Among rare diseases, a fifth of them are associated with oral manifestations. The most frequent are: enamel dysplasia, cleft lip or palate and oligodontia. Beside the pathology, patients are eager of functional therapeutics which often needs prosthodontics. This oral rehabilitation aims to a better life quality.

Teeth absence management in the case of oligodontia necessitates critical analysis of the supporting tissues: the periodontium and the underlying bone. Deciduous teeth with resorbed roots and hypoplasic permanent teeth are often observed. Thus, some questions arise: can we use them as abutments or can we restore them knowing that they present an anomaly in their position and are more fragile? How do we replace many teeth when bone is lacking (clefts, agenesis)? Can we implant on a missing tooth site or can we use autograft? What do we expect for periodontal healing?

Adjacent teeth have often migrated, occlusion is unstable due to mixed dentition and patient’s disease. For example, in mandibular incisors agenesis cases, the remaining deciduous teeth are used when consultation happens at adolescence. This results in upper jaw incisors migration toward mandible and thus an anterior overbite. Orthodontic treatments will allow to recreate gap width and a normal occlusion in order to perform prosthodontics treatment in the best possible conditions. Giving the weak dental and periodontal supports, our attention will be focused on choosing the best option between tooth and implant supported prosthodontics. During the mixed dentition, orthodontic treatment and aesthetic rehabilitation have to be planed at the same time and to last until “definitive” implant and periodontal therapies are possible. In this article, we will present one oligodontia case report to illustrate a possible solution.

Indications for the extraction of permanent healthy teeth in dentofacial orthopedics, has been an object of polarized debate between extractionists and nonextractionist since the beginning of the twentieth century.

In a media-hyped environment, where extractions have become routine, this concern that is not addressed during consultation, poses a problem for the patient-practitioner relationship. The practitioner is confronted with a criminal liability known as a failure to respect the physical integrity of the human body and to treat in the patient's best interest. But the question remains: is it ethical to extract healthy teeth?

The way in which orthodontic patients swallow poses a major problem during treatment, especially for long-term stability of the end result. If clinical diagnosis of atypical swallowing performed in an empirical manner by the practitioner, aided or not by rehabilitation devices, has been the subject of numerous studies, surface electromyography seems to bring new insight in diagnosing the way patients swallow and in re-training atypical deglutition. After a short refresher about the anatomy and physiology of the mechanisms of swallowing as well as the basic principles of electromyography, a descriptive and comparative study was carried out with 60 patients in order to understand and to prove the reliability and pertinence of this diagnostic tool. The results of the study are based on a collection of graphic and visual data compared to maxillo-facial kinesiographic studies where patients underwent a parallel double blind diagnosis. The objective was to determine if surface electromyography provides reliable, exact and reproducible data based on daily screening. Finally, it may be possible to create a flowchart for clinical decision making by using the results of our study as well as the findings in the literature.

This article presents solutions to problems posed by missing teeth in the anterior sector of the arch by synthesizing three groups of parameters, those related to patients, those related to dentists, and those related to the orthodontist.

But the patient, or the parents of patients who are young children, in consultation with the treatment professionals, must make the final decision.

Parents want their children’s’ faces, the most visible part of their bodies, one that marks their identity throughout life, to be perfect. To satisfy this understandably urgent desire, a high quality of primary treatment for cleft lip and palate is essential and must satisfy a double objective: restore normal morphology and normal function. The functional, morphological, and esthetic prognoses depend on the character of the defect, whether it stands alone or is associated in a syndrome with other malformations. Important sequellae flow from the quality of the initial repair, as a consequence of the surgery and other therapies as well as from the deformity itself.

Before the year 2000, the Maxillo-facial and Plastic Surgery Service at the Armand Trousseau Hospital of the Pierre and Marie Curie Faculty of Medicine adhered to the protocol that Malek had described, making an initial repair of the soft palate at 3 months and then a cheiloplasty, with upper and lower triangles, and closure of the hard palate at 6 months. Since then we have adopted the more functional approach that Talmant described, integrating systematic nasal surgery and the type of lip surgery that Millard suggested without leaving any residual exposed bone after closure of the osseous cleft. We then perform gingivo-periosteal surgery with bone grafts on patients when they were between 4 and 6 years of age, after orthodontic therapy had been completed. This constitutes the last stage of primary treatment.

The therapeutic approach we have been using on our service, which has evolved of over the last 20 years, has come to define its principal objective as integration of extensive rehabilitation into the very first stages of our multi-disciplinary therapy so as to minimize the establishment of faulty functioning of phonation, lip competence, and ventilation while avoiding any intervention that would have a harmful impact on facial growth. This multi-disciplinary approach, which integrates surgical evaluation and protocol, is indispensable and fully justifies treatment of patients with cleft lip and palate at accredited centers.

Pierre Fauchard (1678-1761) is known as the father of dentistry. This division of medicine participated fully in the enlightenment. After a second reading of his book, The Dental Surgeon, an examination of recent publications of 18th century practitioners, and the discovery of new documents, we have gained a better understanding of the man, the dental surgeon, and the place of scientists in his century.

Three dimensional images derived from X-Rays, scans or Digital Cone Beam Computed Tomography (CBCT) are components of supplementary diagnostic procedures. Using them, practitioners can visualize the anatomic relationships of teeth with each other and with adjacent structures and can discern the presence or absence of root resorption.

These radiographic films can assist in the diagnostic evaluation of impacted, transposed, or duplicated teeth or those situated on the edges of facial clefts. They are indispensable in helping diagnosticians to rule out contraindications as they establish treatment plans and continue to be useful as guides when mechano- therapy starts.

Recently, CBCT has become accessible for use in dental offices even though it has been an expensive and bulky instrument with a relatively high radiation output. Today, with a more acceptable radiation dosage, it is well accepted as an alternative diagnostic procedure in the field of oro-facial implants, but overall, it cannot yet be considered as a technique that should be systematically employed in every supplementary examination.

There has been a considerable increase in the clinical use of lasers in dentistry over the past thirty years, especially in orthodontics. But clinicians who have not yet made their decisions about participating in this technological revolution can be perplexed by the great variety of wave lengths available, the vast number of machines that can be used to employ them, and the complexity of the principles of physics upon which lasers beams are based.

The objective of this article is to give practitioners a better understanding of the indications for the use of the various types of lasers.

More and more adults are beginning orthodontic treatment because they want to regain the smile they had when they were 20 years-old and to diminish the signs of aging their faces present to degrees that depend upon the severity of their dento-facial deformity.

The dental esthetic criteria that are sought after and regained with treatment are, primarily straightening and whitening of teeth, and a smooth appearance of the teeth and their mutual contours, predominantly in the upper incisor area as well as a regular, broad smile line in harmony with the lower lip. In addition to these dental guide lines, additional important consideration should be taken of the relationship of the size and bulk of the teeth with respect to facial type and the absence of any strain in lip posture.

Orthodontic treatment, in correcting malocclusions of varying severity, can effectively join with other specialties in creating a younger smile line for patients and eliminating many signs of aging.

This article shows how to apply orthodontie force to impacted cuspids and bring them into proper arch position using a unique innovative anchorage system consisting of two short mini-screws placed buccally in cortical bone. Attached to this fixed anchorage is an .018 TMA round wire that emerges from the gingiva to exert direct 3D control on the canine without any additional dental support. The general procedure for moving impacted teeth into position and the mechanics utilized are described in detail with illustrations from clinical cases we have treated.

Change is inevitable: it occurs in every domain and we should realize that it doesn’t work as a one-time leap forward but is, instead, an on-going process. And as an underlying principle we should also understand that planned and well executed development is always preferable to abrupt changes that are imposed by external forces. By exercisingceaseless vigilance we can prepare in advance for the improvements that we must make to keep our offices up to date.

In all organizations, resistance to change is built into the behavior of every staff member. Management should take this factor into account and establish ways of dealing with it in each pro ject that is undertaken. Every activity requires the voluntary and active participation of all members of the office team. As the group leader, the practitioner must define the needs, outline the fra mework of the action, dissolve resistance, and provide the breathing room that is indispensable in stimulating voluntary and motivated cooperation of participants.

The design for the site of an orthodontic office has to encompass a wide variety of heterogeneous concepts that have little or no logical connection with each other including functional and ergonomic requirements, the available existing space, the existing building itself, the flow of traffic, the conduct of the practice, costs, colors, materials, textures, and lighting.

Carrying out this transformation cannot be done without an in depth study of the specifications and characteristics of every phase of the operation, a careful analysis of the needs and mode of operation of the office team. But this plan for a facility remodeling should not respond solely to functional needs; every office location should be designed to house a particular activity. The waiting room and reception desk should encourage communication and empathy. The consulting room should soothe fears and stimulate dialogue. The treatment rooms or area should reflect professionalism. The sterilization area must gleam with an almost virginal cleanliness and demonstrate the rigor of its antiseptic qualities. Throughout, management of space, forms, dimensions, and the choice of materials and colors must flow from a well thought out plan where they all participate in the creation of an atmosphere that sends a message to patients. “Architectural works speak to men’s hearts, awakening emotions. The task of architecture is to stimulate righteous emotions.” [2]

The aim of this study was to observe the effects of treatment with a Trainer T4K® myofunc tional appliance of thirteen late mixed dentition patients. We conducted thorough clinical examinations that included assessment of breathing and swallowing capabilities and took profile cephalograms and study models for each one. We also selected a control group that had been treated only with palatal expansion so that we could distinguish the effects of myofunctional therapy from those of expansion. We observed significant mandibular growth (p<0.05) of 3.24 mm on the average and a significant decrease in overjet, essentially linked to dento-alveolar effects, in the Trainer T4K® group. Swallowing and breathing function also improved in these patients. The two groups had similar maxillary and mandibular expansion.

So we conclude that use of a Trainer T4K® myofunctional appliance results in improved antero-postero dental relationships and an improvement in oral functioning.

Deviations in facial form are discussed. On the basis of previously published hypotheses, it is suggested that oropharyngeal development may be influenced by the posture, and function of the tongue, lips, and jaws. Attention is drawn to the relationship between a firm tongue to palate swallow, and the pump action of the palatine aponeurosis, which it is suggested is necessary for the aeration of the Eustachian tube. The pump action appears to be reduced in long faced adenoidal children, but clinical evidence suggests that it can be regenerated by early Orthotropics (growth guidance) aimed at directing facial growth forward, instead of downward. Any reduction in the height of the face, facilitates an improved lip seal, without which the downward pattern of facial growth is likely to continue. On occasions when these objectives are achieved it would seem that sufficient room is created to align all 32 teeth, with excellent facial form, and little otolaryngological pathology.