Retainer (orthodontics)

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Top (left) and bottom (right) retainers Retainer.jpg
Top (left) and bottom (right) retainers
Vacuum form retainer in the foreground (used on upper); illustration of an early Hawley retainer in the background Retainers.jpg
Vacuum form retainer in the foreground (used on upper); illustration of an early Hawley retainer in the background

Orthodontic retainers are custom-made devices, usually made of wires or clear plastic, that hold teeth in position after surgery or any method of realigning teeth. Once a phase of orthodontic treatment has been completed to straighten teeth, there remains a lifelong risk of relapse (a tendency for teeth to return to their original position) due to a number of factors: recoil of periodontal fibres, pressure from surrounding soft tissues, the occlusion and patient’s continued growth and development. By using retainers to hold the teeth in their new position for a length of time, the surrounding periodontal fibres adapt to changes in the bone which can help minimize any changes to the final tooth position after the completion of orthodontic treatment. [1] [2] Retainers may also be used to treat overjets.

Contents

Removable retainers

Removable retainers include Hawley, Vacuum-formed, Begg and Barrer. They provide orthodontic retention when worn and they can be taken in and out of the mouth. They can be worn part-time or full-time if required or as advised by the orthodontist. In comparison to fixed retainers, removable retainers are easier to clean. [1]

Hawley retainers

The underneath surface of an upper Wrap Around Hawley retainer resting on top of a retainer case RetainerBottom.JPG
The underneath surface of an upper Wrap Around Hawley retainer resting on top of a retainer case

The best-known removable retainers are the Hawley retainers, which consist of a metal wires that typically surround the six anterior teeth and keep them in place. Hawley retainers are one of the oldest types of removable retainers. [1] Named for its inventor, Dr. Charles A. Hawley, the labial wire, or Hawley bow, incorporates 2 omega loops for adjustment. It is anchored in an acrylic baseplate that sits in the palate (roof of the mouth). They are made from metal wire running along the outside of the teeth. There are many adaptations possible with Hawley retainers. [1] The advantage of this type of retainer is that the metal wires can be adjusted to finish treatment and continue minor movement of the anterior teeth as needed. [3] It also benefits from being robust and rigid, easy to construct and allows prosthetic tooth/teeth to be added onto with metal stops placed mesial and distal to the prosthetic teeth to prevent any relapse. To help fix rotations; acrylic facing can be added to the labial bow and a bite plane added to maintain the result of deep overbite correction. Also, to control the position of the canine, reverse U-loop can be employed. Additionally, to avoid occlusal interferences, the labial bow can be soldered to the cribs. [1]

The main disadvantages of this type of retainer is its inferior aesthetics, interference with speech, risk of fracture and inferior retention of lower incisors in comparison to vacuum-formed retainers. [1]

Recently[ when? ], a more aesthetic version of the Hawley retainer has been developed. For this alternative, the front metal wire is replaced with a clear wire called the ASTICS. This retainer is intended to be adjustable similarly to the traditional Hawley retainer, which is not practical with vacuum-formed retainers.

Research shows that Hawley retainers are not effective for preventing incisor irregularity relapse. [4] Hawley retainers also affect speech, especially the d, s, t, and i sounds, however as they are often only worn at night time, this concern may not be so prevalent. [5] Research shows that participants that wear Hawley retainers report being more embarrassed about the appliance than wearing vacuum formed retainers and they found Hawley retainers more difficult to wear. [6] However, if the patient has concerns with regards to the visible metal wire, a clear polyethylene bow can be used to enhance aesthetics. [1]

The process of making an acrylic retainer was featured on the How It's Made TV show on the Science Channel on Season 23, Episode 16.

Vacuum-formed retainers

Another common type of removable retainer is the vacuum formed retainer (VFR). This is a polypropylene or polyvinylchloride (PVC) material. VFRs are made using a thermoforming process, using vacuum- or pressure-thermoforming. [7] This clear or transparent retainer normally fits over the entire arch of teeth, however some designs fit only from canine to canine (clip-on retainer). The retainer is clear and so virtually invisible when worn. Hence, it can offer an aesthetic advantage relative to other retainers. VFRs, if worn 24 hours per day, do not allow the upper and lower teeth to touch, as the retainers cover the occlusal (biting) surfaces of the teeth. [8] Some orthodontists feel that it is important for the top and bottom chewing surfaces to meet to allow for "favourable settling" to occur, thus the need for wearing the retainer only intermittently. [8] VFRs are most commonly worn overnight and removed while eating. [1] If worn while eating, they can behave as a reservoir enclosing the teeth with cariogenic substances and lead to decalcification of teeth over time (formation of cavities). The same can result if the retainer is inserted straight after a meal or drink. VFRs tend to be favoured as an orthodontic retainer as they are more aesthetic, interfere less with speech and are more economical than other removable retainers. [8] However, for patients with disorders such as bruxism, VFRs can be prone to rapid breakage and deterioration due to grinding of the VFR against the opposing teeth. There is, however, an increased ease of fabrication over other retainers if they do break. [8] Another advantage of VFRs is that there is evidence to suggest superior retention of lower incisors compared to other removable retainer types, but the best [9] retention was achieved with fixed retainers. [7]

Begg retainers

The Begg retainers have the labial bow extending around the distal aspect of the terminal molar. [10] They allow occlusal settling, as no wire work crosses the occlusion. Begg retainers are robust enough to be worn during eating, [11] however they are less retentive than Hawley retainers and the labial bow is more prone to distortion. [12]

Barrer retainers

The Barrer retainers (aka Spring retainers) carry acrylic bows both labially and lingually. [10] The original appliance extended only to the canines, however due to the risk of swallowing or aspiration, a modification which includes cribs on the first molars has been described. These retainers can be used to realign minor lower incisor relapse. [12]

SMART retainers

Dental practitioners and orthodontists are sometimes resistant to providing younger patients with removable retainers due to the potential issues of the patient not wearing their retainer consistently after completing their orthodontic treatment. However, the recent innovation of SMART Retainers and related mobile applications that track, remind, and reward the patients for their continued use of their retainer may lead to a significant decrease in the number of adolescents that obtain additional orthodontic treatment in the future due to them not complying with their retainer usage. The mobile application has a unique feature that allows for parental notifications. If the child does not open their Smart Retainer Case, the parent can receive mobile notifications to help reduce retainer non-compliance. [13]

Fixed retainers

Fixed retainers are often used to provide orthodontic retention and avoid relapse. [14] They commonly consist of a wire bonded with acid etch and composite to the lingual/palatal surface of the anterior teeth. In fixed retainers, composite is usually placed to bond and to cover the wire, whilst ensuring no interference in the interdental space. Fixed retainers are used in situations where instability is more likely, such as severe rotations, periodontal disease and median diastemas. Occasionally the patient will require a removable retainer as well. Fixed bonded retainers can be designed with a smooth wire or flexible spiral wire which is also known as multi-strand wire. [15] The most commonly used are multi-strand wire bonded to all six anterior teeth or a round stainless steel wire bonded to the canines only. Although fixed retainers depend less on the patient’s cooperation for regular wearing, they are more difficult to clean and therefore need more attention from the patient to prevent plaque accumulation and subsequent gingival inflammation. [15]

Maintenance

Relapse can occur if retainers are not worn regularly post-treatment. The orthodontist may advise wearing the retainer for a set period of time or indefinitely after orthodontic treatment. Recent innovations of a Smart Retainer Case that utilizes: IoT, motion sensors, and a mobile application to track, remind, and reward patients, might be the most effective way of keeping post-orthodontic patients engaged with their final retention and continued wear of their removable retainer. [13] If not cleaned properly, retainers can act as a food reservoir and lead to caries and gingival inflammation. Cleaning options for removable retainers include retainer/denture tablets, the use of a toothbrush and fragrance-free soap or non-abrasive toothpaste. If the water used to clean the retainer is too hot, it may cause shrinkage. [1]

If the retainer is removable, it should be cleaned before inserting. If the retainer is fixed and cannot be removed, it should be cleaned during the nighttime home care routine. To clean a retainer use a wet toothbrush and gently scrub all surfaces of the retainer to remove any plaque and bacteria. A non-abrasive toothpaste should be used when cleaning a retainer. Alternatively, a mild soap or a brush dipped in mouthwash can also be used to clean it. When not in use keep the retainer in a dry container. Avoid leaving it in high temperatures or in the sun. Do not soak a retainer in liquids overnight. This will ensure the material will stay intact. [16]

See also

Related Research Articles

<span class="mw-page-title-main">Orthodontics</span> Correctional branch of dentistry

Orthodontics is a dentistry specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, as well as misaligned bite patterns. It may also address the modification of facial growth, known as dentofacial orthopedics.

<span class="mw-page-title-main">Dental braces</span> Form of orthodontics

Dental braces are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while also aiming to improve dental health. They are often used to correct underbites, as well as malocclusions, overbites, open bites, gaps, deep bites, cross bites, crooked teeth, and various other flaws of the teeth and jaw. Braces can be either cosmetic or structural. Dental braces are often used in conjunction with other orthodontic appliances to help widen the palate or jaws and to otherwise assist in shaping the teeth and jaws.

<span class="mw-page-title-main">Dental technician</span> Technician working on dental appliances

A dental technician is a member of the dental team who, upon prescription from a dental clinician, constructs custom-made restorative and dental appliances.

<span class="mw-page-title-main">Clear aligners</span> Transparent dental braces

Clear aligners are orthodontic devices that are a transparent, plastic form of dental braces used to adjust teeth.

<span class="mw-page-title-main">Orthodontic headgear</span> Orthodontic device used to correct bite

Orthodontic headgear is a type of orthodontic appliance typically attached to the patient's head with a strap or number of straps around the patient's head or neck. From this, a force is transferred to the mouth/jaw(s) of the subject.

Orthodontic separators are rubber bands or metal appliances used in orthodontics. Spacers are placed between the molars at the second orthodontic appointment before molar bands are applied. They are usually added a week before you get your braces, but can sometimes be added after.

<span class="mw-page-title-main">Malocclusion</span> Medical condition

In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855–1930), the "father of modern orthodontics", popularised it. The word "malocclusion" derives from occlusion, and refers to the manner in which opposing teeth meet.

<span class="mw-page-title-main">Palatal expansion</span> Orthodontics device to widen the upper jaw

A palatal expander is a device in the field of orthodontics which is used to widen the upper jaw (maxilla) so that the bottom and upper teeth will fit together better. This is a common orthodontic procedure. The use of an expander is most common in children and adolescents 8–18 years of age. It can also be used in adults, although expansion is more uncomfortable and takes longer in adults. A patient who would rather not wait several months for the end result achieved by a palatal expander may be able to opt for a surgical separation of the maxilla. Use of a palatal expander is most often followed by braces to then straighten the teeth.

A dental emergency is an issue involving the teeth and supporting tissues that are of high importance to be treated by the relevant professional. Dental emergencies do not always involve pain, although this is a common signal that something needs to be looked at. Pain can originate from the tooth, surrounding tissues or can have the sensation of originating in the teeth but be caused by an independent source. Depending on the type of pain experienced an experienced clinician can determine the likely cause and can treat the issue as each tissue type gives different messages in a dental emergency.

Orthodontic technology is a specialty of dental technology that is concerned with the design and fabrication of dental appliances for the treatment of malocclusions, which may be a result of tooth irregularity, disproportionate jaw relationships, or both.

The SMART Retainer is a small micro sensor which is imbedded in a traditional orthodontic retainer. The sensor monitors how often the retainer is being worn, and the information is loaded onto the orthodontist's computer via a reader.

Percival Raymond Begg AO was a professor at the University of Adelaide School of Dentistry and a well known orthodontist, famous for developing the "Begg technique". Permanent displays dedicated to the Begg technique can be found in the Smithsonian Institution in Washington DC, the Library of the American Dental Association in Chicago, and the PR Begg Museum at the University of Adelaide.

Serial extraction is the planned extraction of certain deciduous teeth and specific permanent teeth in an orderly sequence and predetermined pattern to guide the erupting permanent teeth into a more favorable position.

Pre-eruption guidance is an orthodontic treatment method that allows for expansion of existing erupting teeth long before they appear in the mouth. The use off pre-eruption guidance appliances and the timing of extractions of certain deciduous teeth aligns the teeth naturally as opposed to orthodontic mechanical movement of permanent teeth into alignment after they have erupted. Research shows that pre-eruption guidance produces far more stable tooth alignment than alternative treatments.

Lingual braces are one of the many types of the fixed orthodontic treatment appliances available to patients needing orthodontics. They involve attaching the orthodontic brackets on the inner sides of the teeth. The main advantage of lingual braces is their near invisibility compared to the standard braces, which are attached on the buccal (cheek) sides of the tooth. Lingual braces were invented by Craven Kurz in 1976.

Activator Appliance is an Orthodontics appliance that was developed by Viggo Andresen in 1908. This was one of the first functional appliances that was developed to correct functional jaw in the early 1900s. Activator appliance became the universal appliance that was used widely throughout Europe in the earlier part of the 20th century.

Frankel appliance or Frankel Functional Regulator is an orthodontic functional appliance which was developed by Rolf Fränkel in 1950s for treatment to patients of all ages. This appliance primarily focused on the modulation of neuromuscular activity in order to produce changes in jaw and teeth. The appliance was opposite to the Bionator appliance and Activator appliance.

Intrusion is a movement in the field of orthodontics where a tooth is moved partially into the bone. Intrusion is done in orthodontics to correct an anterior deep bite or in some cases intrusion of the over-erupted posterior teeth with no opposing tooth. Intrusion can be done in many ways and consists of many different types. Intrusion, in orthodontic history, was initially defined as problematic in early 1900s and was known to cause periodontal effects such as root resorption and recession. However, in mid 1950s successful intrusion with light continuous forces was demonstrated. Charles J. Burstone defined intrusion to be "the apical movement of the geometric center of the root (centroid) in respect to the occlusal plane or plane based on the long axis of tooth".

The Herbst appliance is an orthodontic appliance used by orthodontists to correct class 2 retrognathic mandible in a growing patient, meaning that the lower jaw is too far back. This is also called bitejumping. Herbst appliance parts include stainless steel surgical frameworks that are secured onto the teeth by bands or acrylic bites. These are connected by sets of telescoping mechanisms that apply gentle upward and backward force on the upper jaw, and forward force on the lower jaw. The original bite-jumping appliance was designed by Dr. Emil Herbst and reintroduced by Dr. Hans Pancherz using maxillary and mandibular first molars and first bicuspids. The bands were connected with heavy wire soldered to each band and carried a tube and piston assembly that allowed mandibular movement but permanently postured the mandible forward. The appliance not only corrected a dental Class II to a dental Class I but also offered a marked improvement of the classic Class II facial profile.

References

  1. 1 2 3 4 5 6 7 8 9 Mitchell L, Littlewood SJ, Nelson-Moon Z, Dyer F (2013). An introduction to orthodontics (4th ed.). Oxford: Oxford University Press. ISBN   978-0-19-100303-5. OCLC   854583725.
  2. ↑ "Braces Off Process Explained". Orthodontics Australia. 2021-03-24. Retrieved 2021-04-18.
  3. ↑ Lynn S. "Part Six: After the Braces Come Off". Braces 101: a primer for adults new to braces. Retrieved 2008-08-26.
  4. ↑ Outhaisavanh S, Liu Y, Song J (June 2020). "The origin and evolution of the Hawley retainer for the effectiveness to maintain tooth position after fixed orthodontic treatment compare to vacuum-formed retainer: A systematic review of RCTs". International Orthodontics. 18 (2): 225–236. doi:10.1016/j.ortho.2020.02.008. PMID   32201168. S2CID   214617292.
  5. ↑ Chen J, Wan J, You L (January 2018). "Speech and orthodontic appliances: a systematic literature review". European Journal of Orthodontics. 40 (1): 29–36. doi: 10.1093/ejo/cjx023 . PMID   28472259.
  6. ↑ Littlewood SJ, Millett DT, Doubleday B, Bearn DR, Worthington HV (January 2016). "Retention procedures for stabilising tooth position after treatment with orthodontic braces". The Cochrane Database of Systematic Reviews. 2016 (1): CD002283. doi:10.1002/14651858.CD002283.pub4. PMC   7138206 . PMID   26824885.
  7. 1 2 Bahije L, Ennaji A, Benyahia H, Zaoui F (September 2018). "A systematic review of orthodontic retention systems: The verdict". International Orthodontics. 16 (3): 409–424. doi:10.1016/j.ortho.2018.06.023. PMID   30001980. S2CID   51618389.
  8. 1 2 3 4 Littlewood SJ, Mitchell L (2019). An Introduction to Orthodontics (5th ed.). Oxford University Press. pp. 208–209. ISBN   978-0-19-253959-5.
  9. ↑ Iliadi A, Koletsi D, Papageorgiou SN, Eliades T (April 2020). "Safety Considerations for Thermoplastic-Type Appliances Used as Orthodontic Aligners or Retainers. A Systematic Review and Meta-Analysis of Clinical and In-Vitro Research". Materials. 13 (8): 1843. Bibcode:2020Mate...13.1843I. doi: 10.3390/ma13081843 . PMC   7215465 . PMID   32295303.
  10. 1 2 Mitchell, Laura (2019). Introduction to Orthodontics (5th ed.).
  11. ↑ CLINICAL GUIDELINES: ORTHODONTIC RETENTION C.Johnston, D.Burden & D.Morris (2008) Revised July 2013 published by British Orthodontic Society
  12. 1 2 Martyn T. Cobourne, Andrew T. DiBiase (2016). Handbook of Orthodontics (2nd ed.).
  13. 1 2 "Smart Retainer Case". MyToothCase.
  14. ↑ Buzatta LN, Shimizu RH, Shimizu IA, Pachêco-Pereira C, Flores-Mir C, Taba M, et al. (August 2017). "Gingival condition associated with two types of orthodontic fixed retainers: a meta-analysis". European Journal of Orthodontics. 39 (4): 446–452. doi: 10.1093/ejo/cjw057 . PMID   27629261.
  15. 1 2 Cerroni S, Pasquantonio G, Condò R, Cerroni L (2018-09-28). "Orthodontic Fixed Appliance and Periodontal Status: An Updated Systematic Review". The Open Dentistry Journal. 12 (1): 614–622. doi: 10.2174/1745017901814010614 . PMC   6182882 . PMID   30369970.
  16. ↑ "The 3 Types of Retainers". Take Home Smile.
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