Cleft palate with/without cleft lip in French children: radiographic evaluation of prevalence, location and coexistence of dental anomalies inside and outside cleft region.

INTRODUCTION: Prevalence of dental anomalies in cleft patients is higher than that in general population. The objectives of this study were to assess the prevalence of dental anomalies and their coexistence in French children with cleft and, then, to investigate the relation between the dental anomalies and the cleft type. MATERIAL AND METHODS: Seventy-four non-syndromic cleft patients (6-16 years old) from Lille Regional University and Mondor-Chenevier Hospitals (France) were included. Clefts were classified as right/left unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP) and cleft palate (CP). Dental anomalies were investigated on panoramic radiographs and categorized as agenesis, supernumerary teeth, incisor rotations, impacted canines and shape anomalies. Prevalence and gender distribution of dental anomalies, mean number of affected teeth per patient, agenesis occurrence and location, and coexistence of dental anomalies were analysed by cleft type. RESULTS: 96.0% of patients presented at least one dental anomaly (agenesis 83.8%, incisor rotations 25.7%, shape anomalies 21.6%, impacted canines 18.9%, supernumerary teeth 8.1%). BCLP patients had a higher number of affected teeth, and left UCLP patients had a higher one compared to right UCLP patients. Distribution of inside (45.3%) and outside (54.7%) cleft region agenesis was similar. Adjacent (31.8%) and not adjacent (33.3%) combined dental anomalies were often encountered. CONCLUSIONS: Dental anomalies were localized inside as well as outside cleft region and were often associated with each other. BCLP patients were more affected. CLINICAL RELEVANCE: Early radiographic evaluation allows a comprehensive diagnosis of inside and outside cleft region anomalies, required for the multidisciplinary dental treatment.

[Amelogenesis imperfecta and anterior open bite: how to optimize patient management? A review of the literature]. / Amélogenèse imparfaite héréditaire et béance antérieure : comment optimiser la prise en charge ? Une revue de la littérature.

INTRODUCTION: Amelogenesis imperfecta is a genetic disease, characterized by a structural defect of the enamel and has variable clinical expressions. It can be isolated or associated as part of a syndrome. Three clinical forms exist: hypoplastic, hypomature and hypomineralized. DISCUSSION: Enamel fragility involves dentin exposure and dental hypersensitivity as frequent consequences. Some severe forms are mainly associated with an anterior open bite. The care of these patients constitutes a real challenge for the dentist. Materials et Methods: A literature review was carried out using the PubMed, Web of Science and Scopus interfaces over the past ten years in order to highlight the different treatment options available. CONCLUSION: From conservative to surgical treatment, it is necessary to develop a collaboration between the orthodontist and the pediatric dentist in order to offer multidisciplinary care adapted to the patient's needs.

[Influence of mandibular somesthesia on cephalic deviation and spatial representations]. / Influence de la somesthésie mandibulaire sur la déviation céphalique et les représentations spatiales.

Mandibular proprioception would influence postural control. The development of spatial references are governed by the same afferences. This work aims to clarify the role of mandibular proprioception, implicated in postural and spatial dysfunctions, in the control of cephalic posture and spatial repositories. 24 subjects received a vibration of the masseter and temporal muscles. Measurements of head position (HP) (video), subjective visual vertical (SVV) and line bisection (LB) were obtained with and without vibration. Without vibration, HP (0.31 ° ± 1.76 °) was negatively correlated with SVV (+ 0.23 ° ± 0.62 °, r22 = -0.44, p = 0.033); with vibration, HP on the opposite side to the stimulated muscle (t23 = 2.77, p = 0.011). There is a correlation between LB and SVV. Without vibration, the Müller effect is found for SVV. The pseudo-negligence is not found. With vibration, the error of the HP and the SVV go in the same direction. No effects on the LB. Conclusion: Beyond local responses, the vibration can evoke global and oriented responses.

[Primary failure of eruption: combined vision between paediatric dentist and orthodontist]. / Défaut primaire d'éruption: regard croisé entre le pédodontiste et l'orthodontiste.

In their daily practice, orthodontists and pedo- dontists have a common aim which is to ensure a functional establishment of the permanent denture. Due to the increase of eruption defects/failures with no clear obstacles, the doctor may encounter some difficulties to elaborate a diagnosis or even feels helpless when in need to define and put in motion a correct therapeutic strategy. The primary failure of eruption (PFE) is an extensively studied disease that has to be distinguished from an ankylosis during the diagnosis to improve the patient care. A thorough research of scientific literature has been achieved in order to keep our knowledge on the subject up to date and to develop the diagnosis further on primary failure of eruption. The exploitation of scientific data as well as the use of imagery and genetics, provided us with helpful elements for the primary failure of eruption diagnosis. It also allows the pedodontist and the orthodontist to avoid an unsatisfactory patient care who will be informed prior to the start of the treatment.

[Computerized method for calculating cervical vertebral maturation]. / Méthode informatisée pour le calcul de l'âge osseux vertébral.

For Helm, "the rhythm of facial growth often governs the course of orthodontic treatment". The moment of treatment is an important dimension for our therapy to last a minimum of time with a greatest chance of success and stability. This notion of processing time is a daily requirement in our practices. The radiographs of the wrists will gradually disappear according to the ALARA principle, since we can in a single irradiation, via the profile radiography, have sufficient information to situate the patient on its growth curve. The vertebral stages are good biological indicators of individual skeletal maturity but their interpretation remains difficult. In this work, a computerized method was used to determine the stage of vertebral maturation in a reliable and reproducible manner. In this study, 15 young boys and 15 young girls (total 30 patients) were included, 12,2 years old on average with a standard deviation of 2,6 years. To determine the skeletal age of these patients, the practitioner made an hand-wrist x-ray and, for diagnostic reasons, he also made a profile radiography the same day. The patients who didn't made an hand-wrist x-ray were excluded. The vertebral computerized method seems to be a reliable method to be used in orthodontic practices. Other studies would allow to use this method for average ages, gender-appropriate.

[Craniomandibular relations and anti-gravity posture: stabilometric study disclusion wedges]. / Relations cranio-mandibulaires et posture anti-gravitaire : étude stabilométrique de cales de désocclusion.

Cephalometric parameters are thought to influence static posture. The present work evaluates the relationships between skeletal class or facial divergency, on one hand, and body posture, on the other hand. ANB and FMA angles were measured from profile cephalograms in twenty healthy adults. From each, stabilograms were recorded, with eyes open or shut, and with or without disclusion splints. Without splints, ANB and FMA proved to correlate with the accuracy of postural control. Adding splints changes the average position of the center of pressure exerted on the ground by the body, the anterior-posterior axis, and this effect is consistent with that of the typology. It also alters the displacement of the center of pressure on the same axis. These effects depend on whether the eyes are open or closed. The data reinforces the notion of the impact of cephalometric parameters and their mechanical changes on the static posture. They invite us to take greater account of postural impact of splints used in orthodontic practice.

[A particular temporomandibular disorder: the temporomandibular joint ankylosis. Basic and clinical concepts]. / Un trouble temporo-mandibulaire particulier : l'ankylose. Notions fondamentales et cliniques.

Ankylosis of the temporomandibular joint mostly affects children and young adults. Although it is rare, it is an extremely debilitating disease whose effects on growth, morphological development and personal development are significant. To manage this disorder, it is essential to be informed about the causes, about the anatomical shapes it presents and about its symptoms. This knowledge will also help us choose the most appropriate therapy, that may nevertheless result in failures and in relapses requiring prosthetic rehabilitation.

[Upper central incisors and asymmetry: a significant orthodontic challenge]. / Incisives centrales maxillaires et symétrie : un enjeu orthodontique majeur.

In any assessment of the esthetic characteristics of a smile the central incisors play a decisive role. Moreover, correction of their malpositions and, especially, their asymmetry, is one of the principal reasons patients consult orthodontists. The etiology of this asymmetry may be vertical, with one incisor more erupted than its mate or horizontal, with a mid-line discrepancy, and can be objectified by a clinical examination and supplementary studies, especially radiological as a means of helping orthodontists adopt the most appropriate treatment plan. In accordance with the etiopathogenesis of the malocclusion, alveolo-dental trauma, skeletal asymmetry, or asymmetry of arches, the orthodontic treatment may be undertaken on three levels, with the teeth themselves by extrusion, intrusion, or rotation; regionally with the arches by retraction of teeth en masse; or globally at the skeletal level with maxillo-facial surgery. The complexity of some treatment in relation to the coordination of different levels of therapeutic action is intensified by the occasional necessity of obtaining collaboration of other specialists like general dentists, periodontists, and maxillo-facial surgeons. In such cases the initial treatment plan takes on increased importance, as does the choice of collaborating colleagues. However, once successfully completed these complicated treatments become a source of great satisfaction both for practitioners and for patients because of the enormous improvement that has been obtained.

[Planning dental care and orthodontic treatment for children afflicted with malignant hematological diseases]. / Planification des soins bucco-dentaires et des traitements ODF chez les enfants atteints d'une hémopathie maligne.

THE PROBLEM: In France, cancer affects 1 to 3% of all children and represents the second most frequent cause of mortality among children younger than fifteen. Malignant blood diseases are the most frequently occurring childhood cancers. Although their mortality rate has been tending to decrease, they often seem to develop after "opportunistic" latent infections persist, undetected, in un-eradicated sites that may be of dental origin. This infectious risk, frequently undiagnosed in hospitals, should be of concern to both general dentists and orthodontists. OBJECTIVES: General dentists and orthodontists each have specific roles to play in teaching children about oral health at an early age and in detecting and eradicating infection as well as in seeing at risk children in regular follow-up visits. DISCUSSION: Dentists should examine children on regularly scheduled preventive appointments and treat dental caries when they discover it. Orthodontists, who see the children they are treating on frequently scheduled appointments, should always be on the alert for incipient caries in their patients and be careful to make the appliances they wear as well fitting and non-irritating as possible to minimize the risk of inflammation and development of sore spots. Both dentists and orthodontists should teach their patients how to maintain healthy diets and good oral hygiene. They may be called upon to provide local relief for acute lesions that chemotherapy sometimes causes in the soft tissues of patients with hematological cancers and to modify irritating appliances.

[Diagnosis and treatment of temporo-mandibular disorders in orthodontics]. / Détection et thérapeutique des troubles temporo-mandibulaires en orthodontie.

Orthodontists are fully prepared to treat the problems of occlusion that they are called upon to deal with every day. On the other hand temporo-mandibular joint disorders present more obscure difficulties from the point of view of detection and diagnosis as well the management of their treatment. That is why a profound understanding of the anatomical and physiological functioning of the temporo-mandibular joint has become indispensable for today's orthodontists who are now asked to detect and diagnose an assortment of TMJ disturbances whose etiology may vary greatly. By performing a rigorous diagnostic procedure, based on a thorough clinical examination supported by careful axiographic and radiological studies, of temporo-mandibular malfunctioning and its underlying etiological causes, which are primarily dento-alveolar and occlusal in nature, orthodontists will be able to adopt an appropriate therapeutic approach that might be purely orthodontic or multi-disciplinary and carried out with the collaboration of specialists in occlusion, oral surgery, and even osteopathy.

[Supraclusion origins]. / La genèse de la supraclusion.

Orthodontists often observe the clinical sign of supraclusion, or deep overbite, in their patients, a condition that is difficult to correct and that relapses frequently. In order to treat it with the most appropriate therapy, orthodontists should have a precise understanding of its etiology, which can be skeletal, neuromuscular, or dental and may often result from an intricate web of factors. In preparing their diagnoses, orthodontists should examine the possible mechanisms of its installation and evaluate them in an architectural cephalometric analysis of the oral prehensile complex.

[Does dysfunctional swallowing influence posture?]. / La déglutition dysfonctionnelle a-t-elle une influence sur la posture ?

Swallowing is one of the first functions to be set up in utero for vital reasons. Physiological and psychic maturation then occur to lead from a dysfunctional to a functional state. Nevertheless, for certain individuals, maturation is incomplete, and swallowing remains dysfunctional. The clinical literature has already proven the incidence of a dental change of occlusion and the consequences of a lingual dysfunction upon posture. This work proposes to show that the posture can be affected by dysfunctional deglutition because of the lack of dental contacts during this function and because of the lingual dysfunction which characterizes it. We studied a population of 20 young adults, divided into two groups: a group of subjects presenting with a functional swallowing, and a group of subjects presenting with a dysfunctional swallowing. The experimental protocol includes four conditions: mandibular rest, cognitive task of articulation, functional swallowing, dysfunctional swallowing. Their effect on the posture is evaluated by means of a standardized stabilometric platform, and is supplemented by an electromyographic study of a manducator muscle (the masseter) and of a muscle of the cephalic posture (the sternocleidomastoid). The results show that swallowing would have the same postural effects as the cognitive task by increasing the postural oscillations and the energy spent by the postural system. Furthermore, the deglutition would have increased effects when it corresponds to a forced deglutition for the subject.