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Orthodontics/Braces removal



We may need to switch my son's orthodontist because we may be moving soon.  However, we may choose to delay our move, and stay in the area until his orthodontic work is complete. The main reason we are concerned about switching is because we imagine that removing his braces (as the new orthodontist said he will want to do) in order to add his own braces MAY CAUSE UNNECESSARY DAMAGE TO THE TOOTH ENAMEL.  What do you think? Does each additional debanding/removal of braces cause more and more damage to teeth, or is it a safe procedure to do more than once? Thanks you for your help.


Hi  Angela,

Fist of all let me apologize and explain what seems like a long delay. I set my account on "hold" for a few weeks because I had several conferences and papers to prepare. Well, when I returned to change the settings back ...wham bam...three questions, including yours, suddenly popped in.

What I write here are only my opinions based on very limited information. My comments should not be viewed as any form of diagnosis, definitive or otherwise,  or any form of  treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Okay… having said  that…  your  question Angela  focused on whether brackets need to be removed when transferring from one Orthodontist to another.

Angela, you ask an interesting question. I have had patients transfer into my practice and I have always managed to work with the existing braces. This is my choice and I suppose other Orthodontists may "prefer" to switch the entire set up. This may be because they delegate treatment to assistant aa great deal and have a "standard" set up for doing everything, have perhaps dedicated themselves to certain "styles" of brackets such as self-ligating appliances, or any number of other reasons. In the US, brackets generally have two different choices for the "slot size" in which the wire is placed. The slots sizes are .016 and .022 inches; I personally use .022 but any Orthodontist worth their salt ought to be able to manage continuing treatment using either.

You are wise to ask the question of whether bracket removal can cause damage to the enamel. In my almost 30 years of practice as an Orthodontist, I have had this occur twice, and I will never forget either incident. On occasion things happen, no matter how careful or skilled the care provider is. I can therefore say unequivocally that no doctor can completely ever with full certainty, rule out that bracket removal will not create an untoward impact on the enamel.

There are several things to look for. If there has been de-calcification or white spotting on the enamel surrounding the bracket base, I always take extra cautions. In years past, certain dental adhesives were super strong, in deed perhaps too strong, and bracket removal often required quite a struggle before separating from the tooth. As an analogy, imagine a post it note that has adhesive so strong that when you pull it off the wall, it takes the paint with it.

The type of bracket is also important. If a metal bracket is used, when being removed it can be squeezed and crushed with an orthodontic plier or other instrument. In so doing the base of the bracket will flex and bend and in so doing "pop" the adhesive off, facilitating bracket removal. Now if a ceramic bracket is used, the ceramic material has little if any effective "flex" to it and removal can be a "challenge". Ceramic brackets can shatter as well, so proper eye protection is critical.

Now getting to the point of your question as to whether to stay where you now live or to move based on whether bracket removal is needed, I would say you have two options. I would first ask your orthodontist to open his/her American Association of Orthodontists directory and provide you with a referral or two. Your orthodontist can first talk to the doctor and determine if similar slot sizes are used, and whether the new doctor feels ok about working with the existing brackets. Unless where you are moving has only one orthodontist for miles and miles, I would say you will be able to easily identify a doctor who will work with the existing brackets.

A second more personal option would be to simply state up front that you prefer to choose an Orthodontist who can work with the existing brackets. So when you do move into the new area, just ask the office where you might be setting up an initial consultation, that you will be choosing an Orthodontist who does not have to remove the brackets and replace them with new ones.

In summary, I believe you best option is to work with your current Orthodontist. He/she will need to fill out an American Association of Orthodontists (AAO) transfer form, and forward existing records, radio-graphs, progress notes, etc. to your new Orthodontist. Surely finding a compatible new Orthodontist and determining whether they can continue using your current brackets ought not be too difficult.  

Angela  thank you for sending in an Excellent and very relevant question. Please write again if you have any issues or other questions,

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health  


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Paul Supan, DDS, MA, MPH


First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites and are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.


Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Available upon Request.

BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

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Available upon Request Please see my personal websites and for further personal background.

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