Orofacial myofunctional reeducation: how to handle simple in office cases? / Rééducation myofonctionnelle orofaciale : comment prendre en charge les cas simples in office ?

Introduction: The prevalence of lingual dyspraxia is high but not all patients require management by a physical therapist. The aim of this article is to propose a decisional flow chart separating, via diagnostic criteria, patients who can be managed in office from patients requiring oromyofunctional rehabilitation by an oro-myo-functional rehabilitation (OMR) professional and to provide, if necessary, simple exercise sheets. Material and Method: An expert, a maxillofacial physiotherapist from the Fournier school, has proposed, based on the literature, her experience as a clinician and in consultation with orthodontists, different criteria for the severity of dyspraxia as well as exercises to be implemented for cases that are manageable in the office. Results: The decision tree, diagnostic criteria and exercises are provided. Discussion: The flowchart is based on the literature, mainly on expert opinion given the low level of evidence of published studies. The exercise sheet was created by a physiotherapist from the Fournier school and necessarily reflects this influence. Conclusion: Further studies such as a clinical trial could compare the validity of the WBR indication obtained by an orthodontist using the decision tree with the blinded indication given by a physical therapist. In addition, the effectiveness of in-office rehabilitation could be evaluated using a control group.

Introduction: La prévalence des dyspraxies linguales est élevée mais leur prise en charge par un kinésithérapeute spécialisé n'est pas requise pour la totalité des patients. L'objectif de cet article était de proposer un organigramme décisionnel séparant, via les critères diagnostiques, les patients pouvant être gérés in office des patients nécessitant une rééducation myofonctionnelle orofaciale chez un professionnel de la rééducation myofonctionnelle orofaciale (RMOF) et de fournir, le cas échéant, des fiches d'exercices simples. Matériel et méthode: Une experte, kinésithérapeute maxillo-faciale, issue de l'école Fournier, a proposé, en s'appuyant sur la littérature, son expérience de clinicienne et en concertation avec des orthodontistes, différents critères de sévérité de dyspraxies, ainsi que des exercices à mettre en œuvre pour les cas gérables in office. Résultats: L'arbre décisionnel, les critères diagnostiques et les exercices sont fournis. Discussion: L'organigramme s'appuie sur la littérature, essentiellement sur des avis d'experts compte tenu du faible niveau de preuve des études publiées. La fiche d'exercices ayant été réalisée par une kinésithérapeute issue de l'école Fournier reflète nécessairement cette influence. Conclusion: Des études complémentaires, telles qu'un essai clinique, pourraient permettre de comparer la validité de l'indication de la RMOF obtenue par un orthodontiste à l'aide de l'arbre décisionnel avec l'indication posée en aveugle par un kinésithérapeute. Par ailleurs, l'efficacité de la rééducation délivrée in office pourrait être évaluée à l'aide d'un groupe témoin.

Development of professional recommendations on orthodontic retention: short version / Développement de recommandations professionnelles sur la contention en orthodontie : version courte

Introduction: Retention is the set of means, processes or devices that contribute to maintain the teeth in the position and the arches in the shape given by the treatment as long as possible. Given the heterogeneity of practices, devices used and follow-up modalities, the French Society of Dentofacial Orthopedics, a scientific society, has proposed Clinical Practice Guidelines (CPG) for orthodontic retention. This article presents the method used to develop the CPG full-text and the guidelines produced. Materials and Methods: A review of the literature was carried out after a bibliographic search of databases. The CPG full-text and guidelines were drafted, graded according to the level of evidence, then reread, discussed and validated by the experts of the workgroup. A second review by a group of external experts was then carried out before final validation of the CPG for publication. Results: Of 652 articles selected, 53 met the inclusion criteria and were used to prepare the CPG full-text to produce 41 grade C items and 23 expert agreements, constituting 40 guidelines. Discussion: There is still no consensus on the choice of materials. The literature remains poor on the functions. Some devices, more used in France, are poorly documented in the literature. Conclusion: The CPGs provide recommendations on the factors to consider before using a retainer, the effectiveness of the different devices, their failures and adverse effects, as well as the follow-up procedures.

Introduction: La contention est l'ensemble de moyens, de procédés ou de dispositifs contribuant à maintenir le plus longtemps possible les dents dans la position et les arcades dans la forme données, par le traitement. Compte tenu de l'hétérogénéité des pratiques, des dispositifs utilisés et des modalités de suivi, la Société Française d'Orthopédie Dento-Faciale, société savante, a proposé des recommandations de bonne pratique (RBP) sur la contention orthodontique. Cet article présente la méthode d'élaboration de l'argumentaire scientifique et les recommandations produites. Matériels et méthodes: Une revue de la littérature a été réalisée après recherche bibliographique dans les banques de données. Un argumentaire scientifique et des recommandations gradées en fonction du niveau de preuve ont été rédigés, puis relus, discutés et validés par les experts du groupe de travail. Une deuxième relecture par un groupe de lecture, composé d'experts externes, a ensuite été effectuée avant la validation finale des recommandations pour diffusion. Résultats: Sur 652 articles sélectionnés, 53 répondaient aux critères d'inclusion et ont permis de rédiger l'argumentaire scientifique pour en tirer 41 items de grade C et 23 accords d'expert constituant 40 RBP. Discussion: Le choix des matériaux ne fait pas encore consensus. La littérature reste pauvre sur les fonctions. Quelques dispositifs, davantage utilisés en France, sont peu documentés dans la littérature. Conclusion: Les RBP fournissent des recommandations sur les facteurs de choix préalables à la réalisation d'une contention, l'efficacité des différents dispositifs, les échecs et les effets indésirables de ceux-ci, ainsi que sur les modalités de suivi.

Orofacial myofunctional reeducation: what is the scientific background? / Rééducation myofonctionnelle orofaciale : quelles justifications scientifiques ?

Introduction: In 85% of orthodontic patients, lingual dyspraxias are present and may justify orofacial myofunctional rehabilitation because of their morphogenetic potential. The objective of this literature review is to search for scientific arguments corroborating or not the relationships between dysmorphias and the static, dynamic labio-lingual-jugal balance during functions and parafunctions. Material and Method: A review of the literature was carried out by keywords on PubMed. The search covered the period from 1913 to 2022. A complementary selection of articles or book chapters was made from the references of the included articles. Results: The morphogenetic role of the tongue is mainly involved at rest and during ventilation in all three dimensions. Oral ventilation is associated with many craniofacial dysmorphy. Concerning swallowing, phonation, non-nutritive sucking and temporomandibular joint dysfunctions, it is the combined association of several anomalies that is found in dysmorphia without a causal link being established. Thus, for some, the lingual posture would only constitute an adaptation to a dysmorphia. Discussion: Essentially based on expert opinion, the level of evidence is still insufficient. The authors are confronted with the difficulty of finding adequate, quantifiable and reproducible indicators. Conclusion: This subject, which probably remains neglected because it is interdisciplinary and the result of a historically European reflection, deserves to be further studied.

Introduction: Chez 85 % des patients orthodontiques, les dyspraxies linguales sont présentes, pouvant justifier une rééducation myofonctionnelle orofaciale en raison de leur supposé potentiel morphogénétique. L'objectif de cette revue de littérature était de rechercher les arguments scientifiques corroborant ou non les relations entre les dysmorphies et l'équilibre labio-linguo-jugal statique, dynamique lors des fonctions et des parafonctions. Matériel et méthode: Une revue de littérature a été réalisée par mots clés sur les bases de données PubMed (Medline) et EM Consulte. La recherche s'étend sur la période de 1913 à 2022, une sélection complémentaire d'articles ou de chapitres de livres a été effectuée à partir des références des articles inclus. Résultats: Le rôle morphogénétique de la langue intervient essentiellement au repos et lors de la ventilation dans les trois dimensions. Une ventilation buccale est associée à de nombreuses dysmorphies cranio-faciales. Concernant la déglutition, la phonation, la succion non nutritive et les dysfonctionnements des articulations temporo-mandibulaires, c'est la conjugaison de plusieurs anomalies qui est retrouvée dans les dysmorphies, sans que le lien de cause à effet ne soit établi. Ainsi, pour certains, la posture linguale ne constituerait qu'une adaptation à une dysmorphie. Discussion: Essentiellement basé sur des avis d'experts, le niveau de preuves demeure encore insuffisant. Les auteurs se heurtent à la difficulté à trouver des indicateurs adéquats quantifiables et reproductibles. Conclusion: Ce sujet, qui reste probablement délaissé car il est interdisciplinaire et le résultat d'une réflexion historiquement européenne, mérite d'être davantage étudié.

Comparative study of two software for the detection of cephalometric landmarks by artificial intelligence / Étude comparative de deux logiciels de détection de points de repère céphalométriques par intelligence artificielle

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.

INTRODUCTION: Les analyses céphalométriques manuelles, fastidieuses souffrent d'un défaut de reproductibilité (erreurs de tracé et de mesure), rendant la perspective d'un algorithme totalement automatisé séduisante. Les objectifs de l'étude étaient d'évaluer le positionnement (justesse et précision) de repères courants par deux logiciels proposant une détection par intelligence artificielle (WebCeph™ et DentaliQ®) par rapport à une référence manuelle puis de les comparer. MATÉRIELS ET MÉTHODES: 68 téléradiographies de profils ont été sélectionnées, 22 repères ont été placés manuellement puis les écarts entre ce gold standard et les points positionnés par chaque logiciel ont été mesurés, ainsi que le taux de détection avec succès (ou Success Detection Rate, SDR). L'analyse statistique a été effectuée par « ellipses de confiance ¼ et t-test bilatéral (p-value de 5 %). RÉSULTATS: En termes de précision, WebCeph™ et DentaliQ® affichent un SDR à 2 mm de 57,2 % et 66,5 % respectivement. En termes de justesse, les meilleurs résultats sont obtenus pour S, Na et les bords incisifs. Des erreurs aléatoires importantes sont trouvées pour les points Po, So, ENA, ENP, Ba et Go. D'autres points comme Pog et B présentent une grande dispersion verticale. Globalement, un léger avantage revient à DentaliQ®, même si la différence n'est pas significative. DISCUSSION: La précision de détection mesurée semble encore insuffisante pour une utilisation sans supervision humaine. Les résultats s'avèrent prometteurs sur la détection de certains points, l'intelligence artificielle permettant un gain de temps, mais le repositionnement des points doit rester possible. CONCLUSION: Les progrès sont rapides et permettront probablement prochainement une utilisation clinique efficiente.

Does positional plagiocephaly affect the need for orthodontic treatment, and the mandibular and occlusal symmetry? / La plagiocéphalie positionnelle a-t-elle des répercussions sur le besoin de traitement orthodontique et sur la symétrie mandibulaire et occlusale ?

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: Les plagiocéphalies positionnelles (PP) sont caractérisées par un aplatissement asymétrique de la partie postérieure du crâne pouvant impliquer la partie frontale du crâne et la face. L'objectif de cet article était d'évaluer si les enfants et les adolescents atteints de PP ont davantage de dissymétries occlusales et squelettiques, et si le besoin de traitement orthodontique est plus important que dans la population saine. Matériel et méthode: Une étude épidémiologique transversale comparative a été menée. Cent enfants et adolescents ont été inclus : 50 dans le groupe PP et 50 dans le groupe témoin. Le besoin de traitement orthodontique a été évalué par l'Index of Orthodontic Treatment Need (IOTN). La dissymétrie squelettique et dentaire a été évaluée radiologiquement par deux indices : l'Index of Mandibular Asymmetry (IMA) et l'Index of Dental Asymmetry (IDA). Des tests d'indépendance du Chi et Student ont été effectués avec un seuil de 5 %. Résultats: L'IMA (p = 0,02) et l'IOTN (p = 0,000012) sont significatifs. L'IDA est non significatif. Discussion: Le traitement ortho-chirurgical des latéromandibulies par recentrage mandibulaire crée parfois une dissymétrie mandibulaire, alors que le décalage est basal. Il faudrait pouvoir agir précocement sur la voûte du crâne pour espérer obtenir un effet consécutif sur la base et donc sur la position des cavités glénoïdes. Une prise en charge par thérapies manuelles et orthèse crânienne précoce pourrait être évaluée. Conclusion: Le besoin de traitement orthodontique est significativement plus important en cas de PP. Contrairement à la dissymétrie mandibulaire, la dissymétrie dentaire n'est pas significativement plus importante que dans le groupe témoin, témoignant des capacités adaptatives de l'organisme.

Bisphosphonates: how to proceed in orthodontics / Bisphosphonates : conduite à tenir en orthodontie

Introduction: Bisphosphonates are mainly used in the treatment of osteoporosis and in oncology. They bind to bone and inhibit the action of osteoclasts, leading to a decrease in bone remodeling and thus hindering tooth movement. The main objective was to present, through a review of the literature, the indications and therapeutic modalities for orthodontic treatment of patients who are or have been treated with bisphosphonates. The second objective was to propose a decisional organization chart for medical care. Materials and Methods: The search was done by keywords on PubMed. Results: 189 articles were found, mostly case reports. 1) Intravenous treatment is a contraindication to ODF treatment. 2) Per os treatment is possible with precautions: to be in accordance with the prescribing practitioner, avoid major travels, avoid surgical procedures (extractions...) which must be as atraumatic as possible. A delay in healing is to be expected. The benefit-risk ratio must be taken into account. The risks - the patient must be informed of them - are slowed movement and osteonecrosis. Clinical and radiological follow-up is necessary and may warrant re-evaluation of treatment at any time: excessive tooth mobility, molar furcation damage, unusually persistent periodontal pain and symptoms, fistulas, exposed areas of necrotic bone. Discussion: The articles are of low grade. Most of the articles are studies made on animals. Conclusion: Research is ongoing to evaluate the value of bisphosphonates as anchorage reinforcement.

Introduction: Indiqués essentiellement dans le traitement de l'ostéoporose et en oncologie, les bisphosphonates se lient à l'os et inhibent l'action des ostéoclastes, entraînent une diminution du remodelage osseux et inhibent donc le déplacement dentaire. L'objectif principal de cet article était de présenter, via une revue de littérature, les indications et les modalités thérapeutiques orthodontiques pour les patients sous ou ayant été sous bisphosphonates. L'objectif secondaire était de proposer un organigramme décisionnel de prise en charge. Matériels et méthodes: La recherche a été faite par mots-clés sur PubMed. Résultats: Au total, 189 articles ont été trouvés, majoritairement des rapports de cas. On peut en déduire : 1) Un traitement par voie intraveineuse en cours est une contre-indication au traitement ODF. 2) En per os, le traitement est possible avec des précautions : se mettre d'accord avec le médecin prescripteur, éviter les gros déplacements, éviter les gestes chirurgicaux (avulsions…) qui doivent être le plus atraumatiques possibles. Un retard de cicatrisation est à prévoir. Le rapport bénéfice/risque doit être pesé. Les risques ­ dont le patient doit être informé ­ sont le ralentissement de déplacement et l'ostéonécrose. Un suivi clinique et radiologique est nécessaire et peut justifier à tout moment une réévaluation du traitement : mobilité excessive des dents, atteinte de la furcation des molaires, douleurs et symptômes parodontaux inhabituellement persistants, fistules, zones exposées d'os nécrotique. Discussion: Les articles sont de faible grade. La majorité des articles sont des études sur l'animal. Conclusion: Des recherches sont en cours pour évaluer l'intérêt des bisphosphonates en renfort d'ancrage.

Third molars in the orthodontic therapeutic decision / Les troisièmes molaires dans la décision thérapeutique en orthodontie

Introduction: Despite a high prevalence of agenesis, third molars should frequently be considered in our orthodontic treatment plans. Material and Method: The aim of this study was to describe, according to the literature, the therapeutic possibilities of third molar management. Results: The avulsion isn't systematic. The French National Authority for Health has updated its guidance about it. Indeed, surgical procedures can present with potentially irreversible risks (nerve damage, bone necrosis). It is necessary to assess the benefit/risk balance and to inform the patient accordingly. Whether symptomatic or not, pathological third molars are among the most obvious indication for avulsion as well as third molars that may lead to resorption or carious lesion of the adjacent molar. On the other hand, it is not recommended to avulse third molars to prevent the appearance of anterior crowding or in case of a favorable evolution. Some of our orthodontic therapies can lead to the avulsion of the third molars: the orthognathic surgery (especially mandibular surgery) or the distalization. They can be placed by transplantation, by mesialization, sometimes with the help of bone anchors, or by straightening the axis for a prosthetic or implant-prosthetic restoration. Discussion: In the adolescent, the germs of the third molars would not limit the amount of distalization; these molars would continue to grow despite the distalization of the more anterior molars. Conclusion: Wisdom teeth should be considered as third molars in their own right and can thus be used in edentulous situations.

Introduction: Les troisièmes molaires, malgré une prévalence d'agénésie élevée, doivent fréquemment être prises en compte dans nos plans de traitement orthodontique. Matériel et méthode: L'objectif de l'étude était de décrire, selon la littérature, les possibilités thérapeutiques de gestion de la troisième molaire. Résultats: L'avulsion n'est pas systématique. La Haute Autorité de Santé a mis à jour ses recommandations à ce sujet : la chirurgie présente des risques dont certains peuvent s'avérer irréversibles (lésion nerveuse, nécrose osseuse). Il est nécessaire d'apprécier la balance bénéfice/risque et d'informer le patient. Les troisièmes molaires pathologiques, qu'elles soient symptomatiques ou non, font partie des indications d'avulsions, de même que les troisièmes molaires pouvant entraîner une résorption ou une lésion carieuse de la molaire adjacente. En revanche, il n'est pas recommandé d'avulser les troisièmes molaires pour prévenir un hypothétique encombrement antérieur, ni en cas de susceptibilité d'évolution favorable. Certaines de nos thérapeutiques orthodontiques peuvent amener à l'avulsion des troisièmes molaires : la chirurgie orthognathique (notamment mandibulaire) ou la distalisation. Leur mise en place peut être effectuée par transplantation, par mésialisation parfois à l'aide d'ancrage osseux ou par redressement d'axe en vue d'une restauration prothétique ou implanto-prothétique. Discussion: Chez l'adolescent, les germes de troisièmes molaires ne limiteraient pas la quantité de distalisation ; celles-ci poursuivraient leur évolution malgré la distalisation des molaires plus antérieures. Conclusion: Les dents de sagesse doivent être considérées comme des troisièmes molaires à proprement parler et peuvent ainsi être mises à profit dans des situations d'édentement.

Orthodontic brackets debonding: evaluation of the time factor and the tooth type / Décollement des attaches orthodontiques : évaluation du facteur temps et du type de dent

Introduction: The aim of the study was to assess the time factor and tooth type during premature debond of orthodontic brackets. Material and Method: A retrospective epidemiological study was carried out on adolescents who had benefited from a multi-metal vestibular attachment treatment, having all 6 to 6 teeth bonded to the arch on the day of installation. Results: 333 patients were included. The detachment rate decreased as the treatment progresses. The teeth with most orthodontic debonding were the maxillary first molar, mandibular first molar, mandibular second premolar, and maxillary second premolar. Skeletal class II patients tended to take off more than class I patients. Detachments were significantly more frequent in the mandibular arch in deepbite compared to normalbite patterns, the mandibular second premolar being the tooth at risk. There seems to be a correlation between the quality of oral hygiene and the rate of detachment, regardless of the time of treatment. Discussion: The type of orthodontic movement, the quality of the bonding, the failure to observe the precautions by the patient may affect the date of the detachment. The low coronary height, hygiene, the biting force, the divergence seems to intervene on the type of attachment debonded. Conclusion: The brackets are more particularly debonded at the start of treatment and on the posterior teeth. Anteroposterior and especially vertical dysmorphosis could have an implication in debonding.

Introduction: L'objectif de l'étude était d'évaluer le facteur temps et le type de dent lors du décollement prématuré des attaches orthodontiques. Matériel et méthode: Une étude épidémiologique rétrospective a été réalisée sur les adolescents ayant bénéficié d'un traitement multi-attache vestibulaire en métal, ayant toutes les dents collées de 6 à 6 sur arcade le jour de la pose. Résultats: Au total, 333 patients ont été inclus. Le taux de décollement diminuait au fur et à mesure du traitement. Les dents avec le plus de décollements d'attaches orthodontiques étaient la première molaire maxillaire, la première molaire mandibulaire, la deuxième prémolaire mandibulaire et la deuxième prémolaire maxillaire. Les patients en classe II squelettique ont tendance à davantage décoller que les patients en classe I. Les décollements étaient significativement plus fréquents à l'arcade mandibulaire chez les hypodivergents que chez les mésodivergents, la deuxième prémolaire mandibulaire étant la dent à risque. Il semble exister une corrélation entre la qualité de l'hygiène buccale et le taux de décollement, quel que soit le moment du traitement. Discussion: Le type de déplacement orthodontique, la qualité du collage, le défaut d'observance des précautions par le patient peuvent intervenir sur la date de décollement. La hauteur coronaire faible, l'hygiène, la force de morsure, la divergence semblent intervenir sur le type d'attache décollé. Conclusion: Les attaches sont plus particulièrement décollées en début de traitement et sur les dents postérieures. Les dysmorphoses antéro-postérieures et surtout verticales pourraient avoir une implication dans le décollement.

[Relevance of Class II interceptive treatments. Synthesis of the valid conventional means of study]. / Pertinence des traitements interceptifs de classe II. Mise en perspective avec la validité des moyens conventionnels d'étude.

The relevance of Class II interceptive therapy is controversial. The objective of this literature review was to note its indications and if a benefit is proven. We carried out a systematic search on PubMed from 1999 to 2019 by keywords on randomized trials. Fourteen articles were selected, mainly grade B or C. The criteria evaluated were dental, skeletal, psychological, aesthetic, as well as cost, duration, incisor fractures, rate of stroke, complexity and treatment need. Overjet is an important criterion for the indication of interceptive treatment, but it is not the only one. The skeletal criterion, assessed mainly by the ANB, is only significant for three articles; the improvement of self-esteem is proven in one article and the interceptive treatment allows an aesthetic improvement (alignment of the maxillary incisors). The overall cost of treatment would be higher for two-step treatment. In only two articles, the authors wonder if the interceptive treatment facilitates future treatment. The rate of compensatory strokes and extractions are widely studied. The main criteria studied are ANB (controversial indicator), incisor fracture rate (trauma) and overjet. Certain non-significant results must be put into perspective with the aim of the studies and the methods used.

[What are the risk factors specific to patient for debonding of orthodontic brackets?] / Quels sont les facteurs de risque de décollement des attaches orthodontiques propres au patient ?

The premature detachment of orthodontic brackets has consequences for the patient and the practitioner. While the responsibility for the bonding protocol has been widely assessed, the responsibility of the patient is poorly understood. The main objective of the study was to look for patient-specific predictors of metal vestibular attachment detachments. An historical cohort study was carried out from adolescents having benefited from a fixed vestibular appliance treatment lasting 27 months +/- 3 months, having all teeth from first molar to first molar on arch to pose. Univariate and multivariate analyses were performed by logistic regression. 333 patients were included. In univariate analysis, boys tended to take off more than girls, patients in skeletal Class II more than those in Class I, those with at least two cooperative remarks more than those with less than two remarks. The percentage of patients with debonding increases with the number of hygiene remarks. Younger patients were more prone to debond than older patients. The "age" factor has a significant effect in multivariate analysis. Neither the vertical skeletal pattern nor the socio-economic level would intervene in the rate of debonding. The role of patient-specific factors in detachment should be put into perspective. The reliability of the results would be increased by a prospective study using validated indicators of compliance.

[Miniscrews during the retention phase: indications, therapeutic means and effects]. / Les minivis pendant la phase de contention : indications, moyens et effets thérapeutiques.

Even if miniscrews are mainly used in the active phase, their uses during the contention have been reported for a few years either by installation of miniscrews de novo or by taking advantage of miniscrews inserted during the active phase. The objective of this article is to describe the uses - reported in the literature - of miniscrews during the retention phase. We have conducted a research from the database PubMed with keywords associations. Nineteen articles were found with three indications: to temporarily replace toothlessness while awaiting the final prosthetic solution at the end of growth while maintaining bone level; to contain open-bite treatments in order to avoid as much as possible the relapse; to improve the comfort and aesthetics of Hawley plate. This prospect of using miniscrews after active treatment further opens up the field of possibilities. However, there is the problem of osteointegration and bone damage caused by the removal of miniscrews linked to the maintenance of miniscrews over the long term.

[Openbite in hyperdivergent adult: Le Fort I impaction versus maxillary molar intrusion using bone anchorage. A literature review.] / L'infraclusie chez l'hyperdivergent : impaction de Le Fort I versus ingression molaire maxillaire par ancrage osseux. Une revue de la littérature.

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.

[Biomechanics of mini-implants : analysis of the adverse effects of four clinical situations and proposed resolutions]. / Biomécanique des mini-implants : analyse des effets parasites de quatre situations cliniques et propositions de résolutions.

The biomechanical adverse effects generated by our treatments must be considered among the failures of mini-implants, certainly excellent means of anchorage. The aim of this article was to illustrate and comment on mechanical adverse effects and to propose solutions. Four common clinical situations in vestibular technique are analyzed, decomposed three-dimensionally and solved. Maxillary incisor intrusion in direct traction (mini-implant between lateral incisors and canines in direct anchorage) can lead to a disto-labial rotation of the supporting teeth and an incisor flaring. Maxillary incisivo-canine retraction (mini-implant between 5 and 6 in direct anchorage) leads to a canine rotation, a clockwise rotation of the occlusal plane and a version of the adjacent teeth. The maxillary molar two-steps distalization (mini-implant between 5 and 6 with metal ligation to the canine) causes a rotation of the adjacent to the spring teeth, an incisor flaring and a molar disto-version. The protraction of a mandibular molar (mini-implant between 3 and 4 in direct anchorage) causes a disto-labial rotation, a lingual torque and a mesio-version of the molar as well as an incisor flaring and a clockwise rotation of the occlusal plan. The compensation bends on the adjacent teeth, the choice of the location and the type of mini-implant, the use of a power arms to get closer to the center of resistance are among the means of resolution. If mini-implants anchorage allows a significant quantitative effect, adverse effects should be considered individually with a three-dimensional biomechanical analysis.

[What are the factors influencing the aesthetic requirement in the choice of orthodontic appliances in adults?] / Quels sont les facteurs influençant l'exigence esthétique dans le choix du dispositif orthodontique chez l'adulte ?

Although adult patients are said to be demanding in terms of discretion of the orthodontic appliance, the factors influencing the choice of the appliance are still poorly understood. The main objective of this study was to determine if there is a correlation, in adults, between the importance of the orthodontic treatment need and the aesthetic preference of the orthodontic appliance (metal braces, ceramic braces in buccal, lingual or aligner). The secondary objectives were to evaluate the impact of the patient's personal factors, his eventual orthodontic past and his perceived orthodontic need. Patients were interviewed by questionnaire before the first consultation. An index, depending of the discretion of the appliance, was used. The need for treatment was calculated via dental health component and aesthetic component of IOTN. Given the size of the sample, only trends can be emitted. The real need for treatment had no influence on the choice of the aesthetic appliance. The most demanding patients would be women, in their thirties, single, employed, executive or practicing a higher profession, with previous orthodontic treatment and having recently consulted an orthodontist, as an adult. These patients felt that their orthodontic treatment need was minimal or significant. Patients estimated the duration of treatment at 17 months. Lingual was considered the most aesthetic appliance far ahead of the aligners. A larger scale study is needed to determine the influence of each factor.

[Google Reviews: a descriptive study of 700 orthodontic practices]. / Avis Google : une étude descriptive sur 700 cabinets d'orthodontie.

As it is the case in the medical sector, Google reviews of orthodontic practices are on the rise. The main objective of the study was to describe the internet ratings and opinions on orthodontic practices in France. The second objective was to test the factors that influence the number of reviews and the overall rating. We conducted a descriptive study on Google reviews, on 700 specialists in orthodontics in mainland France. 87% of offices got at least one review on Google. An office receives an average of 9.6 comments; 63.6% of reviews are associated with comments; 10.8% of opinions receive a response from practitioners. The average number of stars is 4.1 (+/- 0.7) out of 5. Four types of comments are significant in the context of a multivariate analysis: monetary considerations, the level of hygiene felt, temporal parameters (punctuality…) and the setting of the office. Opinions regarding therapeutic assessments, even though they are the most frequent, only concern 40% of the comments. The socio-economic level of the city, the population density and the concentration of practices are not explanatory factors for the number of reviews or the average rating. A comment related to punctuality or fees lowers the grade. Opinions are given spontaneously and do not necessarily reflect patient satisfaction. A comparative study of the patient actual satisfaction with the average rating on Google could be interesting.

[The Ball Abutment: new orthodontic applications for fixed and removable appliances. Case series]. / L'attachement boule : nouvelles applications orthodontiques pour dispositifs fixes ou amovibles. Une série de cas.

Widely used, especially for supra-implant solutions, the indication of attachments is now extended to orthodontics. The objective of this series of cases was to describe three clinical situations in which attachments on miniscrews have been adapted to orthodontics, leading to the development of a new connection: the ball attachment or Ball Abutment making it « semi removable ¼ anchoring devices which until now had to be fixed. A series of three cases is presented. For each case, the miniscrew(s) already in place during the active orthodontic treatment phase is (or are) used with a palatal device (palatal plate or palatal expander). In the latter case, the Ball Abutment, of relatively simple use, is fixed over the miniscrews allowing the device to offer controlled looseness. This attachment allows the clinician to put in place space-saving devices promoting the retention of the devices, at the border between the fixed and the removable device, sometimes less bulky and more discreet, particularly for adult patients. They could be part of lingual technique treatments. Tests are necessary to assess this orthodontic device in terms of materials, design and retention. This connection offers a new range of possibilities and design of semi-removable passive devices that increase the multifunctionality of miniscrews during treatment.

[Multipurpose miniscrews: combined canine disimpaction and malocclusion correction]. / Mini-vis polyvalentes : désinclusion de canine combinée à la correction de différentes malocclusions.

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.

[Brackets positioning errors and available solutions. A review of the literature]. / Erreurs de positionnement des boîtiers et solutions disponibles. Une revue de la littérature.

Due to many innovations, bonding in the sense of bracket positioning is continually remodeling itself. Therefore, we wanted to define what a good bonding was and how to achieve it, both by identifying factors that could alter it and by evaluating the bonding assistances currently available. We carried out the synthesis of 65 comparative studies from PubMed. The inter-individual variations in dental morphologies are greater than the differences in the prescriptions available for the brackets. Tweed's bonding procedure at constant heights alters the leveling of the marginal ridges of the posterior teeth. The gauge improves the vertical positioning of the brackets, regardless of the clinician's experience. There is no clinical evidence to a superior efficiency of individualized techniques. The prescriptions of Mc Laughlin and Bennettseem more aesthetic than those of Andrews for the anterior teeth. The avail of indirect bonding is not obvious. Individualization is necessary in lingual technique, but does not allow better results in vestibular technique compared to conventional standardization. Evolutions are to be expected with the modeling of the individual biological response to induced tooth movement. While digital assistance is promising, it does not replace the expertise of the orthodontist.

[Magnets in orthodontics : which indications, which effects ? A review of the literature]. / Les aimants en orthodontie : quelles indications, quels effets ? Une revue de la littérature.

The first publication on the use of magnets in dentistry for stabilizing prosthetics on implants dates back to 1953. Clinical development in orthodontics, without having experienced a real boom, has increased over the past ten years, in parallel with the improvement of the device. The objective of this review of the literature is to synthesize clinical applications and reported iatrogenic effects. A systematic review of the international literature from the Pubmed and Cochrane databases from 1999 to July 2018 was conducted which resulted in 36 articles. The factors studied are the indications and contraindications, the means or procedure, as well as the iatrogenic effects. Original cases are presented. The correction of infraclusions is the main indication, followed by the correction of anteroposterior malocclusions and then the correction of over-erupted teeth. Traction of an impacted teeth and diastema closure have not been found in recent publications probably because of the low benefit-risk ratio. The future no longer seems to be buried magnets or left in the long term in the mouth considering there seems to be concerns in terms of toxicity (or even the risk in terms of vital prognosis). The magnets could offer interesting perspectives to manage the current limits of the aligners, the movements of anterior egression, rotation and previous torque being still problematic...

[Dentofacial dysmorphoses : distant links with musculo-skeletal system and posture] / Dysmorphoses dento-faciales : relations à distance avec le système musculo-squelettique et la posture : une revue de la littérature.

According to several theories, the oro-facial sphere would be interconnected with the rest of the body justifying the requests for care to improve a body zone at a distance. The aim of this literature review was to look for potential distant links of dysmorphoses of the three dimensions of space according to the etiopathogenic theories and the data of science. We carried out a keyword search leading to 58 references. In the transverse dimension, the transverse maxillary hypoplasia and dissymmetry of the molar class of the transverse dimension would not induce a change in the distribution of the weight of the body on a stabilometric platform. In the vertical dimension, hyperdivergent patients have a decreased bite force, cephalic extension with respect to the spine, an extension of the base of the skull, and decreased cervical lordosis. In the anteroposterior dimension, skeletal classes II would be associated with increased cervical lordosis and posterior cephalic extension according to the « true vertical ¼ (inversely for classes III). The prevalence of dental classes II would be increased in scoliosis subjects. Studies with a low level of evidence (grade III, IV or even V) should be interpreted with caution because the simultaneous presence of concomitant anomalies does not allow us to conclude that there is a cause-and-effect relationship.