Lingual Appliance Research Articles

Dentoskeletal and soft tissue changes associated with miniscrew anchorage in customized lingual orthodontics.

ObjectivesThe goal of this study was to analyze skeletal, dental, and soft tissue changes of patients treated with customized lingual systems and to evaluate the clinical effectiveness of miniscrew anchorage.MethodsNine upper first premolar extraction patients who were treated with customized lingual appliances were included in this study. Miniscrews were used for reinforcement of molar anchorage. Cephalometric films and study models were obtained before treatment (T1), after alignment (T2), and after treatment (T3). Treatment effects were analyzed by cephalometric radiographs and study models.ResultsThe upper anterior teeth were retracted significantly at T2 and T3 (4.41 ± 4.14 mm and 5.51 ± 2.48 mm, respectively). During space closure, the upper first molars showed slight mesial movement (1.50 ± 1.97 mm). The intercanine width of the upper arch increased at T2 (1.59 ± 1.81 mm), but decreased at T3 (0.11 ± 1.00 mm). The sella-nasion-A, A-nasion-B, and mandibular plane angles were not significantly changed at T3. The upper lip showed continuous retraction at both T2 and T3 (1.40 ± 1.46 mm and 2.32 ± 2.48 mm, respectively).ConclusionsBy using miniscrew anchorage for lingual orthodontics, patients’ dental and soft tissue changes considerably improved and molar anchorage was reinforced.

Clinical efficiency with lingual orthodontics – It takes a team

With customized lingual appliances, we are able to predictably treat practically any type of case. Although providing lingual orthodontics is a fantastic service to offer, it can be challenging to implement in an already busy practice. This article covers strategies and logistics of integrating lingual treatment into your practice. Scheduling properly, excellent team training, case selection, appropriate delegation, and having realistic expectations are all part of the formula for success. Knowing the limitations of lingual treatment, especially in your hands, and understanding the unique potential side effects that can occur with lingual treatment is also important. Although lingual appliances can be tricky at first, having an enthusiastic and dedicated team that is willing to learn makes the transition into lingual braces much smoother. From making sure your team gets the best lingual training and an abundance of hands-on experience, to starting with less complicated cases to learn how to manage clinical time, this article highlights key tips and tricks on how to adequately incorporate the new techniques of lingual braces.

Lingual orthodontics: Understanding the issues is the key to success with lingual mechanics

Clear aligners disrupted the orthodontic marketplace almost twenty years ago.1 The result of this disruption has been a significant increase in the demand for adult esthetic orthodontic treatment.2,3 Today, we are in the midst of another disruption in orthodontics; direct to patient orthodontic care. Direct to patient care is a result of the evolution of digital orthodontics, which has led to the development of custom orthodontic appliances. Besides the disruption of the orthodontic marketplace, custom appliances also offer an opportunity to add value to the care that we offer our patients through the development of appliances systems that are superior in esthetics and in certain circumstances offer biomechanical advantages4 In this paper, we will present issues related successful lingual mechanics, one of the custom appliance opportunities available to us that add value to the care we offer our patients. We will consider the problem associated with lingual mechanics and the solutions offered by custom lingual appliance systems.

Appreciating the art of custom surgical orthodontic care

Orthodontics has changed a lot since its humble beginnings. Today orthodontics is not considered a luxury, but more likely 1Diplomate, American Board of orthodontics. Assistant Professor of Surgery University of Illinois Craniofacial Center.a proactive attempt to create better oral health through improving facial harmony and esthetics. Occlusion and functional issues such as mastication, breathing, speech, and self esteem are now issues that patients understand and want to improve. Educational mechanisms such as the internet combined with a multidisciplinary team approach drive patients to ask for very specific treatment objectives. However, there is a huge disparity in the variety of treatment mechanisms that a patient may utilize. The choices presented to the patient are often limited not by what the patient wants, but rather to mechanics that the doctor uses daily. It is not reasonable to think that an adult will want to have mechanics similar to what a growing 12 year old uses. Older patients desire to hide their orthodontic mechanics, and thus the need for a more cosmetic solutions was born. Isn't it ironic that the most advanced and accurate custom orthodontic appliance happens to be on the lingual of the teeth?! This article will discuss and review how the Incognito appliance system may be used to prepare cases for orthognathic surgery. The benefits to this system are numerous. It's effectiveness at setting cases up for orthognathic surgery is real. Multiple multidisciplinary cases will be demonstrated with issues in transverse, sagittal, and vertical planes. Cases will be shown from treatment planning through retention. Historically, lingual orthodontics has been perceived as a challenging concept to master. The Incognito appliance system is uniquely different compared to labial mechanics as the arch wire is a ribbon arch and as such it displays torque moves much more effectively when it is planned and deployed. Properly utilized, the Incognito appliance system can be the difference when teeth need to be decompensated for surgery. It's strength is delivering an accurate, predictable tooth position while achieving esthetic excellence. Regardless of the dimension(s) to correct (transverse, vertical or antero-posterior dimension) via a combination of comprehensive orthodontics and orthognathic surgery, lingual appliances simply represent the best option when a patient demands esthetic appliances to correct their malocclusion.

Biomechanics in lingual orthodontics: What the future holds

The field of orthodontics faced a few fundamental pivots since 1800. Edward Angle introduced a systematic approach to treating patients in 1899. Between 1920 and 2000, development of new orthodontic appliances as well as improvements in orthodontics education reshaped orthodontics. Digital technology has changed how orthodontists treat malocclusions in the last two decades. Specifically, advances in digital orthodontics introduced a paradigm shift in lingual orthodontics attracting more orthodontists especially recently graduated practitioners to offer lingual appliances. This review aimed to point out some of important biomechanical factors in lingual orthodontics and to delineate commonalities and contrasts of these factors in clear aligners and labial systems. Highlights of two work in-progress lingual systems were also discussed. One can reason that better understanding of the advantages and challenges associated with lingual systems especially in comparison to clear aligners and labial systems is essential to creating a fully customized orthodontic experience for patients.

Corticotomy-assisted orthodontic camouflage in a class III adult patient with a severe transverse discrepancy

A 25-year-old man presented with a maxillary transverse discrepancy, posterior cross bite, anterior open bite, molar and canine class III. Treatment included a corticotomy in the upper lateral and posterior teeth, a palatal expansor and a sectional archwire to assist the expansion. The following treatment phase included bonding with Incognito System lingual appliance, interproximal reduction to solve the crowding and bite blocks to control the verticality. Two months after the bonding intermaxillary class III elastics were used to solve the sagittal discrepancy and eight months after the bonding vertical elastics were used in order to solve the anterior open bite until the end of the treatment. A Boston splint was applied for the upper arch, an essix splint was applied for the lower arch. The patient compliance was an essential aspect in the success of the orthodontic treatment.

Completely-customized lingual orthodontics to correct class II malocclusion in adolescents

Completely-customized lingual orthodontics is an efficient, predictable and esthetic solution for our patients. Adolescents showing a class II malocclusion represent the majority of patients in orthodontic practices. Several modes of treatment are available to correct this sagittal discrepancy such as inter-maxillary elastics, flexible or rigid protrusion devices, maxillary distalization using mini-screws or symmetric and asymmetric extractions. The choice depends on several decision criteria such as the severity of the malocclusion, the symmetry of the class II discrepancy as well as the age and the motivation of the patient. In this article, the authors will describe the current therapeutical strategies to correct a class II malocclusion in adolescents with a completely-customized lingual appliance. It is as easy to correct a significant class II malocclusion with a lingual technique as it is with vestibular techniques, completely-customized lingual orthodontics providing the advantage of facilitating treatments.

Lingual orthodontics – clinical applications and patient information

The demand for adult orthodontic treatment is an ever-increasing trend that has driven the development of aesthetic orthodontic systems. Lingual orthodontic appliances provide the ultimate in aesthetics and their use has grown with the development of the appliances. The clinical application of different lingual appliances is described and evidence-based patient information is provided. CPD/Clinical Relevance: Increasing demand for aesthetic orthodontic systems means that lingual appliances are, and are likely to become, more popular in the future. A broad knowledge of their clinical application and useful evidence-based information to give to patients is invaluable for all dental practitioners.

Digital Dynamic 3D Monitoring of Lower Incisors Intrusion in Lingual Orthodontics.

Objective:The aim of the present study is to propose a 3-dimensional evaluation of lower intrusion obtained with lingual orthodontics considering not only the crowns but also dental roots.Methods:9 adult patients underwent fixed lingual orthodontic treatment with i-TTя lingual brackets system for the correction of crowding in the lower arch associated with a deep overbite. Initial records, consisting of photos, CBCTs and intraoral scans were collected. Threshold segmentation of the CBCT was performed to generate a three-dimensional virtual model of each the teeth of the lower arch, superimposed with the crown of the same teeth obtained by intraoral scan models to generate a complete set of digital composite lower arch The same procedure was performed to monitor one key step of the i-TTЯ technique consisting in lower incisors intrusion (T2). T1-T2 three-dimensional superimposition and color displacement maps were generated to measure and evaluate the movements obtained at the lower arch.Results:The root displacement of the incisors during their intrusion in the early stage was totally “bone-safe” in the 88.9% (8 of 9) of the cases observed. No significant extrusion of the premolars used as anchorage unit was measured.Conclusion:This method has proved to be an accurate and reliable approach to dynamically visualize the 3-dimensional positions of the teeth, including their roots, with no additional radiation for in-progress treatment monitoring. The 3-dimensional evaluation showed that the employed lingual appliance allowed to obtain significant lower incisors intrusion with negligible undesired extrusion of premolars employed as anchorage teeth.

Congenitally absent maxillary lateral incisors. A case report illustrating the use of a Mesialslider and a customised lingual appliance

Abstract Background A young adolescent female, aged 17 years and one month, presented seeking orthodontic treatment to address the congenital absence of her maxillary lateral incisors. Aims The therapeutic aims were to provide an adequate aesthetic and functional occlusion, coupled with sound adjunctive periodontal tissue relationships and a favourable long-term prognosis. Methods The malocclusion was managed by customised lingual orthodontic appliances and the adjunctive use of direct skeletal anchorage derived from two palatal mini-implants. Results The treatment objectives of good aesthetics, a functional occlusion, normal function, a healthy periodontium and a balanced profile were readily achieved. The retention records demonstrate the stability of the correction. The treatment duration was approximately 41 months, which encompassed the use of full fixed customised lingual appliances over a period of 24 months.

A regularity changes occlusal plane inclination in the case of treatment of distocclusion by fixed individual lingual appliance

To assess the direction of rotation and the degree of change in inclination of the occlusal plane in cases with distocclusion. The study included 56 patients, of which 44 were female and 12 were male, with distal occlusion of the dentition and deep overbite. We studied the position of the occlusal plane, relative to the geometric center of the Ramus - point Xi in two groups of patients: 50% with occlusal Biteplanes and 50% without occlusal Biteplanes in the upper canine's brackets. In both groups, the position of the occlusal plane, relative to the point Xi, has improved: in the first - by 1.2 mm, the second - by 2.4 mm. The comparison of the dataset shows automatical improving of position of the occlusal plane in both groups. The most pronounced changes, detected in the treatment with lingual braces, shows Biteplane group.

Scope of practice and supervision of orthodontic therapists in the United Kingdom: Part 2: a national cross-sectional survey of orthodontic therapists

Orthodontic therapists (OTs) are the most recent addition to the orthodontic clinical team. The General Dental Council (GDC) and the British Orthodontic Society have formulated guidance and guidelines relating to their scope of practice and level of supervision, however there has been no contemporary UK-based research investigating practice and supervision of OTs. The aim of this study was to investigate the scope of practice and level of supervision of OTs working in the UK. Ethical approval was received from the University of Manchester Research Ethics Committee. An anonymous postal questionnaire was dispatched using postal details acquired through the British Orthodontic Societies mailing list. Three mailings of the questionnaire were conducted. A 74% response rate was achieved. OTs routinely conducted 16 of the 20 procedures from their scope of practice. Uncommon procedures included fitting headgear (24%), lingual appliances (27%), inserting or removing temporary anchorage devices (20%), and taking facebow record (18%). A total of 62% of OTs took patient consent for treatment. 59% were supervised through a written prescription with no direct supervision. OTs were directly supervised for only a quarter of their clinical practice. Orthodontists viewing frequency for OTs varied significantly, and was found to be the following: every 2-4 visits (36%), every other visit (35%), and every visit (26%). OTs mostly carried out the scope of practice as permitted by the GDC. Procedures uncommon to routine orthodontic practice were also uncommon to Orthodontic therapist clinical practice. OTs work mostly through written prescription with no direct supervision.

Construction and assessment of a three-dimensional finite element model of mandibualr second molar mesialization using customized lingual appliance and mini-implant

Objective: To construct a three-dimensional (3D) finite element model and analyze the biomechanical characteristics during mandibular second molar mesialization using customized lingual appliances and mini-implant. Methods: One adult student volunteer from The First Affiliated Hospital of Zhengzhou University with lower left first molar extraction was selected. After CT scanning, Mimics, Geomagic, ANSYS were employed to develop a 3D finite element model including customized lingual brackets, stainless steel lingual arch wire, buccal buckles, lower dentition, periodontal ligaments and alveolar bone. Four different loading methods (1. the force of 1.470 N loaded at the lingual side only; 2, 3, 4. the forces of 0.490, 0.735 and 0.980 N loaded at both buccal and lingual sides, respectively.) were included. The initial displacements of the lower second molar and stress distribution in the periodontal ligaments were analyzed. Results: More uniform stress distributions in the periodontal membrane of mandibular left second molar were found when the mesial force were loaded at both buccal and lingual sides than the force loaded at lingual side only. More inclination of the second molar was observed when force loaded at both sides than at lingual side only. With the values of the force increased, the mesial inclination potential of the second molar, the initial movement of the second molar and the stress distribution in the periodontal membrane increased. Under the force of 0.735 N at both buccal and lingual sides, mesially inclined initial displacements of the mandibuar second molar were observed and the stress values of von Mises was in the suitable area. Conclusions: Less second molar rotation was found when the force loaded at both buccal and lingual sides than loaded at lingual side only. However, force loaded at both sides would increase the measial inclination potential of the second molar.

Are there more adverse effects with lingual orthodontics?

Data sourcesPubMed, Embase, Cochrane Library and LILACS database, review of references cited in included articles and a manual search of leading orthodontic journals. No language restrictions were imposed in the search. Study authors were contacted when necessary.Study selectionRandomised controlled trials (RCTs) and controlled clinical trials (CCTs) in healthy patients that directly compared the adverse effects following treatment using buccal and lingual appliances. Studies involving single arch or dual arch appliances were considered. Studies on patients with systemic diseases, animal studies and in vitro studies were excluded. The primary outcomes of interest to the authors were a list of adverse effects: pain, caries, eating and speech difficulties and oral hygiene.Data extraction and synthesisTwo authors reviewed the titles and abstracts of all studies identified through the search without blinding to names of authors or publication dates. Selected articles from searches were evaluated independently by two authors against established inclusion criteria, disagreements were resolved by consensus or by consulting a third author. Two authors independently assessed the risk of bias using the Cochrane Collaboration's tool (randomised trials) and the Newcastle-Ottawa Scale for non-randomised studies. The level of agreement between the authors was assessed using the Cohen kappa statistic. A meta-analysis was performed to provide pooled effect estimate (expressed as odds ratio) as well as 95% confidence interval. The outcomes of interest were pain, caries, eating difficulties, speech difficulties and deficient oral hygiene. Heterogeneity was quantified using I2 statistic and potential causes explored. Publication bias was assessed using a funnel plot.ResultsEight articles were included; three RCTs and five CCTs. One RCT was considered to be at high risk of bias, one moderate risk and one low risk. Of the non-randomised studies, four were low risk and one was high risk of bias. Six studies involving a total of 131 patients were included in a meta-analysis. The lingual appliance was associated with significant pain in the tongue (OR=28.32, 95% CI 8.6-93.28), difficulty in maintaining oral hygiene (OR=3.49, 95%CI 1.02-11.95) and greater speech difficulty (OR = 9.39, 95% CI 3.78-23.33) compared to buccal appliances. On the other hand, patients with lingual appliances had decreased pain in the lips and cheeks. There was no difference between the two appliances with regards to caries risk.ConclusionsLimited available evidence indicates that lingual orthodontic appliances are associated with increased pain in the tongue, speech difficulties and difficulty in maintaining oral hygiene.

Are there differences in treatment effects between labial and lingual fixed orthodontic appliances? A systematic review and meta-analysis

BackgroundAn evaluation is made of possible differences in treatment effects between labial and lingual fixed appliances.MethodsA comprehensive search was made of the PubMed-Medline, Cochrane Library and LILACS databases, with an additional manual search covering the period up until April 2017. There were no restrictions in terms of year of publication or language. Agreement between the authors was quantified by the Cohen kappa statistic. A random-effect model was applied to calculate weighted mean differences with 95% confidence intervals.ResultsA total of 249 patients corresponding to four eligible studies were included in the systematic review. Among the six angles and distances entered in the meta-analysis, a tendency was observed in lingual appliances to increase the interincisal angle (95% CI −0.80-8.99; p = 0.101) and reduce the angle between the major axis of upper central incisor and the sellar-nasion plane - though statistical significance was not reached (95% CI −5.75-0.32; p = 0.079).ConclusionThe results obtained indicate that treatment with lingual appliances favors incisor tipping by exerting lingual crown torque, but there are no differences in cephalometric values between labial and lingual fixed appliances. Because of the small number of included studies, the results of this meta-analysis should be interpreted with caution. Future research should focus on the generation of a consensus document allowing selection of the type of orthodontic approach not only conditioned to the esthetic requirements of the patient but also considering the characteristics of the malocclusion. On the other hand, standardized international guidelines are lacking; the measurements of angles and distances therefore have to be unified with a view to future investigations.

Single tooth torque correction in the lower frontal area by a completely customized lingual appliance

BackgroundAim of this study was to analyze the efficacy and precision of the completely customized lingual appliance (CCLA) regarding the single tooth torque correction. The study also examined external apical root resorptions as possible side effects of torque correction and the changings of the periodontal situation.MethodsA case series of three patients were included. The patients showed a single tooth torque problem with a gingival recession and were treated with the CCLA. Plaster casts before and after treatment and plaster casts of the set up were scanned and superimposed. Deviations between the two plaster casts were analyzed at different points of interest. Changes of the gingival recession were compared before and after treatment. Relative root resorptions were measured by the orthopantomograms. Treatment times were assessed by the records of the patients. Results were presented descriptively.ResultsThe mean change of the most apical part of the root reached by the orthodontic treatment was 1.8 ± 0.3 mm. The largest deviation between set up and final model was measured on the occlusal surface of the tooth 36 with 0.8 mm. Most measurement points showed a deviation of 0.5 mm or less. The depths of the gingival recession showed a significant reduction of 4.7 mm. The widths of the gingival recession were reduced by 1.1 mm. The average relative root resorption of the corrected teeth was 2.7 ± 1.5%. The average treatment time was 13.8 ± 4.5 months.ConclusionsThis is the first study showing that the CCLA with its high precision is very effective in correcting single tooth torque problems. Orthodontic torque correction resulted in a significant reduction of gingival recessions and caused only negligible root resorptions.

Adult orthodontics in the Republic of Ireland: specialist orthodontists' opinions.

To report the opinions of specialist orthodontists regarding the profile, characteristics and treatment of adults currently undergoing orthodontic treatment in the Republic of Ireland (ROI) Design/setting: A national cross-sectional questionnaire study in the ROI. A pilot-tested questionnaire was distributed to 122 specialist orthodontists in the ROI. Questions addressed general and treatment information for current adult orthodontic patients. Those whose treatment involved orthognathic surgery were not excluded. A response of 83% was obtained. Ninety-five per cent of specialists reported treating adults, most of whom were self-referred and were typically professional, female and aged 25-35 years. The overall ratio quoted of professionals to non-professionals was almost 3:2. For 50% of specialists, males were estimated to account for 20-40% of their adult cases and for 23%, this increased to an estimated 40-60%. Class II division 1 malocclusion and skeletal II were considered the most common dentofacial characteristics. Occlusal features encountered in decreasing frequency were generalised crowding, increased overjet, deep overbite, late lower incisor crowding, spacing and impacted teeth. Fifteen per cent reported that at least 10% of their adult cases required orthodontics with maxillofacial surgery but 8% reported that this was at least 50%. Treatment challenges commonly acknowledged were overbite reduction, anchorage management, 'black triangles' and overjet reduction. Tooth whitening was reckoned to be used by 19% of specialists. Aesthetic upper and stainless steel lower brackets were indicated to be used most often whereas only 19% used clear aligners and 10% used lingual appliances often. The profile and characteristics of adults currently undergoing orthodontic treatment in the ROI were diverse. Higher estimates were quoted for self- than for general dental practitioner-referral. A high percentage of treatment was reported to be undertaken for non-professionals and males. A wide range of treatment and varying use of appliance types were cited.

Gummy Smile Correction Using Lingual Orthodontics and Augmented Corticotomy in Extremely Thin Alveolar Housing.

Tooth movement out of anatomic limitations was assisted by augmented corticotomy using deproteinized bovine bone mineral. Lip protrusion can be reduced by premolar extraction followed by retraction of the anterior teeth. Surgical intervention is appropriate when the alveolar bone housing of the anterior region is insufficient for the tooth movement. In this patient, corticotomy in upper palatal area and anterior segmented osteotomy in the mandible were performed. Anatomic limitation to the retraction was expanded by xenograft. An antero-posterior lingual appliance was used to bodily retract the upper anterior teeth. The gummy smile was resolved by intrusion of upper entire arch using 2 mid-palatal temporary skeletal anchorage devices. New bone formation was observed on palatal side of upper anterior teeth. The teeth were moved into augmented area without fenestration or vitality loss. Lip protrusion was resolved, and the gummy smile was effectively improved. Orthodontic tooth movement beyond the limitation of the alveolar bone housing can be achieved with surgical assistance, which can be performed under local anesthesia. Without orthognathic surgery, the gummy smile can be reduced using an antero-posterior lingual retractor with mid-palatal skeletal anchorage.

Invisible orthodontics: clear aligners and customized lingual appliances

In recent years, invisible orthodontics has been one of the concerns of both orthodontists and patients. As two types of invisible orthodontics, clear aligners fit for cases that have high demand for living quality, need distalization of molars or intrusion of incisors, suffer from severe periodontitis, or that have non-abundant time for visits. While customized lingual appliances fit for cases that have high demand for aesthetics, have deep overbite or complex malocclusion, need maxillary expansion or retraction of incisors, or that have low compliance and good economic conditions. Based on aspects of clinical application, this article presents the characteristics of these two types of invisible orthodontics, in order to provide reference for individualized options according to different situations.

Orthodontic Metallic Lingual Brackets: The Dark Side of the Moon of Bond Failures?

Lingual orthodontics, among both young and adult patients, increased in popularity during last years. The purposes of the present investigation were to evaluate the shear bond strength (SBS) values and Adhesive Remnant Index (ARI) scores of different lingual brackets compared with a vestibular control bracket. One hundred bovine teeth were extracted and embedded in resin blocks. Four different lingual brackets (Idea, Leone; STB, Ormco; TTR, RMO; 2D, Forestadent) and a vestibular control bracket (Victory, 3M) were bonded to the bovine enamel surfaces and subsequently shear tested to failure utilizing a Universal Testing Machine. SBS values were measured. A microscopic evaluation was performed to obtain ARI scores. Statistical analysis was performed at a statistically significant level of p < 0.05 to determine significant differences in SBS values and ARI Scores. No statistically significant variations in SBS were reported among the different groups. Conversely, significant differences were shown in ARI scores among the various groups. Clinical relevance of the present study is that orthodontists can expect similar resistance to debonding forces from lingual appliances as with vestibular brackets.