Osteogenic distraction to treat solitary median maxillary central incisor (SMMCI) syndrome: a case report.

Solitary median maxillary central incisor (SMMCI) syndrome is a rare developmental disorder characterized by a single symmetrical maxillary central incisor. Only a small number of cases with comprehensive dental treatment have been reported in the literature. No surgical treatment has been proposed before. We report the case of an 8-year-old girl who presented SMMCI syndrome associated with an Angle class II occlusion and a maxillary transverse deficiency. After the failure of two rapid maxillary expansions, a surgical option was proposed: osteogenic maxillary distraction. The distraction, associated with multi-bracketed fixed orthodontic treatment, created enough space to place a prosthetic central incisor without dental extractions. Osteogenic distraction is an interesting option to treat patients with SMMCI.

Clinical impact of two types of mandibular retention devices - A CAD/CAM design and a traditional design - On upper airway volume in obstructive sleep apnea patients.

OBJECTIVE: This pilot randomized crossover study evaluated the outcomes of two custom-made mandibular retention devices (MRDs), a computer-aided design (CAD)/computer-aided manufacturing (CAM) device (Narval CC™) and a non-CAD/CAM device (Narval™), on oropharyngeal airway volume in patients with obstructive sleep apnoea (OSA). METHODS: 12 OSA patients were recruited from an University Hospital for MRD therapy with either CAD/CAM or non-CAD/CAM first. A cone-beam computed tomography evaluation (CBCT) and polysomnography assessment was performed during baseline assessment and at the end of each study period. RESULTS: Upper airway volume increased significantly with the CAD/CAM device (7725 +/- 6540 mm3, p = 0.008) but not with the non-CAD/CAM device (3805 +/- 7806 mm3, p = 0.13). The CAD/CAM device was also associated with a significant decrease in AHI (mean AHI after treatment 9.4±6.7 events/h, p = 0.003) and oxygen desaturation index (mean ODI of ≥ 3%/h 11.9 ± 6.8, p = 0.011). Changes in AHI (14.7 +/- 11.7 events/h, p = 0.083) and ODI (15.5 +/- 19.2, p = 0.074) were not statistically significant with the non-CAD/CAM device. The vertical dimension of occlusion increased significantly following treatment with both MRD devices (both p = 0.003), but was significantly less pronounced with the CAD/CAM device (mean difference: -2.7 +/- 1.7 mm, p = 0.003). Final mandibular protrusion after titration was the same with both devices (85%, p = 0.317). CONCLUSION: The CAD/CAM (Narval CCTM) device was associated with a significant increase in upper airway volume that may be caused by a lower degree of vertical separation between the jaws when compared to the non-CAD/CAM design.

[Adolescent obstructive sleep apnoea syndrome: Characteristics and treatment]. / Syndrome d'apnées obstructives du sommeil de l'adolescent : particularités et prise en charge.

Although the prevalence of the obstructive sleep apnoea syndrome (OSAS) is high in adolescents, studies pertaining to adolescent OSAS are less numerous than childhood studies. Cases of adolescent OSAS may consist of residual OSAS after adenotonsillectomy, but most often are de novo cases. Major pathophysiological factors are weight excess or even high-grade obesity, and the association of upper airway narrowing and tonsillar hypertrophy (pharyngeal, palatal or even lingual). ENT and systematic orthodontic assessments are the main points. In case of predisposing factors such as dental, occlusal or dento-facial abnormalities, a specific orthodontic treatment can be discussed. First line treatment is surgical adenotonsillectomy; surgical reduction of the lingual tonsils is seldom required. CPAP treatment may be indicated in the case of severe comorbidities (craniofacial malformations, neuromuscular diseases…) or in obese adolescents with severe residual OSAS. Treatment of adolescent OSAS has to be comprehensive and multidisciplinary, taking into account the specific treatments of obesity and abnormal sleep/wake rhythms.

Long-term effectiveness and side effects of mandibular advancement devices on dental and skeletal parameters.

INTRODUCTION: Continuous positive airways pressure, generally used to treat obstructive sleep apnea-hypopnea syndrome (OSAHS), is not tolerated well by many patients. An alternative is to treat OSAHS with mandibular advancement devices (MAD). This research assesses the long term (> 2 years) effectiveness and the side effects on dental and skeletal parameters of these devices. MATERIAL AND METHODS: We selected 24 patients with moderate to severe OSAHS. All were treated with MADs for at least 2 years. We gathered cephalometric teleradiographs in centric relation and sleep recordings before and after the patients were treated. We evaluated the patients' apnea-hypopnea indexes (AHI) as well as their Epworth sleepiness scale (ESS) scores. We measured the inclination of the central incisors and the positions of the upper and lower jaws. RESULTS: Mandibular advancement devices were used for more than 2 years (3.9 ± 1.9 years). We observed a statistically significant decrease of the patients' AHI and their ESS scores. We also observed a modification of the inclination of the lower central incisors (+0.521; P = 0.047) and of the position of the maxilla (-0.287; P = 0.039). DISCUSSION: We demonstrated the clinical effectiveness of mandibular advancement devices for treating OSAHS, with a very low rate of side effects on dental and skeletal positions.

[Management of impacted cuspid--July 2015]. / Prise en charge d'une canine incluse--juillet 2015.

The French Society of Stomatology, Oral and Maxillofacial Surgery (SFSCMFCO) together with the Medical Society of Dento-Maxillofacial Orthopedics has drawn up in 2015 a new practice guideline concerning the management of one or several impacted cuspids. As the previous ones, this guideline is based on a rigorous French Heath Regulation Authorities type methodology. It is thus intended to become a major reference in its field. We report hereafter the short version of the text in the same way it has been presented during the 2015 French National Congress of the SFSCMFCO in Lyon - France. Each of these recommendations is marked A, B or C according to a decreasing evidence based rating scale. Lacking any evidence-based data, the recommendation is considered as an expert opinion (AE). The full text of this guideline is available on the website of the SFSCMFCO at the following address: http://www.sfscmfco.fr/; "Recommandations de bonnes pratiques" section. A patient information sheet is also proposed by the working group. Happy reading.

[Management of cleft lip and palate in university hospital of Rouen]. / Prise en charge des fentes faciales et palatines à la clinique chirurgicale du centre hospitalier universitaire de Rouen.

Cleft lips and cleft palates are managed in the department of Pediatric surgery in Rouen for the last 30 years. From the antenatal diagnosis, the parents got in touch with the surgeon who will coordinate this management. Around thirty new patients are treated every year. The chronology of the treatment is of "classic" manner. The cleft lip is repaired at about 3 weeks of age and the palatoplasty is performed after the age of 1 year. In view to maintain the intimacy of the consultation we did not institute multidisciplinary consultations. The other members of the interdisciplinary team will intervene during the follow up depending on the form of the cleft and the encountered problems. The information and the files circulate freely and are discussed together.

[Evaluation of mandibular propulsion appliances in children. A study of 18 cases]. / Evaluation des appareils de propulsion mandibulaire chez l'enfant. Etude de 18 cas.

PURPOSE: Mandibular propulsion appliances are used currently in the treatment of class II malocclusion. The purpose of this study was to evaluate their effects on facial development to formulate specific indications. PATIENTS AND METHODS: Eighteen children (mean age 9-12) treated with a propulsion device for a class II division 1 malocclusion with a minimum of 4 mm overjet were included in a retrospective study over a 4 year period. We compared maxillomandibular and dentoalveolar position before and after treatment using Delaire computer software cephalometric analysis and superpositions. RESULTS: Statistically significant effects on molar discrepancy (p = 0.0002), overjet (p = 0.0003), sagittal mandibular position (p = 0.0040 for FM-Me/theoretical and p = 0.0010 for NP-FM-Me), mandibular length (p = 0.004 for FM-Me/theoretical), mandibular corpus length (p = 0.0286 for Go-Me/theoretical), upper incisors palatal version (p = 0.0002), and on lower incisors lip version (p = 0.0436) were assessed. No action on maxillary growth (p = 0.7274 for FM-NP/theoretical), ramus length (p = 0.9651 for Cp-Go/theoritecal), lower facial height (p = 0.7045 for ENA-Me/theoretical) or translation of the alveolar arches (p = 0.9571 for A-Pti'/ENA-Pti and p = 0.1564 for B-Pa'/B-Pa) could be confirmed. CONCLUSIONS: An increase in mandibular corpus development and no effect on alveolar arches suggests a basal mandibular action for this device. This concludes that retromandibular position and brachycorpus with upper incisor lip version, without lower incisors lip version are the best indications for mandibular propulsion appliances. Prospective studies should be carried out to confirm this hypothesis.

[A comparison of standard radiographs and "scout-view" radiographs. The value for cephalometric analysis]. / Comparison des télécrânes et des "modes radios". Intérêt pour le bilan céphalométrique.

Is the scout-view as reliable as the standard lateral view for cephalometric analysis? Cephalometric data (Delaire analysis) were obtained in ten patients with CT-scan and standard x-ray for comparison. Qualitative results showed imprecisions for craniofacial contours and soft tissue ptosis. Quantitative results were analyzed statistically and revealed a significantly higher level of error with scout-view tracings. The scout-view does not appear to be as reliable and takes longer to acquire than the standard lateral x-ray: for the pediatric population, it could be a disadvantage.

[Jaffe-Campanacci syndrome. Report of a case]. / Syndrome de Jaffé-Campanacci. A propos d'un cas.

Jaffe-Campanacci syndrome is a rare entity characterized by disseminated non ossifying fibromas in association with extraskeletal congenital anomalies: cutaneous, genital, ocular and cardiovascular. Mental retardation is also frequently observed. Pathological fractures are the usual mode of revelation. We report one case original because of causal discovery during orthodontic check-up and because of extraskeletal anomalies not previously described. In fact the true incidence of this syndrome is probably underestimated because of unrecognized features.