Life After Treatment: Pros and Cons of Permanent Retainers (+ other options) | Dr. Ana Castilla

Life After Treatment: Pros and Cons of Permanent Retainers (+ other options)

The braces have finally come off. Yay! Now you have the smile of your dreams. (And you can eat corn straight off the cob again!) 

But that’s not the end of the story. When the treatment phase is done, next comes the retention phase. The goal of this phase is to keep your teeth in their new positions. It’s important because teeth have strong forces pulling them back to their original positions once the braces come off.

The retention phase typically involves a retainer for your upper teeth and one for your lower teeth. The two most common types of retainers are removable or permanent (also known as fixed).

 Let’s take a look at both types of Retainers.

 Removable Retainers:

There are several styles or types of removable retainers. One is the vacuum-formed retainer, also known by brand names as an Essix or Clear retainer. They look like Invisalign clear aligners: a piece of strong, clear plastic that is molded to fit perfectly onto the surfaces of the teeth. Another kind is the Hawley retainer, named after its inventor. It’s composed of an acrylic plate that covers the roof of the mouth (for upper teeth) and attaches to side teeth with a metal wire, and has a wire running across the front of the teeth to keep them in place.

Pros:

In our office we offer the clear, Essix retainer.  These provide ultimate hold of the finished result with no chance of tooth movement or relapse as long as the retainer is worn as directed.  The clear acrylic is nearly invisible, so you can show off your new smile and protect it at the same time!  Cleaning the Essix is as easy as dropping it in a water/white vinegar solution for about the amount of time it takes you to eat your breakfast. 

Cons:

Because the Essix is SO clear it may be easier to misplace!  We give a colorful, hard plastic case with each set of retainers to help keep them protected and easy to keep track of when they are not in the mouth.

The Hawley retainer requires a few more post braces office visits.  Any unintentional bends in the wire can allow teeth to move out of their finished position, so checking for this is important.

One thing they have in common is the need for regular replacement. A removable retainer may need to be replaced every twelve months to every few years, depending on several factors including how well the patient has cared for it. (Or if they have lost it altogether, which happens.) Habits, like grinding your teeth while sleeping, take a toll on the Essix retainers. Both of these retainer types can be broken by inadvertently stepping or sitting on them.  Dogs love to grab them off the coffee table while no one is looking so taking care of them is key!

Since the goal of our practice is to give you the Smile of Your Life for the rest of your life, we offer our Lifetime Retainer Program. It’s kind of like insurance for your retainer. Patients who take part in the program can get replacement retainers as needed for a low cost.

Permanent Retainers:

Permanent or fixed retainers are thin round wires glued to the lingual (tongue) side of selected teeth.  The most common spot for a bonded retainer is the back of the lower front six teeth or the back of the upper four front teeth.

Our office uses this type in conjunction with the removable Essix retainer.  We have found that using the fixed retainer alone does not provide the best protection against movement of the teeth.   If a patient has started treatment with a space, such as a gap between the upper two front teeth, we will glue a bonded retainer to the back of those teeth, which will keep the space closed.  The patient will wear a removable Essix over the top of the bonded retainer to keep their beautiful, finished smile perfect!

Pros:

Probably the best thing about the bonded retainer is they are hard to lose!  It has been done, but because they are glued into place there is no chance of leaving it on the dinner table wrapped in a napkin!

Cons:

Keeping the teeth clean with a permanent retainer clean can be challenging.  Floss needs to be threaded under the wire to reach the gum line and below. Small, plastic floss threaders, which help direct the floss, can be purchased at the drugstore.  We always stress the importance of seeing a dentist and hygienist regularly.  A professional cleaning will ensure the removal of any build up that may have been missed with at home care. 

As mentioned before, the bonded retainer, on its own, does not prevent all aspects of movement that can happen once the braces are off.  Holding a space closed is its specialty. Shifting can still happen and tilting of the teeth forward, away from the wire is a possibility.  

 Relapse:

Don’t braces come before retainers? Yes. But sometimes they come after, too. This usually happens when a patient stops wearing their removable retainer as instructed and later finds that their smile isn’t as beautiful as it once was. At a certain point, when the teeth have shifted so much that retainers won’t do the job anymore, braces are the only way to get that straight, even smile back.

The good news is that in almost all cases, braces or clear aligners the second time around aren’t on as long. Depending on how much the teeth have shifted, they can be corrected in a matter of just a few months.

As an orthodontist, my dream scenario is for my patients to wear their retainers as instructed for the rest of their lives. But I know that this is not realistic, so in my practice we’ve created the Guarantee My Smile program. For a small monthly fee, patients have the option to get braces put back on until they are happy with their smile again.

Keeping Your Beautiful Smile for Life

In the past, orthodontists often advised their patients to wear their retainers for a year or two after the end of treatment. Nowadays it’s more common for orthodontists to recommend wearing retainers for many years after braces come off, if not for life. Whether you end up having permanent retainers, removable retainers, or a combination of both, make friends with them because they will be with you for a long time – and they can help you keep that Smile of Your Life for the rest of your life.