[Predictors of re-consultation and impact of the retainer on relapse and debonding rate ten years after removal of orthodontic appliances]. / Facteurs prédictifs de reconsultation et influence du dispositif de contention sur la récidive et le taux de recollage dix ans après la dépose orthodontique.

Once the orthodontic retention phase is complete, a number of patients return to the office following retainer detachment or complaining about the stability of the result. The aim of this study was to search for predictors of re-consultation and to evaluate how the choice of retainer impacts re-consultation for misalignment or debonding. A systematic retrospective cohort study was conducted ten years after removal of orthodontic appliances. Of the 380 patients included, 23% re-consulted on average 4.5 years after appliance removal. The patients most likely to re-consult were those with a severe initial aesthetic deficit. Mandibular retainers bonded on six teeth resulted in three-fold more re-consultations than wires bonded exclusively on the canines, but the difference was non-significant. Mandibular retainers bonded on the canines certainly generated significantly more maintenance appointments than the six-teeth retainers, but fewer malposition problems (non-significant result). These results raise questions regarding indications for bonded maxillary retainers as opposed to removable devices and also regarding the management of long-term post-retention follow-up.

[The smile: a challenge in the treatment of class III]. / Le sourire : un enjeu dans la décision thérapeutique des classes III.

INTRODUCTION: The smile poses a challenge in the treatment of class III. Untreated, the class III patient presents excessive maxillary torque and a predominant display of the mandibular incisors, a sign that becomes more visible with age. Functional orthopedics restores the aesthetic appearance of the smile by maxillary protraction (sometimes temporarily because 20% of cases will still need surgery). Depending on the initial severity of the case (-4.5 mm AoBo would be the threshold value), the options are compensation or surgical correction. In both cases, the profile is improved but without normalising the cephalometric values. In recent years, the number of published cases treated by compensations (often using skeletal anchorage) has multiplied with broader indications, particularly for Asian patients in whom Le Fort I surgery gives questionable aesthetic results. Attention must be focused on the occlusal plane rotation which alters the smile by displaying the mandibular incisors. Nevertheless, surgery can handle the most severe cases with a greater degree of improvement. AIM: The aim of this article is to determine the cephalometric cut-off values for an acceptable smile in Class III patients. MATERIALS AND METHODS: We performed a search on Pubmed using the following keywords: Class III, anterior cross bite, smile, camouflage, orthognathic surgery; then secondarily, using references supplied by the articles found. We then analysed the data. RESULTS: The ortho-surgical protocol associated with extractions of maxillary first premolars appears to be the way to obtain the best results in terms of the smile (versus surgery without extractions and versus orthodontic compensations) because it is, in fact, the only way to restore the normal position and torque of the maxillary incisors, thus increasing their display during smiling.