The final step in orthodontic treatment is the retention phase, which is when a custom-made appliance called a retainer is introduced. This device is necessary to maintain the new alignment of the teeth achieved by the braces. Without retention, the teeth will gradually shift back toward their original positions, a process known as relapse. The retainer ensures that the investment of time and effort in straightening the smile is preserved for the long term.
The Transition Appointment and Fabrication Period
The process of receiving a retainer begins immediately at the final appointment where the braces are removed. During this visit, the orthodontic brackets and wires are taken off, and the teeth are thoroughly cleaned and polished to remove any residual bonding material. This appointment marks the end of active tooth movement and the start of the crucial retention phase.
Following the removal and cleaning, the orthodontist takes a precise record of the newly aligned teeth. This is typically done either by taking physical impressions using a putty-like material or, more commonly today, by performing a quick digital scan of the mouth. These accurate models are the master template used to fabricate the custom-fit retainer.
The actual delivery of the retainer usually does not occur on the same day as the brace removal, as the appliance must be constructed in a dental laboratory. The fabrication time varies based on the type of retainer chosen and the lab’s schedule, but it generally takes a few days to a week. Some practices may provide a temporary retainer or place a fixed retainer immediately to minimize the time the teeth are left completely unrestrained.
Once the retainer is ready, a second appointment is scheduled for the patient to try on the new appliance, receive wear instructions, and confirm the fit. A proper fit ensures the teeth are held securely in place and prevents any unwanted movement while the surrounding bone stabilizes.
Fixed Versus Removable Retainers
Orthodontic patients will receive one of two broad categories of retainers, each serving the same purpose of holding the teeth in their corrected position. The choice between a fixed or removable appliance is made by the orthodontist based on the complexity of the original correction, the patient’s oral hygiene habits, and their expected level of compliance.
A fixed retainer, sometimes called a bonded or permanent retainer, consists of a thin, braided wire that is permanently cemented to the tongue-side surface of the front teeth. This type is generally placed on the lower front teeth, which are highly susceptible to shifting. The major advantage of a fixed retainer is that it provides continuous, twenty-four-hour retention without relying on patient compliance.
The drawback to fixed appliances is that they can make cleaning the teeth more challenging, requiring the use of specialized tools like floss threaders or interdental brushes to clean beneath the wire. Removable retainers offer greater flexibility and come in two primary forms: the Hawley and the clear Essix style.
Hawley retainers are made of an acrylic base combined with a metal wire that wraps around the outside of the teeth. Clear retainers, also known as Essix retainers, are vacuum-formed from a transparent plastic material that fits snugly over the entire arch of the teeth. Removable retainers simplify oral hygiene, as they can be taken out for brushing and flossing, but their success depends entirely on the patient remembering to wear them consistently.
Navigating the Initial Wear Schedule
The period immediately following brace removal is the most delicate phase of the entire orthodontic journey due to the biological state of the surrounding tissues. During active treatment, the teeth moved because the bone tissue around the roots was systematically broken down and rebuilt, and the periodontal ligaments were stretched and reorganized. This process, known as bone remodeling, leaves the teeth temporarily unstable and highly prone to relapse.
To counteract this instability, the orthodontist mandates a period of full-time wear, which means the retainer must be worn for approximately 22 hours per day. This initial phase typically lasts between three and six months. The retainer should only be removed for eating, brushing, and flossing. Consistent full-time wear allows the bone density to increase and the periodontal ligaments to tighten and reorganize around the new, correct tooth positions.
After the initial stabilization period, the patient transitions to a nighttime-only wear schedule, usually totaling eight to ten hours of wear per night. The long-term retention plan often involves gradually reducing the nightly wear to a few times a week, but the commitment is generally considered lifelong.
The successful navigation of the wear schedule relies heavily on diligent care. Retainers should be cleaned daily with a toothbrush and non-abrasive soap or a specialized cleanser, and they must always be stored safely in their case when not in the mouth. Any sign of tightness when putting the retainer in indicates that the teeth have shifted, requiring an immediate increase in wear time to prevent further movement and protect the finished alignment.