CLINICIANS CORNER

A practical method of fabricating a lingual

retainer
Ali Ihya Karaman, DDS, MS, PhD,
a
O

mu r Polat, DDS,
b
and Tamer Bu yu kyilmaz, DDS, MSD
c
Konya, Turkey
Retention is a major part of orthodontic treatment, not an optional secondary protocol. In recent years,
studies investigating dentofacial changes during and after the growth period have led most clinicians to use
xed retention appliances after treatment. Fixed retainers can be attached to the teeth directly or indirectly.
We present a practical, indirect method for bonding xed retainers, using Sondhi Rapid-set Indirect Bonding
Adhesive (3M Unitek, Monrovia, Calif). (Am J Orthod Dentofacial Orthop 2003;124:327-30)
I
n orthodontic treatment, the stability of the nal
occlusion is as important as the correction
achieved. Increases in crowding have been found
in untreated (growing) normal subjects at 10-year
follow-up examinations.
1
Even when excellent tooth
alignment and occlusion are obtained through orth-
odontic therapy, unorganized periodontal bers, im-
mature bones, and functions not yet adapted to the
new form can make these changes hard to maintain.
Orthodontists must consider the dentofacial and den-
titional changes during and after normal growth and
development and choose an appropriate retention
protocol.
In 1881, Smith introduced a retention appliance
made from a simple vulcanite plate with a bar that
extended over the labial aspect of the maxillary inci-
sors.
2
Jackson
3
said not infrequently cases are pre-
sented that require more skill in retaining the teeth than
in regulating them, and he was the rst to mention
xed retention. He also advised removing the circum-
ferential gingival bers after correcting rotation, and he
was the rst to introduce berotomy in the orthodontic
literature. Angle
4
stated that obtaining normal occlu-
sion during the eruption period would decrease the
retention time, but he added that when habits are not
overcome and the rotation and disturbance to the
periodontal bers are extreme, it might be necessary to
cut the gingival bers. He stated that most appliances
are removed too soon, before the teeth are thoroughly
established in occlusion, and he advised, In doubt-
ful cases, wearing delicate and efcient appliances
indenitely may be far less objectionable than a
malocclusion.
As more studies of long-term stability were
published, support for xed retention grew. Tweed
5
suggested attaching a lingual bar between banded
mandibular premolars. With the evolution of acid
etching in orthodontic practice, bonding provided
new retention alternatives. Lingual retainers were
being made from smooth round or rectangular wires,
but Zachrisson
6
reported on the structural advantages
of multistranded exible wires and said that, because
of their exibility, these wires did not restrict physio-
logical tooth movement. Thus, the multistranded
structure provides extra mechanical retention with
the bonding adhesive.
Fourth generation retainers
6
and polyethylene ber
materials
7
have recently come into clinical use, but
0.0215-in multistranded stainless steel wire remains the
most popular choice for retainers.
8
When placing a retainer with a direct bonding
technique, various materials and methods are used to
xate the wire, including dental oss,
9
elastics,
10
ligature wire, wires tack-welded to the retainer
wire,
11
and nger pressure.
11
But contamination of
the etched surface or changes in wire position can
disturb the contacts, and incorrect placement of the
retainer not only puts the stability of the treatment
result at risk, but also often leads to failure. To avoid
this, an indirect bonding method was introduced in
which the attachment is rst t to a stone cast and
then transferred to the mouth with a tray. Indirect
bonding has several advantages over direct bonding,
including correct placement of the attachments,
12,13
less chair time,
13
and prevention of etched surface
contamination. But the method also has some disad-
From the Department of Orthodontics, Selcuk University, Konya, Turkey.
a
Associate professor.
b
Research assistant.
c
Associate professor and clinical instructor; private practice, Adana, Turkey.
Reprint requests to: O

mur Polat, Selcuk Universitesi, Dis Hekimligi Fak.

Ortodonti AD, Kampus, 42079, Konya, Turkey; e-mail, omur_polat@
yahoo.com.
Submitted and accepted, January 2003.
Copyright 2003 by the American Association of Orthodontists.
0889-5406/2003/$30.00 0
doi:10.1016/S0889-5406(03)00451-7
327
vantages: a sensitive technique is required, more
laboratory time is needed to fabricate the appli-
ance,
13
and there is some risk of adhesive leakage to
gingival embrasures and subsequent oral hygiene
problems.
In this report, we present a technique for fabricating
an indirectly bonded lingual retainer using Sondhi
Rapid-set Indirect Bonding Adhesive (3M Unitek,
Monrovia, Calif) and 0.0215-in coaxial stainless steel
wire (Penta-one, Masel Orthodontics, Bristol, Pa), and
the 6-month retention results of 15 patients.
FABRICATION AND PLACEMENT
Using a posttreatement dental cast, prepare a
0.0215-in coaxial stainless steel retainer wire. Attach
the retainer to the model with Transbond LR (3M
Unitek), an adhesive especially designed for lingual
retainers. Light-cure each tooth for 30 seconds with a
conventional halogen light (480-500 nm wavelength)
or place the model in an oven (Triad 2000, Dentsply
International, York, Pa) for 10 minutes. For extra
retention of the tray, add composite retentive balls to
the adhesive on the canines (Fig 1).
To fabricate the tray, place the model into a
vacuum machine. Use a 2-mm thick polyethylene
thermoplastic plate (GAC International, Inc, Central
Islip, NY). Trim the edges of the tray, polish the
lingual surface, and sandblast the adhesive with 50
aluminum oxide. Rinse in water and use acetone at
the base to remove any remnants of the separating
medium. The retainer is now ready to be placed in
the mouth (Fig 2).
Pumice, etch, and dry the lingual surfaces of the
teeth. The Sondhi indirect bonding resin has 2 compo-
nents. Apply resin A to the etched surfaces of the teeth
and apply resin B to the custom base. These resins
contain 5% ne-fumed silica particles to ll small voids
in the base (other indirect bonding resins are unlled,
and their viscosity makes them hard to control clinical-
ly). Place the tray in the mouth and hold it for 30
seconds; allow an additional 2 minutes for complete
polymerization (Fig 3). Remove the tray, then remove
the composite retentive balls using a high-speed hand
piece, and check the gingival embrasures for excess
resin (Fig 4).
While the retainer is in place, the patient should use
super dental oss (Oral B, South Boston, Mass).
This method of fabricating a lingual retainer was
used in 15 patients, who were followed for 6 months.
During this period, failures occurred in 4 teeth, includ-
ing 2 teeth in 1 patient. Two failures were on canines;
the others were on incisors. According to rtun and
Zachrisson,
14
possible reasons for the failures include
distortion of the wire during polymerization of the
resin, too little adhesive, and direct trauma to the
retainer.
Fig 1. Retainer wire on dental cast, with composite
retentive balls on canines.
Fig 2. Vacuum-formed tray with wire.
Fig 3. Tray in mouth during polymerization. Fig 4. Retainer wire afxed to teeth.
American Journal of Orthodontics and Dentofacial Orthopedics
September 2003
328 Karaman, Polat, and Buyukyilmaz
Dahl and Zachrisson
15
concluded that most failures
in direct bonded retainers occur at the wire-adhesive
interface. All failures in this study occurred at the
tooth-adhesive interface. The reasons for these failures
are probably small movements during placement that
disrupted polymerization.
RESULTS
The gingival status of the 15 patients was assessed
at the start of treatment and at the end of the 6-month
retention period with the gingival index of Loe and
Silness.
16
The results were analyzed with the Wilcoxon
signed rank test and the SPSS statistical package for
Windows (SPSS, Chicago, Ill). The results are given in
the Table. The mean ( SD) gingival index values
were 0.25 0.417 at the beginning of the treatment and
0.42 0.52 after the 6-month retention period. The
Wilcoxon signed rank test showed no differences be-
tween the 2 times (P .05).
DISCUSSION
The advantages of this indirect bonding method are
reduced clinical time, correct placement of the retainer,
and proper polymerization without moisture contami-
nation. Moreover, although some laboratory time is
required, it is relatively brief. Other indirect bonding
resins on the market are unlled, making them more
viscous and harder to control. They also require using a
thermally polymerized laboratory resin that might
cause movement of the attachment in the oven. On the
other hand, Sondhis resin contains ne silica particles,
and this not only makes the material easier to control,
but also improves the bond strength
17
and lls un-
wanted voids. Reduced polymerization time means the
chair time is shorter.
An adhesives resistance to abrasion is determined
by ller particle size and loading in vitro.
18
Pilo and
Caradash
19
demonstrated a positive correlation be-
tween ller content and hardness, and highly lled
resins have better mechanical properties.
Because the retainer is placed just under the contact
points and patients are instructed to use dental oss,
gingival health is the same after 6 months retention as
at the end of treatment. Only a small amount of calculus
was detected in the patients who were prone to it. These
ndings agree with those of rtun and Zachrisson
14
; in
contrast to those ndings, we found no demineraliza-
tion.
The colorless adhesive can leak into the gingival
embrasures. To prevent this, use a scaler to make sure
that no excess adhesive remains in the embrasures.
CONCLUSIONS
A practical method of lingual retainer fabrication
with Sondhi resin is described. The advantages of
this method are reduced chair time and correct
placement of the retainer. The material is also easier
to control clinically and more resistant to abrasion
because of the composition of the ller material. The
need for a sensitive technique and the possible
leakage of the transparent adhesive into the embra-
sures are its main disadvantages. Additional studies
are needed to evaluate the physical properties of
Sondhi indirect bonding adhesive both in vitro and in
vivo.
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Table. Gingival index at start of treatment and after 6
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Before After
P Test Mean SD Mean SD
Gingival index 0.25 0.41 0.41 0.52 .124 NS
*P .005.
NS, Nonsignicant; SD, standard deviation.
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 124, Number 3
Karaman, Polat, and Buyukyilmaz 329
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American Journal of Orthodontics and Dentofacial Orthopedics
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330 Karaman, Polat, and Buyukyilmaz