Les « aligneurs » INVISALIGN® : études des pratiques professionnelles dans la région PACA
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(9) )"!"0* 1&:/"0G I. INVISALIGN® ....................................................................................................................8 1) Introduction : .................................................................................................................8 2) Historique : ..................................................................................................................10 3) Description et indications ............................................................................................10 4) Fonctionnement ...........................................................................................................12 5) Limitations du système ................................................................................................16 6) Les « arguments » Invisalign® ....................................................................................17 a. Traitement esthétique : .............................................................................................17 b. Traitement amovible : ..............................................................................................17 c. Traitement confortable : ...........................................................................................18 d. Résultats prévisibles: ................................................................................................18 II. INVISALIGN® et les données acquise de la science : ..................................................19 1) Introduction .................................................................................................................19 2) Efficacité ......................................................................................................................21 3) Matériels et méthodes ..................................................................................................22 4) Résultats.......................................................................................................................24 a. La biomécanique ......................................................................................................34 b. Age ...........................................................................................................................35 c. Durée du traitement ..................................................................................................35 Selon une étude de Boilen et al en 2006, l’activation de gouttières s 2 semaines .................36 d. Douleur .....................................................................................................................37 e. La Prise analgésique .................................................................................................38 f. État parodontal .............................................................................................................38 Alignement et nivellement .......................................................................................40 g. h. Expansion .................................................................................................................40 i. Ingression.....................................................................................................................41 j. Egression .....................................................................................................................42 k. Tipping .....................................................................................................................43 l. Torque..........................................................................................................................44 m. Rotation ....................................................................................................................45 n. La Distalisation molaire ...........................................................................................46 o. Invisalign® et finition ..............................................................................................48 p. Invisalign® et Resorption radiculaire ......................................................................49 q. Invisalign® et extraction ..........................................................................................49 r. Stabilité et récidive ......................................................................................................50 s. Chirurgie orthognatique et Invisalign® .......................................................................51 5) Conclusion ...................................................................................................................63 III. Etude sur la pratique d’INVISALIGN® dans la région PACA :....................................64 1) Materiel et méthodes : .................................................................................................64 a. Population : ..............................................................................................................64 b. Echantillon ...............................................................................................................64 c. Méthodologie ...........................................................................................................64 d. Questionnaire ...........................................................................................................65 e. Envoie et relance du questionnaire...........................................................................65 f. Formule de calcul de la taille de l'échantillon .............................................................66 2) Résultats : ....................................................................................................................67 a. Réponses aux questionnaires :..................................................................................67 b. Statistiques descriptives : .........................................................................................67. ,$-0+ 2'-,1%=,=0 *#1V ...............................................................................................67 . 6.
(10) #6#"#11-,"=1V ...........................................................................................................67 %#"#1-,"=1V ..............................................................................................................67 !3*2="\- 2#,2'-,"3"'.*B+#V .................................................................................68 "=. 02#+#,2"\ !2'4'2= ..................................................................................................68 203!230# !23#**#"\#6#0!'!#V ......................................................................................69 +,'.0 2'!'#,-31.=!' *'12##,-02&-"-,2'#V ...........................................................69 6.=0'#,!##,-02&-"-,2'# ...........................................................................................70 2'*'1 2'-, kV ............................................................................................71 ,,=#"#!#02'$'! 2'-, kV ........................................................................72 -0+ 2'-, k13..*=+#,2 '0#9* !#02'$'! 2'-,V ...................................72 +,'.0 2'!'#,V!-301"\-02&-"-,2'# 320#/3# k .................................73 -30/3-'"#4#,'0.0 2'!'#, kV ...............................................................73 expérience INVISALIGN® : .............................................................................................74 -+ 0#"#! 120 '2="#.3'1!#02'$'! 2'-, ...................................................................74 -+ 0#"#! 120 '2=!#1mn"#0,'#01+-'1V ...............................................................74 .-30!#,2 %#"#! 120 '2=1" ,1*#"=* '1.0= * *#+#,2=2 *'................................75 1,=!#11'2 ,2+-"'$'! 2'-,"#.* ,"#20 '2#+#,2V ................................................75 2#+.1. 11=130*',!&#!)V ..........................................................................................76 2'*'1 2'-,"3120'..',% .................................................................................................76 11-!' 2'-,20 '2#+#,2$'6##2 kV ............................................................77 32'*'1 2'-,"\=* 12'/3#1',2#0 0! "#1V..........................................................................77 20 '2#+#,2"#! 1"\#620 !2'-, .....................................................................................78 $0=/3#,!#"#10#,"#8Y4-31V.........................................................................................78 32'*'1 2'-,"\ k##,V................................................................................79 c. Cas Cliniques : .........................................................................................................80 d. Analyses statistiques uni-variées : tableaux de contingence : ..................................86 Cas traité dans les délais : ..................................................................................................89 cas nécessitant modification du plan de traitement : ..........................................................90 Nombre de temps passé sur Clincheck ...............................................................................91 Utilisation du stripping :.....................................................................................................92 Association de traitements fixes et INVISALIGN®..........................................................92 Traitement des cas d’extraction avec INVISALIGN® / spécialité : ..................................93 Traitement des cas d’extraction avec INVISALIGN® / nombre de cas traité depuis certification : ......................................................................................................................93 Traitement des cas d’extraction avec INVISALIGN® / nombre de cas traité depuis un an : .....................................................................................................................................94 Fréquence des rendez-vous : ..............................................................................................94 e. Test de régression logistique : ..................................................................................95 3) Discussion : ...............................................................................................................103 a. Limitations de l’étude.............................................................................................103 b. Puissance taille et représentativité de l’échantillon................................................104 c. Profil type des praticiens de la région PACA et confrontation des résultats avec la littérature : ........................................................................................................................105 d. Expérience des praticiens .......................................................................................106 e. Désir de devenir Invisalign® provider ...................................................................109 f. Comportement thérapeutique ....................................................................................110 g. 3. Etude de cas :......................................................................................................112 IV. Conclusion ....................................................................................................................117 V. BIBLIOGRAPHIES......................................................................................................119 VI. Table des figures ...........................................................................................................125 VII. Annexe :........................................................................................................................... . 7.
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(45) 30*#1osul 02'!*#1. 11=1#,0#43#Tno-,2=2=!&-'1'1.-30*i',!*31'-," ,1,-20#0#43# 1712=+ 2'/3#W -301 2'1$ '0#,-20#!30'-1'2=1!'#,2'$'/3#T,-31 4-,12#,2="#4-'0* 0=. 02'2'-,"#!#1 02'!*#1#,$-,!2'-,"#1 ,,=#1"#.3 *'! 2'-,1W #0=13*2 2- 2#,3##12.0=1#,2=" ,1*#2 *# 313'4 ,2V ++;"!"/" %"/ %" ,* /" /1& )"01/,23;0 X],3"* /"XVW] omp "-2&0XVW\ rlq "-2&0XVWV nnol XVVVIXVWV mlsl 3 +1XVVV pm Figure 10 : tableau recensant les articles bibliographiques par année. '19,-20#130.0'1# 3!3, 02'!*#.-02 ,2130 ,4'1 *'%,k,\ =2=20-34=#,$0 ,; '1W )T;1 -". E20#,2#Y/3 20# 02'!*#1-,2=2=. 11=1#,0#43#.-30* /3 *'2="i=23"##2* !-,!#.2'-,"#*\=23"#W )K 1 -". # ,3#* "# #!-++ ," 2'-,1 "i *','! * nllu 1#0 32'*'1= .-30 =4 *3#0 *#1 #6 +#,1 1712=+ 2'/3#1T *#1 =23"#1 "# !-,20B*# "# ! 1T "# !-&-02# #2 *#1 #,/3>2#1 0 ,"-+'1=1Y!-,20B*=1W #1 02'!*#1"=0'4 ,21"#* 0#!�!&# ,4'1 *'%,k#2 1#=4'"#,!#1-,2.0=1#,2=1" ,1*# 2 *# 313'4 ,2W 1 0"
(46) "64,/!0 ;02)1 10 2 *"!. ,4'1 *'%,k sm /"3&"4! 1 0". ,4'1 *'%,k o , %/ +". ,4'1 *'%,k l &"+ "!&/" 1. ,4'1 *'%,k mqs %,*0"+K0 4" ,#. ,4'1 *'%,k pl 0 &"+ " Figure 11 : tableau des résutats de la recherche d'articles scientifiques. . 25.
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