Orthodontics

Traditional metallic braces are one of the most trusted and reliable treatment choices for a wide array of orthodontic problems. They have been used for decades and thanks to the latest advancements, they are now smaller, sleeker and more effective than ever.

In this treatment choice, teeth are aligned with the use of metallic brackets and wires. The metallic brackets, made of stainless steel or titanium, are applied to the teeth and connected with a wire that is held in place using a small elastic band on each bracket. There are many choices of sleek metallic brackets, like smaller size metallic brackets with round edges, mini metallic laser-cut brackets, metallic brackets with child-friendly shapes such as a daisy, a star, a heart, or a rugby ball. This, together with the option of multicolored elastic bands, make metallic braces stylish, fun, and the Number 1 treatment choice among teenagers. Treatment time with metallic braces varies according to the patient’s special needs, but on average it usually lasts about 1-2 years.

One of the biggest concerns with traditional braces is their noticeable appearance, which causes many patients to avoid getting the orthodontic care they need. Clear braces are revolutionary, because they offer the reliability and guaranteed results of traditional braces with none of their cosmetic drawbacks.

Clear braces shift the teeth using the same method as traditional ones : brackets are applied to the teeth, a wire is used to connect them, and it applies a gentle force that gradually brings the teeth into alignment. These brackets are made of a transparent material that is much less noticeable than traditional metallic ones: porcelain or the latest polycrystalline alumina (Clarity Advanced braces). Clarity advanced braces create a far better aesthetic result as they are completely clear and resistant to staining from coffee, mustard, red wine etc. The wires and elastics are made of clear or tooth-colored material as well. The end result is a much less noticeable treatment that easily blends with the teeth’s natural color. Apart from the superior aesthetic result, clear braces also have a very smooth surface and rounded tips, so they offer great comfort to the patient.

The drawback of clear braces, especially the ceramic ones, is that they are slightly more brittle than the metallic braces, so the patient should be careful to avoid sticky or hard foods that could damage them. Also, clear brackets and wires can sometimes be discolored if they are exposed to food or drinks with dark pigments, such as coffee or wine. This drawback is faced with the latest half ceramic-half metal Clarity Advanced braces, that are stain resistant.

This method is a totally different orthodontic approach to the traditional bracket and wire system. Instead of fixed appliances, it uses a series of custom-made removable clear plastic aligners to gradually straighten the teeth. Each set of aligners represents a unique stage of the treatment, which is progressed to the next one after the patient wears them for about 2 weeks for 22 hours a day. There are many removable aligners systems, such as Invisalign, Clear-Correct, ClearPath, eCligner, etc. The most well known system worldwide is the Invisalign system, and this is why the whole clear aligner technique is named after it.

Invisalign technique has some limitations. First of all, it is not the best choice for correcting all types of malocclusions. In comparison to conventional braces, removable systems don’t offer the dentist the same level of detailed control over creating some types of tooth movements. This is why problems like severely rotated teeth, deep overbites, skeletally based malocclusions and open bites are better treated with bracket and wire orthodontics. In general, Invisalign technique is typically thought of as best suited for treating mild to moderately complex malocclusions. However, applications for clear aligner therapy are constantly expanding, so we expect that in the near future it will be able to cover the whole spectrum of orthodontic problems .

Another limitation of the Invisalign technique is that teeth must be in excellent health before orthodontic therapy begins. Any new or replacement dental restorations placed during Invisalign treatment may alter the fit of the aligners. Because of this, any planned dental work should be placed either before or after, but not during, treatment process. This also means that children or adults with poor dental hygiene may not be good candidates for this treatment choice.

Finally, the main feature that makes Invisalign so attractive to patients is also one of its biggest weaknesses. The aligners are removable; this provides patient with comfort, easier chewing and self esteem, but requires his cooperation, and that can be a huge disadvantage. Since no progress can be made unless the patient wears the aligners 22 hours per day, treatment’s success relies merely on patient’s motivation and dependability.  That means the Invisalign system is not the best choice for any individual where there is some question about their ability or desire to comply with the orthodontist’s directions.

With this method, brackets are fixed on the inside (lingual) surfaces of the teeth and are therefore invisible. Overall, lingual braces can correct the same types of malocclusion as conventional ones. They are fabricated specifically for each patient, based on the anatomy of the lingual (inside) surfaces of his teeth and this is why they are much more expensive than stock metallic or ceramic braces.

The most obvious advantage of this technique is that braces are virtually invisible; they can hardly be seen unless someone closely watches the patient speak. Another advantage is that, by fixing braces on the lingual surfaces of the teeth,  buccal surfaces are left intact. In the end of the treatment, when braces are removed, any possible white spots (signs of decalcification under the brackets due to poor oral hygiene) will be seen on the inner surfaces of the teeth, so they will not cause an esthetic problem. But perhaps the biggest advantage of lingual braces over other invisible solutions, like Invisalign, is that they remain on the teeth and therefore are functioning the whole day. This makes orthodontic treatment faster and, because not relied on patient’s dependability, with a much higher success rate.

The advantages of this modern technique are obvious, but lingual braces do have drawbacks as well. Many patients complain about tongue irritation from the constant contact between metal and tongue. Even the smaller bracket profile developed to lessen this irritation still does not eliminate it completely. Some patients also report speech changes with lingual braces. Typically, any pain, discomfort and speech impairments dissipate 3-4 weeks after wearing the braces; however there are patients that never get fully used to them. Other disadvantage of lingual braces is that they, much more than the traditional ones, impair oral hygiene; with front-facing braces the patient can better see and clean areas that need attention. This automatically makes any individual with poor oral hygiene a bad candidate for this technique. Finally, not every orthodontist will offer the option of lingual braces, as the procedure requires additional training and certification.

To conclude, invisible orthodontics with lingual braces is in our days a very trustworthy but expensive technique, usually preferred by adult patients. The specialized orthodontist should inform the patient about the pros and cons and help him weigh his options if lingual braces are best for him.