The Instagram age and pandemic-era video conferencing are motivating more and more Australians to straighten their smiles. The emergence of clear aligners means patients no longer need to put up with unsightly traditional braces on their quest for perfect teeth. That — and the lower cost of aligner treatments versus traditional braces — is making it more attractive than ever for Australian adults to discreetly straighten their teeth.
In fact, according to a report by Meticulous Research, the Asia-Pacific orthodontics market is tipped to grow to a staggering $4.2 billion by 2025. And growth in the clear aligner market is also having a flow on effect on demand for post-orthodontic retainers. That’s because retainers are required following clear aligner treatment. And there’s no sign of the market slowing, because many orthodontic patients will need to wear retainers for years, if not for the rest of their lives.
Just like traditional braces, clear aligners slowly loosen ligaments and connective tissue to pull teeth into place over time. But those fibrous connections are not set in stone. Once aligner treatment is complete, the patient’s teeth can easily move back out of alignment, seemingly overnight. This, of course, is frustrating for the patient and can destroy even the most successful aligner treatment outcomes.
Retainers are used to solve this problem. Post-orthodontic retention is crucial for maintaining successful treatment outcomes into the future. That means lots of ongoing follow-up appointments and more opportunities for dentists to build life-long relationships with their patients.
But there’s a downside too. Patients can and do lose, damage and break their retainers over time. Removable retainers often need to be replaced, and if you want to do that quickly, you’ll need to keep patient scans on file to send straight to your dental lab so they can manufacture the replacement retainers. Those digital scans can be very large files, so you’ll either need on-site server space or a cloud storage provider. On-site servers can come with some steep IT set up and maintenance costs, or you’ll need to pay data hosting fees to your cloud storage provider.
Unless you partner with a modern digital dental lab. At Avant Dental, for example, on request we can store patient scans and case files for you in our lab management system so you don’t have to pay to store them yourself. But more on that later. First, let’s take a look at the different types of retention solutions available, and their pros and cons.
There are two overarching categories of retainers — permanent and removable.
Permanent retainers are referred to as fixed, lingual wire or bonded retainers. They essentially consist of a solid or braided lingual wire that is bonded to the inside of the patient’s teeth. Permanent retainers are most often used on the lower teeth, and some dentists may choose to recommend a permanent retainer when the retainer needs to be retained indefinitely, or if there is concern the patient may not adhere to wearing removable retainers as instructed. A good laboratory will include a putty guidance key with the lingual wire which provides the dentist with a tool to engage the lingual wire in the exact position to achieve optimal patient outcomes.
Removable retainers are fitted over the patient’s teeth, and are generally removed when the patient wants to eat and when they brush or floss their teeth. There are two types of removable retainers — Hawley retainers and clear plastic retainers.
Hawley retainers may also be referred to as wire retainers. They tend to consist of a thin metal wire attached to a plastic or acrylic plate that is shaped to fit the roof of the patient’s mouth. The metal wire curves around the outside of the patient’s teeth to maintain the appropriate alignment.
Clear plastic aligners are also known as an essix or pressure-formed retainers. These are essentially a thin plastic or polyurethane mould that encases the patient’s teeth. They typically do not include a metal wire. Rather, a mould of the patient’s teeth is made, and the plastic or polyurethane material is heated and -pressure-formed as highlighted in the above photo.
As the permanent retainer consists of a wire that is bonded to the inside of the patient’s teeth, they are essentially invisible. They are also very durable, it’s difficult for the patient to damage them, and they can’t be lost. Permanent retainers are also unlikely to affect the patient’s speech, and don’t require the patient to follow wear instructions in order to achieve a successful outcome.
However, there is a downside to permanent retainers. Some patients can find it challenging to maintain proper oral hygiene, and some complain that permanent retainers irritate the tongue. Permanent retainers should be cleaned daily with a threader that enables the patient to floss underneath the wire. This is required to remove food, and avoid plaque and tartar build up. If not properly cleaned, permanent retainers can contribute to gum disease.
Let’s start with Hawley retainers. Hawley retainers are typically adjustable, so it’s easy for the dentist to make slight adjustments to maintain the correct alignment. They are also slightly more durable than clear plastic retainers, and may be repairable depending on the type and extent of the damage.
On the downside, the metal wire runs around the outside of the patient’s teeth, so a Hawley retainer will tend to be the most visible option. It’s also possible for the patient to lose or break a Hawley retainer, and the success of the treatment outcome will depend on the patient’s ability and willingness to comply with instructions on when and for how long to wear it. A Hawley retainer may also affect the patient’s speech a little more than other retainer options, there may be some initial lip or cheek irritation.
A clear plastic retainer, on the other hand, is practically invisible. That’s perhaps the reason that clear plastic retainers have become more popular than Hawley retainers. They are also less bulky than a Hawley retainer, and many patients report that clear plastic retainers are more comfortable. They are also less likely to affect the patient’s speech, which makes the patient more likely to wear it. And that’s critical to achieve a good treatment outcome.
However, clear plastic retainers can’t be adjusted. If realignment is required, a new clear plastic retainer will need to be made. Cracks and breakages generally can’t be repaired, and clear plastic retainers can be damaged if exposed to excessive heat. They also require frequent cleaning, and may become discoloured over time. And, as with a Hawley retainer, the success of the treatment outcome is dependent on the patient’s ability and willingness to strictly follow wear instruction.
That depends entirely on the type of retainer. Permanent retainers like a lingual wire, fixed or bonded retainer will likely last indefinitely. And as they are permanently fixed into the patient’s mouth, they can’t be lost either.
A removable Hawley retainer can be quite durable and can last for years. It is also adjustable which tends to increase its functional lifespan. However, due to its removable nature, it can be lost or damaged and may need to be replaced from time to time.
Clear plastic retainers are made thinner to increase patient comfort, however may need to be replaced annually. They are also easier to damage, and are often lost.
Replacing frequently lost or damaged removable retainers can significantly add to the workflow of your dental practice. This must be carefully managed.
Think of it like this. With the clear aligner market skyrocketing, many dental practices are keen to enter the market. However, part of your aligner workflow will involve frequently replacing lost or damaged retainers.
If your retainer workflow is efficient and profitable, then your practice will be nicely set up to reap the full benefits from the surging aligner market. On the other hand, if you have given little thought to how you will manage retainer replacements, then any efficiencies in the workflow will take a significant bite out of your aligner profit margin.
When a patient phones or visits your practice with a broken or damaged retainer, it obviously needs to be replaced. That will initiate a workflow with your dental lab.
That is, you’ll need to order a replacement retainer. Depending on how your workflow is set up, you might need to provide the lab with a digital scan of the patient so they can manufacture a new retainer. Or if you don’t have an existing digital scan on file, you’ll need to take a new scan or impression.
If the replacement retainer requires a new scan or impression to be taken, the accuracy of the replacement retainer will also need to be verified. That might require another appointment with the patient, and any inaccuracies will need to be rectified.
This can be particularly problematic if you are taking impressions rather than digital scans. Impressions tend not to be as accurate as digital scans, and any inaccuracies in the impression will require remakes of the replacement retainer. If you absorb this cost, it comes out of your profit margin. Or if you pass it on to the patient, suddenly your retainer replacement prices start to look pretty uncompetitive.
There’s also the issue of storing digital scans. Best practice is to take a scan or impression of the final aligner treatment outcome — before the lingual wire goes in. This is a safety mechanism so that a retainer can be made quickly and easily if the patient’s wire snaps.
However, storing patient scans and having the data on record to enable quick retainer replacements can become a storage issue for dentists. For large and growing practices, an expensive on-site IT setup with physical servers and ongoing service and maintenance costs may be required in order to store and quickly retrieve the large case files you’ll need to order replacement retainers.
Or if you opt for cloud storage instead, you’ll still need to pay data hosting fees. And you’ll need to carefully assess the data security measures your cloud storage provider has in place. The last thing you want is a data breach that may put your patients’ personal data in the hands of malicious players.
Avant Dental has solved these problems for you. On request we can store your patient case files in our lab management system. This can be done both before and post a lingual wire being inserted if this is the preferred treatment preference of the dentist. When a replacement retainer is required, you simply contact us and we’ll already have the patient data and scans on file in our system, and we can start manufacturing straight away.
That means you don’t have to worry about storing huge volumes of digital scans on your on-site servers. Or you don’t need to pay data storage costs to store your scans in the cloud. You also don’t have to spend time or resources retrieving archived case files to send to your lab, because we’ll already have them.
We also look after data protection for you with industry-leading privacy complainant storage within the cloud. This saves you the headache of identifying and meeting your data protection obligations if you store patient data on on-site servers, or worrying about whether your cloud storage provider has the right data protection measures in place.
This all adds up to a highly efficient retainer replacement workflow. As we have your patient scans already on file, we can manufacture retainer replacements very quickly. Your patients will have confidence they won’t experience an orthodontic relapse while waiting for retainer replacements to arrive.
It’s also great for your profit margin. Ordering replacement retainers from Avant takes seconds, so there’s no time spent on file management or rescanning for lost case files. And there are no data storage costs to factor in. That means you save time and money, while also delivering positive long-term aligner treatment outcomes with fast and easy retainer replacements whenever your patient needs it.