Revisiting the History of Lingual

Orthodontics: A Basis for the Future

Pablo Echarri

The history of lingual orthodontics has not been a smooth one. There was a
period of initial euphoria as the technique made its clinical debut; this was
followed by a period of frustration, disappointment, and rejection. Thanks to
the effort of several dedicated clinicians, many of the issues responsible for
this decline have been overcome. We are now in a period of resurgence, the
technique has become more sophisticated, the clinical results achieved can
stand on an equal footing with the best of conventional labial techniques,
and the acceptance of technique by the profession is growing rapidly. The
history of this technique is peppered by individuals who have shown per-
severance and ingenuity; in this article I will endeavor to cover some of the
aspects related to these individuals and their contributions to lingual
orthodontics. (Semin Orthod 2006;12:153-159.) © 2006 Elsevier Inc. All rights
reserved.

ne of the most important challenges in Lingual orthodontics, as we understand it to-

O orthodontics is to attain excellence in
treatment with comfortable and esthetic appli-
ances. From the esthetic perspective, lingual
orthodontics provides the best option for com-
prehensive treatment of most malocclusions
while maintaining full three-dimensional con-
trol of the dentition.
In 1726, Pierre Fauchard1 suggested the pos-
sibility of using appliances on the lingual sur-
faces of teeth. In 1841, Pierre Joachim Lefoulon2
designed the first lingual arch for expansion and
alignment of the teeth. Since the era of Edward
Angle, numerous orthodontists have combined
active labial appliances with lingual appliances
such as the Mershon (lingual arch), Goshgarian
(transpalatal bar), Ricketts (Quad-Helix) and
Wilson (3D Modular Enhanced Orthodon-
tics).3-5
Post Graduate Department of Orthodontics, University of Bar-
celona, Spain.
Address correspondence to Pablo Echarri, DDS, Museu, 6
1o1a, 08912 Badalona, Barcelona, Spain. Phone: 00 34 93 384
47 05; Fax: 00 34 93 464 22 42; E-mail: echarri@
centroladent.com
© 2006 Elsevier Inc. All rights reserved.
1073-8746/06/1203-0$30.00/0
doi:10.1053/j.sodo.2006.05.002
day (a full, multibracket appliance), began in
the 1970s. Curiously, the lingual appliance was
not the consequence of an esthetic demand, but
it was started in Japan by Kinja Fujita6-10 to satisfy
the orthodontic needs of patients who practiced
martial arts, to protect the soft tissues (lips and
cheeks) from the possible impact against brack-
ets. Fujita was the first to develop the lingual
multibracket technique using the mushroom-
shaped archwire. He submitted his concepts on
lingual orthodontics in 1967, began his research
in 1971, and published the Fujita method in
1978, treating Class I and Class II cases with
extraction of four bicuspids. The Fujita bracket
had three slots— occlusal, horizontal, and verti-
cal (US patent No. 4,209,906; July 1, 1980) (Figs
1 and 2).
Craven Kurz started his investigations with
Jim Mulick in 1975 (UCLA School of Dentistry),
using plastic brackets (Lee Pharmaceuticals,
1434 Santa Anita Ave, South El Monte, CA
91733) bonded to the lingual tooth surfaces.
Apparently an employee of the Bunny Playboy
Club with crowded teeth came to Craven Kurz’s
office asking him for nonvisible orthodontic
treatment, further stimulating his interest in the
subject. Using plastic brackets, it was easy to
reshape them for a better fit to the lingual sur-

Seminars in Orthodontics, Vol 12, No 3 (September), 2006: pp 153-159 153

154 P. Echarri

Figure 1. Patent for the Fujita lingual bracket (US patent No. 4,209,906).

faces; however, there were many problems, espe-
cially with regard to bonding failures and patient
comfort (US patent No. 4,337,037; June 29,
1982) (Fig 3).
Engineers Craig Andreiko and Frank Miller
(Ormco, Sybron Dental Specialties, 1717 West
Collins Ave, Orange, CA 92867) began their re-
search with orthodontist Jim Wildman, who, as
far as I can ascertain, in 1976 treated the first
patient in the United States by using a lingual
appliance.
Later, Craven Kurz and these two engineers
developed the first generation of the Kurz lin-
gual bracket. To test and continue their research
in this field, Ormco founded a Task Force11-21
comprising Craven Kurz (Beverly Hills, CA),
 History of Lingual Orthodontics 155

tioning of the mandible, extrusion of molars,

intrusion of incisors, and facilitating any expan-
sion and mesiodistal movement of molars unin-
hibited by occlusal forces. In the second gener-
ation (1980), hooks were added to canine
brackets; and in the third generation (1981),
hooks were added to all brackets and to molar
tubes. The fourth generation (1982-1984) in-
cluded a lower profile facilitating insertion of
the archwire. With the fifth generation (1985-
1986), the bite plane became more pronounced,
the torque was increased, and the molar brack-
ets included an accessory tube for a transpalatal

Figure 2. Patent for the Fujita lingual bracket (US

patent No. 4,209,906).

Jack Gorman (Marion, IN), Bob Smith (Stan-

ford, FL), “Wick” Alexander and “Moody” Alex-
ander (Dallas, TX), James Hilgers (Mission
Viejo, CA) and Bob Scholz (Alemeda, CA), and
administrators Floyd Pickrel, Ernie Strauch, and
Michael Swartz.
The principal characteristics of this bracket
were a bite plane, a base pad adapted to the
anatomic characteristics of the lingual surfaces
of the teeth, and a preangulated slot according
to the conversion of the torque used on the
labial surface. The Kurz lingual bracket devel-
oped and evolved to the 7th Generation Ormco
Lingual Bracket in 1990. The first generation
included a bite plane and rounded margins;
hooks were absent and the bracket was large.
The advantages of the bite plane included: Figure 3. Patent for the Craven Kurz lingual bracket
opening the bite anteriorly with possible reposi- (US patent No. 4,337,037).
156 P. Echarri

bar. For the sixth generation (1987-1990), the movement. Also in France, Didier Fillion has
hooks were elongated, the transpalatal bar at- had and still continues to play an important role
tachment was optional, and the hinge-cap tube in the history and development of lingual orth-
for the second molar was developed (self-ligated odontics. He has been involved in research, pub-
bracket). With the seventh generation (1990), lishing, and lecturing internationally on this sub-
the square bite plane became rhomboid shaped, ject.28-31 He has stimulated and been involved in
increasing the interbracket distance, and the the establishment of many lingual scientific so-
premolar brackets were widened mesiodistally cieties, such as the European Society of Lingual
for better rotational control (Fig 4). Orthodontics (ESLO), Société Française
Kurz also developed numerous pliers and in- d’Orthodontie Linguale (SFOL), British Society
struments for the clinical practice of lingual of Lingual Orthodontics (BLOS), and most re-
orthodontics; he was the owner of 22 patents. cently the World Society of Lingual Orthodon-
In the United States, pioneers in this field tics (WSLO). Furthermore, together with Alain
were Kelly22 (1982), who used Unitek labial Decker and Gerard Altounian he established
brackets (3M Unitek, 2724 South Peck Road, one of the first university lingual orthodontics
Monrovia, CA 91016) on the lingual surfaces, programs at Paris V University. Still in France,
and Paige23,24 (1982), who used Begg light wire the important role of Jean-Françoise Leclerc, the
brackets on the lingual surfaces. Creekmore25 fourth president of the ESLO, needs to be re-
(1989) developed a complete technique with corded.
vertical slot lingual brackets, together with a lab- In Italy, Massimo Ronchin32 (1992) was
oratory system (The Slot Machine). Creekmore elected as the first president of ESLO. He devel-
also designed archwire templates and clinical oped, in 1994, a self-ligating lingual bracket
instruments. The biomechanics of his lingual based on the Begg technique (Forestadent,
brackets (Conceal; 3M Unitek) was based on his
previous uni-twin labial brackets, which in-
creased the interbracket distance but main-
tained rotation control with extended wings.
Following this initial development and expan-
sion of lingual orthodontics in the 1990s, inter-
est, particularly in the United States, decreased,
probably due to the poor standard of completed
cases. The reasons for this were attributed to
inadequate training, poorly developed labora-
tory systems, and the unavailability of preformed
archwires. In 1996, Craven Kurz, William Laugh-
lin, Thomas Creekmore, Jim Wildman, Gi-
useppe Scuzzo, Didier Fillion, and Pablo Echarri
together with other clinicians founded the Lin-
gual Study Group, in Denver, Colorado, with the
aim of relaunching lingual orthodontics, espe-
cially in the United States. The American Lin-
gual Orthodontics Association (ALOA),
founded in 1987 but which had been inactive for
a number of years, was reactivated in 1997 by
Mario Paz, John Napolitano, and Frank Ando-
lino. Since then, the ALOA has prospered and
continues to attract to their annual meeting in-
creasing numbers of clinicians from many coun-
tries.
In France, Fontenelle26,27 (1979) published
his approach to invisible orthodontics by using a Figure 4. Evolution of the Craven Kurz lingual
palatal mechanism incorporating bodily tooth bracket.
 History of Lingual Orthodontics
Westliche 151, 75172 Pforzheim, Germany). The
same company also developed the Philippe
bracket, a simple bracket without torque con-
trol, but useful for alignment and leveling.33
Aldo Macchi34 and Giuseppe Nidoli published a
series of articles and helped to further dissemi-
nate information on the lingual technique. They
developed the bracket Torque N/M, a self-ligat-
ing bracket with vertical archwire insertion path
for the anterior teeth and with a horizontal slot
for the posterior teeth. Giuseppe Siciliani pub-
lished one of the first books on lingual orth-
odontics3 describing the features and mechanics
of the lingual technique.
Giuseppe Scuzzo was the third president of
the ESLO, and he also contributed to the devel-
opment of the Associazione Italiana de Ortodon-
zia Linguale (AIOL). Together with Kyoto Take-
moto from Japan they published a series of
articles, a CD syllabus, and a comprehensive text
book35 on the lingual technique. They also de-
veloped a prototype of a lingual straight wire
bracket and technique, the STb (Scuzzo/Take-
moto bracket, Ormco), This bracket represents
a significant advance, because its design facili-
tates the use of light forces with reduced friction
and its small size enhances patient comfort.
In Germany, Dirk Wiechmann36-38 developed
a customized lingual bracket advancing the tech-
nique into a high technology level. The Incog-
nito bracket is perfectly adapted to the lingual
surfaces of the teeth, using a scanned model, the
bracket base, and the bracket itself is cast as one
unit for each individual tooth. The prescription
for tip and torque is customized according to the
orthodontist’s treatment plan.
Wiechmann has also been involved with the
development of a robot for designing and con-
structing lingual archwires perfectly adapted
and customized for each dental arch. His con-
tribution to lingual orthodontics is marked by
his many publications, lectures, and involvement
in study groups.
Also in Germany, Hatto Loidl developed a
self-ligating lingual bracket, Evolution LT (Ad-
enta GmgH, Gutenbergstrasse 9, D-82205 Gilch-
ing, Germany). The second generation of this
bracket was launched in 2001 incorporating in-
creased maxillary incisor torque (60°), a modi-
fied stronger arch retaining clip, and a reduced
buccal-lingual thickness of 2.1 mm.
157
In Israel, the promoters of lingual orthodontics
are Silvia Geron,39 who developed the Lingual
Bracket Jig for direct and indirect bonding in lin-
gual orthodontics, and Rafi Romano, who edited a
book40 presenting an update on the state of the art
of lingual orthodontics. Furthermore, they
founded the virtual journal www.lingualnews.com
and a lingual orthodontics forum that facilitates
the interchange of information between inter-
ested clinicians (http://health.groups.yahoo.
com/group/lingualortho).
In South Korea, where many clinicians use
the lingual technique, two individuals need spe-
cial mention, namely Tae Weon Kim and Hee-
Moon Kyung.
Tae Weon Kim founded the Korean Society
of Lingual Orthodontics (KSLO) and developed
the Model Checker, a bracket positioner, and
CRC Ready-Made Core Trays41 (plastic pre-
formed attachment, perfectly adapted to the ex-
ternal surface of the Ormco lingual bracket),
which together form the Korean Indirect Bond-
ing Setup System (KIS System).5 Dr. Kim also
designed special pliers to be used exclusively in
the lingual technique.
Hee-Moon Kyung founded the Korean Lin-
gual Orthodontics Association (KLOA) and de-
veloped the Individual Indirect Bonding Tech-
nique (IIBT), the Mushroom Bracket
Positioner, as well as the Lingual Straight Wire
Technique.5 He is also well known for the devel-
opment of the micro screw implant, a major
advance in the provision of bony anchorage for
both lingual and labial orthodontic techniques.
The Japanese Lingual Orthodontics Associa-
tion (JLOA) is currently the largest lingual orth-
odontic society, reflecting the state of lingual
orthodontics in that country. Apart from Kinja
Fujita, and others too numerous to list, mention
should be made of Kyoto Takemoto, who, with
Giuseppe Scuzzo, developed the STb bracket, as
well as Toshiaki Hiro, who developed the tech-
nique of creating individual indirect bonding
trays for each bracket. Hitoshi Koyata has written
a book on lingual orthodontics with particular
reference to the biomechanics of the tech-
nique.42
In Spain, lingual orthodontics is growing in
popularity, and I am proud to have contributed
to this development by creating the Sociedad
Iberoamericana de Ortodoncia Lingual
(SIAOL), organizing the first international con-
158 P. Echarri
gress of SIAOL, organizing regular lingual
courses, both private and in combination with a
number of universities, as well as organizing the
6th ESLO Meeting as its sixth president. I have
published many articles and authored a book5
on lingual orthodontics.
Due to the limited space it is impossible to
name all the important lingual orthodontists
who have contributed to the development of the
technique, but I do not want to forget Stuart
McCrostie and Derek Mahony from Australia,
Eduard Pümpel from Austria, Marcelo Marigó
from Brazil, and Andre Hugo and Ziegfried We-
ber from South Africa.
The author considers that lingual orthodon-
tics will continue to develop and evolve at an
accelerating pace. Consumer demand will en-
courage a growing number of clinicians to learn
and use the technique. Commercial companies
are investing in appliance production and tech-
nique promotion. The creation of WSLO
(World Society of Lingual Orthodontics; www.
wslo.info) will certainly contribute to engaging
lingual orthodontists from many countries and it
will become the showcase of this remarkable
technique for all orthodontists, patients, and
commercial companies throughout the world.
Acknowledgments
I want to thank to Craig Andreiko, Stuart McCrostie, Fred
Marconi, Silvia Geron, Rafi Romano, André Hugo, María
Guerra Cubero from Dentaurum, Betina Schendell from
Adenta, Courtney Gorman Jr, Lori Garland Parker, Keith
from 3M Unitek, and Stephen L. Hertzberg and Jim Wild-
man for their support and unselfish help in providing me
with information on the subject. I also wish to apologize to
all the people who I might not have mentioned in this
article, especially because I am sure that “the history of
lingual orthodontics ” is still being written by each and every
one of us.
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