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How Do Braces Work

The facts about working of the braces have always been on the minds of the persons, thinking about undergoing correction of the deformities of their teeth by the use of the orthodontics branch of dentistry. Let me tell you that even though our teeth are one among the strongest things in the world, force applied over a planned duration of time can move them easily. The orthodontic braces work by applying particular value of force which is sufficient to apply the force on the teeth to align them properly in shape and to correct the deformities which act as a hindrance to a beautiful smile. The arch wires placed in the slots of the brackets a part of braces which are bonded securely to the teeth with the use fluoride releasing glue in place of the earlier used wire bands. The fluoride glue is very useful in reducing the amount of caries. The arch wires adapted on to the braces help in the application of forces, which lead to mainly five kind of tooth movement.

How do braces work

1.   First being rotation which is one of the toughest types of tooth movement when force is applied on the mid-point of the root of the tooth.

2.   Translation which is also called as the bodily movement of the tooth.

3.   A combination of bodily and the spinning or rotational movement of the tooth is one of the most simple and common movements of the teeth.

4.   Intrusion or the movement of the teeth towards the bone is a part of orthodontics.

5.   Extrusion known to be the simplest movement of the teeth is movement of the teeth out of the bone.

Braces which are used in the field of orthodontics consist of the following parts

Brackets which are made up of metal or ceramic and they are attached to each tooth.

A glue (especially fluoride containing glue) or metal band is involved which helps in the attachment of the bracket to the tooth.

An arch wire which is the main component of application of the force on the teeth is places in the bracket.

One of the latest advances today is the nickel titanium wires activated by heat which react to body’s natural temperature. The temperature of the body causes the causes the wires to produce a gentle but constant force. These new advances reduce the frequencies of adjustments and orthodontist visits. The nickel titanium wires activated by heat are more efficient than the stainless steel wires and are quite popular among the young orthodontic patients and also the pain associated with them is less as compared to stainless steel wires. Arch wires have a very efficient property of elasticity and then there are nickel titanium wires with the property of shape memory that is they tend to get back to the same shape as they were before bending also so they want to retain their normal straight shape. The wires commonly used these days are the twist wires having resemblance to a small cable. The wants to remain straight even after it is put into your mouth to keep the braces in place in your mouth. The mouth temperature is 20-25 degrees more than the room temperature, this enhances the tendency of the wire to be stiff and in the process provides the forces necessary for bringing about the biomechanical process of bone remodeling and make the orthodontic tooth movement possible.

Ligature wires or elastic rings (o-rings) are used for binding the arch wire with the bracket firmly. The ligatures are adjusted and if needed are changed at each follow up visit. But recently used self binding brackets don’t need  adjustments.

How do Braces Work

The movement of the teeth is caused by the pressure applied on the brackets and the teeth. Springs and rubber bands are also used to exert force in required amount and direction in some cases. Braces are the components exerting constant force over a period of time leading to the movement of the teeth in the required particular directions. The use of extra oral appliances like the head gear may also be needed in some cases especially the adults to complete the treatment in said form and time.

The teeth are surrounded by the gum tissue all around and the periodontal membrane is present around the root portion of the teeth and alveolar bone surrounds the root portion of the teeth and periodontal membrane joins the cementum of the tooth with the alveolar bone.

The pressure applied by the braces on the teeth causes the stretch of periodontal membrane on one side and compression on the other side of the periodontal membrane. The process scientifically called as bone remodeling leads to growth of bone in the new position. 

Movement of the Teeth via the Process of Bone Remodeling

Bone is a tissue made up of cells called as the osteoblasts or the bone forming cells and the osteoclasts or the bone eating cells, both of which are involved in the process of bone remodeling i.e. a biomechanical process which makes bone stronger by bone deposition in stress bearing areas and bone is made weaker in areas of no load by bone resorption. The osteoclasts or the bone dissolving cells are responsible for bone resorption and osteoblasts or the bone forming cells are responsible for the bone deposition process and both combined together lead to bone re-modeling. The bone density is increased by this process.

The teeth are placed in the bone and are the roots are connected to the bone is periodontal membrane and the force applied by the arch wires pushes the tooth in the desired direction and creates stress in this periodontal membrane. The stress produced in this ligament leads to compromised blood supply in it and the biological response leads to bone remodeling which causes bone resorption by osteoclasts on one side and bone deposition by osteoblasts on the other side. The bone resorption is possible in two different ways known as the direct resorption from the cells lining the alveolar bone and indirect resorption or the retrograde resorption from the activity of osteoclasts in the surrounding bone marrow. The retrograde resorption takes place in case of excessive stress for a longer time which causes diminished blood supply of the periodontal ligament and necrosis after that. This necrosis or hyalinization leads to resorption of a larger area then deposition which is also referred as negative balance by the orthodontists occur whenever there is the application of the force to produce indirect resorption. The acellular periodontal ligament undergoes retrograde resorption under the effect of the desired stress on the enamel of the teeth for the desired amount of the teeth. Deposition of bone is also very important as without it tooth movement is not possible. If bone deposition does not occurs on the side opposite to that of tooth movement there would occur gaps on that side and teeth will become loose. These gaps make the tooth movement difficult and hamper proper treatment. A patient should understand the concept of the bone deposition and bone resorption. All these movements occur due to the compression and biological changes in the periodontal ligament all due to the forces applied.

The periodontal ligament acts as a joining b/w teeth and surrounding alveolar bone. Pressure created b/w the periodontal ligament and the alveolar bone leads to the production of osteoclasts and one lysis occurs and normal gap is created b/w the teeth and the alveolar bone. The tension created in the ligament on the distal side of the teeth causes the osteoblasts to make new bone in the direction opposite to that of the tooth movement and re- establish the normal gap b/w the teeth and the bone. The force required is only a part of the maximum. Then there are the brackets and the arch wire are the creators of the artificial force which sustains the pressure. The process of force transmission is complete with the placement of the arch wires in the braces placed on the teeth. This transmission leads to the transfer of force from the braces to the teeth and cause bone remodeling to take place and move the teeth in new functionally and aesthetically desired orthodontic positions. 

The process of bone resorption caused by the osteoblasts takes about 72 days to get completely going and bone deposition process by the osteoblasts takes about 90 days to start the action in full swing. The stabilization of the result achieved takes about 10 months which makes it necessary to wear the retainer to avoid relapse to the old uncorrected or some in b/w undesirable position after the completion of treatment.

The movement seen in the tooth is about a millimeter in a month which is accounted by the orthodontists but it can vary from individual to individual, depending upon the type of treatment, the type of movement and correction needed and also the type of appliance and technique used. An understanding is required.

Now after this knowledge on the working of braces one can easily go ahead with procedure of wearing braces to have a wonderful smile.

 

 User Comments on -  How Do Braces Work


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Posted By : Al on 20-Nov-2013 04:22 PM
My wife has upper braces for 6 months and she keeps getting wires out the back tube poking her cheeks when she eats. Three times she has had to go in for a change to the arch wire or to somehow trim that wire near to flush to the end of the tubular bracket. Is this poor workmanship or should it be expected? The current problem was installed on Wednesday, trimmed on Friday and again ground down Monday. Moving teeth are not causing this! The tech suggests she is being fussy and she should expect moving teeth and some discomfort. Many thanks, Dr.
 


Posted By : Dr. Rtiz on 18-Apr-2013 10:09 AM
The treatment for the space closure depends upon the amount of space present but if your orthodontist says that the space can be closed by the orthodontic treatment then that is the best way to get the space closed as compared to the artificial tooth.
 


Posted By : mishi on 16-Apr-2013 02:40 PM
sir i need ur email id plz ,want to knw about orthodontist treatment and artificial tooth cuz there is one tooth missed geneticaly.dentist suggest me to do orthodontist treatment instead of putting artifical tooth treatment.kindly guide me which treatment is gud for space removal.thnk u
 


Posted By : Dr.Ritz on 17-Oct-2012 02:50 AM

Hi TERESA,Braces cost anywhere up to around $5000 for both the upper and lower teeth and entails two years of treatment.This will vary slightly depending on the specific service that you might require.There are private orthodontists who charge on a higher scale when compared to the dental schools.In dental schools,treatment is done by budding dentists under the watchful eye of their professor.Normally the braces treatment takes around 18 to 24 months.However many factors affect the treatment time like age,overbite percentage and frequency of breakage of wires / brackets during treatment.It is better to get the braces treatment done at early stage as with advancing age,the duration of the treatment time increases and chances of relapse are also more.Hope this helps.Keep us updated.

 


Posted By : Teresa on 16-Oct-2012 08:06 PM
I'd like to get braces and want to know how much it will be and also how long I will have them. my four top front teeth are badly space from one another. my teeth next to the left and right of the two front teeth are smaller than the other teeth (almost the size of a baby tooth).
 


Posted By : Dr.Ritz on 17-Jul-2012 01:19 AM
Pankaj the duration of treatment depends on ur condition as to how severe it is but on an average if u get braces it will take around 2 years.The cost of treatment also varies from place to place and person to person depending on the condition.However it can cost u anything b/w $2500 to $5500.You can go to ur nearest orthodontist for check up and ask about costs.
 


Posted By : Pankaj on 16-Jul-2012 08:17 PM
hlo...sir gud mrng...m 17 years old..above part of my teeth slightly outward..plz tell me that how much time will take the braces to make it correct...and how much it cost plz tell me.
 


Posted By : Dr.Ritz on 26-Jun-2012 09:35 PM
Dear NIRAJ, Your dentist might have come to the conclusion after careful evaluation only. Also as per your case only one thing can be done. Either causes upper teeth to move inside or lower teeth to move outside. Though i don't have any live picture of your profile but i suppose that putting braces on upper teeth would be better and will definitely improve your profile.
 


Posted By : niraj on 26-Jun-2012 06:10 AM
hello doctor, i am getting braces for my teeth,as my upper teeth are protruding. my dentist says, that i wont have to put lower braces as my lower teeth are inside.. is it ok to put only upper braces. will i get a good smile.
 


Posted By : Tanya on 25-May-2012 07:17 AM
thank u so much Dr Ritz i am very grateful to u.i can send u my pic and all the x rays which i have on computer .kindly write ur email address to that i cud provide u.by birth i had the problem of class 3 under bite and at the age of 31 i got i operated but after surgery i am facing this asymmetry problem.i have the plates on both sides.may be surgery was not done properly thats y i am facing this problem.plz help me out by sending ur email and guide me that after a major surgery can a surgery b planned with out any complication.wud there b any problem if i get it done again.
 


Posted By : Dr.Ritz on 24-May-2012 10:01 PM
without having a manual examination we can't make out the treatment that you require. So, i would suggest you visit an orthodontist and get your case checked. Also you should consult an oral surgeon if in case any surgery is required.
 


Posted By : david on 24-May-2012 01:26 AM
I ha an accident when i was 7 that distorted my lower jaw and now it's affecting the whole system my lower tooth is out of shape and i can't open my mouth properly and i can see it shifting i am now 17 how can i get treatment. please i need your answers
 


Posted By : Dr.Ritz on 22-May-2012 12:32 AM
SURESH KUMAR, the effectiveness and cost of braces depends upon for what treatment you want them. The cost depends from braces to braces. I would recommend you to first tell us your deformity that for what you want then it would be lot easier to tell the cost and success rate at your age.
 


Posted By : Dr.Ritz on 22-May-2012 12:24 AM
TANYA, though i would be requiring your facial pics but without surgery it is near impossible to deviate your chin. You would be requiring an orthognathic surgery. This surgery manipulates with the elements of the facial skeleton to restore the proper anatomic relationship. But before planning this surgery, your doctor has to make careful evaluation of the soft tissue, skeletal evaluation and dental evaluation.
 


Posted By : Tanya on 21-May-2012 10:16 AM
hello Dr Ritz i have a facial asymmetry problem.my age is 32.can it be corrected with out surgery.my chin is not in middle but slightly on right side.the other question is can the chin bone be moved through braces at the age of 32 plz give the ans .i am very disturb.
 


Posted By : Suresh Kumar on 21-May-2012 04:58 AM
How much is the cost of bracing these days and how effective it will be at the age of 25?
 


Posted By : Dr. Ritz on 23-Apr-2012 10:09 AM
Ankit, it is difficult to give the treatment plan with out seeing the case. It is not that palatal expanders do not work in adults. but yes as the age increases the treatment duration increases and the retention period also increases. The orthodontist do the analysis and then they decide about the space deficiency. According to the space deficiency the treatment is done.
 


Posted By : Ankit on 23-Apr-2012 04:32 AM
thnx Dr Ritz fr ur reply...actually i hav visited two orthodontists n both of them r different in dre opinion...As u knw my case,one is saying dat he'll do wid teeth extraction n the other is saying palatal expanders will b used to create space. I am 21 yrs old, n hav heard dat palatal expanders doesnt work in adults...i dont want nything to b experimentd wid my teeth...cn u plz tel me whr to go and wich is a safer option..
 


Posted By : Dr. Ritz on 18-Apr-2012 11:04 AM
Ankit, if your arches are v shaped then that means they have to be expanded by giving palatal expanders. When the arch becomes u shaped which is the ideal shape of the arch then the teeth can be aligned using the space created.
 


Posted By : Ankit on 18-Apr-2012 05:10 AM
i hav an over crowded teeth....so i thought dat sme of my teeth wil hav to be removed in order to get it rite...bt wen i visited an orthodontic last week...he said dat my teeth r alinged in V-shape on jaw( or jaw is in V shape )...dey wil put smethin wich wil help my jaw to become in U shape so dat space can be created n dere is no need for extraction.....is he rite??
 


Posted By : Dr Ritz on 31-Dec-2011 02:39 AM
Rakesh, In case of crowding of dental arch, tooth extraction is done to gain space for braces treatment. Wisdom teeth and or premolars are removed for braces treatment. Tooth extraction is done to gain space. In children, space can be regained with palate expansion or other methods, but in adults, to relieve severe crowding, tooth extraction is required. Space which is created by missing teeth will close in 4months to 1 year after treatment.
 


Posted By : Rakesh Kumar on 29-Dec-2011 01:24 PM
I am going through tooth alignment treatment with metallic braces. My dentist had removed my 4 teeth (Pre Molar Teeth). Two from upper jaw & 2 from lower jaw. I am scared of it. Am i going in right direction?? According to dentist first we need to make the space thats why we had removed your tooth . They are going to put force on teeth then all front teeth will move to backside & will make the proper alignment. Please suggest. I look forward for your suggestions.
 


Posted By : Shardae on 05-Nov-2011 11:34 PM
Brace Work, Although It Takes A Year Or Two, Its Worh It In The End Result.
 


Posted By : Dr Ritz on 29-Oct-2011 02:29 AM
Shailini, At the age of 40 years, you can get braces treatment done. you can opt for ceramic dental braces to correct the alignment of teeth. ceramic dental braces are not visible from distance and will make teeth straight. You can also opt for cosmetic procedures like dental lumineers, veneers or dental crowns to correct the misalignment of teeth, if misalignment is small.
 


Posted By : Shalini on 29-Oct-2011 02:14 AM
After 40's can we put bracelet to correct the order of teeth
 

 
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