Thème Deauville Lieu Programme scientifique Informations Hébergement Programme social Inscription

 

 

 

Location : Hôtel le Normandy

14h30

15h30

Pre-congress : Face driven treatment : multidisciplinary approach and new technologies for a better esthetic result

Renato Cocconi

 
 

I think that the Face represents today the best chance for the Orthodontist to be recognized by the Colleagues and by the Patients as a Specialist.
The common misunderstanding is : to achieve an esthetic outcome it is necessary to align teeth and create a broad Smile. This stereotype encourages the confusion of messages created by Companies or Low Cost Franchises that identify the success of treatment with a specific appliance and not with a proper treatment.

When the Orthodontic Specialist defines a Face driven treatment He/She needs to consider 3 levels of interventions:

  1. How to position the Framework of hard Tissues (Jaws and Teeth) within the contest of 2 very important components of the Face . The Nose Lip Unit (NLU) and the Lip Chin Unit (LCU).
  2. Morphology of hard tissues
  3. Enhancement of Soft Tissues


The aim of a Face Driven Treatment is to imitate what is attractive in Nature and the criteria of Success is when the imitation is so effective that nobody can recognize that is a result of treatment.

Sometimes an interdisciplinary treatment is necessary and might involves the Surgeon, the Restorative Dentist, the Periodontist or other component of the Interdisciplinary team.

Interdisciplinary treatment requires a strict Hierarchy of decisions (Who does What and When).
Digital Technology is an incredible help to properly plan and visualize our end result.

In the PreCourse I will explain how we use digital technology to execute proper sequencing of multidisciplinary intervention, digital set up, TADs guided position, guided bonding, Mini Invasive Restorative Procedure, Surgical Interventions.

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16h00

17h00

Pre-congress : Face driven treatment : multidisciplinary approach and new technologies for a better esthetic result

Renato Cocconi

 
 

I think that the Face represents today the best chance for the Orthodontist to be recognized by the Colleagues and by the Patients as a Specialist.
The common misunderstanding is : to achieve an esthetic outcome it is necessary to align teeth and create a broad Smile. This stereotype encourages the confusion of messages created by Companies or Low Cost Franchises that identify the success of treatment with a specific appliance and not with a proper treatment.

When the Orthodontic Specialist defines a Face driven treatment He/She needs to consider 3 levels of interventions:

  1. How to position the Framework of hard Tissues (Jaws and Teeth) within the contest of 2 very important components of the Face . The Nose Lip Unit (NLU) and the Lip Chin Unit (LCU).
  2. Morphology of hard tissues
  3. Enhancement of Soft Tissues


The aim of a Face Driven Treatment is to imitate what is attractive in Nature and the criteria of Success is when the imitation is so effective that nobody can recognize that is a result of treatment.

Sometimes an interdisciplinary treatment is necessary and might involves the Surgeon, the Restorative Dentist, the Periodontist or other component of the Interdisciplinary team.

Interdisciplinary treatment requires a strict Hierarchy of decisions (Who does What and When).
Digital Technology is an incredible help to properly plan and visualize our end result.

In the PreCourse I will explain how we use digital technology to execute proper sequencing of multidisciplinary intervention, digital set up, TADs guided position, guided bonding, Mini Invasive Restorative Procedure, Surgical Interventions.

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Location : Casino de Deauville

08h30

08h45

congress opening

08h45

09h05

Once upon a time the CEO

Jean Pierre Ortial

 

 

In 1966 Roger O’Meyer organized the EPGET course with well-known instructors like Carriere, Halden, Hixon, Miotti, Ruff, Steiner…

One year after, in 1967 the participants at this course created the Collège Européen d’Orthodontie in a spirit of exchange on the state of the art in orthodontics at this moment.

It was the beginning of orthodontics and the CEO already worked to define best quality clinical standards. In this sprit, the college membership was and is related to orthodontic studies, leading into the orthodontic specialization (EPGET, post graduation specialization in orthodontics)

The particularity of this study group in a brotherhood and friendship spirit is unique in the CEO, and continues since its’ creation particularly due to the different boards and leaders of this scientific society.

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09h05

09h30

Orthopedic and orthodontic prognosis of open bite pattern

Laure Frapier

 

 

During growth the orthopedic prognosis is related to the age, the potential and growth direction but also to the dysfunctional and periodontal pattern. When all conditions are favorable, some orthopedic actions are valid. In some less favorable cases, second bicuspids, molar intrusion and early functional genioplasty present orthopedic advantages. Likewise when the growth is over the orthodontic treatment needs occlusal and functional balance to avoid a relapse. When the functional and esthetic limits are exceeded a compromise is unacceptable et must leave the place to the orthognatic surgery. In any case we need to keep in mind that the therapeutic stability is very difficult to obtain without lips competency and nasal breathing.

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09h30

09h55

Vertical dimension and OSAHS from prevention to ortho-surgical treatment

Boris Petelle

 

 

Vertical anterior excess associated to open bite pattern is frequently associated to OSAHS. This skeletal predisposition is responsible to a setback of the genioglossus muscle, the main elevator of the pharynx, and to a decrease of the volume of the oral cavity.

On children, during the facial growth a functional etiology can be involved, due to a nasal or a tonsils obstacle. An OSAHS detection is mandatory and can necessitate a nasal correction or at the tonsils level, or potentially at the skeletal level by orthodontic devices.

For the adult patients, the vertical excess due to a disharmonic growth and responsible to OSAHS can necessitate an ortho-surgical treatment. This protocol must take into account to the apnea disease but also to the skeletal pattern necessary to the treatment stability.

For all these reasons in front of vertical excess, the research of clinical signs like frequent snoring, or anomalies of the sleep quality are indispensible and can help to detect the OSAHS, to prevent it or treat with adapted solutions.

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09h55

10h20

Interest of the orthodontic Bone Stretching for the correction of an anterior open bite related to ankylozed teeth

Laurent Delsol

 

Ankylozed teeth following a trauma is a quite frequent phenomena and presents severe consequences particularly for children and growing adolescents. The damage and disappearance of the periodontal ligament is linked to a partial or complete fusion of the dental root with the alveolar bone with a stop of the eruption and a bone underdevelopment as consequences.

The infra occlusion linked to ankylozed teeth during the growth leads to many functional and esthetics troubles. Many treatments, more or less iatrogenic, are described in the literature for the repositioning of ankylozed teeth to recover esthetic and function.

These therapies need a repositioning of the whole dento-alveolar complex. Recently a new technique named Orthodontic Bone stretching (OBS) raised to replace ankylozed teeth associating a deep corticotomy and an immediate orthodontic traction.

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10h20

10h45

Invisalign technique use in anterior open bite correction: a real treatment option

Aldo Giancotti

 

 

Anterior open bite is considered a malocclusion that still defies correction, especially in terms of diagnosis, biomechanics and stability. The literature reports numerous studies on the subject but with controversial and conflicting information. Disagreement revolves around the definition of open bite, its etiological factors and available treatments. It is probably due to a lack of consensus over the aetiology of anterior open bite that a wide range of treatments has emerged. The use of clear aligners has expanded the available options of treatment in cases of open-bite. Even though aligners was initially developed to correct mild-to-moderate crowding, to close natural or pathologic spaces, and to produce dental tipping. After years of experience with the Invisalign technique, orthodontists have reported its successful use in more complex cases, such as those involving extractions, open bites, and Class II malocclusions. The aim of the lecture is to show how to successfully treat open-bite cases by using clear aligners alone or in combination with auxiliary devices.

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10h45

11h30

Break

 

11h30

11h55

Vertical deficiency treated with customized lingual technique

Magali Mujagic

 

In our daily practice several types of vertical deficiency can be observed: skeletal deep bite with a cephalometric evaluation modulated by the facial esthetic, but also dento-alveolar evaluation: overbite, increase of the curve of Spee, extrusion of mandibular incisors and/or of maxillary incisors, teeth positioning in the smile and the “pink” esthetic (tooth/gum line).

This lack of vertical dimension can be the only malocclusion in the patient, or can be combined with sagittal dimension troubles (class II or III) or transversal.

With this lecture, clinical signs of the lack of vertical dimension will be detailed, and illustrated by clinical cases different therapeutic strategies will be developed on adults and adolescents patients.

To conclude the approach with lingual technique will be evaluated.

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11h55

12h20

Bi-maxillary surgery advantages for class II short face correction

Dominique Deffrennes

 

When a patient presents an Angle class II with retrognathic mandible, the correction needs often an orthodontic treatment and a maxillo-facial surgery with mandible advancement associated sometimes with a genioplasty. Nevertheless this treatment can sometimes be disliked by the patient on the esthetic point of view. An heavy sensation of the lower third of the face is noticed by the patient. The long-term evolution revealed a skeletal class III evolution.

The advantage of the bi-maxillary surgery is esthetic but mostly functional for a better result. The patient get a better smile and a thinner face in the transverse dimension. Anyway the patient don’t suffer any more of “heavy face”.

Which rules must be applied for a satisfactory result?

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12h20

12h45

Vertical dimension in the frontal plane: TADs versus surgery

Camille Melki / Emmanuel Frèrejouand

 

The cant of the occlusion plane in the frontal view are responsible of TMJ dysfunctions and affect significantly the esthetic perception of the smile by patients and orthodontists.

Traditionally treated by a Lefort I osteotomy with an asymmetrical impaction of the maxilla, some of these malocclusions can be treated with orthodontics with the help of skeletal anchorage.

The aim of this lecture is to focus trough clinical cases on the indications of these different protocols treatments by examination of the diagnosis and etiology of these asymmetries, the associated malocclusions and the treatment objective that arise out, the age of the patient and finally the possible orthodontic mechanics.

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12h45

13h10

Mandibular condyle hyperplasia: a diagnosis and an original clinical picture

Guillaume Lecocq / Gonzague Deffrennes

 

 

The condyle hyperplasia is a well know desease: the evolution is linked to an anarchic proliferation of pre-chondroblastic cells at the condyle level. Nevertheless the etiology his not clear even if some trauma or hormonal etiologies are evoked. The condyle hyperplasia creates skeletal asymmetries and aveolar compensations sometimes very important. These posterior vertical troubles lead to many difficulties for the treatment.

  • What are the limits of conventional orthodontics?
  • Is the care always ortho-surgical?
  • What is the benefit of condylectomy to reduce the pathology and associated malocclusions?
  • When to treat?
  • Which solutions for malocclusions in adults patients?

We will illustrate different solutions with some clinical solutions

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13h10

13h25

O’Meyer Price

Aurélie Sellier

We will illustrate different solutions with some clinical solutions

 

 

The normalization of the oro-facial functions represents an important part in the success and the stability of our treatments. However the parents are not so well informed on the behavior and actions to acquire to facilitate and harmonious facial growth. The aim of this work were to evaluate with a questionnaire the parents knowledge on this topic followed by the realization of an informative booklet on buccal and dental health fo the children aged between 0 to 6 yo.

The analyze of the 340 answers shows that in despite of the parents real interest, important gaps remain concerning each oro-facial function; particularly concerning the breathing function, its impact on growth and the pathological character of the oral breathing are particularly unknown.

The booklet dissemination to many parents would raise awareness very early on the bucco-dental health of young children.

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Location : Casino de Deauville

08h30

08h55

Skeletal anchorage : New therapeutic perspectives for the vertical dimension control

François Darqué / Skander Ellouze

 

 

Effectiveness of open bite treatments with skeletal anchorage (TADs) seems undeniable in comparison to conventional orthodontics.

Indeed the reasoned association between fixed appliance and TAD sis the only system allowing to control the maxillary and mandibular occlusal plane.

We will develop the indications and biomechanic protocols adapted to clinical situations of dental and skeletal open cases.

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8h55

09h20

Lingual orthodontics and open bite treatments

Catherine Galletti

 

 

Whatever the technique, open bite cases are well known to be difficult to treat and stabilize.

Indeed there are multiples etiologic factors and an unfavorable functional environment is often associated.

The diagnosis once gain will be essential. It will orientate the therapeutic choice and will raise decision criteria.

Complete individualized lingual orthodontics presents some interesting mechanical particularities interesting to notice. This will be explained in this communication with clinical cases illustration.

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09h20

09h45

Open bite and second bicuspids extractions: 20 years after!

Patricia Obach Dejean

 

 

The vertical dimension is particularly important because it’s often a worsening factor in our orthodontic therapeutic. When the vertical dimension is increased and associated to a severe class II that we need to treat, different protocols can be proposed taking into account the tridimensional anomalies (sagittal, vertical and transversal) which are closely linked; the associated functional troubles must be also controlled.

In this lecture we will develop a treatment protocol for skeletal open bite patients, set up during the nineties, advocating the seconds maxillary and mandibular bicuspids.

20 years later, what happened to them?

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09h45

10h10

Gingival recession and orthodontics: the right technique at the right time

Jacques Malet

 

 

Gingival recession treatments in orthodontics are based on the periodontal risk evaluation. Anamnesis and clinical evaluation permit to collect decision elements to decide if a preventive surgery or a correction is necessary. Do we have to do this surgery before or after the orthodontic treatment? What is the results pre-visualization in relation of the initial situation particularly in open bite cases where the symphysis and the bone support are thin? The contemporary micro-surgery techniques allow to have today treatments more predictable and less invasive with an optimal esthetic integration.

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10h10

10h35

The vertical positioning of the smile

Claude Garcia / Pierre Olivi

 

 

Orthodontists and surgeons work together to offer a bright smile to our patients. The vertical dimension determine the facial pattern and we differentiate long faces, short faces and balanced faces. The gum exposition is too big in long faces. The smile is poor, masked in short faces.

With a posterior rotation growth, the surgeon will do an anterior rotation of the face with a maxilla impaction.

With an anterior rotation growth, the surgeon will do a posterior rotation of the face. The use of bone grafts is often necessary to lower the maxilla and reveals the smile.

This vertical positioning of the smile is our daily challenge, we need to take it

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10h35

11h20

Congress 2018 presentation, General assembly and election

 

11h20

12h00

Break

 

12h00

12h45

Surgical treatment of Open Bite Malocclusions

Renato Cocconi

 

 

Surgical Treatment of Skeletal Open Bites is one of the most challenging Treatment for the Ortho- Surgical Team.
Literature review is somehow discouraging for 2 reasons:

  1. Instability of results: in most instances a 30-40% of Skeletal relapse and a 10-20% of Open Bite relapse is reported.
  2. A Poor description of the Orthodontic and Surgical Method used in the studies to treat the Patients make very difficult to draw proper comparison and conclusions.

Knowing that some skeletal relapse might occur Hayes brings out a key point :

…since open-bite correction might relapse in a clinical significant manner … ” the patient’s expected improvements in facial proportions, post surgery, might be the better prime mover for proposed treatment rather than open bite correction…

The name of the game is:

  1. Overbite overcorrection
  2. Face Driven Surgery

Concerning the Orthodontic and Surgical Methodology all the procedural steps must be critically analyzed to resolve weak points and Instability factors in the different stages of treatment:

  • PreTx. Phase (Growth, TMJ stability)
  • PreSurgical Phase (transverse diameter, Wilson Curve, Upper Dual Plane of Occlusion, Bkts Positioning)
  • Surgical Phase (Bimax. Surgery, Occlusal Plane Rotation, Mandible first procedure, Passive rigid Fixation)
  • Post Surgical Phase (Skeletal Anchorages, Overbite overcorrection, II Upper molars management)

Retention

The lecturer will provide clinical protocols and guidelines to achieve the best possible results.

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12h45

13h05

Vertical dimension, open bite, postural and functional etiologies: detect and re-educate : The reality on the ground

Isabelle Breton

 

 

Concerning an initial treatment, or the prevention of an orthodontic or surgical treatment relapse, the authors will present their physiotherapy approach: detection, treatment, problems.

Anterior open bite have several etiologies, but one of the most common is the functional origin. The oro-facial muscles contribute to the skeletal base and the dental arch development. Tongue dysfunction with wrong posture and deglutition, an oral breathing, late sucking habits, are factors leading to malocclusions. Troubles of the cervical-cephalic posture are also often a consequence of a functional trouble and play a key role.

In young children most of open bite due to dysfunction are corrected spontaneously after elimination of functional troubles or sucking habits. An early detection is a priority.

For adults patients the relapse prevention is a complex procedure requiring correction of praxis and postures. The recovering of free airways, the patient behavior and motivation are essentials for the treatment success. A bad management of these factors will lead to failures or relapse.

The correction of these malocclusions needs a multidisciplinary approach centered on the patient, actor of his healing

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13h05

13h30

Vertical index: numbers on Björk rotations

André Horn

 

 

The vertical Index is a ratio between posterior height (PFH) and anterior heigh (AFH) of the maxilla-mandibular space. AFH is the orthogonal distance from Menton point to palatal plane. PFH is the Ar-Go segment in millimeters. Before treatment this index suggests an idea of the mandibular rotation. The variations are often more sensitive than the FMA angle (Total rotation, matrix and intra-matrix rotation described by Björk)

When FHI increases, it means than ramus growth is faster than anterior vertical growth (positive rotation). The tendency is the closure of the horizontal planes (deep bite)

When FHI decreases the rotation is negative, the anterior growth is faster than ramus growth, the tendency is open bite pattern. If FHI is between 60 to 80%, the vertical dimension can be orthodontically controlled. Beyond these limits surgery must be proposed (open bite or deep bite).

Prognosis interest: During the growth for a same value of FMA, if FHI increases the tendency is anterior growth the prognosis is good. On the contrary if FHI decreases the tendency is posterior rotation and the prognosis is less favorable.

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Location : Casino de Deauville

09h00

09h25

Vertical dimension deficiency: what redress to correct the severe malocclusion on adult patients

Bruno Grollemund

 

 

Time and oral hygiene neglect can worsen a pre-existing malocclusion. For adult patients presenting a severe loss of the vertical dimension, there is an occlusion degradation with TMJ and periodontal troubles. The bad position of the incisors, particularly visible in this kind of malocclusion, reinforces the patient demands looking for a new smile. The deficiency of the vertical dimension the breakage of the occlusal plane and the occlusal lock of maxillary incisors compromise a prosthetic rehabilitation. For patients where a compromise is impossible, a multidisciplinary approach is mandatory to avoid an ineluctable occlusion degradation. The orthognathic surgery, the help of skeletal anchorage, new techniques of bonding in prosthetics are pushing the boundaries of the treatments limits and improve long term prognosis.

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09h25

09h50

Lowering first « on-the-spot » of the maxilla to correct severe deep bite: Technical and esthetic advantages

Emmanuel Racy

 

 

The management of severe deep bite faces with skeletal class I, II or III necessitate in the majority of the cases a bi-maxilla surgery to increase the vertical dimension.

The bi-maxilla surgery needs an offset in time mobilization of the maxilla and the mandible. For more than 20 years the maxilla surgery was generally performed first followed by the mandible repositioning, but since few years numerous surgical teams have proposed with success the mandibular surgery first allowing the maxilla repositioning (whose fixation and positioning is more difficult) on a mandible arch with an ideal position.

The lowering fisrt “on-the-spot” of the maxilla in selected cases, the interest of a surgery first of the maxilla thanks to a minimal vertical mobilization of the maxilla, permits a very stable increase of the vertical dimension due the persistence of posterior bone contacts.

This technique is particularly adapted to ethnic faces which can’t stand an important advancement because of an important modification of the nose unacceptable on the esthetic point of view.

This technique needs a perfect orthodontic preparation with some key points:

  • The maxillary midline must the be reference
  • The maxillary occlusal plane in the frontal plane must be perfectly horizontal
  • A labial torque of the maxillary incisors must be applied before the surgery to anticipate the clockwise rotation of the maxilla during the lowering “on-the-spot”

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09h50

10h15

Easily open or close the bite with only 2 mini-screws

Pascal Baron

 

 

The control of the vertical direction is now easily facilitated by the use of screwed anchorages. The skeletal plates historically were presented first and allow spectacular corrections. However, miniscrews are less invasive and are more easily generalizable. Two miniscrews, used in a reasoned way, allow to treat most of cases with vertical anomalies using a simple and reproducible biomechanical control. Clinical examples highlight our therapeutic approach.

KEY WORDS: Miniscrews, mini-implant, Temporary Anchorage Device (TAD), fixed appliance, vertical dimension

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10h15

10h45

Vertical dimension and function: ups and downs debates

Antonin Hennequin / Charly Kohaut

 

 

Review of the literature: Among the studies looking for correlations between arch form and dysfunctions, frontal asymmetries are recognized as etiologic factor, and in the sagittal plane retrognathic position of the mandible is also mentioned. We will explain what’s going on with the vertical dimension trough the literature, and in a second part we will detail the use of occlusal pads, widely used during treatment, showing the indications the shape and the positions of this pads.

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10h35

11h20

Break

 

11h20

11h45

Relationships between the obstructive characteristic of palatal tonsils and vertical measurements

Joseph Diouf

 

 

Introduction: the role of the palatal tonsils in skeletal troubles of the vertical dimension is well described in the literature but is still controversial. The literature data on the link between tonsils hypertrophy and these troubles are subjective. The aim of this study was to search a link between hypertrophic palatal tonsils and skeletal troubles of the vertical dimension.

Material and methods: this transversal study was realized with children aged between § to 12 yo. The subjects are divided in two groups (A and B) in relation with the obstructive character of the palatal tonsils. On each children, cephalometric measurements were performed. The data were analyzed with the SPSS 20.0 software. A t test for independent sample was realized to compare the quantitative variables with the obstructive character of the tonsils. The results were significant for a p value of 0.005.

Results: The group B patients were more hyperdivergent with posterior rotation of the mandible and an increase of the lower third vertical dimension

Conclusion : An early evaluation of the children with palatal tonsils hypertrophy would allow to prevent the unsightly effects on the vertical dimension of the facial skeletal structures. So late treatments more complex and no so efficient as early treatments could be avoided.

Keywords: palatal tonsils, oropharynx, cephalometry, vertical dimension

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11h45

12h10

palatal tonsils, oropharynx, cephalometry, vertical dimension

Eric Solyom

 

 

In orthodontics open bite is defined as an excessive obliquity between occlusal plane and mandibular in relation to the Sn line or the Frankfort plane.

Beyond the cephalometric definition, open bite is present in various clinical situations where skeletal modifications responsible of the open bite are particularly revealed by the Delaire analysis.

The maxillo-mandibular dysmorphia associated with an open bite can be corrected surgically in stable way but the bone structures responsible or the malocclusion must be treated (with the help of the Delaire analysis) and taking particularly in to account to the functional components especially muscular of this surgery

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12h10

12h35

Application of preformed bone apposition by microporous titanium implants for increasing the posterior vertical dimension

Jean-Baptiste Charrier

 

 

The microporous titanium customized implants are a modern technique to increase the bone volume. Their cosmetic application is increasing. One particular indication of this prosthetics is to increase the vertical posterior dimension, particularly in case of lack of projection of the mandibular angles.

The practical modalities and the main indications concerning these techniques will be developed and clinical cases presented.

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12h35

13h00

Management of open bite malocclusions relapse

Elvire Le Norcy

 

 

Open bite malocclusions are frequent. They could be from alveolar basal or mixed etiology. Their etiology is often functional, but can be increased by skeletal open bite pattern. The open bite treatment by a functional therapy on children followed by an orthodontic treatment on adolescence is well described as welle as ortho-surgery treatment of skeletal open bite on adluts. However very often in despite final occlusion quality, open bite tends to relapse progressively. We will try to understand the mechanisms and the ways in which we can limit this relapse.

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