Bonded (Permanent) Retainers- Pros and Cons

I was asked to weigh in on a facebook discussion about bonded retainers.  The opinions ranged from “why would you want to attach something to your teeth forever,” “They are hard to clean because you have to floss under them (or waterpik around them), ” “they promote tooth decay and periodontal disease because of plaque build- up (i.e  it is difficult cleaning around them) “ to “at least you can’t lose them” and “they keep the front teeth looking straight so you haven’t thrown your money out for the braces when everything moves.”

I loved this opinion:

“If it helps to hear a positive old-school retainer story: my kids have managed to not only NOT lose, but use their retainers for five years now. They can keep track of keys and wallets too. It's not a bad skill to develop and less risky than the permanent option.”

I also enjoyed reading this one:

“I sometimes wonder when orthodontists recommendations cross the line between good dental health and strictly cosmetics reasons. I probably could have used a permanent retainer, but the slight crookedness of my lower teeth has never had a bad impact on my dental health. I would want a second opinion and a very detailed explanation why a permanent retainer was necessary.”

Here is how I responded:

Teeth will move your whole life- from any force that is put on them. This includes over-bulked fillings that make the contact too tight, mouth habits (such as pencil biting, improper tongue posture, clenching your teeth), and aging (which causes the lower jaw to rotate forward "throwing" the lower front teeth against the upper front teeth.) Some orthodontists choose to "guarantee" the lower front teeth stay straight with respect to "each other" by bonding them together. This does not stop them from moving as a unit! It can also have other undesirable side effects (such as creating space between the upper front teeth, or pushing the lower jaw backwards causing clicking in the temperomandibular joints) in patients who clench their teeth. It is necessary to floss or waterpik the bonded retainer daily to prevent gum problems, and to have it checked every year to make sure that it is still bonded securely- otherwise you can get decay under it.

 "Invisalign" or "Essex" vaccuum formed retainers stretch-out over time so that they become less effective, and they prevent posterior teeth from settling fully into occlusion (i.e. they prevent your bite from working properly) when used long term.

 I still prefer removable hawley style retainers (with a shelf on the front of the top one for vertical control)- worn full time when the braces come off, and then just “at night” after the first year- at least til the patient stops growing. (I switch to an occlusal guard if the patient is a clencher.) If the braces were worn as an adult it is likely retainers will be needed at night forever.

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