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      Evidence of Effectiveness of Lingual Orthodontics as an Alternative to Conventional Labial Orthodontics. A Systematic Review

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          Abstract

          In orthodontics, both the treatment goals and the impact of orthodontic equipment on patients' aesthetic appearance have contributed to a rise in patients' aesthetic demands over the years. Patients considering orthodontic treatment are significantly concerned about the potential compromise in facial appearance that conventional orthodontic therapy might cause. Clinical practice has integrated aesthetic materials and procedures to address these restrictions. This review will examine the present data and outcomes linked to lingual orthodontics. PubMed, Scopus, Web of Science, Cochrane Library, and Embase were the electronic databases searched. Research interests mainly included biomechanics, appliance design, bonding, laboratory settings, case reports, survey research, and treatment outcomes. The goal was to locate the most recent data regarding lingual orthodontics. A consistent and predictable pattern emerges from the available evidence on lingual orthodontics. Several areas have received a lot of attention over the past decade, including the ability to forecast outcomes and patients' preparedness to embrace these changes. The current state of knowledge on the biomechanical principles of lingual orthodontics is solid, as this review shows. Lingual orthodontic appliances can efficiently handle any orthodontic scenario that a labial appliance can handle. The reason is that the completely customized lingual appliance might bring about the desired result in terms of treatment.

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          Caries outcomes after orthodontic treatment with fixed appliances: do lingual brackets make a difference?

          Orthodontic treatment with fixed appliances is considered a risk factor for the development of white spot caries lesions (WSL). Traditionally, brackets are bonded to the buccal surfaces. Lingual brackets are developing rapidly and have become more readily available. Buccal surfaces are considered to be more caries prone than lingual surfaces. Furthermore, lingual brackets are shaped to fit the morphology of the teeth and seal almost the entire surface. In the present study we tested the hypothesis that lingual brackets result in a lower caries incidence than buccal brackets. We tested this hypothesis using a split-mouth design where subjects were allocated randomly to a group receiving either buccal or lingual brackets on the maxillary teeth and the alternative bracket type in the mandible. The results indicate that buccal surfaces are more prone to WSL development, especially when WSL existed before treatment. The number of WSL that developed or progressed on buccal surfaces was 4.8 times higher than the number of WSL that developed or progressed on lingual surfaces. When measured using quantitative light-induced fluorescence (QLF), the increase in integrated fluorescence loss was 10.6 times higher buccally than lingually. We conclude that lingual brackets make a difference when caries lesion incidence is concerned.
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            Impact of Fixed Orthodontic Appliance and Clear Aligners on the Periodontal Health: A Prospective Clinical Study

            This study aimed to evaluate the periodontal health of orthodontic patients with supportive periodontal therapy in a 3 month follow-up. The sample comprised 20 patients (mean age 20.6 ± 8.1 years) in treatment with multibracket fixed appliances (fixed group—FG) and 20 patients (mean age 34.7 ± 12.5 years) in treatment with clear aligners (clear aligners group—CAG). At baseline (T0) and after 3 months (T1), probing depth (PD), plaque index (PI), bleeding on probing (BOP), and gingival recession (REC) were measured. Patients were trained to perform an individualized tooth brushing technique, and every 2 weeks they were re-called to reinforce the oral hygiene instructions. The intra-group comparisons (T1 vs. T0) were calculated with the Wilcoxon signed-rank test, while a linear regression model was used for the inter-group comparisons (FG vs. CAG). The significance level was set at p < 0.05. Statistically significant decrease in both groups was found for PD (FG: Δ, −9.2 inter-quartile range (IQR), −22.5, −5.5; CAG: Δ, −12.6 IQR, −25.4, −4.8), BOP (FG: Δ, −53.5 IQR, −70.5, −37; CAG: Δ, −37.5 IQR, −54.5, −23), and PI (FG: Δ, −17.5 IQR, −62.5, 14.5; CAG: Δ, −24 IQR, −49.5, −5). The result of the linear regression models suggested that the type of appliance did not have any effects on the improvement of periodontal variables. Therefore, patients undergoing orthodontic treatment with fixed appliances and clear aligners did not show differences in gingival health when followed by a dental hygienist.
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              Control of mandibular incisors with the combined Herbst and completely customized lingual appliance - a pilot study

              Background The traditional Herbst appliance induces mandibular incisor proclination independent of the anchorage system used. The dental effects of the Herbst appliance as an element of a completely customized lingual orthodontic (LO) appliance (Incognito, 3 M) has not been analyzed yet and the aim of this paper was to measure the effect of mandibular incisor proclination using this Herbst-LO device. Methods Retrospective study. Inclusion criteria: a) Class II ≥ 5 mm molar relationship; b) Herbst appliance ≥ 9 months in situ; and c) finished active treatment. Incisor position was measured on digital models before treatment, on the digital target setup, and on digital models obtained at the day of debonding. All measurements were performed by one investigator. Results Twelve patients (8 females, 4 males) out of 632 cases treated with a lingual appliance were included in the study. The measurement error computed with Dahlberg's formula was 0.2°. Seven cases had planned (target setup) mandibular incisor uprighting (ccr), and five cases had proclination (clockwise rotation). There was no statistical difference (p > 0.05) between planned incisor rotations of the target setup and achieved incisor rotations at the day of debonding. The overall mean difference was 2.2° ± 1.0°. Conclusions The Incognito-Herbst combination is the first Herbst device with full control over mandibular incisor movement. Using this system, anchorage loss or anchorage gain is independent of the Herbst treatment. It depends only on the planned tooth position of the individual target setup.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                4 January 2024
                January 2024
                : 16
                : 1
                : e51643
                Affiliations
                [1 ] Maxillofacial Surgery, Riyadh Elm University, Riyadh, SAU
                [2 ] Orthodontics and Dentofacial Orthopaedics, Prince Sattam Bin Abdulaziz University, Al-Kharj, SAU
                [3 ] Dentistry, Security Forces Hospital, Riyadh, SAU
                [4 ] Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
                [5 ] Dentistry, Batterjee Medical College, Jeddah, SAU
                [6 ] General Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
                Author notes
                Article
                10.7759/cureus.51643
                10837819
                38313975
                a8fec15a-6dcb-4917-8e20-d593130a9639
                Copyright © 2024, Ahmed et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 4 January 2024
                Categories
                Dentistry

                anterior aesthetics,braces,alternative orthodontics,incognito,lingual orthodontics

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