After your active treatment is completed, you are not quite done. No matter what was used to move your teeth, braces or clear aligners, you need orthodontic retainers to preserve the work that has been done. At the end of the treatment, teeth are unstable and can shift their position very easily. Even later in life, facial changes can occur that can push teeth out of alignment. Because of this, many orthodontists recommend wearing retainers for life.
You may be instructed to wear your retainers full time for a period of time, and then at nights for the rest of your life. However, even with proper retainer use, some degree of relapse can be expected, especially in the lower front area. Habits, such as mouth breathing and tongue thrust, may affect future position of the teeth as well as age related bone changes.
There are several types of retainers available today. Many are removable, and some are permanently attached to your teeth. There is no one retainer that is the best. All have some advantages and disadvantages. Here we discuss the most common retainers prescribed by orthodontists.
Vacuform retainers
Vacuform retainers are removable clear plastic trays that cover all teeth. Esthetically, they are virtually unnoticeable and they are excellent at holding the alignment of the teeth. Because they cover the chewing surfaces of the teeth, however, these retainers are more likely to wear down faster in people who grind their teeth or clench their jaws. They also may cause back teeth to separate after prolonged wear. Therefore, after these retainers are removed in the morning, it is normal for the bite to feel slightly off for a little while until teeth settle together again.
Hawley retainers
Hawley retainers have hard acrylic plastic on the tongue side of the teeth and a wire in the front. They attach to the teeth with metal clasps. These retainers are great at holding the alignment and preserving the overall space. They are frequently used after expanders and phase 1 treatment. Unlike vacuform retainers, they allow the back teeth to settle into a comfortable bite. There are some disadvantages. Since these retainers do not cover teeth on all sides, some shifting is still possible. Because the plastic covers the roof of the mouth some patient may experience more gagging. The rigid plastic may cause the teeth to be sore even if a day or two of wear are missed.
Permanent retainers
Permanent retainer is a piece of wire that is bonded to the back of teeth. It is commonly used behind the lower front teeth, which are most susceptible to relapse, and sometimes behind upper front teeth, especially if there was space there before treatment. Since these retainers are fixed and can only be removed by a dentist, compliance is not an issue, as it is with removable retainers. However, there are several drawbacks. Since permanent retainers only hold the alignment of the front teeth, removable retainers are still needed to hold the back teeth. They make brushing and flossing between the teeth harder and tend to collect plaque and calculus. If biting into something hard, the wire can break or bend and consequently push teeth out of alignment.
Space maintainers
Space maintainers are commonly used in young children to preserve space for a permanent tooth if a baby tooth is lost or extracted early. They are cemented to the teeth and can be removed once the permanent tooth erupts. Lingual holding arch, a common example, consists of metal bands encircling permanent molar teeth and a heavy duty wire that runs behind front teeth.