The question I received at almost every orthodontic consultation. Some of us made up our minds before even coming in but some of us are not sure what works best. After all, majority of us have not had these on before. In this article, I will subdivide them to technical reasons as well as non clinical factors to consider.

The number of ways to straighten teeth has largely remained at braces and clear aligners, despite the increasing number of companies and clinics claiming to revolutionise orthodontics. When it comes to human biology, as a dentist, I shall firmly reiterate there is no magic and human body does not behave like engineering principles. The human self coping mechanism is beyond comprehensible of even the most adept scientist and experts are always making discoveries, showing its complex nature. We can only rely on the current most widely adopted evidence and constantly updating ourselves. Any breakthrough, believe you me, does not come from a social media advertisement but would be from a reputable institution of renowned standing.

There is also disagreement on if braces or aligners are superior. Spoiler alert, they are both effective, in different ways, and must be used as such. There is a historical context to this hesitation. The current form of conventional metal braces has been around for a century! Exactly since 1925 by Edward Angle whom proposed sticking a square metal bracket on to tooth surface and ligating it with an alloy wire to slowly pull teeth into place. Over the century, modifications has been made to tackle different malocclusion and situations. In other words, given its long standing history and worldwide acceptance, virtually any condition has been tackled by a clinician successfully and therefore it can be said it is reliable enough for everyone. It is however, not without its downside.

Chiefly, the sharper edges causes ulceration when first bonded on teeth. Once the ulcer heals after two weeks, the inner mucosa lining of our lips thicken and subsequently does not perceive the edges as sharp anymore. Secondly, society gets more aesthetically conscious as a whole. We all know of someone who was teased in school for having braces and it is even barred in some profession. I recalled a patient of mine was so desperate to remove her braces in order to be recruited as a Singapore Airline stewardess! Thirdly, just like our attention span, it is getting shorter and our desire to shorten treatment time. Last but not least, cheaper and more accessible treatment are always welcomed.

In the 1980s, an improved version, namely self-ligating brackets is developed (Source: British Orthodontic Society). This almost improves on all pain points of traditional braces in a very slight cumulative manner. It has rounded corners to reduce ulcerations, sleeker looking metallic design without the coloured rubber modules wrapping around it and faster teeth alignment. The downside being, a slightly higher initial cost but in absolute terms where fewer visits and longer intervals are possible, it arguably balances itself off. This is my absolute go to for anyone that wants metal braces.

More adults are seeking teeth alignment as they see the benefits of it, especially AFTER their children has gone through them. The next step of evolution naturally being a push towards aesthetics and that gives rise to the ceramic brackets. By and large, it is replacing as much of the metal components of braces with off white colour components of primarily ceramic composites. Even the wires can be white colour but a rectangle stiff steel wires are still required for extraction or more complex cases. They don’t stain easily but rather, the stains around brackets appears more prominent as it is in contrast to white brackets rather than a backdrop of metal. This renders it less obvious from a conversational distance, albeit still visible if one were to know what to look for. Ceramic version of conventional or self ligating brackets also poses a significant bump in pricing but hey, Tom Cruise had it in 2002, 23 years ago!

The elephant in the room now is, what about placing braces on the inner part of teeth away from the observers eyes? Some orthodontist absolutely swears by it. It has different biomechanics, better aesthetics for sure and seems like an all around great idea! Except, like everything else, there is a trade off. It is more technique sensitive and requires regimental oral hygiene routine along with a much, much higher pricing. The go to manufacturer, Incognito by 3M also decided to discontinue production of it, casting its future into a limbo. There are other reputable brands still producing them, but that was no doubt a dagger in the heart to the lingual braces fanbase.

Finally, we enter the era of clear aligners, spearheaded by Invisalign back in the mid 1990s and in 2013, launched its patented SmartTrack thermoplastic material to fabricate aligners that moves the teeth in sequence. At the start it was mocked upon by traditional braces community but has since gained traction and nobody doubts its ability presently. What started of as simple treatment for minor teeth movements are now into the territory of full blown growth modification like mandibular advancement device, palatal expander and the ability to incorporate special features like attachments, elastics, bite block, bite ramps, pontics, amongst others, which allows masking of extractions spaces whilst the gaps are closing. Since 2017 when its patents expires, the number of aligner manufacturer has increased and some are direct to consumers without going through a dentist prescription. Whilst some maybe lucky to get an excellent results, some irreversible long term consequences can arrive from it, making it an extremely dangerous gamble.

What aligners lack are the years and volumes of cases braces has ( a hundred year head start) but it makes up for it by having the attention of multiple stakeholders like researchers, commercial interest, healthcare providers and of course eyes of patients wishing for a comfortable and discreet way to straighten teeth. There are malocclusion where it struggles to perform as well as braces and vice versa. Its reputation plummet whenever its envelope is pushed unsuccessfully just like any other new endeavours. Its biomechanics and force systems are completely different from fixed braces but yet, it serves as a foundation to build on our understanding of it.

In conclusion, when choosing between braces or aligners, it is vital to seek unbiased advise from a professional dentists that provides all the options. Without having experienced one or the other, it is not possible to provide a comprehensive treatment plan or working both of these polar opposite appliances for an individual’s needs. And as usual, there is no substitute to years and volume of experience. Find out more from our dentists whom had done 1000+ braces cases and almost 1000 Invisalign cases to date before making this decision. I wish you all the best in this journey!