Fixed-only retention in the lower jaw fell from 20 to 7 per cent in a decade

Foil retainers have pushed out acrylic plates

The way Croatian orthodontists hold the result they have achieved changed in the decade between the two measurements. Martina Žigante and co-workers repeated in 2023 a survey they first carried out in 2013: the questionnaire was sent to 150 orthodontic specialists in the first round and 185 in the second, covering 69% and 85% of active specialists respectively, with response rates of 61% and 75%.

The most pronounced shift is in the type of appliance. Vacuum-formed retainers are on the rise, while acrylic retention plates are losing ground in both jaws (p ≤ 0.001). Reliance on fixed retention alone in the lower jaw fell from 20% to 7% (p = 0.007), and the combination of a fixed and a removable appliance in the upper jaw from 29% to 17% (p ≤ 0.033). Removable appliances are chosen more often for rotations, open bite and extraction cases, while combined fixed-removable retention has held on for spacing (p ≤ 0.001).

Follow-up has changed too. The number of scheduled check-ups during the retention phase has fallen (p = 0.001), and the emphasis has moved to patient self-monitoring (p = 0.021). The share of orthodontists who give the patient written retention instructions rose from 39% to 69% (p < 0.001). Starting from the same baseline was the share of those for whom personal experience is the main criterion when choosing a protocol: from 39% to 62% (p < 0.001).

Limitations

The data come from self-reported questionnaires in two separate cross-sections, not from outcome follow-up. Surveys show what orthodontists say they do, not how well retention actually holds.

For your practice

• If you still routinely make an acrylic retention plate, check the reason: in ten years the profession has moved towards foil retainers and dual retention in the lower jaw.
• Written wear instructions are now the rule rather than the exception, and they are the cheapest change of protocol you can introduce immediately.
• Fewer check-ups mean a greater burden on the patient; without clearly defined self-monitoring, that shift carries a risk of unnoticed relapse.