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Control of lower incisor inclination with a completely customized lingual appliance for dentoalveolar compensation of class III malocclusion

Inklinationskontrolle der unteren Frontzähne bei der konservativen Therapie der Klasse III mit einer vollständig individuellen lingualen Apparatur



Bracket slots and orthodontic archwires offering high dimensional precision are needed for fully customized lingual appliances. We aimed to investigate whether high-precision appliances of this type enable dentoalveolar compensation of class III malocclusion so that lower incisor inclination at the end of treatment will closely match the anticipated situation as defined in a pretreatment setup.

Materials and methods

This retrospective study included a total of 34 consecutive patients who had worn a fully customized lingual appliance to achieve dentoalveolar compensation for class III malocclusion by intermaxillary elastics, or proximal enamel reduction, or extraction of teeth in one or both jaws. Casts fabricated at different points in time were three-dimensionally scanned to analyze how precisely the lower incisor inclinations envisioned in the setup were implemented in clinical practice.


Aside from minor deviations of ±3.75°, the lower incisor inclinations were clinically implemented as planned even in patients with major sagittal discrepancies.


Treatment goals predefined in a setup of dentoalveolar compensation for class III malocclusion can be very precisely achieved via a customized lingual appliance. Correct planning can prevent undesirable lingual tipping of the lower incisors. This finding should not encourage a more liberal use of dentoalveolar compensation, but it should heighten clinicians’ awareness of how essential it is to sufficiently consider the individual anatomy of the dentoalveolar complex during treatment planning.



Bei der Herstellung vollständig individueller lingualer Apparaturen werden besonders hohe Anforderungen an die Präzision der Dimension der Bracketslots und der kieferorthopädischen Bögen gestellt. In der Studie sollte überprüft werden, ob dadurch bei der dentoalveolären Kompensation einer Klasse-III-Malokklusion auch die Inklination der Unterkieferfrontzähne erreicht wird, die im prätherapeutischen Set-up festgelegt wurde.

Material und Methode

34 konsekutiv behandelte Patienten, bei denen eine Klasse-III-Malokklusion mittels intermaxillärer Gummizüge, approximaler Schmelzreduktion oder uni- bzw. bimaxillärer Extraktionen im Rahmen einer Lingualbehandlung mit einer vollständig individuellen Apparatur dentoalveolär kompensiert wurde, bildeten das Untersuchungskollektiv dieser retrospektiven Studie. Die im Set-up geplante Inklination der Unterkieferfrontzähne wurde nach einer dreidimensionalen Digitalisierung mit dem Behandlungsergebnis verglichen.


Die geplante Inklination der Unterkieferfrontzähne konnte auch bei Patienten mit größeren sagittalen Diskrepanzen bis auf geringe Abweichungen (±3,75°) realisiert werden.


Bei der dentoalveolären Kompensation einer Klasse-III-Malokklusion mit individuellen lingualen Apparaturen kann das am Set-up festgelegte Behandlungsergebnis mit hoher Präzision erreicht werden, und unerwünschte Lingualkippungen der Unterkieferschneidezähne können bei korrekter Planung verhindert werden. Dieses sollte aber nicht zu einer Ausweitung der Indikation für eine dentoalveoläre Kompensation führen, sondern vielmehr den Behandler sensibilisieren, die individuelle Anatomie des dentoalveolären Komplexes bei der Therapieplanung hinreichend zu berücksichtigen.

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The authors wish to thank the team at D. W.’s orthodontic practice for assistance in compiling and digitizing the patient data. They are indebted to Professor Hartmut Hecker (Hannover Medical School) for supporting the statistical analysis.


Die Autoren danken den Mitarbeitern und Mitarbeiterinnen der Praxis PD Dr. Wiechmann und Partner für die Unterstützung bei der Zusammenstellung und Digitalisierung der Patientenunterlagen. Besonderer Dank gebührt Herrn Prof. em. Dr. Hartmut Hecker (Medizinische Hochschule Hannover) für seine Hilfe bei der statistischen Analyse.

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On behalf of all authors, the corresponding author states that there are no conflicts of interest.


Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

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Correspondence to S. Lossdörfer.

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Lossdörfer, S., Schwestka-Polly, R. & Wiechmann, D. Control of lower incisor inclination with a completely customized lingual appliance for dentoalveolar compensation of class III malocclusion. J Orofac Orthop 74, 381–396 (2013).

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