Orthodontic retention has been and still is, a much-debated area, yet, if this phase of treatment is not undertaken, the teeth may return back to their original untreated position.1
In this blog, we examine the argument for trying a dual retention system, the pros of removable and fixed retainers, and share some of the areas of the treatment process which, if carried out correctly, can make a positive difference for all, regardless of individual circumstances.
Is two better than one? Dual retention has its benefits.
Why choose dual retention following orthodontic treatment?
Choosing a system which incorporates both removable and fixed lingual retention may offer the best of both worlds for the patient. Combining advantages of both fixed and removable retainers, patients are given peace of mind, knowing they have a “belt and braces” style treatment to ensure long lasting retention.
A fixed retainer offers the following:
- Discreet and reduced demand on patient compliance.
- Provides stability for patients with reduced periodontal support.
- An effective solution particularly for long-term retention of the labial segments and a midline diastema.2
Photo courtesy of David Waring
"There is evidence of an increased risk of deterioration of lower incisor alignment post-retention in cases with root resorption or crestal bone loss. These cases may therefore benefit from prolonged retention" BOS Clinical Guidelines
Removable retainers, with the right education, are easy for the patient to clean and store. If the patient was unlucky enough to damage or lose the removable retainer, the permanent retainer is still in force; removing any concerns of tooth movement occurring whilst waiting for a replacement.
Adding a removable retainer provides an extra:
- Invisible treatment for superior aesthetics.
- Non-invasive and familiar treatment for patients.
- An element of patient participation and responsibility.
- Additional support of the full arch.
- A treatment which is proven to be effective even when worn at night only.
Top four things to consider for hassle-free orthodontic retention
Tip one: Choose an easy to use transfer jig
Even with the best, most accurate, custom-made retainer, a fiddly and cumbersome transfer jig can make it difficult to place and potentially introduce torque and unexpected tooth movement.3 Choose a system which has an easy to use transfer jig and your fitting appointment will run smoothly.
Tip two: Patient participation improves patient satisfaction
Patient compliance and buy-in are important for maintaining long-lasting results and a good relationship with your patient. One study proved the merits of patient participation1. Encouraging patients to remember to wear their retainer nightly improves patient satisfaction and could reduce the likelihood of complaints at a later date.
Tip three: Check the quality of your retainer wire
Choose a highly polished rectangular wire with a low profile. Not only does it promote better hygiene as it is designed to harbour less bacteria in comparison to a rounded braided wire, but the lower profile offers more comfort for the patient; in addition to a greater bonding surface contact.
Tip four: Go digital and reduce appointments
Many laboratories now accept scans and impressions with brackets still on. This can cut out an additional appointment as you have the opportunity to fix the retainer during the de-bonding stage.
Try Maintain: A Dual Retention System designed by David Waring
Consultant Orthodontist David Waring created dual retention system, Maintain. He says of the system,” Dual retention is the desired approach for retention following active orthodontic treatment. The design of the Maintain Retainer performs both roles and allows easy placement of the bonded retainer.”
Effective and clinically proven, Maintain tackles many challenges associated with modern retention systems. With Maintain, patients benefit from the permanent support of a bonded lingual retainer, and the additional reinforcement of a removable retainer worn at night. Available from DB Orthodontics' in-house lab, Studio 8, is an easy to fit and convenient dual retention system.
Maximum support and dual responsibility
Maintain is comprised of the following: a bonded braided flattened retainer wire, made with Straight 8 Plus rectangular wire for maximum surface contact; and a removable pressure formed retainer to be worn at night by the patient. This approach offers greater support for both the posterior and anterior zones. Maintain also introduces the positive element of patient participation. Providing the patient with the removable retainer and requesting long-term retainer wear delegates an element of responsibility to the patient in ensuring long-term success.
Photo courtesy of David Waring
Low profile retainer with maximum surface contact
Straight 8’s flattened rectangular shaped low profile retainer wire provides maximum surface contact with the lingual surface in comparison to rounded brands which have a minimal sized contact point. Fabricated by the experienced team at Studio 8, clinicians can enjoy the ease of fitting a high quality, highly polished low profile product designed to minimise bacterial colonisation.
Straight 8 Retainer wire possesses a lower profile than many leading brands.
Ensuring passive placement with an easy to use transfer jig
The wire component of Maintain is attached to the transfer jig; a vacuum formed full arch featuring a cut-out window. This presents ease of use in three ways: minimised risk of dropping the wire, full visibility at all times and freedom of both hands. Once bonded, the jig is easily cut away with a high or slow speed bur or a wire cutter.
The vacuum formed retainer element of the jig, which is cut away following bonding and used as a retainer, helps to minimise the risk of torque forces. In addition, as the retainer can be placed in the debond appointment, the risk of tooth movement occurring between appointments is eliminated.
Step 1: Easy to use transfer Jig ensures passive placement. Step 2: Bonding is easy as retainer wire is accessible through the cut-out window. Step 3: light cure.
Step 4: Separate the removable retainer from the bonded lingual wire with a high-speed bur, slow-speed bur or wire cutter. Step five: Remove jig and wear nightly for dual retention.
Choosing the right retainer for the right patient
Studies suggest no single method of retention alone can be recommended for reliable, long-term orthodontic retention for all patients.1 A patient’s age, likelihood of compliance, periodontal and oral health, and the severity of malocclusion may determine the choice of treatment. Taking this into account, a dual retention system involving a removable and fixed retainer may offer a solution to a broader patient base. Furthermore, all Maintain patients are sure to benefit from the convenience of fewer appointments, a quick and easy fitting, and a personal and inclusive approach.
- Green JIJ (2015) Dental materials: the multi-stranded wire retainer. doi: 10.1038/bdjteam.2015.54
- Burden D, Morris D (2008) (Revised 2013) Parvizi F, Morris D, Atack N; Clinical Guidelines: Orthodontic Retention; clinical-guidelines-retention-final-version-august-2013.pdf. Retrieved online, 31.10.2018.
- Katsaros C, Livas C, Renkema AM. Unexpected complications of bonded mandibular lingual retainers. Am J Orthod Dentofacial Orthop 2007; 132(6): 838–41.
Call in-house laboratory Studio 8 today
Fully digital In-house Laboratory Studio 8, based at DB Orthodontics West Yorkshire headquarters, offers a 5-day turnaround and accept Alginate, Silicone or Digital scans. As with all DB Orthodontics’ products and services, a highly trained team are always available for support over the phone and can provide a lab order form via email on request. For more information call 01535 656 999, email firstname.lastname@example.org or visit www.dbortho.com