The technology behind modern lingual braces: how custom appliances are made

Lingual braces are a popular choice for people who want to straighten their teeth without visible braces. Fixed behind the teeth, they offer a discreet way to improve your smile while still providing effective, reliable treatment. To achieve the best results, every appliance is carefully designed to suit the individual.

Modern lingual braces technology has made it possible to create highly accurate hidden braces, and a personalised approach helps ensure a comfortable fit and precise tooth movement, making treatment more efficient from start to finish. Behind every set of lingual braces is a carefully planned process that combines precision with patient-focused care.

Scanning and imaging

Every treatment begins with a detailed digital scan of the patient’s teeth. This creates an accurate 3D model that allows the dental team to see exactly how the teeth fit together before planning the next steps.

Many practices now use intraoral scanners, which are passed gently around the mouth and capture thousands of images in just a few minutes that are then combined to create a highly detailed 3D model of the teeth. For patients, the process is usually more comfortable compared to traditional impressions, appointments can be quicker, and the digital records are available straight away. It also avoids the small distortions that can sometimes happen with traditional impression materials.

Depending on the patient’s needs, additional imaging like X-rays or CBCT scans might also be taken to give a clearer view of the tooth roots, jawbone, bite relationship, and any impacted or unerupted teeth. Together, these digital records provide the information needed to plan treatment. 

Feature	Traditional impressions	Digital intraoral scans
Patient comfort	Can feel uncomfortable, especially for people with a strong gag reflex	More comfortable, as no impression material is involved
Time required	Involves multiple steps and can take longer, especially if more than one impression is taken	Quick, with images captured in just a few minutes
Results	Physical impressions need to be processed before they can be used	Digital images are available instantly
Accuracy	Produces accurate results, but is more prone to distortions or errors	Highly accurate, reducing the need for retakes
Data storage	Physical models require storage space and are harder to share	Digital files can be stored, shared, and integrated with other dental technologies
Environmental impact	Uses disposable trays and impression materials	Reduces physical waste by elimiating most disposable impression materials

Digital planning

Once the digital records have been created, the next step is to plan the treatment using CAD/CAM technology, which acts as a blueprint for designing the custom appliance. Using specialised software, a dental technician can map out how the teeth are expected to move before treatment even begins. 

The software allows each tooth to be positioned virtually, helping to plan the final bite and calculate safe, controlled tooth movements. It can also highlight potential challenges early, giving the lab the opportunity to refine the treatment plan before the braces are made.

This stage is especially important for lingual braces because they are fitted to the inside surfaces of the teeth. These surfaces vary much more than the front of the teeth, so each bracket can be designed to match the unique shape and contours of the individual tooth.

Using digital orthodontics during planning makes it possible to improve treatment precision, reduce unnecessary adjustments, and make the final results more predictable. While the software provides valuable support, every decision is guided by a combination of the lab technician’s and orthodontist’s knowledge and experience.

Custom manufacturing

Once the treatment plan has been finalised, the custom appliances can be made. Each bracket is individually manufactured to fit the tongue side surface of a specific tooth, rather than using a standard design. This personalised approach helps ensure the braces fit as accurately as possible.

The manufacturing process uses the digital treatment plan as a guide and might involve CAD/CAM technology, precision milling, metal casting, and 3D printing to produce the brackets. Custom archwires are also made to match the planned tooth movements and help the teeth move in a controlled and predictable way throughout treatment. 

Custom-made appliances offer several advantages, including:

• Better bracket fit
• Greater comfort
• More precise force application
• Potentially fewer refinements during treatment

Before the custom lingual braces are fitted, they are carefully checked to make sure they match the approved digital design. These quality control checks help ensure that every bracket and archwire has been manufactured accurately and is ready for the next stage of treatment.

Bonding

Bonding is the stage where the custom brackets are attached to the teeth. With lingual braces, this process needs to be carried out with particular care due to the brackets being placed on the back of the teeth. Even small differences in their position can influence how the teeth move during treatment. 

A technique often used for lingual braces is indirect bonding, which is where the brackets are positioned in advance in the laboratory using digital planning software on a model of the patient’s teeth. A custom transfer tray is then made to hold the brackets in place, allowing several to be fitted accurately in one step during the appointment.

The bonding appointment typically follows the following steps:

• The teeth are cleaned and prepared to make sure the brackets can be securely attached
• A bonding adhesive is applied to help fix each bracket in position
• The transfer tray is placed to move the brackets onto the teeth according to the planned positions
• A special light is used to cure the adhesive, helping it set firmly
• The transfer tray is removed, leaving the braces securely attached
• The archwire is fitted to begin the planned tooth movements

Accurate placement from the beginning helps the braces work effectively and may reduce the need for adjustments or bracket repositioning later in treatment. For lingual braces, careful bonding is an important part of creating a smooth and predictable treatment process. 

Adjustments during wear

Once the lingual braces are fitted, treatment continues with a series of planned adjustment appointments. These regular visits give the orthodontist the opportunity to check how the teeth are moving and make sure everything is progressing as expected. 

During each appointment, tooth movement is reviewed and compared with the digital treatment plan. The archwire might be changed as treatment progresses, and small adjustments can be made where needed to help keep the teeth moving in the right direction. 

Digital records make it easier to track changes over time and monitor progress throughout treatment. Some practices may also use additional digital scans during treatment to provide an updated view of how the teeth are moving. 

Because custom appliances are carefully planned before treatment begins, they may require fewer major adjustments during wear. However, every patient responds differently, so the orthodontist will continue to monitor progress and make changes when needed.

Precision orthodontics: where technology meets expertise

At Direct Dental Balham, we believe the best orthodontic care comes from combining the latest technology with a personal, expert approach. With lingual braces, we can plan treatment with an impressive level of detail, creating a solution that is designed around individual smiles rather than a one-size-fits-all approach. 

While digital tools and advanced manufacturing techniques play an important role in creating precise appliances, the experience and judgement of our orthodontic team remain at the heart of every treatment plan. We take the time to understand your goal, assess your needs, and guide you through each stage of your smile journey.

Lingual braces have come a long way. By bringing together innovation, accuracy, and specialist care, we help our patients achieve the results they are looking for while feeling supported at every stage of their treatment. 

FAQs