マッシュルームアーチを用いて長年治療してきたがワイヤーベンディングの複雑性、又 上下のアーチコーディネーションの困難等、多くの問題が残っていた。そこで、よりシンプルに治療システムを標準化するため、プレーンアーチフォームを用いたリンガルストレートワイヤーシステム（LSWS）の研究を1996年より開始した。
　LSWSに必要なブラケットデザインの要点は、１）上下前歯のブラケットには、ジンジバルオフセットが必要である。２）特に頬舌径インアウトの大きい中切歯、第一小臼歯、第一大臼歯の舌側歯面の限りなく近くをワイヤーが通るインアウトの薄いデザインをとる必要がある。３）矯正力を弱めるため、ブラケットスロットの幅を出来る限り狭くし、十分なブラケット間距離を確保する必要がある。
　これらの要求を満たすためスクエアスロットを用いたブラケットが考案された。スペースクローズ時のワイヤー剛性ならびにレベリング時のワイヤーとスロットのあそび両面から考え、スロットのサイズを.018×.018 スクエアスロットと決定した。又、厚みは1.7mmに設計されており非常に薄い。スロットの幅は上顎前歯ブラケットで1.5mm、下顎前歯ブラケットで1.2mmである。その結果ブラケット間距離が増加し、ライトフォースでの治療が可能となる。
　加えて精密なセットアップモデルとボンディングポジションなどすべての治療ステップやシステムが正確かつ綿密に計画された結果として、よりスムーズに、かつワイヤーのベンドを極力減らした治療が進んでいくことになる。

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　リンガルブラケットを用いた矯正治療のメリットとして、審美性の優位が最初にあげられる 1）。一方ラビアルブラケットと比較すると、術者にとっては操作性が困難なこと 2）、患者にとっては舌感の悪さなどがデメリットとしてあげられる 3）。特に、下顎にリンガルブラケットを用いる場合、舌房が狭くなるため、その傾向はより顕著となる。その為、患者からの要望で、上顎のみリンガルブラケットを装着し、下顎にはラビアルブラケットの装着（以下ハーフリンガルとする）を選択することもしばしばある。しかし、リンガルブラケットの力学的な特性を活かすことにより、症例によっては、下顎にもリンガルブラケットを用いる方が有効な治療が行える。
　今回、フルリンガルとハーフリンガルの比較をしながら、舌側矯正装置の特性を取り入れて診断を行った症例を紹介する。

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　The posterior region of the mid-palatal suture is an appropriate location for placing screw implants. Using safe, multifunctional and solid (SMS) screws, a skeletal anchorage system known as the mid-palatal absolute anchorage system (MAAS) has been developed to withstand more substantial orthodontic forces. In this article, MAAS is introduced and various clinical applications of MAAS in lingual orthodontic treatment are described. MAAS plays a role not only in direct skeletal anchorage (e.g. posterior intrusion, total intrusion, total distalization, anterior retraction and unilateral constriction), but also as indirect skeletal anchorage (e.g. molar distalization). In conjunction with lever arms, MAAS works as an absolute anchorage instrument, with which full control over the axial inclinations of the anterior teeth during retraction is possible. In addition, MAAS drives orthodontic forces not only with respect to individual tooth movements, but also where required to move whole dental arches in any direction with the assistance of a diverse array of power arm configurations and modified lingual arches. MAAS is versatile enough to allow the provision of orthodontic forces in any required direction and can be effectively used as an absolute anchorage device in lingual orthodontic treatment.

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　One of the utmost concerns that constantly linger in my mind is what disrupts lingual orthodontic procedures as originally planned, which causes enormous stress amongst orthodontists. Since a number of studies as well as clinical case reports have been conducted and presented upon its devices, techniques and basic mechanism for quite some time, I have to believe that those who are already somewhat familiar with orthodontic procedures can now easily start practicing and explore such procedures. Nonetheless, many have said that they run into unexpected problems which were never envisioned as the procedure progresses. As I happen to have gone through the same experience, I have always been reexamining what I have done, and I would also like to take this opportunity to investigate this matter thoroughly.
　As soon as a patient express his/her wish to go through lingual orthodontic procedure, my mind immediately sets to believe that I am about to begin a special procedure, which at the same time usually makes me to concern that I might experience difficulties as soon as a procedure begins. In other words, despite I didn't have any problems while working on the labial orthodontic procedures, I somehow totally forget about it at one moment, and I start to feel like I now have to work on something completely new as if I were possessed by 'evil tooth fairy'.
　There are certain steps that have to be assured each step by step in order to make sure that proper procedures have been followed from a simple leveling to space closure. While I have accepted and treated substantial number of patients who were transferred over to me in the middle of treatments due to their residential relocations, I learned that not a few of them were already going through anterior retraction before their leveling work was fully completed. Such incomplete leveling works, I came to believe, are caused by the impatience of their attending orthodontists. Of course, there are occasions where dentists become weary since they feel as if they were being dictated by patients because the leveling takes up too much of time. And it would lead anterior retraction to cause too much of tension which could end up causing the loss of torque.
　In short, I would be more than happy if this literature would help any of my fellow dentists to take extra caution to attain the satisfactory outcome when they run into the situation that I have described above.

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　The purpose of this presentation was to determine whether customized Incognito TM Lingual appliances are working in orthognathic surgical cases.
　The present case report describes the episode of an 18 year-old female with prognathic chin, diagnosed as skeletal class III malocclusion with facial asymmetry.
　The treatment modalities were as follows; extraction of the two upper first bicuspids, the employment of Incognito TM Lingual System and one-jaw orthognathic surgery.
　The changes in denture manifested full-cusp class II molar relationship with a class I canine relationship. Cephalometric analysis showed that the ANB improved from -3° to 3°, indicating a balanced relationship of the denture bases to each other with pleasing facial profile.
　The present case demonstrates that the correction of the complicated orthodontic problem requiring orthognathic surgery is feasible with a customized lingual appliance. The lingual appliance in conjunction with orthognathic surgery brings the clinician the best esthetic advantage without any obstacles.

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　The control of the labiolingual inclination of incisors, or torque, is considered one of the challenging issues in the lingual orthodontics. However, by utilizing lingual/palatal anatomical structures for using miniscrews in conjunction with lever arms, efficient treatment is possible and predictable. This article aims to provide insight into the control of tooth movement using segmented arch mechanics in combination with miniscrews.

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　Nowadays so many brackets and techniques in lingual orthodontics have evolved. Nonetheless, the tipping control, rotation control and torque control of both anterior and posterior teeth are always main issues of troubles. However, the use of two main arch wire in leveling, anterior retraction and finishing stages eliminates almost all of above mentioned troubles. Other accessory wire like TPA(trans-palatal arch wire), MLA( mandibular lingual arch wire) and intrusion/extrusion spring(sectional arch wire) help coordinate both arches. Multi-slot lingual bracket like Fujita lingual bracket and Chois lingual bracket(CLB) permits the insertion of two main arch wires and sometimes third accessory arch wires at the same time showing the merits of multi-slot bracket and enables the three dimensional tooth movement as the practitioner wants. Two main arch wires also permit the use of elastic ring instead of ligature wires for arch wire fixation by counter-force directional insertion of arch wires in slots resulting in generous reduction of chair side time consuming. Another merit of tandem mechanism is the possibility to predict the treatment result by holding and keeping the moving teeth with a preformed passive arch wire to the ideal treatment goal. Newly developed CLB enables the use of preformed straight lingual arch wire resulting in accelerating treatment procedure and chair side work.

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　私は25年前に歯科衛生士になりました。当時の虫歯に対する考え方は「早期発見早期治療」でしたが、コンセンサスが変化し、今では、エナメル質に限局したカリエスは見守り、象牙質への侵襲が認められてからMI治療という考え方が主流になっています。新しい予防関連商品も毎年多く新商品が発売され、器具機材、材料の選択についても改めて考え直さなければならない機会によく遭遇します。
　今回は、口腔の健康維持のための新しいコンセンサス、臨床の中で試行錯誤し疑問解消したことなどを矯正中の患者さんの話題を交えながらＱ＆Ａ形式にまとめてみました。

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１．下顎骨右側偏位を伴うアングルⅡ級叢生症例・・・網野 弘二
２．上顎前突と前歯部開咬を伴うアングルⅡ級１類症例・・・網野 弘二
３．上顎前歯の著しい唇側傾斜を伴うアングルⅠ級叢生症例・・・網野 弘二
４．Angle ClassⅠ上顎前突症例・・・大塚 重雄
５．下顎右側側切歯欠損を伴う叢生症例・・・大塚 重雄
６．Angle ClassⅡdivision 1 malocclusion・・・大塚 重雄
７．正中離開を伴った成人女子上顎前突症例・・・川崎 由香子
８．成人男子叢生症例・・・川崎 由香子
９．成人女子上下顎前突症例・・・川崎 由香子
10．叢生を伴うアングルⅡ級１類症例・・・斎藤 安弘
11．Angle ClassⅠ叢生症例・・・斎藤 安弘
12．Angle ClassⅠ上下顎前突症例・・・斎藤 安弘
13．Angle ClassⅠmalocclusion 上下顎前突、小臼歯４本抜歯症例・・・高橋 治
14．Angle ClassⅡdivision 1 malocclusion 抜歯症例・・・高橋 治
15．Angle ClassⅠmalocclusion 非抜歯症例・・・高橋 治
16．上顎前歯唇側傾斜を伴うアングルⅠ級叢生症例・・・玉川 幸二
17．下顎前歯叢生を有するアングルⅡ級ハイアングル症例・・・玉川 幸二
18．下顎左側第一大臼歯欠損と下顎骨の後退を伴う骨格性上顎前突症例・・・玉川 幸二
19．上下口唇の突出を伴う上下顎前突症例・・・永木 恵美子
20．上下顎前歯部の叢生を伴うAngle ClassⅡ症例・・・永木 恵美子
21．過蓋咬合を伴うアングルⅡ級１類症例・・・永木 恵美子

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１．多数の問題を抱えた右側交叉咬合を伴うAngleⅡ級叢生症例・・・竹元 京人
２．著しい叢生症例（舌側矯正治療）・・・中川 学

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１．著しい叢生および下顎の劣成長を伴う片側性 Angle C1 Ⅱ div2・・・倉島 茂樹

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