Invisible orthodontics
I. Lingual orthodontics
1. Introduction
Today, the aesthetic demand in our society is growing, the importance of a full, balanced smile has become a necessity for everyone.
Lingual orthodontics has made significant progress. Today, it can effectively treat all dentofacial dysmorphoses. It is likely that, little by little, all adult orthodontics will be provided using the lingual technique.
The ” Incognito” system has made it possible to correct the most significant defects of the lingual devices.
2. History :
*The first cases treated by an adaptation of the “Edgewise” mechanics to lingual faces were published by Fujita (1979).
*In 1999, Wiechmann introduced the TOP system, which facilitates individual placement of each bracket on the malocclusion model.
*In 2002, Wiechmann developed a new individualized gold attachment, made “to measure” on each tooth.
*In 2004, the “Incognito” bracket was born.
3-Indications:
It is the treatment of choice for adolescents and adults who need complex orthodontic treatment but want it to be invisible, this treatment can be with or without tooth extraction; most often with stripping, with mini-screws to ensure anchoring; and also in case of orthognathic surgery (before or after).
Invisible orthodontics
* Contraindications:
*Unmotivated patient;
*In children: reduced enamel surface and therefore poor adhesion.
*Difficulty maintaining good hygiene.
*Short clinical crowns
The Incognito System
In 2004, the appearance of the Incognito system made it possible to meet the expectations of all practitioners. The main characteristics of this system are:
1-The steps of the process optimized by digital modeling (laboratory)
Invisible orthodontics
1 .1Fingerprint taking
This imprint must be extremely precise; it will allow two successive castings.
*The chosen material is Silicone, we use the Wash technique
*The first impression is taken with a light silicone;
*The second impression is made with a heavy silicone on the first impression:
Currently, optical impressions are more recommended because of their high precision and ease of implementation;
Invisible orthodontics
1.2 . Implementation of the Set-up
The Set-up is carried out in the laboratory according to the practitioner’s instructions. The technician respects the six Andrews keys whenever possible.
The set-up is scanned in order to be transformed into a virtual set-up.
1.3 Individualization of attachments in the laboratory
On this virtual model The bases are drawn; They are as wide as possible. Their thickness is 0.5 mm.
*The fasteners are then transformed into wax using the “Rapid prototyping” machine.
*The wax attachments are connected to their casting rods.
*The wax attachments are then transformed into gold using a “lost wax” casting process.
1.4 Bonding in the laboratory
Given the difficulty of access, lingual orthodontics could only develop with the use of indirect bonding, which offers the advantage of controlling the positioning of the brackets in the laboratory. The bracket is fixed to the plaster with a loaded resin. Once all the brackets are bonded to the model, a transfer tray is made.
2. The steps of placement in the mouth :
2.1. Indirect bonding of fasteners
– The positioning of the brackets is very delicate and cannot be done directly. For this, a specialized laboratory must be involved to produce “Gluing gutters” or “Transfer gutters” which contain all of the brackets which will be glued in one go.
After etching, rinsing and drying, application of an adhesive on the surface of the etched enamel, a layer of photo composite (scotch tape) is deposited on the enamel of each tooth then on the pre-glued bases of the attachments held in the transfer tray, the latter is reinserted in the mouth and will be removed 4 minutes later.
2.2 making the arches:
* Leveling wires in Copper-Niti .016 then .016 × .022 in cases without extraction, .016 × .022 directly in cases with extractions.
*Steel wires allowing sliding mechanics. The .016 × .022 or the .016 × .024 with or without extraction.
*The finishing threads in TMA.
*Mechanics: close to that of the straight bow.
The manufacture of the arches is ensured by a robot which is a development of that of Orthomate System. By means of software;
Invisible orthodontics
3-The course of treatment:
*We usually start with the lower arch appliance, then after 5 to 6 weeks the upper arch.
*The adaptation period is 1 to 3 weeks.
*The frequency of checks is 1 appointment every 5 to 6 weeks.
*Brushing is essential after each meal; the use of a dental jet is strongly recommended.
*Avoid hard and sticky foods, in case of detachment of the brackets a new clinical session is necessary.
The duration of treatment varies depending on the complexity of the dental anomalies to be treated. It is relatively the same duration as a classic multi-attachment treatment.
4. Lingual retention and orthodontics
For some patients, when the device is removed, they are asked to wear a positioner for two days, 24 hours a day, then five days, 3 to 4 hours a day. It is then replaced by thermoformed retention plates.
5. Advantages / constraints:
5.1. Advantages:
Invisibility of the device: which implies psychological and social comfort.
5.2 Constraints:
*Adaptation phase: Patients with lingual appliances commonly complain of impaired speech and chewing.
*Hygiene measures: systematic and regular use of hydropropellant and interdental brushes.
*High cost: indirect bonding in lingual technique is 4 times more expensive than in lingual technique; detachment: while in vestibular technique the rebonding is done directly, in lingual technique the rebonding is done with an individual splint from the initial splint which implies longer sessions in clinic.
*Glue hindered by tongue and salivary secretions.
*Limited access and visibility for practitioners.
6. Conclusion
Excellent laboratory work is absolutely necessary. However, there are so many laboratory steps that are sources of error that one must not only choose one’s laboratory very carefully but also be able to identify one’s errors.
Only the orthodontist is able to do a good job. He is the only one who is able to really adapt the position of the teeth to the patient’s measurements.
An expert orthodontist is able to give a result in lingual orthodontics as good as in classic orthodontics .
Invisible orthodontics
II-INVISALIGN SYSTEM
- Introduction :
Orthodontists have used removable and fixed devices to move teeth to control and minimize unwanted movements in all three planes of space.
The Invisalign system, through the intimate contact of the surface of almost the entire dental crown and the aligner, attempts to provide the missing link between the qualities of removable appliances and fixed appliances.
Invisible orthodontics
2- Definition:
It is an invisible method of moving teeth without braces, wires or brackets, it involves wearing a series of transparent “aligners” to gradually move the teeth.
Each Invisalign aligner (kit) is a dental aligner made with custom-made, removable and comfortable thermoformed polycarbonate medical plastic.
There are 3 types of “Invisalign ” treatments :
a- Complete: which concerns all the teeth for the most complex malocclusions;
b- Lite : for mild malocclusions to be treated in a maximum of 14 aligners;
c- Teen : for the treatment of children and adolescents.
3-Indications and contraindications : the “Invisalign” method is mainly indicated:
* For treatment with stripping of light to medium congestion;
*For the correction of average transverse or anteroposterior incoordinations;
*In cases requiring maximum plaque control (periodontal conditions at risk, high caries risk, etc.)
*Translation movements after extractions, significant rotation or version movements and egression movements are quite difficult to achieve and control and may require the use of auxiliaries (elastic, sectional, etc.)
4 – The advantages: The “Invisalign” technique has two essential advantages for the patient: aesthetics and comfort .
*Invisible: The patient will be able to keep smiling throughout the treatment even in the event of extraction (prosthetic solution incorporated).
*Removable: the patient can drink and eat without constraints throughout the treatment, tooth brushing is greatly facilitated.
*Comfortable: Custom-made aligners fit perfectly to the teeth, lips, tongue and cheeks slide naturally, avoid irritation caused by brackets, rings, wire and other accessories. do not cause any discomfort or injury and do not disrupt speech.
*Fast: by limiting parasitic movements, elimination of dental arch leveling phases.
*Virtual simulations of the “Invisalign” treatment allow you to visualize the planned corrections in three dimensions.
*You can see, even before the treatment begins, the final corrections programmed into your aligners. So you will know what to expect as a result.
*Easy: through computer-aided graphic design, most of the work is done in the specialized laboratories “Align technology”, it is a computerized design.
5-Disadvantages and limits:
“Removable” : in the absence of patient cooperation (non-compliance with the wearing time, loss of aligners).
* Limits : These limits are due to several factors :
-The practitioner’s ability: knowledge of the system improves with its use, it is better to start with small movements.
-The system’s ability to move teeth: some movements are difficult:
*Skeletal corrections such as large offsets:
– (Cl II –Cl III) – transverse expansions – marked vertical insufficiency and excess.
*Dental corrections related to the morphology and position of the teeth:
*Teeth with significant intrusions and egressions.
*The round morphology of teeth such as the lower premolars.
*Teeth with insertion axes preventing the placement of aligners .
6-The “INVISALIGN” concept:
6.1 Processing steps
Step 1 : During the first appointment, the orthodontist checks that Invisalign is suitable for the patient and explains the treatment process.
Step 2 : The second appointment consists of taking fingerprints but also taking X-rays and photographs.
The optical imprint:
The optical impression allows the practitioner to obtain a three-dimensional image of one or more teeth using an intraoral camera coupled to a computer. These impressions have many advantages such as: space-saving, comfortable for the patient, and great stability.
The optical impression is defined as the projection of a light signal on the dental surfaces. The reflected signal will be recaptured by the camera which will allow the creation of the 3D three-dimensional model.
Step 3:
The complete file is then sent directly to “invisalign” which will then take charge of making a simulation , called ” clin check” and of predicting the movement of the teeth every 15 days. The orthodontist then takes control of the “clin check” thus carried out and then moves the teeth one by one, also modifying the positioning of the cleats on the teeth. There are generally between 5 and 10 back and forths between the orthodontist and “invisalign” to carry out the simulation.
Step 4 : When the “clin check” is approved, the aligners (kITS) for the entire treatment are made using a 3D printer. There are generally between 24 and 30 of them. The patient then comes to the office to have the aligners and retainers fitted, the role of which is to help rotate a tooth, bring some closer together or orient a tooth in a specific movement. The patient then only comes to the office every 2 months, except in exceptional cases. During these appointments, the orthodontist may be required to do “stripping”, i.e. polishing between the teeth, or an enameloplasty which consists of reshaping a tooth that is too long by micro abrasion.
Step 5 : After the end of the treatment, and obviously the reissue of a set of finishing splints (in 1 to 2 cases out of 10), the patient enters the last phase which is that of retention with a wire at the bottom and a wire at the top from canine to canine to keep for life. A safety splint is also given to the patient in case of wire breakage and while waiting for the appointment with the orthodontist .
Invisible orthodontics
6.2 – Wearing aligners (kits):
Each aligner is worn for 300 hours, or 2 weeks, day and night, for 22 hours per day, with the remaining 2 hours for eating and brushing teeth.
Each aligner is referenced and numbered, it will be replaced every 2 weeks by another aligner (the next one), allowing dental movement little by little until the final position defined by the diagnosis and the treatment plan of the orthodontist.
7 – Conclusion
The “Invisalign” technique is part of the practitioner’s therapeutic arsenal. When used well, it will allow you to obtain very good results that fully satisfy the patient and the practitioner, but it can sometimes remain hazardous in certain malocclusions, especially for inexperienced practitioners.
Course outline :
Invisible orthodontics
I. The technique of lingual orthodontics
1. Introduction
2. History
3. Indications/contraindications
4. Description of the lingual apparatus
The Incognito System
1-The steps of the process optimized by digital modeling (laboratory)
1.1 Taking a fingerprint
1.2. Implementation of the Set-up
1.3. Individualization of attachments in the laboratory
1.4. Bonding in the laboratory
2. The steps of placement in the mouth:
2.1. Indirect bonding of fasteners
2.2. Manufacture of bows.
3-The course of treatment
4. Lingual retention and orthodontics
5. Advantages / constraints
6. Conclusion
II. Invisalign system
1-Introduction
2-Definition
3-Indications/contraindications
4-The advantages
5-Disadvantages and limits
6-The INVISALIGN concept:
6.1 Processing steps
6.2 – Wearing aligners (kits)
7-Conclusion
Invisible orthodontics
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Good oral hygiene Regular scaling at the dentist Dental implant placement Dental x-rays Teeth whitening A visit to the dentist The dentist uses local anesthesia to minimize pain