Fixed appliances are reentering the spotlight as shifting patient behavior, the realities of clinical compliance, and advanced bracket systems fundamentally reshape orthodontic treatment planning.
By Alison Werner
The results of the 2025 AAO Economics of Orthodontics Survey illustrated a notable trend in the specialty: while the total number of patients in active treatment reached an all-time high of 696 per member, clear aligner starts declined to 23% of total starts, down from 25% two years prior. After more than a decade of aligner dominance in the public consciousness, new patient starts with brackets and wires have rebounded, signaling a shift in treatment patterns.
For a specialty that has spent the last several years heavily focused on the digital revolution of clear aligners, this data might seem counterintuitive. But this isn’t a regression to the “dark ages” of analog orthodontics. Instead, the resurgence of fixed appliances is being powered by a convergence of patient behavior, compliance realities, and advances in bracket technology.
Why Are Braces Booming?
For years, the promise of aligners centered on aesthetics and convenience. But as millions of patients have completed treatment, a more nuanced understanding of the aligner journey has emerged, leading many new patients and parents to reconsider fixed appliances.
The most significant driver is the reality of compliance. Nicolas Freda, DMD, who practices in New Jersey and upstate New York, sees it daily. “I hear from parents that, ‘I don’t trust my child,’ or ‘I just want the confidence that it’s going to get completed with traditional braces,’” he says. “I think they’re almost kind of de-risking the investment.” This sentiment extends directly to adults, many of whom are now opting for what Rick O’Neil, DMD, who practices in Mobile, Alabama, calls the “easy button.” Freda adds, “Some of my adults who are in braces say, ‘I don’t trust myself.’ They’re realistic.”
That lack of trust in personal compliance has also led some patients to believe aligners are less effective. Kristen Knecht, DDS, MDS, who practices in a suburb of Houston, frequently encounters this skepticism from adults who claim they’ve heard that clear aligners don’t work well. She finds herself explaining that while the systems are highly effective, the human element is the variable. “It’s just so heavily based on compliance,” she says. “If you’re talking to a friend who was wearing them 14 hours a day, of course they’re going to tell you that clear aligners don’t really work.”
At the same time, one of the biggest psychological barriers to braces—a multi-year treatment time—is dissolving. Thanks to technological advancements, orthodontists are now confidently quoting treatment times that rival or even beat aligner estimates. “I think in the last five to six years, we’ve had a lot of braces technologies that have allowed us to not only shorten the number of visits, but shorten the number of months,” says Michael Bicknell, DDS, MS, who practices in the Chicago suburbs. He points to the shift in patient perception: “When you say it’s going to be two years of braces, they’re like, ‘I want aligners.’ And then if you say, ‘Look, it’s going to be one year [in braces],’ they’re like, ‘Okay, I can do anything for a year.’” Michael Ragan, DDS, who practices in the Dallas area, confirms this, stating his average treatment time is just 14.6 months.
Finally, a cultural shift has reframed braces from a medical necessity to a fashion statement. The stigma that once drove patients to seek invisible options has largely vanished, especially among younger demographics. “Now everyone wants braces,” Knecht observes. “I don’t know if they think of it as an accessory or something.” Bicknell has seen the same trend, noting that for teens and certain adult demographics, braces have become a “weird status symbol.” He explains, “There’s a segment of the population that looks at it as status, and then there’s a segment … that looks at it to be in the in-crowd.” This desire for a visible, customizable accessory—complete with colored bands—is a powerful force pulling patients back toward metal brackets.
But for patients who aren’t looking to make a fashion statement, the evolution of ceramic brackets has provided the ultimate compromise. Older teens and adults who want the compliance-free reliability of fixed appliances often still prioritize discretion. David Solid, global orthodontic portfolio expert at Solventum, notes that modern ceramic brackets offer a “middle road between the aesthetics of aligners, but the performance of brackets.” It’s a crucial tool for case conversion. As Mike Parlante, director of business development at DynaFlex, points out, if a doctor is going to steer a patient away from aligners to achieve a faster or more predictable result, “the alternative to aligners is something that’s going to need to be aesthetic.” For O’Neil, whose patients overwhelmingly choose clear options, this aesthetic evolution is exactly what convinces compliance-wary adults to confidently commit to brackets.
The New Era of Bracket Technology
For orthodontists who haven’t taken a look at fixed appliances in the last few years, the category has evolved far beyond the analog systems of the past. The single biggest change is the adoption of a digital-first approach that mirrors the aligner workflow, transforming fixed appliances from a reactive, hands-on modality into a proactive, digitally planned system.
“Doctors who haven’t taken a fresh look at brackets in a few years might not expect innovation but they’ll be surprised by how much has changed, from the relationship between the bracket slot and the archwires to digitally driven treatment planning and micron-level bracket placement,” says Veronica Acurio, president of Ormco. “Today’s systems are more efficient, easier to use, and deliver more predictable, faster results.” Knecht’s practice transformation illustrates this perfectly. After adopting a fully digital bracket system, she says, “a start became a scan, just like Invisalign.” That shift allows orthodontists to plan bracket placement digitally and apply it with custom indirect bonding trays, eliminating the need for the orthodontist to handle direct bonding chairside. This proactive approach frees up the doctor’s time and significantly reduces the daily stress of managing same-day starts for the staff.
At the heart of this evolution is the move from standard prescriptions to customized, patient-specific planning. Instead of relying on manual bracket placement and continuous wire-bending to compensate for anatomical variations, orthodontists can now design the end result on a computer. “Traditional braces are not designed for the individual patient. It’s a standard prescription, and it relies on an orthodontist to manually customize treatment throughout,” explains Ryan Elmore, CEO of KLOwen. “With custom braces, we do all the customization and the design of the system at the start.” This front-loaded digital planning allows doctors to start with the end in mind, a cornerstone of aligner treatment planning.
This new workflow has profound economic and operational implications. By pairing modern bracket systems with remote monitoring platforms like DentalMonitoring or Grin, orthodontists are achieving appointment intervals once reserved for aligner patients. Knecht notes, “At the end of the day, I’m seeing aligner and braces patients at almost the same intervals.” Ragan, an early adopter of remote monitoring, is even more direct: “If I didn’t have remote monitoring, I would not be as efficient as I am.” He combines the technology with a passive self-ligating system to extend intervals, monitor hygiene and elastic wear, and catch issues like broken brackets or passive wires before they derail treatment. The result is a dramatic increase in chair capacity and a more predictable, less stressful clinical day.
Market Spotlight: Key Players Innovations
As the market matures beyond a simple “braces versus aligners” debate, manufacturers are focusing on creating integrated digital ecosystems that give orthodontists greater control, efficiency, and flexibility, regardless of the appliance they choose.
Ormco
Ormco is leaning into the concept of a unified digital platform. “Orthodontists today are running hybrid practices,” says Acurio. “They want systems that allow them to plan digitally, execute precisely, and move seamlessly between appliances based on what the case requires.” The company’s focus is on developing a workflow-based approach where digital planning, indirect bonding, and the brackets and wires themselves are all designed to work together.
This is embodied in its Damon Ultima system, a full-expression passive self-ligation system engineered for greater precision and control. Bicknell, who uses the system, has seen the clinical impact firsthand. He notes that the system’s precision, where the bracket and wire were engineered together, has dramatically changed his finishing protocol. “As long as I’m good at putting braces on and I’m refining that workflow, I don’t have to bend as much wire, which is increasing my daily workflow,” he says. “My treatments are going much faster.” This reduction in wire bending and increased predictability allows him to focus on diagnosis and oversight rather than manual adjustments.
KLOwen
KLOwen is built on the premise that digital custom braces are the next major market mover, according to Elmore. The system uses cloud-based software to create a 100% custom fixed appliance, enabling a fully digital workflow from scan to debond. For Knecht, adoption had a positive impact on both practice efficiency and profitability.
“You’ve cut down on your lab bill tremendously when you compare to aligners,” she says. “It’s ultimately like a third of the cost, but then you’re still getting a lot of the benefits in terms of reduced number of visits.”
The KLOwen system also transformed her practice’s operations. The shift to an indirect bonding workflow streamlined scheduling and dramatically reduced the pressure staff were under. Knecht observed a significant shift in her team’s demeanor after the practice moved away from the stress of same-day manual starts, replacing that bottleneck with an efficient digital scanning protocol. The result is a workflow that combines the clinical control of braces with the operational efficiency of aligners.
Solventum
Solventum is focusing on seamless integration within its Clarity brand, which includes both aligners and bracket systems. Solid emphasizes offering hybrid options—such as aligners on the upper arch and brackets on the lower—managed within a single digital ecosystem.
When patients do choose fixed appliances, older concerns about aesthetics and durability are vanishing. O’Neil, who uses Clarity Advanced Ceramic Brackets, notes these modern polycrystalline brackets resist staining, blend with multiple tooth shades, and won’t break during complex mechanics.
These aesthetic brackets are further complemented by Solventum’s APC Flash-Free adhesive. “With a clear bracket and that pre-pasted [adhesive], that [curing] light is able to penetrate through the bracket, so you get better bond strength,” O’Neil explains. He also highlights a significant side benefit: by creating a complete seal around the base, this flash-free system may reduce the risk of white spot lesions forming in the microscopic voids left by traditional bonding techniques.
Henry Schein Orthodontics
Henry Schein Orthodontics is centered on developing advanced appliances that streamline biomechanics and reduce overall treatment time. Ragan has built his highly productive practice around this philosophy, using the company’s Carriere SLX 3D Self-Ligating Bracket System and the Carriere Motion 3D Class II Appliance. To push that efficiency further, Ragan pairs these tools with remote monitoring—a combination that has restructured his clinical day.
“My practice numbers went from 70 patients a day to 35 patients a day,” he says. “And so now we’ve shortened our schedule to two less days a month.” This dramatic reduction in patient volume, achieved without sacrificing profitability, has lowered stress for him and his staff, and opened up time for marketing and team development.
Ragan argues that orthodontists who focus only on the per-bracket cost of advanced systems are missing the bigger economic picture. “Yes, you’re paying more for that technology,” he admits, “but if you can see patients less and be more efficient in your practice, you’re actually going to make more per case.”
DynaFlex
DynaFlex has carved out its niche by focusing on precision manufacturing and reliability to minimize chair time and emergency visits. Parlante points out that many standard brackets suffer from “slop in the slot,” where discrepancies in the archwire slot fail to express the intended prescription, leading to more wire bending. To combat this, the company’s Norris 20/26 passive self-ligating bracket system is engineered with an ultra-precise slot. “We put a post-manufacturing process in place that always ensures that the archwire slot is the most precise in the market,” he says.
Another key feature is their injection-molded non-foil mesh base, which is designed to create a stronger mechanical bond than traditional foil mesh bases. Parlante notes this leads to fewer bond failures, a critical factor in practice efficiency.
Freda pairs DynaFlex brackets with digital indirect bonding setups from DIBS AI, leveraging the precision of a digital plan. For him, the accuracy of the digital setup is paramount. “If you have more accurate bracket placement, you’re going to save time and improve efficiency in the chair,” he states. “That’s going to mean fewer appointments and shorter appointments for the patients.”
The Future of Fixed Appliances
The data and the experiences of clinicians on the ground make it clear: the future of orthodontics is not a battle of “Braces vs. Aligners.” It is about the rise of the true hybrid practice, where orthodontists utilize custom digital workflows for both modalities to deliver the best possible outcome for each patient. “The future isn’t aligners versus brackets,” Acurio states. “It’s the right appliance, delivered through a digital workflow producing more predictable results that is right for the patient.” This integrated approach allows clinicians to leverage the strengths of each system—the compliance-free efficiency of braces for complex movements and the aesthetic appeal of aligners for finishing or less complex cases.
This technological shift is also redefining the roles within the orthodontic team. As digital indirect bonding and computer-aided planning become standard, the responsibilities of clinical staff are evolving. The process requires a learning curve, as Elmore notes that “you’re transferring the bonding responsibility from the doctor onto the team.” However, once mastered, it creates a more empowered and efficient staff. Knecht has found that with repetition, the process becomes “second nature” for her team, allowing them to play a more crucial role in the execution of treatment plans.
Ultimately, the resurgence of braces is not a return to the past but a clear indicator of the future. Fixed appliances have caught up to the digital age, armed with the technology to offer the efficiency and predictability that modern practices demand. As Bicknell aptly concludes, the definition of a top-tier orthodontist has changed. “The best orthodontists in the world used to be wire benders,” he says. “Now, the best orthodontists in the world are the ones that are adapting and understanding technology and using it properly.” OP
Photo: ID 63000322 | © Vladimirfloyd | Dreamstime.com
Alison Werner is chief editor of Orthodontic Products.
