Survival of flexible, braided, bonded stainless steel lingual retainers: a historic cohort study

The objectives of this study were to retrospectively evaluate the clinical survival rate of flexible, braided, rectangular bonded stainless steel lingual retainers, and to investigate the influence of gender, age of the patient, and operator experience on survival after orthodontic treatment at the Department of Orthodontics, University of Groningen, between the years 2002 and 2006. The study group comprised of 277 patients [162 females: median age 14.8 years, interquartile range (IQR) 13.6-16.5 years and 115 males: median age 15.3 years, IQR 14.2-16.7 years]. After acid etching the lingual surfaces of each tooth, an adhesive resin was applied and retainers were bonded using a flowable resin composite. Data concerning, failures, gender, age of the patient, and operator experience were retrieved from the patient files that were updated by chart entries every 6 months or when failure was reported by the patient. The maximum follow-up period was 41.7 months. All 277 patients received flexible, braided, bonded mandibular canine-to-canine retainers. Eighteen failures were observed in the maxilla. A failure was recorded when there was debonding, fracture, or both, occurring in one arch. Only first failures were used for statistical analysis. When failures occurred in both jaws, these were considered as two separate incidences. Ninety-nine debonding (35.7 per cent), two fractures (0.7 per cent), and four debonding and fracture (1.4 per cent) events were observed. No significant effect (P > 0.05) of gender (females: 41 per cent, males: 32 per cent) or patient age (<16 years: 37 per cent, > or =16 years 38.7 per cent) was observed. The failure rate did not differ due to operator experience (n = 15; less experienced: 38.0 per cent; moderately experienced: 28.9 per cent, professional: 46.7 per cent; P > 0.05; chi-square test). Kaplan-Meier survival curves showed a 63 per cent success rate for the bonded lingual retainers over a 41.7 month period.     

A technique for placement of direct bonded lingual retainer

Different methods of bonding lingual retainers have evolved over the past three decades, both direct and indirect methods. The indirect method involves certain laboratory procedures to hold the retainer wire on the teeth, whereas the direct technique involves bonding the prefabricated retainer wire. The present article describes a new technique for direct-bonded lingual retainer.     

Clinical experience with direct-bonded orthodontic retainers.

The experience obtained in clinical evaluation of forty-three direct-bonded mandibular canine-to-canine retainers after a minimum observation period of 1 year (range, 1 to 2.5 years) is summarized. Results indicate that the bonded retainer has all the advantages of a fixed soldered retainer, in addition to being invisible. Patient acceptance was excellent, and the failure rate in terms of loose retainers was low. Also, for a number of other retention problems, direct bonding with different types of lingual wire seems to open up a range of promising new possibilities.     

Stability of the Bonded Lingual Wire Retainer—A Study of the Initial Bond Strength

Bonded lingual retainers (individually adjusted multistranded wires with one bond site per tooth) are used extensively to maintain the orthodontic treatment result. Failure or loss often leads to a relapse.The bond strength of bonded lingual retainers has not yet been studied in respect of the loads that can be withstood by them through deflection of the interdental archwire region. Furthermore, human anterior teeth have never before been used for a study of this kind.Six different wire/composite combinations were studied (wires: Dentaflex co-axial 0.018", Dentaflex multistranded 0.018", and Respond Dead Soft straight, length 0.0175"; composites: Tetric Flow and Heliosit Orthodontic) by bonding 1 cm lengths of wire to the lingual surfaces of 360 extracted lower anterior teeth. Using an Instron 6025 universal testing machine, vertical shear bond strength tests at the bond site as well as vertical shear bond strength tests and horizontal tensile strength tests were performed. The failure characteristics after failure at maximum force were evaluated by light microscopy, scanning electron microscopy, and morphometry. Most failures were observed at the enamel/composite interface. The selected wires displayed no significant differences; Tetric Flow proved to be the most stable resin; and no enamel tear-outs were observed.     

A practical method for lingual retainer fixation before direct bonding: Clinical suggest

The retention phase is initiated after orthodontic treatment completion to prevent orthodontic relapse. There are several techniques, direct and indirect, available for placing bonded lingual retainers, but none of them is considered as a standard clinical protocol. The best choice should be the association of simplicity and efficiency. This article presents a practical method sequence for fixation of the lingual retainer before direct bonding.     

Breakage incidence with direct-bonded lingual retainers.

This study examined the effects of a number of patient and clinical variables on the breakage of bonded retainers, and consisted of a retrospective review of the survival of 200 bonded retainers. Data was collected from two clinical centres between November 1996 and February 1997. The subjects comprised 198 patients of both sexes divided into three age groups. Retainers at both centres were made in 018-inch co-axial wire with Relyabond and Helioprogress adhesives used at each respective centre. The effects on time to first breakage of adhesive, patient sex, and arch (upper/lower) were considered using Kaplan Meier survival graphs and in Log Rank Tests. Finally, a Cox Proportional Hazard Model was used to examine the joint effects of these factors and the patients' ages. Breakage over a 5-year period with Relyabond was 38.8 per cent upper, 22.1 per cent lower, and with Helioprogress 75 per cent upper and 23.2 per cent lower. Breakage appears to be unrelated to the materials used or to the age and sex of the patients. Upper retainers break more often than lowers (P = 0.016) and early breakage is more likely to occur at an adhesive pad than at a wire (9.6 versus 2.5 per cent within 6 months).     

A 15-month evaluation of bond failures of orthodontic brackets bonded with direct versus indirect bonding technique: a clinical trial

Background

The purpose of this clinical longitudinal study was to investigate the effectiveness of indirect bonding technique evaluating the number of bond failures which occurred during treatment.

Methods

Fifty-two patients were selected and divided into two groups: group A (33 patients) bonded with the direct technique and group B (19 patients) bonded with the indirect technique. The number and date of bracket failure were recorded for over 15 months. Moreover, also the effect of crowding level on bracket failures was calculated. Statistical analysis was performed by means of t-test, Kaplan-Meier survival estimates and chi-squared test.

Results

No statistically significant differences were found in the total bond failure rate between direct and indirect techniques, also when comparing the upper and lower arches. The only significant difference was found comparing the posterior segment of the lower arches, in which a higher percentage of detachments were recorded in group B, bonded with the indirect technique. Moreover, no significant differences between direct and indirect bonding were found when evaluating crowding level.

Conclusions

Orthodontic practitioners can safely use the indirect bonding technique, even in patients with severe crowding, because it does not influence the adhesive quality and the bracket survival rate.     

A clinical comparison of bracket bond failures in association with direct and indirect bonding

OBJECTIVE: To compare bond failure rates between direct and indirect techniques for bonding orthodontic brackets. DESIGN: A two-centre single blinded prospective randomized controlled clinical trial. MATERIALS AND METHODS: This study was undertaken at the Birmingham Dental Hospital and Good Hope Hospital, Sutton Coldfield. Thirty-three subjects meeting the inclusion criteria were selected from orthodontic waiting lists and assigned to either of two study groups according to a split-mouth study design. The number and site of bracket failures between tooth types was recorded over 1 year. Statistical analysis was carried out using chi-square tests. RESULTS: Brackets were lost from 14 of the 553 teeth bonded, giving an overall bond failure rate of 2.5%. There were no significant differences in bond failures between direct and indirect bonding or in the tooth types of the failures. CONCLUSIONS: There was no significant difference in the bond failure rates between direct and indirect bonding.     

A method for stabilizing a lingual fixed retainer in place prior to bonding

AIM: The objective of this article is to present a simple technique for stabilizing a lingual fixed retainer wire in place with good adaptation to the teeth surfaces and checking for occlusal interferences prior to the bonding procedure. BACKGROUND: Bonding of an upper or lower fixed lingual retainer using stainless steel wires of different sizes and shapes is a common orthodontic procedure. The retainer can be constructed in a dental laboratory, made at chair side, or it can be purchased in prefabricated form. All three ways of creating a fixed retainer are acceptable. However, the method of holding the retainer wire in place adjacent to the lingual surfaces of the teeth before proceeding with the bonding process remains a problem for some practitioners. REPORT: The lingual fixed retainer was fabricated using three pieces of .010" steel ligature wire which were twisted into a single strand wire. Another four to five 0.010" pieces of steel ligature wires were twisted in the same way to serve as an anchor wire from the labial side of the teeth. The retainer wire was bonded using the foible composite. SUMMARY: The technique presented here for stabilizing the retainer wire prior to bonding provides good stabilization, adaptation, and proper positioning of the retainer wire while eliminating contamination of etched surfaces which might arise during wire positioning before bonding. This technique also allows the clinician the opportunity to check the occlusion and adjust the retainer wire to avoid occlusal interference prior to bonding maxillary retainers. This same clinical strategy can be used to stabilize wires for splinting periodontally affected teeth and traumatized teeth.     

Molar bands for 'precision' bonding of lingual retainers

Bonded retainers have been used principally for long-term retention of treated cases. Various methods of bonding lingual retainers have been described in the literature over the past two decades. However, accurate and passive placement of retainers has always been a matter of concern. This report presents a simple and economical method for accurate and passive placement of bonded lingual retainers that enables the operator to save considerable chair time.     

A comparative evaluation of lingual retainer failure bonded with or without liquid resin: A randomized clinical study with 2-year follow-up

Objective:To prospectively evaluate and compare the effect of liquid resin on lingual retainer failure after a 2-year follow-up.Materials and Methods:Fifty-two patients (26 males, 26 females) with a mean age of 18.3 ± 1.3 years at follow-up, were randomized into two groups: the resin group and the nonresin group. The lingual retainers in the resin group were bonded to the enamel surfaces with two-step bonding resin, Optibond FL, and Tetric EvoFlow. The nonresin group followed the same procedure of bonding retainers but without applying the Optibond FL. Retainer failure, calculus accumulation, and discoloration of composite pads adjacent to the retainers during the 2-year observation period were registered, compared, and statistically analyzed with a Fisher''s exact test and chi-square test.Results:In the resin group, the incidence of retainer failure was 4% and occurred at the composite-wire interface; in the nonresin group, the incidence was 27% and occurred at the enamel-composite interface. The difference between the groups was statistically significant (P  =  .049). The incidences of calculus accumulation and discoloration adjacent to the composite pads were 27% and 69% (P  =  .003 and P < .001) higher in the nonresin group, respectively.Conclusion:Application of resin in bonding of lingual retainers appears to reduce the incidence of retainer failure as well as the incidence of calculus accumulation and discoloration adjacent to the composite pads.     

Caries and periodontal reactions associated with long-term use of different types of bonded lingual retainers

An investigation was carried out (1) to test the tendency of different types of bonded retainers to accumulate plaque and calculus and (2) to find out whether long-term use of bonded retainers caused any damage to the teeth involved. Two test groups of patients--one with 3-3 retainers made of 0.032-inch spiral wire, and the other with 3-3 retainers made of 0.032-inch plain wire--and a reference group of persons without 3-3 retainers were compared. Also, a test group of patients with retainers made of flexible spiral wire (0.0195 inch) bonded lingually to each anterior tooth in the maxilla was compared to a reference group of patients with retention plates in the maxilla. All the persons selected had received routine orthodontic treatment with a multibonded edgewise light wire technique and had been out of active treatment for 1 to 8 years. Different indices were used to score accumulation of plaque and calculus, prevalence of caries, and periodontal reactions. The findings indicated that there was no basis on which to claim that retainers made of spiral wire accumulated more plaque and calculus than retainers made of plain wire. The presence of a bonded lingual retainer and the occasional accumulation of plaque and calculus gingival to the retainer wire after long-term use caused no apparent damage to the hard and soft tissues adjacent to the wire.     

Hygiene status associated with different types of bonded, orthodontic canine-to-canine retainers

The present study was performed to test whether bonded, orthodontic canine-to-canine retainers made of spiral wire tended to accumulate more plaque than retainers made of plain wire, and whether the presence of such retainers caused any damage to the teeth involved. 44 patients were classified in eight strata according to age, gender and gingival status. From each stratum, the patients were randomly divided into 4 groups, each of which received either retainers made of thick plain wire bonded only to the canines, thick twisted wired bonded only to the canines, thin twisted wire bonded to each tooth or removable retainers. Accumulation of plaque and calculus along the gingival margin and gingival inflammation were scored in lingual areas from canine to canine at time of fixed appliance removal and again 4 months after retainer insertion. In addition, accumulation of plaque and calculus and development of caries along the retainer wires were scored after 4 months. The results revealed no differences between the groups for any of the variables. No differences in accumulation of plaque was found between baseline and follow-up examinations. Gingival bleeding was scored less frequently after 4 months in retention than at time of debonding.     

Molar bands for ‘precision’ bonding of lingual retainers

Abstract

Bonded retainers have been used principally for long-term retention of treated cases. Various methods of bonding lingual retainers have been described in the literature over the past two decades. However, accurate and passive placement of retainers has always been a matter of concern. This report presents a simple and economical method for accurate and passive placement of bonded lingual retainers that enables the operator to save considerable chair time.     

A Prospective Randomized Study of Different Retainer Types

BACKGROUND AND AIM: In recent years, fixed lingual retainers have been gaining importance in relapse prevention. The aim of this prospective, randomized study was to compare different types of fixed retainers used for stabilization of the lower anterior segment with respect to detachment rate, relapse, periodontal and oral hygiene problems, as well as subjective patient discomfort. PATIENTS AND METHOD: Two types of fixed, customized canine-to-canine retainers (attached to six teeth) with wire diameters of 0.0215" and 0.0195" as well as one type of prefabricated canine-and-canine retainer (bonded to two teeth) were investigated in a total of 103 patients. Some retainers were inserted under dry field conditions using a rubber dam, and the others under relatively dry conditions using cotton rolls. In addition, two types of composite, Heliosit and Concise, were compared. RESULTS: The canine-and-canine retainer displayed an 18% detachment rate, a value significantly lower than the 29% determined for the 0.0195" canine-to-canine retainers. The 0.0215" canine-to-canine retainer had the highest detachment rate (53%). The 37% detachment rate with dry field bonding was slightly higher than the 32% with relatively dry field bonding. Comparison of the composites showed a significantly higher detachment rate for Heliosit (73%) than for Concise (27%). Plaque accumulation increased with all retainer types in the course of the study, but with no significant inter-group differences. Tooth position with canine-to-canine retainers showed a good degree of stability. The canine-and-canine retainer induced frequent relapse of incisors not bonded to the retainer. In view of their higher rate of subjective discomfort, canine-and-canine retainers were given a significantly poorer rating than their canine-to-canine counterparts.     

Upper bonded retainers: Survival and failure rates

Objective:To assess the frequency and type of upper bonded retainer failure and to identify possible predisposing factors.Materials and Methods:The records of 466 consecutive patients with upper bonded retainers were analyzed retrospectively with respect to retainer failures and failure type as well as timing of failure, differences among operators, and the number of defects of the multibracket appliances (MB) prior to the retention period.Results:A total of 58.2% of all patients experienced retainer failures. The average failure odds were 1.26 failures per retainer. The odds were highest for 3-3 retainers (1.37) and lowest for the 1-1 retainer (0.54). The detachment and total loss rates were significantly influenced by operator experience—both rates were lower for experienced practitioners. Total retainer losses occurred more frequently in case of previous MB defects, while retainer fractures were seen more frequently when the retainer included the canines.Conclusions:Upper bonded retainer failures are a frequent problem during the retention period (58.2% of patients). Less operator experience correlated with higher failure rates. An increased number of total retainer losses must also be expected with a decreasing number of bonding sites and in cases involving previous MB defects.     

The bonded mandibular lingual retainer

The lower fixed retainer from cuspid to cuspid has been one of the commonly used methods of retention at the end of the orthodontic treatment. Orthodontists mostly use the lingual wire soldered to cuspid bands for the fixed lower retainer. With the advent of the new effective bonding materials many orthodontists prefer to use cuspid-to-cuspid/biscuspid-to-biscuspid bonded retainers to obtain optimal retention of lower anterior teeth both functionally and aesthetically. After experimenting with a variety of previous methods, such as the use of rubber bands, elastic threads, cotton pliers, ligature wires and silastic trays for the accurate placement and immobilization of a lower lingual retainer during the bonding, we have found that the use of two 1 to 1 1/2 inch pieces of 0.016 inch wires tack welded to lingual wire gives the best results. It is more accurate, simple, inexpensive and designed to save the orthodontist chair time.     

Six-month bracket failure rate evaluation of a self-etching primer

The aim of this study was to compare the clinical performance of a self-etching primer (SEP) with a conventional two-step etch and primer [conventional method (CM)]. The chair time required for bonding was also evaluated. Thirty-seven patients (14 males and 23 females) with a mean age of 16 years 5 months were included in the study. Six hundred and seventy-two brackets were bonded by one operator using a split-mouth design, with either SEP (Transbond Plus) or CM (Transbond XT). Bracket failure rates were estimated with respect to bonding procedure, dental arch, type of tooth (incisor, canine, and premolar), and gender. The results were evaluated using the chi-square test. The survival rate of the brackets was estimated with Kaplan-Meier analysis. Bracket survival distributions with respect to bonding procedure, dental arch, type of tooth, and patient gender were compared with a log-rank test. Bond failure interface was determined with the adhesive remnant index (ARI). The failure rates were 0.6 per cent for both bonding procedures. The failure and survival rates did not show significant differences between the bonding procedures, upper and lower dental arches, or gender. However, premolar brackets displayed a higher bond failure rate and a lower survival rate than incisor and canine brackets (P < 0.05). The mean bracket bonding time per tooth with SEP was significantly shorter than with CM (P < 0.001). No significant difference was observed for the ARI scores (P > 0.05). The results of this in vivo, randomized, cross-mouth clinical trial demonstrated a high survival rate with Transbond Plus. This finding indicates that SEP can be effectively used for bonding of orthodontic brackets.     

A clinical comparison of bracket bond failures in association with direct and indirect bonding

Abstract

Objective: To compare bond failure rates between direct and indirect techniques for bonding orthodontic brackets.

Design: A two-centre single blinded prospective randomized controlled clinical trial.

Materials and methods: This study was undertaken at the Birmingham Dental Hospital and Good Hope Hospital, Sutton Coldfield. Thirty-three subjects meeting the inclusion criteria were selected from orthodontic waiting lists and assigned to either of two study groups according to a split-mouth study design. The number and site of bracket failures between tooth types was recorded over 1 year. Statistical analysis was carried out using chi-square tests.

Results: Brackets were lost from 14 of the 553 teeth bonded, giving an overall bond failure rate of 2.5%. There were no significant differences in bond failures between direct and indirect bonding or in the tooth types of the failures.

Conclusions: There was no significant difference in the bond failure rates between direct and indirect bonding.     

Orthodontic bonded retainers

Retention is usually necessary following orthodontic treatment to overcome the elastic recoil of the periodontal supporting fibres and to allow remodelling of the alveolar bone. The degree of change is variable and largely unpredictable. Bonded lingual retainers have been shown to be an effective means of retaining aligned anterior teeth in the post-treatment position in the long term. Two basic designs of lingual bonded retainers are currently in use. Rigid mandibular canine-to-canine retainers are attached to the canines only. They are effective in maintaining intercanine width but less so in preventing individual tooth rotations. Flexible spiral wire retainers are bonded to each tooth in the segment, their flexibility allowing for physiological movement of the teeth. This design is more effective at preventing rotation of the bonded teeth. Failure of bonded retainers may occur at the wire-composite interface, at the adhesive-enamel interface or as a stress fracture of the wire. Failure of a retainer may lead to unwanted tooth movement. In many cases it will be possible to repair the appliance in the mouth. However, in some instances it will be necessary to replace the retainer. A disadvantage of fixed retainers is that they complicate oral hygiene procedures, and favour the accumulation of plaque and calculus. Despite this, the presence of a bonded retainer appears to cause no increase in incidence of caries or periodontal disease. Use of interdental cleaning aids is required to ensure adequate oral hygiene.