From my experience, there is a great tendency for patients to be under the misguided impression that retention is not as important as the active orthodontic phase when teeth were being straightened. Nothing could be further from the truth. If you think about it, if your objective was to have straight teeth and poor retainer wear will make your teeth become misaligned again, then by logic, retention is just as important as the “straightening” of teeth phase.
There are many quite a number of retainer designs out there and all do about the same job just as well. It is not uncommon for patients who were less than ideal with their retainer wear to try and assert that perhaps their teeth shifted because of poor retainer design. The fact of the matter is that teeth can only shift due to poor patient compliance, not poor design.
Every orthodontist has their own take or variation on the proper retention regime. There is not fixed or correct version. But all regime’s have the same features, namely, an initial phase of extended or full time wear followed by a period of shortened wear. Ideally, based on recent research, retainer wear should never cease and should continue throughout life in one form or another so that teeth will always remain straight.
The Types of Retainers
Retainers are generally divided into 2 categories, fixed retainers and removable retainers. Removable retainers are by far the most common retainers used by orthodontists. There are many different designs and it is not unusual for an orthodontist to prefer a few designs that he regularly uses and he will disregard the rest. The advantages of a removable retainer include optimal oral hygiene as they can be removed when eating and the ability to control all teeth and maintain their final positions. However, a big disadvantage is that because they are removable, its success depends very much on good patient compliance.
Fixed retainers are wires that are cemented on the “inside” of the teeth where they are not visible. While they have the advantage of being permanently stuck there and patients have no need to remove them and insert them at meals or while brushing, they do come with a number of disadvantages. Namely, they do not extend to the back and therefore do not control the “back teeth”, they are plaque retention areas and lastly, they do become unstuck and sometimes patients are unaware and therefore the teeth may shift.
Combination Fixed and Removable Retainers
Recently, wearing a fixed retainer in combination with a removable has become more popular. The idea being that both these retainers provide insurance in case one of them were to fail. In reality, patients often think that because they have a fixed retainer, they can opt to slacken on the removable retainer wear. This often has disastrous consequences. Indeed, it begs the question, why are you not wearing the removable retainer as instructed in the first place? A bit of soul searching may reap its benefits.