How long do braces take to close a gap

How long do braces take to close a gap

How long braces take to close a gap depends on the size of the gap between the teeth and the treatment method. With braces you can count on a gap closure of 0.5 to 1.0mm per month.
The duration of the gap closure depends on the specific clinical case. The correction time is influenced by both the patient's age and the size of the discrepancy.

With similar pathologies, people aged 12 to 25 wear braces 6-8 months less than older patients. The thing is, by the age of 25, the formation and growth of the dentition is completely completed, and by 30, all metabolic processes slow down and tissue regeneration is more difficult.

So, for example, it may take several months to eliminate the anomaly in a child, while an adult patient will need from six months to 2 years to solve this dental problem, since his jaw has already formed.

The size of the gap can vary. In some people, the teeth may even diverge by 10 mm. Modern orthodontics has its own methods of correcting this anomaly. To move the teeth and correct the defect, braces are most frequently installed.

Treatment with braces takes place in several stages, and the duration of each doctor determines individually for each patient. For some, the first results will be noticeable after 4 months, and for others only after six months.

However it should be noted that the orthodontic method of gap closure is the safest and also permanently solves the problem. Also with braces treatment, tooth tissues are not damaged.

In terms of aesthetics, modern braces are straightforward. To correct the gap, dentists also offer mouthguards - designs with the same principle of action as braces. The orthodontic method allows you to gradually move your teeth in a natural way.

The “speed” at which dental spaces (gaps) will close depends on several factors. It is difficult to generalize for all types of cases with large gaps, but some basic principles can provide a “benchmark” as to whether gap closure occurs normally or not.

Here are some factors that can influence the ease or difficulty in closing teeth gaps in orthodontics:
The width of the gap; obviously a larger gap will take to wear braces longer to be closed. gaps of less than 1 mm can sometimes close very quickly (a few days) because part of the closure comes from the compression of the periodontal ligament surrounding the root (s) of the tooth.

The location of the gap; higher or lower; there is usually more resistance in the mandible to displace a posterior tooth with braces whose roots are closer to the cortical plate (bony walls) of the jaw than a tooth located in the upper arch. But this is not always the case and sometimes lower gaps close as quickly as upper spaces.

The type of tooth to be moved (the anatomy of its roots); an incisor with a single conical root is very different from a large lower molar with 3 large divergent roots.

The quality and density of the alveolar bone surrounding the teeth to be moved; denser bone around the roots will provide more resistance to tooth movement which can extend the duration of movement. People who have had bone loss from periodontal disease will have less bone supporting their teeth and forces should be adjusted accordingly to avoid further damage. The quality of the gum tissue is also important. Good hygiene is essential because the build-up of plaque and the presence of inflammation can cause loss of tissue (bone and gum) and interfere with the movement of teeth.

The orthodontic mechanics used; for optimal tooth movement, proper mechanics are needed including the right wires (arcs) (shape, size, alloy, no mechanical interference, etc.), the right forces (not too strong or too weak). To learn more about orthodontic wires.

The cooperation of the patient; some gap closure mechanisms require the wearing of rubber bands. No rubber bands = no tooth movement = no gap closure.

It has been shown that the biological limit of tooth displacement varies between 0.4 and 1.2 mm / month for healthy dentition and periodontium (P. Buschang, 2011). A close rate of ~ 1mm / month is considered excellent.

The presence of interference; for the teeth to move freely on the wires (arcs) there must be as little friction or interference as possible. Wrinkles or deformation in the wires can slow down or prevent the movement of a tooth. Deformities can occur if the patient bites hard food on the wire.

Occlusion (the relationship between teeth when they close together) can also create interferences that block or interfere with the teeth being moved.

Special situations; taking certain medicines such as bisphonates , used to treat people with osteoporosis, disrupts the bone resorptive metabolism which is essential for the movement of teeth. These drugs inhibit the action of cells that resorb alveolar bone in the direction the tooth moves and can prevent tooth movement no matter how long the force is applied. Find out more about moving teeth.

Why my gap is not closing with braces?

We regularly have questions from patients who are concerned that the gap or spaces in their mouths seem not to close quickly or decrease in width after several months of treatment. Another point to consider in addition to those listed above is the ideal time to close a gap.

While it is normal for patients to desire a gap in an aesthetic region such as a diastema between upper incisors to close as quickly as possible, it is sometimes necessary to make other preliminary corrections before tackling. ”Directly when the gap is closed.

For example, to bring the teeth on either side of a superior diastema closer together, it may be necessary to disengage them vertically from the opposing teeth (open the bite) to eliminate interference that would prevent the incisors from bringing the incisors together. For posterior spaces, it is common to have to make certain corrections such as correcting rotations, straightening tilted teeth, harmonizing the width of the arches and waiting for rigid wires (arches) to begin closing the gaps.

However, after these preliminary fixes, if it is determined that the existing mechanics are activated specifically to close a gap and that no significant change or closure of a gap is visible after a few minus then in this case there is a problem… and the cause is usually one of the points discussed above.

Another point worthy of mention but which is not a great “revelation”; if the closure of a gap depends on wearing a rubber band or a device and the patient has to manage himself but there is a lack of cooperation on his part, then, do not expect to a miracle!

The average rate of gap closure with braces

The closing of the spaces can occur normally at a rate which can vary from 0.8 to 1.0 mm per month and this begins with the application of the force which must be light and constant (not intermittent). These are only averages and the closing speed can vary greatly from case to case.

For example; a 9-10mm gap , which is the width of a permanent molar, will therefore take an average of 9-12 months to close. The gap of a 7-8 mm bicuspid should take 7-10 months.

If this rate is slower, there may be different causes as described above but most of the time it is either obstructions, inadequate mechanics or a lack of cooperation with wearing rubber bands that slow down normal closing.

Types of Spaces (gap) in teeth setup

Below variouse types of teeth gaps and time bracs takes to close these gaps are discussed

THE CENTRAL SPACE: THE DIASTEMA

A gap between the upper centrals is normal during the transition from temporary dentition to permanent or permanent dentition. Under optimal conditions, this gap can close by itself during the eruption of the canines around the age of 11 to 13 years.

This gap often worries people because they find it unsightly and unsightly.
The closing of a gap between the anterior teeth can sometimes be the object of limited corrections aimed only at closing that gap. However, the presence of spaces is often associated with other occlusion problems which will require larger or global corrections so it is not always possible to stick to the closure of the gap.

Before considering the closure of a diastema , it is necessary to determine the cause as this will influence the orthodontic approach to close the gap and the retention used to keep this gap closed. As for other interdental gaps, a central diastema can be caused by narrow teeth (central and / or lateral), the presence of a significant labial frenulum, the action of the tongue, the presence of a supernumerary tooth that has not come out. (mesiodens), etc.

Esthetic only : Note that the presence of a central diastema and anterior interdental gaps is rarely problematic and does not constitute a problem from a functional point of view . The main motivation of patients to close such gaps is aesthetic , which is also a good reason for doing so, but this choice is very personal. Some people prefer to keep a central diastema, probably because they find it attractive or aesthetic (look at pictures of Madonna or Vanessa Paradis to realize that it doesn't really affect them!).

MESIODENS: A SPECIAL CASE

A mesiodens is an additional or supernumerary tooth located between the two maxillary central incisors . The presence of such a tooth can cause certain problems such as:
It creates gaps or diastema between the units.
Causes a late eruption of the permanent incisors or prevent their eruption (in 26 to 52% of cases)

Cause an ectopic eruption (in an abnormal position), displacement or rotation of the permanent incisors (in 28 to 63% of cases).
May alter the occlusion and appearance (aesthetics).

A loss of gap and a deviation of the median lines.
The laceration (deformation) or resorption and loss of vitality of the roots of adjacent developing teeth.
An ectopic rash, for example in the palate.
The appearance of dentigerous cysts (in 4-9% of cases).

An early diagnosis is important to allow the clinician to administer treatment to both optimal and minimum and minimize the impact of the presence of such a tooth. Taking x-rays and ideally a cone-beam volume computed tomography (CTCT) makes it possible to identify and locate in 3D the presence of a mesiodens.

TREATMENT

Only 25% of mesiodens will erupt spontaneously in the oral cavity. Treatment of a mesiodens will depend on several factors and may include the following options:
Extraction: in 75% of cases the incisor will erupt spontaneously once a mesiodens has been extracted. Timely extraction will increase the chances of a normal incisor eruption.

Mesiodens extraction during the primary teething stage is not recommended because supernumerary primary teeth often erupt in the mouth and surgical removal of impacted teeth may increase the risk of displacement or damage to permanent incisors. 2, 3 The extraction at the beginning of mixed dentition will however promote a normal eruption of the central incisors with normal eruptive forces. The recommended time to extract a mesiodens is around the age of ± 10 years, at which time the apex of the unerupted central incisor is almost mature or closed.

The longer the extraction is postponed, the greater the risk that it will affect the eruption of permanent teeth.

Observation: if the dentist or maxillofacial surgeon considers that it is too risky to extract the mesiodens because of its extreme malposition because the surgical intervention would risk damaging the other teeth or devitalizing them, the extraction can be postponed. If the mesiodens is really badly positioned and does not affect the roots of the other incisors, in rare cases it could remain in place. A radiological follow-up would then be indicated to detect the appearance of any problem.

Orthodontic treatment: Once the mesiodens has been extracted, if the incisors do not erupt spontaneously or there is no sign of eruption within 6-12 months after extraction, it may be necessary to create gap in the arch to accommodate the incisors (if there has been a loss of gap) or to make a surgical exposure of the nonerupted incisors in order to apply orthodontic traction to them to lower them and lodge them in the dental arch.

THE ANTERIOR SPACES

An imbalance between the width of the incisors may explain the presence of gap on either side of the upper laterals. Depending on the width of these gaps, it may be possible to close them by bringing the teeth together, but if the laterals are really narrow, it is preferable to keep one of the gaps that can be filled by the general dentist after orthodontic corrections.

Attempting to close all the gaps in the presence of teeth that are too narrow can be unsightly and will affect the good relationship of the posterior teeth (occlusion), which can have an impact on function.
The musculature (tongue, lips) can contribute to the presence of gap between the anterior teeth especially.

Anodontia (also called hypodontia); congenital absence of a louse several teeth. With the exception of wisdom teeth the upper lateral ones are among the most common congenitally ( inherited ) missing teeth , although this is only 2% of the population.

Their absence creates gap in the anterior part of the dental arch allowing the centrals to move to the sides while the canines migrate forward. Orthodontics will aim either to close all the spaces present or to open a gap large enough to allow prosthetic replacement (bridge or dental implant ) of the missing lateral ones.

POSTERIOR GAPS

The gaps between the posterior teeth are, most of the time, the result of either a tooth extraction or the loss of a temporary tooth that did not have a permanent replacement ( anodontia , congenital absence).

The loss of a tooth creates a large gap and adjacent teeth can migrate to this gap creating other spaces elsewhere in the dental arch, functional interference, inadequate contact between opposing teeth, places where the tooth can lodge. food, etc. So the loss of a tooth is not trivial.
A new technology allowing the use of mini-screw anchors makes it easier to close large spaces.

TEMPORARY DENTITION GAPS

During a stage of dental development, it is normal to see gaps appear between the anterior temporary teeth. These gaps allow the primary teeth to prepare for the arrival of permanent teeth which are larger.
Temporary dentition without anterior interdental gaps around the age of 5-6 years may seem more aesthetic to some, but this is a definite sign that it will run out of gap when permanent teeth erupt.

ANTERIOR TEETH

Permanent incisors and canines are larger than the temporary teeth they replace.
Since permanent anterior teeth are wider than temporary teeth, interdental gaps must be present to allow normal eruption of the incisors without dental crowding.

It is normal and even desirable to see spaces between the anterior temporary teeth before and during the eruption of the permanent teeth. These gaps will accommodate the larger permanent teeth that will replace the temporary teeth.
Temporary dentitions that do not have such gaps will have more dental overlap in permanent dentition.

It has been shown that the biological limit of tooth displacement varies between 0.4 and 1.2 mm / month for healthy dentition and periodontium (P. Buschang, 2011). A close rate of ~ 1mm / month is considered excellent.

The orthodontic mechanics used; for optimal tooth movement, proper mechanics are needed including the right wires (arcs) (shape, size, alloy, no mechanical interference, etc.), the right forces (not too strong or too weak).
The cooperation of the patient ; some gap closure mechanisms require the wearing of rubber bands. No rubber bands = no tooth movement = no space closure.

It has been shown that the biological limit of tooth displacement varies between 0.4 and 1.2 mm / month for healthy dentition and periodontium (P. Buschang, 2011). A close rate of ~ 1mm / month is considered excellent.

The presence of interference; for the teeth to move freely on the wires (arcs) there must be as little friction or interference as possible. Wrinkles or deformation in the wires can slow down or prevent the movement of a tooth. Deformities can occur if the patient bites hard food on the wire.
Occlusion (the relationship between teeth when they close together) can also create interferences that block or interfere with the teeth being moved.

Special situations; taking certain medicines such as bisphonates , used to treat people with osteoporosis, disrupts the bone resorptive metabolism which is essential for the movement of teeth. These drugs inhibit the action of cells that resorb alveolar bone in the direction the tooth moves and can prevent tooth movement no matter how long the force is applied.

THE PRIMATE SPACE: THE PROOF THAT WE DESCEND FROM THE MONKEY!

There are gaps that develop in some people in particular places in temporary dentition and which persist in permanent dentition. These gaps, which can be a few millimeters wide, are located in front of the upper canines and behind the lower canines.

We give them the name of “ primate space ” or spaces of primates in temporary dentition because they are vestiges of our dental evolution as carnivores. Our ancestors and the great apes and some modern primates present these peculiar gaps which aim to accommodate the canine of the opposite arch which is much longer and wider and extends beyond the plane of the dental arch on which it is located.

Thus, the upper canine needs this lower gaps behind the lower canine to properly lodge when closing the mandible. Same phenomenon for the lower canine which must articulate in front of the upper canine.
Approximately 50% of the population has such gaps. If they did not appear as a temporary dentition by the age of 3-4, it is unlikely that they will appear later.

Occasionally, after orthodontic corrections and despite proper alignment of the teeth, it is possible that slight gaps similar to primate spaces remain. These gaps do not cause functional problems but may be considered unsightly for some people, especially in the upper arch. It is then possible to modify the shape of the teeth near the spaces to “close” these spaces

Causes of teeth gaps

The cause of interdental gaps can be multiple. Some gaps are “ natural ” and will be present normally in a dentition while others may appear or are the result of changes in the dentition or of procedures such as extraction.

There are also spaces that are temporary ; they will appear during the development of the dentition and eventually disappear. The gaps appearing between the front teeth can have several causes such as:
An imbalance between the width of the teeth (some teeth are too narrow, which causes gaps);
An abnormal position of the tongue against the teeth, which creates ± constant pressure against these teeth and can move them and create gaps between them;

The presence of a labial frenulum ( lip attachment) which prevents the natural or spontaneous closure of a gap; A malocclusion causing dental malposition so that the eruption of the teeth is not normal and did not allow the closure of a gap which then persists.

The loss of supporting tissues of the teeth (bone and gum - the periodontium ) allowing the forces applied to the teeth to move them and gradually create or increase spaces.
A remnant of our evolution called the primate space which may be present in some untreated people.


Refrences

Optimal orthodontic space closure in adult patients (R E Siatkowski)
Prosthetic replacement vs space closure for maxillary lateral incisor agenesis: A systematic review(Giordani Santos Silveira)
Effectiveness of nickel‐titanium springs vs elastomeric chains in orthodontic space closure: A systematic review and meta‐analysis
Corticotomy for orthodontic tooth movement (Won Lee)

Den Tim


Practicing Dentistry for 20 years