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Five-year postretention outcomes of three retention methods: a randomized controlled trial
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).
2015 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 37, no 4, p. 345-353Article in journal (Refereed) Published
Abstract [en]

Objective: Comparison of three different retention strategies 5 years or more postretention. Design, Setting, and Participants: Randomized, prospective, single-centre controlled trial. Forty-nine patients (33 girls and 16 boys) were randomly assigned to one of three retention methods during 2 years by picking a ballot shortly before start of retention treatment. Inclusion criteria were no previous orthodontics, permanent dentition, normal skeletal sagittal, vertical, and transversal relationships, Class I dental relationship, space deficiencies, treatment plan with extractions of four premolars followed by fixed straight-wire appliance. Maxillary and mandibular Little's irregularity index (LII), intercanine and intermolar width, arch length, and overbite/overjet were recorded in a blinded manner, altogether 10 measurements on each patient. Significant differences in means within groups assessed by t-test and between groups by one-way analysis of variance. Interventions: Retention methods: removable vacuum-formed retainer (VFR) covering the palate and the maxillary anterior teeth from canine-to-canine and bonded canine-to-canine retainer in the lower arch (group V-CTC); maxillary VFR combined with stripping of the lower anterior teeth (group V-S); and prefabricated positioner (group P). Results: Maxillary mean LII ranged from 1.8 to 2.6 mm, mean intercanine width 33.6-35.3 mm with a significant difference between groups V-S and P, mean intermolar width 46.8-47.4 mm and mean arch length 21.8-22.8 mm. Mandibular mean LII ranged from 2.0 to 3.4 mm with a significant difference between groups V-S and P, mean intercanine width from 25.4 to 26.6 mm, mean intermolar width from 40.8 to 40.9 mm and mean arch length from 16.9 to 17.3 mm. Mean overbite ranged from 1.8 to 2.7 mm and mean overjet from 3.7 to 4.1 mm. Limitations: A single centre study could be less generalizable. Conclusions: The three retention methods disclosed equally favourable clinical results.

Place, publisher, year, edition, pages
Oxford University Press, 2015. Vol. 37, no 4, p. 345-353
Keywords [en]
Oral surgery & medicine, Dentistry
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-15807DOI: 10.1093/ejo/cju063ISI: 000359669100001PubMedID: 25452629Scopus ID: 2-s2.0-84939605358Local ID: 20064OAI: oai:DiVA.org:mau-15807DiVA, id: diva2:1419329
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
In thesis
1. Orthodontic retention: studies of retention capacity, cost-effectiveness and long-term stability
Open this publication in new window or tab >>Orthodontic retention: studies of retention capacity, cost-effectiveness and long-term stability
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Retention strategies, cost-effectiveness and long-term stability oftreatment outcome are essential aspects of orthodontic treatmentplanning.The overall aim of this thesis was to compare and evaluate threedifferent retention strategies, with special reference to short- andlong-term clinical stability and cost-effectiveness. The approach wasevidence-based, hence randomized controlled methodology was usedin order to generate high levels of evidence.This thesis is based on four studies:Papers I and II are based on randomized controlled trials, evaluatingthe stability of treatment outcome after one and two years of retention,using three different retention strategies: a maxillary vacuum-formedretainer combined with a mandibular canine-to-canine retainer; amaxillary vacuum-formed retainer combined with stripping of themandibular anterior teeth and a prefabricated positioner.Paper III presents a cost-minimization analysis of two years ofretention treatment.Paper IV is based on a randomized controlled trial documentingthe results five years post-retention.The following conclusions were drawn:Papers I and II• From a clinical perspective, asssessment after one year ofretention disclosed that the three retention methods weresuccessful in retaining the orthodontic treatment results.• After two years of retention, all three retention methods wereequally effective in controlling relapse at a clinically acceptablelevel.• Most of the relapse occurred during the first year of retention;only minor or negligible changes were found during the secondyear.• The subjects were grouped according to the level ofcompliance (excellent or good). After two years of retentionthere was a negative correlation between growth in bodyheight and relapse of mandibular LII in the group of subjectswith excellent compliance. The group with good complianceshowed a positive correlation (Paper II, Figure 3).• After two years of retention, growth in body height, initialcrowding and gender had no significant influence onmandibular LII (Paper II, Figure 4 and Table 4).Paper III• The cost minimization analysis disclosed that although thethree retention methods achieved clinically similar results, theassociated societal costs differed.• After two years of retention, the vacuum-formed retainer(VFR) in combination with a canine-to-canine retainer (CTC)was the least cost-effective retention appliance.Paper IV• After five years or more out of retention, the three retentionmethods had achieved equally favourable clinical results.Key conclusionsand clinical implicationsThis study compared the short- and long-term outcomes of orthodonticretention by three different methods: a maxillary vacuum-formedretainer combined with a mandibular canine-to-canine retainer;a maxillary vacuum-formed retainer combined with stripping ofthe mandibular anterior teeth and a prefabricated positioner. Allmethods gave equally positive clinical results in both the short-term,i.e. after one and two years of retention, and in the long-term, fiveyears or more post-retention. After two years of retention, the level of compliance affected theretention treatment result. However, no such effect was shown forbody height, the severity of initial crowding or gender.Today, there is increasing emphasis on the importance of economicaspects of healthcare. Of the three methods evaluated in this study,the least cost-effective, after two years of retention, was a vacuumformedretainer combined with a bonded canine-to-canine retainer.The clinical implication of this finding is that in patients meetingthe inclusion criteria, interproximal stripping of the mandibularanterior teeth, or the use of a prefabricated positioner, are highlyappropriate alternatives to a mandibular bonded canine-to-canineretainer.The overall conclusions are that there are a number of effectiveretention methods available and the clinician is not limited to routineuse of a bonded mandibular canine-to-canine retainer. The mostappropriate retention method should be selected on an individual,case to case basis, taking into account such variables as orthodonticdiagnosis, the expected level of patient compliance, patient preferencesand financial considerations.

Place, publisher, year, edition, pages
Malmö University, Faculty of Odontology, 2014. p. 66
Series
Swedish Dental Journal : Supplement, ISSN 0348-6672 ; 236
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7719 (URN)18050 (Local ID)9789171046031 (ISBN)9789171046048 (ISBN)18050 (Archive number)18050 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2022-06-27Bibliographically approved

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Petrén, SofiaBondemark, LarsLilja-Karlander, Eva

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