Orthodontic Retention. Why is it so important?

The benefits of orthodontic treatment are well known; attractive straight teeth which are easier to clean, a healthy bite, a lovely smile and a big boost to self-confidence. These are some of the reasons why orthodontic treatment is so popular. The questions my patients most commonly ask me before treatment begins are “what’s the quickest way to straighten my teeth, what’s the best brace system to use, can I have clear or invisible braces and how much will treatment cost”. Very few people, however, ask the question “will my teeth stay straight forever” and there lies a problem!

What is orthodontic relapse?

Orthodontic treatment can make spectacular changes to the alignment of a person’s teeth and can produce the smile an individual has always wanted. However, we need to be mindful that teeth can and will move once braces are removed and this can sometimes spoil some of the results achieved. This change is known as orthodontic relapse and can be defined as the movement of teeth out of their aligned position after treatment has been completed. This can lead to the reappearance of crowding, gaps, spacing and bite changes. Its extent is unpredictable and some patients are more prone to relapse than others. Consequently, it’s vitally important that we let our patients know that if they want to keep their teeth straight after braces have been removed, then a plan needs to be in place to retain teeth in their aligned position. Some form of retention will be required for life!

So how do we limit or prevent orthodontic relapse?

The answer is by wearing ‘retainers’ once brace treatment has been completed. There are two types of retainers, removable and fixed. At present, all young patients are given removable retainers at the end of their treatment with the instruction to wear them routinely at night. Some patients, especially those who have had complex treatments, will also be fitted with fixed/bonded retainers. Generally, all adult patients will be given bonded retainers in addition to removal retainers.

What do retainers look like?

Removable retainers are thin, transparent and slightly flexible plastic tooth guards that fit snugly over your teeth. They are made from a mould taken of your teeth. They are generally worn during bedtime hours.

A fitted or bonded retainer is a thin strand of orthodontic wire which is bonded to the back of the upper and lower incisor teeth and sometimes onto the canine teeth. It is a permanent retainer and cannot be removed.

How often should I wear my retainers?

Orthodontists vary a little with their preferred retention regimes. At Colchester Orthodontic Centre we advise bedtime wear of removable retainers for 6 months following brace removal, followed by a gradual reduction to approximately two or three nights a week wear by one-year after brace treatment has been completed. We now advise that removable retainers are subsequently worn at a baseline level of once or twice a week for as long as you want to keep your teeth as straight as the day your braces were removed. If your retainers begin to feel tight at any stage it reflects the fact that teeth are starting to move out of alignment and so your retainers should be worn more often again until any movement is stabilised. It’s important to remember that our bodies never stop changing and our teeth are no exception. Some movement of teeth will continue throughout the years. Just as we get wrinkles in our skin and grey in our hair, our teeth will move with time.

Do retainers need to be replaced?

From time to time, yes. Removable retainers will flex and bend a little as they fit over your teeth. This together with nighttime tooth grinding and general wear and tear means that cracks and breaks can appear with time. A new mould will be needed to make a new removable retainer. Bonded retainers can also break, but are more robust than removable retainers. They are bonded to the back of teeth with tooth coloured bonding material. These small bonds can weaken with time as your teeth flex slightly in their tooth sockets whilst eating and chewing.

The British Orthodontic Society has recently released a short film animation called ‘Hold that smile’ which communicates the benefits of retainers. Hold that smile has the support of the British Dental Association and the Faculty of General Dental Practice UK (FGDP (UK).

So, there is little point in proceeding with orthodontic treatment unless you are willing and able to commit to long-term retention. Regardless of whether your treatment involves comprehensive orthodontic treatment or a “six-month smile”, or Invisalign or fixed braces retention is essential. Without lifelong retention, teeth will move out of alignment!