Retention & Relapse

MOHAMED E. AMER, BDS, MSC

DEPARTMENT OF ORTHODONTICS, ZAGAZIG UNIVERSITY
 Relapse
It is the fall back into the former state of malocclusion, or the loss of correction
achieved by orthodontic treatment after the removal of the retaining device
Causes of Relapse
1. Periodontal ligaments
2. Persistence of Habits
3. Unbalanced occlusion
4. Change in arch form
5. Unfavourable growth pattern
6. Soft tissues & muscular factors
7. Role of 3rd molar
8. Poor Patient Co-operation
 Causes of Relapse
1. Periodontal ligaments
Whenever teeth are moved orthodontically through braces, the periodontal and
gingival fibres that encircle the tooth are stretched. These stretched fibres can
contract and can cause the teeth to come back to their original untreated
position causing the relapse
 Causes of Relapse
2. Persistence of Habits
The cause of the malocclusion should be determined at the time of diagnosis and
adequate treatment steps should be planned to eliminate them. Failure to remove
the etiology can result in relapse (e.g. Thumb sucking, or Tongue thrust).
If the habit is not treated at the beginning of the treatment, then relapse will
occur after removing the braces. Presence of certain habits such as clenching,
grinding, nail biting, lip biting are important causes of relapse
 Causes of Relapse
3. Unbalanced occlusion
Good intercuspation of upper and lower teeth is important factor in maintaining
the stability of treated cases.
 Causes of Relapse
4. Change in arch form
Maintenance of the intercanine and intermolar distances reduces the risk of
relapse and increases the chance of stability
 Causes of Relapse
5. Unfavourable growth pattern
Patients with skeletal problems may
exhibit relapse due to continuation of
the abnormal growth pattern after
orthodontic therapy. Hence prolonged
retention is indicated until active
growth is completed
excessive forward growth and upward
rotation of the mandible can result in
an increase in overbite, and anterior
crowding
 Causes of Relapse
6. Soft tissues & muscular factors
Teeth are encapsulated in all directions by a blanket of muscles. Muscle
imbalance at the end of the orthodontic therapy can result in reappearance of
the malocclusion.
 Causes of Relapse
7. Role of 3rd molar
The pressure exerted by the erupting 3rd molars in believed to cause late
anterior crowding predisposing to relapse.
 Causes of Relapse
8. Poor Patient Co-operation
If the bonded wire comes loose or breaks, the orthodontist must replace it
immediately. Meanwhile, the patient must wear the clear aligner 24 hours. If
the patient did not commend to take an appointment for replacement of the
fixed retainer then relapse will occur.
 Retention

Maintaining newly moved teeth in a position long enough to aid in stabilizing

correction.

Is the passive stage of orthodontic treatment or, the procedure of mechanical

maintenance of orthodontically improved relationship of the teeth until both
periodontal ligament and alveolar bone have been remodeled in function and
structure to meet the new demand.
 Retention
Classification of retention according to period
1) No Retention
2) Standard Retention
3) Prolonged Retention
4) Semi-permanent
5) Permanent
 Retention
Classification of retention
according to period
1) No Retention
❑ Some serial extraction cases.
❑ Cross bite cases:
• Anterior cross bite with adequate
bite.
• Posterior cross bite with adequate
cusp height and good bucco-lingual
axial inclination.
 Retention
Classification of retention according to period
2) Standard Retention
• Reorganization of the periodontal ligament occurs over a 3-to-4-month
period, whereas the gingival collagen-fiber network typically takes 4 to 6
months to remodel, and the elastic supracrestal fibers remain deviated for
more than 10 months
• A retention period of 6 months full time wear followed by 6 months
nights only has been recommended as a standard period of retention
 Retention
Classification of retention according to period
2) Standard Retention
• Nearly all dental problems need a standard period of retention
When teeth are carried into positions of balanced occlusion and soft tissue,
for example:
1. Class I non-extraction cases with increased overjet where the upper
anterior teeth are retroclined until controlled by the lower lip.
2. Class I and II extraction cases, finished with good occlusion.
 Retention
Classification of retention according to period
3) Prolonged Retention
This is needed in cases of Rotations, which tend to relapse by the elastic supra-
gingival fibers.
Almost one year is required for reorganization of elastic gingival fibers that tend
to recoil after removal causing relapse

The retention can be shortened by:

• Precision: (surgical cutting of supra gingival fibres)
• Over correction
 Retention
Classification of retention according to period
4) Semi-permanent retention
Skeletal Problems in Growing Child until Cessation of Growth
 Retention
Classification of retention according to period
5) Permanent retention
• Generalized diastemas with enlarged tongue
• Late teen crowding

Late teen crowding

Relapse of spacing
 Retention
Classification of retention according to mechanism
I. Removable
II. Fixed
 Retention
Classification of retention according to mechanism
I. Removable
1. Hawley’s retainer:
Used to be the most commonly used retainer
Components:
Acrylic base: supports all elements of the appliance.
Wire Component: Adam’s clasps: assures retention of the appliance.
Labial bow: provides anterior stabilization, controls the position of
incisors that aren’t meant to move, or the loops can be adjusted for
appliance activation. (Active retainer !)
 Retention
Classification of retention according to mechanism
I. Removable
1. Hawley’s retainer:
Advantages
• Can be used in most cases.
• Hygiene not an issue.
• Can be modified.
Disadvantages
• Susceptible to fracture
• Requires patient compliance.
• Visible labial bow.
• Interproximal wire may cause opening of spaces.
• High incidence of breakage and loss.
 Retention
Classification of retention according to mechanism
I. Removable (Hawley’s retainer modification )

Hawley’s retainer with long labial bow

• Simple modification to the original

appliance where the labial bow has U-
loops on premolar distal to canine.
• This modification allows closure of spaces
distal to canine.
 Retention
Classification of retention according to mechanism
I. Removable (Hawley’s retainer modification )

Hawley’s retainer with C-clasp

• Indicated in tight occlusal contacts

 Retention
Classification of retention according to mechanism
I. Removable (Hawley’s retainer modification )

Hawley’s retainer with contoured labial bow

• Labial bow is contoured to anterior teeth.

• Has better control over the anterior teeth.
 Retention
Classification of retention according to mechanism
I. Removable
2. Wrap around
• The labial bow extends distally posterior to the last
erupted molar to be embedded in the acrylic base plate.
• Ideal for cases where settling of occlusion is required,
especially in the posterior segments, as there is no wire
framework crossing the occlusion.

Advantage : There is no cross over wire that extends

between the canine and premolar thereby eliminating
the risk of space opening.
 Retention
Classification of retention according to mechanism
I. Removable
3. Essix retainer (vacuum or clear retainer)
• The most commonly used retainer nowadays
• Plastic removable appliance. Made of thin
thermoplastic sheets.
• Material fully covers the clinical crown and extends
partly on to the adjacent gingiva
Advantages
• Esthetic
• Well accepted by patients
• High strength
 Retention
Classification of retention according to mechanism
II. Fixed retainer
• Used in the situations where intra arch instability is
anticipated and “prolonged retention” is planned.
• They are generally cemented directly to the teeth.
Indications
• Maintaining lower incisor position.
• Following diastema closure.
• Pontic space maintenance
• Retaining closed extraction spaces.
• Prevention of rotational relapse
 Retention
Classification of retention according to mechanism
II. Fixed retainer

Advantages of Fixed Retainer:

• Do not affect speech.
• Better tolerated by patients
• Recall visits are reduced
• Reduced need for patient corporation
• Can be used when conventional retainers cannot provide same degree of stability.
• Bonded retainers are more esthetic
• No tissue irritation unlike what may been seen in tissue bearing areas of Hawley’s retainer
• Can be used for permanent and semi permanent retention.
 Retention
Classification of retention according to mechanism
II. Fixed retainer

Disadvantages of Fixed Retainers

• More cumbersome to insert
• Increased chair side time
• More expensive
• More prone to breakages
• May interfere with occlusion in deep bite cases
• May cause tooth movements if it wasn’t passive before bonding
• May interfere with oral Hygiene maintenance.
• Loss of healthy tooth material
 Retention
Classification of retention according to mechanism
II. Fixed retainer

Disadvantages of Fixed Retainers

• More cumbersome to insert
• Increased chair side time
• More expensive
• Banded variety may interfere with oral
• Hygiene maintenance.
• More prone to breakages
• Loss of healthy tooth material
 Retention
Classification of retention according to mechanism
II. Fixed retainer

canine to canine
Lateral to lateral
Central to central

Straight
Zig zag (allow easy flossing)
 Retention
Retention techniques
1) Percision- Circumferential Supracrestal-Fiberotomy
2) Placement of Teeth in Orofacial Soft Tissue Balance
3) Placement of Teeth in Occlusal Equilibrium
4) Orthodontic Overcorrection
5) Importance of Lower Incisor Position in Stability
6) Maintain Inter-canine & Inter-molar Distances
7) Adaptation of Bone and Adjacent Soft Tissues
 Retention
Retention techniques
1) Percision (Circumferential Supracrestal-Fiberotomy)
Relapse of severely rotated teeth due to rebound of elastic fibres in the Supera-crestal
tissues can be reduced by percision.
Circumferential Supracrestal-Fiberotomy (CSF) prevents orthodontic relapse. CSF is
performed immediately after removal of the orthodontic appliance.
 Retention
Retention techniques
2) Placement of Teeth in Orofacial Soft Tissue Balance
Proper alignment of the teeth so that they function in harmony with the jaw joints and
muscles will allow teeth to wear and function evenly, be stable, and decrease trauma to the
surrounding supporting bone.
 Retention
Retention techniques
3) Placement of Teeth in Occlusal Equilibrium
Obtaining proper occlusion is an important factor in maintaining corrected positions
It has been suggested that good interdigitation of teeth post-treatment may reduce the
likelihood of relapse and improve the stability of the final result of orthodontic treatment

Unstable occlusion Stable occlusion

 Retention
Retention techniques
4) Orthodontic Overcorrection
Overcorrection is especially likely to be needed for these types of movement:
a. Rotations (particularly single-rooted teeth whose roots have a circular cross-section)
b. Labial-lingual alignment (particularly of incisors)
c. Expansion
d. Extrusion (because the PDL tends to pull the tooth back into the socket)
 Retention
Retention techniques
5) Importance of Lower Incisor Position in Stability
More stable results are obtained when the mandibular incisors are either
upright or slightly retroclined over the basal bone.
 Retention
Retention techniques
6) Maintain Inter-canine & Inter-molar Distances

• Apical base is one of the most important factors

in both correction of malocclusion as well as
maintenance of correct occlusion.
• Increased inter canine or inter molar widths will
lead to improper bucco-lingual axial inclination
 Retention
Retention techniques
7) Adaptation of Bone and Adjacent Soft Tissues
Bone and adjacent tissues must be allowed to reorganize around newly
positioned teeth
Thank you