For comprehensive orthodontic treatment, most permanent teeth are fitted with a bracket. Braces are a mechanical system consisting of brackets bonded to the tooth surface, archwires that connect them, and ligatures that secure the wire. This hardware applies constant, gentle pressure to gradually shift teeth into their correct positions and improve the overall bite.
The Comprehensive Strategy of Bracing
The placement of a bracket on nearly every permanent tooth is a fundamental aspect of comprehensive orthodontic care. The goal extends beyond simply straightening the teeth that are visible when a person smiles. It involves aligning all teeth on both the upper and lower arches to ensure a stable, functional relationship between the jaws, known as ideal occlusion.
Every tooth in the arch, typically 20 to 28, plays a distinct role in this biomechanical process. The teeth act as both active points of movement and sources of anchorage, the resistance needed to move other teeth. Force distribution across the entire arch is necessary because moving one tooth often requires the resistance of several others to achieve the desired result without causing unintended movement.
The brackets are precisely positioned on each tooth to dictate the exact direction and amount of force applied by the archwire. For instance, the molars, which are the largest teeth, are crucial for chewing and require stable positioning, often serving as the primary anchors for moving the smaller front teeth. If an orthodontist did not include all available teeth in the system, they would lack the necessary control and leverage to achieve the proper alignment and bite correction. This full engagement ensures that the final result is structurally sound for long-term oral health.
Scenarios Where Teeth Are Not Included
While comprehensive treatment typically involves most teeth, there are specific, planned exceptions where a tooth might not receive a bracket. The most common exclusion is the third molars, commonly known as wisdom teeth, especially if they are impacted, partially erupted, or scheduled for extraction. They are often excluded because they are not needed for bite function. In cases where the treatment plan is limited and not aimed at full bite correction, only the front six to eight teeth might be fitted with brackets.
Deciduous (baby) teeth are generally not braced if they are expected to fall out naturally within the treatment timeline. Bonding a bracket to a tooth that is soon to be shed is impractical and unnecessary for the final adult alignment. Furthermore, teeth that are congenitally missing or those previously extracted to create space are also excluded from the system. In these specific circumstances, the lack of a bracket is a deliberate part of the overall strategy.
Essential Components Beyond the Bracket
The bracket is only one part of the complex mechanical system that makes up traditional braces. The archwire is arguably the most active component, as it runs through the slots of the brackets and applies the continuous pressure that physically moves the teeth. This wire is periodically replaced with thicker or differently shaped wires to increase the force and guide the teeth progressively toward their target positions.
Other hardware is also used to complete the system and provide the necessary anchorage and directional forces. Metal bands, which are sturdier than brackets, are often cemented around back molars to serve as robust anchors for the archwire and other auxiliaries. The system may also include small springs to create space or elastic rubber bands to connect the upper and lower jaws to correct bite discrepancies.