Orthodontic treatment is a branch of dentistry focused on diagnosing and correcting misaligned teeth and jaws. It uses controlled force, applied through devices like braces or clear aligners, to gradually shift teeth into better positions. The goal is both functional and cosmetic: improving how your bite works, how easily you can clean your teeth, and how your smile looks. Most treatment with fixed appliances averages about 20 months, though complex cases can take 30 months or longer.
How Teeth Actually Move Through Bone
Teeth aren’t cemented rigidly into your jaw. Each tooth sits in a socket, cushioned by a thin layer of connective tissue called the periodontal ligament. When braces or aligners apply pressure to a tooth, they compress this ligament on one side and stretch it on the other. That compression triggers a controlled inflammatory response. On the compressed side, specialized cells break down tiny amounts of bone, creating space for the tooth to shift into. On the stretched side, other cells deposit new bone to fill the gap left behind.
This cycle of bone breakdown and rebuilding is why orthodontic treatment takes months rather than days. The bone needs time to remodel safely at each step. It’s also why you feel soreness after adjustments: the pressure is real, and your body is actively reshaping tissue in response.
What Orthodontics Corrects
The clinical term for a misaligned bite is “malocclusion,” and it comes in several forms. An ideal bite has upper and lower teeth fitting together with only 1 to 2 millimeters of overlap both vertically and horizontally, with little to no crowding. Most people fall short of that standard in at least one way.
- Crowding: Teeth overlap or twist because there isn’t enough room in the jaw. This is the most common reason people seek treatment, and it makes flossing and brushing between teeth difficult, raising the risk of cavities and gum disease.
- Overbite (deep bite): The upper front teeth overlap the lower front teeth too much vertically, sometimes covering them almost completely.
- Overjet (protrusion): The upper front teeth stick out horizontally well beyond the lower teeth, increasing vulnerability to injury.
- Underbite: The lower jaw sits forward of the upper jaw, so the bottom teeth protrude over the top teeth.
- Crossbite: Some upper teeth sit inside the lower teeth rather than outside them. This can affect one side or both and often involves a narrow upper jaw.
- Open bite: The front teeth don’t touch when the back teeth are closed, which can interfere with biting into food and with speech.
Left untreated, these issues go beyond appearance. Crowded teeth trap food and are harder to keep clean, leading to higher rates of decay and gum problems. A misaligned bite can also cause uneven tooth wear, jaw joint pain, difficulty chewing, and in some cases, speech difficulties.
Treatment Options
Traditional Braces
Metal or ceramic brackets are bonded to each tooth and connected by an archwire. The wire is periodically tightened or replaced to guide teeth through a planned sequence of movements. Braces remain the most versatile option. They allow precise adjustments within fractions of a millimeter, and because the wire can torque tooth roots (not just tip the visible crowns), they handle complex cases especially well. They’re also effective at expanding arches and fine-tuning how upper and lower teeth meet.
Clear Aligners
Clear aligner systems use a series of custom-made plastic trays, each slightly different, to move teeth in small increments. You swap to a new tray every one to two weeks. Their biggest advantages are aesthetics and convenience: the trays are nearly invisible and removable for eating and brushing.
A meta-analysis published in BMC Oral Health found that both aligners and braces effectively treat malocclusion, with no statistically significant difference in overall treatment quality scores. Aligners did show a shorter average treatment duration for non-extraction cases. However, braces outperformed aligners in controlling root position, achieving proper bite contact between upper and lower teeth, and expanding arch width. Aligners also showed more relapse in tooth alignment after treatment ended. For cases requiring tooth extraction, aligner treatment actually took 44% longer than braces. Because aligners are removable, treatment success depends heavily on wearing them the recommended 20 to 22 hours per day.
Palatal Expanders
For patients with a narrow upper jaw, an expander is sometimes used before braces. It gradually widens the upper arch, creating room to resolve crowding or crossbites. This works best in children and adolescents whose jaw bones are still developing.
When to Start
The American Association of Orthodontists recommends that children have their first orthodontic evaluation by age 7. At that age, enough permanent teeth have come in for an orthodontist to spot developing problems, even if treatment won’t begin for several more years. Early evaluation doesn’t always mean early treatment. Often, the recommendation is simply to monitor growth and intervene later if needed.
Some problems benefit from early intervention between ages 7 and 10, particularly crossbites and severe crowding. For most cases, though, comprehensive treatment starts between ages 11 and 14, once most permanent teeth have erupted. Adults can undergo orthodontic treatment at any age. The biological process of bone remodeling works the same way in adults, though treatment may take somewhat longer since adult bone is denser and no longer growing.
What the Process Looks Like
Treatment follows three stages. The first is planning: your orthodontist takes X-rays, photographs, and impressions of your teeth to map out a detailed treatment strategy. Many offices now use digital intraoral scanners instead of the traditional putty molds. These scanners create a precise 3D model of your teeth in minutes, with significantly fewer errors. Digital scans eliminate the gagging and discomfort of putty trays and allow the orthodontist to review the image from every angle in real time before moving forward.
The second stage is active treatment. If you’re getting braces, brackets are bonded to your teeth and connected with an archwire. You’ll visit for adjustments roughly every four to eight weeks. If you’re using aligners, you’ll switch trays on a set schedule and check in periodically. Average treatment time with fixed appliances is about 20 months when assessed by general studies, and closer to 25 months when held to board-certification standards of quality. Simpler cases may wrap up in 14 months, while complex cases with significant bite discrepancies average around 30 months.
The third stage is retention, and it’s just as important as active treatment.
Why Retention Matters
Once your braces come off or you finish your last aligner tray, your teeth will try to drift back toward their original positions. The bone and gum tissue around each tooth need time to stabilize in the new arrangement. Retainers prevent this relapse.
There are two main types. Removable retainers are clear trays or wire-and-acrylic devices you wear at night. Fixed retainers are thin wires bonded to the back surfaces of your front teeth, where they’re invisible from the outside. Fixed retainers require no daily effort to remember, work around the clock, and are suitable for long-term or even lifelong use. Their downsides are that they can make flossing more difficult and may occasionally break. Removable retainers are easier to clean around but only work if you actually wear them consistently. Most orthodontists prescribe full-time retainer wear for the first few months, then transition to nighttime wear.
Health Benefits Beyond Appearance
Straighter teeth are easier to brush and floss, which directly lowers the risk of cavities and gum disease. But the benefits extend further. Research published in the Journal of Dentistry found that people who completed orthodontic treatment had roughly 1.9 times better oral function compared to untreated individuals with similar malocclusions. That improvement showed up in everyday tasks like chewing efficiency and food taste perception. Correcting a misaligned bite also distributes chewing forces more evenly across all teeth, reducing the kind of abnormal wear that can crack or erode individual teeth over time. For people with jaw joint discomfort linked to a poor bite, treatment can relieve chronic tension and pain in the jaw muscles.