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.
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.
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.
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.
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.