When older adult patients request esthetic enhancement they are mainly concerned about the lower incisors. In fact, for older adult patients, the impact of the mandibular incisors is at least as important as that of the upper jaw incisors on their facial esthetics. This article discusses the importance of specifically documenting this claim and proposes that the diagnostic evaluation of older adult patients should routinely include two specific photos.

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.

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.

Self-ligating brackets have become increasingly established in orthodontics in recent decades. While proponents haveprofessed overwhelming advantages of self-ligation, most notably a reduction in treatment time and a reduced requirement for extractions, there has been little convincing evidence to support many of these claims. In this review the evidence concerning the influence of self-ligating brackets on the efficiency of orthodontic treatment is considered.

The way in which orthodontic patients swallow poses a major problem during treatment, especially for long-term stability of the end result. If clinical diagnosis of atypical swallowing performed in an empirical manner by the practitioner, aided or not by rehabilitation devices, has been the subject of numerous studies, surface electromyography seems to bring new insight in diagnosing the way patients swallow and in re-training atypical deglutition. After a short refresher about the anatomy and physiology of the mechanisms of swallowing as well as the basic principles of electromyography, a descriptive and comparative study was carried out with 60 patients in order to understand and to prove the reliability and pertinence of this diagnostic tool. The results of the study are based on a collection of graphic and visual data compared to maxillo-facial kinesiographic studies where patients underwent a parallel double blind diagnosis. The objective was to determine if surface electromyography provides reliable, exact and reproducible data based on daily screening. Finally, it may be possible to create a flowchart for clinical decision making by using the results of our study as well as the findings in the literature.

Describing an anatomical shape with a landmark points diagram allows the practitioner to use all the tools of geometric morphometry. Using a 14 point trigeminal for maxillofacial morphology, 10 points for basicranial morphology and 6 points for the orbital area, we have been able to identify the specific maxillofacial shapes associated with the major dysplasias (Class II or Class III ‘‘surgical limit’’) or simple malocclusions and to research the possible relationships between basicranial morphologies and maxillofacial morphologies. The asymmetries have thus been linked to other pathologies.

We have compared these results with those obtained by using a three-dimensional cephalometric analysis and with results obtained from the literature.

The conclusions on the epidemiology of the asymmetries are in agreement. Basically, the mandible with dominance of the right hemi-face was confirmed as the causative factor. The stability of the basicranial shape makes a solid case that it is not responsible for maxillofacial or occlusal pathologies.

Faced with a patient who has extensive esthetic enhancement demands, simply aligning the teeth and achieving a functional occlusion might not suffice.

The goal of this article is to help orthodontists to analyze and to optimize the positioning of upper anterior teeth so as to improve the esthetics of the smile.

Of course, esthetics is not an objective notion. Therefore, maintaining good communication with our patients is essential. Nonetheless, esthetic rules as they are defined in the literature will serve as a “framework” for creating a smile.

In this context, the orthodontist will have to take into account the shape of the teeth, particularly since not all shapes are ideal. In fact, the incisors have three main shapes: rectangular, triangular and ovoid. The shape of the teeth will perhaps guide orthodontists in their choice of treatment. Opting for stripping will be the preferred treatment in some cases.

Similarly, orthodontists have to take into consideration incisal edge defects caused by wear associated with the initial malocclusion that becomes more apparent after alignment. In some cases, a simple recontouring or enameloplasty of the incisal edges will be sufficient and should be discussed with the patient before it is performed using a simple and reliable procedure.

Three 10-mm-long miniscrews commonly employed in orthodontic treatment were compared in four different situations involving diverse thicknesses of cortical bone. The finite element method (FEM) was used in the study, in which a force of 250 g was applied in two directions: perpendicular and parallel to the bone surface. As the parameter under study was the thickness of cortical bone, simulations were performed in four different bone loss situations: 2.5, 2, 1.5 and 1 mm. Our aim was also to quantify the stresses and displacements generated when applying a force of 250 g perpendicular and parallel to the bone surface under the same skeletal conditions. The results reveal similar performance in the three analysed samples, with increased stresses and displacements in the surrounding bone in relation to similar variations in the thickness of cortical bone.

Enamel is the most visible tissue of the tooth. It gives the tooth its whiteness, its brilliance and is the main focus of our attention from an esthetic point of view. Unfortunately, it is not uncommon to see alterations in this enamel, whether they are simple localized discolored spots, or more extensive loss of tooth substance. The etiologies, then, are multiple: toxicity during the mineralization of the bud, hyperthermia or a genetic abnormality. As professionals, making an etiological diagnosis and reassuring the parents is a challenge that we must address on a daily basis.

The objective of this article is to offer a simplified and reasonable approach for periodontal disease screening that should be a mandatory part of each and every oral examination. The main purpose of this examination is to answer the question of whether or not there are any infection sites that require periodontal management. This assessment has three parts: the initial patient interview (medical history), the clinical oral examination and the radiological examination. Using a periodontal probe, the dentist should place a high priority on performing PD screening and it should be done systematically and routinely during every consultation. Orthodontists and dentists are both licensed to perform this examination. After this examination, the practitioner can make a diagnosis, initiate periodontal management of the patient or refer the patient to an appropriate specialist.

PD screening should be repeated before orthodontic treatment or before any functional rehabilitation in order to maintain periodontal stability.

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.

Requests for orthodontic treatment have changed over the last few years due to the influence of social discourse and the promotion of the ideal of a forever young and ‘‘perfect’’ body.

The esthetic nature of these requests, even if they have always been implied in any orthodontic consultation, has changed and recently esthetics has been increasingly emphasized by prospective patients.

One consequence of these urgent requests is that orthodontists are on a slippery slope to becoming service providers and they therefore run the risk of no longer being recognized as Health Professionals.

Another consequence is that we now have patients with a very different ‘‘profile’’ which we will attempt to define in this article.

We will discuss esthetic treatment requests and the respective problems for each of three orthodontic age groups (children, adolescents and adults). We will illustrate these problems with three specific clinical cases. And since we are not trained to either identify or successfully manage the problems associated with this type of request, each of us has had to come up with our own clinical response. However, once we are certain or even suspect that we are dealing with a patient at risk (we will define this later) for whom an orthodontic solution is not appropriate, we then have to overcome our own reservations and refer the patient to a mental health professional whose specialized care will make it possible for the patient to become clearer about esthetic requests.

In most cases after everything is resolved, we can then professionally and respectfully take on the management of the patient. By taking these precautions, we will conduct ourselves as Health Professionals who seriously assess both the somatic and psychological dimensions of our patients’ requests.

By limiting its objective to correcting dysmorphisms of the dento-alveolar arches, current treatment of malocclusions loses a great deal of effectiveness that technical procedures might otherwise achieve. An inadequate understanding of the mechanics of the facial envelope can allow the dysmorphisms and breathing dysfunctions associated with malocclusions to persist.

However, the oral fissure has a profound impact on the mechanical behavior of the facial envelope. Like an operational command, it transforms the local mechanics of the facial envelope by creating a phenomenon of a concentration of stress and deformations whose manifestations are visible not only on facial soft tissues, but also on their cartilage and osseous supports. This phenomenon also influences the physiology of the facial muscles by distorting them as they are forced to adapt to the fissure, and by guiding the functional adaptations of the envelope.

Basically, the impact of this phenomenon on the structural organization of the facial envelope is transformed by the oronasal morphophysiologic integration of the structures of the face and practitioners must necessarily adapt their therapy to address these problems. Finally, the functional relationship between the nasal mucosa and the cavernous sinus increasingly broadens orthopedic perspectives for therapy that will most importantly encompass the cephalic hypothalamic-pituitary axis.

The effectiveness of a procedure appropriately initiated by practitioners of DFO due to their specific expertise will require them to exercise a greater attentiveness to the global functionality of this complex into which the face is integrated.

The presence of a chin is a specific and unique feature of the human face that is absent from the face of our hominid ancestors and all other primates. A number of anthropologists have studied this anthropomorphic characteristic and elaborated various theories concerning its genesis and anatomical usefulness. Recent research based on the analysis of stress using the finite element method (FEM) seems to establish that the presence of the chin is a biomechanical consequence of skeletal and muscular equilibrium peculiar to the human face. This data is an important addition to our matrix of thoughts that influences our attitude concerning the chin and orthognathic surgery. In particular, whether or not a genioplasty is necessary, and whether it should be performed separately from orthognathic surgery or at the same time.

Orthodontists and maxillo-facial surgeons are very aware of the different therapeutic options for the correction of maxillary transverse deficiencies. But what about mandibular transverse deficiencies? A number of dentofacial orthopedic mandibular expansion techniques have been suggested, but they often have a tendency to relapse. Symphyseal distraction is the easiest solution for the correction of mandibular transverse defects, particularly in cases of a major deficiency such as Brodie’s Syndrome. In addition to recreating a physiologic occlusion, this technique makes it possible to considerably increase the width of the bony and soft tissue that not only improves the patient’s function and esthetics, but also helps to ensure long-term occlusal stability as well.

The maxillary incisor-canine group above all, plays a crucial role both in the esthetics of the smile as well as in mastication.

The most frequent morphological problems, agenesis, stunted, or peg-shaped maxillary lateral incisors will hinder the anterior guidance and have an adverse impact on the smile (‘‘fang’’ shaped teeth, spaces/overlapping teeth, anomalies in size in relation to neighboring teeth).

The satisfactory reconstruction of the upper six anterior teeth requires first and foremost a proportional relationship between the lateral and central incisors and between the upper and lower six front teeth. A study of the esthetic indices (L/C: lateral/central) and functional (I/S: inferior/superior – mandibular anterior teeth/maxillary anterior teeth) can be a decision aid and can measure the effectiveness of different treatments (adding composites, stripping, ceramic cap, single implant-supported crown).