Upper fixed retainer technique

[@قطراتالمطر-ه2ر]

Dr. I wonder if I can use the fixed retainer in all cases to avoid to avoid the inconvenience caused by the removable one from not wearing it regularly?

[@FionaLee17]

Hi Dr. Doug, thank you for sharing this helpful video!! I was wondering if you extruded laterals during the course of ortho treatment do you still bond 2-2 or would you then bond 3-3 in the maxillary to keep the laterals from relapse intrusion?

[@drdougortho]

I personally never use a 3-3 fixed on the upper as the rate of breakage is too high to have it be reliable. (There is research to show this significantly increased rate of failure when extended to 3-3). Even if you could keep it from failing, if there will be significant re-intrusion, it will then affect the teeth bonded to the lateral as well via the fixed retainer. I rather just have the lateral intrude somewhat alone then cause an open bite with other teeth re-intruding as well. I only use an upper fixed for pre-treatment diastemas and sometimes for severe lateral rotations.

[@FionaLee17]

@@drdougortho Thanks so much for your response!

[@mutazshabanah971]

@@drdougortho thank you for the demonstration .. i have 2 questions 1. during bending of the retainer extrorally as you did what if bends didn't match the interdental contacts "there were no markings for a precise bends" .. also using a bendable wire for a fixed retainer increases the risk of what is called "wire syndrome" .. using a dead soft wire commercially purchased as "ortho flex" from AO is much safer & less time consuming in spite of the increased cost. 2. using an upper 2-2 fixed retainer is not always feasible in cases where upper canines were rotated or high\ palatally positioned .. a 3-3 fixed retainer in these situations will surely prevent relapse . what do you think ?? regards

[@drdougortho]

I never do upper 3-3, as the research shows too much breakage vs 2-2

[@drdougortho]

@@mutazshabanah971 the wire i used in the video is a titanium flat ribbon wire from reliance, specifically made for retention, "Retanium" No "wire syndrome" risk. I use "flextech" for my lower 3-3 also from reliance. And braided wire like flextech )or maybe ortho flex/AO (thought i'm not familar as i find reliance the best in this area) will NOT hold diastema's on the upper well even if they don't break, b/c the stretch over time. Retanium does not. I guess clinical experience and skill over time has helped med not have to mark the wire before bending. I do it as you see, hen adjust it closer intra-orally. never an issue. Also i NEVER place 3-3 upper. The data is clear on the significant breakage on 3-3 vs 2-2.

[@Francotujk]

Hi! My dentist put a fix retention in the top teeth, that “retain” only the incisors. Will I have a problem? Do I need to use movable retention? Does a fix retention that includes the canines work better? Sorry for my english, and thanks

[@drdougortho]

I would always give an upper removable retainer as well... everything but those incisor can still move. Also it's proven if you extend the fixed retainer to the upper canines the wire breaks too often.

[@Francotujk]

@@drdougortho Ok Dr. thank you so much for your advice

[@surajorthodont]

Hi Dr, if we include only the incisors, will space not open up distal to laterals? Unless ofcourse we give an essix too?

[@aadilcassamally8213]

Can we do the same bends for the lower?

[@drdougortho]

No, different anatomy and doing 6 teeth on the lower. Also no need to because I'm not using a rigid wire, rather something flexible like flextech which doesn't need bends most of the time

[@قطراتالمطر-ه2ر]

Hi Dr. What's up? I have a case of CL 1, moderate crowding, upper 6 s are missed, every thing was alright till I reached 17 * 25 NiTi wire, the upper left 2 became with flared crown and +ve root torque, tipped distally. I did all I know to solve the problem but it didn't work, torque spring, torque bend, reposition of the bracket, Z bend, upside down bracket but no hope. the tooth is with normal phisiological movement, no sign of ankylosis, the x_ray showrd no Pdl widening or changes. Please Dr. your kind opinion 🌹🙏🙏

[@drdougortho]

unfortunately very hard to help/give suggestions from just words on a screen. I co-admin a orthodontic facebook group called "controversies, concepts and items of interest in orthodontics". If you join that group, please post some records and i'd be happy to help!

[@قطراتالمطر-ه2ر]

@@drdougortho Dr. do you have an account on Instagram?.. to send you pictures as soon as possible.

[@hussainaamir786]

Which wire should be use sir for this retainer?

[@drdougortho]

My preference is for Reliance brand "Retanium" wire. A flat titanium wire

[@sleepmoreworryless4547]

Why don’t orthodontist recommend doing upper permanent bracket?

[@drdougortho]

I assume you mean the bonded retainer i showed here? They are more prone to break, and sometimes there is NO ROOM to fit one on/patient may bite on the wire when it is behind the upper teeth. We use the only when we can fit it on safely and usually only when indicated (when a patient originally had a large diastema/space between the upper central incisors, which is likely to relapse. Either way we STILL recommend a clear removable retainer to sleep as well.

[@sleepmoreworryless4547]

Wow thank you for a quick response, that is my concern. My two top teeth will not remain closed, my ortho wants me to wear my retainers which I do everyday however I am highly concern about my two upper teeth reopening.

[@BalochKhan-r5q]

Which wire is best

[@drdougortho]

My preference is Reliance "Retanium" for these upper fixed retainers shown here. It's titanium ribbon wire

[@steev927]

seems pretty fast and loose for implementing a decades-long retainer. I really wish there was a more refined and studied way to implement this. Seems like a lot of random bending without any kind of actual science-backed information.

[@drdougortho]

Are you an orthodontic specialist? If so you'd be the first I've seen criticise this. What do you mean a "refined and studied" way to bend a wire? This is not a video on all the reasons/when to use this appliance, but just how we bend it. You may be looking for an entirely different discussion.

[@norbert7297]

@@drdougortho how much do you charge for a bend wire like this?