Orthodontic Patient

Three Aesthically Pleasing Orthodontic Approaches To Straightening Crooked Teeth

By Barry Rouch, DDS, MS

Today consumers have many options to straighten teeth, and marketers are going straight to them with their advertising. So, it is natural that I get questions from prospective patients in my initial consultations with them. I appreciate savvy patients who come into our office having done a little homework and with some good questions about various treatment methods and what might be the best choice to achieve their desired smile and treatment goals. One of the more frequent questions I get from patients who do not want visible metal braces is, “Can you straighten my teeth without braces?”

Before I answer any questions, I like to make a clinical assessment and determine: 1) what type and severity of malocclusion or other issue needs to be addressed and 2) what are the patient’s treatment goals and expectations?

Just like when realtors say it is all about location, location, location, I say it is all about diagnosis, diagnosis, diagnosis. Not every orthodontic issue is best served by the same treatment modality. And not all modalities create the same type of finished smiles. Plus, when you factor in a patient’s aesthetic, lifestyle or other requests, this information might change the recommended approach. Some patients want teeth straightening products that are as invisible as possible. Others want to quickly fix their smile because they have a major life event and want to look their best by that date.

The good news is that technological advances have led to new appliances that offer both effectiveness and efficiency in treating misaligned teeth and are much easier on the eye than traditional metal braces. These modalities, suitable for both adults and teenagers, include:

  • Clear aligners
  • Clear ceramic braces
  • Lingual braces

In a world that places high ideals on physical looks, let alone one where we are consumed with social media and taking selfies, most patients are concerned about how they will look while in braces. This is as true for adults and college-age patients who may be concerned about getting braces later in life as it is for teens who are self-conscious of their looks. So, let us take a quick look at three options that do not have to take a hit on your self-esteem.

Clear Aligners

By now, almost everybody has heard about clear aligner therapy. Although considered a newer treatment method, aligners have been around for more than 20 years. For those of you who do not know what aligners are, they are nearly invisible custom-manufactured, clear plastic removable trays. My patients like aligner therapy because it provides a discreet option for those who do not want the look of traditional braces. Patients wear them day and night to move teeth incrementally and consistently with gentle force to a desired location. They can be removed to eat and drink, and because they can be removed, oral hygiene (brushing and flossing) is much easier than with traditional braces. And although aligners can be very effective for most patients, depending upon case needs and what the patient wants from his or her finished smile, it may not be the best treatment modality for very severe cases.

The original aligner brand is Invisalign®. Since the introduction of the first aligners, many other companies have gotten into the market, many of them marketing products at a cheaper price directly to consumers and cutting out the role of a doctor. I obviously am concerned about this, as I find myself re-treating patients who did not get what they thought they were getting from mail-order or do-it-yourself aligners. It is important to have a doctor involved in every step of treatment to ensure progress is going as planned and to address any problems along the treatment journey. Could you imagine setting your own cast to heal a broken bone, such as your wrist, without the help of a doctor? Moving teeth (with their root structures) and jaws can be serious business.

A new aligner brand that my patients have enjoyed, in terms of beautiful outcomes and some very nice differences, is called Spark™. It has been around a few years and offers several distinct advantages. It is made from the clearest material available, so Spark provides a near-invisible look. And the material is softer and comes with polished edges, so it is a more comfortable option for my patients. Treatment time varies widely from 10-20 months, on average.

Clear Ceramic Braces

Clear braces can treat a wide variety of teeth alignment problems, including severe malocclusion, and are a more discreet way to straighten teeth than traditional metal braces. But clear braces should not be confused with removable, clear plastic aligners. Clear braces are permanent braces affixed to the teeth. Because the brackets are made of ceramic, they are much less visible than metal braces, especially from a distance. Fixed ceramic (instead of metal) brackets are bonded to each tooth and connected with a wire that we call an archwire. Sometimes the wire is also tooth-colored so the entire appliance blends in with the patient’s teeth. Most clear brace systems use small elastic ties or ligatures to hold the arch wire in place. These ties are usually clear or gray and blend in nicely with the brackets. Patients with this type of treatment modality usually see their orthodontist for a checkup about every 6-8 weeks to ensure treatment is progressing as planned and get regular adjustments to the wire to keep teeth moving to their desired locations. Treatment time depends upon the severity of the correction needed but is usually around 18-24 months.

My patients find Damon™ Clear braces offer a very nice aesthetic option while being a much more comfortable treatment method to traditional braces. This is because the Damon System uses “self-ligating” technology to move teeth gradually under more gentle, consistent pressure, rather than being tightened in stages as with traditional braces. This technology utilizes a small door on the bracket to hold the archwire in place rather than the elastic ligature. This system allows the wire to move more freely and with less friction, applying gentler forces to straightening the teeth. Gentler forces typically result in less patient discomfort throughout the process*. The added benefit of not having to change the discolored or stained elastic ties reduces the number of visits to the office as well**.

Damon Clear is a very popular choice for people who want an aesthetic option with greater patient comfort than traditional braces, and an overall reduced treatment time with fewer appointments.

Besides the comfort and aesthetic appeal, I like the Damon System because it creates that signature, broad, full-mouth smile of Hollywood stars that my patients love!

Lingual Braces

Although lingual braces have the same components as traditional braces — brackets, wires, and ligatures — I will include them in this article as an option for patients seeking a discreet way to straighten teeth. Why? Because lingual braces are affixed to the back of a patient’s teeth — on the lingual side, next to the tongue. With this unique placement, they are nearly invisible.

Similar to what I said about aligners, lingual braces can correct most of the same kinds of alignment issues as traditional braces. But they are not right for every patient. As an example, patients with very deep overbites might run into some trouble with brackets breaking off more frequently. To determine whether you are an ideal candidate for lingual braces, you should ask your orthodontist if your treatment is appropriate for them.

In closing, it is important to note two things. The first is that not all treatment methods cost the same or are covered by insurance. The other is that not all orthodontists use the same types of treatment approaches and products. Some doctors only use Invisalign for all patients, regardless of diagnosis. Some doctors only use Damon, while others do not use this system at all. Same for Spark; not every orthodontist has been trained to use this newer offering. Some doctors still only use traditional metal braces. You need to identify an orthodontist in your area who has evolved with the times and uses more modern products and technologies while not using one approach to treat all patients. Ask your general dentist for an orthodontist they trust, do your online research, ask the right questions and you will find the right doctor for you. Your smile is uniquely yours, and you deserve one that will give you a great reason to smile for a lifetime.

Align is a registered trademark of Align Technologies, Inc.
The opinions expressed are those of Dr. Barry Rouch. Ormco™ is a medical device manufacturer and does not dispense medical advice. Individuals should seek the advice of an orthodontist. Individual results may vary.

About the Author

Dr. Barry Rouch has been in private practice in Austin, TX since 1999. He has two office locations serving patients of all ages from children to adults. He treats all aspects of orthodontics from early phase treatment to complex surgical cases. Dr Rouch loves creating that beautiful Damon Smile with braces or using Spark aligners!

1 4(4):228-234; Keim, Robert, et al. 2014 JCO Study of Orthodontic Diagnosis and Treatment Procedures. Part 3. Journal of Clinical Orthodontics. 2014
2 Sharmada BK, et al. A Comparative Evaluation of Microbial Colonization with Different Ligation Techniques J Dent Med Sc. 15(3). Mar 2016 https://pdfs.semanticscholar.org/cf53/0e7b71d8e3f2b8a4aa9e7fc0bd9cc0f0bf1c.pdf
3 Barron, T. and Bogdan, F. A Practical Treatment Objective: Alveolar Bone Modeling with a Fixed, Continuous-Arch Appliance. Clinical Impressions. Vol. 20 No 1. 2017.; Eberting JJ, Straja SR, Tuncay OC. Treatment time, outcome and patient satisfaction comparisons of Damon™ and conventional brackets, Clinical Orthodontics and Research 2001; 4(4):228-234.

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