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The objective of this nonsystematic review of the literature is to determine whether or not self-ligating brackets are an equally effective alternative to traditional brackets for non-extraction treatments. The agreed upon criteria are indications for extractions, the biomechanical approach, the stability of the treatment results, the iatrogenic effects and the ergonomics.
The studies discuss arch expansion with the use of self-ligating brackets. One study mentions a lack of control of osseous management including tipping and buccal bone thickness in the lateral sectors. The mandibular incisor inclination that was obtained does not appear to be correlated to the type of bracket but rather to initial factors specific to the patient. We didn’t find any study dealing with the long-term stability of the results.
Regarding patients, self-ligating brackets do not reduce the pain, the number of extractions, the incidence of resorption or the risk for caries. Self-ligating brackets shortened the clinical time for an experienced practitioner but not the length of the time of comprehensive treatment and alignment. Some studies report an increase in cases of emergency. Finally, these brackets are more difficult to position.
Rare diseases represent a major public health challenge due to their number, presently estimated to be between 6000 and 8000, their severity and the absence of any preventive treatment. The enactment of two National Plans for Rare Diseases by the establishment of Referral Centers and Diagnosis and Treatment Centers has brought about a recognition of the specificity of these disorders, the creation of a epidemiological database, a framework for rapid diagnosis protocols at the first symptoms, greater access to specialized care to accompany the afflicted and their families during their frequently difficult medico-social journey, training of skilled health professionals in the field of these rare diseases, promotion of basic and clinical research and finally the development of European partnerships in both research and therapeutic planning.
This article offers a series of justifications for early interceptive treatment as opposed to later treatment that might necessarily involve the extraction of permanent teeth. The biological responses of the membranous sutures, of the periosteum, of the periodontal ligaments, and of the condylar cartilages but also of the potential for growth in stature, well before the pre-pubertal growth spurt and the administration of effective treatments, are also reasons that support an early phase of treatment, in the early mixed dentition, even in the primary dentition!
Some early orthodontic or orthopedic treatments and their appliances such as buccal screens, myofunctional trainers, occlusal splints or sectional expansion plates and other maxillary expansion and protraction appliances are useful for correcting deformities or severe under-developments that are already in place.
But myofunctional re-education, when carried out according to a structured and prioritized program, is perhaps the most important because these etiopathogenic treatments used to both suppress the causes of the deformations and to restore balanced function, make it possible to re-establish a normal growth pattern and perhaps consequently, to avoid the need for extraction of permanent teeth.
Pediatric dentistry plays an important part in the orthodontic treatment of patients with rare orofacial diseases. Interactions between these two disciplines are numerous and particularly noteworthy in the following pathologies:
cleft lip and palate;
After reviewing the main characteristics of these pathologies, we will highlight the fundamental role of pediatric dentistry in the early diagnosis, the prevention and the dental care throughout the orthodontic treatment. A close cooperation between the orthodontist and the pediatric dentist is a key factor to a successful treatment.
The dental surgeon can feel inadequate when confronted with a rare disease: (a) difficult diagnosis, (b) therapeutic complexity, (c) and questioning by the parents, are three major obstacles that we have to overcome in order to carry out our therapy. Even if the field of genetics has made major advances during the last few years, it is clinical knowledge, above all, that leads us to a diagnosis. Certain syndromes present with very subtle signs which alone can appear trivial but which, taken together, defines a pathological entity. To know or to discover these signs and to recognize them is therefore the first challenge.
Among rare diseases, a fifth of them are associated with oral manifestations. The most frequent are: enamel dysplasia, cleft lip or palate and oligodontia. Beside the pathology, patients are eager of functional therapeutics which often needs prosthodontics. This oral rehabilitation aims to a better life quality.
Teeth absence management in the case of oligodontia necessitates critical analysis of the supporting tissues: the periodontium and the underlying bone. Deciduous teeth with resorbed roots and hypoplasic permanent teeth are often observed. Thus, some questions arise: can we use them as abutments or can we restore them knowing that they present an anomaly in their position and are more fragile? How do we replace many teeth when bone is lacking (clefts, agenesis)? Can we implant on a missing tooth site or can we use autograft? What do we expect for periodontal healing?
Adjacent teeth have often migrated, occlusion is unstable due to mixed dentition and patient’s disease. For example, in mandibular incisors agenesis cases, the remaining deciduous teeth are used when consultation happens at adolescence. This results in upper jaw incisors migration toward mandible and thus an anterior overbite. Orthodontic treatments will allow to recreate gap width and a normal occlusion in order to perform prosthodontics treatment in the best possible conditions. Giving the weak dental and periodontal supports, our attention will be focused on choosing the best option between tooth and implant supported prosthodontics. During the mixed dentition, orthodontic treatment and aesthetic rehabilitation have to be planed at the same time and to last until “definitive” implant and periodontal therapies are possible. In this article, we will present one oligodontia case report to illustrate a possible solution.
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.
Orthodontists frequently prescribe prophylactic enucleation of the lower third molars. These teeth are mostly totally asymptomatic. This practice is being recommended more and more frequently, even though published studies are more reserved in this respect. Orthodontists have to reconsider their recommendations for prophylactic enucleation of the lower third molars, but they have to make sure whether or not these teeth will erupt into their correct positions in the arch.
Over the past decade, the interest for miniscrews is continuously growing as confirmed by the amount of recent published studies. In particular, their use allows to make corrections in a single phase and avoids extractions of premolars, while keeping usual goals of treatment. Main results of pilot studies and some clinical examples are presented here to illustrate our therapeutic approach for the treatment of tooth discrepancy in Class I, Class II and Class III situations.
Orthognathic surgery, is often required for patients with rare diseases in order to normalize occlusion that is generally severely affected. There is no one specific surgical approach because anomalies encountered in this population often require various complex technical procedures. Unlike common dental malocclusions, agenesis, skelettal dystrophies and functional problems are gathered. Orthodontic preparation, before surgery, is made difficult, resulting in a challenging treatment process. In certain cases, the stability of the result can be uncertain due to major dysfunctions. However, given the functional as well as morphological improvement that these procedures bring about, they should be planned if the dysmorphia is significant.
Indications for the extraction of permanent healthy teeth in dentofacial orthopedics, has been an object of polarized debate between extractionists and nonextractionist since the beginning of the twentieth century.
In a media-hyped environment, where extractions have become routine, this concern that is not addressed during consultation, poses a problem for the patient-practitioner relationship. The practitioner is confronted with a criminal liability known as a failure to respect the physical integrity of the human body and to treat in the patient's best interest. But the question remains: is it ethical to extract healthy teeth?
Our study among an orthodontic population of 1,095 patients indicates that 9% of the subjects have at least one agenesis (3% for maxillary lateral or mandibular central/lateral incisors).
Regarding possible treatments, we evaluated the different solutions from the less invasive to the most invasive: simple space closure, space closure with laminated veneers, space opening with a cantilevered bonded bridge, space opening with implant.
Recent advances in biomimetic dentistry suggest that now is the time for a paradigm shift.
Hypohidrotic ectodermal dysplasias (HED) are a heterogeneous and complex group of syndromes characterized by a dental craniofacial phenotype associated with severe oligodontia, maxillary hypoplasia with broad face and most notably facial concavity. Cephalometric analyses show insufficient maxillary sagittal growth, a protruded mandible, reduced facial and ramus heights, as well as basicranial changes. Early diagnosis and care from a multidisciplinary team are essential. In the primary dentition, initial prosthetic treatment is recommended and may possibly be combined with interceptive orthodontic treatment. In the mixed dentition, treatment of a transverse maxillary deficiency consists in installing a removable expander or a quadhelix in the case of moderate phenotypes where there is adequate anchorage support. To achieve mandibular anterior repositioning of the maxilla the patient must wear a facial mask. In the permanent dentition, the important steps are correlated with the pre-implant and pre-prosthetic orthodontic adjustments, as well as the presurgical orthodontic preparation that precedes subsequent single or double jaw orthognathic surgery. Temporary skeletal anchorage with mini-screws or plates can be used in cases of insufficient anchorage.