Metal Braces

Metal braces are fixed orthodontic treatment, what most people simply call "braces". A small metal bracket is bonded to the front of each tooth, and a thin, flexible wire runs through the brackets. The wire is made from an alloy that tries to return to the shape of a straight arch, so it applies a light, continuous force to the teeth. Under this force the teeth move slowly through the bone: bone is broken down on the pressure side and new bone forms on the other.

Braces correct crowded teeth, gaps, bites that sit too far forward or too far back, and some problems with how the jaws relate to each other. Because you cannot take them out, the result does not depend on your discipline in wearing an appliance.

Why braces when there are clear aligners?

In many mild and moderate cases, clear aligners and braces reach a similar result, and the choice then comes down mostly to appearance and lifestyle. But in some situations fixed treatment is more predictable:

• Severe crowding and cases that need extractions
• Teeth that are markedly rotated, especially canines and premolars
• Moving a tooth vertically, or pulling an impacted tooth down into place
• Marked bite problems such as a deep bite or an open bite
• Orthodontics planned together with jaw surgery
• Patients who doubt they could wear aligners for 20–22 hours a day, particularly some teenagers

	Metal braces	Clear aligners
Visibility	Clearly visible	Noticeable up close
Removable?	No, the orthodontist removes them	Yes, taken out to eat
What is expected of you	Meticulous cleaning and eating rules	Wearing them 20–22 hours a day
Complex movements	More predictable	Limited, depending on the case
Check-ups	Every 4–8 weeks, at the clinic	Less frequent, partly remote

How long does treatment take?

It depends on how far the teeth have to travel and how much the bite has to change. Simple cases can be finished in a year or less; most treatment takes between eighteen months and two years; cases involving extractions or surgery can take longer. Coming to check-ups regularly, not breaking brackets and wearing your elastics as instructed all have a direct effect on the timeline. Treatment can take a little longer in adults, but age alone is not an obstacle.

When for children, and what decides it for adults?

For children, a first orthodontic assessment is recommended at around the age of 7. At this age the aim is not to fit braces but to monitor jaw growth and the teeth coming through; for some problems, such as a crossbite, early intervention makes later treatment easier. Treatment with braces usually starts once the baby teeth have been lost, at around 11–13; the fact that the child is still growing is an advantage with some bite problems.

In adults, growth has finished, so large differences between the jaws may not be correctable by moving the teeth alone; in that case planning together with jaw surgery is discussed. In adults with missing teeth, orthodontics is also often used to rearrange the spaces before an implant or a bridge.

What happens before the braces go on?

The first step is taking records: photographs of the teeth and face, impressions or a scan, and panoramic and lateral cephalometric X-rays. We explain what these images are for on the oral diagnosis and dental imaging page. Then the treatment plan, any need for extractions and the estimated length of treatment are discussed.

The mouth needs to be healthy before braces go on. Decay is treated, and if the gums are inflamed, a scale and polish comes first. Moving teeth through inflamed gums can speed up bone loss, which is why, in adults with gum disease, orthodontics starts only after gum treatment has been completed.

Living with braces: cleaning and eating

The areas around brackets are very good at trapping food debris and bacterial plaque. If cleaning is neglected, permanent white marks and decay can start in the enamel around the brackets; straight but stained teeth at the end of treatment are a result nobody wants.

• Brushing after every meal, with an orthodontic toothbrush and interdental brushes
• Fluoride toothpaste, and a fluoride mouthwash when needed
• Not biting on hard things such as nuts, roasted chickpeas, ice or hard sweets
• Staying away from sticky foods such as toffee and chewing gum
• Cutting apples and carrots into small pieces and chewing them with your back teeth
• Limiting acidic and sugary drinks

In the first days after the braces go on, and for two or three days after each wire change, the teeth ache; soft food and, if needed, a simple painkiller are enough. If a bracket rubs your cheek, we give you orthodontic wax. A loose bracket or a wire that is digging in is not an emergency, but let us know as soon as you can.

Is that it once the braces come off?

No. This is where the most underestimated part of treatment begins. Teeth tend to drift back towards their old positions until the bone and gum fibres have settled around their new ones, and even years later. That is why retention follows once the braces are removed: usually a thin fixed wire bonded to the back of the front teeth, together with or instead of a clear retainer worn at night. Retention should be thought of as long term and, for most patients, indefinite.

What does the cost depend on?

The cost depends on the complexity of the case, the estimated length of treatment, whether extractions or additional appliances are needed, and the retention method. Once your records have been taken and you have been examined at our İzmir clinic, you receive a written, itemised quote.