Invisible orthodontics, Esthetic brackets

Dental and facial esthetics is considered a new paradigm in diagnosis and planning for orthodontic treatment .Patient demands for esthetic orthodontic treatment outcomes have grown to include esthetic appliances during treatment. Efforts have been made to increase the esthetic quality of orthodontic appliances. Bands with attachments evolved into bondable brackets. Bondable brackets were produced in ceramic and plastic. Coated, tooth colored wires that more closely resemble natural tooth color can be used during part of the treatment period. Although less visible, lingual orthodontic appliances have some popularity. More recently, plastic trays were developed to gradually align the teeth. Although these trays are less visible, there appear to be limits to the types of malocclusion that they can efficiently correct . Ziuchkovski et al examined appliance attractiveness and found a hierarchy of appliance types: alternative appliances (clear trays and lingual appliances)were found most acceptable followed by ceramic appliances; all stainless steel and self-ligating appliances, with a few differences in each type of appliance. Furthermore, acceptability of appliances can also be determined by attractiveness, esthetic, comfort, economic value to the patient. This concept was explored by Parekh et al when evaluating smiles and attractiveness. 

ceramic aesthetic brackets 

As the number of adults seeking orthodontic care increased, orthodontists felt the need to provide their patients with more esthetically appealing appliances. This perceived need motivated manufacturers to provide acceptable esthetic brackets. The material that Orthodontists selected for esthetic brackets was Ceramic as the Dentists are familiar with its resemblance to dental enamel.

Ceramic Brackets After their introduction in 1986, various types of ceramic brackets are currently available by all major orthodontic manufacturers , thus gaining widespread popularity and becoming an integral part of the clinician. All currently available ceramic brackets are composed of aluminum oxide. However, because of their distinct differences during fabrication, there are two types of ceramic brackets, namely, the polycrystalline alumina and the single crystal alumina .The manufacturing process plays a very important role in the clinical performance of the ceramic brackets . Because production of polycrystalline brackets is less complicated, these brackets are more readily available at present . The most apparent difference between polycrystalline and single crystal brackets is in their optical clarity. Single crystal brackets are noticeably clearer than polycrystalline brackets, which tend to be translucent. Fortunately, both single crystal and polycrystalline brackets resist staining and discoloration

At the beginning esthetic production, there were transparent brackets made of ceramic or composite but the archwires were still made of metals such as titanium molybdenum alloy, nickel titanium, or stainless steel. Recently, coated metallic and fiber-reinforced wires have been introduced to solve esthetic appearance problem . Fiber-reinforced wires are experimental and not universally commercial available, there are good expectations from them for the future . Coated esthetic wires are the only esthetic archwire available for usage. Materials used for coating are plastic resins such as epoxy resin or synthetic resin . Teflon coating improves esthetics but has some disadvantages. But there are controversial studies in the literature. When the frictional manner of coated archwires was compared with non-coated archwires by the same manufacturer, coating was found to have an effect in decreasing friction. In contrast, a similar study described coating as undurable . Elayyan F et al found that, when coated, the colored wires are damaged from mastication forces and enzyme activities in the oral cavity . Lim KF et al. encountered difficulties with these coated archwires, expressing that the color tends to change with time and the coating splits during usage in the oral cavity, exposing the underlying meta

Lingual Orthodontics With invent of lingual appliances an entirely new treatment biomechanics emerged. Orthodontists are also determined towards this goal and have given a new dimension by changing from the labial to the lingual so as to give rise to a new concept the Invisible Braces concept or Lingual Orthodontics. Due to increasing social awareness and esthetic demands of young patients , the application of lingual orthodontics today is not only restricted to adults, but has been extended to adolescents as well 

Orthodontic treatment is mainly surrounded with metals like wires and brackets. This esthetic compromise repels adult orthodontic patient from accepting treatment. Tooth colored brackets and wires tried to overcome these limitations but could not proved to be good option to metals because of its bulk, and cost. In last few decades lingual orthodontics has gained worldwide popularity in terms of esthetics but its widespread use is restricted because of complexity in bracket positioning, treatment mechanics, limited access to the lingual / palatal surface and cost. In addition, bracket bonding procedure endangers the precious enamel to chemical insult, making it unaesthetic and susceptible to microbial attack. So, clear aligners have emerged as a promising option for adult orthodontic patients .

Therapy is an orthodontic treatment modality in which the patient wears a series of customized clear, removable aligners that gradually moves the teeth to a desired position. The total number of aligners varies depending on severity of malocclusion. Clear aligners do have some limitations and inconveniences. The benefits of Clear Aligner Therapy generally outweigh the drawbacks . Clear aligner treatment falls into two basic categories. The first category consists of those thermoformed appliances, sometimes known as Essix Retainers, that are fabricated by making adjustments to the tooth positions on plaster or stone models and fabricating one or more aligners to correct a minor malocclusion . These types of appliances are sometimes fabricated in the orthodontist’s office or sometimes sent out to commercial laboratories. These types of in-office prepared aligner systems have been in use since around 1994. Invisalign is a proprietary orthodontic technique that uses a series of computer generated custom plastic aligners to gradually guide the teeth into proper alignment

clear aligner (invisalign system ) 

Invisible orthodontic appliances are among the latest entrants in the range of orthodontic appliances. Clear aligners like the Invisalign have increased acceptance from adult patients due to the acceptable asthetics. These products are full-coverage, clear and removable, and are used standalone or following the use of fixed orthodontic appliances. Clear aligners are also more comfortable to the patients and leads to less periodontal inflammation than fixed braces. However, such appliances only address minor to moderate misalignments and cannot treat severe conditions, thus serving only a fraction of the orthodontic patients. 

Increasing marketing by the manufacturers of invisible orthodontics has raised awareness of the public regarding this option. Furthermore, technological advancements such as CAD/CAM have made orthodontic procedures faster, more efficient and simpler, while ensuring better treatment outcomes. This will also make way for more and more dental laboratories and clinics becoming able to offer clear aligners. Experts are optimistic about the future of invisible orthodontics and the dental appliances market, overall. With faster treatment procedures, and containment of material costs, dental laboratories are already becoming able to serve dentists at better prices. Emerging regions such as Asia Pacific and Latin America are already witnessing entry by the market players with their breakthrough products that already have stronghold in North America and Europe. In the future, it is anticipated that technological advancements, improving awareness about asthetics and increasing disposable incomes, invisible appliances will become frontrunner in the field of orthodontics.

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