Retention Protocol Research Articles

Performance of Hawley-type retainers: a systematic review of randomized clinical trials.

Although post-treatment changes are almost inevitable, and retention has long been recognized as one of the most critical and routine problems faced by orthodontists, there remains a lack of certainty regarding the parameters of any definitive retention protocol following orthodontic treatment. To investigate the performance of the Hawley-type retainers. Search without restrictions in 15 databases and hand searching until December 2016. Randomized clinical trials comparing the performance of Hawley-type retainers to other removable appliances or comparing different Hawley-type retainers' wearing schedules. Following study retrieval and selection, data extraction and individual study risk of bias assessment using the Cochrane Risk of Bias Tool took place. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach. Finally, 10 studies were identified involving 854 individuals, followed for up to 1 year after debonding. Eight studies compared subjects using Hawley and clear thermoplastic retainers; another compared Hawley to positioner and, finally, one trial involved individuals allocated to different Hawley appliance wearing schedules. Three studies were considered as being of low, four of unclear, and three of high risk of bias. In general, few differences were observed between the Hawley and other removable retainers regarding outcomes relevant to maxillary and mandibular dental arch measurements, dental arch relationships and occlusal contacts, speech evaluation, patient reported outcomes, adverse effects, and problems related to the appliances, as well as economic evaluation related outcomes. Moreover, no differences were observed between the compared Hawley wearing schedules. Overall, the quality of the available evidence was considered low. Given the overall quality of the available evidence and the multitude of parameters, which may have affected the results of the included trials, good practice would suggest further research in the respective field in order to increase both the quantity and quality of information available. PROSPERO (CRD42015029279). No funding was received for the present systematic review.

Localised "vertical relapse" following orthodontic correction in young growing patients with cleft lip/ palate: Case studies potentially leading to a revision of the retention protocol

Localised "vertical relapse" following orthodontic correction in young growing patients with cleft lip/ palate: Case studies potentially leading to a revision of the retention protocol

The need for retention—An important consideration

Retention is a culmination of all our orthodontic knowledge. This is when we have planned, treated, and now have to maintain what has been attained. Moreover, we have to understand how we reached our goal and also be respectful of those factors wanting to disrupt a successful correction of a malocclusion. If we planned correctly and our treatment plan was executed well then retention is merely a passive process of observation and minimal adjustments. On the contrary, if the treatment did not go according to our treatment plan albeit because of the nature of the difficult malocclusion, patient compliance problems or aberrant growth interferences, it is imperative to have an excellent retention protocol in place to actively pursue our ultimate goal of a healthy and functional occlusion. This article will enlighten the reader to important factors as to why planning retention is a responsibility from the beginning of orthodontic treatment.

HIV patient retention: the implementation of a North Carolina clinic-based protocol

ABSTRACTDecreased visit attendance leads to poor health outcomes, decreased viral suppression, and higher mortality rates for persons living with HIV. Retention in care is an important factor in improving health status for people living with HIV but continues to be a challenge in clinical settings. This paper details the development and implementation of the NC-LINK Retention Protocol, a clinic-based protocol to locate and reengage out-of-care patients, as part of overall clinic retention efforts. The protocol was implemented as one of four interventions of the NC-LINK Systems and Linkages Project, a multi-site initiative funded by the HIV/AIDS Bureau and the Special Projects of National Significance. Lists of out-of-care patients who had not received HIV medical care in over nine months and did not have a future appointment were created each month. Patient navigators, case managers, and other staff then followed a standardized protocol to locate and reengage these patients in care. A total of 452 patients were identified for reengagement services. Of those, 194 (43%) returned to care, 108 (24%) had another definitive outcome (incarcerated, deceased, or relocated) and 150 (33%) were referred for additional follow-up to locate and reengage in care. In summary, 67% of patients were located through the efforts of the clinic staff. The results of this intervention indicate that it is possible to successfully integrate a protocol into the existing infrastructure of a clinic and reengage a majority of out-of-care patients into medical care.

Performance of clear vacuum-formed thermoplastic retainers depending on retention protocol: a systematic review.

We aimed at comparing the performance of vacuum-formed thermoplastic retainers (VFR) worn either full-time or part-time, in maintaining orthodontic treatment results in terms of tooth alignment, arch form and occlusion. We reviewed randomized and prospective controlled clinical trials comparing VFR wearing protocols and searched databases, without restrictions, for published and unpublished literature. The risk of bias was assessed using the Cochrane Risk of Bias tool and the overall level of certainty in the evidence following ADA methodology. 184 studies were initially identified and reduced to the 3 randomized controlled trials included in the systematic review by means of specific criteria. One study followed patients 1year into retention, and the other two for 6months. Little's Irregularity Index, intermolar and intercanine width, arch length, overjet and PAR score did not differ significantly between the patients wearing their retainers part time or full time. We observed a slight increase in the overbite in the part-time group in only one trial. With a moderate level of certainty, we found that during the observation period, full-time VFR wear is not superior to part-time, bearing in mind the potential implications for health burden, retainer longevity and cost-effectiveness, as well as patient satisfaction and compliance.

Unexpected complications associated with mandibular fixed retainers: A retrospective study.

The purposes of this retrospective study were to describe the types of unexpected complications associated with mandibular fixed retainers and to assess their prevalences and possible etiologic causes. A total of 3500 consecutive patients (1423 male, 2077 female) treated with fixed appliances and a mandibular fixed retainer as a part of the retention protocol were screened during the retention period (2008-2013) for unexpected complications. Thirty-eight subjects (12 male, 26 female; mean age, 20.7 ± 8.9 years) with unexpected complications were identified and assigned to the unexpected complications group and compared with a randomly selected control group of 105 subjects (43 men, 62 women; mean age, 29.5 ± 9.7 years) without unexpected complications. Relationships between unexpected complications and cephalometric and clinical variables were evaluated. An opposite inclination of the contralateral canines (twist effect) was found in 21 subjects. In 89.5%, the left canines were tipped buccally. A torque difference of 2 adjacent incisors (X effect) was identified in 12 patients. In 5 subjects, nonspecific complications were noted. Subjects in the unexpected complications group were significantly younger at debonding (P = 0.03) and had higher mandibular plane angles (P <0.0001) and increased pretreatment ventral positions of the mandibular incisors (P = 0.029). No differences were found between the groups with regard to treatment duration, wire type, failure rate, treatment changes in incisor proclination, or intercanine distance. Unexpected complications of mandibular fixed retainers are relatively rare. Facial divergence was identified as a possible predictor. However, the etiology is most likely multifactorial. Strong asymmetry among the patients with the twist effect suggests that the mechanical properties of retention wires may play a role and should be examined in the future.

Residents' journal review

Residents' journal review

Factors influencing fixed retention practices in German-speaking Switzerland

Several surveys evaluate different retention approaches among orthodontists, but none exist for general dentists. The primary aim of this survey was to record the preferred fixed retainer designs and retention protocols amongst general dentists and orthodontists in Switzerland. A secondary aim was to investigate whether retention patterns were associated with parameters such as gender, university of graduation, time in practice, and specialist status. An anonymized questionnaire was distributed to general dentists (n = 401) and orthodontists (n = 398) practicing in the German-speaking part of Switzerland. A total of 768 questionnaires could be delivered, 562 (73.2 %) were returned and evaluated. Descriptive statistics were performed and responses to questions of interest were converted to binary outcomes and analyzed using multiple logistic regression. Any associations between the answers and gender, university of graduation (Swiss or foreign), years in practice, and specialist status (orthodontist/general dentist) were assessed. Almost all responding orthodontists (98.0 %) and nearly a third of general dentists (29.6 %) reported bonding fixed retainers regularly. The answers were not associated with the practitioner's gender. The university of graduation and number of years in practice had a moderate impact on the responses. The answers were mostly influenced by specialist status. Graduation school, years in practice, and specialist status influence retention protocol, and evidence-based guidelines for fixed retention should be issued to minimize these effects. Based on the observation that bonding and maintenance of retainers are also performed by general dentists, these guidelines should be taught in dental school and not during post-graduate training.

Midline diastema and its aetiology--a review.

Maxillary midline diastema is a common aesthetic complaint of patients. Treating the midline diastema is a matter of concern for practitioners, as many different aetiologies are reported to be associated with it. The appearance of midline diastema as part of the normal dental development makes it difficult for practitioners to decide whether to intervene or not at an early stage. The aim of this article is to review the possible aetiology and management options which will help the clinician to diagnose, intercept and to take effective action to correct the midline diastema. The available data shows that an early intervention is desirable in cases with large diastemas. Treatment modality, timing and retention protocol depends on the aetiology of the diastema. Therefore, priority needs to be given to diagnosing the aetiology before making any treatment decisions. Clinical Relevance: This article aims to determine and evaluate the aetiology and possible treatment options of midline diastema.

Irrigation and Debridement

Irrigation and Debridement

Overcoming recruitment challenges in palliative care clinical trials.

Palliative care is increasingly viewed as a necessary component of cancer care, especially for patients with advanced disease. Rigorous clinical trials are thus needed to build the palliative care evidence base, but clinical research-especially participant recruitment-is difficult. Major barriers include (1) patient factors, (2) "gatekeeping," and (3) ethical concerns. Here we discuss an approach to overcoming these barriers, using the Palliative Care Trial (PCT) as a case study. The PCT was a 2 × 2 × 2 factorial randomized controlled trial (RCT) of different service delivery models to improve pain control in the palliative setting. It used a recruitment protocol that fused evidence-based strategies with principles of "social marketing," an approach involving the systematic application of marketing techniques. Main components included (1) an inclusive triage algorithm, (2) information booklets targeting particular stakeholders, (3) a specialized recruitment nurse, and (4) standardization of wording across all study communications. From an eligible pool of 607 patients, the PCT enrolled 461 patients over 26 months. Twenty percent of patients referred to the palliative care service were enrolled (76% of those eligible after screening). Several common barriers were minimized; among those who declined participation, family disinterest was uncommon (5%), as was the perception of burden imposed (4%). Challenges to clinical trial recruitment in palliative care are significant but not insurmountable. A carefully crafted recruitment and retention protocol can be effective. Our experience with designing and deploying a social-marketing-based protocol shows the benefits of such an approach.

Recruiting and Retaining Indigenous Farmworker Participants

There is limited information on the specific practices used to successfully recruit and retain indigenous and Latino farmworkers in research studies. This article describes the strategies used in a community-based participatory research project with indigenous agricultural workers. Participants were recruited through consulting with indigenous relatives and friends, identifying and meeting with indigenous leaders from hometown associations in countries of origin, and asking current participants to recruit fellow farmworkers. Adjustments were initiated to the second year protocol to enhance recruitment and retention. The difference in attrition rates between years one and two was statistically significant, a difference partially attributed to modifications to recruitment and retention protocol. Findings confirmed that active recruitment techniques and word-of-mouth recruitment were more effective than passive methods. Trust among academic, organization, and community partners, and shared language and culture between those doing the recruitment and the participants, contributed to sustained farmworker participation.

Retention: Type, duration and need for common guidelines. A survey of Norwegian orthodontists

To survey retention protocols and need for practical retention guidelines among orthodontists in Norway and to compare the results with similar studies in other countries. A questionnaire was mailed to all members of the Norwegian Association of Orthodontists. It included questions about their background and their current retention protocol, as well as their perceived need for common retention guidelines. The response rate was 77.7% (69.3% males and 30.7% females). The most common maxillary retainer was a combination of a fixed and removable retainer, followed by a clear thermoplastic retainer. In the mandible, a fixed retainer bonded to all anterior teeth was most common (66.4%). Retention in the maxilla lasted 2 to 3 years (34.7%) or 3 to 5 years (23.8%). In the mandible, 41.5% of the orthodontists left the retainer in place for >5 years. When retention lasted more than 3 years, 70% of the orthodontists left the responsibility for retainer checkups to the patients or the general practitioners. The main reason for choosing a certain retention protocol was clinical experience (57.4%). Only 3.5% of the orthodontists based their protocols on information from the literature. Half?of the orthodontists, significantly women, expressed a need for common retention guidelines. In Norway, bonded retainers alone were reported to be most commonly used in the mandible, while bonded retainers used in combination with a removable retainer appear to be the most commonly used appliances in the maxilla. This is similar to the most frequently used retainers in other countries, but there are disparities in duration and follow-up protocols. Most female orthodontists desire common retention guidelines.

Craniofacial Magnetic Resonance Imaging With a Gold Solder–Filled Chain-Like Wire Fixed Orthodontic Retainer

Magnetic resonance imaging (MRI) is one of the most powerful tools in diagnostic imaging. With the growing rates of orthodontic treatment, there are increasing chances of post-orthodontic treatment patients permanently wearing fixed retainers who shall undergo MRI examination.Three adolescent patients were referred for craniofacial MRI examination. All the patients had completed full orthodontic treatment with a retention protocol of permanently wearing bonded gold solder-filled wire fixed retainers. In the first 2 cases, the MRI examination was performed on a 1.5-T system and in the last case on a 3-T system.All the images achieved were of good quality and high resolution. No adverse effects were reported by the first 2 patients including no complaint of heat sensation or any other discomfort in the anterior teeth area. The third patient complained of a headache during the MRI examination.Radiologists and technicians may consider allowing performance of MRI examination using 1.5-T systems when a gold solder-filled wire fixed retainer is involved with no concern regarding the patient's health or the accuracy of the MRI scans.

P.4.e.004 The frequency of anxiety disorders in parents of children with attention deficit hyperactivity disorder

The aim of this study was to establish an accumulated strain pattern in different parts of rapid maxillary expansion appliances and relate them to different vertical growth patterns. A clinical study was conducted of 40 patients with posterior crossbite who required rapid palatal expansion.Patients (mean age, 8.48 years) were recruited and treated at the Dental Hospital of Bellvitge, Hospitalet de Llobregat, Barcelona, Spain. Strain gauges were placed on the arms of the RME hyrax screw appliance to record deformation (strain) during the expansion and the retention phases for 75 days. A finite element model was used to place the gauge at the point where the strain was most expressed. The vertical coefficient of variation was used to classify the patients by their vertical growth pattern. P = 0.05 was considered to be statistically significant.During the expansion phase, the highest values of accumulated strain were measured in the posterior part of the appliance for all facial biotypes, but these values passed to the anterior area at the end of the retention phase of the mesocephalic and brachycephalic patients. There was statistically significant difference in the strain of the posterior arms in accordance with the vertical growth pattern (P = 0.05) during the retention phase. At 75 days of retention, 61.25% of the arms had already begun to have strain dissipation.The accumulated strain pattern in the rapid maxillary expansion appliance can vary depending on the facial biotype. In the future, orthodontists should try to tailor the activation and retention protocol based on each patient's characteristics.

Skeletal class III and anterior open bite treatment with different retention protocols: a report of three cases

The treatment of skeletal class III and anterior open bite can be unstable and orthodontists frequently observe relapse. Here, we report on the management of three patients with skeletal class III profiles and open bites treated by orthodontic camouflage. Each received a retention protocol involving the use of two separate appliances during the night and day accompanied by myofunctional therapy. Long-term follow-up revealed a stable outcome.

Residents’ journal review

Residents’ journal review

Moving an incisor across the midline: A treatment alternative in an adolescent patient

A 13-year-old sought treatment for a severely compromised maxillary left central incisor and an impacted fully developed left canine. Extraction of both teeth became necessary. As the key component of the revised comprehensive treatment plan, the right maxillary central incisor was moved into the position of the left central incisor. All other maxillary teeth were moved mesially to close any gaps. Active orthodontic treatment was completed after 34 months. Frenectomy, minor periodontal surgeries, and bonded lingual retainers were used to improve aesthetics and stabilize the tooth positions. The patient was pleased with the treatment outcome. Cone-beam computed tomography provided evidence that the tooth movement was accompanied by a deviation of the most anterior portion of the median palatine suture. This observation may make relapse more likely if long-term retention cannot be ensured. Root resorption was not observed as a consequence of the major tooth movement.

Infected total hip arthroplasty treated by an irrigation-debridement/component retention protocol. A prospective study in a 12-case series with minimum 2 years’ follow-up

Treatment of infection after total hip replacement (THR) is complex and costly. Debridement with component retention is an attractive solution. Success rates in the literature vary widely (18-90%) according to patient selection criteria. The present prospective study assessed the selection criteria used in our department. A prospective study included all patients (n=210) surgically managed for infection following THR between November 2002 and December 2008. Patients underwent debridement in case of acute infection: i.e., early postoperative infection within 1 month of THR, or secondary hematogenic infection with less than 2 weeks' evolution. Beyond this deadline or in case of implant loosening, implant replacement was performed. The debridement series thus comprised 12 patients (mean age, 69 ± 11.3 years; mean evolution from contamination was 4.8 ± 3.5 days). Bacteriologically adapted antibiotherapy was administered for 6 weeks intravenously followed by 6 weeks per os. Mean follow-up was 40 ± 23 months. No patient was lost to follow-up. The success criterion was apparent eradication of infection at a minimum 2 years, defined by absence of clinical, biological or radiological signs of infection and of death attributable to infection or treatment. Where infection was suspected, hip aspiration or peroperative sampling determined recurrence (identical bacterium) or reinfection (different bacterium). There were nine cures (75%) and three failures. Mean Postel Merle d'Aubigné Score, at end of follow-up, was 17 ± 2. The three failures involved the same bacteria (two streptococci [one group B, one group G] and one Enterococcus faecalis) as implicated in the primary infection. The present results are comparable to those in the literature but poorer than for implant exchange. The technique remains, however, an interesting alternative, allowing less complex surgery and lower cost. Patient selection criteria need refining so as to increase success rates with this technique. Level IV; prospective non-randomized non-comparative study.

Management of an Adult with Spaced Dentition, Class III Malocclusion and Open-bite Tendency

The aim of this case report was to present the orthodontic treatment of an adult with spaced dentition, Class III malocclusion, and open-bite tendency. A 28.4-year-old adult woman was concerned about the unesthetic appearance of her spaced dentition localized at both upper and lower arches while smiling. She had a mild tongue thrust, hypertropic upper frenum, and mild speech difficulty while pronouncing "s". Her profile was straight with prominent lips. Molar relationship was Class III on both sides. Anterior teeth were in an end-to-end relationship. Lower dental midline was deviated to the left side. Cephalometric analysis revealed a skeletal Class III relationship with hyperdivergent facial pattern. The treatment plan included myotherapeutic exercises for the tongue thrust habit and a diagnostic set-up for closure of diastemas. A strict retention protocol was followed combined with gingivoplasty, fiberotomy, and frenectomy procedures. All spaces were closed successfully, adequate overbite and overjet relationships were obtained, and tongue thrust habit and speech difficulty while pronouncing "s" were eliminated. Clinical and cephalometric results indicated the maintenance of the treatment outcome at 6-months post-retention period.