Ceramic braces

How invisible are they, really

Not invisible. Ceramic brackets are made from a polycrystalline or single-crystal alumina that picks up the shade of the tooth beneath, so from a metre away they read as a slight texture rather than as hardware. Close up, and in a flash photograph, they are visible. The archwire is still there too, and a metal wire across tooth-coloured brackets is the part most people notice. Tooth-coloured coated wires exist and help, though the coating wears at the contact points over a few months.

Do they stain?

The brackets themselves do not. Ceramic is glass-like and does not absorb pigment. What stains is the elastic ligature holding the wire, and it stains readily with curry, tomato sauce, red wine, coffee and smoking. Ligatures are replaced at every adjustment visit, so discolouration lasts weeks rather than the whole treatment, but between visits it is noticeable. Two ways around it: choose a self-ligating ceramic bracket with no elastics at all, or accept a colour change every six to eight weeks and moderate the pigment load in between.

Strength and handling

Ceramic is harder than steel but more brittle, so a bracket occasionally fractures under heavy load — a knock during sport, an unlucky bite on something hard. It happens infrequently and it costs a repair visit when it does. Because ceramic is harder than enamel, ceramic brackets are usually avoided on the lower front teeth in a deep bite where the upper teeth would strike them, since the risk of wearing the opposing enamel is real. In that situation a common solution is ceramic on the upper arch, which is the arch people see, and metal on the lower.

Debonding ceramic takes more care than debonding steel and adds a little chair time at the end. It is routine, but it is not instant.

Cost

Expect a modest premium over metal, reflecting the bracket cost and the additional chair time at both ends of treatment. It is a smaller premium than most people assume, and much smaller than the step up to lingual braces.

Who they suit

Adults in workplaces where appearance matters to them, older teenagers who would refuse metal outright, and anyone whose case needs fixed mechanics but who would otherwise be drawn to aligners for cosmetic reasons alone. They are a poor choice for a patient in a contact sport without a mouthguard, and they are usually not the first recommendation for a young teenager with a deep bite.