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Lingual orthodontics with or without attacks? Lingual appliances in comparison

Curiosity about lingual orthodontics with or without attacks is becoming more and more frequent in the patient’s imagination, let’s try to clarify a bit.

What is lingual orthodontics?

Lingual orthodontics is an orthodontic technique that allows the correction of misaligned teeth by means of an invisible fixed device because it is glued on the internal (lingual) face of the teeth; in this way, the alignment of the teeth can take place in total discretion without the orthodontic appliance being visible, but also in absolute comfort since the latest generation miniaturized lingual attachments ensure an almost immediate adaptation to the appliance.

How does lingual orthodontics arise?

Lingual orthodontics was born in the 80s in Hollywood for the need to correct the smiles of movie stars without the discomfort and aesthetic dimensions of conventional metal appliances.

The first attachments or brackets to be glued on the inner face of the teeth were simply standard attachments of common orthodontic appliances for application on the outer surface of the teeth, which were adapted and used on the inner face of the teeth, in order to move them invisibly. Subsequently, under the impulse of orthodontist experts, companies began to invest in innovation and in the development of lingual technique and attacks designed specifically to be glued and work invisibly from the internal or lingual side of the teeth began to come out on the market.

What are the latest generation lingual devices?

To date, the best performing lingual devices on the market are undoubtedly the customized Win or Incognito devices designed and developed by Prof. Dirk Wiechmann of the University of Hannover in Germany who is one of the world’s leading experts in the field of lingual orthodontics. These latest generation customized devices are supported by modern information technology and robotics, where every single orthodontic attachment is designed and tailored to the specific anatomy of each patient’s teeth, using computer-assisted procedures, while a robot takes care of the folding of the arches that inserted in the attachments will constitute the motor of the appliance for the purpose of dental movements.

All this allows the personalization of the device on the internal surfaces of the teeth which is therefore extremely thin and guarantees excellent patient comfort both from the point of view of phonation and chewing.

Do customized lingual appliances work the same way as classic external orthodontic appliances?

These customized devices also ensure the maximum degree of precision and predictability of the results, even sometimes higher than those achievable with traditional external orthodontic appliances, as the construction and construction process of the device passes through the creation of a simulation (setup) treatment, straight teeth, of the result to be achieved; the tailored and customized lingual attachments are precisely designed and made on the simulation models with the teeth aligned and therefore already have, in their own manufacturing process, all the three-dimensional information of the final position of the teeth to be reached as the goal of the therapy.

This engineering technology makes use of the realization and previsualization of the therapeutic project to be achieved, together with the standardized mouth gluing protocols of the attacks on the internal surfaces of the teeth through transfer masks and the application of the sequence of individualized arches bent by the robot for expression. of dental alignment, fully confers customized features on the gold standard for the resolution of malocclusions and dental misalignments, even of a very severe degree.

Is lingual orthodontics good for all cases?

Nowadays, with the WIN lingual device, the latest invention of the German manufacture, it is possible to treat and cure patients with any type and severity of malocclusion: malocclusions of I, II and III class of Angle, associated or not associated with the presence of a deep bite or bite open and still lateral cross bite due to the presence of narrow upper arches. It is also possible to correct various situations of dental misalignment such as protruding teeth, teeth with diastemas and that is with the presence of small or large spaces between them, crowded teeth, teeth inclined towards the back or inside the mouth, etc …

What is and how does lingual orthodontics arise without attacks?

Lingual orthodontics without attachments is a therapy that makes use of a device consisting of orthodontic wires and composite resin. The idea was born from the observation of the unstable position of the anterior teeth, despite the presence of bonded retainers, in the post orthodontic therapy restraint phase, and it is precisely that of using and pre-activating the same orthodontic wires to obtain the desired dental movements without using orthodontic attacks. These devices, initially called pre-activated retainers or fixed orthodontics without attachments because they can be used both on the external and on the lingual side of the teeth, have been used over the years to realign the front teeth in the event of post-orthodontic recurrence, then to resolve crowding in the aesthetic area in the frontal sector in patients who have not previously undergone orthodontic treatment and still to finalize patients on standard active therapy to remove attacks early. In a subsequent phase, the applications were increasingly extended until they came to be used by some orthodontists for increasingly complex situations and also for the resolution of the various malocclusions in full.

The device, called today in its common sense as lingual orthodontics without attachments for the prevalent use of it on the internal side of the teeth, does not have precise instruments, such as attachments, which have incorporated the information to be transmitted to the teeth through the The application of orthodontic wires nor does it present well-coded and standardized therapeutic sequences, and therefore the results are entrusted to the operator’s clinical expertise, his knowledge of the principles of orthodontic biomechanics and let’s say it also to an artistic vein that knows how to direct engineering forces and moments through folds and lugs inserted in the orthodontic wires to obtain all the necessary and / or desired dental movements.

The absence of attachments to insert orthodontic wires for reading and expressing the information contained in the attachment slot for the purpose of dental movement makes the system considerably more complex to manage and also requires frequent adhesive procedures for detaching and re-gluing the wires orthodontic on dry and uncontaminated dental surfaces, often to be practiced at each check for the reactivation of the orthodontic wires and therefore of the relative force system.

We are a little distant from the concepts expressed above, that is, of a personalized and tailor-made appliance whose realization passes through a treatment simulation and whose orthodontic attachments are instruments through which orthodontic wires transfer the programmed information of the final position of the teeth to the teeth to reach. As we have amply described, the latest generation of WIN customized devices offer excellent comfort for the patient who adapts to it almost immediately, apart from some slight initial pain that resolves within a few days.

In fact, it would be wrong to think that a lingual device without attachments is increasingly comfortable, as emphasized by some orthodontists who support “without attachments”, only because of the absence of attachments as it also depends on the specific configuration of loops and folds inserted in the wire orthodontic glued on the teeth (sometimes it is also necessary to glue double arches on the teeth for the expression of the necessary forces) and also by the quantity of glue / composite resin used to glue the wire itself; in any case, a comparative study of the two comparison methods should be made to detect the presence or absence of significant differences.

In light of the above, it seems a little anachronistic and nowadays unjustifiable to rely on an interpretation of orthodontic therapy of malocclusions in their entirety, which is fundamentally based on imaginative and artistic expressions of clinical knowledge, biomechanical skills and individual manual modeling skills of wires in the absence, however, of codified, standardized protocols and above all within everyone’s reach.

I would assign to lingual technique without attacks a more appropriate and specific or restricted field of application that recognizes dignity in relation to the real merits of having added value and imagination to lingual orthodontics itself in the treatment of simple cases of prior crowding or post-orthodontic recurrences , having among other things the undeniable advantage of substantially containing the costs of lingual therapy; but without wanting to have the presumption of being proposed as a technique within everyone’s reach when it is far from the standardizations and codifications that a technique must possess in order to be fully entitled, even if only in terms of initial potential, in the strings of every orthodontist.

Even today, lingual orthodontics is considered too often a difficult technique and, although there is a growing interest in it for the increased aesthetic needs and demands of patients, orthodontists often do not know its principles and methods of application well. In this scenario, the dissemination and teaching of well-coded and standardized procedures, of tested protocols, of advanced technologies and computer-assisted systems for the integration of information (to be transferred to the teeth) in tools such as orthodontic attacks and arches that they leave little to the imagination and art of particularly gifted and / or competent operators, but they constitute a very precise paraphernalia in the hands of the orthodontist able to translate into extremely predictable therapeutic results, behind the application of clear and detailed protocols.

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