Smiling Through by Elvira Maricic Today's braces are clearly less visible than they used to be print article      send to a friend

A Wire Runs Through It

Clear braces first appeared 15 years ago--about five years too late for Tony's mother--and they haven't changed much over time.  And even though they're called "clear," they're still visible. "They're pretty much like they used to be," says George Souris, DDS, DMD. "They're made of porcelain or plastic, and they're clear, but if you get into close enough range, you can tell that there's something there. They work better, they stay on the tooth better, and they're a little easier to work with, but the materials haven't really changed," he says.

"What they haven't been able to do yet is come up with a clear wire, in other words, a wire you can't see," adds the Cleveland, Ohio, orthodontist. "Now, when you see somebody with clear braces, you can still see a thin metal line running through them, which is the wire that straightens the teeth."  

The fact the that braces aren't completely invisible seems to be lost on Tony Gray. "I like them, and my friends don't say anything," he adds. It's all a mother could wish for.

Looking for Less

Unfortunately, not everyone is as easy to please as a 10-year-old boy is. According to the American Association of Orthodontists, some 400,000 adults are now starting orthodontic treatment yearly. While clear braces are popular with many of these patients, for some of them, even the visible supportive arch wire is more than they'd like to share with the world. "A lot of adults want their teeth straightened, but they just don't want the hassle of braces, whether clear or regular," says Dr. Souris. "They say, if you can straighten my teeth with anything but braces, I'm willing to do it, but I'm not going through braces."

Until recently, the only other options these patients have had were lingual braces--metal-and-wire braces that are affixed to the back of the teeth and out of sight.  However, these braces have a downside. "The control of the teeth is much more difficult from the inside versus the outside, because the inside of the mouth is a much smaller area," says Dr. Souris. In addition, many patients complain that their tongues receive cuts from these braces. "I think lingual braces started off as the hot thing and they've cooled off because they've never gotten to where they need to be," he adds.

Today, adult orthodontic patients have yet another "barely there" treatment option, in the form of a clear, polymer plastic retainer, called the Invisalign SystemT, which somewhat resembles the wax fangs children pop into their mouths at Halloween.

According to Align Technologies, the maker of Invisalign, treatment with the system begins with an orthodontist taking an impression of a patient's teeth and pouring up a mold. The orthodontist sends the mold, along with a diagnosis and treatment plan, to Align. The company uses computer software to generate a series of 3-D images that represent the patient's teeth moving from their original, untreated state to their final, treated state, as prescribed by the orthodontist. The orthodontist reviews and approves the treatment based on the series of computer-generated images. The company then produces a series of customized, clear polymer orthodontic aligners, and sends them to the orthodontist. The orthodontist uses the customized aligners to treat the patient, and tracks the patient's progress through office visits.

Patients wear each aligner for one to two weeks before switching to the next one in the series. The aligners can be easily popped out for meals and for daily oral hygiene. The system is effective in treating mild to moderate crowding and space closure cases, but because it's not designed to treat patients with mixed dentition and/or growing palates, it's not appropriate for children.

A Moving Experience

"Now I can move patients' teeth without using braces," says Dr. Souris, the first orthodontist in Cleveland to be certified in the relatively new procedure. "We take a very accurate mold of the teeth, and send it to the company. I dictate how I want the teeth moved, and they three-dimensionally laser scan the mold, get it in the computer, and move the teeth three-dimensionally in the computer a quarter of a millimeter at a time. Then they go backwards, recreate a model, and create a clear plastic aligner, which is like a retainer. They go back in, move it some more, create another aligner, and every two weeks the patient is given a brand new set of plastic clear aligners that move their teeth without braces.

"Patients actually get to see a computer movie of their teeth being moved before they even move," he says. "You can't do anything really heavy or severe [with the Invisalign system] but you can treat mild to moderate cases involving just a straightening of teeth without ever having to use braces.

"Treatment lasts just the same as with traditional braces," Dr. Souris notes. However, at an average cost of $6,000, it's at least $2,000 more that the cost of traditional braces. "Obviously, you're paying for technology, so it's a higher price tag, " he says.

But how many patients would be willing to pay that amount for something that can barely be seen? According to research by the makers of Invisalign, 50 percent of adults ages 25 to 49 wish their teeth were straighter and are willing to do something about it. And of that 50 percent, 66 percent say they would choose a product like Invisalign, despite its price tag.