Lingual orthodontics in an adult patient with upper premolar extraction: Case report

Evidence of Effectiveness of Lingual Orthodontics as an Alternative to Conventional Labial Orthodontics. A Systematic Review

In orthodontics, both the treatment goals and the impact of orthodontic equipment on patients' aesthetic appearance have contributed to a rise in patients' aesthetic demands over the years. Patients considering orthodontic treatment are significantly concerned about the potential compromise in facial appearance that conventional orthodontic therapy might cause. Clinical practice has integrated aesthetic materials and procedures to address these restrictions. This review will examine the present data and outcomes linked to lingual orthodontics. PubMed, Scopus, Web of Science, Cochrane Library, and Embase were the electronic databases searched. Research interests mainly included biomechanics, appliance design, bonding, laboratory settings, case reports, survey research, and treatment outcomes. The goal was to locate the most recent data regarding lingual orthodontics. A consistent and predictable pattern emerges from the available evidence on lingual orthodontics. Several areas have received a lot of attention over the past decade, including the ability to forecast outcomes and patients' preparedness to embrace these changes. The current state of knowledge on the biomechanical principles of lingual orthodontics is solid, as this review shows. Lingual orthodontic appliances can efficiently handle any orthodontic scenario that a labial appliance can handle. The reason is that the completely customized lingual appliance might bring about the desired result in terms of treatment.

Ortho-Perio Risk Assessment and timing flowchart for lingual orthodontics in an interdisciplinary adult ortho-perio patient: A case report of ``Perio-Guided'' Orthodontic treatment

INTRODUCTION

The treatment of ortho-perio patients is a challenge for the interdisciplinary team. Not only are adult patients with overt perio pathology involved, but any ortho patient, even young ones, can be a perio patient and vice versa. Diagnosis and risk assessment of every ortho-perio patient is essential to establish a correct treatment plan, schedule and prognosis. Orthodontics becomes a ``Perio-Guided" Orthodontic Treatment and Periodontics a "Ortho-Guided Periodontal Treatment".

MATERIAL AND METHODS

This case report presents a man with a very compromised dentition asking for a complete interdisciplinary rehabilitation treated with a combined ortho-perio treatment in lingual mechanics. The periodontal evaluation confirmed the possibility of performing orthodontic treatment after active periodontal treatment. Treatment objectives were the resolution of the crowding, the correction of the levels of the gingival margin, the bone levelling, the preparation for restorative spaces; the objectives of the latter prior to implant placement were: redistribution of space, optimization of the position of adjacent teeth and their parallelism, exploitation of edentulous sites to correct dental class II and placement of the least number of implants possible. After integrating the conventional perio risk assessment with a new Ortho-Perio Risk Assessment (OPRA), a lingual fixed appliance was applied with the help of miniscrews to correct class II division 2 by substituting the upper right first premolar into a canine and retracting the entire upper arch, while correcting the deep bite and optimising the occlusion.

RESULTS

At the end of the treatment, the patient had molar relationships of class II on the right and class I on the left with a class I canine and the 14 in the position of 13. Incisal relationships were corrected, the position of the incisors was optimized, the spaces in the upper arch were fully resolved by orthodontics. During the treatment, orthodontics corrected the uneven gingival margin of the anterior teeth and levelled the bone.

CONCLUSIONS

Correct ortho-perio risk assessment (OPRA) is necessary to plan the risk of expression of the periodontal phenotype in ortho-patient. OPRA and the lingual mechanics allowed an orthodontic resolution of the malocclusion and an enhancement of the perio-implant-restorative contributions. OPRA followed by periodontal therapy and lingual mechanics resolved the malocclusion by improving the restorative peri-implant conditions. Orthodontists and periodontists should be aware of the characteristics of the individual expression of the periodontal phenotype at the beginning of treatment and involve patients in the outcome, sequencing of combined treatments, ortho-perio retention and stability.