GAP Magazine Clear Idea Volume 5

www.acasociety.com | info@acasociety.com 13 straight. When you stop is up to you.” Once this is discussed, they normally are more open to wearing or using them as they can see the multiple benefits. Also, if you find retention difficult to discuss, I can promise you that you will find their eventual relapse even harder to discuss with them after they have paid and gone through treatment with you. Please note: If any of my esteemed colleagues disagrees with any or all of this, and I’m sure there will be some that do – I welcome you to join in and contribute to the discussion. I would then have achieved my goal – of making retention somewhat interesting and opening discussion around a topic that is way too often dismissed. In saying all of the above, I have recently seen a couple of cases where even with good compliance with a thermoplastic retainer – patient still getting some lower anterior relapse. Having run this by one of my mentors, we believe it has to do with inherent “slop” or inaccuracies in a suckdown retainer. So for the last two years, I have trialled a novel modified approach to thermoplastic retainers which I will outline below. Before you keep reading though, please note that there is absolutely no evidence to validate my approach (one day I hope there will be). My protocol is: • Ask the technician to add horizontal attachments on lingual of 33 to 43 at the end of active aligner treatment, ask for one attachment template (A) and two passive aligners (B, C) • Cut out window for attachments on the passive aligner and place it on the teeth • Withaligner (B) on the teeth, Sandblast, etch and bond – this helps accuracy of surface etched and bonded, and hence clean up. • Fill template (A) with packable composite, and bond attachments onto teeth • Clean up, ensure all contacts can be flossed • Scan for retainers, instruct patient to wear aligner C until retainers arrive The pros and cons of this can be somewhat summarised below: Cons: • It takes patients a couple of days to get used to, and can affect speech initially. I must say I have not had much complaints from this end and is generally well accepted. • If compared to a fixed wire, this method still relies on patient compliance. I do find aligner patients to be more compliant in thermoplastic retainers. Similarly, having stressed the attachments means there is no room for lapses in compliance, patients seem to heed this advice more seriously (anecdote, of course). Pros: • Attachment surfaces engaging the retainer helps better control vertical/ crown tip in comparison to only thermoplastic retainers • Compared to a fixed wire, the teeth are easily flossed – hence hygiene is improved. A major short coming of fixed retainers. • If an attachment falls off, it is rarely an emergency – in comparison to a wire debonding