Braces are an effective and established method for correcting a crooked smile, a condition orthodontists refer to as malocclusion. This term describes any misalignment of the teeth, including dental crowding, excessive spacing, and problems with how the upper and lower jaws fit together. The goal of orthodontic treatment is not only to straighten the visible teeth but also to create a functional, stable bite. The process relies on a precise application of gentle force over time to physically move the teeth into their correct positions.
How Braces Reposition Teeth
Tooth movement is possible because of a natural biological process called bone remodeling, which occurs in the jawbone surrounding the tooth roots. When the appliance applies consistent, light pressure to a tooth, it initiates a response in the periodontal ligament (PDL), the tissue that anchors the tooth to the bone. This pressure creates distinct areas of compression and tension on opposite sides of the tooth socket. On the compression side, where the PDL is squeezed, specialized cells called osteoclasts are activated to break down and resorb the alveolar bone. Simultaneously, on the tension side, other cells called osteoblasts are recruited to deposit new bone material. This coordinated cellular activity allows the tooth to slowly move through the bone in the direction of the applied force. The forces must be calculated precisely to ensure continuous movement without causing damage to the tooth root or surrounding tissue.
Different Approaches to Straightening
While the biological mechanism remains the same, patients can choose from several types of appliances to deliver the necessary force. The choice of appliance often depends on the severity of the malocclusion, aesthetic preference, and the patient’s lifestyle.
Types of Braces and Aligners
- Traditional metal braces consist of stainless steel brackets bonded to the front of the teeth and connected by a thin archwire. These are durable and effective for the most complex cases due to their strength and ability to apply controlled force.
- Ceramic braces function identically to their metal counterparts but utilize tooth-colored or clear brackets that blend in with the natural tooth surface.
- Clear aligners offer a highly aesthetic and removable alternative, consisting of a series of custom-made, clear plastic trays. They require high patient compliance, as they must be worn for 20 to 22 hours per day to be effective.
- Lingual braces are custom-made brackets and wires placed on the tongue-side surface of the teeth, making them virtually invisible from the front for maximum discretion.
The Full Treatment Timeline
The journey to a straighter smile is typically divided into three distinct phases, beginning with a thorough initial assessment. This diagnostic phase involves taking detailed records, including X-rays, digital scans or physical molds of the teeth, and facial photographs. This information allows the orthodontist to develop a precise, customized treatment plan that maps out every planned tooth movement.
Once the appliance is placed, the active treatment phase begins, characterized by regular appointments for adjustments. For fixed braces, this involves changing or tightening the archwires to maintain continuous pressure on the teeth, usually every four to eight weeks. The average active treatment time for most patients falls within a range of 18 to 24 months, though simpler cases can be completed faster, and highly complex cases may take longer.
After the active phase is complete and the braces are removed, the retention phase begins, which is important for long-term stability. Teeth have a natural tendency to drift back toward their original positions, a phenomenon known as relapse. Retainers, which can be fixed (bonded to the back of the teeth) or removable, are used to hold the teeth in their new alignment while the surrounding bone and soft tissues stabilize. Consistent retainer wear is necessary to maintain the corrected position.
Limitations and Other Options
While braces are effective for correcting dental misalignment, they primarily address problems within the dental arches. Severe bite issues, such as extreme overbites or underbites, may be caused by a skeletal misalignment where the upper jaw (maxilla) and lower jaw (mandible) are positioned incorrectly relative to each other. In these cases, braces alone may not be sufficient to achieve a functional bite.
Treatment for a significant skeletal discrepancy often requires orthognathic surgery, commonly known as jaw surgery, performed in conjunction with orthodontics. The braces are used before and after the operation to align the teeth so they fit together perfectly once the jawbones have been surgically repositioned.
For patients with very minor cosmetic concerns, non-orthodontic options may be considered. Procedures like dental bonding or porcelain veneers can visually mask slight crookedness or gaps by altering the shape and surface of the teeth. However, these cosmetic procedures do not change the underlying tooth position or correct the bite.