Esthetic Orthodontics 104: Incognito

We have come to what is largely considered the “State of the Art” when it comes to esthetic orthodontic treatment, Incognito™.  Incognito™ is a whole system that involves a patented technology to allow braces to be placed on the inside (tongue side) of the teeth so that the braces do not show.  This is generically called “lingual braces.”

At first, lingual braces appears fairly simple, but there is actually a lot more to it than just putting the brackets on the inside.  In the past, lingual braces were performed by orthodontists with mixed success.  The problems were that the brackets were much more bulky and uncomfortable and the mechanics were very difficult for the orthodontist to get just right.  3M makes the Incognito bracket system to overcome these shortcomings of the past.  Through a proprietary system of customized brackets, wires and tooth planning, they deliver on the possibility of achieving the results that we get with braces on the outside of the teeth.
The first innovation is that the brackets are custom made for each patient.  This allows the brackets to be made very thin and close to the tooth surface.  This increases comfort and helps the brackets stay on the teeth.  Next, the wires are also customized by having the whole set of wires bent by the lab.  This removes the challenge of bending the wires for the orthodontist and allows a very high level of precision to be obtained.  Finally, all of the tooth movements are pre-planned.
Pre-planned and customized tooth movements are quickly becoming the way that orthodontic treatment is planned.  We can set a goal on the computer and then have the brackets and wires manufactured to achieve that end result. 
Here isan example of what a “set-up” looks like for a patient.  The orthodontist role is to guide the lab and make sure that the tooth movement is correct and the end result achievable.

We can even superimpose the final ‘goal’ with the ‘initial’ position of the teeth to better plan the tooth movement.  Here the initial position is in purple and the final position is represented in white.

The most impressive aspect of the Incognito system is that fact that we can achieve with great precision the tooth movement that we set out to accomplish.  In other words, the final result will match the “set-up”.  Published in AJODO in 2011, “Accuracy in tooth positioning with a fully customized lingual orthodontic appliance” by Dan Grauer and William Proffit showed how the system can produce the set-up goal in actual clinical patients.

But of course, what patients care about is that the brackets do not show and yet we can accomplish all of the movement.   This patient has lingual braces on the upper and lower teeth and has even had a teeth extracted.

We also have lingual braces on just the upper teeth as shown here on a different patient.  This helps reduce the added cost of the customized braces but improves the esthetics of the smile during  treatment.

To see more videos of our patients with lingual braces and to hear how this might affect speech, visit our video library.