Clinical effectiveness of 2 orthodontic retainer wires on mandibular arch retention

Comparing the Impact of Titanium and Stainless Steel Retainers on Lower Incisor Stability, Periodontal Health, and Retainer Survival: A Preliminary Study

Objective

This study aims to compare the impact of titanium and stainless steel (SS) retainer wires on lower incisor stability and periodontal health.

Methods

Fifty patients between the ages of 14.1 and 29.5 years were recruited for the study. The impact of 0.027x0.011-inch rectangular titanium dead-soft wire retainers was compared with that of 0.0215-inch six-stranded SS wire retainers. The retainers were bonded to the mandibular arch, and 3D models were evaluated after completion of the orthodontic treatment (T1), at the third month (T2), and at the sixth month (T3). Little's irregularity index (LII), the intercanine width, the pocket depth, the plaque index, bleeding on probing, and retainer survival were analyzed. The generalized linear model method was used to compare scores on LII, the intercanine width, the pocket depth, and plaque index values. Cochran's Q test was used to compare intragroup bleeding.

Results

A significant increase was found in the irregularity index parameter according to time (p=0.004) but no statistically significant difference was found between groups in terms of the LII according to material and time (p=0.826). No significant difference was found in intercanine width parameters between the groups according to material and time (p=0.977). No statistically significant difference was found between the groups in terms of pocket depth and plaque index scores, according to material and time. No retainer failure was observed in either group.

Conclusion

Both retainer wires offer successful results in terms of stability parameters and periodontal parameters after six months.

A Novel 3-Dimensional Printed Nanoceramic Hybrid Resin Fixed Lingual Retainer: Characterization and Mechanical Tests

Introduction: An innovative retention protocol was developed to create a new 3D-printed fixed retainer employing SprintRay OnX nanoceramic hybrid resin. The feasibility and usability of the retainer were subsequently evaluated. Methods: Identification and characterization of SprintRay OnX was done using Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy with energy dispersive X-ray (SEM-EDX), field emission scanning electron microscope (FE-SEM), X-ray diffraction (XRD), and flexural strength. Load-deflection and pull-out tests were conducted on the 3D-printed straight wires, with three distinct cross-sectional geometries: round (1 mm), oval (1 mm × 1.5 mm) and semielliptical (1 mm × 1.5 mm). Twisted G&H and coaxial Respond stainless steel multistrand retainers were used for comparison. In the load-deflection test, a three-point bending test (3PBT) was employed. For the pull-out test, the retainer wire was inserted into the composite, which was placed in a centrally located hole of an acrylic block; the retainer wire was subjected to a tensile force along its long axis. Results: Characteristic bands close to those of PMMA were observed in the FTIR spectra. SEM-EDX and XRD revealed a crystalline material with homogeneously distributed Yb element signals (19.4%). On FE-SEM micrographs, small clumps were displayed on smooth surfaces. The flexural strength and the flexural modulus were, respectively, 142.48 MPa and 7.842 GPa. All groups of 3D-printed wires exhibited significantly higher load-deflection levels than the multistrand wires (MSWs). Concerning pull-out forces, they fell in between twisted G&H (96 N) and coaxial Respond (48.09 N) retainer wires. The 3D-printed wires fractured cohesively without detachment from the adhesive, suggesting that the chemical bond was adequate for satisfactory wire integration, yet the wire's strength was compromised. Concerning the cross-sectional geometry, the load-deflection and the pull-out forces of 3D-printed oval and semielliptical wires were significantly higher than that of 3D-printed round wires, which was attributed to the larger cross-sections of the wires. Conclusion: Oval and semielliptical 3D-printed wires offered favorable features as lingual retainers.

Poly-ether-ether-ketone (PEEK) versus dead-soft coaxial bonded retainers: a randomized clinical trial. Part 1. Stability, retainer failure, and participant satisfaction

BACKGROUND

Poly-ether-ether-ketone (PEEK) was introduced in dentistry as an alternative to metal alloys.

OBJECTIVE

To assess the effectiveness of PEEK-fixed retainers in preserving the stability of mandibular anterior and participant satisfaction as compared to the Dead-soft coaxial fixed retainer (DSC).

TRIAL DESIGN

A single-centre, two-arm parallel groups randomized clinical trial.

METHODS

The patients treated with pre-adjusted orthodontic appliances who have a Little's Irregularity Index (LII) ≤ 0.5 mm have been enrolled in the trial. PEEK retainers were prepared to round 0.8 mm wire by computer-aided design and manufacturing, and the DSC wire was carefully adapted to the lingual surface of the lower anterior teeth. The primary outcome was the stability of lower anterior teeth as assessed by LII, while the secondary outcomes were changes in occlusal parameters, retainer failure, and patient satisfaction. The data were collected at the debonding stage (T0), 1 month (T1), 3 months (T3), and 6 months (T6) after starting the trial, except for patient's satisfaction, which was recorded using an electronic form at T1 and T6.

BLINDING

Single blinding of participants.

RESULTS

A total of 46 participants with an age range of 12-28 years old were randomly allocated to the two groups (n = 23 in each). Only one participant dropped out; therefore, 45 participants were analysed. The DSC group showed a significant increase in LII at T3. Both retainer groups had comparable occlusal measurements, failure frequency, and survival time, with no significant difference. The patients in the DSC group reported a statistically significant perception of change in the position of their teeth compared to those in the PEEK group.

HARMS

No harmful effects have been reported.

LIMITATIONS

Limited follow-up duration and the inability to blind the operator due to the nature of the intervention.

CONCLUSIONS

After 6-month retention, the PEEK retainer was equally effective to DSC retainers in maintaining the teeth alignment, with no significant differences regarding the failure frequency, survival rate, and general patient satisfaction.

TRIAL REGISTRATION

https://register.clinicaltrials.gov. (NCT05557136).

Three-dimensional assessment of virtual clear aligner attachment removal: A prospective clinical study

INTRODUCTION

In digital dentistry, virtual attachment removal (VAR) optimizes clear aligner therapy by enhancing efficiency for refinements and enabling prefabricated retainer production through the removal of attachments from a digital scan before the clinical removal of clear aligner attachments. This prospective clinical study aimed to evaluate the accuracy of VAR in the maxillary arch.

METHODS

A total of 110 teeth were analyzed from a sample of 54 maxillary scans from 25 subjects. Models with attachments were virtually debonded using Meshmixer (Autodesk, San Rafael, Calif) and superimposed over the control group in MeshLab. Vector Analysis Module (Canfield Scientific, Fairfield, NJ) was used to calculate and analyze 3-dimensional Euclidean distances on the buccal surfaces between the superimposed models. Statistical analysis was performed using SPSS (version 23.0, IBM, Armonk, NY). The Shapiro-Wilkes (α = 0.05) test determined a nonnormal distribution of results. The Kruskal-Wallis (α = 0.05) was used to determine differences between different tooth types and the number of attachments.

RESULTS

The VAR protocol showed no statistical differences in the root mean square between different tooth segments with an overall tendency for inadequate attachment removal. No difference between the groups was found regarding the number of attachments when used as a main factor.

CONCLUSIONS

The VAR technique is precise enough for the fabrication of retainers from printed dental models in a clinical setting and is not affected by the number of attachments on the tooth.

Keeping the teeth in line: Exploring the necessity of bonded retainers in orthodontics: A narrative review

In most recent studies, long-term retention after orthodontic treatment has been hypothesized that may be necessary to maintain the stability of the dentition and avoid post-treatment changes. The bonded fixed retainer is characterized by its clinical effectiveness, patient acceptance, and lack of patient complaints as compared with a removable retainer. An electronic database (such as PubMed, PubMed Central, Web of Science, Science Direct, Cochrane Library, Scopus, and ResearchGate) has been collected using specific keywords. Of the 152 articles, only randomized clinical trials that investigated different types of fixed retainers or compared fixed with removable retainers were illustrated in tables and included in this review. The present review has gone some way towards enhancing our understanding of the bonded fixed retainer, types, material, bonding methods, and how to improve its the success rate, besides the importance of new technology in fixed orthodontic retention.

Retention procedures for stabilising tooth position after treatment with orthodontic braces

BACKGROUND

Without a phase of retention after successful orthodontic treatment, teeth tend to 'relapse', that is, to return to their initial position. Retention is achieved by fitting fixed or removable retainers to provide stability to the teeth while avoiding damage to teeth and gums. Removable retainers can be worn full- or part-time. Retainers vary in shape, material, and the way they are made. Adjunctive procedures are sometimes used to try to improve retention, for example, reshaping teeth where they contact ('interproximal reduction'), or cutting fibres around teeth ('percision'). This review is an update of one originally published in 2004 and last updated in 2016.

OBJECTIVES

To evaluate the effects of different retainers and retention strategies used to stabilise tooth position after orthodontic braces.

SEARCH METHODS

An information specialist searched Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase and OpenGrey up to 27 April 2022 and used additional search methods to identify published, unpublished and ongoing studies.  SELECTION CRITERIA: Randomised controlled trials (RCTs) involving children and adults who had retainers fitted or adjunctive procedures undertaken to prevent relapse following orthodontic treatment with braces. We excluded studies with aligners.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened eligible studies, assessed risk of bias and extracted data. Outcomes were stability or relapse of tooth position, retainer failure (i.e. broken, detached, worn out, ill-fitting or lost), adverse effects on teeth and gums (i.e. plaque, gingival and bleeding indices), and participant satisfaction. We calculated mean differences (MD) for continuous data, risk ratios (RR) or risk differences (RD) for dichotomous data, and hazard ratios (HR) for survival data, all with 95% confidence intervals (CI). We conducted meta-analyses when similar studies reported outcomes at the same time point; otherwise results were reported as mean ranges. We prioritised reporting of Little's Irregularity Index (crookedness of anterior teeth) to measure relapse, judging the minimum important difference to be 1 mm.

MAIN RESULTS

We included 47 studies, with 4377 participants. The studies evaluated: removable versus fixed retainers (8 studies); different types of fixed retainers (22 studies) or bonding materials (3 studies); and different types of removable retainers (16 studies). Four studies evaluated more than one comparison. We judged 28 studies to have high risk of bias, 11 to have low risk, and eight studies as unclear.  We focused on 12-month follow-up.  The evidence is low or very low certainty. Most comparisons and outcomes were evaluated in only one study at high risk of bias, and most studies measured outcomes after less than a year. Removable versus fixed retainers Removable (part-time) versus fixed   One study reported that participants wearing clear plastic retainers part-time in the lower arch had more relapse than participants with multistrand fixed retainers, but the amount was not clinically significant (Little's Irregularity Index (LII) MD 0.92 mm, 95% CI 0.23 to 1.61; 56 participants). Removable retainers were more likely to cause discomfort (RR 12.22; 95% CI 1.69 to 88.52; 57 participants), but were associated with less retainer failure (RR 0.44, 95% CI 0.20 to 0.98; 57 participants) and better periodontal health (Gingival Index (GI) MD -0.34, 95% CI -0.66 to -0.02; 59 participants). Removable (full-time) versus fixed   One study reported that removable clear plastic retainers worn full-time in the lower arch did not provide any clinically significant benefit for tooth stability over fixed retainers (LII MD 0.60 mm, 95% CI 0.17 to 1.03; 84 participants). Participants with clear plastic retainers had better periodontal health (gingival bleeding RR 0.53, 95% CI 0.31 to 0.88; 84 participants), but higher risk of retainer failure (RR 3.42, 95% CI 1.38 to 8.47; 77 participants). The study found no difference between retainers for caries.  Different types of fixed retainers Computer-aided design/computer-aided manufacturing (CAD/CAM) nitinol versus conventional/analogue multistrand One study reported that CAD/CAM nitinol fixed retainers were better for tooth stability, but the difference was not clinically significant (LII MD -0.46 mm, 95% CI -0.72 to -0.21; 66 participants). There was no evidence of a difference between retainers for periodontal health (GI MD 0.00, 95% CI -0.16 to 0.16; 2 studies, 107 participants), or retainer survival (RR 1.29, 95% CI 0.67 to 2.49; 1 study, 41 participants). Fibre-reinforced composite versus conventional multistrand/spiral wire  One study reported that fibre-reinforced composite fixed retainers provided better stability than multistrand retainers, but this was not of a clinically significant amount (LII MD -0.70 mm, 95% CI -1.17 to -0.23; 52 participants). The fibre-reinforced retainers had better patient satisfaction with aesthetics (MD 1.49 cm on a visual analogue scale, 95% CI 0.76 to 2.22; 1 study, 32 participants), and similar retainer survival rates (RR 1.01, 95% CI 0.84 to 1.21; 7 studies; 1337 participants) at 12 months. However, failures occurred earlier (MD -1.48 months, 95% CI -1.88 to -1.08; 2 studies, 103 participants; 24-month follow-up) and more gingival inflammation at six months, though bleeding on probing (BoP) was similar (GI MD 0.59, 95% CI 0.13 to 1.05; BoP MD 0.33, 95% CI -0.13 to 0.79; 1 study, 40 participants). Different types of removable retainers Clear plastic versus Hawley When worn in the lower arch for six months full-time and six months part-time, clear plastic provided similar stability to Hawley retainers (LII MD 0.01 mm, 95% CI -0.65 to 0.67; 1 study, 30 participants). Hawley retainers had lower risk of failure (RR 0.60, 95% CI 0.43 to 0.83; 1 study, 111 participants), but were less comfortable at six months (VAS MD -1.86 cm, 95% CI -2.19 to -1.53; 1 study, 86 participants). Part-time versus full-time wear of Hawley There was no evidence of a difference in stability between part-time and full-time use of Hawley retainers (MD 0.20 mm, 95% CI -0.28 to 0.68; 1 study, 52 participants).

AUTHORS' CONCLUSIONS

The evidence is low to very low certainty, so we cannot draw firm conclusions about any one approach to retention over another. More high-quality studies are needed that measure tooth stability over at least two years, and measure how long retainers last, patient satisfaction and negative side effects from wearing retainers, such as tooth decay and gum disease.

Comparison of microleakage and shear bond strength of ribbon and twisted wire retainers bonded on human mandibular incisors with two different types of adhesives with and without primer: An in-vitro study

BACKGROUND AND OBJECTIVES

Shear bond strength and microleakage are the success factors of fixed retainers. Recently, primer-free composites were introduced to reduce chair time. The main objectives of this study were to compare the shear bond strength (SBS) and microleakage of GC Ortho Connect^TM Flow (OF) and Transbond^TM XT (TXT) with two types of common retainer wires (0.0175-inch twisted wire and 0.028×.0.008-inch ribbon dead soft wire retainers). The secondary objectives of the study were to compare enamel-adhesive interface and wire-adhesive interface microleakages.

MATERIALS AND METHODS

This in vitro study was conducted on 132 human mandibular incisors (96 for bond strength and 36 for microleakage). The teeth were randomly divided into four groups for use of ribbon and twisted wires with OF and TXT adhesives. The bond strength was measured by a universal testing machine. Microleakage was evaluated by the dye penetration test using 0.05% fuchsine. Data were analysed by two-way ANOVA (alpha=0.05).

RESULTS

No significant difference was noted in bond strength among the four groups (P>0.05). However, the microleakage of OF was significantly higher than that of TXT at both the enamel-adhesive and wire-adhesive interfaces (P<0.001). The microleakage at the wire-adhesive and enamel-adhesive interface was not significantly different in groups 1 and 4 and was significant in group 2 and 3.

CONCLUSION

Type of adhesive significantly affected the microleakage, and OF resulted in higher microleakage than TXT at both the enamel-adhesive and wire-adhesive interfaces. Type of wire had no significant effect on microleakage. Although OF showed comparable SBS to TXT, its higher microleakage may compromise its successful long-term clinical service.

The effect of different bonded retainer wires on tooth mobility immediately after orthodontic treatment

OBJECTIVES

This study aimed to compare the immediate influence of four commonly used retainer wires on tooth mobility following orthodontic treatment with fixed appliances.

MATERIALS AND METHODS

Eighty patients after orthodontic treatment were assigned to four study groups (n = 20 in each group). Groups were provided with directly bonded fixed retainers-0.0150″ (group A), 0.0175″ (group B), 0.016 × 0.022″ (group C), and 0.0215″ (group D). Tooth mobility was measured using the Periotest device at two times-after removal of fixed appliance (T1) and after bonding of the retainer (T2). Values of tooth mobility, 'Periotest values', were analysed between groups and compared with the physiologic tooth mobility in a control group of untreated patients (n = 65). Kruskal-Wallis H, Mann-Whitney U, Dunn's test, Fisher's exact test, and binary logistic regression tests were used to analyze the data.

RESULTS

Tooth mobility after orthodontic treatment was significantly increased. While canines remained within normal range of tooth mobility, values for incisors increased on average to the first degree of tooth mobility (slight mobility). Logistic regression analysis identified age as a significant predictor for increased tooth mobility (P = 0.032) with odds ratio 1.065 (95% CI 1.005-1.128), with mobility increasing with age. After bonding of the retainer in all four groups, the tooth mobility was reduced to values which were not significantly different form normal physiological values found in the control group (P > 0.05). There were no differences in the amount of change or in tooth mobility values at T2 between the different types of bonded retainers.

LIMITATIONS

Age of subjects in the control group was significantly higher than that in the study groups. An alternation method was used instead of randomization to distribute the four different types of retainers.

CONCLUSIONS

All of the retainer wires were able to successfully reduce the increased tooth mobility caused by orthodontic treatment to normal levels. The values of tooth mobility after placement of retainers were within the range of physiologic tooth mobility.

What causes failure of fixed orthodontic retention? - systematic review and meta-analysis of clinical studies

BACKGROUND

Orthodontic retention aims to maintain optimal teeth positions after active treatment. The stability is affected by numerous factors, including patients' individual features, thus retention should be adjusted in the most optimal way. Bonding a retainer makes retention less dependent on patient's compliance.

QUESTIONS ARISE

What wire or fiber splint type provides the best treatment stability? What materials should be used to bond the wire or fiber splint? Should be the bonding procedure be direct or indirect? The aim of the study is to assess and synthesize available controlled trials investigating failures of fixed retainers.

METHODS

Literature searches of free text and MeSH terms were performed in Scopus, Web of Science, Embase and PubMed Central in order to find studies, referring to failures of fixed retention (12th February 2021). The keywords were: ("orthodontic retainers AND failure AND wire"). The framework of this systematic review according to PICO was: Population: orthodontic patients; Intervention: fixed orthodontic retainer bonding; Comparison: Different protocols of fixed orthodontic retention applied; Outcomes: failure rate, survival rate. Three different specific scales from the Cochrane Collaboration Handbook were used, according to each study type. Additionally, a meta-analysis was conducted to compare the effectiveness of retention using fiber reinforced composite and multistranded steel wire.

RESULTS

The search identified 177 potential articles: 114 from PubMed, 41 from Scopus, 20 from Web of Science and 2 from Embase. After excluding studies inconsistent with selection criteria, 21 studies were included and subjected to qualitative analysis. The main outcome investigated was failure rate. This systematic review has some potential limitations due to the heterogeneity of design between included studies.

CONCLUSIONS

No retainer is proved to guarantee a perfect stability of dental alignment. The retainer should be bonded to all adherent teeth, preferably with additional use of bonding resin. No wire or fiber splint present superior characteristics concerning failure rate. Fiber reinforced composite retention is more sensitive to operator skills, and with imperfect bonding technique, failure rate is much higher. During the first 6 months after bonding retainer the patient should be under frequent control. The study protocol was registered in PROSPERO database with the number CRD42021233406.

Effects of different lingual retainers on periodontal health and stability

OBJECTIVES

To evaluate the effects of different lingual retainers on periodontal health and stability of mandibular anterior teeth at the 1-year follow-up.

MATERIALS AND METHODS

One hundred thirty-two patients were randomly allocated to four groups using different lingual retainers: group 1, 0.016 × 0.022-in dead-soft wire; group 2, 0.0215-in 5-strand stainless steel wire; group 3, 0.014 × 0.014-in computer-aided design/computer-aided manufacturing nitinol retainer (Memotain); group 4, connected bonding pads. Plaque, gingival, and calculus indexes were used to evaluate periodontal health, and Little's irregularity index, intercanine width, and arch length measurements were performed to evaluate stability. All measurements were performed at each time point (debonding and 3, 6, 9, and 12 months).

RESULTS

The mean value of the gingival index obtained in group 3 was lower than the mean value for all other groups. The mean value of the calculus index was the lowest in group 3, and there was a significant difference between group 3 and groups 1 and 2. No differences were found among the groups in terms of plaque index, intercanine width, and arch length. The least irregularity was obtained in groups 2 and 3. There were no significant differences between these groups and groups 1 and 4.

CONCLUSIONS

Gingival inflammation and calculus accumulation were the lowest in group 3 (Memotain). The irregularity for Memotain and stainless steel retainers was less than or the other groups. However, no clinically significant worsening of periodontal health or relapse were seen in any groups after 1 year.

Orthodontic retention protocols: an evidence-based overview

In view of the diversity of orthodontic presentations, a single optimal retention protocol does not exist, with approaches tailored based on pre-treatment characteristics, treatment-induced changes and general patient characteristics. However, orthodontic practitioners should be responsive to the best available evidence to formulate optimal retention protocols in terms of appliance type, design and regimen, in particular. Based on a comprehensive search strategy, we discuss fundamental aspects concerning orthodontic retention of particular interest both to orthodontists and general dentists. These include stability and periodontal outcomes, cost-effectiveness, patient experiences, survival and failure rates of retainers, and the duration of retention.

Fixed retention: pitfalls and complications

Long-term stability of orthodontic treatment results is problematic. Long-term or even lifelong retention with bonded retainers is being increasingly used among clinicians. Bonded retainers can provide an efficient and attractive method of retention, particularly because they require minimal compliance from patients. However, the use of bonded retainers is associated with relatively frequent complications, such as detachments of the adhesive layer or wire fractures, as well as unexpected complications with potentially severe consequences with associated periodontal and general health risks. It is imperative that the whole dental team are aware of these pitfalls and complications, and appreciate how to minimise and address these.

Innovative customized CAD/CAM nickel-titanium lingual retainer versus standard stainless-steel lingual retainer: A randomized controlled trial

Objective

To compare computer-aided design and computer-aided manufacturing (CAD/CAM) customized nitinol retainers with standard stainlesssteel fixed retainers over a 12-month study period.

Methods

This randomized controlled trial (RCT) was conducted on 62 patients randomly allocated to a control group that received stainless-steel retainers or a test group that received customized CAD/CAM nickel-titanium retainers. Four time points were defined: retainer placement (T0) and 1-month (T1), 6-month (T2), and 12-month (T3) follow-up appointments. At each time point, Little's irregularity index (LII) (primary endpoint) and dental stability measurements such as intercanine width were recorded in addition to assessment of periodontal parameters. Radiological measurements such as the incisor mandibular plane angle (IMPA) were recorded at T0 and T3. Failure events (wire integrity or debonding) were assessed at each time point.

Results

From T0 to T3, LII and other dental measurements showed no significant differences between the two groups. The data for periodontal parameters remained stable over the study period, except for the gingival index, which was slightly, but significantly, higher in the test group at T3 (p = 0.039). The IMPA angle showed no intergroup difference. The two groups showed no significant difference in debonding events.

Conclusions

This RCT conducted over a 12-month period demonstrated no significant difference between customized CAD/CAM nickel-titanium lingual retainers and standard stainlesssteel lingual retainers in terms of dental anterior stability and retainer survival. Both retainers eventually appeared to be equally effective in maintaining periodontal health.

Thermoformed Retainer: An Effective Option for Long-Term Stability

Introduction

The concept of orthodontic retention is moving toward the idea that teeth will move unless retained indefinitely. However, permanent retention implies permanent supervision, and that is where reality clashes with stability. The cornerstone of Essix permanent retention is the complete delegation of responsibility to the patient. Essix retainers have nothing to adjust, but maximum collaboration of the patient is essential to achieve long-term stability. The purpose of this paper is to show the effectiveness of the thermoplastic appliance as a retainer, using a clinical case with a 10-year follow-up. Case Report. A 33-year-old male patient presented with a class II malocclusion division 2 and normal skeletal pattern. According to the patient's desire, a treatment plan was proposed to obtain the aesthetic result of the smile, maintaining the molar and canine class II relationship. The orthodontic therapy was performed by using the Invisalign System. In this case, it was possible to appreciate a posterior occlusal stability after 10 years.

Conclusion

Currently, among orthodontists, the use of removable plastic devices is gaining popularity thanks to their capability to encapsulate and retain both posterior and anterior teeth. In this article, the technical features of thermoformed retainers will be described and one clinical case with a 10-year follow-up will be presented to emphasize the effectiveness of these retainers.

Development of a clinical practice guideline for orthodontic retention

OBJECTIVES

To develop a clinical practice guideline (CPG) for orthodontic retention (OR).

MATERIALS AND METHODS

The CPG was developed according to the AGREE II instrument and EBRO (Dutch methodology for evidence-based guideline development). Reporting was done according the RIGHT statement. A Task Force developed clinical questions regarding OR. To answer these questions, a systematic literature search in PubMed and EMBASE was performed. Two independent researchers identified and selected studies, assessed risk of bias using Cochrane RoB tool and rated quality of evidence using GRADE. The Task Force formulated considerations and recommendations after discussing the evidence. The concept CPG was sent for commentary to all relevant stakeholders.

RESULT

One systematic review-with 15 studies-met the inclusion criteria. In case of low evidence and lack of outcome measures, expert-based considerations were developed. Over four meetings, the Task Force reached consensus on considerations and recommendations, after which the concept CPG was ready for the commentary phase. After processing the comments, the CPG was presented to the Dutch Association of Orthodontists, whereafter authorization followed.

LIMITATIONS

The paucity of evidence-based studies concerning OR and the reporting of measurable patient outcomes.

CONCLUSION

This CPG offers practitioner recommendations for best practice regarding OR, may reduce variation between practices and assists with patient aftercare. A carefully chosen retention procedure for individual patients, combined with clear information and communication between orthodontist, dentist and patient will contribute to long-term maintenance of orthodontic treatment results.