Lingual orthodontic treatment duration: performance of two different completely customized multi-bracket appliances (Incognito and WIN) in groups with different treatment complexities

INTRODUCTION: The occurrence of side-effects of fixed orthodontic therapy, such as white-spot lesions and root resorption, are known to be significantly more frequent with increasing duration of treatment. Multi-bracket treatment should be as short as possible, in order to minimize the risks of collateral damage to teeth. The aim of this non-randomized clinical trial was to compare treatment duration with each of two types of customized lingual orthodontic appliances (Incognito, 3 M-Unitek; WIN, DW LingualSystems), taking into account treatment complexity. The null-hypothesis was that there would be no significant difference in active orthodontic treatment duration between them. METHODS: Of 402 potentially eligible participants, a population sample of n = 376 subjects (n(Incognito) = 220; n(WIN) = 156; m/f 172/204; mean age ± SD 17.3 ± 7.7Y) treated in one orthodontic center (Bad Essen, Germany) with completely customized lingual appliances in upper and lower permanent dental arches was recruited with the inclusion criterion of initiated and completed lingual multi-bracket treatment within the assessment period of April 1st 2010 – Nov 30, 2013, and the exclusion criterion of less than 24 bracketed teeth. We used four-factorial ANOVA to assess the impact of the following factors: initial degree of severity of malocclusion (mild to moderate, S1; severe, S2), appliance type (Incognito; WIN), sex, and age group (<=16; >16 Y) on the duration of lingual multi-bracket treatment. RESULTS: Overall, mean treatment duration was 21.7 (SD 7.2) months, which was significantly shorter for WIN for both sub-groups of treatment complexity (S1: 17.96 mo; S2: 20.49 mo) compared to Incognito (S1: 22.7 mo; S2: 29.79 mo). ANOVA revealed a significant influence of the main effects ‘appliance type’, and ‘severity’, independent of each other. Therefore, the null-hypothesis was rejected. CONCLUSION: In terms of treatment duration, the WIN appliance performed significantly better than the Incognito appliance. Consequently, subjects treated with the WIN appliance are expected to be exposed to lower risks of the typical side-effects associated with longer multi-bracket treatment durations, such as root resorption and enamel decalcification.