Dévitalisation dentaire : STOP !

Dr Bruno DARMON

Lorsqu’on enlève des dents dévitalisées, la façon la moins risquée et la plus thérapeutique pour la santé de les remplacer semble être sans conteste, la prothèse amovible, le dentier. Les dentiers ont des inconvénients certes et il y a dentier et dentier et des façons de le réaliser.

Prothèse amovible en nylon (type valplast ou autre)

La revue professionnelle dentaire Clinic a publié une brève en ces termes « Réconcilier patient et prothèse. Elle traitait des nylons utilisés en prothèse amovible. Les nylons de la couleur de la dent ou de la gencive devraient réconcilier le patient avec la prothèse amovible. Malgré son absence de métal et sa finesse, cet appareil est flexible et très résistant. Il présente une véritable mémoire. 

Son adaptabilité exceptionnelle permet de réaliser des fausses gencives et, des crochets particulièrement esthétiques. Il est revenu à la mode ces dernières années en raison d’une demande de confort et d’esthétique de la part des patients en prothèse amovible. Ces dentiers sont sans crochet métallique. La résine utilisée est thermoplastique en nylon biocompatible de la famille des Superpolymides (un nylon très pur hypoallergénique et biocompatible) qui ne se détériorerait pas chimiquement quand il entre en contact avec les fluides, bactéries et l’environnement buccal. Il existe donc maintenant divers dentiers qui n’ont plus de métal du tout et qui sont particulièrement esthétiques car même les crochets sont de la couleur de la gencive. Esthétiquement c’est donc très bien. Bien sûr il vaut toujours mieux les enlever pour dormir, ainsi que les enlever après chaque repas pour les nettoyer sous l’eau. Tout le monde est d’accord pour dire qu’avoir en bouche une prothèse amovible n’est pas ce qu’il y a de plus extraordinaire et qu’il vaut mieux conserver ses vraies dents. C’est d’ailleurs ce qui a contribué à faire tout le succès de la dent dévitalisée et ce qui a souvent fait avorter nombre de tentatives visant à informer de sa toxicité. En plus, certaines personnes semblent à l’évidence mécontentes de leur prothèse amovible même si nombreux sont ceux qui semblent pleinement satisfaits toutefois. Peut-être cela vient il de la qualité du travail du dentiste et du prothésiste ainsi que des matériaux utilisés ? La prothèse amovible permet en tout cas de restaurer les fonctions masticatoire, esthétique et phonétique très correctement lorsque les patients sont satisfaits. Certains cas sont un peu complexes toutefois. Néanmoins on peut aussi concevoir que la simple idée du dentier et l’image associée à la vieillesse que le public en a, fait que la plupart des personnes veuillent conserver leurs dents dévitalisées pour l’éviter. Ce choix me paraît lui aussi respectable car certaines personnes extrêmement soucieuses des apparences pourraient être gravement perturbées psychologiquement par l’idée même de posséder un dentier. Mais quand on observe certaines guérisons après élimination des dents dévitalisées et donc qu’on comprend ce qu’elle provoquaient, les inconvénients du dentier pourraient alors paraître négligeables à côté de la conservation des dents dévitalisées, surtout en cas d’affection chronique grave et cela même si on est encore jeune. J’ai vu des maladies graves comme une maladie d’Alzheimer installée, disparaître en quinze jours après élimination des dents dévitalisées. Il est évident que pour une maladie d’Alzheimer trop avancée, il n’aurait plus suffi alors d’enlever les dents dévitalisées pour retrouver la mémoire. Et c’est la même chose pour nombre de pathologies graves lorsqu’elles sont à un stade très avancé. Comme la meilleure thérapeutique est bien sûr la prévention, cela me fait dire qu’il vaudrait mieux idéalement se débarrasser de ses dents dévitalisées avant d’être malade. Pour remplacer les dents absentes, il existe aussi les bridges sur dents vivantes et les implants bien sûr si vous avez un peu plus d’argent encore. Ce sont des solutions qui paraissent plus confortables en général car il n’y a pas à enlever ses dents le soir, bien qu’on puisse aussi éventuellement garder son dentier la nuit. Mais c’est déconseillé car la gencive aurait alors tendance à se résorber plus qu’il ne le faut et la prothèse nécessiterait alors des rebasages plus fréquemment que nécessaire. Le rebasage est une technique prothétique de laboratoire qui consiste à remettre de la matière sous la prothèse amovible pour compenser la résorption de l’os sous la gencive. Les bridges sont donc aussi une solution de remplacement parfois possible. Ils ont toutefois des petits inconvénients en ne s’appuyant pas sur la zone édentée qui est donc non stimulée par les forces masticatoires. Cela a de petits inconvénients d’un point de vue énergétique, ce qui peut donc avoir des petites répercussions à distance. Ils nécessitent aussi souvent de tailler comme pour les couronnes, des dents piliers indemnes en leur faisant ainsi prendre des risques pour le futur. Mais ma foi après le dentier, ou prothèse amovible dit-on plus professionnellement, il semble que ce soit la meilleure façon de remplacer les dents manquantes, bien que certains préfèrent aujourd’hui de plus en plus les implants. Les implants sont aussi un peu controversés par certains médecins qui s’intéressent aux rapports entre la santé et les dents et qui sont assez réputés pour guérir des affections sur lesquelles leurs confrères avaient échoué. Si l’os se soude à l’implant notamment en titane, un métal couramment utilisé en implantologie, la gencive elle, n’a pas vraiment d’attache à l’implant. On parle d’absence d’attache épithéliale plus précisément. Cela fait que les bactéries de la bouche peuvent cheminer le long de l’implant jusqu’à l’os.

Implant dentaire 

Les implants sont constitués d’une racine artificielle généralement en métal titane. Ils sont implantés dans l’os de la mâchoire. Mais on n’a pas réussi à obtenir de véritable attache entre l’implant et la gencive (l’attache épithéliale), ce qui fait que les bactéries de la bouche peuvent cheminer le long de l’implant jusqu’à l’os et donc la circulation sanguine. Cela pourrait expliquer que les implants puissent eux aussi constituer des foyers infectieux et que certains médecins les déconseillent systématiquement. Mais ce serait bien moins problématique que les dents dévitalisées toutefois, il faut relativiser et dans certains cas notamment pour bien faire tenir des prothèses totales parfois particulièrement difficiles à faire tenir, c’est appréciable.

 

Certains implantologistes, refusent d’ailleurs de poser des implants aux personnes diabétiques et à ceux qui ont un moins bon système immunitaire et qui font donc plus facilement des infections. La raison est que l’implant a beaucoup moins de chance de se souder à l’os car une infection locale pourra le rejeter plus facilement. Mais cela accrédite aussi d’une certaine façon que les implants sont un peu toxiques mêmes si certains qui possèdent un bon système immunitaire peuvent quand même bien les supporter, mais jusqu’à quand ? Toutefois et contrairement aux dents dévitalisées, la littérature scientifique ne possède pas assez d’éléments pour pouvoir aujourd’hui affirmer le caractère toxique des implants qui semble toutefois bien moindre que celui des dents dévitalisées. Il existe aussi des personnes qui ont retrouvé la joie de vivre grâce à leurs implants car leur dentier les dérangeait vraiment, et qui restent aussi en bonne santé.

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