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Choosing between Fixed Orthodontics with Brackets and Removable clear aligners

On Friday, March 16th, 2018

You have finally decided that would you like to have your teeth straighten with braces.

There are many options on the market for patients to include :

Fixed braces either metal or ceramic or the more aesthetic option of having something more discreet like clear aligners.

In my practice I mainly use Invisalign for clear aligners and for the Fixed option I predominately use Damon Self ligating brackets.

The factors which can help you decide on which option to go for include :

  • Complexity of Treatment. For treatments that include extractions and rotational movements of teeth I tend to advise Fixed orthodontics.
  • Patients Lifestyle. For cases where both options are feasible I tend to ask about their social and work factors, any contact sports and availability to attend regular appointments.
  • Cost
  • Duration of Treatment. Is it important for you to have an idea of how long the treatment will take.

So what are the advantages and disadvantages of both options.

Fixed option

  • Capable of more complex tooth movements.
  • Cost : The treatment can be cheaper than clear aligners.
  • Compliance is not an issue since there are fixed and cannot be removed by the patient.
  • Treatment time is often quicker than aligners.

The disadvantages include:

  • Appearance of the brackets although you can also opt for clear ceramic brackets.
  • Eating. Certain foods are avoided to prevent the brackets debonding

Aligners have the advantages of :

  • Being clear and very cosmetic.
  • Can be removed to eat and drink.
  • Great for patients that travel and have a busy lifestyle.

Disadvantages are :

There are some limitations in what can be achieved. This is discussed at the consultation stage. However I have found that Invisalign can now successfully treat more cases compared to what it can achieve 10-12 years ago.

Compliance can be an issue. If you know you are one of those people that cannot stick to doing things then please don’t choose clear aligners. It needs to be kept in the mouth for 20hrs minimum daily.

I can give you examples of cases that have I seen recently in my practice and the advice which was given.

Case 1

A University student studying outside of London wants to have her teeth straightened.

On examination both aligners and the Fixed option are both suitable. Cost of each option was not a concern and the patient has not worried about anything cosmetic. She accepted that treatment time may take up to a year.

She was studying about 250miles away from home and perhaps came back home twice a term, which means every 6 weeks with a long summer break.

With this patient I advised to go ahead with the Clear aligners from Invisalign which seemed more practical for the patient. She did not have to worry about any breakages of the brackets or loose wires digging which can happen with Fixed brackets.

We could plan the treatment around her visits back home during half term and holidays.

Case 2

I have recently completed a case which involved extractions with some difficult movements. For this patient he needed it done before his wedding and wanted something cosmetic due to work and social reasons.

Due to the complexity and his cosmetic requirements we chose to go ahead with Damon Clear brackets.

Case 3

A 14 year old boy was referred to me by a colleague. He was declined treatment on the NHS since the crowding was mild.

The parents were concerned that he would not comply with anything removable and preferred something fixed.

They chose to go ahead with Damon Metal braces. The treatment time was just over 12months.

March 16, 2018

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