Considerations of the Fully Customised Lingual Bracket System in Extraction Cases

with Dr Toru Inami



We have used Fully Customised Lingual Systems (Incognito & WIN) for over 15 years. One of the most important features of Fully Customised Lingual Systems is using ribbon-wise arch-wires and vertical slots in the anterior region. We will consider the biomechanics of it and show the treatment risks through extraction cases.


1. Root exposure by uncontrolled tipping when using 0.016 X 0.022 Ni-Ti archwires from the beginning.

2. Root resorption: when we use the robotically produced ribbon-wise archwires and the anterior vertical slot, it is necessary to use optimum force (not excessive force) to the tooth. However, the archwires are always the same custom archwires produced by the bending robot machines, so there will be less ‘jiggling’ forces to the tooth roots. Hence it will be possible to treat severe root resorption cases, if we avoid the prolongation of the treatment period by applying optimum ‘gentle forces’ using this system.

3. Decalcification; For avoiding bracket debonding, we use the half occlusal pads for the lower premolars and molars. However we did not appreciate the caries/decay under the pads.

4. Uncontrolled movement: When anterior teeth are retracted using the alveolar bone screws or TADS, the force of the lingual inclination occurs anteriorly. But if we used ribbon-wise archwires and a vertical slot, the counter force of ‘rabitting’ is unlikely to occur, but unfortunately the palatal cusps of the molars are depressed with palatal crown torque easily due to the low stiffness of the ribbon-wise wire.

5. Factors exacerbating periodontal disease in lingual treatment.


We have to be careful with extraction cases when using Fully Customised Lingual systems.


Dr Toru Inami graduated from School of Dentistry, Aichi-gakuin University in 1976 (D.D.S.) and took the postgraduate program of orthodontics (1976-1977).

From 1977 to 1981 he was research associate at the Dept. of Orthodontics in the same School of Dentistry.

Dr Toru Inami previously held prominent positions such as: Senior consultant (1990~2000) of the Level Anchorage System society, The president (2005-2007) of the Japan Lingual Orthodontic Association (JLOA), The chairman of the 4th World Society of Lingual Orthodontics (WSLO) congress in Japan (2011), Director (2010-2016) of the executive committee of the Japanese Orthodontic Society (JOS) and Chairman (2012-2014) of the Japanese Orthodontic Board (JOB).

He was director of Inami orthodontic office in Kyoto Japan from 1981 and was also a designated dentist for developmental and corrective medical care of C.L.P. and abnormality by the Ministry of Health, Labor and Welfare, and an accredited dentist for treatment of jaw deformities under the national health insurance.

His certificate of Orthodontics was given in 1997 and he became board certified member of the Japanese Orthodontic Society (JOB) in 2008 and active member of JLOA and WSLO, a titular member of the European Society of Lingual Orthodontics (ESLO). He has been honoured with the Aldo Carano Award (7th ESLO congress in 2006).

Presently, he was clinical professor of the school of dentistry, Aichi-gakuin university from 2013. President of the Kinki-Tokai Orthodontic Society. His main clinical practice involves use of the lingual bracket appliance treatment for younger patients and his research interests include the differential diagnosis of Class III malocclusion and the predictability of Class III treatment.