What you can expect

Treatment is done in three phases: the initial placement of the braces (or clear aligners), periodic adjustments and use of a retainer after the braces are removed.

Placement of braces

Fixed dental braces typically consist of these components:

• Brackets attached to the outside surfaces of the teeth. Or they can be attached to the backside of teeth, hiding them from view, but this makes them a bit harder to access. Brackets can be made of stainless steel, ceramic (clear or tooth-colored) or other materials. Modern metal brackets are smaller and less noticeable than they used to be.
• Ring-like bands that encircle the molar teeth. Before bands are applied, space is created by placing very small rubber bands (spacers) between the molar teeth. These bands are made of stainless steel or titanium. A buccal tube attached to the band of the last molar holds the end of the connecting wire in place.
• A flexible wire (archwire) that connects all of the brackets and bands. The archwire controls movement of the teeth.
• Small rubber bands (elastic ties) or metal ties to secure the wire to the brackets (though some braces have a sliding mechanism instead of ties to secure the wire). Larger rubber bands also may be used to help move teeth. Stretching elastics between the upper and lower jaws is an option to produce more corrective pressure.
• Headgear attached to the braces. Headgear is usually only worn at night, and it may be helpful in more-complex cases. Headgear is attached to headgear tubes in the mouth to produce additional pressure and to help hold or move teeth into the correct position.
• Temporary anchorage devices (TADs). Instead of headgear or rubber bands, TADs may be an option for some patients. Tiny screws are placed through the gums into the jawbone, and can then be used as anchors to apply continuous pressure to move the teeth.

Removable clear aligners

Instead of using fixed braces, certain people who need only minor corrections may benefit from a series of customized, removable appliances called clear aligners. Typically, each set of aligners is worn for one to three weeks, as close to 24 hours a day as possible — except when eating, brushing or flossing — until it's replaced by the next set. The entire series of aligners may take up to nine months or longer, allowing better alignment.

Only plain water is OK to drink when wearing aligners. After taking the aligners out to eat or drink any other food or beverage, be sure to brush your teeth before putting the aligners back in. Floss as often as directed — at least daily.

Periodic adjustments

After fixed braces are placed on your teeth, your orthodontist adjusts them periodically by tightening or bending the interconnecting wires. This puts mild pressure on the teeth and gradually shifts them into new positions. The jaw responds to the pressure by dissolving bone in the path of the moving tooth and laying down new bone behind it.

Occasionally, the orthodontist may use tension between the upper and lower jaws to help correct alignment. This is often done with elastic bands stretched between opposing teeth.

Your teeth and jaws may feel slightly sore for the first few days after an adjustment. This discomfort can usually be eased with an over-the-counter pain reliever. Tell your orthodontist if the discomfort is severe or becomes worse.

Retainers

After dental braces are removed, the newly straightened teeth need to be stabilized for a period of time (retention period) to prevent them from shifting back to their original position. This is accomplished with the use of a custom-made appliance typically made of plastic or plastic and metal wires that help teeth stay in place (retainer).

Retainers are usually removable, but may be fixed. Or a combination of fixed and removable may be used.