Orthodontic retention is a crucial aspect of orthodontic treatment aimed at preserving the corrected position and alignment of teeth achieved during the treatment process. Without proper retention, there's a risk that teeth may gradually shift back to their original positions or undergo further undesired movement over time. This retention is typically achieved through the use of orthodontic retainers.

Why is orthodontic retention important?

Orthodontic retention is important because of the following reasons:

Tendency of teeth to revert

After braces are removed, there is a natural tendency for teeth to move back to their original positions. Retainers help to counteract this movement and maintain the results of orthodontic treatment.

Continued tooth movement

Teeth can continue to shift throughout a person's lifetime, and without retention, these shifts may compromise the results achieved through orthodontic treatment.

Age-related changes

Changes in the soft tissues of the face as we age can exert pressure on the teeth, leading to further movement. Retainers help stabilize the teeth against these changes.

Wisdom teeth

Contrary to previous practices, the removal of wisdom teeth is no longer universally recommended solely to prevent overcrowding. This is because the lower jaw continues to grow, influencing tooth positioning, but does not necessarily affect the eruption of wisdom teeth.

Periodontal disease and bone support

Patients with periodontal disease or reduced bone support may be more susceptible to tooth movement. Retention can help mitigate this risk by stabilising the teeth in their corrected positions.

There are different types of orthodontic retainers, one of which is the fixed retainer. This retainer consists of a thin stainless steel wire attached to the back of the incisors using cement. It is commonly placed behind the lower incisors, though it may also be used behind the upper incisors depending on the depth of the patient's bite. Research suggests that the use of fixed retainers with two arches provides significant long-term benefits to orthodontic patients.

One advantage of fixed retainers is that they do not rely on patient compliance, as they are always in place once installed. This addresses concerns about patients forgetting or neglecting to wear removable retainers consistently.

In summary, orthodontic retention, achieved through methods such as fixed retainers, is vital for maintaining the outcomes of orthodontic treatment and preventing undesired tooth movement. It addresses the natural tendency of teeth to revert to their original positions and helps stabilize them against various factors that could cause further movement.

In addition to the advantages mentioned, there are also some disadvantages associated with both fixed and removable retainers:

Fixed retainers

• Difficulty in cleaning: Fixed retainers can make it challenging to effectively floss between the teeth, particularly the incisors where the wire is attached. This can lead to plaque buildup and increase the risk of dental issues
• Professional care requirement: Fixed retainers may require professional maintenance and care, which can incur additional costs for the patient

Removable retainers

• Compliance: Removable retainers rely on the patient's compliance with wearing them as prescribed. Failure to wear them consistently can result in inadequate retention and potential relapse of tooth movement

Regarding the frequency of wearing retainers, there are considerations between part-time and full-time wear, as well as the type of retainer used:

Vacuum-formed retainers

• Full-time wear

Research suggests that wearing vacuum-formed retainers full-time does not offer significant clinical advantages compared to part-time wear, particularly concerning incisor irregularity, canine width, and overbite correction.

Hawley retainers

• Part-time wear

 Both part-time and full-time wearing of Hawley retainers are equally effective in the first year after treatment. Therefore, it may be clinically justifiable to advise patients to wear their retainers only at night.

Benefits of wearing retainers after orthodontic treatment

The following are the advantages of wearing retainers after orthodontic treatment:

• Prevention of relapse

 Retainers help maintain the corrected tooth positions, preventing them from shifting back to their original alignment.

• Protection of bite

Retainers ensure that the corrected bite is maintained, preserving the functional benefits achieved through orthodontic treatment.

• Ease of maintenance

 Removable retainers can be easily cleaned and maintained, promoting good oral hygiene.

• Comfort

 Well-fitted retainers are typically comfortable to wear, allowing patients to adapt to them easily.

• Preservation of smile

Retainers help to retain the improved aesthetics of the smile achieved through orthodontic treatment.

Key points to note

• There may be a deterioration of occlusion in the period after orthodontic retention, highlighting the importance of long-term monitoring and maintenance
• Treatment with two fixed appliances, especially in both arches, tends to yield the best post-treatment results
• A significant proportion of patients (84%) continue to benefit from orthodontic treatment even years after retention, emphasizing its long-term efficacy

Summary

Overall, orthodontic retention plays a crucial role in ensuring the long-term success of orthodontic treatment, with studies showing that a significant percentage of patients still benefit from treatment years after retention. Therefore, it is essential for orthodontic patients to adhere to their retainer-wearing instructions to maintain the outcomes of their treatment and enjoy a beautiful, well-aligned smile.