Lingual dental braces

- What are they? / Advantages & Disadvantages / Who can have them? / Problems with wearing. / Incognito®, iBraces®, In-Ovation® L, Harmony®

Lingual dental braces.

A lingual orthodontic appliance.

Lingual braces are one of the "invisible" treatment methods that your orthodontist may have to offer.

For the most part, they look like conventional dental braces that have been mounted on the backside (lingual, tongue side) of of your teeth. This hides them from view, making them unnoticeable to others.

Brand names.

Some of the brands associated with this technique are: Incognito® and iBraces® (by 3M), In-Ovation® L (by Dentsply), and Harmony® (by American Orthodontics).

We've broken this topic into the following sections:


Lingual dental braces -

A comparison of lingual and conventional dental braces.

"Inside" vs. "Outside" dental braces.

What are they?

Lingual braces are a treatment method where the appliance (brackets, wires and elastics) used to rearrange your teeth is mounted on their backside (tongue side).

Due to this positioning, they're sometimes called "inside" braces. In comparison, conventional "outside" braces are placed on the side of your teeth that shows.

While the location of the appliance used is reversed, both conventional and lingual technique share many similarities in terms of the type of hardware and orthodontic principles involved.

Advantages

The chief advantage of having lingual treatment lies in the fact that your braces are non visible.

If someone carefully looks into your mouth they may catch a glimpse of your appliance (especially if you're wearing them on your lower teeth). But otherwise they're not easily detected.

If you feel that wearing conventional braces would simply be too embarrassing, this is one of the "invisible" orthodontic methods (see box below) that you might consider.

Disadvantages

As disadvantages for this technique:

  • The biggest issue is that lingual braces can be difficult to get used to and wear. (We discuss this matter at length below.)
  • And, in general, each periodic office appointment you have during your treatment process takes longer than it would with conventional braces.

However, with continued advancements in the design of lingual systems these points have become less and less of an issue.


Who can have lingual treatment?

Lingual brackets may interfere with the patient's bite.

Bite interference.

The best (and really only) way to find out if lingual braces can be used in your situation is to have a consultation appointment with an orthodontist. For the most part, however, most adults and adolescents will usually make suitable candidates.

Some practitioners may express issues of concern about some aspects of patient selection. However, a lot of this probably just boils down to clinical bias and preference.

a) "Bite" considerations.

It's been argued that a patient must have a bite relationship that can accommodate their braces.

The idea is that people whose teeth overlap excessively (have a "deep vertical overbite") might place heavy forces on their brackets when they chew or close their teeth together and dislodge them. It's debatable about how much of a problem this really tends to be.

b) Quality of results.

Despite insinuations voiced decades ago, there's nothing inherently lacking about lingual technique. Results on par with conventional braces can be expected.

The application of sophisticated CAD/CAM and robotic wire-bending technology to this technique (as detailed below) have only made its results more predictable.


How difficult is it to get used to wearing lingual dental braces?

What type of problems or difficulties can you expect?

As a general rule, it's more difficult and takes longer to get used to wearing lingual braces than it does conventional ones. Here are some of the common problems that people encounter.

a) Difficulties with speech.

You can expect, at least initially, that your braces will make it difficult for you to speak in your usual fashion. For most patients, speech difficulty is the most severe problem they encounter. (Caniklioglu 2005) [Reference sources.]

You may notice a new lisp or whistling sound when you speak. That's because your tongue needs to make contact with the backside of your upper front teeth when it makes certain sounds.

Since that's the same place your braces have been placed, it will take a while for your tongue to find another location it can use that produces similar results.

b) Tongue soreness.

Your lingual braces will certainly be a curiosity to your tongue, in the sense that it won't be able to stay away from them. And of course as it functions, it will want to occupy some of the exact same locations that your braces already do.

As a result, and especially for the first few weeks of wearing your new braces, you can expect that your tongue may be sore, even persistently so. You may notice some redness, or even the formation of an outright sore.

c) Eating

Having lingual braces will make eating more difficult. Some foods will tend to get trapped in them. Others might even damage them.

d) Cleaning your teeth.

Wearing lingual braces will make it more difficult for you to brush and floss your teeth. Even so, your goal should still be to clean them and your braces after every meal and snack.

Statistically speaking, how much difficulty can you expect?

  • An article written in 2011 (Slater 2011) mentions a 1997 survey that determined that 82% of patients wearing lingual braces felt that their speech had returned to normal within 1 month.

    However, the author of the survey suggested that for the remaining 18%, there likely was no solution for their problem.

  • Another study (Caniklioglu 2005) found that 23% of study subjects were still having difficulties with speech after 3 months.
  • A second study cited in the Slater article concluded that 90% of subjects wearing lingual braces suffered with discomfort (with 1/2 reporting it as a high level of discomfort). In comparison, only 27% of subjects wearing traditional braces reported discomfort (generally ranging from low to medium in intensity).

Design advancements.

The manufacturers of lingual hardware are continually making design improvements.

  • One general trend is smaller brackets. Today's low-profile brackets are 1.5mm thick whereas older-style ones may be as much as 3.5mm (a little more than 1/8th of an inch).
  • Another trend is to make bracket contours more rounded and smoother.

Together, these advancements have help to make the issues of tongue irritation and speech difficulty less troublesome.

Some of the newest lingual brackets are self-ligating (the bracket itself traps and holds the archwire instead of being bound in place with elastic bands). This feature helps to make appointments simpler and quicker.


How are lingual braces made and placed?

Today's systems are very sophisticated.

The fabrication and placement process used with the newest lingual systems (like Incognito®) is very different than that used with conventional "front side" dental braces.

  • The metal components (brackets and wires) of lingual systems are all custom fabricated for each individual patient using CAD/CAM and robotic wire bending technology.
  • When a patient's (upper or lower) brackets are attached to their teeth, they're all cemented into place at the same time.

In comparison, getting conventional braces usually involves the use of stock parts and individual bracket placement.

The steps of getting lingual dental braces.

A detailed, high-accuracy dental impression.

The first step involves taking dental impressions.

A) Taking impressions of your teeth.

As a first step, your orthodontist will take a set of very accurate and detailed impressions of your upper and lower teeth.

These impressions are then sent to the dental laboratory that will make your hardware (brackets and wires), along with a prescription outlining the desired final alignment outcome of your case.

B) Fabricating your braces.

Once received, the orthodontic laboratory will make casts from the impressions that your dentist has sent.

A technician will then, per your orthodontist's instructions, create a "setup" of your case by modifying these casts. (A "setup" is a mockup of your teeth arranged in perfect alignment.)

Designing a lingual orthodontic bracket by computer.

Custom brackets are computer designed for each tooth.

Creating your hardware.

Once completed, the setup is scanned into a computer.

This digitized information is then used to design and make your customized orthodontic brackets (CAD/CAM technology). Robotic wire bending is used to create the series of arch wires that will be needed for your case.

The applicator tray.

Once fabricated, your brackets are imbedded into an applicator tray. This custom-made stent will fit over your teeth and hold your brackets in precise alignment during the procedure used to bond them in place.

At this point all of the your orthodontic hardware is returned to your dentist's office. The turn-around time needed for the fabrication process is usually several weeks.

C) Attaching your braces to your teeth.

An appointment will be made where you return to your orthodontist's office so your lingual braces can be attached to your teeth. This is usually about four weeks after your impressions were initially taken.

Placing your brackets.

The cementation process is relatively straightforward. All of your brackets for each arch (either upper or lower) are bonded simultaneously.

  • To start, your orthodontist will prepare the surface of your teeth so the bonding will adhere to them properly.
  • They'll then apply cement (the bonding) to each of the brackets and then press the applicator tray that holds them into place over your teeth.
  • The idea is that the applicator tray ensures that each individual bracket remains in precise alignment until its cement has cured.
A lingual orthodontic appliance.

Once the cement has set, your orthodontist will break away the applicator tray. Your brackets will remain in place on your teeth. Any excess bonding will be scraped off or trimmed away.

Now that your brackets have been secured, the first of the pre-bent arch wires that the laboratory has prepared can be installed. Your active treatment has now begun.


Why don't all orthodontist place lingual braces?

Not all orthodontists have an interest in providing treatment using lingual dental braces. (At least here in the USA. In other parts of the world, the use of this treatment approach is much more common.)

Here's why:

a) Providing treatment is more involved.

As a technique, preforming lingual treatment creates some difficulties for the orthodontist that they would otherwise not have.

  • The patient's orthodontic brackets are attached to the backside of their teeth where visibility and access is more difficult.
  • The archwire that runs through each bracket doesn't have a smooth continuous curve like that used with front-side braces. Instead it requires more complex bends.

The introduction of modern lingual systems (as described above) have simplified the way treatment is performed.

b) Competing "invisible" methods.

Other, easier to provide, minimally-obvious orthodontic systems are available. This includes clear and tooth-colored ceramic brackets and clear, removable aligner systems like Invisalign® (see above).

c) Additional training is needed.

Companies that make some of the more sophisticated lingual braces systems require that the treating orthodontist must take specialized training from them. And while there is a learning curve to providing this type of service, don't be too impressed by this requirement.

The time involved in completing this education is sometimes as little as a day (lingual braces are a variation on the theme of traditional braces, not a reinvention of the wheel). However, for those dentists who are interested, certainly more advanced courses are available.


What's the fee for lingual braces?

The only issue we haven't discussed on this page is lingual braces costs. Use this link for fee estimates for this procedure, ways to minimize your overall expenses, and a comparison to costs using other orthodontic methods.

 

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