Fixed Braces: A Very Precise Way to Move Teeth
Fixed braces, including metal train track braces, are brackets glued to the teeth and joined by a wire that moves them over time. For adults weighing them up: how they work, what reviews compare with aligners, adjustments, discomfort, duration and debond day. The core point: the British Orthodontic Society says fixed systems allow greater three-dimensional control than removable treatments; review findings depend on the case.
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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, reviewed this page. He is a General Dental Practitioner: BDS, BSc (Hons), MSc (Leeds), PG Dip Implant Dentistry, PG Cert Restorative and Aesthetic Dentistry.
How do fixed braces work?
Fixed braces apply a small amount of pressure through a wire joining brackets on the teeth, which moves them over time, NHS guidance explains.
The British Orthodontic Society (BOS) says fixed appliances, or fixed braces, come in metal, ceramic and lingual (fitted behind the teeth) types. Conventional metal ones are often termed train tracks. BOS describes the main parts:
- Brackets: attached to each tooth with tooth-coloured filling material (composite resin), a step known as bonding.
- Archwire: the wire held in the brackets. BOS says treatment moves on to thicker wires, which can place greater forces on the teeth; some people call this tightening.
- Ligatures: elastic rings tie the wire to each bracket. BOS says they can discolour between visits.
- Self-ligating brackets: an alternative with a built-in clip in place of elastics, letting the wire slide more freely, BOS explains.
BOS says fixed braces are most commonly silver-coloured metal, usually fitted to the outside of the teeth, while tooth-coloured materials are more discreet. Why pressure moves a tooth is on our page about how teeth move in orthodontic treatment.
What do reviews compare between fixed braces and aligners?
Reviews comparing fixed braces with aligners report differences by type of case and tooth movement, and each sets limits on its findings.
BOS says all brace systems fixed to the teeth allow greater three-dimensional control than removable treatments and can treat and improve a wider range of problems. It also says fixed appliances can produce very precise tooth movement.
An archived BOS page, copyright 2014, says routine aligner treatments include mild to moderate irregularity, crowding correctable by mild to moderate arch expansion or by reducing tooth width, and mild spacing. Its examples of aligner treatment that may need added techniques, such as fixed appliances, are severe crowding, extractions, complex movements and problems with jaw size or position.
| Review | What it compared | What it reported |
|---|---|---|
| 2025 review, searched to February 2025 | 15 studies, 5 of them randomised trials, 1,084 patients | Without extractions, pooled scores for treatment quality went each way (two studies of broader severity favouring braces, two of milder cases favouring aligners) and two randomised trials found no significant difference, at very low certainty. With extractions, four pooled studies favoured fixed braces, at low certainty, though its summary table reports no significant difference. Duration without extractions did not differ significantly, though sensitivity analyses suggested aligners were shorter; with extractions it went each way by case type. Both very low certainty. Limited evidence, with short follow-up, indicated similar stability after treatment. |
| 2026 review, searched to September 2024 | 12 studies of front-tooth movement in adults, 2 of them randomised trials | Mixed by movement. Torque (root angle): 1 study favoured fixed braces, 1 found no significant difference. Extrusion (moving a tooth further out of the gum): 3 favoured aligners, 2 fixed braces. It concludes fixed braces appear to offer superior rotation and torque control, on limited evidence from a small number of studies. |
| 2019 review of studies from 2005 to 2018 | 8 university studies, 2 of them randomised trials: one aligner system against braces in 706 people | It concludes both were effective and aligners had an advantage in moving teeth in segments. Treatment without extractions was shorter with aligners (pooled from 3 studies), though one extraction trial ran 31.5 months with aligners and 22 with braces. Aligners might not be as effective for biting contacts, torque, arch width (two studies, pointing different ways) and retention (one study, alignment only). An overall score from two studies showed no significant difference, to be read with caution. Among its limits, newer studies reported better aligner outcomes. |
The 2025 review's abstract says both appliances effectively achieve treatment goals, and that case complexity and compliance should guide selection. Its full text concludes that aligners may achieve comparable outcomes in mild to moderate non-extraction cases, with potential advantages in treatment duration and patient comfort, and that fixed braces show superior control in complex cases, particularly extractions. Its extraction result is low certainty, and its summary table shows no significant difference. Most of its studies did not incorporate recent aligner developments, it notes, which limits how far the findings apply to current clinical practice. The full comparison has its own page on choosing between fixed braces and aligners.
How often are fixed braces adjusted?
NHS guidance gives adjustment appointments every 6 to 8 weeks for fixed braces; BOS says regular appointments every four to ten weeks are usual.
A 2016 systematic review of prospective studies in university settings averaged 17.8 visits for comprehensive treatment, from 5 studies. BOS says it is not advisable to start treatment if you know you cannot keep these appointments. Each stage is set out on our page about the orthodontic treatment process.
As general guidance, fixed braces have an adjustment roughly every 6 to 8 weeks, and your consultation confirms this.
Do fixed braces hurt?
Having fixed braces fitted should not be painful and needs no anaesthetic, BOS says, but the teeth are likely to feel sore afterwards.
BOS's 2019 treatment leaflet says slightly sore teeth for 3 to 5 days are common after fitting and after each adjustment. BOS's FAQs add that some people stay tender for longer, and that discomfort varies enormously from person to person. NHS guidance says you may need soft food and painkillers in the first few days.
As non-urgent advice, NHS guidance 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
Cleaning, eating and daily life with braces have their own pages: browse this section.
How long do fixed braces take?
NHS guidance describes a fixed brace as staying in place for 1 to 2 years, and BOS says more difficult problems may take longer.
A 2016 systematic review of prospective studies in university settings found comprehensive treatment averaged 19.9 months across 22 studies and 1,089 participants. NHS Lothian says usually 24 to 30 months for most people, and some cases involving jaw surgery or restorative treatment may take longer.
As general guidance, fixed braces usually take around 1 to 2 years, and your consultation confirms this.
Questions about this treatment? Book online or call the practice.
What happens on debond day?
Debond day is when fixed braces are removed at the end of treatment and a retainer follows, NHS Lothian explains.
BOS says conventional metal braces can easily be removed, leaving the teeth intact, and that ceramic ones are slightly more difficult to remove but unlikely to damage healthy teeth in most cases, though its FAQs add a slightly higher risk of damage to the tooth surface. On removing the remaining glue, a 2024 review of 27 studies, 25 of them in the laboratory, with varying bias, found some methods used alone left much rougher enamel, and a two-stage method seems optimal for preserving it.
A 2025 review of 15 studies of pain during removal, 886 patients aged 12 to 65, reported on added techniques: two studies found less pain with a wafer to bite on, one with finger pressure and two no significant difference between methods.
NHS guidance says you will need a retainer to stop the teeth moving back. BOS says relapse is a particular risk in the early months after removal and remains in the longer term. Types and care are on our page about keeping your teeth in their new position.
What are the risks of fixed braces?
Fixed braces can affect the teeth, gums and roots, a 2006 BOS leaflet explains.
- Roots: all brace work causes minor root changes. This is not usually a problem, but changes can occasionally be more serious.
- Marks on the teeth: poor cleaning, or frequent sugary food and drink, risks lasting white or brown marks. If you notice any, show a dentist.
- Gums: most people have a little redness and swelling, usually gone once the brace is removed, but poor brushing may cause very swollen gums and lasting damage. If your gums are very red, swollen or painful, NHS guidance says to contact the team treating your braces.
When should you speak to a dentist about fixed braces?
Before fitting, mention any front tooth that has been knocked or damaged, NHS guidance says, as it may need further treatment while you wear braces.
During treatment, NHS guidance says to keep having regular dental check-ups, and BOS says your teeth are at greater risk at this time. BOS's 2006 leaflet adds that a previously knocked tooth may become dark. If that happens, show a dentist.
Are fixed braces priced on the practice's fee list?
The practice's current fee list does not name fixed braces, and it does not say whether any of its lines covers them.
Does the practice offer fixed braces?
Yes. Fixed metal, ceramic and lingual braces are offered at Deepcar Dental Care, and orthodontic treatment at the practice is for adults only.
See orthodontics at Deepcar Dental Care for the treatments offered.
Frequently asked questions
Can adults have metal braces?
Yes, in general. NHS guidance says adults can also have braces, and an archived BOS page, copyright 2014, says teeth can be moved at any age as long as the teeth and gums are healthy. It adds that adults may want different treatment end points.
Are fixed braces available on the NHS?
Not usually, for adults. NHS guidance says braces are usually only free on the NHS for people under 18 who have a problem with their teeth, and that people aged 18 or over usually pay. The NHS Business Services Authority says adult care is not usually available but may be approved case by case if needed for health reasons.
Do self-ligating brackets work better than conventional ones?
Not shown on most measures. BOS says there is no evidence the clip gives a better result. A 2021 analysis of 30 trials and 9 split-mouth studies, searched to January 2019, found most measures did not differ significantly; one type made wire changes quicker, another made fitting or removing one wire size more painful.
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Patient reviews of Deepcar Dental Care are on our patient reviews page. Ceramic and lingual braces are among the options in this section.
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