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Treatment consists essentially of three phases: the initial placement of the braces (or clear aligners), periodic adjustments and wearing of a retainer after the braces are removed.
Placement of braces
Your visit to have the braces applied typically lasts about 45 minutes. Fixed braces typically consist of the following components:
- Brackets attached to the outside surfaces of the premolar and front teeth (sometimes they can be attached to the backside of teeth, hiding them from view, but this makes them slightly more difficult to access). Brackets can be made of stainless steel, titanium, polycarbonate, ceramic, or a combination of a polycarbonate base and ceramic bracket. Modern metal brackets are smaller and less noticeable than they used to be. Ceramic brackets are usually clear or tooth-colored, and are less obvious than metal brackets.
- Ring-like bands that encircle the molar teeth. Bands are made of stainless steel or titanium. A buccal tube attached to the band of the last molar holds the end of the connecting archwire in place.
- A flexible wire (archwire) that connects all of the brackets and bands, controlling movement of the teeth. Today's wires may be made of nickel and titanium, which are superelastic and have shape memory, making them more flexible than stainless steel. While they are more expensive, they tend to require fewer adjustments.
- Various accessories may help position the teeth, in addition to the fixed components. Small rubber bands (elastic ties) secure the archwire to the brackets. Headgear (usually worn at night) may be used to help hold or move teeth in the correct position.
Removable clear aligners
For adults who need minor corrections, an alternate option to fixed braces is a series of clear, customized, removable appliances called aligners. You may have heard these referred to as "invisible braces." Each set of aligners is worn for a period of two weeks, 22 to 23 hours a day, until it's replaced by the next set. Aligners can be removed for eating, drinking, brushing and flossing. Clear aligners may be more expensive than fixed braces but may also be more aesthetically acceptable to some adults.
Periodic adjustments
After braces are placed on your teeth, your orthodontist adjusts them every four to six weeks by tightening the interconnecting wires. This puts mild pressure on the teeth and gradually shifts them into new positions. The jaw responds to the pressure by dissolving bone in the path of the moving tooth and laying down new bone behind it.
Occasionally, the orthodontist may use tension between upper and lower jaws to help promote correct alignment. This is often done with elastic bands stretched between opposing teeth.
Your teeth and jaws may feel slightly sore for a day or two after an adjustment. This discomfort can usually be eased with an over-the-counter pain reliever; tell your orthodontist if the discomfort is severe or becomes worse.
Retainers
After dental braces are removed, the newly straightened teeth need to be stabilized for a period of time (retention period) to prevent them from shifting back to their original position. This is usually accomplished with the use of a retainer, a custom-made appliance typically made of plastic and metal wires that help teeth stay in place. These are usually removable, but may be fixed in some cases.
- Why do people get braces? Academy of General Dentistry. http://www.knowyourteeth.com/print/printpreview.asp?content=article&abc=w&iid=322&aid=1304. Accessed June 11, 2010.
- Braces and retainers. Cleveland Clinic. http://my.clevelandclinic.org/devices/dental_care/hic_braces_and_retainers.aspx. Accessed July 27, 2010.
- Today's orthodontic treatment. American Association of Orthodontists. http://www.braces.org/learn/Straight-teeth-are-healthy-teeth.cfm. Accessed June 11, 2010.
- Barbara Woodward Lips Patient Education Center. Orthodontic instructions. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2010.
- Harrison JE, et al. Orthodontic treatment for prominent upper front teeth in children (Review). Cochrane Database of Systematic Reviews. 2007:CD003452.
- Braces and orthodontics. American Dental Association. http://www.ada.org/2598.aspx. Accessed June 9, 2010.
- What is malocclusion? American Academy of Pediatric Dentistry. http://www.aapd.org/publications/brochures/maloccl.asp. Accessed June 10, 2010.
- Littlewood SJ, et al. Retention procedures for stabilising tooth position after treatment with orthodontic braces (Review). Cochrane Database of Systematic Reviews. 2006:CD002283.
- Heasman P. Master Dentistry, Volume Two: Restorative Dentistry, Paediatric Dentistry and Orthodontics. 2nd ed. Philadelphia, Pa.: Elsevier Limited; 2008:283.
- Carr AB (expert opinion). Mayo Clinic, Rochester, Minn. July 26, 2010.
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