Braces or aligners: types and choice

Question 1

Is it possible to straighten the teeth in just one jaw?

Accepted Answer

Orthodontic treatment can be carried out on one jaw only, if the case allows it. In some situations it is possible to correct just the six front teeth without involving the rest. Partial treatment of the upper or lower jaw is possible if the teeth in the opposite jaw do not prevent the desired movement. Partial corrections like this are usually done in preparation for later restorations, such as veneers or bonding. In every case, a detailed orthodontic examination is needed to determine whether this kind of treatment is suitable.

Question 2

I don't think my lower teeth are noticeable. Can I have aesthetic braces on my upper teeth and metal ones on my lower teeth?

Accepted Answer

Braces can be combined – for example, metal on the lower jaw and aesthetic (tooth-coloured) on the upper, or metal on the back teeth only and aesthetic on the front teeth. It is worth bearing in mind that, although the upper teeth are more noticeable when you smile, the lower teeth can also be visible, depending on your bite. Experience shows that some patients who initially choose a combination of different types of braces later regret it, and even say they would have preferred all-metal braces. This is a matter of personal feeling, but it is worth thinking about when choosing your braces.

Question 3

Which is better – braces or aligners?

Accepted Answer

Advantages of braces: They are fixed, so the patient doesn't have to remember to put them in. They don't affect speech, unless they are lingual braces. They are suitable for correcting all types of orthodontic problems. Treatment is shorter in more complex cases. Disadvantages of braces: More discomfort at the start of treatment and irritation of the soft lining of the mouth. Eating restrictions – hard and sticky foods should be avoided. Cleaning is more difficult, requiring special care and more time. They are less aesthetic. Advantages of aligners: They can be taken out for eating and brushing your teeth. They are more comfortable, because they don't irritate the soft tissues in the mouth. They are almost invisible, which makes them more aesthetic. You can eat normally, with no restrictions on your diet. Both the teeth and the aligners themselves are easier to clean. Treatment is shorter in milder cases. Disadvantages of aligners: They require discipline – if the patient doesn't wear them for enough hours a day, the treatment won't be effective. Speech may be slightly affected during the adjustment period. They have to be taken out for eating, which can be inconvenient. Treatment may take longer in more complex cases.

Question 4

Which is quicker – braces or aligners?

Accepted Answer

There's no simple answer to this question. How long treatment takes depends on many factors: 1. The type of problem; 2. The density of the jawbone; 3. The treatment method. Additional factors: 1. A metabolic condition in the patient; 2. Pregnancy; 3. The patient's motivation and involvement in the treatment (are they wearing their elastics?); 4. The number of missed check-ups, loose brackets and lost aligners. Generally speaking, mild cases are resolved faster with aligners. The average length of treatment with braces is about 20 months.

Question 5

Which braces should I choose – metal, ceramic or sapphire?

Accepted Answer

Braces differ in the material they're made of, which gives them different physical and visual qualities. On this basis, we can distinguish between metal braces and aesthetic braces (ceramic and sapphire). Depending on how they hold the archwire, braces can be conventional (with elastic ties) or self-ligating (with a small built-in clip). Depending on which side of the tooth they're bonded to, braces are either labial, placed on the side facing the lips, or lingual, bonded on the tongue side. Metal braces are the most visible when they're on the front of the teeth, because they're grey. Metal is a smooth, polished material, which helps the archwire slide more easily through the brackets and leads to faster tooth movement. Ceramic braces are a translucent white, which makes them much less noticeable in the mouth. Their surface isn't as smooth as metal, so there's more friction on the archwire as the teeth move, which slows the process down. The same applies to sapphire braces, which are transparent and the most aesthetic option, even compared with ceramic ones. If appearance matters to you, you can choose ceramic, sapphire or lingual braces, or clear aligners. If speed of treatment is your priority, go for metal braces – conventional or self-ligating.

Question 6

Ceramic or sapphire braces – which are better?

Accepted Answer

In terms of appearance, sapphire braces are superior to ceramic ones. Sapphire is completely transparent, like glass, whereas ceramic is white. Teeth move more slowly with aesthetic braces than with metal ones, with no significant difference between the two types of aesthetic braces. As materials, both are comparably durable in the mouth and very good – in other words, they don't break easily. If both types are suitable for you, the choice between them is mainly a matter of appearance and cost.

Question 7

What is the most aesthetic treatment option?

Accepted Answer

The most aesthetic option for orthodontic treatment is a completely invisible appliance – and that's what lingual braces are. In second place for aesthetics come clear aligners. They're made of a transparent material, and the reason they're more noticeable than lingual braces is the attachments or buttons on the front surfaces of the teeth. These are tooth-coloured, but because they stand out from the surface and have a different shape, they're slightly noticeable. After aligners come sapphire braces, followed by ceramic braces. The most noticeable part of treatment with these braces is the archwire. In aesthetic treatments a white archwire (a metal wire with a white Teflon coating) is sometimes used. White archwires are whiter than the teeth, which makes them noticeable, and after a few weeks in the mouth the white coating starts to wear off from brushing and food, so the wire looks greyish-white. Aesthetic braces can be used with clear elastic ties. Within a month, the clear silicone picks up colour from food and often turns yellow. At each check-up the archwires and elastic ties are replaced, which restores the aesthetics of this type of braces.

Question 8

Which braces are suitable for a teenager?

Accepted Answer

Teenagers usually aren't bothered by the look of metal braces – in fact, they often wear them as an accessory. The different colours of elastic ties are designed to motivate children to wear these appliances. Of course, aesthetic and even lingual braces can be fitted at any age, but since teenagers' oral hygiene often isn't good enough, any reduction in the time an orthodontic appliance has to be worn matters. That's why metal braces are preferable.

Question 9

Do aesthetic braces break easily?

Accepted Answer

Sapphire and ceramic braces are made of a material that is very hard but brittle, which makes them more prone to breaking than metal braces. Aesthetic braces are bonded to the front surfaces of the teeth, which aren't exposed to much pressure during chewing, especially if the patient follows the advice to avoid hard foods. I can say that, although they are more brittle, aesthetic braces rarely break in the mouth. It's more common for them to come loose under the pressure of food, but how firmly a bracket stays on is determined mainly by the bracket adhesive. This means that metal and aesthetic braces are bonded to the tooth comparably firmly. Even so, it's fair to say that aesthetic braces come loose more easily, and the reason is their size – the bracket is larger, so it's easier for it to be pressed on and knocked off.

Question 10

Are elastics used with self-ligating braces too?

Accepted Answer

The most distinctive feature of a self-ligating bracket is that the archwire is held in the bracket by a small clip, rather than by a coloured or clear elastic tie as with the other type of braces – conventional braces. This doesn't mean that no elastics are used during treatment with self-ligating braces. One example is the elastic chain (power chain). It's a row of several small round elastic rings joined together, and when it's placed over the braces you feel a pulling force that moves the teeth towards each other. This chain is used to close gaps between the teeth. Other elastics you can expect to wear during treatment are intermaxillary elastics, which run between the upper and lower jaws. They hook onto specific brackets in the mouth, and the patient puts them in and takes them out. They can be used to correct the bite, to tighten the contacts between the teeth and to help with certain tooth movements.

Question 11

Which braces should I choose – self-ligating or conventional (with elastic ties)?

Accepted Answer

There are many studies comparing the effects of these two types of braces. Both self-ligating and conventional braces can correct any kind of dental problem that is suitable for treatment with braces. The most important condition for an excellent result is the treatment plan and how well it's carried out technically. Still, there are small differences between the two types of braces that have been demonstrated in scientific publications, rather than simply being claimed by the companies that sell them. Self-ligating braces straighten crooked teeth faster than conventional ones. This doesn't shorten treatment overall, because the later phases of treatment progress more slowly, and in the end treatment takes just as long with self-ligating braces as with conventional ones. Self-ligating braces generally produce a broader smile as the final result, as their archwires allow more expansion in the side teeth. Before you rush to choose these braces, bear in mind that this expansion comes from the side teeth tilting outwards. In the final result, the contacts between the side teeth often don't look tight. Pain is said to be less with this type of braces. This is probably true, as self-ligating braces apply lighter forces to the teeth. Conventional braces allow better control over the tilt of the side teeth, and with them we can finish the case with the upper premolars fitting snugly against the lower ones. They also come in colours, which motivates some children to wear them. In terms of price, self-ligating braces are more expensive than conventional ones.

Question 12

Can I have braces on my upper teeth only and add the lower ones later if I decide to?

Accepted Answer

If the treatment plan allows only the upper teeth to be aligned without causing problems for the appearance of the smile or the bite, then it's probably possible to start by treating only the upper teeth and to include the lower teeth later if the patient wishes. Of course, splitting treatment into two phases like this will make it longer and more expensive.

Question 13

Can removable appliances (plates) straighten teeth in adults?

Accepted Answer

Removable plates are orthodontic appliances that clip onto the teeth with small wires and have a plastic part on the inside. Their effect is mainly orthopaedic – that is, they act on the jaws, encouraging them to widen or to grow in a way that corrects a bite problem. Of course, the wire components can also move teeth, but they rely mainly on tipping them in a particular direction. So if a plate is worn by a child who needs their jaw growth stimulating and whose permanent teeth are still coming through, the plate will guide these teeth into their correct position while it corrects the bite. If a plate is fitted for an adult, all the movements of the teeth that have already come through will be tipping movements. Such movements are not stable, and the teeth immediately want to go back.

Question 14

Is there such a thing as the ‘best’ braces?

Accepted Answer

There are many different models of braces. We have already discussed that braces can be conventional or self-ligating, and that they can be made from different materials such as metal, ceramic and sapphire. It isn't the braces that carry out the treatment. The optimal result of orthodontic treatment depends on the orthodontist's abilities, skills and experience. Detailed, carefully gathered initial information about the patient, a well-constructed treatment plan and its precise technical execution are what guarantee the perfect smile. That is why you can't say there are ‘best’ braces. Different models of braces can have their advantages and disadvantages. And the best braces are the ones your orthodontist knows best.

Question 15

What does ‘partial braces’ mean for children?

Accepted Answer

In children, treatment can be carried out with appliances, braces or aligners. When we fit braces, they are usually bonded to the surface of the permanent teeth that have already come through. In the early mixed dentition stage – that is, when the child is around 8–9 years old – the permanent teeth in the mouth are the four front incisors at the top and bottom and the back teeth, the first molars. The braces system used at this age is placed on these permanent teeth and is called 2 x 4, because it covers 4 teeth at the front and 2 teeth at the back in the same jaw. The aim of braces placed this way is to straighten the front teeth, using the back teeth as anchorage, while not being bonded to the baby teeth, which will soon become loose and fall out – so the braces don't get in the way of these teeth being replaced.

Question 16

Do teeth move faster with Fast Braces?

Accepted Answer

The speed of orthodontic treatment is one of patients' main concerns. Many scientific studies have tried to determine whether any method can speed up tooth movement. Methods studied include low-level laser therapy, vibration, light therapy and even micro-incisions in the bone. Only manipulating the bone around the tooth has been found to produce any increase in the speed of tooth movement. Different types of braces can differ in design and promise different functions. The creators of the Fast Braces system claim that the shape of the bracket and the way it interacts with the archwire can speed up tooth movement. This has not yet been proven in the scientific literature, so we have to assume that this type of braces works at the same speed as classic conventional braces.

Question 17

Are removable plates (with wires) still used?

Accepted Answer

Removable orthodontic appliances (plates) are a varied group of treatment devices that generally have a plastic part and wires. They have been used to straighten teeth since the mid-19th century, and the first braces were invented around the same time. Since then, both types of orthodontic appliance have developed a great deal thanks to the discovery of new materials, but innovation in braces is still continuing in terms of design, function and materials, whereas with removable appliances it is limited. Both braces and removable plates are still used to straighten teeth. While plates are more widespread in Europe and some Asian countries, braces are used everywhere in the United States, where they originated, and throughout the world.

Question 18

Can removable plates straighten teeth so that braces aren't needed later?

Accepted Answer

Removable plates can be used from early childhood to guide the alignment of the teeth while they are still growing. If they are worn as the orthodontist prescribes, the end result should be well-aligned teeth and properly developed jaws. I wouldn't say we can expect perfect alignment of the teeth with plates. Some minor irregularities may not be resolved, but they often go unnoticed by the patient.

Question 19

Can removable plates correct the bite?

Accepted Answer

Removable plates are orthopaedic appliances. They are used to stimulate jaw growth in the desired direction – for widening, or for correcting the bite from front to back. This can only be expected in patients who are still growing.

Question 20

What are silicone myofunctional trainers used for?

Accepted Answer

A myofunctional trainer, as its name suggests, is an appliance used to train a particular function – such as tongue position at rest, swallowing and breathing. These appliances help to correct harmful habits and, if the jaws are still growing, support their proper development. If a trainer is worn by a patient who has no harmful habit, what we can expect as a result is that the teeth coming through will be guided into their correct position. A trainer on its own cannot solve the problem of a harmful habit. It can ‘show’ the tongue where its correct place is and, by keeping the mouth closed, direct air through the nose when breathing. This appliance is suitable to use while a speech therapist works on the tongue problems with exercises.

Question 21

Can myofunctional trainers straighten teeth in patients who are no longer growing?

Accepted Answer

Myofunctional trainers are made of silicone of varying hardness. They can apply pressure to teeth that have already come through, encouraging them to line up. However, the older the patient, the smaller the result we expect from the trainer – down to almost none.

Question 22

Can myofunctional trainers fix my bite?

Accepted Answer

Myofunctional trainers are silicone appliances which, when placed in the mouth, cover the upper and lower jaws at the same time and make the patient bite on the appliance in a particular way. In this way they stimulate the correct growth and development of the jaws. If the patient is at a suitable growing age and has a bite problem caused by the way the jaws have developed, the trainer encourages growth in the right direction. It is a relatively soft appliance and corrects the jaws not so much through pressure as by holding them in a better position and waiting for growth to do the rest of the work.

Question 23

Can lingual braces achieve the same result as other types of braces?

Accepted Answer

Lingual braces are bonded to the inner surface of the teeth (on the tongue side). Fitting them is difficult because visibility on the inside is reduced, and adjusting them is also harder for the orthodontist. These factors can have a negative effect on the final result. Of course, orthodontists who are experienced with lingual braces can also promise excellent results. There are different types of lingual braces – conventional, self-ligating, 2D, 3D, custom-made and off-the-shelf. As you already know, the best braces are the ones your orthodontist knows best.

Question 24

Is it normal to have braces fitted on one jaw first and on the other a few months later? Why is this done?

Accepted Answer

When you have a deep bite at the front and the upper incisors are tilted backwards, hiding a large part of the visible crown of the lower incisors, we may prefer to fit braces only on the upper jaw to begin with. The expected effect is that the upper front teeth move out of the way, and then we fit the lower braces. This movement can take a varying amount of time – from 1 month to 5–6 months. In some patients, the lower teeth aren't expected to move as much as the upper ones, so we put off fitting the lower braces to give the patient a little more comfort for longer – wearing braces only on the upper jaw is easier to get used to, to clean and to eat with. We delay fitting the lower braces so that they need to be worn for a shorter time.

Question 25

Why are linked elastics (a ‘chain’) put on braces?

Accepted Answer

Elastic ligatures can be single – each elastic goes around one bracket – or a chain made up of single elastics linked together. Chain elastics connect several brackets and are stretched when they're put on, so their job is to pull the brackets, and with them the teeth, towards each other. They are used to close gaps between any teeth in the same arch. On average, they close gaps at a rate of about 1 mm a month. If the gaps are larger, the elastic chain is replaced at every check-up for several months. As the teeth move towards each other, the end of the archwire may start to poke out behind the last bracket and injure the lining of your mouth. If this happens, you'll need to come and see us so that we can sort out the discomfort.

Question 26

What is a wire ligature for?

Accepted Answer

Wire ligatures, like elastic ones, can be single – going around one bracket – or woven around several or all of the brackets in an arch. A single wire ligature does the same job as a single elastic: it holds the archwire in the centre of the bracket. A long wire is usually tightened around several teeth to stop them from moving apart. It can be used, for example, to hold the result after we've closed gaps with an elastic chain.

Question 27

What is a spring on the archwire for?

Accepted Answer

There are two types of springs that can be placed in the mouth along with braces – opening springs and closing springs. When the spring is shorter than the distance between the two brackets its ends are attached to, it pulls those brackets, and the teeth they're on, towards each other and reduces the space between them. When the spring is cut longer than the space between two brackets – it's usually threaded onto the archwire – it pushes the teeth apart and creates space.

Question 28

My orthodontist wants to take my braces off and finish one stubborn tooth with aligners. Will the tooth move if braces couldn't manage it?

Accepted Answer

Braces and aligners are different systems for moving teeth, and each has its advantages and disadvantages. Aligners, for example, can break the desired movements down into stages more precisely, and in some cases this gives better anchorage. They also raise the bite, because their material covers the biting surfaces of the teeth as well, and they can close some stubborn gaps or move a group of teeth over a certain distance. If one of these advantages of aligners is used to overcome a limitation of braces in moving your teeth, then aligners may be able to do something that braces can't do, or can only do slowly.

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