Lingual orthodontic treatment of a bidentoalveolar protrusion case with multi-slotted brackets and preformed straight archwires

A 23-year-old female patient with lip protrusion and crowding received lingual orthodontic treatment with multi-slotted brackets and preformed straight archwires. After 5 months of alignment and leveling, anterior retraction was performed for 21 months. Final detailing took five months. The appliances were removed 31 months after the start of treatment. With these multi-slotted lingual brackets, treatment progressed in the simplest and most effective way and board-standard finishes were achieved. Furthermore, the use of preformed lingual straight archwires (PLSWs) allowed much more convenient treatment application.     

Lingual vs. labial fixed orthodontic appliances: systematic review and meta‐analysis of treatment effects

The aim of this systematic review was to compare the therapeutic and adverse effects of lingual and labial orthodontic fixed appliances from clinical trials on human patients in an evidence‐based manner. Randomized and prospective non‐randomized clinical trials comparing lingual and labial appliances were included. Risk of bias within and across studies was assessed using the Cochrane tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random‐effects meta‐analyses were conducted, followed by subgroup and sensitivity analyses. Six electronic databases were searched from inception to July 2015, without limitations. A total of 13 papers pertaining to 11 clinical trials were included with a total of 407 (34% male/66% female) patients. Compared with labial appliances, lingual appliances were associated with increased overall oral discomfort, increased speech impediment (measured using auditory analysis), worse speech performance assessed by laypersons, increased eating difficulty, and decreased intermolar width. On the other hand, lingual appliances were associated with increased intercanine width and significantly decreased anchorage loss of the maxillary first molar during space closure. Based on existing trials, there is insufficient evidence to make robust recommendations for lingual fixed orthodontic appliances regarding their therapeutic or adverse effects, as the quality of evidence was low.     

Differences in psychological traits between lingual and labial orthodontic patients: Perfectionism,body image,and the impact of dental esthetics

Objective:To examine some of the patients'' psychological traits in relation to their levels of perfectionism and their body image, and to discover whether these differ between lingual and labial orthodontic patients.Materials and Methods:A cross-sectional study was designed with a consecutive sample of 80 patients attending a private orthodontic office. Three questionnaires were used to assess the patients'' body image and level of perfectionism. The mean age was 33 years. The men numbered 32 and the women 48. The validated Spanish version of the Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ) was used to assess the psychosocial impact of their dental esthetics. The Multidimensional Perfectionism Scale (MPS) was used to assess how perfectionist the patients were. A version of the Multidimensional Body-Self Relations Questionnaire (MBSRQ) was used for assessment of their body image. Student''s t-test was used to compare the means and 95% confidence intervals (P < .05), and a logistic regression model was used for multivariate analysis.Results:The PIDAQ (55.4 vs 60, P  =  .218) and MBSRQ (128.7 vs 125.9, P  =  .523) results of the patients who chose lingual orthodontics did not differ significantly from those who opted for labial orthodontics. However, the MPS scores of the lingual orthodontic patients were significantly higher (95.9 vs 86.3, P  =  .044), and high social class, over 30 years of age, and perfectionist traits were significant independent variables in this group.Conclusions:This pilot study may indicate that lingual orthodontic patients are more perfectionists than labial orthodontic patients.     

Efficacy of clear aligners in controlling orthodontic tooth movement: A systematic review

Objective:To assess the scientific evidence related to the efficacy of clear aligner treatment (CAT) in controlling orthodontic tooth movement.Materials and Methods:PubMed, PMC, NLM, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Knowledge, Scopus, Google Scholar, and LILACs were searched from January 2000 to June 2014 to identify all peer-reviewed articles potentially relevant to the review. Methodological shortcomings were highlighted and the quality of the studies was ranked using the Cochrane Tool for Risk of Bias Assessment.Results:Eleven relevant articles were selected (two Randomized Clinical Trials (RCT), five prospective non-randomized, four retrospective non-randomized), and the risk of bias was moderate for six studies and unclear for the others. The amount of mean intrusion reported was 0.72 mm. Extrusion was the most difficult movement to control (30% of accuracy), followed by rotation. Upper molar distalization revealed the highest predictability (88%) when a bodily movement of at least 1.5 mm was prescribed. A decrease of the Little''s Index (mandibular arch: 5 mm; maxillary arch: 4 mm) was observed in aligning arches.Conclusions:CAT aligns and levels the arches; it is effective in controlling anterior intrusion but not anterior extrusion; it is effective in controlling posterior buccolingual inclination but not anterior buccolingual inclination; it is effective in controlling upper molar bodily movements of about 1.5 mm; and it is not effective in controlling rotation of rounded teeth in particular. However, the results of this review should be interpreted with caution because of the number, quality, and heterogeneity of the studies.     

Lingual orthodontics (part 1): Laboratory procedure

A key factor for successful correction of a malocclusion with lingual orthodontics is optimal bracket positioning.This presentation focuses on the development of an innovative laboratory procedure for indirect bracket positioning using a modified positioning device (TARG Professional) called Transfer Optimized Positioning System (TOP). In contrast to commonly used approaches to indirect bonding such as CLASS and BEST, the TOP System uses a target set-up technique in order to facilitate the 3-dimensional individualized positioning of brackets while allowing the brackets to be placed on the malocclusion model. The reliability and accuracy of this system in both the laboratory and the clinical environment are discussed.This discussion highlights the high precision of the TOP System and its significance in eliminating the usage of second and third order corrective archwire bends in the finishing stage of lingual orthodontic therapy. In other words the TOP System allows for the usage of almost flat orthodontic archwires to successfully treat a malocclusion with lingual braces. This is the key factor in enhancing the cost effectiveness and success of a lingual treatment concept.

---

Lingualtechnik (Teil 1): Laborprozeß

Zusammenfassung Ein Grundstein für den Erfolg einer orthodontischen Korrektur von Zahnfehlstellungen mit der Lingualtechnik ist eine möglichst optimale Bracketpositionierung.In dieser Studie wird ein neuer Laborprozeß zur indirekten Positionierung lingualer Brackets mit Hilfe eines modifizierten Positionierungsgerätes (TARG Professional) vorgestellt. Von den bisher gängigen Verfahren (CLASS-System, BEST-System) unterscheidet sich dieses neue Positionierungskonzept (Transfer Optimized Positioning System, TOP) unter anderem dadurch, daß zwar ein individuelles Set-up die dreidimensionale Individualisierung der Bracketbasen definiert, die Brackets aber dennoch primär auf dem Malokklusionsmodell positioniert werden. Die Präzision dieses Verfahrens wird anschließend experimentell und anhand eines klinischen Beispiels überprüft.Es zeigt sich, daß aufgrund der hohen Präzision einer Bracketpositionierung nach dem TOP-System idealerweise im Finishing auf Korrekturbiegungen zweiter und dritter Ordnung verzichtet werden kann. Der Einsatz relativ planer Bögen vom Anfang bis zum Ende einer orthodontischen Behandlung mit der Lingualtechnik ist ein wesentlicher Faktor in einem ökonomischen lingualen Behandlungskonzept.

     

舌侧二维矫治器的临床应用初步研究

目的 总结9例用舌侧二维矫治器（德国非凡公司）完成正畸治疗的不拔牙病例,为正畸医生应用这一技术提供治疗参考.方法 9名不拔牙矫治患者,采用舌侧二维托槽进行矫治,分析临床使用情况,总结操作流程及应用体会,并对治疗前后的头颅侧位片进行回顾性分析,评价其对牙（牙合）和面型的影响.结果 9例完成病例在矫治期间获得最大美观的同时,在3～4个月时间内实现排齐整平,下颌牙列排齐时间及效果优于上颌,托槽脱落率15.6%,下前牙转矩增加2.1±0.8°.结论 舌侧二维矫治器可以满足临床美观矫治的需要,应用时上颌需要弯制较多补偿曲,下切牙有唇倾倾向.     

Need of orthodontic treatment in 7-year-old Finnish children

The purpose of the investigation was to determine the need of orthodontic treatment in 7-year-old Finnish children. The series consisted of 200 Finnish children, 100 girls and 100 boys. With regard to the main lines of occlusion a close agreement was observed between the prevalence of malocclusion in this and other. Scandinavian series. The need of orthodontic treatment was assessed using a treatment scale for the age group concerned. No treatment was required in 42% of the children, while 23.5% were in immediate need of orthodontic treatment. In 34.5% it was considered necessary to follow the occlusal development.     

Perceptions of orthodontic treatment need: Receiver Operating Characteristic analysis

Abstract This study aimed to investigate the variations in dentists' perception of need for orthodontic treatment. Sixteen dentists viewed forty clinical vignettes and recorded their decisions according to the certainty with which they would offer treatment for each case. Receiver Operating Characteristic (ROC) analysis was performed on this data, using the Index of Orthodontic Treatment Need (IOTN) as the ‘gold standard'. The data suggest that dentists treatment decisions do not concur with current guidelines in use in the UK.     

Root resorption in orthodontic treatment with clear aligners: A systematic review and meta‐analysis

The aim of this study was to investigate the external root resorption in participants receiving clear aligners and compare it with those treated with fixed appliances. Systematic review with meta‐analysis. Electronic and manual search were performed, and specific inclusion and exclusion criteria were used. Data extraction and analysis were conducted by two investigators independently. The original outcome underwent statistical pooling by Review Manager 5. The quality of studies was assessed by ROBINS‐I tool. A total of 11 studies were included for qualitative analysis (six in moderate risk of bias while another five in serious risk of bias), and three of them were statistically pooled in meta‐analysis. The external root resorption in treatment with clear aligners was significantly lower than that with fixed appliances (SMD = ?0.65, 95% CI [?0.74, ?0.55], P < .01). Subgroup analysis on each quadrant of incisors was consistent with the former result. Current evidences suggest that clear aligners might not avoid root resorption, but the incidence and severity of resorption could both be lower compared with results reported by treatment with fixed appliances.     

The nature and accuracy of Instagram posts concerning marketed orthodontic products:: A cross-sectional analysis

ObjectivesTo scrutinize claims contained within Instagram posts related to six popular marketed orthodontic products.Materials and MethodsThree hundred publicly available Instagram posts were identified using the following Instagram hashtags: #carrieremotion, #damonbraces, #invisalign, #acceledent, #propelorthodontics, and #myobrace. Pilot coding was undertaken on a subset of claims (n = 50) and a coding guide was developed. The associated claims were categorized under 24 recognized themes and their accuracy assessed on a five-point scale.ResultsOf 1730 posts screened, 300 were included for analysis. The majority of posts were based on photographs (n = 244, 81.3%) with the remainder (n = 56, 18.7%) including videos. Half of the posts involved a picture of the product in isolation (n = 150, 50%), with clinical cases presented in a minority (n = 99, 33%). Overall, 472 claims were included with treatment duration being the most frequent theme (n = 125, 26.5%). In terms of accuracy, most of the claims were judged to be “false” (n = 283, 60%) with less than 2% considered “objectively true.”ConclusionsMost of the claims relating to six popular marketed orthodontic products concerned treatment duration. The vast majority of these claims were not supported by evidence and were judged to be false. Efforts should be made to promote the provision of accurate orthodontic information and to verify marketing claims on social media platforms.     

A comparison of treatment results of adult deep-bite cases treated with lingual and labial fixed appliances

ObjectivesTo compare the cephalometric treatment results of adult deep-bite cases after labial and lingual fixed orthodontic treatment.Materials and MethodsA total of 102 patients underwent lingual orthodontic treatment and complete records were evaluated. The following inclusion criteria were used: patients who had Angle Class I or mild Class II malocclusion; comprehensive orthodontic treatment that did not include intrusion mechanics or any extractions; patients with an initial overbite of more than 3.7 mm. Thirteen patients met the inclusion criteria. These cases were matched with the same number of patients according to age with a labial orthodontic treatment group. Pre- and post-treatment cephalometric radiographs were evaluated. Independent t test or Fisher exact tests were performed to assess the differences between the groups.ResultsProclination of the upper incisors was higher in the labial group. Incisor mandibular plane angle (IMPA) showed an increase of 1.2° in the lingual group and 9.7° in the labial group. Lower incisor edge was approximately in a stable sagittal position in the lingual group but significant lower incisor proclination was seen in the labial group. The lower incisors were intruded (-1 mm) in the lingual group but lower incisors were minimally extruded (0.3 mm) in the labial group. No significant difference was found in the movements of upper and lower molars for both groups.ConclusionsThe nature of lower incisor movement involved less protrusion in lingual orthodontics than the labial treatment. Lingual orthodontic treatment is a better option in adult cases where intrusion of lower incisors without labial tipping is desired.     

΢�Ѱ�֧����������Ч��Ӱ��

目的探讨微钛板支抗对正畸治疗的有效性。方法选择2003年12月至2006年11月期间,大连市口腔医院应用微钛板矫治的12例患者,分析其治疗前后头颅侧位片、模型等临床资料,评价微钛板对牙齿移动特征及正畸疗效的影响。结果12例正畸矫治患者均取得了满意的治疗效果,12例患者使用的23枚微钛板均由同一外科医生埋入,每个微钛板埋入时间需10min左右。微钛板作为绝对支抗的应用时间为9～20个月。治疗中23枚微钛板均稳定,无脱落。其中9例患者利用微钛板在远、近中方向上调整牙齿位置,其移动方式以整体移动为主,上下颌磨牙远中移动最多可达3.5mm。结论微钛板作为一种绝对支抗,实现了传统正畸手段在牙齿近远中移动、压低方面难以完成的牙齿移动类型,有效地获得了传统正畸方法难以达到的临床效果。     

A validation study of three indexes of orthodontic treatment need in the United States

Abstract The purpose of this study was to compare the reliability and validity of three occlusal indexes of orthodontic treatment need in predicting the opinion of treatment need of a panel of 18 orthodontists. A set of 160 study casts representing all types of malocclusion was used. The casts were scored with the following occlusal indexes: the Index of Orthodontic Treatment Need (IOTN), the Handicapping Labio-Lingual Deviations index (HLD), and the Handicapping Malocclusion Assessment Record (HMAR modified). The diagnostic accuracy or validity of each index was calculated using the mean opinion of the orthodontic raters as a “gold standard”. Receiver Operating Characteristic curves were plotted for each index. The overall diagnostic accuracy, as determined by percent area under the curve, was similar for each index: IOTN 98.6%; HLD 96.1%; HMAR 96.6%. The score optimizing the sensitivity and specificity relationship for each index was as follows: IOTN (dental health component) 4; HLD 13; HMAR 12. These results indicate that the three occlusal indexes provided valuable information for determining orthodontic treatment need.     

Objective treatment outcome assessment of a completely customized lingual appliance: A retrospective study

ObjectiveTo assess the outcome quality of subjects treated with a completely customized lingual appliance (CCLA) in a postgraduate university program, using the ABO Objective Grading System (OGS), by testing the null-hypothesis of a significant proportion of post-treatment cases exceeding an adjusted ‘exam failure’ threshold value of OGS = 24.Materials and MethodsThis retrospective single-arm study included 66 consecutively debonded CCLA cases (m/f 19/47; mean age: 25.1 ± 9 years) treated at Hannover Medical School (MHH, Hannover, Germany). The discrepancy index (DI) was assessed on initial plaster casts. The OGS of the cast-radiograph evaluation was scored for both set-up and post-treatment casts, including the seven components of alignment/rotation, marginal ridges, buccolingual inclination, overjet, occlusal contacts, occlusal relationships and interproximal contacts, to parameterize differences between those.ResultsDI score distribution (≥ 20, < 20) was 25 (37.9%)/41 (62.1%) subjects. Mean initial DI was 17.3 ± 8.5. Mean set-up OGS was 10.4 ± 4.4 (min-max: 3–21), mean final OGS was 17.7 ± 5.9 (min-max: 7–33), and the difference 7.3 (post-treatment - set-up) was statistically significant (p < 0.0001; 95% CI [5.8, 8.7]). The null-hypothesis was rejected: A statistically significant proportion of the final casts (n = 58; 87.8%) scored below OGS = 24 by exact binomial test (P < 0.0001; 95% CI [77.5%, 94.6%]). The rate of a final OGS score < 24 was not significantly different (P = 0.98) between both DI (≥ 20, < 20) groups.ConclusionsThe outcome quality of the CCLA treatment in this postgraduate university setting was high and therefore sufficient for a vast majority of treated cases to pass the ABO-OGS clinical examination.     

Patient satisfaction after orthodontic treatment combined with orthognathic surgery: A systematic review

Objective:To synthesize available evidence about factors associated with patients’ satisfaction after orthodontic treatment combined with orthognathic surgery.Materials and Methods:Studies that evaluated any factor associated with patients’ satisfaction after the conclusion of an orthodontic treatment combined with an orthognathic surgery were identified. Orthognathic surgical procedures should have been undertaken after completion of craniofacial growth. Any satisfaction psychometric tool was considered. No language limitation was set. A detailed individual search strategy for each of the following bibliographic databases was crafted: MEDLINE, PubMed, EBM Reviews, Web of Science, EMBASE, LILACS, and Scopus. The references cited in the identified articles were also cross-checked, and a partial gray-literature search was undertaken using Google Scholar.Results:Eight articles satisfied the inclusion criteria of this systematic review and accounted for 998 patients. The included studies showed large variation in sample size (range  =  44 to 505 patients), age (range  =  15 to 72 years old), distinct psychological evaluation tools, and time elapsed between the assessment and the completion of surgery and postorthodontic treatment. Most of the studies (five of eight) were classified as having high risk of bias.Conclusion:Factors associated with satisfaction were final esthetic outcome, perceived social benefits from the outcome, type of orthognathic surgery, sex, and changes in patient self-concept during treatment. Factors associated with dissatisfaction were treatment length; sensation of functional impairment and/or dysfunction after surgery, and perceived omitted information about surgical risks.