Why are retainers so important

Why do we need retainers?

Teeth move after brace removal because of:

  1. Relapse: these are changes where teeth move back towards their original positions - almost as though the teeth have a 'memory'. This is due to the elasticity of the gums pulling them towards the original positions.
  2. Biological form: E.g. Strong muscle in the lower lip, lip tone, wisdom teeth, tongue function, digit habits, lip trapping.
  3. Biological development: These changes are ongoing through one's life-time and largely not predictable. E.g. arch form changes, growth of the jaws.
How are teeth kept straight?

Teeth can be kept straight with retainers. There are two main types:

  1. Fixed retainers - these are fitted to the back of the front teeth.  They are very thin, easy to keep clean and of course cannot be worn incorrectly, forgotten or lost. They feel as natural as you own teeth. If one was keen to keen the teeth perfect the fixed retainer could be a better option.
  2. Removable retainers - Removable retainers can only be worn part time. As a result, small changes to the teeth are to be expected.
Which teeth are most prone to relapse?

Relapse is most likely to occur when the original teeth were:

  1. Irregular front teeth.
  2. Teeth with gaps.
  3. Deep bites.
  4. Twisted/rotated teeth.
  5. Incisor teeth originally angulated.
  6. Impacted canines.
  7. Teeth originally at different heights.
  8. Tooth size variations when there is a mixture of teeth sizes.
  9. Crossbites.
  10. Arch shape changes.
Which ones are better?

If you had any of the above 1-9 features, fixed retainers are better.

Each patient has individual needs and we would advise according. We are very selective when we advise fixed retainers as it dependants on the overbite and the degree of calculus build on the back of the lower front teeth. We need to be sure that long term prognosis is favourable and maintenance is easy.

Under ideal circumstances, fixed retainers are more effective on the front teeth and removable on the back teeth and therefore, often we recommend a combination of both. Literally, we feel this is the absolute best.

Are there other reasons to choose fixed retainers?

Yes. quite a few:

  1. As the teeth will be more stable, one can aim for a more perfect result in the knowledge the changes will remain.
  2. Improvement in gum health as small spaces between the teeth can be closed.
  3. The tips of the teeth can be build as a part of the retainer improving the appearance of the teeth.
  4. Thin edges of the teeth due to bruxism and wear and tear can be reinforced as part of the retainer.
  5. Erosion of the back of the teeth can be protected as we cover the teeth with a thin veneer. However, one will also need to address the initial cause of the erosion.

Examples: Click image to enlarge

Why are retainers expensive?

Good question. Our private fees are £260 for a fixed retainer and £95 for a removable retainer. The true cost of a fixed retainers is reflected in:

  1. Additional time and work towards a more perfect result.
  2. They take TWICE as long to fit one fixed retainer than a brace. Clinical time is more expensive with fitting a fixed retainer taking 30-40 minutes each and a removable retainer about 1-2 minutes.
  3. Where possible we will fit them on 8 teeth on each arch - unlike most of the ones we see elsewhere which are on 6,4 or even just two teeth.
  4. Other clinics charge slightly below or even more than ours. What defines ours is the quality: it is thin with each tooth layered like a thin veneer to aid good gum health and maintenance.

 

How often are they replaced?

Fixed retainer: this is hardly replaced EVOLUTION Orthodontics. Since 1988, we have advised replaced 6 and on advice removed 19. Considering we fit 8-9 a week, this is a small fraction. The low failure rate is we are selective in patient choice. We would not advise it for those at risk to complications: e.g calculus build, deep bites or poor gum health. The repair rate at this clinic is 2% over a two year period on one tooth. Considering we fit them on 16 teeth this is low and manageable.

Removable retainer: on average we would provide one to two per day due to wear and tear, loss of fit or misplacement.

 

Can we do it cheaper?

We can fit a retainer at a much reduced rate. These would be similar to the ones below. However, it does not reflect our philosophy to quality and good patient care.

If we do it, we will do it well or not at all. There is no half way. In the immortal words of Arton Senna: 'If you see a gap and do not go for it, you are no longer a racing driver.'

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How often do I need to come back afterwards?

We check our fixed retainers one year after fitting then every 2 to 3 yearly intervals depending on gum health, any calculus build, stability and evidence or bruxism (grinding of the teeth).

During the check-ups we have a comprehensive 6 point check list.

Can anyone have fixed retainers?

No. The main factor is the health of the mouth. We will not advise them if we feel maintenance may be a factor.

Do I keep them of forever?

Not necessarily though long term retention is generally advised.  However, with good of the mouth most of our patients opt to keep them. We may advise considering removal depending on the rate of calculus build and gum health when the patient is in the 20's.

 

Mahesh Patel

Original: 26th January 2019

Updates: 6th May 2019

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