Application of TADs in Lingual Orthodontics: A Modified Segmented Arch Approach
Lingual orthodontic treatment is indicated for adults who do not want appliance show. Considering the limitation of tissue response in adults, precision tooth movement without round-tripping is crucial. Moreover, in order to camouflage underlying skeletal
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Kee-Joon Lee and Young-Chel Park
Abstract
Lingual orthodontic treatment is indicated for adults who do not want appliance show. Considering the limitation of tissue response in adults, precision tooth movement without round-tripping is crucial. Moreover, in order to camouflage underlying skeletal discrepancies, translation-type tooth movement rather than tipping is essential. For those, adequate segmentation of the dental arch and specific goal-oriented movement of each segment can be helpful. Since maxillary palatal area is characterized by various insertion sites for the miniscrews, combination of the miniscrew position and various lever arms for preliminary segmental movement effectively eliminates the round-tripping, providing a reliable lingual treatment protocol in adults with periodontal complication or temporomandibular joint resorption. A typical inconsistent movement such as total arch displacement is also attainable. The biomechanical backgrounds and applications are explained and demonstrated.
10.1
Introduction
It is evident that the demand for orthodontic treatment among adults has been constantly increasing [1]. While the adults are more motivated for orthodontic treatment than the children, they tend to raise inquiries regarding the pros and cons of the treatment. They are concerned about the specifics, such as possible duration of the treatment, discomfort or pain from the appliance, and overall expense
[2]. One of the important issues may be the exposure of the appliance. Therefore, an invisible orthodontic treatment may be very appealing to many of the adults who seek for orthodontic treatment. This chapter will briefly discuss the diagnosis and appliance construction procedure for reliable lingual orthodontic treatment in adults, with the incorporation of miniscrew implants.
10.2 K.-J. Lee, DDS, PhD (*) • Y.-C. Park, DDS, PhD Department of Orthodontics, Yonsei University, Yonsei-ro 50, Seodaemon-gu, Seoul 120-752, South Korea e-mail: [email protected]; [email protected]
Limitation of Orthodontic Treatment in Adults
What are the characteristics of adults? The limitation of orthodontic treatment in adults has been extensively discussed in the previous literature.
K.B. Kim (ed.), Temporary Skeletal Anchorage Devices, DOI 10.1007/978-3-642-55052-2_10, © Springer-Verlag Berlin Heidelberg 2014
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In particular, Melsen classified the limitations into two categories: intrinsic and extrinsic factors [3]. The intrinsic factors include reduced cellular reaction to a mechanical stimulus, age-related changes in the periodontal ligament, age-related bone changes, local age changes, and biological and mechanical interfaces. The extrinsic factor mainly refers to an inability to reproduce the desired stimulus. For example, reduction in the alveolar bone height caused by marginal bone loss proportionally lowers the position of the center of resistance of a tooth [4]. In order to avoid undesired tipping of the tooth with an apically located center of resistance, an accurat
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