how orthodontic treatment works

Teeth are moved by placing gentle, controlled forces on them, as the orthodontist uses “appliances” such as braces or clear aligners to guide them to their ideal positions over a period of time. Tooth movement happens because of the breakdown and rebuilding of bone tissue.

At the end of “active” treatment (when teeth are being moved), most patients will wear retainers to give the new bone a chance to harden and support the new positions of the teeth.

It’s truly a complex biological process, and orthodontists master the multi-faceted intricacies of orthodontic treatment through years of study, including four years of dental school followed by two-to-three years of education in an accredited orthodontic residency program.

“Appliances” Used in Orthodontic Treatment

Orthodontists use a variety of “appliances” to move teeth and align jaws. Braces may be top-of-mind when you think about orthodontic treatment. But there are many more appliances that orthodontists use in treatment.

What kinds of appliances are there?

Here are examples of some of the orthodontic appliances used to move teeth and align jaws.


Braces are the most common appliance used is orthodontic treatment. Fortunately, they have come a long way.

Basically, braces have two parts: brackets and wires. Wires move the teeth; brackets serve as stationary handles to hold the wires. As needed for an individual’s treatment, other components can be added.

Contemporary braces can be:

  • Stainless steel
  • Gold-colored
  • Tooth-colored ceramic

Brackets are affixed directly to teeth. Wires are threaded through slots in the brackets.

Most braces go on the front of the teeth. Sometimes braces can be put on the backs of teeth – these are called “lingual” braces. These are virtually invisible. Not all orthodontists offer this form of treatment, and not all kinds of orthodontic problems can be successfully treated with lingual braces.

The wires on some braces are held in place by tiny rubber bands (“ligatures”), and come in a huge assortment of colors. Other braces are “self-ligating” – they do not require ligatures to hold the wires in place.

Clear aligners

People sometimes call clear aligners “invisible braces.” They are made of a transparent plastic-like material. They are made to fit the patient’s teeth at different stages of their treatment. Each set of aligners is worn for 1-3 weeks, at least 22 hours a day, before moving on to the next set. Each set is engineered to move the teeth incrementally, per the orthodontist’s treatment plan, until the desired alignment is reached. Tooth-colored attachments on the teeth will help aligners move teeth properly. Many, but not all, kinds of orthodontic problems can be successfully treated with clear aligners.

Palate expander

A palate expander is used when a youngster has a narrow upper jaw and there is not enough room for permanent teeth. The appliance works by widening the two halves of the upper jaw, called the “palate,” and increases the space available for permanent teeth. As the palate expands, new bone fills in between the two halves. For some patients, expansion may prevent the need to remove permanent teeth. Most patients will need braces later on, when they have most or all of their permanent teeth, to optimize their tooth and jaw alignment.


“Headgear” is the general name for a type of appliance that creates directional forces to move teeth and align jaws that braces alone cannot generate. Headgear contributes to the desired growth of the face and jaws.

Temporary Anchorage Devices (TADs)

Temporary anchorage devices, or TADs, are tiny implants used as a fixed point from which to apply force to move teeth predictably. They can be placed in many different sites in the mouth, depending upon the patient’s needs. TADs are removed when no longer needed.

Which treatment is fastest?

Thanks to advances in technology, just about every type of treatment is relatively fast. AAO orthodontists make use of the full range of orthodontic appliances – not just one or two – and will recommend the type they believe is best suited to your child and correcting his/her orthodontic problem. Orthodontists are uniquely positioned to make this recommendation based on their education and clinical experience.

To make treatment go as quickly as possible:

  • Follow your orthodontist’s instructions on brushing and flossing, and take your child to your dentist for a professional cleaning at least every six months during orthodontic treatment, or more often if recommended.
  • Watch what your child eats – avoid hard, sticky, and crunchy foods. Opt for foods that are soft and easy to chew.
  • Beware of sugary, acidic soft drinks including regular and diet soda pop, fruit juices, fruit drinks and sports drinks. Tap water is recommended.
  • Wear your elastics (rubber bands) as instructed.
  • Keep scheduled appointments with your orthodontist.

Which treatment is best?

The best treatment is the kind performed by an AAO orthodontist.

When you choose an AAO orthodontist, you can be assured that the doctor is an orthodontist – someone who first graduated from dental school and then went on for two-to-three more years of education at an accredited orthodontic residency program to become an expert in orthodontic treatment.

Removing Teeth

On occasion, it may be necessary to remove teeth to achieve a healthy bite.

Why remove baby teeth?

Sometimes baby teeth need to be removed because they are blocking the path of a permanent tooth. This can cause the permanent tooth to not come in at all, or to appear in the wrong place. Removing a stubborn baby tooth may be all that is needed to make way for the permanent tooth.

Why remove permanent teeth?

Sometimes insufficient space exists, or sufficient space cannot be created to accommodate permanent teeth. In order to allow teeth to work together to bite, chew and speak (“function”) properly, or so an individual to comfortably close his/her mouth, it can be necessary to remove permanent teeth to achieve a healthy bite.