After braces come off: why retention matters

Short answer: after braces or aligners are removed, teeth tend to move back towards their old position, because the surrounding tissues need time to adapt and teeth move slowly throughout life. A retainer prevents this relapse. The choice between a fixed and a removable retainer is individual; the main rule is to wear it as recommended for a long time.

The day the braces come off is a very happy one. But treatment does not end there. The next stage, retention, is at least as important as active treatment for protecting the result. In most patients who come for retreatment the reason is exactly this: the retainer was not worn or was stopped too early.

Why teeth move back

• The gum fibres "remember" the previous position for a while and pull the teeth back
• The bone around the tooth needs time to adapt to the new position
• The tongue, lips and cheeks constantly press on the teeth
• Teeth move slowly throughout life, even in people who have never had treatment
• Growth continues for some time after adolescence

That is why some relapse without retention is very much to be expected. Rotated teeth, gaps between the front teeth and crowding of the lower front teeth are especially prone to coming back.

Types of retainers

Sometimes I recommend two types together: for example, a fixed retainer on the lower front teeth and a clear retainer worn at night on the upper teeth.

Which is better

According to a Cochrane systematic review, there is not yet strong enough evidence to say which retainer is best for everyone. So I choose the type of retainer and the wearing schedule individually for each patient: I consider the initial problem, the type of bite, the state of the gums and the patient’s lifestyle. For example, if there was a large gap between the front teeth or the teeth were very rotated, a fixed retainer may be more reliable.

How long retention lasts

In the first months the retainer is worn more, then gradually only at night. Because teeth move throughout life, I recommend that those who want to fully protect the result wear the retainer at night for a long time, sometimes for years. A fixed retainer can stay in place for years if it is well looked after.

Are wisdom teeth to blame

Wisdom teeth are often blamed for crowding of the lower front teeth. Research does not clearly confirm this link. More: wisdom teeth and braces.

What to remember

• Wear the retainer as recommended and do not stop on your own
• Clean the clear retainer every day and do not put it in hot water, it can lose its shape
• Clean around the fixed retainer with floss or a small brush
• If the retainer breaks, comes loose or the clear retainer starts to feel tight, message me without delay
• Come to check-up visits, the first year is especially important
• Always take the retainer with you when travelling

If the teeth have already moved back

Minor relapse can sometimes be corrected by wearing the retainer again or with a short course of aligners. Larger changes may need retreatment. More: orthodontic retreatment.

Caring for your retainer

Do not scrub clear retainers and plates hard with toothpaste: it scratches the surface and makes the retainer cloudy. Do not leave a clear retainer in hot water, in the sun in a car or near a radiator, as it loses its shape.

Visits during retention

In the first year after active treatment I plan several check-ups: I check that the teeth are stable, the condition of the retainer and the gums. In later years visits become less frequent. If the clear retainer starts to feel tight, you feel the fixed retainer coming loose or notice changes in your teeth, do not wait for the next visit.

What the science says

• Cochrane review (2023): different types of retainers and wearing schedules have been compared, but the certainty of evidence about which is better for everyone is low.