HISTORY OF LINGUAL ORTHODONTICS - FROM
PAST, PRESENT AND FUTURE
ISSN 2320-3722
Pawan Kumar Bhandari D’, Anbuselvan G J’, Karthi M? =
CORRESPONDING ADDRESS
4. Dr. D, Pawan Kumar Bhandari
Pos! Gractate Student
Dept. of Orinodntcs and Dentofacial Orthopedics,
SR Intute of Dental Science and Research,
Tiruchengode, Namakkal~ 637 215, Tamil Nadu, India,
2, Dr.G.J Anbuselvan
Vice Principal and HOD,
Dept. of Orinodantcs and Dentofacial Orthopedics,
SR Institute of Dental Science and Research
Tiruchengode, Namakkal~ 637 215, Tami Nadu, India,
3. DrMKarthi
Reader, Dep, of Orthodontics and Dentofacial Orthopedics,
KSR Insute of Dental Science and Research
Tiruchongode, Namakkal~ 637 216, Tami Nadu, India,
ABSTRACT
For many years, lingual orthodontics was perceived as extremely complex and problematic and.
therefore not widely used internationally. During the last decade, the percentage of patients treated with
lingual orthodontics has increased and the technique has developed to such an extent that in some
cases, it is easier, quicker, and more accurate than traditional buccal orthodontics. Currently, an,
increasing number of patients, especially young adults, are asking for esthetic alternatives to
conventional orthodontics in the treatment of probiems related to malalignment of the anterior teeth.
This article will endeavor to cover some of the aspects related to individuals and their contributions to,
lingual orthodontics.
KEY WORDS: Lingual brackets, STB Brackets, Incognito.
INTRODUCTION
One of the most important challenges in
‘orthodontics is to attain excellence in treatment
with comfortable and esthetic appliances. From
the esthetic perspective, lingual orthodontics
provides the best option for comprehensive
treatment of most malocclusions while maintaining
{ull tree-dimensional control of the dentition,
HISTORY OF LINGUAL APPLIANCES
The Beginnings: Kinja Fujita, 6 was the
first to develop the lingual multibracket technique
using the mushroom shaped archwire. He
Ree Loe
submitted his concepts on lingual orthodontics in
1967, began his research in 1971, and published
the Fujita method in 1978, treating Class | and
Class II cases with extraction of four bicuspids.
The Fujta bracket had three slots-occlusal,
horizontal, and vertical
EARLY CONTRIBUTORS
Craven Kurz12 with Jim Mulick in 1975,
using plastic bracket bonded to the lingual tooth
surfaces. Apparently an employee of the Bunny.
Playboy Club with crowded teeth came to Craven
Kurz's office asking him for nonvisible orthodonticHISTORY OF LINGUAL ORTHODONTICS - FROM PAST, PRESENT AND FUTURE
treatment, further stimulating his interest in the
subject. Using plastic brackets, it was easy to
reshape them fora better fitto the lingual surfaces;
however, there were many problems, especially
with regard to bonding failures and patient comfort.
Jim Wildman, in 1976 treated the frst patient in the
United States by using a lingual appliance.12
Craven Kurz, developed the first generation
of the Kurz lingual bracket. The brackets were
made up a bite plane, a base pad adapted to the
anatomic characteristics of the lingual surfaces of
the teeth, and a preangulated slot according to the
conversion of the torque used on the labial surface.
In 1990, The Kurz lingual bracket developed and
evolved to the 7th Generation Ormeo Lingual
Bracket.12
The first generation included a bite plane
and rounded margins; hooks were absent and the
bracket was large. The advantages of the bite
plane included: opening the bite anteriorly with
possible repositioning ofthe mandible, extrusion of
molars, intrusion of incisors, and facilitating any
expansion and mesiodistal movement of molars
Uninhibited by occlusal forces. In the second
generation (1980), hooks were added to canine
brackets. In the third generation (1981), hooks
were added to all brackets and to molar tubes. The
fourth generation (1982-1984) included a lower
profile facitating insertion of he archwire. The fith
generation (1985- 1986), included the bite plane
became more pronounced, the torque was
increased, and the molar brackets included an
accessory tube for a transpalatal bar. For the sixth
generation (1987-1990), the hooks were
elongated, the transpalatal bar attachment was
optional, and the binge-cap tube for the second
molar was developed. With the seventh generation
(1990), the square bite plane became rhomboid
shaped, increasing the interbracket distance, and
the premolar brackets were widened mesiodistally
for better rotational control.”
Ree Loe
Ormco founded a Task Forcet, 2
comprising Craven Kurz, Jack Gorman, Bob
‘Smith, "Wick" Alexander and "Moody’ Alexander,
James Hilgers and Bob Scholz, and administrators,
Floyd Pickrel, Ernie Strauch, and Michael Swartz.
Paige10 in 1982, who used Begg light wire
brackets on the lingual surfaces. Lingual lightwire
technique has horizontal slotted unipoint
combination bracket and both round and ribbon
wires.
‘The Enlightenment: The TARG machine12
\was launched by the Ormco Society in 1984 as an
important aid to the laboratory technique, It allows.
the accurate placement of the brackets ata precise
distance from the incisal and occlusal surfaces of
the teeth, as well as making it possible to prescribe
the torque and angulation for each tooth
individually
Didier Fillion? in 1986, developed precise
‘measuring device to the original TARG machine to
allow compensation for the different thickness
between the teeth called as the Electronic TARG.
Creekmore3 (1989) developed a complete
technique with vertical slot lingual brackets,
together with a laboratory system. Creekmore also
designed archwire templates and clinical
instruments,
Stagnation Abounds: Following this initial
development and expansion of lingual
orthodontics in the 1990s, interest, particularly in
the United States, decreased, probably due to the
poor standard of completed cases. The reasons for
this were attributed to inadequate training, poorly
developed laboratory systems, and the
unavailability of preformed archwires. 12HISTORY OF LINGUAL ORTHODONTICS - FROM PAST, PRESENT AND FUTURE
In 1996, Craven Kurz, William Laughlin,
Thomas Creekmore, Jim Wildman, Giuseppe
Scuzzo, Didier Fillion, and Pablo Echarti together
with other clinicians founded the Lingual Study
Group, in Denver, Colorado, with the aim of
relaunching lingual orthodontics, especially in the
United States.
Proliferation Abounds: The American
Lingual Orthodontics Association (ALOA), founded
in 1987 butwhich had been inactive for anumber of
years, was reactivated in 1997 by Mario Paz, John
Napoiitano, and Frank Andolino.
Fillion has continues to play an important
role in the history and development of lingual
orthodontics. He developed European Society of
Lingual Orthodontics (ESLO), Société Francaise
dOrthodontie Linguale (SFOL), British Society of
Lingual Orthodontics (BLOS), and most recentiy
the World Society of Lingual Orthodontics
(WSLO),
In Waly, 1994, Massimo Ronchin13
developed, a self-ligating lingual bracket based on.
the Begg technique. The same company also
developed the Philippe bracket, a simple bracket,
without torque control, but useful for alignment and
leveling
In Germany, Hatto Loidl developed a self-
ligating lingual bracket, Evolution LT. Lingual Self
Ligating Brackets
1. Philippe 2D seltligating lingual brackets by
Forestadent.
2. Forestadent 3D Torque-Lingual self-ligating
brackets.
3, The Adenta Evolution lingual bracket.
4. n-Ovation-L GAC International lingual brackets.
5. Phantom brackets from Gestenco international
(ceramic selfligating)
In Israel, the promoters of lingual
orthodontics are Silvia Geron,8 who developed the.
Lingual Bracket Jig for direct and indirect bonding
in lingual orthodontics, and Rafi Romano, who
edited a book'2 presenting an update on the state
Ree Loe
of the art oflingual orthodontics.
Tae Weon Kim founded the Korean Society
of Lingual Orthodontics (KSLO) and developed the
Model Checker, a bracket positioner, and CRC
Ready-Made Core Trays which togather form the
Korean Indirect Bonding Setup System (KIS
System).11
Hee-Moon Kyung founded the Korean
Lingual Orthodontics Association (KLOA) and
developed the Individual Indirect Bonding
Technique (IIBT), the Mushroom Bracket
Positioner, as well as the Lingual Straight Wire
Technique. He is also well known for the
development of the micro screw implant, a major
advance in the provision of bony anchorage for
both lingual and labial orthodontic techniques, 11
The Japanese Lingual Orthodontics
Association (JLOA) is currenily the largest lingual
orthodonticsociely. Toshiaki Hiro9, who
developed the technique of creating individual
indirect bonding trays for each bracket. The Hiro
system was created by Toshiaki Hiro and improved
by Kyoto Takemoto and Giuseppe Scuzzo.
COMING OF NEWAGE
‘Scuzzo Takemoto Bracket Appliance
(Ormeo Corp)
Giuseppe Scuzz014, the third president of
the ESLO, developed Associazione Italiana de
Ortodonzia Linguale (AIL). Together with Kyoto
‘Takemoto from Japan, developed a prototype of a
lingual straight wire bracket and technique, the
STb (ScuzzofTakemoto bracket, Ormco). The
‘Scuzzo-Takemoto bracket (STb) was developed in
2003 to improve the comfort, speed, and reliability
of lingual treatment. Because the LSW method
requires the brackets to be much closer to the
gingival margins and lingual tooth surfaces,
however, a new STb Light Lingual System bracket,
was introduced in 2009. This bracket represents a
significant advance, because its design facilitates
the use of light forces with reduced fricion and its,
small ize enhances patient comfort.HISTORY OF LINGUAL ORTHODONTICS - FROM PAST, PRESENT AND FUTURE
‘This recently introduced smaller, more
comfortable bracketed appliance siill requires
indirect bracket placement in the manner
developed over the past two decades. The STb
appliance maximizes the inter-bracket distance
‘and uses very light forces to create very rapid initial
alignment. It has been suggested that for certain
non-extraction malocclusions, the STb appliance
may be easily set up on the malocclusion model
without a sophisticated laboratory set-up
procedure. Such a treatment protocol would
reduce laboratory procedures, resulting in lower
laboratory fees, and therefore lessen the cost to
the patient. In an extraction treatment program, the
use of a more sophisticated diagnostic set-up is to,
be recommended,
Incognito Appliance (3M UNITEK)
In Germany, Dirk Wiechmann15 developed
a customized lingual bracket. The Incognito
bracket is perfectly adapted to the lingual surfaces
of the teeth, using a scanned model, the bracket,
base, and the bracket itself is cast as one unit for
each individual tooth. The prescription for tip and
torque is customized according to the
orthodontist’s treatment plan. He also developed a
robot for designing and constructing lingual
archwires perfectly adapted and customized for
each dental arch.
‘This computer-generated appliance uses
three dimensional (3D) computer ‘scanning to
ensure efficiency of tooth movement by designing
brackets and bonding pads specifically for each
individual tooth with the bracket slot in the most
advantageous position on the lingual surface of the
dentition. A series of archwires is then created by a
wire bending robot to achieve the orthodontist's,
treatment goals; bending archwires by hand would
be difficult and reduce the efficiency of this
appliance. These computer-generated lingual
appliances are expensive,
FUTUR
Orapix System:
‘The newest lingual orthodontic laboratory
technique is the Orapix system. Ascannerwill scan
@ patient's model and create a three dimensional
Ree Loe
(3D) data file. The orthodontist will receive the 3D
data file of the patient and a 3-Txer software
package via the Internet. With the 3-Txer software
the orthodontist will visualize a 3D mode! and will
be able to create his own virtual set-up on his
computer for that particular patient. The
orthodontist will decide on the required angulation,
torque, curve of the arch, and any other
adjustments of the occlusion. The main concept
behind this technique is to make use of the precise
bracket positioning produced by the computer
software as opposed to using a technique that is.
dependent on human hands and eyes, as is the
case for mostother techniques.
List of lingual brackets and their manufacturers:
Brackets pe Manufacturer
‘Sleath, Farrony ramnorean OrmoOATES
Zand 30 Lngual rackets | Foretadont
‘Sa Seuzzo Takoma Brackets [Ormco
Tak generation — Karz Formas
Ever aa
Tgvaion, MW E-Cips | Denisa GAC
‘ORG=ORT Eg
Wage Dana
Tinga RAO
Taeal Teo
CONCLUSION
Patient comforts improved by a low-profile,
form-fiting appliance, speech is less affected, and
the tongue less irritated. Currently excellent clinical
results can and are being achieved with lingual
orthodontics. For many patients, due to esthetic
considerations, this is their only choice. This
technique has introduced significant treatment
alternatives in 21st century orthodontics.
ACKNOWLEDGEMENT
Thanks to Dr.S.Dwaragesh for contributing
case photos of a treated lingual appliance patient.HISTORY OF LINGUAL ORTHODONTICS - FROM PAST, PRESENT AND FUTURE
REFERENCE
1. Alexander CM, Alexander RG, Gorman JC, etl
Lingual orthodontics: a status report. Part 1. J Clin,
Orthod 16: 255-62, 1982.
2. Alexander CM, Alexander RG, and Gorman, JC
et al: Lingual orthodontics: a status report. Part 5.
Lingual “mechanotherapy. J Clin Orthod 17:99-
115, 1983.
3.Creekmore TD: Lingual orthodontics—its
renaissance. Am J Orthod Dentofac Orthop
96:120-137, 1988.
4.Echari P: Lingual Orthodontics. Complete
technique, step by step. Barcelona, Nexus
Ediciones, 2003.
5. Fujita K: New orthodontic treatment with lingual
bracket and mushroom archwire appliance. Am J
Orthod 76: 657-675, 1979,
6. Fujita K: Multilingual bracket and mushroom,
archwire technique: a clinical report. Am J Orthod
82:120-140, 1982.
7. Fillgn D: Improving patient comfort with lingual
brackets. J Clin Orthod 31:689-694, 1997.
8, Geron S: The lingual bracket jig. J Clin Orthod
33:457-463, 1999,
9, Laura Buso-Frost Didier Filion. An Overall View
of the Different Laboratory Procedures used in
‘conjunction with Lingual Orthodontics. Semin
Orthod 2006; 12:203-210.
10. Paige SF: A lingual light-wire technique. J Clin
Orthod 16:534-544, 1982.
11. Pablo Echarr. Lingual Orthodontics: Patient
Selection and Diagnostic Considerations. Semin
Orthod 2006; 12: 160-166,
12. Romano R’ Lingual Orthodontics. Ontario, BC
Decker, 1998.
13.Ronchin M: Aesthetics with lingual
orthodlontics. Resolving Class II malocclusion with,
molar distaization. Pract Perio Aesthet Dent 6:51-
58, 1994.
414. Scuzzo G, Takemoto K: Invisible Orthodontics.
Current Concepts and Solutions in Lingual
Orthodontics. Berlin, Quintessenz Verlags-GmbH,
2003.
15.Wiechmann D, Rummel V, Thalheim
AWiechmann L; Customized bracket and
archwires for lingual orthodontic treatment. Am J
Orthod Dentofacial Orthop 124:593-599, 2003,
Ree Loe