Orthodontic Patient

A Guide To Today's Teeth Straightening Options

By Dr. Robert Gire

Choosing The Right Teeth Straightening Product For You

Metal braces. Ceramic or “clear” braces. Lingual braces. Self-ligating braces. Aligners you can get through mail order. Aligners you can only get through an orthodontist.

Wow, that’s a lot of choices. And, if you are in the market for braces, it’s a wealth of information to take in and absorb.

Do Your Homework – Not All Approaches And Doctors Create The Same Finished Smiles

If you are starting your research to learn about various options in orthodontic treatment for you or a child, congratulations and well done! Doing your homework is important. By now, you have likely heard from friends, read on social media, and seen a multitude of ads for various products. It can be very confusing to determine what all the options are and what might be best for your circumstances. And, just like all doctors are not created equal, nor are smiles. Finished smiles come from different types of treatments, and not every orthodontist does every type of treatment. An experienced orthodontist understands the science and the art of creating a great smile, not just treating crooked teeth or fixing alignment.

Some doctors work with aligners; some do not. Some create very appealing, broad arch smiles, such as a Damon™ smile, and others do not use that approach. Experienced orthodontists understand that their job goes beyond putting on braces and straightening teeth. You need to understand your specific diagnosis, talk through your treatment options, and ask questions to determine which treatment will be best for you or your child. A smile is the number one feature of a first impression, in my opinion. In this article, I would like to help de-mystify today’s bevy of choices.

What Do I Regularly Get Asked By New Patients?

  • What are today’s best options for straightening teeth?
  • Do aligners work and for what types of patients?
  • What are lingual braces and how is treatment different from traditional metal braces?
  • What are the differences between aligners and lingual braces?
  • What are the differences between clear braces and lingual braces?

Seek Out A Specialist

Every day, I get asked some form of these questions. The good news is that prospective patients are coming in to seek the consultation of a specialist. Beyond dental school, orthodontists like me have another three to four years of school and some 3700 hours of training just in the specialty of moving teeth and aligning jaws. We base our recommendations off a thorough examination and proper diagnosis. It may surprise you to learn that about six percent of dental school graduates become orthodontists.

Understanding The Fundamentals Of How Braces Work

The process of straightening teeth requires a gentle, constant pressure (force) on the teeth. The need for treatment may be due to overcrowding, excess spacing, overbite, underbite, crossbite, or another issue. Many people think that the brackets on traditional braces provide the movement necessary to move teeth. That’s technically not true. It’s the pressure from the wire, or series of wires, that moves teeth into place, not the brackets. The last component of traditional braces are the ligatures, the small elastics that holds traditional brackets to the wire. Today, these tiny rubber bands come in a variety of colors for the user to personalize his or her look. But thanks to advances in technology, not all braces use this more traditional approach of wires/brackets/ligatures. I will get to that in a moment.

The Science Of Orthodontics Has Advanced

The science behind orthodontics – as well as the actual appliances themselves – has significantly advanced since parents were kids. I feel fortunate to work in a field that has advanced significantly over the last 10-20 years with a better understanding of the biology of tooth movement. Advancements in technology have led to the creation of products that straighten teeth and fix orthodontic issues more efficiently and, in less time, with less discomfort, and with better outcomes. As an added bonus, we now can do many of these exciting things without requiring extractions.

It is sometimes surprising for people to hear that modern braces have come a long way. Adults and parents often equate orthodontics with bulky metal brackets, heavy force on the teeth, clunky headgear, and lots of painful rubber bands. Thankfully, with the right products, we can move beyond those days. Through the use of improved treatment techniques, I can now complete many of my patients' treatments in about half the time it required 20 years ago. Oftentimes, my cases can be completed in under a year – and that’s treating all the teeth, not just the front teeth.

A Look At Some Of Today’s Best Orthodontic Treatment Options

What Are Aligners?

One of the newest advances you have likely heard about is clear aligner therapy. What exactly are aligners, and who are they best for?

Aligners are nearly invisible custom-manufactured, clear plastic, removal “trays” that patients wear about 22 hours a day. Using gentle force, these trays move teeth from their original state to a more optimal, treated state. Aligners may not be the appropriate treatment for every type of orthodontic issue and can be challenging for more severe cases. However, aligners can be very effective for the right patient. Patients can remove aligners to eat, drink and brush their teeth. For those who feel more self-conscious about their treatment, aligners present a more discrete option.

There are many different manufacturers of aligners these days. Several are sold over the internet and do not require doctor visits during treatment. I obviously do not encourage those as I believe a doctor should oversee patient treatment to ensure progress is tracking as it should, course correct if it isn’t, or even switch or try new appliances. I end up retreating many patients unhappy with the outcome of their mail-order aligners. But there are also aligners that are doctor-prescribed and managed throughout treatment, like Spark, which is a softer, more comfortable aligner option for many of my patients.

What Are Lingual Braces?

Lingual braces have the same components as conventional braces — brackets, wires, and ligatures — but they’re fixed to the back of a patient’s teeth, on the tongue (lingual) side of the teeth. Because they are placed behind the teeth, they are nearly invisible.

Overall, lingual braces can correct the same kinds of alignment issues as conventional (buccal) braces. But lingual braces are not right for everyone. Patients with very deep overbites, for example, might run into some trouble with brackets popping off more frequently. The only way to know for sure whether lingual braces are right for you is to consult with an orthodontist.

Costs may be higher with lingual braces than traditional braces, in part because the process of applying them is delicate and a little more time-consuming than conventional braces, and they can be customized for the individual patient, which can bump up cost.

What Are Clear Braces?

Not to be confused with removable clear aligners, ceramic braces are permanent braces affixed to the teeth. They are much less visible than metal braces. Imagine metal braces made from white or clear material to make them less obvious. Fixed ceramic, instead of silver-colored metal brackets, are bonded to each tooth and connected with an archwire. Sometimes the wire is also frosted (tooth colored) so the entire appliance blends in with the patient’s teeth. Most clear brace systems use small elastic bands, called ligatures, to hold the wire in place on each bracket. These are usually clear or the same color as the brackets. Treatment time for ceramic braces depends upon the severity of the correction needed, but it usually takes around 18 to 24 months. Ceramic braces may be a little more costly than traditional braces since ceramic material is more expensive than metal.

What Are Self-ligating Braces And How Are They Different From Traditional Braces?

Many people in the market for braces have not heard of self-ligating braces. Self-ligating braces afford my patients many benefits. In recent years, self-ligating braces have gained popularity amongst orthodontists and patients because they tend to cause less discomfort, require fewer visits to the orthodontist, and due to their efficiency, create a shorter treatment time. In the right hands, self-ligating braces also can address almost all orthodontic issues for which you are seeking treatment.

What are self-ligating braces, and how are they different from traditional braces?

Unlike traditional brackets that use o-rings or mini-elastics to tie down the wire, self-ligating braces, such as the Damon™ System (which my practice uses), eliminate those elastic ties. Without plastic bands there is less friction. And, like most things in life, friction slows things down. Damon uses a small door to hold the wire within the bracket. This results in less binding, friction, and lower pressure to the teeth for improved patient comfort and treatment efficiency.

Patients may find Damon self-ligating braces more comfortable as teeth move gradually under more gentle, consistent pressure, rather than being tightened in stages as with traditional braces. My patients enjoy the following benefits of self-ligating braces technology:

  • Shorter treatment time: Damon brackets applied during the beginning of treatment apply continual pressure and move teeth faster than traditional braces.
  • Reduced friction and discomfort: Lack of ligatures, such as rubber bands on brackets, causes less friction than traditional braces, helps improve patient comfort, and promotes efficient tooth movement.
  • Easier to keep clean: Lack of ligatures also makes self-ligating braces easier to clean and less likely to trap food.
  • Less chair time: Ongoing doctor visits for self-ligating braces tend to be much quicker than tightening appointments for traditional braces and less frequent (every couple of months). At office visits for traditional braces, your orthodontist will need to place a new elastic on each bracket. This process can be very time-consuming. Opening and closing the clips on self-ligating brackets tend to be much quicker, allowing for shorter appointment times.
  • Fewer, if any need, for painful palatal expanders or extraction: Damon braces widen the arch to move all teeth into place without the need, in most cases, for expanders or tooth removal.

Additionally, if patients want a more aesthetic option with self-ligating technology, Damon™ Clear is a ceramic, nearly clear option my patients enjoy.

I hope this background has been helpful. The good news is that there are lots of newer options for patients to consider – from aligners to nearly invisible ceramic braces, and braces behind the teeth to self-ligating braces that come with many benefits over traditional braces – depending upon a patient’s diagnosis, personal interests, and budget. The most important first step after getting “educated” on the options today is to seek one or two orthodontic consultations and to bring questions and even pictures of an ideal smile so that you can have an informative discussion about what is right and possible for you or your child.


About the Author

Robert Gire, DDS, MSD, earned his doctorate at the USC Herman Ostrow School of Dentistry and his orthodontic certificate and a master’s degree in dentistry at the University of Colorado School of Dental Medicine. Gire, who maintains three private orthodontic offices in Southern California, has been an orthodontic pre-clinical instructor since 2009 at the Ostrow School of Dentistry and is a board-certified diplomate through the American Board of Orthodontics.

*The opinions expressed in his article are those of Dr. Gire. Ormco™ is a medical device manufacturer and does not dispense medical advice. Consumers should seek the advice of an orthodontist. Individual results may vary.


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