Ceramic Braces

When ceramic braces may be considered

Ceramic brackets are an option for people who need fixed braces and would like the brackets to show less. Fixed braces are used for:

• Teeth that are crooked because there is not enough room for them in the jaw.
• Gaps between teeth.
• A bite where the upper and lower teeth do not meet properly. For example, the lower teeth close in front of the upper teeth, or the upper front teeth sit well in front of the lower ones.

Orthodontic treatment is not only for children; it is also done in adults. Bite problems, early treatment in children and all the appliance options are covered on the braces page.

When metal brackets may be discussed instead

• If a failed bracket would be a real problem for you. In the larger of two studies, ceramic brackets failed more often than metal ones. The difference was in the lower teeth and the back teeth¹; no difference was found in the upper teeth or the front teeth. The authors say ceramic brackets may involve delays and inconvenience¹ for this reason. The smaller study found the opposite (see risks below). A bracket that fails is repaired at an appointment, which matters more when your appointments are far from home. Ask your treating dentist which teeth would have ceramic brackets.
• Your bite. In a laboratory test, ceramic brackets wore away more enamel from the teeth that rubbed against them⁴ than metal brackets did (see risks below). Ask your treating dentist whether ceramic brackets suit your bite, and whether your teeth would touch the brackets when you bite.

When clear aligners may suit better, or not

Clear aligners are clear trays that you take out and put back in yourself. For aligners, the choice also depends on whether you can wear them consistently. In cases where teeth have to be taken out to make room, fixed braces have shown better treatment quality than clear aligners⁵. In cases without extractions, no clear difference has been seen⁵ between the two. More detail is on the clear aligner treatment page.

When something else is discussed first

• Decay or gum disease. The state of your teeth and gums is assessed at an examination before treatment. If there is decay or gum disease, your treating dentist explains how it will be dealt with before orthodontic treatment starts.
• When the problem lies in the position of the jaw bones. In people who have stopped growing, adding jaw surgery to orthodontic treatment may be discussed for some jaw mismatches. We cannot say on this page when this is needed; your treating dentist explains the options after the examination.
• A child under 18. On the NHS in England, braces are usually only free for people under 18 who have a problem with their teeth⁶. If the braces are for your child, ask your own dentist first.

• Not having treatment. If crowding or a gap is only about appearance, not having treatment is also an option.
• Metal brackets. The brackets are glued to the front surface of the teeth and stay in the mouth throughout treatment; you cannot take them out. They show more than ceramic brackets.
• Ceramic (tooth-coloured) brackets. They work in the same way as metal brackets and are less noticeable. Whether they fail more or less often than metal brackets is not settled. They may also carry more risk to the enamel when they are removed (see risks).
• Lingual braces. The brackets are glued to the back surface of the teeth and cannot be seen from outside. Studies of lingual braces mostly followed patients for about the first three months. In them, tongue soreness was reported clearly more often⁷ than with braces on the front of the teeth. Changes in speech were much more common⁷.
• Clear aligners. Clear trays that you take out and put back in yourself, replaced one after another (see above).
• Braces in the UK. Braces are also provided by dentists and orthodontists in the UK. On the NHS in England, an orthodontist decides who is eligible for free braces. Adults usually pay for braces privately⁶. Only a dentist on the GDC's specialist list may use the title specialist in the UK (see who carries out the treatment, below).

How long treatment takes depends on the state of your teeth, how severe the problem is and which appliance is chosen. According to the patient information page of the American Dental Association (ADA), most people are in treatment for one to three years⁸. This range comes from general patient information, not from research. For braces offered on the NHS, the NHS says a fixed brace usually stays in place for 1 to 2 years⁶. We cannot say on this page whether treatment takes longer with ceramic brackets than with metal ones. Your treating dentist tells you the likely length of your treatment and how often you will need appointments after the examination.

On this page, "your treating dentist" means the dentist who plans and supervises your braces. Whether that dentist is an orthodontist is a question to ask (see who carries out the treatment, below).

What is different with ceramic brackets

• Brackets that fail. Two clinical studies compared ceramic and metal brackets over the first 12 months of treatment, and they disagree. In a study of 80 patients, about 16 in every 100 ceramic brackets failed, against about 9 in every 100 metal brackets¹. That study was not randomised. A smaller study of 20 patients, randomly divided into two groups, found the opposite. In that study, about 7 in every 100 metal brackets came off, against about 1 in every 100 ceramic brackets². With so few studies, we cannot say which kind fails more often. These figures come from published studies, not from our own records.
• Enamel when the brackets are removed. A 2024 systematic review of 14 studies looked at changes to the teeth after braces are removed. It notes that ceramic is a brittle material. It concluded that ceramic brackets may lead to more enamel fractures, particularly when the brackets are taken off³. Much of the evidence on this point comes from laboratory studies on extracted teeth, and the review gives no rate. Ask your treating dentist how the brackets will be removed at the end of treatment.
• Wear of the teeth that bite against the brackets. In a 1990 laboratory test, upper teeth were rubbed against brackets on lower teeth in an artificial mouth. Ceramic brackets wore away more enamel from the upper teeth than metal brackets did⁴. This is one old laboratory study with no patients, and it gives no rate. Ask your treating dentist whether your teeth would touch the brackets when you bite.
• Colour. Ceramic brackets can pick up colour. In a small randomised trial, 40 teenagers with ceramic brackets rinsed with black tea or cola. Afterwards the brackets had changed colour, more with tea than with cola⁹. The change was measured with an instrument on the brackets after they were taken off; this page cannot say how visible it would be.
• Pain. We cannot say on this page whether ceramic and metal brackets differ in pain.

Risks and disadvantages of all fixed braces

• Pain and tenderness. When braces are first fitted or adjusted, your teeth can feel tender and under pressure for a few days. In studies of the first week, pain was usually at its highest in the first 24 to 48 hours and eased within about a week¹⁰.
• White spots (early decay). While fixed braces are on, plaque builds up around the brackets. In an analysis of orthodontic patients, based on 44 studies, new white spots developed during treatment in about 34 in every 100 patients¹¹. The longer treatment lasted, the more common the spots were. These figures come from published studies, not from our own records, and they are not a personal risk estimate. This is why careful brushing and cutting down on sugary food and drinks are recommended.
• Teeth shifting after treatment. After orthodontic treatment ends, teeth tend to move back¹² towards where they started. This is why the retention phase is part of treatment (below).
• Gum recession. Orthodontic treatment, poor oral hygiene and thin gums are listed among the factors that may raise¹³ the risk of the gums pulling back. This is an expert opinion and does not give a rate.
• Loose brackets and poking wires. A bracket can come away from the tooth, or the end of a wire can poke into your cheek. If this happens, contact the clinic or the dentist who looks after your braces (see below).
• A front tooth that was knocked in the past. Before braces are fitted, tell your treating dentist if a front tooth has ever been knocked or damaged. According to the NHS, such a tooth may need further treatment while wearing braces⁶.
• Long treatment and regular appointments. Treatment takes months, often years, and needs you to come to adjustment appointments regularly. If you live in the UK, this is the main practical question (see below).
• Other possible side effects. Other side effects, such as shortening of the tooth roots during treatment (root resorption), can also happen. We cannot say on this page how often they happen; ask your dentist at the examination.

Benefits

• The aim is to line the teeth up more evenly, improve the bite and close gaps. How far this is achieved varies; your treating dentist explains what is realistic for you.
• During treatment, ceramic brackets are less noticeable than metal brackets.

If you have pain

• Over-the-counter painkillers reduced orthodontic pain compared with taking no medicine. This result comes from a Cochrane review covering 32 studies; the quality of the evidence is moderate¹⁴. When anti-inflammatory painkillers (NSAIDs, such as ibuprofen) were compared with paracetamol, no clear difference was found; the quality of that comparison's evidence is low. Follow the instructions on the pack; if you are not sure, ask your pharmacist or doctor.
• Non-drug methods such as chewing gum, bite wafers and vibration devices have not been shown¹⁵ to reduce orthodontic pain. The evidence on this is of very low quality.
• In the first days, soft foods may be easier to chew.

Eating and drinking

• Avoiding chewing gum during fixed braces treatment is recommended; gum can stick to the braces⁶. It is also best to avoid hard, crunchy and sticky foods.
• Cut down on sugary food and drinks; sugar can lead to plaque building up⁸ around the brackets.
• Black tea changed the colour of ceramic brackets in the trial described above. If colour matters to you, ask your treating dentist about drinks while the braces are on.

Cleaning

• Brush your teeth twice a day with fluoride toothpaste; take care around the brackets and along the gumline.
• Clean between the teeth and under the wires every day, not only where food gets caught. The NHS advises using an interdental brush⁶ for this; ask your treating dentist which size to use.
• Alongside your orthodontic appointments, keep having regular check-ups with your own dentist in the UK. How often you need them is set according to your risk of decay and gum disease¹⁶.

When treatment ends, teeth tend to move back towards where they started. A retainer is used to hold the teeth⁶ in their new position.

• Which retainer? There are fixed wires glued behind the teeth and removable retainers. A Cochrane review covering 47 studies has not shown any one of them to be clearly better¹² at keeping teeth straight. Each has pros and cons in terms of breakages, comfort and the gums; the certainty of the evidence is low or very low.
• For how long? Your treating dentist decides how long you wear the retainer⁶. According to a UK opinion piece, the British Orthodontic Society (BOS) has given patients the message that retainers should be worn for life¹⁷. The author of the piece, a dentist, argues that research does not support this general advice. In his view, most retention studies lasted 6 to 24 months¹⁷. There is no evidence-based fixed length of time, and no retention method has been shown to hold teeth completely still for life.
• A fixed retainer wire can come loose. In studies, bond failure with multistrand twisted wires has been reported at between 12 and 50 per cent¹⁸. This is not a single rate but the lowest and highest values reported in different studies; the quality of the evidence is low.
• Who looks after the retainer in the UK? Retention goes on after you are back home. Agree before the brackets are fitted who checks the retainer in the UK and who repairs or replaces it if it breaks or stops fitting. Ask whether that is part of your plan. More on retainers: retainers.

Your treatment is provided by our clinic in Antalya, Turkey. The appointments in Antalya are carried out by the clinic's dentists. On this page, "we" means that clinic.

Orthodontics is one of the nine dental specialties set by law in Turkey¹⁹. Turkish law ties the specialist title to a specialist certificate¹⁹, issued and registered by the Ministry of Health²⁰. In the UK, a dentist may call themselves a specialist only if they are on the GDC's specialist list²¹. A dentist does not have to be on the list²¹ to provide orthodontic treatment, but only those on it may use the title.

If you are comparing with a UK orthodontist, compare like with like. Ask who will plan your treatment, who will fit the braces and who will carry out the adjustments. Ask what their titles are, where they qualified, and whether the dentist planning your braces holds a Ministry-registered specialist certificate in orthodontics. Ask for the answers in writing.

Contact your treating dentist, or the dentist who looks after your braces in the UK, if you notice any of these.

• Pain that lasts more than a few days⁶ after braces are fitted or adjusted
• A bracket that has come off a tooth or looks cracked or broken, or the end of a wire poking into your cheek or tongue
• A fixed retainer wire that feels loose or has broken
• A removable retainer that no longer fits or has broken
• White spots around the brackets, or gums that bleed or are swollen
• A knock to the front teeth during or after treatment

If you think you have a dental abscess, do not wait; an abscess does not go away on its own and needs urgent dental treatment²². In England, the NHS advises asking for an urgent dentist appointment. If you have no dentist or cannot get an emergency appointment, get help from NHS 111²². If you have swelling in your face or jaw, or a fever, get seen the same day by a dentist where you are.

Emergencies. The following need urgent medical help²². Do not wait for a dental appointment or for the clinic's reply. In the UK, call 999 or go to A&E. In Turkey, the emergency number is 112.

• Swelling that makes it hard to breathe, speak or swallow
• Swelling around your eye or in your neck²³
• Swelling or pain in the eye, or sudden problems with your sight
• A lot of swelling inside your mouth
• Difficulty opening your mouth

Before you fly home

Know who will carry out your next adjustment, where and when. Make sure you have written care instructions, your treatment record and a way to reach the clinic.

Once you are back in the UK

If a bracket comes off or a wire pokes, write to the clinic and send photographs. See the dentist or orthodontist who looks after your braces in the UK for anything that needs someone to look in your mouth. In the emergencies above, do not wait for a reply.

Braces are not a one-trip treatment. After the brackets are fitted, the wires are changed or adjusted at set intervals until treatment ends. Then the braces are taken off and a retainer is fitted. For its own patients, the NHS describes an adjustment appointment every 6 to 8 weeks⁶. So before you decide, the practical question is who will carry out each appointment, and where.

Two ways to arrange it

There are two ways, and a plan may combine them. You come back to Antalya for the adjustment appointments. Or a dentist or orthodontist near your home in the UK takes over after the brackets are fitted. Repeated trips over many months need to fit your work, your family and your budget. For a child, they also need to fit around school.

A UK dentist or orthodontist has to agree to take over treatment in progress, and some may not want to. They may also want to change the plan or the appliance. Adults usually pay for braces privately in the UK (see the options above). So ask a UK practice in advance whether it would take over, and on what terms.

If a UK dentist does take part, agree what they are asked to do. The GDC states that when a dentist relies on another professional's examination, the responsibility for that judgement rests wholly with the prescribing dentist²⁴. The GDC wrote this for dentists on its UK register. For your plan, it means asking which dentist is responsible for it at each stage.

Between appointments

Photographs you send can show the clinic a loose or broken bracket, or a wire that pokes. But a loose bracket is repaired, and a wire changed or adjusted, at an appointment. Ask before the brackets are fitted who repairs a loose bracket or a broken wire between trips, and who pays for it.

What to agree in writing

Agree the arrangement before the brackets are fitted, and have it in writing. Before you start, ask:

1. Who carries out each adjustment, and where?
2. Roughly how often are the adjustments, and how many trips to Antalya does the plan include?
3. What happens if an appointment is missed?
4. Who repairs a loose bracket or a broken wire between appointments, and who pays?
5. Who takes the braces off and fits the retainer, and where?
6. Which teeth will have ceramic brackets, and how will they be removed at the end?

If you are considering clear aligners instead, ask the same questions about their check-ups; see clear aligner treatment.

The examination comes first

The UK dental regulator, the GDC, states that some contact between dentist and patient can take place at a distance. For other stages of care, however, a face-to-face appointment or a physical examination is needed for patient safety. For orthodontics, the GDC says there is currently no effective substitute for a physical clinical examination²⁴. This is the view of a UK regulator, not a binding rule in Turkey. Before you book, you receive a written preliminary plan based on the photographs and any X-rays you send. It sets out the appointments and how many days the first trip needs. It is not a diagnosis: the examination confirms or changes it, and with it the days and the cost. If it changes, you receive the revised plan in writing before treatment starts. You can take time to decide, and you can say no, or ask to stop, at any stage. Having braces with a dentist or orthodontist in the UK remains an option.

Flying. We have found no guidance that sets a waiting time before flying after braces are fitted or adjusted. A 2023 review of flying after dental treatment does give times for tooth extraction, which matters if teeth are taken out to make room. It suggests waiting 24 to 48 hours after a simple extraction and 72 hours after a surgical one²⁵. These times apply only if there is no pain, swelling or bleeding where the tooth was taken out. The authors note that the research is limited and comes mainly from military aviation. Ask the clinic when you can fly after the brackets are fitted.

Your own dentist

The General Dental Council suggests talking to your own dentist²⁶ before you go. They need to know the plan, and you keep seeing them for check-ups during treatment (see daily care above). The NHS lists exchanging medical records and arranging aftercare back home²⁷ among the things to consider before treatment abroad.

Ask for a written record of the appliance and brackets used, the stage your treatment has reached and the wires in place. Ask too for copies of your X-rays, scans and photographs. A dentist or orthodontist in the UK needs it to continue treatment or repair the braces. In Turkey, the health tourism regulation entitles international patients to an itemised bill. On request, they also get free copies of the records of the materials used, the tests and the imaging²⁸.

What the NHS does and does not do

In England and Wales, an NHS dental practice may accept you for a course of treatment, not only an urgent appointment. If it does, it provides clinically necessary treatment, with your consent²⁹. That does not mean an NHS practice will take over braces fitted abroad. The NHS free-repair and replacement provisions do not apply²⁹ to work done by another provider. These are the free repair or replacement an NHS practice can give for its own work. The NHS also states that it is not liable for negligence or failure of treatment²⁷ when you have treatment abroad. On the NHS England routes that fund planned treatment abroad, you cannot get reimbursement for dental treatment³⁰.

The NHS guidance quoted on this page is for England, and for England and Wales where stated. Scotland and Northern Ireland have their own NHS rules, which we have not checked. Elsewhere in the UK, ask your own dentist how the rules apply to you.

Travel insurance

The NHS notes that most travel insurance policies will not cover you for planned treatment abroad²⁷, so you may need specialist cover. Ask your insurer before you book whether anything linked to your treatment is covered, such as a complication or an extra trip.

The General Dental Council lists questions to ask before treatment abroad²⁶. Below is our selection: what this page can answer today, and what to ask for in writing.

1. Who will carry out my treatment, and what are their qualifications? The treatment is provided by our clinic in Antalya, Turkey. Ask for the name of the dentist who will plan your braces and fit and remove the ceramic brackets. Ask too for the name of each dentist who will adjust them. Ask where they qualified and what their title is (see who carries out the treatment, above).
2. Will they speak English, or will there be a translator? Ask who will explain the plan, the consent form and the care instructions to you in English.
3. Are you regulated by a professional body and registered with it? In Turkey, a health facility needs an authorisation certificate²⁸ from the Ministry of Health to treat international patients. Authorised facilities appear in a register the Ministry publishes³¹, so you can check it yourself. The authorisation belongs to the facility, not to the dentist, and it says nothing about the result of your treatment. Ask for the treating dentist's own registration details as well. See health tourism authorisation.
4. How many times have you done this treatment, and what are your complication rates? The figures on this page come from published studies, not from the clinic's own results. Ask for the clinic's figures in writing, and how they were collected.
5. Is the work guaranteed, are the terms in writing, and for how long do they apply? This page makes no guarantee. Ask for the clinic's written terms for braces. They should cover missed or extra adjustments, loose or broken brackets, the retainer, and what happens if teeth move back after treatment.
6. What aftercare do you provide, and who can I contact after the treatment? Your written plan should name who to contact, how, and who carries out each adjustment (see above).
7. If there are complications, who pays for further treatment, extra flights and the hotel? Ask for the answer in writing before you commit. Ask too what you would pay, and what is refunded, if the examination in Antalya shows that braces do not suit you.
8. Do you have insurance to cover this treatment? In Turkey a facility treating international patients must take out complication insurance for surgical and interventional procedures carried out in an operating theatre²⁸. That does not by itself tell you whether your treatment is covered, so ask which procedures in your plan, if any, fall under it. Ask too, in writing, whether the clinic or the treating dentist holds insurance for complications or errors, what it covers and whom it protects.
9. Do you have a complaints system, and can I see a copy? Ask for it before treatment. The GDC says it cannot resolve complaints or help with refunds³²; its investigations concern the dentists on its own register. Turkish regulation makes the facility responsible for complications and medical malpractice arising after the health service it provided²⁸.

If the braces are for your child, ask whether the clinic treats under-18s who live in the UK. Ask how a parent gives consent. A child under 18 may be able to have braces free on the NHS, so ask your own dentist first.

The NHS names warning signs to think about before booking any treatment abroad. They are a hard sell, a lack of information, pressure to make a quick decision, no discussion of possible complications, and no mention of aftercare³⁰. Apply them to this clinic too.

This page does not show prices. A treatment plan is prepared for you after an examination. The main factors that shape it are:

• The brackets chosen: ceramic or metal, and on which teeth
• How severe the problem is and the likely length of treatment
• Extra procedures, such as taking teeth out, or fillings or gum treatment before orthodontic treatment
• The number of adjustment appointments, and how many of them are in Antalya
• Repairs to brackets that come off or break, and where they are done
• The retainer after treatment and its check-ups

Ask for the plan in writing. It should say what is included, and especially whether the adjustments, bracket repairs, the retainer and its check-ups are included. Ask too who pays for further treatment and extra travel if there is a complication.

If you are comparing with a quote from a UK practice, compare what each one includes, item by item. Add the cost of your own trips for adjustment appointments, and of any UK appointments your plan relies on.