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Review Article http//doi.org/10.18231/j.ijodr.2019.003
IP Indian Journal of Orthodontics and Dentofacial Research, January-March, 2019;5(1):11-15 11
Retainer in orthodontics
Rahul Kumar Anand1,*, Tripti Tikku2, Rohit Khanna3, Rana Pratap Maurya4, Snehlata Verma5, Kamana
Shrivastava6
1Junior Resident III, 2Professor and HOD, 3Professor, 4-6Reader, 1-6Dept. of Orthodontics and Dentofacial Orthopedics, 1-5Babu Banarasi
das college of dental sciences, Faizabad road, Lucknow, Uttar Pradesh, India
*Corresponding Author: Rahul Kumar Anand
Email: rahulmtg@gmail.com
Abstract
Retainer is a removable retainer that is popular in the present day. Compared with conventional fixed and removable orthodontic retainers,
it is a more esthetic, comfortable, and inexpensive appliance.
Keywords: Retainer removable fixed.
Introduction
Malocclusion is not a disease by itself, it is s a
morphological deviation from normal growth and
development which might be or might not be associated
with any pathological condition.1
Orthodontic treatment is recommended for all classes of
malocclusion, in order to restore normal functions, improve
jaws relation, and achieve the required aesthetic goals.1
Besides achieving patient’s goals, be it functional or
esthetics, treatment result have to be retained for its long
term success.1
A phase of retention is normally required to prevent the
inherent tendency of the teeth to return to their original
position.2 Stability can only be achieved if the forces
derived from the periodontal and gingival tissues, the
orofacial soft tissues, the occlusal forces and post treatment
facial growth are in equilibrium. Keeping in mind the
importance of retention in Orthodontic treatment, various
types of retainers i.e fixed or removable are given after
completion of Orthodontic treatment.2
During formulation of treatment plan, type of retention
depending on the correction achieved by Orthodontic
treatment should also be documented before hand.2 There
are certain conditions like high placed canine, anterior
crossbites and posterior crossbites with proper axial
inclination required limited or no retention. Class I non
extraction cases and condition like, maximum retention
corrected deepbite, all first premolar extraction.2
Hellman gave nine theorems of retention whose
principles should be followed while executing Orthodontic
treatment and after the completion of active treatment i.e in
retention phase2.
This review article will list various types of retainers
used in Orthodontics and these are broadly classified
into:
1. Removable retainer
2. Fixed retainers
Removable Retainers
The removable retainers provide adequate retention for
intra-arch stability and are useful as retainers in patients in
where
Growth is remaining and are compliant. Various types
of removable retainer are:3
1. Hawley’s retainer and its modification
2. Clip on retainer
3. Wrap around retainer
4. Vander linden retainer
5. Clear retainer
Hawley’s Retainer
The most common removable retainer is the Hawley
retainer, designed in the 1920’s by E H Hawley. It
incorporates clasps on molar teeth and has a characteristic
outer bowwith adjustment loops, from canine to canine.4
There is an acrylic coverage of the palate, which
automatically provides a potential bite plane effect to retain
overbite correction and rigid enough to maintain palatal
expansion achieved during Orthodontic treatment.4(Fig. 1 a)
Mechanical retention can be a problem in patients with
short clinical crowns or exfoliated deciduous teeth4
The clasp locations for a Hawley retainer must be
selected carefully, since clasp wires crossing the occlusal
table can disrupt rather than retain the tooth relationships,
established during the treatment. Circumferential clasps on
the terminal molar may be preferred over the more effective
Adams clasp if the occlusion is tight.4
When first premolars have been extracted, standard
design of Hawley retainer cannot keep the extraction space
closed, rather it tends to open up the extraction space
aswires of labial bow extends distal to canines, tending to
act like a wedge at an extraction site. A common
modifications of the Hawley retainer for use in such cases
can be-
1. Labial bow soldered to the bridge of Adams clasps on
the first molars, so that the action of the bow helps to
hold the extraction space closed.4
Rahul Kumar Anand et al. Retainer in orthodontics
IP Indian Journal of Orthodontics and Dentofacial Research, January-March, 2019;5(1):11-15 12
2. Using long labial bow extending from 2nd premolar to
2nd premolar on the other side.4
3. Wrap the labial bow around the entire arch, till the first
molars and using circumferential clasps on second
molars for retention.(Fig. 1 d)4
4. Fitted labial bow:-A 22 gauge SS wire of appropriate
length is taken and adapted according to the contour of
the individual teeth at the level of the junction of the
middle and incisal thirds, staring from the central
incisors progressing towards the junction of middle and
distal thirds of the labial surface of the canine.4 At this
point the free ends of the wires are bent at 90 degrees
towards the apex and the further construction is carried
out in a similar way as in case of a short labial bow.
Used to retract anteriors when the space is present distal
to canine.(Fig. 1 d)4
5. To bring the labial wire from the baseplate between the
lateral incisor and canine and to bend or solder a wire
extension distally to control the canines.(Fig. 1 b)
Fig. 1: A hawley retainer, b: Hawley with soldered labial
bow, c: Hawley with long labial bow, d: Hawley with
fitted labial bow
Removable wraparound retainers
Fig. 2: clip on retainer
Clip On Retainer
A second major type of removable retainer is a clip-on
retainer (C3-3 clip or 4-4 clip).4 It consist of acrylic bar
(usually wire reinforced) along the labial and lingual
surfaces of the teeth.4
This retainer though quite esthetic is often less
comfortable than a Hawley retainer. It is used to control
alignment of anterior teeth or preferred in mandibular arch
when mandibular teeth were well aligned and prior to
treatment, retention of these teeth is unnecessary and
undercuts lingual to molars make to difficult to extend
retainer posteriorly4 (Fig. 2)
It is generally used in cases with anterior spacing and
can also be used to realign mandibular incisor if mild
crowding develop after the treatment.
Fig. 3: Begg’s modified wraparound retainer
Begg’s Modified Wraparound Retainer
Original Wraparound retainer was popularized by
P.R.Begg
It consists of labial wire that extended till the last
erupted molar and curves around it to get embedded in
acrylic that spans the palate.5 There was no cross -over of
wires between the canine and second premolar there by
eliminating the risk of extraction space opening up.5
The original design was modified by placing a single
arrowhead in distal undercut of last tooth both first and
second molar can be incorporated in the retainer to improve
retention of the appliance.6(Fig. 3)
Both these type of wraparound retainer have following
advantage:
1. Overcomes the limitation of Hawley type retainers with
Adam’s clasps or labial wire crossing the occlusion that
create interference or can open that up to the extraction
space.4
2. Better retention than the conventional appliance
Vander linden retainer
The Vander linden retainer is constructed to offer
complete control over the maxillary anterior teeth, with firm
fixation provided by clasps on the canines. The continuous
Rahul Kumar Anand et al. Retainer in orthodontics
IP Indian Journal of Orthodontics and Dentofacial Research, January-March, 2019;5(1):11-15 13
0.028"labial arch and left and right three quarter
0.032"molar clasps are embedded in the palatal acrylic
plate.7 The premolars and molars should be of acrylic,
except where there are clasps.7 This retainer does not
usually interfere with the occlusion, because most maxillary
lateral incisors have rounded disto-incisal corners with
sufficient space for the retainer wire on the palatal side.7
Nevertheless the patient’s occlusion should be checked to
ensure that 0.028" wire can pass between the lateral incisor
and canine without causing interference.7
Fig. 4
Clear retainer/invisible retainer are also a type of
removable retainer made with varying thickness of
preformed thermoplastic sheets.8 They are considered as
invisible ratianer that can be made by Biostar or Vaccum
pressure machines using thermoform sheets. (Essix retainer,
thermoplastic retainer, or vacuum‑formed retainer) were the
first thermoplastic clear retainers introduced in 1993 by Dr.
John Sheridan.8
As these retainers are made entirely of transparent
plastic, which makes them less noticeable and more esthetic
than the traditional wire retainers, they are easily accepted
by the patients.8
These retainers also acts as positioners and gently guide
the teeth into proper position and can correct tooth
discrepancies. They can serve as temporary bridge for
missing anterior teeth. They also act as a night guard for
subjects who have the habit of Bruxism and also have a bite
plane like effect. The delivery of these retainers require less
chair side time. They encourage good dental hygiene as
patients can take out their retainer and brush or floss their
teeth.8
However clear retainer has certain disadvantages like
they demand good patient compliance, interferen with
settling of occlusion, and can be lost due to its
transparency.8
There is certain contraindication to use of clear
retainers like swollen interproximal tissue, Severe
pretreatment dental rotations, in cases where arch expansion
has been done or inpatient with anterior open bite.
Several Modifications of clear retainer have been given
like
1. Clear retainer with bite plane- bite plane is added in
anterior region
2. Clear retainer with a crown or denture teeth for missing
teeth
3. Osamu active retainer for correction of mild relapse
This retainer consists of two superimposed layers. The
inner layer, made of 1.5mm ethylene vinyl acetate
copolymer adapts to the interproximal areas and covers the
palatal and lingual aspects of the teeth.8 The outer layer,
made of 0.75mm hard elastic polycarbonate, covers the
occlusal aspects of the teeth and makes the retainer elastic
and stable. The Osamu active retainer is inexpensive, simple
to make and It can correct individual tooth positions while
maintaining close adaptation to the remaining teeth8.
Fixed Retainers
A fixed retainer typically consists of a passively bonded
wire to the lingual side of the teeth in maxillary and
mandibular incisor region. The complete analysis of patients
bite must be taken. Orthodontists prescribe fixed retainers,
especially in cases where stability is questionable and long
term retention is required4. As fixed retainer are easily
acceptable by the patients and their popularity has increased
in recent times. Initially, for fixed retainer rigid wire was
used that did not provide physiologic tooth movement.
However, nowadays we use flexible wires like
multistranded or ligature were twisted together as fixed
retainer.4
Types of Fixed Retainers
Based on type of attachment to teeth
1. Banded Retainers- canine were banded to fix the
retainer that was esthetically unacceptable
2. Bonded Lingual Retainers -Retainer bonded on the
lingual aspect for maintaining anterior tooth position
relatively independence’s of patient’s cooperation.
3. Band and Spur Retainer- used in cases where a single
tooth has been orthodontically treated for rotation,
correction or labiolingual displacement. The tooth that
has been moved is banded and spurs are soldered on to
the bands so as to overlap the adjacent teeth.
4. 4-4 crozat retainer: 4-4 Crozat appliance has cribs on
the first bicuspids, recurved double lapping lingual
finger springs and a labial bow. It combines may of
theadvantages of other types of retainers and offers firm
retention, because of its clasping mechanism.9 It
prevent good labiolingual control of anterior teeth to
maintain or restore arch form in the lower or upper arch
and is a flexible retainer. It also provides adequate oral
hygiene being removable.9 The major disadvantages of
the appliance are is that must be fabricated at a quality
laboratory, not making it cost effective and can break
easily.9
Rahul Kumar Anand et al. Retainer in orthodontics
IP Indian Journal of Orthodontics and Dentofacial Research, January-March, 2019;5(1):11-15 14
Based on the material used
1. First generation fixed retainer : Plain blue Elgiloy wire
with a loop at each terminal end is used10
2. Second generationfixed retainer: Similar diameter
multistranded wires are used
3. Third generation fixed retainer: Round 0.032” stainless
steel or 0.030” gold coated wires are used10
4. Recent advancement includes Resin fiberglass bonded
retainers
With introduction of resin resinforced fiberglass composites,
Michael developed these retainers. The main advantages are
that they are rigid and impervious. The Patients appreciate
the tooth colored material and the comfort that is provided
by smoothening of the margins with rubber abrasive points
or wheels. Retainer sections can easily be recontoured,
removed or repaired in the mouth. As no metal wires are
used, additional material can be applied to the teeth or the
fiberglass or both.10
-
Fig. 5: bonded canine to canine
Based on extensions of lingual retainer
1. Canine to canine retainer– These are commonly used in
lower anterior region. Canine are banded and a thick
wire is contoured over the lingual aspects and soldered
to the canine bands.11 The bands predispose to poor oral
hygiene and are unesthetic, hence not preformed
nowadays. Bonded canine to canine retainer overcome
this limitation and are used commonly. These are used
in non extraction cases or in mandibular incisor
extraction cases.11 (Fig. 5)
2. Bonded premolar to premolar retainer- These are
commonly used in extraction cases, where extraction of
first premolar had been planned11 (Fig. 6)
Fig. 6: bonded premolar to premolar
3. Banded molar –molar retainer:-The molar to molar
mandibular retainer is made by the heavy gauge wire
soldered on the molar bands. It allows the mandibular
canines and molars to settle naturally and maintain the
arch 12
Bonded Fixed Retainer
Indications
Zachrisson listed the following indications for clinical use
of flexible wire retainer: 11
1. Closed median diastema
2. Spaced anterior teeth
3. Adult cases with potential post-orthodontic tooth
migration
4. Accidental loss of maxillary incisors requiring closure
and retention of large anterior space
5. Spacing reopening, after mandibular incisor extractions
6. Severely rotated maxillary incisors or severe
pretreatment crowding
7. Palatally impacted canines
8. Planned increase in mandibular intercanine width
Advantages
1. Invisible, are well-tolerated by patients
2. Virtually compliance-free.
3. No damage to the teeth and to the hard and soft tissues
adjacent to the wire.
Disadvantages
1. Time-consuming
2. Technique sensitive
3. Difficult to maintain, encouraging plaque and calculus
accumulation.
Conclusion
This review article suggest indication, limitation and
precaution takes with various types of retainers used in
orthodontics be it removable or fixed. The selection of
appropriate means for providing retention should state from
day one of orthodontic treatment planning for attaining
optimal result post treatment that lasts for life time.
Conflict of Interest: None.
Reference
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IP Indian Journal of Orthodontics and Dentofacial Research, January-March, 2019;5(1):11-15 15
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How to cite this article: Anand RK, Tikku T, Khanna
R, Maurya RP, Verma S, Shrivastava K, Retainer in
orthodontics. J Orthod Dentofacial Res 2019;5(1):11-15
