Treatment time and visits

Question 1

How long does it take to have braces fitted?

Accepted Answer

The time it takes to fit braces depends on the method the orthodontist uses. There are two main approaches – direct and indirect. With the indirect method, the brackets are positioned in advance in a laboratory and then bonded in the mouth using a special transfer tray. With the direct method, the orthodontist places each bracket individually during the procedure. Both methods give good results. The procedure can take anywhere from 30 minutes to 2 hours per jaw.

Question 2

How often do I need to see the orthodontist with braces and with aligners?

Accepted Answer

Conventional braces need a visit to the orthodontist every five weeks or once a month. This is the optimal interval for adjustments with standard braces held with elastic ties. Coming in more often doesn't speed up treatment, because the bone needs time to adapt to the new position of the teeth. If you can't get to your orthodontist on time, it's no problem to stay on your current archwires for a little longer – your teeth will keep moving, just at a slower pace. With some bracket systems, such as Damon self-ligating braces, appointments can be scheduled every two months. Aligners need less frequent check-ups – usually once every two to three months, depending on the stage of treatment and whether additional procedures such as stripping (interproximal reduction, IPR) are needed.

Question 3

How long does orthodontic treatment take?

Accepted Answer

The length of orthodontic treatment varies with the complexity of the case. The main stages of treatment are straightening the teeth, correcting the bite, finishing, and making sure the teeth meet properly. The average length of treatment with braces has been calculated at 19.9 months, but it can be shorter or longer depending on the individual case: Treatment with braces without extractions – about 20 months; Treatment with removal of two premolars – 25 months on average; Treatment with removal of four premolars – approximately 26 months; Combined orthodontic and surgical treatment – about 26.8 months; Treatment with removable appliances (plates) – 13 months on average. Treatment with clear aligners has no fixed average length, as it depends on the complexity of the case. For correcting minor imperfections, aligners can be the quicker solution, but when the bite needs correcting they often take longer than braces. The factors that affect how long treatment takes are: The patient's age; How severe the bite problem and the irregularities in the alignment of the teeth are; The patient's cooperation (attending appointments regularly, wearing elastics, keeping up good oral hygiene); Whether teeth need to be extracted. Treatment is usually shortest in children and young people who have milder problems and don't need any extractions.

Question 4

What does the length of my treatment depend on?

Accepted Answer

The length of treatment depends mainly on the following factors: 1. How complex the problem is – the bite, lack of space; 2. The patient's age; 3. Bone density, any metabolic conditions, pregnancy; 4. The patient's cooperation and motivation – wearing elastics, training the position of the tongue if needed, or correcting another harmful habit; 5. Keeping booked appointments; 6. Following instructions – not knocking off brackets, not losing aligners, etc.; 7. Keeping up good oral hygiene.

Question 5

How long does the shortest orthodontic treatment take?

Accepted Answer

A minor correction of a few crooked front teeth with clear aligners, without treating the bite, can take as little as 3–4 months.

Question 6

How soon after starting treatment will I see a difference in my smile?

Accepted Answer

During the first month of treatment, changes happen gradually. By the end of this period you may notice slight movements of your teeth, although they can be so small that you're not quite sure whether you're really seeing them. This is completely normal. Of course, every rule has its exceptions. In some patients, the changes are more noticeable not only to them but also to those around them. The younger we are, the faster our teeth can move. In rare cases, significant changes only begin in the second or third month, which usually means that tooth movement in these patients is slower. After about 4–5 months of wearing braces or aligners, your teeth will be noticeably straighter and the changes will become even more visible.

Question 7

How often do the elastic ties on my braces get changed?

Accepted Answer

Conventional braces, which use small elastic ties (ligatures) to hold the archwire in the brackets, are adjusted by the orthodontist every month. At this appointment the elastic ties are taken off and sometimes the archwire is changed. New elastic ties are put on, because the old ones have stretched from being in the mouth and plaque has built up on them. If a patient can't see their orthodontist within the month, the elastic ties will stay in place, but if they aren't changed for several months they may start to break and fall off.

Question 8

How long can I keep the same archwire in?

Accepted Answer

Different types of braces use different sets and sizes of archwires. Some systems need 5-6 archwires per jaw over the whole course of treatment. Some systems use more archwires and some use fewer. The number of archwires doesn't determine how effective the braces are. The second-to-last and last archwires stay in the mouth the longest. They are known as the ‘working’ and ‘finishing’ archwires respectively. While the working archwire is tied into the braces, the bite is corrected – whether it's a deep bite, open bite, distal bite or underbite. Correcting the bite is one of the slowest stages of treatment, so this archwire may not be changed for a long time. The working archwire can also serve as the finishing archwire, or it can be replaced. Finishing is the final fine-tuning of small irregularities in the position of the teeth that have arisen during the earlier stages of treatment. This can also take a long time – from 2-3 months to 6-7 months or more.

Question 9

Are the archwires on my braces changed at every appointment?

Accepted Answer

Archwires are changed when the current wire has achieved the tooth movements expected of it. For example, the thin, soft, round archwires used at the start are for lining the teeth up in a row and straightening out irregularities. Rectangular archwires work on the tilt of the teeth. If the round archwire currently in your mouth hasn't yet corrected the rotation of a particular tooth, it may be left to work for another month.

Question 10

My teeth get used to each new aligner within 2 days. Can't I change them more often?

Accepted Answer

Aligners come with a recommended wear schedule. The number of days each aligner is worn depends on the force that has been set by computer for each step of the treatment. That's why aligners may be worn for 5 days, one week or two weeks each. The pressure your teeth feel when a new, tighter aligner goes in triggers changes in the cells around each tooth that are responsible for moving it through the bone. This is a biological process, and it takes time. The fact that the pressure from the aligner has eased or stopped doesn't mean it's time to put your teeth under a new force. Stick strictly to the stated wear time for each aligner, so that you don't put the health of your teeth at risk or end up with unwanted effects.

Question 11

My teeth were crowded, but after 3 months in braces I now have gaps. When will they close?

Accepted Answer

The first phase of orthodontic treatment with braces is levelling – correcting rotated teeth and teeth that are out of line vertically. Lining the teeth up requires space. This can be gained by expanding the dental arches or the jaws, or by taking teeth out. With expansion, the archwires pull the teeth forwards and outwards to find room. Sometimes this creates even more room than is needed, and gaps appear between the teeth. They will of course be closed, but this happens at a specific stage of treatment, not straight away. You may have to put up with some gaps between your teeth for a while.

Question 12

I got braces because I had gaps between my teeth, but I haven't seen any movement in the first 3-4 months. When will the gaps close?

Accepted Answer

Once your braces are fitted, the levelling phase begins. It ends when the teeth are largely straight and lined up in a neat row. The next phase is called the working phase. During this phase the bite is corrected and any gaps are closed. The reason the gaps don't start closing straight away is that this is done only once the archwire has reached a large enough size. Treatment starts with thin, soft archwires and progresses to thicker, stiffer ones. It usually takes at least 6 months to reach an archwire suitable for closing gaps.

Question 13

Can I have my braces check-ups more often so that my teeth move faster?

Accepted Answer

Although the teeth adapt very quickly after ‘tightening’ and the patient feels only slight discomfort for a few days, this doesn't mean that braces or splints can be adjusted, or aligners changed, more often than scheduled. Regular, overly frequent ‘tightening’ not only fails to speed up tooth movement – it actually has the opposite effect: the teeth can't ‘get used to’ the new force and move, so their movement slows down, their roots become shorter and the bone around them breaks down abnormally.

Question 14

My teeth straightened out really quickly at first, but I'm still wearing braces. Why?

Accepted Answer

The early stages of tooth movement involve correcting rotated teeth, bringing high-positioned teeth down and, in general, lining the teeth up in a single row. Patients most often seek orthodontic treatment to straighten their crooked teeth, and in the first six months these changes are the most visible, so patients are at their most satisfied. The later stages of treatment involve correcting the bite and fine, detailed alignment of the teeth. Some patients didn't even know they had a problem with their bite before they saw the orthodontist, so they may not pay much attention to its correction and may not notice the changes that are happening. Because correcting a misaligned bite takes longer than straightening crooked teeth, it may seem to you that you are wearing braces or aligners for longer than necessary, but that is not the case.

Question 15

My treatment is taking longer than I was told. Why might that be?

Accepted Answer

When a patient comes for their first consultation, one of the questions they always ask is ‘How long will my treatment take?’ Although this information matters to them, and sometimes even decides whether they start treatment at all, there is no way for us to give an exact answer. Treatment time depends on many factors: how complex the problem is, the patient's age and sex, whether they can visit us regularly, how well they cooperate with treatment (for example, whether they wear their elastics), the density of the jawbone, whether they take any medication that affects metabolism, whether they have any medical conditions, whether brackets come off through carelessness, whether they clean their teeth well, and which type of treatment they have chosen – appliances, braces (metal or aesthetic) or aligners. When we give you a treatment time, it is based on average figures from studies on how quickly a problem similar to yours is treated, so it is an estimate.

Question 16

Is it true that lower teeth straighten more slowly than upper teeth?

Accepted Answer

Although many patients notice that their lower teeth straighten more slowly than their upper teeth, I can't say for certain that there is a difference in the speed of movement in every patient.

Question 17

How long does it take to have braces removed?

Accepted Answer

Detaching the braces from the teeth takes about a minute. Cleaning off the adhesive is done carefully and takes longer, and then the teeth are polished. We usually take final photographs to document the case and an impression of the teeth so that removable retainers can be made. If a fixed retainer is planned, it is made in advance and bonded at the same appointment. Every orthodontist takes a different amount of time over these steps, so I can only tell you how long they take me: removing the braces, taking the photographs and the impression takes around 40–50 minutes. Fitting a fixed retainer takes about 1 hour.

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