Many orthodontic patients are excited to have their braces removed. You think, finally I’m done with braces. Not so. You are half way through treatment. You must wear retainers to keep your teeth straight. All patients must go through a period of retention. The retention phase of treatment is just as important as the braces. Your orthodontist wants to keep a close observation of your teeth and keep the proper alignment made by the braces.
Do I have to wear a retainer after my braces are removed?
Yes you do. Once braces are removed the patient must wear retainers. It is not an option. If you don’t wear your a retainer or have a fixed retainer placed, your teeth will move. They may not move completely back to where they use to be but back into the direction they came from.
What are retainers?
Retainers just hold your teeth in their new positions and allow the teeth to stabilize. When braces are removed, the patient may notice that their teeth are slightly mobile. That is because during treatment with braces, the periodontal ligament widens. Surrounding each root and between the root and the jaw bone is gum tissue called the periodontal ligament. During orthodontic treatment, the periodontal ligament becomes wider and the teeth become slightly mobile. A patient wears retainers to hold the teeth while the periodontal ligament thins back to normal size which takes a short period of time of about a week. The rest of retention phase of treatment is to create a stable bite. One where the alignment created by the orthodontist stays over a period of time, hopefully a lifetime.
How long do I have to wear my retainers?
Some patient’s teeth will try to move a lot during the retention phase of treatment. For those patients, you will have to wear your retainers longer. The idea is to slowly wean you off of the retainers under supervision of the orthodontist. Once the orthodontist sees that your occlusion is stable, they will change how often you need to wear the retainers. Some patients teeth try to move all the time. In those cases, they have to wear retainers for a lifetime. We find that this is the case for the adult orthodontic patients. The wear facets on their enamel or the position of their jaws tends to try to move teeth more. Adults usually have to wear retainers longer than the younger patient who has started treatment during their growing years.
What makes the teeth move? Why aren’t they set?
Teeth never really “set” in placed. If there is constant unequal forces placed on the teeth, they will move out of alignment until an equilibrium of those forces are created. These forces come from the oral musculature around the mouth, the position of the maxilla (upper) and mandibular (lower) jaw, the size of the jaws and the size of the teeth and any changes in the occlusion, like an extraction or decay.
There are a variety of reasons teeth move after braces. The most common reason is that the patient doesn’t wear their retainer as instructed. If you don’t wear your retainer, your teeth will move. On the other hand, some patients do wear their retainers as instructed and their teeth still move.
Some of the reasons for tooth movement would be that the size of the jaws cannot accommodate the size of the teeth. This is a tooth size discrepancy. In some cases to eliminate this problem, permanent teeth are removed to create enough room for the remaining teeth. The extraction spaces are closed with braces and a stable bite is created.
Another reason for tooth movement after braces is that the 3rd molars (wisdom teeth) are trying to erupt. If the 3rd molars are impacted, talk to your orthodontist about a referral to an oral surgeon to have them removed.
Finally, some tooth movement can occur from the gingival elastic fibers in the gum tissue pulling on the tooth or from occlusal forces from the occlusion itself. So, as outlined, there are a variety of reasons why teeth try to move after braces are removed.
What types of retainers are there?
There are basically two types of retainers, removable and fixed. A removable retainer is one that you can take in and out of your mouth. The removable retainer can be a traditional hawley retainer or an “invisible” clear plastic retainer. Most patients like the invisible retainer because of the ease of wear and that you can’t tell that they are wearing it from a distance. It’s invisible and comfortable. The Hawley retainer is more durable and can place pressure on the teeth with the labial bow (front wire).
A fixed retainer is retainer that cannot be removed by the patient. It consists of a wire bonded to the back side of each tooth or two bands attached to the ends of a wire that touches the backside of the teeth. They are mainly placed on the lower teeth and have to be monitored at certain intervals while in place. The can accumulate plaque easily and should not be used in patients who have a plaque or calculus buildup problem.
Do I have to wear my retainer all the time?
Yes. 24/7 Every orthodontist will have a schedule of how long you should wear your retainer full time. Most orthodontists want you to wear your retainer full time for about six months after your braces are removed. Then most will allow you to wear the retainer just when you are sleeping.
What is the orthodontist looking for when I go into see them for a retention visit?
Retention visits are usually very quick and short appointments. Your orthodontist is looking for teeth that are starting to move. If you orthodontist sees a tooth trying to move, they will make an adjustment to your retainer or your teeth. Some orthodontists will use interproximal reduction to change the pressure being applied to the turning tooth from the adjacent teeth. Sometimes an invisible retainer will need to be changed to a standard hawley retainer so that the orthodontist can apply pressure to the moving tooth. The teeth that try to move the most during retention is the lower incisors.
What can I do to help?
Wear your retainers as instructed. Do a visual examination of your teeth daily and if you see a tooth trying to move, call your orthodontist. Also, keep regular appointments. Your orthodontist will slowly wean you off your retainers and start lengthening the intervals between your appointments.
So remember, the retention phase of treatment is just as important as the braces. To keep that smile, wear your retainers.