Le contrôle de la position de l’incisive mandibulaire dans les traitements orthodontiques des classes II par tractions intermaxillaires

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(1)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 orthodontiques 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. HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers.. L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignement et de recherche français ou étrangers, des laboratoires publics ou privés..

(2) 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. !$!-%%29, Née le 22 septembre 1989 à Cannes Pour obtenir le grade de :. DOCTEUR EN CHIRURGIE DENTAIRE (Diplôme d’État). Examinateurs Madame le Professeur Madame le Professeur Monsieur le Docteur Monsieur le Docteur Monsieur le Docteur. . Armelle Manière-Ezvan Laurence Lupi-Pégurier Charles Savoldelli Floriant Busson Philippe Orosco. Présidente du jury Assesseur Assesseur Directeur de thèse Membre invité. e.

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(4) 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.

(5) 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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(36) C. Indications et contre-indications du traitement orthodontique de classe II par tractions intermaxillaires sans extraction C. 1. Indications $ 31 (3$,$-3 .13'.#.-3(04$ #$ + "+ 22$. #$-3 (1$ / 1 ,?" -(04$ #$ "+ 22$. 2.42 %.1,$#V?+ 23(04$2(-3$1, 7(++ (1$2[2 -2$731 "3(.-#$/1?,.+ (1$2[2V #1$22$ 47" 2 /.45 -3@31$31 (3?2/ 12(,/+$".,/$-2 3(.- +5?.+.T#$-3 (1$+.1204$R - $2 1" #$22.-31?&4+(>1$2.4/1?2$-3$-3#$2#( 23>,$2Q - V 1" #$, -#(!4+ (1$-$-?"$22(3$/ 2#$".11$"3(.- -3?1($41$(,/.13 -3$\j]Q - V$-".,!1$,$-3$23% (!+$.4-4+Q - ".41!$#$/$$$23% (!+$.4,.#?1?$Q - $2(-"(2(5$2, -#(!4+ (1$2-$-?"$22(3$-3/ 2#$1$/.2(3(.--$,$-3+(-&4 +Q - $2 , +/.2(3(.-2 /$45$-3 @31$ ".11(&?$2 / 1 $7/ -2(.- 31 -25$12 +$ $3Y.4 2 &(33 +$Q - V$23'?3(04$ % "( +$ $23 ' 1,.-($42$P 5$" 4- /1.%(+ 2.42T- 2 + : ".-5$7(3? ,.#?1?$P$-/ 13("4+($1"'$9+$2!1 "'8% "( 47\h]S C.2. Contre-indications $/$-# -3P# -24-"$13 (--.,!1$#$" 2P+ ".11$"3(.-#4#?" + &$2 &(33 +#$2 1" #$2 #$-3 (1$2 -$ /.411 @31$ 4-(04$,$-3 .!3$-4$ / 1 #$2 31 "3(.-2 ?+ 23(04$2 \2 -2 $731 "3(.-]S C.2.1. Les cas nécessitant des extractions - V$-".,!1$,$-3 , -#(!4+ (1$ $23 (,/.13 -3 5$" 4-$ #82' 1,.-($ #$-3.T , 7(++ (1$\tm,,].44-$#82' 1,.-($#$-3.T#$-3 (1$Q - -$ ".41!$ #$ /$$ $7"$22(5$,$-3 , 104?$ #.-3 +$ -(5$++$,$-3 -$ /$43 2V$%%$"34$1# -2+$2+(,(3$2/'82(.+.&(04$2#$+ #$-341$Q - -$ 5$12(.- ".1.-.T5$23(!4+ (1$ $7"$22(5$ #$ +V(-"(2(5$ , -#(!4+ (1$ ".,/1.,$33 -32.-".-3$73$/ 1.#.-3 +Q - - #?" + &$ ".-2?04$-3 2 -2 "1.(22 -"$ 1?2(#4$++$P .F #$2 $731 "3(.-2 #$ /1$,(>1$2 /1?,.+ (1$2 , 7(++ (1$2 2.-3 /1?%?1 !+$2 \ !2$-"$ #$ 1(204$ $23'?3(04$, )$41]/.414-$%(-(3(.-$-"+ 22$. #(3$3'?1 /$43(04$S. . ee.

(37) C.2.2. Les cas orthopédiques -#?" + &$#$"+ 22$. 204$+$33(04$".-"$1- -34-/ 3($-3$-".412#$"1.(22 -"$S C.2.3. Les cas chirurgicaux - -#?" + &$204$+$33(04$#$"+ 22$. (,/.22(!+$:".,/$-2$1 4-(5$ 4 +5?.+.T #$-3 (1$# -2+$1$2/$"3#4/ 1.#.-3$$3#$+V?04(+(!1$%.-"3(.--$+P "".,/ &-? .4 -.- #$ #82,.1/'.2$2 5$13(" +$2 .4 28,?31($2 +.41#(22 -3 +$ /1?)4#("$ $23'?3(04$$3".,/+(04 -3+$2".,/$-2 3(.-2 +5?.+.T#$-3 (1$2S - - /1.%(+ : 1(204$ 04( 2$1 (3 /.3$-3($++$,$-3 &&1 5? $- " 2 #$ 1$"4+ (-"(2(5.T " -(-$-, 22$/.41".11(&$1+$241/+.,!Q - -$"+ 22$. 22."(?$:4- 2?5>1$-?"$22(3 -34-31 (3$,$-3/ 1"'(141&($ #V 5 -"$,$-3, -#(!4+ (1$S. . ef.

(38) . !#/22%#4)/.$%,!#,!33%. 0!242!#4)/.3 ).4%2-!8),,!)2%3 0# $#*!%#$#!%#0 . eg.

(39) J !#/22%#4)/.$%,!#,!33%. 0!242!#4)/.3).4%2-!8),,!)2%3R S

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(45) . I.1. Présentation des tractions intermaxillaires de classe II $2 31 "3(.-2 (-3$1, 7(++ (1$2 #$ "+ 22$. 2.-3 #$2 ?+ 23(04$2 /+ "?2 -3?1($41$,$-3 : +V 1" #$, 7(++ (1$$3/.23?1($41$,$-3:+V 1" #$, -#(!4+ (1$\k]\(&41$j]S. )'52%[J2!#4)/.).4%2-!8),,!)2%$%#,!33%. R0/3)4)/..%-%.4,%0,53#/52!.4S. $2 ?+ 23(04$2 2.-3 ,(2 $3 $-+$5?2 / 1 +$ / 3($-3S +2 2.-3 1$-.45$+?2 /+42($412 %.(2 / 1 ).41$-%.-"3(.-#$+ /1$2"1(/3(.-\/.13#(41-$P-."341-$.4".,!(-?]S ".,/.2(3(.-?+ 23(04$#$"$231 "3(.-2(-3$1, 7(++ (1$2$-31 (-$4-$#?3?1(.1 3(.-$3 4-$/$13$#$+ ,?,.(1$?+ 23(04$" 42?$2/ 1+$/ $3+V$-5(1.--$,$-3!4"" +\+ 2 +(5$P + -.411(341$P+$2!.(22.-2$3+ /+ 04$#$-3 (1$]S /1>2 f' $- !.4"'$P +$ ,.#4+$ #$ %.1"$ ?+ 23(04$ #?"1.(3 #$ gdp $3 #$ /+42 #$ hdp /1>2g'S$/+42P 5$"+$3$,/2P(+22$&.-%+$-3$3#$5($--$-3.#.1(%>1$2\l]S . . eh.

(46) $2 ?+ 23(04$2 #.(5$-3 #.-" @31$ "' -&?2 1?&4+(>1$,$-3 /.41 , (-3$-(1 4-$ 31 "3(.- ".-23 -3$S $41 " 1 "3>1$ ,.5(!+$(,/+(04$ 4-$ ".,/+( -"$ $3 4-$ "../?1 3(.- (,/.13 -3$2 #4 / 3($-3S ( + /1$2"1(/3(.-P -.3 ,,$-3 +$41 /.2(3(.--$,$-3P -V$23 / 2 1$2/$"3?$P #$2 %.1"$2(,/1?54$2$3(-#?2(1 !+$2/$45$-3@31$$7$1"?$2S . + % 43 2.4+(&-$1 04$ +$2 ,.45$,$-32 , -#(!4+ (1$2 $7"412(%2 4&,$-3$-3 +$412 ?3(1$,$-32 $3 #.-" + %.1"$ #?+(51?$ \, 23(" 3(.-P /'.- 3(.-]S -2 "$2 ,.,$-32 #$ #8- ,(04$ , -#(!4+ (1$P +$2 %.1"$2 $7$1"?$2 2.-3 (-".-23 -3$2P 5$" 4-$ ".,/.2 -3$ 5$13(" +$, ).1?$P1(204 -3#V 4&,$-3$1+$2$%%$32/ 1 2(3$2(-#?2(1 !+$2S $ -.,!1$47 43$412 .-3 3$-3? #$ #?%(-(1 + %.1"$ ./3(, +$ /.41 +$ #?/+ "$,$-3 #$-3 (1$P %(-04$"$#$1-($12.(3+$/+421 /(#$/.22(!+$2 -2@31$( 31.&>-$S - emifP $3 ?5.04$-3 #$2 %.1"$2 #$ +V.1#1$ #$ eidTfdd& +.12 #V?34#$ 241+$1$"4+" -(-\m]S +42 1?"$,,$-3P #$2 ?34#$2 /.13 -3 2/?"(%(04$,$-3 241 +$2 #$ "+ 22$. ?5.04$-3 4-$%.1"$,.8$--$#$kgPk&\ed[eh]S ?-?1 +$,$-3P (+ $23 #,(2 04$ + %.1"$ /1$2"1(3$ \ --.-"?$ / 1 +$ % !1(04 -3] $23 .!3$-4$+.1204$+V?+ 23(04$$23?3(1?#$g%.(22.-#( ,>31$\k]S ).43.-2$-%(-04$+$/.13/1.+.-&?#V?+ 23(04$2#$"+ 22$. /$43@31$:+V.1(&(-$#V4-$ .""+42(.-#$".-5$- -"$\#4 +!(3$.4#.4!+$ ]R+$/ 3($-32(,4+$4-$".11$"3(.-#$ + , +.""+42(.-:+ %$1,$341$!4"" +$S . I.2. Les effets des TIM de classe II V.!)$"3(% #$ "$ #(2/.2(3(% $23 + ".11$"3(.- .13'.#.-3(04$ #$ + "+ 22$. / 1 ".,/$-2 3(.- #$-3.T +5?.+ (1$S + $23 ?3 !+( # -2 + +(33?1 341$ 04$ !($- 04$ +$2 ?+ 23(04$2 (-3$1, 7(++ (1$2 #$ "+ 22$. 2.($-3 $%%(" "$2 /.41 + ".11$"3(.- #$2 1$+ 3(.-2 -3?1.T/.23?1($41$2 #$ + #$-341$P (+2 2V "".,/ &-$-3 #V 431$2 $%%$32P 2.45$-3 (-#?2(1 !+$2S . . ei.

(47) I.2.1. Effets des TIM de classe II sur les arcades dentaires. )'52%\J&&%43$%3 $%#,!33%. 352,%3!2#!$%3$%.4!)2%3. $2$%%$32#$2 #$"+ 22$. \(&41$k]2.-3/1(-"(/ +$,$-3#$-3.T +5?.+ (1$2\jPei]R 4-W$%%$33(1.(1X241+$2 1" #$2P:2 5.(14-1$"4+$-, 22$#$+a 1" #$, 7(++ (1$$34- ,.45$,$-3 ,?2( + #$ +a 1" #$ , -#(!4+ (1$P 2$+.- +$ /1(-"(/$ #$ +V -"1 &$ #(%%?1$-3($+ \ ]R - 4-$?&1$22(.-P4-1$"4+$34-$/ + 3.5$12(.-#$2(-"(2(5$2, 7(++ (1$204(/$45$-3 &&1 5$14-2.41(1$&(-&(5 +Q - 4-$5$23(!4+.5$12(.-#$2(-"(2(5$2, -#(!4+ (1$2Q - 4-$ ?&1$22(.-P 4-$ 5$12(.- ".1.-.,?2( +$ $3 4-$ ,?2(.1.3 3(.- #$ + #$-3 , -#(!4+ (1$24//.13 -3+$231 "3(.-2S $+.- +V(-3$-2(3? $3 + +." +(2 3(.- 2.4' (3?$ #$2 ".,/.2 -3$2 5$13(" +$2 #V?&1$22(.-P (+ $23(-3?1$22 -3#$% (1$5 1($1+$2/.(-32#V //+(" 3(.-#$2 R .(-3 #V //+(" 3(.- " -(- , 7(++ (1$ $3 e>1$ ,.+ (1$ : + , -#(!4+$ \e]R + #(231(!43(.- #$2 %.1"$2 4 -(5$ 4 #$ e $23 3$++$ 04$ +$ 5$"3$41 '.1(9.-3 + $23 (,/.13 -3 , (2 04$ +$ 5$"3$41 5$13(" + 1$/1?2$-3$P 4 /.(-3 #V 33 "'$P /+42 #V4- 04 13#$+ %.1"$ //+(04?$\ ]S . . ej.

(48) 1 $7$,/+$ \(&41$ l]P $- .""+42(.-P 2( "$3 ?+ 23(04$ % (3 4- -&+$ #$ fdu 5$" +V 1" ".-3(-4$32(+ %.1"$$7$1"?$$23#$edd&\$-5(1.-e]P+ 31 "3(.-2$#?".,/.2$$-R - -$%.1"$:".,/.2 -3$'.1(9.-3 +$#$edd7".2fdurmgPmd& - -$%.1"$:".,/.2 -3$5$13(" +$#$edd72(-fdurghPfd&. )'52%]J&&%43$%3 $%#,!33%. %./##,53)/.. .(-3 #V //+(" 3(.- " -(- , 7(++ (1$$3 f-#$ ,.+ (1$ : + , -#(!4+$ \f]R $- .""+42(.-P +V -&+$ $-31$ +V?+ 23(04$ $3 +V 1" #(,(-4$P + #(231(!43(.- #$2 %.1"$2 ,.-31$ +.124-$".,/.2 -3$'.1(9.-3 +$/+42(,/.13 -3$$34-$#(,(-43(.-#$ + ".,/.2 -3$ 5$13(" +$ #V$73142(.-S $/$-# -3P $- 1 (2.- #$ + /.2(3(.- 3$1,(- +$ #$ fP $3 #4 /$4 #$ +.-&4$41 #$ %(+ (-".1/.1? # -2 +$ 34!$P +V 1" ".-31E+$1 ,.(-2+$2,.45$,$-32#$,?2(.5$12(.-$3#$1.3 3(.-#$"$33$#$-3S $/+42P+V$%%$3#$! 2"4+$#4/+ -#V.""+42(.-$23 4&,$-3?\"%S"(T /1>2]S .(-3 #V //+(" 3(.- " -(- , 7(++ (1$ $3 f-# /1?,.+ (1$ : + , -#(!4+$R "$2 31 "3(.-2 #$ "+ 22$. #(3$2 W".413$2X (-23 41$-3 4-$ ".,/.2 -3$ 5$13(" +$ /+42 (,/.13 -3$04(".-31(!4$:/ 1% (1$+$2$-25$13(" +# -2"$13 (-$22(34 3(.-2S . I.2.2. Effets des TIM de classe II sur le plan occlusal V /1>2 4-$ ?34#$ ,$-?$ $- fddk / 1 $3 +SP $,/+.8 -3 #$2 ,$241$2 31(#(,$-2(.--$++$2P +$ "$-31$ #$ 1?2(23 -"$ #$2 1" #$2 #$-3 (1$2 ?3? #?3$1,(-? $- 1$& 1# #$ + 2$".-#$ /1?,.+ (1$ 4 , 7(++ (1$ $3 $-31$ + 2$".-#$ /1?,.+ (1$ $3 + /1$,(>1$,.+ (1$:+ , -#(!4+$\ej]\(&41$m]S. . ek.

(49) . )'52%^J/3)4)/.$%3#%.42%3$%2>3)34!.#%$%3!2#!$%3$%.4!)2%3RV[SK. $2 /.(-32 #V -"1 &$ #$2 ?+ 23(04$2 #$ "+ 22$. 2.-3 #.-" #(23 -32 #4 "$-31$ #$ 1?2(23 -"$ #$2 1" #$2S $2 ".,/.2 -3$2 2 &(33 +$2 $3 5$13(" +$2 #$ "$2 31 "3(.-2 $-31 (-$-34-$! 2"4+$#4/+ -#V.""+42(.-$-! 2$3$- 5 -3\ekPel]S $3 $%%$3 $23 ,.(-#1$ 5$" #$2 31 "3(.-2 #$ "+ 22$. ".413$2 #.-3 + +(&-$ #V "3(.- 2$ 1 //1."'$#4"$-31$1?2(23 -"$#$2 1" #$2\(&41$ed]S )'52%VUJ/-0!2!)3/.$%,M%&&%4$%"!3#5,%$50,!.$M/##,53)/.%.42%,%3 $%#,!33%. #/524%3%4,/.'5%3H>45$)>%3%,/.,!$)34!.#%%.42%,!,)'.%$M!#4)/. $%,!&/2#%>,!34)15%%4,%3#%.42%3$%2>3)34!.#%$%3!2#!$%3$%.4!)2%3. . el.

(50) I.2.3. Effets sur le schéma facial $231 "3(.-2(-3$1, 7(++ (1$2#$"+ 22$. 2.-31$2/.-2 !+$2#V4-$1.3 3(.-/.23?1($41$ #$ + , -#(!4+$ 5$" 4&,$-3 3(.- #$ + ' 43$41 % "( +$ -3?1($41$ [ +$2 ".-31$T (-#(04 -3 "'$9 +$2 / 3($-32 '8/$1#(5$1&$-32 \ed] [ (-2( 04$ #V4- ! (22$,$-3 $3 #V4- 1$"4+#4,$-3.-\j]S I.2.4. Effets orthopédiques V$%%$3204$+$33(04$2 &(33 +#$2 -V / 2?3?$-3(>1$,$-3?3 !+(# -2+ +(33?1 341$S -fddkP $3 +S\em]$%%$"34$-34-$".,/ 1 (2.-1?31.2/$"3(5$P:".413$3:+.-& 3$1,$P #$2 ,.#(%(" 3(.-2 204$+$33(04$2 $3 #$-3.T +5?.+ (1$2 /1.5.04?$2 / 1 +$2 #$ "+ 22$. \$-3$"'-(04$2$&,$-3?$#$]$3/ 1+$2!($++$2#$ S ".4133$1,$P+V // 1$(+%.-"3(.--$+$-&$-#1$#$2$%%$32.13'./?#(04$22 &(33 473 -#(2 04$ +$2 #$ "+ 22$. -V$- $-31 (-$-3 / 2 #$ % =.- 2(&-(%(" 3(5$S $/$-# -3P : +.-& 3$1,$P+$2$%%$32#$2#$47#(2/.2(3(%2-$,.-31$-3 4"4-$#(%%?1$-"$2(&-(%(" 3(5$Q+V(224$ #431 (3$,$-3#$+ "+ 22$. 2$,!+$@31$(-#?/$-# -3$#4#(2/.2(3(%,(2$-/+ "$S -fdegP4-$1$54$#$+ +(33?1 341$\ei]?5.04$+V !2$-"$#V$%%$3204$+$33(04$#$2 #$ "+ 22$. / 1 1 //.13 47 // 1$(+2 .13'./?#(04$2S $2 1?24+3 32 2$ )423(%($-3 / 1 + % (!+$22$ #$ + %.1"$ #?+(51?$ / 1 +$2 $3 +$41 /?1(.#$ #$ /.13 31./ ".413$R $- ,.8$--$lPi,.(2P 5$"4-/.131$".,, -#?#$fh'$41$2/ 1).41\eg]S $2,.#(%(" 3(.-2204$+$33(04$22.-3&?-?1 +$,$-3.!3$-4$2 /1>2 //+(" 3(.-#$%.1"$2 +.41#$2#41 -3#$2/?1(.#$2/+42+.-&4$2S .43$%.(2P #$2 ?34#$2 : /+42 ' 43 -(5$ 4 #$ /1$45$ 2.-3 -?"$22 (1$2 %(- #V?3 !+(1 #$2 1$+ 3(.-2/+42/1?"(2$2S I.2.5. Effets sur l’articulation temporo-mandibulaire $2?34#$2$7/?1(,$-3 +$2 -(, +$2.-3,(2$-?5(#$-"$#$2"' -&$,$-32 4-(5$ 4#4 ".-#8+$$3#$+ %.22$&+?-.C#$ 5$"4-31 (3$,$-3/ 1 #$"+ 22$. \fd]S . em.

(51) -fdehP4-$?34#$"'(-.(2$\fe]".,/ 1$+$1$,.#$+ &$".-#8+($-"'$9+$2/ 3($-32 31 (3?2/ 1 #$"+ 22$. $3/ 16(-+."*S $2 #$"+ 22$. 4&,$-3$-3 2(&-(%(" 3(5$,$-3+$#( ,>31$".-#8+($-S$/$-# -3P 4"4-$#(%%?1$-"$2(&-(%(" 3(5$-V$23 ,(2$$-?5(#$-"$+.12#$+ ".,/ 1 (2.- 5$"+$6(-+."*S -fddkP4-$?34#$#$ \ff]".,/ 1$+ /.2(3(.-#4".-#8+$#$2/ 3($-32 31 (3?2/ 1 #$"+ 22$. :"$4731 (3?2/ 1!($++$2#$ $3:"$47/1?2$-3 -34-$ .""+42(.-)4&?$".,,$W(#? +$X".11$2/.-# -3 4.+3.-3 -# 1#\&1.4/$".-31E+$]P: j,.(2$3:+V 11@3#$2 \fPj -2]\(&41$ee]S. )'52%VVJ .#)$%.#%$%3'2/50%3>,!34)15%3R)0$'%SH %4 352,!0/3)4)/.#/.$9,)%..%%4$50/'/.)/.RWWS. ".,/ 1 (2.-#4&1.4/$ 4&1.4/$".-31E+$,.-31$4-$ !2$-"$#$#(%%?1$-"$ 2(&-(%(" 3(5$#$+ /.2(3(.-".-#8+($--$:j,.(2P3 -#(204V4-$5$13(" +(2 3(.-#$+ /.2(3(.-".-#8+($--$\#?% 5.1 !+$:+ ".11$"3(.-#$+ , +.""+42(.-]$23.!2$15?$: fPj -2S ".,/ 1 (2.-#4&1.4/$ 4&1.4/$ ,.-31$:j,.(2\%(-#431 (3$,$-3 .13'./?#(04$]$3:fPj -2\%(-#431 (3$,$-3.13'.#.-3(04$]4-$/.2(3(.-".-#8+($--$ /+422 &(33 +$# -2+$&1.4/$ $3/+425$13(" +$# -2+$&1.4/$ S - ".-"+42(.-P +$2 #$ "+ 22$. -V.-3 / 2 #V$%%$3 13("4+ (1$ % 5.1 !+$ 4 31 (3$,$-3 #$+ "+ 22$. S. . fd.

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(78) )'52%WYJ0/34L42!)4%-%.4$%,M).#)3)6%,!4>2!,%-!.$)"5,!)2%'!5#(%H!6%#5.%65%3!')44!,% %4#/2/.!,%$54)%23!0)#!,-/.42!.4,T/3!5.)6%!5$%3-523,).'5!,%4->3)!,$%,!2!#).%RX]S. II.2.4. Esthétique : rôle dans le sourire et la phonation $2(-"(2(5$2, -#(!4+ (1$2.-34-1E+$#(1$"3+.12#$+ /'.- 3(.-$3#42.41(1$P#$/ 1 +$41%.1,$P+$41".4+$41$3+$415.+4,$S $ 2.41(1$ $23 1$-#4 /.22(!+$ / 1 +V "3(.- ".,!(-?$ #$2 ,42"+$2 + !( 47 $3 % "( 47 /?1(!4"" 47S - 2.41(1$ &1? !+$ $23 #?%(-( / 1 ".,,$ 4- 2.41(1$ 04( #?".451$".,/+>3$,$-3+$2#$-32, 7(++ (1$2$3$-5(1.-e,,#$3(2242&(-&(5 47\gm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fi]S . . gf.

(79) )'52%WZJ T!5'-%.4!4)/.$%,T%80/3)4)/.$%3).#)3)6%3-!.$)"5,!)2%3!6%#,T<'%RYUS. $+.-\emkm]PW+$1E+$#$2(-"(2(5$2, -#(!4+ (1$2# -2+V$23'?3(04$#$2/ 3($-32 #$ jd -2 $3 /+42P $23 +$ ,@,$ 04$ "$+4( #$2 (-"(2(5$2 , 7(++ (1$2 "'$9 +$2 )$4-$2 #$ ,.(-2#$gd -2X\he]S \hd] /1?".-(2$ #.-" "'$9 +$2 / 3($-32 2$-(.12 #$ ".,/+?3$1 +$ #.22($1 /'.3.&1 /'(04$ ' !(34$+ #$ #$47 /'.3.&1 /'($2R 4-$ 54$ $7.!4"" +$ $3 4-$ 54$ $-#.!4"" +$!.4"'$.45$13$P+.12#$+ /'.- 3(.-#4WX#$W,, XP$7/.2 -33.43 / 13("4+(>1$,$-3 +$ 2$"3$41 (-"(2(% , -#(!4+ (1$ \(&41$ fj]S $2 "+("'?2 //.13$1.-3 +.124-$(-%.1, 3(.-?5(#$-3$241+$,.3(%#$".-24+3 3(.-$23'?3(04$S. )'52%W[J5%3%.$/"5##!,%3%4%8/"5##!,%3,/23$%,!0(/.!4)/.352 ,%NO$%N--!OH!6!.4%4!02=3.)6%,,%-%.4/24(/$/.4)15%RYUS. $2(-"(2(5$2, -#(!4+ (1$2/1?2$-3$-3?& +$,$-34-1E+$(-#(1$"3#$2.43($-+ !( +P$++$2 (-%+4$-3241+$,.#$+?$3+ /.2(3(.-#$+ +>51$(-%?1($41$S . gg.

(80) .41 . P +$ 2(++.- + !(.T,$-3.--($1 \ ] $23 4- ?+?,$-3 $23'?3(04$ #.-3 +a(,/.13 -"$ $23 2.42T$23(,?$S $+.- +4(P (

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(89) .- + !(.T ,$-3.--($1(-24%%(2 -3\fi]S (!($-04V$-fdejP4-$?34#$#$ \hf]P,$-?$241W+$2"1(3>1$2$23'?3(04$2#$ 1?422(3$ #$2 &?-(./+ 23($2XP (-2(23$ 241 +V(,/ "3 #$ + /.2(3(.- #$2 (-"(2(5$2 , -#(!4+ (1$2 241 +$ 2(++.- + !(.T,$-3.--($1 \ ] \(&41$ fk]S 1? +(2 3(.- #$ 2(,4+ 3(.- "?/' +.,?31(04$ \2$3T4/] /$1,$3 ?& +$,$-3 #V8 - +82$1+ /.2(3(.- (#? +$ #4,$-3.-.22$47/ 11 //.13 4!.1#+(!1$#$+V(-"(2(5$, -#(!4+ (1$S . )'52%W\J -0!#4$%,M).#,).!)3/.$%3).#)3)6%3352,!'>.)/0,!34)%$%02/05,3)/.H 0/33)"),)4>$%#!-/5&,!'%$%,!6%34)"5,/6%23)/.$%3).#)3)6%3).&>2)%52%30!2,! '>.)/0,!34)%-!)3%&&%4)!42/'=.%352,% RYXS. /.2(3(.- #$ +V(-"(2(5$ , -#(!4+ (1$ $23 #.-" : (-#(5(#4 +(2$1 $- /1$- -3 $- ".-2(#?1 3(.-"$2#(%%?1$-32% "3$412S. . gh.

(90). KXK002/#(%#>0(!,/->42)15% $2 ,.8$-2 #V?5 +4 3(.- #$ "$33$ /.2(3(.- [ .431$ +V$7 ,$- "+(-(04$ [ 2.-3 +$2 #(%%?1$-3$2 - +82$2"?/' +.,?31(04$2\(&41$fl]S . . . . . . )'52%W]J).1%8%-0,%3$%$>4%2-).!4)/.$%,!0/3)4)/.$%,M).#)3)6%-!.$)"5,!)2% 3%,/.,%3!.!,93%3#>0(!,/->42)15%354),)3>%3RYYSJ )*! ' &)*! &)*! &)*!"( &)*!"#

(91) . --.3$4-$#(5$12(3?#$/.2(3(.-(#? +$#$+V(-"(2(5$, -#(!4+ (1$2$+.-+$2 43$412P$++$ 2$1 #.-" 22$95 1( !+$P/+42.4,.(-25$23(!4+?$$-%.-"3(.-#$+V - +82$1? +(2?$S II.3.1. Selon l’analyse de TWEED V /1?2\emih]P+ /.2(3(.-#$+V(-"(2(5$, -#(!4+ (1$$23+(?$ 42$-25$13(" +S 5$13(" +(3? #$ +V 7$ #$ +V(-"(2(5$ , -#(!4+ (1$ 241 2 ! 22$ .22$42$ ".-23(34$ + /($11$ -&4+ (1$ #$ +V?04(+(!1$ % "( + $3 ".-23(34$ 4- .!)$"3(% 3'?1 /$43(04$ %.-# ,$-3 +P ".-#(3(.-- -3+ 1?422(3$$23'?3(04$$3+ 23 !(+(3?#431 (3$,$-3\hi]S . . gi.

(92) $ /1$,($1P (+ /$-2? : 5(24 +(2$1 + /.2(3(.- #$ +V(-"(2(5$ , -#(!4+ (1$ $- %(- #$ 31 (3$,$-3 04( ?3 (3 2.- /1(-"(/ + .!)$"3(%S + 31 "$ 241 4- %(+, 4- 31( -&+$ %.1,? / 1 +$ /+ - #$ 1 -"%.13P +$ /+ - , -#(!4+ (1$ #$ .6-2 \3 -&$-3$ 4 !.1# (-%?1($41 #$ + , -#(!4+$] $3 +a 7$ #$ +a(-"(2(5$ (-%?1($41$ \(&41$ fm]S $2 31.(2 -&+$2 #$ "$ 31( -&+$ 2.-3R\hj] - \""$ %" ]R $-31$ +$ /+ - #$ 1 -"%.13 $3 +$ /+ - , -#(!4+ (1$Q - \""$ %"#"]R$-31$+V 7$#$+V(-"(2(5$, -#(!4+ (1$ $3+$/+ -#$1 -"%.13Q - \#" %" ] R $-31$ +$ /+ - , -#(!4+ (1$ $3 +V 7$ #$ +V(-"(2(5$, -#(!4+ (1$S. )'52%W^J2)!.',%&!#)!,$%7%%$RY\S. $2 ,$241$2 "?/' +.,?31(04$2 2.-3 $-24(3$ $%%$"34?$2 $3 ".,/ 1?$2 : #$2 -.1,$2 ?3 !+($2 / 1 P 2$+.- #$2 ?"' -3(++.-2 #$ / 3($-32 2?+$"3(.--?2 /.41 +$41 ".-%.1,(3?:2.-(#? +$23'?3(04$P:2 5.(14-W/1.%(+/+ 3 4,$-3.-/1.?,(-$-3X\hi]S V -&+$ P#?%(-(22 -3+V.1($-3 3(.-#$+V 7$#$+V(-"(2(5$, -#(!4+ (1$/ 11 //.13: 2.- .2 ! 2 +P #.(3 3$-#1$ 5$12 4-$ -.1,$ #$ lkuS 5 +$41 ./3(, +$ #$ +V -&+$ 5 1($$-%.-"3(.-#$+ 5 +$41#$+V -&+$\$-+($- 5$"+$2$-25$13(" +/ 1#(5$1&$-"$ % "( +$]P#.-3+ 5 +$41$23-.-,.#(%( !+$R. . gj.

(93) - fdussfluR" 2-.1,.#(5$1&$-3P+a -&+$04$%.1,$+a(-"(2(5$(-%?1($41$ 5$" +$/+ -#$1 -"%.13\ ]#.(3@31$#$jluQ - t fluR " 2 '8/$1#(5$1&$-3P +a -&+$ 04$ %.1,$ +a(-"(2(5$ (-%?1($41$ 5$" +$ /+ -#$1 -"%.13\ ]#.(3@31$#$jiuQ - s fduR " 2 '8/.#(5$1&$-3P +$ #?" + &$ 2 &(33 + $23 %1?04$,,$-3 % (!+$P +V?5 +4 3(.- #$ + /.2(3(.- #$ +V(-"(2(5$ , -#(!4+ (1$ / 1 1 //.13 4 1$23$ #$ + % "$ /$1# #$ 2.- (-3?1@3S V -&+$ $23 +.12 +V -&+$ #$ 1?%?1$-"$P (+ -$ #.(3 "$/$-# -3 / 2 $7"?#$1 mfu /.41 #$2 1 (2.-2 #$ 23 !(+(3? #$ +V(-"(2(5$ (-%?1($41$ \hi]\(&41$gd]S . )'52%XUJ/2-5,%$%RX]S. 31 "$ +.12 $- /.(-3(++?2 4- -.45$+ 7$ (-"(2(% / 22 -3 / 1 +a /$7 #$ +a(-"(2(5$ (-%?1($41$\+$,.45$,$-3#$+a(-"(2(5$2$% (3 5$"4-"$-31$#$1.3 3(.- 4-(5$ 4#$2.- /$7]$3%.1,$ 5$"+$/+ -#$1 -"%.134- -&+$#a 4,.(-2jiuS (-2( 2$ 5(24 +(2$ + /+ "$ 2.4' (3?$ #$ +a(-"(2(5$ $- %(- #$ 31 (3$,$-3P +a(,/.13 -"$ #4 ,.45$,$-3 : 1? +(2$1 : / 13(1 #$ +a 7$ #$ #?!43 #$ 31 (3$,$-3S ".11$"3(.- "?/' +.,?31(04$: //.13$1 4-(5$ 4#$+V(-"(2(5$, -#(!4+ (1$P$-+ 1$"4+ -3$3$-+ 5$12 -3+(-&4 +$,$-3P$-31$# -2+V?5 +4 3(.-#$+ #82' 1,.-($3.3 +$S' 04$#$&1?#$ 5$12(.-+(-&4 +$".-2.,,$$-5(1.-dPl,,#V$2/ "$241+V 1" #$S //+(04? 231("3$,$-3P +$ 1$/.2(3(.--$,$-3 (-"(2(% ".-#4(3 31>2 %1?04$,,$-3 : #$2 $731 "3(.-2#$/1?,.+ (1$2S4).41#V'4(P".-2(#?1 -304$"$2$731 "3(.-21(204$1 ($-3#$ ".-#4(1$ : 4- /1.%(+ 31./ 1?3142(% $- %(- #$ 31 (3$,$-3P #$2 ".,/1.,(2 241 +$ 1$/.2(3(.--$,$-3#$+V(-"(2(5$2.-32.45$-3+ 1>&+$S . gk.

(94) (-2(P +$ W6$$#(23$X "34$+P 2$ %." +(2$ ,.(-2 241 + /.2(3(.- 3'?.1(04$ #$ +a(-"(2(5$ (-%?1($41$ 04$ 241 +a?04(+(!1$ %.-"3(.--$+ #$2 1" #$2 $-31$T$++$2 # -2 4- ".-3$73$ #a' 1,.-($% "( +$S $ ".-"$/3 #V' 1,.-($ % "( +$ #?"1(3 / 1 $- emjj \hlPhm]P $23 ?5 +4? / 1 +V -&+$%.1,?$-31$+ +(&-$$23'?3(04$\).(&- -3+$/.&.-(.-"43 -?:+ +>51$+ /+42 /1.3142(5$]$3+$/+ -#$1 -"%.13\(&41$ge]S . )'52%XV J !2-/.)%&!#)!,%$>&).)%0!2,M!.',%&/2->%.42%,!,)'.%%4,%0,!.$%2!.#&/24 RYZS. +(&-$?5.+4$$-1 //.13 5$"+V 7$#$+V(-"(2(5$(-%?1($41$S 5 +$41,.8$--$$23#$ klu/.414- -&+$ #$jiuS .1204$+ +(&-$$233 -&$-3$:+ +>51$(-%?1($41$P2( +V(-"(2(5$(-%?1($41$-$24!(3/ 2#$#?/+ "$,$-3P+ 5 +$41#$+V -&+$-$"' -&$1 / 2S 1".-31$P2("$33$+(&-$$233 -&$-3$:+ +>51$24/?1($41$P+V -&+$2V ,?+(.1$1 5$" + 1?#4"3(.-#$+V -&+$S V' 1,.-($#4/1.%(+1$/.2$?& +$,$-3241+ ,$241$#$+V?/ (22$41#$23(2242,.42 \(&41$gf]R - W//$1+(/3'("*-$22X\ ]R?/ (22$41,$241?$$-31$+ % "$5$23(!4+ (1$#$ +V(-"(2(5$"$-31 +$, 7(++ (1$$3+$/.(-3+$/+42/1.?,(-$-3#$+ +>51$24/?1($41$Q - W.3 +"'(-3'("*-$22X\]R?/ (22$41,$241?$$-31$+ +(&-$$3+$/.&.-(.- "43 -?S . gl.

(95) )'52%XWJ00%2,)0%44/4!,#().RY]S. V' 1,.-($#$+ 1?/ 13(3(.-#$23(2242,.42$23 +.12?5 +4?$$-" +"4+ -3T R (T tdR/1.%(+' 1,.-($47 (T sdR#82' 1,.-($ #$2 3(2242 ,.42P 4-$ ".,/$-2 3(.- / 1 1$/.2(3(.-T -$,$-3 #$2 (-"(2(5$2 (-%?1($41$2 $23 -?"$22 (1$ %(- #$ 1?3 !+(1 +V?04(+(!1$ #$ +V?3 &$(-%?1($41#$+ % "$S II.3.2. Selon l’analyse de STEINER V /1>2 P+ /.2(3(.-#$+V(-"(2(5$, -#(!4+ (1$#?/$-##4/+ - 2(.-T.(-3 \]$3$23#?3$1,(-?$/ 14-$,$241$,(++(,?31(04$$34-$,$241$ -&4+ (1$S 5$"+$W ,(-(,4,5(3 + XP(+ (-31.#4(32.- - +82$$-emig $3 + /1?"(2$$-emim$- //.13 -3+$2#.--?$2#$2.-$7/?1($-"$ %(-#V$-% "(+(3$1+V43(+(2 3(.-\idPie]S . + ?3? +$ /1$,($1 : 24&&?1$1 04$ +$2 ,$241$2 (-#(5(#4$++$2 4 -(5$ 4 204$+$33(04$P #$-3 (1$$3#$23(2242"43 -?2P/4(22$-3@31$(-3$1#?/$-# -3$2S V - +82$#$3$(-$1$23 4-$ - +82$ 2 &(33 +$ 04( /1."41$ 4-$ !.--$ 5(24 +(2 3(.- #$ + /.2(3(.- #$2 (-"(2(5$2 , -#(!4+ (1$2P/$1,$33 -3:+ %.(24-$,$241$ -&4+ (1$$34-$,$241$+(-? (1$1$+ 3(5$ 4/+ - 2(.-T.(-3S . . gm.

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