L'' Orthodontie française最新文献

Introduction: The prevalence of lingual dyspraxia is high but not all patients require management by a physical therapist. The aim of this article is to propose a decisional flow chart separating, via diagnostic criteria, patients who can be managed in office from patients requiring oromyofunctional rehabilitation by an oro-myo-functional rehabilitation (OMR) professional and to provide, if necessary, simple exercise sheets.

Material and method: An expert, a maxillofacial physiotherapist from the Fournier school, has proposed, based on the literature, her experience as a clinician and in consultation with orthodontists, different criteria for the severity of dyspraxia as well as exercises to be implemented for cases that are manageable in the office.

Results: The decision tree, diagnostic criteria and exercises are provided.

Discussion: The flowchart is based on the literature, mainly on expert opinion given the low level of evidence of published studies. The exercise sheet was created by a physiotherapist from the Fournier school and necessarily reflects this influence.

Conclusion: Further studies such as a clinical trial could compare the validity of the WBR indication obtained by an orthodontist using the decision tree with the blinded indication given by a physical therapist. In addition, the effectiveness of in-office rehabilitation could be evaluated using a control group.

Introduction: Pediatric OSAS is a complex condition, comprising a plurality of clinical signs, complicated by the phenomena of growth. Its etiology is dominated by the hypertrophy of lymphoid organs, but obesity and certain craniofacial and neuromuscular tone abnormalities also contribute.

Material and method: The authors summarize the interrelations between pediatric OSAS endotypes, phenotypes and orthodontic anomalies. They report clinical practice recommendations on the multidisciplinary management of pediatric OSAS and define the place and timing of orthodontics.

Results: There is an indication for treatment of pediatric OSAS for an OAHI greater than 5/h, regardless of comorbidity, as well as for symptomatic children, whose OAHI is between 1-5/h. The first line of treatment is adenotonsillectomy, but it does not always normalize the OAHI. Complementary treatments are often necessary: early orthodontics (rapid maxillary expansion, myofunctional appliances), oral reeducation, as well as the management of obesity and allergies. Careful watching, without treatment is possible for mild cases with few symptoms, as pediatric OSAS tends to resolve naturally with growth.

Discussion: The therapeutic approach is stratified, depending on the severity of OSAS and the child's age. In terms of orthodontic repercussions, obesity is associated with earlier maturation and some facial morphological differences, while oral hypotonia and nasal obstruction can alter facial growth, promoting mandibular hyperdivergence and maxillary deficiency.

Conclusion: Orthodontists are in a privileged position for the detection, follow-up and certain treatments of OSAS.

Introduction: The term « adenoid facies » suggests a causal relationship between nasopharyngeal obstruction and facial hyperdivergence in growing subjects. The strength of this association is controversial and few « quantified » values exist.

Materials and methods: A rapid electronic search was conducted on PubMed and Embase to find the main cephalometric studies involving patients with nasal/nasopharyngeal obstruction compared to a control sample. A meta-analysis was carried out to quantify the effect of obstruction (1) and intervention to relieve the obstruction (2) on mandibular divergence (SN/Pmand angle), maxillo-mandibular divergence (PP/Pmand angle), inclination of the occlusal plane (SN/Poccl) and the gonial angle (ArGoMe).

Results: Qualitatively, the studies' bias level ranged from moderate to high. Results were concordant about the significant effect of the obstruction on facial divergence (1) with an increase in SN/Pmand (+3.6° on average, +4.1° in children <6 years), PP/Pmand (+5.4° on average, +7.7° <6 years), ArGoMe (+3.3°) and SN/Pocc (+1.9°). Surgical interventions to remove the respiratory obstacle in children (2) generally did not normalize the direction of growth, with the exception, with a very low level of evidence, of adenoidectomies/adeno-tonsillectomies, performed at an age less than 6-8 years.

Conclusion: Early detection of respiratory obstacles and postural abnormalities associated with oral breathing appears to be decisive in order to hope for management at a young age and normalization of the direction of growth. However, the effects on mandibular divergence remain limited, requiring caution, and cannot be considered a surgical indication.

Introduction: Sleep-disordered breathing could affect 10% of an orthodontic population. The integration of obstructive sleep apnea syndrome (OSAS) diagnosis could influence the choice of orthodontic techniques or their implementation, with the aim of improving ventilatory function.

Material and method: The author summarizes the clinical studies using dentofacial orthopedics, alone or in combination with other interventions, in pediatric OSAS or the repercussions of orthodontic interventions on upper airways.

Results: For the same orthodontic anomaly, in particular, transverse maxillary deficiency, the temporality and the modality of treatment could be modified by a diagnosis of OSAS. It could be recommended to propose early orthopedic maxillary expansion, seeking to potentiate its skeletal effect, to reduce the severity of OSAS. Class II orthopedic devices have shown interesting results but the evidence value of the studies is not yet sufficient to recommend them widely and as an early treatment. Extractions of permanent teeth do not significantly reduce the upper airway.

Discussion: OSAS in children and adolescents includes several endotypes and phenotypes for which orthodontics may or may not be indicated. It is not recommended to orthodontically treat an apneic patient with no significant malocclusion, for the sole purpose of having an effect on the respiratory tract.

Conclusion: The orthodontic therapeutic decision is likely to be modified by a diagnosis of sleep-disordered breathing underlining the interest in systematic screening.

Introduction: In 85% of orthodontic patients, lingual dyspraxias are present and may justify orofacial myofunctional rehabilitation because of their morphogenetic potential. The objective of this literature review is to search for scientific arguments corroborating or not the relationships between dysmorphias and the static, dynamic labio-lingual-jugal balance during functions and parafunctions.

Material and method: A review of the literature was carried out by keywords on PubMed. The search covered the period from 1913 to 2022. A complementary selection of articles or book chapters was made from the references of the included articles.

Results: The morphogenetic role of the tongue is mainly involved at rest and during ventilation in all three dimensions. Oral ventilation is associated with many craniofacial dysmorphy. Concerning swallowing, phonation, non-nutritive sucking and temporomandibular joint dysfunctions, it is the combined association of several anomalies that is found in dysmorphia without a causal link being established. Thus, for some, the lingual posture would only constitute an adaptation to a dysmorphia.

Discussion: Essentially based on expert opinion, the level of evidence is still insufficient. The authors are confronted with the difficulty of finding adequate, quantifiable and reproducible indicators.

Conclusion: This subject, which probably remains neglected because it is interdisciplinary and the result of a historically European reflection, deserves to be further studied.

Introduction: Several cross-sectional studies have shown the association of a dysfunctional orofacial environment with a greater prevalence of malocclusions. Orofacial myofunctional reeducation (OFMR) is the rehabilitation of the muscles, functions and resting postures of the orofacial complex. It is used in the therapeutic management of orofacial dysfunction in patients of all ages and with a wide range of disorders and comorbidities. RMOF mainly uses isotonic and isometric exercises targeting the oral and oropharyngeal structures, combined with specific exercises for ventilation, swallowing and mastication. It may involve the use of prefabricated reeducation appliances (PRAs), which may also be prescribed to modify the shape and relationship of the dental arches.

Objectives: The primary objective of this systematic review of the literature was to describe and evaluate the efficacy of prefabricated reeducation appliance-assisted OFMR in orthodontics, occlusodontics and dental sleep medicine. Its secondary objective was to assess whether the use of currently available PRAs is associated with adverse effects.

Materials and methods: The systematic literature review was undertaken using five electronic databases: Medline (via PubMed), Web of Science, Cochrane Library, Embase, and Google Scholar, to identify studies evaluating the efficacy of PRA-assisted OFMR in the treatment of orofacial dysfunctions and parafunctions, temporo-mandibular dysfunction (TMD) or obstructive sleep apnea (OSA) in children, adolescents and adults, published until 20 March 2023. The primary outcome of interest was the therapeutic efficacy of PRA-assisted OFMR. In patients with obstructive sleep apnoea (OSA), efficacy was assessed primarily by a decrease in the apnoea/hypopnoea index (AHI) of at least five episodes per hour from baseline, improvement in subjective sleep quality, sleep quality measured by nocturnal polysomnography and subjectively measured quality of life. In patients with orofacial dysfunctions, parafunctions or TMD, efficacy was assessed mainly by electromyography (EMG), history and clinical examination. Secondary outcomes were dentoalveolar or skeletal improvements, and possible adverse effects of the PRAs used, including adverse effects on occlusion.

Results: Only fourteen studies met all inclusion criteria: two randomised controlled trials, one non-randomised controlled trial, five prospective case-control studies, two retrospective case-control studies, two prospective case series and two retrospective case series. The two randomised controlled trials were assessed as "low risk of bias" according to the Cochrane Back Review Group's 12 risk of bias criteria. The methodological quality of the remaining 12 included studies was assessed using the ROBINS-I tool, according to the recommendations of the Cochrane Handbook. One was judged to have a measured risk of bias, ei

Introduction: Considered from the perspective of the finesse and skill they require of those who practice them, each of the existing trades has its own specificity. However, by referring to literature on expertise and talent7, we realize to what extent the patterns of the acquisition of expertise and its implementation can have invariants among the different trades.

Methods: Human expertise has been studied in depth, among others, by cognitive sciences, psychology and neurosciences. After exposing the notions of domain of expertise, perceptual-cognitive and sensory-motor competence, the neurobiological and cognitive mechanisms of expertise demonstrating the importance of long-term memory in the acquisition of expertise, for example, by reference to the concept of chunking.

Results: We will seek to determine the characteristics of the orthodontist as an expert, the implications of this quality for the expert's training process, the importance of clinical experience, the extent to which the expert can trust his/her intuition (clinical sense) in his/her daily practice and the paradigm shift constituted by the digital transition, which requires new expertise in the field of developing spatial mental models of 3D structures.