Ceramic Braces

When ceramic braces may be considered

Ceramic brackets are an option for people who need fixed braces and want the brackets to show less. Orthodontic treatment can address crowded teeth, gaps and problems with how the upper and lower teeth meet¹. Treatment is also possible in adults.

Your dentist will assess whether ceramic brackets suit your teeth and bite.

When metal brackets may be discussed

• Bracket failure. In the larger clinical study, ceramic brackets failed more often. The difference was in the lower teeth and the back teeth³; no difference was found in the upper teeth or the front teeth. The authors said failures may cause delays and inconvenience³. The smaller study found the opposite overall result⁴. Ask which teeth would have ceramic brackets and how repairs would be arranged.
• Your bite. In a laboratory test, ceramic brackets wore away more enamel from teeth rubbing against them than metal brackets did⁶. This was an artificial-mouth experiment, not a study in patients. Ask whether your teeth would touch the brackets when you bite.

When clear aligners may be considered

Clear aligners are removable trays worn over the teeth¹. Discuss whether you can wear them consistently as prescribed.

In cases where teeth were taken out to make room, fixed braces showed better treatment quality than clear aligners⁷. In cases without extractions, no clear difference was found⁷. These research findings do not decide which appliance suits you.

Questions for the examination

Ask your dentist whether any decay or gum problem needs treatment first. If you are concerned about the position of your jaws, ask whether braces alone can address the problem. Your dentist will explain the options after examining you.

If the braces are for your child, discuss the available options with their dentist first.

• Not having treatment. If your concern is appearance, ask about leaving your teeth as they are as well as the treatment options.
• Metal brackets. These are fixed to the front of the teeth and remain in place during treatment¹.
• Ceramic brackets. These are tooth-coloured brackets that show less than metal brackets¹. The studies of bracket failure disagree, and ceramic brackets may carry more risk of enamel fractures during removal⁵.
• Lingual braces. The brackets sit on the inner surfaces of the teeth. Studies mainly followed patients during the first three months. Compared with brackets on the front, tongue soreness and changes in speech were reported more often, while cheek and lip soreness were reported less often⁸.
• Clear aligners. These are removable trays fitted over the teeth and replaced in sequence¹. They are taken out for eating. Your dentist will advise whether they suit your treatment needs.

The table summarises the position, appearance and removability of these appliances¹.

Treatment length depends on your teeth, the problem being treated and the appliance chosen. The American Dental Association's patient information says most people are in treatment for one to three years¹. This is general patient information, not a research estimate. That range does not predict your treatment length.

We cannot say whether ceramic brackets make treatment longer than metal brackets. Your dentist will advise on your likely treatment length and appointment schedule after examining you.

The stages below outline fixed-brace treatment and retention². Your treating dentist is the dentist who plans and supervises your braces. Ask who will perform each stage. Teeth may be tender after fitting or adjustments⁹, and the method of ceramic bracket removal deserves discussion because of the possible risk to enamel⁵.

The study figures below come from published research, not from our own records. They do not predict your personal outcome.

What is different with ceramic brackets

• Bracket failure. Clinical studies comparing ceramic and metal brackets during the first 12 months gave conflicting results. In a non-randomised study of 80 patients, about 16 in every 100 ceramic brackets failed, compared with about 9 in every 100 metal brackets³. A smaller study randomly divided 20 patients into groups. It found about 7 failures in every 100 metal brackets, compared with about 1 in every 100 ceramic brackets⁴. These figures count brackets, not patients. The evidence does not settle which kind fails more often.
• Enamel during removal. A 2024 systematic review of 14 studies examined changes to teeth after braces were removed. It noted that ceramic is brittle and suggested that ceramic brackets may lead to more enamel fractures, particularly during removal⁵. Much of this evidence comes from laboratory studies on extracted teeth. The review gives no rate and did not grade the certainty of the evidence. Ask how your brackets would be removed.
• Wear of opposing teeth. In a 1990 artificial-mouth experiment, upper teeth rubbed against brackets on lower teeth. Ceramic brackets wore away more enamel from the upper teeth than metal brackets did⁶. This was an old laboratory study with no patients, done with the bracket products of that time, and it gives no clinical rate. Ask whether your teeth would contact the brackets when you bite.
• Colour changes. In a small randomised trial, 40 teenagers with ceramic brackets rinsed with black tea or cola. The brackets changed colour, more with tea than with cola¹⁰. An instrument measured the colour after the brackets were removed. The findings do not tell us how noticeable the change would be.
• Pain compared with metal brackets. The evidence used on this page does not establish whether ceramic and metal brackets differ in pain.

Risks and disadvantages of fixed braces

• Pain and tenderness. Teeth can feel tender or under pressure after fitting or adjustment. In studies of the first week, pain was usually strongest in the first 24 to 48 hours and eased within about a week⁹.
• White spots, or early decay. An analysis of 44 studies found that new white spots developed during orthodontic treatment in about 34 in every 100 patients¹¹. The patients were about 16 years old on average. Spots were more common with longer treatment. These findings are not a personal risk estimate. Careful cleaning and limiting sugary food and drinks¹ are recommended during treatment.
• Teeth moving after treatment. Teeth tend to move back towards their original position¹². Retention is therefore part of treatment.
• Gum recession. Orthodontic treatment, poor oral hygiene and thin gums are listed among factors that may increase the risk of gums pulling back¹³. This is expert opinion and does not give a rate.
• Appliance problems. Loose brackets and wires that irritate the mouth¹ need attention. Ask whom to contact between appointments.
• Previous injury to a front tooth. Tell your dentist if a front tooth has ever been knocked or damaged. Such a tooth may need further treatment while you wear braces².
• Time and appointments. Fixed braces involve ongoing adjustment appointments over a prolonged course of treatment². Discuss how the schedule fits your work or family responsibilities before starting.
• Other side effects. Ask your dentist to explain other possible effects, including root resorption, and how these would be assessed in your case. This page does not give a frequency estimate.

Benefits

Orthodontic treatment aims to improve tooth alignment and the way the teeth meet¹. Ceramic brackets are less noticeable than metal brackets during treatment. Ask your dentist what changes are realistic for your teeth and bite.

If you have pain

• A Cochrane review of 32 studies found that painkillers reduced orthodontic pain compared with taking no medicine¹⁴. The evidence was of moderate quality. It found no clear difference between anti-inflammatory painkillers, such as ibuprofen, and paracetamol; that comparison had low-quality evidence. Follow the packet instructions and ask your pharmacist or doctor if you are unsure.
• Non-drug methods such as chewing gum, bite wafers and vibration devices have not been shown to reduce orthodontic pain¹⁵. The evidence is of very low quality.
• Ask your dentist what to eat if chewing is uncomfortable.

Eating and drinking

• Avoid hard, crunchy and sticky foods¹. Chewing gum can stick to fixed braces².
• Cut down on sugary food and drinks, which can contribute to plaque building up around brackets¹.
• Black tea changed bracket colour in the small trial described above¹⁰. Ask your dentist about drinks if colour changes concern you.

Cleaning and check-ups

• Brush twice a day with fluoride toothpaste, taking care around the brackets and along the gumline.
• Clean between the teeth and under the wires every day. Patient guidance recommends an interdental brush²; ask your dentist which size to use.
• Continue regular dental check-ups alongside your adjustment appointments. A clinical guideline from NICE recommends setting check-up intervals according to the risk of decay and gum disease¹⁶. Your dentist will advise on your schedule.

After treatment, teeth tend to move back towards where they started¹². A retainer helps hold them in their new position².

• Which retainer? Options include fixed wires bonded behind the teeth and removable retainers. A Cochrane review covering 47 studies did not show any retainer to be clearly better at keeping teeth straight¹². There are trade-offs involving breakages, comfort and the gums. The certainty of the evidence is low or very low.
• How long should you wear it? Your treating dentist sets the wearing schedule². A British opinion piece describes advice from the British Orthodontic Society that retainers should be worn for life¹⁷. The author argues that research does not support this as a general instruction and notes that most retention trials lasted 6 to 24 months¹⁷. There is no evidence-based fixed duration, and no method has been shown to hold teeth completely still for life. This is not a reason to stop early: follow your treating dentist's schedule.
• Can a fixed retainer come loose? Studies of multistranded retainer wires reported bond failure ranging from 12 to 50 per cent¹⁸. These are the lowest and highest values from different published studies, not our own records or a single pooled rate. The evidence is low quality. The published summary does not specify the follow-up period, so this is not a risk over a set number of years. It also does not establish a clear counting unit for this range.
• Who checks and repairs it? Before treatment starts, ask who will check the retainer and whom to contact if it breaks, feels loose or stops fitting. Include these arrangements in your written plan.

Ask who will plan your treatment, fit the brackets, carry out adjustments and remove the braces. Ask for their names and qualifications in writing.

Orthodontics is one of the nine dental specialties recognised by Turkish law¹⁹. The specialty title requires a certificate in that specialty¹⁹, issued and registered by the Ministry of Health²⁰. Ask whether the dentist planning your treatment holds a registered specialty certificate in orthodontics.

A dentist in private practice must register with the provincial or regional dental chamber within a month of starting²¹. You can ask for the treating dentist's registration details.

Contact your treating dentist if pain lasts more than a few days after fitting or adjustment².

Also contact them about:

• A loose or broken bracket, or a wire irritating your cheek or tongue²
• A fixed retainer wire that feels loose or has broken¹⁸
• A removable retainer that breaks or no longer fits
• White spots around the brackets¹¹, or bleeding or swollen gums²

A dental abscess does not go away on its own and needs urgent dental treatment²². If you suspect an abscess, ask for an urgent dental appointment. If you have swelling in your face or jaw, or a fever, seek dental care the same day.

Emergencies. The following symptoms need urgent medical help²². Go to a hospital emergency department or call 112. Do not wait for a dental appointment or a reply from the clinic:

• Swelling that makes breathing, speaking or swallowing difficult
• 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

Ask for a written plan that covers:

1. Who plans the treatment and carries out each adjustment.
2. Which teeth will have ceramic brackets and how they will be removed.
3. How often appointments are expected and what happens if you miss one.
4. Who handles a loose bracket or a wire problem between appointments.
5. Who removes the braces, fits the retainer and checks it afterwards.
6. How to contact the dental team with a concern.

Ask your treating dentist to set your appointment intervals.

Your records and consent

Ask for the treatment plan, the materials and brackets used, and your care instructions in writing. Ask for a copy of your X-ray records. Ask who will explain the plan and consent form to you in English.

In private dental facilities in Turkey, a consent form is required for every intervention²⁴. The form is signed in duplicate, and a copy is given to you²⁵. You can take time to decide, decline treatment or ask to stop.

If treatment is for a child, ask how consent will be handled. Turkish patient rights rules require permission from a parent or guardian for treatment of a minor²⁵. The young person is also heard and involved as far as they can understand.

If you have a complaint

Ask for the clinic's complaints procedure. Raise the concern with the clinic first. If it remains unresolved, you can apply to the provincial health directorate's Patient Rights Board²⁵, which does not assess allegations of medical error. The dental chamber can also open disciplinary proceedings against a dentist²¹.