Practice of lingual orthodontics among specialist orthodontists in France: a national survey study

OBJECTIVE: To characterize current lingual orthodontic (LO) practice among orthodontists in France, assess how the emergence of clear aligner (CA) therapy has influenced its clinical use and document clinicians' perspectives on the future of LO. METHODS: A survey using a 39-item questionnaire was administered via the SurveyMonkey® platform. The survey was distributed through the French Syndicate of Specialists in Orthodontics (SFSO), the Syndicate of Orthodontists of France (Les ODF), and a professional Facebook group, reaching an estimated 2971 orthodontists. Responses were collected anonymously. Data were analyzed using Python v3.12.7 with univariate and bivariate statistics; associations were assessed using χ2 and Spearman correlation tests, with significance set at α = 0.05. RESULTS: Of 201 respondents, 59.7% (n = 120) reported active practice of LO. The most frequently used systems were WIN® (43.9%) and Incognito® (36.7%). A majority of practitioners treated 1-10 lingual cases annually, whereas aligner therapy was reported more frequently, with 28.3% indicating 21-50 aligner cases per year. Nearly half (48.4%, n = 46 of 95 respondents) reported offering lingual treatment less often since the rise in aligner use, and 76.8% (n = 73 of 95 respondents) perceived a decrease in patient demand for lingual appliances. Major reported barriers to lingual practice included prolonged chairside time (28.5%), limited clinician training (23.5%), and low patient demand (22.3%). Despite these challenges, 92.3% of respondents reported satisfaction with their clinical outcomes. Following the discontinuation of the Incognito® system, 28.6% of users planned to discontinue LO, and 80% expressed intent to transition to aligner therapy. CONCLUSIONS: Although a majority of the respondents report experience with LO, it represents a minority of their annual caseload. The increasing use of CAs appears to have influenced reported practice patterns. However, these findings reflect practitioner-reported behaviors and perceptions rather than clinical indications or appropriateness. LO is still perceived by clinicians as offering advantages in predictability, efficacy, and esthetic discretion, suggesting it may continue to play a role for select patients in contemporary orthodontic practice.