Orthodontic treatment is a systematic process that requires close cooperation between the dentist and patient to achieve optimal results. This article details the standard steps of teeth straightening, including key phases like initial examination, treatment planning, appliance implementation, and retention. Whether you're considering traditional metal braces or clear aligners, understanding these professional steps will help you make informed decisions and achieve the best treatment outcomes.

Initial Examination and Diagnosis Phase

The first step in orthodontic treatment is a comprehensive initial examination, which forms the foundation for developing a personalized treatment plan. Patients should visit the orthodontic department of a reputable dental hospital for a professional evaluation by an orthodontist. The initial examination typically includes these key components:

Clinical oral examination: The dentist will thoroughly assess tooth alignment, bite relationship, and periodontal health, checking for issues like cavities or tartar that may need prior treatment

Imaging studies: Including panoramic X-rays (orthopantomogram) and lateral cephalometric radiographs. Complex cases may require cone-beam CT scans. These images clearly show jaw structure, root morphology, and tooth relationships, providing scientific evidence for diagnosis

Dental impressions: Using quick-setting impression materials to create precise models of the patient's teeth for pretreatment analysis, treatment planning, and post-treatment comparison

Photographic documentation: Taking facial and intraoral photographs from multiple angles as baseline records to compare with post-treatment results

After completing these examinations, the orthodontist will analyze all data comprehensively, preliminarily determine if treatment is needed, identify existing problems, and estimate the general treatment plan including potential duration, costs, and precautions. This phase also involves thorough communication about patient expectations to ensure shared understanding of treatment goals.

Treatment Planning and Preparatory Phase

After completing the comprehensive diagnosis, the orthodontist will develop a personalized treatment plan based on the findings. This phase considers multiple factors to ensure a scientifically sound approach:

Appliance selection: Based on the patient's dental condition and personal preferences, the dentist will recommend suitable appliance types such as traditional metal brackets, ceramic brackets, self-ligating brackets, or clear aligners (like Invisalign), each with distinct advantages for different situations

Extraction decisions: For patients with severe crowding or protrusion, extracting certain teeth (typically premolars) may be necessary to create space. Dentists follow the principle of "preserving teeth whenever possible," recommending extractions only when essential. The number varies but typically involves 2-4 teeth

Treatment duration estimate: The dentist will project treatment time based on age and case complexity. Adolescents typically need 1-2 years while adults require 2-3 years; mild malocclusions may take about 1 year, with complex cases needing longer

Cost explanation: The plan will specify estimated total costs including examination fees, appliance costs, adjustment visits, and retainers, ensuring full financial transparency

After finalizing the plan, some patients require preparatory procedures like fillings, cleanings, extractions, or tooth separation. Separation involves placing spacers between molars to create space for braces, which may cause mild soreness. These preparations establish the foundation for successful treatment implementation.

Appliance Placement and Periodic Adjustments

The active treatment phase centers on appliance placement and regular adjustments, requiring patient compliance for proper tooth movement:

Appliance placement: Installation varies by appliance type. Traditional brackets are bonded to tooth surfaces with special adhesives then connected with archwires; clear aligners involve wearing series of transparent trays changed every 1-2 weeks. Placement typically takes 1-2 hours

Adaptation period: Initial discomfort (1-2 weeks) may include tooth soreness and mucosal irritation. Dentists provide orthodontic wax for relief and recommend soft foods during adjustment

Adjustment visits: Regular follow-ups are crucial for success. Metal braces typically require adjustments every 3-4 weeks; clear aligner patients visit every 2-3 months for new trays. Frequency adapts to treatment progress

Auxiliary devices: Some cases require elastics to improve bite relationships or close extraction gaps. Patients change these rubber bands as instructed, usually removing them while eating

Oral hygiene: Appliances increase cleaning difficulty. Patients must use orthodontic brushes, floss, and water flossers thoroughly, brushing after every meal to prevent cavities and gingivitis

Teeth gradually move to ideal positions during treatment. Initial changes often appear within a month, with basic alignment achieved around six months, followed by fine-tuning and bite optimization. Patients should follow instructions precisely, attend all appointments, and protect appliances from damage.

Appliance Removal and Retention Phase

When teeth reach their ideal positions, treatment enters the final retention phase critical for maintaining results:

Appliance removal: After confirming satisfactory alignment and bite, the dentist removes appliances—a quick, painless process

Retainer wear: To prevent relapse, retainers are fitted immediately after removal. Common types include removable Hawley retainers and fixed lingual wires. Initially worn full-time (except when eating), use gradually reduces to nighttime only

Retention duration: Typically 1-2 years, potentially longer for complex cases. Research shows some degree of long-term or intermittent retainer use helps maintain results

Periodic checkups: During retention, visits every 3-6 months allow stability assessment and retention plan adjustments. Annual dental checkups are recommended even after discontinuing retainers

Retention requires high patient compliance. Inconsistent retainer use is the leading cause of orthodontic relapse. Additionally, maintaining good oral hygiene and a balanced diet supports long-term stability.

Orthodontic treatment represents a valuable investment in oral health and aesthetics. Understanding the complete process helps patients prepare mentally and cooperate actively. By choosing an experienced orthodontist at a reputable institution and following professional guidance diligently, you can achieve ideal results and maintain a healthy, beautiful smile long-term.