After teeth straightening · Berlin-Mitte
Once the teeth are where they are meant to be, the part begins that decides whether they stay that way. We secure every result in two ways: with a bonded wire and with a removable set of trays.
Why
On the last day of treatment everything looks finished. The teeth are in the planned position, the result is there. What you cannot see: the bone that carries these teeth is still in the middle of its work.
A tooth does not sit rigidly in the jaw. Between root and bone lies a narrow gap of taut fibers, the supporting structures of the tooth. When a tooth is moved, the body breaks bone down on one side so that the bone can give way, and builds new bone up on the other side so that the tooth finds support there. Breaking down is quick. Building up takes longer.
That gap is exactly where the tooth stands at the end of treatment: in the right place, but in a socket that is not yet finished. Added to this are the fibers of these supporting structures. They were stretched and are contracting again, like a rubber band that is released. Together the two pull the tooth back toward its old position, reliably, and without your having done anything wrong.
That is why securing the result is not an accessory and not an add-on sale. It is the part of the treatment that decides whether the preceding months hold.
Phases
With our patients we speak of two stages, because that sets the expectation right from the start.
The passive phase is the less conspicuous of the two. It asks for nothing but consistency, and that is exactly where it most often fails.
We explain this distinction before the first aligner, not after the last. If you know that the treatment has two stages, you do not experience the second as an unannounced extra demand. And that is why retention is in the cost estimate with us from the start, and not on an invoice at the end.
Procedure
A thin wire is attached to the inner surface of the front teeth, in the upper and in the lower jaw from canine to canine, in dental jargon three to three. It cannot be seen from outside and you cannot forget it, because it is always there. That is its strength.
We work with wire made of stainless steel or of gold, or white gold. The choice depends on tolerance and on the situation. Gold alloys are an option when a nickel sensitivity is known or suspected.
Added to this is a set of transparent trays that you insert and take out yourself. We use Vivera retainers, a set of three trays for the upper jaw and three for the lower. They encompass the whole jaw, not only the front, and so they also hold the back teeth where they belong.
Because the set contains several identical trays, there is a replacement if one is lost or damaged. That is more practical than it sounds: a single lost tray is the most common reason why people break off retention.
Principle
Each of the two procedures has a weakness, and in each case it is the one the other does not have.
The bonded wire works around the clock, but only where it is bonded: on the front teeth. It does not hold the back teeth. A bond point can also come loose without your noticing, and then it no longer holds what it is meant to hold. It is even possible for a partly detached or deformed wire to move teeth itself, slowly and unnoticed. That is precisely why it needs to be checked and not forgotten.
The removable set encompasses the whole jaw and so secures the back as well. In return, it only works while you wear it, and experience is unambiguous: wear discipline slackens over the years, in almost everyone.
Together the two cover what the other leaves open. The wire bridges the nights on which the tray stays in its box. The tray secures the areas the wire does not reach, and catches it when a bond point comes loose.
This is a judgment call, not a truth established by studies. Why we make it this way nonetheless is set out further below in the section on the evidence.
Process
The bonded bumps that served as points of purchase during the aligner treatment come off. The tooth surface is smoothed and polished until nothing can be felt any more.
We look at the position in the bite, not only from the front. If anything needs reworking, now is the moment and not after the bonding.
The wire is shaped to the inner surface of the teeth and fixed there point by point, upper and lower, from canine to canine. The area has to be dry while this is done, otherwise the bond does not hold.
A second scan records the new situation, this time with the bonded wire in place. Only then do the trays really fit later on.
The set is manufactured and delivered. You collect it or we send it to you, and we insert it together once and check the fit.
We look at the bond points, the gums and the fit at intervals. The wire is not something you place once and then forget.
Everyday life
Little, but that little over years.
Replacement
This is one of the most common situations and one of the few cases in which people walk into a dental practice with a very specific request: the wire has come loose at one point, or it has come off completely, and the former practice is in another city or no longer exists.
You do not need any prior history with us for this. We look at what is still there, whether the teeth have already moved, and whether the existing wire can be bonded again or has to be replaced.
One thing matters above all: be quick. As long as the teeth are still in place, bonding it again is a manageable matter. Once they have moved, the old wire no longer fits, and then the more unpleasant question arises of whether a correction is needed again before the result can be secured.
The same applies to removable trays that no longer fit or have been lost. Here too a new scan is the first step.
If your retainer came off today, call us instead of putting it on the list for next month. The difference between the two can be a new course of treatment.
Evidence
A systematic review by the Cochrane Collaboration evaluated 47 controlled trials with 4,377 participants on retention procedures. The result: “The evidence is low to very low certainty, so we cannot draw firm conclusions about any one approach to retention over another.”
Cochrane Database of Systematic Reviews, May 2023, Martin and colleagues – PubMed 37219527. The review compares different retention procedures with one another. It does not question that retention is necessary; it concludes that the existing studies are too weak to identify one procedure as superior. What does not follow from this: that the choice is arbitrary.
We write this down because it is the honest answer to a question we are often asked: which is better, fixed or removable? The reliable answer is that there is no reliable answer to it.
What follows from it is our decision and not a study result: if the data do not identify either procedure as the better one, but both have known weak points, then we combine them instead of relying on one. That takes somewhat more effort and closes both gaps.
And one more thing follows from it: if someone sells you a retention method as scientifically proven to be superior, it is worth asking questions.
Costs
Retention is a dental service in its own right and is assessed according to the effort involved under the German scale of fees for dentists (Gebührenordnung für Zahnärzte). If the retention is part of a treatment with us, it is in the cost estimate from the start and not an additional claim at the end.
In adults, orthodontic services, and with them retention, are as a rule not a benefit of statutory health insurance. In adolescents whose treatment ran through the statutory health insurance fund, retention is part of the treatment plan. Private policies cover different things. What applies in your case we clarify beforehand and not afterward.
Questions
As things stand today, for an unlimited period, if the result is to hold. That is not a sales statement but the consequence of the fact that teeth keep moving throughout life, even without earlier treatment. How much retention is still needed after many years is something we discuss as we go.
Not from outside. It sits on the inner surface of the teeth. With your tongue you will clearly feel it in the first few days; after that most people no longer notice it.
Not after a short period of getting used to it. What is noticeable is the tooth care: dental floss can no longer simply be inserted from above, and for that there are floss threaders and interdental brushes.
If it is left unchecked, yes. A loose bond point can lead to individual teeth shifting unnoticed, and tartar forms on a wire that is not cleaned underneath. Both are a reason for regular check-ups, not a reason against the wire.
Because they only work while you wear them. Reckoned over years, every forgotten night becomes a gap in the retention. The bonded wire keeps working on those nights.
Because it only connects the front teeth. It does not hold the back teeth, and if a bond point comes loose you may not notice it for months.
No, but it changes the task. The question is then whether a correction comes first, before the result can be secured. How much effort that involves depends on how far the teeth have moved, and that can only be said from the clinical findings.
Yes. For a loose or lost retainer you do not need any prior history with us. Come soon, while the teeth are still in place.
The set contains several identical trays, so a loss is not immediately a problem. If they are all used up or nothing fits any more, a new scan is the first step.
It is made from a different plastic and is supplied as a set. Whether the material lasts longer in everyday use is something the manufacturers advertise; independent comparisons between retention procedures are, as described above, limited in what they can show. We use the set above all because replacement trays are included.
Whether your teeth were straightened with us or elsewhere: arrange an appointment at Friedrichstraße 80. We look at what is there and tell you how the situation can be secured.
Or call: 030 436665501