Orthodontic spacers, also known as separators, are small elastic rings or metal springs placed between the back molars. Their purpose is to gently push these teeth slightly apart to create a minute gap of a few millimeters. This temporary separation prepares the mouth for the next stage of treatment, which involves placing stronger hardware around the molars. Spacers are typically worn for about one to two weeks, allowing for the comfortable fitting of metal bands.
Spacers Out: Placement of Molar Bands
The immediate next step is the removal of the spacers and the installation of molar bands. The orthodontist uses a specialized instrument to gently pluck the spacers out. The newly created space allows the placement of metal bands, which are stainless steel rings that fully encircle the back molars.
Molar bands are necessary because molars bear the greatest biting force, making it difficult for smaller, bonded brackets to remain securely attached. These bands serve as anchors for the orthodontic system, providing a stable foundation for moving teeth.
The procedure involves selecting the correct band size, cleaning the tooth surface, and then seating the band with light pressure. The patient may be asked to gently bite down on a bite stick to fully push the band into its final position. Once seated, a special dental cement is applied to the interior of the band and cured with a light to secure it permanently. This process is generally not painful, as the spacers have already created the necessary clearance.
Brackets and Archwires: Installing the Main Hardware
With the molar bands securely in place, the focus shifts to bonding brackets onto the remaining teeth. Brackets are small metal or ceramic components individually bonded to the front and side surfaces of each tooth. The tooth surface is first prepared by cleaning and etching to create microscopic pores, enhancing the adhesive bond.
A composite resin adhesive is applied to the back of the bracket, positioned on the tooth, and hardened using an LED light. These brackets function as handles, transmitting the force from the archwire to the tooth structure. Once all brackets are bonded, the archwire is installed, connecting the brackets and the molar bands.
The archwire is a thin, flexible metal wire threaded through the slots in each bracket and secured to the molar bands. This initial wire is typically a nickel-titanium alloy, chosen for its flexibility and ability to apply a light, continuous force. Small elastic ties, known as ligatures, or a built-in gate on self-ligating brackets, hold the archwire into the slot. The archwire begins the biological process of gentle tooth movement toward alignment.
First Weeks of Treatment: What to Expect Next
After the full appliance is placed, the patient enters the adjustment phase as the mouth adapts to the new hardware. Within a few hours, initial soreness or a dull ache is common as the teeth respond to the archwire’s gentle pressure. Over-the-counter pain relievers can help manage this discomfort, which usually peaks within the first two to four days.
The inside of the cheeks, lips, and tongue may become irritated as they rub against the brackets and wires. Orthodontic wax can be applied to any protruding or rough areas to create a smooth barrier and provide immediate relief. During this initial week, stick to a diet of soft foods, such as mashed potatoes, soups, and yogurt, to minimize chewing pain and avoid damaging the new braces.
Maintaining oral hygiene becomes more involved, requiring careful brushing and flossing around the hardware to prevent plaque buildup. Patients are typically scheduled for their first follow-up appointment within a few weeks, where the orthodontist will check progress and potentially change the archwire. The soreness generally dissipates within five to seven days as the mouth tissues toughen and the teeth accommodate the new forces.