A.DIAGNOSIS
In case diagnosis, all similar procedures established so far in other disciplines are valid.
When we specialize in lingual orthodontics, the primary patient group we focus on is adult patients whose development has completed. Diagnostic inputs will definitely be required. In this regard, the help of a periodontist (gum treatment specialist), prosthodontist (prosthesis specialist) 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 with few trabeculae and low blood supply and therefore nutrition. In this regard, the treatment approach of the case should be lingual (back of the teeth), labial (front of the teeth), mobile or any Determining whether it is on another path is an issue that should be emphasized after the review in all these different disciplines.
Although the treatment plan is shaped according to the initial diagnosis, the advantages, limitations of the various treatment approaches to be used, patient preference and of course time and cost factors also affect the plan. The factors that can be considered as time and cost factors can be listed as follows:
a. The initial detailed questioning phase, diagnosis, consultation and treatment planning require an additional average of 30 - 45 minutes
compared to the patient who will undergo conventional treatment.
b. Laboratory procedures and set-up will increase both time spent and cost.
c. The patient may need to use conventional labial devices during the finishing phase.
d. For a detailed, desired result, it may be necessary to additionally use transparent plaque.
All these above-mentioned factors will increase the time and treatment expenses of the orthodontist and his team by 30 - 50% compared to conventional approaches.
B.TREATMENT PLANNING
To be able to create a definitive treatment plan and to obtain results close to the results of traditional (front surface of the teeth) applications at the end of the treatment. To know this, it is necessary to master the aspects of lingual mechanotherapy that differ from conventional approaches, and to have sufficient current knowledge and sufficient clinical experience on this subject.
First of all, as in all orthodontic cases, the condition of the gingiva and surrounding tissues should be carefully evaluated. . This evaluation is of greater importance in adult lingual technique patients. Periodontist support may be required at any stage of the treatment.
Again, in adults, the probability of encountering large restorations and prosthetic work is much higher. The adhesive materials used can only adhere to roughened enamel, plastic surfaces and some types of porcelain. For this reason, the lingual technique patient should be evaluated from a prosthetic perspective and the existing metal porcelain crowns or other metallic restorations in the mouth should be replaced with temporary plastic crowns that do not prevent lingual bonding.
Treatment is contraindicated in cases with many tooth losses and many bridge restorations.
One rule. As a matter of fact, in cases that will cause many technical problems when treated with the labial technique (front surface of the teeth), these problems will grow exponentially when treatment with the lingual technique (back surface of the teeth) is considered. In an average patient, the tooth size from the lingual surface is approximately 30% smaller than the tooth size from the labial surface. is shorter. The critical crown size frequently occurs in the upper lateral incisors and lower premolars. Lower premolars can be bypassed in cases where the tooth size is very short. However, for upper incisors, at least 7 mm of lingual tooth height is required. Otherwise, it would be better to direct the patient to treatment approaches other than the lingual technique.
C. PATIENT SELECTION
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 in this context. The patient should be informed about the treatment and should be informed about the problems that the treatment will cause, especially at the beginning. should be mentioned. 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, the use of lingual devices. It can take us all the way to collapse. 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 the light of all this information, cases that are/are not suitable for treatment can be grouped as follows;
1. IDEAL CASES
a. Deep bite, moderate crowding, balanced fascial pattern,
b. Deep bite, widespread interdental spaces, balanced facial pattern,
c. Deep bite, upper jaw protrusion, balanced facial pattern,
d. Closing disorders caused by lower jaw retardation,
e. Cases requiring expansion,
2. DIFFICULT TO TREAT CASES
a. Surgical cases,
b. Cases prone to protrusion of the lower jaw,
c. Protrusion of the upper jaw, cases with extraction of four first premolars,
d. Patients with multiple restorations,
3. CONTRAINDICATED (NON-IDEAL) CASES
a. Acute joint disorder patients,
b. Patients with no closure in the posterior group molars,
c. Patients with overbite in the front group incisors,
d. Patients with large anterior incisor dentures,
e. Short clinical tooth dimensions,
f. Severe maxillary protrusion patients,
g. Poor oral hygiene or critical periodontal condition,
h. Unwanted character structure,
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