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DEVELOPMENT OF THE IN-OVATION-L BRACKET FROM GAC
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Carlos F. Navarro D.D.S., M.S.D.
Marco A. Navarro D.D.S., M.S.D.
Jorge Perez-Salmeron D.D.S.
Aldo Buccio D.D.S.
Scott Huge
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www.lingualnews.com Vol 4 No 2 September 2006 |
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Lingual brackets have been used in orthodontic practices for many years. Dr. Craven Kurz is generally credited with the early development of lingual bonded brackets in the 1970's.
The JCO article "Keys to Success in Lingual Therapy"(1), states that due to the increase in the demand for orthodontic care by adults, extensive research and development over the past 10 years has been aimed at providing a truly "invisible" edgewise appliance.
Dr. Paul Ling reported that advancements were slow because of the level of difficulty. Much more rigorous attention to detail, as well as a fundamentally different approach to treatment planning and biomechanics is required.(2)
There are many companies that offer lingual appliances, but no substantive modifications to the design have been released since the early 1990s. This brings us to the latest advancements in lingual brackets.
In order to create and optimal appliance for a successful lingual orthodontic treatment, one should consider the following:
-Proper oral hygiene and gingival irritation
-Lingual irritation and Transient speech difficulties
-Differences in tooth size and morphology
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GAC recently introduced a lingual bracket, the In-Ovation-L (IOL), with innovative characteristics that improve the patient's comfort and takes into consideration these three concepts (Fig. 1) |
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Fig 1: In-Ovation-L Lingual brackets |
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Proper oral hygiene and gingival irritation
Most of the time, lingual brackets are bonded close to the gingival margin, especially on teeth with smaller clinical crowns such as the upper lateral incisors, lower incisors, lower premolars, and lower second molars. The In-Ovation-L (IOL) brackets are small enough to allow sufficient inter-bracket distance, yet wide enough to have good rotation correcting control. This provides more space between the bracket and the gingival margin, thus allowing the patient to achieve better oral hygiene (Fig. 2,3) |
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| Fig. 2: The IOL brackets are small enough to allow sufficient Interbracket distance and gingival clearance |
Fig. 3: The IOL brackets are wide enough to allow good rotational control |
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In addition, the In-Ovation-L (IOL) anterior brackets can be placed in the deepest portion of the lingual fossa (Fig 4), better adapting to the anatomical contours. In particular the forked design built into the base (Fig. 5), allow the base pad to be easily bent to fit to the complicated lingual shape of the cuspid securely.
This adaptation reduces excess bonding material (resin) and decreases the area for plaque and calculus deposits to occur. |
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| Fig.4: The IOL brackets can be placed in the deepest portion of the lingual fossa |
Fig.5:The fork design bhe base allow the base pad to be easily bent to fit to the cuspid lingual shap |
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Lingual irritation and transient speech difficulties
Some lingual brackets may cause dysphonia or dysfunction of the masticatory system due to their large profile. The In-Ovation-L (IOL) height has been reduced to 1.8 mm for the purpose of minimizing these issues. However there is always some discomfort that the patient may experience, so it is recommended to bond the upper arch first, and then the lower in a different appointment. This also accommodates the tongue posture to the new surroundings. (Fig. 6,7). |
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Fig. 6: IN-OVATION-L GAC BOHEMIA NY |
Fig. 7:The lower arch is bonded in a different appointment |
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Difference in tooth size and morphology
It is important to consider the tooth size, especially when we encounter problems like congenitally small teeth, such as peg laterals, also partially erupted, fractured or worn teeth. Ideally, one should placed the In-Ovation-L (IOL) brackets using and indirect bonding procedure, to assure bracket placement accuracy. (Fig. 8). As previously mentioned, the In-Ovation-L bracket is placed at the deepest portion of the lingual fossa. Until recently, it was all but impossible to do that, but this bracket makes it possible by bending the base pad. Furthermore, it is possible to change the bracket torque and the position to be bonded easily by adjusting the angle of the extended base pad. Fig. 9-11). |
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Fig. 8: IOL Bracket IBT/Trays by S. Huge
*Specialty Appliances Atlanta GA. |
Fig. 9: A case of changing the torque |
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| Fig. 10: Example of mounting in the gingival direction. |
Fig. 11: Example of mounting in the occlusal direction |
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The In-Ovation-L (IOL) has a self-ligating clip that remains interactive and in stage of constant activation, this eliminates the need to change ligature ties during office visits, as a result of this the offices visits are three times faster. This lingual bracket has the same interactive function as the GAC labial bracket (In-Ovation-R) so that it will be possible not only to shorten the treatment period, but also lengthen the treatment intervals. (Fig. 12) |
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| Fig. 12:IOL brackets with interactive function which enables shorter treatment period and longer treatment intervals. |
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The self-ligating system of the labial bracket, having a sliding clip, has a strong mechanical property and a high reliability, but it is not suited for lingual brackets since the distance of the clip movement makes the size of the bracket increased. Also the self-ligation bracket having a rotating clip has a problem that it can be broken easily, thought it can decrease the distance of clip movement. (3)
GAC's lingual bracket was designed with the dual advantages of strong mechanical properties and minimal size. This was achieved through good design and the decision to incorporate sliding and rotating mechanisms into the bracket. (Fig. 13). |
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| Fig. 13:IOL brackets with design of sliding and rotating mechanisms of the clip |
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Conclusions
One sometimes hears that the length of treatment with lingual appliances is longer than that with labial appliances, but there is no objective evidence to support this claim.
In fact, if one takes advantage of self-ligation systems, you can reduce the friction in sliding mechanics and still have the friction necessary to maintain constant force to shorten the total treatment time with precise control. (5)
Also with the newer brackets, improved oral hygiene, decreased gingival irritation, and fewer lingual irritations may be expected.
References
1. John R. Smith, DDS, MSD; John C. Gorman, DMD, MS; Craven Kurz, DDS; Richard M. Dunn, DDS. Keys to Success in Lingual Therapy. Journal of Clinical Orthodontics (April 1986).
2. Paul H. Ling, DDS, MDS, MOrthRCS; Lingual Orthodontics: History, Misconceptions and Clarification. Journal of the Canadian Dental Association (February 2005).
3. Gorman JC, Smith RJ. Comparison of treatment effects with labial and lingual fixed appliances. American Journal of Orthodontics and Dentofacial Orthopedics (November 1991).
4. Fillion D. Improving patient comfort with lingual brackets. Journal of Clinical Orthodontics (October 1997).
5.Ji-Hoon Park, DDS, MDS; Yong-Keun Lee, DDS, PhD; Bum-Soon Lim, MS,PhD; Cheol-We Kim, DDS, PhD. Frictional Forces Between Lingual Brackets and Archwires Measured by a Friction Tester. Angle Orthodontist, International Journal of Orthodontics and Dentofacial Orthopedics (January 2004).
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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
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