Download to our Retention Phase paperwork.

Retention Phase
Congratulations on your upcoming “braces off” appointment. You will soon begin the retention and
observation phase of your treatment. This final phase of your orthodontic treatment is just as important as
the braces or aligners that moved the teeth into their new positions. If you are not completely satisfied with
your result, now is the time to address your concerns. Once your teeth have been moved into their desired
positions, a long period of time is needed to stabilize the teeth so that the surrounding bone and soft tissues can
conform to your dental alignment. Now is a good time to review several important aspects of your upcoming
retention phase:
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Specific retention instructions will be given to you at the deband appointment.
Retainers must be worn a minimum of 14 hours per day, sometimes longer.
It is important not to miss any of your retainer check appointments over the next 12 months.
Remember to bring your retainers to each appointment.
After the 12 month observation period you should continue retainer use indefinitely.
Failure to wear retainers as directed will result in undesirable tooth movement.
If retainers are lost or damaged, they need to be replaced immediately.
Current replacement cost of retainers is $150 for a set or $75 for one arch
Tooth movement can happen quickly and once it does, your retainers may not fit
Retainers will only “hold” teeth in their current position. They cannot correct tooth movement.
The only way to correct relapse is with braces or Invisalign at an additional charge.
There will be no additional charges during the first 12 months of your retention phase unless you lose or break
your retainers. Phone the office right away for an appointment to replace or repair your retainer. Although you
will incur an additional charge for a replacement or repair, it’s a relatively inexpensive way to protect the
investment you have made in your smile. .
We understand that losing or breaking your retainers can be a frustrating experience. No one loses their
retainers on purpose and accidents do happen. Knowing this, we encourage you to consider purchasing an extra
“insurance set” of retainers. If you lose your retainers or they become damaged, having a backup set will help
prevent undesired tooth movement. Rather than waiting multiple days for a replacement and risking tooth
movement, you’ll have an extra set already.
When multiple sets of retainers are ordered at the same time, the prices are reduced as follows:
1 extra set: $80 (1st set included with treatment. For an additional $80, you’ll receive 2 sets instead of 1)
2 extra sets: $140 (1st set included w/ treatment. For an additional $140, you’ll receive 3 sets instead of 1)
3 extra sets: $200 (1st set included w/ treatment. For an additional $200, you’ll receive 4 sets instead of 1)
Replacement retainers are $150 for 1 set, $230 for 2 sets, or $350 for 4 sets. When only one arch is needed, the
cost of each option is reduced by half.
Retention Phase
I have received information regarding the importance of the retention phase of treatment. I also acknowledge
that the facts about retention and post-treatment have been fully explained to my satisfaction.
Patient Name: ______________________________________
Signed: __________________________________________ Date: _______________________
Parent/Guardian if under 18
Extra set(s) desired:
Yes
No
Not Sure
How many extra sets? ______________
Custom mouth guard desired? __________ Color: ________________ $52 per mouth guard
Opalescence Go Whitening? _______________
5 Pack @ $45 or 10 Pack @ $80
Patient’s General Dentist______________________________________________________________
I agree to schedule recommended retention check appointments for one year following the end of my active
treatment phase. If I miss a scheduled retention appointment, I will promptly call the office to reschedule. If I
fail to schedule a recommended retention check appointment or reschedule a missed appointment, Elliott
Orthodontics should assume I have made the decision to self-monitor my retention. I also understand that if I
require a replacement retainer or have any other need following the one year retention observation period I can
schedule an appointment for a nominal fee.
Signed____________________________________________Date_______________________
Parent/Guardian if under 18
Print Name_________________________________________
Explained by: ______________________________________