Retainers after Braces
Thursday, May 5, 2005
Dear Dr. Mady: I have been wearing braces for the past two and a half years and I will be getting them off in four weeks. My doctor said that I will need to wear some type of retainers to keep the teeth straight. Is this really necessary and what types are available?-Paulina in Las Vegas
Dear Paulina: When it is finally time for your braces to come off, your teeth will be straight and beautiful at last, but you won’t be finished yet. Most individuals need something to help retain the teeth in their new and proper position. The “something” that I am talking about is called retainers.
Impressions will be taken for study models and working models for your new retainers. Retainers are designed to hold your teeth in place while they settle into their new and final position. Depending on your case, your dentist or orthodontist will make recommendations on which type of retainers you will require, how long you will need to wear them each day and for how many months or years. In some situations, they will need to be worn for life. Orthodontic retaining appliances resist the natural tendency of teeth to return to their pre-treatment positions under the influence of periodontal, occlusal (biting) and soft tissue forces, and continuing dentofacial growth.
Your doctor will fill out a prescription slip for his lab technician with instructions for the type of retainer and the specific design that they want the lab technician to follow when making your appliances. Some doctors have a technician in their office but in most cases your retainers will be sent out to an orthodontic laboratory to be fabricated.
These orthodontic dental retainers are appliances that are most commonly made of plastic and stainless steel wire (Hawley type), clear vacuum formed plastic or can be a custom wire permanently bonded in the mouth. While the orthodontic retainer is holding the teeth in their new position, the surrounding bone and gums adjust around them to compensate for the previous movement. If the appliance is removable, the length of time that it must be worn will vary, but most teenagers will be advised to wear their orthodontic retainer at least until their early twenties. I personally feel that they should be worm indefinitely. Immediately after braces are removed, the retainers should be worn at all times except eating during the first one to four weeks and then at least twelve hours per day for the first year. Some individuals wear them twenty-four hours a day except while eating. It all depends on what your doctor prescribes for your specific case.
The plastic/acrylic and stainless wire or Hawley type of retention appliance is the most common and has been used in orthodontics for many years. It is utilized mostly for retention in the upper arch but can be used on the lower as well. In addition to retaining tooth positioning, it can also be used for additional minor tooth movements or even for space maintenance prior to orthodontic treatment.
The Hawley appliance is made of acrylic which can hold various wire attachments. In general, a Hawley constructed for the upper arch will cover most of the palate or roof of the mouth, and the lower Hawley will be shaped like a horseshoe. The wire attachments may include certain types of clasps and rests to help stabilize the position of the retainer. Small springs may also be attached to achieve tooth movement if desired. These springs will require activation by the dentist at certain time intervals to achieve the desired results if movement is needed.
The clear retainer is vacuum formed over models of the straight teeth when one desires not to have a straight wire showing on the top or bottom. This retainer is see-through, and can sometimes be used with tooth whitener gels. It better esthetically than the holly type and is more cost efficient to replace if it gets damaged or lost in a napkin at a restaurant.
The "bonded lower retainer" for the lower teeth is actually simple. There is a small diameter wire bonded to the back of each tooth between and including the lower cuspids. It is also called a "bonded 3 to 3" in orthodontic terminology. This is a retainer which will hold the lower six front teeth in perfect position as long as the retainer remains in place. It can sometimes be used for upper front teeth also. I tell my patients that it is "forever", or as long as you want your teeth to remain perfect. In reality, the wire is unseen and unnoticed after the first few days. You have to thread floss under the "bonded retainer" to keep it clean, or else it can become a plaque trap. That is about the only negative aspect of this fixed type.
The rationalization behind lower permanent retainers is prevention of a naturally occurring process that tends to crowd the lower front teeth as one ages. In the late teen years, the mandible or lower jaw will normally grow forward a bit, at the end of growth, crowding the bottom teeth against the inside of the upper front teeth. As long as the bonded retainer is in the lower, the teeth will stay straight and not move.
Ask your dentist or orthodontist to show you samples of the different types of retainers that are recommended for you specifically. A decision can be made after taking cost and esthetics into consideration. Good Luck!
If you want more information about orthodontics and cosmetic dental procedures, go to www.drmady.com and click “articles” and then type a search topic in the search box on the left and simply select “go”. There is an abundance of interesting and educational information in all of these articles.
Thursday, October 7, 2004 .
Dear Dr. Mady: I just got my braces off after wearing them for two and a half years. My orthodontist said that I need to wear retainers now but they are not ready yet. What exactly are retainers and why are they so important?-Jo Ann in St. Clair Beach
Dear Jo Ann: Almost always after orthodontic treatment, the teeth need a way to be maintained in their new correct position. Teeth naturally have the tendency to want to rotate and drift back to the position they were in prior to orthodontic treatment, especially the lower front teeth.
The teeth need to maintain where they are while the muscles of the oral cavity adapt to their new positions. Also the supporting ligaments, fibres and bone surrounding the roots of the teeth will mature more over time and decrease the chance of future tooth movements.
Retainers are removable or fixed oral appliances that hold the teeth where your orthodontist engineered them to be for health, function and esthetics. If you desire good results and don’t want to feel that you wasted two and a half years and a lot of money, then it is vitally essential that you follow the recommended directions with respect to your retainers and wear them for the prescribed time or longer.
There are many kinds of retainers, but the three most common are the removable clear retainer, the removable Hawley and the bonded wire type. A clear retainer is a clear plastic overlay that covers the entire surface of the teeth in the upper or lower arch. It is a semi-rigid clear plastic that is not noticeable when you wear it. The clear retainer can be worn at night or twenty-four hours a day if you wish.
The Hawley type is made of a coloured plastic that covers the gums behind the teeth with a wire that goes along the fronts of the teeth. There are usually two cribs that help stabilize the retainers around the molar teeth. There are many fun colors that you can choose from for the plastic/acrylic portion and this removable kind has no special hygiene requirements and no real restrictions related to eating. After each meal, these removable appliances must be taken out and cleaned but remember not to use water that is too hot because the acrylic could get distorted. Many people take them out when they eat. Your orthodontist will instruct you as to what is best for you. Always remove it during sports and take note that dogs love to chew Hawley retainers. When you first start to wear this type of retainer you may get a plastic taste that usually disappears within a few days and your speech will be different initially but will return to normal quickly. The removable types are often used for minor tooth movements and for fine tuning the alignment of your teeth, even if you have never had orthodontic treatment.
The third one is the Bonded Wire type. It is custom shaped on a model of your upper or lower teeth (or both) to fit the inside of the front teeth after they have been straightened. It does not show because of it’s location on the tongue side and is permanently bonded in place. It usually fits behind two to six front teeth and can be either bonded at the two ends only or to all the teeth that it lies against. I feel it is better if it is bonded on every tooth adjacent to it. This type is most often used on lower front teeth because these teeth are more prone to crowding and movement again. The wire can be left on for the rest of your life if you want to be sure that the teeth maintain proper position. The only negative side of this bonded wire is that it does not allow floss to slide in between the teeth where it is and a floss threader or super-floss must be used in order to maintain good preventive oral hygiene. Your dentist or orthodontist can remove this wire very quickly at any time.
Although your braces are removed, the retainer is the most important part of your treatment. If you choose a removable appliance and do not wear it as directed, your teeth will move. As a result, re-treatment may be required and this will involve additional time and costs.
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5