When we remove your braces, you will enter the most important stage of your treatment. Your final orthodontic result depends upon your retainers, so follow through with the hard work you have put in so far and wear them as prescribed. The teeth become more stable with time, but they will always want to relapse to their original malocclusion. You need to wear the retainers faithfully for a minimum of three years. For growing patients we recommend wear until all growth has completed and decisions have been made about the wisdom teeth.
Retainers fall into two broad categories: removable and fixed. There are advantages and disadvantages to each class of these retainers.
Removable retainers are typically worn day and night for approximately three months after braces are removed. The schedule then goes to twelve hours per twenty-four hours for three months and then eight hours per day for a minimum of three years. I like for patients to wear their retainers faithfully for a minimum of three years and until facial growth and third molar eruption has completed. We then begin to wear the retainers less and eventually just one night per week.
The removable retainers provide a nice index for the patient to assess any change. If the retainer is tight when inserted, the teeth are moving. The retainer is then worn every night until it is no longer tight. This can literally go on for a lifetime, and the teeth remain aligned.
Fixed retainers may be round or flat wires that are bonded to the back of the teeth. These retainers are very popular because the patient does not have to remember to wear the retainers, there is no concern about losing them, and the teeth stay straight. The most common problem with orthodontic relapse is with the front teeth. With the fixed retainers these teeth are not going to move. These fixed retainers may be worn indefinitely. A clear overlay retainer for nighttime wear is provided with the fixed retainers.
Each of these retainer systems has disadvantages. The primary disadvantage of the removable appliances is that patients have to wear them. They do not work if left in the retainer case. Many of my patients have worn retainers very faithfully for a year or two just at night. The teeth are relatively stable so they may miss a few nights and the retainers still fit. The problem comes when they go to the beach with their friends or to camp and forget to take their retainers. When they return home, the retainers either don’t fit or are very tight so they don’t wear them very often. In a few weeks or months mom notices that the teeth are getting crowded, and the patient sheepishly reports that his/her retainers no longer fit. Then we begin the arduous and expensive process of making new retainers and trying to correct minor crowding with retainers. Although improved, the teeth never look as good as they did before the relapse and this causes lots of disappointment and stress for everyone involved.
Another big disadvantage of the removable retainers is the possibility of loss. It is very easy to leave these retainers on a luncheon tray or in a hotel room. Dogs will go to extraordinary lengths to get a retainer and crunch down on it. Replacement retainers are expensive.
The primary disadvantage of the fixed retainers is difficulty with flossing. Just like with braces, the floss needs to be threaded between the teeth and underneath the retainer wire. Many patients just floss down just to the top of the retainer wire at an angle and only occasionally take the time to floss beneath the wire. Some oral irrigators, e.g., the Hydro Floss, will remove plaque and reduce the need to thread floss, but they have to be used regularly.
You also have to be careful not to bite into hard foods with fixed retainers or they will bend, break, or come loose. If the bond on the retainer comes loose, it must be repaired. Fortunately this does not happen very often, but repair is an additional expense.
My preference is the removable retainer if patients will wear as prescribed. I like the fact that we can reduce the wear in time and most patients can get down to wearing it only once a week. This leaves the teeth free to function six and a half days per week with only eight hours a week with retainers. That is opposed to retention 24/7 with fixed retainers.
With these facts in mind I will tell you that we make more fixed retainers than we do removables. Many parents have experienced relapse of their orthodontic correction and want to be sure that their children’s teeth stay straight. It is interesting to me that a majority of our adult patients select the fixed retainers also.
Wearing braces has not been easy. We have all worked hard to gain the treatment result and we want to retain it to the best of our ability.