Braces can straighten your teeth, correct bite problems and improve the appearance of your smile. But it can also be uncomfortable. “Wires and brackets protrude into your lips and cheeks, which can cause soft tissue tears and ulcers,” says David Chen, DDS, 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 tooth decay, says Karin Grinbaum, DDS, 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 number of options are available for straightening teeth without braces, he says.
Invisible aligners
“Invisible aligners are effective for many common alignment problems, including mild to moderate crowding, spacing problems, overbites, crossbites, underbites, rotations, and crooked teeth,” says Daniel Weinstein, DDS, a dentist at ProHEALTH Dental in Howard Beach, New York.
“These are a series of clear ‘invisible’ adjustment trays that are calibrated to move teeth slowly,” adds Nile Davis, DDS, director of orthodontics at Risas Dental and Braces in Chandler, Arizona. Because they move teeth in a similar way to braces, aligners can cause discomfort, he says, but unlike braces, they come off when you eat or brush your teeth. Invisible aligners also usually have a shorter healing time than braces. For example, most Invisalign treatment plans last six to 18 months, while braces treatment can last up to five years. Sometimes, elastics 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 move the teeth,” he adds.
Retainers
“Certain types of retainers can move teeth in limited amounts,” says Dr. Davis. However, they’re usually only recommended for very minor problems (like tooth adjustments and bite) and aren’t effective for most people who need correction, he notes. To ensure a successful outcome, Dr. Davis recommends wearing your retainers as directed.
“Removable retainers are an essential part of maintaining the benefits of various tooth corrections, whether achieved through orthodontic treatments, orthognathic surgery, or space corrections,” says Dr. Weinstein. They ensure that improvements in tooth alignment, jaw position or spacing are maintained over time, he says.
Palatal Expanders
“Palate expanders can correct a narrow upper arch by widening the palate to create more space for the teeth,” says Dr. Chen. Expanders can be used in conjunction with braces or clear aligners, or before starting treatment with them, she explains.
Palatal expanders, which are inserted into the upper arch of the teeth, are most often used for children ages seven to 13, notes Dr. Greenbaum. This is done to correct cases of crowding (when the upper teeth sit behind the lower teeth instead of on top of the lower teeth) and to create spaces for the adult teeth to come in when there is crowding, he says.
There are two types of extenders commonly used, which can be removed or fixed:
- Rapid palatal dilators (RPEs) they are fixed and made of plastic and metal and cemented in place with screws or hinges, which work to make incremental adjustments.
- Removable Expansion Devices (REAs) they are made of acrylic and held in place with clips or wire. They are removable for eating and cleaning.
Cosmetic Dentistry
Cosmetic dentistry, such as porcelain veneers and bonding, can correct the appearance of mildly misaligned teeth, Dr. Chen says. “However, I will caution that if you have a severe obstructive disorder [a misaligned bite], you run the risk of damaging the veneers. Veneers with the best longevity are made on teeth with a harmonious bite,” he says.
Bonding or veneers work best for people who don’t like the size, shape, or color of their teeth, Dr. Grinbaum says. In other words, they give you an aesthetic upgrade, he says. Depending on the type, they can last anywhere between five and 10 years.
“Veneers are usually made of a porcelain-like material that is placed on the surface of teeth to improve their shape and aesthetics,” says Dr. Davis. They require the removal of some of the surface enamel of your teeth. According to a 2019 literature review, porcelain veneers achieve excellent esthetic and long-term results.
Bonding uses a similar process to veneers, but by applying a dental resin to the surface of the teeth (without damaging your enamel), Dr. Davis explains. Bonding is a less expensive way to improve the color, texture or shape of teeth, he adds.
Surgery
Technically, orthognathic (jaw) surgery does not straighten your teeth, says Dr. Chen. Instead, it corrects skeletal malformation, a developmental disorder that causes malformation of the upper or lower jaw, he notes. A 2010 case report shows that orthognathic surgery is usually performed when orthodontic problems are too severe to be treated with orthodontics alone.
Surgery is often combined with other treatments, Dr. Chen adds. For example, let’s say you have severe crowding with an underbite with the lower jaw protruding more forward 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 is done to correct the jaw’s position, he says.
