essix retainers

[BuckeyMcGee]

Any ortho residents know much about these? They seem a little flimsy to provide adequate retention but supposedly they work pretty well. Any thoughts? Just curious..

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[Doggie]

Any ortho residents know much about these? They seem a little flimsy to provide adequate retention but supposedly they work pretty well. Any thoughts? Just curious..

I wear them every night before hitting the sack. These things work great, although I do have to replace them every few months because they will eventually crack. The stent material that I use are slightly thicker than the ones you would use for making temp crown/bridges and definitely thinner than occlusal/night guards. For all intents and purposes, I think they work and they are definitely more comfortable than the hawley appliances.

 

[charlestweed]

Any ortho residents know much about these? They seem a little flimsy to provide adequate retention but supposedly they work pretty well. Any thoughts? Just curious..

You’re right! The Essix retainers are not as durable as the Hawley retainers (acrylic plate with stainless steel labial bow). You must use the right material. It must be .040” in thickness. http://www.essix.com/orstore/ShowItem.aspx?productID=1C478

With proper care, they can last up to 2 years. Essix retainers are very good at holding the teeth in their final ideal alignment. However, they don’t allow the upper and lower posterior teeth to settle (occlusal settling). Contraindications:
- short clinical crowns.
- Swollen gum (due to poor oral hygiene during ortho tx)
- Can’t use essix to maintain spaces for congenitally missing teeth or for peg laterals.
- Can’t use essix at the end of phase I treatment.
- Can’t use essix on patients who have been treated with expansion appliances (RPE, quad helix, Schwartz expander etc). Essix is too flimsy to maintain the arch width.

I use Hawley retainers in my office b/c of their durability. I only give patients essix retainers if they don’t mind paying for new ones every year. Most people don’t realize that orthodontic retention is a life long process.

 

[vorosvirag]

It must be .040" in thickness.

I went to the link you provided and found .040" is 1 mm in thickness.

Some of the folks in our department use .75 mm essix retainers--a bit thinner than what you routinely use. In fact, a guy who does research on the material itself even told me he likes .75 mm. I'm guessing the .75 mm essix retainers I've recently delivered may break more frequently than the 1 mm stuff, right?

Ever used the .75 mm material, tweed? What sort of fee do you tie to your yearly essix replacement protocol?

Thanks.

 

[charlestweed]

I'm guessing the .75 mm essix retainers I've recently delivered may break more frequently than the 1 mm stuff, right?

I think the .030" (.75mm) material is too weak to be used as retainer.

Ever used the .75 mm material, tweed? What sort of fee do you tie to your yearly essix replacement protocol?

Thanks.

Yes, I use the .030" (.75mm) material mainly for temporary retention when the Hawley retainers don't fit properly (due to distorted impression). It is a lot easier to separate the thinner .75mm essix material from the dental cast. It is more time consuming (approx 30 minutes…. from pouring the impression to trimming the essix) to work with the thicker .040" material. Before separating the essix, you have to use a special heat knife to cut around the material. http://www.ortho-direct.com/details.php?prodId=324&category=26. You don't have to use this knife for the 030" (.75mm) material

The first pair is included in the ortho treatment fee. There is no discount for replacement…patients will have to pay full retainer fee if they want new pair of retainers.

 

[BuckeyMcGee]

I have heard of a single arch essix going for as low as 40 dollars at some offices. An added plus of these retainers is that they can supplement as a bleaching tray. One more question about these retainers: is it common for the orthodontist to tip the molars out on the cast and then form the retainer to prevent relapse of a posterior crossbite? I've heard this done before but I'm wondering how it would work in terms of retention down the road. Thanks guys and gals.

 

[kato999]

I haven't done the molar tipping, but if you have a mandibular incisor relapse (or any other tooth), you can cut out a tooth in the cast set it in wax and make a poor man's invisalign tray out of an essix. They work pretty slick.

 

[drdents999]

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[charlestweed]

I love your posts, they are always very informative and real-life issues that most people don't discuss openly!

Thank you!

-I've come across a lot of breakage of Adams Clasps with Hawleys, sometimes it's okay, because the retainer will still provide adequate retention. Do you use a Wraparound?

Yes, I use wrap around Hawley retainers for most of my extraction cases. I use standard Hawley retainers for nonext cases. I've worn the same wraparound retainers for 14 years….and they are still in excellent shape. I use mostly C clasps and they rarely break b/c they don't go over occlusal surface like the Adam clasps.

-I feel that Hawley's are poor at keeping rotations corrected especially around the canine area.
-How long do you provide followup (retainers checks/adjustments after delivery?) I think 2 years is an adequate time frame. 2, 3, 4, 6 month intervals, etc.

It is very rare (less than 1%) to see the Hawley retainers fail to hold the teeth in proper alignment. If relapse occurs and pt is not happy, I usually retreat with braces at N/C and then bond fixed lingual 3-3. And I only had to retreat 4-5 times in 6 years.

Since ortho retention is a life long process, I think it would make more sense to give pt the type of retainers (ie Hawley) that last at least 5-10 years. I've retreated a lot of ortho relapse because the essix retainers broke and patients didn't return to their orthodontist to buy new ones.

I do retainer check in 1,3, and 6 months. Instruction: 24/7 for 1 year…. and after that, wear them during bedtime for the rest of your life.

-I use two sets of retainers for patients with missing teeth (i.e. laterals etc), one Hawley and one Essix, both with the tooth. I make two because if they lose one it's not an esthetic emergency. I actually feel that is better for a Essix to hold "tip" and root positions for edentulous area, if the patient is waiting for implants in the future. The Hawley just does not seem to hold tips in place. How do you feel about that?

Two sets? Do you charge patients for the extra set? I agree with you that it is ok to use essix for space maintainer if you add a tooth to it (some orthodontists don't even do this).

I think one Hawley retainer with a false tooth is good enough…… when patient gets the dental implant and crown, I simply knock off the false tooth…. and he/she doesn't have to pay $200 for another retainer.

-Do you really believe that C+ material is not strong enough to hold expansion? I'm a young guy like you and haven't had the experience to tell you otherwise, but I would think that if a 16x22 SS can hold expansion, a C+ rigid material should? Have you seen any actual relapse?

No, I don't think an expanded 16x22 SS (or 17x25 SS) arch wire is strong enough. I've seen many dental arches collapse as soon as the RPE is removed. When I remove the RPE or quad helix after 6 months in pt's mouth, I always have to retain the dental arch w/ a TPA. The essix may be strong enough if you don't over-trim the palatal part. I would still use Hawley retainers b/c they are more rigid and durable.

-As for swollen gums, I will make them an Essix (which acts to massage the gums like a positioner would) and then remake an Essix 6 mo later as needed free of charge.

Why re-make? I hate to lose chair time, money and patients' trust. I would just give patient a pair of Hawley retainers and I don't have to worry about re-making new ones in the future.

-Do you have any experience with Invisatain or Vivera materials? I'm curious to try them out -- maybe more durable?

No, I don't.

Very nice talking to you! and thanks for sharing your thought on essix retainers!

 

[uBeR]

After having worn an Essix retainer for about a year, I think I perhaps should have gone with the Hawley. The first mold made did not fit properly. The second one did, but over time it no longer fits correctly. Even with regular cleaning, I still get calculus buildup. For someone who had surgery to correct an open bite, a lack of occlusal settling is unsettling. (I no longer have a perfect bite.) They seem fragile, but I have not yet break them, which is good. On the whole though, I've had a bad experience with them.

 

[drdents999]

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[charlestweed]

Do you treat 7s all the time? What if you finish a case early where 7s are just erupting? Do you know any good designs to deal with only 6s and still not cross the occlusal? The only think I can think of is a C-clasp on either side of the 6s. As for having the same retainers for 14 years, how can the patient tighten and adjust them? No matter what, Hawley's need to tightened at some point. With us only following up for 1-2 years, there is no way to ensure a proper fit for life?

I band 7's (about 25-30% of all my cases) only when I need to align (and upright) them, to increase posterior anchorage, to correct deep overbite, and to set up for orthognathic surgery. I cannot use wraparound Hawleys when 8's are present.

When the 7's are still erupting, I usually ask the lab to solder C clasps to the distal part of the canine loops. These C clasps will stay on the facial of 4's. Please see the attached image below.

Retainers are passive appliances that hold the teeth in their final position. Therefore, I don't need to tighten them. I tighten the C clasps only if the retainers fall out easily when patients talk.

I think the lab guy we use doesn't make the labial wire as well adapted as he should and therefore I see small rotations sometimes. Also, I find using a Flat rectangular labial wire to be useful along with C-claps on the canines to prevent rotation.

90% of the times the labial bows don't touch all anterior teeth b/c we always take impressions with braces still on our patients' teeth. The lab technicians have to shave these brackets off when they make retainers. I always have to use 3 prong pliers to flatten the bow and tighten the loops.

Nah I dont charge for the extra set. It takes staff 5-10 minutes to make an in-house Essix. It's a good patient builder. A lot of people dont want the wire in the front. Question, what do you think about children that play sports? They cannot wear the Hawley during sports...

Good question. I really don't know the answer. Just like when they had braces, I guess they have buy a moldable type of mouthpiece and make it fit over the Hawley retainer.

Yes, but I am still concerned with "tip" on the roots of the adjacent teeth. If these teeth tip back, the implant cannot be placed and patient will not be happy. I believe that an Essix can hold tip better than Hawley.

With regard to the "tip" on roots, I think both types of retainers are equally effective. As long as there are plane contacts (as opposed to a single point contact) between a false tooth and mesial/distal surfaces of 2 adjacent teeth, their roots will not tip toward each other. I am usually very careful about this since my periodontist wife places implants for most of my patients.

 

[charlestweed]

Here is the image of the Hawley retainer that I described earlier.

 

[drdents999]

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