Lingual orthodontic appliances meet growing esthetic demands and are replacing traditional labial systems, yet they pose challenges to patient comfort and treatment efficiency that require comparative evaluation. Therefore, it is of interest to compare lingual versus labial fixed appliances in orthodontic patients, assessing pain perception, speech impairment, tongue irritation, oral hygiene, alignment rate, visit frequency and total duration during adaptation and follow-up phases. Patient comfort parameters and treatment efficiency metrics were collected at baseline and regular intervals and analyzed statistically across both groups. Lingual appliances showed greater initial discomfort but equivalent long-term alignment and duration outcomes to labial systems with proper case selection. Thus, we report the viability of lingual orthodontics as an esthetic alternative when patient motivation and individualized selection balance early adaptation challenges.

To characterize current lingual orthodontic (LO) practice among orthodontists in France, assess how the emergence of clear aligner (CA) therapy has influenced its clinical use and document clinicians' perspectives on the future of LO. A survey using a 39-item questionnaire was administered via the SurveyMonkey® platform. The survey was distributed through the French Syndicate of Specialists in Orthodontics (SFSO), the Syndicate of Orthodontists of France (Les ODF), and a professional Facebook group, reaching an estimated 2971 orthodontists. Responses were collected anonymously. Data were analyzed using Python v3.12.7 with univariate and bivariate statistics; associations were assessed using χ2 and Spearman correlation tests, with significance set at α = 0.05. Of 201 respondents, 59.7% (n = 120) reported active practice of LO. The most frequently used systems were WIN® (43.9%) and Incognito® (36.7%). A majority of practitioners treated 1-10 lingual cases annually, whereas aligner therapy was reported more frequently, with 28.3% indicating 21-50 aligner cases per year. Nearly half (48.4%, n = 46 of 95 respondents) reported offering lingual treatment less often since the rise in aligner use, and 76.8% (n = 73 of 95 respondents) perceived a decrease in patient demand for lingual appliances. Major reported barriers to lingual practice included prolonged chairside time (28.5%), limited clinician training (23.5%), and low patient demand (22.3%). Despite these challenges, 92.3% of respondents reported satisfaction with their clinical outcomes. Following the discontinuation of the Incognito® system, 28.6% of users planned to discontinue LO, and 80% expressed intent to transition to aligner therapy. Although a majority of the respondents report experience with LO, it represents a minority of their annual caseload. The increasing use of CAs appears to have influenced reported practice patterns. However, these findings reflect practitioner-reported behaviors and perceptions rather than clinical indications or appropriateness. LO is still perceived by clinicians as offering advantages in predictability, efficacy, and esthetic discretion, suggesting it may continue to play a role for select patients in contemporary orthodontic practice.

Multidisciplinary treatment of missing incisors with lingual orthodontics and skeletal anchorage

There is no current evidence in the literature that clearly guides clinicians in selecting the most effective polishing protocol in lingual orthodontics. This study aimed to compare the reduction of adhesive remnants after polishing customized lingual composite brackets using tungsten carbide, fine diamond, and Arkansas burs. A total of 504 extracted teeth were included and randomly assigned to three groups according to bur type (n = 168). Brackets were bonded and debonded following a standardized protocol, and digital scans were obtained before and after polishing. Each bur was tested at both low speed (contra-angle) and high speed (turbine). Tungsten carbide burs produced the greatest reduction in cement thickness under both rotary conditions. At low speed, the mean Pre-Post thickness differences were 0.64 mm (TUN), 0.31 mm (ARK), and 0.37 mm (DIA). At high speed, differences were 0.45 mm (TUN), 0.39 mm (ARK), and 0.41 mm (DIA). Statistically significant differences were found between the tungsten carbide group and both the Arkansas and diamond groups (p < 0.005), with no differences between the latter two. Tungsten carbide burs removed significantly more adhesive than Arkansas and diamond burs, regardless of rotary speed. These findings support clinical decision-making by helping optimize polishing protocols in lingual orthodontics.

653 - The challenges of treating impacted canines with lingual orthodontics

648 - Severe Angle Class II, Division 2 Cases with Lingual Orthodontics and Orthognatic Surgery

<h2>Abstract</h2> This review article discusses the current state of lingual orthodontics in the context of an increasingly superficial general perception of treatment outcome quality in orthodontics. Recent technological advances in bracket and archwire manufacturing, as well as in the processing of modern SE-NiTi-alloys, have contributed to defining a new "state of the art" in the lingual technique. Furthermore, the paper emphasizes the need for a more precise definition of key tooth movements within the orthodontic nomenclature, in order to enable especially younger colleagues to better assess the quality of contemporary orthodontic publications.

Background: Lingual orthodontics offers esthetic advantages by placing brackets on the inner surfaces of teeth. However, the impact of lingual appliances on periodontal health remains under-explored. Aim: To evaluate periodontal changes in patients undergoing lingual orthodontic therapy over a 6-month period. Materials and Methods: A prospective observational study was conducted on 60 systemically healthy participants (aged 18-35 years) receiving fixed lingual appliances. Periodontal parameters including Plaque Index (PI), Gingival Index (GI), Bleeding on Probing (BOP), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL) were assessed at baseline (T0), 3 months (T1) and 6 months (T2). Statistical analysis was performed using repeated measures ANOVA. Results: Significant increases in mean PI (T0: 0.68 to T2: 1.52) and GI (T0: 0.62 to T2: 1.48) were observed (p&lt;0.001). BOP increased from 12.5% to 41.9%. Mean PPD and CAL also increased significantly over time (p&lt;0.001), though within mild clinical thresholds. The most pronounced changes occurred in posterior lingual regions. Conclusion: Lingual orthodontic appliances are associated with a progressive decline in periodontal health, particularly due to plaque retention and hygiene challenges. Close monitoring and patient education are critical to prevent long-term periodontal complications during lingual therapy. These findings highlight the need for tailored oral hygiene protocols and close interdisciplinary monitoring during lingual orthodontic therapy to minimize long-term periodontal risks.

ABSTRACTObjectivesTo investigate the prevalence and contributing factors of mandibular labial gingival recession in patients with fixed lingual orthodontic retainers.MethodsThis cross‐sectional study involved 83 post‐orthodontic patients with fixed lingual retainers. Labial gingival recession was assessed on the lower incisors and classified using Cairo's Recession Type system. Clinical parameters were collected, including bleeding on probing, biofilm, brushing habits and oral hygiene behaviours. Logistic regression was used to analyse factors associated with recession.ResultsLabial gingival recession was observed in 27 of 83 patients (32.53%). The mean recession was 0.66 mm. Significant associations were found between gingival recession, age (p = 0.008) and nail/pen/pencil biting habits (p = 0.021). Brushing technique and frequency also showed a significant association.ConclusionsLabial gingival recession was present in one‐third of patients with fixed lingual retainers. Age and mechanical habits, such as nail‐biting, were significant predictors. Preventive strategies should target behaviour modification and enhanced oral hygiene education.

Introduction: Digital planning and evolution of technology is allowing dentistry to be more efficient in time than before. In orthodontics the main purpose is to obtain fewer patient visits and to reduce the bonding time. For that, indirect bonding planned with CAD-CAM softwares is used to obtain a shorter treatment period, in general, and less chair-time. This waste of chair-time should also be reduced in other fields of dentistry such as endodontics, surgery, prosthodontics, and aesthetics. Methods: A total of 504 teeth were embedded into epoxy resin models mounted as a dental arch. Customized lingual multibracket appliances were bonded by a current adhesion protocol. After that, they were debonded, the polishing of cement remnants was performed with three different burs and two drills. The polishing time of each group was recorded by an iPhone 14 chronometer. Results: Descriptive and comparative statistical analyses were performed with the different study groups. Statistical differences (p < 0.005) between diamond bur and tungsten carbide and white stone burs and turbine were obtained, with the first being the slowest of them. Discussion: Enamel roughness was widely studied in orthodontics polishing protocol as the main variable for protocols establishment. However, in lingual orthodontics, due the difficulty of the access to the enamel surfaces, the protocol is not clear and efficiency should be considered. It was observed that the tungsten carbide bur is the safest bur. It was also recommended that a two-step protocol of polishing by tungsten carbide bur be followed by polishers. Conclusions: A tungsten carbide bur mounted in a turbine was the most efficient protocol for polishing after lingual bracket debonding.

Background and Objectives: Halitosis poses a clinical and psychosocial burden, particularly in orthodontic contexts where plaque retention can exacerbate odor production. This cross-sectional study aimed to compare halitosis and oral health-related quality of life (OHRQoL) in three distinct groups: patients wearing removable clear aligners, patients with lingual orthodontic brackets, and non-orthodontic controls. We further explored dietary factors (frequent snacking vs. infrequent snacking) to identify their influence on halitosis severity and self-perceived well-being. Methods: A total of 162 participants (55 aligners, 58 lingual brackets, 49 controls) were recruited. Halitosis was assessed by the Halitosis Associated Life-Quality Test (HALT) questionnaire (range 0-100) and an organoleptic evaluation (range 0-5). OHRQoL was examined with the OHIP-14 instrument (range 0-56). Data on frequent vs. infrequent snacking were also recorded. One-way ANOVAs with Tukey's post hoc and chi-square tests were utilized for group comparisons. Spearman's correlation examined relationships between HALT scores, organoleptic measures, and OHIP-14. A significance threshold of p < 0.05 was adopted. Results: Aligner users demonstrated lower mean HALT scores (31.7 ± 5.8) compared to the lingual group (37.4 ± 6.2, p = 0.001) and controls (34.6 ± 6.0, p = 0.039). Lingual bracket wearers had the highest mean organoleptic score (2.4 ± 0.6, p < 0.001). Frequent snackers exhibited worse HALT outcomes (36.9 ± 6.3) than infrequent snackers (32.6 ± 5.9, p = 0.005). A correlation analysis showed a moderate positive correlation (r = +0.52, p < 0.001) between HALT and organoleptic scores and a strong negative relationship (r = -0.63, p < 0.001) between HALT and OHIP-14. Conclusions: Removable aligner use correlated with lower self-reported halitosis and better OHRQoL relative to lingual brackets. Frequent snacking appeared to aggravate halitosis across all groups. These findings emphasize the importance of tailored oral hygiene measures, dietary counseling, and orthodontic appliance selection to mitigate halitosis and enhance overall well-being.

Rationale: Lingual brackets are typically bonded indirectly based on setup models with ideal tooth alignment to overcome the variability in lingual tooth anatomy and difficulties in measuring bracket position. However, direct bonding is the original philosophy of the inventor of lingual orthodontics and is still performed by a minority of lingual orthodontists. This article aims to revise the clinical procedures of direct bonding of lingual brackets and forming of lingual archwires and prove the effectiveness of the direct bonding philosophy through two case reports. Patient concerns: The patient in Case 1 was a 29-year-old female who presented with moderate crowding and normal inclinations of the maxillary and mandibular incisors. The patient in Case 2 was a 25-year-old female patient who presented with severe crowding and proclined maxillary and mandibular incisors. Diagnoses: The patient in Case 1 was diagnosed with a half-cusp Class II relationship on a Class I skeletal relationship. The patient in Case 2 was diagnosed with Class I dental and skeletal relationships. Both patients had a normodivergent facial pattern. Interventions and outcomes: The treatment option in Case 1 was to extract all third molars combined with total distalization of both arches and interproximal stripping. The treatment option in Case 2 was to extract maxillary and mandibular first premolars to create spaces for relieving crowding. The post-treatment records in both cases showed improved smile aesthetics and occlusion. Conclusions: Direct lingual bracket bonding offers some advantages and disadvantages compared to indirect one. Successful treatment results of two case reports demonstrate the accuracy and effectiveness of the direct lingual bracket bonding approach.

Adult patients seeking orthodontic treatment consistently have aesthetic concerns, even throughout the course of the treatment. This has lead to the introduction of Lingual Orthodontics in 1970s by Dr. Craven Kurz of USA and Dr. Kinya Fujita of Japan. Lingual orthodontics, in addition to its aesthetic benefits, offers several other advantages. The cooperation and confidence level of the patient has increased with the invisible appliances. The Anchorage control, indirect bonding and biomechanics is completely different from labial technique. In this article the concept of lingual orthodontics has been highlighted. The article shows a case report with lingual technique treated in the department of orthodontics at Farhat Hached University Hospital.

This preliminary randomized clinical trial, designed with two parallel arms, sought to evaluate both the efficiency of tooth movement and patient-reported comfort during alignment and leveling when using the BRIUS™ lingual appliance (BR) compared with conventional labial full fixed appliances (LFFAs). Individuals in permanent dentition presenting with mild to moderate crowding were recruited from the University at Buffalo. Participants were randomly allocated to either the BR group (n = 7) or th

Adult patients seeking orthodontic treatment consistently have aesthetic concerns, even throughout the course of the treatment. This has lead to the introduction of Lingual Orthodontics in 1970s by Dr. Craven Kurz of USA and Dr. Kinya Fujita of Japan.

Tip control in lingual orthodontics may be challenging because of the presence of a vertical slot and the particular configuration of the customized appliances. The aim of this in vitro experimental study was to investigate the role of the ligature-wire-slot system in achieving better tip control. A set of customized lingual brackets was obtained for a dedicated typodont made of extracted human teeth. A compression/traction machine tested two types of ligatures in combination with seven different wires, and the tipping angle of each configuration was derived. A statistically significant difference was found between ligatures when the complete set of data was tested. In addition, differences between ligatures were found when testing each wire separately. A statistically significant difference was found among all wires. Full-size wires showed the smallest angles, which correspond to the greatest efficiency of the slot-archwire-ligation system in terms of tip control, and this efficiency appeared to be ligature-related. The role played by the type of ligature was more relevant for undersized wires.

Introduction: This pilot two-arm, parallel group, randomized clinical trial aimed to compare the efficacy of tooth movement and patient comfort during orthodontic leveling and alignment with the BRIUS™ lingual system (BR) versus labial full fixed appliances (LFFAs). Methods: Patients in the permanent dentition with mild to moderate crowding were recruited at the University at Buffalo and randomly assigned into the BR group (seven patients) or LFFAs group (six patients). The patients’ dental arches were scanned before bonding (T1) and after 18 weeks (T2). Digital dental model superimpositions were performed to three-dimensionally evaluate tooth movement. Changes between T1 and T2 were measured in the x, y, and z planes. Little’s Irregularity Index (LII) was also assessed at T1 and T2. An electronic questionnaire was completed daily for 7 days after T1 to evaluate the patients’ comfort levels. Results: After 18 weeks, similar displacements were observed for all teeth in both groups except for the lower left second premolar (LL5) in the x-axis which showed greater displacement in the BR group (p = 0.016). Groups showed similar changes in LII. Discomfort during the first week after bonding was greater on the tongue in the BR group and on the lips and cheeks in the LFFAs group. Tongue discomfort caused by the BR lasted for around 3 days. Conclusion: The BR and LFFAs showed similar teeth displacements and therefore were equally effective at leveling and aligning teeth. LFFAs caused cheek- and lip-borne discomfort while the BR caused tongue-borne discomfort during the first week after bonding. Larger studies with longer follow-ups are needed to obtain more definitive results.

Lingual orthodontic technology has been in existence for over 50 years, undergoing various stages of emergence, development, decline, and maturity. In recent years, with the advancement of digital technology, customized lingual orthodontics has gradually become widely used in clinical practice, representing a significant achievement of digital technology in orthodontic clinical diagnosis and treatment. The integration of digital technology has made customized lingual orthodontics more convenient, precise, and efficient, enhancing patient comfort while significantly reducing the operational difficulty and technical barriers for orthodontists. This article focuses on analyzing the technical characteristics, operational challenges, and coping strategies of customized lingual orthodontics based on digital technology, aiming to provide a reference for clinical practice.

In orthodontics, the treatment plan and the impact of orthodontic appliances on patients' aesthetic appearance have significantly influenced patients' aesthetic demands over time. Patients considering orthodontic treatment are very concerned about the potential compromise in facial appearance that conventional orthodontic treatment could cause. Lingual orthodontics offers an aesthetically pleasing appearance compared to conventional orthodontic systems, addressing the growing demand for inconspicuous treatment options. This review examines the implications of lingual orthodontics compared to conventional orthodontics, focusing on aesthetics, oral health outcomes, and patient satisfaction. The benefit of lingual brackets is that when positioned on the teeth's lingual surfaces, they are almost undetectable. However, they are associated with increased difficulty in oral hygiene maintenance due to their placement, leading to higher plaque accumulation that causes compromised periodontal health. Conversely, studies show a lower incidence of white spot lesions on lingual surfaces compared to buccal surfaces, suggesting a reduced risk of caries. Challenges with lingual systems include increased tongue discomfort and speech difficulties. Despite these challenges, lingual orthodontics demonstrates favourable outcomes for patients prioritising aesthetics. Future advancements should focus on improving appliance designs to enhance patient comfort and oral hygiene accessibility, ensuring optimal treatment outcomes. Interdisciplinary collaboration and comprehensive oral hygiene education are essential to maximise the benefits of lingual orthodontics.

Aims: It was the scope of this study to explore the biomechanical implications of retraction force application point modifications in lingual orthodontics, aiming to mitigate the bowing effect and enhance anchorage stability in the anterior teeth. Methods: Using the FE method on an idealized maxillary model, en masse retraction was simulated using a modified lingual fixed appliance including edgewise lingual brackets, a 0.017″ × 0.025″ mushroom-shaped archwire, and power arms between lateral incisors and canines, with a transpalatal arch (TPA) connecting the first molars. Applying bilateral retraction forces of 1.5 N at twelve positions, initial tooth displacements during space closure were evaluated. Results: Shifting power arms gingivally did not effectively counteract palatal tipping of incisors but reduced posterior and palatal tipping of canines with a power arm length of 11.3 mm preventing posterior tipping. Apically displacing the TPA retraction force increased mesiobuccal rotation while preventing mesial molar tipping for retraction forces applied 12.6 mm from the archwire. Conclusions: Apically shifting retraction forces can mitigate vertical bowing effects in lingual orthodontics, yet it also highlights the challenges in maintaining torque in the anterior teeth. Further research and clinical validation are essential in order to confirm these results, emphasizing the complexity and need for advanced biomechanical strategies in personalized lingual orthodontic treatments.