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RETENTION AND

RELAPSE

Dr. Ashwin Thejaswi. M

DEFINITON
RETENTION:
Maintaining newly moved teeth in
position, long enough to aid in stabilizing their
correction MOYERS

RELAPSE:
The loss of any correction achieved by
orthodontic treatment.

CAUSES OF RELAPSE

Periodontal ligament traction


Relapse due to growth related changes
Bone adaptation
Muscular factors
Failure to eliminate the original cause
Role of third molars
Role of occlusion

WHY RETENTION IS
NECESSARY?
1. The gingival and periodontal tissues are
affected by orthodontic tooth movement arc
require time for reorganization when the
appliances are removed.

2. The teeth may be in an inherently unstable


position after treatment, so that soft tissue
pressure constantly produces a relapse
tendency.

3. Changes produced by growth may alter the


orthodontic treatment result.

SCHOOLS OF RETENTION

The Occlusion Base KINGSLEY

The Apical Base ALEX LUNDSTROM, McCAULEY


& NANCE

The Mandibular Incisor School GRIEVES &


TWEED

The Musculature School ROGERS

THE OCCLUSION BASE


KINGSLEY

Proposes that proper occlusion is a key factor in


determining the stability of the newly moved teeth.

THE APICAL BASE

ALEX LUNDSTROM, McCAULEY & NANCE

ALEX LUNDSTROM suggested that the apical base is an


important factor in the correction of malocclusion and
maintenance of the stability of treated cases.

McCAULEY added that the intercanine and intermolar


widths should be maintained during orthodontic
therapy to minimize retention problems.

NANCE noted that the arch length cannot be


permanently increased to a major extent.

THE MANDIBULAR INCISOR SCHOOL


GRIEVES & TWEED

They suggested that post treatment stability was


increased when mandibular incisors were placed
upright or slightly retroclined over the basal bone.

THE MUSCULATURE SCHOOL


ROGERS

According to him functional muscle balance is


necessary in order to ensure post treatment stability.

THEORIES OF RETENTION
THEOREM 1 :

Teeth that have been moved tend to


return to their former position.

THEOREM 2

Elimination of the cause of malocclusion will prevent


relapse.

THEOREM 3:

Malocclusion should be over corrected as a safety


factor.

THEOREM 4:

Proper occlusion is a potent factor in holding teeth in


their corrected positions.

THEOREM 5:

Bone and adjacent tissues must be allowed time to


reorganize around newly positioned teeth.

THEOREM 6:

If the lower incisors are placed upright over basal


bone they are more likely to remain in good
alignment.

THEOREM 7:

Corrections carried out during periods of growth are


less likely to relapse

THEOREM 8:

The farther the teeth have been moved the lesser is


the risk of relapse.

THEOREM 9:

Arch form, particularly in the mandibular arch


cannot be permanently altered by appliance therapy

THEOREM 10:

Many treated malocclusions require permanent


retaining devices.

RAYLEIGHS 6 KEYS TO ELIMINATE


LOWER RETENTION
Incisal edges of the lower
incisors should be
placed on the AP line
or 1mm in front of it.

The lower incisor apices should be spread distally


to the crowns more than is generally considered
appropriate and the apices of the lower lateral
incisors must be spread more than those of the
central incisors.

Apex of lower cuspid should be


positioned distal of the crown

All four lower incisors apices must be in the


same labiolingual plane

The lower cuspid root apex must be positioned


slightly buccal to the crown apex.

The lower incisors should be


slenderized as needed after treatment

TYPES OF RETENTION
REIDEL

NATURAL RETENTION OR NO RETENTION

LIMITED RETENTION OR SHORT TERM RETENTION

PROLONGED RETENTION OR PERMANENT RETENTION

NATURAL OR NO RETENTION

Anterior cross bite

Serial extraction procedures

Blocked out or highly placed canines in Class I extraction


cases

Posterior cross bite in patients having steep cusps.

Corrections achieved by retardation of maxillary growth


once the patient has completed growth

LIMITED OR S

HORT TERM

RETENTION

Class I non extraction with dental arches showing


proclination and spacing

Deep bites

Class I, Class II div 1 and 2 cases treated by extraction.

Early corrections of rotated teeth to their normal


position before root completion

Cases involving ectopic eruption or supernumery teeth

Class II div 2 cases for muscle adaptation

PROLONGED OR PERMANENT
RETENTION

Midline diastema

Severe rotations

Arch expansion

Class II div 2 with deep bite cases

Patients exhibiting abnormal musculature or tongue habits

Expanded arches in cleft patients

RETAINERS

Passive Orthodontic appliances

Maintaining and stabilizing the position of teeth long


enough to permit reorganization of the supporting
structures after the active phase of orthodontic
therapy.

DEAL REQUIREMENTS OF RETENTION


APPLIANCE

It should restrain each tooth in its direction of


relapse

It should permit the forces associated with the


functional activity to act freely on the teeth,
permitting them to respond in as nearly a
physiologic manner as possible

It should be as self-cleansing as possible and should


be reasonable easy to maintain optimal hygiene

Should be as inconspicuous as possible, esthetically


good.

Strong enough to bear the rigors of day to day


usage.

EMOVABLE

ETAINERS

Hawleys appliance
With long labial bow
With contoured labial bow
Continuous labial bow soldered to clasps
With elastic replacing labial bow

Beggs retainer Single arrowhead partial wraparound retainer

Clipon retainer/spring aligner


Wrap around retainer
Kesling tooth positioner
Invisible retainers

HAWLEYS A

PPLIANCE

The retainer consists of a labial extending from


canine to canine with retentive clasps on permanent
molars.

Good retention

Prevents anterior teeth from rotating or developing


gaps.

Prevents the opening up of extraction spaces.

Capable of closing minor spacing in the anterior


segment.

MODIFICATIONS OF HAWLEYS APPLIANCE:

BEGGS RETAINER

Labial wire that extends up to the last erupted


molars
Wire curves around the molar and get embedded in
acrylic that spans the palate.

EMOVABLE WRAP AROUND


RETAINER
This is the second most commonly used removable
retainer.

INDICATIONS:
Primarily when periodontal break down requires
splinting the teeth together.

Disadvantages over Hawleys :

1. Individual tooth movements are not allowed to


stimulate periodontal reorganization.

2. Less comfortable.

3. Not effective in maintaining overbite correction.

PRING RETAINER APPLIANCE:


It is a versatile appliance which can be used as ,

Anterior retainer in either arch.

Can be used as active appliance to re align incisors


(post relapse)

EMOVABLE PLASTIC HERBST RETAINER:


It has property of both single arch and dual

arch retainers

Components:

Upper and lower plastic splints connected on

each side by the telescoping Herbst mechanism.

OOTH POSITIONERS AS RETAINERS:


Tooth Positioners can be used as removable

retainers. They should be worn at least 4 hrs during


daytime and full night time wear.

Can be effective in maintaining occlusal


relationships and intra arch tooth positions.

E SSIX RETAINER
These are thermoplastic co
polyester vacuum formed retainers.

DVANTAGES:

Esthetic and absolute stability of anterior teeth

Less expensive, good durability, oral hygiene


maintenance.

Less bulk and thickness (0.015 inch).

RAWBACKS:

Cannot be used for expanded arches

Prolonged use can cause anterior open bite

Less durable when compared to Hawley retainer.

F IXED R

ETAINERS

CLASSIFICATION

Intracoronal

Fixed Appliance
Band and spur retainer
Direct contact splinting

Extracoronal
Canine to canine bonded/banded
Flexible spiral wire retainer
Mesh pad retainer

NDICATIONS

Maintenance of lower incisor position during late


mandibular growth.

Following closure of diastema.

Maintenance of bridge- pontic space.

Compromised periodontal conditions with the


potential for post orthodontic teeth migration.

Prevention of rotational relapse.

Prevention of relapse after the correction of palatally


erupted canines

Prevention of opening up of closed extraction space.

DVANTAGES

Reduced need for patient co-operation.

Can be used when conventional retainers cannot provide


same degree of stability.

Bonded retainers are more esthetic.

No tissue irritation.

Tolerated by patient

Do not affect speech.

DISADVANTAGES

More cumbersome to insert.

Increased chair side time

More expensive

Banded variety may interfere with oral hygiene


maintenance.

More prone to breakage.

FLEXIBLE SPIRAL WIRE RETAINERS

ADVANTAGES:

1. They may allow safe retention of treatment results


when proper retention is difficult or even impossible
with traditional retainers.

2. They allow slight movement of all bonded teeth


and segment of teeth

3. They are invisible, neat and clean and can be


placed without occlusal interference.

4. They can be used alone or in combination with


removable retainers.

ISADVANTAGES:

1. Good oral hygiene should be maintained.

2. Daily flossing should be recommended gingival to the wire.

3. Undesirable movement of bonded teeth may occur if the


wire is too thin or not passive while bonding.

4. Not indicated in deep bite cases where wire cannot be


placed out of occlusion

BANDED AND BONDED


CANINE TO CANINE RETAINERS

Banded -0.036/0.04 wire

Bonded -0.036 mesh on canine.

Bonded mesh throughout the length

REVENTION OF

Over rotation.

Prolonged retention.

ELAPSE

Treatment of rotated tooth should be performed at early age.

Placement of teeth in orofacial soft tissue balance.

Placement of teeth in occlusal equilibrium.

Pericision surgical resection of stretched fiber around gingival


socket margin (supra-alveolar fibers).

CONCLUSION

Retention is a part of orthodontic treatment.

The benefit of orthodontic treatment cannot be


appreciated without undergoing retention of the
moved teeth for a period of time.

Though many devices are available for retention of


orthodontically adjusted teeth, they must still be
tailor-made to suit each individual.

REFERENCES

Gurkeerat Singh A Textbook of Orthodontics

S M. Balaji Textbook of Orthodontics

Grabers Textbook of Orthodontics