[Class II interceptive therapy in the mixed dentition: intra-oral distalization appliances]. / Traitements interceptifs de la classe II en denture mixte: thérapeutiques intra-orales de distalisation.

Treatment of Class II malocclusion during the mixed dentition may sometimes require upper molar distalization. To achieve this, many devices have been suggested. The purpose of this article is to classify them and to point out their effects on the dentition and upon skeletal structures.

[Not Available]. / Traitement précoce des classes II en thérapeutique «Distal Active Concept¼. Stabilité à 30 mois de la croissance squelettique et de la longueur d'arcade.

This cephalometric study evaluates the stability of skeletal and dento-alveolar changes after 6 to 9 months of early orthodontic treatment of Class II malocclusions with the Distal Active Concept (DAC). An analysis of the results showed significant skeletal changes, notably an average of 8.5 mm of mandibular growth, which remained stable after the close of treatment. However, the correction of the maxillary incisal protrusion relapsed slightly. The treatment-provoked lower incisal labial inclination proved to be temporary, with the lower anterior teeth returning to their initial position at the close of the 30-month post-treatment observation period.

[Individualized clinical evaluation of tooth movement. Treatment of Class II: molar splints and structural effects]. / Evaluation clinique individualisée du déplacement dentaire. Traitement des classes II: cales postérieures et incidences structurales.

The presentation of a synoptic chart allowing a dental arch analysis and Class II correction strategy is presented and followed by a study on 30 patients in mixed dentition and 37 growing patients in permanent dentition. These patients presenting a Class II malocclusion have been treated by Class II mechanics and lower molar individualised splint enhancing the vertical lower face height and skeletal Class II correction. This study shows a good vertical stabilization of the facial planes during the treatment, a significant growth of the lower face but it is noticed a posterior rotation of the occlusal plane in the mixed dentition sample.

[Orthopedic aspects of Distal Active Concept therapy applied in the mixed dentition. Comparative study with an untreated population]. / Aspects orthopédiques de la thérapeutique Dac appliquée a la denture mixte. Etude comparative avec une population non traitée.

Our present study compares the skeletal and dentoalveolar changes between 120 subjects in mixed dentition treated with "Distal Active Concept" therapy versus 157 untreated subjects of class II served as a control group. Upon considering the treated subjects, a highly significant difference of mandibular growth (p < or = 0.001) with an anticlockwise rotation is noticed. The comparisons done according to gender and facial divergence show that the linear measurements are greater in males than females but the vertical relations are identical. Moreover, when considering hypodivergent and normodivergent subjects, all cephalometric values are similar and when regarding treated or non treated subjects, a significant difference of vertical growth factors exists and prevails. After comparaison, results clarify the benefits of early treatment for Class II malocclusion when the skeletal imbalance is considerable as it causes a quick mandibular response and hence improving the facial harmony dramatically.

[Inter- and intrafamilial expression of cleidocranial dysostosis]. / L'expressivité inter- et intrafamiliale de la dysostose cléido-crânienne.

Cleidocranial dysplasia is a bony autosomal dominant disorder, defined by late closure of fontanels and sutures, clavicular aplasia or hypoplasia and supernumerary teeth. The aim of our study was to define the CBFA1 mutations in three families with cleidocranial dysplasia and to describe the phenotype expression within and between the families. While the mutation R225Q caused a similar phenotype within one family, the mutation G146R, located in the same domain, was the cause of a variable expression between two family members. A third mutation, R190Q was responsible for symptoms not commonly associated with this disorder. The results of our craniofacial examination are in agreement with the numerous descriptions in the literature. This study accents the difficulty in establishing a clinical based diagnosis due to the wide variability.

[The Top Wire Appliance bracket: tooth movement and friction]. / Le bracket Top Wire Appliance: déplacements et frottements.

The TWA (Top Wire Appliance) bracket enables a vertical insertion of the rectangular orthodontic archwire. This updated biomechanical evolution of the TWA technique promotes corrections during the first therapeutic stages of a fixed treatment. This bracket has been designed to take full advantage of the properties of shape memory archwires, reducing chairtime and making deep bite correction easier, dental rotations, alignment, leveling and stabilization, thanks to the rigidity of the vertically inserted arch, working heightwise. Progressive tightening ligature, adapted to the therapeutic sequence in progress is an element of biomechanics in TWA technique.

[The distal active concept applied to the mixed dentition: a comparative study]. / La thérapeutique du "Distal Active Concept" appliquée à la denture mixte: une étude comparative.

The "Distal Active Concept" (DAC) therapy used during the mixed dentition period shows a mandibular growth of 7.6 mm whereas the same treatment applied on the permanent dentition only shows a mandibular growth of 3.9 mm. This difference is highly significant. The DAC therapy is prescribed to a group of 30 nine years old patients with a mixed dentition for six months. The DAC therapy is prescribed to a group of 34 twelve years old patients with a permanent dentition for 24 months. As the mandibular answer to treatment seems to be more effective at the age of 9 than later, during the prepubertal period, the DAC therapy appears to be of interest and an alternative to activator treatments. Our results show the efficiency of a first stage treatment, for all the patients showing a significant class II malocclusion.

[Comparative study of mandibular growth and rotation in two sample groups treated according to the "Distal Active Concept" or the Edgewise technique]. / Etude comparative de la croissance et de la rotation mandibulaire sur deux échantillons traités selon le "Distal Active Concept" ou en technique Edgewise.

The "Distal Active Concept" therapy, favours an immediate repositioning of the mandible and introduces new therapeutic sequences which allow an easy correction of the Class II molar relationship, enhancing the mandibular growth simultaneously. The "Distal Active Concept" therapy is a combined treatment which induces the correction of the Class II malocclusion without extractions and without headgear. The dento-alveolar unit is used as a functional matrix to free, then enhance the mandibular growth and induce its counter-clockwise rotation. 35 patients treated with the "Distal Active Concept" therapy are compared to 33 patients, treated with the extraction of four bicuspids and in Edgewise therapy, in order to visualize the mandibular growth and the counterbalancing rotation described by Dibbets.

[Embryo reduction in multiple pregnancies. A French multicenter study]. / Réduction embryonnaire dans les grossesses multiples. Une enquête multicentrique française. Pour le Club Francophone de Médecine Foetale.

OBJECTIVE: To study the outcome of multifetal pregnancy embryo reductions (MFPR) in France. STUDY DESIGN: A retrospective questionnaire multicenter survey was conducted in 11 French centers. 262 consecutive MFPR were collected. Miscarriage and prematurity rates were analyzed as a function of the starting number of embryos, the finishing number after MFPR, and the technique of MFPR. RESULTS: There were 41 pregnancy losses before 24 weeks (16%), and 221 deliveries at 25 menstrual weeks or later (84%). Prematurity was significantly correlated to the finishing number of embryos following MFPR. However, even when a single embryo was left, there were 30% of premature deliveries. CONCLUSION: MFPR decreases the risk of prematurity in multifetal pregnancies of high order, and this is best achieved when a single embryo is left.

Is there an indication for embryo reduction?

The selective reduction of embryos in multiple pregnancies poses numerous medical, technical, ethical and psycho-social problems. In a retrospective study, we analysed nine hundred and twenty-two pregnancies obtained using medically assisted procreation between May 1982 and May 1990. Among 922 successful pregnancies, 372 were singleton, 102 were twin and 13 were triplet. Data from this analysis and from a French multicentre study of 262 embryo reduction procedures demonstrated the value of an embryo quality score for minimizing the risk of multiple pregnancy and the existence of extremely infrequent, ethically acceptable indications for embryo reduction. These indications included ultrasound-proven malformations of one fetus, multiple pregnancies in patients with extensive uterine scarring, and multiple pregnancy despite the appropriate use of preventative measures which can be expected to make this technique unnecessary in the future.

PIP: This review of the medical and ethical indications and techniques of embryo reduction in multiple pregnancy induced by ovulation induction, in vitro fertilization, or embryo transfer, discusses incidence, consequences, and prevention of high-order multiple pregnancies. Also presented were an analysis of results of 922 pregnancies and a French multicentre study of 262 embryo reduction procedures where an embryo quality score was employed. The incidence of multiple pregnancies in ovarian stimulation ranges from 11 to 44%. In the authors' series of 922 pregnancies followed between May 1982 and May 1990 there were 20% twins and 3% triplets. Triplets were more common after cocyte donation and embryo transfer. Embryo reductions can be done transcervically, transabdominally, or transuterine under endovaginal echo control, which is the safest method. All selective embryo reductions reduce somewhat the risk of premature threatened labor, prematurity and perinatal mortality that would result in higher order multiple pregnancies. A retrospective study of 372 singleton, 102 twin, and 13 triplet pregnancies suggested that the only way to prevent multiple pregnancies is to control the dose of hCG used and the number of embryos transferred. Another approach is to use an embryo quality score based on anatomic uniformity of the embryos transferred. The optimum is to transfer 2 embryos with a total score of 16 or 3 with a score of 16-22. For ovarian stimulation, the number of follicles 10 mm or the estradiol level can be followed. A survey of embryo reduction procedures done in France found that most were done after ovulation induction and for 3, 4, or more fetuses. Other controversial indications for reduction procedures are chromosomal abnormalities and fetal malformations.

[The orthopedic effect of the Edgewise technic]. / Contribution a l'étude de l'effet orthopédique de la technique Edgewise.

A statistical study of 30 cases treated in Edgewise technic shows the orthopedic effects of this technic upon adolescent patients who have a Class II, division 1 malocclusion. The Harvold's triangle and Mac Namara's analysis show the sagittal break of the maxillary growth, the significant acceleration of the horizontal growth of the mandible and the stabilization of the vertical growth of the face. The results are compared to the initial situation and to a prevision of growth without treatment.

[Skin aplasia of the vertex. Report of a familial form]. / Aplasie cutanée du vertex. A propos d'une forme familiale.

The authors report about a familial case of skin aplasia of the vertex cranii, of which they present a form that required emergent surgical repair with a favorable outcome. The investigation allowed tracing two relatives with minor forms expressed as alopecia of the vertex. Skin aplasia of the vertex cranii is an exceptional condition, which consists in the congenital absence of cutaneous, bony and/or dural tissue in the cranium. The various etiopathogenetic, clinical, diagnostic, evolutive and therapeutic aspects are reviewed.

[Takayasu's disease and post-traumatic scalp necrosis]. / Maladie de Takayasu et nécrose post-traumatique du cuir chevelu.

This relates the case of a 19-years old female suffering from Takayasu's disease, who sustained injury with extradural hematoma formation calling for emergent evacuation thereof. The immediate postoperative period in this neurosurgical patient was characterized by extended necrosis of the scalp and underlying bone, due to low blood supply to the head in connection with her disease. The authors review the main characteristics of this rare inflammatory arteriopathy, and point out to the multidisciplinary collaboration which prompted healing of the patient's loss of substance.

[Necrotizing fasciitis of the face. Clinical and therapeutic aspects]. / Les fasciites nécrosantes de la face. Aspects cliniques et thérapeutiques.

Necrotizing fasciitis is a synergic infection, the chief causal agents of which are beta-hemolytic group A streptococci. The authors insistingly review the different aspects of this rare affection and stress the importance of emergent medical and surgical management, as the evolution of the disease is still often lethal.

[Wide orbital exenteration and maxillofacial prosthesis. Practical problems]. / Exentération orbitaire élargie et prothèse maxillo-faciale. Problèmes pratiques.

We report two cases of wide orbital resection requiring the use of an oculo-palpebro-jugal prosthesis. The latter being indispensable in the treatment of advanced orbital cancer in order to facilitate social reinsertion.

[Skeletal deep bite and esthetics]. / Deep bite squelettique et esthétique.

The patient who present a deep bite pattern with a low FMA angle have contradictional functional and esthetic objectives. The cephalometric alarm signs help the clinician to locate the esthetic risks.

The management of multiple pregnancies after induction for superovulation.

The high rate of multiple pregnancies after embryo transfer depends upon the number of embryos replaced and amounts to approximately 20% for four or more embryos. This incidence justifies a preventive or curative treatment after the induction of superovulation. Aspiration of one or more embryos via the cervix under ultrasound control has been undertaken on 42 patients since 1983, and involved two sextuplets, 10 quadruplets, 18 triplets and 12 twins. Twenty six embryo reductions were performed before 9 weeks of amenorrhoea. Five failures after 9 weeks were due, in the early stages of this procedure, to infection. In the case of twins, the indication was a scarred uterus in 10 cases and a psychiatric reason for two patients. In 19% of our cases delivery occurred within 32 weeks of amenorrhoea.