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Which is better, lingual orthodontics or Invisalign?

Which is better, lingual orthodontics or Invisalign?

Lingual orthodontics or Invisalign, which is better?

Other similar questions including: “Is it true that lingual is very uncomfortable, gives you sores and you can’t talk properly?” “People have told me that Invisalign doesn’t work, is it true?” These and other questions are a reflection of our patients’ doubts.

Before discussing the issue and clearing up doubts, it should be remembered that the orthodontics system is a vehicle that enables us to reach a destination; whether we do actually reach the desired destination will depend on the driver more than the vehicle. In similar fashion, the orthodontics system allows us to use one type of treatment or another. However, the final result and its quality will depend on the orthodontist rather than the system or technique. The quality of the final result of the orthodontic treatment will depend on the working philosophy of the orthodontist and the levels to which they aspire.

At the current time there is more than enough evidence to demonstrate that both lingual orthodontics and Invisalign deliver de results we want to achieve. It is our understanding that it is neither correct nor prudent to talk about these two techniques without having tried them or having a certain level of experience with them.

On some occasions patients have told me that their dentist or orthodontist has told them that Invisalign doesn’t work very well, that Invisalign only works for the correction of small problems, or that lingual orthodontics is very uncomfortable, or is slower.

My advice is to seek the opinion of an orthodontist who uses these techniques regularly (treating 5 patients per year is not the same as treating 60), as this will mean that they have a certain level of experience in using these systems. I also recommend not settling for just one opinion about one technique, as it may be the case that for one patient one technique works best, but for another the same technique will not work so well. Not all patients are the same, and not all problems are always solved best using the same orthodontics system. There are cases that are not well suited to Invisalign and are better treated using fixed braces. Accordingly, it is important to watch out for the enthusiasm some orthodontists have for ‘selling’ one technique or another in particular.

Professionals who work with these systems can show examples of cases solved successfully and can give opinions based on their own experience. It is very unlikely that you will find an orthodontist who works regularly with Incognito invisible lingual orthodontics or with Invisalign transparent orthodontics and speaks badly of these techniques, as they really do work wonders. Each technique has its advantages and disadvantages, just like traditional braces, but when correctly chosen and well applied, both systems are excellent.

Why doesn’t my orthodontist recommended them for me?

We can start with the fact that both lingual orthodontics and Invisalign require special training, a certification course that is not open to all and sundry; they also require ongoing training, and together with their clinical experience, all of these elements determine whether or not an orthodontist is able to provide these treatments. Those that do not recommend them usually choose not to because they have not tried them, are not certified or do not have sufficient training and experience.

It is important to remember that each case must subjected to an individual and thorough analysis in order to pick the right system to use. The treatment must be performed by an orthodontist who prepares a proper treatment plan, not by a establishment or a company that is part of a commercial chain or a brand.

To help with the decision-making process regarding which system to go with, I am going to make a comparison between the two techniques according to the following criteria:

  • Aesthetics
  • Precision
  • Comfort and emergencies
  • Hygiene
  • Treatment time
  • Price
  1. Aesthetics

Lingual orthodontics and Invisalign are the two techniques known universally as Invisible Orthodontics, although it should be clarified that Invisalign is NOT invisible, but in fact transparent, especially once we fit the attachments. All the same, it is a system that is highly aesthetic and discreet. Lingual orthodontics is more aesthetic, given that it is totally invisible from the outside, with the brackets on the interior surfaces of the teeth. Invisalign is transparent, very aesthetic and hardly noticeable at all; sometimes it may be seen just a little because of the attachments or the shine on the plastic.

 ortodoncia friedlander barcelona invisalign ortodoncia lingual invisible

Image of an Invisalign aligner in the mouth of a patient.

  1. Precision

One definition of precision would be achieving what was planned in platforms such as Inconito’s TMP or Invisalign’s Clincheck Pro. Both of these platforms work very well, and can lead to excellent results. However, due to the characteristics of Invisalign (use of aligners rather than brackets) certain dental movements are not fully achieved, which means that some cases cannot be solved 100% with Invisalign alone, requiring help from auxiliaries such as lingual buttons, micro-screws, elastics or even the use of sectional orthodontics with brackets. I think everyone clearly understands that techniques develop constantly, and Align Technology invests heavily in research and development for its system. Nowadays around 70% of cases can be treated with Invisalign without any problems, supplementing the aligners with appliances such as those mentioned. Invisalign is able to treat ever increasing numbers of malocclusions successfully.

Lingual orthodontics has the great advantage of being able to treat all types of malocclusion or dental problem, although it does also require help from auxiliary appliances. Lingual orthodontics can be classified similarly to labial orthodontics, i.e. the classical exterior brackets. In general, we can say that orthodontics with braces has better control over the teeth’s root movements.

  1. Comfort and emergencies

By comfort, we are referring to the ease of wearing them, for example when eating and talking. For the majority of patients a period of two weeks is enough to get used to lingual orthodontics, and they say that they are very comfortable to wear; for many it takes just a few days to get used to them. The two main reasons lingual braces are comfortable are: firstly, their small size and low profile; and secondly, that they are custom made for each teeth of each patient, meaning that they adapt perfectly to the tooth. This is the ideal technique of orthodontics for models, actors and actresses who want to improve their teeth and be able to continue working normally. An advantage over Invisalign is that it is a fixed orthodontic treatment, so it does not depend on patient compliance. Some patients prefer a fixed option so that they need not worry about taking out and putting in appliances such as Invisalign.

 ortodoncia friedlander barcelona invisalign ortodoncia lingual invisible

Image of one of our patients where you can see the brackets and the Incognito wire.

The main inconvenience patients may have is with emergencies. Occasionally a bracket may debond or a wire might get loose or dislodged and cause a sore on the tongue or the cheek. These are emergencies that are easily solved, but which nonetheless are an annoyance for the patient. With Invisalign this type of emergency does not exist. With lingual orthodontics, just like in labial orthodontics, patients must be a little more careful when eating so that the brackets do not accidentally debond.

With Invisalign transparent orthodontics the adaptation period is practically non-existent, as it is very comfortable to wear, does not affect speech and may be taken out when eating. I think that a major disadvantage for orthodontists is the fact they are removable, ‘easy in easy out’, which means that the success of the treatment depends more on the patient, who must be more responsible and consistent, wearing the appliances for the 20-22 hours a day recommended and never leaving it anywhere or forgetting it when traveling. For some patients (albeit not a great many) all of this is a hassle.

ortodoncia friedlander barcelona invisalign ortodoncia lingual invisible quita y pon

Series of images of a patient putting in her Invisalign aligner.

Taking such inconveniences into account, patients can choose the treatment that suits them best, in accordance with their personality, lifestyle and therapeutic needs. We always offer advice on the most appropriate technique for each patient in their first visit and after their analysis.

  1. Hygiene

Hygiene deserves a special mention as it can have a very damaging effect on the results of orthodontic treatment. Invisalign scores a ten out of ten in hygiene, having no effect whatsoever on the patient’s hygiene. Because it is not fixed in the mouth, patients can take it out to brush their teeth and perform their oral hygiene in a normal way, using floss and whatever other hygiene products might be necessary. With lingual orthodontics hygiene is a bit more difficult, but is easily achievable. We have dozens of patients who manage it every day in excellent fashion; it simply requires more time and dedication when it is time to clean your mouth.

For these reasons I recommend Invisalign for patients who have periodontal problems (if their dental problem is compatible), who have a high risk of caries or who do not manage to clean very well.

  1. Treatment time

The duration of the orthodontic treatment depends on each patient’s physiology. Teeth need time for physiological adaptation if they are to make the correct movements and not cause damage to the roots. This time is independent of the orthodontic system. Invisalign tends to be slower than orthodontics with fixed braces, especially in the final finishing stage of the treatment when we are working on details such as symmetry, inclinations, the correct alignment of upper and lower teeth, etc. These small movements are slower with Invisalign. On the other hand, Invisalign can initiate certain movements (such as the expansion of the dental arches) as of the very first day, something that lingual orthodontics only achieves after several months.

In general treatments with Invisalign can go on for 4-9 months longer than those with lingual orthodontics. Very often this is compensated by the comfort and aesthetics provided by the Invisalign treatment.

  1. Price

The price of lingual orthodontics is greater than that of Invisalign for various reasons:

  1. The materials for lingual orthodontics cost considerably more.
  2. The periodic visits for lingual orthodontics are longer (often 45-60 minutes long and sometimes more). When I see a lingual orthodontics patient I spend time that could be spent seeing two or three Invisalign patients (even though it does not cost two or three time more).
  3. Lingual orthodontics is one of the most mechanically complex techniques, and the orthodontist must take additional special training to what they have already learned (this training is costly).

All of the information on the costs of Invisalign and lingual orthodontics treatments can be found in our price and financing section.  

For further information please contact us by telephone (+34) 93 832 72 81.

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