hey it's dr amanda with straight smile solutions street smash solutions.com and today we're
going to talk a little bit more about bonded retainers and no we're not going to talk about
why you place some indications replacing them how to place them how to write the lab slip
which design you should pick et cetera et cetera techniques um paperwork nope none of that because
i already done all that if you want to watch any of those you can go to my youtube channel
not youtube in general but mine which is straight smile solutions that means you go to your youtube
channel youtube.com type in the search bar straight smile solutions you should see a green
banner and from there there's a tiny magnifying glass where you can put in a keyword like bonded
retainer or permanent retainer it's towards the top right or even easier scroll down on
my home page on youtube straight smile solutions and you're going to see playlists there's about
i don't know 10 or 12 playlists and towards the middle to the bottom you're going to see one that
says retention within the retention one i've got hours upon hours of content about body retainers
everything you want to know but specifically i realized i was missing one important part of it
because it came up in a message board that i was in which was what if my patient asked me to take
off a bonded retainer next steps paperwork um consent forms etc etc what's my risk what's my
liability so this was my answer to that question first of all first question would be who did the
ortho okay if it was you totally different story than if it was someone else if it was someone else
and the patient is local and their orthodontist is nearby or within you know driving distance
i would send that patient back to their ortho why because as soon as you remove that bottle
retainer you're now married to that case and all the ortho complications that come to come with it
okay because that was the solution for the retention you don't know what type
of warranties came with that what's included if there's relapse and you took that retainer off
you're now liable for it even if you have some you have to have some pretty robust paperwork
i'm not saying you couldn't create that but it still might give you a major headache if it if
it made its way to either insurance company or the dental board or to court you know so i just
say prestige cautiously now first of all i'll tell you my personal story i always have stories
so when i was in college um of course this was back in the early 90s 80s no early 90s um i had
braces and they were taken off and my orthodontist put in a bonded retainer which by the way was very
ugly but in any case um it was one of those ones that was anchored by bands it was so ugly it made
it look like i had stainless steel crowns it was not going to fly from me in college um so
i was like after like six months 20 yards like get this stupid thing off and you know i was over 18
so my parents got no say and i didn't even ask i was like do i need a retainer and they basically i
went to i don't even know who i went to to take it off i i just remember wanting the darn thing off
and i didn't start with lower crowding so i think i remember the orthodontist saying well
you probably be fine because you didn't start with lower crowding well he was wrong so you know it
did relapse and it wasn't explained to me that even if you didn't start with crowding you can
still relapse because teeth have an inclination to always move mesial a lot of people blame it on the
wisdom teeth but i had no lower wisdom teeth and they still bunched up even though i didn't start
with that that's just how teeth move over time as you age unless you have a retainer they will
bunch up okay so they'll just bunch in towards the midline so that's exactly what happened and
i think in hindsight and someone explained that to me and i don't remember if i signed anything or
i didn't and certainly think we weren't litigious back in the you know 80s and 90s so you mean it's
just what it was um but anyways teeth will move okay so i never ever ever take one off unless i'm
placing a removable retainer afterwards okay that's just my nope go find someone else to do
it okay and if it's my patient you know the first question is first of all i don't place bonded
retainers on patients unless there's an indication to do it if a patient demands and there's a few
indications and i'm not going to go through that because you can get all those indications in the
other videos that i referred you to no sense in beating a dead horse so it's a very rare occasion
when i use a bonded retainer it's fine if you like using them but my problem with using them
all the time that you'll get from my videos is a lot of people hate them so now for me they're
always an upgrade fee like it you're you're well if not indicated they're an update a great fee so
your case comes with a set of retainers okay you may need more than one set in a lifetime
certain types of retainers have different types of lifespans of course you're going to explain what
the warranty is 30 days 60 days 90 days whatever this should all be built into your paperwork and
each doctor's gonna have a different plan if you do not explain the warranty behind it
if there's no answer then you're pretty much replacing it for free so just remember that
you need to explain these things um for bonded retainers for the most part unless indicated
they are an upgrade fee and up charge because they're extra work for me they're extra cost for
me and i'm married to that case once i put it on i have to check it i gotta babysit it and all that
there's a warranty for x amount of time however you want to do it 30 days 90 days one year after
that there's a cost of x y and z to repair one if nothing has moved and a cost of x y and z you need
to spell it out to replace one assuming nothing has moved two different things repair and replace
um for the most part unless it's a phase one which is a temporary bonded retainer um i send out for
my bond retainers i have them professionally made bent because i don't like to bend wire and if
you don't do it right it will move teeth and it's going to be a nightmare and most general dentists
i know don't do it right so better to send off and paint the latvian have it done made properly and
again go back to my other videos that i mentioned to learn more about design lab slips fabrication
indications all that but anyways go back to the scenario at hand which is what if a patient asks
you to take it off so again first question is who did the ortho right if it's me and i placed it and
it was indicated or the patient paid the upgrade fee and it's within the warranty period okay
i'll take it off you know if there's a reason for it and i'll replace it with a removable
retainer at no charge whatever when i think it's best remember clear retainers need you need many
more than one in a lifetime so if you're taking something that's permanent and could last for
decades and replacing with something that's more temporary and only lasts for 6 to 12 months it
has to be replaced regularly in order to keep the teeth straight then you need to let the patient
know that both verbally and in writing it's part of the risk benefits and alternatives that you
know this is a compliance-based thing if you don't wear it teeth will move we're not responsible for
the relapse um you're going to need more than one of these in a lifetime the replacement cost is axe
if nothing has moved it's why if things have moved and you need re-treatment et cetera et
cetera you need to spell everything out what you don't want to do is take this darn thing off even
if they sign to take it off and replace it with nothing because i wouldn't touch it in that case
unless there was trauma or something like that you know it's a different story then it has to come
off um it's a medical necessity um but otherwise if the patient just asked and get it off i'm only
gonna do it if i'm gonna replace it with a removable retainer and i'm gonna spell out
how many of these they might need in a lifetime and what the fees are going to be
if you do not do that and that retainer is faulty doesn't work well things move not made right or
wears out and you didn't explain that it could then potentially the patient could come after
you later which is why i want you to be very very very cautious about doing this so that's pretty
much all i have to say is that and someone asked me if they if i had a standard form for removing
one of these and that would be a no because it's a very particular situation each time
and i'm just gonna type it up so and i mean what is my fee well again it depends on
depends on if i did the ortho and or if i placed the bonded retainer and or if i placed it how long
it's been on so it's going to vary let's say it was a patient i didn't do the ortho they're
demanding to get it out um and they're willing to get a removable retainer well again i'm gonna let
them know that they're gonna need more than one in a lifetime um my fee for the removal retainer is
probably going to be two times the lab fee for my time um at least two if not three times the
lab fee and a cost obviously you're going to want to take records before you take this out always
always always take records and then take records of the retainer once it fits so there's a fee for
records there's a fee for removal there's a fee for a new retainer so if it wasn't my patient
and i was doing a retainer somewhere between 800 and 1000 would be my fee for this process
and a lot of people are gonna get upset they can find someone cheaper to do it but there's a lot
of liability like i said that comes with this so i'm not doing it for free or for cheap um if it
was my patient there could be no charge if it was in a certain time span since
and especially if it was clinically indicated there might be a minor charge if it was within
a year if it was more than a year it's going to be less than it was if it wasn't my patient so again
it could be free it could be 200 it could be 400 it could be 800 could be a thousand so particular
situation it also depends on how it's anchored too if it's something like this where there's glue
on each tooth that's gonna take me a lot longer than if it's just two mesh pads on the end that's
gonna take me like two minutes to pop off so i'm gonna have to look at it and see how much work it
is to take it off you know clean it off smooth it records um and then it's not accurate if you scan
you want to have a retainer ready to deliver as soon as it comes off you don't know how quick
things are going to relapse so because if there's any movement between when you take that off and
when you deliver you're responsible for that movement now labs can digitally have this removed
you know and deliver a retainer but it's not going to be as good of a fit as if you made
another one so normally i'm going to make two sets of retainers i'm going to make a temporary
in-house retainer which could be a slightly sloppy retainer it's not going to be perfect that's going
to be delivered chair side you know so i could take you know take an impression or a scan before
they take it off and it might have the bumps back there right but at least they have something to
keep it somewhat straight and then after it's all cleaned up and the hygiene is good and
they've been scaled and everything like that and the gums have swelling has gone down then
i'm gonna scan and deliver the new retainer all this is gonna be included in that price
i'm not going to make shortcuts with this either you do it my way or you don't do it at all
because i know i'm going to be responsible when things happen and things will happen
like i said you give that kind of price especially it wasn't your patient 800 to a thousand a lot
of people are gonna go find someone else to do it and that's totally fine with me
because again this is one of these procedures if you don't do things right things are gonna go
haywire and crazy so anyways don't mean to scare you but just proceed cautiously this seems like
that simple thing but it can get very complicated alright hopefully that was helpful thanks