In contrast to the classic external braces, which are increasingly being rejected these days, Lingual braces for orthodontic treatment are becoming more and more popular with adult patients. Thanks to new technologies and innovative advances, a system has been developed that was unthinkable a few years ago: invisible braces that are advertised on the market as being just as precise as their visible version. But does the lingual brace really keep what it promises?
Table of Contents
The essentials in brief:
A Lingual brace is a fixed orthodontic appliance that is attached to the inner surface of the teeth and is therefore invisible.
The internal braces can be used for children and adults and for almost all bite positions and tooth misalignments.
The duration of treatment depends on the tooth misalignment in question and ranges from a few months to several years.
The costs for a lingual brace have to be borne privately and are between 4,500 euros and 8,500 euros.
General information on Lingual braces
The term “lingual” comes from Latin and stands for “lingua”, the tongue. The lingual technique thus describes an orthodontic treatment concept in which the brackets are glued “tongue side” and not, as with classic braces, on the outside.
In contrast to conventional braces from the outside, the wire arch runs through the brackets on the inner surface of the teeth. The brackets of the Lingual braces are made according to the individual tooth shape. For this reason, before the start of treatment, an impression or a 3D scan is necessary in order to have the brackets and wire arches custom-made.
Areas of application of the Lingual technique
Just like the braces from the outside, the braces on the inside can be used for almost all bite positions and tooth misalignments. It is also suitable for patients of all ages.
Advantages of the Lingual braces in detail
Due to their invisibility, lingual braces are very important for adult patients. In this way, patients who have a lot of customer contact in their professional lives or for whom a flawless appearance is essential (e.g. models, singers, politicians) can have their teeth corrected inconspicuously and discreetly. Thanks to modern 3D technology, brackets, and wires are individually manufactured based on the shape of the tooth and fit perfectly on the inside of the tooth. Thus, an exact tooth movement from the original to the desired position is possible without any problems.
Furthermore, due to the constant flushing with saliva, the risk of demineralization of the tooth surfaces is negligible. Since the salivary glands are in the immediate vicinity of the lingual braces, permanent wetting of the inside of the tooth with saliva is guaranteed and the risk of caries is thus greatly reduced.
Disadvantages of Lingual braces in detail
A disadvantage of the expensive lingual braces is the direct proximity to the tongue; one of the most sensitive sensory organs in the body. This can easily be injured and irritated by the pointed brackets and wires. The adjustment phase is significantly longer than with conventional braces and eating and chewing are often more difficult for the patient at first. Phonation (language formation) can also be impaired. Lisping is one of the most common speech disorders that occurs with lingual braces and in some cases lasts for the entire duration of treatment.
Furthermore, the lingual brace cannot be removed from the mouth by itself (such as removable aligner splints). If the symptoms are too great and the patient wants the lingual braces to be removed, this is immediately accompanied by a termination of the orthodontic treatment. Therefore, all possible disadvantages should be well considered before starting treatment.
Comparison of lingual braces: Incognito versus WIN
The two most common manufacturers on the market, Incognito, and WIN, hardly differ from each other in terms of their effectiveness and duration of treatment. With the Incognito lingual braces, the brackets are manufactured individually and with a high gold content using CAD-CAM technology. This means that the brackets have a very flat design with a large base and can therefore be placed precisely on any tooth. This is characterized by a low breakage rate and an extremely high adhesive force.
Due to the high proportion of gold, however, these lingual braces are correspondingly expensive. With the second system of the lingual technique, the WIN system, the brackets are also manufactured with a flat base individually and precisely for each tooth, which is reflected in an equally low breakage rate and high adhesive strength. The alloy here is not made of gold, but of silver, which explains the slightly lower price.
duration of treatment
Overall, the treatment time for lingual braces can be compared to that of ordinary braces from the outside. It depends on the patient’s individual bite position and tooth misalignment and can last from a few months, in the case of minor tooth misalignments, to several years. The intervals between the check-up appointments are also similar to those for conventional braces. On average they are around four to eight weeks; depending on the scope of treatment per appointment.
Manufacturing the lingual brace
Since the brackets of a lingual brace are adapted to the individual tooth anatomy, an impression of the jaw base and teeth must be taken before the start of treatment. This can be done conventionally with a common impression material such as silicone or alginate, or with a 3D scanner.
With both methods, an exact model of the teeth is produced in the previous initial situation. A so-called “set-up model” is then created, which presents the teeth in their later, optimal position and dental arch shape. This means that brackets can be manufactured on an individual basis. A bending robot can use special computer software to create precise bends so that the teeth move into their correct position during treatment.
This complex manufacturing process explains, among other things, the relatively high costs involved in treatment with lingual braces.
course of treatment
After the lingual brace has been made, it can now be fitted by your orthodontist. This process is very similar to that of conventional braces from the outside (see article metal brackets, ceramic brackets). One difference here is that the lingual brackets can be glued to the inside of the tooth either directly or with the help of a transfer splint. If all brackets are firmly in their desired positions, only the wire arch must be firmly attached to the brackets. The orthodontist now checks the progress of the treatment at regular intervals and changes the archwires or introduces additional archwires as required.
Once the desired treatment goal has been achieved, the orthodontist can remove the lingual braces from the inside of the tooth using special removal pliers. After all plastic residues have been removed and a suitable fixed or removable stabilization mold has been manufactured and attached (see article: retainer, retention splint), the patient can now look forward to a permanently straight smile.
Oral hygiene is an essential factor
The lingual technique is not only complex for the orthodontist himself. The patient also has to adapt to more complex oral hygiene, which can often cause difficulties, especially in the early stages of treatment. Due to the poor accessibility of the interdental spaces, food components could remain longer and plaque could form. Although this is compensated for by the good flushing with saliva, a lingual brace still requires intensive care. The orthodontic team will be happy to show you the various cleaning techniques that are essential for optimal oral hygiene with lingual braces and that make cleaning easier. Professional tooth cleaning before and during treatment is also recommended.
Cost of the lingual brace
A disadvantage of lingual braces is the high treatment costs. These come about because the lingual braces are manufactured using highly specialized 3D technology, the brackets are made of a high-quality gold or silver alloy and the treatment effort for the orthodontist is significantly greater than with conventional braces due to poor visibility. The costs are around EUR 4,500 to EUR 8,500 and vary from practice to practice. The costs also depend on the severity of the tooth and/or jaw misalignment and whether one or both jaws are to be treated.
Does the statutory health insurance fund cover the costs?
Children under the age of 18 are initially classified in the orthodontic indication group. However, the statutory health insurance companies only provide medical necessity in its cheapest form (large brackets that are attached to the outside of the teeth). For this reason, a high financial deductible for the treatment and the material and laboratory costs for the lingual technique can be assumed. For patients over 18 years of age, all orthodontic treatment must be paid for privately, unless there is an indication for surgery. But even in this case, the service catalog of the statutory health insurance only provides for the cheapest form of braces from the outside. Especially in the case of an operation, a high financial deductible is expected
Does private health insurance or supplementary dental insurance pay?
Whether private health insurance or supplementary dental insurance will cover the costs of lingual braces depends on the specific details of the contract. These can be found in the policies of the respective insurance companies.
