Pour les femmes immigrées d’Afrique sub-Saharienne l’arrivée en France peut constituer une rupture dans leur trajectoire sexuelle, affective et reproductive. Si beaucoup ont déjà fait l’expérience d’une grossesse avant leur arrivée, un certain nombre n’aura pas encore débuté sa vie reproductive. Toutefois et pour les femmes qui le souhaitent, l’arrivée en France, et le changement du paysage contraceptif peut être l’occasion d’accéder à une contraception efficace ou bien de changer de méthode. En 2010, en France, sur l’ensemble de la population des femmes âgées entre 15-49 ans et en besoin de contraception, 78.5% déclarait utiliser une contraception médicale contre 22.9% en Afrique subsaharienne (tous pays confondus) pour les femmes de la même tranche d’âge. Par ailleurs, la population originaire d’Afrique subsaharienne est particulièrement touchée par le VIH/sida en Afrique mais aussi en France, où ils représentent le deuxième groupe le plus affecté.A partir de deux enquêtes, Parcours et Vespa 2, notre étude a visé à mettre en lumière les pratiques contraceptives et les éventuelles inégalités en matière de contraception dont les immigrées originaires d’Afrique subsaharienne feraient l’objet, afin de repérer les leviers d’une meilleure prise en charge de leur santé sexuelle et reproductive.Les résultats de cette thèse mettent en évidence que les femmes africaines immigrées se saisissent d'un système qui articule la promotion de la contraception, un dispositif d'accès facilitant et des pratiques médicales aboutissant à une forte adhésion à la contraception médicale efficace puisque la majorité des femmes déclare utiliser la pilule, l’implant et parfois le DIU. Ces résultats sont toutefois à moduler pour deux raisons. D’une part, lorsque les femmes vivent avec le VIH, (les femmes immigrées ou nées en France) utilisent très majoritairement le préservatif. D’autre part, le recours à l’implant est nettement plus marqué qu’en population générale ce qui doit nous inciter à poursuivre les études pour savoir jusqu'à quel point les méthodes en usage correspondent à un choix et conviennent aux besoins des femmes . / For immigrant women from sub-Saharan Africa, arriving in France may be a break in their sexual, emotional and reproductive trajectory. If many have already experienced pregnancy before arriving, a number will not have started their reproductive life. However, for women who wish so, the arrival in France and the change in the contraceptive landscape may be an opportunity to access effective contraception or to change the method. In 2010, in France, of the entire population of women between the ages of 15-49 and in need of contraception, 78.5% reported using medical contraception compared to 22.9% in sub-Saharan Africa (all countries combined) for women in the same age group. Moreover, the population from sub-Saharan Africa is particularly affected by HIV/AIDS in Africa but also in France, where they represent the second most affected group.Based on two surveys, Parcours and Vespa 2, our study aimed to highlight the contraceptive practices and possible inequalities in contraception that immigrant women from sub-Saharan Africa face, in order to identify improvements in their sexual and reproductive health care.The results of this thesis highlight that African immigrant women seize a system that articulates the sponsoring of contraception, easier access and medical practices resulting in a strong adherence to effective medical contraception since the majority of women report using the pill, the implant and sometimes the IUD. These results must however be adjusted for two reasons. On one hand, women living with HIV (immigrant women or women born in France) use condoms for the most part. On the other hand, the use of an implant is much more pervasive than in the general population which should encourage us to continue studying to what extent the methods in use correspond to a choice and are adapted to the needs of women.

L’implant cochléaire, la neuroprothèse la plus répandue et la plus réussie de nos jours, permet à des sujets sourds profonds de récupérer une perception auditive permettant une compréhension du langage. Bien que les technologies et les processeurs actuels aient grandement évoluées depuis ces vingt dernières années, la stratégie optimale pour coder l'intensité sonore dans l’implant n’a pas encore été trouvée. L'accès à des indices physiologiques est difficile chez le patient humain alors qu’il est relativement simple chez l’animal. Le but de cette thèse était de développer un modèle animal (cobaye) d'implantation cochléaire et d'étudier la réponse du système auditif à différentes stratégies de stimulation. Les réponses du nerf auditif et des neurones du cortex auditif primaire ont été obtenues lors de stimulations via un implant cochléaire simplifié.Nous avons observé que l’importante variabilité inter-individuelle dans l’efficacité de 2 stratégies (augmentation d’amplitude vs. de durée des pulses électriques) à augmenter les réponses du nerf auditif se répercute au niveau du cortex auditif. Les tests de nouvelles formes de pulses (pulses asymétriques ou en rampes) sur les réponses des neurones corticaux suggèrent que ce type de pulses permettrait de réduire l’étendue corticale activée par la stimulation électrique même aux charges les plus élevées. Là aussi, une importante variabilité inter-individuelle a été observée. Cela a conduit à ce que les activations corticales les plus proches de l’activation normalement observée par des sons purs, soient obtenues soit avec une forme de pulses soit une autre. Cette thèse prône donc qu’il est indispensable d’avoir accès à de nombreuses stratégies de stimulation sur chaque sujet afin de choisir celle la plus adaptée pour un patient donné. / Cochlear implant, the most successful neuroprosthesis allows deaf subjects to recover auditory perception and speech intelligibility. Over the last decades, the technology and the coding strategies in cochlear implants have been largely improved but the optimal strategy for coding loudness is still problematic. Human studies face a lot of restrictions especially regarding the collection of electrophysiological events. The primary goal of this thesis is to develop an animal model (guinea pig) of implantation and to study the auditory system's responses for different strategies for coding sound loudness (increase in amplitude vs. duration of electrical pulses). We studied the responses of the auditory nerve and primary auditory cortex obtained with electrical stimulation delivered through a simplified cochlear implant.We observed that the large inter-individual variability in the efficacy of these two classical strategies for increasing auditory nerve responses is reflected in the auditory cortex. Testing new forms of pulses (asymmetric pulses or ramped pulses) suggests that this type of pulses would reduce the evoked responses of cortical neurons even at the highest injected charges. Again, a large inter-individual variability was observed. As a consequence, for each animal, the cortical response the closest from the activation normally observed with pure tones, is obtained either with one form of pulses or another. This thesis advocates that it is essential to have access to several stimulation strategies on each subject in order to choose the most appropriate for a given patient.

Magister Scientiae Dentium - MSc(Dent) / Background: The two-stage implant system has proven to be a successful technique in replacing missing teeth (Nascimento et al., 2008). Nevertheless, the presence of micro-gaps that could entrap microbes at the implant-abutment interface (IAI) is unavoidable. This microbial leakage has been considered as one of the causes of peri-implant infection and bone loss (Scarano et al., 2005). Several companies have attempted to manufacture an implant with a connection design that provides hermetic sealing against bacterial leakage. Studies indicated that implants with internal connection, in particular the conical (Morse taper) design, have better sealing capacity in the implant abutment interface than the external design (Koutouzis et al., 2011, Jaworski et al., 2012). An internal conical implant system with a novel connection design, known as the Grand Morse (GM) connection, is reported to offer secure connection against micro-leakage (Neodent® Implant Systems Inc., 2018). Aims: The aim of this study was to test the sealing ability against bacterial leakage in the implant-abutment interface provided by an implant with a novel deep internal conical (GM) connection design.

Aim: To investigate retrospectively the outcome of surgical peri-implantitis treatment taking potentially relevant parameters into account. Material and method: Patients being treated for peri-implantitis during 2013-2019 by a single specialist with sufficient radiographic and clinical documentation and at least a nine-month follow-up were considered herein. Patient-, prosthodontic-, and implant-related data were collected from the journals and available radiographs at baseline and follow-ups. Surgical procedures were divided into open flap debridement (OFD), resective, regenerative and combined treatments. Treatment outcome was defined as: good (PPD≤5mm+no BoP); acceptable (PPD>5mm without BoP or BoP+PPD≤5mm); bad (PPD>5mm+BoP and/or suppuration); and failure (explantation or re-operation). Descriptive statistics, chi-square or Fisher’s exact test were performed to assess potential predictors for the combined outcomes good and acceptable, coined as “successful”, and bad and failure, coined as “unsuccessful”. Results: Thirty-seven patients and 69 implants with a follow-up of 9 to 63 months fulfilled the inclusion criteria. Overall, 71% of the treated implants showed a good outcome and 13% an acceptable outcome, i.e., in 84% of the cases a successful outcome was achieved. Regenerative treatment had the highest success rate (87%) followed by resective (84%), OFD (83%) and combined treatment (83%). One of the predictors (i.e., smoking) affected the successful outcome negatively with >10%. However, statistical analysis failed to prove significance. Conclusion: Based on this retrospective analysis of a relatively limited number of implants, surgical treatment of peri-implantitis was successful in 84% of the cases. For defining risk factors affecting the treatment outcome a larger sample size is required. The results were of no statical significance. / Syfte: Retrospektivt undersöka resultatet av kirurgisk peri-implantitbehandling med hänsyn till potentiellt relevanta parametrar. Material och metod: Alla patienter som kirurgiskt behandlades för peri-implantit under tidsperioden 2013-2019 av en enda specialist med minst nio månaders uppföljning beaktades här. Patient-, protes- och implantatrelaterade data samlades in retrospektivt från journaler och tillgängliga röntgenbilder pre- och postoperativt. Kirurgiska ingrepp delades in i open flap debridement (OFD), resektiv, regenerativ och kombinerad behandling. Behandlingsresultatet definierades som: good (PPD≤5mm+ingen BoP); acceptable (PPD>5mm utan BoP, eller BoP+PPD≤5mm); bad (PPD>5mm+BoP och/eller suppuration); och failure (explantering eller re-operation). Beskrivande statistik, chi-square eller Fisher’s exact test utfördes för att bedöma potentiella prediktorers påverkan på resultatet. För ”lyckat” kombinerades resultaten good och acceptable, medan för ”misslyckat” kombinerades resultaten bad och failure. Resultat: Trettiosju patienter och 69 implantat med en uppföljning på 9 till 63 månader uppfyllde inklusionskriterierna. Sammantaget visade 71% av de behandlade implantaten ett bra resultat och ytterligare 13% ett acceptabelt resultat, dvs. i 84% av fallen uppnåddes ett lyckat resultat. Regenerativ behandling hade den bästa lyckandefrekvensen (87%) följt av resektiv (84%), OFD (83%) och kombinerad behandling (83%). En av prediktorerna, mer specifikt rökning, påverkade lyckandefrekvensen negativt med >10%. Statistisk analys misslyckades dock med att bevisa statistisk signifikans. Slutsats: Baserat på denna retrospektiva analys av ett relativt begränsat antal implantat lyckades kirurgisk behandling av peri-implantit i 84% av fallen. För att definiera riskfaktorer som påverkar behandlingsresultatet krävs en större provstorlek. Resultaten visade ingen statistisk signifikans.

Purpose: The present study aimed to evaluate the impact of bruxism on dental implant failure rates andmarginal bone loss (MBL), based on a systematic review of the literature. Materials and methods: An electronic search without time restrictions was undertaken (last updated in September2021) in three databases, plus handsearching. Only studies that provided enough informationon the criteria used for the diagnosis of at least ‘probable bruxism’ (self-report + clinicalexamination) were considered for inclusion. Meta-analyses were performed besides meta-regressions, in order to verify how the odds ratio (OR) was associated with follow-up time. Results: The review included 23 publications. Altogether, there were 1,991 and 9,438 implants placedin bruxers and non-bruxers, respectively. Pairwise meta-analysis including only the studiesthat provided enough information on the criteria used for the diagnosis of at least ‘probablebruxism’ resulted in significant failure rate difference between the groups (OR 1.987, p =0.015). There was an estimated increase of 0.010 in OR for every additional month of follow-up (p = 0.209). None of the included studies reported results on MBL separated betweenbruxers and non-bruxers. Conclusion: Implants placed in bruxers present a significant higher risk of failure than in non-bruxers.Studies comparing MBL between the groups are still lacking. / Syfte Den aktuella studien syftade till att utvärdera effekten av bruxism på dentala implantats misslyckandefrekvens och marginell benförlust (MBL), baserat på en systematisk översikt av litteraturen. Material och metod: En elektronisk sökning utan tidsbegränsningar gjordes (senast uppdaterad i september 2021) i tre databaser, plus handsökning. Endast studier som gav tillräckligt med information om de kriterier som användes för diagnos av åtminstone ’trolig bruxism’ (självrapportering + klinisk undersökning) övervägdes för inkludering. Metaanalyser utfördes förutom metaregressioner, för att verifiera hur oddskvoten (OR) var associerad med uppföljningstid. Resultat: Översikten omfattade 23 publikationer. Sammanlagt fanns det 1 991 och 9 438 implantat placerade i bruxare respektive icke-bruxare. Parvis metaanalys som endast inkluderade studierna som gav tillräckligt med information om kriterierna som användes för diagnosen av åtminstone ’probable bruxism’ resulterade i signifikant skillnad i felfrekvens mellan grupperna (OR 1,987, p = 0,015). Det var en uppskattad ökning med 0,010 i OR för varje ytterligare månad av uppföljning (p = 0,209). Ingen av de inkluderade studierna rapporterade resultat på MBL separerade av bruxare och icke-bruxare. Slutsats: Implantat placerade i bruxare innebär en signifikant högre risk för misslyckande än hos icke-bruxare. Studier som jämför MBL mellan grupperna saknas fortfarande.

This study evaluated the survival rates of dental implants and prostheses in patients with maxillary edentulism using both randomized controlled trials (RCT) and prospective studies. The follow-up time for the selected articles ranged from 5 to 15 years. The implant survival rates ranged from 51% to 100% in RCT studies and 72% to 99% in prospective studies. Prostheses survival rates ranged from 78% to 100% in prospective studies, while RCT studies reported rates between 91% to 100%. Marginal bone loss rates ranged from 0.5mm to 2.45mm in RCT studies and 0.23mm to 1.39mm in prospective studies. This study suggests that the number and location of implants, need for sinus lift, and the type of opposing dentition can impact implant and prosthesis survival rates. Overall, this study provides valuable insights for clinicians in the management of maxillary edentulism using implant-supported prostheses.

No description available.

No description available.

Resumo: O objetivo do presente trabalho de pesquisa foi avaliar a influencia do tipo de conexao protetica, do platform-switching, e do design do implante no ambiente biomec.nico de implantes imediatos com carga imediata. Para tanto, um modelo de alveolo de extraçao de um incisivo central superior foi constru.do baseado em tomografia computadorizada. Implantes inseridos no alveolo de extra..o foram avaliados por meio de analises em elementos finitos. Uma Analise de Variancia (α=0.05) foi utilizada para interpretar os dados do pico de deformaçao equivalente no osso, do pico de tens.es equivalentes no parafuso do abutment, do deslocamento relativo osso-implante e do gap do abutment. A maior influ.ncia do tipo de conexao protetica e do platform-switching foi observado na tensao do parafuso e no gap do abutment. Por sua vez, o design do implante afetou consideravelmente as deformaçoes no osso e o deslocamento relativo entre o osso e o implante. Nao obstante, evitar a sobrecarga do implante e garantir uma alta estabilidade inicial sao os fatores mais importantes na previsibilidade de implantes imediatos com carga imediata / Abstract: The aim of the present research work was to evaluate the influence of different connection type, platform switching and implant designs on the biomechanical environment of immediately placed implants. A CT-based model of an upper central incisor extraction socket was constructed. The immediately placed implants were evaluated by finite element analysis. An Analysis of Variance was used to interpret the data for the peak equivalent strain in the bone, peak Von Mises stress in the abutment screw, bone-to-implant relative displacement and abutment gap. The largest influence of the connection type and platformswitching was seen on the peak equivalent stress in the abutment screw and implant-abutment gap. On contrary, the implant design considerably affects the biomechanical environment of immediately placed implants. However, avoiding implant overloading and ensuring a high implant initial stability are the most important factors for the predictability of implants in this protocol / Orientador: Luis Geraldo Vaz / Coorientador: Elcio Marcantonio Junior / Coorientador: Sonia Aparecia Goulart de Oliveira / Banca: José Maurício dos Santos Reis Nunes / Banca: Rogério Margonar / Banca: Pedro Yoshito Noritomi / Banca: Flávio Domingues das Neves / Doutor

Made available in DSpace on 2014-06-11T19:32:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-03-25Bitstream added on 2014-06-13T19:43:55Z : No. of bitstreams: 1 pessoa_rs_dr_arafo.pdf: 1780565 bytes, checksum: 78498002897f7571851e27403dd44a72 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / O objetivo do presente trabalho de pesquisa foi avaliar a influencia do tipo de conexao protetica, do platform-switching, e do design do implante no ambiente biomec.nico de implantes imediatos com carga imediata. Para tanto, um modelo de alveolo de extraçao de um incisivo central superior foi constru.do baseado em tomografia computadorizada. Implantes inseridos no alveolo de extra..o foram avaliados por meio de analises em elementos finitos. Uma Analise de Variancia (α=0.05) foi utilizada para interpretar os dados do pico de deformaçao equivalente no osso, do pico de tens.es equivalentes no parafuso do abutment, do deslocamento relativo osso-implante e do gap do abutment. A maior influ.ncia do tipo de conexao protetica e do platform-switching foi observado na tensao do parafuso e no gap do abutment. Por sua vez, o design do implante afetou consideravelmente as deformaçoes no osso e o deslocamento relativo entre o osso e o implante. Nao obstante, evitar a sobrecarga do implante e garantir uma alta estabilidade inicial sao os fatores mais importantes na previsibilidade de implantes imediatos com carga imediata / The aim of the present research work was to evaluate the influence of different connection type, platform switching and implant designs on the biomechanical environment of immediately placed implants. A CT-based model of an upper central incisor extraction socket was constructed. The immediately placed implants were evaluated by finite element analysis. An Analysis of Variance was used to interpret the data for the peak equivalent strain in the bone, peak Von Mises stress in the abutment screw, bone-to-implant relative displacement and abutment gap. The largest influence of the connection type and platformswitching was seen on the peak equivalent stress in the abutment screw and implant-abutment gap. On contrary, the implant design considerably affects the biomechanical environment of immediately placed implants. However, avoiding implant overloading and ensuring a high implant initial stability are the most important factors for the predictability of implants in this protocol