Retainers

RETENTION - IN MANY WAYS, JUST AS IMPORTANT AS THE ACTIVE TREATMENT

After any active treatment, retention is required. We start with the acceptance that teeth will continue to move, to a greater or lesser extent, throughout life. 

Retention simply means the holding-on after teeth have been aligned and bites corrected.

Types of retention will differ with different types of active treatment, and after treatment of different presenting problems in patients of different ages and with different facial shapes.

It is not reasonable to say that one size fits all.

Commonly used retainers are:

Traditional rigid removable acrylic plates with wires to hold the teeth firmly against the acrylic arch shape,

Clear flexible removable templates which, at first, fit like gloves over the aligned teeth, and

Fixed (bonded) wires on the inside of the teeth.

The safest, most efficient and most predictable form of retention for individual patients will be discussed throughout treatment and especially when it has been decided that active devices can be removed.

In most cases, retention will commence as close to full-time as possible - apart from meals, tooth-brushing, sport with a mouthguard or really special occasions. After a few months, retention will generally be reduced to night-time only - with further reductions over the next few years in the number of nights that retainers should be worn. 

 In our practice, we are well-known for taking long-term responsibility after active treatment. That typically means that teenagers will be followed from time to time through until their early twenties. During that long retention period, in most cases, decisions regarding wisdom teeth or other back teeth are made.

In the end though, there is never a recommendation that the wearing of retainers should stop altogether. Some patients will be lucky that, with the particular treatment carried out for them, an obviously very stable situation has been reached. For others, who may have seemed to have been treated for similar problems, there will be obvious continued movement. In those cases, the teeth can be held straight with normal night-time retainers being worn - the minimum amount of time to keep the alignment in those individuals.

Special types of retainers are bite-splints worn at night to try to reduce the progression of tooth wear in those patients who grind their teeth or who continue to be managed for various jaw joint and muscle problems. Other retainers may include false teeth to temporarily replace missing teeth - until ready for more permanent replacements to be made. 

For adults, the choices are similar although, in most adults, the initial day-time retainers will be clear templates. Fixed wire retainers can be especially useful to hold teeth in young patients if there is a very real chance of significant movement occurring (such as the re-opening of an upper midline gap) or if there is a question of compliance with the necessary program. In the long-term though, there is definitely a cleaning problem associated with the placement of bonded fixed wires and so the need to keep the gum tissues clean and healthy may eventually outweigh the facility of placing the fixed wires.