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Clinical Pearl

Modified Precision Lingual Bonding Technique: A Step‑wise Approach

with Torque Angulation Device‑bracket Positioning Device

Abstract Rosaline Tina Paul,

Objectives: Contemporary preadjusted edgewise appliance is all about the precision in bracket A. R. Ligil1,
design, prescription and positioning in addition to the orthodontist’s skill and training. However, V. T. Vineeth2,
achieving it is a bigger challenge as the anatomy of the lingual surface of a tooth is uneven,
dissimilar, and moreover the tooth alignment on the lingual surface is variant. Thus, the need for P. P. Biswas3
an accurate method of bracket positioning with predetermined torque and angulation incorporated in Consultant Orthodontist,
the brackets according to the patients’ need is of key importance. Materials and Methods: A TAD- Dr. Kuruvilla Memorial Dental
Clinic, Kunnamkulam, Thrissur,
BPD machine used to enhance the accuracy of bracket positioning and bioplast accurate tray transfer Departments of Orthodontics
technique was used. Results: A step‑wise procedures in bracket positioning and fabricating an and Dentofacial Orthopedics,
indirect bonding tray for lingual orthodontics using the torque angulation device‑bracket positioning 1
PSM College of Dental Science
device. Conclusions: This technique facilitated unhindered bonding even in severely crowded cases and Research, Thrissur,
and easy rebonding during mid-treatment stages. 2
Azeezia College of Dental
Sciences and Research, Kollam
Keywords: Indirect bonding, lingual orthodontics, torque angulation device‑bracket positioning and 3Royal Dental College,
device Palakkad, Kerala, India

Introduction guide (TARG) machine which

incorporated the necessary torque and
“Necessity is the mother of invention.” So
angulation required but had a wooden
was the invention of the lingual orthodontic
base which impeded precision during
technique in 1980 by Kurz,[1] California,
bonding[5]
and Fujita,[2] Japan, whose clientele was
• In 1986, the customized lingual
dominated by renowned personalities.
appliance setup service system was
As in contemporary preadjusted edgewise introduced with the idea of dealing
labial orthodontic appliance, the greatest better with the anatomic discrepancies
challenge in the success of lingual of the lingual surfaces of the teeth. This
orthodontic therapy depends undoubtedly was accomplished by constructing an
on the perfection in bracket design, ideal diagnostic setup from a duplicate
prescription, and its positioning in addition setup model of the patient’s original
to the orthodontist’s skill and training. malocclusion[6]
• In 1987, Fillion introduced the BEST
The reason being the anatomy of the lingual
system in which the second‑order bends
surface of a tooth is uneven, dissimilar, and
in the anterior section were eliminated,
moreover the tooth alignment on the lingual
but the bends in the premolar and molar
surface is variant. Thus, the need for an Address for correspondence:
regions were not avoided[7]
accurate method of bracket positioning Dr. V. T. Vineeth, Azeezia
• In 1996, HIRO system used the ideal College of Dental Sciences
with predetermined torque and angulation
arch form with 0.018” × 0.025” stainless and Research, Meeyannoor,
incorporated in the brackets according to Kollam ‑ 691 537, Kerala,
steel wire to position the brackets on the
the patients’ need is of key importance.[3] India.
setup. In this, they used single tooth E‑mail: drvineethvt@gmail.com
There are various methods of bracket transfer trays[8]
positioning as follows: • In 1997, the Transfer Optimized
• The lingual bracket jig by Dr.  Silvia Positioning System was devised by a Access this article online
Geron in 1982 was a method in which German professional Dr. Weichmann. Website:
lingual brackets were bonded directly[4] Later, he invented the CAD/CAM www.apospublications.com
• In 1984, the Ormco Company devised Incognito system with its customized DOI: 10.4103/apos.apos_97_16
the torque angulation reference gold brackets[9] Quick Response Code:

This is an open access article distributed under the terms of the

Creative Commons Attribution-NonCommercial-ShareAlike 3.0 How to cite this article: Paul RT, Ligil AR,
License, which allows others to remix, tweak, and build upon the Vineeth VT, Biswas PP. Modified precision lingual
work non-commercially, as long as the author is credited and the bonding technique: A step-wise approach with torque
new creations are licensed under the identical terms. angulation device-bracket positioning device. APOS
For reprints contact: reprints@medknow.com Trends Orthod 2017;7:199-203.

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Paul, et al.: Modified precision lingual bonding technique

• In 2004, a real breakthrough in lingual orthodontics

occurred with the invention of the torque angulation
device (TAD)[10]
• In 2006, the first TAD with digital TARG accurate
to 0.1° was invented. Along with this, a bracket
positioning device (BPD) was devised to facilitate easy
bracket placement.[10]
In this article, the step‑wise procedure in bracket
positioning and fabricating an indirect bonding tray for
lingual orthodontics is detailed using the TAD‑BPD.

Armamentarium
TAD: It consists of a fine adjustment screw, locking screw,
liquid crystal display  (LCD), angulation fine adjustment Figure 1: Torque angulation device
knob, torque arc movement assay, and torque fine
adjustment knob [Figure 1].
BPD: It consists of a fine adjustment screw, locking screw,
LCD, a caliper, and a bracket attachment jaw [Figure 2].
In addition, there are a cast surveyor [Figure 3]; height-
measuring gauge, hand instruments, adhesive and lingual
brackets [Figure 4].

Steps Involved in Indirect Bracket Positioning

and Transfer Tray Fabrication
Step I: Preparing the casts
• Working models are trimmed appropriately so that they
could be easily mounted on the cast surveying base
[Figure 5]
Figure 2: Bracket positioning device
• Long axis of the clinical crown is marked on the labial
and lingual surfaces of the tooth [Figure 6a and b]
• The midpoint of the clinical crown is also marked with
a measuring gauge [Figure 7a and b]
• Horizontal orientation lines corresponding to the
midpoint of the clinical crown are marked to get an
intersecting point on the labial surface of the crown
• Once the models are ready, they are sectioned into
three different parts using a die cutter. This procedure is
done so that the lingual bonding could be accomplished
unhindered [Figure 8a and b].
Step II: Setting the model according to the desired
angulation and torque using the torque angulation
device
• Before setting the machine to the desired torque and
angulation, the accuracy of the TAD is verified using Figure 3: Cast surveyor

the orientation guide [Figure 9]

• Torque fine adjustment knob is set to the desired torque model. Once the position of the model is verified three
value [Figure 10] dimensionally, the models are fixed on the model survey
• Angulation fine adjustment knob is set to the desired base by closing the knob [Figure 12].
angulation value [Figure 11]
Step III: Positioning the bracket using the bracket
• The models with the orientation lines are mounted on
positioning device and curing the adhesive
the cast survey base. They are adjusted such that the
center of the torque arc movement assay corresponds • The bracket attachment jaws are adjusted to an initial
to the intersecting lines on the labial surface of the height and thickness corresponding to 0 (zero). After

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Paul, et al.: Modified precision lingual bonding technique

surveying the model, the desired height and thickness are

formulated and a chart is prepared. With this preparations,
the model is ready for the bonding procedure [Figure 13]
• Bracket is fixed on one of the bracket adjustment jaws.

Figure 5: Trimmed models with bases

Figure 4: Height‑measuring gauge, hand instruments, adhesive and lingual

brackets

a b
Figure 7: (a and b) Midpoint of the clinical crown is marked with the help
of the measuring gauge, and the horizontal orientation lines are marked

a b
Figure 6: (a and b) Marking the long axis of the clinical crown on the labial
and lingual surfaces of the tooth

a b
Figure 8: (a and b) The models are sectioned into three different parts
using a die cutter
Figure 9: Verifying the accuracy of the torque angulation device using the
orientation guide

Figure 10: Adjusting the torque to the desired value Figure 11: Adjusting the angulation to the desired value

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Paul, et al.: Modified precision lingual bonding technique

Primer is applied on the bracket base followed by trays are cut neatly and the trays are now ready for
placing sufficient amount of adhesive bonding intraorally [Figures 18 and 19].
• The bracket attachment jaw is adjusted to the
predetermined height and thickness according to the Discussion
formulated chart. Once again the position of the bracket Considering the variations in lingual crown morphology
is verified three dimensionally and the adhesive is and the slope of the maxillary anterior teeth,[11] any
cured [Figure 14, 15a, b, 16a and b] small variation in bracket height could affect the torque
• Similarly, the rest of the brackets are placed on the teeth delivered to the tooth much more than with labial
according to the chart prepared [Figure 17a and b]. appliance. Kyung used a Mushroom bracket positioner
Step IV: Preparation of the transfer trays to determine the most suitable height for bracket
positioning.[3] In our method of bonding, the individual
• Once the bracket positions are confirmed, vacuum trays tooth was surveyed initially and a chart was prepared
made of 1 mm soft sheets are prepared. The vacuum according to the particular case using the TAD/BPD.
Moreover, to ensure the most accurate unhindered bracket
position on the lingual surface, we used a cast which
was precisely cut into three sections using a model die
cutter. Care was taken so that the morphology of the
lingual surface of the teeth was preserved. Previously, for

Figure 12: Adjusting the cast on the cast surveying base so that the center
of the torque arc movement assay coincides with the intersection of the
vertical and horizontal orientation lines

Figure 13: The bracket attachment jaw is corrected to a height and thickness

of 0 initially

a b
Figure 15: (a and b) Applying the primer and adhesive onto the bracket base

Figure 14: Chart prepared after surveying the model

a b
a b
Figure 16: (a and b) Excess composite is smoothened and light cured after
confirming the bracket position three dimensionally Figure 17: (a and b) Completed bonding according to the prepared chart

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Paul, et al.: Modified precision lingual bonding technique

Figure 18: Fabricated transfer trays Figure 19: Transfer trays ready for intraoral bonding

bonding severely rotated tooth, duplication of models was Conflicts of interest

mandatory. By following this technique, duplication of
There are no conflicts of interest.
models was avoided by bonding onto a rotated tooth by
detaching the hindering portion on the model easily. References
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transfer tray system offered easy removal of occlusal status report. Part 2: Research and development. J Clin Orthod
and incisal flash removal, it lacked rigidity for individual 1982;16:735‑40.
tooth bracket transfer which was required in the cases 2. Fujita K. New orthodontic treatment with lingual bracket
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plain‑wire system with micro‑implant anchorage. J Clin Orthod
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2004;38:388‑95.
for rebonding procedure. We used transfer trays made
4. Geron S. The lingual bracket jig. J Clin Orthod 1999;33:457‑63.
of 1 mm thickness vacuum‑formed soft sheets. This
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facilitated easy removal of the sheet after completion of technique. Int Orthod 2010;8:125‑51.
the bonding procedure. Moreover, rebonding was also very 6. Huge SA. The customized lingual set-up service system. In:
easy as the individual tooth on the tray could be easily Romano R, editor. Lingual Orthodontics. London: B. C. Decker,
cut using a scissors and the rebonding could be done even Hamilton; 1998. p. 63-173.
during the mistreatment when the adjacent tooth changed 7. Fillion D. The thickness measurement system with the dali
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The main advantage in this method of lingual bonding is Orthod Soc 1998;57:83‑91.
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bonding even in severely crowded tooth. Duplication of procedure. J Orofac Orthop 1999;60:371‑9.
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beneath the bracket delivered the exact amount of torque eLABORATE 2007;6:24‑6.
required. The use of soft vacuum form trays not only 11. Smith JR, Gorman JC, Kurz C, Dunn RM. Keys to success in
facilitated precise bonding, but also removal of the trays lingual therapy. Part 1. J Clin Orthod 1986;20:252‑61.
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Financial support and sponsorship 14. Komori A, Fujisawa M, Iguchi S. KommonBase for precise
direct bonding of lingual orthodontic brackets. Int Orthod
Nil. 2010;8:14‑27.

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