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The Key Role of Orthodontic Retainers in Post-Clear Aligner Treatment

Writer's picture: Dr. Niki Shah - Principal EducatorDr. Niki Shah - Principal Educator

Completing clear aligner treatment marks a significant milestone in a patient's journey towards a perfectly aligned smile. However, it is vital for dentists to educate patients about the importance of orthodontic retainers in maintaining the achieved results. In this article, we will explore what retainers are, the different types available, why they are necessary, duration of wear, how to order them through the doctor portal, and a recommended wear schedule.


What are Retainers?

Orthodontic retainers are custom-made dental devices designed to maintain the corrected position of teeth after orthodontic treatment, such as clear aligner therapy. These appliances help prevent teeth from relapsing or reverting to their original positions.


Types of Retainers:

a.     Removable Retainers:

Removable retainers are commonly recommended for patients who have completed clear aligner treatment due to their convenience and ease of use.

 

  • Clear Retainers: Also known as Essix retainers, these retainers are made from transparent polyurethane material, making them inconspicuous. The look similar to clear aligners but are slightly thicker and unlike aligners, retainer don’t move the teeth.

Clear Retainer


  • Hawley Retainers: Consisting of a plastic arch that fits inside the mouth, along with a metal wire that wraps around the teeth, Hawley retainers provide stability and can be adjusted. They are however more noticeable, but also more durable.

Hawley Retainer


b.    Fixed Retainers:

Fixed retainers may be recommended for patients with complex tooth movements or a history of poor compliance, and often used complemented by clear aligner.

 

  • Bonded Wire Lingual Retainers: These retainers consist of a thin wire that is bonded to the back of the teeth, providing effective long-term retention. These retainers remain in place for a few years and need to be removed by a dentist. Patients should be warned about eating hard foods or crunching ice as the wire can break. The wire can be straight or braided.

Bonded Wire Lingual Retainer


  • Bonded Ribbond Lingual Retainer: Alternatively, a fibre reinforced ribbon such as Ribbond or other fibre reinforced plastics can be used as fixed retainers. These can be bonded with composite and can therefore be blended into the tooth structure, unlike metal. It can be very strong and, with Ribbond for example, can use the 1mm wide ribbon to make a bonded retainer. This can be more comfortable for patients than metal wires.

 

Fibre glass reinforced fixed bonded retainers


Why Retainers are Necessary

Teeth have a natural tendency to shift back to their original positions, as the tissues surrounding them undergo a remodelling process after orthodontic treatment. Retainers play a crucial role in maintaining the achieved results by providing stability and preventing relapse.

 

Removable Clear Retainers

Duration of Wear:

The initial phase of retainer wear is critical in achieving long-term stability. For removeable retainers, dentists usually recommend full-time retainer wear (20-22 hours per day) for the first few months, followed by transition to night-time wear. However, the duration of retainer wear may vary according to the patient's individual case, and it is essential to provide specific instructions tailored to their needs.

 

You should note that teeth will move natural as a person ages, the only way of retaining the desired position of teeth is to continue wearing a retainer.

 

Clear retainers are usually replaced every 6 months but a single set can be expected to last well over a year, and potentially up to 5 years. If the retainers are broken, damaged or misshapen, they won't be as effective at maintaining alignment, so it's important to replace the retainer right away.

 

Wear Schedule:

To ensure effective retention and minimise the risk of relapse, it is crucial to provide patients with a wear schedule and educate them on its importance. The wear schedule may include the following recommendations, depending of the patient’s specific requirement:

 

  1. Initial Phase (First 3-6 months): Full-time retainer wear (20-22 hours per day), removing them only for meals, brushing, and flossing.

  2. Transition Phase (6-12 months): Gradually transition to night-time wear, wearing retainers during sleep. Emphasize the importance of consistent retainer use during this phase.

  3. Long-term Maintenance: Continue wearing retainers at night, ideally for a minimum of 3-5 nights per week. Advise patients to monitor their retainer fit and contact the dental office if any issues arise.

 

Cleaning:

  • Before wearing, advise patients to brush and floss their teeth. In the morning, immediately on removal, clean the retainers, not letting saliva dry on them.

  • Use lukewarm water (NOT HOT) and a soft bristled brush to gently clean them. If necessary, mix mild dish soap with the lukewarm water.

  • Cotton swabs may assist with any hard-to-reach corners.

  • Occasionally soaking them in water or using a specialised cleaning solution will help to minimise eventual staining.

  • Discolouration is likely as the plastic ages. This can be minimised with cleaning, removing when eating and drinking, and avoiding smoking. They are however easy and relatively inexpensive to replace if the patient becomes uncomfortable with any staining.


Pros and Cons of Clear Retainers

Pros:

  • Clear retainers share the benefits of clear aligners, being moulded to the patient’s teeth they fit securely and feel comfortable, especially for the clear aligners patients who have gotten used to wearing removable aligners 22 hours/day. They are also similarly discrete, and easy to clean with a brush in the same manner as clear aligners.

  • They are particularly useful and, in many cases, essential with complex and for posterior tooth movements, as bonded retainers usually are for the front 6 teeth.

  • Their form fit provides comprehensive and longer-lasting effectiveness.

  • As they are removeable they are easy to clean and therefore more hygienic than fixed retainers which trap food debris.

  • Compared to the Hawley retainer, clear retainers are slimmer and less irritating to the gums, lips, cheeks and tongue.

 

Cons:

  • Can’t be repaired, however are cheap to replace. Metal retainers are easier to repair but their expense justifies it.

  • Susceptible to heat, causing them to warp.

  • Over time they are susceptible to staining

  • Thicker plastic may cause initial discomfort as teeth don’t occlude the same.

  • Must become an essential part of the patient’s ritual when going to bed, or they don’t work at all!

  • Need replacing more often than Hawley retainers.


Fixed Retainers

Permanent fixed bonded retainers either consist of a metal wire or a fibre reinforcement ribbon that an orthodontist bonds onto the back of a person’s teeth. The wire/fibre usually rests behind four to six teeth at the front of the mouth. This might be on the upper teeth, lower teeth, or both. They are more common on lower teeth as upper metal fixed retainers tend to break more often. The fibre reinforced ribbon, Ribbond, is an alternative to metal wire retainers.


Fixed wire retainers: Straight/Zig-zag, Braided (A & B)/Single (C & D)


Pros and Cons of Fixed Retainers

Pros:

  • Fixed to patients’ teeth so compliance not an issue

  • Invisible to others as bonded to lingual of teeth

  • Strong as made of metal or fibre

  • Can’t lose it

  • Usually last longer than removable retainers

 

Cons:

  • Oral hygiene maintenance, as fixed, interdentally difficult

  • Can break/debond

  • Sometimes can debond off a tooth and patient may not realise until tooth starts moving

  • Usually more expensive than removable retainers

  • Can be uncomfortable as bonded to lingual and can irritate tongue

  • Usually only bonded to 6 anterior teeth

 

How to Order Clear Retainers on the Proligner Doctor Portal:

  1. Log in to the dr.proligner.com portal.

  2. Access the Add Retainers page ordering section and select the appropriate patient.

  3. Choose the desired type of retainer (removable or fixed) based on the patient's requirements.

  4. Enter the specific details, including the patient's prescription.

  5. Add the number of sets required.

  6. Review the order and submit the order.

 

Conclusion

Orthodontic retainers play a crucial role in maintaining the results achieved through clear aligner treatment. By educating patients about the importance of retainers and providing them clear instructions for wear duration, and applying the suitable type, dentists can ensure long-term stability and patient satisfaction. Remember, consistent retainer use is the key to preserving the beautiful smiles you helped create.


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