Post-orthodontic rehabilitation

I finished my braces, but my teeth do not meet properly. Why?

Orthodontics aligns the position of the teeth. How they meet also depends on their shape and size, and sometimes these two things do not fit together perfectly.

At the end of treatment, contacts can be few or point-like, and they can settle in the following weeks. Differences in shape (small, worn or peg-shaped teeth) are not corrected by braces. If the problem is one of position, the orthodontist can make finishing adjustments, so the first conversation should be with them. Restorations do not move teeth and do not replace orthodontic finishing.

Why do gaps remain after orthodontic treatment?

The most common causes are teeth smaller than the space available, relapse, meaning the tendency of teeth to drift back, and the anatomy of the surrounding tissues.

• Teeth smaller than the space. Small or peg-shaped lateral incisors leave gaps that braces cannot close without affecting other positions.
• Relapse. If the retainer is not worn as instructed, teeth can drift back, including the gaps.
• The labial frenum or gum tissue. Sometimes it contributes to a gap returning between the central incisors.
• A gap left on purpose. The orthodontist may leave space so the teeth can then be restored to the right proportions. This is a planning decision, not a mistake.

A more detailed article is Why do gaps remain after braces?

How do we restore tooth shape after braces?

Most often with additive restorations, meaning we add material instead of removing enamel. There are two main options: composite applied directly to the tooth, or ceramic veneers.

The aim is correct proportions, contacts between teeth that support each other, and a shape that suits the face. The choice depends on how much has to be added, on the bite, and on whether the patient wants to keep the treatment reversible. I describe the differences on the page about veneers and bonding.

What role does a wax-up play after orthodontics?

A wax-up is a three-dimensional model of the final shape. I use it to see how much space the teeth need to reach the desired proportions before adding any material.

Ideally the plan is discussed with the orthodontist during treatment, so that space is distributed for restorations. The wax-up is then transferred into the mouth with a reversible mock-up, and for composite work it serves as a guide through a silicone key.

When is the right time for restorations?

After the teeth have stabilised and the retention has been decided. Restorations during fixed braces are limited to minor details, agreed with the orthodontist.

I do not remove or change a retainer without the orthodontist's agreement. Restorations adapt to the retainer, not the other way round.

What about the retainer?

Retention stays important after restorations. Teeth have a tendency to move throughout life, and restorations do not stop that.

A retainer can be fixed, bonded to the inside of the teeth, or removable, usually a clear tray worn at night. The orthodontist chooses with the patient, and the restoration plan takes it into account.

What options are there?

From the most conservative to the most extensive:

• Orthodontic finishing adjustments, when the problem is position.
• Minimal reshaping of enamel, when the correction is very small.
• Direct additive composite, for small gaps and small teeth.
• Ceramic veneers, when stability and precise control of shape and colour are wanted.
• More extensive restorations, in cases with wear or heavily modified shape. See complex oral rehabilitation.

When do I not recommend restorations straight away?

When tooth position can be improved more conservatively with orthodontics, when the gums are inflamed, or when the retention period has not finished. Rushing restorations before the teeth have stabilised can lead to work that has to be redone.