The origin and evolution of the Hawley retainer for the effectiveness to maintain tooth position after fixed orthodontic treatment compare to vacuum-formed retainer: A systematic review of RCTs

Abstract

This systematic review aims to summarize the effectiveness and patient compliances of Hawley retainer (HR) compared to vacuum-formed retainers (VFR) and provide the best clinical evidence related to the use of these retainers for maintaining tooth position following fixed orthodontic appliance so that orthodontists can decide which are the most appropriate methods and retainers to use for each individual patient. We searched the Cochrane Library, EMBASE, PubMed, Web of Science, Orthodontic journals, and relevant articles for eligible studies. Only RCTs studies were included; no restrictions on publication status or language were applied until May 20, 2019. We collected the study related to the effectiveness of these two retainers. Furthermore, patient-reported outcomes, survival time, cost-effectiveness, occlusal contact, and adverse effect on gingival and speech articulation were also collected. We finally included fifteen articles in the qualitative synthesis. No significant difference was observed in patients who had worn the retainers on a full-time or part-time, basis in both HR and VFR in terms of the change in arch widths and arch lengths. VFR appeared to be better at preventing relapses of incisor irregularity than HR. Patient satisfaction with VFR was higher than with HR, and there was no difference in survival rates for both types of retainers. In terms of cost-effectiveness, occlusal contacts, and gingival health, there were a few studies with limited evidence to compare these retainers. For speech articulation, VFR was less affected in comparison to HR. We found that wearing VFR provides better relapse prevention of incisor irregularity than HR in both arches, indicating their usefulness in clinical practice. However, there is no evidence to show that the pattern of time duration wearing these retainers provides excellent stability. Overall, there are insufficient high-quality RCTs to provide additional evidence, and further high-quality RCTs research is needed.