It is not uncommon for us as patients to get lazy with our retainer wear. Once we get lazy and start to move away from consistent retainer wear, it doesn’t take long before we are never wearing our retainers. If the orthodontist has done their job and finished the case so it is compatible with all the forces involved in chewing, speaking, and everything else we do that involves the teeth; the patient has done their job by wearing elastics and other auxiliaries, showing up for appointments, keeping good hygiene and oral health; and mother nature has done job by having the muscles and supporting tissues adapt to the new tooth positions, bite and function; the teeth should have some natural stability and retainers are only supportive of the new tooth position and bite.
If teeth do not want to stay straight, or the bite doesn’t want to stay corrected, there are other forces at play to disrupt the tooth position. Oftentimes these forces are not under the control of the orthodontist, or even the patient. Proper diagnosis with realistic treatment objectives and well executed treatment may overcome some of these issues, but human beings are dynamic and constantly changing organisms so it is always like attempting to hit a moving target. Retainers are meant to support the teeth and provide some transition time between orthodontic treatment and the desired establishment of natural physiologic stability.
If a person is fortunate enough to be born with a natural correct bite and beautiful smile, they obviously don’t need braces or any kind of orthodontic treatment. They do not need retainers to support the teeth and bite either. The teeth are able to sustain their position and the nice bite because they are supported in that place by the muscles and functional forces placed on the teeth and supporting structures. It is important to understand that even with this natural stability of the teeth and bite, the teeth are not set in cement and continue to move throughout life. As the teeth wear with use, the muscle tone changes with age and all the natural aging and maturation changes that naturally occur throughout the body are taking place, the teeth will move and change as well. The teeth are not exempt from changing along with the rest of the body. Even people who have been blessed with a naturally beautiful smile will see changes in their bite and the alignment of their teeth over time.
There are some times when the natural changes are more likely to occur, or they tend to occur more rapidly. The late teenage years through the 20’s is one of those time periods. A couple of contributors to this are the potential for a late lower jaw growth spurt, and the eruption of the wisdom teeth. With a normal overbite and overlap of the front teeth, there should be light even contact of the front teeth. If the lower jaw experiences a late growth, it may push the lower front teeth into a heavy contact with the upper front teeth and cause the teeth to move in order to reduce the heavy contacts and prevent damage to the teeth and their supporting structures. If the wisdom teeth are pushing on the 2nd molars as they attempt to erupt, they will push all the teeth forward, changing the bite and also causing heavy anterior contact during function.
It is impossible to predict late lower jaw growth, so all you can do is address it afterwards when it happens. The wisdom teeth can be addressed ahead of time for most people. If the 3rd molars/wisdom teeth do not have the room or are not displaying a favorable eruption pattern, you can expect that they will push on the teeth in front as they erupt. If they get aggressive in their eruption, they can overpower retainers (including permanent retainers) and change the bite and crowd the teeth. Since most young patients complete their orthodontic treatment well before the wisdom teeth will make contact with the 2nd molars and start to erupt, it is wise to evaluate their eruption pattern and make a recommendation regarding their extraction or maintenance.
A high percentage of the time, the wisdom teeth will not be able to erupt into a normal position and function and should be removed early. There are many advantages to early prophylactic removal of the 3rd molars. One of the biggest benefits is that the roots have not fully formed and the teeth are not anchored into the jaw bone so it is less traumatic to remove the teeth, and there is a reduced risk of post-surgical complications. Removing them early also eliminates them from causing unwanted changes to the straight teeth and nice bite that was created by mother nature or the orthodontist.
Another important point is that even if the orthodontist determines that the wisdom teeth are expected to erupt into a normal position and function and there is no orthodontic reason to remove them, there may be very valid reasons for the dentist to recommend their removal. If the dentist recommends extraction of the wisdom teeth, it is best to follow this recommendation even if the orthodontist does not find it advisable for post-treatment stability of the bite and tooth alignment. Once the 3rd molars are removed, you no longer need to worry about any of the multiple problems and complications that can make life miserable if they are left in place and they are not in a normal position and function.
Besides 3rd molar impaction and attempted eruption, and late lower jaw growth, there is a natural change that takes place in the tooth alignment and bite that occurs with aging and maturation. These changes affect everyone, not just those who have had orthodontic treatment. Everyone who has been blessed with an ideal bite and tooth alignment naturally will also experience some changes as they age. The natural aging changes that occur are not considered favorable. Whether we look at the skin, hair, bones, muscles, or teeth, the natural changes that take place with age are usually fought with a vengeance. The way we fight the tooth changes is with retainers. Without lont-term retainer wear on some consistent basis, the natural changes occur without restriction.
This brings us full circle to the point of this blog which is invisalign touch up treatment. Since most of us who had orthodontic treatment have not kept up with our retainer wear, we have experienced some of the natural changes that take place over time. If we did not have orthodontic treatment, we never had any retainers to restrict the natural tooth movements and have experienced those changes as part of life. Either way, we may find ourselves in a position where we would like to make some changes and straighten our teeth.
Aligners are an excellent way to address these changes. A short series of aligners may be all it takes to re-align the teeth and make minor adjustments to the bite to recapture the natural or post-treatment bite and straight teeth. With aligners offering an alternative to going back into braces to provide a tune-up, it makes it easier than ever to address the changes that mother nature throws at us throughout our lifetimes. It is great that our teeth are not set in cement, otherwise we would be stuck with the problems we face. As it is, age is not a factor in our ability to move the teeth, it just takes a little longer because we are more set in our ways, and so are the teeth. This slightly stubborn streak can be overcome with an invisalign tune-up and we can have a second chance to do better with our retainer wear so we enjoy the ideal natural beauty we have achieved with treatment and a tune-up later in life.