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Misaligned teeth and jaws: Learn More – Treatment with fixed braces

Last Update: February 13, 2023; Next update: 2026.

Treatment with dental braces aims to improve the position of certain teeth or the position of the upper and lower jaw, to make them fit together better. Fixed braces stay in your mouth until the end of the treatment. So it’s particularly important to keep your teeth and mouth clean if you have fixed braces.

It is estimated that more than half of all children and teenagers in Germany have misaligned teeth or jaws. The treatment generally involves using either fixed or removable dental braces. Sometimes both types of braces are used: Then you might wear removable braces at first, followed by fixed braces afterwards.

The active treatment phase (when the braces are worn) is followed by a phase where you use something known as a retainer. This is done to prevent the teeth from moving back to their original position.

How do fixed braces work?

Fixed braces are usually made up of ring-like metal bands, square metal brackets and a thin metal wire. The wire, known as the archwire, runs along the teeth like a rail. It threads through the brackets, which are glued to the outside of the teeth. At the sides of the mouth it can be fixed to one or more back teeth using ring-like metal bands. There are also less visible types of braces, for instance with ceramic brackets.

The archwire pushes or pulls the teeth in the desired direction. This causes the jawbones and teeth to gradually change position. At regular appointments, an orthodontist (specialized dentist) adjusts or replaces the archwire. This procedure can gradually straighten out crooked teeth, for example.

The pulling or pushing effect can be increased through extra elastic bands, among other things. Elastic bands can help to straighten a tooth that is leaning backwards – or to move the lower jaw forward a bit. You can fix the elastic bands between two brackets yourself and then remove them again. In this way, it’s also possible to “tie” brackets in the upper row of teeth to brackets on lower teeth.

Illustration: Fixed braces with glued-on brackets

Fixed braces with glued-on brackets

What are the advantages?

The pushing and pulling forces of fixed braces can effectively move the teeth in different directions. That makes it possible to change the position of all the teeth.

People who have fixed braces don’t need to worry about when or whether they have to put their braces in: The braces stay in until the end of the treatment. They also can’t fall out of your mouth while you’re sleeping or doing sports, for instance.

What are the disadvantages?

Not being able to remove your braces can sometimes be a problem, too. They are always visible when you smile, and you can’t remove them for things like special occasions or for photos.

When you first start wearing braces or when the archwires are adjusted, it can be uncomfortable or painful. The pain usually goes away after 24 hours or several days at the latest. You can take a low-dose painkiller to relieve the pain for a short while, if needed. It is best to talk to your orthodontist about which painkiller is most suitable.

People who have fixed braces have to take care when eating: It is best to cut hard foods into small pieces because they might damage the braces otherwise. Food can quite easily get trapped in the wires, and can be difficult to remove – especially chewy and sticky foods like toffee. That makes it harder to keep your teeth clean, which is already tricky if you have fixed braces. But it’s very important in order to reduce the risk of tooth decay and gum disease.

As well as brushing your teeth thoroughly with a normal or electric toothbrush, it’s essential to clean the spaces between your teeth too, for instance with interdental brushes or special dental floss. It is also important to go to the scheduled check-up appointments and play an active part in your treatment – for example, by attaching elastic bands to the braces as instructed.

What else can be used?

There are various special types of braces that are different to normal fixed braces in certain ways: In some, the part of the braces on the upper teeth is connected to the lower jaw by a metal hinge-like appliance at the side of the mouth. The appliance gradually moves the lower jaw forward. But you can still open and close your mouth normally. If the upper jaw is too narrow overall, the orthodontist can attach a special appliance known as a palatal expander between the metal bands of the braces (on the upper molars). The expander fits along the roof of the mouth.

If the forces exerted by normal braces aren’t strong enough, more force can be put on the back teeth from outside of the mouth. This is done by attaching the wires of a headgear to the metal bands of the braces (on the molars) for several hours a day. The part of the headgear in the mouth is anchored at the back of the head or neck with straps, via a wire that runs along the side of the face. There are also other appliances that influence the position of the jaws from the outside, such as an orthodontic face mask (reverse-pull headgear) or headgear with a chin strap.

Sometimes surgery is needed – for instance, if someone has a very narrow jaw. The surgery may involve removing certain teeth in order to make more room for the other teeth, which can then be moved into the correct position with the help of braces. In rare cases, braces are fixed in the jawbone using small screws (implants). After the treatment, the braces and screws are removed again.

What is the retention phase?

Once the misalignment has been corrected, the retention phase of treatment begins. This involves wearing something known as a retainer to keep the teeth in their new position. Without the retention phase, they would probably move back to where they were before. Unlike braces, retainers don’t push or pull the teeth in a different direction: They just hold them in place.

Fixed or “bonded” retainers are usually made out of wires that are glued (bonded) to the back of the teeth and stay in the mouth for several years. Some types only hold the front teeth in place, while others are also glued to the back teeth. Removable retainers include types that look like removable braces and are worn at night.

It is best to talk to your orthodontist about which type of retainer is most suitable for you and how long you should use it for. This is also true when deciding whether to use a fixed or removable retainer. In Germany, statutory health insurers only cover the costs of fixed retainers in a few specific situations – for example, if the lower front teeth are very close together.


© IQWiG (Institute for Quality and Efficiency in Health Care)
Bookshelf ID: NBK553378


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