If you’re new to orthodontics, you may be wondering if braces go on all teeth, including molars. Perhaps your orthodontist didn’t bond all your back teeth, or maybe your molars are straight and you’re wondering why it’s necessary to bond them. We’ll try to cover your questions in this article.
Braces go on all teeth, molars included. There are eight molars inside the mouth that need to be bonded, and they may get either buccal tubes, orthodontic bands, or a combination of both. It’s important to engage all molars in treatment, whenever possible, to achieve a stable occlusion.
Orthodontics is highly individual, so there will always be exceptions, and some teeth won’t be included in treatment. This is all up to your orthodontist and their better judgment. I’m here to explain the most common scenarios and why your situation may not be typical.
Do braces go on all teeth, including Molars?
Ideally, whenever starting orthodontic treatment with braces, we want to bond all teeth, from incisors to molars – including the second molars.
It’s essential to engage all the molars in the archwire from the very beginning. Molars can be rotated or misaligned, sit in a crossbite, or far out into the cheek in a scissor bite. These are all things that affect the occlusion, the health of your temporomandibular joint, and the health of your teeth and gums.
Sometimes, the changes that need to be made to molars are subtle but still meaningful – such as correcting an angle or aligning a marginal ridge. It may not look like much, but occlusal interferences can cause all kinds of imbalances, so it’s best to address them.
Molars also act as very important anchors for tooth movement, particularly in space-closing mechanics, when we want to pull groups of teeth back. In extraction cases, for example, bonding molars is crucial. They act as true pillars because they’re so massive and move slower than other, smaller teeth.
So the rule is – bond all molars, all the time. However, with every rule, there are plenty of exceptions.
We don’t put braces on:
- 3rd molars or wisdom teeth (unless other molars are missing and we plan to substitute them with the wisdom teeth);
- dental implants and crowns (unless we want to use the anchorage of an implant to move other teeth);
- fragile, cracked, and reconstructed teeth (unless the dentist says it’s okay);
- primary teeth or baby teeth (unless it’s for a very short time, to achieve a quick correction of permanent teeth).
As you can see, even our exceptions aren’t that strict. So, in the end, it’s up to your orthodontist’s treatment plan. But typically, you will have braces on all your teeth, all the way back.
What types of braces go on molars?
Your molars will receive either buccal tubes or molar bands as part of your braces:
- Buccal tubes are tiny brackets shaped like a tube that are glued on the cheek side of your molars. The archwire runs through them all the way to the back of your mouth.
- Molar bands, or orthodontic bands, are metal rings customized to your molars, that get cemented on your back teeth. They also have a tube for the archwire, but the tube is welded onto the metal band instead of being directly glued to the teeth.
If you’re getting molar bands, your orthodontist will place spacers (or separators) in between your molars so that the bands can actually go in. This is a separate appointment from braces and can be a little uncomfortable. I’ve written about the pain from spacers in this article if you’re curious.
Molar bands can look like a lot of hassle, and they’re also much bigger than tubes. Many patients wonder if they’re really necessary, and I’ve answered that question here.
Why didn’t your orthodontist brace your second molars?
Now that we’ve established that bonding all teeth is vital, what happens if your orthodontist doesn’t bond all your molars? You may have noticed that some of your back teeth don’t have any braces on. This often concerns the second molars.
The second molars are a set of teeth located after the first molars. If you still have your wisdom teeth, you’ll notice three large molars on one quadrant, and the second molar is the one in the middle. If you don’t have your wisdom teeth anymore, the second molars are the last molars all the way to the back of your mouth.
Although many orthodontic treatment philosophies state the importance of bonding second molars, practitioners often skip this step for practical reasons:
Since second molars are so far back in the mouth, it’s very difficult to maintain them dry while bonding the buccal tubes, which can lead to bonding failure – a.k.a. the buccal tube falling off at home.
Bonding second molars from the very beginning and inserting a starter wire in the second molars can really hurt your cheek since the wire is so flimsy and can dig into the cheek mucosa. Only having the first molars bonded will help the patient adjust better to braces.
Certain malocclusions, such as an open bite, can be made worse if second molars are bonded, as they can open up the bite even more. But this can be easily remedied if the brackets are placed higher, close to the occlusal surface.
Other malocclusions, however, may greatly benefit from bonding second molars – such as deep bites and crossbites. And if second molars are improperly angled or torqued, it’s absolutely essential to treat them, because they can negatively impact the occlusion.
These are all practical aspects of bonding second molars which cause doctors to often skip treating them unless they’re severely rotated or misaligned. Orthodontists can also postpone bonding second molars, so you might get your molars bonded even a year into treatment.
It’s best to ask your orthodontist about your second molars, and whether it’s necessary to include them in braces. Bonding your second molars can benefit the overall occlusion, especially in adult cases, so it’s still strongly recommended.
Bonding molars offers stability to your braces, but the poking end of the archwire can be a major inconvenience. But, discomfort aside, engaging molars in orthodontic treatment still needs to be done. If you don’t have braces on all your molars, you could still get them in the future because many orthodontists skip them in the initial phases of treatment.