After your braces are removed, an orthodontic retainer will be used to minimize relapse or a shifting of the teeth back toward their original position. Some shifting is inevitable as we age, but it is typically mild
Just as the field of orthodontics has evolved, so has the use of orthodontic retainers and the concept of retention. In the early days, retainers were not used. The theory was, if a patient was properly treated, nature would cooperate and maintain the result. Unfortunately, this was not the case. The teeth tend to relapse, so retainers were developed to maintain the alignment.
Long Term vs Lifetime Orthodontic Retention
At first, it was thought that a year or two of retainers would be sufficient to prevent relapse. However, in some cases, such as the alignment of the lower front teeth, this was found to be inadequate. Studies on the stability of orthodontic treatment at the University of Washington found unacceptable relapse in about 70 percent of their sample. These cases had 1 to 2 years of orthodontic retention after braces.
As a result, Haas Orthodontic Arts in Akron, began using long-term retention in the early 1970s. This has significantly reduced the amount of relapse in our patients. When we repeated the University of Washington study noted above, using our patients treated with long-term retention, the amount of unacceptable relapse was reduced to less than 10 percent.
Some orthodontists advocate retainers for life. Although this would probably reduce some shifting of the teeth, we find it impractical for a number of reasons:
- Who will maintain your retainer if you move out of the area or your orthodontist retires?
- Who will pay for broken retainers over a lifetime? What is the additional cost?
- Dentists and hygienists are anxious to have fixed retainers removed. Although we have their support for retainer use for 5 to 7 years, we doubt they would welcome a lifetime.
- Lifetime retainers are unnecessary as only a small percentage of cases require re-treatment.
- Do you really want to wear a retainer forever?
There are certain orthodontic movements that will relapse even years after the retainers are removed. They require “over correction” to allow for the inevitable long-term changes. Many orthodontists do not favor “over correction” as they want the teeth to look perfect the day the braces are removed. While the teeth may look good initially, a year or two later they will start to appear crooked again.
We often tell our patients that we are not overly concerned with the appearance of their teeth the day the braces are removed. We care how they look the next year or 10 years down the road.
The Class III Challenge
A Class III bite is an orthodontic problem where the lower teeth are biting ahead of the upper teeth. The challenge with this type of problem is long-term stability. Typically most cases are treated in the 10 to 14 age range.
The problem is the upper jaw finishes its growth at about age 14 in females and age 16 in males. The lower jaw, however, doesn’t finish its growth until around age 19-20 in females and 24-25 in males. This late growth in the lower jaw can carry the lower teeth ahead of the upper teeth again.
Our strategy to counteract this late growth is to “over correct” the bite. There are a few cases where even with “over correction,” the lower jaw growth is strong enough to cause the Class III problem to return. If this should happen, orthodontic surgery may be necessary to correct the problem.