When the day finally arrives to have braces removed, patients feel excitement for their new smile. The active phase of orthodontic treatment is complete, but the process is not truly finished until the teeth are stabilized. This final stage of retention is the most important step for ensuring long-term success. Maintaining the corrected alignment requires careful planning that begins immediately after the brackets come off.
The Standard Procedure: Debonding and Impressions
The definitive answer is that braces must come off first before impressions are taken. This process, known as debonding, involves the orthodontist removing all the brackets and wires. After the appliances are removed, the teeth are cleaned and polished to remove any remaining adhesive, leaving the enamel smooth.
The impression or scan, which is the mold used to create the retainer, must capture the exact final contours of the tooth surface. Brackets, wires, and residual cement would distort the impression, making it impossible to fabricate a retainer that fits correctly. Orthodontists use either traditional impression material or a modern digital scanner to create an accurate three-dimensional model of the aligned teeth. This entire sequence is typically completed during the same appointment to minimize the time the teeth are left unrestrained.
The Critical Period of Immediate Stabilization
Once the braces are off, a temporary gap exists while the custom retainers are fabricated, which can take a few hours to a week. This interim period is critical because the teeth are most vulnerable to relapse immediately following active treatment. The periodontal ligaments surrounding the teeth still possess a “memory” that tries to pull the teeth back toward their original positions.
These ligaments are elastic fibers connecting the tooth root to the jawbone, and they were stretched during orthodontic movement. The supporting bone also needs time to solidify around the new root positions, a process that takes several months. To mitigate shifting during this vulnerable time, some orthodontists use a temporary or “same-day” retainer until the final appliances are ready. This immediate stabilization protects the investment spent on the active phase of treatment.
Navigating Retainer Types and Wear Schedules
The custom-made retainers fall into two main categories: removable and fixed.
Removable Retainers
Removable retainers include the classic Hawley retainer, which uses metal wires and acrylic. They also include clear plastic aligner-style retainers, often called Essix retainers. Clear retainers are more discreet, while Hawley retainers are durable and allow for minor adjustments.
Fixed Retainers
Fixed or bonded retainers are thin wires permanently attached to the inside surface of the lower front teeth, and sometimes the upper teeth. They provide continuous retention without relying on patient compliance. However, they require meticulous flossing to prevent plaque buildup. Patients often receive a combination of both types, such as a fixed retainer on the lower arch and a removable retainer for the upper arch.
The initial wear schedule for removable retainers is intensive, requiring full-time wear for 20 to 22 hours per day for the first few months. This period allows the supporting bone and ligaments to stabilize. Wear is then gradually reduced to night-time only, and eventually to several nights per week. Retention is a lifetime commitment, as teeth naturally continue to shift due to aging and everyday forces.