Treatment with removable braces

Photo of two teenage girls playing table football (PantherMedia / Alfred Hofer)

The position of misaligned teeth and jaws can be corrected with dental braces in children and teenagers. Unlike fixed braces, removable braces aren’t worn all the time. But it’s important to wear them for long enough.

If you have crooked teeth or your upper and lower jaw don’t fit well together when you close your mouth, the position of your teeth or jaws can be corrected. You can discuss the options with a specialized dentist known as an orthodontist. If treatment is needed or if someone wishes to improve the way their teeth and jaw look, removable or fixed braces are usually considered. Some children and teenagers use both types of braces, one after the other.

The aim of orthodontic treatment is to gradually move the teeth and jaws into a different position, so most types of dental braces exert force on the teeth or jaws. They push or pull the teeth in the desired direction or influence the growth of the jaws.

The active treatment phase (when the braces are worn) is followed by a phase where you use something known as a retainer. This is done to prevent the teeth from moving back to their original position.

How do removable braces work?

Removable braces usually consist of two plastic plates: One cup-shaped one for the upper jaw and one arch-like one for the lower jaw. Every set of braces is tailor-made for the person who wears them, and only fits that person. Removable braces are placed in the mouth and worn at night, as well as for several hours during the day. When you eat or do sports you can take them out and put them in a special storage box. The plastic plates have loop- or U-shaped wire components attached to them. These wires fit around the teeth, keeping the braces in place. They also push against certain teeth in order to change their position.

The braces often contain screws too. These screws allow the braces to be widened very gradually whenever the teeth or jaws have moved a little. As a result, the braces continue to apply force. The jawbones can be influenced in this way too. For instance, a narrow upper jaw can be gradually widened. Children and teenagers or their parents can turn the screws themselves at home. The doctor will tell them how to do this. But sometimes the braces are adjusted at check-up appointments with the orthodontist.

Illustration: Removable braces for the upper and lower jawRemovable braces for the upper and lower jaw

What are the advantages?

It’s nice to be able to take the braces out sometimes. For instance, you can then eat as usual and don’t have to avoid certain types of foods. You also remove the braces when you brush your teeth, so you can clean your teeth as usual. But the braces also have to be cleaned thoroughly with a toothbrush several times a day. You can use special cleansing products for braces too – for instance, in the form of a powder or soluble tablet that you can put in a cleansing box or a glass, together with the braces.

What are the disadvantages?

Removable braces can cause discomfort or pain when you first start wearing them and after you tighten the screws. But they are usually less painful than fixed braces.

Wearing removable braces can affect your speech at first. Because of this, many people take the braces out of their mouth when they have to talk a lot. It can also be a good idea to remove the braces when doing certain types of sports. You can talk to your orthodontist about whether this is necessary. Being able to take your braces out can also have its downsides: Teenagers have to make sure that they actually wear the braces as much as the doctor says they should. If they don’t, the braces won’t have the desired effect.

What are functional orthodontic appliances?

There are also removable appliances that don’t put any direct force on the teeth or jaws. Typical examples include the Bionator, the Activator and Fränkel’s functional regulator. They are known as “functional orthodontic appliances” and are consist of one single piece. A functional orthodontic appliance can be roughly described as two removable braces that are stuck together. The appliance rests loosely in your mouth. But it is designed to influence the movements of your jaws when you close your mouth. This strengthens or activates the face muscles, chewing muscles and tongue muscles. Some appliances also have small plates that keep your lips and cheeks away from your teeth. The idea is that the activated muscles and the altered influence of the soft tissue on the teeth will correct the misalignment. These appliances are used for things like moving the lower jaw forward.

Illustration: The Bionator is made up of one pieceThe Bionator is made up of one piece

What other types are there?

Misaligned teeth and jaws can also be treated with the help of clear plastic trays known as aligners. To provide extra grip for the aligners, dots of “glue” known as attachments are put in certain places on the teeth. Like braces, clear aligners also push the teeth in a certain direction in order to change their position. Because the aligners can’t adapt to the new position once the teeth have moved a bit, they have to be replaced a few times until the final position has been reached.

The costs of orthodontic treatment with these aligners aren’t covered by statutory health insurers in Germany, so people have to pay for them themselves.

What is the retention phase?

Once the misalignment has been corrected, the retention phase of treatment begins. This involves wearing something known as a retainer after the active phase of treatment, in order to keep the teeth in their new position. Without the retention phase, they would probably move back to where they were before. Unlike braces, retainers don’t push or pull the teeth in a different direction: They just hold them in place.

Fixed or “bonded” retainers are usually made out of wires that are glued (bonded) to the back of the teeth and stay in the mouth for several years. Some types only hold the front teeth in place, while others are also glued to the back teeth. Removable retainers include types that look like removable braces and are worn at night.

It is best to talk to your orthodontist about which type of retainer is most suitable for you and how long you should use it for. This is also true when deciding whether to use a fixed or removable retainer. In Germany, statutory health insurers will only cover the costs of fixed retainers if they are used to correct the position of overcrowded teeth in the lower jaw.