The lingual appliance is more problematic than the labial one in terms of speech articulation. Although patients with both appliances suffered from different degrees of oral impairment, patients with lingual appliances had more untoward effects, particularly during the first month of treatment.

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Objective: To compare speech performance and levels of oral impairment between two types of lingual brackets. Methods: A parallel-group randomized controlled trial was carried out on patients with Class II, Division 1 malocclusion treated at the University of Hama School of Dentistry in Hama, Syria. A total of 46 participants (mean age: 22.3 ± 2.3 years) with maxillary dentoalveolar protrusion were randomly distributed into two groups with 23 patients each (1:1 allocation ratio). Either STb (Ormco) or 7th Generation (Ormco) lingual brackets were applied. Fricative sound/s/ spectrograms were analyzed directly before intervention (T0), one week following premolar extraction prior to bracket placement (T1), within 24 hours of bracket bonding (T2), one month after (T3), and three months after (T4) bracket placement. Patients′ acceptance was assessed by means of standardized questionnaires. Results: After bracket placement, significant deterioration in articulation was recorded at all assessment times in the 7th Generation group, and up to T3 in the STb group. Significant intergroup differences were detected at T2 and T3. No statistically significant differences were found between the two groups in reported tongue irritation levels, whereas chewing difficulty was significantly higher in the 7th Generation group one month after bracket placement. Conclusions: 7th Generation brackets have more interaction with sound production than STb ones. Although patients in both groups complained of some degree of oral impairment, STb appliances appeared to be more comfortable than the 7th Generation ones, particularly within the first month of treatment.

Background The C-lingual retractor (CR) is an alternative lingual technique to retract anterior teeth with minimum torque expression loss. Although the effects of lingual braces upon speech and oral comfort have been studied previously, there is no published data about the C-lingual retractor in this aspect. The aims of this trial were to compare (1) speech performance based on objective acoustic analysis and (2) levels of oral impairment between C-lingual retractor and conventional lingual brackets (LBs). Materials and methods A parallel-group randomized controlled trial was conducted on patients with class II division 1 malocclusion who sought orthodontic treatment at the Department of Orthodontics, Hama University Dental School. Thirty-six patients who met inclusion criteria were randomly selected and divided into two groups. Eighteen patients in the C-lingual retractor group (CR group) were treated with a C-lingual retractor, whereas eighteen patients in the lingual brackets group (LB group) were treated with conventional lingual brackets (Stealth H, American Orthodontics, Sheboygan, WI, USA). Fricative /s/ sound spectrograms were analyzed before (T0), immediately after (T1), one month after (T2), and three months after appliance placement (T3). The levels of oral discomfort were assessed using standardized questionnaires to evaluate speech, irritation, chewing difficulties, and other oral impacts. Results At all assessment times, the C-lingual retractor caused significant deteriorations in articulation, whereas in the lingual brackets group these deteriorations were statistically significant at T1 and T2 (P<0.001) but not significant at T3 (P=0.073). No intergroup differences were detected. Questionnaire analysis revealed that irritation of the tongue was significantly higher in the lingual brackets group after 24 hours of appliances' placement (P=0.007), whereas speech and mastication problems were insignificantly higher in the C-lingual retractor group. Conclusions The findings indicate that the C-lingual retractor has insignificantly a little more interaction with sound production than lingual brackets. Although the levels of oral impacts were almost similar among both groups, more tongue irritation was observed in the lingual brackets group. However, the oral discomfort decreased over the observation period in both groups.

The University of Al-Baath Postgraduate Research Budget (UBDS-00786223-PG).