A new way to look at retainers

You may have believed that a single retainer is enough to keep patients in working retention indefinitely.

by Lou Shuman, DMD, CAGS

For more on this topic, go to www.dentaleconomics.com and search using the following key words: Vivera, Align Technology, Invisalign, retainer, Dr. Lou Shuman.

You may have believed that a single retainer is enough to keep patients in working retention indefinitely. On the contrary, studies have shown that regular replacement of retainers is a critical component of a retention program. The studies show that without retention, even perfectly aligned teeth can revert to their pretreatment state, and that dentition continues to change over time. So if we are to maintain effective long-term retention, regular replacement of retainers is needed. But the traditional model and method for providing replacements pose costly and time-consuming challenges. Therefore, practitioners need a long-term strategy that can continue to work effectively and economically for doctors and patients.

I would like to introduce a new retention system called Vivera® retainers. Introduced by Align Technology, Inc. in late 2007, this subscription-based program delivers four new, clear thermoplastic retainers over a scheduled time period. The retainers are suitable for both Invisalign and non-Invisalign patients, and are produced either from a final Invisalign treatment stage or from a dental impression. (Currently these retainers are available only to Invisalign providers.)

Through its research, Align learned that one of the initial barriers for doctors is their thinking that patients need only one retainer, which they hope will work forever. But it has been proven that retainers don't last forever. They can shrink, develop cracks, break, wear out, or get lost. When doctors recognize that multiple retainers are needed to keep a patient in working retention, and that the new retainers can be provided with minimal office time and no office lab work, they begin to see the advantages of the Vivera system.

The primary value of this new program to clinicians and their practices is that it helps reduce their need to deal with significant relapse. Relapse can occur for many reasons, including the device's failure to retain the teeth, the patient doesn't wear the retainer as prescribed, or the patient loses it. In these situations, the doctor must determine the best option for keeping the patient in working retention.

This new system will adapt to doctors' individual retention philosophies. Some practitioners may place a patient in retention for six months full time and then switch to nights only; others prescribe "nights only" from the start. The effective working retention of Vivera will vary based on wear time, and can last from at least a year to many years. This is a true benefit of the four-retainer approach, as compared to the life of a single retainer.

If patients forget to wear their retainer and their teeth start to relapse, the Vivera retainers are strong enough to self-correct certain types of relapse back to the original retained position during the subscription period, up to .25 mm. So the doctor avoids the traditionally lengthy and expensive process of correcting it. When office time is considered — impressions, stone model preparation, trimming, polishing and finishing the retainer, and delivery and fitting — the new retainer system is a more efficient way of doing business. The total average office chair time for the Vivera system is 20 minutes. In that time, one impression is taken, but it will result in four retainers. Using the traditional method, chair time averages 45 minutes, and it only produces one retainer.

Increasing efficiencies

Align consulted with doctors about the costs they and their offices incur when creating their own retainers, which includes the entire process mentioned above for just one retainer. If the patient loses it, the entire process must be redone. The new system keeps a digital model on file of the patient's original finished position. If there is a need to have another retainer made, the practitioner simply makes a phone call. This also is a significant benefit when one doctor refers a patient to another doctor. The new doctor can easily obtain the digital model from the former doctor.

Vivera is designed using Align's proprietary manufacturing process, so it is comfortable and no extra office visits are needed for adjustments.

"I used to make my own retainers, which fit relatively well," said Dr. Sam Daher of Vancouver, B.C. "About a year ago, I was asked to try the new Vivera system. I've been using them for about six months now, and they have been problem-free. The fit is impeccable, and patients feel that the retainer is holding their teeth in place, which gives them assurance that it's working.

"Also, when I explain to patients that they get four sets of retainers, they love the idea. Plus, of the four retainers, the first is the only one they need to come to our office for — we just want to make sure it fits properly. The three remaining retainers can be sent directly to their homes, according to the schedule."

Another benefit is hygiene. The patient will receive his or her replacement retainers on the retention schedule that you prescribe. Old retainers can become unpleasant and patients lose their enthusiasm to wear them. Regular replacements remind patients of the importance of retention.

Since the retail retainer fee is typically already embedded in the total orthodontic fee, the same can be done with Vivera, with the added benefit of receiving four retainers instead of one. Lab tests show that many leading clear thermoplastic retainers begin to deform after as little as two months of simulated daytime use. The importance of recognizing that the retainer itself is a source of relapse is crucial. Recognizing the true effective working retentive capabilities of your existing retainer is critical in order for any replacement timing to be successful. That is why the Vivera system was created — to provide us with a solution to meet these needs.

Dr. Lou Shuman is a management consultant to the dental industry, focusing on practice management, emerging technologies, and clinical education. He recently served as Vice President of Strategic Relations for Align Technology for six years. He has lectured on Invisalign extensively throughout the United States, Canada, Europe, and Japan. He also was the professional and clinical lead on multiple concept development projects at Align, including Vivera.

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