Orthodontic braces are specialized appliances designed to gradually reposition teeth, correcting alignment issues and improving bite function. Applying braces is a non-surgical procedure involving the meticulous bonding of metal or ceramic brackets to the tooth surfaces. Understanding the precise steps of this installation appointment helps demystify the process and set accurate expectations for the treatment journey.
Preparing the Teeth for Bonding
The installation process begins by preparing the teeth to ensure a strong, lasting bond between the enamel and the bracket. The teeth are thoroughly cleaned and polished using a specialized paste that removes all plaque, debris, and surface contaminants. This initial cleaning is necessary because foreign material compromises the adhesive strength.
To maintain a dry environment, which is crucial for effective bonding, the orthodontist places cheek retractors and cotton rolls inside the mouth. The prepared tooth surface is then treated with a conditioning solution, often called an etching gel, which is a mild acidic substance. This etchant is applied for about 30 seconds, thoroughly rinsed off, and the teeth are dried with air.
The etching solution slightly roughens the smooth enamel surface, creating microscopic pores and irregularities. This textured surface provides a better mechanical grip for the bonding material, similar to how sanding wood prepares it for paint or glue. The teeth must remain completely dry after this step, as moisture or saliva contamination significantly weakens the final bond.
Affixing the Brackets
Once the teeth are clean and conditioned, the process moves to placing the brackets, which serve as the anchors for the appliance. A specialized bonding agent, such as a primer or resin, is carefully applied to the etched enamel surface of each tooth. This agent acts as an intermediary layer, enhancing adhesion between the tooth and the bracket base.
The orthodontist applies a small amount of dental adhesive, often referred to as “glue” or cement, directly to the back of the bracket. Precision is paramount, as the exact position of each bracket dictates how the tooth will move throughout treatment. The bracket is carefully placed onto the primed tooth surface using predetermined measurements to ensure optimal alignment.
After the bracket is correctly seated, any excess adhesive is meticulously removed from around the edges. To finalize the bond, a high-intensity curing light, typically an LED or UV light, is used. The light activates photoinitiators within the adhesive, causing it to harden rapidly—often within 10 to 15 seconds per bracket—securely locking the bracket onto the tooth.
Installing the Archwire and Ligatures
With all the brackets firmly bonded, the focus shifts to installing the archwire, the component that applies the necessary force to move the teeth. The orthodontist selects a wire, usually thin and flexible for the initial phase, to fit the patient’s individual arch form. This wire is gently threaded through the horizontal slot present on each bracket across the arch.
The archwire transmits corrective forces to the brackets and the teeth. Once the wire is in place, it must be secured to prevent it from slipping out of the bracket slots. This is achieved using small elastic bands, known as ligatures, or fine metal wires called ligature ties.
These small bands or ties are stretched or wrapped around the “wings” of the bracket, holding the archwire deeply into the slot. Ligatures are often available in various colors, allowing patients to customize the look of their appliances. The tension created by the archwire and its securing mechanism begins the biological process of tooth movement.
Immediate Expectations After Installation
The initial installation appointment typically lasts between one to two hours, making it one of the longer visits in the treatment process. Immediately after the hardware is placed, patients commonly experience a feeling of pressure or tightness across their teeth. This sensation is a direct result of the archwire beginning to exert gentle, continuous force to initiate tooth movement.
Within a few hours of leaving the office, a dull ache or general soreness in the teeth and gums may develop as the body reacts to the new pressure. This initial discomfort is most noticeable in the first 24 to 72 hours, but it usually subsides significantly within the first week. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can manage this initial tenderness.
Patients are advised to stick to a diet of soft foods for the first few days to a week, avoiding anything hard, sticky, or crunchy that could damage the new appliances. The brackets and wires can also cause temporary irritation to the soft tissues of the mouth, such as the cheeks, lips, and tongue. Orthodontic wax is provided to cover rough or protruding parts, creating a smoother surface and allowing the mouth to adjust.