A descriptive presentation highlighting the challenges orthodontics face in the management of relapse and effective management strategies to assist retention after orthodontic treatment

1. RETENTION AND RELAPSE IN
ORTHODONTICS
DR BIMMA NWEZE

2. OUTLINE
◼ INTRODUCTION
◼ TERMINOLOGIES
◼ HISTORY
◼ THEORIES OF RETENTION
◼ AETIOLOGY OF RELAPSE
◼ FACTORS AFFECTING PLANNING FOR RETENTION
◼ CONCLUSION
◼ REFERENCES

3. INTRODUCTION
◼ Within the realm of orthodontics, one of the most intricate phases lies in
preserving the corrections accomplished during the course of orthodontic
treatment.
◼ The achievement of aesthetics and functional occlusion should not mark the
end of orthodontic intervention.
◼ Stability can only be achieved if the forces derived from the periodontal and
gingival tissues,the orofacial soft tissues ,the occlusal forces and post
treatment facial growth are in equilibrium.
◼ Finalization of treatment should involve active stabilization and passive
guidance problems.
◼ Meticulous planning and implementation of an effective retention strategy is
critical to ensuring success of orthodontic treatment.

4. TERMINOLOGIES
◼ RETENTION
➢ Moyers defined retention as maintaining newly moved teeth in a position long enough to aid in the
stabilizing correction
➢ It is describes the method of minimizing or preventing relapse
◼ RELAPSE
➢ Loss of any correction achieved by orthodontic treatment (Moyers)
➢ It simply is the loss of stability of orthodontic results and therefore any change from final tooth position
at the end of treatment

5. HISTORY/SCHOOL OF THOUGHT
◼ OCCLUSAL SCHOOL : Proper occlusion is a key factor in determining stability of newly moved teeth.
◼ APICAL BASE SCHOOL :
➢ Apical base is an important factor in the correction of malocclusion and maintenance of stability of
already treated cases (Lundstrom)
➢ Inter-canine and Intermolar widths should be maintained during orthodontic treatment to minimize
retention problems (McCauley)
➢ Arch length cannot be permanently increased to a major extent (Nance)
◼ MANDIBULAR INCISOR SCHOOL : Grieves and Tweed suggested that post treatment stability increased
when mandibular incisors were placed upright or slightly retroclined over the basal bone.
◼ MUSCULATURE SCHOOL: Rojers postulated that functional muscle balance is necessary in order to
ensure post treatment stability.

6. 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 overcorrected as a safety factor
◼ Theorem 4
Proper occlusion is a potent factor in holding teeth in their corrected positions

7. ◼ Theorem 5
Bone adjacent to the tissue must be allowed time to reorganize around newly positioned
teeth
◼ Theorem 6
If the lower incisors are placed upright over the 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

8. ◼ Theorem 8
The farther the teeth have been moved the lesser the risk of relapse
◼ Theorem 9
Arch form particularly the mandibular arch cannot be permanently altered by
appliance therapy
◼ Theorem 10
Many malocclusion requires permanent retaining device model

9. LOWER INCISOR RETENTION
◼ Raleigh Williams proposed six keys to eliminate lower incisor retention
◼ KEY 1 : The incisal edge of the lower incisor should be placed on the A-Pog line
or 1mm in front of it
◼ KEY 2 : The lower incisor apices should be spread distally to the crown and the
lower lateral incisors must be spread more than those of the central incisors
◼ KEY 3 : The apex of the lower cuspid should be positioned distal to the crown
◼ KEY 4 : All four incisor apices must be in the same labiolingual plane
◼ KEY 5 : The cuspid root apex must be positioned slightly buccal to the crown
apex
◼ KEY 6 : Flattening lower incisor contact points by slenderizing or stripping
creates flat contact surfaces which help resist labiolingual crown displacement.

10. KEY 1
◼ The incisal edge should be
placed on the A-P line or 1mm
in front of it. This is because the
position serves as the optimum
location to ensure lower incisor
stability. It also creates
optimum balance of soft tissues
in the lower third of the face for
all variations in apical bsse
differences within the normal
range

11. KEY 2
◼ The lower incisor apices should be spread
distally and the lower lateral incisors must be
spread more than those of the central incisors
◼ When the lower incisor roots are left
convergent or even parallel the crowns tend
to bunch up and a fixed lower retainer is
needed to prevent post-treatment relapse
◼ The Begg technique has been found to be
more effective in achieving the necessary
progressive spreading

12. KEY 3
◼ The apex of the lower cuspid should be
positioned distal to the crown
◼ Angulation of the lower cuspid is
important in creating post-treatment
incisor stability
◼ This is because it reduces the tendency
of the cuspid crown to tip forward into
the incisor area
◼ If this happens the lower incisor crowd
up even if the roots are spread and the
incisal edges are on the A-P line or in
front of it

13. KEY 4
◼ All four incisor apices must be in the same
labiolingual plane
◼ Spreading the apices of the lower incisor
roots distally causes a strong reciprocal
tendency for the crowns to move mesially
◼ Strong mesial pressure on the crowns during
the root spreading process causes a
tendency for the contact points to displace
each other labiolingually
◼ This causes a reverse movement of the
apices linguolabially

14. KEY 5
◼ The cuspid root apex must be positioned slightly buccal
to the crown apex
◼ There is a natural tendency for the crown of the cuspid
to upright over its root apex
◼ Occlusal forces await their chance to exert lingual forces
on the lower cuspid crown
◼ If at the end of treatment the forces of occlusion can
more easily move the crown to the space reserved for
the lower incisors because of a functional pressure

15. KEY 6
◼ Flattening lower incisor contact points by slenderizing or stripping
creates flat contact surfaces which help resist labiolingual crown
displacement.
◼ The slightest amount of continuous mesial pressure can cause various
degrees of collapse in the lower incisor segment
◼ Post-treatment pressure on the lower incisors from the molars can
cause displacement of lower incisor contact points

16. AETIOLOGY
The etiology of relapse is complex and unclear. Several factors have been
found to compromise the stability of orthodontic results. They include
◼ ROLE OF SUPPORTING TISSUES
◼ SOFT TISSUE FACTORS
◼ OCCLUSAL FACTORS
◼ FACIAL GROWTH AND OCCLUSAL DEVELOPMENT

18. SUPPORTING TISSUES
◼ The supporting periodontal and gingival tissues as well as the alveolar bone are involved during
orthodontic tooth movement.
◼ Forces applied to these structures cause widening of the periodontal space and disruption of
collagen fibers.
◼ Time is therefore required to allow for reorganization of these structures following treatment
◼ Timelines have been suggested which indicate the duration each structure requires to
remodel.Although variation exists within individuals
◼ Alveolar bone usually remodels within 3-4 months
◼ Gingival collagen and principal collagen fibers usually take as much as 6 months
◼ Greater than 232 days are needed for the formation of transseptal and free gingival elastic fibers
whose attachment to the dental arch is influenced by tooth position and direction throughout
fiber development.

20. SOFT TISSUE FACTORS
◼ Normal function and balance of orofacial musculatures are very important in facial balance and
occlusal stability after orthodontic treatment.
◼ The neutral zone is a zone of equality between centripetal and centrifugal forces
◼ Lying in a neutral zone of soft tissue balance between the lips,cheeks and tongue. The
maintenance of tooth position is conditional on the response of an intact periodontium to resist
lingual than labial forces.
◼ Orthodontic treatment should aim for teeth position within a narrow zone. Placing the teeth in a
markedly labial or lingual position increases risk of relapse
◼ SIGNIFICANCE
➢ Muscle aberration may be expected in Class II and Class III muscular malocclusion, Skeletal deep
bite, Presence of abnormal habits
➢ Use of exercise training program to strengthen muscles of mastication and facial muscles to aid
in treatment as well as retention.

21. OCCLUSAL FACTORS
◼ TOOTH SIZE DISCREPANCY
◼ AXIAL INCLINATION
◼ TRANSVERSE DISCREPANCY
◼ THIRD MOLARS

22. NEED FOR RETENTION
1. Gingival and periodontal tissues require time post-
treatment to reorganize
2. Soft tissue pressures are likely to cause relapse if teeth are
placed in an unstable position
3. Growth post-treatment may cause relapse

23. MEASUREMENT OF RELAPSE
◼ Clinical assessment
◼ Orthodontic indices e.g PAR or Little index
◼ Study model
◼ Clinical photographs
◼ Cephalometric analysis

24. FACTORS AFFECTING PLANNING FOR RETENTION
◼ INFORMED CONSENT
◼ AGE OF PATIENT
◼ ORIGINAL MALOCCLUSION
◼ GROWTH PATTERN OF THE PATIENT
◼ TYPE OF TREATMENT PERFORMED
◼ TYPE OF RETAINER
◼ NEED FOR ADJUNCTIVE PROCEDURES TO ENHANCE STABILITY
◼ DURATION OF RETENTION

25. INFORMED CONSENT
◼ROLE OF THE
ORTHODONTIST
◼ROLE OF THE PATIENT

26. AGE OF THE PATIENT
◼Normal physiological may be confused with relapse in a pt who
earlier received orthodontic treatment
◼Increasing age of patient usually presents with slow tissue remodeling
and soft tissue age related changes
◼Normal maturation changes include decrease in arch length after
adolescence, static or reduced intermolar width after 13 years, small
decrease in overbite and overjet
◼This may indicate permanent retention to avoid relapse
◼Also patients who present with minimum to moderate periodontal
disease may require permanent retention

27. ORIGINAL MALOCCLUSION
◼ INCISOR RELATIONSHIP : High risk of relapse in class II division II
◼ LOWER INCISOR IRREGULARITY : Prolonged retention of the lower labial segment
until the end of facial growth reduces severity of lower incisor crowding
◼ GENERALIZED SPACING : Highly prone to relapse and needs permanent retention.
◼ ANTERIOR CROSSBITE : Retention is naturally due to increased overbite
◼ ANTERIOR OPEN BITE : Extractions improve stability, Incorporation of posterior bite
planes in pts with unfavourable growth pattern
◼ POSTERIOR CROSS BITE : Highly prone to relapse. Posterior intercuspation,Further
stabilization using slight expansion by archwire,at least 3months retainer appliance
therapy
◼ ROTATIONS : Overcorrection,Early correction to allow formation of new fibers,Pericision

28. GROWTH PATTERN OF THE PATIENT
◼Facial growth continues throughout life generally in the same direction as
occurring in adolescence but to a smaller degree
◼Retention of skeletally corrected problems should be carried until cessation
of growth
◼The following devices may be used
➢Class II skeletal discrepancy : modified activator appliance, head gear or
upper removeable appliance with inclined bite plane
➢Class III skeletal discrepancy : Frankel III, chin cap
➢Deep bite : Anterior bite plane

29. OCCLUSION AT THE END OF TREATMENT
◼Occlusion plays a role in retention and stability
◼Good occlusal relationship aids in providing
favourable dentoalveolar compensation
◼Well interdigitated Class I occlusion aids in stability
◼Cases such as Correction an anterior cross bite with
a positive overbite requires no retention

30. METHODS OF RETENTION
◼ FUNCTIONAL
Oral muscle exercise plays a role in maintaining tooth position e.g Lip exercise
Activator may also be used as a functional retainer
◼ NATURAL
Here, proper inter-cuspation and proper incisor relationship will prevent relapse in
corrected cross-bite.
◼ APPLIANCE THERAPY
Use of retainers.

31. RETAINERS
◼ Retainers are orthodontic appliances which passively
maintain and stabilize tooth position achieved by
orthodontic treatment.
◼ Factors affecting choice of retainers include but are not
limited to
1. Type of malocclusion
2. Esthetic need of patient
3. Cost effectiveness
4. Patient co-operation
5. Duration of retention
6. Oral hygiene of the patient

32. IDEAL REQUIREMENTS OF A RETAINER
❖ It should restrain each tooth in its desired position against the direction of
relapse movements.
❖ It should permit the functional forces to act freely upon the retained teeth
permitting them to respond in physiologic manner as possible
❖ Easily constructed and tolerated by the patient
❖ Strong and durable enough to achieve its objective over a period of time
❖ Self cleansing and can provide good oral hygiene
❖ Esthetically pleasant.

33. CLASSIFICATION OF RETAINERS
◼ ACCORDING TO THEIR FORCE APPLICATION
➢ Active retainers : Ni-Ti retainers, Positioners
➢ Passive retainers
◼ ACCORDING TO THEIR USABILITY BY THE PATIENT
➢ Removeable retainers : Hawley’s retainer, Begg’s wraparound retainer, Removeable canine to canine,
Removeable molar to molar metal retainers,Positioners,Essix retainers.
➢ Fixed retainers : Ling lock retainers, Glass fiber reinforced retainer, V-loop design, Multi stranded stainless steel
wire
◼ ACCORDING TO THEIR VISIBILITY
➢ Visible retainers : these retainers have a labial wire component. They include Hawley’s retainer, Begg’s retainer,
Spring retainer, removeable canine to canine, removeable molar to molar metal retainers.

34. ➢ Invisible Retainers : These retainers possess a lingual wire placement or are made from
transparent thermoplastic sheets. They include : Thermoplastic vacuum-formed retainer,V-
loop design, Ling lock retainers, Glass fiber reinforced retainers.
◼ ACCORDING TO THEIR GENERATIONS
➢ First generation: Plain round 0.032-0.036blue elgiloy wire with terminal loop
➢ Second generation: Same as first generation without terminal loop
➢ Third generation : Easier to place and conforms more closely
◼ ACCORDING TO THEIR METHOD OF FABRICATION
➢ Pre-formed
➢ Custom made

35. ◼ ACCORDING TO ADJUNCTIVE RETENTION PROCEDURES
➢Pericision
➢Frenectomy
➢Interproximal reduction

36. HAWLEY’S RETAINER
◼ First designed by Charles Hawley in 1920
◼ It is one of the most commonly used retainer

37. ◼ DESIGN
1. Labial bow
2. Adam’s crib
3. Palatal baseplate (which may be full coverage or horse shoe design
ADVANTAGES
• Facilitates proper occlusal settling
• Armamentarium for fabrication is easily available
• It can be adjusted according to clinical condition for finished treatments
• Can be removed for cleaningasily repairable when component parts are broken.
• Durable
• Patient compliance is notably better with Hawley retainer because of its reduced bulk

38. ◼DISADVANTAGES
1. Success of the treatment depends on patient compliance
2. Display of labial wire is unaesthetic which affects patient satisfaction
3. Higher evidence of breakage than loss
4. First few weeks,Patients experience interference in speech articulation
5. It may not hold the corrected labial segments in the upper and lower
arch for a larger period of time due to insufficient contact surfaces
leading to relapse and incisior crowding.

39. MODIFICATIONS
◼ Hawley’s retainer can be
modified according to the
clinical requirement for
retention. It is therefore
important to select the
appropriate clasp design as
clasp crossing the occlusal table
can disrupt tooth relationship
1. HAWLEY’S RETAINER WITH
ANTERIOR BITE PLANE : This
addition controls bite depth
such as cases of reduction of a
corrected deep over bite.

40. ◼ HAWLEY’S WITH LONG LABIAL
BOW
Incorporation of labial bow from
premolar to premolar rather than
from canine to canine
USE: Space closure distal to the
canine

41. ◼ HAWLEY’S WITH C-CLASP
ON SECOND MOLARS
DISTALLY
It avoids risk of space opening
due to decreased interference
with cross over wire

42. ◼ HAWLEY'S RETAINER WITH
REVERSE U LOOPS
This provides better control of
the canines

43. ◼ HAWLEY’S WITH FITTED LABIAL BOW
Fitted labial bow anteriorly and base
plate posteriorly
USE : Better control of the incisors

44. ◼ HAWLEY’S WITH FINGER/Z-SPRING
Incorporation of finger/Z-springs makes
it an active appliance used to achieve
minor tipping movement

45. THERMOPLASTIC VACUUM FORMED RETAINER
◼ It is also called Essix retainer
◼ Fabricated from a variety of thickness of
polyvinylchloride sheets by heating to
475 degrees and vacuum pressure of 1.5
b for 50 seconds
◼ DESIGN: Full coverage of all the teeth
generally extending across the terminal
tooth. The most posterior tooth must be
at least half covered to prevent
supraeruption

46. ◼ ADVANTAGES
1. An aesthetic appliance
2. Easy to construct
3. Cheap
4. Improved patient compliance
5. Better incisor alignment control than the Hawley retainer
6. It permits modifications such as temporary addition of a
pontic or wire placement in the palatal side in expansion
cases
◼ DISADVANTAGES
1. Less settling of occlusion
2. Risk of de calcification in the presence of retainer acting
as a resolver
3. Ineffective in retaining intrusion or extrusion movement
4. Partial VFR may cause open bite due to over eruption of
teeth

47. POSITIONER’S ‘ACTIVE’ RETAINER
◼ Developed by HD Kesling in 1945
◼ It is an elastomeric or rubber removeable
retainer
◼ It may be pre-formed or custom made
◼ DESIGN
1. Thermoplastic rubber material with no wire
components
2. Covering of the clinical crown of the maxillary
and mandibular teeth although it spares the
inter-occlusal space and small portion of the
gingiva

48. ◼ ADVANTAGES
1. It may provide further minor correction and thus guide in the
settling of occlusion
2. Useful when desired finish is not achieved because the case had to
be discontinued early
3. Durable as it is unlikely to break
4. Needs no activation at regular intervals
◼ DISADVANTAGES
1. Expensive
2. Used for finishing stages of treatment
3. Does not make a good retainer because of the pattern of wear
differs from retainers
4. Need for replacement by other forms of retainers after achieving
final teeth alignment
5. Lack of patient compliance and acceptance
6. Associated risk of TMJ problems

49. BEGG’S RETAINER
◼Introduced by P.R BEGG
◼Circumferential retainer
◼DESIGN : A labial wire that extends
till the last erupted molar and curves
around it to get embedded in acrylic
that spans the palate
◼MODIFICATION : Begg’s retainer with
incorporated delta clasp.

50. ◼ ADVANTAGE :
➢It has no clasps and therefore no cross over wire between the canine and premolar
thereby eliminating the risk of space opening
➢Incorporation of bite plane to maintain overbite reduction
➢Temporary addition of an acrylic tooth to replace a missing tooth
➢Maintain lateral expansion
◼ DISADVANTAGE
➢Less aesthetic due to labial bow
➢Speech interference may occur due to palatal coverage
➢Less retentive than Hawley

51. CLIP-ON/SPRING RETAINER
◼ It is a major type of removeable retainer
◼ It consists of an acrylic bow seen both along the
lingual and labial surfaces of the teeth. Both the
lingual and labial wires are embedded in acrylic
ADVANTAGES
1. Aesthetic
2. Useful in cases of anterior segment spacing – it
can be used to realign minor lower incisor
relapse

52. MODIFICATION
Modified Barrer retainer
which includes cribs on the
first molars. It reduces the
risk of inhalation.

53. WRAP-AROUND RETAINER
◼ It is a modification of clip on
retainer but it covers all the
teeth
◼ DESIGN : It consists of a wire
that passes along the labial as
well as lingual surfaces of all
erupted teeth
It is embedded on acrylic
◼ INDICATION : Cases of weak
periodontal condition

54. DAMON’S SPLINT
◼ It was introduced by Dr. Damon Dwight
◼ DESIGN: Hard pressure formed, dual hardness/soft
liner and elastic silicone upper and lower splints
joined together with acrylic
◼ It is basically a connected upper and lower essix
retainers
◼ It may be used in adults or patients in mixed
dentition
◼ ADVANTAGES
1. Holds teeth and arches in corrected position
2. Retentive splint used in Class II, Class III , Bilateral
crossbite and orthognatic cases
3. Assists in tongue training

55. FIXED RETAINERS
◼ These are fixed to the teeth and cannot be removed by the patient
◼ They are invisible retainers which are either banded or bonded to the lingual surface of the teeth.
◼ Indicated in cases where prolonged retention is required
◼ TYPES
1. Band and spur retainer
2. Banded canine to canine retainer
3. Bonded lingual retainers
4. Passive corrective fixed retainer

56. ◼ ADVANTAGES
1. Reduced need for patient co-operation
2. Provides permanent or semi-permanent retention
3. No or minimal tissue irritation
4. Bonded retainers are esthetic in nature
5. Provides degree of stability which conventional removeable retainers may not provide
6. Unlikely to interfere with speech
◼ DISADVANTAGES
1. Increased chairside time
2. Technique sensitive and cumbersome to insert
3. Expensive
4. Tend to discolor

57. ◼ BONDED RETAINERS
➢ It may be flexible – bonded on the lingual/palatal surface of
each individual tooth, Design is a 0.0175” multi-stranded
wire,
➢ Rigid- where it is bonded only on the canines although it
touches the lower incisors. Design is a 0.030 stainless steel
wire.
▪ ADVANTAGES
➢ Invisible and well tolerated by the patient
➢ Compliance
▪ DISADVANTAGES
➢ Time consuming
➢ Technique sensitive
➢ Difficult to mainatain encouraging plaque and calculus
retention

58. ◼INDICATIONS OF A BONDED
LINGUAL RETAINER
➢Closed midline diastema
➢Severe pre-treatment lower incisor
crowding or rotation
➢Planned alteration in the lower inter-
canine width
➢Non-extraction treatment in mild
crowding cases
➢After proclination of the anteriors
during active treatment
➢After correction of deep overbite

59. ◼ BANDED CANINE TO CANINE
RETAINERS
➢Usually used in the lower anterior
segment
➢Fitting of the canines with
preformed bands and adaptation of
a thick wire over the lingual contour
of the anterior teeth which is then
soldered at the end of the canine
band

60. ◼BAND AND SPUR RETAINERS:
➢DESIGN : The tooth that has been
moved is banded and spurs are
soldered to overlap the adjacent
teeth.
➢Indicated in cases of single tooth
rotation correction or labio-lingual
displacement

61. ACTIVE RETAINERS
◼ These retainers first bring about some slight
tooth movement and then act as passive
retainers.
◼ INDICATION
➢ Irregular incisors alignment
➢ Management of class II or class III relapse with
functional appliance
◼ TYPES OF ACTIVE RETAINERS
1. Barrer Spring retainer
2. Head gear
3. Activator or Bionator

62. MONITORING AND FOLLOW UP
➢There are currently no guidelines or universally accepted retention regimen.
➢Patients should be encouraged to wear retainers at least on a part time basis
for as long as they want the teeth to remain well aligned
➢Retainer wear is the patient’s responsibility and must be fully emphasized
➢Long term maintenance and repair of the retainers should be sought by the
patient
➢Fixed retainers should be reviewed annually to ensure no excessive calculus
build up around the retainer and that the composite and wire are still intact.
➢Patient must realize the commitment prior to starting treatment

63. WEAR REGIMEN
◼ No universal removeable retainer wear regimen
◼ FULL OR PART TIME proponents exist
◼ Full time is advised for the first 3-4 months even while eating
◼ Although full time wear usually reduce to part time
➢ Full time wear for three months gradually reducing to one or two nights a week
➢ Full time wear for six months
➢ Full time wear for three months reduced to night only for three months
➢ Full time wear gradually reducing to one or two nights a week
➢ Part time must be continued until growing is complete such as night only for six months
➢ Reducing from 10 hours daily in the first six months to one or two nights weekly

64. ADJUNCTIVE RETENTION PROCEDURES
◼ CIRCUMFERENTIAL SUPRACRESTAL FIBEROTOMY
➢ Also known as Pericision
➢ There is a tendency of the elastic fibers within the
interdental and dento-gingival fibers to pull the
teeth back to its original position
➢ PRINCIPLE : Incision to the interdental and dento-
gingival fibers ABOVE the level of the aveolar bone.
Papilla dividing procedure is used when attached
gingiva is thin to prevent relapse
➢ INDICATION : Rotated teeth
➢ CONTRAINDICATION : Poor gingival health, medical
contraindications

65. ◼ ENAMEL INTERPROXIMAL STRIPPING
➢ Also known as reproximation.
➢ This involves the removal of small amounts of enamel mesio-
distally.
➢ It is suggested that by flattening interdental contacts stability
will increase between adjacent teeth
➢ INDICATION: Relieve minor crowding of the lower incisors
with favourable contact points,
➢ To avoid possible proclination and increase inter canine width
➢ DISADVANTAGES : Tooth sensitivity, may lead to periodontal
disease.
➢ It is necessary to repolish enamel surfaces after reduction
with diamond abrasion to create smooth enamel surface

66. ◼ FRENECTOMY
➢ Repositioning of the frenum and sectioning the transeptal fiber with gingivectomy
➢ Thick fibrous maxillary frenum is usually the cause of reopening of maxillary diastema after closure.
➢ Frenectomy is planned after and not before space closure to prevent scar tissue interfering.
➢ This procedure provides long term stability in orthodontically closed midline diastema

67. RECENT ADVANCES
◼ MEMOTAIN
➢ Ni-Ti Lingual memory retainer fabricated
through CAD/CAM
➢ Very flexible and precise alternative to
available multi stranded lingual retainers
➢ Resistant to corrosion and microbial
colonization
➢ Effective in minor corrections because of
shape memory
➢ Highly successful in the maxilla as it does
not cause occlusal interference or tongue
irritation

68. ◼ BIOMEDICAL AGENTS
➢ Use of biopharmacological agents such as osteoprotegrin, RANKL inhibitor agent denosumab,
bisphosphonates like pamidronate and zoledronate, bone morphogenic proteins,relaxin, simvastatin,
strontium ranelate,olive oil.
➢ They have an inhibitory effect on tooth movement and thus a positive effect on post-treatment stability.
➢ LIMITATIONS : Long term safety concerns with agents such as Denosumab

70. DURATION OF RETENTION
◼ NATURAL RETENTION
◼ MEDIUM TERM RETENTION
◼ PERMANENT RETENTION

71. ◼ NATURAL RETENTION- Here no retention is indicated. It is only applicable in cases
where the occlusion will hold the correction or where no active treatment is taken.
1. Anterior Crossbite with adequate open bite, retroclined or upright teeth and
favourable growth pattern
2. Posterior crossbite with adequate cuspal interdigitation, inclination of buccal teeth
and favourable growth
3. Serial extractions
4. Correction achieved by retardation of maxillary growth once patient has passed
through growth period

72. ◼ MEDIUM TERM RETENTION
1. Class 1 Non Extraction cases with proclination of the incisors
2. Class 1 or Class II extraction cases esp until lip and tongue pressure becomes
normal
3. Corrected deep bite
4. Early corrections of rotated teeth before root completion
5. Cases involving ectopic eruption or supernumerary teeth

73. ◼ PERMANENT RETENTION
These cases have higher chances of relapse. Hence permanent retainers are indicated. These include :
1. Spacing and Midline diastema
2. Rotations
3. Anterior open bite
4. Expansion of mandibular arch
5. Peridontal ligament compromised cases
6. Hypodontia cases
7. Cleft lip and palate with scar
8. Correction of overjet with lip incompetence at the end of treatment

74. CONCLUSION
Retaining the results for orthodontic treatment is crucial to
long term success. Understanding the factors which affect
retention and addressing these through personalized
treatment plans can help improve stability and minimize
relapse.
Proper treatment mechanics,good occlusion and excellent
retention protocols are important. Close co-operation
between the orthodontist and the patients is crucial to
ensuring retention is achieved

75. REFERENCES
N Dogra, A Jaglan, J Nindra. "Demystifying Retention in Orthodontics - A Review." Bulletin of Environmental,
Pharmacology and Life Sciences. Special Issue [2]. 2022:484-489.
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76. “ANY FOOL CAN MOVE TEETH BUT IT
TAKES A WISE MAN TO MAKE THEM
STAY’'
- CHARLES HAWLEY