After difficult startings in the beginning of 80', the lingual orthodontics became slowly widespread among the orthodontic community due to the courses given by three american orthodontists: Craven Kurz, Jack Gorman and Bob Smith.
These three orthodontists have published in JCO in 1986 the first results of their clinical experience: Keys to success in lingual Therapy.
At our turn, after15 years of exclusive lingual orthodontic it seemed us interesting to have a look on the evolution of this technique and precise our “20 essentials keys” to get excellence.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Disadvantages of lingual treatment were exaggerated and there have been many orthodontic specialist who do not believe in lingual orthodontics. I will mention several advantages of lingual treatment over labial, showing 2 cases treated by lingual orthodontics.
Case 1 is Class II, div. II and upper bilateral first bicuspid extraction case. This show that the lingual orthodontics is easy to correct overbite due to bite-plane effect.
Case 2 is Class I crowding case and upper bilateral second bicuspids were already loss. This show less frequent extraction owing to lingual tip of the lower incisors.

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One of the major purposes in the orthodontic treatment, regardless of lingual or labial, is profile improvement. It is, therefore, necessary to set a treatment goal, where the upper and lower anteriors are to be positioned in order to improve the profile. In other words, the most important are, appropriate diagnosis and treatment plan with due consideration to improvement of arch form in addition to decision of the teeth to be extracted.
Difference in mechanics and force directions, teeth to be extracted should be decided paying due consideration to different element from labial treatment. We don't have to take the growth factor in consideration in diagnosis, as most of the patients are adults in lingual orthodontics. The author will show a case with a unique extraction site, which cannot be thought in usual labial treatment.

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The purpose of this paper is to clarify biomechanical characteristics of lingual orthodontics. Orthodontic treatment of patients with lingual appliances necessitates modification of the conventional mechanotherapy used with labial appliances because of the very unique type of tooth movement in lingual orthodontics, which is obviously caused by the different bracket position. The unique bracket position, morphology of the lingual tooth surface, anatomical difference of the cortical bone, and reduced arch circumference and interbracket distance result in very different characteristics of tooth movement.
In my estimate, approximately double orthodontic force should be applied in lingual orthodontics to produce the same magnitude of toque on incisors as in labial orthodontics.
It must be understood that lingual orthodontics belongs to an entirely different world of orthodontics.
For example, it is naturally tempting to apply the straight wire concept to lingual orthodontics.
To realize this with a lingual straight wire appliance, however, anterior brackets would be located too far lingually. (Fig. 3) The moment of force created with lingual brackets is opposite in direction to that with labial brackets. In addition the further lingually the brackets are positioned, the greater the moment of force will be, increasing anterior crown lingual torque significantly. (Fig. 2)
The treatment of open bite and so-called gummy smile cases with lingual orthodontics requires special consideration to its biomechanics, which is distinct from that of conventional orthodontics.

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In recent years, opinions vary on the use of lingual appliances for treatment of temporomandibular disorders. In our clinic, we treated two patients with maxillary protrusion who had a titled median line due to deformed temporomandibular heads and shifted jaws using lingual appliances. We obtained excellent result with improved jaw position and facial profile. The cases are presented.

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Dr. Kinya Fujita is a pioneer of lingual bracket system. 1978, he reported about development of the lingual bracket. In the recent Fujita method, tooth axis can be controlled precisely, with maximum utilization of its occlusal slot and horizontal slot. The occlusal slot, which is the main slot, provides precise rotation control and make it possible to place and remove arch wires from occlusal side. The horizontal slot can be used for auxiliary purposes and it provides precise tipping control.

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Since Fujita Method was developed early 70's, the number of adult patients who prefer lingual treatment to labial has been steadly increasing.
For most of the clinical lingual cases, mushroom arches, having inset bends between first and second bicuspids and second bicuspids and first molars, must be used because of the morphological shape of the lingual surface of the teeth.
You will find, however, linguo-buccal distance of each tooth do not differ so much each other, when you see a plaster model after cutting its clinical crown part of all the teeth. It hinted me that we could adopt straight wire concept also to lingual orthodontics if we set arch wires as close to gingiva as possible. We started trying to apply the straight wire concept to our routine lingual treatment for more effective clinical treatment.
One of the clinical cases treated with 3^rd generation prototype brackets is shown in this article.

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Conceal is a brand name of lingual appliances developed in 1986 by 3M Unitek based on the theory and disign originated by Dr. Creekmore. One of the major features of this appliances is that it has .016×.022 occlusal slot which any other edgewise appliances do not have. This special slot design facilitates wire bending and insection. It also help provide optimal and right direction of orthodontic force. The author will show a 2mm Angle Class II extraction case treated with this appliance. The treatment goal is to improve molar relationship after removing 7mm crowdings.

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I started lingual orthodontics in 1980s. At that time lingual orthodontics, as well as doctors practicing it, used to be criticized and misunderstood. Despite that, I continued lingual orthodontics and in 1986 when I retired the Nippon Dental University, I was treating about 40 cases annually.
Almost 20 years have passed since then, and now the bias and misunderstanding about lingual orthodontics are reduced. However, still some orthodontists criticize it and others accept their opinion.
I treated several 8 -tooth extraction cases, which requires the highest technique for orthodontic treatment, either lingually or labially. The difference between the two treatments was reviewed in terms of the length of treatment period and the result. One of the cases treated lingually is presented.

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There is an obvious need for a more simplifid lingual orthodontic system for the maxillary arch to reduce the operator's strain from working in an unnatural posture and the patient's discomfort from keeping the mouth open for a long time during treatment. The authors developed a lingual orthodontic treatment system in which canine retraction using sectional archwires is followed by spontaneous distal migration of the maxillary incisors while the mandibular incisors rest on the bite planes of the maxillary incisor brackets. The maxillary incisors undergo controlled tipping around the root apices as they drift distally. This phenomenon may be attributable to lip pressure and ‘driftodontics’. Sectional archwires, which are easier and quicker to bend and place than a continuous archwire, are utilized to reduce the operator's fatigue. This approach enabled us to achieve maxillary anterior retraction with minimal strain on posterior anchorage. A case will be presented to describe this maxillary lingual orthodontic treatment system.

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