Clear Braces: Ceramic Brackets, Staining, Fragility and Price

Clear braces are usually ceramic braces. The brackets are made from a hard ceramic material that is either translucent or shaded to sit close to tooth color. Everything else follows the pattern of metal braces:

• Brackets bonded to the front of each tooth
• An archwire through the brackets, which supplies the force that moves the teeth
• Ties holding the wire in each bracket, usually clear or tooth-colored elastic rings, unless the brackets are a self-ligating design with a built-in clip
• Adjustment visits every several weeks, on a schedule the orthodontist sets
• Retainers once the braces come off

The archwire is usually still metal, so a thin silver line across the teeth remains visible. Some offices offer tooth-colored coated wires for parts of treatment. Coatings can wear with time, and the wire an orthodontist wants at a given stage may only come in plain metal.

Many orthodontists place ceramic brackets on the teeth that show most and use metal on the back teeth, and sometimes on the lower teeth, for reasons covered below.

Three different things get called clear or plastic braces:

• Ceramic braces. Fixed brackets in a tooth-colored ceramic. This is what orthodontic offices generally mean by clear braces.
• Plastic brackets. Fixed brackets made from a clear plastic or composite material. They exist but are less widely used than ceramic, partly because plastic is softer and can discolor and wear over a long treatment. If an office offers them, ask how they hold up.
• Clear aligners. Removable clear plastic trays, changed in sequence and generally worn 20 to 22 hours a day. They are not braces, though people often call them plastic braces or invisible braces.

The difference matters when comparing prices and expectations. Aligners come out for eating and cleaning but depend on being worn, while ceramic braces are fixed in place around the clock. The comparison of Invisalign vs braces goes through how the two kinds of treatment differ. Some cases are better suited to one than the other, and an orthodontist can explain which applies to you.

Ceramic brackets are less visible than metal ones, not invisible. In general:

• From a few feet away they tend to blend into the teeth, and what shows is mainly the wire.
• Up close the brackets can be seen as slightly raised, glassy or matte shapes on the teeth.
• In photographs they are usually far less obvious than metal.
• The match depends on your tooth shade. Translucent brackets take on the color of the tooth behind them. Tooth-colored brackets come in a set shade that may be lighter or darker than your own teeth.

Ceramic brackets are often a little larger than metal ones, because the material needs more bulk for strength. Some people notice them more against the lips for the first few weeks.

This is the most common worry, and the answer has two parts.

The ceramic brackets themselves generally resist staining. They usually keep their color through treatment.

The clear or white elastic ties are what tend to discolor. They can pick up color from strongly pigmented food and drink, and yellowed ties make the whole set look stained. Common culprits include:

• Coffee and tea
• Curry and dishes heavy in turmeric
• Tomato-based sauces
• Mustard
• Dark sodas and deeply colored berries
• Tobacco, which also harms the gums and is worth avoiding for many other reasons

Ties are replaced at adjustment visits, so the color resets each time. Rinsing with water after eating and brushing after meals can slow the staining in between. Some offices offer self-ligating ceramic brackets, which have no elastic ties.

The adhesive around the edge of a bracket can also discolor slightly over a long treatment. It is polished off when the braces are removed.

Whitening products are generally left until after the braces come off, because they cannot reach the enamel under a bracket and can leave uneven color. Ask your orthodontist before using any.

Ceramic is hard but brittle. Where metal bends, ceramic can chip or crack. In practice that means a few things:

• Brackets can fracture. Biting into something hard, a knock during sport, or a habit such as chewing pens can chip a bracket or break part of it off.
• Food rules matter at least as much as with metal. Hard, sticky and chewy foods are the usual cause of damage.
• Ceramic is harder than tooth enamel. If a tooth bites against a ceramic bracket repeatedly, the enamel can wear. This is one reason orthodontists often avoid ceramic brackets on lower teeth in certain bites, or place them on the upper teeth only.
• Tooth movement may differ slightly. A wire does not always slide through a ceramic slot as easily as through a metal one. Some orthodontists find certain movements take a little longer, and others see little difference. No bracket type comes with a promised treatment time.
• Removal takes care. Ceramic brackets do not flex the way metal ones do when they are taken off, so orthodontists use techniques and instruments made for them.

None of this makes ceramic braces a poor option. It explains why an orthodontist might suggest metal on some teeth, or metal throughout, for a particular bite.

Ceramic braces are often quoted at roughly $4,000 to $8,000 for a full case in the US, against roughly $3,000 to $7,000 for metal braces. Fees vary widely by region, provider and how complicated the case is. These are general ranges, not a quote.

The usual reasons given for the difference are that ceramic brackets cost the practice more than metal ones, need more careful handling, and cost more to replace when they break.

Ways the difference is sometimes narrowed:

• Ceramic on the upper front teeth only, with metal elsewhere. Ask whether the office prices this differently.
• Insurance. Plans with orthodontic benefits usually have a separate lifetime maximum, commonly $1,000 to $3,000, often paid at 50 percent of the fee, and sometimes only for dependents under 19. Some plans limit what they pay toward a cosmetic upgrade. Rules differ by plan and change over time, so check your own plan documents.
• Payment plans that spread the fee across the months of treatment.

For context, self-ligating braces are often quoted at roughly $3,500 to $8,000, lingual braces at roughly $8,000 to $10,000 or more, and clear aligners from a dentist or orthodontist at roughly $3,000 to $8,000. You can put a fee, insurance and a down payment into the braces cost calculator to see a rough monthly figure. A written estimate from the office is the number to rely on.

Looking after ceramic braces is mostly the same as looking after any braces, with more attention to color.

• Brush after meals and before bed, working above, below and over each bracket.
• Clean between the teeth every day with floss threaders, interdental brushes or a water flosser, as shown by your orthodontist or hygienist.
• Rinse with water after strongly colored food or drink when you cannot brush.
• Check foods you are unsure about in the braces food checker. The guide on what not to eat with braces lists the usual problem foods.
• Keep up dental checkups and cleanings with your general dentist throughout treatment.
• Ask about a mouthguard if you play contact sports.

Soreness for a few days after fitting and adjustments is common. For over-the-counter pain relief, follow the directions on the label and ask a pharmacist or your orthodontist what is suitable for you.

A chipped or loose ceramic bracket is not usually an emergency, but the office needs to know.

• Cover any sharp edge or poking wire with orthodontic wax.
• Call the orthodontic office. Tell them what broke and whether anything is sharp or loose in the mouth.
• Keep any piece that comes off and bring it with you if the office asks.
• Do not attempt a repair. No glue, no filing a sharp edge, and no bending or cutting the wire.

If you think a piece was swallowed, tell the office when you call. Coughing, wheezing or trouble breathing after a piece comes loose is an emergency. More generally, trouble breathing or swallowing, swelling spreading toward the eye or neck, fever with facial swelling, or bleeding that will not stop means calling 911 or going to the emergency room.