Ortho Wire To Use For Fixed Retainer?

T he importance of retention after orthodontic treatment is well recognized.^1,2 In 1934, Oppenheimⁱⁱⁱ stated "Retention is a trouble in orthodontic treatment, in fact, it is the trouble." Retention is the final phase of active orthodontic therapy, and the clinical goal is to maintain teeth in a healthy, functional and esthetic position. In orthodontics, planning for memory begins with proper diagnosis, treatment planning, sound biomechanical principles, and placing the teeth in optimal functional occlusion. It is considered inevitable that for the majority of treated cases, some degree of relapse will occur, either with or without retentivity.^four

Among the many suggested factors that influence stability, the chief three are: (1) periodontal ligament fibers and gingival fibers affected by orthodontic molar movement, which require time for reorganization when the appliances are removed; (2) late mandibular growth and; (iii) physiologic imbalance of local extrinsic forces, such as lip, cheek and natural language pressures acting on the corrected dentition so the teeth may be in an inherently unstable position.

The method of retention is best selected at the outset of handling and incorporated in the treatment plan for that particular case. Retention requirements are determined past the characteristics of the original malocclusion and effects of orthodontic treatment. While the blazon and term of a retention regimen may prove controversial, it is more often than not accepted in orthodontics that sure situations are best addressed by fixed retention.^five,6 These include diastemas, anterior crowding, rotated teeth, maintenance of lower incisor position during tardily growth, maintenance of pontic or implant space, inter-canine width expansion, adult treatment, and where patient compliance is questionable (specially over long term).

Figure 1. Clinical view of  0.016×0.025-inch multistrand
stainless steel wire bonded to the maxillary incisors.

DEVICE Selection

In recent times, stock-still retention has been an increasingly pop approach in orthodontics. Surveys in the United States and elsewhere have identified trends in the pick and duration for servant wear.^seven–11 Choosing stock-still retainers for the lower dental curvation is most popular, with increasing employ of upper vacuum-formed retainers — with or without fixed bonding to the maxillary incisors. Most orthodontists recommend removable retainers for a minimum of two years, and even upwardly to five years or longer.

Fixed retainers may be utilized unless there are contraindications, which might include active caries or periodontal disease, poor oral hygiene, anterior deep bite for maxillary retention, atypical lingual tooth morphology, or incomplete handling.

Potential problems and complications can occur with fixed retainers, still. For case, at that place tin can exist areas of plaque accumulation — although studies exercise not report an increment in interproximal caries or periodontal disease.^12,13 In addition, detachment of the retainer from the tooth surface can cause teeth to shift. While rare, other significant problems include torqueing of teeth (leading to tooth displacement), gingival recession and bone loss.^xiv,15 Fixed retainers therefore require long-term maintenance and follow-up with either the orthodontist or general dentist. Cocky-intendance is also important, and use of interdental cleaning aids is advised to ensure adequate oral hygiene.

Several types of fixed retainers are available. Some can be fabricated straight in the mouth, if desired, while others are all-time fabricated indirectly on a stone model. A transfer tray fashioned out of vinyl polysiloxane putty can facilitate access and ease of placement on the teeth, and is highly recommended so it is passively placed. The two basic designs of lingual bonded retainers are a flexible wire bonded to each molar in the segment, or a more than rigid wire bonded only on the canines.

The utilize of flexible multistrand spiral wire for stock-still retainers was first advocated by Zachrisson in the 1980s (Figure one). Electric current orthodontic opinion recommends either the utilise of 0.0215- or 0.0195-inch multistrand wire, or a 0.030- or 0.032-inch sandblasted, rigid, circular stainless steel wire.¹⁶ V-stranded coaxial wires are suggested for use in bonded lingual retainers rather than dead soft.¹⁷ Failure rates of approximately 12% in two years have been reported.¹⁸ The most common style of failure is loosening between the wire and adhesive, or adhesive-enamel and wire breakage acquired by stress.^nineteen The flexibility of the wire allows differential tooth move and is particularly useful for patients who nowadays with loss of periodontal support. It also reduces the concentration of stress inside the adhesive, thus minimizing the possibility of subsequent failure. However, baloney of the wire can atomic number 82 to unin­tentional molar motility.

Another quick choice for fabrication of a flexible retainer wire is to take two 0.010- or 0.012-inch stainless steel ligatures and tightly twist them together, double fold them, and go on twisting so that iv filaments are present.

Figure 2. Preformed direct bonded servant on maxillary centrals after diastema closure.

CLINICAL ALTERNATIVES

Rigid mandibular canine-to-canine retainer bars with bonding pads at the terminals are available in unlike sizes through various vendors. These tin can be used canine to canine or on two adjacent incisors to maintain closure of a diastema (Effigy 2). They are fantabulous for maintaining inter-canine width, but less so in preventing individual tooth rotations, as they are fastened just to the canines. Movement of the lower incisors can occur if the wire is not attached to them, but bonded only on the last teeth (the canines), especially if the wire is not intimately contacting the teeth on their entire lingual surfaces. Although bonding to all incisors remedies this problem, it tin can lead to bond failure at the adhesive/​wire interface. This occurs equally there is a natural tendency of teeth to move from the periodontal ligament (PDL), and the wire's rigidity does non permit this. If the adhesive is practical across the entire width of the tooth and interproximally (rather than spot locations on the teeth), rigidity is improved — but the splinting of teeth does non allow physiological movement and bond failures will occur. Figure three shows a custom, laboratory-made lingual retainer, with bonding pads on all half dozen anterior teeth and accessible interproximal spaces.

FIGURE 3. Custom, laboratory-fabricated lower canine-to-canine retainer, with
bonding pads on all teeth.

As a further case of clinical choices in stock-still retention, the White Gilded Ortho FlexTech (Reliance Orthodontic Products) (Effigy 4) is fashioned from 14-karat white gilt and has a depression profile (0.0383 inches wide by 0.01580 inches high). It can exist directly placed, and adaptation to the tooth surfaces is excellent, as it naturally forms to the lingual curvation curvature and lays flat against the teeth. It besides offers good mechanical retention of the agglutinative and low failure rates due to "flex linkage" of the chain.

FIGURE four. Flexible chain bonded to six mandibular anterior teeth.

Another choice that is gaining popularity is Retainium wire (Reliance Orthodontic Products) (Figure v), which is a rectangular 0.027×0.eleven-inch ribbon-form, nickel-free titanium wire that is dead soft. It is easy to configure and adjust passively, therefore minimizing inadvertent tooth movement from forces if the wire were active. Sandblasting the surface volition ameliorate the mechanical attachment with the bonding adhesive.

FIGURE 5. Retainium wire for maxillary incisors.

Fashioned using estimator aided design/​computer aide manufacturing (CAD/​CAM) applied science, Memotain (AOA Orthodontic Appliances) is a 0.016×0.016-inch nickel titanium retainer (Figure vi). Its memory-based metal helps information technology maintain its shape integrity and provides flexibility. These devices are electropolished to a smooth surface and the servant'southward edges are rounded for comfort. Due to the small dimensions and contoured custom fit, this may be a skillful choice for maxillary inductive teeth. The transfer tray makes placement like shooting fish in a barrel and predictable. Even though all the teeth are bonded, the flexibility of the metallic allows independent normal motility of the teeth within the PDL during mastication, without breakage or bonding failure between teeth.^twenty

Figure vi. Memotain for maxillary incisors.

Fiber reinforced plastics (FRP) for retainers were first introduced in orthodontics in the 1990s using a two-step process from pre-im­preg­nated, unidirectional long glass fibers in a thermoplastic resin matrix of either poly(ethylene terephthalate glycol) or polycarbonate.²¹ The ad­vantages include ease of fabrication and customization of design, direc­tional mechanical strength, skilful esthetics, and a nickel-free design (Figure 7). Current commercially available FRPs include Ribbond (Ribbond) and everStick ORTHO (StickTech). Due to the style in which bonding is achieved (with agglutinative coverage across all the teeth, including interdental areas), they human action equally splints and forbid private tooth motion. A potential downside is that low flexibility tin induce loftier strain inside the adhesive composite, leading to micro-cracks or weakening of the wire-adhesive and agglutinative-enamel interface, leading to loosening or fracture of the wire.

FIGURE 7. Fabricated cobweb reinforced plastic retainer on a study model.

Available since 1992, Ribbond reinforcement material is composed of pre-impregnated, silanized, high-molecular-weight polyethylene fibers woven in a ribbon form. This is lightly wetted with an adhesive resin consisting of methacrylate ester monomers only before placing on the teeth.²² Made from silanated continuous unidirectional glass cobweb bundles in a thermoplastic polymer network construction and resin matrix of bisphenol A-glycidyl methacrylate and dimethacrylate-polymethylmethacrylate, everStick ORTHO cloth is calorie-free cured and adjusted, and then placed directly in the oral fissure. Its advantages include predictable bonding and handling.^23,24

With the advances in 3-dimensional printing and polymer chemical science, new materials and methods are on the horizon. PEEK is a thermoplastic composite fabricated with poly ether ketone polymer. Used in medical and dental applications, PEEK is white colored and features excellent mechanical properties.²⁵ It can be milled to a customized shape using CAD/​CAM technology and bonded using the acid compose technique. The digital design matches the patient's individual tooth anatomy. Positioning jigs on the canines facilitate placement of the retainer. The 0.8-mm thickness of the wire offers a comfortable fit while however allowing physiological movement of the teeth — an important goal in orthodontics. In addition, it facilitates flossing because the interproximal areas are adhesive-free.

Conclusion

Fixed bonded retainers are preferred when long-term retention is indicated or patient compliance may be poor. Various techniques and materials for stock-still bonded retainers take been described in the literature. Numerous clinical options are available, and range from direct fabrication to in-house or lab fabrication utilizing a diversity of materials. They all seem to work equally well, then the terminal clinical approach will be determined based on the individual patient and case, every bit well as clinician preference.

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Cardinal TAKEAWAYS

• Retention is the terminal phase of active orthodontic therapy, with a clinical goal of maintaining teeth in a good for you, functional and esthetic position.
• Planning for retention begins with proper diagnosis, treatment planning, sound biomechanical principles, and placing the teeth in optimal functional occlusion.
• Retention requirements are determined by the characteristics of the original malocclusion and effects of orthodontic treatment.
• The method of retention is best selected at the get-go of treatment and incorporated in the treatment plan for that detail example.
• Stock-still retainers may be utilized unless there are contraindications, which might include active caries or periodontal disease, poor oral hygiene, inductive deep bite for maxillary retention, atypical lingual tooth morphology, or incomplete treatment.
• Several types of fixed retainers are bachelor. Some can be fabricated directly in the oral cavity, if desired, while others are best fabricated indirectly on a stone model.
• Ultimately, the private case — likewise as clinician preference — will determine the best clinical approach.

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REFERENCES

1. Nanda R, Burstone CJ. Retention and Stability in Orthodontics. Philadelphia:Westward.B.Saunders;1993.
2. Lilliputian RM. Stability and relapse of dental arch alignment. BJ J Orthod .1990;17:235–241
3. Oppenheim A. Crisis in orthodontia Part I. ii. Tissue changes during retentiveness. Skogborg's septomy. Int J Orthod . 1934;20:639–644.
4. Johnston CD, Littlewood SJ. Retentivity in orthodontics. Br J Orthod . 2015;218:119–122.
5. Rody WJ, Wheeler TT. Retention direction decisions: a review of current evidence and emerging trends. Semin Orthod . 2017;23:221–228.
6. Rossouw PE, Shaima Malik S. The memory protocol. Semin Orthod . 2017;23:237–248.
7. Pratt MC, Kluemper GT, Hartsfield JK Jr, Fardo D, Nash DA. Evaluation of retention protocols amid members of the American Clan of Orthodontists in the Usa. Am J Orthod Dentofac Orthop . 2011;140:520–526
8. Padmos JA, FudaleJ PS, Renkemac AM. Epidemiologic written report of orthodontic retentivity procedures. Am J Orthod Dentofacial Orthop. 2018;153:496–504.
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12. Artun J, Spadafora AT, Shapiro PA. A 3-year follow-upwards written report of various types of orthodontic canine-to-canine retainers. Eur J Orthod. 1997;19:501–509.
13. Berth FA, Edelman JM, Proffit WR. Twenty-twelvemonth follow-upwards of patients with permanently bonded mandibular canine-to-canine retainers. Am J Orthod Dentofac Orthop . 2008;133:70–76.
14. Shaughnessy TG, Proffit WR, Samara SA. Inadvertent molar motion with fixed lingual retainers. Am J Orthod Dentofacial Orthop . 2016;149:277–286.
15. Kuč era J, Marek I. Unexpected complications associated with mandibular stock-still retainers: a retrospective study. Am J Orthod Dentofacial Orthop. 2016;149:202–211.
16. Zachrisson BU. Multistranded wire bonded retainers: from start to success. Am J Orthod Dentofacial Orthop. 2015;148:724–727.
17. Baysal A, Uysal T, Gul N, Alan MB, Ramoglubl SI. Comparison of three different orthodontic wires for bonded lingual retainer fabrication. Korean J Orthod. 2012;42:39–46.
18. Tacken MP, Cosyn J, Wilde P, De Aerts J, Govaerts E, Vannet BV. Glass fibre reinforced versus multistranded bonded orthodontic retainers: a 2-year prospective multi-center study. Eur J Orthod. 2010;32:117–123.
19. Bearn DR, McCabe JF, Gordon PH, Aird JC. Bonded orthodontic retainers: the wire-composite interface. Am J Orthod Dentofacial Orthop . 1997;111:67–74.
20. Kravitz ND, Grauer D, Schumacher P, Jo YM. Memotain: a C/​D/​CAM nickel-titanium lingual retainer. Am J Orthod Dentofacial Orthop . 2017;151:812–815.
21. Ardeshna AP. Clinical evaluation of a cobweb-reinforced blended orthodontic retainer. Am J Orthod Dentofacial Orthop . 2011;139:761–767.
22. Salehi P, Najafi HZ, Roeinpeikaret SM. Comparison of survival time betwixt two types of orthodontic fixed retainer: a prospective randomized clinical trial. Progress in Orthodontics . 2013;xiv:25.
23. Sfondrini MF, Fraticelli D, Castellazzi L, Scribante A, Gandini P. Clinical evaluation of bail failures and survival betwixt mandibular canine-to-canine retainers made of flexible screw wire and fiber-reinforced composite. J Clin Exp Dent . 2014;6:e145–e149.
24. Annousaki O, Zinelis S, Eliades G, Eliades T. Comparative analysis of the mechanical properties of fiber and stainless steel multi stranded wires used for lingual fixed retention. Dent Mater . 2017;33:2e205–e211.
25. Zachrisson P. A New Blazon of Fixed Servant. Available at: https:/​/​www.orthopracticeus.com/​clinical/​a-new-type-of-fixed-servant. Accessed September 30, 2019.

The author has no commercial conflicts of interest to disclose.

FromDecisions in Dentistry. November/December 2019;5(10):16,18,21—22.

Ortho Wire To Use For Fixed Retainer?,

Source: https://decisionsindentistry.com/article/fixed-retention-in-orthodontics/#:~:text=Current%20orthodontic%20opinion%20recommends%20either,rigid%2C%20round%20stainless%20steel%20wire.&text=Five%2Dstranded%20coaxial%20wires%20are,retainers%20rather%20than%20dead%20soft.

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