Variations of the Plaque Index in Four Timelines during 12 Months in Patients with Two Models of Fixed Retainers after Orthodontic Treatment is Finished

Jeta Kiseri Kubati, Zana Sllamniku, Arijeta Sllamniku, Burim Kiseri

For citation: Kubati JK, Sllamniku Z, Sllamniku A, Kiseri B. Variations of the Plaque Index in Four Timelines during 12 Months in Patients with Two Models of Fixed Retainers after Orthodontic Treatment is Finished. International Journal of Biomedicine. 2024;14(1):148-152. doi:10.21103/Article14(1)_OA23
Originally published March 1, 2024


Background: Fixed retainers are retention tools bonded on the lingual side of the frontal teeth to prevent relapse after orthodontic treatment is finished. While stability remains the biggest concern, periodontal response remains the subject of discussion. This study aimed to compare plaque index (PI) levels on the lingual side of the lower dental arch in the inter-canine region after bonding two different models of fixed retainers.
Methods and Results: The study included 60 subjects aged 16-25 who finished orthodontic treatment. Thirty subjects got flat fixed retainer (FFR), and 30 other subjects got round fixed retainer (RFR) bonded in the lower six frontal teeth on the lingual side. Adapted PI was recorded and photographed at four time points (3, 6, 9, and 12 months). Three months after the intervention, there were no significant differences between the FFR and RFR related to the PI value (P=0.363). PI was significantly lower in the FFR group than in the RFR group 6, 9, and 12 months after the intervention (P<0.004, P=0.004 and P=0.001, respectively).
Conclusion: Bonded fixed retainers, in general, cause increased plaque formation and make oral hygiene routines more difficult.

fixed retainers• flat retainer• round retainer• plaque index
  1. Little RM, Riedel RA, Artun J. An evaluation of changes in mandibular anterior alignment from 10 to 20 years postretention. Am J Orthod Dentofacial Orthop. 1988 May;93(5):423-8. doi: 10.1016/0889-5406(88)90102-3. PMID: 3163221.
  2. Katsaros C, Elisades T. Stability Retention and Relapse in Orthodontics. Quintessence Publishing: Berlin; 2017.
  3. Pratt MC, Kluemper GT, Hartsfield JK Jr, Fardo D, Nash DA. Evaluation of retention protocols among members of the American Association of Orthodontists in the United States. Am J Orthod Dentofacial Orthop. 2011 Oct;140(4):520-6. doi: 10.1016/j.ajodo.2010.10.023. PMID: 21967939; PMCID: PMC5161457.
  4. Vandevska-Radunovic V, Espeland L, Stenvik A. Retention: type, duration and need for common guidelines. A survey of Norwegian orthodontists. Orthodontics (Chic.). 2013;14(1):e110-7. doi: 10.11607/ortho.964. PMID: 23646321.
  5. Lai CS, Grossen JM, Renkema AM, Bronkhorst E, Fudalej PS, Katsaros C. Orthodontic retention procedures in Switzerland. Swiss Dent J. 2014;124(6):655-61. PMID: 24943474.
  6. Chinvipas N, Hasegawa Y, Terada K. Repeated bonding of fixed retainer increases the risk of enamel fracture. Odontology. 2014 Jan;102(1):89-97. doi: 10.1007/s10266-012-0095-9. Epub 2012 Dec 14. PMID: 23239387.
  7. King GJ, Keeling SD. Orthodontic bone remodeling in relation to appliance decay. Angle Orthod. 1995;65(2):129-40. doi: 10.1043/0003-3219(1995)065<0129:OBRIRT>2.0.CO;2. PMID: 7785804.
  8. Artun J. Caries and periodontal reactions associated with long-term use of different types of bonded lingual retainers. Am J Orthod. 1984 Aug;86(2):112-8. doi: 10.1016/0002-9416(84)90302-6. PMID: 6380296.
  9. Pandis N, Vlahopoulos K, Madianos P, Eliades T. Long-term periodontal status of patients with mandibular lingual fixed retention. Eur J Orthod. 2007 Oct;29(5):471-6. doi: 10.1093/ejo/cjm042. PMID: 17974536.
  10. Torkan S, Oshagh M, Khojastepour L, Shahidi S, Heidari S. Clinical and radiographic comparison of the effects of two types of fixed retainers on periodontium - a randomized clinical trial. Prog Orthod. 2014 Aug 27;15(1):47. doi: 10.1186/s40510-014-0047-8. PMID: 25162332; PMCID: PMC4145221.
  11. Dietrich P, Patcas R, Pandis N, Eliades T. Long-term follow-up of maxillary fixed retention: survival rate and periodontal health. Eur J Orthod. 2015 Feb;37(1):37-42. doi: 10.1093/ejo/cju001. Epub 2014 Aug 2. PMID: 25086911.
  12. Artun J, Spadafora AT, Shapiro PA. A 3-year follow-up study of various types of orthodontic canine-to-canine retainers. Eur J Orthod. 1997 Oct;19(5):501-9. doi: 10.1093/ejo/19.5.501. PMID: 9386336.
  13. Heier EE, De Smit AA, Wijgaerts IA, Adriaens PA. Periodontal implications of bonded versus removable retainers. Am J Orthod Dentofacial Orthop. 1997 Dec;112(6):607-16. doi: 10.1016/s0889-5406(97)70225-7. PMID: 9423692.
  14. Storey M, Forde K, Littlewood SJ, Scott P, Luther F, Kang J. Bonded versus vacuum-formed retainers: a randomized controlled trial. Part 2: periodontal health outcomes after 12 months. Eur J Orthod. 2018 Jul 27;40(4):399-408. doi: 10.1093/ejo/cjx059. PMID: 29059293.
  15. Levin L, Samorodnitzky-Naveh GR, Machtei EE. The association of orthodontic treatment and fixed retainers with gingival health. J Periodontol. 2008 Nov;79(11):2087-92. doi: 10.1902/jop.2008.080128. PMID: 18980517.
  16. Rody WJ Jr, Akhlaghi H, Akyalcin S, Wiltshire WA, Wijegunasinghe M, Filho GN. Impact of orthodontic retainers on periodontal health status assessed by biomarkers in gingival crevicular fluid. Angle Orthod. 2011 Nov;81(6):1083-9. doi: 10.2319/011011-15.1. Epub 2011 Jun 9. PMID: 21657829; PMCID: PMC8903857.
  17. Störmann I, Ehmer U. A prospective randomized study of different retainer types. J Orofac Orthop. 2002 Jan;63(1):42-50. English, German. doi: 10.1007/s00056-002-0040-6. PMID: 11974451.
  18. Shirasu BK, Hayacibara RM, Ramos AL. Comparação de parâmetros periodontais após utilização de contenção convencional 3x3 plana e contenção modificada. Rev Dental Press Ortod Ortop Facial. 2007;12(1):41-7.
  19. Al-Nimri K, Al Habashneh R, Obeidat M. Gingival health and relapse tendency: a prospective study of two types of lower fixed retainers. Aust Orthod J. 2009 Nov;25(2):142-6. PMID: 20043549.
  20. Higgins, J.P.T. and Green S. Addressing reporting biases in Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0; 2011.
  21. Buzatta LN, Shimizu RH, Shimizu IA, Pachêco-Pereira C, Flores-Mir C, Taba M Jr, Porporatti AL, De Luca Canto G. Gingival condition associated with two types of orthodontic fixed retainers: a meta-analysis. Eur J Orthod. 2017 Aug 1;39(4):446-452. doi: 10.1093/ejo/cjw057. PMID: 27629261.
  22. Zachrisson BU. Clinical experience with direct-bonded orthodontic retainers. Am J Orthod. 1977 Apr;71(4):440-8. doi: 10.1016/0002-9416(77)90247-0. PMID: 322500.
  23. Sambunjak D, Nickerson JW, Poklepovic T, Johnson TM, Imai P, Tugwell P, Worthington HV. Flossing for the management of periodontal diseases and dental caries in adults. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD008829. doi: 10.1002/14651858.CD008829.pub2. Update in: Cochrane Database Syst Rev. 2019 Apr 23;4:CD008829. PMID: 22161438.
  24. Berchier CE, Slot DE, Haps S, Van der Weijden GA. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. Int J Dent Hyg. 2008 Nov;6(4):265-79. doi: 10.1111/j.1601-5037.2008.00336.x. PMID: 19138178.

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Received February 3, 2024.
Accepted February 24, 2024.
©2024 International Medical Research and Development Corporation.