TRIBUNA BOOKS RIPANO
Nº 2 - 2014
Lingual Orthodontic Journal
Contents •
The Biomechanics of Lingual Orthodontics for Producing the Inner Beauty of Patients: The Effectiveness of a Treatment Method Combined with a New Type of Multifunctional Alloys and Self-ligating System. Hitoshi Koyata
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Laboratory protocol for lingual brackets positioning without set-up models. Accuracy Bracket Positioner (ABP). Pablo Echarri, Martín Pedernera, Miguel Ángel Pérez-Campoy
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Lingual orthodontics and its links to dental medicine. Hatto Loidl
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I ntercanine Distance Evaluation by CAD/CAM technology. Gimenez, C.M.M., Fillion, D., Porto, C.
Editor in Chief
Pablo Echarri, DDS
Editorial Committee
Silvia Geron Ryoon-Ki Hong Hee-Moon Kyung Jean-François Leclerc Marcelo Marigó Martín Pedernera Miguel A. Pérez-Campoy 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 2 - 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 LAB
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Editorial Dear colleagues, Again, I am here to deliver you another issue of Tribuna Books Ripano – Lingual Orthodontic Journal, in which we have published four articles which will be surely very interesting to you. Also, I would like to invite you again to submit the articles, because it is the way to stay in touch professionally during the periods between two national and/or international meetings. In the page 42, you’ll find a summary of a 11th ESLO Congress scientific program, which is going to be held in Como Lake (Italy) in June this year. Don’t miss a chance to hear many of the most important lecturers of our specialty, and to get in touch with your colleagues and friends. New achievements in lingual orthodontic industry will also be presented, so this is also a great opportunity to see the latest scientific and technological novelties. Also, I would like to thank again to all the e-mails supporting this journal, and a great number of its downloads, which confirms the fact that we are now fulfilling a space that was once empty but necessary for spreading the knowledge in lingual orthodontics field. Warm regards, and see you at Lake Como!
Pablo Echarri
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The Biomechanics of Lingual Orthodontics for Producing the Inner Beauty of Patients: The Effectiveness of a Treatment Method Combined with a New Type of Multifunctional Alloys and Selfligating System Author: Hitoshi Koyata
Abstract Aim: The aim of this article is to present practical research into the effectiveness of the combination of treatment method with new type of multifunctional alloys (GUMMMETAL) and self-ligating system (INNOVATION, CLIPPY-L). Methods: This presentation is based on 50 clinical cases treated with the new type of self-ligation system with multifunctional alloys. Results: Through the observation of treated cases, the merits of this treatment system which combines new type of self-ligating system and multifunctional alloy is proven. It can apply ideal optimum orthodontic force in the passive, the interactive and active stage. Especially, smooth sliding of the wire is possible in the interactive stage. Discussion: The responsibility of orthodontists is producing outer beauty and inner beauty of the patients. Since nowadays we can have more precise image of bone and teeth thanks to the development of 3D-CT system, orthodontists should pay more attention to inner beauty of the patients. The inner beauty of patients can be achieved because of the ideal biological orthodontic movement through the use of this treatment system which combines a new type of multifunctional alloys (GUMMETAL) and selfligating system (INNOVATION, CLIPPY-L). Key words: Gummetal, new type of multifunctional alloys, ideal optimum orthodontic force, treatment method, outer beauty, inner beauty, 3D-CT system, the interactive stage, biomechanics in lingual orthodontics.
Introduction I have been practicing lingual orthodontics for over 30 years. I presented the lingual case which was treated with core system in 1984 at the convention of Japan Association of Orthodontics. The objectives of this article will be to show you the new type of the combination treatment methods with lingual orthodontics in adult patients. Modern day orthodontists should strive to help patients to improve not only outer (superficial) beauty but also inner (functional) beauty. A 3D-CT scanning and other recent technological innovations in dentistry made it easier for patients to visualize their own inner (functional) beauty through the images of their bones and teeth. The treatment system combining a new type of multifunctional alloys (GUMMETAL) and self-ligating sys-
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tem (CLIPPY-L) can help patients achieve their inner beauty or the ideal biological orthodontic movement. Observations of the patients proved the effectiveness of the treatment system combining a new type of self-ligation system and multifunctional alloys. The treatment applies ideal optimum orthodontic force in a passive, interactive and active stage. Also, smooth sliding of the wire is possible in the interactive stage.
Self-ligating bracket A self-ligating bracket is defined as a bracket which uses a permanently installed, moveable component to fasten the arch wire. Self-ligating brackets may be classified into three categories: passive, active and interactive. CLIPPY-L has
Lingual Orthodontic Journal a low profile and special clip system which is easy to open and close, and it has a a special bonding base which fits to the lingual surface of the teeth (Fig.1). Three different types of self-ligating systems are compared. The passive type of bracket cannot apply enough torque to the teeth at the active stage. With the active type of bracket, special types of arch wire must be used, so the active capability precisely corresponds to the needs of every treatment stage. With the interactive type of bracket it is possible to apply automatically the passive, interactive and active forces depending on the size of the regular type of wires. Then I reached the following conclusions:
1. Shorter treatment time and less pain can be achieved because of ideal biological orthodontic tooth movement through the use of friction free system, especially at the passive stage. 2. Effective and smooth sliding wire movement is possible at the interactive stage. 3. Proper anterior torque control can be applied at the active stage. 4. Patient comfort is increased and there are less speech problems because of the small size of the bracket. CLIPPY-L bracket offers ideal low force in the passive stage, ideal moderate control in the interactive stage, and ideal full control in the active stage with the stoplock system (Fig. 2).
Gummetal GUMMETAL is a new titanium alloy developed by Toyota Central R&D Labs, a Toyota think tank, which displays the properties of rubber (Fig. 3). Whatever pressure is applied, GUMMETAL does not become hard, and possesses unlimited press ability because of combining pliability and flexibility with high strength robustness. Fig. 1. Clippy L Bracket. With the interactive type of bracket it is possible to automatically apply the passive, interactive and active forces depending on the size of the regular type of wires.
GUMMETAL is far less prone to rust than conventional titanium alloys, lighter and infinitely more people and environment friendly. It has a limitless number
Fig. 2. It can apply ideal low force in the passive stage, ideal moderate control in the interactive stage, and ideal full control in the active stage with the stop-lock system. Especially, smooth sliding of the wire is possible in the interactive stage.
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Fig. 3. According to the metallographic investigation, Gum metal has a very unique marble-like appearance.
Fig. 4. Arch wires made of Gum metal, developed by Dr. Hasegawa.
of possible applications, such as automotive springs, sports gear (golf clubs etc.), medical devices (such as artificial bones), watch cases etc. (Fig. 4).
2. Ideal orthodontic force can be generated because of high spring back characteristic features.
The main features of GUMMETAL are:
3. No risk to health because it contains no heavy metal (Ti, Nb, Ta and Zr).
1. It can be bent easily even though it is super elastic wire.
4. It rarely breaks because it causes no work hardening.
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Lingual Orthodontic Journal 5. Ideal sliding mechanics because of minimum friction. 6. These main features are suitable for lingual orthodontics.
• Anterior crowding • Extraction of upper 1st bicuspids and lower left 2nd bicuspid • Active Treatment Time: 21 months
Case report • A 20-year old female patient
The archwire sequence is explained in the text of the pictures.
Figs. 5 - 8. Initial facial photographs.
Figs. 9 - 14. Initial intraoral photographs.
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Figs. 15 - 18. Initial cephalometric tracing, cephalometric values, and profile and panoramic X-rays.
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Figs. 19 - 22. Axis-Path Recorder (Panadent System).
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Figs. 23 - 25. Indirect bonding system – Ideal arch wire form.
Figs. 26 - 31. Alignment. Passive stage. A .014” and .016” NiTi arch wires are used.
Figs. 32 - 37. Alignment, leveling. Passive stage. A .014” nad .016” NiTi and .016” x .016” Gummetal arch wires are used.
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Figs. 38 - 43. Sliding mechanics. Interactive stage. A .016” x .022” Gummetal arch wire is used.
Figs. 44 - 49. Loops mechanics. Interactive stage. A .017” x .025” Gumetal arch wire is used.
Figs. 50 - 55. Finishing and detailing. Active stage (full control). A .017” x .025” Gummetal arch wire is used.
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Figs. 56 - 61. Final photographs, after debonding of the brackets.
Figs. 62 - 64. Final facial photographs.
Figs. 65 - 70. Final intraoral photographs.
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Fig. 71. Comparison: before and after the treatment. Active treatment time: 21 months.
Fig. 72. Treatment process. Summary.
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Figs. 73 - 76. Final tracing, cephalometric values, and profile and panoramic X rays.
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Fig. 77. Comparison of cephalometric tracings before and after the treatment.
Fig. 78. Superimposition of initial and final cephalometric tracings.
Conclusions
References
Research indicates that optimum orthodontic forces should be just high enough to stimulate tooth movement without cutting off the vascular supply to the periodontal ligament. CLIPPY-L brackets are designed to allow the clinician to use these optimum low forces throughout all phases of treatment.
1. Hasegawa S. A new super elasto-plastic titanium alloy simplify Orthodontic procedure. J of Japan Association of Orthodontists 2006;375. 2. Nishino K. Super Multifunctional Alloy “GUMMETAL�. R & D Review of Toyota CRDL. 2003;38(3): 50. 3. Kojima Y, Fukui H. Numetric simulations of en-mass space closure with sliding mechanics. Am J Orthod Dentofacial Orthop 2010;138(6):702-4. 4. Rinchuse DJ, Miles PG. Self-ligating brackets: Present and future. Am J Orthod Dentofacial Orthop 2007;132:216-222.
The treatment system combining a new type of multifunctional alloys (GUMMETAL) and self-ligation system (CLIPPY-L) facilitates healthy tooth movement with complete control.
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Laboratory protocol for lingual brackets positioning without set-up models. Accuracy Bracket Positioner (ABP) Authors: Pablo Echarri Martín Pedernera Miguel A. Pérez-Campoy Keywords: Indirect bonding, brackets positioning without set-up model, Accuracy Bracket Positioner.
Abstract Indirect bonding technique with set-up models is very precise, but it requires very long laboratory procedure. The Accuracy Bracket Positioner (ABP) allows the positioning of lingual and labial brackets on the model without carrying out the set-up models, and with the possibility to customize any of the bracket parameters independently.
Introduction The importance of lingual brackets positioning has been demonstrated by many authors through in many publications. As a matter of fact, the case finishing is in direct relationship with brackets prescription which, in lingual orthodontics, doesn’t depend much on bracket fabrication but on brackets positioning on the lingual surface of the tooth. A certain number of authors use direct bonding of lingual brackets in simple cases treatment, cases which do not require torque control, but it has the following drawbacks: 1. Direct vision working. 2. Irregular anatomy of lingual tooth surface can significantly modify the rotation and torque prescription of the brackets. 3. Difficult access. 4. Less inter-bracket space to carry out compensation bends in arch wires. 5. Less inter-bracket distance of the arch wire in anterior teeth considerably increases the pressure of the arch wire over the teeth, which also makes difficult to carry out the compensations in arch wires. 6. The arch wires are affected by the progressive minimization of the force, which means that the arch wires, as they recover their shape, they
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exert less pressure and they are not as effective as to be able to finish the teeth positioning. This, combined with the arch wire “play” inside the brackets slots, makes the overcorrection of some parameters necessary. This is why the exact positioning of the brackets facilitates the technique, and it achieves more predictable results which do not depend on the skillfulness of the clinician to carry out compensation bends in the arch wire. Many authors have used CLASS method (Custom Lingual/Labial Appliances Set-up Service)1,2,3 for lingual or labial brackets positioning. It consists of set-up models fabrication and correction according to the treatment plan, and positioning of the brackets ligated to the “full Size” ideal arch wire. This procedure is very precise, but its setback is that it needs a very long working time. As a matter of fact, the authors of this article use this system with precise appliances such as Set-Up Model Maker (SUM), and Occlusal Plane Reference (OPR), designed by Dr. Pablo Echarri and eng. Claus Schendell4,5. Other authors have approached this problem by mounting the brackets without set-up models. Creekmore6 designed the Slot Machine for labial brackets and vertical slot lingual brackets, and Echarri3,7,8,9 introduced modifications to adapt it to all bracket types and for better customization of prescription.
Dental Tribuna Books Recently, Echarri and Schendell have developed the Accuracy Bracket Positioner (ABP) to achieve precise labial and lingual brackets positioning in approximately 30 minutes per jaw for labial brackets, and 45 minutes for lingual brackets10,11.
Accuracy Bracket Positioner – ABP The ABP allows the precise and reproducible positioning of any type of bracket, labial or lingual, according to the indicated prescription. The ABP (Fig. 1) consists of a rotating base, which allows easy manipulation and visualization of the bracket positioning from any angle, and three towers: anterior tower, model tower and posterior tower. The model tower is situated in the middle of the ABP, and it is used for model positioning. It allows the following movements: • Sagittal or antero-posterior movement. • Vertical movement. • Rotation. • Labio-lingual inclination.
• Mesio-distal inclination. Anterior tower holds a torque and inclination indicator and height styluses, as well as the torque measuring scale. Height styluses allow the tooth positioning in height, in-out, and rotation (1st order), and the indicator allows the tooth positioning in mesio-distal inclination (2nd order) and torque (3rd order). Posterior tower holds the bracket holder and allows the bracket movements like in-out, height and rotation. The bracket holder has two positions – for labial and lingual bracket positioning. The bracket holder holds the bracket slot holder which holds the bracket to its slot. This accessory has three parts which can be adjusted to occupy the slot completely so it can always act as a “full size” arch wire.
Labial brackets positioning procedure Draw the longitudinal axes in the model crowns, a horizontal line passing through the LA point (the most prominent point of the crown) (Fig. 2) and rotation axes (incisal edges of anterior teeth and labial cusps of posterior teeth) (Fig. 3). Paint the model with the plaster separator.
Fig. 2. Draw lognitudinal axes and LA points on the model.
Fig. 1. Accuracy Bracket Positioner – ABP.
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Fig. 3. Draw rotational axes.
Lingual Orthodontic Journal The process depends on the selected arch wire form, which can be Mushroom12, Christmas12, Customizer Archwire13, or Lingual Straight Wire14. The following example follows the brackets positioning for the treatment with Mushroom arch wire and with Evolution SLT brackets. In canine-to-canine zone the arch wire is curved and in-out of all brackets is determined by the tooth with the largest labio-lingual width, which is a canine. This is why the bracket positioning is started from this tooth.
The model is fixed to the swivel model platform with some silicone (Fig. 4), and the canine is positioned with indicated prescription. In this case, it is Roth prescription with -2º torque and 9º tip. The model is placed so that the upper pin of the torque and inclination positioner matches with the LA point, and the lower pin matches with the longitudinal axis (Fig. 5). In this position, the torque reading should be -2º and the tip reading should be 9º (Fig. 6). To fix the height, level the canine cusp using stylus (Fig. 7), and to fix rotation, make two ends of stylus match with the rotation axis (Fig. 8). The Evolution SLT brackets of anterior teeth are available with two inclinations in the base – 40º and 60º - and you should use the one which adapts better to the anatomy of the lingual surface of the teeth. The ABP positions the brackets from the slot, to make sure the prescription used to position the bracket. With the Bracket Slot Holder, and adjusting the micrometric screws of the posterior tower, the bracket is centered in the lingual surface of the tooth (Fig. 9).
Fig. 4. Model fixed to the swivel model platform with silicone.
Fig. 5. Torque and inclination positioner on the canine, matching the upper pin with the LA point, and lower pin with longitudinal axis.
Fig. 6. Canine torque measurement at -2º, and tip at 9º.
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Fig. 7. Canine cusp leveling with the stylus to determine the height.
Fig. 8. Positioning of the stylus with the canine rotational axis to determine the rotation.
Fig. 9. Canine bracket positioning.
Fig. 10. Bracket in-out measurement.
Fig. 11. Bracket height measurement.
Fig. 12. Canine bracket, bonded on the model.
In-out (Fig. 10) and height (Fig. 11) position used to position the bracket are put on record, and the bracket is bonded to the model with light-curing composite (Fig. 12).
and the figures 15 and 16 show the lateral incisor positioning. When all canine-to-canine brackets are bonded (Fig. 17), bicuspid brackets are positioned. The bicuspids are positioned with a -7ยบ torque and a 0ยบ inclination, and the brackets are positioned at the same height, but with different in-out to compensate the difference in canine and bicuspid width (Figs. 18 and 19). The in-out difference used for bracket positioning is put on record, because it is also a measure for disto-canine in-set of Mushroom arch wire.
When positioning anterior teeth, each tooth is positioned according to its own torque and inclination, height and rotation prescription, and the bracket with the same in-out and height of the canine. The figures 13 and 14 show the central incisor positioning,
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Fig. 13. Positioning of central incisor with 12ยบ of torque and 5ยบ of tip.
Fig. 14. Positioning of the central incisor bracket.
Fig. 15. Positioning of lateral incisor with 8ยบ of torque and 9ยบ of tip.
Fig. 16. Positioning of the lateral incisor bracket.
Fig. 17. Canine-to-canine brackets positioning.
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Fig. 18. Bicuspid positioning with -7º torque and 0º tip.
Fig. 19. Bicuspid bracket positioning.
Fig. 20. Bonding of upper brackets.
Fig. 21. Smart System single-tooth transfer trays.
The figure 20 shows bonded upper brackets, and the figure 21 shows Smart System single-tooth transfer trays15.
References 1. Scholz RP, Swartz ML. Lingual orthodontics: A status report: Part 3. Indirect bonding – laboratory and clinical procedures. J Clin Orthod 1982;16:812-20 2. Echarri P. Técnica de posicionamiento de brackets linguales CLASS System. Rev. Iberoamericana de Ortodoncia 1997;16:1-17
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3. Echarri P. Ortodoncia Lingual. Técnica completa paso a paso. Barcelona (España): Nexus Ediciones S. L.; 2003. 4. Echarri P, Schendell C. Kein Schleifen und Trimmen mehr. Kieferorthop Nachrichten 2013;5;13-5. 5. Echarri P, Schendel C. Einfach und präzise. Kieferorthop Nachrichten 2013;6;14-16. 6. Creekmore T. Lingual orthodontics, Its renaisence. AmJ Ortod Dentofac Ortop 1989;96(2):120-37. 7. Echarri P. Procedimiento para el posicionamiento de brackets en ortodoncia lingual II. Ortod Ling 1998;1(3):107-17.
Dental Tribuna Books 8. Echarri P. Lingual Orthodontics: An up-date of the bracket positioning and bonding procedures. J Orthod Society and Research of Thailand 2003;3:1-14. 9. Echarri P. Lingual Orthodontics. Bracket set-up using Model Checker, Slot Machine, and CRC Ready Made Core Trays. Korean J Lingual Orthod 2003; 2: 58-71. 10. Echarri P, Pedernera M. Ortodoncia lingual simplificada. Técnica CLO3. Tribuna Books Ripano Lingual Orthod J 2014;(1):17-21. 11. Echarri P, Pedernera M, Campoy MA. Técnica CLO3: Una solución ortodóncica estética para las malposiciones de los dientes anteriores. Dental Tribune Spain 2014;9(2):6-9.
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12. Fujita K. New orthodontic treatment with lingual bracket mushroom arch wire appliance. Am J Orthod. 1979;76(6):657-75. 13. Wiechmann D, Rummel V, Thalheim A, Simon JS, Wiechmann L. Customized brackets and archwires for lingual orthodontic treatment. AJO-DO 2003; 124(5); 593-9. 14. Scuzzo G, Takemoto K, Takemoto Y, Takemoto A, Lombardo L. A New Lingual Straight-Wire Technique. JCO 2010; 44(2); 114-23. 15. Echarri P, Pedernera M, Schendell C. Avances en la técnica de cementado indirecto. Tribuna Books Ripano Lingual Orthod J 2013;(0):4-8.
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Lingual orthodontics and its links to dental medicine Author: Hatto Loidl
Abstract An increasing number of adult and older patients is a phenomenon in our orthodontic surgeries and the possibility to treat not only children and adolescents has become better known all over the world. Generally, adults have not only orthodontic problems but also other dental diseases that have to be dealt with. As a consequence it is very important to have a standardized interdisciplinary concept to ensure an organized course throughout the treatment. Keywords: Treatment concept, interdisciplinary approach, adult patients.
Introduction
• Surgery part 1.
Different disciplines in dental medicine have extensively developed within the last few decades. A vast number of scientific studies on clinical aspects and the development of new materials and techniques, such as invisible lingual treatments, have massively increased our possibilities in dental treatment, and especially in dental treatment of adults.
• Orthodontic treatment.
As the therapies become more and more complex, a controlled, standardized procedure is useful to be applied to the single disciplines as well as to the communication and procedures among the different disciplines.
Treatment concept Before starting a dental therapy which involves various disciplines, a basic workflow should be set up. This makes it easier to keep the overview especially in complex, time consuming treatments.
• Surgery part 2. • Orthodontic fine tuning. • Provisional Retention. • Definite restorative treatment. • Tissue surgery. • Prosthodontic treatment and Implants. • Retention.
Before the orthodontic treatment Consultation
• Multidisciplinary consultation.
Multidisciplinary treatments require consultations performed by the single disciplines as our patients need to be adequately informed about the different consecutive steps of the following treatment. On the other hand there has to be communication between the involved doctors to make sure that the upcoming workflow is well coordinated (Fig. 1).
• Dental hygiene plan.
Dental hygiene
• Restorative pretreatment.
As dental hygiene is the basic issue not only during every treatment but also in the whole dental life of our patients, it has to be set up properly.
The following table is ment to be a possible guideline and it specifies consecutive steps within multidisciplinary treatments.
• Periodontal pretreatment.
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Lingual Orthodontic Journal orthodontics, when all teeth are in their place (Fig. 3). Lingual orthodontic treatment The following case shows an example for a multidisciplinary treatment: A 33-old male patient was referred to our surgery. He showed an extremely abraded dentition in both jaws. The palatal surfaces of the upper incisors and canines had nearly no enamel left, the lower incisors were reduced by nearly one third of the original length. Also the bicuspids and molars showed extensive abrasions. Consequently there was a deep bite and the facial height was reduced. The occlusion showed a Class I and the dental hygiene performed by the patient could be called rather poor (Fig. 4 a-e). The following interdisciplinary approach was chosen (Figs. 5 - 8): Fig. 1. Consultation room in our surgery.
• Improving the dental hygiene, treating gingival inflammations and setting up a hygiene plan. • Treating cavities with provisional restorations.
Normally, the general practices organize the routine hygienic care for their patients. During orthodontic treatments the need for dental hygiene increases so the orthodontists are in charge to perform the specific orthodontic dental care within the routine checkups. Professional tooth cleaning, especially in sensitive areas like crowding points, interproximal areas, or apical spaces of lingual appliances, can be very useful in wire changes appointments (Fig. 2). Restorative and periodontal pretreatment Prior to orthodontic treatments caries lesions need to be treated. In some cases definite fillings can be placed but if the lesions are extensive, provisional fillings can work better during orthodontic treatments and the definite occlusal anatomy can be restored at the end of the entire treatment. Concerning periodontal pretreatment, there is an “all or none” rule. Orthodontic tooth movement in dentitions with periodontal disease means to risk even more bone loss. As a consequence, periodontal treatment, such as pocket cleaning and gingival inflammations treatment, is compulsory. When orthodontics starts, our patients should show a non-inflamed healthy gingiva, no pocket bleeding and generally a stable and reliable oral hygiene. On the other hand, periodontal surgery and bone grafts should be performed after
Fig. 2. Instructing the patients in oral hygiene.
Fig. 3. Periodontal pretreatment.
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Fig. 4 a-e. Initial photographs of the patient.
• Creating an ideal set-up and defining the target amount of bite opening.
• Retention.
• Manufacturing palatal provisional veneers that can serve as customized bases for the adaptation of lingual appliance.
After the orthodontic treatment
• Bonding the brackets to the patient’s dentition. • Orthodontic lingual treatment. • Debonding. • Prosthodontic treatment.
Fig. 5a. Ideal set-up with lingual brackets and ideal archwire in place.
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Periodontal treatment Bone and tissue grafts, tissue remodeling and periodontal surgery can be carried out at this stage to consolidate the oral health and to provide an individual optimized long term prognosis. Also implants can be put in place now in order to prepare the prosthodontic treatment.
Fig. 5b. Customized veneers with embedded brackets.
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Fig. 5c. Veneers and brackets on the ideal set-up.
Fig. 6 a-e. Start of the treatment with veneers, brackets and initial archwires in place.
Fig. 7 a-b. After 6 months of treatment.
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Fig. 8 a-e. Final result.
Definite restorative and prosthodontic treatments Close to the end of a multidisciplinary treatment all the restorative and prosthodontic measures can be taken. Inlays, crowns, prosthodontic bridgeworks, supraconstructions on dental implants, cosmetic improvements such as veneers or bleaching can be carried out at this point. The last step would be to coordinate the retention and to choose if bonded retainers, splints or Hawley retainers are adequate for the individual needs of our patient. A long term hygiene plan has to be set up and recall intervals should be set.
Conclusion Taking into account that nowadays the number of adult patients is rapidly increasing, our surgeries should be properly prepared to match the variety of different oral diseases and the demands in terms of esthetics and comfort in daily life. In many cases single-handed orthodontic approaches are simply sometimes insufficient to achieve satisfying results.
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Interdisciplinary treatments open many doors to a variety of treatment possibilities and help us to help our patients.
References 1. Echarri, P.: Comparacion de los tratamientos ortodoncico realizados con ortodoncia vestibular y con ortodoncia lingual. Revista Espaniola de Ortodoncia 2002;32:207-232. 2. Fujita, K.: New orthodontic treatment with lingual bracket and mushroom arch wire appliance. Am J Orthod 1979;76:657-675. 3. Loidl, H.: Evolution LT-ein neues linguales Bracketsystem. Deutscher Zahn채rztekalender 2003. 4. Loidl, H.: Evolution LT. El sistema de autoligado en ortodoncia lingual. Revista Espaniola de Ortodoncia 2005;8: 102-110. 5. Redaelli, O, Loidl, H.: Zahnerhalt bei fortgeschrittener Parodontitis. Parodontologie 2003;14/1: 55-65. 6. Redaelli, O, Stiller, M, Loidl, H.: Weichgewebsvermehrung durch kieferorthop채dische Zahnbewegung. Parodontologie 2003;14/2: 177-186. 7. Smith, JR, Gorman JC, Kurz, C et al.: Keys to success in lingual therapy. Part 1. J Clin Orthod 1986;89: 252-261. 8. Smith, JR, Gorman JC, Kurz, C et al.: Keys to success in lingual therapy. Part 2. J Clin Orthod 1986;89: 330340.
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Intercanine Distance Evaluation by CAD/CAM technology Authors: Gimenez, C. M. M. Fillion, D. Porto, C.
Summary Aim: To evaluate the intercanine distance maintanance, comparing the initial value from the initial malocclusion models with the final results prevision presented by the 3D virtual set up. Method: Was selected the initial malocclusion models of 25 adult patients submited to lingual orthodontic treatment; which were scanned by CAD/CAM technology. Were built virtual set ups by software 3Txer 2.1.1, considering that final result will be similar with the set up. The measurements were made by one unique examinator, clicking on the canines’ tip edge for left and right sides of the dental archs. The datas were submited to Student Text T, with significance level 5%. Results: There were no statystically significant difference between the initial and final intercanine distance for upper (average: 33,39mm and 34,60mm) and lower (average: 26,09mm and 26,63mm) dental archs. Conclusion: There was no difference in the comparison of the original intercanine distance and the set up, what is important to provide stability respecting the biological limits. Key words: lingual orthodontics, intercanine distance, stability, previsibility.
Introduction Treatment stability is one of the most important aims in orthodontics, but despite decades of research, it is still agreed that is variable and largely unpredictable (Freitas et al., 2004). Maintaining the results is one of the most difficult aspects of the entire orthodontic treatment process. Normal maturational changes, together with post-treatment tooth alterations, conspire against long-term stability despite to the treatment modalities and discuss the need for retention’s protocols (Blake M, Garvey MT, 1998; Blake and Bibby, 1998). Retention in adults should include maintenance of tooth position, overall dental health, and a periodontal status. However, there is no guarantee for longlife stability after orthodontic tooth movements in adults without an anomaly- and treatment--specific retention phase (Kahl-Nieke, 1996). This theme is one of the challenges facing orthodontists today. Relapse of the anterior segment during the post retention period is perhaps the most predictable and frustrating of all orthodontic relapses. It is sometimes erroneously construed as a sign of inappropriate treatment or evidence of misdiagnosis or incorrect mechanics; although
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almost inevitable regardless of orthodontic techniques and timing of orthodontic treatment (Shah, 2003). Analyzing post-retention changes and revealing factors which may play a role as predictors for longterm prognosis, measures like intercanine distance, arch length, sum of the incisors mesio-distal dimension, Irregularity Index, crowding are considered in order to assess influences. Several findings indicated that post-retention crowding and incisor irregularity increased more frequently in the mandible; pretreatment variables such as increased mesio-distal incisor dimension, severe crowding, incisor irregularity, arch constriction, arch expansion, increased arch length, were found to be associated factors in the process of post-retention increase of crowding and incisor irregularity. Moreover, ‘overexpansion’ was found to be an important factor in mandibular incisor relapse (Kahl-Nieke, Fischiback, Schwarze, 1995). The effect of the bracket systems (conventional and self-ligating) on arch width or lower incisor inclination looks like do not interfere greatly in the results’ quality and stability. An alignment-induced increase the lower incisors proclination, it was observed for both systems as well an increase in intercanine and
Dental Tribuna Books intermolar widths; although the self-ligating group showed a higher intermolar width increase (Pandis et al. 2010). Significant relapse predictors like narrow pretreatment intercanine width and high pretreatment incisor irregularity demonstrated an increase of incisor irregularity and a reduction of intercanine width and arch length post-retention. Treatment increase of intercanine width and post-retention decrease of intercanine width and arch length were associated with relapse (Artun J, Garol JD, Little RM, 1996). The influence of the finished occlusion quality on post retention occlusal stability can be translated in the follow way: greater the quality of the orthodontic finished occlusion, greater the treatment changes and the amount of relapse and the better is the occlusal status at the post retention stage (Freitas et al. 2007). In other side, the mandibular-incisor-crown morphology is not correlated with the amount of mandibular-anterior-crowding relapse (Freitas et al. 2006). For lingual orthodontics, considering the indirect bracket bonding needs is essential to build a set up to the adequate bracket positioning (Kyung 1989; Hiro & Takemoto, 1998; Takemoto & Scuzzo 2003; 2010). In this way all characteristics for the ideal occlusion will be presented by the set up, contributing to improve the precision to bracket positioning, making possible a considerable individualization, easier finalization and providing results previsibility and excellence. It is also useful to avoid rebonding events and bends in the archwire, as well to the determination of torque, inclination, in/out; promoting praticity and decreasing adjustments (Pauls, 2010). Is important to evidenciated that in the set up step, if the biological limits are respected, will be noted more stability in the post treatment stage. Overall avoiding biological high costs with orthodontics the stability is increased (Birte Melsen, 2009).
locclusion models with the final results presented by the virtual set up, considering the importance of this characteristic for the post treatment stability.
Material and method Was selected the initial malocclusion models of 25 adult patients (both genders, Class I and II malocclusions) submitted to lingual orthodontic treatment; which were scanned by CAD/CAM technology (Fig. 1). The images were captured by software 3DXer (Fig. 2). Were built, by one unique examinator, the virtual set ups of all cases by software 3Txer 2.1.1 (Fig. 3a), considering that orthodontic treatment final result will be similar with the set up previsibility (Fig. 3b). In this way the references guides for set up building were based in the Andrews six keys for ideal occlusion: • Torque. • Angulation. • Rotation. • Alignement and leveling. • Arch form. • Overbite. • Overjet. • Contact points. • Class I relation. • Midline coincidence. With the set up finalization, the measurements were made by one unique examinator, clicking on the ca-
Nowadays is possible to work with digital set up, by the tridimensional CAD/CAM technology improving significantly the precision and previsibility; avoid laboratory errors, contributing to make easier biomechanical management, as well to the chair time reducing (Fillion, 2010). In this context our purpose is to provide previsibility and confiability to the orthodontic treatment, promoting characteristics to contribute for the stability improvement.
Aim To evaluate the intercanine distance maintanance, comparing the initial value showed in the initial ma-
38
Fig. 1. Orapix® scanner: CAD/CAM technology.
Lingual Orthodontic Journal
Fig. 3a. Set up built by software 3TXer 2.1.1.
Fig. 2. Initial malocclusion models images captured by software 3DXer.
nines tip edge for left and right sides of the dental archs. In this way the software provided automatically the values. This procedure was the same for the initial malocclusion models scanned (Fig. 4) and for the respective set ups (Fig. 5); and it was made twice to the error´s method evaluation. The data were submitted to Student Text T and Correlation, with significance level 5%.
Results There was no statystically significant difference between intercanine distance in the initial malocclusion model and set up prevision for upper (average: 33,39mm and 34,60mm) and lower (average: 26,09mm and 26,63mm) dental arches.
Fig. 4. Intercanine distance measurement in the scanned initial malocclusion model.
Fig. 3b. Final lingual orthodontic treatment result similar with the set up prevision.
The error’s method evaluation showed the method confiability, with great measurements similarity in the 2 repetitions.
Discussion Despite treatment type, with or without extraction, the investigation showed no statystically significant difference in the upper arch as well in the lower arch when was compared the initial malocclusion situa-
Fig. 5. Set up distance measurement.
39
Dental Tribuna Books tion and the previsibility provided by the 3D set up for the lingual orthodontic treatment. It is a favorable result, considering the fact that all the characteristics inserted in the set up will be reach in the end of the lingual orthodontic treatment. In this way the set up works like a previous view of the potenciality to provide improvements and changes in the initial malocclusion situation in accordance with Kyung 1989; Hiro & Takemoto, 1998; Takemoto & Scuzzo 2003; 2010 and also to do it in a easier way, with less technical efforts, practicity and reduced time, like diescribed by Pauls, 2010. The new CAD/CAM technology is able to improve more and more the precision, avoiding laboratorial errors, simplifying the biomechanical management, saving more clinical time, and promoting excellence for the finalization phase; described by Fillion, 2010. With this possibility to build the set up and to the bracket positioning the chance to get success is high and the security to work with previsibility and confidence is ideal and very well controlled.
The importance facing to the intercanine distance maintenance is related with the post treatment stability, respecting the biological limits (what is postulated by Melsen, 2009), and avoinding the risks for relapse, registered by Artun et al. 1996; Freitas et al., 2004; Shah, 2003. Significant relapse predictors are very well discussed in the specifical literature (Blake M, Garvey MT, 1998; Blake and Bibby, 1998; Artun J, Garol JD, Little RM, 1996, Freitas et al. 2006; 2007), and the intercanine distance maintenance is strongly considered (Pandis et al. 2010) independent of the technique and bracket system. Moreover, ‘overexpansion’ was found to be an important factor for mandibular incisor relapse (Kahl-Nieke, Fischiback, Schwarze, 1995), so looks like intelligent to keep and respect the intercanine dimensions. It is also important to record that the retention protocols are necessary, especially in adult patients. The maintenance of tooth position, overall dental health, and a periodontal status must be considered although these efforts do not guarantee the long-life
Table 1. Intercanine Distance Frequency, Average, Deviation Pattern in accordance with the original models and set up evaluation. Values to t0 and p (mm). Treatment
With and Without Extraction
Without Extraction
Condition
Freq.
Average
D. P.
Initial Upper
25
33,34
2,83
Set up Upper
25
34,50
2,35
Initial Lower
25
26,02
2,61
Set up Lower
25
26,53
2,52
Initial Upper
20
33,66
2,85
Set up Upper
20
34,71
1,88
Initial Lower
20
25,77
1,83
Set up Lower
20
26,27
1,85
Initial Upper
5
32,08
2,64
Set up Upper
5
33,66
3,93
Initial Lower
5
27,01
4,83
Set up Lower
5
27,61
4,49
t0
p<
-1,569 n
0,123
-0,716 n
0,478
-1,376 n
0,178
-0,856 n
0,397
-0,746 n
0,477
-0,205 n
0,843
With Extraction
n = no significant, at level of 0,05.
40
Lingual Orthodontic Journal stability after orthodontic tooth movements (KahlNieke, 1996). Permanent retention is being recommended as the only way to ensure long-term stability (Blake and Bibby, 1998). The greater the quality of the orthodontic finished occlusion, the greater the treatment changes and the amount of relapse are and the better the occlusal status at the post retention stage is (Freitas et al. 2007).
Conclusion There was no significant difference in comparing the original intercanine distance and the set up previsibility. Considering that the lingual treatment results should be similar with the set up characteristics, it is important to provide stability respecting the biological limits.
References 1. Andrews LF. The six keys to normal occlusion. Am J Orthod. 1972 Sep;62(3):296-309. 2. Artun J, Garol JD, Little RM. Long-term stability of mandibular incisors following successful treatment of Class II, Division 1, malocclusions. Angle Orthod. 1996;66(3):229-38. 3. Blake M, Bibby K. Retention and stability: a review of the literature. Am J Orthod Dentofacial Orthop. 1998 Sep;114(3):299-306. 4. Blake M, Garvey MT. Rationale for retention following orthodontic treatment. J Can Dent Assoc. 1998 Oct;64(9):640-3. 5. Cattaneo PM, Dalstra M, Melsen B. Strains in periodontal ligament and alveolar bone associated with orthodontic tooth movement analyzed by finite element. Orthod Craniofac Res. 2009 May;12(2):120-8. 6. de Freitas KM, Janson G, de Freitas MR, Pinzan A, Henriques JF, Pinzan-Vercelino CR. Influence of the quality of the finished occlusion on postretention occlusal relapse. Am J Orthod Dentofacial Orthop. 2007 Oct;132(4):428.e9-14.
7. Fillion D. Clinical advantages of the Orapix-straight wire lingual technique. Int Orthod. 2010 Jun;8(2):12551. 8. Freitas KM, de Freitas MR, Henriques JF, Pinzan A, Janson G. Postretention relapse of mandibular anterior crowding in patients treated without mandibular premolar extraction. Am J Orthod Dentofacial Orthop. 2004 Apr;125(4):480-7. 9. Freitas MR, Castro RC, Janson G, Freitas KM, Henriques JF. Correlation between mandibular incisor crown morphologic index and postretention stability.Am J Orthod Dentofacial Orthop. 2006 Apr;129(4):559-61. 10. Hiro T, Iglesia F, Andreu P. Indirect bonding technique in lingual orthodontics: the HIRO system. Prog Orthod. 2008;9(2):34-45. 11. Kahl-Nieke B, Fischbach H, Schwarze CW. Post-retention crowding and incisor irregularity: a long-term follow-up evaluation of stability and relapse. Br J Orthod. 1995 Aug;22(3):249-57. 12. Kahl-Nieke B. Retention and stability considerations for adult patients. Dent Clin North Am. 1996 Oct;40(4):961-94. 13. Kyung HM. Individual indirect bonding technique (IIBT) using set-up model. Taehan Chikkwa Uisa Hyophoe Chi. 1989 Jan;27(1):73-82. 14. Pandis N, Polychronopoulou A, Makou M, Eliades T. Mandibular dental arch changes associated with treatment of crowding using self-ligating and conventional brackets. Eur J Orthod. 2010 Jun;32(3):248-53. Epub 2009 Dec 3. 15. Pauls AH. Therapeutic accuracy of individualized brackets in lingual orthodontics. J Orofac Orthop. 2010 Sep;71(5):348-61. Epub 2010 Oct 21. 16. 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. 17. Shah AA. Postretention changes in mandibular crowding: a review of the literature. Am J Orthod Dentofacial Orthop. 2003 Sep;124(3):298-308. 18. Takemoto K, Scuzzo G.The straight-wire concept in lingual orthodontics.J Clin Orthod. 2001 Jan;35(1):4652.
41
11:30 – 12:15 O RAL COMMUNICATIONS: Fundamentals of Lingual Technique 12:15 – 13:15 A LAIN DECKER HONORARY LECTURE: The art of finishing. Didier Fillion, France 13:15 – 14:30 Lunch on the exhibition 14:30 – 14:50 K EYNOTE LECTURE: Aesthetic appliances for aesthetic smiles. Guillaume Lecocq, France 14:50 – 15:35 O RAL COMMUNICATIONS: Lingual mechanics with Microimplants: Bone anchorage Finishing 15:35 – 15:55 K EYNOTE LECTURE: A new typodont system for simulating tooth movement in lingual orthodontic treatment. Hee– Moon Kyung, South Korea 15:55 – 16:25 Coffee break on the exhibition 16:25 – 16:45 K EYNOTE LECTURE: Clinical lingual orthodontic treatment with consideration for the differences between labial treatment on biomechanics based on statistical evidence. Masatoshi SANA, Japan 16:45 – 17:30 O RAL COMMUNICATIONS: New technology: Digital approach 17:30 – 17:50 K EYNOTE LECTURE: Lingual orthodontics – solving problems, finding solutions. Asif Chatoo, United Kingdom 17:50 – 18:05 K EYNOTE LECTURE: Treatment Mechanics: present and future on clinic approach. Stefano Velo, Italy SATURDAY, JUNE 7 09:00 – 09:20 KEYNOTE LECTURE: Finishing in lingual orthodontics: re-bonding brackets or wire bending. Pablo Echarri, Spain 09:20 – 10:05 ORAL COMMUNICATIONS: Research 10:05 – 10:25 K EYNOTE LECTURE: Versatility of Common base for safe and sound lingual orthodontics. Akiko Komori, Japan 10:25 – 10:55 Coffee break on the exhibition 10:55 – 11:15 KEYNOTE LECTURE: Ligate or not ligate? Takis Kanarelis, Greece THURSDAY, JUNE 5
11:15 – 12:00 ORAL COMMUNICATIONS: Treatment Mechanics A
PRE-CONGRESS COURSE: INCOGNITOTM ADVANCED COURSE
12:00 – 12:20 K EYNOTE LECTURE: The art and passion of 2D lingual orthodontics. Vittorio Cacciafesta, Italy
SPEAKERS: Germain Becker (Luxemburg), Robbie Lawson (UK), Esfandiar Modjahedpour (Germany), Roberto Stradi (Italy)
12:20 – 14:00 Lunch on the exhibition 14:00 – 14:20 K EYNOTE LECTURE: Treatment mechanics using the new features for IncognitoTM. Benefi ts in your practice. Esfandiar Modjahedpour, Germany
•
Class I : Cases.
•
Class II cases: Herbst, ForsusTM, Elastics, surgical.
•
Managing extraction cases.
•
Impacted canines.
•
Open bites surgical cases.
15:05 – 15:25 K EYNOTE LECTURE: Optimization of surgical mandibular advancement through the use of mini screws and bite planes. Adrien Marinetti, France
•
IncognitoTM Lite cases (3–3, 4–4, 5–5).
15:25 – 15:55 Coffee break on the exhibition
•
Restorative cases.
•
Typical IncognitoTM Biomechanics: Space gaining, LocatelliTM spring.
15:55 – 16:15 K EYNOTE LECTURE (ESLO BEST SPEAKER AWARD 2012) : Mini– screw, my best choice. Guanying Wu, China
•
Updates on new Systems: Low Profi le Bracket, Clear Precision Tray, RelyTM X.
•
TransbondTM IDB.
•
IncognitoTM Digital world: intraoral Scanner.
14:20 – 15:05 ORAL COMMUNICATIONS: Treatment Mechanics B
16:15 – 17:00 ORAL COMMUNICATIONS: Treatment Mechanics C 17:00 – 17:20 K EYNOTE LECTURE: Treatment of class II malocclusions with the Incognito TM appliance system: biomechanical features and clinical cases. Roberto Stradi, Italy
ESLO candidates for Active and Titular Membership
17:20 – 17:40 K EYNOTE LECTURE (ESLO BEST SPEAKER AWARD 2012) Multi– slotted lingual brackets; Addiction to perfection. Jung Min Heo, Korea
FRIDAY, JUNE 6
SUNDAY, JUNE 8
09:00 – 09:15 OPENING CEREMONY
09:00 – 09:20 K EYNOTE LECTURE: Introduction of “Mienai Lingual Brackets”. Toshiaki Hiro, Japan
CASES EVALUATION SESSION
09:15 – 09:35 K EYNOTE LECTURE: 2D ideal lingual treatment: what were the limits, what are the limits, can we go beyond the limits? Fabio Giuntoli, Italy
09:20 – 09:40 K EYNOTE LECTURE: The benefits of combining mechanics in lingual orthodontics. Sylvia Geron, Israel
09:35 – 10:20 O RAL COMMUNICATIONS: 3D Orthodontic Diagnosis & Fundamentals of Lingual Technique
09:40 – 10:25 ORAL COMMUNICATIONS: Tips & Tricks
10:20 – 10:40 K EYNOTE LECTURE: Effective use of absolute anchorage in lingual treatment. Ruyzo Fukawa, Japan
10:55 – 11:15 K EYNOTE LECTURE: The era of digitization and 3D in orthodontic treatment for Class II. High-angle extraction cases. Toru Inami, Japan
10:40 – 11:10 Coffee break on the exhibition 11:10 – 11:30 K EYNOTE LECTURE: A new concept in maxillary expansion in lingual orthodontics. Gérard Altounian, Patrick Leyder, France
10:25 – 10:55 Coffee break on the exhibition
11:15 – 11:35 K EYNOTE LECTURE: My way for finishing, in line with lingual total treatment process. Germain Becker, Luxemburg 11:35 – 11:45 CLOSING CEREMONY
R E L
B
T S E
L E S
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
Tratamiento Ortodóncico con Extracciones Author: Pablo Echarri
More than 300 full color pages Size: 21x29,7 cm. Hard cover binding ISBN: 978-84-937238-3-5 More information: www.ripano.eu
Handbook for modern functional treatment approaches and techniques Authors: Michael Gorbonos, Toshio Kubodera, Bakr Rabie, Brian Preston
364 full color page Size: 21x29,7 cm. Hard cover binding ISBN: 978-84-940554-7-8 More information: www.ripano.eu
Ortodoncia y Microimplantes. Sardac Technique (2ª edición) Authors: Pablo Echarri and Lorenzo Favero
More than 450 full color pages Size: 22x31 cm. Hard cover binding ISBN: 978-84-940232-2-4 More information: www.ripano.eu
Ortodoncia y Ortopedia con Aparatos Funcionales. 2ª edición Author: Juan José Alió Sanz
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Desde el Arco Recto Convencional al Sistema Damon. Mis Caminos Diagnósticos y Mecánicos Author: Alfredo Nappa Aldabalde
More than 680 full color pages Size: 23x32 cm. Hard cover binding ISBN: 978-84-936756-2-2 More information: www.ripano.eu
Tratamiento Ortodóncico y Ortopédico de 1ª Fase en Dentición Mixta. 2ª Edición Author: Pablo Echarri Lobiondo Collaborators: William Clark, Emma Vila Manchó, Jordi Coromina and José Duran von Arx
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Rehabilitación Neuro-Oclusal (RNO) Author: Pedro Planas
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Atlas de Cefalometría y Análisis Facial Authors: Jesús Fernández Sánchez & Omar Gabriel da Silva Filho
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Diagnóstico y Plan de Tratamiento en Ortodoncia Author: Pablo Echarri
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Atlas de Odontología Infantil para Pediatras y Odontólogos Author: Elena Barbería Leache
More than 330 full color pages Size: 28,5x28,5 cm. Hard cover binding ISBN: 978-84-941269-9-4 More information: www.ripano.eu
Alineadent. Ortodoncia invisible Author: Jesús García Urbano
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Guía Teórico-Práctica de Clínica Odontológica Integrada en Adultos Author: José Luís Calvo Guirado
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