Why Are Top Braces Placed First? 3 Important Reasons

Congratulations on your new braces! I bet you’ve been waiting for this moment for a long time! If you only got braces on your upper arch, you’re probably wondering what’s happening. After all, many orthodontists place both top and bottom braces during the same appointment.

Some orthodontists choose to only bond braces on the upper arch for the first few months. This is because of certain bite situations – like a deep, tight bite that doesn’t allow room for bottom braces. When the upper incisors are tilted inward, it’s better to correct them before adding lower braces.

My personal preference is to get both arches bonded during the same appointment, or at least within the first 6 weeks, but that’s not always possible, and I’ll explain why in this article.

3 reasons why Top braces are placed first

Braces get placed on the top teeth first for many different reasons. Some are medical, some are just practical. Here are the most common causes why treatment sometimes gets delayed and only the upper arch gets bonded:

1. The presence of deep bite

Deep bite is difficult to treat when it comes to bonding lower braces, particularly a type of bite anomaly called Class II Division 2 malocclusion.

In Class II Div 2, the patient’s face typically displays horizontal growth, meaning short lower face height, retroclined incisors (incisors tilted toward the back of the mouth), and a broad maxillary arch.

The upper teeth in this type of deep bite are closing on top of the lower teeth like a tight lid on a box, covering the lower teeth to the gums.

Not only is this an unhealthy bite that needs to be corrected, but it’s also a bite that makes it almost impossible for the lower brackets to get bonded without the risk of coming off. I’ve seen upper incisors get chipped from hitting lower braces, and lower teeth become dangerously mobile from the repeated trauma.

During regular cases, orthodontists bond braces on both arches and place bite blocks to prevent the teeth from touching each other and potentially breaking brackets off. With Class II Div 2 malocclusion, this is very hard to do, since the bite blocks should be very high and, as a result, very uncomfortable.

By only placing the braces on the top teeth for a few months in case of a deep, tight bite like Class II Div 2, a few things happen:

• The upper incisors stop pointing toward the back of the mouth and start tilting forward like they’re supposed to.
• This creates a gap between the upper and lower teeth, known as “overjet” in medical terms.
• The overjet allows enough space for lower braces to be bonded.
• This entire process can take 3-4 months or more.

2. Appointment duration

For practical reasons, some orthodontists choose to only bond one arch at a time. Bonding brackets is meticulous, difficult work, and only focusing on one arch can avoid potential placement errors due to fatigue.

Getting both sets of braces on can take about 2 hours, and if everything gets done in one appointment, you might be looking at a LOT of procedures:

• Records & photographs are taken;
• Teeth get cleaned and prepped;
• Teeth get dried and isolated (from this point forward you won’t be able to close your mouth);
• Bonding is applied and brackets are placed and checked for correct positioning;
• Bracket glue is cured with UV light;
• Archwires, ligatures, and elastic ties are put in;
• The patient receives indications on how to care for braces.

Sometimes, 2 hours is barely enough to do all those things, and little time is left for actual talking, so the patients may go home confused. As an orthodontist, I can tell you that sitting in the same position for nearly two hours can get very tiring, and doing this multiple times per day will lead to some serious back issues over time.

Getting only one arch bonded (usually the upper arch) is great because it takes less than an hour (it only takes me 30-40 minutes on average), and the second time the patients come in, they usually know what to expect and are prepared with many more questions.

Obviously, creating a good workflow (taking records, impressions, photographs, and talking to the patient in a different appointment), can ease some of that time pressure and make it possible for all braces to be bonded in one session.

3. Getting the patient used to braces

Another reason why I like bonding just the upper arch on certain patients is getting the patient used to braces. The upper arch is a great place to start because the patient won’t need bite blocks, so they will be able to chew like before.

Until the next appointment, when it’s time to bond the lower arch, the patient will have time to get habituated with how the braces, wires, and hooks can poke or feel uncomfortable, as well as discover what foods to eat.

The pain experienced in the upper arch will also be milder than if both arches were bonded at the same time. Except for severe crowding cases, the pain in the upper arch is usually milder because the bone is softer and helps teeth ‘loosen up’ faster.

3 Cons to placing Top braces first

As you’ve learned, practicality and even the patient’s tolerance may dictate how braces are bonded. We’re human and we make concessions, but that doesn’t always make it right. Here are a few medical reasons why placing only one arch, to begin with, is a bad idea:

1. The Lower teeth move slower

Waiting too long to bond the lower braces is a mistake, even if the lower teeth are seemingly straight.

The lower teeth take longer to move through bone because of bone density. The mandible’s bone is much harder than the maxilla, and, as a result, it takes longer to restructure to allow for teeth to move.

This particularity makes the first phase of treatment – alignment – take longer.

2. Arch coordination takes longer

We don’t just align teeth and call it a day. Both the upper and the lower arch have to be perfectly in sync so that when the patient bites, everything fits together.

This phase of the treatment is called arch coordination, and it’s achieved by leaving thick wires for months in place so that they express the desired shape on both arches.

It’s a subtle process that takes a long time, and if we’re late to implement it on the lower arch, we’re missing months of potential progress.

3. You can’t use early elastics

Intermaxillary (IM) elastics – or rubber bands, as patients call them – are sometimes needed early in the treatment to achieve certain corrections.

For example, up-and-down elastics, or class II elastics are great when we want to bring down a canine that’s lodged high in the gum line.

Under the strict supervision of the orthodontist, light IM elastics can be used from the very start of the treatment and accelerate it considerably. But without lower braces, it’s impossible to use those elastics like they’re intended.

Can you only get braces on your Top teeth?

Only getting top braces is a mistake I see often. Patients request it, it’s true, but as professionals, it’s essential to explain why this compromise can affect the health of their teeth and jaws in the long run.

Both the upper and the lower teeth need each other to get corrected and coordinated at the same pace. This means using elastics, coordinating the archwires, and just working hard overall to get a good bite.

Those patients that only get one arch aligned end up eventually starting treatment on the opposing arch as well. Wouldn’t it have been better if things were done correctly from the beginning?

Conclusion

I hope I’ve clarified why getting top braces first is something that happens often, while also stressing the importance of having both arches bonded as soon as possible. Most orthodontic treatments take a long time, so doing things as efficiently as possible saves precious time.