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Introduction: L’arthrite juvénile idiopathique (AJI) est la maladie rhumatologique la plus répandue chez les enfants. Lorsque l’articulation temporo-mandibulaire est touchée, le processus inflammatoire peut causer une perturbation de la croissance cranio-faciale et une destruction du condyle, ce qui peut engendrer des difformités dentofaciales et des malocclusions dentaires. Des facteurs environnementaux, tels que les médicaments et les habitudes parafonctionnelles, ont le potentiel d’influencer la progression de la maladie et, par conséquent, jouer un rôle dans l’étiologie des malocclusions des patients avec AJI. Objectifs : L’objectif principal est de comparer la fréquence et la sévérité des malocclusions des patients avec et sans AJI. L’objectif secondaire est d’investiguer la relation entre la sévérité des malocclusions des patients avec AJI et leurs médicaments et habitudes parafonctionnelles. Méthodes: L’échantillon était divisé en deux groupes: AJI (n=30) et contrôle (n=30). Un questionnaire médical, un examen orthodontique et un examen radiologique ont été complétés pour chaque patient. Résultats : Par rapport au groupe contrôle, les enfants avec AJI avaient plus d’asymétries dentofaciales (p=0.009), de classe II canines (p=0.05) et molaires (p 3.5 mm (p=0.011) et horizontal > 5.0 mm (p=0.033) augmentés, des courbes de Spee (p=0.044), de Wilson (p=0.044) et de Monson (p=0.003) accentuées, de chevauchement incisif mandibulaire (p=0.042) et de manque transverse maxillaire (p, Introduction: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease found in children. In cases affecting the temporomandibular joint (TMJ), the inflammatory process may cause disturbances in craniofacial growth and condylar destruction, both of which can lead to dentofacial deformities and dental malocclusions. Environmental factors such as medication and parafunctional habits have the potential to influence the disease progression and therefore play a role in the etiology of malocclusions of children with JIA. Objectives: The main objective of this study was to compare the frequency and the severity of malocclusions of patients with and without JIA. The secondary objective was to investigate the relationship between the severity of malocclusions of patients with JIA and their medication and parafunctional habits. Methods: The sample was divided into two groups: JIA (n=30) and control (n=30). A health questionnaire, an orthodontic examination, and radiographic records were completed for each patient. Results: Compared to the control group, children with JIA had more dentofacial asymmetry (p=0.009), Class II canine (p=0.05) and molar (p 3.5 mm (p=0.011) and overjet > 5.0 mm (p=0.033), accentuated curves of Spee (p=0.044), Wilson (p=0.029) and Monson (p=0.003), lower incisor crowding (p=0.042) and maxillary transverse discrepancy (p

Introduction : Plusieurs effets secondaires sont associés au traitement de l’apnée obstructive du sommeil (AOS) par appareil d’avancement mandibulaire (AAM). Pour minimiser leur occurrence, plusieurs professionnels préconisent l’utilisation d’une attelle de repositionnement matinal (ARM) malgré le manque d’évidences valides soutenant cette approche. Objectifs : L’objectif principal de cette étude pilote randomisée contrôlée est d’évaluer l’utilisation d’une ARM comme moyen d’atténuer les effets secondaires à court terme associés au traitement par AAM. Méthode : 9 sujets souffrant d’AOS nécessitant un traitement par AAM ont été inclus et assignés aléatoirement au groupe témoin (n=5) et au groupe traitement (n=4). Tous les participants ont été traités avec un AAM fabriqué sur mesure et ajustable (SomnoDent Flex, SomnoMed, USA). Les sujets du groupe traitement ont également reçu une qu’ils devaient porter 1 heure le matin suivant le retrait de leur AAM. La participation comprenait 6 visites échelonnées sur une période approximative de 8 mois durant lesquelles plusieurs variables ont été évaluées, notamment les changements occlusaux, les effets secondaires et l’adhérence au traitement. Résultats : Des tendances de réduction des surplombs horizontaux et verticaux, de la distance intermolaire maxillaire et de la longueur d’arcade totale supérieure ont été observées uniquement au sein du groupe témoin (p=0,063). Six mois suivant la fin de la période de titration, les problèmes masticatoires étaient plus fréquemment rapportés dans le groupe témoin. 60% des sujets traités uniquement avec un AAM en rapportaient sur une base hebdomadaire comparativement à ceux recevant conjointement une ARM, où la survenue était rare, voire absente. Conclusion : Nos résultats suggèrent que l’ajout d’une ARM pourrait être bénéfique au traitement de l’AOS par AAM en réduisant la survenue de certains effets secondaires à court terme. D’autres études bien construites sont nécessaires pour confirmer nos observations., Introduction: There are several side-effects associated with mandibular advancement devices (MAD) used to treat obstructive sleep apnea (OSA). Despite the lack of evidence supporting their use, some providers advocate the use of morning repositioning splints (MRS) to minimize these side effects. Objectives: The main objective of this randomized controlled pilot study is to evaluate MRS-use as a means of mitigating MAD-associated short-term side-effects. Methods: 9 subjects with OSA requiring MAD-use were included in this study and were randomized into a control group (n=5) and a treatment group (n=4). All participants were treated with a customized adjustable MAD (SomnoDent Flex, SomnoMed, USA). Subjects in the treatment group also received an MRS that was to be used every morning for 1 hour after removal of their MAD. Follow-up consisted of 6 appointments over approximately 8 months. During this time, variables including occlusal changes, side effects and treatment adherence were evaluated. Results: A tendency for overjet and overbite reduction as well as maxillary intermolar distance reduction and superior arch length shortening were observed in the control group only (P=0.063). Six months after completion of MAD titration, masticatory problems were more frequently reported by subjects in the control group. 60% of these subjects reported masticatory problems on a weekly basis whereas subjects in the treatment group never or rarely reported these issues. Conclusion: Our results suggest that MRS-use can minimize short-term side effects associated with MADs used to treat OSA. Additional, well-constructed, studies are needed to confirm these findings.

Orthodontic diagnosis is generally centered on the morphological aspect, as is the treatment: it is most often a matter of modifying the shape of the arches and their relationships to adjust them to a morphological norm with the goal of a beautiful smile. However legitimate it may be, this diagnostic approach may seem reductive if we consider that teeth are also used to chew: it is even their main function. But how to take into account the masticatory function?With the help of clinical examples, the author develops the modalities of the clinical exploration of the mandibular kinematics, reflection of the mastication, on which the systemic diagnosis is based. It highlights the proprioceptive resources of the masticatory system that systemic treatment targets during the correction of malocclusions.The systemic diagnosis highlights the functional role of the arches, inviting, during their correction, to rehabilitate mastication in order to improve their stability.Le diagnostic orthodontique est, de façon générale, centré sur l’aspect morphologique, comme l’est d’ailleurs le traitement : il s’agit le plus souvent de modifier la forme des arcades et leurs rapports pour les ajuster à une norme morphologique avec comme finalité un beau sourire. Toute légitime qu’elle soit, cette démarche diagnostique peut paraître réductrice si l’on considère que les dents servent aussi à mastiquer : c’est même leur fonction principale. Mais comment tenir compte de la fonction masticatrice ?À l’aide d’exemples cliniques, l’auteur développe les modalités de l’exploration clinique de la cinématique mandibulaire, reflet de la mastication, sur laquelle se fonde le diagnostic systémique. Elle met en valeur les ressources proprioceptives du système masticateur que le traitement systémique cible lors de la correction des malocclusions.Le diagnostic systémique met en avant le rôle fonctionnel des arcades, invitant, lors de leur correction, à réhabiliter la mastication dans le but d’améliorer leur stabilité.

Relations between dental occlusion and posture present a growing interest for dental surgeons. It seems nowadays accurate to think about possible postural issues in case of an odontognathic pathology with side effects. We actually do receive patients presenting larger clinical syndromes than just the -ORL- system, and possibly even the posture. In the first part of this thesis you will find the relation between posture and the manducator apparatus. It will allow you to understand the impacts of the orofacial system o postural balance. In the second part my work gives the dentists the ability to find the postural disorders and measure its dental origin by simple clinical exams and postural tests easily feasible at the office. The goal is to be able to give a specific occlusal care when necessary. This approach is still new and is in need of fondamental and clinical research programs to enforce the knowledge of postural disorder causes on which depend therapeutic indications.; Les relations entre l’occlusion et la posture présentent un intérêt grandissant pour les chirurgiens-dentistes. Il est pertinent aujourd’hui de penser à un éventuel trouble postural lorsque nous prenons en charge une pathologie odontognathique en présence de troubles associés. En effet, nous recevons des patients présentant des signes cliniques ne se limitant pas à la sphère oro-faciale mais pouvant aussi impacter la posture. Cette thèse évoque, dans une première partie, les relations entre les systèmes manducateur et postural. Elle permet de rendre compte de l’influence et des impacts de la sphère orofaciale sur l’équilibre postural. Dans une seconde partie, ce travail fournit aux chirurgiens-dentistes la possibilité de desceller un trouble postural et d’en mesurer l’origine dentaire par l’intermédiaire d’un examen clinique et de tests posturaux simples réalisables au cabinet. L’objectif est de fournir une prise en charge occlusale adaptée, lorsque celle-ci est nécessaire. Cette approche, encore récente, nécessite le développement de programmes de recherche fondamentale et clinique permettant de renforcer les liens de causalité dont dépend l’indication d’une thérapeutique.

There is often a dysfunctional dimension with poor oral habits and parafunctions in the etiology of malocclusions. A multidisciplinary care seems essential. Through a review of the literature, this article analyzes old and current theories on the origin of parafunctions and the therapeutic possibilities for their correction. Our therapeutic approach to correct these parafunctions must take into account the behavioral approach, which can have a beneficial effect, but also the neurobiological approach. The current evolution in neuroscience now allows us to better understand the origin of these parafunctions and facilitate a better approach for their correction through behavioral methods. Taking into account the psychological and blood pressure dimension of our patients increases the chances of success. The use of removable or fixed devices can complete this therapeutic approach.

Although adult patients are said to be demanding in terms of discretion of the orthodontic appliance, the factors influencing the choice of the appliance are still poorly understood. The main objective of this study was to determine if there is a correlation, in adults, between the importance of the orthodontic treatment need and the aesthetic preference of the orthodontic appliance (metal braces, ceramic braces in buccal, lingual or aligner). The secondary objectives were to evaluate the impact of the patient's personal factors, his eventual orthodontic past and his perceived orthodontic need. Patients were interviewed by questionnaire before the first consultation. An index, depending of the discretion of the appliance, was used. The need for treatment was calculated via dental health component and aesthetic component of IOTN. Given the size of the sample, only trends can be emitted. The real need for treatment had no influence on the choice of the aesthetic appliance. The most demanding patients would be women, in their thirties, single, employed, executive or practicing a higher profession, with previous orthodontic treatment and having recently consulted an orthodontist, as an adult. These patients felt that their orthodontic treatment need was minimal or significant. Patients estimated the duration of treatment at 17 months. Lingual was considered the most aesthetic appliance far ahead of the aligners. A larger scale study is needed to determine the influence of each factor.

The aesthetic and functional success of mandibular advancement surgery often depends on the quality of the orthodontic preparation that preceded it. In order to be optimal, this preparation must try to reproduce a class II malocclusion equivalent to the sagittal skeletal discrepancy, to allow a surgical procedure of sufficient amplitude. The aim of this article is to present, thanks to a clinical case, a new mandibular posterior anchorage device, called Abalakov, used in the context of these preparations. The modalities of placement and use of this simple osteosynthesis wire, placed in the anterior part of the ramus, are exposed step by step, until the final result is obtained. The advantages and effectiveness of the technique are then discussed and compared with other treatment alternatives. It can be concluded that this new device is a simple, comfortable, inexpensive and above all reproducible and highly effective means of distalization of the mandibular arch, with clear uprighting of the incisors.

The discussion on whether to extract or not is still a source of debate. However, primacy must be given to the diagnosis based on a dental, skeletal, aesthetic and functional assessment. The therapeutic means are intended to achieve the goals resulting from this diagnosis which are the only way to individualize the treatment plan according to the patient. Symphyseal distraction is a surgical procedure intended to increase the mandibular bone base at the symphysis level and then allow an ideal positioning of the mandibular incisor. After explaining the procedure to integrate this intervention in the treatment plan, the author studied in 25 clinical cases the displacement of the mandibular incisor according to the initial crowding and the increase of the distance between the mandibular cuspids before and after bone distraction. Symphyseal distraction is an effective alternative to the treatment of dental crowding to the mandible by helping to restore nasal breathing by its association with maxillary disjunction while respecting of physiology and balance facial.

The objective of this case series was to show how only one miniscrew can be used to treat simultaneously or successively canine impaction and different malocclusions. Three patients aged of 13 years old who had malocclusions, such as Class II, overbite and canine impaction, were each one treated with the same miniscrew throughout the treatment period. Palatal miniscrews were placed mesially to the first molar and used as a direct or indirect anchorage depending on the moment of the treatment. In each case, satisfactory treatment was obtained with correction of overbite, class II malocclusion and canine impaction. The first steps of treatment were aesthetic for the patient and did not require patient cooperation.

The link between occlusion and posture is already established. It seems logical to think, that important changes in maxillo-mandibular relation and occlusion, as orthognathic surgery can generate, could possibly have a repercussion on posture. The aim of this study, is to show with international bibliography and with a clinical case what are the consequences of orthodontic and surgical treatment on body posture on patients with skeletal class II discrepancy., Le lien entre occlusion et posture n’est plus à démontrer. En partant du principe que ces deux sont liées, il paraitrait logique de penser que des changements importants au niveau des rapports maxillo-madibulaires, et de ce fait, au niveau de l’occlusion, telle que peut l’engendrer la chirurgie orthognathique, pourrait être à l’origine d’une adaptation de la posture chez ces patients. Le but de cette thèse est de démontrer, au travers de la bibliographie internationale et à l’aide d’un cas clinique, les conséquences posturolales de ces traitements orthodontico-chirurgicaux, en prenant le cas spécifique des classes II squelettiques.

Orofacial functions (such as ventilation, lingual resting posture, swallowing, phonation and chewing) play an important role in child dental occlusion. Any disturbance of the orofacial balance that is the result of a dysfunction or a parafunction can therefore cause a more or less severe malocclusion. Dentists are part of the front line in the detection and diagnosis of dysfunctions and parafunctions. They are able to treat some etiologies, eliminate anatomical obstacles, correct dysfunctions and remove parafunctions. However, they will have to work with different health professionals in order to offer the patient the most complete, strategic and coordinated care.; Les fonctions oro-faciales jouent un rôle important dans la mise en place de l’occlusion dentaire chez l’enfant : il s’agit de la ventilation, la posture linguale au repos, la déglutition, la phonation ainsi que la mastication. Toute perturbation de l’équilibre oro-facial causée par une dysfonction ou une parafonction peut donc être à l’origine d’une malocclusion plus ou moins importante. Le chirurgien-dentiste est en première ligne dans le dépistage et le diagnostic des dysfonctions et des parafonctions. Il est en mesure de traiter certaines étiologies, de supprimer des obstacles anatomiques, de supprimer des parafonctions et de corriger des dysfonctions. Cependant, il devra s’entourer de professionnels de santé afin d’offrir au patient une prise en charge complète, stratégique et coordonnée.

Nowadays, nearly one on two children has a malocclusion. In this work, we were interested in the different types of malocclusions encountered in temporary dentition that the dentist can intercept in his daily practice. The first part is a reminder of the malocclusions encountered in temporary dentition, their definitions as some anatomical reminders. The second part focuses on anamnesis and the screening examination carried out by the dental surgeon (exo-oral, endo-oral, complementary and functional examination). The third part focuses on the different ways of interceptions depending on the pathologies encountered in children under 6 years-old, which will be illustrated in the last part by several clinical cases.; A l’heure actuelle, près d’un enfant sur deux présente une malocclusion en denture temporaire. Dans ce travail, nous nous sommes intéressés aux différents types de malocclusions rencontrés en denture temporaire que le chirurgien-dentiste peut intercepter dans sa pratique quotidienne. Une première partie constitue un rappel des malocclusions rencontrées en denture temporaire, leurs définitions ainsi que quelques rappels anatomiques. La deuxième partie se focalise sur l’anamnèse et l’examen de dépistage réalisé par le chirurgien-dentiste (examen exo-buccal, endo-buccal, complémentaire et fonctionnel). La troisième partie se focalise sur les différents moyens d’interception possibles en fonction des malocclusions rencontrées chez des enfants de moins de 6 ans, qui seront illustrés dans la dernière partie par plusieurs cas cliniques.

Temporomandibular dysfunction and neck pain are common symptoms in patients. In fact, 50% of patients with temporomandibular dysfunction (TMD) present neck pain, and conversely, 20 to 33% of patients with neck pain present TMD. There are many contributing or triggering factors common to these disorders due, for example, to their common anatomy. The aim of this systematic review of the literature is to find out whether TMD or malocclusions can cause neck pain or, conversely, neck pain is likely to decompensate TMD. This work will allow dentists to know the link between these cervical pains and disorders of the manducator apparatus in order to know how to treat or refer the patient for better care., Les dysfonctions de l’appareil manducateur et les douleurs cervicales sont des symptômes fréquemment retrouvés chez les patients. En effet, 50% des patients atteints de dysfonctions temporo-mandibulaires (DTM) présentent des cervicalgies, et inversement, 20 à 33% des patients atteints de cervicalgies présentent des DTM. Il existe de nombreux facteurs favorisants ou déclenchants communs à ces désordres du fait, par exemple, de leur anatomie commune. L’objectif de cette revue systématique de la littérature est de savoir si les DTM ou les malocclusions peuvent provoquer des cervicalgies ou si, à l’inverse, les cervicalgies sont susceptibles de décompenser un DTM. Ce travail permettra au chirurgien-dentiste de connaitre le lien entre ces douleurs cervicales et les troubles de l'appareil manducateur afin de savoir traiter ou adresser le patient pour une meilleure prise en charge.

This study is aimed at evaluating the Oral Health Related Quality of Life (OHRQoL) in adolescents aged 11-14 years-old during orthodontic therapy and 18 months after the start of treatment and the possible role of psychological parameters. Sixty patients were recruited, and data were collected using self-administrated questionnaires and intraoral clinical examinations. The questionnaires included sociodemographic characteristics (age, gender), the Lebanese version of the Child Perception Questionnaire between 11 and 14 years CPQ11-14 to assess the OHRQoL, the Discrepancy Aesthetic Index (DAI) for malocclusion, and the Child Health Questionnaire « CHQ-CF87 » to appraise Self-Esteem (SE) and Psychological Well-Being (PWB). The mean scores of CPQ11-14 and its four subdomains were significantly better for participants with high SE /PWB compared to those with low SE / PWB at baseline. These same scores improved significantly during orthodontic treatment (p < 0.001). However, DAI was significantly better in patients with low self-esteem and psychological well-being. Our findings showed improvement in oral health perception and psychologic parameters during orthodontic treatment. Investigators should consider the need to control the psychological parameters of patients when assessing orthodontic treatment need and improvement in OHRQoL during orthodontic treatment.

Since 1907, the international community has used Angle's classification to assess the mesio-distal relationships of the dental arches. It is the basis of the diagnosis of malocclusion in the sagittal dimension and indicates or not an orthodontic correction treatment. This work was aimed to inventory the classification methods of malocclusions used today. Indices of treatment need were also presented because they are based on one or more occlusal anomalies to indicate treatment. The classifications were criticized and the contribution of a functional analysis based on the use of the trilogy setting, centering and guiding was detailed. The type of anomalies (skeletal and dental) must be completed by the analysis of the occlusal anomaly of setting (centering or guiding) and of the category of occlusion (functional occlusion, functional malocclusion or pathogenic malocclusion), ie its possible pathogenic impact on orofacial structures. A consensus on the classification of occlusal anomalies is necessary in order to better identify the anomalies and their global repercussions, and to better define the needs for orthodontic treatment.

The objective of this comparative retrospective cohort performed on 202 patients was to evaluate the influence of instrumental extraction (forceps, suction cup, spatula) during delivery on the need for orthodontic treatment. Questionnaires on the type of delivery were distributed in three different structures. The need for treatment was assessed using the IOTN indicator (Index of Orthodontic Treatment Need). The groups were compared by statistical tests at the significance level of 5 %. 202 patients were included (51 in the group « instrumental delivery », 151 in the control group). With an average IOTN of 3.3 in the « instrumental delivery » group versus 2.5 in the « non-instrumental delivery » group, the difference between the two groups is statistically significant (p = 0.00015). Since the need for orthodontic treatment is significantly higher in patients born by instrumental delivery compared to patients born without instrumental support, instrumental extraction is therefore a risk factor in orthodontics, diagnosis and orthodontic treatment may be indicated in these patients. In addition, provided that it is proven effective, early osteopathic management may be recommended.

L’endoalvéolie maxillaire fait partie des malocclusions de la dimension transversale par déficit maxillaire. Sa prise en charge, préventive et interceptive, dès le plus jeune âge, est une priorité pour l’orthodontiste et les acteurs intervenant autour de l’enfant, afin de limiter les conséquences sur les bases osseuses et favoriser une croissance harmonieuse. Ainsi, il existe différents appareillages fixes ou amovibles, adaptés aux anomalies et aux stades de denture. Des dispositifs d’expansion palatine en alliages de type Nickel-titane sont aujourd’hui proposés afin de délivrer des forces légères et continues. L’objectif de ce travail est d’étudier l’intérêt des biomatériaux à mémoire de forme pour la prise en charge des anomalies du sens transversal. Dans un premier temps, nous rappellerons les différents moyens de traitement interceptifs du sens transversal, puis nous aborderons les nouvelles stratégies thérapeutiques et l’apport des alliages à mémoire de forme. Enfin, nous proposerons un protocole de recherche clinique comparant trois dispositifs orthodontiques dans le traitement interceptif de l’endoalvéolie maxillaire : le quad’hélix, le transforce et le palatal expander.