Things fall apart; the centre cannot hold; – William Butler Yeats, “The Second Coming”
published in 1921.
The word “Retain”
means to hold something together or hold
something back, much like a stone retainer wall in a garden might hold back the
soil of a terrace in “retention”.
Two Retainer Walls,one made of stone, the other of wood. The stone wall is strong enough to hold and retain, the wooden one is failing, and the dirt and soil is slowly changing location.
A side view of a failing Retaining Wall. In the same manner, Orthodontic Retainers are also used after Braces are removed to hold the teeth in place and to prevent changes.
The soil and grass is shifting forwards.
This patient completed Orthodontic treatment and Braces were removed. She probably did not wear her retainers as much or as long as was needed. Similar to example shown earlier, the lower front incisor teeth have shifted and changed.
An Orthodontic retainer is an oral appliance which is used
to hold the teeth stable and in alignment. Retainers are usually used after
orthodontic treatment is completed and a patient is given two retainers, one
for the upper, and a second for the lower teeth. Retainers
are designed to help ensure that your wonderful smile and all the beautifully
aligned teeth stay exactly that way and do not shift or change (relapse) . Retainers fall into two basic
categories, namely 1) Removable retainers ; and 2) Fixed retainers.
Removable retainers are the most commonly used. Two types of
removable retainers are most popular.
The classic “ Hawley”style removable retainer, designed in
the 1920s, has for years reigned as the most popular retainer used by
Orthodontists and General Dentists alike after braces are removed. A Hawley
retainer usually is made of clear pink acrylic plastic and uses stainless steel
clasps to cover the back molar teeth. A long thin metal bow is also used to
span across the front incisors from the right canine to the left canine.
Example of a removable LOWER Hawley retainer. Once Braces are removed, retainers like this need to be worn full time. The two retainers shown here were made by Northstar Orthodontic Laboratories in Minnesota.
Lower Hawley Retainer helping to keep the lower teeth straight and stable once Braces have been removed.
An upper Hawley retainer for the upper teeth has a different
design than a lower Hawley for retaining the lower teeth. This is similar to a glove being different
from a shoe. The upper and lower teeth & jaws are different just as a
person’s hand is different from their foot. An upper Hawley retainer cannot be
used on the lower teeth and vise versa.
UPPER Teeth Removable Hawley Retainer. The Upper Retainer has a different shape and design from the Lower just as a glove has a different shape and design from a shoe. When Braces are removed retainers Must be used to help ensure stability.
Upper Hawley Retainer helping to keep the upper teeth straight and stable once Braces have been removed.
Not all Hawley retainers have to be made of clear pink
acrylic. Some patients ask for designs or special colors. Some retainers have
school emblems or colorful designs.
Just some of the colorful patterns &designs which can adorn a Hawley Retainer. These designs are courtesy of Northstar Orthodontic Laboratories in Minnesota. Northstar is a major US Dental Laboratory serving Dentists and Orthodontists throughout the United States.
More examples of colorful designs for Retainers. Once the Braces are removed, retainers need to be used full time. Check with your Dentist or Orthodontist for more information on what is appropriate for you.
The second very popular type of removable retainer is the
Clear Retainer, or clear overlay retainer. Clear retainers are made of clear
plastic and much resemble the Invisalign Appliances which have become so
popular in recent years. Clear retainers cover the teeth entirely, and do not
use any metal clasps or metal bows. Whereas the Invisalign series of appliances
is used to move teeth and to correct an orthodontic problem, the clear retainer
is basically designed to do the opposite, namely to keep everything stable and
Two clear appliances, one an Invisalign Aligner, & the other a Clear Retainer. They look very similar. The Aligner functions to move crooked teeth. The Retainer functions to keep already straight teeth straight & to prevent shifting.
Two Clear Removable Appliances. They look almost identical. The clear appliance on the left is a Clear Retainer, The other clear appliance with the green dot is an Invisalign Aligner.
This patient has had the Braces removed and is now wearing Retainers. She has an Upper Hawley Retainer and a Lower Clear Retainer.
Again, just as a glove is not designed to be worn on the
feet, upper and lower clear retainers are NOT INTERCHANGEABLE. One cannot, for
example, wear an upper clear retainer on the lower teeth.
Hawley Retainers -- Some Pros:
Sturdy construction and less fragile than Clear Retainers.
Adjustable by the orthodontist to better customize the fit
Auxiliary elastics can be used, if needed, to better
The Hawley design permits desirable “settling” of the bite
to occur by allowing slight incremental vertical movement of the posterior
teeth which may enhance stability.
Hawley Retainers -- Some Cons:
Bulkier and less esthetic than clear retainers, due to the highly
visible “labial wire bow” which spans the front six upper and lower teeth from
canine to canine.
Some patients have speech difficulties because of the bulkiness
of Hawley retainers.
Lower compliance with many patients who abandon wearing
Hawley retainers whereas clear retainers might be more acceptable and used more
regularly by the patient.
The metal clasps and bows on a Hawley retainer can sometimes
break or distort.
Clear Retainers -- Some Pros:
Clear retainers act like a corset for the teeth, and keep
everything very snugly aligned.
Patients report that clear aligners are more comfortable to
wear than Hawley retainers.
Better compliance because of improved esthetics in
comparison to Hawley retainers.
Some patients report using clear retainers as bleaching
trays to help whiten the teeth by holding tooth whitening strips, such as those
made by Crest, in place.
Clear aligners can serve double duty as a night guards as
well for patients who grind their teeth (bruxism).
Clear Retainers -- Some Cons:
Some clear retainers are very delicate and prone to cracking
Clear retainers cover all the teeth, and patients who clench
or grind their teeth, may produce cracks or small holes in the retainers.
The clear plastic used in clear retainers may become stained
or clouded overtime, but this may or may not be a problem if retainers are only
worn at night.
Clear retainers are less bulky and made of translucent
plastic, and therefore can be more easily lost when say left accidentally on a
fast food tray at McDonalds.
Impressions for making clear aligners is often much more
critical than for Hawley retainers, because puffy & inflamed gums can compromise the accuracy of the fit.
The best retainer is one which you will wear. Because in
2008 esthetic Orthodontic treatment is becoming increasingly more popular, many
young teens will refuse to wear the traditional Hawley retainers. If the
Orthodontist or General Dentist finishes the Orthodontic treatment by allowing
passive settling to take place, then the vertical settling movement of the
Hawley retainers is not needed.
Either style of removable retainer is acceptable. As of May
2008, at least regionally in the Northern Virginia
suburbs of Washington, DC.
( USA), the
clear retainers seem to be in favor.
Regional trends may differ, and what is preferred in Northern
Virginia, may differ entirely from trends in New
England, Southern California, or areas
outside of the United States.
By the way, did I say yes ? Why yes I did.
Washington & Lee University in Lexington, Va. named after George Washington and Robert E. Lee.
By George, the man himself, President George Washington perched atop the main Administrative Building at Washington & Lee University.
1) From 1969,
Horrowitz and Hixon in an article entitled “ Physiologic recovery following
Orthodontic Treatment.” which appeared in the American Journal of Orthodontics,
Volume 55 noted:
may temporarily alter the course of continuous physiologic change and possibly
for a time even reverse them; however,
following mechanotherapy and a period of restraint, the developmental;
maturation process resumes.”
2) From 1981,
Little,Wallen, and Reidel in an article
entitled “ Stability and relapse of mandibular anterior alignment.” which appeared in the American Journal
of Orthodontics, Volume 80 noted:
“Treated cases should
be viewed as dynamic and constantly changing, at least through the third and
fourth decade and perhaps throughout life.”
3) From 1990,
Little in an article entitled “ Stability and relapse of dental arch
alignment.” which appeared in the British Journal of Orthodontics, Volume 17
“Patients face a
normal physiologic process of arch constriction and crowding, and only by some
artificial means can we guarantee success post-treatment.”
4) From 2005,
Joondeph commenting in the November
28, 2005 issue of BusinessWeek Magazine noted:
“Your teeth naturally
shift as you age, causing crowding and overbites.”
“It’s only within the
past few years that we’ve realized you should wear your retainers every night
for the rest of your life. If you want your teeth to stay put.”
This patient completed treatment years ago,and then returned because of slight changes in the upper front teeth. Long term wear of Retainers once Braces are removed can help prevent such changes from occurring.
During the retention
phase of Orthodontic treatment Orthodontic retainers keep teeth in the
correct alignment and position after the Orthodontic braces have been removed. Retainers
are also needed after treatment with Invisalign appliances. Without retainers
there is a tendency for the teeth to go back to their earlier crooked positions.
This change of the teeth going back to being crooked or
spaced has been popularly called relapse. Relapse however may be the wrong term to use, and the word
change might be far more accurate.
Change means that the teeth do not go back exactly to their earlier
crooked positions, but may assume new crooked orientations. Moreover, both
doctor and patient should assume that all orthodontic treatment results may
show some instability. To prevent “undesirable
changes” (not exactly relapses) almost every patient who has orthodontic
treatment will require Orthodontic retainers.
” Eternity is really long, especially near the end. “ -- Woody
Quoth the Raven ..."Wear your Retainers"
Dr. Don Joondeph, who
was just previously quoted, is a widely
respected Board Certified Orthodontist, past President of the American Board of
Orthodontics where he served as an examiner, and a professor in the Department
of Orthodontics at the University of Washington
in Seattle. He and Woody Allen have
something in common, namely they both work hard to make people smile.
To keep that smile, the concept of ongoing and permanent
retention is gaining favor among experienced clinicians. As an analogy, one may successfully finish a diet or
complete a weight reduction program at
weight watchers and finally attain the ideal desired weight. Nevertheless,
although the diet is technically over, one still steps on the weight scales say
once or more a week to monitor any weight changes. The responsibility of weight
management is really a long term and ongoing process.
Similarly with Orthodontic retainers. A practical compromise approach
Full time wear day
& night for 12 months except when eating or brushing the teeth.
Night time wear every
night thereafter until age 21.
From age 21 on
continued every night wear or every other night ongoing.
Full time wear should continue if there are special
conditions such as missing teeth, gum or periodontal instability issues, or
other concerns which the doctor has noted.
What are Fixed Retainers ?
Bonded Wire Fixed Retainers.
This patient has had the Braces removed and is wearing a Retainer. Can you see it ?
Now you can see it ! The retainer is an Upper Fixed Retainer and is attached to the insides of the Upper teeth. This example spans just from one central incisor to the other. Other Fixed Retainers may span from canine to canine securing six teeth in total.
Another closer view of the Bonded Upper Fixed Retainer.
There are many types of fixed retainers, but the main ones
of interest are so called “lingually bonded fixed retainers.” This is basically a small thin metal bar or wire
which is glued or bonded with a special adhesive to the insides of the
front teeth. The fact that they are
attached to the inner tongue side of the teeth means that they are not visible.
For some patients who just absolutely can not wear any form of removable appliances, such as Hawley retainers of
clear retainers, a bonded fixed retainer
is an option.
Whenever a Fixed Lingually Bonded Retainer is provided, it is important to check the bite to ensure that the lower incisor teeth do not hit too strongly against the Fixed Upper Retainer. In this example blue articulating contact paper is used to check the bite.
Bonded fixed retainers are sometimes the ONLY answer for
particular types of retention challenges such as preventing a big space or
diastema from re-appearing between the
upper two front teeth. In such cases
permanent retention is needed to maintain successful closure. Even minor tongue pressures or forces due to chewing can
cause a space to re-appear.
There are, as always,
advantages and disadvantages to fixed retainers.
Bonded Fixed Retainers -- Pros:
Very esthetic and can not be seen because the attach to the
inside of the teeth.
Are there all the time 24/7 which is important for many
otherwise non-compliant patients.
Require less maintenance & cleaning than removable
Hawley retainers or clear retainers.
Not likely to be ever lost.
Bonded Fixed Retainers -- Cons:
Excellent hygiene is required to prevent plaque& tartar build up on the fixed
Fixed retainers are subject to damage when biting on hard or
Flossing is a challenge because the wire is bonded
continuously across several teeth.
Sticky Candies like these dreaded Gummi-Bears can cause fixed retainers to loosen and separate from the tooth. People with fixed bonded Retainers should avoid excessively hard or sticky foods. Chewing Gumm-Bears and ice is a No No
There is one other major type of fixed retainer which deserves mention. This is called the Lower
Lingual Holding Arch, or LLHA, fixed retainer. This is actually of limited use
and is most commonly employed when a patient has completed limited Phase I or
Early Interceptive Treatment. It is only used on the lower teeth. It is
generally used when a young patient is
in the so called ”mixed dentition” state. This means that the patient has a
mixture of adult and baby teeth.
A Lower Lingual Holding Arch style Fixed Retainer on a plaster model. This plaster model was used by a Dental Laboratory to fabricate this appliance. Courtesy of Northstar Orthodontic Laboratory in Minnesota.
The LLHA fixed retainer maintains space between the lower
six year molars and the lower front four
incisors. The space being maintained is to allow enough room for the later
adult canine, first premolar, and second premolar to come in
A lower lingual holding arch is attached to the permanent lower 1st molars. Two lower baby molar teeth have stainless steel crowns. This patient finished early Phase I treatment and after more permanent teeth come in will start Phase II treatment.