Fitting and Checking Retainers

8
This chapter will provide guidance on what
should be checked once retainers have been
fitted following the end of active treatment. It
will be assumed that treatment has been com-
pleted satisfactorily as planned and that two-
arch fixed appliances have been used.
Many operators will not see the patient
again for about 3 months after retainers are
fitted. Ideally, it might be argued that an earlier
check (perhaps 4–6 weeks after the retainers
have first been fitted) would ensure that there
are no problems or misunderstandings with
retainer wear at this crucial stage of treat�
ment. Unfortunately, should either the patient
or operator not appreciate this, then an entire
2-year treatment can easily be rendered useless
due to poor or no retainer wear leading to
rapid and gross relapse. It is therefore extremely
important that operators ensure that patients
are aware of the need and importance of the
retention period.
Learning outcomes
At the end of this chapter you should:
• Be able to explain the importance of regular
retainer checks to patients
• Have the knowledge to be able to undertake a
retainer check
• Have the knowledge to undertake simple
retainer adjustments
First fitting of removable
retainers
When the appliance is received from the labo-
ratory, as with any appliance, basic checks
should be undertaken to confirm:
• It is the correct appliance for the patient
• It is the prescription requested
• The appliance fits the model correctly

Orthodontic Retainers and Removable Appliances: Principles of Design and Use, First Edition.
Friedy Luther and Zararna Nelson-Moon.
© 2013 Friedy Luther and Zararna Nelson-Moon. Published 2013 by Blackwell Publishing Ltd.

132

• There are no obvious deformities in the
working model. This is not always possible
to assess for VFRs, since the model may
have been destroyed when the appliance
was removed from it.
In addition, once the above are confirmed as
correct, the appliance should be checked to
see there are no sharp edges or acrylic ‘blips’,
which may cause discomfort or damage to the
patient (see Chapter 4).
Checking the fit of Hawley
retainers in the mouth (see
Chapter 4)
The appliance should seat down fully around
the teeth and the labial bow (modified with
or without an acrylic facing) should fit snugly
against the teeth without any obvious air gaps
between the wire and the teeth or between the
acrylic facing (if used) and teeth.
Appliance not seating down fully
If well made, these appliances should fit down
properly. However, occasionally the appliance
may not seat down fully if the colleting has
not been sufficiently trimmed from around the
teeth. If this occurs, often further trimming is
needed in the premolar or molar region. You
will need to check how far occlusally the acrylic
lies. If it is preventing full seating, then an
acrylic bur and straight handpiece should be
used to trim the acrylic in the colleted areas
such that the collets rise only to about half way
along the palatal surfaces of, for example, the
premolars and/or first permanent molars.
Another reason the appliance may not seat
fully is if acrylic has crept along the arms of the
fly-overs between the contact points. In this
circumstance, Adams’ pliers can be used to
simply ‘crunch’ off any stray acrylic by squeez-
ing the acrylic between the beaks of the pliers.
Where any acrylic is to be trimmed, this
should of course be done outside the mouth. The
Fitting and Checking Retainersâ•…â•… 133
patient, nurse and operator should wear eye
protection whilst trimming is being undertaken.
Appliance loose
If the appliance fits properly, but is loose, there
are usually two simple solutions:
• Consider tightening the Adams’ clasps to
engage the undercuts more deeply using
Adams’ pliers. This should be done by grip-
ping each of the fly-overs in turn at the most
buccal point and bending the arrowheads
downward so that they engage the under-
cuts more.
• Either alternatively or in addition to the
Adams’ clasp adjustment, it may be neces-
sary to adjust the labial bow. This will
depend on where the appliance is loose.
Figure 8.1 demonstrates a poorly fitting,
loose labial bow and how to adjust it. As shown,
once the retention has been improved, the final
adjustment that may be required is to reposi-
tion the labial bow. This is sometimes needed
due to the fact that when the U-loops are tight-
ened, this tends to move the labial bow incis-
ally. This can only be tolerated for a small
number of visits since the bow will gradually
edge toward the incisor tips. This will lead to
poor retention and, with a Hawley retainer in
the lower arch, potentially occlusal interfer-
ences with the upper teeth. In order to avoid
this, a simple adjustment needs to be made
in the U-loop such that the anterior part of the
bow is pushed gingivally. This is done using
Adams’ pliers to push the mesial component of
the wire (which projects anterior to the U-loop)
in a gingival direction so that the labial bow lies
in the middle of the incisor crowns or as close
to this as possible.
Appliance not fitting
If a new appliance simply does not fit, despite
undertaking the checking and adjustments
134â•…â•… Orthodontic Retainers and Removable Appliances: Principles of Design and Use

a b c

d e f

Figure 8.1â•… A poorly fitting, loose labial bow (a). To tighten the labial bow, the U-loops of the labial bow are
gently squeezed using either Adams’ pliers or spring-forming pliers: place the U-loop between the beaks and
squeeze gently so the U-loop closes or tightens a little (b). This should bring the labial bow into closer contact
with the teeth; this should be done carefully and relatively symmetrically, so that the bow does not distort to one
side – leading to no fit at all. Once the retention has been improved, the final adjustment that may be required
is to reposition the labial bow. This is sometimes needed due to the fact that when the U-loops are tightened,
this tends to move the labial bow incisally (c and d). This should bring the labial bow into closer contact with
the teeth, but again this should be done carefully and relatively symmetrically, so that the bow does not distort
to one side – leading to no fit at all. The improved fit is shown (e and f). (Photographs courtesy of Simon Lit-
tlewood and Carol Bentley.)

described above, the fit on the working model
should be checked. If it fits the model well, but
not the mouth, then it may be that:
• A tooth or teeth have moved since the
impression was taken, or
• The impression was dragged or has other-
wise been distorted, either at the time it was
taken or at some point subsequently.
Any such scenario will mean a re-make with
a new impression is needed.
Checking the fit of vacuum-formed
retainers
The appliance should seat down fully around
the teeth and there should be no rebound as it
is seated. The margin of the appliance extends
just onto the gingivae, buccally and palatally/
lingually, in both arches. These appliances will
normally fit very tightly, so to avoid surprising
the patient, they should be advised of this
before you actually fit them.
As you push the appliance down over the
teeth, be vigilant: if on fitting down, the appli-
ance is seen to be forcibly pressing against the
gingivae (causing blanching), stop and remove
the appliance as this is likely to be painful for
the patient; it will need easing in those areas
before attempting the fit again. The appliance
can be trimmed with scissors and then smoothed
with a greenstone in a straight handpiece if it
is extended excessively onto the gingivae and
engages undercuts. Alternatively, or as well, it
may need easing on the inner (fit) surface, again

using a greenstone. Care should be taken when
easing the appliance as the material is thin and
it is easy to pierce it.
Once the appliance is seated, ask the patient
whether there are any particular areas that feel
much tighter than elsewhere or whether any
points actually feel sore. If so, the above adjust-
ments may be needed once more. In addition,
with the appliance in place, look around the
appliance and check whether the gingivae are
blanching. If there are any such areas, again
easing as above will be needed. Figure 8.2
shows actual trauma caused by a new vacuum-
formed retainer (VFR) being fitted following
debond. If during the fitting of the appliance
it becomes clear that the appliance simply will
not fit down or fails to seat down fully, despite
a Should any problems be evident with regard
b into position, it should first be checked care-
Figure 8.2â•… This vacuum-formed retainer (VFR), just
fitted at debond, is causing not just blanching of the gin�
givae but actual bleeding (a). However, it is very clear
where easing is needed once the VFR is removed (b).
Fitting and Checking Retainersâ•…â•… 135
the adjustments noted previously, then, as with
a Hawley retainer, it suggests either:
• A tooth or teeth have moved since the impresÂ�
sion was taken, or
• The impression was dragged or has other-
wise been distorted, either at the time it was
taken or at some point subsequently.
Any such scenario will mean a re-make and
a new impression will be needed.
Checking and fitting bonded
retainers
Checking bonded retainers
Bonded retainers should be checked in the
mouth before they are cemented.
It is essential to check that they:
• Fit closely to the lingual or palatal surfaces
of the relevant teeth
• Are as far away from the gingivae as possi-
ble (but not visible when viewed from the
front) to maximise the patient’s ability to
clean effectively
• Are not active appliances
• Are not interfering with the occlusion.
to any of the above factors, then either adjust-
ment or a re-make is required.
Before any bonded retainer is placed, the
occlusion should be checked – to see that there
is room for the retainer; this is obviously neces-
sary for upper bonded retainers. This should
be done before active treatment is completed
and before the fixed appliances are removed. If
necessary, the overbite may need to be reduced
further to allow a bonded retainer to be fitted.
Before a bonded retainer is to be bonded
fully for fit in the mouth. It is essential thor-
oughly to dry the relevant teeth beforehand
and the retainer can then be carefully placed
into position whilst holding it tightly in mos-