O’Keiff Orthodontics: New Year, New You Orthodontics at Every Age
In preparation for this article, I re-read an article in the Washington Post, from March of 2025. Even though I’ve lived in New Milford, CT for 22 years, and practiced as an orthodontist there for twenty, I spent a fair amount of my childhood in Maryland. So, the Washington Post feels like “my” newspaper. I read it every day and regard it as the gospel on most things in life. So, the article from March entitled, “Old School Metal Braces are Making a Comeback” really piqued my interest. According to the article, metal braces have lost most of their social stigma for adults, some adults feel that removing and replacing Invisalign aligners many times a day is just too much work, and “braces are now the first choice for some orthodontic patients in their twenties and thirties.”
Over the last 9 months or so, since I read that article, I’ve spent just a little more time discussing fixed braces than I have in the past when discussing treatment plan options with my adult patients. Historically, during an adult orthodontia discussion, we usually focus primarily on Invisalign for those that desire full treatment, night guards for grinders and clenchers and those with expensive crowns and veneers, and nighttime active retainers for those who “just want it a little better and prevent it from shifting more.”
But I think the article may have hit on something. It’s true; I have begun more treatments recently for adult patients that have requested “regular metal braces”. Approximately 1 in 4 orthodontic patients nationwide are adults. When I meet with an adult for the first time, after we’ve taken diagnostic records (pictures, x-ray, and a 3-D scan of their mouth), I talk about all the options that are appropriate for their case, and then we discuss the pros and cons of each option in great detail. After laying out all of the positive and negative aspects of the many options, I usually let the patient lead the conversation and help them choose the option that’s the best option for their personality and lifestyle.
Sometimes, adult patients have particular dental characteristics that make one option the clear choice. For example, for patients with a significant amount of dental crowns or veneers, I would likely choose Invisalign, to prevent damaging the glaze on their porcelain restorations. If a patient had a very severe vertical overlap of the upper front teeth over the lowers, I might encourage them to at least start with braces before transitioning to Invisalign, as this is an area where braces really excel and Invisalign sometimes struggles. But for most patients, both options (Invisalign or braces) are available, and I am open to their input. It is still true that most adults, when given a choice, ultimately choose Invisalign appliances for their comprehensive orthodontic treatment, primarily for esthetic and social reasons but also because their appointments can be made quite far apart (usually 10 weeks) compared to braces (usually 4 weeks for adults, as opposed to 6 weeks for children).
But for many patients, the final choice of braces or Invisalign comes down to personal preference. And for most adults, their choice is Invisalign, a clear, comfortable, esthetic option, but one that requires a fair amount of work on the part of the patient (removing and replacing the appliances several times a day). But for some adults, and for more than it used to be over the last 15 years or so, their first choice is to, “give me the old school ones, Doc, I want to do it right and I don’t care what I look like.” And for those, my goal is to give them my all, as I do for all my patients. But I have to admit, for some reason, there’s just something special about using the silver brackets on an adult rather than the more traditional, clear porcelain brackets- three cheers for the young at heart, that are showing up more frequently, all across the country!
