Results of Treatment
Orthodontic treatment usually proceeds as planned,
and we intend to do everything possible to achieve
the best results for every patient. However, we cannot
guarantee that you will be completely satisfied with your
results, nor can all complications or consequences be
anticipated. The success of treatment depends on your
cooperation in keeping appointments, maintaining good
oral hygiene, avoiding loose or broken appliances, and
following the orthodontist’s instructions carefully.
Length of Treatment
The length of treatment depends on a number of issues,
including the severity of the problem, the patient’s
growth and the level of patient cooperation. The actual
treatment time is usually close to the estimated
treatment time, but treatment may be lengthened if,
for example, unanticipated growth occurs, if there are
habits affecting the dentofacial structures, if periodontal
or other dental problems occur, or if patient cooperation
is not adequate. Therefore, changes in the original treatment
plan may become necessary. If treatment time is
extended beyond the original estimate, additional fees
may be assessed.
The mouth is very sensitive so you can expect an
adjustment period and some discomfort due to the
introduction of orthodontic appliances. Non-prescription
pain medication can be used during this adjustment
Completed orthodontic treatment does not guarantee
perfectly straight teeth for the rest of your life. Retainers
will be required to keep your teeth in their new positions
as a result of your orthodontic treatment. You must wear
your retainers as instructed or teeth may shift, in addition
to other adverse effects. Regular retainer wear is
often necessary for several years following orthodontic
treatment. However, changes after that time can occur
due to natural causes, including habits such as tongue
thrusting, mouth breathing, and growth and maturation
that continue throughout life. Later in life, most people
will see their teeth shift. Minor irregularities, particularly
in the lower front teeth, may have to be accepted. Some
changes may require additional orthodontic treatment
or, in some cases, surgery. Some situations may require
non-removable retainers or other dental appliances
made by your family dentist.
Some cases will require the removal of deciduous (baby)
teeth or permanent teeth. There are additional risks
associated with the removal of teeth which you should
discuss with your family dentist or oral surgeon prior to
Some patients have significant skeletal disharmonies
which require orthodontic treatment in conjunction with
orthognathic (dentofacial) surgery. There are additional
risks associated with this surgery which you should
discuss with your oral and/or maxillofacial surgeon prior
to beginning orthodontic treatment. Please be aware
that orthodontic treatment prior to orthognathic surgery
often only aligns the teeth within the individual dental
arches. Therefore, patients discontinuing orthodontic
treatment without completing the planned surgical
procedures may have a malocclusion that is worse than
when they began treatment!
Decalcification and Dental Caries
Excellent oral hygiene is essential during orthodontic
treatment as are regular visits to your family dentist.
Inadequate or improper hygiene could result in
cavities, discolored teeth, periodontal disease and/
or decalcification. These same problems can occur
without orthodontic treatment, but the risk is greater to
an individual wearing braces or other appliances. These
problems may be aggravated if the patient has not had
the benefit of fluoridated water or its substitute, or if the
patient consumes sweetened beverages or foods.
The roots of some patients’ teeth become shorter (resorption)
during orthodontic treatment. It is not known
exactly what causes root resorption, nor is it possible to
predict which patients will experience it. However, many
patients have retained teeth throughout life with severely
shortened roots. If resorption is detected during orthodontic
treatment, your orthodontist may recommend
a pause in treatment or the removal of the appliances
prior to the completion of orthodontic treatment.
A tooth that has been traumatized by an accident or
deep decay may have experienced damage to the nerve
of the tooth. Also, the nerve of a tooth may die for no
apparent reason, and this is known as “spontaneous
pulpal necrosis.” Orthodontic tooth movement may, in
some cases, aggravate these conditions and cause root
canal treatment to be necessary. In severe cases, the
tooth or teeth, may be lost.
Periodontal (gum and bone) disease can develop or
worsen during orthodontic treatment due to many
factors, but most often due to the lack of adequate
oral hygiene. You must have your general dentist, or
if indicated, a periodontist monitor your periodontal
health during orthodontic treatment every three to six
months. If periodontal problems cannot be controlled,
orthodontic treatment may have to be discontinued prior
Injury From Orthodontic Appliances
Activities or foods which could damage, loosen or
dislodge orthodontic appliances need to be avoided.
Loosened or damaged orthodontic appliances can be
inhaled or swallowed or could cause other damage to
the patient. You should inform your orthodontist of any
unusual symptoms or of any loose or broken appliances
as soon as they are noticed. Damage to the enamel of a
tooth or to a restoration (crown, bonding, veneer, etc.)
is possible when ortho¬dontic appliances are removed.
This problem may be more likely when esthetic (clear or
tooth colored) appliances have been selected. If damage
to a tooth or restoration occurs, restoration of the
involved tooth/teeth by your dentist may be necessary.
Orthodontic headgear can cause injury to the patient.
Injuries can include damage to the face or eyes. In the
event of injury or especially an eye injury, however minor,
immediate medical help should be sought. Refrain from
wearing headgear in situations where there may be a
chance that it could be dislodged or pulled off. Sports
activities and games should be avoided when wearing
Problems may occur in the jaw joints, i.e., temporomandibular
joints (TMJ), causing pain, headaches or ear
problems. Many factors can affect the health of the jaw
joints, including past trauma (blows to the head or face),
arthritis, hereditary tendency to jaw joint problems,
excessive tooth grinding or clenching, poorly balanced
bite, and many medical conditions. Jaw joint problems
may occur with or without orthodontic treatment. Any
jaw joint symptoms, including pain, jaw popping or difficulty
opening or closing, should be promptly reported to
the orthodontist. Treatment by other medical or dental
specialists may be necessary.
Impacted, Ankylosed, Unerupted Teeth
Teeth may become impacted (trapped below the bone or
gums), ankylosed (fused to the bone) or just fail to erupt.
Oftentimes, these conditions occur for no apparent
reason and generally cannot be anticipated. Treatment
of these conditions depends on the particular circumstance
and the overall importance of the involved tooth,
and may require extraction, surgical exposure, surgical
transplantation or prosthetic replacement.
You can expect minimal imperfections in the way your
teeth meet following the end of treatment. An occlusal
equilibration procedure may be necessary, which is a
grinding method used to fine-tune the occlusion. It may
also be necessary to remove a small amount of enamel
in between the teeth, thereby “flattening” surfaces in
order to reduce the possibility of a relapse.
Due to the wide variation in the size and shape of the
teeth, missing teeth, etc., achievement of an ideal result
(for example, complete closure of a space) may not be
possible. Restorative dental treatment, such as esthetic
bonding, crowns or bridges or periodontal therapy, may
be indicated. You are encouraged to ask your orthodontist
and family dentist about adjunctive care.
As third molars (wisdom teeth) develop, your teeth may
change alignment. Your dentist and/or orthodontist
should monitor them in order to determine when and if
the third molars need to be removed.
Occasionally, patients can be allergic to some of the
component materials of their orthodontic appliances.
This may require a change in treatment plan or discontinuance
of treatment prior to completion. Although very
uncommon, medical management of dental material
allergies may be necessary.