The Complete Guide to Orthodontic Treatment: Options, Timelines, Costs and Retention
For adults considering orthodontic treatment: why teeth go out of line, what treatment can achieve, the four phases of assessment, active movement, settling and retention, braces and aligners, timelines, discomfort, risks, relapse and the current fee list. The core point: treatment does not end when the brace comes off, because the bone and gums take time to settle and retainers help stop the teeth moving back.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Dr Ibraheem Ijaz, principal dentist at Deepcar Dental Care, reviewed this page. He is a General Dental Practitioner with a BDS, a BSc (Hons), an MSc from Leeds, a PG Dip in Implant Dentistry and a PG Cert in Restorative and Aesthetic Dentistry.
What is orthodontic treatment?
Orthodontic treatment uses a brace, or appliance, to move the teeth into line or correct the bite, the British Orthodontic Society (BOS) explains. BOS defines an appliance as a device used to apply force to the teeth to achieve that movement. BOS describes orthodontics as the branch of dentistry concerned with the growth of the teeth, jaws and face.
Occlusion is the way the upper and lower teeth fit together, and malocclusion means the teeth are not aligned properly, the US National Library of Medicine explains. This guide follows treatment from why teeth go out of line to how they are kept straight afterwards, using guidance from BOS, the NHS and published reviews.
Why are teeth misaligned?
Misaligned teeth most often run in families: the US National Library of Medicine describes malocclusion as most often hereditary.
It may come from a difference in size between the upper and lower jaws, or between the jaw and the teeth, which leads to crowding or an uneven bite. Other causes it lists include:
- extra teeth, lost teeth, impacted teeth or abnormally shaped teeth
- ill-fitting dental fillings, crowns, dental appliances, retainers or braces
- misalignment of jaw fractures after a severe injury
Malocclusion is grouped into three classes, it explains. In Class 1, the most common, the bite is normal but the upper teeth slightly overlap the lower teeth. In Class 2, also called overbite, the upper jaw and teeth severely overlap the lower jaw and teeth. In Class 3, also called underbite, the lower jaw juts forward.
BOS lists some of the most common reasons people seek orthodontic treatment. They include protruding upper front teeth, which it calls one of the most common dental problems; crowding, where a narrow jaw may leave too little room for the teeth, or the opposite, significant gaps; asymmetry, where the centre lines of the upper and lower front teeth do not match, perhaps because the teeth have drifted or the jaw position has shifted; a deep bite, where the upper teeth cover the lower teeth too much; a reverse bite, where the upper teeth bite inside the lower teeth; an open bite, where the front teeth stay apart when the back teeth meet; and impacted teeth, which come through in the wrong position or do not come through at all.
Crowding, gaps, overbite, underbite, crossbite, open bite and protruding front teeth each have their own page; browse this section to find yours.
What can orthodontic treatment achieve?
Orthodontic treatment can line up crowded or spaced teeth and correct how they bite together, BOS says. It lists the benefits of orthodontic treatment as including:
- removal of dental crowding or closing spaces
- alignment of the upper and lower dental arches
- correction of the bite of the teeth so that the front teeth meet on closing and the back teeth mesh together
- reducing the likelihood of damage to prominent teeth
- accommodating impacted, unerupted or displaced teeth
- preparation for advanced dental treatment, such as crowns, bridges or dental implants
- reversing the drifting of the teeth in older patients who have suffered from advanced gum disease
BOS adds that once you can bite together correctly, you can eat more comfortably and care for your teeth and gums more easily, and that correctly aligned teeth are much easier to keep clean with brushing and flossing.
Research on gum health is less certain. A 2008 systematic review found weak evidence suggesting that orthodontic treatment was associated with small increases in gum recession (0.03 mm), bone loss (0.13 mm) and pocket depth (0.23 mm) compared with no treatment, and effects on gum inflammation (gingivitis) and attachment loss that were inconsistent across studies. Its authors found an absence of reliable evidence of positive effects on gum health, and concluded that the existing evidence suggests small detrimental effects.
Orthodontics is not the only option. Discussing alternatives, BOS says some people have crowns or veneers fitted instead to mask the irregularity, and that whether this suits you needs good professional advice and a full assessment of the risks and benefits. The drawbacks it lists are that preparing the teeth is, to a greater or lesser extent, a destructive and irreversible process; that crowns or veneers cannot be expected to last indefinitely, so replacements are needed over the years; that there are definite limits to how much irregularity can be tackled successfully this way; and that there may be adverse effects on the gum tissues over the years where crown or veneer edges encroach on the gums.
BOS also says doing nothing at all is an option that must not be overlooked.
How do braces and aligners work?
Braces and aligners work by applying force to the teeth so that they move gradually into the desired position, BOS explains.
For a fixed brace, BOS says the brackets are simply glued to the faces of the teeth, and metal bands may also need to be cemented round the back teeth. A wire runs through the brackets, and tiny elastic rings, which are available in different colours, are mostly used to hold the wire into the brackets.
Aligners work in a series, BOS explains: a succession of clear, flexible plastic trays is worn, each bringing the teeth a little closer to the desired position.
In both cases, BOS says, the teeth move within the jaw bones. The parts of a tooth, from enamel to root, are explained on our page about how a tooth is built, and the biology of movement has its own page on how teeth move in orthodontic treatment.
What are the four phases of orthodontic treatment?
This guide divides orthodontic treatment into four phases, or stages: assessment and planning, active tooth movement, settling, and retention. Settling and retention both start when the brace comes off, so the two overlap.
Retention is treated as a phase of its own rather than an afterthought. BOS advises that retainers are explained at the start of treatment, and a 2017 narrative review says retention and the potential for relapse must form a key part of informed consent before orthodontic treatment begins. The table summarises each phase from BOS guidance.
| Phase | What happens, in general | Source |
|---|---|---|
| Assessment and planning | The teeth and gums are examined, and the options and retainers are discussed | BOS |
| Active tooth movement | A brace or aligners apply force to move the teeth | BOS |
| Settling | The tissues and bone around the roots adjust to the new tooth positions | BOS |
| Retention | Retainers help prevent the teeth moving once the brace is removed | BOS |
What generally happens at each stage, from the first assessment to having braces removed, is set out on our page about the orthodontic treatment process.
Phase 1: assessment and planning
In general, BOS says an orthodontic assessment starts with an examination of the teeth and gums, and you may need X-rays or photographs. The possibilities for treatment are then discussed and a way forward agreed, and impressions or moulds of the teeth may be taken. BOS says it is very unlikely that braces would be fitted at the first appointment.
BOS advises that the clinician providing your treatment should, among other things, outline all the different treatment options with their risks and benefits, estimate how long treatment should take, explain about retainers at the start of treatment and the likely need for lifelong wear, explain how likely the teeth are to stay in their new position, and give you thinking time to decide.
Extractions are part of some treatment plans. BOS says that in some patients extractions are necessary to align crowded teeth or correct the bite, and that the decision can only be reached on the basis of a detailed case assessment.
Phase 2: active tooth movement
Active tooth movement is the phase in which the brace or aligners do their work. BOS explains that biological processes get under way around the tooth roots to allow the teeth to move.
Phase 3: settling
Settling is the period after the brace comes off when, as BOS describes it, the tissues and bone around the roots adjust to the new tooth positions. BOS says relapse is a particular risk in the first months after a brace comes off, and is especially likely where treatment is very fast or retainers are not provided appropriately. It notes that teeth can take at least a year for the jawbone and gums to settle. Even in the longer term, BOS says, the risk of relapse remains, and it advises continuing retention for the long term.
A 2015 narrative review in the British Dental Journal adds that relapse can also come from deflecting contacts between the teeth if the final bite is less than ideal.
Phase 4: retention
Retention is the phase in which retainers hold the teeth in their new positions. BOS says retainers are not an orthodontic appliance, because they do not move the teeth, but that they are essential in almost all cases to help prevent the teeth moving once the braces are removed. Retainers can be removable or fixed, BOS explains.
To ask about orthodontic treatment, book online or call 0114 288 2121.
What are the orthodontic appliance options?
Orthodontic appliances are either fixed to the teeth or removable, and BOS says fixed braces remain the most popular type.
Fixed braces now come in a wide range of types, BOS explains, including metal, ceramic (tooth-coloured) and lingual braces, which are fitted behind the teeth. It describes aligners as custom-made, clear plastic trays that fit snugly over the teeth, gradually shifting them into the desired position.
Fixed metal, ceramic and lingual braces and clear aligners are offered at Deepcar Dental Care, provided by our dentists.
Orthodontic treatment at the practice is for adults only. The orthodontic problems treated include mild to moderate crowding and spacing, and bite correction. Complex and extraction cases are assessed case by case; some need braces or a combined approach.
Each type of brace has its own page among the options in this section, and aligners are covered on our page about clear aligner therapy.
How does orthodontic treatment work for adults?
Orthodontic treatment for adults does not really differ from treatment at other ages, BOS says. Age is no barrier, provided the teeth and gums are healthy.
One 2025 review looked only at adults. It included 35 studies with 2,611 participants and found a significant improvement in dental self-confidence after treatment with fixed braces on the front of the teeth. It also concluded that aligners may have less impact on oral health-related quality of life than those braces, and called for further randomised trials.
How long do braces take?
Comprehensive orthodontic treatment with fixed braces takes less than 2 years on average, a 2016 systematic review of prospective studies in university settings found.
The review pooled 22 studies with 1,089 participants and found a mean treatment time of 19.9 months, with a mean of 17.8 visits in the 5 studies that reported visits.
BOS explains why a relatively short treatment of the front teeth is not always a long-term solution: often there is not enough time to move the whole tooth, including the roots, into the right place, so the teeth may soon return to their original positions after the braces come off.
As general guidance, fixed braces usually take around 1 to 2 years. Clear aligner treatment depends on how far the teeth need to move: small front-tooth corrections can take a matter of months, and fuller treatment often takes 12 months or more. For braces or aligners, your consultation confirms the expected length for your teeth.
How much does orthodontic treatment cost?
The practice’s current fee list, which gives “from” prices, shows this price:
- Clear aligners: from £1,495 per arch
The fee list does not say whether the £1,495 per arch line covers fixed metal, ceramic or lingual braces. Retainers and orthodontic consultations have no line on the fee list. Our page about what it costs explains orthodontic costs further.
Is orthodontic treatment uncomfortable?
Some discomfort is likely at the start of treatment and usually settles within a few days, BOS says, though the amount varies enormously between people.
BOS says fitting a fixed brace should not be painful and needs no anaesthetic. As the teeth begin to move, you can expect some aching, and the teeth will be tender to bite on. This usually settles in a few days, although some people stay tender for longer, and further discomfort may follow later adjustments, depending on what has been done. BOS says it may help to take normal painkillers for a day or two.
A 2017 Cochrane review of 32 trials found moderate-quality evidence that painkillers reduced pain at 2, 6 and 24 hours after orthodontic treatment, compared with no treatment or a placebo. Its trials included participants aged 9 to 34, so the findings are not specific to adults. A 2025 review of adult patients detected no difference in short-term pain between aligners and fixed braces on the front of the teeth.
NHS guidance says teeth may be sore for a few days after braces are fitted, and that you may need to eat soft food and take painkillers during this time. As non-urgent advice, it says to contact the team treating your braces if:
- your teeth are painful for more than a few days after your braces are fitted or adjusted
- you have braces and your gums are very red, swollen or painful
- your braces are broken
For clear aligners, as general guidance, mild pressure or soreness for the first few days of a new aligner is normal. If discomfort with aligners does not settle, tell the dental team treating you.
Daily life with braces, including cleaning and eating, is covered one topic per page, and the section's own page answers what does this section cover? in brief.
What are the risks of orthodontic treatment?
Orthodontic risks include effects on the gums and the bite, as well as relapse, BOS says.
BOS explains that the teeth are part of a complex biological system involving the gums, jaw bones and facial muscles. It lists gum disease or gum recession if the teeth are pushed out of the jawbone when there is not enough space for them. It also lists changes to the bite: teeth biting into the gum of the roof of the mouth and causing soreness, less contact between the teeth that reduces biting efficiency, or upper teeth pushed out so that they appear to stick out. It names relapse, where teeth return towards where they started, as one of the most common problems.
If you notice any of these changes, during or after treatment, show them to a dentist.
Changes to the tooth roots and white marks on the enamel are summarised, with their evidence, on our page about orthodontic treatment. If you notice white marks on your teeth, during or after treatment, show them to a dentist.
Do teeth move back after braces?
Teeth do tend to move back after braces and other orthodontic treatment, a 2017 narrative review explains, and orthodontics cannot predict who will relapse.
A 2015 narrative review in the British Dental Journal explains that the fibres around the teeth tend to pull them back towards their pre-treatment positions. It adds that ongoing growth of the face and jaws, and changes in the surrounding soft tissues, can also affect how stable the result is. The 2017 review notes that teeth can also move as a result of normal age changes.
A 2007 systematic review looked at studies with at least 5 years of follow-up after retention. It found that treatment of crowding resulted in successful alignment, but that crowding of the lower front teeth came back after retention and could not be predicted for any one person, on limited evidence. Its authors said meaningful conclusions were difficult to draw because many studies were retrospective and uncontrolled.
Because the extent of relapse cannot be predicted either, the 2017 review says clinicians need to treat every patient as if they have a high potential to relapse, and it advocates long-term retention. It also notes there is currently insufficient high-quality evidence on which type of retention or retention routine works better.
BOS says retainers are essential and should be universally recommended.
As general guidance, retainers are long term because teeth can move at any age, most people end up wearing them at night, and the retainer type and routine are given at the end of treatment; your plan confirms yours. Retainer types and care are covered on our page about keeping your teeth in their new position.
Frequently asked questions
How does the NHS decide who can have orthodontic treatment?
By the Index of Orthodontic Treatment Need, NHSBSA says. Grades 4 and 5 qualify, grade 3 is usually judged individually, and concern about the appearance of your teeth, jaw or face may also qualify. Under-18s with a clear health need get it free. For adults, it is not usually available but may be approved case by case for health reasons.
How often are appointments during orthodontic treatment?
In general, every few weeks. BOS says you will usually need regular appointments every four to ten weeks, and that it is not advisable to start treatment if you know you will not be able to keep these appointments. NHS guidance says that after fixed braces are fitted, there is an appointment every 6 to 8 weeks to adjust them.
Does moving house during treatment affect it?
It can add time. BOS advises avoiding a change of clinician part way through treatment if possible, and says research has shown treatment takes an average of six months longer in transfer cases. If you know you are about to move, BOS says it is better to wait, and that you should give as much notice as possible.
Can orthodontic treatment be sped up?
Evidence suggests not, for vibration or light. A 2023 Cochrane review of 23 trials in younger patients and adults, of low to very low certainty, suggests no additional benefit from light vibrational forces or photobiomodulation (low-level laser or LED light) for reducing treatment time. A possible limited benefit of light in some phases must be interpreted with caution, it says.
What should you ask before starting orthodontic treatment?
Ask about time, stability, retainers, risks and cost. BOS suggests questions including how long treatment will take, whether the end result will be stable, whether you will have to wear retainers and for how long, what the risks are, and how much treatment will cost in total, including whether that covers any breakages and retainers.
Is straightening your teeth at home safe?
BOS warns against it. It says that online advertising and social media from some companies suggest you can get a straighter smile at home without seeing a dentist, and that there are serious risks associated with this kind of DIY orthodontics.
Do lingual braces affect speech?
They can. A 2025 review of adult patients concluded that lingual braces, fitted behind the teeth, have a persistent impact on speech, despite some adaptability. It also concluded that any deterioration in oral health-related quality of life during treatment appears temporary, and called for more randomised trials. If speech changes concern you, tell the team treating your braces.
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