Restoration of a lower incisor’s periodontal health by means of a selected radicular torque control using a fixed lingual orthodontic approach; case report.

REMINDER TO ONE AND ALL………..MOUTHING OFF is at long last changing to a social media and networking friendly platform; Word Press – took four thousand emails and some yelling and screaming but, soon……that’s corporate speak for more hurry up and wait, but it’s coming.  In the meantime…….check out the categories on the side if you are looking for an archive of the close to 1000 blog entries. The one area I have had the least access to is WIRE BENDING or as it’s more commonly known, ORTHOHOMA which is where most wirebenders retire to on their way to their final destination in Scottsdale, AZ.

Enjoy this case from our friends in Italy on the Zerodonto blog:

Dr. Matteo Beretta

Dr. Nunzio Cirulli

Prof. Aldo Macchi

A 25 years old girl previously treated with a fixed orthodontic appliance,has come to the chairside examination because of the gum vestibular resorption on tooth 41, with a sensibility increase and the diffcult to keep a good domiciliar oral hygiene.

The clinical exam showed a severe gum resorption of this tooth with a buccal movement of the rooth and a traumatic contact with the antagonist because of the extrusion.

There was also a fixed contention in the lower arch from 3.2 to 4.2 that was damaged and repaired a lot of time and because of an inadequate bonding procedure has became an active retainer. This exerted a couple of forces that generated an uncontrolled radicular buccal torque of tooth 4.1.

The treatment provided the removal of the old retainer, a professional oral hygiene and the application of a fixed lingual appliance by means of self ligating i-TT? brackets from 3.4 to 4.4. The purpose was to level teeth, to remove the traumatic contact, to correct the radicular torque of 4.1 and to re-establish a periodontal health to let a better domicialiar oral hygiene (Figs: 01-05).



The bonding procedure was accomplished with a direct technique without a previous set-up.

After the brackets application the ectopic position of tooth 41 root is more evident.

A .014 Niti arch (large arch shape) was inserted in the occlusal slot modeled with the rigth “in-out” step bends between canines and first bicuspids and with anti-stress distal end bends to keep the arch length.

In the gIngival slot of teeth 3.1 and 4.1 was inserted a 0.14 preformed NiTi sectional (small arch shape because of the arch length reduction in the gIngival side) and inserted into the central tube of teeth 3.2, 4.2, 3.3 and 4.3. This let immediately during the initial leveling process the exertion of a couple of force in the frontal teeth, especially in the central incisors, that generate a lingual radicular torque (Fig: 06-09).


After one month from the brackets application we can see the full teeth leveling and the initial radicular torque movement of tooth 4.1.

Keeping the same occlusal 0.14 NiTi large arch it was modified the application of the other sectional from 3.3 to 4.3 now inserted in the gingival slot of the four incisors to increase the torque movement (Fig: 10-13).


After 10 weeks the reduction of the gingival resorption of tooth 4.1 is evident together with a better radicular torque position, more evident in the lateral picture.

Keeping the same occlusal arch was added a first order bend to the gingival sectional to tooth 4.1 to increase the torque correction (Figg: 14-18).



After 8 weeks, that was after 5 months and half from the removal of the old retainer and the lingual brackets bonding procedure, the orthodontic correction was ultimated. The treatment required only a .014 NiTi large arch and one sectional .014 NiTi small.

It was considerably improved the gingival resorption of tooth 4.1 togheter with the reduction of the sensibility.

Waiting a complete soft tissues healing the lingual brackets were leaved as contention, to prevent a new relapse, also considering the failure of the previous passive retainer, with a good patient compliance and oral hygiene.

In future it will be valuated the reduction of the contention only from canine to canine together with the valuation of a surgical periodontal treatment according to the patient needs (Figg: 19-22).



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