Controlling incisor torque with completely customized lingual appliances

PURPOSE: To test the null hypothesis of no significant deviation between the center of rotation (C(ROT)) and the center of resistance (C(RES)) during space closure in Angle class II division 2 subjects achieved using a completely customized lingual appliance (CCLA) in combination with class II elastics and elastic chains. METHODS: This retrospective study included 29 patients (male/female 11/18; mean age 15.6 [13–27] years) with inclusion criteria of an Angle class II/2 occlusion of least of half of a cusp, maxillary dental arch spacing, completed CCLA treatment (WIN, DW Lingual Systems, Bad Essen, Germany) in one center with a standardized archwire sequence and use of class II elastics and elastic chains only. Maxillary incisor root inclination was assessed by X‑ray superimpositions of the maxilla at the beginning (T1) and the end (T3) of CCLA treatment. Using Keynote software (Apple®, Cupertino, CA, USA), the incisor’s C(ROT) was assessed with the point of intersection of the incisor axes (T1; T3) following vertical correction of overbite changes. C(RES) was defined at 36% of the incisor’s apex–incisal edge distance. RESULTS: The null hypothesis was rejected: the mean C(ROT) − C(RES) difference was 52.6% (p < 0.001). The mean C(ROT) was located at 88.6% (min–max 51–100%) of the incisor’s apex–incisal edge distance. Although 6.9% of C(ROT) were located between the C(RES) and the alveolar crest, the vast majority (93.1%) were assessed between the alveolar crest and the incisal edge, or beyond. CONCLUSION: CCLAs can create upper incisor palatal root torque even in cases in which lingually oriented forces applied incisally to the center of resistance of the upper incisors counteract these intended root movements.