Fixed Braces: Types, Care & Treatment Duration Explained

Fixed braces – but which ones? I hear this question in my practice almost every day. Because “fixed braces” has long stopped being a single product: there are conventional and self-ligating brackets, metal and ceramic, lingual versions, and fixed appliances with an entirely different job.

I am Dr. Mohammad Hakim, specialist orthodontist in Frankfurt. In this article I go through, step by step, which fixed braces exist, how they differ, how to care for them day to day, and how long treatment realistically takes.

The video accompanying this article

What types of fixed braces are there?

All fixed braces work on the same principle: a small plate – the bracket – is bonded to each tooth. An archwire runs through the brackets, and it is this wire that moves the teeth. It wants to return to its original shape and takes the teeth along with it. What differs between the variants is the material and the way the wire is held in the bracket.

Conventional brackets with elastic ligatures

The best-known version. The archwire is held in each bracket by small elastic rings – the ligatures. They come in many colors, which is a source of considerable delight among children and teenagers. They are replaced at every check-up.

Self-ligating brackets

Here a small clip mechanism in the bracket itself does what the elastics normally do: it holds the archwire on its own. No ligatures are needed. Self-ligating brackets are available both in metal and in the white ceramic version.

Ceramic brackets and combinations

Ceramic brackets are tooth-colored and therefore far less noticeable than metal. We often combine the two: ceramic in the visible front section, metal on the back teeth where hardly anyone looks anyway. That is a very practical solution for adults who do not want to give up the stability of metal.

Lingual braces

These braces sit on the inside of the teeth and are simply invisible from the outside. Functionally they work exactly like braces on the outside: brackets inside, wire inside, ligated either with elastics or self-ligating. Planning and manufacturing them is more demanding, because the inner surfaces of teeth vary considerably in shape.

Fixed appliances with a different purpose

Not every fixed appliance straightens teeth. A palatal expander, for example, is also anchored firmly in the mouth, but has an entirely different goal: creating width in the upper jaw. For the sake of completeness it belongs in this list – just in a category of its own.

Which version suits you depends on your tooth position, your daily life, and how visible the treatment is allowed to be. For teenagers, orthodontic treatment is covered in part by German statutory health insurance under certain clinical criteria; what applies in your case is something we clarify in a personal consultation.

How do I clean fixed braces properly?

This is the point at which treatment becomes either genuinely smooth or genuinely tedious. You cannot remove fixed braces – and wherever bracket, wire and tooth meet, deposits build up more easily than on a smooth tooth surface. With lingual braces this is especially true.

The critical spot is the transition between bracket and gumline. That is where most of it settles, and it is exactly where people brush least thoroughly.

Here is how to go about it:

• Sealant beforehand: Before the brackets are bonded, a protective layer can be applied to the tooth surfaces. It wears off over time, but it gives you a good start.
• Toothbrush: Electric or manual – both work. What matters is not pressure but care. Brushing too hard does more harm than good.
• Interdental brushes: They fit between wire and tooth and remove what the toothbrush leaves behind. Available at any drugstore.
• Mouth rinse: A useful addition, ideally alcohol-free.
• Two zones deserve special attention: underneath the archwire, and between the wire and the gumline.

Why I insist on this: with fixed braces, more simply accumulates, and that can lead to cavities and gum problems. Both are avoidable – it takes only a few more minutes a day than before. I have covered this in more detail in Oral Hygiene for Brace Wearers.

What can I not eat with fixed braces?

There is only one rule here, and it is easy to remember: do not bite straight in.

Hard and sticky foods are the problem – the whole apple, the crusty bread, the chewy chocolate bar. Not because you are not allowed to eat them, but because a bracket can come off when you bite. And every loose bracket costs an extra appointment and treatment time.

The solution is unspectacular: cut things up first, eat slowly, and chew with your back teeth. That way the braces stay where they belong and treatment moves along faster. The foods that cause the most trouble in practice are listed in Eating with Braces: Diet Guidelines.

How often do I need check-ups while wearing fixed braces?

The archwire is usually changed every eight to twelve weeks. These appointments serve two purposes: they move the treatment forward – each new wire sets the next impulse – and they are the moment when I check that everything is going according to plan.

There is one exception. When we close gaps with elastic chains, we see each other more often, roughly every two to three weeks. Elastic chains lose tension over time; if they are renewed too rarely, the movement stalls. Once the gaps are closed, we return to the usual rhythm.

Brackets, wires and elastics: the components at a glance

Over the course of treatment you will encounter several elements:

• Archwires – metal wires running through the brackets. At the ends they are bent over or sealed so they do not irritate. If something does poke, just get in touch; that is quickly adjusted.
• Brackets – made of metal or ceramic. One coming loose does happen. Please let us know right away rather than waiting for your next scheduled appointment.
• Bite turbos – small composite build-ups, used for instance to temporarily open the bite or to speed up a movement.
• Elastics – hooked in to improve the jaw relationship or to move individual teeth. Your cooperation counts directly here: elastics only work when they are actually worn.

How long does treatment with fixed braces take?

With well-planned fixed braces you can usually expect around one and a half years. If something more complex is present – an impacted canine, for example – it takes correspondingly longer. I always address this up front so you know what you are signing up for.

There is a moment I experience with almost every treatment: after a while the teeth already look straight from the front, and the wish to be rid of the braces right now is considerable. Understandable. But that is exactly when the work is not yet finished.

As an orthodontist I look not only at the front view, but at every inclination and every rotation in all three dimensions. You barely see these details when someone smiles – yet they determine whether the result stays stable. A tooth position that only looks straight from the front rarely lasts. That is why the final phase sometimes takes longer than one would like. It is the reason the result holds afterwards.

For adults there is an additional scenario: fixed braces are often used to prepare for orthognathic surgery. If there is a significant discrepancy between the jaws, we first align the teeth so the surgeon can work under optimal conditions – and take care of the fine-tuning after the procedure. In these cases, braces are typically worn for one to two years.

Are fixed braces faster than aligner therapy?

The most common question of all. First of all: the only genuine alternative to fixed braces is aligner therapy. Removable appliances worn only in the evening and at night cannot move teeth to the same extent – they have a different job, as I explain in the article on removable braces.

Between fixed braces and aligners, the picture is this:

• For small corrections, modern aligners are sometimes faster today.
• For more extensive treatment – severely tipped teeth, gaps that need closing – fixed braces are ahead.

What matters to me here: both methods reach the goal. The question is not whether it works, but how long it takes. When I see that a single tooth or a gap would drag out aligner treatment unnecessarily, I also combine the two – partial fixed braces together with aligners. How far aligner technology has come is described in Innovative Aligner Therapy in Frankfurt.

And for anyone who can picture neither visible braces nor trays in permanent use, there are two discreet routes: lingual braces, or particularly small brackets that all but disappear under the lip with a very fine archwire. In everyday life, practically nobody notices. Their range of application is more limited than that of regular fixed braces – but for fine corrections they are an excellent solution.

Are fixed braces suitable for adults as well?

Yes, without reservation. What changes is the care taken in preparation. With adults I assess gums and bone more closely, so that treatment does not result in loosening or even tooth loss later on.

From that follows the most important prerequisite: cavities and periodontal problems must be treated beforehand. Your dentist takes care of that. Once it is done and the starting point is sound, we begin treatment. For more on what is possible in adulthood, see Braces for Adults.

The treatment phases – and your schedule

Before we start, you receive a complete explanation of what lies ahead. Broadly speaking, treatment runs in three phases:

1. Leveling: light, flexible wires bring the teeth into a first common alignment.
2. Working phase: stronger wires carry out targeted movements – closing gaps, uprighting tipped teeth, setting the bite.
3. Finishing: the closing phase, which is all about the last details.

Something I consider particularly important: your schedule belongs in the plan. Is there a wedding coming up, a photo shoot, an important professional appointment where you would rather not wear visible braces? Then we decide together which phase happens when. In a surprising number of cases this can be arranged – you just have to talk about it early enough.

And after active treatment comes the part many underestimate: stabilization with a permanent retainer. It holds the result exactly where we moved it to.

Conclusion

Fixed braces are not a single method but a family: conventional or self-ligating, metal or ceramic, outside or inside. They move teeth more precisely and in more directions than any removable solution – and in return they ask for consistent oral hygiene and a little caution when eating. Around one and a half years is a realistic timeframe, and the final months are the ones that make the result last.

Wondering whether fixed braces are right for you, or already wearing them and have questions? Schedule your no-obligation consultation with Dr. Hakim in Frankfurt – we will take a careful look at your starting point and plan treatment around what matters to you.