Dentists: Weigh in on the Pros and Cons of Permanent Retainers

after braces
  • A permanent retainer is a wire or metal bar that is bonded to the back of the lower front teeth.
  • This device prevents teeth from drifting apart or crowding together.
  • Permanent retainers can be removed if they cause pain or other complications.

Because teeth will naturally move on their own if they are not held in place, your orthodontist or dentist may recommend a permanent retainer after you’ve had your braces removed.

In this article, we explain the pros and cons of getting a permanent retainer, with some advice from the experts on making the choice that’s right for you.

What is a permanent retainer?

A permanent retainer, also referred to as a bonded retainer or fixed retainer, is a wire or small metal bar that holds your teeth in place and prevents them from moving after an orthodontic treatment. This helps prevent issues such as gapping or crowding.

Many orthodontists and dentists bond a permanent retainer to the inside of the lower front teeth.

“The lower front teeth have the shortest, smallest roots, which means that they’re more likely to shift over time due to their smaller foundations,” explains Dr. Seth Newman, an orthodontist practicing in Roslyn Heights, NY. “If we look at someone who had previous orthodontics and was not the most diligent about wearing retainers, without a doubt it’s the lower front teeth that have started to shift.”

A permanent retainer affixed to the lower front teeth.

Pros of a permanent retainer

A permanent retainer eliminates the chance of human error — you can’t forget to wear it.

“One of the best features of a bonded, permanent retainer is that it takes the pressure off the patient to comply with ‘doctor’s orders.’ Because the retainer is permanently cemented to the teeth, the patient doesn’t have to worry about remembering to wear it every night, or keep it clean outside of regular oral hygiene,” says Dr. Robert Rudman, an orthodontist practicing in Denver.

A permanent retainer is also invisible because of its location and is often thinner and more comfortable to wear than a wire removable retainer.

Lastly, while a permanent retainer usually requires an adjustment period, many individuals find that eventually, they forget they even have one.

Cons of a permanent retainer

There are several drawbacks to permanent retainers. They can make it difficult to properly clean teeth, whether brushing at home or having them professionally cleaned by a dental hygienist. Also, the wire can trap food, bacteria, and other debris, increasing the risk of dental problems, especially if you don’t brush and floss regularly.

Like any type of dental hardware, permanent retainers can become damaged or wear down over time, so you may have to replace it at some point.

“Despite the name, a permanent retainer can still break down and require replacement, which is more involved than replacing a set of removable retainers,” Dr. Rudman clarifies. “Some patients also experience issues similar to those caused by braces: poking and rubbing of soft tissue by the appliance, restrictions on hard and sticky foods, and difficulty maintaining oral health.”

Furthermore, since permanent retainers are only affixed to the front teeth, they can’t help keep side or back teeth aligned. If your dentist has concerns about your other teeth moving, a permanent retainer might not be enough to maintain your orthodontic results on its own.

Who should get a permanent retainer?

Not everyone is a good candidate for a permanent retainer.

“Some orthodontists and dentists choose not to use a permanent retainer because of the habits of the patient, such as poor hygiene or eating foods that continually cause the retainer to become detached from the back of the teeth,” explains Dr. Bobbi Stanley, who has been practicing dentistry in Cary, NC, for more than 20 years.

You will need to be extra vigilant about cleaning around the retainer, which can take extra time and effort. Flossing in particular can be tricky, since you need to floss above and below the retainer wire. A water flosser, floss threader, or other devices can make this task easier. However, if you’re not that committed to your dental hygiene, a removable retainer may be a better option.

In fact, many orthodontists combine a permanent retainer with a removable retainer.

“Permanent retainers are not a total substitute for the removable versions, as they can only be placed on the front teeth and don’t do anything to retain the side or back teeth,” Dr. Newman explains. “For this reason, we typically ask a patient to wear a removable retainer along with the permanent one, as it’s the combination of the two that will keep teeth looking amazing for years to come.”

Should you ever have a fixed retainer removed?

Though the name might suggest otherwise, a permanent retainer can indeed be removed. The dentist or orthodontist will remove the bonding cement with a dental drill, detach the retainer, then clean and polish the teeth.

“Sometimes dentists will recommend removing permanent retainers if the patient is repeatedly breaking the bonding or has a severe buildup of calculus (hardened plaque) around the permanent retainer,” Dr. Stanley says.

And of course, if the permanent retainer is causing you any pain, you should talk to your dentist or orthodontist to have it repositioned or removed.

Do not attempt to remove the retainer yourself as you can damage your teeth or gums — seek out a professional.

Alternatives to a permanent retainer

If you choose not to wear a permanent retainer, the alternate is a removable one. In general, these retainers are worn on the following schedule:

  • First six months, day and night
  • Second six months, at night only
  • Next three months, every other day, at night only
  • Then two nights a week, for three months
  • Then one night a week, for life

There are two types of removable retainers — wire and transparent — both of which are custom-fitted to the patient’s mouth.

Wire retainers (known as Hawley retainers) are made of an acrylic dental arch with wires extending out from it to keep teeth in place. They are quite durable, but some wearers find them bulky and uncomfortable.

Transparent retainers (known as Essix retainers) are made of transparent plastic. A mold is taken of the teeth, and then the clear plastic is shaped to fit the mold.

Clear retainers are relatively thin, making them more comfortable to wear than wire retainers. They’re also transparent — a definite plus for those who must wear their retainers during the day.

A clear retainer is not as durable as a wire retainer, especially if you grind your teeth or otherwise subject it to extra wear and tear. An orthodontist will be able to provide advice on the option that’s best suited to your lifestyle and needs.

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