Fig 1

When patients request aesthetic treatment options, there are basically two types of appliances: fixed orthodontics and removable orthodontics (Fig 1).

Fig 2

In today’s post we will focus on fixed aesthetic orthodontics. This orthodontics can be placed on the buccal aspect (the external part. Fig 2) or on the internal aspect (the lingual aspect. Fig 3).

Fig 3

Lingual orthodontics tends to be more expensive and considerably more uncomfortable in the first months of treatment, which is why patients usually choose vestibular fixed orthodontics. Treatment with ceramic fixed orthodontics has an estimated duration of between 18 and 24 months under normal conditions. It should be said that the treatment times are the same as in metal orthodontic cases, unlike what most patients believe.

There are many types of cosmetic brackets on the market, although at Rossell Carol we work with what in our opinion are the ones that give the best results: 3M Clarity Advanced © ceramic brackets (fig 4).

These ultra-small translucent brackets are highly resistant to fracture and present impeccable aesthetics as they have a chameleon effect, since as they are translucent they allow light to pass through and mimic the color of the tooth itself. In addition, they are resistant to stains and food discoloration. Many patients ask us if ceramic brackets change color, and the answer is NO. The ligature or rubber band that we place around the bracket to hold the wire does change color, as there are factors such as tobacco, tea, coffee, curry or food dyes that affect the color change of the elastic ligatures (Fig. 5).

Fig 5

For this reason, on many occasions we place fine metal ligatures (Fig 6) that do not show a change in color between visits. In this way, the patient can eat calmly without affecting the color of their ceramic orthodontics.

Fig 6

There are different types of clear brackets available, although ceramic brackets should always be ordered. The other types are plastic brackets and sapphire brackets. Let’s explain the differences well: in the first place we have the plastic brackets, they are totally inadvisable; They have a lower cost but on the other hand they wear out very easily and lose their aesthetic color quickly, since as plastic is more porous it absorbs all the color pigments in the food. In some cases, even the bracket is so degraded that it is necessary to change it in the middle of the treatment. In addition, due to its manufacturing method, it is an inaccurate bracket, which translates into less accuracy in the final detailed orthodontic treatment, and therefore in the final result. In second place we have the sapphire bracket, this bracket with a very high aesthetic presents a great disadvantage that is its high fragility. When a bracket is made of a very fragile material, it can break without great effort. This negative point greatly influences our criteria in its choice, since in the normal operation of orthodontics, the mouth is subject to many stresses, which can facilitate constant fractures of the bracket. Likewise, when we have to take off the bracket at the end of the treatment it is a very unpleasant experience, since the real sensation is as if the tooth were going to break.

And this is precisely one of the most important factors when choosing the type of appliance: when we have to take off the bracket at the end of the treatment. This fact goes unnoticed by most patients who do not notice it. The Clarity © Ceramic Bracket is easily detached from the tooth without stressing its surface or causing enamel cracks or fractures. It is also very little annoying in the debonding, so that the patient hardly suffers the pressure that the orthodontist must apply to remove it. Unlike other “aesthetic” brackets such as sapphire or plastic brackets, Clarity © brackets detach en bloc so that the amount of ceramic remaining in the tooth is the minimum possible.

As adult patients request more and more cosmetic orthodontic treatments, our advice is clear: Clarity © ceramic brackets or Invisalign © plastic orthodontics.