Retainers After Clear Aligners: How Long Do You Wear Them?

What is retention (a retainer) after clear aligners?

Retention is the phase after orthodontic treatment ends that keeps the teeth in their new position, and the device used for this purpose is called a retainer. Teeth straightened with clear aligners and teeth straightened with braces both tend to return to their former positions when treatment ends; this is called relapse. A retainer prevents this tendency. The generally accepted schedule is: all day for the first 3–6 months except during meals and tooth brushing, then only at night, and over the long term regular nighttime wear for life. Your orthodontist may adjust this schedule for your case. Retention is not the end of treatment but its final phase; the months and effort spent on active treatment are largely wasted if this phase is neglected.

Why do teeth shift back after treatment?

Teeth are not attached directly to the bone but through a thin connective tissue called the periodontal ligament and through gum fibers. Treatment moves the tooth to its new position, but these fibers and the surrounding bone need months to adapt to the new arrangement. The gum fibers in particular "remember" the old position for a long time and pull the tooth back. In addition, the following factors increase relapse:

• Correction of rotated teeth: these teeth have the highest tendency to move back
• Closing gaps between teeth: the space tends to reopen
• Crowding of the lower front teeth: it tends to increase with age in everyone
• Habits such as tongue thrusting, thumb sucking and nail biting
• Continued jaw growth in young patients
• Eruption of wisdom teeth (its effect is debated, but it is monitored)

Since teeth are known to move slightly throughout life, retention is today considered a long-term practice rather than a temporary one.

What types of retainers are there?

Removable clear retainer

It resembles the aligners used in treatment but is made from thicker, more durable thermoplastic material. It does not move the teeth; it only holds them in their current position. Advantages: it is hard to notice, easy to put in and take out, and covers all the teeth together. Limitations: it wears out and may need to be replaced every 1–3 years, it can be lost, and it wears faster in people who clench their teeth. It is the most commonly chosen type after clear aligner treatment.

Fixed (bonded) retainer

This is a thin wire bonded to the back surface of the lower and sometimes the upper front teeth. It is invisible from the outside, cannot be removed and does not depend on patient compliance; it is often used for long-term protection of the lower front teeth. Limitations: a special floss threader is needed for flossing, the wire can break or come loose at one point and, if this goes unnoticed, that tooth can shift; it is prone to tartar buildup and needs regular check-ups. A fixed retainer is often used together with a removable clear retainer.

Hawley (wire) retainer

This is the traditional retainer, made of an acrylic palate section and a metal wire running across the front of the front teeth. It is durable, adjustable, can be used for years and allows the teeth to settle into their natural bite. Its limitations are that the front wire is visible and that it affects speech in the first days. Today it is chosen less often after clear aligner treatment, but the orthodontist may specifically recommend it in some cases.

How long is a retainer worn?

1. First 3–6 months (full-time): Worn all day, 20–22 hours a day, except for meals, drinks other than water and tooth brushing. The gum fibers and bone reorganize during this period; it is the most critical phase.
2. From month 6 up to 1–2 years (nighttime): Worn every night while sleeping. The orthodontist may move this transition earlier or later depending on how stable the teeth are.
3. Long term (for life): Wearing it every night, or at least 3–4 nights a week, is recommended. If the retainer feels tight after one night without it, the teeth have started to move; this is a sign that you need to wear it more.

A fixed retainer can stay in place for years as long as it does not break or cause hygiene problems; it is not removed unless there is a reason to. The wearing schedule is individual and is updated at check-ups; after treatment, check-ups are usually every 3–6 months in the first year.

What happens if you don't wear a retainer after braces come off?

If no retainer is used after braces or clear aligner treatment ends, the teeth start to shift back. The process usually goes like this:

• First weeks: The change is not visible, but the gum fibers have started pulling the teeth. A retainer feeling tight after a few days without it is a sign of this.
• First months: Rotated teeth partially turn back, closed gaps start to reopen, and slight overlapping appears in the lower front teeth.
• 1–2 years: Crowding of the front teeth becomes noticeable; the bite can change. In some cases the teeth come close to their starting position.
• Long term: The lower front crowding that naturally increases with age is more pronounced without retention.

What can be done once shifting has started? If the shift is small and the retainer still fits, the orthodontist may have you wear it full-time again. If the retainer does not fit, do not force it in; it applies uncontrolled force to the teeth. In this case the orthodontist can realign the teeth with a short series of clear aligners and make a new retainer. The earlier the shift is noticed, the shorter the correction. There are also advanced relapse cases in which treatment must be repeated from the start; the way to prevent this is not to stop retention.

How do you clean and store a retainer?

• Brush the removable clear retainer every morning and evening with cold water, a soft brush and a little liquid soap; do not use hot water or toothpaste.
• Soak it in an aligner cleaning tablet for 15–20 minutes two or three times a week; for a retainer used for months, this matters even more than for treatment aligners.
• Always put it in its case when you take it out; do not wrap it in a napkin.
• Clean a fixed retainer every day with a floss threader or an interdental brush; do not skip professional tartar cleaning.
• Keep it away from heat, sunlight and pets.

Cleaning details are on the how to clean clear aligners page.

Retainer problems and what to do

• The retainer is lost or broken: Call the clinic without waiting. A new scan or impression is needed for a new retainer; the teeth may move slightly in the few days in between. Keeping a spare retainer reduces this risk.
• The retainer feels tight: If it was not worn for a few days, the teeth have shifted slightly. If it fits, wear it full-time for a few days; if it does not, do not force it and show it to the clinic.
• One point of the fixed wire has come loose: You may notice it catching on your tongue or a tooth moving. Go to the clinic as soon as possible; the wire is rebonded.
• The retainer has yellowed or smells: This is resolved with cleaning tablets and regular brushing; if it does not improve, a new one is made.
• The retainer has cracked: With a small crack, keep wearing it and let the clinic know; with a large break, a new one is needed.

Is retention included in the fee?

Whether the retainer is included in the treatment fee varies by clinic and by the system used; with some systems the first set of retainers comes with the plan, with others it is produced separately. Replacing a retainer that wears out over the years is usually charged separately. This information should be included in the written fee information given at the start of treatment; the factors that determine the fee are explained on the clear aligner prices page.

Summary: what to keep in mind during retention

1. Start wearing the retainer as soon as treatment ends; any gap in between allows the teeth to shift.
2. Wear it full-time for the first 3–6 months, then every night.
3. Do not stop wearing it completely over the long term; teeth move throughout life.
4. A tight retainer is an early warning; wear it more and tell your orthodontist.
5. Have your fixed retainer checked regularly and do not neglect flossing.
6. Do not wait if it is lost or broken.

The retention schedule is set by your orthodontist according to the initial condition of your teeth, your age and the movements made during treatment. You can find how active treatment progresses on the how clear aligner treatment works page, and how the result is maintained on the clear aligners before and after page.