Adult Orthodontic Treatment Options: Aligners, Lingual, and Vestibular Braces

For adults seeking to straighten their teeth, several effective treatment options are available. While aesthetics are often a consideration, orthodontists prioritize functional improvements to oral health. Dr. David Couchat, spokesperson for the French federation of orthodontics, emphasizes that the primary goal is typically functional, with aesthetic benefits often following improved oral function.

Available Treatment Modalities

Currently, three main types of devices are used to straighten adult teeth: aligners, lingual braces, and vestibular braces.

Aligners

Aligners are thermoformed, transparent, and custom-made gutters created from a 3D model of the patient’s teeth. They offer several advantages, including discretion, minimal discomfort, and high comfort levels. Treatment with aligners allows for well-controlled, slow, and gentle tooth movements. Being removable, aligners facilitate good oral hygiene and are more socially acceptable than fixed braces. However, successful treatment relies heavily on patient compliance; consistent wear is crucial for achieving results. Without consistent use, the treatment will not be effective.

Lingual Braces

Lingual braces are attached to the tongue-side of the teeth. While highly effective for all types of tooth movements, they can be painful, particularly for the tongue, and are difficult to clean. Installation is often a lengthy and complex process. Their use has declined in popularity, particularly in trend-setting countries like the United States, and is becoming less common in France, despite their proven effectiveness.

Vestibular Braces

Vestibular braces are placed on the visible side of the teeth. They are generally more comfortable than lingual braces, although some lip irritation can occur. Like lingual braces, they are very effective but are often considered less aesthetically pleasing. Ceramic braces offer a less visible alternative to traditional metal braces. A key benefit of both lingual and vestibular braces is that they are fixed appliances, promoting better treatment compliance compared to removable options.

Addressing Complex Cases and Treatment Costs

While these three devices are generally suitable for most situations, complex cases may require additional tools. In some instances, hybrid devices, elastics, mini-anchoring screws, or sectionals (wires placed between rings) may be added to aligners to control specific movements, particularly those involving the roots of molars.

The cost of orthodontic treatment varies significantly depending on the patient’s individual needs and the chosen device. In France, Social Security typically does not cover orthodontic treatment for adults, except in cases involving surgery. However, some supplemental insurance companies may offer reimbursement. Metal vestibular braces are generally the least expensive option, followed by ceramic braces, aligners, and lingual braces, reflecting the complexity of manufacturing and installation time.

Treatment Considerations for Seniors

An increasing number of seniors are seeking orthodontic treatment. Dr. Couchat notes that earlier intervention generally leads to easier and more predictable results. As individuals age, cellular renewal slows, tendons lose elasticity, and arteries harden, requiring a gentler approach to treatment with more frequent monitoring to prevent gum problems and tooth loosening. Treatment is still possible, but requires careful calibration of movements and regular check-ups.