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Making a Fresh Start by Dr. Blair Feldman

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Making a Fresh Start  

How to develop your practice’s retainer replacement program

by Dr. Blair Feldman

Orthodontic practices across the country are catching on to the concept that a retainer replacement program is both practice-building and patient-requested. The concept is simple: Removable retention—here, specifically, clear thermoformed retainers—is important to help patients to maintain orthodontic results and their investment in their smiles.

Regular retainer replacement is in the patient’s best interest because retainer performance decreases over time and many become dirty, broken or lost. If your practice can’t provide replacements in a simple, affordable, convenient way, patients will look to other sources, including other providers or online direct-to-consumer companies. Practices that support their patients will be rewarded with happier patients who maintain their treatment results—and will find financial gains as a result of these long-term retainer replacement programs.


Figuring out the right frequency
One of the most common questions from patients at the end of treatment is, “How often should I replace my retainer?” Although data may not support an exact replacement schedule for clear thermoformed retainers, most orthodontists will agree on a few constants:
  • A certain percentage of patients will lose or break their retainers within the first year and need a replacement.
  • A fresh retainer made from a year-old 3D scan will feel different from the original retainer. Even though the scan is the same and if we assume that the patient wore the retainer regularly, an older retainer typically feels loose while the new retainer will feel more rigid.
  • Retainers will build up bacteria over time regardless of the cleaning method, similar to replacement of a toothbrush or a set of aligners.
Many practices comfortably rely on the statement that retainers should be replaced at least once a year. This script is helpful because it gives an orientation to the patient that retainers may not perform well if they’ve been worn for many years. It also helps begin the conversation that returning to the practice for a new set of retainers is considered a normal activity for patients looking to maintain their results. Finally, this comment can be followed up with a recommendation from the practice on the options for retainer replacement within the practice.


Choosing from a spectrum of options
Retainer replacement programs vary across practices, from the most basic version (patients contact the practice each time a replacement is needed) to more sophisticated, done-for-you programs like Retainer Club that incorporate 24/7 online ordering and home delivery. Between these two sides of the spectrum are practices that create membership programs with an initial fee, which gives patients access to low-cost retainers. Many times, that fee can be financed over the course of treatment or paid off through third-party financing. Some of these programs are customized and managed by the practice team, while others, like Retainers for Life, are managed by outside companies to simplify and outsource operations.

There are many things to consider when choosing a retainer replacement program. Some basic items to review with your team:
  • Management.
  • Staff time.
  • Patient benefits.
  • Patient experience.
  • Scalability.
  • Profitability.
Once a program has been designed and its terms have been shared among the team and placed in marketing materials, it requires some form of management. Some practices manage the program through spreadsheet software such as Excel or Google Sheets; others create a tagging system inside their practice management systems. Companies such as Retainer Club use proprietary software to manage the patients, the specific program belonging to the specific family member, the 3D scans, payments and shipping. Options abound, so it’s important to consider the added workload a program brings to the practice.

Determining how the office team will interact with patients who need retainer replacement, and who may or may not be part of an office program, requires some amount of staff time. Other things to consider include how patients use the benefits of the office program. Questions to answer include:
  • Does the patient have to call the office, or can they email or text a request for new retainers?
  • Does the patient have to come in to pick up retainers? Can a parent come by the office? Could the retainers be shipped to the patient’s home?
  • Who makes the retainers—your in-house lab or an outsourced lab?
  • What is the procedure if retainers don’t fit?
  • How long does the patient’s 3D scan last? How is this communicated to the patient?
Each of these questions will need to be answered by the practice so patients can understand their options. Practices must consider how much staff time is involved before they can determine their fees and profitability.


Coming to terms ... and conditions
Typical retainer replacement programs offer some benefit to the patient beyond just being able to call the office every time a retainer replacement is needed. Common options include reduced fees for retainers or added conveniences like online ordering. These benefits can be extended to consider the patient experience with the office program; for example, a program that requires patients to save their 3D models to receive the best pricing may not be viewed as favorably as a system that doesn’t require patients to retrieve their dental models. These patient benefits can by marketed throughout the practice in print, online and through team scripting.

Scalability is the ability of the practice to grow a retainer program to a larger number of patients without creating obstacles that require more staffing to support the growth. A good program should be easy to scale to include all of the patients in the practice.

The profitability of a retainer replacement program is determined by many factors, including all of those mentioned earlier. One of the most common misconceptions about retainer programs is that the most important factor is the cost of the retainers themselves. (This is often referred to as “price per arch.”) Although this may seem compelling, it is too simplistic and ignores many more important factors that determine the profitability of a program. For example, the difference of a few dollars per arch is negligible when compared with staff time or doctor time.

On the other side of the equation, and probably the most important factor in program profitability, is utilization. Utilization is the percentage of the total patient base (TPB) that replaces their retainers regularly. Obviously, TPB grows as the practice matures. For example, a practice that is two years old and has completed 100 cases has a TPB of 100: That’s a hundred patients who, theoretically, need to replace their retainers every year. Although this number will grow each year, a practice that has treated patients for 20 years and averages about 200 removals a year has 4,000 patients in their TPB who could replace their retainers annually.

A practice that services its TPB with regular retainer replacement will realize significant revenue as it grows its utilization percentage. For example, if 50% of the 4,000 patients purchased a set of retainers for $200, the practice would realize $400,000 in annual revenue, while a 75% utilization would gross $600,000 in annual revenue.

One key takeaway is to consider the most expensive components of a retainer program—staff time and doctor time—and choose a program that minimizes or outsources these costs while growing the annual use by the total patient base.


Conclusion
The practice-building opportunities of a well-designed retainer replacement program are significant. Patients are actively looking for advice and services that support their desires to maintain their results and investment in orthodontic treatment through regular retainer replacement.

Practices have several options to support their patients, from plans created in-office to end-to-end solutions. A program that makes it simple for patients and office teams and is used by a high percentage of the total patient base will generate the highest long-term practice benefits.

Author Bio
Blair Feldman Blair Feldman, DMD, MS, MSEd, is an orthodontic specialist and the president of Retainer Club.
Orthotown Magazine
September 2025
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