Orthodontic treatment repositions teeth over months or years, but the work is not complete until a retention phase is established. Dental retention is the long-term process of stabilizing teeth in their new positions using custom-made appliances called retainers. Without this final step, teeth tend to shift back toward their original alignment, a phenomenon known as relapse. Understanding how to obtain and properly maintain these devices is paramount to preserving the results of significant time and financial investment.
Why Teeth Require Retention
Teeth are held within the jawbone by the periodontal ligament, a fibrous network that acts like a hammock around the tooth root. When teeth are moved during orthodontics, these ligaments are stretched and compressed, creating a “memory” that pulls the teeth back toward their starting point. This biological phenomenon is the primary cause of orthodontic relapse.
The supporting bone structure also needs time to remodel and fully mineralize around the new root positions, a process that can take many months. If the teeth are not held in place, soft tissue forces, such as the lips and tongue, can also contribute to unwanted movement. Teeth are most vulnerable to shifting significantly in the first six to twelve months following the removal of braces. Consistent retainer wear during this initial period allows the surrounding tissues to stabilize.
Understanding the Types of Retainers
Retainers generally fall into two broad categories: removable and fixed appliances.
Removable Retainers
Removable retainers offer flexibility and ease of cleaning. The classic Hawley retainer features a custom-molded acrylic plate secured by a thin metal wire that spans the front of the teeth. While durable and adjustable, the prominent wire makes them the least aesthetically pleasing option.
A modern alternative is the clear plastic retainer, often referred to by brand names like Essix or Vivera. These are vacuum-formed, transparent shells that fit snugly over the entire arch of teeth, making them highly discreet when worn. Because they cover the entire tooth surface, they can sometimes trap saliva and make speech slightly more difficult initially. The plastic material is generally less durable than a Hawley and can warp if exposed to excessive heat.
Fixed Retainers
Fixed retainers, sometimes called bonded or permanent retainers, consist of a thin, braided wire custom-fitted and permanently cemented to the tongue-side surface of the front teeth. These are typically placed behind the lower front teeth, where relapse is common, offering constant retention without relying on patient compliance. Because they are permanently fixed, they ensure stability, but they cannot be removed for cleaning. The main drawback is the increased difficulty in maintaining oral hygiene, requiring specialized flossing techniques to prevent plaque buildup around the bonded wire.
The Process of Acquiring a Custom Retainer
Obtaining a new custom retainer begins immediately after the active phase of orthodontic treatment is complete. The orthodontist takes precise records of the stabilized teeth, usually through traditional putty impressions or a digital intraoral scan. These records are sent to a dental laboratory where skilled technicians fabricate the appliance according to specifications. The fabrication process typically takes a few days to a couple of weeks.
The patient returns for a fitting appointment where the orthodontist ensures the retainer seats correctly and provides instructions for wear and care. The initial prescription often involves full-time wear, typically 22 hours a day, for the first few months, before transitioning to nighttime wear indefinitely.
If a retainer is lost, broken, or worn out years after the initial treatment, the patient must contact a dentist or orthodontist immediately. The professional will assess whether any significant tooth movement has occurred. If movement is minimal, a new impression or scan is taken, and a replacement retainer is fabricated to fit the current tooth position. If substantial shifting has occurred, a brief, minor phase of orthodontic realignment may be necessary before a new retainer can be made.
The cost of retainers varies widely, ranging from approximately $150 to over $500 per appliance, depending on the type. While many initial orthodontic packages include the first set, replacements are almost always an out-of-pocket expense. Dental insurance rarely covers replacement retainers, though Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) funds can often be used.
Maintaining and Caring for Your Retainer
Proper maintenance is necessary to ensure the longevity and effectiveness of any retainer.
Removable Retainer Care
Removable retainers should be cleaned daily immediately after removal using a soft-bristled toothbrush and a non-abrasive soap or specialized cleaning tablet. Avoid using standard toothpaste, as the abrasive particles can scratch the surfaces, creating harbors for bacteria. When not being worn, the retainer must be stored safely in its protective case to prevent damage or loss. Never expose the retainer to hot water, which can cause the material to warp.
Fixed Retainer Care
For individuals with fixed retainers, the focus shifts to meticulous flossing to prevent gingivitis and decay. Specialized tools, such as floss threaders or interdental brushes, are necessary to navigate the wire and clean beneath it effectively. Regular check-ups with the dental professional are necessary to monitor the retainer’s fit and assess the stability of the final tooth position.