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How to align lower incisors with 2D lingual appliances. Nicolas Salesse. Episode 19. July 21st 2020

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Hosted by
Farooq Ahmed

Dr Nicolas Salesse talks us through 2D lingual appliances in the lower arch for alignment, how the appliances work, the application as well as his protocol.

Advantages:

2d Vs 3d

Direct bonding

·      Unlikely to debond, due to low profile

·      No complex bonding required (same as conventional labial brackets)

·      0 prescription bracket – no torque treatment conducted round wires round wires only

Cost

·      Headway 2 dollars

·      forestadent 2d 10-20 dollars per bracket

Disadvantages:

·      Metal bracket can deform on opening / closing

·      Complete alignment if required with aligners

Lower incisor alignment ideal:

·      Bracket positioning lower arch

o   Same height of centrals and laterals

o   Relatively upright teeth, no significant tip

·      Upper arch difficult for 2D brackets:

o   large variation in bracket positioning between 1s and 2s

·      Patient expectations: Lower expectation of lower arch

Challenges lingual appliances:

1.     Reduced inter-bracket distance

2.     In out discrepancy on the labial face due to lingual bonding

3.     Bracket position height

4.     Prescription

1/ Inter-bracket distance

·      Smaller distance = wire is stiffer = greater force

·      2d brackets can have the archwire placed above the 2D bracket, increasing the interbracket distance, similar to Incognito

2/ In out discrepancy on the labial face due to lingual bonding

·      Lingual appliances align lingual surfaces  = discrepancy labial aspect due to variation in AP anatomy.

·      Further from labial face – harder to control labial alignment

·      Anterior teeth increase in thickness more Gingival

Height of bracket position

·      Ideal 2D lingual bracket position =  incisal as possible, less AP in out thickness, less variability.

·      Lower arch incisal heights 2-2 same, no bend required

Prescription

·      Only bend required is 2-3 in out direction

o   Only bend lower 2-3 region = 2 bends

Protocol lower 2D brackets

·      Digital set up plan IPR

·      Bonddirectly, close to incisal edge. (no overcorrection)

·      IPR

·      Bond canine and premolar together: bonding composite prevent adverse affects on 3s

·      Wires:

o   Initially straight wire: such as 012NT

o   016NT + wire bends

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