• Braces/Aligner Appliance Removal and Retainer Consent Form

  • Congratulations! Today is the day that your Braces/Aligner appliances are coming off to unveil your beautiful smile!

    You are now entering an important phase of your treatment -- the Retention Phase.

    Completed orthodontic treatment does not guarantee perfectly straight teeth for the rest of your life. Teeth have a “memory” and often try to move back to their original positions. Retainers are required to keep your teeth in their new desired positions. Regular retainer wear is necessary for your lifetime as your body is continually undergoing growth and maturation. Minor changes, particularly in the lower front teeth may occur. In summary, you need your retainers to keep your teeth as straight as possible. But, even with good retainer wear, your teeth may move slightly.

    Even after you have completed treatment with us, you are welcome at our office so that we may monitor your retainers. A nominal office visit charge will be incurred for these visits.

    Consent for Braces/Aligner Appliance Removal

    I consent to the removal of my child’s/my braces/Aligner appliances.

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  • Retainer Instructions and Responsibilities

  • I understand that I have the following responsibilities:

    • Wear my removable retainers after the last meal of the day and while sleeping.
    • Do not wear my removable retainers while eating to prevent appliance damage.
    • Keep my removable retainer in their proper case while not in use.
    • Maintain my scheduled retention appointments as prescribed by my orthodontist.
    • Bring all removable retainers to my retention appointments.
    • Floss my bonded retainer; brush and clean removable retainers.
    • Visit my general dentist to evaluate the readiness for wisdom teeth extraction.
    • Call the office immediately if my retainer breaks or is not fitting properly.
    • Soak the removable retainers in “Efferdent” solution as needed to remove plaque and calcified food debris. * do not boil removable retainers or place them in the dishwasher as they can become destroyed due to the heat*

    Lost or Broken Retainers

    Your retainers are made using the best available material. If a retainer is lost or damaged, call our office immediately to schedule an appointment. There will be a laboratory charge per replacement retainer. We do offer a Retainer Replacement Program, available for purchase during the 6 months following removal of your appliances.

    If further treatment is required due to unexpected jaw growth or inadequate retainer wear, additional charges may apply.

    I understand the above information. I have had an opportunity to ask any questions and I have had those questions adequately answered.

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