Retention and post-treatment stability is the Moby Dick of orthodontics. We have been obsessed with the idea that it should be possible to maintain our finished cases in stasis ad infinitum and have chased this white whale for over a hundred years. If you look at our collective passion and beliefs about retention dispassionately, it becomes obvious that we orthodontists are misguided at best and delusional at worst.

We cannot stop the aging process. Everyone agrees that tooth re-crowding is as natural as skin wrinkling so it’s ludicrous to think that we can keep a part of the human body unchanged without removing it, embalming it and encasing it in glass. Why do we take responsibility for something that is wholly out of our control (long term due to growth/aging and short-term due to compliance)? Why don’t we just speak honestly with consumers about we do (make teeth straighter) and be truthful about what’s most likely to happen to their teeth over time?

We don’t think that consumers will balk at purchasing our services if we tell them that:

• Their teeth will shift over time
• Great retainer wear will minimize shifting but it will still likely happen to some degree
• If they don’t wear their retainer faithfully (the majority will not) they will likely need to consider coming back for re-alignment in the future

Here’s a thought experiment. Substitute facelift for tooth straightening. If plastic surgeons guaranteed the longevity of their results in the same way orthodontists do, plastic surgery would have withered and died a long time ago.

We see the retention phase of orthodontic treatment in the same light as physical fitness. Retainers are included in the price of orthodontic treatment as a sort of trial gym membership. If consumers stick to wearing retainers then they will keep their teeth pretty straight in the same way exercise keeps the pounds off. BUT the natural aging process will continue no matter what in both examples.

Unlike Captain Ahab who was dragged to the bottom of the sea by his nemesis Moby Dick, we recommend that you dispose of your orthodontic nemesis and pay no attention to retention! Well, at least have a more practical approach and realistic expectations.

Retention is a complex topic and we orthodontists need to fully understand why we do what we do if we want to have happy patients and less stress. In future posts, we will discuss lifetime retention, lifetime retainers and bonded retainers.

Marc Ackerman

Ben Burris