closing spaces with the lingual technique in cases of ... · closing spaces with the lingual...

DOI: 10.1051/odfen/2012407 J Dentofacial Anom Orthod 2013;16:107� RODF / EDP Sciences

1

Conflicts of interest declared by the author: NONEArticle received: 06-2012.

Accepted for publication: 08-2012.

Closing spaces with the lingualtechnique in cases of agenesisof the upper lateral incisor

Frederic BONNIN

SUMMARY

How to close gaps with the lingual technique in cases of agenesis of theupper lateral incisor is a therapeutic decision orthodontists often have tomake. We have decided to discuss the mechanical and strategic aspects ofthis issue that arise when we implement the lingual technique to treat thisdisorder, which is a major source of concern for our patients since its estheticrepercussions for the smile are so great.

KEY WORDS

Dental ageneses,

Lingual technique.

1 – INTRODUCTION

‘‘With respect to the destiny of the indi-vidual, a small missing incisor may notseem to be all that important. However, ifthe presence of a grain of sand can hinderthe workings of a powerful machine, in thesame vein the absence of a single toothcan change the appearance, and disor-ganize the functioning of this marvelousand complex ensemble which comprisesthe face.’’

This is how Julien Philippe introducedthe question of agenesis of a maxillary lat-eral incisor when this topic was discussed

by the French Society of Orthodontics andDentoFacial Orthopedics in 1987. Theuncertainty and compromising nature ofour therapeutic choices proving that thissubject continues to preoccupy us.

The implant solution appeals to many ofus because of our academic training:respecting the rules of occlusion and main-taining the privileged relationship of theclass I molar and canine, respecting man-dibular kinesthesia, preserving the peri-odontal environment of the canines andpremolars, and maintaining the dental

Address for correspondence:

F. BONNIN,2 rue George Sand,37000 [email protected]

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harmony that the presence of the sixteeth making up the smile assures.

The considerable progress made inimplantology also makes it possibleto ensure the stability and retentionof a fixed prosthesis. However, wehave to admit our disappointmentregarding the durability of these pros-theses: the appearance of the metalabutment because of gingival reces-sion that takes place over time8 or adiscoloration of the gingiva (in 50%of the cases immediately after theimplant3 is inserted according to theauthors).

At the same time, the results aredisappointing in the long term be-cause the implant does not followthe passive and continuous eruptionof the denture and this inevitablyleads to development of openbites8,9,10,15.

Marco Rosa13 perfectly sums upthe advantages and disadvantages ofthe implant solution:• Advantages:– optimal posterior occlusion;– short-term satisfactory esthetic re-

sult;– comparatively simpler and shorter

orthodontic treatment;– no need for prosthesis or recon-

struction of neighboring teeth;– reliable long-term osteointegration;• Disadvantages:– progressive appearance of open

bites;– torque that is not equivalent with

that of the natural incisors;– discoloration of the gingiva;– appearance of a metal collar over

time;– inter-dental recession particularly of

the distal papillae;

– difficulty in making the ceramiccrown look natural;

– a clinical track record that lasts nomore than 10 to 15 years.Accordingly, the SFODF in 19871

summarized the advantages and dis-advantages of closing the gaps,which is the second option:• Advantages:– avoids resorting to a prosthesis;– reestablishes the continuity of the

natural teeth;– easy integration into a treatment

plan involving extractions in thelower arch;

• Disadvantages:– require long and difficult treatment

to obtain good interproximal con-tacts, good intercuspation, goodocclusion, and satisfactory groupfunction (set-up), and a post-ortho-dontic equilibration;

– does not reestablish the canine toclass I;

– requires reshaping the canine;– there is a risk of reducing the

profile, of worsening the effects ofa very marked horizontal growth orworsening a retrusive profile.Rosa and Zachrisson exploit solu-

tions developed by cosmetic den-tistry11,12 to help the caninesmasquerade as lateral incisors.

Since the lingual technique makesit possible to efficiently accomplishboth objectives, we are going to ex-plore the strategic and mechanicalparticularities inherent to closing gapscaused by congenitally missing upperlateral incisors.

We shall mainly rely on two clinicalcases using the incognito� techniqueto illustrate our remarks.

FREDERIC BONNIN

2 Bonnin F. Closing spaces with the lingual technique in cases of agenesis of the upper lateral incisor

Clinical case no 1 (Fig. 1) is that ofa young woman, 21 years old pre-senting a unilateral agenesis of 12.Her typology is normodivergent. Shepresents no skeletal malformationbut a clinical upper alveolar protrusionresulting in a class II molar and ca-nine relationship. The lower arch isuncrowded but the asymmetry of theupper arch entails a deviation of the

central incisor to the right. The pa-tient consented to have the upperleft lateral incisor extracted in orderto correct this midline deviation andto reduce the upper alveolar protru-sion. At the end of orthodontic treat-ment the molars will be left intherapeutic class II occlusion and thecanines will be masqueraded aslateral incisors.

Figures 1a to 1hClinical case no 1.

CLOSING SPACES WITH THE LINGUAL TECHNIQUE IN CASES OF AGENESIS OF THE UPPER LATERAL INCISOR

Rev Orthop Dento Faciale 2013;16:107. 3

Case no 2 is rather similar sincethe upper left lateral is missing andthere is no skeletal problem (Fig. 2).However, the upper left lateral isstunted and there is moderatecrowding in the lower arch. Theupper central incisor is also unattrac-tively tilted toward the side of theagenesis. Finally, there is no upper

alveolar protrusion instead there is acertain degree of bimaxillary alveolarretrusion, which makes the profile ofthis patient slightly concave. We sug-gested the same treatment for her:extraction of the stunted upper leftlateral incisor and closing of thegaps.

Figures 2a to 2hClinical case no 2.

FREDERIC BONNIN


2 – STRATEGIC PARTICULARITIES

2 – 1 – Reshaping the canine

2 – 1 – 1 – Changing crown by buildup

It is recognized that masqueradingthe canine must be performed at theend of orthodontic treatment. Rosa13

recommends that the crown bereconstructed the same day as theorthodontic appliance is removed inorder to create a shape that is bothesthetic and functional while restor-ing the contact points with the adja-cent teeth. This reconstruction mustalso make it possible to create a castof the upper interdental papillae,which are crucial elements of theesthetics of the smile.

The practitioner must choose thecomposite to harmonize with the col-or of the central incisor, so that afterwhitening, the canine enamel willmatch the reconstruction composite,making it invisible.

It is then possible to attach the pal-atal arch wire from premolar to pre-molar.

Canal2 recommends the placementof a maxillary wire that covers thepalatal surface of the first premolarrather than the occlusal surface.

The breakdown or devitalization ofone or more dental elements canmake it necessary for veneers orceramic crowns to be constructed.Therefore, it is recommended thatthe orthodontist wait until the end ofthe retention period before perform-ing these orthodontic procedures.Further on, we will revisit the plan-ning and coordination between cos-metic dentistry and orthodontic

retention. The patient is often in ahurry to recover an impeccable smileat the end of active treatment, with-out necessarily having in mind thatall the prosthetic work requires per-fect retention of all the formerly mis-aligned teeth.

2 – 1 – 2 – Crown reshaping,correction by grinding

In this case, the coronoplasty ofthe canine must be done in accor-dance with the stripping chart chosenby the practitioner and recorded onthe laboratory sheet. Stripping mustbe performed during the installationof the upper super flexible nitinolwire.

While crown reshaping mesio-dis-tally usually causes no problems, thesituation is different bucco-palatallybecause the palatal surface of the ca-nine is often necessary to obtain asatisfactory anterior guidance andgeneralized contacts with the freeedges of the lower incisor group.

This creates a problem when usingthe lingual technique because brack-et placement makes this procedureimpossible during the finishingphase.

Therefore, it seems to us to beindispensable to ask the laboratoryfor a visualization of the set-up be-

fore fabricating the appliance (Fig. 3).The practitioner can choose to ask

the lab technician, to compensate bydefault its thickness and intrude thecanine. The development of virtualset-up techniques should make itpossible for the practitioner to more



easily control the tridimensionalplacement of the canine before thelab fabricates the device.

However, when the canine has abucco-lingual thickness that is toodisproportionate in relation to that ofthe central incisor and the compensa-tory intrusion would be excessive,we suggest that the practitioner re-duce the palatal surface of the caninebefore taking silicone impressionssince it will no longer be possible todo it afterwards.

2 – 2 – Consolidation of the fouranterior teeth

This is an imperative of the first or-der. It will be difficult, even danger-ous to perform this procedure with arectangular arch because torque will

complicate mesialization of the ca-nines (Fig. 4).

Therefore, we highly recommendthe use of a round arch during thefirst procedure (Fig. 5).

Fabricating the individualized arch-wire from a commercial archwireturned out to be necessary becausethe anterior part of the archwire pro-vided by the lab is often too short.However, it is possible to compen-sate for this deficit by using one ofthree other solutions suggested byGalletti6 when the anterior part of thearchwire is too short.

2 – 3 – Making roots parallel

This is by far the most difficultobjective to attain. A panoramic radio-graph will make it possible to

Figures 3a to 3fClinical case no 1. Visualization of the anterior intrusion on the set-up before making the device.

FREDERIC BONNIN


Figures 4a to 4dClinical case no 1. Failed attempt to mesialize the upper left canine on a rectangular

super flexible 16 by 22 archwire over a 6 month period.

Figures 5a to 5dClinical case no 2. Easy mesialization with a round 0.16 super elastic archwire afterleveling the upper left cuspid in 6 months.



measure how much root uprightingwill be required (Fig. 6).

The placement of the 16 by 22 and18 by 25 super elastic archwiresmust be done at this stage. Usingpower-ties will reinforce theirpressure.

Using an 8-braid ligature can main-tain contact between the four ante-rior teeth but it will diminish theperformance of the power-ties(Fig. 7).

2 – 4 – Closing the gaps

Usually this will be accomplishedwith a steel archwire for smoothersliding with perfect control of torque.It is imperative to ask for an increaseof anterior torque from canine to ca-nine (in relation to standard values)as in all cases of extractions.

The recommended archwire usingthe Incognito� technique is the steel16 by 24 (extra torque) with

Figures 6a and 6bCheck-up radiogram after mesialization of the canines.

Figures 7a and 7bClinical case no 2. Figure 8 ligature had been removed before the picture on the rightwas taken in order to increase the performance of the power-ties.

FREDERIC BONNIN


– 8 braid ligature under the archwireon the anterior part;

– double metallic over-ties on thecanines;

– metallic ligatures on all the otherteeth;

– stretched bracket under the arch-wire between canine and secondmolar.

The practitioner must not forget toask the lab for archwires withstraight lateral sectors unilaterally onthe side of the extraction in order tofacilitate the mechanics of sliding.

The insertion of this archwire ismade easier by the use of 18 by 25super elastic during the precedingphase.

Should the retraction be done aftergrouping the four anterior teeth? Wenoticed that this grouping is some-times difficult to achieve (Fig. 4).Additionally, this grouping requiredthat we create back and forth move-ments that can harm the dentition ifthey are too great. Therefore, for clin-

ical case no 1 where the upper alveo-lar protrusion was pronounced,closing the gaps was performed atthe end of leveling without mesializ-ing cuspids beforehand (Fig. 9).

This choice of treatment calls forseveral remarks:– movement cannot be continuous.

The practitioner will have to inter-rupt it when the canine abuts a 1st

order bend, archwires created withthe Incognito� technique areshaped like a mushroom. This willrequire starting the leveling overagain using a super elastic arch(Fig. 9);

– the canine will even be lingualizedat the end of the retraction whichwill require a painstaking and longerfinal procedure (Fig. 10).Without categorically stating that

the procedure should always be per-formed, the strategy that we choseto treat case no 1, turned out to befaster than the more by the bookgrouping of the four anterior teethwhich determined the treatment cho-sen for case no 2.

2 – 5 – Retention andcoordination with anorthodontic-dentofacialprosthesis

Retention from premolar to premo-lar is essential to maintaining the sixanterior teeth in position and to avoidreopening the diastemas (Fig. 11).

However, it is still difficult to man-age the rapid insertion of a splint

Figure 8Clinical case no 2. Placement of the extra-torque steel16 by 24 archwire and closing the gaps.



without impeding the prostheticaction of disguising the canines(Fig. 12).

It is recommended that the practi-tioner coordinate these actions onthe same day:– inserting the device;– doing prosthetic preparation on the

canines;– taking an impression of the bonded

veneers;

– making a splint for temporary reten-tion.Depending on the delays imposed

by the prosthetic lab, a few days la-ter the following procedures takeplace:– insertion of the bonded veneers;– insertion of the retention wire;– end of period for wearing the tem-

porary splint.

Figures 9a to 9fClosing spaces without mesializing the canine beforehand by the intermediary reuse ofthe super elastic archwire during retraction.

FREDERIC BONNIN


2 – 6 – Strategy for reopeningthe posterior space

As we stated in the introduction,there are clinical situations that arenot conducive to closing spaces.

In such cases, it is possible to planthe insertion of one or several im-plants more distally. This choice in-cludes the advantage of not reducingthe number of teeth in the arch whileat the same time placing implants ina zone where gingival esthetics aremuch easier to manage.

Therefore, in cases of ageneses ofupper lateral incisors, the practitionercan plan on leaving the canines mesi-alized in contact with the central inci-sors and placing ‘‘3rd molar’’ typeposterior implants.

Clinical case no 3 (a case treatedby Dr. Magali Mujajic) shows this op-tion which consists of reopening twoimplant spaces between the upperpremolars (Fig. 13). A Locatelli springmakes it possible to mesialize thefirst premolars more easily.

Figures 10a and 10bSituation of the canine at the end of retraction during placement of the finishingarchwire.

Figure 11Clinical case no 1. Retention wire con-forms to the recommendation ofCanal2.



The development of multidisciplin-ary orthodontics for adults and activecollaboration with our periodontal andimplantologist colleagues combine topromote a very prudent approach inchoice of treatment, which consistsof planning for implants in the place

of the upper lateral incisors. Sincecomplete closing of spaces is not al-ways indicated as we just saw, thestrategy which consists of movingthe site of the future implant distallymust be included among possibleand manageable solutions.

Figures 12a to 12fClinical case no 1, a and b: before placement of orthodontic device;c and d: after insertion of orthodontic device but before prosthesis;e and f: after insertion of ceramic veneers and retention wire.

FREDERIC BONNIN


Figures 13a to 13nCourse of treatment (Dr. Magali Mujajic) with reopening of spaces between first and second premolars.



3 – PARTICULAR MECHANICAL CONSIDERATIONS

3 – 1 – Management of theanterior length of thearch

Since crucial information is deter-mined based on the ideal situation atthe end of treatment, the insertion ofthe individualized brackets will beproblematic as long as spaces fromthe missing teeth are present. Thisproblem, which is resolved in casesof extractions of premolars becausethe possibility of ordering archwireswith straight lateral sectors for thefirst phases of treatment, cannot besolved by the lab in this case.

Galletti6 suggests four ingeniousclinical solutions for managing theproblem of a short wire:– a canine is left free and the arch-

wire is contralaterally displaced;– the canines are ligated and the

incisors are left untied;– the archwire is sectioned in three

parts by adding a continuous elasticchain for distal traction;

– a commercial archwire is bent tocreate a longer anterior portion.

This problem came up in the man-agement of case no 2 when theupper left lateral was extracted.

Initially, we displaced the archwiretowards the right without involvingthe upper left cuspid. We used asuper elastic 16 by 22 archwire(Fig. 14).

This archwire turned out to be tooshort for use in the first solution. Sowe then made a 0.16 nitinol archwireto level the upper left cuspid and todeal with the strategic requirementsdiscussed above (Fig. 15).

This momentary difficulty must beresolved as fast as possible in orderto allow the practitioner to restorethe archwire to the individualizedbrackets (Fig. 16). Notice the smalldistal margin on the canines left bythe lab which complicates the inser-tion of the archwire.

3 – 2 – Second order bendmanagement

As we have seen, the manage-ment of the angle of the canines has

Figure 14Clinical case no 2. The super elastic archwire ismoved to the right because of the high priority ofleveling the upper right cuspid

Figure 15Clinical case no 2. An 0.16 commercial nitinolarchwire with canine offsets.

FREDERIC BONNIN


been delicate for clinical case no 2which has made us doubt how rightthe protocol is which has as its goalto regroup the four anterior teeth asa first-line treatment.

However, the analysis of initial doc-uments shows a natural and particu-larly important angle of these teeth.The lab technician complied with thisparticular request during the prepara-tion of the set-up (Fig. 17).

As with any second order problem,the practitioner has to resort to theusual way of correcting it by verticalinsertion of the archwire into theanterior part of the arch:– power-tie on the treated tooth and

on the neighboring teeth;– TMA 175-175 finishing archwire

with sub-angulation of -10o on thecanines.

3 – 3 – Management ofanchorage

If the mechanics of closing spacesdoes not change in relation to classic

mechanics, i.e. regression ‘‘onmass’’ of the anterior sector on thesteel 16*24 archwire with torquesupplement and straight lateral sec-tors, it is imperative to take into ac-count an anchoring values of eachtooth in order to evaluate the amountof necessary anchorage for achievinga smooth working of the closingmovement.

Recent works by El-Nabbout4 using3D imaging have outdated the workof Jarabak

7

and Freeman5. El-Nabb-out is proposing a new chart ofanchoring values for each tooth(Fig. 18).

Therefore, the anterior group of thecentral incisors and the canines rep-resents a value of 8.5 whereas theresistance of the premolar-molargroup is 23. The risk of loss of anch-orage is therefore minimal.

Resorting to modern reinforcedanchorage as Roussarie14 suggestswith mini-screws or mini-implantscan still be indicated.

In fact, the absence of the lateralincisor diminishes the resistance ofthe labial zone but the anterior posi-tion of the canine complicates itsretraction given the proximity of itsapex to cortical bone.

Torque supplement in the anteriorregion of the retraction arch seemsto us to be essential, both to limitregressive movement and to with-draw the canine apex from corticalbone.

Anchorage can be reinforced by asymmetrical or asymmetrical inter-maxillary elastic mechanism depend-ing on the clinical context (Fig. 19).

Figure 16Clinical case no 2. Insertion of the super elastic 16by 22 archwire.



3 – 4 – Management of parasiticmovements

We have already discussed theproblem linked to regrouping thefront four teeth on the level of thesecond order.

During the closing phase of spaceclosing, there is good reason to beaware of the ‘‘bowing effect’’ on theshape of the upper arch. It would bea prudent then to install a ‘‘doublecable’’ mechanism either uni- or bi-lateral, with which the practitionercan vary the intensity of the buccaland lingual force based on the de-sired effect (Fig. 20).

Another parasitic effect in thecourse of retraction consists of alingual-version of the anterior block.

This block can be controlled by a tor-que supplement.

3 – 5 – Management of the endof treatment

Typically, the final stage of treat-ment is achieved with beta-titaniumarchwires.

The practitioner can adjust:– the inter-canine distance;– the angulation;– the torque;– the in-out;– the dental height.

Remember that:– the 175 by175 is a sub-dimensional

archwire which ensures an excel-lent finish of the 1st and 2nd anteriororder;

Figures 17a to 17fClinical case no 2. Castings from beginning to set-up.

FREDERIC BONNIN


– the 17 25 ensures an excellentfinish of the 2nd posterior ordersince it occupies the entirety ofthe throat in the height dimension;

– the 182 by l82 ensures an excellentfinish of the 3rd anterior order. It isthe most used archwire which is

also indicated in cases of agenesesof the lateral incisors (Fig. 21).Notice that there is a possibility of

asking for an overcorrection of thetorque for the canines in order tomake it possible to eliminate the ca-nine bump on the periodontium;

Figure 18Comparison of the anchorage values proposed by El-Nabbout with Freeman

and Jarabak values.

Figures 19a to 19cClinical case no 2. Asymmetrical elastic mechanism promoting anchoring to the right and a loss of anchoring tothe left.



– the 182*25 makes it possible toboth have a posterior 2nd orderfinish, and a 3rd order anterior finishin the transversal direction.The ancillary means at our disposal

are:– the set-up in order to check what

was planned for by the lab and to

evaluate if there is any reasonto make overcorrections or evento order new archwires with spe-cific data;

– articulated paper to visualize thepossibility of making selective cast-ings of the bases;

– using Masel type pliers to crimparchwires without removing them.

– inter-maxillary elastics in order toobtain a perfect inter-arch coordina-tion in the three dimensions ofspace; 3.5 ounce bands 3/16th inthe saggital dimension and 3.5ounces 1/8th in the vertical andtransverse dimension;

– the power-ties in order to manageproblems of angle and torque;

– stripping using Sheridan drill bits ordiamond bands.The occlusal finishing touches, be-

sides their essential role in stabilizingthe long-term results, must facilitatemasquerading of the canines into

Figures 20a and 20bClinical case no 1. A ‘‘double-cable’’ mechanism is installed on the right side in order tofacilitate retraction and to limit the parasitic effects. Note the dot of resin in the buccalzone from the canine which can no longer be gingival for periodontal reasons despite itsunattractive appearance because of its excessively anterior position.

Figure 21Clinical case no 1. Finishing touches using 182*182beta-titanium and correction of the tip of 21 usingpower ties and stripping.

FREDERIC BONNIN


lateral incisors. Therefore, it is rec-ommended that the practitioner seek

the advice of a prosthodontist beforeplanning retention (Fig. 22).

4 – CONCLUSION

– A lingual technique with custom-ized braces performs well in thetreatment of cases of agenesis ofupper lateral incisors by closingspaces in the following way:

– the goals of treatment are predict-able and even modifiable by usingan initial set-up and this modif-ication is performed before fabrica-tion of the device.The protocols for treatment of

agenesis are not unanimously agreedupon and this leads each practitionerto make an ‘‘acceptable compro-mise’’ in each case.

The set-up then becomes anincomparable tool for making a goodchoice of treatment. Additionally, itis an excellent pedagogical tool forjustifying our choice of treatment toour patient:

– that the creation of an individualizeddevice will lend an immeasurablefinesse to the occlusal adjustmentand to the tridimensional position-ing of each dental element, espe-cially in relation to the maxillarycanines whose angle and torquemust be especially well adapted;

– that the commercial buccal deviceswhich come with no torque or angledata pertinent to our occlusalchoice; the practitioner must beable to skillfully and carefully impro-vise to obtain the same end oftreatment occlusion;

– that the patient, who oftens devel-ops an inferiority complex at thebeginning of adolescence due tounattractive congenitally missingteeth, will be particularly drawn toan invisible orthodontic technique.

Figures 22a and 22bClinical case no 1 before and after end of treatment: a first order adjustment made itpossible to vertically coordinate the lateral sectors. The occlusal finishing touches of thecanines will take 5 months to complete.



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2. Canal P, Salvadori A. Orthodontie de l’adulte. Paris : Elsevier Masson SAS, 2008.3. Dueled E, Gotfredsen K, Trab Damsgaard M, Hede B. Professional and patient-based

evaluation of oral rehabilitation in patients with tooth agenesis. Clin Oral ImplantsRes 2009;20(7):729-36.

4. El-Nabbout F. L’apport du scanner 3D en anatomie dentaire : resultats et applicationsaux calculs d’ancrage et a la mecanique orthodontique. These Doct. Univ. Toulouse :Universite Toulouse III, Paul Sabatier, 2007.

5. Freeman D.C. Root surface area related to anchorage in the Begg technique. Mas-ter’s thesis. Memphis: University of Tenessee, 1965.

6. Galletti C, Mujagic M, Simon JS. Orthodontie linguale : positionnement du premierarc dans la zone anterieure. Intern Orthod 2007;5:301-26.

7. Jarabak JR, Fizzell JA. Technique and treatment with the light-wire appliances. 2nd

ed.StLouis : Mosby Co ed, 1972.

8. Jemt T. Measurements of tooth movements in relation to single implant restorationsduring 16 years: a case report. Clin Impl Dent Relat Res 2005;7(4):200-8.

9. Jemt T. Single implants in the anterior maxilla after 15 years of follow-up: comparisonwith central implants in the edentulous maxilla. Int J Prosthodont 2008;21(5):400-8.

10. Jung RE, Pjetursson BE, Glauser R, Zembic A, Zwahlen M, Lang NP. A systematicreview of the 5year survival and complication rates of implant-supported singlecrowns. Clin Oral Implants Res 2008;19(2):119-30.

11. Rosa M, Zachrisson BU. Integrating esthetic dentistry and space closure in patientswith missing maxillary lateral incisors. J Clin Orthod 2001;35(4):221-34.

12. Rosa M, Zachrisson BU. Integrating space closure and esthetic dentistry in patientswith missing maxillary lateral incisors: further improvements. J Clin Orthod2007;41(9):563-73.

13. Rosa M, Zachrisson BU. The space-closure alternative for missing maxillary lateralincisors: an update. J Clin Orthod 2010;44(9):540-9.

14. Roussarie F, Lesage C, Moatty F. Traitement d’une malocclusion severe de l’adulte.Orthodontie minivis et fibres. Inf Dent 2008;29(3):1567-73.

15. Thilander B, Odman J, Lekholm U. Orthodontic aspects of the use of oral implants inadolescents: a 10-year follow-up study. Eur J Orthod 2001;23(6):715-31.

The author would like to take this opportunity to say thank you to the teachingstaff of the Dental University of lingual orthodontics of Garanciere for theirimmeasurable and highly professional assistance during the procedures that arepresented in this article.

FREDERIC BONNIN


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