Gestion des déficits osseux verticaux : apport de la distraction osseuse alvéolaire par rapport aux techniques conventionnelles

Abstract

Résumé -L'aménagement des tissus péri-implantaires garantit la pérennité d'une réhabilitation prothétique et implantaire. Différentes techniques d'aménagement des tissus durs s'offrent aux praticiens comme par exemple la régénération osseuse guidée et la greffe osseuse d'apposition. Cependant, ces techniques présentent des limites pour la reconstruction des défauts verticaux. La distraction osseuse alvéolaire trouve un intérêt dans la réhabilitation de ces défauts osseux verticaux et elle apparaît alors comme une bonne alternative. La distraction osseuse alvéolaire consiste en l'élévation localisée du rebord alvéolaire par déplacement contrôlé d'un segment d'os alvéolaire. L'objectif premier est la réparation structurale de la crête alvéolaire. Le principal avantage est la simultanéité de l'augmentation du volume des tissus mous et osseux. Ce travail illustre les indications, techniques de mise en oeuvre et protocoles de la distraction osseuse alvéolaire au travers de différentes situations cliniques. La piézochirurgie et la miniaturisation des distracteurs devraient faciliter l'expansion de cette technique.Abstract -Management of vertical bone defects: contribution of alveolar bone distraction compared to conventional techniques. The management of peri-implant tissues is necessary the first step for good conditions for development of endosseous implants. There are differents management techniques. Some are known and practiced by all because they proved their efficiency: guided bone regeneration, and bone grafting. If these techniques are responsible for satisfactory results, they also have their limits. Based on this observation, this work proposes to address an alternative technique: the alveolar bone distraction. The alveolar bone distraction consists in the elevation of localized alveolar ridge by controlled movement of a segment of alveolar bone. This segment is gradually mobilized by a distractor. This technique requires several steps: the surgical placement of the device, its activation, a time-out period and then removing the distractor. The primary objective of this technique is the structural repair of the alveolar ridge. The main sought-after advantage is the simultaneous increase in the volume of soft tissue and bone. This work aims to show the various indications of alveolar bone distraction in the development of peri-implant environment. Two clinical cases which have benefited from this technique are presented: one case of recovery after traumatic bone loss of the four incisors. Then, a case of bone restoration with post-traumatic intrusion of adjacent teeth. Those two cases are used to identify the advantages and disadvantages of this kind of technique. However, it is a costly surgical procedure, because of distractor's cost. In addition, the implementation of this intervention requires significant learning. Despite the fact that the alveolar bone distraction is a major surgery, she found a real interest in the rehabilitation of vertical bone defects. It is therefore a credible alternative to othe...