Retention - Wearing Retainers For Stable Results After Braces

NOT ANOTHER NEWSLETTER (volume VI)

Since much of orthodontics is still not “evidenced based”, and treatments are often influenced by the prejudices (conscious and unconscious) of the practitioners, it is not surprising that different orthodontists often seem to give very different answers to the same problem…just ask a few: “how many months do you require full time retainer wear after braces?” For what’s its worth, we would like to use these letters to give you our philosophies of treatment to help you with your referrals and to understanding the care of our mutual patients.

Retention Our Sixth Topic:

How many times have we seen patients with “relapsed” crowding who say “my orthodontist told me I didn’t need to wear my retainers anymore?”  Well, we never tell patients this anymore, for the simple reason that no matter how good orthodontists we are, we can never guarantee the teeth will never move! (Unfortunately for them, and fortunately for us, we’ve been doing a great Invisalign business retreating these patients!)

So what do we tell our patients?

Q.    When am I finished with retention?
A.    Never...Now don't panic. This doesn't mean you have to come in every year for the rest of your life.  But as orthodontists often say: "teeth are not set in concrete".  No matter how many months or years they are held in place, the bone around the teeth  never gets so “hard” that they can't move.  In fact, like any other organ of your body, the teeth (and their alignment) constantly change as you grow older.  Even people, who had "perfect" teeth when they were young, often find their teeth moving as they age.

Q.    So what good were braces?
A.    The secret of a good orthodontic result is to put the teeth in the most esthetic, functional, and stable position that is possible considering each individual's dental problems, muscular balance and skeletal structure.  Sometimes (although much less frequently than in the past) this means extracting permanent teeth to better balance the size of the teeth and the size of the mouth.  Because of the many factors involved (skeletal disharmony, poor muscular patterns, abnormal tooth size, limits of patient cooperation, etc.) the best final position may not be as stable as we would like. Nevertheless a "D" set of teeth improved up to an "A" that slips to a "B" is far better than an untreated "D" that slips to an "F".

After a few years in retainers, the tooth arrangement should be reasonably stable; although corrected dental and skeletal problems all have varying tendencies to "rebound".  Some, like crossbites and crowding treated with extractions, are usually very stable; others, especially adults with crowded lower front teeth, are especially unstable. Like people who always have to be on a diet or wear eye glasses, some teeth need retention forever.

Q.    So what happens if I stop wearing my retainer(s)?
A.    No one can guarantee your teeth will always remain as perfect as the day the braces came off.  Retainers, however, can be like an insurance policy.  We don't know for sure if the teeth will move, but it is easier to keep them straight than to restraighten them after they have shifted. Realistically many people at some point stop wearing, or lose or break their retainers and go free.  They are willing to (possibly) sacrifice some degree of their original correction for the freedom to do without any retainers at all. It is unlikely your teeth will ever return to their original alignment, although the more minor the initial problem the less relapse that can be tolerated. Grade "D"’s improved to "A’s” that relapse to ”B"’s seldom upset people, but a "B" taken to an "A" can not afford to slip much at all before it’s back to where it started.


Q.      If I decide not to wear my retainer…, should I still see you?
A.    After approximately two years of retainer wear we enter into the post-retention period.  Visits are usually on an "as needed" basis.  Unless you were told that your problem was particularly unstable, you may find that you only need to wear your retainers 2 or 3 nights a week.  If lost or broken, you may decide a  new retainer is not needed.  Keep a close eye on your teeth however.  If you see rotations, space, or crowding developing which concerns you, please contact our office before things get too bad.  

Q.      What about third molars (wisdom teeth)?
A.    Contrary to popular belief, all the crowding that occurs at the time the wisdom teeth erupt (around 16-22) is not caused by these new teeth pushing their way in.  As a matter of fact,  people who do not have third molars also experience similar crowding, especially the lower incisors.. Even if they would have no effect on the orthodontic correction, wisdom teeth often need to be extracted for a variety of dental reasons.   We recommend that your dentist follows their development; and that the wisdom teeth be extracted if there is insufficient room.

Q.      What about bonded (glued in) retainers?
A.    These retainers are used for the most unstable areas: the lower anterior teeth, teeth with poor bone support, and large spaces between the upper central incisors. Although you may come back to see us on a regular basis to have us check fixed retainers this is not really necessary as they can be monitored by your regular dentist. If anything appears wrong, or if it comes loose, please call us immediately to have it checked. You may have it removed whenever you like, but it was placed for a reason and it is likely that the teeth will move if it is removed.  If removed,  we like to replace fixed retainers  with removable retainer for nighttime use.

Types of Retainers:

• Hawley appliances.  These are the traditional retainers that have been used for over 100 years.  They are made out of hard (usually colored) acrylic with a stainless steel labial bow
• Although Hawley appliances are only “retainers” if they are used to retain corrections; in common use, any removable appliance, even if used for active tooth movement, is often called a “retainer”
• Well cared for Hawley appliances can last 10 or more years
• Minor anterior tooth movement can be achieved with adjustments of the wires
• Kids like them because they can pick their favorite color or logo.
• Unless a biteplate is added to the appliance wearing a Hawley allows the posterior teeth to intercuspate and settle into occlusion

• Bonded retainers
• Usually used in hard to retain places such as lower anteriors, teeth with poor bone support  and upper  midline spaces
• Great for poor cooperators
• Very unlikely to cause any decay but can contribute to periodontal problems in poor hygiene patients (unfortunately the same patients who wouldn’t wear a removable retainer very well!)
• No adjustment capability
  

• Clear shell retainers
• Similar to Invisalign aligners
• Good for full time wear, especially after Invisalign treatment due to their “invisibility”
• Can be used to bleach teeth
• Minor tooth movements can be done with them
• They can stretch so ideally should be replaced every year or so.

And to answer our original question: How long do we ask our adolescent patients to wear their retainers after braces? 

For most patients we have them wear their removable upper retainer full time for only one month before nighttime wear.  As the lower anteriors are usually much less stable we typically bond a canine-to-canine retainer that we leave in for at least 2 years before giving them the option of a lower removable retainer to be worn at night.  For our adult patients, pretty much the same program, although we may require more hours of retainer wear at the beginning .

** Please visit author website for more informaton : www.centuryorthodontics.com  - Dr. Waxler - Century Orthodontics **