Sometimes while I am surfing the web, I will check what is “floating around” the internet regarding orthodontic topics. I talk to my patients often about retainer options when their braces are removed, and I was surprised to see the amount of information and discussions out there regarding bonded retainers – small wires that are bonded to the back side of front teeth (usually lowers) – after braces have been removed. Like most topics, there is a large amount of credible information available, and an equally large amount of…how shall I put this…baloney? If you are wondering about if bonded retainers are right for you, here is my take on the subject.
First a little about my overall orthodontic philosophy. There are many ways to treat patients orthodontically. There are many MANY appliances, manufactures of braces, wires, instruments, elastics, etc… that all claim to be the best. There are a large number of “systems” that practitioners can choose to follow exclusively, and there are different types of retainers and retention protocols that orthodontists can choose to offer to their patients. Personally, I choose to be educated and aware of all the options that are available to my patients (both cutting edge and traditional tried-and-true), and do my best to make decisions whenever possible according to evidence based practices (from scholarly peer reviewed journals of our profession) mixed with years of clinical experience. Borrowing from Dr. William Proffit’s article about using research to guide clinical decisions:
An orthodontist, like all health care providers, wants to know three things about the treatment he or she is providing: its
effectiveness (how well it works, i.e., how effective it is in dealing with the patient’s problems, taking into account possible negative side effects),
efficiency (how cost-effective it is, with cost in its broader sense to include time and effort for the provider and impact on the patient), and
predictability (the amount of variation in patient response).
Lets look at bonded retainers in light of these three factors.
- Are bonded retainers effective? Meaning, do they work well? Bonded retainers can work extremely well, and I have found there are two main factors that will determine how well they work. Fist, the patient must be determined to be an excellent candidate for the responsibility to have a bonded retainer. After carefully observing the patient’s habits (oral hygiene, their tendency to keep braces intact or to break them often, and overall compliance and responsibility with treatment), I usually have a good idea if a bonded retainer will work well for them. If a patient does not have excellent hygiene practices, I personally will not recommend a bonded retainer until they prove otherwise. Poor hygiene around bonded retainers is asking for failure, with periodontal health risk. On the other hand, excellent awareness and hygiene usually leads to favorable long term prognosis. The second factor is how well the bonded retainer is applied to the teeth by the orthodontic office. I think properly bonding a retainer is one of the most technique sensitive things that I do day to day, and therefore I exclusively place all bonded retainers in my practice. I know this is not the norm, and not efficient for my practice in the short (see #2!)term, but I have found massive gains in effectiveness since I started doing the bonding myself.
- What about efficiency? As stated above, I spend A LOT of time making sure bonded retainers are placed just right. This not cost efficient for my practice short term, but have found that long term the increase in effectiveness and predictability (see #3!) make this overall very efficient. Much fewer re-treating with braces, much fewer failures, and much happier patients!
- Are bonded retainers predictable? In other words, how much variation is expected in how patients respond to the bonded retainers? This is obviously very dependent on the factors that I described above. I find that if I am selective with who are proper candidates for bonded retainers,and treat each patient on an individual basis, bonded retainers are very predictable. Having said that, I can predict that at some point they will fail (break) and will need maintenance. Just like a car, your furnace, or your roof, a retainer needs proper care, maintenance, and sometimes replacement to work properly. Some people will need to wear the bonded retainers for life to maintain aligned teeth, while others may wish to have them removed at some point in favor of removable retainers. It is all individual, and each individual should be treated according to their unique lifestyle, habits, and wishes.
I hear often from patients who come to see me for re-treatment (their teeth have shifted after orthodontic treatment in the past), ” My previous orthodontist never offered me bonded retainers! Why not?” Honestly, I cannot answer that question. Maybe they found that in their practice they were not effective, efficient, or predictable, and never offered then to anyone. Why? Maybe in the past their staff members placed the retainers and they failed often (By the way, some staff members in practices I know are great at placing bonded retainers!). Maybe they did not choose wisely in who are and are not good candidates for bonded retainers, and they failed often. Maybe they did offer bonded retainers in their practice, but choose not to offer one to you based on your hygiene or compliance issues. Or maybe they just liked removable retainers better to avoid the possible negative side effects that some patients can experience with hygiene, maintenance, etc…The important thing is for me to consult with you in the present, and to engage in an honest discussion about the pros and cons of bonded retainers (and the pros and cons of removable retainers), and then determine if they will be effective, efficient, and predictable for you.
Dr. Dan Rejman is the owner of Meadows Orthodontics in Castle Rock, CO. He has been board certified by the American Board of Orthodontics since 2007, and is in his third year serving as the councilman representing the Rocky Mountain and Southwest Orthodontic Societies for the College of Diplomates of the American Board of Orthodontics.