[Periodontal optimization of the smile: choosing the right moment to achieve a maximum esthetic result]

INTRODUCTION

Today, esthetic enhancement is one of the main reasons why patients seek orthodontic treatment. Governed by the canons of beauty dictated by our society, the smile is a key component in this quest for perfect beauty. Hence, the orthodontist is often the first specialist to be consulted by adolescents, but also, more and more, by adults as well. Using simple tools, the practitioner must be able to make a precise analysis of the patient combining both orthodontic and periodontal examinations with an esthetic periodontal diagnosis.

OBJECTIVES

Using this analysis, the orthodontist must be able to identify his/her patient's periodontal morphotype and assess whether there is a risk of complications during treatment. One of the main complications that may arise is periodontal recession, which can both impact the esthetic result and give rise to patient anxiety, very soon leaving the orthodontist at a loss. If in doubt, it is essential to refer one's patient to the general dentist or to the periodontist.

MATERIALS AND METHODS

In this paper, the authors will describe a didactic decision-making tree, which will assist practitioners in learning how to manage their patients.

DISCUSSION

A synergistic approach to global patient management will ensure an optimal outcome by providing the patient with an appropriate and individualized treatment procedure.

Periodontal surgery of the maxillary impacted canine for orthodontic purposes: Proposal for a surgical decision tree

In a private practice, between January 2010 and December 2015, 621 impacted teeth were exposed for orthodontic purposes. The majority were maxillary canines (464=74.71%), followed by maxillary central incisors (36=5.80%), mandibular canines (32=5.15%) and, finally, second premolars (30=4.83%). The 464 maxillary canines were present in 356 patients with a mean age, at the time of the intervention, of 15 years and 3 months (7 years and 10 months to 45 years and one month). The gender distribution was 60.7% (F) to 39.3% (M); 32.8% of maxillary canines were buccal and 67.2% were palatal. Only 6 canines did not move, with a success rate of 98.7%. At the pretreatment interview, the orthodontists explained that orthodontic-surgical placement of an impacted canine lengthened treatment time by an average 6 months, but in some cases by 12 months or more. The purpose of this surgery is to help the orthodontist to position the impacted tooth in the dental arch with all the periodontal structures and with the best possible integration esthetics. The objective of this article is to illustrate the periodontal orthodontic surgery of the maxillary canine and to propose a surgical decision tree.

Gingival recession and adult orthodontics: a clinical evidence-based treatment proposal

The presence of a gingival recession prior to orthodontic treatment is a real problem. Patients are concerned about losing their teeth but may also complain of their unpleasant appearance or root sensitivity in the exposed area. The orthodontist is not sure whether orthodontic treatment can be performed or whether the tooth movement will not aggravate the recession and whether periodontal surgery needs to be done before or after orthodontic treatment. The aim of this paper is to present recent data from the literature and several clinical situations in adults in order to submit a treatment sequence and clarify the role of different periodontal plastic surgery root coverage procedures.

[Plaque control, a key element of successful orthodontics]

It is mainly because of periodontal tissues and, more particularly, the periodontal ligament that the orthodontist is able to move teeth. According the ratio cost/benefit/security, the orthodontist needs to prevent and/or to avoid the deleterious effects of its treatments on periodontal tissues. Gingival inflammation with a high hyperplasia compound, periodontal attachment loss, bone loss and root resorption may result, in absolute value, in a reduction of periodontal support. The key to prevent these problems is plaque control, phase too often neglected. The challenge before any orthodontic treatment, both in children or in adults, is to change the behavior of the patient concerning the mouth and the dental plaque. The aim of this paper is to explore the evidence based literature (systematic revues, meta-analysis), to provide thought elements and concrete proposals to definitely resolve this critical phase of orthodontic treatment that is the motivation, phase that can also be achieved by "dental auxiliaries".

Multinucleated giant cells elicited around hydroxyapatite particles implanted in craniotomy defects are not osteoclasts

BACKGROUND

The nature of the multinucleated giant cells (MNGC) elicited in contact with implantable biomaterials is still indecisive.

METHOD

In Wistar rats the MNGC recruited after the implantation of hydroxyapatite (HA) particles in standardized skull defects were examined morphologically (at both the light and electron microscope levels), enzymatically (tartrate-resistant acid phosphatase and non-specific esterase), and after a challenge with salmon calcitonin.

RESULTS

The MNGC were of great size and contained abundant mitochondria, vacuoles, and vesicles throughout the cytoplasm; they were either tightly apposed to the HA surface or had long and thin processes penetrating the material. When processed for tartrate-resistant acid phosphatase, only a few cells were weakly stained. The staining was totally suppressed when samples were pretreated with cyanuric chloride in the MNGC but not in the host osteoclasts. Calcitonin induced the withdrawal of the host osteoclasts from the bone surface while the MNGC remained in contact with the HA material.

CONCLUSION

The MNGC recruited to HA particles did not exhibit the morphologic, enzymatic and functional characteristics of the osteoclasts, and consequently must be regarded as macrophage polykaryons.

[Posterior bite collapse. 2. Therapeutic proposals]

In the treatment of posterior bite collapse, the orthodontic phase consists of three steps: uprighting of molar teeth, leveling of the mandibular arch and closure of anterior diastemas. During and after orthodontic therapy, the maintenance of periodontal health is important. For patients in which there is a reduced periodontium, splinting should be accomplished after the teeth are moved into their desired position.

Periodontal and femoral bone status in periodontitis-affected hamsters receiving a high dose indomethacin treatment

The aim of this study was to test the effect of a high dose (6 mg/kg/d) of indomethacin, a PG-synthesis inhibitor, on hamster periodontitis and to verify a possible systemic skeletal action. Thirty animals were separated into three groups: control, untreated periodontitis-affected, and indomethacin treated groups. Compared to affected untreated animals, indomethacin reduced the number of osteoclasts (p less than 0.001) to the control level, and accordingly the extent of resorption (p less than 0.01). A partial decrease in reversal (p less than 0.05) was also obtained; the persistence of aborted reversal lacunae was the scar of the pretreatment period. The extent of formation was markedly increased by indomethacin (p less than 0.01). Bacterial plaque accumulation was not modified but PMNLs investing plaque were dramatically decreased (p less than 0.02). Indomethacin had no influence on the femoral periosteal remodeling, nor on metaphyseal and epiphyseal trabecular density, nor on growth plate thickness. These results confirm the positive effect of indomethacin on hamster periodontitis and emphasize the role of PGs on periodontitic bone disturbances, particularly on the uncoupling of the remodeling sequence. The reduction in PMNL migration is an important feature, which possibly participates in the improvement of the bone status. The lack of femoral changes indicates that a mid-term treatment with indomethacin has no detrimental action on ordered skeletal growth and bone mass.

[Posterior bite collapse. 1. Etiology and diagnosis]

The posterior Bite Collapse is a sequelae of advanced break down. The presence of periodontal inflammation and loss of osseous support can induce teeth migration in a direction partially imposed by occlusal forces. Posterior Bite Collapse often causes mesial drifting of the posterior teeth and flaring of the anterior segments. It may be aggravated by early loss of teeth that are not replaced, by malocclusion or by a neuro muscular disorder.