March, 2006

Easy to Bond Lingual Retainers

En Español

Dr. Madhur Upadhyay, Dr. Sumit Yadav, Dr. Sameer Patil, and Dr. K.M. Keluskar

Since the introduction of bonding in orthodontics, fixed retainers have steadily grown in popularity among orthodontists. [1] They have the advantage of being fixed, esthetic, unobtrusive and provide stability of treatment results without much patient cooperation. However the accurate placement of lingual retainers has been questioned in the past, which has led to the development of numerous direct and indirect techniques for the precise placement of bonded retainers. [2,3,4] In this article we describe a precise, easy, cost effective and less time consuming technique for bonding lingual retainers.

Retainer Fabrication

1. Before taking impressions, remove the molar bands Figure 1. and then place them back on the molars without cementation.

   Figure 1. Before taking impressions, remove the molar bands

   

2. Take an alginate impression using standard trays.
3. Remove the bands from the patient’s mouth and place them in their appropriate position on the impression Figure 2. Sticky wax can be used for reinforcing the position of the bands.

   Figure 2. Remove the bands from the patient’s mouth and place them in their appropriate position on the impression

   

4. After the alginate impression has been poured in stone, the ‘working model’ is trimmed and the bands are checked for proper positioning.
5. A .0175″ multistranded wire is bent conforming to the lingual contours of the teeth to be retained. The terminal ends of the retainer wire, end up in close configuration with the molar bands. Figure 3.

   Figure 3. A .0175″ multistranded wire is bent conforming to the lingual contours of the teeth to be retained

   

6. Secure the retainer wire in place to the cast with super glue (Fevi kwik), the terminal ends of the retainer are soldered to the molar bands. Figure 4.

   Figure 4. Secure the retainer wire in place to the cast with super glue (Fevi kwik), the terminal ends of the retainer are soldered to the molar bands

   

7. Remove the retainer form the cast and wash gently in warm water to remove the adhesive (super glue). Figure 5.

   Figure 5. Remove the retainer form the cast and wash gently in warm water to remove the adhesive.

   

Retainer Placement

1. Isolate and etch the teeth to be bonded.
2. Place the molar bands along with the soldered retainer in the patient’s mouth and checked for accurate fit. Figure 6.

   Figure 6. Place the molar bands along with the soldered retainer in the patient’s mouth and checked for accurate fit. (Fig 6).

   

3. Bond the retainer with Transbond XT light-cured composite. Figure 7.

   Figure 7. Bond the retainer with Transbond XT light-cured composite

   

4. Cut the distal end to the last bonded tooth on either side of the retainer wire with a high speed tungsten carbide bur, and remove the molar bands. Figure 8.

   Figure 8. Cut the distal end to the last bonded tooth on either side of the retainer wire with a high speed tungsten carbide bur, and remove the molar bands

   

5. Trim and smooth the excess composite. Figure 9.

   Figure 9. Trim and smooth the excess composite.

   

Conclusion

An alternative technique for the construction and placement of bonded lingual retainers has been explained in this article. It has the following advantages over other conventional methods:

1. Precise placement of the retainer.
2. Economical, as no other material (like silicone or putty impression materials) or expensive equipment (vacuum formed splints) are required.
3. No need for fabricating transfer trays.
4. Easy to deliver with minimal patient discomfort.
5. Most of the procedure is carried out in the lab, thereby drastically reducing operator chairside time.
6. Minimal finishing and cleanup is required.

References

1. Bearn DR. Bonded orthodontic retainers: a review. Am J Orthod Dento Orthop 108:207 – 213,1995.

2. Hobson, R.S.; and Eastaugh, D.P.: Silicone putty splint for rapid placement of direct bonded retainers, J. Clin. Orthod 27:536-537, 1993.

3. Sheridan, J.J.; Ledoux, W.; and McMinn, R.: Essix retainers: Fabrication and supervision for permanent retention, J. Clin. Orthod 27:37-45, 1993.

4. Zachrisson, B.U.: Silicone Third generation mandibular bonded lingual 3-3 retainers, J. Clin. Orthod 29:39-48, 1995.

5. Acharya, B.; Acharya D.A; and Keluskar K.M: A Simple Transfer Tray For Bonding Lingual Retainers, J. Clin. Orthod 38:557-559, 2004.

Contributed by:

Dr. Madhur Upadhyay, Dr. Sumit Yadav, Dr. Sameer Patil, and Dr. K.M. Keluskar

Tags: lingual, retainer