Advantages of the Incocito ™ Murcia linguistic bracketing system
Currently, some of our patients only agree to be treated with apparatus that are invisible. In these cases, linguistic orthodontics is an excellent alternative. The Incognito system as described in previous editions of this magazine
OOrtoperio editorial team··9 min
Background and details
Introduction Currently, some of our patients only agree to be treated with devices that are invisible. In these cases, the linguistic orthodonticsThat's a great choice. That's how it's been described in previous editions of this magazine. Incognito ™ system challenges that have traditionally been addressed by linguistic orthodontics: difficulties during the cemetering and re-cemetering process, difficulties with the completion phase and patient discomfort. Two cases will be submitted describing how system characteristics can be greatly useful during treatment.Incocito ™ Any other advantage with respect to vestibular orthodontics? I would like to point out and discuss some of the benefits that can be offered to us. Most have been suggested by newly published clinical studies. • The risk of enameling malcalcifications is lower. • Precision allows to achieve scheduled movements. That gives an added value to the setup that can be used in multidisciplinary cases. • It allows a magnificent monitoring of the torque of the incisors. The latter feature is especially interesting in class II treatments that require the combined use of Herbst ® auxiliary equipment. The clinical results observed with respect to Torque Control of lower incisors in Lingual Orthodontics Treatment with Herbst ® are very encouraging. Due to the accuracy of the dimensions of the snap and arc slots, a maximum expression of the torque prescribed in the set-up can be achieved. This combination with the use of extremely rigid arcs (.018 "x .025" steel) and an applying point of force closer to the centre of resistance of the tooth, prevents an excessive proclination of the lower incisors in cases where this is undesirable: it's the Setup that determines the final position of the lower incisor. • The treatment Setup gets a prescription and an individualised form of an arch. • It allows us to cover the extraction spaces with compositional faces so that they do not appear empty during the treatment. • The aesthetic improvement is clear from the first moment. The bracketing system Incocito ™ It's an additional tool at our disposal with its benefits and its disadvantages, as well as Dr Boccio, Dr. de las Heras and Dr. Janer described his earlier issue and with his analysis I agree. Indeed, the learning curve is slow and usually requires far more seating time than traditional systems, but I believe that little by little will be consolidated as an alternative treatment. To this end, it will be necessary to continue with the analytical, autocritical and demanding work that Dr. Wiechmann and his co-workers have been performing up to today, with improvements to the successive versions of the apparatus, all of them previously tested and with proven results, offering us an effective system to be able to trust. The following are shown: Two cases treaties with Incognito ™. These cases have in common that represented particularly uncomfortable situations to face for me as referred to by my previous experience with other types of linguistic orthodontics1. Serious lower cooling (with low interbracket distance that often prevents cemetering of all bracketing from starting treatment and makes it difficult to create space necessary for alignment) and premolar crowns with short clinical crowns. 2. Especially sensitive and demanding patients and little co-operative. Due to the individualised design of the bases of the Incognito ™ bracketers, in the first case all bracketers could be cemeterized from the start despite the harsh stacking. That attached to the autobound clip currently occurring in the lower anteroinferior sector, facilitated the alignment of the lower arcade. The possibility to extend the base of the bracket to the cincangle in lower presmolars with short clinical crowns is very useful. The re-cemeterate of bracket is much easier, faster and more precise thanks to the perfect matching of the base to the palatine or linguistic face of the teeth. The complete individualisation of the arches allows a minimum distance between the slot and the dental surface, reducing: the risk of descending, the vertical discrepancies caused by the different expression of the torque, the final thickness of the apparatus leading to more comfort and less alterations in pronunciation during the adaptation period. That was a key factor in the treatment of the second case submitted. CASO 1: Non-Extractions Treatment of a Skeletal Class II, Angle Milling Class I with Deep Biting and Severe Fingering of the Lower Arfigure A 25-year-old male patient who came to his office in May 2009 to solve his stacking to improve his smile's aesthetics. The patient demand treatment with linguistic orthodontics and avoid dental extractions. Clinical examination It presents a class II skeletal mandibular cause, class I molar and canine. Upper and lower moderate shortness. Medium lines focused with each other and with the filtrum. Excessive override due to increased lower Spee curve. Functional exploration is asymptomatic and there's no limitation of opening. It has no important decline between maximum intercusidation and central relation. It has severe gingivitis and poor hygiene with high accumulation of computation in the lower anteroinferior area. His periodontal biotypes are thick. No important asymmetries. A line of smile (social smile) with complete crowns exposure. Gingival smile at maximum smile. harmonic profile (Fig. 1). Radiological findings of interest Presence of the cordals that are included, 38 are also affected. A skeletal class II of mandibular cause. Mesofacial. Incisives lower to vestibuloversion (Fig. 2). Treatment plan Objectives: To align and level with expansion and stripping at the lower arcade. To improve canine class. Normalize Highlight and Overbiting Fig.1. Fig.2. Aparatology: Orthodontics Lingual Incognito ™ + elasticates class II. Design: Ribbonwise VH bracket series, pines and pines, first molar bracketing, second molar tubes with hooks and dashboard for easy insertion. Self-linked clip at the bottom arcade. Constraints: The vestibuloversion of the lower incisors will not be corrected and may even be increased. Monitoring periodontal response to dentary movement in the anti-inferior sector. Multidisciplinary monitoring and treatment 1. A dental examination by his dentist. Periodontics: Prophylaxis and high periodontal. Maintenance and strengthening of hygiene every 3 months. 3. Orthodontics. 4. Aesthetic: Rebuilding incision edges 11 and 21. 5. Cordal extraction: The patient prefers to postpone his or her 38 at the end of his or her treatment of orthodontics. Ark sequence Upper Arfigure • .014 "Nitinol ™ SE • .016" Nitinol ™ SE • .016 "x .022" Nitinol ™ SE • .016 "x .022" steel with extratorque • .0182 "x .0182" Beta III Titanium Section • .012 "Nitinol ™ SE • .014" Nitinol ™ SE • .016 "Nitinol ™ SE • .016" x .022 "Nitinol ™ SE • .016" Titanium Section .0182 " Treatment Both pits have been cemeterized the same day. Although bieplans had been intended to be used at the canines to open the bite, it was decided to place production plans at the top of the first upper molars to minimize the risk of bracketing. A better choice would have been to design the device with Half-occlusal pics at the second upper and lower molars. A stripping was performed at the lower arcade. A .014 "Nitinol ™ SE arc was placed at the upper arch at the fringes of all bracketes with simple metal ligation. A .012 "Nitinol ™ SE arch was placed at the lower arcade in the autobound clip in all teeth. (Fig. 3). A month later it was possible to insert .016 "Nitinol ™ SE into the upper arcade. A lasso was put up to help correct the rotation of the 22. The same arch was held at the lower arch and this time linked to the slot. The second fine niti arc would probably have been unnecessary at the upper arcade (Fig. 4). Fig.3. Fig.4. Fig.5. Fig. 6. The .016x.022 "Nitinol ™ SE was put with an overlays in the previous sector and elastic modules at the later ones after the tipple. A .014 "Nitinol ™ SE. (Fig. 5) was placed at the lower arcade. A month later, she re-cemeterized the 1 1 1 1 1 bracket that had fallen. The same arch was held at the upper arch. The .016 "Nitinol ™ SE was placed at the lower arcade. Probably only one or two fine niti arcs would have been necessary (Fig. 6). Fig.7. Fig.8. After two months, the upper steel was put up. The lower arcade was uploaded to .016 x .022 "Nitinol ™ SE. Following visits, power was put to improve the 11 and 21 tip on the upper arcade and after another two months lower steel was put. The patient is instructed to wear class II gums (Fig. 7). Three months later .0182 "x .0182" Beta III titanium top and bottom arcs were put up. The upper arch seizes vertically but the 27th bracket leapes and cuts to rectiminate it. A chainet was then put up to prevent spaces from opening up. Lasers were used with the intention of improving the position of 13 and 12. A step in the arch would have been better to achieve a light meso palatine rotation (Fig. 8). The arch deformations are performed with successive views to intrude and rotate 22 and to give tip radiculo distal to 12. (Fig. 9). The apparatus was withdrawn 15 months after treatment had been initiated. A temporary upper circumferential plate was used as a retention to facilitate the reconstruction of 11 and 21, and an established retention from canine to canine at an indefinite lower arcade. The incision edges of 11 and 21 were rebuilt (Fig. 10). Fig.9. Fig.10. Conclusions Despite his profound overbite, only two bracketts have been taken off during his treatment. That was no problem as the perfect adaptation of the base of the bracket to the palatine face allows us to re-cemeterate them directly in the right place. One of the limitation of treatment without extractions was to be unable to correct the vestibuloversion of the lower incisors. Nevertheless, the angle of the lower incisor with respect to the mandibular plane increased only 3 °. We had no problems at the periodontal level. Today I would recommend some changes to the design of the device and sequence of arcs: • Half occlusal pics at 7 upper and lower, rather than with biesteplans. • A single .014 "Nitinol ™ arc with ET instead of .016" x .022 "steel to prevent the potential loss of torque from the upper incisors by using elb _ textics.
Fig.1. 
