Retainer Choices
The perfect retainer would be invisible, undetectable, indestructible, provide lifetime retention, accessible to clean the teeth, and would not rely on the patient to remember to wear it. Some of these features are available in a retainer, but no retainer provides all these criteria. Retainers can be grouped into two general categories: removable and fixed (bonded) retainers. No matter which design is selected, remember, that without lifetime retention the teeth will most surely move or “relapse”.
Removable Retainers Hawley
Removable retainers include the traditional Hawley wire and acrylic with many design variations. We add clear plastic to the front wire and provide many color and design options for the main body of the retainer. This design does not cover the chewing surfaces of the teeth and can allow for more settling of the upper and lower teeth over time. This design is of course more visible while also more durable. We have seen Hawley retainers lasting 15 years.
Clear Thermoplastic Retainers
(A-tains or C-tains) are similar to bleaching trays. The thermoplastic is heated and formed over the stone models of the teeth. The thermoplastic material fits intimately around the teeth for a custom and extremely accurate fit. The retainers are difficult to see when inserted and comfortable to wear. Unlike the Hawley retainers, these retainers do not last as long. One would expect from 1-2 years of service.
Fixed retainers
Fixed retainers are bonded to the inside of the front teeth. These retainers are composed of stainless steel round or twisted wire and are bent to contact the backs of the teeth. The wires are bonded in place with plastic filling materials. The most common location is the lower front teeth. To a lesser degree bonded wires are placed behind the upper front teeth. These wires can remain in place indefinitely. I have seen fixed retainer wires in place for 20 years. Though the wires can remain in place for many years, the wires can break loose on occasion and teeth can drift away from the wire unless all the teeth are bonded. Bonded wires are less convenient for daily flossing and not the favorite of your hygienist who has the challenge of Cleaning around the wire.
Selecting the best retainer for each patient?
I evaluate each patient and assess the clinical retention requirements based upon the original degree of rotation of individual teeth, excessive spacing, crowding, as well as any periodontal or hygiene issues that would dictate a retainer choice.
Are we worried about compliance of the patient in wearing a retainer? Some patients by their nature are conscientious with brushing teeth, wearing orthodontic elastics, and may continue to be compliant with retainer wear. Some patients have a lower probability of wearing retainers consistently.
No matter the choice decided upon, we expect some changes in tooth positions despite these retainer designs. Our goal is to minimize these changes with the care in design and with the assistance of our patients in caring for their retainers.