Braces are an effective orthodontic treatment used to correct misaligned teeth and various bite issues. The process of getting fixed braces attached, known as the bonding appointment, is a precise procedure that sets the foundation for the entire treatment. Understanding the steps involved helps patients feel prepared and informed about this significant dental visit. This guide details the full process, from the initial diagnostic stage to the immediate care required once the hardware is in place.
Initial Assessment and Preparation
The journey begins with an orthodontic consultation where a thorough examination of the teeth and jaws is performed. A comprehensive set of diagnostic records must be gathered to develop a precise treatment plan tailored to the patient’s unique anatomy. These records include digital photographs, impressions or digital scans of the teeth, and various types of X-rays.
Different X-ray types provide distinct views of underlying structures not visible during a physical examination. A Panoramic X-ray captures a comprehensive image of the entire mouth, including all teeth, jawbones, and temporomandibular joints. Cephalometric X-rays offer a side-view of the head, allowing the orthodontist to analyze the relationship between the teeth, jaw structure, and facial profile.
The orthodontist uses this data to identify issues such as impacted teeth, bone irregularities, and the precise position of tooth roots. Advanced Cone Beam CT imaging may be used to provide a three-dimensional view of the oral structures for detailed treatment planning. Before the bonding appointment, any existing issues, such as tooth decay or gum disease, must be addressed to ensure the mouth is healthy enough for the appliances.
The teeth are professionally cleaned and polished on the day of the procedure to ensure optimal adhesion of the brackets. If necessary, small rubber spacers may be placed between the back molars beforehand to create room for the metal bands that anchor the archwires. This preparatory phase ensures the brackets are placed in the exact location required for planned tooth movements.
The Physical Bonding Process
The actual placement of the braces, known as the bonding procedure, typically takes 45 minutes to an hour and does not require anesthetic. The initial step involves isolating the teeth using a cheek retractor to keep the lips away and ensure the teeth remain completely dry. Successful bonding relies on a dry, clean tooth surface, making moisture control important.
The tooth surface is then prepared using an etching agent, commonly a 37% phosphoric acid gel. This gel is applied for 20 to 30 seconds to the enamel, creating microscopic roughness on the surface. This roughened texture promotes micromechanical retention, significantly increasing the adhesive’s bond strength.
After the etching agent is thoroughly rinsed away with water, the teeth are dried using oil-free air. A properly etched and dried surface will appear visibly dull and frosty white, indicating the enamel is ready for the next step. If the prepared surface becomes contaminated with saliva at this stage, the entire etching and rinsing process must be repeated to ensure a strong bond.
Next, a thin layer of liquid bonding agent, often called a primer, is applied to the etched enamel surface. This primer seeps into the microscopic irregularities, linking the tooth and the bracket adhesive. A small amount of a resin-based composite adhesive is then placed directly onto the back of each bracket.
The orthodontist carefully positions each bracket onto the tooth surface using specialized instruments. Any excess adhesive that squeezes out around the edges is removed before the material is hardened. A high-intensity light, typically a specialized LED curing light, is shone onto the adhesive for 10 to 15 seconds per bracket.
This light energy causes a polymerization reaction, curing the resin and permanently bonding the bracket to the enamel. Once all brackets are secured, metal bands are fitted around the back molars to anchor the main wire. Finally, the archwire is threaded through the slots of the brackets, and small elastic ties, or ligatures, are used to hold the wire in place.
Immediate Adjustment and Care
Immediately after the braces are placed, patients should expect a sensation of tightness and pressure across the teeth. This feeling is caused by the archwire exerting the gentle, continuous force required to initiate tooth movement. Soreness or tenderness in the teeth and jaw is common and usually lasts for the first one to two days.
To manage this initial discomfort, over-the-counter pain relievers, such as ibuprofen or acetaminophen, can be taken. Taking a mild pain reliever shortly before the bonding appointment can help preempt the onset of soreness. Applying a cold compress or ice pack wrapped in a cloth to the outside of the cheeks for about ten minutes at a time can also reduce inflammation.
The new hardware may cause irritation to the soft tissues inside the mouth, including the lips, cheeks, and tongue. Orthodontic wax is provided to cover any parts of the brackets or wires that feel sharp or rub against the mouth’s interior. Rinsing the mouth several times a day with warm salt water helps soothe irritated gums and promote healing of minor abrasions.
For the first few days, a soft-food diet is recommended to minimize strain on the sensitive teeth. Foods like mashed potatoes, yogurt, scrambled eggs, and soups are ideal during this adjustment period. Patients must avoid hard, sticky, or crunchy foods, as these items can easily damage the new brackets or bend the archwire. A follow-up appointment is scheduled a few weeks after placement to allow the orthodontist to check progress and perform the first routine adjustment.