Ceramic (clear / white / esthetic) dental braces -

A) What are ceramic braces?

Ceramic dental braces (also sometimes called white, esthetic or clear braces) are a form of conventional orthodontic appliance made up of brackets bonded to your individual teeth and an archwire that runs across them.

Their fundamental difference simply lies in the fact that the bracket used is made out of a ceramic compound instead of metal, which means that they can be clear or tooth-colored (white) instead of shiny metal.

This difference helps to make the patient's braces less obvious to others and generally more esthetic in nature. For the most part (see discussion below), ceramic braces can be used for most patients' treatment if they so desire. (Waring 2013) [page references]

Note: A metal archwire and elastic bands are still needed.

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

In the case of ceramic braces:

• Silver archwires are frequently used.
  

  As a more esthetic, less-obvious alternative, "frosted" or "esthetic" (white) wires may be placed instead.

• At the patient's discretion, the color of the elastic bands used can be white or clear so their presence is less obvious too.

Advantages and disadvantages.

As their primary advantage, opting for ceramic brackets gives a more pleasing, less conspicuous look to the patient's appliances, especially from a distance.

But using this type of bracket does have some treatment and cost disadvantages. We explain 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 (least obvious) look.
  
• 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)

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. But it had a unique twist in that after looking at the model's pictures, its 130 test subjects were asked about their perception of the person's "intellectual ability" (IA).

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

Our comments: The study found that wearing ceramic braces lowered the IA perception of others more than any other type of appliance. We find 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 won't consider any single factor we list below to be all that significant, every prospective patient should at least be aware of these issues.

a) Bracket strength concerns.

The tensile strength (resistance to breaking when stretched) of the ceramic compounds used to make orthodontic brackets is greater than stainless steel (the material used to make metal brackets). This strength, however, also causes them to be brittle. (Waring 2013)

That can lead to a higher incidence of bracket breakage during a patient's treatment, and the associated inconveniences that that involves.

b) 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 worn. But since they are more brittle/fragile in nature, some treatment modifications may be necessary.

Bracket failure.

For example, as a way of minimizing the risk of bracket breakage, an orthodontist will typically use lighter treatment 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 the patient's treatment progress.

It can be said, however, that with each new generation of ceramic bracket the issue of brittleness tends to become less and less.

Bracket friction.

Microscopically the surface texture of ceramic brackets is rougher than stainless steel, thus creating a higher coefficient of friction between the bracket and the archwire that runs through it. The net result is one where the freedom of movement of the components of the patient's appliance is hindered, thus impeding tooth movement.

• Not all cases involve large sliding movements. And for those that don't, this isn't much of an issue.
  

  (Cases where teeth have been extracted typically require sliding movements to shift the teeth into this available space. Non-extraction cases may not require much of this type of long-distance movement.)

• Some ceramic bracket designs help to minimize the amount of friction that exists. One solution is heat polishing the ceramic.
  

  Some bracket designs reduce friction by featuring wire-to-metal contact (self-ligating brackets or else brackets that have a metal slot). The esthetic nature of these types of brackets is however compromised slightly by the presence of their metal parts.

(Waring 2013)

c) 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.

d) 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 wear, possibly significantly so.

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.

A possible solution for this conflict is for the dentist to "open" the patient's bite by way of placing a thickness of filling material on their back teeth which keeps their front teeth from hitting the brackets when they close. (Waring 2013)

e) 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 more brittle/fragile than their metal counterparts, ceramic brackets tend to 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 (the wire that runs across the front side of your teeth through each of your brackets). And it will be visible to others.

Frosted (white) archwires.

As a way of minimizing the shiny look of your archwire, your orthodontist may offer to place a "frosted" or "coated" one. (See picture above.)

There are however limitations and difficulties associated with the use of this alternative and your orthodontist may not be interested in dealing with them. Also, in those cases where this option is offered, there may still be stages where the use of a silver wire is needed (Waring 2013).

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 bands that match your braces.

Most orthodontists will have a variety of colors for their patients to choose from when their elastic bands are placed (or replaced). Patients with ceramic braces tend to choose tooth-colored or clear bands, so to match or blend in with the overall look of their braces.

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 staining. Of course, when your elastic bands are changed (usually every month or so) you'll get a fresh, clean start.

i) Ceramic braces can make it harder to monitor oral home care.

Dental plaque accumulation around the base of tooth-colored or clear ceramic orthodontic brackets can be difficult to detect. And in cases where it is allowed to persist on tooth surfaces, the complication of dental white-spot lesions may develop.

If this problem is anticipated (like with a child or teenager who is expected to be an ineffective brusher), the color contrast created by placing conventional metal brackets may make monitoring plaque accumulation easier, and therefore the wiser choice.

Details about clear and tooth-colored orthodontic brackets.

Ceramic brackets were first made available to orthodontists in 1987. (Transcend brand brackets made by 3M Unitek.)

The National Aeronautics and Space Administration's (NASA) publication Spinoff states that it was a NASA-sponsored center at the University of Southern California that helped to match a ceramic useful in tracking heat-seeking missiles (translucent polycrystalline alumina) with this dental application, thus resulting in the first esthetic orthodontic brackets. (NASA 2002)

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 (aluminum oxide, Al2O3). 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 the absorption of odors. (Compare to plastic below.)

c) Plastic orthodontic brackets.

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

The brackets tended to stain, absorb odor, deform, fracture and/or debond (come off). Thanks to the development of modern ceramic materials, with their superior physical characteristics, plastic brackets are no longer used.

Written by: Animated-Teeth Dental Staff

Content reference sources.

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• Conventional braces. - (Bracket and wire appliances.)
  
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