Lingual braces

Lingual braces - on the inside surfaces of the teeth

In our practice, we have had patients in upper and lower lingual braces for some years. In fact, Michael Woods first practised lingual orthodontics while still working in the United States as a junior orthodontic clinical academic. We also accept lingual transfer cases - patients from overseas, especially from Europe.

Lingual orthodontics is in some ways quite different mechanically to normal braces on the outside. Instead of coordinating upper and lower arch wires with each other (as with labial braces on the outside), with lingual orthodontics the upper and lower shapes are more like mushrooms - shaped to follow the inside curvature of the teeth. So, instead of being proactive and driving treatment from the outside, treatment is mainly reactive - adjusting wires to what has occurred in the few weeks leading up to each appointment. Nevertheless, lingual orthodontics can be used to achieve quite good results in many cases. Small bone anchorage screws can be used on the palate to help control the movements of one group of teeth against another.

At present, we are using the Incognito system from 3M Unitek. We especially like Incognito-lite, with brackets on the front upper 8 teeth (mostly with normal lower labial brackets). This is a very good and predictable alternative to the use of Invisible templates. For Incognito, we take very accurate rubber impressions (as in the construction of fine crowns and bridges), which are then scanned and digitised. As with most of these digitally-derived contemporary systems, the Incognito appliance construction occurs overseas. Potential tooth movements are set up in the 3M Unitek laboratory in Los Angeles and then viewed online in our office. The finished case can be visualised and modifications made to the virtual set-up until we are satisfied. Once we agree with the set-up bite and alignment, the lingual braces can be constructed over there - they are absolutely customised to be used for that patient only.

About 4 weeks later, we receive those customised lingual braces in clear mouthguard-type transfer trays. The brackets can then be indirectly bonded to the palatal surfaces of the teeth in our clinic. With the Incognito system, we also receive a sequence of computer-formed lingual wires, which can really help with initial alignment and achievement of the final arch shapes for each patient.