Factors influencing adherence to vacuum-formed retainer wear: A qualitative study

Abstract

Objective: To explore factors influencing adherence to vacuum-formed retainer wear over a minimum period of four years. Design: A qualitative study based on a randomised controlled trial assessing the effectiveness of orthodontic retainers. Setting: Institute of Dentistry, Queen Mary University of London. Participants: Fifteen participants wearing vacuum-formed retainers for at least four years. Methods: One-to-one semi-structured interviews were undertaken on a criterion-based purposive sample of participants wearing vacuum-formed retainers. The interviews were audio-recorded, transcribed verbatim and analysed using Framework Methodology. Results: High self-reported levels of adherence in the early stages of retention were linked to a desire to maintain orthodontic outcomes and the negative perception of potential post-treatment changes. However, adherence typically reduced over time due to a combination of factors including the negative impact of retainers on quality of life and pragmatic issues related to retainer wear. Network support was found to be important in the short and long term, with instances of self-directed wear and negative beliefs concerning the importance of retainer wear and predisposition to post-treatment changes. Lack of follow-up appointments and immaturity of participants prompted independent decisions to cease retainer wear. Conclusions: Six key influencers of prolonged adherence with vacuum-formed retainer wear were identified. Future strategies to improve adherence should account for these while also being responsive to time elapsed since debond and patient age.

Evaluation of the effectiveness of a tailored mobile application in increasing the duration of wear of thermoplastic retainers: a randomized controlled trial

“…The limited benefit of interventions directed at enhancing adherence levels with orthodontic retainers has been exposed in previous research (4). This may relate to the complex and multi-faceted nature of adherence with extraneous factors including associated negative impact on quality of life and pragmatic issues related to retainer wear also being important (1).…”

“…The multitude of functions built in the 'My Retainers' mobile application were designed to address reported barriers to retainer wear (1,12). For example, a reminder system was included to overcome forgetfulness.…”

“…However, there is some evidence to suggest similar outcomes with parttime wear (40). Part-time wear is also regarded as more realistic and achievable with minimal impact on daily activities (1,11). This is likely to explain the part-time wear of Twin Blocks despite full-time prescription with mean wear rates of 12 hours daily observed in the full-time group and 8 hours daily in the prescribed part-time group (41).…”

“…Maintenance of post-treatment orthodontic outcomes hinges on the levels of adherence to orthodontic retention. Barriers to removable retainer wear including negative impact on quality of life, forgetfulness and a lack of appreciation of the importance of retainer wear have been identified in previous research (1,2). The centrality of the patient-clinician relationship in terms of sharing concerns and frequency of follow-up appointments has also been highlighted in qualitative research (1).…”

“…Barriers to removable retainer wear including negative impact on quality of life, forgetfulness and a lack of appreciation of the importance of retainer wear have been identified in previous research (1,2). The centrality of the patient-clinician relationship in terms of sharing concerns and frequency of follow-up appointments has also been highlighted in qualitative research (1). Notwithstanding this, suboptimal adherence has been exposed in prospective studies with just one-third of participants claiming to be adherent with Essix-type retainer wear 2 years into the retention phase (3).…”