Why Does Orthodontic Treatment Usually Take About Two Years?

 

Many patients ask, “Why do braces or Invisalign take nearly two years?” It is a fair question. Teeth may look as though they could be straightened much faster. Some treatments even advertise a new smile in only six months.

The answer is that complete orthodontic treatment involves much more than making the front teeth look straight. An orthodontist must also create a healthy bite, guide growth when needed, protect the teeth and gums, and move each tooth into a stable position. Doing all of that safely takes time.

A tooth is not simply pushed through the jawbone. When gentle pressure is placed on a tooth, the body slowly removes bone on one side of the tooth and builds new bone on the other side. This natural process allows the tooth to move. This process cannot be rushed too much. Using heavier force does not always make a tooth move faster. Too much force may slow movement or increase the risk of problems. These can include gum recession, loss of bone support, or shortening of the tooth roots. Orthodontists use light, controlled forces to move teeth at a safe speed. Most teeth move only a small distance each month. The front teeth may begin to look straighter during the first several months of treatment. However, that does not mean treatment is finished. The upper and lower teeth must also fit together properly. The orthodontist may need to correct:

• Crowding or spaces
• An overbite or underbite
• Teeth that stick out too far
• A crossbite
• A deep bite or open bite
• The position of the back teeth
• The center lines of the upper and lower teeth

Some teeth must move forward, backward, upward, or downward. Others need to rotate or have their roots moved into better positions. Moving a tooth’s root through bone is usually slower than tipping the visible part of the tooth. In children and teenagers, a poor bite may be caused partly by the way the upper and lower jaws are growing. For example, the lower jaw may sit too far behind the upper jaw, creating a large overbite. In other patients, the lower jaw may be ahead of the upper jaw, creating an underbite. When growth is part of the problem, treatment is not only about moving teeth. The orthodontist may also use appliances, braces, aligners, or elastics to guide the teeth and jaws while the patient grows.

Growth happens gradually and cannot be completed in a few months. An orthodontist must also choose the right time to use that growth. Starting too early may mean treating for longer than needed. Starting too late may miss part of the patient’s strongest growth period. Orthodontic appliances cannot create unlimited jaw growth or completely change a person’s natural growth pattern. However, treatment during the right stage of development may improve how the jaws and teeth fit together. The orthodontist must watch the patient’s growth, adjust the treatment, and allow the body enough time to respond.

Orthodontic treatment is usually completed in steps. First, the teeth are lined up and major crowding is relieved. Next, spaces are closed and the bite is corrected. Growth may be guided during this stage. Finally, the orthodontist makes smaller adjustments to improve how the teeth fit together. These finishing changes may seem minor, but they are important. A good bite helps spread chewing pressure across many teeth and may make the result more comfortable and stable. Treatment may take longer if appointments are missed, braces are broken, aligners are not worn enough, or elastics are not used as directed. Keeping appointments and following instructions can help treatment remain on schedule. 

Some general dentists offer short-term treatments described as “Six Month Smiles,” cosmetic braces, or limited aligner treatment. These treatments usually focus on straightening the front teeth. Short-term treatment is not automatically bad. It may be reasonable for an adult with a healthy bite who wants to correct a small amount of crowding or spacing. However, it is not right for every patient. If treatment focuses only on the teeth that show, it may not correct problems with the back teeth, tooth roots, jaw relationship, or overall bite. Quickly lining up the front teeth may sometimes require them to be pushed outward. This can affect the gums, stability, or appearance of the smile. A result may look finished from the front while leaving important problems untreated.

General dentists provide many valuable dental services. Orthodontists are dentists who complete additional full-time specialty training in tooth movement, jaw growth, facial development, and bite correction. This helps orthodontists plan treatment for both the appearance and function of the entire mouth. Some simple problems can be treated in less than a year. More difficult cases may take longer than two years. Growth, age, crowding, bite problems, missing teeth, and patient cooperation all affect the schedule. The goal is not to keep braces or aligners on longer than necessary. The goal is to move the teeth safely, use growth wisely, and create a smile that looks good, functions well, and has the best chance of lasting.

 

Airway Orthodontics: Separating Facts from Hype

If you have searched online about braces or expanders, you have probably seen claims that orthodontic treatment can cure breathing problems, sleep apnea, ADHD, or many other health conditions. Some websites even suggest that children as young as 3 years old should receive expanders to improve their airway.

These claims can be confusing for parents. So what does the science actually say?

The American Association of Orthodontists (AAO) believes orthodontists should carefully evaluate every patient's growth, bite, and airway. However, the AAO also states that there is not enough scientific evidence to claim that orthodontic treatment alone can predictably improve airway function or treat sleep-disordered breathing.

That is an important difference.

Airway Is Important

Breathing problems are real. Children who snore loudly, struggle to breathe during sleep, or seem unusually tired during the day should be evaluated by their pediatrician or an appropriate medical specialist. These problems deserve careful medical attention.

Orthodontists are trained to recognize possible concerns and refer patients when appropriate. We work as part of a healthcare team—not as the only solution.

What About Expanders?

Palatal expanders are excellent orthodontic appliances when they are used for the right reasons. They are commonly used to correct crossbites, create space for crowded teeth, and improve jaw development in growing children.

In some patients, expansion may also change the size or shape of the nasal cavity. However, studies have not shown that these changes consistently lead to meaningful improvements in breathing, sleep quality, or long-term airway health.

In other words, expanding the upper jaw does not automatically "fix the airway."

Should Every Young Child Receive an Expander?

No.

Some social media posts suggest that nearly every child should receive an expander as early as age 3 or 4 to prevent future health problems. At this time, high-quality scientific research does not support treating all young children this way.

Orthodontic treatment should always be based on a careful diagnosis. A child with a normal bite and no orthodontic problems does not benefit from treatment simply because someone hopes it might improve the airway.

Starting treatment earlier is not always better. In many cases, waiting until the proper stage of growth provides the same orthodontic result while avoiding years of unnecessary treatment.

Following the Evidence

Good healthcare should be based on strong scientific evidence, not exciting marketing claims.

Researchers continue to study the relationship between jaw growth, orthodontics, and breathing. This is an active area of research, and our understanding may continue to improve. But today's evidence does not support promising that braces, expanders, or other orthodontic appliances can reliably treat airway disorders or prevent future medical problems.

Families should be cautious of anyone making guarantees that go beyond what research has shown.

Our Philosophy

Our goal is to provide treatment that is necessary, effective, and supported by the best available evidence. We recommend orthodontic treatment when it is indicated to improve the bite, guide normal dental development, and create healthy, stable results.

When airway or sleep concerns are present, we work closely with pediatricians, ENT physicians, sleep medicine specialists, and other healthcare providers to ensure each patient receives the most appropriate care.

Medicine advances by following good evidence. We believe our patients deserve recommendations based on science—not on trends or unproven promises.

What is the purpose of an orthodontic "supervision" appointment?

We know that moms and dads have busy schedules. Leaving work, picking up their children from school and taking them to the orthodontist is no small task. Sometimes the appointments are very short and seemingly meaningless. One of these appointments is the observation or supervision visit. These appointments are usually less than 15 minutes and many wonder if they are necessary at all. Supervision or observation appointments are very important, however!

Observation or supervision visits are scheduled for orthodontic patients who are either not yet quite ready for braces or have had an interceptive phase of treatment and are waiting for their remaining permanent teeth to come in. The orthodontist may take a progress x-ray at this appointment to help him evaluate your child’s dental development. There are three things that I look for when your son or daughter is in my chair.

First, if the patient has had an interceptive phase of treatment, it is important to check the condition of the retainers. The Phase 1 retainers that we use on the lower teeth are often bonded directly to the teeth.  Sometimes the bonding material wears thin with normal eating or the bonding material comes loose from the tooth surface. If a retainer comes loose or is lost, the teeth can move and the result of the initial treatment compromised. It only takes a couple of minutes to add cement to an intact retainer. If teeth have shifted due to a broken bonded retainer oftentimes braces must be put back on in order to restraighten the teeth. On the upper teeth we normally use a removable plastic-and-wire "Hawley" retainer.  These retainers may need periodic adjustment and tightening if they become loose fitting.  As well, the new permanent teeth that are erupting are a different size and shape than the baby teeth that were lost.  We can trim the plastic on the retainer to accomodate these new erupting teeth and keep the retainer fitting well to preserve the correction we gained.

The second objective of this appointment is to evaluate the loss of primary teeth and the eruption of the permanent replacements. Losing primary teeth on time and in the right order can help the permanent teeth come in straighter. If I notice that a baby tooth is not falling out on time, or I identify in an x-ray that the permanent teeth are headed in the wrong direction, I usually recommend that a patient see their family dentist to get the offending baby tooth removed. Evaluating the loss of primary teeth and the eruption of permanent ones doesn’t take much time, but ignoring developing problems can add months or years to a patient’s orthodontic treatment.

The third objective of an observation appointment is to advise the family about the timing of the next phase of treatment. My philosophy is that I will begin no treatment before a patient is ready. This might mean waiting a few months or even years. If we start too early, your son or daughter may have the braces on longer than necessary. If we wait too long, we might miss the opportunity to keep treatment as short as possible, or miss a growth spurt needed to correct a bite problem.

Having your orthodontist follow your child’s development will help them receive the care they need when they need it. Although they are short and sometimes seem like a wasted trip, your orthodontist knows exactly what to look for at an observation or recall appointment and will make sure that your child is progressing towards an excellent orthodontic result. Next time your son or daughter has an observation visit with your orthodontist, make sure and ask for an explanation of the things he was looking for and what was found. I think you’ll find that these short, to-the-point appointments are as important as any you’ll have.

When Should My Child See an Orthodontist?

Have you noticed more young kids with braces on these days? Why so young? Don’t they still have baby teeth? When should I take my child to see the orthodontist for the first time?

According to the American Association of Orthodontists, the best age for children to be seen by an orthodontist for the first time is 7. Why age 7? What can be done at that age? As you might guess, not every orthodontic problem can be treated at age 7. Surprisingly however, most problems can be identified by that age. Here are a few things that I’ll look for at your child’s first visit.

Tooth Loss and Eruption: Teeth are lost in a fairly specific order. Deviations from this pattern may indicate that a child has developmental issues that need attention. Between the ages of 6 and 8, it is normal for a child to lose his first eight primary teeth. Ideally these eight primary incisors are replaced immediately by eight permanent incisors. It is also normal for the child’s first four permanent molars to emerge at age 6 (hence the name “6-year molars”). By age 7, children should have at least four permanent molars and four permanent incisors. If there are more or less teeth than this, there may be problems with crowding, missing, or extra teeth. Sometimes removing a primary tooth early or maintaining a space where a tooth has been lost prematurely can prevent bigger problems later on.

Crowding and Spacing: By age 7 it is possible to tell if a child has a problem with excessive crowding or spacing. Spacing may mean that a baby tooth has been lost prematurely, a tooth never developed, or that the teeth are just too small. Crowding may require that the arches be expanded or that teeth be removed to help improve the situation.

Alignment: Although teeth can be aligned at an older age, crooked teeth are more susceptible to uneven wear or damage due to trauma, and the shape and position of the overlying gum tissues can be compromised. Crooked teeth can also have social implications that if dealt with at an early age ( 7 or 8 ) will have less impact on a child’s self-esteem.

Protrusive Front Teeth: As mentioned earlier, by age 7 it is obvious if the front teeth stick out farther than is safe or attractive. Although I know that I cannot permanently correct overbites before growth has finished, I can help reduce the severity of the problem and make things easier for young patients both dentally and socially while waiting for growth to be complete.

Underbites: Although it is best to wait to finish treatment in patients with underbites until they have finished growing (usually ages 16 through 18), it is important to try and normalize the anterior bite as early as possible to eliminate bite shifting and damage to the front teeth due to traumatic occlusion. If I notice an anterior underbite at age 7, I will recommend trying to at least “jump the bite” at that age even though definitive correction may not be accomplished until later in their teenage years.

Posterior Crossbites: Not only do posterior crossbites create crowding, they may also cause the jaw to shift laterally (to one side or the other). Expanding the upper jaw at age 7 can reduce the crowding and create the space necessary for the eruption of the anteriors as well as eliminate any shifting that may be present due to a constricted upper arch. It is also likely that the jaw shift will create a skeletal growth asymmetry so it is important to eliminate the sideways or forward shift as early as possible.

Anterior Openbites and Deepbites: By age 7 it is possible to detect vertical problems with the bite. Bites that are too deep (where the top teeth completely cover the bottom ones when biting) may indicate that the patient has a small lower jaw. Bites that don’t overlap enough (openbites) may signal that there is a finger or tongue habit that may be causing dental problems. I like to eliminate these destructive habits early so that normal development can occur.

I recommend screening ALL young patients at age 7 so that these and other conditions can be identified and corrected as early as possible. Although some may be able to wait until all the permanent teeth are in, interceptive treatment can make the final results faster, better, and give your children an additional three to four years of having a great smile at an age when their self-image is developing. If you have a child who is 7 or older, why not set up a screening with an orthodontist today?