What To Do When A Crown Comes Off
As we all know, crowns only come off when your dentist is closed or out of town! I’m going to show you what you should do and the best possible ways to recement your crown until you are able to get back into your dentist.
First things first… Don’t just stick that crown back on just yet! We need to do a little detective work to figure out what the correct thing to do is. Is this a temporary or a permanent crown? If it’s a temporary crown, you definitely want to get it back on as soon as possible. Without the temporary crown, your tooth can shift slightly and cause the permanent crown to not fit correctly. Skip the rest of this article and head right down to the section on “recementing the crown”.
**WARNING** A loose crown is easily swallowed. This won’t hurt you but it costs a lot more to have a new crown made than to have your old one recemented. If you’re not able to get it stable with my recommendations, don’t leave it in place. Leave it off until you’re able to get to the dentist.
Detective Work for Permanent Crowns
If it is a permanent crown you’re going to want to take a look at both the crown and the tooth. First take a look at the crown. Is it hollow inside? There shouldn’t be any filling material inside of it, except possibly a thin layer of cement (usually very white). If there are any bits of tooth, chunks of filling material, or a metal/fiber dental post, we’re in trouble. You’re either going to need a new crown or the tooth may not be able to be saved. You can try putting it back on but it likely isn’t going to stay. See your dentist as soon as possible.
Here is an example of a porcelain fused to metal bridge. The dark grey area is the metal which has porcelain covered over it. Most older crowns (more than 10 years old) will look like this. Try and remove any additional cement that is stuck inside the crown before putting it back on.
Many newer crowns are made entirely of porcelain materials. This is what they usually look like. You’ll want to be more careful with these types of crowns as some of them can be very brittle. Carefully try to remove any additional cement that is inside the crown before trying it back on.
Now let’s look at the tooth if you can. Again the tooth should be relatively clean, or have a thin layer of cement (usually white) all over it. If the tooth is obviously decayed (large hole or a significant amount of soft brown tooth structure) you can try putting the crown back on but it most likely won’t stay. This is another situation in which you should see your dentist as soon as possible.
If the crown and teeth both look good to you, you’ve got much better chance of being able to keep the crown on until you can see the dentist.
Temporarily Recementing Your Crown
**Read / watch all the instructions! Getting it to stay on is going to be hard enough if you do it all right and much much harder if you don’t!**
For the quick version, check out my video on how to do it. If you need more detail, check out all my information below the video…
There are multiple options for temporarily recementing your crown until you can see the dentist. Before you recement it, you’re going to want to try and clean off your crown and tooth as best you can. If any cement is still in place try and flake or peel it off. You’re going to struggle to get it back in place if you all the cement is still in place. If the tooth hasn’t had a root canal, it is likely going to be somewhat sensitive when you are cleaning it. This pain should only occur when you touch the tooth, breathe air on it, drink liquids, etc. If it is hurting all on it’s own constantly or is severe pain, you’ve likely got a more serious problem than just needing the crown recemented.
Practice placing the crown back in the right place. When you bite down with it in place, it should feel like your normal bite. If your bite feels “high” the crown likely isn’t all the way down or in the right place. Once you feel comfortable putting it back in, its time to find a temporary material to “recement” the crown with.
There are a couple of options for materials you can use. They have varying effectiveness and none will work nearly as well as the material your dentist will use. Let’s take a look at what you can use and how effective each one is…
- Temparin or a similar material sold in drugstores for re-cementing crowns
- Fixodent denture adhesive
- Toothpaste
- Corn starch or flour and water mixture.
I did some borderline scientific testing to see how effective each material was. I was actually kind of surprised by the results. This is why we test things!
Here is my testing set-up. The tooth model is in the middle attached by orthodontic elastics to metal poles on either side. The different adhesives were placed inside the crown, the crown was placed on the model, the material was let to set up for 5 minutes, and then I pulled the crown straight upwards slowly to remove it (it is usually vertical forces that cause a crown to come off all the way… lateral forces mostly work to break the seal of the cement). The elastics provided more and more force the further up I pulled the crown. The graphite marked on the paper how far I was able to pull up the crown before it came off.
Now this is what your tooth will generally look like after it has been prepared for a crown. The crown will fit right down over top of it, and will only fit in one very specific orientation.
Whatever material you use, you’re only going to want to use a thin layer of material. If you put too much in you won’t be able to get the crown to go down all the way. This is exactly how much I like to use.
I seated the crown all the way onto the model and some excess squeezed out of the sides (important). I then waited 5 minutes for the material to set up before testing.
Moment of Truth
I took each individual test and marked them on one single piece of paper for comparison. As you can see, the Temp-bond used by your dentist wins by a long margin. The best at home product you can use though is Temparin. If you do decide to use Temparin make sure and read below for specific instructions on using it or it won’t work as well! The instructions on the kit will mess you up if you follow them directly. Bringing up second place were toothpaste and fixodent. Last was the corn starch or flour and water mix (which performed much more poorly than I expected).
Let’s take a look a the individual materials I used. The first I tested was the typical temp cement that dentists use. Temp-Bond. As expected it provided very good retention.
Here is corn starch and water. Notice how it is soft and slightly runny but still mostly holds it’s shape. Definitely not great retention but could work in pinch if you’ve got nothing else.
Fixodent. Now this is normally used to keep dentures in place but again can work in a pinch. The big thing to keep in mind with fixodent is that you’ll need to bleed the tube first if it is new. The first little bit that comes out is really watery and won’t work as well. Fixodent worked much better than the corn starch mixture.
Toothpaste. I used Colgate Total but you can use pretty much anything you have on hand. It is the perfect consistency so you just have to put some in the crown and put it on. It had almost identical retention to the Fixodent.
Now our winner for best at home product! Temparin. It comes out of the tube looking like a piece of chalk. The directions say to place a little in the crown and push it down on the tooth. The material as it comes is WAY too hard to do this with! You will never get the crown to go all the way down. Trust me, I tried many times. I’m pretty sure an elephant could step on it and it still wouldn’t go all the way down. Take a small piece of it and mix it with some water until it is a similar consistency to toothpaste… a soft paste that holds it’s shape. It will work well for you like this. As an added benefit Temparin has some ingredients that will help soothe your tooth and reduce sensitivity.
So to recap. Try the crown in to make sure it goes all the way down. Dry the tooth and the crown. Get your adhesive (use the most retentive material you can get your hands on) and place it in the crown. Put the crown on the tooth and bite down gently to make sure the crown goes all the way down. Once you’ve got the crown in place, clean up the material that squeezed out the sides and you’re done. Take it really easy on the tooth and avoid anything sticky or chewy until you see your dentist.
Smile Direct Club
(Article updated Februrary 23rd, 2017)
Wondering if Smile Direct Club is a good option for straightening your teeth? You’ve come to the right place.
A little about me and why I’m qualified to give you the scoop on Smile Direct Club…
First, I’m a general dentist. I’ve used a variety of orthodontic treatment options in my private practice office over the years. These have included traditional braces, Invisalign, and various types of spring retainers. I’ve also seen some of my own patients start and complete treatment separately with Smile Direct Club. I feel like I’ve got a pretty good handle on what the system realistically can and can’t accomplish.
I’m going to give you all the pros and cons of Smile Direct Club so that you can make an educated decision whether it is a good option for you personally.
A short history of clear aligner therapy…
Clear aligner orthodontic therapy (pioneered by Invisalign) doesn’t nearly have the history of standard braces but improvements in the systems have made it a great option in the majority of cases for straightening teeth. Impressions are taken and then a sequential set of plastic aligners is created. Small plastic attachments are added to a couple of places on your teeth and then you start wearing the aligners. You change to a new set of aligners approximately every two weeks. Every time you change to the next aligner, it is moving your teeth into the correct position. Best of all, it isn’t nearly as noticeable as standard braces. Invisalign treatment in most dentist’s offices costs somewhere in the neighborhood of $5000-8000. It is very costly because the dentist incurs nearly $2000 in material and lab costs before the case even starts. There is also a pretty significant amount of time you spend in the office for adjustment’s and checks and before long it adds up to a lot of money they have to charge to make any profit.
This is typically what the aligners look like…
Much nicer looking than metal braces right?
Then along came Smile Direct Club….
Previously known as Smile Care Club. They allow you to take impressions on yourself and send them to the company where a dentist will create a treatment plan to align your teeth. This allows you to have clear aligner therapy while skipping going to see the dentist (in most cases). In other cases you will still need to see a participating dentist for various modifications that you can’t make yourself… Primarily something known as interproximal reduction (IPR) in which the dentist removes a very tiny amount of enamel in between the teeth in order to make enough room to alleviate the crowding. Some people also aren’t a good candidate for therapy with Smile Direct Club due to more extensive treatment needs than can be accomplished.
In general this ends up being far less expensive than seeing the dentist for full treatment but there are some definite trade-offs for this lower price…
- Unless you have a very easy case, it is unlikely that you will get results as good as you would at a dentist or orthodontist.
- No attachments are used with Smile Direct Club so the aligners can’t create forces that are nearly as precise as Invisalign.
- You have to take your own impressions. If you don’t get accurate impressions (harder than you think) you won’t get good results.
- If complications arise, or treatment doesn’t go as expected, options are going to be much more limited in terms of fixing it.
- If you have cavities or existing periodontal disease, this process can make them worse.
- You are unlikely to get nearly as stable a result as you would get with a dentist or an orthodontist. You will absolutely have to wear your retainers consistently if you don’t want your teeth to relapse to where they were before treatment.
- The material that the trays are made of isn’t as durable as Invisalign trays. If you’re a heavy grinder you do run the risk of breaking them or wearing through them very quickly.
Before you get started with Smile Direct Club…
I think it is very important you are aware of these possible complications before you start on this path.
I also highly recommend you see a general dentist for a full check-up prior to starting any orthodontic treatment. You should ideally have all cavities taken care of and your gum health should be stable prior to any orthodontic treatment.
If you understand all these possible complications and are OK with them, I think this can be a great option for some people to straighten their teeth (see below for more information on some of my patient’s results).
And let’s take a quick look at the nuts and bolts of the process..
The first step is an initial assessment which costs $95. You’ll submit photos and impressions to them and a licensed dentist will create a treatment plan for straightening your teeth.
If you are a good candidate for treatment and decide to proceed they will create your clear aligners and send them to you. This costs $1500 or they have some monthly payment options. You wear the aligners approximately 20-22 hours a day and they will slowly move your teeth. If you need to see a dentist for any help, they’ll refer you to a participating dentist.
After treatment is complete, they will make clear essix style retainers for you for $99. They recommend you replace these every 6 months. I personally think you should wear the essix retainers full time for six months and then have a Hawley style retainer made that you wear at night. The Hawley style retainers will hold up for you much better over time. See my retainer guide for more specific details on retainer design and an effective schedule for wearing them.
Patient results
I have had three of my patients go through process and they have been mostly happy with the results. They were all adults who had braces when they were teenagers, didn’t wear their retainers, and their teeth shifted as they got older. They couldn’t afford professional Invisalign treatment (approximately $6000 in my office) but could do Smile Direct Club. They all had some mild to moderate crowding.
Patient #1: Minor crowding of the lower front teeth. At the end of treatment the crowding looked much better.
Patient #2: Minor crowding of top and bottom front teeth. At the end of treatment the crowding had been eliminated and she had a nice even smile.
Patient #3: Moderate crowding of top front teeth and bottom front teeth. She is still in treatment and has another couple of trays to go. The bottom teeth were looking pretty good but the top teeth hadn’t moved nearly as well. She’ll likely need some additional trays to correct her smile fully. I think her crowding was pushing the limits of what they can do.
Overall, I think the system is an OK option when used correctly and with an understanding of it’s limitations.
Think Smile Direct Club is a good fit for you?
Head over to the Smile Direct Club website and order their initial assessment kit. It will have everything you need to get going.
Retainers
Replacement retainers (initial retainers right after braces should be done by the orthodontist) are one of the major things thing that you can save money on by skipping the dentist or orthodontist. Several companies will sell you a self-impression kit and can make you a retainer at discount over what you would be charged at the dentist. Click on the ad below to go to the website for the company I recommend for this service.
So which type of retainer should you choose? There are multiple types to choose from. The first are “fixed” retainers that are bonded to your teeth. These can only be done by a dentist or orthodontist. They are very difficult to keep clean but you don’t have to worry about losing them or forgetting to wear them.
The second type are removable appliances. Again there are a couple of different types here. A hawley style retainer has a piece of acrylic that covers the roof of your mouth and several wires that extend around your teeth for retention of the retainer and to keep the teeth in place. These are generally the most durable long term option. Unless you break them or lose them, they can last for years and years.
Another type are known as essix retainers. These are similar to Invisalign style trays in that they are made of a hard clear plastic material that fits right over your teeth. They look better than hawley retainers (no metal wire around the front teeth) but generally aren’t very durable. They tend to wear out anywhere from a year to a couple years later.
With retainers you also need to be familiar with how often you should wear them. If you don’t follow the correct schedule you risk your teeth shifting around. Every dentist or orthodontist has a slightly different schedule they like to follow but you can’t go wrong with the following…
First 6 months – All the time
The following 2 years – Every night
The next two years – Wear at night 3-4 times a week
After that wear it once a week at night.
Temporary Partial Dentures
The only situation that I would recommend using a self-impression kit and direct dental lab for dentures would be when you need a cheap temporary partial denture to replace a front tooth/teeth for cosmetic reasons. There are simply too many variables in making full and partial permanent dentures. For the most predictable results with a temporary partial denture you’ll need teeth both in front and behind the space. You can do it without a back tooth to hook on but it definitely makes it more challenging and can create a lot of excess force on the teeth that it does attach to. You also need to be careful if you have cavities or periodontal disease. These appliances can create additional problems in these situations (think broken teeth or loose teeth). I highly recommend you have a full check-up with a general dentist prior to starting this treatment.
There are a couple of types of appliances you should be familiar with if you do decide to go this route.
- Flipper – A flipper is a purely cosmetic appliance. It has acrylic that covers the roof of your mouth, wires in the back to keep it in place, and teeth attached to it. You can’t use this to eat or you run the risk of breaking it. You need at least 8 teeth on the top or bottom to make this work.
- Flexible partial denture – This is made of a flexible plastic material that wraps around the gum tissue and uses these areas for retention. You can eat with this appliance in place as it is much more durable than a flipper. They can be very difficult to adjust and often do need adjustments so please keep that in mind. You need at least 8 teeth on the top or bottom to make this work.
If you understand and are OK with the possible complications involved, you can use the link below to go to a direct dental lab that can fabricate these appliances for you.
Denture Repairs
OK, so what do you do when a tooth falls out of your denture or it breaks in half. Teeth that have fallen off can actually be put back in place with superglue in a pinch. The compound in super glue is very similar to the materials that are used to make the denture. First try the tooth back in to make sure you can put it back in the same place. Dry off the area, roughen it with a dremel or sandpaper, and then place a small amount of superglue in the area where the tooth came out. Seat the tooth back down in the EXACT same spot it was before. If you don’t get it exactly back in, it will cause problems with your bite and you may not be able to get it back out. Make sure to clean up the excess superglue before it hardens all the way. If you don’t like the idea of using superglue, you can also purchase inexpensive denture repair kits. They have adhesives that you can use to reattach teeth.
Dentures that have broken in half or have a crack running through them are an entirely different matter and should be evaluated by a dentist as soon as possible. Denture repair kits are really only a temporary solution as the denture will eventually crack again. In some cases you’ll need a whole new set and in other cases it can be repaired.
As a temporary solution there are a couple of different things you can do. Most denture repair kits will tell you to use their adhesive to simply realign the broken sections. While simple, this type of repair is not going to hold up long for most people. To provide some additional strength I recommend taking a small drill bit and making a small hole that you can put a piece of paperclip or other metal rod in. The rod should fit snugly in the hole if possible. Line this hole up exactly with the other side of the denture and make another hole so that the metal piece connects the two denture pieces. Make sure you can realign them exactly again before using the adhesive to bond the denture pieces together.
Once the denture has been bonded back together I’d also recommend doing a soft reline to provide some additional strength. If the denture fits very well to your gum tissue, you may need to grind some material off of the denture surface. If it has been several years since you had the denture made or it just doesn’t fit well, you’ve likely got enough room for the lining material without doing any grinding. We’ve got specific directions on how to do this in our reline section.
If you are able to successfully do both of these things with your denture, you’ve likely bought yourself a decent amount of time to go and get the denture fixed or get a new set made.
Denture Relines
Updated 04/16/2018
A denture reline is when material is added to the surface of the denture that touches your gum tissue. Usually this is done when the gum tissue underneath the denture has shrunk significantly and the denture no longer fits well. This is very common for people who have had their dentures for a long time (usually 5+ years) or who have had teeth extracted in the last 6 months. The rate that the tissue shrinks slows down very significantly after approximately those 6 months.
Permanent Relines
There are several types of relines. The first is what is known as a hard reline. Either the dentist will take an impression with your denture in place and send it to a dental lab or they will add material and mold it in your mouth that day. Hard relines can extend the life of a denture pretty significantly as long as the teeth are in good shape.
A variation on a reline, is known as a rebase. This always must be done in a dental lab. This is when all of the pink acrylic material is replaced. Only the teeth remain from the original denture. This is a good option when the denture has cracks, chips, or is highly stained.
Both the hard reline and rebase must be done by a dentist. It is definitely not something you can do at home.
Temporary Soft Relines
The last type is known as a soft reline. Just like it’s name implies, a material is placed on the tissue side of the denture that when fully set up has a much softer consistency. This is great as a temporary solution to a loose denture or to help the gum tissue heal after extractions. The downside to a soft reline is that it doesn’t hold up nearly as well long term. The material is more porous and thus picks up stains and odors. It will also eventually start to separate from the denture and need to be replaced. Soft relines are something that you can do at home as a temporary measure. Amazon sells several different types of soft reline products that you can see here. I recommend the products from either Permasoft or Prosoft.
Before you get started, please let me repeat that this is only a TEMPORARY solution. You should see a dentist as soon as you can to evaluate why the denture is no longer fitting. Long term wear of a denture that doesn’t fit can cause problems in your mouth.
Seeing your dentist is a much better solution to loose dentures but I am aware that some people can’t afford to do that and will use these products anyway. My goal here is give you enough information to soft reline your denture correctly without causing problems. These are general instructions. You can cause permanent damage to your dentures if you aren’t careful. Consider yourself warned before proceeding.
The kits come with instructions but there are a couple of major things you need to keep in mind while doing a soft reline.
- The denture should be cleaned well prior to doing this. Any contaminants will cause the material to not stick as well.
- Any soft liner material currently in the denture must be taken out. This is tough to do if it has been in there a long time.
- Ideally, you should lightly roughen the under surface of the denture with a dremel or something similar. This will help the material stay in place longer.
- When you place the material in the denture and put it in place, you want to bite down GENTLY in the correct location. Practice biting down several times in the same spot before placing the material. The back teeth should all contact evenly and at the same time. Also, if you bite too hard all the material will be squeezed out and you can cause areas of pressure leading to sore spots.
- Keep it in place until the material has set up most the way. Once it is relatively solid take it out and use a sharp knife or scissors to quickly trim the excess material away from the borders. Place it back in your mouth and then allow it to set up the rest of the way.
- If you messed up anything along the way, you can pull all the material out of the denture and start over. This won’t cause any problems.
Denture Adjustments
One of the biggest challenges with dentures is creating even pressure everywhere so that you don’t get sore spots. Even with the best techniques, sore spots and adjustments are an inevitable part of the process in getting dentures to a place where they are relatively comfortable to wear. When at all possible, you should have a dentist adjust your denture as they will be able to see things that you can’t and they have generally have a much better grasp of exactly what needs to be done to fix your problem.
That said, there are some cases where you simply can’t get in to see a dentist or you just don’t have the money available. In these cases, I’m going to show you the best way to adjust your denture so that you can get some relief and not destroy your denture in the process.
Before you get started you’ll need a couple of things…
- A Dremel – This link will take you to a list of Dremel rotary tools on Amazon. You can get a cheap one for as little as $25.
- The right dremel tip. Most Dremel’s come with a starter pack of tools that have one of these in them.
3. Non-toxic magic marker (don’t use a sharpie!)
Before you get started there are some major guidelines to follow when adjusting your denture. Following these guidelines will keep you from ruining your denture.
- If it has been a long time (5+ years) since you your dentures were made or if you recently had your teeth extracted your gum tissue may have shrunk causing the denture to not fit well. You get a lot of shrinkage of the tissue in the first 6 months after your teeth are taken out. The denture will move all around the rubbing motion will cause sore spots. In these cases you usually need a reline before doing any adjustments. See our page on relines first.
- If you have a sore spot because the teeth on your dentures don’t hit evenly, you should probably see a dentist. Adjusting the bite on a denture is very challenging and I don’t recommend you try to fix it yourself. Generally you want full, even contact on all the back teeth at the same time. This is very challenging for you to figure out yourself.
- Always remove as little material as possible in the areas of the sore spots. You can always take more away but you can’t add more material (usually). Generally this means you’ll brush over the area with your bur and remove as little as 1/10th of millimeter in thickness (look on a ruler as to how tiny this amount is).
- When you adjust an area on the denture and place it back in your mouth, the sore spot should feel less painful but you will still have some soreness there. It will take several days for the sore areas to heal so that you can re-evaluate if you need to adjust any more. Do not keep adjusting until you feel nothing because at that point you’ll have taken away too much material.
- Be especially careful in the following areas of upper dentures. These are the critical areas for the suction of the denture and if you take too much away, they won’t stay in.
- If there are any unusual areas of tissue growth or areas that won’t heal, you should see a dentist. This can be the sign of a more serious problem.
With all that in mind and your tools ready, you’re going to want to look in your mouth and figure out exactly where the sore spots are. This is typically what they are going to look like. They look whitish-yellow and are generally quite painful. Occasionally early sore spots will be bright red instead (they look like that before the top layer of tissue comes off).
Take your non-toxic magic marker and place a little bit of the ink right around the sore spot. Immediately put your denture in and allow some of the ink to transfer onto your denture. This will show you exactly where the sore spot is on the denture. Don’t try to eyeball it.
Now take your Dremel and remove a small thickness of the denture in just that area (remember, think 1/10th of a millimeter). Try it back in and see if you feel some relief in the area. If it feels better, give it a couple of days to heal before adjusting any more. If no relief, adjust a little more. Do this for all your sore spots. It is not unusual to need several adjustments before the denture becomes comfortable enough to wear and eat in without developing sore spots.
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Dentures
Dentures are a very challenging type of dental appliance. Many dentists spend years doing them and still struggle to get them just right. In most cases I don’t recommend you ever trying to take your own impressions for dentures or partial dentures. The one exception to this is if you need a temporary partial denture to replace some missing teeth. You can use a self impression kit and send it to the lab who will make it for you. One downside of going this route is that if the appliance needs any modifications to fit correctly, you won’t have a dentist to help. It is not unusual to need several modifications for the best fit and function. Another downside is that it can be very difficult to match the shade of your teeth, especially if it is a front tooth. Dentists who do this every single day still find matching front teeth very challenging. If you do decide to do this, proceed with caution and understand that the appliance may not fit.
Also, if you do decide to make adjustments, repairs, or a soft reline at home make sure you read through our pages on how to do this correctly.
Orthodontic Appliances
You may have heard the story about the kid who designed and 3D printed aligners for straightening his teeth. While very impressive that a high school student came up with this, it is not something I would recommend anyone doing. There can be some very serious consequences to trying any sort of active orthodontic treatment on yourself. This includes causing damage to the roots of the teeth or creating a situation that is far worse than what you started with. Here are some of the DIY orthodontics that I REALLY discourage you from trying…
Rubber bands or dental floss to close gaps – Several bloggers online have documented how they used rubber bands around their teeth to close gaps. This is arguably the most dangerous type of DIY orthodontics that I’ve seen. There have been several reported cases where the rubber bands have slipped below the gum-line and worked their way up the roots of the teeth, destroying the bone around them in the process. Once this has happened, the teeth can’t be saved and have to be extracted!
Fake braces with superglue and wire – I don’t quite understand this trend but there are some websites that show you how to use superglue and paperclips or other wire to make it look like you have braces on. Again, just don’t do it. Putting superglue on your teeth is a terrible idea and in the worst case scenario, if the wire puts force on your teeth, it can move them somewhere you don’t want!
Taking braces off yourself – Sometimes I see people who started braces with the orthodontist and didn’t finish. They end up pulling off the wires and brackets themselves. So why is this bad? The brackets are physically bonded to your tooth surface. If you use pliers or some other instrument to remove them, you risk damaging your enamel. On the other end of the spectrum, you will oftentimes leave quite a bit of the bonding material on your teeth. This material becomes a food trap and can possibly lead to cavities. Get a dentist or orthodontist to take them off!
Having said all that, I do have some recommendations for retainers and home clear aligner therapy.
See our pages on retainers and Smile Care Club clear aligner treatment.