8 min read • By Dr. Kevin Baharvand, Diplomate, American Board of Orthodontics
SHORT ANSWER
A newer lingual system called InSmile is marketing itself to orthodontists with digital customization and modern design. The manufacturing improvements are real. What has not changed is where the appliance sits, and that has always been the problem. Lingual braces have been available in some form for decades and never gained broad adoption here, not because they do not work but because of tongue discomfort, speech effects, cost, and a learning curve most orthodontists never climbed. Then clear aligners delivered invisibility without those costs. That is the whole story, and a better bracket does not rewrite it.
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A long history of not quite catching on
Hidden braces have always sounded like the obvious answer. Put the brackets on the inside of the teeth and nobody sees them. The idea has been around since the 1970s and has been reintroduced in a new form roughly every decade since, each time with better manufacturing behind it.
And each time, adoption in the United States stayed small. That pattern is the interesting part. When a good idea repeatedly fails to take hold across fifty years and several genuine technical improvements, the obstacle is usually not the technology.
The problems that never went away
| Problem | Why better engineering does not solve it |
|---|---|
| Tongue discomfort | Your tongue rests against those surfaces constantly. Lower profile brackets help, but the tongue does not toughen up the way lips and cheeks do. |
| Speech changes | The brackets occupy exactly where the tongue contacts the palate for S and T sounds. Most people adapt in weeks. Some never fully do. |
| Cost | Custom brackets mean lab fees, and chair time is longer because the work is harder. Both are structural, not markup. |
| Finishing and detailing | Working on the tongue side with indirect vision is genuinely harder. The last ten percent of a case is where this shows. |
| Bond failures | Lingual enamel surfaces are more variable and harder to isolate from saliva. More rebonds means more appointments. |
Notice that three of these five are about the clinician rather than the patient. That is the adoption problem in a sentence. An appliance that is harder to place, harder to finish, and comes loose more often has to offer something substantial in return, and low demand meant few orthodontists ever did enough cases to get past the learning curve.
Incognito, Brius, InBrace, and what happened
Incognito is the best known fully customized lingual system, with brackets milled per tooth. It works, it still exists, and it never reached broad adoption. It is the clearest evidence that the barrier was not manufacturing quality.
Brius took a genuinely different approach, replacing the continuous archwire with independent arms delivering force to each tooth. Interesting engineering and a real attempt to solve the finishing problem rather than the aesthetics.
InBrace is the cautionary one. It marketed hard to patients as well as orthodontists, and it shut down in 2025, leaving patients in active treatment to be transitioned to other appliances. We wrote about what those patients should do at the time.
This is the part of appliance selection nobody puts on a brochure. When treatment lasts two years, the commercial durability of the company behind a proprietary system becomes a clinical question. Standard braces have no such exposure, because any orthodontist anywhere can continue the case.
Where InSmile fits
InSmile is pitching digital customization and modern bracket design to orthodontists. Taken at face value, those are real improvements over earlier generations, and better bracket fit does reduce bond failures and bulk.
But the honest assessment is that it is addressing the second and third most important problems while the first one is unchanged. The bracket is still on the tongue side. Comfort and speech, which are the reasons patients decline lingual, are functions of location rather than of design quality. You can make the object smaller and better shaped. You cannot move it somewhere the tongue is not.
I would want to see multi-year outcome data and, frankly, evidence the company will still exist in three years before putting patients into a proprietary system. That is not cynicism about InSmile specifically. It is what the last decade taught everyone.
Why clear aligners changed the equation
Lingual braces existed to solve one problem: visible hardware. Clear aligners solve that same problem while also being removable, more comfortable, easier for the clinician, and cheaper to deliver. Once aligners became capable of handling most cases, the market lingual was competing for had largely moved.
Aligners have their own real limitation, which is that they only work if worn. That is exactly the gap where lingual still has a genuine argument: a patient who wants invisibility and knows they will not comply with trays. That is a real person. It is just not a large enough group to build broad adoption on.
What this means if you are a patient
Mostly it means the marketing you encounter for hidden braces should be read with the history in mind. Lingual braces are a legitimate appliance, not a gimmick, and they can finish beautiful cases. The tradeoffs are simply larger than the advertising suggests, and the alternatives have improved more than lingual has.
If you are considering lingual specifically, ask how many lingual cases the orthodontist finishes in a year. This is one appliance where operator volume matters enormously. And ask what happens if the system is discontinued mid-treatment, because that question now has precedent behind it.
Our fuller take on whether lingual is right for an individual patient is here.
Fifty years of better lingual brackets have not moved adoption, because the obstacle was never the bracket. It was where the bracket has to sit.
Frequently asked questions
Is InSmile a new technology or a repackaged idea?
The digital workflow and customization are genuinely modern. The underlying concept, brackets bonded to the tongue side of the teeth, is decades old. Better manufacturing addresses some historical problems, particularly bracket fit and profile. It does not change where the appliance sits, which is the source of most of the difficulty.
Why did lingual braces never take off in the United States?
Several reasons compounding: patient discomfort against the tongue, speech changes, high cost, and a steep learning curve that kept most orthodontists from building volume. Then clear aligners arrived and delivered the main benefit, invisibility, without any of those costs.
What happened to Incognito, Brius, and InBrace?
Incognito is the best known custom lingual system and still exists, but never reached broad adoption. Brius takes a different approach with independent arms rather than a continuous archwire. InBrace shut down in 2025, which stranded patients mid-treatment and is worth reading about separately.
Should a patient consider lingual braces today?
For a narrow group, yes. Someone who genuinely cannot have anything visible on the front teeth, is not a good aligner candidate, and whose work does not depend on speaking clearly for a few weeks. For most people wanting discretion, clear aligners or ceramic braces are the better trade.
Why do orthodontists care which system a company sells?
Because when a system fails commercially, patients in active treatment are the ones affected. Appliance-specific parts stop shipping and cases have to be transitioned. That is not a hypothetical concern, it happened recently.
Do lingual braces work as well as regular braces?
In experienced hands, yes. Effectiveness was never the weakness. Finishing and detailing are harder from the tongue side and bond failures are more frequent, so results depend more heavily on how much lingual the clinician actually does.
Want a discreet option that is actually practical?
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You may also be interested in these
- Lingual Braces: Why I Usually Talk Patients Out of Them
- InBrace Shut Down: What Patients Should Do Next
- Zeeno Robots in Orthodontics: Are They Worth It?
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With over 1,000 five-star reviews across three locations, Elate Orthodontics is led by Dr. Kevin Baharvand, DMD, MS, a Diplomate of the American Board of Orthodontics, whose clinical work was recently selected for the cover of the American Journal of Orthodontics and Dentofacial Orthopedics, the most prestigious peer-reviewed journal in the field, and a national speaker on clear aligner treatment. Alongside Dr. Julia Kang, DMD, MS, both Boston University graduates and members of the Omicron Kappa Upsilon national honor society, our husband-and-wife team has been recognized as D Magazine Best Dentist 2026, Living Magazine Readers’ Choice 2026 Best Orthodontist in Frisco & Plano, Readers’ Choice Best Orthodontist in The Colony, Best New Business by the Chamber of Commerce, Nextdoor Neighborhood Favorite, and featured in Orthotown and Authority Magazine.
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About the author
Dr. Kevin Baharvand, DMD, MS, is a Diplomate of the American Board of Orthodontics and a national speaker on clear aligner treatment. He practices at Elate Orthodontics in West Frisco, North Frisco, and The Colony, Texas.
