retention
TRANSCRIPT
A trial performed in a public dental clinic used a bloodglucose monitor to screen for diabetes. The monitor waseasy to set up. A small cardboard test strip was loadedinto the barrier-wrapped monitor just before use duringthe periodontal assessment. Anterior sites with a periodon-tal probing depth of at least 3 mm were preferred and pro-vided suitable GCB volume. The site was selected, the areawas gently cleared of plaque and debris, then it was rinsed,dried, and reprobed to ensure an uncontaminated sample.The loaded test strip was brought into contact with theGCB, avoiding contact with the tooth or gingival tissue(Fig 3). The sample was collected and processed within 5s (Fig 4). The monitor was then set aside and the periodon-tal assessment completed. Participants were satisfied withthe screening procedure and weremore interested in learn-ing about diabetes and its importance to oral health.
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Clinical Significance.—The ability to screenfordiabetes inadentalsettingappears tobeasim-ply and seemingly cost-effective measure thatshould be well-received by patients. Appropriate
4 Dental Abstracts
follow-up with patients who have increasedblood glucose levels could be included with den-tal appointment reminders. This could also serveas a check on diabetes diagnostic testing out-comes. The screening should be accompaniedby health education for the patient so he or shebecomes more aware of the link between oraland systemichealth. A cost-effectiveness analysisshould be conducted along with an investigationinto the efficacy of the GCB glucose screeningmodel and patient and provider satisfactionlevels with the process.
Garton BJ, Ford PJ: Root caries and diabetes: Risk assessing toimprove oral and systemic health outcomes. Austral Dent J57:114-122, 2012
Reprints available from P Ford, School of Dentistry, The Univ ofQueensland, 200 Turbot St, Brisbane, QLD 4000, Australia; e-mail:[email protected]
OrthodonticsRetention
Background.—After orthodontic treatment, teeth tendto return to their initial position, so a retention phase is anintegral part of orthodontic treatment. Factors that contrib-ute to relapse of position include periodontal causes (bone,periodontal ligament, and gingival fibers remodeling), ac-tive growth after treatment, habits that exert forces for 6-8 h a day or more, and normal maturation and decreasein arch perimeter (adjustments). As a result, arch lengthand intercanine distance decrease and mandibular crowd-ing increases. The timing and extent of relapse cannot bedetermined individually, nor are there pretreatment vari-ables that predict relapse. Despite this known situation,few research data provide a foundation for the clinical basisof retention.
Types of Retainers.—Fixed or bonded retainers can bemade of thick or multistranded wire. Thick wire is bondedto two or three teeth, whereas multistranded wire isbonded to three or more teeth (Fig 1).
Removable retainers include acrylic/wire types, clearthermoplastic types, and other designs. The acrylic/wire(Hawley) retainers are rigid but adjustable and permit the
occlusion to settle somewhat. However, they are not as es-thetic as other options. The clear thermoplastic retainersoffer good esthetics and can be readily fabricated. However,their occlusal coverage does not permit settling. Positionersand silicone-based retainers are also used.
Evidence-Based Use of Retainers.—The principalconcerns associated with retention are efficacy, meaningthe retainer actually maintains orthodontic correction;breakage and repairs with fixed retainers; and long-termeffects in terms of periodontal, gingival, and dental param-eters with respect to adjacent teeth. Fixed retainers arebonded to incisors and can retain tooth alignment.Canine-only bonded retainers maintain orthodontic align-ment for most patients, but incisor irregularity can de-velop in some cases. Removable retainers are only aseffective as patient compliance permits. Most patientscomply with retainer wear less and less over time, withfewer than half of patients wearing retainers as directed2 years after completing orthodontic treatment. However,among removable retainers, clear thermoplastic retainersare associated with better patient satisfaction and compli-ance than are acrylic/wire-type retainers. In addition,
Fig 1.—Examples of mandibular fixed retainer. Top, 0.03000 stain-less steel canine-only bonded retainer. Bottom, 0.019500 multi-stranded fixed retainer bonded to mandibular canines andincisors. (Courtesy of Heymann GC, Grauer D, Swift EJ Jr: Contem-porary approaches to orthodontic retention. J Esthet Restor Dent24:83-87, 2012.)
patients with good hygiene can wear retainers without anincreased risk of long-term gingival or periodontal prob-lems. Operator technique is an essential factor determin-ing success and long-term effectiveness withoutcomplications.
Guidelines.—Each patient must be assessed to formu-late a custom retention protocol. Recommendations are of-fered to guide most cases.
Fig 4.—Overlay mandibular retainers. Left, Clear thermoplastic retainerRemovable acrylic/wire (modified Hawley) mandibular retainer over fixedmann GC, Grauer D, Swift EJ Jr: Contemporary approaches to orthodon
For growing patients, retention is best achieved usinga mandibular bonded retainer to each tooth or to caninesonly, depending on the initial crowding status. An addi-tional acrylic/wire or thermoplasatic mandibular overlay re-movable retainer is also advised (Fig 4). A maxillaryremovable retainer of the acrylic/wire or thermoplastictype can be used. Bonding is advisable in cases where spac-ing was a concern before treatment.
For adult patients, a mandibular retainer bonded toeach tooth or to canines only, depending on the initialcrowding status, can provide adequate retention. An addi-tional mandibular overlay removable retainer of theacrylic/wire or thermoplastic type can also be used. De-pending on pretreatment crowding or spacing, a maxillaryflat splint and/or bonded retainer can be used. The initialvertical facial pattern determines the bite-plane effect anddesign.
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Clinical Significance.—Rather than using theterm relapse, it may be more accurate to denotemovement after orthodontic treatment as post-orthodontic change. Clinicians agree that somesort of retention is needed after orthodontictreatment is complete, and long-term studiesshow that fixed retention has a positive effect.A removable retainer is also used to retain teethnot included in the fixed retainer and asa backup in case the fixed retainer fails.
Heymann GC, Grauer D, Swift EJ Jr: Contemporary approaches toorthodontic retention. J Esthet Restor Dent 24:83-87, 2012
Reprints not available
er fixed mandibular retainer bonded to all anterior teeth. Right,andibular retainer bonded to all anterior teeth. (Courtesy of Hey-retention. J Esthet Restor Dent 24:83-87, 2012.)
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