Retainer Delivery Note

Date: [Date]

Orthodontist: [Name, credentials]

Staff: [Assistant/therapist name(s)] (Omit if not applicable)

Location: [Clinic/site]

Guardian/Accompanying Adult: [Name and relationship] (Include for minors; omit line for adult patients)

Reason for Visit

[Retainer type(s) and arch(es) being delivered; any patient-reported concerns at presentation]

Interval History

[Relevant subjective updates since debond or impression: symptoms, patient goals/concerns, pertinent medical history updates, history of retainer loss or breakage] (If nothing relevant, state "No concerns reported" or omit section)

Clinical Findings

[Oral/gingival status relevant to bonding] (Include hygiene adequacy and gingival health only if a fixed retainer is being delivered or if concerns are relevant)

Retainers Delivered

[Appliance name]: [Type/design] — [Arch] — [Coverage/teeth involved]

Fit Verification (Removable): (Include only for removable appliances)

• Seating: [full / incomplete — describe areas]
• Retention: [adequate / loose / overly tight]
• Border adaptation: [well-adapted / blanching / impingement — note locations]
• Occlusion: [no interferences / interferences present — describe]

Fit Verification (Fixed): (Include only for fixed/bonded appliances)

• Teeth bonded: [list teeth]
• Passive fit: [visual passivity confirmed / floss pass confirmed / not passive — describe]
• Bond integrity: [all pads intact / voids noted — location]
• Contact access: [floss access adequate / limited — describe]
• Occlusal clearance: [adequate / inadequate — describe]

Adjustments: [Adjustments performed with locations and outcomes / No adjustments required]

(Repeat appliance block above for each additional retainer delivered. If fit verification information is not provided, state "[Fit verification not documented]")

Assessment

[Summary confirming delivery with verified fit and function; issues identified such as tissue irritation or tight seating; patient-specific retention risk factors such as hygiene concerns, history of non-compliance, or high relapse risk features] (Document only what was observed or reported; do not infer compliance or understanding)

Plan

Wear Schedule

• Removable: [Appliance/arch] — [full-time / nights-only], [hours per day or nights per week]; [transition plan and timeframe] (If not finalized, state "Wear schedule to be confirmed at first retention check")
• Fixed: Continuous wear inherent; monitor for loosening or breakage

Care Instructions Provided

Method: [verbal / written handout / video / demonstration]

• [Cleaning method provided]
• [Storage instructions: case when not in use]
• [Eating/drinking restrictions: remove for meals; avoid hard/sticky foods with fixed]
• [Precautions: no self-adjusting, no biting into place, avoid heat]
• [Patient demonstration performed and outcome] (Omit if not applicable)

Relapse Counseling

[Counseling content documented: risk of tooth movement over time, role of retainers in reducing relapse, consequences of non-wear or fixed retainer failure, patient/guardian responsibilities]

[If recommended retainer type declined: recommendation made, alternative selected, tradeoffs discussed, patient/guardian decision] (Omit if not applicable)

Follow-Up

• First retention check: [timing]
• Subsequent checks: [frequency or milestones]
• Ongoing monitoring responsibility: [orthodontist / general dentist / shared]
• Return precautions: sore spots, loosening, breakage, poor fit, or tooth movement
• [Handoff plan if transferring to general dentist] (Omit if not applicable)

Written Materials

[Materials provided] (Omit section if none)