Dentaltown October 2016 - 50

orthodontics
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Continued from p. 48
[posted 7/25/2016]
One more comment: Despite using a fi xed retainer, the forces that we are trying to defeat
are still active. This means that there is a loss of arch length with age. Do the lower front teeth
move backward? Do the lower molars move forward? Who knows; who cares? Those forces are
still active, though, despite the best retainer system.
I like to leave the fi xed retainer on until patients start looking at nursing home brochures.
They don't always do that and sometimes I do remove the fi xed retainer. I always use a thin
diamond wheel (0.14mm) and break contact from mesial of 3 to mesial of 3. This seems to make
a big difference in how stable the teeth are after fi xed retention removal.
If I was using a removable retainer, I would periodically do the same thing if I noticed a little
bit of movement of if the contacts were tight. ■
7/26/2016

Billy Wonka
Member Since: 08/31/08
Post: 31 of 36

LA Dentist, cowdr, JimmyJames, ncobb and davidpalmer: I've been in the exclusive
practice of orthodontia since 1999. From 1999-2002 or so, my retention protocol was either U/L
Hawley retainers or U Hawley and L 3-3 fi xed lingual, bonded usually only to L3s but once in
a while to all six lower anterior teeth.
I typically based my decision on L Hawley or L 3-3 fi xed on the amount of pretreatment
crowding and/or how much difference there was between pretreatment and post-treatment
intercuspid widths as measured from cusp tip to cusp tip of LR3-LL3. If I expanded intercuspid
width by more than 1-2 mm, I would tend to use a lower fi xed lingual retainer.
TN Doc: I followed all my retention patients indefinitely. That is, my door is never closed
on them, and I never charge for retainer checkups no matter how long they've been out of treatment. After deband, I see them at six weeks, three months, six months, six months, six months,
then yearly until they decide not to come back.
Everyone: I noticed that with my retention patients who were prescribed Hawley retainers,
lower anterior relapse was much more prevalent than those who had a lower fi xed. Based on my
own empirical findings corroborated by refereed orthodontic research, I decided in 2003 to go
to lower fi xed in 95 percent or more of cases. The only exceptions were patients who tell me they
won't floss, or the parents and/or the patients request removable retention.
I won't try to convince you that a lower fixed lingual retainer bonded to only L3s combined with
an excellent posterior interdigitation and proper anterior coupling is the best method of retention
there is. I have done my fair share of lower lingual retainers bonded to all lower anterior teeth and
have seen many placed by other orthodontists, and I can assure you that flossing is all but impossible.
As to my credentials, I have been in practice for 17 years and have treated more than 8,000
cases. I'm a diplomate of the ABO and an affiliate member of the Angle Society of Orthodontists.
I used to teach at UCLA, albeit very briefly and did not win any teaching awards like Dr. Ruff
(I don't have his dedication, teaching talent or time.)
These four patients below are consecutive retention patients who I saw in the past three
clinical days, and they have been out of treatment from 18 months to over five years. Some of
them still have an upper removable retainer, while others "left them at home." For each case, I
include the deband photos, the current retention photos and an untouched close-up mandibular
occlusal view. I will let you all draw your own conclusions as to the effectiveness of the lingual
fi xed retainer bonded only to L3s.
P.S. To Dr. Ruff, I choose a mesh-pad stainless steel design instead of an .032 TMA, mainly
because I think that it is easier for patients to use just regular floss to thread between L3-L2. With
your TMA design, do your patients have to use floss threaders, or perhaps Superfloss?

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