I completed my specialist training toward the end of the last century! At this time I had little or no knowledge of lingual orthodontics and the number of people offering lingual orthodontic treatment in the UK was relatively small. The first lingual conference I attended was interesting not least because it quickly became apparent that there were a large number of pioneers coming together to give their view on how best to carry out lingual treatment. I imagined that there must have been times in the past when labial orthodontics was in a similar situation and this made the conference very exciting. I came away thinking that whilst there was still a way to go before agreement on the best way to carry out lingual treatments was likely, we were at the forefront of something very new. Since that time the number of appliances available has increased and lingual treatments are being carried out on more and more complex cases by a larger number of clinicians, and lingual presentations are becoming more commonplace at conferences worldwide. There is no doubt that lingual orthodontics is here to stay and I am delighted that this supplement has been put together by the Journal of Orthodontics.
There are still many issues that face clinicians carrying out lingual treatments today, and these need to be considered during the consent and planning phase, before appliances are fitted to the teeth. Treatment with lingual appliances is quite different to that carried out with labial mechanics. However, there is an assumption that the use of lingual appliances is just the same as labial, just on different surfaces of the teeth. It is difficult to see how this could be the case when there are so many differences, such as bracket dimension and design, inter-bracket distance and wire construction, and all depending upon the chosen set-up. Choices can now be made about wire insertion and ligation and one can even ask for individual bracket designs for each tooth. It is not unusual to see appliances with vertical insertion in the labial segment and horizontal insertion posteriorly. Indeed, the lingual technique has now begun to develop its own terminology, such as “Bowing” and “Rabbiting” and more product companies have developed their own range of lingual supplies, now that the demand has increased. The last ten years has also seen the development of scanning and image manipulation software. This has meant that lingual set-ups can be carried out virtually, giving the operator more resources for planning treatment. Combining this software with increased ease of data transfer has also improved communication between clinician and laboratory.
This supplement will help provide some context as to where we are with lingual orthodontics and hopefully, will be a help to anyone with an interest in this recently re-established orthodontic discipline.
Robert Slater
Rob and I were orthodontic trainees together in London and like him, I had little or no knowledge of the lingual technique when I began my career as an orthodontic specialist. Unlike Rob, for me this situation has not really changed, my clinical practice is still based primarily upon the use of pre-adjusted edgewise labial appliances. However, over the last ten years I have seen a number of my respected colleagues positively embrace the lingual technique as a viable option for their patients and therefore I was keen to put together a supplement for the Journal that would provide some insight into the current status of lingual orthodontics for members of the British Orthodontic Society.
The supplement begins with a historical overview of how lingual orthodontics has developed as a technique by Asif Chatoo and continues with a description of fully customized appliances by Richard George and Sunil Hirani. Ian Hutchinson and Jang Yeol Lee then discuss lingual appliance fabrication and Paul Ward covers the subject of bonding with lingual appliances. The current status of lingual orthodontic research is summarized by Angela Auluck and Rob Slater describes the effect of lingual appliances on speech. Robbie Lawson has written two articles that very nicely demonstrate use of the IncognitoTM appliance for extraction treatment and class 2 correction, whilst Peter Huntley outlines common pitfalls associated with treatment planning for lingual appliances. The supplement is concluded with a description of the 2D the Incognito appliance by Vittorio Cacciafesta.
I hope that this supplement will be of interest to a wide range of orthodontists, including those who are both unfamiliar and more experienced with these appliances. I think that the use of these appliance systems is here to stay and that this supplement will provide a useful insight for all.
Martyn Cobourne