Retainers: Their Role in Permanent Success of Orthodontic Treatment

/ Retainers and Post-Orthodontic Tooth Movement

Retainers help maintain tooth positions after orthodontic treatment.

Orthodontic treatment is not limited to aligning the teeth; maintaining the current positions of the teeth after treatment is also an integral part of the process.

At this point, the retainer that comes into play is an oral appliance specially designed for the person, used to maintain and fix the new positions of the teeth obtained with treatment.

Thanks to retainers, it is possible for the bone and soft tissues around the teeth to adapt to the new position.

These appliances provide both aesthetic and functional benefits by ensuring that the result achieved with orthodontic treatment is permanent.

If a retainer is not used, the teeth will start to return to their previous state over time and the entire treatment process will be in vain.

Therefore, the retainer should not be considered as the “last step” of orthodontic treatment, but as a “protective complement”.

During orthodontic treatment, teeth are slowly moved to new positions within the jawbone with the help of controlled forces.

However, these new positions are not permanent. The periodontal ligament tissues, muscles and jawbones surrounding the teeth are accustomed to their old balance structures.

/ Retainer Functions and Types

Retainer functions and types relate to post-orthodontic tooth stabilization.

After orthodontic treatment, the periodontal ligament tissues, muscles and jawbones surrounding the teeth show a “memory effect” to return to their old state.

Especially immediately after treatment, teeth become quite mobile because the bone tissue has not yet fully hardened.

This can lead to teeth shifting back, i.e. relapse. Relapse can cause aesthetic losses as well as chewing disorders, jaw closure problems and the need for orthodontic re-treatment.

A retainer is a fixed or removable apparatus used to fix teeth in place after orthodontic treatment.

It is usually made of transparent plastic, stainless steel wire or acrylic materials and is specially prepared for each individual's tooth structure.

Basic functions of a retainer:

• Preventing teeth from shifting
• Ensuring that bone tissue adapts to the new position
• Preserving the continuity of the aesthetic appearance
• Maintaining functional balance

Fixed Retainer (Lingual Retainer)

A fixed retainer is a thin wire system that is usually placed behind the lower front teeth and fixed to the tooth surface with special dental adhesives.

This system cannot be removed by the patient and ensures that the teeth remain in a permanent fixed position. Being invisible is advantageous in terms of aesthetics.

However, fixed retainers require regular oral hygiene because the area under the wire becomes open to plaque accumulation.

Removable Retainer

These appliances, which can be easily attached and removed by the patient, offer aesthetic and hygienic advantages. Night use is generally recommended.

Hawley Retainer

• It consists of metal wire and acrylic plate.
• It has an adjustable structure.
• It is long-lasting.
• It may be less preferred in terms of aesthetics.

Transparent Retainer (Essix)

• It is made of transparent plastic.
• Invisible from the outside, comfortable.
• Vulnerable to breakage and must be renewed regularly.

/ Retainer Use Duration, Maintenance and Effects

Retainer use requires attention to duration, cleaning and continuity.

How Long Does Retainer Use Last?

The duration of use varies from person to person. However, the general approach is as follows:

• First 6-12 months: Worn day and night.
• Afterwards: Worn only at night.
• In later years: Using it a few nights a week is sufficient.

In some individuals, retainers are worn with no planned end date, and a clinical review advocates long-term retention because it is not possible to predict which patients will relapse (PubMed 28297088). This is especially relevant after treatment in adulthood, where stability is not guaranteed without a retention phase planned for the case (PubMed 8886547).

Maintenance and Cleaning Recommendations for Retainer Users

• Removable appliances: Should be cleaned with warm water and a soft brush, and should be disinfected regularly with special cleaning tablets.
• Fixed appliances: Should be cleaned with an interdental brush and dental floss, and tartar cleaning should be done every 6 months.
• Appliances should not be washed with hot water and should not be left in the sun.
• Should always be protected in a special storage box.

What Happens If Retainer Is Not Used?

• Teeth begin to shift towards their former positions in the first weeks.
• Aesthetic appearance deteriorates.
• Problems occur in chewing and speaking functions.
• Orthodontic treatment may be required again.
• Time, labor and cost are lost.

Psychological and Aesthetic Effects of Retainer Use

• Preserving smile aesthetics supports self-confidence.
• Re-deterioration of teeth causes aesthetic anxiety.
• When continuity is provided, the individual feels better in social life.
• It creates positive psychological effects especially in young individuals.

/ Frequently Asked Questions

Should everyone wear a retainer?

Yes. Everyone who receives orthodontic treatment must wear a retainer for a certain period of time after treatment.

How often are retainers changed?

• Essix (clear) retainers are replaced every 6-12 months.
• Hawley retainers: in patient records covering 591 retainers, median survival before repair, replacement or loss was 1529 days, just over four years (PubMed 29370399).
• Fixed retainers are generally long-lasting but should be checked.

Is it safe to sleep with a retainer?

Yes. In fact, nighttime use is when the retainer is most effective.

When do teeth deteriorate if the appliance is not worn?

Shifting may begin within the first 1-3 weeks. The first 6 months are especially critical.

Does it become difficult to speak with a retainer?

There may be slight difficulty in the first few days. However, the mouth adapts quickly.

Orthodontist Check-ups, Digital Dentistry and Permanent Smiles

Orthodontist check-ups, digital dentistry and retainer use are part of post-treatment follow-up.

The Importance of Orthodontist Check-ups

• You should visit the orthodontist every 6 months for appliance fit and cleaning checks.
• Wire breakage, loosening or relapse risk are detected during these check-ups.
• Long-term success is achieved with regular check-ups.

Retainer and Digital Dentistry: New Generation Solutions

• With 3D intraoral scanners, personalized retainers are produced with millimeter accuracy.
• Digital planning offers faster delivery and comfortable use.
• It provides the best solutions especially for individuals with aesthetic sensitivity.

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Using Retainers for Healthy and Permanent Smiles

If you want your orthodontic treatment to be permanent, using retainers is a must.

Staying loyal to the use of the appliance, not neglecting check-ups and paying attention to oral hygiene are the keys to a smile that you will maintain for years.