Three-dimensional stability during orthodontic retention: A comparative analysis of conventional, CAD/CAM-fabricated, and robotically bent fixed retainers versus removable appliances

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported but confidence intervals exclude null

• Effect Size: Combined fixed and removable retention: 55% stable arches vs removable-only: 33% stable arches

• Primary Outcome: Three-dimensional tooth stability during orthodontic retention

• Nnt Or Sensitivity: Number needed to treat with fixed retention to prevent one case of instability: approximately 5 patients

• Confidence Interval: Maxilla OR 4.37 (95% CI 1.74-10.98); Mandible OR 14.35 (95% CI 3.24-63.56) for moderate-to-severe instability with removable retention

Clinical Application

Fixed retainers require specialist placement and monitoring; CAD/CAM and robotic fabrication may have limited availability Relevant to Australian orthodontic practice; fixed retainers not typically PBS-funded but may be cost-effective long-term; aligns with ANZAOS retention guidelines Post-orthodontic patients requiring retention, particularly those at higher risk of relapse

Abstract

OBJECTIVES: To evaluate three-dimensional anterior tooth position changes during orthodontic retention and to compare the effectiveness of three distinct fixed retainer fabrication designs including robotically bent retainers alongside with removable retainers. MATERIALS AND METHODS: This retrospective cohort study included 113 patients (226 dental arches; mean retention period 1.3 ± 0.6 years). Combined fixed lingual plus removable retention (group 1, n = 148 arches) comprised CAD/CAM Memotain, conventional multistranded stainless-steel (Twistflex), and robotically bent retainers; group 2 (n = 78 arches) received removable retention only. Digital model superimposition using a three-dimensional tooth-specific coordinate system quantified rotational and translational tooth movements, Little's Irregularity Index (LII), transverse arch widths, and bonding failures. RESULTS: Combined fixed and removable retention showed higher stability than removable-only retention (55% vs. 33% stable arches). Removable retention increased the odds of moderate-to-severe instability (maxilla OR 4.37, 95% CI 1.74-10.98; mandible OR 14.35, 95% CI 3.24-63.56), whereas fixed lingual retention was protective (maxilla OR 0.23, 95% CI 0.09-0.58; mandible OR 0.07, 95% CI 0.02-0.31). Instability mainly involved canine rotations and vertical translations. Robotically bent and CAD/CAM Memotain retainers showed the lowest movement magnitudes and variability, with minimal LII increases. Intercanine and intermolar widths remained stable across fixed retainers. Bonding failures (25%) strongly predicted severe instability. CONCLUSIONS: Three-dimensional tooth movements during retention mainly involve canine rotations and vertical translations. All fixed retainer designs (Twistflex, CAD/CAM-fabricated, and robotically bent) provided greater stability than removable-only retention. CLINICAL RELEVANCE: All fixed retainer designs require regular monitoring of bonding integrity; digitally fabricated and robotically bent retainers demonstrated marginally lower dimensional variability, which may be clinically relevant over longer observation periods.

References

1. 1.Köck, J., Lang, F., Niederau, C., Rizk, M., Al-Sakati, H., Lang, N., Wolf, M., & Knaup, I. (2026). Three-dimensional stability during orthodontic retention: A comparative analysis of conventional, CAD/CAM-fabricated, and robotically bent fixed retainers versus removable appliances. Clinical Oral Investigations. https://doi.org/10.1002/14651858.CD002283.pub5