Pacific Coast Society of Orthodontists Bulletin Summer 2013 - (Page 27)

ANNUAL SESSION SUmmARy Quick and Easy Lingual Treatment Presented by Ron Roncone, DDS, MS at the PSCO Annual Session, October 6, 2012. Summarized by Dr. Bruce P. Hawley, Northern Region Editor, PCSO Bulletin. F or years, patients have been telling orthodontists that if they must have orthodontic treatment, it should be as esthetic as possible. Dr. Ron Roncone believes that only a small number of orthodontists in the U.S. have truly listened. Several years ago, small self-ligating lingual brackets were developed; these made treatment easier for the orthodontist and presented a comfortable and quick alternative treatment method for mild orthodontic cases, for a lot less money than the cost of removable clear aligner treatment. BACKGROUND In over 40 years of practice, Dr. Roncone has encountered only two occasions of intensified public interest in orthodontic treatment: in the early 1980s, with the introduction of lingual orthodontics, and from around 2000 to the present, when aligners were introduced on a massive scale. What these two events have in common is that both were an esthetic means of rendering orthodontics, with no metal showing. In the early days of the technique, full lingual treatment was very difficult; it had a steep learning curve and required a lot of effort by the orthodontist to achieve a decent outcome. Lingual appliances bring challenging operator access, patient speech problems, difficult ligation, potential gingival hypertrophy, and having to cope with lingual tooth anatomy. Aligner treatment, while very esthetic, has the downside of requiring patient compliance, as is also the case for active removable retainers . Conventional ceramic braces are esthetic, but still visible. Dr. Roncone believes that lingual braces from canine to canine or first premolar to first premolar are by far the best choice for simpler cases and retreatments. APPLIANCES AND GOALS Dr. Roncone uses the MTM® No•Trace bracket from GAC International. (MTM stands for Minor Tooth Movement.) These brackets are self-ligating and thinner than previous generations, (only 1.5mm). The mesh pad base (not the slot) is positioned near the incisal edges. Gaining competence with the brackets is reasonably simple. Patient compliance involves hygiene and showing up SUMMER 2013 • P C S O B u l l et i n for appointments. There are no laboratory fees, treatment times can be very short (in the six-week to five-month range). The brackets are easy to place, and the self-ligation system makes archwire change simple to train. The reduced base design is cleaner and more comfortable. Patients want straight teeth, great smiles, short treatment time, and comfortable and invisible appliances. We orthodontists want simple mechanics, no patient compliance problems, and a low appliance expense per case. Good case selection typically means one or two round wires completes the case. Patients can be seen on average every five to six weeks. TECHNIQUES AND APPLICATION Brackets are placed with a standard posterior bracket placement instrument. Place the bracket base 1mm from the incisal edge for incisors, and usually 2mm from the canines cusp tip (depending on the anatomy). Dr. Roncone suggests that the archwire sequence can be chosen from four archwires. A straight .012 Sentalloy® is effective if there is a distolingual rotation of any of the canines, or if the first premolars are tipped lingually and you need to move them buccally. The straight wire starts some immediate correction of these two malpositions. For cases without those malpositions the choice is, a .012 Sentalloy with a mushroom archform. An .014 mushroom Sentalloy is often the second wire, and may be the only other wire needed in mild cases. The fourth choice is a .016 Resolve® lingual Beta-titanium wire blank. You can make your own mushroom shape as needed. For incisor retraction, one can place circle loops to engage elastic forces. Sentalloy step-wound open coil springs are excellent to make room for a blocked tooth. Crimpable stops can be used to advance a wire so the anterior teeth can be moved forward (tip: use an old distal end plier and squeeze in two places on the stop). In the lower anterior, Dr. Roncone extends the appliance to the lower first premolars, since it is much easier to place stops on the archwire mesial to the lower first premolar brackets than to the lower canines. In closing spaces, he prefers using figureeight elastic thread, as elastic chains will overpower the 27

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Summer 2013

AAO House of Delegates Meets in Pennsylvania
Time to Invest in Education
Synergy & Diversity
AAO Trustee’s Report
My Nightmare
Class II, Division 2 Malocclusions: Etiology, Development, Diagnosis and Some Aspects of Treatment, part I
Glenn Sameshima DDS, PhD, Chairman and Program Director, Adv. Orthodontic Program, Herman Ostrow School of Dentistry, University of Southern California
Quick and Easy Lingual Treatment
Bonding Outside the Box
AAOF Report
PCSO Business
Component Reports
PCSO at a Glance
Case Report Pre-Treatment

Pacific Coast Society of Orthodontists Bulletin Summer 2013