Abstract
Background: The role of orthodontic retainers in maintaining stability after orthodontic treatment, and side effects associated with orthodontic retainers have not been well established. Objective: To investigate whether fixed retainers improve stability after orthodontic treatment, or increase the risk of side effects on the teeth and periodontium in comparison with removable retainers, no retainer, or fiberotomy. Methods: A systematic literature search was conducted in PubMed, Embase, the Cochrane Library, HTAdatabases of NHS Centre for Reviews and Dissemination, Swedish Council on Health Technology Assessment (SBU), Norwegian Knowledge Centre for the Health Services (NOKC), Danish Health and Medicines Authority, and reference lists. Data extraction was verified by at least two authors. The quality of evidence was rated. Meta-analysis was not suitable. Results: Two systematic reviews (SR), two randomized controlled trials (RCT), four non-randomized controlled studies (CT), and five case series were included. The SRs were well reported, but addressed issues that differed from the addressed question, or did not add to the identified primary studies. Both RCTs and CTs had study limitations, and problems with directness and/or precision. None of the studies compared fixed retainers to fiberotomy. Conclusion: According to the literature there is only low quality of evidence, that treatment stability may be improved by a fixed retainer after orthodontic treatment in comparison with a removable retainer, or no retainer (GRADE ⊕⊕ââ). Furthermore, there is very low quality of evidence, whether periodontal outcomes, dental caries prevalence, or presence of calculus differ between the various types of retainer regimens (GRADE ⊕âââ).
Highlights
Orthodontic treatment in general accomplish well-aligned teeth and a good occlusion
According to the literature there is only low quality of evidence, that treatment stability may be improved by a fixed retainer after orthodontic treatment in comparison with a removable retainer, or no retainer (GRADE ⊕⊕⃝⃝)
There is very low quality of evidence, whether periodontal outcomes, dental caries prevalence, or presence of calculus differ between the various types of retainer regimens (GRADE ⊕⃝⃝⃝)
Summary
Orthodontic treatment in general accomplish well-aligned teeth and a good occlusion. After the teeth have been orthodontically moved into the new position, it takes approximately a year for the surrounding tissues to adapt [1]. If the teeth are not retained during this period a relapse usually occurs, meaning that the teeth return towards their original position. Studies have demonstrated that most of the irregularities appear during the first two years post treatment [2,3]. In addition to the relapse after orthodontic treatment there is a continuous risk that the teeth change position throughout life due to inheritance/genetics and aging processes [4]. A review article from 2006 concludes that most malocclusions are unstable after treatment in the long-term and that stability is unpredictable at the individual level [5]. The role of orthodontic retainers in maintaining stability after orthodontic treatment, and side effects associated with orthodontic retainers have not been well established
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