Retainers and stable results

Question 1

Do I need to wear retainers after orthodontic treatment?

Accepted Answer

Once orthodontic treatment is finished, you must wear a retainer to hold the teeth in their new position. The bone and the structures around each tooth need time to adapt to the corrected position. The stability of the result also depends on how the teeth meet, as well as on factors such as jaw growth and the movements of the soft tissues (cheeks, lips, tongue). How long the retention period lasts depends on the patient's age, the type of treatment and the original problems that were corrected. Depending on these factors, the orthodontist may recommend a fixed or a removable retainer.

Question 2

How are braces taken off? Is there a difference in how different types of braces are removed?

Accepted Answer

Braces are removed at the end of orthodontic treatment with special pliers designed for the purpose. The pliers squeeze the bracket until the bond between the bracket and the adhesive breaks, and once the bracket is off, the adhesive stays on the enamel. It acts as a protective cushion that softens the force of removal. Metal braces are removed together with the archwire and elastic ties (if there are any), whereas aesthetic braces are removed one at a time, without the archwire. The procedure takes 1 minute.

Question 3

Why do you take photos after my braces come off?

Accepted Answer

The photographs taken before treatment starts are part of the analysis of the soft tissues of the face: how prominent the lips are, the position of the nose and chin in profile, the symmetry of the face and chin, the position of the dental midline, how much of the teeth shows when you smile and how they relate to the lips. Once orthodontic treatment is complete, we take the same set of photographs at the end. At this stage, together with the impression, they serve as a record of exactly how the teeth were aligned when the braces (or aligners) were removed.

Question 4

Do I need X-rays before my braces are removed?

Accepted Answer

X-rays can give us valuable information not only before treatment starts, but also during treatment and at the end of it. Your orthodontist may ask you to have a panoramic X-ray, and possibly a cephalometric X-ray, before booking the appointment to remove your braces, in order to check that the roots of the teeth are parallel and how the front teeth are inclined in profile. These X-rays may show that some teeth are not yet in the right position and that treatment needs to continue.

Question 5

How soon after my braces come off will I get my retainers?

Accepted Answer

Fixed retainers are fitted straight after the braces are removed (and sometimes just before), at the same appointment. Removable retainers take longer to make. The earliest you can have them is a few hours later on the same day, but more often you receive them the day after your braces come off. With aligners, once the attachments have been removed from the teeth, the last aligner can be worn as a retainer for a while until a proper retainer is made.

Question 6

Should I put anything on my teeth after my braces come off?

Accepted Answer

Removing braces, or removing the attachments used with aligners, makes the teeth temporarily more sensitive. This sensitivity is expected to settle gradually over a few weeks. Any oral hygiene products with a high fluoride content reduce tooth sensitivity and help shorten this period. You can use an orthodontic mouthwash, a toothpaste for sensitive teeth or an enamel-remineralising toothpaste. Your orthodontist may also recommend, or give you, a special fluoride gel to apply to your teeth to reduce sensitivity. On top of that, keeping your teeth and gums perfectly clean will help any irritated gums settle down more quickly.

Question 7

Which retainers hold the teeth more firmly – fixed or removable?

Accepted Answer

The debate about which retainer is best in terms of strength, durability and effectiveness has existed since the very beginning of orthodontics as a speciality. There is still no consensus among orthodontists as to which option is better, and different specialists and teachers in the field hold different views. My personal view is that fixed retainers have too many drawbacks for the health of the teeth. They can cause: Gum inflammation Difficulty flossing Tartar build-up In addition, fitting them on the upper jaw is often impossible because of the way the teeth bite together, and the risk of them coming unstuck is relatively high. If the retainer comes unstuck and this goes unnoticed, the teeth can become crooked again. For these reasons, I prefer removable aligner-type retainers in most cases. They provide good stability, are easy to clean and do not carry the same risks for the gums and teeth as fixed retainers.

Question 8

Does a fixed retainer need to be replaced?

Accepted Answer

Once it has been fitted, a fixed retainer does not need to be replaced unless it breaks or comes unstuck from several teeth at once.

Question 9

Can I have a fixed retainer that isn’t metal?

Accepted Answer

Fixed retainers are a group of retainers that have one thing in common: they are bonded to the teeth. Most patients have heard of or seen the metal kind, which looks like a thin wire. A fixed retainer can also be made using a cast-metal technique, in the form of a metal strip 2–3 mm wide. Alternatively, a fibre splinting strip can be used, which is tooth-coloured and blends in with the teeth. Its main advantage is its appearance, but its drawback is that it ages in the mouth and becomes discoloured by bacteria, so it may need to be replaced.

Question 10

Why does my fixed retainer come unstuck?

Accepted Answer

According to studies on the stability of fixed retainers , the rate at which they come unstuck or break in the first year is between 30% and 50% . This means that during the retention period there is a considerably high chance of a problem with a fixed retainer. There can be various reasons for it coming unstuck, and some of them are related to errors during bonding , for example: The adhesive getting wet during the procedure The tooth surface not being properly cleaned before bonding If the retainer comes unstuck within the first 6 months after it was fitted, there is a high likelihood that the cause was a bonding error. Other common causes include: Eating hard foods (nuts, crunchy foods) Careless flossing or use of toothpicks Using the front teeth to bite on hard objects – for example tearing sticky tape, chewing pencils or opening packaging These factors can significantly shorten the life of a fixed retainer, which means it will need to be rebonded or replaced if the problem keeps happening.

Question 11

Does a removable retainer need to be replaced?

Accepted Answer

Removable retainers come in a wide variety of designs. Two of the most common are the plate-type retainer (similar to the removable plates children wear, made of plastic and wires) and the vacuum-formed, aligner-type retainer. Plate-type retainers usually don’t need to be replaced unless they break, get lost or become deformed. The vacuum-formed retainer (a clear tray moulded to the shape of the teeth) is made from a thin plastic material that tends to ‘loosen’ over time. So, if there is no other reason to replace this type of retainer, we recommend renewing it every 6 months.

Question 12

How long do my teeth need to be held in place after they’ve been straightened?

Accepted Answer

How long the teeth need to be held in place with retainers after alignment depends on the patient’s age, the type of initial malocclusion (how the teeth were out of line), the bite and the treatment method (expansion, moving the teeth back, or extractions). As a general rule, some authors advise that retention should last twice as long as the treatment, or at least 2 years after the end of active orthodontic treatment. There are cases in which we tell the patient right at the start that the result will need to be retained for life.

Question 13

A small piece has broken off my removable retainer. Do I need to replace it?

Accepted Answer

The reasons for replacing a removable retainer are: breakage, loss, ageing of the material with a change in colour, or your orthodontist advising you to replace it at set intervals. If the piece that has broken off is small and at the back teeth, it is usually not urgent, but it is advisable to replace the retainer within a week or two.

Question 14

My removable retainer has cracked but is still in one piece. Do I need to replace it urgently?

Accepted Answer

A slight crack in a clear aligner-type retainer at the back teeth, caused by clenching, is not a reason for urgent replacement. A crack at the front teeth, however, means the retainer needs to be replaced quickly.

Question 15

Can I have my fixed retainer removed and replaced with a removable one?

Accepted Answer

If you find the fixed retainer uncomfortable, have difficulty cleaning around it, or have problems with your gums or tooth decay, the type of retainer can be changed. A lot depends on the problem you were treated for. For example, if you had gaps between your teeth before orthodontic treatment, a fixed retainer is strongly recommended at the end. If such a retainer does need to be removed, discuss with your orthodontist whether a short fixed wire could be left bonded to the teeth that are most likely to drift apart – for example, the two front incisors if you had a diastema. If your only problem was crooked teeth, switching from a fixed to a removable retainer is not a problem.

Question 16

My retainer no longer feels tight when I put it in each night. Does that mean it isn’t holding my teeth well enough?

Accepted Answer

Removable retainers are worn according to a schedule that aims to phase them out gradually once the teeth have fully settled into their new position. It is completely normal for the retainer to feel tight every time you put it in during the first six months of wear. During this period the teeth are still slightly mobile, and the retainer moves them back into the straight position when it is in. Once the teeth have got used to their new position, they stop making tiny movements and the retainer no longer feels tight when you put it in. The lack of tightness is a sign that the teeth have stabilised. However, bear in mind that the removable retainer itself may have loosened, and this may be why it feels loose when you put it in. It is a good idea to check with your orthodontist, just in case.

Question 17

Is it normal for some of my teeth to be loose after treatment has finished?

Accepted Answer

Moving teeth during orthodontic treatment with braces, aligners or removable plates causes temporary resorption (softening) of the bone, which allows each tooth to move to the desired position. After treatment ends (once force is no longer being applied to the teeth), the bone regains its normal hardness within 3 to 6 months. During treatment and for up to 6 months after it ends, your teeth may feel unstable and you may even notice some of them wobbling slightly. The teeth most affected are those that have been rotated.

Question 18

I wear my removable retainers regularly, but I still notice my teeth shifting. Why is that?

Accepted Answer

In the first 6 months after the end of active orthodontic treatment, the retainer feels tight every time you put it in, which means the teeth have moved slightly while you were not wearing it. This is because the bone is still soft and allows it. After this period, you shouldn’t see any visible shifting of the teeth during the day when you are not wearing the retainer. If this still happens, it is most often due to strong cheek muscles pressing on the dental arches and trying to narrow them slightly, in which case it may take longer for the teeth to settle. Another possible cause is the contacts between the teeth, which push them slightly out of line. Lightly filing certain contact points can solve the problem.

Question 19

How long can I go without wearing my retainer before my teeth start to shift?

Accepted Answer

There is no right answer to this question. In the first six months after the braces come off, when the teeth are more mobile, skipping even one night of retainer wear can have a negative effect on the alignment of your teeth. Don’t cut down on wearing your retainers if you don’t want to undo the result of your orthodontic treatment.

Question 20

Is there any risk to my teeth if I have orthodontic treatment a second time?

Accepted Answer

There are cases where part of the effect of orthodontic treatment is lost over time. The reasons for this can include the patient’s growth, a change in eating habits (switching from soft to hard food), or insufficient or poorly planned retention of the teeth. Retreatment is possible after the patient’s case has been assessed. It is important to check on an X-ray whether the first round of tooth movement has left any consequences (shortened roots, active periodontal disease). If the teeth have already been affected by previous treatment, we may advise you not to start a new one.

Question 21

Do I need a new removable retainer after bonding?

Accepted Answer

A removable aligner-type retainer follows the shape of the teeth extremely precisely. When bonding is carried out, material is added to one or more teeth to change their shape, size or colour . As a result, the clear retainer will no longer fit the altered teeth. After bonding , we strongly recommend taking a new impression the same day and having a new retainer made. If bonding has been done on only one jaw (for example, only the upper teeth), then only that retainer needs to be replaced. If you wear a plate-type removable retainer , it is important to bring it with you on the day of your bonding. That way the dentist or orthodontist can adjust it to fit the altered teeth . In most cases, the plate does not need to be replaced completely . This adjustment is needed to make sure the retainer keeps doing its job and your teeth stay stable in their new position .

Question 22

How often should I replace my removable retainer if it hasn’t broken?

Accepted Answer

According to the material manufacturers, aligner-type retainers should ideally be replaced every 6 months. Plate-type retainers (made of plastic and wire) are replaced if they break, get lost, change colour or start to smell.

Question 23

Should I have my wisdom teeth out after treatment (if they didn’t need to come out before) so they don’t push my teeth out of line?

Accepted Answer

There is a chance of the teeth shifting as the wisdom teeth come through, mainly between the ages of about 18 and 25. There is no consensus on whether wisdom teeth need to be removed for orthodontic reasons. Some patients experience late shifting of their teeth even without wisdom teeth, so it cannot be said that having them out will eliminate the risk of any shifting at all.

Question 24

My teeth have shifted some time after my braces came off. Can they be straightened with aligners, or do I need braces again?

Accepted Answer

Very slight shifting of the teeth can sometimes be corrected with the retainer itself. If the movement is more noticeable and you want to correct it, the question is which type of orthodontic appliance you would prefer to wear. The correction can be done with either braces or aligners.

Question 25

Can I wear a myofunctional trainer instead of a retainer?

Accepted Answer

A myofunctional trainer is a bulky silicone appliance that you bite on with your upper and lower teeth at the same time. It is used as an additional aid for correcting harmful habits in childhood (incorrect swallowing, mouth breathing, thumb sucking), together with exercises to break the habit. The trainer can help guide the teeth in the right direction while they are growing. As a retention aid, the trainer can be used to maintain a corrected deep bite, open bite, Class II (distal) bite or Class III (mesial) bite. It does not hold individual teeth well, and unless it is combined with another retainer, slight crowding may reappear in teeth that were corrected during orthodontic treatment.

Question 26

Do I need to see my orthodontist after treatment has finished, and how often?

Accepted Answer

After treatment has finished, we recommend a visit to the orthodontist after 6 months, and after that according to an individual plan. Of course, if you have a problem with your retainer, notice your teeth shifting or have any other concerns, you should get in touch with your orthodontist.

Question 27

Do I have to wear my retainers all the time?

Accepted Answer

Retainers are worn according to a schedule. In the first 6 months after the end of active orthodontic treatment, we recommend wearing them during the day as well. After 6 months, wear is most often reduced to nights only, which doesn’t affect your daily life.

Question 28

Will the different types of retainer affect my speech?

Accepted Answer

Fixed retainers sit tightly against the teeth and don’t change your speech. Aligner-type retainers cover the inner surface of the teeth, so the tongue touches the retainer material when you talk. There is a slight change in how some sounds are pronounced, but you adapt quickly – within 1–2 days your tongue ‘learns’ to speak with the retainers in. With appliances that resemble a child’s removable plate, the inner part of the appliance is made of a thick layer of plastic, and this affects speech considerably. You can adapt, but it takes longer (possibly more than a month).

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