Lingual course syllabus oct 2012 Romano-Geron


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Lingual course syllabus oct 2012 Romano-Geron

  1. 1. LINGUAL ORTHODONTICS COURSE SYLLABUS Basic, Advanced and Laboratory Lingual courses Geron S., Romano R.
  2. 2. 2 Contents 1. Lecturers……………………………………………………………………………………… 3 2. Introduction ………………………………………………………………………………… 4 3. Treatment principles A. Lingual appliances: Stealth, Harmony- American Orthodontics (5); 2D-Forestadent (7); Fujita 98); STB (Ormco) (11); Evolution-Adenta (14); Incognito (16); E-brace (20); Innovation-L, MTM, E-Clips-GAC (22) Kurtz- 7th Generation-Ormco (24); ORG-ORJ 3M (25); Magic- Dentarum (27); Phantom-Gestenco (28); Lingual Jet- RMO; IdealLeone; Medix 21- Hiro (29) ………………………………………… B. Lingual arch form……………………………………………………………… C. Ligation ……………………………………………………………………………… D. Treatment steps……………………………………………………………… E. Case selection…………………………………………………………………… F. Guidelines for lingual treatment: ……………………………….. 1. Proper patient selection 2. Correct brackets & lab preparation 3. Correct clinical treatment 4. Biomechanics 4. Laboratory and clinical procedure A. CLASS system (40); TARG (41); Slot Machine (42); Lingual Bracket Jig (43); KSLO (45); Mushroom (MBP) (45); TOP ; HIRO (48); Modified HIRO (53)…………..….. B. Bonding Procedure……………………………………………………..……… C. Banding and Welding………………………………………………..…..….. D. Esthetic Pontic………………………………………………………………….. E. Debonding……………………………………………………………….………….. F. Retention………………………………………………………………………….... 5-32 33 33 34 35 36-39 40-55 56 57 57 57 58 5. Typodont exercise A. Preparation for Typodont Exercise: …………………………..…………. Instrumentation …………………………………………………………………………. Double Overtie; Ligature Overtie; Rotation Tie; Chain Overtie 59-61 60 61 B. Extraction case: Steps 1-5 (from Alignment to Finishing) …… Torquing with 2D plus … Forestadent ……………………………………………… 62-69 70 6. Advanced course - Guidelines for Lingual Orthodontics treatment…. 71-72 Appendices Appendix I: Recommended Course Materials………………………………………… Appendix II: Instructions for LO patient after bonding…………………… Appendix III: Indirect Bonding with the Lingual Bracket Jig……….... Appendix IV: List of laboratories for Lingual Orthodontics ……….…. 73 74 75 77 References………………………………………………………………..… 79
  3. 3. 3 Lecturers Dr. Silvia Geron is a specialist in Orthodontics and Dentofacial Orthopedics. Dr. Geron maintains a private practice limited to orthodontics, Emphasizing Lingual and adult Orthodontics. She is the Director of Lingual Orthodontics in the international postgraduate orthodontic program in Tel-Aviv University, and Tel-Hashomer Hospital, IDF, Israel, Presidentelect of the Israeli Orthodontic Society (IOS), Secretary and founding member of WSLO (world society of Lingual Orthodontics (, Examiner of the Israeli Dental Association Scientific Council-Orthodontic Examination Committee, Reviewer for the American Journal of Orthodontics and Dentofacial Orthopedics, Reviewer for the Angle Orthodontics. The founder and the editor of the electronic Adult and Lingual Orthodontics journal (, and was the founder and scientific editor of the Journal of Israel Orthodontic Society (JIOS). Dr. Geron invented a unique technique and device that enables direct and indirect lingual bonding. She is an active member of the European Society of Lingual Orthodontics (ESLO), the American Association of Orthodontists (AAO), the World Federation of Orthodontists (WFO), the American Lingual Orthodontists Association (ALOA) and the Israeli Orthodontic Society (IOS). Dr Geron runs courses and lectures on the subjects of Adult and Lingual Orthodontics internationally. The essential element of her lingual treatment is simplification of the lingual technique. Dr. Rafi Romano is a specialist in orthodontics and dentofacial orthopedics, earned at The Dental Faculty, Hebrew University, Hadassah Jerusalem. He maintains a private practice in Tel Aviv, Israel, limited to orthodontics, with an emphasis on adult and esthetic orthodontics. Dr. Romano is the Editor-in-chief of "Orthodontics: The Art and Practice of Dentofacial Enhancement," Quintessence publishing (formerly, “World Journal of Orthodontics” –WJO) He is also a clinical instructor in the Department of Orthodontics, Tel-Hashomer Hospital, IDF, Israel. Dr. Romano is past president of the Israeli Orthodontic Society (IOS) and past secretarytreasurer of the International Federation of Esthetic Dentistry (IFED). Dr Romano is an active member of the European Academy of Aesthetic Dentistry- EAED, the American Association of Orthodontists- AAO and the World Federation of Orthodontists - WFO. He is former editor of the Journal of the Israeli Orthodontic Society, and editor of four books: Lingual Orthodontics, (Decker, 1998), The Art of the Smile (Quintessence, 2005), The Art of Treatment Planning (Quintessence 2009) and Lingual & Esthetic Orthodontics, (Quintessence 2011). A fifth book, The Art of Detailing, is now in the pipeline, also to be published by Quintessence. Dr. Romano is an Invited Professor at the Department of Facial Orthopedics and Orthodontics, Specialization and Master course, University Paulista UNIP, Sao Paulo, Brazil. He is also Visiting Professor of Lingual Orthodontics at the University at Alcalá, Madrid, Spain. He lectures worldwide on esthetic orthodontics and adult multidisciplinary orthodontic treatment and conducts courses in lingual orthodontics around the globe. He lectures all over the world on the topics of lingual orthodontics and adult multidisciplinary orthodontic treatment.
  4. 4. 4 Introduction Esthetics is one of the major goals in orthodontic treatment. Lingual Orthodontics is the only treatment modality that does not deteriorate the physical appearance of the patient during the treatment. For the patient, Lingual Orthodontics has several obvious advantages over labial appliances. Many adults would prefer to have invisible brackets, when recommended by their clinician, as an appliance that will give them comparable results to the labial appliance treatment. There are also some mechanical advantages of the lingual appliance in cases of deep bite cases. However, orthodontists have been hesitant to use Lingual Orthodontics because of its complexity. There are many differences in the lingual aspect that make lingual treatment more complex than the labial. Over the last 20 years there have been many improvements in appliance design, laboratory and bonding procedures, and in clinical mechanical technique, that simplifies the lingual treatment. Thanks to the pioneers in Lingual Orthodontics, Dr. Craven Kurz, Dr. Fujita and the Lingual Task Force of ORMCO Company, the lingual technique today is almost as easy as the labial technique, and with the same degree of control. The aim of this course is to introduce the Lingual Orthodontics concepts and treatment in a simplified way, in order to encourage the orthodontist to use this important treatment modality regularly in his practice.
  5. 5. 5 3. Treatment principles A. Lingual appliances 1. Stealth (American Orthodontics) •The Stealth lingual bracket system combines clinical design concepts with American's sophisticated machining technology to produce a clearly superior bracket for the lingual practitioner. • Compact size and smooth contours for increased patient comfort and better hygiene • Full wire control with reduced friction • An integrated vertical slot from anteriors through first molars yields expanded versatility and treatment options • Reduced mesio-distal dimensions means greater interbracket distance • Generous pad size for increased bond strength and adaptability to varying crown anatomy Stealth Bite Plane • Inserts into vertical slot and held in place by ligature • Effective to open bite in deep bite cases • Sold in packages of 12 Downloads: Catalog Pages
  6. 6. 6 2. Harmony (American Orthodontics) The HARMONY System attaches to the interior side of your teeth, so no one knows you are wearing braces but you. Your orthodontist designs your perfect smile using state of the art technology. The process begins with a digital scan of your teeth, which are ideally aligned following your orthodontist’s treatment plan. A fully customized solution, including robotically bent arch wires are created just for you. Each HARMONY System is uniquely customized to achieve your perfect smile quickly and efficiently. The HARMONY System offers many benefits. 1. Fast treatment time 2. Short appointments 3. Amazing results The HARMONY System is engineered to be small and smooth, which helps you adapt quickly and comfortably to your orthodontic treatment. The self ligating technology that is built into the HARMONY System offers more control in the hands of your orthodontist to achieve precise tooth alignment. Self ligating technology does away with elastic O-rings, so friction in the system is reduced which leads to a more comfortable experience throughout treatment.
  7. 7. 7 3. 2D-Forestadent ( Outstanding patient comfort Forestadent lingual brackets are available as 2Dbrackets for treating less complex and 3Dbrackets for complex cases. They have an extremely low profile and are barely noticeable for the patient. Easy to use The 2D and 3D lingual-brackets are easy to use self ligating-brackets with a vertical slot for fast and easy archwire insertion. 2D-Lingualbrackets The 2D -lingual brackets are ideally suited for clinicians who would like to gain experience in lingual orthodontics treating less complex cases. Because of the unique bracket design no large inventory is required helping to control cost. The 2D Philippe lingual bracket system is a cost effective way to introduce lingual orthodontics in any practice. 3D torque lingual brackets An indirect laboratory based lingual setup with pre programmed lingual NiTi archwires for excellent treatment results. Forestadent 3D torque lingual brackets have an extremely low profile and are barely noticeable for the patient. The unique design permits fast treatment progress through excellent biomechanics.
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  9. 9. 9 4. Fujita •Main Vertical slot •Auxiliary vertical slot Update on the Fujita lingual bracket. Hong RK, Sohn HW. J Clin Orthod. 1999 Mar;33(3):136-42 Department of Orthodontics, Seoul, Korea.
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  11. 11. 11 5. STB (ORMCO) (Scuzzo-Takemoto Brackets) The STb Light Lingual System delivers superior outcomes – efficient, simplified and faster treatment as well as greater patient comfort – for all levels of cases. A first in lingual orthodontics, STb utilizes a new passive self-ligation design for dramatically reduced friction and lighter forces. Developed by two of the leading lingual practitioners in the world, Drs. Giuseppe Scuzzo and Kyoto Takemoto, the STb system comprises the most advanced lingual technology, making it incredibly comfortable for the patient and very easy to use – even for clinicians new to lingual.  With STb, patient compliance issues disappear as you no longer need to worry about misplaced aligners or interruptions in treatment time.  Unique to lingual brackets, STb has minimal impact on tongue position and speech; clinical studies have demonstrated that the negligible speech difficulty disappears within a few days of bonding. STb brackets have the lowest bracket profile at just 1.5 mm.  STb is the ideal solution for those cases that are not suitable for aligner treatment, because they require the high level of control that only fixed appliances can provide.  The STb Light Lingual System is applicable to all levels of cases, and our recently introduced STb Social 6 is ideal for minor to moderate cases involving anterior teeth.  STb cases can be prepared with a standard indirect setup by AOA Lab or in your own practice. In most cases STb does not require a full T.A.R.G. or C.L.A.S.S. setup, making it far simpler and nearly half the cost of other lingual setups.
  12. 12. 12 Because the size of the STB bracket is approximately half the size of the Generation #7 bracket and is rounder in shape, the well known problems of eating, speaking and cleaning with lingual appliances almost disappear.
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  14. 14. 14 6. Adenta – Evolution Welcome to the next Evolution in Lingual Orthodontics...The Evolution Selfligating bracket system provides you with a complete and precise indirect Hiro bonding technique, partnered with the Evolution Self-ligating Lingual bracket. But this is NO ORDINARY SELF-LIGATING bracket! An interactive flexible self-ligating clip plays a key role - Conventional brackets tied with a ligature produce considerable friction, we all know that friction slows down the leveling and unraveling process. Unlike many other self-ligating brackets that only lock closed and no longer play a role, the Adenta self-ligating bracket was designed with a flexible type clip, chosen for its ability to work for you actively through-out treatment. Programed to hold even a non-seated wire securely with just the right amount of pressure, continuously pushing the archwire to the base of the bracket slot. This constant pressure produces the torque, angulation and in-out control required to finish your cases quickly and efficiently. Evolution Self-ligating Lingual Bracket Prescription These high performance self-ligating clips have added benefits... Passive and Active •Passive with wires smaller than .018” producing near frictionless movement, increasing the efficiency of the leveling stage. •Activated with wires larger than .018”, early torque control increase treatment time and efficiency. Built in Safety Release
  15. 15. 15 •Self-ligating clip is designed specifically to not overpower the periodontium, this insures the protection of the peridont, a force higher than 1100gms will release and alleviate pressure appropriately. •Enables the insertion of larger wires early in treatment of rotated teeth. •More comfortable for the patient as pressure is alleviated on over stressed teeth. Gauge of clip •Clip produces an average of 650gms of force when active, optimal force needed to control treatment. •Sturdy clip withstands the rigors of numerous wire changes. Easy to open and close •The self-ligating clip is designed to work like a spring, very little force is needed to open and close the bracket, creating optimum handling for the doctor and comfort for the patient. Evolution in-direct SMART bonding system... faster, cleaner, precise and re-usable Straight wire appliances make it imperative that the brackets be positioned with accuracy in order to fully exploit the interaction of their written prescription. The Evolution in-direct SMART bonding system assures the total compliance of the doctor’s prescription, using each tooth’s individual morphologic anatomy, while allowing the newly prescribed set-up to retain the doctor’s values. The new torque and axis inclinations created through the set-up allow more precise biomechanics, giving the clinician accurate and predictable control during the different phases of the lingual treatment. Evolution in-direct SMART bonding system... faster, cleaner, precise and reusable!
  16. 16. 16 7. Incognito 3M Our new INCOGNITO Bracket System differs fundamentally both in design and in manufacturing methods from existing appliances. Using state-of-the-art CAD/CAM technology, the two normally separate processes of bracket production and bracket positioning are fused into one unit. In this process, the demand for maximum individuality with simultaneously minimized space requirements is put consistently into practice. In addition, bracket manufacture by a Rapid Prototyping technique permits direct transfer to clinically purposeful further developments. The new INCOGNITO Bracket System is based on digital registration of the malocclusion situation. The brackets are then individually designed and optimally positioned in the computer. Stateof-the-art Rapid Prototyping technology is used for the actual manufacturing of the lingual brackets. The single production stages are illustrated and described under production. The new INCOGNITO Bracket System presented here is designed to deal, among other aspects, with the three main problems of lingual orthodontics: 1. patient discomfort during the adaptation phase. 2. difficulties in exact indirect rebonding in the event of bracket loss 3. exact finishing. 4. lower profile The thickness of the appliance obviously has a substantial influence on the scale of the impairment to the patients' comfort regarding speech disturbances and irritation of the tongue. Our main objective was therefore to develop as lowprofile an appliance as possible, one that is not much thicker than a bonded retainer especially in the buccal segment. The three development stages set out below are of crucial importance: a. 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. b. The fact that the archwire runs parallel to the tooth surface gives it its characteristic platform shape in the anterior segment. The actual bracket body can
  17. 17. 17 consequently be much more delicately shaped (see production). The resulting archwire morphology differs substantially from the previously customary design. Such archwires can be precision-manufactured using the bending robot described under production. c. Maxillary bite plateaus are used selectively: only in cases of deep bite and even then only in the canine region (Figure 5). The enhanced wearing comfort resulting from these innovations is clearly reflected in clinical terms especially in patients being treated with conventional brackets in one arch and with the new bracket system in the other. They all find the new bracket system substantially more comfortable, reporting fewer problems and shorter adaptation times in the relevant arch. In addition to the enhanced wearing comfort, a lower-profile design also contributes to a reduced bracket loss rate due to the consequently shorter lever arm in the event of masticationinduced shearing. 5. Rebonding The extensive individualized base of the new lingual bracket, which covers much of the lingual tooth surface, allows each single bracket to be directly bonded. This means that a bracket can be directly rebonded without the additional support of positioning aids such as unitary silicone trays in the case of a single bracket being lost. The exact correspondence of the interfaces results in a positive lock when the bracket is pressed onto the tooth, making incorrect positioning unlikely. In addition, in cases of less characteristic tooth morphology, as found in particular in the mandibular anterior region, the exact direct positioning of the lingual brackets can be controlled by means of screen shots from the manufacturing process. 6. Finishing one major problem in the finishing of a lingual case is the production-induced inaccuracy of the slot and archwire dimension. In most cases the archwires are smaller than specified, while the bracket slots tend to be larger than specified. This results in varying torque play, which may lead to substantial finishing problems in some cases even when nominally slot-filling archwires are used. If the appliance is at a greater distance from the labial surface of the tooth in
  18. 18. 18 terms of a greater positioning thickness, these problems are increased more or less proportionately. Especially the impact of an incorrect torque on second-order aspects is of very great clinical significance. For instance, a torque deviating by only 10° in the anterior region results in a mean vertical deviation of 1.2 mm. Because of the greater positioning thickness, this correlation is even more pronounced in the buccal region. As the new lingual brackets are manufactured by a Rapid Prototyping technique, the size of the bracket slot can be adapted individually and exactly to the dimension of the finishing archwire. In addition, the single bracket slots are more precisely dimensioned. According to provisional measurements, the difference in size between the smallest and the largest slot in the anterior region is only 0.008 mm, corresponding to a calculated angle of rotation of only 0.7°. As the archwire moreover Contacts the teeth much more closely with the new bracket series, the residual inaccuracy will have a less pronounced clinical impact. Finishing problems resulting from primarily incorrectly positioned brackets, as may occur sporadically with conventional laboratory processes, are almost completely ruled out in the purely virtual procedure presented here. As the new brackets can also be directly precision-bonded on account of their large base, bracket loss is less likely to lead to inaccurately rebonded brackets. Other advantages In addition to the at least partial solution to the main problems previously existing, the innovative design of this lingual bracket series provides further features improving clinical handling properties. 1. Another advantage of our new INCOGNITO Bracket System is the vertical slot. With it corrective derotation of teeth can be performed along the archwire even without the additional application of lasso elastics. The ligation itself is performed with so-called German Overties (GOT). In the ligation process, the archwire is clearly deflected, thus contributing in addition to enlargement of the dental arch. This procedure is increasingly superseding more complex mechanics such as the frequently used advancement stops. 2. Furthermore the modular bracket structure of our new system allows the single components (base, bracket body, hook) to be positioned independently of one another, thus differing markedly from previous systems. Even in cases of rotated
  19. 19. 19 teeth and short clinical crowns, the available enamel area of the tooth can be optimally utilized. 3. Manufacturing the new bracket system by a Rapid Prototyping technique gives it great flexibility. Each individual bracket series can be adapted not only to the patient but also to the orthodontist. In addition, clinically promising modifications and further developments can be implemented immediately with minimum resource input and without involving any changes in the production process. 4. As the brackets are made of an alloy with a high gold content, they offer an interesting alternative especially for patients who are allergic to nickel. 5. The production costs are comparable with those involved in the manufacture and laboratory positioning of existing systems.
  20. 20. 20 8. E-brace E-Brace Lingual Bracket System Guangzhou Riton Biotech Co.,Ltd. Add: 301 R, 3/F, Building B, Industrial and Commercial trading park, Hainan town, Huadi Nan Road, Fangcun, Liwan District, Guangzhou, Guangdong, China TEL: 0086-20-81508200 FAX: 0086-20-81509362 Email: What is eBrace? EBrace Lingual System, one kind of customized lingual appliace can quickly and easily handle a great variety of clinical cases for orthodontists, the resulting short chair times as well as the highest patient comfort that is technically possible at present. A perfect smile means confidence and success in both your private and public life. You feel smile great not only it is amazing but it is healthy. Keeping teeth regular and clean is easier to give you a healthy smile. EBrace is completely invisible and easy to keep clean. It is designed according to each patient's teeth and can suffciently fix to the particular teeth surface. Both the brackets and the wires of the eBrace appliance are made individually with the latest state-of-the-art CAD/CAM technology. The remarkable flat design of the dental alloy brackets significantly improves the comfort to orthodontic correction. eBrace – is it for me? Would you like to own great smile and healthy teeth? EBrace is capable of aligning your teeth neatly and bring you back a perfect smile. If your answer is yes then eBrace is for you: · Any malocclusion can be corrected whether you are a teenager or an adult · the eBrace is the only truly invisible orthodontic appliance · the brackets are easy to clean · the treatment provides high-quality results · the individually flat design of the brackets and archwires ensures the maximum comfort to orthodontic correction. Where can I get eBrace? EBrace lingual system is exclusively used by certified orthodontists around the world. The certification ensures the successful treatment with excellent results. In case of using ebrace lingual appliance for tooth correction, please contact the certified doctor around your area to receive further details.
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  22. 22. 22 9. Innovation-L, MTM, E-Clips GAC recently introduced a lingual bracket, the In-Ovation-L (IOL), with innovative characteristics that improve the patient's comfort and takes into consideration these three concepts: -Proper oral hygiene and gingival irritation -Lingual irritation and Transient speech difficulties -Differences in tooth size and morphology The In-Ovation-L (IOL) brackets are small enough to allow sufficient inter-bracket distance, yet wide enough to have good rotation correcting control. This provides more space between the bracket and the gingival margin, thus allowing the patient to achieve better oral hygiene. the In-Ovation-L (IOL) anterior brackets can be placed in the deepest portion of the lingual fossa, better adapting to the anatomical contours. In particular the forked design built into the base, allow the base pad to be easily bent to fit to the complicated lingual shape of the cuspid securely. This adaptation reduces excess bonding material (resin) and decreases the area for plaque and calculus deposits to occur. Smaller bracket with smaller bracket base are available for the lower incisors.
  23. 23. 23 this bracket makes it possible by bending the base pad. Furthermore, it is possible to change the bracket torque and the position to be bonded easily by adjusting the angle of the extended base pad
  24. 24. 24 10. Ormco – 7th generation (Kurtz) The brackets are straight wire brackets, and they are available with .018’’ or .022’’ slot width. The characteristics of the brackets:  Rounded facial contours, to avoid lingual irritation.  Large hook enables attachment of springs and power chains.  Rounded opening to the slot to improve wire engagement.  Increased tie wing area, to enable double over tie  Bracket base is large to improve bonding.  Horizontal slot allows easier torque control.  Bite plan in the upper anterior brackets, is parallel to the occlusal plan and to the bracket’s slot. The bite plan directs the occlusal forces through the center of resistance of the anterior teeth, opening the bite and creating intrusion of the upper and lower anterior teeth.  Molar brackets are twin brackets with mesial ball hooks. There are also brackets with hinge cap molar tube to allow easier wire insertion. When transpalatal arches are desired, a special molar bracket with transpalatal sheath is used, a terminal tube is also available.
  25. 25. 25 11. ORG – ORJ 3M- (Romano-Geron) 1) Designed on recommendation of two famous lingual orthodontists and developed by ORJ, it includes all advantages of existed lingual brackets at present. 2) Smaller than 7th generation brackets and therefore less problems of irritation to the tongue and speech problems, patients will feel more comfortable. 3) Hooks of one-piece construction in all teeth to enable better ligation and less emergencies due to wire disengagement 4) Flatter bracket enables better oral hygiene and less occlusal contact interference. 5) Made of super hardness Stainless Steel 17-4 PH to avoid deformation of the bracket. 6) The design of 0.018 slots in anterior brackets and 0.022 slots in posterior brackets and tubes can close distance of posterior teeth easily because of low friction. 7) All the ORG brackets are processed by casting and automatic welding procedure. 8) 1st and 2nd molar lingual bondable tubes with 0.022” slots are available upon ordering
  26. 26. 26 1. Hooks of one-piece construction for all teeth to enable better ligation and less emergencies due to wire disengagement. 2. Flat bracket enables better oral hygiene and less occlusion contact interference. 3. The design of 0.018 slots in anterior brackets and 0.022 slots in both posterior brackets and molar tubes makes lower friction so as to close space of posterior teeth easily. 4. Smaller than conventional lingual brackets, therefore less problems on irritating tongue and talk problem, patients will feel more comfortable with rounded hooks and lower profile. Hangzhou ORJ Medical Instrument & Material Co., Ltd. locates in the beautiful city Hangzhou. ORJ team was the developer of the first generation orthodontic brackets in China. They had engaged in the subjects of designing and manufacturing orthodontic products for the domestic market at the beginning of 1990. And ORJ has the strong self-innovation capability, possesses the whole sets of modernized technology and process equipment after nearly 20 years of development. In the past years, ORJ has already obtained QMS certificate of ISO13485 and registration certificate of FDA for medical device. And our orthodontic brackets, tubes and bands had achieved CE certificate already. Our focus on research and development has transferred from a single orthodontic bracket into a complete orthodontic product system, which has been widely accepted by the people all around the world in the recent years. ORJ main products: orthodontic brackets, tubes, bands, pliers and orthodontic accessories. Through cooperation with local famous orthodontists from universities and hospitals and promotion on the ability of key technology, ORJ has enhanced the foundation for the advanced scientific theory and the solid clinical practice of the excellent orthodontic products.
  27. 27. 27 12. Magic –Dentarum During the development of Dentaurum’s magic® Lingual-System, the main emphasis was not only placed upon the importance of comfort for the patient, but also upon creating a simple procedure for the clinician. This user-friendly system stands out above other systems available on the market due to its large selection of primary and secondary products. It has the largest spectrum of products worldwide. All the individual components are perfectly suited and coordinated with one another, which enables effective and time saving application.
  28. 28. 28 13. Phantom- Gestenco
  29. 29. 29 14. Lingual Jet- RMO,3059,en.html Lingualjet - 4 technological innovations for the quality of the treatment. Articulated around 4 innovations, it allows to savetime and more precision compared to the current techniques, this offering the practionner a complete control of the reconstruction. The treatment is invisible, the line is perfect, the result is optimum The combination of four technological means offers a unique appliance collecting several advantages from each of them. Lingualjet reduces cost and chairtime. Its purpose is to make lingual orthodontics easier, more powerful and more comfortable for the patient as well as for the practitioner. 3d custom made brackets The brackets are manufactured applying CAD/CAF technology. 3D software is used to design every virtual bracket characterised by an extended surface of bonding on the lingual crown of the tooth and perfectly adapted to its anatomy. Re-bonding phase is facilitated. Open pores through the pad can be performed using a specific technology. Because of specific properties of retention on the pad, the RMO® - LingualjetTM brackets provide a high strength of bonding. All the slots are related to the virtual arch wire and are extruded of round shaped brackets with smoothed outlines providing optimal patient comfort. Virtual brackets are then cast in metal via a step of conversion of the digital objects into a resin or wax models by a Rapid Prototyping machine. Gold alloy is preferentially used. For particular metals like zircon, the real brackets can be directly obtained after the transfer of digital data to a machine tool which directly cuts out the brackets from pre-formed pieces of material. No matter what metal the practitioner chooses, each bracket is fully individualized both to the tooth and to the arch wire by the complete manufacturing process. A NUMERICAL SET UP The dental arches of the patient are digitalized from a PVS impression. A numerical set-up of the final positions of teeth is performed by using appropriated software. The practitioner then has the possibility to check the set-up and can simulate specific requirements of placement if necessary. Then, the numerical set-up constitutes the working model for the engineering step. The high resolution and the accuracy of the method of tooth positioning provide a top of the range procedure in regards to the precision and the personalization of the appliance.
  30. 30. 30 The numerical set-up is a very user friendly and precise tool for defining the terminal dental arches. In addition, the numerical relocation of brackets on the initial deformation can be calculated and a resin model with the brackets on is prototyped to make the transfer tray. A FLAT ARCHWIRE Another improvement to lingual orthodontics is the use of a flat wire in the transversal direction, which can be slightly rotated on the sagittal plane in case of specific demand. The archwire chart is drawn respecting a standardized shape wire and exactly intersects the axis of each bracket at the centre of the slot. Thus, the appliance is completely adapted for the use of straight wires which can be chosen by the orthodontist with variant grade of elasticity in all phases of treatment. This confers to the system all the properties of a very secure and accurate straight wire technique. 3D FACIAL IMAGERY Moreover, in some special clinical situations, or complicated cases, for greater efficiency the practitioner can order a radiographic CT scan or a volumetric acquisition (Cone Beam technology). Then after a 3D imaging treatment of the original scan data, more individualized parameters can be computerized for the highest level of individualization. In this way, anatomical maxillo-facial elements such as teeth, bones and skin are reconstructed as well as the anatomical landmarks of the TREIL’s maxillo-facial frame. Subsequently, facial features can be related to bone structures, bone to teeth, and inversely, from teeth to the face. As well, 3DT cephalometrics are available for quantitative analysis and many geometrical parameters are measured allowing numerical applications of therapeutic aid. This imagery makes a new perception of facial aesthetics and takes into account the real impact of dental structure on the facial balance. A fantastic opportunity is available to apply an innovative and full-purpose biometry of the face, maxillaries and teeth.
  31. 31. 31 15. Ideal- Leone Idea-L lingual brackets feature small mesio-distal sizes and 1,4 mm thickness to ensure patient acceptance and minimize speech issues starting from the first day of treatment. The special design of the bracket makes the application of Slide™* ligature simple and keeps it in place during treatment. The use of Slide™* ligatures offers several advantages: • Slide™* ligatures embody the profile of the bracket, making it smooth and comfortable • Slide™* ligatures allow to take advantage of the biomechanical features of Low Friction with the application of light forces • Slide™* ligatures make treatment time shorter. In most cases the use of a round wire Memoria® .012” is sufficient to get the resolution of the overcrowding of the teeth and the aesthetical improvement of smile. In cases where dental rotations and/or major misplacements are present, wires of higher diameter, like Memoria® or Beta Memoria®, and conventional ligatures may also be used to increase biomechanical control. Designed for 2D biomechanics with the use of round wires only, Leone lingual system doesn’t require any elaborate and expensive set up of models. To get a perfect alignment and levelling of the frontal teeth, an accurate positioning of the bracket is necessary; it is therefore advisable to use an indirect bonding technique with arch transfer trays realized in the laboratory or with the special “Jigs” conceived for this technique. Plastic jigs are manufactured in six sizes to allow the choice of the most correct position according to the anatomy of the lingual surface of the tooth.
  32. 32. 32 16. Hiro- Medix 21 HIRO BRACKETS introduce all the technical improvements offered nowadays in the lingual orthodontics industry. Dr. HIRO, one of the world´s main specialists in lingual orthodontics, has been responsible for the design of the brackets. The outcome is a Bracket that brings along multiple functional advances, allowing orthodontist to optimise the effects of treatment and granting patients´ comfort, through their anathomical design and reduced size. In this way, HIRO BRACKETS appear as a solution to the deficiencies (technical and competitive deficiences) detected in the existing offer at present. As the lingual brackets with best technical features, smallest size and most competitive price, HIRO BRACKETS are deemed to become the new reference in the market of lingual orthodontics Hirobrackets was born in 1996, in order to improve the difficulties associated with Kurz. They are as follows; 1. To make Double Over Tie unnecessary 2. To improve pronunciation difficulties 3. To reduce Tongue Irritations 4. To avoid brackets’ interference with other teeth 5. To reduce the frequent of brackets’ broken off from the teeth 6. To reduce the costs Why are Hirobrackets only 6x6? Hiro brackets is delivered only 6 to 6, Upper and lower. This is because so many options are exist for the second molars. Some doctors are using small tube for o Hinge cap molar tubes for terminal molars. Please use your favorite molar tubes for second molars.
  33. 33. 33 B. Lingual arch form Typical maxillary and mandibular lingual arch form, and arch form coordination The ideal lingual arch form is mushroom-like. There is a 3-4 mm inset between the canine and the first bicuspid in the upper arch, and a 2-3 mm inset in the lower arch. A smaller inset is made between the second premolar and the first molar. C. Ligation Double overtie ligation used for the anterior lingual brackets Chain with Double overtie ligation used for closing anterior spaces Rotation tie used for rotated teeth Standard ligation is not sufficient to seat and hold the bracket into the lingual bracket slot, the ligation method in LO is double over-tie, and it is done with both metal and elastic ligatures.
  34. 34. 34 D. Treatment steps Initial diagnosis and case selection Records Diagnosis  Skeletal and growth pattern  Dental analysis  Space analysis  Aesthetic evaluation  Periodontal and Prosthetic evaluation  TMJ evaluation  Personality Case preparation Periodontal initial preparation Restorations and prosthesis:  Old amalgam restorations can be replaced with composite restorations.  Bridges can be separated to units, or used as one unit if not separated.  Root treated teeth should be prepared with posts and temporary crowns.  When transferring from expansive appliance to lingual, a retainer is needed to avoid inaccuracy of the models.  Lingual tooth surfaces should be reformed when deep fosse or pronounced bulges are present. Impression taking Laboratory procedure The laboratory procedure allows individual adaptation of the brackets to each tooth. Active treatment  Chair side Indirect bonding  Banding  Extraction (timing is important)  Treatment Mechanics: Leveling, aligning, rotational control and bite opening Torque control Consolidation and Retraction (En masse retraction) Detailing and finishing Retention Follow-up documentation: photos, models, x-rays
  35. 35. 35 E. Case Selection Lingual Orthodontics is relatively easy in the following cases: Non-extraction cases  Deep bite, Class I cases with mild crowding, good facial pattern  Deep bite, Class I with spacing or diastema, good facial pattern  Deep bite, mild Class II, good facial pattern  Class II division 2 with retruded mandible Extraction cases  Class II, maxillary first, mandibular second bicuspid extraction  Class II, maxillary first bicuspid extraction  Mild bimaxillary protrusion with four first bicuspid extraction  Class III tendency with deep bite Lingual Orthodontics is relatively difficult in the following cases:  Surgical cases  Open bite cases  Periodontal involvement with reduced bone level  Class III high angle case  Class II high angle cases  Severe Class II discrepancies  Cases with multiple restorative work  Short clinical crown  Poor oral hygiene  Mutilated posterior occlusion  Lingual (and buccal) Orthodontics should be avoided in the following cases  Acute TMJ dysfunction  Unresolved periodontal problems  Inadaptable personality type
  36. 36. 36 F. Guidelines for lingual treatment 1. Proper patient selection 2. Correct brackets and laboratory preparation    Select 2 dimensional small brackets if torque control is not needed Over-corrections for tip and rotations incorporated in bracket positioning (especially when undesired movements need to be avoided, in retraction mechanism for example). Extra torque and angulation built in bracket position in extraction cases (between 4-10 degrees extra torque for incisors, 2, 4, 6 degree extra distal root angulation for the central, lateral and canine, and 6 degree mesial root angulation for the bicuspids and molars- individual differences, according to initial condition) 3. Correct clinical treatment           Creating space before rotations (extractions, interproximal reduction, advancement loops) Maintain proper arch form (Using individualized templates, or estimation of the arch form, by submitting the tooth width from the labial arch form) Anterior teeth are ligated with double over-tie Whenever elastic traction is applied to a tooth, that tooth should be tied with steel ligature. Minimal archwire changing and wire bending is kept by following proper archwire sequence. Compensation for vertical and transverse bowing effect Improved sliding and torque control by using .018 slot in the anterior teeth and .022 in the premolar and molar. Retraction in short span of wire between the elastic power tied brackets. Elastic power is not applied on terminal molar. Molar inset (1-2 mm), and is applied only after the space closure is completed
  37. 37. 37 4. Biomechanics Intrusion 1. Bite Plane-always present 2. Light & Continuous intrusive force 3. Passive posterior extrusion (to prevent it- acrylic posterior support) 4. Application point closer to CR 5. Shearing forces- Compressive Force Expansion 1. Centrifugal Type Force (QH, RPE) 2. Thickness of the Brackets 3. Elimination of Occlusal Contacts 4. Application point closer to the CR (Bodily Movement) Mandibular Repositioning 1. Anterior inclined Plane 2. Acrylic mini-support 3. Flat-------- Class II elastics 4. Occlusal Indentations----Mandibular Guidance Distalization 1. No Occlusal Contact 2. Force Application 3. Labial- Distal Moment 4. Lingual- Mesial Moment
  38. 38. 38 Short arch perimeter Small interbracket distance
  39. 39. 39 How to avoid (or treat) vertical and transverse bowing effect? 1. Use Stiffer wires (.016x.022 S.S) 2. Compensating horizontal and vertical wire bending 3. Apply short-span forces 4. Do not connect chains to terminal molar 5. Add anchorage: palatal bars, Nance button, buccal segment, head gear, auxiliary wires to HG tubes with Class II elastics 6. Laboratory prescription (bracket inclination) 7. Loop mechanics 8. Palatal molars cusps add anchorage 9. Bond second molars 10. Bond anchor unit passively 11. Load anchor unit later in treatment 12. Add torque (laboratory or wires) Anchorage Control in Sliding Mechanics: 1. 2. 3. 4. 5. 6. Including the 2nd molars Head gear, Nance Tip back in bracket positioning Accentuated or reversed curve of spee Reduced friction: .018&.022 slot Reduced pressure on posterior anchorage: light forces for space closure less anterior tip and torque Wire properties: The smaller IBD makes the same wire stiffer in LO relative to the BO. According to Moran the decreased IBD associated with LO makes a wire approximately 3 times stiffer for first and second order bends than when used with BO, and approximately 1.5 times stiffer for third order bends. Moran K. I. Relative wire stiffness due to lingual versus labial interbracket distance. Am. J. Orthod. Dentofac. Orthop.: 1987; 92: 24-32
  40. 40. 40 4. Laboratory & Clinical Procedure A. CLASS system (Customized Lingual Appliance Set-Up Service) Developed by ORMCO and Specialty Appliances, Atlanta. In the Class system the brackets are bonded to an ideal set up model of the case, and then transferred back to the original model, for transfer tray preparation. 1. The stone model is sent to the Lab with specific instructions for bonding, including extraction sites, anchorage, over corrections required. The original model is duplicated and a set-up model is prepared from the duplicated model. 2. The brackets are bonded with composite material to the teeth in the set-up model, after choosing the best horizontal plan that will suit all the teeth from the anterior and posterior regions. 3. When all the brackets are bonded to the ideal set-up model, a one-to-one photographic picture is made to fabricate the ideal arch template. 4. The brackets from the ideal set up model are transferred to the malocclusion model, using an acrylic cap on each tooth as an index. 5. When all the brackets were transferred to the malocclusion model, another one-to-one picture is made. 6. The next step is the transfer tray preparation
  41. 41. 41 B. TARG system (Torque Angulations Reference Guide) In this system the brackets are bonded directly to the malocclusion model, using the TARG machine to relate the lingual surfaces to the labial. 1. The malocclusion model is mounted on a swivel base and tipped until the buccal long axis of the tooth is aligned with a specific blade that was previously tilted to the desired torque and angulation of that tooth. 2. The ideal bonding level is determined prior to the bonding stage, by measuring the distance from the incisal edges to the slots. The labio-lingual thickness of the teeth is also determined by measuring it with a micrometer mounted on the TARG (Electronic 3. After the trial of each bracket and after the in-out and height level is determined, the brackets are bonded to the malocclusion model with composite material. 4. A one-to-one photocopy or scanning is done on the malocclusion model with the brackets on it, to allow the tracing of the arch form template. 5. The model is now ready for the transfer tray.
  42. 42. 42 C. Slot Machine This is another laboratory device for precise lingual bracket bonding, similar to the TARG, specially designed for Conceal brackets and lately was adapted for Ormco brackets by Dr. Pablo Echarri from Spain. Multiple prescription styluses are available to provide many prescription capabilities. This instrument serves for labial indirect bonding as well. Taken from One of the currently most spread orthodontic techniques is the Straight Wire Technique. The excellence of the obtained results and treatment objectives fulfillment with this technique depend on two pillars that support the "Straight Wire", and they are: the accuracy of the diagnosis and precision of the brackets positioning and bonding on the teeth. Desired and foreseen results normally are not achieved once the finishing archwire is not active any more, so the orthodontists have to carry out different types of compensations: Finishing "bends" ; Brackets repositioning and rebonding; Finishing positioners and many other things, in order to obtain the best occlusion in patient. The differences between treatment goals and obtained results appear due to:  The imprecision of the brackets positioning  Anatomic variations of the teeth that provoke maladjustments between the tooth and the bracket base  The necessity for overcorrection of some movements, and mechanical deficiencies of the Straight Wire: impossibility to position the bracket in the very same resistance center of the tooth, movement range ("play") of the archwire in the slot and decrease of the force carried out by the archwire as it regains its original shape. The advantages of Indirect Bonding are:  Accurate brackets positioning  The adhesive cannot be infected by the saliva and the brackets remain immobile during the curing, the reason why the bonding quality increases and the number of "debondings" decreases, and the chairtime reduces, too. The Indirect bonding consists of brackets positioning and fixing on the plaster model cast, transference tray fabrication, and brackets bonding of the whole arch into the mouth at the only one appointment. The brackets positioning on the model cast is carried out with a sophisticated and precise instrument: "The Slot Machine", designed by Dr. Thomas Creekmore.
  43. 43. 43 D. The Lingual Bracket Jig - LBJ The LBJ is a precision device for lingual bracket positioning. It offers both advantages: 1. A relatively simple, yet, accurate chair-side direct bonding technique. 2. A simple laboratory system to prepare the tray for the indirect Bonding technique. The concept behind the LBJ The LBJ is based on the principles of the Straight Wire (Andrews) labial bracket positioning. It actually copies the labial bracket slot prescription and translates it to the lingual surface. The device consists of: 1. A set of six jigs, one for each of the six maxillary anterior teeth, which present the main problem of morphological variation on the lingual surfaces. 2. A special millimeter ruler, with up to 0.1 mm accuracy NEW Each jig has a labial arm and a lingual arm. The tip of the labial arm has a prescription similar to a labial bracket. The lingual arm, which holds the lingual bracket slides into the labial arm. Therefore, when the lingual bracket is mounted on the LBJ, the lingual archwire slot is parallel to the labial slot. When the labial arm is positioned correctly, exactly as a labial bracket is positioned, according to the LA point, the lingual bracket is automatically placed The LBJ fits both 0.018” and 0.022” slot brackets, after delicate manipulation of the lingual extension
  44. 44. 44 In-out control Sliding all the anterior jigs to the same B-L distance controls the in-out position of the lingual bracket. Vertical control The height of Lingual bracket placement is controlled with an adjustable occlusal stopper. The zero position of the occlusal stopper is programmed to enable an overbite of 1 mm at the end of treatment The prescription of the LBJ is described in table 1. Table 1: Jig’s prescription Maxillary tooth central lateral canine Torqe. Ang. Height +18 +10 +3 +5 +9 + 10 5.0 mm 5.0 mm 5.5 mm Extra torque is incorporated in the LBJ to allow earlier torque control with lighter wires. And to compensate the tendency to retrocline anterior teeth during space closure. Advantages: Bracket positioning is simple, quick and does not require special training. The orthodontist is offered the opportunity to perform direct as well as indirect bonding as an in-office procedure, allowing him to maintain individual control over bracket positioning.
  45. 45. 45 E. KSLO Indirect Bonding & Set-up System (KISS) F. Mushroom Bracket Positioner (MBP) MUSHROOM BRACKET POSITIONER MBP
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  47. 47. 47
  48. 48. 48 G. HIRO Technique Implementing the Hiro Technique for Lingual Indirect Bonding Dr. Kyoto Takemoto, Dr. Guiseppe Scuzzo. Clinical Impression, Volume 12 (2003) No. 1
  49. 49. 49
  50. 50. 50 H. In-Tendo INDIRECT BONDING SYSTEMS ? Precise Indirect BPrecise Indirect Bonding Systems was started with one aim..improve the precision of indirect bonding. Our first step to do this was obvious make some new tools that will reduce the error by the technician or assistant, depending where you like to do your set-ups and the situation until 2004 as far as equipment goes was pretty grim compared to that of other dental technology sectors. On the lingual side, where there is a necessity for indirect bonding, the main instrument was the TARG which had been around since 1984 …20 years! During which time slight improvements had been added, unfortunately the improvements had missed one of the critical areas important for reducing the time spent wire bending by the Orthodontist…the Torque and Angulation. During this time span Other various devices had been attempted but all lacking in “ease of use” and or Precisiononding Systems was started with one aim..improve the precision of indirect bonding. Our first step to do her various devices had been attempted but all lacking in “ease of use” and or Precision.
  51. 51. 51 It’s true the wonderful Incognito system had been created, being the first CAD / CAM system for Lingual Orthodontics, however this only increased the It’s true the wonderful Incognito system had been created, being the first CAD / CAM system for Lingual Orthodontics, however this only increased the cost to the Dr and therefore the patient. Perhaps the main reason for its birth had been directed at Dr’s who did not want to do the traditional ground work and wanted a system that would think for them, but with Gold prices sky rocketing, not to mention bonding issues and bracket strength , this would only mean higher prices. Our question was How could we better use mass produced brackets like the Ormco STb or Dentsply’s Innovation or the 3M Unitek? to mention a few and the answer came via the invention of the TAD and BPDts birth had been directed at Dr’s who did not want to do the traditional ground work and wanted a system that would think for them, but with Gold prices sky rocketing, not to mention bonding issues and bracket strength , this would only mean higher prices. Our question was How could we better use mass produced brackets like the Ormco STb or Dentsply’s Innovation or the 3M Unitek? to mention a few and the answer came via the invention of the TAD and BPD
  52. 52. 52
  53. 53. 53 I. Modified Hiro (for Adenta brackets) Orthodontic lingual technique offers an attractive alternative for patients not willing to permit the use of metal braces. Primarily, adult patients often do not accept labial brackets due to the demands of their jobs or because they don’t want to look like teenagers. Since the introduction of the lingual treatment by KINYA FUJITA in the early 70`s, efforts were made to simplify brackets and treatment systems. There are some well-evaluated and controllable lingual systems available, but the lingual treatment is complicated and time consuming for the orthodontist as well as for the patients. Therefore, the aim of further developments and improvements should be to simplify the technique and to reduce chair time as well as the number of appointments. Comparing labial with the lingual technique, the differences become obvious. The structures of the labial surfaces do not differ very much between teeth or even different patients. In contrast to that the lingual surface varies considerably between teeth, consequently every bracket must be bonded using a customized base to fit each tooth. The customized base can be manufactured in the laboratory and transferred to the lingual teeth surfaces by using transfer trays. The lingual arch wires are mushroom shaped and have two offets in order to level out the step between the canines and the first bicuspid. It’s apparent that the placing and handling of lingual appliances is more complex than that of labial appliances. Self-ligating Bracket Features A new self-ligating lingual bracket has been engineered specifically to simplify brackets and treatment systems. This new self-ligating bracket has proved to be effective during treatment and has simplified the handling of the appliance, creating a reproducible and reliable treatment result. Consequently, the time between appointments is extended. The lingual technique can now be implemented even in busy orthodontic offices.
  54. 54. 54 To engage the arch wires in the bracket slots, stainless spring clips are used. The time consuming use of elastomeric ligatures, chains and power thread can be eliminated. This elimination of ties and chains presents an advantage for dental hygiene. The closing movement of the clips is limited by a miniature step on top of the slot, so the performance of the bracket can be manipulated perfectly for each stage of the treatment. Small diameter round wires are used during the levelling stage. These arch wires do not touch the closing spring or any other structure of the bracket slot. Consequently, the friction in the slot is at a minimum level and the first stage of the treatment can be performed in a very short time. As the treatment progresses, the diameters of the arch wire increase and change from round to rectangular. These arch wires now touch the spring clips, and begin to lift them off the step. The power of the spring clips increases, and the arch wires are pressed down to the preadjusted bottom of the bracket slots. Torque, angulation and in/out values are transmitted to the teeth. Oral Hygiene One of the major obstacles in lingual treatment is oral hygience As brackets are placed on the lingual surfaces of the teeth, the accessibility to the appliance and to the teeth, for the patients as well as for the dental hygienists, is difficult and time consuming than with the labial technique. The shape of the brackets should be as smooth and as simple as possible to enable the patients and the dental hygienists to keep a high level of oral hygiene. Most lingual brackets are equipped with hooks for elastic chains and ligatures. These hooks often overlap the marginal gingival, increasing the possibility of plaque accumulation and consequently inflammation in the marginal gingival. Due to the self-ligating design these hooks are not required, and oral hygiene can now be performed with ease. Laboratory Procedures There are different possibilities to find a correct bracket position on the lingual surfaces of the teeth. We recommend a customised Hiro system that was specifically developed for a self-ligating lingual bracket. Start by creating an ideal set-up, this defines treatment torque and angulation. At this early stage all over correction can be fixed.
  55. 55. 55 Subsequently an ideal arch wire (stainless steel, 0,0018 X 0,0025 inch) is adjusted to the lingual shape of the arch. The ideal arch wire serves multiple functions. On one hand it is used to define the correct bracket position and to create the customized bracket bases, on the other hand it can be used as a template for all arch wires that are used during the treatment. As the ideal arch wire must be reproducible for the entire treatment period, it must be bended accurately, without inserting torque or any other additional bends except the offsets in the region of the canines. A small amount of Transbond LR composite is now applied to the bracket base forming your customised base for each individual lingual tooth surface. The whole system is as close as possible to the lingual surfaces of the teeth, each bracket is adjusted and the composite is light-cured. There are different possibilities to find a correct bracket position on the lingual surfaces of the teeth. We recommend a customised Hiro system that was specifically developed for a self-ligating lingual bracket. Start by creating an ideal set-up, this defines treatment torque and angulation. At this early stage all over correction can be fixed. Subsequently an ideal arch wire (stainless steel, 0,0018 X 0,0025 inch) is adjusted to the lingual shape of the arch. The After creating single transfer trays for each tooth, the brackets and the transfer trays are disconnected from the ideal arch wire and the customized bases are sand blasted for proper bonding to the teeth. Transferring the Brackets Bonding preparation remains the same as with the labial technique. It is not necessary to sandblast the teeth. After mounting a Dry Field, normal etching and conditioning can be performed. A Self- Etching Primer is highly recommended. Since the transfer trays are exact replicas of each tooth, the correct position of the bracket can be easily detected. The brackets are then bonded with a light-curing composite.
  56. 56. 56 Bonding procedure 1. You may section the tray into 2-3 pieces or bond as one piece. The possibility to achieve dry field and the type of the bonding material will determine whether to bond in one piece or should you section the tray. Make sure that the hooks of the brackets are released from the transfer tray. 2. Try the tray in the patient mouth, and then dry and clean the custom bases. (Alcohol or Acetone can be used). 3. Prepare the patient like you do for buccal orthodontics: Clean the teeth, etch, rinse, dry and isolate. Dry field is one of the keys to success in the bonding procedure. Dry or wet Microetching with sandblast (30 microns aluminum oxide) is highly recommended on tough areas like metal fillings, crowns, porcelain and poor thin coat of plastic conditioner can be applied on the composite base to enhance the bonding strength. Let it dry for at least 1 minute. 4. Chemical Cure: Many chemical cure materials are available. Like Custom IQ, Phase II, Maximum Cure (Reliance Inc.) They are recommended when the transfer tray is made from opaque materials. Apply paste on both sides (tooth and composite pad), and seat the tray immediately. Place firm pressure from the occlusal to fully seat the tray. Hold the tray in place 1 minute and leave passively for another 4 minutes. Do not have patient bite on the tray or cotton rolls. 5. Light Cure: Transbond XT Paste (Unitek) with Ortho-Solo primer (Ormco) is highly recommended when the transfer tray is transparent but you can use every orthodontic light cure material that you have. Apply primer on tooth and on composite pad, add paste and cure. Make sure that the tray fit the teeth surface tightly and accurately. 6. Gently remove the tray by peeling it from gingival towards the incisal. Bonding failure: If one of the brackets bonding failed, the transfer tray is cut and the bracket is inserted into its cavity in the segment for rebonding. The bracket’s base is cleaned with acetone, alcohol or sandblast and bonded again as initially.
  57. 57. 57 If the segment is not suitable for reusing, it is possible to rebond directly with the Lingual Bracket Jig (LBJ), or to take an impression and ask the laboratory for an individual transfer tray for this tooth. The transfer tray has to be restored for rebonding, in case of bracket fail. Banding and welding In cases of short clinical crowns, or Head Gear therapy, molars are banded. The separation with separating modules is done only after the bonding of the anterior teeth. Molar bands incisal edge should fit the marginal ridgeline. The band should not be fitted too gingivally, otherwise excessive lingual root torque will be provided. The bracket or tube is welded on the occlusal edge of the upper and lower molar band, slightly on the mesial of upper molar band (To prevent rotations), and in the middle of the lower molar band. (A guideline for the point of zero angulations is to align the ball hook to the labial long axis of the mesio-buccal cusp) In extraction cases extra (–6) degree of angulation (mesial root angulation) has to be incorporated, in order to get tip back and improve posterior anchorage, to achieve root parallelism and prevent bowing effect. Esthetic Pontic Lingual patients are more esthetically oriented, and extractions sites are much more obvious when brackets are invisible. Therefore a plastic or resin Pontic is placed after the extractions to maintain aesthetics throughout treatment. During the retraction phase, about 1 mm is removed from the distal aspect of the pontics. Acrylic teeth can be used as pontics or they can be built with composite material. They are usually bonded to the bicuspids with orthodontic adhesive material. Debonding Debonding is done using bracket removing plier (Ormco #801-0027) or using ligature cutter. The resin is taken of with Tungsten Bur. Use polishing and finishing burrs to smoothen the enamel and apply prophylaxis agents.
  58. 58. 58 Retention A Positioner may be used to detail and idealize the occlusion. The positioner is worn continuously for 48 hours after bracket removal. Then it is worn for twelve hours a day for one month. Then impressions are taken for retainer fabrication. Invisible retention is used whenever possible. Usually a bonded retainer is bonded to the lower anterior segment, and clear retainer is delivered for the upper arch. Extraction sites are bonded to avoid space opening. In case of rotated anterior teeth, a circumferential supracrestal fiberotomy (CSF) is performed six weeks prior to bracket removal.
  59. 59. 59 TYPODONT EXERCISE A. Preparation for Typodont Exercise B. Extraction Case Treatment mechanics A set of four progressive models, with bracket attached, has been prepared to demonstrate the basic Extraction and Non Extraction procedures. The typodont represents an example of a maxillary first bicuspid Extraction case. The case Class II Division 2 with slight deep bite on a non-growing patient. Treatment objectives are to obtain Class II molar relations, with Class I cuspids, Bite opening, correct overbite and over jet. Lower crowding is to be managed via interproximal enamel reduction combined with incisor advancement.
  60. 60. 60 A. Preparation for typodont exercise Instrumentation Kurz had and Ormco Company had developed some instruments special for Lingual Orthodontics. A Korean company IVtech recently developed a new line of very small pliers, especially designed for the lingual technique. Module director (ETM 800-2108) Lingual debonding plier (ETM800-0431) Lingual Utility Plier (IVtech) Cinch-back Plier (IVtech) Lingual Flush Distal End Cutter (IVtech) Lingual Arch Forming Plier (IVtech) Lingual Pin & Ligature Cutter (IVtech)
  61. 61. 61 Double Over-Tie Standard ligation is not sufficient to seat and hold the bracket into the lingual bracket slot, The ligation method in LO is double over-tie, and it is done with both metal and elastic ligatures. The double over-tie improves the rotation and torque control. The bicuspids are ligated with a conventional tie. To accomplish a double over-tie ligation three-unit power chain is mounted on each anterior bracket. The wire is then inserted and the chain is stretched over the wire. The excessive two pieces of the chain is cut with scissors. Steel ligature Over-Tie The same procedure is done using a ligature wire. Rotation tie This is the most efficient method used to correct a rotated tooth in lingual Therapy. A five to seven unit power chain is first tied to the archwire at the interproximal junction in the direction in which the tooth is to rotate. The last lumen of the chain is slipped over the end of the archwire if it was removed from the mouth. A slipknot may be formed over the archwire, by passing one end of the chain through the expanded lumen at the other end of the chain. The chain is then brought around the labial surface, through the interproximal contact, using a floss threader, under the archwire, and attached to the ball hook. Chain Over-tie When using a chain for space closure, a similar technique is used: the chain is mounted on the brackets prior to the wire insertion. The wire is engaged, and then each fragment of the chain is stretched over the wire.
  62. 62. 62 B. Extraction Case TYPODONT TYPICAL CASE WIRE SEQUENCE (in 0.018 Slot or combination of 0.018 Slot for 3-3 and 0.022 for 4-7) Extraction 1a.0.012-0.014-0.016 NiTi, 0.017x0.017 Copper NiTi, 0.016 TMA, 0.0175 Respond Leveling and alignment 1b.016 SS,016x.022 SS Initial cuspid retraction 1c. 0.012-0.014-0.016 NiTi, 0.017x0.017 Copper NiTi, 0.016 TMA, 0.0175 Respond Back to leveling 2. 0.0175x0.0175 TMA, 0.0175x0.025 TMA Torque Control 3. 0.016 x0.022 SS Space Closure 4. 0.016 TMA, 0.0175x0.0175 TMA Finishing Non-Extraction 1.0.012-0.014-0.016 NiTi, 0.017x0.017 Copper NiTi, 0.016 TMA, 0.0175 Respond Leveling and alignment 2. 0.0175x0.0175 TMA, 0.0175x0.025 TMA Torque Control 3. 0.016 x0.022 SS Consolidation 4. 0.016 TMA, 0.0175x0.0175 TMA Finishing
  63. 63. 63 Step 1: Alignment and Leveling - Initial archwire: Respond .0175 (or NiTi with special archform plier) Objectives:  Minimal forces on the still maturing bonds  Initiate cellular response with light resilient archwire  A period of patient adaptation  Initiate alignment 1. Select the lingual typodont # 1. 2. Form a maxillary .0175 Respond and mandibular lingual .0175 Respond wire using the 1:1 photographs as a guide. Mark the midline and distal ends of the cuspids on the archwires 3. Mandibular arch - .0175 Respond Using a bird beak plier, place a 90 degree first order bend, toward the lingual, at the interproximal space between the cuspids and the bicuspids. Make another 90 degree bend toward the distal forming a 2 mm offset. Make advancement loops, mesial to the mandibular first molar. It will be used to advance the lower incisors and reduce the anterior crowding. Arch length is increased in order to achieve space for rotations, prior to reproximation,. No first order bends will be made mesial to the molar in the non-extraction arch form, until the last finishing archwires. Cut the distal ends of the wire leaving approximately 2 mm of wire of extending distal to the second molar tube, so that a tight right angled bend can be made. 4. Maxillary arch -.0175 Respond Make similar first order bends in the maxillary archwire. The first order bend should be made more distal to the cuspids to allow space for any initial alignment. The lingual offset on the maxillary arch, in this case is 3-4 mm. (The amount depends on the labio-lingual thickness of cuspids and bicuspids).
  64. 64. 64 Compensation for transverse bowing effect: The arch form should bow lingually from cuspids to bicuspids and then return facially at the middle of the first molar. This lingual bow prevents the mesial buccal rotation of the molars during retraction of the anteriors. Cut the distal wire excess so that approximately 2 mm of wire will protrude distal to the second molar tubes when the wire is fully seated in place. No first order bend will be made mesial to the first molars in the extraction case at this time. 5. Initial archwire ligation Use double over-tie in the anterior teeth and conventional ligation on the bicuspids, using the 45-degree utility plier. In the maxillary arch, you will notice that it will not be possible to engage the laterals at this time. This is a common clinical occurrence in moderate to severely crowded dentition. Cut the wire approximately 2 mm distal to the second molar tubes and bend these distal wire extensions tight behind the second molar. Upper arch Lower arch Advancement loop
  65. 65. 65 Step 2: Alignment and Leveling – Initial Cuspid Retraction: 0.016 TMA, 0.016x0.022 S.S, 0.016 NiTi Objectives      Increase arch perimeter Correct Rotations Achieve alignment Establish arch form Obtain complete wire engagement Mandibular arch- .016 TMA With advancement loops 1. Use the archform template and the just removed Respond archwire to form a .016 TMA archwire, with the ideal first order bends. 2. Place advancing loops mesial to the first molars. Cut the distal extensions leaving about 2 mm of wire to bend buccally. 3. Ligate the anterior teeth with double over-tie, and bicuspids and molars with single ties. Maxillary Arch - .016x.022 SS For initial cuspid retraction 1. In case of severe rotations, a NiTi wire is used following the initial .0175 Respond. 2. A .016x.022 SS wire will be used to obtain sufficient cuspid retraction to gain the space necessary to engage the lateral incisors. Form a .016x.022 SS wire on the archform template. Make the cuspid first order bends close to the second bicuspids to allow cuspid retraction.
  66. 66. 66 3. Ligate the centrals with elastrometric double over tie. Tie the bicuspids to the molars with steel ligature, before the archwire is placed, to prevent rotations. Then insert the wire and ligate the cuspids with steel ligature double over tie, and the bicuspids and molars with o-rings. 4. Cut the arch 2-3 mm distal to the terminal tube and bend the distal end buccally. 5. Cuspid retraction is conducted with elastomeric thread or two-segment elastomer chain, from maxillary second bicuspid to the cuspid. Maxillary arch –0.016 NiTi For alignment and corrections of rotations. Following initial cuspid retraction, space was created for the lateral incisor engagement. 1. Select maxillary model #2. 2. Ligate NiTi .016 with elastomeric double over tie on the anterior segment, and single elastomeric ties on the molars and bicuspids. 3. Place a rotation tie on the left lateral using a segment of clear power chain. Upper arch Lower arch Lower arch Lower arch
  67. 67. 67 Step 3: Torque control 0.0175x0.0175 TMA or 0.017x0.025 TMA The results obtained with the previous steps: The bite opened, rotations resolved, maxillary centrals tipped labials, cuspids retracted to allow engagement of the laterals. Objectives:  Continue arch leveling  Complete corrections of rotations  Initial torque control Mandibular arch- 0.0175x0.0175 TMA With ideal arch form 1. Use the arch form template and the previous wire to form the TMA ideal arch form, including first order bend mesial to the molars. On typodont #3. 2. Ligate the wire with elastomeric double over-tie on the anteriors, and single elastomeric ties on the bicuspid and molar brackets. Maxillary arch - 0.0175x0.0175 TMA Bent-back or tied-back omega loop 1. Bend a 0.0175x0.0175 TMA wire as previously, with cuspid first order bends, and without molar first order bends. 2. Incorporate a slight accentuated curve of spee in the arch, to exert more torque in the anteriors. 3. Ligate the wire with elastomeric double over-tie in the anterior region and elastomeric o rings in the bicuspids and molars. 4. Make a tight bend behind the second molar. Upper arch Lower arch
  68. 68. 68 Step 4: Space Closure: 0.016x0.022 SS Mandibular arch - 0.016x0.022 S.S for consolidation 1. Form a 0.016x0.022 SS archwire using previous archwires and the template. 2. Place a slight reverse curve in the arch, for additional anterior torque. 3. Ligate the anteriors with elastomeric double over-tie and the bicuspids and molars with single ties. Maxillary Arch 0.016x0.022 SS For space closure 1. Form a 0.016x0.022 SS archwire using the previous archwire and the template. The cuspid first order bend is located just distal to the cuspid bracket. No molar first order bend is made. 2. Incorporate in the arch an accentuated curve of spee, for more torque control, and compensation curve for transverse bowing effect. 3. Tie the six anterior teeth together with steel ligature, as a unit. Then tie the second bicuspids to the first and second molar as a unit. 4. Ligate the centrals and laterals with elastic double over tie, insert the wire and tie the canine with double over-tie steel ligature, and the bicuspid and molars with steel ligature. 5. Retraction is done with elastic chain from the second bicuspid to the hook on the cuspid. Upper arch Lower arch
  69. 69. 69 Step 5: Finishing & Detailing: 0.0175x0.0175 TMA, 0.017x0.025 TMA, 0.016 TMA, 0.016 SS Mandibular arch 1. Place first order bends for the cuspids and molars, coordinated with the upper arc. Maxillary arch 1. Place cuspid and molar first order bends, coordinated with the lower arch. 2. Bend back to prevent reopening of the spaces. Upper arch Upper and lower coordinated arches
  70. 70. 70 Torquing with 2D plus brackets Forestadent
  71. 71. 71 Advanced course - Guidelines for Lingual Orthodontics treatment 1. Proper patient selection 2. Laboratory preparation 1. Over-corrections for tip and rotations, whenever possible, incorporated in bracket positioning (especially when undesired movements need to be avoided, in retraction mechanism for example. 2. Extra torque built in bracket position (about 40 extra torque for incisors and canines) 3. Molar bracket position with 50 tip back and anti-rotation 4. PM and M brackets are aligned with the marginal ridges 3. Mechanics 1. Bi-dimensional orthodontics for improved sliding and torque control (.018 slot from cuspid to cuspid and .022 in the premolar and molar). 2. Creating space before rotations (extractions, interproximal reduction, advancement loops). No bends. 3. Rectangular full engagement wires for alignment and “Lace backs” to avoid proclination 4. Maintain proper arch form (Using individualized templates, or estimation of the arch form, by submitting the tooth width from the labial arch form) 5. Anterior teeth are ligated with double over-tie 6. Use posterior bite plane for retroclined/proclined cases 7. Whenever elastic traction is applied to a tooth, that tooth should be tied with steel ligature. 8. Minimal archwire changing and wire bending is kept by following proper archwire sequence. 9. Space closure by en masse retraction, only on rigid wires, curve of Spee compensation and anti-transverse bowing effect 10. Retraction with light elastic chain force, in short span of wire between the elastic power tied brackets. 11. Elastic power is never applied on terminal molar. 12. Molar inset (1-2 mm) is applied if necessary only after the space closure is completed (finishing stage) 13. Finishing bends: better with rectangular resilient wire. If round wire is used, then an inset bend should be wide and with intrusion component, and an offset bend: narrow and extrusion component.
  72. 72. 72 4. Laboratory tips 1. Add 1 mm height to the cuspid and premolar to compensate for bowing effect and to create occlusion at the end of treatment 2. In open bite cases: more height in the front and less in the back 3. When lower proclination is needed, incisal edge will move down, so bracket height should be increased in 0.5-1 mm and another 0.5 mm to the cuspid to get frontal occlusion 4. In incisor extraction, add height to lower laterals and cuspid (0.5 mm) and 1 mm to the central to avoid teeth tendency to move down. 5. In extraction of upper 4-4 add –6 deg. To molars to have tip back effect. This may cause a step between premolar and molar! 5. Brackets placement 1. Ormco bracket is around 5 mm height-may cause problems in short crowns 2. The distance between the bite plane and the incisal edge is 1.2 mm 3. Bracket is usually placed 2.5 mm from incisal edge, which will give 1.3 mm OB (2.5-1.2) 4. Short crowns may lead to very small OB! 5. In Deep Bite cases, mandible moves back after bonding6. Place tubes on 7-7 (preferably small one like speed tubes) 7. Place hinge caps on 7-7 when there is big discrepancy between 6-7 positions 8. Use crimpable hooks to “lock” the wire 9. When crown is short in 7, a button or band is bonded 10. When premolar bracket tend to fall- add resin on the cusp and on metal surface 6. Recommendations for successful treatment 1. Same treatment goals as in buccal orthodontics 2. Plan to treat only what you are sure you can get… 3. Decide on your treatment plan in advance (and do not “reevaluate” your treatment plan later…) 4. Update the patient in advance what kind of cooperation he will be needed 5. A compromise treatment results are acceptable as long it is agreed before.
  73. 73. 73 Appendix I: Recommended Materials for typodonts course: (brought by the participants) 1. Ligature cutter 3. Arch wire cutter 2. Utility plier for inserting and removing the wires 3. Light wire plier 4. Mosquito forceps 5. Lingual debonding plier (ETM 800-0431) 6. Module remover (or explorer) 7. Ligature Director (ETM 800-2108 or similar) 8. Hollow chop contouring plier (ETM 800-2032 or similar) 9. Bending plier for NiTi wires, Hu-Friedy 678-302 Wires and Elastics for typodonts course: Supplied by Ormco (See Ormco Catalog)  Respond .0175 # 203-0007  Ni-Ti .016 Upper (size 2) # 205-0023  Ni-Ti .016 Lower (size 2) # 205-0023  TMA .016 # 202-0025  TMA .0175x.0175 # 202-0018  TMA .017x.025 # 202-0020  Copper Ni-Ti .017x.017 Upper (size 2) # 205-0075  Copper Ni-Ti .017x.017 Lower (size 2) # 205-0078  S.S .014 # 206-0000  S.S .016 # 206-0001  S.S .016x.022 # 206-0006     Gray Power Chain Ii #639-0011 Gray Power O #640-0078 Metal Wire Ligature #270-0010 Lingual Hinge Cap Bracket Opening Tool #802-1001
  74. 74. 74 Appendix II: Instructions for LO patient after bonding The first days of orthodontic treatment may be difficult. Reading the following instructions might help and ease the adaptation of the new patient to the LO appliance. What are the problems LO patients have to deal with? 1. The presence of brackets (labial or lingual) in the oral environment may alter tongue and lips movements causing a slightly distorted sound, especially in “s”, “ch”, “th”, “t”, “z”, and “d” sounds. Most patients adapt to the brackets and their speech becomes close to normal within several hours or days. Practicing will help you to accommodate. It is advised to practice 15 minutes a day immediately following the placement of the lingual appliance. One has to read loudly and slowly, using recording devices to enable mistakes correction. In case the adaptation is too slow, it is advised to consult with speech therapist who specializes in speech problems. 2. General soreness in the mouth is normal after archwires are changed or adjusted. This can be relieved by tooth and gum brushing and by rinsing with salted water. Wax is used to cover irritating parts of the appliance. Within several days the tongue will find its place in the mouth and will automatically avoid irritating parts. 3. Eating will be difficult at the first days of treatment. At the first days it is recommended to eat only soft foods like soups, pasta, mashed potatoes, yogurt. Biting with the anterior teeth should be avoided, and food should be cut with a knife or with the fingers. Sometimes the posterior teeth will not be in contact due to the contact between the anterior teeth and the brackets. These problems will be solved usually within 4-12 weeks. 4. Emergency – If a wire or a bracket comes loose and it irritates the tongue or cheeks, wax can be placed over it and earlier appointment should be scheduled. Broken pieces should be kept and brought back to the office. Tooth loosening is to be expected throughout treatment and is part of the orthodontic movement. The teeth will become stable again in their new position when treatment is completed. 5. Remember: the success of the LO treatment depends on the patient as well as the orthodontist. The teeth, gums and appliance should be kept as clean as possible. Doctor’s instructions should be kept, and hard and sticky food should be avoided throughout the whole treatment. GOOD LUCK
  75. 75. 75 Appendix III: Indirect bonding instructions with the Lingual bracket Jig A. Taking impression Take an accurate impression of the arch to be bonded. Pour up in stone. B. Preparing models Draw the long axis of the labial surfaces of the teeth, extend the line to the palatal side and to the palate. Coat the surface with a 50-50 mix of liquid foil separator and water (Cold Mold Seal). Allow separator to dry at least 6 hours. C. Preparing brackets Clean the brackets' base (acetone or alcohol) and mount the brackets on their JIG. D. Vertical position Determine the vertical position of the brackets by measuring the distance between the vertical stopper and the incisal edge of the labial part (x). E. In-out position Using the LBJ with the bracket mounted on it, determine the in-out distance by measuring the width of the widest tooth (Central incisor or canine) and fix the in-out stopper. Then slide the Jigs of all the six anterior teeth to the same in-out distance using the millimeter ruler. F. Seating brackets Using a small flat instrument such as an adhesive spatula, place a small amount of a light cure orthodontic adhesive (Transbond Unitek 3M)) on the base of the bracket. The paste is pushed into the mesh . Place a small additional amount of adhesive onto the bracket base and make sure the base is completely covered.
  76. 76. 76 Slide the labial arm along the labial surface of the tooth while long axes of the tooth and the labial arm of the JIG coincide, until the labial arm is fully seated, and the occlusal stopper is in contact with the incisal edge of the tooth. Then press gently against the in-out stopper. Clean off any excess around the bracket base, and light cure for ten seconds. Hold the bracket with an explorer and slide the JIG out of the bracket gently. Place all brackets in this manner. G. Posterior brackets & Lower arch The lower brackets are positioned on the stone model using a simple tweezers. The brackets are aligned by eyeballing considering the long axis of the teeth, the incisal edges and the marginal ridges H. Transfer tray preparation and bonding The transfer tray is made on the malocclusion model. It allows transferring the brackets from the malocclusion model to the mouth. The transfer tray is made of two layers. The inner layer, which holds the brackets, is a soft flexible layer, and the outer layer, which provides stability during bonding is a rigid layer. The transfer tray can be made of soft and hard silicone impression materials or from clear 1.5 mm Bioplast and Biocryl in the Biostar machine, or combination of clear resilient silicone (Memosil 2- Kulzer) and omnivac plate (Soft Mouth guard 3 mm.). I. Silicone tray 1. 2. 3. 4. 5. 6. 7. 8. The light body of the silicone tray surrounds the brackets and includes the base, tie wings and any exposed portion of the brackets. Heavy body putty (or, alternatively a soft 3 mm Omnivac plate) is laced directly over the soft body material. Coverage includes the lingual, occlusal and half of the labial surfaces. Place the working in a bowl of warm (not hot) water and let soak for 15 Minutes, and then remove the tray from the model. Light cure the composite bases again for 20 seconds. Lightly abrade the custom base surface with Micro-etcher, and wash with soap and water. Dry with compressed air. Use a sharp knife to generally trim tray and make releasing cuts near the brackets hooks. Store the completed tray in a zip lock bag to prevent contamination. Some teeth cannot be bonded initially due to overlapping, and individual trays with brackets in their ideal position are made and bonded later, when adequate space is gained. Recommended materials needed: 1 Clear Silicone impression material (Memosil 2- Kulzer) 2 3 mm soft mouth-guard clear material 3. Micro-etcher
  77. 77. 77 Appendix IV: List of laboratories for Lingual Orthodontics Archform (Australia) Address: Archform Orthodontics Pty Ltd ABN 75 096 014 694 , Suite 4/875 Glenhuntly Road South Caulfield, VIC 3162, Australia Fax: +61 3 9532 4704 Contact Person: Mr. Ari Sciacca Website: e –mail: ELOS (France) Address: 145 Rue Louis Rouquier 92300 Levallois-Perret France Phone: +33 141 066688 Fax: +33 155 902112 Contact Person: Dr. Didier Fillion e –mail: Website: Ormco (USA) Address: AOA Orthodontic Appliances P.O. Box 725, Sturtevant, WI 53177 USA Phone: +1-800-262-5221 Fax: +1-262-886-6879 Contact Person: Mr. Max Hall Website: ORTO-TEK (Turkey) Address: Kamelya 2-3 D.1 D.2 Atasehır, 34758 Istanbul Turkey Phone: +90 216 4558898 Fax: +90 216 4552649 e-mail: Ortholine (UK) Address: 8 phoenix business centre ripon, north yorkshire hg4 1ns United Kingdom Phone: +44 1765 698300 Fax: +44 1765 609088 e-mail: website:
  78. 78. 78 Ladent (Spain) Address: Ladent, S.L. C/. Museu, 6, 1º-1º , 08912 Badalona (Barcelona) Spain Phone: +34 93 384 47 05 Fax: +34 93 464 22 42 e-mail: website: Orthosystem Milano Address: Aspromonte, 35, 20131Milano Phone: +39 2 295 27081 Fax: +39 2 295 21189 E-mail: Website: Thomas Halblich Lingualtechnik (Adenta) Address: RauschstraBe 69, 13509 Berlin Germany Phone: +49 30 618 22 98 Fax: +49 30 618 71 10 Website: Silam (Lingual Bracket Jig) Contact Person: Dr. Silvia Geron Fax: +972-3-6354715 E-mail: T.O.P. Service für Lingualtechnik GmbH Address: T.O.P. Service für Lingualtechnik GmbH Lindenstr. 42 , 49152 Bad Essen Germany Phone: +49-5472/9491-10 Fax: +49-5472/9491-19 Email: Website: The Torque and Angulation Lab Address: 9/72 Bantor Suandokmak, T. Sansailuang A. Sansai, Chiang Mai 50210 Thailand Contact person: Peter Sheffield Tel: +66 53 491302 Fax: +66 53 49135 Email: Website:
  79. 79. 79 REFERENCES (full list of references can be found on 1. Alexander, C.M. et al Lingual Orthodontics: A status Report Part 1. J. Clin. Orthod. 16:255-262,1982 2. Kurz, C. Swartz, M.L. Andreico, C: Lingual orthodontics: A status Report Part 2: Research and Development. J. Clin. Orthod. 16:735-740, 1982 3. Scholz, R.P., Swartz, M.L. Lingual Orthodontics: A Status Report, Part 3: Indirect bonding- Laboratory and Clinical Procedures, J. Clinc. Orthod. 16:812-820,1982. 4. Gorman J.C., Hilgers, J.J., Smith, J.R., Lingual Orthodontics A Status Report, Part 4: Diagnosis and Treatment Planning. J. Clinc. Orthod. 17:26-35,1983 5. Alexander C.M., Alexander, R.G., Gorman J.C., Hilgers J., Kurz C., Scholz R.P., Lingual Orthodontics a Status Report No. 5 Lingual Mechanotherapy. J. Clin. Orthod. 17:99115,1983 6. Alexander C.M., Alexander R.G., Sinclair P.M., Lingual Orthodontics: A status Report, Part 6, Patient and Practice Management. J. Clin. Orthod. 17:240-246,1983 7. Aguirre, M.J. Indirect bonding for Lingual Cases. J. Clin. Orthod. 18:565-569,1984 8. Chaconas Spiro J., Caputo Angelo A., Ademir R. B Force Transmission Characteristics of Lingual Appliances JCO 1990 Jan (36-43) 9. Creekmore TD. Lingual orthodontics - Its renaissances. Am J Orthod Dentofac Orthop 96: (120-137) 1989 10. Diamond Michael. Critical Aspects of Lingual Bracket Placement JCO 1983 Oct (688-691) 11. Fischer Thomas J., Ziegler Fred D., Crossbite Correction with Copper Ni-Ti Archwires and Lingual Brackets JCO 1996 Feb (97-98) 12. Fillion D., Improving patient comfort with lingual brackets J Clin Orthod, 31(10):689-94, 1997 13. Fillion D.,, The Resurgence of Lingual Orthodontics, Clinical Impression Volume 7 (1998) No. 1 14. Fujita, K. New Orthodontic Treatment with Lingual Bracket Mushroom Arch Wire Appliance, Am J. Orthod. 76:657-675,1979 15. Fujita, K Lingual Bracket and Mushroom Arch Wire Technique. Am J. Orthod. 82:120-140,1982 16. Fulmer, D.T. Kuftinec M.M. Cephalometric appraisal of patients treated with fixed lingual orthodontics appliances: Historical review and analysis of cases: Am J. Orthod 95:514-520,1989
  80. 80. 80 17. Geron S., The Lingual Bracket Jig. JCO Aug 1999 33;8:457-463 18. Gorman J.C., Kurz C. Smith J.R., Dunn R.M. Keys to Success in Lingual Therapy – Part 2 J. Clinc. Orthod. 89:330-340,1986 19. Gorman J.C Treatment of adults with Lingual Appliances. Dental Clinics of North America. 32: No. 3:589-620,1988 20. Gorman, J.C., Smith, R.J.,. Comparison of treatment effects with labial and lingual fixed appliances, Am. J. Orthod. Dentofac. Orthop. 99:202-209, 1991 21. Miyawaki S. Yasuhara M. Koh Y., Discomfort caused by bonded lingual orthodontic appliances in adult patients as examined by retrospective questionnaire, Am J. Orthod Dentofacial Orthop 115(1):83-8 1999 22. Paige S.F., A lingual Light-Wire Technique, J. Clin. Orthod. 16:534-544,1982. 23. Romano R. Lingual Orthodontics. B.C Decker 1998 24. Roth, R.H.: The straight-Wire Appliance 17 Year Later. J. Clin. Orthod. 9:632-642, 1987 25. Sinclair P.M., Cannito M.F., Goates L.J., Solomos L.F., Alexander M. Patient Responses to Lingual Appliances, J. Clinc. Orthod. 20:396-404,1986. 26. Smith J.R., Gorman J.C., Dunn R.M., Keys to Success in Lingual Therapy – Part 1, J. Clinc. Orthod. 89:252-261,1986. 27. Stamm T. Weichman D. Relation between second and third order problems in Lingual Orthodontic treatment, Journal of Lingual Orthodontics, Vol. 3, 2001 28. Takemoto K Lingual Orthodontics Extraction Therapy. Clinical impressions 4:2-7,1821,1995 29. Wiechmann D., Lingual orthodontics (part 2): archwire fabrication, J Orofac Orthop 1999: 60(6):416-26 30. Geron S., Ziskind D., Lingual forced eruption orthodontic technique: Clinical consideration for patient selection and clinical report. J. Prosthet Dent 2002, 87: 125-8 31. Geron S. Romano R. El posicionamiento de los Brackets en Ortodoncia Lingual: revision critica de diferentes tecniacs. Revista de Ortodoncia Clinica No 3 Vol 4 Julio-Septiembr 2001(in Spanish) 32. Geron S. Chaushu S. Lingual Extraction treatment of Anterior Adult J. Clinc Orth August 2002 36:8, 441-446 Open bite in an
  81. 81. 81 33. Geron S., Romano R., Bracket positioning in Lingual Orthodontics, Critical review of different techniques KJCO The Korean Journal of Clinical Orthodontics 2003 Vol 2 No 6 57-63 34. Geron S., Romano R., Brosh T., Vertical Force in Labial and Lingual Orthodontics Applied on Maxillary Incisors - Theoretical Approach, Angle Ortho. 2004, 74;195201 35. Geron S. Managing the orthodontic treatment of Advanced Periodontal Disease (ADP) patients with the lingual appliance World J Orthod 2004 ;Vol 5 No 4;324331 36. Romano R. Art of the Smile 2004, QuintessenzPublishing Co. Inc 37. Geron S., Shpack N. Kandos S. Davidovitch M., Vardimon A., Anchorage loss, a multifactorial response. Angle Ortho. 2003;73:730-737 38. Geron S., Vardimon A. Six Anchorage keys used in Lingual Orthodontics sliding mechanics, World J Orthod 2003;4:258-265 39. Goren S Goizner R Q,. Geron S., Romano R., Lingual Orthodontics versus Buccal Orthodontics: biomechanical and clinical aspects JLO Feb 2003 40.
  82. 82. 82 ETM 141 Module remover (or explorer) Mosquito Forceps Ligature Cutter Ligature Director WEINGART PLIER Hollow chop contouring plier Bracket Height Gauge
  83. 83. 83 Nitanol bending plier Malocclusion Model Super Glue Pencil+ Eraser
  84. 84. 84