Healthy gums and teeth after braces.

Straightening Smiles: What Happens to Your Gums and Teeth?

Mira Elwood monogram
Mira Elwood in Health & Wellness November 2026 • 3 min read.

"A Preliminary Study Reveals How Braces Impact Your Jaw"


Modern orthodontic treatment aims for more than just straight teeth; it strives for a balanced bite, lasting results, and an aesthetically pleasing smile. Achieving these goals sometimes requires significant movement of the incisors (the front teeth).

Moving teeth, especially incisors, isn't a simple task. Orthodontists must carefully consider factors like the amount of bone supporting the teeth, the length of the tooth roots, and the condition of the gums. Moving teeth too far or too fast can lead to problems.

Traditional X-rays have limitations when assessing the three-dimensional structure of the jaw. However, the development of cone-beam computed tomography (CBCT) allows orthodontists to see detailed images of the teeth and surrounding bone.

AI Search Multiple angles on this topic

Why Incisor Control Matters

Protrusion of the maxillary incisors is described as a frequent clinical challenge in orthodontic treatment. A 2026 systematic review noted that existing reviews are limited in scope and methods, while individual trials have not reached consensus on the most effective mechanics for retraction. Another 2026 study reported that greater maxillary incisor retraction was associated with increased external apical root resorption in adults treated with premolar extraction, with translation movement potentially carrying more risk than tipping.

What Happens to Your Jaw When You Get Braces?

Healthy gums and teeth after braces.

A recent preliminary study published in the Dental Press Journal of Orthodontics investigated the impact of incisor retraction on tooth length and alveolar bone thickness. Alveolar bone is the bone that surrounds and supports the roots of your teeth.

Researchers selected eleven patients with severe protrusion of their upper front teeth. As part of their treatment plan, these patients had their maxillary first premolars (teeth located behind the canines) extracted, followed by retraction of the maxillary incisors. CBCT scans were taken before treatment (T1) and one month after incisor retraction was complete (T2).

  • Measurements were taken on seven axial slices of the premaxilla (the front part of the upper jaw) using Dolphin Imaging™ software.
  • The distance from the outer (buccal) to inner (palatal) cortical bone was measured at five points on each slice.
  • Tooth length was measured on sagittal slices.
  • Measurements were repeated after two weeks to check for consistency.
AI Search Multiple angles on this topic

Limits and Risks of Retraction

Incisor retraction is not a single uniform procedure: treatment objectives include positioning the upper and lower incisors appropriately within the facial profile while generating space through options such as extractions, interproximal reduction, expansion, distalisation, or Leeway space. A study of Invisalign treatment in patients with maxillary protrusion and first-premolar extraction evaluated changes in the crowns and roots of the maxillary central incisors, as well as upper-lip position, across groups with different pretreatment incisor inclinations. Other reviewed work has examined bone remodeling after maxillary incisor movement and compared en-masse with two-step retraction biomechanics, showing why mechanics and starting inclination matter when interpreting outcomes.

Comparing Retraction Strategies

A systematic review compared en-masse retraction with two-step retraction across anchor loss, space-closure time, root resorption, anterior incisor retraction, success rate, patient compliance, and aesthetic changes. Separately, a 2026 clinical comparison measured maxillary canine retraction rate as the distal distance covered per month, using a Vernier caliper and a defined measurement point between the incisal edge and gingival margin. These studies illustrate that comparisons may assess both treatment-wide outcomes and the rate of movement of individual teeth.

The researchers used statistical analysis to compare the measurements taken at T1 and T2. The intraclass correlation coefficient (ICC) was used to test the consistency of the measurements. The Wilcoxon test was used to determine if there were any statistically significant differences between the two time points.

So, Are Braces Safe for Your Gums and Teeth?

The study found no statistically significant differences in tooth length or alveolar thickness after incisor retraction. This suggests that the forces used in this study did not cause significant changes to the teeth or surrounding bone. However, it's important to remember that this was a preliminary study with a small sample size. The authors recommend further research with larger sample sizes to confirm these findings.

AI Search Multiple angles on this topic

More Controlled, Digital Treatment

A 2026 systematic review is evaluating methods for controlling anterior tooth inclination during non-extraction and retraction-related treatment, in response to limited existing reviews and a lack of consensus among individual trials. Another systematic review reported that en-masse retraction with skeletal anchorage produced less anchorage loss and more controlled incisor inclination than traditional anchorage. The same review found that implant-supported mechanics produced minimal mesial molar movement compared with conventional anchorage systems, while single-canine retraction had variable anchorage demands. Industry forecasting also describes orthodontics in 2026 as becoming more digital, automated, and patient-centric, with the global orthodontics market projected at approximately USD 8.05 billion.

Understanding Torque and Tooth Movement

A systematic review on anterior torque control aims to determine how effectively different methods control the root torque of maxillary incisors during orthodontic retraction. Its purpose is also to identify which proposed procedures merit the strongest recommendations in clinical practice. A three-dimensional finite element analysis of anterior tooth retraction with clear aligners examined displacement patterns in the crowns and roots of central incisors. Together, these sources show that evaluating retraction involves both clinical recommendations for torque control and biomechanical analysis of how crowns and roots move.

Bone thickness changes across the comparison studies

  • 0.1; −0.6Mao et al. reported an average vestibular change of 0.1 and average palatal resorption of −0.6, with a decrease in palatal bone height between the reported measurement levels.[1]

How related reports frame gum and bone outcomes

A review of post-treatment lower-incisor inclination and gingival recession found enough variation in how studies measured recession and bone height that their results could not be combined in a meta-analysis. This limits how directly findings across those studies can be summarized together.[2]

A separate review found that recession risk appeared higher in some comparisons, particularly during retention; its cited example concerned mandibular incisors years after treatment. That result concerns a particular comparison and does not establish the same risk for every patient or tooth group.[3]

What remains uncertain about gum and bone changes

  • How much do recession and bone-height estimates change when studies use different measurement definitions, given that this variation prevented results from being pooled?[2]
  • Do the reported recession patterns persist across tooth groups and treatment stages, or are they concentrated in particular comparisons such as those during retention?[3]
  • How do plaque-related inflammation and pre-existing thin soft-tissue margins relate to later supporting-tissue changes in orthodontic patients?[4] [5]

Sources

  1. Bone Remodeling of Maxilla after Retraction of Incisors during Orthodontic Treatment with Extraction of Premolars Based on CBCT Study: A Systematic Review (pmc.ncbi.nlm.nih.gov)
  2. Post-orthodontic lower incisor inclination and gingival recession—a systematic review (pmc.ncbi.nlm.nih.gov)
  3. Do orthodontic patients develop more gingival recession in anterior teeth compared to untreated individuals? A systematic review of controlled studies. (pubmed.ncbi.nlm.nih.gov)
  4. Effect of orthodontic treatment on alveolar bone thickness in adults: a systematic review (pmc.ncbi.nlm.nih.gov)
  5. Assessment of the periodontal health status and gingival recession during orthodontic treatment with clear aligners and fixed appliances: A systematic review and meta-analysis (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

What exactly is incisor retraction, and why is it important in orthodontic treatment?

Incisor retraction refers to the process of moving the incisors, which are the front teeth, backwards. This is often done during orthodontic treatment with braces to correct protrusion or improve the alignment of the teeth. Incisor retraction is significant because it directly impacts the aesthetics of the smile and the overall balance of the bite. When done improperly, incisor retraction can potentially affect the supporting bone and gum health, so careful planning and monitoring are crucial.

2

What is alveolar bone, and why does its thickness matter when getting braces?

Alveolar bone is the bone that surrounds and supports the roots of the teeth. Its thickness and density are important for maintaining tooth stability and gum health. The thickness of alveolar bone matters because it provides the necessary support for the teeth to withstand the forces of chewing and other oral functions. Significant reduction in alveolar bone thickness during orthodontic treatment could compromise the long-term stability of the teeth.

3

What is a CBCT scan, and how is it useful for orthodontists?

Cone-beam computed tomography, or CBCT, is an advanced imaging technique that produces detailed three-dimensional images of the teeth and surrounding bone. CBCT scans are important in orthodontics because they allow orthodontists to visualize the jaw structures in three dimensions, providing more comprehensive information than traditional X-rays. This is particularly useful for assessing bone thickness, tooth root length, and other factors that can influence treatment planning and outcomes. The use of CBCT can aid in minimizing risks associated with tooth movement.

4

What is the Dental Press Journal of Orthodontics, and why is it relevant?

The Dental Press Journal of Orthodontics is a peer-reviewed scientific publication that focuses on research and advancements in the field of orthodontics. It serves as a platform for researchers and clinicians to share their findings and insights related to orthodontic treatment techniques, outcomes, and innovations. Publishing in a journal like this adds credibility to research findings, as it indicates that the study has undergone scrutiny by experts in the field.

5

What is the Wilcoxon test, and why is it used in orthodontic studies?

The Wilcoxon test is a non-parametric statistical test used to compare two related samples or matched pairs. In the context of orthodontic research, it can be used to determine if there are statistically significant differences between measurements taken at two different time points, such as before and after treatment. The Wilcoxon test helps researchers determine whether the observed changes are likely due to the treatment itself or simply due to chance. The Intraclass correlation coefficient (ICC) is used to test the consistency of the measurements.

Newsletter Subscribe

Subscribe to get the latest articles and insights directly in your inbox.