The reason we don't use lingual braces, external, aesthetic braces or aligner systems
The big hit in modern orthodontics is invisible braces. It is no longer used only in adult treatment, but also in many pediatric cases. It may therefore be surprising that a practice does not use these techniques. This blog explores the considerations that have led Hermann Dental and Medical to develop its appliance system.
The big hit in modern orthodontics is invisible braces. It is no longer used only in adult treatment, but also in many pediatric cases. It may therefore be surprising that a practice does not use these techniques. This blog explores the considerations that have led Hermann Dental and Medical to develop its appliance system.
It is indeed very tempting to avoid or reduce the visibility of the appliance when you start orthodontic treatment as an adult. This is reinforced by the huge advertising campaign which tries to make people believe that everything can be done with these invisible appliances. However, the most important goal, once one has started, is to make the treatment a success. This is because there are so many factors that can make it difficult: the dentition itself, the relationship between the jawbones and stress, clenching of teeth, difficulty sleeping. Taking these into account can override a lot of things. At Hermann Dental and Medical, it is very important for us to be able to control both the planned tooth and jaw movement and to be prepared in case we have to deal with a situation arising from stress. Many years of experience and development have formed the basis of the appliance selection methodology we currently use.
It is indeed very tempting to avoid or reduce the visibility of the appliance when you start orthodontic treatment as an adult. This is reinforced by the huge advertising campaign which tries to make people believe that everything can be done with these invisible appliances. However, the most important goal, once one has started, is to make the treatment a success. This is because there are so many factors that can make it difficult: the dentition itself, the relationship between the jawbones and stress, clenching of teeth, difficulty sleeping. Taking these into account can override a lot of things. At Hermann Dental and Medical, it is very important for us to be able to control both the planned tooth and jaw movement and to be prepared in case we have to deal with a situation arising from stress. Many years of experience and development have formed the basis of the appliance selection methodology we currently use.
The advent of Invisalign in 2000 fundamentally rewrote the history of orthodontics. It was the first big wave of the digital age and the introduction of aligners, or clear splint treatments. Invisible orthodontics had been done before with lingual, or tongue-in-cheek, braces, but that technique too only matured in the 2000s after previous failed attempts. In other words, invisible orthodontics has received much more attention since 2000. In addition, over the last 20 years or so, not only Invisalign but many other aligner brands have appeared. Invisible orthodontics is almost on tap, nowadays almost all orthodontic practices offer invisible orthodontics, and in fact many of them advertise that there is no need for bonded braces any more, that all orthodontic problems can be solved with aligners.
In the light of all this, it may indeed be surprising that there are orthodontic practices that have removed aligners and lingual techniques from their services.
The lingual technique, or lingual orthodontics, has not been able to gain ground alongside aligners, it has not been lucky because by the time it has become more widespread, aligners have become much more successful. The lingual technique remained a layering technique.
In principle, you could say that there is no difference in the way you move teeth, that the appliances are completely equivalent, but in reality this is not entirely true.
The advent of Invisalign in 2000 fundamentally rewrote the history of orthodontics. It was the first big wave of the digital age and the introduction of aligners, or clear splint treatments. Invisible orthodontics had been done before with lingual, or tongue-in-cheek, braces, but that technique too only matured in the 2000s after previous failed attempts. In other words, invisible orthodontics has received much more attention since 2000. In addition, over the last 20 years or so, not only Invisalign but many other aligner brands have appeared. Invisible orthodontics is almost on tap, nowadays almost all orthodontic practices offer invisible orthodontics, and in fact many of them advertise that there is no need for bonded braces any more, that all orthodontic problems can be solved with aligners.
In the light of all this, it may indeed be surprising that there are orthodontic practices that have removed aligners and lingual techniques from their services.
The lingual technique, or lingual orthodontics, has not been able to gain ground alongside aligners, it has not been lucky because by the time it has become more widespread, aligners have become much more successful. The lingual technique remained a layering technique.
In principle, you could say that there is no difference in the way you move teeth, that the appliances are completely equivalent, but in reality this is not entirely true.
Lingual techniques
The most common lingual orthodontic appliance treatment systems are now much more comfortable for the patient than before, but this comfort has been achieved by making tooth movement control in many ways weaker. There are certain movement tasks (e.g. rotation and tilt control of canines and incisors) that are particularly difficult, but there are two other big challenges: one is that these appliances are so-called pre-programmed appliances, i.e. an ideal bite pattern is set at the beginning of the treatment and brackets and arches are made to match. This is ideal in principle, but if you need to react to a condition during treatment or add extra information, it is not possible or very complicated. For example, when we want to change the length of the teeth to adjust the smile. The other difficulty is particularly related to the Hermann Dental and Medical procedure.
In general, in the orthodontic profession, if there is a big difference in the position of the upper and lower jaws and someone wants to solve it surgically, then lingual orthodontic appliance treatment is realistic, as the appliances are programmed in the ideal jaw-bite position and the surgery fits the two jaws and dentures together. Conversely, if this large difference is to be resolved non-surgically, the lingual appliance will be a constraint. This is because Hermann Dental and Medical’s successful, non-surgical methodology specifically fixes the elements that move the jawbone in the oral cavity and inside the teeth. That is, exactly where the tongue appliance would be.
In our practice, we perform a lot of treatments that would clearly be considered surgery or tooth extraction by the majority of the orthodontic profession. In these cases, the means to change the position of the jawbone preclude the use of a lingual appliance, and its binding is also a disqualifying factor. In addition, the force system acting on the teeth is different. The passive self-locking technique applies much lower forces on the teeth and bone than the more rigid lingual technique.
The most common lingual orthodontic appliance treatment systems are now much more comfortable for the patient than before, but this comfort has been achieved by making tooth movement control in many ways weaker. There are certain movement tasks (e.g. rotation and tilt control of canines and incisors) that are particularly difficult, but there are two other big challenges: one is that these appliances are so-called pre-programmed appliances, i.e. an ideal bite pattern is set at the beginning of the treatment and brackets and arches are made to match. This is ideal in principle, but if you need to react to a condition during treatment or add extra information, it is not possible or very complicated. For example, when we want to change the length of the teeth to adjust the smile. The other difficulty is particularly related to the Hermann Dental and Medical procedure.
In general, in the orthodontic profession, if there is a big difference in the position of the upper and lower jaws and someone wants to solve it surgically, then lingual orthodontic appliance treatment is realistic, as the appliances are programmed in the ideal jaw-bite position and the surgery fits the two jaws and dentures together. Conversely, if this large difference is to be resolved non-surgically, the lingual appliance will be a constraint. This is because Hermann Dental and Medical’s successful, non-surgical methodology specifically fixes the elements that move the jawbone in the oral cavity and inside the teeth. That is, exactly where the tongue appliance would be.
In our practice, we perform a lot of treatments that would clearly be considered surgery or tooth extraction by the majority of the orthodontic profession. In these cases, the means to change the position of the jawbone preclude the use of a lingual appliance, and its binding is also a disqualifying factor. In addition, the force system acting on the teeth is different. The passive self-locking technique applies much lower forces on the teeth and bone than the more rigid lingual technique.
Aligner systems
As the first Invisalign dentist in Hungary, as the developer of our own Smileazy aligner brand, manufactured by our own aligner laboratory since 2013, and as the designer and builder of thousands of successful treatments, I still think it is overly optimistic to claim that aligners will completely replace bonded braces. Aligners are very good at controlling many movements, but there are still some tooth and bite situations where control is not complete. Overall, this would not be a reason to completely exclude aligners from the palette. In fact, the main reasons for doing so are bite alignment and control of large jaw misalignments, as well as stress and clenching.
As I mentioned above, at Hermann Dental and Medical we do a lot of treatments that are not even borderline in the surgery/dentistry field, but clearly fall into the surgery/dentistry category in most places. The solution to these not only requires flexibility from the appliance during treatment (and not only is the lingual technique inflexible during treatment, but so are the aligners, as both are pre-programmed appliance systems), but the elements that set the bite are also constantly evolving and we place them in different locations on the teeth.
In addition, in the treatment of profound deep bites, raising the bite, raising the lateral teeth by a cap cannot be expected. A further disqualifying factor has become the accumulation of enormous tension in an increasing number of patients due to external circumstances, which manifests itself in clenching.
As the first Invisalign dentist in Hungary, as the developer of our own Smileazy aligner brand, manufactured by our own aligner laboratory since 2013, and as the designer and builder of thousands of successful treatments, I still think it is overly optimistic to claim that aligners will completely replace bonded braces. Aligners are very good at controlling many movements, but there are still some tooth and bite situations where control is not complete. Overall, this would not be a reason to completely exclude aligners from the palette. In fact, the main reasons for doing so are bite alignment and control of large jaw misalignments, as well as stress and clenching.
As I mentioned above, at Hermann Dental and Medical we do a lot of treatments that are not even borderline in the surgery/dentistry field, but clearly fall into the surgery/dentistry category in most places. The solution to these not only requires flexibility from the appliance during treatment (and not only is the lingual technique inflexible during treatment, but so are the aligners, as both are pre-programmed appliance systems), but the elements that set the bite are also constantly evolving and we place them in different locations on the teeth.
In addition, in the treatment of profound deep bites, raising the bite, raising the lateral teeth by a cap cannot be expected. A further disqualifying factor has become the accumulation of enormous tension in an increasing number of patients due to external circumstances, which manifests itself in clenching.
External aesthetic appliance elements (porcelain external appliances)
The passive self-locking technique (Damon technique, or “soft-force orthodontics”) is a special appliance. For many years, its construction from aesthetic materials was only possible at great cost. In order to prevent the self-locking “doors” from breaking out of the bracket, the interior of the appliance was made with a grid of margins. Unfortunately, this led to a weakening of the movement control, which could not be handled in the same way. In addition, the porcelain appliance became larger and we could not engage the tooth in the treatment immediately in the event of a larger crowding. With all this in mind, we only make exceptions in certain cases and only place aesthetic appliances on the top 6 teeth. This is only decided on the basis of the case, i.e. during the consultation.
The passive self-locking technique (Damon technique, or “soft-force orthodontics”) is a special appliance. For many years, its construction from aesthetic materials was only possible at great cost. In order to prevent the self-locking “doors” from breaking out of the bracket, the interior of the appliance was made with a grid of margins. Unfortunately, this led to a weakening of the movement control, which could not be handled in the same way. In addition, the porcelain appliance became larger and we could not engage the tooth in the treatment immediately in the event of a larger crowding. With all this in mind, we only make exceptions in certain cases and only place aesthetic appliances on the top 6 teeth. This is only decided on the basis of the case, i.e. during the consultation.
Contact us
HermannOrtho Professional Orthodontics
- Address: 1036 Budapest, Bécsi út 85.
- Phone: +36-1 306-78-46
- E-mail: info@hermannortho.hu
- Opening hours: Monday: 09:00-14:00 / Tuesday: 09:00-19:00 / Wednesday: 09:00-17:00 / Thursday: 09:00-19:00
Neurotrain Development Programmes
- Address: 1036 Budapest, Lajos utca 91. 3.emelet /1.
- Phone: +36 1 306 78 46; +36 20 996 7846
- E-mail: info@neurotrain.hu
- Opening hours: Monday: 09:00-14:00 / Tuesday: 09:00-19:00 / Wednesday: 09:00-17:00 / Thursday: 09:00-19:00
