June 10, 2002 - Retention

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June 10, 2002 - Retention

  1. 3. PRE-TREATMENT POST-TREATMENT RETENTION RELAPSE UNPREDICTABLE
  2. 4. RELAPSE FUNCTIONAL OPEN BITE SHORT UPPER LIP RELAPSE
  3. 5. PRE-ORTHO AFTER SERIAL EXT. RELAPSE POST-TREAMENT POST-RETENTION
  4. 8. THE ETIOLOGY OF LATE LOWER ARCH CROWDING RICHARDSON, ME. AJODO 1994 <ul><li>CROWDING IN ORTHODONTICALLY TREATED PATIENTS OVER TIME </li></ul><ul><li>ARCH LENGTH AND ARCH DEPTH DECREASE AFTER ERUPTION OF SECOND MOLARS……. LEADING TO CROWDING </li></ul><ul><li>CROWDING IN UNTREATED SUBJECTS BETWEEN 12-18-30 YEARS </li></ul><ul><li>NORMAL PHYSIOLOGIC PHENOMENON </li></ul><ul><li>(10 REFERENCES ) </li></ul>
  5. 9. GROWTH <ul><li>MANDIBLE > MAXILLA LATE MANDIBULAR GROWTH </li></ul><ul><li>BASAL BONE > ALVEOLAR BONE </li></ul><ul><li>MANDIBULAR ARCH CONTAINED BY MAXILLARY ARCH </li></ul><ul><li>GROWTH DIRECTION CLOSING ROTATION: MESIAL PATH OF ERUPTION OF POST. TEETH </li></ul><ul><li>OPENING ROTATION: RETROCLINATION OF INCISORS </li></ul>
  6. 10. GROWTH <ul><li>MUSCLE FORCES LIPS, CHEEKS, TONGUE </li></ul><ul><li>MESIALLY DIRECTED FORCES - PHYSIOLOGIC MESIAL DRIFT -ANT. COMPONANT OF FORCES OF OCCLUSION -THIRD MOLAR DEVELOPMENT </li></ul>
  7. 11. RETENTION PRIOR TO RETENTION THIRD MOLARS NORMAL DEVELOPMENT FEW YEARS POST-TREAMENT LOWER THIRD MOLARS HORIZONTAL IMPACTIONS
  8. 12. <ul><li>OBJECTIVES FOR RETENTION </li></ul><ul><li>Teeth tend to return toward pretreatment condition </li></ul><ul><li>Retain what has been achieved </li></ul><ul><li>Consider the three dimensions + ROTATIONS </li></ul>
  9. 13. <ul><li>MAXILLARY HAWLEY RETAINER </li></ul><ul><li>Palate = transverse+antero-posterior </li></ul><ul><li>Labial bow = overjet + alignment standard or circumferential </li></ul><ul><li>Anterior bite plane = overbite </li></ul><ul><li>Finger springs = rotations, spaces, lingual tipping </li></ul><ul><li>Clasps for retention of appliance -ball, Adams, interproximal, “C” clasp </li></ul><ul><li>Headgear for Class II to molar bands </li></ul>
  10. 14. RETAINERS <ul><li>MAXILLARY </li></ul><ul><li>CIRCUMFERENTIAL </li></ul><ul><li>HAWLEY RETAINER </li></ul><ul><li>MANDIBULAR </li></ul><ul><li>HAWLEY RETAINER </li></ul>MAXILLARY HAWLEY RETAINER
  11. 15. UPPER HAWLEY FINGER SPRINGS POST-TREATMENT SMALL LATERALS
  12. 16. MAXILLARY FRENUM MIDLINE DIASTEMA DEEP OVERBITE CLASS I MALOCCLUSION
  13. 17. FULL FIXED APPLIANCES POST-TREATMENT
  14. 18. SPLINTING/PERMANENT RETENTION 0.022 SPIRAL WIRE ALLOWS FOR PHYSIOLOGIC MOVEMENT OF ADJACENT TEETH
  15. 19. SPLINTING LONG-TERM CLASS III CASE POST-TREATMENT RELAPSE MIN. OVERJET+OVERBITE
  16. 20. MANDIBULAR RETAINERS HAWLEY RETAINER labial bow=space closure +alignment occlusal rests
  17. 21. FIXED BONDED 3-3 BONDING TECHNIQUE MANDIBULAR RETAINERS FIXED BONDED LINGUAL 3-3 0.030 BLUE ELGILOY OR 4-4 (OVERBITE/CURVE OF SPEE) <ul><li>INTERCANINE WIDTH </li></ul><ul><li>INCISOR MALALIGNMENT </li></ul><ul><li>THIRD MOLARS??? </li></ul><ul><li>LONG-TERM </li></ul><ul><li>HOLD AGAINST GROWTH </li></ul><ul><li>INCISOR UPRIGHTING </li></ul>
  18. 22. LOWER ESSIX RETAINER UPPER ESSIX RETAINER
  19. 23. POST-TREATMENT MISSING LATERALS ESSIX RETAINERS WITH ACRYLIC TEETH
  20. 24. IMPRESSIONS FOR TOOTH POSITIONER LAB SET-UP FOR TOOTH POSITIONER
  21. 25. RUBBER TOOTH POSITIONER
  22. 26. PRE-TREATMENT INCISOR ROTATION CIRCUMFERENTIAL SUPRA-CRESTAL FIBEROTOMY
  23. 27. KEYSTONING INTER-PROXIMAL STRIPPING
  24. 28. PRE-TREATMENT CROWDING AND ROTATIONS LAB. SET-UP FOR SPRING ALIGNER
  25. 29. SPRING ALIGNER IDEAL SET-UP INITIAL PLACEMENT
  26. 30. SCHEDULE MANAGEMENT DURING RETENTION <ul><li>LETTERS TO PATIENTS AND PARENTS </li></ul><ul><li>LETTER TO DENTIST-explain plan and request help in monitoring fixed lingual retainer. </li></ul><ul><li>L </li></ul>
  27. 31. SCHEDULE MANAGEMENT DURING RETENTION <ul><li>PLACE RETAINERS </li></ul><ul><li>6-8 WEEK RECALL </li></ul><ul><li>4 MONTH FOLLOW-UP </li></ul><ul><li>6-8 MONTHS FOLLOW-UP </li></ul><ul><li>ONE YEAR LATER </li></ul><ul><li>AFTER 2 YEARS AS NEEDED </li></ul><ul><li>NO RECALLS-letter to patient and dentist </li></ul><ul><li>FEES ??? </li></ul>
  28. 32. FIXED BONDED RETAINER AFTER 8 YEARS <ul><li>REMOVAL OF FIXED LINGUAL RETAINER </li></ul><ul><li>CONSIDER LOWER HAWLEY/ESSIX WHILE </li></ul><ul><li>SLEEPING </li></ul><ul><li>RELAPSE MAY NEED TO BE MANAGED </li></ul><ul><li>LONG-TERM </li></ul>
  29. 33. CLASS I MALOCCLUSION INCREASED OVERBITE SMALL UL LATERAL CONGENITALLY ABSENT UPPER RIGHT LATERAL
  30. 34. POST-TREATMENT
  31. 35. ACID ETCH BRIDGE UPPER RIGHT LATERAL BONDING BUILD-UP LEFT LATERAL INCISOR

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