Neethu Salam Final yr(Part 1)

Retention and Relapse

Moyer defined retention as maintaining newly moved

teeth in position,long enough to aid in stabilising their correction. Relapse has been defined as the loss of any correction achieved by orthodontic treatment.

Need for retention:

Gingival and periodontal tissue require time post-

treatment to reorganize
Soft tissue pressures are likely to cause relapse if teeth

are placed in an unstable position

Growth post-treatment may cause relapse

Timing of Tissue Reorganization

Once teeth are able to move individually from one another

during mastication, reorganization of tissues can begin:

PDL: 3-4 months Collagenous gingival fibers: 4-6 months Elastic supracrestal fibers: 1 year

In cases of severe initial rotations: supracrestal fibrotomies

are recommended at or just before appliance removal to prevent relapse

Principles of Retention
Relapse potential may be predicted by evaluation of initial

occlusion; teeth usually want to return to their original position; this is due to gingival fibers and unbalanced liptongue forces
Full-time retention is required for 3-4 months to allow for

reorganization of PDL
Retention should continue for at least 12 months in non-

growing patients or until growth has ceased in growing patients

Theories of retention
Riedel has discussed a number of popular explanations of

retention and relapse and the available clinical research evidence about them.He has summerised the different philosophies and concepts into nine theories.The tenth theory added by Moyers as an extention to the existing theories.

Theorem 1
Corrected teeth tend to return to their original position

Due to musculature, apical bases, transseptal fibers, and bone morphology Teeth should be held in corrected positions for an extended period of time to prevent relapse

Theorem 2
Elimination of the cause of malocclusion will prevent

relapse

Eg: in cases of abnormal habits such as thumb sucking,tongue thrusting.etc.

Tongue posture

It has been stated that even after successfully completing tongue therapy/exercises correction is not guaranteed

Nasopharyngeal obstruction mouth breathing open bite In a study by Gavito et al., patients who initially started with an open bite where evaluated 10 years following retention 35% had an open bite 3 mm or more.

Theorem 3
Overcorrection is recommended in malocclusions

Class II edge to edge

Deep bite cases

Rotated teeth
Less chance of relapse if there has never been a rotation; should create enough space initially for tooth to erupt into Transseptal fibrotomy is also recommended in severe cases

Theorem 4
Obtaining proper occlusion is an important factor in maintaining corrected positions

Overfunction of maxillary canines on mandibular canines can cause relapse in the lower incisor area No movement is seen from regular grinding

Movement may occur if there is destruction of bone or a build up of fibrous tissue (difficult to maintain tooth position)

Theorem 5
Reorganization of bone and adjacent tissues is required around newly positioned teeth

Use a fixed or rigid appliance or an appliance the is inhibitory and not tooth dependent

Theorem 6
Lower incisors are more likely to remain in good alignment if positioned upright over basal bone

Perpendicular to mandibular plane In terms of stability, it is better to place too much lingual inclination rather than too much labial inclination
Labial inclination is more likely to collapse due to lip pressure

Pretreatment lower incisor proclination is associated with less long-term crowding; this is thought to be due to weaker labial muscular forces

Theorem 7
Corrections carried out during periods of growth are less likely to relapse
Litowitz found that patients which exhibited the most growth during treatment demonstrated less relapse Post-treatment growth (esp. mandibular growth) will cause secondary crowding due to lower incisor retroclination

Theorem 8
The farther a tooth is moved, the less likely it is to relapse

As a tooth moves farther from its original position an equilibrium is formed producing a more ideal occlusion Little evidence to support this statement

May actually case damage (root resorption)

Theorem 9
Appliance therapy cannot permanently alter arch form (esp. in lower arch)

Should maintain the initial archform, as it will tend to return to its pretreatment shape Strang stated: The width as measured across from one canine to another in the mandibular denture is an accurate index to the mandibular balance inherent to the individual and dictates the limits of the denture expansion in this area of treatment

 Lower Incisors: Were found to be stable if proclination occurred in deep bite cases or if digit/lip habit was the cause of retroclined incisors

Proclination was found to be stable if the initial cause for the retroclination is eliminated during treatment

 Expansion: Has been shown to be more stable (intercanine) in Class II Div II than Class I or Class II Div I

This theory was refuted by Little et al who stated that intercanine and intermolar expansion will relapse in Class II Div II RPE followed by edgewise system showed good stability of upper intercanine width and upper and lower intermolar width, but poor lower intercanine maintance 8 years post-retention

Theorem 10
Many treated malocclusions require permanent retaining devices
This was added by Moyers This is true for certain malocclusions.

References
Profitt, Contemp. Ortho, 2007 Graber, Orthodontics, 2005 Gowri Shankar,Text book of orthodontics

Thank You