TRIBUNA BOOKS RIPANO

Nº 0 - 2013

Lingual Orthodontic Journal

Contents
• Advancements in the indirect
bonding technique. Pablo Echarri
DDS, Martín Pedernera DDS,
Eng. Claus Schendell

• cclusogram and occlusal Visual

O
Treatment Objective (occlusal
VTO). Interrelation with lat-
eral cephalogram. Pablo Echarri
DDS, Martín Pedernera DDS

• icroimplants use in Lingual Or-

M
thodontics. Regina Bass, DDS.

Editor in Chief
Pablo Echarri, DDS

Editorial Committee
Silvia Geron
Ryoon-Ki Hong
Hee-Moon Kyung
Jean-François Leclerc
Marcelo Marigó
Martín Pedernera
Rafi Romano
Giusseppe Scuzzo
Kyoto Takemoto

Publish:

Ripano S.A.
Ronda del Caballero de la Mancha, 135
28034 - Madrid, España
Tel.: (+0034) 913 721 377
Fax: (+0034) 913 720 391
e-mail: ripano@ripano.es
www.ripano.eu

Nº 0 - 2013
ISSN: Solicited

Ripano no asume ni se identifica, nece-

sariamente, con las opiniones expresadas
5th WSLO MEETING
Paris France, 4 - 6 July 2013
por sus redactores y colaboradores en el
contenido de los artículos que publica.
Queda prohibida la reproducción total
o parcial del contenido de esta publi-
cación en cualquier medio mecánico o
electrónico, sin autorización previa y
por escrito del editor.
 Lingual Orthodontic Journal

Editorial
Dear friends and colleagues,
I am very glad to be able to announce you the first issue of
Tribuna Books Ripano – Lingual Orthodontics Journal.
After the successful 5th Congress of World Society of Lingual
Orthodontics in Paris in July (my sincerest congratulations to
its President, Didier Fillion, and to all members of Organizing
Committee) we believed we should stay in touch with you
through this journal while waiting the next world Congress
in Seoul in 2016.
I would also like to congratulate to already ex-president, Giusseppe Scuzzo, for his
work as a leader of WSLO during the last years, and to new President, Hee-Moon
Kyung, who, we are sure, will do excellent job in promoting and diffusion of Lingual
Orthodontics. I would also like to wish all the best in organizing the 6th WSLO Con-
gress in Seoul to its Chairman, Ryoon-Ki Hong.
On the other hand, I would like to invite all the orthodontists who practice lingual
orthodontics to send us articles for publishing in this journal.
The Tribuna Books Ripano – Lingual Orthodontics Journal will be published on-line in
English and Spanish, and it will have four issues per year.
I would also appreciate any comments or suggestion you might have regarding the
Journal, hoping it’ll be of your interest.
Until next issue.
Sincerely,

Pablo Echarri, DDS

echarri@centroladent.com

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Dental Tribuna Books

Advancements in the indirect bonding technique

Authors:
Dr. Pablo Echarri

Dr. Martín Pedernera

Eng. Claus Schendell

Keywords: Indirect bonding – Lingual Orthodontics – Set-up Model Maker – Occlusal Plane

Abstract / Introduction
In this article, the authors perform an up-date of Class System Protocol using the laboratory appliances:
Set-up Model Maker (SUM) and Occlusal Plane Reference (OPR). The brackets positioning protocol with this
system is described step by step and the standardized results are obtained together with the reduced working
time.

The Class System1 has been used by many
specialists to position the lingual brackets in the
indirect bonding technique. In this article, the
working protocol revision of this system is carried
out with the aim of obtaining the standardized
results, reducing the working time and making the
technique easier.
When the models are mounted in the articulator
(Fig. 1), the reference lines are traced (Fig. 2), which

Fig. 1. Models mounted in the articulator. Fig. 2. Reference lines.

Fig. 3. SUM Base. Fig. 4. Articulator plate with the set-up model in the SUM
Base.

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are: crown-root axes of the teeth, a horizontal line
passing through LA point, a line marking the gingival
margin of all teeth. All the teeth should be numbered
to make its identification easier.
To carry out the set-up models and their correction,
a Set-up Model Maker (SUM) and the Occlusal Plane
Reference (OPR), designed by Dr. Pablo Echarri and
Eng. Claus Schendell2,3 will be used.
With the SUM (Fig. 3), the use of the models with the
plate of any articulator is possible, which allows to
maintain the interocclusal relationships, and to make
Fig. 5. Silicone impression of dento-alveolar zone.
Fig. 7. Plate with the separated teeth in the SUM.
Fig. 9. Fabrication of the set-up of finished model.
Lingual Orthodontic Journal
easier the positioning of set-up models in the articu-
lator in the same initial position (Fig. 4).
Take the impression of dento-alveolar zone in sili-
cone using SUM (Fig. 5), and then cut horizontally the
model to separate the dento-alveolar zone from the
base. All the teeth are separated one by one and put
back in the silicone impression (Fig. 6).
Vertical dimension, sagittal and transverse rotation of
occlusal plane will be maintained when repositioning
the teeth in the model base (Fig. 7).
Fig. 6. Separation of the teeth in the silicone impres-
sion.
Fig. 8. The teeth are waxed to the set-up model.
Fig. 10. Set-up models transferred to the articulator.
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Dental Tribuna Books
Fig. 11. OPR.
Fig. 13. Superimposition of occlusal VTO over the teeth be-
fore the correction.
The teeth are waxed together with the model (Fig.
8), and in this way the set-up model is finished (Fig.
9).
The SUM allows the fabrication of a set-up model in
a quick and standardized way, maintaining the inte-
rocclusal relationships, and making easier the reposi-
tioning in the articulator (Fig. 10).
The OPR makes easier the set-up models correction
and the brackets positioning in the model in indirect
bonding technique.
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Fig. 12. Occlusal Plane Plate adapted to the teeth.
Fig. 14. Position of the corrected teeth matches with the
VTO.
The OPR uses the same base as SUM, only the upper
part is replaced by Multidirectional Adaptation
Appliance (MAA) and Occlusal Plane Plate (Fig. 11).
The MAA allows the adjustment of the height, an-
tero-posterior position, sagittal and transverse ro-
tation of occlusal plate. Adapt the Occlusal Plane
Plate to the set-up model teeth (Fig. 12), and su-
perimpose the occlusal VTO over the teeth of the
set-up model (Fig. 13). In this way, it will be very
easy to correct the teeth in the set-up model until
they match with occlusal VTO (Fig. 14), making the

Fig. 15. Occlusal view of the set-up models after the cor-
rection.
Fig. 17. Adapted full size arch.
Fig. 19. Anterior reference using the Blue Blokker.
correction to match exactly with the treatment plan
(Fig. 15).
The Occlusal Plane Plate allows to maintain the vertical
dimension, and sagittal and transverse rotation of occlu-
sal plane, and to level the Curve of Spee and the Curve
of Wilson, and the MAA allows the modification of the
vertical dimension, as well as the sagittal and/or trans-
verse rotation of occlusal plane. Since the models are
corrected maintaining the articulator plate, it is very easy
to reposition the corrected set-up models in the articula-
Lingual Orthodontic Journal
Fig. 16. Corrected set-up models in the articulator.
Fig. 18. Adapted full size arch and fixed to the OPR Plate.
Fig. 20. Full size arch.
tor (Fig. 16). In the articulator, the functional occlusion
will be checked: anterior guide, canine guides, etc.
Labial or lingual brackets will be positioned using the
OPR with the plate for arch positioning. The ideal
full size arch wire is adapted (Fig. 17), and the arch
is fixed to the OPR plate with the resin or composite
(Fig. 18). An anterior reference is carried out using
the Blue Blokker (Fig. 19). In this way, it will be easy
to reposition the arch on the model using the ante-
rior reference, and the height, sagittal and transverse
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Dental Tribuna Books
Fig. 21. Full size arch separated from the model.
Fig. 23. Removal of the arch. Brackets bonded to the model.
Fig. 25. Transference trays using the Smart Cap System,
anterior view.
rotation references of the MAA (Fig. 20). The full
size arch is separated from the model (Fig. 21) and
the brackets are ligated to the arch. The arch is po-
sitioned back to the model set-up together with the
brackets, and the brackets are bonded to the model
using the Light Bond (Fig. 22). Then, the arch is sepa-
rated, leaving the brackets on the model (Fig. 23).
In this case, the Evolution SLT lingual brackets have
been used. The transfer trays are carried out using
the Smart Cap System (Figs. 24 and 25).
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Fig. 22. Bonding of the brackets to the model.
Fig. 24. Transference trays using the Smart Cap System,
posterior view.
Conclusions
The SUM and the OPR allow maintaining or control-
led modification of the occlusal plane position during
the fabrication of set-up models, as well as their co-
rrection. Also, the steps of remounting of the set-up
models in the articulator after their fabrication are
eliminated.
The OPR allows to correct the sagittal and transverse
rotations of occlusal plane, and to level the Curve of
Spee and the Curve of Wilson in a controlled way, to
adjust the tooth movement to the treatment plan by
means of occlusal VT superimposition in the model,
and to reposition the ideal lingual arch in a precise
and quick way for possible re-bonding of the brackets.
Bibliography
Echarri P. Técnica de posicionamiento de brackets lin-
guales Class System. Revista Iberoamericana de Orto-
doncia 1997;16:1-17.
Echarri P. In drei Schritten zum Erfolg. Kieferorthop
Nachrichten 2013;4;6-7.
Echarri P, Schendel C. Einfach und präzise. Kiefe-
rorthop Nachrichten 2013;6;14-16
 Lingual Orthodontic Journal

Occlusogram and Visual Treatment Objective (occlusal VTO).

Interrelation with lateral cephalogram
Authors:
Pablo Echarri, DDS

Martín Pedernera, DDS

Keywords: Occlusogram. Occlusal Visual Treatment Objective. Occlusal Plane Reference.

Abstract
The authors of this article present a technique to obtain a 3D vision by putting the occlusogram into a relation
with the lateral cephalogram. They also present a technique to transfer the dental movements carried out in
Visual Treatment Objective in the cephalogram to the occlusogram, and later to set-up models to carry out
the correction and treatment planning.

Introduction cing, and with a simple technique, it is easy to obtain

The realization of occlusogram and occlusal VTO
allows to compare the results which could be ob-
tained with different treatment plans, as well as
to carry out safely the corrections on the set-up
model, to visualize the interocclusal relationship,
to relate the dental arches with the cephalometric
tracing, and to customize the individual arch tem-
plate.
Starting from the basic elements of orthodontic diag-
nosis, such as study models and cephalometric tra-
an occlusogram.
Dr. Echarri’s cephalometric templates should be used
(Scheu-Dental GmbH, Iserlohn, Germany).
Make a photocopy of a model, and find three refe-
rence points, for example, mesial contact points of
the first molars, and interincisal point. Measure the
distance among these points in the model and in the
photocopy (Figs. 1-4). If these measures match, this
means that the photocopy is as the same size as the
model, and that the process can be continued. If this

Fig. 1. Distance between the mesial points of the upper Fig. 2. Distance between the mesial points of the upper
right and left first molar in the photocopy. right and left first molar in the model.

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Dental Tribuna Books

Fig. 3. Distance between the mesial point of the upper Fig. 4. Distance between the mesial point of the upper
right first molar and the interincisal point in the photocopy. right first molar and the interincisal point in the model.

Fig. 5. Upper midline tracing in the photocopy. Fig. 6. Copy the contours of all teeth in black pencil (1).

Fig. 7. Copy the contours of all teeth in black pencil (2). Fig. 8. Copy the contours of all teeth in black pencil (3).

12

is not a case, then the photocopy should be repeated
using a size conversion factor for it.
Trace the midline on the photocopy (Fig. 5) and copy
the midline and the contours of all teeth over the
acetate paper sheet in black pencil (Figs. 6-8). In this
Fig. 9. Upper occlusogram.
Fig. 11. Occlusogram fabrication: Copy the contours of all
teeth in black pencil (1).
Fig. 13. Occlusogram fabrication: Copy the contours of all
teeth in black pencil (3).
Lingual Orthodontic Journal
way, the upper occlusogram is finished (Fig. 9). Fo-
llow the same procedure with the lower model (Figs.
10-16).
Superimpose the upper and lower occlusogram
respecting the occlusal relationships of the pa-
Fig. 10. Lower midline tracing in the photocopy.
Fig. 12. Occlusogram fabrication: Copy the contours of all
teeth in black pencil (2).
Fig. 14. Occlusogram fabrication: Copy the contours of all
teeth in black pencil (4).
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Dental Tribuna Books

Fig. 15. Occlusogram fabrication: Copy the contours of all Fig. 16. Lower occlusogram.
teeth in black pencil (5).

Fig. 17. Superimposition of upper and lower occlusogram. Fig. 18. Place the lower occlusogram and relate the lower
incisors of occlusogram with those of cephalogram.

tient to visualize the interocclusal relationship 7. Distal slope of the labial cusp in upper second bi-
(Fig. 17). cuspids makes contact with the mesial slope of
the mesiolabial cusp in lower first molars.
According to White, normal interocclusal relation-
ships are: 8. Mesial slope of the labial cusp in upper second
bicuspids makes contact with distal slope of la-
1. Incisal overjet 0.7 mm.
bial cusp in lower second bicuspids.
2. Bicuspid overjet 1.9 mm.

3. Molar overjet 1.4 mm. Relationship between the occlusogram and

4. Distal or posterior overjet 2.3 mm.
5. Upper lateral incisors’ distal surface reaches the
center of the lower canines.
6. Upper canines in Centric Occlusion make contact
with the mesial slope of labial cusp in lower first
bicuspids.
cephalometric tracing
According to different authors, the occlusogram
can be related to cephalometric tracing, taking the
Frankfort or occlusal plane as a reference. Place
the lower occlusogram over the cephalogram rela-
ting the incisors from occlusogram with those from
cephalogram, as indicated in the figure 18: place

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 Lingual Orthodontic Journal

Fig. 19. Trace a line perpendicular to the Frankfort plane, Fig. 20. Relationship between the lower occlusogram and
passing through mesial point of lower molars. cephalogram.

the template and trace a line perpendicular to the

Frankfort plane, passing through the incisal edge of
lower incisors (B1 Point) then place the occlusogram
in a way that the incisors from it make contact with
the perpendicular line. To determine the position
of molars, trace another line perpendicular to the
Frankfort plane, passing through the mesial point
of lower molars of the cephalogram, and place the
molars of the occlusogram adjusted to this line (Fig.
19).

In the figure 20, the occlusogram fixed to cephalo-

gram and with reference lines can be seen.

Carry out the correction of lower incisor in the ce-

phalogram according to the treatment plan (in red
pencil), and transfer this position to the occlusogram
(Fig. 21). In this case, a lower incisor proinclination
of 1.5 mm has been carried out, and to transfer this
movement to the occlusogram, a new line perpen- Fig. 21. Transfer the planned movement of lower incisor
dicular to Frankfort plane has been traced in red from the cephalogram to the occlusogram, using the line
pencil. perpendicular to the Frankfort plane.

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Dental Tribuna Books

Fig. 22. Determine the lower ideal arch line by superimpos- Fig. 23. Relationship between the lower occlusogram and
ing the arch template over the midline and the new lower the ideal arch line and the cephalogram.
incisal point.

Fig. 24. Lower occlusal VTO fabrication 1: draw the teeth Fig. 25. Lower occlusal VTO fabrication 2: draw the teeth
over the ideal arch line, correcting the crowding and rota- over the ideal arch line, correcting the crowding and rota-
tions. tions. Continuation.

With this new interincisal point and using the arch

template, select the final arch shape, which can be
with or without expansion, depending on the treat-
ment plan (Figs. 22-23). Then copy the teeth over
the arch line in red pencil, correcting the crowding
and rotations (Figs. 24-29).

In the figure 30, the superimposition of lower occlu-

sogram and lower occlusal VTO can be seen, and in
the figure 31, the relationship between the occlu- Fig. 26. Lower occlusal VTO fabrication 3: draw the teeth
sogram, occlusal VTO and cephalogram. The same over the ideal arch line, correcting the crowding and rota-
procedure is followed with the upper occlusogram. tions. Continuation.

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 Lingual Orthodontic Journal

Fig. 27. Lower occlusal VTO fabrication 4: draw the teeth Fig. 28. Lower occlusal VTO fabrication 5: draw the teeth
over the ideal arch line, correcting the crowding and rota- over the ideal arch line, correcting the crowding and rota-
tions. Continuation. tions. Continuation.

Fig. 29. Lower occlusal VTO fabrication 6: draw the teeth Fig. 30. Superimposition of occlusogram and lower occlusal
over the ideal arch line, correcting the crowding and rota- VTO.
tions. Continuation.

Fig. 31. Relationship of a cephalogram, an occlusogram, Fig. 32. Relationship of the upper occlusogram and cepha-
and lower occlusal VTO. logram. Position the incisors using the line perpendicular
to the Frankfort plane as a reference.

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Dental Tribuna Books

Fig. 33. Relationship of the upper occlusogram and cepha- Fig. 34. Relationship of upper occlusogram with the cepha-
logram. Position the molars using the line perpendicular to logram.
the Frankfort plane as a reference.

Fig. 35. Observe the planned movement of the upper inci- Fig. 36. Transfer the planned movement of upper incisor
sor in the cephalogram. from cephalogram to occlusogram.

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 Lingual Orthodontic Journal

Fig. 38. Select the upper ideal arch line using the midline,
the new incisal point and the lower ideal arch line as a re-
ference.

Fig. 37. Transfer the planned movement of upper incisor

from cephalogram to occlusogram.

Transfer the incisal reference of the cephalogram to

occlusogram (Fig. 32), as well as the molar reference Fig. 39. Draw the midline of upper arch.
(fig. 33). In the figure 34 the upper occlusogram can
be seen in the relationship with the cephalometric
tracing. Correct the upper incisor position in the ce-
phalogram according to the treatment plan (Fig. 35),
and transfer it to the occlusogram (Figs. 36-37). In
this case, a treatment with upper incisors retrusion
and upper right and left first bicuspid extraction will
be carried out.

Superimpose the template over the midline and

interincisal point, and select the arch shape (Figs.
38-39). Correct the alignment and rotations (in
this case, with extraction of both first bicuspids)
to carry out the occlusal VTO of maxilla (Figs. 40-
43). The figure 44 shows the superimposition of
occlusogram with occlusal VTO of the upper arch
treatment, and the figure 45 shows the relation- Fig. 40. Upper occlusal VTO fabrication 1: draw the teeth
ship among the cephalogram, occlusogram and over the ideal arch line, correcting the crowding and rota-
occlusal VTO. tions.

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Dental Tribuna Books
Fig. 41. Upper occlusal VTO fabrication 2: draw the teeth
over the ideal arch line, correcting the crowding and rota-
tions. Continuation.
Fig. 43. Upper occlusal VTO fabrication 4: draw the teeth
over the ideal arch line, correcting the crowding and rota-
tions. Continuation.
The figure 46 shows the occlusal VTOs of upper and
lower treatment, and the figure 47 shows the inter-
occlusal relationship among them.
The Occlusal Plane Reference (OPR) allows the su-
perimposition of occlusal VTO of the treatment over
the set-up model to carry out its correction accor-
ding to the treatment plan. The figure 48 shows a
lateral view of OPR, adjusting the occlusal plane on
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Fig. 42. Upper occlusal VTO fabrication 3: draw the teeth
over the ideal arch line, correcting the crowding and rota-
tions. Continuation.
Fig. 44. Superimpose the upper occlusogram and the up-
per occlusal VTO, and carry out the extractions of both up-
per first bicuspids.
the set-up model, which allows the maintaining or
controlled modification of the vertical dimension,
occlusal plane rotation, and the Spee Curve depth.
The figure 49 shows the upper view of OPR with the
occlusogram superimposed over the set-up model,
making easier the correction of the teeth position
so it can be adjusted according to the treatment
plan.
 Lingual Orthodontic Journal

Fig. 45. Relationship of the upper cephalogram, occluso- Fig. 46. Upper and lower occlusal VTO.
gram and occlusal VTO.

Fig. 47. Superimposition of upper and lower occlusal VTO. Fig. 48. Occlusal Plane Reference (OPR). Lateral view.

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Dental Tribuna Books
Fig. 49. Occlusal Plane Reference (OPR). Upper view.
Bibliography
Marcotte MR. The use of the occlusogram in planning
orthodontic treatment. Am J Orthod 1976;69:655-
67.
Ricketts RM, Roth RH, Chaconas SJ, Schulhof RJ, Engel
GA. Orthodontic diagnosis and planning 1982 Library
of congress catalog card number: 82-62145, United
States of America.
White LW. Individualized ideal arches. J Clin Orthod
1978;12:779-87.
White LW. The clinical use of occlusograms. J Clin Or-
thod 1982;16:92-103.
22
Bolton WA. Disharmony in tooth size and its relation
to the analysis and treatment of the malocclusion.
Angle Orthod 1958;28113-29.
Chuck GC. Ideal arch form. Angle Orthod 1934;4:312-27.
Musich DR, Ackerman JL. The catenometer: a reliable
device for estimating dental arch perimeter. Am J Or-
thod 1973; 63:366-75.
Scott JH. The shape of the dental arches. J Dental Re-
search 1957;36:996-1003.
Brader AC. Dental arch form related whith intraoral
forces. Am J Orthod 1972;61:541-61.
Currier JH. A computarized geometric analysis of hu-
man arch form. Am J Orthod 1969;56:164-79.
Dental Tribuna Books

Microimplants use in Lingual Orthodontics

Author:
Regina Bass, DDS*

*Specialist in Orthodontics, Member of World Society of Lingual Orthodontics, Permanent lecturer at CREO
Fundation, Córdoba, Argentina

Key words: lingual orthodontics, microimplants, orthodontic mechanics.

Abstract
After the appearance of microimplants, the orthodontic mechanics evolved to more efficient strategies in
solving different issues. In case of Lingual Orthodontics, there is a special consideration concerning the me-
chanics because the force application is carried out from behind the resistance center of the tooth, with a
consequent tendency to torque loss in space closure cases.

In this article, the use of microimplants in sagittal, vertical, and transverse plane is described, as well as its use
in orthognatic patients treated with lingual appliances.

Introduction • Minimal anchorage: 75% or more of extraction

There is no doubt that microimplants have revolu-
tionized the orthodontic mechanics. The treatment
efficiency has considerably increased thanks to the
anchorage provided by microimplants. They have
also allowed simpler and more predictable design of
mechanotherapy.
space is occupied by posterior sector and to-
wards with the minimum or zero anterior retru-
sion.
Therefore, depending on anchorage requirements,
different tools can be used in order to achieve our
objective.

Different uses of microimplants in Lingual Orthodon-
tics and in all three planes are going to be described
in continuation.
Microimplants in Sagittal Plane
Although it is true that the extraction space can be
closed both in front-to-back and back-to-front direc-
tion, in this article the anchorage is defined as poste-
rior teeth (molars and bicuspids) movement which
closes the extraction spaces.
Except for reciprocal anchorage, i.e. when the extrac-
tion space can be used both by anterior and posterior
sector, microimplants can be used for maximal pos-
terior anchorage and minimal posterior anchorage,
which means, when the extraction space manage-
ment is more compromised.
Also, microimplants can be used directly or indirect-
ly. Direct force is a force applied directly to microim-
plant (Fig. 1).

Therefore, there are:

• Maximal or critical anchorage: Posterior sector

practically remains in the same place until the
end of treatment, because 75% or more of ex-
traction space will be occupied by anterior sec-
tor.

• Reciprocal anchorage: The extraction space is

shared between the anterior and posterior sec-
tor. Fig. 1. Direct anchorage with microimplant.

24

Fig. 2. Sectional SS or Chrome-Cobalt arch wire from auxil-
iary molar tube to microimplant. The elastics used for trac-
tion are inserted from canine hook to bicuspid hook, which
is also fixed to molar by means of a figure 8 ligature made
of reinforced wire.
Fig. 4. Retrusion with loops mechanics. The traction is car-
ried out with elastic chain from the loop of the arch wire
to microimplants.
Indirectly, the microimplant is used when the teeth
are anchored to microimplant and the force is ap-
plied from tooth to tooth (Fig. 2).
In maximal posterior anchorage, the ideal place for
microimplants is on palatal side, between the 2nd bi-
cuspids and 1st molars.
Space closure can be carried out by sliding mechanics
in which the arch wire is inserted in posterior sectors
as the anterior sector retrusion takes place (Fig. 3).
Another way is loops mechanics, in which the loops
are bent in the chrome-cobalt arch wires with diffe-
rent kinds of shapes, when it is necessary to manage
vertically the anterior sector (Fig. 4).
The arch wire can be clipped or welded with different
types of hooks (Fig. 5) which also allow the orienta-
tion of traction in different heights with the conse-
quent effect over the torque.
Lingual Orthodontic Journal
Fig. 3. Retrusion with sliding mechanics and combined arch
wire (rectangular in anterior sector, and round in posterior
sectors, to reduce the friction). The arch wire is activated
from canines to microimplants.
Fig. 5. Combined arch wire with crimpable hooks for better
overbite and overjet control.
Fig. 6. Low friction system. Rectangular Chrome-Cobalt
arch wire with closed helicoidal loops inserted in the auxil-
iary tube of first molar band. In this way, the space closure
arch wire is less exposed to friction in closing procedure.
The traction is carried out from the loop towards micro.
The posterior sector remains consolidated with a sectional
SS arch wire.
When the anterior torque loss is necessary during
the retrusion, it is preferable to use low friction sys-
tem, where the anterior arch wire passes through the
1st molar accessory tube (Fig. 6).
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Dental Tribuna Books

Case Report With Extractions And Maximal Treatment plan:

Posterior Anchorage The following teeth were extracted: 14, 24, to resolve
• Female 20-year old patient. Class II, and 35 to center the lower midline, and to
obtain the canine classes. Maximal posterior ancho-
• Bio type: dolichofacial, skeletal Class II, convex rage was carried out with microimplants and loops
profile (Fig. 7). mechanics was used (Fig. 10).

• Molar and canine Class II, right subdivision.
Lower midline deviation to the right. Marked
overjet (Fig. 8).
• Occlusal photographs (Fig. 9).
The case is finished with finishing 0.016” Chrome-Co-
balt arches (Fig. 11).
The canine classes are achieved, as well as the midline
match and optimal overjet and overbite (Fig. 12).

Fig. 7. Observe convex profile.

Fig. 8. Right molar and canine Class II: Lower midline deviation to the right. Increased overjet.

Fig. 9. Mesiogresion to the right of the entire lower left quadrant is observed.

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 Lingual Orthodontic Journal

Fig. 10. Space closure with the rectangular retrusion arch wire with closed helicoidal loops. Lower midline centered to-
wards left.

Fig. 11. Finishing arches.

Fig. 12. Canine classes are obtained, upper and lower midline match, optimal overjet and overbite.

Fig. 13. Rhinoplasty and mentoplasty were carried out in order to improve convex profile.

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Dental Tribuna Books
After the orthodontic treatment, advancing mento-
plasty and Rhinoplasty were performed to achieve
the harmony of the convex profile (Fig. 13).
Microimplants and Pendulum Appliance
In some cases, the distalization is necessary, whether
because of mesiogression of upper posterior sectors,
or because the anchorage is lost after the extractions.
Fig. 14. Bilateral molar and canine Class II.
Fig. 15a. Pendulum Appliance anchored to microimplants.
28
To do this, a good choice is the use of Pendulum or
Hilgers Appliance. When anchored to microimplants,
the protrusion is avoided, which can appear as a side
effect of an acrylic button support of the appliance.
This case report is about a female 19-year old patient
with molar and canine Class II, the absence of first bi-
cuspids due to previous orthodontic treatment (Figs.
14-17).
 Lingual Orthodontic Journal

Fig. 15b. Sagittal view of space generated by distalization.

Fig. 16. The microimplant parallel to the median raphe has been used together with the transpalatal bar to anchor the
molars.

Fig. 17. Finished case. Molar and canine classes are obtained.

29
Dental Tribuna Books
Fig. 18. The improvement of smile esthetics can be seen thanks to the reduction of gummy smile.
Fig. 19. Skeletal open bite.
Microimplants in Vertical Plane
In cases with gummy smile due to vertical excess, a
dentoalveolar intrusion can be carried out by insert-
ing the microimplants between the canines and la-
teral incisors, and carrying out traction with elastic
chain from esthetic buttons (Fig. 18).
Microimplants and Open Bite
In cases with open bite of mandibular origin with ex-
truded upper posterior sectors, the microimplants
can be used for their intrusion.
30
A case report of a female 32-year old patient with
skeletal open bite (Fig. 19).
The patient chooses the lingual orthodontics treat-
ment for maxilla, and labial orthodontic treatment
with ceramic brackets in mandible.
The decision is made to carry out the treatment with
extractions and with posterior anchorage loss in or-
der to reduce the fulcrum without compromising the
facial profile. As one of the upper first molars pre-
sented an irreversible periapical process in maxilla,
both first upper molars were extracted and second
and third molars were mesialized. In mandible, the
lower second bicuspids were extracted.

Fig. 20. Microimplants positioned mesially from the extraction spaces. The traction is carried out from distal side of mo-
lars to minimize the distal tipping of molar roots.
Fig. 21. Finished case.
Fig. 22. Modified transpalatal bar with lateral arm in con-
tact with the problematic side. The microimplant stops the
activation of the expansion from the loop towards non-
problematic side.
Maximal anterior anchorage is carried out with mi-
croimplants to mesialize the posterior sectors (Fig.
20).
At the end of the treatment, the bite closure is
achieved, as well as the molar and canine classes
(Fig. 21).
Lingual Orthodontic Journal
Microimplants in Transverse Plane
In Lingual Orthodontics, it is better to treat uni or bi-
lateral cross bites before bonding the brackets.
In case of unilateral cross bite which includes one or
two teeth, a Modified Transpalatal Bar will be used
with the additional loops to generate less quantity
of force. The microimplant is inserted on the side
of cross bite, and it is anchored towards the loop
of Transpalatal Bar so that the expansive force goes
exclusively to the cross bite side without the risk of
appearance of unnecessary overexpansion in the op-
posite side (Fig. 21).
In case of skeletal cross bites the use of expand-
ers anchored to four microimplants allows to cha-
llenge the age in skeletal expansion of maxilla (Fig.
23).
Microimplants in Lingual Orthodontics patients
treated with orthognatic surgery
For patients who need an orthognatic surgery and
present lingual orthodontics, microimplants present
a beneficial option both in intrasurgical management
and in post surgery use of intermaxillary elastics.
31
Dental Tribuna Books

A case report of a young adult patient with latero-
mentonism and mandibular prognatism, depression
of the facial mid third and vertical excess of the chin
(Fig. 24).
In occlusion, a bilateral molar Class III and right ca-
nine Class III can be observed (Fig. 25).
The patient’s treatment of choice is upper lingual or-
thodontics, and lower labial orthodontics.
After the presurgical orthodontic stage of decom-
pensation (Fig. 26), the mandible is centered and
moved backward surgically, as well as the vertical
chin reduction (Fig. 27) and the cheek bone pros-
thesis is added to compensate the depression of the
facial mid third.
The ends of the cheek bone prosthesis were sec-
tioned and fixed in the perinasal area, which also
presented depression (Fig. 28).

Fig. 23. Better transverse dimension and increased arch length are achieved thanks to the separation.

Fig. 24. Patient with facial asymmetry due to the lateromentonism and vertical mandibular excess.

Fig. 25. Right canine and bilateral molar Class III. Lower midline deviation to the left.

32
 Lingual Orthodontic Journal

Fig. 26. The occlusion was decompensated in order to obtain more negative overjet.

Fig. 27. Vertical reduction of chin.

Fig. 28. Cheek-bone implants (porex) were used to compensate the depression of the mid facial third. A section of pros-
thesis was fixed in paranasal area, to fill the surface.

Microimplants were especially useful for intrasur- When the postsurgical orthodontic phase was fi-
gical blocking during the mandibular fixation (Fig. nished, the both facial and occlusal esthetic and
29). functional objectives could be achieved (Figs. 30-31).

33
Dental Tribuna Books

Fig. 29. Microimplants allowed the hold of surgical splint, the fixation of mandible, and they were also useful with inter-
maxillary elastics in post-surgical phase.

Fig. 30. Final occlusion. Molar and canine classes and matching midlines.

Fig. 31. The improvement of symmetry and in general harmony of the face can be seen.

Conclusions
they should be included in orthodontic planning to
After we have analyzed the use of microimplants in make the orthodontic mechanics easier and to re-
different space planes, we can draw a conclusion that duce therapy time.

34

Bibliography
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clínica. Ravindra Nanda Editorial Amolca; 20-26-194-
195, 2007
Diagnostico en Ortodoncia-Estudio Multidisciplinar-
io. Dr Pablo Echarri Lobiondo- Editorial Quintesensse;
419-431, 1998
Ortodoncia y Microimplantes. Técnica completa paso
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y mecánica. Claudio R, Azenha. Eduardo Macluf Filho.
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Ortodoncia Lingual. R.Romano .Espaxis.2000.
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Three-dimensional dental model analysis of treat-
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Comparison of headgear, miniscrew, and miniplate
skeletal anchorage.Eddie Hsiang-Hua Lai, Chung-
Chen Jane Yao, Jenny Zwei-Chieng Chang, I. Chen,
Lingual Orthodontic Journal
Yi-Jane Chen-American Journal of Orthodontics &
Dentofacial Orthopedics- Volumen 134, Numero 5 ,
Pag 636-645, Noviembre 2008
Anchorage capacity of osseointegrated and conven-
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trial- Ingalill Feldmann, Lars Bondemark- American
Journal of Orthodontics & Dentofacial Orthopedics-
Volumen 133, Numero 3 , Pag 339.e19-339.e28, Mar-
zo 2008
Three-dimensional finite element analysis of the
craniomaxillary complex during maxillary protraction
with bone anchorage vs conventional dental anchor-
age- Xiulin Yan, Weijun He, Tao Lin, Jun Liu, Xiaofeng
Bai, Guangqi Yan -American Journal of Orthodontics
& Dentofacial Orthopedics-Volumen 143, Numero 2 ,
Pag 197-205, Febrero 2013,
Comparison of treatment outcomes between skeletal
anchorage and extraoral anchorage in adults with
maxillary dentoalveolar protrusion-Chung-Chen,Jane
Yao, Eddie Hsiang-Hua Lai, Jenny Zwei-Chieng Chang,
I. Chen,Yi-Jane Chen-American Journal of Orthodon-
tics & Dentofacial Orthopedics
Volumen 134, Numero 5 , Pag 615-624, Noviembre
2008
Case report: bimaxillary dentoalveolar protrusion
treated with lingual appliances and temporary an-
chorage devices-Kiyoshi Tai, Jae Hyung Park, Masahi-
roTanino, Kazuhisa Ikeda, -Journal Clinic of Orthodon-
tics -Volumen 46: Numero 12: Pag. 739: Diciembre
2012
Lingual applications of the midpalatal absolute an-
chorage system- Ryoon-Ki Hong, Seung-Min Lim,
Jung-Min Heo, Seung-Hak Baek, -Journal Clinic of
Orthodontics Volumen 46: Numero 6: Pag 344: Junio
2012
Case Report adult class II treatment using a new lin-
gual bracket and skeletal anchorage-Marcos Gabriel
Do Lago Prieto, MS, Carla Maria Melleiro Gimenez,
Lucas Tristao Prieto - Journal Clinic of Orthodontics-
Volumen 46: Numero 3 : Pag. 175: Marzo 2012
35
 E R
L L
New approach to lingual
SE
S T Orthodontics
BE Authors: Dr. Pablo Echarri Lobiondo
Dr. Kyoto Takemoto
Dr. Giuseppe Scuzzo
Dr. Didier Fillion
Dra. Silvia Geron
Dr. Hee Moon Kyung
Dr. Mario Paz
Dr. François Leclerc
Dr. Marcelo Marigo
428 pages in full color
Dimensions: 21x29.7 cm
Luxurious hard cover binding
ISBN: 978-84-937793-0-6
Price: 120 euros
- Shipping price for Europe: 36 euros = 156 euros
- Shipping price for America: 46 euros = 166 euros
OFFER: 80 euros (shipping included)*

PROLOGUE
Having had two our previous two WSLO Congresses in two different continents, in New York in 2006 and Seoul in 2007, we held
our 3rd biennial Congress in March of this year at Buenos Aires with South America as our 3rd new continent. I’m very glad that so
many orthodontists could attend this Congress and could see the newest and the highest level of treatments in lingual orthodontics
in the world.
I would especially like to say thank you for the efforts of the chairman Dr. Pablo Echarri, Dr. Adriana Pascual and Dr. Fernanda Elgo-
yhen, the Presidents of SAO and SAOL. Furthermore, I would like to say a very big thank you to all the staff and volunteers, too many
to name individually here, who worked so hard to make the 2009 congress such a success. I think that everybody appreciates that
putting together such a good event takes a great deal of work and dedication.
In addition, I sincerely hope that everybody will appreciate that this book is the result of many hours of work and research by the
speakers at the Congress who gave us so many excellent presentations. These speakers have greatly helped in our mission to
advance the art and science of lingual orthodontics and to help us to promote the use of lingual orthodontics throughout the world.
I hope everybody will make the best use of this book to understand current trends in lingual orthodontics.
I hope everybody will take the opportunity to present their ideas and help extend the art and science of lingual orthodontics when
we hold our next Congress which will be in Osaka, Japan in April 2011.
The WSLO is always seeking to achieve the highest possible quality of lingual orthodontics.
Let us look forward together to a promising future.

ORDERS:
You can order the book, indicating the offer, by:
• E-mail: ripano@ripano.eu
• Phone: (+34) 91 372 13 77
• Fax: (+34) 91 372 03 91
• Mail: Ripano S.A. Ronda del Caballero de la Mancha, 135 - 28034 Madrid (Spain)
• On-line: www.ripano.eu
*Offer is valid while supplies last.
 CONTENTS
1. Pascal Baron, Cristophe Gualano. Anchorage control performed with mini-screws and the LingualjetTM appliance
2. Regina Bass. Anchorage in lingual orthodontics
3. Germain Becker. Clinical pathways in lingual orthodontics
4. Tamar Brosh y col. Theoretical analysis of maxillary incisors movement due to antero-posterior force: labial vs. lingual orthodontics
5. Julio Cal-Neto. Advantages of the straight wire technique in lingual orthodontics
6. Asif Chatoo. Interdisciplinary management of adult patients with lingual braces
7. Claudia Correga Andreica y Dario Bertossi. Tissue reaction to light orthodontic forces – a comparison of STb versus Damon
appliance
8. Juan Carlos Crespi y Marcos López Rubio. Study group of lingual orthodontics (SGLO). Starting the way
9. Antonio D’Alessandro y Livia Nastri. Advanced active retainer: fixed lingual orthodontics with no brackets
10. Rubens Demicheri. Leveling and systemized treatment mechanics with the Magic® Lingual system
11. Pablo Echarri. Skeletal anchorage in lingual orthodontics
12. Mª Fernanda Elgoyhen y José Carlos Elgoyhen. Therapeutic alternatives with lingual orthodontics
13. Ryuzo Fukawa. Lingual orthodontics in the new era: Treatment according to criteria for occlusion and aesthetics
14. Ricardo Gallardo. Retraction of lower anterior teeth with reduced anchorage loss without using miniscrews
15. José Gaspar y Vivian K. Granadino Gaspar. 20 years of lingual orthodontics in Brazil
16. Silvia Geron. Management of the vertical dimension in severe anterior open bite (AOB)
17. Alfredo Gilbert Reisman. A new in-house lingual bracket transfer system
18. Ana González Blanco. Clinical management of the lingual orthodontic appliance
19. Diana Grandi. Lingual orthodontics and speech – language therapy: the benefits of interdisciplinary team work
20. Julia Harfin. Paradigms in lingual orthodontics
21. Chiori Hashiba. Incisal embrasure and incisal edge: their efficacy of the aesthetic appearance of maxillary anterior teeth
22. Mª Esther Hidalgo. Clinical and laboratory evolution in lingual technique
23. Toru Inami. Clinical standards of the establishment for facial balance and harmony in lingual bracket orthodontic technique
24. Aurelio Jano Takane. Goodbye mushroom
25. Hee-Moon Kyung. Lingual plain wire appliance and microimplant anchorage
26. Hee-Moon Kyung. Microimplants as anchorage in orthodontics
27. Roberto Lapenta. How to obtain success with lingual orthodontics?
28. Jean François Leclerc y col. Partial case report: how to manage lingual treatment with an edentulous anterior teeth patient?
29. Christophe Lesage. Mini screws in orthodontics: contribution of the 3D cone beam in surgical technique
30. Hatto Loidl. Selfligation in lingual technique
31. Marcos López Rubio. From simple to complex
32. Marcelo Marigo y Valter Arima. A new concept for lingual bracket – a point of view
33. Francisco Martino. Lingual orthodontics FAQ
34. Isao Matsuno. Surgical orthodontic treatment in lingual orthodontics
35. Carla Melleiro y col. Evaluation of cephalometric alterations noted during the lingual orthodontic treatment
36. Eliakim Mizrahi. Miniscrews, auxiliaries and lingual orthodontics
37. Nayre Mondino. Class II. Treatment – lingual orthodontics
38. Ramiro Moreno. Small movements and laboratory procedures
39. Magali Mujagic. Lingual orthodontics for each patient: a reality in a daily practice
40. Christine Muller. Contribution of micro-screws to Class II treatment
41. Marino Musilli. The interdisciplinary approach with the bracketless fixed orthodontics
42. Manabu Nakagawa. Bracket “Evolution”: characteristics and case reports
43. Carlos Navarro y col. Development of the “In-Ovation-L” bracket from GAC
44. Thomas Örtendahl. Clinical experience of selfligated aesthetic directbond lingual bracket
45. Mª Giacinta Paolone y col. Lingual orthodontics: a means for osseous and tissue regeneration, conventional treatment and forced
eruption
46. Mª Elsa Pavic. Vertical management in lingual technique: advantages and disadvantages
47. Mario Paz. Lingual and other accessory aesthetic techniques
48. Lucas Prieto. Prieto’s hygiene-friendly pendulum
49. Marcos Prieto. Prieto Lingual Straight-Wire Bracket (PSWb)
50. Caterina Pruzzo. Progress in lingual orthodontics, 8 years of clinical experience
51. Ronald Roncone. Lingual you will love
52. Florence Roussarie. Microscrews and the lingual system: an efficient working combination for the patient
53. Toru Shigeeda. Where is the best placement of micro implants, mid-palatal or alveolar bone or both?
54. Kyoto Takemoto y Giuseppe Scuzzo. New STb lingual straight wire method
55. Rita Thurler y col. Aluminum oxide – to use or not to use?
56. Henrique Valdetaro. Lingual orthodontics: problems and solutions
57. Emma Vila Manchó. Lingual orthodontics lesions vs. labial orthodontics lesions
58. Milena Zulic. Miniimplants as biomechanical auxiliaries in lingual orthodontics
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