The most common question I get as an orthodontist is “When do I get my braces off?” Although treatment is different for every patient, there are some basic objectives and steps of treatment that are similar for the majority of patients. If you have braces and want to know how you are progressing, read on…

3 Phases of treatment In my office there are three distinct phases of treatment through which every patient must pass. Although their order may be switched or there may be some overlap between them, the three phases include resolving the crowding/spacing, aligning the teeth, and correcting the bite.

Resolve crowding
In the first phase, crowding is corrected by expanding the arches or by removing teeth. Teeth cannot be aligned if there is not enough room. The decision to expand or extract is determined by a number of variables including the size of the teeth and jaws, the amount of bone and gum tissue supporting the roots, and the profile. The first step is to create room so that the teeth can be aligned. If a patient has extra space at the start of treatment, that space must be closed during this step.

Align the arches
Once there is room, the second step is to align or straighten the teeth. Aligning the arches is accomplished using wires, elastic chains, springs, and other auxiliaries (“gadgets”) that rotate, tip, and torque the teeth into their desired positions. Another common step in the alignment process is “repositioning” individual brackets. Sometimes brackets cannot be put in the right place on the first day because of the bite, the alignment, or the shape of the teeth. After the teeth have been partially aligned however, the brackets can then be moved to better positions.

Correct the bite
The third phase of treatment is correcting the bite or making the upper teeth fit the lower ones. This must be accomplished in all three planes of space, front to back (overbite or underbite), side to side (crossbites), as well as top to bottom (open bite or deep bite). Making the upper match the lower is accomplished with wires, rubber bands, springs, or surgery. When the bite is right, the backs of the top teeth rest lightly on the fronts of the bottom ones. (There are also some specific functional relationships that must be “just so” at the end of treatment, but the specifics are beyond the scope of this article.)

Correcting the bite usually takes the longest
The “When do I get my braces off?” question usually arises during the third or “bite phase” of treatment. By that time the crowded, crooked teeth are gone and the patient is generally happy with how things look. Admittedly, the first half of treatment is more exciting than the last half. It is during the final phase however where the bite is corrected so that the results will be healthy and stable.

Am I almost finished checklist
If you are wondering if you’re getting close to getting your braces off, compare what you see in your mouth with this list:

1. Are the teeth straight?
2. Are the spaces between the teeth closed completely?
3. Do the upper front teeth overlap the lower front teeth appropriately (not too deep, but no visible space between them)?
4. Are the outer cusps of the upper teeth resting on the outside of the corresponding ones in the lower?
5. Is the overbite or underbite corrected?

If it is obvious that your teeth are still crooked, have spaces between them, or you still have a deep bite or overbite, you probably still have some time remaining. If your treatment time is longer that was originally estimated, check out another article I wrote about called "Three Reasons Your Orthodontic Braces Are Still On." If you have specific questions about your smile, ask your orthodontist to explain what objectives remain in your treatment. If he or she is conscientious, your braces will come off when the best result is achieved and not before. Good luck!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.