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Pros and Cons of Lingual Braces

Lingual braces are perfect for people who do not want to show wires and supports from braces when they smile. “Lingual orthodontics is a great transition from the conventional labial orthodontics that eliminates the visibility of the fixed appliance by avoiding the orthodontic attachments on the labial surface of the teeth, to meet the esthetic demands of the patients. This lingual technique is quite challenging in terms of treatment approach as compared to labial orthodontics due to working in areas with poor accessibility, variable morphology of lingual surfaces posing difficulty in bracket positioning, different mechanical considerations with respect to the position of orthodontic attachments having different relationship with the center of resistance, patient irritability due to tongue irritation. It necessitates a lot of patience, efforts, expertise and time from the orthodontist and good cooperation from the patients in understanding the need of extended chairside time, increased expense, prolonged treatment duration as well as the distress associated, the speech and tongue soreness mainly.”1

“If a patient needs an orthodontic treatment, it should be of real benefit to him/her, by improving occlusion, dental and periodontal health, the longevity of dentition, speech, appearance, and self-esteem. Sometimes, we also have to consider patients’ requirements for an esthetic or invisible treatment that is nowadays offered by aligner technology or lingual techniques. It was in 1979 when Fujita published the first article on lingual appliance, a real progress for the orthodontic practice. Adults and teenagers liked better this innovative and attractive appliance above all for its esthetics. It was then assumed that this appliance provoked less white spot lesions or caries development than the conventional labial appliance with obvious esthetic implication for the patient, thanks to less plaque retention due to the mechanical cleaning of the tongue on the lingual surfaces of the teeth. Moreover, the fixed lingual appliance was also advisable for patients presenting some labial demineralization before starting with orthodontics. We must consider that white spots on the labial side of the teeth can occur rapidly, within the first month of therapy.”2

“The quest for invisible orthodontics with lingual appliances is not a new realm in orthodontics. Efforts have been on since the mid 1970’s to treat patients using fixed lingual orthodontic appliances. The early frenzy associated with this technique was dampened by the biomechanical challenges posed by the appliance which translated into ergonomic difficulties and taxed the skills of even the most dexterous operator. This led to widespread disgruntlement with the appliance. The key to lingual treatment is bracket base customization which clinicians tried to incorporate in the stock bracket bases using setups, laboratory devices for torque/angulation and intra-oral jigs. However, these methods were fraught with inaccuracies despite the labor-intensive procedures, resulting in unsatisfactory treatment outcomes.”3

Because lingual braces are placed on the interior side of the teeth instead of the outer wall, they are completely hidden from view but they perform the same function as regular braces.

The supports and wires for lingual braces are custom designed and placed using a 3D robotic guide that produces accurate results with the help of extremely precise cables. It’s also possible to achieve a uniform and gentle repositioning without risking the discoloration of teeth, even after removal.

Benefits of lingual braces

“The Lingual orthodontics, apart from its esthetic values, also presents several other advantages. Currently, it has become a complete system in itself, starting from an accurate diagnosis, treatment protocol, laboratory procedure to placement of the appliance in the patient’s mouth. Mechanically, conventional lingual orthodontics has always been difficult to finish in comparison to conventional buccal appliances. This is because the inter-bracket distance between lingual appliances is much smaller than on the buccal. Therefore, the finishing and detailing phase of lingual appliances has been protracted greatly. Computerization and robotic technology are changing the disadvantages of lingual appliances into positive results, better outcomes, and decreased chairtime. Because the system incorporates the final occlusion into the computerized process, it allows the orthodontist to incorporate all of the finishing details into the occlusion from the beginning.”4

Nowadays, it isn’t just teenagers that are opting for orthodontic treatment. With the inundation of ads and commercials telling us what we should watch and how to act, the world has produced a generation of highly self-conscious individuals.

“Recently, the number of adults who demand orthodontic treatment is increasing and even those with high motivation are likely to have some concern about the appearance of orthodontic appliances. The lingual orthodontic technique gave an ultimate solution for patients who do not want their appliances to be shown. However, placement of orthodontic brackets on the lingual surfaces of teeth causes changes in their morphology, which results in articulation problems, chewing difficulties, tongue irritation and other impairments. Several studies have investigated patients’ attitude and oral discomfort after lingual appliance placement. Some of them have compared lingual appliances with labial ones regarding sound production and oral discomfort, whereas another has compared different laboratory procedures and concluded that thinner appliances would enhance patients’ adaptation to lingual brackets.”5

While the reasoning behind lingual braces might seem superficial, it actually isn’t when we think about the daily things that we already do to maintain a certain image. What’s important is that lingual braces contribute to oral health.

“A pleasant esthetic look increases people’s self-confidence and provides reassurance when making personal contacts.  To be good looking is always an advantage, especially in relationship between adults. The better looking a person, the more positive the assessment by others.  The esthetic aspect has great importance and is the most frequent motive encouraging patients to undergo Orthodontic treatment. Today, the main goal is to achieve facial balance, and the development of Orthodontic treatment is the balance between esthetic treatment, functionality and patient’s aspirations.  keeping rigorously to skeletal Orthodontic treatment plan is considered an error in modern Orthodontic philosophy.  So, the esthetic aspect has great importance and is the most frequent motive encouraging patients to undergo Orthodontic treatment.  Many patients if given choice, despite of being costly would still opt for an appliance that is invisible, and at the same time which provides good quality of treatment.  Lingual Orthodontics thus represents the best solution for meeting the needs of patients without the risk of damaging biomechanical efficiency.”6

Having beautiful, aligned teeth with an adequate biting structure doesn’t only help you look nice, it helps your overall health. There are some things that we live with and can’t control, such as our height and color of our skin, but if you have crammed or crooked teeth with gaps in between or a misaligned bite structure, you can resolve it permanently with the help of an orthodontist.

“Oral hygiene professionals are constantly faced with patients under orthodontic treatment as fixed appliances cause plaque accumulation around bands and brackets. During last years the patients’ aesthetic demands are deeply rising, thus increasing the requests for invisible lingual orthodontic therapy. Lingual appliances allow the correction of tooth malocclusions through fixed brackets attached to the lingual tooth surfaces. This technique presents high aesthetic if compared with conventional vestibular orthodontic appliance. During lingual orthodontic therapy, plaque and calculus accumulation has been demonstrated to be equal to or higher than vestibular treatment. Dental hygienists therefore are and will be more and more involved in oral health maintenance of patients with these aesthetic appliances. Oral hygiene protocols for patients during orthodontic treatment include both verbal education and professional treatments with rotating brushes and ultrasonic scalers.

Ultrasonic instrumentation (UI) around orthodontic devices can lead to application of unwanted stresses around bracket bases. This is particularly true for lingual appliances that are more complex to reach with scalers.

Accidental application of unwanted forces to orthodontic appliances can cause detachment of brackets. Bond failure can influence treatment duration, total costs, and chair time, so it is undesirable both from the patients and from the clinicians.

The effect of UI has been demonstrated to induce no modifications in shear bond strength values of resin cements used for composite restorations. On the other hand, UI around orthodontic bracket bases has been demonstrated to reduce the bond strength values of conventional metallic orthodontic brackets, emphasizing the need for caution during professional oral hygiene procedures in orthodontic patients.”7

Lingual braces can completely change your self-esteem in an affordable, non-invasive and effective way, helping you achieve the smile of your dreams. Besides, it’s a great option for those who are constantly in the public eye, for example media related professionals, actors and models.

Furthermore, there are specific advantages to using lingual braces

  • They can build or recover self-esteem from an aesthetic standpoint
  • You can maintain a natural smile during the entire treatment
  • There is no age limit to use lingual braces
  • It takes the same amount of time to apply as traditional orthodontic braces

On the other side of the coin, there are also disadvantages in opting for lingual braces:

  • They are more difficult to clean
  • It can be a hindrance to flossing properly
  • Lingual braces can be a little more expensive than traditional ones
  • There is risk for the tongue to become stuck or entangled between the wires. It can also be the victim of cuts and scrapes from the supporting structures of the brace.
  • In terms of sensation, it does require a little more time getting used to. Not to mention becoming accustomed to brushing your teeth.

“Orthodontic treatment should not be commenced, or indeed continued, in the presence of inadequate oral hygiene, or when the patient has unsatisfactory dietary habits. However, decalcification remains a significant risk in labial orthodontics. Lingual orthodontics has the advantage that split mouth studies have shown that the incidence of decalcification is one-quarter of that associated with labial orthodontics, and when decalcification does occur it is one-tenth as severe as the decalcification seen in labial orthodontics. In addition, the decalcification is not of aesthetic importance, as it is on the lingual surface of the teeth. The reduced risk of decalcification is a significant advantage when treating teenagers, although, of course, the practitioner must endeavor to ensure that excellent oral hygiene and dietary habits are maintained throughout the course of orthodontic treatment.”8

“There is an increasing demand for lingual compared to labial fixed orthodontic appliances especially for adult orthodontic patients. However, up to date there is no reported comparison of forces produced by levelling wires between labial and lingual (either conventionally ligated or self-ligated) brackets. This research, to our best knowledge, is the first to report on this comparison.”9

As an aside, it is not a good idea to wear piercings on the tongue or mouth regardless of your orthodontic preference. The simple reason is that using them can cause a slight lisp when you speak. However, the gravest reason is the risk of an oral infection and an increase in the number of cavity-causing bacteria.

Like any orthodontic treatment, you may experience a few speech issues during your first few days while you get used to the wires and supports of the lingual brace in your mouth. “Brackets that are positioned against the tongue cause not only speech disturbances but also oral discomfort, difficulty in chewing, and tongue irritation. Masticatory and speech disturbances induced by lingual brackets may lead to social embarrassment that is greater than that originating from visible labial brackets. Many studies have investigated discomfort during orthodontic treatment with fixed labial appliances and with fixed lingual appliances separately, but few studies have compared patient discomfort between lingual and labial appliances simultaneously. However, the intensity and duration of oral discomfort caused by lingual appliances compared to that caused by labial appliances are not clear yet, and to date there is no published study comparing speech performance between labial and lingual fixed orthodontic treatment that employed acoustic analysis and sonography.”10

“Thorough efforts, methodological approach, and vast experience gained over the years has proved that this specialty of orthodontics has the answer to the ever-increasing cosmetic demands of the patients who insist on appliances which are not seen to the outside world and at the same time want to get their malocclusion treated. Today, the main goal is to achieve facial balance, and the development of orthodontic treatment is the balance between esthetical treatment, functionality and a patient’s aspirations. Esthetic aspirations are now universal and involve younger patients including both male and female adolescents. In this regard, invisible orthodontics, which is highly esthetic play a fundamental part in achieving dental alignment. A smile revealing esthetic harmony is very important at any age as difficult as that of adolescence. Invisible orthodontics thus represents the best solution for meeting the needs of the patients without the risk of damaging functional efficiency.”11

But in general, lingual brackets are a perfect option to maintain a beautiful smile, you just need to pay more attention to your oral hygiene.

References:

(1) Kumar, S., Sonal, S., Khanum, A., Rahman, S. N., & Bano, N. (2017). Comparative Biomechanics of Labial versus Lingual Fixed Appliances-A Review. Journal of Dental and Orofacial Research, 13(2), 56-60. Available online at https://pdfs.semanticscholar.org/f4b1/981904647ccca2fa543b79e97bbaaa881dd6.pdf

(2) Lombardo, L., Ortan, Y. Ö., Gorgun, Ö., Panza, C., Scuzzo, G., & Siciliani, G. (2013). Changes in the oral environment after placement of lingual and labial orthodontic appliances. Progress in orthodontics, 14(1), 28. Available online at https://core.ac.uk/download/pdf/81862657.pdf

(3) Dedeyan, H., & Revankar, A. V. (2013). Lingual Orthodontics simplified: Incognito-customization perfected. APOS Trends Orthod, 3, 116-20. Available online at https://www.researchgate.net/publication/273813387_Lingual_Orthodontics_simplified_Incognito_-customization_perfected

(4) Gupta, A., & Thukral, R. (2015). LINGUAL ORTHODONTICS-AN ESTHETIC CONSIDERATION. Journal of Advanced Medical and Dental Sciences Research, 3(5), S54. Available online at http://jamdsr.com/uploadfiles/14.LingualOrthodontics.20151129055109.pdf

(5) Haj-Younis, S., Khattab, T. Z., Hajeer, M. Y., & Farah, H. (2016). A comparison between two lingual orthodontic brackets in terms of speech performance and patients’ acceptance in correcting Class II, Division 1 malocclusion: a randomized controlled trial. Dental press journal of orthodontics, 21(4), 80-88. Available online at http://www.scielo.br/pdf/dpjo/v21n4/2176-9451-dpjo-21-04-00080.pdf

(6) Vasumurthy, S., & Saritha, T. (2009). Lingual orthodontics. Indian journal of dental advancements, 1(1), 31-38. Available online at https://www.researchgate.net/publication/312947821_Lingual_Orthodontics

(7) Scribante, A., Sfondrini, M. F., Collesano, V., Tovt, G., Bernardinelli, L., & Gandini, P. (2017). Dental hygiene and orthodontics: Effect of ultrasonic instrumentation on bonding efficacy of different lingual orthodontic brackets. BioMed research international, 2017. Available online at https://www.hindawi.com/journals/bmri/2017/3714651/

(8) Buckley, J. (2012). Lingual orthodontics: an illustrated review with the incognito fully customised appliance. J Ir Dent Assoc, 58(3), 149-155. Available online at https://www.lenus.ie/bitstream/handle/10147/237763/June%20JulyArt2.pdf?sequence=1&isAllowed=y

(9) Alobeid, A., El-Bialy, T., Khawatmi, S., Dirk, C., Jäger, A., & Bourauel, C. (2017). Comparison of the force levels among labial and lingual self-ligating and conventional brackets in simulated misaligned teeth. European journal of orthodontics, 39(4), 419-425. Available online at https://academic.oup.com/ejo/article/39/4/419/2953205

(10) Khattab, T. Z., Farah, H., Al-Sabbagh, R., Hajeer, M. Y., & Haj-Hamed, Y. (2012). Speech performance and oral impairments with lingual and labial orthodontic appliances in the first stage of fixed treatment: a randomized controlled trial. The Angle Orthodontist, 83(3), 519-526. Available online at https://www.angle.org/doi/pdf/10.2319/073112-619.1

(11) Hirani, S., Patel, U., & Patel, N. (2016). Invisible Orthodontics-A Review. IOSR Journal of Dental and Medical Sciences, 15(6), 7. Available online at https://pdfs.semanticscholar.org/e038/9657a84a9fff29927051ace20c009c49e56f.pdf

 

Robert Velasquez
13 October, 2018

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Hello everyone, my name is Robert Velazquez. I am a content marketer currently focused on the medical supply industry. I studied Medicine for 5 years. I have interacted with many patients and learned a lot...read more:

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