Misaligned teeth can be fixed with several proven approaches, ranging from traditional braces to clear aligners to surgery for severe cases. The right option depends on how far your teeth or jaw are out of position, your age, and your budget. Most mild to moderate cases take 6 to 24 months to correct, while complex cases can require up to three years.
What Counts as Misalignment
Orthodontists classify misalignment into three broad categories based on how your upper and lower teeth meet. In Class I malocclusion, your jaw aligns properly but your upper teeth stick out slightly beyond your lower teeth. This is the most common type and often involves crowding or minor spacing issues.
Class II malocclusion means your upper teeth protrude significantly, usually because of an underdeveloped lower jaw. You might hear this called an overbite. Class III malocclusion is the opposite: your lower teeth and jaw jut forward past your upper teeth, creating an underbite. Class III cases are generally the most difficult to correct and sometimes require surgery.
Beyond these categories, you might have a crossbite (where some upper teeth sit inside the lower teeth instead of outside), an open bite (where your front teeth don’t overlap vertically at all), or simple crowding where teeth overlap because the jaw is too narrow.
How Teeth Actually Move
Orthodontic treatment works by applying steady pressure to your teeth, which triggers your body to remodel the bone around them. On the side where pressure pushes the tooth, specialized cells break down bone to make room. On the opposite side, bone-building cells fill in the gap left behind. This cycle of breakdown and rebuilding is what allows teeth to shift position permanently rather than just temporarily bending in place.
This biological process takes time, which is why no legitimate treatment can straighten teeth in a matter of days or weeks. The bone needs continuous, controlled force to remodel safely without damaging the roots of your teeth or the surrounding gum tissue.
Metal Braces
Metal braces remain the most versatile option. Stainless steel brackets bonded to the front of each tooth are connected by a wire that your orthodontist tightens at regular appointments. They handle everything from mild crowding to complex bite corrections, and they’re the go-to choice when significant tooth movement is needed.
The tradeoff is visibility. Metal braces are the most noticeable type, which matters more to some people than others. Cost in 2025 typically runs between $3,000 and $7,000, making them one of the more affordable options.
Ceramic and Lingual Braces
Ceramic braces work the same way as metal braces but use tooth-colored or clear brackets that blend with your teeth. They’re effective for moderate to complex cases and popular with teens and adults who want something less conspicuous. They do tend to cost more than metal, and the brackets can stain if you’re not careful with certain foods and drinks.
Lingual braces take discretion a step further. They use the same components as traditional braces but are custom-fitted to the back of your teeth, making them virtually invisible from the front. They’re not suitable for every case, and they can be harder to clean and more uncomfortable against your tongue, especially in the first few weeks. Lingual braces are typically the most expensive bracket-based option, often running $8,000 to $10,000 or more.
Clear Aligners
Clear aligners are removable plastic trays that gradually shift your teeth through a series of slightly different shapes. You swap to a new set of trays every one to two weeks. They’re nearly invisible when worn, and you take them out to eat and brush your teeth.
Clear aligners work well for many orthodontic issues, but their suitability depends on the specifics of your case. Complex movements like rotating severely twisted teeth or correcting significant bite problems can be harder to achieve with aligners alone. As the American Association of Orthodontists puts it, the type of appliance matters less than the skill of the person directing treatment. Cost in 2025 ranges from about $3,500 to $8,000, overlapping significantly with traditional braces.
Palate Expanders for Narrow Jaws
If your upper jaw is too narrow, causing a crossbite or severe crowding, an expander can widen it before or alongside braces. A device fixed to the upper molars applies outward pressure, and you (or a parent) turn a small screw twice a day, widening the jaw about half a millimeter per day. The expansion phase takes roughly three weeks, after which the device stays in place for about two months as a passive retainer while new bone fills the gap.
This approach works best in children and young teens whose jaw bones haven’t fully fused. Research tracking patients from an average age of about 12 through age 20 found that the width gains held up long-term at both the bone and tooth level. For adults, the same degree of skeletal expansion usually requires a surgical assist, since the midpalate suture has hardened.
When Surgery Is Needed
Some misalignments aren’t just about teeth. They’re about the jaw bones themselves being the wrong size or in the wrong position. Braces can move teeth within the bone, but they can’t reshape the bone’s overall structure. That’s where orthognathic (jaw) surgery comes in.
Surgery is typically considered when discrepancies are severe: an overbite or underbite of 5 millimeters or more, a molar relationship off by 4 millimeters or greater, facial asymmetry exceeding 3 millimeters, or an open bite where the front teeth don’t touch at all. These thresholds represent measurements that fall well outside the normal range. Jaw surgery may also be recommended when misalignment contributes to sleep apnea, chronic jaw pain, or speech difficulties.
The process usually involves braces before and after surgery. An oral and maxillofacial surgeon repositions the upper jaw, lower jaw, or both, and the bones are secured with small plates and screws. Recovery typically means a few weeks of a soft or liquid diet and several months before the jaw fully heals, though most people return to normal activities within two to four weeks.
How Long Treatment Takes
Treatment duration depends far more on the severity of your misalignment than on which appliance you choose. Mild cases, like minor crowding or small gaps, often wrap up in 6 to 12 months. Moderate cases involving bite correction or more significant crowding typically take 12 to 24 months. Complex cases with severe skeletal discrepancies or multiple issues can require 24 to 36 months, sometimes longer if surgery is part of the plan.
Why Retainers Are Non-Negotiable
Your teeth will try to drift back toward their original positions after treatment, especially in the first few months. This tendency, called relapse, is why every orthodontic treatment ends with a retainer.
Right after braces come off or your last aligner tray is finished, you’ll typically wear a retainer 24 hours a day. This full-time phase lasts at least four months for most people, though those with severe misalignment may need to wear it day and night for six to ten months. After that, you transition to nighttime-only wear. The reality most orthodontists will tell you: plan on wearing a retainer at night for the rest of your life. Teeth can shift at any age, and a retainer is a small commitment compared to repeating treatment.
Risks of At-Home Kits
Direct-to-consumer aligner companies offer a tempting shortcut: mail-order impressions, no office visits, lower price tags. The American Dental Association strongly opposes this model because of the potential for irreversible harm. Moving teeth without a complete picture of your oral health, including X-rays, gum assessments, and bone-level evaluation, can cause bone loss, receding gums, lost teeth, bite problems, and jaw pain. Without a licensed dentist monitoring progress, there’s no safety check to catch problems before they become permanent. The money saved up front can cost far more to fix later.
Choosing the Right Approach
Start with an orthodontist rather than choosing a treatment on your own. They’ll take X-rays, photographs, and sometimes 3D scans to assess not just your teeth but the underlying bone and jaw structure. This evaluation determines whether you need braces, aligners, expansion, surgery, or some combination.
If aesthetics during treatment are a priority and your case is straightforward, clear aligners or ceramic braces are solid options. If you have a complex bite issue or severe crowding, metal braces give the orthodontist the most control. If your jaw itself is the problem, no amount of tooth movement alone will create a stable result, and surgery becomes part of the conversation. Many orthodontic offices offer payment plans, and dental insurance often covers a portion of treatment for children and sometimes for adults, so cost shouldn’t be the only factor in your decision.