Dentaltown October 2016 - 48

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Continued from p. 46
to clean but it prevents the inevitable minor shifting of the lower incisors that mom and patient
(especially girls) notice in an instant and want corrected.
Not sure how zxzxzx keeps perfect alignment on lower incisors without bonding them to
the wire. ■
7/24/2016

BXT
Member Since: 07/11/05
Post: 23 of 36

As far as retention of the lower anterior teeth, I learned that fiberotomy helps in the retention process. Of course, a retainer (e.g., Hawley, Essix) or fixed retention (i.e., lingual bar) is needed as well.
Has anyone ever done fiberotomy? Do you think it works? What kind of retention do you
use after the fiberotomy? ■
7/24/2016

zxzxzx
Member Since: 02/28/03
Posts: 24, 26 & 29 of 36

I've seen published material saying it makes a difference to the upper anterior teeth but not
to the lower. Not sure why there is a difference.
The lingual bar is a superior choice for lower retention except in the following situations:
1. I've extracted a lower incisor
2. The patient started with lower anterior spacing. If the lower incisors relapse, they will
move forward
3. If the patient, especially an adult, started with severe lower crowding or rotations.
In the above three situations, I will use a wire attached to all front teeth, canine to canine. In
all other situations I will use a bar attached only to the canines. This can be a gold-plated wire,
this can be stainless steel, or this can be a TMA. The wire is whatever your preference is, but
cemented only to the 3s. It needs to be bonded with something other than a flowable composite.
I like Transbond LR, which is very strong and has only a small amount of flow.
As someone pointed out above, removable means just that. I don't expect patients to wear
removable retainers long term. Some do but most don't. You can say what you will about making
patients accept responsibility for long-term retention, and while that might be true legally, it
does not help your practice's reputation if the teeth move because of failure to wear upper and
lower removables. Other potential patients will look at those teeth and wonder why they should
spend the money if the teeth will not be straight long term.
My goal is to finish most patients with normal OB OJ. If I can achieve that, the lower fi xed
retainer holds it all together after the first year's settling has occurred and the patient has stopped
wearing the upper removable. There are exceptions, like midline diastema, that need their own
fi xed retainers, but in general the lower 3-3 holds it all together long term.
For that reason, I think a bar is a far superior retainer than wire attached to each tooth. I've
seen very few wires last long term. On the other hand, I've seen a lot of long-term bar wearers
out there. The wires bonded to all teeth either get loose once or twice and the patient decides to
have it removed, or it gets loose on one tooth and the tooth moves before the patient is aware of
it. That kind of thing usually does not happen when it is bonded just to the 3s. If it gets loose,
the patient knows it right away.
If you are going to use a bar, it has to be contoured to touch each lower tooth. This means
an impression has to be done. It can't be contoured chairside.
Do individual teeth sometimes move? Yes, but usually not much. If I see one start to move,
I will take a small 8mm diameter diamond wheel and polish the contact on both sides. That
seems to reduce movement tendencies. If movement is significant, I can make an Essix-style
retainer with pressure on one tooth to move it back into place. You do not need to remove the
fi xed retainer to do this. In those rare cases where I have to do an Essix, I will occasionally bond
the rotated tooth to the bar on a short term (six-month basis).
Continued on p. 50

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