L'' Orthodontie française最新文献

The objective of this study is to compare, based on literature review, the short and long-term efficiency of the correction of anterior openbite in hyperdivergent adults by orthodontics combined with maxillary molar intrusion using temporary anchorage devices (group A), versus maxillary surgical impaction (group B). The articles were retreived from five databases (last update in May 2020). Data selection and extraction are done independently by two reviewers, then validated and gathered after consensus to limit bias. Twelve low to medium evidence level studies meet the inclusion criteria, including two dedicated to jaw impaction surgery. All the studies analyzed short-term dentoskeletal changes, six assessed long-term stability up to 3.5 years for group B and to 4 years for group A. Both groups showed a decrease in anterior facial height and closure of the anterior openbite by mandibular autorotation. The results were stable over the long term for both groups. The orthodontic solution of molar intrusion associated with skeletal anchorage is an alternative to the surgical solution of mild skeletal openbite in adults. Randomized controlled clinical trials with control groups are essential to reach reliable conclusions.

The objective of this case series was to show how only one miniscrew can be used to treat simultaneously or successively canine impaction and different malocclusions. Three patients aged of 13 years old who had malocclusions, such as Class II, overbite and canine impaction, were each one treated with the same miniscrew throughout the treatment period. Palatal miniscrews were placed mesially to the first molar and used as a direct or indirect anchorage depending on the moment of the treatment. In each case, satisfactory treatment was obtained with correction of overbite, class II malocclusion and canine impaction. The first steps of treatment were aesthetic for the patient and did not require patient cooperation.

Some young patients with a significant skeletal shift with a strong morpho-aesthetic and psychological impact may require surgical correction during their growth. A good understanding of facial growth, the different treatment options and the effects of surgery on the post-operative growth pattern will allow the practitioner to use the technique most suited to each of his patients and improve long-term treatment outcomes. So-called « interceptive » surgery may therefore be considered in cases of severe skeletal dysmorphism of secondary or functional origin. It will lead to early normalization with the immediate consequence of breaking the « dysmorpho-dysfunctional » spiral.

The gum and the gingival festoon in particular are essential elements of the good periodontal health and the harmony of the smile. How does this engage orthodontics? Orthodontists are directly concerned by the vertical position of the collars which they must consider. More indirectly, they can have an influence on the gum festoon and in particular on the papillae. The analysis of the literature of the undesirable effects of orthodontics on the periodontium is provided but with limited conclusions which do not constitute scientific evidence. It remains very important to analyze them in order to draw a guide of clinical conduct. The vestibular version and the alveolar expansion present risks of gingival recession that must be taken into account. The presence of the papillae responds to precise anatomical conditions that have to be controlled to avoid disastrous black triangles when aligning the teeth. The shape of the teeth is directly involved in these phenomena. Stripping may be an appropriate therapeutic response to prevent or limit these iatrogenic effects. The approach is first of all diagnostic (identification of the shape of the teeth, analysis of the dento-dental disharmony (DDD), evaluation of the amount of stripping and its consequences on the DDD) and then prognostic in order to establish the treatment plan... The author will illustrate this approach by the teachings of the literature and by clinical illustrations of treated cases. The balance of a smile is based on the respect of shapes, anatomical proportions and the conditions necessary for healthy tissue. It is our role to respect them in the project of establishing harmony. The beauty of the smile reflects the patient's own personality: « Orthodontists are the technicians of the semaphore of the soul », Axel Kahn, Journées de l'Orthodontie, 2007.

Digital dental technologies for design, simulation and fabrication are constantly evolving. It is possible to digitally simulate dental movements, as well as displacements of both arches and to produce thermoformed splints manufactured from this simulation. The authors present the coupling of intraoral 3D scanning with low-dose radiation 3D radiography that allows for a very precise surgical setup, preparation of repositioning aligners, and fabrication of osteosynthesis plates. The orthodontic-surgical management protocol with aligners used by the first author will be described in detail. The authors present, through clinical cases, the progress made in orthognathic surgery thanks to 3D and the Invisalign^® thermoformed tray system. Looking at the three clinical cases presented, it can be seen that the average treatment time was much less than the average time for usual orthodontic-surgical protocols.

The discussion on whether to extract or not is still a source of debate. However, primacy must be given to the diagnosis based on a dental, skeletal, aesthetic and functional assessment. The therapeutic means are intended to achieve the goals resulting from this diagnosis which are the only way to individualize the treatment plan according to the patient. Symphyseal distraction is a surgical procedure intended to increase the mandibular bone base at the symphysis level and then allow an ideal positioning of the mandibular incisor. After explaining the procedure to integrate this intervention in the treatment plan, the author studied in 25 clinical cases the displacement of the mandibular incisor according to the initial crowding and the increase of the distance between the mandibular cuspids before and after bone distraction. Symphyseal distraction is an effective alternative to the treatment of dental crowding to the mandible by helping to restore nasal breathing by its association with maxillary disjunction while respecting of physiology and balance facial.

Digital technologies are gradually integrating our orthodontic practices and retainers, often less considered compared to active devices, are also benefiting. The author will give in this article a brief presentation of the various current possibilities offered by the use of digital tools for carrying out and monitoring fixed or removable retention methods. The digital workflow is perfectly suited to the production of modern and durable retainers, whether for fixed or removable devices, as well as their long-term monitoring. The objective is not to decide on the superiority of one system over another, but to expose all the possibilities for adapting the digital tool to the orthodontist's method of retention. The benefit of using digital technology is saving time and improving performance, minimizing unnecessary manipulation and improving device precision. Digital technology provides all the elements necessary to achieve new generation retainers both more simply, and for them to be more precise and more durable. These technologies are in constant progress and we can still consider improvements in the near future as software and hardware developments progress.

The digital era opens up the field of possibilities: web, e-mail, networks, optical fingerprints, digital storage... It will then be possible to optimize the use of the digital tool for both data collection and storage, information transfer, restitution, implementation of electronic signature, preservation of digital model... However, it must not alter the practitioner's care for his patients. Indeed, securing patients' medical data is an integral part of their care. Even if it is immaterial, their protection as to be effective, even at the physical level. The aim of this article is to list our obligations towards the virtual tool, the management modalities to avoid any prejudice. The research of the texts was carried out on Legifrance, CNIL, Pubmed and the jurisprudence. The authorization to collect data and the possibility to transfer them to a third part is mandatory. The conservation of these data in adequate conditions, both physical and digital, is essential to avoid the loss of the data and the consequent sanctions. The security of medical data requires the protection of the premises, computers and the Internet tool. The implementation of regulated protocols is the only guarantee of data security and good faith in front of the judge in case of loss. It requires the involvement of the entire healthcare team to implement effective procedures.