Article
Orthodontic Retainers and Removable Appliances – Principles of Design and Use
It has been a long time – a decade or more, in fact – since a book on removable appliances has been published in the UK. At one time, these formed the bulk of the appliances used to treat malocclusions in Britain and Ireland but, as the developments in fixed appliances have continued apace, together with greater ease of their use, removables have become used less and less. Some of the consultants who taught the present generation of the orthodontic ‘great and the good’ could achieve extraordinary results with removables, but they have moved on to happier things (a well earned retirement, hopefully).
This book looks at removable appliances in the broadest possible sense, starting with sections on their use, design and rationale for use, especially in interceptive treatment. Throughout, it is stressed that removable appliances can only tip teeth and that fixed appliances are likely to be needed at a later date in most orthodontic cases. A particularly valuable chapter examines cases that are suitable for treatment with removables: the examination of the patient, assessment of the malocclusion in general and the angulation of the incisors and canines in particular, will give the practitioner an idea of whether or not treatment is likely to succeed. Examples are given of failed treatment and the reasons for these failures, together with a lucid section on that mysterious entity, anchorage. Chapters dealing with the components of removable appliances, their design and retention reiterate that intelligent use can contribute a lot to overall treatment. Fitting and adjusting the components of a removable appliance is covered in detail and, again, many problems of co-operation can be avoided by carefully following the advice in the text.
A ‘test yourself’ section gives clinical examples of cases that may or may not be successfully treated with removables, before moving on to retainers, which are covered in detail. The problems of missing teeth, diastemas and periodontally involved teeth are also covered, together with fixed bonded retainers, vacuum-formed retainers, and the problems that can arise if these break or patient co-operation is poor. A section on repairing fixed bonded retainers may beg the question ‘Who should repair these – the specialist or the GDP?’ Having myself recently seen some cases of severe gingival recession caused by damaged bonded retainers some years after the original treatment ended, I suspect that most GDPs will probably tend to send such cases to a specialist – it is not likely that repair of bonded retainers is taught at undergraduate level in too many of our dental schools.
The final two chapters are more directed towards postgraduate trainees and cover functional appliances (for Class II and Class III malocclusions), headgear, the ‘en masse’ appliance, ‘nudgers’ and, finally, the use of vacuum-formed appliances which are advertised in some of the glossier magazines (and the less than glossy freesheets on the morning bus or train). The authors are careful to state that only minor problems can be corrected by such appliances in six months, and that anything more severe is likely to take as long as conventional fixed appliances.
This book is directed at any dental professionals involved in orthodontic treatment and it has admirably fulfilled that purpose. A minor deficiency is that there is not much by way of discussion about long-term outcomes of orthodontically treated patients with or without retainers, and this should be added to the next edition. Removable appliances are a more than useful adjunct to comprehensive orthodontic treatment, and Drs Luther and Nelson-Moon have produced an excellent text which brings removable appliances right up to date for the 21st Century.
