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Retainer Replacement & Repair Form (Orthodontics)

We strive to exceed expectations and are hopeful that your replacement or repair will go smoothly. The best way to ensure that is to read this entire form carefully.


We typically do not charge an evaluation fee and will schedule you after completing this form.


We charge a $70 evaluation fee that is paid in advance of scheduling and we require that you complete and submit this form. At the evaluation appointment we may be able to begin the process to replace or repair the retainer, however, we cannot guarantee it. A separate appointment may be required after we understand what will be required to replace the retainers.

3D Printed Models: Most retainer replacements are made based on a 3D printed plastic model of your teeth instead of plaster models made from a physical impression mold of your teeth. If you do not already have a 3D printed model based on the CURRENT POSITION of your teeth, we will scan your teeth with our 3D camera system and use our in office 3D printer to create the model of your teeth. For those who already have a 3D model, in the event your teeth have shifted or dental work has been completed after the 3D model was made, we cannot guarantee the exact fit of a replacement retainer.

We are able to provide retainer replacements and we are able to repair most but not all types of permanent bonded wire retainers. We have numerous retainer options to choose from.


All retainer fees are collected prior to beginning the process of repair or replacement. Fees will be confirmed at the evaluation appointment. 



Bring ALL existing retainers, 3D printed models, permanent wire retainers to the evaluation appointment. Even if something is broken, bring it with you please.

Upper Retainer Select All Options That Apply
Lower Retainer Select All Options That Apply

Our team typically responds within two business days or less.
If you do not hear back from us by the end of that period, please call the office.

McNutt Orthodontics
A DBA of Matthew David McNutt DDS, MS, P.A.

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