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Lingual orthodontics /certified fixed orthodontic courses by Indian dental academy
 

Lingual orthodontics /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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    Lingual orthodontics /certified fixed orthodontic courses by Indian dental academy Lingual orthodontics /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

    • INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
    • • 1726 – Pierre Fauchard – first suggestion • 1841 – LeFoulon – first lingual arch for expansion & alignment • Combination of lingual with labial appliances • Appliance system – 1970s
    • • It was major competing appliance in early 20th century • Lingual arch introduced by John Mershon-1908 JOHN MERSHON • round Labial arch – – Lloyd S. Lourie Sr (1877-1959),; – Oren A. Oliver (1887-1965) – Lowrie J.Porter (1895-1981), • refined by Oren A. Oliver who incorporated fixed guide planes OREN A. OLIVER
    • 1. 2. 3. 4. 5. Lingual arch wire Auxiliary spring Lingual locking wire Half round vertical post Intermaxillary elastic hooks 6 7 8 9 10 Molar bands Intermaxillary elastic hooks Labial arch Vertical spring loop Buccal tubes
    • • To protect sumo wrestlers from soft-tissue injury from labial appliances • Concept in 1967, published the method – 1978 • First lingual multi-bracket system with mushroom shaped archwires • 3 slots – occlusal, horizontal, vertical Fujita K. New orth. Tr. with ling. brt mushroom arch wire appl. Am J Orthod 1979; 76: 657-675.
    • • 1975 – plastic brackets on lingual surface – easy to reshape for better fit (Lee Fischer Brackets) • Bonding failure, patient discomfort • ORMCO – Craven Kurz, Craig Andreiko, Frank Miller first generation Kurz bracket in 1976
    • • Craven Kurz • Jack Gorman • Bob Smith • Wick Alexander • Moody Alexander • James Hilgers • Bob Scholz
    • • to help refine bracket design (dimensions, torques, angulations, thickness, etc.), • to develop mechanotherapy techniques, • to create archwire designs, • to discuss treatment sequences, and • to determine case selection criteria.
    • • SFOL: Societe Francais Orthodontic Linguale ( France) – 1986 • ALOA: American Lingual Orthodontic Association – 1987 • ESLO: European Society of Lingual Orthodontics - 1992
    • • Following this initial euphoria- a period of frustration, disappointment and rejection, • Due to poor standard of completed cases • Reasons - Inadequate training, - poorly developed laboratory system, - unavailability better materials
    • • 1996- Craven Kurz, Creekmore, Wildman, Scuzzo together with other clinicians founded lingual study group • Relaunching LO
    • • Scuzzo and Takemoto- published series of articles & text book • Also developed lingual striaght bracket & technique, STb
    •  Reduced B-L dimensions  Conventional ligation  Reduced O-G dimension  SW slot  Twin design for rotation  Stability of the archwire in control  Easy arch wire insertion  Easy ligation  Active spring clip  Passive ligation- low friction slot  Hooks for ligatures and elastics  A bite plane
    • 1st Generation - 1976 - • Bite plane • Rounded margins • Hooks absent • Large brackets
    • 2nd – 1980 – Hooks on canine brackets 3rd – 1981 – Hooks on all brackets
    • 4th – 1982-84 – lower profile
    • • 5th – 1985-86 – bite plane more pronounced and torque increased; Molar brackets had accessory tubes for TPA
    • 6th – 1987-90 – Elongated hooks, TPA tube optional Hinge cap tube for 2nd molar
    • 7th – 1990 – square bite plane changed to heart shaped premolar brackets widened
    • • Kinja Fujita – 1979 • Anterior teeth and premolars – 3 slots – Occlusal Slot - 0.019” square • Rotation control & Archform control – Lingual Slot - 0.018”x0.025” edgewise • Vertical, Torque and Tip control – Vertical Slot • Auxillaries - 0.016” square
    • Molar Bracket – 5 Slots - Occlusal, 2 Lingual & 2 Vertical
    • • Thoams Creekmore – 1989 • Archwire slot opening in occlusal ascpect • Unitwin bracket “centered slot” concept
    • AJO-DO Volume 1989 Aug (120 - 137): Lingual orthodontics Its renaissance - Creekmore
    • Scuzzo Takemoto “Light Lingual Philosophy”
    • STb Comparison
    • • Less Lab Procedures • Low Friction • Low Forces
    • • Stephan Paige- preferred edgewise appliance labially, Begg light wire brackets more suitable on lingual surfaces
    • • Unipoint Combination Brackets • Bonding – Direct • Capable of controlling tip and rotations • Torque control – varying hieght on lingual surface • Auxillaries
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    • kuttydentist@yahoo.com
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    • kuttydentist@yahoo.com
    • • Logically the right and left brackets have to be transposed to allow for distal tipping when required. • Tipping is minimal, possibly due to very gingival bracket placement upper 3-3. Dr ZJ Weber - http://www.bracesbehind.co.za
    • Lingual Orthodontics
    • Lingual Orthodontics
    • State-of-the-art maxillary incisor bracket with vertical insertion direction. In this version, ligating can be done with simple elastic module or with German overtie. Positioning software allows optimum angulation of hook. Accessory occlusal hook is optional. First-generation premolar bracket with horizontal insertion direction (left) and stateof-the-art premolar bracket with vertical insertion direction (right).
    • Bracket bodies (blue) are loaded from bracket archive to dental arch fitted with individual bases (yellow). Whereas second and third order are preset, bracket body can now be shifted and turned in slot plane for optimal positioning. Bracket body and bracket base are then virtually fused.
    • In rapid prototyping, brackets are first produced in wax, applied in 0.02 mm layers. Red support wax required for 3D production is removed thermally. B, Wax lingual brackets before casting. C, Gold lingual brackets after casting.
    • System Includes • iBracket Customized Brackets – Low profile brackets for patient comfort – Large, anatomical-shaped bracket base to reduce bracket loss – Easy to bond and to remove. • iWire Precision Archwires – A three or four-wire sequence is designed with a dental CAD/CAM system and then fabricated using robotic wire bending technology. – SMA wires for initial stages – Stainless steel or TMA for finishing. – Precise wire fabrication means few if any wire adjustments at chairside. • iTray Indirect Bonding Trays – Indirect bonding trays are included with each bracket set to ensure easy, precise bracket placement every time.
    • • Most malocclusions can be treated but not all patients particularly pts with low discomfort tolerance. • LO is technically sensitive and clinicians needs to be slective.
    • • Mild crowding and Ant deepbite. • Long & uniform lingual tooth surfaces. • Good gingival & periodontal health • Compliant pt • Skeletal cl I malocclusion • Normo or hypo divergent growth pattren • Pts who are able to open mouth widely & extend their necks
    • • Hyperdivergent growth pattern- open bite cases • Short, abraded & irregular lingual surfaces • Presence of multiple crowns, bridges & large fillings • Pts with low level compliance • Pts with limited mouth opening & Cervical ankylosis • Surgical cases
    • • Very Short clinical crowns • Pts with severe TMD • Pts with severe periodontal diseases
    • • Evaluate pts level of co-operation and level of discomfort tolerance • Most of the LO pts have mutilated malocclusions • Special considerations are needed
    • Pt should be warned about • Speech difficulties – 2-4 weeks • Tongue irritation • Initial wt loss • Strict oral hygiene instructions
    • • General • Periodontal & gingival • Presence of crowns & large restorations • Dentoalveolar discrepancy • Vertical, Ant –post and transverse skeletal/dental problems • Surgical cases • Preprosthetic cases
    • • Teeth movement slower in adults- less trabeculted bone
    • • Pt should have healthy periodontium & able maintain • Gingival inflammation is more - proximity of brackets - failure to remove flash • LO indicated in pts with a predisposition to gingival recession
    • Gingival inflammation can be minimized by • Bending hooks to reduce gingival impingement • Prophylaxis at each archwire change • Use of liquid adhesive & correct quantity of adhesive • Carefully maintain & control the effect of tooth movement on gingival tissues
    • • Pts with high risk of caries & with decalcifications can be treated with LO • Lingual surfaces of incisors < 7mm & bicuspids with short lingual surfaces should be reconstructed • Gingivectomy to increase crown height • Recontour – prominent cinguli, cusps of Carabelli
    • • Special bonding techniques for plastic, metallic, porcelain surfaces • Replace metallic crowns with acrylic crowns • Section bridges • Provisional restoration for fractured or microdontic teeth
    • • Built-in bite-planes – Posterior open-bite • Open-bite – 2 mm – occlusion re-establishes in 20-30 days
    • Bite-blocks on lower molars when - • Posterior open-bite > 3 mm • Only one lower incisor contacts upper bite planeperiodontium cannot withstand trauma - TRIPODING
    • Measures for vertical molar anchorage control in hyperdivergent cases • bite blocks on second molars • TPA • Headgear • Minimal use of intermaxillary elastics
    • • Skeletal Class I – easiest • Downward & backward rotation of mandible- Class I to Class II • Important to assess initial overjet and overbite before starting treatment
    • Class I with excessive overjet Class I reverse overjet
    • Skeletal Class II and Class III – • Mild cases treated successfully by camouflage • Severe cases – orthognathic surgery
    • • Posterior cross bites should be treated before starting LO • Expansion should maintained stable b/n Impressions & bonding
    • • Many surgeons may refuse to carryout surgery with LO • Best possible Presurgical tooth position should be achieved to minimize post surgical Rx • Possibility of labial brackets just before surgery • Surgical fixation can be done with miniplates & screws
    • • Takemoto bonds SS wires with crimpable hooks
    • • Preprosthetic segmental LO mechanics are rapid, economical and comfortable • LO techniques can be successfully combined with micro implants in preprosthetic cases
    • Smith, Gorman, Kurz and Richard Dunn 1) Patient selection 2) Bracket placement accuracy 3) Indirect bonding 4) Vertical & transverse control of buccal segments 5) Double-over ties on anterior teeth 6) Buccal & lingual molar attachments
    • 7) Correcting rotations 8) Arch form & archwire sequence 9) Archwire stiffness and torque control 10) Enmass retraction 11) Light, resilient wire for detailing 12) Gnathologic positioner and retention
    • • LO provide stronger anchorage control than labial appliances A-P anchorage • Anchorage Vertical anchorage Lower anchorage > upper anchorage
    • • Takemoto – cortical bone anchorage by distal rotation & buccal root torque of molars • Removal of tongue pressure – reinforces the anchorage
    • • Alexander, Gorman et al –bite plane effect reduces anchorage achieved with LO • Craven Kurz- superior anchorage control because of small arch perimeter
    • Silvia Geron- 6 anchorage keys 1) Extra palatal root torque for ant, molar tubes placed off-center in more mesial position. 2) Reduced friction by using bidimensional archwiresrectangular ant section & round post section or Larger slot size for post teeth 3) Bite blocks on molar teeth
    • 4) Light cl I, II, III forces for retraction 5) Incorporation of second molars 6) Exaggerated curve of spee in max arch wire
    • I. Extra palatal root torque for ant, molar tubes placed off-center in more mesial position II. Reduced friction by using bi-dimensional archwires Rectangular ant section & round post section or Larger slot size for post teeth III. Bite blocks on molar teeth IV. Light cl I, II, III forces for retraction V. Incorporation of second molars VI. Exaggerated curve of Spee in max arch wire S. Geron, A.D.Vardimon. Six anchorage keys in lingual orthodontic sliding mechanics. World Journal of Orthodontics Vol.4, 2003 (pp. 258-265).
    • • Difficult of directly viewing and access, particularly of retroclined teeth • Variation in morphology of the lingual surfaces, especially the maxillary anterior teeth • Wide range of labio-lingual thickness from 4.6mm LI to 9.2mm in canines – numerous in-out bends • Critical relationship between the vertical height of the lingual brackets and the labial surface torque, due to the distance of the lingual brackets from he labial surfaces • Much smaller inter bracket distance in the anterior region, making compensatory bends difficult
    • • Reduces chair side time • Shortens treatment time • Improves final result Programmed brackets - spatial position of bracket slot – final tooth position Position – final tip, torque , height and rotation
    • • Tooth morphology of lingual surface is highly variable • Can alter built in tip and torque
    • • Same bracket ht on diff lingual surfaces produce diff torque values
    • • TARG (Torque/Angulation Reference Guide) • BEST ( Bonding with Equal Specific Thickness) • CLASS (Custom Lingual Appliance Set-up Service) • Slot machine • KIS (Korean Indirect bonding Set-up system) • Ray Set • Hiro • TAD/BPD
    • • By Ormco in 1984 • Brackets are placed on malocclusion model
    • • Torque blades prescribe torque & angulations for each bracket • Does not consider diff thickness of the teeth • 1st order archwire bends are necessary
    • • Creekmore • Orients the arch wire slot of bracket according to the facial surface of the tooth • Accomplished by holding the arch wire slot stationary while manipulating each tooth to any tip, torque angle, rotation angle and height through the use of orientation templates and a rotation guide. • Both horizontal/ vertical slot brackets can be used
    • • In 1987- Didier Fillion improved TARG by adding electronic device • Measures labio-lingual thickness • DALI { Dessin Arc Linguale Informatise} - Computer generated arch wire tracing
    • • Electronic TARG & the DALI – BEST system
    • • Set-up is done according to doctors prescription • Special device used to place brackets considering all planes of space • Custom bases for each made
    • • 3-D goniometer control system determines 1st , 2nd & 3rd values for each tooth
    • • Models mounted on hinge articulator
    • • Ray Set template to check the degree of rotation
    • • Tip assessment “0” tip Required tip
    • • Vertical precision gauge to determine bracket ht
    • • Torque assessment
    • • Set-up with over corrections
    • • Invented by Toshiaki Hiro, improved by Takemoto & Scuzzo • No need to purchase costly electronic devices • Uses 018 ×025” SS wire as a transfer tool
    • • Set-up model • Vertical arch position- Ray Set
    • Maxillary arch – mark mid points molars & extend line on to the anteriors • line – with in lower 3rd of incisors • Gingival clearance – 1.5mm Mand arch- mid points of premolars • Inscisors – middle third
    • • Ideal arch forms prepared for both arches & co-ordinated
    • • Individual trays-ultra band-lok
    • • Customizing the bracket base
    • • 3-D reference arch wire
    • • Ideal set up model • Brackets bonded using lingual bracket positioner – holds brackets at the same level • Transferred to malocclusion model – Ready made convertible resin core (CRC)
    • • ideal set up model •Brackets bonded - set up model – slot ss measuring plates and stereoscopic camera •Robot designs archwire – passively fits bracket •
    • • Dirk Wieshmann • Customized Archwires • ECO- lingual therapy • Reduces number of archwires required – 0.016x0.022 Cu NiTi – 0.016x0.022 SS - retraction – 0.0175x0.0175 – finishing • TARG Pro
    • • Reduces bracket losss • Reduced gingival irritation • Increased patien comfort • Simplified finishing process
    • • Isolation –dry field system
    • Etching Apply Primer & bracket adhesive
    • • Removing core
    • • Bracket ht marked- Anderson gauge
    • • Weld tube slightly mesial on upper molars, center for lower molars
    • Interbracket distance in LO lesser Stiffness of arch wire increases Rotational moment decreases
    • Clinical implications of this – • More difficult to correct rotations – difficult to achieve efficient coupling • More resilient, lower size wires necessary to correct crowding
    • Miner tendency of anterior rotation when force applied in M-D direction More crown rotations of posteriors
    • Prevention Reduce retraction forces Increasing intrusive forces Increasing lingual root torque Allow the wire to express torque for 6-8 weeks  should not be retracted on round wires
    • • Introduction • Patient selection and diagnostic considerations • Lingual laboratory procedures • Clinical bonding technique • Special biomechanical considerations in LO • Anchorage in LO • Extraction mechanics • Finishing protocol • Retention
    • • Extraction choices often differ in LO • Cl I cases • Upper 1st premolars & lower 2nd premolars • Cl II cases Max anchorage - 4 4 4 4 ext, lower stripping 4 4 ext, lower incisor ext / one premolar Moderate anchorage 4 4 5 5
    • • Cl III cases - distal tip lower molars improves cl lII - 4 4 5 5 4 4 4 4 4 4 - incisor only - surgery or
    • • Timing of Xn of lower II premolars – after leveling
    • • Esthetic pontics
    • 1) Anterior leveling • Partial canine retraction Lingual arch
    • Full arch wire with loops (014NT, 016 NT, 016 TMA)
    • • Sectional wire(016 x 022 NT, 0175 x 0175 TMA)
    • Anterior leveling (016 Cu-NiTi, 017x017 Cu-NiTi)
    • • Rotation correction • Power arm -
    • • Smith’s rotation tie
    • • Torque leveling (0175 x 0175 TMA, 0175 X025 TMA)
    • • Torque leveling is complete- bite planes are parallel to occlusal plane • Inadequate torque – anchorage loss
    • • Enmass retraction (upper arch- 017 x 025 TMA)
    • Upper arch – Max- TPA, Headgear, cl II elastics 5-7 race- back tie Minimum anchorage- 3-6 circular elastics cl lll elastics
    • • Anchorage control in lower arch- strong anchorage – often difficult to move mesially • Minimum anchorage – cl II elastics in combination with open coil sprigs b/n 1st & 2nd molars & circular elastics
    • Ideal arch form after space closure
    • Ideal arch coordination
    • • Lingual st wire brackets – to reduce cumbersome wire bending • More lingually and more gingivally placed
    • • Comparison b/n Kurz bracket & STb bracket
    • Rotation correction
    • Expansion Rebonding
    • Difficulties encountered in finishing are derived from 1. Patient characteristics - Restorative & Periodontal complications - Thickness of tooth varies - Compensating bends are less accurate & less effective
    • 2. Anatomy of lingual surfaces 3. Mechanics of LO Uprighting Torque Rotations
    • Prevention of finishing problems • Correct diagnosis & Rx planning- asymmetric extractions • Precise bracket bonding • Light forces to avoid side effects
    • Silvia Geron – systematic finishing protocol Step 1 of finishing protocol - Reuse of resilient arch wire for 3-4 months(017x017 Cu-NiTi) - Reposition the brackets
    • Step II finishing protocol • Settling the occlusion, midline correction, A-P & vertical discrepancies • Lower 0175 x 0175 TMA, upper 014 sectional wire canine-canine • Vertical elastics for 4-6 weeks
    • Step lll finishing protocol • Final detailing & finishing bends • Pablo Echarri- finishing wire bends on models • Upper arch 0175 x 0175 TMA • Lower- 016”TMA
    • • Adult patients -esthetically demanding • Gingival recession, missing teeth, occlusal wear – requires dental procedures • Limited time to wear retainers
    • • Clear retainers
    • • Wrap around plastic retainer- QCM wire
    • • Bonded lingual retainer-0.012 SS wire • Zachrisson-0.030”SSwire bonded only to canines
    • • Positioners - detailing
    • Smith, Gorman, Kurz and Richard Dunn 1) Patient selection 2) Bracket placement accuracy 3) Indirect bonding 4) Vertical & transverse control of buccal segments 5) Double-over ties on anterior teeth 6) Buccal & lingual molar attachments
    • 7) Correcting rotations 8) Arch form & archwire sequence 9) Archwire stiffness and torque control 10) Enmass retraction 11) Light, resilient wire for detailing 12) Gnathologic positioner and retention
    • Pre Rx Post Rx
    • • Revisiting the history of lingual orthodontics: Abasis for the future- Pablo Echarri ; Seminar orthod 2006;12:153-159 • Lingual orthodontics: patient selection and diagnostic considerations. Pablo Echarri, Seminar orthod;2006;12:160166 • An overall view of the different laboratory procedures used in conjunction with lingual orthodontics. Buso-Frost and didier fillion
    • • Invisible orthodontics-current concepts and in lingual orthodontics; Giuseppe Scuzzo, Kyoto Takemoto • Anchorage considerations in lingual orthodontics. Silvia Geron: Seminar orthod 2006;12:167-177 • Concepts on control of the anterior teeth using the lingual appliance; Rafi Romano. Seminar orthod 2006;12:178-185
    • • Keys to success in lingual therapy –part 1; smith, Gorman, craven Kurz and Richard Dunn; J Clin Orthod 20;252261,1986. • Keys to success in lingual therapy –part 2; smith, Gorman,craven Kurz and Richard Dunn; J Clin Orthod 20;330340,1986.
    • Thank you For more details please visit www.indiandentalacademy.com