With the increasing understanding that appearance has an undeniably great importance in an individual's personal and professional life, interest in orthodontics is increasing, especially in adults.
However, the relatively unaesthetic appearance of traditional orthodontic mechanics as well as false beliefs and beliefs about the subject. These considerations cause serious differences between the need for orthodontic treatment and the number of patients receiving orthodontic treatment - especially in adults.
In this context, especially those with a certain career, in public, communication, media, etc. 'Lingual orthodontics', which is applied to the existing aesthetic concerns of adult patients who are busy with work, without adding additional burdens with the standard orthodontic mechanics used during treatment, is a unique opportunity for such patients. In addition to meeting the aesthetic needs of the patient, lingual devices are also biomechanically very advantageous compared to the traditional technique, due to the relationship between the point where the force is applied and the center of resistance of the tooth. However, it should be known that not every orthodontic patient is suitable for this treatment. In this regard, determining the treatment approach of the case, whether it is lingual, traditional, removable or any other way (Invisalign, e-cligner… etc.), is an issue that should be emphasized after the review in all dentistry disciplines.
When we specialize as lingual orthodontics, Since the primary patient group to be addressed is adult patients who have completed their development, additional diagnostic inputs will definitely be required. In this regard, the help of a periodontist, prosthodontist and maxillofacial surgeon is inevitable. In addition, the histological changes seen in the head and neck region in adult patients in relation to age are an issue that should not be ignored. During orthodontic treatment, the tissue adaptation required for orthodontic movement to occur after the force applied to the adult tooth takes approximately three months. The fact that this adaptation is much slower than that seen in adolescent individuals is due to the adult bone structure, which has few trabeculae and low blood supply and therefore nutrition.
Although the treatment plan is shaped according to the initial diagnosis, the advantages and limitations of the various treatment approaches to be used, patient preference and, of course, Time and cost factors also shape the plan. In this regard, in order to create a definitive treatment plan and to obtain results close to the results of traditional practices at the end of the treatment, it is necessary to master the aspects of lingual mechanotherapy that differ from conventional treatment approaches, and to have sufficient current knowledge and sufficient clinical experience on this subject.
The most important element when choosing a lingual technique patient is undoubtedly to learn why the patients want to be treated and to make a preliminary personality assessment.
The patient should be informed about the treatment and the problems that the treatment will cause, especially at the beginning, should be mentioned to the patient. Misdirection, incorrect assessment of what the patient expects from the treatment, inadequate information about possible side effects, and as a result of these, the patient's inability to adapt to the treatment may lead us to the dismantling of the lingual devices. For this reason, initial cooperation with the patient is very important. This is entirely related to patient selection. At the beginning, in the first encounter with the patient, factors such as whether the patient is docile, tolerant, easily adapts to new changes, whether he is realistic in his wishes, whether he is sincere and sincere are evaluated in order to provide accurate feedback and a solid evaluation of the treatment results. An attempt should be made to gain an idea about the patient. Personality factor is of undeniable importance in patient selection.
In a study conducted years ago, it was seen that lingual technique patients had very different occupational groups and lifestyles, but when the general trend was looked at, it was seen that those who were engaged in professions that required being in front of society, such as modeling, and It has been observed that the majority of patients live in big cities, have a good income and are aware of the importance of dental appearance. Again, in the grouping made considering the age factor, it was seen that the average age of these patients was mostly in the late 20s and early 30s.
However, the common concern of all these patient groups is undoubtedly their appearance. Lingual orthodontic candidate patients often apply directly to the physician with this request. These patients are often similar to other adult patients. With age they become more suspicious and quite questioning. For this reason, a more careful and attentive preliminary evaluation is required. Potential lingual technique patients generally apply to the physician with the following four basic questions:
a. Can I use lingual braces?
b. How long does the treatment take?
c. What is the cost of treatment compared to conventional practices?
d. Can we achieve the desired results?
Therefore, the physician should be prepared for these questions and be frank about the contraindications of the technique. In addition, the patient should be informed that the treatment period may be prolonged, there will be an increase in the time spent at the bedside, that he/she will encounter discomfort regarding his/her language, speech and eating and drinking, that from time to time the molar brackets will be visible when talking, most of the time when laughing and when their mouth is opened wide, and that if extraction is planned, the extraction sites may be visible. If it is heard, it should be explained in detail before the treatment that conventional applications can be used for a period of 3-4 months for the desired results during the finishing phase. Additionally, the patient should be informed about the possible total cost of the treatment.
Although lingual brackets are completely aesthetic, their use is limited due to physicians' justified doubts about patient adaptation.
Issues that patients complain about during the adaptation period; tongue irritation, speech and chewing problems. As a result of a survey, it was determined that tongue irritation disturbed the patients the most (44%), followed by speech (36%) and chewing problems (20%), respectively. In the same survey, in the answers to the question 'How long does it take to adapt to devices?', those who said more than 3 weeks; It has the highest rate with 36%. Especially in the first days following the placement of lingual brackets, an inevitable irritation will occur in the tongue as a result of the contact of the tongue with the lingual brackets. Under normal conditions, the tip of the tongue is in contact with the back of the upper front teeth during speaking and chewing. However, when foreign objects enter the mouth, the tip of the tongue will inevitably slide towards these new objects, which will increase both speech disorder and irritation in the tongue. Again, lingual technique patients typically have brackets on both sides of the tongue after waking up. trace is seen. In the upper jaw, irritation on the tongue almost always disappears 2-3 weeks after bracket placement. The adaptation period is longer for the lower jaw, especially in individuals who have a habit of tongue thrusting and/or have a wide tongue structure. If it is a topic of conversation, it disturbs the patient in the first months, also related to the irritation in the tongue. However, this situation is temporary. The patient returns to normal speech pattern after a short time. Some words, especially those containing the letter 's', sound more sibilant and longer in the first weeks. Again, problems are frequently encountered in the pronunciation of the letter 't'.
Another problem that disturbs the patient during the adaptation period is chewing. In almost all cases, especially in deep bite patients, coverage (occlusion) is lost in the molar area due to the size and position of the lingual bracket. In this case, it creates difficulty in chewing. Depending on the severity of the deep bite and crowding, the coverage is regained within 1 to 3 months. In this way, it has been observed that patients compensate for the weight loss seen in the first months of treatment as the adaptation period is exceeded and coverage is achieved in the following months. In short, lingual orthodontic mechanics disturb the patient, especially in the first weeks. However, patients who are informed about this issue and have prepared themselves in advance can overcome this period in a short time and easily adapt to the treatment.
As a result; Lingual orthodontics does not differ from traditional front surface orthodontics only in that the attachments used are glued to a different surface. It also has a different manual and mental approach. However, its basic philosophy is based on traditional treatment practices. For this reason, lingual orthodontics should neither be applied lightly, without having sufficient current knowledge and even partial experience, nor should one be afraid of lingual orthodontics and refrain from applying it, seeing this technique as a completely different approach.
In this direction, The decrease in the birth rate seen especially in developed societies, the increasing average age of the population and the increase in the demand for aesthetic expectations during treatment, regardless of age, due to the influence of the media, have forced us orthodontists to turn to new approaches along with conventional orthodontic mechanics. left him face to face with his grief. In this changing social structure, lingual orthodontics, with its biomechanical advantages compared to the traditional technique as well as the aesthetic benefits it provides, when applied correctly, is a valuable treatment alternative, especially for patients who need orthodontic treatment but are hesitant about treatment and physicians who want to refer these patients to treatment.
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