Metal Braces

Since the braces remain in the oral cavity for an extended time duration, they are prepared from materials that possess sufficient strength and excellent resistance to corrosion. Therefore, conventional metal braces are made of high quality stainless steel or titanium alloys. Metallic braces consist of the following components:

Metallic brackets

Brackets are the appliances that are attached to the teeth, and are the ones that become visible whenever you open your mouth for speech or smiling.

Metal brackets are made up of stainless steel, gold, titanium, nickel. Chromium is added to prevent the corrosion of stainless and molybdenum is added to prevent crevice and pitting corrosion.

Brackets are attached to the teeth with the help of special dental cements that are polymerized with the help of visible light. Orthodontic braces contain slots through which an archwire passes.

Metallic archwires

An archwire is simply a metallic wire that passes through specially designed slots within the brackets. Metallic archwires are either prepared from stainless steel, nickel titanium, or β-titanium alloys.

Currently Ni-Ti (55% nickel and 45% titanium) alloys are used more commonly than stainless steel alloys because of the super-elasticity and memory. Stainless steel alloys include 18% chromium and 8% nickel.

The thickness and rigidity of the archwires determines the force that is generated onto the teeth. Usually, flexible wires are used initially to gradually align the teeth followed by using rigid wires (like stainless steel) to bring about major orthodontic movements of teeth.

Orthodontic ligatures

Also commonly known as rubber bands, these are simply elastics that are used for holding archwires into their places in the brackets. Ligatures come in a variety of colors and patients can choose the color of their ligatures at every appointment, when they are replaced with fresh ones.

The metal brackets are attached to the teeth directly with the help of the bonding agent.

Several years ago metal bands had been used on which the metal brackets were welded and these bands were cemented separately on each tooth surface. But this is outdated, as it was not at all esthetically pleasant.

Archwire is a wire available in different dimensions and shapes in different cross sections which are inserted in the bracket slots, secured with a ligature wire/ elastic ligature ties.

Basically these archwire are the component of the entire assembly that delivers the force required for the movement of the teeth, that is why they are the active component. The ligature ties and the brackets bonded to the teeth are the passive components.

The archwire passes from all the bracket slots and extends till the molar teeth (rear teeth) which forms the anchorage unit and attached to the molars with the buccal tube which is bonded on the anchorage unit. They are called anchorage unit because they are multirooted teeth and they firmly hold the archwire and act by pulling the front teeth without any change or slight change in position of themselves.

When a force is applied, the archwire is pulled and held in place with the help of the brackets and posteriorly tightened and secured in the buccal tube. The tightened / activated arch wire tries to move and relax which creates a force on all the teeth, front teeth as well as back teeth.

As front teeth have lesser surface area and are single rooted teeth, they move easily into the required position and the rear teeth which has comparatively greater surface area and are multirooted, acts as the anchorage unit resisting the forces without any movement or slight movement if required.

The type of orthodontic wire, as well as its thickness determine the amount of force that is generated onto the teeth. This force is then used to move or re-align the teeth in their proper positions.

At every appointment, which is usually two to three weeks apart, your dentist will replace your ligatures and adjust the orthodontic wires so that they are tight enough to move your teeth.

• Traditional braces: use brackets made of stainless steel and banded to the teeth.
  Self ligating braces: consist of metal brackets bonded on the surface of the teeth.
• Traditional braces: require a ligature tie to secure the wire in place in the slot of the bracket.
  Self ligating braces: consist of brackets which has a flap of metal. It is opened when the archwire is to be placed. Closing the flap secures the archwire in the bracket.
• Traditional braces. although all types of arch wires can be used but arch wires with round cross-section is extensively used. Advanced arch wire may slip off from the brackets.
  Self-ligating braces: arch wires with round, rectangle cross-section and also the advanced arch wire types like co-axial wires can be secured safely.
• Traditional braces: the elastic ligature tie used is made up of rubber material, which may deteriorate over time and loosen up.
  Self-ligating braces: unlike ligature elastic ties, deterioration is not seen with self-ligating brackets.
• Traditional braces: the ligature ties are changed in every appointment.
  Self-ligating braces: once the self ligating brackets are placed , they serve until the entire treatment is completed.
• Traditional braces: amount of force may change as the grip of the ligature wire loosen up till the next appointment.
  Self-ligating braces: consistent magnitude of force is applied to the teeth resulting in faster and precise tooth movement.
• Traditional braces: more economical.
  Self-ligating braces: comparatively more expensive.

Orthodontic treatment is the movement of the teeth exclusively with little changes in bone whereas orthopaedic treatment focuses more on the bone and the direction of its growth.

For kids, orthodontic treatment is usually accompanied with the orthopaedic treatment which facilitates proper growth of the jaws which greatly improves the facial appearance and features along with the dental appearance and smile.

Orthopaedic appliances can be used only for growing patients which coincides during the pubertal growth phases. They are used before the beginning of prepubertal growth spurts to achieve the maximum results.

Braces are usually avoided in primary dentition unless some major discrepancies noted.

We talk about adult orthodontics when the treatment is done after the eruption of complete permanent dentition.

The treatment is more of resolving the dental issues than jaw growth. If any major jaw problems persist, it can only be corrected by orthodontic treatment accompanied with orthognathic surgery.

Orthopaedic appliances shows no result once an individual crosses puberty.

Metal brackets and archwires are available only in metallic silver color.

The elastic ties are available in plenty of colors, like a palette of an artist.

Available in red, blue, green, pink, violet, purple, maroon, silver, grey, yellow, orange, black, white, clear etc. Even shades of these colrs are available like dark blue, light blue, royal blue, indigo blue etc.

The color can be chosen based on the patient's choice and skin tone. With every appointment they can be changed. Usually kids are more excited to choose their favorite one.

After getting your braces, it is common to have difficulty in eating and speaking for the first few days. However, your mouth will soon get used to the “additional” appliances and they will become a part of your oral cavity. Make sure that you maintain an impeccable oral hygiene and avoid sticky and hard foods during your treatment.

Braces are attached to your teeth with the help of adhesive cements. If you are not careful about your diet and continue to eat sticky and hard foods, there are chances that the metallic brackets may get dislodged from teeth.

What to do in this case?
First, don’t panic! Simply secure the bracket and visit your dentist or orthodontist immediately. At the dental office, the tooth will be cleaned and the bracket will be re-attached to it.

After the orthodontic treatment is completed and the required results have been achieved, your dentist will give you a fixed or removable retainer to wear, so that your teeth do not revert to their previous positions.

Despite the excellent results achieved by the use of metallic brackets for orthodontic treatment, their use is gradually declining due to their unesthetic metallic appearance.

If you don’t want people to notice your braces whenever you speak or smile, then you can choose ceramic braces or Invisalign clear aligners for your orthodontic treatment.

Orthodontic cases vary a lot from individual to individual, so do the costs, but metal braces are the most affordable type of braces.

It depends on the teeth positions, complexity of the treatment and the level of correction required ranging from minor simple crowding to severe crowding and proclination.

The charges add up if bone growth redirecting is required using an orthopaedic treatment along with orthodontic treatment in growing children.

The dentist after the diagnosis and the treatment plan will exactly tell you about the cost and the duration of treatment required.

The average costs for orthodontic treatment ranges between:

• United States: $3,000 - $5,000
• United Kingdom: £2,000 - £4,000
• Canada: $2,500 - $5,000
• Australia: $3,000 - $4,500

Is there an age limitation for metal braces?
The health of the oral cavity and the bone quality is major determining factor for orthodontic treatment. Adult patients over 40 can be treated for crowding if the periodontal health of the patient permits and they have sufficient bone and good general health.

How long does it take to straighten the teeth?
The entire treatment for relieving teeth crowding depends from case to case, treatment times range between 12 and 24 months.

Complex cases require more time, as it takes almost 3 - 4 weeks after every appointment for very small portion of bone to form and adapt to the new position with a very small change in position.

Can metal braces cause health problems?
No, if oral health is maintained properly no health issue is seen.

The brackets placement favors more plaque formation in and around the area and along the arch wires. It also hinders in mechanical cleaning while brushing. So proper brushing
technique with regular use of interdental brushes to clean the area between the teeth and the archwire is mandatory.

Use of mouth-rinse significantly reduces the bacterial load in the mouth thus favoring the reduction in plaque formation aiding in good oral health.

Can I have braces if I have a dental crown?
Full crowns usually posses no problem. The tooth movement mechanism is same as that of natural teeth without crown.

Partial crowns might get removed especially during torque where the crown may dislodge due to the consistent stress with the intermediate cement layer used for bonding the crown with the tooth.

It is better to avoid veneers as they are very thin and might fracture during the tooth movement or while removing the brackets post- treatment.

Do metal braces stain my teeth?
Earlier there were cases reported for discoloration but currently passivating metals are being added to the stainless steel alloys to reduce staining and improve the cosmetic results.

Improper cleaning of the teeth may stain the teeth due to plaque accumulation. Drinking beverages like tea and coffee favors staining.

Can I smoke if I have metal braces?
It is better to avoid smoking as it aids in teeth staining. Also it is not good for periodontal health which is always under active repair and reconstitution during the entire treatment.

Can I switch from metal braces to ceramic braces / Invisalign?
Yes, it can be done. But before placing any brackets, bonding is preceded with acid etching of the teeth to achieve stronger bond strength. Removal of the metal braces and switching onto ceramic ones requires re-etching.

This actually weakens the enamel surface. Even during debonding of the brackets, there is a danger of micro-fractures within the enamel. So, it's better to decide and discuss the treatment plan and options with your dentist before starting the treatment.

Which is cheaper a metal brace or Invisalign?
When comparing the rates between the two, traditional metal braces are much cheaper than Invisalign.