Orthodontic treatment using braces is a systematic process designed to gradually guide teeth into a straighter position and improve overall oral function. Braces are mechanical systems comprised of brackets bonded to the tooth surfaces and connected by a thin archwire. This setup begins the complex process of moving individual teeth through the bone, which is only one part of achieving a healthy bite. The entire treatment is organized into distinct phases, each focusing on a different aspect of alignment.
Components Placed During the Initial Appointment
The first appointment focuses on establishing the fixed appliances that deliver the force for tooth movement. This involves bonding a bracket to the surface of each tooth, creating anchor points for the system. The orthodontist then threads a thin, flexible archwire through the slot in each bracket. This archwire applies the light, continuous pressure necessary to begin straightening the teeth within the dental arch.
To keep the archwire securely seated, small elastic rings called ligatures, or O-rings, are placed around the bracket wings. These tiny elastic ties are replaced at every adjustment visit and are sometimes mistakenly referred to as “rubber bands.” Their function is solely to tie the wire to the bracket, enabling tooth movement. These ligatures do not span between the upper and lower jaws and do not correct the bite relationship. The functional, patient-worn rubber bands that correct jaw alignment are separate components and are not typically introduced on the first day.
When Inter-Arch Rubber Bands Are Introduced
The large rubber bands patients manage themselves are known as inter-arch or intermaxillary elastics, and they are generally not used at the start of treatment. The initial phase, known as leveling and aligning, must first focus on straightening the teeth within their arches. During this phase, the orthodontist uses light, flexible archwires to rotate and align the teeth into a uniform arc. Using inter-arch elastics before the teeth are straight would not be mechanically efficient and could introduce unwanted side effects.
The introduction of these larger elastics usually marks the beginning of the “working phase” or “bite correction phase.” This milestone signifies that individual tooth positioning is largely complete, and the focus shifts to correcting the relationship between the upper and lower jaws. This phase is highly individualized but most commonly occurs six to twelve months after the braces are first placed. By this time, the orthodontist uses stiffer, rectangular archwires that can withstand the additional force required for inter-arch correction.
The Role of Rubber Bands in Correcting Bite Alignment
The primary purpose of inter-arch elastics is to correct malocclusions, which are discrepancies in how the upper and lower teeth meet. These elastics apply a force that guides the upper arch relative to the lower arch, a movement brackets and wires alone cannot achieve. For instance, a Class II malocclusion (overbite) requires elastics to pull the upper teeth backward and the lower teeth forward. Conversely, a Class III malocclusion (underbite) uses elastics in the opposite direction to move the upper teeth forward and the lower teeth backward.
The elastics are carefully chosen to generate precise directional force, often connecting hooks on the canine or premolar of one arch to a molar of the opposing arch. Because this force moves the jaw relationship, patient compliance is important for success. The elastics must be worn consistently, typically for a minimum of 20 to 22 hours per day, and only removed for eating and brushing. Inconsistent wear will cause the teeth to revert to their original position, significantly delaying the treatment timeline.