Lingual main

INTRODUCTION
• There are many patients who would
strongly benefit from better function,
healthier periodontal tissues, and
improved self-image if they had
orthodontic correction.
• Many of these patients never consider
orthodontics because of their
preconceived ideas of "tinsel teeth" and
"metal mouth"
www.indiandentalacademy.com

HISTORY
• 1726 –An appliance on lingual surface of teeth by
PIERRE FAUCHARD
• 1841- first lingual arch for expansion and alignment of
teeth by PIERRE JOACHIM LEFOULON
• 1889 -a "lingual removable arch" by John Farrar.
• 1918 -Dr. John Mershon "The Removable Lingual Arch
as an Appliance for the Treatment of Malocclusion of the
Teeth".

• 1975, Dr. Craven
Kurz developed the
first true lingual
appliance
• He was orthodontist
assistant professor
of occlusion and
gnathology at the
UCLA School of
Dentistry

• The appliance
consisted of plastic
Lee Fisher brackets
bonded to the
lingual aspect of the
anterior dentition
and metal brackets
bonded to the
lingual aspect of the
posterior dentition

• This was a lingual bonded edgewise
appliance by modifying labial
appliances
• Dr. Kurz applied for a patent for the
Kurz Lingual Appliance on November
15, 1976

• 1979 --- Dr.Kinya Fujita introduced
Lingual bracket design and Mushroom
shaped arch wires AJO ,76; 657-
675,1979.
• The American Lingual Orthodontic
Association (ALOA) was established on
November 14, 1987

Ideal Lingual cases
Non extraction cases
• Deep bite, class I with mild crowding
• Deep bite, class I with generalized spacing,
• Deep bite, mild class II ,
• Class II div 2 with retruded mandible
• Cases requiring expansion
• Consolidation (diastema) cases

Ideal Lingual cases
Extraction cases
• Class II,maxillary first bicuspid and mandibular
second bicuspid extractions
• Maxillary first bicuspid only extractions
• Mild double protrusions with four first bicuspid
extractions, where in anchorage is not critical

Difficult lingual cases
• a) Surgical cases
• b) Class II tendencies
• c) Class II four first bicuspids extraction
• d) Mesiofacial pattern and / or moderate
mandibular plane angle.
• e) Cases with multiple restorative work.

Cases contraindicated for
Lingual therapy
• Acute TMJ dysfunction
• Mutilated posterior occlusion
• High angle or dolicofacial patterns
• Extensive anterior prosthesis
• Short clinical crowns
• Critical anchorage cases
• Severe class II discrepancies
• Poor oral hygiene or Unresolved periodontal
involvement
• Inadaptable or demanding personality types

BRACKET
EVOLUTION

ORMCO (KRUZ) LINGUAL BRACKET
Generation # 1-1976
The first Kurz appliance was manufactured by ORMCO.
This appliance had flat maxillary occlusal bite plane from
canine to canine. The lower incisors and pre molar brackets
were low profile and half round. And there were no hooks
on any brackets.

Generation # 2-1976
Hooks were added to all canine brackets.

Generation #3-1981
Hooks were added to all anterior and premolar brackets.
The first molar had a bracket with an internal hook. The
second molar had a terminal sheath without a hook but
had a terminal recess for elastic traction.

Generation # 4-1982-84
This generation saw the addition of a low profile anterior
inclined plane on the central and lateral incisor brackets.
Hooks were optional.

The anterior Inclined plane became more pronounced, with an
increase in labial torque in the maxillary anterior region.The canine also
had an inclined plane. A transpalatal bar attachment was now
available for the first molar bracket.

The inclined plane in the maxillary incisors became more square
in shape. Hooks on the anteriors and premolars were elongated. A
hinge cap, allowing ease of manipulation, was now available for
molar brackets.

• 7th generation
– straight wire brackets
– .018’’ or .022’’
– Rounded facial
contours
– Large hook
– Rounded opening to
the slot
– Increased tie wing
area

– Bracket base is large
– Horizontal slot
– Bite plan in the upper
anterior brackets

• Molar brackets are
twin brackets with
mesial ball hooks.
• also brackets with
hinge cap molar
tube
• a special molar
bracket with
transpalatal sheath
Hinge-cup molar bracket

Bracket design
• Hardened stainless
steel
• brackets for all the teeth
are of the same design
• differ only in the width
• brazed to a diffusion
bonded foil / mesh base
• The bonding base is
contour
• additional adaptation
can be done in the
laboratory

• 0.018” each wire slot
which parallels the
occlusal plane
• A bracket with a slot
size of 0.018” was
selected with two
criteria in mind.
1. It would conserve incisal
– gingival bracket
dimension
2. It would be compatible
with existing arch wires.

• Maxillary anterior
brackets incorporate
bite plane designed
into the incisal edge of
the bracket the bite
plane in parallel to the
arch wire and the
occlusal plane.
– It assisted in opening
the bite.
– It redirected the forces
of occlusion to prevent
shearing of the bond

• A gingival ball hook
– 1. Elastic ligature
placement
– 2. Rotation control
– 3. Placement of intra
and intermaxillary
elastics.

STb (SCUZZO-TAKEMOTO
bracket)
• Introduced by Drs. GIUSEPPE SCUZZO and KYOTO
TAKEMOTO

highlights
• 1. Comfortable
– Reduced dimension,
– The lowest bracket profile of just 1.5mm
– Special rounded design
– Low friction ,low force hence reduced pain
• 2.Easy hygiene maintenance.

• 3.Fast
– Passive ligation step with 0.3 mm clearance
between the slot base and the ligature wire
– Used with the " Light Lingual system " (gentle
forces)

Fujita lingual bracket

Fujita lingual bracket
• Based on an occlusal slot opening
• Brackets for the anterior teeth and premolars
have three slots: occlusal, lingual, and vertical.
• Molar brackets have five slots: one occlusal, two
lingual, and two vertical.
• Each of the three types of archwire slots
provides different capabilities for efficient tooth
movements.

• The .019" × .019"
main occlusal slot
allows
easier archwire
insertion, seating,
and removal than
with lingually
opening slots

• Rotation control is more efficient with the
occlusal slot, since it requires only the
insertion of the light archwire, which produces
an action analogous to tipping with a labial
edgewise appliance

• The .018" × .018" lingual slot is generally
reserved for sliding mechanics such as partial
canine retraction

• The molar bracket has .028"
× .022" outer and .018" × .
018" inner lingual slots (“slot
in slot”).
The outer slot of the maxillary
molar bracket can engage a
transpalatal arch to retain an
expanded maxillary archn or
to inhibit extrusion of the
maxillary first molar during
leveling in dolichofacial
patients.

• The .016" × .016"
vertical slot permits
the insertion of
auxiliary uprighting
springs or elastic
hooks on one or
more teeth at any
time during
treatment

UNITEK CONCEAL BRACKETS
Introduced by THOMAS CREEKMORES, AJO-DO Volume 1989 Aug (120 –
137)
instead of labiolingually
0.016’’ SLOT
Based on occlusal slot

• The first 1 mm of the
molar tube opens to
the occlusal aspect to
simplify arch wire
insertion.

• Premolar bracket tie
wings project mesially
and distally instead of
labiolingually

• Conceal brackets are
designed around the
Unitwin bracket
"centered slot" concept
• The Unitwin bracket is,
in effect, a single
bracket without tie
wings in the center of a
0.045 inch twin bracket

• It uses the advantages of both single and
twin brackets by allowing maximum
interbracket distance for optimal tip and
torque functions, while providing twin tie
wings for rotation control

• The Conceal
system slot is
therefore 0.016 inch
horizontally and
0.022 inch vertically

• Each Conceal bracket
has three different slot
widths for the three
different functions
– TIP (A-B) 0.100 inch
– TORQUE (E-F) 0.070
inch
– ROTATION (C-F OR E-
D) 0.035 inch

Adenta- self ligating evolution
• Dr. Hatto Loidl, an
orthodontist from
Berlin,Germany and Mr.
Claus Schendell, owner
and engineer of adenta
GmbH, together
designed a new self-
ligating lingual bracket
and modified Hiro
system called the
Evolution slt bracket
system.

Highlights
• Self-ligating bracket
eliminates ligature ties
• Easy handling and
archwire changes
• Closing springs are
designed as bite planes
for the lower incisors
• Perfect transmission of
torque and angulation

Highlights
• One piece design
• Occousal archwire
insertion
• Significant reduction of
chair time
• Hygienic situation, the
occurrence of
decalcification is
dramatically reduced

Forestadent lingual brackets
• Easy to use
• Self ligating brackets
• An extremely low profile and are
barely noticeable for the patient.
• A vertical slot for fast and easy
archwire insertion.
• 2D-Lingual brackets for
Treating less complex cases.
• 3D torque lingual brackets for
for complex cases

Phantom lingual attachements
“Ortendahl lingual system”
• First tooth colored self-
ligating bracket
• Made up of composite
polymer
• Manufactured by
GESTENCO

• Direct bonding with built
in placement jig
• Passive initially and
active later- when you
need it
• Tubes on premolars to
avoid speech impediment
• A replacement for
INVISALIGN

GAC –IN – OVATION L
• Twin self - ligating lingual
bracket system
• Provides full functionality
throughout of course of
treatment
• Low profile
• Twin design with
interactive clip

• Passive function is achived
with a small diameter round
wire
• Expressive function with the
light seating a BIO FORCE
wire into the bases of slot so
programming may be
expressed and rotation are
corrected
• Active function by a full size
Beta –Ti wire

I braces (Incognito)
• Conceptualized by dr.
DIRK WIECHMANN
• Using state-of-the-art
CAD/CAM technology
• Based on digital
registration of the
malocclusion
situation.

I braces (Incognito)
• The brackets are then
individually designed and
optimally positioned in the
computer.
• State-of-the-art Rapid
Prototyping technology is
used for the actual
manufacturing of the
lingual brackets. www.indiandentalacademy.com

• Each bracket body is designed independently of
the bracket base, on which it is optimally
positioned.
• Filler spaces such as those occurring in the
individualized positioning of prefabricated
brackets can thus be avoided.
• This also makes the lingual appliance decidedly
more favorable for good oral hygiene.

LINGUAL STRAIGHT WIRE
APPLIANCE
• Future of lingual
orthosontics
• Allows ease of flossing
• Without bite plane it is
easy to establish
adequate overbite during
detailing stage

• Opposite direction of wire
insertion helps in easy
rotation correction
• Easy of anterior
expansion
• Distance of contact point
from the wire long
enough to permit
proximal slicing without
removing wire

Bonding procedures for
Lingual Orthodontics
- Direct bonding
- Indirect bonding

Direct bonding
Gauges are available for direct bonding,
but bonding is difficult and not accurate
with this procedure.

The New Lingual Bracket Jig
(LBJ)
• The Lingual Bracket
Jig (LBJ ) was first
presented in ESLO
congress in Rome in
1998, and published
in JCO in 1999 (1)
• a precision device

The New Lingual Bracket Jig (LBJ)
• a simple direct bonding technique,
• and an in-office preparation for indirect bonding
of Lingual brackets, controlling tip, torque, in-out
and height of the brackets.
• The LBJ is suitable for Ormco Generation 7, STb
and Stealth (American Orthodontics) Lingual
brackets,
• and it fits for both 0.018" and 0.022" slot
brackets

(LBJ)
• The concept of the
LBJ is that it copies
the labial bracket
slot prescription and
translates it to the
lingual surface

(LBJ)
• Prescription of the LBJ and brackets
mounted with the LBJ

Custom made lingual
bracket jig

Constructing the set-up

Setting the maxillary arch

Setting the mandibular arch

Marking the long axis of teeth

Constructing the full size arch wire
and bracket placement

Customizing the bracket basw

Indirect Bonding procedures
for Lingual Orthodontics

Indirect bonding techniques
• 1. TARG : (Torque Angulation Reference
Guide)
• 2. CLASS : ( The Customized Lingual
Appliance Set -up Service System )
• 3. The HIRO system
• 4. Ray set

The TARG
• developed by
Ormco in 1984 for
lingual bracket
bonding
• Placing the lingual
brackets directly
onto the
malocclusion model

• permits us to bond brackets in the
laboratory at an accurate distance from
the occlusal edge of each tooth with
respect to a horizontal occlusal plane.

• The model is tipped
on the swivel base
until the long axis of
the labial face of the
tooth aligns with the
specific gauge
curvature at the
middle third of the
tooth

• The gauge or torque
blade orientates the
tooth in its final
position.
• This orientation
allows us to
preprogram torque
and angulation (tip)
before starting the
treatment

• After the TARG
horizontal blade is
engaged into the
bracket slot, it is
moved toward the
varnished plaster at
the bonding level
determined by the
laboratory
technician

• The bracket is
bonded to the
plaster with a filled
resin, which allows
the gap between the
lingual tooth surface
and the metal base
of the bracket to be
completely filled

• Once all the brackets are bonded to the
model, a transfer tray is fabricated.
• an accurate and quantified two-
dimensional system
• The torque, angulation (tip), and height
measurements are registered by the
technician.

• TARG does not take
into account the
labiolingual
thickness of the
teeth.
• So it did not allow
preprogramming of
in and out bends for
individual teeth

Fillion’s Lingual Indirect
Bonding System
• DIDIER FILLION
improved TARG in 1987
by adding an electronic
device to the machine
with the purpose of
measuring tooth labio-
lingual thickness
• This composed of two
elements—a Thickness
Measurement System
(adapted for the TARG)
and the DALI program

• One end caliper
(MITUTOYO), is
engaged into the
bracket slot, and the
other one is applied
to the labial tooth
surface

• For a selected height
bonding level, the
Thickness
Measurement System
records the thickness
(the width of the teeth
with bracket) of the six
anterior teeth.
• The greatest thickness
is chosen as the
standard thickness

The Customized LingualAppliance Set-Up Service
(CLASS) System
• Account the anatomical discrepancies in the
lingual surfaces of the teeth
• First constructing an ideal diagnostic set-up from
a duplicate set-up model of the patient’s original
malocclusion.
• This ideal set-up or template is then used as a
physical guide to place the lingual brackets in an
ideal configuration.

The Customized LingualAppliance Set-Up Service
(CLASS) System
• The brackets are placed on the diagnostic set-up using
composite adhesive, which acts as a spacer between the
metal mesh pad and the individual dental surfaces.
• After the brackets are placed on the ideal diagnostic set-
up, they are next transferred back to the malocclusion
cast.
• At this point, transfer trays are fabricated so the brackets
can be delivered clinically via the indirect bonding
method.

. Transfer trays
• two-tray system processed on the Biostar
machine.
• The inner tray is a 1.5 mm Bioplast and
the outer tray is a 1.0 Biocryl.

• first seat the Bioplast
tray and bend it as
needed to gain initial
placement
• Once each flexible
section is seated, the
hard acrylic tray is
immediately placed
over it and pressure is
applied to bring the
adhesive and dental
surfaces into complete
contact

• The trays are
removed from the
model by soaking
the cast in warm
water for
approximately 30
minutes

• the trays are
sectioned in two or
three pieces per
arch to allow the
clinician complete
control over the
clinical bonding
process

Arch wires
• The main problem in the biomechanics of lingual
orthodontics is the short interbracket distances
• Biological tooth movement with a low and
continuous force and a constant moment/force
ratio in order to maintain a low stress/strain ratio

• Two different ways
– INCREASE WIRE LENGTH
– USE ELASTIC WIRES
• Shape memory alloys are ideal materials
because they have low Young’s modulus,
present a very small stress/strain ratio,
and have a large cross-section of wire to
achieve a maximum of control

• Mushroom shaped arch
wires.
• The compensatory first
order bends are placed
interproximally at cuspid
–bicuspid and bicuspid
–molar locations.

Biomechanical advantage
• Point of application of
the force in relation to
the center of
resistance of teeth

Sagittal plane

Vertical plane
• Maxillary incisors are best intruded along
their long axis into the broadest area of
alveolar process

Normal inclination

Labial inclination

Lingual inclination

Lower arch
• Easier intrusion
• Less labial inclination

Lower arch

Horizontal plane
• Coupling of force is difficult to apply

Horizontal anchorage
• Distal uprighting of
molars
• Distal rotation of molars

Vetical anchorage
• Buccal root torque
• Mesial tilted molars
• an intrusive force is applied to
the functional or lingual cusps
of the upper molars because
the appliance is placed near
these cusps.
• Therefore, the CO-CR
discrepancy caused by the
primarily initial contact and the
mandibular clockwise rotation
caused by the elongation of
molars are reduced.

• The primary changes induced by the
lingual appliance can best be categorized
as those dynamic effects on vertical,
anteroposterior, and transverse planes.

• Bite opening resulting from the lower
incisors occluding on the maxillary incisor
bracket bite planes
• In the low angle brachyfacial patterns
• posterior occlusion reestablishing in
approximately 3 to 4 months.
• In the mesiofacial and dolichofacial types

vertical bowing effect
• Excessive force
• Upper anterior teeth tip
lingualy
• Premature contacts b/w
the bite plane and lower
anteriors
• Posterior disclussion
• Mesial tipping of the
posterior

• Prevantive measures
• Reduce retraction force
• Placing glable bends and compensating
curve to increase intrusive force
• Place good lingual root torque in anterior
segment
• Highly resilient 0.017 X 0.025 TMA wires
• Medium sized outer bows of head gear
recommonded

Transverse bowing effect
• Upper arch
• Retracting force with
head gear
• Distal rotating force on 1st
molars
• Widen in premolar area
and constrict in 2nd
molars
area

• Prevantive measures
• Retractin wire with a compensating
bowing arch form distal to upper 1st
premolar
• Brackets placed slightly mesialy
• Brackets with small distal offset
• Transpalatal arch placed

Leveling, Aligning, Rotational Control,
and Bite Opening
• The objectives of this initial phase of therapy are to:
• 1. initiate tooth movement with light forces,
• 2. provide for a period of patient adaptation,
• 3. eliminate rotations,
• 4. level and align individual arches to permit wire progression,
• 5. obtain initial torque control when required,
• 6. establish posterior anchorage units with buccal segments,
• 7. initiate posterior segment control with extraoral traction and
transpalatal arch when required,
• 8. reduce any excessive overbite, and
• 9. gain space for rotations and additional bracket bonding.

• Anterior leveling
– Partial canine retraction: 0.016 TMA or lingual
arch
– Anterior leveling: 0.016 cu-NiTi or 0.017 x
0.017 cu-NiTi

Method of partial canine retaction
• LINGUAL ARCH
• Introductory appliance

Full arch wire with loops (.016 Cu-
NiTi)

Sectional wire( .0175 x .0175 TMA)

Rotation correction
• Power arm

Power arm

SMITH’S rotation tie

Rotation correction with loop

En masse retraction
• jsliding mechanics
• loop mechanics.
• Three
• different kinds of loops are commonly
used: closed helical loop , L-loop and T-
loop

closed helical loop

• Open bite cases with little need for upper
anterior torque control or active tipping of
anteriors;
• closure of small spaces.

L-loop

T-loop

• When maximum anterior retraction is
needed while maintaining anterior torque;
• when active intrusion of anteriors is
indicated ; and
• in seventy percent of total extraction
cases.

Sliding mechanics
– .016" TMA with Class I
elastic thread
– .017 x.025 TMA
– .016 X .022 SS lower arch
1. Minimum or moderate
anchorage cases with
upper second bicuspid
extraction
2. nervous patients who do
not want auxiliaries like
loops;
3. lower arch extraction
cases.

• Class II elastics to a
bonded Debnam cleat.

THANK YOU

Lingual main

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (20)

En vedette

En vedette (20)

Similaire à Lingual main

Similaire à Lingual main (20)

Plus de Indian dental academy

Plus de Indian dental academy (20)

Dernier

Dernier (20)

Lingual main

Notes de l'éditeur