Contributed by a Rotarian (Classification: Orthodontist)

In a modern city like Hong Kong, people are very conscious of their appearance. Bright and shiny smile and perfect white teeth contributes a lot to one’s appearance.

The conventional braces (fixed orthodontic appliance) has been used for the last one hundred years to line up crooked teeth and make favorable changes to facial profile. However, there is one big drawback to the conventional braces that it is very conspicuous during treatment (Figure 1) With wires and brackets in one’s  mouth, it is hard not be noticed. This has deterred many from seeking orthodontic treatment. In the last few years, many advertisements claim new treatment methods move teeth with invisible braces which removes the inconvenience and ugliness of having wires and brackets on teeth.

Figure 1

The most commonly known invisible braces e.g. Invisailign (Figure. 2) which was developed in United States, uses a sequence of plastic shells and mould teeth in a gradual manner. Being transparent and removable, it has very good esthetic qualities. Nevertheless, it has some inherent inadequacies. Being a plastic shell, it has no firm grip on teeth which means some of the movements can not be easily achieved with the desired force level to a  precise position. The correction of the relationship of upper teeth and lower teeth is also difficult in most cases. Thirdly, It is very important to wear the shells consistently in order to achieve the desired effects. .This renders patient cooperation vital during treatments and  children who are not motivated to have their teeth straightened may not be the best candidate for such treatment. This kind of braces with its inherent deficiencies and inaccuracies may become less effective in patients with complicated treatment  goals e.g. in patients with very crooked teeth or who wishes not just to line up their teeth but also to  improved facial profile.

Figure 2

There is one more type of true invisible braces which is based on the traditional braces with the difference that everything is being done from the inside (Figure 3). All wires and brackets are hidden from people’s view and located near the tongue instead of the cheek.  hence the name Lingual Orthodontics. It still uses the traditional wires and brackets to generate pressure so teeth would move to its desired position. It achieves good results with minimal embarrassment to patients but at a premium fee as brackets are made of gold alloy (so it can remain thin and comfortable) and wires are custom made by robots.

Figure 3

All these are tools dentists use to move teeth. Lately, there are many litigations and charges being raised by patients who either are not satisfied with the results generated or worse still suffered injuries due to negligent care by inexperienced dentists and you might have read it in newspaper. It is quite common for teeth to be extracted or trimmed to properly align teeth or improve facial esthetics. But such invasive procedure can only be justified with a clear treatment goal and proper procedure to ensure such sacrifice brings merit to overall dental health and esthetics. It is obvious that when one seek dental or medical care, one should not be drawn by sales pitch from newspapers or fashion magazines. Rather one should seek out reputable and experienced professionals to provide the best possible care .