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The dark side of fixed retainers: Case series
Sarah Abu Arqub1, Dalya Al-Moghrabi2, Aliki Tsichlaki3
1Department of Orthodontics, College of Dentistry, University of Florida, Gainesville, Fla.
Summary
Long-term fixed orthodontic retainers can cause complications like bite changes and periodontal issues. Early detection and clear monitoring guidelines are crucial for preventing adverse effects in patients undergoing orthodontic treatment.
Area of Science:
- Orthodontics
- Periodontology
- Dental Materials
Background:
- Fixed retainers are commonly used after orthodontic treatment to maintain tooth alignment.
- Long-term use of fixed retainers can lead to unforeseen complications affecting occlusion and periodontal health.
- A significant time lapse (5-33 years) between initial treatment and complication onset is noted.
Purpose of the Study:
- To present and manage complications arising from long-term use of maxillary or mandibular fixed retainers in adult patients.
- To highlight the detrimental effects of fixed retainers on periodontal health, particularly around mandibular canines.
- To discuss the necessity of orthodontic retreatment and evaluate its effectiveness in resolving retainer-related issues.
Main Methods:
- Case series presentation of 9 adult patients with fixed retainer complications.
- Clinical examination to identify malocclusions such as anterior crossbite, open bite, and incisal cant.
- Radiographic analysis using cone-beam computed tomography (CBCT) or orthopantomogram (OPG) before and after retreatment.
- Review of different fixed retainer types: flexible spiral wire, rigid wire, and fiber-reinforced composite retainers.
Main Results:
- Complications included anterior crossbite, open bite, incisal cant, and twist/x-effects.
- Periodontal health was negatively impacted, especially around mandibular canines.
- All patients required orthodontic retreatment (fixed appliances or clear aligners).
- CBCT scans post-retreatment showed no significant improvement in root proximity to cortical plates despite clinical alignment gains.
Conclusions:
- Long-term fixed retainers necessitate vigilant monitoring to prevent and manage complications.
- Orthodontic retreatment may improve tooth position but not necessarily root positioning relative to bone.
- Implementing dual retention, remote monitoring, and clear clinical guidelines is essential for early detection and prevention of adverse retainer effects.
