Lingual orthodontics – clinical applications and patient information

The demand for adult orthodontic treatment is an ever-increasing trend that has driven the development of aesthetic orthodontic systems. A recent survey of British Orthodontic Society members working in high street practices found that 75%, of 430 respondents, reported an increase in adult treatment.¹ Assessments of attractiveness and acceptability associated with orthodontic appliances have shown that a significant number of adults requiring treatment refuse it on the basis of the negative appearance associated with many commonly used appliances.² A study looking at the attractiveness of different orthodontic appliances found both lingual and ‘clear tray’ (aligner) appliances to be rated as significantly more attractive than labial ceramic appliances, which were in turn rated as significantly more attractive than labial metal appliances.³ It was also no surprise to find that, in the hierarchy of attractiveness, lingual appliances were more attractive than ‘clear tray’ aligner appliances.³ The most popular clear aligner system currently on the market is Invisalign (Align Technology Inc, San Jose, USA), which has widespread use in both the specialist and non-specialist community. However, its well-documented clinical limitations,^4-6 coupled with its reduced attractiveness, has led many clinicians to develop their use of lingual appliances.