Braces are a common orthodontic treatment used to straighten teeth and correct bite issues. When properly executed, braces are an effective way to achieve a beautiful, healthy smile. However, there are cases when braces do not fully achieve the desired results.
Why do people get braces?
There are several reasons why someone may need braces:
- Crooked, overlapping, or gapped teeth
- Overbite or underbite
- Crossbite
- Open bite
- Deep bite
- Crowding
- Spacing between teeth
- Jaw misalignment
Braces exert gentle pressure on the teeth to slowly shift them into a straighter, properly aligned position over time. It takes anywhere from 18-24 months on average to achieve the full results from braces.
Do braces always work perfectly?
Unfortunately, braces do not work 100% of the time. There are several reasons why braces may fail to deliver the expected results:
Poor compliance with orthodontic instructions
Braces require commitment from the patient to follow care instructions diligently. Poor compliance can lead to sub-optimal results. This includes:
- Not wearing rubber bands as directed
- Repeatedly missing appointments
- Not practicing proper oral hygiene
- Eating restricted foods against recommendations
- Failing to wear retainers after braces come off
Unexpected jaw growth
Braces are applied based on the expected jaw growth of a patient. If the jaw grows more or less than predicted, it can alter the outcome of treatment. This tends to happen most in younger teenagers.
Undetected habits
Habits like tongue thrusting or teeth grinding can apply forces that work against braces. If not addressed, these habits can limit brace success.
Complex cases
Severely crooked teeth or complex bite issues can be difficult to fully fix even with braces. Cases with multiple problems pose more of a challenge.
Limitations of technology
Though greatly improved, brace technology still has some limitations. In a small percentage of cases, the technology falls short of delivering the desired outcome even when executed properly.
How often do braces fail?
Fortunately, outright failure of braces is relatively uncommon. With compliant patients and proper oversight, orthodontists report a success rate of about 85-90%. Here are the approximate statistics:
| Treatment Result | Percentage Frequency |
|---|---|
| Ideal final result | 70-75% |
| Acceptable final result | 10-15% |
| Compromised result | 5-10% |
| Failed result | 1-5% |
As the data indicates, complete failure is uncommon. However, there is a percentage of cases where the final results are less than the ideal outcome, with teeth not perfectly straight or aligned.
Reasons for braces failure
Here is a more in-depth overview of some of the top reasons why braces may fail:
Poor patient compliance
As previously noted, the patient plays a pivotal role in the success of braces treatment. Lack of compliance to orthodontic instructions can sabotage results and lead to teeth shifting right back to their original crooked positions. This may include:
- Not wearing elastics or headgear as directed
- Repeatedly missing appointments for wire tightening
- Not wearing retainers after braces come off
- Failing to practice proper oral hygiene
- Eating foods that can damage braces
Unanticipated growth changes
Braces are applied based on a patient’s expected jaw growth. Growth prediction is more of an art than a science. If growth differs significantly from projections, it can alter the outcome. For example, if the lower jaw grows more than expected, it can cause a relapse of an underbite.
Undiagnosed skeletal jaw discrepancies
Sometimes skeletal jaw issues like a narrow upper palate or overjet are not detected initially. Braces alone cannot fully correct skeletal mismatches between the upper and lower jaws. Orthognathic surgery may be required accompanying braces for ideal results.
Complex dental situations
Seemingly simple cases can sometimes prove more challenging once braces are initiated. Teeth may be overly crowded or severely twisted in position. Crossbites, overbites, or other complex bite issues can also make teeth harder to align. Additional interventions may be needed in difficult cases.
Undetected parafunctional habits
Parafunctional habits like tongue thrusting, teeth grinding, or lip sucking can undermine braces progress by exerting pressures that counteract brace forces. Unaddressed habits like these increase the chance of a compromised outcome.
Premature removal of braces
Occasionally braces may be removed earlier than recommended. This is sometimes done because a patient is tired of wearing braces ororthodontic treatment falls behind schedule. Premature brace removal typically results in relapse.
Failure to wear retainers
After braces come off, teeth have a natural tendency to drift back toward their original positions. This is why retainers are a vital part of orthodontic treatment. Not wearing retainers as directed is a common reason for teeth to shift and “relapse”.
Options if braces fail
For patients who experience a compromised or failed outcome with braces, there are options to improve the result. This may include:
Additional standard braces
More cycles of braces can sometimes achieve further improvement. This is generally the least invasive approach.
Invisalign clear aligners
Invisalign is removable and less noticeable than metal braces. It applies light forces to continue moving teeth in the right directions.
Orthognathic surgery
Surgery is done to realign the jaws and get desired occlusion. This is followed by more orthodontic treatment to idealize the bite.
Dental restorations
Veneers, crowns, or reshaping procedures may mask imperfections and create desired aesthetics after braces.
Extraction of teeth
Removing compromised teeth followed by orthodontic space closure can improve crowding and alignment in some cases.
Preventing brace failure
While braces do not work perfectly every time, there are things that can improve the chances of success:
- Select an experienced, reputable orthodontist
- Follow all orthodontic instructions closely
- Keep all brace adjustment visits
- Maintain excellent oral hygiene
- Use retainers as directed after braces
- Promptly address any issues like loose bands or wires
- Inform your orthodontist of any relevant habits
- Commit to the full braces treatment time
Do braces damage teeth?
When done correctly, braces do not damage teeth. However, there are some potential side effects to be aware of:
- Decalcification – Mineral loss showing up as white spots on teeth. Caused by poor cleaning around braces.
- Root resorption – Shortening of tooth roots. A rare side effect primarily with overly aggressive movement.
- Gum irritation – Bracket edges can irritate gums if not properly smoothed.
- Enamel scratches – Bracket removal can sometimes scrape the enamel surface.
Proper care and technique minimizes the risks of these brace side effects which do not happen to most patients.
Do braces work for adults?
It is a common misconception that braces only work for children and teens. But braces can be equally effective for adults. In fact, orthodontists are treating more adult patients than ever before.
Braces essentially move teeth by gently applying pressure over an extended length of time. Adult teeth can still shift and rotate just like teenage teeth given enough time with braces. However, there are a few considerations with adult braces:
- Treatment may take a little longer than with younger patients
- Teeth may be more prone to loss of vitality when moved
- Root resorption risks increase slightly in adults
- Gums may be more likely to recede with orthodontic movement
- Higher importance of excellent oral hygiene
- May require jaw surgery for ideal results in some cases
But none of these factors prevent adults from having a successful outcome with braces. Clear aligner options like Invisalign are also popular cosmetic alternatives to braces for adult patients.
Can braces fix bite problems?
Yes, braces are an excellent treatment for resolving various types of bite problems including:
Overbite correction
Braces close excessive vertical overlap of front teeth. Headgear, elastics, or bite ramps assist this process.
Underbite correction
Braces coordinate upper and lower arch movement to reduce underbite. Retainers help stabilize improvement.
Crossbite correction
Carefully orchestrated archwire adjustments shift teeth into proper alignment to fix crossbites.
Open bite closure
Elastics and vertical control help bring down overerupted back teeth and close open bites.
Crowding alleviation
Dental expansion widens the arches while braces push back teeth to resolve crowding issues.
In moderately severe cases, some form of jaw surgery may be recommended along with orthodontic treatment for maximum correction of problematic bites.
Conclusion
While braces are an excellent treatment option for improving the alignment and occlusion of teeth, no orthodontic solution is 100% effective 100% of the time. Though uncommon, braces can fail or deliver less than ideal outcomes in a minority of cases.
Reasons for suboptimal brace results include poor patient compliance, unexpected growth changes, complex cases, unidentified habits, and premature removal. Working closely with an experienced orthodontist and adhering to instructions can maximize the chances of achieving a successful outcome with braces.
For patients who do experience brace failure, options include additional standard braces, clear aligners, jaw surgery, dental restorations, or tooth extraction. With patience and persistence, significant improvements are still achievable in challenging cases.
