Let’s start at the end of treatment first. If you choose to go to an orthodontist (a specialist who does orthodontics and nothing else), chances are that he will propose a treatment plan that provides you with the best bite and smile possible before the braces come off. Although this may seem obvious, there is a popular trend among non-specialists (general dentists who do some braces along with everything else) to merely line up the front teeth and purposefully not finish the job. They call this “short-term orthodontics,” “Cosmetic orthodontics” “Six months smile” “Fast braces” and market it to the public as an alternative to treatment by real orthodontists. Their promise of “faster treatment for less money” is eye-catching but deliberately misleading since they begin treatment without any intention of finishing (correcting the bite both in the front and the back, moving the roots, but by removing lots of enamel for example). There is no disclosure in their ads that they’re going to just do part of the treatment and then remove the braces. For the purpose of this article, let’s assume that we’re all talking about treatment provided by a real orthodontist that is going to finish your treatment correctly.
The easiest, and therefore shortest, orthodontic cases are those in which all of the permanent teeth are erupted, the bite is normal (jaw size not an issue), and the crowding and alignment problems do not require the removal of permanent teeth. Generally speaking, these cases can be completed in less than a year by an orthodontic specialist.
If you have more crowding (that requires the use of a palatal expander for example), a posterior crossbite, mild to moderate bite issues, but don’t need to have any permanent teeth removed, your treatment will probably take between 12 and 18 months. These are routine cases for a specialist and represent the majority of the patients I see in my office. Some surgery cases that start off with straight teeth but a bad bite can also be finished within 18 months.
When you have moderate to severe crowding, a bite problem that is more than half a tooth off, or any condition that requires the removal of permanent teeth, you should plan on 18 to 24 months of treatment. The reason this takes so much longer is that every tooth in your mouth must be shifted to close the extraction spaces or to compensate for the problems with your jaw-size discrepancy. Most orthodontists consider these moderately severe orthodontic problems.
There are additional variables that complicate treatment and can make treatment time longer and more difficult to estimate. These include impacted or missing teeth and severe jaw-size discrepancies that require supplemental anchorage or jaw surgery. Depending upon how each individual patient’s biology responds to the treatment, these are severe cases and may require 30 months or more to finish. Most adult extraction cases fall into this category.
Everyone is different, but these estimates give you a general idea of what you can expect going in to your treatment. Don’t be fooled by promises of faster treatment by an orthodontist who uses “special brackets” or markets an “advanced technique.” When these claims have been put to the test in controlled studies, they have been shown to be mostly hype. We all play by the same biological rules and no bracket manufacturer has an inside track with Mother Nature to get the job done any quicker. Even the newest technologies claiming to shorten treatment time (tooth vibrators, bone perforators, pulsating light energy, etc.) have been shown to reduce it by only a very small percentage at huge additional cost.
My dad always taught me that if something sounds too good to be true, it probably is. If there really was a faster way to move teeth, wouldn’t orthodontists, who are the experts in moving teeth, know about and use it? There are no shortcuts to excellent orthodontic results. If you follow your orthodontist’s instructions to the letter, take care of your braces, and don’t miss any of your appointments, your braces will be off before you know it… and the job will be done right!