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Lingual Braces Dr. Ronald M. Roncone

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For years patients around the world have been searching to discover the answer to several questions:
  • "How can I improve my smile?"
  • "How can I do it quickly?"
  • "How can I do it without being embarrassed or people noticing?"
  • "How can I do it without the discomfort of long term treatment?"
  • "How can I do it without breaking the bank?"
The answers to these questions have come very slowly! There are various ways to improve one's smile including crowns, veneers, bonding and full orthodontic treatment with braces or clear type aligners. Braces have come a very long way since full banding and multi-loop archwires. Manufacturers have developed ceramic brackets that have wonderful aesthetic properties. Clear aligners have been shown to do more than many of us expect they could do.

Speed of treatment is not the top priority of a typical orthodontic regimen. Patients flocked to their family dentists to obtain porcelain crowns and veneers. This satisfied their need for speed achievement but left many disenchanted with having their teeth reduced or "cut down" to place crowns or veneers. It has been called instant orthodontics. This desire for instant smiles has eliminated most procedures that take more than a year.

The invisibility of the correction has proved to be the main criteria for prospective patients. If patients can obtain straight teeth and a great smile in a reasonable amount of time, it seems they are willing to pay for this result. Finances are not most important; invisibility is. For the most part we are left with two alternatives – clear aligners and lingual brackets.

Clear aligners have several drawbacks:
  1. Patient cooperation is necessary
  2. Significant lab fees
  3. Significant orthodontist time at the computer to instruct lab technicians on tooth movement,
    sequencing, etc.
  4. In many cases, less than satisfactory results
Lingual braces have had their own drawbacks such as placement, difficulty in access, orthodontist learning curve and large lab fees. Full lingual treatment still has some of these problems inherent with their use. What can be done for those patients who have minor crowding or spacing problems, or for those that did not wear retainers as instructed, or whose teeth slowly crowded over the years? I have found the quickest way, which also requires minimal patient cooperation (i.e. show up for appointments and brush teeth properly) is the use of the MTM No-Trace lingual appliance. These brackets can be placed directly or indirectly; treatment takes two to five appointments and can be finished in six weeks to four months; the learning curve is very quick and easy and the self-ligating aspect is very convenient for the assistant and orthodontist.

Several typical cases follow.

Case #1: The patient shown in case #1 is a very simple example of the use of MTM No-Trace
Figure 1a: Shows slight crowding with the lower-right central incisor lingually displaced. The patient exhibits a slight overjet so that IPR was not necessary; and tipping teeth very slightly forward did not cause overcoupling of the incisors. Figure 1b: Shows placement of the MTM appliance and insertion of an .012 Sentalloy mushroom arch. Figure 1c: Shows the patient on the day of removal (six weeks later) and placement of a fixed mandibular retainer.


Case # 2: This patient shows more crowding of the lower arch. The patient also exhibits wear of the lower anteriors with some teeth showing more wear then others. When teeth are worn, a problem arises especially if the wear is uneven. As an incisor is worn, the tooth becomes thicker labiolingually. Therefore, when aligning teeth from the lingual, the most worn tooth (teeth) will appear to be out of alignment on the labial side.
Figure 2a: Shows the crowded lower arch. The lower-right lateral incisor shows mild incisal wear. The lower right central shows moderate wear. The left central shows mild wear and the left lateral show mild wear. Figure 2b: Shows placement of the lingual brackets and a .012 Sentalloy archwire. Note that the most labial incisor is not engaged. Figure 2c: Shows engagement of all brackets with a .012 Sentalloy arch.
 
Figure 2d: Shows placement of a .014 Sentalloy mushroom arch. This photo also shows the variable thickness of teeth. Figure 2e: Shows the patient immediately after removal of MTM NožTrace. Total treatment time was 15 weeks.  

Case # 3 Exhibits a case with moderate crowding.
Figure 3a: Shows the lower arch the day MTM No-Trace was placed. A .012 Sentalloy wire was inserted into all slots except the most labial (lower-left lateral incisor). Advancing crimpable stops were also placed mesial to the first premolar brackets. Figure 3b: Shows the room made by the advancing stops. An open coil Sentalloy spring was placed between the lower-left canine and left central incisor. Also, an elastic chain (I now recommend only elastic thread) was placed from the left first premolar to the left canine. Advancing stops are still in, as is the original .012 Sentalloy. Figure 3c: Shows placement of a .014 Sentalloy mushroom arch.
 
Figure 3d: Shows the lower arch immediately after removal. Total treatment was time 17 weeks.  


With a small learning curve, much more complicated cases can be treated with MTM No-Trace.

For more technical information on the application of MTM No-Trace, a 38-page "White Paper" is available from your Dentsply-GAC International sales representative. Hands-on courses are also available. Please contact GAC or Dr. Ron Roncone at orthobarbarian1@aol.com.
Author’s Bio
Dr. Ronald M. Roncone received his undergraduate degree at Marquette University and pursued graduate study in physiology and neuroanatomy at Marquette University School of Medicine, while simultaneously obtaining his dental degree at the same university. He obtained two postdoctoral certificates from Harvard School of Dental Medicine and the Forsythe Dental Center. Dr. Roncone practices orthodontics in San Diego County, California. He has specialized in adult treatment (aesthetics, surgical, and TMD) as well as "early" treatment for children. While teaching more than 500 seminars worldwide, he has been responsible for a large number of innovations in the practice of orthodontics. He is widely known among orthodontists as the "Guru of Marketing."
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