When Treatment Fails: The Limitations of Braces

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When we think of crooked or overcrowded teeth, braces are often the treatment that comes to mind. It’s true that braces have helped straighten teeth and brighten smiles for decades. But when it comes to jaw misalignment, however, treatment is a different story.

If braces have failed to correct your bite misalignment — or you’re seeking relief from jaw pain and discomfort — it’s important to understand the limitations of this common corrective treatment.

How Braces Work

Knowing the basics of how braces work can make it easier to understand where they are useful and where they are not. Braces are used to correct a variety of issues with the teeth, including overcrowding and crookedness.. 

They are typically composed of metal brackets and wires. Bonding material is also used to attach braces to your teeth. Ceramic braces, which are less visible than metal braces, are a popular option. Lingual braces are placed behind the teeth, and invisible braces can be taken on and off throughout the day.

While there are a number of options for braces, most of them work the same way. On a fundamental level, braces are designed to put pressure on the teeth to change their position.

“When a tooth is subjected to pressure from one side, its root presses against the underlying alveolar bone,” they write. “Eventually, this force causes a portion of the bone next to the root to dissolve, allowing the tooth to move in the direction it is being pushed.”

New bone builds up in the space vacated by shifting teeth, allowing the teeth to move into the desired position permanently. When it comes to crooked and misaligned teeth, braces are a great option. 

But what about issues of jaw alignment and bite challenges? 

Braces can sometimes help with misaligned bites when the malocclusion is the result of teeth positioning, but the ability of braces to reposition a jaw isn’t guaranteed. A more severe underbite or overbite might require a deeper intervention beyond what braces can achieve. 

The side effects of a misaligned jaw can vary greatly from person to person. Some people suffer from pain or stiffness in the jaw, particularly when chewing. Trouble breathing through the nose is another effect of a misaligned jaw. Patients might also experience trouble sleeping, as lying on one side of the face might place extended pressure on a jaw that’s already sore.

If you suffer from frequent or chronic headaches or earaches, consistent jaw pain, clicking of the jaw, the inability to open your jaw all the way, or difficulty chewing or swallowing, you should consult with a medical professional.

What Braces Cannot Help With

For patients with an overbite or underbite due to misaligned teeth alone, braces can be a useful treatment option. Braces can straighten the teeth that cause the misaligned bite. Elastic bands can also be used to help realign the jaw. 

Still, braces aren’t always effective at providing long-term relief. In some cases, overbites, underbites and other malocclusions are caused by problems during the formation of the jaw bones. Those are the cases that require treatments beyond what braces can provide.

This isn’t the only limitation of braces, however, as there are complications that can arise after a course of braces.

Ankylosis

Ankylosis, the fusion of a tooth root to the bone below it, is one serious complication associated with braces. Patients experiencing ankylosis will not experience successful teeth re-alignment with braces. All of the surrounding teeth will start to move around the ankylosed tooth. Braces won’t allow for proper alignment of the teeth and bite.”

While ankylosis can’t be predicted, certain risk factors, such as tooth reimplantation, can put a person at higher risk of this complication.

Relapse

Relapse is another reason why braces fail to provide long-term treatment for the jaw, and it occurs more often than people realize. 

Relapse is when the teeth move and shift after braces. Specifically, relapse often happens when retainers — provided to prevent relapse after treatment with braces — aren’t used correctly.

If the retainers are not worn as instructed by the orthodontist, the risk of relapse is very high, especially immediately after the braces are removed.

Tooth Shifting

Moreover, it’s normal for teeth to move and shift as we age (especially during adolescence). Almost every patient experiences these changes to some degree, requiring long-term retainer use. The degree of misalignment in this instance is often subtle, but it can sometimes be dramatic and require additional treatment.

Orthodontists agree that retainers are essential for maintaining the work that braces achieved. Many of her current patients had success with braces during their childhood and teen years. Now in their 20s and 30s, however, these patients are faced with teeth that have shifted back into their pre-braces positions. 

Expectations vs. Reality

Whether succeed at treatment also depends on the patient’s expectations. Orthodontists must take care to ensure patients understand how braces will change their teeth after treatment. 3D modeling software is one of the best ways to establish these expectations.

The model can be used to show how the patient’s realigned teeth will look and if there are any potential limitations. 

Another factor that complicates expectations is mismatched jaw sizes. Variations in the ratio of teeth to jaw size also plays a role in how the teeth and jaws will appear after braces. The angulation of the teeth will only appear perfectly aligned if both the upper and lower jaws are similar in size. 

However, some patients may have upper and lower jaws that are different sizes, which can cause the teeth to tip in unexpected positions after braces. “If both jaws are small relative to the size of the teeth, both upper and lower teeth will be flared. If both jaws are bigger, the teeth may appear tipped back.”

These are just a few examples of how a person’s jaw and teeth size play a role in the final look of braces. Discussing expectations and goals with an orthodontist before and after braces can help ensure patients end up with a smile they’re proud of.

“Despite the best work of any orthodontist, it is not always possible to predict the precise outcome of teeth straightening procedures. This can lead to your smile still being slightly crooked after orthodontic devices are removed.”

Having a straight smile and a proper bite isn’t just important for cosmetic reasons. A person’s bite plays a role in many daily activities, and misaligned jaws and teeth can negatively impact your quality of life. 

A proper bite ensures you can speak and chew properly. It also helps relieve potential strain on the jaw joints, which can lead to headaches and jaw aches. People with aligned teeth may also find it easier to clean their mouths and practice proper oral hygiene, which in turn avoids uneven wear of tooth enamel and reduces the risk of gum disease.

Images by: gonewiththewind/©123RF.com, luckybusiness/©123RF.com, Javier Sanchez Mingorance/©123RF.com

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