The End of Active Orthodontic Therapy – Retainers

A message from Dr. Gorin

Congratulations

This marks the end of an important phase of orthodontic treatment and the beginning of another. The next phase of treatment is called post treatment stabilization. It is concerned with keeping your teeth as straight as possible after your braces are removed. I consider it the most important phase of treatment and it is the most difficult for me to control. Removable devices called retainers are employed during this phase. Patients who do not wear their retainers, as prescribed, will certainly suffer the frustration of inappropriate tooth re-positioning.

Teeth move after braces are removed

Your teeth, gums and supporting bone have all gone through changes to accommodate the orthodontic movement of teeth. Time is needed to stabilize these structures. Just as a fractured bone needs time in a cast to mend, your teeth need time in retaining devices while the supporting structures stabilize. Your bite might not feel totally comfortable immediately after the braces removal. This will improve in time. The key to stabilizing your orthodontic result is retainer wear. What keeps teeth straight after the braces are removed? Retainers, retainers, retainers.Even people who have not had orthodontics experience tooth movement

Jaws continue to growth and change shape as we age. Teeth will reposition themselves during jaw growth and jaw-shape changes. Orthodontic patients experience this, as well as people who have not had the benefit of orthodontics. Retainer wear will lessen the effects of normal jaw growth and jaw-shape changes on tooth positions. So, now you have two reasons to wear your retainers. The first is to stabilize your orthodontic result. The second is to lessen the effects of jaw growth and jaw-shape changes.

Retainers

I have designed and fabricated removable devices for you called retainers. Retainers will hold your teeth in place during the stabilization process and normal jaw-growth remodeling. Retainers are made of a plastic-like material. They are durable but they don’t last forever. They will have to be replaced and updated occasionally. Your first set of retainers is included in your case fee. The fee for additional retainers will be determined after new models are taken and evaluated. Remove your retainers when you eat a meal or snacks. Don’t expose retainers to high heat or detergents. Retainers should be placed in a retainer case to protect them when they are not in your mouth. To avoid a bacterial overgrowth, rinse and pat them dry before putting them the retainer case. Pets love retainers. Pets consider retainers as chew toys. Keep your retainers away from your pets. If your retainer has wire loops and clasps it is a Hawley retainer. You have an Essix retainer if it is clear plastic without wires. Soak Hawley and Essix retainers daily with Retainer Brite^tm. Additionally, Hawley retainers can be soaked in Efferdent^tmand brushed with tooth paste. Do not soak Essix retainers in Efferdent. Do not brush Essix retainers with tooth paste. Follow the cleaning instructions on the packages and remember not to use hot water. Hot water distorts the plastic of your retainers. Be careful around the metal clasps and wires while cleaning your retainers. Retainers are worn for a period of years and are necessary to achieve and help preserve the final orthodontic results and to counteract normal jaw-growth changes. If the retainers are not worn, as prescribed, the teeth may shift or move into undesirable positions. Poor tooth positions, as a result of incomplete retainer wear, may need to be corrected with a new course of orthodontic treatment. There will be an additional fee to correct any tooth movements resulting from poor retainer wear.

Below you will find the recommend schedule for retainer wear:

Removable retainer wear schedule

Time since braces removed	Upper retainer wear	Lower retainer wear
0 --12 months	24 hrs	24 hrs
13 --18 months	night wear, 7 nights per week	night wear, 7 nights per week
19 -- 24 months	night wear, 1 night per week	night wear, 7 nights per week
24 + months	night wear, 1 night per week for life*	night wear, 1 night per week for life*

* needed to counteract jaw growth and jaw-shape changes

Second molars and un-erupted teeth

Some patients may have delayed eruption of their second molars. The second molars may not have been ready to emerge into the mouth at the time the braces were removed. Waiting for them might not have been practical in your situation. The majority of un-erupted second molars erupt uneventfully at a later date with no complications or attention needed. However, there are some patients whose second molars fail to erupt. A limited scope of treatment involving a minor orthodontic appliance may be necessary to erupt these molars. There will be an additional fee for orthodontics necessary to assist un-erupted molars.

Wisdom teeth (third molars)

It is not uncommon for lower front teeth to experience some minor tooth movement at the same time your wisdom teeth start to erupt. There is no clear-cut evidence that wisdom teeth actually cause the lower front tooth movement. However, we recognize that the two phenomena occur at the same time. It is speculated that the lower jaw experiences some width changes at the same time that the wisdom teeth erupt. This leads to the lower front teeth re-positioning themselves in the narrower jaw. Wearing your retainer will lessen the effects of any jaw-shape changes.

Permanent retainers

Some patients find that removable retainers are just too impractical for their life styles. There are several technologies involved with permanent forms of retention. They range from space-age fabrics to complex alloys. The decision to use permanent retention and what form to use is a complicated one. It is specific to an individual’s case. Permanent retainers have high maintenance demands in that fracture and un-bonding is very common. Permanent forms of retention make hygiene more difficult. You must continue to massage and stimulate your gums to promote blood circulation and healthy, firm tissue. Dr. Gorin recommends the use of Soft-Picks, from G-U-M, which gently cleans and removes food and plaque from between teeth. Shorter dental check-up and cleaning intervals are necessary to successfully maintain a healthy mouth during permanent retainer wear. The same diet restrictions that were in effect during active orthodontic therapy will remain in effect during permanent retainer wear.

In Closing

During post treatment stabilization the mouth is accommodating itself to the new positions of the teeth. Some minor tooth re-positioning is to be expected, secondary to a balance of many forces, and should not be considered a form of relapse or a disappointment in treatment. Your lower front teeth are most at risk for movement. Serious lower retainer wear will give you the best edge against this problem. It is now important to return to the family dentist for regular office visits. Have your dentist keep an eye on any un-erupted teeth. If you are wearing a permanent retainer, have your dentist check for dental decay or any inflammatory process in the area near the retainer.

I would like to take this opportunity to thank you for a very pleasant association. If at any time, any question should arise, please call.

Regards and good luck,

Dr. Neil Gorin