“Wire Syndrome” Following Bonded Orthodontic Retainers: A Systematic Review of the Literature

Abstract

(1) Background and objective: Tooth movements described as unexplained, aberrant, unexpected, unwanted, or undesirable can occur in the presence of an intact orthodontic retention wire, without detachment or fracture. This iatrogenic phenomenon, known little or not by many practitioners, responsible for significant dental and periodontal complications, both functional and aesthetic, is called “Wire Syndrome” (WS). It is therefore considered an undesirable event of bonded orthodontic retainers, which must be differentiated from an orthodontic relapse. The objective was to perform, for the first time, a systematic review of the literature in order to define the prevalence of WS and to study its associated clinical characteristics. (2) Methods: A systematic review of the literature was performed following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and recommendations using an electronic search strategy on four databases complemented by a manual search. All the prospective and retrospective clinical studies, including case reports and series, written in English or French, clearly mentioning the description, detection, or management of WS were included. Three independent blinding review authors were involved in study selection, data extraction, and bias assessment using the Mixed Methods Appraisal Tool (MMAT). (3) Results: Of 1891 results, 20 articles published between 2007 and 2021 fulfilled the inclusion criteria, with a globally high risk of bias since 16 articles were case report/series. The analysis of each article allowed the highlighting of WS through 13 categories, as follows: prevalence, apparition delay, patient characteristics, arch and tooth involved, families of movements, dental and periodontal consequences, type of wire, risk factors, etiologies, treatment, and preventive approach. (4) Conclusion: This systematic review of the literature elaborated a synthesis on WS, allowing general practitioners, periodontists, and orthodontists to understand this adverse event, to facilitate the diagnostic approach, and to underline preventive measures against WS. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; number CRD42021269297).

Importance of Early Detection of Wire Syndrome: A Case Series Illustrating the Main Stages of the Clinical Gradient

“…The movements caused by WS do not correspond to a relapse or a physiological process [21]; the effects of WS on teeth are not correlated with the position of teeth before orthodontic treatment nor with their position at the time of the debonding of an orthodontic appliance. WS can therefore be considered as a new malocclusion observed after the placement of a fixed, bonded, post-orthodontic retainer [21]. The aim of this article was to show, via three clinical cases representing three main situations of WS of increasing complexity, the relevance of the early diagnosis of this syndrome.…”

“…The first systematic review on wire syndrome (WS) was published by Charavet et al [21] in 2022, defining its prevalence and associated characteristics. This review involved an electronic search strategy on four databases supplemented by a manual search.…”

Complications and treatment errors involving periodontal tissues related to orthodontic therapy

“…116 This "wire syndrome" may present in different degrees of severity and depends on the amount of incisor inclination and torque differences. 117 Reported prevalence rates are up to 30%. 118 These unwanted adverse effects of OT in the retention phase should be viewed at least as complications and if left unnoticed and/ or unaddressed in their early stages should be considered as treatment errors.…”

“…Accordingly, gingival recession with root exposure might occur as a consequence of a root position outside the bony envelope 116 . This “wire syndrome” may present in different degrees of severity and depends on the amount of incisor inclination and torque differences 117 . Reported prevalence rates are up to 30% 118 …”

Double Lateral Sliding Bridge Flap versus Laterally Closed Tunnel for the Treatment of Single Recessions in the Mandibular Anterior Teeth: A Pseudorandomized Clinical Trial

“…The increasing demand for orthodontic therapies that lead to buccal displacement of the mandibular incisor roots, associated with the thin buccal cortical bone, facilitates the appearance of gingival recessions [ 4 ]. Additionally, a recent systematic review reported unexpected dental movements after orthodontic treatment has finished—caused by the wire retainers and resulting in dental and periodontal complications—termed “wire syndrome” [ 5 ]. Clinicians may also encounter aberrant frenula with a very coronal attachment, high muscle attachments, a larger avascular surface area, tooth malposition, shallow vestibules and/or thin gingival phenotype [ 1 , 2 , 6 ].…”