orthodontics

1. Seminar by:
Dr. Tony Pious
LINGUAL ORTHODONTICS

2. CONTENTS
• Introduction
• Historical perspective
• Bracket system
• Patient selection and Diagnostic considerations
• Bonding technique and Different lab procedures
• Biomechanics and comparative biomechanics
• Extraction and non extraction mechanics
• Lingual straight wire technique
• Keys to success in lingual therapy
• Conclusion
• References

3. INTRODUCTION

4. Why Lingual Orthodontics ???
With more number of adult patients desiring orthodontic
treatment, special aesthetic demands of the patients pose a
great challenge to the orthodontists.
These patients have professional and social commitments
and cannot accept ‘visible braces’ even for a short time.
To serve such patients, the orthodontic community came
out with the ultimate aesthetic solution – Lingual
Orthodontics.

5.  Lingual orthodontics, apart from offering the aesthetic
benefit, also provides several mechanical advantages.
Since its inception in the 1970s, great advances have been
made in this modality.
 At present, Lingual orthodontics is a complete system in
itself and encompasses accurate diagnosis, treatment
protocol, clinical and laboratory procedures.

6. Historical perspective

7. • In 1726, Pierre Fauchard suggested the possibility of
using appliances on the lingual surfaces
• In 1841, Pierre Joachim Lefoulon designed the first
lingual arch for expansion and alignment of the teeth.
• Mershon – Lingual arch.
• Goshgarian – Transpalatal arch.
• Ricketts – Quad helix.
• Wilson – 3D Modular Enhanced Orthodontics.

8. • Submitted concept in 1967
• In December 1979, Dr. Kinya Fujita, of
Kanagawa Dental University, Japan.
• First lingual multi-bracket system with mushroom
shaped archwires.
1967

9. 1980
Patent for the Fujita lingual bracket (US patent No. 4,209,906).

10. Dr. Craven Kurz (UCLA)

11. 1973-1975

12. Anterior inclined plane (missing link)
• Shearing force converted to compressive force

13. 1982
Patent for the Craven Kurz lingual bracket (US patent No. 4,337,037).

14. • In December 1980, Ormco decided to put together a team of orthodontists (the
Task Force ) to study the appliance further and make suggestions regarding
improvements.
• The Task Force members :
i. Dr. C. Moody Alexander
ii. Dr. Richard (Wick) Alexander
iii. Dr. John Gorman
iv. Dr. James Hilgers
v. Dr. Craven Kurz
vi. Dr. Robert Scholz
vii. Dr. John (Bob) Smith.

15. • The Task Force was initially charged with the responsibilities of evaluating the
appliance design over a two-year period.
• Their specific objectives were:
1. To help refine bracket design (dimensions, torques, angulations, thickness, etc.).
2. To develop mechanotherapy techniques.
3. To create archwire designs.
4. To discuss treatment sequences.
5. To determine case selection criteria.

16. • Kelly (1982), who used Unitek labial Brackets on the lingual surfaces.
• Paige (1982), who used Begg light wire brackets on the lingual surfaces.
• 1984 TARG machine launched by Ormco as an important aid in laboratory
technique.
• 1986 Didier Fillion developed Electronic TARG
• Société Française d’Orthodontie Linguale (SFOL),-1986
• The American Lingual Orthodontics Association (ALOA),-1987

17. Lingual fever
• Public interest continued to grow.
• Rushed the product to the market immaturely.

18. The Fall
• Following this initial euphoria-a period of frustration,
disappointment and rejection due to poor stantard of
completed cases.
• A truly clear, stain-resistant labial bracket was
introduced – Star fire by A company

19. • Enthusiasm for lingual therapy waned in the
profession, and commercial interest also
declined

20. The original Ormco Task Force was reduced to
just three members by 1988 Dr. Kurz, Gorman,
Smith named KGS Ormco Task Force 2
• The lingual appliance had been made available to the
public before testing was complete.
• Orthodontists inadequately trained with lingual therapy
were treating patients in record numbers.
• The public had high expectations from this treatment and
demanded it from the profession immediately

21. Difficulties encountered during the development of the lingual
appliance:
1. Tissue Irritation and speech difficulties
2. Gingival Impingement
3. Occlusal Interference
4. Appliance Control
5. Base pad Adaptation
6. Appliance placement and bonding
7. Appliance Prescription
8. Wire placement
9. Ligation
10.Attachments

22. • Creekmore (1989) developed a complete technique with vertical slot lingual
brackets, together with a laboratory system.
• European Society of Lingual Orthodontics (ESLO)-1992
• British Society of Lingual Orthodontics (BLOS),
• World Society of Lingual Orthodontics (WSLO)
• Associazione Italiana de Ortodonzia Linguale (AIOL)
1987-1996

23. • In Israel, Lingual Bracket Jig for direct and indirect bonding was introduced.
• Rafi Romano-edited a book presenting an update on the state of the art
of lingual orthodontics.
Furthermore, they founded the virtual journal www.lingualnews.com and a
lingual orthodontics forum that facilitates the interchange of information
between interested clinicians.

24. Relauncn
• In 1996 Craven Kurz founded Lingual Study Group with
aim of relaunching lingual orthodontics in United States.
• ALOA was reactivated in 1997
• Korean Society of Lingual Orthodontics (KSLO).
• The Japanese Lingual Orthodontics Association (JLOA)

25. Renaissance
• 7 generations of Kurz lingual brackets
• 2D and 3D brackets
• Lingual self ligating brackets
• STB brackets
• Lingual staight wire system
• Improved indirect bonding procedures
• Improved lab procedures
• CAD/CAM in lingual orthodontics

26. • During the last decade, the percentage of
patients treated with lingual orthodontics has
increased and the technique has developed to
such an extend that in some cases its easier,
quicker and more accurate than traditional
buccal orthodontics.

27. BRACKET SYSTEMS

28. GENERATION 1
1976
018" slot that face lingualy
•Flat maxillary occlusal bite plane from
canine to canine and rounded margins.
•Lower incisor & PM brackets were low
profile & half round.
•No hooks on any brackets
DR. KURZ AND COWORKERS

29. GENERATION 2
1980
Hooks were added to
all canine brackets

30. GENERATION 3
1981
•Hooks were added to
all anterior & PM
brackets.
•The first molar had
bracket with internal
hook.
•The second molar had
terminal sheath without
hook.

31. GENERATION 4
1982-1984
Low profile anterior inclined
plane in central & lateral incisor.
Hooks were optional based on
treatment needs & hygiene
concerns

32. GENERATION 5
1985- 1986
•Increased labial torque in the
maxillary anterior region.
•Bite plane became more
pronounced
•Molar brackets included an
accessory tube for a transpalatal
bar

33. GENERATION 6
•Hooks were elongated.
•TPA attachment is
optional.
•Hinge cap tube for the
second molars.
1987- 1990

34. GENERATION 7
•The square bite plane
became rhomboid shaped,
increasing the interbracket
distance.
•Premolar brackets were
widened mesiodistally for
better angulation & rotational
control.
1990 to present

35. The lingual appliance most widely used today is the generation VII appliance,
developed in 1990 by Ormco Corp.
• The VIIth generation brackets are much refined, low profile, patient friendly
brackets.
• They have a horizontal slot, and are offered in either an 0.018" or 0.022"
slot size.
• The bite plane on the maxillary anterior brackets is heart-shaped. It is
parallel to the archwire and occlusal plane.

36. Significance: The bite plane allows placement of all brackets during initial
bonding even in cases with severe deep bites. The patient’s occlusion is
located on the bite planes of the anterior brackets.
• Possibility of repositioning the mandible.
• Extrusion of the molars, intrusion of the incisors and facilitating any
expansion and mesiodistal movement of molars uninhibited by occlusal
forces.
• Correction of crossbites, bites, rotations and space closure can be
achieved at an accelerated pace without the interference of occlusion.
• At the same time, anchorage loss, bowing of the buccal segment, loss of
arch coordination and extrusion of molars are made easier without the
controlling effect of the forces of occlusion.

37. • Multiple molar attachments are available,
including a tube, a twin bracket and a hinge
cap or terminal sheath (a convertible bracket
that can function as a tube or a self-ligating
slot).
• All brackets have a gingival ball hook which
facilitates elastic ligature placement, rotation
control and placement of intra- and inter-
maxillary elastics.

38. • The ideal archwire has a mushroom shape. This is due
to the large constriction in arch width that occurs as one
proceeds distally from the lingual surface of the canine to
the bicuspid.

39. FUJITA LINGUAL BRACKET

40. RYOON KI HONG, HEE WOOK SOHN, JCO/MARCH 1999
(OS = 0.019 “; LS = 0.018” ×0.025”; VS = 0.016”)

41. The presently available Fujita system is still based on an
occlusal slot opening, but has multiple slots.
• Brackets for the anterior teeth and premolars now 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.

42. BEGG’S LINGUAL BRACKETS
• Dr. Stephen Paige introduced the
Lingual Light Wire technique in 1982.
• The bracket currently used in the Begg
system is the Unipoint combination
bracket (Unitek), with the slot oriented in
the occlusal direction.
• The Unipoint bracket has a gingival "wing"
to place elastic modules on continuous
elastic chains.
(JCO1982)

43. Molar Tube Design:
• Oval tube with a mesiogingival
hook.
• The squashed oval tube has some
advantages in that it allows molar
control, and will accept a ribbon
arch.

44. CONCEAL BRACKETS
Thomas Creekmore

45. STEALTH BRACKETS
• 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

46. • Takemoto and Scuzzo in
2001 found that the bucco-
lingual distances at the gingival
margins do not vary substantially.
This led them to conclude that
straight archwires could be used
in lingual orthodontics if they
were placed as close to the
gingival margin as possible.
JCO 2001
STB (SCUZZO- TAKEMOTO BRACKET)

47. •STb system comprises of the most
advanced lingual technology
•Incredibly comfortable for pt, minimal
impact on tongue, speech
•Easy to use
•Utilizes a passive self ligation design
that dramatically reduces friction &
delivers lighter forces.
•STb social 6 easy to learn and use
for beginners

48. • Flossing is easier as the archwire is farther from the
lingual surface and incisal edge.
• Mesio-distal width of the bracket is smaller, allowing
adequate inter-bracket distances.
• Rotations can be more easily accomplished as the
archwire can be tied tightly to the bottom of bracket slots.
• Torque control is improved.

49. PHILIPPE SELF LIGATING LINGUAL BRACKETS
• First described by Macchi
et al in 2002, the Philippe
Self Ligating Lingual
Brackets (Forestadent, St.
Louis, MO) can be bonded
directly to the lingual tooth
surfaces.
• Since they do not have slots,
only first- and second-order
movements are possible.

50. • Four types of Philippe brackets are available:
- Standard medium twin bracket (most commonly used).
- Narrow single-wing bracket for lower incisors.
- Large twin bracket.
- Three- wing bracket for attachment of intermaxillary elastics and
application of simple third-order movements.

51. • Clinical applications:
- Post – treatment retention.
- Closure of minor spaces.
- Limited intrusion.
- Correction of simple tooth malalignments
and mild crowding, especially in the
mandibular arch.

52. FORESTADENT 3D BRACKETS

53. ADENTA- Germany-Hatto Loidl
• Self ligating
• Easy handling & archwire changes
• Closing springs designed as bite planes for
lower incisors
• Perfect transmission of torque & angulation
• Occlusal archwire insertion
• Hygenic

54. IN- OVATION- L BRACKET FROM GAC
•Twin self lig bracket system gives a complete range
of control options simply by changing archwire
Advantages
• low profile
•Anatomically correct base design
•No plaque build up or periodontal impact due to
small size
•Fast easy placement of archwires
Disadvantages
•Due to small size ,diff to visualize spring clip
•Bracket base of lower anteriors too wide causing
difficulty in bonding smaller teeth

55. PHANTOM POLYCERAMIC SELF-
LIGATING BRACKETS
• First tooth colored SL direct
bonding lingual bracket
made of composite polymer
• Tubes on pre molars to avoid
speech difficulties
• Esthetic & cheaper than
present indirect techniques

56. IBRACES (INCOGNITO)

61. • Print out of three-dimensional bracket-
positioning chart assists in rebonding

62. ilingual

64. Armamentarium

65. Lingual ligature cutter (angulated
45º)
Lingual ligature cutter
(angulated 90º)

66. • Utility plier
• Arch wire cutter

67. Mosquito forceps
Light ligature plier

68. • Lingual hinge cap
opening tool
• Debonding plier

69. • Tongue retractor & saliva
ejector
• First order bending fork

70. • Second order bendng
fork
• Module remover

71. Advantages of Lingual Orthodontics
• Facial surfaces of the teeth are not damaged from bonding, debonding,
adhesive removal,
• decalcification from plaque retained around labial appliances.
• Facial gingival tissues are not adversely affected.
• The position of the teeth can be more precisely seen when their surfaces
are not obstructed by brackets and arch wires.

72. • Facial contours are truly visualized since the contour and drape of the
lips are not distorted by protruding labial appliances.
• Tongue thrust habits are easily managed.
• Mandibular repositioning therapy.

73. Disadvantages of Lingual Orthodontics
• More chair time is required.
• Cost generally is one-third more than labial treatment.
• Mandibular auto-rotation occurs because of the bite plane on the maxillary
anterior brackets.
• Vertical and transverse control of buccal segments often is difficult when the
teeth are disoccluded.

74. Lingual appliances are effective
than labial appliance in following
– Intrusion of anterior teeth
– Maxillary arch expansion
– Combining mandibular repositioning therapy with
orthodontic movements
– Distalization of maxillary molars

75. Patient selection & Diagnostic considerations

76. Patient selection
• Majority of malocclusions can be treated with lingual
orthodontics, but certain cases are more amenable than
others.
• Favourable cases
• Unfavourable cases

77. Favourable Cases
• Mild incisor crowding and with anterior deep bite.
• Long and uniform tooth surfaces without fillings, crowns, or bridges.
• Good gingival and periodontal health
• Keen, complaint patient.
• Skeletal class I pattern.
• Mesocephalic or mild/moderate brachycephalic skeletal pattern.
• Patients who are able to adequately open their mouths and extend their
neck.

78. Unfavourable Cases
• Dolicocephalic skeletal pattern
• Maximum anchorage cases, unless treated with micro implants.
• Short, abraded, and irregular lingual tooth surfaces.
• Presence of multiple crowns, bridges, and large restorations.
• Patients with low level compliance.
• Patients with limited ability to open the mouth (trismus).
• Patients with cervical ankylosis or other neck injuries that prevent neck
extension.

79. Diagnosis
• General, with particular reference to esthetics
• Periodontal and gingival
• Dental, with particular reference to the presence of crowns and large
restorations
• Dentoalveolar discrepancy
• Vertical skeletal/dental problems
• Anteroposterior skeletal/dental problems
• Transverse skeletal/dental problems
• Surgical cases
• Preprosthetic cases

80. Vertical Considerations
• Using kurz 7th generation lingual bracket the built-in bite planes on the
upper incisor and cuspid brackets will interfere with the occlusion and result
in a posterior open bite.
• The lingual brackets on the maxillary incisors should be bonded to allow a
vertical distance of 2 mm from the incisal edge to the bracket, which allows
the case to finish with a normal overbite and good posterior occlusion.
• STB brackets do not have a bite plane.
• Stealth brackets have a removable bite plane.

81. Anteroposterior discrepancy
• Skeletal class I
with Normal
overjet

82. Skeletal class I with Increased overjet

83. Skeletal class I with Decreased Overjet

84. Skeletal class II and class III
• In relatively mild malocclusions, they can be corrected
with extractions or intermaxillary elastics.
• Severe skeletal discrepancy require orthognathic
surgery.

85. Transverse considerations
• Posterior cross bites can be treated before starting the lingual treatment

86. Surgical cases
• Consultation and joint planning with the oral surgeon should be performed
before the start up of treatment
• With these cases the best possible presurgical tooth position should be
achieved to minimize the post surgical orthodontic treatment time
• The patient must be consulted on the possibility of bonding labial brackets
just before the surgery to assist with the postsurgical fixation.

87. Bonding Techniques in Lingual Orthodontics

88. Direct Bonding Technique
(JCO 1984)

89. Indirect bonding system
These include:
1. Torque angulation reference guide (TARG).
2. Fillion’s indirect bonding system.
3. The customized lingual appliance setup service (CLASS) system.
4. The slot machine
5. Hiro system
6. The Ray set system
7. The lingual bracket jig.
8. The mushroom bracket positioner
9. TAD-BPD machine.

90. Torque angulation reference guide (TARG)

91. • Didier Fillion improved this method in 1987 by adding an electronic device
to the TARG machine with purpose of measuring labial-lingual thickness
• This improvement reduced the number of first order bends in the wire,
compensating for the difference in tooth thickness
BONDING WITH EQUAL SPECIFIC THICKNESS (BEST)

92. TARG device Thickness measuring
appliance ELECTRONIC
TARG

93. • Using his DALI (Dessin Arc Linguale Informatise) computer
program he produces an individualized archwire template

94. The Slot Machine
• Introduced by Dr. T.D.Creekmore in
1986, the Slot Machine was meant
to be used with the Conceal bracket
system.
• It also used a labial reference to
position the brackets like the TARG
machine.

95. The Customized Lingual Appliance Setup Service (CLASS) system

96. • Described by Scott Huge
• Brackets are placed on the idealized
model set up of patient malocclusion
• A flat metal plate helps positioning of
the anterior brackets
• Separate posterior device to position
the posterior brackets
CLASS SYSTEM

98. • Individual transfer tray is made for each tooth
• Brackets are transferred to the teeth of patient directly, or transferred to the
casts by using the cap technique and then to the patient using a full arch
transfer tray
• Adv – visualization of final occlusion on the articulated set-up
• Drawback- lengthy and tedious procedure

99. HIRO SYSTEM
• Introduced by Toshiaki Hiro and later improved by Takemoto and
Scuzzo.
• Method:
- An ideal archwire is made on the setup using a full size rectangular
archwire.
- The lingual brackets are transferred onto this wire and secured with
elastic ligatures.
- Single rigid transfer trays are fabricated for each tooth.

100. - The archwire is then removed and custom bases for brackets are made.
• Advantages:
- There is no need to transfer brackets from the setup model to the original
malocclusion model.
- Accuracy is improved due to individual transfer trays.
- Bonding of one tooth is not affected by position of other teeth.
- Rebonding is easier.

103. The Ray Set system
• This system utilizes a 3-dimensional goniometer for analysis of the
first-, second-, and third-order values of each individual tooth.
• Both pre- and post-setup values of individual teeth are evaluated
and the amount of orthodontic tooth movement for each tooth on the
setup model is calculated.

108. The Lingual Bracket Jig
Dr. Silvia Geron in 1999 introduced lingual bracket jig
which is a chairside direct bonding system.
• It is used with a horizontal slot bracket.
• The jig transfers the Andrews Straight-Wire Appliance
labial bracket prescription to the lingual surface.

109. The LBJ consists of:
• A set of six jigs, one for each
of the six maxillary anterior
teeth, which present the most
morphological variation of the
lingual surfaces.
• An accessory universal LBJ for
the maxillary posterior teeth
(no torque or angulation
prescribed).

110. LBJ transfers labial bracket prescriptions to lingual brackets

111. A. Labial arm of LBJ positioned
on labial surface of tooth,
duplicating location of labial
bracket relative to LA point.
B. Lingual bracket automatically
placed in correct position.

113. ADVANTAGES:
- Lingual bracket positioning with the LBJ is simple and quick, and
requires no special training.
- The LBJ automatically incorporates the Straight-Wire labial
prescription into the bonded lingual brackets in all dimensions.
- This allows the orthodontist to perform direct as well as indirect
bonding as in-office procedures.

114. KOREAN INDIRECT BONDING SET UP SYSTEM (KIS)
• Developed by members of KSLO.
• Uses bracket positioning machine that allows positioning of all
brackets at once.
Advantages
Very precise & attainment of high standard of treatment
Allows for bracket hight difference between anterior and post teeth
Simpler and faster

115. KIS System

117. The Mushroom Bracket Positioner
• Developed by Kyung et al, in 2002, the mushroom bracket
positioner is a machine for accurate bracket placement on an ideal
setup.
• At present, 5th generation of MBP is available which places brackets
to accept a straight wire.

119. Simplified Technique

120. LINGUAL INDIRECT BONDING USING THE TAD AND BPD

124. CAD/CAM SYSTEMS IN LINGUAL ORTHODONTICS

125. BENDING ART SYSTEM

126. THE ORAPIX® SYSTEM
Virtual setup checking Brackets arranged together for the
Straight-Wire technique

127. Virtual transfer jig. Real transfer jig.

128. Incognito
Dr. Wiechmann

129. • Brackets and wires are CAD/CAM customized on a model of the
patient’s setup at the beginning of treatment.
• Laboratory technicians fabricate a setup model according to the
orthodontist’s prescription.
• These models are used as a template to design virtual brackets and
wires.
• Virtual brackets are printed in wax and cast in a gold alloy.
• Archwires are formed by a wire-bending robot.
• Dental casts, brackets, and wires are delivered to the orthodontist

132. The Lingual Jet® system
Dr. Gualano and Dr. Baron

133. BONDING PROCEDURE

135. BANDING

137. BIOMECHANICS

139. NORMAL INCLINATION

140. LABIAL INCLINATION

141. LINGUAL INCLINATION

145. Lingual appliances are effective than labial appliance in following
– Intrusion of anterior teeth
– Maxillary arch expansion
– Combining mandibular repositioning therapy with orthodontic
movements
– Distalization of maxillary molars

146. INTRUSION OF ANTERIOR TEETH

147. Severe deep bite correction

149. Anterior and lateral concern
• Patients with severe tongue thrust habit, the lingual appliance, due to the
discomfort associated with tongue contact, redirects the tongue tip to the
palatal vault in speech and swallowing.
• Anterior tongue thrust habit is eliminated and normal muscle balance is
restored.
• Lingual appliance and lingual elastics create a fencing of the tongue
musculature from the dentition FENCE EFFECT
• It increases the anchorage values

150. The six anchorage keys
1. Standard lingual bracket jig prescription for the anterior teeth, incorporating slight
extrapalatal root torque , molar tube placed off-center in a more mesial position and
incorporating a mesial tip to encourage molar tip back.
2. Reduced friction, using sliding mechanics together with bidimensional archwires
incorporating a rectangular anterior sections and round posterior sections or using
standard archwire and placing brackets on the posterior teeth with larger slot sizes
3. Posterior bite stops placed on molar teeth to open the bite.
4. Light class I, II or III forces for retraction or space closure.
5. In corporation of second molars in the anchorage unit
6. Incorporation of an exaggerated curve of Spee in the maxillary space-closing archwire
WJO - Geron, Vardimon

155. • Takemoto compared the anchorage loss in labial versus lingual extraction cases
treated with loop mechanics and found higher anchorage value of the posterior
dentition in lingual cases
 Due to the proximity of lingual brackets to the center of resistance of the tooth .
 Direction of forces during the space closure creates a degree of buccal root
torque and distopalatal rotation of the molar crown, which in turn produces
cortical bone anchorage.

156. Stages of treatment

157. Choice of extraction
 Lower molar tip distally as the arch is levelled and this changes class 1 to
class2, therefore in class1 cases upper 1 pm and lower 2 pm is advised
 In class 2 cases it is desirable to avoid extraction in lower arch, if crowding
is severe one or more lower incisors may be considered
 In class 3 cases pm extn facilitates lingual tipping of lower ant teeth, distal
tipping of molars improves class lll molar relation.

160. Treatment Sequence— General
1. Leveling, aligning, rotational control, and bite opening.
2. Torque control.
3. Consolidation and retraction.
4. Detailing and finishing.
• These phases are generally characterized by a progressive increase
in wire stiffness.

162. Wire sequence in lingual orthodontics
• First initial wire; .o16 NiTi - first initial wire
• Second initial wire;.o16 wilcocks heat treated special plus SS wire.
• Intermediate wire;.017x.025 TMA wire
• Finishing wire;.017x.025 or .016x.025 SS
• Detailing wire ; o16 wilcocks heat treated special plus SS wire

163. 1)0.016 NiTi with increased crowding 0.016 Wilcocks sp+
Minimal crowding all
Teeth bracketed
2) 0.017x0.025 TMA
3) 0.017 x 0.025 SS
4) 0.016 Wilcocks special +
Finishing arch if necessary
If all teeth were initially
bracketed
Bond all teeth initially
unbracketted
a) Adv loops
b) Stops at 1st molars
a)0.016 x 0.022 ss
b)0.018 sp +
EXTRACTION AND NON EXTRACTION

164. Second initial wire

165. Intermediate wire

166. Finishing wire

168. Stage I. Leveling, Aligning, Rotational Control, and Bite Opening.
Objectives
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.

169. • This is achieved using lingual archwires having a low wire stiffness,
combined with complete seating of the archwire within the bracket slot.
• However, a common problem with lingual edgewise brackets is the difficulty
in obtaining complete archwire engagement and the tendency for the
archwire to be pulled out of the bracket slot.

171. HIGHLY TIPPED CANINE

172. DISTALLY TIPPED CANINE

173. HIGHLY and DISTALLY TIPPED CANINE

174. Partial canine retraction

176. Rotation correction

177. DOUBLE-OVER TIE LIGATION

178. ROTATION TIE

180. TORQUING LEVELLING

181. Two types
1. Canines and incisors separately
2. Enmasse retraction
Retraction mechanics

186. Sliding mechanics Vs loop mechanics during en masse
retraction
Sliding mechanics Loop mechanics
• Wire friction and uncontrolled Requires lot of skill
retraction forces results in Difficult to bend the wires
anchorage loss different loops
Increased treatment time

187. LOOP MECHANICS DURING EN MASSE RETRACTION

189. Sliding mechanics

190. Maximum anchorage upper arch
• loop mechanics, combined with
TPA and buccal sectional arch
wire from 1st and 2nd molars for
stabilization

191. Moderate anchorage upper arch
• L loop mechanics combined with TPA
• The anterior segment and posterior
segments are figure eighted with
ligature wire
• In sliding mechanics, power chain is
placed from lingual of canine to the
lingual of 2nd premolar in 1st premolar
xn

192. MINIMUM ANCHORAGE UPPER ARCH
• Power chain is placed on both
buccal and lingual of the canine
and first premolar
• Class III elastics enhance the
mesial movement

193. Maximum anchorage lower arch
• An elastic power chain on the lingual
side with buccal sectional arch for
stabilization
• 0.017 x 0.025 TMA or 0.016 x 0.022
SS
• Class III elastics on buccal and lingual
side

194. Moderate anchorage lower arch
• Sliding mechanics with reciprocal
elastic forces

195. Minimum anchorage lower arch
• An elastic power chain is placed from
the lingual of the 1st molar, encircling
the canine and attaching to the buccal
of the 1st molar
• Class 2 elastic facilitate the mesial
movement of the molar

196. DETAILING

199. The Straight-Wire Concept in Lingual Orthodontics
1. Li-Point
2. Embrasure Line
3.Lingual Crown Height (LCH)
4.Lingual Straight Plane (L-S Plane)
5. Bracket Height (H

201. Advantages
 Flossing is easier
 Mesiodistal width is much smaller, allowing adequate interbracket distances
 Less composite is needed on the mandibular molars to raise the bite
 Rotations can be more easily accomplished because the archwire can be
tied tightly to the bottom of the bracket slots
 Expansion in an anterior direction is more effective because the most
labially positioned tooth is ligated first.

205. Lingual retainers
1st Generation Retainer
• Plain ,round .032” - .036” Blue
Elgiloy wire with loop at each end
bonded only to canines

206. 2nd Generation Retainer
• Three – stranded .032”wire without
terminal loops which is bonded to
canines.

207. 3rd Generation Retainer
• Plain round .030” to .032”
diameter stainless steel wire with
sandblasted ends

210. Keys to Success in Lingual Therapy
JCO 1986 Craven Kurz et al

211. Key 1
• Patient Selection.
• Oral Hygiene - Lingual patients must be well educated in oral hygiene and
motivated from the beginning.
• Speech Adaptation and Tongue Irritation - Patients must be forewarned of
temporary speech alteration.
• Variations in Tooth Size and Anatomy.

212. Key 2
• Bracket Placement Accuracy – use of the TARG for accurate
bracket placement.
Key 3
• Indirect bonding methods for bracket adhesion.
Key 4
• Maintaining vertical and transverse control of buccal segments.
Key 5
• Double over ties on anterior teeth.
Key 6
• Buccal and lingual molar attachments.

213. Key 7
• Correction of rotations.
Key 8
• Arch form and archwire sequence.
Key 9
• Archwire stiffness and torque control.
Key 10
• En masse retraction.
Key 11
• Light, resilient wire for detailing.
Key 12
• Gnathologic positioner and retention.

214. Conclusion
Lingual Orthodontics is the most aesthetic treatment modality , and is the best
treatment option for adult patients, since the brackets are invisible, it provides a high
level of control, and is excellent for the treatment of all kinds of malocclusions.
Over the past 25 years there have been many improvements in appliance
design, laboratory and bonding procedures, and in clinical, mechanical techniques,
that simplify the lingual treatment. Thanks to the pioneers of Lingual Orthodontics,
Dr. Craven Kurz, Dr. Fujita and the Lingual Task Force of ORMCO company.

215. • thanks to the recent developments: CAD CAM, small comfortable
and reduced friction brackets, the lingual technique today is very
reliable and almost as easy as the labial technique.

216. • The history of lingual orthodontics has not been a smooth one. There was a
period of initial euphoria as the technique made its clinical debut; this was
followed by a period of frustration, disappointment, and rejection. Thanks to
the effort of several dedicated clinicians, many of the issues responsible for
this decline have been overcome. We are now in a period of resurgence, the
technique has become more sophisticated, the clinical results achieved can
stand on an equal footing with the best of conventional labial techniques,
and the acceptance of technique by the profession is growing rapidly. The
history of this technique is peppered by individuals who have shown perseverance
and ingenuity

217. Lingual orthodontics has come of age; its acceptance by both the
profession
and the patient population continues to grow internationally. The future of
lingual orthodontics is dependent on the following three important
issues:
(1) advances in technology related to appliance design and laboratory
protocols;
(2) demographic changes in population age groups—the growth in
the number of adult patients seeking orthodontic treatment associated
with
an increase in affluence and disposable income will create a patient-
driven
demand for more esthetically acceptable appliances; and (3) attitudinal
changes of orthodontists.

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