Dr. Greg Jorgensen
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Rio Rancho, NM 87124

The Jorgensen Orthodontics Blog

What Are Lingual Braces?

Posted by Dr. Jorgensen on October 29th, 2012

LingualModern patients are very concerned with their appearance during orthodontic treatment. More patients have received treatment than ever before since the introduction of Invisalign aligners in 1998 (mainly because aligners straighten the teeth without visible braces). Unfortunately, not all patients have problems that can be corrected with plastic aligners alone. Clear brackets have been around for decades, but up-close they still look like braces. Recent advances in 3D imaging and CAD/CAM technology (Suresmile) have facilitated a third option called “lingual braces.” Suresmile (discussed at length in several of my previous blog articles) is the key to modern lingual orthodontics.

The word “lingual” means tongue. Lingual braces (also known as invisible braces) are attached to the inside surfaces of the teeth that face the tongue. There they are practically invisible from the outside, even up-close. What are the advantages and disadvantages of lingual braces, and who is eligible for this treatment option?

Besides being invisible, lingual braces have other advantages. First, they are far more capable and efficient than clear aligners for complex movements like correcting rotations, changing the heights of teeth, and closing extractions spaces. Additionally, even if oral hygiene is not ideal, any discoloration that occurs (white spots) will be on the inside of the teeth where it is not visible.

As you might imagine, there are also challenges associated with having braces on the inside of the teeth. It takes a couple of weeks to get used to having braces next to your tongue. The brackets and wires will feel a little rough initially and they may affect your speech for a while. Lingual braces are also more difficult to keep clean. In fact if you have periodontal problems, inside braces may actually make things worse. Invisible braces may not be possible for patients with short crowns. Your orthodontist will determine this at your initial exam.

Lingual braces are also more challenging for your orthodontist and his staff. Many of the forces applied on the inside of the teeth react just opposite of those applied to the outside. The distances between the teeth are shorter on the inside, requiring smaller and lighter wires. This may add to the treatment time compared to conventional braces. Working upside-down and on inside of the teeth also requires more chair-time at each appointment. Finally, the CAD/CAM technology (Suresmile) and precision brackets required for lingual treatment cost your orthodontist more than those used on the outside. Trickier adjustments, longer treatment times, and higher appliance costs mean that fees for lingual braces are generally more than those for regular braces.

Before offering lingual braces to my own patients, I observed the process in the office of a friend who has been providing them for three years. I took the opportunity to interview about a dozen of his patients regarding their experiences, and I heard the same thing over and over: “It took about two weeks to get used to talking and eating. After that it was no big deal.” Most said that their co-workers made fun of them the first two weeks, asked them questions for the next two weeks, and then scheduled appointments for their own lingual braces a month later. Not one patient that I interviewed regretted their decision!

If you have a job that would not allow you to have regular braces, or if you just don’t want anyone to know that you’re undergoing treatment, consider lingual braces. 3D imaging, Suresmile diagnosis and treatment software, and robotically created wires are the keys to modern lingual orthodontics. Would you consider having braces if they were completely undetectable? Find a Suresmile orthodontist who offers lingual braces today!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

6 comments so far in response to “What Are Lingual Braces?”

  1. Nick says:

    The increase in treatment time is debatable. There are no scientific comparisons of treatment times because all cases are different. Perhaps, by treatment time you mean appointment time here? That is certainly increased.

    • Appointment time is increased due to the increased difficulty of the appliance adjustments being done. It is not a big difference, but any orthodontic tech will tell you that it takes longer to work on the inside of the arch. As for length of treatment, there are some differences in biomechanics because of the reduced interbracket distance. Depending upon what needs to be done (especially torque), it can take longer to achieve the desired result.

  2. Terry says:

    I need to re-align crooked teeth, my problem is that I have exceeded 30 and the idea of bringing a device visible metal causes me anxiety and embarrassment. A friend has the clear aligners that you talk about, and even those are seen, because “transparent” and “Invisible” are different things. There is no invisible braces that is really invisible? On the Blog Zerodonto i read about a technique called fixed lingual orthodontics without attacks (sorry for my translation). It is a valid technique?

  3. Tony says:

    I’m an adult considering either Invisalign or Incognito (the lingual brace). A significant concern is impact on my speech. As a college professor, I have to be able to speak clearly! With Invisalign I could remove the device temporarily if I had to, with Incognito, that’s not really possible. How serious and for how long might I expect any effect on speech to last with either option? Thank you.

    • I have a lot of adult patients wearing lingual braces in professions where they have to speak publicly. There is an adjustment period, but I’ve never had anyone who didn’t adapt.

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