How Long Do Braces Take? What the Evidence Says

Introduction

"How long will I need to wear my braces?" is, as one group of researchers observed, among the first questions asked by new orthodontic patients [PMID 10194290]. The honest answer is that it depends on the individual case, but the published literature offers a useful average and identifies the factors that make treatment shorter or longer. This article summarises that evidence for patients and parents in India who are considering, or already undergoing, orthodontic treatment.

The average duration of treatment with braces

The largest pooled estimate comes from a systematic review and meta-analysis of 34 clinical trials including 6,207 patients (average age 18.4 years). The average duration of comprehensive treatment with fixed appliances was 24.9 months (95% CI 24.6 to 25.1 months). Notably, the review found no significant association between how long treatment lasted and the quality of the final bite [PMID 29090128]. A 2023 Cochrane review similarly states that orthodontic treatment takes 20 months on average to correct malocclusion [PMID 37339352].

Individual studies report a range around these figures. In a study of 140 completed cases from five orthodontic offices in the United States, the average treatment time was 28.6 months, ranging from 23.4 to 33.4 months among the offices [PMID 10194290]. In 688 patients treated at a university department in Iran, the mean duration was about 18 to 20 months depending on sex and treatment plan [PMID 36032626], and in a Finnish sample of 93 children who started treatment aged 7 to 13, the mean treatment time was 2.9 years [PMID 15272514].

In our reading, a patient can reasonably expect comprehensive treatment with braces to take roughly one and a half to two and a half years, while recognising that simpler or more complex cases may fall outside this range.

What makes treatment take longer?

A systematic review of 41 articles concluded that several factors appear to influence treatment duration [PMID 18678758]:

Extractions. There are indications that treatment involving extraction of teeth lasts longer than non-extraction treatment [PMID 18678758]. In the Iranian study, treatment with extractions lasted 19.85 ± 4.30 months compared with 17.56 ± 5.02 months without extractions [PMID 36032626], and the meta-analysis of 34 trials also identified four-premolar extraction as having an important effect on duration [PMID 29090128].
Impacted canines. Impacted upper canine teeth appear to prolong treatment [PMID 18678758].
Severity and complexity. The severity of the initial malocclusion, the technique used, the skill and number of operators involved and patient compliance all seem to play a role [PMID 18678758].
Starting very early. For Class II division 1 malocclusions (prominent upper front teeth), there is evidence that the earlier treatment begins, the longer its total duration [PMID 18678758]. A Finnish study likewise found that an early start, and the use of a higher number of appliances, prolonged treatment in children [PMID 15272514].
Combined orthodontic and surgical treatment. The duration of treatment that includes jaw surgery is variable and appears to depend on the operator [PMID 18678758].

Does age matter?

Many adults assume that braces will take much longer for them than for a teenager. The evidence does not support this as a general rule. A 2020 meta-analysis of studies including 2,969 adolescents and 1,380 adults found no significant difference in the duration of comprehensive fixed-appliance treatment between adults and adolescents (mean difference −0.8 month, 95% CI −4.2 to 2.6 months). The exception was the alignment of palatally displaced canines, which took longer in adults (mean difference 3.8 months in one study). The authors rated their confidence in these estimates as low [PMID 33015719]. The earlier systematic review reached a similar conclusion: age does not seem to play a role provided the patient is in the permanent dentition [PMID 18678758].

Factors the patient can influence

Several studies point to factors that lie partly within the patient's control.

Attending appointments. In the American study, the number of missed appointments was one of five variables that together explained nearly half (46.9%) of the variation in treatment duration; the others were the number of replaced brackets and bands, the number of treatment phases, negative chart entries about oral hygiene and the prescription of headgear [PMID 10194290]. In the Iranian study, patients who missed more than one appointment had significantly longer treatment, and treatment duration correlated with the number of missed sessions (r = 0.365) [PMID 36032626]. A high number of missed appointments also prolonged treatment in Finnish children [PMID 15272514].
Protecting the brackets. Bracket debonding was associated with significantly longer treatment [PMID 36032626], and the number of replaced brackets and bands contributed to longer treatment in the American study [PMID 10194290].
Oral hygiene. Negative chart entries regarding oral hygiene were among the factors associated with longer treatment [PMID 10194290].

In our reading, the practical message is that keeping every scheduled adjustment visit, avoiding hard and sticky foods that can break brackets, and maintaining good oral hygiene are the steps most likely to keep treatment close to the planned timeline. These studies show associations rather than proof of cause, but the findings are consistent across different countries and decades.

Are clear aligners or "fast braces" quicker?

Clear aligners. A 2024 systematic review of ten studies, six of them randomised controlled trials, found low-certainty evidence that treatment duration with clear aligners is similar to that with fixed braces in mild to moderate crowding cases [PMID 38607436]. A 2020 meta-analysis likewise found no significant difference in treatment duration, but reported that aligners were associated with a worse occlusal outcome and more patients with unacceptable results in adults [PMID 31758191].

Devices and lasers marketed to speed up treatment. A 2023 Cochrane review of 23 randomised trials with 1,027 participants found no evidence that light vibrational forces shortened overall treatment (mean difference −0.61 months, 95% CI −2.44 to 1.22). It concluded that there is no additional benefit of light vibrational forces or photobiomodulation for reducing the duration of orthodontic treatment, although photobiomodulation may offer limited benefit for discrete stages, and the certainty of the evidence was low to very low [PMID 37339352].

Treatment does not end when the braces come off

Without a phase of retention after successful treatment, teeth tend to relapse towards their original positions, which is why retainers are fitted once the braces are removed [PMID 37219527]. A 2023 Cochrane review of 47 studies with 4,377 participants could not draw firm conclusions about which retainer or retention strategy is best, because the evidence was of low to very low certainty [PMID 37219527]. Patients should therefore plan for a retention phase after active treatment and follow their orthodontist's instructions on how long and how often to wear retainers.

Practical guidance for patients and parents

The following points are our interpretation of the evidence above. They do not replace the advice of your orthodontist.

Ask for an individual estimate. Averages of about 20 to 25 months [PMID 29090128][PMID 37339352] are a guide only; extractions, impacted canines and case severity can lengthen treatment [PMID 18678758].
Do not assume you are too old. Overall treatment duration appears similar in adults and adolescents [PMID 33015719].
Keep every appointment. Missed appointments are consistently associated with longer treatment [PMID 10194290][PMID 36032626][PMID 15272514].
Look after your brackets and your oral hygiene [PMID 10194290][PMID 36032626].
Be cautious about claims of much faster treatment. Current reviews do not show that aligners [PMID 38607436] or non-surgical acceleration devices [PMID 37339352] shorten overall treatment.
Plan for retainers after the braces are removed [PMID 37219527].

D4dent's patient services let you find a dentist and book appointments online, with email or SMS reminders for appointments booked through the platform. In our reading, reminders are a simple way to support the regular attendance that the studies above link to shorter treatment. A teleconsultation can also help you discuss a concern, such as a loose bracket, with a dentist before deciding whether a clinic visit is needed.

Frequently asked questions

How long do braces usually take?

A meta-analysis of 34 clinical studies including 6,207 patients found an average treatment duration with fixed braces of 24.9 months. A 2023 Cochrane review states that orthodontic treatment takes 20 months on average. Individual cases vary widely, so your orthodontist's estimate for your own teeth is the most useful guide.

Do braces take longer for adults than for teenagers?

A 2020 meta-analysis found no significant difference in the overall duration of comprehensive fixed-appliance treatment between adults and adolescents, although the evidence was of low quality. Bringing a palatally displaced (impacted) canine into place took longer in adults in one study.

Can missed appointments make braces take longer?

Yes. Studies from several countries have found that missed appointments and broken or debonded brackets are associated with longer treatment. In a study of 688 patients, treatment lasted significantly longer in patients who missed more than one appointment.

Are clear aligners faster than braces?

Current systematic reviews have not found a significant difference in treatment duration between clear aligners and fixed braces, mainly in mild to moderate crowding cases. One meta-analysis found that aligners were associated with poorer occlusal outcomes in adults.

Limitations to keep in mind

Most of the evidence on treatment duration comes from retrospective and non-randomised studies [PMID 33015719][PMID 10194290][PMID 36032626][PMID 15272514], and the pooled estimates show considerable heterogeneity [PMID 29090128]. The comparisons of aligners and acceleration methods are of low to very low certainty [PMID 38607436][PMID 37339352], as is the evidence on retention [PMID 37219527]. None of the studies cited was conducted in India. Figures are taken from published abstracts; readers should consult the full texts before citing specific values.

Conclusion

Comprehensive treatment with fixed braces takes about two years on average [PMID 29090128], with individual cases ranging more widely. Extractions, impacted canines, case severity and very early starts tend to lengthen treatment [PMID 18678758], whereas age, in the permanent dentition, does not appear to make a significant difference [PMID 33015719]. In our reading, the factors most within a patient's control are regular attendance, care of the brackets and good oral hygiene, all of which have been associated with treatment that stays closer to schedule [PMID 10194290][PMID 36032626].

More in this series

Find a dentist, book online and get appointment reminders in one place. Create your D4dent patient account.

References

Papageorgiou SN, Höchli D, Eliades T. Outcomes of comprehensive fixed appliance orthodontic treatment: A systematic review with meta-analysis and methodological overview. Korean J Orthod. 2017 Nov;47(6):401-413. PMID: 29090128
El-Angbawi A, McIntyre G, Fleming PS, Bearn D. Non-surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment. Cochrane Database Syst Rev. 2023 Jun 20;6(6):CD010887. PMID: 37339352
Mavreas D, Athanasiou AE. Factors affecting the duration of orthodontic treatment: a systematic review. Eur J Orthod. 2008 Aug;30(4):386-95. PMID: 18678758
Abbing A, Koretsi V, Eliades T, Papageorgiou SN. Duration of orthodontic treatment with fixed appliances in adolescents and adults: a systematic review with meta-analysis. Prog Orthod. 2020 Oct 5;21(1):37. PMID: 33015719
Kiyamehr Z, Razeghinejad MH, Rahbar M, Oskouei SG, Vafaei A. Factors Affecting the Duration of Fixed Orthodontic Treatment in Patients Treated in a University Department between 2016 and 2020. Maedica (Bucur). 2022 Jun;17(2):380-386. PMID: 36032626
Beckwith FR, Ackerman RJ Jr, Cobb CM, Tira DE. An evaluation of factors affecting duration of orthodontic treatment. Am J Orthod Dentofacial Orthop. 1999 Apr;115(4):439-47. PMID: 10194290
Järvinen S, Widström E, Raitio M. Factors affecting the duration of orthodontic treatment in children. A retrospective study. Swed Dent J. 2004;28(2):93-100. PMID: 15272514
Alhamwi AM, Burhan AS, Idris MI, Nawaya FR. Duration of orthodontic treatment with clear aligners versus fixed appliances in crowding cases: a systematic review. Clin Oral Investig. 2024 Apr 12;28(5):249. PMID: 38607436
Papageorgiou SN, Koletsi D, Iliadi A, Peltomaki T, Eliades T. Treatment outcome with orthodontic aligners and fixed appliances: a systematic review with meta-analyses. Eur J Orthod. 2020 Jun 23;42(3):331-343. PMID: 31758191
Martin C, Littlewood SJ, Millett DT, Doubleday B, Bearn D, Worthington HV, Limones A. Retention procedures for stabilising tooth position after treatment with orthodontic braces. Cochrane Database Syst Rev. 2023 May 22;5(5):CD002283. PMID: 37219527