Orthodontic lingual technique offers an attractive alternative for patients not willing to permit the use of metal braces. Primarily, adult patients often do not accept labial brackets due to the demands of their jobs or because they don’t want to look like teenagers.

Since the introduction of the lingual treatment by KINYA FUJITA in the early 70`s, efforts were made to simplify brackets and treatment systems. There are some well-evaluated and controllable lingual systems available, but the lingual treatment is complicated and time consuming for the orthodontist as well as for the patients. Therefore, the aim of further developments and improvements should be to simplify the technique and to reduce chair time as well as the number of appointments.

Comparing labial with the lingual technique, the differences become obvious. The structures of the labial surfaces do not differ very much between teeth or even different patients. In contrast to that the lingual surface varies considerably between teeth, consequently every bracket must be bonded using a customized base to fit each tooth. The customized base can be manufactured in the laboratory and transferred to the lingual teeth surfaces by using transfer trays.

The lingual arch wires are mushroom shaped and have two offets in order to level out the step between the canines and the first bicuspid. It’s apparent that the placing and handling of lingual appliances is more complex than that of labial appliances.

Self-ligating Bracket Features A new self-ligating lingual bracket has been engineered specifically to simplify brackets and treatment systems. This new self-ligating bracket has proved to be effective during treatment and has simplified the handling of the appliance, creating a reproducible and reliable treatment result. Consequently, the time between appointments is extended. The lingual technique can now be implemented even in busy orthodontic offices.

To engage the arch wires in the bracket slots, stainless spring clips are used. The time consuming use of elastomeric ligatures, chains and power thread can be eliminated. This elimination of ties and chains presents an advantage for dental hygiene.

The closing movement of the clips is limited by a miniature step on top of the slot, so the performance of the bracket can be manipulated perfectly for each stage of the treatment. Small diameter round wires are used during the levelling stage. These arch wires do not touch the closing spring or any other structure of the bracket slot. Consequently, the friction in the slot is at a minimum level and the first stage of the treatment can be performed in a very short time.

As the treatment progresses, the diameters of the arch wire increase and change from round to rectangular. These arch wires now touch the spring clips, and begin to lift them off the step. The power of the spring clips increases, and the arch wires are pressed down to the preadjusted bottom of the bracket slots. Torque, angulation and in/out values are transmitted to the teeth.

Oral Hygiene

One of the major obstacles in lingual treatment is oral hygience As brackets are placed on the lingual surfaces of the teeth, the accessibility to the appliance and to the teeth, for the patients as well as for the dental hygienists, is difficult and time consuming than with the labial technique. The shape of the brackets should be as smooth and as simple as possible to enable the patients and the dental hygienists to keep a high level of oral hygiene.

Most lingual brackets are equipped with hooks for elastic chains and ligatures. These hooks often overlap the marginal gingival, increasing the possibility of plaque accumulation and consequently inflammation in the marginal gingival. Due to the self-ligating design these hooks are not required, and oral hygiene can now be performed with ease.

Laboratory Procedures

There are different possibilities to find a correct bracket position on the lingual surfaces of the teeth. We recommend a customised Hiro system that was specifically developed for a self-ligating lingual bracket. Start by creating an ideal set-up, this defines treatment torque and angulation. At this early stage all over correction can be fixed. Subsequently an ideal arch wire (stainless steel, 0,0018 X 0,0025 inch) is adjusted to the lingual shape of the arch. The

ideal arch wire serves multiple functions. On one hand it is used to define the correct bracket position and to create the customized bracket bases, on the other hand it can be used as a template for all arch wires that are used during the treatment. As the ideal arch wire must be reproducible for the entire treatment period, it must be bended accurately, without inserting torque or any other additional bends except the offsets in the region of the canines.

A small amount of Transbond LR composite is now applied to the bracket base forming your customised base for each individual lingual tooth surface. The whole system is as close as possible to the lingual surfaces of the teeth, each bracket is adjusted and the composite is light-cured.

There are different possibilities to find a correct bracket position on the lingual surfaces of the teeth. We recommend a customised Hiro system that was specifically developed for a self-ligating lingual bracket. Start by creating an ideal set-up, this defines treatment torque and angulation. At this early stage all over correction can be fixed. Subsequently an ideal arch wire (stainless steel, 0,0018 X 0,0025 inch) is adjusted to the lingual shape of the arch. The

After creating single transfer trays for each tooth, the brackets and the transfer trays are disconnected from the ideal arch wire and the customized bases are sand blasted for proper bonding to the teeth.

Transferring the Brackets

Bonding preparation remains the same as with the labial technique. It is not necessary to sandblast the teeth. After mounting a Dry Field, normal etching and conditioning can be performed. A Self- Etching Primer is highly recommended. Since the transfer trays are exact replicas of each tooth, the correct position of the bracket can be easily detected. The brackets are then bonded with a light-curing composite.

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