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INTRODUCTION
• There are many patients who would
strongly benefit from better function,
healthier periodontal tissues, and
improved self-image if they had
orthodontic correction.
• Many of these patients never consider
orthodontics because of their
preconceived ideas of "tinsel teeth" and
"metal mouth"
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HISTORY
• 1726 –An appliance on lingual surface of teeth by
PIERRE FAUCHARD
• 1841- first lingual arch for expansion and alignment of
teeth by PIERRE JOACHIM LEFOULON
• 1889 -a "lingual removable arch" by John Farrar.
• 1918 -Dr. John Mershon "The Removable Lingual Arch
as an Appliance for the Treatment of Malocclusion of the
Teeth".
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• 1975, Dr. Craven
Kurz developed the
first true lingual
appliance
• He was orthodontist
assistant professor
of occlusion and
gnathology at the
UCLA School of
Dentistry
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• The appliance
consisted of plastic
Lee Fisher brackets
bonded to the
lingual aspect of the
anterior dentition
and metal brackets
bonded to the
lingual aspect of the
posterior dentition
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• This was a lingual bonded edgewise
appliance by modifying labial
appliances
• Dr. Kurz applied for a patent for the
Kurz Lingual Appliance on November
15, 1976
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• 1979 --- Dr.Kinya Fujita introduced
Lingual bracket design and Mushroom
shaped arch wires AJO ,76; 657-
675,1979.
• The American Lingual Orthodontic
Association (ALOA) was established on
November 14, 1987
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Ideal Lingual cases
Non extraction cases
• Deep bite, class I with mild crowding
• Deep bite, class I with generalized spacing,
• Deep bite, mild class II ,
• Class II div 2 with retruded mandible
• Cases requiring expansion
• Consolidation (diastema) cases
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Ideal Lingual cases
Extraction cases
• Class II,maxillary first bicuspid and mandibular
second bicuspid extractions
• Maxillary first bicuspid only extractions
• Mild double protrusions with four first bicuspid
extractions, where in anchorage is not critical
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Difficult lingual cases
• a) Surgical cases
• b) Class II tendencies
• c) Class II four first bicuspids extraction
• d) Mesiofacial pattern and / or moderate
mandibular plane angle.
• e) Cases with multiple restorative work.
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Cases contraindicated for
Lingual therapy
• Acute TMJ dysfunction
• Mutilated posterior occlusion
• High angle or dolicofacial patterns
• Extensive anterior prosthesis
• Short clinical crowns
• Critical anchorage cases
• Severe class II discrepancies
• Poor oral hygiene or Unresolved periodontal
involvement
• Inadaptable or demanding personality types
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BRACKET
EVOLUTION
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ORMCO (KRUZ) LINGUAL BRACKET
Generation # 1-1976
The first Kurz appliance was manufactured by ORMCO.
This appliance had flat maxillary occlusal bite plane from
canine to canine. The lower incisors and pre molar brackets
were low profile and half round. And there were no hooks
on any brackets.
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ORMCO (KRUZ) LINGUAL BRACKET
Generation # 2-1976
Hooks were added to all canine brackets.
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ORMCO (KRUZ) LINGUAL BRACKET
Generation #3-1981
Hooks were added to all anterior and premolar brackets.
The first molar had a bracket with an internal hook. The
second molar had a terminal sheath without a hook but
had a terminal recess for elastic traction.
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ORMCO (KRUZ) LINGUAL BRACKET
Generation # 4-1982-84
This generation saw the addition of a low profile anterior
inclined plane on the central and lateral incisor brackets.
Hooks were optional.
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ORMCO (KRUZ) LINGUAL BRACKET
Generation # 5-1985-86
The anterior Inclined plane became more pronounced, with an
increase in labial torque in the maxillary anterior region.The canine also
had an inclined plane. A transpalatal bar attachment was now
available for the first molar bracket.
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ORMCO (KRUZ) LINGUAL BRACKET
Generation # 6-1987-90
The inclined plane in the maxillary incisors became more square
in shape. Hooks on the anteriors and premolars were elongated. A
hinge cap, allowing ease of manipulation, was now available for
molar brackets.
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ORMCO (KRUZ) LINGUAL BRACKET
• 7th generation
– straight wire brackets
– .018’’ or .022’’
– Rounded facial
contours
– Large hook
– Rounded opening to
the slot
– Increased tie wing
area
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ORMCO (KRUZ) LINGUAL BRACKET
– Bracket base is large
– Horizontal slot
– Bite plan in the upper
anterior brackets
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• Molar brackets are
twin brackets with
mesial ball hooks.
• also brackets with
hinge cap molar
tube
• a special molar
bracket with
transpalatal sheath
Hinge-cup molar bracket
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Bracket design
• Hardened stainless
steel
• brackets for all the teeth
are of the same design
• differ only in the width
• brazed to a diffusion
bonded foil / mesh base
• The bonding base is
contour
• additional adaptation
can be done in the
laboratory
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• 0.018” each wire slot
which parallels the
occlusal plane
• A bracket with a slot
size of 0.018” was
selected with two
criteria in mind.
1. It would conserve incisal
– gingival bracket
dimension
2. It would be compatible
with existing arch wires.
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• Maxillary anterior
brackets incorporate
bite plane designed
into the incisal edge of
the bracket the bite
plane in parallel to the
arch wire and the
occlusal plane.
– It assisted in opening
the bite.
– It redirected the forces
of occlusion to prevent
shearing of the bond
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• A gingival ball hook
– 1. Elastic ligature
placement
– 2. Rotation control
– 3. Placement of intra
and intermaxillary
elastics.
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STb (SCUZZO-TAKEMOTO
bracket)
• Introduced by Drs. GIUSEPPE SCUZZO and KYOTO
TAKEMOTO
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highlights
• 1. Comfortable
– Reduced dimension,
– The lowest bracket profile of just 1.5mm
– Special rounded design
– Low friction ,low force hence reduced pain
• 2.Easy hygiene maintenance.
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• 3.Fast
– Passive ligation step with 0.3 mm clearance
between the slot base and the ligature wire
– Used with the " Light Lingual system " (gentle
forces)
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Fujita lingual bracket
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Fujita lingual bracket
• Based on an occlusal slot opening
• Brackets for the anterior teeth and premolars
have three slots: occlusal, lingual, and vertical.
• Molar brackets have five slots: one occlusal, two
lingual, and two vertical.
• Each of the three types of archwire slots
provides different capabilities for efficient tooth
movements.
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• The .019" × .019"
main occlusal slot
allows
easier archwire
insertion, seating,
and removal than
with lingually
opening slots
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• Rotation control is more efficient with the
occlusal slot, since it requires only the
insertion of the light archwire, which produces
an action analogous to tipping with a labial
edgewise appliance
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• The .018" × .018" lingual slot is generally
reserved for sliding mechanics such as partial
canine retraction
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• The molar bracket has .028"
× .022" outer and .018" × .
018" inner lingual slots (“slot
in slot”).
The outer slot of the maxillary
molar bracket can engage a
transpalatal arch to retain an
expanded maxillary archn or
to inhibit extrusion of the
maxillary first molar during
leveling in dolichofacial
patients.
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• The .016" × .016"
vertical slot permits
the insertion of
auxiliary uprighting
springs or elastic
hooks on one or
more teeth at any
time during
treatment
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UNITEK CONCEAL BRACKETS
Introduced by THOMAS CREEKMORES, AJO-DO Volume 1989 Aug (120 –
137)
instead of labiolingually
0.016’’ SLOT
Based on occlusal slot
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• The first 1 mm of the
molar tube opens to
the occlusal aspect to
simplify arch wire
insertion.
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• Premolar bracket tie
wings project mesially
and distally instead of
labiolingually
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• Conceal brackets are
designed around the
Unitwin bracket
"centered slot" concept
• The Unitwin bracket is,
in effect, a single
bracket without tie
wings in the center of a
0.045 inch twin bracket
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• It uses the advantages of both single and
twin brackets by allowing maximum
interbracket distance for optimal tip and
torque functions, while providing twin tie
wings for rotation control
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• The Conceal
system slot is
therefore 0.016 inch
horizontally and
0.022 inch vertically
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• Each Conceal bracket
has three different slot
widths for the three
different functions
– TIP (A-B) 0.100 inch
– TORQUE (E-F) 0.070
inch
– ROTATION (C-F OR E-
D) 0.035 inch
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Adenta- self ligating evolution
• Dr. Hatto Loidl, an
orthodontist from
Berlin,Germany and Mr.
Claus Schendell, owner
and engineer of adenta
GmbH, together
designed a new self-
ligating lingual bracket
and modified Hiro
system called the
Evolution slt bracket
system.
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Highlights
• Self-ligating bracket
eliminates ligature ties
• Easy handling and
archwire changes
• Closing springs are
designed as bite planes
for the lower incisors
• Perfect transmission of
torque and angulation
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Highlights
• One piece design
• Occousal archwire
insertion
• Significant reduction of
chair time
• Hygienic situation, the
occurrence of
decalcification is
dramatically reduced
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Forestadent lingual brackets
• Easy to use
• Self ligating brackets
• An extremely low profile and are
barely noticeable for the patient.
• A vertical slot for fast and easy
archwire insertion.
• 2D-Lingual brackets for
Treating less complex cases.
• 3D torque lingual brackets for
for complex cases
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Phantom lingual attachements
“Ortendahl lingual system”
• First tooth colored self-
ligating bracket
• Made up of composite
polymer
• Manufactured by
GESTENCO
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• Direct bonding with built
in placement jig
• Passive initially and
active later- when you
need it
• Tubes on premolars to
avoid speech impediment
• A replacement for
INVISALIGN
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GAC –IN – OVATION L
• Twin self - ligating lingual
bracket system
• Provides full functionality
throughout of course of
treatment
• Low profile
• Twin design with
interactive clip
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• Passive function is achived
with a small diameter round
wire
• Expressive function with the
light seating a BIO FORCE
wire into the bases of slot so
programming may be
expressed and rotation are
corrected
• Active function by a full size
Beta –Ti wire
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I braces (Incognito)
• Conceptualized by dr.
DIRK WIECHMANN
• Using state-of-the-art
CAD/CAM technology
• Based on digital
registration of the
malocclusion
situation.
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I braces (Incognito)
• The brackets are then
individually designed and
optimally positioned in the
computer.
• State-of-the-art Rapid
Prototyping technology is
used for the actual
manufacturing of the
lingual brackets. www.indiandentalacademy.com
• Each bracket body is designed independently of
the bracket base, on which it is optimally
positioned.
• Filler spaces such as those occurring in the
individualized positioning of prefabricated
brackets can thus be avoided.
• This also makes the lingual appliance decidedly
more favorable for good oral hygiene.
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LINGUAL STRAIGHT WIRE
APPLIANCE
• Future of lingual
orthosontics
• Allows ease of flossing
• Without bite plane it is
easy to establish
adequate overbite during
detailing stage
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• Opposite direction of wire
insertion helps in easy
rotation correction
• Easy of anterior
expansion
• Distance of contact point
from the wire long
enough to permit
proximal slicing without
removing wire
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Bonding procedures for
Lingual Orthodontics
- Direct bonding
- Indirect bonding
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Direct bonding
Gauges are available for direct bonding,
but bonding is difficult and not accurate
with this procedure.
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The New Lingual Bracket Jig
(LBJ)
• The Lingual Bracket
Jig (LBJ ) was first
presented in ESLO
congress in Rome in
1998, and published
in JCO in 1999 (1)
• a precision device
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The New Lingual Bracket Jig (LBJ)
• a simple direct bonding technique,
• and an in-office preparation for indirect bonding
of Lingual brackets, controlling tip, torque, in-out
and height of the brackets.
• The LBJ is suitable for Ormco Generation 7, STb
and Stealth (American Orthodontics) Lingual
brackets,
• and it fits for both 0.018" and 0.022" slot
brackets
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The New Lingual Bracket Jig
(LBJ)
• The concept of the
LBJ is that it copies
the labial bracket
slot prescription and
translates it to the
lingual surface
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The New Lingual Bracket Jig
(LBJ)
• Prescription of the LBJ and brackets
mounted with the LBJ
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Custom made lingual
bracket jig
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Constructing the set-up
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Setting the maxillary arch
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Setting the maxillary arch
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Setting the mandibular arch
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Setting the mandibular arch
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Marking the long axis of teeth
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Constructing the full size arch wire
and bracket placement
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Customizing the bracket basw
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Indirect Bonding procedures
for Lingual Orthodontics
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Indirect bonding techniques
• 1. TARG : (Torque Angulation Reference
Guide)
• 2. CLASS : ( The Customized Lingual
Appliance Set -up Service System )
• 3. The HIRO system
• 4. Ray set
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The TARG
• developed by
Ormco in 1984 for
lingual bracket
bonding
• Placing the lingual
brackets directly
onto the
malocclusion model
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• permits us to bond brackets in the
laboratory at an accurate distance from
the occlusal edge of each tooth with
respect to a horizontal occlusal plane.
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• The model is tipped
on the swivel base
until the long axis of
the labial face of the
tooth aligns with the
specific gauge
curvature at the
middle third of the
tooth
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• The gauge or torque
blade orientates the
tooth in its final
position.
• This orientation
allows us to
preprogram torque
and angulation (tip)
before starting the
treatment
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• After the TARG
horizontal blade is
engaged into the
bracket slot, it is
moved toward the
varnished plaster at
the bonding level
determined by the
laboratory
technician
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• The bracket is
bonded to the
plaster with a filled
resin, which allows
the gap between the
lingual tooth surface
and the metal base
of the bracket to be
completely filled
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• Once all the brackets are bonded to the
model, a transfer tray is fabricated.
• an accurate and quantified two-
dimensional system
• The torque, angulation (tip), and height
measurements are registered by the
technician.
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• TARG does not take
into account the
labiolingual
thickness of the
teeth.
• So it did not allow
preprogramming of
in and out bends for
individual teeth
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Fillion’s Lingual Indirect
Bonding System
• DIDIER FILLION
improved TARG in 1987
by adding an electronic
device to the machine
with the purpose of
measuring tooth labio-
lingual thickness
• This composed of two
elements—a Thickness
Measurement System
(adapted for the TARG)
and the DALI program
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• One end caliper
(MITUTOYO), is
engaged into the
bracket slot, and the
other one is applied
to the labial tooth
surface
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• For a selected height
bonding level, the
Thickness
Measurement System
records the thickness
(the width of the teeth
with bracket) of the six
anterior teeth.
• The greatest thickness
is chosen as the
standard thickness
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The Customized LingualAppliance Set-Up Service
(CLASS) System
• Account the anatomical discrepancies in the
lingual surfaces of the teeth
• First constructing an ideal diagnostic set-up from
a duplicate set-up model of the patient’s original
malocclusion.
• This ideal set-up or template is then used as a
physical guide to place the lingual brackets in an
ideal configuration.
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The Customized LingualAppliance Set-Up Service
(CLASS) System
• The brackets are placed on the diagnostic set-up using
composite adhesive, which acts as a spacer between the
metal mesh pad and the individual dental surfaces.
• After the brackets are placed on the ideal diagnostic set-
up, they are next transferred back to the malocclusion
cast.
• At this point, transfer trays are fabricated so the brackets
can be delivered clinically via the indirect bonding
method.
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. Transfer trays
• two-tray system processed on the Biostar
machine.
• The inner tray is a 1.5 mm Bioplast and
the outer tray is a 1.0 Biocryl.
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• first seat the Bioplast
tray and bend it as
needed to gain initial
placement
• Once each flexible
section is seated, the
hard acrylic tray is
immediately placed
over it and pressure is
applied to bring the
adhesive and dental
surfaces into complete
contact
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• The trays are
removed from the
model by soaking
the cast in warm
water for
approximately 30
minutes
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• the trays are
sectioned in two or
three pieces per
arch to allow the
clinician complete
control over the
clinical bonding
process
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Arch wires
• The main problem in the biomechanics of lingual
orthodontics is the short interbracket distances
• Biological tooth movement with a low and
continuous force and a constant moment/force
ratio in order to maintain a low stress/strain ratio
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• Two different ways
– INCREASE WIRE LENGTH
– USE ELASTIC WIRES
• Shape memory alloys are ideal materials
because they have low Young’s modulus,
present a very small stress/strain ratio,
and have a large cross-section of wire to
achieve a maximum of control
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• Mushroom shaped arch
wires.
• The compensatory first
order bends are placed
interproximally at cuspid
–bicuspid and bicuspid
–molar locations.
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Biomechanical advantage
• Point of application of
the force in relation to
the center of
resistance of teeth
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Sagittal plane
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Vertical plane
• Maxillary incisors are best intruded along
their long axis into the broadest area of
alveolar process
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Normal inclination
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Labial inclination
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Lingual inclination
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Lower arch
• Easier intrusion
• Less labial inclination
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Lower arch
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Horizontal plane
• Coupling of force is difficult to apply
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Horizontal anchorage
• Distal uprighting of
molars
• Distal rotation of molars
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Vetical anchorage
• Buccal root torque
• Mesial tilted molars
• an intrusive force is applied to
the functional or lingual cusps
of the upper molars because
the appliance is placed near
these cusps.
• Therefore, the CO-CR
discrepancy caused by the
primarily initial contact and the
mandibular clockwise rotation
caused by the elongation of
molars are reduced.
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• The primary changes induced by the
lingual appliance can best be categorized
as those dynamic effects on vertical,
anteroposterior, and transverse planes.
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• Bite opening resulting from the lower
incisors occluding on the maxillary incisor
bracket bite planes
• In the low angle brachyfacial patterns
• posterior occlusion reestablishing in
approximately 3 to 4 months.
• In the mesiofacial and dolichofacial types
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vertical bowing effect
• Excessive force
• Upper anterior teeth tip
lingualy
• Premature contacts b/w
the bite plane and lower
anteriors
• Posterior disclussion
• Mesial tipping of the
posterior
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• Prevantive measures
• Reduce retraction force
• Placing glable bends and compensating
curve to increase intrusive force
• Place good lingual root torque in anterior
segment
• Highly resilient 0.017 X 0.025 TMA wires
• Medium sized outer bows of head gear
recommonded
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Transverse bowing effect
• Upper arch
• Retracting force with
head gear
• Distal rotating force on 1st
molars
• Widen in premolar area
and constrict in 2nd
molars
area
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• Prevantive measures
• Retractin wire with a compensating
bowing arch form distal to upper 1st
premolar
• Brackets placed slightly mesialy
• Brackets with small distal offset
• Transpalatal arch placed
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Leveling, Aligning, Rotational Control,
and Bite Opening
• The objectives of this initial phase of therapy are to:
• 1. initiate tooth movement with light forces,
• 2. provide for a period of patient adaptation,
• 3. eliminate rotations,
• 4. level and align individual arches to permit wire progression,
• 5. obtain initial torque control when required,
• 6. establish posterior anchorage units with buccal segments,
• 7. initiate posterior segment control with extraoral traction and
transpalatal arch when required,
• 8. reduce any excessive overbite, and
• 9. gain space for rotations and additional bracket bonding.
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• Anterior leveling
– Partial canine retraction: 0.016 TMA or lingual
arch
– Anterior leveling: 0.016 cu-NiTi or 0.017 x
0.017 cu-NiTi
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Method of partial canine retaction
• LINGUAL ARCH
• Introductory appliance
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Full arch wire with loops (.016 Cu-
NiTi)
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Sectional wire( .0175 x .0175 TMA)
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Rotation correction
• Power arm
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Power arm
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SMITH’S rotation tie
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Rotation correction with loop
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En masse retraction
• jsliding mechanics
• loop mechanics.
• Three
• different kinds of loops are commonly
used: closed helical loop , L-loop and T-
loop
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closed helical loop
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• Open bite cases with little need for upper
anterior torque control or active tipping of
anteriors;
• closure of small spaces.
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closed helical loop
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L-loop
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T-loop
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T-loop
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• When maximum anterior retraction is
needed while maintaining anterior torque;
• when active intrusion of anteriors is
indicated ; and
• in seventy percent of total extraction
cases.
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Sliding mechanics
– .016" TMA with Class I
elastic thread
– .017 x.025 TMA
– .016 X .022 SS lower arch
1. Minimum or moderate
anchorage cases with
upper second bicuspid
extraction
2. nervous patients who do
not want auxiliaries like
loops;
3. lower arch extraction
cases.
www.indiandentalacademy.com
• Class II elastics to a
bonded Debnam cleat.
www.indiandentalacademy.com
THANK YOU
www.indiandentalacademy.com

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Lingual main

  • 3. INTRODUCTION • There are many patients who would strongly benefit from better function, healthier periodontal tissues, and improved self-image if they had orthodontic correction. • Many of these patients never consider orthodontics because of their preconceived ideas of "tinsel teeth" and "metal mouth" www.indiandentalacademy.com
  • 4. HISTORY • 1726 –An appliance on lingual surface of teeth by PIERRE FAUCHARD • 1841- first lingual arch for expansion and alignment of teeth by PIERRE JOACHIM LEFOULON • 1889 -a "lingual removable arch" by John Farrar. • 1918 -Dr. John Mershon "The Removable Lingual Arch as an Appliance for the Treatment of Malocclusion of the Teeth". www.indiandentalacademy.com
  • 5. • 1975, Dr. Craven Kurz developed the first true lingual appliance • He was orthodontist assistant professor of occlusion and gnathology at the UCLA School of Dentistry www.indiandentalacademy.com
  • 6. • The appliance consisted of plastic Lee Fisher brackets bonded to the lingual aspect of the anterior dentition and metal brackets bonded to the lingual aspect of the posterior dentition www.indiandentalacademy.com
  • 7. • This was a lingual bonded edgewise appliance by modifying labial appliances • Dr. Kurz applied for a patent for the Kurz Lingual Appliance on November 15, 1976 www.indiandentalacademy.com
  • 8. • 1979 --- Dr.Kinya Fujita introduced Lingual bracket design and Mushroom shaped arch wires AJO ,76; 657- 675,1979. • The American Lingual Orthodontic Association (ALOA) was established on November 14, 1987 www.indiandentalacademy.com
  • 9. Ideal Lingual cases Non extraction cases • Deep bite, class I with mild crowding • Deep bite, class I with generalized spacing, • Deep bite, mild class II , • Class II div 2 with retruded mandible • Cases requiring expansion • Consolidation (diastema) cases www.indiandentalacademy.com
  • 10. Ideal Lingual cases Extraction cases • Class II,maxillary first bicuspid and mandibular second bicuspid extractions • Maxillary first bicuspid only extractions • Mild double protrusions with four first bicuspid extractions, where in anchorage is not critical www.indiandentalacademy.com
  • 11. Difficult lingual cases • a) Surgical cases • b) Class II tendencies • c) Class II four first bicuspids extraction • d) Mesiofacial pattern and / or moderate mandibular plane angle. • e) Cases with multiple restorative work. www.indiandentalacademy.com
  • 12. Cases contraindicated for Lingual therapy • Acute TMJ dysfunction • Mutilated posterior occlusion • High angle or dolicofacial patterns • Extensive anterior prosthesis • Short clinical crowns • Critical anchorage cases • Severe class II discrepancies • Poor oral hygiene or Unresolved periodontal involvement • Inadaptable or demanding personality types www.indiandentalacademy.com
  • 14. ORMCO (KRUZ) LINGUAL BRACKET Generation # 1-1976 The first Kurz appliance was manufactured by ORMCO. This appliance had flat maxillary occlusal bite plane from canine to canine. The lower incisors and pre molar brackets were low profile and half round. And there were no hooks on any brackets. www.indiandentalacademy.com
  • 15. ORMCO (KRUZ) LINGUAL BRACKET Generation # 2-1976 Hooks were added to all canine brackets. www.indiandentalacademy.com
  • 16. ORMCO (KRUZ) LINGUAL BRACKET Generation #3-1981 Hooks were added to all anterior and premolar brackets. The first molar had a bracket with an internal hook. The second molar had a terminal sheath without a hook but had a terminal recess for elastic traction. www.indiandentalacademy.com
  • 17. ORMCO (KRUZ) LINGUAL BRACKET Generation # 4-1982-84 This generation saw the addition of a low profile anterior inclined plane on the central and lateral incisor brackets. Hooks were optional. www.indiandentalacademy.com
  • 18. ORMCO (KRUZ) LINGUAL BRACKET Generation # 5-1985-86 The anterior Inclined plane became more pronounced, with an increase in labial torque in the maxillary anterior region.The canine also had an inclined plane. A transpalatal bar attachment was now available for the first molar bracket. www.indiandentalacademy.com
  • 19. ORMCO (KRUZ) LINGUAL BRACKET Generation # 6-1987-90 The inclined plane in the maxillary incisors became more square in shape. Hooks on the anteriors and premolars were elongated. A hinge cap, allowing ease of manipulation, was now available for molar brackets. www.indiandentalacademy.com
  • 20. ORMCO (KRUZ) LINGUAL BRACKET • 7th generation – straight wire brackets – .018’’ or .022’’ – Rounded facial contours – Large hook – Rounded opening to the slot – Increased tie wing area www.indiandentalacademy.com
  • 21. ORMCO (KRUZ) LINGUAL BRACKET – Bracket base is large – Horizontal slot – Bite plan in the upper anterior brackets www.indiandentalacademy.com
  • 22. • Molar brackets are twin brackets with mesial ball hooks. • also brackets with hinge cap molar tube • a special molar bracket with transpalatal sheath Hinge-cup molar bracket www.indiandentalacademy.com
  • 23. Bracket design • Hardened stainless steel • brackets for all the teeth are of the same design • differ only in the width • brazed to a diffusion bonded foil / mesh base • The bonding base is contour • additional adaptation can be done in the laboratory www.indiandentalacademy.com
  • 24. • 0.018” each wire slot which parallels the occlusal plane • A bracket with a slot size of 0.018” was selected with two criteria in mind. 1. It would conserve incisal – gingival bracket dimension 2. It would be compatible with existing arch wires. www.indiandentalacademy.com
  • 25. • Maxillary anterior brackets incorporate bite plane designed into the incisal edge of the bracket the bite plane in parallel to the arch wire and the occlusal plane. – It assisted in opening the bite. – It redirected the forces of occlusion to prevent shearing of the bond www.indiandentalacademy.com
  • 26. • A gingival ball hook – 1. Elastic ligature placement – 2. Rotation control – 3. Placement of intra and intermaxillary elastics. www.indiandentalacademy.com
  • 27. STb (SCUZZO-TAKEMOTO bracket) • Introduced by Drs. GIUSEPPE SCUZZO and KYOTO TAKEMOTO www.indiandentalacademy.com
  • 28. highlights • 1. Comfortable – Reduced dimension, – The lowest bracket profile of just 1.5mm – Special rounded design – Low friction ,low force hence reduced pain • 2.Easy hygiene maintenance. www.indiandentalacademy.com
  • 29. • 3.Fast – Passive ligation step with 0.3 mm clearance between the slot base and the ligature wire – Used with the " Light Lingual system " (gentle forces) www.indiandentalacademy.com
  • 31. Fujita lingual bracket • Based on an occlusal slot opening • Brackets for the anterior teeth and premolars have three slots: occlusal, lingual, and vertical. • Molar brackets have five slots: one occlusal, two lingual, and two vertical. • Each of the three types of archwire slots provides different capabilities for efficient tooth movements. www.indiandentalacademy.com
  • 32. • The .019" × .019" main occlusal slot allows easier archwire insertion, seating, and removal than with lingually opening slots www.indiandentalacademy.com
  • 33. • Rotation control is more efficient with the occlusal slot, since it requires only the insertion of the light archwire, which produces an action analogous to tipping with a labial edgewise appliance www.indiandentalacademy.com
  • 34. • The .018" × .018" lingual slot is generally reserved for sliding mechanics such as partial canine retraction www.indiandentalacademy.com
  • 35. • The molar bracket has .028" × .022" outer and .018" × . 018" inner lingual slots (“slot in slot”). The outer slot of the maxillary molar bracket can engage a transpalatal arch to retain an expanded maxillary archn or to inhibit extrusion of the maxillary first molar during leveling in dolichofacial patients. www.indiandentalacademy.com
  • 36. • The .016" × .016" vertical slot permits the insertion of auxiliary uprighting springs or elastic hooks on one or more teeth at any time during treatment www.indiandentalacademy.com
  • 37. UNITEK CONCEAL BRACKETS Introduced by THOMAS CREEKMORES, AJO-DO Volume 1989 Aug (120 – 137) instead of labiolingually 0.016’’ SLOT Based on occlusal slot www.indiandentalacademy.com
  • 38. • The first 1 mm of the molar tube opens to the occlusal aspect to simplify arch wire insertion. www.indiandentalacademy.com
  • 39. • Premolar bracket tie wings project mesially and distally instead of labiolingually www.indiandentalacademy.com
  • 40. • Conceal brackets are designed around the Unitwin bracket "centered slot" concept • The Unitwin bracket is, in effect, a single bracket without tie wings in the center of a 0.045 inch twin bracket www.indiandentalacademy.com
  • 41. • It uses the advantages of both single and twin brackets by allowing maximum interbracket distance for optimal tip and torque functions, while providing twin tie wings for rotation control www.indiandentalacademy.com
  • 42. • The Conceal system slot is therefore 0.016 inch horizontally and 0.022 inch vertically www.indiandentalacademy.com
  • 43. • Each Conceal bracket has three different slot widths for the three different functions – TIP (A-B) 0.100 inch – TORQUE (E-F) 0.070 inch – ROTATION (C-F OR E- D) 0.035 inch www.indiandentalacademy.com
  • 44. Adenta- self ligating evolution • Dr. Hatto Loidl, an orthodontist from Berlin,Germany and Mr. Claus Schendell, owner and engineer of adenta GmbH, together designed a new self- ligating lingual bracket and modified Hiro system called the Evolution slt bracket system. www.indiandentalacademy.com
  • 45. Highlights • Self-ligating bracket eliminates ligature ties • Easy handling and archwire changes • Closing springs are designed as bite planes for the lower incisors • Perfect transmission of torque and angulation www.indiandentalacademy.com
  • 46. Highlights • One piece design • Occousal archwire insertion • Significant reduction of chair time • Hygienic situation, the occurrence of decalcification is dramatically reduced www.indiandentalacademy.com
  • 47. Forestadent lingual brackets • Easy to use • Self ligating brackets • An extremely low profile and are barely noticeable for the patient. • A vertical slot for fast and easy archwire insertion. • 2D-Lingual brackets for Treating less complex cases. • 3D torque lingual brackets for for complex cases www.indiandentalacademy.com
  • 48. Phantom lingual attachements “Ortendahl lingual system” • First tooth colored self- ligating bracket • Made up of composite polymer • Manufactured by GESTENCO www.indiandentalacademy.com
  • 49. • Direct bonding with built in placement jig • Passive initially and active later- when you need it • Tubes on premolars to avoid speech impediment • A replacement for INVISALIGN www.indiandentalacademy.com
  • 50. GAC –IN – OVATION L • Twin self - ligating lingual bracket system • Provides full functionality throughout of course of treatment • Low profile • Twin design with interactive clip www.indiandentalacademy.com
  • 51. • Passive function is achived with a small diameter round wire • Expressive function with the light seating a BIO FORCE wire into the bases of slot so programming may be expressed and rotation are corrected • Active function by a full size Beta –Ti wire www.indiandentalacademy.com
  • 52. I braces (Incognito) • Conceptualized by dr. DIRK WIECHMANN • Using state-of-the-art CAD/CAM technology • Based on digital registration of the malocclusion situation. www.indiandentalacademy.com
  • 53. I braces (Incognito) • The brackets are then individually designed and optimally positioned in the computer. • State-of-the-art Rapid Prototyping technology is used for the actual manufacturing of the lingual brackets. www.indiandentalacademy.com
  • 54. • 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. www.indiandentalacademy.com
  • 55. LINGUAL STRAIGHT WIRE APPLIANCE • Future of lingual orthosontics • Allows ease of flossing • Without bite plane it is easy to establish adequate overbite during detailing stage www.indiandentalacademy.com
  • 56. • Opposite direction of wire insertion helps in easy rotation correction • Easy of anterior expansion • Distance of contact point from the wire long enough to permit proximal slicing without removing wire www.indiandentalacademy.com
  • 57. Bonding procedures for Lingual Orthodontics - Direct bonding - Indirect bonding www.indiandentalacademy.com
  • 58. Direct bonding Gauges are available for direct bonding, but bonding is difficult and not accurate with this procedure. www.indiandentalacademy.com
  • 59. The New Lingual Bracket Jig (LBJ) • The Lingual Bracket Jig (LBJ ) was first presented in ESLO congress in Rome in 1998, and published in JCO in 1999 (1) • a precision device www.indiandentalacademy.com
  • 60. The New Lingual Bracket Jig (LBJ) • a simple direct bonding technique, • and an in-office preparation for indirect bonding of Lingual brackets, controlling tip, torque, in-out and height of the brackets. • The LBJ is suitable for Ormco Generation 7, STb and Stealth (American Orthodontics) Lingual brackets, • and it fits for both 0.018" and 0.022" slot brackets www.indiandentalacademy.com
  • 61. The New Lingual Bracket Jig (LBJ) • The concept of the LBJ is that it copies the labial bracket slot prescription and translates it to the lingual surface www.indiandentalacademy.com
  • 62. The New Lingual Bracket Jig (LBJ) • Prescription of the LBJ and brackets mounted with the LBJ www.indiandentalacademy.com
  • 63. Custom made lingual bracket jig www.indiandentalacademy.com
  • 75. Setting the maxillary arch www.indiandentalacademy.com
  • 76. Setting the maxillary arch www.indiandentalacademy.com
  • 77. Setting the mandibular arch www.indiandentalacademy.com
  • 78. Setting the mandibular arch www.indiandentalacademy.com
  • 79. Marking the long axis of teeth www.indiandentalacademy.com
  • 80. Constructing the full size arch wire and bracket placement www.indiandentalacademy.com
  • 83. Customizing the bracket basw www.indiandentalacademy.com
  • 91. Indirect Bonding procedures for Lingual Orthodontics www.indiandentalacademy.com
  • 102. Indirect bonding techniques • 1. TARG : (Torque Angulation Reference Guide) • 2. CLASS : ( The Customized Lingual Appliance Set -up Service System ) • 3. The HIRO system • 4. Ray set www.indiandentalacademy.com
  • 103. The TARG • developed by Ormco in 1984 for lingual bracket bonding • Placing the lingual brackets directly onto the malocclusion model www.indiandentalacademy.com
  • 104. • permits us to bond brackets in the laboratory at an accurate distance from the occlusal edge of each tooth with respect to a horizontal occlusal plane. www.indiandentalacademy.com
  • 105. • The model is tipped on the swivel base until the long axis of the labial face of the tooth aligns with the specific gauge curvature at the middle third of the tooth www.indiandentalacademy.com
  • 106. • The gauge or torque blade orientates the tooth in its final position. • This orientation allows us to preprogram torque and angulation (tip) before starting the treatment www.indiandentalacademy.com
  • 107. • After the TARG horizontal blade is engaged into the bracket slot, it is moved toward the varnished plaster at the bonding level determined by the laboratory technician www.indiandentalacademy.com
  • 108. • The bracket is bonded to the plaster with a filled resin, which allows the gap between the lingual tooth surface and the metal base of the bracket to be completely filled www.indiandentalacademy.com
  • 109. • Once all the brackets are bonded to the model, a transfer tray is fabricated. • an accurate and quantified two- dimensional system • The torque, angulation (tip), and height measurements are registered by the technician. www.indiandentalacademy.com
  • 110. • TARG does not take into account the labiolingual thickness of the teeth. • So it did not allow preprogramming of in and out bends for individual teeth www.indiandentalacademy.com
  • 111. Fillion’s Lingual Indirect Bonding System • DIDIER FILLION improved TARG in 1987 by adding an electronic device to the machine with the purpose of measuring tooth labio- lingual thickness • This composed of two elements—a Thickness Measurement System (adapted for the TARG) and the DALI program www.indiandentalacademy.com
  • 112. • One end caliper (MITUTOYO), is engaged into the bracket slot, and the other one is applied to the labial tooth surface www.indiandentalacademy.com
  • 113. • For a selected height bonding level, the Thickness Measurement System records the thickness (the width of the teeth with bracket) of the six anterior teeth. • The greatest thickness is chosen as the standard thickness www.indiandentalacademy.com
  • 114. The Customized LingualAppliance Set-Up Service (CLASS) System • Account the anatomical discrepancies in the lingual surfaces of the teeth • First constructing an ideal diagnostic set-up from a duplicate set-up model of the patient’s original malocclusion. • This ideal set-up or template is then used as a physical guide to place the lingual brackets in an ideal configuration. www.indiandentalacademy.com
  • 115. The Customized LingualAppliance Set-Up Service (CLASS) System • The brackets are placed on the diagnostic set-up using composite adhesive, which acts as a spacer between the metal mesh pad and the individual dental surfaces. • After the brackets are placed on the ideal diagnostic set- up, they are next transferred back to the malocclusion cast. • At this point, transfer trays are fabricated so the brackets can be delivered clinically via the indirect bonding method. www.indiandentalacademy.com
  • 116. . Transfer trays • two-tray system processed on the Biostar machine. • The inner tray is a 1.5 mm Bioplast and the outer tray is a 1.0 Biocryl. www.indiandentalacademy.com
  • 117. • first seat the Bioplast tray and bend it as needed to gain initial placement • Once each flexible section is seated, the hard acrylic tray is immediately placed over it and pressure is applied to bring the adhesive and dental surfaces into complete contact www.indiandentalacademy.com
  • 118. • The trays are removed from the model by soaking the cast in warm water for approximately 30 minutes www.indiandentalacademy.com
  • 119. • the trays are sectioned in two or three pieces per arch to allow the clinician complete control over the clinical bonding process www.indiandentalacademy.com
  • 120. Arch wires • The main problem in the biomechanics of lingual orthodontics is the short interbracket distances • Biological tooth movement with a low and continuous force and a constant moment/force ratio in order to maintain a low stress/strain ratio www.indiandentalacademy.com
  • 121. • Two different ways – INCREASE WIRE LENGTH – USE ELASTIC WIRES • Shape memory alloys are ideal materials because they have low Young’s modulus, present a very small stress/strain ratio, and have a large cross-section of wire to achieve a maximum of control www.indiandentalacademy.com
  • 122. • Mushroom shaped arch wires. • The compensatory first order bends are placed interproximally at cuspid –bicuspid and bicuspid –molar locations. www.indiandentalacademy.com
  • 123. Biomechanical advantage • Point of application of the force in relation to the center of resistance of teeth www.indiandentalacademy.com
  • 125. Vertical plane • Maxillary incisors are best intruded along their long axis into the broadest area of alveolar process www.indiandentalacademy.com
  • 129. Lower arch • Easier intrusion • Less labial inclination www.indiandentalacademy.com
  • 131. Horizontal plane • Coupling of force is difficult to apply www.indiandentalacademy.com
  • 132. Horizontal anchorage • Distal uprighting of molars • Distal rotation of molars www.indiandentalacademy.com
  • 133. Vetical anchorage • Buccal root torque • Mesial tilted molars • an intrusive force is applied to the functional or lingual cusps of the upper molars because the appliance is placed near these cusps. • Therefore, the CO-CR discrepancy caused by the primarily initial contact and the mandibular clockwise rotation caused by the elongation of molars are reduced. www.indiandentalacademy.com
  • 134. • The primary changes induced by the lingual appliance can best be categorized as those dynamic effects on vertical, anteroposterior, and transverse planes. www.indiandentalacademy.com
  • 135. • Bite opening resulting from the lower incisors occluding on the maxillary incisor bracket bite planes • In the low angle brachyfacial patterns • posterior occlusion reestablishing in approximately 3 to 4 months. • In the mesiofacial and dolichofacial types www.indiandentalacademy.com
  • 136. vertical bowing effect • Excessive force • Upper anterior teeth tip lingualy • Premature contacts b/w the bite plane and lower anteriors • Posterior disclussion • Mesial tipping of the posterior www.indiandentalacademy.com
  • 137. • Prevantive measures • Reduce retraction force • Placing glable bends and compensating curve to increase intrusive force • Place good lingual root torque in anterior segment • Highly resilient 0.017 X 0.025 TMA wires • Medium sized outer bows of head gear recommonded www.indiandentalacademy.com
  • 138. Transverse bowing effect • Upper arch • Retracting force with head gear • Distal rotating force on 1st molars • Widen in premolar area and constrict in 2nd molars area www.indiandentalacademy.com
  • 139. • Prevantive measures • Retractin wire with a compensating bowing arch form distal to upper 1st premolar • Brackets placed slightly mesialy • Brackets with small distal offset • Transpalatal arch placed www.indiandentalacademy.com
  • 140. Leveling, Aligning, Rotational Control, and Bite Opening • The objectives of this initial phase of therapy are to: • 1. initiate tooth movement with light forces, • 2. provide for a period of patient adaptation, • 3. eliminate rotations, • 4. level and align individual arches to permit wire progression, • 5. obtain initial torque control when required, • 6. establish posterior anchorage units with buccal segments, • 7. initiate posterior segment control with extraoral traction and transpalatal arch when required, • 8. reduce any excessive overbite, and • 9. gain space for rotations and additional bracket bonding. www.indiandentalacademy.com
  • 141. • Anterior leveling – Partial canine retraction: 0.016 TMA or lingual arch – Anterior leveling: 0.016 cu-NiTi or 0.017 x 0.017 cu-NiTi www.indiandentalacademy.com
  • 142. Method of partial canine retaction • LINGUAL ARCH • Introductory appliance www.indiandentalacademy.com
  • 143. Full arch wire with loops (.016 Cu- NiTi) www.indiandentalacademy.com
  • 144. Sectional wire( .0175 x .0175 TMA) www.indiandentalacademy.com
  • 145. Rotation correction • Power arm www.indiandentalacademy.com
  • 148. Rotation correction with loop www.indiandentalacademy.com
  • 149. En masse retraction • jsliding mechanics • loop mechanics. • Three • different kinds of loops are commonly used: closed helical loop , L-loop and T- loop www.indiandentalacademy.com
  • 151. • Open bite cases with little need for upper anterior torque control or active tipping of anteriors; • closure of small spaces. www.indiandentalacademy.com
  • 156. • When maximum anterior retraction is needed while maintaining anterior torque; • when active intrusion of anteriors is indicated ; and • in seventy percent of total extraction cases. www.indiandentalacademy.com
  • 157. Sliding mechanics – .016" TMA with Class I elastic thread – .017 x.025 TMA – .016 X .022 SS lower arch 1. Minimum or moderate anchorage cases with upper second bicuspid extraction 2. nervous patients who do not want auxiliaries like loops; 3. lower arch extraction cases. www.indiandentalacademy.com
  • 158. • Class II elastics to a bonded Debnam cleat. www.indiandentalacademy.com

Editor's Notes

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