Many patients are surprised when we explain that after finishing the orthodontic treatment they must wear some device so that the teeth do not move again, and they are even more surprised when we explain that this retention must be carried “for life” if they want to maintain the teeth in the final position that we have left them.

If we look at the evolution of orthodontics and dental retention over the last 50 years, we can see that the thought of retention has gone through different phases: for a time, orthodontists did not place any type of appliance to prevent recurrences (recurrence is when teeth move back to their original position), although they soon realized that teeth need an appliance to hold them in place. Later, they began to wear retainers after orthodontics for only 2 years, but again they observed that the teeth tended to recur, so they lengthened the period to 5 years of retention.

Even so, 5 years was not enough to hold the teeth and avoid unwanted movements. For more than 20 years, retention has been considered a “long” stage, and we explain very well to patients that if they want to have their teeth as we have left them, they should wear the retention appliances for as long as they want to have. teeth well placed.

This is because the teeth are supported by ligaments, and these ligaments have a lot of elasticity which makes it easier for the tooth to move. There are many more factors such as the strength of the muscles, the remodeling of the bones or the pressure exerted by other teeth. Ripening is so complex that retention must be permanent. There is nothing in the human body that is stable.

There are two types of retainers for the dental retention that we use in orthodontics: fixed retention and removable retention, although the choice between one and the other will depend on the orthodontist as he is the professional who can give the best guidance on which is the most suitable for your case.

Figure 1

• The fixed retention consists of a round or rectangular wire, which is adhered to the inside of the teeth (figure 1). It is almost always placed on the lower teeth, while depending on the way of closing there is sometimes no space to put it on the upper part, although we always try to place it if possible.
• The greatest advantage of this type of retention is comfort since the patient does not have to think about wearing anything; Since the hold is stuck, he holds for 24 hours. The main disadvantage is the issue of hygiene, since in patients who produce a lot of tartar on a regular basis, fixed retention does not help. In any case, in the annual check-up with the dentist, the retainer can be cleaned well so that the gums do not suffer over time.

Figure 2

• The removable retention has long been the most widely used retention. Some patients prefer it over fixed retention for its main advantage: ease of cleaning teeth. Its worst disadvantage is the consistency in its use, because over the years some patients stop using it because they believe that the teeth are no longer going to move. In addition, depending on the type of device used, it must be changed from time to time as it can break or deform.
• Laboratory-made Hawley devices (figure 2) are more robust and last up to 15 years, although they are somewhat more uncomfortable. Essix or vaccum type retainers (figure 3) are more comfortable but wear out more easily and must be changed every 1-2 years.

Figure 3

DENTAL RETENTION AFTER ORTHODONTIC TREATMENT

The vision of orthodontic treatment has also changed. Although some patients think it is a “once in a lifetime” treatment, Rossell Carol try to provide a somewhat different view. It is true that if the treatment is well executed there may be slight changes in position, but these changes are attributable to the body’s own aging. The current vision is to undergo a main orthodontic treatment (preferably around 12-16 years of age), put retention and control the maturation and aging of the tissues. If teeth are displaced at any time, there are quick and easy orthodontic “maintenance” techniques, such as aligner treatments, to put them back in place with ease.

Surely we no longer do a single treatment, but we do an important one in adolescence and later we make small adjustments to keep everything perfect. We must assume that getting older implies that everything in our body can change, and the same happens with the gums, tissues and teeth. Everything flows, everything changes, nothing is permanent (Heraclitus).