Adult skeletal Class II high-angle case treated with a fully customized lingual bracket appliance

Digital lingual appliance combined with micro-screws for the treatment of a skeletal bimaxillary protrusion and ‘gummy’ smile

This case report describes the lingual orthodontic treatment of a 28-year-old female patient who presented with a bimaxillary protrusion malocclusion, a hyperdivergent facial pattern, mentalis strain, and a ‘gummy’ smile. To achieve favourable occlusal and facial results, the four first premolars were extracted, and micro-screws utilised to provide maximum anchorage. With the widespread application of three-dimensional technology, a digital goal-oriented treatment plan was applied for its predictability and precision. A fully customised lingual appliance system with preset torque in the anterior teeth combined with ribbon-wise arch wires was placed to prevent excessive lingual inclination of the incisors during retraction. As a result, an attractive facial profile and a well-aligned dentition with ideal intercuspation was obtained.

Torque efficiency of a customized lingual appliance : Performance of wires with three different ligature systems

PURPOSE

Torque control in lingual orthodontics is key to obtain optimal esthetic results. The aim of this in vitro experimental study was to verify the efficiency of the ligature-archwire-slot system in torque control using a customized lingual appliance.

METHODS

An idealized cast with eight extracted human teeth was created and a set of customized lingual brackets was obtained. Tests were performed with the following wires: 0.016″ × 0.022″ nickel-titanium (NiTi), 0.016″ × 0.024″ stainless steel (SS), 0.017″ × 0.025″ βIII titanium (βIIITi), 0.0182″ × 0.0182″ βIIITi, 0.018″ × 0.025″ SS, 0.018″ × 0.025″ NiTi, 0.018″ × 0.025″ βIIITi, and three types of ligatures were tested using a universal testing machine to calculate the efficiency in torque control. A blind statistical analysis was performed.

RESULTS

Based on post hoc multiple comparisons, differences were found for two of the three ligatures when using the 0.016″ × 0.022″ NiTi wires (p < 0.001 for both ligatures). When considering all ligatures, 0.018″ × 0.025″ SS and 0.018″ × 0.025″ βIIITi were significantly different from all other wires (p < 0.001 in all cases). With a moment of 5 Nmm, the 0.016″ × 0.022″ NiTi wire developed median angles of 26.7, 29.8, and 38.7° with the three ligatures, respectively, while the 0.018″ × 0.025″ SS developed median angles of 12.9, 10.7, and 12.7°, respectively.

CONCLUSIONS

The ligature type and geometry did not affect the efficiency of torque control, except for the 0.016″ × 0.022″ NiTi wire. The wires generating the greatest moments were the 0.018″ × 0.025″ SS and 0.018″ × 0.025″ βIIITi.

Ribbon-wise customized lingual appliance and orthodontic anchor screw for the treatment of skeletal high-angle maxillary protrusion without bowing effect

This case report demonstrates the treatment of a skeletal Class II high-angle adult patient with bimaxillary protrusion, angle Class I occlusion, and crowded anterior teeth. A ribbon-wise arch wire and a customized lingual appliance with anterior vertical slots were used to achieve proper torque control of the maxillary anterior teeth. An orthodontic anchor screw and a palatal bar were used for vertical control to avoid increasing the Frankfort-mandibular plane angle (FMA) by maxillary molar extrusion. Through the combined use of the ribbon-wise customized lingual appliance, palatal bar, and orthodontic anchor screw, vertical control and an excellent treatment result were achieved without the vertical and horizontal bowing effects peculiar to conventional lingual treatment.

Dentoskeletal and soft tissue changes associated with miniscrew anchorage in customized lingual orthodontics

Objectives

The goal of this study was to analyze skeletal, dental, and soft tissue changes of patients treated with customized lingual systems and to evaluate the clinical effectiveness of miniscrew anchorage.

Methods

Nine upper first premolar extraction patients who were treated with customized lingual appliances were included in this study. Miniscrews were used for reinforcement of molar anchorage. Cephalometric films and study models were obtained before treatment (T1), after alignment (T2), and after treatment (T3). Treatment effects were analyzed by cephalometric radiographs and study models.

Results

The upper anterior teeth were retracted significantly at T2 and T3 (4.41 ± 4.14 mm and 5.51 ± 2.48 mm, respectively). During space closure, the upper first molars showed slight mesial movement (1.50 ± 1.97 mm). The intercanine width of the upper arch increased at T2 (1.59 ± 1.81 mm), but decreased at T3 (0.11 ± 1.00 mm). The sella-nasion-A, A-nasion-B, and mandibular plane angles were not significantly changed at T3. The upper lip showed continuous retraction at both T2 and T3 (1.40 ± 1.46 mm and 2.32 ± 2.48 mm, respectively).

Conclusions

By using miniscrew anchorage for lingual orthodontics, patients’ dental and soft tissue changes considerably improved and molar anchorage was reinforced.