Transverse maxillary stability assisted by a transpalatal device: a retrospective pilot study of 9 cases.

This retrospective pilot study assessed the transverse stability of an original surgical approach in nine patients with moderate transverse maxillary deficiency associated with a sagittal and/or vertical skeletal anomaly. During the one-stage surgical procedure, bi- or three-dimensional anomalies were corrected. Maxillary expansion was guided by a transpalatal bone-anchored device (TPD). Expansion measurements were made 1-2 months before surgery, 6 and at least 12 months after surgery. The transverse occlusion was corrected in all cases. After 12 months the gingival landmarks revealed an expansion range from -0.83 to +2.92 mm for the cuspids, +1.66 to +6.23 mm for the bicuspids and from +2.68 to +4.80 mm for the molars. For the occlusal landmarks, expansion ranged from -2.01 to +3.15 mm (cuspids), from +1.11 to +7.13 mm (bicuspids) and from +2.70 to +6.26 mm (molars). Cuspid expansion was significantly smaller than that of bicuspids and molars. This more posterior expansion was achieved through the surgical procedure. The transverse stability obtained with the aid of the bone-anchored TPD was satisfying. This preliminary study supports the principle of an original surgical approach, called 'Le Fort I--TPD', which combines a Le Fort I osteotomy with a controlled maxillary expansion.

[Interceptive treatments (ages 6-10) of transverse deformities: posterior crossbite]. / Traitements interceptifs (6-10 ans) des dysmorphies transversales: l'articulé croisé postérieur.

By means of a review of the literature, the authors argue the case for early treatment of posterior cross bites. They outline the particularities and advantages of various therapeutic techniques including grinding down the interfering cusps of deciduous canines and palatal expansion in the mixed dentition.

[Maxillary transversal expansion obtained by transpalatal distractor and Le Fort I osteotomy with posterior impaction of the maxilla, in one stage]. / Expansion maxillaire assistée par distracteur tranpalatin et ostéotomie de Le Fort I d'impaction postérieure, en un seul temps.

INTRODUCTION: The transpalatal distractor (TPD", Surgi-Tec, Bruges, Belgium) is a bone support device whose transversal expansion effect is well known in teenagers at the end of their growth and in adults. Surgical assisted rapid palatal expansion is usually carried out before the orthodontic treatment phase. The transversal gain is mainly seen at the anterior level, and can avoid, in some cases, extraction of bicuspids. It is difficult to correct a sizeable posterior transversal deficit using this technique, and patients presenting a complex dismorphosis must go through a second surgical phase to correct the vertical and sagittal abnormalities at the end of the orthodontic preparation. OBSERVATION: We describe a clinical case of posterior transversal surgical expansion, associated with posterior impaction of the maxilla, in one stage, at the end of orthodontic preparation. The osteotomies, the positioning of the distractor and the orthodontic apparatus enable the palatal transversal expansion to be modulated as required. DISCUSSION: The advantages and limitations of this therapeutic technique are discussed.

[A multidisciplinary approach to orthognathic surgery]. / Approche pluridisciplinaire de la chirurgie orthognathique.

Orthodontists are precisely aware of their therapeutic limits in dealing with maxillofacial dysmorphia. Unstable results and iatrogenic lesions caused by alveolo-dental compensations for displacements of the skeletal base have convinced them of the importance of orthognathic surgery as a complement to their orthodontic treatments. Collaboration between the orthodontist and the maxillofacial surgeon begins as of the moment a displacement of the skeletal bases is established through clinical and cephalometric diagnosis. Due to factors related to their age and dental history, it is necessary to complement the therapeutic provision for adult patients with the provision of a multidisciplinary team. The dentist and the family doctor take part in the decision regarding the treatment to be administered, they provide advice to their patients and treat them according to the chosen therapeutic sequence. Other practitioners are involved, including the physiotherapist or speech therapist, depending on the clinical requirements. This multidisciplinary approach and collaboration are conducive to the quality of the results and patient satisfaction.

[Orthodontic treatment in children and adults]. / L'orthodontie de l'enfant et de l'adulte.

Orthodontics is concerned with the study of dental-maxillofacial development, and the analysis and treatment of anomalies in this development. The orthodontic approach commences with the monitoring of oro-facial functions as of the early stages of childhood (3 to 4 years). This first stage is chiefly preventative. Interceptive orthopaedic treatment is performed, if necessary, on young patients who have reached the mixed dentition stage. This treatment involves the use of fixed or removable braces to correct any irregularity in the maxillofacial development and dental malposition. The treatment for most dental malpositions commences as of the setting in of the secondary dentition (11 to 13 years). The movements of the teeth in the three precise spatial directions are defined with the use of fixed braces. Residual maxillary deformities (prognathism, retrognathism, laterognathism, etc.) are corrected at the end of the growth process or in adulthood through fixed orthodontic treatment combined with maxillofacial osteotomies. Adult patients are treated with the same fixed orthodontic techniques and according to a therapeutic protocol adapted to their specific dental or periodontal mutilations.

[Maxillofacial dysmorphosis and myasthenia. Orthodontic and surgical treatment of a case]. / Dysmorphose maxillo-faciale et myasthénie. Traitement orthodontique et chirurgical d'un cas.

Case report of a patient with myasthenia and dysmorphic facial features. Pluridisciplinary treatments approach.