Dear group,
I am practicing labial orthodontics and want to start lingual orthodontics any suggestion as to what lingual appliance (brackets) you folks would suggest for me and in India we don't have lab support for lingual appliances. hence what would be the suggestion for me to start up.
www.lingualnews.com Vol 4 No 2 September 2006
Amornpong Vachiramon:
I used to use the Kurz 7th Generation before. At the moment, I use only STB brackets exclusively for both non-surgical and surgical lingual orthodontics cases. It is more comfortable and less irritating to the tongue and less disturbing to the speech. The treatment time seem to be faster.
Craig Andreiko
The STB brackets (Scuzzo/Takemoto/Brackets) are about the smallest that can be made with the advantage of reduced friction by ligation design. They are expensive because they are made one at a time on expensive computer controlled equipment. Maybe that will change if volume increases. Seem to have good results even with direct placement.
Dr. J. Eric Selnes
Any one out there using the i-Braces system?? Any comments or suggestions?
Fred Marconi
Dear Dr, Selnes
I have not used i-braces but I am quite familiar with the material and the presentation of cases, with all due respect to Dr Wiechman, I am not all that impressed with the finished results. The problem comes, I feel, from the fact that the mechanics is out of the control of the clinician. All the wires are bent by a machine and in 30 years of experience in orthodontics and 20 years in lingual braces I find that no machine can dictate what happens on a day to day basis in an orthodontic office. There are too many variables that present themselves on a daily basis that I find a machine cannot solve. If this were the case our services as orthodontists who are specialists would soon come to an end. Were we are headed with all this preformed prefabricated stuff is that in the not too distant future orthodontics as we know it will take a drastic change. We are already seeing some of that happening. When we put the fate of our specialty in the hands of big business, nothing good will comes of that, the present world condition is the best example. For those interested in self ligating brackets. I just recently started using the GAC self ligating lingual brackets. The first set I used I placed on a patient that had Ormco's lingual brackets. Her response was quite positive, she found the brackets very comfortable, no effect per say on her speech and I have not had a call form the patient. The same with three other patients that I have placed these brackets on. My only concern is that I bond the brackets directly on the teeth and positioning these brackets visually is different than what I am used to with the Ormco brackets. If you intend to use these brackets, which I highly recommend you try them, I would suggest you use and indirect technique of bonding. Ligation of the wire is really neat and efficient. I am working at developing protocols for the use of this appliance. I see myself using these brackets exclusively in future because of their low profile, comfort to the patient and because they are self ligating brackets.
Robert Rudman
I have about 20 i braces cases going and the fact that everything is pre fabricated gets you in the ball park, but you have the ability to bend the wires as in any fixed appliance case to detail out the case. Like any system there are some quirks that I am not happy with
1. you are charged for every wire after what is sent in the case set up... and wires do break... If I had it my way I would include 2 sets of each wire
2. you have little to no control of how you set up a case after you submit it(unlike Invisalign or "Sure Smile")
All these they are working on to rectify all in all it is a good system, But be very aware it is lingual and many of the issues that come along with it are still there.... don't expect to get a patient in and out in 20 minutes for a retie I will be at there users meeting in Santa-Fe in September and that might be a good exposure for you as the training online gives you about the same info that you would have from any simplified training
Ian Hutchinson
I totally agree with Fred thoughts regarding pre bent arch wires. However my experience is from a technician bending up a series of wires rather than a computer. Things just don't go to plan and you end up bending your own wires!
For the smallest ligating bracket look at the 3d from Forestadent. It takes a little practice to open and close but no complaints from the patient.
Regarding bonding, any system can be placed directly but you will pay with the hassle and time of bending first second and third order bends. I have started using the best technique with indirect bondind and have found lingual much more enjoyable and less stress.
Fred Marconi
We must be cognizant of the fact that our future is in our hands and mind. We must not relinquish that great gift to a machine. We must discriminate. The adjustments that are needed to bring a case to the finished results we have been taught can only be done by us.
One of the problems that we have is that there are colleagues who find or think that manual labor is not for them. I have no idea of why they chose this profession if that was their feelings. Now they want to change the profession so that it will adapt to their way they want to work and of course look for other colleagues that have become license that feel the same. The problem that I see here is that if enough colleagues join the bandwagon we now have a condition that can easily be exploited. It's like taking drugs, we become dependent.
At the ESLO conference this last June, Dr. Boyd requested the audience to please give a chance to Invisalign and try it. The company however has been more interested in profits and promoting this product to whomever wants to try it, that has a license to practice no mater whether they are a specialist or not. If it was possible for them to convince our legislators to let hygienist deliver these appliances you can bet your boots they would invest money into promoting that cause. At this meeting, the conference particularly dedicated to Invisalign, the last person that was allowed to speak was the chairman of an orthodontic program, the voice of authority. He was definitely in favor of Invisalign. I did lear the Invisalign contributes to his program by providing funds so his students can attend courses and who knows what else.
I play tennis and am also a pilot. To be able to drive he ball down court I have to practice and practice my swing. If I want to play tennis well this is what I have to do. As a pilot I am working on my instrument license. I fly a fast plane that must be kept within 100 feet of the assigned altitude. A slight amount of finger pressure can change my altitude by 200-300 feet. If I want to fly in instrument conditions and keep the plane at the assigned altitude, I have to practice and practice. Ah yes, automatic pilots. If a plane can be landed by remote control, they do not need a pilot. But an automatic pilot cannot replace a pilot, under certain conditions someone has to take charge.
Ian Hutchinson
I have a good friend who has set up a new private practice (general dentistry).
He is looking for extra business so guess what - yep, he's going on an Invisalign course - and if he treats a certain number he will be crowned with the title of a Platinum Doctor!
Has he had any ortho training - no. Has he taken my advice and kept away - no. Why? because there are so many other general dentists on the course/ completed the course and are earning easy money. With the promise of big bucks to come. Now who is to blame when things don't go quite to plan? With no formal ortho training how is he going to get out of the hole? But the comment is that things can't go wrong because all the planning etc is done by Invisalign.
Fred Marconi
When Invisalign first appeared in the market I with a large group of orthodontist took the course. My position at that time, and that was many years ago, that I would not offer this appliance to my patients and if so to very, very selected cases. I saw the writing in the wall. Even though two of my biggest orthodontic competitors embraced Invisalign for selfish reasons I choose not to bend. That was years ago and even when my referring colleagues would tell me look what so and so is doing I held my course. I found alternatives like 2D from Forestadent. I still have a viable business that continues to grow. Fear is our worst enemy and it is us that are responsible for what is happening. Like I said in a previous communication, these companies look for colleagues that do not pride themselves on wanting to do orthodontics. Looking for the easy way out.
Ian Hutchinson
Strange but true, I have a patient who came in wanting Invisalign as a lady she works with (both are actresses for the BBC) has it. I eventually got her to have 2D as it was a simple alignment of the uppers and now her friend wants to ditch the Invisalign. It appears that the marketing, to both patients and clinicians, is that the technique is a 'no brainer' - wear it and all will be rosy. Now I know there will be others out there who will provide plenty of arguments against, but I find patients do not like wearing the aligners - all ways in and out. Far better to have an initial learning/adaptation period to the lingual appliance and for the clinician to be in total control and the final outcome to be dictated by the clinicians skill, not some computer. Horses for courses but my money is on the clinician, not the computer.
Courtney Gorman
Guys Come on now. I love lingual and still treat many cases. For some it is the right choice. For others aligners are a better option. With the right technique, and 'tricks' you can achieve great results even in extraction cases. Of course its not for everyone but for some it is the right choice. I recall not all that long ago that our colleagues bad mouthed lingual, and said you could not get the same results as labial. We proved that this was a false hood but let us no perpetrate the same wrong against those who have learned to use aligners to achieve their results. Of course not all practitioners are willing or able to treat a large assortment of cases with aligners but there are those of us who are. I believe that it is always better to be open minded and inclusive as opposed to being exclusive!
Ian Hutchinson
The GAC has recently launched a range of lingual brackets using the active clip from their normal labial self ligating bracket. There is several different brackets corresponding to specific teeth. the slot is horizontal. I have not used them. The Forestadent the 3D system which has passive ligation (as in Damon) but the advantage of a vertical slot. The clip is very basic - there is two arms which bend over the slot thereby securing the wire. The bracket is probably the smallest on the market. Only two designs - one for anterior and one for posterior teeth.
The speed of tooth movement is fantastic and I have had no complaints from patients about the bracket - just me leaving the wire a little long! I have used Damon on the lingual aspect - but from what I understand they are launching a new lingual bracket with the Damon clip towards the end of the year. There is also another company that was present at ESLO which was self ligating but can not remember the name. You could use any bracket ion the lingual aspect as it simply serves as a means of attachment - the skill is in the wire bending.
Fred Marconi
The other company that is fabricating self ligating lingual brackets is LOIDL Orthodontics or ADENTA. It is a company out of Germany and their bracket is a takeoff of the American Orthodontics Time bracket. I think they actually designed the Time bracket and gave American Orthodontics the right to market it.
The GAC bracket is a new lingual self ligating design with the proper lingual torques incorporated. With this appliance you will most definitely need to place them indirectly, for the moment. GAC is different than the Forestadent bracket. The GAC appliance is made to replace the Ormco bracket. The 2D appliance from Forestadent I use in place of the clear aligners for simple cases needing correction of rotations.
Balaji Krishnan
Did any of you used the Phantom self ligating bracket from Gestenco. It seems to be good, on going thru the website.http://www.gestenco.com/phantom.html
It does come with a jig and the manufacturer says direct bonding would do. what is your comment on that. The composite and ceramic brackets are usually having rounded margins hence would be less hurting to the tongue, so it does make sense to use it on the lingual side.
Fred Marconi
Not familiar with the Phantom bracket. As far as the ceramic bracket I will have to question the damage they may do to the incisor edge or the lower incisors. If the brackets are not ceramic but rather plastic, I would have a concern on the viability of the slot and the wear of the tie wings. I have used the Generation 7 Ormco bracket for 18 years and have found it a more than adequate bracket to resolve my orthodontic problems. At one pint I made a change to the American lingual bracket and my clinical experience has not been good. While it was an easier bracket to bond directly and smaller there were many other problems that were created. For one the metal deformed with the occlusion and the slot size changed making wire insertion a problem, I will not go on. I am now considering making a change for the GAC self ligating brackets. I am testing these brackets. So far the closing of the tie lids has been easy and secure. I like the bicuspid brackets. The brackets have a smaller profile and one fo my patients that had Ormco before found the GAC brackets a great deal more comfortable. Why GAC? I use the In-Ovation and Mystique brackets. It's a great deal easier to order as much as I can from one supplier. We are extremely happy with the In-Ovation and Mystique bracket. As I use this lingual bracket I will be providing information on how to use this bracket successfully.
Ian Hutchinson
I have tried the Oyster as well as other plastic brackets - all turned out to be disappointing. Either that would fail at the composite/base interface or they would wear badly and when you tried to out a steel rectangular wire in the bracket would 'give'. In my opinion, keep away. Ceramic - as Fred said, to much danger of wearing the opposing teeth - keep away again! For rounded edges try metal injection moulded brackets. I quite like the Forestadent 3D as it also has a vertical archwire slot. But, it takes some practice getting use to opening and closing. If its horizontal slot you like and, if your using the BEST bonding technique then you can use anything - e.g. a labial bracket. I have used Damon like this - bit bulky but it worked.
Balaji Krishnan:
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