2D Lingual Appliance - Cacciafesta JO 2013
2D Lingual Appliance - Cacciafesta JO 2013
2D Lingual Appliance - Cacciafesta JO 2013
Vittorio Cacciafesta
Viale Papiniano, Milano, Italy
The two-dimensional (2D) lingual bracket system represents a valuable treatment option for adult patients seeking a
completely invisible orthodontic appliance. The ease of direct or simplified indirect bonding of 2D lingual brackets in
combination with low friction mechanics makes it possible to achieve a good functional and aesthetic occlusion, even in the
presence of a severe malocclusion. The use of a self-ligating bracket significantly reduces chair-side time for the orthodontist,
and the low-profile bracket design greatly improves patient comfort.
Key words: Lingual orthodontics, lingual brackets, aesthetics, new technologies, Ni–Ti archwires
Figure 2 Forestadent 2D lingual bracket range: (A) medium twin standard bracket; (B) narrow single bracket; (C) mini-ant bracket; (D)
medium twin with gingival hook; (E) 2D Plus lingual bracket; (F) molar tubes
The clips can be opened with a modified spatula that has should be held against the labial surfaces of the teeth to
been previously customized by thinning the ends with a avoid any slipping of the plier.
grinder or a specific probe, which allows the archwire to
be inserted or removed from the slot. Brackets are easily 2D lingual bracket types
closed with a Weingart utility plier; but it is recom-
mended to close only one lip at a time to reduce the Several different types of 2D lingual bracket exist: the
risk of accidental debonding or damage. A cotton roll medium twin standard bracket can be used on all teeth
and is indicated particularly for relapse cases that do not
require the use of power chains or when comfort is a
Table 1 Main characteristics of 2D lingual brackets. must (Figure 2A), the narrow single (Figure 2B) and
1. Brackets can be used for all teeth, since there is no prescription Table 2 Components of the 2D lingual technique.
2. It is a self-ligating system, with progressive friction
3. They allow a vertical insertion of the archwire 1. 2D lingual brackets
4. Able to engage wires with maximum diameter of 0.022060.0160 2. Titanol superelastic or biolingual archwires
5. The total thickness is 1.4 mm, including the base (0.4 mm) 3. Light wire mechanics
6. They allow the use of thin power chains 4. Low friction and light forces
7. 2D plus brackets allow applying torque when needed 5. Direct or indirect bonding (without the need for any set-up)
S62 Cacciafesta Lingual Supplement JO September 2013
have to be prepared as in the direct bonding procedure. Main characteristics of Titanol lingual
Make sure not to use too much composite to avoid an archwires
excess after removing the tray. Remove the tray carefully
from the brackets. The nickel–titanium archwires normally used in combi-
nation with the 2D lingual brackets are Titanol lingual
archwires (Forestadent, Pforzheim, Germany) in three
classic shapes (small, medium and large, with sections
of 0.012, 0.014 and 0.016 inch, respectively). These
archwires are pre-curved from canine to canine, both for of bending can be checked. This is a very easy clinical
the maxillary and mandibular arch, and allow precise procedure that requires only a few minutes of chair
insertion of a first-order bend between the canine and working time (Figure 8).8 Alternatively, biolingual wires
first premolar in order to produce the typical mushroom can be employed, which are mushroom-shaped lingual
arch configuration.11 We have developed a method archwires available in five different shapes and four
for adding simple first or second-order bends to the different wire dimensions with a template to determine
preformed archwire by overbending the wire whilst it is the correct shape (Figure 9).
in its martensitic (cold) phase. If the wire is then gently The use of nickel–titanium archwires enables the
heated with a flame (up to approximately 60–70uC), it clinician to produce low levels of applied force and to
will regain its austenitic phase, and the effective amount achieve a more consistent tooth movement during the
Figure 11 Treatment of a palatally impacted UR3 in an adult: (A) pre-treatment OPG; (B) post-eruption OPG; (C) intra-oral view
following exposure and bonding of the UR3; (D) accommodation of the UR3 into the arch; (E) alignment of the UR3
S66 Cacciafesta Lingual Supplement JO September 2013
Figure 12 Treatment of an anterior bilateral crossbite associated with the upper canine teeth in an adult: (A, B) pre-treatment; (C, D)
mid-treatment; (E, F) post-treatment
first phase of treatment (levelling and aligning), because ectopic canines (Figure 11), correction of anterior and
these wires have a wide range of deactivation, thus lateral crossbites (Figure 12) pre-orthognathic set-up and
significantly reducing the number of appointments and minor torque control (Figure 13).
reactivations.
Conclusions
Clinical applications
Lingual orthodontics satisfies aesthetic criteria by
The 2D lingual system can be effectively used in a number positioning the fixed appliance on the lingual surfaces
of clinical situations, including post-treatment retention, of the teeth. It demands special biomechanical expertise
closure of minor spaces and diastemas and the limited and technical skills, such as indirect bracket bonding
correction of deep bites. It is useful for the correction of and customized arch bending. However, 2D lingual
crowding, particularly in the mandibular arch (Figure 10) brackets are a valid alternative to conventional lingual
and can also be successfully used for more complex tooth brackets in adult cases that do not require third-order
movements, including the alignment of impacted or tooth movements. Indications for using these brackets
Figure 13 Adult presenting with anterior negative torque and a severe deep bite. (A, B) Pre- and post-treatment occlusion, respectively
JO September 2013 Lingual Supplement 2D lingual orthodontics S67
include post-treatment retention, closure of minor 5. Wiechmann D. A new bracket system for lingual ortho-
spaces, correction of deep bites, and correction of dontic treatment. Part 1 – Theoretical background and
crowding and crossbites. Additional malocclusions that development. J Orofac Orthop/Fortschr Kieferorthop 2002;
can be treated with this technique include management 63: 234–45.
of impacted/ectopic canines or pre-orthognathic surgical 6. Tagliabue A, Levrini L, Macchi A. Attacchi linguali
patients. Once the clinician’s familiarity with lingual Philippe: considerazioni cliniche. Mondo Ortod 2000; 25:
techniques has improved, he or she will be able to treat 187–92.
more difficult cases with more sophisticated 3D brackets 7. Macchi A, Tagliabue A, Levrini L, Trezzi G. Philippe self-
ligating lingual brackets. J Clin Orthod 2002; 36: 42–
and indirect bonding.
45.
8. Macchi A, Norcini A, Cacciafesta V, Dolci F. The use of
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