Treatment stability with bonded versus vacuum-formed retainers: a systematic review of randomized clinical trials

Background In orthodontics, the retention phase can be considered challenging and unpredictable. Therefore, evidence obtained from different retention protocols is important to facilitate clinical decision-making. Objectives This systematic review aimed to compare the clinical effectiveness of bonded versus vacuum-formed retainers (VFRs) regarding their capacity to maintain treatment stability, periodontal effects, and failure rates. Search methods and eligibility criteria Ten databases comprising published and unpublished literature were systematically searched up to August 2021. Randomized clinical trials (RCTs) comparing both retainers were included. Data collection and analysis The risk of bias (RoB) evaluation was performed with the Cochrane Collaboration RoB Tool 2.0. All steps of the screening phase and RoB assessment were performed independently by two reviewers. The Grade of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to evaluate the certainty of the evidence. Results Initial database search yielded 923 studies. After duplicates removal and full-text assessment, five RCTs remained. Overall, the studies presented Low RoB, except one study judged with 'Some concerns'. Based on the included studies, on a short-term (3-6 months) and long-term (4 years) basis, bonded retainers (BRs) were more effective to maintain treatment stability than VFRs in the lower arch. However, from 12 to 24 months both retainers presented the same efficacy. In the upper arch, the retainers were equally effective. BRs were associated with greater plaque and calculus accumulation than VFRs after 12 months. The retainers' failure rates were similar in the upper arch on the first year of retention; however, after 2 years VFRs showed significantly greater failure rates. Contrarily, BRs presented greater failure rates in the lower arch than VFRs. Limitations The findings of the included studies may be influenced by different factors related to the unpredictability of relapse. Conclusions Most of the evidence generated in this systematic review derived from a moderate level of certainty. In the lower arch, BRs are more effective than VFRs to maintain treatment stability in the initial 6 months of retention and in the long term. In the upper arch, both retention protocols are equally effective. Registration Regist0ration number: PROSPERO CRD42020199392. Funding Coordination for the Improvement of Higher Educational Personnel (CAPES, Process code-001).

Automated summary

The retention phase in orthodontics can be challenging and unpredictable. Evidence from this systematic review suggests that bonded retainers are more effective in maintaining treatment stability in the lower arch compared to vacuum-formed retainers, especially in the initial 6 months and in the long term. However, both retainers were equally effective in the upper arch.