EFFICACY OF TEMPORARY FIXED RETENTION FOLLOWING ...

adolescence, into young adult status, and into the early years of college when
expectations of judicious patient compliance can be considered questionable at
best. Fixed retention during this period might also allow for the controversial
issue of the third molars to be addressed. Finally, an additional few years of
fixed retention might provide adequate time for a sense of disconnect from the
orthodontic practice. As time goes by, changes in the dentition might be
perceived to be the result of aging or the lack of retainer compliance, and not a
result of the orthodontic treatment.
Judgments concerning posttreatment retention and stability have become
more of a practice management issue than a clinical issue. If the incisors can be
mechanically retained by some permanent form of retention, then there seems
less of a chance for future problems related to stability, no compliance issues
with patients, and a “stick it and forget it” perspective. These retainers must be
periodically maintained and monitored for signs of distortion, breakage, or
adverse effects on the periodontium. Where the responsibility lies for this
maintenance must be clear from the beginning of a patient’s treatment. If
removable forms of retention are relied on to maintain lifelong stability, the
patient needs to assume liability for his or her occlusal status by faithful
retainer—wear as instructed on an individual basis. In either case, obtaining
documentation of informed consent from the patient is critical from both a
standpoint of patient awareness and that of legal responsibility. Written
communication that describes where responsibilities lie regarding stability and
the prevention of unpredictable changes that can occur as a result of the normal
aging process is paramount to prevent future misunderstandings or litigation
that might arise as a result of poor communication.
The results of the present research indicate that, contrary to previous
reports, overall stability may be better than originally documented. However,
similar to previous reports, there is no doubt that, to guarantee stability, one of
two things must occur. Either lifetime fixed retention must be planned for the
patient, or the patient must acknowledge that he or she must be compliant with
long-term removable retainer wear. Based on the results of the present study, we
conclude that even though there was a slight statistical benefit, there is no clinical
long-term occlusal benefit gained from temporary fixed retention. Because no
form of retention has been found to be superior to another (Littlewood et al.
2006), patients who maintain life long compliance with their removable retainers
should expect the same degree of stability as those patients who rely on
permanent fixed retainers.
In anticipation of the occlusal instability that can be expected to occur in
treated and nontreated patients alike in response to the normal aging process, the
questions that remain are “who should be responsible for posttreatment
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