Post Treatment

And now the story ends!

How are Braces Removed?

Removal of the braces is not difficult. In fact, care must be taken during treatment with braces to avoid breakage of the appliances. The bond between the tooth and a bracket is ideally strong enough to allow for control of tooth movement during treatment, and then allow easy removal when treatment is complete.

Braces bonded directly to the teeth are removed by slightly deforming the base of the bracket. When the base of the bracket is squeezed, the bond releases and the bracket will come off. Usually, the separation occurs at the bracket-glue junction, leaving adhesive on the tooth surface. The orthodontist must then go back and remove the adhesive from each tooth. Leaving adhesive on the tooth is the preferred method for bracket removal, since it assures that the enamel and tooth structure remains undamaged.

The process of removing braces and the adhesive is relatively painless. It is possible that some of the teeth, especially the lower front teeth, may be sensitive to pressure. When the bracket is lightly squeezed, there may be temporary discomfort.

After the braces have been removed, adhesive remaining on the teeth must also be removed. This is usually done with a slow or high-speed dental hand piece. While this is the same type of instrument used by general dentists when they repair a cavity, be assured that there is usually very little discomfort with the removal process. In fact, most describe the feeling more as a “tickle” on the teeth than pain or discomfort. There is no actual tooth structure being removed in this process. The removal is limited to the adhesive only, and the enamel remains in its normal condition.

After the braces and adhesive is removed, most patients describe the teeth as feeling slimy, since the rough feel of the braces is no longer on the teeth. Also, the gum tissue may be slightly puffy and inflamed. This will usually subside within a few days with good brushing and flossing.

Retention and Retainers

Once the braces are removed and the teeth/bite has been aligned, the patient will normally move into the retention phase of treatment. Retention is defined as that period of time where the braces have been removed and the teeth are still relatively unstable. The ligament fiber attachments from the roots of the teeth to the bone surrounding the teeth have been stretched and moved during the braces. These fibers have a tendency to pull the teeth back into the position they were in prior to treatment. Over time, the fibers will reorganize, and the teeth will become stable. It is during this reorganization time that permanent and removable retainer appliances are recommended to maintain the alignment of the teeth until they are stable.

The recommendations regarding retention and retainer wear vary considerably from orthodontist to orthodontist. The following recommendations are generalizations about retainer instructions.

Three different types of retainers are shown below:

Essix (clear, mouthguard-like retainer)

Clear Essix Retainer

Hawley (plastic and wire)

Bonded “permanent” retainer

Permanent Bonded Retainer

Most orthodontists will provide their patients with retainers about a week after the braces are removed. This time is needed for the lab to fabricate the retainers. Tooth movement is usually insignificant during this time period. If there is tooth movement, the retainer will provide a means to re-establish the alignment. A time period longer than a week runs an increased risk of additional tooth movement in some patients. The amount of movement will vary from patient to patient, and also depends on the original position of the teeth. If the teeth have shifted significantly, the retainers may not fit properly. It is therefore important to see the orthodontist within that one week time period.

When the braces have been removed, an impression is taken of the teeth with alginate, similar to what was done at the records appointment for the plaster models. The retainers are then custom-made for each individual patient by the lab. When retainers are given to the patient, the orthodontist may need to perform some adjustment of the plastic or wires to make sure it has a proper fit. The retainers are designed to retain, and are therefore generally passive appliances. Normally retainers are not made to move the teeth, but to hold the teeth in their current positions (although some tooth movement can be done with retainers on a limited basis). It is not uncommon for a patient to feel some tightness, and later, soreness as a result of the retainers when first worn. This may be due to slight amounts of tooth movement since the braces were removed.

Full time wear of the retainers is usually recommended for most patients, especially in the first 6 months following braces removal. Since every patient will have differing amounts of post-treatment tooth movement, this recommendation may be more or less than what is required for most patients. After the initial 6-9 months following braces removal, it is usually safe to wear the retainers at night only. Again, specific instructions should be provided by the orthodontist.

Retainer Placement

An appointment is usually made 1 week following braces removal for retainer placement. One week is usually necessary to fabricate the retainers at the lab. The clear, “Essix” or “Trutain” type retainers can sometimes be made faster, and some offices even make these for a same day delivery.

At the retainer placement appointment, the orthodontist will make sure the retainer fits properly and provides the necessary retention of the teeth. Instructions are usually given to the patient (and parents, if the patient is a minor) regarding the proper wear and care of the appliances.

Retainer wear and care Instructions

Instructions may vary depending on the type and material of a retainer, but they are included here for reference.

Wear the retainers all the time as instructed by the orthodontist. Exceptions may be while eating, brushing, playing sports, or for swimming. Remember, the first 6 months after braces are removed the teeth are the most prone to movement and relapse.

Brush the retainers with a toothbrush and toothpaste regularly. Retainer wear will sometimes be difficult if they are not kept clean and fresh. A retainer cleaner (such as Efferdent or Retainer Brite) can be used every day to keep them fresh and clean.

Keep the retainers away from pets, and especially dogs. They love to chew on the retainers and will likely damage them.

Avoid placing the retainers near heat. Boiling water, dishwashers, dryers, and even a hot dashboard of a car can warp the plastic.

Keep the retainers in a protective case if they are not being worn. This will prevent breakage, loss, or accidentally throwing them away.

The best place for a retainer is in the mouth. It will not be lost or 9 9 broken if it is being worn.

If the suggestions given are followed, and the retainers are worn as instructed, the risk of movement and relapse becomes very low.

Retainer Check Appointments

Some people are surprised to learn that the orthodontist will recommend appointments after the braces have been removed. The time period after the braces are removed can be critical to providing a good treatment result. Since the teeth have a strong tendency to move back to their original position after the braces are removed, retainers are provided to help prevent this from happening.

The initial 6 months post-treatment seems to be the most susceptible time period. There is significant variation from person to person, but the majority of people will need to wear the retainers full-time. It is possible that because of inadequate cooperation, normal wear and tear, or through some sort of direct damage, the retainers may not be functioning as they should. Therefore, many orthodontists will provide appointments to check the fit of the retainers, and also verify that the alignment of the teeth is holding.

The appointments are usually very quick and easy – but they are important to head off any potential complications that may arise. The sooner a developing problem is recognized and dealt with, the less difficult it is to remedy. A poorly fitting retainer over a long period could result in enough relapse so that the retainers will not be able to regain the original alignment. In that case options include making new retainers, placing braces again to re-treat, or leaving the misalignment.

Post-treatment checks vary from one orthodontist to another. Commonly, a visit shortly after the braces are removed, and then at longer intervals are recommended (i.e. 5 weeks, 3 months, 6 months, and 1 year).

Retainer Problems and Emergencies

Many problems with retainers can be solved through prevention. That is, poorly fitting retainers, relapse (teeth getting crooked again), pain and soreness, or other problems may be preventable.

The keys to avoiding retainer problems include: follow retainer wear instructions, keep retainer check appointments, and call the orthodontist if a problem develops

Follow retainer wear intructions

Wearing a retainer as instructed is the most critical piece of advice. Lack of retainer wear is the number one reason for relapse and shifting of the teeth following the braces. Once the braces are removed and a properly fitting set of retainers is worn as instructed, the teeth have a low tendency for movement. If the retainers are not worn, problems can escalate. Once the teeth shift, the retainer will not fit as well and the teeth then continue to shift even further. If this has happened, an appointment should be made as soon as possible with the orthodontist to see if the retainers will still work or if a new set of retainers are needed. In a worst case scenario, if the teeth have moved too much, braces would be required to realign the teeth.

Keep retainer check appointments

Sometimes it is obvious that a retainer is not fitting very well or if the teeth have started to shift significantly. However, many times the changes can be quite subtle. Patients sometimes are unaware that there are problems, especially if the retainers have only recently been given. Sometimes subtle changes can lead to more severe problems if left unchecked. Most orthodontists will schedule retainer check appointments following the braces to watch for these problems and try to catch them early. If problems are detected early, only slight adjustments in the retainer or increased compliance with wearing the retainers may be needed.

Call the orthodontist if a problem develops

As was already mentioned, early detection and management of a retainer problem can dramatically reduce the potential problems. Things to be aware of that might warrant a call to your orthodontist includes: broken or ill-fitting retainer, lost retainer, shifting teeth, overly tight or painful retainer, or a poking wire or plastic.