Incognito & Lingual Braces
Incognito is the name of the lingual (behind the teeth) orthodontic system from 3M Unitek…there are others as well. Unlike conventional braces on the front of the teeth which are designed to a standardized prescription of some type usable across most cases, these lingual braces are individually customized for each tooth on each patient in a gold alloy and are not standardized.
The connecting archwires are created by a lab robot accurate in three dimensions for the customized brackets placed on each patient as compared to the chairside wire creation we typically accomplish with conventional braces from standardized archwires. The highly variable anatomy of the lingual surfaces of the teeth as compared to the front dictates the customization required. As one might expect, the lab fees to create custom braces adds significantly to the treatment fee which makes this approach not something all patients can pursue. The use of tooth colored ceramic braces on the front of the teeth is a cost effective alternative for those patients seeking a more esthetic but less expensive approach. The primary benefit of lingual systems is cosmetic for those patients who demand truly “invisible” braces. Aligner therapy , reviewed elsewhere on this site, may not achieve the accuracy nor address the full range of bite problems we see that lingual and/ or conventional braces do and therefore in my view are not a substitute.
The primary advantage of lingual braces is cosmetic. There are, however, some notable limitations as well.(1) Chairside repair/ replacement of lingual braces and archwires is considerably more complex than with conventional systems sometimes requiring delays of 1-2 weeks before new materials are created in the lab and shipped whereas conventional braces and wires are replaced as needed typically the same day without delays.(2) Multiple chairside archwire adjustments typical of most conventional cases particularly in accurately finishing a case are not possible with lingual braces where any archwire changes are robotically created at a distant lab.(3) As mentioned, the use of a gold alloy to preserve the dimensional accuracy of the braces during polishing in the lab dramatically raises the cost of therapy as compared to conventional braces where less costly alloys suffice.(4) Because of our extensive use of bonded retainers placed behind the upper and lower front six teeth to stabilize our cases long term described elsewhere on this site, having to first remove the lingual braces and then place a bonded retainer over the same tooth structure likely means that the strength of the adhesive attachment will be less than if the tooth surface hadn’t been previously bonded to with the lingual braces.(5)Speech concerns with lingual braces arise more frequently than with conventional braces because of the altered articulation of the tongue and the lingual surfaces of the teeth in producing a number of speech sounds. (6) Customized braces on the FRONT ( such as Suresmile and others) claim faster treatment times as compared to standardized braces but to prove this, a large randomized and controlled study comparing conventionally treated patients with certain bite problems with a customized braces group of similar patients and looking at outcomes would need to be done. Thus far we haven’t seen that in the literature. What we have seen are smaller observational studies without control groups often from practitioners with vested interests and/ or undisclosed financial ties to the manufacturer(s) of such systems. We’ll keep watching the journals.
As a certified Incognito provider, we feel that IF after due consideration of all these factors a patient would like to proceed with lingual braces, this system offers the most predictable outcomes when compared with others on the market at this time. And given the cost factors and duration of most of these types of therapy with lingual braces, knowing that 3M Unitek will be there with research and support long term is reassuring in a business where companies ( and their product lines by extension ) are sold off, close, merge or terminate support with some regularity.