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.     

A bonding technique for fixed maxillary retainers

Abstract

Maintaining incisor alignment is an important goal of orthodontic retention and can only be guaranteed by placement of an intact, passive and permanent fixed retainer. Here we describe a reliable technique for bonding maxillary retainers and demonstrate all the steps necessary for both technician and clinician. The importance of increasing the surface roughness of the wire and teeth to be bonded, maintaining passivity of the retainer, especially during bonding, the use of a stiff wire and correct placement of the retainer are all discussed. Examples of adverse tooth movement from retainers with twisted and multistrand wires are shown.     

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.     

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.     

Comparison of Incisor Mobility after Insertion of Canine-to-Canine Lingual Retainers Bonded to Two or to Six Teeth A Clinical Study

BACKGROUND: Fixed appliance therapy often extends over several years. Debonding is warmly welcomed and is often seen by the patient as the end of treatment. Yet both patients and parents often underestimate the importance of the subsequent retention period and the speed at which negligence in this treatment phase results in relapse. Bonded retainers guarantee excellent long-term stability at least while they are in situ. The reliable attachment of lingual retainers with modern bonding techniques has led to widespread application of this retention method. The present study investigated its influence on tooth mobility and on the damping properties of the periodontal tissue, by means of a dynamic measuring method (Periotest). PATIENTS AND METHOD: For this purpose two groups with mandibular bonded retainers and one control group were formed. The control group wore removable retention appliances. In all groups, active treatment with fixed appliances had been completed at least half a year before baseline. RESULTS: The results showed that bonded retainers had a negative impact on the damping properties of the periodontal tissue and thus in the broader sense on tooth mobility. Tooth mobility decreased with the number of teeth to which the retainer was bonded but remained, as in the control group, within the physiologic range.     

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.     

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.     

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 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.     

常用正畸保持器的对比研究

［摘要］　正畸治疗结束后仍有很多因素容易导致错合畸形的复发,所以保持器的佩戴是必须的。临床上常用的保持器有：压膜保持器及其改良式、Hawley保持器和舌侧固定保持器。本文从保持效果、患者接受度及依从性、保持器对牙周组织的影响这三个方面对各个类型的保持器做一对比,期望对医师临床选择保持器有指导意义。     

正畸舌侧保持器和透明压膜保持器对牙周组织的影响

目的：研究正畸舌侧保持器和透明压膜保持器对下前牙舌侧牙周健康的影响。方法选择新疆医科大学第二附属医院固定矫治结束后患者30人（男14,女16）,随机分成2组,每组15人。A组戴用舌侧固定保持器,B组戴用透明压模保持器。于戴入后1周、1个月、3个月和6个月分别检查记录下前牙的舌侧菌斑指数（PI）、牙龈指数（GI）、牙石指数（CI）和硫化物水平（SUL）,并作统计学分析。结果保持器戴入6个月后与1周时比较,2组PI、CI和SUL指数均显著增加,差异有统计学意义（P<0.05）,但2组的GI差异无统计学意义（P>0.05）。CI在3个月时A组显著大于B组（P<0.05）;SUL在6个月时B组显著大于A组（P<0.05）。结论保持器使口腔自洁作用减弱,对牙周组织有一定的影响,且硫化物引起的口臭影响社交,6个月时应进行必要的刮治去除菌斑和牙石,维护牙周健康。     

The effect of orthodontic treatment on periodontal bone support in patients with advanced loss of marginal periodontium

Loss of periodontal bone support was examined in 24 patients orthodontically treated for pathologic tooth migration in one jaw. Prior to orthodontic realignment of the front teeth, the patients had received periodontal treatment. Active appliance therapy was not given until inflammation was eliminated and the patients demonstrated a high level of oral hygiene. A 0.020-inch spiral wire was bonded to each adjacent realigned tooth for retention. The levels of marginal bone of the front teeth in the treated and untreated jaws were measured in percentage of "maximum bone height" on periapical radiographs made before and after treatment. Relapse was evaluated from study models. Mean averaged loss of periodontal bone from the period before to after orthodontic treatment was 4.94% (SD 4.03, P less than 0.001) and 2.69% (SD 3.66, P less than 0.001) of the treated and untreated front teeth, respectively. The mean difference in averaged loss between treated and untreated front teeth was 2.24% (SD 3.28, P less than 0.01). The majority of the sites showed little or no loss. Maximum loss (35%) was observed in one site only. No association was found between initial bone loss and bone loss during orthodontic treatment. Spaces from 0.1 to 1.8 mm opened up adjacent to the retainer in seven patients. Relapse within the retained segment was associated with failures of the retainer. Of the 19 patients who had been in retention for more than 4 months (mean 16.0, SD 12.1), ten failures were recorded in nine patients. The failure mode was loosening of one or two teeth between wire and composite.     

应用舌侧固定保持器固定松动前牙的临床观察

目的观察舌侧固定保持器固定松动前牙的临床效果。方法选择25例因牙周病或创伤导致前牙松动的患者,首先进行龈上洁治及龈下刮治等牙周基础治疗并调,治疗3个月后前牙仍松动者采用直径0.0195英寸三股弹性不锈钢麻花丝及流动树脂进行尖牙到尖牙间固定,每3个月复诊,根据牙周状况选择相应治疗方法(如洁治和/或刮治甚至牙周手术等),观察12个月。采用临床疗效评定标准以及问卷调查方式进行疗效评估。结果 25例患者中有2例因树脂部分脱落需要重新粘接,所有患者观察期间松动牙均变得稳固,咀嚼效率明显提升,治疗1年内的成功率为92%。问卷调查显示患者对舌侧固定保持器固定效果满意。结论舌侧固定保持器作为牙周夹板固定松动前牙效果可靠、操作简单、美观经济,适合在基层医院推广。     

Clinical comparison of a multistranded wire and a direct-bonded polyethylene ribbon-reinforced resin composite used for lingual retention.

OBJECTIVE: The reliability of posttreatment canine-to-canine retention with resin composite retainers reinforced with plasma-treated woven polyethylene ribbons was compared to the reliability of directly bonded, multistranded wire retainers. METHOD AND MATERIALS: This prospective study was based on an assessment of 20 consecutive patients (eight women and 12 men with a mean age of 22.4 years) who required a fixed canine-to-canine retainer after undergoing orthodontic treatment. The type of retainer used was randomized for each patient. A follow-up examination was carried out once every 3 months. The length of time the retainers stayed in place without resin fracture or loosening from the teeth at one or more points was evaluated. The study's endpoint was 24 months after the retainer had been bonded. RESULTS: The ribbon-reinforced retainer remained in place for an average of 11.5 months, and the multistranded wire for a mean of 23.6 months. The difference was statistically significant. CONCLUSION: In terms of reliability for permanently fixed orthodontic retention from canine to canine, the direct-bonded multistranded wire is superior to the plasma-treated polyethylene woven ribbon and resin retainer.     

An All Porcelain Lingual Bonded Retainer: A Case Study

In recent years, resin bonded metal retainers have been used to replace teeth in a conservative manner. In addition, porcelain laminates or veneers have been used in esthetic dentistry on single teeth in areas that previously dictated reductions of tooth structure. This paper describes a method of replacing a missing lower anterior tooth with an all porcelain bonded retainer.     

An all porcelain lingual bonded retainer: a case study

In recent years, resin bonded metal retainers have been used to replace teeth in a conservative manner. In addition, porcelain laminates or veneers have been used in esthetic dentistry on single teeth in areas that previously dictated reductions of tooth structure. This paper describes a method of replacing a missing lower anterior tooth with an all porcelain bonded 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.     

The multistrand retainer and splint

A method is presented for the accurate application of the modified 3-3 retainer of multistrand wire described by Zachrisson . This lingual retainer or splint is noninvasive of dental tissue and is reversible. Wire breakage does not appear to occur, and the slightly elastic properties of the wire allow a physiologic mobility of the teeth, which is of advantage in the periodontal patient. The only breakage that may occur is of the composite bond, although this appears to be less than with bonded brackets, but repair is quick and simple. The present method is now offered to add simplicity, speed, and accuracy to the important advantages already enjoyed, widening the scope for employment of this type of retainer to as many as eight or ten teeth in a series and, perhaps more significantly, to the maxillary anterior teeth, even where a deep bite exists. The value of the method is also seen when an active orthodontic appliance is removed and retention or splinting is required within an hour or two, as for the patient who is concurrently undergoing periodontal treatment.     

2种舌侧固定保持器与活动保持器对牙周健康的影响

目的观察麻花丝舌侧固定保持器、超强纤维舌侧固定保持器和Hawlay’s活动保持器对牙周组织的影响。方法选择36例固定矫治结束的正畸患者,去矫治器,全口洁治,牙面抛光,测量牙龈指数、菌斑指数、牙石指数为基线水平,随机分成3组,分别戴入Hawlay’s活动保持器、麻花丝舌侧固定保持器和超强纤维舌侧固定保持器。测量1周后及1、3、6个月后的牙周指数。结果麻花丝和超强纤维两种舌侧固定保持器的临床牙周指数明显高于Hawlay’s活动保持器,其中麻花丝固定保持器对牙周指数的影响高于超强纤维固定保持器。结论固定保持器对牙周健康的影响大于活动保持器,其中麻花丝舌侧固定保持器的影响更为明显。     

Torque resistance of different stainless steel wires commonly used for fixed retainers in orthodontics

Objective: Movements of teeth splinted by fixed retention wires after orthodontic treatment have been observed. The aetiological factors for these movements are unknown. The aim of this in vitro study was to compare the resistance to torque of different stainless steel wires commonly used for fixed retainers in orthodontics. Materials and Methods: Torquing moments acting on a retainer wire were measured in a mechanical force testing system by applying buccal crown torque to an upper lateral incisor in both a 3-teeth and in a 2-teeth setup. Seven stainless steel wires with different shape, type (plain, braided, coaxial, or chain) and dimensions were selected for this study. Results: For a torquing angle of 16.2° in the 3-teeth setup torsion moments can vary between 390?cNmm and 3299?cNmm depending on the retainer wire. For the 2-teeth setup the torsion moments are much smaller. Exposure to the flame of a butane-gas torch for 10 seconds to anneal the wire reduces the stiffness of the retainer wire. Conclusions: Clinicians must select wires for fixed retainers very carefully since the difference in resistance to torque is large. A high level of torque control can be achieved with a plain 0.016?×?0.016-inch or a braided 0.016?×?0.022-inch stainless steel wire. A tooth attached by a retainer wire to only one neighbouring tooth is less resistant to torque than a tooth connected to two neighbouring teeth. Annealing a retainer wire with a flame reduces the stiffness of the wire markedly and can lead to a non-uniform and non-reproducible effect.