Ceramic Braces: Fixed Treatment That Is Less Visible

They can. Studies report elastic ties changing colour in the mouth, and BOS says a ceramic brace can become discoloured over time by contact with foods and may become less pleasing in appearance.

Elastic ties (modules)

Ties, also called modules, elastic rings or elastomeric ligatures, hold the wire in each bracket. BOS says the rings can discolour between visits on conventional metal braces. It also says self-ligating appliances, metal or ceramic, use a clip rather than elastics, so there is less likelihood of discolouring between visits, though no evidence shows the clip produces a better result.

In a 2016 split-mouth study of 20 adults, four brands of aesthetic (tooth-coloured or clear) ligature all stained significantly over 30 days, with large variation between people. A 2018 study of seven adults, using ceramic brackets, found aesthetic ligatures became yellowish after 30 days. A 2025 trial of 56 patients found all four brands discoloured after 28 days. A 2024 study of white, grey and pink modules found white most prone, and advised telling patients that food and drink may discolour them.

Ceramic brackets

A 2022 laboratory study of 100 ceramic brackets from five manufacturers indicates these materials are not resistant to discolouration: after 14 days every bracket changed colour, even in artificial saliva, and coffee had the greatest effect in four of the five brands. The authors equate those 14 days with over a year of drinking, and count a colour difference of 3.7 or more as visible or unacceptable. All saliva results, and two manufacturers' brackets in cola, stayed below 3.7. Every other result was above it, up to 23.26 in coffee. The adhesive samples changed colour too. The authors say the test cannot completely imitate the mouth.

A 2015 laboratory study reports ceramic brackets changing colour over 14 days in coffee, red wine, cola and artificial saliva, though the changes could not always be seen by eye. A 2020 randomised trial in 40 adolescents tested brackets on premolars due for extraction, with rinses of black tea or cola. Black tea had the greater effect, with mean colour differences from control brackets of 2.24 and 1.99 across two bracket types, against 1.76 and 1.56 with cola. The trial's abstract sets no visibility cut-off, and the 2022 authors say such studies cannot be completely compared, so do not read these means against that study's 3.7.

So the ties are not the only part reported to change colour, and the bracket results varied by brand and by drink in these studies.

BOS says ceramic brackets are more prone to breakage than metal brackets. Of the three clinical studies of bracket failure below, two found more failures with ceramic and one found fewer.

In a 2024 non-randomised trial of 80 patients, 127 of 800 ceramic brackets (15.88%) failed within 12 months, against 73 of 800 metal brackets (9.13%). The difference sat in the posterior teeth (25.63% against 8.44%) and the lower arch (21.25% against 10.75%). Anterior teeth (9.38% against 9.58%) and the upper arch (10.5% against 7.5%) showed no significant difference. The ceramic group was older on average, 30.7 years against 24.4, and extraction cases were excluded. The authors say patients should know ceramic brackets may involve delays and inconvenience.

A 2018 retrospective study of 78 patients, mean age 12.6, included only people who had lost at least one bracket and who chose their own system. Over a mean 30.6 months of treatment, first-time failure reached 20.0% with ceramic brackets, against 12.3% with conventional stainless steel ones and 11.2% and 13.8% with two other systems. A 2020 study of 20 patients, randomly split and all bonded by one operator, found 2 of 186 ceramic brackets failed in 12 months (1.1%), against 14 of 195 metal ones (7.2%).

The ceramic group was older, 30.1 years against 21.7, and the authors urge extreme caution in generalising to other ceramic brackets. These studies report failures overall, not breakage alone. If a brace breaks, NHS guidance gives this as non-urgent advice: contact the team treating your braces.

Enamel and tooth wear

BOS's FAQs say ceramic brackets can sometimes be difficult to remove, with a slightly higher risk of damage to the tooth surface, while its ceramic appliance guidance says they are unlikely to damage healthy teeth in most cases. A 2024 systematic review of 14 studies says its findings suggest ceramic brackets may lead to an increase in enamel fractures, particularly during removal. The one included study of ceramic bracket removal was a laboratory test on extracted teeth with flattened, polished enamel. It concludes removal was more susceptible to enamel fracture than with metal, and says it may represent an extreme situation.

BOS says ceramic brackets tend to be abrasive and may cause wear to teeth in the opposite jaw if they make contact when biting, and that they are sometimes not recommended for the lower teeth if the bite is deep. A 1990 artificial-mouth study found ceramic brackets caused significantly greater enamel abrasion than stainless steel ones. BOS says any concerns should be discussed with the team treating you.

Yes. Fixed metal, ceramic and lingual braces are offered at Deepcar Dental Care, and orthodontic treatment at the practice is for adults only.

See orthodontics at Deepcar Dental Care for the treatments offered.