Congratulations on reaching this stage of your orthodontic journey. By signing this form below, you are authorising us to remove all orthodontic appliances.
You and/or the patient are satisfied with the position of your/their teeth with the current orthodontic treatment.
I/we hereby request to discontinue my/my child’s orthodontic treatment, and to remove all orthodontic appliances, even though it has been explained to me that his/her/my treatment is not yet complete for functional and/or cosmetic reasons. The consequences of premature discontinuation of orthodontic treatment are difficult to predict. It may cause no harm at all, may result in premature wear of the teeth, TMJ dysfunction, discomfort, any cosmetic shortcomings, etc. Teeth may have cavities or weaknesses that are under the braces and may become further damaged during the removal of the braces. Any damage should be corrected by a dentist as soon as possible. Should you have retainers made, I understand that these retainers will retain the current position of the teeth only if worn as instructed. Should you decline to have retainers made, I understand the teeth will likely change position once the braces are removed.
You are now entering an important phase of your treatment – the Retention Phase. Please read the Post Orthodontic Instructions: https://hughrichdental.com/post-orthodontic-instructions/
RETAINER INSTRUCTIONS & RESPONSIBILITIES
I understand that I have the following responsibilities:
I will wear my retainers 22 hours a day for the first 3 months followed by night time wear for life. This protocol applies to any kind of orthodontic treatment received.
I will not wear my removable retainers during eating and drinking to prevent it from any damage.
I will keep my retainers clean and in the retainer box when I am not wearing them.
I will bring my removable retainers with me during my dental check-up appointments.
I will clean around my bonded retainer/s.
Should my removable retainers get lost, break or don’t fit properly, I will then need to have new retainers made at an additional cost.
Should my fixed retainers become debonded or break, I will then need to schedule an appointment to either rebond the current fixed retainer or replace the fixed retainer at an additional cost.
There will be an additional laboratory cost payable for every replacement retainer.
Completed orthodontic treatment does not guarantee perfectly straight teeth for the rest of your life.
Teeth may tend to move back to their original position. Retainers are required to keep your teeth in their new position. Regular retainer wear is necessary for your lifetime as your body is continually undergoing growth and maturation. 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.
I/we understand that once the braces are removed it will not be possible to adjust the position of my teeth further.
Should further treatment be required after the braces are removed due to unexpected growth or non-compliant retainer use, additional charges will apply as new records and/or a different treatment approach may be required.
If there is any outstanding balance on your account, it will need to be completely paid up before the orthodontic appliance removal appointment is made.
I understand the above information and I had an opportunity to ask any questions that are of concern to me/us.
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