From diagnosis to retention. Is it clinically that easy? Esfandiar Modjahedpour. BOC 2021.September 22nd 2021. Episode 131

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Hosted by
Farooq Ahmed

Join me for Esfandiar’s lecture discussing lingual appliances


He presented an excellently treated case of an impacted canine, which was not evident from the end of treatment


Reflection of 20 years in practice




OPG – we can look at 40 OPGs per day, we need to spend time in analysis and refer when pathology present – odontoma shown in an example



Set up

  • Increasing assessment of outcomes from digital set ups
  • We require analysis in detail of set ups
  • Example
    • Golden proportion Mesial- distal: central to lateral incisor = 62%
    • Height width ratio 80%
    • Gingival zenith
    • Embrasures


Treatment strategy

  • Treatment sequence
    • Patient cooperation can be difficult to detect
    • Finishing can extend treatment, and needs to be learned
    • Example lingual transfer case
      • Centrelines not correct
        • Adding tip to upright teeth and correct cl for example, transferring to a prescription, e.g.13 degrees tip correction
        • It is possible to provide labial brackets for finishing, however one should know of finishing from their appliance, lingual aligners etc
      • Orthodontics is a difficult field and is for the speciality – not companies direct to consumer


Extraction of 1 lower incisor

  • Class 2 case with endodontically failed lower incisor
  • Herbst appliance + lingual
  • Extraction of lower incisor



  • Extraction of lower incisor
  • Posterior intrusion with TADs
    • Placed U6-U7
    • Wire occlusally between U6-U7
    • Powerchain TAD to wire, intrusion and rotation of occlusal plane





Side effect of twistflex retainers 3D evaluation of tooth movement after retainer debonding Knaup 2021

  • Changes in fixed retention 2.7-5o
  • Possible cause Intercanine width reduction resulting in twist force on retainer
  • 6 strand twistflex preforms the best




  • Functional appliances part time – reduce failures
  • Retention – still ideal material not present for BR, wear after 4 yers unlikely
  • Bonding molar tubes – carbide tungsten bur – debonding bur
  • Shared decision making, both in adults and children, increases outcomes to treatment, ask how much involvement patients want
  • Treatment assessment set ups, re-assess at finishing,
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