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Periodontal implications of bonded versus

removable retainers
Evi E. Heier, DDS, a Aimd A. De Smit, DDS, PhD, a Ingrid A. Wijgaerts, D D S , b and
Patrick A. Adriaens, DDS, DMD, MScD, PhD b

Brussels, Belgium
Removable retainers have been used by clinicians since the early years of orthodontic practice.
During the last decades, an increasing number of cases are retained with bonded lingual retainers.
The current study was performed to evaluate whether significant differences in gingival conditions
exist between patients who wear removable or fixed retainers. Differences in build-up of plaque and
calculus were also investigated. Maxillary and mandibular measurements were taken at baseline
(just before debonding) and 1, 3, and 6 months later, from canine to canine on 36 patients. Among
these patients, 22 had fixed retainers, and 14 wore removable retainers. The gingival condition was
scored according to three parameters: Modified Gingival Index, bleeding on probing, and gingival
crevicular fluid flow. After staining with Diaplac, the Plaque Index was registered. The amount of
calculus was measured with a calibrated periodontal probe. Gingival inflammation decreased from
baseline throughout the entire period of retention. A comparable limited gingival inflammation was
found in the presence of both types of retainers. Slightly more plaque and calculus were present on
the lingual surfaces in the fixed retainer group. This did not result in more pronounced gingival
inflammation than in the removable retainer group, within the evaluated period. (Am J Orthod
Dentofac Orthop 1997;112:607-16.)

W h en removable retainers are used, clinicians have to rely on patients' discipline and
long-term compliance. Oral hygiene, however, will
not be complicated by this kind of appliance. The
introduction of bonding techniques enabled the
construction of permanent interdental wire connections as retention device. 16 As these retainers are
placed "invisibly" on the lingual tooth surfaces,
patients' acceptance is evident and compliance with
the orthodontic retention therapy is high. The continuing presence of the retention wires, however,
creates areas that are difficult to keep clean, thus
favoring plaque formation and food impaction. This
situation may lead to the development of carious
lesions, TM favor the formation of calculus, and induce gingival inflammation and periodontal disease. 9
Zacchrisson, 1 one of the pioneers in the field of
From the Faculty of Dentistry, Free University of Brussels.
aAssistant Professor, Department of Orthodontics.
aProfessor and Chairman, Department of Orthodontics, School of Dentistry.
bAssistant Professor, Department of Periodontology.
bProfessor and Chairman, Department of Periodontology, School of
Dentistry.
Reprint requests to: Dr. Aim~ A. De Smit, Department of Orthodontics,
School of Dentistry, Free University of Brussels, Laarbeeklaan 103, 1090
Brussels, Belgium.
Copyright 1997 by the American Association of Orthodontists.
0889-5406/97/$5.00 + 0 8/1/79813

bonded lingual retainers, stressed the importance of


daily interproximal cleaning with dental floss. Despite optimal oral hygiene instructions, calculus
formed to a greater extent on the lingual surfaces of
the incisors with bonded retainers, compared with
incisors without retainers. These findings were confirmed on a long-term basis by Dahl and Zacchrisson. 11 They found more plaque and calculus around
mandibular retainers, compared with the maxilla.
The long-term use of different types of bonded
lingual retainers was analyzed by Artun. 12 Plaque
and calculus were only occasionally registered. Carious lesions or periodontal reactions in the region
surrounding the bonded wires were absent. To our
knowledge, only ~&~rtunet al. 13 have reported on the
differences between the use of bonded and removable retainers. Four months after debonding, no
differences in gingival inflammation and accumulation of plaque and calculus could be detected in the
lower incisor region.
Compared with the widespread and still increasing use of bonded lingual retainers, research reports
on the influence of retainers on dental and periodontal tissues are scarce. In clinical observation,
our attention was drawn to rather obvious calculus
deposits around bonded lingual retainers in some of
our patients. As we had never had this impression in
the formerly, more often used removable retainers,
the current investigation was designed and initiated
607

608 Heier et aL

American Journal of Orthodontics and Dentofacial Orthopedics


December 1997

All measurements were taken in the maxilla and


mandible from canine to canine just before debonding
(baseline) and 1, 3, and 6 months later. The same clinician
scored the lingual, interdental, and buccal tooth sites.

Modified Gingival Index (MGI)


The MG114'I5 permits a noninvasive evaluation of
early and subtle visual changes in the severity and extent
of gingival inflammation. It is scored as follows: absence
of inflammation (0), part of gingival unit mild inflammation (1), complete gingival unit mild inflammation (2),
moderate inflammation (3), and severe inflammation (4).

Bleeding On Probing (BOP)


Fig. 1. Fixed lingual retainer bonded in Dentaflex 0
0.0175 arch from canine to canine.

to evaluate the differences in gingival conditions in


patients w h o wear b o n d e d or removable retainers.
Moreover, differences in plaque and calculus accumulation were analyzed.

MATERIAL AND METHODS


Thirty-six orthodontic patients, between the ages of
12.8 and 21.1 years, (mean 16.3 years) were treated with
fixed Begg appliances in the upper and lower arches.
Some of them were recruited in a private orthodontic
practice, others in the dental clinic at the Free University
of Brussels. A majority of patients wore retainers in both
arches. The decision whether a removable or bonded
lingual retainer would be used after active treatment was
made at treatment planning. Patients with pretreatment
spacing or extensive incisor rotations were given permanent bonded retainers. The others received removable
retainers. The level of oral hygiene was not taken into
account in the choice of retention device. Thus two
experimental groups were created: the fixed retainer
group (FRG) with 22 patients and the removable retainer
group (RRG) containing 14 patients.
At the end of active orthodontic treatment, standard
procedures for adhesive removal, polishing, and prophylaxis were performed. The fixed retainers were bent in
flexible spiral wire (Dentaflex 0.0175, Dentaurum) and
bonded to each lingual tooth surface from canine to
canine (Fig. 1). Care was taken not to leave any bonding
substance (Super C Ortho, Amco) in contact with gingival
tissues. All removable retainers had a labial arch and
several retention clasps embedded in an acrylic plate. At
the time of retainer insertion, oral hygiene instructions
were given. The patients were instructed to brush three
times a day. In order not to influence measurements,
disinfecting or fluoride containing mouthrinsing solutions
could not be applied. The daily use of wooden toothpicks
for interdental hygiene was expected from patients with
fixed retainers, whereas patients wearing removable retainers used dental floss.

The BOP 16 is widely used in diagnosis of gingival


inflammation. To obtain a standardized pressure of 25
gm, 17'18a Florida probe 19with a Michigan O probe tip was
inserted into the gingival crevice. This way the probing
force was standardized and could not be influenced by the
clinician. Bleeding was registered after 15 seconds2: no
bleeding (0), point-bleeding (1), and profuse bleeding (2).

Gingival Crevicular Fluid Flow (GCFF)


The examined teeth were isolated with cotton rolls
and cheek retractors and gently dried with the air syringe.
The tip of a Periopaper strip (Pro Flow Inc.) was placed at
the entrance of the gingival sulcus for 30 seconds. The
amount of gingival crevicular fluid absorbed into the
Periopaper is proportional to the digital reading on the
Periotron 600021-23 (Pro Flow Inc.). Values higher than 30
are considered as pointing to gingival inflammation. The
Periotron registrations were limited to the following sites:
the mesial and buccal surfaces of the upper right central
incisor, the distal and lingual surfaces of the upper left
canine, the distal and lingual surfaces of the lower left
central incisor, and the mesial and buccal surfaces of the
lower right canine.

Plaque Index (PI)


Plaque was disclosed with Diaplac (OY Mdlnlycke
Ab). The modified plaque index, according to Quigley and
Hein (modification according to Turesky), 24 was registered for the buccal and lingual tooth surfaces according
to the following scale: no plaque (0), spots of plaque at the
cervical margin (1), thin continuous band of plaque at the
cervical margin (2), gingival third of tooth surface covered
with plaque (3), two thirds of tooth surface covered with
plaque (4), and more than two thirds of tooth surface
covered with plaque (5).

Dental Calculus Index (DCI)


To measure the amount of dental calculus, the assessment according to Volpe et alY was used. A calibrated
periodontal probe was applied at three locations of the
buccal and lingual sides of each lower incisor and canine:
a mesial location, at the tooth center, and a distal location.

American Journal of Orthodontics and Dentofacial Orthopedics


Volume 11.2, No. 6

H e i e r e t al.

609

Table I. M e a n s of five o u t c o m e m e a s u r e s o n d i f f e r e n t l o c a t i o n s b y t r e a t m e n t g r o u p a n d t i m e o f f o l l o w - u p
Baseline measure

1-month follow-up

3-month follow-up

6-month follow-up

Index

Site

FR

RR

FR

RR

FR

RR

FR

RR

MGI

B
IB
IL
L
B
IB
IL
L
B
ID
L
B
L
B
L

0.71
1.71
1.42
0.79
0.25
0.36
0.50
0.32
24.57
46.91
15.29
2.86
2.78
0.01
0.20

0.74
1.40
1.26
0.80
0.40
0.57
0.70
0.34
25.56
55.27
15.70
2.56
2.78
0.01
0,05

0.44
1.01
1.03
1.12
0.18
0,23
0.37
0.56
11.I1
28.31
16.25
1,12
3.34
0.00
0.13

0.68
1.02
0.87
0.49
0.30
0.46
0.43
0.23
12.04
21.71
4.56
1.18
2.50
0.00
0.01

0.21
0.56
0.86
0.30
0.19
0.23
0.32
0.18
11.04
20.07
8.86
1,38
2.82
0.00
0.19

0.68
1.23
0.99
0.63
0.34
0.35
0.45
0.18
12.32
28.98
10.83
1.59
2.43
0.00
0.01

0.24
0.66
0.94
0.40
0.22
0.30
0.30
0.23
22.29
25.46
8.04
1.02
3.03
0.00
0.20

0,89
1,40
1,23
0,74
0,41
0.47
0.40
0.22
16.88
35.18
11.00
1.24
2.52
0.00
0.06

BOP

GCFF

PI
DCI

MGI: Modified Gingival Index; BOP." Bleeding On Probing; GCFF: Gingival Crevicular Fluid Flow; Ph Plaque Index; DCI: Dental Calculus Index.
B: Buccal; IB: Interdental Buccal; IL: Interdental Lingual; L: Lingual; ID: Interdental.
FR: Fixed Retainer; RR: Removable Retainer.

Statistical Analysis
A univariate repeated measurement analysis of variance (ANOVA) model was used, containing one repeated
factor (time) and one between factor (code:distinguishing
the removable versus the fixed retainer group). Each
analysis resulted in three P values, one for each factor and
one as interaction term. Subsequently, a Scheff6 post hoc
analysis calculated the significance levels of the differences between pairs. Throughout the entire statistical
analysis, a significance level ofp <- 0.05 was maintained.
RESULTS
For each of the two study groups (fixed or
removable retainer), mean values at baseline, at
1-month, 3-month, and 6-month follow-up examinations are presented in Table I. The changes through
time are visualized in Figs. 2 through 6. Table II
shows the changes from baseline to 1-month followup, from 1- to 3-month follow-up, and from 1- to
6-month follow-up. The differences for the five
outcome measures between the group wearing fixed
retainers (FR) and the group with removable retainers (RR) can be seen in Table III.
At baseline, the mean MGI (Fig. 2) of both
retainer groups was below score 1 for the buccal and
lingual sites. The mean interdental values (Table I)
were slightly higher in the F R than in the R R group
(at the lingual aspect FRIL:l.42; RRIL:1.26 and at
the buccal aspect FRIB:I.71; RRIB:I.40). These
differences were only significant for the interdental
buccal region (p = 0.0163). The mean MGI after
wearing retainers for 1 month showed a tendency to
be lower than at baseline for all sites and for both

retainer types. The changes were not significant at


the lingual sites for both retainer types and at the
buccal sites for the removable retainers (Table II).
After the first month, however, the mean MGI
tended to increase in the group with removable
retainers, but generally these increases were not
significant (Table II). At the 6-month follow-up, the
mean values remained below score 1 at the buccal
and lingual sites. At 6 months, the lingual sites
showed a mean MGI of 1.23 and the buccal sites
showed a mean MGI of 1.40 (Table I). In the group
with fixed retainers, a reduction in MGI values was
found between months 1 and 3, followed by a small
increase between the months 3 and 6 (Table II). At
the 6-month evaluation, the mean MGI values at all
sites were lower in the group with fixed retainers
than in the removable retainer group (Table I). The
mean MGI after wearing retainers for 6 months
remained below score 1 for both retainer types at
the buccal and lingual sites. The highest mean MGI
after 6 months (1.40) was seen for removable retainers at the interdental buccal sites. In contrast, for the
fixed retainer group, the lowest mean MGI (0.66)
was registered at these interdental buccal sites (Table I).
The mean BOP index (Fig. 3) of both retainer
groups stayed below score i at all sites from baseline
to 6-month follow-up (Table I). In all instances, the
mean BOP index at baseline was lower in the fixed
retainer group than in the group that would receive
a removable retainer (Table I). Statistical analysis
showed that these differences were only significant

Heier et al.

610

American Journal of Othodontics and Dentofacial Orthopedics


December 1997

F~G
- - c o ~ :
e

1.4

1.2

. . . . . .

2L

0f

1.4

/2

',,

J
jJJ

..... 2.Y'

.L
-1

i!i

D
Fig. 2. Modified gingival index. A, Buccal sites. B, Interdental buccal sites. C, Interdental
lingual sites. D, Lingual sites.

for the interdental sites (Table III). At the lingual


sites, the mean BOP increased to 0.56 after 1 month
with fixed retainers (Table I). This change was not
significant (Table III).
At the other sites, a nonsignificant downward
evolution of the mean BOP was noticed at i-month
follow-up for both retainer groups. With both kinds
of retainers, the changes in the mean BOP toward 6
months were very small (Table II). A slight reduction was observed toward the 6-month follow-up for
the lingual and lingual interdental sites. A tendency
toward an increased BOP was found for the buccal
and interdental buccal sites (Table II). The maximum mean BOP at 6 months was found at the
interdental buccal sites. However, it remained limited to 0.47 (Table I). At that time, the mean BOP
values were slightly, but not significantly, lower in
the group with fixed retainers compared with the
removable retainer group. The values at the lingual

sites were nearly identical for both retainer types


(Table I).
The lowest mean values for the gingival crevicular fluid (Fig. 4) at baseline were found on the
lingual surfaces for both groups (15 periotron units).
For the buccal sites, level 25 was reached; the
interdental sites reached up to 47 in the fixed
retainer group and to 55 in the group that would get
removable retainers (Table I). None of the differences between RR and FR proved to be statistically
significant (Table III). One month later, the periotron score had dropped for all, but one measure
that remained practically unchanged, i.e., the lingual
sites in the fixed retainer group. Toward the 6month follow-up, this downward trend was stopped
or reversed (Table II). The values for the fixed
retainer group were not significantly different from
those in the removable retainer group (Table III).
The highest GCFF values after 6 months were found

American Journal of Orthodontics and Dentofacial Orthopedics


Volume 112, No. 6

Heier et al.

611

B,45

f/1

~ f

....

i!i!I

C~E=
F~

....... i !
v

A
B L E ~ N ~ ON ~ROBZNG=X~OENT~L

~ I N ~ U ~ ~ZTE~

~.TS

o,75

~.SS

~.65

B,55

/
/'

--

-~

COOE=

i!

3
, Em~<months)

. . . . . . .

Fig. 3. Bleeding on probing. A, Buccal sites. B, Interdental buccal sites. C, Interdental


lingual sites. D, Lingual sites.

for the interdental sites: 35 in the removable retainer group and 25 with fixed retainers. The lowest
GCFF values were situated at the lingual sites: 11 in
the RR group, and 8 in the FR group.
Before debonding, comparable mean plaque indexes near 2.8 were found in the two groups on the
buccal and lingual surfaces (Fig. 5). The buccal
value had dropped significantly to about 1.2 on the
buccal surfaces at 1-month follow-up (Table I). It
remained at approximately the same level at 6
months, after a small but nonsignificant increase at
the 3-month follow-up (Table II). The mean lingual
PI in the removable retainer group was reduced to
2.5 after 1 month, 2.4 at month 3, and 2.5 at the
6-month follow-up. In the fixed retainer group, the
mean PI at the lingual sites climbed to 3.3 at
1-month, to end at 3.0 at 6 months (Table I). This
score was significantly higher than the score in the
removable retainer group (Table III).
On the buccal surfaces, the mean DCI (Fig. 6)

remained near zero throughout the evaluation period. The mean DCI on the lingual surface at
baseline was slightly above zero (0.2 ram) in the
group receiving a fixed retainer, whereas calculus
was almost absent (0.05 ram) in the other group.
One month 'later, the mean calculus level was
brought down further to 0.1 mm for the FR group
and to 0.01 mm for the RR group. At 6 months, the
mean lingual measurements had gone up to the
original values (Table I).
DISCUSSION

At the end of the presence of fixed orthodontic


appliances on the buccal tooth surfaces, the recordings of MGI, BOP, and GCFF for the buccal and
lingual gingival units indicate that generally only
limited parts of these gingival units showed mild
inflammation, very few bleeding points were
present, and a normal gingival crevicular fluid flow
existed. For the interdental areas, the MGI pointed

6"12

Heier et al.

American Journal of Orthodontics and Dentofaciat Orthopedics


December 1997
G I ~

~RE~ICU~R ~LU~

~ L O W : ~ C C ~ L SZ~E~

i!

.... COOE:
f~
~OE:
RR6

-?

:I
4~ r

-i

:I
L

C0~EZ
~0~E~

- -

-i

oa.:

t Jm~(~anths)

Fig. 4. Gingival crevicular fluid flow. A, Buccal sites. B, Interdental sites. C, Lingual sites.

to more complete gingival units with mild gingival


inflammation, the BOP test showed the existence of
more point bleedings, and the GCFF was found to
correspond with the presence of mild gingival inflammation. The differences between the fixed and
removable retainer groups being very small, this
suggests that the oral hygiene at the end of the
active orthodontic treatment had been acceptable
for the buccal and lingual tooth surfaces in both
groups, but some inflammation was present in the
approximal area. Somewhat more calculus was
present at the lingual sites of the FR group.
The 1-month, 3-month, and 6-month follow-up
recordings have been gathered in two different
situations, as far as access for oral hygiene was
concerned. In one group, wires bonded to the
lingual surfaces of incisors and canines were crossing the interdental spaces. The use of wooden
toothpicks for plaque removal in the interproximal
areas had been explained and required in this group.

The other group had the opportunity to perform


completely normal oral hygiene procedures as the
removable retainers were used only at nighttime.
Considering the change from fixed orthodontic appliances present on the buccal tooth surfaces at
baseline, to naked buccal tooth surfaces 1 month
later, we were not surprised to find that the three
indices concerning gingival inflammation tended to
be lower at 1-month follow-up. The buccal tooth
surfaces, being easier to clean, could be considered
as healthy. This also applied for the lingual surfaces
in the removable retainer group, but not for the
lingual aspect with fixed retainers. There, the indices
scored somewhat higher, suggesting a little less
favorable gingival health. In the interdental regions,
all indices showed lower mean values at 1-month
than at baseline, especially the GCFF dropped
below 30 periotron units, taking it below the inflammation limit. At all tooth surfaces, the gingival
condition could be considered as healthy for both

American Journal of Orthodontics and Dentofacial Orthopedics


Volume 112, No. 6

l.e

H e i e r et al.

61:3

,,

. . . .

CODE*
FRE

-~

"-'-k
-'k

. .....
""-..

.......

1.B=

1.4 I
L.e

0,6

.... ~E,

0,4 ~
0,2

e~E~
0
Z

B
Fig, 5. Plaque index. A, Buccal sites. B, Lingual sites.
kinds of retainers. Some of the mean indices were a
little lower in the fixed retainer group, some a little
higher than in the removable retainer group, but
these small differences were not statistically significant. On this basis, it can be concluded that, in the
scored patient groups who wore fixed lingual retainers during a 1-month period, this did not lead to a
gingival condition, which was more unfavorable than
that in the group wearing removable appliances.
Our assessments of MGI, BOP, and G C F F at
3-month recall appeared to bring all mean values of
the group with fixed retainers at a lower level than
those with the removable retainers worn only during
the night. As the differences were seldom statistically significant, we cannot state that oral hygiene
conditions were more favorable in the group with
fixed retainers. Moreover, there is even less reason
to accept that they had worse gingival conditions.
Going to 6-month recall, a tendency toward
higher indices was noticed in both groups. How-

ever, these increases were not statistically significant. In general, the m e a n MGI, BOP, and G C F F
in the fixed retainer group remained below the
indices for the removable retainer group. A striking difference between the two groups concerning
gingival health could not be observed. The trend
toward increased values at 6 months for both
groups could be interpreted as an indication for
the need for r e p e a t e d motivation and oral hygiene
instructions at least on a 6-month interval basis.
Further investigation could test the validity of this
interval on a long-term basis.
In both groups, the mean buccal PI before
debonding was found to be very close to the lingual
values. The mean value near 2.8 shows that, at the
end of the orthodontic treatment, the patients did
not succeed in reaching a high standard of oral
hygiene. The mean MGI, BOP, and GCFF values
discussed previously suggest that, in those regions
with a buccal and lingual presence of at least a

614 Heier et aL

American Journal of Orthodontics and Dentofacial Orthopedics


December 1997

~. tv
^

~.tB

o.13

~.ee

%-

RR~
7

DENTAL CALCULUS ZNDEX:LZNGURL SZTES

e . 24
e.e3

0,22
0.21

g.l.9
e,iB

. ,. 1.7.
0

....

....

i/'

B.14

B. ia

B.ll

e.o9

............

o.e8

0.07

.. .3. .'

............

.
---

z.m ~
-B.eI

- -

CODE=
FRG
CODE=
RRG

B
Fig. 6. Dental calculus index. A, Buccal sites. B, Lingual sites.

continuous band of plaque at the cervical margins, a


rather mild gingival inflammation existed.
After removal of the buccal fixed appliances, an
improvement in plaque condition was seen on the
buccal surfaces in both retainer groups. Continuous
bands of plaque were rarely recorded. Rather commonly, spots of plaque have been noticed at the
cervical margin. This nonideal situation of oral
hygiene remained until the 6-month follow-up. It
could be considered acceptable because the local
gingival condition showed no real inflammation.
The lingual plaque condition in both groups
did not improve after debonding. This could be
explained by the remaining lack of direct view on
those surfaces, which makes oral hygiene more
difficult and seemingly less necessary. The presence of the fixed wires was accompanied by a

rather small, but nonsignificant increase in plaque


accumulation on the lingual surfaces. Until the
6-month follow-up, the measured plaque levels
had not caused any significant gingival inflammation. This confirms and extends the results of
Artun et al. 13 of finding no significant differences
in gingival inflammation nor accumulation of
plaque and calculus after 4 months with fixed or
removable retainers.
The deposit of calculus was nearly nonexistent
on the buccal tooth surfaces. For the lingual sites,
this applied for both kinds of retainers.
CONCLUSION

A comparable limited gingival inflammation was


found in the presence of both types of retainers. The
clinical observation of an increased tendency of calculus

615

Heier et al.

American Journal of Orthodontics and Dentofacial Orthopedics


Volume 112, No. 6

T a b l e II. Mean differences a n d p levels from baseline to 1 month follow-up, from 1 to 3 month follow-up, and from 1 to 6 month
follow-up, for five outcome measures on different locations by treatment groups

Baseline to 1-month follow-up


FR
Index

Site

MGI

B
IB
IL
L
B
IB
IL
L
B
ID
L

BOP

GCFF

PI

DCI

L
B
L

X
-0.27
-0.70
-0.39
+0.33
-0.07
-0.13
-0.13
+0.24
-13.46
-18.60
+0.96
- 1,74
+0.56
-0.01
-0.07

1- to 3-month follow-up

RR
P

0.0540*
0.0000"
0.0004*
0.9436
0.8420
0.2364
0.1980
0.8963
0.1933
0.1398
0.9994
0.0000"
0.0009*
0.2472
0.1272

-0.06
-0.38
-0.39
-0.31
-0.10
-0.11
-0.27
-0.11
-13.52
-33.56
-11.14
- 1.38
-0.28
-0.01
-0.04

FR
P

0.9519
0.0013"
0.0005*
0.9567
0.6177
0.3140
0.0006*
0.9896
0.2350
0.0021"
0.5851
0.0000"
0.2553
0.9854
0.7354

-0.23
-0.45
-0.17
-0.82
+0.01
0.00
-0.05
-0.38
-0.07
-8.24
-7.39
+0.26
-0.52
0.00
+0.06

1- to 6-month follow-up

RR
P

0.1474
0.0000"
0.3137
0.4913
0.9999
1.0000
0,8996
0.6653
1.0000
0.7808
0.7904
0.3915
0.0023*
0.1102
0.1903

FR

0.00
+0.21
+0.12
+0.14
+0.04
-0.11
+0.02
-0.05
+0.28
+7.27
+6.27
+0.41
-0.07
0.00
0.00

P
0.9999
0.1832
0.6343
0.9954
0.9594
0.3621
0.9944
0.9990
0.9999
0.8724
0.8927
0.0814
0.9684
0.9999
1.0000

X
-0.20
-0.35
-0.09
-0.72
+0.04
+0.07
-0.07
-0.33
+11.18
-2.85
-8.21
0.10
-0.31
0.00
+0.07

RR
P

0,2717
0.0027*
0.8064
0.6077
0.9763
0.7124
0.7370
0.7662
0.3518
0.9880
0.7318
0.9209
0.1590
0.1253
0.1976

+0.21
+0.38
+0.36
+0.25
+0.11
+0.01
-0,03
-0.01
+4.84
+13.47
+6.44
+0.06
+0.02
0.00
+0.05

0.2420
0.0016"
0.0015"
0.9748
0.5257
0.9963
0.9815"
0.9999
0.9073
0.4921
0.8846
0.9858*
0.9995
0.9999
0.5194

MGI: Modified Gingival Index; BOP: Bleeding On Probing; GCFF: Gingival Crevicular Fluid Flow; PI: Plaque Index; DCI: Dental Calculus Index.
B: Buccal; IB: Interdental Buccal; IL: Interdental Lingual; L: Lingual; ID: Interdental.
FR: Fixed Retainer; RR: Removable Retainer.
*Significant atp -< 0.05.

Ill. Mean differences and p levels between wearing fixed and removable retainers for five outcome measures on different
locations by time of follow-up

Table

Baseline

1-month

Index

Site

MGI

B
IB
IL
L
B
IB
IL
L
B
ID
L
B
L
B
L

-0.03
0.31
0.16
-0.01
-0.15
-0.21
-0.20
-0.02
-0.99
-8.36
-0.41
0.30
0.00
0.00
0.15

0.9950
0,0163"
0.4032
1.0000
0.2615
0.0051"
0.0242*
0.9999
0.9990
0.7977
0.9999
0.2762
0.9999
0.8592
0.0012"

-0.24
-0.01
0.16
0.63
-0.12
-0.23
-0.06
0.33
-0.93
6.60
11.69
-0.06
0.84
0.00
0.12

BOP

GCFF

PI
DCI

3-month

6-month

0.1261
0.9999
0.3597
0.7108
0.5010
0.0035*
0.8250
0.7708
0.9991
0.8887
0.5042
0.9830
0.0000*
0.0214"
0.0242*

-0.47
-0.67
-0.13
-0.33
-0.15
-0.12
-0.13
0.00
- 1,28
-8.91
- 1.97
-0.21
0.39
0.00
0.18

0.0000"
0.0000"
0.5858
0.9436
0.2525
0.3196
0.2679
0.9999
0.9978
0.7648
0.9955
0.6134
0.0533*
0.8582
0.0000*

-0.65
-0.74
-0.29
-0.34
-0.19
-0.17
-0.10
0.01
5.41
-9.72
-2.96
-0.22
0.51
0.00
0.14

P
0.0000"
0.0000"
0.0185"
0.9403
0.0789
0.0517
0.4466
0.9999
0.8667
0,7126
0.9850
0,5321
0.0040*
0.9900
0.0101"

MGI: Modified Gingival Index; BOP." Bleeding On Probing; GCFF: Gingival Crevicular Fluid Flow; PI: Plaque Index; DCI: Dental Calculus Index.
B: Buccal; IB: Interdental Buccal; IL: Interdental Lingual; L: Lingual; [19: Interdental.
FR: Fixed Retainer; RR." Removable Retainer.
*Significant atp -< 0.05.
f o r m a t i o n a r o u n d fixed r e t a i n e r s w a s c o n f i r m e d . H o w ever, this difference w a s a l r e a d y p r e s e n t b e f o r e t h e place-

U n i v e r s i t y o f Brussels, f o r allowing u s to take m e a s u r e m e n t s f r o m s o m e o f h e r p a t i e n t s a n d to G i n o V e r l e y e ,

m e n t o f t h e fixed r e t a i n e r , I f a p r o f e s s i o n a l p l a q u e a n d

A s s i s t a n t P r o f e s s o r in A p p l i e d Statistics, D e p a r t m e n t o f

calculus r e m o v a l
and oral hygiene
is likely t h a t t h e
p r o m i s e d by t h e

a c c o m p a n i e d by a s e s s i o n o n m o t i v a t i o n
i n s t r u c t i o n is r e p e a t e d every 6 m o n t h s , it
periodontal health should not be comp r e s e n c e o f b o n d e d lingual wires.

Statistics, F r e e U n i v e r s i t y o f Brussels, f o r his a s s i s t a n c e


w i t h t h e statistical analysis.

W e e x p r e s s o u r t h a n k s to K a t h y Goeffers, D D S ,
A s s i s t a n t P r o f e s s o r , D e p a r t m e n t of O r t h o d o n t i c s , F r e e

1. GazitE, LiebermanMA.An estheticand effectiveretainerfor loweranteriorteeth.


Am J Orthod 1976;70:91-3.

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616 Heier et al.

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