ortho - the international C.E. magazine of orthodontics

ortho1_201224 I I technique_ lingual ortho Lingual you will love Author_Ronald Roncone, DDS, MS _Lingual orthodontics is not new in the world of orthodontics.Crudeattemptsatlingualorthodontics were tried many years ago. The first true lingual be- ganalmostsimultaneouslyabout1980withDr.Kurz of California and Dr. Fujita of Japan. Patients around the world were hungry for an appliance that would give them straight teeth but could not be seen. Because of the potential com- mercial windfall, various companies entered the marketplace. In the United States, many orthodontists imme- diately jumped into this new area only to realize that working with braces on the inside of teeth was not nearly as easy as it was when they were attached to the outside surfaces of teeth. Due to the steep learning curve, the general ac- ceptance of braces by U.S. citizens and the improve- ment in clear braces, lingual orthodontics disap- peared, with a few notable exceptions. Meanwhile, those orthodontists outside of the U.S. worked on mastering lingual and making slow and steady im- provements to the various techniques. Some common statements arose from the initial experience with lingual orthodontics. • Lingual orthodontic treatment takes longer. • Results of lingual treatment are not as good as labial treatment. • Lingualtreatmentistoohardontheorthodon- tist because of the poor postural positions required. • Patients do not speak well with lingual braces. • Tongue irritations are a constant problem for lingual patients. • Patient visits take substantially longer with lingual braces. • Thetimerequiredtomasterlingualtreatmentis not worth the effort. • It is too difficult to tie-in archwires. Each of these statements has some element of truth in them, yet all can be refuted. This article will attempt to address all of these statements. How- ever, even if they could not be totally refuted, one overriding factor remains: Patients want “invisible” orthodontics! For many years, the most-used bracket in lingual orthodontics was the Kurz bracket (Ormco). It was a solid, well-conceived bracket that went through seven generations. The bracket basically remains the same as it was nearly 20 years ago. Other lingual brackets have been developed over the years, but most of the improvements have come in the area of precision placement of the brackets. Clinicians such as Takemoto, Scuzzo, Fillion, Wiechmann and others have made significant contributions in this area. Severalyearsago,thebiggestleapindevelopment was the size of brackets conceived by Drs. Takemoto and Scuzzo. The bracket was very small and targeted theanteriorteethcommonlyreferredtoasthe“social six.” Interest is again building for use of the lingual Fig. 1_In-Ovation ‘L’ Closed Fig. 2_MTM No•Trace Closed Fig.3_MTM No•Trace side view (Photos/Provided by Dr. Roncone) Fig. 1 Fig. 2 Fig. 3 Capturing the incremental patient with invisible orthodontics