Why Do Orthodontists Reposition Brackets During Treatment?

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At some point during your braces treatment, you might be surprised to notice your orthodontist removing a bracket and placing a new one for no apparent reason. This procedure is called “bracket repositioning” and it’s just what it sounds like – we pop brackets off, only to place them in a slightly different position.

In this article, I’ll explain why orthodontists do this, when they tend to do it, and some specific situations that make properly bonding brackets difficult, to begin with.

Why do orthodontists remove and replace brackets?

Most people get into orthodontic treatment thinking they’re going to receive some braces on their teeth, a wire that gets changed once in a while, and that’s it. And in a nutshell, that’s how braces work.

But it’s these little things, like braces accessories, rubber bands, power chains, ligatures and braces repositioning that inflict more discomfort than some patients expect. And for some, it’s a constant process of fine-tuning and adjusting.

So what is bracket repositioning and why is it needed in the first place? In orthodontics, bracket repositioning consists of 3 steps: identifying brackets that are bonded slightly off-center, removing them with a bracket removing plier, and bonding a new bracket in an improved position that matches the current treatment needs.

Bracket repositioning can be a one-time thing, meaning that your orthodontist will spontaneously decide to do this with one bracket during your regular appointments, or a planned repositioning session. Some orthodontists like to defer all these corrections toward the middle or end of treatment and do a long session where they rebond multiple brackets and make all the necessary adjustments.

You’re probably wondering – why reposition brackets at all, why not glue them where they need to go in the first place? Well, that’s not always possible, and here are the most common reasons why:

Moderate to severe crowding. When certain teeth overlap, it’s impossible to get the brackets where they need to go. As the crowded teeth align, your orthodontist will gradually change the bracket position until it sits in the right place.
Incomplete dental eruption. Some of our younger patients have canines or premolars that haven’t erupted all the way, and it’s quite challenging to estimate where the correct position may be. Swollen gums often have the same effect of masking the tooth’s real size and shape.
Abnormal tooth shape. Some teeth may be more bulbous, or taller/shorter than average. It takes some guessing to bond brackets on those particular teeth, and the brackets may not have the desired effects because of the teeth’s shape.
Practitioner error. Errors in bonding brackets happen all the time because it’s pretty complicated to manually place all the brackets perfectly where they need to go. However, orthodontists are aware of this and constantly scan your teeth at each session to see if repositioning is needed.

How does the orthodontist know where to place brackets?

If I’m making bracket placing sound complicated, it’s because it is. During my residency, when bonding my first brackets, I used to have other colleagues hover over my patient to confirm my bracket positioning was right.

Every single one of my colleagues had a slightly different opinion of where a bracket should go. So long as we place braces manually, we’re going to be subjective. Luckily, tooth movement is more forgiving and we can fine-tune a lot of the movements during the detailing stage of braces.

Here’s how we know where to place any specific bracket:

We choose the right bracket for each tooth. Some orthodontists choose different brackets on purpose, as part of their treatment strategy. Some brackets will have hooks, others may not, and molars will have tubes or molar bands.
We place the bracket on the center of the tooth, with the colored dot pointing toward the gum. Some orthodontists may invert the bracket on purpose to achieve more movement of the root.
We adjust the bracket’s height using a bracket positioning gauge. Ideally, brackets should sit at the same height, but in case of deep bite, open bite, and other vertical issues, the bracket height can be changed to fit the patient’s needs.
We check that the bracket isn’t tipped to the right or left relative to the tooth’s long axis. For incisors, we check that the bracket’s margin is parallel to the tooth’s edge. If the tooth is chipped, we approximate.
If the tooth is rounded (bicuspids), we check that the bracket sits at maximum convexity. It’s easier to check this in the dental mirror.
We double check everything before applying the curing light and make slight changes using a dental probe.

How often are brackets repositioned?

The short answer is: whenever it’s necessary. Bracket repositioning takes time, so it’s better if it’s a planned procedure, however, most orthodontists are skilled and pretty fast at rebonding a bracket.

The steps of repositioning a bracket involve:

removing ligatures and archwires
removing said bracket with a plier
quickly cleaning the composite residue off the tooth
isolating the tooth and drying it
applying the bonding liquid
applying composite paste onto the bracket
placing the bracket in the new position
light curing
placing wires and ligature ties back on

This entire process takes about 20 to 30 minutes, sometimes more if there are multiple brackets to reposition. It’s quite similar to what happens if you go in with a broken bracket. So, as you can see, there are quite a number of extra things to do during your regular appointment so it’s best that these things are planned.

If you go in for a planned bracket repositioning appointment, expect to get a full treatment like you would if your were getting braces all over again: cheek retractors, saliva ejector, and all the steps involved in bonding brackets, plus the added step of removing brackets and cleaning the flash.

A thorough repositioning session might take over an hour, but it’s typically only done 6-12 months into treatment, or sometimes right before the finishing or detailing phase. Orthodontists do this so they don’t have to do as many detailing bends at the end of treatment.

Bends are sometimes difficult to get right or express the needed movement, so many orthodontists consider rebonding brackets in new positions a better solution than wire detailing bends.

After bracket repositioning, expect to experience some soreness in the teeth that have repositioned brackets. This is because the wire is more deflected in those areas and forces the teeth to move into the planned positions.

The level of pain will also depend on the amount of repositioning. Since your teeth will already be straight at this stage, and you’re already accustomed to thicker wires, expect to only experience dental pain for 48 to 72 hrs.

Does bracket repositioning cause the treatment to last longer?

Repositioning brackets shouldn’t cause longer treatment times, but your orthodontist will go back one wire size most of the time. Going back one wire size is needed because some brackets could break after repositioning due to the pressure of the current wire, so it’s best to use something softer. Plus, a small wire will help smooth out the transition and minimize the pain.

This may sound counterintuitive, but I assure you going down a wire size won’t slow things down. If your orthodontist were to place bends instead, those bends would also need some time to work on your teeth, so it all amounts to about the same treatment time.

In my opinion, bracket repositioning is more precise and addresses the root cause of the problem. There are some movements that bends simply cannot do as accurately.

Alternatives to braces repositioning

Some patients are nervous about debonding brackets from their teeth. Perhaps they fear their teeth are fragile, or they might have crowns, even veneers that can crack from the repeated stress of removing braces.

Fear not, we have a few options that can either prevent repositioning or fix teeth using different methods:

Indirect bonding and virtual bracket positioning. In an ideal world, we should all have access to this, and many orthodontic offices are moving toward this practice. Virtual bracket positioning done by powerful software can be more accurate than human positioning, and indirect bonding with Essix-like trays is super fast and comfortable. This is not a foolproof method, but it can save time and errors.
Detailing bends. For minor movements (up and down, left and right), step bends are an easy correction to make, as well as some small torque bends, where the orthodontist twists the wire to correct the tooth’s root position.
Finishing the case with aligners. Digital aligners can move teeth with great precision, especially when it comes to mild corrections. A hybrid approach works great: we correct 80-90% of the case with traditional braces, and we then take them off and give the patient aligners for a few months to work through the rest of the 10-20%. The downside of this method is that it’s more costly than just braces.

Conclusion

Hopefully, you’ve learned by now how necessary and useful bracket repositioning techniques are. In a perfect world we would identify the best spot to place a bracket from day 1, but this is often not the case. Think of bracket repos as course corrections along your treatment journey. We do it so we get you to your destination in the shortest time possible.

Whether you’re new to braces or a braces veteran, taking care of your teeth (and your health) during orthodontic treatment is crucial. That’s why I’ve put together a list of orthodontist-recommended tools that will make caring for your braces a breeze:

The only electric toothbrush you’ll ever need for your braces. Rotating electric brushes are much more effective, in my opinion, than sonic ones.
The most popular water flosser with my braces patients. If you can, choose a countertop model that can hold a lot of water. You’ll need it, and your gums will thank you.
This beast of a blender to create ice cold smoothies and silky soups. Sipping on something cold is a natural pain reliever, and soft foods are perfect for those tough weeks ahead.