Lingual orthodontics - The future is lingual?

In the first in a series of articles from British Lingual Ortodontic Society, Rob Slater on why lingual orthodontics is establishing itself as a technique for the 21st century

Lingual orthodontics - braces worn behind the teeth - has been practised in the UK for at least 30 years now, but it is only in the last 10 years that demand for the technique has escalated. Among those requesting the lingual technique are patients who refused to consider orthodontics in the past because of the appearance of fixed appliances.

Members of the British Lingual Orthodontic Society (BLOS) are enjoying high demand from adult patients who want straight teeth without Ugly Betty train tracks. The lingual technique is a system described by some orthodontic specialists as “One of the most important dental developments of the 21^st century.”

As a specialty, orthodontics is the oldest and has enjoyed enormous innovation and a wide variety of systems, broadly featuring: Edgewise at the start of the 20^th century, Begg in the 1920s, straightwire in the 1970s, aligner systems in the 1990s and now lingual today. However, it is still not taught in any of the dental schools and remains a technique that specialists must learn for themselves.

Interestingly, lingual was also around in the 1980s and 1990s, developed simultaneously in the USA and Japan. Hollywood orthodontist Dr Craven Kurz, was one of two people credited with pioneering the system. The other was Professor Kinya Fujita, who invented lingual braces in Japan for martial arts combatants who wanted to avoid the risk of mucosal lacerations from labial appliances.

In the UK, however, a generation of orthodontic specialists tried out lingual orthodontics but largely gave up early on. It’s agreed that not enough research was carried out beforehand and the mechanical challenges were too great for the technique to be more widely accepted. All this has changed, however, and now lingual orthodontics is in vogue.

As a result of important research (1) published last year, lingual practitioners can be satisfied that there is a lower risk of visible marking or decay on the teeth among patients whose oral hygiene is poor.

The research compared braces on the outside surfaces of the teeth with those on the inside (lingual) surface and showed:

• The outer surface of the teeth are more prone to white spot lesions (WSL)

• The number of WSL that appeared was nearly five times greater when the braces were placed on the outer surface than when they were on the inside surface.

• When WSL did develop, it was 10.6 times more extensive when the braces were on the outer surface than when they were on the inside surface

If visible WSL did develop, it was behind the teeth and therefore invisible if lingual braces were used.

The increase in demand for this style of treatment has necessitated a change in the training pathways for orthodontic specialists and a change in the dissemination of information about this complex subject to the public

The British Lingual Orthodontic Society (BLOS) is the UK’s only society dealing exclusively with lingual orthodontics and is affiliated to the British Orthodontic Society. The aim of the society since its inception in 1995was:

· To provide an organized community for orthodontic specialists who practice lingual orthodontics

· To represent lingual orthodontics and orthodontists in the UK

· To promote excellence in this field by continuing to raise standards

· To provide a source of evidence supported information for the general public to allow them to make the right choices about their treatment

· To provide a way to find a lingual orthodontist in your area

The society has changed and grown with the needs of its members and the public to reflect the dramatic increase in the demand for invisible treatment for adults and children.

At the core of the society is the committee of ten experienced lingual orthodontists who meet four times per year to manage the running of the society. Within this structure, there are various sub-groups who coordinate the current projects.

One of the biggest developments has been the introduction of a two-tier membership enabling BLOS members to achieve accreditation. The format involves submission of three orthodontic cases treated with lingual appliances on all teeth involving extraction and non-extraction based treatment plans with the aim of demonstrating clinical excellence.

Cases are assessed against a standard and established set of criteria by an experienced panel of judges. Only those candidates who achieve the highest standards will become BLOS accredited.

Reference

van der Veen MH, Attin R, Schwestka-Polly R, Wiechmann D. Caries outcomes after orthodontic treatment with fixed appliances: do lingual brackets make a difference? Eur J Oral Sci 2010; 118: 298–303

Robert Slater has an orthodontic practice in Birmingham and is an Associate Clinical Teaching Fellow at Warwick University where he teaches on the Masters Programme in Lingual Orthodontics and is also an examiner on the Orthodontic Therapists Programme. He is a founding member of the British Lingual Orthodontic Society (BLOS) and, the immediate past Chairman.

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