Supracrestal Fiberotomy Research Articles

A systematic and comprehensive protocol for rapid orthodontic extrusion.

The aim of the present paper is to describe a systematic and detailed protocol for rapid orthodontic extrusion, and to summarize the main results of this protocol in terms of migration of dental, hard and soft tissues, for 10 cases. The working design was to apply a protocol lasting 4 weeks of active phase with intense forces (greater than 300 g), perform weekly the circumferential supra-crestal fiberotomy procedure associated with root-planning, follow up with a passive stabilization phase of another 4 weeks and evaluate the results. We believe that despite the partial migration of periodontal tissue, the defined protocol we used is, for simplicity of application, brevity of treatment and results, a viable alternative to the surgical technique of clinical crown lengthening in those cases where it is necessary to have more dental tissue exposed for restorative and prosthetic purposes.

Treatment of patients with crowding of the anterior group of teeth by circumferential supracrestal fiberotomy.

Aim: To evaluate the effectiveness of the use of circumferential supracrestal fiberotomy in the treatment of tortoanomalies to improve the effectiveness of treatment, prevent recurrence and increase the stability of the achieved result. Materials and Methods: Our study consists in determining the effectiveness of the use of methods that prevent the recurrence of tortoanomalies - circumferential supracrestal fiberotomy (CSF) in patients over the age of 16 years and the effect of CSF on the gingival junction in the treatment of tortoanomalіes with fixed orthodontic multibonding equipment. Results: The high level of stability of results proves expediency operations circumferential supracrestal fiberotomy and papilla splitting at orthodontic treatment of frontal teeth density at patients older 16 years and for increasing stability of results of treatment by prevention of relapse tortoanomalies. Efficiency of the offered ways of treatment is proved clinically and anthropometrically on the early and remote terms of supervision (1, 6, 12 months). Conclusions: The high level of stability of results proves expediency operations circumferential supracrestal fiberotomy and papilla splitting at orthodontic treatment of frontal teeth density at patients older 16 years and for increasing stability of results of treatment by prevention of relapse tortoanomalies. Efficiency of the offered ways of treatment is proved clinically and anthropometrically on the early and remote terms of supervision (1, 6, 12 months).

Blanket or tailored prescription of retainers in orthodontics: a questionnaire-based study.

To explore retainer protocols and how they are influenced by orthodontic presentation and the nature of occlusal correction. A prepiloted 45-item online questionnaire targeting orthodontists was developed. The questionnaire covered clinical preferences in terms of retainer type, fabrication, and follow-up during retention; the clinical indications for adjunctive surgical procedures; and the use of active designs to mitigate relapse in specific malocclusions. A total of 206 responses were obtained. The majority of the respondents prescribed maxillary removable and mandibular fixed retainers, with almost half (49.1%) reviewing patients for more than 1 year primarily in person (95.1%). The majority prescribed vacuum-formed (69.6%) 1-mm-thick (44.3%) retainers. Only 37.3% were aware of the type of material used, with polyethylene terephthalate glycol copolymer, followed by polypropylene, being the most common. Hawley retainers were preferred following nonsurgical maxillary expansion and with suboptimal interdigitation. A preference for clear retainers and/or fixed retainers was found in open-bite cases and deep-bite cases. Supracrestal fiberotomy was prescribed commonly (61.1%) for rotations greater than 90°. No retainer was rarely prescribed except after the correction of an anterior crossbite. Blanket prescription of orthodontic retention is common, with limited awareness of clear plastic retainer materials. Future trials evaluating the effectiveness of approaches for retainer prescription based on the presenting malocclusion would be timely.

Retention in Orthodontics: A review

Skeletal and dental correction obtained by orthodontic treatment may tend to return to the pre-treatment state. This condition is defined as relapse. The retention phase applied after treatment is important to obtain stable results. Periodontium, soft tissue pressures, growth and occlusion are among the factors affecting stability. In the last decade, interest in retention procedures has increased and it has been found that retention regimes differ from country to country. Although retention affects nearly every patient, there is minimal agreement on the most appropriate approach to be taken in an individual case. The many variations of the retention procedure, the introduction of different materials for retention, or individual patient factors are among the reasons that lead to difficulties in selecting retention protocols. Basic retention protocol is provided with removable and fixed retention appliances. For removable retention, hawley, wraparound, vacuum formed retention appliance and positioners are used. For fixed retention, rigid steel retention wire bonded to terminal teeth or flexible retention wires bonded to all teeth between 3-3 can be preferred. NiTi retention wires produced with CAD / CAM technology are also among the current materials. While fixed retention appliances do not require patient cooperation, periodontal follow-up is recommended. Patient cooperation is needed for the use of removable retention appliances, but easy cleaning of removable appliances is an advantage. ‘Adjunct’ procedures may also be applied to the teeth or surrounding periodontium to assist the retention process. For example, it involves reshaping teeth such as interproximal reduction or circumferential supracrestal fiberotomy. In this review, information about retention is discussed in the light of current literature. How to cite this article: Seki Yurdakul M, Meriç P. Retention in Orthodontics: A review. Int Dent Res 2022;12(2):88-96. https://doi.org/10.5577/intdentres.2022.vol12.no2.7 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Orthodontic Extrusion: Guidelines for Contemporary Clinical Practice.

Orthodontic extrusion (OE) is an orthodontic tooth movement in a coronal direction to modify the tooth position and/or induce changes on the surrounding bone and soft tissue with a therapeutic purpose. Evidence emanating from clinical reports and case series studies indicates that OE is a predictable treatment option to manage a variety of clinical situations. Common indications include traction of impacted teeth, exposure of teeth presenting structural damage to facilitate restorative therapy, treatment of periodontal bony and papillary defects, and implant site development. Unfortunately, there is a paucity of established protocols and guidelines for its application in clinical practice. Controversy exists in regard to the definition of rapid and slow OE, use of circumferential supracrestal fiberotomy, and tooth stabilization protocols during and upon completion of orthodontic movement. This article provides a concise perspective on the topic of OE by discussing key biologic principles and technical aspects that are translated into guidelines for the management of different clinical scenarios.

One-year rotational relapse frequency following conventional circumferential supracrestal fiberotomy.

BACKGROUNDRelapse following orthodontic treatment has been a common problem that can occur due to several factors. It was suggested that surgical circumferential supracrestal fiberotomy (CSF) is an effective measure to reduce this relapse. However, very few studies have reported the amount of relapse that occurs afterward.AIMTo assess the frequency of rotational relapse on anterior teeth 1 year following CSF.METHODSEleven adults (six male and five female) with a mean age of 23 years (standard deviation = 5.2), who had a total of 90 rotated anterior teeth, were included in this study. CSF was performed after comprehensive orthodontic treatment involving the use of full-fixed preadjusted edgewise appliances (Victory Series APC, 3M, United States) with a 0.022-inch slot and Roth prescription brackets (Ovation; DENTSPLY GAC, Bohemia, New York, United States) and placement of a fixed lingual retainer from canine to canine in both arches using a 0.016 Australian wire (AJ Wilcock, Australia). Degrees of rotational correction and relapse were measured on three sets of casts [pretreatment, post-treatment (at the debond visit), and 1-year post-treatment]. Rotational relapse was categorized as follows: Unnoticeable relapse (0°), barely noticeable relapse (1°-3°), noticeable relapse (4°-9°), and clearly noticeable relapse (≥ 10°). The percent relapse that had occurred 1 year after teeth were aligned to their ideal position was calculated. Data were analyzed by dental arch type and tooth types.RESULTSMean rotational correction was 14.05° during posttreatment. Mean relapse at 1-year follow-up was 1.1° (10.8%). More than half (n = 52, 57.8%) of teeth were categorized as having unnoticeable relapse (0°). Of the remaining teeth, 31 (34.5%) had barely noticeable relapse (1°-3°), 6 (6.6%) had noticeable relapse (4°-9°), and only one (1.1%) had clearly noticeable relapse (> 10°). When analyzed by arch, 54.5% (n = 6) of the relapsed maxillary teeth had barely noticeable relapse (1°-3°). While most of the mandibular teeth (3, 37.5%) fell into noticeable relapse category (4°-9°), only 1 (12.5%) tooth had clearly noticeable relapse (≥ 10°).CONCLUSIONWhen relapse was measured following CSF, it was found to be more pronounced in maxillary than in mandibular arch. Most frequent relapse was found in maxillary lateral incisors and mandibular canines.

Rotational relapse of anterior teeth following orthodontic treatment and circumferential supracrestal fiberotomy

Background/purposeSeveral factors cause relapse of orthodontically de-rotated teeth after appliance removal. Circumferential supracrestal fiberotomy (CSF) may release the tension on the supra-alveolar fibers following tooth de-rotation, thereby reducing the relapse risk. However, careful identification of the amount and location of relapse enables proper clinical evaluation. We aimed to determine the amount of orthodontic relapse following CSF for de-rotated anterior teeth. Materials and methodsEleven patients with 90 orthodontically de-rotated anterior teeth were enrolled. CSF was performed after orthodontic treatment, during fixed retainer placement. Rotational correction and relapse were measured on three casts (preorthodontic treatment, cast 1; postorthodontic treatment + CSF, cast 2; and 12-month follow-up, cast 3). The Wilcoxon test was used to assess significant differences in the tooth rotation angles between casts 1 and 2 and casts 2 and 3. The relationship between the magnitude of relapse and pretreatment severity of rotation was assessed by the point biserial correlation test. The Mann-Whitney U test helped in identifying significant differences in the amount of relapse between maxillary and mandibular teeth. ResultsThe mean amount of rotational correction was 14.05°, while the mean amount and percentage of relapse were 1.1° and 10.8%, respectively [0.81° (8%) and 1.44° (14%) for maxillary and mandibular teeth, respectively]. The relapse amount was proportional to the pretreatment rotation severity, and it was larger for the mandibular canines. There was no significant difference in the amount of relapse between the maxillary and mandibular teeth (P = 0.07). ConclusionPost-treatment rotational relapse of anterior teeth subjected to CSF was minimal and statistically insignificant after 1 year of follow-up. This validates the promising results of CSF when combined with appropriate mechanical retention for an adequate period.

Comparison of conventional and laser-aided fiberotomy in relapse tendency of rotated tooth: A randomized controlled clinical trial

The aim of the present study was to compare the tendency of mandibular incisor rotation relapse after conventional circumferential supracrestal fiberotomy (CSF) with Er,Cr:YSGG laser-aided CSF. In this three-arm parallel study, the patients with one lower incisor rotation greater than 30 degrees before treatment were selected. The patients were randomly assigned to three groups in a 1:1:1 ratio. Rotational relapse tendency was measured on a digitized model one month after arch wire removal. Probing depth, clinical crown height and pain levels were also measured. A total of 46 patients were recruited. Relapse tendency in conventional CSF and laser-aided CSF groups were 5.09±1.59° and 4.87±2.08°, respectively, and significantly lower than 11.28±2.93° in the control group (P<0.001). Relapse tendency was not different between the conventional CSF and laser CSF groups. Probing depth, clinical crown height, and experienced pain levels exhibited negligible differences. Er,Cr:YSGG laser-aided CSF in one month was as effective in reducing rotational relapse tendency of mandibular incisor teeth as conventional CSF.

Expression of proteins of elastic fibers and collagen type I in orthodontically rotated teeth in rats.

The aims of this study were to investigate the expression of proteins of elastic fibers and collagen type I in the supra-alveolar structure of orthodontically rotated teeth in rats and to elucidate whether circumferential supracrestal fiberotomy diminishes relapse. The rats' maxillary left first molars were rotated by couple of force. Specimens were divided into groups according to different orthodontic procedures. A1-3 and B1-3 were blank control groups and operation control groups. Group C underwent rotation only, and group D was treated with rotation and retention. Groups E and F were treated with rotation, retention, and release of retention; additionally, circumferential supracrestal fiberotomy was performed in group F before the release of retention. The animals were killed, and the jaws were processed for histologic evaluation using the immunohistochemical method to evaluate the protein expressions of elastin, fibrillin-1, fibrillin-2, and collagen type I in supra-alveolar structures (around and below the gingival sulcus) between the maxillary left first and secondmolars. The degree and percentage of relapse were measured by a series of impressions. The degree and percentage of relapse in group F were much lower than those in group E (P<0.05). Collagen type I was increased in group C (P<0.05) and at normal levels in groups D, E, and F. Elastin below the gingival sulcus and fibrillin-1 showed the same patterns of expression and were consistently elevated in groups C, D, E, and F (P<0.05). No positive staining for elastin was found around the gingival sulcus in any specimen. The difference in the expression of fibrillin-2 between the experimental groups (C, D, E, and F) and their matching control groups was not statistically significant (P>0.05). Circumferential supracrestal fiberotomy can alleviate the relapse of rotated teeth. Collagen fibers of supra-alveolar structures might contribute to relapse in a short time, whereas elastic fibers may be the reason that rotated teeth relapse to their original positions after retention.

Relapse treatment in a patient with previous first premolar extractions for referral to restorative dentistry

Relapse is an unavoidable challenge for the specialist; in orthodontic practice several recommendations have been stated to prevent it: maintain the original arch form, particularly the lower; do not modify inter-canine width, do not modify the bucco-lingual incisor inclination, achieve a good intercuspation, perform circumferential supracrestal fiberotomy and overcorrect rotated teeth. A case report is here by presented. The patient was 25-year-old and had had a previous orthodontic treatment with four first premolar extractions. He presented moderate upper and lower crowding, gingivitis, no temporomandibular joint symptoms, and dental anatomy abnormalities in teeth 3.4 and 4.4. Objectives:Preparation for referral to restorative dentistry, obtain a normal overbite and overjet, maintain arch form, match dental midlines, achieve good intercuspation, root para llelism and improve periodontal health. Methods: Non-extraction case treated with fixed appliances: In-Ovation® 0.022” x 0.028” Roth Thermo-activated Palatal Expander® to obtain space on the upper arch. Results: All the objectives were achieved despite the dental anatomy abnormalities, except for root parallelism due to anomalies in root form. Conclusions: The case was treated following the established orthodontic recommendations to prevent a second episode of relapse and at the same time obtain a good prognosis for referral to restorative dentistry.

Early Correction of Rotated Incisor Using 2x4 Appliance With Laser Aided Circumferential Supracrestal Fiberotomy

Early Correction of Rotated Incisor Using 2x4 Appliance With Laser Aided Circumferential Supracrestal Fiberotomy

Effects of laser-aided circumferential supracrestal fiberotomy on relapse of orthodontically treated teeth: A pilot study

A significant cause of relapse of orthodontically treated teeth is thought to be the gingival and transseptal fibers of the periodontium, which are stretched and twisted as the tooth is rotated. To relieve the rotated tooth from forces exerted by the stretched fibers, circumferential supracrestal fiberotomy (CSF) was introduced. In simple CSF using a scalpel blade, intergingival, transgingival, transseptal, and semicircular fibers are transected. CSF helps the tissue remodelling and decreases relapse of orthodontically treated teeth. Laser offers numerous advantages compared with surgery. Laser CSF is expected to prevent relapse of orthodontically treated teeth. This study was conducted to evaluate the effectiveness and periodontal side effects of laser CSF on orthodontically rotated tooth. The aims were to compare the: amount of relapse and sulcus depth.The study involves 10 patients between age group of 14- 30 years. Patients with extraction site closure were included with the teeth adjacent to the extracted tooth involved in the study. A split mouth design was made with the maxillary right side as control whereas laser CSF was performed only on the maxillary left side. Laser diode of 980nm wavelength will be used. Evaluation after CSF was done after 4 weeks.

Effectiveness of Er:YAG laser-aided fiberotomy and low-level laser therapy in alleviating relapse of rotated incisors

In this study, we compared the effectiveness of laser-aided circumferential supracrestal fiberotomy (CSF) and low-level laser therapy (LLLT) with conventional CSF in reducing relapse of corrected rotations. The study included 24 patients who were at the finishing stage of orthodontic treatment and had at least 1 maxillary incisor with 30° to 70° of rotation before starting therapy. The subjects were divided into 4 groups by treatment: conventional CSF, Er:YAG laser-aided CSF, LLLT, and control. After alginate impressions were taken, the archwire was sectioned from the experimental incisors, and they were allowed to relapse. The second impression was taken 1month later, and the degree and percentage of relapse were calculated in photographs taken from the dental models. Gingival recession, pocket depth, and pain were also measured in the CSF groups. The mean percentages of relapse were 9.7% in the conventional CSF, 12.7% in the Er:YAG laser-aided CSF, 11.7% in the LLLT, and 27.8% in the control groups. Relapse was significantly greater in the control than the experimental groups (P<0.05), which were not statistically different from each other. The changes in sulcus depth and gingival recession were small and not significantly different among the CSF groups (P>0.05), but pain intensity was greater in subjects who underwent conventional CSF (P=0.003). Er:YAG laser-aided CSF proved to be an effective alternative to conventional CSF in reducing rotational relapse. LLLT with excessively high energy density was also as effective as the CSF procedures in alleviating relapse, at least in the short term.

Comparison of Rate of Canine Retraction into Recent Extraction Site with and without Gingival Fiberotomy: A Clinical Study

Retraction of maxillary canines after first premolar extractions is a very common orthodontic task in cases of crowding or for the correction of large overjet. Many studies have been done to increase the rate of retraction. The aim is to compare the rate of canine retraction into recent extraction site with and without circumferential supracrestal fiberotomy. The rate of movement of the canines into the recent extraction site of the first premolar with or without circumferential supracrestal fiberotomy was measured in 14 patients aged 13 to 22 years. The study was done on 9 maxillary and 5 mandibular arches. The appliance used in the present study was the preadjusted edgewise (0.022 inch Roth prescription) and retraction performed by frictionless mechanics using Composite T Loop. The distalization of canines was measured at regular intervals (T1, T2, T3 and T4). Recordings of the positions of the canines at the beginning and at different intervals were made from dental casts. The mean difference between the two sides for the total time span T1-T4, for maxillary arch was 0.36 mm and for mandibular arch was 0.60 mm respectively. There can be various factors that affect the rate of tooth movement. Factors like bone density, bone metabolism, and turnover in the periodontal ligament, amount of force applied may be responsible for the variation. No clinically significant increased rate of retraction of cuspids in the recent extraction site with fiberotomy was found in comparison to the retraction in recent extraction site without fiberotomy.

EXTRUSIÓN ORTODÓNCICA CON FIBROTOMÍA SUPRACRESTAL: CASO CON FIN PROTÉSICO

La extrusion ortodoncica es el movimiento coronal de un diente por medio de la aplicacion de fuerzas ortodoncicas. Este movimiento, acompanado de la fibrotomia supracrestal logra la migracion del diente sin acompanamiento del periodonto. En este articulo se presenta el caso de un resto radicular de un incisivo central superior izquierdo, en paciente de sexo femenino de 40 anos de edad, a la cual se le propone como tratamiento ideal para rehabilitar el diente, la realizacion de una extrusion ortodoncica acompanada de fibrotomia supracrestal. Se tienen en cuenta las consideraciones tanto del componente periodontal como del protesico, para este procedimiento. Se pretende, entonces, mostrar con este reporte de caso clinico, a la extrusion ortodoncica con fibrotomia supracrestal, como un metodo alternativo para el manejo de restos radiculares sin posibilidad de ser restaurados. Se logra exponer los bordes sanos y asi obtener resultados protesicos adecuados en forma, funcion y estetica.[Botero D, Moncada CA. Extrusion ortodoncica con fibrotomia supracrestal: caso con fin protesico. Ustasalud 2011; 10: 127 - 131]

Effects of laser-aided circumferential supracrestal fiberotomy on root surfaces

To evaluate and compare the effects of circumferential supracrestal fiberotomy in vivo (using diode, CO(2), and Er∶YAG lasers) on the morphology and chemical composition of the root surface. Forty healthy premolar teeth, intended for extraction for orthodontic reasons, were used in this study. Root surfaces were treated using different laser methods, as follows: (1) control; (2) Er∶YAG laser (2.94 µm, 100 mJ, 10 Hz); (3) diode laser (808 nm, 1.2 W, continuous wave); and (4) CO(2) laser (10.6 µm, 3 W, continuous wave). Subsequently, the teeth were removed and subjected to scanning electron microscopic (SEM) examination and energy dispersive x-ray (EDX) spectrometric analysis. SEM analysis indicated that no thermal changes, including melting or carbonization, were observed following the lasing procedures. EDX analysis showed that the laser procedures resulted in similar mineral contents (weight % of calcium and phosphate) as compared to those in the control group. Based on these findings, we concluded that laser-aided procedures, when used at appropriate laser settings, preserve the original morphology and chemical composition of cementum.

Laser-Aided Circumferential Supracrestal Fiberotomy and Low-Level Laser Therapy Effects on Relapse of Rotated Teeth in Beagles

To investigate the effectiveness and periodontal side effects of laser circumferential supracrestal fiberotomy (CSF) and low-level laser therapy (LLLT) on orthodontically rotated teeth in beagles. Eighteen mandibular incisors from nine dogs were divided into three groups by treatment (n = 6/group): A, orthodontic couple force application only (control); B, laser CSF following orthodontic couple force application; and C, LLLT following orthodontic couple force application. Both mandibular lateral incisors were rotated for 4 weeks, and the relapse tendency was observed for 4 weeks more without any retainers. The amount of relapse, sulcus depth, and gingival recession were measured at weeks 4 and 8. One-way analysis of variance (ANOVA) and Scheffé's post hoc test were used for data analysis. Tissue specimens were examined at week 8 under light microscopy after hematoxylin-eosin (H&E) and Masson's trichrome staining. The mean percentage of relapse was 41.29% in group A, 14.52% in group B, and 56.80% in group C (P < .001). Four weeks after laser CSF, the sulcus depth increased by 0.67 mm, but no gingival recession was observed. There was no significant difference between groups A and C in terms of sulcus depth and gingival recession. Laser CSF is an effective procedure to decrease relapse after tooth rotation, causing no apparent damage to the supporting periodontal structures, whereas LLLT on orthodontically rotated teeth without retainers appears to increase the relapse tendency.

Orthodontic extrusion with palatal circumferential supracrestal fiberotomy improves facial gingival symmetry: a report of two cases

Discrepancy in the labial gingival margin of the maxillary incisors poses a major aesthetic problem. Orthodontic extrusion can improve the aesthetic problem caused by gingival margin levels before restoration. In these case reports, orthodontic extrusion was performed with palatal circumferential supracrestal fiberotomy for improving the discrepancy of the labial gingival margin. Two years postoperatively, the position of the tooth and gingival margin remained stable. Orthodontic extrusion with palatal circumferential supracrestal fiberotomy was effective in improving the discrepancy of the labial gingival margin of maxillary incisors.

Orthodontic retention regimes: will we ever have the answer?

The Cochrane Oral Health Group Trials Register, CENTRAL, Medline and Embase were searched to May 2005. Key journals were searched by hand, together with bibliographies of all retrieved papers and review articles. No language restrictions were applied. Authors of trials were contacted to identify unpublished trials. Inclusion criteria specified randomised and quasi-randomised controlled trials which involved children or adults who had retainers fitted or adjunctive procedures undertaken, following orthodontic treatment with braces to prevent relapse. The outcomes were amount of relapse, survival of retainers, adverse effects on oral health and quality of life. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. For dichotomous outcomes, the estimate of effect of an intervention was expressed as risk ratios together with 95% confidence intervals. For continuous outcomes, mean differences and 95% confidence intervals were used to summarise the data for each group. The search identified 27 articles, of which five met the inclusion criteria. These trials all compared different interventions. There was weak unreliable evidence, based on data from one trial, that a statistically significant increase in stability occurs in both the mandibular (P<0.001) and maxillary anterior segments (P<0.001) when the circumferential supracrestal fiberotomy is used in conjunction with a Hawley retainer, compared with a Hawley retainer alone. There was also weak, unreliable evidence that teeth settle quicker with a Hawley retainer than with a clear overlay retainer after 3 months. The quality of the trial reports was generally poor. No data were available from any study on quality of life assessment. Meta-analysis could not be undertaken as no two studies compared the same retention techniques. There are insufficient research data on which to base our clinical practice on retention at present. There is an urgent need for high quality randomised controlled trials in this crucial area of orthodontic practice.

Orthodontic retention: A systematic review

To evaluate the effectiveness of different retention strategies used to maintain tooth position after treatment by orthodontic appliances. The search strategy was carried out according to the standard Cochrane systematic review methodology. The following databases were searched for randomized clinical trials (RCT) or controlled clinical trials (CCT): Cochrane Oral Health Group Trials Register, Cochrane Clinical Trials Register, MEDLINE and EMBASE. No language restrictions were applied. Authors of trials were contacted to identify unpublished trials. Inclusion and exclusion criteria were applied when considering the studies to be included and a quality assessment made for each paper. The primary outcome was the amount of relapse. Secondary outcomes were survival of retainers, adverse effects on oral health and patient satisfaction. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two reviewers. Five studies (2 RCTs and 3 CCTs) fulfilled the inclusion criteria. There was evidence, based on data from one trial, that there was a statistically significant increase in stability in both the mandibular (P<0.001) and maxillary anterior segments (P<0.001) when the CSF (circumferential supracrestal fiberotomy) was used in conjunction with a Hawley retainer, compared with a Hawley retainer alone. However, this evidence may be unreliable due to flaws in the study design. There was also weak, unreliable evidence that teeth settle quicker with a Hawley retainer than with a clear overlay retainer after 3 months. There is currently insufficient evidence on which to base the clinical practice of orthodontic retention.