No one in their 30s wants to even think about getting adult braces, but here I am — a working woman, well into adulthood, in dire need of orthodontic treatment (via lingual braces) for the third time (no, that’s not a typo). Let me explain: Like most ‘90s kids with crooked teeth, I endured an awkward period as a tween when I had to sport old-fashioned metal brackets. After three years, my pearly whites were ruler-straight.
Of course, I, ahem, “forgot” to wear retainer every night. Fast forward to my early 20s and my smile was back at square one. This time I chose Invisalign, a popular treatment for those who favor discreet correction, but the recommended daily wear time of 22 hours proved impossible. I found myself removing the clear trays every time I wanted a snack or coffee (read: often) or went on a first date (often enough). Halfway through treatment, I gave up.
A decade later, I’m giving this one more shot with virtually invisible lingual braces, which are brackets affixed to the back of your teeth. Lingual braces are by no means a new treatment, but modern innovators in this space — such as INBRACE, the technology I’ve opted for — have helped them come a long way. Even better, just like traditional braces, these brackets are permanently attached to your teeth, so you’re forced to wear them 24/7.
If you’re a fellow grown-up who needs braces (according to the American Association of Orthodontists, one in four patients is an adult), read on for my experience with lingual braces and my guide to other options that might work for you. I’m no professional, but over the past two decades, I’ve experienced three treatments and researched more in the process. Future metal mouths, you’re in good hands!
What’s The Deal With Lingual Braces?
Lingual braces (here’s a hint: the word “lingual” refers to anything relating to or near the tongue) have been around since 1976, when they were first developed for a Playboy Bunny. “After being presented with metal braces, she wanted a version that didn’t show metal,” says Vijay Dhaka, INBRACE’s Chief Business Officer. “It was from her demand that Dr. Craven Kurz [an orthodontist who was the founding president of the American Lingual Orthodontic Association] developed lingual braces.”
Although lingual systems have been around for over 40 years, stateside orthodontists rarely present it as an option. In fact, my search for an office offering this treatment took six or seven tries. “Lingual is far more popular in Europe and other places in the world like South Africa,” explains Dr. Ryan McComb, DMD, MS, the Los Angeles-based orthodontist who installed my braces. “They were around [in the United States], just not popular. That’s because they’ve typically been challenging for clinicians, but INBRACE is really working to make the process smoother.”
In their research to find out why lingual braces haven’t gained more traction in the past, INBRACE concluded the same. “It had to do more with clinicians not wanting to offer it than patients not wanting to purchase it,” explains Dr. John Pham, DDS, MS, an orthodontist with a master's in craniofacial biology and one of the co-founders of INBRACE. “I’ve always looked at lingual orthodontics as the final frontier in aesthetic orthodontic treatments. The idea of braces behind the teeth has been around for generations, but most patients in the United States don’t know it exists. It’s the one treatment that is truly invisible and can deliver results without relying on patient compliance. Unlike the situation with aligners, the orthodontist is truly in control.” For someone like me, who couldn’t hack it with Invisalign, the promise of lingual braces sounded golden.
INBRACE Versus Other Lingual Systems
Along with Dr. Hongsheng Tong, DDS, an orthodontist with a PhD in bone biology, Pham invented INBRACE in 2012, creating a system easier for clinicians to use. The process relies on Smartwires® customized for each patient and pre-designed with digital orthodontics to move your teeth in all dimensions automatically. “Traditional braces, including conventional lingual braces, require the orthodontist to manually bend the wire to achieve a result in their mind’s eye,” explains Dhaka.
The innovative Smartwire® also frees you from having to wear elastics that traditional systems require to hold archwires in place. This causes uncomfortable friction, which in turn leads doctors to apply more force than needed to move your teeth and results in painful appointments. “Moving teeth with light, gentle force consistently over time is the most efficient way,” says Dhaka. “Our non-sliding mechanism eliminates friction and applies just enough force to move teeth in a healthy way.” Several orthodontists have echoed that orthodontic tooth movement produced by light, continuous force is the healthiest method, including Dr. Jeffrey Posnick, DMD, MD, in his book Orthognathic Surgery: Principles & Practice. And where traditional lingual braces rely on straight wires that get in the way of flossing, the Smartwire® has interdental loops between every single tooth. “The custom-bent wires curve up and down, so flossing like normal and maintaining hygiene is easy,” explains McComb.
Clearly, lingual braces have come a long way since that Playboy Bunny. “It is the difference between analog and digital,” says Dhaka. “The difference between INBRACE and other lingual braces invented in the ‘70s is like the difference between a battery-powered car in the ‘70s and today’s self-driving Tesla.”
Once McComb determined I was a good candidate for INBRACE—based on a 3-D digital model of my teeth — the process was simple. After my custom Smartwire® arrived, I visited his office for a two-hour bonding appointment. My jaw dropped when I glimpsed my smile in the mirror afterward. The braces were invisible, completely unnoticeable. Not even a hint of metal.
“Lingual braces are amazing because they’re the one time you see nothing,” says McComb. “With clear aligners, sometimes patients say, ‘Oh, I still see it.’ Fifty percent of our practice is clear aligners, but we’re using more lingual braces because it’s an awesome alternative, especially for people who are concerned about aesthetics.”
As with any treatment, there’s soreness and discomfort. But with lingual braces, it’s usually a one-and-done deal; the pain is endured only at the beginning of treatment. “Clear aligners come in and out, so you don’t always get used to them,” explains McComb. “The lingual system is glued in there and constantly working, so you’re able to adapt in a more permanent way. But for about two or three weeks, your tongue will hate you. You’re putting something back there that it’s not used to, so it’ll feel swollen.” It's true: With metal brackets taking up precious real estate behind my teeth, my tongue felt bloated and uncomfortable.
You’ll also have a subtle lisp for the first few weeks — a small price to pay for the inconspicuousness of lingual braces. “The more you talk, the faster it goes away,” says McComb. “I always tell people to sing in the car or read a book aloud. Your tongue will adapt to any changes.” I was told to repeat phrases like “6665 Sunset Boulevard” (which I did, incessantly), and after a brief period, my mouth adjusted and the lisp faded.
I was outfitted in lingual braces five months ago and I’m thrilled with the results. Surprisingly, I noticed a shift in my teeth after only two months — which, if you know anything about this typically lengthy process, is nothing short of a miracle. Within one month, my mild crossbite showed some small improvement. Friends and family commented on the noticeable shift in my teeth.
I still have a ways to go (estimated treatment is about 12 months and follow-up appointments are every six to 10 weeks), but I’m grateful I can snack and drink all I want without ever having to take out a clear aligner.
But don’t take my word for it. Clear aligners might work great for you where they didn’t for me, or you might share the same frustrations. A little research is the best way to make your own informed decision. Keep reading for my crib sheet — which distills all the information I’ve learned and experienced first-hand — on ortho treatments available today.
Braces Price Breakdown
Note: The prices below are typical for Los Angeles, but can vary dramatically depending on whether you seek treatment at a corporate chain or private practice, the latter of which McComb recommends for the best service and results.
Average price in Los Angeles: $4,300-$5,300
Pros: They’re the most efficient — and affordable! — method of straightening your teeth.
Cons: They're super visible (there's no hiding 'em). If you're more concerned with aesthetics than price point, this isn't the way to go.
My take: These did the trick when I was in junior high, but for pure vanity reasons, I’m not sure I’d repeat this treatment as an adult. For those who do, though, all the more power to you!
Clear Ceramic Brackets
Average price in Los Angeles: Similar to metal brackets, although some offices charge an additional $300-$600
Pros: These tooth-colored brackets are less noticeable than their metal cousins and designed to blend in with the rest of your smile.
Cons: They tend to be larger and more brittle than their metal counterparts, and they’re still quite visible. Plus, treatment can set you back a few additional hundos.
My take: I researched ceramic brackets and almost opted for them at one point, but decided against it once I heard that the clear elastics wrapped around the brackets stain easily.
Average price in Los Angeles: Similar to metal brackets, although some offices charge an additional $500-$1,000
Pros: Each new tray takes time to conform to your teeth, but when they fit perfectly over your smile, they’re nearly unnoticeable. And when you’re in an important work or social situation, they’re easily removed.
Cons: They start to yellow over time, create a slight lisp, and honestly, they’re a little gross when you take them on and off. Plus, as I mentioned, you must wear the tray for at least 22 hours a day for treatment to be effective.
My take: The long wear time is truly difficult if you’re a constant drinker and snacker, but clear aligners remain incredibly popular.
Average price in Los Angeles: $5,300-$8,300
Pros: Absolutely no one will be able to tell you’re wearing braces. If you’re constantly meeting people or if your job requires you to chat up clients, this is the way to go.
Cons: You’ll endure a mild lisp for the first few weeks, and food will occasionally get stuck in the brackets. Plus, they’re a tad pricey compared to other treatments.
My take: Of all the systems I’ve undergone, this is my favorite. Lingual braces allow me to eat and drink all day long without jeopardizing treatment, as well as socialize freely without feeling self-conscious. I also saw swift results, although I can only speak for my particular correction issues.