Digital Retainers? Now at a Lab Near You

By Anthony M. Puntillo D.D.S., M.S.D.

It’s the middle of September and a patient you just debanded last month is enjoying her first year of college… and her new smile. After 24 months in orthodontic appliances, however, you are now both relying on her retainers to make sure her smile remains perfect. Unfortunately, her roommate has just accidentally stepped on that very same retainer and with campus 6 hours away from home she has no way of returning until Thanksgiving. Her parents assume that the impressions you took last month can be used to make a new retainer. Not wanting their orthodontic investment to be for naught, mom is calling your office requesting a new retainer with plans to ship it to her daughter. You are now in the unenviable position of delivering the bad news: the original model was damaged during the fabrication of the retainer and her daughter will need to return home for a new impression or attempt to schedule an appointment with an unfamiliar orthodontist closer to campus.

If you have been practicing orthodontics for any length of time, I have no doubt that the circumstances of this story sound familiar. The good news is that technology can now offer both you and your patients a better option. The increased movement toward digital models and intraoral scanners has not only improved our ability to store and manage our patients’ records, but it has also led several well-known commercial laboratories to add capabilities for processing these 3D digital files (STL- stereolithographic). Labs that have made the investment in the technology and equipment can now accept files over the internet and then use the digital data to create any number of well-fitting orthodontic appliances. Using STL files in this manner will save you the material, staff costs, and schedule constraints associated with taking a replacement impression. Furthermore, it saves the patient and parent the inconvenience of an additional trip to the office. So the next time a frantic parent calls requesting a replacement retainer ASAP, if you’re using digital models you can let them know you’ve got it handled. Simply forward the final records STL file to your favorite commercial lab and the replacement appliance will be on its way!

11 thoughts on “Digital Retainers? Now at a Lab Near You

    • On the other hand, getting something to the pt now will prevent further and perhaps more significant changes in alignment….

  1. This assumes they wore the retainer faithfully, no tooth movement has occurred since the digital impression was made, no tooth movement will occur while it is being fabricated and shipped to the patient and that it requires no adjustment upon insertion. And if there is a problem or it doesn’t fit quite right do they then come to see you or do you refund their money. This is fairy tale thinking at it’s finest. Presented by another pitch man for the lab or company trying to sell the product.

  2. We have been using digitally fabricated retainers since March 2012. Other than a few gliches, this has worked beautifully. Finding clasp designs that do not require solder joints work best. Also, based on feedback from my lab, mounting these digital models for appliance fabrication is hit or miss.

    With regards to the replacement retainer, it is only going to work if the patient has worn the retainer as prescribed before losing the retainer. Otherwise, you will be eating the cost of the retainer.

    Mark Lively

  3. Take PVS impressions in disposable trays routinely for your retainers. After pouring these and making the retainers, give the PVS to the patient/parent.
    They now have both the security of a backup plan (repour the PVS locally & remake retainers) AND the responsibility.

  4. I agree. If the patient has not been faithful about wearing the retainer(s) every day (or every night) the new retainer may not fit well enough to move the teeth back to fit the new retainer. It also assumes that the patient called her parent(s)the same day that the retainer(s)was or were broken.

  5. Agree with Anonymous. Retainers made from previous models (or previous scans) won’t fit if there is relapse, which we all know is the norm. Wouldn’t any responsible orthodontist want to see the patient’s teeth to evaluate for relapse before assuming a new retainer could be made from a previous scan?

  6. As an orthodontist whose practice is located across the street from a major university, two blocks from another, and within two miles of two others, I spend a fair amount of time repairing or fabricating new retainers or rebonding loose 3-3 retainers for a fee that is fair to both parties. I would be surprised if most universities didn’t have an orthodontist within a reasonable travel distance who can evaluate and render appropriate treatment to an “out-of-town” patient. Would you rather have a retainer made “on spec” based on old impressions, or have your patient be seen by a qualified colleague with whom you can communicate?

  7. Good work!

    Digital models are definitely a better bet and a more convenient choice.

    A simple alternative is to have a second retainer (Aligner-type) made and delivered to the patient as a back-up in case something happens to the ‘official’ retainer which, according to Murphy, usually happens!

  8. In cases of relapse I have found it useful and effective to make a clear retainer off a duplicate model of the final records.This new retainer acts as an aligner to move the teeth back, and then I often do a fixed lingual retainerfor additional support to prevent future relapse. Often the new retainer will hurt for a few days until the teeth move back – the more relapse, the more pain but it is more effective than placing new braces on.

  9. “Thank you for your comments regarding my “Digital Retainer” article. I am pleased to see that this blog is being read and questions are being asked. In response to the posted comments, I would first start by stating that I have no affiliation with any lab or corporation. I am a Board-certifiied orthodontist with a busy, multiple location private practice that I started from scratch 18.5 years ago. I am also a part-time faculty member at Indiana University’s School of Dentistry, Department of Orthodontics. I did not write the article in hopes of promoting the sales of any product. My intent was merely to suggest how I do and how you could employ this technology in your practice.

    I think we can all agree that for an accurate retainer to be fabricated in the described manner, the patient would need to have worn their previous retainer faithfully. Furthermore, they must have notified your office immediately after the retainer was broken, to minimize the possibility of any shifting. If the following two circumstances were true, in the situation I described, I would simply order a clear “essix” type retainer. I would use this to function not as a long term solution, but as a “stop gap” measure until the patient could return home and be evaluated in my office. I do not disagree that this proposed scenario would not be appropriate in all situations of lost or broken retainers. However, the ability to save, send and reuse a digital model file at least provides you with options.”

    Anthony M. Puntillo D.D.S., M.S.D.
    CEO | Puntillo and Crane Orthodontics, P.C.

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