Orthodontic Treatment Phases
Orthodontic treatment is highly predictable and immensely successful. Depending on the severity of the malocclusion (bad bite) or irregularity, orthodontic treatments may occur in either two or three distinct phases.
The benefits of correcting misaligned teeth are many. Straight teeth are pleasing to look at and greatly boost confidence and self esteem. More importantly, properly aligned teeth enhance the biting, chewing and speaking functions of the jaw. There are several types of irregularities, including:
- Overbite – The upper teeth protrude further than or completely cover the lower teeth.
- Underbite – The lower teeth protrude further than the upper teeth causing the chin to look prominent.
- Crossbite – Some of the upper teeth may close inside the lower teeth rather than on the outside.
- Overcrowding – Insufficient room on the arch causes some adult teeth to erupt incorrectly and become rotated.
The Phases of Orthodontic Treatment
Generally, orthodontic treatment takes between six and thirty months to complete. The treatment time will largely depend on the classification of the malocclusion, the type of dental devices used to correct it and the perseverance of the patient.
Here is a general overview of the three major stages of treatment:
Phase 1 – the Planning Stage
The orthodontist makes an exact diagnosis in order to realign the teeth in the most effective and expedient way. The first several visits may comprise of some of the following evaluations:
- Medical and dental evaluations – Dental and physical problems tend to go hand in hand. Problems in the oral cavity can lead to (or be caused by) medical problems. The goal of this evaluation is to ensure that prior medical and dental issues are completely under control before treatment begins.
- Study model (castings/bite impressions) – The patient is asked to bite down into a dental tray filled with a gel substance that hardens around the teeth. The trays are removed from the teeth and filled with plaster to create models of the patient’s teeth. Study models enable the orthodontist to scrutinize the position of each tooth, and how it relates to the other teeth.
- Panoramic X-rays – X-rays are fantastic tools for viewing potential complications or pre-existing damage to the jaw joint. X-rays also allow the orthodontist to see the exact position of each tooth and its corresponding root(s).
- Computer generated images – Such images allow the orthodontist to treatment plan and examine how specific treatments may affect the shape of the face and symmetry of the jaw.
- Photographs – Many orthodontists like to take “before, during and after” photographs of the face and teeth to assess how treatment is progressing, and the impact the treatment is having on the patient’s face shape.
Phase 2 – the Active Phase
All of the above diagnostic tools will be used to diagnosis and develop a customized treatment plan for the patient. Next, the orthodontist will recommend custom orthodontic device(s) to gently move the teeth into proper alignment. This orthodontic appliance may be fixed or removable. Most commonly, traditional fixed braces are affixed, which utilizes individual dental brackets connected by an archwire. Lingual braces are also fixed, but fit on the inside (tongue side) of the teeth to make them less visible.
Removable devices are an alternative to fixed braces. Examples of removable devices include the Invisalign system, headgear and facemask. These devices are designed to be worn for a specified amount of hours each day to expedite treatment.
Whatever the orthodontic device, the orthodontist will regularly adjust it to ensure adequate and continual pressure is being applied to the teeth. It is essential to visit the orthodontist at the designated intervals and to call if part of the device breaks or becomes damaged.
Phase 3: the Retention Phase
When the teeth have been correctly aligned, fixed braces and removable devices will be removed and discontinued. The most cumbersome part of the orthodontic treatment is now over. The orthodontist will next create a custom retainer. The goal of the retainer is to ensure that the teeth do not begin to shift back to their original positions. Retainers need to be worn for a specified amount of time per day for a specified time period. During the retention phase, the jawbone will reform around the realigned teeth to fully stabilize them in the correct alignment.
If you have any questions about orthodontic treatments, please contact our office.
How Orthodontic Treatment Is Structured Over Time
Orthodontic treatment is structured in phases, each with specific goals and timelines. Understanding the phases helps patients know what to expect at each stage and recognize whether progress is on track. The major phases are: pre-treatment assessment, active treatment, and retention. Within active treatment are sub-phases of leveling and aligning, refinement, and detailing. The total duration from start to finish typically runs one to three years, with retention continuing indefinitely.
The pre-treatment phase begins at the consultation. Records are taken — photographs, x-rays (often panoramic and cephalometric), and digital impressions or scans. A treatment plan is developed showing what movements need to happen, what appliances will be used, and roughly how long treatment will take. Estimated cost is reviewed, insurance coverage is checked, and the patient decides whether to proceed. Some cases involve preparatory work before active treatment starts — extracting baby teeth that are blocking permanent teeth, placing space maintainers, or completing other dental work first.
Active treatment begins when appliances are placed. The first phase, leveling and aligning, takes six to twelve months and is when teeth move the most visibly. Brackets are bonded to each tooth and connected by a thin wire that delivers gentle force. Aligners are switched out every one to two weeks, with each tray applying slightly different pressure than the last. Visits to the office happen every six to eight weeks for adjustments and progress checks.
Sub-Phases of Active Treatment
Active treatment progresses through specific sub-phases:
- Leveling and aligning (6-12 months) — the most visible movement happens; teeth shift toward their target positions
- Major movement (3-6 months) — large movements like closing gaps, expanding the arch, or moving impacted teeth
- Bite correction (3-6 months) — overbite, underbite, or crossbite correction using elastics or other auxiliary appliances
- Refinement (3-6 months) — fine-tuning the alignment as teeth approach their final positions
- Detailing (3-6 months) — final adjustments to root angles, bite contact, and exact positioning
- Retention phase (long-term) — appliances come off, retainers go in, and the new position is held while bone and ligament fully stabilize
- Long-term retention (indefinite) — nightly retainer wear long-term to prevent drift back
Not every case includes every sub-phase. Simple cases may move directly from leveling to detailing with minimal time in the middle phases. Complex cases may revisit earlier sub-phases as new movements are needed. Your specific plan is mapped out at the consultation.
What Happens at Each Phase and What You Need to Do
The pre-treatment phase requires your attention to the records-taking visit, any preparatory dental work, and the consultation discussion. Reviewing the treatment plan thoroughly and asking any questions before agreeing to start treatment matters — once active treatment begins, plans can be adjusted but the major direction is set.
Active treatment requires consistent compliance with what the appliances need to do their work. For braces: avoid foods that can break brackets (hard candies, ice, popcorn, sticky candies), brush carefully around the appliances, attend visits on schedule, follow elastic-wear instructions if elastics are part of treatment. For aligners: wear them 20-22 hours a day, switch trays on schedule, brush after meals before reinserting, attend visits on schedule. Falling behind in any of these areas extends treatment.
Retention requires the same level of consistency. Wear retainers as directed — usually full-time for the first three to six months after active treatment ends, then nighttime long-term. Replace retainers when they wear out (every few years for most patients) or if they become uncomfortable or stop fitting. Attend routine dental cleaning visits, where the dental team can check retainer fit and look for any drift. The most common reason orthodontic results break down years later is inconsistent retainer wear — keeping up the habit is essential.
What This Means for Your Care at Trillium
Trillium provides orthodontic consultations and Invisalign treatment, with referral to orthodontists for traditional braces and complex cases. Our orthodontic services follow the current Ontario Dental Association Suggested Fee Guide. Treatment cost includes all phases — consultation, records, active treatment with all adjustments, and the initial retainer set. Replacement retainers (when they wear out or are lost) are billed separately.
Most private dental insurance plans cover orthodontic treatment with a lifetime maximum applied across all orthodontic treatment. We submit pre-determinations before treatment starts so coverage is clear in advance. Payment timing options can spread the cost across the treatment period. Direct billing is available with most plans.
Frequently Asked Questions
How long is each phase?
Total treatment usually runs one to three years for most cases. Leveling and aligning is the first six to twelve months; refinement and detailing happen over the following months. Complex cases involving jaw surgery extend the timeline. Your specific case is mapped out at the consultation.
Can I shorten treatment?
Sometimes. Some technologies (high-frequency vibration devices, accelerated tooth movement protocols) claim to speed treatment; evidence varies. The most reliable way to keep treatment on schedule is consistent compliance with what the appliances need to do their work. Missed visits, broken brackets, and inconsistent aligner wear all extend treatment.
What happens if I stop treatment partway through?
Teeth may settle in whatever position they have reached, which is often not where you want them. Stopping treatment without completing it usually means partial improvement or, in some cases, worse alignment than when you started. Talk to us before stopping so we can discuss whether the current position can be made stable.
Do I have to wear elastics?
Many cases require elastics for some part of the treatment. The elastics correct bite issues that brackets and wires alone cannot fully address. Compliance with elastic wear directly affects treatment success — wearing them as instructed (often 20 hours a day) is essential, and skipping them extends treatment significantly.
What if my retainer breaks or I lose it?
Call us right away. Without a retainer, teeth start drifting back within days to weeks. We will replace it as quickly as possible. Use the old retainer (if available) in the meantime to slow any drift. Replacement retainers are billed separately from the original treatment cost.
Will I have to wear a retainer forever?
Some form of nightly retainer wear continues long-term. Without retainers, teeth gradually drift back over years. The good news is nightly wear is a small commitment compared to the alternative of seeing your hard-earned alignment slowly disappear. Most patients adapt to nightly retainer wear within a few weeks and continue indefinitely.