Article

Clinical experience with direct-bonded orthodontic retainers

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Abstract

The experience obtained in clinical evaluation of forty-three direct-bonded mandibular canine-to-canine retainers after a minimum observation period of 1 year (range, 1 to 2.5 years) is summarized. Results indicate that the bonded retainer has all the advantages of a fixed soldered retainer, in addition to being invisible. Patient acceptance was excellent, and the failure rate in terms of loose retainers was low. Also, for a number of other retention problems, direct bonding with different types of lingual wire seems to open up a range of promising new possibilities.

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... Thirty-six studies were excluded due to the studies being retrospective in design (Supplementary Table 3). Of the 34 included studies, 25 were RCTs [25, 27-31, 33-35, 37-40, 42, 43, 45-52, 55, 56] and 9 were prospective clinical trials [12,26,32,36,41,44,53,54,57]. The study design, participants, intervention, outcome, and follow-up period of the included studies are summarized in Table 1. ...
... A total of 3484 participants with 4540 FOBR were included in the 34 studies, with participants age ranging from 9 to 60 years. Out of the 34 included studies in this review 6 were conducted in Switzerland [29, 31-33, 43, 56], 5 studies were conducted in Turkey [30,36,37,39,54], 3 studies in Italy [28,47,48], USA [12,26,49] and Iran [25,46,50], 2 studies were conducted in Germany [45,51], Sweden [27,40], Saudi Arabia [44,53], Norway [35,57], and UK [34,38], and 1 study in China [55], Belgium [52], Canada [41], and Pakistan [42]. The majority of studies included (n = 26) were conducted in a university hospital setting where the participants were treated by both specialist orthodontists as well as postgraduate students under supervision. ...
... The percentage of participants lost to follow up in the studies ranged from 0% to 38%. Interventions evaluated in the identified studies included: nine studies comparing multi-stranded wire (MSW) versus fibre-reinforced retainers [25,26,28,42,45,46,48,50,52], nine studies comparing different dimensions of wire [12,19,32,36,37,39,41,44,51], six studies comparing direct versus indirect bonding [29-31, 33, 36, 54], three studies comparing different types of composite bonding material [30,47,53], three studies comparing CAD/CAM versus lab made fixed retainers [35,38,49], two studies comparing bonding with liquid resin versus without liquid resin composite [55,57], two studies assessing vacuum formed retainer verses bonded retainers [34,40], and one study comparing light cured and chemical cure composite [43]. ...
Article
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Objectives To systematically assess the scientific literature for the prevalence of failure rate of fixed orthodontic bonded retainer (FOBR). Method Randomized clinical trials (RCTs) and prospective non-RCTs involving participants who had FOBR fitted were included. The Cochrane Central Register of Controlled Trials, Web of science, MEDLINE, and EMBASE via OVID were searched from inception to January 2023. Risk of bias was assessed using the Cochrane RoB 2 and Newcastle–Ottawa tools. The main outcome was the failure rate of FOBRs. The secondary outcome was to identify factors that can influence the failure of FOBR. Meta-analyses and sensitivity analyses were undertaken using Revman, version5.4. A random-effects model was used. Quality assessment using Grading of Recommendations Assessment, Development, and Evaluation. Results Thirty-four studies (25 RCTs and 9 prospective clinical studies) (3484 participants) were included in this review. The overall failure rate of bonded retainers, after excluding high-risk studies, was 35.22% (95% confidence interval [CI] 27.46–42.98). The failure rate is increased with the duration of follow up; with short-term follow-up rate 24.18% (95% CI 20.16–28.21), medium-term follow up 40.09% (95% CI 30.92–49.26), and long-term follow up 53.85% (95% CI 40.31–67.39). There is a low level of evidence to suggest there is no statistically significant difference in the failure rate of fixed retainers using direct versus indirect bonding methods, using liquid resin versus without liquid resin, and fibre-reinforced composite retainers compared to multi-stranded stainless steel retainers. Discussion There is low-quality evidence to suggest that the failure rate of FOBR is relatively high. There is a need for high-quality, well-reported clinical studies to assess factors that can influence the failure rate of FOBR. Registration CRD42021190910.
... As contenções ortodônticas são importantes recursos usados no tratamento ortodôntico e se propõem a estabilizar os órgãos dentários movimentados ortodonticamente [1][2][3] . O objetivo do tratamento ortodôntico é a movimentação dos dentes para posicioná-los na oclusão ideal através da força ortodôntica exercida pelos aparelhos. ...
... As contenções fixas na lingual dos dentes anteriores inferiores são o modelo mais empregado na rotina clínica dos ortodontistas para estabilização dos resultados alcançados pelo tratamento ortodôntico dada a sua indicação para evitar recidiva e apinhamento dos incisivos inferiores após o término do tratamento [1][2]19 . Encontra-se, frequentemente, dois modelos de contenções fixas em uso, o primeiro é a que se chama de convencional, constituída por um fio retilíneo fixado nos caninos inferiores; o segundo modelo, uma variação do primeiro, apresenta dobras que são fixadas sob as papilas dos incisivos e caninos inferiores, idealizadas para permitir a passagem do fio dental, visando facilitar a higienização 2,20-24 . ...
Article
Determinar se o uso da contenção ortodôntica é capaz de evitar recidivas do tratamento ortodôntico, bem como apontar as indicações e limitações dos diversos tipos de contenções existentes. O delineamento do estudo foi uma revisão de literatura do tipo narrativa. A busca dos artigos foi realizada de forma digital, nas bases de dados PubMed, Bireme e Google Scholar. Foram incluídos artigos publicados em inglês e português nos últimos cinco anos, disponíveis em texto integral. A indicação das contenções ortodônticas faz-se necessária para a manutenção dos resultados alcançados ao longo da movimentação ortodôntica. A literatura evidencia diferentes modelos de contenções que têm diferentes indicações, mas visam um mesmo objetivo, que é a garantia do controle das recidivas e apinhamentos após a fase ativa dos tratamentos ortodônticos. O emprego das contenções na rotina clínica ortodôntica é necessário como medida efetiva de controle das recidivas, devendo o profissional atentar-se para o acompanhamento do paciente após o tratamento finalizado.
... In addition, these wires are somewhat uncomfortable for patients [3]. First introduced by Zachrisson in 1977 [4], thin-wire multistranded fixed retainers (FRs) that bond lingually to all anterior teeth were widely used in orthodontic practice and were the gold standard for maintaining the stability of anterior tooth alignment after treatment [4][5][6]. However, advances in material science and computer technology have made it possible to develop new types of FRs that may be more effective. ...
... In addition, these wires are somewhat uncomfortable for patients [3]. First introduced by Zachrisson in 1977 [4], thin-wire multistranded fixed retainers (FRs) that bond lingually to all anterior teeth were widely used in orthodontic practice and were the gold standard for maintaining the stability of anterior tooth alignment after treatment [4][5][6]. However, advances in material science and computer technology have made it possible to develop new types of FRs that may be more effective. ...
Article
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Purpose: To investigate the elemental composition, corrosion resistance, and mechanical properties of computer-aided design and computer-aided manufacturing (CAD-CAM) retainers versus conventional fixed retainers (FRs). Methods: Eight different retainer wires were investigated. Energy dispersive X-ray spectroscopy was used to determine the elemental composition. Leakage was analysed according to ISO 10271:2020 guidelines. Hardness was tested using the Vickers method with a load of 0.3 kg. The tensile force and tensile strength were evaluated. Multiple comparisons among wires of hardness, tensile force, and strength were conducted using the Welch t-test, with Bonferroni correction. Results: Nickel was present in all wires. The CAD-CAM-FR wire, which contained more nickel than the other wires, had no measurable leakage. The gold-plated wires had the highest total leakage, but did not exceed the ISO standard limit. The hardness of the stainless-steel twisted wires was the highest and that of the CAD-CAM-FR wire was the lowest. The tensile strength of the CAD-CAM-FR wire was significantly lower than that of the other wires and similar to the other twisted-wire retainers. Conclusion: The CAD-CAM-FR wire is likely to have high corrosion resistance and flexibility due to its low hardness.
... The data on the retainer failure rate in the present study is relatively higher than the 11.6% given by Zachrisson. 14 Bolla et al 15 found 21.42% and 22.22% retainer failure in maxillary arch for glass fiber-reinforced and multistranded retainers, respectively. The corresponding value for the mandibular arch is 11.76% and 15.62%, respectively. ...
... Movement of the retainer wire during its initial setting causes bond failure and loosening of the retainer within a few days or months after retainer bonding. 14,17,18 The number and experience of operators may also cause an increased retainer failure rate. Successful clinical outcomes are often reported by experienced operators. ...
Article
Aim and Objectives The present study aims at evaluation and comparison of durability and hygiene between 2 different lingual retainer wires bonded between premolar to premolar, that is, maxillary or mandibular arch in the same patient. Materials and Methods Eighty retainer wires were placed in 40 patients. They were assigned to 2 groups and subjected to 2 different types of retainer wires (multistrand round and 8-braid flat). Results The mean durability of multistrand round retainer wire (235.7 ± 67.28 days) was more than 8-braid flat retainer wire (153.5 ± 43.85 days) irrespective of arches to which they were bonded, which was statistically significant. Scores for plaque index, calculus index, and gingival index were found more with 8-braid flat retainers and in lower arch than multistrand round retainer and in upper arch but these are statistically not significant. Conclusion The mean durability of multistrand round retainer wire was more than 8-braid flat retainer wire. The analysis did not find any statistical significant association for deposition of plaque, calculus, and gingival inflammation between different retainer wires and between arches.
... Early bonded fixed retainers were made from plain round wires; however, Zachrisson [5] proposed the use of multistrand wires for the construction of fixed retainers. Artun and Zachrisson [6] described the clinical technique for using a multistrand wire canine-to-canine bonded retainer. ...
... Among these endeavors to reduce failures of fixed retainers was the use of multistrand wires [5,6]. The irregular surface of the multistrand wire offers increased mechanical retention of the composite resin, and the flexibility of the wire allows physiological movement of the teeth during mastication [7,8]. ...
Article
Full-text available
Objective: The purposes of this study were to evaluate the survival rate of a tube-type mandibular fixed retainer and compare it to conventional multistrand retainers. Materials and methods: In all, 66 patients who had completed their orthodontic treatment were enrolled in this study. They were allocated randomly to a tube-type retainer group or a 0.020 multistrand fixed retainer group. In case of the tube-type retainer, a thermoactive 0.012 NiTi was placed into 6 mini-tubes passively bonded to the anterior teeth. The patients were recalled at 1, 3, 6, 12, and 24 months after retainer placement. During the 2‑year follow-up period, any first-time failure of retainers was recorded. Kaplan-Meier survival analysis and log-rank tests were used to compare the failure rates between the two types of retainers. Results: Of the 34 patients, 14 (41.2%) showed failure in the multistrand retainer group, whereas only 2 of 32 (6.3%) reported failure in the tube-type retainer group. There was a statistically significant difference in failure between the multistrand retainer and the tube-type retainer (log-rank test, P = 0.001). The hazard ratio was 11.937 (95% confidence interval 2.708-52.620; P = 0.005). Conclusion: The tube-type retainer can be used with fewer concerns about recurrent retainer detachments during orthodontic retention.
... Two alternatives have been used, namely an intercanine lingual/palatal wire bonded on all six anterior teeth (canine to canine) (Figure 6a,b), or lingual/palatal intercanine wire bonded only to the canine lingual/palatal surfaces (canine and canine) (Figure 6c) [50][51][52].The latter alternative is regarded as more effective in preventing changes in the intercanine dimension, but may not keep the dental units in their designated position, potentially culminating in future crowding [53]. The wire required is 0.30″of stainless steel, and there is a need for sand-blasting the canines' lingual surfaces. ...
... Two alternatives have been used, namely an intercanine lingual/palatal wire bonded on all six anterior teeth (canine to canine) (Figure 6a,b), or lingual/palatal intercanine wire bonded only to the canine lingual/palatal surfaces (canine and canine) (Figure 6c) [50][51][52]. The latter alternative is regarded as more effective in preventing changes in the intercanine dimension, but may not keep the dental units in their designated position, potentially culminating in future crowding [53]. ...
Article
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The achievement of aesthetic, functional occlusion should not mark the end of the orthodontic intervention. To prevent relapse, retention needs advance planning, and may vary in duration. This review aims to present and comment on the available means of retention. The ever-popular, passive Hawley-like removable appliances are credible in maintaining the desired occlusion. Modifications are the removable appliance Wrap Around, having the labial archwire extending to the premolars; the translucent retainer, Astics, a unique aesthetic Hawley-type device; and the reinforced removable retainer, which features a metallic grid reinforcing the acrylic base. Vacuum-formed retainers are easy to fabricate and are readily prescribed. By contrast, fixed retainers are made of orthodontic wire and composite resin bonded on the lingual or palatal surfaces of the anterior teeth. Patient-related variables need evaluation to select the appropriate retainer, while patients ought to realize the importance of retention and comply with offered guidance. Overall, the orthodontist is responsible for keeping the patient informed on the properties and the duration of retention, even before starting active orthodontic treatment.
... Reference [12] introduced the technique and highlighted the advantages of applying multi-stranded wires as bonded retainers. This was followed by [13] applying this technique but limiting the bonding to canine teeth only. ...
... This was followed by [13] applying this technique but limiting the bonding to canine teeth only. In a later publication [12] discussed the background leading to the evolution of multistrand fixed retainers along with his recommendations arising from more than twenty years of clinical experience with the technique. Included in his recommendations was the use of a 5-stranded 0.0215-in gauge wire [14]. ...
Article
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Retention is the final phase of orthodontic treatment. It is defined as the ‘stabilization of teeth in optimal esthetics and functional occlusion. A retention phase is considered crucial for the stability of treatment outcomes. The novel technique of utilizing a Non bonded fixed retainer (NFR) proved superior to the traditional bonded retainer in preventing relapse during the critical period spanning two to nine months after orthodontic therapy. The method as described in this article is simple to execute and economical. It makes effective plaque control in the vicinity of the retainer significantly easier. Moreover, this technique is recommended in patients with compromised periodontium. Nevertheless, it is essential for maintaining periodontal health and ensuring a successful outcome to treatment. However, studies on long term stability following lengthy periods of retention are needed. These are likely to substantiate the efficacy and durability of this technique.
... In our study, the Fixed Retainer Group exhibited the highest satisfaction levels among all groups. This finding aligns with Zachrisson et al. [15], who reported greater patient satisfaction with fixed retainers due to their comfort and convenience. ...
Article
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Objective: To evaluate the effectiveness of various orthodontic retention protocols, including removable retainers, fixed retainers, and a combination of both. Material and Methods: A cohort of orthodontic patients (n=240) was divided into four groups: Removable Retainer Group, Fixed Retainer Group, Combination Protocol Group, and Control Group. Tooth alignment stability, patient satisfaction, compliance, and adverse event occurrence were assessed over two years. Data analysis included regression analysis and comparisons between groups. Results: Fixed retainers demonstrated superior effectiveness in maintaining tooth alignment stability compared to removable retainers and the combination protocol, with the slightest deviation from baseline alignment. The Fixed Retainer Group also reported the highest patient satisfaction and compliance rates. Adverse events and complications, such as retainer breakage and discomfort, were more frequent in the Removable Retainer Group. Conclusion: Fixed retainers offer superior tooth alignment stability, patient satisfaction, and compliance, while adverse events are relatively infrequent and manageable. However, patient preferences and needs should be considered when choosing the most appropriate retention strategy. Keywords: Orthodontics; Therapeutics; Orthodontic Retainers; Orthodontic Appliances; Fixed.
... The treatment result can be stabilized by using fixed or removable retention devices [5]. Fixed bonded retainers have become increasingly popular since their introduction in the 1970s, as they are not dependent upon patient compliance [6,7]. Currently, most orthodontic retainers are made of thin multistranded stainless-steel (SS) wires [8]. ...
Article
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(1) Background: After more than a decade since their first description, Inadvertent Tooth Movements (ITMs) remain an adverse effect of orthodontic retainers without a clear etiology. To further investigate the link between ITMs and the mechanical properties of different retainers, the response upon vertical loading was compared in three retainer types (two stainless steel and one nickel–titanium). The influence of different reference teeth was also considered. (2) Methods: Three retainers (R1, R2, R3) were tested in a newly developed biomechanical analysis system (FRANS). They were bonded to 3D-printed models of the lower anterior jaw and vertically displaced up to 0.3 mm. Developing forces and moments were recorded at the center of force. (3) Results: The vertical displacement caused vertical forces (Fz) and labiolingual moments (My) to arise. These were highest in the lateral incisors (up to 2.35 ± 0.59 N and 9.27 ± 5.86 Nmm for R1; 1.69 ± 1.06 N and 7.42 ± 2.65 Nmm for R2; 3.28 ± 1.73 N and 15.91 ± 9.71 Nmm for R3) for all analyzed retainers and with the R3 retainer for all analyzed reference teeth, while the lowest Fz and My values were recorded with the R1 retainer. (4) Conclusions: Displacements of 0.2 mm and larger provided forces and moments which could be sufficient to cause unwanted torque movements, such as ITMs, in all analyzed retainers. Clinicians must be mindful of these risks and perform post-treatment checkups on patients with retainers of all materials.
... This can be achieved by using fixed or removable retention devices [4]. Fixed bonded retainers have become increasingly popular since their introduction in the 1970s, as they are not dependent upon patient compliance [5,6]. Nowadays, most orthodontic retainers are made of thin multi-stranded stainless-steel (SS) wires [7]. ...
Preprint
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(1) Background: To further investigate the link between inadvertent tooth movements (ITMs) and mechanical properties of different retainers, the response upon vertical loading was compared in three different retainers (two stainless steel and one nickel-titanium). The influence of different reference teeth was also considered. (2) Methods: Three retainers (R1, R2, R3) were tested in a newly developed biomechanical analysis system (FRANS). They were bonded to 3D-printed models of the lower anterior jaw and vertically displaced up to 0.3mm. Developing forces and moments were recorded at the center of force. (3) Results: The vertical displacement caused vertical forces (Fz) and labiolingual moments (My) to arise. These were highest in the lateral incisors (up to 2.35±0.59N and 9.27±5.86Nmm for R1; 1.69±1.06N and 7.42±2.65Nmm for R2; 3.28±1.73N and 15.91±9.71Nmm for R3) for all analyzed retainers, and with the R3 retainer for all analyzed reference teeth, while the lowest Fz and My values were recorded with the R1 retainer. (4) Conclusions: Displacements of 0.2mm and larger provided forces and moments which could be sufficient to cause unwanted torque movements, such as ITMs in all analyzed retainers. Clinicians must be mindful of these risks and perform posttreatment checkups on patients with retainers of all materials.
... On the other hand, the majority of trials comparing smooth plain or flat retainers to multistranded wires showed no difference between the methods. (10,22) Regarding periodontal health in general, a literature review found no consensus on this topic. Studies the long-term periodontal implications of using fixed retainers are unknown, it is widely agreed that fixed retainers make oral hygiene routines more difficult. ...
Article
Background: Fixed retainers are retention tools bonded on the lingual side of the frontal teeth to prevent relapse after orthodontic treatment is finished. While stability remains the biggest concern, periodontal response remains the subject of discussion. This study aimed to compare plaque index (PI) levels on the lingual side of the lower dental arch in the inter-canine region after bonding two different models of fixed retainers.Methods and Results: The study included 60 subjects aged 16-25 who finished orthodontic treatment. Thirty subjects got flat fixed retainer (FFR), and 30 other subjects got round fixed retainer (RFR) bonded in the lower six frontal teeth on the lingual side. Adapted PI was recorded and photographed at four time points (3, 6, 9, and 12 months). Three months after the intervention, there were no significant differences between the FFR and RFR related to the PI value (P=0.363). PI was significantly lower in the FFR group than in the RFR group 6, 9, and 12 months after the intervention (P<0.004, P=0.004 and P=0.001, respectively).Conclusion: Bonded fixed retainers, in general, cause increased plaque formation and make oral hygiene routines more difficult.
... Changes in types of fixed retainers, for example, from 13-23 to 12-22 and from 34-44 to 33-43, as reported in the present study, also suggest that the retainers were shortened probably because of breakages or debonding. Besides the risk of failure, multistranded stainless steel fixed retainers, which have been considered the gold standard for decades [36], have been shown to produce unexpected post-treatment changes [37,38] in 1 to 5% of patients. Therefore, if fixed retainers are to be recommended [39], the profession needs to find alternatives to multistranded wires, which, for example, could be offered by new CAD/CAM technology [40]. ...
Article
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(1) Aims: The main objective of this retrospective study was to assess the long-term stability of difficult orthodontic treatments treated to an excellent result and to correlate stability to possible prognostic factors. Secondary objectives were to observe the changes in retention protocol over time and to assess Oral Health-related Quality of Life (OHRQoL) after a long-term post-treatment follow-up. (2) Methods: Cases presented for final examination by orthodontic postgraduate students were retrospectively screened for eligibility. Eligible patients were recalled for a post-treatment recall appointment (T2), consisting of a clinical examination and intraoral scan, and were asked to complete the Oral Health Impact Profile-14 (OHIP-14-DK). Gender, age at treatment commencement (T0), treatment modality and duration, and retention protocol were extracted from the records. At T2, the duration of the retention period was recorded, and retainers in place were clinically compared to the original retention protocol. The following variables were assessed on the sets of models at T0, T1 (end of treatment), and T2: arch length and width, overjet and overbite, Dental Aesthetic Index (DAI), Peer Assessment Rating score (PAR), and Little’s Irregularity Index (LII). Multiple regression models were conducted. (3) Results: Eighty-five subjects attended T2. The mean post-treatment follow-up was 9.4 years +/− 2.4. In the upper arch, at T1, 74 patients had a combination of fixed and removable retainers, while at T2, 55 had a fixed retainer only. In the lower arch, at T1, 67 patients had a fixed retainer only, with this number increasing to 76 at T2. From T0 to T1, the PAR score improved by 96.1%, with the improvement remaining at 77.5% at T2. The stability of lower inter-canine and upper inter-premolar widths was significantly correlated with the extent of changes during treatment. The presence of a lower fixed retainer at T2 and a low LII at T1 were prognostic factors for stability. The mean weighted total OHIP-14 score at T2 was very low (1.6 ± 2.4 points). (4) Conclusions: In a sample with an initial high-severity malocclusion and treated to an excellent outcome, long-term stability was very good. Good stability can be retained when a lower fixed retainer is present at T2 and when a low LII is achieved at T1.
... Orthodontic retainers were introduced in the 1970s [1,2] to stabilize tooth alignment without inhibiting tooth mobility and studies have confirmed that conventional multistranded retainers are able to do this [3][4][5][6]. After decades of experience, Zachrisson et al. recommended the 0.0215-inch fivestranded multistranded retainer, including its gold-coated version, as the most appropriate fixed orthodontic retainer because it provides appropriate retention while allowing physiological tooth mobility [7]. ...
Article
Objectives Orthodontic retainers should restrict physiological tooth mobility as little as possible. While this has been investigated for multistranded retainers, there is a lack of data for novel CAD/CAM retainers. To address this, the present study compared the restriction of physiological tooth mobility in multistranded retainers and different CAD/CAM retainers. Material/methods One group of multistranded (n = 8) and five groups of CAD/CAM retainers (nickel-titanium (NiTi), titanium grade 5 (Ti5), polyetheretherketone (PEEK), zirconia (ZrO2), and cobalt-chromium (CoCr); each n = 8) bonded from canine to canine were investigated for their influence on vertical and horizontal tooth mobility using an in vitro model of a lower arch in a universal testing machine. Load–deflection curves were determined and statistically analysed. Results All retainers restricted tooth mobility to varying extents. The retainers had less of an influence on vertical tooth mobility, with less of a difference between retainers (14%–38% restriction). In contrast, significant (P ≤ 0.05) differences were observed between retainers in the restriction of horizontal tooth mobility. ZrO2 retainers had the greatest impact, restricting horizontal tooth mobility by 82% (68 ± 20 µm/100N), followed by CoCr (75%, 94 ± 26 µm/100N) and PEEK (73%, 103 ± 28 µm/100N) CAD/CAM retainers, which had comparable effects on horizontal tooth mobility. Ti5 (54%, 175 ± 66 µm/100N) and NiTi (34%, 248 ± 119 µm/100N) CAD/CAM retainers had less of an influence on horizontal tooth mobility, and were comparable to multistranded retainers (44%, 211 ± 77 µm/100N). Limitations This is an in vitro study, so clinical studies are needed to draw clinical conclusions. Conclusions Multistranded and CAD/CAM retainers have different effects on tooth mobility in vitro. These effects should be further explored in future in vivo studies.
... In 1907, E. H. Angle introduced the use of fixed appliances, specifically a lingual retainer with a steel wire attached over the canines, for retention purposes (5). Later, Zachrisson advocated for the use of adhesively bonded metal wires from canine to canine (6). ...
... 14 Originally, plain round or rectangular orthodontic wires were used until Zachrisson suggested the use of multi-stranded wires. 15 He described his experience with 5-strand wires of 0.0215 inch diameter, which produced better results based on failure rates found in a review of finished cases. 16 In recent years, glass fibre reinforced composite orthodontic retainers have emerged as an alternative to stainless steel wires. ...
Article
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Objective To assess gingival health and predictors of relapse related to braided-wire bonded retainers after the active phase of comprehensive orthodontic treatment. Materials and methods Fifty-one subjects were recruited in a prospective study of whom 42 were available for analysis after 2 years of retention (pre-therapeutic ages 11–18 years; 66% female). A rectangular wire retainer (0.027 × 0.011″) was bonded to the mandibular incisors. Little’s index of incisor irregularity; intercanine width; the accumulation of biofilm, calculus and gingivitis; and the incidence of retainer detachment, were recorded. Subjects were examined before orthodontic therapy, upon therapy completion, and after 2 years of retention. Results The incidence of retainer detachment over the 2 years was 27%. The post-treatment incidence of irregularity was 17%, and intercanine width reduction was 24%. Calculus accumulation increased significantly during retention ( p < 0.001) but not the extent of gingivitis. A multiple logistic regression demonstrated that an increase of mandibular intercanine width by ≥3 mm correspondingly increased the odds of relapse 14.3 times (95% confidence interval [CI], 1.1–196.1; p = 0.046). Patients presenting with retainer failure were 10 times (95% CI 1.6–62.8; p = 0.014) more likely to experience relapse. Subjects who experienced relapse had retainer failure earlier than those without relapse (19 vs. 23 months; p = 0.003). The occurence of relapse was not related to a treatment change in incisor irregularity, the duration of treatment, the age of the patient, gender nor to a change of intercanine width during retention. Conclusion Post-treatment changes in the mandibular arch incorporating bonded retainers were not large, but were common. An increase in mandibular incisor irregularity during retention is mostly related to treatment-induced intercanine width expansion. The bonded retainer often detached and increased calculus accumulation.
... Fixed retainers are the retainers of choice for many orthodontists, especially for stabilizing the treatment result of the lower jaw. Zachrisson in 1977 demonstrated the advantages of using multistranded metallic wires as fixed retainers (18). In 1982, Artun and Zachrisson introduced the bonding of multi-stranded wires to the lingual surface of canines only (19). ...
Article
Full-text available
To ensure that the results of fixed orthodontic therapy are maintained and do not relapse, it is crucial to retain and preserve the treatment outcomes. Retention is an essential aspect of orthodontics and can be viewed as the final stage of treatment. It is necessary to maintain an optimal esthetic and functional occlusion following orthodontic therapy. Aim : The objective of the article is to acknowledge the significance of maintaining the outcomes of orthodontic therapy and to assess the various techniques used to fabricate fixed and removable appliances for retention. Materials and Methods: The present article evaluates the different protocols for lingual fixed retainers, as well as removable retentive appliances such as Hawley, Begg, and vacuum-formed retainers (VFR). Removable appliances have been used for retentive purposes for a long period of time. Bonded fixed retainers were introduced in the 1970s, and they have several advantages over removable retentive appliances, such as better esthetics, the absence of patient cooperation, and suitability for lifelong retention. Fixed retainers can be of conventional or digital type. Conventional fixed retainers can be fabricated and attached directly or indirectly to the teeth using a transfer tray. Moreover, bonded retainers can now be digitally manufactured using computer-aided design and computer-aided manufacturing (CAD-CAM).
... 14 (d)impropersurfacepreparation,(e)disturbancesduringtheadhesivesettingpro cessand(f)moisturecontamination.TheaforementionedobservationsmadebyTuncetal. 14 wereinaccordancewiththestudie sconductedbyZachrissonetal.15 ,Soaresetal.16 ...
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Aim:TocomparetheclinicalsuccessrateofFiberReinforcedCompositeResinspacemaintainerwiththatofConventionalBandandLoopspacemaintainerinchildrenofagegroup6-8years. Methodology:Atotalof60subjects(31girlsand29boys)ofagegroup6to8yearsrequiringspacemaintenanceduetoprematurelossofprimarymolars.ChildrenwhoreceivedFibreReinforcedCompositeResinandBandandLoopspacemaintainerswerecategorizedasGroup1andGroup2respectively.Subjectswererecalledattheendof1st,3rd,and6thmonthsforevaluationofbothtypesofspacemaintainerswhenclinicalsuccessrateofbothtypesofspacemaintainerswereevaluated.Treatmentacceptabilityduringandaftertheprocedurewascheckedusingsix-pointWong-BakerFacesScale. StatisticalAnalysis:ThestatisticalanalysiswasperformedbyusingastatisticalsoftwarepackageSPSSversion25statisticalsoftware.Quantitativevariableswereexpressedasmeanandstandarddeviation.Comparisonofquantitativevariablesbetweenthetwogroupswereanalyzedbyunpairedttest.Qualitativevariableswereexpressedasfrequencyandproportion.Comparisonofqualitativevariablesbetweentwogroupswereanalyzedbychi-squaretest.Apvaluelessthan0.05wasconsideredasstatisticallysignificant Results:Thisstudycomparedthesuccessratesof60spaceMaintainersBandandloopandFRCRsin30childrenintheDepartmentofPediatricDentistryatGovernmentDentalCollege,Thiruvananthapuram.60spacemaintainerswereevaluatedattheendof6months,30bandandloopspacemaintainers wereevaluated,6failedand24weresuccessful.Outof30FRCRspacemaintainers,5failedand25wereconsideredsuccessful.Theclinicalsuccessratewasfoundtobe83.3%forFRCRand81.7%forbandandloop.Thedifferences,however,werenotstatisticallysignificant(P>.05). Conclusion:Althoughstatisticallynosignificantdifferenceinsuccessratesbetweenthesetwotypesofspacemaintainers,FibreReinforcedCompositeResinspacemaintainerhadslightedgeoverBandandloopspacemaintainerintermsofclinicalefficiency.PatientacceptancetowardsthemwerealsofoundFRCRspacemaintainerswasfoundtobeslightlybetterthantothatofbandandloopspacemaintainers.OnasubjectiveopinionmanyofthesubjectspraisedtheestheticqualityofFRCR.TheevidenceobtainedsuggeststhatFRCRisasuitablealternativetoBandandLoopforshorttermspacemaintenanceinyoungchildren.
... -17,1% de décollements des contentions collées à 18 mois -7,9% avec micro-sablage vs 25% avec pierre ponce -Taux de décollement 3 fois moindre dans le groupe micro-sablage par rapport au groupe pierre ponce à 18 mois d'observation (p = 0,040). Les contentions orthodontiques collées ont été introduites par Björn Zachrisson en 1977 [1]. Elles sont utilisées de façon routinière par 83% des orthodontistes français à la mandibule de canine à canine [2]. ...
Poster
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Introduction : L’objectif de cette étude a été de comparer le taux de décollement des contentions collées mandibulaires post-orthodontiques sur une période de 18 mois selon deux préparations différentes de la surface amélaire : micro-sablage vs brossage à la pierre ponce. Matériel et Méthodes : Cet essai clinique contrôlé randomisé à deux groupes parallèles a été mené auprès de 88 patients (âge moyen 16,5 ans) au sein de la structure interne d’Orthopédie Dento-Faciale des Hôpitaux Universitaires de Strasbourg. Après randomisation, la surface amélaire linguale des six dents mandibulaires était préparée soit par micro-sablage, soit à la pierre ponce, puis mordancée. Un fil de contention en acier tressé multibrins de diamètre à 0.0215” était collé de 33 à 43. Le critère d’évaluation principal était la présence ou non d’un décollement au cours des 18 mois de suivi, évalué par examen visuel et tactile au cours des consultations de suivi tous les 3 mois. L’analyse du critère de jugement principal a été réalisée avec un test du χ2 de Pearson. Les courbes de survie ont été générées par la méthode de Kaplan-Meier et analysées par un test du Log-Rank. Résultats : L’analyse à 18 mois s’est portée sur 82 patients. Le taux de décollement de la contention a été de 17,1%. Il y a eu statistiquement moins de décollements dans le groupe micro-sablage (7,9%) que dans le groupe pierre ponce (25,0%) (risque relatif avec intervalle de confiance à 95% de 0,32 [0,10-0,96], valeur-p = 0,040). La probabilité de survie de la contention a été statistiquement supérieure dans le groupe micro-sablage (93%) par rapport au groupe pierre-ponce (75%), valeur-p = 0,02. Une différence significative entre les deux groupes a été constatée dès le 2e rendez-vous à 6 mois (valeur-p = 0,03). Il y a eu 7,1% de mouvements dentaires indésirables à 18 mois. Conclusion : La préparation amélaire par micro-sablage avant mordançage a permis une réduction statistiquement et cliniquement significative du taux de décollement des contentions collées mandibulaires à 18 mois, par rapport à la pierre ponce. Ce micro-sablage préalable a permis de réduire, en moyenne, de trois fois le risque d’observer un décollement.
... Various types of retainers have been reported, including those made with wires of various material characteristics and diameters [2], or with fiber reinforcement [3]. The use of computer-aided design/computer-aided manufacturing (CAD/CAM) technology in dentistry for the fabrication of fixed lingual retainers is limited, as research in this area shows. ...
Article
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Background Retainer is a necessary procedure when orthodontic treatment complete to avoid relapse due to periodontal fiber elasticity and to allow for alveolar bone regeneration. Compare the influence of vertical force on the failure of three fixed retainers: CAD/CAM polyether ether ketone (PEEK), CAD/CAM fiber glass reinforced composites (FRCs), and lingual retainer wire “Bond-A-Braid™”. Materials and methods One hundred and eight maxillary first premolars teeth were randomly allocated to three groups: Group A (CAD/CAM PEEK), Group B (CAD/CAM FRC), and Group C (lingual retainer wire " Bond-A-Braid™”). These retainers were bonded using Assure Plus Bonding Resin and GO TO Paste. For each specimen, a loading cycling and thermocycling machine was used. The failure debonding forces were measured on the interproximal segments using a universal testing machine with a cross-head speed of 1 mm/min. The adhesive remnant index (ARI) was calculated after identifying types of failure with a stereomicroscope at (X 20) magnification. Results Group B and group C showed the highest failure bonding forces, with a mean of 209.67 ± 16.15 and 86.81 ± 4.59 N, respectively. However, Group A had a statistically significant lower bond failure force, with a mean value of 45.73 ± 4.48 N. At baseline, there was a statistically significant difference in connector retainer displacement between the three studied groups (p < .001). The ARI score was not statistically significant (p < .001) between the three study groups; for groups A and B, the ARI was predominantly score 3, and group C showed a mixed score of 2 and 3. The failure mode of retainers was investigated using an optical stereomicroscope. In group B, there was a cohesive breakdown in the retainer, and groups A and C exhibited failures primarily in the adhesive at the retainer interface. Conclusion All groups differed significantly, with group A having the lowest debonding force and group B having the highest. Furthermore, there was not a substantial variation in ARI, but there was a significant difference in connector retainer displacement and the types of failure amongst the three groups.
... Since their introduction in the 1970s, bonded fixed retainers have gained popularity due to their safety, practicality, and aesthetic appeal while requiring minimal patient compliance (4)(5)(6). Multi-stranded wire lingual retainers have been considered the gold standard for anterior teeth stability following orthodontic treatment since Zacchrisson's 1977 clinical trials, leading to increased demand for lingual fixed retainers in orthodontic practices (7,8). However, they have several drawbacks, including labour-intensive and sensitive insertion processes, potential adverse effects on periodontal tissues, potential tooth movement from wire distortion, and frequent bonding failures (9)(10)(11)(12)(13). ...
Article
Objective Comparing computer-aided design and computer-aided manufacturing (CAD/CAM) fixed retainers and conventional fixed retainers for their effectiveness in orthodontic patients using systematic review and meta-analysis of literature. Search methods A comprehensive search was conducted in MEDLINE, Web of Science, EMBASE, Scopus, Cochrane’s CENTRAL, Google Scholar, Ovid, and LILACS up to May 2023, with no language or date restrictions. Selection criteria Only randomized clinical trials (RCTs) that complied with PICO questions were included, and the Cochrane Risk of Bias 2.0 (RoB 2) tool was used to assess the risk of bias in the included studies. Data collection and analysis Using custom-piloted forms, relevant data were retrieved from the included studies. Then a random-effects inverse variance meta-analysis was used to pool the results. Primary outcomes were stability of treatment results measured through dental cast measurements and periodontal status, while secondary outcomes were failure rates and patient-reported outcomes. Results Seven RCTs with 601 participants were included in the review. In the short term (≤6 months), the meta-analysis showed no significant differences in inter-canine distance or arch length between CAD/CAM and conventional fixed retainers in mandibular retainers. However, for Little’s irregularity index, single-stranded stainless-steel retainers were notably worse than Ni–Ti CAD/CAM retainers at 3 and 6 months, while multi-stranded stainless-steel retainers only diverged from CAD/CAM at the 6-month milestone, despite the overall clinical inconsequence of these changes. CAD/CAM retainers were associated with a lower plaque index than traditional retainers but no significant difference in gingival index. Failure rates did not differ significantly between CAD/CAM and other types of retainers in mandibular retainers. Nonetheless, one study had a high amount of CAD/CAM retainer failures leading to the study being stopped. Conclusions In the short term, CAD/CAM fixed retainers show promise as an alternative to traditional retainers. They may enhance periodontal health, as indicated by lower plaque index scores than conventional retainers. However, extensive research is needed to determine the long-term durability and effectiveness of CAD/CAM retainers in orthodontic treatment, particularly regarding their failure rate. Until comprehensive evidence is available, the use of CAD/CAM retainers should be tailored for each case. Registration The protocol for this systematic review was registered at PROSPERO with the ID CRD42023412741.
... 25 The use of FSW for retention has been suggested because of the surface properties that would improve the mechanical retention of the composite, in addition to their flexibility that would allow for physiological tooth movement of teeth. 27 Most described patients in this case series had an FSW (twisted with a round cross section). However, previous literature has shown that among the most common factors related to the etiology of these unwanted tooth movements is the vulnerability of these wires to untwist and unwind because of external factors, which might lead to their displacement and activation. ...
Article
This article focuses on on the presentation and management 9 adult patients who experienced complications because of their maxillary or mandibular fixed retainers 5-33 years after orthodontic treatment. Such complications include the development of an anterior crossbite, open bite, incisal cant, and twist- and x-effects. The detrimental effects on periodontal health were highlighted, especially in the mandibular canines. A range of fixed retainer types was identified, including flexible spiral wire bonded to 4 maxillary or 6 mandibular anterior teeth, rigid wire bonded to mandibular canines only and fiber-reinforced composite fixed retainer. Orthodontic retreatment was necessary in all patients using fixed appliances or clear aligners. Radiographic findings from cone-beam computed tomography or orthopantomogram before and after retreatment are presented when available. Despite the improvement of teeth position clinically, the cone-beam computed tomography scans taken directly after the completion of orthodontic retreatment did not show notable improvement with regards to root proximity to the cortical plates. The prevention of further complications was highlighted, including the use of dual retention, remote monitoring, frequent follow-up appointments and the importance of developing clear guidelines for monitoring patients in retention for treating clinicians and general dentists to promote early detection of adverse changes.
... 1) rigid round wire bonded to the terminal teeth, which can be the first premolars or the canines; and 2) round multi-strand wire retainer bonded to all teeth in the anterior segment, usually from canine to canine. [7][8][9] Multi-strand stainless steel wire retainers are increasing in popularity, due to their flexibility, which allows for some physiologic tooth movement. 10 It has been reported that multi-strand wire retainers are more effective in maintaining individual tooth rotation, compared to the rigid wire retainers, whereas the latter were shown to be more hygienic. ...
Article
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Objective The primary objective was to compare round multi-strand wire and Ortho-Flex-Tech™ rectangular wire retainers in terms of gingival health. The secondary objectives were to assess plaque/calculus accumulation, and to determine the effectiveness of these retainers in maintaining tooth alignment and their failure rate. Material and Methods This single-center study was a two-arm parallel randomized clinical trial and was conducted at the Orthodontic clinics in Dental Teaching Center/Jordan University of Science and Technology. Sixty patients, with bonded retention for the mandibular anterior segment after fixed orthodontic treatment, were randomly selected. The sample comprised Caucasian patients with mild to moderate pretreatment crowding in the mandibular anterior region, Class I relationship, treated without extraction of mandibular anterior tooth. In addition, only patients presenting normal overjet and overbite after treatment were included. Intervention One group received round multi-strand wire retainer (30 patients, average age: 19.7 ± 3.8 years), while the other group received Ortho-Flex-Tech™ retainer (30 patients; average age: 19.3 ± 3.2 years). In both groups, the retainers were bonded to all mandibular anterior teeth from canine to canine. All patients were recalled one year after bracket debonding. Randomization sequence was created using Excel 2010, with a 1:1 allocation, using random block size 4. The allocation sequence was concealed in sequentially numbered, opaque and sealed envelopes. Only participants were blinded to the type of bonded retainer used. The primary outcome was to compare the gingival condition between the two groups. The secondary outcomes were to assess plaque/calculus indices, irregularity index of the mandibular anterior teeth and retainers’ failure rate. Comparisons were conducted using Mann-Whitney U test or chi-square test. Statistical significance was predetermined at the p≤ 0.05 level for all tests. Results Complete data were collected for 46 patients (round multi-strand wire retainer group, n=24 patients; rectangular Ortho-Flex-Tech™ retainer group, n=22 patients). No significant differences were found in the gingival health parameters between the two groups (p>0.05). Ortho-Flex-Tech™ retainers maintained the alignment of mandibular anterior teeth more than multi-strand retainer (p<0.05). No significant difference was found in the failure rate between the two groups (p>0.05). Conclusions Gingival health parameters and failure rate were not different in both groups. However, Ortho-Flex-Tech™ retainers were more efficient to retain the mandibular incisors than the multi-strand retainers; nevertheless, the difference was not clinically significant. Keywords: Bonded retainers; Gingival health; Relapse
... The most basic objective of tooth splinting is to prevent the destruction of periodontal tissue by overloads including secondary occlusal trauma (Bernal et al., 2002). On the other hand, it has been indicated that retainer materials should be passive and semirigid to maintain physiological tooth mobility in tooth splinting after orthodontic treatment (Zachrisson, 1977;Levin et al., 2008;Oshagh et al., 2014). This consideration is developed based on the maintenance of biomechanical homeostasis in periodontal tissues. ...
Article
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This study aimed to evaluate the effect of splinting material type and material location on the force resistance of splinted periodontally compromised teeth with hypermobility. Extracted teeth including the target tooth (maxillary second premolar) and its adjacent teeth were placed into the alveolar sockets of a dental arch model via artificial periodontal ligaments made of elastic impression material. Three different experimental models with varied target tooth mobility including Periotest® values (PTVs) of 20, 30, and 40 were fabricated (named models #20, #30, and #40, respectively). For each experimental model, the force resistance of tooth splinting was tested using the following four materials: everStick PERIO (glass fiber reinforcement: GFR), FORESTAFLEX (braided stainless steel: BSS), Ortho-FlexTech (stainless steel chain: SSC), and Super-Bond (MMA-based resin cement: MRC). The evaluated measures were the PTV after tooth splinting and the required load to cause tooth displacements of 0.05 mm and 0.10 mm in the vertical and lateral directions, respectively. The splinting material type and material location as well as the original PTV of target the tooth significantly affected all the evaluated measures (p < 0.001). MRC revealed the significantly highest force resistance of tooth splinting regardless of material location in each experimental model and was followed by GFR. The PTVs of splinted teeth were comparable to those of adjacent anchor teeth in models #20 and #30 when using GFR, while that was comparable in model #40 when using MRC. Meanwhile, the load causing certain tooth displacement showed a similar tendency to previous-reported data with healthy teeth in model #20 when using GFR, while that showed a similar tendency in models #30 and #40 when using MRC. Overall results concluded that splinting material type and location play a role in the resistance against the deflection force of splinted periodontally compromised hypermobile tooth. It was noted that MRC provided the highest resistance against the deflection force of splinted teeth regardless of material location whereas GFR maintained the physiologically considered tooth mobility.
... Failures in the form of loosening or wire breakages were still reported frequently. In 1977,Zachrisson 7 described the advantages of using multi-stranded wires for retention. Later, in 1982, Artun and Zachrisson 1 introduced the technique of bonding multi-stranded wires from canines to canines only. ...
... Fixed retainers may differ in the type of material they are made of. There are retainers consisting of a piece of orthodontic wire adjusted to the lingual tooth surface, bonded to the canines and manually twisted multistranded wire lingually bonded to all anterior teeth [4]. Pre-fabricated lingual retainers may be of the flexible chain [5], manufactured flattened multistranded wire or rigid wire, ending in both ends like a bracket base for easy fixation [6]. ...
Article
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Following the integration of fixed retainers into the clinical practice, an increasing number of orthodontists prefer this retention method. Further to the proven advantages of those retainers, however, there are some deficiencies, which, if not taken into consideration, might compromise the good treatment result. CAD-CAM methods employ a different approach in design, materials and method of fabrication, and clinical procedures with respect to fixation. This allows for the avoidance of a large part of the deficiencies of the fixed retainers that are made manually. Aim: Our aim is to demonstrate the clinical effectiveness of titanium CAD/CAM fixed retainers. Materials and methods: Swing (DOF) Laboratory scanner was used to scan the models. Retainers were designed through Exocad Matera (Exocad GmbH) software. Retainers were fabricated of titanium Ti G5 (SILADENT Dr Böhme & Schöps GmbH) discs, machined with CORiTEC 650i (Imes-icore GmbH) 5-axis dental milling machine. Results: The outcome is a retainer, which is excellently fitting to the dental surface, absolutely passive, resistant to plastic deformation, fracture-proof and with an extremely easy clinical fixing procedure. Conclusion: CAD/CAM methods employ an innovative approach, providing a different manufacturing technology and the use of various materials for the purposes of fixed retention. These methods eliminate a significant part of the deficiencies of the conventional manually bent retainers.
... Failures in the form of loosening or wire breakages were still reported frequently. In 1977,Zachrisson 7 described the advantages of using multi-stranded wires for retention. Later, in 1982, Artun and Zachrisson 1 introduced the technique of bonding multi-stranded wires from canines to canines only. ...
Article
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Objectives: To Evaluate and Compare Debonding Properties (Detachment Force, Magnitude of Deformation, Adhesive Remnant Index and Pull out Force) for Three Types of Directly Bonded Lingual Retainer Wires. Materials and Method: 36 pairs of extracted mandibular incisors were embedded in Acrylic blocks proximally in contact with each other. The wires used were 0.0195-inch Stainless Steel (SS) Dead soft coaxial (Group A), 0.008- inch x 0.033-inch SS Flat woven (Group B), and the 0.0175-inch SS Multistranded 1 x 6 (Group C). An 8 mm sectioned wire from each category was bonded directly onto the lingual surface of the tooth. The Detachment force was tested using a Universal Testing Machine (UTM) followed by the assessment of the Dr. Shatabdi A. Chakravarty, et al. International Journal of Medical Sciences and Advanced Clinical Research (IJMACR) © 2021, IJMACR, All Rights Reserved Page172 Magnitude of Deformation in the debonded wire and the Adhesive Remnant Index on the enamel surface. For the Pull out Test using UTM, another 36 blocks were prepared. The free end of a 5 cm sectioned wire was embedded in the centre with composite and cured. Results: Group A showed the maximum mean detachment force and pull out force. The maximum deformation was seen in Group B. The amount of deformation was significantly different among groups (p < 0.05). The least ARI was observed for Group C. Conclusion: Based on the values of Detachment Force and Pull out test force values, Group A was found to be a better wire amongst the others. Based on the magnitude of deformation and ARI, Group C was found to be a better choice as a retainer wire.
... Fixed or removable retention appliances can reduce the risk of relapse [1], but to date there is still limited evidence on treatment protocols, wearing time and duration [2]. However, long-term retention with fixed lingual retainers is commonly recommended and often considered the gold standard (method of first choice) in orthodontic retention [3][4][5][6][7]. ...
Article
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Objectives To evaluate post-treatment movements of lower anterior teeth during orthodontic retention in patients with fixed twistflex retainers versus those with combined fixed and removable retainers. Materials and Methods This study was based on a retrospective data analysis of 57 adult patients during orthodontic retention. They were assigned to two groups: In group 1 ( n = 30) the lower jaw was provided with twistflex retainers only and in group 2 ( n = 27) with a twistflex combined with a removable retainer for night-time use. Orthodontic study models of the lower jaw were digitalized and superimposed. Tooth movements were analyzed at the retainer bonding (t0) and follow-up appointment ≥ six months later (t1). Rotational tooth movements (°) were measured around the x-axis (mesial/distal direction), the y-axis (buccal/lingual direction) and the z-axis (longitudinal direction, tooth axis). Translational tooth movements (mm) were registered along the x-axis (buccal/lingual direction), the y-axis (mesial/distal direction) and the z-axis (apical/coronal direction). Results Canine and incisor position changes during orthodontic retention were more pronounced in group 1 compared to group 2 except for canine rotations around the z-axis. In both groups in most of the cases stable lower incisor alignment could be found, but the proportion was significant higher in group 2 (group 1: 56.7% vs. group 2: 81.5%). Severe misalignment was present in 13.3% of the participants of group 1 and only in 7.4% of group 2. The extent of canine tipping and movements along the x- and y-axis in severe misalignment cases was significantly lower in group 2 compared to 1. Conclusions Lower incisor alignment was more stable in patients with combined fixed and removable retainers compared to fixed retainers only. Clinical Relevance Based on the present findings, the routinely application of supplementary removable retainers can be recommended to enhance anterior tooth alignment in patients with fixed twistflex retainers.
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Оценка уровня бедности является одной из глобальных проблем человечества. Его анализ важен с точки зрения выявления и прогнозирования основных тенденций социально-экономического развития как государства, так и его отдельных территориальных единиц. Это дает возможность оценить и сделать более целенаправленным процесс разработки и реализации программ борьбы с бедностью. Корни бедности тесно связаны с социально-экономическим состоянием страны, проблемами социально-экономической жизни, поэтому статистический анализ факторов, влияющих на уровень бедности, оценка механизма и результатов их влияния очень важны.
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During the period of active bone growth and formation of the permanent dentition, the crossbite disturbs the normal development of both the dental arch and the jaws. The aim of our analysis is to present the possibilities of a fixed functional and mechanically acting appliance designed by us and used in practice for simultaneous correction of crossbite in the frontal and distal segments. Material and method: The appliance design includes plastic tooth caps in the distal segments, a rapid expan sion screw and a protruding spring activated by the action of the tongue. Results and Discussion: Adaptation of patients to feeding and speech is within 1-2 days. Expansion of 3 to 5 mm in the lateral segments is within 16 to 28 days depending on the degree of narrowing. In the same period, the protrusion of the frontal teeth is active, based on the function of the tongue, which continues throughout the healing period. Actually, in a period of 2 to 3 months, the crossbite in the frontal and in the distal segment is corrected. The appliance is well combined with braces for leveling the position of the upper incisors after their removal from crossbite. Conclusion: The early interceptive treatment with the presented device solves the transversal and sagittal problem of occlusal relationships even in early mixed dentition. It improves the patient’s aesthetics and, above all, unlocks the bone development of the nasomaxillary complex. The appliance is fixed, which guarantees its constant operation and does not depend on patient cooperation
Article
A BSTRACT Background Orthodontic therapy aims at achieving stable treatment outcomes by ensuring retention of corrected tooth positions. Various retention protocols have been proposed, but their efficacy in sustaining treatment outcomes remains unclear. Materials and Methods This in vitro study evaluated the effectiveness of different retention protocols in maintaining treatment outcomes following orthodontic therapy. Thirty extracted human premolars were subjected to simulated orthodontic movement and then divided into three groups: group A—Essix retainer, group B—Hawley retainer, and group C—bonded retainer. Retention efficacy was assessed through measurements of tooth movement over a period of 6 months using a digital caliper. Results The mean amount of mesial movement observed in group A was 0.5 mm (SD ± 0.1), in group B was 0.7 mm (SD ± 0.2), and in group C was 0.3 mm (SD ± 0.1). Statistical analysis revealed significant differences in retention efficacy among the three groups ( P < 0.05). Conclusion The bonded retainer demonstrated superior efficacy in sustaining treatment outcomes by minimizing post-orthodontic tooth movement compared to Essix and Hawley retainers. Thus, the bonded retainer may be considered a preferable option for retention following orthodontic therapy.
Article
Long-term stability of orthodontic treatment outcome is attained through retention. Fabrication and bonding of the lingually bonded retainer on the lingual tooth surface are a technique-sensitive and time-consuming procedure. Stabilizing the lingual retainer wire on the tooth surface throughout the bonding procedure is a challenging task for the operator. This article introduces a new simplified technique of stabilizing the lingual retainer wire before bonding.
Article
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In Orthodontics, retention period is the most important phase of orthodontic treatment. Malocclusions requiring permanent retention for stability often need fixed lingual bonded retainers for holding the teeth in position. It has several advantages such not being visible and requires no patient cooperation during the retention phase. This article presents a simpler and innovative method of stabilizing the lingual retainer wire during bonding procedure by just holding it with prefabricated Dewdrop retainer holding clip.
Article
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Introduction: Fixed lingual bonded retainers offer the comfort of aesthetics and reduced tissue irritation after orthodontic treatment but are wrought with frequent bond failures. Numerous techniques have been used to adapt the retainer to the lingual surface of the lower anterior teeth, but research on customised lower lingual retainers is scarce. Aim: To evaluate and compare the Shear Bond Strength (SBS), Adhesive Remnant Index scores (ARI), and precision fit of a novel Computer-aided Designing-Computer-aided Machining/ Manufacturing (CAD-CAM) fabricated retainer and conventional retainers. Materials and Methods: This invitro study was conducted at the Department of Orthodontics, and Dentofacial Orthopaedics, SRM Dental College, Ramapuram, Chennai-89 from June 2022 to February 2023. It included a total of 360 human mandibular anterior teeth were collected and embedded in acrylic blocks in groups of six to simulate the mandibular anterior arch form. A total of 60 retainers made of braided Stainless Steel (SS) wires, co-axial wires, customised through CAD/CAM technology were evaluated. The retainers were bonded to the lingual aspect of the teeth using composite resin. A universal testing machine was used for testing SBS. Precision fit was observed using Exocad software. Statistical analysis included one-way Analysis of Variance (ANOVA) for SBS, Kruskal-Wallis for ARI score, and Mann-Whitney U test for precision fit. Results: The CAD-CAM retainers had a more precise fit when compared to conventional retainers (p=0.009). SBS was highest for CAD-CAM fabricated retainer and lowest in the co-axial retainer, and this finding was statistically significant (p<0.001). The CAD-CAM retainer had the highest mean rank in ARI scores (33.90) when compared to braided SS and co-axial wire. Conclusion: The CAD-CAM fabricated retainers would be more effective clinically, as higher bond strength due to precise fit would reduce the failure rate, thus preventing relapse and minimising chairside time.
Article
A BSTRACT Objective This study aimed to evaluate and compare the bond strengths of four different lingual retainers and assess the adhesive remnant index (ARI) to determine their effectiveness in orthodontic retention. Methodology Eighty human incisor teeth were divided into four groups, with each group bonded using a different retainer: Group 1 (E-Glass retainer), Group 2 (0.017” Co-axial stainless steel wire), Group 3 (Splint C.T. fiber mesh), and Group 4 (0.010” stainless steel ligature wire). Bond strength was measured using a universal testing machine, and ARI scores were recorded to assess bond failure types. Results Group 1 (E-Glass retainer) demonstrated the highest bond strength, followed by Group 3 (Splint C.T. fiber mesh), Group 2 (Co-axial stainless steel wire), and Group 4 (stainless steel ligature wire). Cohesive bond failures were observed in most groups, except for the co-axial stainless steel wire group, which exhibited adhesive failures. Conclusion E-Glass fiber-reinforced retainers showed the highest bond strength, making them a promising alternative to conventional stainless steel wires for orthodontic retention, especially in patients with esthetic concerns or nickel hypersensitivity. Stainless steel retainer groups exhibited lower bond strengths, and cohesive bond failures were prevalent. Further research is needed to validate these findings in clinical settings and evaluate the long-term effectiveness of different lingual retainers.
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Introduction: Fixed retainers bonded to the lingual surfaces of the mandibular canines (3-3 retainer) are commonly used type of retention after orthodontic treatment is finished. Purpose of this study is to assess two types of Nickel titanium fixed retainers, flat versus round shaped, for the effectiveness in maintaining the stability of the alignment of the mandibular anterior teeth after orthodontic treatment. Material and methods: the sample consisted of the dental casts of 60 consecutively treated subjects (18 male and 42 female) age 16-25, previously treated for mild crowding in Class I. 30 subjects received a flat Nickel-titanium Retainer, thickness .010" x .029" four-strand twisted in one, manufactured by Forestadent and 30 other patients had bonded multistrained round, co-axial retainer ø0.44mm/17", manufactured by Dentaurum. Retainers were bonded to all anterior teeth, at the end of active orthodontic treatment. The Little irregularity index and intercanine width were measured on dental casts immediately after treatment (T0), and 12 months (T1) post treatment. Results: The main Little irregularity index not significantly increased during the post treatment period from 0 mm to 0.18 mm (SD, 0.24) at (T1) in flat retainer group and 0.34 mm (SD, 0.47) in round retainer group. The intercanine distance increased from (T0) measured values in 0.34 (SD 0.31) in flat retainer group and 0.44 (SD 0.40) in round retainer group. In 4 patients (13.3%), of round group, unexpected post treatment complications (torque differences of the incisors) was recorded. Conclusions: Two types of fixed retainers, maintain the stability of teeth alignment after finished orthodontic treatment, during 12 months of retention phase. Round retainers have the tendency to incline the position of at least one incisor during 12 months of follow up.
Article
Introduction: Long-term or even indefinite retention is routinely prescribed after orthodontic treatment as a preventive safeguard against post-treatment changes induced by tooth movement, physiological healing, and the aging process. Though both fixed and removable versions of retainers may be equally effective in terms of results, sufficient research to support this assumption is missing at the moment. Objectives: Long-term effects of fixed and removable retention on the periodontium, and the compliance level when used for an extended period of time. Methods: For 4 years participants were given a supply of canine-to-canine retainers and vacuum-formed canine-to-canine retainers. The inter-canine, as well as inter-molar widths, the length, and the extraction space opening of the mandibular anterior portion, were measured. Gingival inflammation, calculus, and plaque were observed, as well as the attachment of clinical and the case of bleeding during probing. 42 members had returned in the follow-up period, with 21 from each of the two groups. Measurements of the modified gingival index and plaque scoring were performed on the 10 intra-oral photographs that were taken at 4-week intervals in this study to investigate the intra-examiner reliability. Results: After controlling for confounding variables, there was a 1.64 mm (95% confidence interval [CI], 0.30, 2.98 mm) median between-groups difference among patients who utilized vacuum-formed retainers (VFRs). The treatment groups did not vary in inter-canine and intermolar widths (P = 0.52; 95% CI, -1.07, 1.05), arch length (P = 0.99; 95% CI, -1.15, 1.14), or opening of extraction spaces (P = 0.84). Conclusion: A long-term study demonstrates that fixed retention can preserve the alignment of the mandibular anterior over time for the first time. Gingival discomfort and higher plaque scores were reported in both types of retainers.
Article
Background/purpose Polyetheretherketone (PEEK) is known for its strength, flexibility, biocompatibility, and potential as a replacement for metals in dental appliances; however, uncertainty remains about the mechanical characteristics and dimensions of PEEK-made orthodontic fixed lingual retainers (FLRs). This study aimed to determine the optimal shape of PEEK-made orthodontic FLRs using the finite element method (FEM) and the three-point bending test (TPBT). Materials and methods Seventy-five three-dimensional PEEK rod-shaped models were created, which included five thicknesses (0.4, 0.6, 0.8, 1.0, and 1.2 mm), five widths (0.7, 0.9, 1.1, 1.3, and 1.5 mm), and three cross-sectional shapes (rectangular, oval, and hemielliptical). A 0.9-mm (0.036-inch) stainless steel wire (SSW) was used as a control and the FEM was used to determine six optimal dimensions among the PEEK models. The selected models were then fabricated and subjected, along with the SSW, to the experimental TPBT to assess their mechanical responses against lingual and biting pressures. Results The FEM analysis revealed that Von Mises stresses on the PEEK models decreased with an increase in width and thickness. Six optimal shapes of PEEK models were chosen based on acceptable lingual and biting stresses as well as patient comfort compared to the SSW. Furthermore, PEEK models showed significantly lower deformation during the 3.1-mm deflection test than did the SSW, while no notable differences were observed among different sizes of PEEK models. The hemielliptical PEEK model with a thickness of 1.0 mm and width of 1.5 mm was found to be mechanically robust enough to withstand lingual forces, while none of the PEEK models, including the SSW, were able to resist biting forces. Conclusion Within the limitations of this in vitro study, PEEK-made orthodontic FLRs with a hemielliptical cross-sectional shape and a thickness-to-width ratio of 1.0:1.5 would be suitable for use as orthodontic FLRs.
Article
Background/objectives: To compare retainer survival, periodontal health, and caries implications of fixed lower retainers bonded after pre-treatment of the enamel surface with either pumice or sandblasting. Trial design: Two-arm parallel-group, two-center randomized controlled clinical trial. Methods: One hundred sixty patients (101 females, 59 males, mean age: 17.9) requiring mandibular retainers were consecutively recruited. Patients were randomly allocated to have pre-treatment of the enamel surface with either pumice (n = 80) or sandblasting (n = 80). The primary outcome was retainer survival at 3 (T1) and 12 months (T2) control. Secondary outcomes were carious lesions and periodontal health: plaque index (PI), gingival index (GI), calculus index (CI), and probing depth (PD). The randomization sequence was generated using an online randomization and allocation concealment was secured by contacting the sequence generator for treatment assignment. Blinding was not possible at T0 due to the nature of the intervention. Statistical analyses were carried out using the t-test, Fisher's exact test, repeated measure analysis of variance, and log rank test. Results: Overall, the risk of bonding failure at T1 was 6.7 per cent and at T2 6.9 per cent. There were no statistically significant differences in failure rate between the two groups, neither at T1 (P = 1.000) nor at T2 (P = 0.360). No statistically significant differences were found for the intercanine periodontal indices GI, PI, CI, PD, and caries between the two groups at T0 and T1. At T2, significantly more gingivitis and plaque were seen in the sandblasting group (P = 0.05 and P = 0.047, respectively) compared with the pumice group. Calculus increased during the follow-up period in both groups (P ≤ 0.001) as well as plaque levels (P ≤ 0.001 and P = 0.025, respectively). No harm was reported. Conclusions: Enamel sandblasting prior to bonding mandibular retainers is not better at preventing bonding failure. Registration: 275767 (https://www.researchweb.org/is/sverige).
Article
Article title and bibliographic information: Liu S, Silikas N, Ei-Angbawi A. Analysis of the effectiveness of the fiber-reinforced composite lingual retainer: A systematic review and meta-analysis. Am J Orthod Dentofacial Orthop. 2022 Aug 26:S0889-5406(22)00,432-2. doi: 10.1016/j.ajodo.2022.07.003. Epub ahead of print. PMID: 36,031,511. Source of funding: Not reported. Type of study/design: Systematic review with meta-analysis of data.
Thesis
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Aim: To evaluate the stability of orthodontic treatment outcome 2 years after orthodontic treatment, and to investigate the influence of different pre- and posttreatment prognostic factors on stability. Materials and Methods: Consecutive patients treated with full fixed appliances and retained with fixed retainers were retrospectively selected and assessed for eligibility. Information regarding age, gender, and retention protocol was extracted from the patient's records. Digital models were analyzed at the start of treatment (T0), end of treatment (T1) and 2 years posttreatment (T2). Peer Assessment Rating (PAR) index, Little's Irregularity Index (LII), arch width, arch length, overjet and overbite were assessed. In addition, retainer protocols at T1 and retainer changes at T2 were recorded according to patients’ records. Finally, the presence of unexpected posttreatment changes was recorded. Multiple regression models were conducted to model the relationship of all outcomes with several prognostics simultaneously. Results: The final sample comprised the records of 287 subjects. The mean weighted PAR score was 29.5 (SD 8.6) at T0, 1.8 (SD 2.9) at T1 and 3.2 (SD 3.6) at T2. Ninety-five percent the subjects had a perfect LII at T1, while 86% of the subjects still had a perfect LII at T2. Differences in LII between T1-T2 showed unstable results in 12 subjects, whereas PAR index showed absolute stability in 147 subjects, relative stability in 119 subjects, and instability in 21 subjects. An increase of 1 mm of LII at T1 was shown to correlate with a change of 68 in odds of being in a worse LII category at T2. The PAR score at T1, as well as the PAR score and overjet at T0, were other significant factors for the PAR improvement T0-T2. Five retainers (1.7%) showed unexpected posttreatment changes at T2. Fixed retainers were exposed to changes over the 2-year follow-up period; some retainers were removed, while other retainers were shortened. Conclusion: The treatment outcome and the 2-year stability were very good. Several prognostic factors for stability could be identified, including LII and PAR score at T1, suggesting that good quality of treatment outcome might ensure postretention stability.
Article
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Introduction Orthodontic fixed retainers are preferred as they depend less on patient compliance. Recently, researchers tried to use fiber-reinforced composite (FRC) to replace the multistranded stainless-steel wire (MSW) of the fixed retainers to enhance the mechanical properties and esthetics. This systematic review aimed to analyze the effectiveness of the FRC retainers. Methods We searched the electronic databases (May 1, 2021), including Medline, the Cochrane Library, EMBASE, PubMed, Web of Science, and CINAHL. We applied no language or date restrictions in the searches of the databases. Only randomized controlled trials (RCTs) and prospective clinical controlled trials were included. The revised Cochrane risk of bias tool for randomized trials and risk of bias in nonrandomized studies of interventions were used to evaluate the risk of bias in RCTs and non-RCTs, respectively. The outcomes were pooled using Review Manager 5.4. The primary outcome of this review was teeth relapse, and the secondary outcomes were bonded retainer failure rate, adverse effect on oral health, and patient’s satisfaction. Results Eleven out of 99 studies, which included 873 participants, were used in this review, with the follow-up ranging from 6 months to 6 years. Ten studies compared the FRC retainers with MSW retainers, and 1 study compared FRC retainers with a different fiber material. Ten studies were RCT, and 1 was non-RCT. There was 0.39 less relapse with the FRC retainers than with MSW retainers (mean difference, −0.39; 95% confidence interval [CI], −0.41 to −0.37; P <0.00001). There was no statistically significant difference in the failure rate between the FRC and MSW with the whole retainer as an outcome unit risk ratio of 1.72 (95% CI, 0.57-5.14; P = 0.33) or with the teeth an as outcome unit risk ratio of 0.85 (95% CI, 0.47-1.52; P = 0.58). There was insufficient evidence to conduct the meta-analysis of the adverse effect on oral health and patient satisfaction. Conclusions Low-quality evidence is available to suggest that the effectiveness of the FRC is comparable to the MSW with no significant difference in the failure rate. However, we have very low certainty on these results. It is worth conducting future robust clinical studies to assess the effectiveness of FRC retainers with long follow-up.
Article
Objective: The objectives of the study were to evaluate the survival rates for lower lingual retainers (LLRs) and to establish a correlation between patients' treatment-related factors (age, sex, malocclusion, appliance used for treatment, teeth bonded, retention protocols) to the survival of LLRs. Materials and methods: A total of 765 subjects [474 females and 291 males: mean age = 24.29 ± 10.67 years] between 2013 and 2022 were included. A customized data collection form was utilized to gather the data from the electronic health record (EHR) of subjects. Patient-related factors, crowding or spacing, deep bite or open bite and duration of treatment were extracted from patients' files. Kaplan-Meier estimator was used for the survival function, whereas Cox proportional hazards regression models were used to associate risk factors with retainer survival. Results: 328 (42.9%) subjects had their LLRs failed, and the survival period was on average 17.37 ± 22.85 months. On the other hand, the follow-up period for the retainers that did not fail was on average 47.19 ± 23.66 months. 192 (28.3%) subjects had segment failure (retainer detached from 3 teeth or less), while 51 (7.5%) subjects had failures in more than 3 teeth (complete). None of the evaluated clinical variables were significantly associated with LLRs failure except for the bite category (P = .013) and the appliance used for treatment (P < .001). Conclusion: Success rate for LLRs was 57.1% over 47.19 months, failure rate was 42.9% over 17.37 months. The presence of deep bite and treatment with aligners were significantly associated with increased failure rate.
Chapter
Adults are more likely than adolescents to have dentitions that have undergone some degree of mutilation over time, which may necessitate alterations in the treatment strategy and bonding procedure. Contemporary fixed appliances are mostly variations of the edgewise appliance system developed by Angle in 1928. They consist of an archwire that is inserted into the slots of the brackets which are generally bonded directly or indirectly to the teeth or soldered to steel bands. Bonded brackets became available in the mid‐1970s. Successful bonding requires careful attention to three essential components: the tooth surface and its preparation, the design of the bracket base and the bonding agent. The steps involved for an optimal performance in bonding of orthodontic attachments (on facial or lingual surfaces) are as follows: cleaning, enamel conditioning, sealing, bonding, and light curing. Auxiliary attachments are an integral part of the fixed appliance. Retention is an integral phase after the completion of orthodontic treatment.
Article
A long-term evaluation was made of results achieved in direct bonding of metal attachments with a chemically polymerized composite material. A total of 705 attachments were bonded to different teeth, including premolars and molars, in forty-six children. Slim bracket bases, small quantities of adhesive paste, and trimming of the excess material were used to improve esthetics and to benefit in respect of gingival condition. The same person bonded all brackets and performed the orthodontic treatment by a friction-free edgewise light-wire technique. Mean treatment time was 17 months. The clinical appearance before, during, and after treatment is shown in Figs. 3 to 5. The failure rates for the whole treatment period were 4 to 10 per cent for central and lateral incisors, canines, and first premolars in both dental arches. The second premolars, which were often in various stages of eruption at the time of bonding, and the molars had higher failure rates (Table I). An evident individual variation was noted, as a few children had a high number of loose brackets. Clinical and scanning electron microscopic studies of tooth surfaces following removal of the brackets demonstrated normal surface appearance when plain-cut tungsten carbide burs rotated at low speed were used to remove remnants of adhesive that could not easily be scraped off. Precoating etched enamel with sealant, in combination with daily fluoride mouth rinses and good oral hygiene, virtually eliminated the caries problem, but regular inspection for interproximal cavities was needed. There were no signs of enamel damage or discoloration for periods of up to 12 months subsequent to bracket removal. Further details of the technical operative procedure, failure analysis, bracket type and design, gingival health, and other aspects of direct bonding were also discussed.
Article
A new method of retention
  • Kaswiener