Tribuna Books Ripano 1 (Eng) by Ripano S.A.

TRIBUNA BOOKS RIPANO

Nº 1 - 2014

Lingual Orthodontic Journal

Contents •

Retained Canines in Lingual Technique. Roberto Lapenta

•

Simplified Lingual Orthodontics. CLO3 Technique. Pablo Echarri, Martín Pedernera

•

In vivo lingual brackets: The effectiveness of two different transfer trays and two different bonding materials. Carla Maria Melleiro Gimenez, Didier Fillion, Ana Carla Raphaelli Nahás-Scocate

•

safe zone for microimplants A insertion in Class II correction in Lingual Orthodontics. Henrique Valdetaro

Editor in Chief

Pablo Echarri, DDS

Editorial Committee Silvia Geron Ryoon-Ki Hong Hee-Moon Kyung Jean-François Leclerc Marcelo Marigó Martín Pedernera Rafi Romano Giusseppe Scuzzo Kyoto Takemoto

Editorial assistant and translator Nataša Pešić

Publishing and advertising:

Ripano S.A. Ronda del Caballero de la Mancha, 135 28034 - Madrid, España Tel.: (+34) 913 721 377 Fax: (+34) 913 720 391 e-mail: ripano@ripano.es www.ripano.eu Nº 1 - 2014 ISSN: 2340-9959 Official publication:

The views and opinions expressed in this publication are those of the authors and do not necessarily reflect the official policy or position of Ripano Editorial. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic or mechanical, without permission in writing from the publisher.

11th ESLO Congress Lake Como (Cernobbio), Italy June 5th – 8th 2014

4time LABTEC

Lingual Orthodontic Journal

Editorial With a great excitement we publish the first issue of our Journal in 2014, which, we hope, will bring new winds to the sails of the world’s economy, and will mark at least the beginning of the end of the “crisis”. I want to thank to all of you who sent us so many e-mails of support and encouragement after we had published the latest last year’s issue, and we hope that this journal becomes a way of staying in touch between the congresses for all the members of the lingual orthodontics community. This year, we will have the opportunity to see each other again in May, at the Meeting of American Lingual Orthodontics Association (ALOA) in New Orleans (USA), and in July, at the Meeting of European Society of Lingual Orthodontics (ESLO), at the Lake Como (Italy). Both Organizing Committees are working very hard to offer us scientific programs which will enrich our clinical “armamentarium”, improving in this way our offer to our patients. Please, keep on sending us the information on any national or international lingual orthodontics congresses so we can contribute to its promotion and keep our readers informed. I also thank to all the colleagues who have sent us their articles, and we invite all the colleagues to participate by sending their articles or case reports for publication. We would also like to wish you happy and prosperous new year. Kind regards,

Pablo Echarri

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Retained Canines in Lingual Technique Author: Roberto Lapenta

One of the main challenges we encounter in the office is the treatment of retained canines, especially in lingual technique.

2. Spacing.

We can still hear that the lingual orthodontics can be used to treat only a reduced number of malocclusions. These claims are based on the belief that lingual brackets are less precise than labial ones. But, this is not true at all.

4. Space lack.

It is true that lingual brackets and tubes bonding requires a different series of steps, but once the knowledge and skill to do it is achieved, it is possible to treat any kind of malocclusion with excellent results, retained canines included. Canines are considered basic pillars of disocclusion, and because they are the last erupting teeth of anterior sector, they can undergo different kinds of alterations during their eruption process, which can also result in their impacted position. A retained tooth is a tooth which hasnâ&#x20AC;&#x2122;t erupted in the mouth once the normal eruption period is finished. Their retained or impacted position is statistically more frequent in maxilla than in mandible, because they have the longest and the most sinusoid path. Its etiology includes: 1. Labial-alveolar-palatine fissure. 2. Alterations in permanent dental follicle. 3. Endocrine diseases.

3. Remained temporary teeth.

5. Midline deviation. 6. Rotations. 7. Ankylosis. 8. Root resorption. 9. Etc. The objective of this article is to demonstrate through case reports that retained upper canines can be treated with lingual technique no matter the position they have in the maxilla (labial or lingual).

Case 1 A 20-year old female patient M. D. is sent by a general dentist because she still had temporary canine. The frontal photograph of her shows a harmonic face with pleasant smile (Fig. 1, 2). The profile is straight, but while smiling, a temporary upper right canine can be observed (Figs. 3, 4). Intraoral photographs show a good upper and lower alignment, as well as correct overjet and overbite (Figs. 5, 6).

4. Severe dental crowding. 5. Hereditary factors. 6. Prolonged retention of the primary tooth, producing the rotation or impacted position of the permanent tooth. 7. Present supernumerary teeth. 8. Alterations in eruption sequence. Patients with impacted or retained canines usually present some other associated problems, like: 1. Crowding.

Fig. 1.

Fig. 2.

Lingual Orthodontic Journal Left and right molar Class I. Left canine Class I, and the presence of the temporary upper right canine (Figs. 7, 8). Upper discrepancy is â&#x20AC;&#x201C;2 mm and lower discrepancy is 0 mm (Figs 9, 10). The analysis of X-rays and cephalometric tracings showed that the upper right canine is located in palatal (Figs. 11, 12). Because of the position of a canine, the integrity of the neighboring teeth roots were not at risk, so the decision was to bond the brackets to all the upper teeth except the temporary canine. The first arch wire was made of .0175â&#x20AC;? Twist Flex (Fig. 13). Fig. 3.

Fig. 4.

Fig. 5.

Fig. 6.

Fig. 7.

Fig. 8.

Fig. 9.

Fig. 10.

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Fig. 11.

Fig. 12.

Fig. 13.

Fig. 14.

Fig. 15.

Fig. 16.

The canine was surgically liberated and bonded (G7 by means of set-up), and a lingual ballista was fabricated to extract the canine (Fig. 14).

As the canine erupts, its labial surface makes contact with the lateral incisor bracket, provoking the protrusion of lateral incisor (Fig. 17). Therefore, the lateral incisor bracket is removed, so it doesnâ&#x20AC;&#x2122;t interfere in the canine eruption.

As molar tubes in lingual technique donâ&#x20AC;&#x2122;t have any auxiliary tubes, the lingual ballista should have anti-rotational mechanism which allows the application of extrusive forces to the canine. Therefore, an omega loop is fabricated and leant against the molar tube hook (Figs. 15, 16).

When palatal surface of the canine becomes visible, its impression is taken and the set-up is used to bond the bracket.

Lingual Orthodontic Journal As thereâ&#x20AC;&#x2122;s no sufficient space for correct alignment of anterior sector in the moment of brackets bonding, a coil spring is used to achieve the required space (Fig. 18).

At the end of the treatment, the patient shows a wide smile (Figs. 21-25).

It is recommendable to explain the patient that the canine and central incisor might lose their alignment as a result of this spring effect, but when the lateral incisor takes its final position, the rest of the teeth will get their ideal position back.

Left and right canine and molar Class I (Figs. 28, 29).

After a while, the canine is close to its final position (Figs. 19, 20).

Intraoral photographs show centered midline and correct overjet and overbite (Figs. 26, 27).

An upper fixed retention, to keep the obtained results (Fig. 30). In mandible, orthodontic appliances were not necessary (Fig. 31). Final panoramic and lateral X-rays (Figs. 32, 33).

Fig. 17.

Fig. 18.

Fig. 19.

Fig. 20.

Fig. 21.

Fig. 22.

Fig. 23.

Fig. 24.

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Fig. 25.

Fig. 26.

Fig. 27.

Fig. 28.

Fig. 29.

Fig. 30.

Fig. 31.

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Fig. 32.

Fig. 33.

Case 2

III and left canine Class I (Figs. 40, 41), upper dental discrepancy is â&#x20AC;&#x201C;2 mm, and lower dental discrepancy is +4 mm (Figs. 42, 43).

The next case is a 14 year old female patient P. C. (Figs. 34, 35) who was also sent by a general dentist because she had a retained canine. Her facial photographs show facial symmetry and straight profile (Fig. 36), but when she smiles, the absence of upper right canine can be observed (Fig. 37).

Panoramic X-ray confirms the presence of upper right canine impacted in maxilla on labial surface of the teeth (Fig. 44). In this x-ray we can observe that the canine is reabsorbing the root of upper right lateral incisor.

Intraoral photographs (Figs. 38, 39) show a negative overjet of 41, 42 and 43, left and right molar Class

From the cephalometric point of view, the patient is severe brachyfacial type, with marked reduction of

Fig. 34.

Fig. 36.

Fig. 38.

Fig. 35.

Fig. 37.

Fig. 39.

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Fig. 40a.

Fig. 40b.

Fig. 42.

Fig. 41.

Fig. 43.

Fig. 44.

lower facial height. Skeletal Class III in maxilla compensates this characteristic (Figs. 45, 46). Ormco 7th generation brackets were bonded in maxilla through set-up. The first arch wire was braided .0175â&#x20AC;? wire (Fig. 47). When the canine was surgically liberated and its crown exposed, a metallic bracket was bonded on it and the traction has been started with a lingual ballista. Because the ballista was fabricated with a round arch wire, it was necessary to carry out an anti-rotational

arm which makes contact with the molar band and allows the application of extrusive forces to the canine (Figs. 48, 49). As the canine migrates, a new ballista should be fabricated. In this case, it was made of esthetic arch wire (Figs. 50, 51). To avoid epithelization of the ballista arm, it was completely inserted into the arch sleeve (Fig. 52). To achieve required space, an open coil spring was inserted between the lateral incisor and bicuspid (Fig. 53).

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Fig. 45.

Fig. 46.

Fig. 47.

Fig. 48.

Fig. 49.

Fig. 50.

Fig. 51.

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Fig. 52.

Fig. 53.

Fig. 54.

Fig. 55.

Fig. 56.

Fig. 57.

Fig. 58.

Fig. 59.

Lingual Orthodontic Journal When the necessary space was obtained (Fig. 54), an elastic chain was used to distalize the canine (Fig. 55). To bond the bracket to the canine, a previous gingivectomy was necessary (Figs. 56-58). Esthetic brackets with .022â&#x20AC;? slot were bonded in mandible, to correct overbite and overjet (Fig. 59, 60).

At the end of the treatment, the patient still has her harmonic proportions (Figs. 62, 63), pleasant profile and wide smile (Figs. 64, 65). Centered midline, correct overjet and overbite (Figs. 66, 67). Molar and canine Class I (Figs. 68, 69).

Heavy 1/8 elastics were indicated to achieve correct posterior intercuspation (Fig. 61).

To maintain the obtained results, fixed retention was carried out in both dental arches (Figs. 70, 71).

Fig. 60.

Fig. 61.

Fig. 62.

Fig. 66.

Fig. 63.

Fig. 64.

Fig. 65.

Fig. 67.

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Fig. 68.

Fig. 69.

Fig. 70.

Fig. 71.

Fig. 72.

Fig. 73.

Fig. 74.

Fig. 75.

Lingual Orthodontic Journal Final X-rays show correct position of the teeth (Fig. 72). From the cephalometric point of view, there were no important changes (Figs. 73-75). It is obvious that the ballista is very useful in retained canines treatment, both in lingual and labial technique.

Observing the before/after comparison of both treatments and knowing the diagnosis and treatment plan, it is clear that the identical results can be achieved both with labial and lingual appliances. Case 1, comparison before and after the treatment: Figs. 76-79. Case 2, comparison before and after the treatment: Figs. 80-83.

Fig. 76.

Fig. 77.

Fig. 78.

Fig. 79.

Fig. 80.

Fig. 81.

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Fig. 82.

Fig. 83.

Bibliography

Ericson S., Kurol J. Diagnosis of ectopically erupting maxillary canines: a case report. Eur J Orthod 1988 ; 10: 115-120. Power SM, Short MB: An investigation into the response of palatally displace canines to the removal of deciduous canines an assessment of factors contributing to favorable eruption. Br J Orthod 1993 ; 20: 215-223. Moyers RE. Handbook of orthodontics. Chicago: Year Book medical 4ta. Ed., 1988, p.140-387. Marks S. Jr., SCHOEDER H. Tooth Eruption: Theories and Facts. Anat. Rec 1996; 25(2): 374-93. Kuftienc D. Stom y Shapira. Canino Maxilar Impactado. Parte II. Abordaje Clínico y Soluciones. Journal of Pediatric Dentistry Practice. 1997; 1(4): 29-40. Andreasen, JQ. Lesiones traumáticas de los dientes. Barcelona: Labor, 1998. Harfin J, Lapenta R, Ureña A. The lingual ballista spring”, Hyperlink “http://www.lingualnews.com” www.lingualnews.com Vol. 5 Nº 1 May 2007.

Stanley HR, Collet WR, Hazard JA. Retención de un canino temporal superior: ciencuenta años hacia adelante y atras, un llamado obligado. (ed. Esp) 1997 ; 1(4): 18-20. Kuftienc MM, Stom, Shapira. Canino superior impactado: parte 1, revisión de conceptos. Journal of Pediatric Dentistry Practice (ed. Esp) 1997 ; (2): 55-65. Martins LM, Palucci MA. Erupción dentaria, importan cia y aplicación: molares permanentes retenidos durante la etapa de erupción. Presentación de un caso clínico. Journal of Pediatric Dentistry Practice 1997 ; 2(4) : 39-44. McConnell TL et.al. Impactación de caninos superiors en pacientes con deficiencia maxilar transversal. 1997; 1(1): 43-50. Williams BH. Diagnosis and prevention of maxillary cuspid impaction. Angle Orthod 1981 ; 51: 30-40. Jacoby H. The etiology of maxillary canine impactions. Am J Orthod 1983 ; 84(2): 125-132.

Lingual Orthodontic Journal

Simplified Lingual Orthodontics. CLO3 Technique Authors: Pablo Echarri Martín Pedernera

Abstract A lot of adult patients present correct occlusion of posterior teeth or they use posterior prosthesis, but they also present mal position of anterior teeth which affects their esthetics or their function (anterior guide or canine guides). In such cases, an orthodontic treatment can be carried out in only anterior teeth. Many authors use lingual canine-to-canine bonding techniques, but in CLO3 technique (Custom-made Lingual Orthodontics in 3 steps) the bonding is carried out in incisors, canines and first bicuspids. In this article, the advantages of this technique are presented. Keywords: Simplified Lingual Orthodontics. CLO3 Technique.

Dr. Echarri’s1,2,3 CLO3 technique (Custom-made Lingual Orthodontics in three steps) is a technique in which the lingual brackets bonding is carried out in incisors, canines and first bicuspids in anterior teeth orthodontic treatment to correct esthetic and functional problems (anterior guide and canine guides) in adult patients with correct posterior occlusion or posterior prosthesis and dental mal position of incisors and canines. It is a simplified technique of 4 to 6 months long treatment, and in which the laboratory carries out the indirect bonding transfer trays, as well as the indirect adaptation of arch wires which are going to be used in the treatment. Joy (adenta) brackets are used in this technique. Their main characteristics are low profile, which pro-

Fig. 1. Accuracy Bracket Positioner (ABP).

vides a good comfort for the patient and transfers the torque to the tooth with a minimal influence of the height and low friction due to its design2. The brackets positioning can be carried out with CLASS system4 using the Set-up Model Maker (SUM), and the Occlusal Plane Reference (OPR)5,6,7, or the brackets can be also positioned using some precision machines without set-up models, like Dr. Thomas Creekmore’s Slot Machine8,9,10,11, or Accuracy Bracket Positioner (ABP), whose creators are Dr. Pablo Echarri and eng. Claus Schendell (Figs. 1 and 2) (adenta Lab Tec). The ABP allows the positioning of lingual brackets on the patient’s model without carrying out the setup correction, customizing all the parameters of the bracket:

Fig. 2. Accuracy Bracket Positioner (ABP). Positioning of the lingual bracket.

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Fig. 3. Christmas and individualized arch wire shapes.

Fig. 4. Transfer trays using the Smart Jig system.

Fig. 5. Transfer trays using the Smart Cap system (anterior view).

Fig. 6. Scheme of the transfer tray and indirect bonding.

• Height.

bracket holder can rotate and in this way the rotation prescription of the bracket can be modified.

• In-out. • Rotation. • Mesio-distal inclination. • Torque. Each parameter can be customized independent of the rest of the parameters. In the CLO3 technique, all the brackets should be positioned at the same height, to avoid vertical steps in the arch wire. In most of the cases the brackets are positioned with the same canine-to-canine in-out, too, but it is different in bicuspids, and therefore, a mushroom arch wire should be used. Nevertheless, the in-out can also be modified between the incisors and canines (Christmas arch wire) or between asymmetrical incisors (individualized arch wire) (Fig. 3). The rotation should be overcorrected for 10-15%, to avoid compensation bends in the arch wire. This correction is carried out easily with the ABP, because its

The prescription of the bracket mesio-distal inclination can be also carried out easily with the ABP, by modifying the position of the model in respect to the bracket. The torque can be modified in the same way. A detailed explication of bracket prescription adjustment using the ABP is out of scope of this article. The brackets positioned in this way in the model allow the use of arch wires with only in-out bends, but without rotation, height or 2nd or 3rd order bends. When the brackets are positioned, transfer trays are fabricated (Fig. 4) using the Smart Jig System (adenta), and indirect bonding is carried out. Smart Stick (Fig. 5) is used to transfer the single tooth trays to the mouth. The laboratory also carries out an arch wire template, taking into account the position in which the brackets are bonded on the model, and indirectly adapts the arch wires. In this way, the clinician receives a CLO3 Kit from the laboratory, which includes the brackets

Lingual Orthodontic Journal and the single tooth transfer trays from the first bicuspid to the first bicuspid, arch wire template and two arch wires to be used in the treatment.

in the final arch wire, and it also makes possible the treatment of the cases in which the torque control is necessary (3D control treatments).

The 3 steps mentioned in the name of the technique are: indirect bonding, first arch wire, second arch wire. The indirect fabrication of the Kit considerably reduces the chair time and treatment time, and the obtained results are more predictable.

The arch wire template is used in cases in which it is necessary to reposition the arch wire or to adjust the finishing arch.

The scheme of the figure 6 shows the Smart Jig System of transfer trays which consists of the Quick Socket, connected with the Smart Stick (Fig. 5) to transport easily the transfer tray to the mouth, and the Smart Connector, which connects the Quick Socket with the bracket by means of a retention, made of Fermit (Vivadent). The Quick Socket is adapted to the tooth with a light curing resin. The Joy bracket is bonded to the model with the composite. In the indirect bonding, the following procedure is carried out over the tooth: sand blasting for 3 seconds, rinsing and drying, acid etching for 20-30 seconds, rinsing and drying, application of primer. As far as the tray is concerned, it is prepared by applying the plastic primer and composite. With the transfer trays prepared in this way it is possible to use self curing or light curing adhesives, to remove the excess flash paste, to remove easy the tray after the bracket bonding, and to re-use the tray in de-bonding cases. The indirect bonding of the brackets facilitates the treatment of the cases in which only 2D control is necessary, because it minimizes the necessity for intraoral adjustments of arch wires and finishing bends

This technique can be used in one or in both jaws, and it can be combined with a complete lingual or Clear Aligner treatment in the antagonist arch. The bonding of the first bicuspids is carried out because: • Many patients show alignment alterations in not only the incisors, but also in canines, and the first bicuspids anchorage is necessary to correct mal position of these teeth. • In spacing cases, the first bicuspids anchorage is necessary to carry out the space closure. • In alignment or proclination of the teeth, the disto-canine in-set support of the arch wire in the mesial surface of bicuspids simplifies the sagittal expansion mechanics. • In crowding cases treated with stripping, the first bicuspids anchorage avoids the incisors proclination.

Case report The figures 7-11 show initial photographs of a 28 year-old female patient with molar Class I malocclu-

Fig. 7. Case report. Initial intraoral Fig. 8. Case report. Initial intraoral Fig. 9. Case report. Initial intraoral left right photograph. central photograph. photograph.

Fig. 10. Case report. Initial intraoral upper occlusal photograph.

Fig. 11. Case report. Initial intraoral lower occlusal photograph.

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Fig. 12. Case report. Treatment progress in the lower arch (1).

Fig. 13. Case report. Treatment progress in the lower arch (2).

sion with minor crowding in both arches affecting the anterior teeth.

effective way than it would be without the bonding of the first bicuspids.

A treatment with Clear Aligner was carried out in the maxilla (10 months) and a 5 month CLO3 technique treatment in the mandible. The lingual brackets Joy were bonded from the first lower bicuspid to the first lower bicuspid, and the alignment of the teeth was carried out through their proclination. The rotations were over corrected in the bonding, using the indirect bonding technique.

When the space for alignment is obtained through the incisor proclination, the brackets can be removed from the first bicuspids. The figure 13 shows the over correction of the rotation in the composite base of the lower left central incisor bracket. The second arch wire, a .016” NiTi arch wire, is ligated with metallic ligatures to finish the alignment and correction of rotations. The lower right central incisor couldn’t be ligated completely when this arch was positioned, and it was ligated in the following appointment.

The figure 12 shows the first arch wire, a .014” Thermal NiTi arch wire, whose disto-canine in-sets are touching the mesial surface of the first bicuspids to achieve proclination of the incisors in a much more

The figures 14-19 show the final result of the treatment.

Fig. 14. Case report. Final intraoral Fig. 15. Case report. Final intraoral Fig. 16. Case report. Final intraoral left right photograph. central photograph. photograph.

Fig. 17. Case report. Final intraoral up- Fig. 18. Case report. Final intraoral Fig. 19. Case report. Final intraoral per occlusal photograph. lower occlusal photograph. lower labial photograph.

Lingual Orthodontic Journal Conclusions The CLO3 technique allows us to treat the patients who present mal position of anterior teeth and a correct posterior occlusion in a simple way with protocol and with predictable results and in 4 to 6 months treatment time. The preparation of the transfer trays and indirect adaptation of the arch wires in the laboratory reduce the chair time and treatment time, and make the clinician’s task easier. The bonding of the first bicuspids increases the anchorage, which facilitates the mechanics of different types of treatments.

Bibliography 1. Echarri P. Cementado indirecto en la técnica CLO3. Odontología actual 2011;2(2):3-6 2. Echarri P, Loidl H. Biomecánica en la técnica CLO3 (Custom-made Lingual Orthodontics in 3 Steps – Ortodoncia Lingual Personalizada en 3 pasos). Dental Tribune 2013;8(3):16-8.

3. Echarri P. 10 claves de la técnica CLO3. www.ladentformacion.com 4. Echarri P. Técnica de posicionamiento de brackets linguales Class System. Revista Iberoamericana de Ortodoncia 1997;16:1-17. 5. Echarri P. In drei Schritten zum Erfolg. Kieferorthop Nachrichten 2013;4;6-7. 6. Echarri P, Schendell C. Einfach und präzise. Kieferorthop Nachrichten 2013;6;14-16 7. Echarri P, Pedernera M, Schendell C. Avances en la técnica de cementado indirecto. Tribuna Books Ripano Lingual Orthod J 2013;(0):4-8. 8. Echarri P. Procedimiento para el posicionamiento de brackets en Ortodoncia Lingual. (Parte I). Ortod Clin 1998; 1(2):69-77. 9. Echarri P. Procedimiento para el posicionamiento de brackets en ortodoncia lingual. (Parte II). Ortod Clin 1998;1(3):107-17 10. Echarri P. How to obtain the maximum benefits from the lingual archwires. J Japan Ling Orthod Association (JJLOA) 2002;13:2-13 11. Baca A, Echarri P. Ortodoncia lingual. 10 años de experiencia en el posicionamiento indirecto de brackets. Ortod Clin 2001;4(3):142-50.

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In vivo lingual brackets: The effectiveness of two different transfer trays and two different bonding materials Authors: Carla Maria Melleiro Gimenez Didier Fillion Ana Carla Raphaelli Nahás-Scocate

Abstract Objectives: The effectiveness of two transfer trays and two bonding materials used in lingual brackets were evaluated over a six months period. Methods: Ormco STb® lingual brackets were positioned in 34 adult patients using CAD/CAM technology. For each patient, two types of transfer trays, for indirect bonding, were used: unitary type (resin-based composite) and partial type (silicon). The sample group was divided according to the bonding materials: Flow adhesive, Reliance® and Fuji Ortho LC®. After six months of fixed lingual orthodontic appliance treatment, the debonding occurrences were registered and evaluated by using the variance analysis (significance level of 5%). Results: A total of ten brackets debonded: seven of Flow adhesive and three of Fuji Ortho, with no statistical significant difference between the bonding materials. Regarding the transfer trays, there was also no statistical significant difference between the partial and unitary type, being 3 and 7 respectively. Conclusion: Both bonding materials and types of transfer trays presented a satisfactory clinical response, even though the Fuji Ortho and partial transfer tray showed fewer debonding occurrences. Keywords: Orthodontics, Malocclusion, Appliance, Dental bonding.

Introduction Bracket debonding, during orthodontic therapy, implies an increase in overall treatment time, harm to the enamel, patient discomfort and an increase in time during the re-bonding procedure (Komori 2010; Scuzzo and Takemoto, 2003 and 2010; Brosh, 2005). Lingual bracket debonding occurs mainly due to the indirect bonding technique. However, this is pivotal for succeeding in lingual orthodontics. Several laboratory techniques for indirect positioning and bonding of lingual brackets are available, but demand time and preparation of tooth surface. In most cases, it is essential to build a set up allowing adequate bracket positioning, (Kyung 1989; Hiro, 1998; Takemoto & Scuzzo 2001; 2010) which contributes to favorable end results and occlusion. Moreover, when set up is performed, there is a decrease in re-bonding procedures and archwire adjustments, which favors the clinical practice. (Pauls, 2010) Nowadays, another valuable option is the digital set up by using the tridimensional CAD/CAM technology, which improves precision and predictability. The digital approach minimizes laboratorial errors and also facilitates biomechanical management, thus reducing chair time (Fillion, 2010).

Most laboratory procedures for the lingual technique use the indirect bonding of brackets via transfer trays. It is very important to ensure the precise transfer of lingual bracket positions into the oral cavity, as subsequent manual adjustments are challenging in lingual orthodontics. Minor errors of lingual bracket placement may result in considerably deviating tooth position. The development of KommonBase, (Komori et al. 2010) the direct bonding system, has made an important contribution to clinical practice as it offers an advantageous alternative to conventional indirect bonding systems for bonding lingual orthodontic brackets. This system is characterized by a large bonding base which achieves precise bracket positioning and enhances bond strength. Furthermore, transfer trays are not required because of this system’s self-positioning shape. According to literature, some factors can be related to lingual bracket damages. Some examples are the bracket base, (Chu et al., 2010; Wang, 2004; Sharma-Sayal et al. , 2003) the type of bonding material, (Brauchli et al. 2010; Pick et al. 2010; Park et al. 2009; Sah, 2009; Cal Neto et al. 2009; Rambhia et al. 2009; Valletta et al. 2007; Bishara et al. 2007; Scrib-

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Fig. 1. Lingual Bracket debonding in upper arch.

Fig. 2. Lingual Bracket debonding in lower arch.

Fig. 3. Virtual set up.

Fig. 4. Virtual jigs.

six months of treatment two types of transfer trays (resin-based composite and silicon) and two types of bonding materials (Flow resin, Reliance® and Fuji Ortho LC®) in relation to the lingual bracket failure.

Material and methods

Fig. 5. Resin jigs for bracket positioning.

This study included a sample of 34 adult patients, of both genders, Class I and Class II malocclusions, submitted for the lingual orthodontic treatment in a private dental office. A total of 456 teeth were bonded with Ormco STb® fixed lingual brackets.

ante et al. 2006; Summers et al. 2004; Madal et al. 2003; Toledano et al. 2003, Powers, 1997) any trauma provoked by the brackets, (Laureano Filho, 2008) any force systems and moments produced during orthodontic treatment, (Fuck et al. 2005) and the influence of environmental conditions (Rikuta, 2008; Cacciafesta, 1998) (Figures 1 and 2). In this context, the aim of this study was to evaluate and compare after

The lingual STb® brackets were positioned on the malocclusion models for indirect bonding procedure using jigs made by the CAD/CAM technology, based on a virtual ideal occlusion set up (Figure 3). First of all, the jigs are constructed virtually (Figure 4) and thereafter, in resin by the prototype machine (Figure 5). The jigs have 2 parts: one that is attached to the malocclusion model’s buccal surface; and another that is attached to the lingual brackets. This is determined by the information provided by the virtual set

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Fig. 6. Flow adhesive, Reliance®.

The laboratorial and clinical procedures, as well as, documenting the debonding occurrences were carried out by one investigator (D.F.). After six months of treatment, the data collected was statistically evaluated and compared by the Reduced Normal Distribution test, with a significance level of 5%.

Results Only 10 debonding occurrences were noted in the 456 teeth studied, 7 related to the Flow adhesive (2.6%) and 3 related to the Fuji Ortho (1.7%) (Table 1). Regarding of the type of transfer tray used, 3 failure brackets were noted for the half arch silicone transfer trays (1.3% of the 226 teeth studied) and 7 failure brackets for the unitary transfer trays (3.09% of the 230 teeth studied) (Table 2). Fig. 7. Fuji Ortho LC®.

up, which includes inclination, angulation, torque, height, in/out, and distance of lingual surfaces, in order to achieve ideal occlusion through the orthodontic treatment. In this study, two types of bonding materials and two types of transfer trays were used. In relation to the type of bonding material, the sample was divided in two groups, using Flow resin, Reliance® on 20 patients (Figure 6) and Fuji Ortho LC® on 14 patients (Figure 7). The bonding materials were used according to the manufactures’ instructions. For each patient, the indirect bonding was applied to half of the upper and half of the lower dental arches using unitary transfer trays (Figure 8) and silicon transfer trays were used in the other halves (Figure 9). Flow adhesive, Reliance® was used for the unitary transfer trays (resin-based composite) and Memosil®, for the silicone transfer trays (partial type). It is important to note that the unitary transfer trays were built in accordance with the kommonBase technique (Komori, 2010), characterized by a large bonding base, which enhances an improved bracket fit and precise bracket positioning. Unitary transfer trays made in composite were used for the upper right maxillary teeth (11 to 17) and for the lower right mandibular teeth (41 to 47). Silicon transfer trays were used for the upper left maxillary teeth (21 to 27) and for the lower left mandibular teeth (31 to 37). This procedure was valid for all the 34 patients.

Fig. 8. Unitary tranfer tray.

Fig. 9. Partial silicone tranfer tray.

Lingual Orthodontic Journal Table 1. Frequency of debonding occurrences related to bonding materials. Z0 and P values. Bonding Material

Freq.

Total Teeth

Flow adhesive

7 (2.6)

1.122 n

0.141

270 (100.0)

Fuji Ortho

3 (1.6)

186 (100.0)

n = no significant, at level of 5%. Table 2. Frequency of debonding occurrences related to Transfer trays. Z0 and P values. Tranfer Tray

Freq.

Total Teeth

Unitary

7 (3.0)

1.251 n

0.106

230 (100.0)

Partial Silicone

3 (1.3)

226 (100.0)

n = no significant, at level of 5%.

Discussion This study showed that bonding success is related more to the clinical procedures carried out prior and during bonding rather than to the material or the trays used. Regarding the performance between the two materials, the results of this study, although insignificant, agreed with other studies showing fewer debonding occurrences of Fuji Ortho (Pick et al. 2010; Cacciafesta, 1998; Bishara et al. 2007; Summers et al. 2004; Toledano et al. 2003), and also agreed with the literature showing similar results between Fuji Ortho x Flow adhesive. (Vicente et al. 2010; Park et al. 2009; Vicente e Bravo, 2009; Rambhia et al. 2009; Scribante et al. 2006). Another factor that can influence debonding ocurrences in lingual brackets is that the lingual enamel surface is smoother than the buccal enamel. (Brosh et al. 2005) However, if conventional resin is applied to bond the brackets, although it offers more shear bond strength compared to resin-modified glass ionomer adhesive (Fuji Ortho), it is more difficult for clinicians to clean up the residue on the enamel surface after debonding. (Summer, 2004) Although Fuji Ortho has significantly less shear bond strength, this composite is still clinically adequate when clinicians consider all the properties of the adhesive. Furthermore, it is easier to remove any residue after debonding.

(Summer,2004; Bishara,2007) Valleta et al (2007). On the other hand, it showed that Fuji Ortho was more prone to accidental debonding. Komori et al. (2010) and Miyazawa et al. (2004) suggested that the use of individual tooth transfer trays offers several benefits compared to transfer trays that include all of the teeth. However, this study showed that there were numerically fewer debonding events with partial trays, even though the statistical analysis showed no significant difference. The literature (Kallange, 2004; Pelan, 2007; Fortini, 2007; Keim, 2007; Kasrovi, 1997) is unanimous regarding the advantages of indirect bonding and the satisfactory results in clinical application when using silicon transfer trays.

Conclusion Both bonding materials and types of transfer trays presented a satisfactory clinical response, even though the Fuji Ortho and partial transfer tray showed fewer debonding occurrences.

References Bishara SE, Ostby AW, Laffoon J, Warren JJ. A self-conditioner for resin-modified glass ionomers in bonding orthodontic brackets. Angle Orthod. 2007 Jul;77(4):711-5.

Dental Tribuna Books Bishara SE, Ostby AW, Laffoon JF, Warren J. Shear bond strength comparison of two adhesive systems following thermocycling. A new self-etch primer and a resin-modified glass ionomer. Angle Orthod. 2007 Mar;77(2):337-41. Brauchli L, Muscillo T, Steineck M, Wichelhaus A. Influence of enamel conditioning on the shear bond strength of different adhesives. J Orofac Orthop. 2010 Nov;71(6):411-20. Epub 2010 Nov 17. Brosh T, Strouthou S, Sarne O. Effects of buccal versus lingual surfaces, enamel conditioning procedures and storage duration on brackets debonding characteristics.J Dent. 2005 Feb;33(2):99-105. Cacciafesta V, Jost-Brinkmann PG, Süssenberger U, Miethke RR. Effects of saliva and water contamination on the enamel shear bond strength of a light-cured glass ionomer cement. Am J Orthod Dentofacial Orthop. 1998 Apr;113(4):402-7. Cal-Neto JP, Quintão CA, Almeida MA, Miguel JA. Bond failure rates with a self-etching primer: a randomized controlled trial. Am J Orthod Dentofacial Orthop. 2009 Jun;135(6):782-6. Chu CH, Ou KL, Dong DR, Huang HM, Tsai HH, Wang WN. Orthodontic bonding with self-etching primer and self-adhesive systems. Eur J Orthod. 2010 Aug 20. Fillion D. Clinical advantages of the Orapix-straight wire lingual technique. Int Orthod. 2010 Jun;8(2):125-51. Fortini A, Giuntoli F, Franchi L. A simplified indirect bonding technique. J Clin Orthod. 2007 Nov;41(11):680-3. Fuck LM, Wiechmann D, Drescher D. Comparison of the initial orthodontic force systems produced by a new lingual bracket system and a straight-wire appliance. J Orofac Orthop. 2005 Sep;66(5):363-76. Hiro T, Iglesia F, Andreu P. Indirect bonding technique in lingual orthodontics: the HIRO system. Prog Orthod. 2008;9(2):34-45. Kalange JT. Indirect bonding: a comprehensive review of the advantages. World J Orthod. 2004 Winter;5(4):301-7. Kasrovi PM, Timmins S, Shen A. A new approach to indirect bonding using light-cure composites. Am J Orthod Dentofacial Orthop. 1997 Jun;111(6):652-6. Keim RG The indirect approach. J Clin Orthod. 2007 Nov;41(11):651-2. Komori A, Fujisawa M, Iguchi S. KommonBase for precise direct bonding of lingual orthodontic brackets.Int Orthod. 2010 Mar;8(1):14-27. Epub 2010 Mar 4. Kyung HM. Individual indirect bonding technique (IIBT) using set-up model. Taehan Chikkwa Uisa Hyophoe Chi. 1989 Jan;27(1):73-82. Laureano Filho JR, Godoy F, O’Ryan F. Orthodontic bracket lost in the airway during orthognathic surgery. Am J Orthod Dentofacial Orthop. 2008 Aug;134(2):288-90. Mandall NA, Millett DT, Mattick CR, Hickman J, Worthington HV, Macfarlane TV. Orthodontic adhesives: a systematic review. J Orthod. 2002 Sep;29(3):205-10; discussion 195. Miyazawa K, Miwa H, Goto S, Kondo T. Indirect laminate veneers as an indirect bonding method. World J Orthod. 2004 Winter;5(4):308-11.

Park SB, Son WS, Ko CC, García-Godoy F, Park MG, Kim HI, Kwon YH. Influence of flowable resins on the shear bond strength of orthodontic brackets. Dent Mater J. 2009 Nov;28(6):730-4. Pauls AH. Therapeutic accuracy of individualized brackets in lingual orthodontics. J Orofac Orthop. 2010 Sep;71(5):34861. Epub 2010 Oct 21. Pellan P. Indirect bonding of brackets: don’t wait another day! Int J Orthod Milwaukee. 2007 Fall;18(3):11-7. Pick B, Rosa V, Azeredo TR, Cruz Filho EA, Miranda WG Jr. Are flowable resin-based composites a reliable material for metal orthodontic bracket bonding? J Contemp Dent Pract. 2010 Jul 1;11(4):E017-24. Powers JM, Kim HB, Turner DS. Orthodontic adhesives and bond strength testing. Semin Orthod. 1997 Sep;3(3):14756. Rambhia S, Heshmati R, Dhuru V, Iacopino A. Shear bond strength of orthodontic brackets bonded to provisional crown materials utilizing two different adhesives. Angle Orthod. 2009 Jul;79(4):784-9. Rikuta A, Yoshida T, Tsubota K, Tsuchiya H, Tsujimoto A, Ota M, Miyazaki M. Influence of environmental conditions on orthodontic bracket bonding of self-etching systems. Dent Mater J. 2008 Sep;27(5):654-9. Shah J, Chadwick S. Comparison of 1-stage orthodontic bonding systems and 2-stage bonding systems: a review of the literature and the results of a randomized clinical Trial. Orthod Fr. 2009 Jun;80(2):167-78. Epub 2009 Jun 25. Scribante A, Cacciafesta V, Sfondrini MF. Effect of various adhesive systems on the shear bond strength of fiber-reinforced composite. Am J Orthod Dentofacial Orthop. 2006 Aug;130(2):224-7. Takemoto K, Scuzzo G.The straight-wire concept in lingual orthodontics. J Clin Orthod. 2001 Jan;35(1):46-52. Scuzzo G, Takemoto K, Takemoto Y, Takemoto A, Lombardo L. A new lingual straight-wire technique. J Clin Orthod. 2010 Feb;44(2):114-23; quiz 106. Sharma-Sayal SK, Rossouw PE, Kulkarni GV, Titley KC. The influence of orthodontic bracket base design on shear bond strength. Am J Orthod Dentofacial Orthop. 2003 Jul;124(1):74-82. Summers A, Kao E, Gilmore J, Gunel E, Ngan P. Comparison of bond strength between a conventional resin adhesive and a resin-modified glass ionomer adhesive: an in vitro and in vivo study. Am J Orthod Dentofacial Orthop. 2004 Aug;126(2):200-6; quiz 254-5. Toledano M, Osorio R, Osorio E, Romeo A, de la Higuera B, García-Godoy F. Bond strength of orthodontic brackets using different light and self-curing cements. Angle Orthod. 2003 Feb;73(1):56-63. Valletta R, Prisco D, De Santis R, Ambrosio L, Martina R. Evaluation of the debonding strength of orthodontic brackets using three different bonding systems. Eur J Orthod. 2007 Dec;29(6):571-7. Epub 2007 Oct 25. Wang WN, Li CH, Chou TH, Wang DD, Lin LH, Lin CT. Bond strength of various bracket base designs. Am J Orthod Dentofacial Orthop. 2004 Jan;125(1):65-70.

Objectives: To get to know a new therapeutic option to resolve cases with minor crowding in anterior zone. To get to know the criteria in selection of the patient. To increase the number of different treatments offered in your clinic, giving an efficient, rapid and esthetic solution to the patients who donâ&#x20AC;&#x2122;t want other kind of treatments. To break into the lingual orthodontics in a simple and safe way. Dates: March 1st, 2014 in Spanish.

March 8th, 2014 in English.

ortodoncia lingual

Lingual Orthodontic Journal

A safe zone for microimplants insertion in Class II correction in Lingual Orthodontics Author: Henrique Valdetaro

Abstract The main objective of this article is to describe a simple technique used to find a safe site for microimplants insertion. This procedure is done by using a CT exam to verify the bone thickness in the maxilla and to avoid the injury of noble structures such as maxillary sinus and arteries. Three lingual orthodontics cases were shown to describe clinically the entire procedure from diagnosis until the end of the treatment. The advantages, disadvantages are discussed, too; therefore, the orthodontist can count on this simple diagnostic way to carry out safe and precise work. Keywords: Lingual orthodontics, microimplants, tomography, distalization.

Anchorage has always been a challenge for an orthodontist. Titanium microimplants are easily inserted into the bone, and are great help in moving the teeth with greater precision and without great surgical interventions. In order to have perfect force vectors with a safe position, the correct position of the microimplant should be studied. The following cases illustrate a treatment plan and show how to use a tomography exam which helps us to carry out a safe procedure. This simple and very precise method involves the use of computer tomography (CT) of the Cone Beam type and DentalSlice software or any other software used in large scale implantology (Fig. 1). The first option is to insert the microimplants between the second upper bicuspid and the first molar,

Fig. 1. Using a Cone Beam Tomography we can find the best microimplant insertion site.

where there is space free of roots. This space is not always available, and therefore it is necessary to carry out a tomographic study to find out whether it is possible to do it or not. Only after this evaluation, we can plan microimplant insertion and start the distalization. It is necessary to make the distalization with the microimplants anchorage, using Class II elastics, to avoid unwanted rotations and to achieve a controlled movement. The palatal alveolus between the roots of the second bicuspid and first molar is an alternative location for microimplant insertion, when there is enough space for it (Fig. 2).

Clinical cases In the first case, the patient presents a unilateral Class II with minor crowding in both arches. Her chief

Fig. 2. The tomography slice will help us to verify the possibility for microimplants insertion, avoiding the risk of inappropriate procedures such as maxillary sinus injury.

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Fig. 3. Left Class II and a minor crowding in the lower arch.

To avoid root contact during the distalization, the microimplant must be positioned in an oblique position. Using this procedure no microimplant repositioning is necessary, which makes the treatment procedure much easier.

Fig. 4. As we can see there is enough bone for the microimplant between the second premolar and the first molar.

complaint was that the left canine is located higher and looks “bigger”, according to her. The treatment plan was to carry out a “en masse” distalization, with microimplants anchorage, to correct the left Class II relationship (Fig 3). Tomography exam was carried out to verify the ideal microimplant insertion site. The space between the second bicuspid and the first molar was chosen (Fig. 4) because of the good bone thickness and also because it is a place in which an elastic chain can be placed directly from the microimplant to the first bicuspid, moving backward the entire posterior segment as one unit. The elastic chain was attached to the bicuspid bracket instead of the canine bracket, to avoid canine tipping and the consequent bowing effect.

During the distalization, Class II elastics must be used 24 hours a day to avoid undesirable side effects and also to have full control of the movement. While the posterior segment was moving back, the canine was moved backward and upward. This undesired movement occurred because of the intrusion force which was the result of the elastic chain. This canine intrusion was corrected with the archwire and with the use of Class II elastics (Fig. 7). After distalization, the microimplant was simply removed (Fig. 8). Microimplants anchorage is very helpful in simple cases, where unilateral movement is required. As we can see, all the objectives of this treatment were achieved in 18 months–a good occlusion and a good smile, as well as a completely controlled distalization movement (Fig 9). The second case is a re-treatment case in which the patient presents a bilateral Class II with moderated crowding in the upper and lower arch, and a Bolton discrepancy of 1.9 mm excess in the lower jaw. The initial treatment plan was to use a pendulum appliance for posterior segments distalization. Then, a

Lingual Orthodontic Journal

Fig. 5. Microimplant must be inserted in an oblique position. The treatment plan in the tomography exam (a). Microimplant insertion site in the mouth (b), and microimplant position in a plaster model (c).

Fig. 6. The elastic chain can be attached from the microimplant directly to the first bicuspid (a and b). This procedure will produce an undesirable intrusion force which must be compensated with a rigid wire (stainless steel) and Class II elastics must be used during the distalization process. Sometimes, the elastic chain can be inserted changing the force vector with the help of the arch wire (green dot). The force obtained with this procedure is more favorable, but a very strong wire, like .016â&#x20AC;? x .022â&#x20AC;? stainless steel wire (c) must be used to avoid wire deformation.

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Fig. 7. Distal tooth movement with the undesirable side effect in the canine (b and c).

Fig. 8. Microimplant was simply removed.

Fig. 9. Treatment plane was finished with good results.

Lingual Orthodontic Journal full fixed lingual orthodontic appliance was used to finish the biomechanics procedures, anterior space closure and to carry out finishing details. Pendulum appliance is widely used in distalization treatments in orthodontics. It is a very efficient de-

vice used to avoid the bicuspids extraction and to move the entire posterior segment backward. But sometimes side effects can occur and the entire treatment plan must be changed to reach the final objectives. In this patient, a persistent severe inflammation in the palatal area made impossible the use of the pendulum appliance (fig. 12). A new treatment plan was designed and a tomography exam was carried out to search for a microimplant insertion site. Using the tomography exam, the space between the second bicuspid and first molar was selected as a good microimplant insertion site, with good bone thickness and quality. Finally, microimplant was inserted in an oblique position, to avoid contact with roots.

Fig. 10. A beautiful smile was also obtained.

Fig. 11. Re-treatment case with bilateral Class II and both underdeveloped arches, maxilla and mandible. Extraction therapy was discarded due to the patientâ&#x20AC;&#x2122;s profile.

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Fig. 12. Undesirable effect of palatal inflammation, due to the use of a pendulum appliance without the patientâ&#x20AC;&#x2122;s cooperation (b and c). Even after healing, the affected area remained sensitive to the use of a new Pendulum appliance (d).

Fig. 13. Tomography exam to find a good microimplant insertion site.

A full lingual orthodontic appliance was used and because of the very deep bite, built-ups were also necessary. Expansion was done to correct the mandibular position. Class II elastics were used to control the side

effect of the elastic chainâ&#x20AC;&#x2122;s distalization, with a totally controlled backward movement. The built-ups helped the patient to find a good occlusion during the expansion of maxilla and mandible with the archwires sequence.

Lingual Orthodontic Journal

Fig. 14. Maxilla and mandible expansion before distalization, and mandibular repositioning.

The last case is a bilateral Class II with a deep bite and a moderated crowding in the upper and lower jaw. Due to the convex profile and the overbite, the treatment plan was a non-extraction procedure. The objective was the overjet correction by distalizing the posterior segment with microimplants anchorage.

Fig. 15. Distalization of the posterior segment as one single unit.

Tomography exam was carried out to verify how much bone space is available for the anchorage device insertion. In this case, the space between the second bicuspid and the first molar was not available.

Fig. 16. After the expansion, distalization was finished and the appliance was removed.

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Fig. 17. All the objectives were achieved: a beautiful smile, good occlusion and good function, such as canine guide and posterior disocclusion.

Fig. 18. Deep overbite, Class II, division 2, and lower and upper crowding.

Lingual Orthodontic Journal

Fig. 19. There is insufficient bone for the microimplant insertion, as we can see in the yellow drawing.

Fig. 20. As we can see in the photograph and in the tomography exam tracing, the cortical bone in the chosen area is very thick, which makes it a good and safe site for microimplant insertion.

Fig. 21. A simple method for transpalatal bar construction using a .021â&#x20AC;? x .025â&#x20AC;? stainless steel archwire, depending on the microimplant slot.

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Fig. 22. Arch wire sequence, Class II elastics and distalization with the transpalatal bar.

Then, the tomography exam was used to search for bone space in which the microimplant can be inserted. A very good bone area was found in the palatal midline, between the left first molar and the right first molar.

Fig. 23. To correct overbite, the intermaxillary elastics position can be changed according to the treatment protocol and necessity. Here, the intermaxillary elastics were temporarily positioned in the lower first molar and the upper second bicuspids.

After the microimplant was inserted, the impression was taken and a working model with the corresponding microimplant was carried out to prepare a transpalatal bar which was going to be attached to the microimplant with a simple metallic ligature. The transpalatal bar was used to optimize the force vector, because if only the elastic chain had been used

Fig. 24. After Class II correction and deep bite correction we started the final detailing.

Lingual Orthodontic Journal directly from the microimplant (in the midline of the palate) to the first bicuspid bracket, an excessive contraction force would have been applied in the maxilla. Class II elastics and transpalatal bar were used for distalization and overjet correction. Overbite was

corrected with an appropriate arch wires sequence and a small arch expansion. Mandible was unlocked and then moved forward in a natural way. As we can see, at the end of the treatment, a good profile, good occlusion and good function were achieved.

Fig. 25. Appliance removal after finishing bends.

Fig. 26. Symmetric smile.

Fig. 27. Microimplant was removed. As we can see in this picture, only a small part of the screw was inside the bone (the red colored portion).

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Fig. 28. Canine protected occlusion test is also correct.

Fig. 29. Profile is much better at the end of treatment due to the distalization and overbite correction.

Discussion Microimplants for anchorage control are one of the most useful discovery in the orthodontic field in the last years. Although this procedure helps the professional to conduct his cases with a very controlled movement and with no anchorage loss, the microimplant insertion must be carried out with biological control, avoiding the injury of important structures such as arteries, nerves and maxillary sinus. A simple tomography exam can help us to identify a perfect site for the microimplant insertion in each patient, providing us with the best and the safest result.

Bibliography Robert WE et al. Rigid endosseous implants for orthodontics and orthopaedic anchorage. Angle Orthod 1989;59(4):247-56. Crekmore TD, Eklund MK. Possibility of skeletal anchorage. J Clin Orthod 1983;17: 266-7. Echarri P. Ortodoncia e microimplante. Sillabus Ladent Centro de Ortodoncia y ATM. Melsen B. Mini implants: Where are we? J Clin Orthod 2005;34(9):539-47.

Nanda R, Uribe FA. Temporary anchorage device in orthodontics. Mosby Elsevier, 2009. Lee JS et al. Application of orthodontic mini-implants. Quintessence books 2007 Wiechmann D, Meyer U, Büchter A. Success rate of mini- and micro-implants used for orthodontic anchorage: a prospective clinical study. Clin Oral Implants Res 2007;18:263-7. Kuroda S, Yamada K, Deguchi T, Hashimoto T, Kyung HM, Takano-Yamamoto T. Root proximity is a major factor for screw failure in orthodontic anchorage. Am J Orthod Dentofacial Orthop 2007;131:S68–73. Kravitz ND, Kusnoto B. Risks and complications of orthodontic miniscrews. Am J Orthod Dentofacial Orthop 2007;131:S43–51.1. Poggio PM, Incorvati C, Velo S, Carano A. ‘‘Safe Zones’’: A guide for miniscrew positioning in the maxillary and mandibular arch. Angle Orthod 2006;76:191–197 Fayed MM, Pazera P, Katsaros C. Optimal sites for orthodontic mini-implant placement assessed by cone beam computed tomography. Angle Orthod 2010;80:939-51. Chaimanee P, Suzuki B, Suzuki EY. ‘‘Safe Zones’’ for miniscrew implant placement in different dentoskeletal patterns. Angle Orthod 2011;81:397-403.

R E L

T S E

New approach to lingual Orthodontics Authors:

Dr. Pablo Echarri Lobiondo Dr. Kyoto Takemoto Dr. Giuseppe Scuzzo Dr. Didier Fillion Dra. Silvia Geron Dr. Hee Moon Kyung Dr. Mario Paz Dr. François Leclerc Dr. Marcelo Marigo

428 pages in full color Dimensions: 21x29.7 cm Luxurious hard cover binding ISBN: 978-84-937793-0-6 Price: 120 euros - Shipping price for Europe: 36 euros = 156 euros - Shipping price for America: 46 euros = 166 euros

OFFER: 80 euros (shipping included)* PROLOGUE Having had our previous two WSLO Congresses in two different continents, in New York in 2006 and Seoul in 2007, we held our 3rd biennial Congress in March of this year at Buenos Aires with South America as our 3rd new continent. I’m very glad that so many orthodontists could attend this Congress and could see the newest and the highest level of treatments in lingual orthodontics in the world. I would especially like to say thank you for the efforts of the chairman Dr. Pablo Echarri, Dr. Adriana Pascual and Dr. Fernanda Elgoyhen, the Presidents of SAO and SAOL. Furthermore, I would like to say a very big thank you to all the staff and volunteers, too many to name individually here, who worked so hard to make the 2009 congress such a success. I think that everybody appreciates that putting together such a good event takes a great deal of work and dedication. In addition, I sincerely hope that everybody will appreciate that this book is the result of many hours of work and research by the speakers at the Congress who gave us so many excellent presentations. These speakers have greatly helped in our mission to advance the art and science of lingual orthodontics and to help us to promote the use of lingual orthodontics throughout the world. I hope everybody will make the best use of this book to understand current trends in lingual orthodontics. I hope everybody will take the opportunity to present their ideas and help extend the art and science of lingual orthodontics when we hold our next Congress which will be in Osaka, Japan in April 2011. The WSLO is always seeking to achieve the highest possible quality of lingual orthodontics. Let us look forward together to a promising future.

ORDERS: You can order the book, indicating the offer, by: • E-mail: ripano@ripano.eu • Phone: (+34) 91 372 13 77 • Fax: (+34) 91 372 03 91 • Mail: Ripano S.A. Ronda del Caballero de la Mancha, 135 - 28034 Madrid (Spain) • On-line: www.ripano.eu *Offer is valid while supplies last.

CONTENTS 1. Pascal Baron, Cristophe Gualano. Anchorage control performed with mini-screws and the LingualjetTM appliance 2. Regina Bass. Anchorage in lingual orthodontics 3. Germain Becker. Clinical pathways in lingual orthodontics 4. Tamar Brosh y col. Theoretical analysis of maxillary incisors movement due to antero-posterior force: labial vs. lingual orthodontics 5. Julio Cal-Neto. Advantages of the straight wire technique in lingual orthodontics 6. Asif Chatoo. Interdisciplinary management of adult patients with lingual braces 7. Claudia Correga Andreica y Dario Bertossi. Tissue reaction to light orthodontic forces – a comparison of STb versus Damon appliance 8. Juan Carlos Crespi y Marcos López Rubio. Study group of lingual orthodontics (SGLO). Starting the way 9. Antonio D’Alessandro y Livia Nastri. Advanced active retainer: fixed lingual orthodontics with no brackets 10. Rubens Demicheri. Leveling and systemized treatment mechanics with the Magic® Lingual system 11. Pablo Echarri. Skeletal anchorage in lingual orthodontics 12. Mª Fernanda Elgoyhen y José Carlos Elgoyhen. Therapeutic alternatives with lingual orthodontics 13. Ryuzo Fukawa. Lingual orthodontics in the new era: Treatment according to criteria for occlusion and aesthetics 14. Ricardo Gallardo. Retraction of lower anterior teeth with reduced anchorage loss without using miniscrews 15. José Gaspar y Vivian K. Granadino Gaspar. 20 years of lingual orthodontics in Brazil 16. Silvia Geron. Management of the vertical dimension in severe anterior open bite (AOB) 17. Alfredo Gilbert Reisman. A new in-house lingual bracket transfer system 18. Ana González Blanco. Clinical management of the lingual orthodontic appliance 19. Diana Grandi. Lingual orthodontics and speech – language therapy: the benefits of interdisciplinary team work 20. Julia Harfin. Paradigms in lingual orthodontics 21. Chiori Hashiba. Incisal embrasure and incisal edge: their efficacy of the aesthetic appearance of maxillary anterior teeth 22. Mª Esther Hidalgo. Clinical and laboratory evolution in lingual technique 23. Toru Inami. Clinical standards of the establishment for facial balance and harmony in lingual bracket orthodontic technique 24. Aurelio Jano Takane. Goodbye mushroom 25. Hee-Moon Kyung. Lingual plain wire appliance and microimplant anchorage 26. Hee-Moon Kyung. Microimplants as anchorage in orthodontics 27. Roberto Lapenta. How to obtain success with lingual orthodontics? 28. Jean François Leclerc y col. Partial case report: how to manage lingual treatment with an edentulous anterior teeth patient? 29. Christophe Lesage. Mini screws in orthodontics: contribution of the 3D cone beam in surgical technique 30. Hatto Loidl. Selfligation in lingual technique 31. Marcos López Rubio. From simple to complex 32. Marcelo Marigo y Valter Arima. A new concept for lingual bracket – a point of view 33. Francisco Martino. Lingual orthodontics FAQ 34. Isao Matsuno. Surgical orthodontic treatment in lingual orthodontics 35. Carla Melleiro y col. Evaluation of cephalometric alterations noted during the lingual orthodontic treatment 36. Eliakim Mizrahi. Miniscrews, auxiliaries and lingual orthodontics 37. Nayre Mondino. Class II. Treatment – lingual orthodontics 38. Ramiro Moreno. Small movements and laboratory procedures 39. Magali Mujagic. Lingual orthodontics for each patient: a reality in a daily practice 40. Christine Muller. Contribution of micro-screws to Class II treatment 41. Marino Musilli. The interdisciplinary approach with the bracketless fixed orthodontics 42. Manabu Nakagawa. Bracket “Evolution”: characteristics and case reports 43. Carlos Navarro y col. Development of the “In-Ovation-L” bracket from GAC 44. Thomas Örtendahl. Clinical experience of selfligated aesthetic directbond lingual bracket 45. Mª Giacinta Paolone y col. Lingual orthodontics: a means for osseous and tissue regeneration, conventional treatment and forced eruption 46. Mª Elsa Pavic. Vertical management in lingual technique: advantages and disadvantages 47. Mario Paz. Lingual and other accessory aesthetic techniques 48. Lucas Prieto. Prieto’s hygiene-friendly pendulum 49. Marcos Prieto. Prieto Lingual Straight-Wire Bracket (PSWb) 50. Caterina Pruzzo. Progress in lingual orthodontics, 8 years of clinical experience 51. Ronald Roncone. Lingual you will love 52. Florence Roussarie. Microscrews and the lingual system: an efficient working combination for the patient 53. Toru Shigeeda. Where is the best placement of micro implants, mid-palatal or alveolar bone or both? 54. Kyoto Takemoto y Giuseppe Scuzzo. New STb lingual straight wire method 55. Rita Thurler y col. Aluminum oxide – to use or not to use? 56. Henrique Valdetaro. Lingual orthodontics: problems and solutions 57. Emma Vila Manchó. Lingual orthodontics lesions vs. labial orthodontics lesions 58. Milena Zulic. Miniimplants as biomechanical auxiliaries in lingual orthodontics

Handbook for modern functional treatment approaches and techniques Authors: Michael Gorbonos, Toshio Kubodera, Bakr Rabie, Brian Preston

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