lingual set ups
TRANSCRIPT
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LINGUAL SET UPS
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contents Introduction
Why indirect bonding
Lingual bracket systems
Torque Angulation Reference Guide (TARG) system
Bonding with Equal Specific Thicknessn(BEST) system
Customized Lingual Appliance Setup Service (CLASS)
system.
Slot machine
The lingual bracket jig
Transfer optimized positioning (TOP/INCOGNITO iBRACES system)
Korean indirect bonding set up (KIS) system
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Hiro system
Convertible resin core system
Hybrid core system
Simplified technique
Orapix system
Lingual matrix system
Conclusion
References
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INTRODUCTION
Aesthetics has always been a catchword among patients. With
more number of adult patients desiring orthodontic treatment,
special aesthetic demands of the patients pose a greatchallenge to the orthodontic community.
To be able to serve such patients, the orthodontic community
came out with the ultimate aesthetic solution Lingual
Orthodontics.
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At present, Lingual orthodontics is a complete system in itself
and encompasses accurate diagnosis, treatment protocol,
clinical and laboratory procedures.
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In 1975, Dr. Craven Kurz of Beverly Hills, California created
his own lingual appliances by modifying labial edgewise
appliances
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Michael Diamond (J Clin Orthod, 1983) described the critical
aspects of lingual bracket placement as follows:
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1.) Variation in height (y)
has a direct effect on the
labiolingual position of
the bracket (x).
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2.) Variation in tooth
thickness at the same
distance from the incisal
edge affects bracket
placement by varying the
distance from the labial
surface.
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3.) Variation in heightalters the effective
torque in the bracket,
with either a vertical or a
horizontal insertion of
the archwire.
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4.) Brackets placed at the
same height (y) on
different lingual slope
angulations will be
located at various
distances from the incisal
edge (C).
A is greater than B.
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5.) Altering the angle of the
bracket-positioning
instrument can vary the
amount of torque in the
bracket slot.
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To achieve a bracket setup in lingual orthodontics that suits the
individual patient and the treatment objectives of the
orthodontist, proper bracket placement must be planned to
compensate for tooth form and shape; to alter the tip, in-out,
and torque; and to change the bracket position when the
planned movement does not occur.
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Why indirect bonding????
The difficulty in access and lack of easy direct visualization,
the wide anatomical variation of the lingual surfaces of the
teeth, the precision that is required in bracket placement
makes indirect bonding an essential procedure for high quality
lingual orthodontics.
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The most popular bonding systems can be divided into three
major categories:
1. Systems in which the brackets are positioned directly on the
patients pretreatment casts. Although these techniques
minimize laboratory and bonding time, they require expensive
equipment and do not use setup casts, which can be helpful
tools for diagnosis and case presentation.
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2. Systems in which the brackets are initially positioned on a
setup cast with an ideal arch wire, then transferred to the
patients mouth using a mini tray for each tooth. These
eliminate the step of transferring the brackets back to the
initial cast, but increase the time required for bonding.
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3. Systems in which the brackets are initially positioned on a
setup cast, then transferred to the patients initial cast for
fabrication of a transfer tray. This is a simple, effective method
that reduces chair time in bonding, but requires a precise
transfer of the brackets from the setup cast to the initial cast.
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LINGUAL BRACKET PLACEMENT
SYSTEMSThese include:
1. Customized Lingual Appliance Setup Service (CLASS)
system.
2. Torque Angulation Reference Guide (TARG) system
3. Bonding with Equal Specific Thicknessn(BEST) system
4. Slot machine
5. The lingual bracket jig
6. Transfer optimized positioning (TOP/INCOGNITO i
BRACES system)
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7. Korean indirect bonding set up (KIS) system
8. Hiro system
9. Convertible resin core system
10. Hybrid core system
11. Simplified technique
12. Orapix system
13. Lingual matrix system
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The Customized Lingual Appliance Setup
Service (CLASS) system
Described by Scott Huge, this technique involves an integrated
method of lingual bracket placement and indirect bonding.
Method:
- An ideal setup is made from the original malocclusion cast and
brackets are placed on this setup.
- This ideal set-up or template is then used as a physical guide to
place the lingual brackets in an ideal configuration.
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27Brackets transferred from setup model to malocclusion model
CLASS METHOD
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Advantage
It takes into account the anatomical discrepancies in the
lingual surfaces of the teeth.
Disadvantages
Demands maximum accuracy from the original models &
instructions provided by the clinician.
Tremendous attention to detail must be exercised at all steps to
avoid inaccuracies in bracket placement.
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Torque angulation reference guide (TARG)
This technique of bracket placement was developed by Ormco
in 1984.
It permits bonding of brackets in the laboratory, at an accurate
distance from the occlusal edge of each tooth with respect to a
horizontal reference plane.
A labial reference gauge is used to orient individual teeth.
Using only one unique angulation model, the TARG allows
pre-programming of tip and torque before the start of
treatment.
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Torque AngulationReference Guide.
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Advantages:
- It is an accurate and quantified two-dimensional system.
- Allows accurate placement of the brackets on the cast without
need to cut out the teeth and place in wax.
Disadvantages:
- The system does not take into account the labio-lingual
thickness of teeth.
- The distance of the bracket base and the labial surface varies
according to the level of bonding & tooth type.
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Fillions Lingual Indirect BondingSystem
This system was developed by Dr. Didier Fillion of France in
1987.
Also known as Bonding with Equalized Specific Thickness
(BEST).
It was designed to consider the labio-lingual thickness of the
individual teeth during bracket placement.
A caliper is added as the thickness measurement system.
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Permits us to avoid all first-order
bends, except the ones between the
cuspids and bicuspids and between
the bicuspids and molars. This
considerably reduces chairtime
during archwire bending.
Everything is measured and
registered: height, angulation(tip),
torque, and thickness.
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Transfer system
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DALI
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DALI program
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(DALI= Dessin Arc Linguale Informatise)
1. It permits us to obtain an extremely
accurate tracing of the finishing arch
wire, at a 1:1 ratio.
2. It allows us to know with a very high
accuracy (with 0.1 mm) the width of
the first-order bends placed betweenthe cuspids and bicuspids, and
between the bicuspids and molars.
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Individualized archwire template produced by the DALI program
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3. During treatment, it allows us to know the ideal arch shape
needed to achieve a good occlusion, especially in asymmetric
cases.
4. It permits us to preform all archwires with great precision,
except for the first ones which are bent from the copy of the
bonded brackets on the initial model.
5. It is not necessary to coordinate the archwires during
treatment because the drawing of the upper and lower
archwires are made from the same labial arch curves.
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Advantages:
Easy and accurate
Reduces chairtime, increases clinical efficiency
Standardisation of the thickness decreases first order bends
except between cuspidbicuspid and bicuspidmolar.
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The Slot Machine
Introduced by Dr.
T.D.Creekmore in 1986, the
Slot Machine was meant to be
used with the Conceal bracket
system.
It also used a labial reference
to position the brackets like
the TARG machine.
49Laura Buso-Frost;Dider Fillion : An overall view of the different laboratory procedures used in conjunction with
lingual orthodontics : seminars in orthodontics :vol 12 ,no3,2006,203-210
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The procedure consists of positioning each tooth to a
prescribed torque and angulation; the machine orientates the
bracket slot with the Andrews labial archwire plane (LAplane).
The slot machine can be used for the placement of brackets
having either horizontal or vertical access archwire slots.
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Advantage
No model tooth set-up is required
DisadvantageDifficulty in managing the many pieces of the slot machine
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Lingual Bracket Jig
Dr. Silvia Geron in 1999 introduced lingual bracket jig which
is a chairside direct bonding system.
It is used witha horizontal slot bracket.
The basic idea behind the lingual bracket jig (LBJ) is that
lingual tooth anatomy and inter-tooth relationships are
amenable to a lingual preadjusted edgewise approach.
52Geron S: The lingual bracket jig. J Clin Orthod 33:457-463, 1999
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The jig transfers the Andrews Straight-Wire Appliance labial
bracket prescription to the lingual surface. Thus, the bracket
slots line up around the arch, parallel to one another and to the
occlusal plane, while the prescription provides tip, torque,
rotation, and in-out.
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The LBJ consists of:
A set of six jigs, one for each
of the six maxillary anterior
teeth,
An accessory universal LBJ for
the maxillary posterior teeth
(no torque or angulation
prescribed).
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LBJ transferslabial bracket prescriptions to lingual brackets55
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The tip of the labial arm incorporates a prescription, similar tothat of a preadjusted labial bracket.
The lingual arm, which holds the lingual bracket, slides into
the labial arm.
When the lingual bracket is mounted on the LBJ, the lingual
bracket slot is parallel to the labial slot. When the labial arm is
positioned correctly, the lingual bracket is automatically
placed in its correct position.
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A. Labial arm of LBJ
positioned on labial surfaceof tooth, duplicating
location of labial bracket
relative to LA point.
B. Lingual bracket
automatically placed in
correct position.
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Advantages:
- Lingual bracket positioning with the LBJ is simple and quick,
and requires no special training.
- The LBJ automatically incorporates the Straight-Wire labial
prescription into the bonded lingual brackets in all dimensions.
- This allows the orthodontist to perform direct as well as indirect
bonding as in-office procedures.
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Disadvantages
limited number of prescription jigs available
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Transfer Optimized Positioning
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Transfer Optimized Positioning
(TOP/INCOGNITO i BRACES system)
Developed byDirk Wiechmann
The TOP system uses a set-up technique similar to that used for
the BEST system, allowing the brackets to be placed directly
on the malocclusion model.
The technique uses the TARG Professional, which has a
bracket holder for twin brackets and tubes, modified reference
arm in addition to the horizontal and vertical measuring
systems first described by Fillion.
60Dirk Wiechmann : Lingual orthodontics (part -1) :Laboratory procedure ; J orofac orthop ;1990;60:371-9
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Unlike other techniques, there are no thick resin bases for
compensation of thickness differences; these differences need
to be compensated for by archwire bending.
The archwires sequence for each case is produced
automatically by a computer-controlled bending robot .
Most of the work is delegated to laboratory staff, thus
reducing chairside time.
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K I di t B di S t (KIS)
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Korean Indirect Bonding Set-up (KIS)
System
The KIS system was developed by members of the Korean
Society of Lingual Orthodontics (KSLO) and uses a bracket-
positioning machine that allows the positioning of all brackets
at once .
Once again it is necessary to create a set-up model; however,
the set-up is created with the help of a special set-up model
gauge for increased precision.
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Advantages
It is a very precise system that places the bracket accurately
and eliminates the need for any bracket repositioning during
treatment.
It allows for bracket height differences between anterior and
posterior teeth, which facilitates the intrusion of anterior teeth.
Overall, its accuracy assists the clinician in attaining a high
standard of treatment.
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Hiro system
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Hiro system
(Modified CLASS technique)
Introduced by Hiro and later improved by Takemoto andScuzzo.
Method:
- An ideal archwire is made on the setup using a full size
rectangular archwire.
- The lingual brackets are transferred onto this wire and secured
with elastic ligatures.
- Single rigid transfer trays are fabricated for each tooth.
69Scuzzo G, Takemoto K: Hiro System Laboratory Procedure, in Scuzzo G, Takemoto K (eds): Invisible orthodontics:
current concepts and solutions in lingual orthodontics. Germany, Quintessense 39-44, 2003
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Advantages:
- There is no need to transfer brackets from the setup model to the
original malocclusion model.
- Accuracy is improved due to individual transfer trays.
- Bonding of one tooth is not affected by position of other teeth.
- Rebonding is easier.
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Convertible resin core system
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Convertible resin core system
The most significant challenges involved in indirect bonding
for lingual orthodontics have been:
o Keeping the brackets stable enough for precise positioning
o
Making it easy to remove the indirect transfer tray.
o Bonding in areas with difficult access.
o Using the same materials for accurate rebonding when
necessary.
75Kim T, Bae G, Cho J: New indirect bonding method in lingual orthodontics: convertible resin core system. J ClinOrthod 34:348-350, 2000
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This system uses hard resin to prepare the individual transfer
trays and an elastomeric ligature to hold the tray and bracket
together.
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Advantages
This allows accurate repositioning of the bracket within theresin core and the trays can be reused in cases of bracket
failure.
Disadvantages
The use of unitary trays makes the initial bonding session
longer and the technique still relies on a set-up model to
position the brackets.
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Hybrid core system
The Hybrid Core system developed byMatsunocombines thefavorable properties of silicone and composite resin in the
construction of its indirect transfer tray.
Silicone covers the bracket and this in turn is covered by
composite resin.
This combination allows for stable positioning of the transfer
tray within the mouth, followed by easy removal of the
silicone component from the bonded bracket.
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Matsuno I, Okuda S, Nodera Y: The hybrid core system for indirect bonding. J Clin Orthod 37:160-161,2003
A groove guided indirect transfer system
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A groove guided indirect transfer system
for lingual brackets
Prieto et al in 2005 described this procedure using a red
duralay resin for the bracket transfer.
The key improvement is a change in the position of the red
DuraLay resin: Instead of being placed at the center of the
bracket pad, the resin is applied more incisally or cervically,
depending on the tooth, thus freeing the bracket from potential
interference.
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Prieto, Ishikawa & prieto;A groove guided transfer system for lingual brackets; J Clin Orthod 2007 ;34;372-376
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The Ray Set system
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y y
This system utilizes a 3-dimensional goniometer for analysis
of the first-, second-, and third-order values of each individual
tooth.
Both pre- and post-setup values of individual teeth are
evaluated and the amount of orthodontic tooth movement for
each tooth on the setup model is calculated.
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The RAY SET device (a) with a 3D goniometer(b)
Th M h B k t P iti
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The Mushroom Bracket Positioner
Developed by Kyung et al, in 2002, the mushroom bracket
positioner is a machine for accurate bracket placement on an
ideal setup.
At present, 5th generation of MBP is available which places
brackets to accept a straight wire.
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Simplified techniq e
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Simplified technique
Simplified Technique The Simplified Technique is associated
with the development of the new STb brackets. The brackets
are positioned directly on the malocclusion model by using a
bracket placement plier or simple tweezers.
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ORAPIX SYSTEM
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ORAPIX SYSTEM
Orapix System The newest lingual orthodontic laboratorytechnique is the Orapix system.
This system developed in South Korea by the company of the same
name ,it is distributed in Europe by Eurapix.
Orapixis at first a system of digitalization which transforms the
information of a pair of impression or a pair of plaster models into
3D digital data.
97Didier Fillion : Lingual straightwire treatment with the orpix system: J Clin Orthod 2011: 11 :448-497
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Orapix, it is also a system of bracket placement on fully
individualized virtual set-up and manufacturing of Jigs of
transfer by the technology CAD / CAM.
The Orapix straight-wire system , worked out by Dr Didier
Fillion, facilitates considerably the lingual technique because
it allows the use of straight wires without bend.
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Lingual matrix system
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LINGUALMATRIX is the first and only system in the world
that involves fully digital process developed by Praveen shetty
& Manjul jain.
Treatment plan starts with 3D scanning of u/I models using 5
axis optical white light scanner.
Thereafter, LINGUALMATRIXmoves each tooth to its ideal
position either virtually / manually.
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LINGUALMATRIX software produces a cad model of
lingual bracket with a customized base. Which undergoes a
very precise manufacturing process using avant-grade laser
sintering machine to manufacture a customized single piece
3D lingual bracket that adapts seamlessly to the shape and
contour of the teeth.
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The automation & digitization of the entire system assures the
perfect finish and smile, with minimum physical and mental
fatigue.
This system develops a single piece customized bracket which
fits perfectly on to the teeth, facilitating direct bonding and re
bonding of detached brackets.
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Advantages
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g
Lingual matrix offers one of the most Economical cad cam
based customized bracket in the world.
A single piece 3D lingual bracket system
A State of the art manufacturing process from virtual setup to
laser sintered 3D brackets.
Choice of using straight arch to mushroom shaped archwire
as per the demand.
Horizontal slot opening for better bio-mechanical control.
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Add or delete hooks on Brackets as per requirement.
LINGUALMATRIX can reprint bracket at any point of time
with prescription.
Ease of rebonding due to single piece metal bracket.
LASER etched marketing system for easy identification.
Versatility of using different form, features and sizes of
brackets as per the occlusion and requirement of the case.
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References
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Laura Buso-Frost;Dider Fillion : An overall view of the
different laboratory procedures used in conjunction with
lingual orthodontics : seminars in orthodontics :vol 12
,no3,2006,203-210
Romano : Lingual orthodontics
Geron S: The lingual bracket jig. J Clin Orthod 33:457-463,
1999
Wiechman D: Lingual Orthodontics (part 1): laboratory
procedure. J Orofac Orthop 60:371-379, 1999
109
Weichmann D: Lingual Orthodontics (part 2): arch wire
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fabrication. J Orofac Orthop 60:416-426, 1999
Geron S, Romano R: Bracket positioning in lingual
orthodonticscritical review of different techniques. Korean J
Clin Orthod 2:39-44, 2003
Scuzzo G, Takemoto K: Hiro System Laboratory Procedure, in
Scuzzo G, Takemoto K (eds): Invisible orthodontics: current
concepts and solutions in lingual orthodontics. Germany,
Quintessense 39-44, 2003
Prieto, Ishikawa & prieto;A groove guided transfer system for
lingual brackets; J Clin Orthod 2007 ;34;372-376 110
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