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Atlas of Bracketless Fixed Lingual Orthodontics – Basic Concepts.
This atlas aims to illustrate the use of wires bonded directly to teeth to align them without the use of brackets. It builds on a technique first introduced by Aldo Macchi and Eric Liou who used this method at first to treat mild anterior relapse and then mild, previously untreated, anterior crowding.
The book starts with an understandably brief chapter on the materials used, given the simplicity in principle of a bracketless system. It does, however, give you the first indication that the chairside archwire bending required is technique sensitive and anything other than basic (bearing in mind a large proportion of UK orthodontists would not be comfortable bending up a straight multistrand retainer wire for aligned teeth post-treatment chairside). A novel means of ensuring sliding mechanics is maintained during initial alignment is then discussed, with a sleeve of wax being added to the wire where the composite will encase it on the tooth. The importance of the flowable composite remaining clear of the interdental spaces and the gingival sulci is highlighted, but the difficulty in achieving this is subsequently evident in the illustrations.
The second chapter moves onto wire bending steps, which in the main consists of first and second order (essentially U-shaped loops) bent into 0.0175” multi-strand stainless steel wires. The chapter leads you through the treatment of crowded cases by non-extraction expansion, non-extraction with the use of interproximal stripping and extractions, and then arch length discrepancies where teeth are already aligned. Ten pages are then devoted to how to bend a wire up and a further six on the bonding technique, that is not unreasonable given the involvement required. At this stage the clinical procedures required at review appointments is discussed, and whether composite is judicially removed on certain teeth to reactivate or if, indeed, new wires are needed. This chapter does not resolve the question as to how torque can be expressed in this system and, where arch lengths have been decreased, through overjet reduction or the management of crowding, the occlusal photo shots (there are a few shown in occlusion) do reveal an uprighting of anterior segments. The remainder of this chapter highlights the use of the technique with Temporary Anchorage Devices (TADs) and the principles illustrated here are perhaps more transferable into routine clinical practice
Chapter 3 leads on to analyse the tooth movements that can be achieved over successive appointments mid-treatment. It is here that the limitations of tip and torque control in this system are, this time with the addition of a further lingual wire, which does add to the bulk and complexity of the appliance. It is not clear at this stage how these survive in the upper arch with patients with an increased overbite, as the patients illustrated here do not exhibit this. Further examples are then given showing how extrusive, intrusive and derotation movements can be achieved.
Chapter 4, at 180 pages, is more than half the length of the book and is devoted to clinical examples of the use of the appliance and undoubtedly illustrates the high skill of the operators in delivering results with this bracketless lingual concept. Even without employing this technique, there is something for everyone to develop in their clinical practice here, whether it is the value of taking good clinical records to self-evaluate one's own treated cases, or to use when teaching patients and other clinicians.
Chapter 5 continues the clinical journey through interdisciplinary case management and discusses the use of the system in regenerating bone by means of orthodontic treatment ahead of implant placement. Again the principles in this chapter could be applied to other appliances and this, together with the final chapter, looking at the use of provisional teeth mid-treatment, gives the reader clinical pearls of wisdom on how to maintain aesthetics in patients facing the loss of teeth mid-treatment, especially for adults in the aesthetic zone
There is no doubt that this textbook is beautifully illustrated with excellent clinical photography but, whilst the concept behind this tooth alignment may be basic, on the authors' own admission, a good working knowledge of biomechanics and appropriate wire bending skills is required for correct execution of the technique. The absence of a prescription, normally provided by the bracket slot, or indeed any brackets, plain or otherwise, does makes the management of the system more complex and, as such, I am doubtful that there will be a big uptake in the use of this appliance. With this in mind, I would perhaps recommend an online search of the author and technique before deciding if purchasing this book is an investment for your clinical practice.