Orthodontic Braces & Appliances

The average length of time a patient undergoes orthodontic treatment is approximately two years with a six-month variable depending on the difficulty of the case. However, this does not include the retention phase, which could include removable or permanently cemented retainers. If the retainers are cemented on the lingual aspect of the anterior teeth, they can create a lifetime challenge to the patient in providing adequate plaque removal in this area. During active treatment, the patient should have 3-4 preventive visits every 6 months to include a caries exam, prophylaxis, and fluoride treatment. These visits are opportunities for the dental professional to educate, evaluate, and emphasize the importance of good oral hygiene as well as providing a home care regimen.

When the dental professional understands the purpose of orthodontic braces and appliances, it provides an appreciation for the process and motivation to assist with patient compliance in oral hygiene instruction and orthodontic recommendations. It is also necessary to know the names of the different parts of the braces and appliances to communicate consistently with the patient any areas needing extra attention.

Braces consist of several components. Brackets are small oval or square pieces made of either metal or ceramic material bonded directly to the buccal or sometimes lingual portion of a tooth. Typically, brackets are utilized in the anterior region. However, they may also be used in the posterior areas. They hold the archwire in place with a ligature tie. Ligature ties can be either a rubberized o-ring of different colors or a thin, metal wire. They are tightened around the wings of the bracket to hold the archwire in place (Figure 1). Also self-ligating brackets with doors or clips may be used to eliminate these ligature ties. In most instances, bands are utilized in the molar regions due to greater forces exhibited for movement in these areas.

Sometimes hooks are present on brackets and most often on orthodontic bands. Rubber bands are attached to the hooks to create additional force in specific areas. Rubber bands are changed at least daily and sometimes more frequently because they lose their elasticity over time. The bands contain tubes so wires and other appliances, such as headgear, can be inserted. These tubes tend to harbor food and bacteria, so it is important to clean these areas thoroughly.

Figure 1.
Image: Identification of orthodontic braces and appliances.
  1. Ligature – Either a tiny elastic or twisted wire to hold the archwire to the bracket.
  2. Archwire – wire that is tied to the bracket creating force and proper alignment.
  3. Brackets – directly bonded to the tooth and holds the archwire.
  4. Metal Band – cemented ring of metal that wraps around the tooth.
  5. Elastic Hooks & Rubber bands – used for attaching rubber bands, which help teeth toward their final position.

There are a variety of orthodontic appliances. Some of them are fixed, while others are removable. Removable appliances are easy to clean using a denture brush or toothbrush, toothpaste and enzymatic tablets specifically designed for this purpose. Be sure the patient is performing daily removal of bacteria and plaque from these appliances. Fixed appliances may also be functional in nature using the orofacial muscles of eating, swallowing, and speaking to create additional force for movement. These appliances tend to be bulky in nature and make access to adequate plaque removal very difficult. However, the fixed functional appliances eliminate the dependence on cooperation and deliver a constant force. This constant force results in quicker treatment results, therefore reducing the treatment time for the patient.