SOX Retainers


SOX Retainers

SOX is an abbreviation for the ‘social six’ front teeth, and SOX retainers are designed to maintain the alignment of the upper and/or lower anterior teeth. The device was originally designed as a retainer, but it can also be used for tooth movement and correction of minor overlaps or irregularity of the anterior teeth. It was originally described by Philippe ( Fig. 9.17 ).13 , 17 The system is also known as a two-dimensional lingual bracket, and does not provide torque control. All of the archwires are round and will only provide derotation, intrusion, or extrusion, or changes in angulation. It is not possible to apply torque, as there is no rectangular slot. In most cases, anterior alignment relapse is usually confined to small in-out discrepancies and rotations and this can be easily treated with this appliance. Due to its two-dimensionality, a universal bracket can be used on all teeth, which may lead to reduced inventory. The brackets are individualized by modifying their position on individual teeth. Figs. 9.189.21 show clinical applications for bracket placement and ligation of an archwire.

Fig. 9.17 The basic conformation of the bracket developed by Philippe. The ligation wings have a rounded inner surface and press the wire against the bracket base. The round slot is activated by pressing the wings against the bracket base.
Fig. 9.18 The enamel surfaces are conditioned in the conventional way using phosphoric acid or a self-etching primer. Orthodontic light-cure composite is used to bond the brackets.
Fig. 9.19a–c The bracket is self-ligating by means of two adjustable ligation wings that are open in the occlusal direction, allowing easy access for the wire. A special flat instrument is used to open the clip (a, b). The instrument is placed in the space between the bracket base and the retention clip and is used like a lever to open the bracket.
Fig. 9.20a–c The lingual archwire (a) is held in place by a wire director (b) and locked into the bracket by pressing the ligation wings against the bracket base using small Weingart pliers (c). To protect the buccal tooth surface, one tip of the Weingart pliers can be covered with protective rubber tubing.

The advantage of this concept is that it is possible to use the appliance as a retainer after successful alignment (see Case Study 9.5). To convert the appliance to a retention device, the last wire, usually 0.018 stainless steel, remains in the brackets and is then permanently locked into the individual brackets using a fluoride-containing, flowable composite.

The overall height of the bracket is only 1.4 mm, and patient comfort is improved in comparison with other lingual brackets, which are usually thicker and wider. The wearing comfort is similar to that of a fixed retainer, as the size is very similar.

It is widely known that even fixed retainers allow slight movement of contact points from their original position. With a SOX retainer, it is possible to reopen the retainer and adjust the archwire to correct very minor relapse or tooth movement; especially in adults, where long-term retention appears to be indicated. Many adult patients who have undergone orthodontic treatment experience postorthodontic changes in the alignment of the front teeth in particular. The range of retainers available today may offer these patients the reliable long-term retention they were hoping for after their original orthodontic treatment.

Fig. 9.21 Depending on the initial findings, either a regular buccal 0.010 or 0.012 superelastic NiTi wire can be used.

Case Study 9.5 (Fig. 9.22)

Patient: D.H., female, age 18.

Diagnostic records: models, panoramic radiograph, lateral cephalometric radiograph, intraoral/extraoral photographs.

Main findings: late anterior crowding.

Treatment aims: esthetic alignment of the maxillary and mandibular anterior teeth.

Appliances: two-dimensional lingual brackets, IPR.

Archwire sequence: buccal 0.010 SE, 0.012 SE and 0.016 SE preformed lingual archwires, custom-bent 0.016 SS lingual archwire.

Alternative treatment strategy: n/a.

Active treatment time: 6 months. Retention: bonded retainer.

Fig. 9.22 1–20 1–5 Typical manifestation of late crowding and poor contact points on teeth 11 and 41. 6–10 Two-dimensional lingual brackets in both arches bonded from canine to canine and 0.010 SE archwires in place. Due to the limited access on the lingual tooth surface, tooth 41 is bonded with a smaller, single-wing bracket. 11–15 The situation after insertion of preformed 0.016 SS lingual archwires: the space for tooth alignment was created by IPR. In the meantime, tooth 41 was bonded with a regular two-dimensional lingual bracket. The wire was extended to the premolars to improve anterior arch shape. 16–20 The final result in retention.


  • Lingual surfaces that are difficult to reach (due to crowding and/or rotation of teeth) can often be bonded with a reduced-width two-dimensional lingual bracket.

  • It is recommended to initiate movement using 0.010 superelastic archwire, which we use for buccal alignment as well.

  • It is often advisable to induce tooth movement by incorporating the first and second premolars in the fixed appliance. We tend to use a high-flow composite for adhesion of the wire, without the need for bracket placement on these teeth.

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Jul 7, 2020 | Posted by in Orthodontics | Comments Off on SOX Retainers
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