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Clear aligners are the most debated infusion of technology into the orthodontic stratosphere and currently account for a sizable chunk of the orthodontic commercial market. Data indicate that a series of plastic aligners alone cannot resolve all the variants of malocclusion routinely treated by our specialty. Current literary consensus exists that the discrepancy between the predicted and actual clinical outcomes with clear aligner therapy (CAT) is around 50% or more, necessitating midcourse corrections, refinement, or additional aligners, or even a conversion to fixed appliances before the end of treatment. A practical panacea to improve the predictability of CAT is the addition of creative and customized adjuncts to CAT. This article, inspired by the "Golden Circle Model", addresses questions such as the "WHY, HOW, and WHAT" of adjuncts used in combination with CAT and depicts an "inside out" approach (from WHY to WHAT) to present the rationale, stepwise clinical workflow, and the advantages of these adjuncts. The bootstrap, mini pin-supported mesialization or distalization, Yin-Yang attachments, Beneslider, Mesialslider, BMX Expander, and Computer-Aided Design (CAD) / Computer-Aided-Manufacturing (CAM)...based innovative appliance designs among others, are presented as adjuncts to CAT in this article. These adjuncts can either be used concomitantly with the aligners or planned as a separate phase of treatment before the commencement of the actual CAT, based on the type of tooth movement required and whether the planned tooth movement is indicated for a single tooth or a group of teeth. An astute clinician who wishes to expand the repertoire of malocclusions that can be successfully managed by CAT should judiciously plan the inclusion of such adjunct appliances in their aligner treatment planning.

To describe treatment using aligners in an adult female patient with dental class II malocclusion associated with crowding. Treatment objectives were achieved in 10 months with patient satisfaction. Combining aligners with appropriate attachment location, geometry and staging are efficacious means of resolving class II malocclusion.

Introduction : Les classes II squelettiques, fréquemment associées à une rétromandibulie et un surplomb supérieur à 2 mm, entraînent un préjudice fonctionnel et esthétique que le traitement orthodontique se doit de corriger. L’objectif de cet article est de décrire un protocole de traitement par aligneurs, chez le patient en cours de croissance, en fonction de l’importance de la classe II et du stade de maturité de ses vertèbres cervicales. Matériels et méthodes : Au travers de cas cliniques, cet article va présenter trois approches thérapeutiques différentes en fonction du stade de croissance. Résultats : L’étude du potentiel auxologique et la détermination de l’âge osseux (analyse radiologique de la maturation des vertèbres cervicales) vont permettre de déterminer le moment le plus opportun pour traiter la classe II et l’attitude thérapeutique la plus appropriée en fonction du stade de croissance. Discussion : Ce prérequis avant traitement est donc essentiel afin d’adapter un protocole clinique individualisé à chaque patient. En ce sens, les aligneurs sont des dispositifs qui répondent bien à cet impératif, car ils sont personnalisables au vu de la thérapeutique et du plan de traitement envisagés par le praticien. Toutefois, il faut garder à l’esprit qu’une bonne observance est indispensable, quelle que soit la thérapeutique envisagée.

Digital dental technologies for design, simulation and fabrication are constantly evolving. It is possible to digitally simulate dental movements, as well as displacements of both arches and to produce thermoformed splints manufactured from this simulation. The authors present the coupling of intraoral 3D scanning with low-dose radiation 3D radiography that allows for a very precise surgical setup, preparation of repositioning aligners, and fabrication of osteosynthesis plates. The orthodontic-surgical management protocol with aligners used by the first author will be described in detail. The authors present, through clinical cases, the progress made in orthognathic surgery thanks to 3D and the Invisalign® thermoformed tray system. Looking at the three clinical cases presented, it can be seen that the average treatment time was much less than the average time for usual orthodontic-surgical protocols.

Objective To examine the skeletal, dental, and soft-tissue cephalometric effects of class II correction using Invisalign’s mandibular advancement feature in growing patients. Materials and Methods A retrospective cohort clinical study was performed on cases that were started between 2017 and 2019. A total of 32 patients (13 females, 19 males), with an average age of 13 years old (9.9-14.8 years) had undergone Invisalign treatment (Align Technology, Inc., San Jose, CA) wherein the mandibular advancement phase was completed were included. Photos, digital study models, and cephalograms were taken once during the patients’ initial visit and again upon completing the mandibular advancement phase of treatment. The number of aligners worn and the time of treatment in months was recorded for each subject. Cephalometric analysis was performed and overjet and overbite were measured. Statistical analysis was performed using SPSS statistical software (version 25; SPSS, Chicago, Ill) and the level of significance was set at P t -test. Results All 32 patients had multiple jumps staged for the precision wings, i.e., incremental advancement. The average length of treatment for the MA phase was 9.2 months (7.5-13.8 months) and the average number of aligners used during this time was 37 (30-55). Statistically significant differences between T1 and T2, in favor of class II correction, were observed in the ANB angle, WITS appraisal, facial convexity, and mandibular length. The nasolabial angle, overjet, and overbite also showed statistically significant changes between T1 and T2. Conclusion Invisalign aligners with the mandibular advancement feature took approximately 9 months for 1.5 mm of overjet correction. The lower incisor angulation was maintained during class II correction. The minimal skeletal changes are in favor of class II correction.

Introduction : L'objectif de cette étude est d'évaluer la douleur générée au cours des traitements orthodontiques par aligneurs en termes d'intensité, de durée et de la caractériser. Matériels et méthodes : L'échantillon a regroupé 106 patients. La douleur a été étudiée selon son intensité et ses caractéristiques à partir du questionnaire de la Douleur de Saint Antoine. Pour l'analyse statistique, des tests de Student ont été réalisés. Résultats : 84 % des patients ressentent une douleur faible à modérée, avec une intensité significativement plus élevée chez les femmes. 31 % des patients ont consommé des antalgiques, sans corrélation établie entre le niveau d'intensité de la douleur et la prise d'antalgique. Pour 53 % des patients, la durée de la douleur était ≤ 2 jours ; pour 15 % des patients, elle a duré 7 jours. Chez les patients d'âge ≥ 40 ans, la durée de la douleur était significativement moindre que chez les patients d'âge Conclusion : Les traitements par gouttières provoquent une douleur faible à modérée, qui dure généralement 2 à 3 jours, mais peut durer 7 jours. Cette douleur est décrite comme une sensation de « compression », « élancement », « serrement », « tiraillement », « étirement », « coupure », et peut être « fatigante », « gênante », « désagréable », voire « pénible ».

Skeletal class II, frequently associated with retromandibular and overjet2 mm, lead to functional and aesthetic damage, that orthodontic treatment has to correct. The aim of this article is to describe a treatment protocol by aligners for class II growing patients according to the value of the class II and the maturity state of cervical vertebrae.Through clinical cases, this article will present three different therapeutic approaches depending on the growth state.The study of the auxologic potential and determination of the bone age (radiological analysis of the maturation of the cervical vertebrae) will allow to determine the best moment to treat class II and the most appropriate therapeutic attitude according to growing state.This study before treatment is essential to adapt an individualized clinical protocol to each patient. In this way, aligners are devices that respond well to this imperative because they are customizable in view of the strategy and the treatment plan considered by the practitioner. We must keep in mind, however, that with any therapy, it is essential to ensure good patient compliance.

The aim of this study was to assess pain generated during orthodontic treatment with aligners in terms of intensity, duration and characteristics.The sample consisted of 106 patients. Pain was analyzed according to intensity and characteristics using the Saint Antoine Pain Questionnaire (French Mac Gill questionnaire). For statistical analysis, Student tests were performed.84% of patients experienced low to moderate pain, with a significantly higher intensity in women. Thirty-one per cent of patients consumed analgesics, although no established correlation was observed between intensity of pain and analgesics. For 53% of patients, duration of pain was ≤ 2 days; for 15% of patients, the pain lasted 7 days. Among patients aged ≥ 40 years, duration of pain was significantly lower than in those aged 40 years. Ten characteristics of pain were selected as described by at least one third of patients.Orthodontic treatments with aligners cause mild to moderate pain, which usually lasts 2 to 3 days, but may last 7 days. This pain is described as a sensation of "compression", "twinges", "squeezing", "tightness", "stretching", "cutting", and as being "tiresome", "bothersome", "unpleasant", or even "a nuisance".

Le role de la respiration nasale dans le developpement du squelette facial a deja ete demontre par de nombreux travaux en France et a l’etranger. Par contre l’etiopathogenie des differentes anomalies cranio-faciales consecutives a des problemes respiratoires n’a pas ete suffisamment expliquee avec clarte. L’aerophonoscope constitue l’outil le plus simple qui permet d’evaluer de maniere precise et reproductible les troubles respiratoires et, en plus, de pratiquer la reeducation de la respiration. Une etude portant sur 105 patients avec l’aerophonoscope, effectuee a l’hopital de la Salpetriere a Paris nous a permis d’etudier les correlations entre les differents signes cliniques, radiologiques et fonctionnels des respirateurs buccaux.