Background: Retention protocols vary widely across regions, yet limited data exist on practices in the Western Balkans. This study aimed to compare retention strategies among orthodontists in Croatia, North Macedonia, and Kosovo, evaluating influences such as clinician experience, malocclusion type, and patient factors. Methods and Results: A questionnaire was distributed to 185 orthodontists in Croatia, 150 in North Macedonia, and 125 in Kosovo (representing 78%-100% practicing orthodontists) from December 2023 to May 2024, with response rates of 75%, 63%, and 58%, respectively. Data on appliance preferences, follow-up frequency, and retention protocol were analyzed using Chi-square and Kruskal-Wallis tests. The most preferred appliance options were the following: VFR in Croatia, a combination of fixed and removable in Kosovo, and an acrylic plate in North Macedonia. Retention choices were primarily experience-driven, though Kosovar orthodontists prioritized patient age/growth (88%), while Croatians and Macedonians emphasized malocclusion type (73%-78%). Countries also differed in patient care practices following a procedure. Written instructions were less common in Kosovo and North Macedonia than in Croatia (11% and 19% vs. 69%; P<0.001). Monitoring by an orthodontist beyond three years was higher in Kosovo and North Macedonia than in Croatia (92 and99% vs. 75%; P < 0.001). Conclusion: Significant regional differences in retention practices reflect variations in training traditions, clinical habits, and socioeconomic factors. These findings underscore the need for clearer, evidence-based retention guidelines to support consistent and unified clinical practices across regions, ultimately improving long-term patient outcomes.
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