The retention phase of orthodontic treatment is one of the most important steps but often one of the most overlooked. Near the end of the treatment, you may want to present your patient with their options for retention. These are explained, along with the risks, benefits, and alternatives. There is no “one size fits all” option for retention. There are four basic types of retainers which we will review in this post.
The Essix®-Type Retainer
Essix®-Type is a classification for clear, thermoformed retainers. There are many other brand names within this classification: Zendura®, Invisacryl®, Vivara®. An Essix®-type retainer lasts on average 1-2 years. If your patient bruxes or has parafunction, you may need to replace it every few months. It’s important that patients understand that retainers are for a lifetime so the patient and doctor need to prepare the workflow and costs for proactively replacing broken or worn-out retainers before a relapse occurs. For this reason, it is not uncommon to sell Essix-type® retention in sets.
The Hawley retainer is an old-school, traditional retainer with acrylic in the middle and a metal wire across the front teeth. Hawleys are durable and can last on average 10-20 years. There are many variations of Hawleys, but my favorite is the wrap-around or circumferential Hawley. This design is helpful to balance and close bites after orthodontic treatment, especially in aligner patients. They aren’t as aesthetically pleasing as the Essix®-type and they do need to be worn 24 hours a day initially.
The Fixed Retainer (aka, Permanent Retainer or Lingual Retainer)
There are dozens of types of fixed retainers but the best ones are 3D-printed or custom-bent in a lab. These are metal wires, bars, zirconia or magnets that are glued onto the lingual of the incisors. Hygiene, caries, and breakage are all an issue with these retainers. If they are improperly placed, they can cause the teeth to move so I encourage custom-made, bonded retainers so that they are totally passive when placed.I like to say if you place a bonded retainer, you should plan on “marrying the patient for life” because the liability is always present. Be sure you’ve worked this into your recall flow and have a compliance and breakage contract in place with the patient. If the fixed retainer breaks without the patient’s knowledge, it can go undetected until the next appointment and hence cause the teeth to relapse. Ultimately, unless you had those compliance contracts in place, the dentist is responsible for treating the relapse.
If you have to wear a permanent retainer, the patient really does need to floss daily in order to maintain proper dental hygiene. Pick your patients carefully for bonded retainers to reduce liability and mitigate risks unless you integrate some kind of virtual recall app into your workflow, like Dental Monitoring®.
The Positioner .
Positioners have been around for 50+ years and are the most overlooked but most effective retention solution. They can either be custom or semi-custom and are excellent retention not only in the Phase 1 to Phase 2 period but also long-term, comprehensive retention. Although they are bulky, they are very effective and can only be worn at night. If a minor relapse occurs, the positioner will correct it. Positioners also help to guide unerupted teeth between Phase 1 and Phase 2 (eruptive guidance) and encourage nasal breathing and proper airways.
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