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Braces can straighten your teeth, correct bite issues and enhance the appearance of your smile. But they can be uncomfortable, too. “The wires and brackets protrude into your lips and cheeks, which can cause soft tissue lacerations and ulcers,” says David Chen, D.D.S., a dentist at Jackson Ave Dental in Long Island City, New York. And because they put pressure on your teeth, braces can cause pain—especially after adjustments.
Other reasons people may want to avoid braces include difficulty with oral hygiene, aesthetics, periodontal disease or a high risk of cavities, says Karin Grinbaum, D.D.S, an orthodontist at Smiles + Grins in New York City. If you want a straighter smile but don’t want braces, there’s good news; a range of options for straightening teeth without braces are available, she says.
Invisible Aligners
“Invisible aligners are effective for many common alignment problems, including mild to moderate crowding, spacing issues, overbites, crossbites, underbites, rotations and tilted teeth,” says Daniel Weinstein, D.D.S., a dentist at ProHEALTH Dental in Howard Beach, New York.
“These are a series of clear ‘invisible’ custom fitting trays calibrated to move the teeth slowly,” adds Nile Davis, D.D.S., director of orthodontics at Risas Dental and Braces in Chandler, Arizona. Because they move teeth in a similar way as braces, aligners can cause discomfort, he says, but unlike braces, they’re removable when eating or brushing the teeth. Invisible aligners also typically have a shorter treatment duration than braces. For example, most Invisalign treatment plans take six to 18 months, whereas treatment with braces can take up to five years. Sometimes, rubber bands are used in conjunction with an invisible aligner treatment for complex tooth movements, says Dr. Chen. “They provide anchorage, leverage and force from a different angle to get the teeth to move,” he adds.
Retainers
“Certain types of retainers can move teeth in limited amounts,” says Dr. Davis. Still, they’re only usually recommended for very minor problems (such as adjustments to the teeth and bite), and are not effective for most individuals needing correction, he notes. To ensure a successful outcome, Dr. Davis recommends wearing your retainers as indicated.
“Removable retainers are an essential part of maintaining the benefits of various teeth corrections, whether achieved through orthodontic treatments, orthognathic surgery or spacing corrections,” says Dr. Weinstein. They ensure that the improvements in tooth alignment, jaw position or spacing are preserved over time, he says.
Palatal Expanders
“Palatal expanders can correct a narrow upper arch by expanding the palate to create more room for the teeth,” says Dr. Chen. Expanders may be used in conjunction with braces or clear aligners or before starting treatment with them, he explains.
Palatal expanders, inserted in the top arch of the teeth, are most often used for children ages seven to 13, notes Dr. Grinbaum. This is done to correct cases of crossbite (when the upper teeth sit behind the lower teeth instead of over the bottom teeth) and to create spaces for adult teeth to come in when their crowding is present, she says.
There are two types of expansion devices commonly used, which can be removable or fixed:
- Rapid palatal expanders (RPEs) are fixed, and made of plastic and metal and cemented in place by screws or hinges, which work to gradually make adjustments.
- Removable expansion appliances (REAs) are made of acrylic and are held in place with a clip or wire. They are removable for eating and cleaning.
Cosmetic Dentistry
Cosmetic dentistry, like porcelain veneers and bonding, can correct the appearance of mild teeth misalignments, says Dr. Chen. “However, I would caution that if you have severe malocclusion [a misaligned bite], you run the risk of damaging the veneers. Veneers with the best longevity are done on teeth with a harmonious bite,” he says.
Bonding or veneers work best for individuals who don’t like the size, shape or color of teeth, says Dr. Grinbaum. In other words, they give you an aesthetic upgrade, she says. Depending on the type, they can last anywhere between five and 10 years.
“Veneers are usually made from a porcelain-type material placed on the surface of the teeth to improve their shape and aesthetics,” says Dr. Davis. They require removing some of the surface enamel of your teeth. According to a 2019 literature review, porcelain veneers achieve excellent aesthetic and long-term results.
Bonding uses a similar process as veneers, but by applying a dental resin to the surface of the teeth (without altering your enamel), explains Dr. Davis. Bonding is a less expensive way to improve the color, texture or shape of the teeth, he adds.
Surgery
Technically, orthognathic (jaw) surgery does not straighten your teeth, says Dr. Chen. Rather, it corrects skeletal malocclusion, a developmental disorder causing malformation of the upper or lower jaw, he notes. One 2010 case report indicates that orthognathic surgery is typically performed when orthodontic issues are too severe to be treated with orthodontics on their own.
Surgery is often combined with other treatments, adds Dr. Chen. For example, suppose you have severe crowding with an underbite bite with the lower jaw protruding forward more than the upper jaw. In that case, you need orthodontic treatment like braces or invisible aligners to straighten the teeth before surgery, he explains. Once the teeth are straight, orthognathic surgery to correct jaw positioning is done, he says.
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