Sir, Dr A. Maini's article on short-term cosmetic orthodontics (BDJ 2013; 214: 83) is appropriately named as the benefits of this approach to treatment in many cases are destined to be short lived. For the benefit of readers who may be seduced, orthodontists have learned the hard way that very few patients successfully sustain wearing removable retainers on a long-term basis. The great majority of adult patients need permanent retention, not just some night-time device for a year or two. The only reliable retainers for long-term use are palatal or lingual bonded wires which must be out of occlusion. In the upper arch, this means that overbite reduction is often necessary which usually means that treatment will take longer than six months and that full appliances will be required in both arches. One wonders how many quick fix patients are informed in a clear and unambiguous way that their few months of short-term orthodontics will be just that, short-term, unless followed by a lifetime of retention.

Dr A. Maini responds: I completely agree life long retention is imperative with any adult orthodontics. All my patients have verbal and written understanding of the importance of retainers. If need be we can fit upper retainer wires by either minor lower incisor intrusion or by deep bite correction with levelling of the curve of spee. This can be done within the scope of short-term orthodontics.

1. Reigate