Ceramic (clear / white) dental braces -

A) What are ceramic braces?

Ceramic dental braces (including "white" or "clear braces") are a form of conventional orthodontic appliance (bonded brackets and archwire).

Their fundamental difference is simply the type of bracket that's used. With ceramic braces, they are clear or tooth-colored (white), not metal. (See picture below.)

A metal archwire is still used.

It should be pointed out that with all types of conventional braces there's a metal archwire that runs across your teeth. It's held in place in each tooth's bracket via an elastic band.

In the case of ceramic braces, a silver one is sometimes used. As a more esthetic alternative, a "frosted" or "esthetic" (white) one can be utilized instead, so it's less obvious.

Advantages and disadvantages.

As an advantage, opting for ceramic braces tends to create a more pleasing, less conspicuous look for the patient's appliances, especially from a distance.

But using this type of bracket does have some treatment and cost disadvantages. We outline them below.

A clear ceramic orthodontic bracket.

B) What are clear braces?

Clear braces are just another type of ceramic braces. In this case, the type of bracket that's used has a high level of translucency (it's very clear), as opposed to a more whitish, tooth-colored shade. In all other ways, these two types of appliances are the same thing.

(The term "clear braces" is sometimes used to refer to Invisalign® treatment. If you'd like information about that treatment option, start with this page.)

C) Which should you have placed, regular ceramic or clear braces?

Choosing the kind of bracket that's used for your case should simply depend on which type blends in with the color of your teeth the best. This may vary by brand, and is something that your orthodontist will need to demonstrate for you.

Basic guidelines for choosing ceramic vs. clear brackets.

In general:

• If your teeth are very light in color, more translucent (clear) brackets will usually create the best look (least obvious).
  
• For teeth that have a normal to dark coloration, brackets that are tooth-colored may provide the better match.

(For more information about brands of ceramic brackets and the materials they are made out of, use this link.

D) How do they look compared to other types of orthodontic appliances?

By now, you probably already have your own opinion about the look ceramic braces give. But just to help quantify things, we did find a few research papers that evaluated this issue.

A white ("porcelain") orthodontic bracket.

A white (frosted) archwire is being used.

Research

Study #1 - Feu (2012)

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Researchers set up a study that used pictures of a model wearing different types of orthodontic appliances. Test subjects were show the images and then asked to give their opinion about the "attractiveness" of the model's appearance.

• As one might expect, clear aligners (Invisalign®) without the presence of "attachments" ranked highest (with a score of 81).
• Ceramic braces (sapphire/clear brackets, clear elastics, esthetic archwire) tied for second along with clear aligner treatment involving the use of attachments (we discuss this issue on this page), with scores of 69 and 68 respectively.
• 4th place was taken by ceramic braces (sapphire brackets, clear elastics) with the use of a standard silver archwire (54).
  
• Following the pack was various versions of metal braces.

Our comments: Don't assume that wearing Invisalign® is less noticeable than ceramic braces in all cases, because it's not. If you don't understand this point, use the link above.

Study #2 - Jeremiah (2011)

This study had a design similar to the one above. It's most unique aspect was that after looking at the pictures, its 130 test subjects were asked about their perception of the model's "intellectual ability" (IA).

• IA was rated high for no appliance and clear aligner looks (with scores of 7.56 and 7.08).
• Images showing the model wearing clear braces (with tooth-colored brackets and a silver archwire) and conventional silver braces had lower IA scores (6.65 and 6.67 respectively).
  
• Gold braces ranked the highest of all methods with a score of 7.35.

Our comments: Technically speaking, wearing ceramic braces lowered the IA perception of others more than any other type of appliance. We consider that surprising.

E) Ceramic braces vs. traditional braces. / General disadvantages.

While treatment with ceramic braces is very similar to that with conventional ones, there are some differences. And while most people probably wouldn't consider any single factor we list to be all that significant, any prospective patient should at least be aware of these issues.

a) Your treatment may take longer when ceramics are used.

The orthodontic methods used with ceramic braces are essentially the same as when metal ones are used. But by nature, ceramic brackets are more fragile and for this reason some treatment modifications may be necessary.

Bracket failure.

For example, as a way of minimizing the risk of bracket breakage, an orthodontist may use lighter forces. Doing so, however, typically means that the patient's teeth will move more slowly, thus increasing the overall treatment time needed for their case.

If a bracket does fail, it will have to be reattached or replaced. And this adds inconvenience and aggravation for all involved and slows down treatment progress. However, it can be said that with each new generation of ceramic bracket, the issue of strength has become less and less of an issue.

b) Ceramic brackets may be more irritating to soft tissues.

Ceramics typically feel rougher against soft oral tissues (lips, cheeks) than metal brackets do. And while this is something that you should gradually get used to, or at least learn to tolerate, at first you may find this sharpness quite irritating.

This ceramic bracket interferes with the patient's bite.

c) Ceramics can't always be placed on bottom teeth.

The ceramic that's used to make orthodontic brackets is harder than tooth enamel. And in the case where one touches against natural teeth, it may cause (possibly significant) wear.

For this reason, after examining their patient's bite and evaluating the way their teeth overlap when they close, an orthodontist may decide that they should not offer to place ceramic brackets on the patient's lower teeth for fear of creating a situation where excessive wear will take place.

d) Ceramics tend to cost more than metal braces.

We now discuss the issue of costs for ceramic braces on this page, as well as cost-cutting measures that are sometimes chosen.

f) Ceramic brackets tend to be larger.

Orthodontic brackets must be strong enough to withstand the forces needed to create tooth movement. And since they tend to be weaker and more brittle than their metal counterparts, they usually have a slightly larger and bulkier design.

g) Ceramics still require the use of an archwire.

As mentioned above, ceramic braces still require the use of a metal archwire (a wire that runs across the front side of your teeth). And it will be visible to others.

Frosted (white) arch wires.

As a way of minimizing its shiny appearance, your orthodontist may offer to place a "frosted" or "coated" wire. (See picture above.)

There are, however, limitations and difficulties associated with the use of these types of products and your orthodontist may not be interested in working with them.

h) You'll still wear elastic bands.

The archwire that runs across your teeth will be bound to each bracket via the use of a "rubber" band.

You'll probably choose matching bands.

Most orthodontists will have a variety of colors to choose from when elastics are placed (or replaced). Patients with ceramic braces tend to choose tooth-colored or clear bands, so the overall appearance of their braces blends in with their teeth as much as possible.

Light-colored elastics tend to stain.

Light elastic bands (especially clear or white) often look great at first but then, due to exposure to foods and beverages, become stained and visually detracting. Pretty much any consumable that has a strong color has the potential to stain a patient's orthodontic bands. This includes: coffee, tea, cola, mustard, ketchup, curry, blueberries, and tobacco products.

There's no real solution for this problem other than to minimize your consumption of whatever foods you find tend to cause this problem. Of course, when your elastic bands are changed (usually every month or so) you'll get a fresh, clean start.

Details about clear and tooth-colored orthodontic brackets.

a) What are some of the brand names involved?

Here's a list of some of the companies that make ceramic orthodontic brackets. Next to each, we've listed the brand name of their product(s).

You may have heard of some of these brands, primarily through their advertising campaigns. But don't expect your dentist to be overly influenced by that.

They know that the look of many of these brackets are very similar. They also know, through experience and product reputation among dentists, that subtle differences do exist. And for this reason, an orthodontist may choose to use only one, or just a few, of the brands available.

b) What are ceramic and clear braces made out of?

Most ceramic orthodontic brackets are made out of either polycrystalline or monocrystalline alumina. The primary difference between these two materials is their optical clarity.

• Monocrystalline alumina brackets have a more translucent (clear) appearance. (This material is also sometimes referred to as monocrystalline sapphire.)
  
• Polycrystalline brackets tend to have a more whitish (tooth-colored) look.

These alumina compounds are used because they have superior physical strength and good optical and aesthetic properties. Since these ceramics are non-porous, they are also resistant to staining and absorbing odors. (Compare to plastic below.)

c) Plastic orthodontic brackets.

The first tooth-colored orthodontic brackets were made out of plastic (acrylic, polycarbonate). And related to the nature of these materials, they had a number of inherent problems.

Plastic brackets had a tendency to stain, trap odor, deform or fracture and experience bonding failure. Thanks to the introduction of modern ceramic brackets (and their superior physical characteristics), plastic brackets are no longer used.

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Full menu for topic Dental Braces -

• Types of braces/orthodontic systems.
  
  • Dental braces costs (by type). / Insurace coverage.
• Removable aligner systems - (Invisalign®, ClearCorrect®, Simpli 5®)
  
  • Standard Invisalign® -
    
    • Getting started - Initial consultation, records, ClinCheck® animation.
    • How the aligners move your teeth.
    • Treatment details - Time frames. Specifics about wearing your aligners.
    • Buttons & attachments, teeth stripping, orthodontic techniques.
    • Disadvantages / Case selection.
  • Wearing Invisalign® -
    
    • How invisible is Invisalign®?
    • Drinking, Eating, Talking, Pain
    • Cleaning your aligners.
  • Similar products -
    
    • Invisalign® Express & Teen.
    • Simpli 5, Red White and Blue.
• Lingual braces systems - (Incognito®, iBraces®, In-Ovation® L, Harmony®)
• Conventional braces. - (Bracket and wire appliances.)
  
  • Personalizing metal braces.
  • Gold dental braces.
  • Ceramic dental braces. - (Tooth-colored brackets.)
• Orthodontic retainers. - (Permanent / Removable: Hawley, Essix, Vivera®)
  
  • Wearing & Cleaning retainers.
  • Orthodontic retainer costs.