Before braces are placed on the teeth, patients undergo an examination by an orthodontist. This usually includes collecting a patient’s medical and dental history, physically examining the mouth and teeth, as well as creating plaster models of the teeth. More recently, computers are used to create digital models of the teeth. Photographs of the face and teeth and x-rays of the mouth and head may also be taken.

Treatment with braces consists of two phases:

• Active phase. This involves the use of braces or another device to move the teeth into proper position. In most cases, this phase lasts between one and three years. It tends to last longer for adults than children. During treatment, the braces are occasionally adjusted as the teeth shift position.
  
  
• Retention phase. Once the teeth are properly aligned, a device called a retainer is used to hold the teeth in proper position over the long term.

When braces are first placed, tiny brackets are affixed to each tooth using a special bonding agent. Some bonding agents are designed to continuously release fluoride, which helps protect tooth enamel under the brackets from tooth decay.   

Once the brackets are in place, arch wires made of stainless steel or metal alloys (mixtures) are threaded through the brackets. Wires may also be made of clear or tooth-colored materials for cosmetic purposes, although these are typically more expensive than the metal wires.

Contemporary arch wires are very flexible at room temperature so they can be attached to teeth more easily. Once the wires are threaded through the brackets, body heat causes the wire to warm and apply constant pressure on the teeth to move into place. These more flexible wires both speed up the treatment process and make it more comfortable for patients. Wires require periodic adjustment to maintain continual pressure on the teeth as teeth begin to change position.

Tiny elastic bands called ligatures are used to hold the arch wires to the brackets. These are now available in many different colors, and children may choose different colored bands as a fashion statement. For example, patients who are having their braces adjusted during the fall may choose orange and black ligatures to celebrate Halloween.

Bands made of surgical latex also may be applied to the teeth to provide more pressure than arch wires can apply on their own.

Patients typically experience some discomfort for a few days following the procedure. Teeth are often sore, and the tongue, cheeks and lips may experience irritation as a result of the braces and wires. However, this usually disappears within a week and only recurs when the braces are adjusted. Pain-relief medications can help alleviate this discomfort. However, patients should never take any medication without first consulting their orthodontist or physician.

Treatment time will vary depending on several factors, including the type of problem being corrected, the patient’s age and how well the patient follows the orthodontist’s recommendations. Usually, treatment with braces takes between one and three years. An orthodontist may recommend removing wisdom teeth after the braces are removed to prevent any future complications.

Once treatment with braces has ended, the brackets and wires will be removed and the patient will need to wear a retainer. This is a small piece of hard plastic that contains metal wires and is specially molded to fit the patient’s teeth. It is designed to give the bone and gums additional time to stabilize around the repositioned teeth. Photographs of the teeth and jaws will be taken for comparison with the initial patient photographs.