Can You Get Braces with Amelogenesis Imperfecta?

Yes, you can get orthodontic treatment like braces or clear aligners if you have amelogenesis imperfecta (AI). However, weak or structurally compromised enamel presents unique challenges, particularly when it comes to “bonding” or gluing the brackets to your teeth. Treatment usually requires specialized techniques, alternative approaches, and close coordination between an orthodontist and a restorative dentist to protect your teeth while straightening them.

The Challenge: Bonding to Weak Enamel

Traditional braces rely on attaching metal or ceramic brackets directly to the enamel using a special adhesive and acid etching. In people with AI, the enamel’s mineral composition and structure are altered, which makes it much harder for the brackets to stick predictably ^[1][2].

The success of direct bonding depends heavily on your specific AI subtype ^[2][3].

• Hypocalcified or hypomaturation AI usually means the enamel is softer and more prone to peeling or delamination under the stress of orthodontic forces. Standard acid etching alone may not provide enough grip for the adhesive ^[4][5].
• Hypoplastic AI usually means the enamel is hard but very thin or pitted. While bonding might be more predictable here than with soft enamel, there is simply less surface area to work with ^[6][2].

Additionally, moving teeth with AI requires careful radiographic monitoring (taking routine X-rays). The compromised structure of the teeth can increase the risk of tooth wear, sensitivity, and root resorption (where the roots of the teeth shorten during movement) ^[7][8]. Your orthodontist will use these X-rays to catch any signs of stress early so they can adjust the treatment forces to keep your teeth safe ^[8][9].

Because AI teeth are already porous or rough, they easily trap plaque. Adding brackets drastically increases your risk of cavities, meaning meticulous at-home oral hygiene and possibly prescription fluoride are critical during this time ^[10][3]. Furthermore, if you already struggle with extreme sensitivity, your team will take precautions to ensure your comfort when applying or removing chemical etching, adhesives, and brackets ^[11][3].

Alternative Approaches to Traditional Braces

Because of the difficulty of bonding directly to AI-affected enamel, orthodontists use adapted strategies to move teeth safely and effectively:

• Specialized Bonding Protocols: If your enamel is strong enough, brackets can still be bonded directly to the teeth. However, orthodontists may adapt standard techniques, such as pre-treating the tooth with special chemical agents—like sodium hypochlorite (a safe, diluted dental cleansing solution)—before applying the adhesive to improve the bond strength ^[6][5][12].
• Orthodontic Bands: Instead of gluing brackets to the front of the teeth, orthodontists often use orthodontic bands—small metal rings that wrap completely around the tooth. These are typically used on back molars to provide reliable hold and control without relying on enamel bonding ^[13].
• Temporary Protective Crowns: A very common approach is for a restorative dentist to place temporary (provisional) crowns or composite restorations over the teeth before braces are applied ^[14][13]. The orthodontist then glues the brackets directly onto these durable temporary crowns rather than your natural fragile enamel ^[3]. Once your teeth are straightened, permanent indirect restorations like ceramic crowns or veneers are placed ^[15][16].
• Clear Aligners: Clear aligners (like Invisalign) are a modern alternative that applies gentle pressure using removable plastic trays. While there is a lack of large-scale clinical trials specifically studying clear aligners in AI patients, they can be an option to reduce the need for extensive bracket bonding ^[3][17]. Keep in mind that aligners often still require small composite “attachments” (bumps) bonded to the teeth to help the trays grip, which presents similar bonding challenges depending on your enamel quality. However, because you can remove the trays to brush, they may make it easier to maintain oral hygiene.

A Team Approach

Managing AI during orthodontic movement is not a one-size-fits-all process. It requires a long-term, interdisciplinary plan tailored to your specific severity and enamel type ^[18][13][19]. Because this involves coordinating between multiple specialists—often protecting the teeth first, slowly moving them, and permanently restoring them afterward—you should expect this process to take longer and involve more dental visits than standard braces ^[13][20].

Your core team will usually include an orthodontist to straighten the teeth and a prosthodontist or restorative dentist to rebuild and protect them. In some cases, oral surgery is also involved if there are associated jaw or skeletal differences ^[18][21]. By approaching this comprehensively, you can achieve a healthy, functional bite and a confident smile.