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Orthodontics/permanent bottom retainer

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Question
My daughter is 20 . She has been out of braces for four years with a permanent  bottom retainer behind the six teeth . The retainer broke yesterday and the orthodontist said she should have it replaced and continue to have one for as long as possible. The weird thing is even with that retainer her bottom teeth moved a little. I don't get it....I had braces 35 years ago. I never wore a retainer after and my teeth never shifted or moved??? Why is it today all you here about is your teeth having memory and they move ??? Do you agree to have the retainer replaced and left on ?? She stopped wearing her top one a year ago because we kept having it readjusted and everytime she wore it she said it put pressure on her front teeth and she felt like her tooth moved. Her top teeth have not changed without wearing it.

Answer
Bonded Lingual Wire Retainer
Bonded Lingual Wire Re  

Clear Removable Retainers
Clear Removable Retain  
Dear Marianne,

Thank you for your question, and it comes at such a timely moment. Just this week I had two patients who were visiting from out of town come in for emergency visits due to issues with their lower retainers. The retainers were I am sure much like the one which your daughter has bonded to the inner aspects of her lower incisors.

I think you have submitted a question which will help many many readers. I am going to answer it in some detail, so pardon me if it is a bit of a ramble.

First let me again state that 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 your daughter  in person and who have had an opportunity to take and analyze any required proper diagnostic records.

Retainers in 2015 come in many different varieties, yet the time adage of  “ wear your retainers”  continues to hold true. Over time, the body changes, skin sags, hair can turn grey, and teeth shift. Often this dental process takes place in early years over a short period of time especially after orthodontics has been completed. As an analogy, consider weight loss. It is quite easy to relapse and gain back the weight. A person who has successfully dieted and lost weight may no longer be on a diet, but they perhaps step on a scale to weigh themselves several times a week and monitor what they eat so as not to regain the weight they worked so hard to shed.

Likewise, a person who has completed not a diet, but orthodontic treatment, may need to monitor their tooth alignments, and wear a retainer ongoing at night, or at least several nights a week to help ensure that the teeth do not shift and relapse back.   Let me specifically address the various elements in your question.

You  wrote:

#1
My daughter is 20. She has been out of braces for four years with a permanent bottom retainer behind the six teeth . The retainer broke yesterday and the orthodontist said she should have it replaced and continue to have one for as long as possible. </b>

This is actually not bad advice at all. There may be reason for this if the initial crowding situation was severe and he/she treated it using a non-extraction approach.  If your daughter is able to tolerate a bonded lingual wire retainer, and is able to keep it clean and maintain great hygiene, then perhaps it would indeed be worthwhile.

I have had some lower retainers that I have simply re-bonded back on to the tooth.  Such lingually (i.e. on the inside surface of the teeth) bonded wires generally span from canine to canine, or from the left lateral incisor to the right lateral incisor. When separation of failure occurs, is usually affects only one or two teeth. The old failed adhesive on the lingual surface can be removed and polished, new adhesive placed and the existing wire pushed into place and bonded.

This is not possible if the wire has been distorted or has sharp edges. I had a patient who had tried to clip the wire with a nail clipper. She was not successful and ended up fraying the wire. Since she had been wearing the canine to canine bonded wire retainer for many years, I elected to section off the frayed portion and to re-bond the existing wire. If this can be done, then the cost to you the patient can be minimized.

See Image Above. Bonded Lingual Retainer Wire after Sectioning.
Image Courtesy of http://www.braces.com

#2
The weird thing is even with that retainer her bottom teeth moved a little. I don't get it....I had braces 35 years ago. I never wore a retainer after and my teeth never shifted or moved???  


First of all no two orthodontic cases are alike, and perhaps you were fortunate to have an initial orthodontic problem that was not as profound as that of your daughter. Often the milder the initial problem, the milder is the chance for relapse.  Also the manner in which a case was treated may impact the likelihood of relapse.

In cases of dental crowding where the need to extract or not extract is not an easy diagnosis, there may not be a right or wrong way to treat. One doctor may choose to extract teeth while another may elect to treat the case without extractions. Extracting teeth at times may result in a more stable result. Not extracting may work out okay, but sometimes some tooth “slenderization” is needed to accommodate the need for more room. The final treatment outcome, while very aesthetic, may have adjacent teeth pushing against each other, sort of shoulder to shoulder so to speak. This pressure may cause some teeth to rotate, relapse, or overlap. In summary, an orthodontic crowding case bordering on an extraction diagnosis but  treated using a non-extraction approach may require judicious and dutiful use of retainers.

These retainers can be a fixed bonded lingual wire, or a removable orthodontic retainer. Some doctors, myself included, sometimes employ both on the same teeth if needed. If a case initially was extremely crowded, at the end I may bond a lingual wire as a fixed retainer, and then in addition provide the patient with a clear removable retainer. This is like having a seat belt and an airbag.

See Image Above. Clear Removable Retainers
Image Courtesy of http://www.braces.com

#3
Why is it today all you here about is your teeth having memory and they move ??? Do you agree to have the retainer replaced and left on ??  


The idea of teeth having memory and trying to move back to their pre-treatment position is not new. Teeth, unlike a nail hammered into a stout oak board, are embedded in a hammock of fibers called periodontal ligaments. This enables a tooth to move slightly if for example you push forcefully against an upper incisor with your fingers.

The recommendation I usually make for patients is to keep their lingually wired retainer on as long as possible. If it breaks off, then the question becomes, “ should I repair or replace the bonded wire retainer?” If you have a second removable retainer that is acting to compliment the retention role of the fixed wire, then perhaps just the removable appliance can provide all the retention you need.

Also, you need to ask yourself how long has the bonded wire been in place.  Marianne, five years is a pretty long period of time to have successfully worn a bonded wire retainer. If your daughter does not mind a wire retainer, then the advice from your Orthodontist to repair and/or replace the bonded wire is worth strongly considering.

#4
She stopped wearing her top one a year ago because we kept having it readjusted and every time she wore it she said it put pressure on her front teeth and she felt like her tooth moved. Her top teeth have not changed without wearing it.


It has been said that all teeth should have retainers after orthodontic treatment. This is generally true. Now some teeth  and certain orthodontic results may in fact be stable WITHOUT wearing retainers, but it is not possible to discern which treated cases are so very stable that no retainers are needed. I suppose some cars will never be involved in an accident, and so no seatbelts or airbags are needed. The problem is we cannot tell which cars will be accident free, and likewise we cannot tell which patients have such super stable Orthodontic results so as not to warrant retainers.

The adjustments to the upper retainer which you describe may have been done to allow the retainer to have better retention and to “grip” the teeth so it does not become loose or fall out when your daughter is speaking.  The “tightening” of the retainer may cause some mild forces on the teeth which some patients may find uncomfortable.

Marianne, retainers are a way to protect the time and financial investment you’ve made for your daughter in orthodontic treatment. ”. Retainer use in whatever style you choose, will help to keep in check any Orthodontic relapse and untoward tooth movement.

In Summary, here is what you may wish to consider:

1.   Ask your daughter if she is okay with wearing a lower bonded wire retainer. If so, consider following the advice given by your Orthodontist to get the old wire it repaired/replaced.

2.   Ask your daughter if she would be okay with a second clear removable lower retainer to supplement the fixed wire retainer. If she is game, then ask the Orthodontist if he/she would be willing to provide a removable retainer as well.

3.   If the upper teeth have not moved, count your blessings. However, ask your daughter to please try wearing the old retainer a couple times a week at night only. If it is tight continuously wear it for a week as you did originally, and then see if the fit is less tight and more comfortable.

4.   If your daughter has lost the upper retainer, ask your orthodontist if a replacement can be made.

Marianne, retention is one of the most complex topics in Orthodontics.  I hope that this discussion has helped. I have gone into a great deal of detail because I think your question will prove helpful to many other readers on this website.  If you have any follow up questions please resubmit them, and include some images if possible.  Also, the website hosting people here who run the site encourage readers to leave feedback, so please consider rating this answer.

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.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. I also will sometimes consult with other doctors on complex questions. This of course takes time.  Your understanding is appreciated.  

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Paul Supan, DDS, MA, MPH

Expertise

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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