Braces / Invisalign Removal Form and Retainer Agreement

Congratulations! Today is the day that your braces 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. Regular retainer wear is necessary for lifetime as your body is continually undergoing growth and maturation and minor irregularities, 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.

Consent for Braces Removal

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

Retainer Instructions and responsibilities

I understand that I have the following responsibilities:


1. Wear my removable retainers 22 hours a day (including sleeping) for three months followed by “night-time for life-time” wear.


2. Do not wear my removable retainers during eating to prevent damage. No hot or sugary liquids with retainers in mouth.


3. Keep my removable retainers in the proper case and away from pets when not wearing them.


4. Do not boil your retainers, put them in the microwave, place them on a hot surface or leave them in a vehicle in the summer months. Do not wrap them in a napkin or paper towel to prevent loss of retainers.


5. To clean retainers - brush with hand soap and water . Do not use toothpaste- it is abrasive and can damage your retainers.


6. Maintain my scheduled retention appointment as prescribed by my orthodontist and bring my removable retainers to my appointment.


7. Clean around my bonded retainer.


8. Have my General Dentist evaluate the readiness for wisdom tooth extraction.


9. Call the office immediately if my retainer breaks or is not fitting properly.

Lost or Broken Retainers

Your retainers are made using only the best possible material. If a retainer is lost or damaged, call our office immediately to schedule an appointment for a replacement.


There will be a charge per replacement retainer or you can enroll in our Retainer Program.


If further treatment is required due to unexpected growth or noncompliant
retainer wear, additional charges will be applied.


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

Signature

I understand the above information. I have had an opportunity to ask any questions and I have had those questions adequately answered.
Name(Required)
Patient Name (if different)