Retaining your straight teeth after treatment
Orthodontic treatment involves moving your teeth, either by tipping or rotation, into a new position. Pressure applied to your teeth leads to a biologic process that allows the bone that housed the roots of the teeth to change dimension, permitting the movement of teeth.

Teeth are not fused to the surrounding bone. The roots are surrounded by a “periodontal ligament”. If you place your fingers on your front teeth, you may notice that they have a very slight mobility, due to this tissue that surrounds the root. When teeth are moved, particularly rotated, the fibers of these ligaments are stretched, and due to their elasticity, the tendency for relapse exists. This tendency is particularly noticeable in the short term.

The shape that the “arch” of your teeth form is dictated initially by genetics, but clearly from the play of the muscular forces place by your tongue, cheeks, and other habits during development. The inward and outward forces placed on your teeth eventually reach equilibrium. Once this arch dimension is changed, as is often the case with orthodontics, the resumption of speech, swallowing, and breathing patterns on this new arch form also can lead to shifting back of teeth.

To prevent the possibility of relapse, some form of retention is necessary. Conventionally, “retainers” are delivered after treatment. They are removable appliances, generally worn at night for an indefinite period. Since they are removable, oral hygiene is easy, and eventually they can be worn less frequently then every night. However, after an extended, or in many cases even relatively short time period, teeth will often revert back to their original position. The extent of this relapse is a mysterious variable not completely understood.

For patients who are willing to accept the inevitable settling of teeth into reasonable, though perhaps no perfect position over time, retainers are often phased out, or remade after periods of neglect. For patients who are not willing to tolerate more than minimal change after a beautiful result, either nightly wear of retainers is called for, indefinitely, or the placement of a bonded retainer is recommended.

A bonded retainer is a small wire bonded to the back of the six front teeth. It cannot be seen, and is easy, with a little effort, to floss beneath. They need to be checked by the dentist or orthodontist periodically to ensure stability and gum health beneath. Bonded retainers are becoming more and more common, as some orthodontist grow increasingly frustrated with the poor compliance of old patients, particularly teens, in wearing removable retainers. The bonded retainers can stay on for many years, and often there is no reason to intentionally remove them if they are kept hygienic.

Dr. Goodman is a Certified Invisalign® Provider