Syfte: Föreliggande litteraturstudie syftar till att utvärdera den parodontala hälsan hos patienter som har haft en adhesivt cementerad retentionstråd under en period av minst fem år efter att ha genomgått ortodontisk behandling.   Material och metod: Litteratursökning gjordes systematiskt med hjälp av PICO och PRISMA med väldefinierade inklusions- och exklusionskriterier. Tre sökdatabaser användes, PubMed/MEDLINE, Scopus och Web of Science. Endast studier som uppfyllde kriterierna efter granskningsprocessen inkluderades och resultatet bearbetades efter bedömning av risk av bias via granskningsmall från Statens beredning för medicinsk och social utvärdering.   Resultat: Efter litteratursökning och granskning av potentiellt relevanta studier från de tre databaserna, identifierades endast två studier som uppfyllde alla urvalskriterier. En av de inkluderade studierna undersökte parodontal hälsa hos 211 patienter som genomgått ortodontisk behandling med fast apparatur. Patienterna hade fast retentionstråd på de sex anteriora tänderna lingualt i mer än sex år. Den andra studien som inkluderades omfattade 60 patienter som delades in i två grupper där en patientgrupp hade retentionstråd i 20 år och en kontrollgrupp. Den parodontala hälsan utvärderades i båda studierna med hjälp av olika parametrarna: plackindex, sonderingsdjup, gingivalretraktion, gingivalindex, tändernas placering och tandsten. Trots skillnader i använda utvärderingsverktyg presenterade båda studierna liknande resultat. Det fanns inte någon påverkan av retentionstrådens användning på den parodontala hälsan.   Slutsats: Adhesivt cementerad retentionstråd har inte någon signifikant effekt på den parodontala hälsan, men kan innebära en viss ökad risk för plack- och tandstensbildning hos patienterna.   Nyckelord: Ortodontisk retentionstråd, adhesivt cementerad retentionstråd, långsiktiga effekter, parodontal hälsa, gingival hälsa. / Purpose: This systematic literature study aims to investigate the longterm effect of adhesively cemented retainers on the periodontal health in patients who have undergone orthodontic treatment for at least five years. Materials and methods: Studies were systematically searched using PICO and PRISMA with well-defined inclusion and exclusion criteria, using three databases, i.e., PubMed/MEDLINE, Scopus, and Web of Science. Studies that met the criteria after the review-process were included and results were processed after assessing risk of bias according to a review template from Swedish Agency for Health Technology Assessment and Assessment of Social Services. Results: After searching and assessing potentially relevant studies from the three databases, only two studies were identified that met the selected criteria. One study examined periodontal health in 211 patients who underwent orthodontic treatment with fixed appliances. The patients had fixed retainers on the six anterior teeth lingually for more than six years. The second study consisted of 60 patients divided into two groups, one patient group with retainers for over 20 years and a control group. Different assessment tools were used in both studies: plaque-index, probing-depth, gingival recession, gingival-index, irregularity-index, and calculus. Despite the differences in assessment tools, both studies presented similar results, i.e., fixed retainers did not affect the periodontal health. Conclusion: Fixed retainers do not have a significant effect on periodontal health but may increase the risk of plaque and calculus formation in patients.

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ABSTRACT EVALUATION OF FIT FOR 3D PRINTED RETAINERS AS COMPARED TO THERMOFORM RETAINERS By David Cole, D.M.D. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University Thesis Directors: Eser Tüfekçi, D.D.S., M.S., Ph.D., M.S.H.A. Professor, Department of Orthodontics Sompop Bencharit, D.D.S., M.S., Ph.D. Associate Professor and Director of Digital Dentistry, Department of General Practice Introduction: Despite recent advances in three-dimensional (3D) printing, little information is available on 3D printed retainers Methods: Three reference models were used to fabricate traditional vacuum formed, commercially-available vacuum formed, and 3D printed retainers. For each model, three retainers were made using the three methods (a total of 27 retainers). To determine the trueness, the distances between the intaglio surface of the retainers and the occlusal surface of the reference models were measured using an engineering software. A small difference was indicative of a good fit. Results: Average differences of the traditional vacuum formed retainers ranged from 0.10 to 0.20mm. The commercially-available and 3D printed retainers had a range of 0.10 to 0.30mm and 0.10 to 0.40mm, respectively. Conclusions: The traditional vacuum formed retainers showed the least amount of deviation from the original reference models while the 3D printed retainers showed the greatest deviation.

Fixed retainer after orthodontic treatment is an increasing retention appliance. For the mandibular incisors there are two different fixed retainers that are commonly used, either a canine-to-canine retainer bonded only to the canines or a twistflex retainer bonded to each of the mandibular incisors and canines. Increased mandibular incisor irregularity seems to be a continuous process throughout life even in untreated patients. The natural physiological changes during aging causes changes like those that occur after orthodontic treatment and the removal of retainers. There are few long-term studies that have compared patients who have had a mandibular fixed retainer with patients without retention appliance after treatment, and then compared the treated patients with untreated subjects.The overall aim of this thesis was to compare and evaluate two different mandibular fixed retainers and also to compare orthodontically treated cases with untreated long-term. This thesis is based on two studies and a PAR Index evaluation was presented in the frame story:Paper I is a retrospective longitudinal study done on dental casts and lateral head radiographs from patients who had received either a canine-to-canine retainer or a twistflex retainer after treatment. Different variables were measured, were Little’s Irregularity Index was the main outcome measure. The measurements were done at four different occasions, were the last registration was 12 years after treatment, i.e. 9 years after removal of retainer. Paper II is also a retrospective longitudinal study with three different groups, one group received a fixed mandibular retainer, one group did not receive any retention appliance after treatment and the third group was untreated subjects. Measurements were done on dental casts and lateral head radiographs at four different occasions to analyze dental and skeletal changes 12 years after treatment. Also here Little’s Irregularity Index was the main outcome measure. PAR Index evaluation is done to evaluate the stability of orthodontic treatment outcome after treatment and long-term for two different retainer groups and one non-retention group. The following conclusions were drawn: Paper I•Both the canine-to-canine retainer and the twistflex retainer can be recommended since both are equally effective during retention period.•None of the retention types prevent long-term changes of mandibular incisor irregularity or available space for the mandibular incisors after removal of the retainers.•No differences in bonding failures between the two retainers were found. Paper II•There were no differences found 12 years after treatment in Little’s Irregularity Index for the mandibular incisors between the group that had a retainer and the group that had no retainer after treatment•In the untreated group, Little’s Irregularity Index was increased over time but not to the same extent as in the treated groups. •The crowding before treatment did not explain the crowding at the last registration.•The use of mandibular retainers for two to three years does not appear to prevent long-term relapse. •If the patient wants to constrain the changes that come with natural development, then lifelong retention is needed.•The overjet and overbite were stable long-term.PAR Index evaluation•Twelve years after treatment the mean reduction in PAR score was over 70 per cent only for the groups who had a mandibular retainer after treatment. However, the non-retention group had a PAR score of 66 per cent.•There were more cases in the retention groups that were ”greatly improved and/or improved” 12 years after treatment compared to the non-retention group. After treatment between 16 and 23.3 per cent of all the cases were ”worse or not improved”. Twelve years after treatment between 36 and 43.6 per cent of the total cases were ”worse or not improved”.

Objetivo: avaliar, por meio de modelos digitalizados, o comportamento transversal do arco dentário superior de pacientes submetidos ao tratamento da má oclusão de Classe II, corrigida com o aparelho Pendulum, seguido de aparelhagem ortodôntica fixa nos períodos inicial, pós-distalização, pós-tratamento e longo tempo póstratamento. Material e Métodos: Oitenta modelos de 20 pacientes (14 do gênero feminino e 6 do masculino), foram digitalizados no aparelho REXCAN DS2. A média da idade, ao início do tratamento (T1), foi de 14,02 ± 1,62 anos, pós-distalização (T2), foi de 14,54 ± 1,61, ao final do tratamento (T3), 18,38 ± 1,84 anos, e no póstratamento (T4), 22,94 ± 1,34 anos. As distâncias intercaninos, interpré-molares e intermolares foram realizadas no programa Geomagic Studio 5®. A análise de variância dependente para medidas repetidas (ANOVA) foi utilizada para avaliar as alterações entre os períodos. Resultados: não ocorreram alterações transversais na distância intercaninos nas fases estudadas. Os pré-molares demostram um aumento na fase de aparelhagem fixa (T2-T3), para os segundos pré-molares a diferença foi observada entre o período inicial (T1) e os período pós-tratamento (T3). A distância dos primeiros molares alterou durante a fase de distalização (T1-T2), retornando aos valores iniciais durante a fase pós-tratamento (T3). Para os segundos molares, as alterações ocorreram durante o período de distalização (T2) e pós-tratamento (T3). Não ocorreram alterações na fase de longo tempo pós-tratamento. Conclusão: Os resultados permitem concluir que, durante o tratamento com o aparelho Pendulum seguido pelo fixo, ocorrem alterações transversais no arco superior, no entanto, estas alterações permanecem estáveis cinco anos pós-tratamento. / Objective: The aim of this longitudinal study was to asses transversal changes in maxillary dental arch in twenty patients between 14 and 18 years old, treated first by Pendulum and followed by fixed appliances. Material and Methods: Dental measurements in eighty digital 3D models were obtained in pretreatment, postdistalization, post-treatment and long-term post-treatment phases. The statistical analysis was performed by ANOVA test. Results: Premolars and molars distances increased during the fixed appliance treatment (post-distalization and post-treatment phase) and in the long post-treatment phase there were no significant changes. No significant difference was observed in canines transversal distance. Conclusion: It was concluded that Pendulum followed by the fixed appliances, changes dental arch width during the full treatment and it was stable in the long-term post-treatment.

Objetivo: avaliar, por meio de modelos digitalizados, o comportamento transversal do arco dentário superior de pacientes submetidos ao tratamento da má oclusão de Classe II, corrigida com o aparelho Pendulum, seguido de aparelhagem ortodôntica fixa nos períodos inicial, pós-distalização, pós-tratamento e longo tempo póstratamento. Material e Métodos: Oitenta modelos de 20 pacientes (14 do gênero feminino e 6 do masculino), foram digitalizados no aparelho REXCAN DS2. A média da idade, ao início do tratamento (T1), foi de 14,02 ± 1,62 anos, pós-distalização (T2), foi de 14,54 ± 1,61, ao final do tratamento (T3), 18,38 ± 1,84 anos, e no póstratamento (T4), 22,94 ± 1,34 anos. As distâncias intercaninos, interpré-molares e intermolares foram realizadas no programa Geomagic Studio 5®. A análise de variância dependente para medidas repetidas (ANOVA) foi utilizada para avaliar as alterações entre os períodos. Resultados: não ocorreram alterações transversais na distância intercaninos nas fases estudadas. Os pré-molares demostram um aumento na fase de aparelhagem fixa (T2-T3), para os segundos pré-molares a diferença foi observada entre o período inicial (T1) e os período pós-tratamento (T3). A distância dos primeiros molares alterou durante a fase de distalização (T1-T2), retornando aos valores iniciais durante a fase pós-tratamento (T3). Para os segundos molares, as alterações ocorreram durante o período de distalização (T2) e pós-tratamento (T3). Não ocorreram alterações na fase de longo tempo pós-tratamento. Conclusão: Os resultados permitem concluir que, durante o tratamento com o aparelho Pendulum seguido pelo fixo, ocorrem alterações transversais no arco superior, no entanto, estas alterações permanecem estáveis cinco anos pós-tratamento. / Objective: The aim of this longitudinal study was to asses transversal changes in maxillary dental arch in twenty patients between 14 and 18 years old, treated first by Pendulum and followed by fixed appliances. Material and Methods: Dental measurements in eighty digital 3D models were obtained in pretreatment, postdistalization, post-treatment and long-term post-treatment phases. The statistical analysis was performed by ANOVA test. Results: Premolars and molars distances increased during the fixed appliance treatment (post-distalization and post-treatment phase) and in the long post-treatment phase there were no significant changes. No significant difference was observed in canines transversal distance. Conclusion: It was concluded that Pendulum followed by the fixed appliances, changes dental arch width during the full treatment and it was stable in the long-term post-treatment.