What This Guide Covers and Who It Is For
This guide explains lingual braces, a type of fixed orthodontic appliance placed on the tongue-side (lingual) surface of your teeth. If you want straighter teeth without visible metal on the front of your smile, lingual braces may be worth exploring.
The information here is written for adults and older teens considering orthodontic treatment. It is also useful for parents evaluating options for their teenage children. You will learn how lingual braces compare to traditional braces and clear aligners, what treatment involves step by step, and how to decide whether this approach fits your situation.
Lingual braces fall under the specialty of orthodontics. An orthodontist is a dentist who completed two to three years of additional training focused on tooth movement and jaw alignment. Lingual technique requires even further skill beyond standard orthodontic training, so finding the right provider matters.
How Lingual Braces Work
Lingual braces use brackets and wires to move teeth, just like traditional braces, but everything sits behind the teeth instead of in front.
What Are Lingual Braces?
Lingual braces are fixed orthodontic appliances bonded to the lingual surface of each tooth. The lingual surface is the side that faces your tongue. Because the brackets and wires are hidden behind the teeth, they are essentially invisible to other people during normal conversation and smiling.
Each bracket is custom-made to fit the unique contour of the back of each tooth. A thin archwire connects the brackets, and this wire applies gentle, continuous force to guide the teeth into their planned positions. The orthodontist adjusts the wire at regular appointments to continue the movement.
Several branded lingual systems exist, including Incognito (now 3M) and WIN. These systems use digital scanning and computer-aided manufacturing to design brackets that fit precisely. The custom fit is important because the back surfaces of teeth are much more irregular than the front surfaces. Both the Incognito and WIN systems have received FDA 510(k) clearance as orthodontic bracket systems, meaning the FDA reviewed them for substantial equivalence to previously marketed devices rather than through the more rigorous premarket approval (PMA) pathway.
What Conditions Can Lingual Braces Treat?
Lingual braces can treat most of the same orthodontic problems that traditional braces address. These include crowding (teeth that overlap because of limited jaw space), spacing (gaps between teeth), overbite (upper front teeth overlapping lower front teeth too much), underbite (lower teeth sitting in front of upper teeth), and crossbite (upper teeth biting inside lower teeth on one or both sides).
Orthodontic treatment for crowded teeth has been studied extensively, and systematic reviews confirm that fixed appliances are effective for resolving crowding, though the evidence for choosing one specific bracket system over another remains limited. [2] The choice between lingual and labial (front-side) braces typically comes down to patient preference, case difficulty, and the orthodontist's expertise rather than a fundamental difference in clinical outcomes.
Complex cases involving jaw discrepancies or severe malocclusion (bad bite) may still be candidates for lingual braces, but they may require additional tools such as temporary anchorage devices (small screws placed in the bone for extra leverage) or elastics.
How Do Lingual Braces Compare to Other Options?
Patients seeking discreet orthodontic treatment typically consider three options: lingual braces, clear aligners, and ceramic (tooth-colored) braces on the front of the teeth. Each has trade-offs.
Clear aligners are removable, which makes eating and brushing easier. However, they depend on the patient wearing them 20 to 22 hours per day. Non-compliance can slow treatment. Lingual braces are fixed in place, so compliance is not a factor. They work around the clock.
Ceramic braces on the front of the teeth are less visible than metal braces but still noticeable at close range. Lingual braces are truly invisible from the outside. On the other hand, lingual braces tend to cost more and can cause more initial tongue discomfort than front-side options.
A 2018 analysis of YouTube content about lingual orthodontic treatment found that much of the publicly available patient information was of variable quality. [3] This underscores the importance of getting treatment facts directly from a qualified orthodontist rather than relying solely on online videos or social media.
Practical Details Before You Decide
Lingual braces work well for many people, but certain practical factors help determine whether they are the right fit for you.
Who Is a Good Candidate?
Most adults and older teens with fully erupted permanent teeth can be candidates for lingual braces. The American Association of Orthodontists recommends that children have an initial orthodontic evaluation by age 7, though lingual braces are rarely placed at that age. [5] Lingual treatment is more common in patients whose permanent teeth have fully come in, typically around age 12 to 14 or later.
Certain factors may make lingual braces less suitable. Patients with a very deep overbite may bite directly onto the lower lingual brackets, which can cause bracket breakage or discomfort. In some deep-bite cases, the orthodontist can use bite turbos (small buildups on the teeth) to open the bite enough for the brackets to function. Very short teeth or teeth with unusual shapes may also make bracket bonding difficult.
People who play wind instruments or contact sports should discuss potential interference with their orthodontist. A custom mouthguard is recommended for athletes regardless of the type of braces they wear.
Speech Changes and Comfort
The most common concern about lingual braces is the adjustment period. Because the brackets sit on the tongue side, your tongue will contact them frequently when speaking, swallowing, and eating. Most patients report a temporary lisp and general tongue soreness during the first two to four weeks.
The lisp typically improves as the tongue adapts to the brackets. Reading aloud or practicing speech exercises can help speed this process. Orthodontic wax applied to sharp bracket edges can reduce tongue irritation. Some patients find that the smaller, custom-fit bracket systems cause less discomfort than older, bulkier designs.
After the initial adaptation, many patients report that they forget the braces are there during daily activities. Soreness after each adjustment appointment is normal and usually lasts one to three days, similar to the soreness experienced with traditional front-side braces.
Oral Hygiene with Lingual Braces
Keeping lingual braces clean requires extra effort. The brackets are harder to see and reach, so food and plaque can build up more easily. The American Dental Association recommends brushing at least twice daily and flossing once daily for everyone, and this becomes even more critical when wearing fixed orthodontic appliances. [6]
Your orthodontist may recommend a small interdental brush or a water flosser to clean around brackets and under the archwire. A mirror with good lighting can help you check for trapped food. Regular dental cleanings, typically every six months or as recommended by your general dentist, should continue throughout treatment.
Risks and Limitations
Like all fixed orthodontic appliances, lingual braces carry some risks. Bracket breakage can occur, especially in patients with a deep bite or those who eat hard or sticky foods. A broken bracket requires an extra office visit and can delay treatment progress.
Enamel demineralization (white spot lesions) is a risk with any bonded bracket system if oral hygiene is not maintained. Plaque accumulation around brackets can lead to decalcification of the tooth surface. Keeping up with thorough brushing and regular dental cleanings helps reduce this risk.
Root resorption, a slight shortening of tooth roots, can happen with any orthodontic treatment and is not unique to lingual braces. Your orthodontist will monitor for this with periodic X-rays during treatment.
Allergic reactions to bracket materials are rare but possible. If you have a known nickel allergy, let your orthodontist know. Some lingual bracket systems use gold or nickel-free alloys as an alternative.
What to Expect: Step by Step
Lingual braces treatment follows a predictable sequence from consultation through retention, typically spanning 18 to 36 months of active treatment.
Consultation and Treatment Planning
Your first visit includes a clinical exam, digital X-rays, photographs, and either physical impressions or a digital scan of your teeth. These records allow the orthodontist to assess your bite, identify problems, and determine whether lingual braces are appropriate for your case.
If you proceed, the orthodontist sends your records to a lab that designs and manufactures your custom brackets. This lab process typically takes three to six weeks. During this time, any preparatory dental work (such as fillings or cleanings) should be completed.
Bracket Placement (Bonding)
At the bonding appointment, the orthodontist attaches each custom bracket to the back of the corresponding tooth using dental adhesive. The brackets are often delivered in a transfer tray, a custom jig that holds all the brackets in their exact planned positions for efficient placement. The bonding appointment typically lasts 90 minutes to two hours, which is longer than for traditional braces because of the difficulty of working on the tongue side.
After the brackets are placed, the orthodontist inserts the first archwire. You will feel pressure on your teeth. This pressure is the beginning of tooth movement.
Adjustment Appointments
You will return to the orthodontist every four to eight weeks for wire changes and adjustments. At each visit, the orthodontist replaces or reshapes the archwire to continue guiding the teeth. Elastics (rubber bands) may be added at certain stages to correct bite relationships.
Adjustment appointments for lingual braces can take slightly longer than for traditional braces because access to the brackets is more limited. Each appointment typically lasts 30 to 60 minutes.
Removing Braces and Retention
When active treatment is complete, the orthodontist removes the brackets and wires. The tooth surfaces are then polished to remove any remaining adhesive. This appointment usually takes about an hour.
Retention is a critical phase after any orthodontic treatment. Without retainers, teeth tend to shift back toward their original positions. A Cochrane systematic review found insufficient high-quality evidence to recommend one retention method over another, but noted that some form of retention is generally needed to maintain results. [4] Your orthodontist may recommend a fixed retainer (a thin wire bonded behind the front teeth) or a removable retainer, or both. Wearing retainers as directed is essential for long-term stability.
Lingual Braces Cost and Insurance
Lingual braces typically cost between $8,000 and $13,000, making them one of the more expensive orthodontic options. Costs vary by location, provider, and case complexity.
The higher price compared to traditional metal braces (which typically range from $3,000 to $7,000) reflects several factors. Custom bracket fabrication involves specialized lab work. The technique requires additional training and more chairtime per appointment. Fewer orthodontists offer lingual braces, and limited availability can also affect pricing.
Dental insurance plans that include orthodontic benefits typically cover a set dollar amount, often between $1,000 and $2,500, regardless of which type of braces you choose. Check with your insurance provider to confirm whether lingual braces are covered under your plan. Some plans classify lingual braces as a cosmetic upgrade and may limit reimbursement.
Many orthodontic offices offer in-house payment plans that spread the cost over the duration of treatment. Flexible spending accounts (FSAs) and health savings accounts (HSAs) can also be used to pay for orthodontic treatment with pre-tax dollars. Ask about all available payment options during your consultation.
When to See an Orthodontist
Lingual braces require treatment by an orthodontist, and specifically one with training and experience in the lingual technique. A general dentist does not place lingual braces.
You should consider scheduling an orthodontic consultation if you have crooked or crowded teeth, gaps between teeth, a noticeable overbite or underbite, or difficulty chewing due to misalignment. The American Association of Orthodontists notes that orthodontic problems do not improve on their own and that early evaluation can help identify the best time to start treatment. [5]
If aesthetics during treatment are a priority for you, whether for professional, social, or personal reasons, bring up lingual braces specifically during your consultation. Not every orthodontist offers lingual treatment, so when scheduling, ask the office in advance whether the provider has lingual experience. If they do not, ask for a referral to a colleague who does.
Your general dentist can also refer you to the orthodontics page to learn more about what orthodontists treat and how to find one in your area.
Find a Lingual Braces Specialist Near You
If you are interested in lingual braces, the next step is a consultation with an orthodontist who has specific lingual training and experience. Use our directory on the orthodontics page to search for orthodontists in your area. During your consultation, ask how many lingual cases the provider has completed, which bracket system they use, and what the estimated treatment time and cost would be for your case. Getting this information upfront will help you make a confident, well-informed decision.
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