The process of attaching braces to the teeth has changed significantly in the last 30 years. This is mainly due to the introduction of materials and methods that allow effective bonding of the braces directly to the enamel.
Currently there are two different methods of placing brackets on teeth.
- Indirect bonding is the method of applying brackets for braces to the teeth in such a manner that an entire set of braces can be applied
- Direct bonding is the method where braces are placed on each individual tooth, one at a time.
Both of the techniques have their advantages and disadvantages. However, today we will focus on direct bonding which is the most common method used among the orthodontists.
Most of the orthodontists avoid bonding upper and lower arches on the same appointment in order to introduce braces to the patient more gradually. The entire process of bonding the brackets and placing the arch wires can take anywhere from 15-30 minutes.
Placement of brackets and tubes in a step by step process:
- The teeth are polished with a non-flavored paste (this is similar to a dental polish after a cleaning), to ensure that the brackets will bond properly, after which they are air-dried.
- A cheek retractor is used to keep the teeth visible and dry during the procedure.
- The teeth are lightly air-dried, and the conditioner (blue gel) is placed onto the front surfaces of the teeth for about 30 seconds. The taste of this gel can be a little sour and bitter.
- The conditioner is rinsed and the teeth are again dried using suction and air.
- An adhesive primer is painted onto the teeth to enhance the bonding process and is cured with a LED ‘blue’ light.
- Finally, the bonding cement is placed onto the back sides of the braces, which are then placed on the teeth. The brackets are placed in a very precise position onto the teeth, and excess bonding cement is removed. If the bonding cement is light sensitive, the LED blue light is used to cure (set) the glue. Some bonding agents do not require a light since they have a chemical cure.
- The cheek retractor is removed and the wires are placed.
Placement of bands or rings
Many orthodontists will still place bands (rings) on the back molars. An advantage of using molar bands includes an increased stability of attachment on a large tooth in a very highly active part of the mouth. They also provide additional attachments on the tongue side of the band, as well as attachment tubes for headgear and other appliances.
The process of placing bands on the molars involves the following:
- Separators are placed one week prior to the appointment of band placement.
- The separators are removed, revealing space between the back molar teeth.
- Bands, which come in a variety of sizes, are selected to fit each individual tooth.
- A bite stick is used to help properly place and position the band on the tooth. By having the patient bite together with the stick, less strain is placed on the jaw while positioning the band. The orthodontist will first position the stick, and then let the patient know when and how hard to bite.
- Once the bands are selected and fit to the molars, they are removed and dried.
- The inner portion of the band is lined with band cement, and then it is positioned on the tooth. If the cement is light sensitive, a light will be used to cure it.
When braces are first placed and then later adjusted, you can expect to feel some tightness, which typically progresses to soreness, for approximately four to six hours after your appointment. This soreness is a direct result of arch wires tightening the teeth into position. Over-the-counter pain relievers are recommended to help relieve this pain. You can expect the soreness to decrease in about three to five days.