Le contrôle de la position de l’incisive mandibulaire dans

les traitements orthodontiques des classes II par

tractions intermaxillaires
Meryl Hayat

To cite this version:

Meryl Hayat. Le contrôle de la position de l’incisive mandibulaire dans les traitements orthodon-
tiques des classes II par tractions intermaxillaires. Médecine humaine et pathologie. 2016. <dumas-
01470983>

HAL Id: dumas-01470983

https://dumas.ccsd.cnrs.fr/dumas-01470983
Submitted on 18 Feb 2017

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 UNIVERSITE DE NICE-SOPHIA ANTIPOLIS
FACULTE DE CHIRURGIE DENTAIRE
24 Avenue des Diables Bleus, 06357 Nice Cedex 04


 







V





 






 


 










Année 2016 Thèse n° 4257-1631

 

Présentée et publiquement soutenue devant

la Faculté de Chirurgie Dentaire de Nice
Le 02 novembre 2016
Par

!$!-%
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Née le 22 septembre 1989 à Cannes
Pour obtenir le grade de :

DOCTEUR EN CHIRURGIE DENTAIRE

(Diplôme d’État)

Examinateurs

Madame le Professeur Armelle Manière-Ezvan Présidente du jury

Madame le Professeur Laurence Lupi-Pégurier Assesseur
Monsieur le Docteur Charles Savoldelli Assesseur
Monsieur le Docteur Floriant Busson Directeur de thèse
Monsieur le Docteur Philippe Orosco Membre invité

e


f

 REMERCIEMENTS

A Madame le Professeur Armelle MANIERE-EZVAN

Docteur en chirurgie dentaire Spécialiste qualifiée en ODF
Docteur de l’Université de Nice Sophia-Antipolis
Professeur des Universités, Praticien hospitalier
Responsable de la sous-section Orthopédie Dento-Faciale
Doyenne de la faculté d’odontologie de Nice

Pour m’avoir fait l’honneur d’accepter la présidence du jury de ce travail. Je

vous prie de recevoir mes sincères remerciements et l’expression de mon plus
profond respect pour l’intérêt que vous portez à ce travail.

Vous m’avez prodigué tout au long de mon internat, votre science et votre
savoir. J’ai la chance d’être à vos côtés depuis deux ans et je ne cesse
d’apprendre et de progresser grâce à votre disponibilité, votre enseignement,
vos précieux conseils et votre dynamisme.

Vos qualités professionnelles et votre rigueur sont pour moi des exemples à
suivre. Veuillez trouver par ce travail l’expression de ma gratitude la plus
sincère et de ma plus haute considération.

A Monsieur le Docteur Floriant BUSSON

Docteur en chirurgie dentaire Spécialiste qualifié en orthodontie
Assistant Hospitalier Universitaire
Sous-section Orthopédie Dento-Faciale

Pour m’avoir fait l’honneur d’accepter de faire partie de ce jury.

Pour les précieux conseils que vous m’avez prodigués durant mon internat.
Pour vos qualités humaines, votre patience et votre gentillesse.
Pour votre grande implication dans ce travail.

Veuillez recevoir par ce travail l’expression de ma gratitude et de ma sincère

estime.

g

 A Madame le Professeur Laurence LUPI-PEGURIER
Docteur en chirurgie dentaire
Docteur de l’Université de Nice Sophia-Antipolis
Professeur des Universités, Praticien hospitalier
Responsable de la sous-section Prévention, Epidémiologie, Economie de
la santé, Odontologie légale.

Je vous remercie d’avoir accepté avec grand enthousiasme de siéger dans ce

jury. Merci de m’avoir soutenue et encouragée tout au long de mon cursus.
Votre gentillesse et votre bonne humeur communicative ont illuminé nos études
au quotidien et notamment nos cours de santé publique/ LCA.

Soyez assuré de ma plus profonde gratitude.

A Monsieur le Docteur Charles SAVOLDELLI

Docteur en Médecine
Chirurgien maxillo-facial
Assistant Hospitalier Universitaire

Je vous suis très reconnaissante d’avoir accepté sans hésitation de faire partie
de ce jury et j’en suis honorée. Vos compétences en chirurgie maxillo-faciale
ont rendu notre formation plus exhaustive et nous ont ouvert les voies d’un
travail d’équipe plaisant et formateur.
Merci également pour votre dévotion et votre gentillesse.

Je vous adresse ma profonde reconnaissance ainsi que toute mon estime.

A Monsieur le Docteur Philippe OROSCO

Docteur en chirurgie dentaire Spécialiste qualifié en orthodontie

Vous avez accepté avec enthousiasme de rejoindre ce jury de thèse. Votre

pédagogie, votre expérience, votre gentillesse et votre disponibilité, dont vous
avez toujours fait preuve tous les jeudis, contribuent sans cesse au progrès des
étudiants. Je vous remercie également de m’avoir offert cette première
expérience professionnelle en cabinet d’orthodontie.

Soyez assuré de ma reconnaissance et de mon profond respect.

h

 




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Au niveau des deuxièmes molaires

mandibulaires
ème
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partir de la jambe distale de l’oméga  version
corono-distale de ces molaires et formation d’un
diastème entre première et deuxième molaire.


Au niveau des premières molaires
mandibulaires
Tip back (de 5° à 10°) et marche de compensation
verticale en avant de l’oméga pour contrôler la
passivité de l’arc au niveau des deuxièmes
molaires.

Au niveau des prémolaires mandibulaires

Un tip back (de 0° à 5°) et marche de
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La position de l’incisive mandibulaire est considérée par la plupart des auteurs comme un
critère décisif du plan de traitement et un objectif de finition garant de la stabilité occlusale.
Son positionnement idéal a notamment été décrit au travers d’analyses céphalométriques se
basant sur des repères crâniens, dentaires ou encore cutanés.

Cependant, la mise en place d’une mécanique de classe II par tractions intermaxillaires, sans
précaution, entraîne théoriquement un déplacement de l’incisive mandibulaire de par la
composante mésialante de la force qu’ils exercent.

Différentes techniques orthodontiques ont donc été développées pour contrôler les effets des
TIM dont la vestibulo-version excessive de l’incisive mandibulaire. Deux grandes écoles se
distinguent : la « préparation d’ancrage » décrite par TWEED-MERRIFIELD et la
« technique Bioprogressive » de RICKETTS. Tandis que la première préconise une
préparation standardisée de la denture pour tous les patients, la seconde présente une vision
plus individualisée tenant compte de facteurs environnementaux tels que l’équilibre neuro-
musculaire.

Récemment, l’essor de l’ancrage squelettique temporaire offre l’unique possibilité d’obtenir

un contrôle absolu de l’incisive mandibulaire. Toutefois, la part d’échecs n’est pas
négligeable.

La technique de contrôle de la position de l’incisive mandibulaire dépend donc de critères liés

au praticien (formation initiale, utilisation de minivis), au patient (âge, coopération) et de
critères locaux (possibilité de vestibuler l’incisive mandibulaire).

edi