Q: Would that treatment plan be as effective using braces behind the teeth as conventional braces?
A: Custom made brackets are more efficient than standard stock brackets that are mass produced for the "average" person. The standard prescription in the stock bracket is not ideal for any individual. It is produced to be as close to the correct prescription for the greatest number of patients and thereby is correct for no single individual. Theoretically, custom lingual is more efficient especially in terms of treatment time and precision. The literature show this and I have noticed a difference clinically; that being said it is possible to get an excellent result with either product.
Q: If we chose incognito braces for the top teeth, and braces on the front of the teeth for the bottom teeth, would the treatment time be longer than
lingual braces top and bottom.?
A: I am not sure there would be a significant clinical difference between 1 arch and 2 in terms of treatment time. You should think in terms of aesthetics versus cost.
Q: Does building up the molars with composite help his front teeth avoid hitting both lingual & frontal braces?
A: Yes the buildups on the back teeth keep from biting lower brackets on the outside and the upper brackets on the inside, so you need them with both systems. With the Incognito system you can modify the bracket design to avoid biting on the brackets in the opposing arch therefore composite buildups are not usually needed.
Q: Is it best to get your teeth cleaned before you get braces?
A: It is important to have the teeth free of plaque and calculus anytime you delivering braces but it is especially important when fabricating and delivering a custom bracket system such as Incognito. We want the teeth free of both plaque and calculus before both the impression appointment and the bracket delivery appointment so that we can minimize the chances for distortion in the fabrication of the brackets and contamination during the cementation of the brackets. It is also important not get have had a fluoride treatment in the last couple of weeks before bonding the brackets, as fluoride can decrease the bond strength and lead to increase chance of bracket failure. The efficiency of the custom bracket system is predicated in part on the ability to keep the brackets on. Excessive bond failure can result in increased treatment time as well as reduce precision in the finished result.