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Fixed retention: pitfalls and complications


Long-term stability of orthodontic treatment results is problematic. Long-term or even lifelong retention with bonded retainers is being increasingly used among clinicians. Bonded retainers can provide an efficient and attractive method of retention, particularly because they require minimal compliance from patients. However, the use of bonded retainers is associated with relatively frequent complications, such as detachments of the adhesive layer or wire fractures, as well as unexpected complications with potentially severe consequences with associated periodontal and general health risks. It is imperative that the whole dental team are aware of these pitfalls and complications, and appreciate how to minimise and address these.

Key points

  • Encourages balanced discussion among the dental team concerning long-term retention with bonded retainers, focusing on the possible complications associated with the use of bonded retainers.

  • Discusses the factors influencing occurrence of complications and the potential negative effects on adjacent tissues as well as general health.

  • Stresses the importance of monitoring bonded retainers by all members of the dental team and early interception of complications in order to prevent development of severe clinical consequences.

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  1. Sadowsky C, Schneider B J, BeGole E A, Tahir E. Long-term stability after orthodontic treatment: nonextraction with prolonged retention. Am J Orthod Dentofacial Orthop 1994; 106: 243-249.

  2. Little R M, Riedel R, Årtun J. An evaluation of changes in mandibular anterior alignment from 10-20 years post-retention. Am J Orthod 1988; 93: 423-428.

  3. Blake M, Bibby K. Retention and stability: A review of the literature. Am J Orthod Dentofacial Orthop 1998; 114: 299-306.

  4. Sinclair P M, Little R M. Dentofacial maturation of untreated normals. Am J Orthod 1985; 88: 146-156.

  5. Bishara S, Treder J E, Damon P, Olsen M. Changes in the dental arches and dentition between 25 and 45 years of age. Angle Orthod 1996; 66: 417-422.

  6. Behrents R G. Growth in the aging craniofacial skeleton. Monograph 17, Craniofacial Growth series. Ann Harbour: Centre for Human Growth and Development; University of Michigan, 1985.

  7. Abdulraheem S, Schütz-Fransson U, Bjerklin K. Teeth movement 12 years after orthodontic treatment with and without retainer: relapse or usual changes? Eur J Orthod 2020; 42: 52-59.

  8. Nanda R S, Nanda S K. Consideration of dentofacial growth in long-term retention and stability: Is active retention needed? Am J Orthod Dentofacial Orthop 1992; 4: 297-302.

  9. Booth F A, Edelman J M, Proffit W R. Twenty-year follow-up of patients with permanently bonded mandibular canine-to-canine retainers. Am J Orthod Dentofacial Orthop 2008; 133: 70-76.

  10. Little R M. The irregularity index: a quantitative score of mandibular anterior alignment. Am J Orthod 1975; 68: 554-563.

  11. Alexander R G. The Alexander Discipline - Volume 2: Long-term stability. 1st ed. Hanover Park: Quintessence Publishing, 2011.

  12. Padmos J A D, Fudalej P S, Renkema A M. Epidemiologic study of orthodontic retention procedures. Am J Orthod Dentofacial Orthop 2018; 153: 496-504.

  13. Renkema A M, Fudalej P S. Fixed-retainers: long-term effectiveness. In Katsaros C, Eliades T (eds) Stability, Retention, and Relapse in Orthodontics. 1st ed. pp 203-208. Surrey: Quintessence Publishing, 2017.

  14. Renkema A M, Renkema A, Bronkhorst E, Katsaros C. Long-term effectiveness of canine-to-canine bonded flexible spiral wire lingual retainers. Am J Orthod Dentofacial Orthop 2011; 139: 614-621.

  15. Lai C S, Grossen J M, Renkema A M, Fudalej P S, Katsaros C. Orthodontic retention procedures in Switzerland. Swiss Dent J 2014; 124: 655-661.

  16. Pratt M C, Kluemper G T, Hartsfield J K, Fardo D, Nash D A. Evaluation of retention protocols among members of the American Association of Orthodontists in the United States. Am J Orthod Dentofacial Orthop 2011; 140: 520-526.

  17. Renkema A M, Sips E T H, Bronkhorst E, Kuijpers-Jagtman A M. A survey on orthodontic retention precedures in the Netherlands. Eur J Orthod 2009; 31: 432-437.

  18. Valiathan M, Hughes E. Results of a survey-based study to identify common retention practices in the United States. Am J Orthod Dentofacial Orthop 2010; 137: 170-177.

  19. Littlewood S J. Responsibilities and retention. APOS Trends Orthod 2017; 7: 211-214.

  20. Kucera J, Marek I. Unexpected complications associated with mandibular fixed retainers: a retrospective study. Am J Orthod Dentofacial Orthop 2016; 149: 202-211.

  21. Zachrisson B U. Long-term experience with direct bonded retainers: Update and clinical advice. J Clin Orthod 2007; 41: 728-737.

  22. Årtun J, Spadafora A T, Shapiro P A. A 3-year follow-up study of various types of orthodontic canine-to-canine retainers. Eur J Orthod 1997; 5: 501-509.

  23. Pandis N, Fleming P S, Kloukos D, Polychronopoulou A, Katsaros C, Eliades T. Survival of bonded lingual retainers with chemical or photo polymerization over a 2-year period: a single-centre, randomized controlled clinical trial. Am J Orthod Dentofacial Orthop 2013; 144: 169-175.

  24. Dahl E H, Zachrisson B U. Long-term experience with direct-bonded lingual retainers. J Clin Orthod 1991; 25: 619-630.

  25. Kocher K E, Gebistorf M C, Pandis N, Fudalej P S, Katsaros C. Survival of maxillary and mandibular bonded retainers 10 to 15 years after orthodontic treatment: a retrospective observational study. Prog Orthod 2019; 20: 28.

  26. Årtun J. Caries and periodontal reactions associated with long-term use of different types of bonded lingual retainers. Am J Orthod 1984; 86: 112-118.

  27. Pandis N, Vlahopoulos K, Madianos P, Eliades T. Long-term periodontal status of patients with mandibular lingual fixed retention. Eur J Orthod 2007; 29: 471-476.

  28. Tacken M P, Cosyn J, De Wilde P, Aerts J, Govaerts E, Vannet B V. Glass fibre reinforced versus multistranded bonded orthodontic retainers: a 2 year prospective multi-centre study. Eur J Orthod 2010; 32: 117-123.

  29. Katsaros C, Livas C, Renkema A M. Unexpected complications of bonded mandibular lingual retainers. Am J Orthod Dentofacial Orthop 2007; 132: 838-841.

  30. Shaugnessy T G, Proffit W R, Samara S A. Inadvertent tooth movement with fixed lingual retainers. Am J Orthod Dentofacial Orthop 2016; 149: 277-286.

  31. Eliades T, Voutsa D, Sifakakis I, Makou M, Katsaros C. Release of bisphenol-A from a light-cured adhesive bonded to lingual fixed retainers. Am J Orthod Dentofacial Orthop 2011; 139: 192-195.

  32. Kang Y G, Kim J-Y, Kim J, Won P-J, Nam J-H. Release of bisphenol A from resin composite used to bond orthodontic lingual retainers. Am J Orthod Dentofacial Orthop 2011; 140: 779-789.

  33. Forde K, Storey M, Littlewood S J, Scott P, Luther F, Kang J. Bonded versus vacuum-formed retainers: a randomized controlled trial. Part 1: stability, retainer survival, and patient satisfaction outcomes after 12 months. Eur J Orthod 2018; 40: 387-398.

  34. Rogers M B, Andrews L J. Dependable technique for bonding a 3 x 3 retainer. Am J Orthod Dentofacial Orthop 2004; 126: 231-233.

  35. Störmann I, Ehmer U. A prospective randomized study of different retainer types. J Orofac Orthop 2002; 63: 42-50.

  36. Lie Sam Foek D J, Ozcan M, Verkerke G J, Sandham A, Dijkstra P U. Survival of flexible, braided, bonded stainless steel lingual retainers: a historic cohort study. Eur J Orthod 2008; 30: 199-204.

  37. Bearn D R, McCabe J F, Gordon P H, Aird J C. Bonded orthodontic retainers: the wire composite interface. Am J Orthod Dentofacial Orthop 1997; 111: 67-74.

  38. Zachrisson B U. Third generation mandibular bonded lingual 3-3 retainer. J Clin Orthod 1995; 29: 39-48.

  39. Sfondrini M F, Fraticelli D, Castellazzi L, Scribante A, Gandini P. Clinical evaluation of bond failures and survival between mandibular canine-to-canine retainers made of flexible spiral wire and fibre-reinforced composite. J Clin Exp Dent 2014; DOI: 10.4317/jced.51379.

  40. Fleming P S, Johal A, Pandis N. Self-etch primers and conventional acid-etch technique for orthodontic bonding: a systematic review and meta-analysis. Am J Orthod Dentofacial Orthop 2012; 142: 83-94.

  41. Segner D, Heinrici B. Bonded retainers - clinical reliability. J Orofac Orthop 2000; 61: 352-358.

  42. Scheibe S, Ruf S. Lower bonded retainers: survival and failure rates particularly considering operator experience. J Orofac Orthop 2010; 71: 300-307.

  43. Watted N, Wieber M, Teuscher T, Schmitz N. Comparison of incisor mobility after insertion of canine-to-canine lingual retainers bonded to two or to six teeth. A clinical study. J Orofac Orthop 2001; 62: 387-396.

  44. Al-Nimri K, Al Habashneh R, Obeidat M. Gingival health and relapse tendency: a prospective study of two types of lower fixed retainers. Aust Orthod J 2009; 25: 142-146.

  45. Gunay F, Oz A A. Clinical effectiveness of 2 orthodontic retainer wires on mandibular arch retention. Am J Orthod Dentofacial Orthop 2018; 153: 232-238.

  46. Torkan S, Oshagh M, Khojastepour L, Shahidi S, Heidari S. Clinical and radiographic comparison of the effects of two types of fixed retainers on periodontium - a randomized clinical trial. Prog Orthod 2014; 15: 47.

  47. Kravitz N D, Grauer D, Schumacher P, Jo Y-M. Memotain: A CAD/CAM nickel-titanium lingual retainer. Am J Orthod Dentofacial Orthop 2017; 151: 812-815.

  48. Sifakakis I, Katsaros C, Zinelis S, Eliades T. Biomaterials used for fixed retainers in orthodontics. In Katsaros C, Eliades T (eds) Stability, Retention, and Relapse in Orthodontics. 1st ed. pp 189-202. Surrey: Quintessence Publishing, 2017.

  49. Zachrisson B U, Büyükyilmaz T. Bonding in orthodontics. In Graber L W, Vanarsdall R L, Vig K W L (eds) Orthodontics - Current principles and techniques. 5th ed. pp 727-784. Philadelphia: Elsevier Mosby, 2012.

  50. Bearn D R. Bonded orthodontic retainers: a review. Am J Orthod Dentofacial Orthop 1995; 108: 207-213.

  51. Albandar J M, Kingman A. Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 1999; 70: 30-43.

  52. Kucera J, Marek I, Hanzelka T, Kaminek M. Unexpected complications of fixed retainers. Ortodoncie 2015; 24: 69-80.

  53. Brenchley M L. A cautionary tale of simplified retention. Br J Orthod 1997; 24: 113-115.

  54. Sifakakis I, Pandis N, Eliades T, Makou M, Katsaros C, Bourauel C. In-vitro assessment of the forces generated by lingual fixed retainers. Am J Orthod Dentofacial Orthop 2011; 139: 44-48.

  55. Uysal T, Baysal A, Usumez S, Ulker M. Microleakage between composite-wire and composite-enamel interfaces of flexible spiral wire retainers. Part 1: comparison of three composites. Eur J Orthod 2009; 31: 647-651.

  56. Richman C. Is gingival recession a consequence of an orthodontic tooth size and/or tooth position discrepancy? "A paradigm shift". Compend Contin Educ Dent 2011; 32: 62-69.

  57. Nahm K-Y, Kang J-H, Moon S-C et al. Alveolar bone loss around incisors in Class I bidentoalveolar protrusion patients: a retrospective three-dimensional cone beam CT study. Dentomaxillofac Radiol 2012; 41: 481-488.

  58. Yagci A, Veli I, Uysal T, Ucar F I, Ozer T, Enhos S. Dehiscence and fenestration in skeletal Class I, II, and III malocclusions assessed with cone-beam computed tomography. Angle Orthod 2012; 82: 67-74.

  59. Kim Y, Park J U, Kook Y. Alveolar bone loss around incisors in surgical skeletal class III patients. A retrospective 3-D CBCT study. Angle Orthod 2009; 79: 676-682.

  60. Pelch K, Wignal J A, Goldstone A E et al. A scoping review of the health and toxicological activity of bisphenol A (BPA) structural analogues and functional alternatives. Toxicology 2019; 424: 152235.

  61. Rietschel R L, Fowler J F, Warshaw E M et al. Detection of nickel sensitivity has increased in North American patch-test patients. Dermatitis 2008; 19: 16-19.

  62. Neville B W, Damm D D, Allen C M, Chi A C. Chapter 9: Allergies and immunologic diseases. In Neville B W, Damm D D, Allen C M, Chi A C (eds) Oral and Maxillofacial Pathology. 4th ed. pp 321. St Louis: Elsevier, 2016.

  63. Noble J, Ahing S I, Karaiskos N E, Wiltshire W A. Nickel allergy and orthodontics: a review and report of two cases. Br Dent J 2008; 204: 297-300.

  64. Feilzer A J, Laeijendecker R, Kleverlaan C J, van Schendel P, Muris J. Facial eczema because of orthodontic fixed retainer wires. Contact Dermatitis 2008; 59: 118-120.

  65. Kučera J, Streblov J, Marek I, Hanzelka T. Interdisciplinary orthodontic and periodontal treatment of a severe unexpected complication associated with a lower fixed retainer: A case report. J Clin Orthod 2016; 50: 34-39.

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Correspondence to Josef Kučera.

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Kučera, J., Littlewood, S. & Marek, I. Fixed retention: pitfalls and complications. Br Dent J 230, 703–708 (2021).

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