Lingual Orthodontic Treatment Research Articles

Lingual orthodontic treatment of a bidentoalveolar protrusion case with multi-slotted brackets and preformed straight archwires

A 23-year-old female patient with lip protrusion and crowding received lingual orthodontic treatment with multi-slotted brackets and preformed straight archwires. After 5months of alignment and leveling, anterior retraction was performed for 21months. Final detailing took five months. The appliances were removed 31months after the start of treatment. With these multi-slotted lingual brackets, treatment progressed in the simplest and most effective way and board-standard finishes were achieved. Furthermore, the use of preformed lingual straight archwires (PLSWs) allowed much more convenient treatment application.

Lingual orthodontic treatment with mini-implant-aided distalization of maxillary and mandibular dentitions

Lingual orthodontic treatment with mini-implant-aided distalization of maxillary and mandibular dentitions

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.

Lingual orthodontic treatment: A YouTube™ video analysis.

The aim of this study was to examine the quality of information offered for patients seeking information on lingual orthodontic treatment. YouTube™ was searched for videos about lingual orthodontic treatment using the key word "lingual braces" from the Google Trends application. One hundred and four videos were selected to be analyzed from the first 120 results. The video content was evaluated using a 10-point score, which was used for classifying low- and high-content video groups. The video information and quality index (VIQI) was applied to determine the quality of the videos. The Mann-Whitney U-test, Chi-square test, and logistic regression analysis were used, and the Pearson correlation coefficient was calculated for statistical evaluations. We classified 32 videos as high-content and 72 as low-content. Most videos were uploaded by laypeople (58.7%, n = 61). Definition of lingual braces and psychological impact were the most commonly discussed topics (51.0%), followed by speech performance (47.1%), pain (44.2%), tongue soreness (37.5%), and biomechanics (14.4%). Compared to the low-content group, the high-content video group had a significantly higher mean number of views (19,867.41 vs 6720.08, P = .002) and more "likes" (135.88 vs 13.01, P < .001), "dislikes" (4.34 vs 0.81, P < .001), and "comments" (26.28 vs 5.31, P = .002). There was no difference in the total VIQI score between the groups ( P = .009). The content of YouTube™ videos for lingual orthodontics was generally incomplete. Most videos mentioned psychological effects, but few videos discussed the biomechanics or procedure. Orthodontists should be aware of the information available on YouTube™.

Patient's expectations of lingual orthodontic treatment: a qualitative study.

To investigate patients' expectations of lingual orthodontic treatment. In-depth interviews were conducted. A framework analysis was carried out to identify themes, concepts and a typology. Two secondary care hospital departments and four primary care orthodontic practices, UK. Fifteen new orthodontic patients aged 16-60 years participated in the interviews. All interviews were transcribed verbatim and analysed using framework analysis, including identification of themes within the responses, and typologies of respondents. Patients seeking lingual orthodontics reported expectations that were similar in quality but different in extent to those seeking labial orthodontics. These patients were well informed about lingual orthodontic treatment before they decide to start treatment. Two typologies were identified. Firstly, males less than 30 years of age, undergoing changes in their lives, who were confident that they wanted a hidden brace, but were not entirely sure of the specifics of the system. Secondly, females aged 30-45, who request a hidden brace and had actively researched what particular systems were available. This study shows that patients requesting lingual orthodontics have expectations that are similar in quality but greater in extent when compared to those seeking labial orthodontics.

Influence of ligation method on friction resistance of lingual brackets with different second-order angulations: an in vitro study.

ABSTRACTObjective: To evaluate stainless steel archwire static friction in active and passive self-ligating lingual and conventional brackets with second-order angulations. Methods: Two conventional lingual brackets for canines (STb light/Ormco; PSWb/Tecnident), and two self-ligating brackets, one active (In-Ovation L/GAC) and the other passive (3D/ Forestadent), were evaluated. A stainless steel archwire was used at 0°, 3° and 5° angulations. Metal ligatures, conventional elastic ligatures, and low friction elastic ligatures were also tested. A universal testing machine applied friction between brackets and wires, simulating sliding mechanics, to produce 2-mm sliding at 3 mm/minute speed. Results: Two-way analysis of variance demonstrated a significant effect of the interaction between brackets and angulations (p < 0.001). Tukey test indicated that the highest frictional resistance values were observed at 5° angulation for In-Ovation L, PSWb bracket with non conventional ligature, and STb bracket with metal ligature. As for 3D, PSWb with conventional or metal ligatures, and STb brackets with non conventional ligature, showed significantly lower static frictional resistance with 0° angulation. At 0° angulation, STb brackets with metal ties, In-Ovation L brackets and 3D brackets had the lowest frictional resistance. Conclusions: As the angulation increased from 0° to 3°, static friction resistance increased. When angulation increased from 3° to 5°, static friction resistance increased or remained the same. Self-ligating 3D and In-Ovation L brackets, as well as conventional STb brackets, seem to be the best option when sliding mechanics is used to perform lingual orthodontic treatment.

Short- and Medium-Term Effects of Low-Level Laser Therapy on Periodontal Status in Lingual Orthodontic Patients.

The purpose of this study was to evaluate the short- and medium-term effects of low-level laser therapy (LLLT) applied in repeated doses in adults with a healthy periodontium treated by lingual orthodontic appliances. Plaque accumulation, in combination with difficulty in removing it in lingual orthodontic patients, can cause gingival inflammation. Twelve orthodontic patients scheduled for fixed lingual orthodontic treatment were selected. Clinical measurements [visible plaque index (VPI), bleeding on probing (BOP), and probing depth (PD), and collection of gingival crevicular fluid (GCF)], which was used to measure the levels of interleukin-1beta (IL-1β) and tumor necrosis factor alpha (TNF-α), was performed before bonding the lingual device, and at the short-term (1, 2, 3 months) and medium-term (12 months) follow-up appointments. For each patient, quadrant 1 or 2 was randomly chosen for irradiation by a diode laser (λ = 670 nm, 190 mW, 6.05 W/cm(2), 60 sec/ tooth) (Laser Group) and the contralateral quadrant was used as the Control Group. In both studied groups, a slight worsening of the periodontal condition was observed, which was evident at the 3rd month follow-up and which was mainly at the lingual side in the Control Group. The levels of IL-1β in the GCF were significantly increased in the Control Group compared with the Laser Group at the 2nd and 3rd months after bonding. At the 12th month follow-up, an improvement of the inflammation was observed in both groups in the study. LLLT showed short-term effects by preventing a substantial increase in IL-1β levels. At medium-term follow-up, LLLT diminished VPI, BOP, and PD scores.

Clinical outcomes of lingual orthodontic treatment: a systematic review.

To assess the available evidence on the effectiveness of lingual orthodontic treatment and related clinical parameters through a systematic review of relevant studies. Eligible clinical studies published from January 2000 to March 2015 were identified through electronic (five major databases) and hand searches. Risk of bias was assessed using the Cochrane risk of bias tool for prospective studies and a specially designed tool for retrospective studies. From the 3734 articles identified by the search, after application of specific inclusion and exclusion criteria, 16 papers were included in the study. Eleven studies were retrospective, four were prospective, and only one was a RCT. In detail, six studies evaluated differences of the treatment outcome from the pre-treatment set-up prediction, two studies evaluated the effect of treatment on periodontal and microbial parameters, and 10 studies assessed various clinical treatment related parameters. Despite several promising findings, the quality of evidence supporting them was found to be low in most cases. This systematic review showed encouraging results on the clinical outcome of lingual orthodontic treatment, especially in regards to the achievement of individualized treatment goals and the reduction of decalcifications on the bonded surfaces of the teeth. However, additional well-designed prospective clinical trials with larger samples are needed to confirm those findings. Several aspects of lingual orthodontic treatment were difficult to be conclusively evaluated due to the study design, the heterogeneity, the small samples sizes, and the high risk of bias seen in the majority of the included studies.

Devised lingual trainer tray in consideration for lingual orthodontic treatment.

Devised lingual trainer tray in consideration for lingual orthodontic treatment.

Various Applications of Mid-palatal Absolute Anchorage System Using a Safe, Multifunctional and Solid Screw in Lingual Orthodontic Treatment

Various Applications of Mid-palatal Absolute Anchorage System Using a Safe, Multifunctional and Solid Screw in Lingual Orthodontic Treatment

Lingual orthodontic treatment: what is the current evidence base?

Lingual orthodontic treatment: what is the current evidence base?

Speech and discomfort during lingual orthodontic treatment

The increased use of lingual appliances has meant a continued evolution in the design of lingual brackets. These changes in appliance and bracket design have tended to focus on reducing bracket thickness, with the aim of making appliances more comfortable. A thinner bracket design appears to have had some positive effects on the quality of speech, as well as comfort whilst appliances are in place. However, despite these improvements, some patients do struggle with their speech during treatment, far more than others. It is important therefore, when consenting patients for lingual orthodontic treatment, to ensure that they are made aware of the potential for speech to be disturbed, particularly in the early stages of treatment. The purpose of this article is to outline some of the issues associated with speech problems and discomfort during lingual appliance treatment, so that practitioners are able to advise patients who may be considering this kind of treatment. Advice given during the consent process, including appliance selection, procedures for maintaining oral comfort and management of individual speech issues, will all help lingual patients cope with any speech problems they may experience during their treatment.

Speech and discomfort during lingual orthodontic treatment

The increased use of lingual appliances has meant a continued evolution in the design of lingual brackets. These changes in appliance and bracket design have tended to focus on reducing bracket thickness, with the aim of making appliances more comfortable. A thinner bracket design appears to have had some positive effects on the quality of speech, as well as comfort whilst appliances are in place. However, despite these improvements, some patients do struggle with their speech during treatment, far more than others. It is important therefore, when consenting patients for lingual orthodontic treatment, to ensure that they are made aware of the potential for speech to be disturbed, particularly in the early stages of treatment. The purpose of this article is to outline some of the issues associated with speech problems and discomfort during lingual appliance treatment, so that practitioners are able to advise patients who may be considering this kind of treatment. Advice given during the consent process, including appliance selection, procedures for maintaining oral comfort and management of individual speech issues, will all help lingual patients cope with any speech problems they may experience during their treatment.

Lingual orthodontic treatment: what is the current evidence base?

As the number of adults that seek orthodontic treatment continues to grow, so too is the popularity of lingual fixed appliances. Although the aesthetic advantages associated with these systems are obvious, for some orthodontists, there has been a reluctance to offer lingual-based treatment to their patients. This is often based upon the perceived problems associated with lingual braces, relating to discomfort and difficulties with speech for the patient, and problems in using these appliances for the orthodontist. Although some of these factors have been investigated, the current evidence base is weak, possibly due to the fact that these are evolving appliance systems. Among the studies that have been carried out to date, pain and discomfort for the patient appears to be similar following the placement of labial or lingual appliances, although the onset can be earlier with lingual brackets and the location different, with the tongue more frequently being involved. Customized lingual brackets may be associated with less pain than pre-fabricated. In addition, patients do seem to be more likely to experience difficulties with speech and mastication when fitted with a lingual appliance. However, there is some evidence that the lingual surfaces of the teeth are more resistant to early demineralization and caries. Little data exist regarding treatment outcome and ease of use for the orthodontist, either between lingual or labial appliances or between different lingual systems. Further research is required to investigate the efficiency of lingual appliance systems, both for the patient and orthodontist.

Comparison of adverse effects between lingual and labial orthodontic treatment: A systematic review

To compare adverse effects between labial and lingual orthodontic treatments through a systematic review of the literature. The protocol of this systematic review (CRD42012002455) was registered in the International Prospective Register of Systematic Reviews (PROSPERO). An electronic search was conducted in PubMed, Embase, Web of Science, CENTRAL, SIGLE, ProQuest Dissertations & Theses, and ClinicalTrial.gov for articles published between January 1980 and December 2012. Primary outcomes included pain and caries; secondary outcomes were eating difficulty, speech difficulty, oral hygiene, and treatment duration. Meta-analyses were conducted in Comprehensive Meta-Analysis version 2.2.064. Six studies were included, two randomized controlled trials and four clinical controlled trials; of these, four were medium quality and two were low quality in terms of the risk of bias. Five of the six outcomes were evaluated in the included studies, and treatment duration was not; pain, eating difficulty, speech difficulty were statistically pooled. Meta-analysis revealed that the pooled odds ratios were 1.20 (95% confidence interval [CI] = 0.30-4.87) for overall pain, 32.24 (95% CI = 14.13-73.55) for pain in tongue, 0.08 (95% CI = 0.04-0.18) for pain in cheek, 0.11 (95% CI = 0.03-0.42) for pain in lip, 3.59 (95% CI = 1.85-6.99) for eating difficulty, and 8.61 (95% CI = 3.55-20.89) for speech difficulty. Sensitivity analysis showed consistent results except for eating difficulty. No publication bias was detected. The likelihood of overall pain was similar between the two modalities. Patients who underwent lingual orthodontic treatment were more likely to suffer from pain in the tongue and less likely to suffer from pain in the cheek and lip. Lingual orthodontic treatment increased the likelihood of speech difficulty. Eating difficulty, oral hygiene, caries, and treatment duration could not be compared in this systematic review.

Maxillary expansion using a miniscrew retained expansion device during lingual orthodontic treatment

A deficiency in transverse basal development of the maxilla can lead to an arch length and/or a width discrepancy. Limited alveolus bone volume, which directly depends on the underlying basal bone, creates an upper dental arch that is too narrow in relation to the lower arch creating unilateral or bilateral posterior crossbite(s). The cause of this maxillary deficiency is often related to abnormal nasal breathing associated with abnormal tongue function that compromises the volume of expansion of the maxilla during the growth period. The two maxillary bones determine the volume of the alveolar bone, and also the volume of the inferior area of the nasal fossae due to their palatal processes, worsening nasal breathing, which is often already deficient. Treating this maxillary deficit can require a surgical-medical case management of malfunctions by an ENT which can possibly involve maxillary expansion performed orthopedically before the mid-palatal suture becomes ossified in children (synostosis at approximately 15 years of age), or done as a surgically-assisted procedure for adults. Classically, the expander transmits, by the intermediary of the dentition, horizontal forces which make it possible to progressively expand the two halves of the maxilla by distraction and thus progressively to create bone and soft tissue on the median zone of the palatal processes of the maxilla. This type of expander usually causes no problems for adults who receive orthodontic treatment using traditional dental brackets because the dental pressure of the expander uses the same braces that are supporting the brackets placed on the posterior teeth. It is a very different matter when using the lingual technique whose additional cost and complexity is justified when the patient demands esthetic treatment. The use of a classic expander that is attached to the palatal surfaces of first molars will interfere with the system of lingual bonding, which is located on these same surfaces. Therefore, it is difficult to simultaneously perform both treatments.

The preliminary study on customized bracket system for lingual orthodontic treatment

舌侧矫治技术可满足有隐形矫治愿望者的要求.与以往传统舌侧矫治器相比,个性化舌侧矫治器的进步主要在于其引入了计算机辅助设计与辅助制作(computer aided design and computer aided manufacture,CAD-CAM)技术设计与制作矫治器,克服了传统舌侧矫治器的固有不足,有效解决了牙齿舌侧面形态多变致托槽易脱落、牙间距离窄小、托槽定位不准确、初始或重新粘接困难及精细调整阶段难度偏大等问题。

Computerized analysis of occlusal contacts after lingual orthodontic treatment in adults

Given that lingual orthodontic appliances are bonded onto functional surfaces, the purpose of this study was to assess the nature of occlusal contacts directly after appliance removal (T1) and after a retention period of 3–20 months (T2-T3). Adult patients were chosen as their adaptation potential is limited and they may show prosthetic restorations or tooth wear. The sample consisted of 35 consecutive patients treated by the same orthodontist, having undergone lingual orthodontic treatment with customized appliances. Subjects with edentulous spaces were excluded from the investigation, as were those whose orthodontic treatment had been terminated early either following poor cooperation or at the patient's request. Occlusal contacts were evaluated with carbon paper (horseshoe type) and a T-scan III sensor, a computerized system for occlusal analysis that records intercuspation force and surface distribution. Nineteen patients completed the study with a mean age of 32 years (19–63), including five extraction and six surgical cases. T-scan III records showed high reproducibility. During the retention phase, the quality of contacts increased but no significant change in their location occurred. Asymmetric contacts became more balanced with time, except for some surprising cases. Even when the set-up goal is reached, occlusal forces may be distributed unevenly, remaining asymmetric and potentially signaling a functional imbalance.

Change of gingival with lingual orthodontic treatment

Change of gingival with lingual orthodontic treatment

Therapeutic Accuracy of Individualized Brackets in Lingual Orthodontics

Verification of the therapeutic accuracy of the Incognito ® bracket system. The therapeutic set-up casts and final treatment casts were digitalized using a 3D scanner, and the scans were subsequently superimposed. The deviations in rotation and translation of each tooth in the three spatial dimensions were calculated. The front teeth showed deviations in rotations of less than 4.6 ° and in translations under 0.5 mm. In addition, influences such as upper or lower jaw, growth, type of tooth, anterior tooth position, bracket generation, 3D scanner hardware and finishing archwires were analyzed. The clinical impression was confirmed by the measurements taken in this study. The final results following lingual orthodontic treatment using individualized brackets correlate satisfactorily with the therapeutic set-ups.