"Invisible" Braces

My daughter wants invisible braces. Can you tell me more about them?

Question:

A decade ago, "metal mouth," "tinsel teeth" and "brace face" were common schoolyard taunts directed at young orthodontic patients. These jeers illustrate how noticeable braces (also known as orthodontic appliances) were when mounted on the facial surface of teeth. The facial surface is the front of the tooth on the lip and cheek side.

When bonding gained widespread acceptance in the late 1970s, fixed attachments became smaller, less visible and more versatile. Orthodontists are now able to mount brackets on the lingual, or tongue, side of the teeth. These lingual appliances are like "invisible" braces because they are not noticeable when the patient smiles.

While lingual appliances are the most esthetic fixed appliances, they have several disadvantages. The space between each bracket is smaller when the brackets are bonded to the lingual surface. The reduced interbracket space can create difficulties controlling the three dimensional movement of teeth. In addition, the appliance is relatively inaccessible and difficult to adjust.

Patients may also find the appliances to be intrusive. Miyawaki et al., (1999) found that up to 76 percent of patients complained of tongue soreness, as well as difficulty chewing fibrous foods, pronouncing the "s" and "t" sounds and brushing after bonding of lingual appliances. While improvements have been made in lingual appliances, the difficulty, duration, and cost of treatment may make this option prohibitive. Lingual orthodontics are not useful for all orthodontic procedures.

Currently, clear fixed appliances are bonded on the facial surface. While the original clear plastic brackets had many problems, the newest ceramic brackets do not present the same concerns. For example, the original plastic brackets could discolor, but the ceramic ones do not. Also, the arch wires are relatively small. This renders them almost invisible when they are combined with ceramic brackets.

Before treatment begins, you, your daughter, and her orthodontist should carefully discuss all the pros and cons of lingual appliances versus the more conventional facial appliances.

Your daughter should not feel embarrassed or self-conscious about wearing braces. Moving teeth takes less time and is more esthetic than ever before. In fact, in most schools, braces are now considered a status symbol. Smile with confidence. The new school yard slogan is "braces are beautiful!"

References:

Kurz, "The use of lingual appliances for correction of bimaxillary protrusion (four premolar extraction)" Am. J Orthod. Dentofacial Orthop. (1997) 112(4):357-353.

Miyawaki et al., "Discomfort caused by bonded lingual orthodontic appliances in adult patients as examined by retrospective questionnaire" Am. J Orthod. Dentofacial Orthop. (1999) 115(1):83- 88.

Miyawaki et al., "Correction of mesiolinguoversion of the upper lateral incisors with lingual appliances" J. Clin. Orthod. (1997) 31(8):499-502.

Sorel, "Occlusal interference of lingual appliances: Advantages or inconvenience" Orthod. Fr. (1997) 68(1):275-279.

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