Lingual orthodontic treatment duration: performance of two different completely customized multi-bracket appliances (Incognito and WIN) in groups with different treatment complexities

Abstract

IntroductionThe occurrence of side-effects of fixed orthodontic therapy, such as white-spot lesions and root resorption, are known to be significantly more frequent with increasing duration of treatment. Multi-bracket treatment should be as short as possible, in order to minimize the risks of collateral damage to teeth. The aim of this non-randomized clinical trial was to compare treatment duration with each of two types of customized lingual orthodontic appliances (Incognito, 3 M-Unitek; WIN, DW LingualSystems), taking into account treatment complexity. The null-hypothesis was that there would be no significant difference in active orthodontic treatment duration between them.MethodsOf 402 potentially eligible participants, a population sample of n = 376 subjects (nIncognito = 220; nWIN = 156; m/f 172/204; mean age ± SD 17.3 ± 7.7Y) treated in one orthodontic center (Bad Essen, Germany) with completely customized lingual appliances in upper and lower permanent dental arches was recruited with the inclusion criterion of initiated and completed lingual multi-bracket treatment within the assessment period of April 1st 2010 – Nov 30, 2013, and the exclusion criterion of less than 24 bracketed teeth. We used four-factorial ANOVA to assess the impact of the following factors: initial degree of severity of malocclusion (mild to moderate, S1; severe, S2), appliance type (Incognito; WIN), sex, and age group (<=16; >16 Y) on the duration of lingual multi-bracket treatment.ResultsOverall, mean treatment duration was 21.7 (SD 7.2) months, which was significantly shorter for WIN for both sub-groups of treatment complexity (S1: 17.96 mo; S2: 20.49 mo) compared to Incognito (S1: 22.7 mo; S2: 29.79 mo). ANOVA revealed a significant influence of the main effects ‘appliance type’, and ‘severity’, independent of each other. Therefore, the null-hypothesis was rejected.ConclusionIn terms of treatment duration, the WIN appliance performed significantly better than the Incognito appliance. Consequently, subjects treated with the WIN appliance are expected to be exposed to lower risks of the typical side-effects associated with longer multi-bracket treatment durations, such as root resorption and enamel decalcification.

Clinical outcomes of lingual orthodontic treatment: a systematic review

“…In another study, the number of lost brackets during the first year of treatment was found to be similar for lingual and labial appliances (32). Finally, a recent retrospective study compared two different lingual systems and showed that treatment The number of caries that formed (buccal: n = 16, lingual: n = 1) or progressed (buccal: n = 21, lingual: n = 7) was higher in buccal compared to lingual lesions (P = 0.01); the overall increase in caries extent/total lesion area was 10.6 times higher on buccal surfaces in a subject than on lingual surfaces (P < 0.05) (18). The results of these investigations, however, have to be interpreted taken into account the possibility of the influence of the various biases on the study outcomes.…”

“…and N.G.) evaluated several items according to a modified quality assessment tool designed based on Newcastle-Ottawa scale (18), relevant guidelines of the Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (15), and the GRADE approach (16).…”

“…After reading titles, abstracts, and application of inclusion and exclusion criteria, 87 studies were examined in their full-text forms. From these, 16 studies were deemed eligible for inclusion in the review and for qualitative and/or quantitative synthesis (6,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). The flow chart of study selection together with reasons for exclusion is provided in Figure 1.…”

Mental distress in orthodontic patients during the coronavirus disease 2019 pandemic

“…Treatment duration of both labial and lingual fixed appliances could be affected by replaced brackets and/or bands and missed appointments. 24 The treatment duration of lingual appliances is similar to buccal appliances, 25 but with the invisible characteristics of lingual appliances, patients seem to be less worried about the treatment duration. Another consideration is that lingual appliance wearers had higher incomes than buccal appliance wearers ( P <0.001; Supplementary Table ), and patients with better financial conditions might be less anxious amid this pandemic.…”

Clinical complications during treatment with a modified Herbst appliance in combination with a lingual appliance

“…However, as there has also been an increased use of lingual appliances in more complex treatments in adolscents [17], combination of lingual appliances with a Herbst type functional appliance are a common element of the contemporary orthodontic spectrum of therapy [18–20]. Similarly to vestibular Herbst derivatives, the fixation of Herbst telescopes in common lingual appliances (Incognito, 3 M Unitek, TOP-Service für Lingualtechnik, Bad Essen, Germany) is achieved by bands on the lower canines and upper first molars, which are simultaneously provided with a lingual bracket [21].…”