Revision of Lingual Bracket Direct Bonding Clinical Procedures

Rationale: Lingual brackets are typically bonded indirectly based on setup models with ideal tooth alignment to overcome the variability in lingual tooth anatomy and difficulties in measuring bracket position. However, direct bonding is the original philosophy of the inventor of lingual orthodontics and is still performed by a minority of lingual orthodontists. This article aims to revise the clinical procedures of direct bonding of lingual brackets and forming of lingual archwires and prove the effectiveness of the direct bonding philosophy through two case reports. Patient concerns: The patient in Case 1 was a 29-year-old female who presented with moderate crowding and normal inclinations of the maxillary and mandibular incisors. The patient in Case 2 was a 25-year-old female patient who presented with severe crowding and proclined maxillary and mandibular incisors. Diagnoses: The patient in Case 1 was diagnosed with a half-cusp Class II relationship on a Class I skeletal relationship. The patient in Case 2 was diagnosed with Class I dental and skeletal relationships. Both patients had a normodivergent facial pattern. Interventions and outcomes: The treatment option in Case 1 was to extract all third molars combined with total distalization of both arches and interproximal stripping. The treatment option in Case 2 was to extract maxillary and mandibular first premolars to create spaces for relieving crowding. The post-treatment records in both cases showed improved smile aesthetics and occlusion. Conclusions: Direct lingual bracket bonding offers some advantages and disadvantages compared to indirect one. Successful treatment results of two case reports demonstrate the accuracy and effectiveness of the direct lingual bracket bonding approach.