Smith + Heymann Ortho Retainer Form

Retainer Form
Patient's Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Patient/Guardian Email
example@example.com
Retainer Information
Retainer Type
Congratulations!!!! You did it.
Your active orthodontic treatment has been completed, but now it is important to protect your investment by wearing retainers to maintain the success we have accomplished.
Teeth move throughout our entire lives whether we have had orthodontic treatment or not, so wearing retainers is essential to maintain the positions of teeth achieved via orthodontic treatment. We recommend wearing your removable retainers full time for the first week (at all times except when eating or drinking). After the first week then you will transition to wearing your retainers approximately 12 hours of evening / night time wear indefinitely. To summarize, we recommend FULL TIME WEAR FOR FIRST WEEK, THEN NIGHT TIME FOR A LIFETIME.
Retainers are made to fit the exact positions of the teeth at the completion of orthodontic treatment, and we ensure that they fit perfectly at the time of initial retainer delivery. If retainers are not worn consistently the teeth will shift. Even slight shifting makes the retainers feel tight when they are worn after having not been worn in a while. If your retainers are feeling tight you should wear them more frequently. If retainers are worn to inconsistently the teeth will shift enough that the retainers are unable to “guide” the teeth back into their correct positions. At this point orthodontic retreatment is the only way to move teeth back into place.
Clean your retainers at least two times per day using a toothbrush to gently scrub their inside and outside surfaces. Do not put retainers in dishwasher, cleaning solutions, or boil them. Be careful not to bend or distort retainers when cleaning them. Remember to brush and floss your teeth, especially around fixed / bonded retainers.
Keep retainers away from pets since they are frequently attracted to the smell of retainers and may chew them causing damage or distortion.
Always keep retainers in their case when they are not in your mouth. Please do not wrap your retainers in tissues, napkins, paper towels, etc. They will have a tendency to get thrown away!
Do not leave your retainers in your car on a hot day and avoid eating with them in place. This may cause the retainers to warp, distort or break.
If you lose your retainers, or if your retainers do not fit properly, there will be a replacement charge per retainer. If your retainer is lost, broken, or is no longer fitting properly, please let us know immediately! Without well-fitting retainers, your teeth will move!
For your convenience, Drs. Smith & Heymann are providing two sets of retainers. The second set is provided as a courtesy in the event the first set is broken or lost. I f additional retainers are needed a fee will be charged.
Retainer check visits during the first year after the completion of treatment are included at no charge. After that year, additional checks are $75 per visit.
Bonded / Fixed Retainers
If you have a bonded wire retainer, it can be left in place indefinitely unless advised otherwise by your dentist. They require more effort in cleaning and the bonded material does not necessarily last a lifetime. Be certain your dentist or hygienist checks it at your routine cleaning appointments.
If bonded retainers come loose and your dentist recommends removal, please call so that alternative retainers can be fabricated. If you have any problems with your removable retainers or bonded retainers, call us as soon as possible so we can make necessary repairs before teeth move.
Your financial agreement covers orthodontic treatment and up to one year of retainer supervision; however, any repair or replacement of the removable or bonded retainers would be done at our regular office fees. In the event your bonded retainer is removed or comes off please keep your retainer wire. The bonded retainer is a custom fabrication for you.
I acknowledge that I have read and understand the information in the Retainer Form.
Patient/Parent's Signature
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Retainer Form

Retainer Information

Congratulations!!!! You did it.

Your active orthodontic treatment has been completed, but now it is important to protect your investment by wearing retainers to maintain the success we have accomplished.

Keep retainers away from pets since they are frequently attracted to the smell of retainers and may chew them causing damage or distortion.

Always keep retainers in their case when they are not in your mouth. Please do not wrap your retainers in tissues, napkins, paper towels, etc. They will have a tendency to get thrown away!

Do not leave your retainers in your car on a hot day and avoid eating with them in place. This may cause the retainers to warp, distort or break.

If you lose your retainers, or if your retainers do not fit properly, there will be a replacement charge per retainer. If your retainer is lost, broken, or is no longer fitting properly, please let us know immediately! Without well-fitting retainers, your teeth will move!

For your convenience, Drs. Smith & Heymann are providing two sets of retainers. The second set is provided as a courtesy in the event the first set is broken or lost. I f additional retainers are needed a fee will be charged.

Retainer check visits during the first year after the completion of treatment are included at no charge. After that year, additional checks are $75 per visit.

Bonded / Fixed Retainers

If you have a bonded wire retainer, it can be left in place indefinitely unless advised otherwise by your dentist. They require more effort in cleaning and the bonded material does not necessarily last a lifetime. Be certain your dentist or hygienist checks it at your routine cleaning appointments.

If bonded retainers come loose and your dentist recommends removal, please call so that alternative retainers can be fabricated. If you have any problems with your removable retainers or bonded retainers, call us as soon as possible so we can make necessary repairs before teeth move.