Wnt signaling and orthopedics, an overview

Wnt signaling is a ubiquitous system for intercellular communication, with multiple functions during development and in homeostasis of the body. It comprises several ligands, receptors, and inhibitors. Some molecules, such as sclerostin, appear to have bone-specific functions, and can be targeted by potential drugs. Now, ongoing clinical trials are testing these drugs as treatments for osteoporosis. Animal studies have also suggested that these drugs can accelerate fracture healing and implant fixation. This brief overview focuses on currently available information on the effects of manipulations of Wnt signaling on bone healing

Soft tissue management: the key to the success of periodontal treatment

Esthetic demands are consistently on the rise, the treatment of gingival recession through periodontal plastic surgery has become an important treatment in our repertoire. The etiology of recession is well defined: brushing-related trauma and bacterial plaque are the most frequent etiological factors for gingival recession, and they act on bony dehiscence that may be anatomical or acquired. The objectives of these procedures are to increase the width of the keratinized tissues and the volume of the soft tissues. The evolution of orthodontics with the incorporation of microsurgical techniques, which are minimally invasive and do not require incisions, has led to more predictable esthetic results. The tunnel technique thus perfectly fulfills these criteria for success and ease of recovery with no scarring, and the natural appearance of the epithelial transitions

Gestion des tissus mous : clé du succès des thérapeutiques parodontales

La demande esthétique étant en perpétuelle progression, le traitement des récessions gingivales par chirurgie plastique parodontale est devenu une thérapeutique importante de notre activité. L’étiologie de la récession est bien définie : le traumatisme lié au brossage dentaire et la plaque bactérienne sont les facteurs étiologiques les plus fréquents pour les récessions gingivales agissant sur une déhiscence osseuse qui peut être anatomique ou acquise. Les objectifs de ces procédures sont d’augmenter la largeur des tissus kératinisés et le volume des tissus mous. L’évolution vers des techniques microchirurgicales, peu invasives et sans incision de décharge, a permis de tendre vers des résultats esthétiques prédictibles. La technique du tunnel remplit ainsi parfaitement ces critères de succès de recouvrement avec l’absence de cicatrice, le naturel et l’harmonie des transitions

Management of mandibular second premolar agenesis

In Europe, dental agenesis affects 5.45% of the population. Apart from third molars, the mandibular second premolars are most often affected. For each clinical situation, the orthodontist must select the best treatment option to manage the edentulous space. This space can be closed or left open. If the space is to be closed, the goal is to achieve stable and functional occlusal relationships without negative impact on profile. If the space is to be left open, the goal is to create a space suitable for future prosthetic restoration, render the dental axes parallel, and maintain optimal bone volume, especially if the deciduous molar is in infra-occlusion. In this paper we present various treatment options for managing mandibular second premolar agenesis

Gestion des agénésies des 2

En Europe, l’agénésie dentaire affecte 5,45 % de la population. En excluant les 3es molaires, les 2es prémolaires mandibulaires sont le plus souvent affectées. Pour chaque situation clinique, l’orthodontiste doit décider de la meilleure option thérapeutique pour gérer au mieux l’édentement. Cet espace peut être fermé ou maintenu ouvert. Si l’espace doit être fermé, l’objectif est d’obtenir des rapports occlusaux stables et fonctionnels sans répercussion négative sur le profil. Si l’espace doit être maintenu, l’objectif est de créer un espace adapté à la future restauration prothétique, paralléliser les axes dentaires et maintenir un volume osseux optimal, d’autant plus si la molaire temporaire est en infraclusion. Dans cet article nous présentons les différentes options thérapeutiques que l’orthodontiste peut envisager face à une agénésie de 2es prémolaires mandibulaires

Tooth extraction decision model in periodontitis patients

Objective: The purpose of this study was to build, around several types of input data, a decision analysis model for dental extraction strategy in periodontitis patients. Materials and methods: The decision analysis was based on the following scenario: a fictitious adult chronic periodontitis patient with no chief complaint, being referred to make a decision of extraction on one single tooth presenting a periodontal defect that may affect the decision-making process. A decision tree was used to identify the treatment options within the next 5 years. Scientific evidences were based on probabilities given by a literature analysis using a systematic approach. Clinical expertize was based on subjective utilities (SUs) assigned by an experts' panel. Expected utilities (EUs) were used to rank the following options: no treatment (EU1) or periodontal treatment (EU2); extraction followed by a tooth-supported fixed partial denture – FPD – (EU3) or an implant-supported single crown – ISC – (EU4). Results: The robustness analysis calculation indicates that the probability of tooth survival needed to be equal to 0.78 in order that the passive option becomes optimal. However, EU1 was impossible to calculate due to the lack of available probabilities. The EU intervals were 79–96, 86–89 and 94–95 for EU2, EU3 and EU4, respectively. Consequently, the FPD option is dominated by the ISC option, and it is not possible to conclude to a difference between the periodontal and the ISC therapy. Conclusions: Within the limits of this model, tooth extraction followed by FPD is the worst strategy compared with ISC or periodontal therapies