When patients and parents first come to meet with me for an exam and consultation, I know there are three main questions they want to have answered (1) What (if any) treatment is required?, (2) How long will it take?, and (3) How much will it cost?
Questions #1 and #3 vary from patient to patient and practice to practice, so it is impossible to try to answer those for the general public. However, question #2 can be answered in a general way by providing some education about orthodontic treatment.
The length of orthodontic treatment hinges on two main factors (1) the severity of the orthodontic problems, and (2) the compliance of the patient (wearing elastics/appliances as prescribed by the orthodontist, achieving excellent oral hygiene, keeping regular appointments as prescribed by the orthodontist, avoiding breakage of braces or appliances, etc.). Of course, additional individual factors contribute, such as certain medical conditions, density/thickness of the bone around the teeth, and other individual variations that can affect the rate of tooth movement. However, the two main issues listed above usually contribute the most.
Comprehensive orthodontic treatment generally consists of three stages (and typically in the same order). This is not an arbitrary thing an academic made up to satisfy an urge for organization—no, these stages are a reality because, of necessity, there are certain orthodontic problems that must be corrected before others can. In other words, some orthodontic problems prevent others from being corrected—some steps literally can’t be skipped. For example, if a patient’s main concern is spacing between the upper front teeth, it is literally impossible to close the spaces when there is also excessive overbite (aka “deep bite”). Whenever the patient bites, the lower front teeth hit the tongue surface of the upper front teeth near the margins of the palatal gum tissues; throughout the day, the bite relationship consistently applies pressure that keeps the upper front teeth forward, and hence, spaced apart. Upper and lower braces need to be placed first to level the arches to correct the deep bite (so the lower front teeth are not hitting the tongue-side of the upper front teeth anymore), and only after this interference has been eliminated can the upper front teeth be brought back and together to close the spaces.
However, before we get into the three stages, let’s briefly discuss malocclusion. Hang in there with me for this; by understanding a few key concepts, things will start to make sense and you will understand how an orthodontist estimates the time it will take to complete treatment.
Malocclusion refers to an improper bite relationship; mal = Latin for “bad;” dental occlusion = “bite.” Therefore, malocclusion = “bad bite.” When the malocclusion is primarily due to disproportionate upper and lower jaws (i.e., one jaw is too small or large relative to the other), it requires, on average, 6-12 months to correct or camouflage the faulty jaw positions. Keep that in mind.
Now, without further ado, the three stages of comprehensive orthodontic treatment:
(1) Alignment and leveling (typically takes about 6 months)
During this initial stage, light, flexible wires (made from space-age materials) are used to straighten crowded and crooked teeth. Special arch wires and appliances are used to resolve deep overbites by leveling the arches. When indicated, expanders are used to eliminate problems related to arch width.
(2) Bite correction and space closure (typically about 6-12 months, depending on the magnitude of bite correction required, or in other words, the magnitude of the jaw disproportionality)
In the second stage, stiffer, stronger wires are placed which can accommodate the forces required for bite corrections and space closure. To achieve bite correction, elastics may be prescribed (compliance is essential for these to work!) or an appliance may be incorporated.
(3) Artistic finishing (typically about 6 months)
During the final stage, detailed adjustments are made to the wires for optimal tooth positioning and smile esthetics, worn-down or uneven teeth are recontoured, and esthetic bonding of small/misshapen teeth can be coordinated. Here, the doctor puts the finishing touches on your smile to make it stunning! Once complete, the braces or other appliances are removed.
Ok, so let’s do some math. If your malocclusion is due to disproportionate jaws, you will need to proceed through all 3 stages to finish orthodontic treatment: (1) alignment and leveling = about 6 months + (2) bite correction and space closure = about 6-12 months + (3) artistic finishing = about 6 months. That adds up to 18-24 months. If the jaws are mildly-moderately disproportionate, you are looking at about 18 months, give or take. If the jaws are moderately-severely disproportionate, you are looking at about 24 months. So, what if your malocclusion is not related to disproportionate jaws, or in other words, what if your jaws are balanced and proportionate? Well, you can skip the second stage (bite correction and space closure), which normally takes 6-12 months. So, we are left with only the first and third stages: (1) alignment and leveling = about 6 months + (3) artistic finishing = about 6 months. That adds up to about 12 months.
Obviously, as discussed earlier, a patient’s cooperation is one of the two key components to finishing orthodontic treatment successfully. Cooperation is necessary in all three stages, but can play the biggest role in stage 2 for those with disproportionate jaws—bite correction and space closure. If you aren’t wearing elastics as prescribed, this second stage—which normally takes 6-12 months—will drag on! You are largely in control of your orthodontic destiny in this regard; as the poet Henley wrote, “I am the master of my fate, I am the captain of my soul.”
The Bottom Line
Comprehensive orthodontic treatment (treatment of upper and lower arches in adolescents or adults) generally takes 12-24 months, and the orthodontist estimates the total treatment time in a rational way that is generally accurate within a few months. Feels good to know this isn’t a completely arbitrary number, and that you as the patient, have a great deal of control in finishing treatment on time, doesn’t it?