Your Guide to Better Oral Health

Retainers After Braces: Do I Need Them?

Since braces are temporary and retention is forever, you should comply with the retainer regimen and do a routine checkup even years after braces.

You have been wearing braces in your mouth for months — maybe years. Then, the due date finally arrives and you were told that your braces journey had come to an end. You feel excited from the thought of getting your fixed orthodontic appliance removed or for those with invisible braces, knowing you would not need to wear an aligner anymore. You already imagine smiling with a new set of teeth, free from brackets and wires which have probably poked your gum or cheek causing discomfort. 

However, as you were seated on the dental chair, the dentist explained that you would have to make another impression for a set of “retainers” to wear daily. Some of you might have heard about retainers and some might not. So, what exactly is this retainer?

What are orthodontic retainers?

Orthodontic treatment (or teeth straightening) does not stop after bracket debonding. Afterwards, we still need to maintain the teeth position that were achieved by the endpoint before debonding. Since the mouth serves a mechanical function in chewing and speaking, it is impossible to keep the tooth in the same place for the rest of one’s life without aid. In orthodontic modalities, the dentist or orthodontist achieves the means to maintain the treatment result using orthodontic retainers.

The purpose of using retainers is to maintain teeth in an optimal aesthetic and functional position. The official definition of retainers in orthodontics is an appliance used to prevent relapse or return of teeth following correction of features to the original occlusion or correct between the teeth and jaw arches. In layman terms, retainers are used to keep the teeth in their final and optimal position that has been achieved with orthodontic treatment.

Types of Retainers

Retainers are divided into several classifications; based on usability and visibility. 

  • Under usability categories, there are:

a) Removable Retainers 

  • Removable retainers come in the form of acrylic-based dentures – except without the replacement teeth – with additional stainless-steel wires to help with the final adjustments on your teeth, and there is also a thermoplastic base that looks just like a couple of mouth guards. 

b) Fixed Retainers

  • Fixed retainers are stainless-steel wires or glass fibre tape bonded on your teeth to prevent them from reverting to their misaligned position.
  • Under visibility categories, there are:

a) Visible Retainers

  • The visible retainer generally puts the retaining part of the appliance in front of your teeth so it is pretty much visible when you smile or talk. 

b) Invisible Retainers

  • The invisible retainer puts the retaining part of the appliance behind your teeth, near the tongue, so it is obscured from view when you smile or talk. Some invisible retainers are also available in the form of a thin, clear, thermoplastic mouthguard that precisely covers your teeth without any wire or glass-fibre part. 

Retainers versus Braces

To achieve successful teeth-straightening, a dentist or orthodontist would utilize both retainer and braces in dental alignment correction. The difference? A retainer is an orthodontic appliance used to maintain or slightly modify your teeth position after orthodontic treatment using braces, while braces are a broad term used to address brackets used to significantly move and align your teeth. 

You cannot align your teeth optimally by only using retainers because it is mostly used to maintain. In advanced cases, moving and aligning your teeth to the most optimum result would require the use of braces. However, in some minor cases, retainers can be used to just slightly tip your teeth into a more desirable position.

Wearing retainers after braces

There are three major stages of orthodontic treatment: the planning stage, the active phase, and the retention phase. The planning stage is when you decide to fix your smile and get examined by the orthodontist with some test runs. The active phase starts when you begin wearing the orthodontic appliance until your teeth align into a more desirable arrangement. Lastly, the retention phase begins when you take off the appliance and this phase lasts for the rest of your lifetime.

In the words of Charles H. Tweed, a reputable figure in orthodontics, “I would gladly pay someone half my fee if he relieves me of the responsibility of successfully carrying my patients through their retention period.” Even after decades of experiments and research, the stability of aligned teeth is unpredictable in each patient. 

The relapse of the malocclusion after finishing the removal of braces can be attributed to the continuous ageing process, the recoil of the gum tissues surrounding the moved tooth, maturation of the soft tissues, and occlusal factors. Therefore, you should wear retainers for as long as you want straight teeth since the lack of patient’s compliance is the main cause of relapse in orthodontics.

In terms of practicality, the patients usually prefer fixed retainers so they are not required to take off their retainers when they eat or speak and minimizing the chance of losing the appliance. However, this would compromise oral health since the wires or glass fibre tends to accumulate more plaque and calculus leading to compromised oral hygiene. There is also functional risk such as bonding failure which can cause tooth position relapse without the patient even realising.

Can you wear a retainer without braces? Can metal retainers help to close small gaps after braces?

A retainer’s principal function is to keep teeth in their existing locations. It isn’t designed to move teeth as much as braces do. While removable metal wire retainers can help to close small gaps after braces by incorporating small forces onto the teeth through its metal components, this method is less effective than using braces to align teeth.

Where to get your retainers treatment in Malaysia

Private dental clinics, public dental clinics and even teledentistry companies in Malaysia provide the retainer service with a variety of applied costs. 

  1. Public clinics: 
  • Retainer treatment is conducted for most post-orthodontic treatment and only focused on a treatment below 17 years old with functional concern rather than an aesthetic case. It is usually more time-consuming as the public clinic entry cases require a longer waiting time.
  1.  Private dental clinics: 
  • Getting a retainer in the private dental clinic is more accessible due to the fixed appointments for treatment. This eradicates the need to queue. and saves time efficiently. 
  1. Teledentistry Company: 
  • Teledentistry companies allow patients to attend a single visit for a dental scan and have the dentist analyse their teeth moulds remotely. Furthermore, teledentistry companies can keep the retainer prices relatively low and provide the patient with convenient care and be monitored remotely by the professionals. No more appointments need to be wasted while getting retainers from teledentistry companies. 

Best Way To Keep Retainers Clean

How to Clean Retainers: Easy Steps and Methods [+FAQs]

During sleep, your mouth does not perform the self-cleansing ability as much since there is no active movement that aids in saliva secretion. Hence you might wake up from sleep with a sour or dry taste in your mouth. Remember that the oral cavity is a home for many microorganisms such as bacteria, viruses and fungi. Now imagine all those microorganisms remaining in your retainers which you have to put in your mouth daily.

The most important aspect of maintaining your retainer and your own health is to clean it regularly. The easiest way to do this is to use a soft toothbrush without toothpaste. This is because your toothpaste contains abrasive particles that can damage your retainer. To make sure your retainer is free from bacteria and odour, which brushing cannot guarantee, you can either use mouthwash, white vinegar or peroxide-based cleanser tablets (PBCTs). In a clinical trial, it is found that soaking your retainer using white vinegar is as effective as using PBCTs. To clean your retainer using vinegar, soak your retainer in a 5% solution of white vinegar for five minutes, brush gently, and rinse copiously with clean water. This method might leave a slight vinegary taste on your retainer, so you can use the PBCTs if you want a fresher taste.

Vacuum-formed or thermoplastic material retainers are sensitive to heat, therefore this type of retainers should only be rinsed with cold or warm water and followed by soaking it in PBCTs solution. Soaking your retainer appliance using sodium hypochlorite, another common household cleaning item, is not recommended since it can compromise the strength and physical properties of the appliance. Take a closer look at how to clean your retainer based on the retainer type. 

Currently, there are no methods that can guarantee the result of braces would last without the aid of retainer appliances, not even a surgical approach. Since braces are temporary and retention is forever, the patient should comply with the retainer regimen and do a routine checkup with their orthodontist even years after the active orthodontic treatment phase. 

It is important to wear the retainer and follow the instruction of your care provider and perform daily cleaning based on your retainer type to allow the optimal result of treatment progress while using the retainer.

References:

  1. 2012 – Peter G. Miles, Daniel J. Rinchuse, Donald J. Rinchuse – Evidence-Based Clinical Orthodontics. Illinois: Quintessence Publishing Co, Inc
  2. 2019 – Ahmed M. Alassiry – Orthodontic Retainers: A Contemporary Overview. The Journal of Contemporary Dental Practice (2019): 10.5005/jp-journals-10024-2611 (Alassiry AM. Orthodontic Retainers: A Contemporary Overview. J Contemp Dent Pract 2019;20(7):857–862)
  3. Oxford Dictionary
  4. Kartal, Yasemin, and Burçak Kaya. “Fixed Orthodontic Retainers: A Review.” Turkish journal of orthodontics vol. 32,2 (2019): 110-114. doi:10.5152/TurkJOrthod.2019.18080
  5. Dogramaci, E., Littlewood, S. Removable orthodontic retainers: practical considerations. Br Dent J 230, 723–730 (2021).
  6. 2011- Nd Jampani-Application of Teledentistry: A Literature Review and Update: Journal of International Society of Preventive&community dentistry: Medknow Publication.

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