braces? Invisalign? Traditional
metal? Golden metal? Self-ligating brackets? Viazis Brackets? What about
Lingual braces? These days, there
are many choices available to adults, and it gets confusing!
Which type of braces should you choose? Can you choose, or is
it strictly up to your dentist? These questions come up time
and again in our Metal Mouth Message Board.
type of braces you get depends on a number of factors:
extent of your treatment, such as:
severity of your bite or tooth crookedness problems
extractions are necessary
jaw surgery is necessary
headgear or other special appliances are necessary
amount of time you will need to wear braces
preferences of your dentist or orthodontist
much you are willing to pay
long you will be in braces to correct your problems
you, yourself desire. Would you feel embarrassed in metal?
Are you only willing to straighten your teeth if
Invisalign is used? Do you prefer the look of ceramic or
sapphire? Or don't you care, as long as the outcome is
section will try to answer some of your basic questions by
presenting the pros and cons of each type of braces. Please
remember, your final choice is a combination of your
preferences and your orthodontist's technical expertise!
(including Self-Ligating Braces and Viazis Braces)
brackets are made of composite materials. They are very strong
and generally do not stain. Three popular brands are Clarity and
Transcend, made by 3M Unitek; and Mystique, made by GAC. Adults like to choose ceramic
because they "blend in" with the teeth and are less
noticeable than metal. These are the type of braces actor Tom Cruise
ligatures (tiny rubber bands) that hold the arch wire on to
the ceramic brackets are often white or clear. This looks
great at first, but the ligatures can stain (see the Help!
Did I Stain My Braces?). Unless you eat a lot of curry,
smoke, or drink a lot of black coffee, this generally isn't a
problem. Note that the ligatures are changed each time you get
an adjustment -- usually, monthly. It's only the ligatures
that stain, not the brackets themselves!
The Ultradent company has come out with a tooth-colored
self-ligating bracket which is made of a polycrystalline with a high
glass fiber portion. The Opal Bracket was recently introduced
at an orthodontic convention in Germany. This bracket has a built-in
hinged door which fits over the arch wire (the blue arrows in the
photo show the direction of the swinging door). As explained below,
self-ligating braces do not need ligature elastics. These brackets are
not yet available in the United States, but they may soon be
available in parts of Western Europe. Like all new products, it
takes a while for orthodontists to learn about the product and get
trained on using it effectively. Here is a page with some
information about Opal brackets:
Ultradent Products, Inc. There is a PDF file explaining the
virtues of the Opal Bracket, but it is in German: http://www.updental.de/pdf/KFOpal_6-Seiter.pdf
They blend in with most
teeth, particularly if they are not perfectly white.
They are not very noticeable at a distance or in photos.
Some people feel that
they are more comfortable than metal and irritate your
Contrary to what you
may have heard, ceramic brackets do not usually break or
come off your teeth. They are very strong, and if bound
with a plasma light, stay on as well as metal brackets.
The clear or white
ligatures (little elastics that hold the arch wire to
the brackets) can stain, which defeats esthetics of the
ceramic braces. But those are changed at your monthly
Ceramic brackets are
are usually more expensive than traditional metal
Treatment can take a
few months longer in ceramic braces.
From a purely esthetic
point of view, they are a bit larger than metal
If you have severe
problems, your orthodontist will not use ceramic
brackets in many cases, because they may not be strong
enough to withstand the forces of some types of
brand brackets, manufactured by Ormco, are made of pure
monocrystalline sapphire and are very translucent. They are
very strong and do not stain. If your teeth are already very
white, then Inspire braces will look best on you and seem to
"disappear" on your teeth. If your teeth are less
than white, they may tend to stand out (in this case, the
Ceramic brackets would be a better choice). The pros and cons
for Sapphire brackets are the same as those for Ceramic
braces are great for people who do not have severe problems.
The "braces" consist of strong plastic trays that
are fabricated especially for you. They are indeed invisible.
If your bite is not severely off and your teeth are not
then Invisalign would be a good choice. You would be able to
get your teeth straightened without anyone seeing that you are
wearing "braces"! This appeals to many adults,
especially people who wore traditional braces as children and
then need more treatment later in life. However, if your bite
is very bad, if you need extractions or require headgear or
other appliances, then Invisalign will not work for you; you
will need to wear traditional braces.
orthodontist only has some control over your Invisalign
treatment. The treatment trays are computer-fabricated by
Align Technologies, the company that makes Invisalign. Orthodontists
and dentists that offer Invisalign receive special training from
my personal opinion, it is best to get Invisalign done by an
orthodontist, who has been specially trained in tooth
movement. One of our readers wrote a short essay on the pros
and cons of Invisalign. To read it, click here. The
Links page also has a lot of information
about Invisalign, taken from various sources.
I have heard that the success rate for Invisalign is only 50%.
No doubt, that "failed" 50% had problems beyond
Invisalign's capabilities or were treated with Invisalign
inappropriately. So, if your orthodontist says that
you are not a candidate for Invisalign, you should probably
believe it! If he or she says that Invisalign will
work for you, then great; go for it! I have known people who have
had very successful Invisalign treatment and who have been
very happy with the results. Many readers of this website are
Invisalign wearers. The official Invisalign website is at http://www.invisalign.com.
There are a
couple of other companies that do systems similar to
Red, White, and Blue System also use clear plastic
They are virtually
invisible, and nobody knows you're wearing them but you.
They are easier to
clean than traditional braces.
They don't irritate
your gums as much as traditional braces, so there is
little (if any) need for dental wax.
They do not stain at
aligners are numbered and worn for two weeks each, so
your time in treatment is well established.
You'll get a computer
simulation showing how your teeth will move during
treatment, and see the projected final outcome.
They cost as much as
traditional braces, and sometimes even more.
Treatment can take as
long as traditional braces.
In some cases, you may
still need traditional braces for a few months after
your Invisalign treatment, to correct certain problems.
You will still have
tooth pain, because your teeth will be moved by the
Invisalign trays. Invisalign is not a pain-free
The plastic trays are
computer-fabricated by Align Technologies. Your
orthodontist only has some control over your
takes 6 weeks for the aligners to arrive from the
factory -- a long time to wait. You may need more
aligners (i.e., enhancements) after the original set of
If you have severe
problems, your orthodontist will tell you that you are
not a candidate for Invisalign.
braces are placed behind your teeth, and are therefore
virtually invisible to other people. Usually, lingual brackets
are made of metal.
need special training to be able to treat patients with
lingual braces. Therefore, not every orthodontist provides
them. To find an orthodontist who provides lingual braces, ask
your dentist or search Google for the phrase lingual
braces along with the name of your state, country, or location.
obvious benefit of this type of treatment is that no
one will know that you are wearing lingual braces unless they look inside
your mouth! For more information about lingual braces, visit
Other people can't see
the brackets unless they look inside your mouth.
They tend to hurt your
tongue and make it difficult to speak at first.
They tend to be more
expensive than traditional metal, because
treatment is specialized.
Treatment can take a
few months longer than traditional braces.
Your orthodontist must
be specially trained in lingual treatment. Not every
orthodontist does lingual treatment.
If you have severe
problems, or need certain types of appliances, lingual
treatment may not be applicable.
brackets can be silver or golden. The golden brackets look a
bit more "jewelry-like" and are often a popular
choice with young women.
brackets are very strong and can withstand most types of
treatment. At first they may irritate your gums, but after a
few weeks, when your cheeks get "toughened up" they
are not a problem anymore. Most traditional metal braces
require an elastic o-shaped rubber band, called a ligature to
hold the arch wire onto the bracket. Sometimes orthodontists use
metal tie wires (little wires which are twisted around the bracket)
in place of elastic ligatures.
the "old days", metal braces were not just brackets,
but bands that wrapped around the entire tooth. Nowadays,
people wear small metal brackets that are glued to the front
of each tooth (a big improvement!) Those old-fashioned bands
are usually reserved for molars or teeth with fillings that
spill to the outside surface of a tooth. Metal brackets tend
to be less expensive than other types of brackets. In addition, you
can make them colorful with ligatures that come on a rainbow of
different type of metal bracket is called the Viazi (or Viazis) bracket,
sometimes called "FastBraces." This is a patented
technique created by Texas orthodontist Anthony D. Viazis, DDS and used successfully on
patients since about 1992. Viazis brackets are triangular and
utilize a low-force square wire. The
Viazis technique is reported to result in less pain and sensitivity,
and complete treatment faster than traditional brackets. The
patented braces system moves the crown and the root of the teeth at
the same time, from the beginning of treatment, in one stage, with
typically one square wire. Conventional braces systems typically
move the crown of the tooth with round wires during the first year
and the root of the tooth with square or rectangular wires during
the second year. For more information on Viazis brackets, and to
find orthodontists who use this method, visit the Viazis websites at http://www.fastbraces.com
younger or more adventurous set may be interested in orthodontic
metal brackets that come in interesting shapes. Orthodontist Clarke
Stevens, DDS, in Nebraska developed brackets shaped like hearts,
flowers, footballs, baseballs, and stars. He calls his product WildSmiles
Brackets. If you're interested in these brackets, your
orthodontist can order them from Dr. Stevens' WildSmiles website,
which can be found at
may have heard of "speed braces." These are
sometimes also referred to as "self-ligating brackets" or "Damon
Brackets." Self-ligating means that
the brackets do not need the little o-shaped rubber bands
(ligatures) or metal tie wires to hold the arch wire onto the
bracket. Several companies have come up with various techniques for
holding the arch wire in place without ligatures.
Brackets, developed by Washington
State orthodontist Dwight
DDS, use a 'sliding door' technique, in conjunction with the
Damon bracket low force wires. By using self-ligation
technology, the brackets allow the wire to slide back and
forth. This advancement allows for fewer adjustments and less
These type of brackets
do not need
ligatures (little rubber bands) to hold the arch wire in
place. They use a "trap door" to secure the arch
wire to the bracket. They are smaller than traditional metal
and less food gets trapped around them when you eat.
Self-ligating brackets are only used in certain circumstances,
so if you are interested in them, ask your orthodontist. The
official website for Damon Brackets is http://www.ormco.com/damon/.
of our readers wrote an essay about his experiences with speed
braces. To read it, click here.
the Ormco company came out with a new type of Damon bracket, Damon
3, which is part ceramic (clear or tooth-colored) and part
metal. They are pictured here on the right. These brackets
appear smaller on the teeth and are supposed to be more
comfortable for the patient. To find an orthodontist who provides
Damon braces, ask
your dentist or search Google for the phrase damon braces
along with the name of your state, country, or location.
new type of self-ligating bracket, called In-Ovation is made
by the GAC company. It is a twin bracket made entirely of metal, and
utilizes a special clip built-in clip. The pressure from specific
types of arch wires activates the clip and delivers specific torque
to each tooth, resulting in fast, directed results. The photo on the
left shows a side view of a round arch wire in the bracket's slot,
and the clip resting on the outside of the arch wire. As you can
see, the slot is rectangular and the arch wire is round. However;
when a rectangular arch wire is used (later in treatment), the arch
wire seats more firmly in the slot and engages more pressure from
the clip. For more information about the GAC In-Ovation bracket,
visit their website at http://www.gacinovation.com/home.html,
which has informative PDF files and multimedia presentations. The
main website for the GAC company is: http://www.gacintl.com/products.html.
3M Company also came out with a self-ligating passive bracket called
SmartClips, Unlike other self-ligating systems, SmartClips
brackets do not have a "sliding door" or separate clip.
The arch wire is held in place with a specially designed clip built
into the bracket. For more information, see this PDF file explaining
the SmartClip system: http://www.3m.com/us/healthcare/unitek/pdf/SmartClip_Brochure.pdf
Metal brackets tend to be the
least expensive of all the types of braces.
They tend to take the
least amount of time among all the types of braces.
You can choose a darker
ligature, which will not show curry, smoking, or black
do not contain rubber ligatures, so staining will never
be a problem.
They are strong and
The golden brackets are
different, novel, and generally look nice.
Brackets and self-ligating brackets can complete treatment in a shorter time with
less pain; however orthodontists need special training
in these systems, and they not available everywhere.
They are more visible
than ceramic and Invisalign (the traditional "metal
They tend to be a bit
less comfortable at first, (but that feeling wears off
after a couple of weeks).
When you have a canker
sore, they tend to irritate your gums more than ceramic