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Orthodontics/Retainers after invisalign

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Question
Hi,

I have recently finished an invisalign treatment and I am at the stage of chosing a method of retention. My orthodontist is recommending two lingual wires (upper and lower) plus a Hawley retainer. What I don't understand is what is the point of having a wire and a Hawley retainer for the upper teeth? It seems a bit much.

Thank You

Answer

Hi Benjamin,

Fantastic Question.  Check out this link:

http://braces.com/47601.html  

What I write here are only my opinions based on very limited information. My comments should not be viewed as any form of diagnosis, definitive or otherwise,  or any form of  treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Okay… having said  that…  your  questions focused on retainers after Invisalign treatment.

  I am at the stage of choosing a method of retention. .... My orthodontist is recommending two lingual wires (upper and lower) plus a Hawley retainer.  

Benjamin, unless you have a lot of porcelain anterior restorations (crowns or veneers) on the front incisors, I would concur with your Orthodontist regarding the bonded lingual (inside) wires. In my experience such bonded wires are really great at keeping teeth aligned. They do require a little extra effort to keep clean as they can collect tartar and plaque. Also, one needs to not bite into ice, hard and sticky foods, etc., or they can be loosened.

These lingually bonded wires are much like an airbag in a car and are there all the time to help secure the teeth in place and to help prevent shifting and relapse.  They work to supplement the stabilizing function of a removable retainer. For example, if you forget to buckle your seat belt, the air bags will help you in an accident. Likewise, if you forget or lose your retainers the bonded wires will help keep things from relapsing.  These wires generally cover just the front teeth, going from the inside(tongue side) surface  of the lateral incisor, across the midline, and to the opposite lateral incisor . Some bonded lingual retainers in fact span from canine to canine. A removable retainer will generally cover additional teeth such as the molars and premolars.

Now in addition to the fixed retainers, you say your orthodontist  is also recommending a removable style retainer. Here you may have some options, namely the "Classic Hawley"  with labial wire style as you mentioned, or a clear style retainer which very much resembles the clear aligners which you wore. In contrast to the clear aligners which were designed to move teeth, the clear retainers seek instead to hold all the teeth securely in place.

You wrote :   "  It seems a bit much. " .  Well yes and no. For some it is a burden, yet for others it is not. I would recommend that you speak with your orthodontist to see what styles of removable retainers are available to meet you needs. Ask him/her if you will need to wear these removable retainers full time or just at night. If full time initially, then ask w long it will be  before you can go to night time wear only.

Finally, I hope you are keeping all your old aligners. In case the teeth do shift,  you can often realign them with your appliances.  So the take home message here Benjamin, in my opinion, is to go for the fixed bonded upper and lower retainer wires. To supplement this, and to help stabilize those teeth NOT covered by the bonded wires, please ask whether a clear retainer could be used if indeed you find the Hawley style objectionable. It sounds like you are in good hands Benjamin.

I always tell my patients that the acid test for good orthodontics is NOT what do the teeth look like the day the braces or aligners are removed or discontinued. Rather, what do the teeth look like and how is the bite in 5, 10, or 15 years. It sounds like your caring Orthodontist likewise is concerned not only with the immediate results, but what your smile  will look like in a time line spanning many many more years.

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.com  

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Paul Supan, DDS, MA, MPH

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First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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