Achieving Clinical Success in Lingual Orthodontics Julia Harfin Augusto Ureña 123 Achieving Clinical Success in Lingual Orthodontics Julia Harfin • Augusto Ureña Achieving Clinical Success in Lingual Orthodontics Julia Harfin Department of Orthodontics Maimonides University Buenos Aires Argentina Augusto Ureña Department of Orthodontics Maimonides University Buenos Aires Argentina ISBN 978-3-319-06831-2 ISBN 978-3-319-06832-9 DOI 10.1007/978-3-319-06832-9 Springer Cham Heidelberg New York Dordrecht London (eBook) Library of Congress Control Number: 2014952676 © Springer International Publishing Switzerland 2015 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer Permissions for use may be obtained through RightsLink at the Copyright Clearance Center Violations are liable to prosecution under the respective Copyright Law The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made The publisher makes no warranty, express or implied, with respect to the material contained herein Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To Luis whose unconditional support and dedication made this possible To my daughters Viviana, Nora, and Adriana; to my sons-in-law Gabriel (!), Javier, and Hugo; and to my grandchildren Ari, Damian, Esteban, Nicolas, and Emma for understanding the time that could not be shared To my students that encouraged me to continue teaching and to my professors for having given me their knowledge and wisdom and for showing me that study and hard work are the only way to fulfill our dreams Julia Harfin God, for blessing me once again To my parents and brothers for their unconditional support over the years To my students, for the constant feedback and reciprocity in learning Dr Harfin Julia, my mentor, for allowing me to travel along this wonderful experience in Lingual Technique for 24 years and share a passion for orthodontics To all working colleagues, for a world without borders and to all who dare to cross them So blessed!! Augusto Ureña Preface This book was written with the intention of helping and encouraging orthodontists to use lingual appliances without recurring to expensive outside laboratories It provides detailed descriptions of procedures step by step, and it will enable orthodontists the best results in a very simple and predictable manner Why lingual orthodontics? In general, many adolescents and adults not seek orthodontic treatment because they not like to use “outside braces”, even though they are aesthetic (plastic, ceramic, zafiro, etc.) Today, the lingual technique is a very successful approach to treat all types of patients (children, adolescents, and adults), no matter what type of the initial malocclusion or the amount of periodontal attachment After comparing all the aesthetic appliances, lingual orthodontics is the most aesthetic and can be considered the truly invisible appliance (Poon 1998; Chatoo 2013) Normally lingual patients make more aesthetic demands during the whole treatment, but after a few months, when they observe the results, they are very collaborative, and they highly recommend this treatment to their friends Although there is an adaptation period, the patient’s enthusiasm about the invisible braces seems to help them to go through the first speech difficulties (Miyawaki 1999; Wiechmann 2008) After no more than 10 days, the patient can speak and eat without any difficulties, and they strongly appreciate the improvement of their selfimage since they never consider using classic labial orthodontics at this age (Fillol 1997, 1998) There is no need for special instruments when using the lingual technique, but taking into account the reduced interbracket distance and the small dimension of the brackets, it is easier to use angulated pliers Angled heads facilitate access to the lingual surfaces, especially at the bicuspid and molar areas, and long handles improve visibility in the lateral zones Due to the variability of the lingual tooth anatomy and the difficulty in viewing the palatal or lingual surfaces of the teeth, indirect bonding is mandatory Careful and precise indirect bonding allows total control of first- and third-order tooth movement and also the torque that is more difficult to achieve due to the reduced interbracket distance (Gorman and Smith 1991) vii viii Preface The set-up laboratory procedure is one of the most reliable The correct position of the brackets is the cornerstone to achieve successful treatment outcomes A comprehensive understanding of lingual biomechanics is imperative to obtaining successful results (Kurz 1998; Harfin and Ureña 2010) From the biomechanical point of view, one of the main differences between labial and lingual brackets is the interbracket distance, which plays an important role in relation to the amount of force exerted by the orthodontic wires A small reduction in the slot width can increase the elasticity of the wire, and, as a consequence, lighter forces are used (Smith 1986; Kusy 2000) It has been well established that dental plaque represents a risk factor in the progression of periodontal disease The installation of lingual orthodontic appliances increases the amount of palatal and lingual plaque, which results in the formation of gingival hyperplasia and pseudopockets Sometimes, this situation changes the subgingival ecosystem and facilitates the inflammatory response of the periodontal tissues In order to control or avoid gingivo-periodontal problems, it is important to inform the patient how he/she has to control it, and the orthodontist has to reinforce oral hygiene at every appointment Also, root resorption is not higher when using lingual appliances It is important that the periodontal status of every patient should be evaluated before treatment begins and periodically during the whole orthodontic treatment In combination with an accurate diagnosis and treatment planning, it is ideal to use a bracket-wire system that gives us the possibility of reducing force and friction, improving rotation control, obtaining easier sliding mechanics, lowering patient discomfort, and reducing chair and treatment time It is possible to achieve the same high standard in the finishing stages as when labial brackets are used Buenos Aires, Argentina Buenos Aires, Argentina Julia Harfin Augusto Ureña Bibliography Chatoo A A view from behind: a history of lingual orthodontics J Orthod Suppl 2013;51:S2–7 Fillol D Improving patient comfort with lingual brackets J Clin Orthod 1997;31:689–94 Fillol D The resurgence of lingual orthodontics Clin Impression 1998;7:2–9 Gorman JC, Smith RJ Comparison of treatment effects with labial and lingual fixed appliances Am J Orthod Dentofacial Orthop 1991;99:202–9 Harfin J, Ureña A Ortodoncia Lingual: procedimientos y aplicación clinica Buenos Aires: Editorial Médica Panamericana; 2010 Kurz C, Romano R Lingual orthodontics: historical perspective In: Romano R, editor Lingual Orthodontics Hamilton: BC Decker; 1998 p 3–20 Kusy RP Ongoing innovations in biomechanics and materials for the new millenium Angle Orthod 2000;70:366–76 Preface ix Miyawaki S, Yasuhara M, Koh Y Disconfort caused by bonded lingual orthodontic appliances in adult patients as examined by retrospective questionnaire Am J Orthod Dentofacial Orthop 1999;115:83–8 Poon KC, Taverne AA Lingual orthodontics: a review of its history Aust Orthod J 1998;15:101–4 Smith JR Gorman JC, Kurz C, Dunn RM Keys to success in lingual therapy J Clin Orthod 1986;20:252–61 Wiechmann D, Gerb J, Stamm T, Hohoff A Prediction of oral discomfort and dysfunction in lingual orthodontics A preliminary report Am J Orthod Dentofacial Orthop 2008;133:359–64 166 Finishing Insofar, it is better to break the adhesive bond in the adhesive-bracket interface (Fig 8.2a, b) a b Fig 8.2 (a, b) Composite remains over the palatal surface of the teeth The final procedure is the removal of the adhesive remnants from the tooth surfaces, avoiding enamel iatrogenic damage (Oliver and Griffiths 1992) The most common removal technique uses a low-speed handpiece with a round or barrel tungsten carbide bur It is recommendable not to use water for better contrast between the adhesive and the enamel (Fig 8.3a, b) a b Fig 8.3 (a, b) Burs with a low-speed handpiece to remove adhesive remnants Finishing 167 After that, a careful enamel polishing is necessary, avoiding gingival tissue bleeding (Fig 8.4) Fig 8.4 Different types of burs to polish the enamel It is highly suggested that the retention wire has to be bonded at the same moment the brackets were removed The same procedure has to be made in the lower arch The same removal plier as in the upper arch is used in the lower arch (Fig.8.5a, b) a b Fig 8.5 (a, b) Debonding brackets in the lower arch 168 Finishing After a careful enamel polishing, 37 % etching gel acid for 30″ was placed with an applicator brush, avoiding contact with the gingival tissues Rinse thoroughly with air-water spray and suction using high-speed evacuator It is important to maintain a completely dry field not allowing the patient to contact the etched enamel with saliva After that, the enamel has to be dried with clean air The result is an enamel with a frosty appearance A small amount of sealant with a small brush has to be placed on the etching enamel surface (Fig 8.6a, b) a b Fig 8.6 (a, b) Frosty appearance of the enamel before sealant is placed A 0.0195″ dead soft Respond wire (Ormco) is highly recommended as a lingual or palatal retainer It is easy to adapt to the lingual or palatal surfaces with a lightcure flow composite (Fig 8.7a, b) a b Fig 8.7 (a, b) A dead soft Respond wire was bonded with flow adhesive Finishing 169 It is highly advisable to remove the composite excess before light-curing the surface After that, fluoride topics, varnish, or fluoride mouth rinse is suggested The patient can drink or eat right after (Fig 8.8a, b) a b Fig 8.8 (a, b) Upper and lower retention wire in place Bonded lingual retainers are highly effective and reliable in maintaining the alignment of severely crowded teeth with the benefits of good esthetics, comfort, easy to fabricate, and low cost After 10–12 weeks later than the appliances were removed, occlusal points should be controlled to avoid premature interferences that could cause functional deviations It is important to consider dental and skeletal stability in all three dimensions: vertical, sagittal, and transverse In each one of them, the recurrence of the initial problem is a sign of instability of the orthodontic treatment (Geron 2006) An individualized and exhaustive diagnosis and treatment plan is the only way to avoid difficulties during the finishing process After bonding the retainers, there are other considerations to keep in mind Among them there is one that is very important for the patient: cosmetic appearance As Dr Vincent Kokich said, we have to consider facial and dental esthetics when setting treatment objectives It is necessary to visualize where the treatment is headed from the esthetic point of view, especially with peg-shaped lateral incisors or when lateral incisor agenesis is present One of the most important esthetic considerations is the size and proportion of the anterior teeth The width of the upper central incisors can vary from 8.3 to 9.3 mm and its length from 10.3 to 11.2 mm The proportion between the width and the length is approximately 80 %, and the same proportion is taken into account for the upper lateral incisors 170 Finishing The width of the teeth is normally maintained without significant changes; however, where the length is concerned, the following formula can be applied to determine the ideal proportion (Fig 8.9a, b): width ´100 80 Length = width ´1.25 Length = a b Fig 8.9 (a, b) Ideal tooth proportions (Courtesy Dr Juan Cruz Gallego) In relation to the width of the lateral incisors, it should be 66 % of the width of the central incisors All this information should be gathered before the treatment plan is made Provisional restorations should be prepared before orthodontic treatment starts and final ones after the orthodontic treatment ends The normalization of the periodontal tissues after the orthodontic treatment has to be another important goal It is difficult to place the brackets in the correct position when the anterior teeth are shorter due to passive eruption of the gingival tissues Finishing 171 A gingivoplastic procedure is recommended before the orthodontic treatment begins in order to normalize the length of the anterior teeth (Fig 8.10a–c) a b c Fig 8.10 (a–c) Before, during, and after the gingivoplastic procedure (Courtesy Dr Juan Cruz Gallego) When the periodontal biotype is thin, some dehiscences would be present during the treatment (Fig 8.11a, b) a b Fig 8.11 (a, b) Pre- and during orthodontic treatment, the dehiscence on the right canine is clear (Courtesy Dr Juan Cruz Gallego) 172 Finishing In some cases, a post-orthodontic treatment gingival graft is required to normalize the height of the gingival margin (Fig 8.12a, b) a b Fig 8.12 (a, b) During and weeks after the gingival graft (Courtesy Dr Juan Cruz Gallego) To achieve a highly esthetic goal, the reconstruction of a narrow lateral incisor is required Dental porcelain veneers are the best solute (Fig 8.13a, b) a b Fig 8.13 (a, b) Pre- and post-reconstruction with a porcelain veneer of the right upper lateral incisor to obtain ideal tooth proportion (Courtesy Dr Juan Cruz Gallego) Conclusions The initial correct position of the brackets is fundamental to obtain a correct alignment of the gingival margin and bone height, especially in adult patients Otherwise, some bends have to be performed to intrude or extrude the teeth to achieve a correct smile “It takes a great deal of time and effort to correct unwanted side effects in lingual treatment It is much easier to avoid than to correct the mistakes” (Geron 2006) The reposition of the anterior brackets at the end of Phase I and Phase II is always recommendable to minimize wire bending during the finishing process Bibliography 173 Full engagement of the last archwire in the bracket slot is necessary to express the right torque at the beginning of Phase III to allow full expression of the prescription and in this way reduce treatment time It is important to remember that the dentition will continue to change little by little even during the retention period and the relapse of the mandibular anterior segment during the postretention period is one of the most predictable Long period of time of retention is one of the best suggestions in all these patients Bibliography Geron S Finishing with lingual appliances, problems and solutions Semin Orthod 2006;12:191–202 Hilgers JJ Functional finishing The concept, the tools, the techniques Clin Impressions 1996;5:8–13 Oliver RG, Griffiths J Different techniques of residual composite removal following debonding: time taking and surface enamel appearance Br J Orthod 1992;19:131–7 Rummel V, Weichmann D, Sachdeva RC Precision finishing in lingual orthodontics J Clin Orthod 1999;33:101–13 Zachrisson BU, Artun J Enamel surface appearance after various debonding techniques Am J Orthod 1979;75:121–37 Summary and Outlook Lingual orthodontics is here to stay An increasing number of adults, adolescents, and children consider it the only alternative to orthodontic treatment They don’t settle for the professional opinion of a single doctor who might not recommend it for their particular treatment Quite the contrary, keeping their objective in mind, they tend to seek out doctors who use this technique That is why this treatment option should be available to patients in all offices It is possible to assure that the results obtained by using lingual orthodontics is as good as those obtained with labial orthodontics and that once treatment has ended, it is difficult to determine what type of technique was used (Harfin and Ureña 2010) Since the objective of this book is to provide a simple and efficient way to treat patients with lingual brackets without depending on expensive and outside laboratories, step-by-step procedures are described in each chapter (Harfin and Ureña 2010; Hiro 2011) Today adult patients are looking for more and more invisible orthodontics to treat not only simple but severe malocclusions too, no matter the amount of periodontal attachment that was present As the orthodontist is the one who decides the best treatment plan for the patient, he/she determines the best position and inclination of the teeth It is totally accepted that the indirect method not only increases safety and reduces chair time but also improves efficiency and efficacy The degree of speech problems or other signs of discomfort during the first week is bearable After that, the patient doesn’t have any more inconveniences during the rest of the treatment In some cases, the lingual technique can even be a better choice to labial orthodontics, not only because it is totally invisible but also because it may present greater advantages from the biomechanical point of view (deep overbite, diastemata, etc.) (Romano 2011) © Springer International Publishing Switzerland 2015 J Harfin, A Ureña, Achieving Clinical Success in Lingual Orthodontics, DOI 10.1007/978-3-319-06832-9_9 175 176 Summary and Outlook To achieve optimum results in a reasonable period of time, the exact positioning of the brackets is mandatory Future ???? In the future, lingual orthodontic treatment would be considered a routine treatment technique The ideal bracket has to be designed taking into account the following features: Small dimensions, reduced thickness, and mesiodistal dimension to improve patient’s comfort with minimum speech and mastication discomfort Large bonding surface for bracket stability Large interbracket distance Smooth surfaces Easy archwire insertion Easy ligation Easy hygiene maintenance At the present time, totally individualized brackets and wires are available, but until now, they are a lot more expensive (Weichmann et al 2008) New alloys of wire with controlled memory are also welcome The use of smaller brackets improves patient comfort, with less speech disturbance and better oral hygiene possibilities The combination of lingual brackets and the use of micro-implants for temporary orthodontic anchorage is an effective way to achieve absolute anchorage When reciprocal or minimal anchorage is needed, other classic methods can be used (Nance button, transpalatal bar, etc.) When deciding on the treatment and retention plan, it is very important to take the relationship between the upper lip, the gingival line, and the smile line into account Nowadays, there is an increased tendency to investigate accelerating methods for tooth movement (Liou and Huang 1998) Among them piezocision technique is considered one of the most controlled But the most interesting and important aspect will be the new advances in the genetic field and how orthodontic movement can be improved and accelerated by managing the osseous turnover Some clinical investigations have demonstrated that this hypothesis is totally possible nowadays The future will be based in these new, ambitious, and incredible paths, and the results are not far (Nimeri et al 2013) Today, it is possible to confirm that the treatment results obtained with lingual appliance are similar to the results achieved with labial brackets (Harfin and Ureña 2010) Lingual orthodontic is the only invisible treatment; also it is safer for labial enamel too and makes an important contribution to patient quality of life Long-term retention is the only way to maintain the results that were achieved as minor changes after orthodontic treatment seem to be the norm and should be accepted As it was demonstrated, there is no positive relation between the types of Bibliography 177 malocclusions and post-treatment changes but the relapse in the mandibular anterior segments is one of the most predictable results The cases presented in this book clearly demonstrated that it is possible to achieve excellent results with facial harmony and a pleasing profile by using brackets placed on the lingual or palatal surfaces of the teeth Since no special equipment is needed, all the orthodontists can easily manage this technique in their offices It is important to take into account that correct positioning of maxillary and mandibular incisors is vital to optimum function, stability, and esthetics Excellence in orthodontic lingual treatment demands an exhaustive diagnosis, treatment, anchorage, and retention plan in concordance with an organized biomechanics Bibliography Harfin J, Ureña A Ortodoncia Lingual: procedimientos y aplicación clinica Buenos Aires: Editorial Médica Panamericana; 2010 Hiro T Indirect bonded technique in lingual orthodontics: the Hiro system In: Romano R, editor Lingual and esthetic orthodontics London: Quintessence; 2011 p 239–54 Liou EJ, Huang CS Rapid canine retraction through distraction of the periodontal ligament Am J Orthod Dentofacial Orthop 1998;114:372–82 Nimeri G, Kau C, Abou-Kheir N, Corona R Acceleration of tooth movement during orthodontic treatment- a frontier in orthodontics Prog Orthod 2013;14:42–9 Romano R Future of the lingual orthodontics technique In: Romano R, editor Lingual and esthetic orthodontics London: Quintessence; 2011 p 681–4 Weichmann D, Gerss J, Stamm T, Hohoff A Prediction of oral discomfort and dysfunction in lingual orthodontics A preliminary report Am J Orthod Dentofacial Orthop 2008;133:359–64 Index A Anchorage control anterior torque loss, 31 classification, 28 Mathieu thin-end plier, 34 micro-implants, 30 Nance button, 28, 29 occlusal plane align and torque expression, 31 omega loop, 35, 36 posterior lateral sectional alignment, 33 pre-extraction posterior alignment, 32 reverse curves, 32 sliding mechanics retraction, 33 Anterior crowding See Lower anterior crowding B Biomechanics anchorage control, 28–36 coil springs use, 21–23 elastics use, 37–39 indirect bonding brush, low-speed handpiece, 12 cheek, lip, and tongue retractors, 12 dry air syringe, 13 individual transfer cap, 14 light-cure bonding agent adhesive, 13 molar transferring cap, 14 palatal and lingual tooth anatomy, 11 plication, 13 laboratory procedures, 3–11 ligation approaches, 14–15 lingual bracket reposition, 39–43 lingual utility arch, 17–18 partial canine retraction, 20–21 phase I, 16–17 phase II, 28–36 phase III, 44 quad helix use, in lingual orthodontics, 19 rotated teeth correction, 23–28 silicone impression, 1–3 transverse control of position, upper first molars, 43–44 Brackets alignment phase, 136 debonding, 167 front and occlusal photographs, 155 ideal features, 176 inserts with elastomeric ligatures, lateral views with, 156 removal, finishing process, 165 reposition, lingual, 39–43 Brush, low-speed handpiece, 12 C Cephalometric evaluation, upper incisors proclination, 135 Class I canine and lateral occlusion, 142 Class II elastics to achieve class I canine, 158 occlusion improvement, 147 pendulum usage, lingual appliances, 104, 105 pre-and post right side, 163 remnant lower absent molars spaces, 148 Coil springs use, 21–23 Crowding deep overbite, 61 lower anterior (see Lower anterior crowding) © Springer International Publishing Switzerland 2015 J Harfin, A Ureña, Achieving Clinical Success in Lingual Orthodontics, DOI 10.1007/978-3-319-06832-9 179 180 D Deep overbite Bolton-positive discrepancy, 72 central incisors, 68 cephalometric analysis, 62 class II elastics, 71 clinical examination, 60 etiology, 59 frontal and occlusal view, 70 indirect bonding, 62 interincisal diastema, 71 photographs pretreatment buccal front, 60 pretreatment panoramic, 62 positive discrepancy, 68 posterior teeth, extrusion, 60 pre-and post-Ricketts analysis, 67 pre-and post-treatment smile, 68, 72 prevalence, 59 treatment class I molar, lateral views, 64 lateral views at beginning, 61 Ni-Ti 0.013'' archwire, 63 Ni-Ti-Cu archwire, 63 objectives, 62, 66, 70 optimal buccal occlusion, 65 protocol, 59 radiographs, panoramic and lateral, 67 TMA archwire, 64 upper and lower arches, 65 upper and lower fixed retention, 66 E Elastics class II (see Class II elastics) intermaxillary, 112 open bite malocclusions use chains, 83 at night, 94 use, 37–39 Esthetic composite buttons, 159 F Finishing process adhesive remnants removal, 166 bonded lingual retainers, 169 brackets removal, 165 composite remains, 166 debonding brackets, 167 enamel polishing, 167 gingival graft, 172 gingivoplastic procedure, 171 periodontal biotype, 171 Index porcelain veneer, pre-and post-reconstruction, 172 teeth width, 170 G Gingivoplastic procedure, 171 I Impacted canines brackets, 123 distal canine and mesio-molar bends, 124 front and occlusal photographs, 127 gingivo-periodontal tissues, 126 lingual ballista, 121 Ni-Ti coil spring, 128 occlusal photograph and radiograph, 122 pretreatment panoramic and occlusal radiograph, 126 prevalence, 119 resorption, 119 simple and controlled mechanics, 130 smile and the panoramic radiograph, 125 surgical protocol, 119 temporary crown, 123 treatment, 119 wire ligature, 121 Impression See Silicone impression Indirect bonding, biomechanics brush, low-speed handpiece, 12 cheek, lip, and tongue retractors, 12 dry air syringe, 13 individual transfer cap, 14 light-cure bonding agent adhesive, 13 molar transferring cap, 14 palatal and lingual tooth anatomy, 11 plication, 13 L Labial/lingual brackets See Brackets Lingual utility arch, 17–18 Lower anterior crowding class I canine and molar, 52 diamond single-side strips, 48, 50 enamel reduction, 48 etiology, 47 first molar, mesio-rotated, 52 lingual brackets placement, 50 removal, 51 7th generation, 53, 56 lower anterior stripping, 53 maxillary arch, 52 Index photographs beginning of treatment, 49 overbite, 51 post-treatment front, 54 pretreatment front and lower occlusal, 48 upper and lower arches, 49 primary group, 47 retention wire, upper and lower arches, 55 secondary group, 47 stripping, 48 TMA archwire, 57 treatment 1st phase of, 54 lateral views at end of, 55 objectives, 53 M Mathieu thin-end plier, 34 Micro-implants, 30 Molars extraction spaces, 149 181 pre-and post front photographs, 85 pre-and post lateral radiographs, 96 pre-and post-treatment upper occlusal arch, 86 pre-treatment front and upper occlusal, 76 pre-treatment panoramic and lateral radiographs, 80 pre-vs post lateral radiographs, 79 remnant spaces, 94 retention protocol, 76 retention wires in place, 85 sliding mechanics, 82 soft tissue evaluation, 75 TMA archwire, 81, 84 transpalatal arch, 92 treatment biomechanics, 75 objectives, 81, 90 plan, 90 speech-pathology, 90 upper and lower occlusal view, 91 upper occlusal arch, 89 Overbite See Deep overbite N Nance button, 28 O Omega loop, 35 Open bite malocclusions, nongrowing patients anterior lingual bracket, 77 archwire, 95 cephalometric tracings, superimposition, 97 elastics use chains, 83 at night, 94 esthetic lateral buttons, 83 fixed retention wire, 78 lateral crossbite, anterior open bite, 80 lateral occlusion improvement, 93 lateral views, 76 lip closure, 96 lower arch, 89 Nance button, 92 night dental plaque, 86 overjet and overbite, 78, 93 photographs before and after orthodontic treatment, 86 midline deviation in front, 88 musculature tension, 87 pretreatment front and occlusal, 79 pretreatment lateral views, 88 at rest position, 87 P Partial canine retraction, 20–21 Pendulum usage, lingual appliances bicuspid distalization, 103 class I canine, 109, 114 class II canine, 109 class II elastics, 104, 105 class I molars, 104, 114 class II molars, 109 distalization, second upper bicuspids, 111 intermaxillary elastics, 112 Nance button appliance, 100 non-extraction treatment modalities, 99 normalization, 99 occlusal photographs, 109 panoramic Rx, 102 post-treatment lateral views, 114 post-treatment right and left side, 106 pre-and post-Ricketts superpositions, 115 pre-and postsmile photographs, 107 pre-and post-treatment Ricketts’s analysis, 108 pre-treatment front and smile, 101 retention wires, 116 stainless steel lingual fixed retainer, 106 transpalatal arch, 112 treatment objectives, 103, 110 results after and months, 103 upper and lower arcades, 102 182 Q Quad helix use, in lingual orthodontics, 19 R Retraction procedure, 145 Rotated teeth correction, 23–28 S Silicone impression acrylic distal keys in place, 10 adhesion, densita gypsum rock, with dental wax, deocclusal plane control, dowel pins in place, final alignment, ideal lingual chart plate, malocclusion model, Index mixing, oral hygiene, plaster models, pre-and post-extra anterior torque, 11 pre-and post-second-phase, Ricketts brackets, 10 setup cast model, silicone spray application, softened wax, vestibular plaster contention, Sliding mechanics, 137 Stripping procedure, 139 T Tooth proportions, 170 V Vestibular plaster contention, .. .Achieving Clinical Success in Lingual Orthodontics Julia Harfin • Augusto Ureña Achieving Clinical Success in Lingual Orthodontics Julia Harfin Department of Orthodontics Maimonides... tray is a crucial phase in which errors must be avoided © Springer International Publishing Switzerland 2015 J Harfin, A Ureña, Achieving Clinical Success in Lingual Orthodontics, DOI 10.1007/978-3-319-06832-9_1... RM Keys to success in lingual therapy J Clin Orthod 1986;20:252–61 Wiechmann D, Gerb J, Stamm T, Hohoff A Prediction of oral discomfort and dysfunction in lingual orthodontics A preliminary report