# Retrospective Study Regarding Orthodontic Retention Complications in Clinical Practice
## 4 Discussions
Flossing is the most commonly used auxiliary means for oral hygiene in both male and female groups (57%, respectively 62%), followed by interdental brushes (30%, respectively 35%), mouthwash (26%, respectively 28%), and water flosser (26%, respectively 19%). 9% of the male group and 2% from the female group stated that they did not use any auxiliary method of oral hygiene but only regular tooth brushing. According to the latest studies, it would be desirable to recommend to our patients with orthodontic retainers the use of electric and sonic toothbrushes [34; 35; 36]. The use of both rotating-oscillating heads and sonic action heads powered toothbrushes proved to be better than manual toothbrushes in managing oral hygiene, without causing damages to periodontal structures. It is still difficult to determine which one of these has more efficacy [34]. Better long-term results were in favor of sonic toothbrushes for both the gingival and bleeding indices [34; 36]. The possibility of using kinds of toothpaste for home use with hyaluronic acid, vitamins E, lactoferrin, and paraprobiotics may help the hygiene of soft tissues along the edge of the retainers [37]. [PERSON] et al. [38] had also demonstrated that lower retainers increased plaque accumulation, gingival recession, and gingival inflammation gingival revealed by bleeding on probing. [PERSON] et al. [39] highlighted the negative effects of long-term fixed retention in the lower arch: periodontal irritation, marginal gingival recession, plaque accumulation. Their results were related to the long-term wearing of fixed retainers rather than the bonding materials used [40]. As in our study, [PERSON] and [PERSON] [41] found large accumulationsof dental plaque in interproximal areas that are more difficult to clean. Multistranded wire retainers are bonded to each tooth separately, being effective for the prevention of individual dental rotations caused by the residual tension of the periodontal ligaments that tend to return the teeth to their original position. Their great advantage is the flexibility which allows the physiological movement of the bonded teeth [39]. If the occlusion is not stable at the end of the orthodontic treatment, later changes in the position of the anterior teeth can lead to altered aesthetics of the frontal area that cause dissatisfaction for both doctor and patient. Fixed contention in the anterior frontal arch ensures the stability over time of the results of the active orthodontic treatment [39]. Our study showed that gingival recessions for 62% of male patients and 56% of female patients occur while wearing the lower fixed retainer. A study [42] performed by the \"Third National Health, Nutrition Examination Survey\" found similar results: men had higher gingival recessions and much more tartar accumulation compared to women, mainly due to a much larger size of their teeth [43]. The lowest values of gingival recessions in both male and female groups were in patients wearing Hawley retainers (3% for males and 5% for women). There are still many studies that contradict the opinion that long-term fixed retainers cause gingival retractions and periodontal damages [6; 12; 44]. Other issues are related to damage/detachment/fracture in orthodontic retainers. These accidents make the periodontal tissue reorganize to the status before wearing the orthodontic appliance, with harmful effects on periodontium: gingival recessions, bone resorptions, etc. We found that most damages/detachments/fractures (75%) occurred in patients with fixed lower retainers and only 5% in HRs wearers. A similar study showed that these accidents lead to additional costs for the patients; the authors proposed that all the responsibility for retention should be transferred to the patient by applying a mobile retention device, or that the fixed retainers should be removed after a few years [45]. [PERSON] et al.