Retainers are custom-made devices designed to hold the teeth firmly in their new, straightened positions following orthodontic treatment. This step is necessary because the tissues and bone surrounding the teeth require time to stabilize and adapt to the change in alignment. Without continuous support, the teeth have a natural tendency to shift back toward their original locations, a phenomenon known as orthodontic relapse. Wearing a retainer as prescribed is the sole way to ensure the long-term success and preservation of the orthodontic investment.
Removable Retainer Options
Removable retainers offer flexibility, allowing the wearer to take them out for eating and cleaning, but their effectiveness depends entirely on patient compliance. The two most common types are the traditional Hawley retainer and the clear, vacuum-formed Essix retainer. Both maintain alignment, but they differ significantly in construction and user experience.
The Hawley retainer is constructed from a thin metal wire which wraps around the front of the teeth and is embedded into an acrylic base that rests against the palate or under the tongue. This durable design allows for minor adjustments by the orthodontist if slight tooth movement is needed over time. However, the visible wire across the front teeth makes it less aesthetically pleasing, and the acrylic base can initially affect speech patterns or feel bulky.
In contrast, the Essix retainer is fabricated from a clear, thermoplastic material that is vacuum-formed over a mold of the straightened teeth. This clear plastic design offers superior aesthetics and comfort compared to the Hawley, as it fits snugly. Its primary limitation is durability; the plastic is prone to cracking or wearing down, especially in individuals who grind their teeth, and it typically needs replacement every few years.
Caring for both types of removable retainers involves consistent habits to ensure longevity and hygiene. Retainers must be cleaned daily, usually with a soft-bristled toothbrush and water, to prevent bacterial and plaque buildup. It is important to store the device in its protective case when not in use, as they are easily lost or damaged. Removable retainers, especially the plastic Essix type, should never be exposed to hot water or excessive heat, which can cause the material to warp and permanently lose its custom fit.
Permanent Retainers
Permanent, or fixed, retainers consist of a thin, braided metal wire that is custom-fitted and bonded with dental adhesive to the backside of the front six teeth. Because the retainer is perpetually in place, it eliminates the need for patient compliance, providing continuous stabilization and making it highly effective at preventing movement. Since the wire is placed on the lingual (tongue) side of the teeth, it is virtually invisible to others.
The main drawback to a permanent retainer is the challenge it presents to maintaining optimal oral hygiene. The presence of the bonded wire makes traditional flossing between the secured teeth impossible. Patients must use specialized tools like floss threaders or interdental brushes to clean the areas around the wire and between the teeth every day.
Failure to clean thoroughly can lead to significant plaque and tartar accumulation around the wire, increasing the risk of gum inflammation and tooth decay. The bond itself is not indestructible; the adhesive can break or the wire can bend, usually from biting into hard or sticky foods. When this happens, the patient may not immediately notice, leading to undesirable tooth movement until the retainer is professionally repaired or replaced.
Selecting the Optimal Retainer
The decision of which retainer is “best” is highly personalized, balancing clinical necessity with the patient’s lifestyle and preferences. A primary consideration is the individual’s anticipated level of compliance. Fixed retainers are often recommended for those with low compliance or younger patients, as they require no daily thought to be effective.
The original orthodontic case plays a significant role in the selection process. For example, cases involving severe rotations or a high risk of relapse may benefit most from the consistent pressure of a fixed retainer or the comprehensive coverage and adjustability of a Hawley. In contrast, Essix retainers are frequently favored for patients who highly prioritize aesthetics.
Finally, the long-term cost and potential for replacement are factors to consider. Hawley retainers are generally the most durable and adjustable, often lasting for ten years or more, making them a good long-term value. Essix retainers are less expensive upfront but require more frequent replacement due to wear and tear. Ultimately, the orthodontist’s clinical recommendation should guide the final selection.