SlideShare une entreprise Scribd logo
https://www.concedo.fr
Risques sinusiens
En implantologie secteurs 1 et 2
1
https://www.concedo.fr
Activité à risque
2
Effraction du sinus Pathologie sinusienne
existante?
https://www.concedo.fr
D’après le rapport 2019 de la MACSF
+55% de taux d’augmentation de la
sinistralité ces 5 dernières années
3
https://www.concedo.fr
Timmenga NM and coll. Maxillary sinus function after sinus lifts for the insertion of dental
implants. J Oral Maxillofac Surg 2017;55(9):936-939
1 malade sur 6 à risque de complications
sinusiennes après sinus lift
4
https://www.concedo.fr
Nouvelles recommandations émises en 2019
Par la SFORL assistée des comités de pilotage SFCO AFI SFPIO
• Rechercher systématiquement une pathologie sinusienne à l'interrogatoire par
un score de Dixon

• Rechercher systématiquement une pathologie sinusienne à partir d’une
imagerie 3D Cone Beam (CBCT)

• Le CBCT doit inclure l’ostium du sinus maxillaire au minimum

• En cas d'antécédents sinusiens ou d'interrogatoire anormal un CBCT incluant
toutes les cavités sinusiennes est indiqué
5
https://www.concedo.fr
Seul un médecin ORL est habilité
À se prononcer sur les sinus
Le bilan ORL pré-implantaire rend donc l’activité multidisciplinaire.

Comment se répartissent les responsabilités en cas d’échec ?
6
https://www.concedo.fr
Patrick Simonet, Best of Implantology 2020
« La multi-disciplinarité
ne dilue pas les responsabilités »
7
https://www.concedo.fr
Le bilan ORL pré-implantaire
est une obligation de moyen, mais…
• Délais moyen de rendez-vous ORL
de plus en plus longs ( 3 mois)

• ORL pas toujours spécialisé en
chirurgie sinusienne

• Étape supplémentaire allongeant le
projet de soins

• Non pris en charge par la CPAM

• Risque de perte de vue du patient
8
https://www.concedo.fr
9
• Demande simple sur Internet par télé-expertise reconnue par la HAS

• Réponse rapide en nom propre par un chirurgien ORL français expert en sinus

• Adressage rapide en cas de pathologie

• Respect des recommandations et des obligations médico-légales

• Preuve écrite du respect des recommandations et de l’information du patient

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Risques sinusiens en implantologie - Concedo

  • 2. https://www.concedo.fr Activité à risque 2 Effraction du sinus Pathologie sinusienne existante?
  • 3. https://www.concedo.fr D’après le rapport 2019 de la MACSF +55% de taux d’augmentation de la sinistralité ces 5 dernières années 3
  • 4. https://www.concedo.fr Timmenga NM and coll. Maxillary sinus function after sinus lifts for the insertion of dental implants. J Oral Maxillofac Surg 2017;55(9):936-939 1 malade sur 6 à risque de complications sinusiennes après sinus lift 4
  • 5. https://www.concedo.fr Nouvelles recommandations émises en 2019 Par la SFORL assistée des comités de pilotage SFCO AFI SFPIO • Rechercher systématiquement une pathologie sinusienne à l'interrogatoire par un score de Dixon • Rechercher systématiquement une pathologie sinusienne à partir d’une imagerie 3D Cone Beam (CBCT) • Le CBCT doit inclure l’ostium du sinus maxillaire au minimum • En cas d'antécédents sinusiens ou d'interrogatoire anormal un CBCT incluant toutes les cavités sinusiennes est indiqué 5
  • 6. https://www.concedo.fr Seul un médecin ORL est habilité À se prononcer sur les sinus Le bilan ORL pré-implantaire rend donc l’activité multidisciplinaire. Comment se répartissent les responsabilités en cas d’échec ? 6
  • 7. https://www.concedo.fr Patrick Simonet, Best of Implantology 2020 « La multi-disciplinarité ne dilue pas les responsabilités » 7
  • 8. https://www.concedo.fr Le bilan ORL pré-implantaire est une obligation de moyen, mais… • Délais moyen de rendez-vous ORL de plus en plus longs ( 3 mois) • ORL pas toujours spécialisé en chirurgie sinusienne • Étape supplémentaire allongeant le projet de soins • Non pris en charge par la CPAM • Risque de perte de vue du patient 8
  • 9. https://www.concedo.fr 9 • Demande simple sur Internet par télé-expertise reconnue par la HAS • Réponse rapide en nom propre par un chirurgien ORL français expert en sinus • Adressage rapide en cas de pathologie • Respect des recommandations et des obligations médico-légales • Preuve écrite du respect des recommandations et de l’information du patient