Residual craniofacial growth: A cephalometric study of 50 cases.

Although orthodontists focus intensively on the diagnosis and treatment of their patients, they pay less attention to post-treatment development and the risk of relapse often caused by the late growth of the arches and bony base. The aim of this study, therefore, was to determine the growth changes, which can affect craniofacial dimensions in subjects aged between 13 and 17 years. A retrospective longitudinal study including 50 patients (31 girls and 19 boys) whose end of orthodontic treatment coincided with the end of the post-pubertal period (13-14 years) involved a comparison of the cephalometric analyses for each patient between T1 (end of orthodontic treatment) and T2 (end of retention). The study evidenced changes in the post-pubertal craniofacial dimensions in the vertical and sagittal dimensions. Girls and boys do not have the same potential for growth at the age of 13 years. The residual growth phenomenon is more present in boys than in girls with, on the one hand, an increase in the post-pubertal craniofacial dimensions affecting the mandible more particularly and, to a lesser degree, the maxillary sagittal dimension associated with a decrease in the vertical dimension.

[Etiopathogenic and clinical aspects of asymmetry]. / Approche étiopathogénique et clinique des asymétries.

Complex dysmorphies, asymmetries can affect the various elements of the stomatognathic system: cranial base, maxilla, mandible, musculature and dental arches, in the three dimensions of space. Their etiopathogenesis, as well as their clinical forms, vary considerably. Dysembryopathies, growth disorders, TMJ damages, postural or functional disorders and dental anomalies can create, according to their severity and their moment of appearance, severe or minor facial asymmetries, or asymmetries of the arches. An exo- and endobuccal clinical examination endeavors to specify the localization and the severity of the damage, and to evaluate the importance of the possible alveolar compensations. Consolidated by additional examinations, it enables the clinician to differentiate the various forms of asymmetries.

[Orthodontic approach to asymmetry]. / Approche orthodontique des asymétries.

From an orthodontic point of view, asymmetries can be gathered in three great clinical entities: mandibular lateral deviations, dental asymmetries without skeletal involvement, skeletal asymmetries. Once the therapeutic aims and the principles of the orthodontic approach of these dysmorphoses have been recalled, the authors present the various orthodontic means implemented in this type of treatment. Four cases treated illustrate those types of treatment. Vertical non-surgical asymmetry may have an obvious local origin, for instance, a unilateral damage to a nerve. but usually, there is no evident origin. Frequently the occlusal slippage of a severe sagittal or a vertical malformation, which may evolve as a borderline surgery case, is suspected to be the real cause. In these cases, the diagnosis is always late, with the ending growth. The treatment needs peculiar strong asymmetric mechanics and, sometimes, unilateral mixed extractions. The post-treatment occlusion can be unstable; for this reason, the finishing steps must be carefully conducted. Four clinical case reports develop these points ov view. Multidisciplinary treatments prove very useful to solve three types of clinical situations. In the adult patient, facial esthetics are indicated in severe dentofacial asymmetries. Esthetic improvements of dental nature are still required in deviated smiles, or frontal tippings of the occlusal plane. In addition, asymmetrical intermaxillary relationships will lead to functional anomalies: TMJ disorders, dental wear or lingual dysfunctions. Finally, multidisciplinary treatments in the adult concern the occlusal transverse anomalies, the lateral crossbites, the Class II subdivisions, the deviations of the inter-incisor midlines or unilateral edentulousness. The various plans of treatment, as well as the orthodontic mechanics used, are illustrated in the following development by clinical cases.