L'' Orthodontie française最新文献

Introduction: Retention is the set of means, processes or devices that contribute to maintain the teeth in the position and the arches in the shape given by the treatment as long as possible. Given the heterogeneity of practices, devices used and follow-up modalities, the French Society of Dentofacial Orthopedics, a scientific society, has proposed Clinical Practice Guidelines (CPG) for orthodontic retention. This article presents the method used to develop the CPG full-text and the guidelines produced.

Materials and methods: A review of the literature was carried out after a bibliographic search of databases. The CPG full-text and guidelines were drafted, graded according to the level of evidence, then reread, discussed and validated by the experts of the workgroup. A second review by a group of external experts was then carried out before final validation of the CPG for publication.

Results: Of 652 articles selected, 53 met the inclusion criteria and were used to prepare the CPG full-text to produce 41 grade C items and 23 expert agreements, constituting 40 guidelines.

Discussion: There is still no consensus on the choice of materials. The literature remains poor on the functions. Some devices, more used in France, are poorly documented in the literature.

Conclusion: The CPGs provide recommendations on the factors to consider before using a retainer, the effectiveness of the different devices, their failures and adverse effects, as well as the follow-up procedures.

Introduction: In orthodontics, we need to solve very diverse clinical situations. Classical situations for which the treatment plan will be, with experience, quite quickly carried out. More complex clinical situations for which we are led to think differently. Sometimes, we must modify a treatment plan along the way because unforeseen factors make our original goals unattainable. Faced with these atypical situations, the choice of anchorage arises with even more acuity.

Methods: Through the presentation of two atypical treatment cases, we will discuss the development of the treatment plan, the alternatives, and the choice of anchorage.

Conclusion: In recent years, the advent of mini screws and other bone anchorages have widened the range of possibilities. If, at first glance, conventional anchorage systems might seem to belong to 20th century orthodontics, we believe that they remain an option to consider when establishing even atypical treatment plans, as much for their contribution on the functional and aesthetic level as on the level of the patient journey.

Objective: The focus of this report was to analyze patients who presented for second opinion due to complications and failure following maxillomandibular advancement (MMA) performed elsewhere.

Materials and methods: During a five-year period, 16 patients presented with complications and/ or failure of MMA. The indication for treatment was obstructive sleep apnea (OSA). Analysis of treatment records including plane radiography and/or cone beam computed tomography (CBCT), progress photographs and clinical examination were performed.

Results: Complete clinical and imaging records were available in all patients for analysis. Thirteen patients were surgical failures with advancement ranging from -4 to 5 mm. Five of the 13 patients had limited advancement at the initial surgery, and eight patients had hardware failure that required removal with resultant retrodisplacement of the mandible. Due to complications occurring in 11 patients, additional surgery ranging from two to six additional procedures after the initial operation was required. The complications included hardware failure (ten patients) that led to bone segment displacement (eight patients), non-union of the maxilla (two patients), non-union of the mandible (eight patients), chronic facial and/or joint pain (five patients), facial nerve injury (two patients), complete anesthesia of the lip/chin (five patients) and severe malocclusion (four patients).

Conclusions: Although MMA is typically a predictable operation with excellent outcomes, failure of improvement and severe long-term sequelae from surgical complications are possible. Surgical precision with sufficient skeletal advancement for airway improvement and stable skeletal fixation is necessary to achieve a successful outcome.

Introduction: Despite a high prevalence of agenesis, third molars should frequently be considered in our orthodontic treatment plans.

Material and method: The aim of this study was to describe, according to the literature, the therapeutic possibilities of third molar management.

Results: The avulsion isn't systematic. The French National Authority for Health has updated its guidance about it. Indeed, surgical procedures can present with potentially irreversible risks (nerve damage, bone necrosis). It is necessary to assess the benefit/risk balance and to inform the patient accordingly. Whether symptomatic or not, pathological third molars are among the most obvious indication for avulsion as well as third molars that may lead to resorption or carious lesion of the adjacent molar. On the other hand, it is not recommended to avulse third molars to prevent the appearance of anterior crowding or in case of a favorable evolution. Some of our orthodontic therapies can lead to the avulsion of the third molars: the orthognathic surgery (especially mandibular surgery) or the distalization. They can be placed by transplantation, by mesialization, sometimes with the help of bone anchors, or by straightening the axis for a prosthetic or implant-prosthetic restoration.

Discussion: In the adolescent, the germs of the third molars would not limit the amount of distalization; these molars would continue to grow despite the distalization of the more anterior molars.

Conclusion: Wisdom teeth should be considered as third molars in their own right and can thus be used in edentulous situations.

Introduction: The concept of teleorthodontics was recently born; the Covid-19 crise has participated to the emergence and the amplification of this phenomenon.

Objective: The main aim of the present systematic review was to evaluate the teleorthodontics relevance.

Method: An electronic and manual search was performed in four databases (PubMed, Scopus, Embase and Cochrane Library) up to December 2021 according to PRISMA guidelines. Both prospective and retrospective studies, as well as case reports, case series and satisfaction surveys published in English or in French without time restriction were included. Two independant reviewers were involved in the selection of the studies and a third reviewer was required in case of disagreement. A bias assessment was performed using the Mixed Methods Appraisal Tools.

Results: Out of 1757 articles, 22 articles published mainly between 2019 and 2021 and with varying levels of evidence, were included. Considering the results obtained, different concepts were discussed (time management, quality of communication, reliability and use of tools, satisfaction, quality of human relations, emergency management, compliance).

Conclusions: Teleorthodontics is an interesting and complementary tool that is, in no way, a systematic alternative to face-to-face orthodontic appointments in the office. However, many essential aspects of telemedicine in orthodontics, such as data protection, still need to be investigated in order to fully analyze this tool.

Introduction: Surgical maxillary expansion for the treatment of obstructive sleep apnea (OSA) has become common place. To maximize airway improvement, over-expansion of the maxilla can occur, resulting in an excessively widened maxilla that creates a mismatch to the mandible. Therefore, mandibular symphyseal distraction osteogenesis (MSDO) to widen the mandible along with maxillary expansion is being increasingly advocated in OSA surgery.

Methods: The authors discuss their 20-year experience with MSDO and surgical maxillary expansion. They also analyze the airway impact between Distraction Osteogenesis Maxillary Expansion (DOME) and Endoscopically-Assisted Surgical Expansion (EASE) based on currently available computational fluid dynamic (CFD) data, which has implications in whether MSDO needs to be considered.

Results and conclusion: The goal of surgical maxillary expansion is to enlarge the nasal cavity and reduce the airway resistance. CFD data demonstrates that EASE results in a much greater reduction in airway resistance as compared to DOME. EASE achieved a 12-fold reduction in nasal airway resistance compared to 3-fold reduction by DOME; a 12-fold reduction of retropalatal airway resistance as compared to 3-fold reduction by DOME; a 10-fold reduction of oropharyngeal airway resistance as compared to a 3-fold reduction by DOME, and an 8-fold reduction of hypopharygeal airway resistance as compared to a 3-fold reduction by DOME. Because there is no physiologic basis or data that demonstrates mandibular widening improves OSA, an airway centric surgical expansion technique such as EASE can achieve a much greater airway impact without needing excessive maxillary widening, thus eliminating the necessity MSDO.

Objective: The aim of this study was to evaluate the result of maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA) by a single surgeon.

Materials and methods: Patients that underwent MMA for the treatment of OSA over a 25-year period were included in the study. Patients who initially presented for revision MMA surgery were excluded. Demographics (e.g., age, gender, pre- and post-MMA body mass index [BMI]), pre- and post-MMA cephalometrics (e.g., sella-nasion-point A angle [SNA], sella-nasion-point B angle [SNB], posterior airway space base of tongue [PAS]) and pre- and post-MMA sleep study metrics (e.g., respiratory disturbance index [RDI], lowest desaturation [SpO2-nadir], oxygen desaturation index [ODI], total sleep time [TST], % TST Stage N3 sleep, % TST rapid eye movement [REM] sleep) were abstracted. MMA surgical success was defined as a ≥ 50% reduction in RDI (or ODI) and post-MMA RDI (or ODI) < 20 events/hour. MMA surgical cure was defined as a post-MMA RDI (or ODI) < 5 events/hour.

Results: A total of 1010 patients underwent MMA for the treatment of OSA. The mean age was 39.6 ± 14.3 years, and the majority were male (77%). Nine hundred forty-one patients with complete pre- and postoperative PSG data were analyzed. The mean ODI and RDI improved from 32.6 ± 27.4 to 7.7 ± 15.5 and 39.1 ± 24.2 to 13.6 ± 14.6 events per hour, respectively. The overall surgical success and surgical cure based on ODI was 79.4% and 71.9%, respectively. The overall surgical success and surgical cure based on RDI was 73.1% and 20.7%, respectively. Stratified by preoperative RDI showed older age, greater BMI were associated with greater preoperative RDI. Bivariate predictors of greater RDI reduction include younger age, female gender, lower preoperative BMI, higher preoperative RDI, greater BMI reduction postoperatively and greater change in SNA and PAS. Bivariate predictors of surgical cure based on RDI (RDI < 5) include younger age, female gender, lower preoperative RDI, and greater change in SNA and PAS. Bivariate predictor of RDI success (RDI < 20) include younger age, female gender, lower preoperative BMI, lower preoperative RDI, greater BMI reduction, greater increase in SNA, SNB and PAS postoperatively. Comparison of the first 500 patients and the later 510 patients demonstrate patients undergoing MMA have become younger, having lower RDI while achieving a better surgical outcome. Linear multivariate associations of greater percentage RDI reduction include younger age, greater percent change of SNA, greater preoperative SNA, lower preoperative BMI and higher preoperative RDI.

Conclusions: MMA is an effective treatment to improve OSA, but the result can vary. Patient selection based on favorable prognostic factors and maximizing the advancement distance can improve outcomes.

Introduction: The aim of this study was to analyze the skeletal, dental and airway changes with endoscopically assisted surgical expansion (EASE) to widen the nasomaxillary complex for the treatment of sleep apnea in adults.

Methods: One hundred and five consecutive patients underwent EASE. Cone beam computed tomography (CBCT) was conducted preoperatively and within four weeks after the completion of the expansion process. Computational fluid dynamic (CFD) analysis was performed on 20 randomly selected patients to assess airway flow changes.

Results: One hundred patients (67 males) with the mean age of 35.0±13.5 years (17-64 years) had completed pre- and post-expansion imaging. Ninety-six patients (96%) had successful expansion defined as separation of the midpalatal suture at least 1 mm from anterior nasal spine (ANS) to posterior nasal spine (PNS). The nasal cavity expansion was 3.12±1.11 mm at ANS, 3.64±1.06 mm at first molar and 2.39±1.15 mm at PNS. The zygoma expansion was 2.17±1.11 mm. The ratio of dental expansion to skeletal expansion was 1.23:1 (3.83 mm:3.12 mm) at canine and 1.31:1 (4.77 mm:3.64 mm) at first molar. CFD airway simulation showed a dynamic change following expansion throughout the airway. The mean negative pressure improved in the nasal airway (from -395.5±721.0 to -32.7±19.2 Pa), nasopharyngal airway (from -394.2±719.4 to -33.6±18.5 Pa), oropharyngeal airway (from -405.9±710.8 to -39.4±19.3 Pa) and hypopharyngeal airway (from -422.6±704.9 to -55.1±33.7 Pa). The mean airflow velocity within the nasal airway decreased from 18.8±15.9 to 7.6±2.0 m/s and the oropharyngeal airway decreased from 4.2±2.9 to 3.2±1.2 m/s. The velocity did not change significantly in the nasopharyngeal and hypopharyngeal regions.

Conclusions: EASE results in expansion of the midpalatal suture from the ANS to PNS with a nearly pure skeletal movement of minimal dental effect. The expansion of the nasomaxillary complex resulted in the widening of the nasal sidewall throughout the nasal cavity. The improved air flow dynamics was demonstrated by CFD simulation.