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2013-04-10
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New Options for Aesthetic Appliance
Yeong Sim, DDS, MSD, PhD
Director of Gorman Lingual Orthodontic Seminar
Faculty of Samsung Medical Center & KyungHee Medical School
SIM
Developing lingual orthodontics
Dr Kurz placed clear plastic brackets lingually in 1970
1st generation of ORMCO’s lingual appliance in 1979 by
Dr C Andreiko
ORMCO formed a task force: Drs C Kurz, J Gorman and
JR Smith (first consulting clinicians for a dental company)
3 day lingual courses were taught around world
ORMCO continues to develop the lingual appliances
(Kurz brackets upto 7th G)
SIM
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Lingual Orthodontics
Disadvantages
1. Speech
2. Brushing
3. Food impaction
4. Indirect bonding
5. Technique sensitive
SIM
Why lingual approach?
• Patient demand: tendency to choose more
aesthetic orthodontic treatment
• Appliance improvement: smaller, thinner..
• Doctor demand: expand his/her patient pool
• Now: indirect bonding + wire fabrication
• 3D CAD/CAM service to plan treatment sequence
SIM
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Market trend
03 05 08
SIM
Recently..
SIM
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Satisfying patients
• Lingual technique has a unique value of invisibility.
• There are many patient who would benefit
functionally and aesthetically if they were to have
orthodontic treatment.
• Many of these patients never consider orthodontic
treatment unless implementing this therapy.
-M. Alexander
SIM
Considerations for lingual approach
• Morphological irregularity of
dental arch on lingual side --
Need indirect bonding
• Lingual technique requires
specific laboratory setup to
make a straight wire system
• Need to compensate
mechanics in order to make
proper teeth movements
SIM
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Self-ligating lingual bracket
• Because of design complexity, thicker profile has to be
solved
• Durability of clip should be guaranteed during treatment
• Advantage
1) Shorter chair time
2) Better hygiene
3) Low friction
4) Less pain
SIM
Patient comfort
• Bracket profile: reduced dimensions with clip design
SIM
STb: 1.5mm Cliipy-L: 1.8mm
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Patient’s comfort
0
1
2
3
4
5
6
Kurz 7G Evolution InOvationL 3-3 Retainer
Speech
Eating
Irritation
SIM
N=60
(2010-2012)
WK
Advancement in lingual system
SIM
• Closer to lingual surface:
• Periodontal clearance
• Less bonding failure
• Straight wire system
• Low profile for patient comfort
• 3D CAD/CAM prediction
• No ligation
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Design with gingival offset
SIM
ORMCO
7G
TOMY
InOvationL DENTAURUM
Time
ORMCO
STb
Periodontal irritation
SIM
Just after debonding lingual brackets
Kurz 7G Br InOvationL Br
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Reliable wire insertion
SIM
Friction
SIM
Self-ligating bracket has lesser Friction during alignment
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Mechanical forces acting on tooth
SIM
1. Fld, ligature-derived force;
Fwd, wire-derived shear
force and its counterpart in
the opposite direction.
2. Fld and Fwd together
comprise a resultant
normal force.
Renznikov et al. Measurement of friction forces between stainless steel wires and ‘reduced-
friction’ self-ligating brackets. AJODO 2010.
Components of normal force
SIM
1. The ligature-derived force
depends on the ligation mode
and it is constant.
2. The shear force component
increases linearly with the
wire deflection.
3. The resultant normal force
determines friction resistance
to sliding.
Renznikov et al. Measurement of friction forces between stainless steel wires and ‘reduced-
friction’ self-ligating brackets. AJODO 2010.
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For sliding mechanics
Clinical studies support the view that resistance to bodily
tooth movement by sliding has little to do with friction
and , instead, is largely a binding-and-release
phenomenon that is about the same with conventional
and self-ligating brackets. The clinical trial data do not
support the contention that treatment time is reduced
with self-ligating brackets.
Burrow SJ Friction and resistance to sliding in orthodontics: A critical review. AJODO 2009.
SIM
Play angle during retraction
SIM
016x022 archwire:7.7°
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Secure torque during retraction
SIM
Free vs. Active angle
SIM
InOvationL allows X2 more active angle to reduce binding phenomenon
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Chair Time
20
23 21
17
22
13
Appt No Tx Mo Chair Time
N=100 (50 Conv Br, 50 SL Br) Bimaxillary lingual extraction cases only
Conv Br SL Br
SIM
Final thoughts..
• Actually it does not matter which lingual bracket
system you use. But it does not take a genius to pick
a simpler and reliable system.
• I do not trust wire bending by robotic arms on
animated 3D setup models. I’d rather pick the
manual setup by a trained technician according to
my prescriptions for each different cases.
SIM
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Conclusion
• Self-ligating lingual bracket system does not shorten
treatment time.
• Advancement in lingual bracket design reduces patient
discomfort and decrease periodontal irritation.
• Self-ligating lingual bracket may reduce patient pain in
initial treatment stage due to lower friction.
• The biggest advantage of using self-ligating lingual
bracket system comes from shortening of chair time!
SIM