The most exciting day of orthodontic treatment is the day the braces come off. The teeth look and feel amazing. Getting straight teeth, however, is only half the battle. The other half is keeping them that way. On the day treatment ends, my assistants and I instruct our patients that they must wear their retainers every night for the rest of their lives, or their teeth will move. Although new retainers may feel “snug,” they should snap into place cleanly and not cause any pain. We check every retainer for comfort on the first day and remake any that are not right.
The Only Way to Keep Your Teeth Straight is Wearing Your Retainer
From decades of clinical research, we have learned that no matter how we straighten the teeth, they tend to move after treatment has ended. The only way to preserve the results is by wearing retainers… FOREVER! Although our patients acknowledge this on removal day, forever is a long time and for a variety of reasons, many discontinue wear at some point.
A Retainer That Hurts Usually Means that Your Teeth Have Moved
When a patient returns to our office with a retainer that hurts when they wear it, there are only two possible explanations. Either the retainer has changed, or the teeth have moved. Generally, it is simple to determine which has occurred. In some cases, retainers are damaged, distorted, or “wear out” with daily use. In most cases, however, the retainer is fine, but the teeth have shifted.
Not All Post-Treatment Tooth Movement is Bad
Following orthodontic treatment either by braces or aligners, the teeth naturally “relax” without the wires or plastic to prevent their movement. This slight change in tooth position is good when it results in the improvement of the bite. We call this beneficial relaxation “settling.” When the movement happens up front where people can see it, we call this “relapse.” The goal of orthodontic retention is to allow desirable settling while minimizing unwanted relapse.
What Are the Options If Your Teeth Have Moved?
If the movement that has occurred is minor, sometimes merely wearing your retainer full-time for several weeks will realign the teeth (similar to how clear aligners work). If the relapse is too much for your retainer to correct, however, you will probably need a new one. Even desirable settling can make your retainer uncomfortable or not seat all the way. In these cases, you will also need a new retainer, even if you’re happy with the way the teeth look and feel. If your teeth have shifted so much that you are not satisfied with their appearance, you may an orthodontic “tune-up” (additional treatment) to realign them. Your orthodontist can help you decide what is best for you.
Everything Sags and Wrinkles in Time
Although some are surprised to hear that they will need to wear their retainers every night for the rest of their lives, few deny that everything else on the body sags and wrinkles in time. Retention is forever, and if you do not wear a retainer, your teeth will eventually move. When they do, the retainers you received on the day your braces came off won’t fit comfortably anymore.
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One of the most frustrating problems that occurs during orthodontic treatment (or reappears afterwards) is space between the teeth that just won’t close. This may be due the teeth themselves, the bone around the teeth, or interference from teeth in the other arch. Let’s look at each of these possible causes.
The sizes and shapes of your teeth may be the cause
The most common reason spaces don’t close (or stay closed) is the size, shape, or position of the teeth themselves. A tooth may be too narrow at the top, too narrow at the bottom, or just too small overall. Such a tooth just can’t fill the entire space between two normal sized, correctly positioned teeth. If a tooth is too small or is shaped funny, it must be resized or reshaped. Removing tooth structure or adding restorative material (composite or porcelain) may be performed by your orthodontist or your general dentist.
The angulation of the teeth can prevent space closure
Sometimes the angulation of the teeth can also prevent full space closure. If the roots of two adjacent teeth are touching beneath the bone, it may prevent the crowns from being brought together fully. If the teeth are tipped towards each other, bringing the tops of the crowns together may leave a “space” below the contact point that looks like a triangular space just above the gums. Evaluating the position of your teeth with an x-ray helps the orthodontist know whether he needs to move a tooth or reshape it to eliminate the space.
The gums, bones, and ligaments around the teeth may contribute
Sometimes the teeth are normal but there are issues with the surrounding structures. If there is a problem with the ligaments around the root of a tooth (known as ankylosis), it may be impossible to move that tooth to close a space. In this case veneers or crowns may be necessary to make the tooth wider. In some patients the tissue between two teeth may be too thick or dense to allow full space closure (like the frenum between the upper central incisors). The cure for this is to remove the extra tissue in a procedure known as a frenectomy or a gingivectomy.
Tongue posture or pathology may also prevent space closure
Patients with tongue posturing issues (commonly referred to as “tongue thrust”) may also develop spaces between the teeth that are difficult to close and keep closed. Some patients have success performing tongue exercises (myofunctional therapy), while others require “tongue spurs” during treatment and permanent retention afterwards. Lastly, in rare cases, a patient may have a cyst or growth in the bone between the roots of the teeth that create a space or prevent one from being closed. The remedy for this is the removal of the pathology by an oral surgeon.
Teeth in opposite arch (the bite) may keep spaces from closing
Finally, if there are stubborn spaces that either just won’t close or immediately reopen after they are closed, and none of the above mentioned reasons seem to be the cause, the problem may be the teeth in the other arch (the bite). The lower front teeth can push against the backs of the upper front teeth and create spaces. Similarly, a cuspid or bicuspid in one arch can wedge between two teeth in the other arch to create a space or prevent one from closing. Spaces created by the opposing occlusion can be closed only if the teeth involved are moved or reshaped.
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