Tooth Retention After Braces

by Dustin Burleson, DDS

Years ago, patients and clinicians alike thought you could straighten your teeth and they would stay straight forever. Research has now shown that the only way to guarantee straight teeth for life is through the use of fixed or removable retainers for life.1 As we age, teeth naturally shift to the middle and crowd. Combined with late growth of the lower jaw, shifting of the teeth is expected following orthodontic treatment.2 Therefore, retainers are extremely important in the maintenance of your new smile following orthodontic treatment.


Factors Affecting Treatment Stability

Many of our patients ask what type of retainer we recommend. “Can I get a clear retainer?” or “will I need a fixed retainer?” are common patient questions. Your orthodontist takes into account several factors when he or she plans to retain the positions of your teeth. Growth of the jaws following treatment, the amount of time needed for gum and bone tissues to stabilize, and pressures from the lips and tongue are all important factors that affect the stability of your finished result.3 After considering these factors, your orthodontist decides what type of retainer you should wear and how long you should wear it.

Fixed Retainer

A fixed retainer is typically placed (glued) on the inside surfaces of the lower front teeth. This type of retainer can be attached to the two canine teeth or to every tooth in the area. A fixed retainer is very efficient at maintaining the positions of the teeth in certain situations.4 If your orthodontist decides to place a fixed retainer, it will make cleaning between your teeth more difficult. Ask your orthodontist, dentist, and dental hygienist for tips and tricks to help you keep your teeth clean while wearing a fixed retainer. With proper care and regular visits to your general dentist, your fixed retainer can be left in place until lower jaw growth is completed (early adulthood) or indefinitely, as indicated.3
 

Removable Retainers

Removable retainers have been used successfully for many years and are probably the most common type of retainer. Patients identify immediately with the wire that runs across the front teeth to help maintain tooth alignment and symmetry. The Hawley retainer is probably the most popular type of removable retainer. It is made of plastic and stainless steel wire and is custom-made for your mouth and teeth. Variations of this type of retainer are too numerous to list, but they all achieve the same result – maintenance of your new smile for life.

Since removable retainers can be taken out, patients frequently ask how long they need to wear the retainer. Most relapse, or unwanted tooth movement, occurs in the first 3-6 months after the braces are removed. For the average patent, you will wear your removable retainer full-time for the first 3-6 months, and thereafter only while sleeping. If your orthodontist recommends a period of time longer or shorter than this, he or she is protecting your smile against the factors we mentioned at the beginning of the article. For example, a patient with severely misaligned jaws and teeth might wear retainers for a longer duration than a patient with only minor tooth-alignment problems. If you are unsure of your retention program, be sure to ask your orthodontist or orthodontic assistant for specific instructions regarding the wear and care of your retainers.

 
Clear or Invisible Retainers

With the advent of new, clear plastic materials in orthodontics, patients can benefit from more esthetic options during the retention phase of orthodontic treatment. Clear retainers are comfortable, esthetic, and require no adjustment. However, they can be severely worn or broken if subjected to heavy biting forces. In our office, patients receive clear retainers as a back-up retainer and for social convenience during the first 3-6 months. If the Hawley retainer is lost or broken, the clear retainer can be used as a back-up, while our lab fabricates a new Hawley retainer. We have found this program to be very beneficial in maintaining healthy, beautiful smiles for life.


References:

1. Little RM, Riedel RA, Artun J. An evaluation of changes in mandibular anterior alignment from 10 to 20 years postretention. American Journal of Orthodontics and Dentofacial Orthopedics; 1988 (93): 423-428.

2. Nanda RS, Nanda SK. Considerations of dentofacial growth in long-term retention and stability : is active retention needed? American Journal of Orthodontics and Dentofacial Orthopedics. 1992 (101): 297-302.

3. English JD, Peltomäki T, Pham-Litschel K. Mosby’s Orthodontic Review. St. Louis : Mosby, 2009, pp 265-270.

4. Espen HD, Zachrisson BU. Long-term experience with direct bonded lingual retainers. Journal of Clinical Orthodontics; 1991 (10): 619-630.



Doctor Burleson is an Assistant Clinical Professor in the Department of Orthodontics & Dentofacial Orthopedics at the University of Missouri - Kansas City School of Dentistry. He holds additional teaching affiliations with The Children's Mercy Hospital and Saint Luke's Hospital Cleft Palate and Craniofacial Teams. He also maintains a private practice in Kansas City, Missouri.

Dr. Burleson completed his undergraduate studies at the University of Missouri-Kansas City, where he earned a Bachelor of Arts in Biology, with distinction. He went on to receive his D.D.S. with distinction from the University of Missouri-Kansas City School of Dentistry, graduating with the highest academic standing in his class. Dr. Burleson then completed his residency and certificate of advanced graduate study in Orthodontics and Dentofacial Orthopedics at the UMKC School of Dentistry. He is a board-certified Diplomate of the American Board of Orthodontics.

In the community, Dr. Burleson is active in his church, serves on the North Kansas City Schools Community Advisory Board and participates in the Smiles Change Lives Program. Dr. Burleson and his wife, Amy, reside in Kansas City, Missouri with their son Samuel.

You can reach Dr. Burleson's practice by calling (816) 741-5311 or visiting http://www.burlesonorthodontics.com. His office is located at 4151 N. Mulberry Drive, Suite 210, Kansas City, MO 64116. The email for Dr. Burleson's office is: info@burlesonortho.com

 

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