Overview

Traditional dental braces, commonly referred to as “train tracks” are the most identifiable form of orthodontic treatment, but have fallen out of favour worldwide in exchange for a variety of alternatives. 

These options range in similarity to traditional braces, which are characterised by metal brackets that are glued onto the front of the teeth. Such treatment can be categorised as either fixed or removal orthodontic appliances based on the ability of the patient to physically remove the devices from the mouth. 

The most popular alternative that has continually gained traction is the Invisalign clear aligner, which, like most options, offer subtle advantages over traditional braces but are also more expensive and are only offered via private healthcare.

Introduction

Dental braces have been a longstanding technique in abnormal teeth growth patterns. A majority of the time this involves straightening, to allow people to appear more presentable, but on other occasions, alignments of severe tooth placement are required, where individuals may have trouble with eating and talking, or whereby internal injuries may result (for example, friction against the inner walls of the cheek).

Corrective methods for teeth are generally applied in childhood, when the mouth and teeth are still developing, making straightening and alignment easier to carry out. Traditional braces are by far the most recognised method for teeth position correction, but others exist. These bear varying degrees of similarity to the traditional brace. Each alternative has its own set of advantages and drawbacks.

For reference, orthodontics refers to dentistry specialised in the positioning of teeth. Inquiry into solutions for misaligned teeth are typically made to general dentists (much like other health concerns to a GP initially).

Pros and cons of traditional braces

Dental braces remain not only the most popular method for correcting teeth placement but are widely accessible within the United Kingdom, through the NHS and via private dental care services. 

Under the NHS, braces are free for children, who are the general age demographic that applies them. The quality of braces acquired through private healthcare does not differ much, if at all, from those provided by the NHS, as medical standards within both institutions are almost identical. The only difference between these options is the presence of payment when going private.

Traditional braces are considered to be extremely effective in correcting malocclusions (misalignment) and larger issues such as underbite (lower jaw teeth being too far forward) and overbite (upper jaw teeth being too far forward). 

Success rates for braces are not generally published statistics but are assumed to be almost 100% effective. There is a small proportion of discontinuations (where treatment is not fully completed), with suggestions that these are more prevalent in those with lower socioeconomic status, which is disputed, as well as a rating on the Index of Orthodontic Treatment Need (IOTN) scale.¹

Arguably the largest downside of wearing traditional braces is the physical barrier created between your toothbrush and your teeth, making it difficult to brush and maintain proper dental hygiene. 

You are also prone to food particles and other substances (such as chewing gum) becoming stuck between your teeth and braces. If these substances are not naturally dissolved via digestive enzymes in the saliva, this can increase the risk of staining or even the formation of cavities in more extreme cases.

Invisalign

By far the most popular and widely recognised alternative to traditional braces, Invisalign is a type of clear aligner, which is a clear plastic brace (usually referred to as a “tray”). Developed in the United States, Invisalign is also available within the UK.

Invisalign is an example of a removable orthodontic appliance (ROA), meaning it does not need to be worn continuously, and can be taken out at any time by the user. Despite this, many professionals recommend wearing Invisalign and other ROAs for as long as possible, as this provides the fastest and most reliable results.

The main benefit of clear aligners is the ability to hide the brace due to its transparency, which is preferred much more highly over traditional braces (which are commonly called “train tracks”). 

Tailoring of this treatment is made possible due to thorough 3D scanning of the patient’s mouth to create a tray that can accurately fit whilst being comfortable; this is a process known as computer-aided design (CAD).² 

Patient data is stored and software can be utilised should more trays be created in the future for further adjustment. Each tray is typically worn for six months at a time. It is normal for patients to require two or three trays.

The NHS does not offer Invisalign, nor does it cover the costs of orthodontic procedures for adults, therefore it is only offered through private healthcare. Due to this, Invisalign is popular amongst adults, however, it is also offered to children. In the UK Invisalign costs at least £2500, though this is subject to the complexity of the mould that is required.³ Depending on how severe the issue is, multiple trays would need to be constructed, which would reflect higher total costs for the customer, and “bundles” of multiple trays are available.

Invisalign is a trade name of one of many clear aligners that are available in the UK. Others include ClearCorrect, Smile Direct and the Clear Aligner Treatment from NimroDENTAL, all of which have very similar procedures for assessment and installation.

Lingual braces

In comparison with the design of traditional braces, lingual braces are very similar, though they consist of brackets that fit onto the back of the teeth, as opposed to the front. 

Traditional and lingual braces are both types of fixed orthodontic appliances (FOAs), meaning that the patient cannot remove these and must be continuously worn until a medical professional removes the device.

Aside from the positioning of the brackets, the design and installation of lingual braces are identical to traditional ones; brackets are tailored to the shape of the patient’s teeth with slight but consistent pressure applied onto all teeth. These brackets are glued onto the teeth and must be physically removed with orthodontic pliers.⁴

In terms of comfort, traditional braces can cause buccal irritation (friction against the cheek), especially during talking and eating. Although this is not usually a problem with lingual braces, there is a risk of getting your tongue caught on it, causing soreness.

Lingual braces cost more than traditional braces and are therefore not covered by the NHS. They cost between £2000 and £3000, making them slightly cheaper than Invisalign.

Palatal expansion

Metal bracing can be applied to the roof of the mouth (known as the palate) to change the shape of the upper jaw in a method known as palatal expansion. As only the teeth on the upper jaw are affected, this technique is used to correct overbites or crossbites (malocclusions closer to the tongue or cheeks than normal).⁵

Palatal expansion may be used in certain cases whereby traditional braces cannot be applied, and therefore are available through the NHS. Due to the location of their application, palatal expansion cannot be offered as a general alternative to traditional braces.⁶

Surgically-assisted rapid palatal expansion (SARPE) is a technique whereby, as the name suggests, surgical intervention is required to make the palatal expansion more effective. Such surgery involves the removal of some teeth if they are thought to block other teeth from being properly aligned. 

In other cases, maxillomandibular (jawbone) surgery may be required, whereby the shape of the bone must be altered. This is usually reserved for patients born with dysgnathia (malformation of the jaw), or who have suffered significant injuries.⁷

Both standard palatal expansion and SARPE are types of FOA.

DIY braces and the role of social media

DIY (do-it-yourself) braces have become a popular yet highly controversial alternative to traditional braces and the more costly modern dental procedures and devices.

The emergence of the popularity of DIY braces can be attributed to social media influence and celebrities with whom younger demographics engage. Despite valid aesthetic reasons for wanting orthodontic treatments, exposure to what is considered “perfect” sets of teeth from role models and media can lead others to want treatment done when not properly assessed by a medical professional or even deemed necessary.⁸

Undergoing any type of self-imposed orthodontic measures is never recommended and almost always proves to be unsafe. As well as the risk of injury and infection, there is little evidence or guarantee that these methods are effective. An Internet search will show that ratings, treatment lengths and reviews are neither consistent nor reassuring for consideration.

As DIY braces are not endorsed by any medical professionals, their designs vary greatly but seem to rely on ordinary household materials such as elastic bands, paper clips and wire. 

Positive results (or those that appear so) do not necessarily mean that these are successful or that the method is reliable, especially since orthodontics is very specific, being tailored to each patient. Photos of DIY results are also likely to be edited heavily, and this can go for any aspect of physical appearance.

Summary

There are several methods of orthodontic treatment available within the UK and they all come with their advantages and disadvantages. They do not necessarily outrank the traditional “train-track” braces but have been more popular due to being less noticeable to others and less intrusive when speaking or eating. 

ROAs have allowed patients to be more comfortable with their chosen orthodontic treatments, though habits of not wearing them consistently alter the speed of their effectiveness.

Ultimately, all forms of orthodontic treatment require initial discomfort and issues with everyday activities; each person is different and therefore it is difficult to make a decision based on others’ experiences. 

Length of treatment is structured on an individual basis and professional input is always the best approach when going ahead with any type of dental care, whether via the NHS, private healthcare or at all.