Fixed orthodontic treatment corrects dental alignment issues using devices permanently affixed to the teeth. This approach applies controlled, continuous forces to guide teeth into healthier, more functional positions within the jawbone. Treatment resolves various forms of dental misalignment, leading to improved biting function, easier oral hygiene, and enhanced aesthetics. Achieving successful, long-lasting results requires professional oversight and dedicated patient participation.
Defining Fixed Appliances and Their Purpose
Fixed appliances are complex systems designed to transmit force to the teeth. Primary components include brackets, small devices bonded directly onto the tooth surface, and the archwire, the thin metal wire running through the bracket slots. Ligatures, which are small elastic bands or thin wires, hold the archwire securely, allowing it to exert pressure. Metal bands cemented around the back molars often provide robust anchoring points for the appliance.
Appliances are categorized by bracket material and placement. Traditional metal braces use durable stainless steel, effective for complex movements. Ceramic braces function similarly but use clear or tooth-colored brackets for a less noticeable appearance. Lingual braces are bonded to the back (tongue side) of the teeth, making them virtually invisible from the front.
The purpose of fixed orthodontic treatment is to correct malocclusion, the improper alignment of the teeth or jaws. Fixed appliances are particularly suited for movements requiring precise control over the tooth root and crown, such as rotation or intrusion. Specific issues addressed include:
- Dental crowding, where there is insufficient space for teeth.
- Spacing, which involves gaps between teeth.
- Discrepancies in the bite relationship, such as an excessive overbite or an underbite.
- A crossbite, where upper teeth fit inside the lower teeth.
The Biological Mechanism of Tooth Movement
Tooth movement is a complex biological process involving the surrounding bone and the periodontal ligament (PDL). The PDL is specialized tissue situated between the tooth root and the alveolar bone. When the archwire applies continuous force, it compresses the PDL on one side of the root and stretches it on the opposite side.
This pressure and tension dynamic triggers a cellular response within the PDL. On the compression side, specialized cells called osteoclasts are activated. These osteoclasts break down and resorb the alveolar bone tissue, creating a pathway for the tooth to move.
Simultaneously, on the tension side, osteoblasts become active. Osteoblasts create new bone tissue in the space left behind by the moving tooth. This cycle of bone resorption and formation allows the tooth to gradually shift while the jawbone remodels to support the new position.
The Patient Treatment Timeline
Fixed orthodontic treatment is structured into distinct sequential phases. The initial consultation involves a thorough examination and diagnostic records, including X-rays, scans, and photographs. This allows the orthodontist to formulate a precise treatment plan, with an estimated duration typically ranging from 12 to 30 months based on complexity.
Appliance placement, or “bonding day,” follows the planning stage. Brackets are bonded to the teeth and initial archwires are threaded, marking the start of the active treatment phase. During this longest phase, patients attend regular adjustment appointments every four to eight weeks.
At these periodic visits, the orthodontist changes archwires or makes adjustments to apply new forces, continuing tooth movement. Once teeth reach their ideal positions, the appliances are removed in a process called debonding.
The final stage is retention, which is non-negotiable. This involves the use of custom-made retainers, which may be fixed or removable. Retainers hold the newly aligned teeth in place while the surrounding jawbone and soft tissues stabilize. Failing to wear the retainer consistently compromises treatment results, allowing teeth to shift back toward their original positions.
Essential Daily Care and Management
Successful treatment requires meticulous oral hygiene and patient responsibility. Appliances create numerous crevices where food and plaque easily become trapped. Brushing must be performed after every meal using a soft-bristled toothbrush, carefully cleaning above, below, and around each bracket and wire.
Specialized tools are necessary for hard-to-reach areas. These include interdental brushes to clean between wires and teeth, and floss threaders or water flossers for cleaning between teeth. Neglecting this routine increases the risk of tooth decay, gum inflammation, and permanent white spots on the enamel. A fluoride rinse is often recommended to strengthen enamel during treatment.
Dietary modifications are fundamental to preventing appliance damage and treatment delays. Patients must strictly avoid hard foods, like nuts or ice, which can break components. Sticky or chewy foods, such as caramels, can pull components off the teeth. Firm foods like apples or raw carrots should be cut into small, manageable pieces before consumption.
Following placement or adjustment, patients may experience temporary tenderness managed by over-the-counter pain relievers. If a wire pokes or a bracket causes irritation, orthodontic wax can be placed over the sharp area for relief. Promptly contacting the orthodontist is necessary if a bracket is loose or a wire is broken, as damaged appliances can halt movement or cause undesirable shifts.