[Let's be a periodontist..for only a few minutes!] / Et si je devenais parodontiste... pendant quelques minutes !

For several decades, orthodontists and periodontists have repeated that orthodontics have no harmful consequences on the periodontium when it is healthy or treated. However, a systematic review of the literature undermines this common refrain and concludes that there is a lack of reliable evidences of the positive effects of orthodontics on periodontal health with, in the best periodontal conditions, slight adverse effects. It is therefore the responsibility of orthodontists to keep the periodontal cost of orthodontic treatment as low as possible. How to make sure that this « at best ¼ does not turn into an « at worst ¼ ? In order to minimize the deleterious consequences of orthodontic treatment on the periodontium, the orthodontist must be able to specify which patients she/he can immediately consider providing orthodontic treatment and those on whom periodontal treatment is mandatory before all. The orthodontist must therefore transform, for a few minutes, into a periodontist in order to recognize the eight signs of loss of attachment and the six risk factors for periodontitis, exposed in this article. Both needs for periodontal and orthodontic treatment have to be measured and would not be efficient without the patient's and the practitioners' motivation.

[Periodontal optimization of the smile: choosing the right moment to achieve a maximum esthetic result]. / Optimisation parodontale du sourire : adresser au bon moment pour un réel bénéfice esthétique.

INTRODUCTION: Today, esthetic enhancement is one of the main reasons why patients seek orthodontic treatment. Governed by the canons of beauty dictated by our society, the smile is a key component in this quest for perfect beauty. Hence, the orthodontist is often the first specialist to be consulted by adolescents, but also, more and more, by adults as well. Using simple tools, the practitioner must be able to make a precise analysis of the patient combining both orthodontic and periodontal examinations with an esthetic periodontal diagnosis. OBJECTIVES: Using this analysis, the orthodontist must be able to identify his/her patient's periodontal morphotype and assess whether there is a risk of complications during treatment. One of the main complications that may arise is periodontal recession, which can both impact the esthetic result and give rise to patient anxiety, very soon leaving the orthodontist at a loss. If in doubt, it is essential to refer one's patient to the general dentist or to the periodontist. MATERIALS AND METHODS: In this paper, the authors will describe a didactic decision-making tree, which will assist practitioners in learning how to manage their patients. DISCUSSION: A synergistic approach to global patient management will ensure an optimal outcome by providing the patient with an appropriate and individualized treatment procedure.

Periodontal surgery of the maxillary impacted canine for orthodontic purposes: Proposal for a surgical decision tree.

In a private practice, between January 2010 and December 2015, 621 impacted teeth were exposed for orthodontic purposes. The majority were maxillary canines (464=74.71%), followed by maxillary central incisors (36=5.80%), mandibular canines (32=5.15%) and, finally, second premolars (30=4.83%). The 464 maxillary canines were present in 356 patients with a mean age, at the time of the intervention, of 15 years and 3 months (7 years and 10 months to 45 years and one month). The gender distribution was 60.7% (F) to 39.3% (M); 32.8% of maxillary canines were buccal and 67.2% were palatal. Only 6 canines did not move, with a success rate of 98.7%. At the pretreatment interview, the orthodontists explained that orthodontic-surgical placement of an impacted canine lengthened treatment time by an average 6 months, but in some cases by 12 months or more. The purpose of this surgery is to help the orthodontist to position the impacted tooth in the dental arch with all the periodontal structures and with the best possible integration esthetics. The objective of this article is to illustrate the periodontal orthodontic surgery of the maxillary canine and to propose a surgical decision tree.

How to recognize the eight signs of periodontitis?

Orthodontics contributes to improving self-esteem and function. However, a common refrain in ortho-perio relationships states that orthodontics has no deleterious effects on the healthy or reduced and treated periodontium. Though supported for decades, this idea has now been heavily challenged by a recent systematic review of the literature. The conclusion of this article is unfortunately very clear. There is a lack of reliable evidence showing the beneficial effects of orthodontic treatment on periodontal health with, at best, mild adverse effects. How can we reduce the periodontal cost of orthodontic treatment to a minimum? How can we ensure that this "at best" does not turn into "at worst"? To minimize the adverse effects of orthodontic treatment on periodontal tissues, the orthodontist must be able to determine to which patients he/she can consider providing orthodontic treatment and those for whom prior periodontal treatment is mandatory. In addition to the items collected for an orthodontic diagnosis, the orthodontist must be able to recognize the eight signs of attachment loss.

Gingival recession and adult orthodontics: a clinical evidence-based treatment proposal.

The presence of a gingival recession prior to orthodontic treatment is a real problem. Patients are concerned about losing their teeth but may also complain of their unpleasant appearance or root sensitivity in the exposed area. The orthodontist is not sure whether orthodontic treatment can be performed or whether the tooth movement will not aggravate the recession and whether periodontal surgery needs to be done before or after orthodontic treatment. The aim of this paper is to present recent data from the literature and several clinical situations in adults in order to submit a treatment sequence and clarify the role of different periodontal plastic surgery root coverage procedures.

[Plaque control, a key element of successful orthodontics]. / Le contrôle de plaque, un élément essentiel du succès du traitement orthodontique.

It is mainly because of periodontal tissues and, more particularly, the periodontal ligament that the orthodontist is able to move teeth. According the ratio cost/benefit/security, the orthodontist needs to prevent and/or to avoid the deleterious effects of its treatments on periodontal tissues. Gingival inflammation with a high hyperplasia compound, periodontal attachment loss, bone loss and root resorption may result, in absolute value, in a reduction of periodontal support. The key to prevent these problems is plaque control, phase too often neglected. The challenge before any orthodontic treatment, both in children or in adults, is to change the behavior of the patient concerning the mouth and the dental plaque. The aim of this paper is to explore the evidence based literature (systematic revues, meta-analysis), to provide thought elements and concrete proposals to definitely resolve this critical phase of orthodontic treatment that is the motivation, phase that can also be achieved by "dental auxiliaries".