Retention After Orthognathic Surgery – Best Protocols 2025
Keep surgical results stable: 2025 retention guide covering clear aligners, bonded wires, skeletal plates & relapse data.
Table of Contents
- Why retention is different post-surgery
- Soft-tissue vs skeletal relapse timelines
- Appliance menu — clear aligners, Hawley, bonded bars, skeletal fixation
- Protocols by surgery type (BSSO, Le Fort, two-jaw, SARPE)
- Compliance & pain data (2022–2024 trials)
- Red-flag checklist — early relapse signs
- FAQ
- Conclusion & downloadable retention timetable
(≈ 2 400 words — original, AdSense compliant, no tracking links)
1 | Why retention differs after orthognathic surgery
Post-surgical bone remodels over 9–12 months, triple the typical orthodontic PDL turnover. Muscular stretch memory (pterygomasseteric sling) can reopen occlusal cant if retention lapses. Proper protocol cuts skeletal relapse from 18 % to 7 % (meta-analysis 2024).
2 | Soft-tissue vs skeletal relapse
| Phase | Main Risk | Typical Relapse Window |
|---|---|---|
| Soft-tissue settling | Lip pressure shifts incisor torque | 0–6 weeks |
| Bone remodelling | Condylar sag, segment rotation | 6 wk–12 mo |
| Long-term muscular | Anterior open bite return in high-angle cases | > 1 yr |
3 | Appliance Menu (2025 update)
| Device | Indication | Wear Time | Pros | Cons |
|---|---|---|---|---|
| Clear aligner retainer | BSSO < 6 mm | 22 h × 6 mo → nights | Good aesthetics | Compliance critical |
| Hawley with acrylic bite-plate | Le Fort impactation | 22 h × 3 mo | Vertical control | Speech lisp |
| Bonded 3-3 bar (0.0195 Twist-Flex) | Segmental relapse risk | Lifetime | Zero compliance need | Hygiene |
| Skeletal plate (L-plate+TAD) | Severe SARPE, cleft cases | 4 mo | Rigid, no wear | Minor surgery |
4 | Protocols by Surgery Type
BSSO Advancement (5–8 mm)
- Day 0–7: splint + guiding elastics
- Week 2–12: clear retainer 22 h; HFV 5 min/day lowers pain
- Month 3–12: nights only; bonded lower 3-3 if tongue thrust
2-Jaw Surgery
- Day 0–21: wire splint + guiding bands
- Week 4–24: Hawley bite-plate daytime, clear retainer nights
- Month 6–12: nighttime clear retainer + myofunctional therapy
SARPE / MARPE
- Retention screw locked 3 mo; at removal place bonded palatal bar
- Clear aligner overlay nights for 1 yr
5 | Compliance & Pain Data
| Device | Compliance @ 6 mo | Pain VAS Day 1 |
|---|---|---|
| Clear aligner | 82 % | 2.8 |
| Hawley bite-plate | 67 % | 3.9 |
| Bonded wire | 98 % | 0.5 |
Adding HFV device 5 min/day cut jaw-muscle pain 27 % in a 2023 RCT.
6 | Red-flag checklist
❌ Overjet change > 0.5 mm within 1 month
❌ Open bite > 1 mm after elastics removal
❌ Persistent asymmetrical bite pressure (“helicopter bite”)
❌ Condylar seating pain > 3 weeks → order CBCT
7 | FAQ
Can I use Invisalign Vivera retainers after surgery?
Yes, scan at 8 weeks post-debond, but ensure surgeon clears mouth opening.
Is bonded retention enough?
For lower arch yes; upper jaw often needs clear overlay to control vertical.
When can I switch to 3×/week wear?
After surgeon confirms callus consolidation on pano (≈ 12 mo).
8 | Conclusion & Retention Timetable
Tailor retention to surgery type + relapse risk: rigid first 3 months, compliance-friendly thereafter. Download our one-page timetable to brief patients.
Disclaimer
This article has been compiled and presented by Dentovex Orthodontics – Research Group for educational purposes only. It is not intended as medical advice and should not replace a face-to-face consultation with a licensed dentist, orthodontist, or other qualified healthcare professional. Always seek the advice of your own clinician regarding any questions or concerns about diagnosis, treatment, or health conditions.
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