Patients who are in need of orthodontic treatment to correct malocclusion issues have a few options available to them. These options include traditional metal braces, ceramic or clear braces, lingual braces and Invisalign. Not all patients are eligible for all types of treatment, but usually patients will have a choice between at least two of the options. Considerations that impact the decision can include how much do braces cost, the duration of each treatment, as well as the way the patient feels about wearing braces.
A consultation with an orthodontist, where an initial examination of the teeth is performed, usually including X-rays, to identify the problems, is the only way for a patient to learn what options are available. After the consultation, the orthodontist will present the patient with his recommendations and the cost of braces, and the patient can choose, with the guidance of the orthodontist, which treatment to follow.
Traditional braces use metal brackets, wires and elastic bands to correct misaligned teeth and bite issues. The brackets are bonded to the front side of the teeth, and an arch wire is threaded through the brackets. This wire is attached to the brackets using small elastic bands or thin wire ties. Additionally, some patients, particularly younger patients, also need rubber bands that attach to the top and bottom brackets to apply localized pressure and hasten the speed of the treatment.
The arch wire is adjusted monthly to continue to apply pressure to move the teeth into a correctly aligned position. Treatment with braces is gradual because rushing the treatment can be quite harmful to the teeth. The teeth are slowly moved into new positions then given time for the bone to adjust to this new position and grow in to support the tooth. The pressure loosens the teeth and if it is too forceful too quickly, it can cause the patient to lose a tooth.
The rubber bands that apply localized pressure, known as inter arch elastics, are designed to be worn all day, except when the patient is eating or cleaning his teeth. These elastics are attached vertically or diagonally to the upper and lower brackets. They have a dual function of providing additional pressure to move the teeth and helping the teeth work better in conjunction with the jaw. The pressure they provide is very intense and can actually cause undesirable movement of the jaw when the bones are not growing. This is the reason they are normally used with younger patients who still have growing, more pliable bones. Because these rubber bands lose their elasticity quickly, they must be replaced daily. Patients also need to be careful not to open their mouths too wide, or they can cause the band to snap inside their mouth, which can be very painful. Not wearing the inter arch elastics can also cause slower progress and extend the total duration of the treatment.
The duration of treatment for traditional braces averages from one year and a half to about three years. The actual duration is based on the complexity of each patient’s case. It can also be affected if the patient does not follow all of the orthodontist’s indications. Patients whose treatment includes rubber bands but do not wear these daily as they should can also expect to prolong the duration of the treatment.
Ceramic braces and clear braces work in the same way as traditional braces. The difference between the treatments is aesthetic rather than medical. These braces blend in with the teeth, since they are either transparent or an off-white color that matches the teeth. The materials used for the brackets are polycrystalline or monocrystalline alumina. These materials are responsible for the clear or off-white color of the brackets.
Ceramic brackets are strong, with non-porous surfaces that resist most stains and odors. However, they are somewhat less durable than metal brackets because the material is more brittle. Due to this, orthodontists have to be more careful when adjusting the pressure of the arch wire with these braces, and this can extend the duration of the treatment. Additionally, the type of materials used, the longer duration of the treatment and the specialized training dentists must receive to work with these braces also means that the total cost of this treatment is higher than that of traditional braces.
One disadvantage to choosing this option is that the material of the brackets is harder than tooth enamel, and overexposure to the material can harm the enamel. Because of this, patients with certain bite issues are not eligible for this treatment. This treatment will usually last at least a few months more than traditional treatment.
Another option for patients who are image-conscious are lingual braces, which are, in a way, the inverse of traditional braces. The brackets for these braces are bonded on the tongue-side of the teeth. The technology used for these braces is also different, since advanced Cad/Cam computer technology is utilized to create custom-designed and fitted brackets for each patient. Unlike traditional braces, which use mass-produced brackets and wire, these braces are custom made for each patient.
For this orthodontic treatment, the orthodontist takes an impression of the patient’s teeth at an initial visit. This impression is used to create a mold, which is sent to a laboratory that specializes in designing the brackets for this type of treatment. The brackets are then embedded onto an applicator tray, which is used to bond the brackets to the teeth all at once. Usually, the patient needs to wait about four weeks from the initial visit when the impression is made to the visit for installation of the braces.
After the initial installation of the brackets, the treatment works similarly to the traditional one. Arch wires that are pre-bent at the laboratory are used. The arch wires apply pressure to move the teeth slowly into the correct position. As with traditional braces, elastics can be used to apply additional pressure, usually to correct an overbite. If rubber bands are used, they are attached to the top and bottom brackets on the tongue side of the teeth and work the same way they to with traditional braces. This treatment is generally more costly than that of traditional braces because of the customization of the brackets and the education and experience of the orthodontist. There is also an option called Incognito Braces that includes customized arch wires that do not need any adjusting during treatment, saving the patient some pain and discomfort.
Since everything is on the tongue side of the teeth, this option is a good choice for athletes, especially those involved in contact and extreme sports, and musicians who play wind instruments, as well as for those who are image-conscious about braces. The treatment time line is the same as with traditional braces. Patients can expect to have their braces on for one and a half to three years depending on the particular issues of their case.
Orthodontic treatment is also available through Invisalign. Though this process does not include actual braces, it does address the same malocclusion issues and aims for similar results. The misaligned teeth are corrected through a series of transparent, computer-generated aligner trays made from thermoplastic material. The patient wears each set of aligners for about two weeks and then moves on to the next set. Each set of aligners is responsible for applying pressure to move some teeth towards the desired correct position. Unlike treatment with braces, which applies pressure all around the mouth to move the teeth, treatment with these aligners is focused on one or a few teeth at a time. Patients who are eligible for this treatment often choose it for its aesthetic value. The aligners are completely transparent and therefore practically invisible, and while it can cause some patients to speak with a lisp as they get used to the aligners, treatment is without major pain or discomfort.
The duration of this treatment is 12 months on average. However, for patients who have minor malocclusion issues, an Express version is available. This is a 6 month treatment option, limited to patients who can have their problems corrected by using 10 sets of aligners or less and who meet specific criteria. This criteria includes no true extrusions, no mesial or distal movement of the bicuspids or molars, and minor spacing, expansion and correction. This option is also used in conjunction with veneers and other cosmetic dentistry. This Express version is not an option for most patients who need orthodontic treatment, but for those who are eligible, it provides many benefits.
The cost of braces varies depending on the chosen treatment, the duration of the treatment, the orthodontist’s training and experience, the complexity of the case and the location of the dental office where treatment will be managed. So when patients wonder how much are braces going to cost them, they should first be informed about the benefits and the disadvantages of each type of treatment.
Traditional metal braces are usually the most economical option. The cost of these braces normally ranges from $5,500 to $8,000. However, the price can go as low as $3000 in rural areas and as high as $10,000 in bigger cities. If patients choose to decorate their braces with gold-plated or colored brackets or to cover the brackets with decorative metal or plastic shapes, they can expect the braces cost to increase by up to another $300.
Braces with ceramic or clear brackets are more expensive than the traditional ones, ranging from $6,500 to $8,500 on average. Many patients choose to only have clear brackets bonded to the six top front teeth and metal brackets on the rest of the teeth, since this helps to lower the cost of the total treatment. For patients who choose this option, the total cost of treatment can run about $200 more than for traditional braces in their area.
Lingual braces are more expensive than the other options due to their customization of the brackets and the expertise needed by the orthodontist to administer treatment. This orthodontic treatment costs about $2,000 more than traditional braces and can run as much as $5,000 more for the complete treatment.
Invisalign treatment costs about $3,500 to $8,000 in general. Though this treatment offers patients a way to correct their misaligned teeth without wearing actual braces, the cost for this aesthetically pleasing option is comparable to treatment with regular braces. If eligible and concerned about how much are braces going to cost them, patients can choose the Express version, which is substantially less expensive, ranging from $1,800 to $3,500.
Another consideration for patients when wondering how much do braces cost is their dental insurance coverage. If the dental insurance carried by a patient covers orthodontic treatment, it should cover the cost of braces that use the traditional metal brackets. Many insurance companies can also cover clear and ceramic braces up to an amount comparable with the coverage for traditional braces. Dental insurance will also usually cover lingual treatment as well as orthodontic treatment with aligners.
However, for patients who do have dental insurance or whose insurance does not cover orthodontic treatment, there are other options available to finance the braces cost. Most dental offices offer their patients financing through payment plans. Some plans include a large down payment with a few smaller payments. Other plans do not require a large down payment and the monthly payments are small and manageable.
Patients can buy into discount dental plans. These plans can help patients save up to 50 percent of the total cost of treatment. Another way for patients to manage orthodontic treatment expenses is through third-party Flexible Spending Accounts that are designed to cover the bills generated by medical treatment. Additionally, patients can research dentistry schools nearby that offer discounted dental services. These services are performed by student dentists who have completed all their coursework but need to acquire more experience. They are supervised by their professors and by licensed dentists. This can lower the total cost of treatment up to 30 percent.
While braces are usually installed in both upper and lower arches to help align the jaws and teeth correctly, some patients only have need of or desire for isolated treatment in the upper or lower teeth. Isolated treatment on one arch depends on the initial position of the teeth and the alignment of the jaws and bite. Aligning crowded teeth in the top arch, for example, will shift them slightly forward. For patients who initially have a crossbite, this is actually a beneficial thing, since their top teeth would have rested inside the bottom teeth and the isolated treatment would correct this. Patients without a crossbite, however, can expect the finished result to be a slight overbite. If the patient begins treatment with a small overbite, he can expect it to get more pronounced. Some patients can avoid the overbite by combining the treatment with a reduction in the size of the upper teeth.
Patients who have a large gap in their front teeth can also benefit from upper arch braces only. Since correcting the space in the front teeth will also move them slightly backwards, a patient’s overbite is also corrected. However, patients who are happy with their lower teeth and whose bite is perfect need a different type of treatment when using single arch braces. For these patients, to correct a large gap in their top teeth, the braces can be used to close the space between the front teeth, which are more visible, and move the spacing to the back teeth that do not show. They can also be used to straighten the teeth before enamel is applied to build up the teeth and eliminate the remaining spaces, providing cosmetically more appealing and stable teeth. Similarly, if the problems exist only on the lower arch, braces in the lower arch only are possible. Dentists determine the patient’s eligibility for this limited treatment after an examination, and most patients will need braces in both arches for proper treatment. The cost for single arch treatment is affected by the same conditions as regular treatment. However, average treatment can run from $3,000 to $4,000.
Other patients are looking for fast cosmetic treatment rather than medical. This is also possible with braces. Six-month braces, also known as Six Month Smile, are one treatment that quickly cosmetically corrects the problem of overcrowding in the teeth, without focusing on correcting bite issues. For this treatment, dentists will normally use lingual invisible braces, though ceramic invisible braces can also be used. The combined use of braces with sanding between the teeth and sometimes one or a few extractions makes it possible for patients to have cosmetically straightened teeth in just six months.
With six-month braces, the front teeth are straightened and bite change is limited. Since this treatment is offered to adults, there is also no movement of the jaw because the bones of adults do not grow. Any changes in the teeth with this treatment must fit in with the preexisting jaw shape and size. After treatment is done, a removable or fixed retainer, included in the cost of the treatment, is used to prevent teeth from shifting back into crooked position. This treatment is not possible if the patient needs many extractions or has severe bite issues. While cost for this treatment runs about the same as traditional metal braces, the treatment is normally compete in six months.
There is some pain and discomfort associated with all types of braces. Patients who choose treatment with aligners will actually not experience pain but instead will notice some discomfort, in the form of pressure around the teeth, particularly when they start using a new set of aligners. This pressure is proof that the treatment is actually working, since pressure is used to shift the teeth into the right position.
Patients who choose lingual or traditional braces will experience some pain. When the braces are first installed and each time the arch wire is adjusted, patients can expect to feel some pain and discomfort. Patients usually feel sore around the teeth whenever they chew or when their teeth come together. This pain and discomfort should disappear after a few days, but patients can use over-the-counter pain medications such as ibuprofen as well as cold and hot compresses applied to the area to alleviate the pain.
Additionally, eating a diet of soft foods such as purees will help manage the pain. Some foods such as sticky or overly sugary food should be avoided during treatment. For braces with arch wires and metal ties, patients can also sometimes feel pain if the arch wire sticks out of the back brackets and scratches the cheek or if the wire tie becomes loose and irritates the skin around it. For these cases, patients can cut of the extra arch wire with a sterilized nail clipper or bend it out of the way with a pencil eraser or some wax. Patients can also develop sores when the inside skin rubs against the harsher materials of the brackets and wires. Usually, these go away after a few days, but the patient can cover them with cotton to avoid additional pain. Patients can also visit their orthodontists to deal with the problems.
Patients who have brackets on the tongue side of the mouth can also experience discomfort if a bracket become unattached to the teeth. Lingual brackets are all attached to the wire, so if a bracket falls off the teeth, it will remain attached to wire until the patient visits the dentist to have it reattached.
All types of treatments to fix malocclusion issues have post-treatment care through the use of retainers. The retainers used can be removable or fixed. The purpose of the retainer is to give time for the teeth to become permanent in their new position to prevent any shifting and the return of the malocclusion issues. Removable retainers can be clear or the more common Hawley retainer. Fixed retainers are attached to the back of the teeth, and the patient does not need to worry about taking it out or misplacing it.
Clear retainers are quickly becoming a top choice for patients who need to wear a retainer full time for the first year or so after orthodontic treatment with braces is complete. Adolescents in particular usually need full-time retainers the first year or two and then wear it only at night for a few years after that. Clear retainers are made from transparent plastic and are practically invisible when worn since they mold to the teeth. They do not use any metal hooks or wires to attach to the teeth since they cover the teeth completely. Additionally, these retainers act as mouth guards to prevent patients with bruxism from grinding their teeth together when they sleep.
Hawley retainers have traditionally been the most popular type of retainer. Made from acrylic and wire, they use wire clasps to cover the molars and keep the retainer in place. A metal bow from canine to canine is also used. Some patients need the additional support and pressure provided by rubber bands attached to the retainer. The Hawley retainer is also used with temporary teeth to keep the spacing open while a patient waits for a more permanent solution. The acrylic used with this retainer is usually clear pink but can be personalized with different images, logos and colors. It is studier than a clear retainer and easier to fit to the patient’s teeth, but because it is bulkier and can cause interference with speech, there is higher possibility that a patient will quit using it before treatment is complete.
There are a few types of permanent retainers, but the most common type is a fixed retainer where a thin metal bar or wire is bonded to the back of the teeth. This type of retainer provides a lot of treatment flexibility since it can be bonded just to two incisors or it can cover all the teeth from canine to canine. Fixed retainers are normally used for the bottom front teeth, but they can also be used on the top front teeth to prevent a gap from reopening. This type of retainer is less bulky than the removable ones, but if worn on the top teeth, care needs to be taken that it does not interfere with the patient’s bite, since if it does, a particular hard bite can cause the bar or wire to fall off. For younger patients with a fixed retainer, the retainer must remain in place until the jaw bone stops growing, which can be as late as the age of 25. Some dentists leave the retainer in permanently, unless it begins to cause a problem. For patients who have a high probability of quitting their post-treatment with a removable retainer, a fixed retainer is the preferred choice.
Patients need to continue taking care of their teeth by brushing often and flossing daily. However, with a fixed retainer, flossing is impossible, so additional brushing must be practiced and scheduled dental cleanings cannot be skipped. Patients should also clean their removable retainers to prevent food debris from building up and causing harm to the retainer and tooth decay for the patient.
The cost of retainers is usually included in the total cost of orthodontic treatment with braces. Some plans also include one or two replacement retainers in case of loss or breakage. However, if the cost is not included or a retainer needs to be replaced out-of-pocket, patients can expect to pay $100 to $250 for each retainer.
Treatment with braces can also be used together with other cosmetic dentistry procedures such as dental implants. If a patient needs an implant and orthodontic treatment, it is best to complete the orthodontic treatment first and then have the implant placed. During the orthodontic treatment, the patient’s bones and jaw alignment will change and if the implant is placed before the position is correct, the patient can end up with an implant in the incorrect position. Sometimes, the implant can be placed halfway through the orthodontic treatment if the dentist is sure there will be no more movement to the area where the implant will be placed.
Braces can also be used in conjunction with temporary prosthetic teeth to create and hold the space for missing front laterals. The temporary teeth are attached to the braces during the orthodontic treatment and then become part of the retainers until the patient is ready for a more permanent solution, such as implants or a fixed bridge. For undersized, “peg-shaped” laterals, the treatment with braces can define the space needed around the teeth, and after treatment, the teeth can be capped, built up to regular size or veneers can be applied.
Patients are also usually concerned about the benefits and drawbacks of orthodontic treatment versus cosmetic treatment. Orthodontic treatment is generally a longer process that seeks to correct malocclusion issues that yield a healthy, straight-teeth smile. Cosmetic treatment is normally a shorter process that does not really address the misalignment of the teeth and instead focuses on creating an attractive smile quickly through the use of veneers, capping and other cosmetic procedures.
The costs for both types of treatments are comparable, so a patient would need to consider what they really want to decide on a course of treatment. Patients with severe malocclusion issues that interfere with their health can reap greater benefits from undergoing orthodontic treatment, even if it means that the ideal smile they aim for will take longer to achieve. However, patients with minor issues that are not interfering with their health can choose either type of treatment, as long as they understand that they will remain at risk for some of the long-term problems, such as gum disease, that can develop if malocclusion issues are not corrected.