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Why are so many patients from other orthodontic and dental offices calling our office for replacement retainers?

Why are so many patients from other orthodontic and dental offices calling our office for replacement retainers?

A Lot of People Ask for Hawley Retainers. Learn why.

While we get many people calling our office, one this particular week was different. A mother who was looking for a specific type/style of retainer called a Hawley Appliance called multiple offices until she found one that could provide it. Ours. The Hawley, which happens to be my gold standard of retention under most circumstances, fits all of the variables that need to be addressed during a lifetime of orthodontic retention and maintenance but for one that is evidently falling out of favor with the public and offices.. What variable is that? The Hawley is bulkier and has at least one visible wire! Evidently, aesthetics of the appliance which the clear trays can provide has made them quite popular, but are they as effective? They are certainly quicker, easier and far cheaper to make. It takes me, quite literally, 5 minutes to produce one from model to the patient’s mouth .in my office. So why do I insist on providing the Hawley for all my patients? Let me elaborate.

The Differences Between Retainers

Let’s look at the differences in how dental appliances provide retention of your teeth. The trays that are provided at the end of treatment are based on the positions the last treatment trays put the teeth into. These may or may not be accurate depending on the movement expressed in the last tray. And while the trays are made of ever-increasing thicknesses of acrylic, they still must have enough flex in the material to be able to expand and constrict over the contours of the teeth. As a result, there are times that teeth can actually move and still manage to fit within the tray as the tray “adjusts” to the new position. The Hawley provides absolute maintenance of the positions of the teeth when the impression was taken due to the stiff nature of the minimally flexible acrylic used to construct the appliance. This serves as a check to the patient as even the slightest of changes signal to the patient that the retainer needs to be worn more often than its being presently worn. This will not happen with very slight changes within a tray retainer.

To combat the changes that occur with the tray retainers, more frequent replacement of these trays needs to be done. Early on, it was suggested that they be replaced every 3-4 months and there were, and perhaps still are, companies that automatically send out replacements, for an annual fee, new ones, just like contact lenses! Since they have replaced the thinner, more flexible trays with thicker ones, replacements are not needed as often. However, contrast that with a Hawley, which can and most often does, last for years, in some cases, decades, effectively providing excellent maintenance. But that’s just part of the story. What happens when you are biting on ever-thickening acrylic instead of your teeth?

Hawley Versus Trays

One of the basic tenets of retention we learned decades ago was to avoid covering the teeth unless grinding or clenching needed to be controlled or if overbite and its re-occurrence after full treatment needed to be managed long-term. Unfortunately, full coverage of the occlusion of the teeth cannot be helped with one or two trays in to maintain the alignment. Some people undergo change in their bite unintentionally when using a tray(s) and can then involve problems such as TMJ disorders. By contrast, occlusal contact can be fully controlled with the Hawley, either by making sure no occlusal interferences occur or by intentionally addressing the potential for a return of overbite with selective placement of acrylic within the Hawley framework.

If you are getting the idea that the Hawley is a versatile appliance and the tray is not, then you are absolutely correct. The Hawley has the ability to be adjusted to make small, incremental changes in the positions of teeth, or allow adaptation to the teeth as some late developing skeletal changes occasionally occur in the late teens and early twenties, it can help address certain joint issues that develop later in life, it can easily identify what teeth are moving by how a tooth moves away from the indexing of the plastic next to each tooth. It is an appliance that is dynamic in its ability to adapt and improve the overall occlusion of the patient through its useful life with additional modifications at any time, not static in its single position as in a tray.

And for those patients that are concerned that this appliance will be visible to friends, schoolmates and colleagues, please read on. In my office, I ask patients that are coming out of any full appliance treatment using the Skarin System, the century-old edgewise, or an aligner, to do only wear their retainer tray at night-time for six weeks. Why six weeks? If you have ever sustained a broken bone short of your leg, the orthopedic surgeons will keep you in some form of restraint for that period of time so the new osteoid bone that set following the break can properly heal and callous. The same goes for the newly-laid down osteoid bone surrounding the recently moved teeth. So, I would highly suggest that patients get through the first six weeks of retention followed by a much better form of retention with Hawley retainers than with trays. After all, in my office retention is for the ages, not for the short-term aesthetics!

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