Lingual orthodontics and lingual braces: advantages, frequently asked questions and prices

Orthodontics with lingual brackets is, along with Invisalign removable aligners, the most advanced treatment of all those that currently exist to correct malpositions of the teeth.

Since there are different types of brackets that are placed on the inner side of the tooth – instead of the outer side – we will see which ones offer the best quality.

Only brackets that have been specifically designed to be placed on the inside of the tooth can be considered lingual brackets.

What are brackets or intralingual orthodontics?

The brackets that are placed inside are a fixed orthodontic technique that is characterized by being the only one that absolutely nothing can be seen.

This is achieved because the brackets are placed on the lingual side, that is, on the inside of the tooth.

This type of dental appliance is just as effective as other less esthetic orthodontic systems, such as clear or white brackets, sapphire brackets or conventional metal brackets.

In other words, the lingual technique allows us to solve any defect related to the alignment and bite of our teeth (crowding or crowding, open bite, overbite, diastemas or gaps between teeth, crossbite…).

Brackets inside the teeth
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INCOGNITO LINGUAL BRACES

Differences between lingual and invisible orthodontics
Both Invisalign and lingual orthodontics are framed within invisible orthodontics, although there are several differences between the two.

The main distinction is that the aligners are removable, so the patient can remove them from the mouth to brush teeth and eat.

In addition, lingual orthodontics is metallic and is not made of a clear material like Invisalign braces.

How many types of lingual braces are there?
If we have already advanced that the quality of the bracket that is placed on the patient is extremely important, next, we are going to specify more about the types of internal braces that exist.

As patients, we must make sure that the invisible brackets that our orthodontist is going to fit us with are specifically designed for this purpose.

We say this because many of the brackets that are offered as lingual are metal braces that are simply placed on the inside of the teeth.

In our dental practice we work with 3M’s Incognito brand, which is the market leader and the first in the world.

It launched a fully customized lingual bracket system in 2004.

For this reason, in this article we are going to focus on the invisible brackets that we consider to be the best quality: the Incognito.

They are, without a doubt, the most technologically advanced and the first choice of adult patients who are very demanding with their physical appearance.

We recommend lingual orthodontics to people who care about aesthetics and prioritize this aspect over the price of treatment.

How do Incognito braces work?
In order to correct the aforementioned dental problems, Incognito lingual brackets work slightly differently from other systems (clear or white, sapphire or metal brackets).

First of all, their manufacturing process varies, they are made of a gold alloy and are technologically very advanced.

The bracket design is done by computer and then the manufacturing is carried out in a customized way.

This is because the brackets are created one by one – with this gold alloy – tailored to the patient’s teeth.

In contrast, the other brackets mentioned above do not have this strong technological component, are not custom-made and are made of a much cheaper material (metal, porcelain or even plastic).

Instead of each bracket being custom-made, a multitude of brackets are made at the same time and the same brackets are fitted to all patients.

In addition to brackets, Incognito also custom fabricates dental appliance archwires and bonding trays.

The latter are created from molds of the patient’s mouth and are used to place the brackets that will later be transferred to the teeth.

Lingual orthodontics
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LINGUAL BRACKETS
In which cases is lingual orthodontics recommended?
Since the effectiveness of lingual brackets is more than proven, it is indicated to correct any type of malocclusion.

Thus, it solves problems of overcrowding, open bite, crossbite, overbite, etc.

For this reason, the decision to opt for lingual braces or any other dental appliance is the importance given to appearance during treatment.

At this point, we anticipate that this is the most expensive orthodontics currently offered on the market, so it is chosen by people who put aesthetics before price.

This may be due to their lifestyle, because their work requires them to meet certain standards in terms of their image or simply because they do not want anyone to notice that they are wearing braces.

Although lingual orthodontics does not interfere in any way with the aesthetic aspect of the patient’s life, it does involve a series of difficulties and discomfort when speaking or eating.

This is known as the adaptation period, which is essential no matter what type of braces you wear.

However, in the case of lingual braces, this process varies and may be more manageable depending on the brackets chosen.

Advantages and disadvantages of internal braces
Incognito orthodontics from the 3M brand has numerous benefits, whether compared to any other type of bracket or to Invisalign.

Among all of them, the benefits that make the difference of this system are the following:

Pros
1. The only 100% invisible orthodontics
Although, as mentioned above, Invisalign also falls into the category of invisible orthodontics, it can be noticeable at very short distances.

Despite this, it is a very discreet method, especially because it does not involve the placement of brackets.

This is because it is a procedure that uses transparent splints made to fit the patient’s mouth.

The aligners are changed every two weeks to gradually make small dental movements.

However, we can say that lingual orthodontics is the only procedure that is completely imperceptible, even at short distances.

Therefore, no one will notice that you are wearing braces throughout the entire treatment.

2. Highly effective method
There is a false myth that aesthetic orthodontic methods are less effective than more traditional metal braces.

The truth is that orthodontics with lingual brackets is recommended to address any type of malocclusion: open bite, crossbite, overbite, etc.

Many more complex cases have been treated with lingual orthodontics, such as those requiring extractions or those with severe crowding.

3. It does not produce visible stains on the enamel of your teeth.
Fixed orthodontic methods make oral hygiene at home difficult.

For this reason, it is common that sometimes small stains appear on the enamel of the surface of our teeth.

However, lingual brackets are cemented to the inside of the teeth.

In this way, if dental hygiene has not been as rigorous as it should have been throughout the treatment, there will be no visible staining or discoloration after the treatment.

The result will be more esthetic, therefore, than in the case of having opted for a fixed orthodontic treatment with metal or sapphire brackets.

4. It requires less collaboration from the patient
Compared to the other invisible orthodontic system – transparent braces – the patient does not have to be so aware of his or her treatment.

In order to be effective and meet treatment deadlines, the aligners must be worn for a minimum of 22 hours a day.

This is perceived as a disadvantage for some patients who, due to their lifestyle or habits, do not wish to maintain this regularity of use.

However, even if you opt for lingual orthodontics, it is essential that you take care of your hygiene and attend the check-ups prescribed by your orthodontist.

Lingual braces check-up
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REVISION OF LINGUAL BRACKETS
5. It is recommended for athletes
People who play sports regularly, especially if they are contact sports, have a higher risk of suffering accidental blows to the mouth.

If they wear metal or sapphire brackets, the impact would cause injuries to the inside of the cheeks and lips.

For this reason, lingual orthodontics is a more suitable option for elite athletes or amateurs who practice this kind of activity.

In any case, whether or not they wear orthodontics, it is highly advisable to use a custom-made sports mouthguard.

6. Predictable
The fabrication is done through computer-configured records and the brackets are made to fit the teeth.

As a result, the bonding area is maximized, high precision is achieved and the treatment times planned by the orthodontist are met.

7. Resistant
The gold alloy with which these aesthetic brackets are made allows for high resistance with a minimum thickness.

8. Comfortable
Being so thin, small and custom-made, lingual brackets cause little discomfort on the tongue or when speaking.

DO YOU NEED AN ORTHODONTIST?
Cons
Orthodontics with lingual brackets offers certain disadvantages compared to other orthodontic methods.

1. Hygiene
First of all, like other fixed orthodontic methods, it makes it difficult to access hygiene in all the nooks and crannies of the mouth.

For this reason, you should take special care and complete the cleaning of your mouth with the use of the oral irrigator -or waterpik-.

2. Food
On the other hand, there are certain dietary restrictions that you must follow during the treatment.

You should avoid eating hard foods (nuts, kikos) and sticky foods (candy, chewing gum).

In addition, it is advisable that you do not bite down with a levering motion, for example when eating a snack or an apple.

Feeding with lingual orthodontics
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DRIED FRUIT
3. Adaptation period
All orthodontic appliances require an adaptation period.

In the case of Incognito brackets, this is increased compared to Invisalign.

Initially, you may notice some discomfort when speaking or chewing, which will disappear after 2 to 3 weeks.

4. Price
Currently, Incognito invisible braces are the most expensive orthodontic treatment available.

Therefore, it is used by patients who prioritize esthetics over the cost of the appliance.

How are lingual brackets placed?
Although there are different techniques for placing brackets -whatever type they are-, in our dental clinic we perform this process by indirect bonding.

This technique consists of placing the brackets outside the mouth, using a splint – the bonding tray – and then transferring the brackets to the teeth.

On the other hand, the other placement technique -called direct bonding- involves placing the brackets one by one on the patient’s teeth, which requires the mouth to be open during the whole process and makes the procedure much longer.

Having established the differences between the two alternatives, let’s focus on the technique we perform in our dental clinic: indirect bonding.

Lingual brackets
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LINGUAL BRACKETS
This technique makes invisible brackets very comfortable to place for the patient and also facilitates precision.

The placement process is fundamental, because if it is done incorrectly and the bracket is not placed in the exact place where it should be, the tooth will not make the desired movements.

To proceed with the placement of lingual brackets we carry out the following steps:

1. 3D scanning
By scanning the patient we obtain all the measurements of his mouth and the exact anatomy of his tooth.

2. Sending records
Since we have a 3D scanner, we send the digital image of the patient’s mouth to the Incognito factory (located in Germany), which shortens the time.

If we did not have a 3D scanner it would be necessary to send the records physically to that country.

3. Bracket design
The design of the lingual orthodontics is done in Germany and, from there, the brackets are sent in a bonding tray.

4. Tooth preparation
Once we have the lingual appliance and the patient comes to the office for placement, we proceed to prepare the teeth.

This preparation will be used to fix the adhesive product to the tooth and the bracket, which will hold the brackets in place.

5. Fixing the brackets
Once the adhesive is fixed, the bonding tray -in which the invisible brackets are already placed- is placed and held in the mouth for a few minutes, pressing on the patient’s teeth.

This is how we transfer the brackets to the tooth.

6. Placement of the archwire
Once the lingual brackets are in place, the archwire is placed.

Normally, the placement is done in two sessions.

First, the lower brackets are placed and after a week the upper brackets are placed.

If you want to see in detail, and with images, how the lingual bracket placement technique works, I recommend the following video:

How long does a lingual orthodontic treatment last?
The duration of treatment with lingual brackets will always depend on the complexity of the case to be treated.

However, we can say that it usually ranges between 18 and 24 months of active treatment.

When an orthodontist carries out a preliminary study of the case, he or she will be able to determine the duration of the procedure.

At this point, we would like to stress the importance of complying with all the phases of the treatment, including the one that comes once the brackets have been removed.

We are talking about retention, the aim of which is to keep the teeth in the position that has been achieved thanks to the treatment.

Once you finish orthodontics, we will place 4 retainers, one in each arch: two removable aligners and two fixed aligners, placed on the inside of the teeth.

Does lingual orthodontics hurt?
All orthodontic treatment involves discomfort and pain as soon as it is placed, as it is essential that the patient gets used to wearing it.

In the case of lingual braces, it is common to feel pain and pressure on the teeth during the first few days, especially when chewing.

However, during the fitting process, the person does not feel any pain.

Since they are cemented to the inside of the teeth, it is likely that at first you will not be able to speak normally and sores will appear on the tongue.

To alleviate this discomfort, it is very useful to use orthodontic wax or, if the pain is severe, to take painkillers prescribed by the dentist.

What discomfort can lingual orthodontics cause?
The fitting of an orthodontic appliance involves a period of adaptation, the duration of which varies considerably from one patient to another.

Generally, we can speak of a duration of approximately two to three weeks.

At first, the brackets may cause discomfort in speech or chewing, as well as small wounds or sores caused by the appliance rubbing against the tongue.

At a more advanced stage, patients usually report slight discomfort after the orthodontist’s check-ups.

At these check-ups, the specialist will make the necessary adjustments to the orthodontic appliance so that it can perform the necessary movements of the teeth.

For this reason, patients who experience some discomfort after check-ups do not feel pain: this is the result of the pressure exerted by the appliance on the teeth.

Finally, we should mention the discomfort resulting from treatments necessary to achieve perfect occlusion.

Such procedures are, for example, tooth extractions in cases of severe crowding or the placement of micro-screws -small implants temporarily positioned in the bone whose function is to perform movements that the orthodontic appliance, by itself, is unable to perform-.

In both cases they are simple interventions that are performed under anesthesia and whose discomfort will subside quickly.

Be patient
At first, the braces will make you feel discomfort. However, you will gradually get used to them and in a couple of weeks you will not even notice you are wearing them.

How can I alleviate the discomfort of lingual orthodontics?
We can list a series of tips to remedy the discomfort generated during orthodontic treatment with lingual brackets. First of all, during the adaptation period we must take into account the following factors:

If you have small sores or wounds produced by the friction of the appliance, we advise you to make use of special orthodontic wax. You should only place a small amount on the area that is causing the wound to avoid the direct action of the brackets on the mucosa. The wound will heal quickly, and the discomfort will be eradicated.
It is advisable to follow a bland diet -pures, soups or stews that are easy to chew-. Foods that do not require chewing effort relieve the discomfort caused by the pressure of the appliance in the mouth.
On the other hand, you should eradicate from your diet foods that are too hard or sticky, which not only make chewing difficult, but can also cause one of the most common dental emergencies: a bracket can become detached.
On the other hand, to alleviate discomfort after each check-up, it is recommended to take painkillers -always after consulting your dentist.

And remember that if the discomfort does not persist or if you feel pain outside the adaptation period or after check-ups, it is advisable to inform the orthodontist so that the cause can be diagnosed.

What advice should you follow if you have started lingual orthodontic treatment?
The fact of having a fixed system makes daily hygiene at home difficult, as the toothbrush cannot easily access the nooks and crannies of the mouth.

As a result, plaque build-up or gingivitis is common.

In order to curb its effects and achieve the best possible oral cleanliness, it is advisable to incorporate other types of hygiene utensils at home.

The use of interdental brushes and dental irrigators will contribute greatly to a more thorough daily prophylaxis.

Remember to brush your teeth after every meal and do not skip the scheduled check-ups with your orthodontist.

Regarding the discomfort you may experience during the adaptation period, do not hesitate to consult your dentist about the best way to reduce it.

As for dietary restrictions and eating with braces, it is advisable not to eat very hard foods to prevent the bracket from detaching.

In the following video, Isabel – a real DrAW Dental Clinic patient – tells you what her experience with lingual braces has been like throughout her orthodontic treatment.

Find out Isabel’s opinion on lingual orthodontics.

What is the price of lingual orthodontics or lingual braces?
The price of treatment with lingual braces varies depending on the complexity of the case and, therefore, the duration.

For mild cases, the price of lingual orthodontics is from $4,070.

If the case requires a longer treatment, approximately 18 months, because the patient has a moderate malocclusion, the price starts at $7,150.

Thirdly, a longer orthodontic treatment involving a severe problem costs from $8,840.

It is important to keep in mind that the budget is higher compared to other methods because of the specialization required by an orthodontist to place them.

The fabrication of the brackets and archwires requires a much more complex technique.

In addition, the brackets are made of a gold alloy, a much more expensive material.

I hope this article has helped you to clarify all the doubts you had about invisible brackets.

In any case, if you have any further questions, we will be happy to answer them, either in our dental clinic or by making an inquiry through this page.

guide to lingual orthodontics
Discover our Incognito Guide to Lingual Orthodontics
In this guide you will find a selection of articles on Incognito lingual orthodontics, preferred by the patients most concerned about their teeth….

VIEW THE GUIDE

You will be interested ” Our patients’ opinions about Incognito lingual braces

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Bibliographic references

• Vieira DR, Amaral FM, Maciel MC, Nascimento FR, Libério SA, Rodrigues VP. Plant species used in dental diseases: ethnopharmacology aspects and antimicrobial activity evaluation. J Ethnopharmacol. 2014 Sep 29;155(3):1441-9. doi: 10.1016/j.jep.2014.07.021. Epub 2014 Jul 18. PMID: 25046828. https://pubmed.ncbi.nlm.nih.gov/25046828/.
• Bayan, L., Koulivand, PH and Gorji, A. (2014). Garlic: a review of possible therapeutic effects. Avicenna journal of phytomedicine , 4 (1), 1-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103721/
• Taher, YA, Samud, AM, El-Taher, FE, ben-Hussin, G., Elmezogi, JS, Al-Mehdawi, BF and Salem, HA (2015). Experimental evaluation of anti-inflammatory, antinociceptive and antipyretic activities of clove oil in mice. The Libyan journal of medicine , 10 , 28685. https://doi.org/10.3402/ljm.v10.28685 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558274/

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