Results of a survey-based study to identify common retention practices in the United States


      The purpose of this descriptive study was to use a carefully constructed, pilot-tested survey instrument to identify the most common orthodontic retainers and retention protocols prescribed in the United States as reported by active members of the American Association of Orthodontists.


      We randomly selected 2000 active members, stratified by region of practice, for the study. Information gathered included, but was not limited to, the types of retainers prescribed in the maxillary and mandibular arches, duration of full-time and part-time wear, use of fixed retainers, appliances fabricated in office vs commercial laboratories, the number of debonds per year, and retention appointment schedules. The survey consisted of 20 questions. Data were gathered on a categorical scale and analyzed.


      We received 658 responses (32.9%) during a 12-week period. Maxillary Hawley retainers (58.2%) and mandibular fixed lingual retainers (40.2%) were the most commonly used. Most orthodontists prescribed less than 9 months of full-time wear of removable retainers and thereafter advised part-time, but lifetime wear. Most orthodontists (75.9%) did not instruct patients to have the fixed lingual retainers removed at a specific time. More orthodontists who prescribed Hawley retainers recommended longer full-time wear compared with clear thermoplastic retainers. The timing of scheduled retention appointments varied among clinicians and depended on the number of years in practice, the volume of patients debonded, and the type of prescribed retainer. The only regional difference associated with retainer design was the Northeast region, where mandibular fixed lingual retainers were used less frequently. Female orthodontists did not use mandibular fixed lingual retainers as often as their male counterparts.


      Maxillary Hawley and mandibular fixed lingual retainers are most commonly used. This study is the first to describe retention protocols and the scheduling of retention appointments in the United States.
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        • Lyotard N.
        Evaluation of short-term stability without retention: a pilot study [thesis].
        Case Western Reserve University, Cleveland2006
        • Ingervall B.
        Cheek pressure and head posture.
        Angle Orthod. 1988; 58: 47-57
        • Butler J.
        Assessment of orthodontic stability using removable Hawley retainers with a nighttime only regimen [thesis].
        Louisiana State University, New Orleans2003
        • Lindauer S.
        • Shoff R.
        Comparison of Essix and Hawley retainers.
        J Clin Orthod. 1998; 32: 95-97
        • Sauget E.
        • Covell Jr., D.A.
        • Boero R.P.
        • Lieber W.S.
        Comparison of occlusal contacts with use of Hawley and clear overlay retainers.
        Angle Orthod. 1997; 67: 223-230
        • Tibbetts J.R.
        The effectiveness of three orthodontic retention systems: a short-term clinical study [abstract].
        Am J Orthod Dentofacial Orthop. 1994; 106: 671
        • Littlewood S.J.
        • Millett D.T.
        • Doubleday B.
        • Bearn D.R.
        • Worthington H.V.
        Retention procedures for stabilizing tooth position after treatment with orthodontic braces.
        Cochrane Database of Systematic Reviews. 2006; (Issue 1. Art. No. CD002283; doi:10.1002/14651858. CD002283.pub3)
        • Blake M.
        • Garvey M.T.
        Rationale for retention following orthodontic treatment.
        J Can Dent Assoc. 1998; 64: 640-643
        • Proffit W.R.
        Contemporary orthodontics.
        3rd ed. Mosby, St Louis2000 (p. 597-614)
        • Sheridan J.J.
        • Ledoux W.
        • McMinn R.
        Essix retainers: fabrication and supervision for permanent retention.
        J Clin Orthod. 1993; 27: 37-45
        • Zachrisson B.U.
        Important aspects of long-term stability.
        J Clin Orthod. 1997; 31: 562-583
        • Wong P.M.
        • Freer T.J.
        A comprehensive survey of retention procedures in Australia and New Zealand.
        Aust Orthod J. 2004; 20: 99-106
        • Gottlieb E.L.
        • Nelson A.H.
        • Vogels D.S.
        1986 JCO study of orthodontic diagnosis and treatment procedures.
        J Clin Orthod. 1986; 20: 612-624
        • Gottlieb E.L.
        • Nelson A.H.
        • Vogels D.S.
        1990 JCO study of orthodontic diagnosis and treatment procedures.
        J Clin Orthod. 1990; 25: 145-156
        • Gottlieb E.L.
        • Nelson A.H.
        • Vogels D.S.
        1996 JCO study of orthodontic diagnosis and treatment procedures.
        J Clin Orthod. 1996; 30: 615-629
        • Dillman D.A.
        Mail and internet surveys: the tailored design method.
        2nd ed. John Wiley and Sons, New York2000 (p. 207)
        • Little R.M.
        • Wallen T.
        • Riedel R.
        Stability and relapse of mandibular anterior alignment. First premolar extraction cases treated by traditional edgewise orthodontics.
        Am J Orthod. 1981; 80: 349-365
        • Little R.
        • Riedel R.
        • Årtun J.
        An evaluation of changes in the mandibular anterior alignment from 10 to 20 years postretention.
        Am J Orthod Dentofacial Orthop. 1988; 93: 423-428
        • Reitan K.
        Tissue rearrangement during retention of orthodontically rotated teeth.
        Angle Orthod. 1959; 29: 105-113