Retention Protocols Research Articles

A Survey of Retention Practices and Protocols Followed Among Orthodontists in India.

Background:There are different types of retention protocols and retainers prescribed by the orthodontists across the globe.Aim:The study was conducted with the aim of evaluating the retention practices followed by the orthodontists in India.Materials and Methods:A questionnaire link with a set of 29 questions was generated using the Google Forms App. The questions related to the basic demographic details followed by retention procedures in maxilla and mandible as related to the type of retainer, duration of wear, retention check-ups, and adjunctive procedures being followed. The Google forms were mailed to 1147 registered life members of the Indian Orthodontic Society.Results:The overall response rate was 20.1%. On receiving of the completed questionnaires, the data were statistically analyzed. Dual mode of retention, fixed retainers with removable thermoplastic resin (TR)/vacuum formed retainers (VFR) (24%) were the common type of retention in maxilla whereas the fixed bonded retainer (44.5%) was more commonly used in mandible. Full time wear of maxillary retainer was recommended by 85.2% of the respondents. The recommended duration of the fixed retainer is for 2–5 years (41.9%).Conclusion:A trend towards more dual retention instead of solitary removable or solitary fixed retention, more VFR instead of Hawley-type retainers has been demonstrated in the survey.

Orthodontic retention protocols: an evidence-based overview.

In view of the diversity of orthodontic presentations, a single optimal retention protocol does not exist, with approaches tailored based on pre-treatment characteristics, treatment-induced changes and general patient characteristics. However, orthodontic practitioners should be responsive to the best available evidence to formulate optimal retention protocols in terms of appliance type, design and regimen, in particular. Based on a comprehensive search strategy, we discuss fundamental aspects concerning orthodontic retention of particular interest both to orthodontists and general dentists. These include stability and periodontal outcomes, cost-effectiveness, patient experiences, survival and failure rates of retainers, and the duration of retention.

A Novel Behavioral Intervention for Rural Appalachian Cancer Survivors (weSurvive): Participatory Development and Proof-of-Concept Testing

BackgroundAddressing the modifiable health behaviors of cancer survivors is important in rural communities that are disproportionately impacted by cancer (eg, those in Central Appalachia). However, such efforts are limited, and existing interventions may not meet the needs of rural communities.ObjectiveThis study describes the development and proof-of-concept testing of weSurvive, a behavioral intervention for rural Appalachian cancer survivors.MethodsThe Obesity-Related Behavioral Intervention Trials (ORBIT) model, a systematic model for designing behavioral interventions, informed the study design. An advisory team (n=10) of community stakeholders and researchers engaged in a participatory process to identify desirable features for interventions targeting rural cancer survivors. The resulting multimodal, 13-week weSurvive intervention was delivered to 12 participants across the two cohorts. Intervention components included in-person group classes and group and individualized telehealth calls. Indicators reflecting five feasibility domains (acceptability, demand, practicality, implementation, and limited efficacy) were measured using concurrent mixed methods. Pre-post changes and effect sizes were assessed for limited efficacy data. Descriptive statistics and content analysis were used to summarize data for other domains.ResultsParticipants reported high program satisfaction (acceptability). Indicators of demand included enrollment of cancer survivors with various cancer types and attrition (1/12, 8%), recruitment (12/41, 30%), and attendance (median 62%) rates. Dietary (7/12, 59%) and physical activity (PA; 10/12, 83%) behaviors were the most frequently chosen behavioral targets. However, the findings indicate that participants did not fully engage in action planning activities, including setting specific goals. Implementation indicators showed 100% researcher fidelity to delivery and retention protocols, whereas practicality indicators highlighted participation barriers. Pre-post changes in limited efficacy outcomes regarding cancer-specific beliefs and knowledge and behavior-specific self-efficacy, intentions, and behaviors were in desired directions and demonstrated small and moderate effect sizes. Regarding dietary and PA behaviors, effect sizes for fruit and vegetable intake, snacks, dietary fat, and minutes of moderate-to-vigorous activity were small (Cohen d=0.00 to 0.32), whereas the effect sizes for change in PA were small to medium (Cohen d=0.22 to 0.45).ConclusionsweSurvive has the potential to be a feasible intervention for rural Appalachian cancer survivors. It will be refined and further tested based on the study findings, which also provide recommendations for other behavioral interventions targeting rural cancer survivors. Recommendations included adding additional recruitment and engagement strategies to increase demand and practicality as well as increasing accountability and motivation for participant involvement in self-monitoring activities through the use of technology (eg, text messaging). Furthermore, this study highlights the importance of using a systematic model (eg, the ORBIT framework) and small-scale proof-of-concept studies when adapting or developing behavioral interventions, as doing so identifies the intervention’s potential for feasibility and areas that need improvement before time- and resource-intensive efficacy trials. This could support a more efficient translation into practice.

The effectiveness of Hawley and vacuum-formed retainer usage protocols on the stability of fixed orthodontic treatment results

Abstract Objectives: To compare the effectiveness of Hawley and vacuum-formed retainer (VFR) usage protocols on post-treatment stability. Methods: The inclusion criteria included patients who initially presented with mild or moderate pretreatment crowding and a Class I or Class II malocclusion. The retention protocols were defined as Group 1: Hawley retainers, 12 months full-time wear; Group 2: Hawley retainers, six months full-time, six months night-only wear; Group 3: VFR, 12 months full-time wear; Group 4: VFR, six months full-time, six months night-only wear. Study models were taken prior to treatment (T0), after debonding (T1), six months after debonding (T2), and 12 months after debonding (T3). Little’s irregularity index, intercanine and intermolar widths, arch length, overjet and overbite were measured. Repeated measure ANOVA with one-fixed factor, one-way ANOVA, Kruskal Wallis or Welch’s heteroscedastic F-test, were applied. Results: Fifty-eight patients were analysed at T2, and 52 patients at T3. There was no significant difference between the effectiveness of a Hawley appliance or VFRs on arch stability after six months. The intercanine width changes from the sixth to 12th month of retention showed a significant difference (p = 0.016) between Group 2 (-0.38 ± 0.58 mm) and Group 3 (0.39 ± 0.94 mm). Conclusions: Different wearing regimens of a Hawley appliance or VFR retainers did not reveal any difference determined by Little’s irregularity index. Full-time usage of VFRs provided better intercanine width retention than night-only Hawley retainer wear in the maxillary arch.

Resident Commentary: Is There a Significant Difference in Relapse and Complication Rate of Surgically Assisted Rapid Palatal Expansion Using Tooth-Borne, Bone-Borne, and Orthodontic Mini-Implant-Borne Appliances (Ploder et al, 2020)?

Resident Commentary: Is There a Significant Difference in Relapse and Complication Rate of Surgically Assisted Rapid Palatal Expansion Using Tooth-Borne, Bone-Borne, and Orthodontic Mini-Implant-Borne Appliances (Ploder et al, 2020)?

A SURVEY OF RETENTION PROTOCOLS AND TRENDS PRACTICED BY ORTHODONTISTS FROM CENTRAL INDIA: AN OBSERVATIONAL STUDY

Introduction: Retention is necessary following orthodontic treatment to prevent relapse of the final occlusal outcome. So the aim of the study is to evaluate retention procedures and protocols which are used by the Orthodontists from Central India. Methodology: In this study a total of 128 Orthodontists practicing from Central India were sent questionnaire which consisted of questions regarding different types of conditions or orthodontic treatment and the choice of retainer they would prefer.the questions were so designed to know which retainer would they prefer among both the arch. Also to know which type of retainer (removable or fixed) they prefer for certain conditions. Result:A combination of fixed and removable retainers were commonly used by Orthodontists in both the dental arches, except after expansion of the upper arch when removable retainer was preferably used, and after the correction of rotation of mandibular anterior teeth where in Orthodontists chose fixed retainer over removable. Hawleys retainer was most preferred for upper arch (71.9%), Vaccum formed retainer for the lower arch (49.2%). In the fixed retainer bonded to all the anteriors was most preferred (76.6%) in the lower arch while bonded to Central Incisors in the upper arch (80.5%). Conclusion: The Hawley appliance was a predominant removable retainer. The bonded wire from canine to canine was the most frequent fixed retainer. Evidence-based guidelines are required for drawing a common retention protocol.

Retention Protocols and Factors Affecting Retainer Choice among Iraqi Orthodontists.

Background To identify the most common retention protocols practiced by Iraqi orthodontists using a specially designed e-survey. Furthermore, this study aimed to assess the effect of sociodemographic factors on the participant's choice. Methods Two hundred and twenty-five questionnaires with 23 multiple choice questions were sent to members of the Iraqi Orthodontic Society. The questionnaire was organized into four sections representing information about sociodemographic status of the orthodontists, factors affecting the selection of the retention system, commonly used retainers in the upper arch and lower arch, and duration of the retention system. The chi-square test was used to test the significant association between different variable and sociodemographic factors. Results The response rate was 87.5%. The majority of the respondents considered the original malocclusion (80.2%) and clinical experience (49.7%) as the main factors for choosing the retention protocol. In the maxillary arch, a combination of vacuum-formed retainer and fixed retainer (35%) was mostly applied; in the mandibular arch, a fixed retainer was mainly used (46.7%). Most of the respondents recommended initial full-time wearing of a removable appliance (78.2%), especially in the first 3–6 months (47.2%). According to the respondents, bonding a fixed retainer to all anterior teeth was most common (79.7%), fabricated, and adapted directly inside the patient's mouth (75.1%). More than half used flowable composite (54.8%) and recommend leaving the retainer forever (53.8%). Most of the variables showed a statistically significant association between the sociodemographic factors and type, duration, and fabrication of the retainer used. Conclusions A combination of removable and fixed retainers was commonly used in orthodontics retention, and sociodemographic factors significantly affected retainer choice.

Choice of the Retention Method After an Orthodontic Treatment-Rewiev

Retention is a phase of orthodontic treatment devised to keep the teeth in a correct position once the orthodontic treatment has been completed. There are three main characteristics that each ideal retainer is required to have: to keep the teeth in the correct position after orthodontic therapy, to be long lasting and resistant to mechanical damage, and to have no adverse long-term effects on periodontal tissue. Through a computer-based browsing through a number of databases (such as, e.g. PubMed and Google Scholar) we have found and analysed various articles used in this research. The inclusion criteria to be met were: an overall availability of a research paper, the requirement that these research papers are published in English, that these research papers were published in the period 2007-2019, the requirement that the research papers should involve clinically randomized studies and that their titles contain one of the predefined keywords. The database browsing that is based on the said keywords and carried out within the above time frame has resulted in finding 165 relevant articles. A complete set of the inclusion criteria were met by 8 published research papers, but 7 articles were analysed in the end. The selected articles have compared different types of fixed and mobile retainers, different times of wearing the retainers, the impact that the retainers had on the periodontium, and the acceptability of different retention protocols for patients. The conclusion of this research paper is that bonded retainers prove to be most effective in stabilising the position of the incisors, particularly the lower ones, but that their disadvantages include the reopening of the extraction space and the retention of plaque due to difficulties in maintaining oral hygiene. Vacuum-formed retainers appear to be more effective than Hawley retainers in retaining the position of the incisors, and patients have indicated that they are more acceptable to wear. Hawley retainers prove to be most effective in preserving a closed extraction space, but they do now show solid results with regard to other segments. Changes in the overbite, overjet, arch length, and anterior and posterior widths did not show any significant statistical differences in the different types of retainers. Keywords: orthodontics, retention, stability, impact

Retaining participants in community-based health research: a case example on standardized planning and reporting

BackgroundEffective strategies for participant retention are critical in health research to ensure validity, generalizability and efficient use of resources. Yet standardized guidelines for planning and reporting on retention efforts have been lacking. As with randomized controlled trial (RCT) and systematic review (SR) protocols, retention protocols are an opportunity to improve transparency and rigor. An RCT being conducted in British Columbia (BC), Canada provides a case example for developing a priori retention frameworks for use in protocol planning and reporting.MethodsThe BC Healthy Connections Project RCT is examining the effectiveness of a nurse home-visiting program in improving child and maternal outcomes compared with existing services. Participants (N = 739) were girls and young women preparing to parent for the first time and experiencing socioeconomic disadvantage. Quantitative data were collected upon trial entry during pregnancy and during five follow-up interviews until participants’ children reached age 2 years. A framework was developed to guide retention of this study population throughout the RCT. We reviewed relevant literature and mapped essential retention activities across the study planning, recruitment and maintenance phases. Interview completion rates were tracked.ResultsResults from 3302 follow-up interviews (in-person/telephone) conducted over 4 years indicate high completion rates: 90% (n = 667) at 34 weeks gestation; and 91% (n = 676), 85% (n = 626), 80% (n = 594) and 83% (n = 613) at 2, 10, 18 and 24 months postpartum, respectively. Almost all participants (99%, n = 732) provided ongoing consent to access administrative health data. These results provide preliminary data on the success of the framework.ConclusionsOur retention results are encouraging given that participants were experiencing considerable socioeconomic disadvantage. Standardized retention planning and reporting may therefore be feasible for health research in general, using the framework we have developed. Use of standardized retention protocols should be encouraged in research to promote consistency across diverse studies, as now happens with RCT and SR protocols. Beyond this, successful retention approaches may help inform health policy-makers and practitioners who also need to better reach, engage and retain underserved populations.Trial registrationClinicalTrials.gov, NCT01672060. Registered on 24 August 2012.

Retention in fixed orthodontic treatment: An important aspect affecting success of treatment outcome – A questionnaire study

Context: Postorthodontic treatment, retention is an important phase which can be decisive in determining the stability of the achieved result of functional occlusion and esthetic appearance of the patient. There are different types of retainers and different retention protocols followed among the orthodontists. Aims: The purpose of this study was to determine different factors which affect compliance of the patient with removable retainers. Materials and Methods: Thirty-eight patients, who had finished fixed orthodontic treatment and were in retention phase wearing Hawley removable retainers, were included in the study. They were given a questionnaire which dealt with factors affecting patient compliance with removable retainers and different reasons for not wearing removable retainers. Statistical Analysis Used: Categorical variables were reported as counts and percentages. Gender comparisons were made with the Chi-square test/Fisher's exact test. Conclusion: The most common reason for not wearing retainer was reported as patients forgetting to wear the retainer. The common reason for relapse may be associated with patients who think that responsibility of retention is only of orthodontist and not themselves or of both. Gender wise: it was found that the factors of level of satisfaction during the present retention phase, forgetting to wear it, and responsibility of retention showed statistically significant differences.

Occlusal contact area changes with different retention protocols: 1-year follow-up

The purpose of this study was to evaluate the occlusal contact area and cast-radiograph evaluation (CRE) score changes in patients with 3 different retention protocols after a 1-year retention period. A total of 90 patients with acceptable final occlusion according to American Board of Orthodontics CRE were equally divided into 3 groups according to the retention protocol: upper bonded retainer and lower Essix or bonded retainer (Essix group); upper bonded retainer and Hawley or lower bonded retainer (Hawley group); and upper bonded retainer and lower bonded retainer (bonded retainer group). Digital models were used to assess occlusal contact area changes after a 1-year retention period. The follow-up occlusion models were assessed with the American Board of Orthodontics CRE. Occlusal contact areas increased significantly in the Hawley and bonded retainer groups for all teeth except incisors. The bonded retainer group showed the greatest amount of settling, but differences with the Hawley group were not statistically significant. However, statistically significant decreases in occlusal contact areas were recorded for the Essix group except for incisors. A decrease of CRE scores was seen in the Hawley group, whereas a statistically significant increase was recorded in the Essix group. Both Hawley and bonded retainers allowed settling of the occlusion during the retention phase, whereas the Essix retainer did not allow relative vertical movement of the posterior teeth. The Hawley group showed improvement in the total CRE score, whereas the Essix group showed worsening.

Orthodontist Clinical Experience and Clinical Situation Significantly Influence the Retention Protocol – a Survey from Croatia

SUMMARYThe aim was to assess the views and practice of Croatian orthodontists concerning retention protocols. A total of 150 questionnaire copies were distributed, of which 92 were validly completed. The survey included sociodemographic characteristics, practices of informing patients about retention options, commonly used appliances, and reasons for choosing a particular type of retention and treatment duration. Orthodontists informed patients about retention mostly verbally, the retention period was 3-5 years, the choice of method depended on the malocclusion (76%), and the protocol was influenced by clinical experience of the orthodontist (39%). The most commonly used appliance in the maxilla was the vacuum-formed retainer (52%), whereas a combination of fixed and removable retainers was most common in the mandible (34%). Modus of acquiring knowledge, biological reasons (malocclusion type, oral health, treatment outcome, and growth) and the patient’s wishes were not a predictor of retention duration or recall frequency. With an increase in orthodontic experience, the duration of retention decreased and orthodontists were more likely to change the duration of retention (p=0.001), as well as the type of retention appliance (p<0.001). In conclusion, retention protocols among Croatian orthodontists were influenced mostly by their clinical experience and clinical situation.

Objective evaluation of compliance after orthodontic treatment using Hawley or vacuum-formed retainers: A 2-center randomized controlled trial over a 3-month period

The aim of this 2-arm parallel trial was to assess patient compliance objectively with Hawley or vacuum-formed retainers in the maxillary arch in a 3-month period after active orthodontic treatment through the use of the thermosensitive microsensor TheraMon. Patients who had just completed orthodontic treatment in the Postgraduate Orthodontic Clinic, School of Dentistry, National and Kapodistrian University of Athens and in a private orthodontic practice were randomly allocated to either the Hawley or vacuum-formed group for retention. Eligibility criteria included patients aged 12-18years who had undergone orthodontic treatment in both arches for≤ 5years. The main outcome was the average objective daily difference in compliance measured with TheraMon between patients receiving either Hawley or vacuum-formed retainers in the maxillary arch for 3months. Secondary outcomes pertained to the average objective difference in compliance between the 2 retainers for the first month in retention and the association between objective measurements of compliance and diary-reported duration of wear for both the first and 3- month periods. Randomization was implemented with a computer-generated randomization list; allocation was concealed in sequentially numbered, sealed, opaque envelopes. Blinding to the study protocol was not feasible either for the patient or orthodontist. Patients were instructed to wear the retainer full-time. Data were analyzed using nonparametric statistics and linear regression with standard errors based on the bootstrap method. Seventy-seven patients (median age 14.8years; interquartile range 1.5; range 12.1-17.6) were randomized in a 1:1 ratio to either a Hawley or vacuum-formed retainer. Baseline characteristics did not present significant differences between groups. One patient from the Hawley group was excluded from 3months' follow-up owing to a microsensor fault. Objectively assessed median daily wear time for the Hawley group was 15.3hours (interquartile range 6.8), whereas for the vacuum-formed group it was 18.3hours (interquartile range 4.6) for the 3-month interval. Patients allocated to vacuum-formed retainers had higher wearing values of 2.10h/d compared with the Hawley group, after adjusting for trial settings (mean difference 2.10; 95% confidence interval 0.32-3.89; P=0.02). Patients from private orthodontic practice had an increased potential for compliance of 2.16h/d compared with university settings after adjusting for type of appliance (mean difference 2.16; 95% confidence interval 0.34-3.97; P=0.02). A significant correlation was detected between objective assessment and self-reported compliance for both retention protocols in the first and 3-month intervals. No harm was observed during follow-up. This study found relatively high compliance in the short-term retention phase for both appliances. Vacuum-formed retainers were better accepted by adolescent patients, whereas those proceeding to private orthodontic practice were more compliant. There was a positive and statistically significant correlation between objective and subjective measures of compliance. This trial was registered in ClinicalTrials.gov: NCT03683862. No funding or conflict of interest to be declared. The protocol was not published before trial commencement.

A Comprehensive Survey on Orthodontic Retention Protocols among Iraqi Orthodontists

A Comprehensive Survey on Orthodontic Retention Protocols among Iraqi Orthodontists

Comparison of Two Retention Appliances with Respect to Clinical Effectiveness.

The aim of this study was to compare the clinical effectiveness of Essix and Hawley retainers during the retention period. A total of 30 subjects whose fixed orthodontic treatment results were evaluated according to the American Board of Orthodontics Phase III Objective Grading system were included in this study. After the removal of orthodontic attachments, the study participants were equally divided into two retention protocols: upper-lower Essix and upper-lower Hawley. The subjects were instructed to wear their retainers full time for 6 months, except during meals, and during nights only for 6 months. The clinical effectiveness of the retainers was evaluated according to the overjet, overbite, maxillary, and mandibular intercanine widths, intermolar widths, arch lengths, irregularity indexes, and lateral cephalometric measurements. All dental model and lateral cephalometric measurements were performed by the same investigator during three periods: pre-treatment, post-treatment, and post-retention. The overjet, overbite, maxillary, and mandibular intercanine widths; intermolar widths; and arch lengths and lateral cephalometric measurements were not statistically significantly different between the groups and identified time periods. Although the maxillary and mandibular irregularity indexes increased from the post-treatment to post-retention periods, the difference was not statistically significant. Pre-treatment, post-treatment, and post-retention lateral cephalometric measurements were not statistically significantly different between and within the groups. According to the results of a repeated-measures analysis of variance with two factors, and although an increase was found in the maxillary and mandibular irregularity indexes, the clinical effectiveness of Essix and Hawley retainers was found to be similar during the retention period.

Retention protocols and use of vacuum-formed retainers among specialist orthodontists in India

AimThe study was conducted with the aim of evaluating general retention practices, current trends, and difficulties with vacuum-formed retainers (VFR) by the orthodontists in India. MethodA questionnaire link was generated using the Google Forms App in total with 28 multiple-choice questions representing general retention practice in the first part and VFR practice in the second part. ResultsThe overall response rate was 54.4%. On receiving of the completed questionnaires, the data were statistically analyzed. Most practitioners prescribe retainer wear for 1 to 2 years irrespective of the age of the patients, with 2 to 4 years of follow-up. Also VFR of 1 mm thickness with full-occlusal coverage extending 1 to 2 mm beyond the gingiva is recommended immediately after debonding with full-time wear. Discoloration and breakage within 6 to 9 months of VFR wear are commonly encountered problems. In case of relapse with VFR, practitioners prefer to switch over to removable retainers, which shows the major drawback with VFR usage. ConclusionRemovable and fixed retainers are currently the main preferences of retainers. VFR as the esthetic alternative will replace other retainers in the future provided problems with its usage are resolved.

A social systems analysis of implementation of El Salvador\u2019s national HIV combination prevention: a research agenda for evaluating Global Health Initiatives

BackgroundGlobal Health Initiatives (GHIs) have been instrumental in the rapid acceleration of HIV prevention, treatment access, and availability of care and support services for people living with HIV (PLH) in low and middle income countries (LMIC). These efforts have increasingly used combination prevention approaches that include biomedical, behavioral, social and structural interventions to reduce HIV incidence. However, little research has evaluated their implementation. We report results of qualitative research to examine the implementation of a national HIV combination prevention strategy in El Salvador funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria.MethodsWe conducted in-depth interviews with principal recipients of the funding, members of the Country Coordinating Mechanism (CCM) and front line peer outreach workers and their clients. We analyzed the data using a dynamic systems framework.ResultsEl Salvador’s national HIV combination prevention strategy had three main goals: 1) to decrease the sexual risk behaviors of men who have sex with men (MSM), commercial sex workers (CSW) and transgender women (TW); 2) to increase HIV testing rates among members of these populations and the proportion of PLH who know their status; and 3) to improve linkage to HIV treatment and adherence to antiretroviral therapy (ART). Intervention components to achieve these goals included peer outreach, community prevention centers and specialized STI/HIV clinics, and new adherence and retention protocols for PLH.In each intervention component, we identified several factors which reinforced or diminished intervention efforts. Factors that negatively affected all intervention activities were an increase in violence in El Salvador during implementation of the strategy, resistance to decentralization, and budget constraints. Factors that affected peer outreach and sexual risk reduction were the human resource capacity of grassroots organizations and conflicts of the national HIV strategy with other organizational missions.ConclusionsOverall, the national strategy improved access to HIV prevention and care through efforts to improve capacity building of grass roots organizations, reduced stigma, and improved coordination among organizations. However, failure to respond to environmental and organizational factors limited the intervention’s potential impact.

A systematic review of orthodontic retention systems: The verdict

Retention during both the active and passive phases of treatment has given rise to numerous publications concerning its efficacy, the range of systems available and its variability over time. There are currently many different retention protocols regularly used by orthodontists; however, their efficacy and duration are still subject to debate. There is as yet no consensus as to which retention protocol is the most effective or for how long the retention device needs to be worn. The aim of this research was to perform a systematic review of the scientific literature in order to evaluate the efficacy of the different retention systems and clinical protocols among those most widely used, so as to make recommendations beneficial to both patient and practitioner. A search of the literature was performed in the following databases: PubMed (MEDLINE), ScienceDirect and Cochrane Library. The search was limited to publications in English and French during the period 2006-2016. Out of 1952 references initially identified, 17 articles corresponded to our inclusion criteria. The results show that: fixed retention is more effective than removable retainers for the maintenance of incisor alignment during the first six months of retention; there is no significant difference in efficacy between the different fixed retention systems; there is no significant difference in efficacy between the vacuum-formed systems and the Hawley retainer; part-time use of removable retainers (between 8-10h/day) is sufficient; the most widely used retention protocol combines a vacuum-formed splint or Hawley retainer in the upper arch with mandibular fixed retention. Despite the large number of studies devoted to orthodontic retention only a few articles corresponded to the methodological criteria of bio statistical analysis. Also, on account of the variations in experimental protocols, the levels of proof relating to the efficacy of different systems are very weak. Research into this topic should first seek to normalize methods of analysis and then perform randomized controlled long-term trials to shed light on this problem.

A Roadmap to Retention Protocols Applicable to Various Clinical Cases: An Overview

In Orthodontics the stability of the achieved result remains primary concern and debate. Usually a retention phase is required after active Orthodontic tooth movement to hold teeth in their aesthetic and functional relation and to prevent them in returning to their former position. Therefore it is of utmost importance to retain the teeth by appropriate appliance. Since each case is different, it requires a unique retentive protocol and appliance. This article enlists various retention protocols among various clinical situations including orthognathic surgeries.

The retention characteristics of Hawley and vacuum-formed retainers with different retention protocols

BackgroundThis study aimed to compare the effectiveness of two different protocols of wearing vacuum-formed retainers (VFRs) with the standard protocol of wearing Hawley retainer in maintaining the results of orthodontic treatment.Material and MethodsThis single-blind randomized clinical trial consisted of 90 patients who finished orthodontic treatment at the Department of Orthodontics of Mashhad Dental School, and required removable retainers. The participants were randomly divided into 3 groups and received the following treatments. Group 1: Hawley retainers (4 months full-time and then night-only); group 2: VFR_4M (4 months full-time and then night-only); group 3: VFR_1W (1 week full-time and then night-only). The study models were prepared after debond and at 4 and 8 months later, and intercanine width, intermolar width, arch length and the Little’s irregularity index were compared between groups.ResultsNo significant differences were found in intercanine and intermolar widths between groups (P<05). Upper arch length was significantly lower in Hawley group than the two VFR groups (p<0.05), but lower arch length values were comparable. Upper irregularity index was significantly lower in two VFR groups compared to Hawley group (p<0.05), whereas in the lower jaw, only VFR_4M group showed significantly lower crowding than Hawley group (p<0.05).ConclusionsBoth retention regimens of VFRs were more effective than Hawley retainer in maintaining arch length and tooth alignment in the upper arch. For better incisor alignment in the lower jaw, the patients should be advocated to wear VFR 4 months full-time and then at night instead of wearing Hawley retainer. Key words:Essix, Hawley retainer, orthodontic treatment, retention, vacuum-formed retainer.