Dr Nicolas Salesse talks us through 2D lingual appliances in the lower arch for alignment, how the appliances work, the application as well as his protocol.

Advantages:

2d Vs 3d

· Direct bonding

· Unlikely to debond, due to low profile

· No complex bonding required (same as conventional labial brackets)

· 0 prescription bracket – no torque treatment conducted round wires round wires only

Cost

· Headway 2 dollars

· forestadent 2d 10-20 dollars per bracket

Disadvantages:

· Metal bracket can deform on opening / closing

· Complete alignment if required with aligners

Lower incisor alignment ideal:

· Bracket positioning lower arch

o Same height of centrals and laterals

o Relatively upright teeth, no significant tip

· Upper arch difficult for 2D brackets:

o large variation in bracket positioning between 1s and 2s

· Patient expectations: Lower expectation of lower arch

Challenges lingual appliances:

1. Reduced inter-bracket distance

2. In out discrepancy on the labial face due to lingual bonding

3. Bracket position height

4. Prescription

1/ Inter-bracket distance

· Smaller distance = wire is stiffer = greater force

· 2d brackets can have the archwire placed above the 2D bracket, increasing the interbracket distance, similar to Incognito

2/ In out discrepancy on the labial face due to lingual bonding

· Lingual appliances align lingual surfaces = discrepancy labial aspect due to variation in AP anatomy.

· Further from labial face – harder to control labial alignment

· Anterior teeth increase in thickness more Gingival

Height of bracket position

· Ideal 2D lingual bracket position =  incisal as possible, less AP in out thickness, less variability.

· Lower arch incisal heights 2-2 same, no bend required

Prescription

· Only bend required is 2-3 in out direction

o Only bend lower 2-3 region = 2 bends

Protocol lower 2D brackets

· Digital set up plan IPR

· Bonddirectly, close to incisal edge. (no overcorrection)

· IPR

· Bond canine and premolar together: bonding composite prevent adverse affects on 3s

· Wires:

o Initially straight wire: such as 012NT

o 016NT + wire bends