Traitements très précoces, précoces ou bien expectative armée ? Réflexion à partir du suivi d'un cas de classe III avec excès vertical

FAURE, Jacques
March 2013
Orthodontie Française;2013, Vol. 84 Issue 1, p71
Academic Journal
The debate concerning the optimal timing for beginning treatment of maxillo-facial dysmorphia is far from over. The possible choices are very early treatment in the primary dentition, early treatment only during a period of time when the mixed dentition is stable or waiting until complete adult dentition is present, at the end of, or close to the end of, the growth period. Opting for early treatment is problematic because it is difficult to make a very early diagnosis (and sometimes impossible to make when there are no strong developmental signs for dysmorphia present), long-term prognosis can always be inaccurate, patients may not yet be psychologically mature enough, there is insufficient anchorage available, ultimately a two-stage treatment is required and hence a longer process, the feeling that this is "experimental therapy", that, in case of failure, leads to disappointment and a loss of confidence. Opting for later treatment reassures both orthodontist and patient; however, these delayed treatments might represent a lost opportunity for some patients who must a priori undergo more extractions and additional surgical procedures. The presentation of a case of hyperdivergent class III occlusion, where the orthodontist hesitates to treat at various stages of growth, and finally ends up performing a late surgical treatment, illustrates quite well the problem we face in choosing a timeframe for treatment.


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