Retention Practices of Orthodontists in the Western Balkans

ORIGINAL ARTICLE
J. Kiseri Kubati, B. Dzipunova, M. Zigante, S. Kantor, M. Dzipunova, S. Spalj

 
For citation: Kiseri Kubati J, Dzipunova B, Zigante M, Kantor S, Dzipunova M, Spalj S. Retention Practices of Orthodontists in the Western Balkans. International Journal of Biomedicine. 2025;15(3):552-558. doi:10.21103/Article15(3)_OA16
 
Originally published September 5, 2025

Abstract: 

Background: Retention protocols vary widely across regions, yet limited data exist on practices in the Western Balkans. This study aimed to compare retention strategies among orthodontists in Croatia, North Macedonia, and Kosovo, evaluating influences such as clinician experience, malocclusion type, and patient factors.
Methods and Results: A questionnaire was distributed to 185 orthodontists in Croatia, 150 in North Macedonia, and 125 in Kosovo (representing 78%-100% practicing orthodontists) from December 2023 to May 2024, with response rates of 75%, 63%, and 58%, respectively. Data on appliance preferences, follow-up frequency, and retention protocol were analyzed using Chi-square and Kruskal-Wallis tests.   
The most preferred appliance options were the following: VFR in Croatia, a combination of fixed and removable in Kosovo, and an acrylic plate in North Macedonia.  Retention choices were primarily experience-driven, though Kosovar orthodontists prioritized patient age/growth (88%), while Croatians and Macedonians emphasized malocclusion type (73%-78%). Countries also differed in patient care practices following a procedure. Written instructions were less common in Kosovo and North Macedonia than in Croatia (11% and 19% vs. 69%; P<0.001). Monitoring by an orthodontist beyond three years was higher in Kosovo and North Macedonia than in Croatia  (92 and99% vs. 75%; P < 0.001). 
Conclusion: Significant regional differences in retention practices reflect variations in training traditions, clinical habits, and socioeconomic factors. These findings underscore the need for clearer, evidence-based retention guidelines to support consistent and unified clinical practices across regions, ultimately improving long-term patient outcomes. 

Keywords: 
orthodontic retention • orthodontic retainers • retention protocols • Balkans
References: 
  1. Keim RG, Gottlieb EL, Nelson AH, Vogels DS 3rd. 2002 JCO study of orthodontic diagnosis and treatment procedures. Part 1. Results and trends. J Clin Orthod. 2002 Oct;36(10):553-68. PMID: 12428306.
  2. Littlewood SJ, Millett DT, Doubleday B, Bearn DR, Worthington HV. Retention procedures for stabilising tooth position after treatment with orthodontic braces. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD002283. doi: 10.1002/14651858.CD002283.pub3. Update in: Cochrane Database Syst Rev. 2016 Jan 29;(1):CD002283. doi: 10.1002/14651858.CD002283.pub4. PMID: 16437443.
  3. Johnston CD, Littlewood SJ. Retention in orthodontics. Br Dent J. 2015 Feb 16;218(3):119-22. doi: 10.1038/sj.bdj.2015.47. PMID: 25686428.
  4. Al-Moghrabi D, Johal A, O'Rourke N, Donos N, Pandis N, Gonzales-Marin C, Fleming PS. Effects of fixed vs removable orthodontic retainers on stability and periodontal health: 4-year follow-up of a randomized controlled trial. Am J Orthod Dentofacial Orthop. 2018 Aug;154(2):167-174.e1. doi: 10.1016/j.ajodo.2018.01.007. PMID: 30075919.
  5. Tsichlaki A, O'Brien K, Johal A, Fleming PS. Orthodontic trial outcomes: Plentiful, inconsistent, and in need of uniformity? A scoping review. Am J Orthod Dentofacial Orthop. 2018 Jun;153(6):797-807. doi: 10.1016/j.ajodo.2017.10.022. PMID: 29853237.
  6. Pandis N, Fleming PS, Worthington H, Dwan K, Salanti G. Discrepancies in Outcome Reporting Exist Between Protocols and Published Oral Health Cochrane Systematic Reviews. PLoS One. 2015 Sep 14;10(9):e0137667. doi: 10.1371/journal.pone.0137667. PMID: 26368938; PMCID: PMC4569349.
  7. Papageorgiou SN, Xavier GM, Cobourne MT. Basic study design influences the results of orthodontic clinical investigations. J Clin Epidemiol. 2015 Dec;68(12):1512-22. doi: 10.1016/j.jclinepi.2015.03.008. Epub 2015 Mar 27. PMID: 25910911.
  8. Fleming PS, Seehra J, Polychronopoulou A, Fedorowicz Z, Pandis N. Cochrane and non-Cochrane systematic reviews in leading orthodontic journals: a quality paradigm? Eur J Orthod. 2013 Apr;35(2):244-8. doi: 10.1093/ejo/cjs016. Epub 2012 Apr 16. PMID: 22510325.
  9. Gibson R, Harrison J. What are we reading? An analysis of the orthodontic literature 1999 to 2008. Am J Orthod Dentofacial Orthop. 2011 May;139(5):e471-84. doi: 10.1016/j.ajodo.2010.07.023. PMID: 21536189.
  10. Singh P, Grammati S, Kirschen R. Orthodontic retention patterns in the United Kingdom. J Orthod. 2009 Jun;36(2):115-21. doi: 10.1179/14653120723040. PMID: 19487742.
  11. Wong PM, Freer TJ. A comprehensive survey of retention procedures in Australia and New Zealand. Aust Orthod J. 2004 Nov;20(2):99-106. PMID: 16429880.
  12. Valiathan M, Hughes E. Results of a survey-based study to identify common retention practices in the United States. Am J Orthod Dentofacial Orthop. 2010 Feb;137(2):170-7; discussion 177. doi: 10.1016/j.ajodo.2008.03.023. PMID: 20152670.
  13. Keim RG, Gottlieb EL, Nelson AH, Vogels DS 3rd. 2008 JCO study of orthodontic diagnosis and treatment procedures, part 1: results and trends. J Clin Orthod. 2008 Nov;42(11):625-40. PMID: 19075377.
  14. Popović Z, Trinajstić Zrinski M, Špalj S. ORTHODONTIST CLINICAL EXPERIENCE AND CLINICAL SITUATION SIGNIFICANTLY INFLUENCE THE RETENTION PROTOCOL - A SURVEY FROM CROATIA. Acta Clin Croat. 2020 Mar;59(1):3-9. doi: 10.20471/acc.2020.59.01.01. PMID: 32724269; PMCID: PMC7382889.
  15. 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.
  16. Renkema AM, Sips ET, Bronkhorst E, Kuijpers-Jagtman AM. A survey on orthodontic retention procedures in The Netherlands. Eur J Orthod. 2009 Aug;31(4):432-7. doi: 10.1093/ejo/cjn131. Epub 2009 Apr 28. PMID: 19401355.
  17. 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.
  18. Lovatt R, Goonewardenet M, Tennant M. Relapse following orthodontic rotation of teeth in dogs. Aust Orthod J. 2008 May;24(1):5-9. PMID: 18649557.
  19. Bibona K, Shroff B, Best AM, Lindauer SJ. Factors affecting orthodontists' management of the retention phase. Angle Orthod. 2014 Mar;84(2):225-30. doi: 10.2319/051313-372.1. Epub 2013 Aug 14. PMID: 23944224; PMCID: PMC8673814.
  20. 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. doi: 10.61872/sdj-2014-06-01. PMID: 24943474.
  21. Nagani NI, Ahmed I. Effectiveness of Two Types of Fixed Lingual Retainers in Preventing Mandibular Incisor Relapse. J Coll Physicians Surg Pak. 2020 Mar;30(3):282-286. doi: 10.29271/jcpsp.2020.03.282. PMID: 32169137.
  22. Kučera J, Littlewood SJ, Marek I. Fixed retention: pitfalls and complications. Br Dent J. 2021 Jun;230(11):703-708. doi: 10.1038/s41415-021-2892-4. Epub 2021 Jun 11. PMID: 34117424.
  23. Katsaros C, Livas C, Renkema AM. Unexpected complications of bonded mandibular lingual retainers. Am J Orthod Dentofacial Orthop. 2007 Dec;132(6):838-41. doi: 10.1016/j.ajodo.2007.07.011. PMID: 18068606.
  24. Shaughnessy TG, Proffit WR, Samara SA. Inadvertent tooth movement with fixed lingual retainers. Am J Orthod Dentofacial Orthop. 2016 Feb;149(2):277-86. doi: 10.1016/j.ajodo.2015.10.015. PMID: 26827985.
  25. 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.
  26. Tacken MP, Cosyn J, De Wilde P, Aerts J, Govaerts E, Vannet BV. Glass fibre reinforced versus multistranded bonded orthodontic retainers: a 2 year prospective multi-centre study. Eur J Orthod. 2010 Apr;32(2):117-23. doi: 10.1093/ejo/cjp100. Epub 2009 Oct 16. PMID: 19837746.
  27. 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
  28. Caetano IRCES, Santiago LM, Marques M. Impact of written information on control and adherence in type 2 diabetes. Rev Assoc Med Bras (1992). 2018 Feb;64(2):140-147. doi: 10.1590/1806-9282.64.02.140. PMID: 29641669.

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Received July 15, 2025.
Accepted August 25, 2025.
©2025 International Medical Research and Development Corporation.