Metal Braces in Ukraine

Braces are a fixed orthodontic appliance with three parts: brackets bonded to each tooth, an archwire that runs through the bracket slots, and ligatures or built-in clips that hold the wire in place. The archwire tries to return to its original shape and pulls the teeth with it through the brackets. Braces are called metal when the brackets are made of steel; the archwire is metal in every type, including ceramic and sapphire braces.

The classic bracket material is medical-grade stainless steel, less often titanium or gold-plated steel. The base has a retention mesh bonded to the enamel with light-cured composite adhesive, and the working part is a 0.018- or 0.022-inch slot that holds the archwire. The slot is what sets steel apart: metal does not chip under load, the slot keeps its shape over years of wear, and it creates less friction with a steel archwire than ceramic or plastic.

Metal braces are chosen above all when teeth have to move a long way or along a complex path: severe crowding, where premolars are extracted and the spaces then closed; displaced and impacted canines that have to be brought into the arch; deep bite and open bite; rotated teeth; and preparation for orthognathic surgery, when hooks and intermaxillary elastics are attached to the archwire. For teenagers, reliability is another argument: steel brackets come off less often and do not crack.

In some situations bonding is postponed or another option is chosen. Braces are not fitted until decay has been treated and gum inflammation has settled: plaque builds up faster around brackets, and an untreated cavity has two years to grow. They also do not suit people who are not prepared to spend a few minutes every day cleaning around each bracket. Nickel sensitivity is a separate issue; titanium or ceramic brackets are then considered. If invisibility matters a great deal to you, sapphire or ceramic braces, lingual braces or aligners are discussed, bearing in mind that they are less predictable than steel for large movements.

MediUkraine is a treatment search and coordination service, not a clinic. We select the clinic and the orthodontist, agree visit dates and support patients, including those travelling from abroad. The orthodontist decides on the type of braces and the treatment plan after an in-person examination and a review of the X-rays.

A bracket is a small attachment with three working elements. The base, with a retention mesh or laser etching, is bonded to the enamel with composite adhesive; the wings hold the ligature; the slot is a rectangular groove into which the archwire is seated. The shape and angle of the slot determine the future position of the tooth, so each bracket's position on the tooth is planned individually, not by eye.

The brackets are made from medical-grade stainless steel, the same group of alloys used to make surgical instruments. Steel does not stain from coffee, wine or turmeric, does not crack under the pull of intermaxillary elastics, and its slot does not deform over two years of wear. In practice, a steel wire in a steel slot creates less friction than in a ceramic or plastic slot, so less force is lost to sliding resistance and more goes into moving the tooth.

Depending on how the archwire is held, braces are either ligated or self-ligating. In a ligated system the archwire is secured with an elastic ring or a steel wire tie: this is cheaper and gives the doctor more control over how rigidly the tooth is tied to the archwire. In a self-ligating system the bracket has its own clip, either passive, which leaves the archwire room to slide, or active, which presses the archwire to the bottom of the slot. Self-ligating braces shorten visits and need no ligature changes, but cost more, and clinical comparisons show the difference in overall treatment time is smaller than advertising suggests.

The slot size is 0.018 or 0.022 inch. The wider slot is more common: it takes thicker rectangular archwires and is more practical when teeth have to move a long way with strong elastics. The narrower slot gives more precise control over the tilt of the crown and root in the finishing stages, because the archwire fills the slot more tightly. The orthodontist chooses the system for the clinical task, so there is no single answer to "which is better".

The angle of the slot and the thickness of the base are set in advance by the manufacturer; this is called the system's prescription. The most common prescriptions, Roth and MBT, distribute torque (tilt of the root) and angulation (tilt of the crown) differently for each group of teeth. A prescription saves time, because the appliance performs some of the movements without additional effort from the doctor, but it does not remove the need for individual bends: in real cases the orthodontist almost always adjusts the wire by hand.

Archwires are changed in sequence, from thin and flexible to thick and stiff. Treatment starts with round nickel-titanium wires of 0.012–0.016 inch: this shape-memory alloy produces a gentle constant force and aligns the teeth vertically and horizontally. Next come rectangular nickel-titanium wires of 0.016×0.022 and 0.019×0.025 inch, which start to control root position. The working phase (closing spaces, correcting the midline and using intermaxillary elastics) is done on rectangular steel archwires, because they hold their shape under load. For fine finishing, titanium-molybdenum wires of intermediate stiffness are sometimes used.

Besides the brackets and archwire, the system has auxiliary elements. Buccal tubes are bonded to the molars, or metal bands are placed when the tooth is damaged or a more reliable anchor is needed. Spaces are closed with elastic chains or nickel-titanium springs. Intermaxillary elastics, which the patient changes daily, correct the relationship of the jaws in Class II or Class III malocclusion. To make complex movements without the anchor teeth shifting, orthodontic mini-screws are placed: temporary titanium anchors in the bone that are removed once the stage is complete. Space for alignment is created either by extracting premolars or by interproximal enamel reduction, removing fractions of a millimetre of enamel from the sides of the teeth.

Steel braces remain the mainstay for complex cases precisely because of their strength. When an impacted tooth has to be brought into the arch, a tooth rotated, a 7–8 millimetre extraction space closed, or the jaws held with elastics before orthognathic surgery, the load on the brackets is high and prolonged. Under these conditions ceramic brackets chip at the wing more often, and rebonding means an extra visit and a pause in tooth movement. That is why steel is chosen more often than other materials in adolescent orthodontics and in surgical cases.

The main drawback is visibility, and people adjust to it differently. There are several ways to soften this: fitting steel only on the lower jaw and ceramic or sapphire brackets on the upper jaw, which shows when you smile; choosing smaller brackets; and, for teenagers, coloured ligatures that make the braces part of their style. Only lingual braces, bonded on the tongue side, are completely invisible, but they cost more, take longer to get used to and noticeably affect speech in the first weeks.

The second issue is hygiene. Around the base of each bracket there is an area that a toothbrush cannot reach with normal strokes: plaque is retained between the bracket wing and the gum margin and on the contact surfaces under the archwire. If it is not removed, white demineralised spots appear on the enamel within a few months and stay visible after the braces come off. That is why cleaning with braces is a different routine: a single-tuft brush goes round every bracket, an interdental brush passes under the archwire, and this has to be done after every meal, not twice a day.

For the first 3–5 days your teeth will ache: this is a normal response as the teeth start to move, not a complication. The pain is usually dull, worse when biting and most noticeable on the second day. Eat soft food during this time and take your usual painkiller if needed. In the first week the brackets rub the inside of the cheeks and lips: cover sore spots with orthodontic wax; within 7–10 days the tissues adapt.

Dietary restrictions apply throughout treatment. Do not bite on anything hard, such as nuts, rusks, ice, fruit stones, or whole apples and carrots: this is the most common reason brackets come off. Sticky foods such as toffee, chewy sweets and chewing gum pull at the brackets and clog the space under the archwire. Cut hard fruit and vegetables into pieces and take meat off the bone.

Cleaning takes about 5–7 minutes after every meal: first brush along the teeth with the orthodontic toothbrush, then go round each bracket from above and below with the single-tuft brush, then clean between the teeth and under the archwire with the interdental brush. A water flosser rinses away debris in a minute but does not replace mechanical cleaning. Have a professional clean at the clinic every 3–4 months, and use fluoride toothpaste and mouthwash daily from day one.

The first visible changes appear after 2–3 months, almost always on the front teeth, which have a single root and move faster than multi-rooted molars. This gives the false impression that treatment is nearly over, when the longest phase, correcting the bite and root positions, is still ahead.

Realistically, treatment with metal braces takes 18–24 months in a typical case, and up to 30 months with extractions, impacted canines or preparation for surgery. No orthodontist can give an exact duration before starting: the speed of movement depends on bone density, age and the response of the tissues, and only a doctor can predict the result in an individual case, after an examination and follow-up X-rays.

Once the braces come off, the retention period begins, and it lasts at least as long as the treatment itself. A fixed wire retainer is bonded behind the front teeth, and a clear night-time retainer is usually added. In the first year the clear retainer is worn for longer, then less often, but the fixed retainer stays in place for years and is checked every six months: the ligaments around the teeth keep pulling them back towards their old position for a long time.