Retention and relapse are important concepts in orthodontics. Retention is maintaining the corrected tooth positions after treatment, while relapse is the loss of correction. There are several theories on retention, including proper occlusion, apical base positioning, and mandibular incisor positioning. Retainers help maintain corrections and come in removable and fixed varieties. Factors that can lead to relapse include stretched periodontal ligament fibers, growth changes, inadequate bone adaptation, muscle imbalances, untreated etiologies, and third molar eruption. Maintaining corrections long-term may require permanent retention.

1. BDS, MDS
-
PROF (Dr.) SAIBEL FARISHTA
RETENTION - RELAPSE - RETAINERS

2. DEFINITIONS
RETENTION - RETENTION HAS BEEN DEFINED AS
‘MAINTAINING NEWLY MOVED TEETH IN
POSITION, LONG ENOUGH TO AID IN
STABILIZING THEIR CORRECTION’.
RELAPSE - RELAPSE HAS BEEN DEFINED AS ‘THE LOSS
OF ANY CORRECTION ACHIEVED BY
ORTHODONTIC TREATMENT’.
‘MOYERS’

3. SCHOOLS OF RETENTION
1. THE OCCLUSION SCHOOL (KINGSLEY) -
(VARIOUS PHILOSOPHIES TO EXPLAIN POST – TREATMENT STABILITY)
PROPER OCCLUSION IS A KEY FACTOR IN DETERMINING THE STABILITY OF THE NEWLY
MOVED TOOTH.
2. THE APICAL BASE SCHOOL (LUNDSTORM, 1920) -
THE APICAL BASES ARE IMPORTANT FACTORS IN RETENTION.
McCAULEY- INTER CANINE AND INTER MOLAR WIDTHS SHOULD BE MAINTAINED DURING
ORTHODONTIC TREATMENT TO MINIMIZE RETENTION PROBLEMS.
3. THE MANDIBULAR INCISOR SCHOOL (GRIEVES & TWEED) -
THE POST TREATMENT STABILITY IS INCREASED WHEN MANDIBULAR INCISORS ARE
PLACED UPRIGHT OR SLIGHTLY RETROCLINED OVER THE BASAL BONE.
4. THE MUSCULATURE SCHOOL (ROJERS) -
AS THE DENTITION IS ENCAPSULATED INSIDE AND OUTSIDE BY MUSCLES, FUNCTIONAL
MUSCLE BALANCE IS ESSENTIAL FOR STABILITY.

4. THEORIES OF RETENTION
RIEDEL (1-9 THEORIES)
MOYERS (10TH THEORY)
1. THEOREM 1 -
TEETH THAT HAVE BEEN MOVED, TEND TO RETURN TO THEIR FORMER POSITION
2. THEOREM 2 -
ELIMINATION OF THE CAUSE OF MALOCCLUSION WILL PREVENT RELAPSE
3. THEOREM 3 -
MALOCCLUSION SHOULD BE OVER-CORRECTED AS A SAFETY MEASURE
4. THEOREM 4 -
PROPER OCCLUSION IS A POTENT FACTOR IN HOLDING TEETH IN THEIR
CORRECTED POSITIONS
5. THEOREM 5 -
BONE AND ADJACENT TISSUES MUST BE ALLOWED TIME TO REORGANIZE
AROUND NEWLY POSITIONED TEETH

5. THEORIES OF RETENTION
RIEDEL (1-9 THEORIES)
MOYERS (10TH THEORY)
7. THEOREM 7 -
CORRECTIONS CARRIED OUT DURING PERIODS OF GROWTH ARE LESS LIKELY TO
RELAPSE
8. THEOREM 8 -
THE FARTHER TEETH HAVE BEEN MOVED, THE LESSER IS THE RISK OF RELAPSE
9. THEOREM 9 -
ARCH FORM, PARTICULARLY IN THE MANDIBULAR ARCH, CANNOT BE
PERMANENTLY ALTERED BY APPLIANCE THERAPY
10. THEOREM 10 -
MANY TREATED MALOCCLUSIONS REQUIRE PERMANENT RETAINING DEVICES
IF THE LOWER INCISORS ARE PLACED UPRIGHT OVER BASAL BONE, THEY ARE
MORE LIKELY TO REMAIN IN GOOD ALIGNMENT
6. THEOREM 6 -

6. RETAINERS
DEFINITION -
RETAINERS ARE PASSIVE ORTHODONTIC APPLIANCES THAT HELP IN
MAINTAINING AND STABILIZING THE POSITION OF TEETH, LONG
ENOUGH TO PERMIT REORGANIZATION OF THE SUPPORTING
STRUCTURES AFTER THE ACTIVE PHASE OF ORTHODONTIC THERAPY.
CRITERIA FOR GOOD RETAINER (GRABER) -
1. THE RETAINER SHOULD RETAIN ALL THE TEETH, THAT HAVE BEEN
MOVED
2. IT SHOULD PERMIT NORMAL FUNCTIONAL FORCES TO ACT FREELY ON
DENTITION
3. THE RETAINER MUST BE SELF CLEANSING AND SHOULD PERMIT ORAL
HYGIENE MAINTAINANCE
4. IT SHOULD BE AS INCOSPICIOUS AS POSSIBLE

7. RETAINERS
REMOVABLEFIXED
1. HAWLEY’S APPLIANCE
(CHARLES HAWLEY, 1920)
- LABIAL BOW – C TO C
- LABIAL BOW - PM TO PM
- FITTED LABIAL BOW
- ANT. BITE PLANE
- LABIAL BOW SOLDERED TO
ADAM’S CLASP
2. BEGG RETAINER
3. CLIP – ON RETAINER
4. WRAP AROUND RETAINER
5. KESLING TOOTH POSITIONER
6. INVISIBLE RETAINERS
1. FIXED APPLIANCE
2. BAND AND SPUR
RETAINER
3. BANDED CANINE –
CANINE RETAINER
4. BANDED MOLAR –
MOLAR RETAINER
5. BONDED LINGUAL
RETAINERS

8. HAWLEY’S RETAINER
LABIAL BOW – C TO C
BEGG TYPE RETAINER

9. BEGG TYPE RETAINER

10. ACTIVATOR
BIONATOR

11. INVISIBLE RETAINER
FRANKEL

12. HAWLEY’S RETAINER
HAWLEY’S RETAINER
WITH HABIT BREAKER

13. BANDED 3 – 3 RETAINER
BANDED 6 – 6 RETAINER

14. ETIOLOGY OF RELAPSE
1. PDL TRACTION (STRETCHED FIBRES)
2. RELAPSE DUE TO GROWTH RELATED CHANGES
3. BONE ADAPTATION
4. MUSCULAR FORCES
5. FAILURE TO ELIMINATE THE ORIGINAL CAUSE
6. ROLE OF THIRD MOLARS
7. ROLE OF OCCLUSION IN RELAPSE
RELAPSE

15. 1. PDL TRACTION (STRETCHED FIBRES) -
THE PDL AND GINGIVAL FIBRES WHICH ENCIRCLE THE TEETH ARE STRETCHED DURING
TEETH MOVEMENT. THESE STRETCHED FIBRES CAN CONTRACT AND CAUSE RELAPSE. THE
PRINCIPLE FIBRES OF THE PDL REARRANGE IN 4 WEEKS TIME, WHEREAS THE SUPRA-
ALVEOLAR GINGIVAL FIBRES TAKE 40 WEEKS. AFTER ORTHODONTIC TREATMENT, TEETH
REQUIRE 4-5 MONTHS OF FULL TIME RETENTION TO ALLOW THE REORGANIZATION OF PDL
FIBRES. AFTER THIS PERIOD, RETENTION SHOULD BE CONTINUED FOR A FURTHER 7-8
MONTH PERIOD (FOR GINGIVAL FIBRES).
2. RELAPSE DUE TO GROWTH RELATED CHANGES -
SKELETAL PROBLEMS ASSOCIATED WITH CLASS II, CLASS III, OPEN BITE OR DEEP BITE
MALOCCLUSION MAY EXHIBIT RELAPSE DUE TO THE CONTINUATION OF THE ABNORMAL
GROWTH PATTERN AFTER ORTHODONTIC THERAPY. PROLONGED RETENTION IS INDICATED
UNTIL ACTIVE GROWTH IS COMPLETED.
3. BONE ADAPTATION -
THE TEETH THAT HAVE BEEN MOVED ARE SURROUNDED BY LIGHTLY CALCIFIED OSTEOID
BONE. HERE, THE TEETH ARE NOT ADEQUATELY STABILIZED AND HAVE A TENDENCY TO
MOVE TO THEIR ORIGINAL POSITION. NORMALLY, THE BONY TRABECULAE ARE ARRANGED
PERPENDICULAR TO THE LONG AXIS OF THE TEETH, BUT DURING ORTHODONTIC
TREATMENT, THEY GET ALIGNED PARALLEL TO THE DIRECTION OF THE FORCE. DURING
RETENTION, THEY REVERT BACK TO THEIR NORMAL ARRANGEMENT.

16. 4. MUSCULAR FORCES -
AS THE TEETH ARE ENCAPSULATED IN ALL DIRECTIONS BY A BLANKET OF MUSCLES,
MUSCLE IMBALANCE AT THE END OF THE ORTHODONTIC TREATMENT MAY RESULT IN
REAPPEARENCE OF MALOCCLUSION. MUSCLE HARMONY AT THE CONCLUSION OF
TREATMENT SHOULD BE THE GOAL, SO AS TO INCREASE THE STABILITY OF THE
TREATMENT RESULTS.
5. FAILURE TO ELIMINATE THE ORIGINAL CAUSE -
FAILURE TO ELIMINATE THE ETIOLOGY OF MALOCCLUSION MAY RESULT IN RELAPSE.
7. ROLE OF OCCLUSION -
GOOD INTERCUSPATION OF TEETH IS ESSENTIAL IN MAINTAINING THE STABILITY OF CASES.
THE CENTRIC RELATION AND CENTRIC OCCLUSION SHOULD CO-INCIDE. PRESENCE OF
HABITS LIKE CLENCHING, GRINDING, NAIL BITING, LIP BITING ARE IMPORTANT CAUSES OF
RELAPSE.
6. ROLE OF THIRD MOLARS -
IN MOST CASES, THE THIRD MOLARS ERUPT BETWEEN 18 – 21 YEARS OF AGE. BY THIS TIME,
MOST PATIENTS WOULD HAVE COMPLETED THEIR ORTHODONTIC TREATMENT. SOME
AUTHORS BELIEVE THAT THE PRESSURE EXERTED BY THE ERUPTING THIRD MOLARS MAY
CAUSE LATE ANTERIOR CROWDING, LEADING TO RELAPSE.

17. CASES

18. POST
ORTHODONTIC
TREATMENT
PHOTOGRAPHS

19. POST
ORTHODONTIC
TREATMENT
PHOTOGRAPHS

20. POST
ORTHODONTIC
TREATMENT
PHOTOGRAPHS

21. POST
ORTHODONTIC
TREATMENT
PHOTOGRAPHS

22. DEEP BITE
PRE TREATMENT
POST TREATMENT

23. THINGS TO SEE IN AN OPG ?

24. THANK YOU