Orthodontic treatment using braces is a structured process designed to realign teeth and jaws for improved function and aesthetics. This journey is broken down into distinct, sequential stages, each with specific mechanical goals. Understanding these phases helps patients appreciate how the continuous, gentle pressure applied by the appliances leads to the desired final result. The process systematically moves the teeth from their initial positions to their final, stable locations.
Initial Assessment and Appliance Placement
The first step in braces treatment is a thorough diagnostic assessment to develop a precise treatment plan. This involves obtaining detailed diagnostic records, which typically include panoramic and cephalometric X-rays, digital photographs, and intraoral scans or impressions. These records allow the orthodontist to analyze the underlying skeletal structure, the position of the tooth roots, and the severity of the misalignment. Based on this analysis, a customized strategy dictates the exact movements required for each tooth.
Once the treatment plan is finalized, the placement of the braces begins with the bonding process. Small brackets are affixed to the surface of each tooth using a specialized dental adhesive. After the brackets are placed, the initial archwire is inserted and secured into the bracket slots, often with elastic bands or ligatures. This first wire is highly flexible and marks the beginning of the active tooth movement phase.
Leveling and Alignment
The leveling and alignment phase is the initial period of active treatment where the most dramatic changes in tooth position occur. The primary goal is to correct rotations, eliminate crowding, and bring the crowns of the teeth into a straight line. This stage focuses on achieving a smooth and level arch form, establishing the foundation for subsequent movements.
This phase utilizes archwires made of highly flexible materials, most commonly nickel-titanium (NiTi) alloys. NiTi wires are known for their super-elasticity and shape memory, allowing them to be bent to fit crooked teeth while constantly attempting to return to their original arch shape. This continuous, light force stimulates the bone remodeling necessary for the teeth to shift. As the teeth straighten, the orthodontist progresses the patient to thicker or stiffer wires, moving from round to square or rectangular cross-sections, which provide greater control over tooth position.
Bite Correction and Space Closure
Once the teeth are generally aligned, treatment progresses to the structural phase of bite correction, or establishing functional occlusion. This stage addresses the relationship between the upper and lower jaws, correcting issues like overbites, underbites, and crossbites. Heavier and stiffer archwires, typically made of stainless steel or beta-titanium, are introduced to achieve jaw alignment and manage large gaps.
Auxiliary mechanics are introduced during this phase to apply directional, inter-arch forces for structural changes. Patients frequently use orthodontic elastic bands, which stretch between brackets on the upper and lower teeth to guide the jaws into the correct relationship. Fixed appliances like springs or bite correctors may be used for specific cases to deliver continuous force for overbite reduction, encouraging the lower jaw to move forward. If teeth were removed earlier to relieve crowding, power chains or closed coil springs are used to close the resulting spaces.
Refinement and Finishing
The refinement stage is dedicated to achieving precision and detail in the final tooth positions. At this point, major movements are complete, and the teeth are nearly in their optimal positions. This phase focuses on fine-tuning the alignment, ensuring proper root parallelism, and obtaining ideal intercuspation—how the cusps of the upper and lower teeth fit together.
The orthodontist may place specific bends, known as detailing bends, into the final rectangular archwires to make minute, three-dimensional adjustments. Minor adjustments to bracket placement may also be performed to correct slight rotational errors or vertical discrepancies. Sometimes, a small amount of enamel is removed between select teeth, a procedure called interproximal reduction, to create space for a precise fit. The successful completion of this stage leads directly to the removal of the braces, known as de-bonding.
The Retention Phase
Following the removal of the braces, the final stage—retention—begins, which is necessary for maintaining the results achieved. The surrounding bone and soft tissues require time to stabilize around the newly positioned teeth. Without retention, the teeth tend to shift back toward their original positions, a phenomenon known as relapse. Retention is an indefinite commitment that ensures the long-term stability of the corrected smile.
Retainers are custom-made appliances that hold the teeth firmly in place. There are two main types: fixed, which involve a thin wire bonded to the back surface of the front teeth, and removable, such as clear plastic aligner-style retainers or the traditional Hawley retainer. The initial schedule requires full-time wear, followed by a transition to night-time wear, often for many years or indefinitely, to guarantee the permanence of the new alignment.