Traditional lingual ortho under threat from digital?

BLOS speakers
BLOS speakers (left to right): Dr Roberto Stradi, Dr Sunil Hirani, Dr Asif Chatoo, Dr Ian Hutchinson, Dr Angela Auluck, Dr Alexander Gebhardt, Dr Henrique Valdetaro and Professor Kee-Joon Lee

Did video kill the radio star; will CAD/CAM replace ‘traditional’ lingual techniques? Lingual orthodontists from around the world travelled to London for the British Lingual Orthodontic Society’s annual meeting in March to discuss and debate this very question.

The two-day event began with a pre-congress course delivered by Professor Kee-Joon Lee from Yonsei University in South Korea. His talk ‘up-to-date lingual mechanics’ explored self-ligation, skeletal anchorage and biomechanics.

Professor Lee focused on the significance of the fundamentals of lingual orthodontics – or any orthodontic treatment – which is biomechanics, something that is all too frequently forgotten these days. He illustrated this eloquently with cases where sectional and full arch lingual appliances were used to deliver the required tooth movement purely on a biomechanical blue print.

In the afternoon orthodontic theory was put into action during a practical exercise where the delegates got to grips with bonding using the Hiro approach with self-ligating brackets, followed by torquing and arch wires. For the final session of the day, Professor Lee provided further inspiration by demonstrating how mini screws can extend the envelope of dento-alveolar compensation before resorting to surgery.

‘I’ve known Professor Lee for over ten years, and every time I listen to his lectures I am filled with enthusiasm and inspiration. It’s the first time the BLOS conference has included a pre-congress course and the session provided an excellent warm up to the conference’s main event the following day,’ commented BLOS chairman Ian Hutchinson.

On day two, a panel of internationally renowned speakers joined the line up to discuss the advantages and disadvantages of different CAD/CAM systems compared to more time-honoured techniques.

BLOS hands on
Dr Sunil Hirani and Dr Mark Sayers get to grips with the Hiro approach

CAD/CAM enthusiasts included Dr Asif Chatoo, Dr Sunil Hirani and Dr Roberto Stradi, who were joined by ‘traditionalists’ Dr Alex Gebhardt and Dr Henrique Valdetaro.

Each speaker presented their preferred system, and then Professor Lee provided a roundup of the advantages and disadvantages of the two approaches, along with his advice for selecting the best technique. An interesting notion was that if technology doesn’t make orthodontists treat patients better, yet it costs more, is it worth the money?

The day concluded with a lively debate, with the majority of speakers and delegates agreeing that there’s no right or wrong when it comes to choosing CAD/CAM vs conventional methods. Henrique Valdetaro said, ‘Twenty years of orthodontics and 16 years of lingual orthodontics I do not remember seeing such an intense debate.’

The verdict: CAD/CAM may be high tech but the systems don’t (yet) feature artificial intelligence. So while it undoubtedly has its benefits, it shouldn’t be used at the expense of thorough diagnosis and treatment planning. This outlook that was succinctly summed up by speaker Dr Roberto Stradi, ‘Whatever kind of technology you’re using, the orthodontist has to take control and drive the system.’

For information on upcoming lingual courses, please visit:

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