Orthodontics

What is orthodontics?

Orthodontics is the branch of dentistry that corrects the position of the teeth and the bite — how the upper and lower jaws meet. The aim is not only a straight row: comfortable chewing, teeth that can be cleaned, healthy gums and a stable result. The clinic uses two main systems — fixed braces and clear aligners; which one suits is decided by the diagnosis. Jaw-joint complaints are assessed separately, gnathologically.

Who may need orthodontic treatment?

There is no age limit — adults can be treated with healthy gums and bone; in children some problems are easier to solve during growth.

• Crowding — the spaces between teeth cannot be cleaned, raising the risk of decay and gum inflammation
• Spaced teeth (diastema, gaps)
• Deep, open or cross bite; a mismatch in how the jaws close
• Protruding front teeth (trauma risk) or a tooth set back
• One-sided chewing, uneven tooth wear
• Preparation for prosthetics or implants — creating space, uprighting abutment teeth
• In children — guiding jaw growth (expansion plate)

How is the diagnosis made?

An orthodontic plan is built on records, not estimation: a clinical examination (teeth, gums, bite, jaw joint, facial profile), facial, smile and intraoral photographs, an intraoral scan (digital model) and, when needed, panoramic and cephalometric X-rays. A systematic review found limited high-level evidence on which records are “mandatory” in every case — so X-rays are taken on indication, not routinely. Cephalometry is a standard indication for growth assessment, extraction decisions and skeletal discrepancies; for impacted teeth and root relationships 3D CBCT may be chosen.

Braces versus aligners

Fixed braces work through brackets bonded to the teeth and an archwire; they apply continuous force under the dentist's control, do not depend on compliance and are more predictable for complex movements (large root movements, extrusion, severe rotation, extraction cases). Clear aligners are removable trays made from a digital plan; they are invisible and easy to clean, but must be worn 20–22 hours a day and their effect depends on the patient's discipline. According to a 2018 systematic review, aligners are effective in mild to moderate crowding, while some movements (for example rotation of back teeth, extrusion) are less predictable. The clinic uses ligated and self-ligating metal braces as well as an aligner system.

Which system suits whom?

There is no “best system” — the system is chosen for the diagnosis, the type of movement and the patient's lifestyle; the decision is discussed together with the result shown in the digital plan.

• Mild–moderate crowding, aesthetic demand, high compliance → aligners
• Complex movement, extraction plan, skeletal component → fixed braces
• Teenager with uncertain compliance → braces are more reliable
• Periodontal problems in adults → gum treatment first, then a plan with light forces
• Narrow jaws in children → an expansion-plate stage

Treatment stages

1. 1

   Orthodontic examination

   Complaint and expectations; the teeth, gums, bite, jaw joint and facial profile are assessed; the feasibility and initial direction of treatment are defined.

2. 2

   Records: photos, scan, X-rays

   Intraoral and facial photographs, a digital scan; panoramic and cephalometric X-rays on indication, 3D CBCT when needed.

3. 3

   Diagnosis and digital plan

   Analysis of crowding, bite and skeleton; the movement plan is built on a 3D model, the expected result and duration are explained; the system is chosen.

4. 4

   Preparation

   Decay and gum treatment, professional hygiene; extraction or space creation when needed; a gnathological assessment for jaw-joint complaints.

5. 5

   Fitting the appliance

   Bonding the brackets and placing the wire, or issuing the first set of aligners; instructions on use and hygiene.

6. 6

   Active phase and reviews

   Adjustments every 4–8 weeks with braces; changing sets and reviews every 6–10 weeks with aligners; monitoring hygiene and white-spot risk.

7. 7

   Finishing and removal

   Refining the bite (finishing), removing the brackets and polishing the enamel; final photographs and scan.

8. 8

   Retention

   A fixed (bonded behind the teeth) and/or removable retainer; the wearing schedule and review visits — the stage that keeps the result.

How long does treatment take?

According to a 2016 systematic review the average treatment time with fixed appliances was about 20 months, ranging individually from 12 to 30 months. Factors that extend it: extraction plans, skeletal discrepancy, slower movement in adults, missed visits and broken brackets; with aligners, not meeting the wear time. Simple aligner cases can finish in a few months. General promises such as “straight teeth in 6 months” are not made — the duration is explained individually at the planning stage.

Why is retention needed?

After teeth have moved they tend to return to their previous position until the surrounding fibres and bone remodel — relapse. The Cochrane review (2023) shows that both fixed and removable retainers hold the position, while evidence on which is superior is limited. The clinic most often recommends a combination of a fixed retainer behind the front teeth and a removable retainer worn at night; the duration is individual and can be long-term. Retention is not an “add-on” but the final stage of treatment.

Hygiene and reviews

Plaque collects easily around brackets: brushing after every meal, interdental brushes and floss; fluoride toothpaste; avoiding hard and sticky food. According to the Cochrane review (2019), fluoride varnish and high-fluoride toothpaste reduce early demineralisation during brace treatment. With aligners the teeth are brushed after every meal before the tray goes back in. Professional hygiene every 3–6 months is part of the plan; if hygiene is poor, treatment may be paused — white spots and decay matter more than straight teeth.

Risks and limitations

• White spots (demineralisation) — reported in a substantial share of fixed-appliance patients; reduced by hygiene and fluoride
• Root resorption — slight shortening of the root tip; usually clinically insignificant, little difference between aligners and braces; long treatment and large movements raise the risk
• Gum reaction — gingivitis, recession in adults; managed with periodontal preparation and monitoring
• Relapse — without retention; a long-term retainer is needed
• Compliance with aligners — the plan fails if worn less than 20–22 hours
• A broken bracket or poking wire — needs a review visit
• Jaw joint — orthodontics neither causes nor treats joint complaints; a gnathological assessment is needed if present

Orthodontics and the jaw joint

Systematic reviews have not found a consistent cause-and-effect relationship between occlusal features and temporomandibular disorders; orthodontics is therefore not recommended as a treatment for joint pain, and no promise of “straighten the teeth and the joint will settle” is made. In the clinic orthodontics is carried out by an orthodontist-gnathologist: in patients with joint complaints the jaw joint is assessed first, a splint stage is completed when needed, and only then is the orthodontic plan built. This is explained on a separate service page.

What affects the price?

The prices below come from the same source as the site's Prices section. The total depends on the system (ligated/self-ligating braces, number of aligner sets, expansion plate), treatment of one or both jaws, the duration and number of reviews, preparatory treatment (hygiene, decay, extraction) and the type of retainer. Aligner pricing is calculated per step and finalised after planning; a written plan is given by stage.

Doctor and clinic

At Smile by Dr. Bakhtiyar (Baku, Babek Avenue 1131) orthodontic treatment is carried out by orthodontist-gnathologist Dr. Maharram Mammadov — the author of the site's articles on orthodontics, occlusion and the jaw joint. The digital scan, planning and reviews take place in one clinic; where prosthetic or implant preparation is required, the plan is built together with Dr. Bakhtiyar Aliyev.