Abstract
The aim of this study was to assess, correlate, and compare users' perceptions and preference related to maxillary removable retainers. Volunteers were recruited to use four retainer types: conventional wrap-around (CWA), wrap-around with an anterior opening (OWA), "U" wrap-around (UWA), and clear thermoplastic retainer (CT). The main outcomes were the volunteers' perceptions, evaluated with a 100-mm visual analogue scale, and their preferred retainer. The retainers were used for 21 days each (washout intervals of 7 days). Nineteen volunteers (27 ± 4.53 years) were randomly divided into four groups that used the four retainers, but with a different sequence. Perceptions were evaluated immediately after the use of each retainer and the preference at the end of the research. Repeated measures ANOVA and Friedman tests with post-hoc Tukey's test (intergroup comparisons), and Pearson and Spearman analyses (correlations between perceptions) were applied. The WA retainers did not significantly differ among themselves. The CT was rated significantly worse in speech (p ≤ 0.001), discomfort (p < 0.001), and occlusal interference (p < 0.001), and did not significantly differ from the others in esthetics. Users preferred significant more the WA retainers in comparison with the CT retainers. The occlusal interference caused by the CT was positively correlated to other perceptions, such as changes in speech and discomfort. WA retainers presented similar preference and perceptions, but were significantly better than the CT. The CT occlusal coverage appeared to be the primary cause of its rejection.
Highlights
Several types of orthodontic retainers have been described in the literature, but there is no scientific support for the choice of the best device in clinical practice, or significant evidence that a specific retainer design has a better function than another.[1]
Retainer Sequence: 1st retainer used: clear thermoplastic retainers (CT) 2nd retainer used: conventional wrap-around (CWA) 3rd retainer used: U” wrap-around (UWA) 4th retainer used: OWA Each retainer was used during 21 days, with a washout period of 7 days after each appliance
Retainer Sequence: 1st retainer used: CWA 2nd retainer used: UWA 3rd retainer used: OWA 4th retainer used: CT Each retainer was used during 21 days, with a washout period of 7 days after each appliance
Summary
Several types of orthodontic retainers have been described in the literature, but there is no scientific support for the choice of the best device in clinical practice, or significant evidence that a specific retainer design has a better function than another.[1]. Discomfort of the retainer is reported by 28% of patients as a reason not to use them.[4,5] Data show that clear thermoplastic retainers (CT) are more comfortable than wrap-around retainers (WA),[6,7] or that comfort does not differ between CT and Hawley retainer.[8] Speech interference is an important aspect of comfort, because components of the retainer are located on the lingual surface of teeth and palate, impairing tongue movements during speech.[9,10] Between 10 and 15% of patients report that speech difficulty is a reason not to use the appliance.[4] Esthetics is relevant, since 17.4 and 7.2% of patients reported to be ashamed to use Hawley and CT retainers, respectively This difference corroborates the fact that CTs are more esthetic than other removable retainers.[6,8] On the other hand, WA is better during chewing in comparison with the CT.[6]
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