Many hypotheses concerning the relationships that might exist between the disorders of masticatory system or temperomandibular disorders (TMD) and malocclusions have been advanced. But, in terms of evidence-based medicine, can we say that any of them have scientific merit?

The objective of our project was to analyze the existing international literature of the years 2000 to 2009 on the relationship between malocclusion and malfunction of the masticatory system.

Materials and method: we used MEDLINE to find all papers written in French or English that had an abstract referring to “Malocclusion” and “Temperomandibular joint disorders.” We subjected them to a critical analysis using a reading record program that sorted the papers into types of study, descriptive or analytical, and the intensity of their methodology. Two of our authors calibrated this analysis and we compared their results.

Results: We examined 17 studies out of a panel of 171 articles. Nine out of the seventeen were transverse studies, six were longitudinal studies, one evaluated cases and a control group, and one was a cohort study. An ethical committee had approved of 9 of the studies and 9 out of the group had been randomized. From all seventeen we collected calibrations from observers and made statistical analyses of the data.

Our conclusion was that there is a relationship between malocclusion and TMD but that it is a weak one.

The results of the different studies varied considerably as a factor of the type of malocclusion incriminated and the type of temperomandibular disorder reported. Our work indicated that a relationship between TMD and malocclusion cannot be established and the studies we reviewed had little scientific value primarily because of the heterogeneity of the samples and of the lack of clearly established definitions of the terms “malocclusion” and “disorder” of the masticatory system.

The last stage of orthodontic treatment is occlusal finishing. This complex and subtle treatment period demands careful reflection by orthodontists in order for them to achieve an optimal occlusion.

Elastodontic concept is a straightforward therapeutic tactic, whose essence is a considered and individualised approach to treatment within a well-structured plan.

Elastodontic concept enables orthodontists to construct of a functional occlusion which satisfies the three fundamental criteria of function of the masticatory apparatus: effectiveness, harmony, and economy.

An illustrated case study will give the reader an understanding of the design and unique action of this type of appliance.

Only competent centres are able to provide the full range of multi-disciplinary specialized therapies that cleft lip and palate rehabilitation requires. Despite some detail differences in conducting treatment, the agreed centres produced consensual treatment philosophy and observe equivalent therapeutic schemes. These sequences, to which orthodontics invariably contributes, are designed to favour the normal outcome of facial development and functions.

Beginning early in mixed dentition, orthodontic rehabilitation is designed to afford patients good dental occlusion through orthopaedic and orthodontic therapies. At the end of the growth period, orthodontics prepares for eventual final surgical and prosthetic repair.

We avoid extraction of permanent teeth as an adjunct to treatment because it has deleterious effect on final skeletal harmony. We prefer basic appliances for mechanical therapy, and after completion of active treatment, a prolonged retention. A trained orthodontist is able to complete the orthopaedic and orthodontic stages in cleft lip and palate repair if he fully understands and follows the general cleft lip and palate treatment scheme and effectively communicates with the competent rehabilitation team.

For many years TREFLE, The Ecully team treating labio-palatal clefts, has begun managing the care of patients with clefts at younger and younger ages. Both surgically and orthodontically we design our therapeutic interventions to change the environment of the cleft as rapidly as possible in order to improve patients’ functioning that will in turn have a beneficial effect on growth and esthetics. We have found that our patients treated in this way not only have improved appearance but also less likelihood of needing orthognathic surgery. We have also found that our patients do not routinely require early bone grafts, at about 6 years of age. We determine which children will require this intervention in a re-evaluation that we undertake after the completion of the primary phase of orthopedic and orthodontic therapy.

To make our technique as clear as possible throughout the course of this article we present the different stages of treatment of four children, Leslie, Jules, Nathan, and Élodie.