Orthodontic treatment to align teeth into correct position is not finished when the braces come off. After the orthodontist removes the braces, the patient continues the treatment through the use of retainers, which most often need to be worn indefinitely. There are a few types of retainers, but traditionally, the most common is the removable Hawley retainer, originally designed in the 1920s.
The Hawley retainer is made from acrylic and stainless steel wire. Wire clasps at the end of it cover the back molars and keep the retainer in place. Additionally, a metal bow that spans the length from canine to canine is used. If needed, rubber bands can also be used to provide added support and pressure where necessary. Though the acrylic used is most often a clear pink color, patients can also choose from a variety of colors and designs, including fruits, moon and stars, the American flag, and even school insignias.
The retainer functions like other removable and fixed appliances to prevent wandering of the teeth back into misalignment. Patients with missing teeth need to wear this retainer, along with a pontic (temporary tooth) while they undergo treatment to fill the space with partial dentures, implants or bridges. Patients who have undergone jaw surgery also benefit from a Hawley retainer as the stiff acrylic maintains the space open and the bones in place. Some patients who have minor bite issues can actually use this type of retainer in lieu of braces to correct the issue.
The Hawley retainer tends to be more durable than its clear counterparts (Essix). It is also more convenient for fitting and is more flexible, allowing minor shifting of the teeth as they settle into their new position. However, because it is bulkier, more visible and less aesthetically pleasing, patients can sometimes quit using it before the treatment is complete. In some cases, patients experience difficulty talking because of the bulky nature of the piece.
The retainer will normally be worn full time, except when the patient needs to eat or brush her teeth, for the first six to 24 months. After that, the patient can begin wearing it only at night, but for at least eight hours each day. After a few years, the patient may be prescribed to wear it every other night. Increasingly, orthodontists recommend wearing it like this indefinitely to provide support to the teeth in their correct position. Cleaning should be routine. Patients can wash the retainer and brush it with a toothbrush and some toothpaste. They can also soak it in water with denture tablets a few times a week, which removes any build-up on the surface and eliminates undesirable odors. If a patient is going to participate in any contact sport, it should be replaced with a mouth-guard. When the retainer is part of the braces treatment, its cost is usually included in the total cost. If a replacement is needed and not included, it will cost the patient between $100 and $250. However, for those patients who are using the retainer to correct a misaligned bite, the cost is actually $500 to $1000.
Vignesh P, SumathiFelicita A. Long term effectiveness of various orthodontic retention – a review. IOSR Journal of Dental and Medical Sciences. 2015; 14(2): 56-59. http://www.iosrjournals.org/iosr-jdms/papers/Vol14-issue2/Version-2/M014225659.pdf. Accessed February 4, 2018.