The discussion was conducted in Lingualortho discussion group moderated by Dr. Amornpong Vachiramon
http://groups.yahoo.com/group/LingualOrtho/
Amornpong Vachiramon
Dear Dr Fred Marconi Jr,
If I remember it correctly, last time we met you told me that you use 022 slot lingual brackets for all teeth and you use direct bonding technique. Which working arch wire do you use for traction? What do you think about 022 system on the lingual side? Is it too rigid to use lingually because the interbracket distance very short?
Fred Marconi
Dear Amornpong,
I have used the 022 bracket since the lingual braces first came out. The thicker wires I have felt gave me more control during retraction both in torque of the anterior teeth as well as the bow out effect seen in the bicuspid area. Let me say that I also use the .022 bracket labially. The .022 bracket provides us with a greater choice of wires to use. It is all in what you get use to using. each system has its pros and cons. Knowing what these considerations are will allow you to provide the compensations necessary to achieve your end result. For retraction I will use an .018 x .025 TMA or SS or a .019 x .025 TMA or .019 x .026 SS. My choice of wires depends on need of the patient. If the incisors are very flared I will tend to use a .018 x .025 if they are vertical or show lingual crown torque I will move to a bigger wire. I will also consider a .021 x .027 S.S reduced posteriorly when my torque requirement is severe. My advice is to stick with one system and work with it until you understand its limitations and advantages. Again I use the .022 because of the greater selection of wires.
Garry Creecmore
Dear Group,
It is interesting to note all the conversation regarding slot size either in 022 or 018 and no one has mentioned the 016 system, specifically designed for the lingual environment.
Nicolás Arqueros
What system use a .016 inches spot actually? Is it a new one? In my view this measurement may be successful in children lingual orthodontics but in adults many times you need greater sizes. Now I have a design of a new lingual bracket prototype with some upgrades to facilitate their clinical management like a very low profile but in a .022” slot due their wide range of wire section possibilities from a very light forces to the most heavies depends on the clinical needs. May you show us this soft system?
Courtney Gorman
I believe the system was the old Unitek system which was a 16x22 vertical slot which used a ribon arch I may be wrong but I know that that bracket did exist
Leoncio Menndez
Then vertical slot starting with Beg, until the TP combination with edgewise and Begg brackets. More late the Borussard Brackets was using for long time. Now, with lingual brackets the American have special lingual brackets that I like.Today there is a 20 " slot. I believe that Orthoroganizer sell it. The bracket is created by Dr Nanda
Steve Herzberg
The lingual appliance that Gary Creekmore is referring to is the Conceal appliance that his father, Tom Creekmore invented in the late 80's. Tom won the B.F. and Helen Dewel Award for best article of the year as voted by the Editorial board for his Aug, 1989 article in the AJO-DO titled "lingual orthodontics - its renaissance." The appliance was first sold by Unitek and then later by Creekmore Enterprises and I am sure that it can still be purchased from Creekmore Enterprises.
The appliance uses a .016x.022SS Ribbon arch with vertical insertion and avoids the use of double over-ties. Archwire progression of course varies by practitioner but I typically used 4 archwires: .0155 Coax, .016N. .016SS, and .016x.016SS. I had good success with the appliance for many years and even used one of the cases for the ABO.
Fred Marconi
I have been treating patients with the lingual braces since 1982. I have used Creekmore's brackets, Kelly's Unitek's twin lingual brackets( no longer in the market), American brackets (the first ones), and of course the traditional Series 6 and 7 Ormco brackets. Guys it's not in the appliance that makes the difference but the operator. The bracket issue is a business of the companies and the inventor. We gyrate to the appliance based on the marketing approach of the companies and the personality of the professional promoting the appliance as if they had the ultimate word. These appliances all have their plus and minuses. What will make the difference in your offices is to stick with just one appliance and learn all it's plus and minuses and set a work protocol for each treatment consideration that may arise. This will simplify things for you and your staff.
Take this advise from someone who has been looking for the golden grail for far longer than I should have. I find the Ormco bracket as a good basic bracket, I get no royalties from the company and I have never been supported by Ormco even when I taught the lingual technique using their brackets. After my many travels I have returned to the Ormco bracket and my cases are progressing faster and with better control. The biggest issue I have with this bracket is with rotational corrections but with the use of auxiliaries I have resolved that problem.
The Ormco bracket was a well conceptualized appliance from the onset particularly the design from cuspid to cuspid. The posterior brackets are not as critical.
What is funny is that I just finished building a plane and I am tied in to a communication circle just like this one and it's incredible the similarity of conversations, here about slot size, there about one little issue something like what propeller has the best pitch. The conversation goes on for weeks and the same conversation comes back years later when a new group of builders get to the same stage of building their planes. In the end what counts is to get the plane in the air and have fun flying it be a good pilot, less we are into building planes or bracket design.
Silvia Geron
I fully agree with Dr Marconi. The operator makes the difference and not the appliance. Every appliance has advantages and disadvantages, and after you get used to it you find solutions to its problems. I agree that Ormco generation 7 is a very good bracket (I also am not supported by Ormco); the problem with this bracket is not the slot size but the size of the bracket and the hook, which makes it very irritating to the tongue.
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