Your Guide to Better Oral Health

Types of Dental Braces

Written by Dr. Rebecca James. Medically reviewed by Dr. Zhuo Yuan.

Growing up, have you realised that some of your teeth are not a straight line and everyone says you need braces to correct it? And now that it is time for you to choose suitable braces, you do not know how to choose one because there are so many types out there?

Fear not, for I am here to help clarify the different types of braces available which will make your selection process easier! Before that, here is a list of available braces in Malaysia as of today :

  1. Conventional
  2. Self-Ligating Braces
  3. Lingual Braces
  4. Clear Aligners

Types Of Teeth Braces

Braces have evolved drastically since 400BC when the first teeth irregularities were recorded. From using wires made out of copper or zinc and wrapping a variety of materials of bands around a patient’s teeth to the discovery of dental adhesives to hold brackets in place with stainless steel wires, the braces world has come a long way. 

In 1997, braces evolved from using stainless steel wires and brackets to something known as ‘invisible braces’ or better known as clear aligners.

So, today as of the year 2021, we have a variety of braces that are mainly divided into:

Fixed Braces

Examples of fixed braces are: 

  1. Conventional/Traditional braces
  2. Self-ligating Braces 
  3. Lingual Braces
  4. Sapphire Braces

Let’s read in detail about the specifics of each type of braces under the fixed braces category.

1. Conventional/Traditional Braces

Conventional braces consist of brackets and wires. Traditionally, it existed as metal brackets and metal wires but as time progressed, they have come up with an aesthetic option now which is ceramic brackets and metal wires.

The metal brackets are made of titanium alloys. They are incorporated with a certain amount of nickel and/or chromium. Good metal braces must be created to be corrosion-resistant and biocompatible to prevent major discomfort to patients. Some patients have nickel allergies, thus it is important to inform your dentist before braces fixing or you can consider other alternatives such as using ceramic brackets. The brackets are attached to the teeth using cement.

As for the archwires in braces, they can be made up of stainless steel, nickel-titanium (NiTi) or copper NiTi depending on the type of movement needed for the tooth. The archwires are held on to the brackets using tiny elastic ligatures or “o-rings” which your dentist will change every time you come for an adjustment and you can choose the o-ring colours to make the braces more presentable.

How do these braces move teeth, you ask? Well, the brackets are placed at certain positions on each tooth depending on the type of tooth movement that is required, wire is adapted to the brackets by ligatures and eventually, the force produced by the brackets and wire will produce movement to the teeth.

These traditional braces are capable of fixing misalignment of teeth ranging from mild crowding or spacing to complex problems. Additionally, these traditional braces are the most noticeable type which may make some people self-conscious about their looks.

Price-wise, they range anywhere from RM4,000-RM8,000 in private clinics or universities, whereas at a public clinic (government clinic) or public universities, the price ranges from RM1,000 to RM6,000.

2. Self-Ligating Braces

These braces are almost the same as traditional braces in terms of their material but the mechanism in which it causes the teeth to move differs. They are known as self-ligating braces because instead of using ligatures or o-rings to attach wires to brackets, there are slides created on the brackets to ‘lock’ the archwires in. 

Self-ligating braces are again divided into active self-ligating braces and passive self-ligating braces based on the action of the brackets on the wire. One of the well-known brands of self-ligating braces is Damon Braces. Active self-ligating braces exert an active force on the wires; whereas as the name suggests, passive self-ligating braces do not exert force on the wires. Hence, passive self-ligating brackets, such as Damon brackets exert an even lower friction compared to its active counterpart.1

Self-ligating braces are known to be gentler on the teeth during the moving process due to less friction and hence lower force on teeth which makes them more comfortable to use. Due to this low-force and low-friction system, self-ligating braces allow multiple types of tooth movements to occur simultaneously, making it a much more efficient option as compared to the traditional braces. 

The oral hygiene maintenance with the use of self-ligating braces is easier since fewer attachments on the brackets help make the cleaning process easier. And since it does not use elastic ligatures that need replacement, it reduces the number of visits a patient does to the clinic to replace it, which reduces the chair time2.

Self-ligating braces are only available in private dental clinics, and the price ranges between RM7,000-RM12,000. 

3. Lingual Braces

Young woman showing lingual braces, close up

Lingual, derives its root word from Latin lingua which means tongue; and in medical terms lingual means related to the tongue. The term “lingual braces”, fittingly, is the type of braces that is fixed at the surface near the tongue, which is at the back of the teeth. Lingual braces are usually made of the metal brackets and can be either conventional type or self-ligating brackets. 

Lingual braces are discrete and well-hidden behind the teeth. Not only is it aesthetic, it does not damage the front surface of the teeth due to the bracket placement and removal. However, due to the placement near to the tongue, it could cause tongue discomfort and difficulty in eating and speech in the initial stages. The poorer accessibility can also make cleaning difficult and longer chairside adjustment time for the dentists.3 Interestingly, there is also some research suggesting that the treatment duration for lingual braces can be longer than the conventional braces4

Due to the different mechanics and accessibility, it requires a braces specialist to carry out this treatment. Lingual braces are case selective, and not meant for certain cases where the tooth length is short or cases where patients’ upper and lower front teeth do not overlap.3 Most of the lingual braces in the market now are custom-made for treatment efficiency. Due to the complexity of lingual braces treatment and lab cost, the price can range between RM16,000-RM18,000 and are only available in private specialist clinics. 

4. Ceramic Braces

Essentially, ceramic braces work similarly as metal braces. The difference is in the colour and material the bracket is made of. It comes in conventional form and self-ligating form. The brackets are made of ceramic which is almost similar to tooth colour, making it aesthetically pleasing and a popular option for patients who seek for a more discreet alternative to metal braces. However, the size of ceramic brackets are usually larger as compared to their metal counterparts, which could make cleaning slightly difficult. 

Due to the material, the price is a little more expensive as compared to the metal braces. It ranges from RM6,000-RM10,000 and is available in all private clinics except in government clinics.

5. Sapphire Braces

This braces is still quite new in the market. It is a type of ceramic brackets, made with lab grown monocrystalline sapphire which is highly translucent and allows light to pass through completely, directly adopting the patients’ tooth colour. This makes the bracket even more discrete as compared to the normal ceramic brackets, especially for patients who have teeth that are darker in shade. From afar, the sapphire brackets may make the teeth appear slightly larger due to the light refraction through the braces, but otherwise it is not noticeable. Although the wires used may be metallic, there is an option using PTFE spray-coated wires which camouflages the wire. 

The high translucency of the sapphire brackets and its material type allow better adhesion of the bracket to the tooth, resulting in less bracket detachment from the tooth surface. 

As these sapphire braces work the same way as the conventional/self-ligating braces, the treatment duration is almost the same as the conventional and self-ligating braces. 

Removable Plastic Invisible Braces

Just like the name, these braces are not visible to the eyes. Examples of these are lingual braces and clear aligners. Lingual braces have been discussed above. Now we will read in-depth about clear aligners and the available brands around us.

Clear aligners look like clear mouth guards but with the ability to move misaligned teeth into their perfect position. When you type clear aligners on the internet, a variety of brands and systems may come up which will make the choosing process rather tedious. So let me introduce some of the brands:

Invisalign

This was the first system of clear aligners in the market in 1997. A dentist takes a 3D digital scan of your teeth and maps out a treatment plan for you. Invisalign can correct mild to moderate teeth misalignment for all age groups. They will give you several trays to be replaced as ordered by the doctor. 

You are advised to wear the trays for a minimum of 22 hours a day to achieve the best outcome which is changed every week. Colourless attachments are fixed on the tooth to help with precise tooth movement. You can check out their page and have a free assessment to check if your teeth issue can be fixed by them. Their products range from RM12,000-RM20,000.

Orthocaps

This is another brand of clear aligners. 3D scans are taken of your teeth by a dentist and once the dentist figures out if your teeth misalignment can be fixed with Orthocaps, your treatment starts. 

Unlike Invisalign, Orthocaps will send you two sets of aligners, each to be used during the day and another for the night called DAYcaps and NIGHTcaps and they are to be worn for 2-3 weeks each. They are of different thicknesses. Once the phase is over, new impressions will be taken to create a precise fit for the next aligners.

Their price range is between RM7,500-RM33,500

become Invisible Braces

This particular brand follows a Direct-to-Consumer Alternative system which means you can do the assessment and communication via your smartphone. Once the assessment is done, you will get an appointment for a checkup and dental scan at one of their partnered clinic.

They will design and send the treatment plan to you via email for your review. After you make the purchase, the braces trays are sent to your doorstep.

You will wear each set of trays for 2 weeks and will have to wear it for 22 hours each day to achieve the best outcome. To update your progress, all you have to do is snap pictures of your teeth which will be specified by the dentist on the other end of the line. 

Their prices are also super affordable.

Plastic Braces vs Fixed Braces

Platics (Non-metal) Fixed Braces
Types Clear Aligners Lingual Braces

Metal conventional braces

Metal Self-Ligating Braces

Ceramic conventional braces

Ceramic self-ligating braces

Sapphire Braces
Case Selection Clear Aligners (Invisalign, Become) can manage mild to moderate complexity of teeth misalignments. These braces can manage mild, moderate and severe cases of misalignment. The exception being Lingual braces which is case selective due to the position of the brackets.
Aesthetics Yes, due to the ‘invisible like’ properties Ceramic and sapphire braces are popular options for aesthetic-concerned patients

Lingual braces are placed at the back of the teeth and hence are discrete and well-hidden

Metallic conventional braces are not aesthetic, though some patients look forward to picking colours for the ligatures or O-rings every treatment.
Comfort Research shows that Clear Aligners patients tend to have less discomfort compared to fixed braces patients during the initial stages of treatment. Some research suggests that self-ligating braces patients experience less discomfort compared to traditional braces7, although some find there is no statistical difference in comfort.

Lingual braces, on the other hand, could cause difficulty in eating and speech in the initial stages.
Patient Compliance As Clear Aligners are removable, hence it is highly dependent on the patient’s compliance to work. Poor compliance may cause treatment duration to prolong or inability to fit the subsequent set of aligners. In some cases, a rescan and a revision of the treatment might be needed. Patient compliance is important in certain stages of the treatment where patients need to place and change elastics.
Chairside Time Clear Aligners reduce patient’s visits to the dental clinics. In some systems, patients can be monitored by dentists through an app. Chairside time for lingual braces is longest due to the difficulty in access, followed by conventional braces and self-ligating braces.

Usually patients have to visit the dentist once a month (4-6 weeks) for adjustment and review.
Oral Hygiene Maintenance Clear Aligners being removable, makes cleaning and taking care of oral hygiene much easier. Extra oral hygiene care effort is needed as food will tend to lodge between the brackets during eating and plaque will form around the brackets. An interdental brush is needed to clean around the brackets.
Price Range RM5,000-RM29,000 RM4,000-RM18,000

What Type Of Braces Work Fastest?

One of the questions that concerns most patients when it comes to choosing braces is “which braces work fastest?”. Perhaps, a more precise question would be “which braces work best for me?”

Generally, clear aligners have been shown to work more efficiently than fixed braces. However, it only applies to mild to moderate cases that do not require tooth removal. When it comes to cases requiring tooth removal for space gain, clear aligners work almost 50% slower than the usual fixed braces. 

Self-ligating braces work 2-3 times faster in straightening moderate misalignment cases when compared to conventional braces. The light force mechanics allow multiple types of tooth movement to occur at once, making it more efficient. Hence, self-ligating braces could be a better option if cost is not of concern. 

According to the American Lingual Orthodontic Association (ALOA), the treatment of lingual braces could sometimes be longer than the conventional braces. However, in cases where clear aligners could not be an option due to the complexity of the cases, lingual braces could be an option for aesthetic-concerned individuals. 

The comparison of braces efficiency are all relative based on several other factors. Patient compliance when it comes to wearing the clear aligners will affect the treatment duration and even treatment outcome. Irregular attendance for review appointments for fixed braces patients will also prolong the treatment duration. The complexity of the cases and type of tooth movements required affect the choice of the braces and also the length of treatment. 

In general, mild to moderate cases are suitable for clear aligners which generally work faster than fixed braces. Become is one of the reasonably-priced Direct-to-Consumer Clear Aligners options that you may consider. You may book their free consultation to find out if Clear Aligners is for you. 

References:

  1. KM Shahul Hameed Faizee Frictional Characteristics of Active and Passive Self-Ligation Bracket Systems: An in vitro Study September 2011 The Journal of Indian Orthodontic Society 45(4):154-159 DOI:10.5005/jp-journals-10021-1028
  2. Harradine NW. Self-ligating brackets and treatment efficiency. Clin Orthod Res. 2001 Nov;4(4):220-7. doi: 10.1034/j.1600-0544.2001.40406.x. PMID: 11683811.
  3. Singh, P., & Cox, S. (2011). Lingual orthodontics: an overview. Dental Update, 38(6), 390–395.doi:10.12968/denu.2011.38.6.390 
  4. Ling PH, Lingual Orthodontics: History, Misconceptions and Clarification. J Can Dent Assoc 2005; 71: 99-102
  5. Mohamed JP, Kommi PB, Kumar MS, et al. Evaluating the Type of Light Transmittance in Mono Crystalline, Poly Crystalline and Sapphire Brackets- An Invitro Spectrofluorometer Study. J Clin Diagn Res. 2016;10(8):ZC18-ZC21. doi:10.7860/JCDR/2016/18599.8230
  6. Cardoso PC, Espinosa DG, Mecenas P, Flores-Mir C, Normando D. Pain level between clear aligners and fixed appliances: a systematic review. Prog Orthod. 2020 Jan 20;21(1):3. doi: 10.1186/s40510-019-0303-z. PMID: 31956934; PMCID: PMC6970090.
  7. Zhou Y, Zheng M, Lin J, Wang Y, Ni ZY. Self-ligating brackets and their impact on oral health-related quality of life in Chinese adolescence patients: a longitudinal prospective study. ScientificWorldJournal. 2014;2014:352031. doi:10.1155/2014/352031
  8. Scott P, Sherriff M, Dibiase AT, Cobourne MT. Perception of discomfort during initial orthodontic tooth alignment using a self-ligating or conventional bracket system: a randomized clinical trial. Eur J Orthod. 2008 Jun;30(3):227-32. doi: 10.1093/ejo/cjm131. Epub 2008 Mar 13. PMID: 18339656.
  9. Lai TT, Chiou JY, Lai TC, Chen T, Wang HY, Li CH, Chen MH. Perceived pain for orthodontic patients with conventional brackets or self-ligating brackets over 1 month period: A single-center, randomized controlled clinical trial. J Formos Med Assoc. 2020 Jan;119(1 Pt 2):282-289. doi: 10.1016/j.jfma.2019.05.014. Epub 2019 Jun 14. PMID: 31208826.
  10. Ke Y, Zhu Y, Zhu M. A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health. 2019;19(1):24. Published 2019 Jan 23. doi:10.1186/s12903-018-0695-z
  11. Pandis N, Polychronopoulou A, Eliades T. Self-ligating vs conventional brackets in the treatment of mandibular crowding: a prospective clinical trial of treatment duration and dental effects. Am J Orthod Dentofacial Orthop. 2007 Aug;132(2):208-15. doi: 10.1016/j.ajodo.2006.01.030. PMID: 17693371.

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