acific Coast Society of Orthodontists Bulletin Summer 2018 - 41

Faculty Files
Special Section

RETENTION

Dr. Richard M. Stevens
Clinical Professor
of Dental Medicine
Roseman University
of Health Sciences

Research, Thoughts, and Ruminations
on Orthodontic Retention
As proposed by Drs. Naghavi and Jerrold, the
theory that there should be "a rational rationale
regarding retention"1 is very appealing and
makes sense from a logical as well as a professional perspective. With a myriad of retention
methods, options, protocols, and recommendations, how does one come to any sort of rationale
for their protocol regimen? How do we handle a
patient's need to maintain an investment in
his/her Hollywood smile and avoid the persistent
entropy faced by the orthodontic profession by
rendering treatment in a dynamic and everchanging environment? Within the confines of a
brief article, it is impossible to do anything more
than scratch the surface of this dynamic and perplexing question. But we can provide some food
for thought and trigger some reflection and discussion as we attempt to come to grips with the
expectations of our patients and the demands of
our busy practices and lives.
Hold That Smile
Relapse and retention go hand-in-hand and are
a constant concern to orthodontists and their
patients. The British Orthodontic Society is currently attempting to build awareness among the
previously treated population that retainers are
to be worn for life. They have instituted a campaign entitled "Hold that Smile" in order to help
motivate patients to better comply with retainer
wear.2 A recent, unpublished study completed at
Roseman University of Health Sciences in the
Advanced Education in Orthodontics and Dentofacial Orthopedics/MBA (AEODO/MBA) Residency
Program, makes reference to an increasing number of patients seeking treatment to address
relapse as one of the principle reasons to promote further research in the area of retention.3
Earlier surveys of AAO members done in 2010
and 2011 showed some interesting trends.4,5
The 2010 survey showed that in spite of a move
toward clear retainers, over 58% of clinicians

Summer 2018  PCSO Bulletin

prescribed a maxillary Hawley retainer, and 40%
utilized a mandibular fixed retainer.4 The survey
done in 2011 showed an increase in the use of
vacuum-formed and fixed retainers for both
arches, concurrent with a decrease in the use of
Hawley retainers and a move toward lifelong
retainer wear protocols (which were also recommended by the authors).5 Mention was made of
speculation that the motivation for increased
use of clear vacuum-formed retainers may be
economic with patient demand for more aesthetic types of retention offering some additional justification.
Given the limited reported evidence on retainer
types and retention protocols, the purpose of the
Roseman survey3 was to identify the orthodontic
retainers and retention protocols prescribed
most commonly by orthodontic practitioners in
the United States and to map out retention types
and protocols as they are actually used. Although
there is variation among individual orthodontists, interesting trends exist as to the generally
accepted and most prevalent retainers being
used. The survey respondents (70% solo practitioners, 42% having at least 16 years of clinical
experience) provided the following insights: only
5% used fixed maxillary retention (limited to the
incisors); 41% used mandibular fixed retention
(3-3 with every single tooth in the span bonded);
60% of those using fixed retainers noted braided
wire as the material of choice; and 80% fabricated the retainers in-house. Among those using
removable retainers, there was an even distribution, with 28% using Hawley retainers and 31%
vacuum-formed; 39% of respondents make all
retainers in-house, and most doctors fabricate
their own vacuum-formed retainers. The most
popular and commonly used vacuum-formed
material was the 1 mm clear splint material. In
terms of post-insertion retention protocols, 67%
see their patients for a minimum of three retention checks, with 70% reporting that the first

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