Dental Tribune United Kingdom Edition

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EMAIL: REPAIRS@BAINTERNATIONAL.COM WWW.BAINTERNATIONAL.CO.UK Like us on BAInternationalUK Follow us @BAinternational page 18DTà dibular arches using an indirect bonding technique. Levelling, alignment and expansion of the arch were achieved using heat- activated, super-elastic, custom- ised wire (14, 16, 16 x 22; and 18 x 25). Detailing and finishing were performed using 16 x 22 stainless-steel wire and 18.2 x 18.2 Beta III Titanium Archwire. The total active treatment time was 17 months. Patient compli- ance was good. For retention, fixed maxillary and mandibular retainers were provided, as well as an Essix retainer at night. Treatment results The post-treatment extra-oral photographs showed general improvement in the facial pro- file. The post-treatment intra- oral photographs showed satis- factory dental alignment, Class I canine and Class III molar re- lationships, and a normal over- bite and overjet. In addition, the maxillary and mandibular inci- sors had a normal inter-incisal angle due to the interproximal reduction in the maxillary arch. In Figure 4, we can see how accurate the model was com- pared with the final treatment outcome for both arches. At the end of treatment, a normal mor- phological and functional occlu- sion was obtained, with anterior guidance in lateral and protru- sive excursions. Class I canine relationships were obtained on both sides. The good interden- tal relationship also provided a well-balanced facial profile with lip competence. Discussion The treatment objectives were attained with the non-extraction treatment protocol using a CAD/ CAM lingual system. Obviously, the results reflect the effects of not only the proclination of the mandibular anterior teeth, but also the relief of crowding in both arches and the accuracy of the model in reflecting the final result (Figs 5a-g). We still had to perform interproximal reduction in the maxillary arch to achieve a normal overbite and overjet, with the canines in a Class I relationship. Another treatment option would have been to extract the maxillary and mandibular first premolars. However, this was not a favourable treatment al- ternative owing to its negative effect on the facial profile. Performing lingual ortho- dontic treatment for each pa- tient in the average orthodon- tic office is now a reality. The treatment results are of a high level, and all our patients may benefit from an invisible appli- ance. Former problems, such as discomfort, speech alteration, finishing inaccuracies, and par- ticular tooth anatomy, can be vercome in this manner.5 The extraction of the man- dibular incisors constitutes a therapeutic alternative in treat- ing certain anomalies. It is not a standard approach to symmetri- cally treating most malocclu- sions, but the therapeutic aims must be adjusted in certain clinical situations to individual patient needs, even when this means that the final occlusion achieved is not ideal. The delib- erate extraction of a mandibular incisor in certain cases allows the orthodontist to improve oc- clusion and dental aesthetics with minimal orthodontic treat- ment. In all cases, however, a diagnostic cast is required to predetermine the occlusal pos- sibilities precisely.6 Conclusion The key to success in lingual orthodontics in terms of both professional and patient satis- faction is practice and training. The Incognito system can be used for all types of malocclu- sions with the same precision as labial braces. The possibility of incisor extraction should be a part of every clinician’s portfolio of treatment techniques. If it is planned carefully and executed properly, incisor extraction can be an effective way of satisfying a particular set of treatment ob- jectives. DT Fig. 4 Pre-treatment cephalometric trac- ing and measurements

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