According to the Greek philosopher Heraclitus (c.500BC), “the only constant is change”.
The human body is evidence of this. Most of your tissues are undergoing constant renewal (or “cell turnover”). Red blood cells live for 120 days, the epidermis of your skin is replaced every 2 weeks, the adult skeleton every 10 years. (A few tissues are not replaced… the neurons of your cerebral cortex for example).
The problem for orthodontists is that teeth sit within the supporting tissues (bone and gums) which are continually changing over time either through cell turnover or normal growth (this occurs throughout life, albeit slowly in later years).
And there are other factors at play when teeth are moved. If braces move front teeth too far forwards, the lips will tend to pull back on the teeth after braces are removed. This constant lip pressure can move teeth backwards, making them crooked again.
There is also the “recoil” of the tissues themselves. If you looked at a piece of gum under a microscope you would see tiny elastic fibres which become stretched when teeth are moved with braces. It’s as if there were thousands of stretched elastic bands wanting to pull the teeth back to their original position.
So after putting all the hard work into getting teeth into line, how can we keep them that way for years to come? How do we minimise orthodontic “relapse”?
Careful treatment planning
Specialist orthodontists undergo a lot of training. A five year dental degree, further professional examinations and then three year postgraduate orthodontic training.
That training equips us with the skills to plan orthodontic treatment carefully so that orthodontic relapse is less likely.
A common decision that we must make is whether teeth need to be extracted before braces are fitted. If teeth are very crooked and braces are fitted without extractions, there may be a risk that teeth could crowd back up again after braces are removed.
Providing our patients with good retainers after treatment
Orthodontic retainers hold the teeth in position after braces are removed. These allow the elastic fibres in the supporting tissues to remodel around the newly repositioned teeth. Once this remodeling has occurred, there is less likelihood of relapse.
But orthodontists advise retainers to be worn for as long as our patients want their teeth to remain straight. This is because we know that jaw growth continues throughout life.
Retainers come in all sorts of varieties, We provide clear removable retainers which hold the teeth in place whilst also being comfortable to wear.
Professionals and patients working together
A liver damaged by alcohol-related cirrhosis can be transplanted but the treatment may ultimately fail if the patient continues to drink. As with lungs and smoking. And with dental fillings and sugar consumption.
There is an element of “contract” between professionals and patients for many medical and dental procedures and orthodontics is no exception. There are responsibilities on both sides which need to be made clear before treatment is even started.
Our patients are counselled regarding the need for long term retention before treatment starts. When braces are removed we ensure we give the correct advice on retainers wear, how retainers should be maintained and what to do if there are problems.
It is our responsibility as healthcare professionals to ensure treatment is planned correctly, carried out to a high standard and that suitable retainers are provided. But our patients are responsible for good retainer wear.
Oops…I haven’t been wearing my retainers…what can I do now?
If your teeth have gone crooked again after braces…don’t panic!… there are options for you. And the sooner you let us know, the simpler the options will be!
Click here: What are my options for re-treatment?
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