Straight Teeth: Seven Ways—Most People Know Only Two

The quickest way to straight teeth is to move exactly the six teeth that are visible.

A three-to-three front tooth correction extends from canine to canine and leaves the back teeth in place. For those who want straight teeth—especially in the visible front—this is the shortest path to achieving that goal. We manufacture the aligners for this in-house using 3D printing, without going through a third-party laboratory. Our in-house Formlabs printer is capable of large-format printing and can produce sixteen models per print run. This approach is also effective when teeth have shifted back after a previous treatment, such as following a broken retainer. In technical terms, this relapse is called a recurrence.

Its limitation lies where the cause lies. It corrects the position of the front teeth, not the occlusion behind them—that is, not the way the teeth fit together when you bite down. If the bite caused the crowding, the crowding will return, and the straight teeth will only last for a while. That’s why we start with the scan rather than the aligner: An intraoral scan with the Aoralscan takes about three minutes, after which we analyze the model digitally in OnyxCeph. We don’t need impression material for this—we don’t even have any on hand.

What this approach requires of you is a willingness to set aside the smaller solution if the diagnosis calls for the larger one. You can find out how aligner treatment works and what dental issues it addresses on the page about aligner treatment in Munich.

Three factors determine how far and how quickly a tooth can be moved: the position of the root, the amount of available bone, and the condition of the periodontal tissues—that is, the gums, periodontal ligament, and bone surrounding the tooth. None of these three factors can be seen in a photograph. At ortholoft, an orthodontic practice in Munich, initial diagnostics are therefore performed before any aligner treatment begins: a lateral X-ray, a panoramic X-ray of both jaws, and photographs of the teeth. On the screen, we measure the angles and distances between the jaw, the base of the skull, and the teeth; only then can we determine what kind of movement is even feasible. This process includes checkups every six to ten weeks, the retainer fitted at the end of treatment, and follow-up care afterward. Straight teeth can be achieved this way, but no one knows in advance what the cost will be for the roots.

What this path requires of you is trust without evidence.

An aligner for the entire dental arch can do everything the front-tooth version can do—and much more. But it also demands more: The discreet version is the more challenging one, and it’s a challenge every single day.

An aligner only works as long as it is in your mouth. The recommended wear time is 22 hours a day; you should remove the aligner to eat, drink anything other than water, and brush your teeth. We work exclusively with SPARK by Ormco and hold the highest user status with them. Aligners are replaced every ten days; treatment lasts an average of about twelve months, and checkups take place every eight to ten weeks. In the year leading up to opening his practice, Dr. Pfeil managed approximately 130 ongoing aligner cases. In everyday life, clear aligners are barely visible, and they are not a substitute for a dental evaluation.

An aligner alone wouldn't have enough force to move a tooth. The tooth's surface area must be increased so that the aligner can grip the tooth. To do this, we bond attachments to the teeth and remove a small amount of enamel in specific areas. For working adults, this is the method that fits most discreetly into their daily routine, and at ortholoft in Schwabing-West, it's the most common choice.

There are two clear limitations: We do not use aligners to treat patients with extensive crowns or bridges because the aligners do not provide sufficient support in those areas. And we only treat adolescents with aligners at the express request of their parents, because patient compliance at that age is too unreliable.

This method helps you achieve straight teeth through your consistency. The choice between aligners and braces isn't a matter of comfort versus comfort. It's a matter of commitment versus visibility.

At Ortholoft, ceramic costs the same as metal. For adults, that's often the deciding factor.

Fixed braces work without you having to think about them because they are not removable. However, they are visible throughout the entire treatment period, which lasts one and a half to two years. We bond self-ligating Empower brackets from American Orthodontics, available in metal or ceramic, with no price difference between the two. The treatment involves five archwires: one round archwire and two edge archwires made of thermoelastic nickel-titanium, followed by two edge archwires made of steel. The archwires are changed every six to eight weeks or more, deliberately using low forces. Bonding and removal each take sixty to ninety minutes.

There are movements that braces can perform more reliably than any aligner: moving a root, rotating a tooth around its own axis, and closing an extraction gap—that is, a gap left after a tooth is extracted. When any of these movements is necessary, straight teeth cannot be achieved with aligners alone. This does, however, make oral hygiene more time-consuming. For every patient, we seal the smooth tooth surfaces around the brackets with BracePaste; patients receive brushing instruction when the braces are fitted, and four professional teeth cleanings per year are included in the treatment package. Cleanings are performed with the archwire removed and using an EMS device with extra-fine powder; both dental hygienists on staff are trained on-site for this procedure. Fluoridation has a sustained effect lasting six to nine months.

With this method, straight teeth come at the cost of visibility—for one and a half to two years. On top of that, there are four appointments a year dedicated solely to cleaning. You can find everything you need to know about brackets, archwires, and the process on the page about fixed orthodontic appliances.

This brace is not visible from the outside, and we rarely recommend it anyway.

We use the WIN system, which involves brackets on the inner surfaces of the teeth. Its primary application is for severe deep bites caused by skeletal factors—that is, those rooted in the bone rather than in the position of the individual teeth. When the teeth are closed, there is typically a vertical misalignment of one to two millimeters. For patients with very strong jaw growth, the force of an aligner is not sufficient to correct this. In these cases, lingual braces are the only way to achieve straight teeth—and there is no compromise.

For all other cases, it’s easier to achieve straight teeth with aligners or with brackets on the outside, and we’re open about the cost of this treatment option.

If it is the jaws rather than the teeth that are misaligned, we work with an oral surgery practice to develop a treatment plan.

This approach requires one to two weeks for your tongue to adjust. You can find out when this design is the right choice on the page about the lingual technique in Munich.

If the crowding is caused by an upper jaw that is too narrow, straightening the teeth does not involve making the teeth fit more tightly together. Instead, the jaw is widened at the suture that divides the palate down the middle. In children, this suture is still open, so a removable appliance is sufficient during growth. In adults, this suture is usually fused, so the skeletally anchored version is used, which is supported directly in the bone by mini-screws. This is exactly why some adults are told that this treatment is no longer an option for them. It is possible—just in a different way.

At ortholoft, all products are manufactured exclusively using the casting method, based on a scan produced by Klee, a certified German laboratory. This process does not require an impression taken with a tray and impression material, and the cast version is significantly more comfortable to put on and take off than a design with straps.

Palatal expansion is rarely a standalone method for achieving straight teeth. Most often, it is the first step, after which aligners or braces take over. For adults, this also means that what wasn’t done during growth isn’t lost—it simply shifts the treatment to a different path.

This procedure requires a minor surgical procedure to place the anchors and a few weeks of wearing an appliance on the palate. For details on how the jaw is widened during this process, see the guide to palatal suture expansion.

The most technical method for straightening teeth requires the least effort on your part. You've already seen these screws, and they can support more than just a palatal expansion.

A mini screw provides the mechanism with a fixed point against which it can work. We deliberately use it as the standard treatment rather than as a last resort. The reason is simple: the result does not depend on how consistently the appliance is worn; it takes effect more quickly and reliably, and the treatment is safeguarded in multiple ways. In adults, this is often a prerequisite for achieving straight teeth at all, since growth no longer plays a role in the process.

The mini-screw is not a standalone solution for straight teeth. It is the solution that makes the other six teeth strong enough to bear the load and keeps the teeth aligned even when the mechanism has to work hard.

Anyone planning to straighten their teeth in Munich usually compares treatment options: aligners versus braces, lingual versus conventional. The technical decision is made at a deeper level.

Virtually any treatment can tilt a tooth. However, not every treatment is equally effective at preserving a root, rotating a tooth around its own axis, or properly closing an extraction gap. This distinction determines almost everything else, including the duration and complexity of the treatment. Straightening teeth, therefore, begins with determining what type of movement the patient’s condition requires.

These seven are the approaches actually used to treat adults. There are others, such as removable appliances during growth or combined treatment with an oral surgery practice, when it is not the teeth but the jaws that are misaligned. Both require a diagnosis that determines the choice of treatment anyway.

That is why, at ortholoft, an orthodontic practice in Munich, the diagnostic process comes before the treatment recommendation—not after. The initial diagnostic work includes an intraoral scan, a digital lateral cephalometric X-ray, a panoramic X-ray, individual tooth X-rays if necessary, and a photo record taken with the Dental iPad. Only then can we determine which treatment option is actually suitable for achieving straight teeth.

Not every misalignment requires treatment. A slight crowding in the front is not a medical condition, and tooth movement is possible at any age—only the treatment plan differs. Therefore, waiting to see how things develop is a valid option as long as the condition does not worsen, and straight teeth are not a medical goal in and of themselves.

However, there are situations in which waiting comes at a cost: shifting teeth, a single tooth that bears the entire load when the teeth are closed, or an upcoming crown, bridge, or implant whose placement depends on the position of the teeth. This is more common than one might think among people over forty. A study of a large group of patients, cited by Prof. Meyer-Marcotty in his work on treatment motivation, found that 56 percent of patients over the age of 40 had shifting teeth with gaps forming in the upper front teeth area. In these cases, it is no longer a matter of simply wanting straight teeth, but rather of preserving one’s own teeth—and according to the same study, this is precisely the strongest motivation for treatment in the 40-and-over age group.

No percentage can tell you what that means in a specific case. Only an inspection can.

The evidence regarding the effectiveness of retainers is clear. In about 2 percent of patients with a fixed retainer on their lower front teeth, malocclusion recurred in that area over the course of twenty years. Without a fixed lower retainer, the recurrence rate after the same period is over 85 percent. So, anyone who wants to keep their teeth straight is not only deciding on the treatment itself but also on the period that follows. The phase immediately after the end of retention—that is, after the period during which the teeth are actively held in place—is critical: Long-term observations show that nearly half of all relapse occurs in the first two years following retention.

This process works as follows: The retainer is created digitally via RetainerHub, involving scanning, modeling, bending, and placement. Fixed retainers are the standard at ortholoft; removable retainers are used in cases of high relapse risk. Retention check-ups are scheduled once a year; we provide a two-year warranty on fitted retainers and replacement retainers every two years. We handle retainer emergencies at any time, including—and specifically—for patients who were treated at another practice.

Nowadays, you can achieve straight teeth with any modern orthodontic system. But they’ll only stay straight if you have a plan. You can read about how retention works with Ortholoft on the page about retainers and long-term stability.

In a study on adults’ motivation for treatment, 44 percent of patients had never been informed before that orthodontic treatment is even possible in adulthood. Which of the seven ways to straight teeth is right for you depends on the findings—and we’ll have those in a quarter of an hour. The initial consultation is free for patients with public health insurance and those paying out of pocket, and there’s no obligation. It takes place in our private consultation room, not at the dental chair; your medical history is recorded digitally on an iPad; and you’ll be offered a cup of coffee before we discuss your teeth. There are three appointments before treatment begins: initial consultation, treatment plan discussion, and treatment start.

ortholoft, an orthodontist in Munich, is located on the ground floor of a historic building with wheelchair-accessible entry. Tram 28 stops right in front of the office at the Elisabethplatz stop, and it’s just a few minutes’ walk from Hohenzollernplatz via the U2 subway line. There is no on-site parking, but you can park your bike right outside the door. Appointments are available three days a week until 6:30 p.m. and one Saturday a month by appointment. You’ll usually have to wait five to ten minutes, and if something is bothering you or comes loose during treatment, you can call to schedule a same-day appointment. Consultations and treatments are conducted in German and English. You can book online at any time through ortholoft’s appointment system, or reach us by phone during office hours.