New fundamentals of Lingual Technique

Enza RobottiUniversità degli Studi di Cagliari

Italy

Good Morning every one and thank you for being here!

Today I explaining to you the results

of my work in the field of lingual orthodontic

The History

• This discipline originated in Japan in 1967 by Dr Fujita not

for aestheti reasons but for martial arts.

• In California Dr. Craven Kurz devised and tested the first

lingual brackets, but this technique has never really

developed in the USA.

• While in Europe, in Japan and in the Middle East…a

increasing number of orthodontists using this technique

“Comparison of adverse effects between lingual and labial orthodontic tratment. A systematic review. Hu

long; Yang Zhou,.. Angle Orthod. 2013 Nov; 83(6); 1066-73.”

Lingual Orthodontic… what is this technique?

BRACES FITTED BEHIND THE TEETH ARE DESCRIBED AS LINGUAL, FROM THE

LATIN WORD FOR TONGUE. LINGUAL ORTHODONTICS REFERS TO THE USE OF

ORTHODONTIC APPLIANCES PLACED BEHIND THE TEETH AND THEREFORE DO

NOT SHOW AT ALL……In fact…..ESTHETICS IN ONE OF THE MAJOR GOALS IN THE

ORTHODONTIC TREATMENT!!!!

But….Lingual ortodontics is not only aesthetics

New research brings more news. When brackets are fitted behind the teeth instead of the front surface, the damage which can occur as a result of poor brushing during treatment is likely to be less severe, less frequent and less visible........

LINGUAL ORTHODONTICS:……

PROBLEMS AND SOLUTIONS!

Point one: Anatomy of lingual surface

The problem can be…….:

Brackets are attached to very irregular and inconsistent lingual surfaces

behind the teeth

To eliminate any disadvantages to this procedure we can now consider

Digital Tecnologies.

The solution is a digital approach!

“J. Orthod. 2013 Sept.; 40 Suppl 1 : s27 -33. Lingual orthodontic treatment: was is the evidence base?

Auluck A.”

Models made from

impressions are scanned

into a computer.

This information is used to

determine individual

treatment needs

“Today many companies offer a greater choice of

services due to advances in computer technology”.

it is possible to plan, design the appliance and have

it custom made all with the click of a button.

This also has an important impact on treatment mechanics,

that can be divided into two main approaches:

1)includes manufacturing of a custom pad which includes the

prescription of in-out, torque, angulation and rotation for each

bracket.

2) includes the prescription in the customized wire.

Point two: direct or indirect bonding….Which is better?

Bracket positioning technique also has an important impact on

treatment mechanics.

Because of the anatomic limitations of the lingual surface of the teeth it

is usually recommended to use indirect bonding for the Lingual

technique.

“What are the performances of direct vs indirect bonding?

We found that direct and indirect bonding do not differ

significantly……both have benefits and disadvantages.

Orthodontists can choose one or the other based on cost, laboratory time,

chair time, patient acceptance, quality of the finished results, or personal

preference .

Some photos about :

compensation in the brackets

compensation in the wire

“Lingual orthodontics has evolved and how many of the problems

originally associated with the lingual technique have been minimized

thanks to the manufacture of one type of fully customised lingual

appliance”

The benifts are:

Virtually invisible from the outside

Suitable for all age groups

Individually designed and produced for every patient

Flat bracket design for improved patient comfort

No risk of decalcification on the front tooth surface

Art and craft meets lingual technique

“Am J Orthod Dentofacial Orthop. 2014; May; Accidental debonding: buccal vs fully individualized lingual multibracket

appliances. Ziebura, Hohoff, Flieger, Stamm”

Point three: COMPLICATED WIRE BENDING

OR STRAIGHT WIRE TECHNIQUE

mushroom arc wire

techniquestraight wire technique

I use both techniques in my work and……Now I’d like to share whit you

some cases in which I have used a 2D appliance

• The 2D lingual appliance system

I Used the 2D lingual brackets because this system represents a valuable

treatment option for patients seeking a completely invisible orthodontic

appliance. The ease of direct or simplified indirect bonding of 2D lingual brackets

in combination with low friction mechanics makes it possible to achieve a good

functional and aesthetic occlusion, even in the presence of a severe

malocclusion.

The use of a self-ligating bracket significantly reduces chair-side time for both

the patient and the orthodontist, and the low-profile bracket design greatly

improves patient comfort

I decided to use a method that was:

• Simple

• Inexpensive

• Speedy

• Some interesting case!

In the first case the problem was:

The patient was soon to be married and

required a prompt treatment!!!!

Patient one

Brackets was very comfortable for the patients, and it

was easy for me to manage since the brackets was

small, but not too small. Each bracket had a hook,

which is flat and nonirritating to the tongue.

“Once patients are aware that there is an

adaptation phase this provides reassurance

during the period immediately after the

appliances have been fitted”.

Than the treatment…she was happy

Case Report 2

IN THE SECOND CASE ... THE MOST SIMPLE ….

THE PATIENT WANTED TO SOLVE A PROBLEM BEAUTY….

Second case

SOCIAL 6

This is an invisible treatment, which

necessitates no patient collaboration

and limited chair-side time; patient comfort is

favored due to the use of

small brackets attached only to incisors and

canines and, in a small

number of cases, the first premolars!...Also

know as SOCIAL 6!

Case Report 2

Third case

The third case .was introduced to me by my colleague, who is a periodontist.

We decided to extract one incisor in order to resolve periodontal deseases and then

I re-aligned the teeth to resolve the cross problems..

The results were:

• A GOOD OCCLUSION

• A GOOD ARCH FORM

I strongly believe in the future of this technique!

However, in order to continue developing lingual orthodontics we need

to enhance medical competence in the following areas:

1)MANAGEMENT,

2)TEAM BUILDING,

3)PROFESSIONALISM,

4)INTERPERSONAL COMMUNICATION,

5)TECHNOLOGY,

6)TEACHING, AND

7)ACCOUNTABILITY.

CONCLUSIONS

“I wanted to give a broad view of Lingual Orthodontic

concepts and treatment in a simplified way, to

encourage the orthodontist to use this important

treatment modality, regularly, in their practice”

The success of a good treatment depends on several factors, such as:

Identifying the patients individual needs

A good relationship and trust between orthodontist and the patient.

I really think that our goal should be to provide all our patients with an

exceptional lingual orthodontic experience

OUR GOAL

Please feel free to contact me if you

have any questions or doubts!

gullenza@libero.it

www.studiorobotti.it