KEEPING TEETH STRAIGHT AFTER BRACES

You have spent thousands of dollars to straighten your son’s or daughter’s teeth with an orthodontist, and then a year or two down the road when you ask them where their retainers are, they answer, “I don’t know.” Sound familiar? Long-term compliance use of retainers is an issue. Here is the latest research and my thoughts on keeping your kid’s teeth straight.

Studies show and should not be surprising that the average patient compliance decreases dramatically the longer a patient is out of treatment, and is abysmal at five years following treatment.

There are basically three methods used to retain teeth after braces: a clear, vacuum-formed retainer (typically referred to as an Essix retainer), a hard, pink, plastic retainer with a wire in the front (typically referred to as a Hawley-type retainer), and a bonded wire, which is splinted to the back of the teeth. Obviously, the bonded wire has the best compliance because nothing has to be “worn” but it has its own issues – namely, it only keeps the front teeth straight and flossing compliance is poor because it is a pain-in-the-neck to do.

The most recent studies I have seen suggest using the clear, vacuum-formed retainers for a year or two, and then moving into the Hawley-type retainer. The reasoning is that it is has been shown that kids are more compliant initially with the clear retainers because it is a relief to get rid of all the wires. However, after a while, those types of retainers lose their “memory” and they get pretty nasty looking and stained, which decrease their compliance.

Personally, after I got my braces off about 10 years ago, I had a lower “fixed” wire bonded to the inside of my lower front teeth and a hard “night guard” type of appliance made to retain my upper teeth. This provides very good long-term retention.

Another great system for long-term retention after orthodontics is a system developed by Invisalign called Vivera. Here’s how it works. You have impressions taken after orthodontics with your teeth in their ideal position. Invisalign creates a digital model of the teeth that stays on file. They send you (4) sets of retainers, which look like the Essix-type retainers, although they are made from the harder type Invisalign material. At the end of the first year you throw out the retainers you have been using and use the second set for another year. This provides excellent retention for four years.

Every year you change the retainers the new retainers feel really tight because the teeth have moved slightly over that time because of some memory loss. However, the “new” set of retainers was made from the original model, therefore the teeth are moved back to their starting position. After the four years you order another (4) sets of retainers made from that stored digital impression. Guaranteed retention provided there is good compliance.

The cost of the (4) sets of Vivera retainers is about $600. That’s $150 per year to guarantee the teeth stay straight. Worth it? I think so after spending thousands to straighten the teeth.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.