Outcome assessment of lingual and labial appliances compared with cephalometric analysis, peer assessment rating, and objective grading system in Angle Class II extraction cases

Angle Orthod. 2015 May;85(3):400-7. doi: 10.2319/031014-173.1. Epub 2014 Aug 25.


Objective: To validate our hypothesis that there would be significant differences in treatment outcomes, including cephalometric values, degree of root resorption, occlusal indices, and functional aspect, between cases treated with labial and lingual appliances.

Materials and methods: Twenty-four consecutively treated Class II cases with extractions and lingual appliance were compared with 25 matched cases treated with extraction and labial appliance. Orthodontic treatment outcomes were evaluated by cephalometric analysis, peer assessment rating, and an objective grading system (OGS). Additionally, functional analysis was also performed in both groups after orthodontic treatment. Statistical comparison was performed using the Wilcoxon signed rank test within the groups, and the Mann-Whitney U-test was used to compare between the labial and lingual groups.

Results: The only significant difference between the groups was that the interincisal angle was larger in the lingual group than in the labial group. OGS evaluation showed that control over root angulation was significantly worse in the lingual group than in the labial group. There was no significant difference between groups in the amount of root resorption or in functional evaluation.

Conclusions: Generally, lingual appliances offer comparable treatment results to those obtained with labial appliances. However, care should be taken with lingual appliances because they are more prone to produce uprighted incisors and root angulation.

Keywords: Clinical outcome; Lingual appliance; Objective grading system; Peer assessment rating.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alloys / chemistry
  • Bicuspid / surgery
  • Case-Control Studies
  • Cephalometry / methods*
  • Copper / chemistry
  • Dental Alloys / chemistry
  • Female
  • Follow-Up Studies
  • Humans
  • Incisor / pathology
  • Male
  • Malocclusion, Angle Class II / therapy*
  • Nickel / chemistry
  • Orthodontic Appliance Design*
  • Orthodontic Brackets*
  • Orthodontic Wires
  • Peer Review*
  • Retrospective Studies
  • Root Resorption / classification
  • Root Resorption / diagnostic imaging
  • Stainless Steel / chemistry
  • Titanium / chemistry
  • Tooth Extraction / methods*
  • Tooth Movement Techniques / instrumentation
  • Tooth Root / pathology
  • Treatment Outcome
  • Young Adult


  • Alloys
  • Copper NiTi
  • Dental Alloys
  • titanium molybdenum alloy
  • titanium nickelide
  • Stainless Steel
  • Copper
  • Nickel
  • Titanium