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Revisiting the History of Lingual Orthodontics: A Basis for the Future
Revisiting the History of Lingual Orthodontics: A Basis for the Future Pablo Echarri The history of lingual orthodontics has not been a smooth one. There was a period of initial euphoria as the technique made its clinical debut; this was followed by a period of frustration, disappointment, and rejection. Thanks to the effort of several dedicated clinicians, many of the issues responsible for this decline have been overcome. We are now in a period of resurgence, the technique has become more sophisticated, the clinical results achieved can stand on an equal footing with the best of conventional labial techniques, and the acceptance of technique by the profession is growing rapidly. The history of this technique is peppered by individuals who have shown perseverance and ingenuity; in this article I will endeavor to cover some of the aspects related to these individuals and their contributions to lingual orthodontics. (Semin Orthod 2006;12:153-159.) © 2006 Elsevier Inc. All rights reserved.
ne of the most important challenges in orthodontics is to attain excellence in treatment with comfortable and esthetic appliances. From the esthetic perspective, lingual orthodontics provides the best option for comprehensive treatment of most malocclusions while maintaining full three-dimensional control of the dentition. In 1726, Pierre Fauchard1 suggested the possibility of using appliances on the lingual surfaces of teeth. In 1841, Pierre Joachim Lefoulon2 designed the first lingual arch for expansion and alignment of the teeth. Since the era of Edward Angle, numerous orthodontists have combined active labial appliances with lingual appliances such as the Mershon (lingual arch), Goshgarian (transpalatal bar), Ricketts (Quad-Helix) and Wilson (3D Modular Enhanced Orthodontics).3-5
O
Post Graduate Department of Orthodontics, University of Barcelona, Spain. Address correspondence to Pablo Echarri, DDS, Museu, 6 1o1a, 08912 Badalona, Barcelona, Spain. Phone: 00 34 93 384 47 05; Fax: 00 34 93 464 22 42; E-mail: echarri@ centroladent.com © 2006 Elsevier Inc. All rights reserved. 1073-8746/06/1203-0$30.00/0 doi:10.1053/j.sodo.2006.05.002
Lingual orthodontics, as we understand it today (a full, multibracket appliance), began in the 1970s. Curiously, the lingual appliance was not the consequence of an esthetic demand, but it was started in Japan by Kinja Fujita6-10 to satisfy the orthodontic needs of patients who practiced martial arts, to protect the soft tissues (lips and cheeks) from the possible impact against brackets. Fujita was the first to develop the lingual multibracket technique using the mushroomshaped archwire. He submitted his concepts on lingual orthodontics in 1967, began his research in 1971, and published the Fujita method in 1978, treating Class I and Class II cases with extraction of four bicuspids. The Fujita bracket had three slots— occlusal, horizontal, and vertical (US patent No. 4,209,906; July 1, 1980) (Figs 1 and 2). Craven Kurz started his investigations with Jim Mulick in 1975 (UCLA School of Dentistry), using plastic brackets (Lee Pharmaceuticals, 1434 Santa Anita Ave, South El Monte, CA 91733) bonded to the lingual tooth surfaces. Apparently an employee of the Bunny Playboy Club with crowded teeth came to Craven Kurz’s office asking him for nonvisible orthodontic treatment, further stimulating his interest in the subject. Using plastic brackets, it was easy to reshape them for a better fit to the lingual sur-
Seminars in Orthodontics, Vol 12, No 3 (September), 2006: pp 153-159
153
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P. Echarri
Figure 1. Patent for the Fujita lingual bracket (US patent No. 4,209,906).
faces; however, there were many problems, especially with regard to bonding failures and patient comfort (US patent No. 4,337,037; June 29, 1982) (Fig 3). Engineers Craig Andreiko and Frank Miller (Ormco, Sybron Dental Specialties, 1717 West Collins Ave, Orange, CA 92867) began their research with orthodontist Jim Wildman, who, as
far as I can ascertain, in 1976 treated the first patient in the United States by using a lingual appliance. Later, Craven Kurz and these two engineers developed the first generation of the Kurz lingual bracket. To test and continue their research in this field, Ormco founded a Task Force11-21 comprising Craven Kurz (Beverly Hills, CA),
History of Lingual Orthodontics
155
tioning of the mandible, extrusion of molars, intrusion of incisors, and facilitating any expansion and mesiodistal movement of molars uninhibited by occlusal forces. In the second generation (1980), hooks were added to canine brackets; and in the third generation (1981), hooks were added to all brackets and to molar tubes. The fourth generation (1982-1984) included a lower profile facilitating insertion of the archwire. With the fifth generation (19851986), the bite plane became more pronounced, the torque was increased, and the molar brackets included an accessory tube for a transpalatal
Figure 2. Patent for the Fujita lingual bracket (US patent No. 4,209,906).
Jack Gorman (Marion, IN), Bob Smith (Stanford, FL), “Wick” Alexander and “Moody” Alexander (Dallas, TX), James Hilgers (Mission Viejo, CA) and Bob Scholz (Alemeda, CA), and administrators Floyd Pickrel, Ernie Strauch, and Michael Swartz. The principal characteristics of this bracket were a bite plane, a base pad adapted to the anatomic characteristics of the lingual surfaces of the teeth, and a preangulated slot according to the conversion of the torque used on the labial surface. The Kurz lingual bracket developed and evolved to the 7th Generation Ormco Lingual Bracket in 1990. The first generation included a bite plane and rounded margins; hooks were absent and the bracket was large. The advantages of the bite plane included: opening the bite anteriorly with possible reposi-
Figure 3. Patent for the Craven Kurz lingual bracket (US patent No. 4,337,037).
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P. Echarri
bar. For the sixth generation (1987-1990), the hooks were elongated, the transpalatal bar attachment was optional, and the hinge-cap tube for the second molar was developed (self-ligated bracket). With the seventh generation (1990), the square bite plane became rhomboid shaped, increasing the interbracket distance, and the premolar brackets were widened mesiodistally for better rotational control (Fig 4). Kurz also developed numerous pliers and instruments for the clinical practice of lingual orthodontics; he was the owner of 22 patents. In the United States, pioneers in this field were Kelly22 (1982), who used Unitek labial brackets (3M Unitek, 2724 South Peck Road, Monrovia, CA 91016) on the lingual surfaces, and Paige23,24 (1982), who used Begg light wire brackets on the lingual surfaces. Creekmore25 (1989) developed a complete technique with vertical slot lingual brackets, together with a laboratory system (The Slot Machine). Creekmore also designed archwire templates and clinical instruments. The biomechanics of his lingual brackets (Conceal; 3M Unitek) was based on his previous uni-twin labial brackets, which increased the interbracket distance but maintained rotation control with extended wings. Following this initial development and expansion of lingual orthodontics in the 1990s, interest, particularly in the United States, decreased, probably due to the poor standard of completed cases. The reasons for this were attributed to inadequate training, poorly developed laboratory systems, and the unavailability of preformed archwires. In 1996, Craven Kurz, William Laughlin, Thomas Creekmore, Jim Wildman, Giuseppe Scuzzo, Didier Fillion, and Pablo Echarri together with other clinicians founded the Lingual Study Group, in Denver, Colorado, with the aim of relaunching lingual orthodontics, especially in the United States. The American Lingual Orthodontics Association (ALOA), founded in 1987 but which had been inactive for a number of years, was reactivated in 1997 by Mario Paz, John Napolitano, and Frank Andolino. Since then, the ALOA has prospered and continues to attract to their annual meeting increasing numbers of clinicians from many countries. In France, Fontenelle26,27 (1979) published his approach to invisible orthodontics by using a palatal mechanism incorporating bodily tooth
movement. Also in France, Didier Fillion has had and still continues to play an important role in the history and development of lingual orthodontics. He has been involved in research, publishing, and lecturing internationally on this subject.28-31 He has stimulated and been involved in the establishment of many lingual scientific societies, such as the European Society of Lingual Orthodontics (ESLO), Société Française d’Orthodontie Linguale (SFOL), British Society of Lingual Orthodontics (BLOS), and most recently the World Society of Lingual Orthodontics (WSLO). Furthermore, together with Alain Decker and Gerard Altounian he established one of the first university lingual orthodontics programs at Paris V University. Still in France, the important role of Jean-Françoise Leclerc, the fourth president of the ESLO, needs to be recorded. In Italy, Massimo Ronchin32 (1992) was elected as the first president of ESLO. He developed, in 1994, a self-ligating lingual bracket based on the Begg technique (Forestadent,
Figure 4. Evolution of the Craven Kurz lingual bracket.
History of Lingual Orthodontics
Westliche 151, 75172 Pforzheim, Germany). The same company also developed the Philippe bracket, a simple bracket without torque control, but useful for alignment and leveling.33 Aldo Macchi34 and Giuseppe Nidoli published a series of articles and helped to further disseminate information on the lingual technique. They developed the bracket Torque N/M, a self-ligating bracket with vertical archwire insertion path for the anterior teeth and with a horizontal slot for the posterior teeth. Giuseppe Siciliani published one of the first books on lingual orthodontics3 describing the features and mechanics of the lingual technique. Giuseppe Scuzzo was the third president of the ESLO, and he also contributed to the development of the Associazione Italiana de Ortodonzia Linguale (AIOL). Together with Kyoto Takemoto from Japan they published a series of articles, a CD syllabus, and a comprehensive text book35 on the lingual technique. They also developed a prototype of a lingual straight wire bracket and technique, the STb (Scuzzo/Takemoto bracket, Ormco), This bracket represents a significant advance, because its design facilitates the use of light forces with reduced friction and its small size enhances patient comfort. In Germany, Dirk Wiechmann36-38 developed a customized lingual bracket advancing the technique into a high technology level. The Incognito bracket is perfectly adapted to the lingual surfaces of the teeth, using a scanned model, the bracket base, and the bracket itself is cast as one unit for each individual tooth. The prescription for tip and torque is customized according to the orthodontist’s treatment plan. Wiechmann has also been involved with the development of a robot for designing and constructing lingual archwires perfectly adapted and customized for each dental arch. His contribution to lingual orthodontics is marked by his many publications, lectures, and involvement in study groups. Also in Germany, Hatto Loidl developed a self-ligating lingual bracket, Evolution LT (Adenta GmgH, Gutenbergstrasse 9, D-82205 Gilching, Germany). The second generation of this bracket was launched in 2001 incorporating increased maxillary incisor torque (60°), a modified stronger arch retaining clip, and a reduced buccal-lingual thickness of 2.1 mm.
157
In Israel, the promoters of lingual orthodontics are Silvia Geron,39 who developed the Lingual Bracket Jig for direct and indirect bonding in lingual orthodontics, and Rafi Romano, who edited a book40 presenting an update on the state of the art of lingual orthodontics. Furthermore, they founded the virtual journal www.lingualnews.com and a lingual orthodontics forum that facilitates the interchange of information between interested clinicians (http://health.groups.yahoo. com/group/lingualortho). In South Korea, where many clinicians use the lingual technique, two individuals need special mention, namely Tae Weon Kim and HeeMoon Kyung. Tae Weon Kim founded the Korean Society of Lingual Orthodontics (KSLO) and developed the Model Checker, a bracket positioner, and CRC Ready-Made Core Trays41 (plastic preformed attachment, perfectly adapted to the external surface of the Ormco lingual bracket), which together form the Korean Indirect Bonding Setup System (KIS System).5 Dr. Kim also designed special pliers to be used exclusively in the lingual technique. Hee-Moon Kyung founded the Korean Lingual Orthodontics Association (KLOA) and developed the Individual Indirect Bonding Technique (IIBT), the Mushroom Bracket Positioner, as well as the Lingual Straight Wire Technique.5 He is also well known for the development of the micro screw implant, a major advance in the provision of bony anchorage for both lingual and labial orthodontic techniques. The Japanese Lingual Orthodontics Association (JLOA) is currently the largest lingual orthodontic society, reflecting the state of lingual orthodontics in that country. Apart from Kinja Fujita, and others too numerous to list, mention should be made of Kyoto Takemoto, who, with Giuseppe Scuzzo, developed the STb bracket, as well as Toshiaki Hiro, who developed the technique of creating individual indirect bonding trays for each bracket. Hitoshi Koyata has written a book on lingual orthodontics with particular reference to the biomechanics of the technique.42 In Spain, lingual orthodontics is growing in popularity, and I am proud to have contributed to this development by creating the Sociedad Iberoamericana de Ortodoncia Lingual (SIAOL), organizing the first international con-
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gress of SIAOL, organizing regular lingual courses, both private and in combination with a number of universities, as well as organizing the 6th ESLO Meeting as its sixth president. I have published many articles and authored a book5 on lingual orthodontics. Due to the limited space it is impossible to name all the important lingual orthodontists who have contributed to the development of the technique, but I do not want to forget Stuart McCrostie and Derek Mahony from Australia, Eduard Pümpel from Austria, Marcelo Marigó from Brazil, and Andre Hugo and Ziegfried Weber from South Africa. The author considers that lingual orthodontics will continue to develop and evolve at an accelerating pace. Consumer demand will encourage a growing number of clinicians to learn and use the technique. Commercial companies are investing in appliance production and technique promotion. The creation of WSLO (World Society of Lingual Orthodontics; www. wslo.info) will certainly contribute to engaging lingual orthodontists from many countries and it will become the showcase of this remarkable technique for all orthodontists, patients, and commercial companies throughout the world.
Acknowledgments I want to thank to Craig Andreiko, Stuart McCrostie, Fred Marconi, Silvia Geron, Rafi Romano, André Hugo, María Guerra Cubero from Dentaurum, Betina Schendell from Adenta, Courtney Gorman Jr, Lori Garland Parker, Keith from 3M Unitek, and Stephen L. Hertzberg and Jim Wildman for their support and unselfish help in providing me with information on the subject. I also wish to apologize to all the people who I might not have mentioned in this article, especially because I am sure that “the history of lingual orthodontics ” is still being written by each and every one of us.
References 1. Fauchard P: Le Chirugien Dentiste ou Traitè des dents. Julien Prèlat (ed): París facsímil de la edición original de Tomo I, 494 pages, Tomo II, 442 pages, 1965 2. Walter H-A: History of Dentistry. Chicago, Quintessence, 1981 3. Siciliani G, Terranova S: Ortodonzia Linguale. Masson (ed), Milano, Italy, Vivendi Universal Publishing, 2001 4. Baca GA: Ortodoncia Lingual u Ortodoncia Invisible Tomo II, Cap°tulo 13 en. Tratado de Odontología, 1st ed. Madrid, Smithkline Beecham SA, Trigo Ediciones SL, 1998
5. Echarri P: Lingual Orthodontics. Complete technique, step by step. Barcelona, Nexus Ediciones, 2003 6. Fujita K: Development of lingual bracket technique: esthetic and hygiene approach to orthodontic treatment. J Jpn Res Soc Dent Mater Appliances 46:81-86, 1978 7. Fujita K: New orthodontic treatment with lingual bracket and mushroom archwire appliance. Am J Orthod 76: 657-675, 1979 8. Fujita K: Multilingual bracket and mushroom archwire technique: a clinical report. Am J Orthod 82:120-140, 1982 9. Fujita K: Desarrollo de la Técnica de Brackets Linguales. Una Aproximación Higiénica y Estética al Tratamiento Ortodóncico: Bases y Diseño. Ortod Clín 4:176-180, 2001 10. Fujita K: The Mushroom Archwire and the Lingual Bracket Appliances Philosophy and Technique (manual). Tokyo, Japan, Association of Orthodontists Using the Fujita Method, 1994 11. Alexander CM, Alexander RG, Gorman JC, et al: Lingual orthodontics: a status report. Part 1. J Clin Orthod 16: 255-62, 1982 12. Alexander CM, Alexander RG, Gorman, JC et al: Lingual orthodontics: a status report. Part 5. Lingual mechanotherapy. J Clin Orthod 17:99-115, 1983 13. Alexander CM, Alexander RG, Sinclair PM: Lingual orthodontics: a status report. Part 6. Patients and practice management. J Clin Orthod 17:240-246, 1983 14. Alexander RG, Sinclair PM, Goates LJ: Differential diagnosis and treatment planning for the adult non-surgical orthodontic patient. Am J Orthod 89:95-103, 1986 15. Gorman JC, Hilgers JJ, Smith JR: Lingual orthodontics: a status report. Part 4. Diagnosis and treatment planning. J Clin Orthod 17:26-35, 1983 16. Kurz C, Swartz ML, Andreiko C: Lingual orthodontics: a status report. Part 2. Research and development. J Clin Orthod 16:735-740, 1982 17. Kurz C, Gorman JC: Lingual orthodontics: a status report. Part 7A. Case reports—non-extraction, consolidation. J Clin Orthod 17:310-321, 1983 18. Scholz RP, Swartz ML: Lingual orthodontics: a status report: Part 3. Indirect bonding—laboratory and clinical procedures. J Clin Orthod 16:812-820, 1982 19. Smith JR: Lingual orthodontics: a status report. Part 7B. Case reports— extraction. J Clin Orthod 17:464-473, 1983 20. Smith JR, Gorman JC, Kurz C, Dunn R: 12 keys to success in lingual therapy. Part 1. J Clin Orthod 20: 252-261, 1986 21. Smith JR, Gorman JC, Kurz C, Dunn R: 12 keys to success in lingual therapy. Part 2. J Clin Orthod 20:330-340, 1986 22. Kelly VM: Dr Vincent M. Kelly on lingual orthodontics. J Clin Orthod 15:461-476, 1982 23. Paige SF: A lingual light-wire technique. J Clin Orthod 16:534-544, 1982 24. Paige SF: Une Technique Linguales Avec Arcs Legers. Rev Orthop Dento-Fac 17:391-408, 1983 25. Creekmore TD: Lingual orthodontics—its renaissance. Am J Orthod Dentofac Orthop 96:120-137, 1988 26. Fontenelle A: Une application nouvelle des principes de Burstone: la rétractioncanine sans appareillage visible. Orthod Fr 50:531-543, 1983
History of Lingual Orthodontics
27. Fontenelle A: Lingual orthodontics in adults, in Birte Melsen (ed): Current Controversies in Orthodontics. Chicago, Quintessence, 1991 28. Fillión D: A la Recherche de la Précision en Technique . . . Attaches Linguales. Rev Orthop Dento Faciale 20: 401-413, 1986 29. Fillión D: Orthodontie Linguale: Systèmes de Positionnemet des Attaches au Laboratoire. Orthod Fr 60:695704, 1989 30. Fillión D: Improving patient comfort with lingual brackets. J Clin Orthod 31:689-694, 1997 31. Fillión D: The resurgence of lingual orthodontics. Clin Impressions 7:2-9, 1998 32. Ronchin M: Aesthetics with lingual orthodontics. Resolving Class II malocclusion with molar distalization. Pract Perio Aesthet Dent 6:51-58, 1994 33. Philippe J: Vers des Appareils Non Visibles. Rev Orthop Dento Faciale 20:313-317, 1986 34. Macchi A, Norcini A, Tagliabue A: Primeras experiencias con los nuevos brackets 3D N/M. Ortod Clin 5:154-160, 2002
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35. Scuzzo G, Takemoto K: Invisible Orthodontics. Current Concepts and Solutions in Lingual Orthodontics. Berlin, Quintessenz Verlags-GmbH, 2003 36. Wiechmann D, Rummel V, Thalheim A, Simon VS, Wiechmann L: Customized bracket and archwires for lingual orthodontic treatment. Am J Orthod Dentofacial Orthop 124:593-599, 2003 37. Wiechmann D: A new bracket system for lingual orthodontic treatment. Part I: theoretical background and development. J Orofacial Orthop 63:234-245, 2002 38. Wiechmann D: A new bracket system for lingual orthodontic treatment. Part II: first clinical experience and further development. J Orofacial Orthop 64:372-388, 2003 39. Geron S, Romano R: El posicionamiento de los brackets en ortodoncia lingual: revisión crítica de diferentes técnicas. Ortod Clin 4:136-141, 2001 40. Romano R: Lingual Orthodontics. Ontario, BC Decker, 1998 41. Echarri P, Kim TW: Double transfer trays for indirect bonding. J Clin Orthod 38:8-13, 2004 42. Koyata H: Basic Technique of Lingual Orthodontics. Tokyo, Quintessence Books, 2003
ne of the most important challenges in orthodontics is to attain excellence in treatment with comfortable and esthetic appliances. From the esthetic perspective, lingual orthodontics provides the best option for comprehensive treatment of most malocclusions while maintaining full three-dimensional control of the dentition. In 1726, Pierre Fauchard1 suggested the possibility of using appliances on the lingual surfaces of teeth. In 1841, Pierre Joachim Lefoulon2 designed the first lingual arch for expansion and alignment of the teeth. Since the era of Edward Angle, numerous orthodontists have combined active labial appliances with lingual appliances such as the Mershon (lingual arch), Goshgarian (transpalatal bar), Ricketts (Quad-Helix) and Wilson (3D Modular Enhanced Orthodontics).3-5
O
Post Graduate Department of Orthodontics, University of Barcelona, Spain. Address correspondence to Pablo Echarri, DDS, Museu, 6 1o1a, 08912 Badalona, Barcelona, Spain. Phone: 00 34 93 384 47 05; Fax: 00 34 93 464 22 42; E-mail: echarri@ centroladent.com © 2006 Elsevier Inc. All rights reserved. 1073-8746/06/1203-0$30.00/0 doi:10.1053/j.sodo.2006.05.002
Lingual orthodontics, as we understand it today (a full, multibracket appliance), began in the 1970s. Curiously, the lingual appliance was not the consequence of an esthetic demand, but it was started in Japan by Kinja Fujita6-10 to satisfy the orthodontic needs of patients who practiced martial arts, to protect the soft tissues (lips and cheeks) from the possible impact against brackets. Fujita was the first to develop the lingual multibracket technique using the mushroomshaped archwire. He submitted his concepts on lingual orthodontics in 1967, began his research in 1971, and published the Fujita method in 1978, treating Class I and Class II cases with extraction of four bicuspids. The Fujita bracket had three slots— occlusal, horizontal, and vertical (US patent No. 4,209,906; July 1, 1980) (Figs 1 and 2). Craven Kurz started his investigations with Jim Mulick in 1975 (UCLA School of Dentistry), using plastic brackets (Lee Pharmaceuticals, 1434 Santa Anita Ave, South El Monte, CA 91733) bonded to the lingual tooth surfaces. Apparently an employee of the Bunny Playboy Club with crowded teeth came to Craven Kurz’s office asking him for nonvisible orthodontic treatment, further stimulating his interest in the subject. Using plastic brackets, it was easy to reshape them for a better fit to the lingual sur-
Seminars in Orthodontics, Vol 12, No 3 (September), 2006: pp 153-159
153
154
P. Echarri
Figure 1. Patent for the Fujita lingual bracket (US patent No. 4,209,906).
faces; however, there were many problems, especially with regard to bonding failures and patient comfort (US patent No. 4,337,037; June 29, 1982) (Fig 3). Engineers Craig Andreiko and Frank Miller (Ormco, Sybron Dental Specialties, 1717 West Collins Ave, Orange, CA 92867) began their research with orthodontist Jim Wildman, who, as
far as I can ascertain, in 1976 treated the first patient in the United States by using a lingual appliance. Later, Craven Kurz and these two engineers developed the first generation of the Kurz lingual bracket. To test and continue their research in this field, Ormco founded a Task Force11-21 comprising Craven Kurz (Beverly Hills, CA),
History of Lingual Orthodontics
155
tioning of the mandible, extrusion of molars, intrusion of incisors, and facilitating any expansion and mesiodistal movement of molars uninhibited by occlusal forces. In the second generation (1980), hooks were added to canine brackets; and in the third generation (1981), hooks were added to all brackets and to molar tubes. The fourth generation (1982-1984) included a lower profile facilitating insertion of the archwire. With the fifth generation (19851986), the bite plane became more pronounced, the torque was increased, and the molar brackets included an accessory tube for a transpalatal
Figure 2. Patent for the Fujita lingual bracket (US patent No. 4,209,906).
Jack Gorman (Marion, IN), Bob Smith (Stanford, FL), “Wick” Alexander and “Moody” Alexander (Dallas, TX), James Hilgers (Mission Viejo, CA) and Bob Scholz (Alemeda, CA), and administrators Floyd Pickrel, Ernie Strauch, and Michael Swartz. The principal characteristics of this bracket were a bite plane, a base pad adapted to the anatomic characteristics of the lingual surfaces of the teeth, and a preangulated slot according to the conversion of the torque used on the labial surface. The Kurz lingual bracket developed and evolved to the 7th Generation Ormco Lingual Bracket in 1990. The first generation included a bite plane and rounded margins; hooks were absent and the bracket was large. The advantages of the bite plane included: opening the bite anteriorly with possible reposi-
Figure 3. Patent for the Craven Kurz lingual bracket (US patent No. 4,337,037).
156
P. Echarri
bar. For the sixth generation (1987-1990), the hooks were elongated, the transpalatal bar attachment was optional, and the hinge-cap tube for the second molar was developed (self-ligated bracket). With the seventh generation (1990), the square bite plane became rhomboid shaped, increasing the interbracket distance, and the premolar brackets were widened mesiodistally for better rotational control (Fig 4). Kurz also developed numerous pliers and instruments for the clinical practice of lingual orthodontics; he was the owner of 22 patents. In the United States, pioneers in this field were Kelly22 (1982), who used Unitek labial brackets (3M Unitek, 2724 South Peck Road, Monrovia, CA 91016) on the lingual surfaces, and Paige23,24 (1982), who used Begg light wire brackets on the lingual surfaces. Creekmore25 (1989) developed a complete technique with vertical slot lingual brackets, together with a laboratory system (The Slot Machine). Creekmore also designed archwire templates and clinical instruments. The biomechanics of his lingual brackets (Conceal; 3M Unitek) was based on his previous uni-twin labial brackets, which increased the interbracket distance but maintained rotation control with extended wings. Following this initial development and expansion of lingual orthodontics in the 1990s, interest, particularly in the United States, decreased, probably due to the poor standard of completed cases. The reasons for this were attributed to inadequate training, poorly developed laboratory systems, and the unavailability of preformed archwires. In 1996, Craven Kurz, William Laughlin, Thomas Creekmore, Jim Wildman, Giuseppe Scuzzo, Didier Fillion, and Pablo Echarri together with other clinicians founded the Lingual Study Group, in Denver, Colorado, with the aim of relaunching lingual orthodontics, especially in the United States. The American Lingual Orthodontics Association (ALOA), founded in 1987 but which had been inactive for a number of years, was reactivated in 1997 by Mario Paz, John Napolitano, and Frank Andolino. Since then, the ALOA has prospered and continues to attract to their annual meeting increasing numbers of clinicians from many countries. In France, Fontenelle26,27 (1979) published his approach to invisible orthodontics by using a palatal mechanism incorporating bodily tooth
movement. Also in France, Didier Fillion has had and still continues to play an important role in the history and development of lingual orthodontics. He has been involved in research, publishing, and lecturing internationally on this subject.28-31 He has stimulated and been involved in the establishment of many lingual scientific societies, such as the European Society of Lingual Orthodontics (ESLO), Société Française d’Orthodontie Linguale (SFOL), British Society of Lingual Orthodontics (BLOS), and most recently the World Society of Lingual Orthodontics (WSLO). Furthermore, together with Alain Decker and Gerard Altounian he established one of the first university lingual orthodontics programs at Paris V University. Still in France, the important role of Jean-Françoise Leclerc, the fourth president of the ESLO, needs to be recorded. In Italy, Massimo Ronchin32 (1992) was elected as the first president of ESLO. He developed, in 1994, a self-ligating lingual bracket based on the Begg technique (Forestadent,
Figure 4. Evolution of the Craven Kurz lingual bracket.
History of Lingual Orthodontics
Westliche 151, 75172 Pforzheim, Germany). The same company also developed the Philippe bracket, a simple bracket without torque control, but useful for alignment and leveling.33 Aldo Macchi34 and Giuseppe Nidoli published a series of articles and helped to further disseminate information on the lingual technique. They developed the bracket Torque N/M, a self-ligating bracket with vertical archwire insertion path for the anterior teeth and with a horizontal slot for the posterior teeth. Giuseppe Siciliani published one of the first books on lingual orthodontics3 describing the features and mechanics of the lingual technique. Giuseppe Scuzzo was the third president of the ESLO, and he also contributed to the development of the Associazione Italiana de Ortodonzia Linguale (AIOL). Together with Kyoto Takemoto from Japan they published a series of articles, a CD syllabus, and a comprehensive text book35 on the lingual technique. They also developed a prototype of a lingual straight wire bracket and technique, the STb (Scuzzo/Takemoto bracket, Ormco), This bracket represents a significant advance, because its design facilitates the use of light forces with reduced friction and its small size enhances patient comfort. In Germany, Dirk Wiechmann36-38 developed a customized lingual bracket advancing the technique into a high technology level. The Incognito bracket is perfectly adapted to the lingual surfaces of the teeth, using a scanned model, the bracket base, and the bracket itself is cast as one unit for each individual tooth. The prescription for tip and torque is customized according to the orthodontist’s treatment plan. Wiechmann has also been involved with the development of a robot for designing and constructing lingual archwires perfectly adapted and customized for each dental arch. His contribution to lingual orthodontics is marked by his many publications, lectures, and involvement in study groups. Also in Germany, Hatto Loidl developed a self-ligating lingual bracket, Evolution LT (Adenta GmgH, Gutenbergstrasse 9, D-82205 Gilching, Germany). The second generation of this bracket was launched in 2001 incorporating increased maxillary incisor torque (60°), a modified stronger arch retaining clip, and a reduced buccal-lingual thickness of 2.1 mm.
157
In Israel, the promoters of lingual orthodontics are Silvia Geron,39 who developed the Lingual Bracket Jig for direct and indirect bonding in lingual orthodontics, and Rafi Romano, who edited a book40 presenting an update on the state of the art of lingual orthodontics. Furthermore, they founded the virtual journal www.lingualnews.com and a lingual orthodontics forum that facilitates the interchange of information between interested clinicians (http://health.groups.yahoo. com/group/lingualortho). In South Korea, where many clinicians use the lingual technique, two individuals need special mention, namely Tae Weon Kim and HeeMoon Kyung. Tae Weon Kim founded the Korean Society of Lingual Orthodontics (KSLO) and developed the Model Checker, a bracket positioner, and CRC Ready-Made Core Trays41 (plastic preformed attachment, perfectly adapted to the external surface of the Ormco lingual bracket), which together form the Korean Indirect Bonding Setup System (KIS System).5 Dr. Kim also designed special pliers to be used exclusively in the lingual technique. Hee-Moon Kyung founded the Korean Lingual Orthodontics Association (KLOA) and developed the Individual Indirect Bonding Technique (IIBT), the Mushroom Bracket Positioner, as well as the Lingual Straight Wire Technique.5 He is also well known for the development of the micro screw implant, a major advance in the provision of bony anchorage for both lingual and labial orthodontic techniques. The Japanese Lingual Orthodontics Association (JLOA) is currently the largest lingual orthodontic society, reflecting the state of lingual orthodontics in that country. Apart from Kinja Fujita, and others too numerous to list, mention should be made of Kyoto Takemoto, who, with Giuseppe Scuzzo, developed the STb bracket, as well as Toshiaki Hiro, who developed the technique of creating individual indirect bonding trays for each bracket. Hitoshi Koyata has written a book on lingual orthodontics with particular reference to the biomechanics of the technique.42 In Spain, lingual orthodontics is growing in popularity, and I am proud to have contributed to this development by creating the Sociedad Iberoamericana de Ortodoncia Lingual (SIAOL), organizing the first international con-
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gress of SIAOL, organizing regular lingual courses, both private and in combination with a number of universities, as well as organizing the 6th ESLO Meeting as its sixth president. I have published many articles and authored a book5 on lingual orthodontics. Due to the limited space it is impossible to name all the important lingual orthodontists who have contributed to the development of the technique, but I do not want to forget Stuart McCrostie and Derek Mahony from Australia, Eduard Pümpel from Austria, Marcelo Marigó from Brazil, and Andre Hugo and Ziegfried Weber from South Africa. The author considers that lingual orthodontics will continue to develop and evolve at an accelerating pace. Consumer demand will encourage a growing number of clinicians to learn and use the technique. Commercial companies are investing in appliance production and technique promotion. The creation of WSLO (World Society of Lingual Orthodontics; www. wslo.info) will certainly contribute to engaging lingual orthodontists from many countries and it will become the showcase of this remarkable technique for all orthodontists, patients, and commercial companies throughout the world.
Acknowledgments I want to thank to Craig Andreiko, Stuart McCrostie, Fred Marconi, Silvia Geron, Rafi Romano, André Hugo, María Guerra Cubero from Dentaurum, Betina Schendell from Adenta, Courtney Gorman Jr, Lori Garland Parker, Keith from 3M Unitek, and Stephen L. Hertzberg and Jim Wildman for their support and unselfish help in providing me with information on the subject. I also wish to apologize to all the people who I might not have mentioned in this article, especially because I am sure that “the history of lingual orthodontics ” is still being written by each and every one of us.
References 1. Fauchard P: Le Chirugien Dentiste ou Traitè des dents. Julien Prèlat (ed): París facsímil de la edición original de Tomo I, 494 pages, Tomo II, 442 pages, 1965 2. Walter H-A: History of Dentistry. Chicago, Quintessence, 1981 3. Siciliani G, Terranova S: Ortodonzia Linguale. Masson (ed), Milano, Italy, Vivendi Universal Publishing, 2001 4. Baca GA: Ortodoncia Lingual u Ortodoncia Invisible Tomo II, Cap°tulo 13 en. Tratado de Odontología, 1st ed. Madrid, Smithkline Beecham SA, Trigo Ediciones SL, 1998
5. Echarri P: Lingual Orthodontics. Complete technique, step by step. Barcelona, Nexus Ediciones, 2003 6. Fujita K: Development of lingual bracket technique: esthetic and hygiene approach to orthodontic treatment. J Jpn Res Soc Dent Mater Appliances 46:81-86, 1978 7. Fujita K: New orthodontic treatment with lingual bracket and mushroom archwire appliance. Am J Orthod 76: 657-675, 1979 8. Fujita K: Multilingual bracket and mushroom archwire technique: a clinical report. Am J Orthod 82:120-140, 1982 9. Fujita K: Desarrollo de la Técnica de Brackets Linguales. Una Aproximación Higiénica y Estética al Tratamiento Ortodóncico: Bases y Diseño. Ortod Clín 4:176-180, 2001 10. Fujita K: The Mushroom Archwire and the Lingual Bracket Appliances Philosophy and Technique (manual). Tokyo, Japan, Association of Orthodontists Using the Fujita Method, 1994 11. Alexander CM, Alexander RG, Gorman JC, et al: Lingual orthodontics: a status report. Part 1. J Clin Orthod 16: 255-62, 1982 12. Alexander CM, Alexander RG, Gorman, JC et al: Lingual orthodontics: a status report. Part 5. Lingual mechanotherapy. J Clin Orthod 17:99-115, 1983 13. Alexander CM, Alexander RG, Sinclair PM: Lingual orthodontics: a status report. Part 6. Patients and practice management. J Clin Orthod 17:240-246, 1983 14. Alexander RG, Sinclair PM, Goates LJ: Differential diagnosis and treatment planning for the adult non-surgical orthodontic patient. Am J Orthod 89:95-103, 1986 15. Gorman JC, Hilgers JJ, Smith JR: Lingual orthodontics: a status report. Part 4. Diagnosis and treatment planning. J Clin Orthod 17:26-35, 1983 16. Kurz C, Swartz ML, Andreiko C: Lingual orthodontics: a status report. Part 2. Research and development. J Clin Orthod 16:735-740, 1982 17. Kurz C, Gorman JC: Lingual orthodontics: a status report. Part 7A. Case reports—non-extraction, consolidation. J Clin Orthod 17:310-321, 1983 18. Scholz RP, Swartz ML: Lingual orthodontics: a status report: Part 3. Indirect bonding—laboratory and clinical procedures. J Clin Orthod 16:812-820, 1982 19. Smith JR: Lingual orthodontics: a status report. Part 7B. Case reports— extraction. J Clin Orthod 17:464-473, 1983 20. Smith JR, Gorman JC, Kurz C, Dunn R: 12 keys to success in lingual therapy. Part 1. J Clin Orthod 20: 252-261, 1986 21. Smith JR, Gorman JC, Kurz C, Dunn R: 12 keys to success in lingual therapy. Part 2. J Clin Orthod 20:330-340, 1986 22. Kelly VM: Dr Vincent M. Kelly on lingual orthodontics. J Clin Orthod 15:461-476, 1982 23. Paige SF: A lingual light-wire technique. J Clin Orthod 16:534-544, 1982 24. Paige SF: Une Technique Linguales Avec Arcs Legers. Rev Orthop Dento-Fac 17:391-408, 1983 25. Creekmore TD: Lingual orthodontics—its renaissance. Am J Orthod Dentofac Orthop 96:120-137, 1988 26. Fontenelle A: Une application nouvelle des principes de Burstone: la rétractioncanine sans appareillage visible. Orthod Fr 50:531-543, 1983
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27. Fontenelle A: Lingual orthodontics in adults, in Birte Melsen (ed): Current Controversies in Orthodontics. Chicago, Quintessence, 1991 28. Fillión D: A la Recherche de la Précision en Technique . . . Attaches Linguales. Rev Orthop Dento Faciale 20: 401-413, 1986 29. Fillión D: Orthodontie Linguale: Systèmes de Positionnemet des Attaches au Laboratoire. Orthod Fr 60:695704, 1989 30. Fillión D: Improving patient comfort with lingual brackets. J Clin Orthod 31:689-694, 1997 31. Fillión D: The resurgence of lingual orthodontics. Clin Impressions 7:2-9, 1998 32. Ronchin M: Aesthetics with lingual orthodontics. Resolving Class II malocclusion with molar distalization. Pract Perio Aesthet Dent 6:51-58, 1994 33. Philippe J: Vers des Appareils Non Visibles. Rev Orthop Dento Faciale 20:313-317, 1986 34. Macchi A, Norcini A, Tagliabue A: Primeras experiencias con los nuevos brackets 3D N/M. Ortod Clin 5:154-160, 2002
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35. Scuzzo G, Takemoto K: Invisible Orthodontics. Current Concepts and Solutions in Lingual Orthodontics. Berlin, Quintessenz Verlags-GmbH, 2003 36. Wiechmann D, Rummel V, Thalheim A, Simon VS, Wiechmann L: Customized bracket and archwires for lingual orthodontic treatment. Am J Orthod Dentofacial Orthop 124:593-599, 2003 37. Wiechmann D: A new bracket system for lingual orthodontic treatment. Part I: theoretical background and development. J Orofacial Orthop 63:234-245, 2002 38. Wiechmann D: A new bracket system for lingual orthodontic treatment. Part II: first clinical experience and further development. J Orofacial Orthop 64:372-388, 2003 39. Geron S, Romano R: El posicionamiento de los brackets en ortodoncia lingual: revisión crítica de diferentes técnicas. Ortod Clin 4:136-141, 2001 40. Romano R: Lingual Orthodontics. Ontario, BC Decker, 1998 41. Echarri P, Kim TW: Double transfer trays for indirect bonding. J Clin Orthod 38:8-13, 2004 42. Koyata H: Basic Technique of Lingual Orthodontics. Tokyo, Quintessence Books, 2003