Orthotown March 2020 - 37
patients are intolerant of labial brackets or
attachments on anterior teeth, and lingual
is an excellent aesthetic option for them.
Here are some of the most important
considerations before jumping into lingual:
Fig. 2a
Clinical considerations
Delegation. Especially while introducing
lingual appliances to the practice, treatment
cannot be delegated nearly as well as clear
aligners or labial fi xed to your wonderful
assistants. If you're under any illusion that
you'll be able to add this treatment to your
arsenal without getting your hands dirty,
you'll be sorely disappointed. Yes, the initial
records are the same, and uploading them to
the labs is not difficult. Even virtual planning
of lingual treatment is quite similar to the
setups you're familiar with for aligners.
That, however, is where the parallels
diverge. The indirect bonding delivery of
the brackets and wire insertion requires
new skills, and initially will require more
time and planning to execute. It's appropriate to block out two hours for your
fi rst few indirect lingual bondings with
two assistants available and few if any
other patients scheduled. Most traditional
lingual orthodontists bond just one arch
per appointment, as well. This added time
and elimination of distraction will allow
you to attend exclusively to a critical step
in the treatment process.
As you and your team complete a halfdozen or more successful indirect lingual
bondings, you can reliably begin to delegate
most of the process, although you may still
consider delivering the bonding tray each
time to ensure the highest levels of adhesion.
If you think broken brackets on the labial
are frustrating, you can't imagine what
broken lingual brackets will do to your
temperament! Even with staff reluctant to
change or add something new, I've found
that my enthusiasm has transferred to the
team, and any difficulties we may experience
can be balanced by hands-on assistance
from the doctor.
Managing patient expectations with
lingual treatment is critical. Be clear with
patients that their speech will be affected,
though most adapt well after a few weeks-
most young adults adjust within a month,
older adults by eight weeks. Occasionally,
an isolated patient can be discouraged by a
lack of full speech adaptation, but it's likely
more due to hyper-self-awareness than an
actual communication impediment.
Tongue pain can be hard to bear with
lingual treatment and I clearly explain it
will be difficult to tolerate for two weeks.
In my experience, though, the pain is not
Fig. 2b
orthotown.com \\ MARCH 2020
OT0320_Schofield_Lingual_AG.indd 37
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Orthotown March 2020
Table of Contents for the Digital Edition of Orthotown March 2020
Orthotown March 2020 - Cover1
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Orthotown March 2020 - 1
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