Braces treatment
Correcting teeth and the bite with the Pitts21 Pro system, with attention to how the smile fits the face.
Does this sound familiar
Patients most often come for this with these words:
My teeth are crooked or crowded
There are gaps between my teeth
My upper teeth stick out too far
My teeth do not meet properly and chewing is difficult
My smile does not seem to suit my face
The teeth need to be positioned before an implant or prosthesis
Brackets are small attachments bonded to the teeth. The wire running through them applies a gentle, continuous force, and under this force the teeth gradually change position. The aim of treatment is not only to line the teeth up: it is a correct bite, healthy function and a smile that suits the face. According to a systematic review, treatment with braces takes about 20 months on average, but the duration is individual in each case.
Who needs it
- If the teeth are crowded or crooked
- If there are gaps between the teeth
- If the upper or lower teeth stick out too far
- If the teeth do not meet properly: deep, open, cross or reverse bite
- If the teeth need to be positioned before an implant or prosthesis
- If the teeth have moved again after previous treatment
I work with the Pitts21 Pro system
I mainly use the Pitts21 Pro bracket system developed on the basis of Dr. Tom Pitts’s approach. This system allows the teeth to be moved with gentle forces and the aesthetic position of the front teeth to be controlled precisely. In one patient living abroad we corrected crowding and the bite in only 6 adjustments. This is not the same for every patient, but it shows what a well thought out plan can do. More: what is the Pitts philosophy.
Diagnosis
- Photographs of the face and smile: front, side, at rest and smiling
- Intraoral photographs and models of the teeth
- A panoramic and, when needed, a cephalometric X-ray
- Checking the gums, roots and jaw joint
- Analysis of the smile arc, the height of the front teeth and the arch width
How treatment goes
- Consultation, photographs and the necessary X-rays
- Plan: which tooth will move where and the approximate duration
- Bonding: attaching the brackets to the teeth, about an hour
- Adjustments: usually a planned visit every 1-2 months
- Finishing phase: the details of the smile and bite
- Removing the braces and retention
During bonding I pay attention to every detail. I choose the height of each bracket according to the smile arc. Even small adhesive residues left around a bracket can hold plaque later and make hygiene harder, so I clean them away.
Which braces
| Type | Advantage | What to consider |
|---|---|---|
| Metal | Small, strong, easy to remove | Visible |
| Ceramic | Tooth-coloured, less visible | Can break on impact |
| Self-ligating | No ligatures, gentle forces | The promise of speed is not scientifically confirmed |
More: types of braces. Choosing between braces and aligners: braces or aligners.
The first week
Bonding itself is painless. A few hours later a feeling of pressure starts in the teeth, it is strongest in the first 1-3 days and usually passes within a week. During this time soft food, orthodontic wax and, if needed, an ordinary painkiller help. More: do braces hurt.
Risks and how to prevent them
| Risk | What we do |
|---|---|
| White spots and decay | Hygiene training, fluoride, a check at every visit |
| Gum inflammation | Correct brushing, cleaning aids |
| Root resorption | Gentle forces, a check X-ray in patients at risk |
| Loose bracket, poking wire | Food rules, getting in touch in time |
| Relapse of the result | An individual retention plan |
Most of these risks are greatly reduced by correct daily care: daily braces care guide, white spots and root resorption.
After treatment
When the braces come off, retention begins. I choose a fixed or removable retainer individually for each patient. According to a Cochrane review, there is no strong evidence about which retainer is best for everyone, so the decision is made according to the initial problem and lifestyle. More: why retention matters.
Braces are temporary, but a beautiful smile stays with you for a long time.
What the science says
- Systematic review (2016): the average duration of treatment with braces is about 20 months.
- Systematic review (2010): self-ligating brackets have not been shown to have a clear advantage over conventional brackets in duration and effectiveness.
- Meta-analysis (2015): white spots are common during treatment with braces; hygiene and fluoride are important.
- Cochrane review (2023): evidence about which retainer is better for everyone is weak.
Frequently asked questions
How long does treatment with braces take?
About 20 months on average, but simple cases can be shorter and complex ones longer. I give the approximate duration after diagnosis.
Does getting braces hurt?
Bonding is painless. In the first days and after adjustments there is a feeling of pressure, which usually passes within a week.
How often are the visits?
Usually every 1-2 months. For those living abroad we plan the interval around their travel schedule.
Can I do sport with braces?
Yes. Use a mouthguard for contact sports.
Will teeth need to be extracted?
In many cases crowding can be resolved without extractions. I decide only after diagnosis, taking the profile into account. See: [non-extraction treatment](service:non-extraction).
What foods should I avoid with braces?
Avoid hard and sticky foods such as nuts, ice, caramel and chewing gum. Cut hard fruit into small pieces.
Read more
Scientific sources
The information in this article is based on the following peer-reviewed scientific articles and systematic reviews.
- Tsichlaki, A., Chin, S. Y., Pandis, N., & Fleming, P. S. (2016). How long does treatment with fixed orthodontic appliances last? A systematic review. American Journal of Orthodontics and Dentofacial Orthopedics, 149(3), 308-318. [PMID: 26926017] | [DOI: 10.1016/j.ajodo.2015.09.020]
- Fleming, P. S., & Johal, A. (2010). Self-ligating brackets in orthodontics. A systematic review. The Angle Orthodontist, 80(3), 575-584. [PMID: 20050755] | [DOI: 10.2319/081009-454.1]
- Sundararaj, D., Venkatachalapathy, S., Tandon, A., & Pereira, A. (2015). Critical evaluation of incidence and prevalence of white spot lesions during fixed orthodontic appliance treatment: A meta-analysis. Journal of International Society of Preventive & Community Dentistry, 5(6), 433-439. [PMID: 26759794] | [DOI: 10.4103/2231-0762.167719]
- Benson, P. E., Parkin, N., Dyer, F., Millett, D. T., & Germain, P. (2019). Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment. Cochrane Database of Systematic Reviews, 2019(11), CD003809. [PMID: 31742669] | [DOI: 10.1002/14651858.CD003809.pub4]
- Martin, C., Littlewood, S. J., Millett, D. T., Doubleday, B., Bearn, D., Worthington, H. V., & Limones, A. (2023). Retention procedures for stabilising tooth position after treatment with orthodontic braces. Cochrane Database of Systematic Reviews, 5(5), CD002283. [PMID: 37219527] | [DOI: 10.1002/14651858.CD002283.pub5]