This article reviews the normal and pathological healing processes that take place after tooth extraction in orthodontic cases, and their associated complications within the mucosa or alveolar socket, such as gingival clefts or bone defects. The general and local factors that are involved in such deficient healing cases are detailed, in parallel to surgical procedure to enhance ridge preservation or to ‘regenerate’ tissues. The relationships between the orthodontist and periodontist are underlined, because both praticioners assess patient's risk factors and follow him during this treatment stage.

By definition, orthodontists take special care in achieving a high quality occlusion when finishing cases, believing good contacts are essential to maintain dental health, function, and insure stable long-term of results. The T-scan III system provides a real-time digitized analysis of occlusion, in both static and dynamic modes, and records the distribution of occlusal forces within the dental arches in different clinical situations. While the first T-Scan generations versions showed weaknesses, recent technical improvements have made T-scan a reliable and reproducible tool, whose findings are independent of the operator. It is now possible to calibrate the sensitivity of the sensor for individual patients, and to evaluate the quality of records so that comparisons can be made between various stages of a patient’s treatment, as well as between patients. In addition to the accuracy of occlusal diagnosis, that often exceed clinical requirements, the T-scan III also can help understanding better each patient’s functional pattern. This article describes the T-scan III occlusal analysis system, reviews current literature that evaluated its clinical use, and outlines its principal indications in dentofacial orthopedics. Four clinical cases treated with full bonded lingual appliance will illustrate how the Tscan III influences orthodontic case finishing : one case of “occlusal discomfort” after completion of surgical and orthodontic treatments, a case of cervical abfraction lesions, a case of anterior deep bite restored with an implant-supported prosthesis, and a case of severe facial hemiatrophy treated with a complex protocol.

Dental wear is deterioration as a result of use. It has existed since the beginning of mankind in all civilizations and cultures. It occurred routinely and intensely in early populations but was considered to be a physiological process. Ideas about dental wear are not as clear today because while it is less pronounced it sometimes appears in pathological patterns. Moreover, it is produced by many complex mechanisms acting in synchrony or sequentially, in synergy or additive, in patterns that often mask its true origins. In an effort to ameliorate the means of preventing and diagnosing dental wear and improving our understanding of its diverse manifestations, the primary objective of this article will be to present the principal mechanisms that produce it as well as their consequences. To organize our presentation we have adopted a tribological approach, focusing on the friction, wear, and lubrication of interacting surfaces.

Practitioners should aim to diagnose as early as possible the development of malfunction of the masticatory system, or temporomandibular disorder (TMD), that causes pain, discomfort and a decrease in functional efficiency, especially in those patients whose occlusion is being rehabilitated in the course of orthodontic treatment. This is particularly true for the segment of the patient population who are characterized by certain risk factors.

Armed with a good understanding of the diagnostic classification of TMD, orthodontists will be better prepared to pinpoint and diagnose TMD and, if necessary, adopt the most appropriate mode of therapy for treating it.

Thanks to a good understanding of TMD nosology, orthodontists will be able to distinguish between muscular and joint disorders and then manage patients in accordance with specific diagnostic criteria.

There are many ways dentists can restore teeth prosthetically. Depending on its condition of relative integrity or more serious breakdown and the patient’s loss of other teeth, the practitioner can choose from a variety of quite different procedures ranging from the fabrication of a single ceramo-ceramic crown on a vital tooth to correction of considerable loss of teeth with an implant supported bridge. This paper will evaluate most of these treatment modalities and, in addition to purely prosthetic considerations, will discuss the integration into treatment of periodontal, implant, occlusal, and functional concepts.

Orthognathic surgery has as its objective the repositioning of basal bone in the framework of maxillo-mandibular deformities. Its results are both esthetic and functional. For adults, improved aesthetics results is becoming increasingly important in these procedures to the point where some patients seek only an esthetic amelioration and not a functional one. To achieve their aesthetic purpose, it is becoming progressively more necessary for orthodontists, oral surgeons, and general dentists to collaborate effectively in a well-coordinated effort. In what has now become a true sub-specialty, orthognathic surgeons must master the complementary techniques of rhinoplasty, osseous apposition, aesthetic facial surgery, fat injection or injectable anti-aging tratments. In this article we propose a diagnostic classification based on the aesthetics of the adult smile and describe the therapeutic modalities appropriate for each element.

External root resorption is a feared complication during orthodontic procedures. It can affect both the apex, but also the cervical zone of the roots subjected to orthodontic forces for tooth movement and can compromise the future of the involved teeth. The patient must be informed about the risks of resorption as a consequence of orthodontic treatment. The detection of resorptions can occur during and/or after the active phase of orthodontic treatment.

Knowledge of the clinical situations predisposing the patient to resorption is essential. The data are still insufficient to avoid them completely. Early and precise detection is essential, and the cone beam with its high resolution 3D images, can compensate for the diagnostic inaccuracy of digital panoramic and periapical films. There are treatment solutions and their prognosis is correlated to early detection. Apical resorptions, generally not infected, can mostly be stopped by discontinuing orthodontic forces. Cervical resorptions, with a bacterial component, will require surgical intervention with curettage and restorative build-up of the resorbed area. Current research, particularly in genetics, is in the developmental stage. In the future, the conclusions of this research will allow orthodontists to more precisely target at risk patients so as to avoid these complications.

Angle corrected anterior crowding by advancing the crowns of the incisors. For a long time he hoped the apices would follow along spontaneously. Then because of the uncertainty of this reaction, he started his quest for an appliance that would be able to accomplish root movement. The first one was difficult for orthodontists to manipulate, the second did not incorporate vertical control, but the third had all the qualities Angle was looking for. He died satisfied.

Condylar hyperplasia is a rare pathology of the growth of the mandibular condylar cartilage leading to facial deformation. A bone scan demonstrates the active or inactive character of the condylar hyperplasia and helps guide therapeutic choices. There are two types of condylar hyperplasia, horizontal and vertical growth. Early condylectomy is the treatment of choice for active forms.

Orthodontists, thanks to their keen appreciation of facial morphology and their skills in making functional examinations, are ideally placed to detect breathing problems in their patients that can require an ENT assessment, with special attention paid to the evaluation of sleep patterns. After a site of obstruction, resulting from a soft tissue anomaly and/or a narrowing of the airway passage through bone, has been established, orthodontists may be called upon to undertake corrective treatment sometimes in conjunction with a surgical procedure.

The relationship between occlusion and posture has been a continual source of interest to all participants in the delivery of health care. But a certain amount of confusion still beclouds the subject because of the wide diversity of therapeutic approaches designed to deal with it and the weakness of methodological design in the scientific studies that have been published on it to date.

This article addresses the questions raised by that correlation between occlusion and posture as well as the therapeutic implications of a clinical approach integrating treatment of corporal posture into orthodontic care. A review of the literature shows that there is a dearth of reliable experimental data dealing with this subject. The data that is available points to the existence of this correlation and also asserts the prevalence of associations between idiopathic scoliosis and cranio-facial anomalies in adolescents.

The published facts appear to support our clinical impressions and subjective convictions. In order to enlarge our vision to encompass patients as entire human beings instead of compartmentalized biological segments each to be treated by an appropriate specialty it would be helpful if members of the various medical disciplines improved the lines of communication with each other. An equally desirable development would be the establishment of fundamental research and clinical programs that would help to establish causal relationships that would put therapy on evidence based foundation.

The objective of this work is to study the static and dynamic occlusion of dentitions in a Class III molar relationship to determine what might be the indications for treatment that would leave buccal segments in this position, and to evaluate the occlusal adaptions that would be needed to make it functionally acceptable.

Asymmetries are found in every living being. A non-symmetrical structure is not necessarily pathological. Why then, is the diagnosis of asymmetry relevant for us as practitioners? In orthodontics, we can anticipate difficulties with treatment if we are well informed about the principles of symmetry and thoroughly familiar with craniofacial growth.

Severe mandibular asymmetry is relatively rare, appears early and becomes apparent at first sight to the practitioner. We find it associated with syndromes in patients for whom early multidisciplinary treatment is indicated.

Dyssymetry is a defect rather than an absence of symmetry. It is a mild form of asymmetry where the line between pathological and nonpathological is still unclear. The face can present different types of dyssymmetries including the whole gamut ranging from dental imbalance to imbalances of the jaws to cranial imbalances, each with its own signature that leaves its characteristic mark on the face. When dealing with mandibular laterodymorphias, the diagnosis must be made early in order to initiate an individualized treatment plan. We are providing some summary fact sheets that make it possible for the practitioner to clearly distinguish between the principal mandibular anomalies.

Since 2005 in France, the national technical committee of prenatal ultra-sound screening (CNTE) has recommended that pregnant women have a routine second trimester ultrasound screening for facial clefts. The view on the coronal reference plane visualizes the continuity of the upper lip, and makes it possible to detect most facial clefts, but not isolated palatal clefts.

If thickening of gingival soft tissue and root coverage are indicated, these two procedures should be performed prior to starting orthodontic treatment. The decision to initiate these treatments can be made only based on a clinically exact and reproducible diagnosis. The case described in this article is that of a 53-year-old woman presenting Miller Class III gingival recessions from 13 to 23 and 32 to 42. Because of this impairment, she needs orthodontic treatment. The patient’s periodontal biotype is thin.

The objective of the surgery discussed in this article is both to thicken the periodontium of the patient and to promote coverage of the recessions. To achieve these two objectives, we have chosen the modified “envelope” technique with insertion of connective tissue.

The 18 month post-operative results show an excellent rate of root coverage and a significant esthetic improvement of the gingiva.

Current evidence based data found in the scientific literature recommend that the therapeutic management of patients suffering from temporomandibular disorders (TMD) should be based initially on simple, conservative and reversible procedures including exercise therapy. The integration of this message into oral health instructions for patients makes it easy for them to keep informed about TMD and aware of the steps they can take to deal with their symptoms. The integration of exercise therapy into structured patient education programs provides patients with information about TMD and suggests methods to deal with it. This medical approach is similar to those used to treat other joints in the musculoskeletal system.

Easy to set up, this exercise therapy helps patients suffering from temporomandibular disorders to become partners in the conduct of their treatment plan of reducing pain and restoring functional comfort.