Braces, Dr. Derek Brown, Winning Smiles Orthodontics, Bowie and Hyattsville, MDIf there is one question that every Orthodontist hears on a daily basis, it is “Are my braces ready to come off?” In general, most patients in my office fall into one of two categories of treatment – Phase I Orthodontic Treatment or Comprehensive Orthodontic Treatment (including Invisalign). For the most part the length of treatment is generally consistent with the category of treatment that the patient falls into.

Phase I Orthodontic Treatment

Phase I Orthodontic Treatment, also called Preventive Orthodontic Treatment is usually recommended when a younger child in the mixed dentition (combination of baby and adult teeth in the mouth), presents to our office with an abnormal bite (crossbite, underbite, asymmetric smile, severe overbite, severe protrusion), abnormal spacing issues (either too much spacing or too little spacing), or a smile that is awkward enough to effect a child’s self-esteem. Typically, because Phase I treatment is most commonly started when a child only has half of their permanent teeth in place at the time that they go into braces, the treatment times are usually shorter. In most cases Phase I Orthodontic treatment is completed in 12-15 months. Following Phase I Treatment, our patients are usually placed in some version of a permanent retainer so that we can maintain the results that we achieved in the 1st phase while we are waiting for the rest of the permanent teeth to erupt. After all the permanent teeth erupt, the patient is re-evaluated to determine whether or not they need to go into braces again (Phase II or Finishing Phase Orthodontic Treatment). Typically if the patient requires a Phase II of braces, the braces are then applied to ALL of the teeth in the mouth because all teeth are now permanent. Due to the fact that this patient had prior orthodontic treatment, the 2nd phase usually only requires an additional 12-15 months of treatment to achieve a completed Winning Smiles result.

Comprehensive Orthodontic Treatment

Comprehensive Orthodontic Treatment is treatment that is performed on any child or adult who has all of their permanent teeth at the time that the braces are placed on the teeth. In most cases Comprehensive Orthodontic Treatment lasts anywhere between 18-30 months, with the average case being right around 24 months of total treatment. It is very important to note that we must see our patients on a regular basis, typically 6-8 week intervals, in order to keep them on track with their estimated finishing time. In comprehensive orthodontic treatment, there are different stages that we are putting the teeth through before we make the decision to remove the braces. Although the order of these four stages may sometimes change, each stage MUST be completed in order for us to feel confident that the braces are ready to be removed. The stages are;

1) Creating appropriate space between teeth so that they can move freely and easily;
2) Getting the teeth even (leveled) and aligned (removing all rotations of the teeth);
3) Correcting the bite (or making the upper teeth fit the lower ones. This must be accomplished in all three planes or dimensions of space, front to back (overbite / underbite correction), side to side (crossbite correction), and up and down (open bite or deep bite correction). We use orthodontic wires, rubber bands, springs, or even surgery in extreme cases in order to or make the upper teeth fit the lower teeth.
4) Stabilizing the tooth positions in their new positions from the crown of the tooth to the root of the tooth.

It is usually during Stage 4 that patients begin to ask if their braces are ready to be removed, because the teeth are now even, straight, aligned, all spaces have been removed, all crowding is gone and the bite looks solid everywhere. In our office, we like to be in Stage 4 for at least 6 months before we remove braces. After completing this stage successfully, we are confident that once the braces are removed, the teeth will be in a sound enough position that the retainer should have no problem retaining the teeth in their newly corrected orthodontic positions.

Be sure to use the following checklist to judge for yourself if you are getting close to hearing your Orthodontist say that you are finally ready to get those braces removed;

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

Even though we have not talked specifically about Invisalign, the four stages of treatment and finishing checklist is exactly the same as with Comprehensive Orthodontic Treatment.

So, if you the answer to each checklist question is yes, then rest assured you are about to get some of the best news of your life when we tell you – “Congratulations!!! Yes – Your braces are coming off at your next appointment!!!”

Dr. Brown

Winning Smiles Orthodontics

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