Orthodontic Treatment Process: From First Consultation to Retention

Orthodontic treatment involves much more than simply placing braces or starting a series of clear aligners. A comprehensive orthodontic process includes examination, diagnosis, evaluation of diagnostic records, individualized treatment planning, active tooth movement, regular clinical monitoring and a retention phase after active treatment.

Because every patient has different tooth positions, bite relationships, age, growth and development characteristics and treatment needs, the scope and sequence of these stages may vary between individuals.

Orthodontic treatment should therefore be considered an individualized clinical process rather than a fixed sequence of identical procedures for every patient.

How Does the Orthodontic Treatment Process Begin?

The first stage of orthodontic treatment is clinical assessment.

The patient's main concerns, existing tooth positions, crowding or spacing, upper and lower bite relationships and, when necessary, jaw relationships are evaluated.

This initial assessment helps determine whether orthodontic treatment is needed and whether additional diagnostic records are required.

1. The First Orthodontic Consultation

The first examination does not focus only on the appearance of the front teeth.

The position of the teeth within the dental arches, spacing, crowding, tooth eruption and bite relationships are evaluated as a whole.

The patient's expectations and treatment priorities are also an important part of the consultation.

What Is Evaluated During the First Consultation?

Depending on the patient's clinical condition, the orthodontic assessment may include questions such as:

• Is dental crowding present?
• Are there spaces between the teeth?
• How do the upper and lower teeth meet?
• Are there any differences in tooth eruption?
• Do the jaw relationships need to be evaluated?
• Is the patient still growing and developing?
• Have previous dental treatments been performed?
• Is the oral environment suitable for orthodontic treatment?

The scope of the assessment varies according to the individual case.

2. Obtaining Orthodontic Records

In addition to the clinical examination, different orthodontic records may be required to create an appropriate treatment plan.

These records can provide more detailed information about the patient's existing tooth and jaw relationships.

The specific records required are not the same for every patient.

Why Are Orthodontic Photographs Taken?

Intraoral and facial photographs may be used to document the patient's condition at the beginning of treatment.

Tooth alignment, bite relationships and facial-dental relationships can be evaluated using these records.

Photographs may also help compare the initial condition with changes observed later in treatment.

Why Is Radiographic Assessment Performed?

When clinically indicated, radiographic images may be used to support orthodontic diagnosis and treatment planning.

Tooth roots, unerupted teeth, bone structures and various anatomical relationships may be evaluated using these images.

The type of radiographic record required is determined according to clinical need.

What Is Digital Intraoral Scanning?

Digital intraoral scanning is a method used to create three-dimensional models of the teeth and dental arches.

The current positions of the teeth, degree of crowding or spacing and arch form can be evaluated on these digital models.

When clear aligner treatment is being considered, digital scans may also be used during treatment planning.

3. Preparing for Orthodontic Treatment

Before active orthodontic treatment begins, the general health of the teeth and surrounding tissues should be evaluated.

Orthodontic treatment is ideally carried out in a healthy oral environment.

When necessary, other dental procedures may therefore be planned before active orthodontic treatment starts.

Should Dental Caries Be Evaluated Before Treatment?

Yes. Active caries and restorative needs may need to be addressed before orthodontic treatment.

Good dental health is particularly important because oral hygiene may require greater attention during treatment with fixed orthodontic appliances.

Why Is Periodontal Health Important?

Orthodontic tooth movement occurs together with biological changes in the tissues supporting the teeth.

Periodontal health should therefore be evaluated before and during orthodontic treatment.

If problems involving the gums or supporting tissues are present, assessment in coordination with other dental disciplines may be necessary.

Is Tooth Extraction Required in Every Orthodontic Treatment?

No. Tooth extraction is not a standard stage of every orthodontic treatment.

The need for extraction depends on factors such as the degree of crowding, dental arch characteristics, tooth positions, bite relationships and overall treatment objectives.

The decision should be made through individualized orthodontic treatment planning.

4. Diagnosis and Treatment Planning

Once the clinical examination and necessary diagnostic records have been completed, the orthodontic diagnosis is established and treatment objectives are defined.

This is one of the most important stages of orthodontic treatment.

Before selecting an appliance, it is necessary to determine which teeth need to move, where they should move and in what sequence those movements should occur.

What Does Orthodontic Diagnosis Mean?

Orthodontic diagnosis is the systematic evaluation of the patient's existing tooth positions and bite relationships.

The orthodontist assesses whether the problem is primarily dental, whether jaw relationships are also involved and which factors may influence treatment planning.

How Are Treatment Objectives Determined?

Treatment objectives are individualized according to the patient's orthodontic condition.

These objectives may include aligning the teeth, managing spaces, improving bite relationships or performing specific tooth movements.

Aesthetic expectations may also be considered, but the treatment plan should not be based on appearance alone.

How Is the Treatment Method Selected?

Once the orthodontic diagnosis and treatment objectives have been established, the appropriate treatment system can be evaluated.

Fixed braces, clear aligners or other orthodontic appliances may be considered depending on the clinical problem.

The choice of treatment method should be based not only on aesthetic preference but also on the tooth movements and clinical requirements involved.

5. Active Orthodontic Treatment

During the active treatment phase, the planned orthodontic tooth movements are carried out.

Depending on the treatment method, this may involve fixed brackets and wires or removable clear aligners.

Regular clinical follow-up is required throughout active treatment.

How Does Treatment with Fixed Braces Progress?

In fixed orthodontic treatment, brackets are bonded to the teeth and orthodontic wires are used to apply controlled forces.

Different wires, auxiliary elements or elastics may be introduced as treatment progresses.

The mechanics used vary according to the individual's treatment plan.

How Does Clear Aligner Treatment Progress?

In clear aligner treatment, planned tooth movements are divided into a sequence of stages.

The patient wears a custom-made series of aligners according to the schedule determined by the orthodontist.

Because clear aligners are removable, patient compliance is an important component of treatment.

How Does Orthodontic Tooth Movement Occur?

Orthodontic appliances apply controlled forces to the teeth.

These forces create a biological response in the periodontal tissues and surrounding bone.

Tooth movement occurs gradually through this biological process.

Why Are Teeth Not Moved All at Once?

Teeth need to be moved within appropriate biological limits.

For this reason, treatment objectives are divided into different stages.

Some tooth movements may need to occur before others, making the sequence of treatment an important part of planning.

6. Regular Orthodontic Follow-Up Appointments

Clinical follow-up appointments are scheduled at appropriate intervals during active orthodontic treatment.

These appointments are not performed only to check the appliance.

The orthodontist also evaluates whether tooth movement and bite relationships are progressing according to plan.

What Is Evaluated During Follow-Up Appointments?

Depending on the treatment method, the following may be evaluated:

• Current tooth positions
• Changes in bite relationships
• The condition of brackets and wires
• Clear aligner fit
• The condition of attachments or elastics
• Oral hygiene
• Patient compliance

Can the Treatment Plan Change During Treatment?

Yes. The original plan provides a roadmap for treatment, but orthodontic tooth movement is a biological process.

Depending on the clinical response, certain mechanics or treatment stages may need to be modified.

This is why clinical monitoring remains an important part of orthodontic treatment.

Can Missing Appointments Affect Treatment?

Long delays between follow-up appointments may postpone the evaluation of treatment progress.

Problems involving the appliance or differences between planned and actual tooth movement may not be identified promptly.

The appropriate follow-up schedule is determined according to the treatment method and clinical needs.

7. Completion of Active Treatment

The decision to complete active orthodontic treatment is not based only on whether the teeth appear straight.

The original treatment objectives, tooth positions and bite relationships are reassessed.

When the planned clinical objectives have been achieved, the active orthodontic appliances may be discontinued.

When Are Braces Removed?

In fixed orthodontic treatment, brackets are removed once the planned active tooth movements have been completed and the clinical objectives have been evaluated.

The decision is based on treatment results rather than on the amount of time that has passed alone.

Does Reaching the Last Clear Aligner Mean Treatment Is Finished?

Not always.

At the final aligner stage, tooth positions and bite relationships are reassessed to determine whether the treatment objectives have been achieved.

If necessary, additional aligners or a refinement phase may be planned.

8. Retention Phase

After active orthodontic treatment has been completed, the retention phase begins.

The purpose of this stage is to help maintain the positions achieved during treatment.

Retention is a separate and important stage of the overall orthodontic process.

What Is a Retainer?

A retainer is an orthodontic appliance used after active treatment to help maintain the new positions of the teeth.

Fixed and removable retainer options may be considered.

The appropriate type is selected according to the treatment result and individual clinical situation.

Why Is Retention Necessary?

Teeth do not become permanently fixed in an unchanging position once active treatment has ended.

Natural changes in the teeth and surrounding tissues can continue throughout life.

For this reason, following the recommended retention protocol can help maintain the treatment result.

How Long Is a Retainer Worn?

The duration and schedule of retainer wear are individualized.

There is no single standard duration that applies to every patient.

The retention protocol should be determined according to the orthodontist's clinical assessment.

Do Follow-Up Appointments Continue After Orthodontic Treatment?

Follow-up appointments may also be scheduled during the retention phase.

The condition of the retainer and the positions of the teeth can be evaluated during these visits.

The follow-up schedule varies between patients.

How Long Does Orthodontic Treatment Take?

Total treatment duration varies from patient to patient.

The complexity of the orthodontic problem, required tooth movements, bite relationships, treatment method, biological response and patient compliance can all influence treatment duration.

For this reason, it is not appropriate to provide one exact treatment time that applies to every patient before clinical assessment.

Why Is Patient Compliance Important During Orthodontic Treatment?

Orthodontic treatment involves both clinical planning by the orthodontist and the patient's daily care and treatment habits.

Wearing clear aligners according to the prescribed schedule, using elastics when instructed, maintaining oral hygiene and attending follow-up appointments all contribute to the treatment process.

Are the Stages of Orthodontic Treatment the Same for Every Patient?

No.

Although the general process includes examination, diagnosis and planning, active treatment and retention, the specific procedures involved vary according to the patient's orthodontic condition.

Another patient's treatment experience should therefore not be considered a direct model for an individual's own treatment plan.

Frequently Asked Questions About the Stages of Orthodontic Treatment

Are braces placed at the first appointment?

Not always. An orthodontic assessment is performed first and the necessary diagnostic records are evaluated. The treatment method and timing are then planned individually.

Why are orthodontic records necessary?

Photographs, radiographic images and digital models can help provide a more detailed assessment of tooth and jaw relationships and support treatment planning.

Does every orthodontic treatment require tooth extraction?

No. Extraction is not a standard stage of orthodontic treatment. The need for extraction depends on the patient's dental condition and treatment objectives.

Can the treatment method change during orthodontic treatment?

In some situations, the treatment plan or mechanics may be adjusted according to clinical progress.

Is treatment finished once the teeth look straight?

Not necessarily. Bite relationships and the other orthodontic objectives established at the beginning of treatment also need to be evaluated.

Why is a retainer used after orthodontic treatment?

A retainer is used to help maintain the tooth positions achieved during active orthodontic treatment.

Is retention part of orthodontic treatment?

Yes. Retention is an important stage of the orthodontic process that begins after active tooth movement has been completed.

Content Last Updated: 2 September 2026

Content Reviewed By: Orthodontist Çağrı Şibal

This content has been prepared for general informational purposes and does not replace a clinical diagnosis or personalized treatment recommendation. The stages of orthodontic treatment, treatment method, treatment duration and retention protocol are determined following clinical examination, necessary diagnostic assessments and individualized orthodontic treatment planning.