Can therapeutic reassessment in ODF be based on management principles? / La réévaluation thérapeutique en ODF peut-elle s'appuyer sur les principes du management ?

Introduction: Re-evaluation of therapy is sometimes necessary during treatment. Rarely planned or desired, it is legitimate to look for a way to avoid it while carrying out the correction of the dysmorphosis as initially envisaged. Can the introduction of management into the therapeutic process, and particularly the principle of the feedback loop, make it possible to eliminate any therapeutic re-evaluation? Materials and Methods: After having defined management, cybernetics and the feedback loop as well as the framework for their application, we will look for ways to apply them to the dento-maxillo-facial orthopedics and will then study through historical practice the specific foundations of management and cybernetics in order to be able to conclude that these means are well adapted to our practice. We will rely on a set of historical, sociological and anthropological sources. Conclusions: Management is unsuitable for eliminating the need for therapeutic re-evaluation because, through the deployment of the organizational mode which is consubstantial with it, it is opposed to the institutional order of which any therapeutic approach is a part.

Introduction: La réévaluation de la thérapeutique est parfois nécessaire en cours de traitement ; rarement prévue, ni désirée, il est légitime de chercher un moyen de s'y soustraire tout en menant à bien la correction de la dysmorphose telle qu'initialement envisagée. L'introduction du management dans le processus thérapeutique, et en particulier le principe de la boucle de rétroaction, peut-il permettre de supprimer toute réévaluation thérapeutique ? Matériels et méthodes: Après avoir défini le management, la cybernétique et la boucle de rétroaction, ainsi que le cadre de leur application, nous chercherons les moyens de les appliquer à l'orthopédie dento-maxillo-faciale, puis nous étudierons à travers la pratique historique les fondements propres du management et de la cybernétique afin de pouvoir conclure à la bonne adaptation de ces moyens avec les fins de notre pratique. Nous nous appuierons sur un ensemble de sources historiques, sociologiques et anthropologiques. Conclusion: Le management est impropre à supprimer la nécessité de la réévaluation thérapeutique car, de par le déploiement du mode organisationnel qui lui est consubstantiel, il s'oppose à l'ordre institutionnel dont fait partie toute démarche thérapeutique.

Orthognathic surgery: a significant tool for reassessment / La chirurgie orthognathique : un outil à ne pas oublier dans la réévaluation

Introduction: More than 15 years of experience in orthodontic-surgical collaboration has allowed the authors to identify some situations in which a new perspective is needed. Although it may seem easy to refer a patient to a maxillo-facial surgeon in cases of major dysmorphoses, this can lead to yet other dilemmas: a loss of results at the end of a developmental growth stage, an adult requesting a return to treatment after a camouflage orthodontic treatment or a non-cooperative child in an interceptive and preventive treatment phase. Then, a comprehensive process of reassessment becomes compulsory. Material and Method: In the form of an editorial, this article describes various cases encountered in the authors' practice. Discussion: The aim is not to point out the imperfections of our humanity, but simply to open our eyes to diagnostic elements that are missed, whether in the initial phase or during reassessment. Conclusion: As it is far from ideal to keep offering similar therapies that lead to the same pitfalls, it is time for a shift in the paradigm.

Introduction: Plus de 15 ans de recul en collaboration orthodontico-chirurgicale ont permis aux auteurs d'identifier un certain nombre de situations dans lesquelles un regard différent est devenu opportun. S'il est aisé d'orienter un patient vers un(e) chirurgien(ne) maxillo-facial(e) en cas de dysmorphoses majeures, les orthodontistes sont régulièrement confrontés à d'autres dilemmes : une perte de résultat en fin de croissance, un adulte demandeur d'une reprise après un traitement en compensation ou encore un enfant non-coopérant en phase interceptive. Une phase de réévaluation exhaustive devient alors nécessaire. Matériel et méthode: Sous la forme d'un éditorial, cet article expose différentes situations cliniques auxquelles les auteurs ont été confrontés lors de leur pratique. Discussion: Le propos n'est pas de pointer les imperfections de notre humanité mais seulement d'ouvrir les yeux sur des éléments diagnostiques qui échappent, que ce soit en phase initiale ou en réévaluation. Conclusion: Offrir une thérapeutique identique conduisant aux mêmes écueils n'est pas acceptable : il est temps de changer de paradigme.

Resorptions and orthodontics / Résorptions et orthodontie

Introduction: It's generally accepted that one of the risks associated with orthodontic treatment is apical root resorption, even though this may occur outside orthodontic treatment. In any case, it causes root shortening. Orthodontists are probably the only dental surgeons who use the inflammatory process as a therapeutic tool. They need to be aware of the risk factors for root inflammation. Along with recurrence, leukemia and periodontal problems, resorption is one of the "inconveniences" of orthodontics, which, if not inevitable, must at least be minimized. Material and Method: At present, the orthodontic literature on root resorption provides some clues as to the factors associated with the onset, severity and management of root resorption, although the complexity of this phenomenon does not allow us to arrive at a clear and unequivocal consensus. For this reason, it is important to identify potential risk factors for resorption, to take them into account before/during and after treatment, and to know what attitude to adopt in the event of resorption appearing, all in order to minimize this phenomenon, as everyone agrees that it can be a source of harm and stress for both patient and practitioner. Conclusion: There are still many grey areas in our understanding of the phenomenon, including how the elements of orthodontic treatment influence orthodontic resorption. Irreversible in nature, resorption can be sufficiently extensive to cast doubt on the benefit of successful orthodontic treatment.

Introduction: Il est généralement admis que l'un des risques associés au traitement orthodontique est la résorption radiculaire apicale même si elle peut se produire en dehors de tout traitement orthodontique. Quoi qu'il en soit, elle provoque le raccourcissement radiculaire. Les orthodontistes sont sans doute les seuls spécialistes de la chirurgie dentaire qui utilisent le processus inflammatoire en tant que moyen thérapeutique. Ils doivent connaître les facteurs de risque de cette inflammation sur la racine. La résorption fait partie, au même titre que la récidive, les leucomes et les problèmes parodontaux, des « inconvénients ¼ de l'orthodontie qui, à défaut d'être inévitables, doivent au moins être minimisés. Matériels et méthode: Actuellement, la littérature orthodontique sur la résorption radiculaire fournit quelques pistes sur les facteurs associés à l'apparition, la gravité et la gestion de la résorption radiculaire, même si la complexité de ce phénomène ne nous permet pas d'en dégager un consensus clair et équivoque. Pour cette raison, il est important d'identifier les facteurs de risque de résorption potentiels pour en tenir compte avant/pendant et après le traitement et connaître l'attitude à adopter en cas d'apparition de résorptions, tout ceci afin de minimiser ce phénomène, car tout le monde s'accorde sur le fait qu'elle peut être source de préjudice et de stress pour le patient et le praticien. Conclusion: De nombreuses zones d'ombres subsistent dans la compréhension du phénomène, notamment sur comment les éléments du traitement orthodontique influencent la résorption orthodontique. De nature irréversible, la résorption peut être suffisamment étendue pour jeter un doute sur le bénéfice apporté au succès du traitement orthodontique.

Quantitative evaluation of vertical control in orthodontic camouflage treatment for skeletal class II with hyperdivergent facial type.

BACKGROUND: In this study, we sought to quantify the influence of vertical control assisted by a temporary anchorage device (TAD) on orthodontic treatment efficacy for skeletal class II patients with a hyperdivergent facial type and probe into the critical factors of profile improvement. METHODS: A total of 36 adult patients with skeletal class II and a hyperdivergent facial type were included in this retrospective case-control study. To exclude the effect of sagittal anchorage reinforcement, the patients were divided into two groups: a maxillary maximum anchorage (MMA) group (N = 17), in which TADs were only used to help with anterior tooth retraction, and the MMA with vertical control (MMA + VC) group (N = 19), for which TADs were also used to intrude the maxillary molars and incisors. The treatment outcome was evaluated using dental, skeletal, and soft-tissue-related parameters via a cephalometric analysis and cast superimposition. RESULTS: A significant decrease in ANB (P < 0.05 for both groups), the retraction and uprighting of the maxillary and mandibular incisors, and the retraction of protruded upper and lower lips were observed in both groups. Moreover, a significant intrusion of the maxillary molars was observed via the cephalometric analysis (- 1.56 ± 1.52 mm, P < 0.05) and cast superimposition (- 2.25 ± 1.03 mm, P < 0.05) of the MMA + VC group but not the MMA group, which resulted in a remarkable decrease in the mandibular plane angle (- 1.82 ± 1.38°, P < 0.05). The Z angle (15.25 ± 5.30°, P < 0.05) and Chin thickness (- 0.97 ± 0.45°, P < 0.05) also improved dramatically in the MMA + VC group, indicating a better profile and a relaxed mentalis. Multivariate regression showed that the improvement in the soft tissue was closely related to the counterclockwise rotation of the mandible plane (P < 0.05). CONCLUSIONS: TAD-assisted vertical control can achieve intrusion of approximately 2 mm for the upper first molars and induce mandibular counterclockwise rotation of approximately 1.8°. Moreover, it is especially important for patients without sufficient retraction of the upper incisors or a satisfactory chin shape.

Study on decision-making for orthodontic treatment plans based on analytic hierarchy process.

BACKGROUND: Orthodontics is a common treatment for malocclusion and is essential for improving the oral health and aesthetics of patients. Currently, patients often rely on the clinical expertise and professional knowledge of doctors to select orthodontic programs. However, they lack their own objective and systematic evaluation methods to quantitatively compare different programs. Therefore, there is a need for a more comprehensive and quantitative approach to selecting orthodontic treatment plans, aiming to enhance their scientific validity and effectiveness. METHODS: In this study, a combination of the analytic hierarchy process (AHP) and semantic analysis was used to evaluate and compare different orthodontic treatment options. An AHP model and evaluation matrix were established through thorough research and semantic analysis of patient requirements. This model considered various treatment factors. Expert panels were invited to rate these factors using a 1-9 scale. The optimal solution was determined by ranking and comparing different orthodontic treatment plans using the geometric mean method to calculate the weights of each criterion. RESULTS: The research indicates a higher preference for invisible correction compared to other orthodontic solutions, with a weight score that is 0.3923 higher. Factors such as comfort and difficulty of cleaning have been given significant attention. CONCLUSION: The Analytic Hierarchy Process (AHP) method can be utilized to effectively develop orthodontic treatment plans, making the treatment process more objective, scientific, and personalized. The design of this study offers strong decision support for orthodontic treatment, potentially improving orthodontic treatment outcomes in clinical practice and ultimately enhancing oral health and patients' quality of life.

Orthodontic treatment of a patient with dentinogenesis imperfecta using a clear aligner system.

BACKGROUND: Orthodontic treatment for patients with dentinogenesis imperfecta (DGI) can be risky because of the fragility of their dental hard tissue. Although the Invisalign (Align Technology) clear aligner system should be a suitable orthodontic appliance for patients with DGI, to the authors' knowledge, there has been no related research. CASE DESCRIPTION: A 28-year-old woman with DGI sought treatment with a 1 mm open bite, edge-to-edge occlusion of the central incisors, and a bilateral Class III cusp-to-cusp molar relationship. Invisalign was applied for her treatment, and after 3 and one-half years of orthodontic therapy, a normal overjet and overbite were achieved, accompanied by retraction of the lower lip as well as a bilateral Class I molar relationship. In addition, there was no iatrogenic injury to the patient's teeth. PRACTICAL IMPLICATIONS: The Invisalign system may be a suitable orthodontic appliance for patients with DGI because clear aligners lessen the tensile stress to the teeth, decrease the number and area of bonds to the teeth, and offer protective effects through a full wrap of plastic that covers the crowns of the teeth.

Comparative assessment of two-phase class II treatment with Activator or Bionator followed by fixed appliances: A retrospective controlled before-and-after study.

AIM: Two-phase treatment for children with Class II malocclusion with several functional appliances is still performed by many orthodontists, while the Activator and the Bionator appliances are two of the most popular ones. Aim of this study was to compare the skeletal and dentoalveolar effects of treatment with these two appliances. METHODS: Class II children treated with Activator or Bionator in the first phase, followed by a phase of fixed appliances were included. Skeletal and dentoalveolar parameters were assessed from lateral cephalograms and analysed with linear regressions at 5%. RESULTS: A total of 89 patients (mean age 10.0 years; 47% female) were included. During the first phase, Bionator increased less the SNB (difference in mean treatment-induced changes [MD] -0.7°; 95% confidence interval [CI] -1.3 to -0.2°; P=0.01) and decreased less the ANB angle (MD 0.6°; 95% CI 0 to 1.1°; P=0.03) compared to Activator. Activator slightly increased the facial axis and Bionator reduced it (MD -1.6°; 95% CI -2.3 to -0.8°; P<0.001). Compared to Activator, the Bionator retroclined more the upper incisors (MD -2.4°; 95% CI -4.6 to -0.2°; P=0.03) and increased more the interincisal angle (MD 2.9°; 95% CI 0.5 to 5.4°; P=0.02). After the second phase (6.2 years after baseline), the only differences were a reduced facial axis (MD -1.3°; 95% CI -2.2 to -0.3°; P=0.008) and an increased maxillary rotation (MD 0.9°; 95% CI 0 to 1.8°; P=0.04) with Bionator compared to Activator. CONCLUSION: Similar dentoalveolar effects were seen overall with two-phase treatment with either appliance, with Bionator being associated with more vertical increase compared to Activator.

Thirteen-year-old female patient with Class II division 1 malocclusion and hypodivergent facial pattern treated with buccal fixed appliance. Case report no 230052. European College of Orthodontics. Commission of affiliation and titularisation.

DATE OF BIRTH: 24/09/1998; sex: female. PRE-TREATMENT DOCUMENTS: 13 years 5 months old; 07/03/2012. DIAGNOSIS: Skeletal Class I with biretrusion, hypodivergent facial pattern; angle's Class II division 1 with overbite; moderate dento-maxillary discrepancy; maxillary incisor malposition. TREATMENT PLANNING: Bimaxillary buccal fixed appliance with Class II elastics. Active treatment duration: 25 months. POST-TREATMENT DOCUMENTS: 15 years 7 months old; 09/05/2014. POST-RETENTION DOCUMENTS: (minimum 1 year) 16 years 9 months old; 08/07/2015. Retention period: unlimited.

Class II subdivision treatment and stability with asymmetric Herbst appliance: A case report.

Non-surgical treatment of Class II subdivision may involve complex mechanics or asymmetric tooth extraction in its resolution. This report demonstrates the result and the short-term stability of Class II subdivision treated with asymmetrically installed Herbst appliance followed by conventional fixed orthodontic appliance. The approach allowed the correction of the unilateral Class II molar relationship and increased overjet, as well as the deviation of dental midlines, with improvement in lip posture and facial profile. The results remained stable two years after treatment, confirming the treatment success.

Long-term profile attractiveness of patients with Class I and II malocclusion treated with and without extractions: A 35-year follow-up.

INTRODUCTION: The objective of this study was to compare the profile attractiveness in subjects treated with and without extractions after the long-term 35-year follow-up, according to laypeople, dentists, and orthodontists. METHODS: A total of 40 patients with Class I and II malocclusion were divided into 2 groups, according to the treatment protocol: extraction (E) group, extractions of 4 premolars (n = 24), with mean pretreatment (T1), posttreatment (T2), and long-term posttreatment (T3) ages of 13.13, 15.50 and 49.56 years, respectively. The mean treatment time (T2 - T1) was 2.37 years, and the long-term follow-up (T3 - T2) was 34.19. Nonextraction (NE) group (n = 16), with mean ages at T1, T2, and T3 of 13.21, 15.07, and 50.32 years, respectively. The mean (T2 - T1) was 1.86 years, and the (T3 - T2) was 35.25 years. Lateral cephalograms were used to perform profile facial silhouettes, and an online evaluation was performed by 72 laypeople, 63 dentists, and 65 orthodontists, rating the attractiveness from 1 (least attractive) to 10 (most attractive). The intragroup comparison was performed with the repeated measures analysis of variance and Tukey tests. Intergroup comparison was performed with t tests, 1-way analysis of variance, and Tukey tests. RESULTS: The E group had a longer treatment time than that of the NE group. In the pretreatment, posttreatment, and long-term posttreatment stages, the E and NE groups showed similar profile attractiveness. Laypersons and dentists were more critical than orthodontists. CONCLUSIONS: At long-term posttreatment follow-up, profile attractiveness was similar in patients treated with and without extractions.

Surgery-first in interdisciplinary class II cases.

OBJECTIVES: To present an interdisciplinary case treated with a surgery-first orthognathic approach, followed by orthodontic and prosthodontic treatment. CLINICAL CONSIDERATIONS: After an accurate pre-operative virtual planning, a young patient with skeletal class II, retrognathia, and an anterior open bite was treated with bimaxillary orthognathic surgery without pre-surgical orthodontic decompensation. Orthodontic treatment was carried out post-operatively. The treatment was completed with a prosthodontic phase to improve the final esthetic outcome of the smile. CONCLUSIONS: A surgery-first approach allowed to achieve esthetic and functional results in a reduced treatment duration that remained stable over the course of 1 year. The outcomes were consistent with prior research in terms of advantages brought by following an accurately planned surgery-first protocol. Nevertheless, longer-term follow-up was required to evaluate the treatment stability. CLINICAL SIGNIFICANCE: An accurately planned surgery-first approach significantly helped in shortening the duration of the treatment, while providing a stable, functional, and esthetic solution to the patient's problems.

Vertical effects of cervical headgear in growing patients with Class II malocclusion: a systematic review and meta-analysis.

BACKGROUND: Cervical headgear (cHG) has been shown to be effective in Class II correction both with dental and orthopaedic effects but has traditionally been associated with vertical adverse effects in terms of posterior mandibular rotation. OBJECTIVE: To assess the treatment effects of cHG treatment in the vertical dimension. SEARCH METHODS: Unrestricted literature search of five databases up to May 2023. SELECTION CRITERIA: Randomized/non-randomized clinical studies comparing cHG to untreated controls, high-pull headgear (hp-HG), cHG adjuncts, or other Class II treatment alternatives (functional appliances or distalisers). DATA COLLECTION AND ANALYSIS: After duplicate study selection, data extraction, and risk-of-bias assessment according to Cochrane, random-effects meta-analyses of mean differences (MD)/standardized mean diffences (SMD) and their 95% confidence intervals (CIs) were performed, followed by meta-regressions, sensitivity analyses, and assessment of certainty on existed evidence. RESULTS: Two randomized/16 non-randomized studies (12 retrospective/4 prospective) involving 1094 patients (mean age 10.9 years and 46% male) were included. Compared to natural growth, cHG treatment was not associated on average with increases in mandibular (eight studies; SMD 0.22; 95% CI -0.06, 0.49; P = 0.11) or maxillary plane angle (seven studies; SMD 0.81; 95% CI -0.34, 1.95; P=0.14). Observed changes translate to MDs of 0.48° (95% CI -0.13, 1.07°) and 1.22° (95% CI -0.51, 2.94°) in the SN-ML and SN-NL angles, respectively. No significant differences were seen in y-axis, facial axis angle, or posterior face height (P > 0.05). Similarly, no significant differences were found between cHG treatment and (i) addition of a lower utility arch, (ii) hp-HG treatment, and (iii) removable functional appliance treatment (P > 0.05 for all). Meta-regressions of patient age, sex, or duration and sensitivity analyses showed relative robustness, while our confidence in these estimates was low to very low due to the risk of bias, inconsistency, and imprecision. CONCLUSIONS: cHG on average is not consistently associated with posterior rotation of the jaws or a consistent increase in vertical facial dimensions among Class II patients. REGISTRATION: PROSPERO registration (CRD42022374603).

Extraction vs nonextraction orthodontic treatment: a systematic review and meta-analysis.

OBJECTIVES: To compare four first premolar extraction and nonextraction treatment effects on intra-arch width, profile, treatment duration, occlusal outcomes, smile aesthetics and stability. MATERIALS AND METHODS: An electronic search of the literature to June 2, 2023 was conducted using health science databases, with additional search of gray literature, unpublished material, and hand searching, for studies reporting nonsurgical patients with fixed appliances regarding sixteen sub-outcomes. Data extraction used customized forms, quality assessed with ROBINS-I (Risk Of Bias In Non-randomized Studies-of Interventions) and Cochrane RoB 2 (risk-of-bias) tool. GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessed certainty of evidence. RESULTS: Thirty (29 retrospective studies, 1 randomized controlled trial) studies were included. Random-effect meta-analysis (95% CI) demonstrated maxillary (MD: -2.03 mm; [-2.97, -1.09]; P < .0001) and mandibular inter-first molar width decrease (MD: -2.00 mm; [-2.71, -1.30]; P < .00001) with four first premolar extraction; mandibular intercanine width increase (MD: 0.68 mm; [0.36, 0.99]; P < .0001) and shorter treatment duration (MD: 0.36 years; [0.10, 0.62]; P = .007) in the nonextraction group. Narrative synthesis included three and five studies for upper and lower lip-E plane, respectively. For American Board of Orthodontics Objective Grading System and maxillary/mandibular anterior alignment (Little's irregularity index), each included two studies with inconclusive evidence. There were no eligible studies for UK Peer Assessment Rating (PAR) score. Class I subgroup/sensitivity analyses favored the same results. Prediction interval indicated no significant difference for all outcomes. CONCLUSIONS: Four first premolar extraction results in maxillary and mandibular inter-first molar width decrease and retraction of upper/lower lips. Nonextraction treatment results in mandibular intercanine width increase and shorter treatment duration. There was no significant difference between the two groups regarding maxillary intercanine width, US PAR score, and posttreatment smile esthetics. Further high-quality focused research is recommended.

Effectiveness of pre-alveolar bone graft orthodontics for patients with non-syndromic complete unilateral cleft lip, alveolus and palate: A systematic review and meta-analysis.

The aim of this systematic review was to compare the effectiveness of pre-alveolar bonegraft (ABG) orthodontics with no orthodontic treatment for patients with non-syndromic unilateral cleft lip, alveolus and palate. All relevant studies from 1946 to October 30, 2022, were identified using several sources including The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, Scopus, EMBASE, MEDLINE (Ovid) and EPUB ahead of publications and non-indexed citations. Randomized Controlled Trials (RCT) and Controlled Clinical Trials (CCT) were included. POPULATION: Non-syndromic complete unilateral cleft lip, alveolus and palate patients who have had ABG surgery. INTERVENTION: Orthodontics prior to ABG. Comparison: No orthodontic treatment prior to ABG. PRIMARY OUTCOME: Successful eruption of permanent canines. All articles were screened for the title, abstract and full text independently and in duplicate by 2 reviewers. The quality assessment of RCT was performed using Cochrane's risk of bias tool and the CCT was assessed using ROBINS-I tool. Of the 904 studies retrieved in the search, one RCT and one CCT were included. Both studies were judged as high risk of bias. The results from one study showed a statistically significant increase in bone volume and decreased bone defect post-ABG in the orthodontic treatment group. However, there was no difference with respect to other variables. Both included studies were of low quality. There is not enough evidence to recommend orthodontic treatment pre-ABG for patients with complete unilateral cleft lip, alveolus and palate. Future high-quality studies are required to inform patients and clinicians about the effectiveness of pre-graft orthodontic treatment.

[Technical specification for orthodontic transmission straight wire technique].

Malocclusion is an oral disease with a high prevalence. The goal of orthodontic treatment is health, aesthetics, function and stability. The transmission straight wire appliance and technique is an innovative orthodontic system with independent intellectual property rights invented by Professor Jiuxiang Lin's team based on decades of clinical experience, which provides a new solution for the non-surgical correction of skeletal malocclusions, especially class Ⅲ malocclusion, and it is also a good carrier for the implementation of the concept of healthy orthodontics. Due to the lack of guidelines, how to implement standardized application of transmission straight wire technique remains a problem to be solved. This technical specification was formed by combining the guidance from Professor Jiuxiang Lin and joint revision by a number of authoritative experts from the Orthodontic Special Committee, Chinese Stomatological Association, with reference to relevant literatures, and combined with abundant clinical experience of many experts. This specification aims to provide reference to standardize the clinical application of transmission straight wire technique, so as to reduce the risk and complications, and finally to improve the clinical application level of this technique.

Manejo odontológico en paciente con síndrome de Cornelia de Lange / Dental treatment of a patient with Cornelia de Lange syndrome

El síndrome de Cornelia de Lange (SCdL) es un trastorno genético poco frecuente y se atribuye principalmente a mutaciones en los genes NIPBL, SMC3 y SMC1A. Sus principales características clínicas son múltiples anomalías congénitas, dimorfismo facial, hirsutismo, hipertricosis, retraso psicomotor, discapacidad intelectual, restricción del crecimiento prenatal y postnatal, anomalías de manos y pies, así como malformaciones congénitas que afectan a distintos órganos. En pacientes con SCdL es necesario hacer hincapié en la higiene oral debido a la discapacidad intelectual que puede presentarse y asegurarse de que se realiza una adecuada valoración y saneamiento dental de forma periódica con el fin de prevenir enfermedades bucodentales. El objetivo de este reporte de caso es describir el manejo odontológico de un paciente de 10 años con SCdL y revisar las características clínicas y hallazgos radiológicos presentes en la cavidad oral (AU)

Cornelia de Lange syndrome (CdLS) is a rare genetic disorder and is principally attributed to mutations in the NIPBL, SMC3 and SMC1A genes. The main clinical characteristics are multiple congenital anomalies, facial dimorphism, hirsutism, hypertrichosis, psychomotor retardation, intellectual disability, prenatal and postnatal growth restriction, hand and foot anomalies, as well as congenital malformations affecting different organs. In patients with CDLS, it is necessary to focus on oral hygiene due to the intellectual disability that may be present and to ensure that adequate dental valuation and hygiene is routinely performed in order to prevent oral diseases. The aim of this case report is to describe the dental management of a 10-year-old patient with CDLS and review the clinical characteristics and radiological findings that are present in the oral cavity (AU)

Adult patient expectations and satisfaction: Can they be influenced by viewing the three-dimensional predicted outcome before fixed orthodontic treatment of dental crowding?

BACKGROUND: Investigating the possible changes in patients' expectations of and satisfaction with the orthodontic treatment outcomes when they were given the three-dimensional digital prediction of their teeth alignment before the beginning of treatment. METHODS: A prospective non-controlled single-group clinical trial was conducted on 28 (18 females, 10 males, mean age: 20.68 ± 1.91 years) patients with Class I malocclusion and moderate dental crowding who required a nonextraction orthodontic treatment. Patients were given the expectations questionnaire on their first visit (T0). Then, patients were shown a three-dimensional digital setup-created by Orthoanalyzer software (3Shape, Copenhagen, Denmark)-of the proposed treatment results before orthodontic treatment (T1) and received two questionnaires, the second expectations questionnaire and the satisfaction with the proposed changes questionnaire. Treatment was then initiated using the fixed appliances and completed. After debonding, a question about patients' satisfaction with the achieved changes was completed (T2). RESULTS: Patients' expectations level significantly increased after watching the predicted alignment of teeth compared with the initial levels in terms of chewing (x¯ = 5.54 and x¯= 6.71), speech (x‾ =5.93 and x¯= 6.93), and oral hygiene improvement (x‾= 7.93 and x¯=8.61 ± 1.06; at T0 and T1, respectively). The remaining items showed no significant differences between the two assessment times. Patients had a higher level of satisfaction at the end of treatment than after watching the proposed outcome. There were significant statistical differences in the items related to teeth appearance (x¯= 9.12 and x¯= 9.60 at T1 and T2, respectively), and teeth engagement (x¯= 8.92 and x¯= 9.40 at T1 and T2, respectively) CONCLUSIONS: Watching the predicted alignment outcome increased patients' expectations of chewing, speech, and oral hygiene improvement compared with the initially recorded levels. Patients were more satisfied with the final result than what was recorded after viewing the predicted plan. However, these results were not clinically significant.

Efficacy of an innovative Herbst appliance with TADs for patients with hyperdivergent class II malocclusion: study protocol for a randomised controlled trial.

INTRODUCTION: Class II treatment with mandibular retrusion often involves the Herbst appliance due to its efficiency and low requirement of cooperation. Despite its advantages, it causes side effects concerning the occlusal plane and pogonion in terms of clockwise rotation that hinder the desired mandibular advancement for hyperdivergent patients. In this study, we will use a newly designed Herbst appliance, and a protocol that is accompanied by TADs for vertical control to avoid maxillary clockwise rotation. We hypothesise that the effect of the Herbst appliance with the vertical control approach will be beneficial for maintaining or even decreasing the skeletal divergence in hyperdivergent class II patients compared with conventional Herbst treatment. METHODS AND ANALYSIS: This study is a randomised, parallel, prospective controlled trial that will study the efficacy of Herbst with or without vertical control in children with hyperdivergent skeletal class II malocclusion. A total of 44 patients will be enrolled and randomised in a ratio of 1:1 to either Herbst treatment or Herbst treatment with vertical control. Participants will be recruited at the Shanghai Stomatological Hospital, Shanghai, China. The primary endpoint is the change in the angle indicating the occlusal plane and Sella-Nasion plane from baseline (T0) to the primary endpoint (T2) on cephalometric measurements by lateral X-ray examination. Important secondary outcomes include the root length of the anterior teeth, and the assessment score of the Visual Analogue Scale Questionnaire, etc. Safety endpoints will also be evaluated. ETHICS AND DISSEMINATION: This study has been approved by the ethics committee of the Shanghai Stomatological Hospital (Approval No. (2021) 012). Before enrolment, a qualified clinical research assistant will obtain written informed consent from both the participants and their guardians after full explanation of this study. The results will be presented at national or international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ChiCTR2100049860, Chinese Clinical Trial Registry.