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Which orthodontic retainer provides the best stabilization? : Systematic review and network meta-analysis
Zamira Kalemaj1, Elisa Boccalari2, Marco Tremolati2
1Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 9, 20122, Milan, Italy. kalemajzamira@gmail.com.
Summary
Computer-aided design/computer-aided manufacturing (CAD/CAM) multistrand stainless steel (SS) retainers show the highest probability of maintaining a stable post-orthodontic outcome, particularly for tooth alignment and intercanine width. Removable retainers offer limited effectiveness for long-term stability.
Area of Science:
- Orthodontics and Dentofacial Orthopedics
- Biomaterials Science
- Evidence-Based Dentistry
Background:
- Maintaining stable post-orthodontic tooth alignment is crucial for long-term treatment success.
- Various retainer types exist, but evidence comparing their long-term efficacy is limited.
- Systematic reviews and meta-analyses are essential for synthesizing current evidence on retainer effectiveness.
Purpose of the Study:
- To systematically review and compare available orthodontic retainers.
- To determine which retainer type offers the highest probability of maintaining stable post-orthodontic outcomes.
- To analyze data using network meta-analyses for robust comparisons.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) identified via electronic database searches up to January 2024.
- Risk of bias assessment using the Cochrane checklist.
- Network meta-analyses (NMA) conducted for Little Irregularity Index (LII), intercanine width (ICW), and intermolar width (IMW) using probability of being best (PBB) and surface under cumulative ranking curves (SUCRA) metrics.
Main Results:
- Eighteen RCTs included; 15 in NMA. Seven studies had high risk of bias.
- CAD/CAM multistrand stainless steel (SS), laboratory round multistrand SS, and rectangular flex SS retainers showed highest PBB for maintaining low LII.
- CAD/CAM multistrand SS, CAD/CAM NiTi, and spring hard SS retainers demonstrated highest PBB for maintaining ICW. Removable retainers showed low PBB for LII and ICW. No significant differences for IMW.
Conclusions:
- CAD/CAM and laboratory-bent multistrand SS, followed by rectangular flex SS retainers, appear most effective for maintaining low LII in the short-to-mid-term.
- CAD/CAM multistrand SS, CAD/CAM NiTi, and spring-hard wire retainers are suggested as most effective for maintaining ICW.
- Intermolar width tends to decrease regardless of retainer type, indicating multifactorial influences on this outcome.
