Why is it that only 37% of orthodontists who are certified in a lingual system are active users? This was the question posed by Edinburgh specialist Robbie Lawson in his presentation at the British Orthodontic Conference, held in Edinburgh on 18-20 September, when he highlighted the high standard of outcomes delivered by specialists with digital set-ups and the lingual technique.
In a talk entitled Lingual orthodontics: overcoming the hurdles, Robbie outlined the obstacles that might impede the progress of newly certified lingual users. On the list were patient adaptation to speech difficulties and tongue sensitivity, oral health, cost, complexity and perceived outcome standards.
The research says
The only hurdle that has some limited basis, in his view, is adaptation. Robbie estimated that one in 10 of his patients struggle for a while when their lingual brackets are first in place. Otherwise, he produced research that revealed the other perceived hurdles were ill-founded.
He said: ‘The daddy of reasons that clinicians might not choose lingual is the perception that it might not deliver such a good result as the labial technique.’ But there were studies, he continued, that showed that lingual achieved ‘incredibly good accuracy’.
There was a word of warning, however. ‘We can’t grow bone but we do move bone in the alveolus. We have to be very cautious with what we do to teeth. What I try to do is leave the teeth as upright as possible over the alveolar bone.’
The digital age
‘The thing I am most excited about,’ continued Robbie ‘is the digital age. Digital set-ups help enormously. You get reference points so we know what changes we are making to teeth. We can assess the biological appropriateness of the proposed set up. I think we are going to see digital convergence of the technologies so we can all see what we are going to achieve.
‘Many of you may think you can’t afford to do lingual but I turn this around. Can you afford not to do lingual? For those who want the confidence to move forward with lingual, the BLOS (British Lingual Orthodontic Society) is there for you.’
It was the second year in a row that the organisers of the British Orthodontic Conference had a double session devoted to lingual. Vittorio Cacciafesta gave a talk on lingual and the 2D technique. Vittorio also gave a highly popular hands-on master class in the lingual technique.