Dr. Greg Jorgensen
(505) 891-9440
1401 Barbara Loop SE
Rio Rancho, NM 87124

The Jorgensen Orthodontics Blog

Three Reasons Your Orthodontic Braces Are Still On

Posted by Dr. Jorgensen on March 25th, 2012

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Getting your braces on is exciting, but getting them off is the best day ever! Your orthodontist most likely gave you an estimated treatment time before your braces went on. If that day has come and gone, you are probably wondering why your braces are still on. There are three things that could cause your braces to stay on longer than expected: your orthodontist, you, or biology.

Your orthodontist has advanced training to help him diagnose your problems and come up with a treatment plan that will best correct them. His experience should not only allow him to produce the best result, it should also help him select an approach that gets you there in a reasonable amount of time. Not all orthodontists are the same however. Some place more emphasis on speed than quality. Some are “hands-on” while others are not as intimately involved. It is a personality difference. Your treatment time will be directly affected by the treatment plan your orthodontist choses and how efficiently he executes it. Some ways he can make your treatment take longer include 1) problems with the original diagnosis, 2) problems with the original treatment plan, 3) changes in the original treatment plan during the process, 4) too much time between appointments, or 5) insufficient attention to your progress. Some problems really do take 30 months to correct, but an experienced doctor should be able to warn you about those up front.

You (the patient) are the second variable that affects your treatment time. Your orthodontist may have the perfect diagnosis and treatment plan, but he cannot succeed without your cooperation. Some things you might be doing to sabotage your own treatment time include 1) missing, changing, or spreading out your appointments, 2) arriving late to appointments so the technicians don’t have sufficient time to perform all planned procedures, 3) not getting other necessary procedures done in a timely manner (surgeries, extractions, restorative, etc.), 4) breaking or bending your wires or brackets between visits, or 5) not following instructions regarding rubber bands, aligners, and oral hygiene. Doing your part will not only help keep your treatment on schedule, it will give you the best final results too.

Even if your orthodontist is brilliant and you are the most compliant patient in history, there is still one other factor that neither of you can control. That factor is your biological response. Estimates of treatment time are based upon the complexity of the problem and the normal response of teeth to typical orthodontic forces. In some patients the teeth move faster than normal. In others they move slower. Some patients may have a condition called ankylosis where some teeth won’t move at all. In these cases it won’t matter what you or your orthodontist do, treatment time will be extended. The take home message is that even if you and your orthodontist are both vigilant in your roles, you’ll still need for your teeth to cooperate to get done on time.

If you are in treatment now and are concerned by your prolonged treatment time, consider these three factors: Are you really doing your part? Have you discussed your treatment progress with your orthodontist to see if anything has changed from his perspective? If you’re confident that both of you are doing your best, it may be that your body’s response to treatment is just slow. If you haven’t started yet, ask around and see if the orthodontist you are considering has a reputation for efficient treatment plans and finishing on time. Not all orthodontists are the same.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

52 comments so far in response to “Three Reasons Your Orthodontic Braces Are Still On”

  1. Lisa says:

    Dear Dr. Jorgensen,
    Thank you for offering insight through this blog. I’m 42 years old with an overbite about 4 mm. I have chronic head and neck pain, tinnitus and severe sleep apnea (57 events per hour). I have been on the CPAP for 8 months and according to the report it has brought my sleep apnea under control, but what the report can’t measure is that I awaken about every 45 minutes because I need high pressure. I reset the machine to ramp up to the pressure and fall asleep again for about 45 minutes and then repeat. I’m exhausted and I also had a 3 level spine fusion from my C4-C7 a year and a half ago. I have a right paralyzed vocal cord as a result of the prolonged retraction during the 3-hour surgery. I saw an orthopedic surgeon regarding possible jaw surgery. And he told me I would need the top and bottom jaw operated on to advance my jaw forward and open my airway, but since the surgery is rough on the body he recommended I just use orthodontics to fix my jaw and I would get the same result it would just take longer. What is your opinion on that? One general dentist wants to use a palate expander that will create temporary spaces on the sides and then fix the rest with braces. After that use the sleep appliance as a retainer. Another orthodontist who is a premier provider for Invisalign tells me he can use Invisalign to correct my overbite and open my airway in 2 years. A second orthodontist says that fixing my bite will help none of my problems unless I’m able to have the jaw surgery. He could fix my teeth only with braces for 30 months, but it wouldn’t fix my airway.
    When I was 12 years old I had a bionator and developed severe lock jaw and was unable to continue treatment. I’m afraid if I go to a sleep appliance I won’t be able to tolerate the jaw advancement necessary and it could also permanently change my bite where my teeth no longer touch.
    I’m not one of those people who you can barely see where the chin begins and ends because of the overbite. The surgeon who told me I could get the same result with an orthodontist got me excited. Then an orthodontist said he was wrong. I would so appreciate whatever light you could shed on my situation.

    • Hi Lisa. Orthodontics alone will do nothing for your sleep apnea. The research really does support the concept of moving the upper and lower jaws forward to enlarge the airway. Nothing short of that, especially not an expander at 42, will give you any improvement. I’ve had many adults with sleep apnea who have benefited from this surgery. Good luck.

  2. Matthew says:

    Hello , Ive been wearing my braces for only a year. My dentist says that within a few months they can be taken off. Contrary to all the other people on this post, I seem to be the knotted one that doesn’t want them taken off. My othodontist has only changed the bar every 3 months, but I visit every month regularly and on time. She changes the elastics on each tooth each visit but not the bar. Most people I know have said that’s strange, especially as she wants to take them off soon. I know my teeth have moved but in my opinion they could have better alignment a I can see some teeth are not yet quite in line. I’m worried about taking them off and not being satisfied with the final outcomes. Should I see another dentist ? Why is she moving so slowly but rushing to take them off?

    • You can’t compare your treatment with others because your teeth are different. There is no set number of wire changes or time limits with braces. You have them as long as needed for the treatment goals to be achieved. If you think there are some teeth that are not yet straight, you must point these out to your orthodontist BEFORE the braces come off so they can be fixed while the braces are still on.

  3. Manasa says:

    Hi doctor
    i had removal of 4 wisdom teeths last month. Now my doctor is asking for extraction of 4 other teeths for braces. Is it really required to extract teeths and doesn’t it affect any nerves.

    • Removing teeth is sometimes required to provide the room needed to align the teeth. Please refer to the many articles on my blog discussing extractions for more information.

  4. Sierra says:

    I just got braces on a couple days ago. When I went for a consultation I was under the impression that the Orthdontist who evaluated my mouth and formed the treatment plan would be the one putting my braces on. However,a different Orthdontist placed my brackets on and the Othdontist assistant placed the wires and bands on. She also gave me instructions and a kit. The orthodontist never came back to make sure everything looked good. Is this normal to see different Orthdontist and have an assistant put the remaining wires and bands on? (First time having braces).

    • This is getting more common in corporate dental offices. In my office, I do the diagnosis and place the braces. When my son joins me, we’ll probably work together and I may diagnose a case and he may put on the brackets. I would hope that both he and I know what the other one is saying/doing so that the treatment provided is consistent. Two doctors would be easier than some clinics with many, many dentists.

  5. Dion Mash-Williams says:

    What can I expect at my first ajustment with Braces? I was put on a “started wire”, so will my first adjustment be a different wire or can it remain?

    • If the teeth are better aligned than when you started, your orthodontist will probably try to move you on to your second wire. Wire progression is one step in correcting orthodontic problems.

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