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Orthodontic retention and stability of corrections

Orthodontic retention and stability of corrections

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Aging of the face

  • Braces removal and enjoying a new esthetic and functional smile is the ultimate reward for patients who spent months or years in treatment and for the orthodontist who provided it. These benefits should last a lifetime.
  • However, even if we would all like to have “perfect stability for life”, it is unrealistic.
  • It must be realized that certain changes are possible, unavoidable and even desirable over the years as other changes will 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 people expect to see changes in their hair (greying, loss, thinning), their skin (wrinkles), their waist, eyesight, flexibility, etc. but 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 and cannot be blamed on orthodontics.

Aging produces unavoidable changes in the face and dentition

Aging produces unavoidable changes in the face and dentition

 

Stability… all about balance of forces!

  • Teeth are not anchored into the bone like in cement. They are part of a complex masticatory system that is dynamic rather than static. Teeth constantly respond to forces that are applied to them so there is always a slight normal mobility of teeth.
  • With or without orthodontics, stability of the position of teeth depends a lot on the influence of the muscular environment that surrounds them (tongue, lips, cheeks, masticatory muscles, etc.).
  • Teeth move under the effect of forces. Any force applied long enough to the teeth can move them. It is the principle used in orthodontics to correct dental malpositions by using various appliances that apply “controlled” forces.
  • If teeth move, that means that a force is acting on them. This force can come from orthodontic appliances during treatment or various sources after treatment.
  • There are outside forces of variable intensity that cannot always be predicted or controlled and that could have an effect on the position of teeth (e.g.: facial musculature, masticatory forces, tongue and lip pressure, etc.).
Forces acting on teeth during orthodontic retention
  • Orthodontic retention is aimed at controlling as many forces as possible, but they cannot always be detected and cannot be all neutralized.
  • Even if the interdigitation of the teeth is good or excellent at the end of treatment, it must be remembered that teeth are constantly under the influence of numerous forces. This alone should be a good enough reason to justify wearing retainers faithfully.
  • Certain dental malpositions, mostly the most severe ones, can tend to reappear slightly. Severe rotations and overlapping of anterior lower teeth are the most frequent examples of this situation.
  • The position of teeth can change anytime throughout life. It is why most patients have to wear a retainer for a period of one year or more after their treatment to help stabilize the position of teeth and delay natural changes.
  • Any force acting on dentition can influence the position of teeth. The perioral musculature is an important factor with regard to this. Forces applied by the tongue and lips can affect orthodontic corrections.

Balance of forces in orthodontic contention and retention

We always try to make orthodontic corrections with the most care and we offer to monitor the results carefully. When retention is discontinued, even after several years, it is always possible, even normal, to observe a certain relapse. Sustained cooperation during the retention period can decrease these risks to a minimum. If you notice important changes in the position of your teeth after treatment, communicate with us.

Stabilization or retention period

Corrections can be very stable over several decades as shown on the two following cases treated by Dr Lemay (father).

Excellent stability of orthodontic corrections 35 years after the end of treatment.

 

Acceptable dental alignment, more than 45 years after the end of the orthodontic treatment. Notice the presence of wisdom teeth (third molars) that erupted. The first premolars were extracted for the orthodontic treatment.

 

Following braces removal, patients must wear one or more retention appliances aimed at maintaining the stability of the corrections obtained during treatment.

Retention appliances

Can retention appliances correct teeth?

Lower fixed retainers

Lower fixed retainer

Lower fixed retainer

The standard lower retainer that we use is a fixed stabilizing wire for which a few characteristics are described below:

 

Upper removable retainers

Different types of upper removable retainers
Different types of upper removable retainers

The orthodontist will determine which appliance is most suited for your condition. In the upper jaw, we use two main types of removable appliances (that can be removed by patients).

We use this appliance more frequently but it is not ideal for every case. The other type of upper retainer is a “Hawley“. This appliance:

Upper fixed retainers

Upper fixed retainers

It is also possible that fixed splints be bonded on the tongue side of some anterior upper teeth that presented more severe malpositions before treatment. 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.

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. These particular retainers can be worn over a longer period of time and they may be indicated in occlusal problems such as:

Fixed orthodontic contention wire

Upper retainers can hold 2 or several teeth depending on each case.

Fixed retainers in orthodontics

Additional information on stability

Stability of dentition and long-term orthodontic corrections; What do we know and what does the orthodontic literature say?

Here are a few conclusions of studies about stability of orthodontic corrections several years after the end of treatment.

The influence of wisdom teeth on stability of teeth

How long will I have to wear my retainers?

(A) Twisted retention wire with glue in excess. This makes cleaning difficult and facilitates accumulation of plaque. (B) The arrows indicate 2 areas where the glue does not hold on the teeth anymore and, (C) when the wire is removed, we discover dental carie and gingival inflammation. (D) Another example of carie that developed under a retention wire.

Am I obliged to wear my retainers?

This question is frequently asked to us so we present information allowing each patient to make an informed decision concerning the retention phase following their orthodontic treatment.

In conclusion, retention is not “mandatory”, but strongly recommended and is part of the protocols of any major orthodontic treatment. The orthodontist only recommends a retention protocol to patients and it is up to the patients to decide what they wish to do! It all depends on what they wish in the long term.

My teeth are no longer moving, do I need to keep my retainers?

I bite differently after wearing my removable appliance

Follow-up during the retention period

Maintenance of retainers (plastic shells)

Emergencies and problems with retainers

Breaking of retainers

In case of relapse

 

But results are not guaranteed for life? – “There is nothing permanent… except change”!

Results in orthodontics are not guaranteed.

➡ To know more on the “warranties in orthodontics” and obligations of results.

 

Want to know more about orthodontics?

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