lingual set ups

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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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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

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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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lingual set ups

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