Braces could be considered the most ubiquitous form of orthodontic treatment. There are several types of braces available. They vary in design, appearance, and materials used to make them. Here we discuss the most common types of braces and attachments used by orthodontists today.
Traditional braces
In some form traditional metal braces and wires existed since the early 1800s and the idea of straightening teeth with various metal devices is at least several centuries old. In 1928, after many tries and much experimentation, the prototype of modern braces was introduced by Edward H. Angle, who is considered the father of American Orthodontics. His appliance consisted of brackets and wires and allowed the movement of crown of the teeth as well as the roots.
Most orthodontic problems can be corrected with braces because of their versatility. They can deliver varying amounts of force and can utilize many auxiliary attachments.
So how do braces work? Metal brackets are carefully positioned by the orthodontist and then cemented to the front of your teeth for the duration of the treatment. The brackets serve as anchors for wires which are secured with colored ties. It is actually the wires that move the teeth. They have the shape and the memory of an ideal arch form and slowly pull teeth into this position. The starting wire is very thin and flexible and as your teeth become straighter, stronger and thicker wires are used.
Clear braces
Clear braces are still braces, except that the brackets are made of clear plastic or clear ceramic material. The wires may still be metal, or coated with white color to reduce overall metal appearance. Clear plastic brackets were introduced in the 1970s and the clear ceramic brackets became available in 1987.
They work just as traditional braces, but a few things need to be remembered about them. Since they tend to be brittle, small parts, wings or hooks may fracture off. To make them stronger manufacturers sometimes add bulk, so clear brackets are somewhat thicker than traditional metal counterparts. Earlier designs tended to stain or discolor, but newer clear brackets are much better at maintaining their color for the duration of the treatment.
Self-ligating braces
Self-ligating brackets have a design that includes a clip, a gate, a door, or some other special locking mechanism built in to secure the wire, so that the colored elastic ties are not needed. Even though they existed since the 1930s, the self-ligating brackets have become especially popular in the early seventies with the introduction of Edgelok bracket. Many manufacturers of orthodontic appliances make them. Some of the more commonly used ones are SmartClip by 3M, Damon by Ormco and In-Ovation by Dentsply.
Lingual braces
Lingual braces, which were developed in the 1970s, have the same components as conventional braces, but they are cemented to the back of the teeth, the tongue side, to make them virtually unnoticeable. Because the thickness of the teeth varies from patient to patient and is different between the front and the back teeth, wires for lingual braces have to be custom made. They are harder to place and tend to be more expensive than conventional or even clear braces. Also, they may be more uncomfortable to the tongue and may initially present difficulties with speech.
Elastics used with braces
Many auxiliary attachments can be used with braces. One of the most common ones is elastic rubber bands. Braces straighten upper and lower teeth independently and the rubber bands bring them together to establish a proper bite. When your orthodontist initiates elastics wear, it is very important to wear them as directed. Most commonly elastics have to be worn full time, you should only take them out while eating and brushing. It takes several hours for rubber bands to start working, so intermittent, or inconsistent wear may not produce the desirable result.
When more rigorous overbite or underbite correction is required, your orthodontist may decide to use metal rods or springs instead of elastics. Just like rubber bands, they attach to upper and lower braces. Their use relies less on compliance and delivers more consistent force. They tend to be somewhat uncomfortable at first, however.
Closing gaps between the teeth requires the use of power chains. They are just like colored ties except that they are connected to form a chain that pulls teeth together. To push teeth apart, when needed to create space for a lingually displaced tooth for example, a small open coil spring can be threaded on the wire.
Appliances used with braces
As part of the treatment, you may need a Rapid Palatal Expander. It is an appliance that attaches to the upper back molars and covers the roof of the mouth. It is used to widen a constricted upper arch to create space or to correct a crossbite. Expanders can be a part of early treatment (Phase 1), or can be used in conjunction with full braces in adolescents. There are a few other appliances that can go on the roof of the mouth, such as a Transpalatal Arch, which splints upper molars together to create a better anchor for movement of front teeth, and Nance, which prevents upper molars from drifting forward.
Several types of headgear can be used in childhood and early adolescence while skeletal growth is still occurring. Cervical pull headgear has a neck strap and is designed to pull upper molars back to open more space, or to hold upper teeth and upper jaw from migrating forward. The opposite action can be achieved with a protraction facemask headgear, which uses forehead and chin as support to pull upper jaw forward to correct an underbite.
These are just some of the appliances that can be used with braces. Their use depends on complexity of the case and your orthodontist’s preference.
Clear aligners
Although different from braces, clear aligner therapy should be mentioned as an alternative form of treatment. Since it was introduced by Invisalign in 1997, clear aligner therapy has been growing in popularity over the last two decades. It consists of a series of clear, plastic, removable trays that incrementally move teeth into a desired position. The trays, called aligners, are typically changed every 1-2 weeks depending on your orthodontist’s instructions. The most popular brand that manufacturers clear aligners is Invisalign, but there are others, such as ClearCorrect and Smile Direct Club.