The containment phase, indicated after the end of treatment, is essential to maintain the result
The use of orthodontic braces in childhood or adolescence usually has a basic function: correcting and aligning the teeth. But it is not uncommon that, some time after the end of the treatment, the teeth become crooked again, which generates frustration and the feeling that all the years of effort were in vain.
Throughout life, teeth undergo natural remodeling. Growth in adolescence, aging, habits such as teeth grinding or biting objects and even changes in the bone tissue itself can alter tooth position. “For this reason, a young person who takes off their braces at 16 may still have small movements until the end of their growth and discreet changes in adult life”explains dental surgeon and orthodontist Alexander Cassandri Nishida, professor of undergraduate and postgraduate dentistry at the Albert Einstein Faculty of Health Sciences.
This happens because the tooth is not “glued” directly into the bone. “The root is embedded in a cavity called the alveolus, supported by elastic fibers, which work like small shock absorbers. This is what allows it to move”, details Nishida. “When the orthodontic device forces to one side, a process called bone remodeling occurs: on one side, bone is reabsorbed and, on the other, new bone is formed.”
The role of the retainer device, which will preserve the teeth in the same position, preventing them from continuing to move. “Containment is a fundamental step to maintain the achieved result”says the expert.
How long should I wear the retainer?
Studies indicate that the minimum retention time should be at least twice the duration of orthodontic treatment. In clinical practice, however, the recommendation is more direct: retention should be used as long as the patient wishes to keep their teeth aligned. “If the intention is to preserve the smile throughout life, this will also be the period of use”notes the orthodontist.
The lower teeth tend to be the most unstable, mainly because they have thin roots and are subjected to greater bite loads and harmful habits. Therefore, it is common to recommend fixed retention in the lower arch, with a wire glued behind the teeth, for an indefinite period of time. But you need to take extra care with hygiene. “There is some discussion with other specialties, such as periodontics, as this type of retention can lead to difficulty in cleaning and increased gingival inflammation”pondera Nishida.
In the upper arch, which is generally more stable, it is possible to use removable retainers, such as acrylic plates or transparent models similar to aligners, initially used full time and then only for sleeping. “The choice of the type of containment depends largely on the patient’s profile. Those who correctly follow the guidelines tend to adapt well to removable containment. In cases where we notice difficulty in maintaining the care routine, fixed containment may be the most suitable option”says the expert.
Apparently harmless habits, such as biting nails or objects, and clenching teeth or bruxism are risk factors. Even inadequate oral hygiene can contribute, as gum inflammation weakens the supporting structures of the teeth.
Periodic monitoring of the retainer every six months or at least once a year makes it possible to identify wear or detachment and arrange for replacement. In some cases, digital scans help monitor small changes in tooth position over time.
When to use braces
Common practices in childhood can influence the need to use orthodontic braces. These include prolonged use of pacifiers and bottles, as well as mouth breathing and thumb sucking..
In some cases, so-called interceptive appliances may be indicated, the purpose of which is not to align the teeth, but to stimulate bone growth when the dentist identifies that there will not be enough space for the permanent teeth or when there are changes in bite, tongue position or disproportion between the arches. These treatments are recommended between 5 and 7 years of age and there may be situations in which the child will need this type of device even without a history of harmful habits.
Corrective approaches occur when the permanent dentition is almost complete, between the ages of 11 and 13, and can be done with fixed appliances or invisible aligners to improve the positioning of the teeth and other aspects, such as chewing function, hygiene and breathing.
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