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.

[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.

[Orthognathic surgery of mandibular asymmetry: which results can we expect with and without chin wing? A cohort out of 51 cases]. / Traitement ortho-chirurgical de la latéromandibulie : quels résultats escompter avec et sans chirurgie du contour mandibulaire ? Une étude de cohorte sur 51 cas.

INTRODUCTION: The aim of this retrospective cohort is to evaluate the amount of postsurgical correction of soft and hard tissues in patients with mandibular asymmetries and to compare the results with and without surgery of the lower mandibular contour (chin wing…). MATERIAL AND METHOD: Mandibular asymmetries cases of three surgeons were systematically included. The angles of deviation of the chin, bi-commissural, bi-gonic and occlusal were measured on face photography and radiography. A pre and post-surgical comparison was performed and the amount of correction was analyzed via the Wilcoxon statistical test. RESULTS: 51 patients (44 women and 7 men) were included. After surgery, the correction is significant for all measurements with an improvement of 44 to 60% depending on the measured angles. No patient is normalized but the small initial mandibular asymmetries are the closest to normal after surgery. The correction of the bi-commissural angle is controlled without being optimal (60% correction). The difficulty remains the horizontalization of the bi-gonial plan which is only corrected at 45%. Patients with mandibular margin surgery (chin wing…) showed the greatest improvement in bi-gonial (p = 0.0142) and occlusal (p = 0.0154) angles. CONCLUSION: If surgery allows a significant correction of facial dissymmetry, this is not complete. Surgical procedures on the lower edge of the mandible such as the chin wing could provide a better correction especially for bi-gonial and occlusal angles.

[Discontinuation of Orthodontic Treatment: what are the early predictive factors?] / Abandons de traitement orthodontique : quels sont les facteurs predictifs precoces ?

INTRODUCTION: Discontinuation of orthodontic treatment has iatrogenic, psychological, ergonomic and financial consequences. The objective of this study was to investigate early risk factors (prior to installation) of discontinuation of orthodontic treatment. MATERIALS AND METHODS: We performed a case-control study between a group of patients who dropped their orthodontic treatment ("A") and a randomly selected group of patients who had completed their orthodontic treatment ("NA"). The two groups were compared, with descriptive, uni and multivariate analyzes. The risk factors assessed were age, gender, socioeconomic status, type of treatment, dysmorphism, malocclusion, need for treatment, compliance. RESULTS: In the dropout group 55 patients were included ("A") and 100 in the non-abandoned ("NA") group randomly selected. The subject at risk of abandonment was a girl of less than 11 years of age with a low socio-economic level with antero-posterior and vertical skeletal dysmorphisms, a molar class II, a teeth crowding, a small aesthetic prejudice or, on the contrary, very important, complex treatment (with extractions or with surgery) and having delays or missed appointments before the installation of the orthodontic appliance. CONCLUSION: Patients' motivation needs to be strengthened for both extremes: treatments that appear simple and conversely for complex cases requiring strong cooperation.

[Mandibular asymmetry: determination of a reliable skin measurement technique]. / Latéromandibulie : détermination d'une mesure cutanée fiable.

INTRODUCTION: Clinical measurements in the frontal view underevaluate chin deviation in mandibular asymmetry. The aim of this descriptive study is to search for a reliable method of measuring deviant chins using a facial X-ray as reference. MATERIAL AND METHOD: Seventy patients with mandibular asymmetry who had consulted a maxillofacial surgeon were systematically included. Age, sex, cephalometric characteristics, reasons for patient consultation and type of surgery were collected. Two cephalometric methods were tested with respect to the medial sagittal plane (PSM) to compare the assessment of mandibular asymmetry on soft tissue and by cephalometry. RESULTS: On average, the patients selected were young (26 years +/- 9), women (75% of cases), presented open bite (average FMA: 28° +/- 8°), a skeletal class III tendency, a left-side shift of the chin (63% of cases). They consulted for both aesthetic and functional reasons (51% of cases) and required bimaxillary surgery (66% of cases). Comparison between the photographic angle (formed by the PSM and the line passing through the nasion and reaching the chin point) and the radiographic angle (formed by the PSM and the line passing through the Crista Galli process and the bony chin point angle) showed no significant difference (p = 0.937) and is thus reliable.

[The smile: a challenge in the treatment of class III]. / Le sourire : un enjeu dans la décision thérapeutique des classes III.

INTRODUCTION: The smile poses a challenge in the treatment of class III. Untreated, the class III patient presents excessive maxillary torque and a predominant display of the mandibular incisors, a sign that becomes more visible with age. Functional orthopedics restores the aesthetic appearance of the smile by maxillary protraction (sometimes temporarily because 20% of cases will still need surgery). Depending on the initial severity of the case (-4.5 mm AoBo would be the threshold value), the options are compensation or surgical correction. In both cases, the profile is improved but without normalising the cephalometric values. In recent years, the number of published cases treated by compensations (often using skeletal anchorage) has multiplied with broader indications, particularly for Asian patients in whom Le Fort I surgery gives questionable aesthetic results. Attention must be focused on the occlusal plane rotation which alters the smile by displaying the mandibular incisors. Nevertheless, surgery can handle the most severe cases with a greater degree of improvement. AIM: The aim of this article is to determine the cephalometric cut-off values for an acceptable smile in Class III patients. MATERIALS AND METHODS: We performed a search on Pubmed using the following keywords: Class III, anterior cross bite, smile, camouflage, orthognathic surgery; then secondarily, using references supplied by the articles found. We then analysed the data. RESULTS: The ortho-surgical protocol associated with extractions of maxillary first premolars appears to be the way to obtain the best results in terms of the smile (versus surgery without extractions and versus orthodontic compensations) because it is, in fact, the only way to restore the normal position and torque of the maxillary incisors, thus increasing their display during smiling.

[Dento-facial orthopedics and osteopathy]. / Orthopédie dento-faciale et ostéopathie.

Osteopathy has grown rapidly. Given their common action on children and adolescents, the collaboration between dentofacial orthopedics and osteopathy is increasingly common. It therefore becomes necessary and urgent to investigate whether, based on data acquired from science, there is evidence of possible interrelations between the two disciplines. After reviewing the literature, very few scientific publications demonstrate the utility of osteopathy and its relationships with other disciplines. However, the relationship between occlusion and posture seem relatively proven, especially in the sagittal direction. On the other hand, although the mobility of the cranial bones is established, the primary respiratory motion is still subject to controversy, even among osteopaths. This, even as orthodontics has long been accused of countering the primary respiratory motion of cranial bones (PRM). Today osteopaths do not reject orthodontics anymore, because the return to a physiological bite situation is considered beneficial. According to expert opinion (without proof, however), some orthodontic devices (like headgears) which block the sutures are still to be avoided and require appropriate monitoring osteopathy. The controversy over the adverse effects of orthodontic treatment is becoming more nuanced by osteopaths, and modern orthodontics claiming a «global¼ approach of patient, collaboration may be possible in future year.

[Early treatment of Class III: a long-term cohort study]. / Traitement interceptif de classe III: une étude de cohorte à long terme.

The aim of this comparative retrospective short- and long-term study was to evaluate the interceptive treatment in Class III malocclusion in daily orthodontic practice. The sample was composed of 69 children divided into two groups according to the interceptive treatment applied: 31 children in group F (facial mask) and 38 in group M (interceptive fixed appliance). A Pancherz cephalometric analysis was carried out on the lateral head films at the start of the study (t(0), after the active treatment (t(1) and 29 months after t(1) (t(2). The two groups were compared at the beginning of the study by t-test and chi-squared test: there were no difference between groups M and F except for facial divergence, which was greater in group M. Long-term comparison (interceptive and post-interceptive stage i.e. six years) showed that (i) overjet was corrected in each group: molar discrepancy was stable in both groups, (ii) alveolar discrepancy was stable and (iii) antero-posterior discrepancy was not improved in either group. At t(2) there were no differences, either qualitative or quantitative between groups M and F. In the end, more than 80% of the children did not need an orthognathic surgery.