Conventional Fixed Braces
Fixed appliances are the most commonly used appliances and are able to produce very precise tooth movement to achieve ideal results.
Treatment with fixed appliances usually starts once all the adult teeth have erupted and usually lasts for 18-24 months. All fixed appliance treatment is followed by retention.
Many different brands of fixed appliance are available, which can be very confusing for patients, but they all essentially perform the same function. Manufacturers may claim that their products produce more superior results than others. Care must be taken in accepting such claims as often they are not substantiated by scientific evidence. Below are described the main types of fixed appliances:
Conventional metal fixed appliances
These are the most common form of appliance used in children and are often also termed ‘train tracks’. They are most commonly made from stainless steel and attached onto the teeth using tooth coloured filling material (composite resin). Care has to be taken eating hard foods as the attachment can easily be broken leading to a disruption in treatment. An orthodontic wire (archwire) is tied (or ligated) into the bracket using coloured elastic rings which can discolour in-between visits. These elastics can be silver coloured to blend in which the appliance or brightly coloured. As treatment progresses the orthodontist will progress to thicker wires which can place greater forces onto the teeth. Some patients term this process as ‘tightening’ the appliance. Appliances can easily be removed at the end of treatment leaving the teeth intact.
Ceramic fixed appliances
Rather than using stainless steel, the attachments may be made from a hard ceramic material to blend in with the tooth colour. This produces a more aesthetically pleasing appliance which is more of an attractive option particularly for adults. The orthodontic wires can also be tooth coloured to help improve the appearance further. Ceramic fixed appliances can be as effective as conventional fixed appliances at achieving tooth movement. Sometimes they are not recommended for the lower teeth, if the bite is deep, because the hard material can damage the opposing teeth that contact the attachments. Ceramic appliances are slightly more difficult to remove than conventional fixed appliances, however, they are unlikely to damage healthy teeth in most cases. Any concerns should be discussed with your orthodontist.
Self-ligating fixed appliances
All the main orthodontic manufacturers produce their own brand of self-ligating appliances, that maybe metal or ceramic, and some may make substantive claims about their treatment benefit. Rather than using elastics to hold the orthodontic wire into position, these appliances have an integral clip mechanism that holds the wire which allows the wire to slide more freely. There is no evidence that this mechanism produces a more superior result than a conventional fixed appliance. There is evidence that the time taken to change the wire is reduced with a self-ligating mechanism and there is less likelihood of the appliance discolouring in-between visits as no elastics are used to tie the wires.
Lingual fixed appliances
Unlike the appliances described so far, lingual appliances are attached to the inside surface of the teeth which makes them invisible to the outside world. Many orthodontists offer these systems and they are capable of producing high quality results. Particular problems that maybe encountered with lingual appliances include initial difficulty in speaking, tongue soreness and problems in keeping the appliances clean. The cost of treatment with lingual appliances is considerably more than the appliances mentioned so far which reflects the greater laboratory fees in producing the appliance and the increased surgery time required in the adjustments.