Journal of Orthodontics

ISSN: 1465-3125 (Print) 1465-3133 (Online) Journal homepage: http://www.tandfonline.com/loi/yjor20

The invisible Hawley retainer

Richard Needham, David T. Waring, Jonathan Smith & Ovais H. Malik

To cite this article: Richard Needham, David T. Waring, Jonathan Smith & Ovais H. Malik (2015)
The invisible Hawley retainer, Journal of Orthodontics, 42:4, 333-341

To link to this article: http://dx.doi.org/10.1179/1465313315Y.0000000019

Published online: 16 Feb 2016.

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 CLINICAL SECTION Journal of Orthodontics, Vol. 42, 2015, 333–341

The invisible Hawley retainer

Richard Needham1, David T. Waring2, Jonathan Smith 2 and Ovais H. Malik 3
1
University of Manchester Dental Hospital and Northenden House Orthodontics, Manchester, UK; 2University of Manchester Dental Hospital;
3
University of Manchester Dental Hospital, Salford Royal NHS Foundation Trust, Northenden House Orthodontics, Manchester, UK

This paper provides an overview of orthodontic retention. A clinical case is presented using the aesthetic
Clearboww to retain a hypodontia case prior to restorative replacement of a developmentally absent upper right
lateral incisor tooth (UR2). Clinical relevance: Orthodontic retention is an important part of treatment. This is
especially so in the treatment of multi-disciplinary hypodontia cases. The Clearboww, aesthetic labial bow provides
superior aesthetics in comparison to conventional Hawley retainers.
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Key words: Orthodontics, Retention, Hawley retainer, Clearbow

Received 17 April 2015; accepted 12 July 2015

Introduction one which the patient will continue to wear. However,

Retention is the phase of orthodontic treatment
following completion of the desired tooth movement,
focused solely on maintaining the finished treatment
result and preventing relapse (Johnston et al., 2008).
Historically, retention was undertaken for a defined time
period to allow remodelling of the periodontium, after
which retainer wear was discontinued. The literature
describes that reorganization of the periodontal liga-
ment occurs over a 3–4 month period. The gingival
collagenous fibres reorganize between 4 and 6 months
with the supra-crestal fibres taking up to 232 days
(Reitan, 1967; Pratt et al., 2011). This first year follow-
ing removal of active orthodontic appliances is regarded
as the retention phase.
Movement of the teeth beyond this time point can occur
as a result of normal physiological changes. Contemporary
practice has seen a paradigm shift towards continued
retainer wear for as long at the patient wishes to ensure that
the alignment of the teeth is maintained (Melrose and
Millet, 1998). Patients must be informed of this and advised
on the importance of continued retainer wear in order to
prevent it (Kaplan, 1988).
A variety of retainer designs have been proposed over
time. Broadly, these are first divided into fixed and remo-
vable retainers. The benefits of fixed bonded retainers can be
readily appreciated in cases where there has been significant
labio-lingual movement of incisors; reduced periodontal
support and for retention following closure of a midline
diastema (Proffit and Fields, 1992). A bonded retainer may
also be supplemented with use of a removable retainer.
However, with removable retainers there is no clear
consensus as to the ideal design or optimum retention
regimen (Littlewood et al., 2006). The best retainer is
this requires the patient to accept responsibility and take
ownership for the wear and maintenance of their
appliances (Mollov et al., 2010).
Hawley retainers vs. vacuum formed retainers
The Hawley retainer was first described in 1919 and has
remained relatively unchanged over time. Some clin-
icians may request a fitted labial bow to improve tooth
contact with the bow. However, in recent years, acry-
lation of the labial bow has become common practice in
order to improve the adaptation of the bow to the labial
surfaces of the teeth while also improving the aesthetics,
to a limited degree. Vacuum formed retainers (VFRs)
were first described by Ponitz (1971) and were again
popularized by Sheridan et al. (1993) as Essix retainers
made from strong, thin copolyester plastic sheets. It was
recommended that they be worn full time for a ‘short
period’ before reducing to night only wear.
In a survey of patient compliance with retainer wear
comparing Hawley’s and VFRs, Hichens et al. (2007)
found that patients with VFRs had a higher level of satis-
faction and fewer breakages. This view is contrasted by
Pratt et al. (2011) who reported that while patient com-
pliance is higher with VFRs between debond to 2 years,
beyond this time point patient compliance was greater with
use of Hawley retainers. It has, however, been demon-
strated that Hawley retainers allow for greater posterior
occlusal settling in the first few months following removal
of fixed appliances than can be achieved with VFRs
(Sauget et al., 1997). As there is no strong evidence to
support the use of one retainer over the other it still largely
comes down to operator preference.

*Address for Correspondence: Ovais Malik, University of Manchester

Dental Hospital, Higher Cambridge Street, Manchester, M15 6FH, UK.
Email: ovaismalik@yahoo.com
# 2015 British Orthodontic Society DOI 10.1179/1465313315Y.0000000019
 334 Needham et al. Clinical Section
Clearboww
The Clearbow is an aesthetic component that may be
used in the fabrication of retainers or other removable
orthodontic appliances. It comprises a clear strap made
of food-grade polyethylene terephthalate (PET) and
grade 316 stainless steel, joined together at a Coiltight-
Joint2. The bow is 2.75-mm wide and possesses a
concave inner surface structure to provide optimum
tooth contact and thereby superior retention. The
reported benefits of the Clearbow are:
. excellent aesthetics – being virtually transparent;
. gentle on tooth enamel or anterior restorations – as
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the bow is softer than stainless steel;
. stain resistant;
. free from Bisphenol A;
. anatomic design to improve tooth surface contact;
. virtually unbreakable.
The stainless steel labial bow on a conventional
Hawley retainer is easily distorted, unaesthetic and
produces only point contact on the labial surface of the
anterior teeth. However, long-term evaluation of the
Clearbow may be required to confirm the reported
benefits of dimensional stability, fracture and stain re-
sistance. The Clearbow when viewed in cross-section
clearly demonstrates improved contact with the labial
surface of the teeth over a greater surface area and is
closely adapted to the contour of all of the anterior
teeth. (Figs. 1–3)
The appliance is constructed by first applying separ-
ating medium to the working model before waxing into
place the Adams clasps – to ensure that the Clearbow
does not dislodge the wirework during the process of
thermoforming the bow (Fig. 4.). The size of the bow
required is then determined using the Clearbow ruler
(Fig. 5). This will vary depending on whether it is an
extraction or non-extraction case.
Figure 1 Cross sectional view of a conventional stainless steel labial bow compared to the Clearbow
JO 2015
The Coiltight-Joint2 (Fig. 6) is the point at which the
Clearbow is attached to the stainless steel wire. The coil
in the stainless steel wire is embedded into the polymer
bow creating what is described as a virtually unbreak-
able junction. This should be positioned distal to the
first premolars in a case with both pre-molars present
and distal to the canines in a premolar extraction case.
The stainless steel portion of the bow is then soldered
to the bridge of the Adams clasps (Figs. 7 and 8) before
the bow is thermoformed to the contour of the teeth.
This is performed using a heat gun to soften the plastic
before adapting and cooling each section of the bow
(Fig. 9). This takes approximately 90 seconds.
Once fully adapted, any plastic protruding through the
Coiltight-Joints2 should be removed using a bur.
Clinical Case
A 17-year-old female patient presented with a class III
incisor relationship on a class 1 skeletal base with
average lower anterior face height proportions and
Frankfort-Mandibular plane angle (Fig. 10a–e). Her
malocclusion was complicated by gross caries affecting
the upper right first molar (UR6) and the lower left first
molar (LL6) teeth, developmental absence of the upper
right lateral incisor tooth (UR2), bilateral post-erior
buccal cross-bite along with an upper centreline dis-
crepancy. Her presenting complaint was the asymmetric
appearance of the upper anterior teeth along with the
spacing in the upper arch.
The pre-treatment OPG (Fig. 11) confirmed the pre-
sence of all permanent teeth (except for the UR2), with
good alveolar bone levels and root morphology. After
discussion of all the potential treatment options it was
decided that the most appropriate plan was for extrac-
tion of the upper right first molar and lower left
first molar teeth along with upper and lower
pre-adjusted edgewise fixed appliances (0.0220|0.0280
 JO 2015 Clinical Section Invisible Hawley retainer 335
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Figure 5 Sizing up the Clearbow on the working model

Figure 2 The completed Clearbow Hawley retainer on

the working model

Figure 3 The conventional Hawley retainer on the

working model Figure 6 The Coiltight-Joint™

Figure 4 Wax up of Adam’s clasps and prosthetic UR2 Figure 7 Soldering of the Clearbow to the bridge of the
with stabilizing mesh Adam’s clasps – occlusal view
 336 Needham et al. Clinical Section
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Figure 8 Soldering of the Clearbow to the bridge of the
Adam’s clasps – buccal view
Figure 9 Thermoforming the Clearbow to the working
model
MBT prescription) to open space for the missing upper
right lateral incisor to later be restored with a resin
retained bridge, accepting the residual space in the lower
left quadrant. The decision for space opening was
reached as a result of: the asymmetric aesthetics; the
class III incisor relationship; the grossly carious upper
right first molar tooth – providing space for retraction of
the upper right buccal segment teeth along with the
unfavourable size, shape and colour of the
upper right canine tooth if it were to be disguised as a
lateral incisor.
Treatment was carried out using 3M Clarity advanced
tooth coloured brackets. Space was created around the
upper left lateral incisor tooth (UL2) to allow for
composite build up to match the space created for the
upper right lateral incisor (7 mm). Treatment was com-
pleted in 15 months.
At debond (Fig. 12a–e), the arches were well aligned
with the upper right canine and premolar teeth having
being retracted into a class I position, opening the
required 7 mm of space for the replacement of the upper
right lateral incisor tooth (UR2). At this point, upper
JO 2015
and lower alginate impressions were taken for the fab-
rication of a conventional upper Hawley retainer with
wire stops in the edentulous span, a lower bonded
retainer supplemented with a lower VFR. An additional
upper arch impression was taken for the fabrication of
the Hawley retainer with the Clearbow aesthetic labial
bow to allow direct comparison to the conventional
Hawley retainer (Figs. 13a–e and 14a–e).
Discussion
The case report presented describes the use of the
Clearbow on a Hawley retainer used in the treatment of
a hypodontia case. In such cases, it is essential to
maintain the final orthodontic result, normally for a
period of at least 3 months, prior to embarking on the
restorative phase of treatment.
Hawley retainers are used in these instances because
they afford the orthodontist the ability to incorporate
wire stops – tightly controlling the position of teeth
adjacent to the edentulous spans. Additionally, as
Hawley retainers do not have to be removed for eating
and drinking, this reduces the risk of retainers being lost
or damaged prior to completing the restorative phase of
treatment. Full time wear of a Hawley appliance with a
conventional labial bow, or even an acrylated labial
bow, can be a source of embarrassment for patients,
many of whom are already sensitive with regard to their
dento-facial aesthetics. The post-treatment extra-oral
photos presented for this case demonstrate the highly
aesthetic appearance of the Clearbow.
However, this does not mean that the Clearbow is
solely intended for use in the treatment of hypodontia
cases. Its precise fit coupled with improved durability,
while still allowing for vertical settling of the occlusion,
makes use of Hawley retainers a far more appealing
proposition in standard orthodontically treated cases
compared to previous designs of Hawley retainers. It is
interesting to note that the study by Hichens et al.
reported fewer breakages with use of VFRs, as in the
authors experience, it is a common finding to observe
wear facets or holes in VFRs when patients attend for
retainer review appointments. Whether this is due to
wear and tear or parafunctional habits, it can dramati-
cally reduce the lifespan of a VFR – increasing the
burden on the patient if they are to continue retainer
wear on an indefinite basis. As there is no occlusal
coverage with Hawley retainers, it is less likely they will
require regular replacement.
Conclusion
Retention is an essential part of the orthodontic treatment
process. It is clear from the literature that we do not have an
 JO 2015 Clinical Section Invisible Hawley retainer 337
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Figure 10 Pre-treatment intra-oral photographs

Figure 11 Pre-treatment DPT

 338 Needham et al. Clinical Section JO 2015
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Figure 12 Post-treatment intra-oral photographs

 JO 2015 Clinical Section Invisible Hawley retainer 339
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Figure 13 Post-treatment intra-oral photographs with conventional Hawley Retainer

 340 Needham et al. Clinical Section JO 2015
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Figure 14 Post-treatment intra-oral views with Clearbow Hawley retainer

 JO 2015 Clinical Section
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Figure 15 Post-treatment extra-oral view with conven-
tional Hawley retainer
Figure 16 Post-treatment extra-oral view with Clearbow
Hawley retainer
agreed consensus as to the ideal appliance and regimen for
retention. It may not even be possible to answer this
Invisible Hawley retainer 341
question conclusively as it can vary depending on the in-
dividual patient. Planning for long-term retention and
ensuring that patients accept responsibility for their part in
the process is the only way to ensure that the post-treat-
ment occlusal result is maintained.
Individual operator preference often dictates the retainer
used based on: the need for occlusal settling, parafunc-
tional habits, risk of appliance breakages and aesthetics.
The Clearbow provides a highly aesthetic, durable
alternative to the conventional labial bow with improved
retention of the anterior teeth. This makes use of Hawley
retainers a far more appealing proposition.
Acknowledgements
The authors would like to acknowledge the help of
Mr Jonathan Smith at the University of Manchester
Dental Hospital and Tameside General Hospital.
Disclaimer Statements
Contributors None.
Funding No.
Conflicts of interest There are no conflicts of interest.
References
Hawley CA. A removable retainer. Dent Cosmos 1919; 61: 449 – 455.
Hichens L, Rowland H, Williams A, Hollinghurst S, Ewings P and Clark S.
Cost-effectiveness and patient satisfaction: Hawley and vacuum-formed
retainers. Eur J Orthod 2007; 29: 372 – 378.
Johnston C, Burden D and Morris D. Clinical Guidelines: Orthodontic Reten-
tion, 2008, revised 2013. www.bos.org.uk accessed March 2015
Kaplan H. The logic of modern retention procedures. Am J Orthod Dentofacial
Orthop 1988; 93: 325 – 340.
Littlewood SJ, Millett D, Doubleday B, Bearn DR and Worthington HV.
Retention procedures for stabilizing tooth position after treatment with
orthodontic braces. Cochrane Database Syst Rev 2006; 1: CD002283.
Melrose C and Millet DT. Toward a perspective on orthodontic retention? Am J
Orthod Dentofacial Orthop 1998; 113: 507 – 514.
Mollov ND, Lindauer SJ, Best AM, Shroff B and Tufekci E. Patient attitudes
towards retention and perceptions of treatment success. Angle Orthod
2010; 80: 656 – 661.
Ponitz RJ. Invisible retainers. Am J Orthod 1971; 59: 266 – 272.
Pratt MC, Kluemper GT and Lindstrom AF. Patient compliance with ortho-
dontic retainers in the postretention phase. Am J Orthod Denofacial
Orthop 2011; 140: 196 – 201.
Proffit WR and Fields HW. Contemporary Orthodontics. 2nd edn St. Louis:
Mosby, 1992.
Reitan K. Clinical and histological observations on tooth movement during and
after orthodontic treatment. Am J Orthod 1967; 53: 721 – 745.
Sauget E, Covell DA, Boero RP and Lieber WS. Comparison of occlusal con-
tacts with use of Hawley and clear overlay retainers. Angle Orthod 1997;
67/3: 223 – 230.
Sheridan J, LeDoux W and McMinn R. Essix retainers: fabrication and super-
vision for permanent retention. J Clin Orthod 1993; 27: 35– 45.
www.clearbow.com PWG Orthodontics Specialities Ltd, accessed March 2015