The roll-out of ceramic brackets in the 1980s was good news for patients and orthodontists seeking alternatives to the “metal mouth” look of traditional metal braces. Everybody wanted the versatility and the effectiveness of metal braces, but almost nobody was happy with the way they change a patient’s appearance. Kids, of course, are rarely given veto power over parents’ decisions about orthodontic treatment, but resentment is never a welcome addition to any family. The “metal mouth” complex undoubtedly kept many adults from a treatment which ultimately would be of great cosmetic and health benefit to them.
Metal braces are still with us, still work as well as they always have, and are still a cosmetic issue for most people. Two alternative approaches to treatment which have been developed to address aesthetic concerns are “invisible” aligner trays, such as Invisalign, and ceramic brackets, a field led by the 3M company’s Clarity Ceramic product line. Each of the three options presents a package of advantages and disadvantages, which patients and orthodontists weigh in selecting the one most suited to the patient’s condition, priorities, and resources.
A COSMETIC ALTERNATIVE
The designers of Clarity Ceramic line worked from the observation that the brackets in traditional metal braces are the largest and most visible parts of the appliance. Brackets are bonded to the patient’s teeth, and transfer pressure from the archwire to the teeth, causing them to move over time. The wire itself is very thin and relatively inconspicuous.
Clarity Ceramic brackets are transparent or translucent, so they blend in with the natural colors of the teeth they’re bonded to. The ceramic material itself is the great innovation. The overall structure of an appliance with Clarity brackets is otherwise about the same as that of traditional metal braces and works the same way to reposition teeth.
Inconspicuous Clarity brackets encourage some patients and orthodontists to opt for tooth-colored, or “frosted” archwire, to take another step in the direction of invisibility. This leaves the elastic bands ( ligatures) that secure archwires to brackets as the most conspicuous part of the appliance, and these are available in color tones that blend in with the brackets and teeth. Ligatures also come in a variety of bright colors, chosen by patients who favor a decorative adaptation.
Some Clarity designs do away with the need for ligatures entirely. These self-ligating appliances eliminate the need for periodic replacement of ligatures, and also render the braces less visible.
CLARITY CERAMIC VS. TRADITIONAL METAL
The chief advantage Clarity Ceramic braces offer relative to metal braces is cosmetic. They’re not invisible, to be sure, but are unquestionably much less conspicuous than metal, especially from a distance. The Clarity brackets in use today have solved the staining problem that early versions of sometimes had, so their color doesn’t change during the treatment period. Ligatures, though, are porous and do absorb pigments from food and beverages. Ligatures are generally replaced during regular checkup and adjustment appointments.
Clarity Ceramic brackets are smaller than traditional metal brackets. Some patients find them more comfortable, some report the opposite. Their size may have hygienic benefits because thorough cleaning of the teeth is easier. As far as that goes, there’s no difference in dental hygiene routine between metal and Clarity Ceramic: brushing and flossing as usual. Nor is there any difference between the two regarding food restrictions, or in the frequency of office appointments.
Metal brackets retain some advantages. Patients who need more extensive treatment will find the orthodontist leaning toward metal, and in some cases judging that Clarity Ceramic is not a viable option at all. Metal brackets can tolerate higher pressures than ceramic materials can, which leaves metal the only choice for some people, and in other cases tips the scales against the cosmetic advantages of ceramic. Some orthodontists are less inclined to recommend Clarity Ceramic for their youngest patients and are more disposed to offer this option to older teens and to adults.
In earlier versions, ceramic brackets developed a reputation for causing damage to enamel at the end of treatment, when brackets are removed. These concerns have largely been eliminated by improvements in bracket design, by bonding materials that can be deactivated with heat, and by laser technology methods of zapping the material so that it doesn’t bond anymore. Orthodontic technique, too, has been modified and improved to remove brackets with a minimum of force and minimal risk of trauma.
Ceramic, though much stronger than metal in certain ways, is more brittle. For this reason, some patients who engage in contact sports may want to discuss the risks of chipping and breaking with their orthodontists before opting in.
Finally, there’s the bottom line. Treatment with Clarity Ceramic braces costs more than equivalent treatment with metal brackets. How much more depends greatly on a patient’s individual condition and on the practitioner. Assuming that the orthodontist finds that a patient’s condition can be equally well treated with metal and with Clarity Ceramic braces, the choice between the two boils down to cosmetics: paying more for less visible appliances.
CLARITY CERAMIC VS. INVISALIGN
When an orthodontist determines that a patient can be treated without falling back on the traditional metal option, and offers a choice between aligner trays and Clarity Ceramic, there are practical factors to consider as well as cosmetic. Anyone would agree that Invisalign trays are less visible than a Clarity Ceramic appliance. But this advantage comes with some complications.
Aligner trays have to be removed before eating, and before drinking anything besides water. They have to be properly stored while they’re out, and then the patient’s teeth, and the aligners themselves, have to be thoroughly cleaned before they’re replaced. These are unavoidable responsibilities. Patients considering the aligner tray option should carefully consider whether they’re willing – and in some cases, whether they’re able – to shoulder them faithfully. At home, it’s not that hard to comply, but at work, in school, and while traveling, the inconvenience can be considerable. Or a deal-breaker.
The requirement to remove aligners before eating does provide one advantage some patients might appreciate: no special food restrictions. There’s that.
Invisalign patients have to make more frequent office visits. About twice as often as patients with ceramic braces. The logistics of this commitment are an important consideration for some people.
Other things being equal, an Invisalign patient is opting for superior cosmetics at the cost of inconvenience. Other things are never really equal, though, and it’s important for patients to understand the orthodontist’s evaluation of treatment prospects and potential outcomes. Patients considering orthodontic treatment should avoid becoming emotionally “committed” to one particular type of braces before being evaluated and hearing the orthodontist’s presentation of the options and issues.