CREEKMORE LINGUAL SYSTEM: CONCEAL™ LINGUAL APPLIANCE 1986, TO CII SECOND GENERATION LINGUAL SYSTEM 2002

Gary Creekmore

www.lingualnews.com Vol 4 No 2 September 2006

The following is an abbreviated version of my late father, Dr. Thomas Creekmore's lingual presentation he performed at the 1998 AAO Conference in Dallas, Tx. This presentation is based on the Conceal™ Lingual Appliance, which was the first generation of Creekmore lingual systems. The CII Second Generation Lingual System was introduced in 2002 and is basically the same as Conceal as far as dimensions and functionality, but with the primary difference being the modifications to enhance patient comfort.

In the beginning, 3M Unitek and Creekmore…
assessed the problems of lingual orthodontics by designing a 16X22 occlusal inserting appliance called Conceal™. Its unique bracket tie-wing configuration and occlusal slot simplified archwire insertion/removal, eliminated the need for double over-ties, and made rotation control easier than labial. Tip control became a function of quality of ligation.

Conceal™ brackets were positioned and bonded on the model by hand, then indirect bonded into the mouth. Due to irregular lingual tooth surfaces, placement by hand yielded tedious chair time and bad results (Fig 1).

Fig 1: Wire bends needed as a result of inaccuracy of bracket placement

Fig 2: The slot machine

CREEKMORE then made THE SLOT MACHINE

 The Slot Machine (Fig 2) is NOT a traditional bracket placement device; rather it positions the arch wire slot of the bracket relative to the facial surface of each tooth on the model. Through the use of orientation templates, rotation guides and height adjustment shims the archwire slot of the bracket is oriented relative to the archwire plane for tip, torque, rotation, and height. Each parameter can be selectively varied independently of each other. Once the labial surface is oriented to the archwire plane as desired, the bracket, held by the slot with the bracket holder, is attached to the tooth either on the lingual or facial surface. Brackets can be bonded to the model teeth with either water-soluble adhesive or bonding material. 

 Bonding material is used to fill any surface irregularity between the tooth surface and the bracket base creating a custom base. Custom bases maintain the prescribed orientation of the archwire slot. Brackets are transferred to the patient's teeth via an indirect bonding technique (Fig 3).

Fig 3: Bonding material is used to fill any surface irregularity between the tooth surface and the bracket base creating a custom base

 CASES

Case 1

Fig 4: Retreatment of a relapse case

Case 2

Fig 5: Extraction case treatment

Function of the Double Tube

After the 6 anterior teeth have been aligned with a full size SS Archwire and chained together in mass, the space closure process begins. The wire bi-passes the second bicuspid and is inserted into the innermost, or second tube, of the double tube. Full size SS sectional wires are inserted from second bicuspid to second molar passing through the first tube of the double tube providing maximum anchorage. Space closure is achieved virtually friction free with total control of the anterior teeth. The double tubes are also used as terminal or single tubes on non-extraction cases.

SUMMARY

- Conceal™ or the CII appliance makes arch wire insertion, removal, and ligation equal to labial treatment
- Bracket placement and variable prescriptions are paramount
- Treatment times are equal to labial
- Chair time is about 50% longer
- Labial treatment is not required for finishing

www.lingualnews.com 
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