How Long Does it Take for Braces to Work? Get Answers in this Q&A With Doctor Mike Depascale

Today we will discuss braces treatment time with two members of the Kozlowski Orthodontics team: Dr. Mike DePascale, an orthodontist, and Sara Neigel, a Treatment Coordinator. These two will provide us with expert insights on patient treatment time and how long different teeth issues may take to treat. We also will tackle the age-old question of how long braces take to work.

Professional Background: Dr. DePascale and Sara have seen over 2,400 patients in the last three years.

Q: Okay, the first question that every new patient wants to know: How long does it take for braces to work?

A: Dr. DePascale: I actually love this question. I know that some orthodontists don’t like it or get defensive when asked because they fear they’ll be held to that decision, but my opinion is that we should be held to it. We should be precise and honest and deliver on our word. I like this especially with kids because children’s teeth move a lot more predictably, so there are less variables, but even with adults, we can give a clear picture. One of the things we tell patients when they ask how long braces will take is that it will often happen faster than they think it will. Braces will start working within the first few hours, but the total treatment time can vary. Often, there are issues like an overbite or crossbite that still need to be addressed, despite the teeth appearing aligned and straight. This is where patient education comes in. Patients need to be informed that there is far more to a beautiful, healthy smile than just straight teeth, so it’s important to have the conversation with the patient early on about what we are doing and why we are doing it. In short, braces will start working within the first day, you’ll see changes within weeks to the first few months, and the total time will vary significantly based on complexity. And, with Damon Systems in particular, we have found that the earlier stages are a lot smoother. Often, we see significant changes even at the first visit back (which is approximately two months). One of the things we hear from patients often is they can’t believe how fast the movement took place.

A: Sara: Well, the short answer is in four to six hours when your teeth are sore. At that point, you know that your braces are working because once you feel the soreness, you know that your teeth are moving. Some patients will see teeth that they notice are straightening out really quickly in a few weeks. For crowding issues, patients will typically start seeing substantial results in about 4 months.

Q: Can you speak in detail about the time of treatment that is needed to treat different teeth alignment issues? In your experience, what causes those timelines to vary?

A: Dr. DePascale: In my experience, the degree of malocclusion (poor alignment of upper and lower teeth) itself is the biggest factor that determines treatment time. Severe Class II malocclusions (those with an overbite) are typically the most involved cases and can take the most time. These cases are severe enough that some may consider surgical correction. However, we have been very successful treating many cases without surgery using a combination of braces, elastics, and potentially other appliances. The severe Class II cases (when the upper jaw and teeth severely overlap), can take up to two and a half years to treat in our office. Most other cases, including extractions, will take 15-18 months. Cases that are on that shorter side are typically Class I malocclusions, where there is mild to moderate crowding. Average treatment time for all cases in our office, including the most severe Class II treatments, is about 18 months, meaning that some patients can be treated in as little as 8-12 months by our team. We see a wide variety of malocclusions, which is why diagnosis is important and there is so much variability in the length of treatment.

Q: Are there any common issues with patient compliance that in your experience has led to longer than needed treatment times?

A: Dr. DePascale: There are times when patient compliance plays a significant factor, but that is often overstated. Sometimes patients do not get the proper education upfront and they don’t always know why they need to wear their elastics. We educate our patients from the first day. We are very focused on taking the time to explain why wearing your elastics is so important at the start of treatment. We take photos at every visit to show patients their progress. We can show them at every appointment where they stand compared to their previous visit and where we still need to get to.

We can show them their progress and praise them if they are doing great and educate them if they are missing somewhere and we are not on track. When we bond twin brackets, not Damon System’s self-ligating brackets, we add the elastics the same day as the brackets go on, which is not something most practices do. However, we do this because we are doing as much as we can from the start. Furthermore, we make sure to address the issue during the next visit if a patient is not wearing their elastics so it does not become a consistent struggle. It would be unfair to say patient compliance isn’t a factor, but it’s not as big of a factor as is suspected if handled by the doctor and team properly. It is rare that we do not finish a case on time because the patient does not wear their elastics.

A: Sara: Adding elastics sooner in the process, helps with compliance through education. If the patient knows why wearing elastics is important, they’re more likely to stick with the process and remain compliant. Like Dr. Mike said, the sooner we start elastics to correct the bite, the faster we can finish treatment.

Q: Okay, last question. Are there any advantages Damon Systems have in helping with treatment time or overall performance?

A: Dr. DePascale: Orthodontists will all have different opinions on this, but I will give you mine. The difference with Damon brackets is that they are passive, self-ligating brackets, meaning there is a door and not an elastic tie to hold in the wire. Simply put, this results in less friction on the brackets and teeth move more efficiently in the beginning. I also believe the process is more comfortable for the patient because you need less force to move the teeth. We treat a lot of severely crowded cases without removing teeth; I would not feel confident treating with twin brackets, and I have practiced with both. Since we see a lot of crowded cases, using Damon brackets helps us keep our treatment time down and efficiency up. We can also see patients every 8-12 weeks instead of shorter intervals, while not having to worry as much about hygiene with elastic ties because the absence of elastic ties can help improve oral health. The Damon System allows us to have more predictable treatment because there is far less unwanted teeth movement. This, combined with proper diagnosis and doctor knowledge, allows the patient to be treated in far fewer appointments.

To learn more about the Damon Braces products available at Kozlowski Orthodontics you can visit their site at:

The opinions expressed are those of Dr. DePascale and Sara Neigel. Ormco is a medical device manufacturer and does not dispense medical advice. Patient results may vary. Clinicians use your own judgment in treating your patients.