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 in place.  

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 if needed.

Auxiliary elastics can be used, if needed, to better retain teeth.

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 if mishandled.

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.

Yes.

Again yes.

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:  

“Orthodontic treatment 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 noted:

“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 Allen

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 might be:  

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 retainer.

Fixed retainers are subject to damage when biting on hard or sticky foods.

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.