What are the relative advantages and disadvantages of conventional braces, lingual braces and Invisalign and which are more cost-effective?

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Specialist Orthodontist
Orthodontic Care
BDSc (Melb), MOrth (Hong Kong), MOrth (RCS Edin)

Conventional braces Vs lingual braces Vs InvisalignPatients often ask me to outline for them the relative advantages and disadvantages of conventional braces, lingual braces and Invisalign and which are more cost-effective? Every appliance works slightly differently, and the best type of treatment must be individually prescribed.

What are the advantages/disadvantages of conventional braces?

Conventional braces, or “labial” braces (fixed to the “cheek” side – or outside – of the teeth), are the most common and best known orthodontic appliance. They are suitable for patients of all ages; and as they are fixed to the teeth, patient compliance is not an issue. These braces have been around for a very long time, so there is ample scientific evidence to prove their efficiency. Originally made from metal, conventional braces are now also available in a more aesthetically pleasing ceramic material preferred by most adults; but the metal version uses the smallest possible brackets, making them the most hygienic. This can be an important point of difference. As conventional braces are fixed to the front of the teeth, patients with poor oral hygiene may develop white spot lesions on the teeth. These white areas, only apparent when the braces are removed at the end of treatment, are the beginning of tooth decay caused by a build-up of plaque which inhibits salivary flow.

What are the advantages/disadvantages of lingual braces?

Many adult patients say to me “I don’t mind braces, I just don’t want anyone to see them.” For these patients, I recommend “lingual” braces. Lingual braces (fixed to the “tongue” side of the teeth), are completely invisible to the outside world – unless a patient mentions that they are having orthodontic treatment, nobody will know. Lingual braces, including the wires, are fully customised for each individual. Due to the level of technology involved in the manufacture of these braces and wires, a longer waiting time is involved (which may lengthen the overall treatment by 2 to 3 months), along with a higher cost. These braces are best suited to adult patients, who will appreciate the bespoke nature of the appliance. Lingual braces are not recommended for patients with a narrow jaw as the braces can invade the space for the tongue, creating a feeling of claustrophobia. With either of the above braces, some discomfort is felt in the initial stages of treatment. This may be due to a wire poking into the cheek or tongue, resulting in an ulcer; or to an increase in the usual salivary flow. A soft diet is recommended during the first few phases of braces treatment, particularly with ceramic braces where there is a risk of chipping enamel if the lower braces are positioned high enough to affect the bite. Also, depending on the type of braces, the elastic ties may discolour with time. At every visit, the wires and elastics will be changed, so this should not be a major concern.

What are the advantages/disadvantages of Invisalign?

A third type of braces is available – in the form of Invisalign, a virtually invisible way to straighten your teeth. A series of removable clear aligners, custom-made for your teeth and worn for six to 12 months, gradually move your teeth into position without the need for wires or clips. A more affordable alternative to lingual braces, and more aesthetically pleasing than labial braces, Invisalign is suitable for adults of all ages, including those with narrow and wide jaws. The appliance must be worn almost full-time to work best. As these aligners must be removed for eating, a soft diet is not necessary during treatment. The aligners must also be removed for cleaning, which means there is no excuse for poor oral hygiene throughout Invisalign treatment. There is a waiting time while your aligners are custom-made but treatment time may be shorter than with other braces and can be accelerated with the optional use of an electronic device called Acceledent. Unfortunately, Invisalign is not the ultimate orthodontic appliance for some patients, as some tooth movements are just not possible.

What can I expect to pay for Invisalign?

The average cost of Invisalign treatment varies depending on the complexity of your case. If performed by a general dentist a full course of Invisalign treatment will cost anywhere from $4,800 to $7,500. Alternaively, if treated by a specialist orthodontist you can expect to pay $6,500 to $9,000. If your case is a simple one, a process called Invisalign Lite, with fewer aligners, may be prescribed by your clinician. The cost of this form of Invisalign is usually 20–30% cheaper than standard Invisalign provided by the same clinician. For more information on the costs involved click here.

Things to note

With all kinds of braces, you may initially develop a slight lisp due to the position of the appliance in the upper arch. This usually disappears within two weeks but may take longer with lingual braces, as they are fixed to the teeth. As you can see, each orthodontic appliance has its pros and cons, and the best appliance for you will be suggested by your orthodontist. Invisalign is a wonderful option if you are able to wear it as prescribed.

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