Traditional lingual ortho under threat from digital?

BLOS speakers

BLOS speakers (left to right): Dr Roberto Stradi, Dr Sunil Hirani, Dr Asif Chatoo, Dr Ian Hutchinson, Dr Angela Auluck, Dr Alexander Gebhardt, Dr Henrique Valdetaro and Professor Kee-Joon Lee

Did video kill the radio star; will CAD/CAM replace ‘traditional’ lingual techniques? Lingual orthodontists from around the world travelled to London for the British Lingual Orthodontic Society’s annual meeting in March to discuss and debate this very question.

The two-day event began with a pre-congress course delivered by Professor Kee-Joon Lee from Yonsei University in South Korea. His talk ‘up-to-date lingual mechanics’ explored self-ligation, skeletal anchorage and biomechanics.

Professor Lee focused on the significance of the fundamentals of lingual orthodontics – or any orthodontic treatment – which is biomechanics, something that is all too frequently forgotten these days. He illustrated this eloquently with cases where sectional and full arch lingual appliances were used to deliver the required tooth movement purely on a biomechanical blue print.

In the afternoon orthodontic theory was put into action during a practical exercise where the delegates got to grips with bonding using the Hiro approach with self-ligating brackets, followed by torquing and arch wires. For the final session of the day, Professor Lee provided further inspiration by demonstrating how mini screws can extend the envelope of dento-alveolar compensation before resorting to surgery.

‘I’ve known Professor Lee for over ten years, and every time I listen to his lectures I am filled with enthusiasm and inspiration. It’s the first time the BLOS conference has included a pre-congress course and the session provided an excellent warm up to the conference’s main event the following day,’ commented BLOS chairman Ian Hutchinson.

On day two, a panel of internationally renowned speakers joined the line up to discuss the advantages and disadvantages of different CAD/CAM systems compared to more time-honoured techniques.

BLOS hands on

Dr Sunil Hirani and Dr Mark Sayers get to grips with the Hiro approach

CAD/CAM enthusiasts included Dr Asif Chatoo, Dr Sunil Hirani and Dr Roberto Stradi, who were joined by ‘traditionalists’ Dr Alex Gebhardt and Dr Henrique Valdetaro.

Each speaker presented their preferred system, and then Professor Lee provided a roundup of the advantages and disadvantages of the two approaches, along with his advice for selecting the best technique. An interesting notion was that if technology doesn’t make orthodontists treat patients better, yet it costs more, is it worth the money?

The day concluded with a lively debate, with the majority of speakers and delegates agreeing that there’s no right or wrong when it comes to choosing CAD/CAM vs conventional methods. Henrique Valdetaro said, ‘Twenty years of orthodontics and 16 years of lingual orthodontics I do not remember seeing such an intense debate.’

The verdict: CAD/CAM may be high tech but the systems don’t (yet) feature artificial intelligence. So while it undoubtedly has its benefits, it shouldn’t be used at the expense of thorough diagnosis and treatment planning. This outlook that was succinctly summed up by speaker Dr Roberto Stradi, ‘Whatever kind of technology you’re using, the orthodontist has to take control and drive the system.’

For information on upcoming lingual courses, please visit:


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    Totally agree with this summary, especially the cost factor. Often the ‘wow ‘of digital is preferred over the traditional approach for show and marketing reasons. Recently I ask why two top inventors in the Lingual world have gone back to manual? Last month I was at the ‘Japan Lingual Summit’ in a small group which included some famous names like Dr Chris Chang. The course was run by Dr Takemoto who does a purely manual technique.
    Dr Dirk Weichman the inventor of Incognito has gone back to a manual Kesling model system in his NEW system WIN. So if these two are not using digital like some of the big companies want… Why?
    The next big debate will be in Athens this summer at the ESLO… Be there!

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    Another good thing about this meeting is that: It is not a subject anymore if Lingual Orthodontic works or not, if it is good or not. Lingual Orthodontics is proving to be a great and esthetic way to treat our patients and the technique give us a perfect control of the movement ! The discussion now is just the best way to do it!

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    Totally agree with the summary and the comments by OSDT Peter Sheffield too! And this is not only about the cost factor!!Even in the research of Monica S. Barretoa, Jorge Faberb, Carlos J. Vogelc, Telma M. Araujod (Angle Orthodontist, Vol 86, No 2, 2016), and also the research of Im J, Cha JY, Lee KJ, Yu HS, Hwang CJ (Am J Orthod Dentofacial Orthop. 2014 Apr;145(4):434-42. ) is clear enough that: further studies are warranted to assess the reliability of virtual setups and to develop algorithms to predict gingival response to tooth movement, which would allow further refinement of orthodontic planning. Please watch the video: of Prof.Jung-Yul Cha about the ”Comparison of virtual and manual tooth setups with digital and plaster models in extraction cases”. Are we in a middle of a ”technological race” between the best and the very best? The conclusions are yours and let the years pass to reveal the truth because we also have to make more inovations to speed up the processes of accuracy and finally market expansion.Yes….The next big debate will be in Athens this summer at the 12th ESLO Congress…
    George Antonopoulos

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