Which brace is better?

On Saturday I attended the British Lingual Orthodontic Society (BLOS) spring meeting. (For those who don't know lingual orthodontics is the treatment of misplaced teeth using braces that are attached to the back of the teeth, rather than the front.) I am a committee member for BLOS and having helped with organising the meeting I'm pleased to say it was a really great day.

The meeting was fully subscribed showing a growing interest in lingual orthodontics in the UK (plus there were some European delegates). The venue was the Four Seasons Hotel at Canary Wharf, who were incredibly helpful and provided some amazing food during the breaks, especially the chocolate themed afternoon coffee break (yes dentists eat just as much chocolate as anyone else!).

This meeting brought together some of the best lingual orthodontists in the world, with practices in Paris, Berlin, Italy and Tel Aviv. Many of these ONLY use lingual braces! Each spoke about the lingual system of their choice with reasons why they preferred it over another. There were lots of clinical cases showing some fantastic treatment results and many happy patients. Each system has its own advantages and disadvantages, but there were a few things that really came over as a whole.

• Lingual orthodontics is in demand. The number of people wanting treatment that is rising and as orthodontists we need to be able to select braces that will get the result the patient wants as aesthetically as possible.
• If we, as orthodontists, do not get interested in lingual treatment we risk getting left behind. The UK may be behind other countries but we do follow the same trends eventually.
• Technology is becoming increasingly important. Most of the systems demonstrated used advanced Cad-Cam technology to plan and manufacture the braces. This makes it easier for the orthodontist to plan treatment, the patient to see the potential result, and gives greater accuracy of the braces and the final result.

But the thing that really came over, and was stressed by Dr Silvia Geron, is something that probably applies to all orthodontic treatment. It is not the 'system' that gives a really good result. It doesn't matter whether you choose Harmony, Incognito, eBrace or any of the other lingual systems, as the final result is in the hands of the orthodontist. It's down to how we assess, plan and use the braces that is important, rather than a specific brand. The skill and experience of the person doing the treatment is what really makes the difference between a good result and a fantastic result.

Too Old for Braces?

Prospective clients often use the phrase 'at my age...' or 'I thought I was too old for braces'. So I thought I'd have a look at who my 'typical' adult patient is.

You might be surprised to hear that last year more than half (59%) of my patients were aged 17 or over. The proportion is growing each year, when I started the practice in 2006 adults made up about a third of my clients. I think this reflects both the growing demand for cosmetic dentistry and the availability of more aesthetic types of braces. It's probably not so surprising that women make up 70% of my clients, but the proportion of men seeking treatment is also growing.

The mean age of my adult clients when they started treatment was 38, but this doesn't really tell the full story. My oldest client was 66, with the biggest proportion being the 30-44 year olds, but nearly a third being aged 45 or over. There is no age limit to braces, though the treatment plan may need to be modified depending on missing teeth or dental disease, and sometimes combined with other dental treatment like whitening, crowns or implants.

The types of braces used also reflect the wish of adults to keep treatment as discreet as possible. For teenagers it's quite acceptable to wear metal fixed braces and they often decorate them with bright colours. Whilst a few adults will opt to have this type of treatment I usually use more aesthetic treatments instead. For many years aesthetic fixed braces were considered inferior but modern braces are virtually equivalent so I rarely offer standard metal braces to my adult clients.

The choice of braces is determined both by the problem and the type of tooth movement to be carried out, and the preference expressed by the patient. Standard, or labial fixed braces are attached to the front of the teeth, usually using ceramic brackets which blend fairly well with the teeth. This is the simplest treatment and is often chosen over other, less obviously visible brace types for reasons of time, cost and comfort, which is why it makes up half of the treatments I carry out. Clear aligners are mainly Invisalign, removable clear braces that are virtually invisible. Lingual fixed braces like Incognito are fixed to the back of the teeth so they can't be seen at all, they are perhaps less popular due to cost and worries about comfort, but it's probably the biggest growing area in orthodontics at the moment.

So if you don't notice adults with braces every day, it's probably not because adults don't have them - just that these invisible treatments are often very hard to see!

The truth is, I don't have a 'typical' adult patient. I treat people of all ages, from all walks of life - some of whom travel quite a distance - for all sorts of problems. And I'm happy to say I have a range of skills and treatments available, so I can usually find a treatment to suit each person: it's all part of your assessment, when we sit down together and chat about what you'd like to do. 

It's actually quite common for adults to take action to get the smile they want. So if you'd like to pop in and see us, please do get in touch.