Temporomandibular Disorders and Orthodontics: how to conduct a screening examination? / Dysfonctionnements temporo-mandibulaires et orthodontie : comment conduire un examen de dépistage ?

Introduction: Common Temporomandibular Disorders (TMD) involve the masticatory muscles, temporomandibular joints, and/or their associated structures. Clinical manifestations can vary, including sounds (cracking, crepitus), pain, and/or dyskinesias, often corresponding to a limitation of mandibular movements. Signs or symptoms of muscular or joint disorders of the masticatory system may be present before the initiation of orthodontic treatment, emerge during treatment, or worsen to the point of stopping treatment. How do you screen for common TMD in orthodontic treatment? Materials and Methods: The main elements of the interview and clinical examination for screening common TMD in the context of orthodontic treatment are clarified and illustrated with photographs. Moreover, complementary examinations are also detailed. Results: A clinical screening form for common TMD is proposed. A synthetic decision tree helping in the screening of TMD is also presented. Conclusion: In the context of an orthodontic treatment, the screening examination for common TMD includes gathering information (interview), a clinical evaluation, and possibly complementary investigations. The orthodontist is supported in this approach through the development of a clinical form and a dedicated synthetic decision tree for the screening of TMDs. Systematically screening for common TMD before initiating orthodontic treatment allows the orthodontist to suggest additional diagnostic measures, implement appropriate therapeutic interventions, and/or refer to a specialist in the field if necessary.

Introduction: Les dysfonctionnements temporo-mandibulaires (DTM) concernent les muscles masticateurs, les articulations temporo- mandibulaires et/ou leurs structures associées. Les manifestations cliniques peuvent être diverses : bruits (craquements, crépitements), algies et/ou dyscinésies correspondant le plus souvent à une limitation des mouvements mandibulaires. Or, des signes ou symptômes de troubles musculaires ou articulaires de l'appareil manducateur peuvent être présents avant le début de la prise en charge orthodontique, voire apparaître en cours de traitement ou s'aggraver au point de remettre en question la poursuite du traitement engagé. Comment conduire un dépistage de DTM communs dans le cadre d'une prise en charge orthodontique ? Matériel et méthodes: Les éléments essentiels de l'entretien et de l'examen clinique d'un dépistage des DTM communs dans le cadre d'une consultation d'orthodontie sont clarifiés et illustrés à l'aide de photographies. Le recours aux examens complémentaires a également été détaillé. Résultats: Une fiche clinique de dépistage des DTM communs est proposée. Un arbre décisionnel synthétique aidant au dépistage des DTM est présenté. Conclusion: Dans le cadre d'une consultation d'orthopédie dento-faciale, l'examen de dépistage des DTM communs inclut un recueil d'informations (entretien), une évaluation clinique et éventuellement des examens complémentaires. L'orthodontiste est soutenu dans cette démarche par la création d'une fiche clinique et d'un arbre décisionnel synthétique dédiés au dépistage des DTM. Effectuer systématiquement un dépistage des DTM communs avant d'initier un traitement orthodontique permettra à l'orthodontiste de proposer des moyens diagnostiques supplémentaires si nécessaire, et de mettre en place la prise en charge adéquate et/ou de référer à un spécialiste du domaine pour démarrer le traitement orthodontique dans les meilleures conditions.

Impact of Orthodontic-Surgical Treatments on the Signs and Symptoms of Temporomandibular Disorders: A Systematic Review.

INTRODUCTION: Some patients exhibit temporomandibular joint or muscular disorders of the masticatory system before, during, or after orthognathic surgery (OS). These are collectively referred to as temporomandibular disorders (TMDs). This systematic literature review aimed to determine the relationship between orthodontic-surgical treatment and TMDs. METHODS: An electronic search of the PubMed database, supplemented by a manual search, was performed; the search included any studies published between 2021 (date of the last search in a systematic review of the literature on the subject) and June 2023 that evaluate the prevalence of TMDs during orthodontic-surgical treatment. The diagnosis of TMDs had to be established using the diagnostic algorithm "diagnostic criteria for temporomandibular disorders (DC/TMDs)", and the diagnosis of disc displacement had to be confirmed using magnetic resonance imaging (MRI). The data were extracted and statistically analyzed. RESULTS: Of the 100 results, seven eligible articles were included, representing a total of 529 cases undergoing orthodontic-surgical treatment. A reduction in joint noises (64.8%), arthralgia (57 to 77%), and myalgia (73 to 100%) was found after orthodontic-surgical treatment despite the fact that a minority of patients exhibited these signs and symptoms even though they were asymptomatic before treatment. The effects of OS on disc position were objectively unpredictable. After surgery, the presence of headaches decreased without significance and the risk of their occurrence was very low (1%). The studies converged toward a reduction in the amplitudes of mouth opening and lateral/protrusion movements. Finally, after the treatment, mandibular function was improved. CONCLUSION: Under the conditions of this study, OS seems to have a positive impact on the signs and symptoms of TMDs; however, it is not possible to predict the consequential effects on the position of the TMJ disc, whether it is initially in a normal position or displaced.

Prevalence of the Gingival Phenotype in Adults and Associated Risk Factors: A Systematic Review of the Literature.

The relevance of assessing the gingival phenotype prior to the initiation of periodontal, orthodontic, or prosthetic therapy has been clearly demonstrated. However, publications on this subject are either old or concerned with the means of assessing the gingival phenotype or the main factors likely to modify it. The main objective of this systematic review of the literature was therefore to investigate the prevalence of different gingival phenotypes in adults in good general health and with a healthy periodontium. A systematic review of the literature was performed following the guidelines of PRISMA recommendations using an electronic search strategy on four databases (PubMed, Scopus, Cochrane Library, and Embase) complemented by a manual search. Three independent authors were involved in study selection, data extraction, and bias assessment. Results: Of 807 articles, 17 of them, published between 2012 and 2023, involving 3277 subjects from 11 countries and 9766 dental sites, fulfilled the inclusion criteria. The prevalence of the gingival phenotype could not be determined at the level of an individual or a dental arch because all the publications assessed this phenotype only at the level of certain dental sectors, and were not chosen at random. The maxillary central incisors and maxillary or mandibular first molar sectors were associated with a high and thick gingival phenotype, independently of the dental morphology, gender, and age of adult subjects. Furthermore, in these regions, this gingival phenotype tended to be associated with a thick vestibular bone table. In contrast, maxillary and mandibular incisors and premolars more often had a thin gingival phenotype. For other teeth, the results were less conclusive. It is important not to rely solely on the overall appearance of the dentition but to independently assess the thickness and height of the gingiva at each dental site requiring intervention. Finally, this study highlights a key point, namely the need for further longitudinal studies to determine the prevalence in healthy adults. For practicality and feasibility reasons, these studies should be designed according to therapeutic needs, dental sector by dental sector, and within homogeneous source populations. PROSPERO registration: CRD 42023392602.

The biological effects of Piezocision™ on bone for accelerated tooth movement: A systematic review of animal studies.

OBJECTIVES: This systematic review aimed to assess the biological response at tissue, cellular, and molecular levels following Piezocision™ surgery, and its efficacy in accelerating orthodontic tooth movement. MATERIAL AND METHODS: A systematic review of the literature was conducted across 4 databases following the PRISMA guidelines up to May 2022. Prospective controlled animal studies involving healthy animals under active orthodontic treatment assisted by corticotomy performed with a piezotome (Piezocision™) published in the English language without time restrictions were included. The article selection, data extraction and risk of bias assessment (SYRCLE tool) were performed by two independent blinded review authors. RESULTS: Out of 738 articles screened, 10 studies were included with various level of bias. Biological responses were categorized into tissue, cellular, and molecular levels. Tissue-level changes included a global decrease in bone mineral content post-Piezocision™. At the cellular level, increased bone turnover activity was noted. Molecularly, elevated RANKL and OPG expression, along with increased TRAP+ and cytokines, were observed after Piezocision™. Studies confirmed Piezocision's efficacy, reporting 1.35 to 3.26 times faster tooth movements, peaking between the 3rd and 50th day post-surgery. Biological responses were transient, reversible, and proportional to surgical insult, with reactivation possible through a second Piezocision™. CONCLUSIONS: After Piezocision™ surgery, a transient and reversible biological response was described at the tissue, cellular and molecular levels, which induced faster orthodontic tooth movements. This biological response could be re-activated by an additional Piezocision™ and is proportional to the surgical injury. SYSTEMATIC REVIEW REGISTRATION: Prospero CRD42022303237.

Importance of Early Detection of Wire Syndrome: A Case Series Illustrating the Main Stages of the Clinical Gradient.

(1) Context and Objective: Wire syndrome (WS) refers to dental displacements which can be qualified as aberrant, unexpected, unexplained, or excessive of teeth still contained by an intact orthodontic retainer wire without detachment or fracture, leading to evolving aesthetic and/or functional consequences, both dental and periodontal. The clinical diagnosis of WS in severe cases is often easy. On the other hand, emerging cases must be detected early to stop this evolutionary process as soon as possible, as well as to effectively manage unwanted dental displacements and associated dento-periodontal tissue repercussions. The aim of this retrospective study was to understand the challenges and importance of early diagnosis, highlight the clinical gradient of WS, and clarify the key elements of diagnosis for many practitioners confronted with this type of problem. (2) Materials and Methods: Three cases of increasing complexity were described: the history of wire syndrome, a description of the key elements of its diagnosis, and the final diagnosis itself. (3) Results: Different types and locations of wire syndrome have been observed, from early form to terminal wire syndrome. The three main stages of the clinical gradient are described as follows. In the first case, wire syndrome starting on tooth 41, called the "X-effect" type, was suspected. X-effect wire syndrome on 21, X-effect wire syndrome on 41, and Twist-effect wire syndrome on 33 were diagnosed in the second case, which can be classified as an intermediate case. In the extreme clinical situation of the last case, severe and terminal wire syndrome on tooth 41, the X-effect type, was observed. (4) Conclusions: This case series presents the main stages of the clinical gradient of WS. Although in the case of early WS it is very difficult to identify and/or differentiate it from movements related to a classical relapse phenomenon, the diagnosis of terminal WS is very easy. The challenge for the practitioner is therefore to detect WS as early as possible to stop the iatrogenic process and propose a personalized treatment depending on the severity of clinical signs. The earlier WS is detected, the less invasive the treatment.

The « patient casting ¼: a key decision in orthognathic surgery / Le « casting du patient ¼: clé de décision en chirurgie orthognathique

Introduction: The surgical orthodontic patient is a patient whose management is specific. The success of this protocol goes beyond of the right indication and the control of the pre-surgical orthodontic preparation of the treatment. The coordination revolves around a multidisciplinary team, namely an orthodontist, a maxillofacial surgeon, a physiotherapist, a speech therapist, a general practitioner, etc. but also with the collaboration of a specialized psychotherapist. Material and Method: Does the ideal « patient ¼ exist in orthognathic surgery? The decision criteria are morphological (occlusal, aesthetic and cephalometric) but also psychosocial. Results: A new classification called « psychological ¼ is proposed in this article. Conclusion: This new classification can be considered as a key decision in the « casting ¼ of the surgical orthodontic patient and represents a first basis for further investigations in this field.

Introduction: Le patient orthodontique chirurgical est un patient dont la prise en charge est spécifique. La réussite de ce protocole va au-delà de la pose de la bonne indication et de la maîtrise de la préparation orthodontique pré-chirurgicale du traitement. La coordination s'articule autour d'une équipe pluridisciplinaire, à savoir un orthodontiste, un chirurgien maxillofacial, un kinésithérapeute, un orthophoniste, un omnipraticien, entre autres, mais également avec la collaboration d'un psychothérapeute spécialisé. Matériel et méthode: Le « patient idéal ¼ existe-t-il en chirurgie orthognathique ? Les critères de décisions sont morphologiques (occlusaux, esthétiques et céphalométriques), mais aussi psycho-sociaux. Résultats: Une nouvelle classification dite « psychologique ¼ est proposée dans cet article. Conclusion: Cette nouvelle classification peut être considérée comme une clé de décision dans le « casting ¼ du patient orthodontique chirurgical et représente une première base pour de plus amples investigations dans ce domaine.

Patient's and Practionner's Experiences of a First Face-to-Face vs. Remote Orthodontic Consultation: A Randomized Controlled Trial.

(1) Aim: The purpose of this study was to assess patients' and practitioners' reported experience measures (PREMs) following a first standard orthodontic consultation (face-to-face consultation) versus a first orthodontic teleconsultation (video-assisted remote orthodontic consultation).; (2) Materials and Methods: This study was designed as a randomized controlled trial in which 60 patients were randomly allocated to two groups. In the control group, patients received a first face-to-face consultation (n = 30) whereas, in the test group, patients received a first orthodontic teleconsultation (n = 30). Patients as well as the orthodontic practitioners completed questionnaires after the experience. (3) Results: From the patients' point of view, overall satisfaction was comparable between the control group and the test group (p = 0.23). Quality of communication with the clinician, understanding of the explanations provided and a sense of privacy were also comparable between the two groups. However, from the practitioners' perspective, overall satisfaction after the face-to-face consultation was significantly higher than after the first remote consultation (p < 0.01). (4) Conclusions: In the context of a first orthodontic consultation, teleorthodontics appears to be an interesting and complementary approach to a classical face-to-face appointment, but which should by no means become systematic.

Malocclusions and oral dysfunctions: A comprehensive epidemiological study on 359 schoolchildren in France.

OBJECTIVES: The purpose was to conduct a comprehensive study of malocclusions and oral dysfunctions on 11-year-old children and to study the risk factors associated with malocclusions. MATERIAL AND METHODS: A cross-sectional descriptive epidemiological survey was conducted among 359 children in France. A clinical examination was conducted, and orthodontic and oral functional data were collected. In addition, the need for orthodontic treatment was evaluated using the criteria defined by of the French National Authority for Health (HAS). Finally, a univariate and multivariate analysis was performed to assess the risks associated with malocclusions. RESULTS: Most children (88%) exhibited a malocclusion, regardless of gender (p = .912). The examination of oral functions identified a large number of swallowing (87%) and respiration (42.7%) disorders. The presence of malocclusion was statistically linked to the low position of the tongue at rest (p < .001), abnormal swallowing (p = .03), and improper mouth breathing (p = .001). After a multivariate analysis, the type of respiration (odds ratio [OR] = 3.2 [1.4-7.3]) and the position of tongue at rest (OR = 3.43 [1.7-7.1]) were the two most prominent factors in the prediction of emerging malocclusion. CONCLUSION: This epidemiological survey reveals a high prevalence of dental malocclusions and functional disorders. Oral respiration and the low position of the tongue at rest are the most important factors in the prediction of a malocclusion.

Biofilm and Orthodontic Materials: literature reviews and Scanning Electron Microscopy (SEM) images gallery / Relations entre biofilm et matériels orthodontiques : revues de la littérature et galerie d'images en microscopie électronique à balayage (MEB)

Introduction: Plaque control remains a concern in oral health but also in orthodontics. Objective: The aim of this paper was to investigate the dental plaque adhesion to different orthodontic appliances. Materials and Methods: Four literature reviews were initiated to clarify the accumulation of dental plaque to different orthodontic appliances, namely the type of brackets (conventional versus self-ligating, metal versus clear), the type of ligatures (metal versus elastomeric) in addition to the type of archwires. Moreover, a gallery of Scanning Electron Microscopy (SEM) images was made on different orthodontic appliances before and/or after time in the oral cavity. Results: Considering the strong methodological heterogeneity of the included studies, there is no consensus on which type of bracket should be preferred for the prevention of plaque retention. Metal ligatures would be less prone to plaque accumulation compared to elastomeric ligatures, which are themselves color-dependent. The type of archwire was not investigated in this topic. SEM images highlighted the presence of anfractuosities on the surface of new orthodontic archwires as well as the presence of biofilm at different degrees of maturation on the appliances after time in the oral cavity. Conclusion: Although it is not possible to establish a consensus on which orthodontic appliances should be preferred to decrease plaque retention, different stages of biofilm evolution are observable on their surface and therefore potentially associated with a proportional virulence.

Introduction: Le contrôle de la plaque dentaire reste une préoccupation en santé bucco-dentaire mais aussi en orthodontie. Objectif: Le but de cet article était d'investiguer l'adhésion de la plaque dentaire sur différents dispositifs orthodontiques. Matériels et méthodes: Quatre revues de la littérature ont été réalisées afin d'étudier l'adhésion de la plaque dentaire sur différents dispositifs orthodontiques, à savoir le type d'attaches (conventionnelles versus autoligaturantes ; métalliques versus céramiques), le type de ligatures (métalliques versus élastomériques) et, enfin, le type d'arcs. Une galerie d'images obtenues par microscopie électronique à balayage (MEB) a également été réalisée sur différents dispositifs orthodontiques avant et/ou après vie en bouche. Résultats: Tenant compte de la forte hétérogénéité méthodologique des études incluses, privilégier un type d'attaches dans la prévention de la rétention de la plaque dentaire ne fait pas l'objet d'un consensus. Les ligatures métalliques seraient moins sujettes à l'accumulation de la plaque dentaire par rapport aux ligatures élastomériques, elle-même dépendantes de leur couleur. Le type d'arcs n'a pas fait l'objet d'investigations sur cette thématique. Les images MEB mettaient en lumière la présence d'anfractuosités à la surface des arcs orthodontiques neufs, ainsi que la présence d'un biofilm à différents degrés de maturation sur les dispositifs après vie en bouche. Conclusion: Bien qu'il ne soit pas possible d'établir un consensus sur les dispositifs orthodontiques à privilégier pour diminuer la rétention de la plaque dentaire, différents stades d'évolution du biofilm sont observables à leur surface et donc potentiellement associés à une virulence proportionnelle.

Condylar repositioning according to digital bite registration method for virtual orthognathic surgery planning: A series of 49 consecutive patients.

INTRODUCTION: The accurate mandibular condylar positioning for orthognathic surgical planning is fundamental in obtaining a planned occlusal result. The differences between the position of condyles seen on computed tomography or cone-beam computed tomography (CBCT) scans and during surgery reduce the accuracy of the result. This study aimed to assess the differences between the condylar position recorded on CBCT and a numerical 3-dimensional (3D) model created after mandibular repositioning for orthognathic surgery planning. METHODS: This study retrospectively evaluated 49 patients who underwent virtual orthognathic surgery planning. The procedure involved recording a computed tomography or CBCT of the skull and dental surface using an intraoral digital scanner. The mandible was repositioned on the numerical 3D model according to the superimposed virtual bite registration in centric relation. Linear and angular measurements of the right and left condyles were recorded before and after mandibular repositioning. RESULTS: The positions of 98 condyles were compared. Linear measurements of the posterior and superior joint spaces revealed a significant difference. Subgroup analyses displayed statistically significant differences for patients with skeletal Class II malocclusion. CONCLUSION: According to the digital bite registration method, the difference between the mandibular position recorded on CBCT and on the numerical 3D model after repositioning may have clinical significance. Further studies are needed to validate this theory and test the accuracy of the clinical results.

One-stage versus two-stage piezocision-assisted orthodontic tooth movement: A preclinical study based on Nano-CT and RT-PCR analyses.

OBJECTIVE: To evaluate the effect of a second-stage piezocision on the biological response. MATERIALS AND METHODS: 60 rats were randomly allocated to 6 experimental groups of 10 rats. Rats undergoing a one-stage piezocision were sacrified on day 7, 28 and 42 (groups 1-3) while rats undergoing a two-satge piezocision were sacrified on day 42, 63 and 90 (groups 4-6), respectively. The biological response was investigated in 3D at the tissue level using Nano-computed tomography (Nano-CT) and, at the molecular level using the qRT-PCR technique. Bone Volume Fraction (BVF) loss was the primary endpoint. RESULTS: Similar loss of BVF were observed both after the first and second piezocisions. The change in BVF loss between 7 and 28 days after each piezocision were 25.1 ± 13.0 (SE)% and 11.2 ± 11.6 (SE)% respectively and did not differ from each other (p = 0.43). Changes in BVF loss from 7 to 42 days were also comparable in one-stage and two-stage piezocision (4.9 ± 12.3 (SE) vs. -19.9 ± 13.4 (SE), p = 0.19). At the molecular level, all parameters except Translating Ribosome Affinity Purification (TRAP) protein had identical patterns. CONCLUSION: Within the limits of the present study, a second piezocision allowed to re-induce the Regional Acceleratory Phenomenon (RAP) effect. Nevertheless, the relevance of the findings to the clinical effect has not been tested.

Cleaning and Disinfection Protocols for Clear Orthodontic Aligners: A Systematic Review.

(1) Background: Clear orthodontic aligners support the development of oral biofilms, which could lead to interferences with the oral microbiota already existing and the deterioration of oral health, with the development of dental caries, periodontal disease and even systemic infections. Therefore, preventive oral health care requires a cleaning and disinfection procedure for aligners. (2) Methods: A systematic review of the literature was conducted across four databases following the PRISMA guidelines up to May 2021, combining an electronic and a manual search. Prospective studies, including randomized controlled trials (RCTs), crossover studies (COSs) and controlled clinical trials (CCTs), published in the English language without time restrictions, evaluating the efficacy of cleaning and disinfection protocols for clear orthodontic aligners by comparing them with a placebo or a negative control, were included. The article selection, data extraction and risk of bias assessment were performed by two independent blinded review authors. In case of disagreement, a third author was solicited throughout the selection process. (3) Results: Among the 221 articles screened in the search process, 4 studies were included in the review, all designed as crossover studies (single arm without randomization with the same sequence of different cleaning and disinfection protocols for each participant). Different cleaning and disinfection methods were studied such as mechanical methods (brushing with toothpaste or vibration), chemical methods/pharmaceutical products (chlorhexidine antibacterial substance, anionic or cationic detergents or effervescent tablets) or combinations of both. (4) Conclusion: Although the determination of the most remarkable method of cleaning and disinfection was impossible because no direct comparison was conducted between all these methods, a multi-step protocol, including the combination of a mechanical and a chemical method, seems to be the most effective approach. Further research is needed to define the most preventive oral health care protocol. Registration: PROSPERO CRD 42021278498.

"Wire Syndrome" Following Bonded Orthodontic Retainers: A Systematic Review of the Literature.

(1) Background and objective: Tooth movements described as unexplained, aberrant, unexpected, unwanted, or undesirable can occur in the presence of an intact orthodontic retention wire, without detachment or fracture. This iatrogenic phenomenon, known little or not by many practitioners, responsible for significant dental and periodontal complications, both functional and aesthetic, is called "Wire Syndrome" (WS). It is therefore considered an undesirable event of bonded orthodontic retainers, which must be differentiated from an orthodontic relapse. The objective was to perform, for the first time, a systematic review of the literature in order to define the prevalence of WS and to study its associated clinical characteristics. (2) Methods: A systematic review of the literature was performed following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and recommendations using an electronic search strategy on four databases complemented by a manual search. All the prospective and retrospective clinical studies, including case reports and series, written in English or French, clearly mentioning the description, detection, or management of WS were included. Three independent blinding review authors were involved in study selection, data extraction, and bias assessment using the Mixed Methods Appraisal Tool (MMAT). (3) Results: Of 1891 results, 20 articles published between 2007 and 2021 fulfilled the inclusion criteria, with a globally high risk of bias since 16 articles were case report/series. The analysis of each article allowed the highlighting of WS through 13 categories, as follows: prevalence, apparition delay, patient characteristics, arch and tooth involved, families of movements, dental and periodontal consequences, type of wire, risk factors, etiologies, treatment, and preventive approach. (4) Conclusion: This systematic review of the literature elaborated a synthesis on WS, allowing general practitioners, periodontists, and orthodontists to understand this adverse event, to facilitate the diagnostic approach, and to underline preventive measures against WS. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; number CRD42021269297).

Relevance of teleorthodontic tools: a systematic review of the literature / Pertinence des outils de téléorthodontie : une revue systématique de la littérature

Introduction: The concept of teleorthodontics was recently born; the Covid-19 crise has participated to the emergence and the amplification of this phenomenon. Objective: The main aim of the present systematic review was to evaluate the teleorthodontics relevance. Method: An electronic and manual search was performed in four databases (PubMed, Scopus, Embase and Cochrane Library) up to December 2021 according to PRISMA guidelines. Both prospective and retrospective studies, as well as case reports, case series and satisfaction surveys published in English or in French without time restriction were included. Two independant reviewers were involved in the selection of the studies and a third reviewer was required in case of disagreement. A bias assessment was performed using the Mixed Methods Appraisal Tools. Results: Out of 1757 articles, 22 articles published mainly between 2019 and 2021 and with varying levels of evidence, were included. Considering the results obtained, different concepts were discussed (time management, quality of communication, reliability and use of tools, satisfaction, quality of human relations, emergency management, compliance). Conclusions: Teleorthodontics is an interesting and complementary tool that is, in no way, a systematic alternative to face-to-face orthodontic appointments in the office. However, many essential aspects of telemedicine in orthodontics, such as data protection, still need to be investigated in order to fully analyze this tool.

Introduction: Le concept de téléorthodontie a récemment vu le jour ; la crise de la Covid-19 a fortement participé à l'émergence et à l'amplification de ce phénomène. Objectif: L'objectif premier de cette revue systématique de la littérature était d'évaluer la pertinence de la téléorthodontie. Méthode: Une recherche électronique a été menée dans quatre bases de données (PubMed, Scopus, Embase et Cochrane Library), complétée par une recherche manuelle jusqu'à fin décembre 2021 conformément aux directives PRISMA. Tous types d'études cliniques, prospectives ou rétrospectives, y compris les rapports et les séries de cas ainsi que les enquêtes de satisfaction publiées en anglais ou en français sans restriction de temps, ont été inclus. Deux auteurs indépendants ont été impliqués dans la sélection des études et un troisième auteur a été sollicité en cas de désaccord. Une évaluation des biais a été réalisée à partir du Mixed Methods Appraisal Tools. Résultats: Sur les 1757 articles, 22 articles, publiés majoritairement entre 2019 et 2021 et de niveaux de preuve variables, ont été inclus. Tenant compte des résultats obtenus, différentes notions ont pu être discutées (gestion du temps, qualité de la communication, fiabilité des outils, facilité d'utilisation, satisfaction, qualité du rapport humain, gestion des urgences, observance). Conclusions: La téléorthodontie est un outil intéressant et complémentaire à une approche classique pour certaines indications. Cependant, elle ne constitue en aucun cas une alternative systématique aux rendez-vous orthodontiques en présentiel au cabinet. De nombreux aspects pourtant essentiels (protection des données, etc.) doivent être encore investigués pour analyser pleinement cet outil.

What Are the Cleaning and Disinfection Methods for Acrylic Orthodontic Removable Appliance? A Systematic Review.

(1) Background: The use of removable orthodontic appliances, which is common in early ages, requires careful hygiene, as several different microorganisms are found on their surface during the orthodontic treatment. (2) Methods: Comprehensive electronic searches were conducted up to May 2021. Randomized controlled trials (RCTs) or controlled clinical trials (CCTs), prospective or retrospective, evaluating the efficacy of cleaning and disinfection methods for acrylic removable orthodontic appliances, redacted in the English language, were included. Three independent blinding review authors were involved in study selection, data extraction, and bias assessment. (3) Results: A total of 2491 records were screened and eight studies (six RCTs and two CCTs) fulfilled the inclusion criteria. Among the overall cleaning and disinfection methods described in the included studies, four categories could be defined: liquid antimicrobial agents, commercial tablet cleansers, natural plant extracts and incorporation of quaternary ammonium methacryloxy silicate, all of which demonstrated superior efficacy compared to the placebo/negative control. However, the different methods were not compared with each other. (4) Conclusions: Biofilm control on acrylic orthodontic removable appliances can be performed using the different cleaning and disinfection methods considered in the included studies. Further studies are needed to define the most effective technique. Registration: PROSPERO CRD 42021269297.

Disentangling the effects of CAD/CAM customized appliances and piezocision in orthodontic treatment.

OBJECTIVES: To discern the effects of computer-aided design (CAD)/computer-aided manufactured (CAM) customized appliances and piezocision on orthodontic treatment (OT). MATERIALS AND METHODS: The study combined findings from two previously published randomized controlled trials: (1) standard OT vs piezocision-assisted standard OT, and (2) CAD/CAM OT vs piezocision-assisted CAD/CAM OT. Piezocision is a minimally invasive corticotomy surgical procedure used to accelerate orthodontic treatment and CAD/CAM refers to CAD/CAM customized brackets and archwires. The outcomes were the overall treatment time, and the durations of the alignment phase and fine-tuning phase. Clinical and radiological features also were evaluated. RESULTS: The combined study included 48 patients with similar baseline characteristics. Compared to the standard treatment, CAD/CAM technology alone significantly decreased the overall median OT time from 543 to 394 days (P < .001) and from 543 to 254 days (P < .0001) when combined with piezocision. Although piezocision significantly reduced the duration of the alignment phase in the mandible and maxilla, CAD/CAM technology considerably shortened the fine-tuning phase. All periodontal and radiographic parameters remained stable from the start to the end of treatment in all groups. CONCLUSIONS: CAD/CAM technology combined with piezocision accelerates the entire OT process, during the alignment phase for piezocision and during the fine-tuning phase for CAD/CAM, with a global reduction of the overall treatment time of more than 50%.

[What are the main surgical and non-surgical techniques of the acceleration of orthodontic tooth movement?] / Quelles sont les principales techniques chirurgicales et non chirurgicales de l'accélération du déplacement dentaire orthodontique ?

Different surgical and non-surgical techniques have been developed in order to reduce the duration of orthodontic treatment. Regarding surgical techniques, corticotomies are widely used. The micro-osteoperforation technique (MOP), in addition to the piezocision technique, have been developed to provide minimally invasive surgery as an alternative to conventional corticotomies, without the elevation of a mucoperiosteal flap. Regarding non-surgical techniques, the approach is radically different in terms of physical stimuli or chemical techniques. Corticotomy and piezocision techniques have been found to be effective in accelerating orthodontic tooth movement, although the corticotomy technique presents a significant risk of postoperative treatment. These two techniques also offer the possibility of adding a bone graft using a tunneling surgical approach. Regarding non-surgical techniques, physical stimuli techniques such as with a laser are easy to perform, non-invasive and seem to be promising. However, their effectiveness has not yet been demonstrated, as is the case for chemical techniques. While at first glance these techniques are reassuringly non-invasive, do they not give the sensation of playing the sorcerer's apprentice ? Although surgical techniques seem to have demonstrated their significant efficacy in accelerating orthodontic tooth movement, non-surgical techniques do not yet provide a sufficient level of evidence and / or safety to be performed in our routine clinical practice as orthodontists. As these topics are innovative, new and future scientific evidence should be able to lead to the development of all these concepts.

Buccal bone regeneration combined with piezocision in adult orthodontic patients: Clinical, 3D radiographic, and patient-reported outcomes.

OBJECTIVE: Assess the clinical effects, 3D radiographic results and patient-reported outcome measures (PROMs) of buccal bone regeneration combined with piezocision. METHODS: Ten patients presenting roots prominence with a thin buccal bone thickness or buccal bone dehiscence in the lower front region were enrolled. Patients received orthodontic treatment assisted by piezocison which was combined with a buccal alveolar bone regeneration using a tunneling approach. A comparison between pre- and post-treatment alveolar bone measurements based on CBCT was performed. Periodontal parameters such as recession scores and root resorption were recorded before and after treatment. The PROMs were also investigated. RESULTS: An overall significant buccal bone gain of 2.7 ± 2.7% was found after the treatment. The apical region reached the highest gain of 8.9 ± 5.5% whereas the most coronal region showed no significant increase of the bone envelope (1.2 ± 2.7%). No adverse event such as the appearance of recession or root resorption were observed. However, in 2 patients, the biomaterial was not properly integrated and seemed to be encapsulated. The pain level and the paracetamol consumption were equivalent to those after the placement of the orthodontic appliance except on the day of the surgery. CONCLUSIONS: Within the limitation of this study, piezocision combined with buccal bone regeneration using a tunneling technique seems to be effective to augment bone and did not lead to gingival recession. However, in 2 cases the biomaterial seemed encapsulated, and therefore the predictability of the integration of the material can be questioned. ClinicalTrials.gov registration : NCT03655938.

Standard vs computer-aided design/computer-aided manufacturing customized self-ligating systems using indirect bonding with both.

OBJECTIVE: To compare treatment duration and quality between standard vs computer-aided design/computer-aided manufacturing (CAD/CAM) customized self-ligating systems using indirect bonding with both. MATERIALS AND METHODS: This comparative trial included 24 patients: 12 treated with a CAD/CAM custom indirect bonding self-ligating system (CAD/CAM) and 12 others treated with an indirect bonding self-ligating standard system (I-STD). For each group, overall orthodontic treatment (OT) time was calculated and included the time needed to place each arch as well as the duration of the alignment and fine-tuning phases. The quality of the final result was analyzed using the American Board of Orthodontics Cast-Radiograph Evaluation. Patient-reported outcome measures (PROMs) were also evaluated. RESULTS: Patient characteristics were similar between the 2 groups except for age, which was slightly lower in the I-SDT group. Overall OT time was increased by 26% in the I-STD group compared with the CAD/CAM group (497 ± 40 days vs 393 ± 55 days, P = 0.0002) due to a shorter fine-tuning phase in the latter group (P<0.01). No difference was found between the groups for alignment phase. Quality of the final result was similar (I-STD, 25.7 ± 6.1; CAD/CAM, 21.6 ± 6.3) among the groups. Finally, no difference was found in the PROMs variables. CONCLUSIONS: Despite a 26% longer OT time when compared with the CAD/CAM customized bracket system, the indirect bonding self-ligating bracket system demonstrated the same quality of treatment. PROMs demonstrated a high level of acceptance and satisfaction for both techniques.

Innovative customized CAD/CAM nickel-titanium lingual retainer versus standard stainless-steel lingual retainer: A randomized controlled trial.

OBJECTIVE: To compare computer-aided design and computer-aided manufacturing (CAD/CAM) customized nitinol retainers with standard stainlesssteel fixed retainers over a 12-month study period. METHODS: This randomized controlled trial (RCT) was conducted on 62 patients randomly allocated to a control group that received stainless-steel retainers or a test group that received customized CAD/CAM nickel-titanium retainers. Four time points were defined: retainer placement (T0) and 1-month (T1), 6-month (T2), and 12-month (T3) follow-up appointments. At each time point, Little's irregularity index (LII) (primary endpoint) and dental stability measurements such as intercanine width were recorded in addition to assessment of periodontal parameters. Radiological measurements such as the incisor mandibular plane angle (IMPA) were recorded at T0 and T3. Failure events (wire integrity or debonding) were assessed at each time point. RESULTS: From T0 to T3, LII and other dental measurements showed no significant differences between the two groups. The data for periodontal parameters remained stable over the study period, except for the gingival index, which was slightly, but significantly, higher in the test group at T3 (p = 0.039). The IMPA angle showed no intergroup difference. The two groups showed no significant difference in debonding events. CONCLUSIONS: This RCT conducted over a 12-month period demonstrated no significant difference between customized CAD/CAM nickel-titanium lingual retainers and standard stainlesssteel lingual retainers in terms of dental anterior stability and retainer survival. Both retainers eventually appeared to be equally effective in maintaining periodontal health.