ORTHODONTICS
Braces (Metal Brackets) Treatment
The orthodontic treatment with the widest scope, using a fixed bracket system
Provided at our clinic in Altunizade, Üsküdar (Istanbul).
IN SHORT
In braces treatment, small parts called brackets are bonded to the surface of the teeth and are connected to one another with a wire. The wire applies a continuous, controlled force to the teeth, moving them into the planned position. The brackets cannot be removed by the patient; therefore the success of the treatment does not depend on patient compliance. It is the orthodontic method with the widest scope, applicable in advanced crowding, severe bite disorders and cases requiring tooth extraction.
What is braces treatment?
Teeth are not fixed within the jawbone. When a continuous, controlled force is applied to the connective tissue around the tooth root, the bone resorbs on one side and rebuilds on the other, and the tooth slowly moves. The whole of orthodontic treatment is built on this biological process.
In braces treatment this force is applied through brackets bonded to the teeth and the wire that connects them to one another. The wire is changed or tightened at set intervals; at each stage the teeth come a little closer to the planned position.
Brackets can be metal, ceramic (clear) or of the type bonded to the back surface of the tooth (lingual). The working principle is the same; the difference is in visibility.
In which cases are braces needed?
This is the most important section of the page. Clear aligner treatment has become widespread in recent years and many patients ask for it directly. However, clear aligners are not sufficient in every case. In the following situations, fixed braces treatment is needed or gives a markedly more predictable result:
Advanced crowding. Cases where the teeth do not fit and clearly overlap one another.
Cases requiring tooth extraction. Closing the extraction space requires the root to be moved bodily; this is done in a more controlled way with a fixed system.
Severe bite disorders. Situations such as open bite (the front teeth not meeting), deep bite and crossbite.
Cases where the angle of the root needs to be changed (torque movement).
Bringing an impacted tooth into the mouth. Impaction of the canine (eye tooth) is a typical example; a chain is attached to the tooth to draw it in.
Jaw-relationship disorders. In some cases orthodontics alone is not sufficient and is planned together with orthognathic surgery.
Cases where patient compliance cannot be ensured. Clear aligners must be worn 20–22 hours a day. If it is foreseen that this cannot be done, the fixed system gives a more reliable result. This assessment is particularly important in child and adolescent patients.
For a detailed comparison between clear aligners and braces, you can see the Clear Aligner Treatment page.
Who is it applied to?
There is no age limit for orthodontic treatment. The biological process that allows the teeth to move also works in adults. Because bone remodelling is slower in adults, the treatment duration may be longer.
In children, the timing of treatment is determined according to the state of jaw development. In some cases, early intervention during the growth period can reduce the need for more extensive treatment later on.
In which cases is another treatment needed first?
Untreated gum disease. Orthodontic force accelerates bone loss in inflamed gums. Brackets are not bonded until gum health is established.
Active decay. It must be treated before brackets are fitted.
Patients whose oral care is not sufficient. The area around the brackets is favourable for plaque accumulation. If brushing is inadequate, permanent white spots (decalcification) may form around the brackets. These spots do not disappear once treatment is over.
Adults with a severe skeletal disorder. It may not be correctable with orthodontics alone; it may need to be planned together with orthognathic surgery.
The treatment process step by step
Examination and records
An intraoral examination, panoramic and cephalometric X-rays, photographs and a digital scan or impression are taken.
Analysis and planning
The jaw relationship, tooth dimensions and available space are calculated. Whether tooth extraction is needed is determined at this stage.
Preparation
Any decay and gum treatments are completed and scaling is performed.
Bonding the brackets
The brackets are bonded to the teeth and the wire is fitted. The procedure is painless; no anaesthesia is needed.
Check-ups
The wire is usually changed or activated every 4–6 weeks. Missing these appointments prolongs the treatment.
Removal of the brackets
Once the planned position is reached, the brackets are removed and the tooth surfaces are cleaned and polished.
Retention (retainer)
The final and most often skipped stage of treatment. It is used to prevent the teeth from returning to their old position.
How long does treatment take?
The duration varies according to the degree of crowding, whether an extraction will be carried out, the patient's age and whether the check-ups are attended regularly. In most cases it is between 18–30 months. The exact duration is determined after the examination and analysis.
Not attending the check-ups directly prolongs the treatment. A bracket coming loose and this being reported late has the same effect.
Oral care: the most critical issue in treatment
The area around the brackets is favourable for plaque accumulation. If this area is not cleaned well, two problems arise: gum inflammation and permanent white spots on the tooth (decalcification).
The significance of the white spots is this: they are mineral losses that remain permanently in the enamel. They emerge when the brackets are removed and do not resolve on their own. This is an unwanted and entirely preventable outcome.
For this reason, an orthodontic toothbrush, an interdental brush and fluoride toothpaste must be used throughout treatment. An oral irrigator can help.
Diet: hard foods (ice, hard-shelled nuts, hard bread crust) and sticky foods (chewing gum, caramel) can cause a bracket to come off. Foods such as apples and carrots should be sliced before eating.
Retention (retainer): treatment does not end here
Teeth do not stay on their own in the position to which they have been moved. Until the bone and connective tissue adapt to the new position, there is a tendency for the teeth to return to their old places (relapse). This tendency can continue for years after treatment ends.
For this reason, a retention appliance is used after the brackets are removed. There are two types: a fixed wire bonded to the back surface of the teeth and a clear plate worn at night. The two are often used together.
If retention is not used, the result of months of treatment can be lost. This is the most common disappointment in orthodontic treatment, and it is entirely preventable.
Risks and possible complications
Decalcification (permanent white spots). Seen in cases where oral care is inadequate.
Gum inflammation and gum overgrowth.
Shortening at the root tip (root resorption). It is usually at a level that does not cause a clinical problem; rarely it may be pronounced. It is monitored with X-rays.
Irritation and sores inside the cheeks and lips in the first weeks. This can be reduced with orthodontic wax; the oral mucosa adapts within a few weeks.
Pain and sensitivity lasting a few days after the wire is fitted and after each activation.
A bracket coming off. It should be reported as soon as possible, even outside of an appointment.
Relapse. Seen when retention is not used.
Frequently Asked Questions
Bonding the brackets is painless and does not require anaesthesia. After the wire is fitted and following each activation there is a few days of pain and pressure; this is a sign that the teeth are moving. In the first weeks the brackets can cause irritation inside the cheeks and lips; this can be reduced with orthodontic wax.
In most cases it is between 18–30 months. The duration varies according to the degree of crowding, whether an extraction will be carried out, the patient's age and whether the check-ups are attended regularly. Not attending the check-ups directly prolongs the duration.
There is no age limit for orthodontic treatment. The biological process that allows the teeth to move also works in adults. Because bone remodelling is slower in adults, the treatment duration may be longer. Assessing gum health is of particular importance in adults.
The bracket itself does not cause decay. However, the area around the brackets is favourable for plaque accumulation and, if brushing is inadequate, decay and permanent white spots (decalcification) may form. These spots emerge when the brackets are removed and do not resolve on their own. They can be entirely prevented with regular and correct brushing.
Clear aligners give effective results in mild and moderate cases. In situations such as advanced crowding, cases requiring tooth extraction, severe bite disorders and bringing an impacted tooth into the mouth, fixed braces treatment is needed or gives a markedly more predictable result. In addition, clear aligners must be worn 20–22 hours a day; if it is foreseen that this compliance cannot be ensured, the fixed system is more reliable. Which method is suitable is determined after the examination and X-ray assessment.
If a retainer is not used, the teeth have a tendency to return to their old positions, and this tendency can continue for years. For this reason, after the brackets are removed, a fixed retention wire and/or a clear plate worn at night is used. Retention is part of the treatment; it is not an optional extra.
Hard foods (ice, hard-shelled nuts, hard bread crust) and sticky foods (chewing gum, caramel) can cause a bracket to come off. Foods such as apples and carrots should be sliced before eating.
You should call the clinic without waiting for your appointment day. As long as the loose bracket is not refitted, that tooth does not move and the treatment is prolonged. If the loose bracket is still attached to the wire and is pricking, it can be temporarily covered with orthodontic wax.
Related treatments
The content on this site is for information only and does not replace a clinical examination. The suitability, duration and scope of treatment are determined after a clinical assessment.
This content was prepared by Dt. Mevlüt Yazıcı.
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Altes Diş Kliniği
Altunizade, Üsküdar, İstanbul
- PHONE+90 533 474 43 94
- EMAIL[email protected]
- ADDRESSAlperen İş Merkezi, Valide-i Atik Mahallesi, Altunizade, Nuhkuyusu Cd D:191/B, 34664 Üsküdar/İstanbul
- WORKING HOURSWeekdays 10:00–19:00 · Saturday 10:00–16:00 · Sunday closed