Case Report

By Dr. Nishanth Shetty , Dr. Dinoop Valsan , Dr. ANITHA A
Corresponding Author Dr. Nishanth Shetty
Department of Orthodontics, AJIDS, kuntikana junction - India 575004
Submitting Author Dr. Nishanth Shetty
Other Authors Dr. Dinoop Valsan
ORTHODONTICS, AJIDS, Kuntikana, MANGALORE - India 575004



Retainer, Relapse, Lingual, Aesthetic, Bonded, Crowding

Shetty N, Valsan D, A A. Active lingual retainer - A Case series. WebmedCentral ORTHODONTICS 2016;7(8):WMC005174

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 06 Aug 2016 08:17:24 AM GMT
Published on: 09 Aug 2016 12:28:01 PM GMT


Removable retainers are appliances used extensively to preserve stability and prevent relapse following orthodontic treatment. The magnitude of their importance as a part of routine retention procedure has gained ascent especially since the tendency for relapse occurs in 70 % of cases. Patients invariably need to wear retainers as it takes 8 months for periodontal fibres to reorganize, thus requiring minimum 12 months of retention period. But unfortunately due to various reasons relapse has been seen to occur , which lead us to the only alternative i.e.  fixed lingual retainers especially in lower anteriors.

In this day and age many orthodontist are advocating the use of fixed  lingual retainers in the maxillary arch as well. The ease of fabrication and aesthetics is one of the reasons that lingual retainers  have gained such  popularity. The patient compliance is also well accepted in case of lingual retainers .

However , even with the use of fixed lingual retainers, relapse may occur due to breakage. In such cases active lingual retainers can be used to bring about minor corrections & the need to undergo fixed orthodontic treatment could be counteracted. A clinical procedure first demonstrated by Dr. Marino Musilliillustrates how lingual retainers can be used to bring about active tooth movement. Anna marinielloand liouejhave also published case reports, where they have described the use of varied active lingual retainers. In this case series we put forth 3 cases, treated in similar manner

Materials and Methods

The armamentarium consisted of 0.0175” multi-stranded stainless steel wire, a composite kit and cheek retractors when and if needed. The wire was chosen not only because it was a standard part of armamentarium, but for its ideal flexibility allows for individual tooth movement thus  preventing unnecessary bond failure and irregular surface of wire  provides greater surface area for bonding which helps in treatment protocol. Due to good formability  and the proper load/deflection ratio, this wire is optimal to achieve alignment and/or levelling. The possibility of shaping loops allows the clinician to easily manage the opening and closing of spaces, derotations, as well as minor  intrusions/extrusion.

A simple U loop design was used , as it helps in correction of minor crowding and spacing with activation of the loops. Further step bends (in and out bends) were incorporated in the wire to correct the rotation and torquing of teeth which were in accordance to biomechanical principles explained by burstone4,5. Activation of the loops were done accordingly during each appointments.


Case 1

A 21 year old female patient had a chief complaint of irregularly placed upper front teeth even after orthodontic treatment. The patient had undergone orthodontic treatment 5 years back for correction of crowding. On examination, patient had a class I molar and canine relation with crowding of  3-4 mm in the upper anteriors (Fig 1 A). Since the patient was concerned only with correction of her smile and was not willing for a conventional orthodontic treatment , the lingual active retainer therapy was advised. 

Case 2

A 47 year old female patient reported with a chief complaint of  irregularly placed upper right lateral incisors and expressed displeasure in getting braces of any kind due to her age and social concerns. On examination patient had a class I molar and canine relation with generalised spacing in anteriors. Periodontal health was just not satisfactory and needed improvement for mild recession in anteriors (Fig 2 A). Since patient was only concerned with 12 overlapping 11 the lingual active retainer therapy was advised (Fig 2 B). She was instructed to maintain good oral hygiene using modified bass technique.

A, Case 3, a 25 year old male patient with upper anterior crowding was treated with active lingual retainer 

Treatment was completed in a period of 2 months period with well aligned upper anteriors.


The use of lingual active retainer was able to correct minor correction of crowding and spacing in  Patients. Treatment was successfully completed in a period of 3-4 months without much discomfort to the patients. Hence active lingual therapy can be used as an adjunctive treatment option for relapse cases.


  1. Marino Musillithe : bracketless fixed orthodontics: nine years of clinical experimentation. Progress in orthodontics. 2008; 9(1):72-91.
  2. Anna Mariniello, Fabio Cozzolino :lingual active retainers to achieve teeth levelling in orthodontics: case series. International Dentistry SA vol. 10, no. 5.
  3. Eric J.W. Liou, Louise I. J. Chen, C. Shing Huang, Nickel-titanium mandibular bonded lingual 3-3 retainer: For permanent retention and solving relapse of mandibular anterior crowding. Am J Orthod Dentofacial Orthop. 2001;119:443-9.
  4. Ronay F, Wolfgang Kleinert, Birte Melsen, Charles J. Burstone, Force system developed by V bends in an elastic orthodontic wire. AM J ORTHO  DENTOFACIAL ORTHO 1959;96:295-301 .
  5. Charles J. Burstone, Herbert A. Koenig, Force systems from an ideal arch . AmJ Orthod , .ARCH 1974 Volume 65 Number 3 .

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