Retention
Retention is an ugly word in orthodontics. It’s our little secret that teeth can crowd up again after the braces are removed! Why does this occur? There are actually two types of relapse:
- Short-term (<1year)
- Long-Term (>1 year)
Short-term relapse is primarily caused by elastic fibers that are part of your gum tissue. These elastic fibers become stretched during tooth movement and can pull your teeth back towards their original positions after the braces are removed. This is the major cause of short-term relapse. That is why retainer wear is most critical during the first year after your braces are removed. It takes about one year for your original elastic fibers to be replaced by newer elastic fibers that will actually help the teeth stay in their current (straight) position.
Longer-Term Relapse can occur because our bodies are always changing throughout life. Aging-related changes and/or significant weight gain or loss can affect muscle tone in the head and neck. The muscles of the lips, cheeks, and tongue can apply pressure to the teeth and cause movement which is usually a negative event.
Dr. Martinez has given a lot of thought to the best way of keeping teeth straight after orthodontic treatment. He wants to protect your investment in time, energy, and money so that your smile or that of your child’s will last for decades!
In order for the retention phase of treatment to be successful, Dr. Martinez feels that an orthodontist needs to provide retainers that are not just effective at keeping teeth straight, but must also consider what is reasonable to expect a patient to do for an extended period of time.
Most orthodontists provide 2 retainers (one for the upper teeth and one for the lower teeth) at the completion of treatment. Many times these retainers are ugly or very bulky and uncomfortable to wear. Their bulk can also cause patients to lisp when speaking and therefore many patients (teenagers in particular J) simply do not wear the retainers as instructed. Unfortunately, teeth can relapse quickly after the braces are removed if retainers are not worn full time.
To combat this problem Dr. Martinez instead provides 4 retainers (2 sets). These retainers are both effective at keeping the teeth straight, but also easy to wear. The first set is what we call Bonded Retainers.
Bonded Retainers are glued to the back surfaces of the upper and lower six front teeth where they are completely invisible to others. They are placed on the same day the braces are removed to prevent shifting of the front teeth. These retainers are very small, comfortable and do not affect speech. Importantly, these retainers are ‘glued in’ so they cannot be lost or forgotten so the front teeth will stay straight! The only negative to this type of retainer is that flossing becomes harder and requires the use of Super-Floss or Floss-Threaders.
Because the teeth can always move, Dr. Martinez recommends that the bonded retainers be left in place indefinitely. A study published in 2007 by Booth, Edelman, and Proffit showed that this type of retainers are both safe and effective. The bonded retainers caused no damage to the teeth or gums in patients that wore them for a period of 20 years as long as the patients had good brushing and flossing habits. In addition, patients who chose to remove their bonded retainers experienced much greater relapse in crowding than those who left their retainers on permanently.
Therefore, the only reason to remove these retainers is if your family dentist feels that you are not cleaning them properly. Please remember that regular checkups to your family dentist are extremely important to maintaining the health of your teeth and gums.
Click here to view bonded retainer flossing video.
The second set of retainers is removable and slightly larger but need to be worn just to bed at night.
These retainers are called ‘Invisible Retainers’ and are very similar to the Invisalign system. Of the many kinds of removable retainers, these have the least bulk and do not cover the palate so they are the easiest to wear regularly.
Invisible Retainers are important for two reasons. First, they keep the back teeth straight...a function not provided by the Bonded Retainers. Secondly, if your Bonded Retainer comes loose, you can wear the Invisible Retainer full-time until you can be seen by Dr. Martinez to repair your Bonded Retainer.
A couple of additional notes about retention:
Dr. Martinez warranties both sets of retainers for one year after your braces are removed. However, repair and replacement charges are applied after one year. Retainers should be considered personal use items such as eye glasses that need to be replaced every few years. Please repair or replace your retainers when they are worn out to prevent shifting of the teeth.
The frequency of repair/replacement depends on factors such as the overall health of the gums, flossing technique, diet, strength of the jaw muscles, and whether or not any clenching or grinding patterns exist.
Finally, while retainers maintain most of your orthodontic correction, some minor movement can occur with time.