Consent - Phase 1 Braces / Appliance Removal 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 child’s braces / appliances.

Retainer Instructions and responsibilities

Now that your appliances have been removed, we are in the retention stage of your first phase of orthodontic therapy. Your teeth are in the best possible position to continue your dental and skeletal growth. Good retainer wear is essential to maintain this result. Remember, however, that teeth are not “cast in stone”. Shifting can be expected as your remaining permanent teeth erupt and as your teeth respond to the functional demands of your occlusion. You will be seen periodically to check your retainers and monitor your dental and skeletal growth. Your retainers may also need to be adjusted as primary teeth fall out and permanent teeth erupt.

1. You are expected to wear your retainers every night after appliance removal (only if a removable retainer is required). If you receive a bonded retainer there may not be an additional removable retainer. This allows your teeth to stabilize into their new position.

2. If you do not wear your retainers as instructed, there is a high likelihood that any dental and skeletal corrections will relapse over time (in some people as quickly as a few days).

3. We will check your retainers along with your dental and skeletal growth periodically after you completed your first phase of orthodontic treatment. You are expected to bring your retainers to these appointments.

4. If you lose or break your retainers, call our office immediately so we can address the issue (if your retainer is broken, bring all pieces with you to your appointment).

5. Clean around your bonded retainer and maintain good hygiene.

6. Keep your retainers away from animals/pets. Dogs, especially, love to eat retainers.

7. Do not boil your retainers, put them in the microwave, or leave them in a vehicle during the summer. Do not wrap your retainers in a napkin or paper towel.

8. To clean your retainers – brush them with soap and water. Do not use toothpaste – it is abrasive and can damage your retainers.

Lost or Broken Retainers

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

There will be a charge per replacement/ repair of 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.

Remember, the goal of Phase I treatment is not to prevent the need for future orthodontic treatment. In Phase I we begin treatment to correct specific skeletal, dental and functional issues that are better to correct at a younger age. In Phase 2, we then complete orthodontic treatment to include alignment and bite correction of the remaining permanent teeth.


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

Parent / Guardian Name(Required)
Patient Name(Required)