KEEPING TEETH STRAIGHT

You’ve spent spend thousands of dollars to straighten your teeth or your kid’s teeth with an orthodontist and the goal is to keep them that way. However, long-term compliance of retainers is an issue. Adults who have had braces tend to be better with retainer compliance. 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. Retainer use 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 can be difficult.

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 are also difficult to keep clean. Return visits to the orthodontist for retainer checks also decrease as time goes on.

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 a little tight because the teeth have moved slightly over that time. However, the “new” retainers were 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.

Of all the choices available, however, my preference is a bonded lower wire on the lower front teeth and a hard plastic custom-made nightguard for the upper. This keeps all the teeth straight and also provides protection of the teeth from grinding and clenching, which is a very common problem. This option also lasts the longest, which is the most cost effective.