Appreciating the art of custom surgical orthodontic care

Orthodontics has changed a lot since its humble beginnings. Today orthodontics is not considered a luxury, but more likely a proactive attempt to create better oral health through improving facial harmony and esthetics. Occlusion and functional issues such as mastication, breathing, speech, and self esteem are now issues that patients understand and want to improve. Educational mechanisms such as the internet combined with a multidisciplinary team approach drive patients to ask for very specific treatment objectives. However, there is a huge disparity in the variety of treatment mechanisms that a patient may utilize. The choices presented to the patient are often limited not by what the patient wants, but rather to mechanics that the doctor uses daily. It is not reasonable to think that an adult will want to have mechanics similar to what a growing 12 year old uses. Older patients desire to hide their orthodontic mechanics, and thus the need for a more cosmetic solutions was born. Isn't it ironic that the most advanced and accurate custom orthodontic appliance happens to be on the lingual of the teeth?! This article will discuss and review how the Incognito appliance system may be used to prepare cases for orthognathic surgery. The benefits to this system are numerous. It's effectiveness at setting cases up for orthognathic surgery is real. Multiple multidisciplinary cases will be demonstrated with issues in transverse, sagittal, and vertical planes. Cases will be shown from treatment planning through retention. Historically, lingual orthodontics has been perceived as a challenging concept to master. The Incognito appliance system is uniquely different compared to labial mechanics as the arch wire is a ribbon arch and as such it displays torque moves much more effectively when it is planned and deployed. Properly utilized, the Incognito appliance system can be the difference when teeth need to be decompensated for surgery. It's strength is delivering an accurate, predictable tooth position while achieving esthetic excellence. Regardless of the dimension(s) to correct (transverse, vertical or antero-posterior dimension) via a combination of comprehensive orthodontics and orthognathic surgery, lingual appliances simply represent the best option when a patient demands esthetic appliances to correct their malocclusion.