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10.5005/jp-journals-10021-1198
CLINICAL INNOVATION
Retention Phase: Simplified
Retention Phase: Simplified
1
Shrirang Gajanan Joshi, 2Archana Joshi, 3Rakesh Verma
ABSTRACT
Retention phase is the most important and critical part of an orthodontic treatment. The objective of this article is to explain the benefit of labial
fixed retainers over lingual or palatal retainers. Labial fixed retainers have many advantages over lingual or palatal retainers and using them in
daily routine practice would benefit the orthodontist as well as the patient in many ways.
Keywords: Labial, Fixed retainer, Retention phase.
How to cite this article: Joshi SG, Joshi A, Verma R. Retention Phase: Simplified. J Ind Orthod Soc 2013;47(4):417-418.
INTRODUCTION
PROCEDURE
bite is to be checked and excess of the composite blob is to
be trimmed.
All bonded retainers require regular observation and
maintenance appointments to ensure that all the bonded areas
are intact and there is no gingival inflammation, decalcification
or tooth decay. In most of the situations, it is to be kept for
15 to 18 months, but varies according to the severity of the
malocclusion.
Appliance Fabrication
DISCUSSION
After appliance removal, patient’s impression is taken and
working models are obtained. Multistranded wire is made by
twisting together three ligature wires of 0.009 inch size. This
wire is then adapted firmly in the center on the labial surfaces
of the teeth over their contours from canine to canine or
premolar to premolar depending on the requirement of the case.
It is observed that advantages of using the labial retainer for the
orthodontist as well as the patients are far more than the lingual/
palatal retainer in clinical practice. Surprisingly, what concerns
most of us is esthetics,1 which is not an issue at all for the patients
as only a single thin interrupted wire is seen, which is much better
than a convention removable retainer. Regular use of labial
retainers is beneficial in day-to-day practice, as it is a simple
procedure and saves a lot of chairside time (Fig. 1).
Advantages of using the labial fixed retainers are as follows:
1. Easy to fabricate as well as fix.
2. No indirect bonding technique is required.
3. In case, a single blob of composite comes out or the
retainer breaks, it is noticed immediately by the patient
and can be repaired.
4. Caries, gingival inflammation, etc. can be noticed easily
and treated.
5. Specifically in Class 2, Division 2 cases, if a blob on the
lateral incisor comes out with palatal retainer, then there
are chances of relapse as it may go unnoticed by the patient.
But if placed labially, wire on the labial side will prevent
relapse. Also, it is noticed immediately and can be repaired.
6. Less time is required for fixation, hence chairside time is
reduced.
7. It is easy to clean, hence oral hygiene is maintained.
8. No extra retainer-holding device is required for fixation.
9. Less number of follow-up visits required.
On the contrary, the lingual/palatal retainer had the
following practical disadvantages:
1. Difficult to fix the retainer as compared to labial retainer.
2. Time consuming.
3. Different methods of holding the retainer in place are
required.
Retention phase is the most important and critical part of an
orthodontic treatment. Although removable retainers are used
since years, fixed retainers are nowadays most commonly used.
Here, the objective is to explain the benefit and advantages of
labial fixed retainers over lingual or palatal retainers.
Appliance Fixation
The retainers should be fixed step by step. First the upper
retainer is fixed followed by the lower one. Here fixation of
the upper retainer is explained. Proper polishing of the labial
surfaces of the upper teeth is done. After proper isolation,
etching is done. Primer is applied on the labial surface and
curing is done. Then primer is applied to the retainer and curing
is done. Now, the retainer is placed on the labial surface and
curing is done on each tooth. This helps the retainer to be in
place while placing the composite blobs. Small composite
blobs on each tooth are placed and cured. The blobs should be
small and of uniform size to maintain esthetics. Same
procedure is to be applied to the lower retainer. After this, the
1,2
Private Practice, 3Reader
Sadashiv Peth, Pune, Maharashtra, India
3
Department of Orthodontics, Sudha Rustagi College of Dental Sciences
and Research, Faridabad, Haryana, India
1,2
Corresponding Author: Shrirang Gajanan Joshi, Private Practice, Flat
No.403, A-5, Karishma Society, Kothrud, Pune: 411029, Maharashtra
India, e-mail: [email protected]
Received on: 21/6/11
Accepted after Revision: 12/2/12
The Journal of Indian Orthodontic Society, October-December 2013;47(4):417-418
417
Shrirang Gajanan Joshi et al
CONCLUSION
Figs 1A and B: Extraoral and intraoral views of retainer in place
4. May require indirect bonding.2
5. Formation of caries may go undetected.
6. Increased risk of plaque retention, gingival inflammation
or periodontal problems,3 as it is difficult to clean from
inside and may go unnoticed.
7. If composite blob comes out, then there are chances of relapse
because it may go unnoticed by the patient (Figs 2A and B).
8. More frequent checkups required.
9. As it is placed palatally/lingually, patient may not turn up
for years together until they have a problem. So, it
unnecessarily remains in the mouth for a long period.
418
Using the labial retainer in daily routine practice would benefit
the orthodontist as well as the patient in many ways. It is easy
to fabricate and fix. It facilitates proper cleaning, thus less
incidence of caries, gingival inflammation, etc. Breakage is
noticed even by the patient, hence repaired immediately,
avoiding chances of relapse. Labial retainers fulfills almost all
the requirements of an ideal retainer. The lingual/palatal retainer
can be used only in cases where the patient is in a profession
where esthetics is of prime concern. Otherwise, labial fixed
retainer in daily practice is an excellent practical alternative.
REFERENCES
1. Zachrisson BU. Clinical experience with direct bonded orthodontic
retainers. Am J Orthodont 1977;71:440-48.
2. Ferguson JW. Multistrand wire retainers: An indirect technique.
Brit J Ortho 1987;15:51-54.
3. Levin L, Samorodnitzky-Naveh GR, Machtei EE. The association
of orthodontic treatment and fixed retainers with gingival health. J
Periodontol 2008 Nov;79(11):2087-92.