“Occlusion at the center of orthodontics”

Making the jaws fit perfectly is at the heart of orthodontic practice. These so-called occlusion problems are no longer treated as they were a few years ago. Dr. Robert Garcia, Professor of Orthodontics at the University of Paris VII, gives an update on these new practices.

Less Interventional Orthodontics

As noted by Dr. Robert Garcia: "Occlusion is central to orthodontic practice: when a patient is referred to the specialist, it is most often because the teeth mesh is inadequate and the occlusion (positioning And contacts of teeth of the upper arch on those of the lower arch, when the mouth is closed) is defective. "

Orthodontics: the necessary interventions

Problem of teeth, jaw ... what is the origin of these troubles and are they treated in the same way? No, Dr. Garcia answers: "The precise study of occlusion and articulation is fundamental before any treatment. The mandible is first examined before observing the alignment of the teeth. If there is a problem at this level, the use of the articular head as an anchor to move the teeth can be deleterious (displacement of the mandible instead of a dental repositioning!).

Specialists have long acted primarily to restore optimal mechanical action: return the mouth to a reference position, where the teeth maintain special contacts. Today, a better knowledge of the articulation of the jaw has allowed to change practices, now less interventional.

New imaging techniques, including MRI, have helped to better understand articulation. Result: if a bad occlusion is important, it is only one of the parameters of the joint disorders and their consequences (pains, blockages, noises such as clicks, squeaks, crunches during the movements of the mandible). The manducator (which gathers the teeth, the jaw joint and the muscles that activate it) is able to adapt in a number of situations and to withstand minor defects. "Our therapeutic attitude has therefore changed. We have a less mechanical vision and more function-oriented. If it is satisfactory, and even if the occlusion is not perfect, it is not necessary to intervene, "says Dr. Garcia." Similarly, practices have changed. For a long time, in the face of clicks indicating a dislocation of the disc (the bones of the joint rubbing against each other), the habit prevailed of operating to recover and put in place the disc fragment. However, this fragment is most often shredded, non-functional, repositioning does not bring anything. The technique now consists of washing the joint under arthroscopy.

On the other hand as soon as the disorder has an impact on the function it is important to restore a good occlusion. In children, in particular, a functional asymmetry (chewing more than one side) can induce a dysmorphosis: the bone is more stimulated on one side, the growth is more vigorous and ultimately the Face loses its morphological balance. Until adolescence, "catching up" is possible by orthodontic methods (which will slow the growth of certain bones and, on the contrary, activate that of other zones). Beyond that, the use of the surgeon is necessary. "But here again, progress has been made to reduce the constraints for the patients (4/5 days of hospitalization compared to 5 weeks before)" concludes Dr. Garcia.

French Federation of Orthodontics, French Syndicate of Specialists in Dento-Facial Orthopedics

French Federation of Orthodontics Representing all orthodontic thinking in its diversity, the FFO currently comprises 13 scientific societies and the College of University Teachers in Orthodontics

Union of French Specialists in Dento-Facial Orthopedics