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contents
Introduction
Need for retention
History
Theorems
6 keys
Relapse
-Dental
-Functional
-Skeletal
Retainers
treatment results.
Differential Jaw
Growth
Intra-Arch
Irregularity
Changes in
Occlusal
Relationship
HISTORY
No mention of retention appliance or need for
HISTORY
Brown-Mason (1872)
HISTORY
Victor Hugo Jackson- 1904
step-child
HISTORY
1900 Edward H Angle
"normal
relapse .
Cutting gingival fibers to counteract
rotations.
In doubtful cases, wearing delicate and
efficient appliances indefinitely.
Pin and tube appliance. (working retainer)uprighting teeth that have been tipped
outward during expansion
HISTORY
1920 AJO- Calvin Case
"Principles of Retention in Orthdontia"
HISTORY
HISTORY
1919- Hawley
HISTORY
Retention time
Ferrar 1831 - 1913
when the teeth are fully regulated they should be
retained in position for a year, perhaps longer
George Grieves 1944
When teeth upright over basal bone- stable- no need for
retention
Tweed
Placed teeth upright over basal bone- 5yrs retention or
even longer when needed
HISTORY
Clinicians did not agree about the need for
retention
Hellman : We are in almost complete
ignorance of the specific factors causing
relapse
Difference philosophies/schools of thought
Present day concept = combination
Kingsley (1880)
Bonwill (1887)
Baker anchorage (1893)
Hawley (1919)
Dewey (1942)
Lundstrom (1925)
McCauley (1944)
Intercanine and intermolar width should be
maintained as originally presented to minimize
retention problems
Nance (1947)
arch length may be permanently increased only to
a limited extent
Failures in retention
Failure
axial inclinations.
Failure to manage rotations- over rotation
Tooth size disharmony- interproximal grinding
affecting retention
9 Theorems
Classified retention according to the
requirements of various types of cases.
Theorem - 1
Teeth that have been moved tend to
return to their former positions.
Reasons :
Musculature
Apical base
Transseptal fibers
Bone morphology
General agreement over holding teeth in their corrected
positions
Theorem - 2
Elimination of the cause of
Malocclusion will prevent recurrence.
Habits, Tongue posture, mouth breathing
Theorem - 3
Malocclusion should be
overcorrected as a safety factor
Class II: edge-to-edge
Class III
Open bite
Deep bite
Expansion
Rotations- provide space for eruption, surgical
intervention
Theorem - 4
Proper occlusion is a potent factor in
holding teeth in their corrected
positions.
Maintain health of the periodontium.
Functional occlusion.
Parker (1965)- Opposing forces no role to play in
lower arch crowding.
Theorem - 5
Bone and adjacent tissues must be allowed
time to reorganize around newly positioned
teeth
Fixed retention
No positive fixation- allow natural functioning
Theorem - 6
If the lower incisors are placed
upright over basal bone, they are
more likely to remain in good
alignment.
Better
Raleigh Williams
Several steps during fixed appliance Tx to
20 yrs postretention
6 treatment keys
KEY 1
Incisal edge of lower incisor should be placed on
A-P line or 1mm in front of it. optimum
Angulation not relavent
KEY 1
KEY 2
The lower incisor apices
should be spread distally
to the crowns
The apices of lateral
KEY 3
The apex of the lower cuspid should be
positioned distal to the crown.
Occlusal plane- positioning guide
KEY 4
All four lower incisor apices must be in the same
labiolingual plane
Contact point moves upward
Provision for additional space
Use of uprighting springs
KEY 5
The lower cuspid root apex must be positioned
slightly buccal to the crown apex.
KEY 6
The lower incisors should be slenderized as
needed after treatment
2 sources of post Tx pressure
1. Molars
2. Tooth-jaw discrepancy
Theorem - 7
Corrections carried out during
periods of growth are less likely to
relapse.
Early treatment
Importance of diagnosis and Rx planning.
Interception prior to compensations.
To attain proper muscle balance
Theorem - 8
The further teeth have been moved,
the less likelihood there is of relapse.
Questionable
Theorem - 9
Arch form, particularly in the
mandibular arch, cannot be
permanently altered by appliance
therapy.
Mc Cauley Since molar width and canine width
are of such an uncompromising nature, one
might establish them as fixed quantities and
build the arches around them
RELAPSE
Dental
Skeletal
Functional
Surgical
Mx forward
Mx asymetry
Mx up+mn forward
Mx frward
Mn back
Mn back
Mn down
Untreated normal:
Bishara et al (1989AJO and 1996 AO):
Evaluated changes in lower incisor between 12 and 25 years and
Similar findings by
Lundstrom (1968)
Sinclair and Little (1983 AJO):Little et al (1981AJO)
observed that 90% of extraction cases that were well
treated orthodontically ended up with an unacceptable
lower incisor crowding.
RETAINERS
Retainer- An appliance used to hold teeth in
position after orthodontic treatment.