Recently, Dr. Cartsos asked me about using Invisalign express to treat some simple orthodontic problems or some relapse orthodontic problems. After explaining to her that I didn't believe in Invisalign express because it was too limiting, I turned to one of the residents listening in, and asked him what he would do if he had a relapse problem after braces removal.
His response was the response I expected which was to use some type of removable retainer like a “spring clip” Hawley retainer. It's important to understand your orthodontic history in understanding why the spring clip Hawley retainer still exists as a choice in our armamentarium. Not only should it be your last choice but it should be no choice.
In the old days, as some of you know, it was necessary to construct braces from scratch. That was orthodontist and staff intensive as far as work. That isn't done anymore nor do we even do anything as labor-intensive as fitting lower incisor bands. When it was necessary to construct bands, figuring out a simpler way with the Hawley retainer seemed like a good idea. Additionally, I think it was much more common for patients to be prepared to wear a removable retainer as part of their orthodontic treatment. Recently, Georgios Kanavakis asked me what kind of removable appliances I used in my orthodontic practice. My response was, after some thought, that the only removable appliance I used was an upper retainer after the braces were removed. To ask a teenagr girl to wear a spring clip Hawley 24/7 is a nonstarter.
So if I was in a situation where I had some minor tooth movement during the retainer phase of treatment, I would think of several options that I might use:
1. My 1st choice would be braces. It is so simple and it works so well. We have the most sophisticated braces available now so why use something as primitive as a removable retainer. If you had to use a removable retainer, the orthodontist would then spend a fair amount of his or her time adjusting it at subsequent visits. I don't want to do that. So I would rather take an indirect impression (done by a dental assistant), do a small amount of lab work (done mostly by a dental assistant with only a small amount done by me), deliver the indirect set up (all done by a dental assistant) place an 18 super elastic arch wire (done by a dental assistant) and then retie this arch wire at each subsequent visit (done by a dental assistant). This way there is virtually no work required by the orthodontist other than what we normally do by monitoring treatment. If the patient had been a good patient during the active phase of treatment, I would do this for no fee and consider it part of my marketing especially if the patient’s mom had referred her friends. By using lower braces I'm also testing the patient's commitment to really fixing the problem. If they are not willing to wear braces, it's not that big a deal to them
2. If I suggested braces and the patient really didn't want to wear braces again but I sensed that it was important to her and to mom especially to mom, I would then suggest Invisalign. I would tell mom that I would do Invisalign for the lab fee and then add 10% to the lab fee for impressions, handling and odds and ends (all done by a dental assistant). I think that's a very fair way to handle a problem like this if braces were not an option.
3. The last way I might do this would be if the problem was a very minor one involving a single tooth. I would take an alginate impression and construct a Essix retainer with pressure on the appropriate tooth.
