lingual orthodontics courses in india /certified fixed orthodontic courses by Indian dental academy

Dr. Varun Grover

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


Introduction
 Goals

of orthodontic treatment

End of treatment
 Desire

for esthetics during
treatment

 Lingual

orthodontics


Search 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 cost
Lower arch – judge the progress
Reduced demands on the practitioner


Historic perspective
 John Farrar
 Mershon –

– lingual removable arch (1889)

LRA with finger springs

 Owen Oliver
 Crozat

– Labiolingual app

app


Historic perspective
 Nance

button
 TPA – Robert Goshgarian
 Lingual arch - Wilson

Note – supplement labial orthodontics


LO – As a complete system
 Vision of
 Craven
 Kinya

2 key innovators

Kurz – USA

Fujita – Japan
Kanagawa uni.


1970s

 Fujita

system -1971
 Advantages
Lip injury
Lip relation
Retention
Little anchorage loss
Brackets placed close to the functional line for forces
to pass through C res.

 Fujita

system -1971
 Disadvantages
Longer duration
Speech difficulties
Initial discomfort
Oral hygiene
 AJO

1979 – LO with Mushroom shaped archwires


 Key

features – Fujita system
 Slots facing occlusally

Easy insertion and removal
Prevents deformation


 Grooves

for insertion of lockpins

Mesiodistally
 Auxilliary

grooves


Occlusogingivally

 Multiple

slots – Less publicized
 Ant. And Pm bracket – 3 slots
Occlusal
Lingual
vertical
 Molar

bracket – 5 slots
1 occlusal
2 lingual
2 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 kurz
 Ormco
 1976 – introduced

lingual app
 Slots facing palatally
 Worked as a part of LTF (1990)
Scholz Gorman
Kelly
Alexander
Smith Artun
Greekmore

Craven kurz
 1976 – 1st

generation of
lingual brackets
Larger profile
Crude prescription
 1990 – 7th generation
Low profile
Refined prescription
Mx bite plane – heart shaped, smaller hooks
Inc width of Pm brackets
Variety of molar brackets

Craven kurz
 Slot

size – 018
 Greatest innovation

Addition of bite plane
 Shearing

forces


Compressive forces

Lingual brackets
 Mx

anterior brackets

Built in bite plane
Propping open the bite
Adv in deep bite cases


Lingual brackets
 Mand

anterior brackets
Ball hook extends away from the tissue
Ease in maintaining oral hygiene


Lingual brackets
 Bicuspid

brackets - wider
Better rotational and tip control
More uniform interbracket width
Ball hooks – shortened and flattened


Lingual brackets
 Molar

brackets – variety
 Twin bracket
recommended when both 1st and 2nd molars are bonded
Twin bracket with auxiliary tube


Lingual brackets
 Hinge

cap

Latest
Ideal attachment for terminal tooth
Hinge cap tool


Lingual brackets
 Terminal

tube

Used initially
Crown height is less


Lingual instruments
 Lingual

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


Lingual Begg brackets
 Fujita

and Craven kurz

Edgewise slot
 Stephen

Paige – 1982
 Begg appliance suits well to LO


 Vertical slot
 Use

of round arch wires

 No built
 TP

facing occlusally

in tip and torque

– (256 – 500) labial Begg bracket


 Anatomic considerations

Difficult to position the bracket
 Interbracket

arch wires

distance – precise measurement of the


 Low

profile lingual Begg bracket

Difficult to close the open bite
 Plastic

buttons on labial surfaces – assist
lingual app


 Lockpins

– softer and thinner (014)

 Seated – using

a two hand instrument
Wire tucker

 Weingart

plier


Lingual Begg mechanics
 Low

angle cases – favorable md rotation
 High angle cases
Smith (1986 )- HPHG
Cash and Blackwood (1991) – JJ
Jenner (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

 Lingual

torque of upper lateral incisors

root torque of the canines


 Uprighting springs
 Stage III

– Mesiodistal root movement
 Braking mechanics – stage II
 010 mini springs


Conceal system
 Thomas

Creekmore (AJODO 1989)
 Unitek, Monrovia, California
 Advantages
Facial tooth surfaces are not damaged
Facial gingival tissues health
The position of the teeth can be precisely seen
Drape of the lips – not distorted
invisible

Conceal system
 An



acceptable LOA must include following key elements

Align
Apparatus to position the brackets precisely


Conceal system





Accurate indirect bonding system
Preformed arches
Specifically designed pliers
Torquing keys


Conceal system
 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

Conceal system
 Design of

Pm and molar bracket

Occlusal tie wings projecting mesially and distally
Mesial and distal undercuts II base of the slot
Changes the direction of ligature pull – 90

Conceal system
 Conceal brackets

Unitwin bracket

are designed around the

Centered slot concept
Single bracket without tie wings
Centre of a 0.045 inch twin bracket
Maximum interbracket distance for optimum tip and torque
Twin tie wings – rotational control

Conceal system
 Each

conceal bracket has 3 different slot widths


Conceal system
 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


Conceal system
 The width

of the slot for rotation – 0.070 inch

 Analogous
 Torque

to tip control in the labial system

control is same for both the systems

 Width of

the slot for torque – 0.035 inch


Conceal system
 Play
 Maximum arch


wire size

Conceal 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 selection
 Adults
 Missing

teeth
 Complex restorative needs
 Periodontal problems


Patient selection
 Possible speech
 Absolute

difficulty – 2 to 4 wks

need for perfect speech

 Tongue irritation
 Opening up of
 Oral

the spaces

hygiene considerations

 Initial weight

loss


Patient selection
 Deep

bite cases are ideal for LO
 Short clinical crown height – relative CI
 Initial practitioners
Non Xn
Deep bite
Mild crowding
Upper palatal lower labial app
Low anchorage demands
Unilateral Xn cases

Patient selection
 Deep

bite

Vs

 Open

bite

 Brachycephalic

 Dolichocephic

 Euryprosopic

 Leptoprosopic

 Bite plane

 Difficult

effect
 Favorable Md rotation


cases
 Cross elatics

Patient selection
 Biomechanical differences

 For

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


Patient selection
 For

retroclined anteriors

Advancing loops in initial archwires

Patient selection
 Effects

of vertical extrusive forces
 Labial appliance – extrusion

Labial root torque
 Lingual

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


Patient selection
 Effects

in antero-posterior relation
 Lingual appliances

Vertical opening
Md rotation
Induce Class II tendency
Vertical bowing effect

Patient selection
 Contraindications
 Short

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


Patient selection
 Effects

in transverse dimension

 LA –

expansive nature coupled by posterior
disclusion

 Mesiobuccal
 Transverse

molar rotation – space closure

bowing effect


Bracket placement
 Indirect

bonding
 Why not direct bonding???
Access
Irregular lingual surface
Variation in lingual tooth morphology
 Customized

resin beneath the brackets


Bracket 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 - CLASS
 Scott

huge
Ideal set up is created
Brackets placed
All planes of space considered
Custom bracket bases


 Brackets transferred

to the original cast

Another indirect bonding tray is fabricated
Ideal set up – patients motivation


 Steps
 Precise

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


 Prescription form


 Ideal set

up
2nd molars and single incisor in each arch

Teeth act as reference
Class I canine and molar
Establish adequate tip
Torque
Eliminate rotations
Tight contacts

 Filling

the prescription


 Transfer

trays
 Sectioning of the trays

Preference – Vinyl

Arch width
Maintain
Widen
Constrict

Lower occlusal plane
Flat
Maintain
Deep

Overbite
Ideal
Increased
Decreased

Overjet
Ideal
Increased
Decreased


Bracket 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 - 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 - BEST
 Bonding
 Fillion,

with Equalized Specific Thickness

1987

 Overcomes

the disadvantage of TARG
 A caliper is added
 Direct

working on the malocclusion cast


Bracket placement – Hiro system
 Modified

CLASS technique
 Introduced by HIRO
 Improved by Takemoto and Scuzzo


Clinical bonding
 Lingual

side of the arch

Moisture contamination
Calculus deposition
Pre bonding scaling
Use of antisailogouges
Probanthine – 15 mg 45 min prior to bonding

Clinical bonding
 If

it is desirable to bond one arch
 Mandibular arch
 Special considerations
Porcelain restoration
Presence of aluminium – HF acid
Composite bondable surface
Gold crowns
Large amalgam fillings

Clinical bonding
 Bonding materials
2

part sealant – Maxi cure

 Filled

paste – EXCEL, Reliance orthodontic product

 Light

cure adhesives

 Bracket

side – tooth side adhesive


Clinical bonding
 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
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