A permanent retainer, also known as a bonded or fixed retainer, is a thin wire custom-shaped and bonded to the back surface of the teeth, typically the lower front six. This appliance serves a single purpose: maintaining the alignment achieved through previous orthodontic treatment. It constantly works to prevent the natural tendency of teeth to shift back toward their original positions, a phenomenon known as relapse. For many people, a permanent retainer is a discreet, long-term solution for preserving a straight smile. This article addresses the procedure for removing this fixed appliance and the important considerations surrounding that decision.
Who Should Perform the Removal
A general dentist is technically capable of removing a permanent retainer, as the procedure involves standard dental tools and techniques. They are trained to safely detach the wire and polish the tooth surface. However, an orthodontist is generally the preferred professional for this specific task due to their specialized expertise in tooth movement and retention planning.
An orthodontist’s training centers on the stability of the entire dental arch and the mechanics of tooth position. They are better equipped to assess the specific risk of orthodontic relapse for your unique bite and treatment history. This deep understanding is important for planning the immediate steps following the retainer’s removal.
If the permanent retainer is being removed simply because it is broken or causing discomfort, and a new retention plan is already in place, a general dentist may be suitable. If the case is complex, involves a history of shifting, or requires an immediate assessment for a new custom-made appliance, an orthodontist should be involved. Their specialized knowledge ensures that the removal is part of a coordinated strategy to maintain your alignment.
The Retainer Removal Procedure
The physical process of removing a permanent retainer is typically quick and straightforward, often taking less than 30 minutes. The first step involves breaking the bond between the wire and the tooth surface, which is achieved by targeting the composite resin, or dental glue. Specialized pliers or ultrasonic instruments are often used to gently loosen and fracture the small blobs of adhesive.
Once the bond is released, the thin metal wire is carefully detached and removed from the back of the teeth. Following the wire’s removal, a small amount of composite resin residue remains on the enamel. This material must be meticulously polished away using a slow-speed dental handpiece with specialized burs or discs.
The polishing stage is important to ensure a smooth tooth surface and prevent damage to the enamel or any unnecessary sensitivity. The entire process is not usually painful, and most people only feel slight pressure or vibration. The process concludes with the tooth surface being completely smooth, restoring the natural feel of the back of the teeth.
Post-Removal Considerations and Options
Immediately following the removal of a permanent retainer, the teeth are susceptible to orthodontic relapse. This is the movement of teeth back toward their previous positions. This is due to the phenomenon of “orthodontic memory,” where the periodontal ligaments surrounding the tooth roots exert forces attempting to reverse the alignment. Studies estimate that a significant percentage of patients may experience some degree of relapse within the first decade without proper retention.
Because of this inherent risk, a replacement retention plan should be prepared and ready before the fixed retainer is taken out. The most common alternative options are removable retainers, which require strict patient compliance to be effective.
Hawley Retainers
One popular option is the Hawley retainer, which is fabricated from a combination of acrylic material and a metal wire that wraps around the teeth. A benefit of the Hawley retainer is that the acrylic plate rests against the roof or floor of the mouth, allowing for minor adjustments to be made to the wire if small shifts occur. However, they are more visible than other options and must be sent to a lab for fabrication, making replacement more time-consuming and costly.
Essix Retainers
Another widely used choice is the Essix-style retainer, which is a clear, vacuum-formed plastic appliance that fits snugly over the entire arch of the teeth. This type is highly aesthetic and nearly invisible, and it can often be fabricated in the dental office on the same day the permanent retainer is removed. The Essix retainer provides full coverage and is generally comfortable, but it can wear down over time and may require more frequent replacement than a Hawley retainer. Consistent wear, often full-time initially and then nightly for the long term, is necessary to prevent the teeth from shifting and to preserve the orthodontic result.