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After orthodontic treatment retainers are required to keep the teeth in their new positions. They are generally worn each night at the start and then as often as needed by the individual person.
So why are retainers so important? Orthodontic treatment to straighten crooked teeth can require years to complete. It could well be a long and difficult journey for the patient. Teeth move throughout life and a commitment to retention is needed to keep teeth in the desired positions.
The three standard kinds of retainers are the vacuum (Essix), the fixed (bonded), and the Hawley retainers. Lastly there is a new type of chrome cobalt retainer called the Somnowell.
The Vacuum Retainer (Essix)
The vacuum form retainers, also known ordinarily as the brand Essix, are made from clear plastic and clip over the all the teeth completely. One part for the upper teeth and one part for the lower teeth if needed. They don't permit the teeth to touch which some orthodontists believe is necessary for the teeth to achieve 'favourable settling'. Retention is a long-term commitment. Plastic vacuum retainers are a comparatively short term solution and will need continual replacement.
Fixed retainers, also known as bonded retainers, are completely different from the Essix and Hawley removable retainers. A fixed retainer is a tiny metal wire braid that is bonded to the inside of the lower front teeth. They may occasionally be put on the inside of the upper front teeth depending on the individuals bite. Fixed retainers cannot be removed by the patient. Fixed retainers make flossing harder and the patient will need to use a special floss threader. Placing fixed retainers certainly helps to retain the front teeth, but has no effect on the back teeth, nor arch expansion.
The Hawley retainers are the most well known type and have been around for some time. The Hawley retainer was developed by Dr. Charles Hawley about 100 years ago. The retainer is made of acrylic plastic and fits into the upper arch. It has a metal or clear wire that goes around the teeth to help keep them in position. One advantage of the Hawley retainer is that the wire can be adjusted to help finish treatment if required.
The Somnowell retainers are made from cast chrome cobalt alloy. They effectively retain the back and front teeth and also maintain any arch expansion. Chrome cobalt is a well established material used to make the best quality dentures that frequently last for dozens of years. It is very strong in thin section and very robust. The Somnowell retainers do not cover all the teeth but only need to engage each tooth with a little component, making them a lot less bulky. Chrome cobalt alloy doesn't deform or degrade in the oral environment and should not ever need to be replaced. The material surface is highly resistant to oral fungi and like gold is an inert metal ideal for long term use in the mouth. The Somnowell retainers are always clean, fresh and comfortable, factors that will help improve compliance. Retainers that do not degrade and don't need replacing will further help compliance as the trouble of replacing plastic retainers is removed.
Unfortunately acrylic plastic retainers will degrade and deform over time to the point that the retainer must be replaced. Retention is a serious commitment and any plastic retainer is therefore fundamentally a short term solution. Another issue with the acrylic plastic is that it will quickly become colonized by oral fungi and bacteria. This makes them unsightly and unhygienic.
As a consequence these acrylic retainers require intensive cleaning and upkeep to extend their lifespan and to try and keep them reasonably hygienic. They cannot be sterilized and are a long way from ideal in terms of oral hygiene.
The Somnowell chrome cobalt alloy retainers are small and discreet and will effectively keep all of the teeth in their new positions. Chrome cobalt is a well-established material used to make the highest quality dentures. It is very strong in thin section and extremely robust. Chrome cobalt alloy does not deform or degrade in the oral environment and shouldn't need to be replaced. The material surface is highly resistant to oral fungi and like gold is an inactive metal excellent for long term use in the mouth. The chrome cobalt retainers will always remain clean, fresh, and comfortable.
If you're thinking about having orthodontic work or are in the process of having it, the most important thing for you to understand is this: teeth move throughout life and the rate of natural tooth movement slows down as we age, however teeth will never remain in the same position.
Dentists try and keep recently aligned teeth in position by using retainers after braces or aligner treatment. The solution for the patient is to wear retainers after braces for as long as they wish to keep their teeth in the desired positions. For the great majority of people this means the remainder of their life.
Neither the patient nor the dentist wants the teeth to move after orthodontic treatment. The orthodontic work can take years to finish and is usually a long and challenging journey. Unfortunately there seems to not be a proper appreciation on the part of patients of how important the retention regime is. This is despite the protestations of the dentist and consent forms the patient is asked to sign.
Despite the efforts of the dentist many patients fail in their retention regime and end up disappointed when their teeth move back towards their old positions. This could be due to a problem in patients appreciating the significance of retention. It could also be because of issues related to the retention regime itself.
Regular retention check ups would help the dentist and patient to work out exactly what the required retention regime needs to be for the individual person. They'd also enable the dentist to fix any broken bonded retainers. And they might help to ensure plastic vacuum retainers are regularly replaced.
A significant part of the problem is also the retention regime itself, the tools with which the patient is equipped to manage the retention regime on their own. After orthodontic work and during retention, which conceivably lasts the remainder of the patients life, the patient is left to themselves.
The chrome cobalt Somnowell retainers are the first truly effective lifetime retention solution. There's never been such a serious need for an effective long-term solution to the problem of retention. These days there are greater number of patients having orthodontic work than ever seen before. And the traditional problem of retention just does not go. Indeed one of the most frequent reasons for legal action in dentistry is the issue of retention.
Do not have orthodontic treatment without accepting a commitment to long term retention. This means holding the teeth with retainers in their new position following treatment. So how much change will occur once retention is stopped? As soon as you stop wearing retainers your teeth will move, they may not return to where they started but they won't remain in the corrected position.
Unfortunately all plastic retainers will degrade and deform over time to the point the retainer must be replaced. Retention is a serious commitment and any plastic retainer is therefore fundamentally a short term solution. Another issue with the acrylic plastic is that it will quickly become colonized by oral fungi and bacteria. This makes them unsightly and unhygienic. As a consequence these acrylic retainers require intensive cleaning and upkeep to extend their lifespan and to try and keep them reasonably hygienic. Plastic retainers will typically last 12-24 months.
The Somnowell chrome cobalt alloy retainers are like the plastic vacuum retainers, but visibly smaller and more discreet. They are made of cast chrome cobalt alloy which like gold is an ideal material for long term use in the mouth. It does very resilient and strong and does not suffer wear or tear in the mouth. The surface is highly resistant to oral fungi and bacteria, making it easy to clean and a more hygienic option. Chrome cobalt retainers will last indefinitely.
Once the teeth have moved orthodontic work will be required to move them back. If you're lucky they are going to have only moved very little, it is possible the vacuum retainer can be used as an aligner and will move the teeth back.
Removable retainers (also known as Essix retainers) are the see-through plastic clear type. The vacuum form retainers are made from clear plastic and clip over all the teeth completely. Like all plastic oral devices they deform and degrade. This can be particularly fast if the patient clenches or grinds their teeth at night. Plastic vacuum retainers work but are a non-permanent solution. The plastic degrades and becomes colonized by oral fungi and bacteria. A smelly and ugly retainer won't be pleasant for the patient to wear every night. The patient will constantly need to go visit the dentist and get a new retainer made.
Fixed retainers that are bonded to the back of the front teeth frequently break and come away totally. Unfortunately these frequently break or fall off completely. If it breaks or comes detached it will need urgent replacement. Good cleaning and occasional maintenance is vital. Fixed retainers make flossing harder and the patient will need to use a special floss threader. Placing fixed retainers certainly helps to retain the front teeth, but has no effect on the back teeth, nor arch expansion. When the fixed retainers fail, which they frequently do under the pressures and strains of the teeth and wear and tear. Most patients do not report the breakage or are ignorant of it until the teeth have relapsed. The patient then has the prospect of re-treatment or acceptance of the relapse.
The reality is that retention is often going to be a lifetime commitment, if you'd like to keep your teeth perfectly straight. At the end of orthodontic work the teeth will want to move back to their old natural positions. This is why dentists will fit a bonded retainer and ask you to wear a vacuum retainer at night time.
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