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Treatment progress skeletal adaptability, and functional implications such as altered tongue
The Brava system was bonded using digital indirect placement. By the posture and speech difficulties. Traditional labial fixed appliances,
second appointment, initial leveling and edge-to-edge correction of while effective, are often less acceptable to adult patients because of
the anterior crossbite were observed. Lower IPR was performed, and their visibility and the need for frequent wire adjustments to achieve
labial buttons were placed on teeth 16, 26, 33, and 43 with Class III precise tooth movements.
elastics (Figures 6a to 6e). By the third appointment, uprighting of 42 In the present case, the Brava Lingual Orthodontic System offered
and 43 progressed, with improved tongue space and speech. By the several distinct advantages. Its digitally customized, independent
fourth appointment, the crossbite was fully corrected, and finishing biomechanical design allowed precise, controlled tooth movement,
refinements were completed. facilitating simultaneous correction of the anterior crossbite and
uprighting of teeth 42 and 43. The system’s digital workflow enabled
Treatment results predictable planning and execution, reducing chair time and
Following 8–9 months of active treatment, complete correction of the improving treatment efficiency. Additionally, the appliance met the
anterior crossbite was achieved. Teeth 42 and 43 were successfully patient’s esthetic preference for a virtually invisible system, enhancing
uprighted, and ideal overjet and overbite were established. Crowding compliance and overall satisfaction. Functional benefits were also
in both arches was fully resolved, with concomitant improvement in observed, as corrected tooth positions allowed improved tongue
speech clarity. The final occlusion demonstrated optimal alignment, posture, leading to enhanced speech articulation, particularly in /s/
functional stability, and fulfilled all predetermined treatment and /z/ sounds. This case highlights the Brava system as a reliable
objectives (Figures 7a to 7h). option for managing localized anterior malocclusions while providing
functional rehabilitation and patient-centered esthetic outcomes. The
Discussion patient reported increased confidence, improved speech, and high
Correction of anterior crossbite and lingually inclined teeth in adult satisfaction with the discreet nature of the appliance, underscoring its
patients presents unique challenges due to aesthetic concerns, limited value in adult orthodontic care.

CASE REPORT - 2 movement, resulting in rapid initial alignment of the lower anterior
A 45-year-old female patient presented with lower anterior crowding. teeth. The patient reported only mild discomfort during the first 48
Her medical history was unremarkable, and dental history included root hours following appliance placement, which resolved spontaneously.
canal treatment of tooth 16. Extraoral examination revealed a straight Subsequent appointments demonstrated progressive and consistent
facial profile with competent lips, and no signs of temporomandibular alignment of the mandibular anterior teeth in accordance with the
joint dysfunction were noted. Intraoral examination (Figure 8) planned digital movements (Figure 10). Interproximal contacts were
demonstrated a bilateral Class I molar and canine relationship, with evaluated and adjusted as needed to optimize arch coordination and
moderate crowding in the lower anterior region. Overbite and overjet relieve minor crowding.
were within normal limits, and no crossbite or functional mandibular Throughout the treatment, no emergency visits or unplanned
shifts were observed. interventions were required. The overall treatment duration was
approximately 9 months, primarily due to the patient’s inability to visit
Treatment Objective the practice after 6 months.
The primary objective was to resolve moderate lower anterior crowding
while maintaining the existing Class I molar and canine relationships. Treatment Results
Secondary objectives included preserving normal overbite and overjet, Complete alignment of the mandibular anterior teeth was achieved.
ensuring functional occlusion, and maintaining facial esthetics and lip Moderate crowding was fully resolved, resulting in a well-coordinated
competence. mandibular arch. The Class I molar and canine relationships were
The treatment plan involved alignment and levelling of the maintained, with ideal overbite and overjet preserved throughout
mandibular anterior teeth using Clear aligners. Unfortunately, she treatment.
could not get used to aligners as the appliance required to be removed The patient reported improved comfort and function, with
repeatedly for eating and drinking. She was offered the BRAVA no interference in speech or mastication. The final occlusion
orthodontic appliance for its inherent fixed nature and limited need demonstrated harmonious alignment, stable interproximal contacts,
for reactivation. Arch coordination was carefully managed to achieve and overall functional stability. The appliance effectively delivered
harmonious occlusion. Upon completion of active treatment, retention the pre-programmed tooth movements, achieving predictable and
using a fixed or removable retainer was planned to ensure long-term efficient results without complications or emergency interventions.
stability and maintain both functional and aesthetic outcomes.
DISCUSSION
Treatment Progress Correction of adult anterior crowding requires careful consideration
Treatment was initiated in the lower arch with digital bonding using of biomechanical control, esthetic demands, and functional impact.
an indirect bonding workflow to ensure precise placement of the Lingual orthodontic systems, particularly digitally customized
Brava appliance in the mandibular arch (Figure 9). The digitally appliances like Brava, offer independent, pre-programmed tooth
customized appliance allowed pre-programmed, controlled tooth movement, allowing precise force application tailored to each tooth’s

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