Non-AGP management of fixed retainer hygiene
Featured Products Promotional FeaturesPosted by: Dental Design 12th October 2021
With dental practices having to restructure their diaries, working arrangements and treatment modalities due to the Covid-19 pandemic, dental hygiene appointments have been hugely affected. Both the requirement to justify Aerosol Generating Procedures (AGPs) and implementing fallow times after such procedures have had an impact. Factors that affect the ability of a clinician to provide comprehensive and effective non-AGP scaling and periodontal management include having a supply of well-maintained hand scalers in a range of styles, which are regularly sharpened or made with sharpen-free technology. Chair side assistance and realistic time expectations are also essential.
One of the challenges of hand scaling maintenance patients has been navigating fixed appliances that are more irregular in shape, requiring precision instrumentation and care to ensure they do not become unattached. It is also helpful to ensure they are comprehensively cleaned in order to maximise the ability of the patient to perform effective home care.
Case study
Mrs S attended with a multi-strand stainless steel Twist Flex fixed lower retainer. Her last dental visit was 12 months beforehand and her primary concern was staining between her teeth. The patient’s medical history was clear. The retainer had been placed following orthodontic treatment as a teenager and the patient was not aware that she could clean between the teeth as she had tried floss but failed (Figures 1-2).
On examination there was interdental and subgingival calculus on the lower 3-3 and bleeding on 
probing on all interdental sites. The patient’s plaque score was 40%, mainly accumulated interdentally. Additionally, there was staining accumulation around the retainer attachments and visible interproximally on the buccal aspect of the lower anterior teeth. There were no pockets measuring more than 3mm.
A diagnosis of generalised gingivitis was made and the recommended treatment was full mouth scaling and polishing, followed by comprehensive oral hygiene instruction to include the use of an oscillating rotating electric toothbrush, interdental brushes, floss and education on gingivitis and risks of periodontitis.
Removal of the interproximal deposits was necessary to facilitate oral hygiene instruction.
Hygiene instruments chosen for treatment were the LM Mini Anterior Syntettes – a universal curette with small working end that is excellent for narrow areas and trauma-free subgingival debridement. A LM sharp Jack was also used, which is a thin, long bladed sickle scaler, good for precision scaling and reaching difficult to access interproximal spaces. Both scalers were from J&S Davis’ sharp diamond range (Figure 3).
The mini Syntette was used first to remove the bulk of the deposit, followed by the sharp Jack to reach the interproximal spaces and around the lingual attachments. Patient comfort was maximised by utilising light strokes with the hand scalers and keeping the deposits dry with air from the 3/1 and high-volume suction used throughout the procedure. The remaining soft deposits were removed with fine prophy paste and nylon polishing brush prior to oral hygiene instructions.
Mrs S was instructed in the use of green and yellow TePe interproximal brushes, the Oral B Pro 2000 electric toothbrush and Oral B Glide Floss Picks to achieve comprehensive cleaning at both gingival margins and contact points.
Follow up was arranged at two weeks; on her return, the patient was excelling in home care (Figures 4-5). The plaque score was <10%, with minimal interproximal bleeding on probing. The patient reported a light feeling in her mouth and was very happy with the result. Regular dental hygiene maintenance was advised at six monthly intervals.
Retainer style makes a difference
Dental hygiene maintenance of lower fixed retainers often comes with challenges that vary depending on the style and positioning of the retainer, as demonstrated by the below cases:
The bulky composite on this Twist Flex wire poses a challenge to achieve a good aesthetic result without risking detachment. The patient was instructed to use Superfloss in addition to interdental brushes in order to gently clean the lateral surfaces of the composite.
It is often easier to achieve a good aesthetic result with this preformed arch wire design as attachments are only placed on the lingual of the 3s (Figure 7), resulting in the ability to gently clean between tooth and wire. The patient was advised to use a floss threading technique in order to maintain the lingual surface behind the appliance (Figure 8).
Proper oral hygiene instruction, coupled with thorough and precise deposit removal, is key to maintaining fixed appliances, and this is absolutely achievable as a non-AGP if required. Utilising sharp and well-maintained instruments with correct positioning can help to achieve results that are very much comparable to that of AGP equivalent procedures.
Cat Edney – The Gentle Hygienist thegentlehygienist@gmail.com
For more information on the industry-leading products available from J&S Davis, visit www.js-davis.co.uk, call 01438 747 344 or email jsdsales@js-davis.co.uk
