Retention and stability

Retention is the phase of orthodontic tr eatment,

which maintains the teeth in their orthodontically
corrected positions following the cessation of active orthodontic,
tooth movement.

Orthodontic retainer resists the tendency of teeth to return to their

soft ،original position under the influence of periodontal, occlusal
tissue forces and continuing dentofacial growth.
The main factors responsible for stability:

1- Soft tissue
2- Occlusal features
3- Growth
4- Periodontal & gingival factors
(supporting tissue)

Dont surprise your patient with a

life time retention at the end of the treatment,
-he'll not be happy
Relapse: is recurrence "complete or partial"
following correction of
malocclusion features.
 ;Relapse could be due either
1) Orthodontic TTT itsel:
either proper or improper TTT like(diastema/rotation)
so that the original features are coming back.

2) normal age related changes:

it's related to normal age changes "maturational",

.growth & soft tissues
Starting with the first factor;
1- Soft tissues: teeth lie in a zone of balance between the lips/cheeks
&
tongue,
usually the balance is in favor of the tongue & the stability factor is
the
periodontal tissue (supporting tissue); having
healthy periodontal tissue will
cause the balance between these
2 forces –lips /cheeks & tongue-, that's why
it's wise not to interfere changing the balance between these 2
forces.
a)The incisors in the LLS lie in a very narrow zone between
,the lips & tongue
any change -proclination or over retoclination- will be
."unstable "usually
Lower labial segment (LLS) alignment, b) Arch width (AW) & c) Overjet;
b) The same thing for the arch width (AW); increasing the lower
AW-
especially the intercanine width- is highly unstable,that's why in
orthodontic
TTT we try to maintain the lower AW, we can expand the upper as
it's more
stable, so we try to build up the upper arch according to the
current lower
intercanine width available.
c) The overjet stability; it depends on the lower lip controlling
the upper
incisors, if the lower lip is not controlling the upper incisors at
the end of the
TTT, it won't be stable, so one of the important factors of the
overjet stability is
that the lower lip is competent & covering/controlling the incisal
1/3 of the upper.
 ;The second factor is
2- Occlusal factor; occlusion stability in correcting class 3 or
crossbites
(anterior/posterior) in the short term will depend on proper
overbite between
upper & lower incisors & the intercuspation of molars, if we
don’t have
enough overbite at the end of the TTT, it won't be stable &
also if we don’t
have proper intercuspation of posterior teeth –having
attrition or erosion-, it
won't be stable as well.
occlusal anteriorly directed component of
.the dentition forces lead to mesial migration of
The third factor is;
3- Growth: you should know that rapid growth declines after
puberty, but
there's continued growth throughout life & it's very small
undetected change–
it's continuous-
example; stability of class 3 in the long run depends on
mandibular growth, if
we corrected class 3 & after a couple of years it relapsed, it's
related to
continued mandibular growth " it doesn’t depend on the
overbite."
Late lower incisor crowding is multifactorial & one of its factors is the
continued growth of the mandible –more than maxilla-
& we'll end up with
the late lower incisor crowding, which starts at late teens to 20's.
7 8
after 5 y

17
Reaching the last factor:
4- Supporting tissues: healthy gingival & periodontium is very
important for
stability;
-Alveolar bone remodels within 1 month
-Principal fibers within PDL take3-4 months.
-Collagen fibers in gingival take about 4-6 months –as we go
more toward the
gingival, more time is needed to remodel & more problems
arise.-
Elastic fibers as supracrestal gingival fibers are highly unstable & take
232
days( 7-8 months) –these are our biggest problem-, they are important
especially in rotations, they tend to recoil "like rubber", so we align
teeth
during the time of retention & if we don't stabilize them they tend to
bring teeth back.
 ‪Duration of retention:

Group I –No‪retention
Period‪of‪retention:‪Not‪applicable
Indications:
1- Anterior‪and‪posterior‪cross‪bite
2- ‪Treatment‪after‪extraction‪or‪serial‪extraction
3- Highly‪placed‪canine
4- ‪Impacted‪mandibular‪2nd‪premolar
Group II- Limited‪retention
Period‪of‪retention
Three‪to‪six‪(3-6)‪months.‪First‪3‪months‪full‪time‪retention,‪
and‪next‪3‪
months‪only‪at‪night
Indications:
1- Class‪I proclination‪and‪spacing‪of‪maxillary‪incisor
2- ‪Class I and‪Class II extraction‪cases
3- Corrected‪deepbite‪cases
4- ‪Class II division‪2‪cases
Group IV- Permanent‪retention‪
Period‪of‪retention:‪Lifelong
Indications:
1- ‪Severe‪rotation
2- ‪Midline‪diastema
3- ‪Cleft‪palate‪cases
4- ‪Generalized‪spacing