The objective of this article is to demonstrate the effectiveness of good cooperation between orthodontists and Ear, Nose, and Throat specialists because of the importance of freeing the upper airways from obstruction in order to achieve a good orthodontic result as well as the other side of the coin, the beneficial effect orthodontic treatment can have in stimulating a functional liberation of those airways when no mechanical blockage is present. The article will emphasize how important it is for orthodontists to understand and to be alert to the signs and symptoms that would indicate the need for an ENT evaluation.

Orthodontics has been developing for 282 years. We can distinguish an initial period when practitioners limited themselves to “straightening” teeth that were out of position. Then, under the influence of Edward Hartley Angle, they devoted their efforts to correcting “malocclusions.” Now, during its third period, orthodontics has divided itself into two branches. The American school believes the shape and size of basal bone is genetically determined and that treatment should be limited to the dentition, which must be positioned in conformity to precisely defined standards. But the European school is persuaded that basal bone can be modeled by the play of functional forces, which treatment can change and thereby adjust growth and development. What will be the guiding principle of the orthodontics of tomorrow ?

The periodontium plays a predominant role in the healthy stability of the dentition in general and of canine teeth in particular. After reviewing the make-up of healthy periodontal tissue and evaluating the situations where it is at risk, we describe different techniques of muco-gingival surgery that are applicable to canines.

We then illustrate the integration of periodontal data in treatment planning for orthodontic treatment of impacted canine teeth with clinical cases where our therapeutic choices have a certain original quality.

When a maxillary canine has not appeared in the arch at its scheduled time of arrival, the treating dentist should make a precise analysis of the possible factors responsible for its absence and devise the best therapeutic plan for correcting the problem. Factors to be considered are its agenesis or the more likely possibility of anomalies of tooth size and eruption patterns. Deciding whether to bring an absent canine into place orthodontically or to replace it prosthetically or with an implant almost always constitutes a sort of therapeutic wager.

This article proposes a method for the systematic appraisal of the management of a missing maxillary canine using a decisional tree of the “in cases where” type. It allows for questionable issues to be grouped in logical order, starting with diagnostic procedures that lead to the beginning of a step-like therapeutic sequence that concludes, if it proves negative, with the development of an alternative to the initial treatment plan (fig. 1).

This arboreal schema is comprised of three parts:

     1 – The first deals with diagnosis;

     2 – The second takes up the start of treatment in consideration of the position of the tooth and the possibility of its being ankylosed or becoming ankylosed;

     3 – The third is concerned with replacing the missing canine tooth in accordance with the dictates of implant or prosthetic therapy, or of an orthodontic solution to the problem.

Every day orthodontists observe the consequences habitual mouth breathing has in their patients’ oral cavities and the limitations this dysfunction places on their orthopedic and orthodontic treatments. Orthodontists can enlist the assistance of their ENT colleagues for the elimination of hypertrophied adenoidal and tonsillar tissue, but when asked to perform surgical correction of malformed nasal septa and turbinates for young children most otolaryngologists usually advise strongly against such procedures. Even surgery for labio-maxillo-palatal clefts is still entangled in the same web of dogmatic disapproval. For these unilateral or bilateral cleft patients, 75 % of whom breathe primarily through their mouths, the potential for growth is considered to be limited and unpredictable. This belief, we feel, is related to the tendency of workers in our field to pay insufficient attention to nasal breathing. But in our practice, for the past thirty years we have been re-establishing it for patients at about the age of 6 and now we are doing it for children between the ages of 4 and 5. For the last 13 years we have helped affected children to breathe nasally at the age of 6 months by means of an ambitious but rigorous surgical procedure on all patients with total clefts. The current results on the nasal and maxillary growth of these children are good enough to encourage us to continue along the same lines, with the expectation of very soon being able to confirm our results as they reach the end of their growth periods.

This article reports our study, carried out as a CECSMO assignment, assessing the effectiveness of resin modified glass ionomer cement as a bonding agent on enamel over a two year period and a consideration of the relative influence of two brands of attachments, Orthos and Damon. In our study group we had an overall rate of bonding rupture of 11.6%. 17% of direct and 33% of the indirect bondings loosened in the first trimester. Globally, the direct bonding had a higher survival rate, which was, after one year, 95.2% for the direct bonding and 90.7% for the indirect. The survival rate of attachments bonded to second molars was the lowest for all the teeth in the arch with Damon Indirect recorded at .889 after a year and Orthos Indirect .524 after a year. We categorized our results in relation to the characteristics of our sample (its size, its heterogeneity, and the duration of the observation period) and in relation to the characteristics of the attachments (their size and the surface and type of their bases) and in relation to the protocols (of indirect bonding, of preparation of enamel surface, of photopolymerization, of placement of the first arch, of bracket size, of ligature placement, and type of mechano-therapy used).

Our study confirmed the hypothesis that direct or indirect bonding with Fuji Ortho LC@ functions effectively in the daily practice of orthodontics. Our rates of accidental attachment debonding and our rates of bonding survival were acceptable except in Orthos indirect bonding of mandibular teeth. We found that under the conditions of our study direct bonding functioned slightly better than indirect bonding. Practitioners need to know and understand certain parameters influencing the use of resin modified glass-ionomer cement for bonding orthodontic attachments in order to optimize its success notable with regard to the choice of attachments with respect to bonding material or the effect of overbite on retention of attachments. Furthermore, the multiplicity of interfaces and of materials utilized in indirect bonding weakened bond strength under the conditions and protocols of our study.

Today there is near universal agreement that the cephalometric analyses presented by the Americans Ricketts, Steiner, and Tweed need to be re-evaluated and brought up to date. To this end, our C.R.A.N.I.O.M group has prepared a new method for using cephalometric numerical and angular readings in the preparation of a reasonable and well-reasoned aid to diagnosis.

We analyzed the data from a sample of 83 young adults with Class I occlusions, none of whom had ever received orthodontic treatment.

In our work the most striking new consideration that we employed was to use the extreme values for each variable of this sample. These figures constitute extreme parameter limits very distant from each other: for example there is a gap of 30° between the most buccally inclined incisor and the most lingually, or palatally, inclined.

Therefore, we found incisor inclination to be acceptable within a range of 78 to 114° to Downs’s mandibular plane on the lower arch and from 97.5 to 130.1° to the Frankfort plane for the upper arch. So in our reasoning there is far less need to reposition these teeth in conformity to an arbitrary cephalometric norm.

And, for the same reason, we find far fewer cases requiring extraction in order to allow orthodontists to achieve results that satisfy abusive standards established by Ricketts, Steiner, and Tweed. The osseous measurements that we report simply describe the forms we observed, none of which constitute anomalies but, instead, describe a particular type.

The C.R.A.N.I.O.M group believes that cephalometric analysis occupies a place in orthodontic record taking that comes after those occupied by esthetics, periodontal status, and muscular balance.

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.

The surgical treatment of maxillo-mandibular malformations accompanying cases of hyperdivergence should aim at achieving good function for the patient by increasing space available for the tongue to move in and for proper respiration to take place and by reducing the tensions affecting muscles and ligaments either by dis-inserting them or by moving skeletal structures in the direction that muscles attached to them contract. An analysis of the literature shows that by respecting these principles surgeons can obtain good results in the majority of cases even in instances of extreme deficiency of the body of the mandible or where lengthening of the ascending rami is required. For these patients a cooperative effort of the surgeon and the orthodontist becomes even more than ever indispensable. In addition it will be necessary for the treatment team to follow these patients for an extended post-operative period.