Lingual / orthodontic courses by Indian dental academy

Dr. Varun Grover INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.com

IntroductionIntroduction

Goals of orthodontic treatment

Desire for esthetics during treatment

Lingual orthodontics

End of treatment


Search for absolute estheticsSearch for absolute esthetics

Advancement in orthodontics

Pinching of the bands Direct bonding (Miura – 1971) Plastic and ceramic brackets Lingual brackets



Bands on all teeth



Metallic display



Ceramic brackets – relatively esthetic



Lingual brackets



Good fortune of orthodontist

Reduced costLower arch – judge the progress Reduced demands on the practitioner


Historic perspectiveHistoric perspective John Farrar – lingual removable arch (1889)

Mershon – LRA with finger springs

Owen Oliver – Labiolingual app

Crozat app


Historic perspectiveHistoric perspective

Nance button TPA – Robert Goshgarian Lingual arch - Wilson

Note – supplement labial orthodontics


LO – As a complete systemLO – As a complete system

Vision of 2 key innovators

Craven Kurz – USA

Kinya Fujita – Japan Kanagawa uni.

1970s



Fujita system -1971 Advantages

Lip injuryLip relation RetentionLittle anchorage loss

Brackets placed close to the functional line for forcesto pass through C res.



Fujita system -1971 Disadvantages

AJO 1979 – LO with Mushroom shaped archwires

Longer durationSpeech difficultiesInitial discomfortOral hygiene



Key features – Fujita system Slots facing occlusally

Easy insertion and removal Prevents deformation



Grooves for insertion of lockpins

Auxilliary grooves

Mesiodistally

Occlusogingivally



Multiple slots – Less publicized Ant. And Pm bracket – 3 slots

Molar bracket – 5 slots

OcclusalLingualvertical

1 occlusal 2 lingual2 vertical

Tandem wire mechanics



Do lingual appliances hampers speech???

Sample – 1 patient

Class I crowding All 4s extraction

Pronunciation of vowels Real time third octave analyzer



A and O – no effect



I, E, U – disturbed on 1st and 4th day

Normal by 6th day

S, T, R and L – affected Consonants were not

studied


Craven kurzCraven kurz

Ormco 1976 – introduced lingual app Slots facing palatally Worked as a part of LTF (1990)

Scholz Gorman Kelly AlexanderSmith ArtunGreekmore



1976 – 1st generation of lingual brackets

1990 – 7th generation

Larger profileCrude prescription

Low profileRefined prescriptionMx bite plane – heart shaped, smaller hooksInc width of Pm bracketsVariety of molar brackets



Slot size – 018 Greatest innovation

Shearing forces

Addition of bite plane

Compressive forces


Lingual bracketsLingual brackets

Mx anterior brackets

Built in bite planePropping open the biteAdv in deep bite cases



Mand anterior brackets

Ball hook extends away from the tissueEase in maintaining oral hygiene



Bicuspid brackets - wider

Better rotational and tip controlMore uniform interbracket widthBall hooks – shortened and flattened



Molar brackets – variety Twin bracket recommended when both 1st and 2nd molars are

bonded Twin bracket with auxiliary tube



Hinge cap

Latest Ideal attachment for terminal toothHinge cap tool



Terminal tube

Used initiallyCrown height is less


Lingual instrumentsLingual instruments

Lingual utility plier Ligature cutter Curved mosquito hemostat Small distal end cutter Lingual bracket remover Hinge cap opening tool


Lingual Begg bracketsLingual Begg brackets

Fujita and Craven kurz

Stephen Paige – 1982 Begg appliance suits well to LO

Edgewise slot



Vertical slot facing occlusally

Use of round arch wires

No built in tip and torque TP – (256 – 500) labial Begg bracket



Anatomic considerations

Interbracket distance – precise measurement of the arch wires

Difficult to position the bracket



Low profile lingual Begg bracket

Plastic buttons on labial surfaces – assist lingual app

Difficult to close the open bite



Lockpins – softer and thinner (014)

Seated – using a two hand instrument Wire tucker

Weingart plier


Lingual Begg mechanicsLingual Begg mechanics

Low angle cases – favorable md rotation High angle cases

Smith (1986 )- HPHGCash and Blackwood (1991) – JJJenner (1995) – Post bite plane Convenient surface for mastication Prevents molar extrusion



Lingual archforms – Mushroom shaped Key hole shaped Bicuspid offset Molar offset Anchor bends Distal ends Elastics



Stage 1 archwires No crowding - 016ss

Addition of vertical loops Smaller diameter archwires

Niti or Cu Niti wires Elastics – stiffer wires



Stage II archwires – 018, 020 Stage III archwires – 020 Torquing auxiliaries Uprighting springs



Lingual root torque for upper incisors



Labial root torque of upper lateral incisors

Lingual root torque of the canines



Uprighting springs Stage III – Mesiodistal root movement Braking mechanics – stage II 010 mini springs


Conceal systemConceal system

Thomas Creekmore (AJODO 1989) Unitek, Monrovia, California Advantages

Facial tooth surfaces are not damagedFacial gingival tissues healthThe position of the teeth can be precisely seenDrape of the lips – not distortedinvisible



An acceptable LOA must include following key elements

Align Apparatus to position the brackets precisely



Accurate indirect bonding system Preformed arches Specifically designed pliers Torquing keys



Slots opens occlusally

The first 1mm of the molar tube opens to the occlusal aspect

Direct guidance for insertion

Easier to insert stiffer archwires Eliminates the need of double over

ties



Design of Pm and molar bracket

Occlusal tie wings projecting mesially and distallyMesial and distal undercuts II base of the slotChanges the direction of ligature pull – 90



Conceal brackets are designed around the Unitwin bracket

Centered slot conceptSingle bracket without tie wings Centre of a 0.045 inch twin bracketMaximum interbracket distance for optimum tip and torqueTwin tie wings – rotational control



Each conceal bracket has 3 different slot widths



Tip control in an occlusally inserting system is analogous to rotational control in labial system

Rotational control – length of the lever arm – 0.100 inch

Slot width – 0.100 inch Excellent control in the tipping plane



The width of the slot for rotation – 0.070 inch

Analogous to tip control in the labial system

Torque control is same for both the systems

Width of the slot for torque – 0.035 inch



Play Maximum arch wire size


Conceal system – slot machineConceal system – slot machine

Lingual surfaces – irregular Labiolingual thickness Slot machine Holds the lingual bracket by its slot, which is oriented

to the labial surface of each tooth for- Torque, tip, rotation, height and labiolingual thickness Bracket is bonded on the model – gap is filled Customized base


Patient selectionPatient selection

Adults Missing teeth Complex restorative needs Periodontal problems


Patient selectionPatient selection Possible speech difficulty – 2 to 4 wks

Absolute need for perfect speech

Tongue irritation

Opening up of the spaces

Oral hygiene considerations

Initial weight loss www.indiandentalacademy.com


Deep bite cases are ideal for LO Short clinical crown height – relative CI Initial practitioners

Non XnDeep biteMild crowdingUpper palatal lower labial appLow anchorage demandsUnilateral Xn cases



Deep bite Vs

Brachycephalic Euryprosopic Bite plane effect Favorable Md rotation

Open bite

Dolichocephic Leptoprosopic Difficult cases Cross elatics



Biomechanical differences

For normally inclined or proclined upper incisors, intrusive forces for lingual app are closer to Cres



For retroclined anteriors

Advancing loops in initial archwires



Effects of vertical extrusive forces Labial appliance – extrusion

Lingual app – incisors are inclined more than 20 º to the occlusal plane

Labial root torque



Effects in antero-posterior relation Lingual appliances

Vertical openingMd rotationInduce Class II tendency

Vertical bowing effectwww.indiandentalacademy.com


Contraindications

Short clinical crowns Unresolved periodontal problems Mutilated posterior occlusion High angle cases Severe class II discrepancy with acute TMJ problems



Effects in transverse dimension

LA – expansive nature coupled by posterior disclusion

Mesiobuccal molar rotation – space closure

Transverse bowing effect


Bracket placementBracket placement

Indirect bonding Why not direct bonding???

Customized resin beneath the brackets

AccessIrregular lingual surfaceVariation in lingual tooth morphology


Bracket placementBracket placement

Methods of bonding

TARG – Torque Angulation Reference Guide CLASS – Custom Lingual Appliance Set up Service Fillion LIBS Slot machine Hiro system Ray set system


Bracket placement - CLASSBracket placement - CLASS

Scott huge Ideal set up is created

Brackets placed

All planes of space considered

Custom bracket baseswww.indiandentalacademy.com


Brackets transferred to the original cast

Another indirect bonding tray is fabricated

Ideal set up – patients motivation


Bracket placement - CLASS Bracket placement - CLASS

Steps

Precise impressions Wax bite Articulate the casts Fill the prescription Immobilization of the teeth is a must



Prescription form



Ideal set up

Teeth act as reference

2nd molars and single incisor in each arch

Class I canine and molarEstablish adequate tipTorqueEliminate rotationsTight contacts



Filling the prescription



Transfer trays Sectioning of the trays

Preference – Vinyl



OverbiteIdealIncreasedDecreased

OverjetIdealIncreasedDecreased

Lower occlusal planeFlatMaintainDeep

Arch widthMaintainWidenConstrict


Bracket placement - TARGBracket placement - TARG

Dev by Ormco, 1984

Bracket placed with respect to horizontal reference plane

Labial reference gauge to orient the bracket

The orientation allows preprogramming


Bracket placement - TARGBracket placement - TARG

Advantages Accurate and quantified 2 dimensional system Accurate positioning of bracket without cutting the

tooth and placing it in wax

Disadvantages Labiolingual thickness – not considered


Bracket placement - BESTBracket placement - BEST

Bonding with Equalized Specific Thickness

Fillion, 1987

Overcomes the disadvantage of TARG A caliper is added

Direct working on the malocclusion cast


Bracket placement – Bracket placement – Hiro systemHiro system

Modified CLASS techniqueIntroduced by HIROImproved by Takemoto and Scuzzo


Clinical bondingClinical bonding

Lingual side of the arch

Moisture contaminationCalculus depositionPre bonding scaling

Use of antisailogougesProbanthine – 15 mg 45 min prior to bonding



If it is desirable to bond one arch Mandibular arch Special considerations

Porcelain restorationPresence of aluminium – HF acidComposite bondable surfaceGold crownsLarge amalgam fillings



Bonding materials

2 part sealant – Maxi cure

Filled paste – EXCEL, Reliance orthodontic product

Light cure adhesives

Bracket side – tooth side adhesive



Steps Isolation Etching 10 min before bonding, apply conditioner on exposed

adhesive material on bracket base Mix the bonding material Place the trays


Thank you

For more details please visit www.indiandentalacademy.com


Lingual / orthodontic courses by Indian dental academy

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Transcript of Lingual / orthodontic courses by Indian dental academy