PacificWest Dental

What are Lingual Braces? Everything You Need to Know About Them

Note: Article updated October 26, 2020

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Dental history is rich with fascinating information, much of which is unknown to the average person. Lingual braces trace back to the 1970’s with great advancements made each decade to bring us to the innovative and highly effective dental appliances in use in orthodontic clinics around the world today.

What are Lingual Braces?

Lingual braces are dental appliances that have been specifically designed to address tooth and bite alignment problems while remaining hidden from view. These orthodontic appliances are placed within the inner portion of the teeth to assist with tooth, jaw, and bite correction.

Lingual braces have gained in popularity throughout the years because they are more comfortable for patients undergoing orthodontic treatment. In addition to this, since they are worn inside the teeth, they do not affect the patient’s outer appearance.

The History of Lingual Braces

Lingual braces, orthodontic treatment appliances that are sometimes referred to as inside braces, are placed behind the teeth (by the tongue and palate), rather than in front, and therefore offer a great cosmetic alternative for those who want their teeth straightened, without the braces showing. They were the original “invisible braces” and are still arguably the least noticeable orthodontic appliance available today.

Here is the path that leads from the invention of lingual braces to their present use in orthodontic clinics today:

Lingual braces were invented in the 70’s

Developed in the 1970’s, lingual braces pre-date Invisalign by 20 years. Their development was motivated by the increase in demand for a more aesthetic option to suit adults seeking orthodontic treatment. At the time, clear braces were still in their infancy stages and had one significant drawback: the problem of staining. In 1967, Dr. Kinya Fujita from Japan was the first person to submit the concept of lingual braces to his colleagues, but it was Dr. Craven Kurz from Beverly Hills who first designed an entire bracket system. The patent for the Kurz Lingual Appliance was filed on November 15, 1976. With the help of Omrco, a company in California that makes orthodontic appliances, Dr. Kurz’ lingual braces went into production in 1979. These became the first commercial lingual braces.

Prior to the invention of lingual dental appliances, patients requiring tooth alignment or bite corrections had only one option to choose from: the standard set of metal braces. Lingual braces were similar to their metal counterparts with one key difference: they were attached to the inside of the teeth instead of the outside. This increased the popularity of lingual braces since a person’s external appearance would remain virtually unchanged during the teeth straightening process.

Traditional metal braces are fastened in place through a metal bracket that is anchored to the middle of each tooth. Wire is wound through these anchors to secure the teeth in the correct position to allow straightening to occur. This system of wires and metal anchors is referred to as “brackets.”

Lingual braces achieve the same result as traditional metal braces but through slightly different means. Though they are still constructed of metal, they are placed on the inside of the teeth, forming a barrier between the teeth and the patient’s tongue. Because there is less space on the inside of the mouth than on the outside, the bracket and anchor system had to be adjusted to accommodate the space while still achieving the same result.

The process of installing lingual braces begins with taking an impression of the patient’s mouth. Once this is done, metal posts can be designed for application to the back of each tooth. These posts typically cover the entire surface of the tooth and are secured in place through a special glue. Most typically, they are silver or gold in hue. Each of these metal coverings contains brackets and wires that help move the teeth into the correct position gradually.

Experts agree that the impetus for the development of hidden braces occurred in the 1970’s when influential figures such as celebrities and politicians desired better looking teeth without the hassle and visual distraction of metal braces. Dr. Craven Kurz and Dr. Jim Mulick have been credited with being the first to establish a viable lingual braces prototype in 1975.

This original set of prototypes was not without its problems requiring correction. Early wearers of these devices complained of irritation of the tongue and frequent rupturing of the brackets. To solve these problems, the braces were installed within the teeth on an inclined plane.

Most commonly, lingual braces, like their metal counterparts, are constructed from stainless steel. However, sometimes, they are fabricated from titanium.

In 1976, Dr. Kurz filed for a patent. Once received, production of lingual braces began in earnest in 1979 by a company known as Ormco. Throughout the next 50 years, the Ormco production line would move through seven different versions of lingual braces before finally arriving at the current model in use today.

Lingual braces were once so popular that they were featured in all major media forums

Within only a period of two years after production of lingual braces began, this innovative dental appliance had already been featured in many major magazines and broadcasted on both television and radio. The interest in this new orthodontic product was called “lingual fever,” a sensation that a spread as far as both Europe and Asia. This phenomenon reached the peak of its success in 1986. By that time, Ormco had sold more than 18,000 cases of lingual braces. The development team was forced to provide an appliance for wide-scale use as quickly as possible. Unfortunately, the beta-testing was never completed, and the product was rushed into the market prematurely.

Lingual braces were almost completely abandoned by the orthodontic community in North America

Following the initial excitement over lingual braces was a period of disappointment and frustration. Orthodontists were not happy with the product as it was not able to obtain the same level of finish they expected from regular braces. Furthermore, truly stain-free clear braces were introduced around the same time. These provided a viable alternative to metal braces. This was the last nail in the coffin for lingual braces. The original task force of Omrco that once had over 1000 orthodontists involved in the production process was reduced to just three members in 1988.

Why Lingual Braces Take More Work

Though lingual braces do involve more work, they are still one of the most popular dental appliance options for patients in need of orthodontic treatment today.

Here are several reasons why lingual braces may take more time but are still well worth the effort:

Lingual brackets and wires are 100% customized for each patient

The outside surfaces of the teeth are smooth and generally vary little from person to person. Therefore, orthodontists may use pre-made, stock appliances for outside braces. The inside surface of a person’s mouth, however, has a lot of irregularities. It is so unique that customized brackets and wires are needed for each patient in order to obtain the best results.

This was a huge challenge in the early days of lingual braces and required intensive laboratory service to set up each case. The invention of digital CAD/CAM technology greatly simplified the customization process. Each set of brackets is designed and manufactured to fit each tooth perfectly. The archwires are built with the final (desired) position of the teeth in mind. Finally, extremely precise bends are placed in the archwire by a wire bending robot. Because the brackets and wires need to be customized, lingual braces usually cost about twice as much as traditional braces.

Lingual braces require specialized training, and thus, are not available in all clinics

As previously mentioned, lingual braces were almost completely abandoned by the orthodontic community in North America. While the research and development of lingual braces continued in Europe and Asia, it was not until the early 2000’s before lingual braces were reintroduced in the North American market again. Even today, only a small sampling of graduate schools provide training for lingual braces, and many orthodontists graduate without having treated any patients using this type of orthodontic appliance.

Dr. Wang was an early adopter of the lingual braces technique, having promoted and used the product for over 20 years. As such, he is not only an expert in lingual braces, he also teaches the subject at the graduate orthodontic program at UBC. Being a UBC alumnus, Dr. Lee was one of the students who treated patients using lingual braces under Dr. Wang’s supervision.

Why Some Patients Choose Lingual Braces

Though many patients are not familiar with lingual braces when first approached with this type of treatment, they quickly warm to the subject when they realize the many benefits they can enjoy.

These include:

Invisible appearance

One of the biggest advantages of lingual braces is the fact that they are barely visible externally since they are attached inside the teeth. This is an excellent option for teenagers or working professionals that may feel uncomfortable by the change in their appearance and manner of speech as a result of traditional metal braces. They are popular amongst many celebrities and public figures because of their discreet appearance. Miley Cyrus is but only one famous person that made use of lingual braces to improve her smile and correct dental irregularities.

Lingual braces also ensure that if any discolouration or white spots result from braces that these are on the inside of the teeth and not the outside.

Viable alternative for those with plastic sensitivities

For patients that are not suited to hidden dental appliances such as Invisalign due to sensitivity to plastic orthodontia, lingual braces offer the perfect solution.

Top choice for athletes in contact sports

Those who enjoy contact sports would be at greater risk of mouth injury if a blow was taken to the mouth and they were wearing traditional braces. Since lingual braces are inside the teeth instead of on the outside, they are hidden and protected.

Always working

Clear aligners like Invisalign are becoming immensely popular due to their effectiveness and hidden appearance. However, removable aligners are not for everyone, as some people may struggle to consistently wear them, either due to inconvenience, or forgetting to pop them back in after a snack or meal. Lingual braces are permanently attached to the teeth during treatment, so the temptation to remove them is not a factor. This means treatment will not be slowed or ineffective due to poor habits.

No irritation of the gums

Since lingual braces are found on the inside of the teeth, they do not rub against the gums, and thus, leave the patient free from common irritations such as rubbing, bleeding, or abrasions.

Other Considerations for Those Considering Lingual Braces

For patients considering lingual braces, it’s important to understand the potential disadvantages to this product.

Among the problems patients may face after having lingual braces installed are:

Food restrictions

Certain foods are incompatible with lingual braces and are best avoided. These include the following:

  1. Whole apples
  2. Beef jerky
  3. Raw carrots
  4. Corn on the cob
  5. Sticky candy
  6. Bagels
  7. Crusty bread
  8. Popcorn

Dental professionals recommend that wearers of lingual braces choose a diet that is comprised of soft, clear-coloured foods whenever possible.

Speech difficulties

Adding anything to the inside or outside of the mouth means an adjustment period will be necessary. In the initial days following lingual braces application, the wearer’s speech may be affected. The tongue can become irritated, causing the person’s natural inflections and pronunciation to become blurred. As the patient becomes more accustomed to the appliance, their speaking typically returns to normal.

Generally speaking, speech problems from lingual braces disappear within a matter of days or weeks at the most.

Costs vs metal braces

Unfortunately, one of the main drawbacks to lingual braces for many people is the cost. Because the product is completely customized for a perfect fit for each individual, the expense is dramatically higher than that for traditional metal braces. For patients whose dental plans do not include lingual braces or who do not have dental insurance, it is well worth inquiring about the possibility of a payment plan.

Sore tongue

As the patient speaks and eats, they will experience soreness of the tongue from rubbing up against the new dental appliance. This is most common during the first few days of having the appliance installed. During this time, patients may experience pain and even the development of sores. To help alleviate the discomfort, patients can gargle with saltwater or make use of an over the counter product designed to relieve the pain from mouth sores or general oral discomfort.

Experts also recommend the use of orthodontic wax over the areas of the brackets that are prone to cutting the tongue. Silicone pads are also an excellent option.

Extra cleaning required

The braces located on the back of the teeth easily trap food particles and plaque. This means extra cleaning is required to keep the mouth and teeth completely clean. The best approach to thorough dental hygiene is to make use of an electric toothbrush and dental floss to get into hard to reach places.

Dr. Wang’s Experience Wearing Lingual Braces

To thoroughly understand the intricacies of wearing lingual braces, Dr. Wang had the appliance applied to his own teeth for a period of time. Learn more about his experiences in this great article: https://pacificwestdental.com/eating-cleaning-and-emergencies-with-my-lingual-braces/

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Dr. Wang, DDS, MSc, FRCD(C)
Orthodontist
Dr. Kevin Lee, DMD, MSc, FRCD(C)
Orthodontist