Orthodontic relapse, the shifting of teeth, commonly occurs when a retainer is not worn consistently after active treatment. Teeth are not permanently fixed in the jawbone; they are held in place by elastic fibers in the periodontal ligaments, which allow them to retain a “memory” of their original positions. This natural tendency for movement, combined with forces from chewing, tongue posture, and general aging, means that some degree of shifting is inevitable without a retainer. Dental professionals can assess the extent of the movement and offer tailored solutions to restore alignment.
How Dental Professionals Assess Relapse
A consultation with an orthodontist or dentist is the first step to diagnose the severity of the tooth movement. The professional begins with a thorough visual examination to observe the current alignment and assess the bite. A key diagnostic tool is attempting to fit the patient’s existing retainer, if available, as a tight or non-fitting retainer clearly indicates relapse.
To precisely quantify the shift, new diagnostic records are taken. These records include digital impressions or traditional molds to create an updated three-dimensional model of the teeth. X-rays may also be used to evaluate the position of the roots and surrounding bone structure, especially if the movement is significant or affects the bite. This assessment classifies the relapse as minor or significant, dictating the necessary corrective treatment plan.
Fixing Minor Tooth Movement
When teeth have shifted minimally (usually one or two millimeters), less invasive methods can gently nudge them back into place. The simplest approach involves using the existing removable retainer more consistently, wearing it full-time until the teeth settle. If the current retainer no longer fits, a new, slightly adjusted Hawley or vacuum-formed retainer (VFR) can be fabricated to apply mild pressure and correct small movements.
For more noticeable shifts, a short course of clear aligner therapy, sometimes called a “refinement” or “touch-up,” is recommended. This involves a limited series of custom trays designed to move only the relapsed teeth over a short period. Treatment duration for these minor corrections is brief, lasting three to six months. The cost for this limited re-treatment ranges from approximately $1,100 to $3,500, depending on the number of aligners needed and the provider.
Comprehensive Re-Treatment Options
When relapse is significant, involving multiple teeth, spacing issues, or a noticeable change in the bite, comprehensive re-treatment is necessary. This process is essentially a second round of orthodontics, although the duration is usually shorter than the original treatment since the teeth have already been moved once. The two main approaches for significant relapse correction are fixed appliances and clear aligner systems.
Traditional metal or ceramic braces are effective for correcting severe crowding, large gaps, and complex bite issues. They offer maximum control over individual tooth movements for complex cases. Clear aligner therapy, such as Invisalign, is a popular alternative for adults due to its aesthetic advantages and comfort. Aligners are effective for most moderate to significant relapse cases, but they require the patient to wear them for 20 to 22 hours per day.
Both options require a new treatment plan lasting between six and eighteen months, depending on the extent of the movement. The cost for full re-treatment can be comparable to initial orthodontic treatment, though limited-scope options may reduce the overall expense. The professional weighs factors like aesthetics, complexity, and patient compliance when recommending the most suitable method.
Ensuring Permanent Retention
Once the teeth are corrected, the focus shifts to maintaining alignment indefinitely to prevent future relapse. Long-term retention is necessary because the biological forces causing movement persist. Dental professionals recommend a combination of fixed and removable retainers for optimal stability.
Fixed retainers, also called bonded or permanent retainers, consist of a thin wire cemented to the tongue-side of the front teeth, usually on the lower arch. These offer continuous retention and eliminate the need for patient compliance. However, they require diligent cleaning with special flossing tools to prevent plaque buildup. Removable retainers, like Hawley or VFRs, are worn nightly after the initial full-time phase.
It is important to plan for retainer replacement, as lost or damaged removable retainers are a common cause of relapse. Some orthodontic practices offer replacement programs or “retainer insurance” to reduce the cost of obtaining new appliances quickly. Regular check-ups with the orthodontist, ideally every six months, are necessary to inspect the condition and fit of the retainers and ensure bonded wires remain secure.