Orthodontic treatment with fixed appliances – how long does it take?

shutterstock_81157801-orthodontic appliance

Orthodontic treatment is a lengthy procedure and there is an increasing interest in reducing the duration of treatment particularly with a growing demand for adult orthodontics. Prolonged treatment raises patient compliance issues and may adversely impact on oral health and is linked with root resorption and demineralisation.

The aim of this review was to determine the duration of orthodontic treatment with fixed appliances.


Searches were conducted in the Medline, Cochrane Oral Health Group’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov and the National Research Register database. Reference lists of included studies were screened for additional relevant research.

Randomized (RCTs) and prospective non- randomized studies (CCTs) carried out in primary or secondary care or in the community concerning fixed appliance treatment with treatment duration as an outcome measure were considered. Two reviewers independently extracted data and assessed study quality using The Cochrane Collaboration’s risk of bias tool and the Newcastle-Ottawa scale.


  • 25 studies (20 RCTs, 5 CCTs) were included
  • Most of the included RCTs were considered to be at low or unclear risk of bias.
  • Mean treatment duration (22 included studies involving 1089 participants) =19.9 months (95% CI; 19.58 to 20.22 months)
  • Sensitivity analyses were carried out including 3 additional studies, resulting in average duration of treatment of 20.02 months (95% CI; 19.71 to 20.32 months) based on data from 1211 participants.
  • Mean number of required visits derived from 5 studies = 17.81 (95%CI; 15.47 to 20.15 visits).


It is reasonable to assume that the average duration of comprehensive orthodontic treatment is less than 2 years. If alternative approaches to reduce the treatment time are undertaken, it would be sensible that these interventions or alternatives are chosen with an awareness of this yardstick.


This is a well conducted review and as the authors note in their discussion there is increasing interest in the duration of orthodontic treatment which may possibly linked to a growth in the uptake of adult orthodontic treatment. The authors also highlight that all the included studies were carried out in hospital or university settings so may provide a slight overestimate of the duration of treatment due to provision of care by people in training and the likelihood of more complex malocclusions.


Primary paper

Tsichlaki A, Chin SY, Pandis N, Fleming PS. How long does treatment with fixed orthodontic appliances last? A systematic review. Am J Orthod Dentofacial Orthop. 2016 Mar;149(3):308-18. doi: 10.1016/j.ajodo.2015.09.020. Review. PubMed PMID: 26926017.

Other references

Original review protocol on PROSPERO

Dental Elf – 6th Jul 2015 – Orthodontic treatment: limited research on effectiveness of surgical interventions to accelerate treatment

Dental Elf – 4th Sep 2014 – Orthodontic treatment; can it be accelerated by surgical and non-surgical approaches?

Dental Elf – 2nd May 2014 – Only low quality evidence available to assess the effectiveness of surgically facilitated orthodontic treatment


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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