ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Orthodontic Retention with Fixed Mandibular Retainers is not Detrimental to Periodontal Health in Patients with Good Oral Hygiene
Clinical Question Does retention with mandibular fixed retainers have detrimental effects on periodontal health?
Clinical Bottom Line Mandibular fixed retainers are not detrimental to periodontal health. Retainers bonded only to the mandibular canines may lead to less retention of plaque and calculus.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 17974536 Pandis/200764 patients (male and female) with an average age of 25 wearing the same braided mandibular lingual fixed retainer.Controlled Clinical Trial
Key resultsIn this clinical trial, the 64 patients were divided into two groups, a long-term group and a short term group. The long-term group had 32 patients who wore fixed retainers for more than 9 years. The short-term group had 32 patients who wore fixed retainers for only 3-6 months. At their recall, both groups were seen by a periodontist to view their plaque index (PI), gingival index (GI), calculus index (CI), probing depth (PD), marginal recession (MR), and bone level (BL) of their mandibular anterior teeth. No statistically significant differences were evident between the two groups for PI and GI. Statistically significant differences between the two groups were evident for the CI, PD and MR (p<0.05), with the long-term group retaining more calculus over time. Overall, long-term retention with mandibular fixed retainers can be associated with increases calculus formation, recession, and pocket depth, but has little to no effect on plaque index, gingival index, or bone level.
#2) 18174074Booth/200860 female and male patients with canine-to-canine fixed mandibular retainers in place for a minimum of 20 years.Case Control Study
Key resultsIn this case-control study, 60 patients with fixed mandibular retainers over 20 years were recalled. Forty-five of those patients still had their retainers, while 15 patients had their retainers removed after a period of 5-25 years. GI scores were measured on both the mandibular facial and lingual surface of each tooth from canine to canine. No statistically significant differences were evident between the two groups, and the gingival index data indicated no negative effect on periodontal health from long-term retention of a mandibular fixed retainer.
Evidence Search A PubMed search was conducted using the terms: “periodontal health” and “orthodontic bonded retainers”
Comments on
The Evidence
In the controlled clinical trial, both groups had mandibular fixed retainers made with braided 0.195 inch wire, for different periods of time. Although patients were instructed to maintain proper oral hygiene and visit their dentist annually, their compliance was not stated. The results suggest that long-term retention with mandibular-bonded retainers is associated with some changes in the periodontal condition. However, it is unclear if these periodontal changes can be attributed to the presence of the retainer, or if other factors such as oral hygiene, systemic conditions, smoking etc. were responsible. The authors do not mention if the retainer was bonded to all the lower anterior teeth, or the canines only. These differences in design could explain the different results between the two studies. The case-control study evaluated 60 patients with bonded fixed mandibular retainers. All patients received retainers fabricated from either 0.025 or 0.032 inch steel wire, bonded only to the mandibular canines. With this particular design, the authors noted no negative effect on periodontal health. However, the braided wire retainer design (bonded to all the lower anterior teeth) was not used in this study, and thus these findings cannot be extrapolated to endorse their use.
Applicability The results from these studies are applicable to post-orthodontic patients with good oral hygiene. It appears that fixed retainers bonded only to the mandibular canines may present lower risk of plaque and calculus retention. Compliance with oral hygiene protocols is an important factor to emphasize.
Specialty/Discipline (Orthodontics)
Keywords Orthodontics, Mandibular Fixed Retainers, Periodontal Health
ID# 2696
Date of submission: 04/02/2014spacer
E-mail quachl@livemail.uthscsa.edu
Author Linh Quach
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Clarence C. Bryk, DDS, MS
Faculty mentor/Co-author e-mail brykC@uthscsa.edu
Basic Science Rationale
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