There has been a number of articles written about fixed lingual retainers. I also often get questions on this topic.
In a recent study”Inadvertent tooth movement with fixed lingual retainers” published by Timothy G. Shaughnessy,a William R. Proffit,b and Said A. Samarac state that evidence suggests that: Highly flexible twist wires bonded to all the teeth appear to be the most likely to produce inadvertent tooth movement.
What did they ask? “Our objectives in this article were to illustrate examples of inadvertent tooth movement created by fixed lingual retainers, discuss the most likely causes, make recommendations for prevention and retention management, and discuss the periodontist-orthodontist interactions in retreatment to correct severe problems.”
What did they do? They showed examples of retainer-created inadvertent tooth movement. They looked at the Causes of inadvertent tooth movement. They looked at the Prevention of inadvertent tooth movement. They also showed an example of Coordinated orthodontic-periodontic retreatment of a patient with periodontal damage
What did they think?
1. Passive and securely bonded fixed anterior retainers are an effective way to prevent posttreatment relapse but require regular supervision.
2. Small-diameter flexible spiral wires bonded to each tooth pose the greatest risk for creating significant inadvertent tooth movement and resulting complications.
3. Early detection of bonding failures, wire breakage, and tooth movement created by the retainer is critical in preventing major problems.
4. A patient with a fixed retainer should be seen regularly by the general dentist if not by the orthodontist, and the orthodontist should accept responsibility for dealing with problems if they arise.
5. Interaction with a periodontist using bone-induction procedures is needed for retreatment of patients with severely displaced teeth.
“A fixed retainer made with dead soft wire is the least likely to create torque problems but is the most likely to break. Highly flexible twist wires bonded to all the teeth appear to be the most likely to produce inadvertent tooth movement, but this also can occur with stiffer wires bonded only to the canines.”
What did I think? This was a very interesting paper as it covered several problems that may arise from using fixed lingual retainers and suggested solutions for preventing these issues.
Final thoughts? I think it is important to carefully select patients as candidates for fixed lingual retainers for considering both hygiene and unwanted tooth movement factors. I think it is wise to avoid small-diameter flexible spiral wires as these wires pose the greatest risk for creating significant inadvertent tooth movement and resulting complications.
Patients with a fixed retainer should be seen regularly by the general dentist if not by the orthodontist, and the orthodontist or whoever treated the patient with orthodontic services should accept responsibility for dealing with problems if they arise.