Friday 1 June 2007
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Orthodontics and/or dentofacial Orthopedics are an donto-stomatological discipline which from virtual became real thanks to the effects of the directives from Brussels in 1978, directives which unified both their teaching and their practice throughout the European Union.
For a time the discipline endeavoured to define itself through its semantics by proposing "orthodontie", "orthodontosie" dentaire, "orthodontopédie" "orthomorphie", "orthodontologie", but Izard already underlined in 1950 that "although it is the accepted way of saying, the term orthodontics is incomplete, because etymologically, it only means straight tooth. In fact, orthodonties must be supplemented by orthognathy, aiming at correcting the maxillary deformations and consequently facial deformations. Associating orthodontics and orthognathy constitutes maxillofacial dental orthopedics". More recently the Commission of terminology of the French Society of Dentofacial Orthopedics suggested "orthognathodontics" or "orthodontognathy" to take into account the evolution of the dis¬cipline, while pointing out that this terminology is not aiming at being perennial, the Commission wishing its constant updating to take into account the dynamism of the discipline.
Considering its evolution within the last fifty years one can say that the latter was exceptional. Bled white after the Second World War, the whole of Europe emerging from that mishap was compelled to face shortages in ail fields. Orthodonties for its part, had to look after the anomalies of the numerous children who presented themselves at the consulting room, the war and its deprivations having certainly lead to a reduction of the carious phenomena, but on the other hand presented an increase in dentomaxillary dysmorphoses due to suffering deprivations.
The European general orientation of orthodontic therapeutics of the time was mainly centered on expansion, with the appearance of an extraordinary array of expansion screws of ail kinds. The intel¬lectual honesty of the practitioners quickly made them aware that this approach was destined to almost total relapse, therefore to therapeutic failure, consequently they turned their attention towards fixed appliances, expecting results that could not be attained in the removable approach. Thanks to the proposai of Lucien de Coster, in the early 1920s, of "Orthodonties based on stainless steel", being deprived of any access to the American techniques, the Tacail technique flourished using the intra¬maxillary traction generated by arches and the intermaxillary traction induced by rubber bands. It was a step which, thanks to steel, avoided calling upon precious metals, which for a long time, had limited the spreading of fixed orthodonties, due to their high cost. But once again the limits of those appliances became obvious rather quickly and other solutions were sought after.
It became clear for the majority of the European orthodontists that the only right answer consisted in calling upon the multiband techniques developed by the American schools. And it was the "rush towards the West". France was certainly the country where this process was most justified. Some of its practitioners thus went to Canada or the U.S.A. for training and then came back to practise and teach those techniques to their colleagues staying in their home country Others still, taking advantage of the presence of the American troops on the European soil got in touch with the orthodontists who looked after the children of the families of their forces to getting acquainted with those tech¬niques. However the problem of supply remained both for the armamentarium as for the supply of rings and various "brackets", but thanks to understanding and to dynamic American suppliera of orthodontic material solutions were quickly found.
The following stage consisted, with the assistance of the latter, in having some American colleagues coming to France to provide their homologues interested in that branch more and more structured courses. As a result the French University associated in the process managed to take over. The fixed techniques blossomed in turn, often bringing a cliquishness which inevitably would not find its source in a scientific approach. The fact remains that the orthodontist thus found at his disposai a wide array of techniques often differing only in details relative to attachments which had also evolved to take into account all the curves and torques which had previously to be introduced into the arches requiring enormous time and skill. Twin-Arch, Edgewise, Light-Wire, Bioprogressive Therapy, Straight-Wire, Segmented Arch Technique, Begg Technique, Tip-Edge, Preajusted Appliance Systems, Jasper Jumper, etc. were meant to capture the interest of the practitioners. Metallurgical research joined in turn by offering increasingly sophisticated orthodontic wire regarding its properties.
But the American-European relations born from those steps led to some orthodontic acculturation and the techniques known as functional practised by some European orthodontists aroused the interest of their American colleagues and thus a two time orthodontics was born, with an orthopedic time in the youth followed by an orthodontic time in adolescence. The American Journal of Orthodontics thus became The American Journal of Orthodontics and Dentofacial Orthopedics. But there still, it was necessary to raise the question to know whether such a step was rewarding or if it did nothing but lengthen the duration of treatment. It seems that the assessment is far from being as favourable as one could hope for. Another innovation on the other hand provided a considerable improvement in orthodontic treatment plans. In fact implants by offering unhoped-for anchorages diminished the needs for extra-oral anchorages hardly appreciated by the younger patients and completely rejected by the adults.
One can wonder which improvements could still be brought to this discipline. genetic research having opened new ways of progress which one cannot determine yet. In any case the young practitioners can be grateful to all their eiders who due to their constant efforts of improvement in their discipline brought them an intellectual comfort for which they can only be deeply gratefuL