RETAINERS: What are my choices?
Orthodontic Retainers can be either placed permanently in the mouth, usually by “gluing” something discreetly behind your teeth, or alternatively be a removable form of appliance.
I have met clinicians who swear by either one form or the other, but in my opinion neither one nor the other “ticks all the boxes”, and the general consensus amongst my peers is that perhaps a “combination approach” is best.
This is largely due to the fact that both options have their strengths and weaknesses, with regard to such things as ease of placement, scope of capability, patient acceptance, duration and hence cost.
When your braces are first removed, not only will your teeth have an enormous propensity to try and return to there crooked state (sometimes even in a matter of hours, rather than days or weeks!) but your Gums may be in a less-than-perfect state of health, and your Bite may require time to “settle in” and find its most comfortable position.
During this time, it may be difficult or even impossible to adequately bond (glue) a fixed retainer behind your teeth, and a “provisional” removable appliance may be the first choice. There are several different types, some of which allow the bite to settle more than others, and some designed to allow further dental work to now be carried out without the need to continually modify or replace the retainer until this work is completed.
Secondly, whilst most removable retainers retain the entire arch of teeth, from the front all the way to the back, fixed retainers tend only to protect the front four or six teeth. This will clearly be unacceptable if changes were made further back in the mouth, such as achieving a “broader smile”, correcting an incorrect bite, or closing a space at the back.
Finally, removable retainers are frequently insufficient to prevent certain unwelcome movements from occurring, such as Diastema spaces from re-opening (gaps between the upper front two teeth) or severely rotated teeth from relapsing.
Taking all of the above in to consideration, you should discuss the likely retention requirements for your particular circumstances right from the outset.
It is probable that you will initially be provided with a basic “provisional” removable gum-shield style retainer (an “Essix” Retainer) included in your initial quotation, and this would normally be fitted within 24 to 72 hours. Some of you may then be scheduled to have a fixed retainer bonded behind your teeth (usually after allowing a week or two to pass in order that you see a Hygienist to ensure maximum health of your gums), after which you would either have your provisional removable retainer modified to fit over, or even have moulds taken for a more permanent one,custom-made to fit neatly over the top of it.
In terms of patient preference and acceptability, some patients rapidly adapt the habit of wearing something removable every night without fail, and “don’t fancy the idea” of something permanently fixed behind their teeth. Others however feel more secure with the fixed variety, or doubt their own discipline in remembering to always wear the removable option.