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RelapseRetentionNCT04389879

CAD/CAM Fixed Retainers vs. Conventional Multistranded Fixed Retainers in Orthodontic Patients. Comparison of Stability, Retainer Failure Rate, Adverse Effects, Cost-effectiveness, and Patient Satisfaction. A Randomized Controlled Clinical Trial

A study testing Bonding of either CAD/CAM or conventional multistranded stainless steel fixed retainer in people with Relapse, run by University of Aarhus at 2 sites in 2 countries.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Introduction: Orthodontic retainers are used after the completion of orthodontic treatment to assure dental occlusal stability and to maintain the achieved end-result. However, without retention teeth could go back to their initial dental malposition or could even take a different unpredicted position resulting once… Read more about this study

Who is it for?
Ages 12 to 25 yearsHealthy volunteers can take part
Conditions the study is for
Relapse
What is being tested?
Bonding of either CAD/CAM or conventional multistranded stainless steel fixed retainer
Could I receive a placebo?
No, everyone receives an active treatment
How many people
126 participants
Where
2 sitesin 2 countries
Study dates
1 Sep 2018to Dec 2025
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 12 to 25 years
  • All sexes
  • Healthy volunteers accepted
  • Child, Adult

Who may be able to join

  • Healthy patients.
  • Age: 12-25 years old (at time of debonding).
  • Presence of all maxillary and mandibular anterior teeth, with normal shape and size.
  • Completion of a course of fixed appliance therapy involving both dental arches.
  • Subjects willing to consent to the trial and comply with the trial regime.
  • No restriction to presenting initial malocclusion, type of active orthodontic treatment undertaken provided that it included full fixed appliances (functional/removable appliances in combination with fixed appliances - extraction or non-extraction)

Who cannot join

  • Patients with cleft lip or palate, or both or any other craniofacial syndrome.
  • Patients who had surgical correction of the jaws: Le fort I (2- or 3-piece maxilla) or SARPE (surgically assisted rapid palatal expansion).
  • Lingual appliance treatments.
  • Periodontal disease.
  • Hypoplasia of enamel.
  • Fluorosis.
Show all 9Show fewer
  • Active caries, restorations or fractures in the anterior teeth.
  • Patients who have had separate debonding appointments for each jaw, with a difference of more than 2 months in between.
  • Re-treated patients.

Trial locations and contacts

2 sites in 2 countries.

2 sites in 2 countries

Denmark1 site
  • Marie Anne Michele Cornelis

    Aarhus, 8000

Other trials in Denmark

Norway1 site
  • University of Oslo

    Oslo, 0455

Other trials in Norway

About this study

Official title: CAD/CAM Fixed Retainers vs. Conventional Multistranded Fixed Retainers in Orthodontic Patients. Comparison of Stability, Retainer Failure Rate, Adverse Effects, Cost-effectiveness, and Patient Satisfaction. A Randomized Controlled Clinical Trial.

Introduction:

Orthodontic retainers are used after the completion of orthodontic treatment to assure dental occlusal stability and to maintain the achieved end-result. However, without retention teeth could go back to their initial dental malposition or could even take a different unpredicted position resulting once again in dental malocclusion (a deviation from normal occlusion).

Read more

There are different types of retainers, some are fixed (glued to the back of the front teeth), and others are removable (can be removed and replaced into the mouth by the patient).

While there are various retainers used for retention (stability), there is no perfect method. Fixed retainers (FRs) are used worldwide. On the one hand, FRs focus on preventing relapse. On the other hand, there are sometimes some adverse effects of retainers; they could fail at a certain point (break/get loose), or cause unwanted tooth movements. Until now, the choice of a retention method is based solely on clinicians' experience as there is no substantial evidence regarding the best retention method or the duration of the retention period. Some clinicians prolong the retention period while others prefer to keep the retainers for an indefinite time.

As the world is advancing, so is the orthodontic science. New FR fabricated by CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing), are assumed to have greater accuracy, better fit, and most importantly, might offer a passive positioning of the retainer. However, the evidence about CAD/CAM FRs is very limited.

Purpose:

To investigate and compare the clinical effectiveness of two types of FRs; CAD/CAM vs. multistranded wire, in terms of stability (primary outcome), failure rate, adverse effects, cost-effectiveness, and patient satisfaction (secondary outcomes), substantial up to 5 years after retainer placement.

Hypotheses:

Compared to traditional multistranded FRs, CAD/CAM FRs have:

  • Better long term stability,
  • Similar failure rate,
  • Fewer adverse effects,
  • Similar cost-effectiveness and patient satisfaction.
Read the detailed description

Material and Methods

Setting: Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Denmark and Department of Orthodontics, Faculty of Dentistry, University of Oslo, Norway.

Sample size: 126 participants are needed for this study.

Randomization: After oral and written consent is obtained, allocation to groups, either conventional multistranded Stainless Steel fixed retainers, or CAD/CAM custom-cut Nickel Titanium fixed retainers, will take place at the last appointment before debonding. Subjects will be allocated 1:1 into one of the two groups.

Intervention protocol: After completing a full active orthodontic treatment, at both centers. The achieved treatment end result has to be maintained in the long term in order to prevent relapse (movement of teeth to the initial malocclusion). One of either two different fixed retainers will be bonded (to the upper and lower anterior teeth) by one operator in each center.

This study follows a standard retention protocol procedure carried at both centers and has a long term posttreatment follow-up of 5 years. Patients will be recalled for follow-up appointments after 1, 3, 6, 12, 24, 36 and 60 months. At follow-up visits, we will perform the following: at 1, and 3 months - a clinical examination. At 6, 12, 24, 36, and 60 months - a clinical examination, a digital impression of the teeth known as "an intraoral scan" (Trios 3, 3Shape, Copenhagen, Denmark) and intraoral photographs. In addition, at 1, 6, and 12 months patients will be asked to fill out a Visual Analogue Scale (VAS) form regarding patient satisfaction Furthermore, we will investigate stability by superimposition (Orthoanalyzer, 3Shape, Copenhagen, Denmark) together with recording of adverse effects (i.e. any changes in torque and/or rotations of the teeth).

Conditions
Relapse
Being tested
Bonding of either CAD/CAM or conventional multistranded stainless steel fixed retainer
Keywords
Orthodontic retainer, relapse, stability, CAD/CAM, fixed retainer
Medical subject headings
Recurrence

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Bonding of either CAD/CAM or conventional multistranded stainless steel fixed retainerOther

    Investigate and compare the clinical effectiveness of two types of fixed retainers; CAD/CAM vs. multistranded wire.

Study groups in NCT04389879
Study groupRoleWhat they receive
CAD/CAMExperimentalCAD/CAM custom-cut Nickel Titanium (NiTi) FR
Receives: Other: Bonding of either CAD/CAM or conventional multistranded stainless steel fixed retainer
Conventional multistrandedActive comparatorConventional multistranded Stainless Steel (SS) FR
Receives: Other: Bonding of either CAD/CAM or conventional multistranded stainless steel fixed retainer

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Stability

    Change in lower incisor crowding will be assessed using Little's Irregularity Index (LII). Change in overall occlusal stability will be assessed by the Peer Assessment Rating (PAR) index. In addition, changes in arch dimensions, occlusal relationships, and re-opening of extraction spaces will be recorded.

    Measured: From debonding (T1), and after 6, 12, 24, 36 and 60 months in retention phase (T4, T5, T6, T7, and T8 respectively)

Secondary outcomes (4)
  1. Failure rate and survival time

    Calculated from the first day of retainer's bonding to the day of the first failure episode

    Measured: From the time of retainer bonding to the first failure episode: From debonding, and up to 60 months later

  2. Adverse effects

    Screen for unexpected posttreatment changes in the mandibular anterior region associated with the use of both types of fixed retainers

    Measured: From debonding, and up to 60 months later

  3. Cost-effectiveness

    Unit costs in euros (€) will be used to value the resources included

    Measured: From debonding, and up to 60 months later

  4. Patient satisfaction

    Visual Analogue Scale (VAS)

    Measured: From debonding, and after 1, 6 and 12 months in retention phase

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 May 2020
  2. Study start1 Sep 2018
  3. Primary completionNov 2025 (estimated)
  4. Study completionDec 2025 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
Two-center randomized controlled clinical trial. Consecutive patients who are about to finish their fixed appliance orthodontic treatment at the two orthodontic departments will be screened for eligibility criteria. Eligible subjects will be randomized to have one of either two different fixed retainers to be bonded (to the upper and lower anterior teeth) by one operator in each center. Subjects will be allocated 1:1 into one of the two groups.
Masking
None (open label)
Enrolment
126 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04389879
Sponsor's protocol ID
01286
Acronym
Retention
Status last verified
Nov 2022
First submitted
16 Apr 2020
Last updated
3 Nov 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Owman G, Bjerklin K, Kurol J. Mandibular incisor stability after orthodontic treatment in the upper arch. Eur J Orthod. 1989 Nov;11(4):341-50. doi: 10.1093/oxfordjournals.ejo.a036005.

    PubMed 2591482
  • Al Yami EA, Kuijpers-Jagtman AM, van 't Hof MA. Stability of orthodontic treatment outcome: follow-up until 10 years postretention. Am J Orthod Dentofacial Orthop. 1999 Mar;115(3):300-4. doi: 10.1016/s0889-5406(99)70333-1.

    PubMed 10066979
  • Littlewood SJ, Millett DT, Doubleday B, Bearn DR, Worthington HV. Retention procedures for stabilising tooth position after treatment with orthodontic braces. Cochrane Database Syst Rev. 2004;(1):CD002283. doi: 10.1002/14651858.CD002283.pub2.

    PubMed 14973985
  • Reitan K. Clinical and histologic observations on tooth movement during and after orthodontic treatment. Am J Orthod. 1967 Oct;53(10):721-45. doi: 10.1016/0002-9416(67)90118-2. No abstract available.

    PubMed 5233926
  • Little RM, Wallen TR, Riedel RA. Stability and relapse of mandibular anterior alignment-first premolar extraction cases treated by traditional edgewise orthodontics. Am J Orthod. 1981 Oct;80(4):349-65. doi: 10.1016/0002-9416(81)90171-8.

    PubMed 6945805
  • Littlewood SJ, Millett DT, Doubleday B, Bearn DR, Worthington HV. Orthodontic retention: a systematic review. J Orthod. 2006 Sep;33(3):205-12. doi: 10.1179/146531205225021624.

    PubMed 16926314
  • Gardner SD, Chaconas SJ. Posttreatment and postretention changes following orthodontic therapy. Angle Orthod. 1976 Apr;46(2):151-61. doi: 10.1043/0003-3219(1976)0462.0.CO;2.

    PubMed 1064343
  • Goldberg AI, Behrents RG, Oliver DR, Buschang PH. Facial divergence and mandibular crowding in treated subjects. Angle Orthod. 2013 May;83(3):381-8. doi: 10.2319/061912-505.1. Epub 2012 Oct 18.

    PubMed 23075061
  • Artun J, Spadafora AT, Shapiro PA. A 3-year follow-up study of various types of orthodontic canine-to-canine retainers. Eur J Orthod. 1997 Oct;19(5):501-9. doi: 10.1093/ejo/19.5.501.

    PubMed 9386336
  • Bolla E, Cozzani M, Doldo T, Fontana M. Failure evaluation after a 6-year retention period: a comparison between glass fiber-reinforced (GFR) and multistranded bonded retainers. Int Orthod. 2012 Mar;10(1):16-28. doi: 10.1016/j.ortho.2011.12.005. Epub 2012 Jan 11. English, French.

    PubMed 22240271
  • Rose E, Frucht S, Jonas IE. Clinical comparison of a multistranded wire and a direct-bonded polyethylene ribbon-reinforced resin composite used for lingual retention. Quintessence Int. 2002 Sep;33(8):579-83.

    PubMed 12238688
  • Salehi P, Zarif Najafi H, Roeinpeikar SM. Comparison of survival time between two types of orthodontic fixed retainer: a prospective randomized clinical trial. Prog Orthod. 2013 Sep 11;14:25. doi: 10.1186/2196-1042-14-25.

    PubMed 24326013
  • Saleh M, Hajeer MY, Muessig D. Acceptability comparison between Hawley retainers and vacuum-formed retainers in orthodontic adult patients: a single-centre, randomized controlled trial. Eur J Orthod. 2017 Aug 1;39(4):453-461. doi: 10.1093/ejo/cjx024.

    PubMed 28430890
  • Hichens L, Rowland H, Williams A, Hollinghurst S, Ewings P, Clark S, Ireland A, Sandy J. Cost-effectiveness and patient satisfaction: Hawley and vacuum-formed retainers. Eur J Orthod. 2007 Aug;29(4):372-8. doi: 10.1093/ejo/cjm039.

    PubMed 17702797
  • Tynelius GE, Lilja-Karlander E, Petren S. A cost-minimization analysis of an RCT of three retention methods. Eur J Orthod. 2014 Aug;36(4):436-41. doi: 10.1093/ejo/cjt070. Epub 2013 Oct 1.

    PubMed 24084630

Questions about this trial

What is this clinical trial studying?

A study testing Bonding of either CAD/CAM or conventional multistranded stainless steel fixed retainer in people with Relapse, run by University of Aarhus at 2 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 3 Nov 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Denmark, Norway. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Stability (time frame: From debonding (T1), and after 6, 12, 24, 36 and 60 months in retention phase (T4, T5, T6, T7, and T8 respectively)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04389879, which also lists 26 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Nov 2022.

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