Contributions of Digital Simulation to Orthodontic Therapeutic Decision-Making: A Case Report.

Adult orthodontics aims to achieve optimal functional and aesthetic corrections. However, for several reasons, some patients will wish to benefit from a limited treatment where only certain aspects of a malocclusion will be corrected. In these clinical situations, the therapeutic objectives must be adjusted to the individual needs of the patient insofar as they can bring them real benefits. The use of digital technology makes it possible to study the therapeutic possibilities better and visualize the occlusal results before choosing the best therapeutic approach, especially in cases requiring customization. The aim of this clinical case report is to illustrate the orthodontic compromise made after the analysis of the digital setup in an adult patient who presented with a class III malocclusion but refused orthodontic-surgical therapy and requested an alternative treatment.

Accuracy of hard and soft tissue prediction using three-dimensional simulation software in bimaxillary osteotomies: A systematic review.

INTRODUCTION: Orthognathic surgery is considered nowadays as a revolutionary treatment option for treating skeletal discrepancies and severe malocclusions in the sagittal, vertical and transverse dimensions. This surgery allows both the restoration of facial harmony and the achievement of satisfactory dental occlusion. The technology of computer-assisted surgeries including virtual surgical simulation programs and planning software greatly contributes to providing a three-dimensional simulation and precise mobilization of the maxilla and/or mandible, thus allowing the prediction of the final outcome in soft tissues. This study aims to systematically review the available scientific literature about the accuracy of the hard and soft tissue predictions delivered by the many promoted three-dimensional simulation software. MATERIAL AND METHODS: An electronic search was conducted on various databases: Medline via PubMed, The Cochrane Library, EBSCO-host, and Web of Science. The search was established on a well-defined research question following PICO principle: population, intervention, comparator and outcome. Search evaluation and the assessment of risk of bias were undertaken in each study following its type and design. RESULTS: Fifteen studies were included for qualitative analysis. Seven studies evaluated the accuracy of soft tissue prediction, seven focused more on the accuracy of hard tissue and one study assessed both hard and soft tissue prediction accuracy delivered by the simulation software. Moreover, three studies were judged to be low risk and four were classified as high risk. Included studies revealed that hard tissue prediction is highly accurate and reliable, leading to clinically acceptable results. Yet, soft tissue prediction is unclear due to various factors that bias its results. Caution should therefore be taken when providing information about the soft tissue planning to patients. CONCLUSIONS: Computer assisted 3D simulation protocols allow for more precise repositioning of the maxilla and/or mandible compared to conventional 2D methods. However, 3D soft tissue prediction using simulation software remains less accurate, especially in the labial region.

Oral and dental abnormalities in Coffin Siris syndrome : A new case report.

INTRODUCTION: Coffin-Siris Syndrome (CSS) is a rare genetic disorder of unknown etiology. It combines digital-ungual abnormalities, facial dysmorphism, developmental and intellectual delay, and other organ-system abnormalities. Oral and dental anomalies are rarer. CASE REPORT: 8-year-old boy with clinical diagnosis of CSS presented facial dysmorphism, sparse hair, a flat and wide nose, absence of nails on 3rd and 5th fingers of the right hand and 3rd and 4th fingers of the left hand, malformation of the feet, toes with nail hypoplasia. Oral and dental anomalies included : bilateral complete cleft lip and palate, delayed eruption of permanent teeth, presence of supernumerary tooth and taurodontism in the first permanent molars. CONCLUSION: Early diagnosis of oral problems and regular follow-up in dentist are necessary to promote good oral health and improve the patient's quality of life.

Perception of smile aesthetics between orthodontists and Moroccan patients.

Introduction: One of the main goals of orthodontic management is to achieve a beautiful smile. However, beauty has both objective and subjective dimensions. This study aims to evaluate the factors that affect the perception of the smile in patients consulting for orthodontic treatment about the vision of their practitioners. Materials and Methods: Fifty orthodontic patients and 30 orthodontists evaluated the degree of attractiveness of 16 photographs of the smile. Dental, gingival and labial parameters were used. Statistical analyses of the level of perception of each group were performed. The Student t-test and the Chi-square test were used to compare the attractive and unattractive smile parameters. Results and Discussion: The perception of smile aesthetics between orthodontists and orthodontic patients has shown a significant difference (P < 0.05). Orthodontists were more analytical in judging variables like smile arc, alterations of the gingival display and the palatal inclination of the maxillary incisors.

[Tongue retraining and occlusal stability in a young adult. Case report]. / La rééducation linguale et la stabilité occlusale chez le jeune adulte. A propos d'un cas clinique.

The clinical observation describes the case of a 20-year-old woman who has consulted for aesthetic and functional reasons. She presents a skeletal class III normodivergent, an occlusal class III with a lower proalveoli quite marked. In addition, a lingual dysfunction which manifests itself by important anterior diastema and dento-dental disharmony at the upper jaw complicates the case. The undertaken therapeutic project starts with a first step of a lingual praxis rehabilitation, followed by an orthodontic step and upper lateral incisors-plasty. The purpose of those results is the evaluation of the stability two years later, which was reported positive.

[Impact of incisor repositioning on the cephalometric position of points A and B]. / Le repositionnement incisif: quel impact sur la position céphalométrique des points A et B?

Introduction: points A and B are bony landmarks used in cephalometric studies to assess sagittal ratio between maxilla and mandible. The purpose of this study is to assess the reliability of points A and B as bony landmarks, by investigating the role of incisor repositioning on their cephalometric position. Method: superposition of cephalometric tracings at beginning and end of treatment of 30 patients without bone growth disorders, presenting with biproalveolia and having undergone orthodontic treatment with extraction of four first premolars was carried out to estimate changes in points A and B position. The significance threshold was set at 0.05. Results: our study showed that the influence of orthodontic treatment on point A position was not statistically significant, while its influence on point B position was statistically significant (p= 0,01). Indeed, for every 1mm of incremental repositioning, point B moved back by 0.17mm. Conclusion: incisor repositioning in the mandibular arch induces a change in the position of point B backwards.

[Performance of orthodontic aligners in the aging process: systematic review and in vitro study]. / La performance des aligneurs orthodontiques à l'épreuve du vieillissement : revue systématique et étude in vitro.

INTRODUCTION: The objective of this study was to evaluate, through a systematic review of the literature and an in vitro study, the alteration of the mechanical and chemical properties of aligners after aging in artificial saliva and in the oral cavity. MATERIALS AND METHODS: A systematic literature review was carried out, through an electronic consultation of three databases: PubMed, EBSCO and Sciencedirect, between September 2018 and January 2020. The search was guided by the use of several specific keywords. In our in vitro study, the mechanical properties of our sample of aligners were evaluated using the 3-point bending test after a water immersion. RESULTS AND DISCUSSION: Of the 189 articles found, only six articles met our inclusion criteria. In the light of the studies selected in this systematic review and of our in vitro study, it can be concluded that the orthodontic aligners undergo an alteration in their mechanical properties after stay in the mouth. However, the real impact of these modifications on their clinical performance remains to be demonstrated and it is difficult to make a final judgment on their chemical stability. Other controlled clinical studies, with protocols better suited to the clinical criteria studied, are necessary to objectively assess the aging phenomenon of orthodontic aligners.

[Self-ligating brackets and friction in vivo : micro-morphological and chemical assessment of active slot surface]. / Brackets autoligaturants et friction in vivo : évaluation micro-morphologique et chimique de la surface active.

The use of self-ligating brackets has largely developed in orthodontic practice thanks to numerous advantages, including the reduction of frictional forces during sliding orthodontic mechanic. Faced with scientific evidence, this advantage still seems to be debatable. Our objective was to evaluate in vivo the frictional force of self-ligating brackets by searching for micro-morphological and chemical effects on the active slot surface, after phase of alignment-leveling and after a period in the mouth. 16 brackets from four commercial brands were selected (Damon®, In-Ovation®, Smart-clip® and Carriere®). These brackets were visualized using a scanning electron microscope (SEM) and dispersive energy spectroscopy to study their surface and initial chemical composition. After a period in the mouth, these brackets were debonded and evaluated with SEM, to search topographic and chemical changes in relation to the frictional forces. After a period of three months used for dental alignment, all the brackets show considerable changes in topographic and chemical properties related to frictional forces, with deposit of organic debris whose importance is related to the initial surface different from one manufacturer to another.

Enamel protection after stripping procedures: An in vivo study.

INTRODUCTION: Interproximal enamel reduction (IPR) is a clinical procedure that has been in use since the advent of non-extraction orthodontic techniques. However, such a procedure affects the surface condition of the enamel and may predispose patients to cavities and hypersensitivity. The use of a remineralizing agent is recommended to prevent these side effects. The objective of our study was to evaluate the evolution of stripped proximal dental surfaces after exposure to the oral environment for 4 months with and without fluoride protection. MATERIALS AND METHODS: Our sample consisted of 14 premolars (PM) from 6 patients of the Dentofacial Orthopaedics Department of the Consultation and Dental Treatment Centre of Rabat (CDTC) who required orthodontic treatment with PM extraction and had given their informed consent. The teeth were divided into 5 groups: group 1: intact enamel; group 2: intact enamel+fluoride varnish+4-month oral exposure; group 3: IPR (manual and mechanized)+extraction; group 4: IPR (manual and mechanized) without varnish+4-month oral exposure; group 5: IPR (manual and mechanized)+fluoride varnish+4-month oral exposure. Proximal surfaces were subjected to qualitative analysis by scanning electron microscopy and quantitative analysis by Dispersive Energy Spectroscopy (DES) to quantify the percentage of mineral elements. RESULTS: Exposure of stripped dental surfaces to the oral environment for 4 months with or without fluoride protection showed the persistence of surface irregularities caused by stripping. We noted an improvement in the percentage of mineral elements for both groups with and without fluoride protection. However, the percentages of calcium (Ca) and phosphorus (P) were close to that of intact enamel in the fluoride varnish group. CONCLUSION: Protecting stripped surfaces with fluoride varnish could help preserve the integrity of the enamel surface by restoring some of the mineral elements lost during stripping.

Corono-radicular dilaceration of a maxillary central incisor: A case report.

Coronoradicular dilaceration is a particular abnormality of the permanent incisors, usually maxillary, and usually occurs around the age of 4 to 5 when the crown is formed and the root is still growing. It follows acute mechanical trauma affecting the temporary incisor. This anomaly of shape is characterized by an angulation between the crown and the root of the permanent tooth. The prognosis may be serious because the affected tooth may not erupt normally. It also compromises possible orthodontic treatment later. Our clinical case is that of a young patient (ES) aged 8 years and 4 months, in good general health condition, consulted for the absence 21 on the arch while the contralateral tooth was present. Interrogation revealed that the patient suffered trauma with severe luxation of the 61 at the age of 3 years. Radiographic examination showed the presence of the germ of 21 with an atypical sickle-shaped position and an image of a hand of a traffic policeman with a crown in a horizontal position. Three-dimensional imaging using a CT scan shows the shape of the 21 with a root angulation. The therapeutic attitude allowed the correction of its axis by an orthodontico-surgical treatment.

In vivo enamel stripping: A macroscopic and microscopic analytical study.

INTRODUCTION: Interdental stripping is often used in orthodontics to correct discrepancies of tooth shape or size. However, this procedure involves significant risks for the enamel. The roughness of the enamel surface might depend on the instruments used; it can lead to the accumulation of cariogenic plaque and periodontal problems. The main objective of our study was to evaluate the enamel surface condition after interproximal stripping in the mouth, by comparing different manual and mechanized enamel reduction protocols; on the other hand, the topography of the stripped area was observed to specify its location on the stripped proximal surfaces. MATERIALS AND METHODS: An in vivo study was carried out: interdental stripping was performed in the mouths of patients undergoing orthodontic treatment and on healthy teeth intended for extraction for orthodontic or periodontal reasons. The sample was divided into four groups: in group 1, the distal faces were stripped with conventional single-sided diamond abrasive strips and non-stripped mesial faces (control faces); in group 2: the distal faces were stripped with the manual ContacEZ IRP Kit (single-sided abrasive files of different grain sizes) and non-stripped mesial faces (control faces); in group 3: the faces were stripped with ContacEZ IRP diamond discs attached to a handpiece and the mesial faces were not stripped (control faces); in group 4: the distal faces were stripped with the Intensiv Ortho-Strips mechanized system and the mesial faces were not stripped (control faces). RESULTS: Our study showed that regardless of the type of stripping material used, the enamel surface showed some roughness with the presence of striations and grooves of different widths and depths. Our observations objectivised more regular and less roughened enamel surface conditions when using the Intensiv oscillating files. Manual instruments (abrasive strips and files) have shown rougher and more irregular surface conditions that may constitute a real risk of carious and periodontal disease. The macroscopic evaluation of the topography of the stripped area showed that there is great variability in the situation and extent of the stripped area in relation to several parameters. CONCLUSION: The current mechanized instruments (oscillating files) provide enamel stripping with more comfort for the patient and the practitioner, and seem to produce a more regular and less harmful surface condition for the tooth and periodontium.

Fluoride induced corrosion affecting Titanium brackets: A systematic review.

INTRODUCTION: A number of studies have been published regarding the behaviour of titanium inside the oral cavity or in a similar environment. Very often the results converge although they may on occasion be divergent. There appears to be a strong need for a systematic review because of this disparity, with a view to designing an experimental working method. Our study will attempt to analyse the various aspects of this problem. It will therefore focus on fluoride and its impact, as well as on the role it plays in corroding titanium orthodontic brackets (Ti) according to the synthesis and critical analysis drawn from literature. METHODS: An exhaustive bibliography search was conducted in the following databases: PubMed, Science Direct and Cochrane Library using a search equation based on the following key-words: corrosion, titanium brackets and fluoride. RESULTS: Out of 459 identified references, only 5 matched our inclusion criteria. CONCLUSION: Although very few articles look into the impact of fluoride on titanium orthodontic brackets, one may conclude that in the presence of fluoride ions, resistance to corrosion of Ti attachments decreases in the presence of high fluoride concentrations and lengthy exposure to fluoride ions and an acid pH.

A systematic review of orthodontic retention systems: The verdict.

INTRODUCTION: Retention during both the active and passive phases of treatment has given rise to numerous publications concerning its efficacy, the range of systems available and its variability over time. There are currently many different retention protocols regularly used by orthodontists; however, their efficacy and duration are still subject to debate. There is as yet no consensus as to which retention protocol is the most effective or for how long the retention device needs to be worn. The aim of this research was to perform a systematic review of the scientific literature in order to evaluate the efficacy of the different retention systems and clinical protocols among those most widely used, so as to make recommendations beneficial to both patient and practitioner. MATERIALS AND METHODS: A search of the literature was performed in the following databases: PubMed (MEDLINE), ScienceDirect and Cochrane Library. The search was limited to publications in English and French during the period 2006-2016. RESULTS: Out of 1952 references initially identified, 17 articles corresponded to our inclusion criteria. The results show that: fixed retention is more effective than removable retainers for the maintenance of incisor alignment during the first six months of retention; there is no significant difference in efficacy between the different fixed retention systems; there is no significant difference in efficacy between the vacuum-formed systems and the Hawley retainer; part-time use of removable retainers (between 8-10h/day) is sufficient; the most widely used retention protocol combines a vacuum-formed splint or Hawley retainer in the upper arch with mandibular fixed retention. CONCLUSION: Despite the large number of studies devoted to orthodontic retention only a few articles corresponded to the methodological criteria of bio statistical analysis. Also, on account of the variations in experimental protocols, the levels of proof relating to the efficacy of different systems are very weak. Research into this topic should first seek to normalize methods of analysis and then perform randomized controlled long-term trials to shed light on this problem.

Relationship between the curve of Spee and craniofacial variables: A regression analysis.

INTRODUCTION: The aim of this regression analysis was to identify the determining factors, which impact the curve of Spee during its genesis, its therapeutic reconstruction, and its stability, within a continuously evolving craniofacial morphology throughout life. MATERIAL AND METHODS: We selected a total of 107 patients, according to the inclusion criteria. A morphological and functional clinical examination was performed for each patient: plaster models, tracing of the curve of Spee, crowding, Angle's classification, overjet and overbite were thus recorded. Then, we made a cephalometric analysis based on the standardized lateral cephalograms. In the sagittal dimension, we measured the values of angles ANB, SNA, SNB, SND, I/i; and the following distances: AoBo, I/NA, i/NB, SE and SL. In the vertical dimension, we measured the values of angles FMA, GoGn/SN, the occlusal plane, and the following distances: SAr, ArD, Ar/Con, Con/Gn, GoPo, HFP, HFA and IF. The statistical analysis was performed using the SPSS software with a significance level of 0.05. RESULTS: Our sample including 107 subjects was composed of 77 female patients (71.3%) and 30 male patients (27.8%) 7 hypodivergent patients (6.5%), 56 hyperdivergent patients (52.3%) and 44 normodivergent patients (41.1%). Patients' mean age was 19.35±5.95 years. The hypodivergent patients presented more pronounced curves of Spee compared to the normodivergent and the hyperdivergent populations; patients in skeletal Class I presented less pronounced curves of Spee compared to patients in skeletal Class II and Class III. These differences were non significant (P>0.05). The curve of Spee was positively and moderately correlated with Angle's classification, overjet, overbite, sellion-articulare distance, and breathing type (P<0.05). We found no correlation between age, gender and the other parameters included in the study with the curve of Spee (P>0.05). Seventy five percent (75%) of the hyperdivergent patients with an oral breathing presented an overbite of 3mm, which is quite excessive given the characteristics often admitted for this typology; this parameter could explain the overbite observed in the hyperdivergent population included in this study. For the multivariate analysis, the overbite and the sellion-articulare distance remained independently related to the curve of Spee according to the breathing type, Angle's classification, and overjet. This regression model explains 21.4% of the changes in the curve of Spee.

Is systematic mandibular retention mandatory? A systematic review.

INTRODUCTION: Relapse in orthodontics, and particularly, mandibular anterior crowding is an unforeseeable phenomenon and a quite embarrassing situation for the orthodontist, as it may be interpreted by the patient as a treatment failure. Relapse may be inherent to various factors (periodontal, anatomical, muscular, occlusal, residual growth, third molars development…), which must be imperatively acknowledged in order to be managed during orthodontic treatment and therefore ensure an optimal control on the stability of the achieved final outcomes. The aim of this review was to determine, through a systematic analysis based on a Medline PubMed search, the scientific relevant factors involved in the relapse of mandibular anterior crowding. MATERIALS AND METHODS: A systematic research was performed based on an electronic search (between 2005 and December 2016) among various databases. The search was limited to the use of several specific search words expressed in two languages: English and French. Two investigators selected those meeting the exclusion/inclusion criteria. RESULTS AND DISCUSSION: Out of the 1055 references, only 19 studies met our inclusion criteria. The factors addressed by these studies are: extraction or non-extraction treatment, residual growth, facial divergence, periodontium, type of retainer, incisor morphology and quality of dental occlusion. Divergence in female patients, thin cortical bone and treatment using aligners were associated with a higher rate of mandibular anterior crowding relapse. However, due to the low level of evidence of the included studies, as well as the heterogeneity of protocols between the studies, it was not possible to determine factors truly involved in mandibular crowding relapse. Future reliable prospective studies are required to provide unbiased and quantifiable results.

Contribution of Digital Technology to the Surgical Technique of Miniscrew Insertion: a Literature Review

Orthodontic miniscrews are used to achieve absolute anchorage. Their insertion technique is simple but must be precise to avoid intra- and postoperative complications. This study aimed to review the literature on the role of digital technology in the precise placement of miniscrews and to describe the different stages of the insertion guide manufacturing chain. The databases used were PubMed, Science Direct, and Google Scholar, including the following English descriptors: "Orthodontic Anchorage Procedures," "Cone Beam Computed Tomography." Digital technology improves the accuracy of miniscrew placement by using 3D imaging to assess the quantity and quality of bone and the proximity of anatomical structures in the area to be implanted. By combining 3D imaging with the new techniques of 3D printing and virtual planning, the orthodontist can obtain a personalized placement guide for the patient using computer-aided design and manufacturing techniques. A digitally-assisted miniscrew insertion system is a promising technique for precise and safe miniscrew insertion but cannot be used routinely. Therefore, large-scale studies are needed to map miniscrew insertion in different areas, considering ethnicity, gender, and different anatomical characteristics.

A predictive model of advancement genioplasty in Class III bimaxillary surgical cases.

INTRODUCTION: The aim of our study was to try to standardize the surgeon's clinical sense in order to avoid revision surgery. MATERIALS AND METHODS: Twenty-nine patients with skeletal Class III treated by bimaxillary surgery were selected according to inclusion and exclusion criteria. These patients were divided into two groups according to the type of surgery: Group 1 (G1): bimaxillary surgery alone, and Group 2 (G2): bimaxillary surgery with genioplasty. The study was conducted based on the presurgical (t0) and postchirurgical (t1) lateral cephalograms. The different changes were compared between the two groups using the Mann-Whitney Test. One way and multiple linear regression analyses were used to determine the variables influencing the amount of displacement of the chin fragment during the genioplasty procedure. The significance level was fixed at 0.05. RESULTS: The labiomental profile was significantly more improved in group G2 (bimaxillary surgery with genioplasty), the aesthetic changes included the thickness increase of the lower labial sulcus and soft tissue pogonion, and also the reduction of the labiomental angle (P<0.05). Only the presurgical value of the labiomental angle would influence the amount of chin displacement. Starting from the regression analysis, we suggested a predictive equation allowing to predict this amount of displacement, based on the presurgical value of the labiomental angle. CONCLUSION: The analysis of changes (specifically the aesthetic ones) between the two groups of patients, allowed the proposal of a model predicting the amount of chin displacement performed in genioplasty group, based on the presurgical parameters. This model could contribute to determine an indicative value for bimaxillary surgery with additional genioplasty.

[Timing of alveolar bone graft and sequences of canine eruption in cases of cleft lip and palate: a systematic review]. / Calendrier de la greffe osseuse et séquences d'éruption canine dans les cas de fentes labio-alvéolo-palatines : revue systématique.

INTRODUCTION: The alveolar bone graft (ABG) is an important phase in the surgical treatment of cleft lip and palate (CLP). The purpose of alveolar bone grafting is to eliminate oronasal fistulas, restore the continuity of the maxilla and provide optimal periodontal support for spontaneous eruption of permanent canines adjacent to the cleft. The purpose of this systematic review was to determine the ideal timing of the ABG that would achieve these goals. MATERIAL AND METHODS: Databases consulted were MEDLINE, Embase et EBSCOhost, using keywords present in the MeSH: [cleft lip and palate] and [alveolar bone graft] and [tooth eruption]. Selection criteria included retrospective studies, prospective studies and meta-analyzes dating from January 2005, with available full text. RESULTS: Among 105 references, 9 articles met our selection criteria. ABG carried out before or just after the eruption of permanent canines adjacent to the cleft, between 8 and 12 years old, has the best success rate of the transplant (71% to 89%) and the lowest risk of canine inclusion (5% to 19%). CONCLUSION: According to literature data, the optimal timing of ABG that provide best results is located between 8 and 12 years, before or just after the eruption of permanent canines adjacent to the cleft. However, this timing could be modified by the multidisciplinary team according priorities, particularly aesthetic, defined for each child.

[How to treat hypoplasia of the lateral upper incisors by canine substitution : a clinical case]. / Traitement de l'hypoplasie des incisives latérales maxillaires par substitution canine. A propos d'un cas clinique.

INTRODUCTION: Facing a patient with a morphological or numerical disorder of the lateral upper incisors (mainly pegged or missing incisor), the orthodontist has to choose between two treatment options : either spatial planning for a prosthetic restoration, or space closure with substitution of the lateral incisors by canines; the choice depends on the clinical context we are faced with. Each treatment option has its advantages and disadvantages and it is hard to tip the balance in one direction or another. MATERIAL AND METHOD: This article illustrates the rationale for therapeutic management of space closure, in a patient with skeletal class III, with hypoplastic and peg-shaped upper lateral incisors.