Orthodontic retreatment, often called getting braces a second time, is common after initial alignment is complete. This occurs when successfully straightened teeth shift out of position, a phenomenon known as orthodontic relapse. Despite the time invested in the first treatment, natural physiology and other factors can cause teeth to drift. Recognizing this frequent occurrence helps patients approach retreatment with a clear understanding of the path back to a stable, aligned smile.
Why Orthodontic Relapse Occurs
The most frequent reason teeth shift back after initial treatment is the failure to consistently wear a retainer as prescribed. Retainers hold the teeth in their new positions while the surrounding bone and periodontal ligaments stabilize. Without this support, the ligaments may pull the teeth back toward their original alignment, a process known as elastic rebound.
Beyond compliance, natural physiological changes contribute to movement over time, as teeth are held in a dynamic system. As people age, normal jaw growth and changes in bone structure can cause subtle shifting, often leading to crowding in the lower front teeth. External forces from oral habits, such as chronic teeth grinding (bruxism) or tongue thrusting against the back of the teeth, also exert pressure that pushes the teeth out of alignment.
Determining the Duration of Second Treatment
The duration of a second round of orthodontic treatment is often significantly shorter than the first, typically ranging from a few months to two years. This is because major structural work, such as correcting severe bite issues or large movements, was already accomplished during the initial phase. The severity of the relapse is the primary factor influencing the timeline, as it dictates the amount of tooth movement required.
Minor corrections, like small crowding or a gap that has reopened, may only require a few months of active treatment. Conversely, a more substantial relapse that has significantly altered the original bite will require a longer treatment period, sometimes approaching the length of the first round. The speed at which a patient’s bone and soft tissues respond to orthodontic forces is another individual factor. Since the overall bone structure has already been remodeled once, the biological response of the periodontal ligaments can sometimes be more predictable.
Treatment Options for Second-Time Braces
Orthodontic retreatment for relapse offers options that are often less comprehensive than the original treatment. For cases involving only minor shifting, the orthodontist may recommend limited or targeted treatment focused solely on the few teeth that have moved. This approach minimizes the use of hardware and overall treatment time.
Clear aligners are a popular choice for minor to moderate relapse due to their discretion and removability. These systems use a series of custom-made trays to gradually nudge the teeth back into alignment without the need for fixed brackets and wires. However, for more complex or severe relapse where the bite has significantly changed, traditional metal or ceramic braces may still be the most effective method. Lingual braces, which are fixed to the inside surface of the teeth, offer another discreet option for patients who require the control of fixed appliances.
Retention Strategies to Prevent Future Relapse
After completing a second round of successful orthodontic alignment, the focus shifts to maintaining the result and preventing a third relapse. The retention phase is understood to be an indefinite commitment, with orthodontists recommending lifelong retainer wear, particularly at night. This ongoing support is necessary because the forces that caused the initial relapse, such as age-related changes and muscle pressure, continue throughout life.
Retention uses two main types of appliances: fixed and removable retainers. Fixed retainers consist of a thin, custom-fitted wire bonded directly to the back surface of the front teeth, offering continuous, non-removable support. Removable options include Hawley retainers, made of acrylic and wire, or clear plastic retainers, which fit over the entire arch of the teeth. The choice between a fixed or removable retainer often depends on the specific teeth most prone to movement and the patient’s ability to commit to the long-term wearing schedule.