Invisible orthodontics part 3: aesthetic orthodontic brackets

Although fixed appliances have been used for many years, the brackets have been constructed from a metal stainless steel material. Although functionally the metal brackets provide excellent properties with low friction, good resilience to breakage and superior debonding qualities, the appearance of the brackets are anaesthetic. The metal bracket appearance, often referred to as ‘train-track’ braces, are often unappealing to patients, especially adults who may already be conscious of wearing braces. The introduction of aesthetic ceramic brackets in 1986 has allowed many adults to seek orthodontic treatment, reassured in the knowledge that the aesthetic brackets are less visible and more socially acceptable (Figure 1).

The majority of aesthetic brackets are ceramic, composed from an aluminium oxide material. Originally, plastic brackets constructed from acrylic and later polycarbonate were introduced to improve the aesthetics of fixed appliances.1 Problems with rigidity, strength and staining led to further development, including reinforcing the polycarbonate with ceramic. These brackets demonstrated improved mechanical properties but still maintained torque control problems. Full ceramic brackets, using aluminium oxide in various forms, provided a major improvement in aesthetic brackets, with improved strength resistance to wear and overall aesthetic appearance. A number of manufacturers now produce aesthetic ceramic brackets, each implying an advantage often relating to mechanical or improved aesthetic properties (Table 1).