Orthodontic retainer wear - How often? / How long? -

Usual recommendations and instructions for retainer wear (Essix, Vivera® (Invisalign®), Hawley and fixed/bonded appliances). | Orthodontic relapse - Reasons why it occurs.

Wearing retainers is the second phase of your orthodontic treatment.

Once you've completed the active portion of your treatment plan (the process of wearing your braces / Invisalign® aligners), its retention phase will begin immediately. And following through with it as instructed is every bit as important as having completed the process of straightening your teeth in the first place.

Orthodontic relapse.

If you don't wear your retainers as directed (often enough or for long enough), your teeth will have a tendency to shift back toward their original position. And while it's not expected that they'll revert fully, it is common to see hints of the original (corrected) features of a person's malocclusion to start to return.

Orthodontists refer to this process as "orthodontic relapse," and it's the primary issue they're concerned about after the active phase of a patient's treatment has been completed. They're concerned about this issue because they know that any degree of relapse that does occur isn't always a quick and easy situation to correct.

Facts about orthodontic relapse.

  • It's estimated that between 40% to 90% of patients have unacceptable dental alignment 10 years after the completion of their treatment. (Pratt)
  • Not wearing their dental retainers as directed is the usual reason people have braces a second or even third time later on in life.

 

A point that needs to be considered.
If you're not committed to the idea of wearing retainers (here are the different kinds used) following the completion of your orthodontic treatment (any and all methods including conventional braces, Invisalign®, etc...), the idea of having your teeth straightened at all should be questioned.

Section references - Pratt


How often, and how long, do you need to wear your retainers?

The amount of retainer wear that's required following a person's active orthodontic treatment will vary according to the specifics of their case. It can range from none, limited, prolonged to permanent.

  • Limited retainer usage may involve just 3 months of full-time wear, followed by 3 months of nighttime-only use.
  • Prolonged usage may extend up to a year or more.
  • Permanent retention is precisely that, a lifelong regimen of some level of retainer wear.
  • "None" may be the option you're hoping for. But finding out that it does make the best choice for your case (including providing the most predictable outcome) is relatively unrealistic.

 

The remainder of this page explains factors that will determine which of these categories your case will fall under, and at what point in time. It discusses:

 


The retention phase of orthodontic treatment - What takes place?

The amount of retainer wear that's needed during different periods that follow your active treatment will vary.

a) Initially after your orthodontic work.

Once your active treatment phase has come to an end, your dentist will give you retainers to wear.

Why are they needed?

The idea associated with the need to wear retainers immediately following the completion of your orthodontic work is that the fibers and ligaments that anchor your teeth in the jawbone need time to adjust and reorganize to the new position your teeth now hold. Then, once they have, they'll then be a stabilizing force for the new alignment.

Studies show that this process takes on the order of 7 months to a year (Pratt). So in the meantime, retainers are needed to hold your teeth in their proper position.

Around-the-clock wear or close to it.

Don't be surprised if at first you're instructed to wear your retainers twenty-four hours a day, seven days a week. And your dentist will probably have you continue on with this regimen for the next several months, and possibly as long as 1 or 2 years.

We found a study (Lai) that polled dentists (orthodontists) to find out what their usual recommendations were for removable retainers.

Picture comparing the appearance of Essix and Hawley orthodontic retainers.

Essix and Hawley appliances are the most frequently used removable retainers.

  • On average, the initial stage of a patient's retention process involved wearing their appliances for 16 hours per day (the range was from 2 to 24 hours), 7 days a week.
  • The patient was instructed to keep this schedule for a time period ranging anywhere from 1 to 24 months (with a mean value of 7 to 8 months).
  • Only 5% of the dentists polled ended this retention period within 6 months. 88% of the dentists continued it for more than a year.

 

How often are check-ups?

If you're wondering how many trips you'll make to your dentist's office during this period:

  • 75% of the dentists polled appointed their patients for check-ups 3 or more times during the first year of retention.
  • 13% checked their patients 5 times or more per year.
  • A study by Meade (2013) reported similar findings with over 90% of orthodontists checking their patients' retainers on average 2.9 times during the first year.

Section references - Pratt, Lai, Meade

b) Later on - The long-term phase of retainer wear.

At that point when your initial phase of retention (and the tooth stabilization it accomplishes) has been completed, your dentist will give you a second set of instructions. These will be those that you'll need to follow for at least the next several years (prolonged retainer wear), and likely for the remainder of your life (permanent wear).

This regimen will probably be less intense.

With this new phase, it may be that your retainers just need to be worn at night (like while you sleep).

At first, your dentist will probably want you to comply with these instructions 7 days a week. Over the long-term, however, there may be some wiggle room in what's precisely needed.

Understanding your personal retention requirements.

For many people, the following event may end up happening by accident. If it does, it can help you get an idea of how often you must really wear your retainers in order to maintain your current alignment.

  • Some people inadvertently allow a period to pass where they have not been wearing their retainers as regularly as instructed. And when they do start up again, they may find that the fit of their appliances has changed.

    They may feel extra tight or snug. If so, this is a sign that some tooth movement (orthodontic relapse) has started to occur.

  • This situation needs to be corrected immediately. And a remedy that usually works is for the person to wear their retainers religiously (possibly even around the clock) until they've been able to shift the misaligned teeth back into place.

    Once this has been accomplished, the more passive fit of their retainers should return.

  • Once things have reverted back to normal, the person will always need to make sure that they wear their retainers, at minimum, often enough that the same kind of event never occurs again.

 


What will your case require, limited, prolonged or permanent retainer wear?

Despite what you might have wanted to find stated here, we'll tell you upfront that studies seem to suggest that orthodontists tend to feel that maintaining some level of life-time retainer wear is usually in the patient's best interest. (Meade 2013)

But beyond that blanket statement, there are certain case guidelines that tend to influence a dentist's opinion about how involved (how much, how often, how long) their recommendation about a patient's retention activities need to be.

a) No-retention cases.

Circumstances may be such that once a person's orthodontic correction has been completed that there's essentially no chance of relapse, and therefore no retainer wear is required.

As an example, crossbite cases (like when an upper front tooth has been brought from tucked behind to in front of the lower teeth) can usually be handled this way.

Once the tooth has been repositioned to the front side, it would be essentially impossible for it to find its way back to its original (crossbite) position.

b) Limited, prolonged and permanent retention cases.

Rather than use dental jargon that you'd have little chance of understanding, we outline below in layman's terms several conditions and situations that tend to dictate how extensive a patient's retainer wear will need to be. By no means, however, is this list exhaustive.

  • Cases that involve severe tooth rotations, midline diastemas (tooth gaps), a cleft palate or generalized tooth spacing tend to require more extensive retainer wear.
  • Cases completed during periods of active growth will require comparatively more retainer wear as opposed to those where the patient's growth has slowed to adult levels. (Facial growth continues on throughout adult life.)
  • Case completions that have achieved an ideal occlusion (the perfect "bite") have less potential to relapse.
  • If a person's abnormal habits persist (like thumb-sucking) relapse is more likely.

Section references - Meade, Alam

How many years will you need to wear your retainers?

After weighing the types of factors discussed above, your dentist will then make a determination about the level of retainer wear they feel will be required (months, years, lifetime).

The benefit of lifetime retainer wear.

It's easy enough to suggest that a recommendation of extended/permanent retainer wear is usually the better side for a dentist to error on. And for the vast majority of cases, it's the only option that can offer a predictable long-term outcome.

That's because in addition to the types of factors already discussed on this page, some of which might be of just limited duration, there's also a natural tendency for tooth movement to occur throughout a person's lifetime. And as such, the possibility of complications associated with teeth shifting in the future will always be an issue of concern for all patients.

What this issue boils down to.

Not to be glib, but one lighthearted way to wrap up this discussion is to simply state that you need to wear your retainers for as long as you want straight teeth.


Pictures of orthodontic retainers and accessories.

Our affiliate link can be used to learn about   replacement orthodontic retainers and accessories  on  Amazon.com.


Why does orthodontic relapse occur?

You may wonder why alignment relapse tends to take place. Here are some of the issues known to be involved.

  • The roots of teeth are anchored in their sockets by a network of fibers (a tooth's periodontal ligament). During tooth movement, these fibers become stretched and distorted.

    Once your braces are taken off, their natural reaction is to pull their teeth back toward their original location. By wearing a retainer, your teeth are held in place as these fibers are allowed time to reorganize and adapt to their tooth's new position.

  • A similar effect takes place with fibers found in the gum tissue that surrounds teeth (the gingival collagen-fiber network). And also in a similar fashion, wearing a retainer holds the teeth in their new position until these fibers have had a chance to reorganize.
  • Teeth are surrounded my muscular soft tissues (tongue, lips, cheeks). The persistent pressure they exert can cause tooth shifting.
  • Many patients who have completed their orthodontic treatment are still at a stage in their life when their jawbones are still growing. And as these changes take place, the position of the teeth they hold can be affected. Wearing a retainer helps to control these changes.
  • It may be that the alignment of the patient's teeth has been corrected but a habit that originally contributed to their malocclusion has not (thumb-sucking, teeth clenching and/or grinding). If not, relapse is likely to occur.

Section references - Melrose

Other causes.

Beyond the issues just mentioned, there are many other factors that help to explain why relapse occurs. This includes the classification/type of malocclusion that has been corrected (some are more likely to be associated with relapse than others).

Another is how stable a position in the jawbone the teeth have been moved too. (Moving teeth too far outside of biologic norms can be associated with case relapse.)

Everyone's teeth tend to shift over time.

Other than just the issue of relapse, it's normal and natural that a person will experience some degree of tooth shifting over the course of their lifetime. This is true whether they've had orthodontic treatment or not. (That implies that all humans could benefit from wearing an orthodontic retainer, which is true.)


The bottom line about retainer wear.

For all of the reasons outlined above, it's pretty obvious that if you want to maintain the exact same perfect alignment that your teeth had the day your braces were taken off or you wore your last Invisalign® aligners over the course of your entire life, some type of retainer wear, probably long-term, will likely be needed.

(This link can give you an idea of how long your retainer can be expected to last before replacement is needed.)

That's not to say the amount required may not just be minimal (for example, possibly only a few nights per week). But the only way to guarantee that no changes take place is to continue on with your retainer wear over the long-term.

This is an important issue because as mentioned at the top of this page, 40% to 90% of patients have unacceptable dental alignment 10 years after the completion of their orthodontic treatment. And this correlates with the finding that very few patients are still wearing their retainers as instructed 5 years after their braces have been removed.

Section references - Pratt

 

Update log -

03/06/2020 - Major page revision.

 
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 Page references sources: 

Alam MK. A to Z Orthodontics.

Jin C, et al. Survival analysis of orthodontic retainers.

Lai CS, et al. Orthodontic retention procedures in Switzerland.

Meade MJ, et al. Retention protocols and use of vacuum-formed retainers among specialist orthodontists.

Melrose C, et al. Toward a perspective on orthodontic retention?

Pratt MC, et al. Evaluation of retention protocols among members of the American Association of Orthodontists in the United States.

All reference sources for topic Orthodontic Retainers.

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