L'' Orthodontie française最新文献

Aim: 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.

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 patient), 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: Positional plagiocephaly (PP) is characterized by an asymmetrical flatness of the posterior part of the skull which may involve the frontal part of the skull and the face. The aim is to assess whether children and adolescents with PP have more occlusal and skeletal asymmetries and whether the need for orthodontic treatment is greater than in the healthy population.

Material and method: A comparative cross-sectional epidemiological study was carried out. One hundred children and adolescents were included: 50 in the PP group and 50 in the control group. The need for orthodontic treatment was assessed by the Index of Orthodontic Treatment Need (IOTN). The mandibular and dental asymmetries were measured on lateral cephalometry by two indexes: index of mandibular asymmetry (IMA) and index of dental asymmetry (IDA) respectively. Chi and Student independence tests were performed with a threshold of 5%.

Results: The tests are significant for IMA (p = 0.02) and IOTN (p = 0.000012). IDA is insignificant.

Discussion: Orthosurgical treatment of mandibular laterognathies by mandibular recentering sometimes creates mandibular asymmetry, while the shift is basal. We must be able to act early on the vault of the skull to hope to obtain a consecutive effect on the base and therefore on the position of the glenoid cavities. Management by manual therapy and early cranial orthosis could be estimated.

Conclusion: The need for orthodontic treatment is significantly greater in PP. Unlike mandibular asymmetry, dental asymmetry is not significantly greater than in the control group, testifying to the adaptive capacities of the organism.

Introduction: If we must, in all cases, collect the psychological elements of the profile of our patients, in the case of skeletal dysmorphoses, the time of this information gathering is one of the most essential steps for therapeutic success. We must assess whether we are putting the patient at psychological risk, in the case of surgical correction of the bone bases, but these issues also exist in adult orthodontic treatments.

Material and method: We will see how to organize the verbal exchange during the appointments and how to guide the patient in a human way, if a psychological risk appears to us. We will complete the study with “told” examples of psychotherapeutic management of major problems of recognition and acceptance after maxillofacial surgery.

Conclusion: Gathering psychological signs from patients seeking orthodontic care is the first step in the consultation. It is a prerequisite for the clinical examination and complementary tests and is equally essential for the success of the treatment.

Introduction: For planned orthodontic therapy to be effective, it is important to define a treatment time based on the estimation of the child’s growth stage, skeletal maturation and therefore bone age. In a single irradiation via profile teleradiography, it is possible to obtain sufficient information to place the patient on his growth curve since the vertebral stages are good indicators of physiological maturity.

Objective: The objective was to statistically validate the vertebral computerized method (MIV) on a large sample in order to reliably and reproducibly locate the stage of vertebral maturation.

Materials and methods: Hand-wrist radiographs and profile teleradiographs of 30 patients were included to set up the MIV. To validate the MIV, panoramic and telecranial radiographs of 192 children were included in the study. Spearman correlation tests were then performed to assess correlations and Lin’s concordance coefficient calculations were used to analyze concordances.

Conclusion: The correlations and concordances obtained were statistically significant, positive and moderate. The vertebral computerized method is a method that seems reliable and usable in orthodontic practices.

Introduction: Manual, tedious cephalometric analyzes of a lack of productivity (errors in plotting and measurement) making the prospect of a fully automated algorithm turning out attractive. The objectives of the study were to evaluate the positioning (accuracy and precision) of common landmarks by two software programs offering detection by artificial intelligence (WebCeph™ and DentaliQ®) compared to a manual reference and then to the comparators.

Materials and methods: 68 lateral cephalograms were selected, 22 landmarks were distributed manually and then the differences between this gold standard and the points detected by each software were measured, as well as the success detection rate (SDR). Statistical analysis was carried out by “confidence ellipses” and two-tailed t-test (p-value of 5%).

Results: In terms of accuracy, WebCeph™ and DentaliQ® show a 2 mm SDR of 57.2% and 66.5% respectively. In terms of trueness, the best results are obtained for S, Na and the incisal edges. Large random errors are found for the points Po, So, ENA, ENP, Ba and Go. Other points like Pog and B show a large vertical dispersion. Overall, a slight advantage goes to DentaliQ® even if the difference is not significant.

Discussion: The detection precision still seems insufficient for an utilization without human supervision. The results are promising on the detection of certain points. The artificial intelligence saves time for the clinician but the change of positioning of points should still be possible.

Conclusion: Advances are rapid and will probably be soon for an effective clinical use.