acific Coast Society of Orthodontists Bulletin Summer 2018 - 27

Program Talk
Special Section

RETENTION

Retention

Dr. Dawn Pruzansky
Adjunct Faculty
Postgraduate Orthodontic Program,
Arizona School of
Dentistry & Oral Health

The retention phase of orthodontic treatment
maintains the dentition in their aligned positions. A standardized and universal retention protocol is still controversial, and a 2006 Cochrane
Review found that there was "insufficient research
data on which to base a retention protocol for
clinical practices at present."1 Since then, there
have been attempts to compare the effectiveness
of different retainers and protocols, as well as to
quantify post-treatment tooth movement.2-4

ley (with or without posterior bite plate) or Essix.
Deep bite cases most often receive a Hawley with
an anterior bite plate. Crowding and spacing
cases varied greatly, but many of these, as well as
midline diastema cases, receive a fixed retainer.
Posterior crossbite cases receive a Hawley or TPA,
while anterior crossbite cases receive a Hawley or
Essix. Phase I retention cases receive a Hawley or
fixed retainer to allow for eruption of the permanent dentition.

Statistically insignificant differences have been
found between Hawley and vacuum-formed
retainers as they relate to settling movements.2,3
A 2011 survey of orthodontists revealed some
trends in retainer preference, but no clear-cut
retention protocol.4

Post-retention Protocol
The post-retention protocol varies by faculty, but
a general consensus seems to be full-time wear
for three to six months, followed by nighttime
wear. Time points for retainer checks also vary;
most programs schedule a retainer check within
two months of debond, and the interval after
that ranges from three to six months. Most
patients are considered dismissed from retention
at two years after debond. After two years, most
programs reserve the right to charge for an office
visit to adjust the retainers.

Challenges for Residents
The lack of a definitive protocol may present
challenges to residents due to the variability of
preferences between institutions and faculty
members. Program Directors of all PCSO postgraduate orthodontic programs were e-mailed a
survey regarding the selection of retainers based
on initial malocclusion, retention guidelines and
instructions, and recall protocols. In this issue,
Program Talk explores the various retention
strategies available to our residents.
Of the current PCSO residency programs that
responded to our questionnaire (N=7), slightly
more than half reported that residents make
their own retainers. Some programs require a certain number of retainers to be fabricated, while
other programs require that all vacuum-formed
and/or fixed retainers be made in-house. The
type of retainer that the patient receives varies
greatly with each program, but most programs
do provide a vacuum-formed overlay retainer
when delivering a fixed retainer.
The type of malocclusion will often influence
retainer selection; this is consistent with program responses. Extraction cases most commonly receive a (wraparound) Hawley or Essix
retainer. Anterior open bite cases receive a HawSummer 2018  PCSO Bulletin

Records taken for retention are equally divided
between alginate impressions and intraoral scanners. Post-retention records are typically taken
one to two years after debond. A few programs
take records at debond only with post-retention
records taken as needed.
Anecdotally, some respondents felt that Essix
retainers may have better compliance due to
esthetics, but this finding has not been proven in
the literature.5,6 Breakage seems to be highest in
the fixed retainer group, followed by vacuumformed retainers, and lastly, by Hawley appliances.
Minor relapse in the retention phase can be corrected with both fixed and removable appliances,
depending on the type of tooth movement indicated. The programs were split with regards to
charging a patient to correct relapse - half of
the programs do not charge, while the other half
may charge depending on the severity of the
relapse.
Continued on page 30

Table of Contents for the Digital Edition of acific Coast Society of Orthodontists Bulletin Summer 2018