Lingual orthodontics – no high quality evidence of effectiveness


Traditional fixed orthodontic appliances impact on patients’ aesthetic appearance. The use of lingual orthodontic appliances has been developed as one approach to address these problems. The aim of this review was to assess the effectiveness of lingual orthodontic treatment and related clinical parameters.


Searches were conducted in the Medline, Embase, Google scholar beta, all Cochrane Databases, and Conference Paper Index databases. Randomised clinical trials (RCTs), prospective controlled clinical trials (CCTs), or retrospective studies with a control group reporting on results or treatment parameters related to orthodontic treatment performed with fixed lingual brackets bonded at least to all teeth between first molars, in one or both arches and published in 
English, German, French or Italian were considered. Two reviewers independently selected studies, abstracted data and assessed study quality. The Cochrane risk of bias tool and the Newcastle–Ottawa scale were used to assess study quality. Meta-analysis was not conducted.


  • 16 studies (11 retrospective, 4 CCTs, 1 RCT) were included.
  • 6 studies evaluated differences of the treatment outcome from the pre-treatment set-up prediction.
  • 2 studies evaluated the effect of treatment on periodontal and microbial parameters.
  • 10 studies assessed various clinical treatment related parameters.


The authors concluded:

This systematic review showed encouraging results on the clinical outcome of lingual orthodontic treatment, especially in regards to the achievement of individualized treatment goals and the decreased risk of decalcifications on the bonded surfaces of the teeth. However, additional well-designed prospective clinical trials with large samples are needed to confirm those findings. Several aspects of lingual orthodontic treatment were difficult to be conclusively evaluated due to the study design, the heterogeneity, the small samples, and the high risk of bias seen in the majority of the included studies.


The authors have conducted a wide search for studies and included a number of languages. They decided only to include studies published after 2000 as they considered that developments in appliances and techniques since then would be more representative of current clinical practice. However, the majority of included studies were retrospective in nature with only 5 trials being included and only one of these being randomised. So while the available evidence does suggest encouraging clinical outcomes from the available data there is no high quality evidence available to assess the effectiveness of lingual orthodontics so large high quality trials are needed.


Mistakidis I, Katib H, Vasilakos G, Kloukos D, Gkantidis N. Clinical outcomes of lingual orthodontic treatment: a systematic review. Eur J Orthod. 2015 Sep 10. pii: cjv061. [Epub ahead of print] Review. PubMed PMID: 26359019.


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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