Escolar Documentos
Profissional Documentos
Cultura Documentos
mu r Polat, DDS,
b
and Tamer Bu yu kyilmaz, DDS, MSD
c
Konya, Turkey
Retention is a major part of orthodontic treatment, not an optional secondary protocol. In recent years,
studies investigating dentofacial changes during and after the growth period have led most clinicians to use
xed retention appliances after treatment. Fixed retainers can be attached to the teeth directly or indirectly.
We present a practical, indirect method for bonding xed retainers, using Sondhi Rapid-set Indirect Bonding
Adhesive (3M Unitek, Monrovia, Calif). (Am J Orthod Dentofacial Orthop 2003;124:327-30)
I
n orthodontic treatment, the stability of the nal
occlusion is as important as the correction
achieved. Increases in crowding have been found
in untreated (growing) normal subjects at 10-year
follow-up examinations.
1
Even when excellent tooth
alignment and occlusion are obtained through orth-
odontic therapy, unorganized periodontal bers, im-
mature bones, and functions not yet adapted to the
new form can make these changes hard to maintain.
Orthodontists must consider the dentofacial and den-
titional changes during and after normal growth and
development and choose an appropriate retention
protocol.
In 1881, Smith introduced a retention appliance
made from a simple vulcanite plate with a bar that
extended over the labial aspect of the maxillary inci-
sors.
2
Jackson
3
said not infrequently cases are pre-
sented that require more skill in retaining the teeth than
in regulating them, and he was the rst to mention
xed retention. He also advised removing the circum-
ferential gingival bers after correcting rotation, and he
was the rst to introduce berotomy in the orthodontic
literature. Angle
4
stated that obtaining normal occlu-
sion during the eruption period would decrease the
retention time, but he added that when habits are not
overcome and the rotation and disturbance to the
periodontal bers are extreme, it might be necessary to
cut the gingival bers. He stated that most appliances
are removed too soon, before the teeth are thoroughly
established in occlusion, and he advised, In doubt-
ful cases, wearing delicate and efcient appliances
indenitely may be far less objectionable than a
malocclusion.
As more studies of long-term stability were
published, support for xed retention grew. Tweed
5
suggested attaching a lingual bar between banded
mandibular premolars. With the evolution of acid
etching in orthodontic practice, bonding provided
new retention alternatives. Lingual retainers were
being made from smooth round or rectangular wires,
but Zachrisson
6
reported on the structural advantages
of multistranded exible wires and said that, because
of their exibility, these wires did not restrict physio-
logical tooth movement. Thus, the multistranded
structure provides extra mechanical retention with
the bonding adhesive.
Fourth generation retainers
6
and polyethylene ber
materials
7
have recently come into clinical use, but
0.0215-in multistranded stainless steel wire remains the
most popular choice for retainers.
8
When placing a retainer with a direct bonding
technique, various materials and methods are used to
xate the wire, including dental oss,
9
elastics,
10
ligature wire, wires tack-welded to the retainer
wire,
11
and nger pressure.
11
But contamination of
the etched surface or changes in wire position can
disturb the contacts, and incorrect placement of the
retainer not only puts the stability of the treatment
result at risk, but also often leads to failure. To avoid
this, an indirect bonding method was introduced in
which the attachment is rst t to a stone cast and
then transferred to the mouth with a tray. Indirect
bonding has several advantages over direct bonding,
including correct placement of the attachments,
12,13
less chair time,
13
and prevention of etched surface
contamination. But the method also has some disad-
From the Department of Orthodontics, Selcuk University, Konya, Turkey.
a
Associate professor.
b
Research assistant.
c
Associate professor and clinical instructor; private practice, Adana, Turkey.
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