IS PERMANENT RETAINER THE RIGHT CHOICE AFTER BRACES?

Permanent retainers are fixed orthodontic appliances used after removing braces. Which retainer should I opt for? The removable one or the fixed one? It is one of the common questions every patient will come across after removing braces. I think you also have the same problem. Hence you are here.

This article will provide a brief insight into the types of retainers available and their advantages and disadvantages.

What are retainers?

Retainers help in stabilizing the tooth after removing braces or orthodontic clips and help in maintaining the position of teeth. They are broadly classified as

What is a Removable retainer?

Removable retainers are removable orthodontic appliances given to you after removing braces. Your dentist might advise using the removable appliance regularly for a specific period after the braces treatment.

The removable appliance comes with a plastic plate and a metal wire loop attached to it. The plastic plate fits in between your teeth and rests on the tissues. On the other hand, the metal wire applies pressure on the teeth and prevents their movement.

What is a Permanent retainer?

Fixed retainers lack any plastic plate. In simple words, the appliance is just a metal wire fixed to the teeth on the inner side with the help of adhesive cement-like composites.

Fixed appliance, as the name suggests cannot be removed by the patient. The metal wire is fixed to the teeth’ surface and prevents the movement of teeth.

How does a retainer work?

Our teeth are present in the bone. But when we examine the microstructure of teeth and bone. We can see that the teeth are positioned in bone with the help of some fibers. These fibers connect all the teeth and aid in maintaining the position of the teeth within the bone.

But, during braces treatment, the bone becomes soft, and the tooth easily changes its position. It helps in repositioning the teeth into the required position.

Once the teeth are repositioned into the required position, your dentist will remove the braces and will provide a retainer.

The retainer helps in maintaining the position of teeth and in the meanwhile, the fibers in the bone will realign into the new position of the teeth. This makes the teeth strong and immobile in the new position.

Hence braces help in moving teeth. But retainers help in stabilizing the teeth in the new position. Hence retainers play an important role in orthodontic treatment.

What is the cost of the retainer?

The cost of the retainer is usually charged along with the braces treatment. Occasionally your dentist might ask about your choice of retainer and can charge according to it.

Removable retainer cost?

The cost of a removable retainer ranges between $100 to $500. The charges are for one-time preparation. The impressions of your teeth after removing the braces will be sent to the lab for preparing the retainer.

It usually takes less than 2 days for the retainer to reach the lab to your dentist’s office.

permanent retainer cost

The cost of a permanent retainer ranges between $400 to $600 per arch. Hence for both the arches, it ranges between $800 to $1200.

The retainer is prepared by the dentist himself. No need for any impression-taking. The retainer is usually fixed immediately after removing the braces.

Comparison of removable and fixed retainer (Removable retainer vs Fixed retainer)

	Removable retainer	Fixed retainer
Cleaning	Removable retainers are removable. You can remove the appliance during teeth cleaning and can fix them back after cleaning.	Fixed retainers are fixed and cannot be removed during teeth cleaning. Teeth cleaning is a major issue in these patients.
Flossing	Flossing is easy. Just remove the appliance and floss your teeth.	Flossing is difficult.
Visit your dentist	The retainer must be adjusted frequently.  Hence frequent visits to your dentist might be required.	The appliance once fixed need not be adjusted.
Cost	Low cost	High cost
Appliance Breakage	The chance of breaking is more. If broken, then the appliance must be prepared again.	The chance of braking is less. But the appliance might de-bond from the teeth if not maintained properly.
Visibility	Visible when you smile	They Will not be visible as they are present on the backside of your teeth.
Cleaning the appliance	As the appliance is removable, cleaning the appliance is very easy.	Cleaning the appliance is difficult.
Region advised	Usually, a removable retainer is advised for upper teeth.	Usually, fixed retainers are advised for lower teeth.
Metal density	The metal content is more and can occasionally cause irritation and ulcers on the cheeks and tongue.	The metal content is low and is less irritating.
Debris formation	The removable retainers can be cleaned easily hence retaining less debris.	As the permanent retainers are not removable, they attract a lot of debris and might damage your teeth.
Efficiency	Removable retainers are weak in retaining tooth movement compared to fixed appliances.	Permanent retainers are strong in preventing the shifting of teeth. Hence preserve the teeth’ position after braces treatment.
Splinting	The removable appliance provides short-term splinting. Hence the teeth become viable to movement when the appliance is removed. This helps in maintaining the supporting structures of the teeth.	The permanent retainer provides long-term splinting. As a result, the supporting structures of the splinted teeth lose their viability and result in degeneration or bonelessness. *BUT USUALLY OCCURS IN VERY LONG-TERM CASES ONLY*
Tooth modification	No need for any tooth modification. The appliance is simply placed on the teeth.	The teeth are etched with an acid to become rougher so that they take the composite filling over them.
Allergy	Some people are allergic to plastic materials used in removable appliances. Such patients present with ulcers in the mouth on the next day of using the appliance.	The allergic part in the permanent retainer is less as the materials used here are completely biocompatible. But if patients are allergic to composite cement, then they should avoid permanent retainers.
Repairability	The broken removable retainers are difficult to repair. A new appliance has to be procured.	Repairing a permanent retainer is easy and can be done by your dentist.
Chewing	Chewing with a removable retainer is a bit difficult as it disturbs your natural way of biting.	Chewing will not be a problem as minimum interference will be experienced.
Age	Removable retainers are best for young people in the growing stage	Permanent retainers are the best for adults and whose bone has completed its maturation.
Relapse	More chance of relapse	Less chance of relapse

What if my permanent retainer broke?

Permanent retainers are usually string and are well protected by composite cement on the teeth. But if the retainers are broken, they may provide a hell of complications like impinging on your gums and tongue and may even disturb your speech.

In case of a broken permanent retainer, visit your dentist immediately. He might repair the appliance or may advise you to go for a new one.

He will remove all the composite material present on the teeth and will place a new metal wire and apply composite over it.

The entire procedure takes less than 20 minutes and you will have your retainer repaired in no time.

On the other hand, a broken removable retainer takes a lot of time. The first point is, it cannot be repaired. Your dentist must repeat the entire procedure starting from taking impressions to sending them to the lab. The entire procedure of removable appliance fabrication makes takes at least 2-3 days.

Cost of permanent retainer top teeth

The cost of a single permanent retainer on top teeth usually ranges from $400 to $600. The permanent retainer is fixed on the backside of your front teeth with the help of composite cement or restoration.

A permanent retainer on top teeth is comfortable. But see to it that they do not interfere with your biting. Any interference should be corrected immediately with your dentist.

How to floss with a permanent retainer

Flossing with a permanent retainer is a tedious process. Here are a few steps to be followed while cleaning your teeth with a permanent retainer.

The brushing should be as usual and should be done properly. Any debris around the permanent retainer should be cleaned thoroughly.

While flossing place the floss interdentally and run it over the surface of the teeth. Do not move the floss with pressure as it may damage your permanent retainer and injure your gums.

Gentle flossing only to the areas reachable by your floss is the best way to do flossing. Do not push the floss beyond the boundaries as the metal wire in the permanent retainer may hinder its movement.

Heavy pushing or pushing down the floss with force may dislodge your permanent retainer. Floss gently with caution in front of a mirror. Provide controlled strokes along the surface of teeth and soon you can master the cleaning process.

Remember with a permanent retainer, you may not floss your teeth completely. But to some extent, you can clean the interdental areas.

Permanent bottom retainer

A permanent bottom retainer is an ideal choice after braces. A removable retainer in the lower jaw will not be stable and may provide disturbance while talking and chewing. Moreover, a removable retainer in the lower jaw will be more uncomfortable for the patient.

On the other hand, a permanent retainer produces a snug fit into the lower teeth and will not move with the tongue. As a result, you may have comfort and a stable retainer while eating and talking.  

Permanent retainer after Invisalign

A permanent retainer after Invisalign helps in stabilizing the tooth position. It is a cost-effective treatment solution and a good alternative to Invisalign retainers.

The Invisalign retainer is costly and should be used for years. But permanent retainers are economical compared to the Invisalign retainers and proved to provide the best support and stabilization to the teeth, in the new position.

Permanent retainer pros and cons

Pros

• A permanent retainer is convenient and does not produce major discomfort to the patient.
• They are invisible as they are placed on the backside of the teeth.
• They do not interfere with speech and will not intervene while biting.
• Permanent retainers produce strong anchorage and aid in fixing the position of teeth. Relapses are very uncommon.

Cons

• Permanent retainers are expensive.
• They attract a lot of debris and damage teeth.
• Permanent retainers are difficult to maintain, they need regular brushing.
• Replacement of permanent retainer is expensive.

Permanent retainer problems

Occasionally permanent retainers may cause problems. If not placed properly, permanent retainers may intervene with biting and may cause discomfort.

Any sharp point left on the permanent teeth might impinge on the tongue and lips and may lead to trauma and ulcers.

Long-standing permanent retainers must be cleaned regularly. Any debris left on the retainer may initiate caries on the supporting teeth.

The composite on the permanent retainers may discolor or stain easily and produce an unesthetic appearance.

Permanent retainers may get dislodged easily if not bonded properly.

High-fiber food should be avoided as there are chances that the fiber gets stuck in the permanent retainer.

permanent retainer & MRI

Can patients with permanent retainer undergo MRI? It is one of the most common questions asked by my patients.

Low and non-ferromagnetic substances are safe to be used during MRI scans. The metal wire in the permanent retainer may be made of different compositions.

Stainless steel wires may produce artifacts during the scan and hence should be avoided in MRI scans.

Nickle-titanium or NITINOL wires have weak ferromagnetic properties and produce fewer artifacts compared to stainless steel wires.

Metals cause inhomogeneity in the magnetic fields and produce artifacts In the MRI images. Hence any type of metal, getting removed before an MRI scan is a good practice.

Permanent retainer removal

Permanent retainer removal is a simple process. Your dentist might de-bond the composite from the teeth and the metal wire gets detached from the teeth.

After de-bonding, your dentist might smoot the teeth and remove any traces of the restoration. Later he will apply some de-sensitizing paste and will remove any debris left under the retainer.

What to do if the permanent retainer glue came off?

As soon as the permanent retainer glue came off, call your dentist, and fix an appointment. He will refix the same retainer or might advise you to go for a new retainer.

Anyways the treatment will be expensive compared to the removable retainer.

Permanent retainer removal cost

Your dentist might not charge separately for removing your retainer. But he may charge for cleaning the teeth after removing the retainer.

A lot of debris and calculus get deposited below the permanent retainer and should be cleaning after removing the retainer.

The charges for tooth cleaning may range from $100 to $200 (Without dental insurance) based on your oral hygiene. Dental insurance may range between $50 to $100.

Can a dentist fix a permanent retainer?

Yes! If your dentist is an experienced guy, he may fix the permanent retainer himself. But in most instances, he may fix an appointment with your Orthodontist who fixes your permanent retainer.

What to do when the permanent retainer becomes loose?

Usually, permanent retainers do not become loose unless they get dislodged from the teeth. In such cases, your dentist may refix the retainer or may advise a new retainer.

A loose permanent retainer indicates that the retainer has dislodged from the teeth at a few points or areas. It should be immediately corrected.

Can teeth move with a permanent retainer?

Permanent retainers are intended to stabilize teeth in each position. They are not intended to move the teeth.

The metal wire in the permanent retainer acts as a splint and prevents the movement of teeth. On the other hand, a removable retainer can move teeth to some extent as the metal wire gets anchorage from the posterior teeth and can force the teeth to move to a certain extent.

Special retainers like Invisalign or Clear aligners force teeth to move or rotate in the desired direction or path.  They are completely different from permanent and removable retainers.

Also read:

10 FACTS EVERYONE SHOULD KNOW ABOUT ALIGNERS

My permanent retainer broke & my teeth shifted. What should I do now?

When a permanent retainer breaks, it should be immediately corrected. Otherwise, there may be a relapse and the teeth may shift from their new place.

When teeth relapse is observed after a broken retainer, you should consult your dentist as soon as possible. If the relapse is mild, it can be corrected by your retainer.

But when the relapse is big, your orthodontist might think of re-bracing your teeth and may extend your braces treatment for a few more months.

How long does a permanent retainer last?

If maintained properly, your permanent retainer may last more than 2 years. Occasionally it may get discolored which might require the replacement of the composite cement on the permanent retainer.

Permanent retainer food restrictions?

Do not eat colored and sticky foods as they stain the retainer and may discolor the retainer after some time.

Hand and high-fiber foods may dislodge the retainer, hence do not bite hard foods with the retainer.

Prevent biting fruits like apples and guava with your front teeth, as it may break your permanent retainer.

Chewing gums or stick foods may dislodge permanent retainer from teeth. Hence avoid them while bearing a permanent retainer.