Orthodontic retention

Aging of the face

Aging will cause unavoidable changes in the face and dentition.

• Braces removal and and enjoying a new esthetic and functional smile is the ultimate reward for patients who spent months or years in treatment.
• These benefits should last a lifetime. However, even if we would all like to have “perfect stability for life”, it must be realized that certain changes are possible, unavoidable and even desirable over the years as other changes happen in the face with growth and aging.
• The whole body and especially the face, will undergo multiple changes during a lifetime. Even if they don’t occur at the same time in all individuals, most of these changes are normal and unavoidable! For instance, as we age, most poeple expect to see changes in their hair (greying, loss, thinning), their skin (wrinkles), their waist, eyesight, flexibility, etc. but very few expect changes in their mouth, dentition and smile because they were never told it could happen.
• These “normal” changes will happen whether the person underwent orthodontic treatment or not an cannot be blamed on orthodontics.

Retention period

• The orthodontic retention phase is aimed at minimizing unwanted dental movements during the initial period following the removal of the braces or other appliances used for correction.
• Even if the most critical period is the first few months and year following treatment, it is often indicated to stabilize or retain the teeth for a much longer period (many years). Certain practitioners even advocate “lifetime” retention.

Following braces removal, patients must wear one or more retention appliances aimed at maintaining the stability of the corrections obtained during treatment. Many types of appliances exist but the choice of the appliance is made by the orthodontist depending on the type of case (malocclusion of the patient), the results obtained, and an evaluation of the potential for relaps.

Lower fixed retainer

Lower fixed bonded retainer

The standard lower retainer that we use is a fixed stabilizing wire placed on the tongue side of the teeth.

• The wire is practically invisible.
• It is bonded (glued) to the canines and cannot be removed by the patient (fixed).
• The lower retainer can stay in the mouth many years without any problems if the patient’s oral hygiene is adequate.
• If the retainer becomes loose or falls off, communicate with our office so that we can evaluate if it is necessary to rebond it.
• Do not trhow it out because it can often be rebonded.

Different types of upper removable retainers.

Upper fixed bonded retainers (splints)

Upper retainers

We use two main types of retainers on the upper arch. The main one, called Essix, is a clear plastic shell covering the teeth, sometimes only six front teeth. It must be worn full time for two weeks, except for meals and brushing, then at night only for a period of at leat one year. We use this appliance frequently but it is not ideal for every case. If you have this type of appliance, it is possible that it will show some signs of wear or perforation with time. This is normal and will not affect the performance of the retainer. If the appliance breaks or cannot be worn, call us.

The other type of upper retainer is a “Hawley”. It is made of acrylic, clasps on the molars and a front wire helping maintaining the teeth in place. It must also be worn full time (except for meals and brushing), during 6 to 8 months. After that period, it can be worn at night only or according to the instructions we will give you.

It is possible that fixed splints be bonded on the tongue side of some teeth. If these retainers become loose or fall off, save them and call our office so that we can determine if they need to be rebonded. These upper fixed retainers, just like the lower ones, can be left in the mouth for many years.

Always bring your removable retainers with you when you come for check-up visits.

Retention period

It is important that you follow closely the instructions given to you concerning the wearing of the removable retainers during the retention period. Any negligence in that respect may cause undesirable changes. Even if the interdigitation of the teeth is excellent at the end of treatment, it must be remembered that teeth are constantly under the influence of numerous outside forces that can’t always be predicted or controlled (ex. facial musculature, masticatory forces, tongue and lip pressure, etc.). This alone should be a good enough reason to justify wearing retainers. As a rule of thumb, removable retainer wear is progressively reduced over a period of 18 to 30 months. Fixed retainers may be kept in the mouth for many years as previously discussed. If, during the retention period, you notice significant dental movements or changes, tell us as soon as possible.

It must be emphasized that certain types of malocclusion represent a greater risk of relapse after orthodontic corrections. In such cases, special retainers are often used. They may be indicated in occlusal problems such as:

• evere anterior open bites (front teeth not touching);
• ”tongue thrusting” problems (exerting excessive forche on the teeth);
• severe dental rotations;
• significant jaw size discrepancies or malpositions (these cases may sometimes require a surgical correction);
• adults having significant bone or gingiva loss around the teeth.