Braces are a huge time and money commitment, so it makes sense to try to maintain those beautiful results at all costs. But despite your best efforts, you might be seeing some relapse. So why do teeth move despite wearing a retainer, and how do you make it stop?
I know it’s disappointing to see your precious smile come slightly out of alignment, but the honest truth is that maintaining that level of perfection isn’t always possible. I always warn my patients of the chance of some shifting so they adjust their expectations.
In this article, we’re going to cover why teeth move after braces even with wearing a retainer, how we can minimize that movement, and what retainers are best for this.
Why do teeth move even though you’re wearing a retainer?
Teeth will ALWAYS want to shift after orthodontic treatment, at least during the first year. That’s why we give our patients retainers and warn them of the need for long-term, sometimes life-long retention.
This is because braces will move teeth out of balance. Braces create an entirely new bite which may not be as stable as your old, natural bite. Additionally, we have the muscle pressure of the cheeks and tongue pushing against teeth in an antagonistic way.
And lastly, most importantly, we have the gum fibers that are now very stretched and it will take a more than a year to adapt to the teeth’s new location. Imagine these periodontal ligaments like dozens of tiny elastic bands pulling your teeth back to their old place inside the bone.
Now that you know why teeth move, let’s explore some of the practical reasons:
1. Improper Use of Retainers
You might think you’re wearing your retainers enough, but is that really true? It’s important to wear your retainers as instructed by your orthodontist. For the first 2-3 months, you should wear them full time, except when eating and brushing. After this initial period, retainers should be worn every night without fail.
Not following these guidelines can result in improper use of your retainers, causing your teeth to move back and forth. This constant shifting can eventually lead to loosening of the teeth.
You may find that your teeth are shifting slightly during the day, only to come back into alignment after wearing your retainer at night. If you notice this movement, increase the time you’re wearing your retainers.
2. Correcting Severe Crowding and Rotation
Rotated teeth are the most prone to relapse, meaning they have a higher likelihood of shifting back to their original position even after orthodontic treatment. This is especially true for bottom incisors, which are the weakest teeth and often the chief complaint among patients. The top front teeth also tend to raise concerns.
One of the main reasons for this relapse is the presence of transseptal fibers, which are the stretched gum fibers we talked about. These fibers can pull on teeth, attempting to move them back to their old location inside the bone. This is particularly problematic when the new bone around your teeth is still soft, as it’s more prone to allow shifting.
3. Unstable Occlusion Pushing Teeth Out of Balance
Sometimes, your teeth may be in an unstable location under the force of your bite. This can be traumatic for them, causing them to be pushed out of alignment.
Due to this, even with a retainer, your teeth might still move ever so slightly. It’s important to be aware of this situation and consult with your orthodontist. They will inspect your bite and make small adjustments, grinding certain areas of the enamel on your back teeth so that the occlusion becomes more stable.
4. Type of Retainer: Hawley Instead of Essix
When considering retainers, your orthodontist might recommend a Hawley retainer over an Essix retainer. Hawley retainers are better at settling your bite, but they may allow for slight movement, particularly with small incisors. So if you notice shifting, it may be because your removable retainer isn’t snug enough.
On the other hand, Essix retainers fit more snugly and don’t allow teeth to move much. However, they have some disadvantages compared to Hawley retainers. Ultimately, it’s up to your orthodontist to decide which retainer is best, but it’s never too late to switch retainers or make new ones.
Which retainer is best to prevent relapse
If you ask about the best type of retainers, you’ll get mixed opinions. Removable or fixed? Essix or Hawley? A combination of all of the above? The type of retainer you’ll get is up to your doctor’s preference, but here’s my opinion on this.
To prevent relapse, it’s best not to rely exclusively on the patient’s cooperation. This means we should always have a plan B. As a result, many orthodontists choose a combination of fixed and removable, meaning:
- A fixed bottom retainer and Essix removable retainers.
- A fixed bottom retainer and Hawley removable retainers.
- When the occlusion allows it, top and bottom fixed retainers and Essix or Hawley.
We tend to avoid fixed retainers on top teeth just because they break so easily and it’s hard to find the space to bond them on the back of top incisors.
Thank to this fixed & removable combination, whenever the patient forgets to wear the removable retainer, their front teeth will still stay straight.
You may ask – why not just bond fixed retainers then be done with it?
Well, the truth is, fixed retainers are awful. There, I’ve said it. They may be great at keeping your teeth in one spot, but think of them as permanent braces on the back of your teeth. They will accumulate tartar, break every once in a while, and, worst of all, they may shift your teeth even worse than having no retainers at all.
Some fixed retainers can go rogue and slowly unravel over time, because they’re made of a twisted wire. If left unchecked, some retainers can move a tooth or even groups of teeth into incredibly crooked positions and you may need braces again.
My personal preference over the years has shifted in favor of removable retainers, and I’ve ditched fixed retainers altogether. I’d rather have slightly shifted teeth and a stable bite than risk all the side effects that come with bonded wires on patients’ teeth.
How to minimize teeth shifting after braces
Having your teeth go back and forth every day isn’t a fun feeling, and it’s not healthy either. While some movement is normal after braces, the fact that some teeth are resisting to stay in alignment should give us some clues about what’s going on.
It’s always a good idea to start with the first, most obvious solution:
1. Wear your retainer more hours per day
If it’s indeed user error, and you’re not wearing your retainer enough, you should see your teeth stabilize within one to two months of full time wear of your retainers.
Don’t do this indefinitely, though. Address your orthodontist if you’re still seeing mobility in your teeth and slight rotations or crowding. Poor-fitting retainers can cause damage, so it’s best not to ignore this issue.
2. Get a new retainer
If you’re struggling with teeth moving, and getting your retainer on and off is a tedious and painful procedure, it’s probably best to get a new retainer.
This means accepting the current situation that includes some shifting. It might not be perfect, but it’s healthy. I always advise my patients to accept the tiniest bit of rotation or crowding, and warn them about the possibility (more likely, the reality) of a slight relapse.
Most of the time, no one will notice your teeth moved but you, and your new retainers should feel much better.
3. Get your bite fixed
I know, braces are supposed to do that, right? Well, it would be nice, but that doesn’t always happen. Bite trauma can cause relapse too, but it’s up to your orthodontist to decide if that’s the case.
Teeth have many bumps and ridges that can interfere with what a good, stable bite feels like. In time, the enamel wears out in certain areas that are most in contact, but until that happens, your bite might feel a bit strange. Some teeth may experience more force than others and may start to move as a result.
To prevent your teeth shifting from bite trauma, your orthodontist or dentist will take a look at your bite, check it with occlusion paper, and grind tiny areas of enamel to release certain tight spots and make everything settle better.
In the end, if your teeth have moved visibly and it’s bothering you, it’s an easy fix. Get braces a second time on those particular teeth (don’t worry, this relapse treatment should only last a few months), or get a couple of aligner trays to quickly get your teeth back into position.
If you’re adamant about your teeth staying perfectly aligned, ask your orthodontist for a fixed retainer in addition to the removable ones you have. Keep in mind that you’ll need to check the fixed retainer often and get your teeth professionally cleaned on a regular basis. Hopefully that will fix your shifting issue. Good luck!