Orthodontic treatment in patients with reduced periodontal support presents unique challenges due to the increased risk of relapse, tooth mobility, and potential deterioration of periodontal health. This narrative review synthesizes evidence from peer-reviewed journal articles published on retention strategies tailored to such patients. The objectives are to examine the types of retainers used, their effects on periodontal parameters, factors influencing retainer longevity and failure, and strategies to optimize outcomes in periodontally compromised individuals. Fixed retainers, particularly bonded lingual wires, are commonly employed for their efficacy in maintaining alignment, though they may accumulate more plaque and calculus compared to removable options. Studies indicate that while fixed retainers are generally compatible with periodontal health, careful patient selection, supportive periodontal therapy, and appropriate retainer design are crucial to minimize adverse effects. CAD/CAM-fabricated retainers show promise in reducing gingival inflammation and improving hygiene. Adjunctive procedures like circumferential supracrestal fibrotomy may enhance stability. Long-term retention protocols, including dual retention and regular monitoring, are recommended to prevent relapse and maintain periodontal stability. Overall, multidisciplinary approaches integrating orthodontic and periodontal care yield improved functional and aesthetic results, with no irreversible deterioration of periodontal health when managed appropriately. However, high-quality prospective studies are needed to refine these strategies.
