Obstructive sleep apnea (OSA) in adolescents is characterized by a predominance of OSA type 2 which is associated with overweight/obesity. The treatment of OSA in adolescents depends on the cause of OSA and its risk and / or precipitating factors. Adenotonsillectomy is the cornerstone of OSA treatment in case of hypertrophy of the adenoids and/or tonsils. An anti-inflammatory treatment has proven its efficacy in mild to moderate or mild residual OSA after adenotonsillectomy. Orthodontic treatments such as rapid maxillary expansion or jaw positioning are indicated in case of dentofacial disharmonies. Continuous positive airway pressure (CPAP), is mainly indicated in type-3 OSA, which is associated with craniofacial or upper airway malformations or anomalies and should be performed by a pediatric multidisciplinary team having an expertise in sleep and OSA. Finally, maxillofacial or craniofacial surgery may be indicated in adolescents with type-3 OSA. In conclusion, the treatment of OSA in adolescents is based on the type of OSA, its severity and the medical characteristics of each patient.
Vestibular frena are bands of soft tissue that connect the lip or cheek to the alveolar mucosa or to the gum and that can restrict their movements. These mucosal folds can, in some cases, attach too close to the teeth and are associated to a persistent diastema. Additionally, if this frenum is too tight, it can cause gum recession by pulling the gums away from the teeth. The position of a frenum can become more apical and be corrected during growth with anterior teeth eruption. However, when it causes self-consciousness, pain, or gum recession, a frenectomy is indicated. The frenectomy is a simple procedure which involves total surgical removal of a frenum. The presence of a hypertrophic maxillary vestibular medial frenum associated with a diastema is the most commonly encountered indication in children. Its elimination will contribute to diastema closure that will stay stable over time.
Autotransplantation is a still unknown therapeutic solution that presents multiple indications in the growing patient. It requires close collaboration between the orthodontist, the dentist, and the oral surgeon. We will illustrate this article by a clinical case of transplantation of a premolar in place of a central incisor after a review of the indications, advantages, and surgical procedure of this method.
In this article, we are presenting a new mandibular anchorage solution through three clinical cases.This method is based on a mountain climbing technique. Thanks to a simple fixation wire insert in the jaw bone, it is now possible to obtain a backward movement of the mandibular arch and a significant uprighting of the incisors.
Immature tongue function so-called “tongue-thrust or infantile and teeth apart swallow” and its rehabilitation involves multiple specialities in dentistry (pediatric dentistry, orthodontics, management of temporomandibular disorders, periodontics,…). Fifty years ago Mrs Fournier described a tongue rehabilitation technique. Given the difficulty to find a physiotherapist able to practice such a therapeutic, the aim of this article is to describe this therapeutic so that non-physiotherapists practitioners be able to initiate it and to teach it to their patients, at least for simple cases. It includes corrections of tongue immaturity, tongue resting position, deglutition and phonation. These changes might involve adaptive cortical neuroplasticity. Indeed these last years it has been shown in humans that standardised and calibrated tongue lift or protrusion exercises induce such plasticity in the tongue motor cortex.
Eating disorders and school refusal behavior with delayed sleep phase are pathologies associated with very different or even inverse school problems. It is through these two prisms that we will develop the idea of school care, which is being set up in the innovative framework of the Mediterranean Area of the Adolescent, integrating a National Education Unit within the Child and Adolescent Psychiatry unit. This specific care seems to us interesting in the adolescent because it allows a work in «natural» environment of certain difficulties related to the different psychiatric disorders and seems to us as a help to the revival of the adolescent process.
Orthodontic treatments can have an impact on the soft tissues and more particularly on the cutaneous profile. The aim of this work was to evaluate profile changes following orthodontic treatment. Material and methods: This study concerned 90 patients randomly selected in the orthodontic department of Monastir (Tunisia). Profile headfilms at the start and at the end of orthodontic treatment were compared using, as reference lines, the SN-7° plane and the orthogonal to SN-7° plane going through the S-point (POSN- 7°). The Student test was applied to evaluate the variations in the cephalometric measurements. The Pearson test was used to study the correlation between the horizontal tooth movements and facial profile changes. Results: We noted a significant decrease in the upper labral (Ls) (p=0.049) and lower labral (p=0.048) as well as a significant increase in the labio-mental angle (p=0.025) in patients treated with extractions of premolars. A positive correlation between the incisor movements and the reduction of the labial protrusion was observed. Conclusion: The results of this study have shown that the movements of the incisors consecutive to extractions can have tangible effects on the cutaneous profile. Further investigations should be carried out to highlight the relationship between tooth movement and soft tissue.
Adolescent experiment widespread changes as he/ she goes through this transitional period from childhood to adulthood. Sleep is no exception to this changeover with, as consequences, modifications of the clinical pre- sentation of subjects with Obstructive Sleep Apnea- Hypopnea Syndrome (OSAHS) and potential different alternative diagnosis.
The professionalization of the “management” function in dental practices and especially in group practices and specialized dento-facial orthopedics has become a major challenge for their economic viability. However, most practitioners manage their care structure and team empirically and intuitively on the “patriarchal” model that has been in place for decades in human-sized businesses. Unilateral decision-making, omnipotence and authoritarianism are favored to the detriment of a more participative and delegative mode of management involving the firm’s human and active forces in its continuous improvement approach (Quality approach). The management of organizational change and the adoption of working methods inherited from scientific management are all the more important as the social and economic situation is increasingly undermining the dental industry.
The acceleration of orthodontic tooth movement due to alveolar corticotomies has been well documented in the literature. It is defined by a phenomenon of transient osteopenia named “the regional acceleratory phenomenon” by Frost. This biological mechanism has been described in studies on both humans and animals. However, other interesting effects in orthodontics are associated with alveolar corticotomies: higher amplitude of tooth movements, a decrease of the root resorptions and an increase of stability after orthodontic treatment.
This issue is themed “eclecticism” because it is aimed at discussing wide-ranging topics os that the diverse wishes of the readers are satisfied. Clinicians can ensure effective and reproducible clinical practice by constantly keeping themselves up-to-date on fundamental and clinical research. It requires interdisciplinary collaboration, which is now integrated into treatment processes. The authors attest to this in these pages. Marc Bert shares knowledge on the peri-implant gingiva through the study of its anatomy, physiology, and development. After a concise and precise review of the biology of the periodontium and histology of the gingival–implant sulcus, he demonstrates its resemblance to the epithelial–mucosal attachment of the tooth. He describes the maintenance of the quality of the tissues surrounding the implant and even its improvement over time, with the possibility of strengthening the keratinized gingiva or its creation, provided oral hygiene is satisfactory. This is not the case for implants that are used to stabilize removable prostheses. Fabienne and Frank Pourrat state that the diode laser is insufficiently used by orthodontists. They propose its use in (a) beautifying the smile with a microsurgery for soft-tissue enhancement and (b) increasing the stability of malposition corrections by decreasing malposition recurrence. It is through a comprehensive decision tree that a practitioner can assess the potential of gingivectomies to contribute to soft-tissue esthetics. Qualified Dentofacial Orthodontic Specialist
Adults are often worried and somewhat shocked by teenagers’ behavior, and their way of learning, the so-called “Adolescence Disorders.” The lack of assertiveness of adolescents is the most important issue in the management of orthodontic treatment. With the desirable attitude of empathy in mind, for the majority of teenagers, the orthodontist will manage treatment in a quiet and optimal way. For 15% of them however, real problems such as anxiety, depression or personality disorders may appear. The use of CBT will be useful. The orthodontist must be empathetic enough to guide these young teenagers in their development, through their “mouth,” this organ is psychologically invested to fundamental symbols of life and learning.
The orthodontic treatment of severe class II division 1 malocclusions is often difficult, which leads some specialists to offer a surgical correction of the overjet. Treatment is made complex by the value of the horizontal overlap as much as the « depth » of deep bite that is very often present alongside the malocclusion. This is why we are offering a treatment protocol including a FABP (Fixed Anterior Bite Plate) which will allow, if the patient cooperates, to correct the anatomic anomaly while concurrently establishing new masticatory cycles in order to stabilize and preserve the results obtained. It is this systemic approach of treatment that is the focus of this article.
Periodontology and orthodontics are two closely related odonatological disciplines, both of which affect the periodontium of our patients. If in most cases orthodontics have no adverse effect on the periodontium, in case of fragile (weak?) phenotype periodontium (low height or lake of keratinized tissue, thin bone tables, fenestrations or bone dehiscence) orthodontic treatment can, depending on the movements performed, cause or aggravate periodontal recessions that are unsightly and painful for the patient and compromise the results. Through a clinical case we will see how to prevent and treat these cases to make orthodontic treatment possible and maintain its results over time.
The difficulty of management of a transverse maxillary hypoplasia is to choose the right treatment and the appropriate tools. When transverse maxillary insufficient is associated to sagittal and/or vertical discrepancies in adults, the gold standard treatment is a surgical procedure combined with orthodontic treatment. The surgical procedure can be done in 1 or 2 stages. If the patient chooses a lingual orthodontic technique, the tools for expansion and the stabilization of expansion are not simple to use. The aim of this article is to report the case of a 25-year-old male patient, referred to our cabinet for skeletal Class-III malocclusion associated with laterognathism and transverse maxillary deficiency. The patient underwent one-stage surgery. He choose to be treated by a lingual orthodontic technique, we used the FKS® disjunction device.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article received: 20/11/2017. Accepted for publication: 20/12/2017. Address for correspondence: Laurent Petitpas – 35c impasse des Brasseries – 54700 Pont-à-Mousson E-mail:ortho@petitpas.eu
During adolescence, sleep changes physiologically and biologically. It is during this period of life that development and learning takes place. However, new teenager sleep behaviors appear. A decrease in weekly sleep time and a jet lag during weekends contribute to the deterioration of teenager’s sleep. The use of new social media plays a detrimental role, with a strong negative correlation between time spent on those and sleep time. Teenagers suffering from sleep deprivation develop well-identified consequences such as diurnal fatigue, lack of attention, more anxiety, poor self-esteem, and also an increased risk of obesity and depression. Teenage sleep is a real public health issue.
Children and teenagers with orthodontics may be affected by infectious, hereditary, traumatic, malignant, or idiopathic oral mucosa lesions. Orthodontists have to be able to detect, identify, and treat effectively or to address the patient to a specialist. Here we discuss this difference to make their diagnosis and management easier for the practitioner.
The search for fluidity in an orthodontic practice must be an imperative axis of reflection. Fluidity is a quality that must be targeted because it is synonymous with efficiency and comfort and, consequently, profitability. This profitability is not exclusively financial. It is also at the level of the human. It allows each member of the team to bring the best of himself in his function. And when a team is successful, patients feel it. A satisfied patient is the best advertisement a practice can have. Why deprive yourself?
Sleep Bruxism, the sleep-related movement disorder of tooth grinding and clenching, is highly reported in pediatrics with a prevalence of up to 40 % during childhood and adolescence. The precise etiology of sleep bruxism remains unknown, but it may involve genetic and psychosocial components (such as anxiety and stress). Clinicians should be aware that quite often sleep bruxism is associated with other disorders, such as snoring, sleep-disordered breathing, sleep complaints, and behavioral problems. These comorbidities should be investigated, because they may be severe and prolonged if they are not treated. SB may lead to morning jaw muscle soreness or pain, headache, masticatory muscle hypertrophy, temporomandibular disorders, and tooth wear. Especially in pediatrics, sleep bruxism is usually managed with conservative therapies, such as sleep hygiene, behavioral modifications, biofeedback, familial counseling and, only in cases of severe tooth wear or other serious possible consequences of SB, soft occlusal splints.
