Title	Stability Is Improved When Lower Fixed Lingual Retainers Are Bonded to All Six Anterior Teeth
Clinical Question	For post-orthodontic patients with lower fixed lingual anterior retention, is stability improved when all six teeth are bonded compared to bonding canines only?
Clinical Bottom Line	For post-orthodontic patients with fixed mandibular anterior retention, stability is improved when all six teeth are bonded compared to when only canines are bonded. This is supported by a systematic review of the literature including five studies and 333 patients. With many patients and practitioners opting for fixed lower lingual retention to improve compliance and prevent relapse, it is imperative that the proper bonding procedure is established.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) PMID 31536378 Moda/2019 333 post-orthodontic adolescents and young adults in 5 studies Systematic review of non-randomized trials Key results Two of the five trials showed that retainers bonded to all six teeth resulted in better stability (p<.05); the other three trials showed no significant difference in stability between the two retention methods. Due to heterogeneity between the studies, especially in regard to wire thickness used, a meta-analysis was not performed.
Evidence Search	“Fixed lower retainer bonding”
Comments on The Evidence	Validity: While two of the clinical trials were randomized, three were not. In addition, a high risk for bias was assessed in two of the five included trials. Follow-up times were highly variable (between 1 and 9 years) among the studies, as were the type of retainer wires used. In one study (Artun et al., 1997) that showed no difference in stability between the two retention methods, patients with wire breakages were not included in the data analysis; if the rates of loss to follow up differed between the retention groups, this would have biased the study results. It is also important to note that none of the five studies included a power analysis to determine appropriate sample size. Perspective: While this evidence seems to suggest that there is an advantage to bonding all six teeth in terms of increased stability, there were also multiple shortcomings with the research that was included in the review. More evidence is needed to definitively answer the question of whether lower lingual retainers should be bonded to all six anterior teeth or just canines.
Applicability	For post-orthodontic patients, bonding fixed lingual retainers to all six mandibular anterior teeth may decrease relapse compared to bonding to canines alone. However, the decision of how to bond should be made on a case-by-case basis, because bonding to all six teeth creates an obvious hygiene challenge.
Specialty	(General Dentistry) (Orthodontics)
Keywords	Fixed lower retainer bonding canines anterior orthodontics
ID#	3427
Date of submission	01/25/2020
E-mail	kauffmane@livemail.uthscsa.edu
Author	Erin Kauffman
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Brent Callegari
Faculty mentor e-mail	Callegari@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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available