Seattle Insiders Guide to Incognito Braces Behind the Teeth

PNGThis patient displayed a dental Class II malocclusion and required extractions of her upper first premolars in order to retract her front teeth.  Photographs are obtained before treatment and after treatment. 
A few commonly asked questions are addressed below and for more information check out, 

 1.  Is there anything lingual braces can’t do that regular brackets can?

With the exception of a orthodontic treatment plan that involves orthognathic surgery, these Incognito lingual brackets can do anything that conventional braces can do.  In fact, these brackets in many cases are more efficient because the patients’ specific correction is built in to the brackets.  In the case of conventional braces the correction (prescription) that is built in to the bracket is for an average shape and size tooth and a generalized arch form (average patient).  This obviously does not get us to the final result because no one is “average” so at certain point the orthodontist starts to customize the wire and reposition the brackets in order to refine the tooth movements.  The custom system is more efficient because the Incognito bracket is manufactured to the post treatment setup, it is customized from day one and therefore is moving the teeth into the correct position from the first day these brackets are placed.

2.  I was told by 2 orthodontists that lingual braces aren’t as effective and they don’t move teeth very fast. (Only one of them has worked with lingual braces.)  Any comments?

In the 1970’s lingual orthodontics was popular for about 10 years.  They used stock brackets and did the wire bending by hand.  It was very difficult and treatment times were long.  Almost all orthodontists in North America stopped offering lingual orthodontic treatment.  (Lingual technique continue to progress in Europe and Japan).  Incognito was developed in Germany around 2000-2003, they applied modern technology to overcome and turn some of the limitations into benefits, shorter treatment time, more precision and predictable treatment results.  There is a dissertation that was done at UNC last fall by Dan Gauer that provides real evidence of the advantages of this customized lingual system.  Chapter 6 of this dissertation addresses issues related quality of the finished occlusion with Incognito and how accurately this custom bracket system moves the teeth to the initial setup position.

 3.  How many of your patients with lingual braces decided to change over to non-lingual braces because of discomfort, or any other issues?

I have only had one patient that could not tolerate the lingual brackets.  This patient had very specific oral anatomical issues; in general patient adapt very quickly.

4.  I was also told that if I had lingual braces on the upper row, with my deep bite, the lower teeth which are already damaged might get cracked or chipped even more.

I have not had a problem with damage to the lower teeth from occluding on the upper brackets.   In general you want to minimize contact with these upper brackets because the brackets will tend to debond (fall off the teeth) which slows the treatment.  You lose the advantages of the custom system when you get excessive breakage.  That is why the upper brackets are designed to have some occlusal coverage on the back teeth in order to keep the front teeth from hitting the brackets for the first few months.  I then grind away the coverage over the course of treatment as the teeth align they occlude with one another rather than lowers on the upper brackets.  The same thing happens with conventional braces, the only difference is the upper teeth hit the lower brackets when patients present with a deep bite.

5.  My right rear molar is covered with a crown will you be able to attach a bracket to that tooth?

We are able to bond lingual brackets to metal, ceramic or natural tooth structure.


These answers are provided by Dr Christopher Riolo you can find out more about Dr Riolo at his Google+ page and get more information about lingual braces on this blog.  For more information about getting the smile you have always wanted contact us and make an appointment with Dr Riolo.