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December 4, 2023 c1partners

Orthodontic treatment programs often conclude with the patient using a retainer designed to maintain the position of their newly aligned teeth. Retainers play a critical role in preventing teeth from shifting back to their previous position, ensuring the success and longevity of orthodontic interventions. Here is a comparison between lingual retainers and other types of retainers.

Types of Dental Retainers

There are three main types of retainers. A lingual retainer may also be described as a fixed, permanent or bonded retainer, or a lingual wire. The key feature of a lingual retainer is that it is designed to be permanently fixed to the back of the teeth. Duration of wear varies, but it is likely to be needed for at least one year following treatment. Some patients may keep the retainer indefinitely, particularly if it is not causing any problems and is kept clean.

The other two main types of retainers are removable. Firstly, the Hawley retainer consists of an acrylic or plastic plate that fits behind the teeth, with a metal wire running across the front of the teeth. These retainers vary in shape but are custom-made to fit the patient’s mouth. The other type, clear (such as Essix, Vivera, or Zendura) or vacuum-formed retainers are made of clear plastic or polyurethane and take the form of a tray that sits over the entire row of teeth, much like an Invisalign device.

When comparing different types of retainers, the following aspects should be considered:

Maintenance – The main difference between lingual retainers and removable types is daily maintenance. It is important for patients to follow a rigorous oral hygiene regimen to ensure their lingual retainer is thoroughly cleaned and flossed. Any collection of food debris around the wire and bonds may cause a buildup of plaque and lead to cavities and/or infection. Clear retainers must be cleaned to prevent discoloration and maintain transparency. All removable retainers can be brushed and disinfected with specialist dental appliance cleaners, although patients should be made aware of the importance of cleaning and keeping their appliances safely in their case when they are not being worn.

Adjustability – Hawley retainers are adjustable, so they can handle any necessary fine tuning during the post-treatment period. They can also be tightened if the process of constantly removing and replacing the device causes it to become loose. Repair may also be possible in cases of minor damage. Clear retainers cannot be adjusted and will need to be replaced if damaged. Lingual retainers are not adjustable.

Aesthetics – Lingual retainers tend to have the best aesthetic profile as they are generally not visible. Clear retainers are often barely visible because they are made of thin, clear plastic, although they can usually be seen at close range. Hawley retainers are more obvious due to the visible wire in front of the teeth.

Durability – Lingual retainers have the potential to last indefinitely if they are not damaged by trauma or accidents. Eventually, the patient may not even notice the retainer because it has become such a familiar part of their mouth. Hawley retainers can also last a long time, lasting for up to 20 years if treated with care. In contrast, clear retainers may last only a few months, although some patients may get more than a year of use from them. 

Comfort – Lingual retainers are generally considered comfortable once wearers have adapted to the initial sensation. They do not interfere with tongue movement or speech. Clear retainers are known for being comfortable, but some individuals may experience initial discomfort due to the snug fit. With Hawley retainers, comfort levels vary, with the potential for irritation from the wire or bulkiness of the plastic base. Comfort levels should be checked with any appliance. 

Patient Acceptability – Hawley retainers, as the most visible type of retainer, can present a challenge to patients who are self-conscious about wearing a retainer. Many orthodontists offer a range of brightly colored retainer plates to appeal to patients, which have the added advantage of potentially making the retainer less likely to be lost. Clear retainers may be more acceptable in terms of visibility but can affect the patient’s speech. Lingual retainers will not usually be visible or affect speech, although some patients may be resistant to a permanently fixed appliance.

Long term stability – Lingual retainers provide continuous stability, reducing the risk of relapse. Clear retainers are effective for maintaining alignment but may need to be replaced over time. Hawley retainers offer stability but depend on compliance from the patient in terms of regular wear.

The choice between lingual retainers and removable retainers depends on orthodontic need and individual preferences. Lingual retainers excel in aesthetics and long-term stability. Information provided by professional bodies, including the American Association of Orthodontists and the British Orthodontic Society, supports professionals and patients in the choice and best use of retainers.(1,2)

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1. American Association of Orthodontists (AAO). https://aaoinfo.org/treatments/retainers/&_rt_nonce=c950def8a5 
2. British Orthodontic Society (BOS). https://www.bos.org.uk/patients/retainers/