Here are the facts regarding typical orthodontic protocol: 

Examination and Diagnostic Records

A thorough diagnosis is perhaps the single most important factor in orthodontic treatment. Precise scientific evaluation elevates orthodontics to the realm of “skilled medical treatment,” rather than “cosmetic” teeth straightening. The orthodontist’s education, training, and intelligence are geared to interpret models, x-rays, examinations, and procedures for a maximum satisfactory outcome.

1. Oral Examination
   During the Initial Examination, the orthodontist will carefully check the patient to survey the bite and positioning of the teeth as they open and clench. (S)he will also check the temporal mandibular joint (TMJ), or jaw joint. (S)he will diagnose physical aspects of the case that (s)he will wish to further establish through additional measurements, x-rays, and casts.
2. Study Models and Registration
   An impression is made of both the upper and lower arches with the pasty material that is put over the teeth to create a plaster likeness - a study model. These casts are used for assessment of orthodontic cases. In orthodontic offices, the plaster usually comes in flavors! (My favorite is bubble gum).
   
   Registration: At the time of Phase II Treatment, study model casts may be necessary to mount onto a device that is called an articulator. The articulator simulates the jaw joint. When the casts are mounted onto this articulator, it positions the model with the upper arch to the lower arch, in the lifelike position of jaws and teeth. Precise measurements are made. Accurate establishment of the bite is possible because, while the articulator replaces the jaw joint function, it also eliminates false positioning that can be caused by the facial muscles in their effort to achieve comfortable occlusion. Precise measurement via these study models with an articulator is called “registration,” or registered study models.
3. Beginning Ortho Survey (X-rays)
   A series of important x-rays and photographs are used together with study models to assess orthodontic cases. Several x-rays are required, including a full mouth x-ray, Panorex, and perhaps as many as two sophisticated Cephalogram x-rays which may be accompanied by overlay tracings. These paper tracings are lines and angles on paper that overlay the x-ray to show relationship connections and quantities for areas of the face, jaw, and teeth. They describe proportional facial relationships and deviations for the skilled orthodontist. Additional x-rays may be requested, including TMJ Tomography, if pertinent.

Phase I

Phase I Orthodontic Treatment is operative before the cartilage sutures of the palate have hardened into bone and while a child retains his deciduous (baby) teeth. During Phase I Treatment, the orthodontist can often normalize a degree of deviation by controlling facial growth to advantage before permanent formation of adult bone structure. One of the most common problems that can be successfully treated by Phase I is “crowding,” a condition that occurs when the arches are too narrow to allow the larger permanent teeth to assume the proper position. Thus, permanent teeth come in “crooked” because there isn’t enough room. During Phase I Treatment, a device called a “palate expander” is permanently placed on a temporary basis within the lingual (inside) palate to gently expand, or to push outward, thus widened the arch. Gradual stages of correction are facilitated with periodic adjustments by the orthodontist. A palate expander serves to eliminate much of the correction that would be necessary later to align the permanent teeth in Phase II since the procedure makes space for the permanent teeth to come in.

Phase I is not always an appropriate treatment for all types of orthodontic needs, but it is a valued treatment when natural facial bone growth can be manipulated to permanent advantage, as in the example above. Often a short Phase II is necessary to finish the process to perfection after Phase I.

Phase II

Although in some instances, Phase II may be accomplished by means of a removable appliance, usually and most effectively, Phase II means Banding. Traditional metal bands and brackets connected by wires fitted across each arch is standard Phase II Orthodontic Treatment and is what a child usually means when (s)he says, “I want braces.” Phase II begins after the permanent teeth have erupted and are in place.

Phase II Features - Brackets, Bands, and Wire

Brackets and bands are affixed to the surface of the teeth and are structured with a groove to support the wire. Brackets differ from bands. Brackets are used for the anterior (front) teeth, while bands that encircle the tooth are used on posterior molars. It is the wires that actually move the teeth. But things have changed since Mom had a mouthful of silver!

Ways to Experience Beauty Even While On the Journey!

• Clear bands and brackets – transparent, with only the very thinnest wire
• Mini Speed – small, unobtrusive silver brackets
• Colors!

Jeffrey M. Cohen, D.M.D., Tufts University graduate and practicing Orthodontist and Dentofacial Orthopedic Dentist in Beverly Hills, CA, 90210, has this to say about the changes,

“Orthodontic treatment is no longer uncomfortable for patients. Smaller and more comfortable braces, along with super-elastic titanium wires don’t cause the soreness and mouth irritation that traditional treatment caused. 

“Braces no longer need to be shiny metal bands. More esthetically conscious patients are opting for removable, transparent, or lingual (concealed behind the teeth) braces to correct their malocclusion.”

After the orthodontist has carefully analyzed all diagnostic tests, it is time for the separators (tiny spacers to move the teeth apart that will aid the orthodontist to fit the bands onto the molars) and then the banding appointment. From this point forward, an average of two years is spent in Phase II Treatment. Appointments are scheduled with the orthodontist for quick, periodic, routine adjustments (appointments are often only 10 minutes long), in approximately 2 to 3-week intervals.

Retention Phase 

Retention is the final orthodontic treatment phase. Removable retainers are worn for 24 hours in the initial retention phase, then only at night. The purpose of the Retention Phase is to assure the dazzling new smile will remain for a lifetime, exactly and precisely, as wonderful as it was the moment the braces were removed.

With unnoticeable transparent style – clearly – braces can solve problems from an unattractive, receding chin line and profile to aching, clicking jaws. Orthodontics is not only for children. It is a finely measured science that eliminates nature’s mistakes and pathology while it restores health and beauty.