Fixed braces, by definition, cannot be removed by the patient. They consist of a series of small square attachments cemented to the teeth. These are known as brackets. It is simplest to think of each bracket as a handle with which it is possible to control each tooth individually.

The brackets are highly sophisticated as every tooth has its own bracket design engineered to achieve correct position and angle of axis.

How are brackets controlled?
In the early part of treatment, a flexible but springy wire is fitted to link up all the brackets. Because the teeth are irregular, the wire has to bend up and down or in and out between the teeth. This is the clever bit: the wire, a bi-product of NASA research, has perfect shape memory and will gradually return to its original shape, bringing the teeth with it.

As treatment progresses, stiffer wires are fitted and these act as a monorail. At this time, the teeth are guided by tiny springs and elastics.

What are the advantages?

• There is no plastic in the roof of the mouth. This means speech is unaffected and the flavour of food can be enjoyed fully.
• The temptation of not wearing the appliance does not arise.
• Fixed braces are supreme at fine tuning the way the teeth line up and bite together. Research has shown that patients are happier with their smiles after fixed brace treatment than after other forms of treatment.

What are the disadvantages?

• Fixed braces are not very good at major alterations to the bite. For this, other appliances are used either before or at the same time as the fixed braces. Examples include upper jaw widening or correcting the bite with a functional (orthopaedic) appliance or a headgear.
• Fixed braces are more noticeable. However, if this is a concern, tooth coloured upper ceramic brackets make the appliance socially very acceptable. For technical reasons, ceramic brackets are not usually possible for the lower front teeth, but these are not so noticeable anyway. The cost of treatment is the same regardless of whether ceramic or mini metal brackets are used.
• Cleaning the teeth takes more time, but has to be done. All necessary instructions and brushes will be provided.
• Certain foods cannot be eaten (mainly foods you shouldn't be eating anyway!) but this applies to all types of braces. Again, all necessary guidance will be given.

What about playing sport or musical wind instruments?

• It is essential to wear a mouthguard when playing contact sports such as rugby or dangerous sports such as hockey, whether wearing a brace or not. We provide many custom made mouthguards that fit over fixed braces.
• The problem area for players of wind instruments is the inner surface of the lower lip. We provide low contour brackets for the lower front teeth in such cases with good success, even for professional musicians.