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CAD/CAM - international magazine of digital dentistry

nology is used for the manufacturing of the lin- gual brackets. The braces are then cast from gold alloy, mounted in a flexible indirect bonding tray, and shipped out ready to be bonded. Direct bond- ing is feasible too, owing to the extended individ- ual bases. Bending archwires is one of the most difficult tasks in orthodontics. In this system, computer- operated bending of archwires using robots is used to manufacture precisely shaped archwires. Even super-elastic archwires can be precisely shaped. This helps solve three major problems in lingual orthodontics: 1. Patient discomfort during the adaptation phase: The appliance is designed to be as flat as possible, not much higher than a bonded retainer; this significantly improves patient comfort. 2. Difficulties in re-bonding: The customised bracket base covers the major part of the lin- gual tooth surface and therefore allows direct re-bonding without the need for any other positioning aids. 3. Inaccuracies in finishing: Inaccuracies of the slots due to production and resulting variation in torque play are now part of the past, owing to Incognito. Measuring rates show diver- gencesofnotmorethan0.008mmbetweenthe slots. The precisely shaped archwires also make high-standard finishing easily achievable.2, 3 Figure 1 shows the different steps in manu- facturing braces with the Incognito system. This case report describes the treatment of a patientwithaskeletalClassIImalocclusiondueto a retrognathic mandible and protrusive maxilla. He also had a congenitally missing mandibular left central incisor. The extraction of a single mandibularincisorcanbeemployedasacompro- mise treatment of certain malocclusions if the end result fulfils the requirements for a healthier dentition that is functionally and aesthetically harmonised in relation to the surrounding struc- tures.4 In this case, one of these incisors was missing so extraction was not necessary. The Class II malocclusion was corrected by non-extraction orthodontic treatment with a CAD/CAM fixed lingual appliance (Incognito). The Class III molar relationship had not changed at the end of treatment, but a Class I canine relationship was achieved and the facial profile improved owing to improvement in the position of the mandibular incisor in relation to the man- dibular plane, which affects the position of the lower lip. _Diagnosis and aetiology The patient was male, aged 23 years and 9 months, and had the chief complaint of crowd- ingofthemaxillaryandmandibularanteriorteeth. He had Class III canine and molar relationships on bothsides,a2mmoverjet,a4mmoverbite,amiss- ing mandibular left central incisor, the maxillary midline was coincident with the midsagittal plane, the mandibular midline was shifted to the left, the maxillary dental arch had about 7 mm of crowding and lower dental arch had 8 mm of crowding, excluding the width of the missing mandibular Fig 2_Extraoral and Intraoral Photographs Before Treatment Showing Severe Upper and Lower Crowding and Retruded Lower Lip. Fig 3_Final Photographs Show Normal Overbite and Overjet Relationship, Elimination of Anterior Crowding and Improvement of Facial Profile. I 21 case report _ CAD/CAM lingual orthodontic system I CAD/CAM 3_2013 Fig. 3 Fig. 2