RETENTION AND

RELAPSE

Dr. Haris Khan

Associate Professor
Orthodontics
 Its not over till its over
 There is only one way to completely avoid
relapse. At the end of treatment, remove the
braces, polish the teeth, make study models
and take photographs. And then take the
patient out the back door of the office and
shoot him
- Dr Tom Graber DMD
South African Dental Congress. August 1992
 RETAIN – (re+tenere – to hold) means to “hold
back or to hold secure”

 RELAPSE: “to slip or fall back to a former

condition, especially after improvement or
seeming improvement”
WHY IS RETENTION
NECESSARY ?

Proffit-
 Reorganization of gingival and periodontal
tissues after orthodontic treatment.

 Soft tissue pressure – relapse tendency.

 Changes produced by growth may alter

treatment results.
 Reorganization of gingival and periodontal tissues after
orthodontic treatment.

 Widening of PL space – disruption of fibers

 Teeth respond individually to forces of mastication

 Reorganization 3-4mts

 Slight mobility disappears

 Soft tissue pressure
 Active stabilization from pl
 Gingival fibers Collagen 4-6mts
Elastic
 12mts- part time after 3-4 mts
 NEED FOR RETENTION

Elastic Recoil
of Gingival Fibers
Intra-Arch
Irregularity

Cheek / Lip / Tongue

Pressure Changes in
Occlusal
Relationship

Differential Jaw
Growth
PRINCIPLES OF RETENTION
 Direction of potential relapse by elastic
recoil of gingival fibers and soft tissue
pressure
 Teeth must flex individually during
mastication over alveolar bone during
retention
 Retention for growing and non growing
individual is different
 FAILURES IN RETENTION

 Failure to remove the cause of malocclusion.

 Incorrect diagnosis and treatment planning.
 Lack of normal cuspal interdigitation.
 Arch expansion.- Pre Rx arch dimensions to be
maintained
 Incorrect axial inclinations.
 Failure to manage rotations- over rotation
 Tooth size disharmony- interproximal grinding
TIMING FOR RETENTION
 Full time 3-4 months
 12 months overall
 Permanent splinting in perio or bone loss
 Continue retention till growth remains
 Median diastema ------- permanent
retention
 Rotated tooth -------------- permanent
retention
 Proclination of lower incisor beyond
normal limits – permanent retention
OCCLUSAL CHANGES RELATED
TO GROWTH
 Skeletal problem in all 3 planes of space
recur if growth continues
 Long term transverse change less a problem
RETENTION AFTER CLASS 2
 Relapse in class II is a combination of dental
and skeletal movement
 Overcorrection during finishing is done
 Class II elastics ----- more AP relapse
 As a general rule if more than 2 mm of lower
incisor moved give permanent retention
 Relapse by differential jaw growth depend
upon age and gender
 Retention appliances headgear,
conventional retainer ,functional appliance
RETENTION AFTER CLASS 2
 Less severe cases conventional retainers
 Retention time 12- 24 month
 Guideline

1. More severe the problem

2. Younger the pt.
more likely headgear or functional appliance
will be needed at end of treatment
CLASS III RETENTION
 Early permanent dentition– continued growth
more relapse
 Retention by chin cap ___ don’t restrain
mandibular growth
 Retention by chin cap an FA ___ downward
and backward rotation of mandible
 As a rule if face height is normal or excessive
after treatment – more relapse– surgical
treatment
 mild cases give FA
RETENTION AFTER DEEP BITE
 Anterior bite plane in upper retainer
 Vertical growth is a problem ---- maxillary
removable retainer
 Night time retainer when stability in other
dimensions achieved
 RETENTION AFTER ANT OPEN
BITE
 Controlling molar is the key for retention in
open bite cases
 Appliances

1. Headgears to upper molars

2. Retainer to keep alignment
3. Bite blocks between teeth – bionator and
activator
Vertical growth a problem- long term retention
Severe open bite –day time retainer
night time open bite bionator
RETENTION FOR LOWER
INCISORS
 Lower incisor crowding a problem in
Mandibular growth___ lip pressure
 Also in long face skeletal pattern
 Retain Lower incisor till 3rd Molars erupt
 Lower incisor retention

1. Girls – late teens

2. Boys--- early 20 s
RETENTION
APPLIANCES
HAWLEY RETAINER
MODIFICATION
HAWLEY RETAINER
 Important points
 Removable appliance
 Provide tooth movement while keep the
space between teeth closed
 Space after removal of bands is closed
spontaneously
 May open Ext space so modification available
CLIP ON RETAINER
MOORE RETAINER
POSITIONERS AS RETAINER
LIMITATION
 Bulky
 Don’t retain incisor irregularities and
rotation
 Overbite increase
 Don’t control growth
 Articulation needed if more than 2 to 4
weeks
FIXED RETAINERS
INDICATION
 Maintain of incisor position during growth
 Incisor proclination during treatment
 Retention of median diastema
 Buccal attachment in extraction cases
 Maintenance of implant pontic or implant
space
ACTIVE RETAINER
 Used for correcting incisor irregularities and
occlusal discrepancies
 Hawley retainer
 Canine to canine clip on retainer
 Activator or bionator
RETENTION CONCEPTS
 Occlusion school
 Apical base school
 Mandibular incisor school
 Musculature school
BASIC THEOREM
1. Teeth that have been moved tend to return
to their former position
2. Elimination of the cause of malocclusion
will prevent further recurrence
3. Malocclusion should be overcorrected as a
safety factor
4. Proper occlusion is potent factor in holding
teeth in corrected position
5. Bone and adjacent tissues must be allowed
to reorganized around newly positioned
teeth
6. If lower incisor are placed upright over the
basal bone they are more likely to remain
in good alignment
7. Correction carried out during period of
growth are less likely to relapse
8. The further teeth have been moved the
less likelihood of relapse
9. Arch form particularly the mandibular arch
cant be changed permanently by appliance
therapy