Multilingual-bracket and mzcshroom arch

wire technique
A clinical report

Kinya Fujita, D.D.S., D.Sc.D.*

Yokosrtkri. Jqm

Research was conducted for the purpose of developing an orthodontic treatment technique which would be both
hygienic and esthetically pleasing. In order to achieve this goal, the treatment technique made use of orthodontic
forces coming from the lingual surfaces of the teeth. The development of the lingual-bracket and mushroom-arch
appliance has been reported on previously. General and clinical features of this new technique are discussed in
addition to concentration on Class II cases.

Key words: Fujita technique, esthetics, psychological benefits, adult patients

A new treatment method was developed to

make use of the orthodontic forces coming from the
lingual and palatal surfaces of the teeth to move the
teeth tridimensionally for the correction of malocclu-
sions. The Fujita method is useful not only for the
general orthodontic patient but especially in cases of
adult orthodontic therapy, for limited corrective treat-
ment, as well as for tooth movement and retentive
treatment in prosthodontics or in cases of periodontal
disease.
Recent years have seen a marked increase in the
number of persons desiring orthodontic treatment. Pa-
tients requiring such treatment vary considerably, how-
ever, as to age, oral growth, degree of malocclusion,
and psychological disposition. Some patients, particu-
larly adults, display a negative reaction toward the
esthetics of conventional fixed orthodontic appliances.
There are, therefore, some patients who refuse orth-
odontic treatment and other patients already receiving
treatment who, for the reasons stated above, complain
of psychological stress and lose interest in treatment. In
such cases the patient becomes uncooperative toward
treatment and there is a breakdown in communications
between patient and specialist.
As a means of solving the problems cited above,
direct bonding of brackets to the lingual or palatal sur-
face of the teeth was developed. The present article was
written to answer questions and present case reports
concerning treatment responses to date with the multi-
lingual-bracket and mushroom arch wire technique.
*Associate Professor of Orthodontics, Kanagawa Dental University.
CASE REPORTS
CASE 1
Patient H. N., a 13-year-oldgirl, had a ClassII malocclu-
sion with crowded anterior teeth in both dental arches, an
overjet of 8 mm., and an overbite of 6 mm. (Figs. 1 to 4).
Facial and intraoral photographs, orthodontic study models,
and cephalometric, intraoral, and panoramic radiographs
were taken. There was nothing unusual in the family history.
The patient’s nutrition and growth conditions were good. The
teeth were all I S.D. larger than the normal size range. The
anterior teeth were severely crowded in both dental arches;
the arch length discrepancy in the upper jaw was 9 mm.,
while that for the lower jaw was 10 mm. The cephalometric
evaluation showed that the interim&al angle, FMA, Y axis,
gonial angle, and esthetic line were 2 S.D. from the normal or
mean. Other measurements were within the 1 S.D. range
(SNA, 83.5 degrees; SNB, 78 degrees; ANB, 5.5 degrees;
FMA, 24 degrees; PMIA, 58 degrees; IMPA, 98 degrees;
Y axis, 60 degrees; gonial angle, 118 degrees; interincisal
angle, 110 degrees;esthetic line: upper lip, 0 mm., lower lip
+3.5 mm.).
As a result of analysis, this case was diagnosed as a
dental arch length and A-B difference problem. Although
extraction of the four first premolars would normally he ad-
visable, in this case there was damage to the crown of the
secondpremolar in the lower left quadrant, and consequently
both lower second premolars were extracted.
The lingual-bracket and mushroom-arch appliance was
used. As a first step, the appliance was attached to the man-
dibular teeth, after which leveling and distal movement of the
tirst premolars were carried out. After a period of 7 months,
the appliance was attached to the maxillary teeth. The tirst
premolars were extracted and distal movement of the canines
was achieved with Class II elastics. In addition, retraction of
the anterior teeth was performed. This case required long-

120 0002-9416/82/080120+21$02. IO/O 0 1982 The C. V. Mosby Co.

Volume 82
Number 2
Fig. 1. Case 1. Facial photographs before treatment (left) and 1 year after treatment (right).
term depression of the maxillary anterior teeth. The ideal
mushroom-shaped arch wire acted as a fixed type of retainer
for 6 months following active tooth movement. After the
appliance had been removed, a conventional retainer was
used at night. The patient was very cooperative throughout
the treatment period.
The treatment objectives of ANB reduction (to the
Japanese standard of 3.4 degrees for the ANB angle) and
improvement of the interincisal angle (124 degrees) were
achieved and good results were obtained. In addition, the
treatment period with the lingual-bracket and mushroom-arch
wire was 4 years, but no development of caries was noticed.
Two years after retention the case appears stable.
CASE 2
Patient A. W., a 20-year-old woman, had a Class II
malocclusion with an overjet of 7.0 mm. and an overbite of
4.5 mm. (Figs. 5 to 8). The case required re-treatment for a
relapse following prior orthodontic treatment of maxillary
prognathism. There was nothing unusual in the family his-
Multilingual-bracket and mushroom arch wire technique 121
tory. The patient’s nutrition and growth conditions were
good.
The four first premolars had been extracted during the
previous treatment, and there was no spacing between the
teeth. The teeth were in the normal size range. Cephalometric
films indicated a small mandible. There were also procum-
bent mandibular anterior teeth (SNA, 80 degrees; SNB, 70
degrees; ANB, 10 degrees; FMA, 34 degrees; FMIA, 47
degrees; IMPA, 99 degrees; Y axis, 66 degrees; gonial angle,
119 degrees; interincisal angle, 117 degrees; esthetic line:
upper lip + 1.5 mm., lower lip +2..5 mm.).
After analysis it was decided to improve the occlusion by
distal movement of the maxillary teeth. For esthetic reasons,
the patient was eager to make use of the lingual-bracket and
mushroom-arch appliance, and treatment was carried out ac-
cording to the Fujita technique. At this time, distal movement
of the maxillary teeth was undertaken with use of an extraoral
fixed appliance during sleep (to obtain molar Class I and
maintain that position) and intermaxillary Class II elastics (to
effect distal movement of the canines and incisors).
volut?lP a2 Multilingual-bracket und mushroom arch wire technique 123
Number 2

Fig. 3. Case 1. Intraoral photographs 27 months under treatment (top) and 1 year acer treatment
(bottom).

The patient was very cooperative throughout the treat-
mer it period. Improvement in the ANB angle was not notice-
able :, but results were generally satisfactory as to occlusion
and profile since the lips no longer protruded. Treatment time
was 2% years, which included the active treatment period and
the fixed-retention period. After removal of the appliance, a
retainer was used at night. At present, 3 years after tre atment,
the occlusion is stable and the prognosis is satisfacto bry.
CASE 3
Patient H. K., a 12-year-old girl, had a Class II maloc-
elusion as a result of severe crowding in the canines, a cross-
 Fig. 4. Case 1. Cephalometric and panoramic radiographs before treatment (left) and 1 year after
treatment (right).

AN6 5.5 ANB 1.5

FMA 24 FMA 21
FMIA 58 FMIA 69
IMPA 98 IMPA 90
lnterincisal 110 lnterincisal 138
E line U. 0.0 E line U. 4.5
L. 3.5 out L. 3.5

bite limited to the anterior teeth, an overjet of 1.5 mm., and an
overbite of I mm. (Figs. 9 to 12). There was nothing unusual
in the family history. The patient’s nutrition and growth con-
ditions were good. (This type of case is common in Japan.)
The maxillary anterior teeth were crowded, and the
canines in particular were severely blocked and high. There
was mild crowding in the mandibular anterior teeth but almost
no eruption space for the right second premolar. The maxil-
lary and mandibular teeth were both 1 S.D. larger than the
normal size range. There was a discrepancy of 10 mm. in the
maxillary arch length and 7 mm. in the mandibular arch
length. The cephalometric evaluation showed measurements
for SNA and ANB that were 2 S.D. smaller than normal, but
the others were in normal range (SNA, 75 degrees; SNB,
75.5 degrees; ANB, -0.5 degrees; FMA, 33 degrees; FMIA.
58 degrees; IMPA, 89 degrees; Y axis, 64 degrees; genial
angle, 127 degrees; esthetic line: upper lip, - 1.S mm. and
lower lip, +3.0 mm.).
As a result of the analysis, this case was diagnosed as one
involving poor maxillary growth and poor tooth alignment,
With mesial movement of the maxillary first molars and distal
movement of the mandibular anterior teeth as objectives, ex-
traction of the maxillary second premolars and mandibular
first premolars was considered.
Treatment was undertaken with the lingual-bracket and
mushroom-arch appliance. As the first step in treatment, ex-
pansion of the maxillary anterior teeth and distal movement of
the mandibular canines were carried out. At this point, use
was made of intermaxillary Class III elastics. From the mid-
point of treatment, intermaxillary Class II elastics were used
to carry out distal movement of the maxillary canines. In the
final stage of treatment up-and-down elastics were added. As
in other cases, after completion of active treatment the
appliance was not removed but was used as a retainer.
Including this retention period, the appliance was in use
for 2 years. A satisfactory occlusal relation and profile im-
provement were obtained. Records 2 years following treat-
ment show satisfactory stability.
CASE 4
Patient H. F., a 19-year-old girl, had a Class I malocclu-
sion with crowding in both dental arches, an overjet of 2.0
mm., and an overbite of I .O mm. (Figs. 13 to 16). Facial and
intraoral photographs, orthodontic study models, and cepha-
Volume 82
Number 2
Fig. 5. Case 2. Facial photographs before treatment (left) and 2 years after treatment (right).
lometric, intraoral, and panoramic radiographs were taken.
The patient’s older sister showed the same tooth con-
figurations, and in both the patient and her sister the mandibu-
lar and maxillary central incisors had extremely short roots.
The patient’s nutrition and growth conditions were good.
The maxillary left canine and the mandibular right first
premolar were severely crowded. All the teeth were 1 S.D. to
2 S.D. larger than normal size. There was a discrepancy of 8
mm. in the maxillary arch and of 7 mm. in the mandibular
arch. The cephalometric evaluation showed that the SNA,
SNB, and interincisal angles were 2 S.D. beyond the mean
(SNA, 88 degrees; SNB, 84 degrees; ANB, 4 degrees, FMA,
31 degrees; FMIA, 50 degrees; IMPA, 99 degrees; Y axis,
63 degrees; genial angle, 124 degrees; interincisal angle,
103 degrees; esthetic line: upper lip +2.0 mm., lower lip
-6.5 mm.).
As a result of analysis of the above data, this case was
diagnosed as a bimaxillary protrusion with crowding. Extrac-
tion of the four first premolars was indicated and treatment
was carried out with the Fujita technique, making use of the
Multilingual-bracket and mushroom arch wire technique 125
lingual-bracket and mushroom-arch appliance. In this case, a
band was used for the mandibular molars, but for the maxil-
lary molars the bracket was bonded directly to the teeth. This
directly bonded bracket never came loose throughout the
treatment period.
Distal movement of the mandibular anterior teeth was
carried out with intraoral elastics and a loop which was
formed in the mushroom-arch wire. Retraction of the maxil-
lary teeth was performed with intermaxillary Class II elastics
and a loop formed in the mushroom-arch wire. After comple-
tion of active treatment the appliance was not removed but
was used as a retaining appliance. This was because the pa-
tient was opposed to using a conventional retaining appliance.
In this case the device was used for 3 years. Prognosis is good
2 years after retention.
CASE 5
Patient K. M., a 9-year-old boy, showed pronounced ro-
tation of both central incisors in the maxilla (Figs. 17 and 18).
Fig. 6. Case 2. Intraoral photographs before treatment (top) and 1 month under treatment (bottom)
Volume 82 Multilingual-bracket and mushroom arch wire technique 127
Number 2

Fig. 7. Case 2. Intraoral photographs 24 months under treatment (top) and 2 years after treatment
(bottom).

The chief complaint was rotation of the anterior teeth. After
analysis of materials and upon consideration of caries pre-
vention, it was decided to undertake preventive orthodontic
treatment only in the anterior teeth as an early stage of treat-
ment. Treatment was carried out with the Fujita technique and
appliances. Expansion of the anterior teeth, relieving of the
rotations, and overcorrection were carried out.
After 8 months, treatment objectives were obtained, and
the appliance was used for retention as well as to preserve
space for erupting teeth.
 Fig. 8. Case 2. Cephalometric and panoramic radiographs
treatment (right).
ANB 10
FMA 34
FMIA 47
IMPA 99
lnterincisal 117
E line U. 1.5 out
L. 2.5 out
ASPECTS OF TREATMENT
(A discussion of clinical matters)
Standard brackets are attached to the buccal surface
of the first and second molars. To avoid the loss of
bonds, bands are cemented to the first molars, but
adhesive is used to bond the appliance directly to the
lingual surface of all other teeth. The lingual bracket is
positioned in relation to the cusps of the first molars (in
other words, welded to the upper portion of the band).
For the other teeth, it is important to bond the appliance
to the cervical margin of the teeth. (For Japanese pa-
tients, this is approximately 3 to 4 mm. from the cusps
of the first molars, 4 to 5 mm. from the premolars, and
5 to 6 mm. from the canines and incisors.)
When there is minimal crowding, leveling begins
with 0.016 gauge wire bent into the shape of the mush-
room-arch wire. When the teeth are quite crowded,
leveling can be achieved with two strands of 0.010
gauge wire or 0.014 gauge wire. This is replaced with
before treatment (left) and 2 years after
ANB 10
FMA 35
FMIA 48
IMPA 97
lnterincisal 133
E line U. 1 .o
L. 0.0
increasingly thicker wire as treatment proceeds. The
ideal mushroom-arch wire is either rectangular or
square. Fig. 19 shows various methods of fixation for
the arch wire.
When it is necessary to depress the anterior teeth, a
reverse curve must be included in the mushroom-arch
wire. If the curve of Spee is great, making it difficult to
fix either a plain mushroom-arch wire or a reverse-
curve type of mushroom-arch wire to the lingual
bracket, then the wire is bent in the distal area of the
canines as shown in Fig. 20, A. If the wire used is
square or rectangular, then it will twist when bent in
this fashion (Fig. 20, A). It should therefore be bent as
shown in Fig. 20, B, with a compensatory inset and
downward twist. Also, in forming a loop in the
mushroom-arch wire, it is necessary to first bend the
loop in the same plane as the arch wire (labiolingual
and buccolingual) and then place the vertical bend in
the loop (in the directions of the tooth axes) as shown in
Fig. 20, C.
Volume 82
Number 2
9. Case 3. Facial photographs before treatment (left) and 1 year after treatment (r ight).
In Case 1 a Class II malocclusion involved a palatal
closed bite and crowding. Since it was impossible, as a
result, to bond a lingual bracket to the upper anterior
teeth, it is recommended that one first bond the lingual
bracket to the lower dental arch and start leveling and
correction of crowding by retraction into the second
premolar space. Conventional brackets were bonded to
the buccal surface of the first premolars. In the case of
the lingual bracket, it is best to do all bonding prior to
extraction. During this period of treatment, a bite plate
could be used on low-angle cases.
When the lower anterior teeth are intruded suf-
ficiently, then the maxillary teeth are bonded. It is
best to bond the lingual bracket as early as
possible.
Sectional wire containing a gable bend is attached
buccally, and intraoral elastic thread is used for distal
movement of the first premolars. The same process is
Multilingual-bracket and mushroom arch wire technique 129
used on the lingual side. (It is advisable to use sectional
wire containing a retraction loop on the buccal side.)
Intraoral elastic thread or elastic rings are used for dis-
tal movement of the lower canines.
Class II elastic rings are used in the maxilla. When
elastic thread, elastic rings, and coil springs are used as
sources of orthodontic force, it is important to bend the
mushroom-arch wire in a “toe-out” pattern in the area
of the molars.
When intrusion of the maxillary anterior teeth is
difficult, one can consider nocturnal use of the plastic
jig shown in Fig. 21 in “high-pull” position.
The method for performing retraction in the anterior
teeth is the same as for conventional techniques.
Sources of orthodontic force are elastic rings, elastic
thread, and the loop formed in the mushroom-arch wire
to achieve retraction. Hooks are soldered in this case on
the mushroom-arch wire so that elastic rings can be
130 F‘ujrrtr

Fig. 10. Case 3. Intraoral photographs before treatment (top) and 3 months under treatment (bottom).
Volume 82 Multilingual-bracket and mushroom arch wire technique 131
Number 2

Fig. 11. Case 3. Intraoral photographs 13 months under treatment (left) and 1 year after treatment
(bottom).
132 b’ujirtr

Fig. 12. Case 3. Cephalometric and panoramic radiographs before treatment (left) and 1 year after
treatment (right).

ANB -0.5 ANB 0.5

FMA 33 FMA 30
FMIA 58 FMIA 69
IMPA 89 IMPA 81
lnterincisal 122 lnterincisal 137
E line U. 1.5 E line U. 2.0
L. 3.0 out L. 1.0

Fig. 13. Case 4. Facial photographs before treatment (left) and 1 year after treatment (right)
Volume 82 Multilingucrl-bracket and mushroom arch wire technique 133
Number 2

Fig. 14. Case 4. Intraoral photographs before treatment (top) and 6 months under treatment (bottom).
 Fig. 15. Case 4. Intraoral photographs 15 months under treatment (top) and 1 year after treatment
(bottom).

placed on the distal portions of the lateral incisors.
Alternately, loops can be formed in the arch wire.
When considerable movement of the anterior teeth
is required, a large “crank” is bent into the mushroom-
arch wire at the distolingual region of the canines. As a
result, when the anterior teeth move lingually, this por-
tion of the wire comes into contact with the premolars
and restricts further distal movement. It is necessary in
such a case to re-form the arch wire. Use of the up-
and-down elastic ring is easy for the patient.
Case 2 involved an adult patient whose four first
premolars had been extracted at age 12 in the course of
Volume 82 Multilingual-bracket and mushroom arch wire teelhnique 135
Number 2

Fig. 16. Case 4. Cephalometric and panoramic radiographs before treatment (left) and 1 year after
treatment (right).

ANB 4 ANB 2.5

FMA 31 FMA 31
FMIA 50 FMIA 65
IMPA 99 IMPA 84
lnterincisal 103 lnterincisal 130
E line U. 2.0 out E line U. 0.0
L. 6.5 out L. 2.5 out

Fig. 17A. Case 5. Before-treatment facial photographs. Cephalometric evaluation: ANB, 3; FMA, 34;
FMIA, 53; IMPA, 93; interincisal, 118; E line U, 3.0 out, L, 4.5 out.
 Fig. 176. Case 5. Before-treatment
orthodontic treatment. We now had a Class II case with
deep-bite.
Distal movement of the maxillary molars was
achieved by nocturnal use of a face-bow. During the
day, Class II elastic rings were placed over the mesial
hook of a sectional wire extending to the buccal side of
the premolars. The lingual bracket was bonded to all of
the teeth, after which the mushroom-arch wire was at-
tached. In addition, Class II elastic rings were placed
lingually. Distal movement of the teeth was achieved
by use of a face-bow, intraoral elastic thread, open-coil
springs, and Class II elastic rings. During this period,
the appliance was not visible and the patient remained
cooperative, continuing all daily activities. Three
years have passed since retention, and stability
remains.
In Case 3 treatment had included extraction of the
four first premolars. Treatment time was 18 months.
Case 4 involved an adult patient with a condition
involving a maxillofacial pattern encountered often
among Japanese and other Oriental persons. In addi-
tion, the patient had short central incisor roots. Treat-
intraoral photographs.
ment was routine. without excessive resorption of the
roots.
Case 5 involved treatment of the upper central in-
cisors. After correction of the anterior teeth, an arch
wire was attached to prevent relapse and to secure
space for tooth eruption. After the teeth had fully
erupted, an appliance was attached to the lower dental
arch and adjusted. In the interests of stability following
retention, and to minimize relapse, the treatment goal
for the interincisal angle is set at between 130 and 135
degrees.
ADVANTAGES
The Fujita technique is advantageous (1) in cases in
which esthetic considerations are important, (2) in
cases in which the patient is engaged in sports activities
(less trauma to the lips), (3) in undertaking minor tooth
movement as a preliminary to prosthodontic treatment,
(4) for orthodontic treatment and fixation as treatment
for periodontal disease, and (5) because it makes use of
the lingual-bracket and mushroom-arch appliance in
lieu of a retaining appliance.
Volume 82
Number 2
Fig. 18. Case 5. Intraoral photographs 3 months under treatment (top) and 14 months under treatment
(bottom).
INDICATED CASES
This technique can be adapted to almost all cases
which demand orthodontic treatment. The technique is
especially effective in cases requiring expansion or bite
opening, since the appliance is attached to the lingual
surface.
In treatment of open-bite cases and progenia, it may
be necessary to consider treatment for overcorrection
by conventional methods in the final stages.
PATIENT RESPONSE
A questionnaire survey was conducted on the pa-
tients’ reactions to such matters as treatment technique,
appliance, pronunciation, mastication, and discomfort.
In the survey I selected patients at random who
were undergoing treatment with this new technique and
with conventional methods, and I used a multiple-
choice form. The twenty patients covered in the survey
had been under treatment for 3 months or more and
138 Fr!;itc/

Question 6: I> there any area at present, other thtn the

teeth, which gives you pain’!
New: No.
Conventional: No.
Qmtion 7: How long after insertion of braces did it take
for pain to subside?
New: Less than a week.
Conventional: (A) Less than a week; (B) less
than a month.
Qurstion 8: Was it difficult to speak after insertion of the
braces?
New: Yes.
Conventional: (A) I don’t know; (B) Yes
(A and B about equal).

Regarding pronunciation, I asked whether their

parents had difficulty in understanding them. In both
cases they answered either that it had not been a source
of worry or that they had not noticed.
Question 9: Is it still difficult to speak now’?
New: (A) I had no trouble after a week; (B) I
had no trouble after a month (about equal).
Conventional: (A) I had no trouble after a
week: (B) I had no trouble after a month
(about equal).
Question 10: Have you ever been told that your pronuncia-
Fig. 19. To fix the arch wire pins, elastic 0 rings and, in particu- tion is not clear?
lar, ligature wires are used. It is best to use pins for the molars. New: Yes.
In the early stages of treatment elastic 0 rings are used.
Conventional: No.
Question I I: Was it difficult to eat after insertion of the
ranged in age from 8 to 26 years. I selected for presen- braces’!
tation here the answers which were most numerous and New: Yes.
the questions to which there was about an equal number Conventional: (A) Yes; (B) a little bit.
of both answers. Question 12: Is it still difficult to eat now?
New: (A) I had no trouble after a month; (B) I
QMJ.GMM /: Is the brace a source of annoyance at present’?
had no trouble after a week.
A IZ.\\\‘CI’.’ New technique: A little bit.
Conventional: I had no trouble after a month.
Conventional method: A little bit.
Putting the same question to the parents, I got these answers: Regarding eating, the parents in both cases
New: No. Conventional: Yes. answered that their children had had trouble in
(jurstion 2: Do you think people around you have noticed
eating.
that you are under orthodontic treatment?
Answer: New: I don’t think so. Question 13: Are you able to attach the rubber band to the
Conventional: I think they knew imme- braces by yourself‘?
diately. New: Yes.
Q~resfion 3: Are you self-conscious about wearing braces’? Conventional: Yes.
New: No. Question 14: Did you have any trouble kissing?
Conventional: A little bit. New: No (not when we’re in love.)
Questiorl 4: Do you want to remove the braces as soon as
Conventional: No (not when we’re in love.)
possible’? Examining these answers, we can imagine that pa-
New: I will wait until treatment is over.
tients undergoing treatment with conventional methods
Conventional: (A) I will wait until treatment
is over; (B) I will wait a little longer (A and
are conscious of esthetic matters.
B about equal in number). BRUSHMG
Question 5: Was it painful anywhere when the device was
inserted? A most important and indispensable factor in orth-
New: Teeth, tongue, gums. odontic treatment is brushing. Two kinds of tooth-
Conventional: Teeth, gums, tongue. brushes are recommended. One is a conventional
Volume 82 Multilingual-bracket and mushroom arch wire technique 139
Number 2

Fig. 20. Mushroom arch wire bending.

Fig. 21. Plastic jig for high pull.

Fig. 22. Toothbrushing trainer. A, Battery. B, Angle detector. C, Buzzer. 0, Weight detector. E, Lamp.

toothbrush used to clean the areas not in contact with
the appliance, such as the labial and buccal tooth sur-
faces, the occlusal surfaces, and the gingivae. The
other toothbrush is used to clean the areas in contact
with the appliances, such as the lingual and palatal
surfaces, in addition to massaging the gums. The sec-
ond toothbrush is small, with eight tufts in two rows.
The bristles are medium to soft in hardness. This is
because in this treatment technique the distance be-
tween brackets is smaller than with conventional appli-
antes and there is a greater need for the brush tufts to
reach the surfaces of the teeth.
140 F‘r(;i/tr

An Oral-B sulcus toothbrush in which the number Problems with this new treatment concern the slight
of tufts had been reduced was used. This toothbrush pronunciation problems which occur immediately after
was replaced with a new one about every week or 10 insertion (although these may disappear within I to 2
days. weeks). Moreover, there is also the problem of redden-
The brushing method was divided into two direc- ing of the tongue which occurs with some patients (to
tions: (1) the Bass method starting with the occlusal about the same degree as with the conventional lingual
surfaces of the appliance, and (2) the scrub method button, and disappearing in about a week).
concentrating on the gingival region of the appliance. One problem with this technique is that an extraoral
Patients were told to brush from 3 to 5 minutes in each anchorage appliance making use of the “J hook” can-
of the dental arches. not be used as it could with conventional methods.
In addition to the above points on brushing, it must Furthermore, making use of this new technique re-
also be remembered that the mushroom-arch wire in the quires a somewhat longer treatment time for each visit
distal area of the canines has a large “crank” which and there is an awkward work position.
makes it difficult to brush the neighboring teeth. It is
therefore necessary to advise the patient to take special REFERENCES
care in brushing this region and to take time to brush I. Fujita. Kinya: New orthodontic treatment with lingual bracket and
mushroom arch wire appliance, Aar. J. ORTHOD. 76: 657-675.
each tooth thoroughly.
1979.
In the teaching and practice of brushing methods, a 2. Fujita, Kinya: Orthodontic appliance, United States Patent
brushing practice device was developed. This device is 4209906, Filed Nov. 21, 1977.
sensitive to the angle of the tufts in relation to the tooth 3. Fujita, Kinya: Orthodontic appliances, Japan Patent 55-488 14,
surface as well as to the weight exerted by the tufts. It Filed Dec. 23. 1976.
4. Fujita, Kinya: Development of lingual bracket technique. I.
has the ability to give a sound-and-light readout on this
Esthetic and hygienic approach to orthodontic treatment, J. Jpn.
information (Fig. 22). Sot. Dent. Appar. Mater. 19: 81-86, 1978.
5. Fujita, Kinya: Development of lingual bracket technique. 2.
DISCUSSION Esthetic and hygienic approach to orthodontic treatment. J. Jpn.
The greatest assets of this technique are that the Sot. Dental Appar. Mater. 19: 87-94, 1978.
6. Fujita, Kinya: Development of lingual bracket technique. 3. J.
patient is able to receive orthodontic treatment without
Jpn. Orthod. Sot. 37: 381-384. 1978.
others knowing and this appliance can be used as a 7. Fujita, Kinya: Brushing method for the lingual bracket technique
retention appliance. In addition, since retention follow- with Fujita, J. Jpn. Orthod. Sot. 37: 399403, 1978.
ing removal of this appliance makes use of con-
ventional removable retainers at night only, the patient
will generally wear it through the entire retention pe-
riod without complaint.