Cochrane · intervention · CD002283

Retention procedures for stabilising tooth position after treatment with orthodontic braces

Martin, C, Littlewood, SJ, Millett, DT, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library

Oral Health Orthodontics5 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

as reported

No studies 11 · 33.3%Ungraded 5 · 15.2%Very low 15 · 45.5%Low 2 · 6.1%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Children and adults who have had retainers fitted or adjunctive procedures undertaken following treatment with orthodontic braces. There was no restriction for the presenting malocclusion or type of active orthodontic treatment undertaken. The participants had to be followed up at least three months after completing their orthodontic treatment. Excluded: people who had surgical correction of the jaws; people with a cleft lip or palate, or both, or other craniofacial syndrome; people who had orthodontic treatment based on extractions alone or the fitting of a passive space maintainer, or both	Forty-seven studies were identified that fulfilled the criteria of the review. All studies were parallel randomised controlled trials. Forty-seven studies were parallel-design studies and one was a cross-over clinical study. Thirty-eight studies were two-arm studies, seven were three-arm studies, and three were four-arm studies
Intervention	Retainers or adjunctive procedures, or both, after treatment with orthodontic braces. We included only studies where the full course of definitive orthodontic treatment was completed - we excluded data on retention strategies at the end of an initial phase of removable or functional appliance treatment. We excluded studies comparing techniques (not materials) for placing the bonded retainers. We did not include studies on aligners in this review	Circumferential supracrestal fiberotomy and removable retainer (n=2); Three types of fixed retainers and removable retainer (n=1); Hawley removable retainer (n=1); Multistrand wire versus direct-bonded polyethylene ribbon-reinforced resin composite for lingual retention (n=1); Modified thermoplastic retainer versus full coverage thermoplastic retainer (n=1); Part-time versus full-time wear of thermoplastic retainers (n=2); Begg retainers versus thermoplastic retainers (n=1); Hawley retainers versus thermoplastic retainers (n=10); Part-time versus full-time wear of Hawley retainers (n=1); Different types of fixed retainers (n=25); Lower multistrand stainless steel versus lower thermoplastic (n=2); Upper removable and lower fixed retainer versus upper removable retainer and lower adjunctive procedure (n=1); Upper removable and lower fixed retainer versus positioner (n=1)
Comparison	Fixed retainers/Removable retainers/No retainers/Hard tissue adjunctive procedures/Soft tissue adjunctive procedures	Removable retainer full time (n=2); Removable retainer nights only (n=1); Clear overlay removable retainer (n=1); Direct-bonded polyethylene ribbon-reinforced resin composite (n=1); Full coverage thermoplastic retainer (n=1); Full-time wear of thermoplastic retainers (n=2); Thermoplastic retainers (n=1); Hawley retainers (n=10); Full-time wear of Hawley retainers (n=1); Multistrand bonded retainers (n=25); Lower thermoplastic (n=2); Upper removable retainer and lower adjunctive procedure (n=1); Positioner (n=1)
Outcomes	Assessment of how well the teeth were stabilised using index of tooth irregularity (e.g. Little's index) or how the teeth meet together using index such as PAR index at least 3 months after fitting of retainer; Survival of the retainers assessed by how long they lasted without breaking (in months) or how many times they needed to be replaced or repaired during wear; Quality of life assessed in terms of patient's satisfaction; Adverse effects on health of teeth (decay assessed using indices of demineralisation) and surrounding structures (gums and other supporting structures assessed using periodontal indices or other markers of periodontal disease)	Assessment of stability (n=27); Survival of retainers (n=27); Patient satisfaction (n=14); Adverse effects on oral health (n=15)
Study designs	Randomised controlled trials	NR
Timing	At least 3 months after the fitting of the retainer and/or after adjunctive procedure was carried out	At 1 year after debond (n=1); After 3 months (n=1); Over 3 years (n=1); Over 6 months (n=1); Over 2 years (n=1); Three months (n=17); Six months (n=25); Nine months (n=5); One year (n=20); 18 months (n=4); Two years (n=8); Three years (n=1); Four years (n=1); Five years (n=1); Six years (n=1)

Search date: April 2022. Databases: Cochrane Oral Health Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; OpenGrey

Questions and results

Current version only

Hawley removable retainer vs Clear plastic removable retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB5 (current) · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index (lower arch) 12 months · lower arch same question in other reviews	MD 0.01 [-0.65, 0.67] 0.01 [-0.65, 0.67] mm	1 study · 30 participants	Very low Downgraded: risk of bias, imprecision, publication bias
Survival of retainers (failure, upper and lower arches) 12 months · upper and lower arches same question in other reviews	RR 0.60 [0.43, 0.83]	1 study · 111 participants	Very low Downgraded: risk of bias, imprecision, publication bias
Patient satisfaction: comfort (VAS, upper and lower arches) 12 months · upper and lower arches same question in other reviews	No RCTs at 12 months; 1 RCT at 6 months: Hawley less comfortable (VAS MD -1.86, 95% CI -2.19 to -1.53; very low-certainty)	0 studies	No studies
Adverse effects on oral health 12 months · lower arch same question in other reviews	Not measured	0 studies	No studies

Fibre-reinforced composite fixed (bonded) retainer vs Multistrand / spiral wire fixed (bonded) retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB5 (current) · 6 questions

Outcome	Effect	Evidence	Status / GRADE
Patient satisfaction: aesthetics (VAS 0-10 cm, lower arch) 12 months · lower arch same question in other reviews	MD 1.49 [0.76, 2.22] 1.49 [0.76, 2.22] VAS points	1 study · 32 participants	Very low Downgraded: risk of bias, imprecision, publication bias
Survival of retainers (failure, lower arch) 12 months · lower arch same question in other reviews	RR 1.01 [0.84, 1.21]	7 studies · 1337 participants	Low Downgraded: risk of bias, inconsistency
Adverse effects on oral health: bleeding on probing (lower arch) 12 months · lower arch same question in other reviews	No RCTs at 12-month follow-up; 1 RCT at 6 months found no difference (very low-certainty)	0 studies	No studies
Survival: mean survival time (lower arch, months) 12 months · lower arch same question in other reviews	No RCTs at 12-month follow-up; 2 RCTs at 24 months: earlier failures with fibre-reinforced composite (MD -1.48, 95% CI -1.88 to -1.08; very low-certainty)	0 studies	No studies
Stability: Little's Irregularity Index (lower arch) 12 months · lower arch same question in other reviews	MD -0.70 [-1.17, -0.23] -0.70 [-1.17, -0.23] mm	1 study · 52 participants	Very low Downgraded: risk of bias, imprecision, publication bias
Adverse effects on oral health: Gingival Index (lower arch) 12 months · lower arch same question in other reviews	No RCTs at 12-month follow-up; 1 RCT at 6 months: higher gingival inflammation with fibre-reinforced composite (MD 0.59, 95% CI 0.13 to 1.05; very low-certainty)	0 studies	No studies

Full-time clear plastic (removable) retainer vs Any type of fixed (bonded) retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB5 (current) · 5 questions

Outcome	Effect	Evidence	Status / GRADE
Survival of retainers (failure, lower arch) 12 months · lower arch same question in other reviews	RR 3.42 [1.38, 8.47]	1 study · 77 participants	Very low Downgraded: risk of bias, imprecision, publication bias
Patient satisfaction: discomfort/pain (lower arch) 12 months · lower arch same question in other reviews	No studies measured or reported this outcome	0 studies	No studies
Adverse effects on oral health: gingival bleeding (lower arch) 12 months · lower arch same question in other reviews	RR 0.53 [0.31, 0.88]	1 study · 84 participants	Very low Downgraded: risk of bias, imprecision, publication bias
Stability: Little's Irregularity Index (lower arch) 12 months · lower arch same question in other reviews	MD 0.60 [0.17, 1.03] 0.60 [0.17, 1.03] mm	1 study · 84 participants	Very low Downgraded: risk of bias, imprecision, publication bias
Adverse effects on oral health: caries (lower arch) 12 months · lower arch same question in other reviews	RD 0.00 [-0.05, 0.05] 0.00 [-0.05, 0.05] proportion	1 study · 84 participants	Very low Downgraded: risk of bias, imprecision, publication bias

Full-time wear of clear plastic (thermoplastic) removable retainer vs Part-time wear of clear plastic (thermoplastic) removable retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB5 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index 12 months · upper and lower arches same question in other reviews	no estimate extracted	3 studies	Ungraded

Full-time wear of removable retainer (any type) vs Part-time wear of removable retainer (any type)

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB5 (current) · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Patient satisfaction 12 months · lower arch same question in other reviews	Not measured	0 studies	No studies
Adverse effects on oral health 12 months · lower arch same question in other reviews	Not measured	0 studies	No studies
Survival of retainers 12 months · lower arch same question in other reviews	Not measured	0 studies	No studies
Stability: Little's Irregularity Index (lower arch) 12 months · lower arch same question in other reviews	MD 0.20 [-0.28, 0.68] 0.20 [-0.28, 0.68] mm	1 study · 52 participants	Very low Downgraded: risk of bias, imprecision, publication bias

Upper clear plastic retainer + lower fixed canine-to-canine retainer vs Upper clear plastic retainer + lower interproximal reduction (adjunctive), no lower retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB5 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index (lower arch) 2 years · lower arch same question in other reviews	MD -0.30 [-0.73, 0.13]	1 study · 47 participants	Ungraded

Upper clear plastic retainer + lower fixed canine-to-canine retainer vs Positioner

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB5 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index (lower arch) 2 years · lower arch same question in other reviews	MD -1.00 [-1.65, -0.35]	1 study · 46 participants	Ungraded

Upper clear plastic retainer + lower interproximal reduction (adjunctive) vs Positioner

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB5 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index (lower arch) 2 years · lower arch same question in other reviews	MD -0.70 [-1.37, -0.03]	1 study · 45 participants	Ungraded

Part-time clear plastic (removable) retainer vs Any type of fixed (bonded) retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB5 (current) · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index (lower arch) 12 months · lower arch same question in other reviews	MD 0.92 [0.23, 1.61] 0.92 [0.23, 1.61] mm	1 study · 56 participants	Very low Downgraded: risk of bias, imprecision, publication bias
Survival of retainers (failure, lower arch) 12 months · lower arch same question in other reviews	RR 0.44 [0.20, 0.98]	1 study · 57 participants	Very low Downgraded: risk of bias, imprecision, publication bias
Adverse effects on oral health: Gingival Index (lower arch) 12 months · lower arch same question in other reviews	MD -0.34 [-0.66, -0.02] -0.34 [-0.66, -0.02] index points	1 study · 59 participants	Very low Downgraded: risk of bias, imprecision, publication bias
Patient satisfaction: discomfort/pain (lower arch) 12 months · lower arch same question in other reviews	RR 12.22 [1.69, 88.52]	1 study · 57 participants	Very low Downgraded: risk of bias, imprecision, publication bias

CAD/CAM nitinol fixed (bonded) retainer vs Conventional/analogue multistrand fixed (bonded) retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB5 (current) · 5 questions

Outcome	Effect	Evidence	Status / GRADE
Patient satisfaction: discomfort/pain (lower arch) 12 months · lower arch same question in other reviews	No studies measured or reported this outcome	0 studies	No studies
Survival of retainers (failure, lower arch) 12 months · lower arch same question in other reviews	RR 1.29 [0.67, 2.49]	1 study · 41 participants	Very low Downgraded: risk of bias, imprecision, publication bias
Adverse effects on oral health: Gingival Index (lower arch) 12 months · lower arch same question in other reviews	MD 0.00 [-0.16, 0.16] 0.00 [-0.16, 0.16] index points	2 studies · 107 participants	Low Downgraded: risk of bias, publication bias
Adverse effects on oral health: bleeding on probing (lower arch) 12 months · lower arch same question in other reviews	No RCTs at 12-month follow-up; 2 RCTs at 6 months found no difference (low-certainty)	0 studies	No studies
Stability: Little's Irregularity Index (lower arch) 12 months · lower arch same question in other reviews	MD -0.46 [-0.72, -0.21] -0.46 [-0.72, -0.21] mm	1 study · 66 participants	Very low Downgraded: risk of bias, imprecision, publication bias

Upper fixed (bonded) retainer vs No retention

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB5 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index (upper arch) 2 years · upper arch same question in other reviews	MD -0.90 [-1.33, -0.47]	1 study · 63 participants	Ungraded

Hawley removable retainer vs Clear plastic (thermoplastic) removable retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB4 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Patient satisfaction: embarrassment to wear retainer 12 months	RR 2.42 [1.30, 4.49]	1 study · 348 participants	Low Downgraded: risk of bias, imprecision
Stability: Little's Irregularity Index (lower arch) 12 months · lower arch	MD 0.42 [0.23, 0.61] 0.42 [0.23, 0.61] mm	1 study	Low Downgraded: risk of bias, imprecision
Survival of retainers (how many broke) 12 months	RR 2.96 [1.58, 5.55]	1 study · 346 participants	Low Downgraded: risk of bias, imprecision

Polyethylene ribbon-reinforced resin composite bonded retainer vs Multistrand wire bonded retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB4 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index	Not reported in the included studies	0 studies	No studies
Survival of retainers (failure, lower arch) 18 months to 6 years · lower arch	RR 1.10 [0.77, 1.57]	3 studies · 228 participants	Low Downgraded: risk of bias, imprecision
Patient satisfaction	Not reported in the included studies	0 studies	No studies
Adverse effects on health	Not reported in the included studies	0 studies	No studies

Clear plastic (thermoplastic/vacuum-formed) removable retainer vs Multistrand stainless steel bonded (fixed) retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB4 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index (lower arch) 12 months · lower arch	MD 0.60 [0.17, 1.03] 0.60 [0.17, 1.03] mm	1 study · 84 participants	Low Downgraded: risk of bias, imprecision
Adverse effects on health: gingival bleeding 12 months · lower arch	RR 0.53 [0.31, 0.88]	1 study · 84 participants	Low Downgraded: risk of bias, imprecision
Patient satisfaction: acceptability to wear (0-100 VAS) 12 months	MD -12.84 [-18.60, -7.09] -12.84 [-18.60, -7.09] VAS points	1 study · 81 participants	Low Downgraded: risk of bias, imprecision
Survival of retainers (failure, lower arch) 12 months · lower arch	Downgraded three times: high risk of bias, imprecision and inconsistency; 2 RCTs gave inconsistent results, no pooled estimate (Millett RR 0.66, 95% CI 0.49 to 0.90)	2 studies · 133 participants	Very low Downgraded: risk of bias, imprecision, inconsistency

Full-time wear of thermoplastic (clear plastic) removable retainer vs Part-time wear of thermoplastic (clear plastic) removable retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB4 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index 12 months · upper and lower arches	Downgraded once for imprecision; no evidence of a difference (Gill 2007; Thickett 2010, not poolable)	1 study · 57 participants	Moderate Downgraded: imprecision

Full-time wear of Hawley removable retainer vs Part-time wear of Hawley removable retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB4 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index 12 months · upper and lower arches	Downgraded twice: high risk of bias and imprecision; no difference (Shawesh 2010)	1 study	Low Downgraded: risk of bias, imprecision

Begg removable retainer vs Thermoplastic (clear plastic) removable retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB4 · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index (lower arch) 12 months · lower arch	MD 0.25 [0.19, 0.31] 0.25 [0.19, 0.31] mm	1 study	Low Downgraded: risk of bias, imprecision
Stability: quality of result (PAR index) 12 months	MD 1.71 [1.44, 1.98]	1 study	Ungraded

Modified thermoplastic retainer vs Full-coverage thermoplastic retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB4 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Stability: settling (posterior occlusal contacts) 9 months	MD 0.95 [0.05, 1.85]	1 study	Ungraded

Upper removable retainer + lower fixed (bonded) retainer vs Upper removable retainer + lower adjunctive procedure (interproximal reduction), no lower retainer

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB4 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index (lower arch) 2 years · lower arch	MD -0.30 [-0.73, 0.13]	1 study · 47 participants	Ungraded

Upper removable retainer + lower fixed (bonded) retainer vs Positioner

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB4 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index (lower arch) 2 years · lower arch	MD -1.00 [-1.65, -0.35]	1 study · 46 participants	Ungraded

Upper removable retainer + lower adjunctive procedure (interproximal reduction) vs Positioner

Population: People who had received fixed appliance orthodontic treatment

CD002283.PUB4 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Stability: Little's Irregularity Index (lower arch) 2 years · lower arch	MD -0.70 [-1.37, -0.03]	1 study · 45 participants	Ungraded