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Title The Effect of Mandibular Fixed Orthodontic Retainers on The Development of Dental caries
Clinical Question In a 24-year-old female with good oral hygiene, does a mandibular lingual bar placed after orthodontic treatment increase the risk of dental caries when compared to post-orthodontic retention without a lingual bar?
Clinical Bottom Line Mandibular fixed orthodontic retainers do not lead to an increased risk for the development of dental caries. (See Comments on the CAT below)
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) 9386336 Artun/1997Patients (n=49) were classified into eight strata based on age, gender, and gingival condition at the lingual aspect of the mandibular anterior teeth. From each stratum the patients were randomly assigned to four test groups. Each group received one of four retainers: (1) 1.Thick plain wires bonded only to the canines (n = 11), (2) 2.Thick spiral wire bonded only to the canines (n = 13), (3) 3.Thin, flexible spiral wire bonded to each tooth (n = 11), and (4) 4.Removable retainers (n = 14)RCT
Key resultsNo visible plaque accumulation was observable along the lingual wire. In fact, at the 3-year follow-up, less plaque was evident at the gingival margin, when compared to the orthodontic debond appointment (P <.05). Moderate accumulation of calculus was seen gingival to the wire at five, six and 11 sites, respectively, in three of the 11 patients with retainers of thick plain wire. Two sites in one of the 13 patients with thick spiral wires and 11 sites in one of the 11 patients with retainers of thin, flexible spiral wire, also exhibited moderate calculus accumulation. Although plaque and calculus accumulated along some of the patients’ wires, there was no evidence of dental caries after 3 years.
#2) 21275316Cerny/2010Patients (n=14) had fixed permanent retainers on the mandibular arch and 37 patients had removable mandibular retainers. Each patient had worn retainers for over 15 years.Retrospective Case-Control
Key resultsPlaque index was good for 40% of the fixed retainer group and 80% of the removable retainer group. On the mandibular lingual surfaces, the calculus index was rated very good or good for 80% of the fixed retainer group and 100% of the removable group (p = .259). No decay or decalcification was evident in either group.
Evidence Search Search \"Dental Caries\"[Mesh]Search \"Orthodontic Retainers\"[Mesh]
Comments on
The Evidence
In this prospective study (Artun 1997) the groups were stratified and then randomly assigned to different interventions. At baseline, all subjects had received similar treatment,and were debonded, and provided the same oral hygiene instructions before placement of the lingual wire. Eight of the 35 bonded retainers (22.9%) failed, so >90% completion was not achieved, despite adequate compliance. The four groups were treated with different wires, but were evaluated by the same examiner before wire placement and 3 years following placement. Limitations of the study include the absence of blinding, and the low sample size per group. No bias or competing interests were discernable. In the second article, the average period of retention was at least 15 years; however, the sample size was small (n=14). The gender distribution was not stated. Measurement reliability and validity was established by comparing measurement data with that obtained by two pairs of blinded, independent examiners (two orthodontists and two periodontists).
Applicability Both of these articles are applicable to any dentist’s patients, because there is a large population of young post-orthodontic female subjects with mandibular fixed retainers. Both studies indicated that there was no increased risk of dental caries in patients with a mandibular fixed lingual retainer. However, there was an increase in plaque and calculus accumulation relative to the control group. This carries special implications regarding oral hygiene control in patients with lingual retainers.
Specialty/Discipline (General Dentistry) (Orthodontics) (Periodontics)
Keywords orthodontics, lingual retainer, caries
ID# 535
Date of submission: 03/26/2010spacer Revised: 05/25/2011
E-mail elamm@livemail.uthscsa.edu
Author Maegan Elam
Co-author(s) e-mail
Faculty mentor/Co-author John D. Rugh, PhD & Vishnu Raj, DDS
Faculty mentor/Co-author e-mail rugh@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments and Evidence-Based Updates on the CAT
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by Diego Bonilla (San Antonio, TX) on 04/20/2012
After a PubMed search on this topic April 2012, I found publications: PubMed IDs 15789987 , 9768460. This literature reiterate the same results published in this CAT.

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