Short answer. An orthodontist is a dental specialist who diagnoses and treats malocclusion: misaligned teeth, bad bites, and jaw-position discrepancies. The work covers five clinical areas: aligning teeth, correcting the bite, modifying jaw growth in children, coordinating jaw surgery for skeletal cases in adults, and retention to prevent relapse.
The tools include fixed appliances (metal, ceramic, and lingual braces), removable appliances (Invisalign, Angel Aligners, expanders, headgear, retainers, functional appliances), and adjunct tools (temporary anchorage devices). Most patients come in for cosmetic alignment, but the specialty’s training enables much more.
Across roughly 5,000 cases treated at Limestone Hills Orthodontics, Dr. Rodrigo Viecilli treats patients across the five clinical areas of orthodontics: comprehensive alignment with braces or aligners, Class II and Class III bite correction, palatal expansion and growth modification in children, surgical orthodontic coordination with oral surgeons, and retention protocols.
His CODA-accredited Specialty Certificate from Indiana University, plus a PhD in Orthodontic Biomechanics from the same program, inform the clinical decisions on every case at the practice.
The Five Clinical Areas an Orthodontist Covers
The public picture of orthodontics is straight teeth. The clinical picture is broader. The specialty training, the residency curriculum, and the American Board of Orthodontics examination all organize the work into five clinical areas. Most orthodontists see cases across every one of them.
1. Aligning Teeth
The orthodontist moves teeth into the correct position within each dental arch to resolve crowding, spacing, rotations, and unwanted tipping. Most patients arrive for this reason. Alignment treatment uses braces or clear aligners, and the average comprehensive case runs 12 to 24 months.
Aesthetic motivation is the most common patient driver; the clinical goal also includes function (proper contact between teeth) and stability (a position the teeth will hold over time).
2. Correcting the Bite
The bite is how upper and lower teeth meet when the jaws close. Bite correction addresses Class II (upper jaw or teeth ahead of lower), Class III (lower ahead of upper), open bite (front teeth do not touch when biting down), deep bite (upper teeth cover too much of the lower), and crossbite (one or more upper teeth bite inside the lower).
Bite correction uses the same appliances as alignment plus a different set of clinical mechanics. Many patients need both in the same treatment.
3. Modifying Jaw Growth in Children
This is the area called dentofacial orthopedics in the specialty’s formal name. The orthodontist uses the growth window of childhood and early adolescence to guide jaw development.
The tools include palatal expanders (widening the upper jaw before the suture closes around age 14), functional appliances like Herbst or MARA (positioning a recessed lower jaw forward), headgear (restraining excess upper jaw forward growth), and chin cups (restraining excessive lower jaw forward growth).
The American Association of Orthodontists recommends every child receive an evaluation by age 7 specifically to identify cases where growth modification is indicated.
4. Coordinating Jaw Surgery for Adults
Skeletal Class II and Class III cases that present in adults, after the growth window has closed, cannot be corrected by tooth movement alone. The jaw position itself needs to change.
The orthodontist coordinates with an oral and maxillofacial surgeon: aligning the teeth in their post-surgical position before surgery, working with the surgeon on the surgical plan, and finishing the alignment after surgery heals. The orthodontist owns the tooth-level outcome; the surgeon owns the jaw-bone movement. A surgical orthodontic case typically runs 24 to 36 months total.
5. Retention and Long-Term Stability
Teeth tend to relapse toward their pre-treatment position when active treatment ends. Retention is the protocol that holds the result in place. The orthodontist designs the retention plan during active treatment and hands off at the debond appointment.
Retention is part of the orthodontist’s scope of practice, not an afterthought; the orthodontic outcome is not finished until retention is in place.
What Tools an Orthodontist Uses
The orthodontist’s toolkit divides into three categories: fixed appliances bonded to the teeth, removable appliances the patient takes in and out, and adjunct tools used in specific case types. Most comprehensive cases use more than one tool across the course of treatment.
Fixed appliances.
Metal braces (the workhorse, with brackets bonded to the front of the teeth and a wire that moves the teeth into position), ceramic braces (transparent or tooth-colored brackets with the same mechanics as metal braces, used by adults and teens who prefer a less visible option), and lingual braces (brackets bonded to the back of the teeth, fully hidden from view, used in a small subset of adult cases).
Each variant uses the same underlying mechanics: a wire applies controlled force to the teeth through the brackets.
Removable appliances.
Clear aligners (Invisalign and Angel Aligners are the two systems used at most US orthodontic practices, including Limestone Hills), palatal expanders (widening the upper jaw in growing children), functional appliances (Herbst, MARA, and similar devices that position the lower jaw), headgear and chin cups (growth-direction modifiers used selectively in pediatric cases), and retainers (the post-treatment retention appliance, in both removable Essix and bonded variants).
The patient compliance with removable appliance wear is the single biggest factor in treatment success for the removable category.
Adjunct tools. Temporary anchorage devices (TADs), which are small titanium mini-implants placed in the jawbone to provide a fixed anchor point for difficult tooth movements, are used in a subset of complex cases. The orthodontist places the TAD or coordinates placement with an oral surgeon; the TAD is removed when the tooth movement is complete.
Other adjunct work includes interproximal reduction (small enamel reduction between teeth to create space without extraction), bonded buttons and elastics for vertical or anteroposterior correction, and tooth-position-specific bracket prescriptions chosen at the start of treatment.
When You Should See an Orthodontist (and When a General Dentist Is Enough)
The decision is functional, not credential-based. The credential question is covered separately at orthodontist-vs-dentist. The functional question is what the patient actually needs.
See an orthodontist for tooth movement, bite correction, or growth modification. If teeth need to move (alignment, bite correction, space closure), if the bite is the concern (Class II or III, open bite, deep bite, crossbite), if a child shows signs of jaw-growth issues, or if an adult is considering Invisalign for a moderate-to-complex case, an orthodontist is the right starting point.
The orthodontist’s training and the diagnostic toolkit (CBCT, intraoral scan, treatment-planning software) are specifically designed for these problems.
See a general dentist for prevention, restoration, and routine care. Cleanings every six months, fillings, crowns, root canals, extractions of compromised teeth, gum care, dental emergencies that involve pain or infection, and the day-to-day maintenance of the teeth all belong with the general dentist.
Patients in active orthodontic treatment keep their general dentist for cleanings and any restorative work that comes up during the case.
For mild crowding or a single rotated tooth, a general dentist who has training in basic clear-aligner cases may be sufficient.
The reality is most patients are surprised that orthodontic specialty training covers jaw surgery coordination and growth modification, not just tooth movement; the scope of the specialty is much wider than the average new-patient assumes. For anything beyond mild cosmetic alignment, the orthodontist’s specialty training is what the case calls for.
What an Orthodontist Does at the First Consultation
The new-patient consultation is the foundation of the entire treatment plan. Every subsequent decision flows from what the orthodontist learns at this appointment. The structure is similar across orthodontic practices in the United States.
- Medical and dental history. The orthodontist reviews general health, medications, allergies, prior dental work, prior orthodontic treatment, family orthodontic history, and any specific complaints (cosmetic, functional, TMJ-related, sleep-related). Most growth-modification cases turn on a family history finding the parent did not realize was relevant.
- Clinical exam. The orthodontist examines the teeth, the bite, soft tissue, temporomandibular joints, facial proportions, and the airway. The exam usually takes 10 to 15 minutes. Most diagnostic findings can be identified at this stage; the imaging confirms and quantifies them.
- 3D imaging. The records visit at Limestone Hills includes a CBCT (3D cone-beam scan that shows bones, tooth roots, and the airway in three dimensions) and an intraoral scan (digital impression of the teeth using a wand scanner, no putty trays). Dr. Viecilli reviews the CBCT volume with the patient and parent at the same visit.
- Diagnosis and plan. The orthodontist names the clinical findings (crowding measured in millimeters, bite classification, jaw position, airway status, root and bone observations from the CBCT), proposes a treatment approach (which appliances, what sequence, what age to start, how long), and provides a written cost and timeline estimate.
The family leaves with the plan in hand. At Limestone Hills the consultation is free for kids and teens under 18 and $100 for adults, fully applied to treatment cost if the patient starts.
Age Segmentation: Phase 1, Comprehensive Teens, Adults
The orthodontist’s caseload splits into three age groups, each with a distinct clinical focus. The age-segmentation framework guides what the orthodontist looks for at the consultation and what treatments are appropriate.
Phase 1 (ages 7 to 10). The American Association of Orthodontists recommends the first orthodontic evaluation by age 7 specifically to identify cases where early intervention prevents a bigger problem later.
The most common Phase 1 indications are a narrow upper jaw (treated with a palatal expander), severe Class II growth pattern in a still-growing child (treated with a functional appliance or growth modifier), severe crossbite, severe protrusion that puts the front teeth at risk of trauma, and habits like prolonged thumb sucking that distort the bite.
Phase 1 treatment is usually 12 to 18 months and stops before the permanent teeth are fully erupted. A second phase of treatment in the teen years finishes the alignment after the permanent teeth come in.
Comprehensive teens (ages 11 to 17). The largest age group for most orthodontic practices. The permanent teeth are in or coming in, the growth window is still open, and braces or clear aligners are the typical treatment.
The comprehensive teen case runs 18 to 24 months on average. The teen years are the optimal window for combined alignment, bite correction, and the tail end of growth modification when needed.
Adults (18 and up). Adults are roughly one in three orthodontic patients in the United States per the 2025 AAO Economics of Orthodontics survey. The adult caseload includes patients who never had treatment, patients who had treatment as teens and relapsed, and patients who need orthodontic work before a restorative procedure (crowns, implants, veneers).
Adult treatment uses the same appliances available to teens, with clear aligners more common in the adult cohort. The growth window is closed in adults, so severe skeletal discrepancies require surgical coordination rather than appliance-based growth modification.
The Continuing-Care Role: Retention and Long-Term Stability
The visible part of orthodontic treatment ends at the debond appointment, when the braces come off or the final aligner is delivered. The retention part lasts much longer. Most orthodontic practices, including Limestone Hills, treat retention as a permanent commitment to the patient’s long-term outcome.
The retainer. Most patients leave active treatment with a removable Essix retainer (clear, thin, fitted over the teeth like a thin aligner shell) on the upper and lower arches. Some cases use a bonded retainer (a thin wire bonded to the back of the front teeth) on the lower arch, often in cases with a high relapse risk.
The wear schedule. The orthodontist prescribes a wear schedule that fits the case. The general pattern is full-time wear for the first months after debond, transitioning to nights-only wear over time, with the recommendation that nights-only wear continue indefinitely. Teeth tend to move throughout life, and the retainer is the maintenance protocol that keeps the result stable.
Long-term follow-up. The orthodontist’s role does not end at debond. Limestone Hills schedules follow-up visits to check retention, replace retainers that crack or wear out, and address any movement the patient notices. Patients can return for a retainer check at any time.
What an Orthodontist Does for Austin and Hill Country Patients
Limestone Hills Orthodontics treats families from across the Austin metro and Hill Country. Patients come from Lakeway, Cedar Park, Round Rock, Bee Cave, Westlake, Steiner Ranch, Anderson Mill, and the Northwest Hills neighborhoods, plus the surrounding communities.
The patient flow at the practice reflects the three age segments above: Phase 1 children referred by general dentists or pediatric dentists for growth-modification evaluation, comprehensive teen cases that are the largest segment by case volume, and a growing adult cohort that matches the national trend (adults are now roughly one in three orthodontic patients nationwide, per the 2025 AAO survey).
The Austin-area clinical context shapes a few practice patterns. Pediatric referrals for early evaluation are common because surrounding pediatric dental practices follow the AAO age-7 evaluation guideline closely. Adult cases lean toward clear aligners because the patient profile (technology professionals, healthcare workers, business travelers) values discretion at work.
Surgical orthodontic coordination runs through a local oral and maxillofacial surgery referral network. Every patient leaves the consultation with a written treatment plan naming which of the five clinical areas the case touches and what the timeline and cost look like.
Common Questions About What an Orthodontist Does
What does an orthodontist do for adults?
Adults make up roughly one in three orthodontic patients in the United States per the 2025 American Association of Orthodontists Economics of Orthodontics survey. The orthodontist treats adults for crowding, spacing, bite correction (Class II, Class III, open bite, deep bite), pre-restorative tooth positioning before crowns or implants, surgical orthodontic coordination for skeletal cases, retention after relapse from a previous treatment, and TMJ-related occlusal management. Treatment options for adults include metal braces, ceramic braces, lingual braces, Invisalign, and Angel Aligners. The consultation workflow at Limestone Hills is identical for adults and teens: clinical exam, 3D imaging, diagnosis, treatment plan, cost and timeline. Adult treatment typically runs 12 to 30 months depending on complexity.
Do orthodontists do teeth cleaning?
Orthodontists do not perform routine cleanings, fillings, crowns, root canals, or extractions in the standard sense. Patients keep a general dentist for cleanings every six months throughout orthodontic treatment, and the orthodontist coordinates with the dentist on timing if the dentist needs to do a filling or crown that affects the orthodontic plan. Dr. Viecilli reviews each patient’s general-dentistry record at the consultation to flag any work that should happen before or during active treatment.
What is the difference between an orthodontist and a dental specialist?
An orthodontist is one of the ten dental specialties recognized by the American Dental Association. Each specialty (orthodontics, endodontics, periodontics, prosthodontics, oral and maxillofacial surgery, pediatric dentistry, oral and maxillofacial pathology, oral and maxillofacial radiology, dental public health, oral medicine) completes a CODA-accredited residency after dental school. The orthodontist’s residency focuses on tooth movement, bite correction, jaw growth, and dentofacial orthopedics. A separate post (Orthodontist vs Dentist at Limestone Hills) covers how orthodontist training differs from general dentist training in more detail.
Can an orthodontist pull teeth?
An orthodontist can perform extractions clinically, and the residency includes extraction training, but most orthodontists do not perform extractions in practice. The extractions are referred to a general dentist or oral surgeon who does the procedure routinely. The orthodontist decides which teeth need to be extracted as part of the treatment plan (most commonly first premolars for severe crowding) and coordinates the timing with the referring provider. Dr. Viecilli prefers non-extraction approaches when the case permits, with extraction reserved for severe crowding or specific bite-correction needs.
Do orthodontists do jaw surgery?
Orthodontists do not perform jaw surgery. Jaw surgery (orthognathic surgery) is performed by an oral and maxillofacial surgeon. The orthodontist coordinates the case: aligning the teeth in their post-surgical position before the surgery, working with the surgeon on the surgical plan, and finishing the alignment after surgery. The orthodontist is responsible for the tooth-level outcome; the surgeon is responsible for the jaw-level movement. Surgical orthodontic cases at Limestone Hills run roughly 24 to 36 months total, including pre-surgical alignment, the surgery, and post-surgical finishing.
Sources. American Association of Orthodontists, “Orthodontist vs. Dentist” patient resource (aaoinfo.org/resources/orthodontist-vs-dentist). American Association of Orthodontists, “1 in 3 Orthodontic Patients is an Adult: Why Adult Braces Are Trending” (aaoinfo.org).
American Association of Orthodontists, 2025 Economics of Orthodontics and Patient Census Survey (aao member report). American Board of Orthodontics, certification information for orthodontists (americanboardortho.com). American Dental Association, recognized dental specialties (ada.org/about/governance/current-policies/recognized-dental-specialties).
Commission on Dental Accreditation, Accreditation Standards for Advanced Specialty Education Programs in Orthodontics and Dentofacial Orthopedics (ada.org/coda). Texas State Board of Dental Examiners, licensing and specialty announcement rules (tsbde.texas.gov). Clinical observations on case-mix and patient flow cited from Dr.
Rodrigo Viecilli’s practice records across approximately 5,000 cases treated at Limestone Hills Orthodontics, Austin, Texas. Reviewed by Dr. Rodrigo Viecilli, DDS, PhD in Orthodontic Biomechanics (Indiana University), Diplomate of the American Board of Orthodontics.