Types of Orthodontic Appliances: Fixed Brackets, Lingual Appliances, Clear Aligners and Mini-screws
Orthodontic appliances are divided into fixed appliances that stay attached to the teeth and removable appliances that you put in and take out yourself. Fixed appliances include metal, ceramic and resin brackets and lingual brackets attached to the inside of the teeth, and the main removable appliance is the clear aligner. The Korean Association of Orthodontists (KAO, 대한치과교정학회) explains that each appliance has advantages and disadvantages, and that an accurate diagnosis and treatment plan decide the result more than the appliance itself.
Key facts
| Bracket materials | Metal, ceramic, resin (source: Korean Association of Orthodontists) |
|---|---|
| Lingual brackets | Attached to the back of the teeth (tongue side), so not seen from the front (source: Korean Association of Orthodontists) |
| Clear aligners | Removable transparent plastic, worn most of the day except for meals and brushing (source: Korean Association of Orthodontists) |
| Orthodontic mini-screws | Developed in Korea around 1998, placement within 5 minutes, local anesthesia (source: Korean Association of Orthodontists) |
| Appliance classification | Removable appliances that go in and out, and fixed appliances attached to the teeth (source: Seoul National University Hospital medical information) |
How do fixed and removable appliances differ?
A fixed appliance has brackets bonded to the tooth surface and transmits force with wires and elastic bands. It is not removed until treatment ends, so there is no need to worry about wearing time, but you must clean carefully around the appliance to prevent cavities and gum inflammation.
A removable appliance is one the patient can put in and take out. The clear aligner is the typical example, and appliances that guide jaw growth in growing children or widen the dental arch are sometimes also made removable. Because it can be taken out and cleaned, hygiene is easy to manage, but if the time it is in is insufficient, treatment does not proceed as planned.
Seoul National University Hospital's medical information says the most widely used method is the fixed appliance using brackets.
How do bracket materials and systems differ?
Metal brackets are a long-used appliance, small and strong. Ceramic and resin brackets are close to the tooth color and so less noticeable. With any material, the principle is the same: a wire is placed in the brackets to move the teeth.
A self-ligating bracket holds the wire with a cover on the bracket instead of tying it with an elastic ring or thin wire. The Korean Association of Orthodontists explains that self-ligating brackets and clear aligners cause relatively less pain and discomfort.
Lingual brackets, attached to the tongue-side surface rather than the outer surface of the teeth, are almost invisible from the front. However, because they are where the tongue touches, it takes time at first to adapt to speech and the foreign-body feeling.
When are orthodontic mini-screws used?
To move teeth only in the desired direction, you need a firm point of support (anchorage) on which to apply force. An orthodontic mini-screw is a small screw placed after local anesthesia into the jawbone around the teeth, and it acts to hold so that other teeth do not follow along unnecessarily.
The Korean Association of Orthodontists explains that mini-screws were first developed in Korea around 1998, that placement takes under 5 minutes and that there is almost no pain or bleeding. When the desired movement is finished they can be removed without anesthesia, and the gum recovers in about a week.
They are not needed by every patient, but are often used to get a good result. If inflammation develops from poor cleaning around them, they can loosen or fall out.
What appliances are used for children in the growth period?
In the growth period, not only the arrangement of the teeth but also the growth direction of the jawbone and the space for permanent teeth are dealt with together. Various appliances are used according to purpose, such as appliances that widen the upper jaw, appliances that guide jaw growth, and appliances that hold the space where a baby tooth was lost early.
The orthodontic items covered by health insurance for cleft lip and palate patients in Korea also include stage-by-stage appliance treatments such as arch expansion orthodontics, orthopedic orthodontic treatment and fixed orthodontics for aligning the upper front teeth. Which appliance to use and when is decided by looking at the stage of growth and the pattern of malocclusion.
How do I choose an orthodontic appliance?
The Korean Association of Orthodontists recommends consulting an orthodontist thoroughly and getting a recommendation, because each appliance has advantages and disadvantages and the suitable appliance differs by case. It also stresses that the appliance does not decide the orthodontic result, and that what matters most is carrying out the diagnosis, treatment plan and long treatment process carefully.
When choosing, consider, besides appearance, the type of malocclusion to be treated, whether teeth are extracted, your lifestyle, your ability to keep up hygiene care, and the cost. The interval between adjustment visits and what to do if the appliance comes off also differ by appliance.
- How noticeable: metal < ceramic and resin < lingual and clear
- Hygiene care: clear aligners can be taken out and cleaned
- Cooperation: with clear aligners, wearing time decides the result
- Scope: clear aligners are hard to apply to some malocclusions
Common myths and facts
Myth: The more expensive the appliance, the better the orthodontic result.
The Korean Association of Orthodontists explains that the appliance does not decide the result, and that an accurate diagnosis, planning and a careful treatment process matter most.
Myth: A mini-screw is major surgery.
The Association explains that it is placed within 5 minutes after local anesthesia, with almost no pain or bleeding, and removed without anesthesia.
Frequently asked questions
Are ceramic brackets weaker than metal ones?
Characteristics differ by material, but the treatment principle is the same for any material. Biting hard food can make any bracket come off or break, so avoid hard foods while the appliance is attached. Have the features of each material and why it suits your teeth compared and explained at the consultation.
Can the appliance be changed midway?
Depending on the treatment stage, plans are sometimes made to switch from fixed to clear appliances or the reverse. Switching can change cost and duration, so ask before starting whether it is possible. Switching to a different appliance may require taking new impressions or scanning again.
Do self-ligating brackets mean fewer visits?
Only the way the wire is held is different; the adjustment interval is set by the treatment plan. There is an explanation that pain and discomfort are relatively less, but check the number of visits with the clinic. Seoul National University Hospital's medical information says visits for adjustment are generally about every 4 weeks.
How many mini-screws are placed?
It depends on the direction and amount of movement needed, and sometimes they are not used. Have the positions, the number and whether the cost is included explained at the diagnostic consultation. If one loosens or falls out during treatment it can be placed again at another site, so also ask in advance how the cost would be handled then.
What should I do if the appliance makes my mouth sore?
When an appliance is first attached, the lips or cheeks may be rubbed and mouth sores may form. Pinching off a little of the wax received from the clinic and covering the contact area lessens the discomfort, and most people adapt within a few weeks. If a wire end keeps poking, do not put up with it using wax; have the end trimmed at the clinic.
Related topics
- Orthodontics
- Clear aligners
- Lingual orthodontics
- Orthodontic cost and insurance
- When to start orthodontics for children
References
- Korean Association of Orthodontists FAQ: Bracket Orthodontics and Clear Aligners
- Korean Association of Orthodontists FAQ: Mini-screws
- Seoul National University Hospital Medical Information: Malocclusion
- National Health Insurance Service Webzine: Coverage of Orthodontics for Cleft Lip and Palate and Congenital Maxillofacial Anomalies