|Year : 2020 | Volume
| Issue : 4 | Page : 80-82
Evaluation of orthodontic retention protocol among general dentist: A cross-sectional study
Bhuvaneswari Mani1, Abhishek Janardhanam2, Haritha Doraiswamy3, Selvakumar Ramar2, Anupama S Prakash4, S Srinidhi5
1 Department of Orthodontics and Dentofacial Orthopedics, Karpaga Vinayaga Institute of Dental Sciences, Kancheepuram District 603308, Tamil Nadu, India
2 Consultant Orthodontist, Chennai, India
3 General Dentist, Namakkal, India
4 Pedodontics and Preventive Dentistry, Karpaga Vinayaga Institute of Dental Sciences, Kancheepuram District 603308, Tamil Nadu, India
5 Public Health Dentistry, Karpaga Vinayaga Institute of Dental Sciences, Kancheepuram District 603308, Tamil Nadu, India
|Date of Submission||03-Oct-2020|
|Date of Acceptance||05-Oct-2020|
|Date of Web Publication||29-Dec-2020|
Dr. Bhuvaneswari Mani
Department of Orthodontics and Dentofacial Orthopedics, Karpaga Vinayaga Institute of Dental Sciences, Kancheepuram District 603308, Tamil Nadu.
Source of Support: None, Conflict of Interest: None
Aim: The current survey was conducted to explore the retention protocol, complication regarding retainers, and long-term follow-up regarding orthodontic retention among the general dentist in Tamil Nadu. Materials and Method: This was a cross-sectional web-based questionnaire survey conducted among general dentists in Tamil Nadu. The pilot study was conducted to estimate the sample size and the final sample size arrived was 500 participants. The predesigned and validated, self-administered, structured 10 questions related to retention protocol, complication regarding retainers, and long-term follow-up regarding orthodontic retention. The statistical analysis was done using Statistical Package for Social Sciences SPSS (V 22.0) The frequency distribution was computed. Result: The current survey revealed that 500 (100%) respondents had awareness about the retention protocol after orthodontic treatment. Out of all the respondents 33 (6.6%) chose for a removable retainer, 367 (73.4%) chose a fixed retainer,84 (16.8%) opted for an invisible retainer and the remaining practitioner chose a combination of removable and fixed retainer. Nearly 452 (90.4%) general practitioners advised their patients to contact their orthodontist in case of a broken retainer and the remaining 48(9.6%) general practitioners can make retainers by themselves. Out of all the respondents, nearly 54.6% general dentists gradually taking over the case during monitoring and follow-up phase. Conclusion: In conclusion, the current study showed that a vast majority of the dentists were aware of the retention protocol and they are confident enough to deal emergency situation like broken retainers and most of the dentist prefer fixed retainer over other types of retainer.
Keywords: Elapse, eneral dentist, retention
|How to cite this article:|
Mani B, Janardhanam A, Doraiswamy H, Ramar S, Prakash AS, Srinidhi S. Evaluation of orthodontic retention protocol among general dentist: A cross-sectional study. Int J Oral Care Res 2020;8:80-2
|How to cite this URL:|
Mani B, Janardhanam A, Doraiswamy H, Ramar S, Prakash AS, Srinidhi S. Evaluation of orthodontic retention protocol among general dentist: A cross-sectional study. Int J Oral Care Res [serial online] 2020 [cited 2021 Jan 24];8:80-2. Available from: https://www.ijocr.org/text.asp?2020/8/4/80/305359
| Introduction|| |
The retention concept after orthodontic treatment was agreed by Moyers in 1973. It is defined as “the holding of teeth following orthodontic treatment in the treated position for the period of time necessary for the maintenance of the result.” Marielle Blake et al. in 1998 explained the factors affecting the treatment stability as follows: altered arch form, gingival and periodontal tissues, mandibular incisor dimension, third molar development, growth of an individual, post treatment tooth position and few environmental factors. Blake and Bibby introduced six basic treatment principles for orthodontists to improve posttreatment stability. Retention phase is most essential next to the orthodontic treatment. So, all dentists, orthodontists and patients should aware the importance of retainers., In 2008, a published survey among orthodontists in the United States showed that invisible retainers had continued to gain popularity.
In 2010, the survey conducted among 2000 orthodontists on the subject of orthodontic retention and concluded that maxillary Hawley’s retainers and mandibular fixed lingual retainers were the most common retainers used for less than 9 months. Few authors preferred long-term retention for most of the patients because of complexity in deciding which patients will remain stable after treatment.,, Rigid canine-to-canine retainers have proven more efficient in averts rotation of the bonded teeth and this retainer is more prone to fail at the enamel adhesive interface. Flexible spiral wires (FSWs) possess barrier like torque-issues of incisors or canines even though bonded site being confidently attached and perfect., Wong and Freer suggested that above 50% of patients disclosed truth that they did not wear retainers as per the instruction of the clinician. The current survey was conducted to explore the retention protocol, complication regarding retainers, and long-term follow-up regarding orthodontic retention among the general dentists in Tamil Nadu.
| Materials and Methods|| |
A cross-sectional descriptive questionnaire survey was conducted among the practicing general dentists in Tamil Nadu using an online questionnaire form. A pilot study was conducted to determine the sample size. After conducting pilot study, the final sample size arrived was 500 subjects. Pretesting and pilot study samples were not included in the main sample size. A structured questionnaire was framed which contained 10 questions related to retention protocol, complications regarding retainers, and long-term follow-up regarding orthodontic retention, and then online questionnaire link was forwarded to 500 general dentists. A convenient sampling technique was used. All participants completed questionnaires with the duration of 3 months from March to May 2020.
The data collected were entered into Microsoft Office Excel and analyzed by using the Statistical Package for Social Sciences SPSS (V 22.0) (SPSS, Inc., Chicago, IL, USA). The frequency distribution was computed.
| Results|| |
Among the 500 study subjects, 285 (57%) were females and 215 (43%) were males. Evaluation of 500 study subjects showed that 182 (36.4%) had 0–10 years of experience, 216 (43.2%) had 10–20 years of experience, and 102 (20.4%) had 20–30 years of experience in dental practice [Table 1].
|Table 1: Distribution of study subjects according to years of experience in dental practice|
Click here to view
The current survey revealed that 500 (100%) respondents had awareness about the retention protocol after orthodontic treatment. Out of all the respondents, 33 (6.6%) chose removable retainers, 367 (73.4%) chose fixed retainers, 84 (16.8%) opted for invisible retainers, and the remaining practitioners chose a combination of removable and fixed retainers after orthodontic treatment [Graph 1]. About 40.3% of respondents offer orthodontic services in their practices and bond retainers in their own patients.
|Graph 1: Distribution of study subjects according to the preference of retainer in their clinical practice|
Click here to view
Broken retainer is one of the most common problems encountered by general practitioners. Approximately 452 (90.4%) general practitioners advised their patients to contact their orthodontists and the remaining 48 (9.6%) general practitioners have the ability to make retainers by themselves [Graph 2].
|Graph 2: Distribution of study subjects according to management of broken retainer by general practitioner|
Click here to view
About 82.6% of general practitioners stated that 3-2-1-1-2-3 retainers are highly effective in preventing relapse comparing to 3-3 retainers. The opinion of general dentist varies regarding how long a removable retainer should be worn. About 9.2% of survey participants ended the retention period within 6 months whereas majority of respondents (90.8%) continued for more than 1 year. In case of fixed retainers, 82.2% advised their patients to wear them permanently and 77.8% removed the bonded retainers. Out of all the respondents, nearly 54.6% general dentist gradually taking over the case during monitoring and follow-up phase.
| Discussion|| |
The current survey revealed that 500 (100%) respondents had knowledge about the retention protocol. Out of all the respondents, most of the responded 73.4% chose fixed retainers and other studies conducted by other countries like Australia and New Zealand, the Netherlands, the United States, and Norway chose fixed retainers contrast to other types of retainers. Levin et al. conducted that orthodontic treatment and fixed retainers were associated with an increased incidence of gingival recession, increased plaque accumulation, and increased bleeding on probing. Katsaros et al. and Pazera et al. presented an FSW retainer associated with complication like extreme unwanted movement of mandibular anterior teeth. In the extreme situation, a root of the tooth was moved out of the alveolar bone completely. Other group of study participant prefers removable retainers and essix retainers. On supporting these aforementioned results, the study conducted by Barlin et al. investigated the effectiveness of Hawley’s retainer and vacuum-formed retainers in maintaining incisor irregularity, intercanine and intermolar widths, and arch length. There was no statistically significant difference in the degree of relapse between the two types of retainers. On contrary to this, another study investigated the effectiveness of Hawley and vacuum-formed retainers in a randomized study with a large sample size carried out over a 6-month retention period and concluded that vacuum-formed retainers were more effective in the lower incisor region. Atack et al. concluded that there is no consistent evidence demonstrating that bonded retainers are more valuable than vacuum-formed retainers. About 82.2% general dentists advised their patients to wear them permanently. Previous studies by Reitan verified that periodontal fibers (PDL) required around 8 months for reorganizing and adapting to the new tooth position. On the contrary, the study by Redlich et al. explained that elastic fibers along with active osteoblastic formation and osteoclastic resorption of surrounding alveolar bone are central for relapse to occur. Similar study was conducted in Switzerland and the results showed that majority of respondent recommend permanent retention to their patients.
| Conclusion|| |
As a general dentist, everyone should aware of the retention protocol and long-term follow-up measures to be followed in order to reduce relapse. The present study concluded that vast majority of dentist aware about the retention protocol and they are confident enough to deal emergency situation like broken retainers and most of the dentists prefer fixed retainers than other types of retainers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Moyers RE Handbook of Orthodontics for the Student and General Practitioner. 3rd ed. Chicago: YearBook; 1973. p. 442.
Blake M, Bibby K Retention and stability: A review of the literature. Am J Orthod Dentofacial Orthop 1998;114:299-306.
Blake M, Garvey MT Rationale for retention following orthodontic treatment. J Can Dent Assoc 1998;64:640-3.
Johnston CD, Littlewood SJ Retention in orthodontics. Br Dent J 2015;218:119-22.
Durbin DD Relapse and the need for permanent fixed retention. J Clin Orthod 2001;35:723-7.
Keim RG, Gottlieb EL, Nelson AH, Vogels DS JCO study of orthodontic diagnosis and treatment procedures, part 1: Results and trends. J Clin Orthod 2008;42:625-40.
Valiathan M, Hughes E Results of a survey-based study to identify common retention practices in the united states. Am J Orthod Dentofacial Orthop 2010;137:170-7; discussion 177.
Zachrisson BU Long-term experience with direct-bonded retainers: Update and clinical advice. J Clin Orthod 2007;41:728-37; quiz 749.
Renkema AM, Sips ET, Bronkhorst E, Kuijpers-Jagtman AM A survey on orthodontic retention procedures in the netherlands. Eur J Orthod 2009;31:432-7.
Cerny R, Lloyd D Dentists’ opinions on orthodontic retention appliances. J Clin Orthod 2008;42:415-9.
Butler J, Dowling P Orthodontic bonded retainers. J Ir Dent Assoc 2005;51:29-32.
Katsaros C, Livas C, Renkema AM Unexpected complications of bonded mandibular lingual retainers. Am J Orthod Dentofacial Orthop 2007;132:838-41.
Pazera P, Fudalej P, Katsaros C Severe complication of a bonded mandibular lingual retainer. Am J Orthod Dentofacial Orthop 2012;142:406-9.
Wong P, Freer TJ Patients’ attitudes towards compliance with retainer wear. Aust Orthod J 2005;21:45-53.
Wong PM, Freer TJ A comprehensive survey of retention procedures in australia and new zealand. Aust Orthod J 2004;20:99-106.
Vandevska-Radunovic V, Espeland L, Stenvik A Retention: Type, duration and need for common guidelines. A survey of norwegian orthodontists. Orthodontics (Chic) 2013;14:e110-7.
Levin L, Samorodnitzky-Naveh GR, Machtei EE The association of orthodontic treatment and fixed retainers with gingival health. J Periodontol 2008;79:2087-92.
Barlin S, Smith R, Reed R, Sandy J, Ireland AJ A retrospective randomized double-blind comparison study of the effectiveness of hawley vs vacuum-formed retainers. Angle Orthod 2011;81:404-9.
Rowland H, Hichens L, Williams A, Hills D, Killingback N, Ewings P, et al
. The effectiveness of hawley and vacuum-formed retainers: A single-center randomized controlled trial. Am J Orthod Dentofacial Orthop 2007;132:730-7.
Atack N, Harradine N, Sandy JR, Ireland AJ Which way forward? Fixed or removable lower retainers. Angle Orthod 2007;77:954-9.
Reitan K Clinical and histologic observations on tooth movement during and after orthodontic treatment. Am J Orthod 1967;53:721-45.
Redlich M, Rahamim E, Gaft A, Shoshan S The response of supraalveolar gingival collagen to orthodontic rotation movement in dogs. Am J Orthod Dentofacial Orthop 1996;110:247-55.
[Figure 1], [Figure 2]