The Ultimate Guide to Lingual Braces

In recent years, the use of lingual appliances has grown among orthodontists. Along with other advances in orthodontic treatment modalities, customized lingual systems are entering the market and gaining popularity, while traditional systems continue to adapt to digital platforms.

Lingual braces are an excellent option for patients who are focused on an aesthetic orthodontic treatment option, and want to avoid the challenges associated with clear aligners. Unlike traditional braces, lingual braces are hidden from view. They are also extremely effective at correcting the alignment of teeth and the bite.

What are Lingual Braces?

Lingual means “on the side facing the tongue.” So, lingual braces are just like traditional ones, except that the brackets and archwire are placed on the back of the teeth, where they are out of sight.

Because they are not visible, lingual braces are a great choice for teens and adults. Another advantage is that lingual braces can be more efficient in achieving certain movements as compared to labial (conventional) braces, as well as clear aligners. An example of this is opening a deep overbite.

Lingual Braces

Currently, there are two options for lingual braces: stock or customized brackets. Stock braces can be placed on models of the teeth by a lab, either commercial or in-clinic, and will then be transferred into the patient’s mouth.

Customized lingual brackets are fabricated digitally based on the treatment simulation. These brackets are built based on the shape and form of each individual. The most common system in the market is Incognito.

Each lingual system has its own biomechanical advantages and disadvantages for correcting teeth. You can learn more about the state of lingual appliance in a recent publication by Dr. Rooz in the Seminars in Orthodontics: lingual orthodontics special issue.

Advantages of Lingual Braces

Image

Lingual appliances are placed behind the teeth, so they are truly invisible. Patients in a professional or educational setting don’t have to worry about distracting look of conventional braces. Clear aligners provide a partially invisible option to patients yet attachments (tiny anchors) on front teeth can be noticeable.

Like labial (conventional) orthodontic systems, lingual braces are fixed. The brackets are cemented to the back of the teeth and the archwires are adjusted when the movement of the teeth is needed. There is no need to worry about removing, cleaning, or storing of your orthodontic appliances such as clear aligners like Invisalign, so there is no risk of losing them. Lingual braces require less maintenance than clear aligners, so they are well suited for those with a busy lifestyle.

Compared to clear aligner therapy, lingual braces are significantly more efficient at certain tooth movements. The position of these fixed appliances behind the teeth allows them to move teeth quickly and efficiently. The continuous light forces by these appliances is unique to alternative esthetic options namely clear aligners.

Disadvantages of Lingual Braces

Are lingual braces painful?

As we mentioned before, the lingual system is vastly different from other orthodontic appliances because the brackets and wires are placed behind the teeth rather than on them. It may take time getting used to having the appliance pressed against the inside of the mouth and tongue. Most patients become adjusted to the feeling in 2 weeks. We will walk you through this phase.

Do lingual braces work for everyone?

A major concern with lingual braces is oral hygiene. Like all braces, the brackets and archwires can interfere with a patient’s ability to clean or brush because it’s difficult to reach the gumline when the wires are in the way. Advances in technology provides us with options that help to overcome this issue. For example, the waterpik has been a game changer for all of our lingual patients.

Do lingual braces cost more?

Lingual braces are a significant investment. Since they require complex wire patterns and a very technical skill set, appointments to adjust the wires take longer. All of these reasons contribute to a higher cost of treatment than traditional orthodontic procedures, but many patients find lingual braces are well worth the investment when considering all the factors.

Do all orthodontists do lingual braces?

Because lingual braces are less common than other orthodontic options, there is a very limited number of orthodontists who provide them. At Porth, our orthodontist and clinical assistants have worked with lingual orthodontics extensively, so patients have the option to choose custom lingual orthodontics with expertise supporting their treatment.

Lingual Braces compared to other treatment options

Do lingual braces hurt more than regular braces?
Are lingual braces good?
Do lingual braces take longer?

If you are interested in pursuing orthodontic treatment, there are many options to consider. The lingual system is a unique option.

Lingual Braces vs Clear Aligners: Are lingual braces better than Invisalign?

In terms of appearance, the lingual system is most similar to clear aligners. They are both undetectable, but they use very different mechanisms to move the teeth. Clear aligners offer patients the freedom and convenience to remove their orthodontic appliance at will, so brushing is easier.

With lingual braces, however, there is no risk of losing your appliance because it is secured in place. Lingual braces are in place 24/7, allowing the system to correct teeth at all times. The effectiveness of clear aligners (e.g., Invisalign), on the other hand, can be hindered if the trays are left out of the mouth too long, so patients have to be extremely responsible and conscientious of their orthodontic appliance at all times.

With the use of clear aligners, attachments (tiny bumps) on front teeth are visible. Also, aligners are visible if one pays close attention. Lingual braces are the only truly invisible option in orthodontics.

Lingual Braces vs Traditional Braces: Are lingual braces effective?

Compared to traditional braces, lingual appliances offer a similar or sometimes better treatment outcome. They both offer the advantage of effectively moving teeth at all times with minimal work from the patient.

Having braces, either behind or outside the teeth, requires a few weeks of adjustment to the brackets and wires in your mouth. This comes with a degree of pain during the first few weeks of your treatment. Collectively, it may result in major discomfort. Independent of the appliance we use to straighten your teeth (clear aligners or fixed appliances) the first few weeks can be challenging, as the teeth and jaw are tender and your mouth is adjusting to a foreign body.

Lingual Braces vs self-ligating braces (like Damon braces): Are lingual braces fast?

Self-ligating braces is an add on feature to a basic orthodontic appliance. Both outside and inside brackets can have the self-ligation feature. The majority of lingual systems are self-ligated. Despite lots of claims about self-ligation systems, including Damon braces, none of these claims has been proven in scientific studies. At Porth, we use a self-ligating brackets because not a lot of lingual brackets are available in the market.

Am I a good candidate for Lingual Braces?

Here are three major factors you should take into consideration if you are considering lingual braces:

Bite:

Orthodontic treatment should provide long-lasting, stable results and an even bite. Lots of options are out there to straighten your teeth, including at-home orthodontics treatment. A thorough evaluation of your teeth and jaw bones, along with a comprehensive treatment plan, should be used to fix your teeth and bite in order to result in a life-long outcome. Finding a less expensive treatment, with no visits to the clinic, is a very risky choice.

Achieving an ideal bite with straight teeth is what we offer at Porth. Straightening teeth often results in major changes in your bite. Teeth should be moved with a plan to obtain an ideal bite.

Linguals braces are very unique because where and how they are positioned will affect the orthodontic process. There are both advantages and disadvantages to getting lingual braces. Your orthodontist can let you know if you are a good candidate for lingual braces by a comprehensive exam, taking records including x-rays, and an visual examination of your teeth and bone structure.

Two questions that we like our patients to think about when picking their appliance of choice are:

(i) how important is the esthetic option for them?

(ii) can they really wear clear aligners around 20 hours per day?

Investment:

Lingual braces require a higher investment than traditional braces because they require a high level of technical skill to adjust brackets and wires behind the teeth. It may also take the orthodontist longer to tighten lingual braces at each appointment because of their location in the mouth.

Comfort/User preference:

Lingual braces take a while to get used to, especially if you have a sensitive mouth or teeth. Some people find them more comfortable than traditional braces or aligners because they feel more at ease knowing the brackets are hidden. Others prefer lingual braces because they are invisible, similar to clear aligners, but they don’t require the cleaning and maintenance of clear aligner trays. It really depends on your personal preferences.

Types of lingual braces

Like other orthodontic appliances, digital orthodontics allows for the introduction of new lingual systems, as well as further optimizing the existing lingual braces.

Here is a list of the most common types of lingual braces in the United States:

Incognito is a customizable lingual appliance. Both archwires and brackets are designed and fabricated based on each patient. The time required to fabricate this appliance and the issues associated with rebonding broken brackets are a few major challenges with this system.

Suresmile is a smart, fully digital system that allows orthodontists to plan the treatment digitally. The orthodontist then uses robotically bent wires to move the teeth to their ideal positions.

Aalias system is a straight lingual wire system. The main premise of this system is that the lingual wires have minimal to no bends, hence the appointments may be shorter. Despite the advantages of this system, the logistics of using this system in US remains a work in progress.

The future of lingual orthodontics

INBRACE is an appliance recently introduced to the market that uses customized, multi-looped archwires to induce tooth movement. This system utilizes a self-ligating mechanism to engage the wire with brackets. Similarly Mechanodontics is one of the newest lingual systems that uses a bar and smart arms to independently move each tooth. Both of these new appliances are promising, however they need further study and development. Read Dr. Rooz’s recent publication on what future holds in lingual orthodontics.

With the recent innovations in orthodontic technology, lingual orthodontics have become a more popular orthodontic system. Both orthodontists’ and patients’ attitudes toward lingual appliances have changed as they become more manageable with new technology. Contrary to what many believe, lingual orthodontics is here to stay!

Lingual braces story

Would you like to consult with Dr. Rooz about lingual braces?

your choices

Book a free consultation at our clinic.

Book a Free Consultation
or or

At Porth, we are proud to offer a free, no-obligation Virtual Consult to help you plan your orthodontic care, from the convenience of your home — or anywhere! Your Virtual Consult takes less than 5 minutes to complete, and you’ll get personal feedback from Dr. Rooz about what your options are.