.5. Morphologie coronaire ......................................................................................... 63
III.1.6. Hauteur coronaire utile ........................................................................................ 63
III.1.7. Résistance des parois coronaires ....................................................................... 64
III.1.8. Effet de férule ...................................................................................................... 65
III.1.9. Rapport Couronne / Racine ................................................................................. 66
III.1.10. Morphologie radiculaire ..................................................................................... 66
III.1.11. Résistance radiculaire haute ............................................................................. 66
III.1.12. Résistance radiculaire basse ............................................................................ 67
e
III.2. NOTION DE VALEUR EXTRINSEQUE ................................................................................ 68
III.2.1. Etat médical ........................................................................................................ 69
III.2.2 . Hygiène bucco-dentaire.................................................................................. 69
III.2.3. Edentement ........................................................................................................ 69
III.2.4. Occlusion ............................................................................................................ 69
III.2.5. Prothèses existantes .......................................................................................... 70
III.2.6. Besoins prothétiques .......................................................................................... 70
IV. CONCLUSION ................................................................................................................. 71
V. TABLE DES ILLUSTRATIONS ....................................................................................... 72
VI. BIBLIOGRAPHIE ............................................................................................................. 73

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Dent Traitée ou à traiter Traitement Endodontique Dent Traitée Parodontite

Etat Biologique Dent Saine Pulpée Apicale Aigüe Sans
endodontiquement ancien nécessitant un
Traitement valide RTE difficile et aléatoire Traitement possible
Dent Intacte Perte de substance Perte de substance Perte de substance

Etat structurel mineure coronaire majeure
Contexte de parodontite
Parodonte Parodonte Sain Parodonte Atteint généralisée , support Parodontite Terminale
pouvant être stabilisé
réduit
Edentement Partiel Edentement Partiel

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Mineur et favorable Parafonction Mineure
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Malpositions: Orthodontie
Coloration: Eclaircissement
Micro-abrasion
Lésion carieuse
débutante: Méga- abrasion
Lésion carieuse: Stratification
Malposition, perte de
substance, esthétique: Facettes
Perte de substance: Technique directe
Perte de substance
importante, Inlay Onlay
Malocclusion: Overlay Table top
Perte de substance
importante,Remplacement
de dent absente: Couronne Bridge
Remplacement de
dent absente: Implant

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Limites
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RCR
Foulée
Restauration
partielle étanchéité
per
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Effet de ferrule Limite juxta-

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Pronostic Pronostic favorable Pronostic modéré Pronostic

défavorable
Effet de sertissage Hauteur ≥ 2mm Hauteur ≥0,5 à 2mm Hauteur <0,5mm
(férule effect) Largeur ≥2,2mm Largeur 1,6 à 2,2mm Largeur <1,2mm
(esthétique) (marges visibles)
≥1,6mm (non 1,2 à 1,6mm (marges
esthétique) non visibles)
Longueur ≥ hauteur de la <hauteur de la <hauteur de la
radiculaire couronne + 5mm couronne + 5mm couronne + 3mm
≥ hauteur de la
couronne + 3mm
Etat endodontique Sans complications Sans complications Complications
prévisibles prévisibles ou irréversibles
résultats du
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Traitement
endodontique possible Pilier de prothèse fixée
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effet de ferrule)
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Pathologie carieuse, Retraitement

infectieuse, trauma endodontique
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pathologie persistante
Traitement endodontique à
travers la restauration La prothèse fixée reste
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Dent stratégique pour

la prothèse
Traitement prothétique
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Traitement guerison
endodontique
classique infaisable
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fe

Serment d’Hippocrate

En présence des Maîtres de cette Faculté, de mes chers
condisciples, devant l’effigie d’Hippocrate,
Je promets et je jure, au nom de l’Etre Suprême, d’être

fidèle aux lois
de l’Honneur et de la probité dans l’exercice de La
Médecine Dentaire.
Je donnerai mes soins gratuits à l’indigent et n’exigerai

jamais un salaire au-dessus de mon travail, je ne
participerai à aucun partage clandestin d’honoraires.
Admis dans l’intérieur des maisons, mes yeux ne verront

pas ce qui se passe, ma langue taira les secrets qui me
seront confiés et mon état ne servira pas à corrompre les
mœurs ni à favoriser le crime.
Je ne permettrai pas que des considérations de religion,

de nation, de race, de parti ou de classe sociale viennent
s’interposer entre mon Devoir et mon patient.
Je garderai le respect absolu de la vie humaine dès sa

conception.
Même sous la menace, je n’admettrai pas de faire usage

de mes connaissances médicales contre les lois de
l’Humanité.
Respectueux et reconnaissant envers les Maîtres, je

rendrai à leurs enfants l’instruction que j’ai reçue de
leurs pères.
Que les hommes m’accordent leur estime si je suis fidèle

à mes promesses,
Que je sois couvert d’opprobre et méprisé de mes

confrères si j’y manque.
ff

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fh

2018NICED015

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2018NICED015

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Évaluation des dents piliers en prothèse

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HAL Id: dumas-01880407

HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est

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II. LA DENT « PILIER » ....................................................................................................... 11

II.1. DEFINITION DE LA DENT PILIER ....................................................................................... 13

II.1.1. En Prothèse fixée ................................................................................................. 13

II.1.1.1. Rôle dans le plan prothétique ....................................................................... 13

II.1.1.2. Structures anatomiques concernées ............................................................ 13

II.1.1.2.1. L’émail ................................................................................................... 13

II.1.1.2.2 La dentine ............................................................................................... 15

II.1.1.2.3 Structure dentino-pulpaire ...................................................................... 15

II.1.1.2.4 Parodonte ............................................................................................... 16

II.1.1.2.5 Appareil manducateur ............................................................................ 18

II.1.2 En Prothèse partielle amovible ............................................................................. 19

II.1.2.1 Rôle dans le plan prothétique ........................................................................ 19

II.1.2.2 Structures anatomiques concernées ............................................................. 19

II.1.2.2.1 Le parodonte et la crête alvéolaire : support ostéo muqueux ................. 19

II.1.2.2.2. La dent support de crochet .................................................................... 21

II.2. FORCES APPLIQUEES SUR LA DENT ................................................................................ 23

II.2.2. Sur dent saine et selon l’édentement .................................................................. 25

II.2.2.1. En Prothèse fixée ......................................................................................... 25

II.2.2.1.1 .................................................................................................................. 25

Prothèse fixée unitaires .......................................................................................... 25

II.2.2.1.2. Prothèse fixée plurale ............................................................................ 28

II.2.2.1.2. Bridges en cantilever ............................................................................. 31

II.2.2.1.4. Bridges collés et bridges collés en cantilever ........................................ 32

II.2.2.1.6. Le paradoxe prothétique ........................................................................ 35

II.2.2.2. En Prothèse partielle amovible ..................................................................... 37

II.2.2.2.1. Classification de Kennedy-Applegate ..................................................... 37

II.2.2.2.2. Eléments constitutifs de la prothèse amovible partielle .......................... 39

II.2.2.2.3. Contraintes exercées .............................................................................. 43

II.3. RISQUES ASSOCIES A LA DENT PILIER ............................................................................. 44

II.3.1. Risques de la dent pulpée ................................................................................... 44

II.3.2. Pronostic des dents pulpées/ dépulpées .............................................................. 45

II.3.3. Pronostic des dents coiffées / non coiffées ........................................................ 46

II.3.4. Pronostic selon la quantité de tissu initial ............................................................ 47

II.3.5. Notion de rapport couronne / racine (C/R) .......................................................... 48

II.4. RESTAURATION CORONO-RADICULAIRE .......................................................................... 49

III. CRITERES DIAGNOSTIQUES DE LA DENT PILIER ..................................................... 54

III.1. NOTIONS DE VALEURS INTRINSEQUES ............................................................................ 54

III.1.1. Historique de la dent ........................................................................................... 56

III.1.2. Etat biologique ..................................................................................................... 56

III.1.3. Etat parodontal .................................................................................................... 60

III.1.4. Etat dentaire structurel ........................................................................................ 63

III.1.5. Morphologie coronaire ......................................................................................... 63

III.1.6. Hauteur coronaire utile ........................................................................................ 63

III.1.7. Résistance des parois coronaires ....................................................................... 64

III.1.8. Effet de férule ...................................................................................................... 65

III.1.9. Rapport Couronne / Racine ................................................................................. 66

III.1.10. Morphologie radiculaire ..................................................................................... 66

III.1.11. Résistance radiculaire haute ............................................................................. 66

III.1.12. Résistance radiculaire basse ............................................................................ 67

III.2.1. Etat médical ........................................................................................................ 69

III.2.2 . Hygiène bucco-dentaire.................................................................................. 69

III.2.3. Edentement ........................................................................................................ 69

III.2.4. Occlusion ............................................................................................................ 69

III.2.5. Prothèses existantes .......................................................................................... 70

III.2.6. Besoins prothétiques .......................................................................................... 70

IV. CONCLUSION ................................................................................................................. 71

V. TABLE DES ILLUSTRATIONS ....................................................................................... 72

VI. BIBLIOGRAPHIE ............................................................................................................. 73

Dent Traitée ou à traiter Traitement Endodontique Dent Traitée Parodontite

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