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Medical Forum / General / Dentistry / February 2007Fixed Long-Term Retention
Greetings, About 25 years ago (I am 53 years old), I wore braces for 4 years. Initially they were to open the spaces where my 5-year molars had been removed as a teenager to install bridges. However, I did have a moderate diastema & a rather larger space between my slightly rotated right lateral upper incisor & first canine which were corrected by the treatment. As I recall, I wore a retainer for at least the prescribed period of time after removal of the bands. Over time however, the right lateral incisor has begun to slide under the adjoining central incisor, lifting it up slightly & reproducing the diastema. I have made an appointment with an orthodontist to address this issue. My question is regarding the re-occurrence of this condition after correction. Is it common for an orthodontist to permanently cement a band or wire behind the upper front teeth to retain their position or is this considered unusual? I ask this because there is no obvious reason why this tooth migrated behind the other because my wisdom teeth were removed in my 20's & I had no teeth removed, etc. It seems that this could occur even while wearing a removable retainer for the rest of my life. Any input both pro & con is appreciated. Thank you, Rich > Greetings, > About 25 years ago (I am 53 years old), I wore braces for 4 years. [quoted text clipped - 19 lines] > > Rich If there is reason to believe that an orthodontic result will not be stable, permanent retention is indeed sometimes done. The bite will not always allow an orthodontic wire to be used as a retainer. It is possible to drill a small channel between adjacent teeth and use a wire or other device in the channel and bond in. These retainers tend to require periodic maintenance, patching and replacement in my limited experience. The teeth may also be crowned and splinted this way, which is effective but obviously rather aggressive unless crowns are otherwise needed. It is also possible to do a bonded lingual retainer similar to what is done with a Maryland bridge. Steve > If there is reason to believe that an orthodontic result will not be > stable, permanent retention is indeed sometimes done. The bite will not [quoted text clipped - 8 lines] > > Steve I had considered crowning them but they are in relatively good cosmetic shape & that seemed a little aggressive with no turning back. Do you have a link where I could see or read about the lingual retainer? Otherwise I'll do a search. Thank you for responding. I appreciate your professional opinion. Rich >> If there is reason to believe that an orthodontic result will not >> be stable, permanent retention is indeed sometimes done. The bite [quoted text clipped - 16 lines] > > Rich Google "Maryland Bridges". They usually are used to replace teeth, but the flat metal wings can be extended to cover the linguals of multiple teeth. They may require some reduction of the linguals of your upper teeth (depending on your bite), but certainly less than for traditional crowns/bridges. I haven't had good luck with them as bridges (ie: to replace missing teeth--they've often fallen out) but for your application should be less demanding and less likely IMO to fall out. Steve > Google "Maryland Bridges". They usually are used to replace teeth, but > the flat metal wings can be extended to cover the linguals of multiple [quoted text clipped - 6 lines] > > Steve Yes, actually I found many illustrations after I originally replied to your post. I can see where that would entail almost the expense of a bridge to compensate the dentist for his time to prep the teeth & the lab to fabricate a wing. I was thinking more along the lines where the ortho could cement an lingual arch wire or splint without the necessity of removing any or a minimal amount of tooth enamel. On the other hand, I can also see where a tooth prepped & bridged from behind with a custom Maryland wing would be quite effective & long-lasting inasmuch as the supports are not required to support a prosthetic tooth in a bridge. I'll bring it up at my consult on Wednesday. Thanks again, Doctor Steve. Rich >> Google "Maryland Bridges". They usually are used to replace teeth, >> but the flat metal wings can be extended to cover the linguals of [quoted text clipped - 20 lines] > > Rich Actually the expense should be considerably less--less preparation time for the dentist, easier to impression, and lower lab fee. For lower teeth it is generally not necessary to prepare the teeth at all. There are cemented wire splints--they are frequently placed in drilled channels that may take you closer to the pulp than the etched metal retainer bridge. Without the channel they can work, though more likely on the lower jaw, and will still usually need periodic patching: http://cudental.creighton.edu/images/lingual%20retainer%20fixed%201.jpg http://www.harmonorthodontics.com/lower_retainer.jpg Steve > Actually the expense should be considerably less--less preparation > time for the dentist, easier to impression, and lower lab fee. For [quoted text clipped - 10 lines] > > Steve I had my consultation with the orthodontist. He seemed very conscientious, honest & intelligent. He said he always used fixed lingual retention on adult patients to prevent incisor relapse. The problem is that my overbite mostly relapsed where my bottom teeth impacted my upper incisor just short of my upper palate...exactly where he places the fixed wire. He conjectured that he could place the wire lower on my upper teeth whereby my overbite would allow my lower incisors (possibly)to miss the wire as it passes when I bite. His concern is that when I am chewing I may hit the wire if I were not vigilant. I already had impressions & get brackets (upper 6 front teeth only, 6-9 months) in 10 days. Is it unheard of or bizarre to ask about cutting a channel to counter sink (at least partially)the retention wire making it almost impossible to hit with my lower teeth? I may also ask him about a bonded band (ala the Baltimore bridge). He seems like a professional who enjoys a challenge; at least I hope he does. He also said that he can close the diastema & straighten the lateral incisor but it would create two smaller spaces on either distal side of the lateral incisors. To do it absolutely correctly would be to re-correct my bite which would at age 53 & two lower bridges be a major lengthy & costly production. I told him I could live with the over bite & would be happy with no central space & permanent fixation to prevent re-occurrence (less than $900 out of pocket with insurance). Anybody out there cutting grooves in patient's teeth to embed a fixation wire? Thanks again. Rich. >> Actually the expense should be considerably less--less preparation >> time for the dentist, easier to impression, and lower lab fee. For [quoted text clipped - 37 lines] > Thanks again. > Rich. It is certainly done. I've occasionally done it myself, but not in connection with ortho cases--rather on the prescription of a periodontist who wishes the teeth splinted for periodontal support and prevention of drifting due to periodontal disease (as opposed to prevention of relapse after orthodontic treatment). I used to use something called (IIRC) "Splint-loc" which involved a braided wire with eyelets, through which small pins were threaded into the dentine. Composite resin was flowed in. It was difficult to place, but they held up for quite a while. I would think that some orthodontists might try this, but I don't know how comfortable those who haven't done much restorative dentistry since dental school would be. There is a risk of pulpal involvement, esp. if the teeth are rotated or malposed (I suppose this wouldn't be the case with you). A good set of x-rays would be useful in assessing the risks to the pulp. It sounds like your orthodontist is being diligent and directing treatment well. Steve |
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