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Customized lingual brackets vs. conventional labial brackets for initial alignment

A randomized clinical trial

Individuell angepasste Lingualbrackets vs. konventionelle Labialbrackets zur Erstausrichtung

Eine randomisierte klinische Studie



The aim of this randomized prospective clinical study was to determine whether there are differences between customized lingual brackets and conventional labial brackets regarding the alignment of the mandibular arch and a reduction of the irregularity index during an 18-week treatment interval.


A total of 20 patients who presented with class I malocclusion for scheduled orthodontic treatment without tooth extraction were included. The patients were randomly assigned by numbered, opaque, sealed envelopes to treatment with customized lingual brackets or conventional labial brackets. During the initial alignment (T0), 0.012″ (T1), 0.014″ (T2), and 0.016″ (T3) nickel–titanium archwires were applied, respectively, and the control visits were scheduled at 6‑week intervals. In all sessions, digital models were obtained by an intraoral scanning device after removal of the archwire and were analyzed by software. Little’s irregularity index, intercanine width, intermolar width and arch length were evaluated at three time points and were statistically analyzed with a repeated measures analysis of variance (ANOVA). Changes in these measurements at the three intervals (T1–T0, T2–T1, T3–T2) and overall treatment effects were also compared using the Student t‑test.


Comparing the two treatments regimes, intergroup mean values at T0, T1, T2, and T3 were not significantly different regarding the irregularity index, intercanine width, intermolar width and arch length.


In this pilot study, no differences between the two treatment approaches could be detected for the phase of initial mandibular alignment.



Ziel dieser randomisierten, prospektiven klinischen Studie war es, festzustellen, ob es Unterschiede zwischen individualisierten Lingualbrackets und konventionellen Labialbrackets hinsichtlich der Nivellierung des Kieferbogens und einer Reduktion des Irregularitätsindexes während eines 18-wöchigen Behandlungsintervalls gibt.


Eingeschlossen wurden insgesamt 20 Patienten, die sich mit einer Klasse-I-Malokklusion zur geplanten kieferorthopädischen Behandlung ohne Zahnextraktion vorstellten. Die Patienten wurden durch nummerierte, undurchsichtige und versiegelte Umschläge zufällig einer Behandlung zugewiesen: mit individualisierten Lingualbrackets oder konventionellen Labialbrackets. Während der Erstanpassung (T0) wurden 0,012″ (T1), 0,014″ (T2) bzw. 0,016″ (T3) Nickel-Titan-Bögen appliziert, und die Kontrollbesuche wurden im Abstand von 6 Wochen angesetzt. In allen Behandlungssitzungen wurden digitale Modelle mit einem intraoralen Scangerät nach Entfernung des Bogendrahtes erstellt und per Software ausgewertet. Der Irregularitätsindex nach Little, die Intereckzahnbreite, intermolare Breite und die Bogenlänge wurden zu 3 Zeitpunkten evaluiert und mit wiederholten Varianzanalysen (ANOVA) der Messungen statistisch ausgewertet. Die Veränderungen dieser Messungen zu den 3 Zeitpunkten (T1-T0, T2-T1, T3-T2) und die Gesamteffekte der Behandlung wurden ebenfalls mit dem t‑Test verglichen.


Im Vergleich der beiden Behandlungsregimes unterschieden sich die Mittelwerte zwischen den Gruppen bei T0, T1, T2 und T3 nicht signifikant in Bezug auf den Irregularitätsindex, die Intereckzahnbreite, die Intermolarbreite und die Bogenlänge.


In dieser Pilotstudie konnten keine Unterschiede zwischen den beiden Behandlungsansätzen für die Phase der initialen Unterkieferausrichtung festgestellt werden.

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The authors would like to thank to Prof. Dr. Hüsnü Erbay Bardakçıoğlu for his valuable contribution to the statistical analysis of the data.


This work was supported by Aydın Adnan Menderes University Research Projects (DHF-15010).

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Correspondence to Yazgı Ay Ünüvar DDS, PhD.

Ethics declarations

Conflict of interest

M. Kaptaç and Y. Ay Ünüvar declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (the ethics committee of Aydın Adnan Menderes University, Medicine School [2016/897]) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All patients and legal guardians gave written informed consent before participation. This trial is registered at (NCT04357067). Written informed consent was obtained from the patients for publication of this research and accompanying images.

Trial registration number

NCT04357067 retrospectively registered at on 21 April 2020.

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The data supporting the findings of this research can be obtained directly from the authors of the study.


The full protocol of this study can be accessed from the National Thesis Database of Turkey (

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Kaptaç, M., Ay Ünüvar, Y. Customized lingual brackets vs. conventional labial brackets for initial alignment. J Orofac Orthop (2021).

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  • Mandible
  • Digital model
  • Lingual orthodontics
  • Treatment outcome
  • Angle class I malocclusion


  • Unterkiefer
  • Digitales Modell
  • Linguale Kieferorthopädie
  • Behandlungsergebnis
  • Angle-Klasse-I-Malokklusion