A SIMPLIFIED LINGUAL APPLIANCE.....

 Wasserstein A., D.M.D., Israel

www.lingualcourse.com Vol 2 No 1, May 2004

A "bracket free" lingual technique appeared in the "Clinician's Corner" section of the April 2001 American Journal of Orthodontics and Dentofacial Orthopedics, [119(4):443-9, 2001]. The article was called: Nickel-titanium mandibular bonded lingual 3-3 retainer: For permanent retention and solving relapse of mandibular anterior crowding, written by by Eric J. W. Liou, Louise I. J. Chen and C. Shing Huang.

A medium force 0.018 -inch mandibular NiTi arch wire is adjusted (and sometimes bent) to the "ideal" lingual surfaces of the lower incisors and canines on the dental cast that was obtained at the end of treatment. This wire is microetched by sandblasting on the sections fitted to the canines, and bonded to one of the canines while loosely ligated to the incisors by .010-in ligatures through the embrasures. The wire is then tied tightly to each incisor from the lateral incisor that is adjacent to the bonded canine to the lateral
incisor on the other side. Finally, it is bonded to the contralateral canine. Subjects were seen clinically each month and theligatures were either changed or removed, according to the clinical judgement. The relapse was solved in 2 to 4 months. The NiTi archwire is then left for permanent retention.

The authors also presented a mandibular anterior crowding case that was treated solely by this technique. They put forth that this approach may eliminate the need for lingual brackets in certain clinical situations. This technique as updated by Eric J. W. Liou during the 104th Annual Session of the AAO held this year (2004). Liou presented the use of preformed lingual 0.018 inch NiTi arch wires either for relief of crowding or for space closure. For the last mentioned purpose, the wire is bent to form a loop for each space. The loops are then closed and the teeth are bonded one by one, while stretching the wire to fit the teeth next to the spaces. Instead of metal ligatures, he is using in some cases nylon lines for better esthetic. He presented full arch lingual treatments with minimum use of brackets bonded directly. He is using also TMA and SS wires in his special technique.

The technique presented is easier and much less expensive than any other esthetic method - the classic lingual or the Invisalign technique. However, the technique is limited in its control of vertical tooth positioning as well axial root positioning. In addition, strains  created in bent NiTi arch wire may cause unpredictable movements of teeth. The authors recommend performing heat treatment in the area of wire bending, or, more practically (as they write) to embed the sites of wire-bending inside the bonded resin.
 

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Adult and Lingual Orthodontics
EDITORS:
Dr. Silvia Geron D.M.D., M.Sc
Dr. Rafi Romano D.M.D., M.Sc
Dr. Pablo Echarri D.M.D., M.Sc