Braces treatment is a fixed orthodontic treatment in which the teeth are moved in a controlled way with small brackets bonded to the tooth surfaces and an archwire running through them. Treatment usually begins with an examination and records, moves into the active phase when the brackets are bonded, continues with regular wire changes and check-ups, and is completed with removal of the brackets and the retention (retainer) period. In comprehensive cases the duration is mostly between 1.5 and 2.5 years; the exact duration can only be given after the examination and planning.
Rather than what braces are, this page explains how treatment progresses from start to finish, when it is the preferred option and what you should look at when deciding. For a definition of braces and their general benefits, see our article What is braces treatment.
When are braces the preferred option?
Fixed braces are a tool that can be used for almost any orthodontic problem. Although clear aligners are a good alternative in many cases, bracket treatment comes to the fore in some situations:
- Severe crowding requiring extractions: While the extraction space is being closed, the roots of the teeth need to move in parallel; brackets provide this control continuously.
- Markedly rotated or impacted teeth: Especially when teeth with a round cross-section (canines, premolars) are severely rotated, or when an impacted tooth exposed surgically is being pulled into place.
- Large vertical movements: Some open bite and deep bite cases.
- Patients who think they cannot wear aligners 20–22 hours a day: Fixed treatment does not depend on the patient putting appliances in and taking them out.
- Jaw cases planned together with surgery: Brackets are mostly used in the periods before and after orthognathic surgery.
This list is not a rule. Both braces and clear aligners may be possible in the same case; which will give a more predictable result is discussed at the examination. If you would like to see the two methods side by side, see our clear aligners or braces page.
How does braces treatment progress stage by stage?
1. Examination and records
At the first consultation, the teeth, gums, jaw joint and facial profile are assessed. If treatment is needed, a panoramic X-ray, a cephalometric film if necessary, intraoral and facial photographs, and a digital scan or impression are taken. Any cavities, gum inflammation or tartar are treated before the brackets are placed.
2. Treatment plan and consent
After the records are reviewed, the definition of the problem, the intended result, whether extractions are needed, additional tools (elastics, mini-screws, appliances) and the estimated duration are explained to you. Fee and payment information is given in writing at this stage.
3. Bonding the brackets
The teeth are cleaned and dried, the brackets are fixed to the teeth with a special adhesive and the first thin wire is placed. The procedure does not require numbing. If you are curious about the steps, our article how braces are put on gives details.
4. Leveling and alignment
In the first months, flexible wires bring the teeth into line and rotations are corrected. During this period the change often becomes visible. For a few days after wire changes, there may be a feeling of pressure on the teeth and sensitivity when chewing.
5. Correcting the bite and spaces
Stiffer wires are used; extraction spaces are closed and the lower and upper teeth are brought to fit together. In most patients, orthodontic elastics come into play at this stage; wearing the elastics for the time the orthodontist specifies directly affects the length of treatment.
6. Finishing and detailing
The inclination of the teeth, root parallelism and contact points are completed with fine adjustments. It is natural for patients to find this phase long; however, it is an important stage for stability.
7. Removing the brackets and retention
The brackets are removed, adhesive residue is cleaned off and a retention appliance is provided on the same day or shortly afterward. In most patients, a thin fixed wire is bonded behind the front teeth and/or a clear retainer worn at night is used. Details are on our retention page.
How often do you need to come in for check-ups?
In braces treatment, check-ups are usually scheduled 4–8 weeks apart. At each check-up the wire may be changed or bent, the elastics routine is updated and oral hygiene is assessed. Missed appointments prolong treatment. To plan your work or school schedule in advance, it is helpful to ask about the check-up frequency at the first consultation.
If a bracket comes loose or the end of a wire pokes you, you should contact the clinic without waiting for the next check-up. What to do in such situations is explained in our article braces emergencies.
Another common question is whether the type of bracket shortens treatment. Self-ligating brackets hold the wire with a small clip instead of an elastic tie; this can make cleaning and wire changes easier. However, the main factors that determine total treatment time are the difficulty of the case, planning and patient cooperation; there is no strong evidence that bracket type alone noticeably shortens treatment.
What are your responsibilities during treatment?
- Cleaning: Plaque builds up easily around the brackets. Brushing after every meal and using interdental brushes and fluoride toothpaste are recommended. Inadequate cleaning can lead to permanent white spots on the tooth surface (enamel demineralization) and gum inflammation.
- Diet: Hard foods (nuts in shells, ice), sticky foods (caramel, chewing gum) and hard foods bitten into directly are the most common causes of brackets coming off. Foods such as apples and carrots can be eaten in small pieces.
- Wearing elastics and appliances: If the orthodontist has given you elastics, you need to keep to the daily wear time.
- Attending check-ups regularly: Missed appointments extend the total duration.
- Sports: Using a mouthguard is recommended for contact sports.
What are the limits and possible risks of braces treatment?
Braces move teeth; they do not change the size of the jawbones in adults. If a patient who has finished growing has a pronounced receding or protruding lower jaw, treatment is either limited to dental camouflage or planned together with jaw surgery. Known possible side effects are:
- White spots and cavities due to inadequate cleaning
- Slight shortening of the root tips in some patients (root resorption); it is monitored with regular follow-up
- Temporary gum overgrowth or inflammation
- Teeth shifting back to their old positions if retention is neglected
Most of these risks can be minimized with regular check-ups, good oral hygiene and following the orthodontist's recommendations.
What should you clarify before starting treatment?
Braces are a long-term process. Getting answers to the following questions before you start helps you avoid surprises during treatment:
- Is my problem purely dental, or does jaw structure also play a role?
- Are extractions needed; if not, how will space be created?
- Will elastics, mini-screws or additional appliances be used?
- What are the estimated duration and check-up frequency; how are periods when I will be out of town planned?
- Which appliance will be used for retention, and for how long?
The main factors that determine the fee are the difficulty of the case, the estimated duration, the type of brackets used and additional tools. The fee is provided in writing after the examination and planning. For a more detailed preparation list, you can use our orthodontic consultation question list page.
Is there an alternative to metal braces?
If visibility is important to you, there are less noticeable forms of fixed treatment: tooth-colored ceramic braces and lingual braces bonded to the inner surface of the teeth. If you would like a removable option, clear aligners can be considered. To see all the options together, take a look at our orthodontic treatments page.
Whichever method you choose, the deciding question is the same: Can this problem be solved predictably with this method, and can you keep up with the responsibilities this method requires? The answer to these two questions becomes clear with the examination and records.