Wearing retainers - How much, how long, how often?

Why relapse occurs. | Usual recommendations and instructions for retainer wear.

Wearing retainers is the second phase of your treatment.

Once you've completed the active phase of your orthodontic treatment (the process of wearing braces / Invisalign®), its retention phase will need to begin immediately. And following through with it is just as important as going through the straightening process itself.

Orthodontic relapse.

That's because if you don't, your teeth will have a tendency to shift back to their original position. In most cases they won't revert fully. But it is common to see some of the features of a person's original malocclusion return.

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Orthodontists term this process "orthodontic relapse," and it's the main issue they're concerned about after the active phase of their patient's treatment has been completed. That's because they know if any degree of relapse does occur it's not always a quick and easy situation to correct.

Facts.

  • It's estimated that between 40% to 90% of patients have unacceptable dental alignment 10 years after the completion of their treatment. [Pratt 2011]). [page references]
  • Not wearing their dental retainers as directed is the primary reason people have braces a second or even third time later on in life.

Bottom line, if you're not committed to the idea of wearing one (both top and bottom, here are the different kinds), the idea of having your teeth straightened at all should be questioned.


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

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

Limited retainer usage may involve just 3 months of full-time wear, followed by 3 months only at night. Prolonged usage may extend up to a year or more. Permanent retention is precisely that, a lifelong regimen of some level of retainer exposure.

a) Initially after your orthodontic work.

Immediately after your braces work has come to an end, your dentist will give you retainers to wear.

The idea is that the soft tissues that surround and anchor your teeth (fibers and ligaments) need time to adjust and reorganize before they can play their role in stabilizing their new alignment.

Studies show that this process takes on the order of 7 months to a year (Pratt 2011). So in the mean time, retainers are needed to keep 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 do this for the next several months, and possibly as long as 1 or 2 years.

We found a study (Lai 2014) 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 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 patient 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.
 

b) Later on - (the second phase of your 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 will probably be a more relaxed regimen.

It's common that the new recommendation that your dentist makes will be one where your retainers are just worn at night while you sleep. And at least at first, your dentist will probably want you to do this 7 days a week. Beyond that however, there may be some leeway in what you need to do.

Figuring out your own routine.

There's an event that may happen by accident that can help you understand how often you must wear your retainers to maintain your current alignment.

  • If you've gone through a period where you haven't been wearing your retainers regularly, you may find that their fit has changed. They may feel extra tight or snug. If so, this is a sign that your teeth have started to shift.
  • This is an important turning point, and one that needs to be corrected immediately. The usual remedy that's needed for slight changes is to wear your retainers religiously (possibly even around the clock) until they've been able to shift your teeth back into place. The passive fit of your appliance should return.
  • Once things have reverted back to normal, you simply need to make sure that your retainers are always worn, at minimum, often enough that a change in their fit never occurs again.

c) So, which will your case require, limited, prolonged or permanent retainer wear?

We can tell you up front that studies seem to report 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 good advice (for anyone really, previous orthodontic patient or not), there are certain case guidelines that tend to influence a dentist's opinion about how involved (frequency, duration, extent) their recommendation about a patient's retention activities must be.

a) No-retention cases.

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

Crossbite cases (like when an upper tooth bites to the backside of lower teeth instead of their front) can usually be handled this way. Once the tooth has been repositioned to the front, 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've outlined below in layman's terms many conditions and situations that tend to dictate how extensive your 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.
  • Whereas cases completed during periods of growth tend to be comparatively more stable, those completed before the completion of growth are more prone to relapse.
  • The greater the distance teeth have been moved, the less risk they have of relapsing.
  • Case completions able to achieve an ideal occlusion (a perfect "bite") have less potential to relapse.
  • If a person's abnormal habits persist (like thumb-sucking) relapse is more likely.

(Alam 2012)

How many years will you need to wear your retainers?

After weighing factors such as these, your dentist will make a determination about what level of retainer wear they feel will be required (months, years, lifetime).

Of course as we suggest above, more rather than less retainer wear is usually the better side to error on. But how much any one person will require will simply depend on their situation, both pre and post treatment.

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Why does relapse take place?

You may wonder why orthodontic relapse tends to occur. Here are some of the issues known to be involved.

  • The roots of teeth are anchored in their sockets by fibers that get stretched out during tooth movement.

    Once your braces are taken off, their natural reaction is to contract. By wearing a retainer, your teeth are held in place as these fibers instead reorganize and adapt to their tooth's new position.

  • Moving a tooth creates changes in the bone tissue immediately surrounding it. In general, this "new" bone is less heavily calcified. Wearing a retainer provides stabilization as the bone gradually matures.
  • Teeth are surrounded my muscular soft tissues (tongue, lips, cheeks). The persistent pressure they exert can cause tooth shifting.
  • Many patients who have completed orthodontic treatment are still at a stage in their life when their jawbones are growing. And as changes take place with them, 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 have 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.
Other causes.

Beyond the issues above, there are many other factors that help to explain why relapse occurs. One of these is the type of malocclusion that has been corrected. Another is how stable the position in the jawbone to which the tooth has been moved tends to be.

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 over the course of your entire life, some type of retainer wear, probably long-term, will likely be 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 absolutely insure that no changes ever take place at all is to continue your retainer wear over the long-term.

This is an important issue. 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. (Pratt 2011)

 

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