A permanent retainer, also known as a bonded or fixed retainer, is a thin wire custom-fitted to the back surface of the teeth, typically the front six teeth on the lower arch. This wire is secured using a dental adhesive, making it non-removable by the patient. The primary function is to provide continuous, long-term stability to the teeth after orthodontic treatment. It prevents the natural tendency for teeth to shift back toward their original positions, a phenomenon known as orthodontic relapse.
Determining Eligibility and Making the Decision
The process of getting a permanent retainer begins with a comprehensive consultation with your orthodontist. This specialist will assess your specific history, including the complexity of your original tooth movement and the stability of your corrected bite. Fixed retainers are often recommended for cases that involved severe crowding, significant rotations, or the closure of spaces between teeth.
The orthodontist will also consider your oral hygiene habits, as poor cleaning around a fixed appliance can lead to plaque buildup and gum inflammation. Patients who demonstrated excellent hygiene during active treatment are generally considered better candidates. This discussion also involves comparing the fixed option with removable retainers, weighing factors like continuous retention against the potential challenges in cleaning. Finally, the consultation will cover the cost, which varies but generally ranges between $150 and $500 per arch, and the scheduling for the installation appointment.
The Procedure for Bonding a Permanent Retainer
The installation procedure is generally quick and precise, often taking less than an hour. The first step involves preparing the lingual, or tongue-side, surfaces of the teeth where the wire will be attached. This preparation includes thoroughly cleaning and drying the enamel to ensure a strong bond. A mild acid solution is then applied to the enamel for approximately 30 seconds to lightly etch the surface, creating microscopic pores for mechanical retention.
After the etching solution is rinsed off and the teeth are dried, a bonding agent or primer is applied to the prepared surfaces. The custom-shaped retainer wire, usually made of braided stainless steel or titanium, is then carefully positioned against the teeth. A composite resin adhesive is placed over the wire at each bonding site, securing it to the enamel. A specialized ultraviolet (UV) curing light is used to rapidly harden the composite resin, permanently locking the wire into place. The orthodontist then checks the bite to confirm that the retainer does not interfere with the opposing teeth before polishing the bonding material for comfort.
Long-Term Care and Maintenance
Caring for a permanent retainer requires specific attention to oral hygiene due to the wire’s fixed position. The primary challenge is flossing, as the wire blocks the traditional method of running floss between the teeth. Specialized tools like floss threaders or products such as Superfloss, which have a stiffened end, must be used to thread the floss underneath the retainer wire at each contact point.
Daily Hygiene
This focused flossing technique is necessary once a day to remove plaque and food debris that accumulate around the wire and bonding material. Brushing should be performed at least twice a day using a soft-bristled brush, paying extra attention to the areas above and below the wire and the gumline.
Protecting the Retainer
To protect the bond, patients should avoid biting directly into hard foods like nuts, ice, or crusty bread, and sticky foods such as caramel, which can pull the wire loose. Regular dental check-ups and professional cleanings are essential, as the hygienist can remove any tartar buildup that forms around the retainer and check the integrity of the adhesive bonds. If the retainer ever feels loose or breaks, contact the orthodontist immediately to prevent unwanted tooth movement.